Her knee shredded, Lindsey Vonn done for season

SCHLADMING, Austria (AP) — All it took was a moment. Lindsey Vonn landed hard and tumbled face first with a piercing shriek.

Just like that, her season was done. The star American skier was on the ground with two ligaments in her right knee torn, a bone in her lower leg broken.

The cascading fall down the slope during the super-G at the world championships Tuesday knocked out the four-time World Cup champion for the rest of the season, the latest and most serious in a string of injuries for Vonn at skiing's biggest events.

The U.S. team said in a statement it expects her back for the next World Cup season and the 2014 Sochi Olympics, which start a year from this week.

The harrowing accident came after Vonn was lifted into the air off a jump in the opening race at the championships. As she hit the ground, her right leg gave way and she spun down face first, throwing an arm out to protect herself. She ended up on her back as she smashed through a gate.

On the television feed, Vonn was clearly heard screaming an expletive as she landed, then a despairing "Yes, yes," when someone asked, "Are you hurt?"

Race leader and eventual champion Tina Maze watched with her mouth agape. The concern also was obvious on the face of Vonn's sister, Laura Kildow, who has been traveling with her full time this season.

For 12 minutes, Vonn lay on the snow getting medical treatment before being airlifted by helicopter to a hospital in Schladming.

Vonn tore her anterior cruciate ligament and medial collateral ligament in her right knee, U.S. ski team medical director Kyle Wilkens said in a statement. The broken bone was described as a "lateral tibial plateau fracture."

Christian Kaulfersch, the assistant medical director at the worlds, said Vonn left the Schladming hospital on Tuesday afternoon and will have surgery in another hospital. "She first wanted to go back to the team hotel to mentally deal with all what has happened," Kaulfersch said.

Vonn's father, Alan Kildow, spoke with her by phone and said that she's, "mad at the way things turned out." His daughter told him that she landed in a clump of sugar snow, or ice crystals, that caused her fall forward, he said.

"She's a tough character. A very determined and tough character," Kildow told The Associated Press in a phone interview. "She will be back."

Kildow said that surgery could take place as soon as this weekend, likely at the Steadman Clinic, in Vail, Colo. Recovery time varies, according to Dr. Tom Hackett, an orthopedic surgeon at the clinic and the team physician for the U.S. snowboard squad.

But Vonn could be looking at six-to-eight months before she's back on skis.

"It's not like at six months you say, 'OK, you can get back on a super-G course," Hackett said. "There's a progression to getting back on skis, getting back to taking some easy runs, getting back to some gates, and working your way back to some steeper terrain. There's a whole return to snow progression that we've developed over many years."

Time enough to get back for Sochi?

"I think so," Hackett said. "I would be very optimistic she could come back strong. She's a fierce competitor. She's a fighter and chances are that she will — I would think — essentially take all of that athletic energy and put it into her rehabilitation. There's a really good chance she could come back as strong as ever."

Comebacks are nothing new for Vonn, who has also been afflicted by injuries at her last six major championships — from a thumb she sliced on a champagne bottle at the 2009 worlds in Val d'Isere, France, to a bruised shin that she cured with Austrian cheese at the Vancouver Olympics.

This one, however, could prove the biggest test yet for the 28-year-old who won the downhill at the 2010 Vancouver Olympics.

Vonn took a month off this season after being hospitalized for an intestinal illness in November, and had just regained her form with two wins last month.

That was evident at the start of her Tuesday's run. She led Maze by 0.04 seconds at the first checkpoint and was just 0.12 back at the second interval and seemingly on her way to a medal, if not victory.

Exactly what went wrong was debated by competitors and officials at the championships.

The start of the race was delayed by 3½ hours because of fog hanging over the course and it began in waning light at 2:30 p.m local time. Even before Vonn's crash, a course worker fell and also had to be airlifted. He was reported to have broken his nose.

All the delays made for what skiers call flat light — overcast and dreary conditions — when Vonn raced.

"Lindsey did a great job on top and Lindsey has won a lot of races in flat light so the flat light was definitely not a problem," U.S. Alpine director Patrick Riml told the AP.

"We are upset obviously with what happened but if you don't know the facts and why they decided to start and what the weather forecast was it's hard to say without any reasoning," Riml said. "And they probably had a reason, otherwise they wouldn't have started."

Atle Skaardal, women's race director for the International Ski Federation, defended the decision to go ahead with the event.

"I can confirm that the visibility was great, there were no problems, and the course was also in good shape," he said. "I don't see that any outside factors played a role in this accident. ... The other factors were like they were supposed to be for ski racing."

Vonn's list of injuries at major championships is long.

