OB/GYNs back over-the-counter birth control pills

WASHINGTON (AP) — No prescription or doctor's exam needed: The nation's largest group of obstetricians and gynecologists says birth control pills should be sold over the counter, like condoms.

Tuesday's surprise opinion from these gatekeepers of contraception could boost longtime efforts by women's advocates to make the pill more accessible.

But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance.

Still, momentum may be building.

Already, anyone 17 or older doesn't need to see a doctor before buying the morning-after pill — a higher-dose version of regular birth control that can prevent pregnancy if taken shortly after unprotected sex. Earlier this year, the Food and Drug Administration held a meeting to gather ideas about how to sell regular oral contraceptives without a prescription, too.

Now the influential American College of Obstetricians and Gynecologists is declaring it's safe to sell the pill that way.

Wait, why would doctors who make money from women's yearly visits for a birth-control prescription advocate giving that up?

Half of the nation's pregnancies every year are unintended, a rate that hasn't changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor's visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn't require a prescription, women could "pick it up in the middle of the night if they run out," she said. "It removes those types of barriers."

Tuesday, the FDA said it was willing to meet with any company interested in making the pill nonprescription, to discuss what if any studies would be needed.

Then there's the price question. The Obama administration's new health care law requires FDA-approved contraceptives to be available without copays for women enrolled in most workplace health plans.

If the pill were sold without a prescription, it wouldn't be covered under that provision, just as condoms aren't, said Health and Human Services spokesman Tait Sye.

ACOG's opinion, published in the journal Obstetrics & Gynecology, says any move toward making the pill nonprescription should address that cost issue. Not all women are eligible for the free birth control provision, it noted, citing a recent survey that found young women and the uninsured pay an average of $16 per month's supply.

The doctors group made clear that:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there's no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they'd like to discuss other forms of birth control such as implantable contraceptives that do require a physician's involvement.

The group didn't address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires girls younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers' ages. Presumably regular birth control pills would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don't require a prescription.

Switching isn't a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor's involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country's health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

"Being able to easily get the pill when you need it makes a difference," he said.

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Online:

OB/GYN group: http://www.acog.org

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Violence flares as Clinton seeks Gaza truce

GAZA/JERUSALEM (Reuters) - U.S. Secretary of State Hillary Clinton on Wednesday pursued a Gaza truce, with Israel and Hamas still at odds over key terms, as Israeli air strikes shook the enclave and a bomb exploded on a Tel Aviv bus.

After talks in Ramallah with Palestinian President Mahmoud Abbas, Clinton held a second meeting with Israeli Prime Minister Benjamin Netanyahu before heading to Egypt, the main broker in efforts to end eight days of fighting and avert a possible Israeli ground offensive.

In Tel Aviv, at least 10 people were wounded when a bus was blown up on a main street near the Defence Ministry and military headquarters. Israel's government called it a terrorist attack.

The explosion, which police said was caused by a bomb placed on the vehicle, touched off celebratory gunfire from militants in Gaza and threatened to complicate truce efforts.

Israel's best-selling Yedioth Ahronoth newspaper said an emerging outline of a ceasefire agreement called for Egypt to announce a 72-hour ceasefire followed by further talks on long-term understandings.

Under the proposed document, which the newspaper said neither party would be required to sign, Israel would hold its fire, end attacks against top militants and promise to examine ways to ease its blockade of the enclave.

Hamas, the report said, would pledge not to strike any Israeli target and ensure other Palestinian factions in the Gaza Strip also stop their attacks.

An Israeli political source said differences holding up a deal centered on a Hamas demand to lift the Gaza blockade completely and the kind of activity that would be allowed along the frontier, where Israeli troops often fire into the enclave to keep Palestinians away from an area near a border fence.

Hamas official Ezzat al-Rishq said the main stumbling block was "the temporary timeframe for a ceasefire that the Israelis want us to agree to".

"GOOD INTENTIONS"

The London-based Al Hayat newspaper, citing sources in Hamas and Islamic Jihad, said Israel wanted a 90-day period to determine "good intentions" before discussing Palestinian demands, a position the report said the groups have rejected.

Rishq said a short-term truce, whose proposed duration he did not disclose, "would only buy (Israel) time" until a general election in January and "we would have accomplished nothing in the way of a long-term truce".

Hamas sources said the group was also demanding control over Gaza's Rafah borders with Egypt, so that Palestinians could cross easily, and Israeli guarantees to stop assassinating Hamas leaders.

Israel, one of the Hamas sources said, wanted a commitment from the group to stop smuggling through tunnels that run into Gaza under the Egyptian border. The tunnel network is a conduit for weapons and commercial goods.

