Factores “irracionales” elevarían acceso a radioterapia al final de la vida

NUEVA YORK (Reuters Health) – Los costos y otros factores no

médicos impulsarían el acceso a la radioterapia para aliviar los

síntomas del cáncer en los últimos días de vida, indicó un

reciente estudio.

Un equipo de Estados Unidos que analizó las prestaciones de

Medicare durante casi una década descubrió que una pequeña

proporción de los pacientes oncológicos había recibido

radioterapia en sus últimos 30 días de vida, pero a uno de cada

cinco de ellos se le administró más dosis que las recomendadas.

“El uso de la radioterapia fue bajo, pero el porcentaje de

pacientes que recibió el tratamiento durante 10 días o más fue

alto”, dijo la autora principal del estudio, doctora Ashleigh

Guadagnolo, del Centro de Oncología MD Anderson de University of

Texas.

Guadagnolo se negó a decir cuántas sesiones de radioterapia

eran adecuadas, pero un oncólogo opinó que el estudio demuestra

que existe un uso excesivo e irracional de la terapia.

El doctor Otis Brawley, jefe médico de la Sociedad

Estadounidense del Cáncer, dijo que aunque es razonable el uso

de radioterapia con fines paliativos, 10 o más sesiones durante

el último mes de vida de un paciente son “recursos

desperdiciados”.

El problema, según dijo Brawley a Reuters Health, era que

los pacientes que accedían a la radioterapia recibían demasiadas

dosis y muchas personas que se podrían haber beneficiado con el

tratamiento no lo recibían.

“El estudio demuestra que existe bastante irracionalidad en

cómo tratamos a los pacientes”, dijo Brawley, que no participó

del estudio.

Los autores aseguran que el estudio, publicado en el Journal

of Clinical Oncology, es el primero que analizó cómo los médicos

utilizan la radioterapia en los pacientes terminales.

Para eso, evaluaron a más de 202.000 prestaciones de

Medicare a pacientes mayores de 65 años que murieron por los

cinco cánceres más comunes de Estados Unidos (pulmonar, mamario,

prostático, colorrectal y pancreático) entre el 2000 y el 2007.

Asumieron que la mayoría de los tratamientos del último mes

de vida eran paliativos.

Unos 15.000 pacientes (más del 7 por ciento) recibieron

radioterapia en el último mes de vida. El 18 por ciento de ellos

dedicó más de 10 de esos 30 días a recibir el tratamiento.

Los factores asociados con la administración de 10 o más

sesiones de radioterapia fueron ser blancos, no recibir atención

cuidados paliativos y ser paciente de un centro de tratamiento

oncológico independiente en lugar de un hospital universitario.

Los costos de la radioterapia acumularon unos 3453 dólares

adicionales por paciente. En los que recibían cuidados

paliativos y radioterapia, el costo combinado fue de 2.675

dólares menos que en los casos que no recibían radioterapia ni

cuidados paliativos.

Medicare cubre los costos de los pacientes que optan por

cuidados paliativos con un valor diario menor que el de la

radioterapia. Y una reducción del uso de la radioterapia entre

el 2000 y el 2007 coincide con un aumento del uso de los

cuidados paliativos.

“El mensaje del estudio es que no vamos a ahorrar dinero si

renunciamos a la radioterapia y, de hecho, es un tratamiento que

probablemente esté subutilizado”, dijo el doctor Stephen Lutz,

radiólogo del Centro Regional de Oncología de Blanchard Valley,

Ohio, y que no participó del estudio.

El doctor Michael Steinberg, oncólogo radiólogo de la

Escuela de Medicina David Geffen de UCLA, consideró que hay que

poner los costos en contexto. Muchos de sus pacientes no quieren

usar narcóticos o esteroides con efectos secundarios

desagradables.

Por otro lado, la radioterapia para aliviar los síntomas del

cáncer tiene límites porque sus efectos analgésicos demoran

días, mientras que los narcóticos actúan en horas, según indicó

el doctor Stephen Gripp, oncólogo radiólogo del Hospital

Universitario de Düsseldorf de la Universidad Heinrich Heine.

Además, está la incomodidad: “La radioterapia (el traslado,

la ubicación en la camilla y la espera) es molesta y hasta

dolorosa para los pacientes terminales”, dijo Gripp por e-mail.

FUENTE: Journal of Clinical Oncology, 2012

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Shopping like a Democrat, or Republican

Black Friday: It’s a day in which most American citizens put aside politics in pursuit of shopping bargains. But in Washington we can sort almost anything in the US in terms of partisan proclivity, and temples of commerce are no exception. Want to know whether the big box store where you’re waiting in line leans Democratic or Republican? The folks at the invaluable Center for Responsive Politics have compiled a handy guide based on campaign contributions.

