At Bellevue, a Desperate Fight to Ensure the Patients’ Safety

From the moment the water lapped above street level in Lower Manhattan, the doctors and nurses of Bellevue Hospital Center began a desperate struggle to keep patients safe. By 9 p.m. Monday, the hospital was on backup power, and an hour later, the basement was flooded.

Karsten Moran for The New York Times

Outside Bellevue Hospital Center, a line of ambulances lined up to evacuate patients on Wednesday after fuel pumps for the hospital's backup generators failed.

Officials rushed to move the most critically ill patients closer to an emergency generator. After midnight, doctors heard shouts in the hallway. The basement fuel pumps had stopped working, and medical residents, nurses and administrators formed a bucket brigade to ferry fuel up 13 flights to the main backup generators.

By Tuesday, the elevator shafts at Bellevue, the country's oldest public hospital, had flooded, so all 32 elevators stopped working. There was limited compressed air to run ventilators, so oxygen tanks were placed next to the beds of patients who needed them. Water faucets went dry, food ran low, and buckets of water had to be carried up to flush toilets.

Some doctors began urging evacuations, and on Tuesday, at least two dozen ambulances lined up around the block to pick up many of the 725 patients housed there. People carried babies down flights of stairs. The National Guard was called in to help. On Thursday afternoon, the last two patients were waiting to be taken out.

The evacuation went quickly only because Bellevue had planned for such a possibility before Hurricane Irene hit last year, several doctors said. But the city, which had evacuated two nearby hospitals before that storm, decided not to clear out Bellevue. In the wake of Hurricane Sandy, the consequences of bad calls, bad luck and equipment failures cascaded through the region's health care system, as sleep-deprived health care workers and patients were confronted by a new kind of disarray.

A patient recovering from a triple bypass operation at Bellevue walked down 10 flights of stairs to a waiting ambulance, one of the dozens provided through the Federal Emergency Management Agency to speed patients across the metropolitan region.

Mount Sinai Medical Center, already dealing with the 2 a.m. arrival of a dozen psychiatric patients who spoke only Chinese, was struggling to identify the relatives of brain-injured traffic victims from Bellevue who arrived three hours later with only rudimentary medical records.

Maimonides Medical Center in Brooklyn was straining to meet a rising need for emergency dialysis for hundreds of people shut out of storm-crippled private dialysis centers. Patients who would normally get three hours of dialysis were getting only two, to ensure the maximum number of people received at least a minimal amount of care.

"The catastrophe is growing by the minute," said Eileen Tynion, a Maimonides spokeswoman. "Here we thought we'd reached a quiet point after the storm."

Every hospital maintains an elaborate disaster plan, but after Hurricane Sandy, the fact that many health care facilities are in low-lying areas proved to be something of an Achilles' heel. Bellevue became the third hospital in the city to evacuate after the storm's landfall, after NYU Langone Medical Center, just north of Bellevue, and Coney Island Hospital, another public hospital.

New York Downtown Hospital, the only hospital south of 14th Street in Manhattan, and the Veterans Affairs Hospital, just below Bellevue, had evacuated before the storm.

Hospital executives were reluctant to criticize their colleagues or city officials. But the sequence of events left them with many questions.

"All hospitals are required to do disaster planning and disaster drills," Pamela Brier, the chief executive of Maimonides, noted. "All hospitals are required as a condition of being accredited, to have generators, backup generators."

City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but "as prepared as we think we are we've never had a mock disaster drill where we carried patients downstairs. I'm shocked that we didn't do that. Now we're going to."

The city's health commissioner, Dr. Thomas Farley, defended the decision not to require evacuations of Bellevue, Coney Island and NYU Langone hospitals before the storm, which he said had been made in consultation with the state health commissioner, Dr. Nirav Shah.

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Recipes for Health: Balsamic Roasted Winter Squash and Wild Rice Salad

Andrew Scrivani for The New York Times

Squash absorbs the rich, acidic flavor of balsamic vinegar in the most inviting way; the idea of tossing it with the vinegar before roasting comes from Heidi Swanson. Put this delicious autumn salad in your Thanksgiving file. Make sure to cook the wild rice until it begins to splay or you won't get the full nutty flavor of the grains.

