F.D.A. Approves Sirturo, a New Tuberculosis Drug

The Food and Drug Administration announced on Monday that it had approved a new treatment for multidrug-resistant tuberculosis that can be used as an alternative when other drugs fail.

The drug, to be called Sirturo, was discovered by scientists at Janssen, the pharmaceuticals unit of Johnson & Johnson, and is the first in a new class of drugs that aims to treat the drug-resistant strain of the disease.

Tuberculosis is a highly infectious disease that is transmitted through the air and usually affects the lungs but can also affect other parts of the body, including the brain and kidneys. It is considered one of the world’s most serious public health threats. Although rare in the United States, multidrug-resistant tuberculosis is a growing problem elsewhere in the world, especially in poorer countries. About 12 million people worldwide had tuberculosis in 2011, according to Johnson & Johnson, and about 630,000 had multidrug-resistant TB.

A study in September in The Lancet found that almost 44 percent of patients with tuberculosis in countries like Russia, Peru and Thailand showed resistance to at least one second-line drug, or a medicine used after another drug had already failed.

Treating drug-resistant tuberculosis can take years and can cost 200 times as much as treating the ordinary form of the disease

“This is quite a milestone in the story of therapy for TB,” Dr. Paul Stoffels, the chief scientific officer at Johnson & Johnson, said in an interview. He said the approval was the first time in 40 years that the agency had approved a drug that attacked tuberculosis in a different way from the current treatments on the market. Sirturo works by inhibiting an enzyme needed by the tuberculosis bacteria to replicate and spread throughout the body.

Sirturo, also known as bedaquiline, would be used on top of the standard treatment, which is a combination of several drugs. Patients with drug-resistant tuberculosis often must be treated for 18 to 24 months.

Even as it announced the approval, however, the F.D.A. also issued some words of caution.

“Multidrug-resistant tuberculosis poses a serious health threat throughout the world, and Sirturo provides much-needed treatment for patients who have don’t have other therapeutic options available,” Edward Cox, director of the office of antimicrobial products in the F.D.A.’s center for drug evaluation and research, said in a statement. “However, because the drug also carries some significant risks, doctors should make sure they use it appropriately and only in patients who don’t have other treatment options.”

The consumer advocacy group Public Citizen opposed approval in a letter to the F.D.A. in mid-December, saying that the results of a limited clinical trial showed that patients using bedaquiline were five times as likely to die than those on the standard drug regimen to treat the disease.

“Given that bedaquiline belongs to an entirely new class of drugs, it is entirely feasible that death in some cases was due to some unmeasured toxicity of the drug,” the letter said.

Sirturo carries a so-called black box warning for patients and health care professionals that the drug can affect the heart’s electrical activity, which could lead to an abnormal and potentially fatal heart rhythm. The warning also notes deaths in patients treated with Sirturo. Nine patients who received Sirturo died compared with two patients who received a placebo. Five of the deaths in the Sirturo group and all of the deaths in the placebo arm seemed to be related to tuberculosis, but no consistent reason for the deaths in the remaining Sirturo-treated patients could be identified.

Doctors Without Borders and the Bill and Melinda Gates Foundation, both active in the fight against tuberculosis and other global diseases, applauded the F.D.A.’s decision.

Jan Gheuens, interim director of the TB Program for the Gates Foundation, called it a “long-awaited event” and said the fight against TB had not benefited from new drugs in the way H.I.V. had. Beyond the benefits of the drug itself, he said the quick approval process could be a model for other drugs sorely needed in the developing world.

He also suggested, however, that more trials should be conducted to get a better understanding of the side effects that led to the black box warning.

The F.D.A. approved bedaquiline under an accelerated program that allows the agency to conditionally approve drugs that are viewed as filling unmet medical needs with less than the usual evidence that they work. The drug’s approval was based on studies that showed it killed bacteria more quickly than a control group taking the standard regimen, but it did not measure whether in the end patients actually fared better on bedaquiline. Johnson & Johnson will conduct larger clinical trials to investigate whether the drug performs as predicted.

