Egypt’s Mursi calls referendum as Islamists march

CAIRO (Reuters) – Egypt‘s President Mohamed Mursi called a December 15 referendum on a draft constitution on Saturday as at least 200,000 Islamists demonstrated in Cairo to back him after opposition fury over his newly expanded powers.

Speaking after receiving the final draft of the constitution from the Islamist-dominated assembly, Mursi urged a national dialogue as the country nears the end of the transition from Hosni Mubarak‘s rule.

“I renew my call for opening a serious national dialogue over the concerns of the nation, with all honesty and impartiality, to end the transitional period as soon as possible, in a way that guarantees the newly-born democracy,” Mursi said.

Mursi plunged Egypt into a new crisis last week when he gave himself extensive powers and put his decisions beyond judicial challenge, saying this was a temporary measure to speed Egypt’s democratic transition until the new constitution is in place.

His assertion of authority in a decree issued on November 22, a day after he won world praise for brokering a Gaza truce between Israel and the Palestinian Islamist Hamas movement, dismayed his opponents and widened divisions among Egypt’s 83 million people.

Two people have been killed and hundreds wounded in protests by disparate opposition forces drawn together and re-energized by a decree they see as a dictatorial power grab.

A demonstration in Cairo to back the president swelled through the afternoon, peaking in the early evening at least 200,000, said Reuters witnesses, basing their estimates on previous rallies in the capital. The authorities declined to give an estimate for the crowd size.

“The people want the implementation of God’s law,” chanted flag-waving demonstrators, many of them bussed in from the countryside, who choked streets leading to Cairo University, where Mursi’s Muslim Brotherhood had called the protest.

Tens of thousands of Egyptians had protested against Mursi on Friday. “The people want to bring down the regime,” they chanted in Cairo‘s Tahrir Square, echoing the trademark slogan of the revolts against Hosni Mubarak and Arab leaders elsewhere.

Rival demonstrators threw stones after dark in the northern city of Alexandria and a town in the Nile Delta. Similar clashes erupted again briefly in Alexandria on Saturday, state TV said.

“COMPLETE DEFEAT”

Mohamed Noshi, 23, a pharmacist from Mansoura, north of Cairo, said he had joined the rally in Cairo to support Mursi and his decree. “Those in Tahrir don’t represent everyone. Most people support Mursi and aren’t against the decree,” he said.

Mohamed Ibrahim, a hardline Salafi Islamist scholar and a member of the constituent assembly, said secular-minded Egyptians had been in a losing battle from the start.

“They will be sure of complete popular defeat today in a mass Egyptian protest that says ‘no to the conspiratorial minority, no to destructive directions and yes for stability and sharia (Islamic law)’,” he told Reuters.

Mursi has alienated many of the judges who must supervise the referendum. His decree nullified the ability of the courts, many of them staffed by Mubarak-era appointees, to strike down his measures, although says he respects judicial independence.

A source at the presidency said Mursi might rely on the minority of judges who support him to supervise the vote.

“Oh Mursi, go ahead and cleanse the judiciary, we are behind you,” shouted Islamist demonstrators in Cairo.

Mursi, once a senior Muslim Brotherhood figure, has put his liberal, leftist, Christian and other opponents in a bind. If they boycott the referendum, the constitution would pass anyway.

If they secured a “no” vote to defeat the draft, the president could retain the powers he has unilaterally assumed.

And Egypt’s quest to replace the basic law that underpinned Mubarak’s 30 years of army-backed one-man rule would also return to square one, creating more uncertainty in a nation in dire economic straits and seeking a $ 4.8 billion loan from the IMF.

“NO PLACE FOR DICTATORSHIP”

Mursi’s well-organized Muslim Brotherhood and its ultra-orthodox Salafi allies, however, are convinced they can win the referendum by mobilizing their own supporters and the millions of Egyptians weary of political turmoil and disruption.

“There is no place for dictatorship,” the president said on Thursday while the constituent assembly was still voting on a draft constitution which Islamists say enshrines Egypt’s new freedoms.

Human rights groups have voiced misgivings, especially about articles related to women’s rights and freedom of speech.

The text limits the president to two four-year terms, requires him to secure parliamentary approval for his choice of prime minister, and introduces a degree of civilian oversight over the military – though not enough for critics.

The draft constitution also contains vague, Islamist-flavored language that its opponents say could be used to whittle away human rights and stifle criticism.

For example, it forbids blasphemy and “insults to any person”, does not explicitly uphold women’s rights and demands respect for “religion, traditions and family values”.

The draft injects new Islamic references into Egypt’s system of government but retains the previous constitution’s reference to “the principles of sharia” as the main source of legislation.

“We fundamentally reject the referendum and constituent assembly because the assembly does not represent all sections of society,” said Sayed el-Erian, 43, a protester in Tahrir and member of a party set up by opposition figure Mohamed ElBaradei.

Several independent newspapers said they would not publish on Tuesday in protest. One of the papers also said three private satellite channels would halt broadcasts on Wednesday.

Egypt cannot hold a new parliamentary election until a new constitution is passed. The country has been without an elected legislature since the Supreme Constitutional Court ordered the dissolution of the Islamist-dominated lower house in June.

The court is due to meet on Sunday to discuss the legality of parliament’s upper house.

“We want stability. Every time, the constitutional court tears down institutions we elect,” said Yasser Taha, a 30-year-old demonstrator at the Islamist rally in Cairo.

(Additional reporting by Marwa Awad, Yasmine Saleh and Tom Perry; Editing by Myra MacDonald and Jason Webb)

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Seth MacFarlane on “Family Guy” movie: “it’s just a matter of when”

NEW YORK (TheWrap.com) – “Family Guy” creator Seth MacFarlane wants to bring his beloved and controversial Fox show to the big screen, telling students at UCLA on Wednesday that a theatrical version of the show will definitely happen.

“It’s just a matter of when,” MacFarlane said, according to Entertainment Weekly. “It’s hard to do that while you have the series going on at the same time; I think that’s why it took ‘The Simpsons’ 20 seasons to figure out how to do it.”

“Family Guy,” which is in its 11th season, has made MacFarlane one of the most successful writers in television. A writer, director, voice actor and animator – not to mention singer-of-standards and this year’s Oscar host – MacFarlane created that show, as well Fox shows “American Dad” and “The Cleveland Show.”

He also had been working on a reboot of “The Flintstones,” but that appears to be shelved for now.

MacFarlane then transformed into one of the film industry’s hottest commodities this summer thanks to the breakout success of “Ted,” the Universal comedy that has set a new box-office record for an original, R-rated comedy.

While Universal has every intent of making another “Ted,” MacFarlane said he also has developed the ideas for a “Family Guy” film.

“We do know what the ‘Family Guy’ movie will be,” he told the students. Drawing another comparison to “The Simpsons Movie,” he said his one criticism of the cinematic version of that iconic show was that the plot would have worked on TV.

He claimed his “Family Guy” idea “would be impossible to do on TV.”

The Hollywood Reporter wrote last year that there is a deal in place for a ‘Family Guy” movie, but MacFarlane’s representatives did not respond to a request for more information about the rights to the movie or MacFarlane’s plans.

While MacFarlane still spends a good deal of his time working on television projects, the prospect of a “Family Guy” movie raises two questions: Does he have to make “Ted” first? Does Fox have the rights to the movie?

Neither Universal nor Fox have returned requests for comment.

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Asperger’s dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term “Asperger‘s disorder” is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But “dyslexia” and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation’s psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association‘s new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide “defines what constellations of symptoms” doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it “shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care.”

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association’s board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger’s disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger’s families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term “autism spectrum disorder,” which already is used by many experts in the field. Asperger’s disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don’t talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger’s.

“To give it separate names never made sense to me,” Gibson said. “To me, my children all had autism.”

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won’t affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors’ guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won’t be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook “represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders,” Dr. David Fassler, the group’s treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization’s fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won’t be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual “seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 … there have been important advances in our understanding of the nature of psychiatric disorders.”

