Underwater Scan Finds Significant Heart Changes in Divers
Test May Identify Undetected Abnormalities That Might Prove Fatal in a Dive
An underwater ultrasound scan of scuba divers' hearts found significant changes in cardiac function during and after a dive, according to a small study in the journal Acta Physiologica. The test could be used to identify novice scuba divers with undetected heart disease or cardiac abnormalities that might prove fatal during a dive, researchers said.
Ben Sanders
Among the heart changes recorded during and after the dive: The volume of the left ventricle, a lower heart chamber that pumps newly oxygenated blood to the body, increased significantly, while the flow of blood into the ventricles decreased.
Scuba diving is growing in popularity among older Americans and heart attacks and unknown heart rhythms are the most common cause of diving-related deaths after age 40, according to the Divers Alert Network, a nonprofit research group.
The study, conducted in Italy, involved 18 scuba divers, including 16 men and two women. The participants were about 42 years old and each had made at least 100 dives. None smoked or had hypertension, heart or lung disease.
Cardiac-ultrasound tests were conducted on land before and after diving, and underwater at two depths. The divers wore suits with access for an ultrasound probe and maintained a kneeling position for 10 minutes at a depth of about 33 feet, then five minutes at 16.4 feet.
Among the heart changes recorded during and after the dive: The volume of the left ventricle, a lower heart chamber that pumps newly oxygenated blood to the body, increased significantly, while the flow of blood into the ventricles decreased. These changes may be due to a diving-related shift of blood from the lower extremities to the upper body, exerting a constrictive effect on the chest, the researchers said.
Bradycardia, the term for a slow resting heart rate, a condition that can cause dizziness and weakness if the rate falls below 50 beats per minute, was documented after but not during the scuba diving. The cardiovascular changes that occur during immersion may increase the risk of cardiac problems in divers who are unfit, overweight or have underlying heart disease, researchers said.
Caveat: Heart rate may have been higher underwater because divers were disturbed or stressed by the ultrasound tests, researchers said.
•Sudden hypotension: Turning the head during a typical daily routine, such as shaving, may cause a sudden drop in blood pressure in older people that could increase the risk of falls and injury, says a study in PLoS One. Episodes of low blood pressure, or hypotension, are common as people age, and are usually caused by insufficient blood supply to the brain, researchers said. Hypersensitivity of the carotid sinus, an enlarged area of the carotid neck arteries that helps to regulate heart rate and blood pressure, is thought to be a factor.
From 2006 to 2008, researchers in the Netherlands recruited 105 people with a history of falls or fainting, and 25 healthy controls. Subjects were in their mid-to-late 70s. Blood-pressure changes were recorded during a head-turning test that involved three head movements: rotations to the left and right, and tilted as far back as possible so the eyes faced the ceiling. A drop in systolic blood pressure, the top number on a blood-pressure reading, of 20 points or more during at least one head movement was considered head-turning-induced hypotension. Blood-pressure changes were measured after standing, eating and manual massage of the carotid arteries.
Both the falls and control groups experienced significant hypotension of about equal magnitude, indicating head-turning hypotension isn't found only in patients with symptoms of falling or fainting, researchers said. Systolic blood pressure dropped an average of 36 points.
Carotid hypersensitivity was found in 58% of the falls group and 24% of controls. Also, head-turning hypotension was more common in participants with a lower body-mass index, suggesting increased neck fat may reduce the impact of head turning on the carotid sinus, researchers said.
Caveat: As subjects in the falls group were recruited from a geriatric falls clinic, the probability of finding hypotension in this group was high, researchers said.
• Flat-head syndrome: Parents are strongly advised to place sleeping newborns on their back to reduce the chances of crib death. But a study of 2-month-old infants found nearly half of the babies had flattened areas of the skull, a condition known commonly as flat-head syndrome, according to the study reported in Pediatrics.
The syndrome, formally called positional plagiocephaly, can cause permanent changes to a child's facial features if it isn't caught and treated early, the study's researchers said.
Researchers in 2010 assessed 440 infants, nearly 60% of which were boys, from health centers in Calgary, Alberta. Two researchers examined each infant's head from four angles for asymmetries in the forehead, skull and ear position.
Plagiocephaly was detected in 47% of the infants. Head flattening occurred on the right side in 64% of the cases and on the left in 36%. Deformation was mild in nearly three-quarters of the cases; 19% were moderate; and 3%, severe. About 4% of the babies had abnormal skull widening, called brachycephaly, at the back of the skull.
Researchers suggested parents learn how to detect and prevent plagiocephaly. Severe plagiocephaly can sometimes be reversed with special helmets that relieve pressure on flattened areas of the skull, enabling normal bone growth.
Caveat: Some cases of right-side flattening may occur at the end of pregnancy, when the back of the fetus's head is compressed against the mother's pelvis, the researchers said.
•Dark adaptation: Measuring how quickly eyes adapt in dim light could identify people with very early macular degeneration, before vision loss is noticeable, according to a study in Documenta Ophthalmologica. Age-related macular degeneration (AMD) affects a part of the retina called the macula that controls central vision. AMD is expected to affect three million Americans by 2020, according to the National Eye Institute.
The study involved 20 ophthalmology patients, ages 66 to 76, from Cardiff, Wales. Ten had early AMD and 10 had normal retinas, though vision wasn't significantly different between the groups, researchers said. Over two days, each subject was exposed to three lights of varying brightness for two minutes at each level, which temporarily reduced their ability to see. Only the eye with the best sight was used. Immediately following the light exposures, subjects were seated at a computer in a dark room, where they focused on a cross visible in the center of a dark screen. Researchers compared the time it took to see dim spots of light on the screen—termed rod-cone-break—as the eyes adjusted to the darkness of the room and on the screen.
Subjects with early AMD took an average 17.1 minutes to detect dim light spots after exposure to low-intensity light, while controls required 5.1 minutes. Detection time following medium- and high-intensity light exposure averaged 28.9 minutes and 30 minutes, respectively, in AMD subjects. For controls, these times were 9.7 and 13.4 minutes. The findings indicate that vision in very early AMD is likely to be impaired during routine activities in which light levels change rapidly, researchers said.
Caveat: The study was small.
•Skin reactions: People with chronic eczema may have a tendency to develop metal allergies, especially the common allergic reaction to nickel in jewelry and other items, says a study in the Journal of the American Academy of Dermatology. The study found no association between eczema and allergies to fragrances and perfumes, contrary to findings from earlier studies.
Eczema, an inflammatory skin condition also called atopic dermatitis (AD), is common in children and adults; as much as 80% of patients also develop asthma and allergic rhinitis, researchers said. But the relationship between eczema and reactions caused by exposure to other allergens—termed contact dermatitis—isn't clear, they said.
From 1994 to 2012, skin-patch testing for metal and fragrance allergens was carried out on 2,305 residents of Kansas City. Nearly 300 of the subjects, mainly women, had a history of eczema.