Toys R Us, for instance, seems a solidly blue store. Self-identified employees of the store gave $39,000 to political candidates in the 2012 election cycle, and $36,000 of that went to Democrats.

Dig into the numbers though, and you’ll see that Toys R Us is not so much Democratic as Klobucharian. All that $36,000 went to one candidate, Sen. Amy Klobuchar (D) of Minnesota. (That’s kind of odd, isn’t it? The retailer’s corporate headquarters are in New Jersey.) Other than that, Mitt Romney got $1,750 from Toys R Us workers. President Obama got zilch, according to CRP’s Open Secrets blog.

Are you a smart shopper? Take our quiz to find out.

Macy’s employees, on the other hand, were big Obama fans. They donated $28,870 to the president’s reelection campaign, as opposed to $16,390 to GOP nominee Mr. Romney. This Democratic lean was counterbalanced to a certain extent by the store’s corporate political action committee, however. (Toys R Us doesn’t appear to have a central PAC.) Macy’s PAC gave $12,000 to Republicans, and $4,000 to Democrats.

Best Buy seems more of a red retailer. Both it s employees and the company’s PAC had a slight preference for Republicans, according to CRP. Store employees gave $17,662 to Democrats and $22,419 to the GOP, for instance.

But there’s Senator Klobuchar again – she’s the individual candidate to whom Best Buy-related entities donated the most. Yes, she’s chairperson of a Senate Commerce subcommittee on competitiveness, so that might have something to do with it. Maybe the money comes due to her political affiliation with Minnesota’s Gov. Mark Dayton? Governor Dayton is the scion of the Dayton retail empire, which among other things founded Target.

Hmm, we see that Target leaned GOP as well, so maybe that theory isn’t right. Of the store’s $483,777 in individual and PAC contributions, the majority went to the right side of the aisle, according to Open Secrets. And the top recipient is not Sen. Klobuchar, but Rep. Eric Paulsen – a Twin Cities Republican.

Then there’s Wal-Mart. Sam Walton’s empire has a major presence in politics compared with its big box brethren. Its employees and PAC gave $2.7 million to candidates in the 2012 cycle.

Employee donations skewed Republican – which might not be surprising, since Wal-Mart is a big employer in the exurban/rural areas where Romney ran strongly. The firm’s PAC gave roughly equal amounts to candidates of both parties, however. That might be because Wal-Mart lobbies hard in Washington and needs relationships on both sides of the aisle.

In fact, Wal-Mart has spent more than $12 million on lobbyists in the past two years. It has its own Washington office, with 15 employees, and pays hundreds of thousands of dollars in retainers to such top outside lobby firms as Patton Boggs and the Podesta Group.

The firm’s No. 1 issue is sales taxes – specifically, getting states to slap sales taxes on web retail. Rep. Steven Womack (R) of Arkansas, whose district includes Wal-Mart’s Bentonville headquarters, has long pushed national legislation that would force out-of-state online retailers to collect sales tax. He’s one of the top recipients of Wal-Mart campaign contributions.

“The traditional brick and mortar retailer is not asking for special treatment. They know they have to compete against a number of consumer criterion. What they don’t want – and should not compete against – is a disadvantage based on a tax loophole,” said Congressman Womack earlier this year during a Judiciary Committee hearing on the issue.

Are you a smart shopper? Take our quiz to find out.

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Canada wants to balance budget in 2015, may invest to grow economy

TORONTO (Reuters) – Canadian Finance Minister Jim Flaherty said on Thursday he is aiming to wipe out the federal budget deficit by 2015, in time for the next election, but cautioned the Conservative government would be flexible with that target if the economy soured.

Canada’s fiscal shortfall of 1.4 percent of gross domestic product is tiny compared to that of the United States and some other major economies. But it is a sore point for policy makers in a country that ran an 11-year string of surpluses prior to the global financial crisis.

“It remains our intention to balance the budget during this session of Parliament,” Flaherty said in the prepared text of a speech he was delivering in Toronto.

“Although we are prepared to be flexible and pragmatic should circumstances warrant — our plan is to stick to our plan: balanced budgets and low taxes,” he said.

The parliamentary session is due to end in October 2015, the same month a federal election is scheduled.

Last week, Flaherty presented a fiscal update that showed a return to balanced budgets in 2016-17, including a C$ 3 billion ($ 3 billion) contingency cushion in case the global economy worsens.