News of the Tel Aviv bus bombing, the first serious blast in Israel's commercial capital since 2006, emerged just after Clinton and Netanyahu ended their meeting. A spokesman for Netanyahu declined to give details on their discussions, which followed talks on Tuesday.

Clinton, who flew to the region from an Asian summit, said in her public remarks after Tuesday's meeting with Netanyahu that it was "essential to de-escalate the situation".

"The rocket attacks from terrorist organizations inside Gaza on Israeli cities and towns must end and a broader calm restored," she said.

Clinton earlier assured Netanyahu of "rock-solid" U.S. support for Israel's security, and praised Egyptian President Mohamed Mursi's "personal leadership and Egypt's efforts thus far" to end the Gaza conflict and promote regional stability.

"As a regional leader and neighbor, Egypt has the opportunity and responsibility to continue playing a crucial and constructive role in this process. I will carry this message to Cairo tomorrow (Wednesday)," she said.

"LONG-TERM" SOLUTION

Netanyahu told Clinton he wanted a "long-term" solution. Failing that, Netanyahu made clear, that he stood ready to step up the military campaign to silence Hamas' rockets.

"A band-aid solution will only cause another round of violence," said Ofir Gendelman, a Netanyahu spokesman.

While diplomatic efforts continued, Israel struck more than 100 targets in Gaza overnight, killing a Hamas gunman and destroying a cluster of Hamas government buildings.

Palestinians militants fired 31 rockets at Israel, causing no casualties, and Israel's Iron Dome interceptor system shot down 14 of them, police said.

Israel has carried out more than 1,500 strikes since the offensive began. Medical officials in Gaza said 139 Palestinians, most of them civilians, including 34 children, have been killed. Nearly 1,400 rockets have been fired into Israel, killing four civilians and a soldier, the Israeli military said.

In the West Bank city of Ramallah, Clinton held talks with Palestinian President Abbas, whose bid to upgrade the Palestinians' status at the United Nations, in the absence of peace negotiations with Israel, is opposed by Washington.

"Secretary Clinton informed the president that the U.S. administration is exerting every possible effort to reach an immediate ceasefire and the president expressed his full support for this endeavor," said Palestinian chief negotiator Saeb Erekat.

"Once the Israelis accept to stop their bombardments, their assassinations, there will be a comprehensive ceasefire sustained from all parties," Erekat said.

A Palestinian official with knowledge of Cairo's mediation told Reuters that Egyptian intelligence officials would hold further discussions on Wednesday with leaders of Hamas and the Islamic Jihad group.

"There may be a response from Israel that Egyptian mediators want to present to Hamas and Islamic Jihad leaders," the official said. "Let's be hopeful it would be something Palestinian factions can accept."

Like most Western powers, Washington shuns Hamas as an obstacle to peace and has blamed it for the Gaza conflagration. A U.N. Security Council statement condemning the conflict was blocked on Tuesday by the United States, which complained that it "failed to address the root cause," the Palestinian rockets.

Hamas for its part is exploring the opportunities that last year's Arab Spring has given it to enjoy favor from new Islamist governments, and from Sunni Gulf powers keen to woo it away from Shi'ite Iran.

It may count on some sympathy from Mursi, although Egypt's first freely elected leader, whose Muslim Brotherhood inspired Hamas' founders, has been careful to stick by the 1979 peace deal with Israel struck by Cairo's former military rulers.

Along the Gaza border, Israeli tanks, artillery and infantry remained poised for a possible ground offensive in the densely populated enclave of 1.7 million Palestinians.

But an invasion, likely to entail heavy casualties, would be a major political risk for Netanyahu, who is currently favored to win the upcoming Israeli election. More than 1,400 Palestinians were killed in Israel's three-week war in the Gaza Strip in 2008-9, prompting international criticism of Israel.

(Additional reporting by Ari Rabinovitch in Jerusalem and Cairo bureau; Writing by Jeffrey Heller; Editing by Giles Elgood)

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How Asia sees Obama's pivot to the Pacific

TOKYO (AP) — A lot has happened in Asia while the United States was off fighting its wars in Iraq and Afghanistan, and most of it can be summed up in one word — China. Fueled by China's amazing growth and the promise of its huge and expanding consumer market, the Asia-Pacific region is now, as experts like to say, the global economy's center of gravity. Sorry, Europe.

But prosperity requires stability.

As President Barack Obama tours the region to push his year-old pivot to the Pacific policy, the big question on everybody's mind is how much of a role Washington, with its mighty military and immense diplomatic clout, can play in keeping the Pacific — well, pacific. Here's a look at how different countries perceive the U.S. Pacific policy and how it impacts them:

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CHINA: HOW NOT TO TRAIN YOUR DRAGON

As far as Beijing is concerned, Obama's pivot was pulled right out of the old Cold War containment playbook. Afraid of China's rise, Beijing believes, Washington is trying to enflame new tensions by isolating it and emboldening the countries that China has territorial disputes with, which is just about everybody with whom it shares a border.

