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Librarians are like tour guides: They introduce children to worlds and books they may know nothing about. From books about sharks to graphic novels to anime to elementary school-appropriate "chick-lit," there is something for everyone. But without librarians there to introduce students to this material, books are just listless titles on the shelf.

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Guest Columnist Debbie Joseph is National Council of Jewish Women/Cleveland's former vice president of community service and co-chairs the nonprofit's Building Bridges with Books program. Her own passion for books has empowered her to reinvigorate libraries across the Northeast Ohio, one book at a time.
It's been said that the library is the heart of the school. But trust me when I say that not all libraries are created equal.

As someone who has always loved reading and libraries, I am disheartened by the current state of school libraries. Some only have part-time librarians and many don't have any staff at all. Books are dusty and outdated.

Of course, this isn't true of all school libraries, and I am proud to say I belong to a grassroots volunteer organization - the National Council of Jewish Women/Cleveland (NCJW) -- that improves school libraries. I chair NCJW's Building Bridges with Books project, and this program has one sole purpose: to reinvigorate libraries for under-served populations so that students are provided with a safe escape (through reading!).

We have donated more than 2,000 volunteer hours and 15,000 books to eight different school libraries in the past three years. Based on what we see when we enter a school, we reorganize, we add sections, we clean the space and the books, and we add to the catalog where we see the need.

Based on my experience, here are the top three characteristics of an exceptional school library:

1. A WONDERFUL LIBRARIAN

A full-time, trained librarian/media specialist with knowledge of the students in the school should be utmost on every school system's list of must-haves.

Librarians are like tour guides: They introduce children to worlds and books they may know nothing about. From books about sharks to graphic novels to anime to elementary school-appropriate "chick-lit," there is something for everyone. But without librarians there to introduce students to this material, books are just listless titles on the shelf.

That may be why a 2013 study by the Pennsylvania School Librarians Association (PSLA) found that reading and writing scores are consistently better for students who have a full-time certified librarian at their school over those who don't.

2. DIVERSE BOOKS

Think only "diverse populations" need books that present diversity? Think again.

Granted, it's vitally important for children to see themselves in the books around them. It's paramount to normalize race, religion, gender identity, body mass and a thousand other "differences" for children.

But it's also important for the children who may be in the majority to see others as commonplace.

In a more homogenous school -- maybe especially in a more homogenous school -- books that embrace diversity should be plentiful and presented as the norm. Our future adults -- these children -- will be able to accept others more easily if they see diversity at a young age.

3. AREAS OF COMFORT

A clean rug or carpet square. Beautiful posters or framed book covers. Clear and colorful signage. Low-slung couches or chairs for the older children. Once a student gets the right book in his or her hands, a comfy place to dive in completes the experience. Too often, library furniture is old and dirty or nonexistent. To encourage a love of reading, the space matters.

Books changed my life, and I know they can change others'. But in order for that to happen, people need to understand that libraries are as vital to a student's success as any other must-have school supply.
Have something to say about this topic? Use the comments to share your thoughts, and stay informed when readers reply to your comments by using Notification Settings (in blue) just below. Readers are invited to submit Opinion page essays on topics of regional or general interest. Send your 500-word essay for consideration to Ann Norman at anorman@cleveland.com. Essays must include a brief bio and headshot of the writer. Essays rebutting today's topics are also welcome.

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Good school libraries matter: Debbie Joseph (Opinion)

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Guest Columnist Debbie Joseph is National Council of Jewish Women/Cleveland's former vice president of community service and co-chairs the nonprofit's Building Bridges with Books program. Her own passion for books has empowered her to reinvigorate libraries across the Northeast Ohio,...

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Page 39

Parris, hushed: What book is that?

Mrs. Putnam: What's there, sir?

Hale, with a tasty love of intellectual pursuit: Here is all the invisible world,
caught, defined, and calculated. In these books the Devil stands stripped of all
his brute disguises. Here are all your familiar spirits - your incubi and succubi;
your witches that go by land, by air, and by sea; your wizards of the night and
of the day. Have no fear now - we shall find him out if he has come among us,
and I mean to crush him utterly if he has shown his face! He starts for the bed.

