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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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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Mistrust runs deep despite cease-fire

CAIRO/GAZA (Reuters) - A ceasefire between Israel and Gaza's Hamas rulers took hold on Thursday after eight days of conflict, although deep mistrust on both sides cast doubt on how long the Egyptian-sponsored deal can last.

Even after the ceasefire came into force late on Wednesday, a dozen rockets from the Gaza Strip landed in Israel, all in open areas, a police spokesman said. In Gaza, witnesses reported an explosion shortly after the truce took effect at 9 p.m (14:00 EDT), but there were no casualties and the cause was unclear.

The deal prevented, at least for the moment, an Israeli ground invasion of the Palestinian enclave following bombing and rocket fire which killed five Israelis and 162 Gazans, including 37 children.

But trust was in short supply. The exiled leader of Hamas, Khaled Meshaal, said his Islamist movement would respect the truce if Israel did, but would respond to any violations. "If Israel complies, we are compliant. If it does not comply, our hands are on the trigger," he told a news conference in Cairo.

Israeli Prime Minister Benjamin Netanyahu said he had agreed to "exhaust this opportunity for an extended truce", but told his people a tougher approach might be required in the future.

Both sides quickly began offering differing interpretations of the ceasefire, brokered by Egypt's new Islamist government and backed by the United States, highlighting the many actual or potential areas of discord.

If it holds, the truce will give 1.7 million Gazans respite from days of ferocious air strikes and halt rocket salvoes from militants that unnerved a million people in southern Israel and reached Tel Aviv and Jerusalem for the first time.

"Allahu akbar, (God is greatest), dear people of Gaza you won," blared mosque loudspeakers in Gaza as the truce took effect. "You have broken the arrogance of the Jews."

Fifteen minutes later, wild celebratory gunfire echoed across the darkened streets, which gradually filled with crowds waving Palestinian flags. Ululating women leaned out of windows and fireworks lit up the sky.

Meshaal thanked Egypt for mediating and praised Iran for providing Gazans with financing and arms. "We have come out of this battle with our heads up high," he said, adding that Israel had been defeated and failed in its "adventure".

Some Israelis staged protests against the deal, notably in the southern town of Kiryat Malachi, where three people were killed by a Gaza rocket during the conflict, army radio said.

Netanyahu said he was willing to give the truce a chance but held open the possibility of reopening the conflict. "I know there are citizens expecting a more severe military action, and perhaps we shall need to do so," he said.

The Israeli leader, who faces a parliamentary election in January, delivered a similar message earlier in a telephone call with U.S. President Barack Obama, his office said.

"AN OPEN PRISON"

According to a text of the agreement seen by Reuters, both sides should halt all hostilities, with Israel desisting from incursions and targeting of individuals, while all Palestinian factions should cease rocket fire and cross-border attacks.

The deal also provides for easing Israeli restrictions on Gaza's residents, who live in what British Prime Minister David Cameron has called an "open prison".

The text said procedures for implementing this would be "dealt with after 24 hours from the start of the ceasefire".

Israeli sources said Israel would not lift a blockade of the enclave it enforced after Hamas, which rejects the Jewish state's right to exist, won a Palestinian election in 2006.

However, Meshaal said the deal covered the opening of all of the territory's border crossings. "The document stipulates the opening of the crossings, all the crossings, and not just Rafah," he said. Israel controls all of Gaza's crossings apart from the Rafah post with Egypt.

Hamas lost its top military commander to an Israeli strike in the conflict and suffered serious hits to its infrastructure and weaponry, but has emerged with its reputation both in the Arab world and at home stronger.

Israel can take comfort from the fact it dealt painful blows to its enemy, which will take many months to recover, and showed that it can defend itself from a barrage of missiles.

"No one is under the illusion that this is going to be an everlasting ceasefire. It is clear to everyone it will only be temporary," said Michael Herzog, a former chief of staff at the Israeli ministry of defence.

"But there is a chance that it could hold for a significant period of time, if all goes well," he told Reuters.

Egypt, an important U.S. ally now under Islamist leadership, took centre stage in diplomacy to halt the bloodshed. Cairo has walked a fine line between its sympathies for Hamas, an offshoot of the Muslim Brotherhood to which President Mohamed Mursi belongs, and its need to preserve its 1979 peace treaty with Israel and its ties with Washington, its main aid donor.

