Hamas-Israel ceasefire takes hold but mistrust runs deep

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 (1900 GMT), 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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AP Exclusive: Syrian rebels seize base, arms trove

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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One Direction’s 2nd CD hits No. 1, sells 540,000

NEW YORK (AP) — One Direction‘s “Take Me Home” is the taking the boys to the top of the charts — and to new heights.

The group’s sophomore album has sold 540,000 in its first week, according to Nielsen SoundScan. It’s the year’s third-highest debut behind Taylor Swift‘s “Red,” which sold 1.2 million units its first week earlier this month, and Mumford & Sons’ “Babel,” which sold more than 600,000 albums in September in its debut week.

“We just want to say a massive thanks to all the fans who have supported us,” band member Harry Styles, 18, said in an interview Tuesday from London. “We can send tweets and thank them, but 140 characters is never going be enough to say how much it means.”

The album also debuted at No. 1 in the United Kingdom this week and is No. 1 in more than 30 countries, Columbia Records said Wednesday. The fivesome’s debut, “Up All Night,” came in at No. 2 in the United Kingdom last year; it was just released in March in America, where it hit No. 1 and has achieved platinum status.

“We were a little bit nervous about how people were going to take it,” 19-year-old Niall Horan said of the new album during tour rehearsals. “Everyone gets that second album syndrome.”

They say though they’re excited, they won’t be celebrating too much: “We’re finishing rehearsing soon and we’re going home to bed.”

One Direction, who placed third on the U.K. version of “The X Factor” in 2010, is signed to Simon Cowell’s Syco label imprint. In just a year, the band has become worldwide sensations, thanks to its feverish fans. They released a book and have a 3D movie planned. They also made the cut for Barbara Walters’ most fascinating people of 2012 list, which includes New Jersey Gov. Chris Christie and U.S. gold medalist Gabby Douglas.

One Direction says those experiences have helped the group mature.

“We’ve been working hard. We’re starting to grow up,” Horan said. “We’re still young, but we’ve passed the initial teenage years. …We’ve grown up quite quick in the job we have to do and we became a lot more independent.”

The group — which includes Zayn Malik, Liam Payne and Louis Tomlinson — will launch a worldwide tour in February. They hope to work with Katy Perry and are still trying to adjust to the celebrity and fame that has taken over their lives.

“I can see how it gets to people. I guess it’s quite easy to get wrapped up in it all,” Styles said. “We do the same things every other lad our age does. We go out, we have fun, we meet girls and stuff like that. Sometimes it gets written about, which, yeah, we think about it and it’s absolutely crazy. It’s still a bit weird thinking that that’s the way it is.”

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Online:

http://www.onedirectionmusic.com/us/home/

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Gaza shakes, Israelis killed as Clinton seeks truce

GAZA/JERUSALEM (Reuters) - Israeli air strikes shook the Gaza Strip and Palestinian rockets struck across the border as U.S. Secretary of State Hillary Clinton held talks in Jerusalem in the early hours of Wednesday, seeking a truce that can hold back Israel's ground troops.

Egypt's new Islamist government is mediating talks and had floated hopes for a ceasefire by late Tuesday between Israel and Hamas, the Islamist movement controlling Gaza. However, by the time Clinton met Israeli Prime Minister Benjamin Netanyahu, it was clear there would be more argument, and more violence, first.

Hamas leaders in Cairo accused the Jewish state of failing to respond to proposals and said an announcement on holding fire would not come before daylight on Wednesday. Israel Radio quoted an Israeli official saying a truce was held up due to "a last-minute delay in the understandings between Hamas and Israel."

An initial halt to attacks may, however, not see the sides stand their forces down from battle stations immediately. Clinton, who flies to Cairo to see Egyptian President Mohamed Mursi later on Wednesday, spoke of a deal "in the days ahead."

