Former Ivory Coast leader’s wife wanted by ICC

THE HAGUE, Netherlands (AP) — The International Criminal Court unsealed an indictment Thursday against former Ivory Coast President Laurent Gbagbo‘s wife on charges including murder, rape and persecution. It was the first time in the court’s 10-year history it has charged a woman.

The world’s first permanent war crimes tribunal said the arrest warrant was issued on Feb. 29 for former first lady Simone Gbagbo for crimes against humanity.

Her husband, Laurent Gbagbo, is already in custody at the court’s detention unit in The Hague facing similar charges stemming from his fight to retain power after losing a 2010 presidential election. If his wife is extradited, they could face justice together in an unprecedented husband-wife trial.

But a senior member of Ivory Coast President Alassane Ouattara‘s government, who requested anonymity because he wasn’t authorized to speak to the media, said Ivory Coast has already informed the ICC that the nation will not let her go.

“We informed them of this a long time ago,” he said.

The court’s chief prosecutor, Fatou Bensouda, urged Ivory Coast to extradite Gbagbo.

“The type of crimes committed in the aftermath of the 2010 elections did not happen by chance — they were planned and coordinated at the highest political and military levels and all those bearing the greatest responsibility must be held to account,” Bensouda said in a statement.

She said prosecutors continue to investigate crimes committed by both sides in Ivory Coast’s bloody power struggle and expect to issue further arrest warrants in the future.

“The investigations are objective, impartial and independent, and are conducted in strict accordance with the law,” she said.

Ivory Coast officials are holding the 63 year old under house arrest in the northwest town of Odienne. Last week, Ivorian prosecutor Noel Dje Enrike Yahau said lawyers had questioned Simone Gbagbo there for two days and that the domestic charges against her remained the same: genocide, blood crimes and economic crimes.

Unsealing the ICC arrest warrant issued nearly nine months ago appears to be a tactic by the court to put pressure on Ouattara’s administration to hand over Ms. Gbagbo.

If authorities in Ivory Coast want to prosecute her, they have to convince judges at The Hague tribunal that their case involves the same crimes she is charged with at the ICC. It is a court of last resort, meaning it only takes cases from countries unwilling or unable to prosecute them.

The international court said in the warrant that there is evidence pro-Gbagbo forces deliberately attacked perceived supporters of Ouattara in the aftermath of the election.

Judges who reviewed evidence supporting the charges against Ms. Gbagbo said they found “there are reasonable grounds to believe that Ms. Gbagbo bears individual criminal responsibility for the crimes … as ‘an indirect co-perpetrator.’”

The warrant called Gbagbo an “alter ego for her husband” with the power to make state decisions. It said there is evidence to suggest she “instructed the pro-Gbagbo forces to commit crimes against individuals who posed a threat to her husband’s power.”

Her husband was the first former head of state to be taken into custody by the court when he was extradited to The Hague by the Ivory Coast government last year.

Prosecutors say about 3,000 people died in violence by both sides after Gbagbo refused to concede defeat following the election. Ouattara finally took power in April 2011 with the help of French and U.N. forces.

Ivory Coast is not a member state of the court, but has voluntarily accepted its jurisdiction.

It is very rare for a woman to be charged by an international war crimes court. In the past, the Yugoslav war crimes tribunal convicted former Bosnian Serb President Biljana Plavsic of persecution and sentenced her to 11 years imprisonment.

The announcement of the arrest warrant and Ivory Coast’s refusal to hand over Gbagbo appeared likely to raise tensions between supporters of her husband and those who back Ouattara.

Moussa Toure Zeguen, a leader of the Gbagbo allies in exile in Ghana, said by phone from Accra that the former president’s supporters had no faith in the Ivorian authorities to give Simone Gbagbo a fair trial.

“We don’t trust them. The only thing that Ouattara is doing is revenge,” Zeguen said. “He wants to try us without trying any of the fighters from his side who also committed crimes. It is not fair, and this cannot bring reconciliation.”

____

Associated Press writers Rukmini Callimachi in Dakar, Senegal, and Robbie Corey-Boulet in Abidjan, Ivory Coast, contributed to this report.

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Amazon Kindle Fire HD 8.9 is Good, But No iPad Killer [REVIEW]

Unboxing the Kindle Fire HD 8.9

Click here to view this gallery.

[More from Mashable: Apple Now Owns the iMessage Name]

Amazon expands its tablet sights with the bigger, more powerful Kindle Fire HD 8.9. Can it compete against Apple‘s iPad?

If there’s one company that deserves credit for reigniting the iPad competitor market, it’s Amazon. Despite some bugs and an overall blah design, its 7-inch Kindle Fire was the first Android tablet that made sense to consumers who gobbled it up to help the Fire grab 50% of the Android tablet market in just 6 months.

