Recipes for Health: Apple Pear Strudel — Recipes for Health

Andrew Scrivani for The New York Times

This strudel is made with phyllo dough. When I tested it the first time, I found that I had enough filling for two strudels. Rather than cut the amount of filling, I increased the number of strudels to 2, as this is a dessert you can assemble and keep, unbaked, in the freezer.

Filling for 2 strudels:

1/2 pound mixed dried fruit, like raisins, currants, chopped dried figs, chopped dried apricots, dried cranberries

1 1/2 pounds apples (3 large) (I recommend Braeburns), peeled, cored and cut in 1/2-inch dice

1 tablespoon fresh lemon juice

2 tablespoons unsalted butter for cooking the apples

1/4 cup (50 grams) brown sugar

1 teaspoon vanilla

1 teaspoon cinnamon

1/2 teaspoon freshly grated nutmeg

1/4 cup (30 grams) chopped or slivered almonds

3/4 pound (1 large or 2 small) ripe but firm pears, peeled, cored and cut in 1/2-inch dice

For each strudel:

8 sheets phyllo dough

7/8 cup (100 grams) almond powder, divided

1 1/2 ounces butter, melted, for brushing the phyllo

1. Preheat the oven to 375 degrees. Line 2 sheet pans with parchment.

2. Place the dried fruit in a bowl and pour on hot or boiling water to cover. Let sit 5 minutes, and drain. Toss the apples with the lemon juice.

3. Heat a large, heavy frying pan over high heat and add 2 tablespoons butter. Wait until it becomes light brown and carefully add the apples and the sugar. Do not add the apples until the pan and the butter are hot enough, or they won’t sear properly and retain their juice. But be careful when you add them so that the hot butter doesn’t splatter. When the apples are brown on one side, add the vanilla, cinnamon, nutmeg and almonds, flip the apples and continue to sauté until golden brown, about 5 to 7 minutes. Stir in the pears and dried fruit, then scrape out onto one of the lined sheet pans and allow to cool completely. Divide into two equal portions (easiest to do this if you weigh it).

4. Place 8 sheets of phyllo dough on your work surface. Cover with a dish towel and place another, damp dish towel on top of the first towel. Place a sheet of parchment on your work surface horizontally, with the long edge close to you. Lay a sheet of phyllo dough on the parchment. Brush lightly with butter and top with the next sheet. Continue to layer all eight sheets, brushing each one with butter before topping with the next one.

5. Brush the top sheet of phyllo dough with butter. Sprinkle on half of the almond powder (50 grams). With the other half, create a line 3 inches from the base of the dough, leaving a 2 1/2-inch margin on the sides. Top this line with one portion of the fruit mixture. Fold the bottom edge of the phyllo up over the filling, then fold the ends over and roll up like a burrito. Using the parchment paper to help you, lift the strudel and place it on the other parchment-lined baking sheet. Brush with butter and make 3 or 4 slits on the diagonal along the length of the strudel. Repeat with the other sheets of phyllo to make a second strudel. If you are freezing one of them, double-wrap tightly in plastic.

6. Place the strudel in the oven and bake 20 minutes. Remove from the oven, brush again with butter, rotate the pan and return to the oven. Continue to bake for another 20 to 25 minutes, or until golden brown. Remove from the heat and allow to cool for at least 15 minutes. Serve warm or room temperature.

Yield: 2 strudels, each serving 8

Advance preparation: The fruit filling will keep for a couple of days in the refrigerator. The strudel can be baked a few hours before serving it. Recrisp in a medium oven for 10 minutes. It can also be frozen before baking, double-wrapped in plastic. Transfer directly from the freezer to the oven and add 10 minutes to the baking time.

Nutritional information per serving: 259 calories; 13 grams fat; 4 grams saturated fat; 3 grams polyunsaturated fat; 5 grams monounsaturated fat; 15 milligrams cholesterol; 34 grams carbohydrates; 4 grams dietary fiber; 91 milligrams sodium; 4 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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The Shrewd Shopper Carries a Smartphone on Black Friday

Tim Gruber for The New York Times

From left, Tara Niebeling, Sarah Schmidt, Bridget Jewell and Erin Vande Steeg are members of the social media team at the Mall of America in Bloomington, Minn.

Retailers are trying to lure shoppers away from the Internet, where they have increasingly been shopping to avoid Black Friday madness, and back to the stores. The bait is technological tools that will make shopping on the busiest day of the year a little more sane — and give shoppers an edge over their competition.

Those with smartphones in hand will get better planning tools, prices and parking spots. Walmart has a map that shows shoppers exactly where the top Black Friday specials can be found. A Mall of America Twitter feed gives advice on traffic and gifts, and the Macy’s app sends special deals for every five minutes a shopper stays in a store.

“The crazy mad rush to camp out and the crazy mad rush to hit the doorbusters have really made people think, ‘I’m just going to stay home on Black Friday,’ ” said Carey Rossi, editor in chief of ConsumerSearch.com, a review site. “This is going to invite some people back and say, ‘You know what? It doesn’t have to be that crazy.’ ”

Part of the retailers’ strategy is to slap back at online stores like Amazon.com, which last year used apps to pick off shoppers as they browsed in physical stores. But the stores are also recognizing that shopping on the Friday after Thanksgiving need not require an overnight wait in line, a helmet and elbow pads. A smartphone gives shoppers enough of an edge.

“This takes away that frantic Black Friday anxiety,” said Lawrence Fong, co-founder of BuyVia, an app that sends people price alerts and promotions. “While there’s a sport to it, life’s a little too short.”

Denise Fouts, 45, who works repairing fire and water damage in Chandler, Ariz., is already using apps to prepare for Black Friday, including Shopkick, Target’s app and one called Black Friday. “There still are going to be the crowds, but at least I already know ahead of time what I’m going specifically for,” Ms. Fouts said.

Last week, Macy’s released an update to its app with about 300 Black Friday specials and their location. In the Herald Square store, for instance, the $49.99 cashmere sweater specials will be in the Broadway side of the fifth-floor women’s department.

“With the speed that people are shopping with on Black Friday, they need to be really efficient about how they’re spending their time,” said Jennifer Kasper, group vice president for digital media at Macy’s.

When shoppers keep the app open, Macy’s will start sending special deals to the phone every five minutes. The deals are not advertised elsewhere.

Walmart has had an app for several years, but recently introduced an in-store mode, which shows things like the current circular or food tastings when a shopper is near a certain location. Twelve percent of Walmart’s mobile revenue now comes from when a person is inside a store.