A positive skin response to at least one allergen was recorded in 72% of subjects with a history of eczema and 65% of those without the condition. Nickel reactions were most common, occurring in 21% of eczema subjects and 12% of the non-eczema group. Eczema subjects reacted more often to chromium, a common coating on kitchen utensils, and to cobalt, a component of batteries, magnets and orthopedic implants.
Immunologic abnormalities, genetic factors or skin changes caused by frequent use of medicated creams may make people with eczema more susceptible to contact dermatitis, researchers said.
Caveat: The study didn't account for piercings, which are associated with an increased risk of metal allergy. Only patients with suspected contact dermatitis were tested.
Allspice: A New Weapon Against Prostate Cancer?
Allspice, a popular flavoring world-wide, contains an antioxidant compound that inhibited the growth of prostate-cancer cells in experiments, according to a study in the journal Carcinogenesis. Allspice is produced from the dried, unripe berries of the Pimenta dioica tree, which grows mainly in the Caribbean and Central America.
Researchers at the University of Miami tested a solution of allspice extract and distilled water on human prostate-cancer cells. The solution significantly slowed the growth of cancer cells within 48 hours. It killed more than 50% of the cancer cells compared with less than 10% of noncancerous control cells. Continuous treatment for up to 10 days significantly interfered with the formation of cancer-cell colonies.
The allspice solution also was fed to mice with implanted human prostate tumors for 42 days. Control mice received plain water. Two additional groups of mice with prostate tumors received injections of allspice or saline solution, respectively, three times a week for six weeks. Tumor growth was inhibited by about 62% in mice that got allspice orally and by 58% in the injected mice, compared with controls. Levels of prostate-specific antigen, a protein secreted by prostate-cancer cells, were 58% lower in the allspice-treated mice than controls.
Researchers identified a compound called ericifolin from allspice extract that suppresses a hormone that stimulates prostate-cancer growth, they said. The concentration of ericifolin used in the experiments was about 10 times greater than the amount found in freshly ground allspice. An average-size man would have to consume 3 to 5 grams of whole allspice daily to ingest an equivalent amount, they said.
Caveat: The safety of ericifolin isn't known.
—A.L.How to Cope When Your Spouse Embarrasses You
Mark Leary, Psychology Professor at Duke University, Says There Are Four Ways Couples Experience Embarrassment
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The number of ways for spouses to embarrass each other is seemingly endless. Elizabeth Bernstein joins Lunch Break with tips for what you can do if your partner embarrasses you, and Michele Phillips and Gary Wadds share their own personal experience. Photo: AP.
Michele Phillips and her husband, Gary Wadds, were hanging out on the porch with friends one evening in Piermont, N.Y., when the talk turned to hiking. One person mentioned a local trail, another raved about her new hiking boots. Then Ms. Phillips chimed in with, "Gary and I fooled around behind some rocks on a path on Bear Mountain—and another hiker saw us."
The reaction? Silence. Mr. Wadds shook his head and retreated into the house. Ms. Phillips finished her story, and the friends had a laugh.
Later that night as they were getting ready for bed, Mr. Wadds confronted his wife. "I can't believe you said that," he said. "Isn't anything sacred?" Ms. Phillips became defensive and asserted the story was benign. "I only told a few close friends," she replied. "Get over it."
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Honey, you're embarrassing me! Don't tell me you've never heard that line, or thought it.
I hear plenty about wives who never speak in a group, and husbands who never shut up. People have partners who misuse words, launch into political rants and are much too fond of bad puns. Some have regrettable table manners or clothing choices. Others think their jokes are hilarious.
"The number of ways for spouses to embarrass each other is almost endless," says Mark Leary, professor of psychology and neuroscience and director of the Social Psychology Program at Duke University. It is perfectly ordinary in a loving relationship for one spouse to mentally wince from time to time because of something the other spouse has said or done. But chronic feelings of embarrassment, and constant fighting about them, could be a sign of serious problems in the relationship.
Why do we often find a spouse's faux pas so much more embarrassing than our own? Spouses represent one another. Doesn't it say something about you if the person you chose to spend your life with tells insensitive jokes or dances with a lamp shade on his head? You may feel torn between your spouse and the people watching the behavior. And there's the lack of control: "It's the uncertainty that gets us—how bad is this going to get?" Dr. Leary says.
Phillips Wadds Family
Michele Phillips and her husband, Gary Wadds, at Hadrian's Wall in England. She revealed a story to friends that embarrassed him.
Social psychologists say embarrassment is an emotional mechanism with an evolutionary purpose. It keeps us behaving in ways that are socially acceptable so we don't get kicked out of our group.
Researchers have studied it by making subjects perform awkward tasks in front of others, such as solo disco dancing or sucking on a pacifier. It's worth remembering that many studies have reached the same conclusion: People's embarrassment tends to be exaggerated because they overestimate how much others notice.
Spousal embarrassment falls into four distinct categories, Dr. Leary says. The most simple is secondhand, or "empathic," embarrassment—what you feel when your partner does something unintentionally embarrassing, like trip on a stair or knock over a glass of water. Sadly, this is probably the least common type of spousal embarrassment, Dr. Leary says.
"Reflective" embarrassment is what you feel when your spouse does something you find humiliating. Think of the wife who gets angry and raises her voice in a restaurant, or the husband who tells an inappropriate joke. "Our big worry is that people will think we had to sink pretty low to put up with this clown," Dr. Leary says.
"One sided" embarrassment is when you are mortified, but your partner isn't—such as when he or she insists on break-dancing at the family wedding. Not surprisingly, this type of embarrassment often leads to conflict. The partner whose behavior has been questioned may deny he or she did anything wrong. Dr. Leary says the attitude can be summarized as, "I don't know why you think that I embarrassed you. The lamp shade I wore on my head was funny."
Finally, there is "targeted" embarrassment, when one spouse, intentionally or not, directly embarrasses the other. It can be as simple as telling a story that your partner thinks should remain private (Ms. Phillips's specialty). Typically, in this scenario, everything seems fine until the couple gets home—and one person finds out the other is furious.
People who become embarrassed often engage in "remedial tactics" afterward, Dr. Leary says. He asked research subjects to sing the 1970s song "Feelings" ("whoah, whoah, whoah") into a tape recorder, played it back for them and others, and then asked the subjects to rate themselves on attributes such as being pleasant, confident or ethical. When they learned their self ratings would be shared with people who had heard the recording, subjects rated themselves more highly than when they thought their answers would be shared only with people who hadn't heard them sing. "They're trying to repair the damage," Dr. Leary says. He didn't look specifically at couples in that study but says spouses who have been embarrassed by a partner will try to repair their own images after the mortifying fact, just as if they had embarrassed themselves.
So what can you do when your partner embarrasses you? Start by asking: Is it really that bad? Remember, everyone's partner eventually says or does something humiliating. And most of the time, we are way more self-conscious about our spouse's foibles than others are.
