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

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

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

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

Still, momentum may be building.

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

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

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

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

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

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

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

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

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

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

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

The doctors group made clear that:

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

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

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

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

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

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

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

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

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

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

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Online:

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

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Tel Aviv bus blast shakes Gaza diplomacy

TEL AVIV, Israel (AP) — A bomb struck an Israeli bus near the nation's military headquarters in Tel Aviv on Wednesday, wounding 10 people and complicating major diplomatic efforts to forge a truce between Israel and Gaza's militant Hamas rulers.

The attack came as U.S. Secretary of State Hillary Rodham Clinton shuttled between Jerusalem and the West Bank to help piece together a deal to end Israel's weeklong offensive against Palestinian militants in the Gaza Strip that has killed more than 130 Palestinians. Militant rocket fire into Israel has killed five Israelis. Clinton was due to travel later to Egypt, which is mediating in the crisis.

"What does it say about the future of the (truce) talks? I leave it to (the senior officials), but this doesn't add anything," Yitzhak Aharonovich, Israel's minister of internal security, told Army Radio.

The bus exploded around noon on one of the coastal city's busiest arteries, near the Tel Aviv museum, the district courthouse and across from an entrance to Israel's national defense headquarters.

The bus was completely charred, its side windows blown out and glass scattered on the asphalt. The wounded were evacuated and blood was splattered on the sidewalk.

"We suddenly heard a huge explosion and immediately knew it was a terror attack," said Nir Zano, 35. "I saw someone running in to carry out a woman who was injured."

Aharonovitch said the device was placed inside the bus by a man who then disembarked. The explosion took place while the bus was in movement, he said.

Police set up roadblocks across the city trying to apprehend the attacker.

"We strongly believe that this was a terror attack," said police spokesman Micky Rosenfeld. He said three of the 10 wounded were moderately to seriously hurt.

In Gaza, the Tel Aviv bombing was praised from mosque loudspeakers, while Hamas' television interviewed people praising the attack as a return of militants' trademark tactics.

No group claimed responsibility for the attack, but Hamas spokesman Fawzi Barhoum welcomed it.

"We consider it a natural response to the occupation crimes and the ongoing massacres against civilians in the Gaza Strip," he told The Associated Press.

Israeli Deputy Prime Minister Silvan Shalom, who heard the explosion from his Tel Aviv office, called it "an escalation."

The cease-fire efforts come with thousands of Israeli ground troops massed on the Gaza border, awaiting a possible order to invade.

After meeting with Israeli Prime Minister Benjamin Netanyahu in Jerusalem Tuesday night, Clinton conferred with Palestinian President Mahmoud Abbas in the West Bank on Wednesday morning and was due to travel later to Cairo, which is mediating in the crisis.

The two sides had seemed on the brink of a deal Tuesday following a swirl of diplomatic activity also involving U.N. chief Ban Ki-moon and Egypt's President Mohammed Morsi. But sticking points could not be resolved as talks — and violence — stretched into the night.

Israeli aircraft pounded Gaza with at least 30 strikes overnight, hitting government ministries, smuggling tunnels, a banker's empty villa and a Hamas-linked media office.

Dozens of civilians are among the more than 130 Palestinians killed in a week of fighting. Four Israeli civilians and a soldier have been killed by rocket fire — a toll possibly kept down by a U.S.-funded rocket defense system that has shot down hundreds of Gaza projectiles.

The Tel Aviv bus bombed Wednesday was relatively empty during the explosion, which explains the relatively low number of casualties. The bombing was the first in the coastal city since April 2006, when a Palestinian suicide bomber killed 11 people at a sandwich stand near the city's old central bus station. A bomb left at a bus stand in Jerusalem last year killed one person.

More than 1,000 Israelis were killed during the violent Palestinian uprising in the last decade in bombings and shooting attacks. More than 5,000 Palestinians were killed as well.

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Associated Press writer Ibrahim Barzak contributed to this report from Gaza City.

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Afghan president praises Pakistan prisoner release

KABUL, Afghanistan (AP) — Afghanistan's president praised Pakistan on Tuesday for releasing a group of Taliban prisoners, a move he hopes will kick start peace talks with the militant group, the president's office said.

The praise came in a meeting between President Hamid Karzai and Pakistan's powerful army chief of staff, Gen. Ashfaq Kayani, who is in Kabul for a one-day visit. Kayani also met with senior members of the international military coalition.

