Mystery News

The Doctor’s World: BMJ’s Holiday Tradition of Lighthearted, but Rigorous, Scholarship

Label: Health

LONDON — Dutch and Norwegian scientists say they have solved a glowing mystery: why Rudolph the reindeer’s nose is red.

By traveling to the Arctic and using video-microscope and thermal imaging technology, the scientists showed that the glow is from tiny blood vessels that are more abundant in the noses of reindeer than in humans’. Yes, seriously. The findings are being reported next week in BMJ, formerly known as The British Medical Journal, a publication with a quirky holiday tradition.

For the past 30 years, BMJ has devoted its Christmas-week issue to a lighter and sometimes brighter side of medicine, publishing unusual articles that vary from simply amusing to bizarre to creative or potentially important. All are based on methodologically sound science.

Alongside Rudolph on the cover of this year’s holiday issue is Cliff, a 2-year-old beagle who was trained by another Dutch team to accurately sniff out the sometimes fatal bacterial bowel infection Clostridium difficile and make the diagnosis in minutes — days faster than standard laboratory tests. The Christmas tradition began in 1982, originally intended as a one-time effort to give readers a break from stodgy scientific reports written in technical jargon. The editor then, Dr. Stephen P. Lock, recalled in an interview that he wanted to present “another side of medicine” by offering lighter reading: research oddities, bizarre stories and history. But this was no April fools’ issue: Dr. Lock insisted that the articles meet the same rigorous criteria as research published in regular issues.

Indeed, some articles in the holiday issue are also suitable for regular issues, said Dr. Tony Delamothe, the BMJ deputy editor who has overseen the last eight Christmas issues. “We are on an incessant search for novelty,” he said.

Over the years, BMJ Christmas reports have demolished myths, including a Danish one that people could get drunk by absorbing alcohol through the feet. After soaking their feet for three hours in a basin containing three bottles of vodka and measuring their blood alcohol levels, three Danish scientists found no such absorption.

The first Christmas issue included an account of a resuscitation from 1650 that still astounds today. An unwed 22-year-old mother in Oxford was condemned to death after being accused of murdering her premature, stillborn son and concealing his body. She was executed by hanging by the neck for half an hour while people present jerked her up and down.

At the time, the bodies of executed prisoners were given to doctors for anatomical dissection. Two doctors who opened the woman’s coffin were startled to hear raspy breaths. They revived her, and she went on to recover her memory and live another 15 years, marrying and giving birth to three children. The 17th-century doctors’ report met the criteria for a modern case report, wrote J. Trevor Hughes, the author of the 1982 article.

Dr. Lock, the editor, also encouraged historical back stories. In 1984, Dr. Charles Fletcher wrote about how he tested ways to safely administer the first precious batches of penicillin in 1941. The initial full test was on a 43-year-old British policeman who developed the widespread bacterial infection septicemia. He showed striking improvement from small doses of the antibiotic, but he died after the scarce supply — much of it recycled from his urine — ran out.

Many Christmas issue accounts would have upset earlier BMJ editors “like mad,” Dr. Lock said. “But so what?” he added. “It was fun.” Now there is so much competition for a spot in the issue that some authors submit papers early in the year and request publication at Christmastime.

Some articles poke fun at hoary traditions, such as diagnosing ailments in historical figures despite the lack of medical evidence. Mozart is a special favorite of armchair diagnosticians, Dr. Lucien R. Karhausen wrote in 2010 after tabulating articles reporting 140 possible causes of death and 27 mental disorders in the composer. Many, he said, were based on shoddy medical interpretations, undocumented “eyewitness accounts” or the ignoring of criteria that separate normal and abnormal behavior.

“Some causes are plausible,” Dr. Karhausen wrote, “only a few — maybe one, or maybe none of them — can be true, so most if not all are false.”

In 2006, BMJ reported on the results of a questionnaire sent to 110 members of the Sword Swallowers’ Association International. Forty-six members responded; they reported having swallowed more than 2,000 swords in the three preceding months. Sore throats (“sword throats”) were common during the learning phase, and after frequent repeated performances. Swallowers rarely sought medical advice. Of six who perforated their pharynx or esophagus, three needed surgery. No deaths were reported.

Still other articles play on the vanity of doctors, many of whose names are attached to instruments and syndromes. An article in 2010 extended the list to food products developed by doctors, including Kellogg’s Corn Flakes, various cookies, and Penfolds and Lindeman’s, the Australian wines.

As for the animals featured in this year’s holiday issue: The story of the infection-sniffing beagle began with a report from a nurse in the Netherlands, who mentioned that a patient’s stool had the distinctive odor of C. difficile — a bacterium that is causing serious and growing public-health problems in many countries, including the United States.

