Newtown Shooter Had Sensory Processing Disorder

From the time he was little, Adam Lanza couldn't bear to be touched. By middle school, the chaos and noise of large, bustling classrooms began to upset him. At 20, just before the Newtown shootings, he was isolated and, the world would later learn, disturbed.

All this was revealed in "Raising Adam Lanza," an investigative report by the Hartford Courant in partnership with the PBS news program FRONTLINE, which aired Tuesday night.

Before the age of 6, Lanza had been diagnosed with a controversial condition, "sensory integration disorder" -- now known as sensory processing disorder, according to the report.

Those with sensory processing disorder or SPD may over-respond to stimuli and find clothing, physical contact, light, sound or food unbearable. They may also under-respond and feel little or no reaction to pain or extreme hot and cold. A third form involves sensory motor problems that can cause weakness and clumsiness or delay in developing motor skills.

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Whether SPD is a distinct disorder or a collection of symptoms pointing to other neurological deficits, most often anxiety or attention-deficit hyperactivity disorder (ADHD), has been debated by the medical community for more than two decades.

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No one will know why the withdrawn Lanza shot his mother four times in her own bed, then went to Sandy Hook Elementary School to slaughter six women and 20 first-graders before taking his own life on Dec. 14, 2012.

But this report, the most detailed account to date on his troubled life, paints a picture of a child coping with special needs and a mother, "devoted but perhaps misguided," struggling unsuccessfully to help.

"The most surprising thing for me was this sort of inwardness of Adam, a world view of someone that was afraid of the world," said show producer Frank Koughan. "He just reacted badly to the whole world and didn't want to be part of it. He was not some violent monster, except on one particular day, when he was exceedingly monstrous."

The investigative team interviewed family and friends of the shooter's parents, Nancy and Peter Lanza, and reviewed a decade's worth of messages and emails from his mother to close friends, describing her son's socially awkward behavior.

"Adam was a quiet kid. He never said a word," Marvin LaFontaine, a friend of Nancy Lanza, told them. "There was a weirdness about him and Nancy warned me once at one of the Scout meetings … 'Don't touch Adam.' She said he just can't stand that. He'd become teary-eyed and I think he would run to his mother."

In 1998, the Lanzas left their home in New Hampshire for Connecticut with Adam, who had already been diagnosed with the sensory disorder and was "coded" with an individual education plan, according to a family member who did not want to be identified by FRONTLINE.

"It was somebody well-placed who was completely in a position to know," said Koughan, 45, a veteran journalist who produced the film, "Drop-Out Nation."

Lanza didn't recognize pain, another feature of some types of SPD. He couldn't cope with loud noise, confusion or change, which would cause him to "shut down," according to the report.

"He'd almost go into a catatonic kind of state, which is another reason why in hindsight, he didn't seem like a threat to anybody," said Koughan. "He didn't lash out or beat up kids. He went within himself, until one day he didn't."

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Syria "Scud-type" missile said to kill 20 in Aleppo

AMMAN (Reuters) - A Syrian missile killed at least 20 people in a rebel-held district of Aleppo on Tuesday, opposition activists said, as the army turns to longer-range weapons after losing bases in the country's second-largest city.

The use of what opposition activists said was a large missile of the same type as Russian-made Scuds against an Aleppo residential district came after rebels overran army bases over the past two months from which troops had fired artillery.

As the uprising against President Bashar al-Assad, now a civil war, nears its two-year mark, rebels also landed three mortar bombs in the rarely-used presidential palace compound in the capital Damascus, opposition activists said on Tuesday.

The United Nations estimates 70,000 people have been killed in the conflict between largely Sunni Muslim rebels and Assad's supporters among his minority Alawite sect. An international diplomatic deadlock has prevented intervention, as the war worsens sectarian tensions throughout the Middle East.