Three days later, amid criticism, both he and Prime Minister Stephen Harper were at pains to say they still intended to end the red ink by 2015.

Flaherty said on Thursday the next budget in early 2013 would continue with what he called “pro-growth initiatives” of the past year, giving as examples previously-announced initiatives to strengthen the venture capital system and to provide skills training for the work force.

He hinted there would be “much more,” without giving details.

The plan will not include tax hikes and the government will continue to look for ways to cut spending, he said.

“From the experience of Greece and beyond, Canadians know that the consequences of unsustainable finances are all too painful,” he said.

($ 1 = $ 1 Canadian)

(Writing by Louise Egan; editing by Andrew Hay)

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Pussy Riot protester alone in cell after inmate tension

MOSCOW (Reuters) – Jailed Pussy Riot punk protester Maria Alyokhina has been moved to a single-person cell for her own protection because of tension with other prisoners, her lawyer and Russia‘s federal penitentiary service said on Friday.

Alyokhina, 24, is serving a two-year sentence for a raucous protest against President Vladimir Putin in Moscow‘s main Russian Orthodox cathedral. Activists said her trial, and that of two band mates, was part of a crackdown on dissent.

“There was a conflict” between Alyokhina and other inmates and “she was transferred to a individual cell,” her lawyer Irina Khrunova said by telephone. She said it was not yet clear what caused the conflict.

Prison authorities said Alyokhina was moved at her own request.

“Some tensions arose in relationships and, apparently to prevent this situation from escalating, she decided to submit a request to the prison leadership and they moved her to a one-person cell,” a federal prison service spokeswoman said.

The spokeswoman dismissed Russian media reports Alyokhina argued with inmates over religion at the Ural Mountains prison about 1,150 km (715 miles) northeast of Moscow. Pussy Riot’s protest offended many members of Russia’s Orthodox Church.

The spokeswoman also said she had no information regarding a report on the tabloid-style Life News website that Alyokhina had received violent threats from cell mates.

Alyokhina’s main meal is taken to her cell and she is accompanied by a guard when she leaves it, the spokeswoman said.

Alyokhina and two band mates were convicted in August of hooliganism motivated by religious hatred for their “punk prayer”, which the dominant Russian Orthodox Church has cast as part of a concerted attack on the church and the faithful.

The women said the protest, in which they burst into Christ the Saviour Cathedral and called on the Virgin Mary to rid Russia of Putin, was not motivated by hatred and was meant to mock the church leadership’s support for the longtime leader.

Putin, a former KGB officer who has cultivated close ties with the church over 13 years in power, has rejected criticism from the United States and European leaders who called the two-year sentences disproportionate.

Alyokhina, who has a young son, argued with the judge and cross-examined witnesses during her trial.

Her band mate Nadezhda Tolokonnikova, 23, is serving her sentence in a different prison. Yekaterina Samutsevich, 30, was freed last month when a court suspended her sentence on appeal.

(Additional reporting by Ludmila Danilova and Steve Gutterman; Writing by Nastassia Astrasheuskaya; editing by Jason Webb)

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Amazon Kindle Fire HD 8.9 is Good, But No iPad Killer [REVIEW]

Unboxing the Kindle Fire HD 8.9

Click here to view this gallery.

[More from Mashable: Apple Now Owns the iMessage Name]

Amazon expands its tablet sights with the bigger, more powerful Kindle Fire HD 8.9. Can it compete against Apple‘s iPad?

If there’s one company that deserves credit for reigniting the iPad competitor market, it’s Amazon. Despite some bugs and an overall blah design, its 7-inch Kindle Fire was the first Android tablet that made sense to consumers who gobbled it up to help the Fire grab 50% of the Android tablet market in just 6 months.

[More from Mashable: 9 Black Friday Deals For iPhone Owners]

That tablet essentially opened the flood gates for a new set of ever-more-powerful 7-inchers from, notably, Barnes & Noble and Google. All three companies have already updated their 7-inch offerings to more powerful components and higher-resolutions screens. They’re all still running Android, though Amazon and Barnes & Noble choose to hide the Google OS behind smarter and much more consumer-friendly interfaces.

All this led Apple to finally enter the mid-sized tablet space with the iPad Mini. It’s easily the best-looking tablet of the bunch, but also $ 120 more expensive than its nearest competitor.

