Clinton Arrives in Middle East as Egypt Says Truce in Gaza Is Close

JERUSALEM — Diplomatic efforts accelerated on Tuesday to end the lethal confrontation between Israel and Palestinian militants in Gaza on one of the most violent days yet in the conflict, as the United States sent Secretary of State Hillary Rodham Clinton to the Middle East and Egypt’s president and his senior aides expressed confidence that a cease-fire was close.

But by late evening there was no announcement, and Mrs. Clinton said she would be working in coming days to complete an agreement. Appearing beside Prime Minister Benjamin Netanyahu of Israel to speak briefly to the press, Mrs. Clinton said she hoped to achieve an end to the hostilities with a deal that moves “toward a comprehensive peace for all people in the region.” Mr. Netanyahu told Mrs. Clinton that if the rocket fire from Gaza stopped he was prepared to agree on a “long-term solution.”

The diplomatic moves to end the nearly week-old crisis came as the antagonists on both sides intensified their attacks before any cease-fire takes effect.

Israeli aerial and naval forces assaulted several Gaza targets in multiple strikes, including a suspected rocket-launching site near Al Shifa hospital, which killed more than a dozen people. Those deaths brought the total number of fatalities in Gaza so far to more than 130 — roughly half of them civilians, the Gaza Health Ministry said. A delegation visiting from the Arab League canceled a news conference at the hospital because of the Israeli aerial assaults as wailing ambulances brought victims in, some of them decapitated.

The Israeli assaults carried into early Wednesday, with multiple blasts punctuating the darkened Gaza skies.

Militants in Gaza fired a barrage of at least 200 rockets into Israel, killing an Israeli soldier — the first military casualty on the Israeli side since the hostilities broke out last week. The Israel Defense Forces said the soldier, identified as Yosef Fartuk, 18, died from a rocket strike that hit an area near Gaza. Israeli officials said a civilian military contractor working near the Gaza border was also killed, bringing the total number of fatalities in Israel from the past week of rocket mayhem to five.

Other Palestinian rockets hit the southern Israeli cities of Beersheba and Ashdod, and longer-range rockets were fired at Tel Aviv and Jerusalem, but neither main city was struck and no casualties were reported. One Gaza rocket hit a building in the Israeli city of Rishon Lezion, just south of Tel Aviv, injuring one person and wrecking the top three floors.

Senior Egyptian officials in Cairo said Israel and Hamas, the militant Islamist group that governs Gaza, were “very close” to a cease-fire agreement that could be announced within hours. “We have not received final approval but I hope to receive it any moment,” said Essam el-Haddad, President Mohamed Morsi’s top foreign affairs adviser.

Foreign diplomats who were briefed on the outlines of a tentative agreement said it had been structured in stages — first, an announcement of a cease-fire, followed by its implementation for 48 hours. That would allow time for Mrs. Clinton to involve herself in the process on the ground here and create a window for negotiators to agree on conditions for a longer-term cessation of hostilities.

By late evening, however, there was no word on an announcement, and Israeli television was saying the talks needed more time. In Cairo, Egyptian news reports quoted Hamas officials as blaming Israel for delaying a deal and an announcement was unlikely before Wednesday.

The announcement of Mrs. Clinton’s active role in efforts to defuse the crisis added a strong new dimension to the multinational push to avert a new Middle East war. Israel has amassed thousands of soldiers on the border with Gaza and has threatened to invade the crowded Palestinian enclave for the second time in four years to stop the persistent rockets that have been lobbed at Israel.

Mrs. Clinton, who accompanied President Obama on his three-country Asia trip, left Cambodia on her own plane immediately for the Israel, and upon arrival in the late evening went into immediate talks with Israeli leaders.

She was scheduled to visit the West Bank later to meet with Palestinian leaders and then go to Cairo to consult with Egyptian officials.

Isabel Kershner reported from Jerusalem; Peter Baker from Phnom Penh, Cambodia; and Rick Gladstone from New York. Reporting was contributed by Jodi Rudoren and Fares Akram from Gaza City, David D. Kirkpatrick from Cairo, Ethan Bronner from Jerusalem and David E. Sanger from Washington.

This article has been revised to reflect the following correction:

Correction: November 20, 2012

Because of an editing error, an earlier version of this article misspelled the family name of the Israeli soldier who was killed in a Palestinian rocket attack on Tuesday. He is Yosef Fartuk, not Yosef Faruk. 