Two years ago, she pulled out midway through the last worlds in Garmisch-Partenkirchen, Germany, because of a mild concussion. At the 2010 Vancouver Olympics, Vonn skied despite a severely bruised shin to win the downhill and take bronze in the super-G.

At the 2009 worlds in Val d'Isere, she sliced her thumb on a champagne bottle after sweeping gold in the downhill and super-G, forcing her out of the giant slalom. At the 2007 worlds in Are, Sweden, Vonn injured her knee in training and missed her final two events.

And at the 2006 Turin Olympics, she had a horrific crash in downhill training and went directly from her hospital room to the mountain to compete in four of her five events.

The conditions Tuesday varied from racer to racer, and as the light began to fade even more, organizers stopped the race after only 36 of the 59 skiers had come down.

Maze skied immediately before Vonn.

"I saw it was a very high jump, so I knew I had to take the right line to make the next gate," she said. "World championship races often have special conditions and the mistakes from the girls were not because of the slope."

The two racers who started immediately after Vonn, former overall winner Maria Hoefl-Riesch of Germany and local favorite Anna Fenninger of Austria, each skied off course. In all, six women who started the course failed to finish. Still, Skaardal said he never thought about stopping the race.

"It's not a very difficult course but in some parts you couldn't see anything," said Fabienne Suter of Switzerland, who finished fifth.

Vonn's teammate Julia Mancuso also thrived in the difficult conditions and won the bronze medal.

"It's the same for everybody," U.S. speed coach Chip White said. "Everyone had to wait for a long time and that's always difficult. And the holds were every 15 minutes so it really doesn't give you a chance to go and do something else. You're always kind of on edge at the ready. It's a difficult situation but everybody had the same difficult situation."

Not long after Vonn was injured, NBC hosted a news conference in New York to discuss its coverage of the Sochi Games. A poster of a smiling Vonn hung in the room next to one of snowboarder Shaun White, evidence of the network's unsurprising expectations that she would be one of the biggest stars in Sochi.

The network's executives chose to put a positive spin on the injury.

"We expect her to be the comeback Olympian of the year," NBC Sports Group Chairman Mark Lazarus said.

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Associated Press writer Eric Willemsen in Schladming and AP Sports Writers Pat Graham and Rachel Cohen contributed to this report.

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Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

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Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Bits Blog: Most Facebook Users Have Taken a Break From the Site, Study Finds

Facebook is the most popular social network in America — roughly two-thirds of adults in the country use it on a regular basis.

But that doesn’t mean they don’t get sick of it.

A new study released on Tuesday by the Pew Research Center‘s Internet and American Life Project found that 61 percent of current Facebook users admitted that they had voluntarily taken breaks from the site, for as many as several weeks at a time.

The main reason for their social media sabbaticals?

Not having enough time to dedicate to pruning their profiles, an overall decrease in their interest in the site as well as the general sentiment that Facebook was a major waste of time. About 4 percent cited privacy and security concerns as contributing to their departure. Although those users eventually resumed their regular activity, another 20 percent of Facebook users admitted to deleting their accounts.

Of course, even as some Facebook users pull back on their daily consumption of the service, the vast majority — 92 percent — of all social network users still maintain a profile on the site. But while more than half said that the site was just as important to them as it was a year ago, only 12 percent said the site’s significance increased over the last year — indicating the makings of a much larger social media burnout across the site.

The study teases out other interesting insights, including the finding that young users are spending less time overall on the site. The report found that 42 percent of Facebook users from the ages of 18 to 29 said that the average time they spent on the site in a typical day had decreased in the last year. A much smaller portion, 23 percent, of older Facebook users, those over 50, reported a drop in Facebook usage over the same period.

Facebook’s biggest challenge revolves around figuring out how to continue to profit from its rich reservoir of one billion users — and a large part of that involves keeping them entertained and returning to the site on a regular basis. Most recently, the company introduced a tool called Graph Search, a research tool that promises to help its users find answers on everything from travel recommendations to potential jobs and even love connections.

Lee Rainie, the director of the Pew Research Center’s Internet & American Life Project, which conducted the survey, described the results as a kind of “social reckoning.”

“These data show that people are trying to make new calibrations in their life to accommodate new social tools,” said Mr. Rainie, in an e-mail. Facebook users are beginning to ask themselves, ” ‘What are my friends doing and thinking and how much does that matter to me?,’ ” he said. “They are adding up the pluses and minuses on a kind of networking balance sheet and they are trying to figure out how much they get out of connectivity vs. how much they put into it.”

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Afghan Airline, Kam Air, No Longer Under U.S. Ban

KABUL, Afghanistan — The American military on Monday reversed a recent decision to blacklist one of Afghanistan’s main airlines, Kam Air, on suspicion of drug smuggling, and it agreed to share details of its accusations with the Afghan government.

