Well: Running in Reverse

This column appears in the Dec. 9 issue of The New York Times Magazine.

Backward running, also known as reverse or retro running, is not as celebrated as barefoot running and will never be mistaken for the natural way to run. But a small body of science suggests that backward running enables people to avoid or recover from common injuries, burn extra calories, sharpen balance and, not least, mix up their daily routine.

The technique is simple enough. Most of us have done it, at least in a modified, abbreviated form, and probably recently, perhaps hopping back from a curb as a bus went by or pushing away from the oven with a roasting pan in both hands. But training with backward running is different. Biomechanically, it is forward motion’s doppelgänger. In a study published last year, biomechanics researchers at the University of Milan in Italy had a group of runners stride forward and backward at a steady pace along a track equipped with force sensors and cameras.

They found that, as expected, the runners struck the ground near the back of their feet when going forward and rolled onto the front of their feet for takeoff. When they went backward though, they landed near the front of their feet and took off from the heels. They tended to lean slightly forward even when running backward. As a result, their muscles fired differently. In forward running, the muscles and tendons were pulled taut during landing and responded by coiling, a process that creates elastic energy (think rubber bands) that is then released during toe-off. When running backward, muscles and tendons were coiled during landing and stretched at takeoff. The backward runners’ legs didn’t benefit from stored elastic energy. In fact, the researchers found, running backward required nearly 30 percent more energy than running forward at the same speed. But backward running also produced far less hard pounding.

What all of this means, says Giovanni Cavagna, a professor at the University of Milan who led the study, is that reverse running can potentially “improve forward running by allowing greater and safer training.”

It is a particularly attractive option for runners with bad knees. A 2012 study found that backward running causes far less impact to the front of the knees. It also burns more calories at a given pace. In a recent study, active female college students who replaced their exercise with jogging backward for 15 to 45 minutes three times a week for six weeks lost almost 2.5 percent of their body fat.

And it aids in balance training — backward slow walking is sometimes used as a therapy for people with Parkinson’s and is potentially useful for older people, whose balance has grown shaky.

But it has drawbacks, Cavagna says — chiefly that you can’t see where you’re going. “It should be done on a track,” he says, “or by a couple of runners, side by side,” one facing forward.

It should be implemented slowly too, because its unfamiliar motion can cause muscle fatigue. Intersperse a few minutes periodically during your regular routine, Cavagna says. Increase the time you spend backward as it feels comfortable.

The good news for serious runners is that backward does not necessarily mean slow. The best recorded backward five-kilometer race time is 19:31, faster than most of us can hit the finish line with our best foot forward.

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The Next Crisis for German Banks — Shipping

FRANKFURT — For all the talk about Germany’s financial exposure to Greece, it turns out that some German banks have a problem of more titanic proportions — their vulnerability to the global shipping trade.

Germany’s 10 largest banks have 98 billion euros, or $128 billion, in outstanding credit or other risks related to the global shipping industry, according to Moody’s Investors Service. That is more than double the value of their holdings of government debt from Greece, Ireland, Italy, Portugal and Spain. And it is more than any other country’s financial exposure to the shipping industry, which is in the fifth year of a recession.

Moreover, German banks bear a generous share of the blame for spawning that recession. By helping to finance and market funds used to build and buy ships, a popular tax shelter, the banks helped create a glut in large container ships that has led to a collapse in cargo hauling prices worldwide.

Germans grumble chronically about having to pay for Greece’s bad debts, and German policy makers style themselves as guardians of fiscal prudence. But the shipping-related crisis, and the threat it poses to the German economy from billions of euros in bad loans and losses at shipping-related companies, is a reminder that German banks and political leaders also have plenty to answer for.

The recession in shipping has been overshadowed by the euro zone debt crisis, but it has many of the same causes. They include complex financial products that turned sour, market-distorting government incentives and a gigantic underestimation of risk.

“The container ship market is completely overbuilt,” said Thomas Mattheis, a partner at TPW Todt, an accounting firm in Hamburg that advises clients in the industry. He attributed the situation to banks that granted easy credit, cargo companies that ordered too many vessels and investors eager for the tax-free profits that were part of the allure, thanks to German law.

