Longer waits for breast cancer patients on Medicare

NEW YORK (Reuters Health) – Women with a new diagnosis of breast cancer who are covered by Medicare are waiting longer and longer to get treatment, according to a new nationwide study.

Researchers found that between 1992 and 2005, the average waiting time between being diagnosed and having surgery rose from 21 days to 32 days. The delay was especially long for black and Hispanic women, and for those living in large cities.

Still, the study team noted, it’s unclear how big a difference the extra week or two would make in women’s long-term health.

“I don’t believe the delays we’re seeing here are problematic, (but) we’re clearly going to need to keep any eye on it because if those delays keep increasing, they may become problematic,” said the study’s lead author, Dr. Richard Bleicher.

Bleicher, from Fox Chase Cancer Center in Philadelphia, and his colleagues analyzed cancer registry data and Medicare claims for 72,586 older adults diagnosed with breast cancer between 1992 and 2005, 99 percent of whom were women.

Over that period, both the time between a patient’s first breast cancer-related visit and her first biopsy increased, as did the time between biopsies and surgery, according to findings published this week in the Journal of Clinical Oncology.

When the researchers accounted for patient characteristics such as tumor stage, as well as number and type of pre-surgery visits and screenings, the relative delay shrank from 11 days to five days.

Whether the extra waiting in more recent years is “clinically meaningful” remains to be seen, according to Bleicher‘s team.

Another report published in the same journal found that for women with advanced cancer, waiting 60 days or more for treatment was tied to a greater likelihood of dying in the five years after diagnosis.

Shorter delays, however, weren’t associated with worse outcomes.

Among 1,786 North Carolina women on Medicaid, the average time between diagnosis and treatment – usually surgery – was 22 days between 2000 and 2002, Dr. Electra Paskett from The Ohio State University in Columbus and her team found.

The length of that interval didn’t seem to affect a woman’s chance of surviving early-stage breast cancer. But for those with late-stage cancer, women who waited 60 days or more between diagnosis and treatment were 66 percent more likely to die of any cause over the next five years and 85 percent more likely to die of breast cancer, in particular.

In Paskett’s study, one in 10 women waited at least 60 days for treatment.

She pointed out that people on Medicaid, like those in her study, may have more problems getting timely treatment compared to people with private insurance.

“It could be that they had problems finding a doctor who would accept them, because they’re low income, or (there were) scheduling problems with the clinic,” Paskett told Reuters Health.

She recommended health systems look into having “patient navigators” to guide low-income people and others who may need help through the treatment process.

Bleicher said doctors and health systems can start using the new data to figure out how to consolidate the biopsies, second opinions and other visits that often happen between diagnosis and treatment.

But for now, he told Reuters Health that women with breast cancer shouldn’t panic if it takes them a few weeks to coordinate their surgery.

“Getting to the operating room for treatment is not something that’s an emergency, even though it feels like one,” Bleicher said.

Up to 60 days, Paskett said, should be “plenty of time to get second opinions, plenty of time to get consults and things like that.”

SOURCE: http://bit.ly/10tpzc9 and http://bit.ly/10tpIMu Journal of Clinical Oncology, online November 19, 2012.

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Silent skies over Gaza after cease-fire

The rockets and missiles fell silent over Gaza for the first time in eight days today, but gunfire erupted in the crowded streets of the Palestinian enclave to celebrate the announcement of a ceasefire in the bloody conflict between Israel and Hamas.

The two sides fired final salvos at one another up until the final moments before the 2 p.m. ET cease-fire deadline. At least one Israeli missile landed at 1:57 p.m. ET in Gaza, and four rockets were launched toward the Israeli province of Beer Sheva at 1:59 p.m. ET.

After 2 p.m. ET, however, the sky was finally empty of munitions.

The eight days of fighting left 130 Palestinans and five Israelis dead, and badly damaged many of Gaza's buildings. A bomb that exploded on a bus in Tel Aviv earlier today left an additional 10 Israelis wounded.

FULL COVERAGE: Israel-Gaza Conflict

The fighting came to an end after a meeting between Egyptian President Mohammed Morsi and U.S. Secretary of State Hillary Clinton.

"This is a critical moment for the region," Clinton said after the meeting, standing next to Egyptian Foreign Minister Mohamed Kamel Amr to announce the deal.

"The people of this region deserve a chance to live free of fear and violence and today's agreement is a step" in that direction, Clinton said. "Now we have to focus on reaching a durable outcome."