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group’s autism task force, said anyone who met criteria for Asperger’s in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don’t provide services for children and adults with Asperger’s, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don’t lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids’ who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term “gender identity disorder.” It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn’t a disorder and say calling it one is stigmatizing. The term would be replaced with “gender dysphoria,” which means emotional distress over one’s gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Police: Kansas City Chiefs player kills girlfriend, takes own life

Chiefs and Panthers will play at regularly scheduled time on Sunday:
The Kansas City Chiefs announced that Sund... http://t.co/Ah1nFJf4

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Oliver Stone, Benicio del Toro visit Puerto Rico

SAN JUAN, Puerto Rico (AP) — Benicio Del Toro didn’t wait long to collect on a favor that Oliver Stone owed him for working extra hours on the set of his most recent movie, “Savages”, released this year.

The favor? A trip to Del Toro‘s native Puerto Rico, which Stone hadn’t visited since the early 1960s.

“I told him, you owe me one,” Del Toro said with a smile as he recalled the conversation during a press conference Friday in the U.S. territory, where he and Stone are helping raise money for one of the island’s largest art museums.

Del Toro, wearing jeans, a black jacket and a black T-shirt emblazoned with the name of local reggaeton singer Tego Calderon, waved to the press as he was introduced.

“Hello, greetings. Is this a press conference?” he quipped as he and Stone awaited questions.

Both men praised each other’s work, saying they would like to work with each other again.

“I deeply admire him as an actor, the way he thinks, the way he expresses himself,” Stone said. “Of all the actors I’ve worked with, he’s the most interesting.”

Stone said Del Toro always delivers surprises while acting, even when it’s as something as subtle as certain gestures between dialogue.

“I think Benicio is the master of keeping you watching,” he said.

Stone said he enjoys meeting up with Del Toro off-set because he’s one of the few actors in Hollywood who can talk about something other than movies.

“He is very interested in the world around him,” Stone said, adding that the conversations sometimes center around politics and other topics.

Del Toro declined to answer when asked what he thought about Puerto Rico’s referendum earlier this month, which aimed to determine the future of the island’s political status. He said the results did not seem to point to a clear-cut outcome.

Del Toro then said he would like the island’s movie business to grow, especially in a way that would encourage learning.

“I’m talking about movies in an educational sense, as a way to discover other parts of the world,” he said. “Create a film class. You’ll see, kids won’t skip it.”

Del Toro also shared his thoughts on being a father after having a daughter with Kimberly Stewart in August 2011.

He said the girl is learning how to swim and is discovering the world around her.

“She has her own personality,” Del Toro said. “She’s not her mother. She’s not me.”

Both Del Toro and Stone are expected to remain in Puerto Rico through the weekend to raise money for the Art Museum of Puerto Rico, which is hosting its annual movie festival and will honor Stone’s movies.

Museum curator Juan Carlos Lopez Quintero said the money raised will be used to enhance the museum’s permanent collection, especially with Puerto Rican paintings from the 19th century and early 20th century.

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Dolly Parton talks dreams, love, plastic surgery

NEW YORK (Reuters) – Although Dolly Parton has cemented her place in country and popular music, pop culture, and as an entrepreneur and philanthropist, she still, on occasion, gets nervous.

Her new book, “Dream More: Celebrate the Dreamer in You” encourages readers to overcome their fears, believe in their passions and keep taking risks.

The “I Will Always Love You” singer/songwriter, 66, who has written more than 3,000 songs and sold more than 100 million records, talked to Reuters about the message of the book, which was published this week.

Q. You say you put off writing this book?

A. “It’s just a simple little book. It’s not meant to save the world, or it’s not a complete book of how to be successful, but I think there is enough stuff in it for people to see kinda how I conduct my business and kinda what my thoughts are. And the good part is that all the money, if it sells good, goes to Imagination Library.”

Q. Right – your nonprofit quest to get kids to read?

A. “It’s one of the reasons I wanted to write this too, because I usually do concerts every year, for the foundation to make money to afford a lot of books, but I am not on tour now.”

Q. Talk about your 2009 commencement address at the University of Tennessee. Were you nervous?

A. “Well, yes, when I am out of my element doing things. I am not that educated and I didn’t go that far in school and I thought, ‘What am I going to say to these educated people, not just these kids who have just graduated college and are probably brilliant, but all these professionals and all these teachers?’ And I thought, ‘Oh, I am not smart enough’, but I thought, ‘Well, at least I am a hometown girl. At least they can see that in America, you can start from humble beginnings, that everybody can make it.”

Q. Which is one of the book’s messages, overcoming fears?

A. “Any time I am in a situation where I am just not comfortable, I am uneasy, but that doesn’t mean I won’t go on with it, just like the speech. And that I won’t be good at it, but there are just some things I would prefer not to do!”

Q. Success doesn’t equal happiness, yet you seem so hopeful and modest?

A. “I am always hopeful as a person, I have been since I was little…I really want things to be good. As I mention in the book, I wake up everyday expecting it to be good, and if it is not, then I try to set about changing it before I go to sleep at night.”

Q. Would you describe yourself as religious or spiritual?

A. “Just spiritual, I am not religious. Although I grew up in a very religious family, but…I am no fanatic by any stretch of the word, and I am no angel, believe me. I wrote a song called ‘The Seeker’ many, many years ago, and it says ‘I am a seeker, just a poor sinful creature, there is no one weaker than I am.’

“People say, ‘What do you regret?’ I say, ‘I can’t say that I regret anything because at the time I was doing it, whatever it was, it seemed to be the thing to be doing at the time.’

“I have a good friend base, I have a good husband. So I have a lot of things and people who help me and guide me. I have never had to go to a psychiatrist, but I would if I thought that I needed to.

Q. But we are in New York, Dolly! No psychiatrist?

A. “Well yes (laughs), I guess not. But I do that in my songs, I write my feelings out and then I have such a strong faith and then I have such good friends. I am very close to several of my sisters, and we just talk about everything and anything….And my best friend Judy, there is nothing I can’t tell her, even if it is the awful-est thing in the world.”

Q. You recently had to deny gay rumors. Who is your greatest love?

“My husband is my greatest love, I have been with him 48 years…He is my best buddy.”

Q. Why do you think people always wonder about him?

A. “They don’t think he really exists! When I was doing my show, we were thinking about having a different guy knock on the door every night, as my husband, and then one night he would be a midget, and one night he would be a black man, and one night he would be like a boxer or a wrestler, all these different things that people imagine what my husband looks like.”

Q. You say that looking so artificial works for you, as it lets you prove how real you are. Why all the plastic surgery?

A. “Because I need it. Why does anybody get it?”

Q. Why do you think you need it?

A. “Because I am in show business. I am not a natural beauty. And I am on camera all the time. And I just always see, like if I need – Oh take one of my chins off, at least! – Or whatever. I mean, I don’t go to extremes with it. I just do little bits and pieces, just to try and keep things touched up, just tweaking.”

(Reporting by Christine Kearney, editing by Jill Serjeant and Carol Bishopric)

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Little apparent progress in U.S. “fiscal cliff” talks

HATFIELD, Pennsylvania (Reuters) – With barely a month left before the “fiscal cliff,” Republicans and Democrats remained far apart on Friday in talks to avoid the across-the-board tax hikes and spending cuts that threaten to throw the country back into recession.

While President Barack Obama visited a Pennsylvania toy factory to muster public support for tax hikes on the rich, portraying Republicans as scrooges at Christmas time, his primary adversary in negotiations, Republican House Speaker John Boehner, continued to describe the situation as a stalemate.

The argument will resume on Sunday when Boehner, along with Obama’s Treasury secretary, Timothy Geithner, and others, take to weekly political talk shows and pick up further steam next week with a possible confrontation in the House of Representatives between Democrats and Republicans over the timing of a vote on tax hikes.

Lawmakers are nervously eyeing the markets as the deadline approaches, with gyrations likely to intensify pressure to bring the drama to a close.

The markets, in turn watching the politicians, fell as Boehner spoke, but recovered afterward. It was a repeat of the pattern earlier in the week when the speaker offered a similarly gloomy assessment.

The latest round of high-stakes gamesmanship focuses on whether to extend the temporary tax cuts that originated under former President George W. Bush beyond their December 31 expiration date for all taxpayers, as Republicans want, or just for those with incomes under $ 250,000, as Obama and his fellow Democrats want.

