The New Old Age Blog: Debate Over Brain Scans and Alzheimer's

Should brain scans for older adults with suspected Alzheimer’s disease be covered by Medicare?

Many medical experts say yes. But late last month, an expert panel convened by the Centers for Medicare and Medicaid Services concluded that data supporting use of the scans was weak.

Specifically, the panel noted there is no solid evidence that these imaging tests have a meaningful impact on patients’ health; studies that might establish this have not yet been done.

This controversy deserves attention because positron emission tomography, known as PET scans, are becoming available across the country, and proposed guidelines for their use have just been published by the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging.

Currently, Medicare does not pay for the tests, which cost about $3,000 — an amount that puts them out of reach for many families. The expert panel’s findings will be used by the government later this year to determine whether Medicare should change this policy.

Nearly 400 medical centers already offer this technology or are preparing to do so, according to Eli Lilly, which makes a radioactive agent used in the scans. That agent binds to protein clusters known as amyloid plaques that are a signature characteristic of Alzheimer’s disease, making it possible to see them for the first time in the brains of living patients.

The Medicare panel confronted the question: “How useful is this information, for which patients and under what conditions?” Several experts who testified in late January suggested that the PET imaging tests could help physicians diagnose Alzheimer’s disease or other types of dementia. Currently, diagnosis proceeds from a comprehensive medical evaluation, a careful patient history, and typically, a round of neuropsychiatric tests.

“Should I tell my patients that we have a test available to help clarify their diagnosis but we can’t use it because Medicare doesn’t cover it?” asked Dr. Stephen Salloway, a professor of neurology at the Warren Alpert Medical School at Brown University.

If scans show a lack of amyloid plaques, the “worried well” could be reassured that they don’t have Alzheimer’s and doctors could pursue other lines of medical inquiry, like investigating the potential for thyroid problems, depression or vitamin B12 deficiency, said Dr. Paul Aisen, a professor of neuroscience at the University of California, San Diego, School of Medicine.

If the tests are positive, they could rule out conditions like frontotemporal dementia and motivate patients to start taking medications for Alzheimer’s, enroll in clinical trials and get their financial, legal and household affairs in order, other experts said.

But while amyloid plaques are closely associated with Alzheimer’s, their role has not yet been definitively established. They could be a cause of this condition, a byproduct or serve another function not yet understood. Underscoring this is a notable research finding: about 30 percent of older adults with no symptoms of dementia have been found to have amyloid plaque buildup in their brains.

That means the brain scans cannot ensure the accurate diagnosis of Alzheimer’s. “I see a big potential for overuse and misuse,” warned Dr. Raymond Faught, Jr., a member of the Medicare advisory panel and a professor of neurology at Emory University in Atlanta.

Given that large caveat, the question emerges of which patients would benefit most from getting the tests.

The Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging tried to address that in their recently published “appropriate use” guidelines. The guidelines, which have no binding force, suggest that scans should be considered for patients with Alzheimer’s-type symptoms but “an unclear clinical presentation”; those who develop dementia symptoms before age 65; and those with “persistent” mild cognitive impairment, a condition that often precedes Alzheimer’s.

Tests should not be given to “normal” patients or those who have Alzheimer’s disease already, they say. In other words, if you’re getting older, have mild memory loss, but are still functioning well, you’re not a candidate. Nor is there any value in giving the tests to people who are already deep in the throes of dementia.

The recommendations assume that there is value in knowing test results for physicians, patients and families; that physicians will be better able to manage patients’ care as a consequence; and that doctors will order fewer diagnostic tests or more appropriate tests once they have findings from amyloid PET imaging in hand.

But those assumptions are not backed up by solid evidence yet. Medications for patients with Alzheimer’s have a modest impact on symptoms for a limited period of time and no impact on the underlying illness. Given this, “the clinical utility of a diagnostic test to alter patient management and result in a quantifiable benefit is very difficult to establish,” the panel writes in the journal Alzheimer’s & Dementia. Also, they note, “data supporting specific outcomes for amyloid PET are not yet available.”

This lack of data was the reason the Medicare panel gave amyloid brain imaging such low marks late last month. Dr. Rita Redberg, chairwoman of the Medicare Evidence Development and Coverage Advisory Committee and a professor of medicine at the University of California, San Francisco, summed up that group’s deliberations this way:

We were there to evaluate the impact of this test on patient outcomes. But all of the speakers said there wasn’t any data linking amyloid scans to outcomes . . . They presented evidence that the test is very good at identifying amyloid, but they did not present evidence that it was very good at identifying the clinical presence of Alzheimer’s disease.

