Ecstasy Treatment for Post-Traumatic Stress Shows Promise

Gretchen Ertl for The New York Times

ALTERNATIVE TREATMENT Rick Doblin of the Multidisciplinary Association for Psychedelic Studies, which is financing research into the drug Ecstasy.

Hundreds of Iraq and Afghanistan veterans with post-traumatic stress have recently contacted a husband-and-wife team who work in suburban South Carolina to seek help. Many are desperate, pleading for treatment and willing to travel to get it.

The soldiers have no interest in traditional talking cures or prescription drugs that have given them little relief. They are lining up to try an alternative: MDMA, better known as Ecstasy, a party drug that surfaced in the 1980s and ’90s that can induce pulses of euphoria and a radiating affection. Government regulators criminalized the drug in 1985, placing it on a list of prohibited substances that includes heroin and LSD. But in recent years, regulators have licensed a small number of labs to produce MDMA for research purposes.

“I feel survivor’s guilt, both for coming back from Iraq alive and now for having had a chance to do this therapy,” said Anthony, a 25-year-old living near Charleston, S.C., who asked that his last name not be used because of the stigma of taking the drug. “I’m a different person because of it.”

In a paper posted online Tuesday by the Journal of Psychopharmacology, Michael and Ann Mithoefer, the husband-and-wife team offering the treatment — which combines psychotherapy with a dose of MDMA — write that they found 15 of 21 people who recovered from severe post-traumatic stress in the therapy in the early 2000s reported minor to virtually no symptoms today. Many said they have received other kinds of therapy since then, but not with MDMA.

The Mithoefers — he is a psychiatrist and she is a nurse — collaborated on the study with researchers at the Medical University of South Carolina and the nonprofit Multidisciplinary Association for Psychedelic Studies.

The patients in this group included mostly rape victims, and experts familiar with the work cautioned that it was preliminary, based on small numbers, and its applicability to war trauma entirely unknown. A spokeswoman for the Department of Defense said the military was not involved in any research of MDMA.

But given the scarcity of good treatments for post-traumatic stress, “there is a tremendous need to study novel medications,” including MDMA, said Dr. John H. Krystal, chairman of psychiatry at the Yale School of Medicine.

The study is the first long-term test to suggest that psychiatrists’ tentative interest in hallucinogens and other recreational drugs — which have been taboo since the 1960s — could pay off. And news that the Mithoefers are beginning to test the drug in veterans is out, in the military press and on veterans’ blogs. “We’ve had more than 250 vets call us,” Dr. Mithoefer said. “There’s a long waiting list, we wish we could enroll them all.”

The couple, working with other researchers, will treat no more than 24 veterans with the therapy, following Food and Drug Administration protocols for testing an experimental drug; MDMA is not approved for any medical uses.

A handful of similar experiments using MDMA, LSD or marijuana are now in the works in Switzerland, Israel and Britain, as well as in this country. Both military and civilian researchers are watching closely. So far, the research has been largely supported by nonprofit groups.

“When it comes to the health and well-being of those who serve, we should leave our politics at the door and not be afraid to follow the data,” said Brig. Gen. Loree Sutton, a psychiatrist who recently retired from the Army. “There’s now an evidence base for this MDMA therapy and a plausible story about what may be going on in the brain to account for the effects.”

In interviews, two people who have had the therapy — one, Anthony, currently in the veterans study, and another who received the therapy independently — said that MDMA produced a mental sweet spot that allowed them to feel and talk about their trauma without being overwhelmed by it.

“It changed my perspective on the entire experience of working at ground zero,” said Patrick, a 46-year-old living in San Francisco, who worked long hours in the rubble after the Sept. 11, 2001, attacks searching in vain for survivors, as desperate family members of the victims looked on, pleading for information. “At times I had this beautiful, peaceful feeling down in the pit, that I had a purpose, that I was doing what I needed to be doing. And I began in therapy to identify with that,” rather than the guilt and sadness.

This article has been revised to reflect the following correction:

Correction: November 20, 2012

An earlier version of this article described incorrectly the office arrangement the Mithoefers use to conduct therapy sessions using MDMA. They hold the sessions in an office in a converted house, but they do not conduct the sessions in their home office.

Read More..

Ecstasy Treatment for Post-Traumatic Stress Shows Promise

Gretchen Ertl for The New York Times

ALTERNATIVE TREATMENT Rick Doblin of the Multidisciplinary Association for Psychedelic Studies, which is financing research into the drug Ecstasy.

Hundreds of Iraq and Afghanistan veterans with post-traumatic stress have recently contacted a husband-and-wife team who work in suburban South Carolina to seek help. Many are desperate, pleading for treatment and willing to travel to get it.

