Why Sanofi’s Zaltrap Deal Won t Help Patients
















Nurse administers chemotherapy to patient. Credit: National Cancer Institute.

I got excited when I read the New York Times story Nov. 9 (“Sanofi Halves Price of Cancer Drug Zaltrap After Sloan-Kettering Rejection)”. Zaltrap is an intravenous infusion colon cancer drug for metastatic colorectal cancer that is resistant to or has progressed with platinum-based chemotherapy. With a list price of $ 11,000 per patient per month, Zaltrap is about double the cost of Genentech’s Avastin. Sloan Kettering doctors rejected Zaltrap, claiming it offered no added value over Avastin, because it works no better than Avastin, and costs twice as much. Doctors from Sloan-Kettering Cancer Center, one the United States flagship cancer hospitals, published an op-ed in the NYTimes Oct. 14, titled “In Cancer Care, Cost Matters,” arguing that hospitals need to put their foot down when drugs are outrageously expensive with no added value. They wrote: “Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver.” The importance of getting bang for your buck, or value in healthcare, has been a huge point in health policy circles in the United States. In fact, politicians of all stripes are quick to point to health outcomes data that show that despite the United States spending in the top tier of all nations for healthcare, health outcomes are far lower. What Sanofi announced in its response Nov. 8 to Sloan-Kettering, one could have easily thought that it was a victory for patients. However, the New York Times headline stating “Sanofi halves price…” is misleading. Sadly, the Zaltrap half-off deal is not a list price reduction at all. It is just a business discount plan for hospitals and oncologists. As Lisa Jane Hubbell, who uses high-cost disease modifying drugs for a noncancerous, chronic condition told me: “It won’t help patients, will it? Our copay will be based on full price, the docs will pocket the extra from insurance companies. It doesn’t really help anyone who is in need of help paying for healthcare.” Another woman with stage IV breast cancer says that she has been deemed ineligible for any discount for her high-priced cancer drugs because she is insured. In general, drug discount plans go to the uninsured. She emailed me: “The drug I took for five years was re-patented three times while I was on it, as I recall. It was orders of magnitude more expensive than the old standby tamoxifen for only a slight advantage in efficacy.” As The Times points out, Medicare patients are unlikely to see a lower price for Zaltrap for a long while until the discount is incorporated into Medicare payment calculations for Part B, which covers physician-administered drugs. In addition, oncologists have long marked up drugs that they administer for insurers and patients. Fortunately, Sloan-Kettering doctors are on the patients’ side and question whether Sanofi’s discount will make Zaltrap more affordable for patients. Peter Bach, MD, told me: “I don’t know if they’re going through steps to ensure reimbursement goes down to follow price or not. I’m hoping that is in their plans. If not, then yes, the windfall goes to providers, and our concern is the costs passed on to patients.” Leonard Saltzman, MD, the op-ed coauthor, and gastroenterology oncologist, from Sloan Kettering also called Sanofi to task for missing the boat in making Zaltrap affordable for patients. But pharmaceutical price fixing is nothing new, according to Frederic Kaye, MD, professor of hematology and oncology at the University of South Florida in Gainesville, Florida. “I saw this happen for the first time in the late 1980s when a veterinary pill levamisole, which cost pennies for the treatment of heartworm, underwent a 100 times price escalation when it was used for treating colon cancer. There was outrage at the time over lack of regulations for price fixing, but you see almost 25 years later, it is the same.” Sanofi’s drug discount plan is clearly a business imperative. If one of the US flagship cancer treatment centers says that they will not use Zaltrap, others could follow. But the refusal to lower Zaltrap’s list price is worrisome because patient copays are based on price. More importantly, if the Sanofi plan becomes the pharmaceutical industry’s modus operandi to the era of value-based healthcare, patients will still remain out in the cold, without any added relief for the high cost of drugs. Value-based healthcare will be something for facilities and hospitals and leave patients out in the cold. These days, you have to critically review the hoopla about “patient-centered health care” and the allegedly positive partnerships shaping healthcare. Were patients included when it really mattered in drafting this drug discount program? We need to maintain a high level of skepticism about deals made strictly between drug companies and hospitals, or arrangements made between industry and physicians, or industry and health plans. It’s been said before and it must be said again: “Nothing about me [the patient] that pertains to me should be done without me at the table.”  












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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Israel says prefers diplomacy but ready to invade Gaza

GAZA/JERUSALEM (Reuters) - Israel bombed dozens of targets in the Gaza Strip on Monday and said that while it was prepared to step up its offensive by sending in troops, it preferred a diplomatic solution that would end Palestinian rocket fire.


Mediator Egypt said a deal for a truce to end the fighting could be close. The leader of Hamas said it was up to Israel to end the new conflict it had started. Israel says its strikes are to halt Palestinian rocket attacks.


U.N. Secretary-General Ban Ki-moon, touring the region in hopes of helping broker a peace arrived in Cairo, where he met Egypt's foreign minister in preparation for talks with the new, Islamist president, Mohamed Mursi, on Tuesday. He also plans to meet Israeli Prime Minister Benjamin Netanyahu in Jerusalem.


Israeli attacks on the sixth day of fighting raised the number of Palestinian dead to 101, the Hamas-run Health Ministry said, listing 24 children among them. Hospital officials in Gaza said more than half of those killed were non-combatants. Three Israeli civilians died on Thursday in a rocket strike.


