Alarm Over India’s Dengue Fever Epidemic

Enrico Fabian for The New York Times

Filthy standing water abound in New Delhi has contributed to an epidemic of dengue fever in India. More Photos »

NEW DELHI — An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world’s nations.

“The global dengue problem is far worse than most people know, and it keeps getting worse,” said Dr. Raman Velayudhan, the World Health Organization’s lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India’s capital, where areas of standing water contribute to the epidemic’s growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.

Among them was Neelam, who said her two grandchildren were deathly ill inside. Eight-year-old Sneha got the disease first, followed by Tanya, 7, she said. The girls’ parents treated them at home but then Sneha’s temperature rose to 104 degrees, a rash spread across her legs and shoulders, and her pain grew unbearable.

“Sneha has been given five liters of blood,” said Neelam, who has one name. “It is terrible.”

Officials say that 30,002 people in India had been sickened with dengue fever through October, a 59 percent jump from the 18,860 recorded for all of 2011. But the real number of Indians who get dengue fever annually is in the millions, several experts said.

“I’d conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations,” said Dr. Scott Halstead, a tropical disease expert focused on dengue research.

A senior Indian government health official, who agreed to speak about the matter only on the condition of anonymity, acknowledged that official figures represent a mere sliver of dengue’s actual toll. The government only counts cases of dengue that come from public hospitals and that have been confirmed by laboratories, the official said. Such a census, “which was deliberated at the highest levels,” is a small subset that is nonetheless informative and comparable from one year to the next, he said.

“There is no denying that the actual number of cases would be much, much higher,” the official said. “Our interest has not been to arrive at an exact figure.”

The problem with that policy, said Dr. Manish Kakkar, a specialist at the Public Health Foundation of India, is that India’s “massive underreporting of cases” has contributed to the disease’s spread. Experts from around the world said that India’s failure to construct an adequate dengue surveillance system has impeded awareness of the illness’s vast reach, discouraged efforts to clean up the sources of the disease and slowed the search for a vaccine.

“When you look at the number of reported cases India has, it’s a joke,” said Dr. Harold S. Margolis, chief of the dengue branch at the Centers for Disease Control and Prevention in Atlanta.

Neighboring Sri Lanka, for instance, reported nearly three times as many dengue cases as India through August, according to the World Health Organization, even though India’s population is 60 times larger.

Hari Kumar contributed reporting.

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Square Feet: Geothermal Energy Advocates Hope Systems Get a Second Look

Advocates for geothermal energy say that the path of destruction cut by Hurricane Sandy, which unearthed fuel tanks, ravaged cooling towers and battered air-conditioners, has already persuaded some building owners to switch to geothermal systems that use underground pipes to harness the earth’s energy for heating and cooling buildings.

Andrea Mohin/The New York Times

The geothermal energy system at the Brooklyn Children’s Museum, installed in 2007 at a cost of $675,000.

“We’re seeing dozens of these half-empty and empty oil tanks just popping up all over the place in the flooded areas,” said David E. Reardon, the manager of geothermal drilling for the Miller Environmental Group, an environmental response, remediation and restoration services company based in Calverton on Long Island that has been involved in poststorm environmental cleanup throughout the region.

“Those tanks become buoyant in all that water,” he said. But since geothermal systems don’t use fossil fuels or mechanical systems that are exposed to the elements, Mr. Reardon said, he started fielding calls from people asking for estimates on geothermal systems just days after the storm. “Often it’s a case where they were considering doing it, but were waiting for something to finally no longer be able to be repaired,” he said, and the storm has ended that wait.

Geothermal energy systems, common in countries like Iceland and China, use the constant temperature of the earth to heat and cool buildings.

Geothermal wells are dug to a depth where the earth regulates the temperature of water or a liquid circulating through the system. Geothermal systems may require one well or dozens to regulate a building’s temperature, depending on the size of a building and type of system installed. While the systems are called wells, they are actually an underground network of pipes connected to heat pumps to circulate water or some other liquid.

Because digging geothermal wells can be expensive and logistically difficult, the systems have been slow to catch on in New York City. Yet, according to the Rockefeller Foundation and DB Climate Change Advisors, “buildings consume approximately 40 percent of the world’s primary energy and are responsible for 40 percent of global carbon emissions,” said Jack DiEnna, the executive director of the Geothermal Heat Pump National and International Initiative, based in Washington.

Installing a geothermal system can significantly reduce a building’s carbon footprint, and over the last decade, the number of geothermal heat pump systems in the city has grown steadily. More geothermal systems are installed in New York, New Jersey and Pennsylvania than anywhere else in the United States.