In a statement responding to Public Citizen’s letter, a spokeswoman for Johnson & Johnson said the company was committed to supporting appropriate use of Sirturo and would “work to ensure Sirturo is used only where treatment alternatives are not available.”

Dr. Stoffels said the hope was that other new tuberculosis drugs would also be approved that, when used in combination with bedaquiline, could shorten and simplify the current standard of treatment. “That is still a long time away,” he acknowledged, but “this is a first step in a new regimen for TB.”

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Times Reporter in China Is Forced to Leave Over Visa Issue

BEIJING — A correspondent for The New York Times was forced to leave mainland China on Monday after the authorities declined to issue him a visa for 2013 by year’s end.

Chris Buckley, a 45-year-old Australian who has worked as a correspondent in China since 2000, rejoined The Times in September after working for Reuters. The Times applied for Mr. Buckley to be accredited to replace a correspondent who was reassigned, but the authorities did not act before Dec. 31, despite numerous requests. That forced Mr. Buckley, his partner and their daughter to fly to Hong Kong on Monday.

Normally, requests to transfer visas are processed in a matter of weeks or a couple of months.

The Times is also waiting for its new Beijing bureau chief, Philip P. Pan, to be accredited. Mr. Pan applied in March, but his visa has not been processed.

The visa troubles come amid government pressure on the foreign news media over investigations into the finances of senior Chinese leaders, a delicate subject. Corruption is widely reported in China, but top leaders are considered off limits.

On the day that The Times published a long investigation into the riches of the family of Prime Minister Wen Jiabao, both its English-language Web site and its new Chinese-language site were blocked within China, and they remain so.

In June, the authorities blocked the English-language site of Bloomberg News after it published a detailed investigation into the family riches of China’s new top leader, Xi Jinping. Chinese financial institutions say they have been instructed by officials not to buy Bloomberg’s computer terminals, a lucrative source of income for the company.

The Ministry of Foreign Affairs declined to comment on Mr. Buckley’s forced departure. Ministry officials have not said if they are linking Mr. Buckley’s visa renewal or Mr. Pan’s press accreditation to the newspaper’s coverage of China. In a statement, The Times urged the authorities to process Mr. Buckley’s visa as quickly as possible so that he and his family could return to Beijing.

“I hope the Chinese authorities will issue him a new visa as soon as possible and allow Chris and his family to return to Beijing,” Jill Abramson, the executive editor of The Times, said in the statement. “I also hope that Phil Pan, whose application for journalist credentials has been pending for months, will also be issued a visa to serve as our bureau chief in Beijing.”

The Times has six other accredited correspondents in China, and their visas were renewed for 2013 in a timely manner. David Barboza, the Shanghai bureau chief, who wrote the articles about Mr. Wen’s family, was among those whose visas were renewed.

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Mexico City Journal: Mobile Factory With Hope for a Better Life – Mexico City Journal

MEXICO CITY — The sound of a surprising opportunity rose above the tumult of traffic. “Factory for electronic textiles offering work,” came the message, shouted from a megaphone that sat in the basket of a white bicycle pedaled by Amor Muñoz, an artist in a black jumpsuit. “One hundred pesos an hour!”

Even on the streets of this busy capital, where sales pitches flow from speakers attached to anything with wheels, the offer stood out. Work? For about $7.50 an hour, a little above the American minimum wage?

The rush was on. By the time Ms. Muñoz parked in her usual spot outside a hospital in one of Mexico City’s peripheral neighborhoods, a line had already formed. Women of all ages squeezed together — one held a baby, another was nearly too old to walk — as Ms. Muñoz opened up a white wooden box revealing thread, needles, cloth, timecards and employment contracts. The work involved creating interactive art pieces that combine the old craft of sewing with 20th-century electronics and 21st-century tags allowing smartphone users to look up who worked on a given piece.

“It’s about community,” Ms. Muñoz said. “I’m interested in sharing the experience of art.”

If that were her only interest, it would be enough to make alpha geeks swoon; a local glossy magazine and the technology Web site Ars Technica recently honored Ms. Muñoz with their annual awards. But behind her vintage glasses and dimpled smile, Ms. Muñoz has a sharper message.

