Hypothermia and Carbon Monoxide Poisoning Cases Soar in New York After Hurricane Sandy

The number of cold-exposure cases in New York City tripled in the weeks after Hurricane Sandy struck compared with the same period in previous years, the health department reported in an alert to thousands of doctors and other health care providers on Wednesday.

And even though power and heat have been restored to most of the city, there are still thousands of people living in the cold, the department said.

The department warned health care providers that residents living in unheated homes faced “a significant risk of serious illness and death from multiple causes.”

The number of cases of carbon monoxide exposure, which can be fatal, was more than 10 times as high as expected the week of the storm and 6 times as high the next week, reflected in greater numbers of emergency department visits. Calls to the city’s poison center also increased, health officials said.

And as temperatures dip, health officials said the cold could lead to other health problems, including a worsening of heart and lung diseases and an increase in anxiety and depression.

“My bigger concern is what happens in the future as we get closer to winter in the next four weeks,” Dr. Thomas A. Farley, the city’s health commissioner, said in an interview. “There are probably about 12,000 people living in unheated apartments right now.”

Between Nov. 3 and 21, more than three times as many people visited emergency rooms for cold exposure as appeared during the same time periods from 2008 to 2011, the health department said. The storm hit on Oct. 29.

It took days before many elderly and disabled residents, trapped in cold, dark apartments without working elevators or phones, were visited by emergency responders and health workers. Some went to emergency rooms.

Dr. Farley said prolonged exposure to cold even slightly below room temperature could be deadly, and he urged residents of unheated apartments to consider relocating. He said they could find help by calling 311.

The alert said residents in cold apartments should wear layers of dry, loosefitting clothing. They should not use ovens or portable gas heaters because of the risks of fire and carbon monoxide.

The statistics were collected through a system that gathers major complaints daily from most of the city’s hospital emergency departments. The number of hypothermia cases reported to the system since the storm is 65, but that is considered an undercount.

Health department officials said the figure also did not reflect the much larger number of people whose underlying heart and lung problems had worsened in cold environments. An increase in asthma attacks, heart attacks and stroke would be more difficult to detect immediately. Officials said both the very young and older people, as well as people with chronic diseases, mental illness and substance use, were most at risk.

Dr. Farley said the increase in hypothermia cases was greatest immediately after the hurricane and during the cold period around the northeaster on Nov. 7.

Some people exposed to cold were treated at Staten Island University Hospital. “Our initial cases were people immersed in water, most in the process of being rescued,” said Dr. Brahim Ardolic, chairman of the hospital’s department of emergency medicine.

Makeshift efforts to keep warm also caused health problems. Many city residents without heat used stoves and, in some cases, generators indoors or in garages, leading to exposure to carbon monoxide, a colorless, odorless gas.

“It’s a really scary exposure because you usually don’t realize what happened,” Dr. Ardolic said. “It can be insidious enough that you can go to sleep and wake up, if you’re lucky, with a severe headache. If you’re unlucky, you just won’t wake up.”

One post-storm patient was Hazel Mintz, 90, who lives on the 12th floor of an apartment building in Far Rockaway, Queens, that lost heat. She was taken to the emergency room after the storm because of chest pain. Days later, after neighbors heard a carbon monoxide alarm and smelled something burning in Ms. Mintz’s empty apartment, a caregiver opened the door to find a blackened kettle atop a burner with a gas flame. “I put on the gas to warm up,” Ms. Mintz, who has recovered, said.

At St. John’s Episcopal Hospital in Far Rockaway, one of the areas hardest hit by the storm, 13 people have been treated for carbon monoxide exposure since the storm, including a family of three burning charcoal indoors to keep warm, said Dr. Rajiv Prasad, the emergency department director.

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Hurricane Sandy pushed U.S. air travel down in October, report says

Overall domestic air travel in the U.S. dropped slightly in October, partly because of the closure of several East Coast airports during the onslaught of Superstorm Sandy.

The analysis of the impact of the storm on the airline industry came in a report Thursday by the International Air Transport Assn., a trade group for the world's largest airlines.