Militants in the Gaza Strip fired 110 rockets at southern Israel on Monday, causing no casualties, police said.


For the second straight day, Israeli missiles blasted a tower block in the city of Gaza housing international media. Two people were killed there, one of them an Islamic Jihad militant.


Khaled Meshaal, exiled leader of Hamas, said a truce was possible but the Islamist group, in charge of the Gaza Strip since 2007, would not accept Israeli demands and wanted Israel to halt its strikes first and lift its blockade of the enclave.


"Whoever started the war must end it," he told a news conference in Cairo, adding that Netanyahu, who faces an election in January, had asked for a truce, an assertion a senior Israeli official described as untrue.


Meshaal said Netanyahu feared the domestic consequences of a "land war" of the kind Israel launched four years ago: "He can do it, but he knows that it will not be a picnic and that it could be his political death and cost him the elections."


For Israel, Vice Prime Minister Moshe Yaalon has said that "if there is quiet in the south and no rockets and missiles are fired at Israel's citizens, nor terrorist attacks engineered from the Gaza Strip, we will not attack."


Yaalon also said Israel wanted an end to Gaza guerrilla activity in the neighboring Egyptian Sinai peninsula.


Although 84 percent of Israelis supported the current Gaza assault, according to a poll by Israel's Haaretz newspaper, only 30 percent wanted an invasion, while 19 percent wanted their government to work on securing a truce soon.


DIPLOMACY "PREFERRED"


"Israel is prepared and has taken steps, and is ready for a ground incursion which will deal severely with the Hamas military machine," a senior official close to Netanyahu told Reuters.


"We would prefer to see a diplomatic solution that would guarantee the peace for Israel's population in the south. If that is possible, then a ground operation would no longer be required. If diplomacy fails, we may well have no alternative but to send in ground forces," he added.


Egypt, where Mursi has his roots in the Muslim Brotherhood seen as mentors to Hamas, is acting as a mediator in the biggest test yet of Cairo's 1979 peace treaty with Israel since the fall of Hosni Mubarak.


"I think we are close, but the nature of this kind of negotiation, (means) it is very difficult to predict," Egyptian Prime Minister Hisham Kandil, who visited Gaza on Friday in a show of support for its people, said in an interview in Cairo for the Reuters Middle East Investment Summit.


Egypt has been hosting leaders of both Hamas and Islamic Jihad, a smaller armed faction.


Israeli media said a delegation from Israel had also been to Cairo for truce talks. A spokesman for Netanyahu's government declined comment on the matter.


Egypt's foreign minister, who met U.N. chief Ban on Monday, is expected to visit Gaza on Tuesday with a delegation of Arab ministers.


THOUSANDS MOURN FAMILY


Thousands turned out on Gaza's streets to mourn four children and five women, among 11 people killed in an Israeli strike that flattened a three-storey home the previous day.


The bodies were wrapped in Palestinian and Hamas flags. Echoes of explosions mixed with cries of grief and defiant chants of "God is greatest".


The deaths of the 11 in an air strike drew more international calls for an end to six days of hostilities and could test Western support for an offensive Israel billed as self-defense after years of cross-border rocket attacks.


Israel said it was investigating its air strike that brought the home crashing down on the al-Dalu family, where the dead spanned four generations. Some Israeli newspapers said the wrong house may have been mistakenly targeted.


In scenes recalling Israel's 2008-2009 winter invasion of the coastal enclave, tanks, artillery and infantry have massed in field encampments along the sandy, fenced-off border and military convoys moved on roads in the area.


Israel has also authorized the call-up of 75,000 military reservists, so far mobilizing around half that number.


The Gaza fighting adds to worries of world powers watching an already combustible region, where several Arab autocrats have been toppled in popular revolts for the past two years and a civil war in Syria threatens to spread beyond its borders.


In the absence of any prospect of permanent peace between Israel and Islamist factions such as Hamas, mediated deals for each to hold fire unilaterally have been the only formula for stemming bloodshed in the past.


Israel's declared goal is to deplete Gaza arsenals and force Hamas to stop rocket fire that has hit Israeli border towns for years.


Hamas and other groups in Gaza are sworn enemies of the Jewish state which they refuse to recognize and seek to eradicate, claiming all Israeli territory as rightfully theirs.


Hamas won legislative elections in the Palestinian Territories in 2006. A year later, after the collapse of a unity government under President Mahmoud Abbas, the Islamist group seized Gaza in a brief civil war with Abbas's forces.


(Writing by Jeffrey Heller, Dan Williams and Peter Graff; Editing by Alastair Macdonald)


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Canada pledges again to balance budget by 2015
















OTTAWA/NEW YORK (Reuters) – The Canadian government on Friday reiterated its intention to balance its budget by 2015, three days after projecting there would be deficits until 2016-17.


In separate appearances in Quebec City and New York, Prime Minister Stephen Harper and Finance Minister Jim Flaherty were at pains to say they still intended to end the red ink by 2015.













“It remains the government’s plan, intention, to balance the budget prior to the next federal election. The recent economic and fiscal update by the minister indicates we are actually very close to that objective,” Harper told reporters in Quebec City. The next election is in October 2015.


Flaherty’s fall fiscal update on Tuesday had pushed back the target date for eliminating the deficit by a year, to 2016-17, citing a weak global economy.