For Black Friday, the app will have a map of each store, with the precise location of the top sale items — so planners can determine the best way to run. “The blitz items are not where you think they would be, because for traffic reasons, maybe the hot game console is in the lawn and garden center,” said Gibu Thomas, senior vice president for mobile and digital for Walmart Global eCommerce.

Target is also testing a way-finding feature on its app at stores that include some in Seattle, Chicago and Los Angeles. If a shopper types in an item, the app will give its location.

Other app makers are betting that shoppers want apps that pull in information from a range of stores.

RedLaser, an eBay app, lets shoppers use their phones to compare prices and recently started using location data to give shoppers personalized promotions when they walk into stores, including items not on store shelves at Best Buy, for instance. RetailMeNot, which offers e-commerce coupons, now has offline coupons that will pop up on users’ cellphones when they step near 500 malls on Black Friday.

“Consumers are not going to download 40 different apps for 40 different stores,” said Cyriac Roeding, co-founder of Shopkick, a location-based app that gives shoppers points, redeemable for discounts or gifts, when they walk into stores or scan certain items.

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Israel and Hamas Maintain Cease-Fire, After Push by the U.S. and Egypt

CAIRO — A cease-fire agreed to under intense Egyptian and American pressure between Israel and the Palestinian militant group Hamas to halt eight days of bloody conflict seemed to be holding on Thursday, averting a full-scale Israeli ground invasion of the Gaza Strip without resolving the underlying disputes.

With Israeli forces still massed on the Gaza border, a tentative calm in the fighting descended after the agreement was announced on Wednesday night. Some of the tens of thousands of Israeli reservists called up during the conflagration appeared to be making preparations on Thursday to redeploy away from staging areas along the Gaza border where the Israeli military had mounted a buildup of armor and troops.

The success of the truce will be an early test of how Egypt’s new Islamist government might influence the most intractable conflict in the Middle East.

In southern Israel, the target of more than 1,500 rockets fired from Gaza over the past week, wary residents began to return to routine. But schools within a 25-mile radius of the Palestinian enclave remained closed and thousands of soldiers, mobilized for a possible ground invasion, remained along the Gaza border. The military said that a decision regarding the troop deployment would be made after an assessment of the situation later Thursday.

A rocket alert sounded at the small village of Nativ Haasara near the border with Gaza on Thursday morning, sending residents skeptical from the start about the cease-fire running for shelter. The military said the alert had been a false alarm.

In Gaza, traffic returned to streets that had been deserted, stores and markets opened and workers began the huge task of cleaning up the debris left by days of aerial and naval bombardment. Thousands of Palestinians demonstrated in Gaza in support of the cease-fire as the Hamas leadership emerged from the fighting claiming victory.

Israel Radio said a dozen rockets were fired from Gaza in the first few hours of the cease-fire, but Israeli forces did not respond. In the rival Twitter feeds that offered a cyberspace counterpoint to the exchanges of airstrikes and rockets, the Israel Defense Forces said they had achieved their objectives while the armed Al Qassam Brigades in Gaza said Israeli forces had “raised the white flag.”

After more than a week of nights punctuated by the crash of bombardment and the sound of outgoing missiles, reporters in Gaza said the night had been quiet.

At the same time, Israeli security forces said on Thursday that they detained 55 Palestinian militants in the West Bank after earlier confrontations. The army said the detentions were designed to “continue to maintain order” and to “prevent the infiltration of terrorists into Israeli communities.”

The United States, Israel and Hamas all praised Egypt’s role in brokering the cease-fire as the antagonists pulled back from violence that had killed more than 150 Palestinians and five Israelis over the past week. The deal called for a 24-hour cooling-off period to be followed by talks aimed at resolving at least some of the longstanding grievances between the two sides.

Gazans poured into the streets declaring victory against the far more powerful Israeli military. In Israel, the public reaction was far more subdued. Many residents in the south expressed doubt that the agreement would hold, partly because at least five Palestinian rockets thudded into southern Israel after the cease-fire began.

The one-page memorandum of understanding left the issues that have most inflamed the tensions between the Israelis and the Gazans up for further negotiation. Israel demands long-term border security, including an end to Palestinian missile launching over the border. Hamas wants an end to the Israeli embargo.

The deal demonstrated the pragmatism of Egypt’s new Islamist president, Mohamed Morsi, who balanced public support for Hamas with a determination to preserve the peace with Israel. But it was unclear whether the agreement would be a turning point or merely a lull in the conflict.

The cease-fire deal was reached only through a final American diplomatic push: Secretary of State Hillary Rodham Clinton conferred for hours with Mr. Morsi and the United Nations secretary general, Ban Ki-moon, at the presidential palace here. Hanging over the talks was the Israeli shock at a Tel Aviv bus bombing on Wednesday — praised by Hamas — that recalled past Palestinian uprisings and raised fears of heavy Israeli retaliation. After false hopes the day before, Western and Egyptian diplomats said they had all but given up hope for a quick end to the violence.

David D. Kirkpatrick reported from Cairo, and Jodi Rudoren from Gaza. Reporting was contributed by Fares Akram from Gaza, Isabel Kershner and Ethan Bronner from Jerusalem, Mayy El Sheikh from Cairo, Rick Gladstone from New York, and Alan Cowell from Paris.

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Tech’s New (Geographical) Frontier: ‘Silicon Prairie’

DES MOINES — As Ben Milne feverishly sought money for the mobile-payment company he began developing here in his hometown three years ago, investors responded with rejections by the dozens.

Eventually, he coaxed $1 million from a pair of local investors. His app, Dwolla, has since attracted more than 100,000 users, and now moves $30 million to $50 million worth of transactions a month.

So when he decided to seek a second round of financing last year, Mr. Milne, a 29-year-old college dropout, had an easier sell. This time investors courted him. This year, he announced that Dwolla had drawn another $5 million in capital from investors on both coasts, including Ashton Kutcher and a firm with Twitter and Foursquare in its portfolio.

From here to Omaha to Kansas City — a region known more for its barns than its bandwidth — a start-up tech scene is burgeoning. Dozens of new ventures are laying roots each year, investors are committing hundreds of millions of dollars to them, and state governments are teaming up with private organizations to promote the growing tech community. They are calling it – what else? – the Silicon Prairie.