Is the behavior simply the result of who your partner is? A spouse who is withdrawn at a social gathering may be shy. Let isolated incidents go. If you try to change your spouse, you will only be creating a problem where one didn't exist.
What about repeated behavior? Dr. Leary says it's OK to raise the topic with your partner, "just as you would report any inappropriate behavior, such as, 'I wish you'd pick up your socks.' " Timing is critical. Wait for a neutral moment, not right before you arrive at a party. Focus on other people's reactions, not your own. If the behavior seems deliberate, or recurs so that you are fighting constantly, you should consider marriage counseling, Dr. Leary says.
Ms. Phillips says she has unintentionally embarrassed her husband a few times, including when she showed her friends some love poems he had written. And Mr. Wadds, a project manager for a glass and aluminum company, has been known to embarrass his wife, usually by being too quiet at her family's parties. Part of the problem, Ms. Phillips says, is that she is a chatty American and he is a reserved Brit.
The day after she shared the story of their hiking exploits, though, Ms. Phillips vowed to think twice before revealing private details of her marriage again. "This is my second marriage, and I don't want to blow it," says the 48-year old corporate training consultant.
The couple created their own guidelines for discussing an embarrassing event. They have agreed never to use "hateful" language. They make sure to apologize when they realize they have made their partner uncomfortable. "We always say, 'What is the outcome I want?' " Ms. Phillips says. "I want to have a loving relationship and I want it to last."
"And we learned to laugh about it—that you're still getting embarrassed at 50," Mr. Wadds says.
—Write to Elizabeth Bernstein at Bonds@wsj.com or follow her column at www.Facebook.com/EBernsteinWSJ. Fatty Liver Disease: More Prevalent in Children
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A type of liver disease once thought to afflict primarily adult alcoholics appears to be rampant in children.
Some 1 in 10 children in the U.S., or more than 7 million, are thought to have the disease, according to recent studies.
The condition, in which the normally rust-colored organ becomes bloated and discolored by yellowish fat cells, has become so common in non-drinkers that it has been dubbed nonalcoholic fatty liver disease.
The disease's prevalence is alarming doctors who worry about its progression to nonalcoholic steatohepatitis, or NASH, when the fatty liver becomes inflamed and cells are damaged. That leads to the end stage of cirrhosis, when the liver forms scar tissue and ultimately stops working.
Organ Damage
Some facts about nonalcoholic fatty liver disease:
- About 10% of children in the U.S. are thought to have the condition.
- Several factors likely contribute, including genetics, obesity, diet and insulin resistance.
- It has no detectable symptoms.
- Weight loss is the standard treatment for earlier stages of liver disease.
Source: Miriam Vos, Emory University
The condition's rise is tied to the obesity epidemic—about 40% of obese children have it—but isn't caused solely by being overweight. The disease appears to be growing among normal-weight children too, experts say.
And even though obesity rates are starting to level off, the prevalence of fatty liver disease continues to rise, they say.
It also has no symptoms, which means a person could have it for decades without knowing.
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Cleveland Clinic The Cleveland Clinic's Pediatric Preventive Cardiology and Metabolic Clinic treats and studies nonalcoholic steatohepatitis (NASH).
"The disease is very silent," said Naim Alkhouri, director of the Pediatric Preventive Cardiology and Metabolic Clinic at the Cleveland Clinic.
Because fatty liver disease has been recognized only fairly recently in children, it's unclear how the disease progresses into adulthood. Roughly 10% of people with fatty liver disease will develop NASH; another 15% to 20% of those will get cirrhosis. While the early stages of fatty liver disease and NASH are reversible, cirrhosis is not.
"This is just really worrisome to have this number of children who have a disease this severe," said Miriam Vos, a pediatrics professor at Emory University School of Medicine who studies and treats kids with fatty liver disease.
In a study published this year, Dr. Vos and her colleagues looked at data from a national health study for elevated liver enzymes, a sign of fatty liver disease. The percentage of children in the sample suspected of having the disease grew to 10.7% between 2007 and 2010, from about 4% between 1988 and 1994.
In the last decade, more scientists have started studying fatty liver disease and NASH, trying to figure out who gets them and why. Last week, the U.S. Food and Drug Administration held a two-day meeting to discuss with industry and other stakeholders the best way to study new treatments and speed up clinical trials.
NASH, the inflamed fatty liver condition, is currently the third-most-common reason for liver transplants, behind alcoholism and hepatitis C. Experts expect it will eclipse the other two by 2030. The liver helps digest food, absorb nutrients and expel toxins from the body.
It's likely there are multiple factors that worsen fatty liver disease. Early research shows that the disease is partly genetic but likely needs to be triggered by environmental conditions, like obesity or insulin resistance. Much of the current research has focused on genes and specific nutrients in the diet that might cause the disease. One culprit is fructose, a type of sugar found in corn syrup and fruit juice, which are widely consumed in western diets, according to Dr. Vos's research.
Some imaging studies of children born from obese women show that even the infants have more fat on their liver.
Also, certain ethnic groups, including Mexican-Americans, appear to be particularly susceptible, whereas African-Americans appear more protected against fatty liver disease, even though rates of obesity are high in the U.S. population. Scientists have discovered several genes linked to the disease. At least one, PNPLA3, appears more often in the Mexican-American population, according to Dr. Vos.
Usually fatty liver disease is detected when other health problems arise. Obesity, insulin resistance or diabetes may prompt a doctor to order blood work to determine how the liver is functioning.
Sherry Waskowski's son Gregory was 12 when he was diagnosed with fatty liver disease two years ago. He had gone to see a doctor for his long-standing acid reflux, but because he was overweight, the physician checked his cholesterol levels, blood sugar, and—unbeknown to Ms. Waskowski—his liver enzymes, his mother says. His liver enzymes came back elevated and the ultrasound that followed glowed bright, indicating an accumulation of fat.
"It was very frightening and I felt so totally responsible," Ms. Waskowski says.
The medical team educated the Waskowskis, who live in Cleveland, about the condition and what Gregory needed to do to reduce his weight, which is the primary recommendation for treatment. He now exercises five hours a week, mostly by walking on the treadmill, and eats more fruits and vegetables. The Cleveland Clinic's Dr. Alkhouri, one of his doctors, wrote a note to his school advising against excess snacking there for Gregory.
Gregory's weight is now in the normal range and his last ultrasound, in March, showed his liver had much less fat, according to Ms. Waskowski.
There's a debate in the field about whether kids should be routinely screened for the condition and, if so, the best way to do it, Dr. Alkhouri says.
While elevated liver enzymes can be a sign of the disease, hepatitis C and other metabolic liver diseases must be ruled out first. Ultrasound helps detect the presence of fat on the liver, but is expensive. The best way of diagnosing a fatty liver is to take a sample of the liver with a biopsy, but this procedure can be painful and has side effects.