After five days of increasingly confrontational exchanges, the work week drew to a close with an announcement by Democrats of a long-shot effort next week to force an early tax-hike vote in the Republican-controlled U.S. House to break the deadlock.

MEDICARE, SOCIAL SECURITY

House Minority Leader Nancy Pelosi said she would undertake the rarely successful effort unless Boehner agreed by Tuesday to bring a bill to the floor allowing taxes on the wealthy to rise, something Boehner is highly unlikely to do until he is ready.

“The clock is ticking,” Pelosi said at a news conference. “The year is ending. It’s really important with tax legislation for it to happen now. We’re calling upon the Republican leadership in the House to bring this legislation to the floor next week.”

While Boehner offered no immediate response to Pelosi’s threat, Cathy McMorris Rodgers of Washington state, recently elected by Republicans to be the fourth-ranking party leader in the House, told Fox News in an interview not to expect any tax vote next week.

Amid the competing statements from the two sides, there were some actual, albeit modest, signs of potential movement.

Senate Minority Leader Mitch McConnell threw Republican proposals into the mix for reform of Medicare, the government health insurance program for seniors, which has exploded in cost in recent years and is a major contributor to the country’s soaring deficit.

McConnell of Kentucky told the Wall Street Journal in an interview that Republicans would agree to more revenue – although not higher tax rates – if Democrats agreed to such changes as raising the eligibility age for Medicare and slowing cost-of-living increases in the Social Security retirement program.

Rodgers, in her Fox News interview, declined to completely rule out a much-discussed potential compromise in which Republicans would accept some increase in tax rates on the rich, but not to the level desired by Obama.

‘A LUMP OF COAL’

More House Republicans – although still just a handful -expressed flexibility beyond that of their party leaders about considering an increase in tax rates for the wealthy, as long as they are accompanied by significant spending cuts.

Most House Republicans refuse to back higher rates, preferring to raise revenue through tax reform.

Obama, speaking in Pennsylvania, said he was encouraged by the shifting views of some Republicans, and urged House approval of a bill that has already cleared the Democratic-controlled Senate that would lock in the middle-class tax cuts and raise the rates for the rich.

“If we can get a few House Republicans on board, we can pass the bill. … I’m ready to sign it,” Obama said.

But neither he nor the other principals in the debate budged from their basic positions.

Instead, Obama turned up the pressure on Friday, hitting the road to drum up support for his drive to raise taxes on the wealthy and warning Americans that Republicans were offering them “a lump of coal” for Christmas.

In a visit to the Pennsylvania toy factory, Obama portrayed congressional Republicans as scrooges who risked sending the country over the fiscal cliff rather than strike a deal to avert the tax increases and spending cuts that begin in January unless Congress intervenes.

“We already all agree, we say, on making sure middle-class taxes don’t go up. So let’s get that done. Let’s go ahead and take the fear out for the vast majority of American families so they don’t have to worry,” Obama said at the Rodon Group factory, which makes K’NEX building toy systems as well as Tinkertoys and consumer products.

In Washington, Boehner said Obama’s plan to raise taxes on the rich was the wrong approach.

“There is a stalemate. Let’s not kid ourselves,” the Ohio Republican said. “Right now we are almost nowhere.”

(Additional reporting by Richard Cowan, Thomas Ferraro, Kim Dixon, Edward Krudy; Writing by John Whitesides; Editing by Fred Barbash and Todd Eastham)

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Israel moves to build 3,000 new homes

JERUSALEM (AP) — Israel responded swiftly Friday to U.N. recognition of a Palestinian state, revealing it will build 3,000 more homes for Jews on Israeli-occupied lands that the world body overwhelmingly said belong to the Palestinians.

The plans also include future construction in a strategic area of the West Bank where critics have long warned that Jewish settlements would kill hopes for a viable Palestinian state.

Israel's moves served as a harsh reminder to Palestinians — euphoric over the U.N. upgrade — that while they now have a state on paper, most of it remains very much under Israeli control.

"This is a doomsday scenario," Daniel Seidemann of Ir Amim, a group that promotes coexistence in Jerusalem, said of the building plans.

Israel's decision was bound to embarrass the United States, which was among just nine countries in the 193-member General Assembly to vote against accepting Palestine as a nonmember observer state.

Accelerated settlement construction could also set a more confrontational tone as Palestinian President Mahmoud Abbas weighs his next moves.

In Washington, State Department spokeswoman Victoria Nuland criticized the Israeli announcement. "These actions are counterproductive and make it harder to resume direct negotiations or achieve a two-state solution," she said.

Friday's decision was taken by Prime Minister Benjamin Netanyahu and eight senior Cabinet ministers, according to the Israeli news website Ynet.

The plans include 3,000 new apartments in the West Bank and east Jerusalem, as well as preparations for new construction in other large West Bank settlements, including Maaleh Adumim, near east Jerusalem, said an Israeli government official.

Among the projects is an expansion of Maaleh Adumim, known as E-1, said the official, speaking on condition of anonymity because he was not authorized to discuss the decision with reporters.

Successive U.S. administrations have pressured Israel not to build in E-1 because it would effectively cut off east Jerusalem from the West Bank, and split the northern part of the territory from the southern part. Israel has said in the past it envisions 3,500 apartments there.

"E-1 will be the death of the two-state solution," said Seidemann, referring to the establishment of a state of Palestine alongside Israel. "If the pronouncements are to be treated seriously, we are months away from the implementation of E-1. This is very serious and very problematic."

Tzipi Livni, Israel's former foreign minister and chief negotiator with the Palestinians, warned that "the decision to build thousands of housing units as punishment to the Palestinians only punishes Israel ... (and) only isolates Israel further."

Since 1967, the number of Israelis living in settlements in the West Bank and east Jerusalem has risen to half a million, compared with 2.7 million Palestinians in those areas, and continued construction makes partition of the land increasingly unlikely.

The new U.N. observer state status could enable the Palestinians to pursue possible war crimes charges against Israel at the International Criminal Court over settlement construction on war-won land.

In his speech to the U.N. on Thursday, Abbas said he would coordinate with sympathetic countries and act responsibly, suggesting he would not seek confrontation with Israel.

"It is our right to get the membership of the ICC, but we don't want to go to it now," Abbas told reporters in New York on Friday, before the Israeli decision on new settlements became known. "We will not go unless we are attacked."

Following Israel's decision to accelerate settlement building, however, Abbas aide Saeb Erekat said the Palestinian leadership was studying its options. He would not elaborate.

Erekat accused Netanyahu of "defying the whole international community and insisting on destroying the two-state solution."

The U.N. endorsed a Palestinian state in territories Israel captured in 1967. Abbas has said he is ready to negotiate the final borders with Israel, provided Netanyahu drops his refusal to use the 1967 lines as a starting point.

Abbas asserted Friday that a Palestinian demand for a settlement freeze ahead of negotiations still stands.

"I'm ready for negotiations," Abbas said, rejecting Netanyahu's portrayal of the demand for a settlement freeze as a precondition. "Is stopping settlement activities a precondition?" he said. "There are 15 Security Council resolutions that say settlements are an obstacle to peace."

On the Israeli side, compromise on settlements seemed unlikely. Netanyahu is seeking re-election two months from now at the helm of a Likud party turned more hawkish since primaries earlier this week and in an electoral alliance with an ultra-nationalist pro-settler party.

Abbas returns Sunday to the West Bank, where Palestinians are preparing a hero's welcome. The U.N. bid has given a boost to his standing, which has been suffering after years of failed peace efforts with Israel. At the same time, the rival Islamic militant group Hamas in Gaza has scored points domestically, after an eight-day cross-border conflict with Israel earlier this month.

Abbas aides say his top priority is to reconcile with Hamas, which seized Gaza from him in 2007 and has been running its own government there since then. Abbas heads the Palestinian Authority, a self-rule government that administers 38 percent of the West Bank, while he has no say in Israeli-annexed east Jerusalem.

The U.N. vote drew mixed reactions among Palestinians trying to reconcile global recognition with the limitations imposed by Israeli control, including border restrictions in Gaza.

Shahira Taleb, a 45-year-old Gaza housewife who has been unable to visit family in the West Bank because of an Israeli travel ban between the territories, was skeptical.