Wei-Li Shao, senior director of the Alzheimer’s business division of Eli Lilly, which stands to benefit from the greater use of the scans, disagreed, saying, “Lilly remains steadfast and resolved in its belief that amyloid imaging provides significant clinical value for clinicians and patients.” The company will work with Medicare going forward to try to secure coverage, he said.

For Dr. Redberg, the essential question is this: “Would you want to know you have an increased chance of getting a disease in (the future) when there are no effective treatments available and you might not even get it in the end? Is that of benefit to patients?”

What do you think, readers?

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DealBook Column: Relationship Science Plans Database of Names and Connections

It sounds like a Rolodex for the 1 percent: two million deal makers, power brokers and business executives — not only their names, but in many cases the names of their spouses and children and associates, their political donations, their charity work and more — all at a banker’s fingertips.

Such is the promise of a new company called Relationship Science.

Never heard of it? Until recently, neither had I. But a few months ago, whispers began that this young company was assembling a vast trove of information about big names in corporate America. What really piqued my interest was that bankrolling this start-up were some Wall Street heavyweights, including Henry R. Kravis, Ronald O. Perelman, Kenneth G. Langone, Joseph R. Perella, Stanley F. Druckenmiller and Andrew Tisch.

It turns out that over the last two years, with a staff of more than 800 people, mostly in India, Relationship Science has been quietly building what it hopes will be the ultimate business Who’s Who. If it succeeds, it could radically change the way Wall Street does business.

That’s a big if, of course. There are plenty of other databases out there. And there’s always Google. Normally I wouldn’t write about a technology company, but I kept hearing chatter about it from people on Wall Street.

Then I got a glimpse of this new system. Forget six degrees of Kevin Bacon. This is six degrees of Henry Kravis.

Here’s how it works: Let’s say a banker wants to get in touch with Mr. Kravis, the private equity deal maker, but doesn’t know him personally. The banker can type Mr. Kravis’s name into a Relationship Science search bar, and the system will scan personal contacts for people the banker knows who also know Mr. Kravis, or perhaps secondary or tertiary connections.

The system shows how the searcher is connected — perhaps a friend, or a friend of a friend, is on a charitable board — and also grades the quality of those connections by identifying them as “strong,” “average” or “weak.” You will be surprised at the many ways the database finds connections.

The major innovation is that, unlike Facebook or LinkedIn, it doesn’t matter if people have signed up for the service. Many business leaders aren’t on Facebook or LinkedIn, but Relationship Science doesn’t rely on user-generated content. It just scrapes the Web.

Relationship Science is the brainchild of Neal Goldman, a co-founder of CapitalIQ, a financial database service that is used by many Wall Street firms. Mr. Goldman sold CapitalIQ, which has 4,200 clients worldwide, to McGraw-Hill in 2004 for more than $200 million. That may explain why he was able to easily round up about $60 million in funds for Relationship Science from many boldface names in finance. He raised the first $6 million in three days.

“I knew there had to be a better way,” Mr. Goldman said about the way people search out others. Most people use Google to learn about people and ask friends and colleagues if they or someone they know can provide an introduction.

Relationship Science essentially does this automatically. It will even show you every connection you have to a specific company or organization.

“We live in a service economy,” Mr. Goldman said. “Building relationships is the most important part for selling and growing.”

Kenneth Langone, a financier and co-founder in Home Depot, said that when he saw a demonstration of the system he nearly fell off his chair. He used an unprintable four-letter word.

“My life is all about networking,” said Mr. Langone, who was so enthusiastic he became an investor and recently joined the board of Relationship Science. “How many times do I say, ‘How do I get to this guy?’ It is scary how much it helps.”

Mr. Goldman’s version of networking isn’t for everyone. His company charges $3,000 a year for a person to have access to the site. (That might sound expensive, but by Wall Street standards, it’s not.)

Price aside, the possibility that this system could lead to a deal or to a new wealth management client means it just might pay for itself.

“If you get one extra deal, the price is irrelevant,” Mr. Goldman said.

Apparently, his sales pitch is working. Already, some big financial firms have signed up for the service, which is still in a test phase. Investment bankers, wealth managers, private equity and venture capital investors have been trying to arrange meetings to see it, egged on, no doubt, by many of Mr. Goldman’s well-heeled investors. Even some development offices of charities have taken an interest.

The system I had a peek at was still a bit buggy. In some cases, it was missing information; in other cases the information was outdated. In still other instances, the program missed connections. For example, it didn’t seem to notice that Lloyd C. Blankfein, the chief executive of Goldman Sachs, should obviously know a certain senior partner at Goldman.