But the minister said in a speech in New York that the government was on track to balance the budget in the next two to three years, barring major external events, and he later clarified that he intended a balanced budget by 2015.


“The prime minister’s always correct,” he chuckled.


He sought to explain the discrepancy by saying the fiscal update had built in a C$ 3 billion ($ 3 billion) contingency cushion, meaning there was an underlying surplus of C$ 1.2 billion for 2015-16. He said the projection of a C$ 1.8 billion deficit amounted to about half a percent of the C$ 275 billion federal budget.


“There’s lots of water to go under the bridge between now and then,” he said.


The opposition New Democratic Party noted the discrepancy in a release headlined: “Stephen Harper makes stuff up about balancing the budget.”


It pointed out that balancing the budget by the next election was not the same as balancing it by 2016-17.


As it is, even the 2015-16 timetable is a year later than offered in the Conservative campaign for reelection in May 2011. They had promised a balanced budget by 2014-15, followed by major personal income tax relief before the 2015 election.


Flaherty’s timetable drew criticism this week from the Canadian Taxpayers Federation, which said the minister had become expert at kicking the can down the road.


The projections could be thrown out of whack if the United States goes off the fiscal cliff, a set of automatic tax hikes and spending cuts that are to be triggered on January 2 if legislators and the White House cannot agree on a more nuanced budget deal.


Flaherty said U.S. failure to avert the fiscal cliff would cause a significant and immediate decline in Canada’s gross domestic product, and he would counter it.


Referring to a possible economic shock from Europe or the United States, he said: “If that were to happen and if the Canadian economy were to be pushed back into recession with the resulting danger for higher unemployment and the danger always of a prolonged recession, then we would act.”


He added: “We would not stand by and let that happen. The kinds of measure we can take: there are various tax measures we can take, there are measures with respect to stimulus we can take, these are things that we have done before and we can do again.”


On Tuesday, Flaherty spoke of having prepared various contingency plans.


(Additional reporting by Louse Egan; Editing by David Gregorio)


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Rock band AC/DC releases entire catalog on iTunes
















NEW YORK (AP) — AC/DC is finally releasing its music digitally on iTunes.


Columbia Records and Apple announced Monday that the classic rock band’s music will be available at the iTunes Store worldwide. Sixteen studio albums will be released, including “High Voltage” and “Back in Black.”













AC/DC was one of the few acts that would not release music through the digital outlet. The Beatles and Kid Rock were also against selling music on iTunes, but have since jumped onboard. Country star Garth Brooks has yet to release his music on iTunes.


Four of AC/DC’s live albums and three compilation records are also available. The statement said the songs have been mastered for iTunes “with increased audio fidelity.”


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Wii U: New console launches in a sea of gadgets
















NEW YORK (AP) — In the six years since the last major video game system launched, Apple unveiled the iPhone and the iPad, “Angry Birds” invaded smartphones and Facebook reached a billion users. In the process, scores of video game consoles were left to languish in living rooms alongside dusty VCRs and disc players.


On Sunday, Nintendo Co. is launching the Wii U, a game machine designed to appeal both to the original Wii’s casual audience and the hardcore gamers who skip work to be among the first to play the latest “Call of Duty” release. Just like the Wii U’s predecessor, the Wii, which has sold nearly 100 million units worldwide since 2006, the new console’s intended audience “truly is 5 to 95,” says Reggie Fils-Aime, the president of Nintendo of America, the Japanese company’s U.S. arm.













But the Wii U arrives in a new world. Video game console sales have been falling, largely because it’s been so long since a new system has launched. Most people who wanted an Xbox 360, PlayStation 3 or a Wii already have one. Another reason: People in the broad 5-to-95 age range have shifted their attention to games on Facebook, tablet computers and mobile phones.


U.S. video game sales last month, including hardware, software and accessories, totaled $ 755.5 million, according to the research firm NPD Group. In October 2007, the figure stood at $ 1.1 billion.


The Wii U is likely to do well during the holiday shopping season, analysts believe —so well that shoppers may see shortages. But the surge could peter out in 2013. The Wii U is not expected to be the juggernaut that the Wii was in its heyday, according to research firm IHS iSuppli. The Wii outsold its competitors, the Xbox 360 and the PlayStation 3, in its first four years on sale, logging some 79 million units by the end of 2010. By comparison, IHS expects the Wii U to sell 56.7 million in its first four years.


In the age of a million gadgets and lean wallets, the storied game company faces a new challenge: convincing people that they need a new video game system rather than, say, a new iPad.


The Wii U, which starts at $ 300, isn’t lacking in appeal. It allows for “asymmetrical game play,” meaning two people playing the same game can have entirely different experiences depending on whether they use a new tablet-like controller called the GamePad or the traditional Wii remote. The GamePad can also be used to play games without using a TV set, as you would on a regular tablet. And it serves as a fancy remote controller to navigate a TV-watching feature called TVii, which will be available in December.


Nintendo, known for iconic game characters such as Mario, Donkey Kong and Zelda, is expected to sell the consoles quickly in the weeks leading up to the holidays. After all, it’s been six long years and sons, daughters, brothers and sisters are demanding presents. GameStop Corp., the world’s No. 1 video game retailer, said last week that advance orders sold out and it has nearly 500,000 people on its Wii U waitlist.