A team led by Dr. Marije K. Bomers at the VU University Medical Center in Amsterdam reasoned that it might be possible to train dogs to detect the infection, and Cliff the beagle did just that.

Cliff was trained to sit or lie down when he smelled C. difficile in the air walking by a patient’s bedside, and he also quickly and accurately identified all 50 stool samples with C. difficile and 25 of 30 infected patients — along with 50 stool samples free of the bacteria and 265 of 270 uninfected patients.

And the Dutch team that studied reindeer, working with researchers at the University of Tromso in the Norwegian Arctic, used a hand-held video microscope to observe the deer’s nasal capillaries as they ran on a treadmill.

The capillaries are arranged in circular clusters at different locations through the nose. Those in reindeer noses are 25 percent thicker than those observed in the human nose and are believed to perform critical roles like heating, delivering oxygen and humidifying inhaled air to keep the animal’s nose from freezing. (The leader of the team, Can Ince, a physiologist at Erasmus University Medical Center in Rotterdam, says he has a financial interest in the company that manufactures the technology, which is used to monitor reactions to various drugs and therapies among critically ill human patients.)

By showing that a large number of red blood cells flowed through the small nasal vessels, the scientists said they had unlocked the mystery of Rudolph’s red nose. May it long glow.

The Doctor’s World: BMJ’s Holiday Tradition of Lighthearted, but Rigorous, Scholarship

Label: Lifestyle

LONDON — Dutch and Norwegian scientists say they have solved a glowing mystery: why Rudolph the reindeer’s nose is red.

“Some causes are plausible,” Dr. Karhausen wrote, “only a few — maybe one, or maybe none of them — can be true, so most if not all are false.”

A team led by Dr. Marije K. Bomers at the VU University Medical Center in Amsterdam reasoned that it might be possible to train dogs to detect the infection, and Cliff the beagle did just that.

By showing that a large number of red blood cells flowed through the small nasal vessels, the scientists said they had unlocked the mystery of Rudolph’s red nose. May it long glow.

DealBook: Sprint Nextel Reaches a Deal to Buy Rest of Clearwire

Label: Technology

7:07 p.m. | Updated

Sprint Nextel agreed Monday to buy all of the wireless network operator Clearwire, an important step for the cellphone service provider as it continues its big turnaround campaign.

Under the terms of the bid, Sprint will pay $2.97 a share for the nearly 50 percent stake in Clearwire that it did not already own for a total of about $2.2 billion.

The two companies must still convince restive Clearwire shareholders that they should accept a bid only modestly raised from last week and that some have called too low.

The price is a bump up from the $2.90 a share that it offered last Thursday, and represents a premium of 128 percent over Clearwire’s stock price in early October, before speculation emerged that Sprint would seek to buy the wireless network operator. Sprint’s first proposal to Clearwire, made around Nov. 21, was worth about $2.60 a share.

Clearwire’s board approved the offer based on the recommendation of a special committee of directors not appointed by Sprint. Clearwire also has commitments for the deal from Comcast, Intel and Bright House Networks, which collectively own 13 percent of the voting shares.

Shares of Clearwire closed on Monday at $2.91, having fallen more than 13 percent as investors gave up on the prospects of a significantly higher offer.

Sprint is able to make the offer as a result of a cash injection from SoftBank of Japan, which agreed in October to a $20.1 billion transaction to gain majority control of the American telecommunications company. Sprint still lags far behind the market leaders, Verizon Wireless and AT&T.

The Clearwire deal would allow Sprint to expand its Long-Term Evolution network, which is based upon the same data standard used by the newest generation of smartphones. Clearwire owns spectrum that is similar to what SoftBank uses in Japan, potentially giving the newly strengthened Sprint more clout in ordering the latest devices.

Sprint initially invested in Clearwire in 2008 as part of an unusual consortium that also included Google, Intel and Time Warner Cable, with the aim of creating a next-generation data network. The telecom had long been the biggest investor, with significant leverage over Clearwire, but did not have full control.

“It feels good,” Daniel R. Hesse, Sprint’s chief executive, said in a telephone interview. “It’s been a four-year journey for me, and a long journey for Clearwire’s management and its board.”

Some of Clearwire’s minority shareholders have said that the company should hold out for a higher price, with one analyst calling for at least $5 a share.

One of these investors, Crest Financial, said that it would try to block Sprint’s deal with SoftBank if the earlier offer of $2.90 a share had gone through.