[More from Mashable: 9 Black Friday Deals For iPhone Owners]

That tablet essentially opened the flood gates for a new set of ever-more-powerful 7-inchers from, notably, Barnes & Noble and Google. All three companies have already updated their 7-inch offerings to more powerful components and higher-resolutions screens. They’re all still running Android, though Amazon and Barnes & Noble choose to hide the Google OS behind smarter and much more consumer-friendly interfaces.

All this led Apple to finally enter the mid-sized tablet space with the iPad Mini. It’s easily the best-looking tablet of the bunch, but also $ 120 more expensive than its nearest competitor.

The more interesting development, though, is Amazon‘s (and Barnes & Noble‘s) decision to go toe-to-toe with Apple’s full-size iPad and launch the Amazon Kindle Fire HD 8.9 (in 4G LTE and WiFi-only). The move is akin to a middle weight boxer putting on the pounds to take on the Heavyweight world champion. Amazon’s Kindle Fire HD is slightly smaller (the iPad is 9.7-inches), lighter (567g vs. 625g), cheaper ($ 369 for 32 GB model vs. $ 599 for the iPad 4th Gen — Amazon subsidizes with sleep-state ads, that I do not mind) and overall somewhat less powerful. In order to win the battle, the 8.9-inch Kindle Fire HD better be pretty nimble on its feet, while able to throw that all important knockout punch.

Short version of this story: the Kindle Fire HD 8.9 does some serious damage, but the iPad 4th Gen gets the decision and retains the tablet leader title.

The Kindle Fire HD 8.9 is by no means a failure. In many ways, it’s as good as the smaller Kindle Fire HD, but throughout my tests I noticed odd bugs and glitches (which should all be fixable by software) and a somewhat disturbing lack of power that’s especially obvious when you put the Fire HD 8.9 next to the iPad 4th Gen

What It Is

If you’ve never seen an iPad and someone handed you the Kindle Fire HD .9, you’d likely say its jet-black, soft-to-the-touch plastic body felt good in your hands and was more than effective at all the core tasks (reading, game playing, e-mail, web browsing).

Design-wise, the 8.9 device looks exactly like the 7-inch model, complete with the too-hard to find volume and power buttons. There are no other physical buttons on this device, but Amazon chooses to hide the few it has by making them the exact same color as the chassis and flush with the body. Every time I use the tablet I do the “where’s the damn button” dance, rotating the Kindle Fire HD round and round until I feel the buttons (since I can barely see them).

I have applauded Barnes & Noble for putting the physical “N” home button right on the face of their Nook HD. Bravo for having the guts to do this. Amazon apparently looks at Apple’s iPad home button and thinks to have anything similar would be seen as “copying” the Cupertino hardware giant, when instead they should realize that it works, consumers like it and tablets without it are at a distinct disadvantage.

Amazon’s interface has you make do with a virtual, slide-out home button that is always available. Problem is, I found times when it wasn’t available. When I played Spider-Man and Asphalt 7, the tiny little left-had bar would disappear and I couldn’t exit the game unless I hit the sleep/power button.

The rest of the Kindle Fire HD 8.9′s body is solid and unremarkable (if you read my Kindle fire HD 7 review, then you know exactly what to expect.). Like the iPad 4th Gen, the Kindle Fire HD 8.9 has a front-facing 720p-capable camera. It’s useful for capturing video, snapping 1 Megapixel images and, probably most important, Skype video chats. Skype has built a fairly sharp-looing Kindle Fire app, though the design doesn’t fully fit the larger 8.9-inch screen. Skype just updated its Android app for better tablet viewing and hopefully, we’ll see this update hit the Kindle Fire HD 8.9 as well.

The iPad also has an HD rear-facing camera. The Kindle fire HD 8.9 does not (Barnes & Noble leave out cameras altogether)

Not Packing a Punch

As a large-screen high-resolution tablet (though iPad’s 2048×1536 retina display beats it), the Kindle Fire HD 8.9 offers plenty of attractive screen real estate for web browsing, book and magazine reading and games. But the results can be mixed. Silk, Amazon‘s custom web browser, was occasionally less than responsive and games, though, they ran well, never looked half as good as they do on the considerably more expensive iPad 4.

Granted, you can’t always find the same high-quality immersive action games on both Android and iOS, but Asphalt 7 Heat is a notable exception and it throws the performance differences between the two tablets into stark contrast. Game play is equally responsive on both platforms: the Kindle Fire HD 8.9’s accelerometer reads my moves just as well as the iPad.

The graphics on the Kindle Fire HD, however, are reduced to blobs and blocks (palm trees without distinct leaves, buildings without discernible windows) . The iPad’s quad-core graphics simply overmatch the Kindle Fire. I have never, for example, seen an iPad draw the game as I was playing, as I did when I tried out The Amazing Spider-Man.

Additionally, I experienced more than my share of crashes with games and even magazine apps like Vanity Fair.