Most systems are being installed in institutional buildings, multifamily residential buildings and relatively small commercial buildings. There have been systems installed by several prominent organizations and sites in the city, including the American Institute of Architects, the Times Square TKTS Booth, the Brooklyn Children’s Museum, the Queens Botanical Garden and the Bronx Zoo Lion House. In some of the outer boroughs and the suburbs, geothermal systems for single-family homes are also becoming more popular.

In all, more than 100 geothermal projects are in operation in the five boroughs, and about 90 percent of those projects are what are known as closed loop vertical bore systems, Mr. DiEnna said. A closed loop system is sealed from the ground and liquids are reused within the system, while an open loop system has discharge water it releases into a ground well or surface water.

Because building sites in the city, particularly Manhattan, tend to be small, the wells tend to be vertical, just like the buildings. Manhattan is not an ideal location for geothermal heat pump systems, because the wells must go so deep — to depths of roughly 1,500 feet — to reach the volume of land necessary to provide a constant temperature. In other areas with more available land, a geothermal heat pump system can be more spread out and much shallower, making it less costly to dig.

Elsewhere, larger scale geothermal projects known as enhanced geothermal systems have raised serious concerns because these larger power-production projects involve drilling wells down to tens of thousands of feet and fracturing the bedrock so water can be injected to create steam.

A few years ago, a project in Switzerland was shut down after it caused small earthquakes, and another project in Northern California was also stopped because of similar concerns. But the static, small-scale geothermal heat pump systems installed in the New York area bear little relation to these projects, said Daniel P. Schrag, a professor of geology and director of the Center for the Environment at Harvard.

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Unlikely Model for H.I.V. Prevention: Adult Film Industry

Stephanie Diani for The New York Times

INDUSTRY DATABASE Shylar Cobi, right, a film producer, confirmed test results of the actors who perform as James Deen and Stoya.

LOS ANGELES — Before they take off all their clothes, the actors who perform as James Deen and Stoya go through a ritual unique to the heterosexual adult film industry.

First, they show each other their cellphones: Each has an e-mail from a laboratory saying he or she just tested negative for H.I.V., syphilis, chlamydia and gonorrhea.

Then they sit beside the film’s producer, Shylar Cobi, as he checks an industry database with their real names to confirm that those negative tests are less than 15 days old.

Then, out on the pool terrace of the day’s set — a music producer’s hilltop home with a view of the Hollywood sign — they yank down their pants and stand around joking as Mr. Cobi quickly inspects their mouths, hands and genitals for sores.

“I’m not a doctor,” Mr. Cobi, who wears a pleasantly sheepish grin, says. “I’m only qualified to do this because I’ve been shooting porn since 1990 and I know what looks bad.”

Bizarre as the ritual is, it seems to work.

The industry’s medical consultants say that about 350,000 sex scenes have been shot without condoms since 2004, and H.I.V. has not been transmitted on a set once.

Outside the world of pornography, the industry’s testing regimen is not well known, and no serious academic study of it has ever been done. But when it was described to several AIDS experts, they all reacted by saying that there were far fewer infections than they would have expected, given how much high-risk sex takes place.

“I don’t think there’s any question that it works,” said Dr. Allan Ronald, a Canadian AIDS specialist who did landmark studies of the virus in prostitutes in a Nairobi slum. “I’m a little uncomfortable, because it’s giving the wrong message — that you can have multiple sex partners without condoms — but I can’t say it doesn’t work.”

Despite the regimen’s apparent success, California health officials and an advocacy group, the AIDS Healthcare Foundation, are trying to make it illegal to shoot without condoms. They argue that other sexually transmitted diseases are rampant in the industry, though the industry trade group disputes that.

In January, the city of Los Angeles passed a law requiring actors to wear condoms. A measure to do the same for the whole county is on the ballot on Tuesday.

Producers say the condom requirement will drive them out of business since consumers will not buy such films. Local newspapers like The Los Angeles Times oppose the ballot measure, calling it well-intentioned but unenforceable, and warning that it could drive up to 10,000 jobs out of state.

Very frequent testing makes it almost impossible for an actor to stay infected without being caught, said Dr. Jacques Pepin, the author of “The Origins of AIDS” and an expert on transmission rates. “And if you are having sex mostly with people who themselves are tested all the time, this must further reduce the risk.”