The soldiers have no interest in traditional talking cures or prescription drugs that have given them little relief. They are lining up to try an alternative: MDMA, better known as Ecstasy, a party drug that surfaced in the 1980s and ’90s that can induce pulses of euphoria and a radiating affection. Government regulators criminalized the drug in 1985, placing it on a list of prohibited substances that includes heroin and LSD. But in recent years, regulators have licensed a small number of labs to produce MDMA for research purposes.

“I feel survivor’s guilt, both for coming back from Iraq alive and now for having had a chance to do this therapy,” said Anthony, a 25-year-old living near Charleston, S.C., who asked that his last name not be used because of the stigma of taking the drug. “I’m a different person because of it.”

In a paper posted online Tuesday by the Journal of Psychopharmacology, Michael and Ann Mithoefer, the husband-and-wife team offering the treatment — which combines psychotherapy with a dose of MDMA — write that they found 15 of 21 people who recovered from severe post-traumatic stress in the therapy in the early 2000s reported minor to virtually no symptoms today. Many said they have received other kinds of therapy since then, but not with MDMA.

The Mithoefers — he is a psychiatrist and she is a nurse — collaborated on the study with researchers at the Medical University of South Carolina and the nonprofit Multidisciplinary Association for Psychedelic Studies.

The patients in this group included mostly rape victims, and experts familiar with the work cautioned that it was preliminary, based on small numbers, and its applicability to war trauma entirely unknown. A spokeswoman for the Department of Defense said the military was not involved in any research of MDMA.

But given the scarcity of good treatments for post-traumatic stress, “there is a tremendous need to study novel medications,” including MDMA, said Dr. John H. Krystal, chairman of psychiatry at the Yale School of Medicine.

The study is the first long-term test to suggest that psychiatrists’ tentative interest in hallucinogens and other recreational drugs — which have been taboo since the 1960s — could pay off. And news that the Mithoefers are beginning to test the drug in veterans is out, in the military press and on veterans’ blogs. “We’ve had more than 250 vets call us,” Dr. Mithoefer said. “There’s a long waiting list, we wish we could enroll them all.”

The couple, working with other researchers, will treat no more than 24 veterans with the therapy, following Food and Drug Administration protocols for testing an experimental drug; MDMA is not approved for any medical uses.

A handful of similar experiments using MDMA, LSD or marijuana are now in the works in Switzerland, Israel and Britain, as well as in this country. Both military and civilian researchers are watching closely. So far, the research has been largely supported by nonprofit groups.

“When it comes to the health and well-being of those who serve, we should leave our politics at the door and not be afraid to follow the data,” said Brig. Gen. Loree Sutton, a psychiatrist who recently retired from the Army. “There’s now an evidence base for this MDMA therapy and a plausible story about what may be going on in the brain to account for the effects.”

In interviews, two people who have had the therapy — one, Anthony, currently in the veterans study, and another who received the therapy independently — said that MDMA produced a mental sweet spot that allowed them to feel and talk about their trauma without being overwhelmed by it.

“It changed my perspective on the entire experience of working at ground zero,” said Patrick, a 46-year-old living in San Francisco, who worked long hours in the rubble after the Sept. 11, 2001, attacks searching in vain for survivors, as desperate family members of the victims looked on, pleading for information. “At times I had this beautiful, peaceful feeling down in the pit, that I had a purpose, that I was doing what I needed to be doing. And I began in therapy to identify with that,” rather than the guilt and sadness.

This article has been revised to reflect the following correction:

Correction: November 20, 2012

An earlier version of this article described incorrectly the office arrangement the Mithoefers use to conduct therapy sessions using MDMA. They hold the sessions in an office in a converted house, but they do not conduct the sessions in their home office.

Read More..

Clinton Visits in Effort to Defuse Gaza Conflict; Egypt Hints at Truce

JERUSALEM — Diplomatic efforts accelerated Tuesday to end the deadly confrontation between Israel and Palestinian militants in Gaza, as the United States sent Secretary of State Hillary Rodham Clinton to the Middle East and Egypt’s president expressed confidence that a cease-fire was close.

The diplomatic moves to end the nearly week-old crisis came on a day of some of the most intense violence yet. Militants in Gaza fired a long-range rocket toward Jerusalem for the second time in a week. The rocket fell short, but Israeli forces responded with an aerial assault on the suspected launching site near Gaza’s Al Shifa hospital that killed at least nine people. A delegation visiting Gaza from the Arab League postponed a news conference because of the Israeli assault, as wailing ambulances brought victims to the hospital, some of them decapitated.