Her maquiladora, or factory, she said, is a “fantasy” meant to condemn the harsh reality of a global economy that uses and discards poor workers, especially women, to keep prices low.

In Mexico these days the project amounts to artistic subversion. At a time when the country’s new president, Enrique Peña Nieto, is trying to recast Mexico as an economic marvel, with growth rates surpassing Brazil, Ms. Muñoz’s factory is a countervailing force — a mobile reality check highlighting Mexico’s darker economic truths.

Take wages. The minimum wage in Mexico is about 60 cents an hour, and while the average pay in manufacturing has grown over the past decade, it is still only about $3.50 an hour, according to government statistics. Even according to higher estimates by the Bureau of Labor Statistics in Washington, Mexico’s hourly compensation costs are still only two-thirds of those found in Brazil, where the benefits of economic growth have helped a larger share of workers rise from poverty.

Economists recognize the problem. “We need to increase wages to become a true modern country,” said Luis de la Calle, a former Mexican government official who helped negotiate the North American Free Trade Agreement. But as Mexico tries to improve its image and gloss over its violent drug war, government officials have mostly described Mexico’s low wages in positive terms, as a way to compete with China. The market, it is generally assumed, will eventually drive up wages.

Ms. Muñoz is unwilling to wait. She described Mexican wages as an insult to human dignity, and every time her mobile factory appears, the power of work for reasonable pay goes on display. The crowds that gather are typically large. Sometimes people push and shove for two hours of work and $15, though once the day’s employees are selected (first come first hired), a calm tends to follow.

Earlier this month, the team included nearly a dozen women and one young man, all that Ms. Muñoz could afford. Many, like Sara Peregrino, 50, were homemakers with sewing experience. Others, like David Quiróz, 18, a taxi dispatcher, struggled to thread a needle without drawing blood.

Nearly everyone said the money they earned would go to one of two things — food or Christmas presents. “For women, it’s very hard to find a good job,” said Patricia Zamora, 33, a mother of two who arrived with Ms. Peregrino, one of her neighbors. “There is a lot of work for not much pay.”

Many of the women seemed to appreciate a chance to be involved in an art project. María González, 75, smiled widely when handed a needle and adjusted her purple scarf, excited to be creating something rather than worrying about her husband in the hospital. “This,” she said, sewing without looking down, “is a wonderful distraction.”

Ms. Muñoz seemed to agree. She stood nearby, waiting for her favorite time of day — when she paid the workers and took their photographs, which she would post online, linked to the artwork. It is an effort to make the workers more visible, she said, but also hints at her working-class past.

She grew up playing among the hammers and nails of the hardware store her parents owned in a marginal neighborhood like the one with her factory. She said she always appreciated manual labor and never felt comfortable in an office, even after receiving a law degree.

Textiles had once been a hobby — she used to collect huipiles, the traditional woven tunics of Mexico and Central America — but when she decided to become an artist in 2006, she returned to cloth and sewing. Her work now involves a mixture of textiles and technology. Many of her pieces involve sewn images with circuits that let users push buttons for sounds or displays of light.

Completed works from the mobile maquiladora project, for example, will create the whine of an ambulance siren.

Like many other young artists in the capital, she is trying to push Mexico forward by combining older traditions with the interactivity of social media and open-source software development. She dreams of finding financing for more mobile factories, and her lack of faith in government and industry is matched only by the optimism she expresses when discussing the power of networked youth.

“With technology, everything can be democratized,” she said. “It’s fabulous.”

Still, the human interactions are what she values most, so when Ms. Peregrino suddenly appeared and presented her with a pink plastic bag after being paid, Ms. Muñoz was visibly touched. The two women hugged as Ms. Muñoz put the gift in into the bicycle basket with the megaphone. Only later did she look inside, finding a hand-sewn purple scarf that must have taken days to complete.

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Questcor Finds Profit for Acthar Drug, at $28,000 a Vial

Kevin Moloney for The New York Times

Christina Culver with her son Tyler, 6, at home in Colorado Springs this month. In 2007, Tyler was hospitalized when the price of Acthar soared.

THE doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.

The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.

“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.

How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers.