"Using China's rise and the 'China threat' theory, the U.S. wants to convince China's neighbors that the Asia-Pacific needs Washington's presence and protection in order to 'unite' them to strike a 'strategic rebalance' against China in the region," security scholar Wang Yusheng wrote recently in the China Daily.

It's a strategy that's bound to lose, Beijing says.

China sees its rise as inevitable and unstoppable and believes its neighbors will ultimately opt for stronger ties while gradually excluding the U.S. Beijing also views its economic dominance as an unalloyed good. And as it tests out its first aircraft carrier, stealth jets, cyber capabilities and high-tech missiles, it is in an increasingly strong position to deny Washington access to its shores and some key Pacific sea lanes, which could be a problem if Obama's pivot ever has to go from push to shove.

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JAPAN: ALREADY FEELING THE PINCH

Without a doubt, Japan is Washington's most faithful security partner in the Pacific. And it's the most pinched by China's rise.

For months, Japan and China have been in an increasingly tense dispute over a group of small, uninhabited islands in the East China Sea. The near-constant presence of Chinese ships around them has stretched the Japanese Coast Guard to its limits. Japan's air force says Chinese surveillance flights in the area have increased significantly.

Wary of getting caught up in the volatile brew of nationalism, historical animosity and populist politics that is fueling the flare-up, the U.S. has been careful not to take sides. Instead, it has urged the two countries to work out their problems among themselves, diplomatically.

That has confounded many in Japan, which hosts 52,000 U.S. troops under a treaty signed in 1960 that obliges the U.S. to defend territories under Japanese administration. Washington has repeatedly affirmed that includes the isles at the center of the current tensions with China. Tokyo would have preferred at least some moral support to its claim.

"It's strange," said Kazuhiko Togo, a former senior diplomat who now heads the Institute for World Affairs at Kyoto Sangyo University. "I trust the U.S. as our ally, but we need to address this issue of U.S. 'neutrality.'"

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MEANWHILE, IN THE SOUTH CHINA SEA...

Washington took a similarly standoffish stance early this year in the dispute between China, Brunei, Malaysia, the Philippines, Vietnam and Taiwan over the South China Sea islands, believed to be rich in gas and oil and straddling busy shipping routes.

The Philippines — America's closest ally in that dispute — eventually pulled its ships out of the hotly contested Scarborough Shoal, but Chinese vessels have remained.

Manila-based political analyst Ramon Casiple said the disputes have left America's allies more aware of their own vulnerabilities and what they can — or can't — expect from the U.S.

"America's treading a very fine line," Casiple said. "It has to reassure its allies that at the end of the day the U.S. would be there for them." He added that the U.S. has made it clear it is not willing to risk a major confrontation in which its options would be limited "to either intervene or lose influence."

There is, however, one other thing it might do in the meantime.

When U.S. Defense Secretary Leon Panetta visited Vietnam in June, he hinted the Navy would like access to Cam Ranh, a deep water port facing the contested waters of the South China Sea. Hanoi's counter-proposal?

Lift a ban on selling it lethal weapons.

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TAIWAN: LEFT OUT IN THE COLD

Best friends forever? Not so much.

As China has gotten stronger and more important to the U.S. economy, Washington has become extremely wary of engaging Taiwan as a full security partner — a big pullback from the 1950s and the 1960s, when the two had a formal defense treaty and the U.S. based thousands of troops on what it considered a — if not the — key forward base to keep China at bay.

Today, cooperation is limited to some intelligence sharing, the training of Taiwanese air force personnel in the U.S., occasional security consultations and very restricted arms sales — definitely not the kind of advanced F-16 fighters and diesel submarines the Taiwanese military really wants.

Even so, political scientist Alexander Huang of Taipei's Tamkang University says Taiwan can play a role in Obama's pivot — but only if Washington decides to make a clear commitment.

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THE KOREAS: STEALTH OVER SEOUL?

Ah, North Korea.

It's got a new leader, about whom, typically, the world knows almost nothing, a nuclear weapons/ballistic missile program that it likes to trot out every so often to raise regional tensions and a belligerent attitude toward the U.S.

But Obama has a friend in Seoul.

Back in the 1950s, the U.S. fought on Seoul's side in the Korean War — and contemplated nuking China before it was over. China still supports the North, and Washington continues to have about 28,500 troops in the South. South Korea also buys about 70 percent of its weapons from the United States, and a big payday for an American company might come soon after Obama's inauguration, when South Korea is expected to formally announce the winner in a $7.6 billion project to build 60 sophisticated fighter jets.