“When you look back you can say they all had a share,” Mr. Mattheis said.

HSH Nordbank in Hamburg, the world’s largest provider of maritime finance, is expected to raise its estimate of potential losses from shipping on Wednesday when it reports quarterly earnings. The bank, owned by local governments and savings banks, has already warned that in coming years it will need to avail itself of 1.3 billion euros in guarantees offered by Hamburg and the state of Schleswig-Holstein, putting a further strain on taxpayers.

“I have to admit that grave mistakes were made in the years before 2009,” Constantin von Oesterreich, chief executive of HSH, said in an interview published on Saturday by The Hamburger Abendblatt. In October, Mr. von Oesterreich became the bank’s third chief executive since 2008.

Other German banks that were particularly active in ship finance, including Commerzbank in Frankfurt and NordLB in Hanover, which both rank in the top five globally in that market, have said they have made adequate provisions for losses and will not need any government aid.

Commerzbank, which is partly owned by the German government after a bailout, shut down a unit specializing in ship financing this year and is winding down its holdings. The bank warned in its most recent quarterly report that it would be at least another year before it could sell units that were set up to finance construction of cargo ships with names including Marseille and Palermo. While larger, relatively new cargo ships sell for tens of millions of dollars, older, smaller ships often fetch only a few million — not much more than the value of the scrap metal.

Exposure to shipping is one reason Moody’s affirmed its negative outlook for German banks last month. In a report, the ratings agency warned that the global shipping industry “faces weakened demand amid sluggish global economic growth and evolving structural overcapacity.” It said money that the 10 largest German banks had lent to the shipping industry equaled 60 percent of their capital, the funds held in reserve for potential losses.

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IHT Rendezvous: Tibet's Desperate Toll Keeps Climbing

HONG KONG — What pushes them to do it, these desperate Tibetans, more than 90 of them, dozens in recent days and another one on Monday, the ones drenching themselves in gasoline, sometimes even drinking the fuel beforehand, and then setting themselves on fire, their robes bursting into pennants of flame as they die such painful deaths, why, what is happening here? Are they killing themselves because of politics, sadness, despair, religion, what?

We don’t yet know what drove Lobsang Gedun, 29, a Buddhist monk who burned himself to death on Monday in the western Chinese province of Qinghai. My colleague Edward Wong reported on the death, and Radio Free Asia quoted an account of the immolation: “With his body on fire, he walked about 300 steps with hands folded in prayer posture, and raised slogans before he collapsed dead on the ground.”

Lobsang Gedun’s slogans were likely in praise of the Dalai Lama, the exiled spiritual leader of Tibetan Buddhists, or condemnations of Beijing’s harsh, militarized rule in Tibet and the Tibetan areas of western China. Foreign reporters, United Nations investigators and many international relief groups are almost universally barred by the Chinese authorities from entering Tibet.

“The Chinese still blame everything on us,” the Dalai Lama said in an interview with The Hindu newspaper. “If the Chinese have the confidence, they must allow the international community to see the truth. That is very important. If they do not allow, it is an indication that they have the feeling of guilt, that they have something to hide.”

“The Chinese propaganda always says the Tibetan people are very happy, that they were liberated from the feudal system under the Dalai Lama,” he said. “So now their propaganda is on shaky ground.”

The full interview, conducted in July at the Dalai Lama’s residence in the Indian hill-station town of McLeod Ganj, in Dharamsala, can be seen here.

A harrowing and deeply reported piece in National Geographic by Jeffrey Bartholet examines the final days and fiery death of one self-immolator, a young exile named Jamphel Yeshi, who burned himself to death in a Tibetan enclave of New Delhi in March.

He was known as Jashi to his friends. He had a couple of dragon tattoos on his muscular body, and he was known as a strong swimmer. During the winter back home in Tibet he loved to go sledding on makeshift toboggans.