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Leonor Varela Welcomes a Son

Mom & Babies
Celebrity Baby Blog

11/20/2012 at 07:00 PM ET

David Livingston/Getty

Leonor Varela‘s days as villainous vixen may be over, but her role in motherhood has only just begun.

The former Dallas actress, 39, and producer Lucas Akoskin have welcomed their first child together, the new mom announced on Twitter Tuesday.

“Matteo V. Akoskin is finally in our arms!” Varela writes, keeping any further details under wraps.

Confirming the pregnancy in July, Varela and Akoskin were elated to be starting a family together. “The couple are over the moon,” her rep told PEOPLE at the time.

Courtesy Leonor Varela

– Anya Leon

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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.

___

Online:

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

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Bonds of tradition are a financial bind for Oaxacan migrants

SANTA ANA DEL VALLE, Mexico — Isaias Garcia had labored for decades to raise a family in Torrance when in 2009, the Zapotec Indian faced a life-changing decision.

The authorities of his family village of Santa Ana del Valle in the state of Oaxaca had called him home to serve without pay as a councilman for three years. If he refused, they could confiscate his property — a house and nine acres — under a centuries-old system of local Indian governance known as usos y costumbres (uses and customs).

Garcia came to America illegally, and he knew that going home would be tantamount to permanent deportation; border security and drug-cartel violence had made returning to the United States more dangerous and costly. Nor could he afford to pay someone in Santa Ana to do the job for him.

Under usos y costumbres, a system recognized in Mexican law, Indian towns choose municipal workers — mayors, councilmen, policemen and sanitation workers — in open assemblies. The system is practiced by 418 Indian municipios, similar to counties but much smaller, across Oaxaca.

In most villages, each man before he turns 60 must perform at least 15 years of work — each job can last between one and three years — or pay someone to take his place.

California has close to 300,000 Oaxacan Indian migrants, and more than half of them live in Southern California. Virtually all are from villages run by usos y costumbres; many are in the same bind as Garcia.

For centuries, usos y costumbres kept Mexican Indian villages functioning and unified. But many villagers were now in the United States, and the system increasingly pitted migrants against those who remained behind. Migrants say the system keeps their hometowns and people in poverty, and as Garcia prepared to return home, Santa Ana migrants in the U.S. were battling the system.

In December 2010, Garcia, 59, with his wife, Angelica Morales, 54, left their apartment in Torrance and returned to Mexico for what he assumed was forever.

A quiet, self-effacing man and a political novice, Garcia would soon become a conduit for the cause of upending, at least in Santa Ana, the system that had governed the town for centuries.

"It would be a radical change," he said. "Change is good. We only need the village to approve it."

::

Santa Ana del Valle — 20 miles east of the state capital of Oaxaca City — had once been a town of weavers and subsistence corn farmers living in adobe houses.

Then in the 1970s and 1980s, a wave of young men immigrated to California, finding restaurant jobs in Culver City, Venice and Torrance. Garcia was among two dozen who found kitchen work in a Torrance Szechwan restaurant.

Now he walked Santa Ana's quiet streets. Red-brick homes had replaced the adobe. There were small grocery stores, and even though men often herded donkeys and bulls through town, many families also had trucks.

As he began his tenure as councilman, he and his wife settled into the house that he and his brothers had built in place of their late father's adobe home. He also planted corn on their nine acres, just as his ancestors had on the same soil. Like them, he plowed the fields using bulls.

He also knew that many villagers thought the migrants were getting rich in the United States.

In 1986, villagers decided that migrants had to do service jobs, even if it meant they would have to return home. The jobs began to proliferate. Because the workers didn't draw a salary, essential services could be provided without draining the municipal budget. In one instance, a different person for every day of the week was put in charge of turning on the water system.

Some migrants, preferring not to leave the United States, began paying others to do their work, and it became common in Santa Ana to name migrants to jobs in the expectation that they would pay others back home. Some villagers relied on this income. Migrants compared the system to extortion.

Others saw the essence of Indian life and culture wrapped up in usos y costumbres. The work helped youths understand their responsibilities to one another and to the town, said Jacinto Matias, a former weaver who spent 31 years in the United States and now lives in Santa Ana.