When the virus first enters a high-risk group like heroin users, urban prostitutes or habitués of gay bathhouses, it usually infects 30 to 60 percent of the cohort within a few years, studies have shown. The same would be expected in pornography, performers can have more than a dozen partners a month, but the industry says self-policing has prevented it..

“Our talent base has sex exponentially more than other people, but we’re all on the same page about keeping it out,” said Steven Hirsch, the founder of Vivid Entertainment, one of the biggest studios.

Performers have to test negative every 28 days, although some studios recently switched to every 14.

If a test is positive, all the studios across the country that adhere to standards set by the Free Speech Coalition, an industry trade group, are obliged to stop filming until all the on-screen partners of that performer, all their partners, and all their partners’ partners, are found and retested. In 2004, the industry shut down for three months to do that.

It has had briefer shutdowns in each of the last four years.

In 2009 and 2010, no other infected performers were found. Coalition representatives said an infected woman in 2009, from Nevada, may have had an infected boyfriend, and offered evidence that a man infected in 2010 in Florida had worked outside the industry as a prostitute. The 2011 test was a false positive.

A shutdown in August came after several actors got syphilis, not H.I.V. All performers were given a choice: Take antibiotics, or pass two back-to-back syphilis tests 14 days apart.

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Silicon Valley Objects to Online Privacy Rule Proposals for Children

Washington is pushing Silicon Valley on children’s privacy, and Silicon Valley is pushing back.

Apple, Facebook, Google, Microsoft and Twitter have all objected to portions of a federal effort to strengthen online privacy protections for children. In addition, media giants like Viacom and Disney, cable operators, marketing associations, technology groups and a trade group representing toy makers are arguing that the Federal Trade Commission’s proposed rule changes seem so onerous that, rather than enhance online protections for children, they threaten to deter companies from offering children’s Web sites and services altogether.

“If adopted, the effect of these new rules would be to slow the deployment of applications that provide tremendous benefits to children, and to slow the economic growth and job creation generated by the app economy,” Catherine A. Novelli, vice president of worldwide government affairs at Apple, wrote in comments to the agency.

But the underlying concern, for both the industry and regulators, is not so much about online products for children themselves. It is about the data collection and data mining mechanisms that facilitate digital marketing on apps and Web sites for children — and a debate over whether these practices could put children at greater risk.

In 1998, Congress passed the Children’s Online Privacy Protection Act in an effort to give parents control over the collection and dissemination of private information about their children online. The regulation, known as Coppa, requires Web site operators to obtain a parent’s consent before collecting personal details, like home addresses or e-mail addresses, from children under 13.

Now, federal regulators are preparing to update that rule, arguing that it has not kept pace with advances like online behavioral advertising, a practice that uses data mining to tailor ads to people’s online behavior. The F.T.C. wants to expand the types of data whose collection requires prior parental permission to include persistent ID systems, like unique device codes or customer code numbers stored in cookies, if those codes are used to track children online for advertising purposes.

The idea is to preclude companies from compiling dossiers on the online activities — and by extension the health, socioeconomic status, race or romantic concerns — of individual children across the Web over time.

“What children post online or search as part of their homework should not haunt them as they apply to colleges or for jobs,” Representative Edward J. Markey, Democrat of Massachusetts and co-chairman of the Bipartisan Congressional Privacy Caucus, said in a recent phone interview. “YouTube should not be turned into YouTracked.”

The agency’s proposals have provoked an intense reaction from some major online operators, television networks, social networks, app platforms and advertising trade groups. Some argue that the F.T.C. has overstepped its mandate in proposing to greatly expand the rule’s scope.

Others say that using ID systems like customer code numbers to track children “anonymously” online is benign — and that collecting information about children’s online activities is necessary to deliver the ads that finance free content and services for children.

“What is the harm we are trying to prevent here?” said Alan L. Friel, chairman of the media and technology practice at the law firm Edwards Wildman Palmer. “We risk losing a lot of the really good educational and entertaining content if we make things too difficult for people to operate the sites or generate revenue from the sites.”

The economic issue at stake is much bigger than just the narrow children’s audience. If the F.T.C. were to include customer code numbers among the information that requires a parent’s consent, industry analysts say, it might someday require companies to get similar consent for a practice that represents the backbone of digital marketing and advertising — using such code numbers to track the online activities of adults.

“Once you’ve said it’s personal information for children that requires consent, you’ve set the framework for a requirement of consent to be applied to another population,” Mr. Friel said. “If it is personal information for someone that’s 12, it doesn’t cease being personal information when they are 13.”

