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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Arms With a Long Reach Help Hamas

TEL AVIV — When Israel assassinated the top Hamas military commander in Gaza on Wednesday, setting off the current round of fierce fighting, it was aiming not just at a Palestinian leader but at a supply line of rockets from Iran that have for the first time given Hamas the ability to strike as far as Tel Aviv and Jerusalem.

The commander, Ahmed al-Jabari, had shifted Hamas’s low-grade militia into a disciplined force with sophisticated weapons like Fajr-5 rockets, which are named after the Persian word for dawn and have significantly increased the danger to Israel’s major cities. They have a range of about 45 miles and are fired by trained crews from underground launching pads.

Hamas had perhaps 100 of them until the Israeli attacks last week, which appear to have destroyed most of the stockpile. The rockets are assembled locally after being shipped from Iran to Sudan, trucked across the desert through Egypt, broken down into parts and moved through Sinai tunnels into Gaza, according to senior Israeli security officials.

The smuggling route involves salaried employees from Hamas along the way, Iranian technical experts traveling on forged passports and government approval in Sudan, Israeli officials said.

Mr. Jabari’s strategy has been so effective and alarming for Israel that it is preparing for a possible next stage in the four-day-old battle: a ground war in which its troops would seek to destroy remaining rocket launching bases and crews and munitions factories.

Under Mr. Jabari, Hamas also developed its own weapons industry in Gaza, building long-range rockets as well as drones that they hoped to fly over Israel just as Israeli drones roam the skies of Gaza, sowing fear in its population.

The current operation to eliminate the Hamas rocket launchers could serve to cripple the ability of Iran’s allies in Gaza from retaliating should Israel ever carry out its threat to attack Iranian nuclear facilities.

“Both Hamas and Islamic Jihad are building weapons with experts from Iran,” one top security official said Saturday, speaking on condition of anonymity. “What we took care of last night was their own production facility for U.A.V.’s,” he added, referring to unmanned aerial vehicles, or drones. “This was all the work of Jabari, who was a very sophisticated and strategic thinker.”

A number of recent Israeli military attacks were aimed at cutting the supply chain into Gaza. In late October, a munitions factory in Sudan was hit from the air. Israel did not acknowledge carrying out the attack, but the winks and nods of officials here make clear that it did. Israel has carried out several other such attacks on Sudan, including on convoys, in the past few years.

In addition, Mossad agents killed a Hamas official in a Dubai hotel in early 2010 because he was thought to be crucial to the Hamas supply chain of weapons and rockets into Gaza.

One official here said that until Israel ended its military occupation of Gaza in 2005, there were only primitive weapons factories there. The Hamas rockets had a flight capacity of about a mile, they could not be aimed and they flew in a wild cylindrical pattern. Hamas then built better rockets that could fly up to 12 miles.

That changed little until 2007, when Hamas fighters pushed the Fatah-dominated Palestinian Authority out of Gaza into the West Bank and took over governing the coastal strip.

“At that point, Jabari turned his neighborhood defense operation into a real army,” said a retired Israeli general whose portfolio included Gaza and who spoke on condition of anonymity. “He organized what was a militia into companies, battalions and brigades. He sent commanders to Syria and to Iran to be trained by the Revolutionary Guards. And then he built up this whole new branch to develop military technology focusing on long-range missiles.”

The collapse of the government of Col. Muammar el-Qaddafi in Libya last year created other supply options for Hamas as Libyan military storehouses were raided and the equipment sold off. Those weapons were driven across Egypt and into Gaza.

It remains to be seen whether Mr. Jabari’s death will truly cripple Hamas, or whether it will find someone equally adept to take his place, the officials said.

Either way, Hamas now has a range of rockets and weapons in its arsenal, said Jeffrey White, a former analyst with the United States Defense Intelligence Agency and now a fellow at the Washington Institute for Near East Policy.

In addition to the Fajr-5, Hamas has a few hundred of what are known as enhanced Grad rockets, which have a range of about 25 miles. The Grads are 122-millimeter rockets that have bigger warheads than the standard Grads, but their accuracy is relatively low. The Grads may also be coming from Iran, Mr. White said, but others are made in Gaza and imported from Libya.

