MorganRants

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Turner Syndrome

Turner syndrome is a genetic disorder that affects a girl’s development. The cause is a missing or incomplete X chromosome. Girls who have it are short, and their ovaries don’t work properly. Most are infertile. They are at risk for health difficulties such as high blood pressure, kidney problems, diabetes, cataracts, osteoporosis and thyroid problems.

Other physical features typical of Turner syndrome are

• Short, “webbed” neck with folds of skin from tops of shoulders to sides of neck
• Low hairline in the back
• Low-set ears
• Swollen hands and feet

There is no cure for Turner syndrome, but there are some treatments for the symptoms. Growth hormone often helps girls reach heights that are close to average. Hormone replacement can stimulate sexual development. Assisted reproduction techniques can help some women with Turner syndrome get pregnant.

What is Turner syndrome?

Turner syndrome is a chromosomal condition that alters development in females. Women with this condition tend to be shorter than average and are usually unable to conceive a child (infertile) because of an absence of ovarian function. Other features of this condition that can vary among women who have Turner syndrome include: extra skin on the neck (webbed neck), puffiness or swelling (lymphedema) of the hands and feet, skeletal abnormalities, heart defects and kidney problems.

This condition occurs in about 1 in 2,500 female births worldwide, but is much more common among pregnancies that do not survive to term (miscarriages and stillbirths).

Turner syndrome is a chromosomal condition related to the X chromosome.

Researchers have not yet determined which genes on the X chromosome are responsible for most signs and symptoms of Turner syndrome. They have, however, identified one gene called SHOX that is important for bone development and growth. Missing one copy of this gene likely causes short stature and skeletal abnormalities in women with Turner syndrome.

What are the symptoms of Turner syndrome?

Girls who have Turner syndrome are shorter than average. They often have normal height for the first three years of life, but then have a slow growth rate. At puberty they do not have the usual growth spurt.

Non-functioning ovaries are another symptom of Turner syndrome. Normally a girl’s ovaries begin to produce sex hormones (estrogen and progesterone) at puberty. This does not happen in most girls who have Turner syndrome. They do not start their periods or develop breasts without hormone treatment at the age of puberty.

Even though many women who have Turner have non-functioning ovaries and are infertile, their vagina and womb are totally normal.

In early childhood, girls who have Turner syndrome may have frequent middle ear infections. Recurrent infections can lead to hearing loss in some cases.

Girls with Turner Syndrome are usually of normal intelligence with good verbal skills and reading skills. Some girls, however, have problems with math, memory skills and fine-finger movements.

Additional symptoms of Turner syndrome include the following:

• An especially wide neck (webbed neck) and a low or indistinct hairline.
• A broad chest and widely spaced nipples.
• Arms that turn out slightly at the elbow.
• A heart murmur, sometimes associated with narrowing of the aorta (blood vessel exiting the heart).
• A tendency to develop high blood pressure (so this should be checked regularly).
• Minor eye problems that are corrected by glasses.
• Scoliosis (deformity of the spine) occurs in 10 percent of adolescent girls who have Turner syndrome.
• The thyroid gland becomes under-active in about 10 percent of women who have Turner syndrome. Regular blood tests are necessary to detect it early and if necessary treat with thyroid replacement
• Older or over-weight women with Turner syndrome are slightly more at risk of developing diabetes.
• Osteoporosis can develop because of a lack of estrogen, but this can largely be prevented by taking hormone replacement therapy.

How is Turner syndrome diagnosed?

A diagnosis of Turner syndrome may be suspected when there are a number of typical physical features observed such as webbed neck, a broad chest and widely spaced nipples. Sometimes diagnosis is made at birth because of heart problems, an unusually wide neck or swelling of the hands and feet.

The two main clinical features of Turner syndrome are short stature and the lack of the development of the ovaries.

Many girls are diagnosed in early childhood when a slow growth rate and other features are identified. Diagnosis sometimes takes place later when puberty does not occur.

Turner syndrome may be suspected in pregnancy during an ultrasound test. This can be confirmed by prenatal testing - chorionic villous sampling or amniocentesis - to obtain cells from the unborn baby for chromosomal analysis. If a diagnosis is confirmed prenatally, the baby may be under the care of a specialist pediatrician immediately after birth.

Diagnosis is confirmed by a blood test, called a karyotype. This is used to analyze the chromosomal composition of the female. More information about this will be discussed in the section “Is Turner syndrome inherited?”

What is the treatment for Turner syndrome?

During childhood and adolescence, girls may be under the care of a pediatric endocrinologist, who is a specialist in childhood conditions of the hormones and metabolism.

Growth hormone injections are beneficial in some individuals with Turner syndrome. Injections often begin in early childhood and may increase final adult height by a few inches.

Estrogen replacement therapy is usually started at the time of normal puberty, around 12 years to start breast development. Estrogen and progesterone are given a little later to begin a monthly ‘period,’ which is necessary to keep the womb healthy. Estrogen is also given to prevent osteoporosis.