1 cup wild rice

3 1/2 cups water or stock (chicken or vegetable)

Salt to taste

2 pounds kabocha or butternut squash, peeled and cut in small dice (about 3 cups peeled and diced, weighing 1 1/2 to 1 3/4 pounds)

Salt to taste

1 tablespoon balsamic vinegar

3 tablespoons extra virgin olive oil

2 tablespoons fresh lemon juice (more to taste)

1 garlic clove, minced or puréed

1 teaspoon Dijon mustard

3 tablespoons walnut oil, or substitute extra virgin olive oil

1/2 cup chopped fresh herbs, like parsley, chives, tarragon

1/2 cup diced celery

1 5- or 6-ounce bag baby arugula or spinach

1. Rinse the wild rice. Bring the water or stock to a boil in a medium saucepan, add salt to taste and the rice. Bring back to a boil, reduce the heat, cover and simmer 45 minutes, until the rice is tender and has begun to splay. Drain through a strainer, return to the pot and cover the pot with a clean dishtowel. Return the lid to the pot and let sit for 10 minutes.

2. Meanwhile, preheat the oven to 425 degrees. Line a baking sheet with foil. Place the squash in a bowl or directly on the baking sheet and toss with salt to taste, the balsamic vinegar and 1 tablespoon of the olive oil. Spread on the baking sheet in an even layer and make sure to tip all of the liquid remaining in the bowl over the squash. Roast for 20 to 30 minutes, stirring every 10 minutes so that the squash browns evenly. The squash should be tender all the way through. Remove from the heat.

3. In a small bowl or measuring cup, whisk together the lemon juice, garlic, salt to taste and mustard. Whisk in the remaining olive oil and the walnut oil.

4. Combine the wild rice, squash, herbs and celery in a large bowl. Toss with the dressing. Add salt and pepper to taste. Line a platter, individual plates or a wide salad bowl with the baby spinach or arugula. Top with the salad and serve.

Yield: 6 servings.

Advance preparation: This salad holds well for a couple of days in the refrigerator, without the arugula or spinach.

Nutritional information per serving (6 servings): 268 calories; 14 grams fat; 2 grams saturated fat; 5 grams polyunsaturated fat; 7 grams monounsaturated fat; 0 milligrams cholesterol; 32 grams carbohydrates; 4 grams dietary fiber; 44 milligrams sodium (does not include salt to taste); 6 grams protein

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

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Arthur R. Jensen, Who Set Off Debate on I.Q., Dies

Arthur R. Jensen, an educational psychologist who ignited an international firestorm with a 1969 article suggesting that the gap in intelligence-test scores between black and white students might be rooted in genetic differences between the races, died on Oct. 22 at his home in Kelseyville, Calif. He was 89.

His death was confirmed by the University of California, Berkeley, where he was an emeritus professor in the Graduate School of Education.

Professor Jensen was deeply interested in differential psychology, a field whose central question — What makes people behave and think differently from one another? — strikes at the heart of the age-old nature-nurture debate.

Because of his empirical work in the field on the quantification of general intelligence (a subject that had long invited a more diffuse, impressionistic approach), he was regarded by many colleagues as one of the most important psychologists of his day.

But a wider public remembered him almost exclusively for his 1969 article "How Much Can We Boost I.Q. and Achievement?" Published in The Harvard Educational Review, a scholarly journal, the article quickly became — and remains even now — one of the most controversial in psychology.

In the article, Professor Jensen posited two types of learning ability. Level I, associative ability, entailed the rote retention of facts. Level II, conceptual ability, involved abstract thinking and problem-solving. This type, he argued, was roughly equivalent to general intelligence, denoted in psychology by the letter "g."

In administering I.Q. tests to diverse groups of students, Professor Jensen found Level I ability to be fairly consistent across races. When he examined Level II ability, by contrast, he found it more prevalent among whites than blacks, and still more prevalent among Asians than whites.