In addition, Hamas has hundreds of standard Grads that have a range of about 12 miles, as well as thousands of homemade mortars and Qassam rockets with a range of about six miles.

Israeli officials said the movement of the Fajr-5 rockets through Egypt could not go unnoticed there, given their size. Each is 20 feet long and weighs more than 2,000 pounds — the warhead alone weighs 375 pounds — and the trucks carrying them across Egyptian bridges and through roadblocks into Sinai would be hard to miss.

In the current conflict, Israel’s antirocket system, known as Iron Dome, has been more effective than expected, but still dozens of rockets have landed.

Whether the military operation against Gaza is a dress rehearsal for any future attack on either Iran or Lebanon — where Hezbollah has thousands of rockets pointed at Israel — is a matter under debate here. Some see it as clearing away any possible trouble from Gaza. Others say that makes little sense, given the difference of scale in the conflict in Gaza and any war against Iran or Hezbollah. Hamas’s arsenal is tiny compared with what Hezbollah in Lebanon is thought to have: thousands of rockets capable of hitting Tel Aviv.

Yonatan Touval, an analyst with Prime Source, a private Tel Aviv risk-assessment company, said, “The Iron Dome system is ineffective in intercepting longer-range projectiles, such as those that would be launched from Lebanon toward the Tel Aviv area. To address this threat, Israel is currently developing the Magic Wand system, but it is not expected to become operational before 2015.”

He added that the fighting now was therefore not really a test of a future conflict involving Iran and Lebanon. “If Israel’s political leadership is treating the current operation in Gaza as something of a rehearsal for a future war with Hezbollah and Iran, it is rehearsing the wrong play,” he said.

Michael R. Gordon contributed reporting from Washington.

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DealBook: As Labor Talks Collapse, Hostess Turns Out Lights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The negotiations have been contentious.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Shortcuts: The Meaning in a Drawer Full of Old Family Snapshots

Eric Thayer/Reuters

A resident found photos as she sifted the debris of a house destroyed by Hurricane Sandy in Union Beach, N.J.

I WASN’T going to write about Hurricane Sandy. I was going to write about the changing nature of photographs and our relationship to them in this digital age.

Doug Mills/The New York Times

Picture-taking is now mainly digital, making prints of photos uncommon.

But as I began my research, I came across a Facebook page where lost photos from the storm were posted. Called “Union Beach — Photos and Misplaced Items,” the page shows photos of newborns and birthday parties, weddings and family gatherings.

Starting the morning after the storm devastated her community of Union Beach, N.J., Jeanette Van Houten and her niece have collected over a thousand photos and some photo albums. She is making it her mission to scan and post to Facebook as many as possible, including those turned into the fire department, police station and borough hall.

In addition, she was handed a drawerful of over a thousand family photos that must have been wrenched from a dresser.

About 60 photos have been claimed so far, and some professionals have offered to restore damaged photos free.

“These photos were passed down through families and they survived Sandy, even if the structures they were in didn’t,” Ms. Van Houten said. “They tell our story.”

With the Facebook page, Ms. Van Houten uses newer technology to help people reconnect with their old-fashioned snapshots. And seeing the photographs of mundane scenes and milestones on Facebook, along with the grateful comments from people who got back a bit of their lives, reminded me of both the fragility and strength of photos and their continuing importance in our lives. Judith Dupré, author of “Monuments: America’s History in Art and Memory” (Random House, 2007), and other books, teaches a class at her local library in Mamaroneck, N.Y., called “Stories from My Life,” for older residents. They use photos and stories to write about their lives.

“They bring in a basketful of photos,” Ms. Dupré said. “Each one of these photos contains a story — they’re like a key that opens the door to a life.”

And a printed photo “is a different species than a digital photo,” she said. “I don’t think anyone’s figured out the place of digital photos in terms of memory keeping.”

When an elderly aunt of hers died and left behind lots of photographs, Ms. Dupré said the family took them to the memorial service.

“We had a table and people could select and take what they wanted,” she said. “It was a very moving part of the memorial.”

Of course, even prints can lose their meaning and poignancy through the generations.

