Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing ten years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

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Netflix buys exclusive rights to Disney movies

Netflix Inc. has acquired exclusive U.S. rights to movies from Walt Disney Studios in a deal that catapults the Internet video-on-demand service into direct competition with pay TV giants such as HBO and Showtime.

The three-year agreement takes effect in 2016 and is a blow to the pay channel Starz, which currently has the rights to broadcast Disney movies, including its Pixar animated films and Marvel superhero pictures, about eight months after they are released in theaters.

Starz's sole remaining movie provider is now Sony Pictures. That partnership ends in 2016.

VIDEO: Disney buys Lucasfilm - Mickey meet Darth Maul

Disney has also agreed to give Netflix nonexclusive streaming rights to more of its older titles — including "Dumbo," "Pocahontas" and "Alice in Wonderland" — starting immediately.

Netflix's chief content officer, Ted Sarandos, called the deal "a bold leap forward for Internet television."

"We are incredibly pleased and proud this iconic family brand is teaming with Netflix to make it happen," he said.

Netflix stock soared on the news, rising $10.65, or 14%, to $85.65.

Shares in Starz's parent company, Liberty Media Corp., fell $5.49, or 5%, to $105.56.

Currently, Netflix has nonexclusive rights to movies from Paramount Pictures, Lionsgate and Metro-Goldwyn-Mayer via a deal with pay channel Epix, as well as an array of library titles from other studios. Its only exclusive movie rights come from independent studios such as Relativity Media and DreamWorks Animation. It also has a wide variety of television reruns.

Sarandos and Netflix Chief Executive Reed Hastings have long said the company wanted to get exclusive pay TV rights to films from one of Hollywood's six major studios to boost its online entertainment service.

PHOTOS: Disney without Pixar

However, Hastings has also at times downplayed the importance of new movies. Netflix previously had streaming rights to Disney and Sony movies via a deal with Starz. In January, investors expressed their concerns that the pending disappearance of those movies would hurt the service. Hastings said in a letter to investors that Disney films accounted for only 2% of domestic streaming and the loss would not be felt.

Since then, though, the Disney movie slate has become more attractive. At that time, Netflix did not have access to movies from Disney's Marvel superhero unit or the "Star Wars" titles from its pending acquisition of Lucasfilm Ltd.

The end of the Starz agreement accelerated a trend that has seen Netflix evolve into a television company, with reruns of shows such as "Mad Men" accounting for about two-thirds of the content streamed by users.

With several original programs launching next year, including the Kevin Spacey political drama "House of Cards," and a direct connection to a growing number of Internet-enabled televisions, Netflix is on the verge of standing on par with many TV networks.

Netflix charges $8 a month for its streaming service, while premium cable networks such as HBO cost $13 to $18 a month, and that's on top of a monthly bill for other channels that typically exceeds $50. It remains to be seen whether the addition of Disney products and more original programming could lead Netflix to increase its price.

PHOTOS: Hollywood back lot moments

The Netflix spending spree could continue, with Sarandos telling Bloomberg News on Monday that his company would bid for rights to Sony movies when its Starz deal expires.

Netflix might have a tougher time wresting away the rights to Warner Bros., 20th Century Fox or Universal Pictures releases from their current deals with HBO, which like Warner is part of Time Warner Inc. Paramount, Lionsgate and MGM are almost certain to stick with Epix, of which the trio are co-owners.

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A Utah craftsman races illness to finish a vintage carousel

PETERSBORO, Utah — By any measure, Vean Woodbrey looms large.

Dressed in denim bib overalls, he stands 6 feet 4, weighs 275 pounds and wears size 16 shoes. His children — all 16 of them — jokingly call him Sasquatch because of the cartoonish spread of his footprint. So do many of his 70 grandchildren and great-grandkids.

And then there is the 7-foot-tall wooden giraffe he's carving inside his home workshop in this farming town near the Idaho border. He runs a gnarled hand along the figure's neck, wiping off the sawdust that covers everything like an early season snow.

"It's simple, but there's a certain beauty to it," Woodbrey, 69, said. "The best part is that it came straight out of my imagination."

Woodbrey is an aging craftsman on a mission to finish an amusement-park-sized carousel for his grandchildren and other other youth in this Mormon community before his declining health finally fails him.