A Russian official said on Tuesday that Moscow, which is a long-time ally of Damascus, would not immediately back U.N. investigators' calls for some Syrian leaders to face the International Criminal Court for war crimes.

Moscow has blocked three U.N. Security Council resolutions that would have increased pressure on Assad.

Casualties are not only being caused directly by fighting, but also by disruption to infrastructure and Syria's economy.

An estimated 2,500 people in a rebel-held area of northeastern Deir al-Zor province have been infected with typhoid, which causes diarrhea and can be fatal, due to drinking contaminated water from the Euphrates River, the World Health Organization (WHO) said on Tuesday.

"There is not enough fuel or electricity to run the pumps so people drink water from the Euphrates which is contaminated, probably with sewage," the WHO representative in Syria, Elisabeth Hoff, told Reuters by telephone.

The WHO had no confirmed reports of deaths so far.

BURIED UNDER RUBBLE

In northern Aleppo, opposition activists said 25 people were missing under rubble of three buildings hit by a several-meter-long missile. They said remains of the weapon showed it to be a Scud-type missile of the type government forces increasingly use in Aleppo and in Deir a-Zor.

NATO said in December Assad's forces fired Scud-type missiles. It did not specify where they landed but said their deployment was an act of desperation.

Bodies were being gradually dug up, Mohammad Nour, an activist, said by phone from Aleppo.

"Some, including children, have died in hospitals," he said.

Video footage showed dozens of people scouring for victims and inspecting damage. A body was pulled from under collapsed concrete. At a nearby hospital, a baby said to have been dug out from wreckage was shown dying in the hands of doctors.

Reuters could not independently verify the reports.

Opposition activists also reported fighting near the town of Nabak on the Damascus-Homs highway, another route vital for supplying forces in the capital loyal to Assad, whose family has ruled Syria since the 1960s.

Rebels moved anti-aircraft guns into the eastern Damascus district of Jobar, adjacent to the city centre, as they seek to secure recent gains, an activist said.

"The rebels moved truck-mounted anti-aircraft guns to Jobar and are now firing at warplanes rocketing the district," said Damascus activist Moaz al-Shami.

Russian Deputy Foreign Minister Gennady Gatilov told a news conference a U.N. war crimes report, which accuses military leaders and rebels of terrorizing civilians, was "not the path we should follow ... at this stage it would be untimely and unconstructive."

Syria is not party to the Rome Statute that established the ICC and the only way the court can investigate the situation is if it receives a referral from the Security Council, where Moscow is a permanent member.

(Writing by Oliver Holmes; Editing by Jason Webb)

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Retinal implants clear new hurdle

PARIS: German-designed implants aimed at restoring vision to patients blinded by retinal disease have succeeded in the second phase of trials, researchers reported on Wednesday.

The device was tested for up to nine months among nine people with retinitis pigmentosa, an inherited disease in which light receptors on the back of the eyeball degenerate and eventually cease to function.

"Of the nine patients observed in the study, three patients were able to read letters spontaneously," Retina Implant AG, a nine-year-old technology startup company that invented the device, said in a press release.

"During observation in and outside the laboratory, patients also reported the ability to recognise faces, distinguish objects such as telephones and read signs on doors."

The study appears in Proceedings of the Royal Society B, a journal published by Britain's de-facto academy of sciences.

The device consists of a tiny light-sensitive chip measuring 3mm by 3mm (0.11 x 0.11 inches), which sends electrical signals down the optic nerve to the brain, providing a "diamond-shaped" black-and-white image with a field of 15 degrees.

Attached to the retina, the implant is powered via a thin cable which connects to a small coil fitted under a fold of skin behind the ear.

The coil is charged when a handheld battery unit is brought up close to it -- the same principle of wireless charging that is used, for instance, in electrical toothbrushes -- and thus means it can be used outdoors.

The battery unit also has two knobs, enabling the user to adjust the brightness and contrast of the image.

The patients received the implant in one eye, the one with the worst visual function.