Drawing on these findings, Professor Jensen argued that general intelligence is largely genetically determined, with cultural forces shaping it only to a small extent. For this reason, he wrote in 1969, compensatory education programs like Head Start are doomed to fail.

While some observers praised Professor Jensen as a scientist unafraid to go where the data led him, others called him a racist. He continued to be heckled at speaking engagements throughout his career. He was burned in effigy on some college campuses and received death threats; for a time, he was accompanied by bodyguards.

The idea that intelligence cleaved along racial lines quickly became known as Jensenism, and its merits were the subject of heated public discussion for years afterward. The evolutionary biologist Stephen Jay Gould, for instance, devoted much of his 1981 book, "The Mismeasure of Man," to criticizing Professor Jensen's claims.

More recently, Professor Jensen's ideas about race and the heritability of intelligence were cited approvingly in "The Bell Curve," the 1994 book by Richard J. Herrnstein and Charles Murray that engendered renewed debate on the subject.

Today, some psychologists say that Professor Jensen's work has been misunderstood. In a telephone interview on Wednesday, Douglas Detterman, a psychologist at Case Western Reserve University who edits the journal Intelligence, said: "If you look at the Harvard Educational Review paper, he discusses race very little in that paper, but he did say that it's a possibility that there are genetic differences among racial groups. And that was not a very popular idea when that paper came out."

Professor Detterman, who in 1998 devoted a special issue of Intelligence to Professor Jensen's work, added: "When he wrote that paper, probably a large portion of psychologists wouldn't have believed that there was a hereditary basis for intellectual ability. Now, there's very little argument about that in the field. Whether there are differences between races is another thing altogether."

Arthur Robert Jensen was born in San Diego on Aug. 24, 1923. An accomplished clarinetist, he considered pursuing a career as an orchestra conductor before taking a bachelor's degree in psychology from Berkeley, followed by a master's in the field from San Diego State College and a Ph.D. from Columbia. He joined the Berkeley faculty in 1958.

Professor Jensen's wife, Barbara, died before him. Survivors include a daughter, Bobbi Morey.

Among his books are "Genetics and Education" (1972), "Educability and Group Differences" (1973), "The g Factor: The Science of Mental Ability" (1998) and "Clocking the Mind: Mental Chronometry and Individual Differences" (2006).

Even psychologists who disagree with Professor Jensen's conclusions defend him against charges of racism.

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Enduring the Storm for Homebound Patients

Nine flights above East 22nd Street, Russell Oberlin, 84, had no heat or electricity, no phone, no elevator service and two cancerous tumors on his right leg that required daily medical attention.

As two burners on his stove provided warmth on Thursday, Suzanne Gilleran, 47, carefully cut the gauze around Mr. Oberlin's leg. "How's your pain today?" she asked. "Did you take anything?"

As parts of the city edged toward some semblance of normal on Thursday, tens of thousands of people like Mr. Oberlin, who depend on essential home medical care, remained tenuously connected to lifesaving services by agencies like Partners in Care, an affiliate of the Visiting Nurse Service of New York.

At the Visiting Nurse Service of New York alone, more than 5,000 nurses, aides, social workers and others were out serving patients around the city during and after the storm.

Nurses and home aides, who often earn minimum wage or just above it, had to make a decision: go out in the storm or its aftermath, possibly risking their lives and ignoring conditions in their own homes, or make life possible for the patients depending on them.

"I saw six patients yesterday," said Ms. Gilleran, who trains nurses at Partners in Care, and does not ordinarily make home visits. But because of Hurricane Sandy, the agency pressed all available registered nurses into field duty, as did other agencies around the city, often sending them into conditions made difficult by the weather: the power failures, the lack of public transit, the traffic.

It took Ms. Gilleran three hours on the express bus from Forest Hills, Queens, to get to Mr. Oberlin. Then there were the stairs. The lowest patient "was on the fourth floor," she said, "the highest was on the 14th."

"I realized," she added, "I walked halfway up the Empire State Building, and most of the stairwells were pitch black."