Although a relatively small share of the country’s angel investment deals – 5.7 percent – are done in the Great Plains, the region was just one of two (the other is the Southwest) that increased its share of them from the first half of 2011 to the first half of this year, according to a report commissioned by the Angel Resource Institute, Silicon Valley Bank and CB Insights. About 15 to 20 start-ups, most of them tech-related, are now established each year in eastern Nebraska, a more than threefold increase from five years ago, according to the Omaha Chamber of Commerce. Today, there is more than $300 million in organized venture capital available in the state, as well as tax credits for investors; six years ago there was virtually none, according to the chamber.

About a dozen start-ups have flocked to a single neighborhood in Kansas City, Kan., alone after Google Fiber installed its first ultrafast Internet connection there last week. And over the past seven months, about 60 start-ups have presented their ideas in Kansas City at weekly forums organized by Nate Olson, an analyst with the Ewing Marion Kauffman Foundation. In Iowa, Startup City Des Moines, an incubator financed with $700,000 in public and private money, including a quarter-million dollars from the state, received applications from 160 start-ups over the past two years. It has accepted nine so far.

“Traditionally, you’d say, ‘Hey, if I want the safe lifestyle, I’ll stay here and I’ll do what generations before have done,’” said Jeff Slobotski, an Omaha native who four years ago started Silicon Prairie News, a Web site covering the region’s tech scene. Now, he continued, “there is a newer potential in terms of what can take place here and not having to hop on the first plane out of here – saying, ‘Hey, I’m going to set up shop in the Midwest in our cities and make a go at it here.'”

Still, the region’s entrepreneurs insist that they are not striving to replicate Silicon Valley or other well-known tech hubs like Boston.

“We’re creating different types of start-ups using local ingredients,” said Christian Renaud, a principal at an information technology start-up incubator here.

Among the companies that have started in the region over the past few years is Ag Local, a firm that created an online marketplace for trading meat; EyeVerify, which uses technology to verify people’s identities through their eyes; and Tikly, which created a platform for bands to sell concert tickets. But there also are many start-ups outside the information technology realm, focusing on fields like biotechnology, advanced manufacturing and medical devices.

Many entrepreneurs credit Silicon Prairie News for the region’s start-up growth. In addition to writing about start-up activity, The News also organizes conventions that connect entrepreneurs and investors. In the four years since its creation, Silicon Prairie News has covered the emergence of more than 80 companies in the region and more than 50 additional endeavors that spawned mobile or Web apps.

The Silicon Prairie still lags in national recognition as a start-up hub, however. Capital remains relatively sparse, and software engineers are in shorter supply than on the coasts.

“We’re just not aware of, potentially, the opportunities that exist in a variety of places in the middle of the country,” said Stephen T. Zarrilli, the president and chief executive of Safeguard Scientifics, a Philadelphia-based venture capital firm that has invested in companies across the country but not in the Great Plains.

Tech enthusiasts in the region are hoping to change that by pointing to other strengths: lower costs and a work force focused more on building strong companies than moving on to the next big thing, they say.

“In Nebraska and the Midwest in general, because the work ethic is so strong, you will find people that will work like they worked on the farm,” said Gordon Whitten, the chairman of VoterTide, an Omaha-based start-up that tracks and analyzes social media trends for campaigns, media companies and others.

Dwolla exemplifies both the potential and the challenges for the region’s start-ups.

Business owners here said that few people in Des Moines seemed familiar with Dwolla, which allows real-time money transfers that are less costly for merchants than credit card fees. Yet the fast-talking, matter-of-fact Mr. Milne, with a penchant for jeans and untucked shirts, has proved to be a savvy ambassador for his company and the region. He always pays with Dwolla when he can.

“How much do I owe you?” he asked a barista at a coffee shop he frequents, before tapping his iPhone and watching his payment register on the shop’s touch screen.

He eagerly rattles off the advantages of building Dwolla here, where his headquarters boast all the trappings of Silicon counterculture: beer-stocked refrigerators, neon orange accent walls with well-used whiteboards tacked to them and a legal counsel who comes to work in flip-flops. One of the biggest boons, he said, was siphoning the expertise of executives in the city’s robust financial services sector. They advised him on structuring the company so it would not have to hold customers’ money, saving millions of dollars in licensing and bonding costs. That structure also led the company to create a unique system for transferring money without the usual days of processing delays.

“I don’t know if we would have found that relationship in the Valley,” Mr. Milne said. “We just hit so many golden-nugget opportunities in Des Moines and golden-nugget pieces of feedback.”

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Ask an Expert: Ask and Expert About Alzheimer’s, Part 3

(Some questions published here have been edited, and not all questions can be answered.)

The doctor’s answers are meant for educational purposes and are not meant to be a substitute for advice from your own doctor. Readers should contact their physician before making health care decisions.

Q. What practical steps can a baby boomer take to stave off dementia of any type? — Canoe9, Hawaii

Q. My dad’s family has a history of Alzheimer’s disease: my grandfather and many of his brothers have either passed away from the disease, or are currently suffering from it. The disease can be traced back for many generations. My father has not yet started to show symptoms. Are there any medications he can take as a preventative measure? What are the best diet and lifestyle choices a person can make who has an increased risk of developing the disease? — VB, Canada

Q. Both of my inlaws have Alzheimer’s. What steps can my husband and his brothers take now to delay/prevent the disease? And should he be monitored at an Alzheimer’s center? — lbs, New Jersey

Q. My mother, two older brothers and two older sisters all had progressive mental dementia (I believe Alzheimer’s ) before age of 65. I am 64 and had extensive mental exam that found no symptoms. For prevention I am doing it as follows. 1. Have become a Vegan with very little use of vegetable oils after reading China Study by Campbell and Starch Solution by McDougall. 2. I use lots of turmeric, ginger, cinnamon in my food. 3. I have run 20 to 30 miles a week for the last 10 years. 4. I retired to reduce work related stress. Is there any other preventive measures you recommend? — Jaque, Champaign, Ill.

Q. My mother had a form or dementia, not sure if it was Alzheimer’s, and she lived to 96. And what can I do to improve my chances? I work out and am not overweight and am in good health otherwise. — Mitchellmcg, New York

A. There are dozens of causes of dementia and steps for prevention are different for each one. We have no proven preventive strategies for Alzheimer’s. The decision to monitor people at risk is made on a case by case basis, but I don’t usually recommend any monitoring until someone is about five years within the age their relative developed it; or they note changes in their memory. My top strategies to keep your brain healthy are listed below.

1. Vascular risks: Minimize your risk for strokes, heart disease and diabetes (keep your body weight, blood pressure, cholesterol and sugar in normal range). Studies find strong links between vascular risks and Alzheimer’s.