The announcement of Mrs. Clinton’s active role in efforts to defuse the crisis added a strong new dimension to the multinational push to avert a new Middle East war and raised expectations of a truce. Israel has amassed thousands of soldiers on the border with Gaza and has threatened to invade the crowded Palestinian enclave for the second time in four years to stop the persistent rockets that have been lobbed at Israel.

Mrs. Clinton, who accompanied President Obama on his three-country Asia trip, left Cambodia on her own plane immediately for the Middle East. She was en route to Jerusalem to meet with Prime Minister Benjamin Netanyahu of Israel, then head to the West Bank to meet with Palestinian leaders and finally to Cairo to consult with Egyptian officials.

In Cairo, President Mohamed Morsi of Egypt added to the atmosphere of guarded optimism. The official Middle East News Agency quoted him as saying Israel’s “aggression” against Gaza would end, and Egyptian-mediated efforts would produce “positive results” in several hours.

The decision to dispatch Mrs. Clinton dramatically deepens the American involvement in the crisis. Mr. Obama made a number of late-night phone calls from his Asian tour to the Middle East on Monday night that contributed to his conclusion that he had to become more engaged and that Mrs. Clinton might be able to accomplish something.

With Ban Ki-moon, the United Nations secretary general, also scheduled to arrive in Israel on Tuesday, a senior official in the prime minister’s office said Israel had decided to give more time to diplomacy before launching a ground invasion into Gaza. But Israel has not withdrawn other options.

“I prefer a diplomatic solution,” Mr. Netanyahu said in a statement at the start of a meeting in Jerusalem with the German foreign minister, Guido Westerwelle. “I hope that we can get one, but if not, we have every right to defend ourselves with other means and we shall use them.

“As you know, we seek a diplomatic unwinding to this, through the discussions of cease-fire,” Mr. Netanyahu added. “But if the firing continues, we will have to take broader action and we won’t hesitate to do so.”

About three hours before Mr. Ban was scheduled to meet Mr. Netanyahu in Jerusalem, sirens sounded across the city in the early afternoon announcing an incoming rocket from Gaza. The military wing of Hamas said it had fired at the city. The rocket fell short, landing harmlessly in the West Bank just south of Jerusalem, and the military said it landed on open ground near a Palestinian village.

The rocket attack on the city, which is holy to Jews, Muslims and Christians, was the second in less than a week. On Friday, a rocket landed in a similar location, the police said.

The Israeli military said its air force had struck Tuesday morning at 11 Palestinian squads involved in planting explosives and firing rockets, as well as underground rocket launchers and a store of weapons and ammunition. The military said it had also used tank shells and artillery fire against unspecified targets in Gaza.

The Health Ministry in Gaza said the Palestinian death toll had climbed by late Tuesday morning to 112, roughly half of the dead civilians, including children. Three Israelis died in a rocket attack last week.

After an Asian summit dinner in Phnom Penh on Monday night, Mr. Obama called President Morsi to discuss the situation, then spoke with Mr. Netanyahu and called Mr. Morsi back. He was up until 2:30 a.m. on the phone, the White House said. He consulted with Mrs. Clinton repeatedly on the sidelines of the Asian summit meetings on Tuesday.

“This morning, Secretary Clinton and the president spoke again about the situation in Gaza, and they agreed that it makes sense for the secretary to travel to the region, so Secretary Clinton will depart today,” said Benjamin Rhodes, a deputy national security adviser to Mr. Obama. “Her visits will build on the engagement that we’ve undertaken in the last several days.”

Isabel Kershner reported from Jerusalem and Peter Baker from Phnom Penh, Cambodia. Reporting was contributed by Jodi Rudoren from Gaza City, David D. Kirkpatrick from Cairo and Rick Gladstone from New York.

Read More..

Investors Rush to Beat Threat of Higher Taxes

Business owners and investors are rapidly maneuvering to shield themselves from the prospect of higher taxes next year, a strategy that is sending ripples across Wall Street and broad areas of the economy.

Take Steve Wynn, the casino magnate, who has been a vocal critic of higher tax rates. He and his fellow shareholders in Wynn Resorts, the company announced, will collect a special dividend of $750 million on Tuesday, a payout timed to take advantage of current rates. Experts estimated that taking the payout this year instead of next could save Mr. Wynn, who owns a sizable stake in the company, more than $20 million.

For the wealthy like Mr. Wynn, the overriding goal is to record as much of their future income this year as they can. This includes moves as diverse as sales of businesses, one-time dividends and the sale of stocks that have been big winners.

“In my 30 years in practice, I’ve never seen such a flood of desire and action to transfer a business and cash out,” said Kenneth K. Bezozo, a partner in New York with the law firm Haynes and Boone. “We’re seeing a watershed event.”