The deal will be South Korea's biggest-ever weapons procurement. The top contender is believed to be Lockheed Martin's stealthy F-35 Joint Strike Fighter — which after a long run of development problems and cost overruns could certainly use a multi-billion dollar boost. Boeing and European aerospace giant EADS are also in the running.

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AUSTRALIA: LIVING WITH THE US MARINES

Australia got one of the first waves from the pivot when the U.S. announced last year it would begin rotating up to 2,500 U.S. Marines through the northern city of Darwin. Now the U.S. is seeking access to an Australian navy base south of the western city of Perth and to bombing ranges in the northern Outback.

Some experts fear the relationship may be moving too fast.

On one hand there is broad support for Australia's defense relationship with the U.S., so having American Marines was seen as a natural step. But it has also raised concerns that Washington will push for more — something Australia might not be ready for. After all China is central to Australia's economy, buying a bulk of its mineral and coal resources.

"What worries us is the way in which it seems to confirm that the United States and China are increasingly viewing each other as strategic rivals," said Hugh White, professor of strategic studies at Australian National University.

"We worry about the idea of the U.S.-China relationship becoming more adversarial," he said. "America wants to remain the dominant power in Asia, and China wants to become the dominant power in Asia.

"What the rest of us all want is for neither of them to be the dominant power in Asia."

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AP writers Christopher Bodeen in Beijing, Peter Enav in Taipei, Taiwan, Jim Gomez in Manila, Philippines, Hyung-jin Kim in Seoul, South Korea, Elaine Kurtenbach in Tokyo, Chris Brummitt in Hanoi, Vietnam, Jocelyn Gecker in Bangkok and Kristen Gelineau in Sydney contributed to this report.

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'Trapped' on Broadway? R. Kelly is working on it

NEW YORK (AP) — Is Broadway ready for Twan, Sylvester, Pimp Lucius and "the package"? R. Kelly thinks so — and says he's working to bring the wacky characters and plotlines in his even wackier "Trapped in the Closet" series to the Great White Way.

The superstar announced on Monday night that he's had an offer to bring the cult classic to the stage, and he may even be in some performances.

"To transform it into a Broadway version, that's what I'm working on," he told a packed house at the Sunshine Theater, where he unveiled the latest chapters in "Trapped in the Closet," which will debut on the IFC on Friday.

Kelly gave no other details about a possible Broadway adaptation of the wildly popular video opera. It got its start from a stirring series of songs Kelly debuted in 2005, which ended with a cliff-hanger. The songs captured so much attention, Kelly made an over-the-top video series about it that just got crazier and crazier as he added more chapters.

Kelly has often referred to "Trapped" as an alien, and on Monday, he said: "I'm glad to be one of the astronauts to take this thing to the unknown."

He thanked the enthusiastic crowd for accepting the series, and admitted that he always wanted to act: "Somehow, I landed 'Trapped in the Closet' from being silly."

He also joked about the ridiculous nature of the series.

"I'm just having a lot of fun. I don't have a job so I sit in the studio all day and think of stuff to do and this is just something stupid I've done that's been successful for me," he said. "I'm having a lot of fun with it."

The latest chapters introduce a few new faces, and like the others series, ends with a cliffhanger. While it's taken Kelly five years to add these latest chapters to the series, Kelly says he won't take as long to produce more.

"I want everybody to know I've got 85 chapters of 'Trapped in the Closet' waiting in the studio for y'all," he said. "The chapters that are coming — the show, we call it — is going to exceed every chapter that you have ever seen."

Kelly capped of the evening with a rendition of one of his biggest hits, "I Believe I Can Fly," for the audience.

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http://www.r-kelly.com

http://www.ifc.com

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Nekesa Mumbi Moody is the AP's Global Entertainment & Lifestyles Editor. Follow her at http://www.twitter.com/nekesamumbi

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New push for most in US to get at least 1 HIV test

WASHINGTON (AP) — There's a new push to make testing for the AIDS virus as common as cholesterol checks.

Americans ages 15 to 64 should get an HIV test at least once — not just people considered at high risk for the virus, an independent panel that sets screening guidelines proposed Monday.

The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a check-up, something a doctor can order with as little fuss as a cholesterol test or a mammogram. Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening.

Yet not nearly enough people have heeded that call: Of the more than 1.1 million Americans living with HIV, nearly 1 in 5 — almost 240,000 people — don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.

The updated guidelines will bring this long-simmering issue before doctors and their patients again — emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.

"It allows you to say, 'This is a recommended test that we believe everybody should have. We're not singling you out in any way,'" said task force member Dr. Douglas Owens of Stanford University and the Veterans Affairs Palo Alto Health Care System.

And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV — which includes gay and bisexual men and injecting drug users — were eligible for that no-copay screening.