Announcing the agreement in Cairo, Egyptian Foreign Minister Mohamed Kamel Amr said mediation had "resulted in understandings to cease fire, restore calm and halt the bloodshed".

U.S. Secretary of State Hillary Clinton, standing beside Amr, thanked Mursi for peace efforts that showed "responsibility, leadership" in the region.

The Gaza conflict erupted in a Middle East already shaken by last year's Arab uprisings that toppled several veteran U.S.-backed leaders, including Egypt's Hosni Mubarak, and by a civil war in Syria, where President Bashar al-Assad is fighting for survival.

In his call with Netanyahu, Obama in turn repeated U.S. commitment to Israel's security and promised to seek funds for a joint missile defence program, the White House said.

BUS BOMBING

The ceasefire was forged despite a bus bomb explosion that wounded 15 Israelis in Tel Aviv earlier in the day and despite more Israeli air strikes that killed 10 Gazans. It was the first serious bombing in Israel's commercial capital since 2006.

Israel, the United States and the European Union all classify Hamas as a terrorist organization. It seized the Gaza Strip from the Western-backed Palestinian President Mahmoud Abbas in 2007 in a brief but bloody war with his Fatah movement.

"This is a critical moment for the region," Clinton said. "Egypt's new government is assuming the responsibility and leadership that has long made this country a cornerstone for regional stability and peace."

In Amman, U.N. chief Ban Ki-moon urged both sides to stick to their ceasefire pledges. "There may be challenges implementing this agreement," he said, urging "maximum restraint".

(Additional reporting by Noah Browning in Gaza, Ori Lewis, Allyn Fisher-Ilan and Crispian Balmer in Jerusalem, Yasmine Saleh, Shaimaa Fayed and Tom Perry in Cairo, Suleiman al-Khalidi in Amman and Margaret Chadbourn in Washington; Writing by Alistair Lyon and David Stamp; Editing by Louise Ireland)

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Chevy Chase Exiting “Community”

NEW YORK (TheWrap.com) – Chevy Chase is leaving “Community” after a rocky run on the NBC series.

The actor is leaving by mutual agreement with the show’s producers, a person close to the show told TheWrap. He will appear in most of the 13 episodes of the show’s upcoming fourth season, but not the final one or two episodes.

Chase had a very public feud with former showrunner Dan Harmon that included Harmon airing an angry rant by Chase. The situation hardly improved when new showrunners Moses Port and David Guarascio took over this season.

The original “Saturday Night Live” player reportedly used the N-word last month in an on-set rant complaining about the racism of his character, Pierce Hawthorne. Chase asked how far the character’s bigotry would go, and whether he would be forced to say the word. He later apologized.

Chase made little effort to hide his mixed feelings about the show, telling the Huffington Post in March, “I probably won’t be around that much longer, frankly.”

“I have creative issues with this show,” he said. “I always have. With my character, with how far you can take character … just to give him a long speech about the world at the end of every episode is so reminiscent. It’s like being relegated to hell and watching ‘Howdy Doody‘ for the rest of your life. It’s not particularly necessary, but that’s the way they do these things. I think it belies the very pretenses that his character, Jeff, has, that he’s giving these talks. They’re supposed to, in some way, be a little lesson to people who watch sitcoms … to that degree, I can’t stand sitcoms. … I think, if you know me and my humor over the years, you know that this is certainly not my kind of thing.”

“Community” returns February 7.

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Ob-Gyns: Sell ‘The Pill’ Over The Counter

Women’s health and reproductive rights experts are lining up to lend support to the push to make oral contraceptives available without a prescription.

This week, the American College of Obstetricians and Gynecologists issued a committee opinion, calling for the switch.

The aim is to increase access and lower the unintended pregnancy rate, which has held steady at 50% in the U.S. for two decades.

RELATED: Affordable Care Act Won’t End Disparities

“I think it’s great,” says Jeff Peipert, MD, PhD, the Robert J. Terry professor of obstetrics and gynecology at Washington University in St. Louis. “These pills are very, very safe. Pregnancy is far riskier than taking a birth control pills. In fact aspirin has greater health risks than the birth control pill.”

“I think the benefits outweigh any downsides,” says Dan Grossman, MD, vice president for research at  Ibis Reproductive Health, a nonprofit organization dedicated to research and the promotion of reproductive rights and women’s health.

Ibis issued a statement applauding the move.