"I don't know if it's something that will change our life or is just a new paper added to thousands of papers issued over the past years in support of our cause," she said, standing in line at a bakery.

But Talal Jafari, a 47-year-old shopkeeper in the West Bank city of Hebron, said for Palestinians, every victory counts. "The entire world supports us, and that by itself is great for us," he said.

___

Laub reported from Ramallah. Associated Press writer Mohammed Daraghmeh in Ramallah, West Bank, Nasser Shiyoukhi in Hebron and Ibrahim Barzak in Gaza City contributed reporting.

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Noisy city: Cacophony in Caracas sparks complaints

CARACAS, Venezuela (AP) — This metropolis of 6 million people may be one of the world’s most intense, overwhelming cities, with tremendous levels of crime, traffic and social strife. The sounds of Caracas‘ streets live up to its reputation.

Stand on any downtown corner, and the cacophony can be overpowering: Deafening horns blast from oncoming buses, traffic police shrilly blow their whistles and sirens shriek atop ambulances stuck in bumper-to-bumper traffic.

Air horns routinely used by bus drivers are so powerful they make pedestrians on crosswalks recoil, and can even leave their ears ringing. Loud salsa music blares from the windows of buses, trucks with old mufflers rumble past belching exhaust, and “moto-taxis” weave through traffic beeping high-pitched horns.

Growing numbers of Venezuelans are saying they’re fed up with the noise that they say is getting worse, and the numbers of complaints to the authorities have risen in recent years.

One affluent district, Chacao, put up signs along a main avenue reading: “A honk won’t make the traffic light change.”

“The noise is terrible. Sometimes it seems like it’s never going to end,” said Jose Santander, a street vendor who stands in the middle of a highway selling fried pork rinds and potato chips to commuters in traffic.

Prosecutor General Luisa Ortega recently told a news conference that officials have started “putting an increased emphasis on promoting peaceful coexistence” by punishing misdemeanors such as violations of anti-noise regulations and other minor crimes. That effort has translated into hundreds of noise-related cases in recent years.

Some violators are ordered to perform community service. For instance, two young musicians who were recently caught playing loud music near a subway station were sentenced to 120 hours of community service giving music lessons to students in public schools.

Others caught playing loud music on the street have been charged with disturbing the peace after complaints from neighbors. Fines can run as high as 9,000 bolivars, or $ 2,093.

On the streets of their capital, however, Venezuelans have grown used to living loudly. The noisescape adds to a general sense of anarchy, with many drivers ignoring red lights and blocking intersections along potholed streets strewn with trash.

“This is something that everybody does. Nobody should be complaining,” said Gregorio Hernandez, a 23-year-old college student, as he listened to Latin rock songs booming from his car stereo on a Saturday night in downtown Caracas. “We’re just having fun. We’re not hurting anybody.”

Adding to the mess is the country’s notoriously divisive politics, which regularly fill the streets with marches and demonstrations.

On many days, the shouts of protesters streaming through downtown can be heard from blocks away, demanding pay hikes or unpaid benefits.

And the sporadic crackling of gunfire in the slums can be confused for firecrackers tossed by boisterous partygoers.

It’s difficult to rank the world’s noisiest cities because many, including Venezuela’s capital, don’t take measurements of sound pollution, said Victor Rastelli, a mechanical engineering professor and sound pollution expert at Simon Bolivar University in Caracas. But Rastelli said he suspects Caracas is right up there among the noisiest, along with Sao Paulo, Mexico City and Mumbai.

Excessive noise can be more than simply an annoyance, Rastelli said. “This is a public health problem.”

Dr. Carmen Mijares, an audiologist at a private Caracas hospital, said she treats at least a dozen patients every month for hearing damage caused by prolonged exposure to loud noises.

“Many of them work in bars or night clubs, and their maladies usually include temporary hearing loss and headaches,” Mijares said. For others, she said, the day-to-day noise of traffic, car horns and loud music can exacerbate stress and sleeping disorders.

Several cities have successfully reduced noise pollution, said Stephen Stansfeld, a London psychiatry professor and coordinator of the European Network on Noise and Health.

One of the most noteworthy initiatives, Stansfeld said, was in Copenhagen, Denmark, where officials used sound walls, noise-reducing asphalt and other infrastructure as well as public awareness campaigns to fight noise pollution.

But such high-tech solutions seem like a remote possibility in Caracas, where streets are literally falling apart and aging overpasses regularly lack portions of their guard rails. Prosecutors, angry neighbors and others hoping to fight the noise will have to persuade Venezuelans to do nothing less than change their loud behavior.

For Carlos Pinto, however, making noise is practically a political right.

The 26-year-old law student and his friends danced at a recent street party to house music booming from woofers in his car’s open trunk, with neon lights on the speakers that pulsed to the beat.

When asked about the noise, he answered: “We will be heard.”

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AP freelance video journalist Ricardo Nunes contributed to this report.

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Christopher Toothaker on Twitter: http://twitter.com/ctoothaker

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Taking a page from Louis C.K., Chill launches online store for films, comedy specials

NEW YORK (TheWrap.com) – Chill, a social video platform with close to 20 million users, has launched Chill Direct, a new store for creatives like Maria Bamford and Michael Urie to sell their movies, specials and documentaries directly to fans.

Comedian Louis C.K. sent shockwaves through the entertainment industry this summer by selling a comedy special directly online rather than making a distribution deal with a television network or online service. He made millions, and various others have followed suit, including Jim Gaffigan and Aziz Ansari.

Chill sees an opportunity to enter this emerging market, empowering artists and offering them an opportunity to control the distribution and monetization of their ongoing projects.

“The community gives filmmakers and comedians the ability to distribute premium video directly to fans,” CEO Brian Norgard told TheWrap. “The common analogy is to Louis C.K. and his ‘Live at Beacon Theater.‘ That was a seminal moment in the entertainment business and a lot of things now allow direct-to-fan to become a viable model.”

Artists who choose to sell through Chill also can sell their videos elsewhere, but Chill Direct launches with eight videos exclusive to the site. That slate includes “Maria Bamford: the Special Special Special!,” an hour-long comedy special starring Bamford, “Thank You For Judging,” a documentary from “Ugly Betty” actor Urie about high school speech and debate and “Unknown Sender,” a suspense series from “48 Hrs” and “Die Hard” scribe Stephen E. de Souza.

Starting Thursday, any artist can create a page for a project and has complete creative control over the page, from information about the project to trailers to pricing. Meanwhile, Chill handles distribution across devices as well as payments.

Artists retain rights to their own intellectual property while Chill takes a 30 percent cut of any transaction.

“What Chill does is let anyone build out socially integrated marketing pages – we call them story pages – beautiful, high-resolution tantalizing receptacles of premium videos,” Norgard said.

Chill, funded by WME and Kleiner Perkins Caulfield & Byers and others, has previously enabled frictionless uploading, consumption and sharing of the web’s most popular videos. This maintains a social layer, allowing for commenting and offering bundles that combine the video with other perks like merchandise or meeting the creator.

“The land of premium video is still a very closed marketplace,” Norgard said. “If you have tremendous business development skills or connections to sell a film to Netflix or Hulu, you’re lucky. The ad-supported model doesn’t fit every type of content. There is plenty of stuff out there like documentary films and comedy specials where creators are between a rock and a hard place and wan to get it out there, distribute it, own the right but not put it on a free streaming site like YouTube.”

Selling direct to fans also offers a new revenue stream to a company that until now was mostly luring people a few times a day for videos.

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he’s a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America’s battlefields and an “honest conversation about the country’s history.”

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Online:

http://www.traceadkins.com

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Man Wins Suit Over Sex Addiction

A French man who claimed a Parkinson’s drug turned him into a gambling and gay sex addict has been awarded 197,000 euros in damages, the French Press Agency reported.

Didier Jambart, 52, of Nantes, France, sued the pharmaceutical giant GlaxoSmithKline in 2011, claiming the drug, Requip, caused him to lose 82,000 euros gambling on the Internet. He said he also became addicted to gay sex and risky sexual encounters. He said he was raped after starting the drug in 2003 and attempted suicide eight times.

“It’s a great day,” Jambart, who was accompanied by his wife during the emotional ruling, told the French Press Agency. “It’s been a seven-year battle with our limited means for recognition of the fact that GSK lied to us and shattered our lives.”