Karzai "praised Pakistan's decision to release, for the success of the peace process, a number of Taliban prisoners," the Afghan president's office said in a statement.

Pakistan has so far released at least nine Taliban prisoners. The most prominent was former Justice Minister Nooruddin Turabi, who served when the Taliban ruled Afghanistan in the 1990s. Afghan officials said last week that the Pakistanis have agreed to release others as well.

The release is seen as a signal that Pakistan might be willing to take concrete steps to revive efforts to lure the Taliban to the negotiating table to work out an agreement before international forces hand over security duties to the Afghans by the end of 2014.

The prisoner release could help in that, but obstacles remain. It is unclear whether the Taliban even intend to take part in the process, or just wait until foreign forces withdraw to make a move.

Pakistan is seen as key to the peace process. Islamabad has ties to the Taliban that date back to the 1990s, and many of the group's leaders are believed to be based on Pakistani territory, after fleeing there following the U.S.-led invasion of Afghanistan in 2001.

Karzai's office said his discussions with Kayani on Tuesday were "frank, cordial and in depth." The two talked about the Afghan peace process and how to improve relations, the statement said. The Afghans said Kayani supported efforts to bring peace and security to Afghanistan.

But fighting continues. In western Afghanistan on Tuesday, a bombing killed a former Taliban commander who left the insurgency and joined the Afghan police force. The remote-controlled bomb exploded near Noor Mohammad Jahani's house in Farah city, the capital of the province of the same name, said provincial government spokesman Abdul Rahman Zhawandai. Jahani was killed and one of his bodyguards was wounded, Zhawandai said.

Jahani repudiated his Taliban ties two years ago and joined the Afghan police. He was in charge of two police checkpoints in Farah province's Bala Buluk district, Zhawandai said.

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N.Y. police officer says not guilty of plan to cook, eat women

NEW YORK (Reuters) – A New York City police officer pleaded not guilty on Monday to conspiring to kidnap, torture, cook and eat women.

Gilberto Valle, 28, of Forest Hills, Queens, was charged and arrested in October with conspiring to cross state lines to kidnap the women and with illegally accessing a federal database.

Prosecutors said some of the women were acquaintances of Valle but it was not clear if he knew or had met all of them. Valle, who an official said had no prior criminal record, was not charged with carrying out any of his suspected plans.

At a brief hearing Monday in U.S. District Court in Manhattan, Valle’s attorney, Julia Gatto, told the judge she would again seek to have her client freed on bail after two other judges previously denied her request.

Investigators uncovered a file on Valle’s computer containing the names and pictures of at least 100 women, and the addresses and physical descriptions of some of them, according to the criminal complaint. It said he had undertaken surveillance of some of the women at their places of employment and their homes.

Gatto argues that Valle, a 6-1/2 year NYPD veteran, was all talk and should be released on bail.

The charges carry a maximum sentence of life in prison.

The case is U.S. v. Gilberto Valle, U.S. District Court for the Southern District of New York, No. 12-cr-847.

(Reporting by Basil Katz; Editing by Cynthia Osterman)

Internet News Headlines – Yahoo! News

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

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

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

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

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

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

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

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

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

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

Monday's proposal also recommends:

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

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

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

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

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

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

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

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

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

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

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

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Clinton heads to Mideast amid Gaza crisis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Myanmar or Burma? Obama calls it both on visit

YANGON, Myanmar (AP) — Officially at least, America still calls this Southeast Asian nation Burma, the favored appellation of dissidents and pro-democracy activists who opposed the former military junta's move to summarily change its name 23 years ago.

President Barack Obama used that name during his historic visit Monday, but he also called Burma what its government and many other people have been calling it for years: Myanmar.

Obama's use of that single word was warmly welcomed by top government officials here, who immediately imbued it with significance.

Myanmar presidential adviser Ko Ko Hlaing called the wording "very positive" and said it was an "acknowledgement of Myanmar's government," which has taken major steps toward easing repression and transitioning to democratic rule since the military stepped aside last year.

Speaking aboard Air Force One after Obama's departure, U.S. Deputy National Security Adviser Ben Rhodes said the presidential phrasing was "a diplomatic courtesy" for Myanmar's reformist President Thein Sein.