PHOTOS: Israel, Hamas Fight Over Gaza

Clinton said that Egypt and the U.S. would help support the peace process going forward.

"Ultimately every step must move us toward a comprehensive peace for people of the region," she said.

Israeli Prime Minister Benjamin Netanyahu confirmed the cease-fire from Tel Aviv after Clinton's announcement.

"I agree that that it was a good idea to give an opportunity to the cease-fire... in order to enable Israeli citizens to return to their day to day lives," Netanyahu said.

He reiterated that it was vital to Israel's security to "prevent smuggling of arms to terrorist organizations" in the future.

An Israeli official told ABC News that the ceasefire would mean a "quiet for quiet" deal, in which both sides stop shooting and "wait and see what happens."

"Who knows if the ceasefire will even last two minutes," the official said. The official said that any possible agreement on borders and blockades on the Gaza/Israel border would come only after a period of quiet.

INFOGRAPHIC: Strike Point: Israel, Hamas, and the Unwinnable Conflict

Clinton and Morsi met for three hours in Cairo today to discuss an end to the violence. The secretary of state met with Netanyahu Tuesday night for more than two hours, saying she sought to "de-escalate the situation in Gaza."

The fighting dragged on Tuesday night and Wednesday morning despite Hamas officials declaring publicly Tuesday afternoon that they expected a cease-fire would be announced Tuesday night, after Clinton and Netanyahu's talks.

The airstrikes by the Israeli Defense Forces overnight hit government ministries, underground tunnels, a banker's empty villa and a Hamas-linked media office. At least four strikes within seconds of each other pulverized a complex of government ministries the size of a city block, rattling nearby buildings and shattering windows.

Hours later, clouds of acrid dust still hung over the area and smoke still rose from the rubble. Gaza health officials said there were no deaths or injuries.

On Wednesday morning, the IDF said they had destroyed 50 underground rocket launching sites in Gaza. They also said that Israel's "Iron Dome" missile shield intercepted two rockets from Gaza into Israel overnight as well.

Around 12 p.m. in Israel, however, a bomb exploded on a public bus near the nation's military headquarters in Tel Aviv, in one of the city's busiest areas. Israel police said the explosion was a terrorist attack, the first in Israel since 2006.

Upon landing in Cairo to meet with Morsi, Clinton released a statement condemning the attack.

"The United States strongly condemns this terrorist attack and our thoughts and prayers are with the victims and the people of Israel. As I arrive in Cairo, I am closely monitoring reports from Tel Aviv, and we will stay in close contact with Prime Minister Netanyahu's team. The United States stands ready to provide any assistance that Israel requires," she said.

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AP Exclusive: Syrian rebels seize base, arms trove

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Elmo puppeteer Clash resigns following new sex claims

NEW YORK (Reuters) – Kevin Clash, the puppeteer behind the “Sesame Street” character Elmo, resigned on Tuesday following new allegations that he had sex with an underage boy, adding to an ongoing controversy involving one of America’s most popular children’s brands.

In a lawsuit filed on Tuesday, Cecil Singleton is seeking more than $ 5 million in damages from Clash. Singleton claims he met the then-32-year-old puppeteer in 1993 in a gay chat room when he was 15.

It added that on numerous occasions over a period of years Clash engaged in sexual activity with Singleton.

The news came just a week after another man recanted his claims that Clash had sex with him when he was 16 years old.

Clash, 52, said he was leaving Sesame Workshop, the company behind the television show, after nearly 30 years with a very heavy heart.

“I have loved every day of my 28 years working for this exceptional organization. Personal matters have diverted attention away from the important work Sesame Street is doing and I cannot allow it to go on any longer,” he said in a statement issued by his publicist, Risa B. Heller.

“I am deeply sorry to be leaving and am looking forward to resolving these personal matters privately,” he added.

The New York-based Sesame Workshop said it was a sad day for “Sesame Street,” which premiered in 1969 and has been educating and entertaining children for decades with characters such as Elmo, Big Bird, Bert and Ernie, Oscar the Grouch and Cookie Monster.

“Unfortunately, the controversy surrounding Kevin’s personal life has become a distraction that none of us wants, and he has concluded that he can no longer be effective in his job and has resigned from Sesame Street,” the company said in a statement.

A representative declined further comment.