The group had previously estimated that the world's airlines lost up to $500 million in revenue because of the cancellation of thousands of flights during the storm in late October and early November.

The trade group estimated that the industry lost most of the revenue between Oct. 28 and Nov. 3. At the peak of the storm, on Monday, Oct. 29, about 9% of global airline capacity was grounded, according to IATA.

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“Slowing world trade and weak business confidence are affecting demand for air travel, while Hurricane Sandy delivered a concentrated punch to U.S. domestic and North Atlantic travel," said Tony Tyler, IATA’s director general and chief executive officer. "And its impact was felt globally.”

The percentage of available seats on domestic flights in October dropped 1.1% in the U.S., while revenue per passenger declined 0.7%, compared with the same month in 2011, according to the report.

In total, the nation's airlines canceled nearly 17,000 flights, primarily along the East Coast, where the superstorm flooded subways and airports and demolished hundreds of homes.

Although airlines allowed most travelers to rebook their flights for later dates, many fliers canceled travel plans altogether, said Victoria Day, a spokeswoman for Airlines for America, the trade group for airlines in the U.S.

"It is understandable that some U.S. carriers experienced a drop in the number of available seats and related revenue due to the Hurricane Sandy," she said.

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Norquist: GOP concern over tax pledge just 'impure thoughts'

Grover Norquist on Wednesday rebuffed claims that his anti-tax crusade is losing steam, calling statements from prominent Republicans hinting at their departure from his anti-tax pledge "impure thoughts."

Norquist, president of Americans for Tax Reform, met with Politico’s Mike Allen to offer his thoughts on the looming “fiscal cliff,” and the growing narrative that Republicans, after years of tying themselves to ATR’s pledge not to raise taxes, may be ready to jump ship.

Most recently, Rep. Tom Cole (R-Okla.) said in a private meeting with the House Republican whip team Tuesday morning that Republicans should take the opportunity to extend President George W. Bush’s tax cuts for 98% of Americans, calling it an “early Christmas present” for taxpayers.

And on Sunday, Sen. Lindsay Graham (R-S.C.) and Rep. Peter King (R-N.Y.) joined Sen. Saxby Chambliss (R-Ga.) in voicing concern over continued adherence to Norquist’s pledge.

House Speaker John A. Boehner (R-Ohio) responded to Cole on Wednesday, saying that though Cole is a friend and supporter, he disagrees entirely with his stance. “The goal here is to grow the economy and control spending. You’re not going to grow the economy if you raise tax rates on the top two rates,” Boehner said.

Though Norquist commented that Cole’s recommendation was “an interesting tactic,” he remained firm that his pledge remains viable, saying that anyone suggesting that opposing tax increases is no longer in vogue is “an idiot.”

The pledge, Norquist claimed, “takes weasel words out” of campaign promises to cut taxes, and provides voters a clear picture of a candidate's stance, a stance he said the Republican Party has built its brand upon.

Norquist said that signing the pledge is about informing voters and entrenching a preexisting policy stance, instead of an oath of fealty to ATR and its champion cause.

“They don’t need my permission to raise taxes,” he said, adding that such power lies in the hands of voters.

And he dismissed claims that the pledge’s powers extend beyond the promises tied to its concise wording.

“It doesn’t solve all of the world’s problems; it doesn’t design tax reform,” Norquist said.

But Norquist did design a general road map for Republicans to use in fiscal cliff negotiations.

“You need to have this conversation in public, you need to be online so you can have the moral higher ground,” he said, recommending that the GOP aim for a temporary extension of Bush’s tax cuts, with comprehensive tax reform to follow soon after.

“If the Republicans lose in such a way that they have their fingerprints on the murder weapon, then you have a problem,” he said, adding that public debate over the fiscal cliff would allow Republicans a chance to turn the tide against President Obama and the Democrats, so long as they maintain “credible clarity” in espousing their low-tax vision.

Norquist said he worries about conceding any ground to Democrats on tax increases.