As he painstakingly crafts a menagerie of 22 animals — horses, a panda, a zebra, a lion, a tiger, a camel, an elephant and the giraffe — Woodbrey knows time is running out. He has already battled prostate and bone cancer, both of which have slowed his once-loping gait. He also suffers from a neuropathy that numbs the toes in both feet, making him teeter like a child's top in its final throes of movement. To keep his balance in his shop, he holds onto his animals and various saws and sanders.

Every morning, he slowly scales the ramp onto his second-floor workshop to create his imaginary world out of scavenged lumber. Each day is one more sunrise wrung out of a life as a father, community leader, coach and scoutmaster.

"I've got to get this carousel done," he said. "There's this sense of urgency, but I'm inching my way there."

There have been delays: Once he stapled three fingers together with a nail gun. Then he took a fall and broke five toes on one foot. He's already burned through two drills.

He shakes his head. The illness has made him see things so clearly. The doctors say the bone cancer is 85% licked, but that either could return at any time. "When you have cancer, you take an inventory of what you've done, but there's so many things you still want to do," Woodbrey said. "Every day, my wife knows exactly where I am — up in the wood shop with my animals. I'm a man on a time clock."

****

Woodbrey's fondness for carousels dates to his boyhood in San Diego, where his father took the family's four children to a local amusement park. "My dad would buy one ticket he said would go to the eldest — and that was him," he said. "But he'd grab so many brass rings he'd win free tickets so we could all ride."

When the family moved to Salt Lake City, Woodbrey collected soda bottles to redeem for the money to ride the carousel at a local park. If he was lucky, he'd make enough to buy a drink or an ice cream cone.

Years later, after Woodbrey married his wife, Tonya, and they started raising their 16 kids, he took a job at nearby Hill Air Force Base where, for 40 years, he repaired F-4 fighter jets and, later, Minuteman missile systems. At home, he began making wooden dollhouses for his eight daughters and toys for his eight sons.

At age 58, he was struck with prostate cancer. As he lay in the hospital, one of his kids bought him a copy of a magazine dedicated to carousels. Once again, he was hooked — checking each new issue for trends, seeing which old carousels were up for sale.

Eight years later, Woodbrey was treated for a golf-ball-sized tumor in his skull. After weeks of radiation treatments, weary and depressed, he asked his wife, "What am I going to do?"

"She responded: 'Go do whatever you want. Just don't give up.'"

Woodbrey retired from his job at the base and began scouting a carousel to refurbish. He finally found the 7-ton shell of a 1930s Allan Herschell ride — its animals long ago sold off as antiques by the previous owner — for sale in Montana for $5,000

Woodbrey got the contraption home and set to work. One day, he called his eight sons and eight sons-in-law over to the house for a meal. But first the men were instructed to hoist the carousel's 16-foot center pole aloft into the sky and set it into place. They worked together, grunting and sweating, like Amish barn builders. "I told them nobody could eat until we were done," Woodbrey recalled.

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Swiss spy agency warns U.S., Britain about huge data leak

ZURICH (Reuters) – Secret information on counter-terrorism shared by foreign governments may have been compromised by a massive data theft by a senior IT technician for the NDB, Switzerland‘s intelligence service, European national security sources said.

Intelligence agencies in the United States and Britain are among those who were warned by Swiss authorities that their data could have been put in jeopardy, said one of the sources, who asked for anonymity when discussing sensitive information.

Swiss authorities arrested the technician suspected in the data theft last summer amid signs he was acting suspiciously. He later was released from prison while a criminal investigation by the office of Switzerland’s Federal Attorney General continues, according to two sources familiar with the case.

The suspect’s name was not made public. Swiss authorities believe he intended to sell the stolen data to foreign officials or commercial buyers.

A European security source said investigators now believe the suspect became disgruntled because he felt he was being ignored and his advice on operating the data systems was not being taken seriously.

Swiss news reports and the sources close to the investigation said that investigators believe the technician downloaded terrabytes, running into hundreds of thousands or even millions of printed pages, of classified material from the Swiss intelligence service’s servers onto portable hard drives. He then carried them out of government buildings in a backpack.