Babies born with a heart murmur or narrowing of the aorta may need surgery to correct the problem. A heart expert (cardiologist) will assess and follow up any treatment necessary.

Girls who have Turner syndrome are more likely to get middle ear infections. Repeated infections may lead to hearing loss and should be evaluated by the pediatrician. An ear, nose and throat specialist (ENT) may be involved in caring for this health issue.

High blood pressure is quite common in women who have Turner syndrome. In some cases, the elevated blood pressure is due to narrowing of the aorta or a kidney abnormality. However, most of the time, no specific cause for the elevation is identified. Blood pressure should be checked routinely and, if necessary, treated with medication. Women who have Turner syndrome have a slightly higher risk of having an under active thyroid or developing diabetes. This should also be monitored during routine health maintenance visits and treated if necessary.

Regular health checks are very important. Special clinics for the care of girls and women who have Turner syndrome are available in some areas, with access to a variety of specialists. Early preventive care and treatment is very important.

Almost all women are infertile, but pregnancy with donor embryos may be possible.

Having appropriate medical treatment and support allows a woman with Turner syndrome to lead a normal, healthy and happy life.

Is Turner syndrome inherited?

Turner syndrome is not usually inherited in families. Turner syndrome occurs when one of the two X chromosomes normally found in women is missing or incomplete. Although the exact cause of Turner syndrome is not known, it appears to occur as a result of a random error during the formation of either the eggs or sperm.

Humans have 46 chromosomes, which contain all of a person’s genes and DNA. Two of these chromosomes, the sex chromosomes, determine a person’s gender. Both of the sex chromosomes in females are called X chromosomes. (This is written as XX.) Males have an X and a Y chromosome (written as XY). The two sex chromosomes help a person develop fertility and the sexual characteristics of their gender.

In Turner syndrome, the girl does not have the usual pair of two complete X chromosomes. The most common scenario is that the girl has only one X chromosome in her cells. Some girls with Turner syndrome do have two X chromosomes, but one of the X chromosomes is incomplete. In another scenario, the girl has some cells in her body with two X chromosomes, but other cells have only one. This is called mosaicism.

NHGRI Clinical Research on Turner Syndrome

NHGRI is not currently conducting clinical research on Turner syndrome.

• ClinicalTrials.gov provides information on clinical research studies. Currently, there are several clinical trials at other institutes and organizations who are enrolling individuals with Turner syndrome. They include:
  • Defining the Optimal Hormonal Replacement Therapy in Turner Syndrome [clinicaltrials.gov]
  • Turner Syndrome: Genotype and Phenotype [clinicaltrials.gov]
  • Long-Term Growth and Skeletal Effects of Early Growth Hormone Treatment in Turner Syndrome [clinicaltrials.gov]
  • A Study to Evaluate Subjects With Turner Syndrome Treated With Growth Hormone [clinicaltrials.gov]
  • Study to Identify Markers of Insulin Resistance During Growth Hormone Treatment for Short Stature [clinicaltrials.gov]
  • Bone Mineral Density (BMD) in Adolescents With Growth Hormone Deficiency (GHD) [clinicaltrials.gov]
  • Study to Define Optimal IGF-1 Monitoring in Children Treated With NutropinAq [clinicaltrials.gov]
• Current NHGRI Clinical Studies
• Search ClinicalTrials.gov [clinicaltrials.gov]
• Clinical Research FAQ

Additional Resources for Turner Syndrome

• Turner Syndrome [nichd.nih.gov]
  From Genetics Home Reference
• Turner’s Syndrome [aaa.dk]
  From the Turner Syndrome Center
• Turner Syndrome [ghr.nlm.nih.gov]
  From Genetics Home Reference
• Turner Syndrome [turners.nichd.nih.gov]
  From the National Institute of Child Health and Development.
• Turner’s Syndrome [nlm.nih.gov]
  From Medline Plus
• Turner Syndrome [nlm.nih.gov]
  More from Medline Plus
• Turner Syndrome Society of the United States [turner-syndrome-us.org]
  Encourages medical research, the dissemination of state-of-the-art TS information, and social support services to individuals, families, physicians and the general public.
• The Magic Foundation: Turner Syndrome [magicfoundation.org]
  A national non-profit organization created to provide support services for the families of children afflicted with a wide variety of disorders, syndromes or diseases that affect a child’s growth.
• Turner Syndrome [rarediseases.org]
  From the National Organization for Rare Disorders
• Health Supervision for Children With Turner Syndrome [pediatrics.aappublications.org]
  An article from Pediatrics, the official journal of the American Academy of Pediatrics
• Turner Syndrome [emedicine.com]
  From eMedicine
• Finding Reliable Health Information Online
  A listing of information and links for finding comprehensive genetics health information online.

For more information follow this link - Medscape. If you’re unable to access this page – please advise and I will post information and links for those that are interested.