Researchers are trying to identify biomarkers detectable through breath or blood samples instead. At a major conference in the field called Digestive Disease Week, Dr. Alkhouri and his colleagues presented the results of a pilot study. It showed that different concentrations of chemicals were found in the breath of obese kids with fatty liver disease compared with those without. If the test is validated upon further study, it may be useful clinically in several years, he says.
Treatments for fatty liver disease are limited. They include weight loss through diet and exercise. Another way to battle the condition is vitamin E, an antioxidant found in supplements and foods including eggs and some leafy vegetables like spinach, that helps to reduce inflammation in adults and children with NASH, according to Joel Lavine, chief of Gastroenterology, Hepatology and Nutrition at Columbia University.
Several trials are under way for treatments for pediatric NASH. The National Institute of Diabetes and Digestive and Kidney Diseases is sponsoring one study and co-sponsoring another.
Bariatric surgery is also being studied as a possible treatment, though it's controversial because no randomized studies exist looking at NASH. Preliminary data from the Cincinnati Children's Hospital Medical Center—not yet published—suggest the procedure is very effective in adolescents with NASH, according to Stavra Xanthakos, medical director of the Surgical Weight Loss Program for Teens there, who collected data.
"If you could mimic the effect of surgery without going through the surgery, that's where a lot of interest is," said Dr. Xanthakos.
Write to Shirley S. Wang at Shirley.Wang@wsj.com
A 13th-Floor Condo? No Such Luck
Although most people don't believe the myth of unlucky 13, less than 5% of residential condo buildings in Manhattan and Brooklyn have a designated 13th floor.
When construction is complete on 56 Leonard Street, a 60-story skyscraper in Manhattan's TriBeCa neighborhood, amenities will include an indoor/outdoor theater, 75-foot lap pool, library lounge and private dining salon. What it won't have: a 13th floor.
"I'm not particularly superstitious myself, but not having a 13th floor is a no-brainer," says Izak Senbahar, the building's developer and president of Alexico Group. "You don't want to preclude anyone, a buyer who happens to be superstitious. It boils down to that."
Lucky 13
Dorothy Hong for The Wall Street Journal
![[SB10001424127887324886704579053302037770652]](http://s.wsj.net/public/resources/images/OB-YT612_0906th_D_20130903152939.jpg)
The Studio Building on Manhattan's Upper West Side, shown here, is one of the few residential buildings in New York City with a designated 13th floor.
Although academic research shows the vast majority of people don't buy into the idea of unlucky 13, less than 5% of mid- and high-rise residential condo buildings in Manhattan and Brooklyn have a designated 13th floor, according to an analysis of roughly 1,500 condo declarations by real-estate listings website CityRealty. In the rest, the 13th floor is labeled as the 14th, so no one in the building is saddled with the 13th-floor address.
Although most people don't believe the myth of unlucky 13, less than 5% of residential condo buildings in Manhattan and Brooklyn have a designated 13th floor. Sanette Tanaka and Pete Culliney, City Realty Director of Research and Analytics, join Lunch Break. Photo: Getty Images.
Extell Development Co. left floor 13 out of the Aldyn and the Rushmore, both high-end, glassy condos completed in the past decade. Related Companies plans to omit the 13th floor in the residential towers of its Hudson Yards complex. A number of other high-profile projects, such as 432 Park Avenue and One57, both in Midtown, bypass the issue, because the residential floors will begin higher than the 13th floor; the lower floors will be occupied by commercial spaces.
The decision to omit the 13th floor occurs well before ground is broken. Both developers and marketers discuss floor layouts in initial planning meetings, but the developer has the final say. Then, if the 13th floor is omitted, developers work off two sets of plans—technical plans that show a 13th floor and marketing plans that don't.
"If there's even a 1% risk that someone won't like it, then why would you do it? It's a simple change to the numbers," says Kevin Maloney, principal at Property Markets Group, a New York City-based real-estate acquisition and development firm. "It also makes a building seem a little bit taller, which is important in New York. You get an extra floor."
Older buildings and co-ops are more likely to feature a designated 13th floor, though the exact number is hard to calculate, since co-op information isn't made public, says Pete Culliney, director of research and analytics at CityRealty.
"Most new buildings don't have a 13th. It goes from 12 to 14," says Lisa Lippman, associate real-estate broker at Brown Harris Stevens.
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Still, when they do come on the market, 13th-floor units aren't particularly difficult to sell, Ms. Lippman says. She recently sold a two-bedroom apartment in an Upper West Side co-op for roughly $4.2 million, just under the asking price. Kelly Robinson of Town Residential, who represented the buyers of the apartment, said her clients saw it as a nonissue. Throughout the process, Ms. Lippman says no one even mentioned the 13th floor.
Units on floor 13 seem to do just as well as ones on neighboring floors, says Jonathan Miller, a New York City-based appraiser and president of Miller Samuel Inc. "I've done lots of floor-level studies, and I haven't seen anything that suggests it sways consumer behavior or impacts value or marketability," he says.
Still, Mr. Miller says he believes it is prudent to omit the 13th floor. "Why take a chance if maybe that one buyer has a problem with it?" he asks.
Frederico Sève, an art dealer, is trying to sell a three-bedroom penthouse on the 13th floor on Manhattan's Upper West Side. Listed for $15.5 million, the unit is in a co-op building with a full-time doorman, playroom and central laundry room, and has been on the market for about a year. The listing agent, Monica Luque of Douglas Elliman, says one feature has been mentioned by every potential buyer: It's on the 13th floor.
The myth of unlucky 13 has multiple origins. In the Christian tradition, some people trace it back to the Last Supper, where Jesus shared the table with his 12 disciples. Judas, the disciple who betrayed Jesus before his crucifixion, is considered the 13th guest. The superstition spread to Christian areas as well as non-Christian areas, says Phil Stevens, associate professor of anthropology at the University of Buffalo who studies superstitions.
In real estate, marketers and residents have their own 13th-floor horror stories. Philip Spiegelman, co-founder and principal of International Sales Group, a sales and marketing firm for developers, recalls a Miami residential building in the early 1970s where none of the 13th-floor units sold until he finally renumbered it six months later. Jennifer Dorfmann, executive vice president and managing director of sales at residential brokerage Modern Spaces, spoke of a high-profile Manhattan building where the units on the 13th floor were the last to sell.
Former New York resident Carole Shanis believes omitting the 13th floor creates more trouble than not. During the city's blackout of 1977, Ms. Shanis got confused in the stairwells as she tried to find her 14th-floor unit. "I got off at the floor I thought I lived on, and I couldn't find my apartment," she says. "Then I realized I was on the wrong floor. I got off at 14, but it wasn't really 14. I actually lived on 13."
Now Ms. Shanis, a former interior designer, lives in a 6,000-square-foot duplex in Philadelphia that spans both the 13th and 14th floors. On floor 13, she and her husband knocked down walls to create a large living and entertaining space. "I've never really thought about it in terms of being unlucky. Great things have happened on that 13th floor," she says.