“What the Democrats do is trickle-down taxation,” he said. “They tax the rich and then they screw everybody.”

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Egypt court sentences 8 to death over prophet film

CAIRO (AP) — An Egyptian court convicted in absentia Wednesday seven Egyptian Coptic Christians and a Florida-based American pastor, sentencing them to death on charges linked to an anti-Islam film that had sparked riots in parts of the Muslim world.

The case was seen as largely symbolic because the defendants, most of whom live in the United States, are all outside Egypt and are thus unlikely to ever face the sentence. The charges were brought in September during a wave of public outrage in Egypt over the amateur film, which was produced by an Egyptian-American Copt.

The low-budget "Innocence of Muslims," parts of which were made available online, portrays the Prophet Muhammad as a fraud, womanizer and buffoon.

Egypt's official news agency said the court found the defendants guilty of harming national unity, insulting and publicly attacking Islam and spreading false information — charges that carry the death sentence.

Maximum sentences are common in cases tried in absentia in Egypt. Capital punishment decisions are reviewed by the country's chief religious authority, who must approve or reject the sentence. A final verdict is scheduled on Jan. 29.

The man behind the film, Mark Basseley Youssef, was among those convicted. He was sentenced in a California court earlier this month to one year in federal prison for probation violations in an unrelated matter. Youssef, 55, admitted that he had used several false names in violation of his probation order and obtained a driver's license under a false name. He was on probation for a bank fraud case.

Multiple calls to Youssef's attorney in Southern California, Steve Seiden, were not returned Wednesday.

Florida-based Terry Jones, another of those sentenced, is the pastor of Dove World Outreach, a church of less than 50 members in Gainesville, Fla., not far from the University of Florida. He has said he was contacted by the filmmaker to promote the film, as well as Morris Sadek, a conservative Coptic Christian in the U.S. who posted the video clips on his website.

In a telephone interview Wednesday, Jones said the ruling "shows the true face of Islam" — one that he views as intolerant of dissent and opposed to basic freedoms of speech and religion.

"We can speak out here in America," Jones said. "That freedom means that we criticize government leadership, religion even at times. Islam is not a religion that tolerates any type of criticism."

In a statement sent to The Associated Press Wednesday, Sadek, who fled Egypt 10 years ago and is now a Coptic activist living in Chantilly, Virginia., denied any role in the creation, production or financing of the film.

He said the verdict "shows the world that the Muslim Brotherhood regime wants to shut up all the Coptic activists, so no one can demand Copts' rights in Egypt."

Coptic Christians make up most of Egypt's Christian minority, around 10 percent of the country's 83 million. They complain of state discrimination. Violent clashes break out occasionally over land disputes, worshipping rights and love affairs between Muslims and Christians.

The connection to the film of the other five sentenced by the court was not immediately clear. They include two who work with Sadek at a radical Coptic group in the U.S. that has called for an independent Coptic state, a priest who hosts TV programs from the U.S. and a lawyer living in Canada who has previously sued the Egyptian state over riots in 2000 that left 21 Christians dead.

The other person is a woman who converted to Christianity and is a staunch critic of Islam.

The official news agency report said that during the trial, the court reviewed a video of some defendants calling for an independent Coptic state in Egypt, and another of Jones burning the Quran, Islam's holy book. The prosecutor asked for the maximum sentence, accusing those charged of seeking to divide Egypt and incite sedition. All the defendants, except Jones, hold Egyptian nationality, the agency added.

Some Christians and human rights groups worry that prosecutions for insulting religion, which existed to a degree under the secular-leaning regime of deposed President Hosni Mubarak, will increase with the ascent of Islamists to power in Egypt.

____

Curt Anderson contributed reporting from Miami, Florida; Matthew Barakat from McLean, Virginia, and Gillian Flaccus in Orange County, California.

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Well: Ignoring the Science on Mammograms

Last week The New England Journal of Medicine published a study with the potential to change both medical practice and public consciousness about mammograms.