One of the sources familiar with the investigation said that intelligence services like the U.S. Central Intelligence Agency and Britain’s Secret Intelligence Service, also known as MI6, routinely shared data on counter-terrorism and other issues with the NDB. Swiss authorities informed U.S. and British agencies that such data could have been compromised, the source said.

News of the theft of intelligence data surfaced with Switzerland’s reputation for secrecy and discretion in government and financial affairs already under assault.

Swiss authorities have been investigating, and in some cases have charged, whistleblowers and some European government officials for using criminal methods to acquire confidential financial data about suspected tax evaders from Switzerland’s traditionally secretive banks.

The suspect in the spy data theft worked for the NDB, or Federal Intelligence Service, which is part of Switzerland’s Defense Ministry, for about eight years.

He was described by a source close to the investigation as a “very talented” technician and senior enough to have “administrator rights,” giving him unrestricted access to most or all of the NDB’s networks, including those holding vast caches of secret data.

Swiss investigators seized portable storage devices containing the stolen data after they arrested the suspect, according to the sources. At this point, they said, Swiss authorities believe that the suspect was arrested and the stolen data was impounded before he had an opportunity to sell it.

However, one source said that Swiss investigators could not be positive the suspect did not sell or pass on any of the information before his arrest, which is why Swiss authorities felt obliged to notify foreign intelligence partners their information may have been compromised.

Representatives of U.S. and British intelligence agencies had no immediate response to detailed queries about the case submitted by Reuters, although one U.S. official said he was unaware of the case.

SECURITY PROCEDURES QUESTIONED

Swiss Attorney General Michael Lauber and a senior prosecutor, Carolo Bulletti, announced in September that they were investigating the data theft and its alleged perpetrator. A spokeswoman for the attorney general said she was prohibited by law from disclosing the suspect’s identity.

A spokesman for the NDB said he could not comment on the investigation.

At their September press conference, Swiss officials indicated that they believed the suspect intended to sell the data he stole to foreign countries. They did not talk about the possible compromise of information shared with the NDB by U.S. and British intelligence.

A European source familiar with the case said it raised serious questions about security procedures and structures at the NDB, a relatively new agency which combined the functions of predecessor agencies that separately conducted foreign and domestic intelligence activities for the Swiss government.

The source said that under the NDB’s present structure, its human resources staff – responsible for, among other things, ensuring the reliability and trustworthiness of the agency’s personnel – is lumped together organizationally with the agency’s information technology division. This potentially made it difficult or confusing for the subdivision’s personnel to investigate themselves, the source said.

According to the source, investigators now believe that in the months before his arrest, the data theft suspect displayed warning signs that should have been spotted by his bosses or by security officials.

The source said that the suspect became so disgruntled earlier this year that he stopped showing up for work.

However, according to Swiss news reports, the NDB did not realize that something was amiss until the largest Swiss bank, UBS, expressed concern to authorities about a potentially suspicious attempt to set up a new numbered bank account, which then was traced to the NDB technician.

A Swiss parliamentary committee is now conducting its own investigation into the data theft and is expected to report next spring. Investigators are known to be concerned that the NDB lacks investigative powers, such as to search premises or conduct wiretaps, which are widely used by counter-intelligence investigators in other countries.

(Reporting by Mark Hosenball; Editing by Mark Heinrich)

Tech News Headlines – Yahoo! News

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Fleetwood Mac readies tour and new music

NEW YORK (AP) — Fleetwood Mac is heading back on the road, and that means the top-selling group will release new music — sort of.

On its 34-city North American tour, which kicks off April 4 in Columbus, Ohio, the band will perform two new songs, and it could mean a new album will follow. Or not.

Stevie Nicks recently sang on tracks that Lindsey Buckingham, Mick Fleetwood and John McVie worked on, calling the sessions "great." But Nicks also says she's not sure where the band fits in today's music industry.

"Whether or not we're gonna do any more (songs), we don't know because we're so completely bummed out with the state of the music industry and the fact that nobody even wants a full record," she said. "Everybody wants two songs, so we're going to give them two songs."

Nicks said depending on the response to the new tracks — which Buckingham calls "the most Fleetwood Mac-y stuff ... in a long time" — more material could come next.

"Maybe we'll get an EP out of it or something," Buckingham said.