Toll Brothers' TOL -2.44% One Ten Third, a 21-story luxury condo in Manhattan's East Village, was built six years ago and includes a designated floor 13. And Toll Brothers' two newest planned buildings, in Midtown East and SoHo, will also have a 13th floor. "I think it's a silly thing to be afraid of," says David Von Spreckelsen, division president of Toll Brothers City Living in New York.
In Chicago, real-estate agent Jenna Smith of Redfin says 13th floors are fairly common. A few years ago, she sold a 13th-floor apartment in the Fulton River District to Tony Guth, a manager at an audit, tax and advisory firm. He says he didn't really register the floor number until moving in. Then every few weeks, a neighbor or stranger would comment—" 'Ooh, number 13,' or something like that," Mr. Guth says. What's worse, the 13 button in the elevator is backlit in green, while every other number is backlit in red. (His wife says it's coincidental.)
Mr. Guth says he's not superstitious. "I don't have any lucky numbers. I was born on April 13. I have had birthdays on Friday the 13th. I've taken flights on Friday the 13th," he says. Still, he was a little concerned when he put his unit on the market in July, also with Ms. Smith.
Luckily, it went under contract days later for $465,000, pretty much in line with the asking price. "That kind of alleviated our concerns about any negative stigmas of being on the 13th floor," he says.
Mr. Miller, the appraiser, says New Yorkers are unlikely to see a change in their building specs anytime soon. The superstition has "taken on a life of its own," prompting some developers to even drop the fourth floor, which is unlucky in Chinese culture. Scheduled for completion in October, the 15-story Vista in Long Island City, Queens, for instance, omits both the 13th and fourth floors.
Still, some developers, including Mr. Senbahar of 56 Leonard, say they draw the line at omitting the fourth: "That's going a little overboard for me," he says.
A sampling of New York City residential buildings that don't have a designated 13th floor.
*under construction .
How to Get Investment Advice for Less Online
Young companies use computer algorithms to suggest and in some cases oversee portfolios of ETFs and mutual funds
Thinking of sitting down with a financial adviser to review your investment strategy? You might consider sitting down in front of your computer instead.
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A group of mostly startup companies—including Wealthfront Inc., Personal Capital Corp., Jemstep Inc. and FutureAdvisor—now offer services that use computer algorithms to suggest and in some cases oversee portfolios of exchange-traded funds and mutual funds at a lower cost than hiring a financial adviser to meet with you one-on-one.
It's a nascent but fast-growing industry, propelled by hundreds of millions of dollars in venture capital and a confluence of technological changes that have helped turn the often opaque world of money management into a breezy online experience with colorful graphs—and plenty of advice.
Richard Borge
"I've been watching this space for more than 10 years and I've seen this movie before," says Bill Doyle, a principal analyst at Cambridge, Mass.-based Forrester Research FORR +0.43% . "I'm paying a lot more attention this time around because the software required to transform this industry finally works."
There are other factors fueling the fire: For younger investors, it's almost second nature to embrace online tools. And "the financial crisis created a lot of disgruntled investors" who may be open to alternatives to traditional companies, says Grant Easterbrook, who follows the industry as a senior research associate at Corporate Insight, a research and consulting firm in New York.
Some of these firms are backed by big names. Burton Malkiel, a Princeton University economist and author of the investing classic "A Random Walk Down Wall Street," leads Wealthfront's investment team, while distinguished investor Charles Ellis, author of "Winning the Loser's Game," is an adviser. Personal Capital's chief executive, Bill Harris, headed PayPal Inc. and Intuit Inc. Betterment LLC has Steve Lockshin, founder of Convergent Wealth Advisors, as an adviser. Jemstep has a partnership with Windham Capital Management LLC, an asset-management firm for institutional investors.
Old-school financial advisers will tell you these services won't give you a holistic, tailored financial plan, which is true. A financial planner will spend hours getting to know your specific situation. Of course, they may charge a middle-income client around $200 to $300 an hour, or 1% or more of assets annually, to do it.
But for investors who either can't or won't go to a traditional advisory firm—maybe because of a small account balance or distrust of established providers—online services could offer big benefits at a fraction of the cost.
How They Work
Many of these online services aim to act like an investment adviser by either evaluating and advising you on your current investments or managing your money for you.
Richard Borge
Firms like Wealthfront and Betterment fall into the latter category. They will invest your money in one of a number of portfolios made up of ETFs at a cost of about 0.15% to 0.35% of assets annually. Exactly which portfolio usually depends on your answers to a short set of questions related to your finances, goals and tolerance for risk.
Generally, your account is rebalanced for you, so that your asset mix stays close to the original plan without you having to push yourself to sell securities that have gone up in value and buy those that have fallen. Some offer tax-loss harvesting—that is, selling securities that have dropped in value to recognize losses that can offset taxable gains in your portfolio.
Services such as Wealthfront and Betterment, which have about $300 million and $250 million in assets under management, respectively, can get investors into low-cost, diversified portfolios and provide continuing oversight that helps control risk and taxes. But many of these tools don't consider your overall financial life; you are simply investing one chunk of money.
Other companies, such as Jemstep, Personal Capital and FutureAdvisor, are aggregators: You provide login information for your brokerage and retirement accounts, and these services display and analyze all your holdings together. They may tell you which investments to buy or sell, based on your goals, financial situation and risk tolerance.
Most of these companies offer a large chunk of their online advice free, and then charge for additional services. Jemstep, for example, offers free asset-allocation advice based on your current holdings and retirement goals, but charges for buy/sell advice on specific investments, plus other services. Jemstep's fee starts at $216 annually for customers with assets of $25,000 to $150,000 and increases for larger accounts. Personal Capital and FutureAdvisor, meanwhile, offer account-management services for a fee.
Some of these firms include access to a financial adviser, often by email or phone, as part of their paid service—or even free, in some cases. Investors who link accounts with $100,000 or more through Personal Capital's free aggregation service, for example, can talk with an adviser at no charge.
As with traditional advisers, portfolio suggestions will vary by company, as this writer found. For my retirement portfolio, Personal Capital suggested I increase my U.S. and international stock exposure. Jemstep said I'm weighted too heavily in U.S. stocks and should increase my allocation to international equities. FutureAdvisor suggested I increase my exposure to international real-estate investment trusts, emerging markets and small-cap stocks.
SigFig Wealth Management LLC's service, known as SigFig, wanted to move me into some different (often higher cost) funds that had significantly outperformed my holdings over the recent three-year period.
Do Your Homework
Evaluating an online asset manager may mean testing its free product to see whether the investment strategy suits you. Betterment's current bond-fund selection, for example, is limited to ETFs that hold short-term Treasurys and Treasury inflation-protected securities, though the company has said it will soon add five more bond ETFs.