The more interesting development, though, is Amazon‘s (and Barnes & Noble‘s) decision to go toe-to-toe with Apple’s full-size iPad and launch the Amazon Kindle Fire HD 8.9 (in 4G LTE and WiFi-only). The move is akin to a middle weight boxer putting on the pounds to take on the Heavyweight world champion. Amazon’s Kindle Fire HD is slightly smaller (the iPad is 9.7-inches), lighter (567g vs. 625g), cheaper ($ 369 for 32 GB model vs. $ 599 for the iPad 4th Gen — Amazon subsidizes with sleep-state ads, that I do not mind) and overall somewhat less powerful. In order to win the battle, the 8.9-inch Kindle Fire HD better be pretty nimble on its feet, while able to throw that all important knockout punch.

Short version of this story: the Kindle Fire HD 8.9 does some serious damage, but the iPad 4th Gen gets the decision and retains the tablet leader title.

The Kindle Fire HD 8.9 is by no means a failure. In many ways, it’s as good as the smaller Kindle Fire HD, but throughout my tests I noticed odd bugs and glitches (which should all be fixable by software) and a somewhat disturbing lack of power that’s especially obvious when you put the Fire HD 8.9 next to the iPad 4th Gen

What It Is

If you’ve never seen an iPad and someone handed you the Kindle Fire HD .9, you’d likely say its jet-black, soft-to-the-touch plastic body felt good in your hands and was more than effective at all the core tasks (reading, game playing, e-mail, web browsing).

Design-wise, the 8.9 device looks exactly like the 7-inch model, complete with the too-hard to find volume and power buttons. There are no other physical buttons on this device, but Amazon chooses to hide the few it has by making them the exact same color as the chassis and flush with the body. Every time I use the tablet I do the “where’s the damn button” dance, rotating the Kindle Fire HD round and round until I feel the buttons (since I can barely see them).

I have applauded Barnes & Noble for putting the physical “N” home button right on the face of their Nook HD. Bravo for having the guts to do this. Amazon apparently looks at Apple’s iPad home button and thinks to have anything similar would be seen as “copying” the Cupertino hardware giant, when instead they should realize that it works, consumers like it and tablets without it are at a distinct disadvantage.

Amazon’s interface has you make do with a virtual, slide-out home button that is always available. Problem is, I found times when it wasn’t available. When I played Spider-Man and Asphalt 7, the tiny little left-had bar would disappear and I couldn’t exit the game unless I hit the sleep/power button.

The rest of the Kindle Fire HD 8.9′s body is solid and unremarkable (if you read my Kindle fire HD 7 review, then you know exactly what to expect.). Like the iPad 4th Gen, the Kindle Fire HD 8.9 has a front-facing 720p-capable camera. It’s useful for capturing video, snapping 1 Megapixel images and, probably most important, Skype video chats. Skype has built a fairly sharp-looing Kindle Fire app, though the design doesn’t fully fit the larger 8.9-inch screen. Skype just updated its Android app for better tablet viewing and hopefully, we’ll see this update hit the Kindle Fire HD 8.9 as well.

The iPad also has an HD rear-facing camera. The Kindle fire HD 8.9 does not (Barnes & Noble leave out cameras altogether)

Not Packing a Punch

As a large-screen high-resolution tablet (though iPad’s 2048×1536 retina display beats it), the Kindle Fire HD 8.9 offers plenty of attractive screen real estate for web browsing, book and magazine reading and games. But the results can be mixed. Silk, Amazon‘s custom web browser, was occasionally less than responsive and games, though, they ran well, never looked half as good as they do on the considerably more expensive iPad 4.

Granted, you can’t always find the same high-quality immersive action games on both Android and iOS, but Asphalt 7 Heat is a notable exception and it throws the performance differences between the two tablets into stark contrast. Game play is equally responsive on both platforms: the Kindle Fire HD 8.9’s accelerometer reads my moves just as well as the iPad.

The graphics on the Kindle Fire HD, however, are reduced to blobs and blocks (palm trees without distinct leaves, buildings without discernible windows) . The iPad’s quad-core graphics simply overmatch the Kindle Fire. I have never, for example, seen an iPad draw the game as I was playing, as I did when I tried out The Amazing Spider-Man.

Additionally, I experienced more than my share of crashes with games and even magazine apps like Vanity Fair.

The Good

Not everyone, however, will compare the Kindle Fire HD 8.9 to the iPad. Some will see the $ 299 entry-level price point (for the 16 GB model) and appreciate the power, flexibility and utility of this device. Like all Fire’s before it, the Kindle Fire HD 8.9 makes it easy to consume mass quantities of content. Nearly every menu option: Games, Apps, Books, Music, Videos, Newsstand, puts you just one click away from shopping for fresh content. If you have an Amazon account (and who doesn’t) your desired book, music or movie is just a click away. Plus, you can still easily store any of it locally, and worry about running out of storage space, or in the cloud, and never worry about space or accessibility—you can get to that purchased Kindle content from any Kindle app or registered Amazon device.