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American Association for the Advancement of Science

"The scientific evidence is clear: global climate change caused by human activities is occurring now, and it is a growing threat to society." (2006)³

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Climate Change: Vital Signs of the Planet

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It's important to remember that scientists always focus on the evidence, not on opinions. Scientific evidence continues to show that human activities ( primarily the human burning of fossil fuels) have warmed Earth's surface and its ocean basins, which in turn have continued to impact Earth's climate. This is based on over a century of scientific evidence forming the structural backbone of today's civilization.

NASA Global Climate Change presents the state of scientific knowledge about climate change while highlighting the role NASA plays in better understanding our home planet. This effort includes citing multiple peer-reviewed studies from research groups across the world, illustrating the accuracy and consensus of research results (in this case, the scientific consensus on climate change) consistent with NASA's scientific research portfolio.

With that said, multiple studies published in peer-reviewed scientific journals show that climate-warming trends over the past century are extremely likely due to human activities. In addition, most of the leading scientific organizations worldwide have issued public statements endorsing this position. The following is a partial list of these organizations, along with links to their published statements and a selection of related resources.

AMERICAN SCIENTIFIC SOCIETIES

Statement on Climate Change from 18 Scientific Associations

"Observations throughout the world make it clear that climate change is occurring, and rigorous scientific research demonstrates that the greenhouse gases emitted by human activities are the primary driver." (2009) ²

SCIENCE ACADEMIES

International Academies: Joint Statement

"Climate change is real. There will always be uncertainty in understanding a system as complex as the world's climate. However there is now strong evidence that significant global warming is occurring. The evidence comes from direct measurements of rising surface air temperatures and subsurface ocean temperatures and from phenomena such as increases in average global sea levels, retreating glaciers, and changes to many physical and biological systems. It is likely that most of the warming in recent decades can be attributed to human activities (IPCC 2001)." (2005, 11 international science academies)

U.S. GOVERNMENT AGENCIES

INTERGOVERNMENTAL BODIES

Intergovernmental Panel on Climate Change

"It is unequivocal that the increase of CO ₂, methane, and nitrous oxide in the atmosphere over the industrial era is the result of human activities and that human influence is the principal driver of many changes observed across the atmosphere, ocean, cryosphere, and biosphere.

"Since systematic scientific assessments began in the 1970s, the influence of human activity on the warming of the climate system has evolved from theory to established fact." ¹³⁻¹⁷

OTHER RESOURCES

List of Worldwide Scientific Organizations

The following page lists the nearly 200 worldwide scientific organizations that hold the position that climate change has been caused by human action.
http://www.opr.ca.gov/facts/list-of-scientific-organizations.html

U.S. Agencies

The following page contains information on what federal agencies are doing to adapt to climate change.
https://www.c2es.org/site/assets/uploads/2012/02/climate-change-adaptation-what-federal-agencies-are-doing.pdf
Technically, a "consensus" is a general agreement of opinion, but the scientific method steers us away from this to an objective framework. In science, facts or observations are explained by a hypothesis (a statement of a possible explanation for some natural phenomenon), which can then be tested and retested until it is refuted (or disproved). As scientists gather more observations, they will build off one explanation and add details to complete the picture. Eventually, a group of hypotheses might be integrated and generalized into a scientific theory, a scientifically acceptable general principle or body of principles offered to explain phenomena.
References​

# data[].attributes.attachment_link.title
Scientific Consensus: Earth's Climate is Warming

# data[].attributes.attachment_link.description
Vital Signs of the Planet: Global Climate Change and Global Warming. Partial list of leading scientific organizations endorsing human-induced climate change, along with a selection of related resources.

# data[].attributes.body
McElyea said that "what happened to (McKaig) could have easily happened to my mom (or late dad) and should be a warning for anyone with an elderly parent still on the road. They put others and themselves at risk every time they get behind the wheel."

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CLOSE

Unusual death of woman, 88, after traffic ordeal raises concern.

DETROIT - Jim Bassett turns 72 next month and still drives himself wherever he needs to go.

He assumes he might have to give up driving some day but notes that his mother drove into her late 80s.
STORY: Grandmother found dead after traffic ticket, car crash
"Driving, to me, is an individual thing. There's people in their 80s who are quite capable, and there's people in their 40s I don't think should drive," said Bassett, who lives in Roseville, Mich. "If you're capable, I could see no reason why you should give up your driving."