The unnamed 23-year-old man who first accused Clash recanted his claims last week, saying the relationship was consensual. His lawyers were not immediately available to comment on the lawsuit.

Clash had denied the allegations and acknowledged a past relationship with his first accuser. He added the pair were both consenting adults at the time.

“I am a gay man. I have never been ashamed of this or tried to hide it,” Clash said at the time.

Sesame Workshop said the first allegations involving Clash came to its attention in June when the earlier accuser contacted the company by email.

The Elmo character debuted on “Sesame Street” in 1979. While Clash was the third performer to animate the child-like shaggy red monster, Sesame Workshop credits him with turning Elmo into the international sensation he became.

(Reporting by Patricia Reaney; additional reporting by Steve Gorman; Editing by Ellen Wulfhorst and Cynthia Osterman)

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Clinton’s high-profile swan song

Secretary of State Hillary Rodham Clinton at a meeting with President Barack Obama, second from left, and Japan's …Secretary of State Hillary Rodham Clinton was supposed to be heading for the exit, even as the fight over who should succeed her escalated. Instead, America's top diplomat sped Tuesday to the Middle East on an urgent mission to douse flaring violence between Israel and Hamas, the Islamist Palestinian group that controls Gaza.

Amid early, disputed reports of a possible truce, Clinton had several major goals: Ease the violence, bolster Egyptian President Mohammed Morsi, and avoid an appearance of giving Hamas any sort of legitimacy on the world stage. The U.S. regards Hamas as a terrorist group and deals only with the Palestinian Authority of President Mahmoud Abbas, which controls the West Bank but has been relegated to the sidelines of the latest deadly clashes.

As Clinton winged her way to the troubled region, President Barack Obama—en route to Washington from a trip to Asia—spoke by telephone to Morsi from Air Force One, their third such conversation in 24 hours.

Obama "commended President Morsi's efforts to pursue a de-escalation," Deputy National Security Adviser Ben Rhodes told reporters aboard the presidential plane. "And he also underscored that President Morsi's efforts reinforce the important role that President Morsi and Egypt play on behalf of regional security and the pursuit of broader peace between the Palestinians and Israelis."

Morsi, whose country shares a peace accord with Israel and a border with Gaza, is thought to have sway with Hamas.

Clinton was to stop in Jerusalem for talks with Israeli Prime Minister Benjamin Netanyahu, in Ramallah to meet with Abbas and in Cairo for discussions with Morsi. State Department spokeswoman Victoria Nuland said Clinton aimed for a "de-escalation of violence and a durable outcome that ends the rocket attacks on Israeli cities and towns and restores a broader calm."

American officials have been leery of using the term "cease-fire," preferring variations on "de-escalation" of the conflict.

Clinton's visit came as the political battle over the Sept. 11 terrorist attack on the American compound in Benghazi, Libya, clouded the debate over who will succeed her.

Republicans have accused the Obama administration of covering up the role of suspected extremists in the assault, and questioned whether Clinton's State Department correctly handled requests for more security at the site. The president's foes have targeted Susan Rice, the U.S. ambassador to the United Nations, who at the request of the White House in several television interviews incorrectly tied the attack to protests sparked by an Internet video that ridiculed Islam.

The Benghazi strike claimed the lives of Ambassador Chris Stevens and three other Americans. It has also highlighted the uncertain fate of so-called Arab spring countries—like Egypt—where popular movements swept aside decades-old authoritarian regimes.

Ahead of Clinton's visit, the White House renewed its support for Israel's military operations but hinted at disapproval of a possible ground offensive. Netanyahu's government has called up thousands of troops in what could be preparations for such an onslaught.

Rhodes told reporters the U.S. would prefer to see the Israelis work "diplomatically and peacefully" to resolve the crisis, noting both Palestinian and Israeli civilians would be at risk in the event of a ground assault.

Clinton's stop in Ramallah underscored a diplomatic peculiarity of her trip: Top U.S. officials regard the Palestinian Authority as such minor players in the current crisis, neither Obama nor Clinton have spoken to Abbas since the violence escalated nearly a week ago.

While Clinton by Monday had reached out to leaders—including Jordan's King Abdullah; the foreign ministers of Israel, Egypt, France and Turkey; Egypt's prime minister; and U.N. Secretary-General Ban Ki-moon—she had not spoken to Abbas.

By refusing to deal directly with Hamas and reaching out to the Palestinian Authority instead, Clinton appeared to be trying to resolve the conflict without involving one of the key participants.