At least until recently, that is. Now some doctors, insurance companies and investors are beginning to have doubts about whether the drug is really any better than much cheaper alternatives. Short-sellers have written scathing criticisms of the company, questioning its marketing tactics and predicting that its shareholders are highly vulnerable.

 That Acthar is even a potential blockbuster is a remarkable turn of events, considering that the drug was developed in the 1950s by a division of Armour & Company, the meatpacking company that once ruled the Union Stock Yards of Chicago. As in the 1950s, Acthar is still extracted from the pituitary glands of slaughtered pigs — essentially a byproduct of the meatpacking industry.

The most important use of Acthar has been to treat infantile spasms, also known as West syndrome, a rare, sometimes fatal epileptic disorder that generally strikes before the age of 1.

For several years, Questcor, which is based in Anaheim, lost money on Acthar because the drug’s market was so small. In 2007, it raised the price overnight, to more than $23,000 a vial, from $1,650, bringing the cost of a typical course of treatment for infantile spasms to above $100,000. It said it needed the high price to keep the drug on the market.

“We have this drug at a very high price right now because, really, our principal market is infantile spasms,” Don M. Bailey, Questcor’s chief executive, told analysts in 2009. “And we only have about 800 patients a year. It’s a very, very small — tiny — market.”

Companies often charge stratospheric prices for drugs for rare diseases — known as orphan drugs — and Acthar’s price is not as high as some. Society generally tolerates those costs to encourage drug companies to develop crucial, possibly lifesaving drugs for these often neglected diseases.

But Questcor did almost no research or development to bring Acthar to market, merely buying the rights to the drug from its previous owner for $100,000 in 2001. And while the manufacturing of Acthar is complex, it accounts for only about 1 cent of every dollar that Questcor charges for the drug.

Moreover, the tiny “orphan” market soon became much bigger. Before long, Questcor began marketing the drug for multiple sclerosis, nephrotic syndrome and rheumatologic conditions, even though there is little evidence that Acthar is more effective for those other conditions than alternatives that are far cheaper. And the company did so without being required to prove that the drug actually works. That is because Acthar was approved for use in 1952, before the Food and Drug Administration required clinical trials to show a drug is effective for a particular disease. Acthar is essentially grandfathered in.

Today, only about 10 percent of the drug’s sales are for infantile spasms. The new uses, Mr. Bailey has told analysts, represent multibillion-dollar opportunities for Acthar and Questcor, its sole maker.

The results have been beyond even the company’s wildest dreams. Sales of Acthar, which accounts for essentially all of Questcor’s sales, totaled nearly $350 million in the first nine months this year, up 145 percent from the period a year earlier. In the same period, Questcor’s earnings per share nearly tripled, to $2.12. In the five years after the big Acthar price increase in August 2007, Questcor shares rose from around 60 cents to about $50, in one of the best performances of any stock in any industry.

But in September, the shares plummeted after Aetna, the big insurer, said it would no longer pay for Acthar, except to treat infantile spasms, because of lack of evidence the drug worked for other diseases. The stock now trades at $26.93.

Peter Wickersham, senior vice president for cost of care at Prime Therapeutics, a pharmacy benefits manager that has found the drug is possibly being overused, says the huge increase in Acthar’s price for patients “just invites the type of scrutiny that it’s received.”

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Dr. Rita Levi-Montalcini, a Revolutionary in the Study of the Brain, Dies at 103

Fabio Campana/European Pressphoto Agency

Rita Levi-Montalcini, the Italian Nobel laureate, in 2007.

Dr. Rita Levi-Montalcini, a Nobel Prize-winning neurologist who discovered critical chemical tools that the body uses to direct cell growth and build nerve networks, opening the way for the study of how those processes can go wrong in diseases like dementia and cancer, died on Sunday at her home in Rome. She was 103.

Her death was announced by Mayor Gianni Alemanno of Rome.

“I don’t use these words easily, but her work revolutionized the study of neural development, from how we think about it to how we intervene,” said Dr. Gerald D. Fishbach, a neuroscientist and professor emeritus at Columbia.