He fled Tibet on foot in 2006 and eventually made his way to Dharamsala, home of the Tibetan government in exile, “where every newcomer gets an audience with the Dalai Lama, and everyone gets free schooling,” Mr. Bartholet writes.

“Jashi cried when the Dalai Lama blessed him, touching his head. He couldn’t get a word out.”

Later, reaching Delhi, he lived in a one-room flat, splitting the $90-a-month rent with four Tibetan friends. He became somewhat active in Tibetan politics. At the time of his death, Jashi owned a thin vinyl suitcase, two pens, a scarf, four pairs of pants and a small Tibetan flag.

The night before his death, he ate well, sharing a Tibetan mutton stew with seven friends. The next day, at a large street protest, Mr. Bartholet writes, “He poured the gasoline over himself. It ran down his shoulders, over his clothes, and into his shoes. Then he put a flame to it. Jashi ran about 20 strides, stumbled and fell under a giant banyan tree.”

A crowd gathered. “Above all of the cries and shouts,” Mr. Bartholet says, “several witnesses later recalled most distinctly the roar of the fire: foh-foh-foh.”

As we have written and reported on Rendezvous, young Tibetans are increasingly inclined to more aggressive protests over Chinese authority. The Dalai Lama’s Middle Way — nonviolent pursuit of Tibetan autonomy rather than outright independence — is too incremental for many political activists.

The rise in self-immolations, many believe, is an expression of this anxiety and impatience.

“The world hardly notices when another young man or woman goes up in flames,” Mr. Bartholet says. “Some young activists are talking darkly of another possible phase, of how thin the line is between killing yourself and killing your enemies.”

The Dalai Lama has largely refrained from commenting on the self-immolations, except to express sadness, along with his disapproval of violent or extreme forms of protests. But in the Hindu interview he calls the immolations “a very, very delicate political issue.”

“Now, the reality is that if I say something positive, then the Chinese immediately blame me,” he said. “If I say something negative, then the family members of those people feel very sad. They sacrificed their… life. It is not easy. So I do not want to create some kind of impression that this is wrong.”

Mr. Bartholet quotes Tenzin Wangchuk, 38, the president of the Delhi chapter of the Tibetan Youth Congress:

The older generation is 90 percent religious and 10 percent nationalistic; they want to spread happiness and make the world a better place. But the younger generation is not a bunch of Buddhas. We are Buddhists but not Buddhas. If you kill evil, we don’t think that’s bad. We need actions. . . One day, who knows? We may raise our issue by bombing ourselves, and if you are going to die, maybe it’s better to take some enemies along with you.

And he offers this comment from Lodi Gyari, a former Tibetan negotiator with China:

The only reason the Tibetans are so committed to nonviolence is purely because of the influence of the Dalai Lama. I have also told the Chinese this. It’s a very thin line. One day, somebody may say, “I’ve had enough, it’s meaningless for me, but I’m not going to go alone … I’m going to take a couple of Chinese guys with me.” That can happen any day.

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Video Games: Little Inferno; Hitman; Assassin’s Creed III; Persona 4 Golden; Angry Birds Star Wars; My Little Pony

Ubisoft

Ratonhnhaké:ton is a half-British, half-Mohawk assassin in Revolutionary America.

Released on Nov. 18

Developed by Tomorrow Corporation

For PC, Mac, Linux and Wii U

Rated T for Teen (drug reference and crude humor)

Here’s an odd one. Little Inferno is an interactive fireplace. It’s an emotional, interactive fireplace with a story line and some notions about the dangers of amusing ourselves with distracting trifles.

At first this strange creation appears to be a simple puzzle game consisting of little more than a fireplace, a catalog of items to burn and 99 clues that challenge the player to burn these things in proper combinations. One clue is “Movie Night.” Burn the popcorn. Burn the TV. A weirder one is “Bike Pirate.” Burn the wooden bike. Burn the pirate.

As you play, an unseen character begins to send letters. They burn, too, but something seems off. The messages are alternately cheerful and sad, a wee bit wicked and increasingly desperate.