Even so, it’s a “very, very crowded space in consumer electronics” this holiday season, notes Ben Bajarin, a principal analyst at Creative Strategies who covers gaming.


Apple‘s duo of iPads, the full-size model and a smaller version called the Mini, will be competing for shoppers’ attention. Not to be outdone, Amazon.com Inc. has launched a trove of Kindle tablets and e-readers in time for the holidays. These range from the Paperwhite, a touch-screen e-reader, to the Kindle Fire HD, which features a color screen and can work with a cellular data plan. Then there are the new laptops and cheaper, thinner “ultrabooks” featuring Microsoft’s new Windows 8 operating system —not to mention smartphones from Apple Inc., Samsung and other manufacturers.


Nintendo has to be a cut above the noise here,” Bajarin says.


The Wii U is the first major game console to launch in years, but in some ways Nintendo is merely catching up with the HD trend. Sony Corp. and Microsoft Corp. began selling their own powerful, high-definition consoles six and seven years ago, respectively. Both Sony and Microsoft are expected to unveil new game consoles in 2013.


Baird analyst Colin Sebastian thinks the question is not how well the Wii U will do during the holidays, but how it will fare three and six months later.


Gaming has changed significantly in the past six years, especially when it comes to the type of mass-audience experiences that serve as Nintendo‘s bread and butter. Zynga Inc., the online game company behind Facebook games such as “FarmVille” and “Texas HoldEm Poker,” was founded in 2007. The first “Angry Birds” game, that addictive, quirky distraction that has players flinging cartoon birds at structures hiding smug green pigs launched in late 2009. The first iPad, of course, came out in 2010 —three years after the first iPhone.


Fils-Aime acknowledges that Nintendo competes in the broad entertainment landscape, “minute-by-minute,” for consumers’ time.


“That’s true today and that was true 20 years ago,” he says, adding that Nintendo‘s challenge is communicating to people “what is so fun and appealing about the new system.”


Analysts expect Wii U sales to be brisk over the holidays. Nintendo‘s loyal —some would say, fanatical— fan base has been placing advance orders and will likely keep the systems flying off store shelves well into next year. The classic Mario and Zelda games are a huge part of the appeal, since they can’t be played on any gaming system but Nintendo‘s.


Research firm IHS iSuppli estimates that by the end of the year, people will have snapped up 3.5 million Wii U consoles worldwide, compared with 3.1 million Wii units in the same period through the end of 2006.


After the Wii went on sale, shortages persisted for months. Stores were met with long lines of shoppers trying to get their hands on a Wii as late as July 2007, more than seven months after the system’s launch.


Though supply constraints are expected this time around, Fils-Aime says Nintendo will have more hardware available in the Americas than it had for the Wii’s initial months on the market. The company says it will also replenish retailers more frequently than it did six years ago.


An initial sell-out doesn’t mean the Wii U will be successful over the long term, IHS notes, citing its estimate that the Wii U won’t match the Wii’s sales over time.


Bajarin believes it’s going to take “a little bit of time” for the Wii U’s dual-screen gaming concept to sink in with people. If it proves popular, Nintendo could see even more competition at its hands.


“Technologically, it’s not a leap of the imagination to see Apple, Google, Microsoft do something like this,” he says.


____


Follow Barbara Ortutay on Twitter at https://twitter.com/BarbaraOrtutay


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Questions of Blame Linger 34 Years After Jonestown
















From the age of 13, Leslie Wagner Wilson had been indoctrinated in the California-based Peoples Temple, led by the charismatic Jim Jones, whose mission was to foster racial harmony and help the poor.


But on Nov. 18, 1978, she and a handful of church members fought their way through thick jungle in the South American country of Guyana, escaping a utopian society gone wrong where followers were starved, beaten and held prisoner in the Jonestown compound.













She walked 30 miles to safety with her 3-year-old son, Jakari, strapped to her back and a smaller group of defectors. But just hours later, the mother, sister and brother and husband she left behind were dead.


“I was so scared,” said Wagner, now 55. “We exchanged phone numbers in case we died. I was prepared to die. I never thought I would see my 21st birthday.”


Today, on the 34th anniversary, Wilson said it’s important to remember the California-based Peoples Temple Jonestown massacre, especially the survivors who have wrestled with their consciences for decades.


PHOTOS: Jonestown Massacre Anniversary


Nine members of her family were among the 918 Americans who died that day, 909 of them ordered by Jones to drink cyanide-laced Kool-Aid in the largest ritual suicide in history.


Her husband, Joe Wilson, was one of Jones’ top lieutenants who helped assassinate congressman Leo Ryan and his press crew when they tried to free church members who were being held against their will.


After arriving back in the United States, Wilson said she “went through hell” — three failed marriages, drug use and suicidal thoughts she describes in her 2009 book, “Slavery of Faith.”


“I was like Humpty Dumpty, but you couldn’t put me back together again,” she said.


Survivors, many of them African-American like Wilson, say they felt guilt and shame and faced the most agonizing question surrounding the nation’s single largest loss of life until 9/11: Was it suicide or murder?


Full Coverage: Jonestown Massacre


In the now-famous “death tape,” supporters clapped and babies cried as Jones instructed families to kill the elderly first, then the youngest in protest against capitalism and racism. Mothers poisoned 246 children before taking their own lives.