Nicks will continue to record solo albums, though. The group is celebrating the 35th anniversary of the best-selling "Rumours" album, which has moved some 20 million units in the United States. She knows that's not possible again, despite the success of Adele's "21," which has sold 10 million units in America in less than two years.

"This is Adele's 'Rumours,'" Nicks said. "She had a baby, she's going to take a year off to take care of her baby — that's why I never had any kids. She's going to go back and start writing again, you never know what the next record's going to be. Is it going to sell 10 million records? You don't know," she said.

Buckingham said he initially wanted to record a new album, but Nicks "wasn't too into that." But the guitarist and singer knows that new music isn't a priority for the band's fans.

"It wouldn't matter if they didn't hear anything new. In a way there's a freedom to that — it becomes not what you got, but what you do with what you got. Part of the challenge of this tour is figuring out a presentation that has some twists and turns to it without having a full album," he said.

Fleetwood Mac, which was formed in 1967, last released an album in 2003, though they hit the road in 2009. Nicks and Buckingham — who originally joined the band in 1974 as a couple — both released solo albums and toured last year. Buckingham had suggested that Fleetwood Mac tour last year, but says getting everyone to agree was tough.

"If you look at Fleetwood Mac as a group, you can make the case of saying we're a bunch of individuals who don't necessarily belong in the same group together, but it's the synergy of that that makes us so good. But it also makes the politics a little more tenuous," he said. "You can say that not only can it be a political minefield, someone's always causing trouble, right? I caused trouble for years so I can't point any fingers."

The tour also includes cities such as New York, Chicago, Boston, Las Vegas and Los Angeles, and will end June 12 in Detroit.

_____

Online:

http://www.fleetwoodmac.com/

You can follow Music Writer Mesfin Fekadu on Twitter at twitter.com/MusicMesfin

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National Briefing | New England: New Hampshire: Not Guilty Plea in Hepatitis Case

A traveling hospital technologist accused of stealing drugs and infecting patients with hepatitis C through contaminated syringes pleaded not guilty in federal court on Monday. The technologist, David Kwiatkowski, whom prosecutors described as a “serial infector,” was indicted last week on charges of tampering with a consumer product and illegally obtaining drugs. Until May, Mr. Kwiatkowski worked as a cardiac technologist at Exeter Hospital, where 32 patients were given diagnoses of the same strain of hepatitis C he carries. Before that, he worked in 18 hospitals in seven states, moving from job to job despite having been fired twice over accusations of drug use and theft. In addition to the New Hampshire patients, a handful of patients in Kansas and one in Maryland have been found to carry the strain Mr. Kwiatkowski carries.

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Autonomy founder Mike Lynch creates website to rebut HP allegations

Autonomy founder Mike Lynch appears on CNBC to defend himself against HP's allegations. (Autonomy Accounts website)

By Chris O'Brien

December 4, 2012, 7:39 a.m.

Autonomy founder Mike Lynch has stepped up his unusual public defense by launching a website designed to bolster his argument that allegations of accounting fraud are untrue. 

Hewlett-Packard made that stunning accusation last week, claiming that Lynch and other Autonomy executives engaged in systematic accounting tricks that inflated the company's revenues before HP acquired it last year. 

Rather than offering the standard "no comment" and ducking behind a wall of lawyers, Lynch has been all over TV and newspapers shooting down the notion that anything funny was going on at Autonomy. 

The website is called "AutonomyAccounts.org" and appears to have gone live Monday. 

"This website is maintained by Dr Mike Lynch on behalf of the former management team of Autonomy. The site provides relevant information pertaining to the accusations made by Hewlett Packard (HP) on 20 November 2012 of financial impropriety at Autonomy. The former management team of Autonomy strongly rejects the accusations made by HP," reads the site's "About" page.

The site also contains a timeline of Autonomy events, and Lynch's letter to the HP board, disputing the claims, and demanding more information so he can defend himself: 

"Having no details beyond the limited public information provided last week, and still with no further contact from you, I am writing today to ask you, the board of HP, for immediate and specific explanations for the allegations HP is making. HP should provide me with the interim report and any other documents which you say you have provided to the SEC and the SFO so that I can answer whatever is alleged, instead of the selective disclosure of non-material information via background discussions with the media."

