Well: Boosting Your Flu Shot Response

Phys Ed

Gretchen Reynolds on the science of fitness.

As this year’s influenza season continues to take its toll, those procrastinators now hurrying to get a flu shot might wish to know that exercise may amplify the flu vaccine’s effect. And for maximal potency, the exercise should be undertaken at the right time and involve the right dosage of sweat, according to several recent reports.

Flu shots are one of the best ways to lessen the risk of catching the disease. But they are not foolproof. By most estimates, the yearly flu vaccine blocks infection 50 to 70 percent of the time, meaning that some of those being inoculated gain little protection. The more antibodies someone develops, the better their protection against the flu, generally speaking. But for some reason, some people’s immune systems produce fewer antibodies to the influenza virus than others’ do.

Being physically fit has been found in many studies to improve immunity in general and vaccine response in particular. In one notable 2009 experiment, sedentary, elderly adults, a group whose immune systems typically respond weakly to the flu vaccine, began programs of either brisk walking or a balance and stretching routine. After 10 months, the walkers had significantly improved their aerobic fitness and, after receiving flu shots, displayed higher average influenza antibody counts 20 weeks after a flu vaccine than the group who had stretched.

But that experiment involved almost a year of dedicated exercise training, a prospect that is daunting to some people and, in practical terms, not helpful for those who have entered this flu season unfit.

So scientists have begun to wonder whether a single, well-calibrated bout of exercise might similarly strengthen the vaccine’s potency.

To find out, researchers at Iowa State University in Ames recently had young, healthy volunteers, most of them college students, head out for a moderately paced 90-minute jog or bike ride 15 minutes after receiving their flu shot. Other volunteers sat quietly for 90 minutes after their shot. Then the researchers checked for blood levels of influenza antibodies a month later.

Those volunteers who had exercised after being inoculated, it turned out, exhibited “nearly double the antibody response” of the sedentary group, said Marian Kohut, a professor of kinesiology at Iowa State who oversaw the study, which is being prepared for publication. They also had higher blood levels of certain immune system cells that help the body fight off infection.

To test how much exercise really is required, Dr. Kohut and Justus Hallam, a graduate student in her lab, subsequently repeated the study with lab mice. Some of the mice exercised for 90 minutes on a running wheel, while others ran for either half as much time (45 minutes) or twice as much (3 hours) after receiving a flu shot.

Four weeks later, those animals that, like the students, had exercised moderately for 90 minutes displayed the most robust antibody response. The animals that had run for three hours had fewer antibodies; presumably, exercising for too long can dampen the immune response. Interestingly, those that had run for 45 minutes also had a less robust response. “The 90-minute time point appears to be optimal,” Dr. Kohut says.

Unless, that is, you work out before you are inoculated, another set of studies intimates, and use a dumbbell. In those studies, undertaken at the University of Birmingham in England, healthy, adult volunteers lifted weights for 20 minutes several hours before they were scheduled to receive a flu shot, focusing on the arm that would be injected. Specifically, they completed multiple sets of biceps curls and side arm raises, employing a weight that was 85 percent of the maximum they could lift once. Another group did not exercise before their shot.

After four weeks, the researchers checked for influenza antibodies. They found that those who had exercised before the shot generally displayed higher antibody levels, although the effect was muted among the men, who, as a group, had responded to that year’s flu vaccine more robustly than the women had.

Over all, “we think that exercise can help vaccine response by activating parts of the immune system,” said Kate Edwards, now a lecturer at the University of Sydney, and co-author of the weight-training study.

With the biceps curls, she continued, the exercises probably induced inflammation in the arm muscles, which may have primed the immune response there.

As for 90 minutes of jogging or cycling after the shot, it probably sped blood circulation and pumped the vaccine away from the injection site and to other parts of the body, Dr. Kohut said. The exercise probably also goosed the body’s overall immune system, she said, which, in turn, helped exaggerate the vaccine’s effect.

