The Neediest Cases: Emerging From a Bleak Life to Become Fabulous Phil

For years, Phillip Johnson was caught in what seemed like an endless trench of bad luck. He was fired from a job, experienced intensifying psychological problems, lost his apartment and spent time in homeless shelters. At one point, he was hospitalized after overdosing on an antipsychotic drug.

“I had a rough road,” he said.

Since his hospital stay two years ago, and despite setbacks, Mr. Johnson, 27, has been getting his life on track. At Brooklyn Community Services, where he goes for daily counseling and therapy, everybody knows him as Fabulous Phil.

“Phillip is a light, the way he evokes happiness in other people,” his former caseworker, Teresa O’Brien, said. “Phillip’s character led directly to his nickname.”

About six months ago, with Ms. O’Brien’s help, Mr. Johnson started an event: Fabulous Phil Friday Dance Party Fridays.

One recent afternoon at the agency, 30 clients and a few counselors were eating cake, drinking soft drinks and juice, and grooving for 45 minutes to Jay-Z and Drake pulsating from a boom box.

Mr. Johnson’s voice rose with excitement when he talked about the party. Clients and counselors, he said, “enjoy themselves.”

“They connect more; they communicate more,” he continued. “Everybody is celebrating and laughing.”

The leadership Mr. Johnson now displays seems to be a far cry from the excruciatingly introverted person he was.

As an only child living with his single mother in public housing in Bedford-Stuyvesant, Brooklyn, he said, he tended to isolate himself. “A lot of kids my age would say, ‘Come outside,’ but I would always stay in my room,” he said. He occupied himself by writing comic books or reading them, his favorites being Batman and Spiderman because, he said, “they were heroes who saved the day.”

After graduating from high school in 2003, he worked odd jobs until 2006, when he took a full-time position at a food court at La Guardia Airport, where he helped to clean up. The steady paycheck allowed him to leave his mother’s apartment and rent a room in Queens.

But the depression and bleak moods that had shadowed him throughout middle and high school asserted themselves.

“My thinking got confused,” he said. “Racing thoughts through my mind. Disorganized thoughts. I had a hard time focusing on one thing.”

In 2008, after two years on the job, Mr. Johnson was fired for loud and inappropriate behavior, and for being “unpredictable,” he said. The boss said he needed counseling. He moved back in with his mother, and in 2009 entered a program at an outpatient addiction treatment service, Bridge Back to Life. It was there, he said, that he received a diagnosis of schizophrenia and help with his depression and marijuana use.

But one evening in May 2010, he had a bout with insomnia.

He realized the antipsychotic medication he had been prescribed, Risperdal, made him feel tired, he said, so he took 12 of the pills, rather than his usual dosage of two pills twice a day. When 12 did not work, he took 6 more.

“The next morning when I woke up, it was hard for me to breathe,” he said.

He called an ambulance, which took to Woodhull Hospital. He was released after about a month.

Not long after, he returned to his mother’s apartment, but by February 2011, they both decided he should leave, and he relocated to a homeless shelter in East New York, where, he said, eight other people were crammed into his cubicle and there were “bedbugs, people lying in your bed, breaking into your locker to steal your stuff.”

In late spring 2011, he found a room for rent in Manhattan, but by Thanksgiving he was hospitalized again. Another stint in a shelter followed in April, when his building was sold.

Finally, in July, Mr. Johnson moved to supported housing on Staten Island, where he lives with a roommate. His monthly $900 Social Security disability check is sent to the residence, which deducts $600 for rent and gives him $175 in spending money; he has breakfast and lunch at the Brooklyn agency. To assist Mr. Johnson with unexpected expenses, a grant of $550 through The New York Times Neediest Cases Fund went to buy him a bed and pay a Medicare prescription plan fee for three months.

“I was so happy I have a bed to sleep on,” he said about the replacement for an air mattress. “When I have a long day, I have a bed to lay in, and I feel good about that.”

Mr. Johnson’s goals include getting his driver’s license — “I already have a learner’s permit,” he said, proudly — finishing his program at the agency, and then entering an apprenticeship program to become a plumber, carpenter or mechanic.

But seeing how his peers have benefited from Fabulous Phil Fridays has made him vow to remain involved with people dealing with mental illnesses or substance abuse.