And, of course, the site provides a way to contact Lynch for further comment. 

Also: 

Yet-to-be-born royal baby already subject of Twitter parody

iTunes 11 tweak could indicate Apple will start 'iRadio' in 2013

Google Nexus 4 smartphone sold out until after Christmas?

Follow me on Twitter @obrien.

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Supreme Court keeps California in suspense on gay marriage

By Jessica Garrison, Los Angeles Times

December 3, 2012, 7:27 a.m.

The U.S. Supreme Court did not address the California gay-marriage case on Monday morning. The next time they can consider it is on Friday.

The case against Proposition 8, the 2008 ballot initiative that banned gay marriage in California, had been discussed by justices last Friday, but was not on the list of cases the court said it would review.

Many speculated that the court might have decided not to take the case, which would let an appeals court ruling on the matter stand. The 9th Circuit Court of Appeals found earlier this year that Proposition 8 was unconstitutional, clearing the way for same-sex marriage in California unless the Supreme Court decides to get involved.

But the matter will remain in suspense for a while longer. The court could continue to discuss the case at conferences this year and early next year in advance of possibly hearing the case in June. They could also hold the matter over for the fall. 

Gay-marriage activists expressed disappointment that there was no news Monday.

"We understand that it is a complex case, and if they need another week to reach the right decision, we're fine with that," said Adam Umhoefer, executive director of the American Foundation for Equal Rights, which is fighting to overturn Proposition 8.

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Study shows growth in second screen users

NEW YORK (AP) — Television viewers were once called couch potatoes. Many are becoming more active while watching now, judging by the findings in a new report that illustrates the explosive growth in people who watch TV while connected to social media on smartphones and tablets.

The Nielsen company said that one in three people using Twitter in June sent messages at some point about the content of television shows, an increase of 27 percent from only five months earlier. And that was before the Olympics, which was probably the first big event to illustrate the extent of second screen usage.

"Twitter has become the second screen experience for television," said Deirdre Bannon, vice president of social media at Nielsen.

Social networking is becoming so pervasive that the study found nearly a third of people aged 18-to-24 reported using the sites while in the bathroom.

An estimated 41 percent of tablet owners and 38 percent of smartphone owners used their device while also watching television at least once a day, Nielsen said.

That percentage hasn't changed much; in fact, 40 percent of smartphone owners reported daily dual screen usage a year earlier, Nielsen said. The difference is that far more people own these devices and they are using them for a longer period of time. The company estimated that Americans spent a total of 157.5 billion minutes on mobile devices in July 2012, nearly doubling the 81.8 billion the same month a year earlier.

"There are big and interesting implications," Bannon said. "I think both television networks and advertisers are onto it."

The social media can provide networks with real-time feedback on what they are doing. The performance of moderators at presidential debates this fall was watched more closely than perhaps ever before, because people were instantly taking on Twitter to provide their own critiques.

It also makes for some conflicting information: Twitter buzzed with complaints last summer about NBC's policy of airing many Olympics events from London on tape delay, yet ratings for the prime-time Olympics telecast soared past expectations.

The increase in people watching television and commenting about it online would seem to run counter to another big trend this fall: more people recording programs and watching them at a later hour. Those contrary trends both increase the value of live event programming like awards shows or sporting events.

The Nielsen study also found that 35 percent of people who used tablets while watching TV looked up information online about the program they were watching. A quarter of tablet owners said they researched coupons or deals for products they saw advertised on television

As rapid as the use of social media while on television is growing in the United States, it already lags behind other countries. Nielsen said that 63 percent of people in the Middle East or Africa report using social media while on TV, and 52 percent of people in Latin America.

The U.S. media survey is based on a representative sample of 1,998 adults in Nielsen's regular TV ratings panel, conducted online between July 19 and Aug. 8. Nielsen's global survey involved more than 28,000 people in 51 countries and was taken between March 23 and April 12, 2011.

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Call That Kept Nursing Home Patients in Sandy’s Path

Chang W. Lee/The New York Times

Workers were shocked that nursing and adult homes in areas like Rockaway Park, Queens, weren’t evacuated.