Published on Thanksgiving Day, the research examined more than 30 years of United States health statistics to determine, through observation, if screening mammography has reduced breast cancer deaths. The researchers found that, as expected, the introduction of mammogram screening led to an increase in the number of breast cancers detected at an early stage.

But importantly, the number of cancers diagnosed at the advanced stage was essentially unchanged. If mammograms were really finding deadly cancers sooner (as suggested by the rise in early detection), then cases of advanced cancer should have been reduced in kind. But that didn’t happen. In other words, the researchers concluded, mammograms didn’t work.

This is a bold claim for an observational study. There are countless reasons why conclusions from such studies are commonly fraught with error. What if, for instance, the lion’s share of advanced cancers occurred among women without access to screening mammograms—a fact often not available in health statistics? Or what if mammography successfully prevented a major increase in advanced cancers, leaving the health statistics unchanged?

Hippocrates, the father of medicine, called experience “delusive.” He recognized that uncontrolled observations may lead to faulty conclusions. For centuries the flawed logic of observational data seemed to validate bloodletting, an unhelpful and often harmful therapy. But most who were bled eventually improved—no thanks to the bloodletting—an observation that led medical authorities to believe in the practice.

Fortunately, we have learned something about bad logic. Today we seek studies designed to neutralize illusions. By enrolling people in a study and assigning them randomly to treatments, for instance, groups tend to be evenly balanced in every way except one: the treatment. Controlled studies led to the discovery that bloodletting is harmful rather than helpful, and randomized trials of screening mammography would therefore be a worthy gold standard to answer once and for all the question of whether the test saves lives.

It may be surprising, therefore, to learn that numerous trials of mammography have indeed randomly assigned nearly 600,000 women to undergo either regular mammography screening or no screening. The results of more than a decade of follow-up on such studies, published more than 10 years ago, show that women in the mammogram group were just as likely to die as women in the no-mammogram group. The women having mammograms were, however, more likely to be treated for cancer and have surgeries like a mastectomy. (Some of the studies include trials from Norway, the Netherlands, Sweden, and this major review of the data.)

In other words, mammograms increased diagnoses and surgeries, but didn’t save lives—exactly what the researchers behind last week’s observational study concluded.

It is affirming to see this newest study. But it raises an awkward question: why would a major medical journal publish an observational study about the effects of screening mammography years after randomized trials have answered the question? Perhaps it is because many doctors and patients continue to ignore the science on mammograms.

For years now, doctors like myself have known that screening mammography doesn’t save lives, or else saves so few that the harms far outweigh the benefits. Neither I nor my colleagues have a crystal ball, and we are not smarter than others who have looked at this issue. We simply read the results of the many mammography trials that have been conducted over the years. But the trial results were unpopular and did not fit with a broadly accepted ideology—early detection—which has, ironically, failed (ovarian, prostate cancer) as often as it has succeeded (cervical cancer, perhaps colon cancer).

More bluntly, the trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

Medical authorities, physician and patient groups, and ‘experts’ everywhere ignore science, and instead repeat history. Wishful conviction over scientific rigor; delusion over truth; form over substance.

It is normally troubling to see an observational study posing questions asked and answered by higher science. But in this case the research may help society to emerge from a fog that has clouded not just the approach to data on screening mammography, but also the approach to health care in the United States. In a system drowning in costs, and at enormous expense, we have systematically ignored virtually identical data challenging the effectiveness of cardiac stents, robot surgeries, prostate cancer screening, back operations, countless prescription medicines, and more.

When Thomas Jefferson described his vision for the institution that would become the University of Virginia, he said:

This place will be based on the illimitable freedom of the human mind. For here we are not afraid to follow truth, wherever it may lead.

As we begin down the arduous path of health care reform, requisite to economic success, the question for policymakers and health care authorities is this: Are we ready to stop ignoring science? If so, the road may be smoother than we imagined for there is, and has been, much truth to follow.