He was asked at the party: Might he be like the comic-book heroes he loves? A smile spread across his face. He seemed to think so.

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N.F.L. Paid Millions Over Brain Injuries, Article Says

Three retired N.F.L. players received at least $2 million in disability payments as a result of brain trauma injuries from their playing days, according to an article by ESPN and the PBS series “Frontline.”

The payments were made in the 1990s and early 2000s by the Bell/Rozelle N.F.L. Player Retirement Plan, a committee comprising representatives of the owners, players and the N.F.L. commissioner.

The N.F.L. is being sued by several thousand retired players who accuse the league of concealing a link between head hits and brain injuries. The league denies the accusation and has said it did not mislead its players.

The article, however, cites a letter written in 2000 from the director of the retirement plan who stated that Mike Webster, who retired in 1990, had a disability that was “the result of head injuries he suffered as a football player with the Pittsburgh Steelers and the Kansas City Chiefs.”

Webster died in 2002. The article cites similar payments to Gerry Sullivan, a Browns lineman, and a third, unnamed player.

The article provides more details than were known about Webster’s case; his fight for disability benefits was known. The retired players say in their complaint that “the N.F.L.’s own physician independently examined Webster and concluded that Webster was mentally ‘completely and totally disabled as of the date of his retirement and was certainly disabled when he stopped playing football sometime in 1990.’ ”

However, Greg Aiello, an N.F.L. spokesman, said that the ESPN report “underscores that we have had a system in place with the union for many years to address player injury claims on a case-by-case basis.” The disability plan, he said, was “collectively bargained with the players.”

“All decisions concerning player injury claims are made by the disability plan’s board, not by the N.F.L. or by the Players Association,” Aiello said.

The board has seven members: three owner representatives, three player representatives and one nonvoting representative of the commissioner.

The disclosures in the article came a day after Commissioner Roger Goodell spoke at the Harvard School of Public Health, where he trumpeted the league’s efforts to increase the safety of its players and proclaimed that “medical decisions override everything else.”

Jeffrey Standen, a law professor at Willamette University in Oregon, said the details about Webster’s disability payments did not amount to a smoking gun. The plan’s determination that Webster sustained head injuries is not the same as the N.F.L. making that decision.

“The problem is the N.F.L. didn’t make the admission; it was the board,” Standen said. “They’re not the same body. As a legal matter, the fact that they paid Webster is not going to matter much in legal terms. But it’s evidence to throw in front of a jury.”

Read More..

N.F.L. Paid Millions Over Brain Injuries, Article Says

Three retired N.F.L. players received at least $2 million in disability payments as a result of brain trauma injuries from their playing days, according to an article by ESPN and the PBS series “Frontline.”

The payments were made in the 1990s and early 2000s by the Bell/Rozelle N.F.L. Player Retirement Plan, a committee comprising representatives of the owners, players and the N.F.L. commissioner.

The N.F.L. is being sued by several thousand retired players who accuse the league of concealing a link between head hits and brain injuries. The league denies the accusation and has said it did not mislead its players.

The article, however, cites a letter written in 2000 from the director of the retirement plan who stated that Mike Webster, who retired in 1990, had a disability that was “the result of head injuries he suffered as a football player with the Pittsburgh Steelers and the Kansas City Chiefs.”

Webster died in 2002. The article cites similar payments to Gerry Sullivan, a Browns lineman, and a third, unnamed player.

The article provides more details than were known about Webster’s case; his fight for disability benefits was known. The retired players say in their complaint that “the N.F.L.’s own physician independently examined Webster and concluded that Webster was mentally ‘completely and totally disabled as of the date of his retirement and was certainly disabled when he stopped playing football sometime in 1990.’ ”

However, Greg Aiello, an N.F.L. spokesman, said that the ESPN report “underscores that we have had a system in place with the union for many years to address player injury claims on a case-by-case basis.” The disability plan, he said, was “collectively bargained with the players.”

“All decisions concerning player injury claims are made by the disability plan’s board, not by the N.F.L. or by the Players Association,” Aiello said.

The board has seven members: three owner representatives, three player representatives and one nonvoting representative of the commissioner.

The disclosures in the article came a day after Commissioner Roger Goodell spoke at the Harvard School of Public Health, where he trumpeted the league’s efforts to increase the safety of its players and proclaimed that “medical decisions override everything else.”