Advice might vary, too, because each company uses a different measure to gauge your needs. Wealthfront has a 10-question tool. Betterment asks questions about your risk tolerance and goals. SigFig evaluates your needs based on what it can glean from the investment accounts you link to it.
Mr. Easterbrook warns investors that unless the online service they are using includes access to a financial adviser, the advice they are getting is based on limited information. "These questionnaires do a horrible job of understanding what your financial situation is," he says.
The companies say online investors won't stick around for an in-depth intake form, and that they base their advice on more than questionnaires—for example, they look at the investor's age and current allocation, which they see as a signal of risk tolerance.
When choosing a service, ask yourself what you want: a service to handle a portion of your investment portfolio (say, a cash inheritance) or advice on your entire financial outlook? Are you happy working only with an online interface, or do you want the option of talking to a professional should the need arise? Companies such as LearnVest and RebalanceIRA, for example, focus on the adviser relationship.
This is a fast-changing niche, so watch for new arrivals, departures and product evolution. In July, Bloomberg LP withdrew a pilot online-advice product called BloombergBlack, and in August LPL Financial Holdings Inc. said it would close Nestwise, its online adviser service. Some of the other startups say they are launching new or expanded services in coming months.
"Ten years out, this is going to be a different market," says Mr. Doyle. Younger investors, who by then will be older and wealthier, "have a different set of preferences," he says.
Ms. Coombes is a writer in San Francisco. Email her at reports@wsj.com.
What Is a Hedge Fund, Anyway?
We explain the basics as a longtime ban on advertising ends
Ask 10 investors to define "hedge fund" and you're likely to get 10 different answers.
Podcast
Daisy Maxey tells WSJ's Mathew Passy what hedge funds are as we prepare for them to start advertising to the general public.
The catchall term is used to describe an industry with an estimated $2.4 trillion in assets and an array of portfolios that feature dramatically different investment strategies, tolerance for risk and goals for returns.
"It's a misguided term that tells you nothing" about the manager's investment approach, says Jason Gerlach, president of the California Hedge Fund Association and managing director at hedge-fund firm Sunrise Capital Partners LLC in San Diego.
Instead, the term generally refers to the structure of the investment: "It generally means a private investment partnership" instead of, say, a mutual fund, Mr. Gerlach says.
Though long viewed by many as secretive instruments offered only to the extremely wealthy via privileged connections or exclusive websites, hedge funds are about to come out of the closet: An 80-year-old ban on hedge-fund advertising is falling away, and some of these private investment pools are gearing up to launch ad campaigns—likely as early as this month.
Mysterious for a Reason?
Some believe the advertisements will help demystify the strategies used by hedge-fund managers. "Hedge funds are often raked over the coals because they're mysterious, but they're mysterious because regulators don't let them talk," says Mitch Ackles, president of the Hedge Fund Association and chief executive of Hedge Fund PR LLC, a strategy and marketing company.
Bloomberg News
Hedge-fund manager John Paulson reaped huge gains betting against subprime mortgages in 2007 and 2008.
The term "hedge fund" was reportedly first used by Alfred Winslow Jones, a sociologist and financial journalist who created an investment partnership in 1952. Mr. Jones used leverage—that is, borrowing—to increase his investment exposure, and sold short what he believed to be overvalued securities in an attempt to "hedge" the market and profit regardless of whether it rose or fell.
Today, hedge funds still generally employ a hedging technique—counterbalancing one investment against another—but even that is not always the case, says Josh Charney, a fund analyst at investment-research firm Morningstar Inc. "That was the first purpose of a hedge fund, to hedge and offer some safety, but over time it has strayed from that original definition," he says.
But hedge funds still typically have more-flexible investment strategies than mutual funds. They may have higher leverage, for instance, or invest heavily in illiquid holdings such as art, antiques or thinly traded securities.
For these more aggressive tactics, the funds typically charge steeper fees than do mutual funds, generally an asset-management fee of 1% to 2% and a performance fee of 20% of the fund's profit annually.
In an effort to protect investors with limited means, hedge funds are closed by federal securities law to all but "accredited" investors—which includes individuals with an annual income that exceeds $200,000 for the past two years or a net worth exceeding $1 million excluding their primary residence. In addition, the funds generally require minimum investments of at least $250,000 and limit how frequently investors may withdraw cash.
Hedge Fund Research Inc.'s HFRI Fund Weighted Composite Index, a broad proxy for the hedge-fund universe, gained 3.8% this year through August (net of fees), while the S&P 500 index gained 16.2% with dividends and the Barclays Government/Credit Bond Index shed 3.2% over the same period, according to HFR. For the five years through August, the HFRI Fund Weighted Composite Index gained an annualized 3.4% while the S&P 500 index gained 7.3% with dividends.
Range of Volatility
Investors generally look to the funds to reduce volatility. But prospective investors should understand that just as some hedge-fund strategies may enhance returns, they may also amplify losses, and some strategies are more volatile than others.
"Investors have to judge each fund individually because fund managers may be doing vastly different things," says Mr. Ackles.
"Relative value" arbitrage strategies account for about 27% of industry assets, according to HFR. Managers of relative-value funds will simultaneously buy markets or investments expected to appreciate, while selling related securities expected to depreciate, seeking to profit from their relative value. That allows the funds to generate returns with little correlation to markets. Such strategies can be executed with convertible bonds, preferred securities, options, warrants and other instruments.
As Hurricane Katrina bore down on the U.S. in the summer of 2005, for example, some hedge-fund managers owned short-term contracts on oil and gas, a bet that prices would rise soon. But they also took bearish positions on longer-dated contracts, a bet that the prices would fall in coming months.
Relative-value arbitrage funds may employ lots of leverage, which can result in big gains or losses. Long-Term Capital Portfolio LP, which famously collapsed in 1998, was a relative-value fund.
This year through July, the HFRI Relative Value (Total) Index has gained about 3.6%, according to HFR.
Then there are event-driven hedge funds, which invest in securities that may be affected by corporate activity such as bankruptcies, mergers, reorganizations and hostile takeovers. Managers of these funds seek to predict the relative movement of the securities involved. A manager may invest, for example, in the stock of a company that is being acquired while also selling short the stock of the acquiring company. Event-driven strategies that focus on companies in financial trouble are often referred to as distressed investing.
Among event-driven funds are the Paulson Advantage and Advantage Plus funds run by billionaire John Paulson.
Event-driven funds fared well in the first half, partly due to a dynamic merger-and-acquisition and corporate-actions environment, according to HFR. The HFRI Event-Driven (Total) Index gained 6.9% this year through July. Funds using these strategies account for about 26% of industry assets, according to HFR.
Next in size, with about 21% of industry assets, HFR says, are so-called macro strategy hedge funds, which, as their name suggests, invest with a broad outlook that tries to anticipate changes in economic trends and policy decisions.
Some of the funds that use a macro strategy invest in stocks, bonds, currencies and commodities, and may shift their exposure to asset classes and countries rapidly. Such funds often employ leverage and derivatives to enhance the impact of market moves, and their returns may be very volatile as a result.