"It doesn't change the fact that the United States government position is still Burma," he said. "But we've said we recognize that different people call this country by different names. Our view is that is something we can continue to discuss."

The issue is so sensitive that Obama's aides had said earlier Monday he would likely avoid mentioning either politically charged name. But he used both during his six-hour trip — "Myanmar" during morning talks with Thein Sein, "Burma" afterward while visiting with opposition leader Aung San Suu Kyi.

Suu Kyi herself was criticized by the government for calling the nation Burma during a trip to Europe over the summer. The government said she should use the proper name, "Republic of the Union of Myanmar," as stated in the constitution. But Suu Kyi has said "it's for each individual to make his or her own choice as to which he or she uses."

The debate is almost exclusively confined to the English language.

Myanmar, comprising a vast array of ethnic groups, did not exist as a single entity until it was colonized by the British in the 19th century. The country achieved independence in 1948 and took the English-language name used by its former rulers, Burma.

But it was formally known in Burmese, the national language, as "myanma naing ngan" or more colloquially as "bama pyi" or "country of Burma." Both those usages persist, and the national anthem still refers to "bama pyi."

When the now-defunct army junta altered the name in 1989, the change applied only to the English-language title.

But exiles and critics, just like the U.S., kept on using "Burma." And some, including the U.S., still call its main city "Rangoon" instead of Yangon.

But like Myanmar itself, that has all begun to change.

Visiting U.S. senators have used both names. Even at congressional hearings in Washington, there's an occasional mention of "Myanmar."

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Associated Press writer Julie Pace contributed to this report from Air Force One. Pitman reported from Bangkok.

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Justin Bieber gets love at American Music Awards

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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ABC is owned by The Walt Disney Co.

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

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

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EU drug regulator OKs Novartis' meningitis B shot

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

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

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

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

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

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

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Palestinian civilian toll climbs in Gaza

GAZA CITY, Gaza Strip (AP) — Israeli aircraft struck crowded areas in the Gaza Strip on Monday, driving up the Palestinian death toll to 94 and devastating several homes belonging to one clan as Israel broadened its targets in the 6-day-old offensive meant to quell Hamas rocket fire on Israel.

Escalating its bombing campaign, Israel on Sunday began attacking homes of activists in Hamas, the Islamic militant group that rules Gaza. These attacks have led to a sharp spike in civilian casualties, killing 24 civilians in just under two days and doubling the number of civilians killed in the conflict, a Gaza health official said.

The rising toll was likely to intensify pressure on Israel to end the fighting. Hundreds of civilian casualties in an Israeli offensive in Gaza four years ago led to fierce international condemnation of Israel.

Hamas fighters, meanwhile, have fired hundreds of rockets into Israel in the current round of fighting, including 75 on Monday, among them one that hit an empty school. Twenty rockets were intercepted by the Iron Dome anti-missile battery, police spokesman Micky Rosenfeld said. Rockets landed in open areas of Beersheva, Ashdod, Asheklon. Schools in southern Israel have been closed since the start of the offensive Wednesday.

The new airstrikes came as Egypt was trying to broker a cease-fire, with the help of Turkey and Qatar. Turkish Foreign Minister Ahmet Davutoglu and a delegation of Arab foreign ministers were expected in Gaza on Tuesday. However, Israel and Hamas appeared far apart in their demands, and a quick end to the fighting seemed unlikely.

A senior Egyptian official told The Associated Press on Monday that Hamas and Israel were each presenting Egypt with their conditions for a cease-fire.

"I hope that by the end of the day we will receive a final signal of what can be achieved," said the official, who is familiar with the indirect negotiations. He said Israel and Hamas are both looking for guarantees to ensure a long-term stop to hostilities. The official says Egypt's aim is to stop the fighting and "find a direct way to lift the siege of Gaza."

The official spoke on condition of anonymity because of the sensitivity of the indirect negotiations.

Overall, the offensive that began Wednesday killed 94 Palestinians, including 50 civilians, and wounded some 720 people, Gaza heath official Ashraf al-Kidra said. Among the wounded were 225 children, he said.

On the Israeli side, three civilians have died from Palestinian rocket fire and dozens have been wounded. An Israeli rocket-defense system has intercepted hundreds of rockets bound for populated areas.