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

As Clinton arrived in Israel after nightfall, Israel was stepping up its bombardment from air and sea. At one point munitions slammed into Gaza at a rate of one every 10 minutes.

Gazan rocket fire waned overnight but resumed before dawn on Wednesday with six launches, Israel said. No one was hurt.

After seven days of hostilities that have killed over 130 Palestinians and five Israelis, both sides are looking for more than a return to the sporadic calm that has prevailed across the blockaded enclave since Israel ended a much more devastating air and ground offensive four years ago.

ELECTION

Netanyahu, who faces an election in two months that he is, for now, favored to win, told Clinton he wanted a "long-term" solution. Failing that, Netanyahu made clear, he stood ready to step up the military campaign to silence Hamas' rockets.

Hamas for its part is exploring the opportunities that last year's Arab Spring has given it to enjoy favor from the new Islamist governments of states once ruled by U.S. proteges, and from Sunni Gulf powers keen to woo it away from Shi'ite Iran. It has used longer-range missiles, some sent by Tehran, and hopes to eclipse Western-backed Palestinian President Mahmoud Abbas.

Hamas has spoken of an easing of Israel's blockade on the 40-km (25-mile) slice of Mediterranean coast that is home to 1.7 million people. It may count on some sympathy from Mursi, though Egypt's first freely elected leader, whose Muslim Brotherhood inspired Hamas' founders, has been careful to stick by the 1979 peace deal with Israel struck by Cairo's former military rulers.

Clinton, who broke off from an Asian tour with President Barack Obama and assured Netanyahu of "rock-solid" U.S. support for Israel's security, spoke of seeking a "durable outcome" and of Egypt's "responsibility" for promoting peace.

She repeated international calls for the kind of lasting, negotiated, comprehensive Israeli-Palestinian settlement that has eluded the two peoples for decades - something neither of the two warring parties seems seriously to be anticipating.

"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," Clinton said.

"It is essential to de-escalate the situation in Gaza. The rocket attacks from terrorist organizations inside Gaza on Israeli cities and towns must end and a broader calm restored," she said.

"SELF-DEFENCE"

Netanyahu, who has appeared in no immediate rush to repeat the invasion of winter 2008-09 in which over 1,400 Palestinians died, said: "If there is a possibility of achieving a long-term solution to this problem with diplomatic means, we prefer that.

"But if not, I'm sure you understand that Israel will have to take whatever action is necessary to defend its people."

As Israeli aircraft have carried out hundreds of strikes on rocket stores, launchpads and suspected Hamas command posts since assassinating the head of its military wing a week ago. Tens of thousands of Israeli soldiers have been preparing tanks and infantry units for a possible invasion.

During the night, explosions again rocked the city of Gaza and other parts of the Strip, while rockets from the enclave, some essentially home-made, others Iranian-designed and smuggled through tunnels from Egypt, landed in southern Israel.

One reached as far as Rishon Lezion, near Tel Aviv, on Tuesday, the latest to jar Israel's metropolis, long untroubled by Palestinian attacks. Another rocket fell close to Jerusalem, the holy city claimed by both sides in the conflict.

Medical officials in Gaza said 31 Palestinians were killed on Tuesday. An Israeli soldier and a civilian died when rockets exploded near the Gaza frontier, police and the army said.

Gaza medical officials say 138 people have died in Israeli strikes, mostly civilians, including 34 children. In all, five Israelis have died, including three civilians killed last week.

AMMUNITION STORES

Obama, whose relations with the hawkish Netanyahu have long been strained, has said he wants a diplomatic solution, rather than a possible Israeli ground operation in the densely populated territory, home to 1.7 million Palestinians.

Israel's military said it targeted overnight more than 100 sites in Gaza, including rocket launchers, tunnels and the Ministry of Internal Security, used by Hamas as a command center. Israeli police said more than 150 rockets had been fired from Gaza by Tuesday evening.