MorganLighter

(NYT) - For the Olympic torch relay, every day just seems to bring bad news. What began last Tuesday in Beijing as a “Journey of Harmony” had by Sunday become a “public relations nightmare” in London, and worse on Monday in Paris, when the torch was extinguished several times. On Tuesday, international Olympics officials mulled the prospect of canceling the rest of the relay.

Jacques Rogge, chief of the International Olympic Committee, later dismissed the possibility, clearing one negative piece of torch news from the register. But others soon filled the void, as the torch landed in its next city of protesters, San Francisco.

In the past 24 hours, two major news agencies decided to add a historic touch toward the bottom of their torch-relay articles, the kind that is easy to ignore in happier Olympic times. Here’s The Associated Press version:

The Olympic flame wasn’t part of the ancient games, and the torch relay didn’t become a fixture in the modern Olympics until the 1936 Berlin Games, when it was part of the Nazi pageantry that promoted Hitler’s beliefs of Aryan supremacy in the world of sports.

And from Reuters:

The Olympics first held a torch relay in 1936, the year dictator Adolf Hitler made the Berlin games a showcase of Nazi propaganda. That torch run is captured in one of the most famous — and infamous — Olympic movies ever made, Leni Riefenstahl’s “Olympia.”

Upsetting? Maybe. New? No way. Secret? It’s right there on the Beijing Olympics official web site.

This history lesson also innocently includes a list of problems that beset the first torch relay in 1936. Those were the days:

— the site of Olympia [in Greece, where the torch is first lit] was hard to access and roads had to be specially built;
— planning of the itinerary required a lot of traveling for that period in time;
— the absence of suitable products (torch, cauldron, etc.) meant that research into specialist technology had to be undertaken, such as tests with the sun’s rays and different optical instruments [for lighting the torch].

Cauldrons and parabolic mirrors aside, another question remains: Should the torch’s Nazi-linked past affect its future? Absolutely, says Mary Beard, a columnist for The Times of London (via Clive Davis):

I don’t quite understand how we have forgotten that the “Olympic Torch” ceremony was invented by Hitler and his chums.

If ever there was an “invented tradition” well worth stamping out, it is this ridiculous, Fascist-inspired waste of money.

She was writing on Friday, days before the relay plunged into chaos for completely different reasons.

A crackdown on the misuse of government credit cards is underway.

Oh whoopee for that ! It’s our tax dollars that are being misused!

(WP) - The Office of Management and Budget said yesterday that it would welcome Congress’s help in disciplining federal employees who misuse their cards, pointing to a Senate bill that would authorize agencies to fire employees for egregious abuse of government credit cards. Employees suspected of fraud would have their cases referred to federal prosecutors.

“The vast majority of civilian employees, government employees, use the cards responsibly. At the same time, I would say there is abuse, and the goal is zero, and we need to make it zero,” said Clay Johnson III, deputy director for federal management issues at the OMB.

An investigative report released by senators Tuesday showed that government employees used their credit cards in 2005 and 2006 to buy cameras, laptop computers, iPods, high-end suits, lingerie, and steak and booze dinners.

The inquiry by the Government Accountability Office was not the first to discover abuse in federal credit card and travel programs. Previous reports by the GAO and inspectors general have documented federal employees using their government cards to buy baseball tickets, jewelry, cellphones, escort services and, in one instance, breast enhancement surgery for a girlfriend.

“Here We Go Again,” was the headline yesterday on a news release from the Project on Government Oversight, a nonprofit group that investigates corruption in government. It noted that the group uncovered similar problems in 2002.

The GAO findings, reported by Washington Post staff writer Dan Eggen yesterday, sparked a flurry of comments on Federal Diary Live at washingtonpost.com. “As a current fed I just wanted to say that this misuse of government credit cards is exactly the sort of thing that gives working for the federal government a bad reputation,” one person wrote.

Johnson and Danny Werfel, the OMB’s deputy controller, said yesterday that the president’s budget director, Jim Nussle, will issue a memo reminding agencies of rules prohibiting the abuse and fraudulent use of government credit cards by federal employees.

The OMB issued a memo in 2005 directing agencies to tighten internal accounting controls to monitor credit-card use by their employees. Werfel said the OMB is working with Sen. Charles E. Grassley (R-Iowa) on legislation that would put “the force of law” behind the 2005 requirements. Congress can also institute penalties that are tougher than what the OMB can impose on employees, Werfel said.

In general, the “purchase card” programs were set up to permit employees to buy as much as $2,500 worth of goods and services that are necessary and reasonable for the operation of their agencies. The government contracts with five banks for credit cards in exchange for favorable interest rates and rebates. In fiscal 2007, the banks provided the government with more than $170 million in refunds, the GAO said.

There are several types of government credit cards, but the GAO report focused on “purchase cards.” Bills for charges on these cards are sent to the agencies for payment, although the cards are assigned to employees and carry their names, the OMB said.