“We really can’t understand the Peoples Temple without looking at the historical time period when it arose,” said Rebecca Moore, a professor of religious studies at San Diego State University.


“With the liberation movements of the ’60s and ’70s, the collapse of the black-power movement, the Peoples Temple was the main institution in the San Francisco Bay area that promoted a message of integration and racial equality.”


Moore lost her two sisters and her nephew, the son of Jim Jones. “They were hardcore believers,” she said of her siblings.


Jim Jones, who was white, came from a “wrong side of the tracks,” poor background in Indiana where in the 1950s he became known as a charismatic preacher with an affinity for African-Americans.


“A number of survivors, including those who defected, believe to this day he had paranormal abilities,” said Moore, who met him years later. “He could heal them and read their minds.”


In the 1960s, Jones moved to San Francisco, where at the height of the Peoples Temple there were about 5,000 members.


WATCH: A Look Back at Jonestown Massacre


“They wanted my parents to join,” she said. “Like most outsiders, we didn’t have any idea what was happening outside closed doors.”


Jones ingratiated himself with celebrities and politicians, mobilizing voters to help elect Mayor George Moscone in 1975 and becoming chairman of the city’s housing authority.


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Medics: Israel strike intended for militants kills 11 Gaza civilians

GAZA CITY, Gaza Strip (AP) — An Israeli missile flattened a two-story house in a residential neighborhood of Gaza City on Sunday, killing at least 11 civilians, mostly women and children, Palestinian medical officials said, as Israel expanded a military offensive to target homes of wanted militants.

The attack, which Israel said targeted a militant, was the single deadliest incident of the five-day-old Israeli operation and hiked a toll Sunday that was already the highest number of civilians killed in one day, according to Gaza medics. The bloodshed is likely to raise international pressure for a cease-fire, with Egypt taking the leading role in mediating between Israel and Hamas.

President Barack Obama said he had been in touch with the leaders of Israel, Egypt, and Turkey in an effort to halt the fighting. "We're going to have to see what kind of progress we can make in the next 24, 36, 48 hours," he said.

Obama cautioned against a potential Israeli ground invasion into Gaza, warning it could only deepen its death toll. At the same time, he blamed Palestinian militants for starting the round of fighting by raining rockets onto Israel, and he defended Israel's right to defend itself.

"Israel has every right to expect that it does not have missiles fired into its territory," Obama said in Thailand at the start of a three-nation tour in Asia.

An Israeli envoy arrived in Cairo on Sunday and held talks with Egyptian officials on a ceasefire, according to Egyptian security officials and Nabil Shaath, a top aide of Palestinian President Mahmoud Abbas who was in the Egyptian capital.

But Israel and Gaza's militant Hamas rulers remain far apart on any terms for a halt in the bloodshed, which has killed 70 Palestinians — including 36 civilians, according to Gaza health officials — and three Israeli civilians.

Hamas is linking a truce deal to a complete lifting of the border blockade on Gaza imposed since Islamists seized the territory by force. Hamas also seeks Israeli guarantees to halt targeted killings of its leaders and military commanders. Israeli officials reject such demands. They say they are not interested in a "timeout," and want firm guarantees that militant rocket fire into Israel will finally end. Past ceasefires have been short lived.

As the offensive moved forward, Israel found itself at a crossroads — on the cusp of launching a ground offensive into Gaza to strike an even tougher blow against Hamas, or pursuing Egyptian-led truce efforts.

"The Israeli military is prepared to significantly expand the operation," Israeli Prime Minister Benjamin Netanyahu declared at the start of the weekly Cabinet meeting.

At the same time, Gaza militants continued their barrage of rocket fire at Israel, firing more than 100, including two at Tel Aviv. More than 10 Israelis were injured by shrapnel, two moderately, according to police spokesman Mickey Rosenfeld. Israel's "Iron Dome" rocket-defense system shot down at least 30 rockets, including the ones aimed at Tel Aviv.

Israel's announcement Sunday that it was widening its campaign to target homes of militants appeared to mark a new and risky phase of the operation, given the likelihood of civilian casualties in the densely populated territory of 1.5 million Palestinians. Israel launched the offensive Wednesday in a bid to end months of intensifying rocket fire from the Hamas-ruled Gaza Strip.

The day's deadliest strike hit the home of the Daloo family in Gaza City, reducing the structure to rubble.

Frantic rescuers pulled the bodies of several children from the ruins of the house, including a toddler and a 5-year-old, as survivors and bystanders screamed in grief. Later, the bodies of the children were laid out in the morgue of Gaza City's Shifa Hospital.

Among the 11 dead were four small children and five women, including an 80-year-old, Gaza health official Ashraf al-Kidra said.

Israeli military spokesman Brig Gen. Yoav Mordechai told Channel 2 TV that the Israeli navy had targeted the building and killed a "global jihad" militant.

"The targets are exact," Mordechai said. "Every (Israeli) missile has an address."

He said the army would continue its operation "as if there were no (cease-fire) talks in Egypt."

The presence of a militant in the house could not be verified. Al-Kidra said the two adult men killed in the strike were civilians.

Sami Abu Zuhri, a Hamas spokesman, said that "the Israeli people will pay the price" for the killing of civilians. One of the rocket attacks targeting Tel Aviv came soon after the strike on the Daloo home.