The turnaround came after days of Afghan criticism and what some Western officials described as a disagreement between the military and the American Embassy on the prudence of the ban, which would have forbidden any American military contracts with Kam Air. The prohibition came to light in news reports last week, and it was an embarrassment after a positive meeting between President Obama and President Hamid Karzai in Washington in which Mr. Karzai stressed the importance of Afghan sovereignty.

According to a statement released late Monday evening by United States Forces-Afghanistan, the military said that senior officials met with senior Afghan officials at the Foreign Ministry on Saturday, explaining the reasons behind the blacklisting and offering information about the company that led to the ban.

In return, the statement said, the Afghan government agreed to investigate Kam Air and take further action, if needed. Afghan officials could not be reached for comment.

The statement noted deference to the Afghan government’s sovereignty as one reason that it had lifted the ban. The United States military does not directly contract with Kam Air, but the lines are somewhat blurry because the military pays for many activities by the Afghan government. Banning Kam Air from military contracts cast a shadow over the company and posed difficulties for Mr. Karzai’s travel plans. He frequently charters Kam Air planes for official visits abroad, but he was forced to make other plans for his current visit in Europe, officials said.

On Monday, he met in London with Prime Minister David Cameron and President Asif Ali Zardari of Pakistan to discuss halting efforts to restart the peace process with the Taliban. The leaders reaffirmed support for establishing an office in Qatar to aid in talks with Taliban delegates there, and set a six-month deadline for progress, officials said.

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Live action: Twitter grabs Super Bowl spotlight

NEW YORK (AP) — Beyonce’s splashy show, a freak power outage, and —oh, yeah— a captivating game of football combined to generate a record 24.1 million posts on Twitter during Sunday night’s Super Bowl.

That’s up from 13.7 million last year — and that doesn’t even include chatter surrounding the ads.

Twitter said in a late Sunday blog post that about half of the more than 50 national TV spots that aired during the game included a “hashtag,” a word or phrase preceded by a number sign that’s used to organize subjects on the short messaging site. During last year’s game, only one in five ads included one. Brands ranging from Oreo to Tide and Budweiser, meanwhile, captured online buzz by linking the blackout to their brands in humorous tweets.

Super Bowl XLVII, like the London Summer Olympics and the U.S. presidential election, was yet another moment in which Twitter became the platform for millions of people to share quick reactions and participate in a massive, public conversation. Though it’s not as popular as Facebook Inc. or its buttoned-up cousin LinkedIn Corp., Twitter’s surging popularity during big events is a testament to its reach and utility. The question is whether these moments can translate into revenue for the 7-year-old company.

The company makes money by charging advertisers to promote individual tweets, accounts or trends designed to spark a conversation. Research firm eMarketer estimates that Twitter will book advertising revenue of $ 545.2 million this year, up 89 percent from 2012. Next year, worldwide ad revenue is expected to hit $ 807.5 million, a 48 percent increase from 2013.

Tweetable events such as the 34-minute Super Bowl power outage are ripe with marketing potential, provided that brands act quickly.

“It’s really clear right now that Twitter has a lock on real-time conversation on the Internet,” says eMarketer analyst Debra Aho Williamson.

To capitalize on this, Twitter has to show advertisers that it pays to promote their tweets — even though fans are likely to spread the catchiest slogans on their own, free of charge.

That’s what happened with a certain cream-filled cookie on Sunday.

It took Oreo’s marketers roughly 10 minutes after the power went out to tweet a picture of an Oreo cookie in the half-dark with the words: “You can still dunk in the dark.” As of Monday afternoon, the image had been shared on Twitter more than 15,000 times. Tide followed suit with the slogan “we can’t get your blackout. But we can get your stains out” with more limited success. The message was re-tweeted about 1,300 times. Calvin Klein, meanwhile, tweeted a video of a shirtless, chiseled male model doing crunches “since the lights are still out…”

Such “real-time marketing” is still in its infancy, but Williamson expects this to change, as more companies develop the ability to respond to events immediately.”

“To do what Oreo did actually takes a lot of pre-planning,” she says.

Laurie Guzzinati, spokeswoman for Oreo owner Mondelez says the power outage was a natural moment to engage consumers. The cookie’s TV ad had a planned social media component asking people to follow Oreo on Twitter and post photos on Instagram. The company had set up a “social media command center” that included people from Oreo’s brand team, the ad agency 360i and other partners whose job was to follow the Super Bowl and interact with fans on Facebook, Twitter and elsewhere.

