'The Hobbit' stays atop box office for third week


LOS ANGELES (AP) — "The Hobbit: An Unexpected Journey" continues to rule them all at the box office, staying on top for a third-straight week with nearly $33 million.


The Warner Bros. fantasy epic from director Peter Jackson, based on the J.R.R. Tolkien novel, has made $222.7 million domestically alone.


Two big holiday movies — and potential awards contenders — also had strong openings. Quentin Tarantino's spaghetti Western-blaxploitation mash-up "Django Unchained" came in second place for the weekend with $30.7 million. The Weinstein Co. revenge epic, starring Jamie Foxx and Christoph Waltz, has earned $64 million since its Christmas Day opening.


And in third place with $28 million was the sweeping, all-singing "Les Miserables." The Universal Pictures musical starring Hugh Jackman and Anne Hathaway has made $67.5 million since debuting on Christmas.


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Well: Exercise and the Ever-Smarter Human Brain

Anyone whose resolve to exercise in 2013 is a bit shaky might want to consider an emerging scientific view of human evolution. It suggests that we are clever today in part because a million years ago, we could outrun and outwalk most other mammals over long distances. Our brains were shaped and sharpened by movement, the idea goes, and we continue to require regular physical activity in order for our brains to function optimally.

Phys Ed

Gretchen Reynolds on the science of fitness.

The role of physical endurance in shaping humankind has intrigued anthropologists and gripped the popular imagination for some time. In 2004, the evolutionary biologists Daniel E. Lieberman of Harvard and Dennis M. Bramble of the University of Utah published a seminal article in the journal Nature titled “Endurance Running and the Evolution of Homo,” in which they posited that our bipedal ancestors survived by becoming endurance athletes, able to bring down swifter prey through sheer doggedness, jogging and plodding along behind them until the animals dropped.

Endurance produced meals, which provided energy for mating, which meant that adept early joggers passed along their genes. In this way, natural selection drove early humans to become even more athletic, Dr. Lieberman and other scientists have written, their bodies developing longer legs, shorter toes, less hair and complicated inner-ear mechanisms to maintain balance and stability during upright ambulation. Movement shaped the human body.

But simultaneously, in a development that until recently many scientists viewed as unrelated, humans were becoming smarter. Their brains were increasing rapidly in size.

Today, humans have a brain that is about three times larger than would be expected, anthropologists say, given our species’ body size in comparison with that of other mammals.

To explain those outsized brains, evolutionary scientists have pointed to such occurrences as meat eating and, perhaps most determinatively, our early ancestors’ need for social interaction. Early humans had to plan and execute hunts as a group, which required complicated thinking patterns and, it’s been thought, rewarded the social and brainy with evolutionary success. According to that hypothesis, the evolution of the brain was driven by the need to think.

But now some scientists are suggesting that physical activity also played a critical role in making our brains larger.

To reach that conclusion, anthropologists began by looking at existing data about brain size and endurance capacity in a variety of mammals, including dogs, guinea pigs, foxes, mice, wolves, rats, civet cats, antelope, mongooses, goats, sheep and elands. They found a notable pattern. Species like dogs and rats that had a high innate endurance capacity, which presumably had evolved over millenniums, also had large brain volumes relative to their body size.

The researchers also looked at recent experiments in which mice and rats were systematically bred to be marathon runners. Lab animals that willingly put in the most miles on running wheels were interbred, resulting in the creation of a line of lab animals that excelled at running.

Interestingly, after multiple generations, these animals began to develop innately high levels of substances that promote tissue growth and health, including a protein called brain-derived neurotrophic factor, or BDNF. These substances are important for endurance performance. They also are known to drive brain growth.

What all of this means, says David A. Raichlen, an anthropologist at the University of Arizona and an author of a new article about the evolution of human brains appearing in the January issue of Proceedings of the Royal Society Biology, is that physical activity may have helped to make early humans smarter.

“We think that what happened” in our early hunter-gatherer ancestors, he says, is that the more athletic and active survived and, as with the lab mice, passed along physiological characteristics that improved their endurance, including elevated levels of BDNF. Eventually, these early athletes had enough BDNF coursing through their bodies that some could migrate from the muscles to the brain, where it nudged the growth of brain tissue.