That labor "is how we're a community," said Matias, who has put in nine years of service work as a police officer, a caretaker at a school and a church, and an operator of the water system. His brother helped him a little financially, but he and his wife mostly supported themselves by working in the fields, growing corn.

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Hamas Strengthens as Palestinian Authority Weakens

RAMALLAH, West Bank — In the daily demonstrations here of solidarity with Gaza, a mix of sympathy and anguish, there is something else: growing identification with the Islamist fighters of Hamas and derision for the Palestinian Authority, which Washington considers the only partner for peace with Israel.

“Strike a blow on Tel Aviv!” proclaim the lyrics of a new hit song blasting from shops and speakers at Monday’s demonstration, in a reference to Hamas rockets that made it nearly to Israel’s economic and cultural capital. “Don’t let the Zionists sleep! We don’t want a truce or a solution! Oh Palestinians, you can be proud!”

Pop songs everywhere are filled with bravado and aggression. But this one reflects a widespread sentiment that does not augur well for President Mahmoud Abbas and his Palestinian Authority, which is rapidly losing credibility, even relevance. The Gaza truce talks in Cairo, involving Egypt, Turkey and Qatar, offer a telling tableau. The Palestinian leader seen there is not Mr. Abbas, but Khaled Meshal, the leader of the militant group Hamas, who seeks to speak for all Palestinians as his ideological brothers in the Muslim Brotherhood rise to power around the region.

Israel is also threatening Mr. Abbas, even hinting that it may give up on him, as he prepares to go to the United Nations General Assembly on Nov. 29 to try to upgrade the Palestinian status to that of a nonmember state. The Israelis consider this step an act of aggression, and even some Palestinians say it is somewhat beside the point at this stage.

“His people are being killed in Gaza, and he is sitting on his comfortable chair in Ramallah,” lamented Firas Katash, 20, a student who took part in the Ramallah demonstration.

For the United States, as for other countries hoping to promote a two-state solution to this century-old conflict, a more radicalized West Bank with a discredited Palestinian Authority would mean greater insecurity for Israel and increased opportunity for anti-Western forces to take root in a region where Islamism is on the rise.

Since Hamas, which won parliamentary elections in 2006, threw the Fatah-controlled authority out of Gaza a year later, Mr. Abbas has not set foot there. Yet he will be asking the world to recognize the two increasingly distinct entities as a unified state.

Manar Wadi, who works in an office in Ramallah, put the issue this way: “What is happening in Gaza makes the Palestinian Authority left behind and isolated. Now we see the other face of Hamas, and its popularity is rising. It makes us feel that the Palestinian Authority doesn’t offer a path to the future.”

In Cairo on Monday, Mr. Meshal seemed defiant and confident in his new role, daring the Israelis to invade Gaza as a sixth day of Israeli aerial assaults brought the death toll there to more than 100 people, many of them militants of Hamas and its affiliates. Rockets launched from Gaza hit southern Israel, causing some damage and panic, but no casualties, leaving the death toll there at three.

“Whoever started the war must end it,” he said at a news conference. “If Israel wants a cease-fire brokered through Egypt, then that is possible. Escalation is also possible.”

Officials in the authority have been holding leadership meetings, staying in close touch with the talks in Cairo and issuing statements of solidarity. They have also sent a small medical delegation to Gaza and argue that there is a new opportunity to forge unity between the two feuding movements. But they are acutely aware of their problem.

“The most dangerous thing is the fact that what we could not do in negotiations, Hamas did with one rocket,” one official said, speaking on the condition of anonymity. “The people had such excitement seeing the occupiers run in panic. It’s a very dangerous message.”

Mr. Abbas, whose popularity has been on the decline as the Palestinian Authority faces economic difficulty and growing Israeli settlements, also ran into trouble not long before the Gaza fighting began when he seemed to give up on the Palestinian demand of a right of return to what is now Israel.

Many Palestinians believe that Israel launched its latest operation in Gaza to block the Palestinian Authority’s United Nations plans by embarrassing it. Israeli officials say that is ridiculous: the operation’s purpose is to stop the growing number of rockets being fired at their communities, and Israelis interrupted their deliberations over the United Nations bid to wage the military campaign.