Mondelez likely spent the going rate of as much as $ 4 million on its Super Bowl television spot. But Guzzinati says the company didn’t pay Twitter anything for the “dunk in the dark” picture. Still, Twitter says advertisers moved quickly following the outage.

Matt McGee, editor-in-chief of the blog Marketing Land, counted 26 Twitter mentions in the 52 national spots that aired during the game. Facebook, meanwhile, got only four shout-outs, while Google Plus walked away with zero (though Google Inc.’s YouTube scored one mention from Hyundai).

“When it comes to second-screen advertising, it’s Twitter’s world now and there’s no close second place,” McGee wrote in a blog post late Sunday night. “Last year, brands split their focus on Twitter and Facebook with eight mentions each. This year, brands recognize that Twitter is where they need to try to attract the online conversation around one of the world’s biggest events.”

David Berkowitz, vice president of emerging media at 360i, which worked on the Oreo campaign, says Twitter has done a good job tying itself into major television events.

“If you look at (Twitter’s) trending topics any day especially during prime time or major events, they’re heavily fueled by television,” he says. “So TV is responsible for Twitter’s growth in general.”

He thinks Twitter has done a better job than other social media sites like Tumblr and Pinterest in proving it’s the place to be when it comes to talking about big events online.

“A large part of it right now is just showing this is where the conversation is happening and building their brand around that,” he says. “Even with other very successful social media sites, no one is better at conversation than Twitter.”

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AP Retail Writer Mae Anderson contributed to this story.

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Cause of Super Bowl power outage remains unclear

NEW ORLEANS (AP) — Who turned out the lights?

The day after the 34-minute blackout at the Super Bowl, the exact cause — and who's to blame — were unclear, though a couple of potential culprits had been ruled out.

It wasn't Beyonce's electrifying halftime performance, according to Doug Thornton, manager of the state-owned Superdome, since the singer had her own generator. And it apparently wasn't a case of too much demand for power. Meters showed the 76,000-seat stadium was drawing no more electricity than it does during a typical New Orleans Saints game, Thornton said.

The lights-out game Sunday proved an embarrassment for the Big Easy just when it was hoping to show the rest of the world how far it has come since Hurricane Katrina in 2005. But many fans and residents were forgiving, and officials expressed confidence that the episode wouldn't hurt the city's hopes of hosting the championship again.

To New Orleans' great relief, NFL Commissioner Roger Goodell said the city did a "terrific" job hosting its first pro football championship in the post-Katrina era, and added: "I fully expect that we will be back here for Super Bowls."

Fans watching from their living rooms weren't deterred, either. An estimated 108.4 million people saw the Baltimore Ravens beat the San Francisco 49ers 34-31, making it the third most-viewed program in television history. Both the 2010 and 2011 games hit the 111 million mark.

The problem that caused the outage was believed to have happened around the spot where a line that feeds current from the local power company, Entergy New Orleans, connects with the Superdome's electrical system, officials said. But whether the fault lay with the utility or with the Superdome was not clear.

Determining the cause will probably take days, according to Dennis Dawsey, a vice president for distribution and transmission for Entergy. He said the makers of some of the switching gear have been brought in to help figure out what happened.

An attorney for the state board that oversees the Superdome said the blackout did not appear to be related to the replacement in December of electrical equipment connecting the stadium to Entergy. Officials with the utility and the Superdome noted that an NFL game, the Sugar Bowl and another bowl game were played there in recent weeks with no apparent problems.

The blackout came after a nearly flawless week of activity for football fans in New Orleans leading up to the big game.

"I hope that's not what they'll remember about this Super Bowl," French Quarter artist Gloria Wallis said. "I hope that what they'll remember is they had a great time here and that they were welcomed here."

Ravens fan Antonio Prezioso, a Baltimore native who went to the game with his 11-year-old son, said the outage just extended the experience.

"The more time we could spend at the game was a good thing, as long as it ended the way it did," he said, laughing.

The city last hosted the Super Bowl in 2002, and officials were hoping this would serve as the ultimate showcase for the city's recovery. The storm tore holes in the roof of the Superdome and caused water damage to its electrical systems, and more than $330 million was spent repairing and upgrading the stadium.

Sunday's Super Bowl was New Orleans' 10th as host, and officials plan to make a bid for an 11th in 2018.

Mayor Mitch Landrieu told WWL-AM on Monday that the outage won't hurt the city's chances, and he joked that the game got better after the blackout: "People were leaving and the game was getting boring, so we had to do a little something to spice it up."

Jarvis DeBerry, a columnist for nola.com and The Times-Picayune, wrote that the power outage gave the media "an opportunity to laugh at the apparent ineptitude or suggest that the ghosts of Hurricane Katrina were haunting the Superdome."