Indeed, many of the F.T.C.’s proposed rule revisions have vocal detractors.

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Syrian Rebels Claim to Kill Dozens of Soldiers

SANA, via Associated Press

An image released by Syria’s official news agency showed Damascus residents gathering at the scene of a blast on Monday.

BEIRUT, Lebanon — Some of the worst violence in months racked Syria on Monday with residents of southern Damascus fleeing heavy shelling, several smaller towns shattered by air attacks, and at least two car bombings.

The Local Coordinating Committees, a collection of activist organizations across Syria, said the daily toll reached at least 159, including 72 killed in Idlib, and 47 in Damascus and its suburbs.

People in Damascus, the capital, said the fighting was the fiercest they could remember since July, with thousands of people having fled as a Palestinian faction that supports the Assad government skirmished with government opponents in three southern neighborhoods.

“It’s a real war,” said an activist reached in southern Damascus via Skype, who used only one name, Eman, for her safety. “Explosions, bombing and gunfire, and of course the helicopters, which have become part of the sky in Damascus now, like birds,” she said.

The fighting, escalating over three days, ignited the quarters of Yarmouk and Tadamon, both heavily Palestinian, as well as Hajjar al-Aswad, a center of resistance to the government.

Syria took in large numbers of Palestinians who fled their homes at the founding of Israel, and they and their descendants number about 450,000 now. Many have sided with those leading the uprising, but the Popular Front for the Liberation of Palestine-General Command, a faction with a prominent role in the neighborhoods, still supports the government. Much of the fighting involved Popular Front units, backed by government artillery. Rounds fired from the military airfield in Mezze slammed into the area, activists said.

Yarmouk, founded as a Palestinian refugee camp in 1957, gradually became a residential district barely distinguishable from the rest of greater Damascus. A Facebook page focused on camp news published a statement from the Popular Front group saying it had thwarted an infiltration by government opponents.

“When the terrorists failed to enter, they fired mortars killing a large number of martyrs and wounding a lot of people,” the statement said.

Civilians have been fleeing in droves. Small artillery hit a minibus carrying people trying to escape from Yarmouk, killing five of them. Each side blamed the other for that strike.

Displaced families have started camping in back gardens or schoolyards, Eman said.

A car bomb exploded in Mezze 86, a Damascus neighborhood on the slopes below the official palace that houses the offices of President Bashar al-Assad. The area is heavily populated by families linked to the security forces, which Mr. Assad’s Alawite minority dominates. Pictures posted on Facebook showed a large black column of smoke rising from the area.

The Free Syrian Army claimed responsibility for that attack, saying in a statement that it targeted military officers and members of the armed militias who fight for the government.

The bomb, a booby-trapped car, exploded in Bride Square, killing at least 11 people and wounding more than 30, some of them critically, said the Syrian Observatory for Human Rights, which tracks the conflict from abroad.

The official news agency, SANA, also put the death toll at 11 but said at least 56 were injured. The explosion ignited other cars and caused widespread destruction, it said.

Accounts differed more sharply on another car bombing, outside a government-owned Rural Development Center near Hama. The rebels and activists reported that dozens of soldiers were killed; the government said just two civilians had died.

The Syrian Observatory said that Jabhet Al-Nusra — known as a jihadist organization — and other rebel groups in the region collaborated to explode a car bomb at a government checkpoint in a village near Hama, killing at least 50 soldiers. If true, that would make it one of the single deadliest anti-government attacks since the uprising started in March 2011.

The accounts from the observatory and rebel groups stated that the military had taken over the development center to house military units. Checkpoints in rural areas often serve as rudimentary bases for the government, with large numbers of men and equipment.

“They targeted one of the biggest checkpoints in the region,” said Ahmad Raadoun, a member of the Free Syrian Army in the Hama suburbs who was reached by Skype. “It’s a big building where the regime forces were headquartered.”

Mr. Raadoun said he was about 20 miles from the site, the village of Ziyara. He said the bomb caused extensive casualties and other damage.

Hania Mourtada contributed reporting from Beirut; Hala Droubi from Dubai, United Arab Emirates; and Rick Gladstone from New York.

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Silicon Valley Objects to Online Privacy Rule Proposals for Children

Washington is pushing Silicon Valley on children’s privacy, and Silicon Valley is pushing back.

Apple, Facebook, Google, Microsoft and Twitter have all objected to portions of a federal effort to strengthen online privacy protections for children. In addition, media giants like Viacom and Disney, cable operators, marketing associations, technology groups and a trade group representing toy makers are arguing that the Federal Trade Commission’s proposed rule changes seem so onerous that, rather than enhance online protections for children, they threaten to deter companies from offering children’s Web sites and services altogether.