More than a dozen homes of Hamas commanders or families linked to Hamas were struck on Sunday. Though most were empty — their inhabitants having fled to shelter — at least three still had families in them. Al-Kidra said 19 of the 24 people killed Sunday were civilians, mostly women and children.

Israeli Vice Premier Moshe Yaalon said civilian casualties are inevitable.

"You can't avoid collateral damage if they position the rockets in densely populated areas, in mosques, school yards. We shouldn't be blamed for the outcome," he said.

Israel also struck two high-rise buildings housing media outlets, damaging the top floor offices of the Hamas TV station, Al Aqsa, and a Lebanese-based broadcaster, Al Quds TV, seen as sympathetic to the Islamists. Six Palestinian journalists were wounded, including one who lost a leg, a Gaza press association said.

Foreign broadcasters, including British, German and Italian TV outlets, also had offices in the high-rises.

Two missiles made a direct hit on Al Aqsa TV's 15th floor offices, said Bassem Madhoun, an employee of Dubai TV, which has offices in the same building.

Building windows were blown out and glass shards and debris were scattered on the street below. Some of the journalists who had been inside the building at the time took cover in the entrance hallway.

Lt. Col. Avital Leibovich, an Israeli military spokeswoman, said the strikes targeted Hamas communications equipment on the buildings' rooftops. She accused the group of using journalists as "human shields," and urged journalists to stay clear of Hamas bases and facilities.

The repeated militant rocket fire on Tel Aviv and a volley fired Friday toward Jerusalem have significantly escalated the hostilities by widening the militants' rocket range and putting 3.5 million Israelis, or half the country's population, within reach. The attempt to strike Jerusalem also has symbolic resonance because both Israel and the Palestinians claim the holy city for a capital.

Israeli radio stations repeatedly interrupted their broadcasts to air "Code Red" alerts warning of impending rocket strikes. In the southern city of Ashkelon, rocket fire damaged a residential building, punching a hole in the ceiling and riddling the facade with shrapnel.

With fighting showing no signs of slowing, international attempts to broker a ceasefire continued.

Nabil Shaath, an aide to Palestinian President Mahmoud Abbas who was in Cairo, confirmed that the Israeli envoy had arrived in Egypt for talks, saying there are "serious attempts to reach a ceasefire." There was no immediate Israeli confirmation.

Hamas' prime minister, Ismail Haniyeh, spoke to Egyptian President Mohammed Morsi. He told the Egyptian leader he supports such efforts, provided Hamas receives "guarantees that will prevent any future aggression" by Israel, his office said in a statement.

Morsi over the weekend hosted talks with Hamas' supreme leader, as well as leaders from Hamas allies Turkey and Qatar. He also held contacts with Western leaders.

French Foreign Minister Laurent Fabius visited Israel on Sunday to offer his country's help toward forging an "immediate ceasefire," the French government said.

Meeting with Fabius, Israeli Foreign Minister Avigdor Lieberman thanked him for "France's efforts to prevent casualties" but said "the moment that all the terror organizations announce a ceasefire, we can consider all the ideas that French foreign minister and other friends are raising."

___

Aron Heller contributed reporting from Beersheba.

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Israel, Gaza fighting rages on as Egypt seeks truce
















GAZA/JERUSALEM (Reuters) – Israel bombed Palestinian militant targets in the Gaza Strip from air and sea for a fifth straight day on Sunday, preparing for a possible ground invasion though Egypt saw “some indications” of a truce ahead.


Militant rocket fire into Israel subsided during the night but resumed in the morning with three rockets fired at the nearby coastal city of Ashkelon, the Israeli army said.













“As of now we have struck more than 1,000 targets, so Hamas should do the math over whether it is or isn’t worth it to cease fire,” Israeli Vice Prime Minister Moshe Yaalon, over Twitter.


“If there is quiet in the South and no rockets and missiles are fired at Israel’s citizens nor terrorist attacks engineered from the Gaza Strip, we will not attack.”


Forty-eight Palestinians, about half of them civilians, including 13 children, have been killed in Israel’s raids, Palestinian officials said. More than 500 rockets fired from Gaza have hit Israel, killing three people and injuring dozens.


Israel unleashed intensive air strikes on Wednesday, killing the commander of the Hamas Islamist group that governs Gaza and spurns peace with the Jewish state. Israel’s declared goal is to deplete Gaza arsenals and press Hamas into stopping cross-border rocket fire that has plagued Israeli border towns for years.


Air raids continued past midnight into Sunday, with warships shelling from the sea. A Gaza City media building was hit, witnesses said, wounding 6 journalists and damaging facilities belonging to Hamas’s Al-Aqsa TV as well as Britain’s Sky News.


An Israeli military spokeswoman said the strike had targeted a rooftop “transmission antenna used by Hamas to carry out terror activity”.


Two other predawn attacks on houses in the Jabalya refugee camp killed two children and wounded 13 other people, medical officials said.


These attacks followed a defiant statement by Hamas military spokesman Abu Ubaida, who told a news conference: “This round of confrontation will not be the last against the Zionist enemy and it is only the beginning.”


The masked gunman dressed in military fatigues insisted that despite Israel’s blows Hamas “is still strong enough to destroy the enemy”.


An Israeli attack on Saturday destroyed the house of a Hamas commander near the Egyptian border.