Jeffrey Standen, a law professor at Willamette University in Oregon, said the details about Webster’s disability payments did not amount to a smoking gun. The plan’s determination that Webster sustained head injuries is not the same as the N.F.L. making that decision.

“The problem is the N.F.L. didn’t make the admission; it was the board,” Standen said. “They’re not the same body. As a legal matter, the fact that they paid Webster is not going to matter much in legal terms. But it’s evidence to throw in front of a jury.”

Read More..

DealBook: As Labor Talks Collapse, Hostess Turns Out Lights

What might be the last Twinkie in America — at least for a while — rolled off a factory line Friday morning. It was just like the millions that had come before it, golden, cream-filled empty calories, a monument to classic American junk food.

But it is likely to be the last under the current management. After not one but two bankruptcies, Hostess Brands, the beleaguered purveyor of Twinkies, Ho Hos, Sno Balls and Wonder bread, announced plans to wind down operations and sell off its brands.

Since filing for Chapter 11 bankruptcy protection in January, Hostess has been trying to renegotiate its labor contracts in a bid to cut costs. But the talks fell apart, and last week one union went on strike.

The so-called liquidation will probably spell the end of Hostess, an 82-year-old company that has endured wars, countless diet fads and even an earlier Chapter 11 filing. Although the company could theoretically negotiate a last-minute deal with the union, Hostess is moving to shut factories and lay off a large majority of its 18,500 employees.

But Twinkies and the other well-known brands could eventually find new life under a different owner. As part of the process, Hostess is looking to auction off its assets, and suitors could find value in the portfolio.

“The potential loss of iconic brands is difficult,” said the company’s chief executive, Gregory F. Rayburn. “But it’s overshadowed by the 18,500 families that are out of work.”

The company’s current problems stem, in part, from the legacy of its past.

An amalgam of brands and businesses, the company has evolved over the years through acquisitions. In the 1960s and 1970s, the company, then called Interstate, bought more than a dozen regional bakeries scattered across the country. A couple of decades later, it paid $330 million for the Continental Baking Company, picking up a portfolio of brands like Wonder and Hostess.

As the national appetite for junk food waned, the company fell on hard times, struggling against rising labor and commodity costs. In 2004, it filed for bankruptcy for the first time.

Five years later, the company emerged from Chapter 11 as Hostess Brands, so named after its most prominent division. With America’s new health-conscious attitude, it sought to reshape the business to changing times, introducing new products like 100-calorie Twinkie Bites.

But the new private equity backers loaded the company with debt, making it difficult to invest in new equipment. Earlier this year, Hostess had more than $860 million of debt.

The labor costs, too, proved insurmountable, a situation that has been complicated by years of deal-making. The bulk of the work force belongs to 12 unions, including the International Brotherhood of Teamsters and the Bakery, Confectionery, Tobacco Workers and Grain Millers International Union.

The combination of debt and labor costs has hurt profits. The company posted revenue of $2.5 billion in the fiscal year 2011, the last available data. But it reported a net loss of $341 million.

With profits eroding, the company filed for Chapter 11 in January. It originally hoped to reorganize its finances, seeking lower labor costs, including an immediate 8 percent pay cut.

The negotiations have been contentious.

The Teamsters, which has 6,700 members at Hostess, said it played an instrumental role in ousting Hostess’s previous chief executive, Brian J. Driscoll, this year after the board tripled his compensation to $2.55 million. The union also hired a financial consultant, Harry J. Wilson, who had worked on the General Motors restructuring.

While highly critical of management missteps, the Teamsters agreed in September to major concessions, including cuts in wages and company contributions to health care. As part of the deal, the union was to receive a 25 percent share of the company’s stock and a $100 million claim in bankruptcy.

“The objective was to preserve jobs,” said Ken Hall, the Teamsters’ general secretary-treasurer. “When you have a company that’s in the financial situation that Hostess is, it’s just not possible to maintain everything you have.”

But Hostess reached an impasse with the bakery union. Frank Hurt, the union’s president, seemed to lose patience with Hostess’s management, upset that it was in bankruptcy for the second time despite $100 million in labor concessions. He saw little promise that management would turn things around.