Parkinson’s disease destroys neurons deep within the brain that release the “feel-good” neurotransmitter dopamine. Requip belongs to a class of drugs called dopamine agonists that relieve Parkinson’s symptoms — such as shaking, stiffness, slowness and trouble balancing — by activating dopamine receptors. But the drugs have side effects that, while rare, can be serious.

“There are plenty of reports of people developing side effects from Parkinson’s drugs, such as hypersexuality, gambling and excessive shopping,” Dr. David Standaert of the Center for Neurodegeneration and Experimental Therapeutics at the University of Alabama at Birmingham told ABC News when the lawsuit was filed. “It’s uncommon, but very dramatic when it happens.”

Up to 17 percent of people with Parkinson’s disease who take dopamine agonists exhibit an impulse control disorder, according to a 2010 study published in the Archives of Neurology.

“It can be devastating for those people,” said Dr. Mark Stacy, the Duke University neurologist who first linked the drugs to gambling in 2000. “And I think that because of the embarrassing nature of the complaint, it’s a bit amplified.”

Jambart is not the first Parkinson’s patient to sue a drug maker over these symptoms. In 2008, a court in Minneapolis awarded Gary Charbonneau $ 8.2 million in a suit against the makers of Mirapex, Pfizer and Boehringer Ingelheim. And in 2010, more than 100 patients in Australia sued Pfizer and Aspen Pharmacare — the makers of Cabaser and Permax respectively — over sex and gambling addictions.

“Dopamine is a reward signal,” Standaert said, adding that certain illicit drugs, such as cocaine and methamphetamine, act on dopamine receptors. Standaert said he has met patients who have gambled or shopped away hundreds of thousands of dollars. “In certain individuals who seem sensitive to this, these dopamine agonists really make them overcome their normal inhibitions… They lose their moral compass.”

Compulsive behaviors such as pathological gambling and hypersexuality are now listed as side effects on the drugs’ package inserts. But Jambart claimed this wasn’t the case when he starting taking Requip in 2003. By the time he stopped taking Requip in 2005, he had already been demoted at work and suffered psychological trauma because of his addictions, his lawyers told the French Press Agency.

In the United States, GSK added warnings about unusual behaviors to the Requip package insert in July 2005 and expanded them in 2006, company spokeswoman Mary Anne Rhyne told ABC News at the time the lawsuit was filed.

“We urge patients to talk to their doctor before deciding to stop or start taking any medicine,” she said. “Anyone receiving treatment with dopamine agonists who notices unusual behaviors, such as new or increased gambling urges, increased sexual urges or other intense urges should talk to their doctor.”

Standaert stressed that while the drug’s side effects are “colorful and serious,” they’re very rare.

“These are very useful medications,” he said. “People shouldn’t be frightened, they should just know about the risks.”

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U.N. recognizes Palestinian state, U.S. objects

UNITED NATIONS (Reuters) - The 193-nation U.N. General Assembly on Thursday overwhelmingly approved the de facto recognition of the sovereign state of Palestine after Palestinian President Mahmoud Abbas called on the world body to issue its long overdue "birth certificate."

The U.N. victory for the Palestinians was a diplomatic setback for the United States and Israel, which were joined by only a handful of countries in voting against the move to upgrade the Palestinian Authority's observer status at the United Nations to "non-member state" from "entity," like the Vatican.

Britain called on the United States to use its influence to help break the long impasse in Israeli-Palestinian peace talks. Washington also called for a revival of direct negotiations.

There were 138 votes in favor, nine against and 41 abstentions. Three countries did not take part in the vote, held on the 65th anniversary of the adoption of U.N. resolution 181 that partitioned Palestine into separate Jewish and Arab states.

Thousands of flag-waving Palestinians in the West Bank and the Gaza Strip set off fireworks and danced in the streets to celebrate the vote.

The assembly approved the upgrade despite threats by the United States and Israel to punish the Palestinians by withholding funds for the West Bank government. U.N. envoys said Israel might not retaliate harshly against the Palestinians over the vote as long as they do not seek to join the International Criminal Court.

If the Palestinians were to join the ICC, they could file complaints with the court accusing Israel of war crimes, crimes against humanity and other serious crimes.

U.S. Secretary of State Hillary Clinton called the vote "unfortunate and counterproductive," while the Vatican praised the move and called for an internationally guaranteed special status for Jerusalem, something bound to irritate Israel.

The much-anticipated vote came after Abbas denounced Israel from the U.N. podium for its "aggressive policies and the perpetration of war crimes," remarks that elicited a furious response from the Jewish state.

"Sixty-five years ago on this day, the United Nations General Assembly adopted resolution 181, which partitioned the land of historic Palestine into two states and became the birth certificate for Israel," Abbas told the assembly after receiving a standing ovation.

"The General Assembly is called upon today to issue a birth certificate of the reality of the State of Palestine," he said.

Israeli Prime Minister Benjamin Netanyahu responded quickly, condemning Abbas' critique of Israel as "hostile and poisonous," and full of "false propaganda.

"These are not the words of a man who wants peace," Netanyahu said in a statement released by his office. He reiterated Israeli calls for direct talks with the Palestinians, dismissing Thursday's resolution as "meaningless."

ICC THREAT

A number of Western delegations noted that Thursday's vote should not be interpreted as formal legal recognition of a Palestinian state. Formal recognition of statehood is something that is done bilaterally, not by the United Nations.

Granting Palestinians the title of "non-member observer state" falls short of full U.N. membership - something the Palestinians failed to achieve last year. But it does have important legal implications - it would allow them access to the ICC and other international bodies, should they choose to join.

Abbas did not mention the ICC in his speech. But Palestinian Foreign Minister Riyad al-Maliki told reporters after the vote that if Israel continued to build illegal settlements, the Palestinians might pursue the ICC route.

"As long as the Israelis are not committing atrocities, are not building settlements, are not violating international law, then we don't see any reason to go anywhere," he said.

"If the Israelis continue with such policy - aggression, settlements, assassinations, attacks, confiscations, building walls - violating international law, then we have no other remedy but really to knock those to other places," Maliki said.

In Washington, a group of four Republican and Democratic senators announced legislation that would close the Palestinian office in Washington unless the Palestinians enter "meaningful negotiations" with Israel, and eliminate all U.S. assistance to the Palestinian Authority if it turns to the ICC.

"I fear the Palestinian Authority will now be able to use the United Nations as a political club against Israel," said Republican Senator Lindsey Graham, one of the sponsors.

Abbas led the campaign to win support for the resolution, which followed an eight-day conflict this month between Israel and Islamists in the Gaza Strip, who are pledged to Israel's destruction and oppose a negotiated peace.

The vote highlighted how deeply divided Europe is on the Israeli-Palestinian conflict.

At least 17 European nations voted in favor of the Palestinian resolution, including Austria, France, Italy, Norway and Spain. Abbas had focused his lobbying efforts on Europe, which supplies much of the aid the Palestinian Authority relies on. Britain, Germany and many others chose to abstain.

The traditionally pro-Israel Czech Republic was unique in Europe, joining the United States, Israel, Canada, Panama and tiny Pacific Island states likes Nauru, Palau and Micronesia in voting against the move.

'HOPE SOME REASON WILL PREVAIL'

Peace talks have been stalled for two years, mainly over Israeli settlements in the West Bank, which have expanded despite being deemed illegal by most of the world. There are 4.3 million Palestinians in the West Bank and Gaza.

After the vote, U.S. Ambassador to the United Nations Susan Rice called for the immediate resumption of peace talks.

"The Palestinian people will wake up tomorrow and find that little about their lives has changed save that the prospects of a durable peace have only receded," she said.

She added that both parties should "avoid any further provocative actions in the region, in New York or elsewhere."

Palestinian Prime Minister Salam Fayyad said he hoped all sides would use the vote to push for new breakthroughs in the peace process.

"I hope there will be no punitive measures," Fayyad told Reuters in Washington, where he was attending a conference.

"I hope that some reason will prevail and the opportunity will be taken to take advantage of what happened today in favor of getting a political process moving," he said.

Britain's U.N. ambassador, Mark Lyall Grant, told reporters it was time for recently re-elected U.S. President Barack Obama to make a new push for peace.