Easier access to birth control pills should help reduce the U.S. unintended pregnancy rate, according to the ACOG.  The price tag for U.S. taxpayers is about $ 11.1 billion every year.

No birth control pills are currently available over the counter. Emergency contraception (such as Plan B) is sold over the counter.

Making the pill available over the counter will reduce or remove two barriers–access and convenience, the doctors say. Teens who may be reluctant to ask a family doctor for the pill would have access.

How it will affect the barrier of cost remains to be seen. On average, the cost for birth control pills is about $ 16 a month, surveys suggest.

Some women could be affected adversely if the pills goes over-the-counter and they lose insurance coverage. While the U.S. Department of Health and Human Services guidelines require new private health plans to cover, cost-free, all FDA-approved contraceptive methods, it is not clear how those guidelines will play out. Medicaid is exempted.

RELATED: Pediatrician Group Urges Doctors To Offer Teens Emergency Birth Control In Advance

“But it’s important to remember this would [if approved by the FDA] add another way to access birth control–it wouldn’t eliminate any existing ways,” Grossman tells Take Part. “Women who want to go to a doctor [for their contraceptives] would still have that option.”

In a video released by ACOG along with the announcement, it emphasizes the importance of an annual ”well woman” visit to her doctor, regardless of  how a woman gets her birth control method.

Research suggests that those who get birth control pills without a prescription will still see their doctor for screening and other preventive health needs.

One oft-mentioned risk of oral contraceptives–blood clots–is low, the ACOG says, “and significantly lower than the risk of blood clots during pregnancy and the postpartum period.”

Women are able to determine their own health risks and decide if they should or should not take the pill, according to ACOG.

The process of reclassifying drugs from prescription to over-the-counter status is regulated by the Food and Drug Administration. It relies on its advisory panels to make the decision.

That takes time, of course. “I think the timeline might be two to four years,” Grossman says.

The complete opinion by the college is published in the December 2012 issue of the journal Obstetrics & Gynecology.

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Kathleen Doheny is a Los Angeles journalist who writes about health. She doesn’t believe inmiracle cures, but continues to hope someone will discover a way for joggers to maintain their pace.

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Exclusive: TV networks start seven-day ratings push with advertisers

LOS ANGELES (Reuters) – U.S. television broadcast networks are taking the first steps to persuade advertisers to pay for commercial viewership that occurs up to seven days after a program airs, a shift that would provide a new revenue stream to help combat ratings erosion.

The networks argue that the rising popularity of digital video recorders is pushing a sizeable number of viewers to delay watching their favorite programs beyond the first three days, the time period most often used for calculating ad payments.

Some advertisers are ready to make the move to a seven-day metric. One of the big four networks, Walt Disney Co’s ABC, earlier this year reached deals with some sponsors that bring in payments for eyeballs counted between days four and seven.

The other broadcasters have begun talks with advertisers and hope to convince them to switch to the longer window in time for the “upfront” selling season that starts early next year, when billions of dollars in ad commitments will be made, according to people familiar with the discussions.

Since 2007, most TV ad time has been bought and sold based on “C3,” a ratings measurement based of the average number of commercial minutes watched during a program either live or within three days of its airing.

TV networks want advertisers to shift to “C7,” which captures commercials watched within seven days.

Advertisers hesitate to pay for the added days, particularly for time-sensitive ads pitching a department store’s one-day sale or the opening of a summer movie blockbuster. Media buyers are pushing for precise measurements of each commercial viewed, rather than an average for an entire program, as well as a tabulation of how many people are watching on mobile devices.

The debate intensified after Nielsen data showed a sharp decline in three-day viewing at the start of the fall TV season compared with last year.

The drop is partly due to “the greater penetration of DVRs and the greater usage of DVRs, which clearly have shifted the rating in the direction of C3, and ultimately, hopefully, C7,” Disney CEO Bob Iger told analysts on a November 8 conference call.

Most viewing of network prime time shows still takes place within three days. But the post-three day viewers are growing and can be significant. Ratings for ABC comedy hit “Modern Family” increased by 5 percent, to 6.5 million viewers age 18 to 49 viewers, when counted by the C7 measurement instead of C3.

The later viewers also are among the most-coveted by advertisers, according to ABC research, which showed people who watched a show after three days were more highly educated and had higher incomes. For days four through seven, “the people who are doing the viewing are some of the most desirable available from an advertiser’s perspective,” said Charles Kennedy, senior vice president of research for ABC and the ABC Family cable network.