Casualties there were averted however, because Israel had fired non-exploding missiles at the building beforehand from a drone, which the militant’s family understood as a warning to flee, and thus their lives were spared, witnesses said.


Israeli aircraft also bombed Hamas government buildings in Gaza on Saturday, including the offices of Prime Minister Ismail Haniyeh and a police headquarters.


Among those killed in air strikes on Gaza on Saturday were at least four suspected militants riding motorcycles, and several civilians including a 30-year-old woman.


ISRAELI SCHOOLS SHUT


Israel said it would keep schools in its south shut on Sunday as a precaution to avoid casualties from rocket strikes reaching as far as Tel Aviv and Jerusalem in the past few days.


Israel’s “Iron Dome” missile interceptor system destroyed in mid-air a rocket fired by Gaza militants at Tel Aviv on Saturday, where volleyball games on the beach front came to an abrupt halt as air-raid sirens sounded.


Hamas claimed responsibility for the attack on Tel Aviv, the third against the city since Wednesday. It said it had fired an Iranian-designed Fajr-5 at the coastal metropolis, some 70 km (43 miles) north of Gaza.


In the Israeli Mediterranean port of Ashdod, a rocket ripped into several balconies. Police said five people were hurt.


Israel’s operation has drawn Western support for what U.S. and European leaders have called Israel’s right to self-defense, but there was also a growing number of calls from world leaders to seek an end to the violence.


British Prime Minister David Cameron “expressed concern over the risk of the conflict escalating further and the danger of further civilian casualties on both sides,” in a conversation with Israeli Prime Minister Benjamin Netanyahu, a spokesperson for Cameron said.


London was “putting pressure on both sides to de-escalate,” the spokesman said, adding that Cameron had urged Netanyahu “to do everything possible to bring the conflict to an end.”


Ben Rhodes, a deputy national security adviser to President Barack Obama, said the United States would like to see the conflict resolved through “de-escalation” and diplomacy, but also believes Israel has a right to self-defense.


Egyptian President Mohamed Mursi said in Cairo as his security deputies sought to broker a truce with Hamas leaders, that “there are some indications that there is a possibility of a ceasefire soon, but we do not yet have firm guarantees.”


Egypt has mediated previous ceasefire deals between Israel and Hamas, the latest of which unraveled with recent violence.


A Palestinian official told Reuters the truce discussions would continue in Cairo on Sunday, saying “there is hope,” but it was too early to say whether the efforts would succeed.


In Jerusalem, an Israeli official declined to comment on the negotiations. Military commanders said Israel was prepared to fight on to achieve a goal of halting rocket fire from Gaza, which has plagued Israeli towns since late 2000, when failed peace talks led to the outbreak of a Palestinian uprising.


Diplomats at the United Nations said Secretary-General Ban Ki-moon is expected to visit Israel and Egypt in the coming week to push for an end to the fighting.


POSSIBLE GROUND OFFENSIVE


Israel, with tanks and artillery positioned along the frontier, said it was still weighing a ground offensive.


Israeli cabinet ministers decided on Friday to more than double the current reserve troop quota set for the Gaza offensive to 75,000 and around 16,000 reservists have already been called up.


Asked by reporters whether a ground operation was possible, Major-General Tal Russo, commander of the Israeli forces on the Gaza frontier, said: “Definitely.”


“We have a plan. … It will take time. We need to have patience. It won’t be a day or two,” he added.


A possible move into the densely populated Gaza Strip and the risk of major casualties it brings would be a significant gamble for Netanyahu, favored to win a January election.


The last Gaza war, a three-week Israeli blitz and invasion over the New Year of 2008-09, killed 1,400 Palestinians, mostly civilians. Thirteen Israelis died in the conflict.


But the Gaza conflagration has stirred the pot of a Middle East already boiling from two years of Arab revolution and a civil war in Syria that threatens to spread beyond its borders.


One major change has been the election of an Islamist government in Cairo that is allied with Hamas, potentially narrowing Israel’s maneuvering room in confronting the Palestinian group. Israel and Egypt made peace in 1979.


(Writing by Allyn Fisher-Ilan; Editing by Douglas Hamilton)


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‘Twilight’ finale dawns with $141.3M weekend
















LOS ANGELES (AP) — The sun has set on the “Twilight” franchise with one last blockbuster opening for the supernatural romance.


The Twilight Saga: Breaking Dawn — Part 2″ sucked up $ 141.3 million domestically over opening weekend and $ 199.6 million more overseas for a worldwide debut of $ 340.9 million.













The finale ranks eighth on the list of all-time domestic debuts, and leaves “Twilight” with three of the top-10 openings, joining 2009′s “New Moon” (No. 7 with $ 142.8 million) and last year’s “Breaking Dawn — Part 1″ (No. 9 with $ 138.1 million).


Last May’s “The Avengers” is No. 1 with $ 207.4 million. “Batman” is the only other franchise with more than one top-10 opening: last July’s “The Dark Knight Rises” (No. 3 with $ 160.9 million) and 2008′s “The Dark Knight” (No. 4 with $ 158.4 million).


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How new Kindle Fire compares with rivals
















Amazon.com Inc. started shipping a larger version of its Kindle Fire HD tablet computer on Thursday. Here’s a look at how it compares with the iPad and other tablets with similar screens.