Watching movies on the tablet is a pleasure. I streamed a couple through Amazon Prime; they looked good on the 1920 x 1200 screen and the Dolby Stereo speakers produced sharp, loud, almost room-filling sound—an impressive feat not even the iPad can match.

The Kindle Fire HD 8.9 also includes a mini-HDMI-out port, which prompted me to connect the tablet to my 47-inch LED HDTV so we could watch Disney’s Brave. Yes, I had to get up and tap on the Kindle screen each time I wanted to pause and restart the move, but otherwise, I was pretty impressed with how the Kindle handled the task.

Obviously I yearn for an Apple Airplay-like feature on Android tablets (rumor has it one is coming), but this is the next, best thing.

There isn’t a lot to say about the Kindle Fire HD 8.9-inch interface that I did not say in the Kindle Fire HD 7 review. I will note, however, that the increased real estate makes the trademark task carousel seem almost too big. Icons for everything from your recently played Spider-Man game to magazine apps, books and Web sites all sit side-by-side-by side. Some, like book covers, look gorgeous.

Others like a broken web-page link look stupid. Worse yet, none of them have labels, which can occasionally make it hard to identify which app or task you’re looking at. I’m just not sure this interface metaphor is sustainable.

Personally I prefer either the clean consistent look of iOS, or the uber-user friendly, family-oriented Nook HD profile-based one. Amazon may want to take a hard look at those and start over.

Staying Connected

The Kindle Fire HD 8.9 is also Amazon’s first cellular-based tablet. That fact puts it even more squarely in competition with the iPad (which obviously has always had 3G models and now offers blazing fast 4G LTE ones as well on all major carriers).

Amazon’s mobile broadband plans are a little more conservative, with just the AT&T 4G LTE option (the 32 GB 4G model that I tested lists for $ 499, which is still $ 224 less than a comparable iPad 4th Gen).

In my experience, the connectivity is superfast and fairly ubiquitous. Amazon‘s $ 49 (a year) flat fee plan is attractive, but with a cap of 250MB per month of data, it’s unlikely it will satisfy the most data-hungry users. If you do need more data, users can also get 3GB and 5GB data plans directly from AT&T on the device.

At press time, Amazon had not enabled streaming video over LTE. Having it sounds nice, but even with the most generous data plans, streaming video would eat it up faster than you can say, “I’m streaming Back to the Future in HD over 4G LTE on my Kindle fire HD!”

The reality for most users is that WiFi is plentiful and you’ll be hard pressed to find a spot where you can’t connect for free or a small one-off fee. It’s the reason Barnes & Noble’s line of HD Nooks do not include a cellular option.

Review continues after FreeTime Gallery

FreeTime

Kindle HD FreeTime Start

Click here to view this gallery.

Perhaps the best new addition to the Kindle Fire family is not a piece of hardware or new component, but the new FreeTime app. Amazon put a lot of loving care into this parental control interface, but almost mucks the whole thing up by hiding the tool under an app that you have to scroll down to (or search) to find. By contrast profiles and age and content controls are baked into the Barnes & Noble Nook HD in a way that makes them impossible to ignore.

Even so, once you do access FreeTime, I think you’ll be pleased with the level of control it gives you. I added test profiles for my two children and then hand-picked every app and piece of content they could access. I was also able to block broadband mobile and even set time limits for access to content and overall screen viewing time (on a per profile basis). The set-up is a bit wonky and it bizarrely switches between landscape and profile screens, but I still applaud the effort. It would make sense for Amazon to move FreeTime into a device set-up screen. If the user has no additional family members or kids using the device, they can easily skip it.

To Buy or Not to Buy

Amazon’s expansive content and shopping ecosystem has always been a strong draw and it’s just as good in this large screen tablet as it was in the very first Kindle Fire. Still, you have to compare it with the equally strong iOS ecosystem, which is no slouch in the content shopping department. Apple doesn’t connect you as seamlessly to physical products, but there’s nothing difficult about shopping on Amazon.com via your iPad. It’s also notable that tablet competitor Barnes & Noble has added movie and TV viewing, rental and purchase.

Ultimately, all of these tablets are offering more and more of the same content options, apps, and features. The decision will likely come down to price, app selection, interface and overall ease of use. The Amazon Kindle fire HD 8.9 scores well on all of these, but does not always lead.

For the price, it’s a great value, but I want Amazon to focus on hardware and interface design for the next big update. Then, they may get my full endorsement.