The purpose of the pyromaniac pastime becomes smoky with doubt. Why are we doing this? What are we missing? It’s odd enough to play a new video game that questions our decision to play video games. That it’s an interactive fireplace game that does this is all the stranger and more wonderful. It’s a yule log for our times.

HITMAN

Absolution

Released on Nov. 20

Developed by IO Interactive

Published by Square Enix

For PC, Xbox 360 and

PlayStation 3

Rated M for Mature (intense violence, partial nudity and strong language)

It’s a vile, dangerous world in Hitman: Absolution. Nearly everyone is in need of a good killing, and Agent 47, the depilated murder machine at the center of the long-running Hitman franchise, is just the man for the job.

Absolution is consistent with the setup of past Hitman games: At the start of a level, 47 is given an assassination target, and he must make his way through semi-open areas by any of a number of possible routes. The reactive artificial intelligence keeps things enjoyably unpredictable, and the best levels feel like a buffet of sadistic improvisation.

The story is pure B-movie hogwash. It’s mostly enjoyable in a certain exploitive way, but it often feels as if the writers were trying too hard.

When it gets cooking, Hitman: Absolution evokes the feeling of a deadly, measured dance. It’s a tango between you and the computer, with each party alternately taking the lead through arenas that shift and upset expectations.

ASSASSIN’S CREED III

Released on Oct. 30

Developed and published by Ubisoft

For PlayStation 3, Xbox 360, Wii U and PC

Rated M for Mature (blood, intense violence, sexual themes and strong language)

Assassin’s Creed III is really the fifth major Assassin’s Creed game. The numbering signifies that this new historical epic is a shift, as this Ubisoft series about the ancestral lives of a man named Desmond Miles leaps to its third era. Finished with the 12th-century crusades and 15th-century Renaissance Italy, Assassin’s Creed now lets us do interactive historical tourism in Boston, New York and the nearby woods of Revolutionary America.

Assassin’s Creed games are lavish action-adventure blockbusters. In this new one, we primarily play as a young, bitter, half-British, half-Mohawk greenhorn assassin named Ratonhnhaké:ton, who finds himself crossing paths and sometimes doing the bidding of Sam Adams, Paul Revere, George Washington and other real figures. Most of the bad guys are red coats with slow-firing muskets. We’re best with a tomahawk and a bow and arrow.

The new game involves a lot of climbing and killing across a sprawling landscape of bustling cities and gorgeous frontier. Add in a mix of awkwardly instituted horseback riding, homestead building, trading, trapping, hunting and, at the wheel of your own tall-masted warship, epic naval combat. There is much to do and witness in a ripped-from-the-history-books adventure that is refreshingly unwilling to ignore the unsavory aspects of America’s birth. A lengthy production cycle didn’t spare the game from a wealth of bugs that are only now being patched out.

The series’s low-key multiplayer games of competitive assassination return, but the star of this epic is something that might seem almost quaint: Assassin’s Creed III is easily the best tree-climbing simulator in history.

PERSONA 4 GOLDEN

Released on Nov. 20

Developed and published by Atlus

For PlayStation Vita

Rated M for Mature (violence, alcohol reference and partial nudity)

Persona 4 Golden is part turn-based role-playing game, part high school simulator and a rerelease of a celebrated PlayStation 2 game on the portable Vita.

These edited and condensed reviews are from the writers and editors of the gaming Web site Kotaku.com. Full reviews are at kotaku.com/nytselects.

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Willis Whitfield, Clean Room Inventor, Dies at 92

The enemy was very small but it was everywhere. World peace, medical advancement, iTunes — all would eventually be threatened.

Half a century ago, as a rapidly changing world sought increasingly smaller mechanical and electrical components and more sanitary hospital conditions, one of the biggest obstacles to progress was air, and the dust and germs it contains.

Stray particles a few microns wide could compromise the integrity of a circuit board of a nuclear weapon. Unchecked bacteria could quickly infect a patient after a seemingly successful operation. Microprocessors, not yet in existence, would have been destroyed by dust. After all, an average cubic foot of air contained three million microscopic particles, and even the best efforts at vacuuming and wiping down a high-tech work space could only reduce the rate to one million.