2. Exercise regularly: Regular aerobic activities, such as walking, may reduce risk for dementia by keeping the brain’s blood vessels healthy, boosting nerve growth chemicals and slowing age-related brain shrinkage.

3. Stimulate your mind: Socialize actively, make new friends, try new activities, travel to new places and be passionate about learning new things. Adult brains can grow new brain cell connections and developing a greater cognitive reserve might help the buffer against dementia pathology.

4. Heart healthy diet: follow a heart healthy diet such as a Mediterranean diet but heed the old Okinawan saying Hari Hachi Bu – eat only till you are 80 percent full; drink in moderation (but not till you cannot remember what happened the prior night!)

5. Minimize your risk for head injury by wearing helmets. (The Hovding is a new invisible helmet that promises to keeps your hair looking pretty and your head safe!)

6. Take part in clinical trials – pros are that trials may offer regular check-ups and you are helping science; cons are that there are safety risks. Our book, The Alzheimer’s Action Plan gives a step-by-step guide to evaluate which clinical trials are best for you. You might enjoy reading the new book, “Super Brain.” It’s coauthored by the dementia scientist Rudolf Tanzi and the mind-body guru, Deepak Chopra.

Q. I can´t find a Spanish version of “The Alzheimer’s Action Plan.” Will we have it soon? — Marisabel Neuman, Orlando, Fla.

A. Not yet, but we are open to it if you know an interested publisher! But your question does highlight the fact that many Spanish only speakers in the United States and elsewhere are often left out of the mainstream of information on Alzheimer’s. Hispanics in the United States may be at a slightly greater risk for Alzheimer’s due to higher rates of heart disease. Gracias por su interes!

Q. Since my mother developed Alzheimer’s in her mid-80’s, presumably I am at greater risk than the general population, should I live to a similar age. What is your best guess about the likelihood of preventative medications or treatments being developed in the next 25 years? — Beth, Singapore

A. The track record of scientists at predicting a “cure” is not very good (about the same as that of stock analysts predicting the market). The last dozen or so experimental medicines for Alzheimer’s (all touted as the next big thing) have not only failed but results have often been the opposite of what was predicted.

That said, in the next 5-10 years, we will have the results from over 25 trials testing a broad range of strategies such as drugs targeting plaques, drugs targeting tangles, drugs boosting brain memory chemicals, aerobic exercise, different types of diets and medical foods, gene therapy, as well as novel devices to stimulate the brain’s memory centers. (You can check clinicaltrials.org or adcs.org for more information). So the odds are quite good that we will have one or more new treatments by 2025. But even if a cure were in a test tube today, it would take ten years to get to the market. That’s why it’s critical that individuals, such as yourself, sign up for clinical trials.

You may be surprised to learn that one type of “cure” is already available. About 10 years ago, a woman with familial early onset Alzheimer’s successfully conceived a healthy baby free of the harmful APP gene mutation through a technique called preimplantation genetic diagnosis (PGD) at a fertility clinic run by the doctor, Yuri Verlinski. That baby, who would now be 10 years old, has hopefully been cured of familial Alzheimer’s and will in turn be able to have risk free children.

Q. My father, his mother, his mother’s sister, my maternal grandmother and her sister and my maternal aunt all had or have Alzheimer’s - symptomatic onset at 70 and in the early 80’s. I have just turned 60 and think I’d be a great research subject in terms of lifestyle. Can you suggest any research projects that might use me? I understand that some very important studies are being run through Duke. — Kristin Pop’s daughter, Ithaca.

Q. Kristin’s background, age, concerns, and interest in research studies mirror mine - which I have posted. Please inform us of potential studies. I am willing to travel, even to Duke, which she mentioned in her post. —Mary Christian Madden, East Greenwich, RI

A. Thanks for the offer! Most research studies require people to come for multiple visits over several months/years which would be difficult for people living far away. A university affiliated medical center closer to your home might be more ideal. Clinicaltrials.gov has a listing of all ongoing prevention studies. Many such studies are also advertised in pages of local newspapers. The Alzheimer’s Association chapter in your home town may be able to guide you to find a suitable research study in your town. Don’t sign up for a trial just because you have a spare half day. Make sure you thoroughly research the pros and cons. Fewer than 1 percent of drug trials are positive, but 100 percent of all drug trials carry risks. So the odds of you personally benefiting are the same as in a lottery.

Q. Her whole life my mother drank four cups of tea every day, read two to three books a week, ate mostly vegetables, didn’t smoke, drank wine moderately, and stayed slim. She started showing signs of Alzheimers in her mid 50’s and has been steadly declining for 15 years now. Although a bad lifestyle can cause dementia in many people, it is more complicated than that. — Joseph, Fla.

Read More..

Ask an Expert: Ask and Expert About Alzheimer’s, Part 3

(Some questions published here have been edited, and not all questions can be answered.)

The doctor’s answers are meant for educational purposes and are not meant to be a substitute for advice from your own doctor. Readers should contact their physician before making health care decisions.

Q. What practical steps can a baby boomer take to stave off dementia of any type? — Canoe9, Hawaii

Q. My dad’s family has a history of Alzheimer’s disease: my grandfather and many of his brothers have either passed away from the disease, or are currently suffering from it. The disease can be traced back for many generations. My father has not yet started to show symptoms. Are there any medications he can take as a preventative measure? What are the best diet and lifestyle choices a person can make who has an increased risk of developing the disease? — VB, Canada

Q. Both of my inlaws have Alzheimer’s. What steps can my husband and his brothers take now to delay/prevent the disease? And should he be monitored at an Alzheimer’s center? — lbs, New Jersey

Q. My mother, two older brothers and two older sisters all had progressive mental dementia (I believe Alzheimer’s ) before age of 65. I am 64 and had extensive mental exam that found no symptoms. For prevention I am doing it as follows. 1. Have become a Vegan with very little use of vegetable oils after reading China Study by Campbell and Starch Solution by McDougall. 2. I use lots of turmeric, ginger, cinnamon in my food. 3. I have run 20 to 30 miles a week for the last 10 years. 4. I retired to reduce work related stress. Is there any other preventive measures you recommend? — Jaque, Champaign, Ill.

Q. My mother had a form or dementia, not sure if it was Alzheimer’s, and she lived to 96. And what can I do to improve my chances? I work out and am not overweight and am in good health otherwise. — Mitchellmcg, New York

A. There are dozens of causes of dementia and steps for prevention are different for each one. We have no proven preventive strategies for Alzheimer’s. The decision to monitor people at risk is made on a case by case basis, but I don’t usually recommend any monitoring until someone is about five years within the age their relative developed it; or they note changes in their memory. My top strategies to keep your brain healthy are listed below.