Allison Chisholm, 46, who works for the Visiting Nurse Service, lives with a frail mother in Park Slope, Brooklyn. When the lights started flickering during the storm on Monday, she had images of her mother falling in the dark. But she also had patients who needed her, including one receiving hospice care in a 12th floor apartment in Chinatown, and one needing an intravenous round of antibiotics in the West Village.

"It was treacherous driving during the hurricane," said Ms. Chisholm, fitting an intravenous line into the arm of Jill Gerson, 71, who teaches social work at Lehman College in the Bronx. "But it's just something you have to do as a nurse. That continuity of care helps the healing. I don't see this as being heroic. I have a conscience. I need to get to sleep at night."

Dr. Gerson had been hospitalized twice — first as a result of complications from a dental implant, then because of a reaction to her antibiotics. If she missed one day of antibiotics now, she would probably be all right, but two or three days could be life-threatening.

Dr. Gerson, who lives in the West Village, close to the Hudson River, stayed in her home rather than move in with friends, even as the water flowed down her street and into her basement.

"This woman has been saving my life," she said, pointing to Ms. Chisholm.

Ghislaine Chery, 50, provides home care to patients at two housing projects in the Rockaways; under normal circumstances she travels with a guard. When the storm approached, and the Rockaways were subject to mandatory evacuation, she talked with her clients about leaving.

"After Irene, many of them had had to wait several days for buses to return, and they didn't want to go through that again," Ms. Chery said in a telephone interview. So they stayed — blind and in wheelchairs, blind and diabetic — counting on Ms. Chery, who lives on Long Island, to reach them with their medications and other essential services.

"I was here by 7:45 Tuesday morning," Ms. Chery said. "I've been seeing 8 or 10 patients every day. It's been a real experience."

As the recovery drags on, a growing need is for mental health care. Scott Feldman, a social worker for the Visting Nurses, answered a call on Wednesday night for volunteers on Staten Island, where he lives. When he arrived at Tottenville High School, which was serving as a temporary shelter and evacuation center, he was directed to a couple in severe distress.

"They'd seen cars coming up their street, not being driven by anyone, just by the flood," Mr. Feldman said. "They'd lost everything." Then they tried to help another couple across the street, but had only been able to save the woman, Mr. Feldman said. "The wife was sleeping when I got there. The husband was waking up every hour screaming. So now what do they do?"

At Mr. Oberlin's apartment, as Ms. Gilleran prepared to leave, taking the trash with her, Mr. Oberlin, who was a well-known countertenor and founding member of the New York Pro Musica Antiqua ensemble, beamed. "I can't get over this service," he said. "At the same time, I can see how expensive it must be."

Dr. Gerson had a different opinion: "This service saves a fortune, because we don't have to be in hospitals. They don't pay these people enough."

Ms. Chisholm waited patiently for the antibiotic drip to finish. She had a long way to go from the West Village back to Park Slope.

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Global Update: Gates Foundation Backs Hospital Transportation for Expectant Mothers

Finbarr O'Reilly/Reuters

The Bill & Melinda Gates Foundation has given a $5 million grant to a Massachusetts nonprofit group to work on a very specific problem: how to get new mothers in Ghana to hospitals.

Child mortality is very high in Ghana, but many newborns can be saved if the mother gives birth with someone trained, even rudimentarily, in Western medicine and if the baby is seen within two days by a doctor or nurse.

But in rural Ghana, explained Dr. Pierre M. Barker, vice president of the Institute for Healthcare Improvement, which received the Gates grant, there are many obstacles. Besides the obvious, like rutted roads, there are prejudices against wives or newborns leaving the house.

Sending expert committees to visit village chiefs, he said, has turned many into advocates for getting women to clinics instead of giving birth with untrained local midwives who may be unable to diagnose pneumonia or who have habits that cause tetanus, like cutting umbilical cords with dirty blades.

Dr. Barker described how his agency helped set up a village meeting that produced a way to get women in labor to hospitals when they had no money. He expected villagers to donate funds. Instead, local minibus-taxi drivers proposed a deal: They would carry the women at no charge if, once they arrived, they were allowed to jump the line for paying passengers headed back home.