Whether small business owners or individuals saving for retirement, investors are being urged by their advisers to reconsider their holdings. Along the way, many are shedding the very investments that have been the most popular over the last year, contributing to recent sell-offs in formerly high-flying shares like Apple and Amazon.

Investors typically take profits in their own portfolio at year-end, but the selling appears to be more targeted this year. Stocks with large dividends, for instance, are seen as less attractive because of the perceived likelihood of a sharp increase in the tax rate on dividends.

All this is weighing on the broader financial markets, as worries mount about the economic drag from the combination of higher tax rates and reduced government spending set for January if President Obama and Senate Republicans cannot reach a budget compromise before then.

Fears about the fiscal impasse in Washington, along with anxiety about fading corporate profits and weakening economies abroad, have pushed the benchmark Standard & Poor’s 500-stock index down about 5 percent since the election. On Friday, major stock indexes had their best showing of the week after President Obama and Republican leaders signaled that a compromise was possible.

Even if many of the tax breaks scheduled to expire survive a new budget deal, some business owners and investors are bracing for substantial increases in specific areas of the tax code.

The top rate on dividends, for example, could climb to 39.6 percent from 15 percent if no action is taken. Capital gains taxes, which now top out at 15 percent, could rise above 20 percent, many financial advisers say. Most investment income will also be subject to a 3.8 percent charge to help pay for President Obama’s health care law.

Stocks that pay big dividends have been popular in recent years among investors eager for an alternative to the meager returns on bank savings accounts and Treasury securities. Since October, though, the two sectors that provide the most generous dividend payments — utilities and telecommunication stocks — have been among the worst performers, hurt also in part by the devastation of Hurricane Sandy on the East Coast. Utility companies in the S.& P. 500 have fallen 9.4 percent from their highs in October. Telecommunication stocks in the index have dropped 11.3 percent from theirs, compared with the broader index’s 6.8 percent decline from its recent high.

John Moorin, the founder of a medical equipment company near Indianapolis, said he sold about $650,000 in dividend-paying stocks like McDonald’s and Coca-Cola a few days after the election, worried about the potential increase in taxes.

“I love these companies, but I’m so scared that now all of the sudden I’m going to get taxed at such a rate with them that they won’t be worth anything,” Mr. Moorin said.

Although Mr. Wynn has declared special dividends at the end of the year before — most recently in 2011 — in a call with analysts last month, he hinted that higher taxes would cause him and other chief executives to rethink big payouts in future years.

In the meantime, he added, it was “very difficult to do long-range planning with a government that moves as much as this does on so many issues.”

Leggett & Platt, a diversified manufacturer based in Carthage, Mo., decided to move up payment of its fourth-quarter dividend to December from January so shareholders could take advantage of the lower rate.

“If we can help our shareholders avoid taxes and keep more of their dividends, we’ll do it,” said David M. DeSonier, senior vice president for corporate strategy and investor relations.

David Kocieniewski contributed reporting.

Read More..

Novelties: Single-Incision Surgery, Via New Robotic Systems

SURGEONS once made incisions large enough to get to a gallbladder or other organs by using conventional tools they held in their own hands. Today, many sit at a computer console instead, guiding robotic arms that enter the patient’s body through small openings not much larger than keyholes.

But even this minimally invasive surgery usually requires multiple incisions: one for the camera system showing the way to the surgeon at the console, and others for each of the robotic arms that do the cutting and stitching.

Now there are robotic systems — one on the market, others in development — that are even less intrusive. They require only a single, small incision through which the robotic arms and camera enter.

This could lead to faster recovery, said Dr. Michael Hsieh, a Stanford professor and a urologist at Lucile Packard Children’s Hospital and Stanford Hospital. “There’s only one wound to heal with this procedure, rather than three,” he said.

Dr. Hsieh, who performs abdominal surgery on small children, uses minimally invasive techniques that typically now require three incisions. His patients generally go home a day or two after surgery, he said, “but I think they would recover more quickly if I could reduce my multiple incisions to just one,” he said. “And there will be less scarring, or even no scarring, if you enter through the navel.”

He will soon have a chance to try out the new method on his patients. Stanford Hospital is buying a system from Intuitive Surgical called Single-Site that requires only a single incision of about one inch. The system, approved by the Food and Drug Administration only for gallbladder removal, is used as an add-on to a basic robotic system from Intuitive, known as the da Vinci Si.

The Si costs $1.3 million to $2.2 million, said Angela Wonson, a spokeswoman for Intuitive, based in Sunnyvale, Calif. The Single-Site can add $60,000 or more to the bill, or far less, depending in part on the equipment that hospitals might already have.