"No country would tolerate rocket attacks against its cities and against its civilians," Netanyahu said with U.N. Secretary-General Ban Ki-moon, who arrived in Jerusalem from talks in Cairo, at his side. "Israel cannot tolerate such attacks."

Critics have accused Israel of using disproportionate force that has killed civilians. Israel accuses Hamas of putting Gaza's people in harm's way by siting rockets among them.

Media groups have criticized attacks on Gaza media facilities. On Tuesday, three local journalists died in air strikes on their vehicles.

A building housing AFP's bureau was bombed. The French news agency said its staff were unhurt. Israel's military said it had been targeting a Hamas intelligence centre in the tower.

Hamas executed six Palestinians accused of spying for Israel, who a security source quoted by Hamas Aqsa radio said had been "caught red-handed" with "filming equipment to take footage of positions." The radio said they had been shot.

Militants on a motorcycle dragged the body of one of the men through the streets.

A delegation of nine Arab ministers, led by the Egyptian foreign minister, visited Gaza in a further signal of heightened Arab solidarity with the Palestinians.

(Additional reporting by Cairo bureau; Writing by Alastair Macdonald; Editing by Lisa Shumaker)

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Turbulence on Cuba-Italy flight leaves 30 bruised

ROME (AP) — An airliner flying from Havana to Milan abruptly plunged some 1,000 meters (3,300 feet) when it hit unusually strong turbulence over the Atlantic on Monday, terrifying passengers and leaving some 30 people aboard with bruises and scrapes, airline officials said.

The flight continued to Milan’s Malpensa airport after the plane’s captain determined that it suffered no structural damage and two passengers who are physicians found no serious injuries, Giulio Buzzi, head of the pilots division at Neos Air, told Sky TG24 TV.

The ANSA news agency quoted bruised passenger Edoardo De Lucchi as saying meals were being served when suddenly there was “10 seconds of terror.” He recounted how plates went flying and some passengers not wearing seatbelts bounced about.

Buzzi had said that the drop measured some 3,000 meters (10,000 feet) in a cloudless sky. But Milan daily’s Corriere della Sera’s web site, quoting Neos official Davide Martini, later reported that the plane first bounced up some 500 meters (1,650 feet), then dropped some 1,000 meters (3,300 feet) to some 500 meters (1,650 feet) below the original altitude.

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Jackie Chan: upcoming film will be last big action movie

BEIJING (Reuters) – Kung Fu superstar Jackie Chan said that while the upcoming film “Chinese Zodiac 2012″ will be his last major action movie, citing his increasing age, he will still be packing punches in the world of philanthropy.

Chan wrote, directed and produced his latest film, set to premiere in cinemas in China next month. He also plays the lead role and said that he regarded it the “best film for myself” in the last ten years.

“I’m the director, I’m the writer, I’m the producer, I’m the action director, almost everything,” the 58-year-old Hong Kong actor told Reuters while in Beijing to film a documentary.

“This really, really is my baby. You know, I’ve been writing the script for seven years,” and the film took a year and half to make, he added.

In the film, Chan is a treasure hunter seeking to repatriate sculpture heads of the 12 animals of the Chinese zodiac, which were taken from Beijing‘s Summer Palace by French and British forces during the Opium Wars.

He said it was an important movie for him because it will be his last major action feature, although he insisted it is not the end of his action career.

“I’m not young any more, honestly,” he said, noting that with special effects technology and doubles a lot can be done without physical risk.

“Why (do) I have to use my own life to still do these kind of things?” he said. “I will still do as much as I can. But I just don’t want to risk my life to sit in a wheelchair, that’s all.”

Chan was recently awarded the Social Philanthropist of the Year award by Harpers Bazaar magazine. He said he wanted to increase time devoted to charitable work and hoped China’s leagues of newly wealthy will follow his example – which he underlined by auctioning a Bentley 666 for around 6 million yuan ($ 961,837).