In theory, having an employee’s name on a card permits an agency to track the account and spot improper purchases. Although the agencies pay the credit-card bills, the employees are required to reimburse the agencies for any improper purchase.

But the GAO report suggested that government-wide policies on how agencies should monitor credit-card use need to be improved. It cited numerous instances in which employees and their bosses were not held accountable for questionable purchases.

The GAO estimated that 41 percent of purchase-card transactions were not properly authorized, for example. Agencies also could not account for about $1.8 million worth of goods identified in the audit, such as cameras and computers, that employees may have diverted to personal use.

As an example of the weak controls at some agencies, the GAO cited a Navy employee who purchased more than $900 of general office supplies on a government credit card. As part of the purchase, the employee bought a digital camera for $400 and an iPod for $200.

The employee, the official who ordered the office supplies and the official who approved the purchase “had no recollection of requesting or receiving” the iPod, the GAO said.

Asked to determine whether the camera and the iPod had been converted to personal use or stolen, the Navy told the GAO that the items “were not reported on a property tracking system and therefore could not be located.”

WASHINGTON (Reuters) - Middle-aged men who ate seven or more eggs a week had a higher risk of earlier death, U.S. researchers reported on Wednesday.

Men with diabetes who ate any eggs at all raised their risk of death during a 20-year period studied, according to the study published in the American Journal of Clinical Nutrition.

The study adds to an ever-growing body of evidence, much of it contradictory, about how safe eggs are to eat. It did not examine what about the eggs might affect the risk of death.

Men without diabetes could eat up to six eggs a week with no extra risk of death, Dr. Luc Djousse and Dr. J. Michael Gaziano of Brigham and Women’s Hospital and Harvard Medical School found.

“Whereas egg consumption of up to six eggs a week was not associated with the risk of all-cause mortality, consumption of (seven or more) eggs a week was associated with a 23 percent greater risk of death,” they wrote.

“However, among male physicians with diabetes, any egg consumption is associated with a greater risk of all-cause mortality, and there was suggestive evidence for a greater risk of MI (heart attack) and stroke.”

They urged more study in the general population.

Eggs are rich in cholesterol, which in high amounts can clog arteries and raise the risk of heart attack and stroke.

One expert on nutrition and heart disease said the study suggests middle-aged men, at least, should watch how many eggs they eat.

“More egg on our faces? It’s really hard to say at this point, but it still seems, if you’re a middle-aged male physician and enjoy eggs more than once a day, that having some of the egg left on your face may be better than having it go down your gullet,” said Dr. Robert Eckel of the University of Colorado and a former president of the American Heart Association.

“But, remember: eggs are like all other foods—they are neither ‘good’ nor ‘bad,’ and they can be part of an overall heart-healthy diet,” Eckel wrote in a commentary.

The Harvard team studied 21,327 men taking part in the much larger Physicians’ Health Study, which has been watching doctors since 1981 who have agreed to report regularly on their health and lifestyle habits.

Over 20 years, 1,550 of the men had heart attacks, 1,342 had strokes, and more than 5,000 died.

“Egg consumption was not associated with (heart attack) or stroke,” the researchers wrote.

But the men who ate seven eggs a week or more were 23 percent more likely to have died during the 20-year period.

Diabetic men who ate any eggs at all were twice as likely to die in the 20 years.

Men who ate the most eggs also were older, fatter, ate more vegetables but less breakfast cereal, and were more likely to drink alcohol, smoke and less likely to exercise—all factors that can affect the risk of heart attack and death.

I don’t buy their story. They cite no empirical data. And who eats just eggs for breakfast? Isn’t it ham and eggs or bacon and eggs or sausage and eggs?

Could it be that ham, bacon and sausage are genetically modified as well as the eggs we’re eating? Did these quacks take that into consideration?

(AFP)- Twenty percent of scientists admit to using performance-enhancing prescription drugs for non-medical reasons, according to a survey released Wednesday by Nature, Britain’s top science journal.

The overwhelming majority of these med-taking brainiacs said they indulged in order to “improve concentration,” and 60 percent said they did so on a daily or weekly basis.

The 1,427 respondents — most of them in the United States — completed an informal, online survey posted on the “Nature Network” Web forum, a discussion site for scientists operated by the Nature Publishing Group.

More than a third said that they would feel pressure to give their children such drugs if they knew other kids at school were also taking them.

“These are academics working in scientific institutions,” Ruth Francis, who handles press relations for the group, told AFP.

The survey focused on three drugs widely available by prescription or via the Internet.

Ritalin, a trade name for methylphenidate, is a stimulant normally used to treat attention-deficit hyperactivity disorder, especially in children. Modafinil — marketed at Provigil — is prescribed to treat sleep disorders, but is also effective against general fatigue and jet lag.

Both medications are common currency on college campuses, used as “study aids” to sharpen performance and wakefulness.

“It doesn’t seem to be causing too much trouble since most [students] use the drugs not to get high but to function better,” Brian Doyle, a clinical pyschiatrist at Georgetown University Medical Centre, told a US newspaper last month. “When exams are over, they go back to normal and stop abusing the drugs.”