But, she cautions, data about exercise and flu vaccines is incomplete. It is not clear, for instance, whether there is any advantage to exercising before the shot instead of afterward, or vice versa; or whether doing both might provoke the greatest response – or, alternatively, be too much and weaken response.

So for now, she says, the best course of action is to get a flu shot, since any degree of protection is better than none, and, if you can, also schedule a visit to the gym that same day. If nothing else, spending 90 minutes on a stationary bike will make any small twinges in your arm from the shot itself seem pretty insignificant.

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Roche Hires Dr. John Reed to Lead Research Operations

The Swiss pharmaceutical giant Roche is turning to a prolific American academic scientist to revitalize its lagging research operations.

Dr. John C. Reed, the chief executive of the Sanford-Burnham Medical Research Institute in San Diego, will become head of Roche’s pharmaceutical research and early development group in April, the company announced Tuesday.

Dr. Reed, 54, has spent 21 years at Sanford-Burnham, formerly known as the Burnham Institute, the last 11 as chief executive.

During his tenure as chief executive, the institute grew rapidly, opened a new research site in Florida, and broadened its role from basic research to also doing drug discovery, in some cases in collaborations with pharmaceutical companies. It also received its largest donation ever, $50 million, from the credit card industry executive T. Denny Sanford, which led the institute to change its name.

Dr. Reed, 54, who holds both a medical degree and a Ph.D., is the author of more than 800 scientific papers, many dealing with why cancer cells do not commit suicide as errant cells are supposed to do. A triathlete, Dr. Reed used to get to his office around 3:30 a.m. each day, though now, with better computers, he works at home in the early hours.

“With his broad scientific and medical background, he is ideally positioned to drive Roche’s strategy of translating a better understanding of disease mechanisms into promising therapeutics,” Severin Schwan, the chief of Roche, said in a statement.

It is not unprecedented for drug companies to tap academic scientists to run research. Sanofi’s research and development is now run by Elias Zerhouni, the former director of the National Institutes of Health and professor at Johns Hopkins. Mark Fishman, a cardiologist at Harvard, was recruited to run research at Novartis, and Peter S. Kim, who heads research at Merck, was previously a biology professor at the Massachusetts Institute of Technology.

Dr. Reed, who has been on biotechnology company boards but never had a full-time corporate job, said in an interview that he was joining Roche to “have an opportunity to contribute on a larger stage, so to speak.”

At Roche he will oversee not only research but also early- and middle-stage clinical trials, something Sanford-Burnham does not do. He will supervise about 2,000 people with an annual budget in the billions, while Sanford-Burnham has about 1,200 people and a budget of around $175 million.

Dr. Reed, who will move to Basel, where Roche is based, said it was too early to discuss his agenda at Roche, other than to make its research more collaborative.

The operation Dr. Reed will run, called Pharma Research and Early Development, or pRED, does not include Genentech, the California biotechnology company that Roche fully acquired in 2009. In an effort to preserve the culture at Genentech, Roche left it autonomous, forming a group it calls gRED.

Recently, gRED has been eclipsing pRED. Roche’s three best-selling drugs, the cancer medicines Rituxan, Herceptin and Avastin, were developed at Genentech. So have some of its most attractive experimental drugs, including T-DM1, a breast cancer drug that could win regulatory approval early this year.

The organization Dr. Reed will run, by contrast, has had its share of problems in recent years. Several hundred researchers were cut in a corporate reorganization. And last year Roche discontinued development of a heart drug after it failed to work in a late-stage clinical trial.

The troubles contributed to Roche’s decision in June to shut its campus in Nutley, N.J., the birthplace of valium. At that time, Jean-Jacques Garaud, head of the Roche unit that Dr. Reed will run, left the company and was replaced on an interim basis by Mike Burgess. Roche said Tuesday that Mr. Burgess would now also leave the company.