One of the nine had to drop out of the experiment after the optic nerve was damaged during the implant operation, and another experienced a buildup in eyeball pressure which was successfully treated with drugs.

New drugs and revolutionary medical devices typically undergo a three-phase process of trials on human volunteers.

The number of patients and the scope of the test gradually widens, in a bid to ensure that the innovation is both safe and effective.

The first trial of the implant, published in 2010, used a cable, rather than wireless technology, to power the device.

There are several other entrants in the field for retinal implants, reflecting big advances in electronic miniaturisation and microsurgery in the past decade.

None claims to be a cure but rather an aid to distinguish between light and darkness and ascertain the shape of objects.

"Although the restoration of vision described here is limited, blind persons with no alternative therapy options regard this type of artificial vision as an improvement in everyday life," the German doctors said.

Last week the US firm Second Sight Medical Products gained US regulatory approval in addition to the green light from Europe for its Argus II retinal prosthesis.

There is also a 24-electrode device made by Bionic Vision Australia, which has so far been tested on one patient.

-AFP/gn

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US supports India's constructive role in Afghanistan

WASHINGTON: Asserting that the United States and India share a vision of a secure, peaceful, democratic and prosperous Afghanistan, the Obama administration has said it strongly supports the constructive role being played by New Delhi in the war-torn country's ongoing development.

During the just concluded trilateral dialogue involving India and Afghanistan in New Delhi on Tuesday, the US expressed particular appreciation for the former's leading role in developing regional trade and investment.

"The US side expressed particular appreciation for India's leading role in helping to advance opportunities for regional trade and investment - and noted our shared interest in advancing the New Silk Road vision of connectivity between South and Central Asia - with Afghanistan at its core," a State Department spokesperson said on the conclusion of the trilateral dialogue in New Delhi.

Officials from the three countries, the spokesperson said, held in-depth consultations on issues ranging from political and security spheres to trade, commerce and investment.

"The United States and India share a vision of a secure, peaceful, democratic and prosperous Afghanistan. We strongly support the constructive role that India plays in Afghanistan's ongoing development," he said.

The US delegation was led by the assistant secretary of state for South and Central Asia, Robert Blake. The US delegation also included the deputy special representative for Afghanistan and Pakistan, Dan Feldman, for the trilateral dialogue.

This meeting follows the inaugural trilateral consultations held at the Afghan Mission in New York City on September 25, 2012.

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Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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Arias Says Violent Sex Preceded Killing

Jodi Arias and her ex-boyfriend, Travis Alexander,, had increasingly violent sex in which he tied her to his bed, twisted her arm, bent her over a desk for anal sex, and made sex videos with her in the hours leading up to the stabbing and shooting frenzy that left Alexander dead.

It was a day in which Arias, 32, inched closer to telling the court how the killing of Alexander took place, but after several hours of increasingly emotional testimony the court was adjourned until Wednesday.

In her sixth day on the stand, Arias tearfully described the sex-filled hours that led to Alexander's death on June 4, 2008. She is charged with murder for killing her former boyfriend, but claims she was forced to kill him self-defense. She could face the death penalty if convicted.

"He tied me up, (on) the bed. It's not my favorite but it's not unbearable," Arias told the court.

She said he used a kitchen knife in the bathroom to cut the rope to the proper length, but she didn't remember whether he left the knife in the bathroom or brought it back to the nightstand in the bedroom.

"There are a lot gaps that day... a lot of things I don't remember that day," she said.

Arias and Alexander then took graphic sexual photos of one another and made a sex video, both of which Arias said were Alexander's ideas. Arias has girlish braids in the pictures.

But the mood of the afternoon turned, she said, when Alexander became angry over a scratched computer disk of photos she gave him. He threw the CD and Arias said she became "apprehensive" of his rising temper.

"I know he's getting angry because Napoleon [Alexander's dog] got up and left the room and he always leaves the room when he gets mad." she testified.