Those particular early humans then applied their growing ability to think and reason toward better tracking prey, becoming the best-fed and most successful from an evolutionary standpoint. Being in motion made them smarter, and being smarter now allowed them to move more efficiently.

And out of all of this came, eventually, an ability to understand higher math and invent iPads. But that was some time later.

The broad point of this new notion is that if physical activity helped to mold the structure of our brains, then it most likely remains essential to brain health today, says John D. Polk, an associate professor of anthropology at the University of Illinois at Urbana-Champaign, and co-author, with Dr. Raichlen, of the new article.

And there is scientific support for that idea. Recent studies have shown, he says, that “regular exercise, even walking,” leads to more robust mental abilities, “beginning in childhood and continuing into old age.”

Of course, the hypothesis that jogging after prey helped to drive human brain evolution is just a hypothesis, Dr. Raichlen says, and almost unprovable.

But it is compelling, says Harvard’s Dr. Lieberman, who has worked with the authors of the new article. “I fundamentally agree that there is a deep evolutionary basis for the relationship between a healthy body and a healthy mind,” he says, a relationship that makes the term “jogging your memory” more literal than most of us might have expected and provides a powerful incentive to be active in 2013.

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Narrower Tax Deal Floated as Lawmakers to Sit With Obama





WASHINGTON — Congressional leaders prepared for what was looming as a make-or-break White House meeting on the fiscal crisis Friday afternoon as top aides said they were exploring a scaled-back proposal that would prevent tax increases on household income of $400,000 or below.




The potential compromise, which was in the early stages and far from a certainty, was emerging as the top four Congressional leaders — Senator Harry Reid, the majority leader; Senator Mitch McConnell, the Republican leader; Speaker John A. Boehner; and Representative Nancy Pelosi, the Democratic leader — were set to meet with President Obama as a group for the first time in weeks to try to reach a resolution as Congress headed toward a rare New Year’s Eve session.


Congressional officials say staff-level talks between the White House and the Senate Republican leader are centering around a deal that would extend all the expiring Bush income tax cuts up to $400,000 in income. Some spending cuts would pay for a provision putting off a sudden cut in payments to medical providers treating Medicare patients. The deal would also prevent an expansion of the alternative minimum tax to keep it from hitting more of the middle class. It would extend a raft of already expired business tax cuts, like the research and development credit, and would renew tax cuts for the working poor and the middle class included in the 2009 stimulus law. The estate tax would stay at current levels.


It would not stop automatic spending cuts from hitting military and domestic programs beginning on Wednesday, nor would it raise the statutory borrowing limit, which will be reached on Monday. Congressional aides said those issues would be dealt with early next year in yet another showdown.


White House officials denied that any such offer was developing and said that the president was sticking with his insistence that household income only up to $250,000 would be protected from tax increases.


While neither side was confident of any agreement, some top lawmakers said there was still a chance of a breakthrough that could at least avoid the most far-reaching economic effects. “I am hopeful that there will be a deal that avoids the worst parts of the fiscal cliff; namely, taxes’ going up on middle-class people,” Senator Charles E. Schumer, the No. 3 Senate Democrat, said Friday on the “Today” show on NBC. “I think there can be. And I think the odds are better than people think that they could be.”


Democrats from high-tax, high-wealth states have pressed the White House and their leaders to accept a threshold higher than the president’s $250,000, but they appear ready to accept anything that can pass.


“I have a very practical standard to apply: whatever threshold we need to avoid the fiscal cliff,” said Senator Joseph I. Lieberman, a Democrat-turned-independent from Connecticut.


Much of the legislative attention was focused on Mr. McConnell as Democrats pushed him to provide assurances that Republicans would not use procedural tactics to block any measure that the Senate might consider. House Republican leaders have already said they would be willing to consider whatever legislation the Senate could pass when the House convenes beginning Sunday afternoon. If Republicans chose to erect hurdles to any legislation, Congress might not have sufficient time to advance a measure before the deadline on Tuesday.


Mr. McConnell was well aware of the Democratic efforts to put the onus on him. “Make no mistake: the only reason Democrats have been trying to deflect attention onto me and my colleagues over the past few weeks is that they don’t have a plan of their own that could get bipartisan support,” he said on Thursday.


But he also said he was willing to review any proposal that would come from the White House and then “we’ll decide how best to proceed.”


“Hopefully there is still time for an agreement of some kind that saves the taxpayers from a wholly preventable economic crisis,” he added.