With the number of elderly drivers expected to explode in coming years, the question of when is it time to turn over the keys because of diminished abilities echoes more urgently. By 2030, 85% to 90% of the 70 million Americans older than 65 are projected to have driver's licenses, according to auto insurer AAA. That's a substantial boost from 2009, when 33 million licensed drivers were older than 65.

In Michigan, as of Dec. 29, 515,185 of the state's almost 7.1 million licensed drivers were 75 or older, and 242 of them were 100 or older, according to the Michigan Secretary of State. The office does not track whether more complaints are raised about elderly drivers than other groups, but it does receive about 400 driver re-examination requests every month for drivers suspected to be unsafe, and the largest number, behind law enforcement, comes from family members.

The debate over elderly drivers reached a fever pitch last week as details emerged involving the death of 88-year-old Lorraine McKaig. The Livonia woman was detoured after being ticketed by Livonia police because she tried to drive through a barricaded area near an industrial fire Wednesday. McKaig, whose official cause of death was heart disease, never made it to the restaurant and instead was found more than eight hours later on the ground outside her car on Detroit's east side after a crash into a fence.

Family members said McKaig was stubborn and could be forgetful but always stuck to her driving routine around Livonia. And her driving record before Wednesday was free of tickets, according to Secretary of State records covering the past seven years. Still, McKaig's plight prompted many Free Press readers to suggest that family members should have pre-emptively taken her keys away. Others related the difficulties of trying to stop their own parents from driving when they began exhibiting signs of dementia or were no longer physically able.

"I sympathize with people trying to care for elderly parents who resist no longer driving out of fear (of) losing their independence as they near the end of their lives. My mom also used her car to stay within a 5-mile radius of her home, but had an accident, which - thankfully - did not hurt anyone but convinced her it was time to stop driving," said Mary McElyea in an e-mail recalling her experience with her 83-year-old mother.
Self-policing
McElyea said that "what happened to (McKaig) could have easily happened to my mom (or late dad) and should be a warning for anyone with an elderly parent still on the road. They put others and themselves at risk every time they get behind the wheel."

Experts and advocates for older residents cautioned against a rush to judgment.

Mark Hornbeck, spokesman for AARP Michigan, said concluding that older drivers are a problem is "not a jump that people should make."

"Driving skill is more related to health than it is to age. There's no magic age at which everyone needs to give up their keys. It's a health-related issue," Hornbeck said.

"Driving skill is more related to health than it is to age. There's no magic age at which everyone needs to give up their keys."
Mark Hornbeck, spokesman for AARP Michigan
Fred Woodhams, a spokesman for the Michigan Secretary of State's Office, noted that those 65 and older in the state represented 16.5% of drivers in 2009 but only 8.3% of crash victims.

That lower crash rate could be attributable in part to changing habits, said Nancy Cain, spokeswoman for AAA Michigan.

"A lot of older drivers, as they get older, they self-police themselves," Cain said, noting that some stop driving at night and others avoid freeways or limit their driving to times when traffic is lighter.

Or they avoid situations that, according to Hornbeck, the AARP spokesman, tend to pose more problems for older drivers - left turns, for example.

That type of self-policing was at work for McKaig, who had already been limiting her own driving before Wednesday's events. According to family members, McKaig stuck to driving during the day, and she crafted routes where she could avoid left turns.
How to get help
And while experts note that elderly drivers tend to engage in fewer of the risky activities that younger drivers might be inclined to, such as aggressive or drunken driving, they face higher rates of fatal crashes as they age. The Centers for Disease Control and Prevention reports that per mile traveled, "fatal crash rates increase starting at age 75 and increase notably after age 80."

If family members suspect their older loved ones pose a danger behind the wheel, there are options.
RELATED: Feds making new rules for senior drivers
Cynthia Burt is a certified driving instructor and driver rehabilitation specialist who is preparing to open an office in the Oak Park area for her business, Drive-Able. Burt assesses the driving skills of her clients, some of them elderly, by doing clinical checks, reviewing their medical histories and testing their memories and reaction times, among other things.

Burt, who has tested drivers in their 100s, also takes clients on two driving tests, once in their own neighborhoods and once with a manufactured detour thrown in to assess their problem-solving abilities.