There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.

Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.

Monday's proposal also recommends:

—Testing people older and younger than 15-64 if they are at increased risk of HIV infection,

—People at very high risk for HIV infection should be tested at least annually.

—It's not clear how often to retest people at somewhat increased risk, but perhaps every three to five years.

—Women should be tested during each pregnancy, something the task force has long recommended.

The draft guidelines are open for public comment through Dec. 17.

Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.

"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.

The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.

"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said — the reason that making it routine during any health care encounter could help.

But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 percent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 percent of ER patients known to be at increased risk were tested while there.

Mermin calls that "a tragedy. It's a missed opportunity."

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Clinton heads to Mideast amid Gaza crisis

GAZA CITY, Gaza Strip (AP) — Efforts to end a week-old convulsion of Israeli-Palestinian violence drew in the world's top diplomats on Tuesday, with President Barack Obama dispatching his secretary of state to the region on an emergency mission and the U.N. chief appealing from Cairo for an immediate cease-fire.

Israel and Gaza's militant Hamas rulers have staked out tough, hard-to-bridge positions, and the gaps keep alive the threat of an Israeli ground invasion. On Tuesday, grieving Gazans were burying militants and civilians killed in ongoing Israeli airstrikes, and barrages of rockets from Gaza sent terrified Israelis scurrying to take cover.

From Egypt, U.N. chief Ban Ki-moon said he came to the region because of the "alarming situation."

"This must stop, immediate steps are needed to avoid further escalation, including a ground operation," Ban said. "Both sides must hold fire immediately ... Further escalation of the situation could put the entire region at risk."

U.S. Secretary of State Hillary Rodham Clinton departed for the Mideast on Tuesday from Cambodia, where she had accompanied Obama on a visit. Clinton is to meet with Israeli Prime Minister Benjamin Netanyahu in Jerusalem, Palestinian President Mahmoud Abbas in the West Bank and Egyptian leaders in Cairo, according to U.S. and Palestinian officials.

The U.S. considers Hamas, which has killed hundreds of Israelis in suicide and other attacks, to be a terror group and does not meet with its officials. Washington blames Hamas rocket fire for the latest eruption of violence and says Israel has the right to defend itself. At the same time, it has cautioned that a ground invasion could send casualties spiraling.

By Tuesday, 115 Palestinians, including 54 civilians, have been killed since Israel mounted an air onslaught that has so far included nearly 1,500 strikes. Some 840 people have been wounded, including 225 children, Gaza health officials said.

Three Israeli civilians have also been killed and dozens wounded since the fighting began last week, the numbers possibly kept down by a rocket-defense system Israel developed with U.S. funding. More than 1,000 rockets have been fired at Israel this week, the military said.

Netanyahu said Tuesday that Israel wouldn't balk at a broader military operation.

"I prefer a diplomatic solution," Netanyahu said in a statement after meeting with Germany's foreign minister, Guido Westerwelle, who is also in the region trying to advance peace efforts. "But if the fire continues, we will be forced to take broader measures and will not hesitate to do so."

Successive Israeli governments have struggled to come up with an effective policy toward Hamas.

Neither Israel's economic blockade of the territory of 1.6 million people nor bruising military strikes have cowed Gaza's Islamists, weakened their grip on the coastal strip or fire rockets at the Jewish state.

An Israeli ground invasion would risk Israeli troop losses, and could send the number of Palestinian civilian casualties ballooning — a toll Israel could be reluctant to risk just four years after its last invasion drew allegations of war crimes.

Still, with Israeli elections just two months away, polls show Israeli public sentiment has lined up staunchly behind the Netanyahu government's offensive.

Turkey's foreign minister and a delegation of Arab League foreign ministers headed to Gaza on Tuesday on a separate truce mission. Before setting off, Foreign Minister Ahmet Davutoglu signaled Turkey was in contact with Israel bout a truce — an important development given the two countries' chilly ties.

"We would be involved in all kinds of efforts if it amounted to saving the life of a single brother from Gaza," Davutoglu said. "We are determined to keep all direct or indirect channels (of dialogue) open."

Turkey's once-close ties with Israel frayed badly over the high civilian toll during Israel's 2009 war in Gaza.

With tens of thousands of Israeli soldiers dispatched to the Gaza border, awaiting a possible order to invade, the truce missions were all the more urgent.

Egypt, the traditional mediator between Israel and the Arab world, has been at the center of recent diplomatic efforts.

Israel demands an end to rocket fire from Gaza and a halt to weapons smuggling into Gaza through tunnels under the border with Egypt. It also wants international guarantees that Hamas will not rearm or use Egypt's Sinai region, which abuts both Gaza and southern Israel, to attack Israelis.