As it awaited a proposal on tax and spending issues, the Senate did make some progress on other legislation, sending the president a renewal of antiterrorism surveillance laws and advancing some relief for states and communities hit by Hurricane Sandy this year.


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Apple loses another copyright lawsuit in China: Xinhua


SHANGHAI (Reuters) - A Chinese court has fined Apple Inc 1 million yuan ($160,400) for hosting third-party applications on its App Store that were selling pirated electronic books, the official Xinhua news agency reported on Friday.


Apple is to pay compensation to eight Chinese writers and two companies for violating their copyrights, the Beijing No.2 Intermediate People's Court ruled on Thursday, Xinhua said.


Earlier in the year, a group of Chinese authors filed the suit against Apple, saying an unidentified number of apps on its App Store sold unlicensed copies of their books. The group of eight authors was seeking 10 million yuan in damages.


"We are disappointed at the judgment. Some of our best-selling authors only got 7,000 yuan. The judgment is a signal of encouraging piracy," Bei Zhicheng, a spokesman for the group, told Reuters.


Apple said in a statement that it takes copyright infringement complaints "very seriously".


"We're always updating our service to better assist content owners in protecting their rights," Apple spokeswoman Carolyn Wu said.


China has the world's largest Internet and mobile market by number of users, but piracy costs software companies billions of dollars each year.


Apple, whose products enjoy great popularity in China, has faced a string of legal headaches this year. In July, Apple paid 60 million yuan to a Chinese firm, Proview Technology, to settle a long-running lawsuit over the iPad trademark in China.


($1 = 6.2360 Chinese yuan)


(Reporting by Shanghai Newsroom and Melanie Lee; Editing by Kazunori Takada and Matt Driskill)



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FBI removes many redactions in Marilyn Monroe file


LOS ANGELES (AP) — FBI files on Marilyn Monroe that could not be located earlier this year have been found and re-issued, revealing the names of some of the movie star's communist-leaning acquaintances who drew concern from government officials and her own entourage.


But the files, which previously had been heavily redacted, do not contain any new information about Monroe's death 50 years ago. Letters and news clippings included in the file show the bureau was aware of theories the actress had been killed, but they do not show that any effort was undertaken to investigate the claims. Los Angeles authorities concluded Monroe's death was a probable suicide.


Recently obtained by The Associated Press through the Freedom of Information Act, the updated FBI files do show the extent the agency was monitoring Monroe for ties to communism in the years before her death in August 1962.


The records reveal that some in Monroe's inner circle were concerned about her association with Frederick Vanderbilt Field, who was disinherited from his wealthy family over his leftist views.


A trip to Mexico earlier that year to shop for furniture brought Monroe in contact with Field, who was living in the country with his wife in self-imposed exile. Informants reported to the FBI that a "mutual infatuation" had developed between Field and Monroe, which caused concern among some in her inner circle, including her therapist, the files state.


"This situation caused considerable dismay among Miss Monroe's entourage and also among the (American Communist Group in Mexico)," the file states. It includes references to an interior decorator who worked with Monroe's analyst reporting her connection to Field to the doctor.


Field's autobiography devotes an entire chapter to Monroe's Mexico trip, "An Indian Summer Interlude." He mentions that he and his wife accompanied Monroe on shopping trips and meals and he only mentions politics once in a passage on their dinnertime conversations.


"She talked mostly about herself and some of the people who had been or still were important to her," Field wrote in "From Right to Left." ''She told us about her strong feelings for civil rights, for black equality, as well as her admiration for what was being done in China, her anger at red-baiting and McCarthyism and her hatred of (FBI director) J. Edgar Hoover."


Under Hoover's watch, the FBI kept tabs on the political and social lives of many celebrities, including Frank Sinatra, Charlie Chaplin and Monroe's ex-husband Arthur Miller. The bureau has also been involved in numerous investigations about crimes against celebrities, including threats against Elizabeth Taylor, an extortion case involving Clark Gable and more recently, trying to solve who killed rapper Notorious B.I.G.


The AP had sought the removal of redactions from Monroe's FBI files earlier this year as part of a series of stories on the 50th anniversary of Monroe's death. The FBI had reported that it had transferred the files to a National Archives facility in Maryland, but archivists said the documents had not been received. A few months after requesting details on the transfer, the FBI released an updated version of the files that eliminate dozens of redactions.