The Good

Not everyone, however, will compare the Kindle Fire HD 8.9 to the iPad. Some will see the $ 299 entry-level price point (for the 16 GB model) and appreciate the power, flexibility and utility of this device. Like all Fire’s before it, the Kindle Fire HD 8.9 makes it easy to consume mass quantities of content. Nearly every menu option: Games, Apps, Books, Music, Videos, Newsstand, puts you just one click away from shopping for fresh content. If you have an Amazon account (and who doesn’t) your desired book, music or movie is just a click away. Plus, you can still easily store any of it locally, and worry about running out of storage space, or in the cloud, and never worry about space or accessibility—you can get to that purchased Kindle content from any Kindle app or registered Amazon device.

Watching movies on the tablet is a pleasure. I streamed a couple through Amazon Prime; they looked good on the 1920 x 1200 screen and the Dolby Stereo speakers produced sharp, loud, almost room-filling sound—an impressive feat not even the iPad can match.

The Kindle Fire HD 8.9 also includes a mini-HDMI-out port, which prompted me to connect the tablet to my 47-inch LED HDTV so we could watch Disney’s Brave. Yes, I had to get up and tap on the Kindle screen each time I wanted to pause and restart the move, but otherwise, I was pretty impressed with how the Kindle handled the task.

Obviously I yearn for an Apple Airplay-like feature on Android tablets (rumor has it one is coming), but this is the next, best thing.

There isn’t a lot to say about the Kindle Fire HD 8.9-inch interface that I did not say in the Kindle Fire HD 7 review. I will note, however, that the increased real estate makes the trademark task carousel seem almost too big. Icons for everything from your recently played Spider-Man game to magazine apps, books and Web sites all sit side-by-side-by side. Some, like book covers, look gorgeous.

Others like a broken web-page link look stupid. Worse yet, none of them have labels, which can occasionally make it hard to identify which app or task you’re looking at. I’m just not sure this interface metaphor is sustainable.

Personally I prefer either the clean consistent look of iOS, or the uber-user friendly, family-oriented Nook HD profile-based one. Amazon may want to take a hard look at those and start over.

Staying Connected

The Kindle Fire HD 8.9 is also Amazon’s first cellular-based tablet. That fact puts it even more squarely in competition with the iPad (which obviously has always had 3G models and now offers blazing fast 4G LTE ones as well on all major carriers).

Amazon’s mobile broadband plans are a little more conservative, with just the AT&T 4G LTE option (the 32 GB 4G model that I tested lists for $ 499, which is still $ 224 less than a comparable iPad 4th Gen).

In my experience, the connectivity is superfast and fairly ubiquitous. Amazon‘s $ 49 (a year) flat fee plan is attractive, but with a cap of 250MB per month of data, it’s unlikely it will satisfy the most data-hungry users. If you do need more data, users can also get 3GB and 5GB data plans directly from AT&T on the device.

At press time, Amazon had not enabled streaming video over LTE. Having it sounds nice, but even with the most generous data plans, streaming video would eat it up faster than you can say, “I’m streaming Back to the Future in HD over 4G LTE on my Kindle fire HD!”

The reality for most users is that WiFi is plentiful and you’ll be hard pressed to find a spot where you can’t connect for free or a small one-off fee. It’s the reason Barnes & Noble’s line of HD Nooks do not include a cellular option.

Review continues after FreeTime Gallery

FreeTime

Kindle HD FreeTime Start

Click here to view this gallery.

Perhaps the best new addition to the Kindle Fire family is not a piece of hardware or new component, but the new FreeTime app. Amazon put a lot of loving care into this parental control interface, but almost mucks the whole thing up by hiding the tool under an app that you have to scroll down to (or search) to find. By contrast profiles and age and content controls are baked into the Barnes & Noble Nook HD in a way that makes them impossible to ignore.

Even so, once you do access FreeTime, I think you’ll be pleased with the level of control it gives you. I added test profiles for my two children and then hand-picked every app and piece of content they could access. I was also able to block broadband mobile and even set time limits for access to content and overall screen viewing time (on a per profile basis). The set-up is a bit wonky and it bizarrely switches between landscape and profile screens, but I still applaud the effort. It would make sense for Amazon to move FreeTime into a device set-up screen. If the user has no additional family members or kids using the device, they can easily skip it.

To Buy or Not to Buy

Amazon’s expansive content and shopping ecosystem has always been a strong draw and it’s just as good in this large screen tablet as it was in the very first Kindle Fire. Still, you have to compare it with the equally strong iOS ecosystem, which is no slouch in the content shopping department. Apple doesn’t connect you as seamlessly to physical products, but there’s nothing difficult about shopping on Amazon.com via your iPad. It’s also notable that tablet competitor Barnes & Noble has added movie and TV viewing, rental and purchase.

Ultimately, all of these tablets are offering more and more of the same content options, apps, and features. The decision will likely come down to price, app selection, interface and overall ease of use. The Amazon Kindle fire HD 8.9 scores well on all of these, but does not always lead.

For the price, it’s a great value, but I want Amazon to focus on hardware and interface design for the next big update. Then, they may get my full endorsement.

This story originally published on Mashable here.