Sanford-Burnham said that Dr. Kristiina Vuori, its president and head of its cancer center, would take over as chief executive on an interim basis. Dr. Vuori, who is originally from Finland, has worked closely with Dr. Reed.

M. Wainwright Fishburn Jr., the chairman of Sanford-Burnham, said it was “bittersweet” to see Dr. Reed leave. While the institute will lose a very successful leader, he said, the move could advance the institute’s efforts to get drug discovery work from pharmaceutical companies.

“We have one of our own in one of the most influential positions around,” he said.

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At War Blog: Russian Military Ordered to Switch Portyanki for Socks

Near the end of World War II, Soviet and American soldiers met at the Elbe River in Germany. Lacking a common language, they compared their boots.

The Americans wore socks and lace-up boots. The Russians wore something that boggled the minds of their allies from the West: pieces of cloth twirled around their feet and inserted into bulky, knee-high boots.

The cloth strips, called portyanki, have been a signature element of the Russian military uniform since the 16th century. On Monday Russia’s minister of defense issued an order for a militarywide switch to socks.

“I have an instruction for you,” the minister, Sergei K. Shoigu, said to a gathering of the equivalent of the chiefs of staff and regional commanders in comments broadcast on NTV television news. “In 2013, or at least by the end of this year, we will forget foot bindings. I’m asking you, please, if there is need we will provide additional funds. But we need to finally, fully reject this concept in our armed forces.”

It is hardly the stuff to alarm a Central Intelligence Agency military analyst. But it sheds light on the Russian military all the same.

NTV in Russia, reporting the change, noted that foot bindings were a common solution in militaries predating industrial looms, though “Russia is just about the only country where new enlisted men still learn to twirl portyanki.” (The video below gives a sense of what twirling looks like.)

The bindings are not unique to Russia. Such foot coverings were known as puttees when they had wide-scale use in the United States, Canadian and British militaries before and during World War I. Then, they were worn wrapped around the calf, above the boot.

(The video below shows another variety of these sock alternatives.)

In the Russian version, a swath of cloth about a foot wide, cotton in the summer, flannel in the winter, is inserted into the boot, effective against trench foot and frostbite alike, if bound correctly.

In basic training, even before breaking down a Kalashnikov, a Russian conscript learns to twist the portyanki around his feet to form mummylike cocoons, fit for the inside of the standard-issue Russian infantry boots, made today, as they were a century ago, of blackened canvas on a sole of rawhide. Running in these heavy boots, former soldiers say, is all but impossible.

This system of footwear had its principal advantage in military-industrial planning and logistics, freeing up Soviet factories from sewing millions of socks and allowing soldiers to tear wraps from old sheets in the field, if needed. During the Afghan war, however, Russian soldiers soured on the heavy boots; officers allowed soldiers to shed them for nonregulation running shoes.

The switch to socks began during the never-completed military reform in 2007, so some units march at parades in socks and lace-up boots, others in portyanki and boots without laces.

The minister’s statement on socks to the assembled generals may also have carried a deeper meaning, said Ruslan Pukhov, an analyst with the Center for Analysis of Strategies and Technologies. The cloth strips, almost a symbol of the Russian enlisted man’s life, are also emblematic of outmoded practices, he said.

Deeper changes, with higher stakes, are under way in the Russian military. Since 2007, the political leadership has systematically thinned the top-heavy officer ranks to alter the “egg-shaped” hierarchy of the army into a pyramid form. Mr. Shoigu’s order to complete the switch to socks, Mr. Pukhov said, signaled to the generals that they would not be exempt from following through with the reforms begun by his disgraced predecessor, Anatoly E. Serdyukov, who is under investigation for real estate deals involving the ministry’s property.

“We cannot fight the wars of the 21st century with the equipment we used 35 years ago in Afghanistan,” Mr. Pukhov said. “That is impossible to think about.”