"That's not the kind of attention the city was looking for, obviously," he wrote, "but it's certainly too soon to say if people will remember the power shortage over San Francisco's furious comeback attempt against Baltimore or if this will harm the city's future opportunities to host the Super Bowl."

Bjorn Hanson, dean of New York University's Center for Hospitality and Sports Management, said the episode shouldn't hurt the city's reputation as a big convention destination. "I think people view it for what it was: an unusual event with a near-record power draw," he said. "It was the equivalent of a circuit breaker flipping."

The American Association of Neurological Surgeons will meet in New Orleans from April 27 to May 1. Patty Anderson, director of meetings for the group, said of the blackout: "I never even gave it a second thought. To me, the city is bigger, stronger and more vibrant than it's ever been."

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Associated Press writers Beth Harpaz, Brett Martel, Stacey Plaisance and Barry Wilner contributed to this report.

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Well: Gluten-Free for the Gluten Sensitive

Eat no wheat.

That is the core, draconian commandment of a gluten-free diet, a prohibition that excises wide swaths of American cuisine — cupcakes, pizza, bread and macaroni and cheese, to name a few things.

For the approximately one-in-a-hundred Americans who have a serious condition called celiac disease, that is an indisputably wise medical directive.

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Kenneth Chang speaks about gluten.

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Now medical experts largely agree that there is a condition related to gluten other than celiac. In 2011 a panel of celiac experts convened in Oslo and settled on a medical term for this malady: non-celiac gluten sensitivity.

What they still do not know: how many people have gluten sensitivity, what its long-term effects are, or even how to reliably identify it. Indeed, they do not really know what the illness is.

The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness.

“We have absolutely no clue at this point,” said Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center.

Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group.

She did not consult a doctor before making the change, and she also does not know whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.

Many advocates of gluten-free diets warn that non-celiac gluten sensitivity is a wide, unseen epidemic undermining the health of millions of people. They believe that avoiding gluten — a composite of starch and proteins found in certain grassy grains like wheat, barley and rye — gives them added energy and alleviates chronic ills. Oats, while gluten-free, are also avoided, because they are often contaminated with gluten-containing grains.

Others see the popularity of gluten-free foods as just the latest fad, destined to fade like the Atkins diet and avoidance of carbohydrates a decade ago.

Indeed, Americans are buying billions of dollars of food labeled gluten-free each year. And celebrities like Miley Cyrus, the actress and singer, have urged fans to give up gluten. “The change in your skin, physical and mental health is amazing!” she posted on Twitter in April.

For celiac experts, the anti-gluten zeal is a dramatic turnaround; not many years ago, they were struggling to raise awareness among doctors that bread and pasta can make some people very sick. Now they are voicing caution, tamping down the wilder claims about gluten-free diets.

“It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”

Nonetheless, Dr. Guandalini agrees that some people who do not have celiac receive a genuine health boost from a gluten-free diet. He just cannot say how many.

As with most nutrition controversies, most everyone agrees on the underlying facts. Wheat entered the human diet only about 10,000 years ago, with the advent of agriculture.

“For the previous 250,000 years, man had evolved without having this very strange protein in his gut,” Dr. Guandalini said. “And as a result, this is a really strange, different protein which the human intestine cannot fully digest. Many people did not adapt to these great environmental changes, so some adverse effects related to gluten ingestion developed around that time.”

The primary proteins in wheat gluten are glutenin and gliadin, and gliadin contains repeating patterns of amino acids that the human digestive system cannot break down. (Gluten is the only substance that contains these proteins.) People with celiac have one or two genetic mutations that somehow, when pieces of gliadin course through the gut, cause the immune system to attack the walls of the intestine in a case of mistaken identity. That, in turn, causes fingerlike structures called villi that absorb nutrients on the inside of the intestines to atrophy, and the intestines can become leaky, wreaking havoc. Symptoms, which vary widely among people with the disease, can include vomiting, chronic diarrhea or constipation and diminished growth rates in children.

The vast majority of people who have celiac do not know it. And not everyone who has the genetic mutations develops celiac.

What worries doctors is that the problem seems to be growing. After testing blood samples from a century ago, researchers discovered that the rate of celiac appears to be increasing. Why is another mystery. Some blame the wheat, as some varieties now grown contain higher levels of gluten, because gluten helps provide the springy inside and crusty outside desirable in bread. (Blame the artisanal bakers.)

There are also people who are allergic to wheat (not necessarily gluten), but until recently, most experts had thought that celiac and wheat allergy were the only problems caused by eating the grain.

For 99 out of 100 people who don’t have celiac — and those who don’t have a wheat allergy — the undigested gliadin fragments usually pass harmlessly through the gut, and the possible benefits of a gluten-free diet are nebulous, perhaps nonexistent for most. But not all.