"I don't know that I was consciously thinking (of violence) but I was more tense. I stood up, went to walk over to him, to rub his back and make sure he was okay," she said. "But he grabbed me on the upper arms, spun me around and grabbed my right arm and twisted it behind my back, and bent me over the desk, and pressed up against me."

Charlie Leight/Pool/The Arizona Republic/AP Photo

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"I was scared he was going to throw me or something, kick me," she continued. "He pressed his groin up against my butt, did a few thrusts and then started pulling my pants down."

The pair then had anal sex, which Arias said pacified Alexander.

"I was very relieved. I felt like we had avoided catastrophe. It could have led to another fight," she said.

Instead of a fight, Alexander, who was 27 and a devout Mormon, and Arias decide to go upstairs and take more nude photos of one another. Arias said she hoped the photos would satisfy Alexander over his frustration with the scratched CD.

Evidence introduced earlier in the trial show that Alexander was killed while Arias was photographing Alexander in the shower.

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Timeline of the Jodi Arias Trial

Earlier, Arias explained that she wasn't planning to visit Alexander during her roadtrip from her home in California, but was convinced by him to spontaneously take a detour to his house for sex and to hang out.

"The very last time I called Travis it was kind of like, I don't know how to describe it, he had been very sweet and was guilting me and making me feel bad that I was taking this big trip without going to see him," Arias said this afternoon.

"When I called him last time it was just like all right, I'm going," she said. "(Sex) was our thing at that time. I wasn't going to go there, stay the night and not do that."

Arias' attorney, Kirk Nurmi, asked her repeatedly on the stand if Arias brought a gun or knife with her on the roadtrip and to Alexander's house. She said that she did not.

She also denied a series of allegations made by the prosecution that she dyed her hair, rented an inconspicuous car, borrowed gas cans, turned off her cell phone, and switched money around her bank accounts as she left for Alexander's house because she was planning to murder him when she got there.

Arias said that her hair remained the same color, auburn-brown, throughout May and June, that she rented a car because her own car was not stable enough for highway travel, that she requested a white car instead of a red one because police pull red ones over more often, and that she transferred money to a business banking account for a tax write-off to classify it as a business trip.

The testimony about the road trip and Arias' planning could be key to the jury as they decide whether the killing was pre-meditated, as the prosecution claims. Arias could face the death penalty if convicted of murder with aggravating factors such as pre-meditation.

Arias said that she "didn't sleep at all last night" before testifying about the dramatic incident today. Her comment was stricken from the record.

Arias also described a barrage of threatening text messages sent by Alexander in which he told her he would exact "revenge" on her soon and called her a "sociopath."

She told the court that Alexander's temper would make her "cower."

The messages show a growing discord between the pair in April 2008, less than two months before Arias killed Alexander.

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Time to refer Syrian war crimes to ICC: U.N. inquiry

GENEVA (Reuters) - United Nations investigators said on Monday that Syrian leaders they had identified as suspected war criminals should face the International Criminal Court (ICC).

The investigators urged the U.N. Security Council to "act urgently to ensure accountability" for violations, including murder and torture, committed by both sides in an uprising and civil war that has killed about 70,000 people since March 2011.

"Now really it's time ... We have a permanent court, the International Criminal Court, who would be ready to take this case," Carla del Ponte, a former ICC chief prosecutor who joined the U.N. team in September, told a news briefing in Geneva.

But because Syria is not party to the Rome Statute that established the ICC, the only way the court can investigate the situation is if it receives a referral from the Security Council. Russia, Assad's long-standing ally and a permanent veto-wielding member of the council, has opposed such a move.

"We cannot decide. But we pressure the international community to decide because it's time to act," del Ponte said.

Brazilian expert Paulo Pinheiro, who leads the U.N. inquiry set up in 2011, said: "We are in very close dialogue with all the five permanent members and with all the members of the Security Council, but we don't have the key that will open the path to cooperation inside the Security Council."