This article has been revised to reflect the following correction:

Correction: November 1, 2012

An article on Tuesday about efforts to get pregnant women in rural Ghana to clinics to give birth misstated, at one point, the surname of the vice president of the Institute for Healthcare Improvement, which received a grant to organize the efforts. As the report correctly noted elsewhere, he is Dr. Pierre M. Barker — not Parker.

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Recipes for Health: Winter Squash and Molasses Muffins

Andrew Scrivani for The New York Times

These moist muffins are reminiscent of pumpkin molasses bread, but they aren't as sweet (though you can add more sugar or molasses if you want them to be sweeter).

2 pounds kabocha squash, cut in large chunks

1 cup (140 grams) whole-wheat pastry flour

1 cup (135 grams) unbleached all-purpose flour

1 teaspoon baking soda

1 teaspoon ground cinnamon

1/2 teaspoon ground nutmeg

1/4 teaspoon ground allspice

1/8 teaspoon ground cloves (2 cloves)

1/2 teaspoon salt

2 large eggs

1/3 cup raw brown sugar (turbinado) or packed light brown sugar

1/3 cup blackstrap molasses

1/4 cup canola oil

1/2 cup buttermilk

1 teaspoon vanilla extract

1/2 cup walnuts

1. Preheat the oven to 425 degrees. Line a sheet pan with foil and lightly oil the foil. Brush the squash with a small amount of oil. Place on the baking sheet skin side down. Roast for 20 minutes and use tongs to turn the pieces of squash over. Roast for 20 to 30 minutes more, until the squash is soft enough that you can pierce the skin with the tip of a paring knife. Remove from the heat and allow to cool, then peel away the skin. Purée in a food processor or a mortar and pestle. You should have about 1 cup of purée.

2. Turn the oven down to 375 degrees with a rack in the middle. Oil or butter muffin tins and line the bottoms with parchment if desired.

3. Sift together the flours, baking soda, cinnamon, nutmeg, ground cloves, allspice and salt.

4. Beat together the eggs and sugar. Beat in the molasses, oil, buttermilk, puréed squash, and vanilla. Quickly beat in the flour and fold in the walnuts.

5. Spoon into the muffin tins and place in the oven. Bake 20 to 22 minutes, until the muffins have risen and a tester comes out clean. Let the muffins cool in the tins for 15 minutes, then turn out onto a rack to cool completely.

Yield: 1 dozen large muffins, 18 smaller muffins

Advance preparation: These will remain moist and fresh-tasting for a couple of days. They freeze well.

Variation: Substitute raisins or chopped dried apricots for the walnuts, or use both.

Nutritional information per muffin (12 muffins): 244 calories; 9 grams fat; 1 gram saturated fat; 4 grams polyunsaturated fat; 4 grams monounsaturated fat; 31 milligrams cholesterol; 37 grams carbohydrates; 2 grams dietary fiber; 233 milligrams sodium; 5 grams protein

Nutritional information per serving (18 muffins): 163 calories; 6 grams fat; 1 gram saturated fat; 3 grams polyunsaturated fat; 3 grams monounsaturated fat; 21 milligrams cholesterol; 25 grams carbohydrates; 1 gram dietary fiber; 151 milligrams sodium; 3 grams protein

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

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N.Y.U.’s Lab Rats and Mice Die in Flooding

Among the smaller but still important casualties of Hurricane Sandy were thousands of laboratory rodents, genetically altered for use in the study of heart disease, cancer and mental disorders like autism and schizophrenia, that drowned in basement rooms at a New York University research center in Kips Bay.

The collection of carefully-bred rodents was considered one of the largest and most valuable of its kind in the country. The animals lived in colonies in the cellar of the Smilow Research Center, on 1st Avenue near 30th Street.

New York University medical and research staff worked furiously to protect their human patients — and others threatened by the storm — in all three of its facilities in Kips Bay. Though most of the animals at the center were unharmed, the center staff could not rescue the animals in one of the facilities, despite hours of work amid the flooding that started at the institute on Monday night.