This story originally published on Mashable here.

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Do drunks have to go to the ER?

NEW YORK (Reuters Health) – With the help of a checklist, ambulance workers may be able to safely reroute drunk patients to detoxification centers instead of emergency rooms, according to a new study.

Researchers in Colorado found no serious medical problems were reported after 138 people were sent to a detox center to sleep it off, instead of to an ER.

In 2004, according to the researchers, it’s estimated that 0.6 percent of all U.S. ER visits were made by people without any problems other than being drunk. Those visits ended up costing about $ 900 million.

“Part of the issue has been – as it is in many busy ER departments – there’s a lot of chronic alcoholics that are brought in by ambulance, police or just come in. Often they are brought in because they have not committed a crime or there is limited space in our detoxification center. So the majority were brought to the ER department,” said Dr. David Ross, the study’s lead author from Penrose-St. Francis Health Services in Colorado Springs.

Ross said the ambulance company where he serves as medical director created the checklist with the help of the local detox center, which provided limited medical care by a nurse, and the local hospitals to reduce the number of drunks without medical needs being sent to the local ERs.

They created a checklist with 29 yes-or-no questions, such as whether the patient is cooperating with the ambulance worker’s examination and if the patient is willing to go to the detox center.

The patient was sent to the ER if the ambulance worker checked “no” on any question.

The researchers then went back to look at the patients they transported between December 2003 and December 2005 to see whether or not any of them ended up having serious medical problems at the detox center.

During that two year period, the ambulance workers transported 718 drunks. The detox center received 138 and the local ERs got 580.

Overall, 11 of the patients who were taken to detox were turned away because there was no room, their blood alcohol level exceeded the limit, their family came to pick them up or they were combative.

Another four patients at the detox center were taken to the ER because of minor complications, including chest and knee pain. However, there were no serious complications reported.

“We really believe that we did not miss anybody with a serious illness and injury that didn’t go to the ER as they should have,” said Ross.

But the researchers write in the Annals of Emergency Medicine that their study did have some limitations.

Specifically, the researchers did not plan in advance to do a study when they were creating the checklist, which means their findings are limited to whatever information was collected at the detox center and ERs.

Also, the number of people who were sent to the detox center in their study is relatively small, so it’s hard to tell how many serious complications they’d see among a larger group of people.

“We tried to estimate how likely we would have been to encounter a serious event… We estimated at most we’d encounter three serious adverse events (in 748 patients),” Ross told Reuters Health.

SOURCE: http://bit.ly/QgPCT5 Annals of Emergency Medicine, online November 9, 2012.

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Black Friday starts on Thursday right after Thanksgiving dinner

Black Friday is the Super Bowl of retail, but some of the nation's largest big-box stores can't wait until the day after Thanksgiving to open their doors to shoppers eager to grab great deals the same day as their turkey dinners.

Traditional Black Friday door-busting deals now start tonight, on what's been dubbed Gray Thursday. Major retail stores such as Kmart, Toys R Us, Walmart and Sears will open their doors beginning at 8 p.m. Target will join the party an hour later.

"It's traditionally been the day after Thanksgiving when the stores go into the black, where they make all their money. But that's not true anymore," retail expert Michelle Madhock said.

With Black Friday sales starting Thursday, that means lines started forming Wednesday, or in some extreme cases a week before as bargain hunters tried to get a turkey leg up on their competition.

READ: The Best Black Friday Freebies 2012

Luciana Pendleton pitched a tent outside a Deptford Township, N.J., Best Buy Monday fully equipped with all she needed to spend the next few days away from home so she could be first in line when the doors open.

"I am just happy I beat my competition. They pulled up here around 3 p.m., and we were already here so I was happy," she said Monday.

READ: How to Beat Black Friday Stress

Last year, some sale seekers became a little too excited and turned holiday shopping into a contact sport. In one ugly incident, a woman was accused of unleashing pepper spray on other shoppers in a dash for electronics at Walmart in Los Angeles.

This year, stores are beefing up security, and Best Buy even participated in training drills to handle the large crowds. More than 147 million people plan to shop this weekend, according to the National Retail Federation.

The hottest deals that are up for grabs this year include a 46-inch Samsung LED flat screen TV at Walmart with $200 off the original price. If that's not good enough, Sears has knocked $500 off the price of a 50-inch Toshiba flat screen. Target is offering the Nook Simple Touch at half price.

Black Friday officially kicks off at midnight for Best Buy, Sports Authority and Macy's.