In Monday's violence, a missile struck a three-story home in the Gaza City's Zeitoun area, flattening the building and badly damaging several nearby homes. Shell-shocked residents searching for belongings climbed over debris of twisted metal and cement blocks in the street.

The strike killed three adults and a 2-year-old boy, and wounded 42 people, al-Kidra said.

Residents said Israel first sent a warning strike at around 2 a.m. Monday, prompting many people in the area to flee their homes. A few minutes later, heavy bombardment followed.

Ahed Kitati, 38, had rushed out after the warning missile to try to hustle people to safety. But he was fatally struck by a falling cinderblock, leaving behind a pregnant wife, five young daughters and a son, the residents said.

Sitting in mourning with her mother and siblings just hours after her father's death, 11-year-old Aya Kitati clutched a black jacket, saying she was freezing, even though the weather was mild. "We were sleeping, and then we heard the sound of the bombs," she said, then broke down sobbing.

Ahed's brother, Jawad Kitati, said he plucked the lifeless body of a 2-year-old relative from the street and carried him to an ambulance. Blood stains smeared his jacket sleeve.

Another clan member, Haitham Abu Zour, 24, woke up to the sound of the warning strike and hid in a stairwell. He emerged to find his wife dead and his two infant children buried under the debris, but safe.

Clan elder Mohammed Azzam, 61, denied that anyone in his family had any connections to Hamas.

"The Jews are liars," he said. "No matter how much they pressure our people, we will not withdraw our support for Hamas."

Late Sunday, an Israeli missile killed a Hamas policeman and his 8-year-old son on the roof of their Gaza City home. The father was on the roof to repair a leaking water tank, his relatives said.

In another area of Gaza City, the patriarch of the Daloo family, Jamal, sat in mourning for 11 members of his family killed in a missile strike on his home Sunday. Among the dead were his wife, his son, daughter-in-law, his sister and four grandchildren. He embraced relatives and neighbors paying their condolences, his face swollen from crying.

The mourners sat in plastic chairs just meters away from bulldozers clearing the ruins of Daloo's home. His 16-year-old daughter Yara was still missing and believed under the rubble, family members said.

Daloo, who is left with two sons, tried to take comfort in the belief that the loss of his family was God's will and that the dead are now in paradise. He vehemently disputed Israel's initial claim that a senior operative of Islamic Jihad, a smaller sister group of Hamas, was hiding in his house. He said his son Mohammed, one of those killed, was a policeman in the Gaza police, but not an activist.

"The international public opinion witnessed the facts," he said of the tragedy that befell him. "This does not require my words."

Also Monday, Israel bombarded the remains of the former national security compound in Gaza City. Flying shrapnel killed one child and wounded others living nearby, al-Kidra said. Five farmers were killed in two separate strikes, al-Kidra said, including three who he said had been mistakenly identified earlier by Hamas security officials as Islamic Jihad fighters.

Other strikes killed two fighters on a motorcycle in southern Gaza and two passengers in a taxi that had put a press sign in the windshield, al-Kidra said.

Israel launched the current offensive after months of intensifying rocket fire from the Gaza Strip, which has continued despite the strikes.

In the night from Sunday to Monday, aircraft targeted about 80 militant sites, including underground rocket-launching sites, smuggling tunnels and training bases, as well as Palestinian command posts and weapons storage facilities located in buildings owned by militant commanders, the Israeli military said in a release. Aircraft and gunboats joined forces to attack Hamas police headquarters, and Palestinian rocket squads were struck as they prepared to fire, the release said.

In all, 1,350 targets in the Gaza Strip have been struck since the Israeli operation began. However, military activity over the past two nights has dropped off as targets change and international efforts to wrest a cease-fire plod ahead.

Israel and Hamas have put forth widely divergent conditions for a truce. But failure to end the fighting threatens to touch off an Israeli ground invasion, for which thousands of soldiers, backed by tanks and armored vehicles, have already been mobilized and dispatched to Gaza's border.

President Barack Obama said he was in touch with players across the region in hopes of halting the fighting. While defending Israel's right to defend itself against the rocket fire, he also warned of the risks the Jewish state would take if it were to expand its air assault into a ground war.

"If we see a further escalation of the situation in Gaza, the likelihood of us getting back on any kind of peace track that leads to a two-state solution is going to be pushed off way into the future," Obama said.

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Associated Press writer Amy Teibel in Jerusalem contributed reporting.

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