Earlier this year, ABC made deals with some sponsors to pay for ad time based on C7 numbers, ABC spokesman Kevin Brockman said. “We expect to do more of them if they make sense for us and our clients,” Brockman said.

At CBS, the flagship network of CBS Corp, CEO Leslie Moonves has been outspoken in pressing for a C7 metric and said it “represents a significant opportunity for us that is still in the very early stages.”

“As we move forward, we will make it a priority to get paid for all of the viewing that is going on across our shows, including DVR viewing beyond C3,” Moonves told analysts on a November 7 conference call.

Advertisers are not ready to commit to the switch and will be looking for something in return if they agree to a longer window. Timing is a big concern for many brands that want to get a message out to large numbers of consumers during a specific time period. Some commercials lose their value for sponsors over a few days.

“In moving to C7, you’ve got to be careful because you are taking away some of the advantage of why clients buy television,” said Sam Armando, director of strategic intelligence for SMGx, a division of media buying agency Starcom MediaVest Group.

Advertisers believe simply adding more days to the current metric fails to adequately capture viewership. Brands are lobbying for a more precise measurement that tracks viewership of each commercial, rather than an average for a program over a time period, they say. They also want information on how many people see their ads on programs watched on computers or Internet-connected mobile devices like phones and tablets.

“If the industry is going to make a move, we need to consider it all before we just make a little baby step to C7,” Armando said.

(Reporting By Lisa Richwine; Edited by Ronald Grover and Andrew Hay)

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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.

___

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

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Securing Gaza cease-fire proves elusive

JERUSALEM (AP) — Israel and the Hamas militant group edged closer to a cease-fire Tuesday to end a weeklong Israeli offensive in the Gaza Strip, but after a day of furious diplomatic efforts involving the U.S. secretary of state, U.N. chief and Egypt's president, a deal remained elusive and fighting raged on both sides of the border.

Israeli tanks and gunboats pummeled targets in Gaza in what appeared to be a last-minute burst of fire, while at least 200 rockets were fired into Israel. As talks dragged on near midnight, Israeli and Hamas officials, communicating through Egyptian mediators, expressed hope that a deal would soon be reached, but cautioned that it was far from certain.

"If there is a possibility of achieving a long-term solution to this problem by diplomatic means, we prefer that. But if not, then I am sure you will understand that Israel will have to take whatever actions are necessary to defend its people," Israeli Prime Minister Benjamin Netanyahu said at a late-night meeting with visiting Secretary of State Hillary Rodham Clinton.

Clinton was hastily dispatched to the region by President Barack Obama to join a high-profile group of world leaders working to halt the violence. Standing alongside the Israeli leader, Clinton indicated it could take some time to iron out an agreement.

"In the days ahead, the United States will work with our partners here in Israel and across the region toward an outcome that bolsters security for the people of Israel, improves conditions for the people of Gaza and moves toward a comprehensive peace for all people of the region," she said.

Clinton expressed sorrow for the heavy loss of life on both sides, but called for the Palestinian rocket attacks on Israel to end and stressed that the American commitment to Israel's security is "rock solid."

"The goal must be a durable outcome that promotes regional stability and advances the security and legitimate aspirations of Israelis and Palestinians alike," she said.

In Washington, State Department spokeswoman Victoria Nuland said Clinton met with Netanyahu and other Israeli officials for two hours.

"They discussed efforts to de-escalate the situation and bring about a sustainable outcome that protects Israel's security and improves the lives of civilians in Gaza," Nuland said. "They also consulted on her impending stops in Ramallah and Cairo, including Egyptian efforts to advance de-escalation."

Israel launched the offensive on Nov. 14 in a bid to end months of rocket attacks out of the Hamas-run territory, which lies on Israel's southern flank. After assassinating Hamas' military chief, it has carried out a blistering campaign of airstrikes, targeting rocket launchers, storage sites and wanted militants.

The campaign has killed more than 130 Palestinians, including dozens of civilians, and wounded hundreds of others. Five Israelis have been killed by rocket fire, including a soldier and a civilian contractor on Tuesday.

With Israel massing thousands of ground troops on the Gaza border, diplomats raced throughout the region in search of a formula to halt the fighting.

In a meeting with Netanyahu, U.N. chief Ban Ki-moon condemned Palestinian rocket attacks, but urged Israel to show "maximum restraint."