Erik E. Prusch, Clearwire’s chief executive, said his company had explored a wide range of alternatives to a sale. But those options — including a sale of excess spectrum, a deal with another strategic partner or raising additional capital — would have fetched far less money.

And he noted that Clearwire had retained the Blackstone Group as an adviser on reorganization options, which people briefed on the matter have said included a potential bankruptcy filing. The company said that as of Sept. 30, it had enough cash to last for about a year, though it had slowed important network improvements.

As part of the deal announced Monday, Sprint will provide the company with up to $800 million in interim financing.

“At this point, we believe that a restructuring is quite possible, should our transaction with Sprint not close,” Mr. Prusch said on a conference call with analysts.

In an interview, he noted that Google had sold its holdings in Clearwire this year at $2.26 a share. Time Warner Cable sold its shares for $1.37 apiece.

Citigroup and the law firms of Skadden, Arps, Slate, Meagher & Flom and King & Spalding advised Sprint. The Raine Group acted as financial adviser to SoftBank and Morrison Foerster acted as counsel to SoftBank.

Evercore Partners and the law firm Kirkland & Ellis advised Clearwire. Centerview Partners acted as financial adviser and Simpson Thacher & Bartlett and Richards, Layton & Finger acted as counsel to Clearwire’s special committee. Blackstone Advisory Partners advised Clearwire on restructuring matters. Credit Suisse acted as financial adviser and Gibson Dunn & Crutcher acted as counsel to Intel.

A version of this article appeared in print on 12/18/2012, on page B2 of the NewYork edition with the headline: Sprint Nextel Reaches a Deal to Buy Rest of Clearwire.

Attackers in Pakistan Kill Anti-Polio Workers

Label: World

ISLAMABAD, Pakistan — Five Pakistani women and a man were killed on Tuesday in separate attacks on health workers participating in a national drive to eradicate polio from Pakistan.

Athar Hussain/Reuters

Family members mourned the death of Nasima Bibi, a female worker with an anti-polio drive campaign in Pakistan, who was shot by gunmen on Tuesday.

Akhtar Soomro/Reuters

The bodies of two female workers with an anti-polio drive lay in the morgue at Jinnah Hospital in Karachi on Tuesday.

The attacks forced health officials to temporarily suspend a large polio vaccination drive in Karachi, the country’s most populous city, where the disease has been making a worrisome comeback in recent years.

Saghir Ahmed, the health minister for southern Sindh Province, said he had ordered the 24,000 aid workers taking part in the campaign in Karachi to immediately stop work. It was not clear when they would resume.

The shooting represented a brutal setback to polio immunization efforts in Pakistan, one of just three countries in the world where the disease remains endemic. Pakistan accounted for 198 new cases last year — the highest rate in the world, followed by Afghanistan and Nigeria.

There was no immediate claim of responsibility, but Taliban insurgents have repeatedly vowed to target anti-polio workers, accusing them of being spies.

In the tribal areas along the Afghan border, Taliban leaders have issued religious edicts declaring that the United States runs a spy network under the guise of vaccination programs.

That perception was strengthened after the American commando raid that killed Osama bin Laden in June 2011, when it emerged that the Central Intelligence Agency had paid a Pakistani doctor to run a vaccination program in Abbottabad, where Bin Laden was hiding, in a bid to obtain DNA evidence from his family.

Pakistani authorities arrested the doctor, Shakil Afridi, shortly after the American raid, and he has been sentenced to 33 years in prison.

Despite the negative perceptions, the government has pressed ahead with a large polio vaccination campaign, usually conducted in three-day spurts involving tens of thousands of health workers who administer medicine to children under 5.

The shootings on Tuesday came on the second day of the latest drive, which has now been called off in Karachi. After an attack on a United Nations doctor from Ghana in Karachi last July, officials were braced for some sort of militant resistance. But the extent and scale of the attacks Tuesday caught the government by surprise.

In the attacks in Karachi, three teams of health volunteers were targeted in poor neighborhoods: Landhi, Orangi and Baldia Town.

Two female aid workers were killed in an attack in Landhi, according to local news reports. In Orangi, unknown gunmen opened fire on a health team, killing one woman and a male volunteer. Another female worker was killed in nearby Baldia Town.

The Karachi neighborhoods where aid workers were targeted Tuesday are being used as safe havens by militants, who have escaped American drone strikes in North and South Waziristan tribal regions, according to police officials. Security forces regularly conduct search operations in these neighborhoods.

In the northwestern city of Peshawar, gunmen riding a motorcycle opened fire on two sisters who had volunteered to help administer polio drops, killing one.