But Israel says anything that does not involve direct negotiations is a waste of time. The government of Prime Minister Benjamin Netanyahu has repeatedly threatened to take severe retaliatory steps against the Palestinian Authority, including cutting off badly needed tax receipts to Palestinian coffers, should Mr. Abbas go ahead at the United Nations.

In a speech here on Sunday night at a Palestinian leadership meeting, Mr. Abbas repeated his determination to go to New York and ask for a change in status to that of nonmember state. He has chosen the symbolically significant date of Nov. 29, when the General Assembly voted in 1947 to divide this land into two states, one Jewish and the other Palestinian Arab.

The United States has asked Mr. Abbas not to do so but instead to resume direct negotiations with Israel, which have essentially been frozen since 2008.

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Google should not be accused of “unfair” acts: lawmakers

WASHINGTON (Reuters) – Two lawmakers urged the Federal Trade Commission on Monday to steer clear of expanding its authority as it investigates allegations search engine company Google violated antitrust law.

The two California Democrats in the House of Representatives, who count Google as a major campaign contributor, asked the FTC not to accuse the company of “unfair” acts if it believes it broke antitrust law.

Anna Eshoo, on the Energy and Commerce Committee, and Zoe Lofgren, who is on the Judiciary Committee, said there were reports to suggest the FTC planned to use the unfair standard to avoid proving some elements required in an antitrust claim.

They said such a move could lead to over-broad authority for the FTC that could create legal uncertainties for firms and stifle economic growth.

“Such a massive expansion of FTC jurisdiction would be unwarranted, unwise, and likely have negative implications for our nation’s economy,” the lawmakers wrote in the letter, which was dated November 19 and sent to the five FTC commissioners.

The FTC is looking into a long list of complaints brought by rivals of Google, which is also accused of using its dominance to squash competitors in vertical search areas such as shopping and travel.

The FTC staff has reportedly given the commission a report urging them to file a complaint against Google for suing competitors based on standard essential patents and asking for injunctions to stop the sales of their products. Standard essential patents are supposed to be broadly licensed at a fair rate.

Google is the seventh largest contributor to Eshoo, donating $ 13,000 during the 2012 election cycle, according to data from the Center for Responsive Politics. It is the third largest contributor to Lofgren, who got $ 14,500 from Google. The donations came from a Google political action committee and employees and lobbyists associated with Google.

Complaints about Google to the FTC over standard essential patents arise from a raft of litigation between Apple Inc, Google and Microsoft Corp, which have sued each other numerous times in various countries, each alleging that their respective patents are being infringed upon by rivals in the highly competitive smartphone market.

In many cases, the companies ask that their rivals’ products be banned from stores. Many antitrust enforcers believe it is inappropriate for companies to ask for sales bans based on the infringement of essential patents.

FTC Chairman Jon Leibowitz, who is expected to leave the agency soon, said in mid-September that he expected a decision in the case by the end of the year. A decision could be in the form of a lawsuit or, more likely, a settlement.

Google has settled with U.S. law enforcement agencies in the past.

For example, it settled with the FTC following privacy gaffes during the botched roll-out of its social network, Buzz. Later, it paid $ 22.5 million to settle charges that it bypassed the privacy settings of customers using Apple’s Safari browser.

Google also paid a $ 500 million settlement in 2011 to the Justice Department for knowingly accepting illegal advertisements from Canadian pharmacies selling in the United States.

FTC spokesman Peter Kaplan confirmed that the commission had received the letter but said the agency declined comment.

(Reporting By Diane Bartz; editing by Andrew Hay)

Tech News Headlines – Yahoo! News

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Miley Cyrus Celebrates in New York - with Her Entire Family!

11/19/2012 at 07:05 PM EST

From left: Noah, Bill Ray, Tish, Miley, Brandi and Braison Cyrus

Bruce Glikas/Filmmagic

The Cyrus family has a lot to be thankful for this year.

Miley Cyrus is celebrating her 20th birthday on Friday. Her dad, Billy Ray Cyrus, is starring as slick lawyer Billy Flynn in the Broadway hit musical Chicago. And it looks like (practically) the whole family is together for the occasions.

Photos show Billy Ray – dressed in a tuxedo – his wife Tish and their kids, Miley, 19, Noah, 12, Brandi, 25, and Braison, 18, all posing together backstage at the Ambassador Theater in New York City on Sunday. (Brother Trace is the only one absent.)