Hurricane Sandy was swirling northward, four days before landfall, and at the Sea Crest Health Care Center, a nursing home overlooking the Coney Island Boardwalk in Brooklyn, workers were gathering medicines and other supplies as they prepared to evacuate.

Then the call came from health officials: Mayor Michael R. Bloomberg, acting on the advice of his aides and those of Gov. Andrew M. Cuomo, recommended that nursing homes and adult homes stay put. The 305 residents would ride out the storm.

The same advisory also took administrators by surprise at the Ocean Promenade nursing home, which faces the Atlantic Ocean in Queens. They canceled plans to move 105 residents to safety.

“No one gets why we weren’t evacuated,” said a worker there, Yisroel Tabi. “We wouldn’t have exposed ourselves to dealing with that situation.”

The recommendation that thousands of elderly, disabled and mentally ill residents remain in more than 40 nursing homes and adult homes in flood-prone areas of New York City had calamitous consequences.

At least 29 facilities in Queens and Brooklyn were severely flooded. Generators failed or were absent. Buildings were plunged into a cold, wet darkness, with no access to power, water, heat and food.

While no immediate deaths were reported, it took at least three days for the Fire Department, the National Guard and ambulance crews from around the country to rescue over 4,000 nursing home and 1,500 adult home residents. Without working elevators, many had to be carried down slippery stairwells.

“I was shocked,” said Greg Levow, who works for an ambulance service and helped rescue residents at Queens. “I couldn’t understand why they were there in the first place.”

Many sat for hours in ambulances and buses before being transported to safety through sand drifts and debris-filled floodwaters. They went to crowded shelters and nursing homes as far away as Albany, where for days, they often lacked medical charts and medications. Families struggled to locate relatives.

The decision not to empty the nursing homes and adult homes in the mandatory evacuation area was one of the most questionable by the authorities during Hurricane Sandy. And an investigation by The New York Times found that the impact was worsened by missteps that officials made in not ensuring that these facilities could protect residents.

They did not require that nursing homes maintain backup generators that could withstand flooding. They did not ensure that health care administrators could adequately communicate with government agencies during and after a storm. And they discounted the more severe of the early predictions about Hurricane Sandy’s surge.

The Times’s investigation was based on interviews with officials, health care administrators, doctors, nurses, ambulance medics, residents, family members and disaster experts. It included a review of internal State Health Department status reports. The findings revealed the striking vulnerability of the city’s nursing and adult homes.

On Sunday, Oct. 28, the day before Hurricane Sandy arrived, Mr. Bloomberg ordered a mandatory evacuation in Zone A, the low-lying neighborhoods of the city. But by that point, Mr. Bloomberg, relying on the advice of the city and state health commissioners, had already determined that people in nursing homes and adult homes should not leave, officials said.

The mayor’s recommendations that health care facilities not evacuate startled residents of Surf Manor adult home in Coney Island, said one of them, Norman Bloomfield. He recalled that another resident exclaimed, “What about us! Why’s he telling us to stay?”

The commissioners made the recommendation to Mr. Bloomberg and Mr. Cuomo because they said they believed that the inherent risks of transporting the residents outweighed the potential dangers from the storm.

In interviews, senior Bloomberg and Cuomo aides did not express regret for keeping the residents in place.

“I would defend all the decisions and the actions” by the health authorities involving the storm, said Linda I. Gibbs, a deputy mayor. “I feel like I’m describing something that was a remarkable, lifesaving event.”

Dr. Nirav R. Shah, the state health commissioner, who regulates nursing homes, said: “I’m not even thinking of second-guessing the decisions.”

Still, officials in New Jersey and in Nassau County adopted a different policy, evacuating nursing homes in coastal areas well before the storm.

Contradictory Forecasts

The city’s experience with Tropical Storm Irene last year weighed heavily on state and city health officials and contributed to their underestimating the impact of Hurricane Sandy, according to records and interviews.

Before Tropical Storm Irene, the officials ordered nursing homes and adult homes to evacuate. The storm caused relatively minor damage, but the evacuation led to millions of dollars in health care, transportation, housing and other costs, and took a toll on residents.

As a result, when Hurricane Sandy loomed, the officials were acutely aware that they could come under criticism if they ordered another evacuation that proved unnecessary.

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