1. Vascular risks: Minimize your risk for strokes, heart disease and diabetes (keep your body weight, blood pressure, cholesterol and sugar in normal range). Studies find strong links between vascular risks and Alzheimer’s.

2. Exercise regularly: Regular aerobic activities, such as walking, may reduce risk for dementia by keeping the brain’s blood vessels healthy, boosting nerve growth chemicals and slowing age-related brain shrinkage.

3. Stimulate your mind: Socialize actively, make new friends, try new activities, travel to new places and be passionate about learning new things. Adult brains can grow new brain cell connections and developing a greater cognitive reserve might help the buffer against dementia pathology.

4. Heart healthy diet: follow a heart healthy diet such as a Mediterranean diet but heed the old Okinawan saying Hari Hachi Bu – eat only till you are 80 percent full; drink in moderation (but not till you cannot remember what happened the prior night!)

5. Minimize your risk for head injury by wearing helmets. (The Hovding is a new invisible helmet that promises to keeps your hair looking pretty and your head safe!)

6. Take part in clinical trials – pros are that trials may offer regular check-ups and you are helping science; cons are that there are safety risks. Our book, The Alzheimer’s Action Plan gives a step-by-step guide to evaluate which clinical trials are best for you. You might enjoy reading the new book, “Super Brain.” It’s coauthored by the dementia scientist Rudolf Tanzi and the mind-body guru, Deepak Chopra.

Q. I can´t find a Spanish version of “The Alzheimer’s Action Plan.” Will we have it soon? — Marisabel Neuman, Orlando, Fla.

A. Not yet, but we are open to it if you know an interested publisher! But your question does highlight the fact that many Spanish only speakers in the United States and elsewhere are often left out of the mainstream of information on Alzheimer’s. Hispanics in the United States may be at a slightly greater risk for Alzheimer’s due to higher rates of heart disease. Gracias por su interes!

Q. Since my mother developed Alzheimer’s in her mid-80’s, presumably I am at greater risk than the general population, should I live to a similar age. What is your best guess about the likelihood of preventative medications or treatments being developed in the next 25 years? — Beth, Singapore

A. The track record of scientists at predicting a “cure” is not very good (about the same as that of stock analysts predicting the market). The last dozen or so experimental medicines for Alzheimer’s (all touted as the next big thing) have not only failed but results have often been the opposite of what was predicted.

That said, in the next 5-10 years, we will have the results from over 25 trials testing a broad range of strategies such as drugs targeting plaques, drugs targeting tangles, drugs boosting brain memory chemicals, aerobic exercise, different types of diets and medical foods, gene therapy, as well as novel devices to stimulate the brain’s memory centers. (You can check clinicaltrials.org or adcs.org for more information). So the odds are quite good that we will have one or more new treatments by 2025. But even if a cure were in a test tube today, it would take ten years to get to the market. That’s why it’s critical that individuals, such as yourself, sign up for clinical trials.

You may be surprised to learn that one type of “cure” is already available. About 10 years ago, a woman with familial early onset Alzheimer’s successfully conceived a healthy baby free of the harmful APP gene mutation through a technique called preimplantation genetic diagnosis (PGD) at a fertility clinic run by the doctor, Yuri Verlinski. That baby, who would now be 10 years old, has hopefully been cured of familial Alzheimer’s and will in turn be able to have risk free children.

Q. My father, his mother, his mother’s sister, my maternal grandmother and her sister and my maternal aunt all had or have Alzheimer’s - symptomatic onset at 70 and in the early 80’s. I have just turned 60 and think I’d be a great research subject in terms of lifestyle. Can you suggest any research projects that might use me? I understand that some very important studies are being run through Duke. — Kristin Pop’s daughter, Ithaca.

Q. Kristin’s background, age, concerns, and interest in research studies mirror mine - which I have posted. Please inform us of potential studies. I am willing to travel, even to Duke, which she mentioned in her post. —Mary Christian Madden, East Greenwich, RI

A. Thanks for the offer! Most research studies require people to come for multiple visits over several months/years which would be difficult for people living far away. A university affiliated medical center closer to your home might be more ideal. Clinicaltrials.gov has a listing of all ongoing prevention studies. Many such studies are also advertised in pages of local newspapers. The Alzheimer’s Association chapter in your home town may be able to guide you to find a suitable research study in your town. Don’t sign up for a trial just because you have a spare half day. Make sure you thoroughly research the pros and cons. Fewer than 1 percent of drug trials are positive, but 100 percent of all drug trials carry risks. So the odds of you personally benefiting are the same as in a lottery.

Q. Her whole life my mother drank four cups of tea every day, read two to three books a week, ate mostly vegetables, didn’t smoke, drank wine moderately, and stayed slim. She started showing signs of Alzheimers in her mid 50’s and has been steadly declining for 15 years now. Although a bad lifestyle can cause dementia in many people, it is more complicated than that. — Joseph, Fla.

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Tech’s New (Geographical) Frontier: ‘Silicon Prairie’

DES MOINES — As Ben Milne feverishly sought money for the mobile-payment company he began developing here in his hometown three years ago, investors responded with rejections by the dozens.

Eventually, he coaxed $1 million from a pair of local investors. His app, Dwolla, has since attracted more than 100,000 users, and now moves $30 million to $50 million worth of transactions a month.

So when he decided to seek a second round of financing last year, Mr. Milne, a 29-year-old college dropout, had an easier sell. This time investors courted him. This year, he announced that Dwolla had drawn another $5 million in capital from investors on both coasts, including Ashton Kutcher and a firm with Twitter and Foursquare in its portfolio.

From here to Omaha to Kansas City — a region known more for its barns than its bandwidth — a start-up tech scene is burgeoning. Dozens of new ventures are laying roots each year, investors are committing hundreds of millions of dollars to them, and state governments are teaming up with private organizations to promote the growing tech community. They are calling it – what else? – the Silicon Prairie.

Although a relatively small share of the country’s angel investment deals – 5.7 percent – are done in the Great Plains, the region was just one of two (the other is the Southwest) that increased its share of them from the first half of 2011 to the first half of this year, according to a report commissioned by the Angel Resource Institute, Silicon Valley Bank and CB Insights. About 15 to 20 start-ups, most of them tech-related, are now established each year in eastern Nebraska, a more than threefold increase from five years ago, according to the Omaha Chamber of Commerce. Today, there is more than $300 million in organized venture capital available in the state, as well as tax credits for investors; six years ago there was virtually none, according to the chamber.