The East Jefferson General Hospital in Metairie, La., has bought a Single-Site system. Seated at a computer there, Dr. Joseph Uddo Jr. can control the instruments, which can enter the body by way of one incision in the navel. Surgical instruments like scissors are at the ends of the robotic arms. “To change a tool, you take out one instrument and load in another,” he said.

ANOTHER surgical robotic system, now in development, enters the body through a remarkably small incision — six-tenths of an inch, or 15 millimeters. The robot was designed by Drs. Dennis Fowler and Peter Allen of Columbia University and Dr. Nabil Simaan of Vanderbilt University. Once inside the body, it unfolds to reveal a camera system and two snakelike arms that perform the surgery. The system has been licensed to Titan Medical in Toronto.

Minimally invasive surgery through a single incision can also be performed with long, thin laparoscopic tools that surgeons wield as they watch a video monitor. But single-incision laparoscopic surgery with hand-held instruments can have problems, said Dr. Adrian Park, chairman of the department of surgery at the Anne Arundel Medical Center in Annapolis, Md., who specializes in minimally invasive gastrointestinal surgery. One difficulty is its ergonomic challenge to doctors, while another is the pressure that the tools place on tissue during single-incision operations.

Robotic systems, by contrast, are likely to ease single-incision surgery, said Jeffrey J. Tomaszewski, a fellow in urologic oncology at the Fox Chase Cancer Center in Philadelphia.

“Robots are an extension and multiplier of our own surgical hands,” Dr. Tomaszewski said. He has done traditional laparoscopic surgery with hand-held instruments, including operations through a single incision. “But you can be working at constrained angles,” he said. “A robot can improve the angle of workability.”

Robotic systems, though, have yet to show that they are always worth the extra money they cost. Such proof will take time, said Allison Okamura, an associate professor of mechanical engineering at Stanford who directs the Collaborative Haptics and Robotics in Medicine Lab. “The jury is still out because of the longevity of the studies that are required,” she said.

Dr. Tomaszewski agreed. “We surgeons love using the robot,” he said. “But the question is, and what we all have to fight hard to do, is to determine for what procedure the robotic approach provides the best benefit.”

Dr. Hsieh says he hopes that single-site robotic systems will someday bring a benefit he’s long dreamed about.

“We may get to the point where we do outpatient, scarless robotic surgery,” he said. “That’s what I’m shooting for.”

E-mail: novelties@nytimes.com.

Read More..

Novelties: Single-Incision Surgery, Via New Robotic Systems

SURGEONS once made incisions large enough to get to a gallbladder or other organs by using conventional tools they held in their own hands. Today, many sit at a computer console instead, guiding robotic arms that enter the patient’s body through small openings not much larger than keyholes.

But even this minimally invasive surgery usually requires multiple incisions: one for the camera system showing the way to the surgeon at the console, and others for each of the robotic arms that do the cutting and stitching.

Now there are robotic systems — one on the market, others in development — that are even less intrusive. They require only a single, small incision through which the robotic arms and camera enter.

This could lead to faster recovery, said Dr. Michael Hsieh, a Stanford professor and a urologist at Lucile Packard Children’s Hospital and Stanford Hospital. “There’s only one wound to heal with this procedure, rather than three,” he said.

Dr. Hsieh, who performs abdominal surgery on small children, uses minimally invasive techniques that typically now require three incisions. His patients generally go home a day or two after surgery, he said, “but I think they would recover more quickly if I could reduce my multiple incisions to just one,” he said. “And there will be less scarring, or even no scarring, if you enter through the navel.”

He will soon have a chance to try out the new method on his patients. Stanford Hospital is buying a system from Intuitive Surgical called Single-Site that requires only a single incision of about one inch. The system, approved by the Food and Drug Administration only for gallbladder removal, is used as an add-on to a basic robotic system from Intuitive, known as the da Vinci Si.

The Si costs $1.3 million to $2.2 million, said Angela Wonson, a spokeswoman for Intuitive, based in Sunnyvale, Calif. The Single-Site can add $60,000 or more to the bill, or far less, depending in part on the equipment that hospitals might already have.

The East Jefferson General Hospital in Metairie, La., has bought a Single-Site system. Seated at a computer there, Dr. Joseph Uddo Jr. can control the instruments, which can enter the body by way of one incision in the navel. Surgical instruments like scissors are at the ends of the robotic arms. “To change a tool, you take out one instrument and load in another,” he said.

ANOTHER surgical robotic system, now in development, enters the body through a remarkably small incision — six-tenths of an inch, or 15 millimeters. The robot was designed by Drs. Dennis Fowler and Peter Allen of Columbia University and Dr. Nabil Simaan of Vanderbilt University. Once inside the body, it unfolds to reveal a camera system and two snakelike arms that perform the surgery. The system has been licensed to Titan Medical in Toronto.