Hamas wants Israel to halt all attacks on Gaza and lift tight restrictions on trade and movement to and from the territory imposed after Hamas seized Gaza by force in 2007. Israel has rejected such demands in the past.

Resurgent rocket fire set off the Israeli offensive, launched with the assassination of the Hamas military chief and followed by hundreds of airstrikes on militant rocket launchers and weapons stores.

The onslaught turned deadlier over the weekend, as airstrikes began targeting the homes of suspected Hamas activists, leading to a spike in civilian casualties. Israel sent warnings in some cases, witnesses said, but in other instances missiles hit suddenly, burying residents under the rubble of their homes.

Hamas is deeply rooted in densely populated Gaza, and the movement's activists live in the midst of ordinary Gazans. Israel says militants are using civilians as human shields, both for their own safety and to launch rocket strikes from residential neighborhoods.

In one case, a senior member of the military wing of Islamic Jihad rented a small apartment in a 15-story high-rise of offices and news outlets. The militant, Ramez Harb, was killed Monday in a rocket strike that damaged the building.

One journalist said he and others were furious that Harb had apparently used their building as a hideout, putting others at risk. He spoke on condition of anonymity because he feared repercussions from Gaza militants.

Early Tuesday, Israeli aircraft targeted another Hamas symbol of power, the headquarters of a bank senior Hamas officials set up to sidestep international sanctions on the militant group's rule. After Hamas overran Gaza, foreign lenders stopped doing business with its militant-led government, afraid of running afoul of international terror financing laws.

The inside of the bank was destroyed and a building supply business in the basement was damaged.

"I'm not involved in politics," said the business owner, Suleiman Tawil. "I'm a businessman. But the more the Israelis pressure us, the more we will support Hamas."

Israel and Gaza's militants have a long history of fighting, but the dynamics have changed radically since they last warred four years ago. Though their hardware is no match for the Israeli military, militants have upgraded their capabilities with weapons smuggled in from Iran and Libya, Israeli officials claim.

Only a few years ago, tens of thousands of Israelis were within rocket range. Today those numbers have swollen to 3.5 million, as the militants' improved weapons reached Tel Aviv and Jerusalem for the first time this past week.

Hamas, a branch of the region-wide Muslim Brotherhood, is also negotiating from a stronger position than four years ago. At that time, Hamas was internationally isolated; now, the Muslim Brotherhood is in power in Egypt and Tunisia, and Hamas is also getting political support from Qatar and Turkey.

At home, too, the military offensive has shored up Hamas at a time when it was riven by internal divisions over its direction and the new Egyptian government's refusal to lift the blockade it imposed along with Israel after Hamas seized the territory.

This newfound backing contrasts radically with the loss of stature the Western-backed Palestinian President Mahmoud Abbas has endured as Palestinians lose faith in his ability to bring them a state through negotiations with Israel.

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Teibel reported from Jerusalem. With contributions from Ibrahim Barzak in Gaza City and Suzan Fraser in Ankara, Turkey.

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China's Xi warns party of corruption scourge

BEIJING (AP) — China's new leader Xi Jinping is highlighting corruption as a scourge that could bring down the Communist Party, though he has yet to offer any specific new proposals to stop it.

In a weekend speech that was carried Monday by the official Xinhua News Agency, Xi told the new 25-member Politburo that the party must be vigilant against graft, noting that corruption in other countries in recent years has prompted major social unrest and the collapse of governments.

"The large number of facts tells us that if the problem of corruption becomes increasingly severe, it will lead to the ruin of the party and the country!" Xinhua quoted Xi as saying in a speech that can be read as an indication of the priorities of the incoming administration.

Xi's language was unusually direct for a top leader, indicating his seriousness about the problem, but his speech gave few indications of how the party could better police itself, said Jean-Pierre Cabestan, a political scientist at Hong Kong Baptist University.

"He used strong words. It was clearly a warning: 'We have to do something about this,'" Cabestan said. "Clearly, for him, the crux of the matter is corruption. The trouble is, of course, that he doesn't tell us much about what are going to be the efficient tools or weapons he will put together to fight corruption."

Several corruption investigations have targeted high-level leaders in recent years, most notably former Politburo member Bo Xilai, who was purged this year after an aide disclosed that Bo's wife murdered a British businessman. Bo is accused of obstructing the investigation into the murder as well as unspecified corruption while in office.

Foreign media, meanwhile, have reported in recent weeks that the families of Chinese leaders have accumulated enormous wealth.

Xi urged officials at all levels to obey anti-corruption regulations and to better limit their relatives or associates from abusing their influence for personal gain, but he gave no indication of any independent mechanism for investigating graft.