But the promise is there, if the initial kinks are worked out. I discovered I had paths I never knew existed to certain people or companies. (Mr. Goldman should market his product to reporters, too.)

One of the most vexing and perhaps unusual choices Mr. Goldman seems to have made with Relationship Science is to omit what would be truly valuable information: phone numbers and e-mail addresses.

Mr. Goldman explained the decision. “This isn’t about spamming people.” He said supplying phone numbers wouldn’t offer any value because people don’t like being cold-called, which he said was the antithesis of the purpose of his database.

Ultimately, he said, as valuable as the technology can be in discovering the path to a relationship, an artful introduction is what really counts.

“We bring the science,” he said. “You bring the art.”

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this column misspelled the surname of one of the backers of Relationship Science. He is Ron O. Perelman, not Pearlman.

A version of this article appeared in print on 02/12/2013, on page B1 of the NewYork edition with the headline: A Database Of Names, And How They Connect.

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Catch a Nostalgic Glimpse of Geocities on Tumblr

The digital remnants of the long since deleted world of Geocities are slowly being reborn, page by page, on Tumblr.

One Terabyte of Kilobyte Age may be the best Tumblr blog we’ve seen, posting screenshots of old Geocities pages for a nostalgic look at the early web, back when everything was “Under Construction.”

For a brief time in the early ’90s Geocities was the web. And, for all its shortcomings, Geocities did nevertheless usher in much of what makes the web great — that anyone can create nearly anything.

The One Terabyte of Kilobyte Age Tumblr project is part of a Geocities research blog by Olia Lialina and Dragan Espenschied. The Tumblr portion consists of automatically generated screenshots from the massive torrent of old Geocities homepages rescued by the Archive Team back in 2009. For posterity’s sake each post also carries the original URL (which obviously goes to a 404 page) and the date the page was last modified.

With Geocities long since deleted from Yahoo’s servers, browsing through One Terabyte of Kilobyte Age is as close as you’re likely to get to a trip down Geocities memory lane.

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Famous film couple back 9 years on in “Before Midnight”

BERLIN (Reuters) – Ethan Hawke and Julie Delpy reprise the roles of Jesse and Celine in “Before Midnight”, the third but not necessarily the last movie in their long-running series based on the same characters as they age over time.

In this film, set 18 years after “Before Sunrise”, the couple is on holiday in Greece and we learn that they live with their twin daughters in Paris while Jesse’s son has stayed with his mother in Chicago.

Screening at the Berlin film festival on Monday, “Before Midnight” examines how life’s twists have taken their toll on the American tourist and French student who met on a train bound for Vienna in 1995 and again in Paris nine years later in “Before Sunset”.

They still love each other but this time they are older, heavier, and bicker more, and the forces pulling Jesse back towards his teenage son and Celine’s determination to pursue her career in France test that bond to its limits.

Director Richard Linklater, on board throughout the series, underlined the organic nature of the “Before…” films when he was asked whether there might be a fourth installment, presumably sometime around 2022.

“The fact that we’ve made two sequels, I guess it begs the question, but I think I speak for the group here, I’m sure we have absolutely no idea what that (sequel) could possibly be,” he told reporters at the 11-day film festival.

“We probably won’t for another six years. Who knows the future?”

French actress Delpy joked that the final film in the series would be a remake of Michael Haneke’s Oscar-nominated drama “Amour”, about an elderly couple aged in their 80s facing the inevitability of imminent death.

“STIFLING” EXPECTATIONS

Critical reaction to “Before Midnight” has been mixed.

In its review, the Guardian newspaper said the movie felt forced, but The Hollywood Reporter wrote: “Though this stage is harder to watch, audiences who have aged along with Celine and Jesse will treasure this new episode.”

Hawke said he, Delpy and Linklater, who jointly developed the script over two years, felt the weight of expectation as they embarked on the third part of a story which many viewers identified with so closely.

“I haven’t met a director in the last nine years that didn’t tell me what he or she thought the third film should be. So we knew we were up against a lot of people having an agenda about where Jesse and Celine should be. That agenda is stifling.”

“Before Midnight” consists of a handful of long, single-shot scenes focusing on the couple as they navigate a life complicated by broken families, work pressures and the familiarity of living together.

In the first scene Jesse sees his son off at the airport in an awkward exchange that underlines how the two have grown apart. In the next Jesse and Celine discuss children, work and their relationship in frank and often funny exchanges.

At one point Celine says men measure themselves against leading figures from history. When Jesse counters that women do too, he mentions Joan of Arc.