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Do drunks have to go to the ER?

NEW YORK (Reuters Health) – With the help of a checklist, ambulance workers may be able to safely reroute drunk patients to detoxification centers instead of emergency rooms, according to a new study.

Researchers in Colorado found no serious medical problems were reported after 138 people were sent to a detox center to sleep it off, instead of to an ER.

In 2004, according to the researchers, it’s estimated that 0.6 percent of all U.S. ER visits were made by people without any problems other than being drunk. Those visits ended up costing about $ 900 million.

“Part of the issue has been – as it is in many busy ER departments – there’s a lot of chronic alcoholics that are brought in by ambulance, police or just come in. Often they are brought in because they have not committed a crime or there is limited space in our detoxification center. So the majority were brought to the ER department,” said Dr. David Ross, the study’s lead author from Penrose-St. Francis Health Services in Colorado Springs.

Ross said the ambulance company where he serves as medical director created the checklist with the help of the local detox center, which provided limited medical care by a nurse, and the local hospitals to reduce the number of drunks without medical needs being sent to the local ERs.

They created a checklist with 29 yes-or-no questions, such as whether the patient is cooperating with the ambulance worker’s examination and if the patient is willing to go to the detox center.

The patient was sent to the ER if the ambulance worker checked “no” on any question.

The researchers then went back to look at the patients they transported between December 2003 and December 2005 to see whether or not any of them ended up having serious medical problems at the detox center.

During that two year period, the ambulance workers transported 718 drunks. The detox center received 138 and the local ERs got 580.

Overall, 11 of the patients who were taken to detox were turned away because there was no room, their blood alcohol level exceeded the limit, their family came to pick them up or they were combative.

Another four patients at the detox center were taken to the ER because of minor complications, including chest and knee pain. However, there were no serious complications reported.

“We really believe that we did not miss anybody with a serious illness and injury that didn’t go to the ER as they should have,” said Ross.

But the researchers write in the Annals of Emergency Medicine that their study did have some limitations.

Specifically, the researchers did not plan in advance to do a study when they were creating the checklist, which means their findings are limited to whatever information was collected at the detox center and ERs.

Also, the number of people who were sent to the detox center in their study is relatively small, so it’s hard to tell how many serious complications they’d see among a larger group of people.

“We tried to estimate how likely we would have been to encounter a serious event… We estimated at most we’d encounter three serious adverse events (in 748 patients),” Ross told Reuters Health.

SOURCE: http://bit.ly/QgPCT5 Annals of Emergency Medicine, online November 9, 2012.

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Black Friday starts on Thursday right after Thanksgiving dinner

Black Friday is the Super Bowl of retail, but some of the nation's largest big-box stores can't wait until the day after Thanksgiving to open their doors to shoppers eager to grab great deals the same day as their turkey dinners.

Traditional Black Friday door-busting deals now start tonight, on what's been dubbed Gray Thursday. Major retail stores such as Kmart, Toys R Us, Walmart and Sears will open their doors beginning at 8 p.m. Target will join the party an hour later.

"It's traditionally been the day after Thanksgiving when the stores go into the black, where they make all their money. But that's not true anymore," retail expert Michelle Madhock said.

With Black Friday sales starting Thursday, that means lines started forming Wednesday, or in some extreme cases a week before as bargain hunters tried to get a turkey leg up on their competition.

READ: The Best Black Friday Freebies 2012

Luciana Pendleton pitched a tent outside a Deptford Township, N.J., Best Buy Monday fully equipped with all she needed to spend the next few days away from home so she could be first in line when the doors open.

"I am just happy I beat my competition. They pulled up here around 3 p.m., and we were already here so I was happy," she said Monday.

READ: How to Beat Black Friday Stress

Last year, some sale seekers became a little too excited and turned holiday shopping into a contact sport. In one ugly incident, a woman was accused of unleashing pepper spray on other shoppers in a dash for electronics at Walmart in Los Angeles.

This year, stores are beefing up security, and Best Buy even participated in training drills to handle the large crowds. More than 147 million people plan to shop this weekend, according to the National Retail Federation.

The hottest deals that are up for grabs this year include a 46-inch Samsung LED flat screen TV at Walmart with $200 off the original price. If that's not good enough, Sears has knocked $500 off the price of a 50-inch Toshiba flat screen. Target is offering the Nook Simple Touch at half price.

Black Friday officially kicks off at midnight for Best Buy, Sports Authority and Macy's.

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Ivory Coast: New prime minister named

ABIDJAN, Ivory Coast (AP) — President Alassane Ouattara has tapped Foreign Minister Daniel Kablan Duncan to serve as prime minister in a new government one week after the surprise dissolution of cabinet.

The appointment of Duncan, a member of the PDCI party of former President Henri Konan Bedie, was announced at a press conference Wednesday by Amadou Gon Coulibaly, general secretary of the presidency.

Ouattara dissolved the cabinet last week over a feud between his political party and the PDCI over proposed changes to the country’s marriage law.