Then, in 1962, Willis Whitfield invented the clean room.

“People said he was a fraud,” recalled Gilbert V. Herrera, the director of microsystems science and technology at Sandia National Laboratories in Albuquerque. “But he turned out to be right.”

Mr. Whitfield, who worked at Sandia from 1954 to 1984, died on Nov. 12 in Albuquerque. He was 92. The cause was prostate cancer, his wife, Belva, said.

His clean rooms blew air in from the ceiling and sucked it out from the floor. Filters scrubbed the air before it entered the room. Gravity helped particles exit. It might not seem like a complicated concept, but no one had tried it before. The process could completely replace the air in the room 10 times a minute.

Particle detectors in Mr. Whitfield’s clean rooms started showing numbers so low — a thousand times lower than other methods — that some people did not believe the readings, or Mr. Whitfield. He was questioned so much that he began understating the efficiency of his method to keep from shocking people.

“I think Whitfield’s wrong,” a scientist from Bell Labs finally said at a conference where Mr. Whitfield spoke. “It’s actually 10 times better than he’s saying.”

Willis James Whitfield was born in Rosedale, Okla., on Dec. 6, 1919. In addition to his wife, his survivors include his sons, James and Joe; a sister, Amy Blackburn; and a brother, Lawrence.

Mr. Whitfield became fascinated with electronics as a young man and received a two-year degree in the field after high school. He served in the Navy late in World War II, working with experimental electronic systems for aircraft. In 1952, he received a bachelor’s degree in physics and math from Hardin-Simmons University in Abilene, Tex.

By 1954 he was working at Sandia, which was involved in making parts for nuclear weapons and at the time was overseen by the Atomic Energy Commission. Mr. Whitfield’s duties soon included contamination control. By 1960, he had established his basic idea for the clean room.

“I thought about dust particles,” Mr. Whitfield told Time magazine in 1962. “Where are these rascals generated? Where do they go?”

The clean room was patented through Sandia, and the government shared it freely among manufacturers, hospitals and other industries.

Mr. Whitfield’s original clean room was only about six feet high, built as a small, self-contained unit. Some modern electronic devices, including the iPhone, are now built in China in huge clean rooms in structures that are more than a million square feet. Workers wear protective clothing, and other anticontamination methods have been added, but they still depend on Mr. Whitfield’s approach to suck up dust.

“Relative to these electronics, the particles are just massive boulders that would short out all of your electronics and make them not work,” Mr. Herrera said. “The core technology, just the cleaning part, hasn’t really changed a lot.”

Mrs. Whitfield said she was often been asked if her husband was a particularly fastidious man, and she always noted that he tended not to put his shoes away. He did live in a tidy house, though, and colleagues say he never tired of getting out a flashlight and shining it sideways across his coffee table to illuminate the prevalence of tiny dust particles that most people never notice.

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Willis Whitfield, Clean Room Inventor, Dies at 92

The enemy was very small but it was everywhere. World peace, medical advancement, iTunes — all would eventually be threatened.

Half a century ago, as a rapidly changing world sought increasingly smaller mechanical and electrical components and more sanitary hospital conditions, one of the biggest obstacles to progress was air, and the dust and germs it contains.

Stray particles a few microns wide could compromise the integrity of a circuit board of a nuclear weapon. Unchecked bacteria could quickly infect a patient after a seemingly successful operation. Microprocessors, not yet in existence, would have been destroyed by dust. After all, an average cubic foot of air contained three million microscopic particles, and even the best efforts at vacuuming and wiping down a high-tech work space could only reduce the rate to one million.

Then, in 1962, Willis Whitfield invented the clean room.

“People said he was a fraud,” recalled Gilbert V. Herrera, the director of microsystems science and technology at Sandia National Laboratories in Albuquerque. “But he turned out to be right.”

Mr. Whitfield, who worked at Sandia from 1954 to 1984, died on Nov. 12 in Albuquerque. He was 92. The cause was prostate cancer, his wife, Belva, said.