The party, which controls courts, police and prosecutors, has proved feeble in policing itself yet does not want to undermine its control by empowering an independent body. Some officials have been required to report income, real estate holdings and other wealth to their superiors since 2010, but the measure has done little to staunch graft.

Xi took over as China's top leader last Thursday when he assumed the posts of party leader and head of the military commission from President Hu Jintao. Hu will retain the title of president — the ceremonial head of state — until next spring, when he hands that position to Xi as well.

Xi has been gradually replacing key Hu-appointed party officials.

On Monday, former public security minister Meng Jianzhu was named head of the Political Science and Law Commission that oversees police and the courts, replacing Zhou Yongkang.

Zhao Leji, the former party boss of the northern province of Shaanxi, was named the new head of the Organization Department responsible for key government and party appointments. He takes over from Li Yuanchao, a Hu ally who last week failed to gain a seat on the all-powerful Politburo Standing Committee.

In his remarks to the Politburo, Xi dwelled on the importance of the party's theoretical foundations in Marxism, Leninism and the ideas espoused by his predecessors, but his remarks on corruption stood out for being relatively free of political jargon.

Xi also emphasized the need to narrow the gap between the party and the people in what seemed like an implicit critique of his predecessors, said Willy Lam, a political analyst at the Chinese University of Hong Kong.

Lam said Xi's frequent references to "the people" in his speech indicated that "the past two decades have resulted somehow in the people feeling alienated from the party."

"Now what he's saying is that from day one is that we shall stick to the people. We will do what the people want," Lam said.

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Online gaming firms urge EU to open up markets

LONDON (Reuters) – Online gaming companies have accused Belgium and Greece of keeping them out of their markets illegally and urged European competition authorities to take action.

A long-running dispute over licenses in Belgium made headlines last week when Belgian authorities questioned one of the co-chief executives of bwin.party, the world’s largest listed online gaming group.

The bwin.party case has underlined the problems faced by companies in the growing online gaming sector when they operate in countries where regulations are unclear or restrictive.

Bwin.party says it is losing 700,000 euros ($ 889,400) in gaming revenue each month after access to its websites was blocked in Belgium.

Executives from 12 gaming companies including bwin.party said the European Commission had failed to follow through on concerns over Belgian laws first raised in 2009.

“We hope that the Commission will now enforce compliance with the European treaty and do so swiftly,” they said in a letter to the Financial Times.

“Countries such as Belgium and Greece that are in clear breach of EU law and that are seeking to enforce those laws domestically are likely to be at the top of the list,” it added.

“The time for polite rhetoric is now over. It is time for deeds not words.”

Belgian rules state that a company must offer the same services both online and offline to obtain a license. Opponents say that favors companies based in Belgium and means pure online providers cannot operate.

In Greece, bookmakers including Britain’s William Hill launched a legal challenge to monopoly operator OPAP after being denied licenses.

(Writing by Keith Weir; Editing by Tom Pfeiffer)

Internet News Headlines – Yahoo! News

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Justin Bieber gets love at American Music Awards

Justin Bieber may be Canadian, but he was the all-American boy at Sunday night's American Music Awards.

The pop singer dominated the awards show, winning three trophies, including artist of the year. His mom joined him onstage as he collected the award, beating out Rihanna, Maroon 5, Katy Perry and Drake.

"I wanted to thank you for always believing in me," Bieber said, looking to his mom.

The 18-year-old also won the honor in 2010. He said it's "hard growing up with everyone watching me" and asked that people continue to believe in him.

But the teenager who brought his mom as a date also got in some grinding with Nicki Minaj — who shared the stage with him and took home two awards — and a kiss on the neck from presenter Jenny McCarthy.

"Wow. I feel violated right now," he said, laughing.

"I did grab his butt," McCarthy said backstage. "I couldn't help it. He was just so delicious. So little. I wanted to tear his head off and eat it."

Another collaboration was the night's most colorful performance: Korean rapper PSY and MC Hammer. Hammer joined the buzzed-about pop star for his viral hit "Gangnam Style." PSY rocked traditional "Hammer" pants as they danced to his jam and to Hammer's "Too Legit to Quit."

Minaj, who wore three different wigs and four outfits throughout the night, repeated her AMAs wins from last year, picking up trophies for favorite rap/hip-hop artist and album for "Pink Friday: Roman Reloaded." She was in an all-white get-up, including fur coat and pink hair when she performed her new song "Freedom." The scene was ghostly and snowy, as a choir — also in white — joined her onstage. One background singer stole the performance, belting semi-high notes as Minaj looked on.

Usher kicked off the three-hour show with green laser lights beaming onstage as he performed a medley of songs, including "Numb," ''Climax" and "Can't Stop, Won't Stop," which featured a smoky floor and a number of backup dancers, as Usher jammed in all black, with the exception of his red shoes. He won favorite soul/R&B male artist.