The PDCI supported Ouattara in the November 2010 runoff election in exchange for the prime minister’s post, helping him defeat incumbent President Laurent Gbagbo. Gbagbo’s refusal to cede office led to five months of violence that claimed at least 3,000 lives before Ouattara’s forces won.

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PlayStation Mobile Now Lets PS Vita Owners Create Their Own Games

Think you (or someone you know) has what it takes to write games for the PlayStation Vita? Sony just opened up its PlayStation Mobile game store to anyone who wants in. All you need is a half-decent Windows PC and a Vita, and the cash for a $ 99 developer fee — the same yearly price Apple charges.

​How PlayStation Mobile fits in

PlayStation Mobile isn’t the same thing as the PlayStation Store, where you can buy most PlayStation games and downloadable content. It’s more like a separate department that’s only on the PlayStation Vita and on PlayStation Certified Android devices like Sony’s smartphones and tablets.

In a nutshell, it’s Sony’s version of Xbox Live Indie Arcade, except that it’s for portable PlayStation consoles instead of home Xbox ones. It’s where small, indie studios can get their work published and featured, and where PlayStation Vita owners can look for unique, inexpensive game titles.

​How developers can get started

Game developers can start with PlayStation Mobile by registering on its developer site. After that, they download the PlayStation Mobile SDK (software development kit), and get to work on their games. Third-party software like the free Blender 3D modeling program can be used to create in-game art assets, while the SDK itself is powered by the open source Mono version of C#, the same programming language used by Xbox Live Indie Arcade’s XNA toolkit.

​How PlayStation Mobile compares to other game and app markets

For starters, the $ 99 annual fee and the cost of a PlayStation Vita or PlayStation Certified device put it right up there with Apple’s App Store in terms of up-front expense, except that you don’t have to buy a Mac to write things for it. This is a lot more than the $ 25 one-time fee to get in to the Google Play store, which you can use pretty much any computer and Android device to write for. On the other hand, anyone who’s considering writing PlayStation Vita games probably already owns a Vita to begin with.

Developers aren’t allowed to write non-game apps for PlayStation Mobile, unlike with most markets. Pretty much the only apps seen on the Vita so far are official licensed ones like YouTube and Flickr, while PlayStation Certified devices running the Android OS get their apps from the Google Play store anyhow.

Perhaps the strangest restriction? Developers don’t get to set their own games’ price. They instead specify a “wholesale price,” as though they were selling their games to Sony, and it decides how much to sell them for. In essence, the company chooses its own profit margin on a per-game basis, unlike most app markets’ 70/30 split. It also seems to be able to decide when and whether games go on sale.

​Success stories?

Rami Ismail told “The Story of Super Crate Box” on the PlayStation Blog, explaining how he and a fan managed to bring an iOS game that he’d already made to the PlayStation Vita on very short notice. He said the game “feels right at home” on the portable console, while Joystiq’s JC Fletcher calls the Vita port “the definitive version.” As for whether it’s selling well or not, though, we may have to wait to find out.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

Gaming News Headlines – Yahoo! News

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Tom Hanks, Will Farrell offer custom recordings

NEW YORK (AP) — Imagine having William Shatner supply your outgoing voicemail message. Or maybe you’d prefer Morgan Freeman coolly telling callers to wait for the beep. Or perhaps having Betty White joke around is more your speed.

All it takes is $ 299 and some luck.

The advocacy group Autism Speaks is offering custom-recorded messages from those celebrities as well as Will Ferrell, Carrie Fisher, Tom Hanks, Derek Jeter, Leonard Nimoy, Patrick Stewart and Ed Asner.

From Dec. 3 to Dec. 9, a limited number of 20-second long MP3 messages will be recorded by each celebrity on a first-come, first-served basis for fans to do with as they wish. All requests must be of the PG variety.

Asner, the curmudgeonly Emmy Award winner of “The Mary Tyler Moore Show” and “Lou Grant,” dreamed up the unusual fundraiser with his son Matt, who works for Autism Speaks.

“I think people will get a charge out of it,” says Asner, who is currently on Broadway in the play “Grace.” ”I’ll probably say, ‘What are you wearing?’ Or, ‘Take it off.’ Something like that.”

All proceeds will support autism research and advocacy efforts.

If he could get a message from one of the other stars participating, which would Asner want?

“I’m awfully stuck on Will Ferrell, having been subjected to him in ‘Elf,’” Asner says. “But they’re all such standouts — Patrick Stewart, Leonard Nimoy, Shatner. The list doesn’t stop. Even Betty White,” he adds about his “MTM” co-star. “She’s still got some good left in her.”

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“Irrational” factors may drive end of life access to radiation

NEW YORK (Reuters Health) – Access to radiation treatments to ease cancer symptoms in the last days of life may be driven by costs and other non-medical considerations, a new U.S. study concludes.