For years, the files have intrigued investigators, biographers and those who don't believe Monroe's death at her Los Angeles area home was a suicide.


A 1982 investigation by the Los Angeles District Attorney's Office found no evidence of foul play after reviewing all available investigative records, but noted that the FBI files were "heavily censored."


That characterization intrigued the man who performed Monroe's autopsy, Dr. Thomas Noguchi. While the DA investigation concluded he conducted a thorough autopsy, Noguchi has conceded that no one will likely ever know all the details of Monroe's death. The FBI files and confidential interviews conducted with the actress' friends that have never been made public might help, he wrote in his 1983 memoir "Coroner."


"On the basis of my own involvement in the case, beginning with the autopsy, I would call Monroe's suicide 'very probable,'" Noguchi wrote. "But I also believe that until the complete FBI files are made public and the notes and interviews of the suicide panel released, controversy will continue to swirl around her death."


Monroe's file begins in 1955 and mostly focuses on her travels and associations, searching for signs of leftist views and possible ties to communism. One entry, which previously had been almost completely redacted, concerned intelligence that Monroe and other entertainers sought visas to visit Russia that year.


The file continues up until the months before her death, and also includes several news stories and references to Norman Mailer's biography of the actress, which focused on questions about whether Monroe was killed by the government.


For all the focus on Monroe's closeness to suspected communists, the bureau never found any proof she was a member of the party.


"Subject's views are very positively and concisely leftist; however, if she is being actively used by the Communist Party, it is not general knowledge among those working with the movement in Los Angeles," a July 1962 entry in Monroe's file states.


___


Anthony McCartney can be reached at http://twitter.com/mccartneyAP


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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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Putin to Sign Ban on U.S. Adoptions of Russian Children





MOSCOW President Vladimir V. Putin said on Thursday that he would sign into law a bill banning the adoption of Russian children by American citizens, retaliating against an American law that punishes Russians accused of violating human rights and dealing a potentially grave setback to bilateral relations.




Mr. Putin announced his decision at a meeting with senior government officials, including cabinet members and legislative leaders. The adoption ban, included in a broader law aimed at retaliating against the United States, was approved unanimously by the Federation Council, the upper chamber of Parliament, on Wednesday.


Mr. Putin also said he would sign a decree calling for improvements in Russia’s deeply troubled child welfare system that the Federation Council also adopted Wednesday. “I intend to sign the law,” Mr. Putin said, “as well as a presidential decree changing the procedure of helping orphaned children, children left without parental care, and especially children who are in a disadvantageous situation due to their health problems.”


United States officials have strongly criticized the measure and have urged the Russian government not to enmesh orphaned children in politics.


“It is misguided to link the fate of children to unrelated political considerations,” a State Department spokesman, Patrick Ventrell, said on Wednesday before Mr. Putin announced his decision.


Internally, however, Obama administration officials have been debating how strongly to respond to the adoption ban, and are trying to assess the potential implications for other aspects of the relationship with Russia. The United States, for example, now relies heavily on overland routes through Russia to ship supplies to military units in Afghanistan, and has enlisted Russia’s help in containing Iran’s nuclear program. The former cold war rivals also have sharp disagreements, notably over the civil war in Syria.


Until Thursday, these larger considerations, along with the possibility that Mr. Putin might veto the adoption bill, seemed to forestall a more forceful response from Washington.


The ban is set to take effect on Tuesday, and some senior officials in Moscow said they expected it to have the immediate effect of blocking the departure of 46 children whose adoptions by American parents were nearly completed. Adoption agency officials in the United States who work regularly with Russian orphanages said they expected the number of families immediately affected by the ban to be far larger, about 200 to 250 who have already identified a child that they planned to adopt.


Since Mr. Putin returned to the presidency in May, Russian officials have used a juggernaut of legislation and executive decisions to curtail the United States’ influence and involvement in Russia, undoing major partnerships that began after the fall of the Soviet Union.


The adoption ban, however, is the first step to take direct aim at the American public and would effectively undo a bilateral agreement on international adoptions that was ratified this year and took effect Nov. 1. That agreement called for heightened oversight in response to several high-profile cases of abuse and deaths of adopted Russian children in the United States.