His team of some two dozen experts is tracing the chain of command in Syria to establish criminal responsibility and build a case for eventual prosecution.

"Of course we were able to identify high-level perpetrators," del Ponte said, adding that these were people "in command responsibility...deciding, organizing, planning and aiding and abetting the commission of crimes".

She said it was urgent for the Hague-based war crimes tribunal to take up cases of "very high officials", but did not identify them, in line with the inquiry's practice.

"We have crimes committed against children, rape and sexual violence. We have grave concerns. That is also one reason why an international body of justice must act because it is terrible."

Del Ponte, who tried former Yugoslav President Slobodan Milosevic at the International Criminal Tribunal for the Former Yugoslavia on war crimes charges, said the ICC prosecutor would need to deepen the investigation on Syria before an indictment could be prepared.

Karen Koning AbuZayd, an American member of the U.N. team, told Reuters it had information pointing to "people who have given instructions and are responsible for government policy, people who are in the leadership of the military, for example".

The inquiry's third roster of suspects, building on lists drawn up in the past year, remains secret. It will be entrusted to U.N. High Commissioner for Human Rights Navi Pillay upon expiry of its mandate at the end of March, the report said.

Pillay, a former ICC judge, said on Saturday Assad should be investigated for war crimes, and called for outside action on Syria, including possible military intervention.

Pinheiro said the investigators would not speak publicly about "numbers, names or levels" of suspects.

SEVEN MASSACRES IDENTIFIED

The investigators' latest report, covering the six months to mid-January, was based on 445 interviews conducted abroad with victims and witnesses, as they have not been allowed into Syria.

"We identified seven massacres during the period, five on the government side, two on the armed opponents' side. We need to enter the sites to be able to confirm elements of proof that we have," del Ponte said.

The U.N. report said the ICC was the appropriate institution for the fight against impunity in Syria. "As an established, broadly supported structure, it could immediately initiate investigations against authors of serious crimes in Syria."

Government forces have carried out shelling and air strikes across Syria including Aleppo, Damascus, Deraa, Homs and Idlib, the 131-page report said, citing corroborating satellite images.

"Government forces and affiliated militias have committed extra-judicial executions, breaching international human rights law. This conduct also constitutes the war crime of murder. Where murder was committed as part of a widespread or systematic attack against a civilian population, with knowledge of that attack, it is a crime against humanity," the report said.

Those forces have targeted bakery queues and funeral processions to spread "terror among the civilian population".

Rebels fighting to topple Assad have also committed war crimes including murder, torture, hostage-taking and using children under age 15 in hostilities, the U.N. report said.

"They continue to endanger the civilian population by positioning military objectives inside civilian areas" and rebel snipers had caused "considerable civilian casualties", it said.

George Sabra, a vice president of the opposition Syrian National Coalition, asked about the U.N. report, told Reuters at a conference in Stockholm: "We condemn all kind of crimes, regardless who did it.

"We can't ignore that some mistakes have been made and maybe still happen right now. But nobody also can ignore that the most criminal file is that of the regime."

(This story has been corrected to fix name of Milosevic tribunal in 11th paragraph)

(Reporting by Stephanie Nebehay; additional reporting by Anna Ringstrom in Stockholm; Editing by Mark Heinrich)

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Tennis: Mass security for Nadal's Mexico event

ACAPULCO, Mexico: A brutal gang rape and other crimes have prompted a massive security operation for Acapulco's tennis tournament, with 4,000 personnel to be deployed at an event headlined by Rafael Nadal.

The Pacific port has become Mexico's deadliest city and local police have struggled to stem a brutal turf war between drug gangs where the intimidation of rivals includes the dumping of headless bodies in the streets.

The unprecedented show of security at the tennis event is three times the size of Acapulco's own police force and will feature army, navy, federal, state and municipal police, a senior Guerrero state government official told AFP.