The attacks on polio workers followed a bold Taliban assault on a major Pakistan Air Force base in Peshawar over the weekend that killed at least 15 people and a militant bomb attack in a nearby tribal village on Monday that killed another 19.

For Pakistan’s beleaguered progressives, the attack on female health workers was another sign of how the country’s extremist fringe would stoop to attack the vulnerable and minorities.

“Ahmadis, Shias, Hazaras, Christians, child activists, doctors, anti-polio workers — who’s next on the target list, Pakistan?” asked Mira Hashmi, a lecturer in film studies at the Lahore School of Economics, in a post on Twitter.

Zia ur-Rehman contributed reporting from Karachi

In Spain, Having a Job No Longer Guarantees a Paycheck

Label: Business

Working but Waiting:
The Times’s Suzanne Daley reports on struggling Spanish workers who have avoided losing their jobs but often face weeks or months without paychecks.

VALENCIA, Spain — Over the past two years, Ana María Molina Cuevas, 36, has worked five shifts a week in a ceramics factory on the outskirts of this city, hand-rolling paint onto tiles. But at the end of the month, she often went unpaid.

Still, she kept showing up, trying to keep her frustration under control. If she quit, she reasoned, she might never get her money. And besides, where was she going to find another job? Last month, she was down to about $130 in her bank account with a mortgage payment due.

“On the days you get paid,” she said at home with her disabled husband and young daughter, “it is like the sun has risen three times. It is a day of joy.”

Mrs. Molina, who is owed about $13,000 by the factory, is hardly alone. Being paid for the work you do is no longer something that can be counted on in Spain, as this country struggles through its fourth year of an economic crisis.

With the regional and municipal governments deeply in debt, even workers like bus drivers and health care attendants, dependent on government financing for their salaries, are not always paid.

But few workers in this situation believe they have any choice but to stick it out, and none wanted to name their employers, to protect both the companies and their jobs. They try to manage their lives with occasional checks and partial payments on random dates — never sure whether they will get what they are owed in the end. Spain’s unemployment rate is the highest in the euro zone at more than 25 percent, and despite the government’s labor reforms, the rate has continued to rise month after month.

“Before the crisis, a worker might let one month go by, and then move on to another job,” said José Francisco Perez, a lawyer who represents unpaid workers in the Valencia area. “Now that just isn’t an option. People now have nowhere to go, and they are scared. They are afraid even to complain.”

No one is keeping track of workers like Mrs. Molina. But one indication of their number can be seen in the courts, which have become jammed with people trying to get back pay from a government insurance fund, aimed at giving workers something when a company does not pay them.

In Valencia, Spain’s third-largest city, the unemployment rate is 28.1 percent and the courts are so overwhelmed that processing claims, which used to take three to six months, now takes three to four years.

Since the start of the crisis in 2008, the insurance fund has paid nearly a million workers nationally back pay or severance. In 2007, it paid 70,000 workers. It is on track to pay more than 250,000 this year, and experts say the figures would be much higher if not for the logjam in the courts.

Often the unpaid workers, like Mrs. Molina, whose company is now in bankruptcy proceedings, hope their labor will keep a struggling operation afloat over the long run. Unemployment benefits last only two years, they point out, and they wonder what they would do after that. But in the meantime, they cannot even claim unemployment benefits. And no amount of budgeting can cover no payment at all.

Beatriz Morales García, 31, said she could not remember the last time she went shopping for herself. A few years ago, she and her husband, Daniel Chiva, 34, thought that they had settled into a comfortable life, he as a bus driver and she as a therapist in a rehabilitation center for people with mental disabilities. His job is financed by the City of Valencia, and hers by the regional government of Valencia.

They never expected any big money. But it seemed reasonable to expect a reliable salary, to take on a mortgage and think about children. In the past year, however, both of them have had trouble being paid. She is owed 6,000 euros, nearly $8,000. They have cut back on everything they can think of. They have given up their landline and their Internet connection. They no long park their car in a garage or pay for extra health insurance coverage. Mr. Chiva even forgoes the coffee he used to drink in a cafe before his night shifts. Still, the anxiety is constant.

“There are nights when we cannot sleep,” he said. “Moments when you talk out loud to yourself in the street. It has been terrible, terrible.”

Mrs. Morales said it was particularly hard to watch other mothers in the park with their children while she must leave her own toddler to go to work, unsure she will ever get paid.

“We are working eight hours, and we’re suffering more than people who are not working,” she said.

The couple’s pay has been so irregular that they are having a hard time even keeping track of how much they are owed, because small payments show up sporadically in their account.

Rachel Chaundler contributed reporting.

The New Old Age Blog: In the Middle: Why Elderly Couples Fight

Label: Health

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.