"Sometimes performances vary from day to day," Burt said.

The key is to monitor suspect drivers - including riding along as a passenger - and to be willing to address the issue with any driver who poses a potential risk.

"It's not an easy conversation for young people to talk to their parents about when it's time to stop driving ... but it's an important conversation to have, that's for sure," said Cain, the AAA spokeswoman, noting that an elderly driver has the same responsibilities as any other licensed driver.

Many families struggle with the issue of when an elderly person should stop driving because it signals a loss of independence, can pose real transportation problems in areas where mass transit is sketchy and can increase depression, experts say.
Warning signs
For Jim Bassett, driving represents freedom.

"Without that, I'd be stranded at the house ... you start looking at four walls and start wondering about what life (is)," Bassett said.

According to AARP, here are 10 signs it's time to limit or stop driving:

Almost crashing, with frequent close calls.

Finding dents or scrapes on the car, or fences, mailboxes and garage doors at home.

Getting lost, especially in familiar locations.

Having trouble following traffic signals, road signs and pavement markings.

Responding more slowly to unexpected situations, or having trouble moving foot from gas to brake pedals, confusing the two pedals.

Misjudging gaps in traffic at intersections and on highway entrance and exit ramps.

Experiencing road rage or causing other drivers to honk or complain.

Easily becoming distracted or having difficulty concentrating while driving.

Having a hard time turning around to check the rear view while backing up or changing lanes.

Receiving multiple traffic tickets or warnings from law enforcement officers.

Read or Share this story: http://usat.ly/1doQGss

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When should elderly people stop driving?

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CLOSE Unusual death of woman, 88, after traffic ordeal raises concern. DETROIT - Jim Bassett turns 72 next month and still drives himself wherever he needs to go. He assumes he might have to give up driving some day but notes that his mother drove into her late 80s.

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A comparison of fundamentally dissimilar cases that draws attention to the common function they perform.

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The decision before Prime Minister Shinzo Abe now is either to barrel on — getting Japan’s Supreme Court to overrule any legal objections Mr. Tamaki throws in the way of the new base — or to do what should have been done a long time ago: accept that Okinawa does have a legitimate gripe, and search for less onerous ways of sharing the burden of the American security umbrella.

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For years, Japan has tried to get Okinawans to agree to a big new seaside base for American Marines to replace an old one in a crowded urban area. The national government has tried carrots, like supporting construction of a Disney resort on the island; it has tried sticks, going to court to overrule local resistance to the base; it has thrown its weight behind candidates who favor the new base. But again and again, Okinawans have responded that they don't want the new base. They believe they're already carrying far more than their share of the American military.

The message sounded with special clarity when Denny Tamaki was elected governor on Sunday. Like most other elections on the island, this one was at least partly a referendum on the American bases. Mr. Tamaki represented an anti-base coalition; his pro-base opponent was heavily supported by Japan's governing Liberal Democratic Party. What made the choice especially noteworthy is that Mr. Tamaki, 58, is the son of a Japanese mother and an American Marine father, who left the island before he was born.

Image

Denny Tamaki, center right, with supporters in Okinawa last week. Credit Lauren DeCicca for The New York Times

The decision before Prime Minister Shinzo Abe now is either to barrel on - getting Japan's Supreme Court to overrule any legal objections Mr. Tamaki throws in the way of the new base - or to do what should have been done a long time ago: accept that Okinawa does have a legitimate gripe, and search for less onerous ways of sharing the burden of the American security umbrella.

Most Japanese support their alliance with the United States, especially now that China is flexing its muscles in the region. The problem is the hugely disproportionate burden placed on Okinawa, the poorest of Japan's prefectures. Okinawa was the site of an enormously bloody battle in the closing months of World War II; today it still hosts 33 American installations and half the 50,000 American troops in the country. The concentration of military gear and troops has created noise, pollution, deadly accidents and a history of assaults - most notably the rape of a 12-year-old girl by three servicemen in 1995.

It was after that episode that the United States and Japan agreed to relocate the big Marine air base clogging the center of the city of Ginowan to a less crowded area and to shift some troops to Guam and Hawaii. But nothing has moved. Local resistance has blocked construction of the new base, partly because of the environmental damage that would come from building a runway in the relatively unspoiled Henoko Bay.