Scientists had virtually no idea how embryo cells built a latticework of intricate connections to other cells when Dr. Levi-Montalcini began studying chicken embryos in the bedroom of her house in Turin, Italy, during World War II. After years of obsessive study, much of it at Washington University in St. Louis with Dr. Viktor Hamburger, she found a protein that, when released by cells, attracted nerve growth from nearby developing cells.

In the early 1950s, she and Dr. Stanley Cohen, a biochemist also at Washington University, isolated and described the chemical, known as nerve growth factor — and in the process altered the study of cell growth and development. Scientists soon realized that the protein gave them a new way to study and understand disorders of neural growth, like cancer, or of degeneration, like Alzheimer’s disease, and to potentially develop therapies.

In the years after the discovery, Dr. Levi-Montalcini, Dr. Cohen and others described a large family of such growth-promoting agents, each of which worked to regulate the growth of specific cells. One, called epidermal growth factor and discovered by Dr. Cohen, plays a central role in breast cancer; in part by studying its behavior, scientists developed drugs to combat the abnormal growth.

In 1986, Dr. Levi-Montalcini and Dr. Cohen shared the Nobel Prize in Physiology or Medicine for their work.

Dr. Cohen, now an emeritus professor at Vanderbilt University, said Dr. Levi-Montalcini possessed a rare combination of intuition and passion, as well as biological knowledge. “She had this feeling for what was happening biologically,” he said. “She was an intuitive observer, and she saw that something was making these nerve connections grow and was determined to find out what it was.”

One of four children, Rita Levi-Montalcini was born in Turin on April 22, 1909, to Adamo Levi, an engineer, and Adele Montalcini, a painter, both Italian Jews who traced their roots to the Roman Empire. In keeping with the Victorian customs of the time, Mr. Levi discouraged his three daughters from entering college, fearing that it would interfere with their lives as wives and mothers.

It was not a future that Rita wanted. She had decided to become a doctor and told her father so. “He listened, looking at me with that serious and penetrating gaze of his that caused me such trepidation,” she wrote in her autobiography, “In Praise of Imperfection” (1988). He also agreed to support her.

She graduated summa cum laude from the University of Turin medical school in 1936. Two years later, Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. She began her research anyway, setting up a small laboratory in her home to study chick embryos, inspired by the work of Dr. Hamburger, a prominent researcher in St. Louis who also worked with the embryos.

During World War II, the family fled Turin for the countryside, and in 1943 the invasion by Germany forced them to Florence. The family returned at the close of the war, in 1945, and Dr. Hamburger soon invited Dr. Levi-Montalcini to work for a year in his lab at Washington University.

She stayed on, becoming an associate professor in 1956 and a full professor in 1958. In 1962, she helped establish the Institute of Cell Biology in Rome and became its first director. She retired from Washington University in 1977, becoming a guest professor and splitting her time between Rome and St. Louis.

Italy honored her in 2001 by making her a senator for life.

An elegant presence, confident and passionate, she was a sought-after speaker until late in life. “At 100, I have a mind that is superior — thanks to experience — than when I was 20,” she said in 2009.

She never married and had no children. In addition to her autobiography, she was the author or co-author of dozens of research studies and received numerous professional awards, including the National Medal of Science.

“It is imperfection — not perfection — that is the end result of the program written into that formidably complex engine that is the human brain,” Dr. Levi-Montalcini wrote in her autobiography, “and of the influences exerted upon us by the environment and whoever takes care of us during the long years of our physical, psychological and intellectual development.”

This article has been revised to reflect the following correction:

Correction: December 30, 2012

An earlier version of this obituary misstated the year Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. It was 1938, not 1936.

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Dr. Rita Levi-Montalcini, a Revolutionary in the Study of the Brain, Dies at 103

Fabio Campana/European Pressphoto Agency

Rita Levi-Montalcini, the Italian Nobel laureate, in 2007.

Dr. Rita Levi-Montalcini, a Nobel Prize-winning neurologist who discovered critical chemical tools that the body uses to direct cell growth and build nerve networks, opening the way for the study of how those processes can go wrong in diseases like dementia and cancer, died on Sunday at her home in Rome. She was 103.

Her death was announced by Mayor Gianni Alemanno of Rome.