"The combined tide and wind resulted in extensive flooding in the building, and unfortunately, my mouse colonies were wiped out," said Gordon J. Fishell, associate director of the N.Y.U. Neuroscience Institute. "These animals were the culmination of 10 years of work, and it will take time to replace them."

N.Y.U. officials said that, storm warnings notwithstanding, there was every reason to expect the Smilow building to be protected; the building was designed to withstand surges 20 percent higher than had historically occurred.

Dr. Fishell said that his lab alone lost about 2,500 mice. Other programs at the Smilow center, including research into cancer, cardiovascular disease and epigenetics, lost a combined 7,500 more animals, both mice and rats, according to faculty estimates. The animals were an important resource, but research in all of these areas is broadly based and will continue, university officials said.

"It's an absolute tragedy any way you look at it," Dr. Fishell said.

The colonies are bred to carry some of the same genetic glitches thought to contribute to disorders in humans like high blood pressure, cancer or epilepsy. The Fishell lab has been studying the effect of specific genetic mutations on neurons that inhibit runaway electrical activity in the brain. Such neural overheating is associated with seizures, among other mental symptoms. The mouse lines included about 40 genetic variants.

Medical centers typically have veterinarians on hand, as well as other lab staff, to feed and care for research animals. "That facility is top-notch, one of the leading centers in the country, so the loss is just terrible," said Dr. Yariv Houvras, a cancer researcher at NewYork-Presbyterian/Weill Cornell Medical Center.

The loss is the second major blow to basic research in developmental disorders in just the past several months. In June, a freezer failure at the Harvard Brain Bank in Belmont, Mass., ruined 150 brain specimens, many of them from people with autism who died young.

Lines of genetically altered animals, like brain banks, are painstakingly built up over time. But the mouse colonies can be restored, researchers said; many of the rodents lost in the storm have genetic relatives living elsewhere, and those animals could be used to begin the process.

Already scientists at two research centers, the University of Pennsylvania and Cold Spring Harbor Laboratory on Long Island, have pledged to donate animals to restart some of the Smilow center's colonies. "That's the one really positive thing to come out of this," Dr. Fishell said. "Individuals in the research community, who in most businesses would be considered my competitors, have been eager to help."

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Bellevue Hospital Evacuates Patients After Backup Power Fails

Bellevue Hospital Center, New York City's flagship public hospital and the premier trauma center in Manhattan, shut down Wednesday after fuel pumps for its backup power generators failed, and it worked into the night to evacuate the 300 patients left in its darkened building. There were 725 patients there when Hurricane Sandy hit.

Stan Honda/Agence France-Presse — Getty Images

The National Guard was called in at Bellevue Hospital Center. More Photos »

At a news conference Wednesday night, Alan Aviles, the president of the Health and Hospitals Corporation, which runs Bellevue, described third-world conditions, with no hot water, no lab or radiology services and pails of water hauled up the stairs to use for flushing toilets.

After pumping out 17 million gallons of water from the basement, the water is still two and a half feet deep in the cavernous basement where the fuel pumps apparently shorted out and became inoperable — unable to feed the 13th-floor backup generators, Mr. Aviles said.

"If we can get this hospital back up within two to three weeks we will be doing really well," he said. "Nothing has happened like this in Bellevue's 275-year history."

Bellevue is on the East River, in the blacked-out portion of Manhattan south of 34th Street.

An evacuation had been under way for two days, doctors said, with the most critical patients and all but a few infants transferred to other hospitals before Wednesday, as volunteers and then the National Guard mounted a bucket-brigade to supply diesel fuel to the generators.

The evacuation had been a "slow trickle" since Monday, when the storm surge from the hurricane hit, said Matthew McCarty, 24, a New York University medical student who had been volunteering at Bellevue, doing everything from carrying patients and holding flashlights to ferrying fuel to the generators on the 13th floor.

Outside the hospital on Wednesday, ambulances lined up to ferry patients elsewhere, and inside, relatives sought information about where patients had been sent.