Global macro investing is one of the best-known hedge-fund strategies, partly because it has been employed by well-known managers such as George Soros and Julian Robertson.
Many macro hedge funds were popular in the 1990s and posted big gains during the 2008 financial crisis. This year through July, the HFRI Macro (Total) Index has slipped 0.95%, according to HFR.
Ms. Maxey is a special writer for The Wall Street Journal in New York. Email her at daisy.maxey@wsj.com.
Elizabeth Holmes: The Breakthrough of Instant Diagnosis
A Stanford dropout is bidding to make tests more accurate, less painful—and at a fraction of the current price.
Palo Alto, Calif.
'The reality within our health-care system today is that when someone you care about gets really sick, by the time you find that out it's most often too late to do anything about it. It's heartbreaking. Because in those moments, there's nothing you wouldn't do to change it, and too often you're helpless," says Elizabeth Holmes. "We're finding cancer when you have a tumor, or heart disease by virtue of the fact that you're having a heart attack."
She wants to change that.
Ms. Holmes, a 29-year-old chemical and electrical engineer and entrepreneur, dropped out of Stanford as an undergraduate after founding a life sciences company called Theranos in 2003. Her inventions, which she is discussing in detail here for the first time, could upend the industry of laboratory testing and might change the way we detect and treat disease.
Ten years ago, Ms. Holmes was working out of the basement of a group college house, a world away from her current headquarters at a rambling industrial building in a research park just off campus. The company's real estate was one of the few Theranos facts known to Silicon Valley, but one suggestive of the closely held business's potential: The space was once home to Facebook, and before that Hewlett-Packard.
The secret that hundreds of employees are now refining involves devices that automate and miniaturize more than 1,000 laboratory tests, from routine blood work to advanced genetic analyses. Theranos's processes are faster, cheaper and more accurate than the conventional methods and require only microscopic blood volumes, not vial after vial of the stuff. The experience will be revelatory to anyone familiar with current practices, which often seem like medicine by Bram Stoker.
Fred Harper
A Theranos technician first increases blood flow to your hand by applying a wrap similar to one of those skiing pocket warmers, then uses a fingerstick to draw a few droplets of blood from the capillaries at the end of your hand. The blood wicks into a tube in a cartridge that Ms. Holmes calls a "nanotainer," which holds microliters of a sample, or about the amount of a raindrop. The nanotainer is then run through the analyzers in a Theranos laboratory. Results are usually sent back to a physician, but a full blood work-up—metabolic and immune markers, cell count, etc.—was in my inbox by the time I walked out the door. (Phew: all clear.)
It's the kind of modern, painless service that consumers rarely receive in U.S. health care, though Ms. Holmes makes the point the other way around: "We're here in Silicon Valley inside the consumer technology world . . . and what we think we're building is the first consumer health-care technology company. Patients are empowered by having better access to their own health information, and then by owning their own data."
And a Theranos clinic may be coming soon to a pharmacy near you. On Monday the company is launching a partnership with Walgreens for in-store sample-collection centers, with the first one in Palo Alto and expanding throughout California and beyond. Ms. Holmes's long-term goal is to provide Theranos services "within five miles of virtually every American home."
Diagnostics is one of those corners of the health markets that is more irrational the closer you look. Tests account for between 2% and 2.5% of health spending, but Ms. Holmes notes that they drive an estimated seven or eight of every 10 clinical decisions by physicians, with 6.8 billion lab tests annually in the U.S.
"The art of phlebotomy originated with bloodletting in 1400 B.C. and the modern clinical lab emerged in the 1960s—and it has not fundamentally evolved since then," she says. The billions of tests generally follow the same ritual: In a hospital or clinic, "you go in, sit down, they put a tourniquet on your arm, stick you with a needle, take these tubes and tubes of blood," as Ms. Holmes describes it.
The specimens are then transported, via a courier or hospital pneumatic tube, to a centralized lab, where they are manually removed from the tubes with a pipette and mixed with a chemical reagent or sent through instruments like a centrifuge or mass spectrometer. After days or weeks of waiting, your doctor finally gets the results.
One major problem, Ms. Holmes says, is that physicians rarely have "the best actionable information to make the best possible diagnosis at the time it matters." She posits a hypothetical patient whose doctor orders a test and discovers that she has a dangerously low hemoglobin count, so he puts her on an anti-anemia drug. He must order another test to find out what kind of anemia she has, and days later it turns out to be merely an iron deficiency. The best final treatment was actually "take some iron pills or eat more spinach."
Theranos's technology eliminates multiple lab trips because it can "run any combination of tests, including sets of follow-on tests," at once, very quickly, all from a single microsample. Ms. Holmes estimates that patients and doctors will receive readouts in "as little as two hours" and can even do so before an office visit based on their physician's recommendation for better, or at least less ad hoc, consultations.
Only about 62% of tests that doctors order are ultimately carried out, according to health-policy researchers at the Lewin Group. One reason tests aren't performed: not enough blood. To ensure that labs don't reject samples, several studies have documented that medical institutions sometimes collect as much as 45 times the amount of blood from patients that conventional tests actually require.
Luckily, blood is a renewable resource, though the small Theranos sample size is a particular advance for the elderly, for whom blood draws can be agony because of collapsed veins. It's also good news for children who fear needles, and for oncology patients, whose blood is being constantly tested.
Another Theranos advance is its testing's accuracy. Ms. Holmes believes the chain of conventional laboratory custody introduces too many opportunities for error, "which is basically wherever humans are involved." The integrity of lab specimens can be contaminated if they sit too long on the bench, or if they're mistakenly processed by a tech, or by temperature, and so forth.
A 2002 review in the journal Clinical Chemistry found error estimates ranging from one out of every 33-50 tests to one of every 8,300, though the rate has likely since improved. The same sample sent to two different labs can yield two varying results, and the same lab testing the same sample twice can yield different results too.
That's because the precision of lab instruments, and their reference ranges, vary from manufacturer to manufacturer. Labs buy from different vendors and often don't calibrate the machines to each other. Certain tests may be reported with fairly wide margins of error, such as a plus-or-minus 30% of allowable error for HDL cholesterol. Ms. Holmes notes that a measurement that is essentially a 60% error range isn't very useful, especially over time, since disease itself is a progression over time.
Theranos's technology is automated, standardized, and attempts to subtract human error from the process. It can thus achieve much lower variance ranges for a given test. Ms. Holmes says its tests have margins of "allowable error" targets less than 10%.
The medical promise of this speed and better information means catching disease in its earliest stages before the onset of symptoms. The company's analytic tools might also help realize the possibilities of truly personalized medicine, as scientists gain a better understanding of the heterogeneity of disease and how to treat individuals based on their own bodies, not large averages.