Anecdotally, people like Ms. Golden Testa say that gluten-free diets have improved their health. Some people with diseases like irritable bowel syndrome and arthritis also report alleviation of their symptoms, and others are grasping at gluten as a source of a host of other conditions, though there is no scientific evidence to back most of the claims. Experts have been skeptical. It does not make obvious sense, for example, that someone would lose weight on a gluten-free diet. In fact, the opposite often happens for celiac patients as their malfunctioning intestines recover.

They also worried that people could end up eating less healthfully. A gluten-free muffin generally contains less fiber than a wheat-based one and still offers the same nutritional dangers — fat and sugar. Gluten-free foods are also less likely to be fortified with vitamins.

But those views have changed. Crucial in the evolving understanding of gluten were the findings, published in 2011, in The American Journal of Gastroenterology, of an experiment in Australia. In the double-blind study, people who suffered from irritable bowel syndrome, did not have celiac and were on a gluten-free diet were given bread and muffins to eat for up to six weeks. Some of them were given gluten-free baked goods; the others got muffins and bread with gluten. Thirty-four patients completed the study. Those who ate gluten reported they felt significantly worse.

That influenced many experts to acknowledge that the disease was not just in the heads of patients. “It’s not just a placebo effect,” said Dr. Marios Hadjivassiliou, a neurologist and celiac expert at the University of Sheffield in England.

Even though there was now convincing evidence that gluten sensitivity exists, that has not helped to establish what causes gluten sensitivity. The researchers of the Australian experiment noted, “No clues to the mechanism were elucidated.”

What is known is that gluten sensitivity does not correlate with the genetic mutations of celiac, so it appears to be something distinct from celiac.

How widespread gluten sensitivity may be is another point of controversy.

Dr. Thomas O’Bryan, a chiropractor turned anti-gluten crusader, said that when he tested his patients, 30 percent of them had antibodies targeting gliadin fragments in their blood. “If a person has a choice between eating wheat or not eating wheat,” he said, “then for most people, avoiding wheat would be ideal.”

Dr. O’Bryan has given himself a diagnosis of gluten sensitivity. “I had these blood sugar abnormalities and didn’t have a handle where they were coming from,” he said. He said a blood test showed gliadin antibodies, and he started avoiding gluten. “It took me a number of years to get completely gluten-free,” he said. “I’d still have a piece of pie once in a while. And I’d notice afterwards that I didn’t feel as good the next day or for two days. Subtle, nothing major, but I’d notice that.”

But Suzy Badaracco, president of Culinary Tides, Inc., a consulting firm, said fewer people these days were citing the benefits of gluten-free diets. She said a recent survey of people who bought gluten-free foods found that 35 percent said they thought gluten-free products were generally healthier, down from 46 percent in 2010. She predicted that the use of gluten-free products would decline.

Dr. Guandalini said finding out whether you are gluten sensitive is not as simple as Dr. O’Bryan’s antibody tests, because the tests only indicate the presence of the fragments in the blood, which can occur for a variety of reasons and do not necessarily indicate a chronic illness. For diagnosing gluten sensitivity, “There is no testing of the blood that can be helpful,” he said.

He also doubts that the occurrence of gluten sensitivity is nearly as high as Dr. O’Bryan asserts. “No more than 1 percent,” Dr. Guandalini said, although he agreed that at present all numbers were speculative.

He said his research group was working to identify biological tests that could determine gluten sensitivity. Some of the results are promising, he said, but they are too preliminary to discuss. Celiac experts urge people to not do what Ms. Golden Testa did — self-diagnose. Should they actually have celiac, tests to diagnose it become unreliable if one is not eating gluten. They also recommend visiting a doctor before starting on a gluten-free diet.

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This post has been revised to reflect the following correction:

Correction: February 4, 2013

An earlier version of this article misspelled the surname of Thomas O'Bryan. It is O'Bryan, not O'Brien.

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On The Road: Glow of Familiar Hotel Brands in Unfamiliar Places

I KNOW that travel is enriching and that locally managed hotels in exotic places can provide wonderful experiences.

Still, when I’m traveling abroad on business, the last thing I want in a hotel is cultural adventure. Instead, I want predictability and value. I want a comfortable bed in a clean, quiet room with a nice bathroom — in a place that’s conveniently located and doesn’t cost too much. Oh, and dependable Wi-Fi service and a friendly front-desk staff who have at least some proficiency in English.

Does that make me the prototypical Ugly American?