Researchers looking at Medicare claims over nearly a decade found that only a small proportion of cancer patients received radiation in their final 30 days of life, but of those who did get the treatment – typically used to ease pain and other symptoms in the terminal stages of the disease – one in five got more than the recommended number of doses.

“The use of radiation itself was low, what was high was the percentage of patients who were getting 10 days or more,” said Dr. Ashleigh Guadagnolo of the MD Anderson Cancer Center at the University of Texas, who led the study.

Guadagnolo declined to comment on whether the number of treatments was appropriate, but one cancer expert said that the study showed wasteful, irrational thinking behind some radiation therapy.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that while radiation therapy for palliative care is reasonable, 10 or more treatments for patients during the last month of life is a “waste of resources.”

The conundrum, Brawley told Reuters Health, was that patients who received radiation got too much, but that too many patients who could have benefited from radiation got no therapy.

“This study shows there’s a lot of irrationality in how we treat patients,” said Brawley, who was not involved in the new work.

Doctors use radiation not only to blast away cancer cells and tumors when attempting to cure cancer, but also as an alternative to steroids and pain medications to relieve bleeding and painful symptoms when cancer spreads to the bones, brain and spine.

Many previous studies have focused on the use of chemotherapy at the end of a cancer patient’s life, but the new report, published Monday in the Journal of Clinical Oncology, is the first to examine how doctors use radiation with terminal patients, according to Guadagnolo’s team.

The researchers were interested specifically in what factors might determine when radiation treatment is given to terminal cancer patients, and especially whether Medicare payment policies have any influence on the treatment’s use.

So the researchers evaluated more than 202,000 Medicare claims for patients over age 65 who died from the five most common cancers in the U.S., including lung, breast, prostate, colorectal and pancreatic cancers between 2000 and 2007.

They assumed that most radiation treatments during a patient’s final 30 days were palliative, that is, meant to treat symptoms rather than to cure the cancer.

Overall, about 15,000 patients (a little more than seven percent) received radiation therapy in the last month of life. And of those, almost 18 percent spent more than 10 of their final 30 days getting radiation treatments.

Factors that were linked to receiving 10 or more treatments included being white, not receiving hospice care and being treated in a freestanding cancer treatment facility rather than a university-associated hospital.

The costs for patients who got radiation treatment amounted to an additional $ 3,453 per patient, on average. However, among those who were getting hospice care and radiation, the combined costs were $ 2,675 less than the costs for patients who got neither radiation nor hospice care.

Medicare caps payments for patients who elect hospice care at a daily rate that’s below what a radiation treatment would cost, the report points out. And a general decline in the use of radiation from 2000 to 2007 tracks with an increase in hospice use.

Besides cost, previous research has also found a variety of barriers to access in the use of radiation therapy at the end of life, including race, sex, household income, nursing home residence and travel time to a hospital, the authors note.

“The take home message for me from this study was that it’s not likely the case that we’re going to save money by forgoing radiation and in fact, radiation is probably a little bit underutilitzed,” Dr. Stephen Lutz, a radiation specialist at the Blanchard Valley Regional Cancer Center in Ohio, told Reuters Health. Lutz was not involved in the study.

Dr. Michael Steinberg, a radiation oncologist at the David Geffen School of Medicine at UCLA, said the costs need to be put into context. Many patients in his practice don’t want to be on narcotics or steroids that can cause many unpleasant side effects such as mental fogginess.

“(Narcotics and steroids) are not necessarily solutions, this is more like warehousing very old patients and something to be avoided, if you can control the pain with a short course of radiation, there is a value proposition,” said Steinberg, who was not involved in the new study.

On the other hand, radiation therapy to lessen cancer symptoms has limits since its pain-reducing effects can take days as opposed to hours for narcotics, noted Dr. Stephen Gripp, a radiation oncologist at the University Hospital Düsseldorf at Heinrich-Heine-University.

Plus, there’s the inconvenience factor.

“Radiotherapy (transport, positioning on the table, waiting) is annoying or even painful for terminally ill patients,” Gripp told Reuters Health in an email.

In past research, radiation oncologists have examined how many treatments are appropriate for end-of-life care and found in some cases, such as bone metastasis, a single treatment is just as effective in reducing pain as multiple treatments.

However, doctors tend to be reluctant to use fewer treatments for patients who are near death, Lutz said, because they are unsure how long the patient will survive and benefit from the treatments.

In 2011, the American Society for Radiation Oncology, a trade group, published guidelines to help doctors reduce the number of treatments for patients with bone metastasis.

The study was unable to “tell why patients got radiation; nor do we have any data in this study on what benefit they received or whether it improved their quality of life,” Guadagnolo told Reuters Health.

The study had other shortcomings, Steinberg noted.

“When you look at cost – why do these patients cost more to get the radiation – it’s not just because of the radiation, they’re typically getting a lot of other things as well,” Steinberg said.

Experts said that the long-term risks for radiation therapy in terminal patients were negligible, and most patients wouldn’t survive to see any longer-term side effects.

“This is more about a broken payment system than anything about radiation overdose,” Steinberg concluded.