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California to Give Web Courses a Big Trial

A plan to offer an array of online college classes at a California state university could, if the students are successful, open the door to teaching hundreds of thousands of California students at a lower cost via the Internet.

Udacity, a Silicon Valley start-up that creates online college classes, will announce a deal on Tuesday with San Jose State University for a series of remedial and introductory courses.

Because the courses are intended to involve the classroom instructor, it could also help to blunt professors’ unease with the online classes. 

The state university’s deal with Udacity is also the first time that professors at a university have collaborated with a provider of a MOOC — massively open online course — to create courses with students first watching videos on their own, with support from online mentors, and then coming to class to work on assignments with a professor.

Eventually, such blended courses could be offered to hundreds of thousands of students in the state.

California Gov. Jerry Brown, who has been pushing state universities to move more aggressively into online education, approached the company to come up with a technological solution for what has become a vexing challenge for the state.

Ellen N. Junn, provost and vice president for academic affairs at the university in San Jose, said the California State University System faces a crisis because more than 50 percent of entering students cannot meet basic requirements.

“They graduate from high school, but they cannot pass our elementary math and English placement tests,” she said.

The Udacity pilot program will include a remedial algebra course, a college-level algebra course and introductory statistics.

For the pilot project starting this month, however, the courses will be limited to 300 students — half from San Jose State University, and half from local community colleges and high schools — who will pay lower than usual tuition. The cost of each three-unit course will be $150, significantly less than regular San Jose State tuition. Sebastian Thrun, one of the founders of Udacity, would not disclose how much the company would be paid for its participation.

San Jose State will receive funds from the National Science Foundation to study the effectiveness of the new online classroom design.

Open online courses exploded in American higher education in 2011 after Mr. Thrun, a nationally known artificial-intelligence researcher at Stanford, and Peter Norvig, Google’s director of research, offered to teach an introductory artificial-intelligence course online. More than 160,000 students initially registered for the class.

After two other Stanford courses each attracted more than 100,000 students, Dr. Thrun started his venture. Two other Stanford computer scientists, Andrew Ng and Daphne Koller, also established a competing private company, Coursera, to develop technologies necessary to change the reach and effectiveness of online education.

The courses have rapidly moved from the periphery to the center of higher education policy as a growing number of schools have begun experimenting with ways to offer the courses for credit toward a degree.

EdX, a university collaboration initiated by the Massachusetts Institute of Technology and Harvard last year, this month will begin offering some of its courses at two Massachusetts community colleges, also in a blended format.

Recently edX completed a pilot offering of its difficult circuits and electronics course at San Jose State to stunning results: while 40 percent of the students in the traditional version of the class got a grade of C or lower, only 9 percent in the blended edX class got such a low grade.

Last fall, for the first time, Udacity’s courses were tried on a small group of struggling high school students, at the Winfree Academy Charter School system, a cluster of schools near Dallas-Fort Worth created to help struggling students and reclaim dropouts.

“I was a little scared to put our kids, who are struggling and at risk of dropping out, into a class written by a Stanford professor,” said Melody Chalkley, Winfree’s founder. “But of the 23 students who used Udacity, one withdrew from the school, and the other 22 all finished successfully. And two young women got through the whole physics course in just two weeks.”

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Well: Turning to the Web for a Medical Diagnosis

Thirty-five percent of American adults said they have used the Internet to diagnose a medical condition for themselves or someone else, according to a new Pew Research Center study. Women are more likely than men to turn to the Internet for diagnoses. Other groups more likely to do so are younger people, white adults, people with college degrees and those who live in households with income above $75,000.

The study, released by Pew’s Internet and American Life Project on Tuesday, points out that Americans have always tried to answer their health questions at home, but that the Internet has expanded the options for research. Previous surveys have asked questions about online diagnoses, but the Pew study was the first to focus on the topic with a nationally representative sample, said Susannah Fox, an associate director at Pew Internet. Surveyors interviewed 3,014 American adults by telephone, from August to September 2012.