About 1,000 Russian children were adopted in 2011 by parents from the United States, which leads in adoptions here, and more than 45,000 such children have been adopted by American parents since 1999.


Pavel A. Astakhov, Russia’s child rights commissioner and a major proponent of the ban, said the 46 pending adoptions would be blocked regardless of previous agreements, and he expressed no regrets over the likely emotional turmoil for the families involved.


“The children who have been chosen by foreign American parents — we know of 46 children who were seen, whose paperwork was processed, who came in the sights of American agencies,” Mr. Astakhov said in his statement. “They will not be able to go to America, to those who wanted to see them as their adopted children. There is no need to go out and make a tragedy out of it.”


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Amazon most satisfying website to shop: survey


(Reuters) - Amazon.com Inc remained the best website for shopping online while JC Penney Co Inc suffered the largest drop in customer satisfaction of any major online retailer this holiday season, according to a survey released on Thursday.


Flash sale sites Gilt.com and RueLaLa.com were among the worst performers in online shopping satisfaction this season, according to ForeSee's Holiday E-Retail Satisfaction Index.


"The importance of satisfying them and giving a great consumer experience is going to pay back huge dividends in terms of profitability for these retailers," said Larry Freed, president and chief executive officer of ForeSee, which measures customer satisfaction for companies, including retailers.


Amazon has held the highest score in each of the eight years of the index, due in part to the wide variety of merchandise it offers and a site that is easy to use.


"They've really done a great job in setting the standard for everybody else," Freed said of Amazon.


Amazon's score was again 88 out of 100, while Gilt.com and Fingerhut.com shared the lowest score of 72. LLBean.com had the second-highest ranking, 85, up 4 points from a year earlier.


A score of 80 or higher is considered strong, Freed said.


JC Penney's score fell to 78 from 83.


"They've struggled a lot in their stores as they've tried to reinvent themselves a bit and that's carried over a little bit to the website," Freed said.


Other retailers that saw their ForeSee satisfaction scores drop included Apple Inc - down to 80 from 83 - and Dell Inc, which fell to 77 from 80.


At Apple, as the popular tech company has brought out more products, navigating the site has become more of an issue, said Freed. Improving the functionality of the site would give it the biggest boost, he said.


No. 1 U.S. retailer Wal-Mart Stores Inc, which is trying to grow its online sales, scored a 78 for its Walmart.com website, down from 79 in 2011. Rival Target Corp's website scored 79, up from 76 last year, when it had some struggles after taking over control of the site from Amazon.


As for those flash sale sites coming in at the low end of the scores, Freed noted that some are trying to grow beyond the premise of flash sales, which offer a limited amount of marked down merchandise at specific times.


"It works for some kinds of consumers, it's not going to work for every kind of consumer," said Freed. "Their models today are going to work and they're going to have a chance to be successful, but at the end of the day it's not the right answer for everybody."


ForeSee's 2012 report was based on more than 24,000 surveys collected from visitors to websites of the 100 largest online retailers from Thanksgiving to Christmas, up from 40 retail sites in prior years.


(Reporting by Jessica Wohl in Chicago; Editing by Phil Berlowitz)



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It's husband No. 3 for actress Kate Winslet


NEW YORK (AP) — Kate Winslet has tied the knot again.


The Oscar-winning actress wed Ned Rocknroll in New York earlier this month. The private ceremony was attended by Winslet's two children as well as a few friends and family members, her representative said Thursday.


It is the third marriage for the 37-year-old Winslet. She was previously married to film directors Jim Threapleton and Sam Mendes.


The 34-year-old Rocknroll, who was born Abel Smith, is a nephew of billionaire Virgin Group founder Richard Branson.


The couple had been engaged since last summer.


Winslet won a Best Actress Oscar for her performance in the 2008 film "The Reader."


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New York’s Mental Health System Thrashed by Services Lost to Storm


Marcus Yam for The New York Times


Dr. Richard Rosenthal, physician in chief of behavioral services for Continuum hospitals, at St. Luke’s-Roosevelt Hospital Center.







When a young woman in the grip of paranoid delusions threatened a neighbor with a meat cleaver one Saturday last month, the police took her by ambulance to the nearest psychiatric emergency room. Or rather, they took her to Beth Israel Medical Center, the only comprehensive psychiatric E.R. functioning in Lower Manhattan since Hurricane Sandy shrank and strained New York’s mental health resources.




