Global Update: Polio Eradication Efforts in Pakistan Focus on Pashtuns

Michael Kamber for The New York TimesPolio will never be eradicated in Pakistan until a way is found to persuade poor Pashtuns to embrace the vaccine, according to a study released by the World Health Organization. A survey of 1,017 parents of young children found that 41 percent had never heard of polio and 11 percent refused to vaccinate their children against it. The survey was done in...

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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 TimesThe geothermal energy...

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Doctor: Colts coach Pagano's leukemia in remission

INDIANAPOLIS (AP) — Colts head coach Chuck Pagano is winning his battle with leukemia.On Monday, Dr. Larry Cripe, Pagano's physician, told The Associated Press that the illness which has sidelined Indy's head coach for more than a month was in "complete remission." Cripe said a morning exam showed Pagano's white blood cell count and bone marrow tests were normal as he prepares to start a second round...

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

Stephanie Diani for The New York TimesINDUSTRY 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...

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New Drugs for Lipids Set Off Race

LOS ANGELES — A new class of powerful cholesterol-reducing drugs is showing promising results, potentially offering a new option for people who do not respond to medication now on the market, according to studies presented at a conference of heart specialists here on Monday. Although the final word on the effectiveness of the drugs is still a few years away, the results so far are so promising...

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

Esam Omran Al-Fetori/ReutersThe 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...

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Google's Android software in 3 out of 4 smartphones

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NHL and union make progress, will meet again soon

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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.

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A Storm-Battered Supply Chain Threatens Holiday Shopping

The economic effects of Hurricane Sandy are reverberating beyond areas hit by the storm as businesses warn customers of delays, try to get merchandise out of closed ports and face canceled orders.

In addition to shutting down shipping terminals and submerging warehouses, the storm also tangled up deliveries because of downed power lines, closed roads and scarce gasoline in parts of New York and New Jersey.

The supply chain is backing up at a crucial time, just as retailers normally bring their final shipments into stores for the holiday shopping season, which retailers depend on for annual profitability.

“Things are slowing down,” said Chris Merritt, vice president for retail supply chain solutions at the trucking company Ryder. “This whole part of the supply chain is clogged up.”

FedEx, for example, has rented fuel tankers to supply its delivery trucks as commercial gas stations run dry. Ryder has been hunting down rental trucks to add capacity. CSX, the major railroad company, was continuing to advise customers to expect delays of at least 72 hours on shipments. And retailers ranging from Amazon to Diane von Furstenberg have told customers to expect delays on shipments.

Many economists expect the storm to shave up to half a percentage point from growth in the fourth quarter. That is a big reduction, with growth estimated to reach an annual rate of 1 to 2 percent before the storm, and the economy facing other significant headwinds, including fiscal uncertainty in Washington.

While economic losses from the storm are expected to be significantly lower than those from Hurricane Katrina in 2005, this storm’s impact has been intensified because the Northeast is densely populated.

The region is responsible for about $3 trillion in output, or roughly 20 percent of the country’s total gross domestic product, said Gregory Daco, a senior economist with IHS Global Insight. “Part of what was lost will be delayed, but part is lost forever,” Mr. Daco said.

Last week, the Port Authority of New York and New Jersey reported that all of its major marine terminals were closed by the storm. While parts of the system have started to reopen, delays persist. The New York area’s port system is the largest on the East Coast, and the third largest in the nation. Last year, it handled $208 billion in cargo.

As a result of the closings, delays may ripple through the holiday season, according to Paul Tsui, chairman of the Hong Kong Association of Freight Forwarding and Logistics. As of Sunday, almost all rail service from the ports was suspended, terminals were damaged and much of the ports’ equipment was being reviewed to see if it still worked.

Several customers with facilities in the New York area told him “their warehouses are totally damaged, and presume the merchandise inside will have to be reported lost to insurance companies,” Mr. Tsui said.

“We are now coming into the cutoff for seasonal orders for the Thanksgiving and Christmas holidays,” he added, and companies that missed shipment deadlines must either send products by expensive air freight, pay a penalty to retailers for late shipments or face canceled orders.

Mr. Merritt of Ryder said he expected that some items that have already been advertised for sales on the day after Thanksgiving — traditionally the busiest shopping day of the year — would not get to stores in time.

The delays are hitting smaller merchants like Robert Van Sickle particularly hard.

His pet supply company, Polka Dog Bakery, was relying on a shipment of cardboard tubes from China with a merry design, intended to hold popular holiday dog treats. The products represent about 15 percent of sales at the company. But the New York Container Terminal in Staten Island, where the tubes arrived shortly before the storm, was devastated, and Mr. Van Sickle’s freight forwarder has been unable to track down the containers.

It is too late to reorder the tubes from China in time for the holidays, and Mr. Van Sickle has tens of thousands of baked dog treats piled up at his Boston headquarters. Insurance will cover the cost of the cardboard tubes, but not the finished products, and those payments will not come close to making up for lost revenue.

Last week, he was forced to call customers like L.L. Bean and tell them he probably could not fulfill their orders. “Without this product, we’re in trouble,” Mr. Van Sickle said. “I am a business owner and this is pretty much my year.”

In Cape May, N.J., Rich Layton’s six-week-old start-up, Layton Sports Cards, was supposed to be shipping sports card orders all week. But his apartment partially flooded, his Allentown distributor could not find clear roads to get to him, and U.P.S. held his other deliveries during the storm.

“It’s thousands of dollars worth of cards that people were already paying for,” Mr. Layton said.

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