“I don’t use these words easily, but her work revolutionized the study of neural development, from how we think about it to how we intervene,” said Dr. Gerald D. Fishbach, a neuroscientist and professor emeritus at Columbia.

Scientists had virtually no idea how embryo cells built a latticework of intricate connections to other cells when Dr. Levi-Montalcini began studying chicken embryos in the bedroom of her house in Turin, Italy, during World War II. After years of obsessive study, much of it at Washington University in St. Louis with Dr. Viktor Hamburger, she found a protein that, when released by cells, attracted nerve growth from nearby developing cells.

In the early 1950s, she and Dr. Stanley Cohen, a biochemist also at Washington University, isolated and described the chemical, known as nerve growth factor — and in the process altered the study of cell growth and development. Scientists soon realized that the protein gave them a new way to study and understand disorders of neural growth, like cancer, or of degeneration, like Alzheimer’s disease, and to potentially develop therapies.

In the years after the discovery, Dr. Levi-Montalcini, Dr. Cohen and others described a large family of such growth-promoting agents, each of which worked to regulate the growth of specific cells. One, called epidermal growth factor and discovered by Dr. Cohen, plays a central role in breast cancer; in part by studying its behavior, scientists developed drugs to combat the abnormal growth.

In 1986, Dr. Levi-Montalcini and Dr. Cohen shared the Nobel Prize in Physiology or Medicine for their work.

Dr. Cohen, now an emeritus professor at Vanderbilt University, said Dr. Levi-Montalcini possessed a rare combination of intuition and passion, as well as biological knowledge. “She had this feeling for what was happening biologically,” he said. “She was an intuitive observer, and she saw that something was making these nerve connections grow and was determined to find out what it was.”

One of four children, Rita Levi-Montalcini was born in Turin on April 22, 1909, to Adamo Levi, an engineer, and Adele Montalcini, a painter, both Italian Jews who traced their roots to the Roman Empire. In keeping with the Victorian customs of the time, Mr. Levi discouraged his three daughters from entering college, fearing that it would interfere with their lives as wives and mothers.

It was not a future that Rita wanted. She had decided to become a doctor and told her father so. “He listened, looking at me with that serious and penetrating gaze of his that caused me such trepidation,” she wrote in her autobiography, “In Praise of Imperfection” (1988). He also agreed to support her.

She graduated summa cum laude from the University of Turin medical school in 1936. Two years later, Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. She began her research anyway, setting up a small laboratory in her home to study chick embryos, inspired by the work of Dr. Hamburger, a prominent researcher in St. Louis who also worked with the embryos.

During World War II, the family fled Turin for the countryside, and in 1943 the invasion by Germany forced them to Florence. The family returned at the close of the war, in 1945, and Dr. Hamburger soon invited Dr. Levi-Montalcini to work for a year in his lab at Washington University.

She stayed on, becoming an associate professor in 1956 and a full professor in 1958. In 1962, she helped establish the Institute of Cell Biology in Rome and became its first director. She retired from Washington University in 1977, becoming a guest professor and splitting her time between Rome and St. Louis.

Italy honored her in 2001 by making her a senator for life.

An elegant presence, confident and passionate, she was a sought-after speaker until late in life. “At 100, I have a mind that is superior — thanks to experience — than when I was 20,” she said in 2009.

She never married and had no children. In addition to her autobiography, she was the author or co-author of dozens of research studies and received numerous professional awards, including the National Medal of Science.

“It is imperfection — not perfection — that is the end result of the program written into that formidably complex engine that is the human brain,” Dr. Levi-Montalcini wrote in her autobiography, “and of the influences exerted upon us by the environment and whoever takes care of us during the long years of our physical, psychological and intellectual development.”

This article has been revised to reflect the following correction:

Correction: December 30, 2012

An earlier version of this obituary misstated the year Mussolini issued a manifesto barring non-Aryan Italians from having professional careers. It was 1938, not 1936.

Read More..

Day Laborers at Premium on Storm-Wrecked Coast

Ozier Muhammad/The New York Times

Reina Vega and Victoriano de la Cruz worked in the cellar of a home in Bay Ridge, Brooklyn.