“She was burned at the stake and was a virgin,” jokes Celine. “Who wants to be Joan of Arc?”

As the film goes on, banter becomes bickering, then descends into a blazing row. Linklater stressed that the dialogue may seem off-the-cuff but it required a lot of hard work.

“It feels improvised. It’s not,” he said. “It’s meticulously rehearsed and structured.”

(Reporting by Mike Collett-White; Editing by Belinda Goldsmith)

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Personal Health: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Bits Blog: Reporter's Notebook: Snapchat's Path From Stanford to the Beach

Over the weekend, I reported about the recent successes of an up-and-coming start-up, Snapchat, that lets people send messages that disappear after they are viewed. I spent two days with the founders of the company, Evan Spiegel and Bobby Murphy, in Los Angeles, interviewing them and learning about their business.

Snapchat’s headquarters are on the sunny stretch of the Venice Beach boardwalk, steps from surf and sand, in an airy beach house whose previous tenants include a medical marijuana dispensary and a Nike party house.

Their offices have a glowing, life-size replication of their app icon positioned outside the main entrance.

The company also has security detail, 24 hours a day, seven days a week, to keep anyone wandering by from trying to break into the offices.

The company also has a lot of Snapchat-themed art in its offices, including a series of prints that say “No photographs please” and a glitter portrait of their company mascot, “Ghostface Chillah.”

Snapchat does not currently generate any revenue, but its founders envision a future where the company could partner with brands or advertisers that want to show certain Snapchat users a glimpse of a new device, a preview of a new movie or a sneak peek of an upcoming line of clothing. Or, they say, they could show “exploding coupons,” an image that gives information about a deal or discount that expires after a certain amount of time.

Mr. Spiegel and Mr. Murphy met at Stanford, and eventually became roommates. Mr. Spiegel said he would often ask Mr. Murphy for help with computer science and Mr. Murphy recalled being impressed with a line of shirts that Mr. Spiegel designed for their fraternity, which set the precedent for their future business partnership.

One of Snapchat’s defining features is that it allows users to take screenshots of photos they receive, which sends a notification to the sender, alerting them that an image of their photo was taken. This, of course, means that nimble-fingered Snapchat users can make copies of photos that would otherwise disappear after a few seconds. Snapchat’s founders say that feature can also be considered akin to a “like” or a “favorite,” a signal to the sender that their image was favorably received.

Before working on Snapchat, Mr. Spiegel and Mr. Murphy collaborated on a Web product, Future Freshman, a guide for high school students who were applying to college. The product failed to gain any significant traction, however, and the founders went back to the drawing board before coming up with Snapchat.

Snapchat’s original name was Pickaboo — a riff on the kid’s game Peekaboo. But that name was taken by another photo company, and after a brainstorm session, the founders settled on Snapchat.

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This post has been revised to reflect the following correction:

Correction: February 11, 2013

An earlier version of this post misspelled the surname of one of Snapchat's founders on some references. He is Evan Spiegel, not Siegel.

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Ambitious makeover planned for old housing project

Denise Penegar puts a little extra effort into the teenage girls, the ones who've dropped out of high school to care for their firstborns.

Don't be afraid, the outreach worker tells them. Come down to the housing project's community center, get your GED and some job skills. Change your life.

"I was one of those girls," said Penegar, now 51 and still living in Jordan Downs, the Watts housing project where she was born.

Sometimes, she imagines how different her life might have been if someone had knocked on her door when she was 17, caring for her first baby. What would it have meant just to have "someone who is here who can help pick me up"?

Penegar is on the front lines of a bold social experiment underway at Jordan Downs, a project notorious to outsiders for its poverty, blight and violence but seen by many longtime residents, for all its problems, as a close-knit community worth preserving.

In the last year, the Housing Authority of the City of Los Angeles has begun an effort to transform Jordan that could cost more than $600 million. The plan is to turn the complex of 700 aging units into a mixed-income community of up to 1,400 apartments and condominiums, with shops and restaurants and fancy touches such as native plant gardens. The city hopes to draw in hundreds of more-affluent residents willing to pay market rate to live side by side with the city's poorest.

Spurred by changes in federal funding and policy, such "mixed use" developments have sprung up in place of infamous housing projects all over the country. But experts say Jordan is taking an approach that has not been tried on this scale.

Typically, public housing residents are moved out ahead of the bulldozers, scattered to search for new shelter. In Los Angeles, the housing authority has promised that any of the 2,300 Jordan residents "in good standing" can stay in their old units until the day they move into new ones. The project is to be built in phases, beginning with units on 21 acres of adjacent land purchased by the authority in 2008 for $31 million.