His clean rooms blew air in from the ceiling and sucked it out from the floor. Filters scrubbed the air before it entered the room. Gravity helped particles exit. It might not seem like a complicated concept, but no one had tried it before. The process could completely replace the air in the room 10 times a minute.

Particle detectors in Mr. Whitfield’s clean rooms started showing numbers so low — a thousand times lower than other methods — that some people did not believe the readings, or Mr. Whitfield. He was questioned so much that he began understating the efficiency of his method to keep from shocking people.

“I think Whitfield’s wrong,” a scientist from Bell Labs finally said at a conference where Mr. Whitfield spoke. “It’s actually 10 times better than he’s saying.”

Willis James Whitfield was born in Rosedale, Okla., on Dec. 6, 1919. In addition to his wife, his survivors include his sons, James and Joe; a sister, Amy Blackburn; and a brother, Lawrence.

Mr. Whitfield became fascinated with electronics as a young man and received a two-year degree in the field after high school. He served in the Navy late in World War II, working with experimental electronic systems for aircraft. In 1952, he received a bachelor’s degree in physics and math from Hardin-Simmons University in Abilene, Tex.

By 1954 he was working at Sandia, which was involved in making parts for nuclear weapons and at the time was overseen by the Atomic Energy Commission. Mr. Whitfield’s duties soon included contamination control. By 1960, he had established his basic idea for the clean room.

“I thought about dust particles,” Mr. Whitfield told Time magazine in 1962. “Where are these rascals generated? Where do they go?”

The clean room was patented through Sandia, and the government shared it freely among manufacturers, hospitals and other industries.

Mr. Whitfield’s original clean room was only about six feet high, built as a small, self-contained unit. Some modern electronic devices, including the iPhone, are now built in China in huge clean rooms in structures that are more than a million square feet. Workers wear protective clothing, and other anticontamination methods have been added, but they still depend on Mr. Whitfield’s approach to suck up dust.

“Relative to these electronics, the particles are just massive boulders that would short out all of your electronics and make them not work,” Mr. Herrera said. “The core technology, just the cleaning part, hasn’t really changed a lot.”

Mrs. Whitfield said she was often been asked if her husband was a particularly fastidious man, and she always noted that he tended not to put his shoes away. He did live in a tidy house, though, and colleagues say he never tired of getting out a flashlight and shining it sideways across his coffee table to illuminate the prevalence of tiny dust particles that most people never notice.

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British Business Hesitant to Defend Staying in European Union

LONDON — The chairman of the London Stock Exchange, Chris Gibson-Smith, simply does not have the time to speak. Christopher North, the boss of Amazon in Britain, is too busy as well. And Charles Dunstone, the founder of the mobile phone retailer Carphone Warehouse, also has an exceptionally full agenda.

All three are among a dozen or so top business and financial leaders concerned enough about Britain’s future in the European Union to join the advisory council of a group campaigning to keep the country in the bloc.

But not many of them seem ready to explain why in public.

Bringing access to an economic area of about 500 million people, membership in the European Union is vital to many British businesses. Yet with the public divided over Britain’s ties to the bloc, most business leaders prefer a discreet silence to risking criticism.

Recently the stakes have increased, with Prime Minister David Cameron promising to loosen British ties to the bloc and possibly hold a referendum after negotiating a more arm’s-length relationship. After almost three years of crisis in the euro zone, there is more speculation than ever about a possible British withdrawal.

Britons have never been enthusiastic about the idea of European integration. So pro-Europeans are frustrated by the reluctance of business to stress the commercial benefits, particularly since, in private, company bosses can be outspoken about the risks of withdrawal.

“What they say to me when I meet them is this would be disastrous for British business,” said Glenis Willmott, leader of the British Labour Party’s members of the European Parliament.

Last month, Roger Carr, chairman of the main business lobbying organization, the Confederation of British Industry, appealed to his colleagues to break their silence or risk a possibility that now goes by the shorthand “Brixit”: British exit.

On Europe it was “essential that the voice of British business is loud and clear in extolling the virtues of future engagement,” he said.