Of the one in three Americans who used the Internet for a diagnosis, about a third said they did not go to a doctor to get a professional medical opinion, while 41 percent said a doctor confirmed their diagnosis. Eighteen percent said a doctor did not agree with their diagnosis. As far as where people start when researching health conditions online, 77 percent said they started at a search engine like Google, Bing or Yahoo, while 13 percent said they began at a site that specializes in health information.

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Well: Turning to the Web for a Medical Diagnosis

Thirty-five percent of American adults said they have used the Internet to diagnose a medical condition for themselves or someone else, according to a new Pew Research Center study. Women are more likely than men to turn to the Internet for diagnoses. Other groups more likely to do so are younger people, white adults, people with college degrees and those who live in households with income above $75,000.

The study, released by Pew’s Internet and American Life Project on Tuesday, points out that Americans have always tried to answer their health questions at home, but that the Internet has expanded the options for research. Previous surveys have asked questions about online diagnoses, but the Pew study was the first to focus on the topic with a nationally representative sample, said Susannah Fox, an associate director at Pew Internet. Surveyors interviewed 3,014 American adults by telephone, from August to September 2012.

Of the one in three Americans who used the Internet for a diagnosis, about a third said they did not go to a doctor to get a professional medical opinion, while 41 percent said a doctor confirmed their diagnosis. Eighteen percent said a doctor did not agree with their diagnosis. As far as where people start when researching health conditions online, 77 percent said they started at a search engine like Google, Bing or Yahoo, while 13 percent said they began at a site that specializes in health information.

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Wheels Blog: The Seventh-Generation Corvette Is Unveiled in Detroit

DETROIT — The Stingray is back, in name and in spirit.

At an invitation-only gathering hours before the North American International Auto Show was scheduled to open for press previews, General Motors introduced the 2014 Corvette, the seventh generation of Chevrolet’s hallmark sports car.

Underscoring the importance of this vehicle was Chevrolet’s revival of the long-dormant Stingray badge, a name it first used on a 1959 racecar built by G.M.’s design chief, Bill Mitchell. The hope for that original Stingray racecar was to beat Europe’s best, and G.M. still seems to be thinking along those lines.

According to G.M.’s president for North America, Mark Reuss, the latest Stingray is a potential worldbeater.

“Like the ’63 Sting Ray, the best Corvettes embodied performance leadership, delivering cutting-edge technologies, breathtaking design and awe-inspiring driving experiences,” Mr. Reuss said. “The all-new Corvette goes farther than ever, thanks to today’s advancements in design technology and engineering.”

The release of a new Corvette is always highly anticipated by auto enthusiasts; speculation about “C7″ — shorthand for the seventh generation — has run high. Would it get a twin-cam turbocharged powertrain? Would Chevy switch to an exotic midengine chassis?

In actuality, the 2014 model will again have a pushrod V-8 engine in its nose, driving the rear wheels. That conservative approach might be seen as a timid compromise from a company that has just begun to get back on solid financial footing. But the front-engine, rear-drive layout has long defined the Corvette, and this car, like its C6 predecessor, may well show its taillights to cars with specs that more closely conform to what is considered state of the art.

While automakers are quick to toss around the words “all new” to describe their latest offerings, however warmed over they might be, in this case the term is justified — the 2014 Corvette shares only two parts with its predecessor.

The C7 Corvette’s styling is in keeping with the brand’s persona, yet it projects a more aggressive image than previous generations. The clean front fascia is devoid of parking lights, and is energized by a sharp edge where it meets the hood, which is itself defined by a prominent bulge and more hard edges. The curve of the front fenders peaks at yet another edge that blends seamlessly into the body side at the A-pillar. The body’s flanks are defined by character lines that race back from vents behind the front wheel, not unlike those of previous Corvettes, but here those lines are more sharply drawn, with the upper line sweeping up and back to define the shape of the rear quarter panel. The lower character line projects from the body, forming a wing of sorts that flows out of the front fender and terminates at the rear of the door. The coupe’s roofline arcs smoothly to meet the rear spoiler, rather than terminating at the rear window, as in the C6. The individual rear taillights that have long been a part of Corvette design are now paired in a deep recess on each side. Four large exhaust pipes exit center-stage, rear.