Amazon.com Inc.‘s Kindle Fire HD 8.9″:













— Price: $ 299 for 16 gigabytes of storage, $ 369 for 32 GB.


Screen size: 8.9 inches diagonally


— Screen resolution: 1920 by 1200 pixels, at 254 pixels per inch.


— Weight: 1.25 pounds.


— Cameras: Front-facing camera.


— Battery life: 10 hours.


— Operating system: Modified version of Google‘s Android


Pros: Cheap and portable. Convenient access to Amazon store. Dolby audio. Available with access to fast 4G wireless broadband networks, for $ 499 (starts shipping next Tuesday).


Cons: Small selection of third-party applications available from Amazon. No rear camera for taking video and photos.


Apple Inc.‘s iPad:


— Price: Starts at $ 499 for 16 gigabytes of storage, goes up to $ 699 for 64 gigabytes, more for versions with cellular data access. (Apple still sells the older, iPad 2 for $ 399.)


Screen size: 9.7 inches diagonally


— Screen resolution: 2048 by 1536 pixels, at 264 pixels per inch.


— Weight: 1.44 pounds


— Cameras: 5-megapixel camera on back and a low-resolution camera on front, for videoconferencing


— Battery life: 10 hours.


— Operating system: Apple’s iOS


Pros: Unmatched access to third-party applications, high-quality Apple software and the iTunes store. Widest range of cases and accessories available. Available with access to fast 4G wireless broadband networks, starting at $ 629.


Cons: Data storage cannot be expanded with memory cards.


Google Inc.’s Nexus 10


— Price: $ 399 for 16 gigabytes of storage, $ 499 for 32 GB


Screen size: 10.1 inches diagonally


— Screen resolution: 2560 by 1600 pixels, at 300 pixels per inch.


— Weight: 1.33 pounds.


— Cameras: 5-megapixel camera on back and a low-resolution camera on front, for videoconferencing


— Battery life: 9 hours for video playback, 7 hours for Web browsing.


— Operating system: Google‘s Android


Pros: Access to a variety of games, utilities and other software for Android devices, though not as extensive as apps available for iPad. Longer, narrower screen better suited to movies. Cheaper than newest full-size iPad.


Cons: Integrates with Google Play store, which is still new and isn’t as robust as Apple or Amazon’s stores. Data storage cannot be expanded with memory cards. No option for cellular wireless broadband.


Samsung Electronic Co.’s Galaxy Tab 2 10.1:


— Price: $ 399 for 16 gigabytes of storage


Screen size: 10.1 inches diagonally


— Screen resolution: 1280 by 800 pixels, 149 pixels per inch


— Weight: 1.24 pounds


— Cameras: low-resolution front camera, 3-megapixel back.


— Battery life: 11 hours.


— Operating system: Google‘s Android


Pros: Storage is expandable with microSD memory cards. Can act as a universal remote control for an entertainment center. Option for wireless broadband starting in November.


Cons: Selection of third-party applications not as good as iPad’s, but wider than Kindle. Screen resolution lower than iPad’s.


Samsung Electronic Co.’s Galaxy Note 10.1:


— Price: $ 499 for 16 gigabytes of storage, $ 549 for 32 GB


Screen size: 10.1 inches diagonally


— Screen resolution: 1280 by 800 pixels, 149 pixels per inch


— Weight: 1.3 pounds


— Cameras: low-resolution front camera, 5-megapixel back.


— Battery life: 9 hours.


— Operating system: Google‘s Android


Pros: Comes with a pen, for jotting notes and drawing on the screen. Slightly thinner and lighter than an iPad. Longer, narrower screen better suited to movies. Storage is expandable with microSD memory cards. Can act as a universal remote control for an entertainment center.


Cons: Selection of third-party applications not as good as iPad’s, but wider than Kindle. Screen resolution lower than iPad’s. No option for wireless broadband. Pen sensor slightly shortens battery life.


Barnes & Noble Inc.’s Nook HD+


— Price: $ 269 for 16 gigabytes of storage; $ 299 for 32 GB


Screen size: 9 inches diagonally


— Screen resolution: 1920 x 1280 pixels, 256 pixels per inch


— Weight: 1.14 pounds


— Cameras: None.


— Battery life: 10 hours of reading, 9 hours of video


— Operating system: Modified version of Google‘s Android


Pros: Cheap and portable. Storage is expandable with microSD memory cards. Easy access to Barnes & Noble book store.


Cons: Selection of third-party applications is small. Barnes & Noble lacks wide range of content. Lacks cameras and option for wireless broadband.


Microsoft Corp.’s Surface:


— Price: $ 499 for 32 gigabytes of storage, $ 100 extra for keyboard cover. $ 699 for 64 GB version, includes keyboard cover.


Screen size: 10.6 inches diagonally


— Screen resolution: 1366 by 768 pixels, 148 pixels per inch


— Weight: 1.5 pounds.


— Cameras: Front and back cameras


— Battery life: 8 hours.


— Operating system: Microsoft’s Windows RT.


Pros: Storage can be expanded with microSD memory cards. Comes with free Microsoft Office software. Models running full version of Windows 8 coming soon, offering compatibility with programs available for traditional Windows computers.


Cons: Operating system lacks good track record on tablets. Selection of tablet-adapted third-party applications small. No option for wireless broadband.


Gadgets News Headlines – Yahoo! News



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