Other experts expressed more concern about what the survey revealed.

“It alerted us to the fact that scientists, like others, are looking for short cuts,” Wilson Compton, director of epidemiology and prevention research at the US National Institute for Drug Abuse (NIDA), told AFP.

Ritalin, he noted, can become addictive, even if it has proven safe and effective when taken as prescribed.

The third class of drugs included in the survey was beta blockers, prescribed for cardiac arrhythmia and popular among performers due to its anti-anxiety effect.

Of the 288 scientists who said that had taken one or more of these drugs outside of a medical context, three-fifths had used Ritalin, and nearly half Provigil. Only 15 percent were fans of beta blockers.

More than a third procured their meds via the Internet, with the rest buying them in pharmacy.

Other reasons cited for popping pills were focusing on a specific task, and counteracting jet lag.

Almost 70 percent of 1,258 respondents who answered the question said they would be willing to risk mild side effects in order to “boost your brain power” by taking cognitive-enhancing drugs.

Half of the drug-takers reported such effects, including headaches, jitteriness, anxiety and sleeplessness.

Wilson of the NIDA expressed surprise at the rate of substance abuse shown, but cautioned that the survey did not meet rigorous scientific standards.

“This is a volunteer poll of people responding to an Internet survey. There might be an over-representation,” he said.

But previous research has shown that, as the boundary between treating illness and enhancing wellbeing continues to blur, taking performance-boosting products continues to gain in cultural acceptance.

“Like the rise in cosmetic surgery, use of cognitive enhancers is likely to increase as bioethical and psychological concerns are overcome,” opined Nature in a commentary.

In the survey, 80 percent of all the scientists — even those who did not use these drugs — defended the right of “healthy humans” to take them as work boosters, and more than half said their use should not be restricted, even for university entrance exams.

More than 57 percent of the respondents were 35 years old or younger.

Perhaps this will spur the children of America to become scientists. How about you?

NEW YORK (Reuters) - Pfizer Inc and Nektar Therapeutics said on Wednesday clinical trials of the inhaled insulin Exubera found increased cases of lung cancer, leading Nektar to stop seeking a marketing partner for the troubled product and abandon it.

Nektar shares tumbled 25 percent, while shares of MannKind Corp, which has been developing its own inhaled insulin, plummeted 58 percent. Pfizer was down slightly at $20.90.

The lung-cancer revelation dealt a final setback to Exubera, which held the promise of letting diabetics avoid needle sticks and was once projected by Pfizer to be a $2 billion-a-year blockbuster. Instead, Exubera has been a commercial flop that has sullied the inhaled insulin field.

Over the course of the clinical trials, Pfizer said six of the 4,740 Exubera-treated patients versus one of the 4,292 patients not treated with Exubera developed lung cancer. One lung cancer case was also found after Exubera reached the market.

Pfizer said on Wednesday it updated the product’s labeling to include a warning with safety information about lung cancer cases found in patients who used Exubera, which U.S. regulators approved in January 2006.

The warning states all patients who developed lung cancer had a history of cigarette smoking, and that too few cases existed to determine whether the development of lung cancer is related to Exubera use.

HIGH HOPES

Despite high hopes for Exubera, it garnered few prescriptions. The medicine was dogged by concerns about lung safety and about the inconvenience of the bulky device used to administer the product.

Pfizer said in October it would stop marketing Exubera and returned rights to Nektar. Pfizer reported $12 million in Exubera sales through the first three quarters of 2007; in October it took a pretax charge of $2.8 billion related to exiting Exubera.

Since then, Exubera has not been actively marketed but existing patients were able to get prescriptions while transitioning to an alternative therapy.

The warning in the label stemmed from an ongoing review of data from the Exubera clinical trial program and post-marketing experience by Pfizer and the U.S. Food and Drug Administration, Pfizer said.

Pfizer said it will be discussing withdrawals of marketing authorizations for Exubera with regulatory agencies.

Nektar said it will cease all spending associated with its inhaled insulin programs, including a next-generation version in early clinical testing, and will not incur charges related to the event.

“The news of an increased number of lung cancer cases is disappointing given that as recent as the year-end quarterly conference call, management reiterated the high level of interest from potential partners,” Pacific Growth Equities analyst Patricia Bank said in a research note.

MOVED AWAY

Bank downgraded her rating on Nektar stock to “Neutral” from “Buy” on the news.

Nektar Chief Executive Howard Robin said in a statement the company has moved away from inhaled insulin the past year. Its experimental pipeline includes a treatment for pneumonia in the lung about to enter late-stage development, and mid-stage projects for colorectal cancer and opioid-induced constipation.

Since Pfizer’s exit last year, Eli Lilly <LLY.N> and Novo Nordisk <NOVOb.CO> also ended inhaled insulin development programs.