The United States military argues that scattering Okinawa's logistical, air and ground forces to other sites in Japan will degrade their ability to respond quickly in the East China Sea. But the security this brings to Japan and the region cannot come at the expense of an unfair, unwanted and often dangerous burden on Japan's poorest citizens. Prime Minister Abe and American military commanders should join them with an equal willingness to find equitable solutions.

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Opinion | Toward a Smaller American Footprint on Okinawa

# data[].attributes.attachment_link.description
For years, Japan has tried to get Okinawans to agree to a big new seaside base for American Marines to replace an old one in a crowded urban area. The national government has tried carrots, like supporting construction of a Disney resort on the island; it has tried sticks, going to court to overrule local resistance to the base; it has thrown its weight behind candidates who favor the new base.

# data[].attributes.body
American Association for the Advancement of Science

"The scientific evidence is clear: global climate change caused by human activities is occurring now, and it is a growing threat to society." (2006)³

# data[].attributes.attachment_link.provider_name
Climate Change: Vital Signs of the Planet

# data[].attributes.attachment_link.readable_text
It's important to remember that scientists always focus on the evidence, not on opinions. Scientific evidence continues to show that human activities ( primarily the human burning of fossil fuels) have warmed Earth's surface and its ocean basins, which in turn have continued to impact Earth's climate. This is based on over a century of scientific evidence forming the structural backbone of today's civilization.

NASA Global Climate Change presents the state of scientific knowledge about climate change while highlighting the role NASA plays in better understanding our home planet. This effort includes citing multiple peer-reviewed studies from research groups across the world, illustrating the accuracy and consensus of research results (in this case, the scientific consensus on climate change) consistent with NASA's scientific research portfolio.

With that said, multiple studies published in peer-reviewed scientific journals show that climate-warming trends over the past century are extremely likely due to human activities. In addition, most of the leading scientific organizations worldwide have issued public statements endorsing this position. The following is a partial list of these organizations, along with links to their published statements and a selection of related resources.

AMERICAN SCIENTIFIC SOCIETIES

Statement on Climate Change from 18 Scientific Associations

"Observations throughout the world make it clear that climate change is occurring, and rigorous scientific research demonstrates that the greenhouse gases emitted by human activities are the primary driver." (2009) ²

SCIENCE ACADEMIES

International Academies: Joint Statement

"Climate change is real. There will always be uncertainty in understanding a system as complex as the world's climate. However there is now strong evidence that significant global warming is occurring. The evidence comes from direct measurements of rising surface air temperatures and subsurface ocean temperatures and from phenomena such as increases in average global sea levels, retreating glaciers, and changes to many physical and biological systems. It is likely that most of the warming in recent decades can be attributed to human activities (IPCC 2001)." (2005, 11 international science academies)

U.S. GOVERNMENT AGENCIES

INTERGOVERNMENTAL BODIES

Intergovernmental Panel on Climate Change

"It is unequivocal that the increase of CO ₂, methane, and nitrous oxide in the atmosphere over the industrial era is the result of human activities and that human influence is the principal driver of many changes observed across the atmosphere, ocean, cryosphere, and biosphere.

"Since systematic scientific assessments began in the 1970s, the influence of human activity on the warming of the climate system has evolved from theory to established fact." ¹³⁻¹⁷

OTHER RESOURCES

List of Worldwide Scientific Organizations

The following page lists the nearly 200 worldwide scientific organizations that hold the position that climate change has been caused by human action.
http://www.opr.ca.gov/facts/list-of-scientific-organizations.html

U.S. Agencies

The following page contains information on what federal agencies are doing to adapt to climate change.
https://www.c2es.org/site/assets/uploads/2012/02/climate-change-adaptation-what-federal-agencies-are-doing.pdf
Technically, a "consensus" is a general agreement of opinion, but the scientific method steers us away from this to an objective framework. In science, facts or observations are explained by a hypothesis (a statement of a possible explanation for some natural phenomenon), which can then be tested and retested until it is refuted (or disproved). As scientists gather more observations, they will build off one explanation and add details to complete the picture. Eventually, a group of hypotheses might be integrated and generalized into a scientific theory, a scientifically acceptable general principle or body of principles offered to explain phenomena.
References​

# data[].attributes.attachment_link.title
Scientific Consensus: Earth's Climate is Warming

# data[].attributes.attachment_link.description
Vital Signs of the Planet: Global Climate Change and Global Warming. Partial list of leading scientific organizations endorsing human-induced climate change, along with a selection of related resources.