“Our members decided they were not going to take any more abuse from a company they have given so much to for so many years,” said Mr. Hurt. “They decided that they were not going to agree to another round of outrageous wage and benefit cuts and give up their pension only to see yet another management team fail and Wall Street vulture capitalists and ‘restructuring specialists’ walk away with untold millions of dollars.”

About a month ago, Mr. Rayburn said, the bakers union stopped returning the company’s phone calls altogether. For its part, the bakery union said the company had taken an overly aggressive approach. David Durkee, the union’s secretary-treasurer, said Hostess had given an ultimatum. “They said, ‘If you do not ratify this, we are going to liquidate based on your vote.’ ”

With the company standing firm, the bakery union struck last week, affecting nearly two-thirds of the company’s factories across the country. The Teamsters drivers honored the picket line, further shutting down the operations. The company gave union members until 5 p.m. on Thursday to return to work.

Mr. Rayburn said the financial strain of the strike was too much for the company, which had already reached the limits of its bankruptcy financing. Over the last week, Hostess lost tens of millions of dollars as many customers’ orders went unfilled. And its lenders would not open their wallets one more time.

By Thursday morning, Hostess’s executives were ensconced in the company’s headquarters in Irving, Tex., still hoping that enough employees would return to work to resume production. A small number of workers had already crossed the picket lines that had sprung up at most of the baker’s factories, but more than 10 plants remained well below their necessary capacity.

Mr. Rayburn’s deadline of 5 p.m. passed without either side backing down. Soon after, executives asked the company’s legal advisers to finish the court motions that would begin the liquidation. Papers had been drawn up well before that afternoon.

Around 7 p.m., Mr. Rayburn had his final discussions with the company’s board and his senior managers and made the call to begin winding down.

“We were trying to focus on where people were having success, but I had to make a call,” Mr. Rayburn said.

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Egypt Sends Prime Minister to Gaza in Show of Solidarity

Ilia Yefimovich/Getty Images

Smoke rose over Gaza on Friday. Israel denied launching airstrikes. More Photos »

GAZA CITY — Egypt launched a remarkable diplomatic initiative on Friday after a night of ferocious Israeli airstrikes in Gaza and militant rocket fire toward Israel, sending its prime minister to show support for Palestinians in the beleaguered enclave and to try to end the hostilities.

But the intervention was soon overtaken as air-raid sirens wailed for the second successive day over Tel Aviv, the police said, and at least one explosion was heard, apparently from a rocket fired toward the city from Gaza. Hamas said it fired a single “homemade” projectile at the city.

The rocket may have landed offshore or in an open area, the Israeli police said. But, like a pair of rockets fired on Thursday into Tel Aviv, the projectiles did not land in the city itself.

Earlier, as Prime Minister Hesham Kandil of Egypt prepared to travel to Gaza, Israel agreed to a temporary cease-fire for the visit, even as it sent armed vehicles toward Gaza and called up reservists for a possible invasion. But the truce never took root.

Israel Radio said Palestinian militants fired 25 rockets into southern Israel, with one of them striking a house. There were no immediate reports of casualties.

What sounded like airstrikes by Israeli F-16s were also audible in Gaza City. The Israeli military said no such strikes had taken place, but the Hamas health ministry reported that two people, including a child, were killed in the north of Gaza City while the Egyptian delegation was on the ground, pushing the Palestinian death toll in three days of aerial bombardment to 21.

Three Israelis were killed in a rocket attack on Thursday in Kiryat Malachi, a small town in southern Israel, when a rocket fired from Gaza struck their apartment house.

Mr. Kandil’s visit produced dramatic imagery to underpin Cairo’s support for Hamas, which Israel, the United States and much of the West consider to be a terrorist organization.

Mr. Kandil and Ismail Haniya, his Hamas equivalent, visited the Al Shifa hospital amid a huge scrum of bodyguards and journalists, saying they had carried the body of Mohammed Yasser, one of eight children who Palestinian health officials say have been killed in the surge of violence since a top Hamas commander was killed in an Israeli airstrike on Wednesday.

“This is the blood of our children on our clothes,” Mr. Haniya said as he showed spatters on his clothing, “These are the Egyptian and the Palestinian blood united together.”