“Well, that phrase did just come to mind,” Robert Mandelbaum, the director of research information services at the consulting firm PKF Hospitality Research, said with a laugh. We were talking in general about conditions in the hotel industry, which is continuing a steady recovery.

But one of the trends in the industry is the international expansion of midlevel hotels by major hotel companies.

The big chains have come a long way since the 1950s, when four-star Hilton Hotels spread through postwar Europe to cater to American tourists. So while top luxury hotels, like Marriott International’s Ritz-Carlton, are established in major and even secondary cities around the world, midlevel brands have only recently begun to turn up in large numbers in foreign cities.

Certainly, we all welcome the local experience, within reason. But, as Mr. Mandelbaum acknowledged, there’s virtue in “coming back at night knowing that the hotel room is safe, that the bathroom works and the Wi-Fi is available.”

I appreciated that in a hotel that otherwise looked right at home near the teeming historic Zócalo plaza in central Mexico City, where my wife and I recently stayed at a Hilton Hampton Inn on a short business trip.

Beautifully renovated from an 18th-century monastery, the hotel had the standard Hampton Inn amenities, including a big, comfortable suite with free (working) Wi-Fi, and a free buffet breakfast, all for $116 a night. The staff was helpful — and they even kept at the front desk a supply of chargers for various laptop and smartphone models for guests who’d forgotten theirs.

Intensely trained in adhering to Hampton brand standards, employees there have “skin in the game,” according to Phil Cordell, the worldwide brand manager for Hampton.

A few days later, we had an example of standards not being so well enforced. It involved a frustrating exchange of e-mails with a manager and reservations clerk at the Hilton DoubleTree in Querétaro, 124 miles northwest of Mexico City, where we attended the Mexico Business Summit.

We finally canceled our reservation in annoyance and booked elsewhere, after being curtly informed by a hotel representative that we would need to show proof of being 65 to qualify for a measly 5 percent AARP discount on the $128 rate. (In fact, the age requirement for AARP membership and travel discounts is 50.)

Instead, we stayed at the Fiesta Americana, a highly recommended local hotel, which turned out to be more expensive ($175), less convenient and maddeningly noisy because it was near a major highway.

Brand standards matter. When the international hotel company IHG opened a Crowne Plaza Hotel recently in Kochi, a commercial center on the west coast of India, the company’s head of regional operations, Douglas Martell, said that “business and leisure travelers in India are seeking a hotel with a brand name they can trust.”

Like its competitors, IHG, whose brands include Intercontinental Hotels and Holiday Inn, has been expanding in Asia, where it has 160 hotels in 60 cities. Also active in Asia is Marriott, which has about 60 hotels in China, from its Ritz-Carlton brand to its midlevel Courtyards, with plans to double that.

The hotel brands are also expanding in Latin America. Even in Europe, a well-established midlevel brand market is getting greater attention. In Germany, Starwood Hotels recently announced plans to open Aloft hotels in Munich and Stuttgart, underscoring the Aloft brand’s intention to “shake up the traditional midmarket hotel sector.”

Hilton’s DoubleTree hotels are growing rapidly internationally, too. Five years ago, DoubleTree had no hotels in Britain. Now it has 18. It has 12 in China, and 30 in development. DoubleTree plans to expand in India from three hotels to two dozen. Last year, DoubleTree entered markets in Japan, Thailand, Croatia and Spain. This year it will enter South Africa, Poland and Indonesia, said the global brand manager, Rob Palleschi.

Maintaining strict brand standards is the goal, he said.

“Part of the challenge is educating our team members,” he added. “Many of our team members out there, particularly in the emerging markets, have never actually stayed in a hotel, so you really have to take things from ground zero.”

E-mail: jsharkey@nytimes.com

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Reformers Aim to Get China to Live Up to Own Constitution

Pool photo by Ed Jones/Getty images

A recent speech by Xi Jinping in which he stressed the need to enforce the Constitution has stirred hope among reformers.

BEIJING — After the chaos of the Cultural Revolution, the surviving Communist Party leaders pursued a project that might sound familiar to those in the West: Write a constitution that enshrines individual rights and ensures rulers are subject to law, so that China would never again suffer from the whims of a tyrant.

The resulting document guaranteed full powers for a representative legislature, the right to ownership of private property, and freedoms of speech, press and assembly. But the idealism of the founding fathers was short-lived. Though the Constitution was ratified in 1982 by the National People’s Congress, it has languished ever since.

Now, in a drive to persuade the Communist Party’s new leaders to liberalize the authoritarian political system, prominent Chinese intellectuals and publications are urging the party simply to enforce the principles of their own Constitution.