And in some cases, as with Hurricane Sandy, photos may be safer in cyberspace than in an album on a bookshelf — as long as you remember to upload them to a site like Flickr, Shutterfly, Snapfish or countless other photo sites available. (And make sure you know how long a site will keep your photos. Some, for example, require you to show some activity at least once a year.) That way, if you lose your hard drive, you don’t lose your photos.

But Ms. Dupré said she worried that photos that existed only online somewhere might die with the photographer.

“I don’t even know what my parents have in terms of digital photography,” she said. She said she put the password to her photos safely away with her will and other documents, so her children can access them.

Now I’m not trying to say that the old-fashioned way is the only way. Photography has constantly evolved. The Brownie camera, first sold by Kodak for $1 in 1900, radicalized photography by making it available to just about everyone.

But, and I know this largely a generational thing, I can’t help but wonder about the ubiquity of the cellphone photo. As Ms. Dupré said, “The infinite number of digital photos that can be taken has devalued the single image and made one-of-a-kind prints that much more precious.”

E-mail: shortcuts@nytimes.com

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Israel Sticks to Tough Approach in Conflict With Hamas

TEL AVIV — With rockets landing on the outskirts of Tel Aviv and Jerusalem on Friday and the Egyptian prime minister making a solidarity visit to Gaza, the accelerating conflict between Israel and Hamas — reminiscent in many ways of so many previous battles — has the makings of a new kind of Israeli-Palestinian face-off.

The combination of longer-range and far deadlier rockets in the hands of more radicalized Palestinians, the arrival in Gaza and Sinai from North Africa of other militants pressuring Hamas to fight more, and the growing tide of anti-Israel fury in a region where authoritarian rulers have been replaced by Islamists means that Israel is engaging in this conflict with a different set of challenges.

The Middle East of 2012 is not what it was in late 2008, the last time Israel mounted a military invasion to reduce the rocket threat from Gaza. Many analysts and diplomats outside Israel say the country today needs a different approach to Hamas and the Palestinians based more on acknowledging historic grievances and shifting alliances.

“As long as the crime of dispossession and refugeehood that was committed against the Palestinian people in 1947-48 is not redressed through a peaceful and just negotiation that satisfies the legitimate rights of both sides, we will continue to see enhancements in both the determination and the capabilities of Palestinian fighters — as has been the case since the 1930s, in fact,” Rami G. Khouri, a professor at the American University of Beirut, wrote in an online column. “Only stupid or ideologically maniacal Zionists fail to come to terms with this fact.”

But the government in Israel and the vast majority of its people have drawn a very different conclusion. Their dangerous neighborhood is growing still more dangerous, they agree. That means not concessions, but being tougher in pursuit of deterrence, and abandoning illusions that a Jewish state will ever be broadly accepted here.

“There is a theory, which I believe, that Hamas doesn’t want a peaceful solution and only wants to keep the conflict going forever until somehow in their dream they will have all of Israel,” Eitan Ben Eliyahu, a former leader of the Israeli Air Force, said in a telephone briefing. “There is a good chance we will go into Gaza on the ground again.”

What is striking in listening to the Israelis discuss their predicament is how similar the debate sounds to so many previous ones, despite the changed geopolitical circumstances. In most minds here, the changes do not demand a new strategy, simply a redoubled old one.

The operative metaphor is often described as “cutting the grass,” meaning a task that must be performed regularly and has no end. There is no solution to security challenges, officials here say, only delays and deterrence. That is why the idea of one day attacking Iranian nuclear facilities, even though such an attack would set the nuclear program back only two years, is widely discussed as a reasonable option. That is why frequent raids in the West Bank and surveillance flights over Lebanon never stop.

And that is why this week’s operation in Gaza is widely viewed as having been inevitable, another painful but necessary maintenance operation that, officials here say, will doubtless not be the last.

There are also those who believe that the regional upheavals are improving Israel’s ability to carry out deterrence. One retired general who remains close to the military and who spoke on the condition of anonymity said that with Syria torn apart by civil war, Hezbollah in Lebanon discredited because of its support for the Syrian government, and Egypt so weakened economically, Israel should not worry about anything but protecting its civilians.

“Should we let our civilians be bombed because the Arab world is in trouble?” he asked.