"We believe the window for the two-state solution is closing," he said. "That is why we are encouraging the United States and other key international actors to grasp this opportunity and use the next 12 months as a way to really break through this impasse."

(Additional reporting by Andrew Quinn in Washington, Noah Browning in Ramallah, Jeffrey Heller in Jerusalem, Robert Mueller in Prague, Gabriela Baczynska and Reuters bureaux in Europe and elsewhere; Editing by Eric Beech and Peter Cooney)

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Rapper PSY wants Tom Cruise to go ‘Gangnam Style’

BANGKOK (AP) — The South Korean rapper behind YouTube’s most-viewed video ever has set what might be a “Mission: Impossible” for himself.

Asked which celebrity he would like to see go “Gangnam Style,” the singer PSY told The Associated Press: “Tom Cruise!”

Surrounded by screaming fans, he then chuckled at the idea of the American movie star doing his now famous horse-riding dance.

PSY’s comments Wednesday in Bangkok were his first public remarks since his viral smash video — with 838 million views — surpassed Justin Bieber‘s “Baby,” which until Saturday held the record with 803 million views.

“It’s amazing,” PSY told a news conference, saying he never set out to become an international star. “I made this video just for Korea, actually. And when I released this song — wow.”

The video has spawned hundreds of parodies and tribute videos and earned him a spotlight alongside a variety of superstars.

Earlier this month, Madonna invited PSY onstage and they danced to his song at one of her New York City concerts. MC Hammer introduced the Korean star at the American Music Awards as, “My Homeboy PSY!”

Even President Barack Obama is talking about him. Asked on Election Day if he could do the dance, Obama replied: “I think I can do that move,” but then concluded he might “do it privately for Michelle,” the first lady.

PSY was in Thailand to give a free concert Wednesday night organized as a tribute to the country’s revered King Bhumibol Adulyadej, who turns 85 next month. He paid respects to the king at a Bangkok shopping mall, signing his name in an autograph book placed beside a giant poster of the king. He then gave an outdoor press conference, as screaming fans nearby performed the pop star’s dance.

Determined not to be a one-hit wonder, PSY said he plans to release a worldwide album in March with dance moves that he thinks his international fans will like.

“I think I have plenty of dance moves left,” he said, in his trademark sunglasses and dark suit. “But I’m really concerned about the (next) music video.”

“How can I beat ‘Gangnam Style’?” he asked, smiling. “How can I beat 850 million views?”

___

Associated Press writer Thanyarat Doksone contributed to this report.

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Adele’s “21″ sells 10 million, Rihanna leads Billboard

LOS ANGELES (Reuters) – British singer and Grammy darling Adele reached the 10 million sales mark in the United States on Wednesday with her heartbreak album “21″ becoming the first by British woman to reach the milestone, Nielsen SoundScan said.

“21,” released in February 2011, produced the hits “Someone Like You” and “Rolling In The Deep” and became the top-selling album of 2011. Earlier this year, Adele swept the Grammy Awards with six, including song, record and album of the year.

“21″ became the third album to cross 10 million in 2012, along with Linkin Park‘s “Hybrid Theory” and Usher’s “Confessions.” But it is the only album to reach the milestone in less than two years in the last decade, Nielsen said.

“What an incredible honor,” Adele said in a statement. “A huge, huge thank you to my American fans for embracing this record on such a massive level.”

“21″ will receive the diamond certification from the Recording Industry Association of America, marking its 10 million milestone, joining the ranks of albums by artists such as Michael Jackson, The Beatles and Madonna.

“Adele‘s unique talent is a gift to music fans, and her success is certainly cause for a celebration of Diamond magnitude,” Cary Sherman, RIAA’s chairman & CEO, said in a statement.

Adele, 24, is enjoying the success of her latest single “Skyfall,” the official theme song for the James Bond film of the same name. It has sold more than 2 million copies worldwide. The singer also gave birth to her first child earlier this year.

On the Billboard 200 chart this week, R&B star Rihanna scored her first No. 1 album with “Unapologetic,” selling 238,000 copies.

She held off new entries from “American Idol” winner Phillip Phillips, who landed at No. 4 with his debut album “The World From the Side of the Moon,” and country-rock singer Kid Rock, who rounded out the top five with his latest album “Rebel Soul.”

(Reporting By Piya Sinha-Roy Editing by Jill Serjeant, Grant McCool and Andre Grenon)

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Cutting consultations led to more Medicare spending

NEW YORK (Reuters Health) – Medicare unintentionally spent more money on doctor’s-office visits in 2010, the year it introduced a simplified fee schedule, according to a new study.

Researchers found that the U.S. government-run insurance for the elderly paid an average of $ 40 more per beneficiary after it stopped paying for consultations with specialists and increased its payments for regular doctors’ visits – even though the goal had been to break even while streamlining fee categories.

“It’s important to emphasize the increase is – as far as we know right now – just a onetime change… We don’t know if this change will last or if the growth rate will go back to what it was,” said the study’s lead author Zirui Song of Harvard Medical School in Boston.

Before the change, Medicare paid doctors about $ 125 for a consultation of “medium complexity,” about $ 92 for a standard first-time office visit and about $ 61 for seeing a regular patient.

Specialists, such as surgeons and obstetrician-gynecologists, typically billed for the more expensive consultations and family doctors, known as primary care physicians, billed for the cheaper office visits.

The income gap between specialists and family doctors is often cited as one reason that medical students choose not to go into primary care, which many fear will cause a doctor shortage within the next decade.

One study from 2010 found that family doctors earn as little as half what their colleagues who specialize in areas such as surgery and oncology take home. (see Reuters Health story of October 25, 2010 here: http://reut.rs/O2mVG9)

By making both family doctors and specialists charge for office visits rather than consultations, the Centers for Medicare and Medicaid Services (CMS) may have leveled the playing field somewhat, but the agency intended the policy change to be “neutral” in cost terms.

To see if that was the result, Song and his collaborators, who include a chairman of the Medicare Payment Advisory Commission, analyzed 2.2 million Medicare patients’ claims made from 2007 through 2010.

The study used a Thomson Reuters database and one of the co-authors is a Thomson Reuters employee.

The researchers, who published their findings in the Archives of Internal Medicine, found that Medicare paid about $ 628 annually per patient from 2007 through 2009.

After the change in 2010, the program paid about $ 668 per patient – a 6.5 percent jump.

Most of the increase can be explained by Medicare’s higher payments for office visits, they conclude, but not all of it. Doctors also started charging Medicare for more “complex” office visits.

The characterization of a patient visit is somewhat subjective, the authors explain in their report. A simple visit might involve a 10-minute exam and “straightforward” attention to a specific problem, whereas a “high-complexity” visit might last 60 minutes, entailing exhaustive history taking, examination and “decision-making.”

“You might say just from a third-party perspective, simply changing the fee schedule should not have an effect on how sick a patient is… but physicians were coding at a higher level,” Song told Reuters Health.

As for specialists being paid more than family doctors, the researchers found the change did help to narrow the payment gap.

Of the 6.5 percent extra Medicare expenditure in 2010, about $ 6 of every $ 10 went to family doctors and the rest to specialists.

“It was a noble effort on the CMS’ part to try and change incentives to improve the payment disparity between primary care physicians and specialists,” said Dr. Patrick O’Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

But O’Malley told Reuters Health that “meddling” with fees will not solve the broader problems facing primary care, including high expectations for family doctors, increasingly complex patients and the worsening doctor shortage.

In an editorial accompanying the study, O’Malley says that doctors across specialties and organizations need to help fix these problems.

“It’s not only up to primary care providers alone to fix the primary care problem; it’s up to every physician to be responsible for helping to fix it,” he writes.

“I think it’s going to be a process of incremental change. I’m hoping the Affordable Care Act will move us in the right direction, but I think we will also hit rock bottom, where we’ll see ourselves in a desperate state,” O’Malley said.

SOURCE: http://bit.ly/11cDCDk and http://bit.ly/Se1HFR Archives of Internal Medicine, online November 26, 2012.

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No more government contracts for BP

WASHINGTON (Reuters) - The U.S. government banned BP Plc on Wednesday from new federal contracts over its "lack of business integrity" in the 2010 Deepwater Horizon oil spill, possibly imperiling the company's role as a top U.S. offshore oil and gas producer and the No. 1 military fuel supplier.