His protege Bieber won favorite pop/rock male artist in the first award handed out and gave a shout-out to those who didn't think he would last on the music scene.

"I want to say this is for all the haters who thought I was just here for one or two years. I feel like I'm going to be here for a very long time," he said.

He also won favorite pop/rock album for his platinum-selling third album, "Believe." He gave a stripped down, acoustic performance of "As Long As You Love Me," then transitioned to the dance-heavy "Beauty and a Beat," where Minaj joined him onstage, grinding with the teen for a few seconds.

Swift won her fifth consecutive award for favorite country female artist.

"This is unreal. I want to thank the fans. You guys are the ones who voted on this," she said.

Swift gave a masquerade-themed performance of the pop song "I Knew You Were Trouble." She sang onstage in a light dress while dancers wore mostly black. But then she changed into a red corset and black skirt, matching their dark mood. She even danced and sang on the floor as lights flickered throughout the performance.

Dick Clark, who created the AMAs, was remembered by Ryan Seacrest and an upbeat performance by Stevie Wonder.

"What a producer he was," said Seacrest, as Wonder sang his hits, including "My Cherie Amour."

Carly Rae Jepsen, who performed early in the night, won favorite new artist.

"I am floored. Wow," she said, thanking Bieber and his manager, Scooter Braun.

Party girl Ke$ha was glammed up on the red carpet, rocking long, flowy blonde hair and a light pink dress. She switched to her normal attire when she performed her hit single "Die Young." It was tribal, with shirtless dancers in skin-tight pants, silver hair and skeleton-painted faces, who also played the drums. Ke$ha was pants-less, rocking knee-high boots and rolling on the floor as she finished up the song.

Minaj and Christina Aguilera were blonde bombshells, too: Minaj's hair was busy and full of volume and she sported a neon strapless gown to accept her first award. Aguilera wore a blonde bob in a purple dress that matched her eyeshadow.

Aguilera performed a medley of material from her new album and joined Pitbull onstage.

Kelly Clarkson also hit the stage, making a nod to her "American Idol" roots with a number on her dress and three judges looking on as she sang "Miss Independent." Then she went into "Since U Been Gone," ''Stronger" and "Catch My Breath."

Fellow "Idol" winner Carrie Underwood won best favorite country album and performed, hitting the right notes while singing "Two Black Cadillacs." She talked about singing competition shows backstage.

"These people that go on these shows are so talented, you know? And I would love to see if so many of the other artists that are out there today would go back and try out for these shows, because they might get their behinds kicked by some of the contestants," she said.

Luke Bryan won favorite country male artist and Lady Antebellum favorite country group.

American Music Awards nominees were selected based on sales and airplay, and fans chose the winners by voting online. At this award show, even the stars were fans: Pink said on the red carpet that she'd like to collaborate with Lauryn Hill. Cyndi Lauper said her musical playlist includes Pink and Minaj. Boy band The Wanted said they were excited to see PSY and Colbie Caillat wanted to watch No Doubt.

"What makes the American Music Awards special is the fans choose the winning artists," said Chester Bennington of Linkin Park, who won favorite alternative rock artist and performed "Burn It Down," as Brandy sang along and Gwen Stefani, Usher and Phillip Phillips bobbed their heads.

David Guetta won the show's first-ever electronic dance music award. Non-televised awards went to Katy Perry for pop/rock female artist, Beyonce for soul/R&B female artist, Adele for adult contemporary artist and Shakira for Latin artist.

Along with Rihanna, Minaj was the top nominee with four nominations.

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AP Entertainment Writer Sandy Cohen contributed to this report from Los Angeles.

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Follow Mesfin Fekadu on Twitter at http://twitter.com/MusicMesfin

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Online:

http://beta.abc.go.com/shows/american-music-awards

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EU drug regulator OKs Novartis' meningitis B shot

LONDON (AP) — Europe's top drug regulator has recommended approval for the first vaccine against meningitis B, made by Novartis AG.

There are five types of bacterial meningitis. While vaccines exist to protect against the other four, none has previously been licensed for type B meningitis. In Europe, type B is the most common, causing 3,000 to 5,000 cases every year.

Meningitis mainly affects infants and children. It kills about 8 percent of patients and leaves others with lifelong consequences such as brain damage.

In a statement on Friday, Andrin Oswald of Novartis said he is "proud of the major advance" the company has made in developing its vaccine Bexsero. It is aimed at children over two months of age, and Novartis is hoping countries will include the shot among the routine ones for childhood diseases such as measles.

Novartis said the immunization has had side effects such as fever and redness at the injection site.

Recommendations from the European Medicines Agency are usually adopted by the European Commission. Novartis also is seeking to test the vaccine in the U.S.

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