The Greater New York Hospital Association, a hospital trade group, worked into Wednesday evening with the State Health Department and emergency management officials to find beds for the patients at other hospitals, some of which had just absorbed more than 300 patients from NYU Langone Medical Center, also a casualty of failed backup power.

Brian Conway, a spokesman for the hospital association, said:

"The New York hospital community has always come through in finding beds for evacuated patients, and we're confident that'll happen again, but we're pushing the envelope right now. This is an unprecedented challenge."

The Health Department authorized "surge-capacity plans" that allow hospitals to accept patients beyond their normal capacity in a disaster, if necessary converting nonclinical space like conference rooms and auditoriums into dorm-style wards. Appeals for other hospitals to take Bellevue patients went out at midday.

Among those responding was Continuum Health Partners, which offered to take as many as 200 patients at its St. Luke's and Roosevelt Hospitals, Jim Mandler, a spokesman said.

Mount Sinai Hospital, which took in 64 emergency evacuees from NYU Langone on Monday, offered to take about 40 patients from Bellevue, and Maimonides Medical Center in Brooklyn offered spaces for 50 patients.

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Well: How to Carbo-Load for a Marathon

It appears that despite the depredations of the big storm, the New York City Marathon is likely to take place as scheduled on Sunday. While the 47,000 runners entered have too little time to remedy any major lapses in training, there is one element that can still be tweaked, two new studies show: what to eat in the days before the race.

Phys Ed

Gretchen Reynolds on the science of fitness.

The ideal composition of a pre-marathon diet has been somewhat in dispute recently. For years, marathoners were told that they should swallow as many carbohydrates as possible in the week leading up to the race in order to "load" their muscles with stored carbohydrates, or glycogen, the readiest energy source for working muscles.

But such prolonged carbo-loading often leaves runners bloated and heavy; when muscles pack in glycogen, they also add water, and therefore weight, which must be hefted throughout the 26.2 miles of the marathon. Women, in particular, have been found in some studies to benefit little, if at all, from prolonged carbo-loading before marathons.

However, a study published last month in The International Journal of Sport Nutrition and Exercise Metabolism found that carbo-loading can be effective for both men and women — but is best if it's truncated, encompassing only a day or so of dietary manipulation.

For the study, researchers at the University of Minnesota turned to a ready-made pool of volunteers, consisting of students enrolled in Physical Education 1262: Marathon Training, who were aiming to finish the local Eau Claire Marathon for class credit.

Forty-six students joined the study, 36 of them women and all but two of them first-time marathon runners.

Several weeks before the event, the runners completed a two-mile time trial, to determine their endurance and running ability.

Then, beginning three days before the race and continuing through breakfast on race morning, they kept detailed food diaries. They also noted, to the extent possible, what they ate and drank during the race.

All of the students finished the race, with an average time of 4 hours 43 minutes (and, one would hope, an A grade in P.E.).

But, statistical analysis showed, those runners, both men and women, who'd eaten the most carbohydrates on the day before the race finished faster than those who'd eaten fewer carbohydrates that day.

These results neatly replicate those of a larger study published last year of 257 male and female runners who completed the 2009 London Marathon. Those runners also kept detailed food and training diaries, which researchers compared with their finishing times. In this case, the scientists also tracked each runner's pace at five-kilometer increments throughout the race.

They found that, as in the Minnesota study, runners who'd loaded up on carbohydrates the day before the race ran faster than those who had eaten fewer carbohydrates. The difference was especially striking beginning at about the 18-mile mark, just when many runners famously "hit the wall" and feel their energy flag. The carbo-loaded runners jauntily maintained their pace. The others did not.

In both studies, carbohydrates eaten at breakfast on race day, during the race itself or on days earlier in the week were relatively unimportant. It was primarily what people ate on the day before the race that mattered.

And yet, few of the runners in either study actually consumed enough carbohydrates to benefit, even if they thought that they were doing so. In both studies, the minimum effective "dose" of carbohydrates was at least six or seven grams for every kilogram of a person's body weight, or about a quarter-ounce of carbohydrates for every 2.2 pounds of body weight. By that formula, a 220-pound runner would need to consume at least 25 ounces, or more than a pound and a half, of carbohydrates on the day before a marathon to finish faster.