Minimally invasive surgery through a single incision can also be performed with long, thin laparoscopic tools that surgeons wield as they watch a video monitor. But single-incision laparoscopic surgery with hand-held instruments can have problems, said Dr. Adrian Park, chairman of the department of surgery at the Anne Arundel Medical Center in Annapolis, Md., who specializes in minimally invasive gastrointestinal surgery. One difficulty is its ergonomic challenge to doctors, while another is the pressure that the tools place on tissue during single-incision operations.

Robotic systems, by contrast, are likely to ease single-incision surgery, said Jeffrey J. Tomaszewski, a fellow in urologic oncology at the Fox Chase Cancer Center in Philadelphia.

“Robots are an extension and multiplier of our own surgical hands,” Dr. Tomaszewski said. He has done traditional laparoscopic surgery with hand-held instruments, including operations through a single incision. “But you can be working at constrained angles,” he said. “A robot can improve the angle of workability.”

Robotic systems, though, have yet to show that they are always worth the extra money they cost. Such proof will take time, said Allison Okamura, an associate professor of mechanical engineering at Stanford who directs the Collaborative Haptics and Robotics in Medicine Lab. “The jury is still out because of the longevity of the studies that are required,” she said.

Dr. Tomaszewski agreed. “We surgeons love using the robot,” he said. “But the question is, and what we all have to fight hard to do, is to determine for what procedure the robotic approach provides the best benefit.”

Dr. Hsieh says he hopes that single-site robotic systems will someday bring a benefit he’s long dreamed about.

“We may get to the point where we do outpatient, scarless robotic surgery,” he said. “That’s what I’m shooting for.”

E-mail: novelties@nytimes.com.

Read More..

Bits: In New Apps, Tools for Volunteering After Hurricane Sandy

LIKE many other New Yorkers horrified by the devastation of Hurricane Sandy, I leapt at the chance to volunteer and get the city back on its feet, particularly the hardest-hit sections of Staten Island, Brooklyn and Queens.

Yet it was hard to figure out how to sort through the various relief organizations and community-led efforts to donate money, supplies and my personal time.

For someone who is accustomed to procuring information quickly and efficiently with a few searches, taps and clicks, the chaos was bewildering. And some of the tools and services that we use in our everyday lives — Facebook, Twitter, simple e-mails and the like — were less effective in the mayhem that followed the storm.

In many kinds of disasters, it can be hard to sift through the dozens, or hundreds, of images and messages to determine where help is most needed — and who needs what. In addition, many of the neediest people are often left without cellular reception and access to a reliable Internet connection.

After a disaster, a top priority “is organizing information and being able to allocate resources,” said Mac Sims, who works at the Rain Agency, a digital advertising agency that has a New York office.

Not long after the hurricane hit, Mr. Sims’s company was among those that began organizing events known as hackathons, where programmers and engineers develop applications and services around a central need or theme.

George Shank, an interactive software developer who works with Mr. Sims, helped build a service called Sprout Help that relays information about where to send supplies and how to volunteer effectively.

“A lot of it stemmed from wanting to help but not being sure how to do it,” Mr. Shank said. “We heard stories of people going to fire stations to volunteer and being turned away.”

Although voice and data connections often succumb to power failures, many people can still send text messages over cellphone networks. Sprout takes advantage of that loophole. Volunteers could post fliers with information about how to send a text to Sprout to join the service, which doubles as a real-time alert system that fires off messages with information about where volunteers should go. Those in need can also send messages through Sprout outlining their location, and detailing the area’s needs, like fresh water or medical help.

Mr. Shank said the company wanted to recreate the effectiveness of posting a beacon for help on Facebook or Twitter, but one that would not become lost in the myriad other messages coursing through those systems at any given moment. Sprout, he said, is similar to a social network system like Facebook, but is “one that people would have access to during a disaster.”

Robert Grazioli and Eric Candino, who work at Rounded, a design agency in Syracuse, developed a service called HugoHelps that lets disaster victims search for places to stay after their homes have been flooded or stripped of basic utilities like electricity and heat.

Mr. Grazioli said they built their application after hearing that several friends were stranded in Lower Manhattan without a warm place to sleep.

“They were safe, but displaced,” he said. “We wanted to help them find better places to stay nearby that had power.”

Their application also delivers information via text message.

“Data is very difficult during a disaster, and we wanted to make sure people without smartphones could also use it too,” he said.

Currently, the application funnels information about nearby hotels, but Mr. Grazioli and Mr. Candino think that future iterations could relay details about shelters, free disaster housing and inexpensive rooms for rent.