China now has more billionaires than any other Asian country, but very few philanthropic organizations, and giving to charity remains a relatively new phenomenon in the world’s most populous country.

Chan said while Chinese philanthropists have made some encouraging strides, much more still needs to be done – a task made harder by the Internet, with netizens willing to leap on every perceived wrong move.

“Right now people (must) very, very be careful, but that doesn’t stop them to want to do the charity. I think it’s a good sign,” Chan said. (Reporting by Reuters Television, editing by Elaine Lies and Christine Kearney)

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Pharmacies Dispense Meds Even After Docs Stop Prescription

Image courtesy of iStockphoto/monkeybuisnessimages

When doctors take patients off of a prescription medicine, it is often for a good reason. But pharmacists don’t always get the memo. A new study finds that more than 1 in 100 discontinued prescriptions were filled by the pharmacy anyway, putting some patients at serious risk. In the U.S., pharmacists filled more than 3.7 trillion prescriptions in 2011. With so many prescriptions and refills–and our still largely human- and paper-based prescribing system–there are bound to be mistakes. Pharmacists may overlook drug interactions, dispense inappropriate medications, or commit other little-understood errors. One such underappreciated problem area is the process of taking patients off medication. While errors in initial prescribing have drawn much attention, potential for error when doctors order a prescription to stop also looms large. And electronic health records, which have helped to minimize medical errors in other areas, might be partly to blame. These electronic communiqu?s might be giving some doctors–and patients–a false sense of efficacy. Doctors might assume that when they make a note on a patient’s electronic health record to stop a prescription the pharmacy will automatically get the message as it does when they first prescribed that medication. This, however, is not always the case, wrote Adrienne Allen, of the North Shore Physician Group, and Thomas Sequist, of Brigham and Women’s Hospital in the new paper, published online November 19 in Annals of Internal Medicine. To find out how often the pharmacies continue to dispense meds the doctor no longer ordered, Allen and Sequist analyzed electronic health records of 30,406 adults in a Massachusetts health system whose doctor had discontinued a drug to treat a high-risk condition such as high cholesterol, hypertension, diabetes, blood coagulation or platelet aggregation. Some 83,900 medications were discontinued during the course of a year. Nevertheless, pharmacists still dispensed 1,218 of these prescriptions after they were discontinued. The most common drug that pharmacists dispensed after a doctor canceled the prescription was metoprolol (Lopressor or Toprol), which is often prescribed to treat high blood pressure after a heart attack and which can have harmful drug interactions with other commonly prescribed drugs. In a subset of medical records, a computer analysis flagged more than a third (34 percent) of the improper dispensations as creating a “high risk of potential adverse events” such as a harmful reaction, potential drug interaction or suspect lab test result, the researchers noted. And manual assessment verified that potential harm actually occurred in at least 12 percent of cases. Patients receiving these drugs were more likely to be taking more medications, older, enrolled in Medicare and black. Additional medications make it more likely that a patient will suffer an adverse drug interaction if they take an unintended prescription (especially if a doctor has subsequently prescribed a similar drug to take the discontinued drug’s place). And older adults might be less likely to notice a mistake. One limitation of the study is that the researchers could only study the 52 percent of discontinued prescriptions that were filled at participating health care system pharmacies; unaffiliated pharmacies might have even higher inappropriate dispensation rates. Additionally, the researchers only studied a limited number of drugs. Adding other drugs to the analysis would likely increase the number of discontinued prescriptions dispensed, even if the risk of side effects might be lower. They researchers see promise for filling this communication gap in the future. Electronic health records offer an opportunity to track these missteps, and adding more direct communication with pharmacies about prescription discontinuation should help avoid these errors. For now, however, the new technology is often not as powerful as many doctors think it is. So some of the responsibility will continue to lie with the patient. Officials would be wise to help “increase patient awareness of their medication list,” the researchers concluded. That is, until the computers can just do it for us.

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.