“If adopted, the effect of these new rules would be to slow the deployment of applications that provide tremendous benefits to children, and to slow the economic growth and job creation generated by the app economy,” Catherine A. Novelli, vice president of worldwide government affairs at Apple, wrote in comments to the agency.

But the underlying concern, for both the industry and regulators, is not so much about online products for children themselves. It is about the data collection and data mining mechanisms that facilitate digital marketing on apps and Web sites for children — and a debate over whether these practices could put children at greater risk.

In 1998, Congress passed the Children’s Online Privacy Protection Act in an effort to give parents control over the collection and dissemination of private information about their children online. The regulation, known as Coppa, requires Web site operators to obtain a parent’s consent before collecting personal details, like home addresses or e-mail addresses, from children under 13.

Now, federal regulators are preparing to update that rule, arguing that it has not kept pace with advances like online behavioral advertising, a practice that uses data mining to tailor ads to people’s online behavior. The F.T.C. wants to expand the types of data whose collection requires prior parental permission to include persistent ID systems, like unique device codes or customer code numbers stored in cookies, if those codes are used to track children online for advertising purposes.

The idea is to preclude companies from compiling dossiers on the online activities — and by extension the health, socioeconomic status, race or romantic concerns — of individual children across the Web over time.

“What children post online or search as part of their homework should not haunt them as they apply to colleges or for jobs,” Representative Edward J. Markey, Democrat of Massachusetts and co-chairman of the Bipartisan Congressional Privacy Caucus, said in a recent phone interview. “YouTube should not be turned into YouTracked.”

The agency’s proposals have provoked an intense reaction from some major online operators, television networks, social networks, app platforms and advertising trade groups. Some argue that the F.T.C. has overstepped its mandate in proposing to greatly expand the rule’s scope.

Others say that using ID systems like customer code numbers to track children “anonymously” online is benign — and that collecting information about children’s online activities is necessary to deliver the ads that finance free content and services for children.

“What is the harm we are trying to prevent here?” said Alan L. Friel, chairman of the media and technology practice at the law firm Edwards Wildman Palmer. “We risk losing a lot of the really good educational and entertaining content if we make things too difficult for people to operate the sites or generate revenue from the sites.”

The economic issue at stake is much bigger than just the narrow children’s audience. If the F.T.C. were to include customer code numbers among the information that requires a parent’s consent, industry analysts say, it might someday require companies to get similar consent for a practice that represents the backbone of digital marketing and advertising — using such code numbers to track the online activities of adults.

“Once you’ve said it’s personal information for children that requires consent, you’ve set the framework for a requirement of consent to be applied to another population,” Mr. Friel said. “If it is personal information for someone that’s 12, it doesn’t cease being personal information when they are 13.”

Indeed, many of the F.T.C.’s proposed rule revisions have vocal detractors.

Read More..

Well: The Mental Fallout of the Hurricane

In the small Connecticut town where I grew up, the tornado of 1979 remains the storm, a freak tornado packing 86-mile-per-hour winds that churned through the streets, killing three people, injuring hundreds and destroying several hundred homes and businesses, including many in my neighborhood.

I was 15 at the time, at home alone looking after my 10-year-old sister and 5-year-old brother. For months afterward, like others caught in the surprise storm, we struggled with memories of that afternoon. During the first few days, I kept reliving the moments huddled with my siblings in the corner; later, I had recurring nightmares and became paralyzed with fear whenever I heard a clap of thunder.

Even today, I tend to worry more than most whenever the sky looks odd or when the weather suddenly turns muggy and dark, the slightest hint of what my sister and I have come to call “tornado weather.”

For almost three decades now, health care experts have been studying the psychological effects of natural disasters and have found that disasters as varied as the 1994 earthquake in Northridge, Calif., and Hurricanes Katrina (2005), Andrew (1992) and Hugo (1989) left significant, disabling and lasting psychological scars in their wake. While individuals with pre-existing mental health issues were at particular risk, everyone was vulnerable. In New Orleans a month after Hurricane Katrina, for example, 17 percent of residents reported symptoms consistent with serious mental illness, compared with 10 percent of those who lived in surrounding areas and only 1 to 3 percent in the general population.