SOURCE: http://bit.ly/UR8kwk Journal of Clinical Oncology, online November 19, 2012.

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Silent skies over Gaza after cease-fire

The rockets and missiles fell silent over Gaza for the first time in eight days today, but gunfire erupted in the crowded streets of the Palestinian enclave to celebrate the announcement of a ceasefire in the bloody conflict between Israel and Hamas.

The two sides fired final salvos at one another up until the final moments before the 2 p.m. ET cease-fire deadline. At least one Israeli missile landed at 1:57 p.m. ET in Gaza, and four rockets were launched toward the Israeli province of Beer Sheva at 1:59 p.m. ET.

After 2 p.m. ET, however, the sky was finally empty of munitions.

The eight days of fighting left 130 Palestinans and five Israelis dead, and badly damaged many of Gaza's buildings. A bomb that exploded on a bus in Tel Aviv earlier today left an additional 10 Israelis wounded.

The fighting came to an end after a meeting between Egyptian President Mohammed Morsi and U.S. Secretary of State Hillary Clinton.

"This is a critical moment for the region," Clinton said after the meeting, standing next to Egyptian Foreign Minister Mohamed Kamel Amr to announce the deal.

"The people of this region deserve a chance to live free of fear and violence and today's agreement is a step" in that direction, Clinton said. "Now we have to focus on reaching a durable outcome."

Clinton said that Egypt and the U.S. would help support the peace process going forward.

"Ultimately every step must move us toward a comprehensive peace for people of the region," she said.

Israeli Prime Minister Benjamin Netanyahu confirmed the cease-fire from Tel Aviv after Clinton's announcement.

"I agree that that it was a good idea to give an opportunity to the cease-fire... in order to enable Israeli citizens to return to their day to day lives," Netanyahu said.

He reiterated that it was vital to Israel's security to "prevent smuggling of arms to terrorist organizations" in the future.

An Israeli official told ABC News that the ceasefire would mean a "quiet for quiet" deal, in which both sides stop shooting and "wait and see what happens."

"Who knows if the ceasefire will even last two minutes," the official said. The official said that any possible agreement on borders and blockades on the Gaza/Israel border would come only after a period of quiet.

Clinton and Morsi met for three hours in Cairo today to discuss an end to the violence. The secretary of state met with Netanyahu Tuesday night for more than two hours, saying she sought to "de-escalate the situation in Gaza."

The fighting dragged on Tuesday night and Wednesday morning despite Hamas officials declaring publicly Tuesday afternoon that they expected a cease-fire would be announced Tuesday night, after Clinton and Netanyahu's talks.

The airstrikes by the Israeli Defense Forces overnight hit government ministries, underground tunnels, a banker's empty villa and a Hamas-linked media office. At least four strikes within seconds of each other pulverized a complex of government ministries the size of a city block, rattling nearby buildings and shattering windows.

Hours later, clouds of acrid dust still hung over the area and smoke still rose from the rubble. Gaza health officials said there were no deaths or injuries.

On Wednesday morning, the IDF said they had destroyed 50 underground rocket launching sites in Gaza. They also said that Israel's "Iron Dome" missile shield intercepted two rockets from Gaza into Israel overnight as well.

Around 12 p.m. in Israel, however, a bomb exploded on a public bus near the nation's military headquarters in Tel Aviv, in one of the city's busiest areas. Israel police said the explosion was a terrorist attack, the first in Israel since 2006.

Upon landing in Cairo to meet with Morsi, Clinton released a statement condemning the attack.

"The United States strongly condemns this terrorist attack and our thoughts and prayers are with the victims and the people of Israel. As I arrive in Cairo, I am closely monitoring reports from Tel Aviv, and we will stay in close contact with Prime Minister Netanyahu's team. The United States stands ready to provide any assistance that Israel requires," she said.

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AP Exclusive: Syrian rebels seize base, arms trove

BASE OF THE 46TH REGIMENT, Syria (AP) — After a nearly two-month siege, Syrian rebels overwhelmed a large military base in the north of the country and made off with tanks, armored vehicles and truckloads of munitions that rebel leaders say will give them a boost in the fight against President Bashar Assad‘s army.

The rebel capture of the base of the Syrian army’s 46th Regiment is a sharp blow to the government’s efforts to roll back rebels gains and shows a rising level of organization among opposition forces.

More important than the base’s fall, however, are the weapons the rebels found inside.

At a rebel base where the much of the haul was taken after the weekend victory, rebel fighters unloaded half a dozen large trucks piled high with green boxes full of mortars, artillery shells, rockets and rifles taken from the base. Parked nearby were five tanks, two armored vehicles, two rocket launchers and two heavy-caliber artillery cannons.

Around 20 Syrian soldiers captured in the battle were put to work carrying munitions boxes, barefoot and stripped to the waist. Rebels refused to let reporters talk to them or see where they were being held.