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Israeli aircraft hit Hamas bank HQ in Gaza

GAZA CITY, Gaza Strip (AP) — Israeli aircraft have battered the headquarters of the Gaza Strip bank the territory's Hamas rulers set up to sidestep international sanctions.

Tuesday's strike on the Islamic National Bank in Gaza City is part of a widening Israeli onslaught against the militants and their rocket squads targeting Israel. The offensive is now in its seventh day.

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

The bank's 31-year-old owner, Suleiman Tawil, denounced the strike, saying he is not "involved in politics."

Hamas set up the bank after foreign lenders, afraid of running afoul of international terror financing laws, stopped doing business with the militant-led Gaza government.

The U.S., Israel and others in the West consider Hamas a terror group.

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Rebels in Congo reach door of Goma

GOMA, Congo (AP) — A Rwandan-backed rebel group advanced to within 3 kilometers (1.8 miles) of Goma, a crucial provincial capital in eastern Congo, marking the first time that rebels have come this close since 2008.

Congolese army spokesman Col. Olivier Hamuli said the fighting has been going on since 6 a.m. Sunday and the front line has moved to just a few kilometers (miles) outside the city. After more than nine hours of violent clashes the two sides took a break, with M23 rebels establishing a checkpoint just 100 meters (yards) away from one held by the military in the village of Munigi, exactly 3 kilometers (1.8 miles) outside the Goma city line.

Contacted by telephone on the front line, M23 rebel spokesman Col. Vianney Kazarama said the group will spend the night in Goma.

“We are about to take the town. We will spend the night in Goma tonight,” said Kazarama. “We are confident that we can take Goma and then our next step will be to take Bukavu,” he said mentioning the capital of the next province to the south.

The M23 rebel group is made up of soldiers from a now-defunct rebel army, the National Congress for the Defense of the People, or CNDP, a group made-up primarily of fighters from the Tutsi ethnic group, the ethnicity that was targeted in Rwanda‘s 1994 genocide. In 2008, the CNDP led by Rwandan commando Gen. Laurent Nkunda marched his soldiers to the doorstep of Goma, abruptly stopping just before taking the city.

In the negotiations that followed and which culminated in a March 23, 2009 peace deal, the CNDP agreed to disband and their fighters joined the national army of Congo. They did not pick up their arms again until this spring, when hundreds of ex-CNDP fighters defected from the army in April, claiming that the Congolese government had failed to uphold their end of the 2009 agreement.

Reports, including one by the United Nations Group of Experts, have shown that M23 is actively being backed by Rwanda and the new rebellion is likely linked to the fight to control Congo’s rich mineral wealth.

The latest fighting broke out Thursday and led to the deaths of 151 rebels and two soldiers. On Saturday U.N. attack helicopters targeted M23 positions in eastern Congo.

Also on Saturday, United Nations Secretary-General Ban Ki-Moon had called Rwandan President Paul Kagame “to request that he use his influence on the M23 to help calm the situation and restrain M23 from continuing their attack,” according to peacekeeping chief Herve Ladsous who spoke at the U.N. headquarters in New York on Saturday.

North Kivu governor Julien Paluku said Saturday that the Congolese army had earlier retreated from Kibumba, which is 30 kilometers (19 miles) north of Goma, after thousands of Rwandans, who he says were backing the rebels, attacked early Saturday.

“Rwandan forces bombarded our positions in Kibumba since early this morning and an estimated 3,500 crossed the border to attack us,” he said Saturday.

In downtown Goma, panicked residents had come out to try to get more information on what was happening. A 45-year-old mother of five said that she has nowhere to go.

“I don’t really know what is happening, I’ve seen soldiers and tanks in the streets and that scares me,” said Imaculee Kahindo. Asked if she planned to leave the city, she said: “What can we do? I will probably hide in my house with my children.”

Hamuli, the spokesman for the Congolese army, denied reports that soldiers were fleeing.