Members of the deployment will begin to arrive on Wednesday, said the official, who spoke on condition of anonymity regarding next week's tournament.

Tourists had been relatively shielded from the city's violence until a group of gunmen stormed a beach bungalow on February 3 and raped six Spanish women after tying up seven Spanish men and a local woman.

The scaled up force will secure access to the Mextenis stadium, which has a capacity of 7,500, and the Hotel Fairmont Acapulco Princess, with a security perimeter being installed and cars will also be checked.

Former world number one Nadal, who won the Brazil Open on Sunday after a seven-month hiatus due to a knee injury, will be the top ranked player at Acapulco's red clay tournament which begins February 25 and ends March 2.

- AFP/al

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Hold panchayat polls as per existing quota: SC to Andhra Pradesh

NEW DELHI/HYDERABAD: The Supreme Court on Monday cleared the decks for elections to the panchayati raj (PR) institutions in the state and an upbeat chief minister Kiran Kumar Reddy wants to hold the polls at the earliest. With state election commissioner P Ramakanth Reddy stating that his department is fully prepared, the PR polls, touted as an acid test for the chief minister as well as new entrant YS Jaganmohan Reddy, could be held as early as April this year.

In its judgment on Monday, the SC bench of Justice P Sathasivam and Justice J S Khehar directed the state to conduct the polls on the basis of the existing 60.5% reservation for BCs (34%), SCs (18.25%) and STs (8.25%). Following a petition challenging the quota as exceeding the limit fixed by the apex court, the AP High Court had directed the state to hold the PR polls by fixing 50% as upper limit of the quota for the BCs, SC-STs . Monday's decision of the Supreme Court was on the basis of an appeal filed by the state government against the HC order.

Kiran Kumar Reddy's optimism of the Congress putting up a good performance is based on the public assurance given by Union panchayat raj minister Kishore Chandra Deo in Delhi soon after the SC verdict on Monday that Rs 2,400 crore that was held up for the last two years for providing drinking water and sanitation in rural areas will be released as soon as the local bodies are in place. "Assured of the funds, the CM can sway the voters in Congress' favour by announcing several welfare schemes," averred political analysts.

The term of the panchayati raj institutions, namely 1,094 zilla parishad territorial constituency (ZPTC) members , 14,591 mandal parishad territorial constituency members (MPTC), and 21,843 sarpanches , ended in July 2011 and since then, they have been under the control of special officers in the absence of elected councils. The PR polls could not be held till now as the issue was pending in the court.

Confident that he will be flush with funds, the chief minister has directed the concerned departments to be ready for the polls at the earliest . "Jagan is in jail. Telangana is calm. The state government is politically stable. And summer is far away. All this should work in Congress favour ," said a senior Congress leader.

Deo promises to release blocked funds

Although the recently held primary agricultural cooperative societies polls were not party-based , the Congress has claimed that it won a majority. In fact, the Congress claims that candidates owing allegiance to it won the elections even in Telangana, much to the chagrin of TRS and other parties .

The PR polls will be party based and the opposition parties, including the YSR Congress, TDP, TRS, BJP, Left parties and Lok Satta welcomed the SC order and wanted the state to hold the local body elections immediately. Jagan is confident that the polls will prove that he has mass following, while the TDP believes that the elections will pave the way for its leader Chandrababu Naidu's return to power. Panchayat raj department officials said they would initiate the process of delimitation of the constituencies and fixing quota in a week. State election chief Ramakanth Reddy told the media in Delhi that the commission would launch its process once it receives the data from the government.

Welcoming the SC decision, Union panchayat raj minister Kishore Chandra Deo announced that he would release the amount withheld as per the Constitution. "We have withheld Rs 2400 crore in the past two years, meant for providing drinking water and sanitation for rural areas, as there were no local governing bodies. We will release the amount once the local bodies are in place," Deo told media in Delhi.

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Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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