"The whole family had a great time," an observer tells PEOPLE.

They came backstage at intermission to spend time with Billy Ray in his dressing room, and again after the show to meet some of his fellow cast members.

Billy Ray, who began his Broadway run recently, told PEOPLE that his family hadn't come to see him yet partly because he wanted to get comfortable in the role. "I gotta get my legs up [before they see it]," he said. "I think everybody's coming in for Thanksgiving. So we'll see what happens."

Now that they've seen it, it seems his family is giving his performance a thumbs-up. "So glad to be back with my daddy (@billyraycyrus) for the first time in 3 MONTHS!! He was so great on broadway," Noah Tweeted on Monday.

Miley, too, is having a blast in the Big Apple. "What a dope morning. So many fans outside my hotel this a.m. in NYC. If there's this much chaos NOW imagine when I drop this record! #ohsnap," she Tweeted.

As for Billy Ray, whose Chicago run ends Dec. 23, he says taking the part on Broadway has been great fun – and a great challenge.

"I couldn't come up here and do something predictable," he says of the role. "I was offered Rock of Ages, and my instincts said, 'That's a bit predictable for me.' "

But when the role of Billy Flynn came up, Ray explained, "He's the total opposite of me" – and that was just what he wanted.

For more on Billy Ray Cyrus – including what he does (and doesn't) know about Miley's wedding plans – pick up PEOPLE, on newsstands Friday

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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 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."

___

Online:

Task force recommendation: http://www.uspreventiveservicestaskforce.org

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An ethics debate over embryos on the cheap

Dr. Ernest Zeringue was looking for a niche in the cutthroat industry of fertility treatments.

He seized on price, a huge obstacle for many patients, and in late 2010 began advertising a deal at his Davis, Calif., clinic unheard of anywhere else: Pregnancy for $9,800 or your money back.

That's about half the price for in vitro fertilization at many other clinics, which do not include money-back guarantees. Typically, insurance coverage is limited and patients pay again and again until they give birth — or give up.

Those patients use their own eggs and sperm — or carefully select donors when necessary — and the two are combined in a petri dish to create a batch of embryos. Usually one or two are then transferred to the womb. Any embryos left over are the property of the customers.

Zeringue sharply cuts costs by creating a single batch of embryos from one egg donor and one sperm donor, then divvying it up among several patients. The clinic, not the customer, controls the embryos, typically making babies for three or four patients while paying just once for the donors and the laboratory work.

People buying this option from Zeringue must accept concessions: They have no genetic connection to their children, and those children will probably have full biological siblings born to other parents.

Inside the industry, Zeringue's strategy for making embryos on the cheap has spurred debate about the ethical boundaries of creating life.

"I am horrified by the thought of this," said Andrew Vorzimer, a Los Angeles fertility lawyer alarmed that a company — not would-be parents — controls embryos. "It is nothing short of the commodification of children."

Other experts say they see no problem with the arrangement, although the business model and the issues it raises are to be discussed at a meeting in January of the ethics committee of the American Society for Reproductive Medicine.

Zeringue said the concerns are overblown.

Most of his customers have run out of money and patience by the time they come to his clinic, he said: "They're kind of at the end of the line."

::

Natosha Dukart and her husband, Brad, an oil field worker, spent more than $100,000 without producing a child. They ran up credit cards, flipped houses and moved four times to help finance round after round of IVF.

It was never clear if the problem was her eggs or his sperm.

After eight unsuccessful attempts, Natosha took to the Internet and found Zeringue's clinic, California IVF: Davis Fertility Center Inc., and its embryo program, California Conceptions. With no financial risk, there was nothing to lose.

"It was an easy choice," Natosha said.

She sent their photographs to the clinic and filled out a form saying they wanted a Caucasian baby. Two months later, they received a profile of an embryo the clinic had frozen in storage. Both donors had brown eyes and healthy family histories.

The Dukarts liked the description and this February traveled from their home near Calgary to Davis in an attempt to get Natosha pregnant.

"It was just as emotional as it was with our own embryos," she said.

Last month, at age 39, she gave birth to a healthy 7-pound girl with blue eyes and dark hair. The couple named her Milauna.