To ease the transition, the city has dispatched "community coaches" like Penegar, along with teachers, social workers, therapists — even police officers whose charge is not to make arrests but to coach youth football and triathlon teams.

In essence, officials intend to raze the buildings, not the community — and radically change its character.

It will be an enormous challenge, with success likely to be measured in tiny increments.

Only 47% of adults at Jordan reported any wages to the housing authority last year. As in many urban projects, poverty and social ills have multiplied through the generations, leaving some residents unfamiliar with opportunities and expectations beyond the neighborhood. Some rarely leave the area.

Before inviting in new neighbors with expectations of safety and comfort, the housing authority has begun flooding Jordan Downs with social services. Many of the programs are focused on women, because more than 60% of Jordan Downs' tenants live in households headed by single mothers. But men are targeted too — for job training and lessons in parenting, for instance.

By December, 10 months into the effort, more than 450 families had been surveyed by intake workers and 280 signed up for intensive services.

"Most people would say it's ambitious, but I think it's essential," said Kathryn Icenhower, executive director of Shields for Families, the South Los Angeles nonprofit that is running many of the new programs under a more than $1-million annual contract with the housing authority.

It is unknown, however, how effective the social services will be, how easy it will be to draw in wealthier residents and how many millions of dollars the federal government — a major source of funding — will provide.

Already, the housing authority has picked a development team — the for-profit Michaels Organization and the nonprofit Bridge Housing, both with respectable track records in other cities. But with financing still uncertain, it is unclear exactly how many units will be built or how much various occupants would pay.

Ultimately, a working family could pay hundreds of dollars more in rent than unemployed tenants next door for a nearly identical unit. Officials say they do not expect Watts to draw the same kind of high-income residents as the former Cabrini Green project in Chicago, which sat on prime real estate near downtown. But Jordan is in a convenient location, near the intersection of the 105 and 110 Freeways; and in a high-rent city like Los Angeles, even the steepest rates at Jordan are likely to seem a bargain.

Despite the onslaught of social services and some palpable changes — including a 53% plunge in the violent crime rate at Jordan last year — financial risks abound.

Later this spring, the authority plans to put in an application for $30 million from the federal government's Choice Neighborhoods Program as seed money. Without it, the project could be delayed.

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Wired Science Space Photo of the Day: Wings of the Seagull Nebula

This image shows the intricate structure of part of the Seagull Nebula, known more formally as IC 2177. These wisps of gas and dust are known as Sharpless 2-296 (officially Sh 2-296) and form part of the “wings” of the celestial bird. This region of the sky is a fascinating muddle of intriguing astronomical objects — a mix of dark and glowing red clouds, weaving amongst bright stars. This new view was captured by the Wide Field Imager on the MPG/ESO 2.2-metre telescope at ESO’s La Silla Observatory in Chile.

Image: ESO [high-resolution]

Caption: ESO

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Boeing 787 Completes Test Flight

A Boeing 787 test plane flew for more than two hours on Saturday to gather information about the problems with the batteries that led to a worldwide grounding of the new jets more than three weeks ago.

The flight was the first since the Federal Aviation Administration gave Boeing permission on Thursday to conduct in-flight tests. Federal investigators and the company are trying to determine what caused one of the new lithium-ion batteries to catch fire and how to fix the problems.

The plane took off from Boeing Field in Seattle heading mostly east and then looped around to the south before flying back past the airport to the west. It covered about 900 miles and landed at 2:51 p.m. Pacific time.

Marc R. Birtel, a Boeing spokesman, said the flight was conducted to monitor the performance of the plane’s batteries. He said the crew, which included 13 pilots and test personnel, said the flight was uneventful.

He said special equipment let the crew check status messages involving the batteries and their chargers, as well as data about battery temperature and voltage.

FlightAware, an aviation data provider, said the jet reached 36,000 feet. Its speed ranged from 435 to 626 miles per hour.

All 50 of the 787s delivered so far were grounded after a battery on one of the jets caught fire at a Boston airport on Jan. 7 and another made an emergency landing in Japan with smoke coming from the battery.

The new 787s are the most technically advanced commercial airplanes, and Boeing has a lot riding on their success. Half of the planes’ structural parts are made of lightweight carbon composites to save fuel.

Boeing also decided to switch from conventional nickel cadmium batteries to the lighter lithium-ion ones. But they are more volatile, and federal investigators said Thursday that Boeing had underestimated the risks.

The F.A.A. has set strict operating conditions on the test flights. The flights are expected to resume early this week, Mr. Birtel said.

Battery experts have said it could take weeks for Boeing to fix the problems.

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