Most commonly and most immediately, the survivors suffered post-traumatic stress symptoms like recurrent nightmares, flashbacks, a hair-trigger temper and an emotional “numbing,” much of which could be considered normal in the first couple of months after a disaster. “It’s a pretty natural thing to have nightmares after living through a natural disaster,” said Ronald C. Kessler, a professor of health care policy at Harvard Medical School who has studied the effect of natural disasters on the mental health of survivors. “It would almost be abnormal if you didn’t.”

Over time, when those symptoms abated, survivors were able to move on. When they didn’t, or when other mood disorders like anxiety and depression appeared, mental health issues quickly became a leading cause of disability for survivors, further hampering other efforts at recovery.

But the research has also revealed that we can mitigate the psychological fallout, even after the disaster has occurred. Studies from Hurricanes Katrina and Rita have shown that what communities, governments and even elected officials do in the weeks, months and years that follow can have a significant effect on how individuals fare psychologically.

For example, among Hurricane Katrina survivors, there were striking differences in the rates of mental health disorders, depending on how people felt about the difficulties they had finding food and shelter. Survivors who continued to face such adversity because of the government’s slow response had significantly higher rates of mental health problems.

“There’s no question that the best thing the federal, state and municipal governments can do to protect against psychopathology in these kinds of situations is to restore the day-to-day functioning that keeps everyone healthy,” said Dr. Sandro Galea, lead author of the study and chairman of epidemiology at the Columbia University Mailman School of Public Health.

For now, experts are predicting that the psychological fallout from Hurricane Sandy will be less severe than that from Hurricane Katrina. But their optimistic predictions rest in part on the response thus far of government officials and the larger community.

“People pull together at times like this,” Dr. Kessler noted. “To the extent that those affected by Sandy can build on this sense of community and get back to normal, it could be an opportunity for people to grow and even develop a sense of accomplishment because of what they’ve been through.”

What I remember today as clearly as the blinding whiteness of the tornado winds that enveloped our house and the terror that gripped my siblings and me back in 1979 are the state and local officials and rescue workers who appeared almost immediately, the churches and community organizations that organized shelters and fund-raisers, and the neighbors, sleeves rolled up, who cleared debris and cooked for one another.

When the new homes finally began to emerge from the rubble the following spring, it wasn’t the cookie-cutter skyline of raised ranches and colonials that was restored. Instead, the neighborhood became a showplace of modest but quirky family abodes — a brown, modern geometric house on one corner, a yellow, partly subterranean one a few doors down.

From a devastating storm, my neighbors had managed to build new dreams.

Read More..

Well: The Mental Fallout of the Hurricane

In the small Connecticut town where I grew up, the tornado of 1979 remains the storm, a freak tornado packing 86-mile-per-hour winds that churned through the streets, killing three people, injuring hundreds and destroying several hundred homes and businesses, including many in my neighborhood.

I was 15 at the time, at home alone looking after my 10-year-old sister and 5-year-old brother. For months afterward, like others caught in the surprise storm, we struggled with memories of that afternoon. During the first few days, I kept reliving the moments huddled with my siblings in the corner; later, I had recurring nightmares and became paralyzed with fear whenever I heard a clap of thunder.

Even today, I tend to worry more than most whenever the sky looks odd or when the weather suddenly turns muggy and dark, the slightest hint of what my sister and I have come to call “tornado weather.”

For almost three decades now, health care experts have been studying the psychological effects of natural disasters and have found that disasters as varied as the 1994 earthquake in Northridge, Calif., and Hurricanes Katrina (2005), Andrew (1992) and Hugo (1989) left significant, disabling and lasting psychological scars in their wake. While individuals with pre-existing mental health issues were at particular risk, everyone was vulnerable. In New Orleans a month after Hurricane Katrina, for example, 17 percent of residents reported symptoms consistent with serious mental illness, compared with 10 percent of those who lived in surrounding areas and only 1 to 3 percent in the general population.

Most commonly and most immediately, the survivors suffered post-traumatic stress symptoms like recurrent nightmares, flashbacks, a hair-trigger temper and an emotional “numbing,” much of which could be considered normal in the first couple of months after a disaster. “It’s a pretty natural thing to have nightmares after living through a natural disaster,” said Ronald C. Kessler, a professor of health care policy at Harvard Medical School who has studied the effect of natural disasters on the mental health of survivors. “It would almost be abnormal if you didn’t.”

Over time, when those symptoms abated, survivors were able to move on. When they didn’t, or when other mood disorders like anxiety and depression appeared, mental health issues quickly became a leading cause of disability for survivors, further hampering other efforts at recovery.