MannKind has been steadfast in its commitment to its experimental inhaled insulin, Technosphere Insulin, saying it held advantages over the other products.

But Natixis Bleichroeder analyst Jon LeCroy downgraded his rating on MannKind stock to “Sell” from “Hold” on the Exubera news.

“We view this as an absolute disaster for MannKind and do not see a believable scenario in which the FDA would approve another inhaled insulin,” LeCroy said in his downgrade note.

MannKind shares were off $3.39 at $2.46 in morning trading on the Nasdaq to a multiyear low. Nektar shares fell $1.79 to $5.40.

If this was a regular company, say, ummm, like Wal-Mart, how fast do you think they’d be out of business? Oh, that’s right, the left is trying to destroy Wal-Mart. Sorry, bad example.

(NYT) -ALBANY — In the latest rebuke to Mayor Michael R. Bloomberg’s agenda, state lawmakers have decided to bar student test scores from being considered when teacher tenure determinations are made.

Legislators said the move was the final detail negotiated as part of the budget, which they expect to complete on Wednesday. It was a setback to efforts by the mayor and former Gov. Eliot Spitzer to hold teachers accountable by using student performance data, and a boon for the teachers’ unions, which hold enormous influence over the political process in the capital.

The new language being prepared for the state law says that for the next two years student scores will not be considered in decisions on teachers’ tenure; in the meantime, a commission is to be created to study the issue.

The move was denounced Tuesday night by the Bloomberg administration.

“I am dismayed that the State Legislature would even consider tying the hands of principals and school districts as they decide who gets lifetime job security,” said Schools Chancellor Joel I. Klein. “This is unconscionable. Lawmakers should do all they can to ensure every student has a good teacher. I urge our lawmakers to vote no tomorrow. Our children deserve better.”

The development was another sign that the fledgling administration of Gov. David A. Paterson, a Democrat, could be a rocky one for the mayor. The new governor was unable to rally support for the mayor’s congestion pricing plan, which would have charged drivers to enter Manhattan below 60th Street. While Mr. Paterson supported the measure, he could not persuade Assembly Speaker Sheldon Silver or other Assembly Democrats to bring the measure to the floor, and it was pronounced dead without a vote on Monday.

The mayor and his staff members were seething when it became known on Tuesday that the teacher accountability measure in state law was being revised. Lawmakers and legislative aides said they expected to return to work Wednesday morning and vote on the final piece of the budget — education financing and taxes — and it was the tenure issue, they said, that held it up.

“That is the last piece,” Mr. Silver said. “And I think there’s, you know, some good compromise language we’re considering right now.” He added, “I think everybody will be comfortable with it.”

He did not discuss details of the compromise, but a draft of the relevant portion of the budget obtained by The New York Times changes language added to state law last year while Mr. Spitzer was governor.

That section said teachers would be evaluated for tenure based on, among other things, an “evaluation of the extent to which the teacher successfully utilized analysis of available student performance data.”

The newer language says that “the teacher shall not be granted or denied tenure based on student performance data.”

The matter is to be turned over to a study commission for further review.

“They’re just reviewing final language on the tenure bill, new language that the school boards have signed off on,” said John McArdle, a spokesman for the Senate majority leader, Joseph L. Bruno, the state’s top Republican. “I think it works. Once that’s resolved, they’ll print the bills.”

Pressure from unions weighed heavily in the process, and particularly with Senate Republicans.

“From very early on, the Assembly and the governor understood what was at issue here,” said Richard C. Iannuzzi, president of New York State United Teachers. “It may have taken us a little bit longer to get the Senate to understand, but I think they do.”

He added, “Student assessments are designed to assess students, not teachers.”

Though the bills were still being drafted, the last unresolved pieces of the state’s budget seemed in place by Tuesday night. Legislative officials said that agreements had been reached about increases to various state taxes and fees, one of the issues that had stymied budget negotiations over the last several weeks.

Overall, officials said, spending of all funds in the roughly $122 billion budget would increase by 4.9 percent, nearly twice the rate of inflation, assuming that the final budget materializes as expected Wednesday morning. While the increase would be less than what Mr. Spitzer originally proposed in January, many budget critics and the governor himself have said the budget is bloated.

The state’s $1.50 cigarette tax will go up $1.25 more, but many of the taxes and fees that were first proposed by Mr. Spitzer will not be included. The proposal to quadruple the state’s motor vehicle insurance fee to $20 has been dropped, as has the plan mockingly called the “crack tax,” which would have taxed drug dealers on drugs confiscated by the authorities, and a plan to eliminate the tax cap on fuel purchases.

In a victory for Senate Republicans, some of the tax increases will expire after three years, Mr. McArdle said. Mr. Paterson had fought to make the new tax and fee increases permanent because he said the state’s debt rating with credit agencies would suffer if they were only temporary.

The likelihood that coming financial estimates from the state comptroller will show a further deterioration of the state’s financial picture put more pressure on the Legislature to avoid last-minute spending increases.