About a dozen start-ups have flocked to a single neighborhood in Kansas City, Kan., alone after Google Fiber installed its first ultrafast Internet connection there last week. And over the past seven months, about 60 start-ups have presented their ideas in Kansas City at weekly forums organized by Nate Olson, an analyst with the Ewing Marion Kauffman Foundation. In Iowa, Startup City Des Moines, an incubator financed with $700,000 in public and private money, including a quarter-million dollars from the state, received applications from 160 start-ups over the past two years. It has accepted nine so far.

“Traditionally, you’d say, ‘Hey, if I want the safe lifestyle, I’ll stay here and I’ll do what generations before have done,’” said Jeff Slobotski, an Omaha native who four years ago started Silicon Prairie News, a Web site covering the region’s tech scene. Now, he continued, “there is a newer potential in terms of what can take place here and not having to hop on the first plane out of here – saying, ‘Hey, I’m going to set up shop in the Midwest in our cities and make a go at it here.'”

Still, the region’s entrepreneurs insist that they are not striving to replicate Silicon Valley or other well-known tech hubs like Boston.

“We’re creating different types of start-ups using local ingredients,” said Christian Renaud, a principal at an information technology start-up incubator here.

Among the companies that have started in the region over the past few years is Ag Local, a firm that created an online marketplace for trading meat; EyeVerify, which uses technology to verify people’s identities through their eyes; and Tikly, which created a platform for bands to sell concert tickets. But there also are many start-ups outside the information technology realm, focusing on fields like biotechnology, advanced manufacturing and medical devices.

Many entrepreneurs credit Silicon Prairie News for the region’s start-up growth. In addition to writing about start-up activity, The News also organizes conventions that connect entrepreneurs and investors. In the four years since its creation, Silicon Prairie News has covered the emergence of more than 80 companies in the region and more than 50 additional endeavors that spawned mobile or Web apps.

The Silicon Prairie still lags in national recognition as a start-up hub, however. Capital remains relatively sparse, and software engineers are in shorter supply than on the coasts.

“We’re just not aware of, potentially, the opportunities that exist in a variety of places in the middle of the country,” said Stephen T. Zarrilli, the president and chief executive of Safeguard Scientifics, a Philadelphia-based venture capital firm that has invested in companies across the country but not in the Great Plains.

Tech enthusiasts in the region are hoping to change that by pointing to other strengths: lower costs and a work force focused more on building strong companies than moving on to the next big thing, they say.

“In Nebraska and the Midwest in general, because the work ethic is so strong, you will find people that will work like they worked on the farm,” said Gordon Whitten, the chairman of VoterTide, an Omaha-based start-up that tracks and analyzes social media trends for campaigns, media companies and others.

Dwolla exemplifies both the potential and the challenges for the region’s start-ups.

Business owners here said that few people in Des Moines seemed familiar with Dwolla, which allows real-time money transfers that are less costly for merchants than credit card fees. Yet the fast-talking, matter-of-fact Mr. Milne, with a penchant for jeans and untucked shirts, has proved to be a savvy ambassador for his company and the region. He always pays with Dwolla when he can.

“How much do I owe you?” he asked a barista at a coffee shop he frequents, before tapping his iPhone and watching his payment register on the shop’s touch screen.

He eagerly rattles off the advantages of building Dwolla here, where his headquarters boast all the trappings of Silicon counterculture: beer-stocked refrigerators, neon orange accent walls with well-used whiteboards tacked to them and a legal counsel who comes to work in flip-flops. One of the biggest boons, he said, was siphoning the expertise of executives in the city’s robust financial services sector. They advised him on structuring the company so it would not have to hold customers’ money, saving millions of dollars in licensing and bonding costs. That structure also led the company to create a unique system for transferring money without the usual days of processing delays.

“I don’t know if we would have found that relationship in the Valley,” Mr. Milne said. “We just hit so many golden-nugget opportunities in Des Moines and golden-nugget pieces of feedback.”

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Bus Bombing Complicates Truce Talks, Clinton Delays Departure

CAIRO — American efforts to help negotiate a cease-fire between Israel and Palestinian militants in the week-old Gaza rocket battle faced a new obstacle on Wednesday when the first bus bombing in years traumatized Tel Aviv, raising the prospect of a new Israeli retaliation just as Secretary of State Hillary Rodham Clinton was working to achieve even a brief pause in the fighting.

Mrs. Clinton, who rushed to the Middle East late Tuesday in an intensified diplomatic push, delayed her departure from Cairo on Wednesday because of intensive consultations with Egypt’s President Mohamed Morsi, his aides, and United Nations Secretary General Ban Ki-moon. Mrs. Clinton came to the Egyptian capital after talks with Israeli leaders in Jerusalem and Palestinian leaders in the West Bank.

Mr. Ban, who made an early exit from the talks, told reporters in Cairo that the Tel Aviv bus bombing had been “designed to test the resolve” of the negotiators and “made it all the more urgent to reach a cease-fire.”

Mr. Morsi’s good relationship with the Hamas government in Gaza has emerged as pivotal to the negotiations that were under way at his presidential offices.

The Tel Aviv bus bombing, which happened near Israel’s Defense Ministry building and wounded at least 21 Israelis in an act that at least two Palestinian militant factions took responsibility for, resurrected fears in Israel of past Palestinian uprisings. It followed Israeli airstrikes overnight and into Wednesday on government buildings in Gaza and suspected smuggling tunnels under Gaza’s Rafah border crossing with Egypt, among other targets.

The back-and-forth attacks emphasized the underlying problems in finding any lasting solution to a conflict rooted in deep-seated hostilities and mistrust between Israelis and Palestinians.

Egyptian and American officials in Cairo said negotiations over a cease-fire, which the Egyptian media and Hamas officials had said was on the verge of completion Tuesday, had been hung up on a number of issues, including Hamas’s demands for unfettered access to Gaza via the Rafah crossing and other steps that would ease Israel’s economic and border control over other aspects of life for the more than one million Palestinian residents of Gaza, which Israel vacated in 2005 after 38 years of occupation.

The Hamas Health Ministry in Gaza said the Palestinian death toll after a week of fighting stood at 140 at noon. At least a third of those killed are believed to have been militants. On the Israeli side, five Israelis have been killed, including one soldier.