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Gaza Violence Is Unabating as Other Nations Push for Truce

GAZA CITY — Israeli forces killed at least 11 people, including several children, in a single airstrike that destroyed a home here on Sunday, as Israel pressed its bombardment of the Gaza Strip for a fifth day, deploying warplanes and naval vessels to pummel the coastal enclave.

The airstrike, which the Israeli military said was meant to kill a Palestinian militant involved in the recent rocket attacks, was the deadliest operation to date and would no doubt weigh on negotiations for a possible cease-fire. Among the dead were five women and four small children, The Associated Press reported, citing a Palestinian health official.

Two media offices were also hit on Sunday, and Prime Minister Benjamin Netanyahu of Israel warned of a “significant” expansion in the onslaught, which has already killed over 50 people, many of them civilians.

Speaking on Sunday from Bangkok, President Obama condemned missile attacks by Palestinian fighters in Gaza and defended Israel’s right to protect itself.

“There’s no country on earth that would tolerate missiles raining down on its citizens from outside its borders,” Mr. Obama said in his first public comments since the violence broke out. “We are fully supportive of Israel’s right to defend itself.”

The president also said that efforts were under way to address Israel’s security concerns and end the violence. “We’re going to have to see what kind of progress we can make in the next 24, 36, 48 hours,” Mr. Obama said.

Even as the diplomacy intensified on Sunday, the attacks continued in Gaza and Israel.

Mr. Netanyahu made his warning as militants in Gaza aimed at least one rocket at Tel Aviv, a day after Israeli forces broadened the attack beyond military targets, bombing centers of government infrastructure in Gaza, including the four-story headquarters of the Hamas prime minister.

“We are exacting a heavy price from Hamas and the terrorist organizations, and the Israel Defense Forces are prepared for a significant expansion of the operation,” Mr. Netanyahu told his cabinet at its routine Sunday meeting, referring directly to the of thousands of reservists who have been called up and the massing of armor on the Gaza border that many analysts have interpreted as preparations for a possible invasion.

“I appreciate the rapid and impressive mobilization of the reservists who have come from all over the country and turned out for the mission at hand,” Mr. Netanyahu said. “Reservist and conscript soldiers are ready for any order they might receive.”

His remarks were reported shortly after a battery of Israel’s Iron Dome defense shield, hastily deployed near Tel Aviv on Saturday in response to the threat of longer-range rockets, intercepted at least one aimed at the city on Sunday, Israeli officials said. It was the latest of several salvos that have illustrated Hamas’s ability to extend the reach of its rocket attacks.

Since Wednesday, when the escalation of the conflict began, Iron Dome has knocked 245 rockets out of the sky, the military said Saturday, while 500 have struck Israel.

The American-financed system is designed to intercept only rockets streaking toward towns and cities and to ignore those likely to strike open ground. But on Sunday a rocket fired from Gaza plowed through the roof of an apartment building in the southern Israeli city of Ashkelon. There were no immediate reports of casualties there.

In Gaza City, the crash of explosions pierced the quiet several times throughout the early morning.

Before the latest deadly strike involving civilians on Sunday, Hamas health officials had said the Palestinian death toll had risen to 53. One of the latest victims was a 52-year-old woman whose house in the eastern part of Gaza City was bombed around lunchtime.

A few hours earlier, a Hamas militant was killed and seven people were wounded in an attack on the Beach Refugee Camp, where Ismail Haniya, the Hamas prime minister, has a home. Those killed on Sunday included three children ages 1 through 5, the health officials said.

In Israel, 3 civilians have died and 63 have been injured. Four soldiers were wounded on Saturday.

The onslaught continued despite talks in Cairo that President Mohamed Morsi of Egypt said Saturday night could soon result in a cease-fire. Mr. Netanyahu said he would consider a comprehensive cease-fire if the launchings from Gaza stopped.

The attack on Mr. Haniya’s office, one of several on government installations, came a day after he hosted his Egyptian counterpart in the same building, a sign of Hamas’s new legitimacy in a radically redrawn Arab world.

Jodi Rudoren and Fares Akram reported from Gaza City. Reporting was contributed by Isabel Kershner, Carol Sutherland and Iritz Pazner Garshowitz from Jerusalem; Tyler Hicks from Gaza, Peter Baker from Bangkok, Alan Cowell from London, Michael Schwirtz from New York and David D. Kirkpatrick and Mayy El Sheikh from Cairo.

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