Like President Mohamed Morsi of Egypt on Thursday, Mr. Kandil walked a delicate line between support for Hamas, condemnation of Israel and a quest for calm in a region increasingly threatened by the spillovers from Syria’s civil war into neighboring countries, as well as by the long-festering impasse between Israelis and Palestinians.

“The aim of this visit is not only to show political support but to support the Palestinian people on the ground,” Mr. Kandil said, noting that he had brought with him a delegation from the Egyptian Health Ministry. He said a cease-fire between Gaza and Israel was “the only way to achieve stability in the region” and also called on the Palestinians to repair the rift between Hamas in Gaza and the Fatah group that dominates the Palestinian Authority in the West Bank. “We call on the Palestinian people to unite because their power and strength is in their unity,” Mr. Kandil said. “That’s the only way to liberate Palestine.”

The visit was the first of such a high-ranking Egyptian official to this coastal enclave since the militant Hamas faction gained control in 2007 and offered a potent sign of how Egypt’s revolution and new Islamist leadership since the overthrow of President Hosni Mubarak last year has shifted the geopolitics of the Israeli-Palestinian conflict.

Egypt, Mr. Kandil said, will “save nothing to stop the aggression and achieve a continuous cease-fire on the way to having a Palestinian state with Jerusalem as its capital.”

The display of support — improbable throughout the Mubarak era — emboldened the Hamas leadership.

“The time in which the Israeli occupation does whatever it wants in Gaza is gone,” Mr. Haniya said. “Egypt cannot accept the aggression as before. I welcome Egypt for this historical visit that comes in harmony with the will of the free Egypt.”

Before the visit, residents in Gaza said the night was filled with the boom and crash of airstrikes, with loud explosions at dawn on Friday, a day after Israel and the Hamas rulers of Gaza brushed aside international calls for restraint and escalated their lethal conflict. In Gaza, Palestinian militants launched hundreds of rockets into Israeli territory on Thursday, targeting Tel Aviv for the first time, and Israel intensified its aerial assaults.

Jodi Rudoren reported from Gaza City, Isabel Kershner from Jerusalem, and Alan Cowell from Paris. Reporting was contributed by Fares Akram from Gaza, Rick Gladstone from New York, Rina Castelnuovo from Kiryat Malachi, Israel, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem, and Elisabeth Bumiller from Bangkok.

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Gadgetwise Blog: Q&A: Removing Programs on a Mac

Windows computers have the Add/Remove Program option and many programs include uninstaller software, but how do you uninstall a Mac program?

Some Mac programs do come with their own uninstaller programs to remove the software from the computer. If the program you want to delete does not offer that utility, you can get rid of it in other ways.

Just dragging the program’s icon out of the Applications folder to the Mac’s desktop Trash can — and then going to the Finder’s File menu and choosing Empty Trash — gets rid of the program and many of its associated files. Some Mac application icons contain many more files than just the program itself; just right-click on an icon in the Applications folder and choose Show Package Contents from the menu to see what lies beneath.

Some programs leave other files around the Mac’s system, though, and just deleting the application’s icon from the computer may leave some digital detritus on your drive. If you are comfortable with poking around in OS X, tutorials like those from Cult of Mac or Raw Computing show where to look in your clean-up mission. For a more automatic approach, free or inexpensive utility apps like AppDelete, AppZapper and CleanApp can take care of the job for you.

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For Alzheimer’s, Detection Advances Outpace Treatment Options

Joshua Lott for The New York Times

Awilda Jimenez got a scan for Alzheimer’s after she started forgetting things. It was positive.

When Awilda Jimenez started forgetting things last year, her husband, Edwin, felt a shiver of dread. Her mother had developed Alzheimer’s in her 50s. Could his wife, 61, have it, too?

He learned there was a new brain scan to diagnose the disease and nervously agreed to get her one, secretly hoping it would lay his fears to rest. In June, his wife became what her doctor says is the first private patient in Arizona to have the test.

“The scan was floridly positive,” said her doctor, Adam S. Fleisher, director of brain imaging at the Banner Alzheimer’s Institute in Phoenix.

The Jimenezes have struggled ever since to deal with this devastating news. They are confronting a problem of the new era of Alzheimer’s research: The ability to detect the disease has leapt far ahead of treatments. There are none that can stop or even significantly slow the inexorable progression to dementia and death.