The day after the storm, Manuel Sinchi, like some other New Yorkers, gathered a few friends, hopped on his bicycle and headed down to badly stricken Coney Island to volunteer his services.

The next day, however, he started offering his services at his usual rate of $15 an hour.

A day laborer for whom making a living in recent years has meant often pointless idling on street corners for increasingly hard-to-get construction work, Mr. Sinchi said that owners of houses ravaged by Hurricane Sandy were now searching him out seven days a week. In the first weeks after the storm, he performed work that required muscle and a strong back, hauling waterlogged sofas and broken refrigerators out of flooded basements, stripping mold-infested walls and sweeping away mounds of sand from front yards. But, as homeowners turned to rebuilding, he has performed more skilled jobs, installing new wallboard, wood floors and bathroom tiles.

There has been so much demand that he was able to buy his two sons in Ecuador a computer, bicycles and new shoes.

“While we have lots of sorrow for those who lost everything, at the same time Sandy has done us a favor by creating jobs that were not there,” Mr. Sinchi said, speaking in Spanish.

His tale of finding fortune along the streets of ruined homes and upended lives is similar to those of hundreds of day laborers in New York City and its coastal suburbs. For a population accustomed to scraping by, Hurricane Sandy has been a boon, conjuring up demolition and construction work that has been mostly absent since the housing market’s collapse and providing a spike in remittances to families in Mexico, Central America and South America.

These mostly Hispanic workers, some of whom are in the country illegally, have suddenly become a ubiquitous and indispensable presence in seaside communities in New York and New Jersey, where residents who might once have spurned hiring them are racing to make their homes livable again as soon as possible. Despite the influx of volunteers — sometimes regarded as competitors by the day laborers — there is so much demand for their services that even women who have typically made a living as domestics are gathering on street corners and in front of hardware stores to help with the grueling work.

“Day laborers are like first responders to this crisis,” said Ligia M. Guallpa, director of the Workers Justice Project, which operates a shack alongside a shopping plaza in Bensonhurst, Brooklyn, where day laborers gather and contractors and homeowners come to hire them. Before the storm, fewer than 15 workers a week were sent out on jobs. Now that number has grown to 45.

In the first week after the storm hit, homeowners were desperate for help getting their lives back to something approaching normal. Some day laborers like Carmelo Hernandez, 46, a Mexican immigrant and tile installer, even bought headlamps so they could work at night, so great was the demand.

More recently, some workers said that jobs had slowed as cleaning up shifted to rebuilding, which had prompted homeowners to turn to licensed professionals for skilled tasks like plumbing, carpentry and electrical work. But other laborers said they expected the volume of work to pick up when homeowners received money from their insurance companies or from the Federal Emergency Management Agency.

Standing on a corner of 69th Street in Woodside, Queens, dozens of men waited in the early morning cold for contractors’ trucks to pass by. Each time a car stopped, the men would sprint to the window. After a brief negotiation — $15 an hour was the going rate, though some agreed to work for less — a few would climb inside and speed off.

One of them, Pedro Cabrera, 28, who is from Mexico, had worked 10 straight days in the Rockaways. Even though one homeowner vanished without paying him, he had made enough to buy new gloves to work in the wet and freezing buildings. Some owners told him to take anything he found, since it was all headed for the trash anyway — even a ring that he was able to pawn for $200 at a jewelry store. Still, it was painful, he said, being watched by a family whose hard-earned belongings he was throwing into the garbage.

Sarah Maslin Nir and Jessica Weisberg contributed reporting.

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India Ink: Delhi Rape Victim's Trauma 'Too Severe to Overcome'

A 23-year-old woman, whose rape in Delhi on Dec. 16 galvanized thousands to protest for better treatment of women, died on Saturday morning. The full statement from Kelvin Loh, chief executive of Mount Elizabeth Hospital, where she was being treated, is below:

“We are very sad to report that the patient passed away peacefully at 4.45am on 29 Dec 2012 (Singapore time). Her family and officials from the High Commission of India were by her side. The Mount Elizabeth Hospital team of doctors, nurses and staff join her family in mourning her loss.”