A poll of business leaders by Ipsos MORI, commissioned in 2011 by Business for New Europe, a lobbying group campaigning for continued British membership, showed that 33 percent said they strongly agreed that a British exit from the European Union would damage business.

So why the silence when the stakes are so high?

“I ask myself, Why are these people not willing to be more outspoken?” said Phillip Souta, director of Business for New Europe. Its advisory council includes Mr. Gibson-Smith, Mr. North and Mr. Dunstone — all of whom declined to be interviewed.

“But I understand why they are not willing to be more outspoken is because it is so politically divisive,” he added. “Boards are divided on all of these issues. If you don’t have consensus they will agree not to talk.”

Some business leaders who supported earlier pro-European initiatives have been compromised by having advocated British membership in the now struggling euro.

Martin Sorrell, chief executive of the advertising group WPP and one of a handful of business figures happy to go on television to make a pro-European case, says many colleagues find the European Union too politically charged.

“Business leaders don’t want to speak out on these controversial issues,” he said. “They’ve got enough to do trying to run their own businesses and focusing on their own businesses and challenges.”

And even pro-European company bosses tend to have some reservations about the way the European Union is run, including the level of bureaucracy, the “more extreme” pieces of European legislation and the increases demanded by some in the bloc’s budget, he said.

Nevertheless, Mr. Sorrell says he believes that Europe’s internal market is “a major economic opportunity that we would live to regret passing up” and Britain has a better chance of resolving its problems with the union if it argues from within.

With the debate moving so swiftly in a euro-skeptic direction, pro-union campaigners are beginning to organize a counteroffensive.

If there is a referendum on Britain’s relations with the union, Mr. Sorrell says he believes that his business colleagues will stir.

Ms. Willmott thinks there’s no time like the present. “They say this to us privately, why not say it publicly?” she said. “It’s about time we heard these arguments.”

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Syrian Government Beset by Battles and Diplomatic Setbacks

Narciso Contreras/Associated Press

A kitchen in a residence in Aleppo, Syria, damaged Sunday in fighting between Free Syrian Army fighters and government forces.

BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government on Monday as fresh signs emerged of a worsening battle for control of the capital.

A senior Turkish official said that Russia had agreed on Monday to a new diplomatic approach that would seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the government. Fighting raged around Damascus, the Syrian capital, and its airport, disrupting commercial flights for a fourth straight day.

A prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and both President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.

The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”

The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.

Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was inflicting heavy losses. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.

But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.

A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.

“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.

“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”

Many observers — United Nations personnel in Syria, Arab diplomats and opposition activists — stress that it is difficult to reliably assess the state of the government. But taken together, the day’s events suggested that the government’s position was declining more sharply than it had in months and that an international scramble to find a solution to the crisis was intensifying.

Nabil al-Araby, the head of the Arab League, said on Monday that the government could fall at “any time,” Agence France-Presse reported.

“I think there will be something soon,” he said. “Facts on the ground indicate very clearly now that the Syrian opposition is gaining, politically and militarily.”

The Arab League has long called for Mr. Assad to step down. But Russia, Mr. Assad’s most powerful ally, has held out the possibility of his staying in power during a transition, so the Russian government’s apparent shift of emphasis carried more weight.

Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut and Christine Hauser in New York.

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Software Programs Help Doctors Diagnose, but Can’t Replace Them

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

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With Some Hospitals Closed After Hurricane Sandy, Others Pick Up Slack

A month after Hurricane Sandy struck New York City, unexpectedly shutting down several hospitals, one Upper East Side medical center had so many more emergency room patients than usual that it was parking them in its lobby.

White and blue plastic screens had been set up between the front door and the elevator banks in the East 68th Street building of that hospital, NewYork-Presbyterian/Weill Cornell. The screens shielded 10 gurneys and an improvised nursing station from the view of people obliviously walking in and out of the soaring, light-filled atrium.

“It’s like a World War II ward,” Teri Daniels, who had been waiting a day and a half with a relative who needed to be admitted, said last week.