Families like the Jimenezes, with no good options, can only ask: Should they live their lives differently, get their affairs in order, join a clinical trial of an experimental drug?

“I was hoping the scan would be negative,” Mr. Jimenez said. “When I found out it was positive, my heart sank.”

The new brain scan technology, which went on the market in June, is spreading fast. There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, according to Eli Lilly, which sells the tracer used to mark plaque for the scan.

The scans show plaques in the brain — barnaclelike clumps of protein, beta amyloid — that, together with dementia, are the defining feature of Alzheimer’s disease. Those who have dementia but do not have excessive plaques do not have Alzheimer’s. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques.

Many insurers, including Medicare, will not yet pay for the new scans, which cost several thousand dollars. And getting one comes with serious risks. While federal law prevents insurers and employers from discriminating based on genetic tests, it does not apply to scans. People with brain plaques can be denied long-term care insurance.

The Food and Drug Administration, worried about interpretations of the scans, has required something new: Doctors must take a test showing they can read them accurately before they begin doing them. So far, 700 doctors have qualified, according to Eli Lilly. Other kinds of diagnostic scans have no such requirement.

In another unusual feature, the F.D.A. requires that radiologists not be told anything about the patient. They are generally trained to incorporate clinical information into their interpretation of other types of scans, said Dr. R. Dwaine Rieves, director of the drug agency’s Division of Medical Imaging Products.

But in this case, clinical information may lead radiologists to inadvertently shade their reports to coincide with what doctors suspect is the underlying disease. With Alzheimer’s, Dr. Rieves said, “clinical impressions have been misleading.”

“This is a big change in the world of image interpretation,” he said.

Like some other Alzheimer’s experts, Dr. Fleisher used the amyloid scan for several years as part of a research study that led to its F.D.A. approval. Subjects were not told what the scans showed. Now, with the scan on the market, the rules have changed.

Dr. Fleisher’s first patient was Mrs. Jimenez. Her husband, the family breadwinner, had lost his job as a computer consultant when the couple moved from New York to Arizona to take care of Mrs. Jimenez’s mother. Paying several thousand dollars for a scan was out of the question. But Dr. Fleisher found a radiologist, Dr. Mantej Singh Sra of Sun Radiology, who was so eager to get into the business that he agreed to do Mrs. Jimenez’s scan free. His plan was to be the first in Arizona to do a scan, and advertise it.

After Dr. Sra did the scan, the Jimenezes returned to Dr. Fleisher to learn the result.

Dr. Fleisher, sad to see so much plaque in Mrs. Jimenez’s brain, referred her to a psychiatrist to help with anxiety and suggested she enter clinical trials of experimental drugs.

But Mr. Jimenez did not like that idea. He worried about unexpected side effects.

“Tempting as it is, where do you draw the line?” he asks. “At what point do you take a risk with a loved one?”

At Mount Sinai Medical Center in New York, Dr. Samuel E. Gandy found that his patients — mostly affluent — were unfazed by the medical center’s $3,750 price for the scan. He has been ordering at least one a week for people with symptoms ambiguous enough to suggest the possibility of brain plaques.

Most of his patients want their names kept confidential, fearing an inability to get long-term care insurance, or just wanting privacy.

Read More..

For Alzheimer’s, Detection Advances Outpace Treatment Options

Joshua Lott for The New York Times

Awilda Jimenez got a scan for Alzheimer’s after she started forgetting things. It was positive.

When Awilda Jimenez started forgetting things last year, her husband, Edwin, felt a shiver of dread. Her mother had developed Alzheimer’s in her 50s. Could his wife, 61, have it, too?

He learned there was a new brain scan to diagnose the disease and nervously agreed to get her one, secretly hoping it would lay his fears to rest. In June, his wife became what her doctor says is the first private patient in Arizona to have the test.

“The scan was floridly positive,” said her doctor, Adam S. Fleisher, director of brain imaging at the Banner Alzheimer’s Institute in Phoenix.

The Jimenezes have struggled ever since to deal with this devastating news. They are confronting a problem of the new era of Alzheimer’s research: The ability to detect the disease has leapt far ahead of treatments. There are none that can stop or even significantly slow the inexorable progression to dementia and death.