---

Dr. David Newman is an emergency room physician in New York City and author of the book, “Hippocrates Shadow: Secrets from the House of Medicine.“

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Embattled hedge fund tells investors of looming SEC action

Steve Cohen is founder and head of the hedge fund SAC Capital Advisors. (Ronda Churchill / Bloomberg via Getty Images)

By Andrew Tangel

November 28, 2012, 11:49 a.m.

NEW YORK -- The hedge fund SAC Capital Advisors told investors it has received a notice of potential action by the U.S. Securities and Exchange Commission, according to a source familiar with the matter.

Looming civil action by the regulator would take direct aim at the $14-billion hedge fund after federal prosecutors accused one of its former portfolio managers -- Mathew Martoma, who worked at an SAC unit called CR Intrinsic Investors -- of taking part in history's most lucrative insider-trading scheme.

Prosecutors claim the scheme generated $276 million in profits and avoided losses for Martoma's fund. The illicit tips involved an Alzheimer's drug under development by two publicly traded drug companies.

Martoma was the latest former SAC employee to face insider-trading charges in the federal government's crackdown on Wall Street corruption.

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The SEC's so-called Wells notice is a procedural step by which the agency informs targets of investigations it may take action.

While the source would not specify what claims the SEC might level, Bloomberg News reported the potential litigation could involve fraud claims stemming from Martoma's case. Bloomberg also reported the SEC indicated it might take action alleging a breakdown of the hedge fund's management and compliance system.

SAC hosted a conference call with investors Wednesday. The call was not open to the media.

Martoma's attorney has said he expected his client would be exonerated. The criminal case against him has been widely interpreted as an attempt by prosecutors to win Martoma's cooperation against Steven Cohen, who founded and runs SAC. But Cohen has not been accused of any wrongdoing and has said he acted appropriately.

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Yasser Arafat's grave dug up in poisoning probe

RAMALLAH, West Bank -- Forensic experts from Switzerland, France and Russia on Tuesday took 20 samples each from the remains of Palestinian leader Yasser Arafat after his grave in the presidential headquarters here was opened.

The experts will take the samples to their respective countries to carry out tests to determine if Arafat, who died on Nov. 11, 2004, at a military hospital in France, was killed by polonium, a poisonous radioactive material.

French hospital reports at the time said he died from a massive brain hemorrhage, but gave no details on what caused a related blood condition, giving rise to Palestinian suspicions he was killed by Israel. Arafat's wife requested at the time that no autopsy be performed, and Israeli officials have labeled as ridiculous any allegations that they played a role in his death.

The process Tuesday took only hours. The grave, buried 12 feet underground, was opened early in the morning and Palestinian forensic technicians removed samples for the international experts.

After the grave was again closed, Palestinian officials held a short ceremony in which they laid wreaths.

Members of the media were not allowed to witness the grave opening; the site was sealed from view by blue industrial sheeting.

Tawfik Tirawi, head of the Palestinian committee investigating Arafat's death, said at a news conference following the exhumation that the process went smoothly and that "everything was done legally and professionally."

He stressed that the remains of Arafat were handled only by Palestinians and that none of the international experts had touched the corpse.

Abdullah al-Bashir, a Jordanian doctor who heads a Palestinian medical committee empowered to follow up on the circumstances of Arafat’s death, said results should be available in about three months.

"If polonium was evident, we would have reached the truth," he said, "and if it was not, we would want them [the experts] to continue searching until they determine what kind of poison was used."

Bashir, who was Arafat's personal doctor, said he believes that the Palestinian leader died of poisoning and that the French hospital medical reports did not rule out that possibility.

The Palestinians said that if polonium is determined to be the cause of death, they will have hard evidence that Israel was behind it.

"Once we get the evidence, we are going to ask the International Court of Justice to follow up on this matter, and this will be our first case after we become a non-member state in the United Nations," said Tirawi, a former head of Palestinian intelligence.

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'Two and a Half Men' actor not expected on set

NEW YORK (AP) — The teenage actor who stars in "Two and a Half Men" and called the CBS comedy "filth" may have some time before he faces the show's producers.