"Further escalation benefits no one," he said.

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 in and out of the territory that have been in place since Hamas seized Gaza by force in 2007. Israel has rejected such demands in the past.

Egypt's new Islamist government is expected to play a key role in maintaining a deal.

The crisis has thrust Egypt's president, Mohammed Morsi, into the spotlight as he plays a difficult balancing act.

Morsi belongs to the Muslim Brotherhood, Hamas' parent movement, and clearly sympathizes with the Islamic militant group. At the same time, he relies heavily on U.S. aid and is trying to preserve a historic peace agreement with Israel.

Earlier, Morsi raised hopes that a cease-fire was near when he predicted the negotiations would yield "positive results" during the coming hours.

Netanyahu also said his country would be a "willing partner" in a cease-fire agreement.

But as the talks stretched into the evening, it became clear that a deal remained a ways off.

"Most likely the deal will be struck tomorrow. Israel has not responded to some demands, which delayed the deal," Hamas official Izzat Risheq said.

Hamas officials refused to discuss the remaining sticking points.

Israeli media quoted Defense Minister Ehud Barak as telling a closed meeting that Israel wanted a 24-hour test period of no rocket fire to see if Hamas could enforce a truce.

Palestinian officials briefed on the negotiations said Hamas wanted assurances of a comprehensive deal that included new border arrangements — and were resisting Israeli proposals for a phased agreement. The officials spoke on condition of anonymity because they were not authorized to talk to the media.

Although Israel claims it has inflicted heavy damage on militants' capabilities, its roughly 1,550 airstrikes and shelling attacks have failed to halt the rocket fire.

More than 1,400 rockets have been fired at Israel, including about 200 on Tuesday. A U.S.-financed Israeli rocket-defense system has knocked down roughly 400 of the incoming projectiles.

Violence raged on as the talks continued. An airstrike late Tuesday killed two journalists who work for the Hamas TV station, Al-Aqsa, according to a statement from the channel. A third journalist, from Al Quds Educational Radio, a private station, also was killed.

The Al-Aqsa TV cameramen were in a car hit by an airstrike, Gaza health official Ashraf al-Kidra said. Israel claims that many Hamas journalists are involved in militant activities. Earlier this week it targeted the station's offices, saying they served as a Hamas communications post.

Late Tuesday, a Palestinian rocket hit a house in the central Israeli city of Rishon Lezion, wounding two people and badly damaging the top two floors of the building, police spokesman Micky Rosenfeld said.

Minutes before Ban's arrival in Jerusalem from Egypt, Palestinian militants fired a rocket toward Jerusalem, just the second time it has targeted the city. The rocket fell in an open area southeast of the city.

Jerusalem had previously been considered beyond the range of Gaza rockets — and an unlikely target because it is home to the Al-Aqsa Mosque compound, Islam's third-holiest shrine.

Israeli warplanes dropped leaflets on several Gaza neighborhoods asking residents to evacuate and head toward the center of Gaza City along specific roads. The army "is not targeting any of you, and doesn't want to harm you or your families," the leaflets said. Palestinian militants urged residents to ignore the warnings, calling them "psychological warfare."

Israeli security officials acknowledge they rely on a network of Palestinian informants to identify targets. Masked gunmen publicly shot dead six suspected collaborators with Israel in a large Gaza City intersection Tuesday, witnesses said.

An Associated Press reporter saw a mob surrounding five of the bloodied corpses shortly after the killing, and one of the bodies was dragged through the streets by a motorcycle.

Hamas did not provide any evidence against the alleged collaborators.

Clinton was also scheduled to meet with Palestinian President Mahmoud Abbas in the West Bank and Egyptian leaders in Cairo on Wednesday. Turkey's foreign minister and a delegation of Arab League foreign ministers traveled to Gaza on a separate truce mission. Airstrikes continued to hit Gaza even as they entered the territory.

"Turkey is standing by you," Turkish Foreign Minister Ahmet Davutoglu told the Hamas prime minister in Gaza, Ismail Haniyeh. "Our demand is clear. Israel should end its aggression immediately and lift the inhumane blockade imposed on Gaza."

At the United Nations, U.N. ambassadors after hours of closed-door meetings announced the Security Council will hold an open debate on the Gaza crisis Wednesday afternoon if a cease-fire is not called before then. The move comes after the United States blocked adoption of a unanimous press statement from the council because it did not explicitly criticize Hamas' rocket attacks on Israel.