In the Minnesota study, fewer than a quarter of the marathoners consumed that many of carbohydrates on the day before the race. In the London study, barely 12 percent did.

What those numbers suggest is that many more marathon runners could benefit from a brief bout of carbo-loading than currently do. And the process itself is relatively simple, says Patrick Wilson, a graduate student at the University of Minnesota who led the study of novice runners. You don't need to increase your food volume or calories the day before a race; just replace some fats or proteins with carbohydrates.

"I often tell people to choose relatively concentrated sources of carbs, like juices, pasta, rice and sweets," Mr. Wilson says. "That way, the volume of food needed isn't so enormous." In addition, he says, "lower-fiber foods may be good, since that could reduce the potential for stomach distress during the race." (According to a rather intrusive study this year, extremely high intake of carbohydrates was associated with faster times during endurance races but also with "nausea and flatulence.")

Don't completely upend your normal diet, though. "Stick to foods that are familiar," Mr. Wilson says. "It's always a bad idea to experiment right before a race."

And don't expect that diet alone will lift you from the back of the pack. In the British study, every increase of 1 gram per kilogram of body weight in the carbohydrates that runners consumed on the day before the race increased their speed by about 0.1 miles per hour.

Far more important in the overall determination of people's finishing times was their training and their fundamental fitness. In the Minnesota study, the runners who were fastest during the time trial were fastest in the marathon, too.

You can't alter your training or talent at this point. You can, though, have a chocolate chip cookie on Saturday and call it race preparedness.

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Patients Evacuated From NYU Langone After Power Failure

Chang W. Lee/The New York Times

N.Y.U. Langone began transporting all 215 patients after a backup power system failed on Monday evening. More Photos »

A backup power system failed at one of New York City's premier medical centers on Monday night, forcing the evacuation of all patients to nearby hospitals amid the storm's strong gusts, officials said.

The medical center, NYU Langone Medical Center, a sprawling complex in the low 30s near the East River, began transporting all 215 patients at the hospital to other facilities on Monday evening, They were still being transported to other nearby hospitals, including Sloan Kettering and Mount Sinai, early on Tuesday, a spokeswoman for the hospital said.

"They evacuated everybody," said the spokeswoman, Lorinda Klein, who said the main communications systems at NYU Langone — phones and e-mail — were down. She could not say what had caused the failure of the hospital's emergency systems, which power critical care units there.

NYU Langone said in a statement that the evacuations were "due to the severity of Hurricane Sandy and the higher than expected storm surge." It added, "We are having intermittent telephone access issues and for this reason the receiving hospital will notify families of their relatives arrival."

By 11 p.m., dozens of ambulances from various companies across the city were lined up in front of hospital extending down First Avenue and west on 30th Street.

On the ground floor of the hospital, medical staff members, firefighters and emergency medical technicians moved about as patients on gurneys — at least one in an oxygen mask — were wheeled from the building and lifted into the ambulances outside.

A spokeswoman for Memorial Sloan-Kettering Cancer Center, on the Upper East Side, said at least 26 patients had been taken there.

In a statement, Mount Sinai Medical Center described joint efforts to evacuate patients "in the areas of adult critical care, pediatric critical care, neonatal intensive care and obstetrics." It said the patients were "being transported to Mount Sinai via ambulance and will be accompanied by NYU Langone staff and physicians."

In southern Brooklyn, Coney Island Hospital also saw its backup power systems fail on Monday, said the city's Office of Emergency Management, but there were no evacuations. Critical patients had been evacuated on Friday during storm preparations and the 209 remaining patients would be re-evaluated in the morning, the office said.

The trouble at NYU Langone began Monday evening as hospital officials began to detail in e-mails the spread of large-scale power failures in critical areas, including the emergency room, the transplant unit and labor and delivery. The emergency systems did not kick in, the hospital said.

Where necessary, patients were connected to battery-operated monitors and pumps, hospital employees reported, and the hospital appeared to have no emergency or land-line phones on some units.

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