Angus T. Jones wasn't expected at rehearsal Tuesday because he is not going to be in the episode they are filming, according to a person close to the show who spoke on condition of anonymity because producers were not commenting publicly.

Jones, 19, has been on the show, which used to feature bad-boy actor Charlie Sheen and remains heavy with sexual innuendo, since he was 10 but says in a video posted online by a Christian church that he doesn't want to be on it anymore.

"Please stop watching it," Jones said. "Please stop filling your head with filth."

The person familiar with the production schedule said Jones does not appear in either of the two episodes filming before the end of the year, so he wouldn't be expected back at work until after the New Year.

His character has been largely absent because he has joined the Army.

CBS and producer Warner Bros. Television have not commented.

"Two and a Half Men" survived a wild publicity ride less than two years ago, when Sheen was fired for his drug use and publicly complained about the network and the show's creator, Chuck Lorre.

Jones plays Jake, the son of Jon Cryer's uptight divorced chiropractor character, Alan, and the nephew of Sheen's hedonistic philandering music jingle writer, Charlie. Sheen was replaced by Ashton Kutcher, who plays billionaire Walden.

In the video posted by Forerunner Chronicles in Seale, Ala., Jones describes a search for a spiritual home. He says the type of entertainment he's involved in adversely affects the brain and "there's no playing around when it comes to eternity."

"You cannot be a true God-fearing person and be on a television show like that," he said. "I know I can't. I'm not OK with what I'm learning, what the Bible says, and being on that television show."

The show was moved from Monday to Thursday this season, and its average viewership has dropped from 20 million an episode to 14.5 million, although last year's numbers were somewhat inflated by the intense interest in Kutcher's debut. It is the third most popular comedy on television behind CBS's "The Big Bang Theory" and ABC's "Modern Family."

The actors on "Two and a Half Men" have contracts that run through the end of the season.

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Amid Hurricane Sandy, a Race to Get a Liver Transplant

It was the best possible news, at the worst possible time.

The phone call from the hospital brought the message that Dolores and Vin Dreeland had long hoped for, ever since their daughter Natalia, 4, had been put on the waiting list for a liver transplant. The time had come.

They bundled her into the car for the 50-mile trip from their home in Long Valley, N.J., to NewYork-Presbyterian Morgan Stanley Children’s Hospital in Manhattan. But it soon seemed that this chance to save Natalia’s life might be just out of reach.

The date was Sunday, Oct. 28, and Hurricane Sandy, the worst storm to hit the East Coast in decades, was bearing down on New York. Airports and bridges would soon close, but the donated organ was in Nevada, five hours away. The time window in which a plane carrying the liver would be able to land in the region was rapidly closing.

In a hospital room, Natalia watched cartoons. Her parents watched the clock, and the weather. “Our anxiety was through the roof,” Mrs. Dreeland said. “It just made your stomach into knots.”

The Dreelands, who are in their 60s, became Natalia’s foster parents in 2008 when she was 7 months old, and adopted her just before she turned 2. They have another adopted daughter, Dorothy Jane, who is 17.

Natalia is a “smart little cookie” who loves school and dressing up Alice, her favorite doll, her mother said. At age 3, Natalia used the word “discombobulated” correctly, Mr. Dreeland said.

Natalia’s health problems date back several years. Her gallbladder was taken out in 2010, and about half her liver was removed in 2011. The underlying problem was a rare disease, Langerhans cell histiocytosis. It causes a tremendous overgrowth of a type of cell in the immune system and can damage organs. Drugs can sometimes keep it in check, but they did not work for Natalia.

In her case, the disease struck the bile ducts, which led to progressive liver damage. “She would have eventually gone into liver failure,” said Dr. Nadia Ovchinsky, a pediatric liver transplant specialist at NewYork-Presbyterian. “And she demonstrated some signs of early liver failure.”

The only hope was a transplant.

Dr. Tomoaki Kato, Natalia’s surgeon, knew that the liver in Nevada was a perfect match for Natalia in the two criteria that matter most: blood type and size. The deceased donor was 2 years old, and though Natalia is nearly 5, she is small for her age. Scar tissue from her previous operations would have made it very difficult to fit a larger organ into her abdomen.