Families like the Jimenezes, with no good options, can only ask: Should they live their lives differently, get their affairs in order, join a clinical trial of an experimental drug?

“I was hoping the scan would be negative,” Mr. Jimenez said. “When I found out it was positive, my heart sank.”

The new brain scan technology, which went on the market in June, is spreading fast. There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, according to Eli Lilly, which sells the tracer used to mark plaque for the scan.

The scans show plaques in the brain — barnaclelike clumps of protein, beta amyloid — that, together with dementia, are the defining feature of Alzheimer’s disease. Those who have dementia but do not have excessive plaques do not have Alzheimer’s. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques.

Many insurers, including Medicare, will not yet pay for the new scans, which cost several thousand dollars. And getting one comes with serious risks. While federal law prevents insurers and employers from discriminating based on genetic tests, it does not apply to scans. People with brain plaques can be denied long-term care insurance.

The Food and Drug Administration, worried about interpretations of the scans, has required something new: Doctors must take a test showing they can read them accurately before they begin doing them. So far, 700 doctors have qualified, according to Eli Lilly. Other kinds of diagnostic scans have no such requirement.

In another unusual feature, the F.D.A. requires that radiologists not be told anything about the patient. They are generally trained to incorporate clinical information into their interpretation of other types of scans, said Dr. R. Dwaine Rieves, director of the drug agency’s Division of Medical Imaging Products.

But in this case, clinical information may lead radiologists to inadvertently shade their reports to coincide with what doctors suspect is the underlying disease. With Alzheimer’s, Dr. Rieves said, “clinical impressions have been misleading.”

“This is a big change in the world of image interpretation,” he said.

Like some other Alzheimer’s experts, Dr. Fleisher used the amyloid scan for several years as part of a research study that led to its F.D.A. approval. Subjects were not told what the scans showed. Now, with the scan on the market, the rules have changed.

Dr. Fleisher’s first patient was Mrs. Jimenez. Her husband, the family breadwinner, had lost his job as a computer consultant when the couple moved from New York to Arizona to take care of Mrs. Jimenez’s mother. Paying several thousand dollars for a scan was out of the question. But Dr. Fleisher found a radiologist, Dr. Mantej Singh Sra of Sun Radiology, who was so eager to get into the business that he agreed to do Mrs. Jimenez’s scan free. His plan was to be the first in Arizona to do a scan, and advertise it.

After Dr. Sra did the scan, the Jimenezes returned to Dr. Fleisher to learn the result.

Dr. Fleisher, sad to see so much plaque in Mrs. Jimenez’s brain, referred her to a psychiatrist to help with anxiety and suggested she enter clinical trials of experimental drugs.

But Mr. Jimenez did not like that idea. He worried about unexpected side effects.

“Tempting as it is, where do you draw the line?” he asks. “At what point do you take a risk with a loved one?”

At Mount Sinai Medical Center in New York, Dr. Samuel E. Gandy found that his patients — mostly affluent — were unfazed by the medical center’s $3,750 price for the scan. He has been ordering at least one a week for people with symptoms ambiguous enough to suggest the possibility of brain plaques.

Most of his patients want their names kept confidential, fearing an inability to get long-term care insurance, or just wanting privacy.

Read More..

Attacks Resume After Israeli Assault Kills Hamas Leader

KIRYAT MALACHI, Israel — Israel and Hamas widened their increasingly deadly conflict over Gaza on Thursday, as a militant rocket killed three civilians when one struck an apartment block in this small southern town. The Israeli deaths are likely to intensify its military offensive on Gaza, now in its second day of airstrikes.

The regional perils of the situation sharpened, meanwhile, as President Mohamed Morsi of Egypt warned on Thursday that his country stood by the Palestinians against what he termed Israeli aggression, echoing similar condemnation on Wednesday.

“Israel must realize that we don’t accept the aggression that negatively affects security and stability in the region,” he said before a meeting of senior ministers. Egypt, he said was telling the Palestinians in Gaza that “we stand by them to stop this assault on them.”

Thursday’s deaths were the first casualties on the Israeli side since Israel launched its most ferocious assault on Gaza in four years in response to persistent Palestinian rocket fire. In Gaza, the Palestinian death toll rose to 11 as Israel pummeled what the military described as medium- and long-range rocket and infrastructure sites and struck rocket-launching squads. The military said it had dispersed leaflets over Gaza warning residents to stay away from Hamas operatives and facilities, suggesting that more was to come.