Since the storm, a number of New York City hospitals have been scrambling to deal with a sharp increase in patients, forcing them to add shifts of doctors and nurses on overtime, to convert offices and lobbies to use for patients’ care, and even, in one case, to go to a local furniture store to buy extra beds.

At Beth Israel Medical Center, 11 blocks south of the Bellevue Hospital Center emergency room, which was shuttered because of storm damage, the average number of visits to the E.R. per day has risen to record levels. Visits have increased by 24 percent this November compared with last, and the numbers show no sign of dropping. Hospital admissions have risen 12 percent compared with last November.

Most of the rise in volume is from patients who had never been to Beth Israel before. An emergency room doctor at the hospital described treating one patient who said he had been born at Bellevue and had never before gone anywhere else.

Emergency room visits have gone up 25 percent at NewYork-Presybterian/Weill Cornell, which in Bellevue’s absence is the closest high-level trauma center — treating stab wounds, gun wounds, people hit by cars and the like — in Manhattan from 68th Street south. Stretchers holding patients have been lined up like train cars around the nursing station and double-parked in front of stretcher bays.

In Brooklyn, some patients in Maimonides Medical Center’s emergency room who need to be admitted are waiting two or three days for a bed upstairs, instead of four or five hours. Almost every one of the additional 1,100 emergency patients this November compared with last November came from four ZIP codes affected by the storm and served by Coney Island Hospital, a public hospital that was closed because of storm damage.

The number of psychiatric emergency patients from those same ZIP codes has tripled, in a surge that began three days before the hurricane, perhaps fueled by anxiety, as well as by displacement from flooded adult homes or programs at Coney Island Hospital, doctors said.

The Maimonides psychiatric emergency room bought five captain’s beds — which do not have railings that can be used for suicide attempts — at a local furniture store, to accommodate extra patients. The regular emergency room had to buy 27 new stretchers after the hurricane, “and we probably need a few more,” the department’s chief, Dr. John Marshall, said.

The emergency room and inpatient operations of four hospitals remain closed because of flooding and storm damage. Besides Bellevue and Coney Island, NYU Langone Medical Center and the VA New York Harbor Healthcare System, both near Bellevue on the East Side of Manhattan, are closed.

While the surge in traffic to other hospitals has been a burden, it has also been a boon, bringing more revenue.

On the Upper East Side, the storm has helped Lenox Hill Hospital, which has a history of financial problems. It took two or three wards that had been turned into offices and converted them back to space for patients. Emergency room visits are up 10 percent, and surgery has been expanded to seven days a week from five.

“We usually operate at slightly over 300 beds, and now we’re at well over 550,” Carleigh Gustafson, director of emergency nursing, said.

Conversely, administrators at the shuttered hospitals, especially NYU Langone, a major teaching center, worry that their patients and doctors are being raided, with some never to return.

NYU’s salaried doctors are being paid through January, on the condition that they do not take another job. But at the same time, they need a place to practice, so NYU administrators have been arranging for them to work as far away as New Jersey until the hospital reopens. Lenox Hill alone has taken on close to 300 NYU doctors, about 600 nurses, and about 150 doctors in training, fellows and medical students.

Obstetricians and surgeons from the closed hospitals have been particularly disadvantaged, since they are dependent on hospitals to treat their patients. Many displaced surgeons have been reduced to treating only the most desperately ill, and operating on nights and weekends, when hospitals tend to be least well staffed.

“I think there’s no question that a lot of people have postponed anything that they can postpone that is elective,” said Dr. Andrew W. Brotman, senior vice president at NYU.

In mid-November, Dr. Michael L. Brodman, chairman of obstetrics at Mount Sinai Medical Center, sent out a memo saying his department had taken on 26 NYU physicians, as well as nurses and residents, but “clearly, that is too much for us to handle long term.”

Since then, 15 of the physicians have gone to New York Downtown Hospital, while Mount Sinai has retained 11 doctors and 26 nurses.

“We are guests in other people’s homes,” Dr. Brotman of NYU said, “and we are guests who have to some degree overstayed their welcome.”

Joanna Walters contributed reporting.

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