Theranos's tools may also allow doctors to analyze data "longitudinally"—to see trends, clusters and rates of change that they can't now. Medicine would ask fewer on-off, do-you-have-this-disease-or-not questions, and instead "meaningfully and powerfully answer the question of how to detect and manage these diseases early on," says Ms. Holmes.
She first funded Theranos at age 19 by cashing out an education trust that her parents set up, which allowed her to hire her first employee and rent lab space. Later rounds of funding were raised from venture capital and private equity. Once Theranos was more established, it started to earn revenue from contracts conducting pharmaceutical testing in cancer drug and other clinical trials.
A word about costs and what that investment bought, which doesn't follow the usual rules about a new medical technology. Ms. Holmes says Theranos can conduct a battery of tests for "tens of dollars," a phrase that does not exist in U.S. health care. She calls it "a watershed opportunity to change the trajectory of health costs through price transparency."
Since 1984, the Medicare Clinical Laboratory Fee Schedule has set reimbursements for 1,140 unique lab tests across 57 U.S. jurisdictions. That's 64,980 different price controls. Meanwhile, the prices that private insurers negotiate with providers are virtually trade secrets.
Theranos is committing to a half-off discount on Medicare fees. "So a test that costs $100 now, we'll do $50 or less. The quote-unquote payer community I don't think has ever seen someone walk in and say we want to bill you at less than you're willing to reimburse," she says. If this strategy succeeds in squeezing down prices—say, lowering testing as a share of total health costs to 1.5% from 2.3% now—it could save Medicare $61 billion over 10 years and Medicaid $96.1 billion, according to what Theranos calls a conservative estimate.
Ms. Holmes says her larger goal is increasing access to testing, including among the uninsured, though she might also have a market-share land grab in mind. For instance, she says Theranos will publish all its retail prices on its website. The company's X-ray of self-transparency also includes reporting its margins-of-error variations online and on test results and order forms, which few if any labs do now.
This strategy may be inviting a hell of a battle with the health industry, where the incentives are rigged against startups and the empire usually finds a way of striking back. Witness the medical-practice regulations that make medicine a cartel against competitors. Pathologists, lab scientists and technicians won't be pleased if their jobs go the way of travel agents.
Ms. Holmes declines to discuss Theranos's future plans, though one may speculate. There could be military applications in the battlefield, especially given the numerous framed American flags across the Theranos office and the presence on its corporate board of retired Gens. Jim Mattis and Gary Roughead, former Defense Secretary Bill Perry and former Secretary of State George Shultz.
The other obvious tech reality is that the devices keep shrinking, and over the last several years Theranos has been granted several patents for portable diagnosis system at the point of care. One of them even invokes—forget the iWatch—a wearable diagnostic device that would attach to the body with silicon microneedles "about the size of a human hair."
The biggest question is whether Ms. Holmes has discovered one of those often promised, more often elusive disruptive innovations designed to cut costs while improving quality. In a conversation about a year ago, Secretary Shultz said Ms. Holmes could be "the next Steve Jobs or Bill Gates."
When I put it to him again on my recent visit, he smiles slyly. "This is not the last thing she's going to invent or create."
Mr. Rago is a member of the Journal's editorial board.
Should Students Use a Laptop in Class?
Is it OK to use a smartphone in class, email an instructor, record a lecture? A professor offers lessons.
There's a widely shared image on the Internet of a teacher's note that says: "Dear students, I know when you're texting in class. Seriously, no one just looks down at their crotch and smiles."
College students returning to class this month would be wise to heed such warnings. You're not as clever as you think—your professors are on to you. The best way to stay in their good graces is to learn what behavior they expect with technology in and around the classroom.
Too much texting in the classroom could jeopardize your academic future, says R.I.T. Assoc. Professor Evan Selinger. So before you post that status update, keep in mind these tips.
Let's start with the million-dollar question: May computers (laptops, tablets, smartphones) be used in class? Some instructors are as permissive as parents who let you set your own curfew. Others are more controlling and believe that having your phone on means your brain is off and that relying on Google for answers results in a digital lobotomy.
Professors are united, though, in the conviction that the classroom is a communal space and that students share the responsibility for ensuring that nobody abuses it by diminishing opportunities to learn. An instructor who lets you squander your tuition by using class time to fuss with your iPhone is likely to have zero tolerance for distracting activities that make it hard for the rest of the class to pay attention.
One of my colleagues has resorted to a severe policy that he calls the "Facebook rule," which turns the classroom into a wild west of bounty hunters and social media outlaws. Students are encouraged to earn extra credit by busting classmates who use their computers for activities like social networking, shopping or gaming during his lectures.
Other professors prefer imposing the scarlet letters themselves. One colleague became so fed up with a student who played games whenever the class went to a computer lab that he installed speakers on the offender's machine. Halfway through the class, the speakers got turned on and everyone stared as the post-apocalyptic sound track started blaring.
Peter Arkle
Ultimately, rule-breakers are their own worst enemies. Students may be savvy enough to text the occasional query to partners-in-crime during exams. But it is only a matter of time before the mute button isn't pushed and the whole class gets to hear your "I'm sexy and I know it" ringtone.
Emailing professors is another self-sabotaging land mine. Some instructors appreciate students who don't bother with formalities and shoot off quick, direct questions about an assignment or grade. Others, however, expect a formal greeting and sign off, and view the cut-to-the-chase approach as a rude affront that treats educational conversation like an automated customer-service call.
As for that funny personal email address you got because it seemed cool in high school, ditch it. Your note from lovetoparty@____.com is on a collision course with a spam folder. And if it does reach your professors, they may question your judgment and priorities. If you forget to include your name, you can expect a reply like: "Dear alwaysstoned@____.com, I guess we know the real reason you missed class."
To avoid the double whammy of irritating professors and peers at the same time, record classes only if you have explicit permission. Privacy concerns in the digital age extend beyond worries about sharing personal information. Complete transcripts of class discussions will make some peers feel like you're the NSA. And when a digital recording gets posted online, the whole class is at risk of having outside parties receive and misconstrue sensitive remarks. Recordings also make students self-conscious and less spontaneous, which ruins the free exchange of ideas.
As students consider how to use their devices in the classroom, they should remember, above all, that tuition merely gets them into the lecture hall. If they want college to culminate in life-changing courses, mentoring from dedicated teachers and compelling recommendations for the world after graduation, they will earn these things the time-honored way, with courtesy and hard work.
As for professors, we can make things easier for students by including detailed etiquette policies in our syllabi. Too many of us leave our likes and dislikes to be discovered by trial and error.
But even the most detailed code of conduct can't hope to specify or resolve every possible sticking point. Society writ large is constantly struggling to come to grips with technological disruption, and so too are the adults at the front of the college lecture hall and the wired, distracted young adults who are there to learn from them.
— Mr. Selinger is a professor of philosophy at the Rochester Institute of Technology and a fellow at the Institute for Ethics and Emerging Technology. A version of this article appeared September 7, 2013, on page C3 in the U.S. __._,_.___
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