In 2008 as Nkunda’s CNDP rebels amassed at the gates of Goma, reporters inside the city were able to see Congolese soldiers running in the opposite direction, after having abandoned their posts. The Congolese army is notoriously dysfunctional with soldiers paid only small amounts, making it difficult to secure their loyalties during heavy fighting.

“We are fighting 3 kilometers from Goma, just past the airport. And our troops are strong enough to resist the rebels,” said Hamuli. “We won’t let the M23 march into our town,” he said. Asked if his troops were fleeing, he added: “These are false rumors. We are not going anywhere.”

U.N. peacekeeping chief Ladsous said that the rebels were very well-equipped, including with night vision equipment allowing them to fight at night.

Reports by United Nations experts have accused Rwanda, as well as Uganda, of supporting the rebels. Both countries strongly deny any involvement and Uganda said if the charges continue it will pull its peacekeeping troops out of Somalia, where they are playing an important role in pushing out the Islamist extremist rebels.

The U.N. Security Council called for an immediate stop to the violence following a two-hour, closed-door emergency meeting. The council said it would add sanctions against M23 rebels and demanded that rebels immediately stop their advance toward the provincial capital of Goma.

“We must stop the M23″ because Goma’s fall “would, inevitably, turn into a humanitarian crisis,” said France‘s U.N. Ambassador, Gerard Araud. He added that U.N. officials would decide in the coming days which M23 leaders to target for additional sanctions.

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Associated Press writer Maria Sanminiatelli at the United Nations and Rukmini Callimachi in Dakar, Senegal, contributed to this report.

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Seacrest, Wonder, Usher, others praise Dick Clark

LOS ANGELES (AP) — Ryan Seacrest and Stevie Wonder paid homage to Dick Clark on stage, while Usher and will.i.am shared their praise for the TV icon and music lover off camera.

Clark, who died earlier this year, was the subject of a special tribute at the American Music Awards, which he created 40 years ago.

Seacrest said the show still reflects Clark’s original vision: Bring together the year’s most popular artists and “let the music speak for itself.”

“Dick loved the power of music and its ability to create pure joy,” Seacrest said Sunday before introducing Wonder, whom he described someone Clark loved as a friend and musician for 49 years.

“I remember his friendship and his kindness. I remember his love for music and his love for people,” Wonder said. “I challenge you, you as communicators, leaders, politicians, spiritual leaders: Put your love first like we musicians put our music first… Then we can be jamming until the break of dawn.”

Wonder played a medley of songs as images of Clark and the many musicians he worked with flashed across the screen.

Other artists shared their admiration for Clark on the red carpet and backstage at the Nokia Theatre. Will.i.am, who presented the artist of the year award to Justin Bieber, said Clark’s legacy for spotting and encouraging talent is why the American Music Awards have endured for 40 years.

“I remember seeing Whitney Houston on the American Music Awards. Lionel Richie. Santana. Jefferson Airplane,” he said. “Think of all the classic, iconic television moments. Now, my generation is part of it and the next generation is part of this American iconic family time.”

Usher, who was named favorite male soul/R&B artist Sunday, said he always admired Clark and aims to emulate his legacy of fostering young talent.

“He’s so rich with culture and been able to recognize talent for so many years and have an incredible legacy. I’m just really happy to still be a part of it and still take an award home,” Usher said. “To be an artist that’s been able to continue to evolve and transcend culture, it’s from the book of Dick Clark, the fact that he’s, throughout generations, been able to recognize incredible talent across genres.”

Usher helps guide the career of the night’s big winner, Bieber, who accepted awards for pop/rock male artist, pop/rock album for “Believe” and artist of the year Sunday.

“The proof is in the pudding,” Usher said. “The longer you do it, the more of an example you can set and being able to be that to him, being a mentor and just being an artist who continues to evolve… we’re just going to continue to push him to be his best self.”

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AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

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Online:

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

Entertainment News Headlines – Yahoo! News

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