NOT all such applications and tools developed were turned into full-fledged products. Instead, their makers hope that they can serve as guidelines for the types of services that could be deployed by government and relief organizations during future disasters or national crises.

Sasha Costanza-Chock, a professor of civic media at the Massachusetts Institute of Technology, says disaster preparedness is about more than stocking up on bottled water, packaged meals and fresh batteries. It’s also a matter of pooling technical resources to solve the problems that can arise quickly, like how to move supplies to those in need and relay reliable information about shelters and food.

In the hours before the hurricane struck, Mr. Costanza-Chock started Hurricane Hackers, an online hub where software engineers and developers could share ideas as the storm advanced.

“We were looking at ways to support and build together, even people from a distance who wanted to support relief efforts,” he said.

Mr. Costanza-Chock emphasized the importance of realistic ideas that can be deployed quickly.

“It’s easy to dream up fantastic solutions, but what works on the ground and will be useful in the moment are the ones that are the most successful,” he said. “Whether it is beautiful or not does not matter.”

In his experience, tools that are tied to a real need — grounded in an organization with people working on the scene, and limited to a specific geographic area — are those that have worked the best.

“The challenge is not to build the tools,” he said, “but rather, how do you capture the attention and energy that people have and plug it in?”

Read More..

Palestinian Death Toll Rises as Israel Presses Onslaught

GAZA CITY — After a night of sustained Israeli strikes by air and sea and a morning of rocket attacks on Israel, the Health Ministry here said on Monday that the Palestinian death toll in six days of conflict had risen to 91 with 700 wounded, including 200 children, as the assault ground on unrelentingly despite efforts toward a cease-fire.

The casualties — 19 people reported killed since midnight local time — included Palestinians killed in strikes by warplanes and a drone attack on two men on a motorcycle. Another drone attack killed the driver of a taxi hired by journalists and displaying “Press” signs, although it was not clear which journalists hired it, Palestinian officials said.

On Sunday, Israeli forces attacked two buildings housing local broadcasters and production companies used by foreign outlets. Israeli officials denied targeting journalists, but on Monday Israeli forces again blasted the Al Sharouk block used by many local broadcasters as well as Britain’s Sky News and the Al Arabiya channel.

The attack, apparently aimed at a computer shop on the third floor of the building, sparked a blaze that sent plumes of dark smoke creeping up the sides of the building. Video footage showed clouds of gray smoke billowing from the high-rise building as the missiles struck home.

An Israeli bomb pummeled a home deep into the ground here on Sunday, killing 11 people, including nine in three generations of a single family, in the deadliest single strike in six days of cross-border conflict. Members of the family were buried Monday in a rite that turned into a gesture of defiance and became a rally supporting Gaza’s militant Hamas rulers.

A militant leader said Tel Aviv, in the Israeli heartland, would be hit “over and over” and warned Israelis that their leaders were misleading them and would “take them to hell.”

The airstrikes further indicated that Israel was striking a wide range of targets. Three Israelis have been killed and at least 79 wounded by continued rocket fire into southern Israel and as far north as Tel Aviv.

Israel says its onslaught is designed to stop Hamas from launching the rockets, but, after an apparent lull overnight, more missiles hurtled toward targets in Israel, some of them intercepted by Israel’s Iron Dome defense system. Of five rockets fired on Monday at the southern Israeli city of Ashkelon, four were intercepted but one smashed through the concrete roof at the entrance to an empty school. There were no reports of casualties. Other rockets rained on areas along the border with Gaza. 

Later a second volley struck Ashkelon. Several rockets were intercepted, but one crashed down onto a house, causing damage but no casualties. News reports said 75 rockets had been fired by midafternoon.

On Sunday, a new blitz of Palestinian rockets totaled nearly 100 by nightfall, including two that soared toward the population center of Tel Aviv but were knocked out of the sky by Israeli defenses.

In a statement on Monday, the Israel Defense Forces said overnight targets included “underground rocket launchers, terror tunnels, training bases, Hamas command posts and weapon storage facilities.” But news reports said the strikes flattened two houses belonging to a single family, killing two children and two adults and injuring 42 people, while a shrapnel burst from another attack killed one child and wounded others living near the rubble of the former national security compound.

The latest exchanges offered a grim backdrop to Egyptian-led cease-fire efforts that have so far proved inconclusive. The United Nations secretary general, Ban Ki-moon, was set to join the effort in Cairo on Monday.

Brig. Gen. Yoav Mordechai, the spokesman for the Israel Defense Forces, said there had been a reduction of up to 40 percent in rocket fire from Gaza, while Israeli forces had launched 40 attacks on tunnels between Egypt and Gaza, both at the entrances and along the road leading to them, causing considerable damage.