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Former Ivory Coast leader’s wife wanted by ICC

THE HAGUE, Netherlands (AP) — The International Criminal Court unsealed an indictment Thursday against former Ivory Coast President Laurent Gbagbo‘s wife on charges including murder, rape and persecution. It was the first time in the court’s 10-year history it has charged a woman.

The world’s first permanent war crimes tribunal said the arrest warrant was issued on Feb. 29 for former first lady Simone Gbagbo for crimes against humanity.

Her husband, Laurent Gbagbo, is already in custody at the court’s detention unit in The Hague facing similar charges stemming from his fight to retain power after losing a 2010 presidential election. If his wife is extradited, they could face justice together in an unprecedented husband-wife trial.

But a senior member of Ivory Coast President Alassane Ouattara‘s government, who requested anonymity because he wasn’t authorized to speak to the media, said Ivory Coast has already informed the ICC that the nation will not let her go.

“We informed them of this a long time ago,” he said.

The court’s chief prosecutor, Fatou Bensouda, urged Ivory Coast to extradite Gbagbo.

“The type of crimes committed in the aftermath of the 2010 elections did not happen by chance — they were planned and coordinated at the highest political and military levels and all those bearing the greatest responsibility must be held to account,” Bensouda said in a statement.

She said prosecutors continue to investigate crimes committed by both sides in Ivory Coast’s bloody power struggle and expect to issue further arrest warrants in the future.

“The investigations are objective, impartial and independent, and are conducted in strict accordance with the law,” she said.

Ivory Coast officials are holding the 63 year old under house arrest in the northwest town of Odienne. Last week, Ivorian prosecutor Noel Dje Enrike Yahau said lawyers had questioned Simone Gbagbo there for two days and that the domestic charges against her remained the same: genocide, blood crimes and economic crimes.

Unsealing the ICC arrest warrant issued nearly nine months ago appears to be a tactic by the court to put pressure on Ouattara’s administration to hand over Ms. Gbagbo.

If authorities in Ivory Coast want to prosecute her, they have to convince judges at The Hague tribunal that their case involves the same crimes she is charged with at the ICC. It is a court of last resort, meaning it only takes cases from countries unwilling or unable to prosecute them.

The international court said in the warrant that there is evidence pro-Gbagbo forces deliberately attacked perceived supporters of Ouattara in the aftermath of the election.

Judges who reviewed evidence supporting the charges against Ms. Gbagbo said they found “there are reasonable grounds to believe that Ms. Gbagbo bears individual criminal responsibility for the crimes … as ‘an indirect co-perpetrator.’”

The warrant called Gbagbo an “alter ego for her husband” with the power to make state decisions. It said there is evidence to suggest she “instructed the pro-Gbagbo forces to commit crimes against individuals who posed a threat to her husband’s power.”

Her husband was the first former head of state to be taken into custody by the court when he was extradited to The Hague by the Ivory Coast government last year.

Prosecutors say about 3,000 people died in violence by both sides after Gbagbo refused to concede defeat following the election. Ouattara finally took power in April 2011 with the help of French and U.N. forces.

Ivory Coast is not a member state of the court, but has voluntarily accepted its jurisdiction.

It is very rare for a woman to be charged by an international war crimes court. In the past, the Yugoslav war crimes tribunal convicted former Bosnian Serb President Biljana Plavsic of persecution and sentenced her to 11 years imprisonment.

The announcement of the arrest warrant and Ivory Coast’s refusal to hand over Gbagbo appeared likely to raise tensions between supporters of her husband and those who back Ouattara.

Moussa Toure Zeguen, a leader of the Gbagbo allies in exile in Ghana, said by phone from Accra that the former president’s supporters had no faith in the Ivorian authorities to give Simone Gbagbo a fair trial.

“We don’t trust them. The only thing that Ouattara is doing is revenge,” Zeguen said. “He wants to try us without trying any of the fighters from his side who also committed crimes. It is not fair, and this cannot bring reconciliation.”

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Associated Press writers Rukmini Callimachi in Dakar, Senegal, and Robbie Corey-Boulet in Abidjan, Ivory Coast, contributed to this report.

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Ex-’Price is Right’ model gets $8.5M in damages

LOS ANGELES (AP) — The producers of “The Price is Right” owe a former model on the show more than $ 7.7 million in punitive damages for discriminating against her after a pregnancy, a jury determined Wednesday.

The judgment came one day after the panel determined the game show’s producers discriminated against Brandi Cochran. They awarded her nearly $ 777,000 in actual damages.

Cochran, 41, said she was rejected when she tried to return to work in early 2010 after taking maternity leave. The jury agreed and determined that FremantleMedia North America and The Price is Right Productions owed her more than $ 8.5 million in all.