But the research has also revealed that we can mitigate the psychological fallout, even after the disaster has occurred. Studies from Hurricanes Katrina and Rita have shown that what communities, governments and even elected officials do in the weeks, months and years that follow can have a significant effect on how individuals fare psychologically.

For example, among Hurricane Katrina survivors, there were striking differences in the rates of mental health disorders, depending on how people felt about the difficulties they had finding food and shelter. Survivors who continued to face such adversity because of the government’s slow response had significantly higher rates of mental health problems.

“There’s no question that the best thing the federal, state and municipal governments can do to protect against psychopathology in these kinds of situations is to restore the day-to-day functioning that keeps everyone healthy,” said Dr. Sandro Galea, lead author of the study and chairman of epidemiology at the Columbia University Mailman School of Public Health.

For now, experts are predicting that the psychological fallout from Hurricane Sandy will be less severe than that from Hurricane Katrina. But their optimistic predictions rest in part on the response thus far of government officials and the larger community.

“People pull together at times like this,” Dr. Kessler noted. “To the extent that those affected by Sandy can build on this sense of community and get back to normal, it could be an opportunity for people to grow and even develop a sense of accomplishment because of what they’ve been through.”

What I remember today as clearly as the blinding whiteness of the tornado winds that enveloped our house and the terror that gripped my siblings and me back in 1979 are the state and local officials and rescue workers who appeared almost immediately, the churches and community organizations that organized shelters and fund-raisers, and the neighbors, sleeves rolled up, who cleared debris and cooked for one another.

When the new homes finally began to emerge from the rubble the following spring, it wasn’t the cookie-cutter skyline of raised ranches and colonials that was restored. Instead, the neighborhood became a showplace of modest but quirky family abodes — a brown, modern geometric house on one corner, a yellow, partly subterranean one a few doors down.

From a devastating storm, my neighbors had managed to build new dreams.

Read More..

The Media Equation: Google News Faces Challenges From Publishers Abroad

They say you should never take on people who spill ink by the barrel, but your odds are better when you traffic in terabytes of data. In the United States, Google and big media went at it for several years over Google News and Google won, taking its argument for a free and open Internet all the way to the bank.

Kim Kyung-Hoon/Reuters

“Whenever you are dealing with government, you want to be very clear about what you will do and will not do,” said Eric Schmidt, Google’s executive chairman. “And we don’t want to pay for content that we do not host. We are very clear on that.”

It’s a little counterintuitive, but large newspapers believed that Google was hurting them by generating a page of links — with headlines and a short summary — to articles that the newspapers had paid to create. Publishers said that what was supposed to be an index of the news had become the news, and was a disincentive for people to click through to the source.

American publishers eventually decided that the only thing worse than being aggregated by Google News was not being aggregated at all, but the fight has been joined anew in other countries by publishers who argue that the giant American search company is picking their pockets every time it links to articles.

There’s a large boycott under way in Brazil, punishing legislation is gaining momentum in Germany, and there is talk of a similar effort in France.

You wouldn’t know it by speaking to Eric Schmidt, Google’s executive chairman. He takes the challenges to Google News seriously — he just returned from talks with President François Hollande of France — but he sounded sanguine on a phone call from Chicago.

“We had some good discussions, and I would expect that we will reach some kind of agreement by the end of the year,” he said.

Don’t expect that agreement to acknowledge the principle of so-called ancillary copyright, which has been pushed in Germany and elsewhere. It suggests that Google and others should pay for featuring headlines and the first few lines of an article, while Google asserts that this constitutes fair use.

In France and Germany, publishers have found willing partners in their national governments as they try to put the squeeze on Google. It probably won’t work no matter who is doing the squeezing, because while the rhetoric from Google is always friendly, its position is always firm.

“Whenever you are dealing with government, you want to be very clear about what you will do and will not do,” Mr. Schmidt said. “And we don’t want to pay for content that we do not host. We are very clear on that.”

Back in this hemisphere, more than 150 newspapers in Brazil decided in 2011 to unilaterally pull themselves out of Google News, including many of the largest papers in the country. The debate blew up again at a conference in Brazil last month in which representatives from Google and the country’s newspapers had a heated argument over just how fair “fair use” is. Again, Mr. Schmidt was hardly frantic about it.

“That’s a fine choice,” he said. “Publishers are free to do as they wish, and there is plenty of competition for news in that country, so we are not overly concerned.”

There are a few reasons Google remains calm amid a storm of pushback. According to Google, its search engine delivers four billion clicks a month to news media outlets, one billion of which come from Google News. That’s a lot of leverage.