The strategy reflects an emerging consensus among advocates for political reform that taking a moderate stand in support of the Constitution is the best way to persuade Xi Jinping, the party’s new general secretary, and other leaders, to open up China’s party-controlled system. Some of Mr. Xi’s recent speeches, including one in which he emphasized the need to enforce the Constitution, have ignited hope among those pushing for change.

A wide range of notable voices, among them ones in the party, have joined the effort. Several influential journals and newspapers have published editorials in the last two months calling for Chinese leaders to govern in accordance with the Constitution. Most notable among those is Study Times, a publication of the Central Party School, where Mr. Xi served as president until this year. That weekly newspaper ran a signed editorial on Jan. 21 that recommends that the party establish a committee under the national legislature that would ensure that no laws are passed that violate the Constitution.

After the end of the party’s leadership transition last November, liberal intellectuals held a meeting at a hotel in Beijing to strategize on how to push for reform; constitutionalism was a major topic of discussion. At the end of the year, 72 intellectuals signed a petition that was drafted by a Peking University law professor who had helped organize the hotel meeting. In early January, a censored editorial on constitutionalism at the liberal newspaper Southern Weekend set off a nationwide outcry in support of press freedoms.

Several people involved in the advocacy say their efforts are not closely coordinated, but that rallying around the Constitution was a logical first step to galvanize reform.

“We have a common understanding that constitutionalism is a central issue for China’s reform,” said Zhang Qianfan, the law professor who drafted the petition. “The previous reform was preoccupied with economic aspects. But we learned from the experiences of the recent two decades that economic reform can go wrong if it’s not coupled with political reform, or constitutional reform actually.”

Through the decades, party leaders have paid lip service to the Constitution, but have failed to enforce its central tenets, some of which resemble those in constitutions of Western democracies. The fifth article says the Constitution is the supreme authority: “No organization or individual may enjoy the privilege of being above the Constitution and the law.” Any real application of the Constitution would mean severely diluting the party’s power.

It is unclear whether the latest push will be any more successful than previous efforts. A decade ago, a similar wave of advocacy failed to significantly alter the status quo, despite some initially encouraging words from Hu Jintao, the newly designated president at the time. The authorities admonished scholars who took part in seminars on the issue, and propaganda officials ordered the state news media not to publish articles on calls for constitutional government.

Liberals have been encouraged by a speech that Mr. Xi gave on the 30th anniversary of the Constitution in which he said, “The Constitution should be the legal weapon for people to defend their own rights.” He added that implementation was needed for the document to have “life and authority.” Analysts say the speech, delivered Dec. 4, was much stronger than the one given by Mr. Hu on the Constitution’s 20th anniversary. And on Jan. 22, Mr. Xi said in a speech to an anticorruption agency that “power must be put in the cage of regulations.”

But Deng Yuwen, an editor at Study Times, said he had so far only seen talk from Mr. Xi. “We have yet to see any action from him,” Mr. Deng said. “The Constitution can’t be implemented through talking.”

And since taking power, Mr. Xi has appeared more concerned with maintaining party discipline than opening political doors. In remarks made during a recent southern trip that have circulated in party circles, Mr. Xi said China must avoid the fate of the Soviet Union, which broke apart, in his view, after leaders failed to stick to their socialist ideals and the party lost control of the military.

In part, liberals advocating constitutional checks on power have been energized by the party’s takedown of Bo Xilai, the polarizing former Politburo member who is expected to be prosecuted soon on charges of corruption and subverting the law.

One journal supported by reform-minded party elders, called Yanhuang Chunqiu, published a New Year’s editorial that said fully carrying out the Constitution would mean “our country’s political system will take a big step forward.”

Mia Li contributed research.

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BlackBerry Z10 Smartphone Already Going for $1,500 on eBay

The new BlackBerry Z10 smartphone won’t be out for weeks, but you can already get your hands on it via eBay for about $ 1,500.

BlackBerry — the company formerly known as Research In Motion (RIM) — announced the new smartphone at an event earlier this week and handed out samples to guests and members of the press in attendance. It didn’t take long for the Z10, which could potentially turn around the struggling company, to pop up on eBay.

[More from Mashable: BlackBerry’s Secret Weapon: Women]

One page notes “this particular device was given to all attendees of the Jan. 30, 2013 product launch.”

[More from Mashable: Don’t Hold Your Breath for More BlackBerry Tablets]

BlackBerry didn’t tell attendees what they can or can’t do with the device, which comes unlocked, according to the listing, and without a SIM card.

Four units are currently being sold on eBay, with bids starting at $ 800 and rising quickly. The auction for the one going for $ 1,500, which has eight bids so far, will end this afternoon.

Images by Mashable and via eBay, eBay

Click here to view the gallery: BlackBerry Z10 Review

This story originally published on Mashable here.

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