The sheet-molded fiberglass body, with carbon-fiber hood and roof panels and carbon-nano composite underbody panels, is 37 pounds lighter than the C6’s body. It rides on a new aluminum frame that is 57 percent stiffer and 99 pounds lighter than the current model’s. The wheelbase is about one inch longer than that of the C6, and the track is almost an inch wider — changes said to provide a more stable feel at high speed.

Inside the cockpit, considerable effort was lavished on upgrading what has generally been considered a blighted zone. Optional carbon fiber trim and real aluminum combine with plastic in a wraparound configuration. The steering wheel, with a 14.1 inch diameter, is smaller than that of the previous model, and two seat choices are offered, with the competition sport version providing more side bolstering to hold occupants in place in spirited maneuvers. Indicative of the car’s purpose is the inclusion of a console-mounted steel grab bar for the passenger.

Under the hood, Chevrolet’s 6.2-liter small block V-8 — now in its fifth-generation design — produces an estimated 450 horsepower and 450 pound-feet of torque. At low speed, torque output exceeds that of the previous 6.2-liter engine by 50 pound-feet. The engine shares few parts with prior Corvette V-8s and is fitted with direct fuel injection that, in combination with other refinements, enables a high compression ratio of 11.5:1. Active Fuel Management, G.M.’s system for deactivating cylinders when they are not needed, lets the car cruise on four cylinders in some driving modes. Final fuel-economy numbers are not yet available.

Two transaxles will be offered: a 6-speed automatic with paddle-shift mode or a 7-speed manual with rev-matching capability — an electronic version of the heel-and-toe shifting techniques that competition drivers employ to enable smooth gear changes when negotiating twisty bits.

The Corvette driver will be able to select from among five driving modes: weather, Eco, Tour, Sport and Track; the default setting will be Tour. Changing modes alters 12 vehicle attributes, including throttle response, shift points, engagement of the limited-slip differential engagement, shock damping and more. Four-piston Brembo brakes provide stopping power, and electric power steering sets the course.

An optional Z51 performance package adds an electronic limited-slip differential that can continuously vary torque split between the rear wheels, dry-sump oiling, upgraded shock absorbers, a revised version of the automaker’s Magnetic Ride Control suspension-regulating system, close-ratio gears for the manual transmission, larger brake rotors and aerodynamic refinements that incorporate air-flow management for cooling of heat-stressed components.

Like its predecessor, the 2014 Corvette Stingray will be built at a G.M. plant in Bowling Green, Ky. The car is expected to arrive at dealerships in the third quarter of this year.

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Electronic Records Systems Have Not Reduced Health Costs, Report Says

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Jim Wilson/The New York Times

Dr. Alvin Rajkomar tracks patient data on a Samsung Galaxy Note. A new report questions whether electronic records reduce health care costs.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The report predicted that widespread use of electronic records could save the United States health care system at least $81 billion a year, a figure RAND now says was overstated. The study was widely praised within the technology industry and helped persuade Congress and the Obama administration to authorize billions of dollars in federal stimulus money in 2009 to help hospitals and doctors pay for the installation of electronic records systems.

“RAND got a lot of attention and a lot of buzz with the original analysis,” said Dr. Kellermann, who was not involved in the 2005 study. “The industry quickly embraced it.”

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Health care spending has risen $800 billion since the first report was issued, according to federal figures. The reasons are many, from the aging of the baby boomer population, to the cost of medical advances, to higher usage of medical services over all.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm’s acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.