On April 15, the comptroller, Thomas P. DiNapoli, is to update state revenue collections through the end of March, and most experts predict a drop from previous revenue estimates.

Moreover, in the next day or two, the comptroller will also issue a separate report detailing actual revenues and spending over the last fiscal year, a measure of how closely the state followed its own financial plan. If actual spending was lower than planned, as has been the case previously, that would in effect magnify proposed spending increases for the coming fiscal year, putting further pressure on budget negotiators to avoid last-minute spending increases.

“I do think that the revenue picture is deteriorating, and it’s going to be very important to keep an eye on those revenue updates,” said Elizabeth Lynam, the deputy research director for the Citizens Budget Commission, a nonprofit group that favors fiscal discipline.

At last, someone who has an idea for fixing the hole where the rain washes in. If you ain’t teaching the kids then you don’t deserve the pay. If you can’t teach the kids then get into another profession. If you hide behind all your bullshit – then God will get you! There’s no excuses that will satisfy. Beside being an elected official or a government employee, name me another ‘career’ where you are not paid on the merit system. Shut your pie hole and quit whining.

(NYT) - State Assemblywoman Diane M. Gordon of Brooklyn was convicted on Tuesday of receiving a bribe for offering to help a developer acquire a parcel of city-owned land in her district if he would build her a free house in a gated community in Queens.

The conviction means that Ms. Gordon, 58, a four-term Democrat from East New York, immediately loses her Assembly seat, which will remain vacant until the general election in November.

She was acquitted of the top count against her, bribe-receiving in the second degree, but was convicted of bribe-receiving in the third degree and three other corruption felonies. She faces up to 10 years in prison at her sentencing next month.

The gated community, in Lindenwood, Queens, just over the Brooklyn border, was never built, though Ms. Gordon did have a pair of doors worth $600 installed in her office. And the developer, Ranjan Batheja, never acquired the city-owned parcel.

Prosecutors said that for much of 2004 and 2005, though, she lobbied to help Mr. Batheja in his bid to build affordable housing on the parcel, while they moved forward with plans for the home she called her dream. She told him she wanted an “impressive” detached house with ample living space and walk-in closets.

Ms. Gordon’s comments were captured on tape by Mr. Batheja, who had been caught trying to bribe an undercover investigator. Hoping to win lenient treatment from prosecutors, he had agreed to wear a wire while meeting with her.

Ms. Gordon’s lawyers had argued that she was the victim of entrapment by prosecutors and said there was no quid pro quo because at one point Ms. Gordon told Mr. Batheja that she would help him with the redevelopment project regardless of what happened with her house.

But on tapes played at the trial, Ms. Gordon tells Mr. Batheja, “One hand washes another,” and while showing him the vacant land, on New Lots Avenue near her office, she says to his hidden camera, “We got to do something with this land so I can get, get me a home now.” If it had been built, the house would have been worth about half a million dollars, Mr. Batheja testified.

In a statement released after the verdict, Rose Gill Hearn, the commissioner of the city’s Department of Investigation, said, “That Gordon, a state legislator, seized on a city program to build affordable housing on city-owned land in her district as her opportunity to sell her office and to obtain her own luxury housing elsewhere adds a layer of outrageousness to her misconduct.”

Assembly Speaker Sheldon Silver said of the conviction, “This is an unfortunate situation, and my heart goes out to Ms. Gordon’s family. However, this has been proved to be a breach of the public trust.”

Ms. Gordon is the third state lawmaker from Brooklyn to be convicted of corruption in recent years. Former Assemblyman Clarence Norman Jr., once the chairman of the Brooklyn Democratic Party, is serving three to nine years in prison for extortion and campaign-finance violations. And former Assemblyman Roger L. Green pleaded guilty in 2004 to falsely billing the state for travel expenses.

Ms. Gordon, a former schoolteacher with a business degree, declined to comment on the verdict or on her plans as she left court on $35,000 bail. One of her lawyers, Bernard Udell, said he was disappointed at the verdict, but added, “We’re going to do our best to see that the sentence is one of probation or less.”

The lead prosecutor, Michel Spanakos, noted that Ms. Gordon was convicted of eight out of nine charges, and said he hoped she would get prison time.

The top charges that Ms. Gordon was convicted of were third-degree bribe-receiving — soliciting or agreeing to accept a benefit in return for taking action as a public servant — and a similar charge covering state legislators.

She was also convicted of official misconduct for trying to obtain the house. The jurors, who deliberated for three days, would not comment on why they convicted Ms. Gordon on charges pertaining to the house but acquitted her of second-degree bribe-receiving, which covers gifts worth $10,000 or more.

Ms. Gordon was elected in 2000 to represent the 40th Assembly district, where she grew up. It includes parts of East New York, Brownsville and Canarsie, three working-class communities in eastern Brooklyn.