He said six rocket launching teams and two men on motorcycles were hit, while the Israeli forces continued to intercept Palestinian radio signals to urge Gaza residents to steer clear of activists.

In the Israeli strike on Sunday morning, it took emergency workers and a Caterpillar digger more than an hour to reveal the extent of the devastation under the two-story home of Jamal Dalu, a shop owner. Mr. Dalu was at a neighbor’s when the blast wiped out nearly his entire family: His sister, wife, two daughters, daughter-in-law and four grandchildren ages 2 to 6 all perished under the rubble, along with two neighbors, an 18-year-old and his grandmother.

Fares Akram and Jodi Rudoren reported from Gaza City, and Alan Cowell from London. Reporting was contributed by Isabel Kershner from Ashkelon, Israel; Ethan Bronner, Myra Noveck and Irit Pazner Garshowitz from Jerusalem; Rina Castelnuovo from Ashdod, Israel; Peter Baker from Bangkok; and David D. Kirkpatrick from Cairo.

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The iEconomy: As Boom Lures App Creators, Tough Part Is Making a Living

Daniel Rosenbaum for The New York Times

Shawn and Stephanie Grimes’s efforts have cost $200,000 in lost income and savings, but their apps have earned less than $5,000 this year.

ROSEDALE, Md. — Shawn and Stephanie Grimes spent much of the last two years pursuing their dream of doing research and development for Apple, the world’s most successful corporation.

But they did not actually have jobs at Apple. It was freelance work that came with nothing in the way of a regular income, health insurance or retirement plan. Instead, the Grimeses tried to prepare by willingly, even eagerly, throwing overboard just about everything they could.

They sold one of their cars, gave some possessions to relatives and sold others in a yard sale, rented out their six-bedroom house and stayed with family for a while. They even cashed in Mr. Grimes’s 401(k).

“We didn’t lose any sleep over it,” said Mr. Grimes, 32. “I’ll retire when I die.”

The couple’s chosen field is so new it did not even exist a few years ago: writing software applications for mobile devices like the iPhone or iPad. Even as unemployment remained stubbornly high and the economy struggled to emerge from the recession’s shadow, the ranks of computer software engineers, including app writers, increased nearly 8 percent in 2010 to more than a million, according to the latest available government data for that category. These software engineers now outnumber farmers and have almost caught up with lawyers.

Much as the Web set off the dot-com boom 15 years ago, apps have inspired a new class of entrepreneurs. These innovators have turned cellphones and tablets into tools for discovering, organizing and controlling the world, spawning a multibillion-dollar industry virtually overnight. The iPhone and iPad have about 700,000 apps, from Instagram to Angry Birds.

Yet with the American economy yielding few good opportunities in recent years, there is debate about how real, and lasting, the rise in app employment might be.

Despite the rumors of hordes of hip programmers starting million-dollar businesses from their kitchen tables, only a small minority of developers actually make a living by creating their own apps, according to surveys and experts. The Grimeses began their venture with high hopes, but their apps, most of them for toddlers, did not come quickly enough or sell fast enough.

And programming is not a skill that just anyone can learn. While people already employed in tech jobs have added app writing to their résumés, the profession offers few options to most unemployed, underemployed and discouraged workers.

One success story is Ethan Nicholas, who earned more than $1 million in 2009 after writing a game for the iPhone. But he says the app writing world has experienced tectonic shifts since then.

“Can someone drop everything and start writing apps? Sure,” said Mr. Nicholas, 34, who quit his job to write apps after iShoot, an artillery game, became a sensation. “Can they start writing good apps? Not often, no. I got lucky with iShoot, because back then a decent app could still be successful. But competition is fierce nowadays, and decent isn’t good enough.”

The boom in apps comes as economists are debating the changing nature of work, which technology is reshaping at an accelerating speed. The upheaval, in some ways echoing the mechanization of agriculture a century ago, began its latest turbulent phase with the migration of tech manufacturing to places like China. Now service and even white-collar jobs, like file clerks and data entry specialists or office support staff and mechanical drafters, are disappearing.

“Technology is always destroying jobs and always creating jobs, but in recent years the destruction has been happening faster than the creation,” said Erik Brynjolfsson, an economist and director of the M.I.T. Center for Digital Business.

Still, the digital transition is creating enormous wealth and opportunity. Four of the most valuable American companies — Apple, Google, Microsoft and I.B.M. — are rooted in technology. And it was Apple, more than any other company, that set off the app revolution with the iPhone and iPad. Since Apple unleashed the world’s freelance coders to build applications four years ago, it has paid them more than $6.5 billion in royalties.

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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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