The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems. “We could be getting much more if we could take the time to do a little more planning and to set more standards,” said Marc Probst, chief information officer for Intermountain Healthcare, a large health system in Salt Lake City that developed its own electronic records system and is cited by RAND as an example of how the technology can help improve care and reduce costs.

The RAND researchers pointed to a number of other reasons the expected savings had not materialized. The rate of adoption has been slow, they said, and electronic records do not address the fact that doctors and hospitals reap the benefits of high volumes of care.

Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.

Technology “is only a tool,” said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. “Like any tool, it can be used well or poorly.” While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.

Federal officials say they are drafting new rules to address many of the concerns about the current systems.

This article has been revised to reflect the following correction:

Correction: January 14, 2013

An article on Friday about a new RAND Corporation study that found few savings from electronic health records misstated, in some copies, the name of the city in Florida that is home to a physician practice that is suing a health care technology firm that stopped supporting a system it sold to doctors in the practice. It is in Panama City, not Panama.

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Susan Nolen-Hoeksema, Psychologist Who Studied Depression in Women, Dies at 53

Susan Nolen-Hoeksema, a psychologist and writer whose work helped explain why women are twice as prone to depression as men and why such low moods can be so hard to shake, died on Jan. 2 in New Haven. She was 53.

Andrew Sacks

Susan Nolen-Hoeksema at the University of Michigan in 2003. Dr. Nolen-Hoeksema's research showed that women were more prone to ruminate, or dwell on the sources of problems rather than solutions, more than men.

Her death followed heart surgery to correct a congenitally weak valve, said her husband, Richard Nolen-Hoeksema.

Dr. Nolen-Hoeksema, a professor at Yale University, began studying depression in the 1980s, a time of great excitement in psychiatry and psychology. New drugs like Prozac were entering the market; novel talking therapies were proving effective, too, particularly cognitive behavior therapy, in which people learn to defuse upsetting thoughts by questioning their basis.

Her studies, first in children and later in adults, exposed one of the most deceptively upsetting of these patterns: rumination, the natural instinct to dwell on the sources of problems rather than their possible solutions. Women were more prone to ruminate than men, the studies found, and in a landmark 1987 paper she argued that this difference accounted for the two-to-one ratio of depressed women to depressed men.

She later linked rumination to a variety of mood and behavior problems, including anxiety, eating disorders and substance abuse.

“The way I think she’d put it is that, when bad things happen, women brood — they’re cerebral, which can feed into the depression,” said Martin Seligman, a professor of psychology at the University of Pennsylvania, who oversaw her doctoral work. “Men are more inclined to act, to do something, plan, beat someone up, play basketball.”

Dr. Seligman added, “She was the leading figure in sex differences in depression of her generation.”

Dr. Nolen-Hoeksema wrote several books about her research for general readers, including “Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life.” These books described why rumination could be so corrosive — it is deeply distracting; it tends to highlight negative memories — and how such thoughts could be alleviated.

Susan Kay Nolen was born on May 22, 1959, in Springfield, Ill., to John and Catherine Nolen. Her father ran a construction business, where her mother was the office manager; Susan was the eldest of three children.

She entered Illinois State University before transferring to Yale. She graduated summa cum laude in 1982 with a degree in psychology.

After earning a Ph.D. in psychology at the University of Pennsylvania, she joined the faculty at Stanford. She later moved to the University of Michigan, before returning to Yale in 2004.

Along the way she published scores of studies and a popular textbook. In 2003 she became the editor of the Annual Review of Clinical Psychology, an influential journal.

Dr. Nolen-Hoeksema moved smoothly between academic work and articles and books for the general reader.

“I think part of what allowed her to move so easily between those two worlds was that she was an extremely clear thinker, and an extremely clear writer,” said Marcia K. Johnson, a psychology professor and colleague at Yale.

Dr. Nolen-Hoeksema lived in Bethany, Conn. In addition to her husband, a science writer, she is survived by a son, Michael; her brothers, Jeff and Steve; and her father, John.