Mr. Batheja, owner of a company called Stoneridge Homes in Queens, testified at the three-week trial that he met Ms. Gordon in 2003 and that she said she would like him to put in new doors in her district office in Brooklyn. Nothing immediately came of the conversation, but in 2004, Mr. Batheja said, he asked to meet with Ms. Gordon.

By then, he had been caught trying to bribe an undercover investigator posing as a city inspector and had mentioned Ms. Gordon to prosecutors, piquing their interest. Prosecutors would not say what specifically about her caught their interest.

In October 2004, Mr. Batheja and Ms. Gordon met at her office. On a tape of the meeting played at trial, the assemblywoman asks Mr. Batheja what happened to her doors, then says she would advocate for him to be named redeveloper of a vacant city-owned parcel in her district. She then asks Mr. Batheja if she would be able to get a house in a gated community he was building in Lindenwood. “Let’s work one hand work together,” she tells him. “One hand washes another.”

In subsequent taped conversations, Ms. Gordon tells Mr. Batheja that she wants to get the house for a dollar, though she later says that a lawyer told her she had to pay a significant amount for the house, at least on paper, to avoid the appearance of impropriety.

Shortly after Ms. Gordon’s initial conversations with Mr. Batheja about the house and the vacant parcel on New Lots Avenue, she began urging city officials to allow redevelopment of the parcel, which prosecutors valued at $2 million. In November 2005, she faxed several letters of recommendation to Mr. Batheja — one from her and two from other local officials — to be included in his application to be named redeveloper of the site.

Mr. Batheja, meanwhile, was trying to get Ms. Gordon to accept $3,000 in cash from him that she would then return to him as a down payment on the house to make the transaction look legitimate.

By then, she had received anonymous letters warning her not to take gifts from him, and she rebuffed him. But prosecutors said she was too late. She was indicted in July 2006. Four months later, she was re-elected with more than 90 percent of the vote.

This article has been revised to reflect the following correction:

Correction: April, 10, 2008

An article on Wednesday about the conviction of Assemblywoman Diane M. Gordon, a Brooklyn Democrat, on corruption charges misidentified, in some copies, the person who said in a statement released after the verdict, “That Gordon, a state legislator, seized on a city program to build affordable housing on city-owned land in her district as her opportunity to sell her office and to obtain her own luxury housing elsewhere adds a layer of outrageousness to her misconduct.” The speaker was Rose Gill Hearn, New York City’s commissioner of investigation — not Charles J. Hynes, the Brooklyn district attorney.

(NYT) - CONCORD, N.H. — Calls from obese patients had increased nearly 25 percent in recent years, and the Fire Department could no longer handle them.

The department’s gurneys could not adequately support the patients’ weight, and the department had to pay a private ambulance company.

Last fall, the department bought three gurneys that can hold patients weighing up to 600 pounds, about twice the holding capacity of a regular stretcher.

“We had to do something,” Acting Chief Tim McGinley said. “It was one of those things where we would try to use the equipment we had and were afraid that you were going to end up hurting somebody, the patients themselves or the staff.”

As obesity rates increase around the country, fire departments and emergency medical workers are responding similarly.

“I think everybody is moving to a stretcher that has a higher weight capacity,” said Jerry Johnston of Mount Pleasant, Iowa, president of the National Association of Emergency Medical Technicians. “We have to be able to deal with it and have the equipment to take care of those people appropriately. It’s part of our job.”

But the effort can be expensive.

A bariatric ambulance that can transport patients weighing up to 1,000 pounds costs $110,000 to build, compared with $70,000 for a standard ambulance, said Doug Moore, a spokesman for American Medical Response, which operates 4,200 ambulances nationwide.

A bariatric cot costs around $4,000, four times the price of a regular cot.

Fire Chief Tim Robbins of Gilmanton, N.H., received $15,800 from the town for new equipment that can hold patients weighing up to 650 pounds.

“People should have a fair shake when they’re transported to the hospital,” Chief Robbins said.

Jerry Socha, a spokesman for Ferno, which sells emergency medical equipment, said that the company started increasing production of bariatric products about five years ago and that sales had steadily increased.

“A lot of the motivation was our customers,” Mr. Socha said, speaking of the emergency workers, “who are experiencing a higher call volume regarding bariatric patients.”

Some departments say they bought the equipment to help prevent injuries to patients and first responders.

Mike Smith, director of emergency medical services in Durham, N.C., bought bariatric cots in 2004, after several paramedics had strained their backs and injured their shoulders transporting patients on inadequate equipment.

The stretchers operate on battery power and lift patients, so paramedics do not have to hoist patients into ambulances.

Mr. Johnston, in Iowa, said the equipment should be standard.

“If something collapses, you injure a patient and yourself,” he said. “We’re in the people business. We’re about taking care of people who get sick and hurt, and we have to be prepared for anything.”

No need for new equipment. You can hire all the truck drivers who are out of business because the price of diesel is $4.35 a gallon where I live. Just make sure you have a fork lift and a sling. Hell, I just might buy a flat bed truck and start another business.