# data[].attributes.body
Relies on the credibility and expertise of the source to warrant acceptance of a claim.

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"Fewer hours of sleep on an average school night [is] associated with increased odds of all selected unsafe behaviors," the authors wrote, including risk-taking while driving, such as drunken driving, potentially unsafe sexual activity, aggressive behavior and use of alcohol, tobacco and other drugs.

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less sleep associated with risky behavior in teens

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Less sleep for teens associated with risky behavior

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A new study found an association between the amount of sleep a teen gets per night and their risk of risky behavior, such as drinking alcohol or suicidal thoughts.

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Page 44

Abigail: She sends her spirit on me in church; she makes me laugh at prayer!

Parris: She have often laughed at prayer!

Abigail: She comes to me every night to go and drink blood!

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Forces a choice between two unacceptable alternatives.

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"We began with diabetes is not a big problem in the Asian community" to now thinking "simply being Asian is a risk factor," said Dr. Edward Chow, an internist who has worked in San Francisco's Chinatown since the 1970s.

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The patients filing into Dr. Ronesh Sinha's clinic in Redwood City, Calif., were like nothing he had ever seen.

As a doctor in training, Sinha studied which patients were usually diagnosed with Type 2 diabetes: they were at least middle-aged, ate too much fast food, drank soda and didn't exercise.

The Silicon Valley techies visiting his office were typically slender Asian Americans in their 30s who worked out regularly and ate healthy meals. But, as Sinha repeatedly found, they either already had or were about to get diabetes.

"It was such a discordance from what I'd learned about in medical school," Sinha said. "Maybe, I thought, this is just an anomaly."

It wasn't. What Sinha noticed a decade ago is now supported by a growing body of scientific research: Asians, in part for genetic reasons, are disproportionately likely to develop diabetes. They get the disease at younger ages and lower weights than others, experts say.

Diabetes, a condition in which blood sugar levels are higher than normal, often remains undiagnosed until it's too late, especially in Asians who haven't historically been considered high-risk. It's the seventh most common cause of death nationwide and can lead to blindness, amputations and strokes.

To prevent the insidious disease from gaining ground among the country's fastest-growing minority group, doctors and health advocates are trying to increase diabetes testing and treatment for Asian Americans, including Chinese, Indians and Filipinos. Diabetes is largely preventable, experts say - but only if people know they are at risk.

"We began with diabetes is not a big problem in the Asian community" to now thinking "simply being Asian is a risk factor," said Dr. Edward Chow, an internist who has worked in San Francisco's Chinatown since the 1970s.

As Americans put on weight over the last two decades, diabetes rates more than doubled. Scientists have long known that obesity is closely linked to diabetes, but newer research shows the picture is more complicated.
See more of our top stories on Facebook >>
In Los Angeles County, Asian American adults have the lowest obesity rate of any ethnic group, at 9%, compared with 18% of whites and 29% of Latinos and blacks.

"You would think ... Asians would have the lowest diabetes rate," said Dr. Paul Simon, chief science officer with the L.A. County Department of Public Health.

But 10% of Asian Americans in L.A. County are diabetic, compared with 7% of whites, despite Asian Americans' drastically lower obesity levels.

Scientists think the mismatch is because obesity is a measure of weight, not necessarily fat - the real culprit in diabetes.

Asians tend to have less muscle and more fat than Europeans of the same weight and height, studies show. So an Asian who isn't obese or even overweight could have enough fat to be in danger of getting diabetes, a phenomenon sometimes referred to as "skinny-fat."

"We've got to be suspicious even if somebody looks normal," Chow said.

Asians also tend to accumulate more fat around their waists than people of other ethnicities, and abdominal fat is a bigger risk factor for diabetes than fat stored in other places, such as hips or arms.

Alan Owyang, 58, found out he was diabetic 15 years ago, when he was barely overweight.

"I had a little, a very slight gut, but I just thought it was OK," said Owyang, an actor in San Francisco. He's shed some pounds and changed his diet, but still has to take medications to keep the disease under control.
NEWSLETTER: Get the day's top headlines from Times Editor Davan Maharaj >>
In October, San Francisco, which is 35% Asian, passed a resolution expanding diabetes testing to Asian Americans who aren't considered overweight.