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. The Obama administration blames Hamas for the latest eruption of violence and says Israel has the right to defend itself. At the same time, it has warned against a ground invasion, saying it could send casualties spiraling.

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Barzak reported from Gaza City, Gaza Strip. Associated Press writers Hamza Hendawi in Cairo, Karin Laub in Gaza City and Ian Deitch in Jerusalem contributed to this report.

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“Hitchcock” trains lens on the love story of Alfred and Alma

NEW YORK (Reuters) – She won Oscar gold for her uncanny performance as Britain’s Queen Elizabeth, but Helen Mirren‘s latest portrayal finds her as the power behind the throne — or, more precisely, the director’s chair.

In “Hitchcock,” Mirren stars opposite Anthony Hopkins as legendary director Alfred Hitchcock’s devoted wife Alma Reville, and early buzz has her a contender for another Oscar nomination.

The film, which opens in limited release on Friday, explores the domestic life of one of Hollywood‘s most iconic and revered directors, set during the days of his struggle to put the ground-breaking 1960 classic, “Psycho” on the silver screen.

Toggling back and forth between his on-set battles with censors and his cast including Janet Leigh (Scarlett Johansson), Vera Miles (Jessica Biel) and Tony Perkins (James D’Arcy), and his strained relationship with Alma as she copes with his well-documented obsession with his ravishing leading ladies, “Hitchcock” treats film fans to a glimpse of bygone Hollywood.

But it paints a more nuanced and sympathetic portrait of the director Hopkins called “a damaged man” than the recent television film “The Girl,” which dramatized the hell Hitchcock put Tippi Hedren through during filming of “The Birds.”

“It’s a great role,” Mirren said of Alma, a film editor and assistant director in her own right who ceded the spotlight to her husband, but as the film makes clear was involved in virtually every aspect of his films and even re-cut “Psycho” into the masterpiece it is known as today.

“So, you don’t turn that down,” she told Reuters.

Having won her Oscar as one of the world’s most famous women, Mirren said she finds herself drawn to “the ones I don’t know anything about, like Alma. Those are the most fun.”

With little to go on, Mirren said she turned to the 2003 book “Alma Hitchcock: The Woman Behind the Man,” by the couple’s daughter Patricia, who also acted in several Hitchcock films.

“I’m not that much of a film buff that I knew about Alma, and I had no idea about Hitchcock‘s private life,” she said, adding the book aimed “to bring her mother out of the shadows.”

HITCH THE BRAND

By all accounts making the movie about the movies was a joy, with Mirren and Hopkins co-starring in their first film together under first-time director Sacha Gervasi (“Anvil: The Story of Anvil”), who fixed a script that had made the rounds.

Hopkins described it as the “most fun” since his Oscar-winning role in the thriller “Silence of the Lambs.”

Mirren recalled rushing off to work each day: “I couldn’t wait.” And it helped that the actors have the same approach.

“There’s no mystery to it … They talk about chemistry, and Helen agrees with me, there’s no such thing. You know your part, she knows hers, and off you go, hope it works,” Hopkins said.

But Mirren and Hopkins, who is also being touted for an Oscar nomination, parted ways when speculating on how the auteur director, who never won an Oscar during five decades of work, would have fared in the Hollywood of today.

“He would have despaired,” Hopkins said. “It would have been anathema to him. That kind of artistry is gone.”

Corporate control means “you have eight or nine producers on the set, everyone’s got a say in the scripts, and even craft services!”

But Mirren differed, imagining “he’d do brilliantly well.”

“He was a great salesman, and the Hollywood of today is so much about being a salesman and being able to sell yourself as a brand,” she explained. “He did that brilliantly. I think the two of them sold Hitch. Hitch was the faceman, he was the brand.”

“Also,” she added, “his filmmaking techniques would be incredibly successful,” given the technological advances since Hitchcock’s death in 1980.

Hitchcock was on a roll in his early 60s, with his “Psycho” follow-up, the shocking thriller “The Birds” becoming a hit and a much-loved classic. But none of the handful of films he made afterward attained their iconic status.

Mirren, 67, by contrast, truly hit her stride during her 40s, despite a steady two-decade career by that point.