Southern Israel has been struck by more than 750 rockets fired from Gaza this year that have hit homes and caused injuries. On Thursday, a rocket smashed into the top floor of an apartment building in Kiryat Malachi, about 15 miles north of Gaza. Two women and a man were killed, according to rescue officials and Army Radio. A baby was among the injured and several Israelis were hospitalized with shrapnel wounds after rockets hit other southern cities and towns, they said.

The apartment house was close to a field in a blue-collar neighborhood and the rocket tore open top-floor apartments, leaving twisted metal window frames and bloodstains.

Nava Chayoun, 40, who lives on the second floor, said her husband, Yitzhak, ran up the stairs immediately after the rocket struck and saw the body of a woman on the floor. He rescued two children from the same apartment and afterward, she said, she and her family “read psalms.”

It was the first time that a building in Kiryat Malachi had been struck and the farthest north a projectile had landed in the current violence. With schools closed after Wednesday’s turmoil, residents said, many people had stayed home with their children.

Residents said people living on the lower floors of the apartment house had taken cover in stairwells, as the police urged residents to do when they heard warning sirens, but those on the top floor apparently had not. Police said 180 rockets had been fired at southern Israel since Wednesday.

Three Gaza militants were killed when Israeli missiles hit their motorcycles in the southern Gaza town of Khan Younis. Palestinian security officials said they were most likely members of the Hamas military wing. Overnight, the body of a man, 65, was recovered from an open area that had been struck in the center of the Gaza Strip.

Five other civilians, including a baby and a 7-year-old girl, have been killed in Gaza since the operation began and at least 70 have been wounded, according to the Hamas-run Health Ministry in Gaza.

The Israeli offensive has damaged Israel’s fragile relations with Egypt and escalated the risks of a new war in the Middle East.

It opened on Wednesday with the killing of the top military commander of Hamas, Ahmed al-Jabari, who was killed in a pinpoint airstrike as he was riding in a car on a Gaza street. The Israelis also warned all Hamas leaders in Gaza to stay out of sight or risk the same fate.

On Thursday, hundreds of people took part in Mr. Jabari’s funeral, but Hamas leaders did not attend. As the procession wound its way through the streets from Mr. Jabari’s home to a mosque, the participants sometimes broke into a jog as Israeli warplanes dropped bombs nearby. Shops were closed in Gaza, and the streets were empty.

Isabel Kershner reported from Kiryat Malachi, Israel, and Fares Akram from Gaza. Reporting was contributed by Rina Castelnuovo from Kiryat Malachi; Mayy El Sheikh and David D. Kirkpatrick from Cairo; Gabby Sobelman from Jerusalem; Rick Gladstone from New York; and Alan Cowell from Paris.

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Gadgetwise Blog: Q&A: Making Picture Books on a PC

My Mac friends make these really nice picture books with iPhoto, but I use Windows. What options for easily making comparatively good-looking photo books are out there for me?

Apple iPhoto books, which can be designed and uploaded right from the iPhoto program, simplify the process for Mac users, but that does not mean Windows users are without similar resources. When shopping for a photo-book service, be sure to check out the selection of photo-editing tools, page templates and cover options to make sure the company provides everything you want for your custom photo book. Microsoft has a slightly outdated but general guide to publishing your own photo album in book form here.

Sites where you can upload photos and design your book right in your Web browser are plentiful. Shutterfly, which took over photo services from the now-defunct Kodak Gallery this year, and Snapfish are two established companies that have offered custom photo products for years. Mixbook and MyCanvas are also sites that let you create custom photo books.

Reviews of these sites and others are online. Prices for finished books are also comparable, averaging around $30 for a 20-page book before shipping charges. If you use the Flickr photo-sharing site, you can find links to sites that let you create custom books, cards and calendars with your pictures as well.

Depending on the photo-editing software you use on your computer, you may also be able to use a plug-in or an integrated service to create and upload a photo book. For example, Adobe Photoshop Elements has book-creation services and the Snap MyLife Creations Photo Book Uploader plug-in is available for the Windows Live Photo Gallery on Microsoft’s site.

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