“There has never been a battle before with this much booty,” said Gen. Ahmad al-Faj of the rebels Joint Command, a grouping of rebel brigades that was involved in the siege. Speaking on Monday at the rebel base, set up in a former customs office at Syria’s Bab al-Hawa border crossing with Turkey, he said the haul would be distributed among the brigades.

For months, Syria’s rebels have gradually been destroying government checkpoints and taking over towns in the northern provinces of Idlib and Aleppo along the Turkish border.

Rebel fighters say that weapons seized in such battles have been essential to their transformation from ragtag brigades into forces capable of challenging Assad’s professional army. Cross-border arms smuggling from Turkey and Iraq has also played a role, although the most common complaint among rebel fighters is that they lack ammunition and heavy weapons, munitions and anti-aircraft weapons to fight Assad’s air force.

It is unclear how many government bases the rebels have overrun during the 20-month conflict, mostly because they rarely try to hold captured facilities. Staying in the captured bases would make them sitting ducks for regime airstrikes.

“Their strategy is to hit and run,” said Elias Hanna, a retired Lebanese army general and Beirut-based strategic analyst. “They’re trying to hurt the regime where it hurts by bisecting and compartmentalizing Syria in order to dilute the regime’s power.”

The 46th Regiment was a major pillar of the government’s force near the northern city of Aleppo, Syria’s economic hub, and its fall cuts a major supply line to the regime’s army, Hanna said. Government forces have been battling rebels for months over control of Aleppo.

“It’s a tactical turning point that may lead to a strategic shift,” he said.

At the 46th Regiment’s base, about 25 kilometers (15 miles) west of Aleppo, the main three-story command building showed signs of the battle — its walls punctured apparently from rebel rocket attacks. The smaller barracks buildings scattered around the compound, about 2.6 square kilometers (1 square mile) in size, had been looted, with mattresses overturned. A number of buildings had been torched.

Reporters from The Associated Press who visited the base late Monday saw no trace of the government troops who had been defending it — other than the dead bodies of seven soldiers.

Two of them, in camouflage uniforms, lay outside the command building. One of them was missing his head, apparently blown off in an explosion.

The rest were in a nearby clinic. Four dead soldiers were on stretchers set on the floor, one with a large gash in his arm, another with what appeared to be a large shrapnel hole in the back of his head. The last lay on a gurney in another room, his arms and legs bandaged, a bullet hole in his cheek and a splatter of blood on the wall and ceiling behind him as if he had been shot where he lay.

It could not be determined how or when the soldiers had been killed.

The final assault that took the base came after more than 50 days of siege that left the soldiers inside demoralized, according to fighters who took part.

Working together and communicating by radio, a number of different rebels groups divided up the area surrounding the base and each cut the regime’s supply lines, said Abdullah Qadi, a rebel field commander. Over the course of the siege, dozens of soldiers defected, some telling the rebels that those inside were short of food, Qadi said.

The rebels decided to attack Saturday afternoon when they felt the soldiers inside were weak and the rebels had enough ammunition to finish the battle, Qadi said. The battle was over by nightfall on Sunday. Seven rebel fighters were killed in the battle, said al-Faj of the rebels’ Joint Command. Other rebel leaders gave similar numbers.

It remains unclear how many soldiers remained in the base when the rebels launched their attack and what happened to them.

Al-Faj said all soldiers inside were either killed or captured. He said he didn’t know how many were killed, but that the rebels had taken about 50 prisoners, all of whom would be tried in a rebel court. Aside from the 20 prisoners seen at the rebel’s Bab al-Hawa base, the AP was unable to see any other captured soldiers.

The Syrian government does not respond to requests for comment on military affairs and said nothing about the base’s capture. It says the rebels are terrorists backed by foreign powers that seek to destroy the country.

Disorganization has plagued the Syrian opposition since the start of the anti-Assad uprising in March 2011, with exile groups pleading for international help even when they have no control over those fighting inside of Syria.

A newly formed Syrian opposition coalition received a boost Tuesday, when Britain officially recognized it as the sole representative of the Syrian people.

The National Coalition of the Syrian Revolutionary and Opposition Forces was formed in the Gulf nation of Qatar on Oct. 11 under pressure from the United States for a stronger, more united opposition body to serve as a counterweight to more extremist forces.

British Foreign Secretary William Hague said Tuesday the body’s members gave assurances to be a “moderate political force committed to democracy” and that the West must “support them and deny space to extremist groups.”

The United States and the European Union have both spoken well of the body but stopped short of offering it full recognition.

Key to the body’s success will be its ability to build ties with the disparate rebel groups fighting inside Syria. Many rebel leaders say they don’t recognize the new body, and a group of extremist Islamist factions on Monday rejected it, announcing that they had formed an “Islamic state” in Aleppo.

Anti-regime activists say nearly 40,000 people have been killed since Syria’s crisis started 20 months ago.

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Associated Press write Elizabeth Kennedy contributed reporting from Beirut, Lebanon.

Middle East News Headlines – Yahoo! News

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