Starting with the TV show “Prime Suspect” to the films “Gosford Park,” “The Queen” and “The Last Station,” she racked up four Oscar nominations and a mantel full of Emmys, which raises a question about the validity of complaints that Hollywood has no use for actresses over 40.

“I think what has changed is, the world around has changed,” Mirren said when reflecting on her success and acclaim.

“I was lucky that I hit my 40s just as the world around me was changing. Twenty years before I never would have been cast in ‘Prime Suspect’ because there were no women inspectors.”

And so, she looks forward.

“As I’ve carried on, my God, 20 years ago it was inconceivable that you’d have a female president of the United States,” she said.

“Now, the next president of America may well be a woman, and if there is a female president, that means that if a movie comes along, and there’s the president of America …” She laughs.

“You know what I mean?”

(Editing by Christine Kearney)

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U.S. soldier accused of Iraq shooting “psychotic”: doctor

TACOMA (Reuters) – A U.S. soldier accused of killing five fellow servicemen at a military combat stress center in Baghdad in 2009 was psychotic and suffered from post-traumatic stress disorder during the shooting frenzy, a top U.S. forensic psychiatrist testified on Tuesday.

Sergeant John Russell, 48, is accused of going on a shooting spree at Camp Liberty, near the Baghdad airport, in an assault the military said at the time could have been triggered by combat stress.

Russell, of the 54th Engineer Battalion based in Bamberg, Germany, faces five charges of premeditated murder, one charge of aggravated assault and one charge of attempted murder in connection with the May 2009 shootings.

Six months ago, he was ordered to stand trial in a military court that has the power to sentence him to death, if he is convicted.

Russell’s civilian attorney, James Culp, entered no plea at an arraignment on Monday at a military base in Washington state. Russell’s court martial is tentatively set for mid-March and could last four to five weeks, attorneys told Reuters on Tuesday.

In a second day of hearings to discuss Russell’s state of mind at the time of the shooting and establish what evidence or testimony to admit at the court martial, Robert Sadoff, a University of Pennsylvania forensic psychiatry expert, gave the opinion that Russell was suffering from post-traumatic stress disorder.

Russell has “dissociative disorder,” or a lack of memory about the shootings, said Sadoff, who examined Russell for a total of 20 hours after the shootings. “He cannot remember. It’s a legitimate disorder. He also has post-traumatic stress disorder.”

Sadoff, a veteran of 10,000 criminal cases added: “It’s a matter of what’s going on in this man’s mind. He was psychotic. He was not dealing with reality. That’s what psychosis is.”

If the defense can persuade a jury that Russell was not in control of his actions, it may be able to argue that he is not legally responsible and could spare him from the death penalty, if convicted.

During Tuesday’s hearing, Culp sought authority from Judge Colonel David Conn to hire a forensic hypnotist to unlock Russell’s buried memories and conduct a specialized magnetic resonance imaging (MRI) test to measure Russell’s “mild diffused brain atrophy”, which Culp argues played a part in his behavior.

This would help diagnose “the extent of brain damage as it relates to criminal responsibility,” Culp said.

Army prosecutors urged the judge to decline. Major Dan Mazzone, one of four Army attorneys prosecuting the case, told the judge that an Army medical review already indicated that Russell’s brain atrophy was typical of a man his age and further testing is an unnecessary expense to the Army.

“The bottom line, this is just not necessary. It’s something the government should not be entitled to fund,” Mazzone said.

The judge is set to rule on the matter over the next few days.

The proceedings, held at Joint Base Lewis-McChord near Tacoma, Washington, come at a sensitive time for the Army, which is in the process of deciding how to prosecute Staff Sergeant Robert Bales, a soldier accused of killing Afghan villagers in cold blood earlier this year.

A two-week hearing at Lewis-McChord to establish if there is sufficient evidence to send Bales to a court martial wrapped up last week after harrowing testimony from Afghan adults and children wounded in the attack.

Bales’ civilian defense lawyers have also suggested he was suffering from post-traumatic stress disorder.

On Monday, Russell’s attorney outlined a defense based on his declining mental state.

Russell suffered from depression, thoughts of suicide, anxiety and stress from multiple deployments, and suffered “at least one traumatic experience involving civilian casualties” and “mass grave sites” while serving in Bosnia and Kosovo during 1998 and 1999, Culp said in presenting arguments to the judge after the arraignment.

(Reporting by Bill Rigby; Editing by Lisa Shumaker)

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