Around noon on Wednesday in the Gaza Strip, according to the Hamas government media office, a bomb hit the house of Issam Da’alis, an adviser to Ismail Haniya, the Hamas prime minister. The house had been evacuated. Earlier, a predawn airstrike near a mosque in the Jabaliya refugee camp killed a 30-year-old militant, a spokesman said, and F-16 bombs destroyed two houses in the central Gaza Strip.

There were 23 punishing strikes against the southern tunnels that are used to bring weapons as well as construction material, cars and other commercial goods into Gaza from the Sinai Peninsula.

Within Gaza City, Abu Khadra, the largest government office complex, was obliterated overnight. Businesses were also damaged, including two banks and a tourism office, and electricity cables fell on the ground and were covered in dust.

Separately, a bomb dropped from an F-16 created a 20-foot-wide crater in an open area in a stretch of hotels occupied by foreign journalists. Several of the hotels had windows blown out by the strike around 2 a.m., but no one was reported injured. By morning, the hole in the ground had filled with sludgy water, apparently from a burst pipe, appearing almost like a forgotten swimming hole with walls made of sand and cracked cinder block.

Surveying damage near a government complex, Raji Sourani of the Palestinian Center for Human Rights said Gaza civilians were “in the eye of the storm,” and accused Israel of “inflicting pain and terror” on them. Israeli officials accuse Hamas of locating military sites in or close to civilian areas.

Overnight, as the conflict entered its eighth day, the Israeli military said in Twitter posts that “more than 100 terror sites were targeted, of which approximately 50 were underground rocket launchers.” The targets included the Ministry of Internal Security in Gaza, described as “one of Hamas’s main command and control centers.”

David D. Kirkpatrick reported from Cairo and Ethan Bronner from Jerusalem. Reporting was contributed by Jodi Rudoren and Fares Akram from Gaza; Isabel Kershner from Jerusalem; Alan Cowell from London; Andrea Bruce from Rafah; and Christine Hauser and Rick Gladstone from New York.

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DealBook: Hewlett-Packard Takes $8.8 Billion Charge

Hewlett-Packard said on Tuesday that it had taken an $8.8 billion accounting charge, after discovering “serious accounting improprieties” and “outright misrepresentations” at Autonomy, a British software maker that it bought for $10 billion last year.

It is a major setback for H.P., which has been struggling to turn around its operations and remake its business.

The charge essentially wiped out its profit. In the latest quarter, H.P. reported a net loss of $6.9 billion, compared with a $200 million profit in the period a year earlier. The company said the improprieties and misrepresentations took place just before the acquisition, and accounted for the majority of the charges in the quarter, more than $5 billion.

Shares in H.P. plummeted nearly 11 percent in early afternoon trading on Tuesday, to less than $12.

Hewlett-Packard bought Autonomy in the summer of 2011 in an attempt to bolster its presence in the enterprise software market and catch up with rivals like I.B.M. The takeover was the brainchild of Léo Apotheker, H.P.’s chief executive at the time, and was criticized within Silicon Valley as a hugely expensive blunder.

Mr. Apotheker resigned a month later. The management shake-up came about one year after Mark Hurd was forced to step down as the head of H.P. after questions were raised about his relationship with a female contract employee.

“I’m both stunned and disappointed to learn of Autonomy’s alleged accounting improprieties,” Mr. Apotheker said in a statement. “The developments are a shock to the many who believed in the company, myself included. ”

Since then, H.P. has tried to revive the company and to move past the controversies. Last year, Meg Whitman, a former head of eBay, took over as chief executive and began rethinking the product lineup and global marketing strategy.

But the efforts have been slow to take hold.

In the previous fiscal quarter, the company announced that it would take an $8 billion charge related to its 2008 acquisition of Electronic Data Systems, as well as added costs related to layoffs. Then Ms. Whitman told Wall Street analysts in October that revenue and profit would be significantly lower, adding that it would take several years to complete a turnaround.

“We have much more work to do,” Ms. Whitman said at the time.

Hewlett-Packard continues to face weakness in its core businesses. Revenue for the full fiscal year dropped 5 percent, to $120.4 billion, with the personal computer, printing, enterprise and service businesses all losing ground. Earnings dropped 23 percent, to $8 billion, over the same period.

“As we discussed during our securities analyst meeting last month, fiscal 2012 was the first year in a multiyear journey to turn H.P. around,” Ms. Whitman said in a statement. “We’re starting to see progress in key areas, such as new product releases and customer wins.”

The strategic troubles have weighed on the stock. Shares of H.P. have dropped to less than $12 from nearly $30 at their high this year.

The latest developments could present another setback for Ms. Whitman’s efforts.

When the company assessed Autonomy before the acquisitions, the financial results appeared to pass muster. Ms. Whitman said H.P.’s board at the time – which remains the same now, except for the addition of the activist investor Ralph V. Whitworth – relied on Deloitte’s auditing of Autonomy’s financial statements. As part of the due diligence process for the deal, H.P. also hired KPMG to audit Deloitte’s work.

Neither Deloitte nor KPMG caught the accounting discrepancies. Deloitte said in a statement that it could not comment on the matter, citing client confidentiality. “We will cooperate with the relevant authorities with any investigations into these allegations,” the accounting firm said.

Hewlett-Packard said it first began looking into potential accounting problems in the spring, after a senior Autonomy executive came forward. H.P. then hired a third-party forensic accounting firm, PricewaterhouseCoopers, to conduct an investigation covering Autonomy sales between the third quarter 2009 and the second quarter 2011, just before the acquisition.

The company said it discovered several accounting irregularities, which disguised Autonomy’s actual costs and the nature of the its products. Autonomy makes software that finds patterns, data that is used by companies and governments.

H.P. said that Autonomy, in some instances, sold hardware like servers, which has higher associated costs. But the company booked these as software sales. It had the effect of underplaying the company’s expenses and inflating the margins.

“They used low-end hardware sales, but put out that it was a pure software company,” said John Schultz, the general counsel of H.P. Computer hardware typically has a much smaller profit margin than software. “They put this into their growth calculation.”

An H.P. official, who spoke on background because of ongoing inquiries by regulators, said the hardware was sold at a 10 percent loss. The loss was disguised as a marketing expense, and the amount registered as a marketing expense appeared to increase over time, the official said.

H.P. also contends that Autonomy relied on value-added resellers, middlemen who sold software on behalf of the company. Those middlemen reported sales to customers that didn’t actually exist, according to H.P.

H.P. also claims that that Autonomy was taking licensing revenue upfront, before receiving the money. That improper assignment of sales inflated the company’s gross profit margins.pfront, before receiving the money. It had the effect, the company said, of significantly bolstering Autonomy’s gross margin.