“I’m humbled. I’m shocked,” Cochran said after the jury announced its verdict. “I’m happy that justice was served today not only for women in the entertainment industry, but women in the workplace.”

FremantleMedia said it was standing by its previous statement, which said it expected to be “fully vindicated” after an appeal.

“We believe the verdict in this case was the result of a flawed process in which the court, among other things, refused to allow the jury to hear and consider that 40 percent of our models have been pregnant,” and further “important” evidence, FremantleMedia said.

In their defense, producers said they were satisfied with the five models working on the show at the time Cochran sought to return.

Several other former models have sued the series and its longtime host, Bob Barker, who retired in 2007.

Most of the cases involving “Barker’s Beauties” — the nickname given the gown-wearing women who presented prizes to contestants — ended with out-of-court settlements.

Comedian-actor Drew Carey followed Barker as the show’s host.

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Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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New York Athletes Use Twitter to Gain Cult Hero Status

If you’re one of the over 20.6 million Americans who has a Twitter account, chances are you’ve stumbled across the official SoccerGirlProblems Twitter handle, @SoccerGrlProbs, at least once while using the popular social media networking site.

SoccerGirlProblems, a feed spawned by three New York-based athletes, is a Twitter handle dedicated to the true-life outrageous complaints about everyday life as a high school or college soccer player.

The simple concept was started as a joke, but it has grown to startling dimensions.

SoccerGirlProblems has over 148,000 Twitter followers, and its explosive popularity led to the creation of a spinoff blog, a well-known YouTube account, a custom-made T-shirt business, and an official website.

Since opening in the beginning of 2012, the SoccerGirlProblems YouTube account has racked up over 3.2 million video views, and T-shirts have been selling like hotcakes. The SoccerGirlProblems Twitter page is also busier than ever, as it gained 50,000 new followers between May and November.

Punch #SGP or #SoccerGrlProbs into the Twitter search box on any given day, and you’ll immediately get a slew of hilarious tweets like “Took a long, hard stare at a pair of jeans this morning…Almost felt bad for neglecting them for so long. SWEATS IT IS,” along with other comedic gems like “family dreads thanksgiving if…i’m not on their team for flag football. Come on people what’s wrong with a little ‘friendly’ competition??”

With the SoccerGirlProblems brand finding so much success, one would expect the girls behind it to be household names by now, much like other Twitter/YouTube personalities like Jenna Marbles and Tay Zonday.

In fact, the founders of SoccerGirlProblems were afraid to reveal their identities until recently, as they feared retribution from conservative school administrators at their current school, Fairfield University.

The SoccerGirlProblems ladies believed that school officials from Fairfield would possibly find some of their hilarious tweets to be offensive or inappropriate. The founders did not want their tweets to bring negative exposure to their current or former schools.

It took over a year for the SoccerGirlProblems girls to reveal their identities publicly, but two of the three founders finally decided it was time to come out and detail how they became cult heroes via Twitter.

Carly Beyar, a South Hempstead, New York, resident and graduate of South Side High School in Rockville Centre, New York, along with Alanna Locast of Wantagh, New York, revealed that they are among the core group of tweeters handling the SoccerGirlProblems Twitter and YouTube accounts.

Locast, a graduate of Long Island’s Seaford High School, was an attacking offensive option for Fairfield until her graduation in 2011, while Beyar is still playing for the Fairfield Stags.

“It is still a shock to us that all of these girls relate to what we are saying,” Beyar said of her dedicated legion of Twitter followers in an exclusive online interview in May. “The soccer world is evidently a small one. It is comforting to know that we are not the only women soccer players out there dealing with these problems every day. Also, don’t get us wrong, we love soccer and will do anything for it; sometimes you just need to complain to keep you sane. ‘With training comes complaining.’”

Beyar and Locast, both standout high school soccer players on Long Island, think they can take SoccerGirlProblems to new heights due to the power of online marketing.

“I think it is easy to relate to our tweets when we are sarcastic and humorous,” Beyar said. “We try to take bothersome problems every day and turn it into something to just sit back and laugh about. We appreciate all of the support that our fans have given us since August. They are the best fans any Twitter account can ask for. Originally, we made this Twitter account for fun. We wanted to make it a team-based thing where everyone would tweet a problem from our team to get a laugh out of it. Little did we know how powerful the Web can be.”

Eric Holden covered the South Side Lady Cyclones girls’ soccer team in the 2010-11 season and has reported on Long Island soccer events since 2009. Follow him on Twitter @ericholden.

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