The suspension, announced by the Environmental Protection Agency, comes on the heels of BP's November 15 agreement with the U.S. government to plead guilty to criminal misconduct in the Gulf of Mexico disaster, the worst offshore oil spill in U.S. history. The British energy giant agreed to pay $4.5 billion in penalties, including a record $1.256 billion criminal fine.

BP and its affiliates are barred from new federal contracts until they demonstrate they can meet federal business standards, the EPA said. The suspension is "standard practice" and BP's existing U.S. government contracts are not affected, it said.

The EPA acted hours before a government auction of offshore tracts in the Gulf of Mexico, a region where BP is the largest investor and lease-holder of deep-water tracts and hopes for further growth. BP is also the top fuel supplier to the U.S. military, the largest single buyer of oil in the world.

Suspension of contracts could give the government leverage to pressure BP to settle federal and state civil litigation that could top $20 billion if a court finds BP was grossly negligent in the Deepwater Horizon disaster.

An EPA official said government-wide suspensions generally do not exceed 18 months, but can continue longer if there are ongoing legal cases.

In a statement, BP said it has been in "regular dialogue" with the EPA, and that the agency has informed BP that it is preparing an agreement that "would effectively resolve and lift this temporary suspension." The EPA has notified BP that the draft agreement will be available soon, BP said.

U.S. operations accounted for more than 30 percent of BP's pre-tax profits in the third quarter, and the United States accounts for about a fifth of BP's global oil production.

The U.S. military has been a reliable customer of BP's jet fuel and other refined products. As recently as September, BP affiliates won two military fuel contracts worth as much as $1.37 billion, according to a website that tracks U.S. military contracts.

The EPA's action is a sign that all federal contractors will be held to high standards, said Scott Amey, general counsel for the Project on Government Oversight, a private watchdog group.

"BP had years to improve its business ethics and is paying the price for its inaction," Amey said.

On November 15, BP Finance Director Brian Gilvary told investors on a conference call that any blanket ban could force the company to rethink its entire U.S. business.

The Justice Department says it intends to prove in a court case set to get underway in February 2013 that BP was grossly negligent under the Clean Water Act, a claim the company has adamantly denied.

"The critical question is whether this a shot across BP's bows to get settlement, or a more sustained stance, in which case the importance of the context is underlined" by Gilvary's comments, said Peter Hutton, an analyst with RBC Capital Markets.

The EPA's suspension will not impair BP's ability to produce oil and gas from existing U.S. assets, said Pavel Molchanov, an analyst with Raymond James & Associates Inc in Houston.

"BP's supply contract of fuels to the Pentagon might be at risk, but of course BP could supply other customers if this supply contract is not renewed," Molchanov said in a research note.

BP and the U.S. government likely worked out a deal on the timing of the suspension before BP agreed to sign off on the November 15 criminal plea deal, said Samuel Buell, a Duke University Law School professor and former federal prosecutor.

"It's just inconceivable to me that BP's lawyers ... would have entered into that agreement last week without the issue of a suspension or debarment having been addressed," Buell said.

BP did not participate in Wednesday's federal auction of 20 million acres (8 million hectares) of drilling tracts in the Gulf of Mexico, one of BP's biggest oil production regions globally.

One long-time critic of BP applauded the decision.

"After pleading guilty to such reckless behavior that killed men and constituted a crime against the environment, suspending BP's access to contracts with our government is the right thing to do," U.S. Rep. Edward Markey, a Democrat from Massachusetts, said in a statement.

BP's U.S.-traded shares closed flat, while London-traded shares were down less than 1 percent at 427 pence.

(Additional reporting by Andrew Callus in London, Ayesha Rascoe in Washington, Joshua Schneyer in New York and Kristen Hays in Houston; Writing by Chris Baltimore; Editing by John Wallace, Grant McCool, Andrew Hay and Marguerita Choy)

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Rugby-England add flyhalf Burns to squad for All Blacks’ test

LONDON, Nov 27 (Reuters) – England called up uncapped Gloucester flyhalf Freddie Burns on Tuesday to their squad for Saturday’s test against New Zealand in place of the injured Toby Flood.

Flood sustained ligament damage to a big toe during the 16-15 loss to South Africa at Twickenham last Saturday.

Owen Farrell, whose last start was in the first test in South Africa this year, is set to replace Flood in the starting XV against the world champions.

Lock Courtney Lawes, who missed England’s first three tests of the November series because of a knee injury, has also been included in the 23-man squad. Two other locks, Mouritz Botha and Tom Palmer, have been omitted.

After beating Fiji in their opening match, England have lost to Australia and the Springboks and now face a daunting match against the All Blacks who are unbeaten in 20 tests since the start of their victorious World Cup campaign last year.

“For those in Saturday’s squad the message is clear – last week we went toe to toe with the second best team in the world and felt we should have won,” England head coach Stuart Lancaster said in a statement.

“Now we have a chance to take on the number one side in front of a passionate Twickenham crowd, who have been fantastic throughout the Internationals, and it is a challenge we will meet head on.” (Reporting by John Mehaffey; Editing by Ken Ferris)

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Ex-Elmo puppeteer faces new sex-with-minor allegation

NEW YORK (Reuters) – The puppeteer formerly behind the “Sesame Street” character Elmo faces a new accusation of having sex with an underage boy, a week after a similar allegation prompted him to resign from the iconic public television children’s program.

In a lawsuit filed Tuesday in U.S. District Court in Manhattan, a man identified only as John alleges Kevin Clash engaged in oral sex and other sex acts with him when John was 16 years old. The suit seeks at least $ 75,000 in damages.

The suit alleges the incident occurred in either 2000 or 2001 when John, who is from Florida, visited New York for modeling opportunities. John came to know Clash, then 40, through a telephone chat line for gays on which Clash claimed to be a 30-year-old named Craig, according to the suit.

John returned to New York when he turned 18, and he and Clash renewed the relationship, the lawsuit said.

“Mr. Clash believes the lawsuit has no merit,” Clash’s publicist, Risa B. Heller, said in an emailed statement.

It is the latest charge levied against Clash, now 52, who resigned on November 20 from Sesame Workshop, the company behind “Sesame Street,” after nearly 30 years on the show.

His resignation came the same day Cecil Singleton filed a claim seeking more than $ 5 million in damages from Clash. Singleton claims he met the then-32-year-old puppeteer in 1993 in a gay chat room when he was 15.

It added that on numerous occasions over a period of years Clash engaged in sexual activity with Singleton.

The newest allegation comes about two weeks after another man recanted his claims that Clash had sex with him when he was 16 years old. The man later said the relationship was consensual.

Clash had denied the allegations and acknowledged a past relationship with his first accuser. He added the pair were both consenting adults at the time.

The Elmo character debuted on “Sesame Street” in 1979, 10 years after the show premiered and introduced the now-iconic characters Big Bird, Bert and Ernie, Oscar the Grouch and Cookie Monster, among others, to American children.

While Clash was the third performer to animate the child-like shaggy red monster, Sesame Workshop credits him with turning Elmo into the international sensation he became.

(Reporting by Dan Burns; Editing by Paul Thomasch and Cynthia Osterman)

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Flu Symptoms Drove Boston Mayor to Hospital

When Boston Mayor Thomas Menino ended his vacation in Italy short this fall and checked into a Boston hospital complaining of a respiratory infection, it led doctors to find and treat a blood clot in his leg, a fracture in his back, an infection around the fracture and type 2 diabetes.

Cold and flu symptoms from respiratory infections can be a hassle, but sometimes that fever and cough can be good for just getting people to the doctor.

“That’s why every patient needs a careful evaluation because every once in a while, what the patient thinks is the flu or reports as the flu is not,” said Dr. William Schaffner, chairman of preventative medicine at Vanderbilt University in Tennessee. “I would say 99 percent of people who present to the emergency room and doctor’s office with symptoms of influenza – that is cough, fever and the like – are certainly going to have influenza.”

Click here to read about cold- and flu-fighters.

Menino, 69, arrived at Brigham and Women’s Hospital on Oct. 25, complaining of fatigue and a cough, and doctors described him as “extremely washed out” with some “malaise.” In addition to the respiratory infection, doctors found a blood clot that traveled from Menino’s leg to his lungs.