Hewlett Packard turned over its findings to Securities and Exchange Commission in the United States and the Serious Fraud Office in Britain with the last week. In a conference call with analysts, Ms. Whitman said the company might consider legal actions against several parties.

The former management team of Autonomy, which includes the company’s founder Mike Lynch, rejected H.P. claims about the accounting issues.

“H.P. has made a series of allegations against some unspecified former members of Autonomy Corporation PLC’s senior management team. The former management team of Autonomy was shocked to see this statement today, and flatly rejects these allegations, which are false,” the group said in a statement. “It took 10 years to build Autonomy’s industry-leading technology and it is sad to see how it has been mismanaged since its acquisition by H.P.”

While Mr. Schultz would not detail H.P.’s future legal strategy, he said “we intend to be aggressive in recovering value for our shareholders.” In addition to Mr. Lynch, the company indicated this could include other individuals, including perhaps former senior executives of H.P. who missed the bad accounting. “We’re not limiting it to Autonomy,” Mr. Shulz said.

H.P. also underscored the importance of Autonomy to the broader strategy, emphasized the quality of the products. “This is a very healthy company with good products that exist,” said Mr. Shultz. “At its core, these are very good products.”

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Responding to Illnesses Manifesting Amid Recovery From Storm

Nicole Bengiveno/The New York Times

Dr. Aaron Gardener, center, attended to a patient at an ad hoc medical unit in Long Beach, N.Y. Many people have coughs, rashes and other ailments.

Day and night, victims of Hurricane Sandy have been streaming into ad hoc emergency rooms and relief centers, like the MASH-type medical unit on an athletic field in Long Beach, and the warming tent in the Rockaways the size of a small high school gym.

They complain of rashes, asthma and coughing. They need tetanus shots because — house-proud and armed with survivalist instincts — they have been ripping out waterlogged boards and getting poked by rusty nails. Those with back pain from sifting through debris receive muscle relaxants; those with chest pain from overexertion are hooked up to cardiac monitors.

“I’ve been coughing,” said Gabriel McAuley, 46, who has been working 16-hour days gutting homes and hauling debris in the Rockaways since the storm hit. “I’ve never felt a cough like that before. It’s deeper down.”

It is impossible to say how many people have been sickened by what Hurricane Sandy left behind: mold from damp drywall; spills from oil tanks; sewage from floodwater and unflushable toilets; tons upon tons of debris and dust. But interviews with hurricane victims, recovery workers, health officials and medical experts over the last week reveal that some of the illnesses that they feared would occur, based on the toxic substances unleashed by the storm and the experience of other disasters, notably Hurricane Katrina, have begun to manifest themselves.

Emergency rooms and poison control centers have reported cases of carbon monoxide exposure — and in New Jersey, several deaths have been attributed to it — from the misuse of generators to provide power and stoves to provide heat.

In Livingston, N.J., the Burn Center at St. Barnabas Medical Center had 16 burn cases over about six days, three times as many as usual, from people trying to dispel the cold and darkness with boiling water, gasoline, candles and lighter fluid.

Raw sewage spilled into homes in Baldwin and East Rockaway, in Nassau County, when a sewage plant shut down because of the surge and the system could not handle the backup. Sewage also spilled from a huge plant in Newark. “We tried to limit our presence in the house because the stink was horrible,” said Jennifer Ayres, 34, of Baldwin, who has been staying temporarily in West Hempstead. She said that she felt ill for several days, that her son had a scratchy throat, and that her mother, who lives in the house, had difficulty breathing, all problems she attributed to the two days they spent inside their house cleaning up last week. “I had stomach problems. I felt itchy beyond itchy on my face.”

Coughing — locally known as the Rockaway cough — is a common symptom that health officials said could come from mold, or from the haze of dust and sand kicked up by the storm and demolitions. The air in the Rockaways is so full of particles that the traffic police wear masks — though many recovery workers do not, worrying people who recall the fallout of another disaster.

“It’s just like 9/11,” said Kathy Smilardi, sitting inside the skeleton of her gutted home in Broad Channel, wrapped in a white puffy jacket, her breath visible in the afternoon cold. “Everyone runs in to clean up, and they’re not wearing masks. Are we going to wait 20 years to figure out that people are dying?”

Health officials and experts say the risks are real, but are cautioning against hysteria. Some coughing could be due to cold, damp weather. Lasting health effects from mold, dust and other environmental hazards generally require long-term, continuous exposure, they said. And the short-term effects can be mitigated by taking precautions like wearing masks, gloves and boots and removing mold-infested wallboard. “The reality is that cleaning up both muck and sewage and spills and removing walls and reconstruction and dealing with debris all do in fact pose concerns,” Daniel Kass, New York City’s deputy commissioner for environmental health, said Friday. “Are they vast or uncontrollable? No. But they depend on people doing work correctly and taking basic precautions.”

The Katrina cough was found to be temporary, said Roy J. Rando, a professor at Tulane’s School of Public Health and Tropical Medicine. Felicia Rabito, an epidemiologist at the school, said that healthy children exposed to mold after Hurricane Katrina showed no lasting respiratory symptoms when they moved back to new or renovated homes.

Immediately after Hurricane Katrina, lead levels in New Orleans’s soil dropped after the top layers of dirt, where lead from paint and gasoline can accumulate, were washed away. But in the two years afterward, soil testing found extremely high lead levels, Dr. Rabito said, which she theorized came from renovating old homes. “That’s a cautionary tale,” she said. Lead in soil can be tracked into homes and pose a health hazard to children playing inside or outside.

Though at least one outbreak of norovirus, a contagious gastrointestinal virus, occurred in a Brooklyn high school that was used as a shelter, New York and New Jersey health officials said they had not seen any significant spike in respiratory or gastrointestinal diseases related to the storm.

In Broad Channel, most homes on Noel Road, where Ms. Smilardi lives, have outdoor oil tanks that were overturned by the storm. The innards of many homes, built when asbestos was used, lie spilled among major and minor roads.

Ominous red spots covered both sides of Paul Nowinski’s burly torso. After the storm, Mr. Nowinski, a musician, waded into the basement of his childhood home on Beach 146th Street in the Rockaways to try to salvage records, books and instruments. He was up to his chest in water, which he thinks might have been contaminated with sewage. He said that he did not know the cause of the red marks; and that he had been too busy “schlepping” to go to the doctor.

Angela Macropoulos contributed reporting.

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