“The patient had remained in an extremely critical condition since admission to Mount Elizabeth Hospital in the morning of 27 Dec (Singapore time). Despite all efforts by a team of eight specialists in Mount Elizabeth Hospital to keep her stable, her condition continued to deteriorate over these two days. She had suffered from severe organ failure following serious injuries to her body and brain. She was courageous in fighting for her life for so long against the odds but the trauma to her body was too severe for her to overcome.”

“We are humbled by the privilege of being tasked to care for her in her final struggle. We acknowledge the faith the Indian Government and the patient’s family have placed with us to ensure the best care possible was indeed provided to her at Mount Elizabeth Hospital. We share their huge sadness at her passing and will work with the High Commission of India to provide the family support in this time of grief.”

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China Toughens Restrictions on Internet Use

HONG KONG — The Chinese government issued new rules on Friday requiring Internet users to provide their real names to service providers, while assigning Internet companies greater responsibility for deleting forbidden postings and reporting them to the authorities.

The decision came as government censors have sharply stepped up restrictions on China’s international Internet traffic in recent weeks. The restrictions are making it harder for businesses to protect commercial secrets and for individuals to view overseas Web sites that the Chinese Communist Party deems politically sensitive.

The new regulations, issued by the Standing Committee of the National People’s Congress, allow Internet users to continue to adopt pseudonyms for their online postings, but only if they first provide their real names to service providers, a measure that could chill some of the vibrant discourse on the country’s Twitter-like microblogs. The authorities periodically detain and even jail Internet users for politically sensitive comments, such as calls for a multiparty democracy or accusations of impropriety by local officials.

Any entity providing Internet access, including over fixed-line or mobile phones, “should when signing agreements with users or confirming provision of services, demand that users provide true information about their identities,” the committee ordered.

In recent weeks, Internet users in China have exposed a series of sexual and financial scandals that have led to the resignations or dismissals of at least 10 local officials. International news media have also published a series of reports in recent months on the accumulation of wealth by the family members of China’s leaders, and some Web sites carrying such reports, including Bloomberg’s and the English- and Chinese-language sites of The New York Times, have been assiduously blocked, while Internet comments about them have been swiftly deleted.

The regulations issued Friday build on a series of similar administrative guidelines and municipal rules issued over the past year. China’s mostly private Internet service providers have been slow to comply with them, fearing the reactions of their customers. The committee’s decision has much greater legal force, and puts far more pressure on Chinese Internet providers to comply more quickly and more comprehensively, Internet specialists said.

In what appeared to be an effort to make the decision more palatable to the Chinese public, the committee also included a mandate for businesses in China to be more cautious in gathering and protecting electronic data.

“Nowadays on the Internet there are very serious problems with citizens’ personal electronic information being recklessly collected, used without approval, illegally disclosed, and even traded and sold,” Li Fei, a deputy director of the committee’s legislative affairs panel, said on Friday at a news conference in Beijing. “There are also a large number of cases of invasive attacks on information systems to steal personal electronic information, as well as lawbreaking on the Internet through swindles and through defaming and slandering others.”

Mr. Li denied that the government was seeking to prevent the exposure of corruption.

“When citizens exercise these rights according to the law, no organization or individual can use any reason or excuse to interfere, and cannot suppress them or exact revenge,” he said. “At the same time, when citizens exercise their rights, including through use of the Internet, they should stay within the bounds of the Constitution and the laws, and must not harm the legitimate rights and interests of the state, society, the collective or of other citizens.”

A spokesman for the National People’s Congress said that 145 members of the committee voted in favor of the new rules, with 5 abstaining and 1 voting against them.

The requirement for real names appeared to be aimed particularly at cellphone companies and other providers of mobile Internet access. At the news conference, an official from the Ministry of Industry and Information Technology, Zhao Zhiguo, said that nearly all fixed-line services now had real-name registration, but that only about 70 percent of mobile phones were registered under real names.

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Surgery Returns to NYU Langone Medical Center

Chang W. Lee/The New York Times

Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.

NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.

While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.

The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.

“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.

Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.

“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.

The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.

The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.

In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.

Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.

The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.

The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.

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