Though Dr. Kato had considered transplanting part of an adult liver into Natalia, a complete organ from a child would be far better for her. But healthy organs from small children do not often become available, Dr. Kato said. This was a rare opportunity, and he was determined to seize it.

But as the day wore on, the odds for Natalia grew slimmer. The operation in Nevada to remove the liver was delayed several times.

At many hospitals, surgery to remove donor organs is done at the end of the day, after all regularly scheduled operations. The Nevada hospital had a busy surgical schedule that day, made worse by a trauma case that took priority.

At the hospital in New York, Tod Brown, an organ procurement coordinator, had alerted a charter air carrier that a flight from Nevada might be needed. That company in turn contacted West Coast carriers to pick up the donated liver and fly it to New York.

Initially, two carriers agreed, but then backed out. Several other charter companies also declined.

Mr. Brown told Dr. Kato that they might have to decline the organ. Dr. Kato, soft-spoken but relentless, said, “Find somebody who can fly.”

Dr. Kato used to work in Miami, where pilots found ways to bypass hurricanes to deliver organs. Even during Hurricane Katrina, his hospital performed transplants.

“I asked the transplant coordinators to just keep pushing,” he said.

Mr. Brown said, “Dr. Kato knew he was going to get that organ, one way or another.”

As the trajectory of the storm became clearer, one of the West Coast charter companies agreed to attempt the flight. The plan was to land at the airport in Teterboro, N.J. The backup was Newark airport, and the second backup was Albany, from where an ambulance would finish the trip.

The timing was critical: organs deteriorate outside the body, and ideally a liver should be transplanted within 12 hours of being removed.

Early Monday, as the storm whirled offshore, the plane landed at Teterboro. Soon a nurse rushed to tell the Dreelands that she had just seen an ambulance with lights and sirens screech up to the hospital. Someone had jumped out carrying a container.

At about 5 a.m., the couple kissed Natalia and saw her wheeled off to the operating room.

Three weeks later, she is back home, on the mend. The complicated regimen of drugs that transplant patients need is tough on a child, but she is getting through it, her father said.

Recently, Mr. Dreeland said, he found himself weeping uncontrollably during a church service for the family of the child who had died. “Their child gave my child life,” he said.

Though only time will tell, because the histiocytosis appeared limited to Natalia’s bile ducts and had not affected other organs, her doctors say there is a good chance that the transplant has cured her.

This article has been revised to reflect the following correction:

Correction: November 27, 2012

An earlier version of a picture caption with this article misspelled the surname of the family whose daughter received a liver transplant. As the article correctly noted elsewhere, it is Dreeland, not Vreeland.

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Apple fires Maps manager as it works to fix the widely panned app

Apple has fired the manager in charge of its homegrown Maps app two months after the software debuted to harsh criticism.

Richard Williamson was let go by Senior Vice President Eddy Cue, according to Bloomberg, which cited unnamed sources familiar with the situation. Cue is reportedly seeking advice from outside mapping experts and working with digital map company TomTom to fix navigation information and other data it provides to  Apple.

Apple has been quick to own up to the app's problems, which include poor directions, mislabeled landmarks, lack of information on public transportation and wildly inaccurate images (melting Las Vegas strip, anyone?). The outcry over the Maps app forced Apple Chief Executive Tim Cook to issue an apology in September in which he encouraged users to try alternatives from the company's competitors.

The Cupertino, Calif., company's Maps app replaced rival Google's popular version on iOS 6 devices, including the new iPhone 5. Google's Maps app had been a feature on the iPhone since the original device launched in 2007; Google is said to be working on a version of its Maps software for iOS 6 that will be available in Apple's App Store. 

Cue, who was promoted last month as part of a management shakeup that saw the departure of iOS head Scott Forstall, is hoping to develop a new leadership team that can oversee the company's efforts to fix Maps, Bloomberg said. It's unclear whether a successor to Williamson has been named.

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