“Over the past four decades women have experienced unprecedented growth in independence and opportunities,” Dr. Nolen-Hoeksema wrote in 2003, adding, “We have many reasons to be happy and confident.”

“Yet when there is any pause in our daily activities,” she continued, “many of us are flooded with worries, thoughts and emotions that swirl out of control, sucking our emotions and energy down, down, down. We are suffering from an epidemic of overthinking.”

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Susan Nolen-Hoeksema, Psychologist Who Studied Depression in Women, Dies at 53

Susan Nolen-Hoeksema, a psychologist and writer whose work helped explain why women are twice as prone to depression as men and why such low moods can be so hard to shake, died on Jan. 2 in New Haven. She was 53.

Andrew Sacks

Susan Nolen-Hoeksema at the University of Michigan in 2003. Dr. Nolen-Hoeksema's research showed that women were more prone to ruminate, or dwell on the sources of problems rather than solutions, more than men.

Her death followed heart surgery to correct a congenitally weak valve, said her husband, Richard Nolen-Hoeksema.

Dr. Nolen-Hoeksema, a professor at Yale University, began studying depression in the 1980s, a time of great excitement in psychiatry and psychology. New drugs like Prozac were entering the market; novel talking therapies were proving effective, too, particularly cognitive behavior therapy, in which people learn to defuse upsetting thoughts by questioning their basis.

Her studies, first in children and later in adults, exposed one of the most deceptively upsetting of these patterns: rumination, the natural instinct to dwell on the sources of problems rather than their possible solutions. Women were more prone to ruminate than men, the studies found, and in a landmark 1987 paper she argued that this difference accounted for the two-to-one ratio of depressed women to depressed men.

She later linked rumination to a variety of mood and behavior problems, including anxiety, eating disorders and substance abuse.

“The way I think she’d put it is that, when bad things happen, women brood — they’re cerebral, which can feed into the depression,” said Martin Seligman, a professor of psychology at the University of Pennsylvania, who oversaw her doctoral work. “Men are more inclined to act, to do something, plan, beat someone up, play basketball.”

Dr. Seligman added, “She was the leading figure in sex differences in depression of her generation.”

Dr. Nolen-Hoeksema wrote several books about her research for general readers, including “Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life.” These books described why rumination could be so corrosive — it is deeply distracting; it tends to highlight negative memories — and how such thoughts could be alleviated.

Susan Kay Nolen was born on May 22, 1959, in Springfield, Ill., to John and Catherine Nolen. Her father ran a construction business, where her mother was the office manager; Susan was the eldest of three children.

She entered Illinois State University before transferring to Yale. She graduated summa cum laude in 1982 with a degree in psychology.

After earning a Ph.D. in psychology at the University of Pennsylvania, she joined the faculty at Stanford. She later moved to the University of Michigan, before returning to Yale in 2004.

Along the way she published scores of studies and a popular textbook. In 2003 she became the editor of the Annual Review of Clinical Psychology, an influential journal.

Dr. Nolen-Hoeksema moved smoothly between academic work and articles and books for the general reader.

“I think part of what allowed her to move so easily between those two worlds was that she was an extremely clear thinker, and an extremely clear writer,” said Marcia K. Johnson, a psychology professor and colleague at Yale.

Dr. Nolen-Hoeksema lived in Bethany, Conn. In addition to her husband, a science writer, she is survived by a son, Michael; her brothers, Jeff and Steve; and her father, John.

“Over the past four decades women have experienced unprecedented growth in independence and opportunities,” Dr. Nolen-Hoeksema wrote in 2003, adding, “We have many reasons to be happy and confident.”

“Yet when there is any pause in our daily activities,” she continued, “many of us are flooded with worries, thoughts and emotions that swirl out of control, sucking our emotions and energy down, down, down. We are suffering from an epidemic of overthinking.”

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