So much was happening elsewhere in the region — the Egyptian and Libyan revolutions, the Syrian civil war, dramatic changes in Yemen and elections in Tunisia — that a few rockets a day that sent tens of thousands of Israeli civilians into bomb shelters drew little attention. But in the Israeli view, the necessity of a Gaza operation has been growing steadily throughout the Arab Spring turmoil.

In 2009, after the Israeli invasion pushed Hamas back and killed about 1,400 people in Gaza, 200 rockets hit Israel. The same was true in 2010. But last year the number rose to 600, and before this week the number this year was 700, according to the Israeli military. The problem went beyond rockets to mines planted near the border aimed at Israeli military jeeps and the digging of explosive-filled tunnels.

“In 2008 we managed to minimize rocket fire from Gaza significantly,” said Lt. Col. Avital Leibovich, a military spokeswoman. “We started that year with 100 rockets a week and ended it with two a week. We were able to give people in our south two to three years. But the grass has grown, and other things have as well. Different jihadist ideologies have found their way into Gaza, including quite a few terrorist organizations. More weapons have come in, including the Fajr-5, which is Iranian made and can hit Tel Aviv. That puts nearly our entire population in range. So we reached a point where we cannot act with restraint any longer.”

Gazans see events in a very different light. The problem, they say, comes from Israel: Israeli drones fill the Gazan skies, Israeli gunboats strafe their waters, Palestinian militants are shot at from the air, and the Gaza border areas are declared off limits by Israel with the risk of death from Israeli gunfire.

But there is little dissent in Israel about the Gaza policy. This week leaders of the leftist opposition praised the assassination of Ahmed al-Jabari, the Hamas military commander, on Wednesday. He is viewed here as the equivalent of Osama bin Laden. The operation could go on for many days before there is any real dissent.

The question here, nonetheless, is whether the changed regional circumstances will make it harder to “cut the grass” in Gaza this time and get out. A former top official who was actively involved in the last Gaza war and who spoke on the condition of anonymity said it looked to him as if Hamas would not back down as easily this time.

“They will not stop until enough Israelis are killed or injured to create a sense of equality or balance,” he said. “If a rocket falls in the middle of Tel Aviv, that will be a major success. But this government will go back at them hard. I don’t see this ending in the next day or two.”

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Twinkies Maker Hostess Plans to Go Out of Business

(Reuters) - Hostess Brands Inc, the bankrupt maker of Twinkies and Wonder Bread, said it had sought court permission to go out of business after failing to get wage and benefit cuts from thousands of its striking bakery workers.

Hostess said a strike by members of the Bakery, Confectionery, Tobacco Workers and Grain Millers International Union that began last week had crippled its ability to produce and deliver products at several facilities.

The Irving, Texas-based company said the liquidation of the company would mean that most of its 18,500 employees would lose their jobs.

Hostess said it took the decision to liquidate the company after determining that not enough employees had returned to work by a deadline on Thursday.

The company, which filed for bankruptcy in January, said it had filed a motion with U.S. Bankruptcy Judge Robert Drain in White Plains, New York, for permission to shut down and sell assets.

"We deeply regret the necessity of today's decision, but we do not have the financial resources to weather an extended nationwide strike," Chief Executive Gregory Rayburn said in a statement.

"Hostess Brands will move promptly to lay off most of its 18,500-member workforce and focus on selling its assets to the highest bidders," Rayburn added.

Union President Frank Hurt said on Thursday that the crisis at the company was the "result of nearly a decade of financial and operational mismanagement" and that management was trying to make union workers the scapegoats for a plan by Wall Street investors to sell Hostess.

Hostess said its debtor-in-possession lenders had agreed to allow the it to continue to have access to $75 million to fund the wind-down process.

The case is In re: Hostess Brands Inc, U.S. Bankruptcy Court, Southern District of New York, No. 12-22052.

(Reporting by Tanya Agrawal in Bangalore and Carey Gillam; Editing by Saumyadeb Chakrabarty and Ted Kerr)

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For Alzheimer’s, Detection Advances Outpace Treatment Options

Joshua Lott for The New York Times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read More..

For Alzheimer’s, Detection Advances Outpace Treatment Options

Joshua Lott for The New York Times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read More..