It was a victory for " Screen at 23," a national campaign that aims to lower the diabetes screening guidelines from the current standard of a body-mass index of 25 - the traditional cutoff for being overweight - to 23 for Asian Americans. The effort was launched last year by the National Council of Asian Pacific Islander Physicians and a coalition of diabetes advocates.

Simon in L.A. County - which, like California, is approximately 15% Asian - said he was looking into a similar change, and the American Diabetes Assn. and the World Health Organization have also endorsed lower screening thresholds.

But identifying those at risk is just the beginning of the battle against diabetes, said Scott Chan, program director of the L.A.-based Asian and Pacific Islander Obesity Prevention Alliance. He said that many Asian Americans are reluctant to believe that they could get diabetes, in part because of what he called a long-standing "model minority" myth when it comes to health.

"You're skinny, you're healthy, there's nothing wrong," he said.

When physicians tell patients to eat less rice to prevent developing diabetes, many of them say "they would rather die," Chan said.

Wendy Kim, 45, had to give up bagels and sushi with white rice after being diagnosed with diabetes more than 10 years ago. Even if she skips the rice that comes with Korean barbecue, the meat marinades contain sugar that she can't gorge on.

"There are people who eat to live and there are people who live to eat. I live to eat," says Kim, who lives in L.A.'s Koreatown. "I'm a foodie, and I can't have noodles."

Studies have shown that more than medication, dieting and exercising greatly reduce people's chances of getting diabetes. But making those lifestyle changes can be especially difficult for Asian Americans, because healthy eating guidelines have typically been based on traditional American diets.

The dietitian to whom Pratap Merchant of Artesia was referred after he was diagnosed with diabetes couldn't help him much. "She had very little knowledge of vegetarian foods," said Merchant, 82, who was raised in India as a vegetarian.

Sinha, the Bay Area doctor, has spent the last several years trying to solve this problem. After diagnosing dozens of Asian Americans with diabetes, he realized he didn't have appropriate dietary suggestions to help them manage the disease. Telling vegetarians to eat less red meat, for example, wasn't going to work, he said.

Through Sutter Health's Palo Alto Medical Foundation, Sinha launched a consult service in 2011 specifically for South Asians, who have some of the highest diabetes rates among Asians.

Its doctors recommend food modifications such as doubling the amount of vegetables in a curry dish, or switching from white rice to a dish made of cauliflower florets.

Manjusha Kulkarni, head of the nonprofit South Asian Network in Artesia's Little India, also runs food workshops for diabetics and started a walking group to help Asian American seniors improve their health. But, she said, the first line of defense against diabetes is raising awareness.

She and her colleagues travel from Irvine to Westwood, visiting temples and cultural festivals, warning Asian Americans that when it comes to diabetes, "we need to be more vigilant than other communities."
soumya.karlamangla@latimes.com Twitter: @skarlamangla MORE FROM HEALTH You'll burn 30% more calories with this sweaty, sandy L.A. workout You're taking care of someone with Alzheimer's, but who is taking care of you? Coffee lovers rejoice: 4 reasons why coffee is good for your health

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Doctors' message to Asian Americans: Watch out for diabetes even if you're young and thin

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The patients filing into Dr. Ronesh Sinha's clinic in Redwood City, Calif., were like nothing he had ever seen. As a doctor in training, Sinha studied which patients were usually diagnosed with Type 2 diabetes: they were at least middle-aged, ate too much fast food, drank soda and didn't exercise.

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Explains how one event leads to another.

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Reasoning based upon the similarity of two cases.

# data[].attributes.body
Page 37

Putnam, pleased: It does not seem to help us today, Mr. Hale. We look to you to
come to our house and save our child.

Hale: Your child ails too?

Mrs. Putnam: Her soul, her soul seems flown away. She sleeps and yet she
walks...

PutNAM: She cannot eat.

Hale: Cannot eat!

# data[].attributes.body
Observable signs, marks, or symptoms are used to prove a condition exists.

# data[].attributes.body
One looks at the details of examples, specific cases, situations, and occurrences and draws inferences about the entire class they represent.