Respiratory illnesses, like the one that initially drove Menino to seek medical attention, can often range from mild to severe, Schaffner said.

“He was feeling poorly enough to end what was supposed to be a very pleasant vacation, and when he got here, he was very weak and very washed out,” Dr. Dale Adler, Menino’s doctor, said during a press conference in mid-November.

Doctors can usually tell whether flu-like symptoms are the result of a respiratory infection or something else soon after the patient is admitted. If not, they can perform a series of tests to find out.

Click here to read about flu fact and fiction.

(The flu can lead to other ailments, the most common of which is pneumonia, or an infection of the lungs, Schaffner said.

About 1.1 million pneumonia patients were hospitalized and discharged in 2009, according to the latest data from the Centers for Disease Control and Prevention. On average, they stayed in the hospital 5.2 days.)

Weeks later, Menino was still in the hospital. Although his illness and clot had been resolved, he was complaining of back pain, which doctors discovered was the result of a compression fracture and an infection around the fracture.

Finally, doctors discovered that Menino had underlying type 2 diabetes, which may have contributed to the infection, Menino’s doctor said during a press conference on Monday.

It’s not clear how Menino’s initial flu-like symptoms tied into his other ailments, but doctors said they are positive about his prognosis. The mayor relocated to a rehabilitation center on Monday.

“It is a run of bad luck,” Morris said of Menino. “He will rebound from this.”

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Protesters pack Tahrir Square, dispute Morsi

CAIRO (AP) — The same chants used against Hosni Mubarak were turned against his successor Tuesday as more than 200,000 people packed Egypt's Tahrir Square in the biggest challenge yet to Islamist President Mohammed Morsi.

The massive, flag-waving throng protesting Morsi's assertion of near-absolute powers rivaled some of the largest crowds that helped drive Mubarak from office last year.

"The people want to bring down the regime!" and "erhal, erhal" — Arabic for "leave, leave" — rang out across the plaza, this time directed at Egypt's first freely elected president.

The protests were sparked by edicts Morsi issued last week that effectively neutralize the judiciary, the last branch of government he does not control. But they turned into a broader outpouring of anger against Morsi and his Muslim Brotherhood, which opponents say have used election victories to monopolize power, squeeze out rivals and dictate a new, Islamist constitution, while doing little to solve Egypt's mounting economic and security woes.

Clashes broke out in several cities, with Morsi's opponents attacking Brotherhood offices, setting fire to at least one. Protesters and Brotherhood members pelted each other with stones and firebombs in the Nile Delta city of Mahalla el-Kobra, leaving at least 100 people injured.

"Power has exposed the Brotherhood. We discovered their true face," said Laila Salah, a housewife at the Tahrir protest who said she voted for Morsi in last summer's presidential election. After Mubarak, she said, Egyptians would no longer accept being ruled by an autocrat.

"It's like a wife whose husband was beating her and then she divorces him and becomes free," she said. "If she remarries she'll never accept another day of abuse."

Gehad el-Haddad, a senior adviser to the Brotherhood and its political party, said Morsi would not back down on his edicts. "We are not rescinding the declaration," he told The Associated Press.

That sets the stage for a drawn-out battle that could throw the nation into greater turmoil. Protest organizers have called for another mass rally Friday. If the Brotherhood responds with demonstrations of its own, as some of its leaders have hinted, it would raise the prospect of greater violence after a series of clashes between the two camps in recent days.

A tweet by the Brotherhood warned that if the opposition was able to bring out 200,000 to 300,000, "they should brace for millions in support" of Morsi.

Another flashpoint could come Sunday, when the constitutional court is to rule on whether to dissolve the assembly writing the new constitution, which is dominated by the Brotherhood and its Islamist allies. Morsi's edicts ban the courts from disbanding the panel; if the court defies him and rules anyway, it would be a direct challenge that could spill over into the streets.

"Then we are in the face of the challenge between the supreme court and the presidency," said Nasser Amin, head of the Arab Center for the Independence of the Judiciary and the Legal Profession. "We are about to enter a serious conflict" on both the legal and street level, he said.

Morsi and his supporters say the decrees were necessary to prevent the judiciary from blocking the "revolution's goals" of a transition to democracy. The courts — where many Mubarak-era judges still hold powerful posts — have already disbanded the first post-Mubarak elected parliament, which was led by the Brotherhood. Now it could also take aim at the Islamist-led upper house of parliament.

Morsi's decrees ban the judiciary from doing so and grant his decisions immunity from judicial review. Morsi also gave himself sweeping powers to prevent threats to the revolution, stability or state institutions, which critics say are tantamount to emergency laws. These powers are to remain in effect until the constitution is approved and parliamentary elections are held, not likely before spring 2013.

Opponents say the decrees turn Morsi — who narrowly won last summer's election with just over 50 percent of the vote — into a new dictator, given that he holds not only executive but also legislative powers, after the lower house of parliament was dissolved.

Tuesday's turnout was an unprecedented show of strength by the mainly liberal and secular opposition, which has been divided and uncertain amid the rise to power of the Brotherhood over the past year. The crowds were of all stripes, including many first-time protesters.

"Suddenly Morsi is issuing laws and becoming the absolute ruler, holding all powers in his hands," said Mona Sadek, a 31-year-old engineering graduate who wears the Islamic veil, a hallmark of piety. "Our revolt against the decrees became a protest against the Brotherhood as well."

"The Brotherhood hijacked the revolution," agreed Raafat Magdi, an engineer who was among a crowd of some 10,000 marching from the Cairo district of Shubra to Tahrir to the beat of drums and chants against the Brotherhood. Reform leader Mohammed ElBaradei led the march.

"People woke up to (Morsi's) mistakes, and in any new elections they will get no votes," Magdi said.

Many in the crowd said they were determined to push ahead with the protests until Morsi retreats. A major concern was that Islamists would use the decree's protection of the constitutional assembly to drive through their vision for the next charter, with a heavy emphasis on implementing Shariah, or Islamic law. The assembly has been plagued with controversy, and more than two dozen of its 100 members have quit in recent days to protest Islamist control.

"Next Friday will be decisive," protester Islam Bayoumi said of the upcoming rally. "If people maintain the same pressure and come in large numbers, they could manage to press the president and rescue the constitution."

A fellow protester, Saad Salem Nada, said of Morsi: "I am a Muslim and he made me hate Muslims because of the dictatorship in the name of religion. In the past, we had one Mubarak. Now we have hundreds."

Even as the crowds swelled in Tahrir, clashes erupted nearby between several hundred protesters throwing stones and police firing tear gas on a street leading to the U.S. Embassy. Clouds of tear gas hung over the area, where clashes have broken out for several days, fueled by anger over police abuses.

A photographer working for the AP, Ahmed Gomaa, was beaten by stick-wielding police while covering the clashes. Police took his equipment and Gomaa was taken to a hospital for treatment.

Rival rallies by Morsi opponents and supporters turned into brief clashes in the Mediterranean city of Alexandria, where anti-Morsi protesters broke into the local office of the Muslim Brotherhood, throwing furniture out the windows and trying unsuccessfully to set fire to it. Protesters also set fire to Brotherhood offices in the city of Mansoura.

Morsi's supporters canceled a massive rally planned for Tuesday in Cairo, citing the need to "defuse tension." Morsi's supporters say more than a dozen of their offices have been ransacked or set ablaze since Friday. Some 5,000 demonstrated in the southern city of Assiut in support of Morsi's decrees, according to witnesses there.

So far, there has been little sign of a compromise. On Monday, Morsi met with the nation's top judges and tried to win their acceptance of his decrees. But the move was dismissed by many in the opposition and the judiciary as providing no real concessions.

Saad Emara, a senior Muslim Brotherhood member, said Morsi will not make any concessions, especially after the surge of violence and assaults on Brotherhood offices.

Emara accused the opposition "of resorting to violence with a political cover," claiming that former ruling party and Mubarak-era businessmen were hiring thugs to attack Brotherhood offices with the opposition's blessing.

"The story now is that the civilian forces are playing with fire. This is a dangerous scene."

___

Associated Press writer Hamza Hendawi in Cairo contributed to this report.

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