The case was one of 9,548 “emotionally disturbed person” calls that the Police Department answered in November, and one of the 2,848 that resulted in transportation to a hospital, a small increase over a year earlier.


But the woman was discharged within hours, to the shock of the mental health professionals who had called the police. It took four more days, and strong protests from her psychiatrist and caseworkers, to get her admitted for two weeks of inpatient treatment, said Tony Lee, who works for Community Access, a nonprofit agency that provides supportive housing to people with mental illness, managing the Lower East Side apartment building where she lives.


Psychiatric hospital admission is always a judgment call. But in the city, according to hospital records and interviews with psychiatrists and veteran advocates of community care, the odds of securing mental health treatment in a crisis have worsened significantly since the hurricane. The storm’s surge knocked out several of the city’s largest psychiatric hospitals, disrupted outpatient services and flooded scores of coastal nursing homes and “adult homes” where many mentally ill people had found housing of last resort.


One of the most affected hospitals, Beth Israel, recorded a 69 percent spike in psychiatric emergency room cases last month, with its inpatient slots overflowing. Instead of admitting more than one out of three such cases, as it did in November 2011, it admitted only one out of four of the 691 emergency arrivals this November, records show. Capacity was so overtaxed that ambulances had to be diverted to other hospitals 15 times in the month, almost double the rate last year, in periods typically lasting for eight hours, officials said.


Dr. Richard Rosenthal, physician in chief of behavioral services for Continuum Health Partners, Beth Israel’s parent organization, said he was proud of how much Continuum’s hospitals had done to handle psychiatric overflow since storm damage shuttered Bellevue Hospital Center, the city’s flagship public hospital; NYU Langone Medical Center; and the Veterans Affairs Hospital. But these days, he said, as he walks on Amsterdam Avenue between Continuum’s Roosevelt hospital on West 59th Street and its St. Luke’s hospital on West 114th Street, he notices more mentally ill people in the streets than he has seen in years.


“When you have the most vulnerable folks, all you need is one chink in the system and you lose them,” Dr. Rosenthal said. “Whether they lost their housing, or the outpatient services they usually go to were closed and they were lost to follow-up, they have become disconnected, with predictable results.”


Similar patterns are playing out in Brooklyn, where Maimonides Medical Center has been overwhelmed with mental health emergencies from the Coney Island vicinity since Coney Island Hospital, one of the city’s largest acute care psychiatric hospitals, suspended operations, hospital officials said.


“Triage has reached a different level: You have to get sicker to get in,” said Dr. Andrew Kolodny, the chairman of psychiatry at Maimonides, citing a 56 percent increase in psychiatric emergency room visits there from Oct. 26 to Dec. 7, compared with the same period last year, and a 24 percent rise in admissions. The increase in admissions was possible only with emergency permission from the state to exceed licensed limits.


“Not only is there decreased capacity, because Bellevue and Coney Island are off line,” Dr. Kolodny added, “but there’s increased demand because the storm or the loss of their residence has been a stressor for mental illness.”


The storm battered a mental health system that still relies heavily on private nursing homes and substandard adult homes to house people with mental illness. Such institutions have a sordid history of neglect and exploitation, and the courts have repeatedly found that their overuse by the state isolated thousands of people in violation of the Americans With Disabilities Act.


Plans are under way to increase supportive housing — dwellings where mentally ill people can live relatively independently, with support services. But even before Hurricane Sandy, the expansion fell far short of demand.


The storm underscored the fragility of the system. Many disabled evacuees who were sent first to makeshift school shelters lost access to the psychiatric medications that kept their symptoms at bay, Dr. Kolodny said. Even those lucky enough to have the drugs they need are at greater risk of relapse as they experience crowded living conditions. “If they’re now sleeping in a gym with 100 people, that can tip them over the edge and start making them really paranoid,” he said.


On Staten Island, where the chief of psychiatry at Richmond University Medical Center says psychiatric resources have been stretched to the limit, clergy members report that mentally ill people transferred to a large adult home in New Brighton from one that was washed away in Far Rockaway, Queens, are now showing up at church rectories, begging for socks and underwear.


“It’s heartbreaking, because they just found us by chance,” said Margaret Moschetto, a missionary at the Church of Assumption-St. Paul in New Brighton. “They were just walking around the neighborhood. They really didn’t know where they were.”


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