Publishers elsewhere have monitored the woes of American newspapers with a great deal of interest. German and Brazilian publishers are in good shape — French newspapers less so — and they still have a hold on their customers and their business models. They’d like to keep it that way.

“German publishers are in a much stronger position than their American counterparts. They watched the decline in American publishing and they are trying to fortify their lines while they can,” said Wolfgang Blau, editor in chief of Zeit Online in Germany, saying that legacy publishers would rather change the subject than their business model. “It’s a lost battle really, but for the time being, Google is an easy target.”

In an e-mail, Mathias Döpfner, chief executive of Axel Springer, the largest newspaper publisher in Germany, said publishers everywhere needed to protect themselves in order to thrive.

E-mail: carr@nytimes.com;

Twitter: @carr2n

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Benghazi Attack Raises Doubts About U.S. Abilities in Region

Esam Omran Al-Fetori/Reuters

The attack at the American Mission on Sept. 11, seen here, and an annex in Benghazi, Libya, points to a limitation in the capabilities of the American military command responsible for countries swept up in the Arab Spring.

WASHINGTON — About three hours after the American diplomatic mission in Benghazi, Libya, came under attack, the Pentagon issued an urgent call for an array of quick-reaction forces, including an elite Special Forces team that was on a training mission in Croatia.

The team dropped what it was doing and prepared to move to the Sigonella naval air station in Sicily, a short flight from Benghazi and other hot spots in the region. By the time the unit arrived at the base, however, the surviving Americans at the Benghazi mission had been evacuated to Tripoli, and Ambassador J. Christopher Stevens and three other Americans were dead.

The assault, on the anniversary of the Sept. 11, 2001, attacks on the United States, has already exposed shortcomings in the Obama administration’s ability to secure diplomatic missions and act on intelligence warnings. But this previously undisclosed episode, described by several American officials, points to a limitation in the capabilities of the American military command responsible for a large swath of countries swept up in the Arab Spring.

At the heart of the issue is the Africa Command, established in 2007, well before the Arab Spring uprisings and before an affiliate of Al Qaeda became a major regional threat. It did not have on hand what every other regional combatant command has: its own force able to respond rapidly to emergencies — a Commanders’ In-Extremis Force, or C.I.F.

To respond to the Benghazi attack, the Africa Command had to borrow the C.I.F. that belongs to the European Command, because its own force is still in training. It also had no AC-130 gunships or armed drones readily available.

As officials in the White House and Pentagon scrambled to respond to the torrent of reports pouring out from Libya — with Mr. Stevens missing and officials worried that he might have been taken hostage — they took the extraordinary step of sending elite Delta Force commandos, with their own helicopters and ground vehicles, from their base at Fort Bragg, N.C., to Sicily. Those troops also arrived too late.

“The fact of the matter is these forces were not in place until after the attacks were over,” a Pentagon spokesman, George Little, said on Friday, referring to a range of special operations soldiers and other personnel. “We did respond. The secretary ordered forces to move. They simply were not able to arrive in time.”

An examination of these tumultuous events undercuts the criticism leveled by some Republicans that the Obama administration did not try to respond militarily to the crisis. The attack was not a running eight-hour firefight as some critics have contended, questioning how an adequate response could not be mustered in that time, but rather two relatively short, intense assaults separated by a lull of four hours. But the administration’s response also shows that the forces in the region had not been adequately reconfigured.

The Africa Command was spun off from the European Command. At the time it was set up, the Pentagon thought it would be devoted mostly to training African troops and building military ties with African nations. Because of African sensitivities about an overt American military presence in the region, the command’s headquarters was established in Stuttgart, Germany.

While the other regional commands, including the Pacific Command and the Central Command, responsible for the Middle East and South Asia, have their own specialized quick-reaction forces, the Africa Command has had an arrangement to borrow the European Command’s force when needed. The Africa Command has been building its own team from scratch, and its nascent strike force was in the process of being formed in the United States on Sept. 11, a senior military official said.

“The conversation about getting them closer to Africa has new energy,” the military official said.

Some Pentagon officials said that it was unrealistic to think a quick-reaction force could have been sent in time even if the African Command had one ready to act on the base in Sicily when the attack unfolded, and asserted that such a small force might not have even been effective or the best means to protect an embassy. But critics say there has been a gap in the command’s quick-reaction capability, which the force would have helped fill.

A spokesman for the command declined to comment on how its capabilities might be improved.

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