Rhodes on Tuesday reiterated U.S. conditions for dealing directly with Hamas: The group must renounce terrorism and recognize Israel's right to exist.

He also defended Clinton's trip to Ramallah, calling it a worthwhile investment "both as it relates to what's happening in Gaza and our efforts going forward to improve the situation in Gaza, but also in terms of our broader efforts to pursue peace between the Israelis and Palestinians."

Rhodes's message was implicit but unmistakable:  If the Palestinians want a lasting peace deal, they should align with the Palestinian Authority and not with Hamas or other extremist groups.

The U.S. has for years been steadfast in its posture toward Hamas. Massachusetts Sen. John Kerry, a top contender for Clinton's job, did not talk to Hamas when he made a surprise visit to Gaza in January 2009.

Clinton headed to the Middle East after traveling to Asia with Obama on what aides to both expected would be their final joint trip overseas, including a history-making stop in Myanmar.

Aboard Air Force One on a flight between Rangoon and Cambodia, the one-time political rivals sat in Obama's private office sharing memories of their work together.

"As the president said, it wasn't just the last four years; they have been through a lot together over the last five or six years," Rhodes said. "But right now there is urgent business to be done."

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Turbulence on Cuba-Italy flight leaves 30 bruised

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

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

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

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

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Aussie rockers AC/DC’s music to be sold on iTunes

NEW YORK (Reuters) – AC/DC‘S entire catalogue, including 20 studio and live albums and three compilations will be available on iTunes for the first time worldwide, Columbia Records and Apple said on Monday.

Until now the Australian heavy metal group that was formed by two brothers, Angus and Malcolm Young, in 1973, had refused to put their music on Apple Inc’s online music store.

“AC/DC’s thunderous and primal rock and roll has excited fans for generations with their raw and rebellious brand of music, which also resonates with millions of new fans discovering AC/DC everyday,” Columbia Records and Apple, said in a statement announcing the deal.

“Their growing legion of fans will now experience the intensity of AC/DC’s music in a way that has never been heard before,” they added.

The group’s 1976 debut album “High Voltage,” its classic “Back In Black” and 2008′s “Black Ice” are among the albums available on iTunes.

All the of music has been mastered for iTunes and fans can download entire albums or individual songs.

(Reporting by Patricia Reaney; editing by Paul Casciato)

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Unemployment may increase chances of heart attacks

CHICAGO (AP) — Unemployment hurts more than your wallet — it may damage your heart. That’s according to a study linking joblessness with heart attacks in older workers.

The increased odds weren’t huge, although multiple job losses posed as big a threat as smoking, high blood pressure and other conditions that are bad for the heart.

The researchers analyzed data on more than 13,000 men and women aged 51 to 75 taking part in an ongoing health and retirement survey partly sponsored by the National Institute on Aging. Since 1992, participants have been interviewed every two years about their employment and health.

The new analysis has several limitations. The data show periods of unemployment but don’t indicate whether people were fired, laid off, out of work while switching jobs, or had voluntarily left a job. The researchers considered all of these situations “job losses,” but it’s likely the greatest risks for heart attacks were from being fired or laid off, said researcher Matthew Dupre, an assistant professor at Duke University and the lead author. Retirement was not considered unemployment

Sarah Burgard, a University of Michigan researcher who has studied the relationship between job loss and health, called the research solid but said it would be important to know the reason for the unemployment.

“There probably are differences in consequences of job loss when it’s voluntary or more or less expected” and when it comes as a sudden shock, said Burgard, who was not involved in the study.

The analysis appears in Monday’s Archives of Internal Medicine. An editorial in the journal says the study adds to decades of research linking job loss with health effects and that research should now turn to examining how and why that happens.

Theories include that the stress of losing a job may trigger a heart attack in people with clogged arteries or heart disease; and that the unemployed lose health insurance and access to medical care that can help keep them healthy, Burgard said.

The analysis covers 1992-2010. Participants were mostly in their 50s at the study’s beginning and were asked about their job history, and about employment status and recent heart attacks at subsequent interviews. People who’d had heart attacks before the study began were excluded.

Nearly 70 percent had at least one job loss, or period of unemployment after working at a job, and at least 10 percent had four or more before and/or during the study period.

There were 1,061 heart attacks during the study. Those with at least one job loss were 22 percent more likely to have a heart attack than those who never lost a job. Those with at least four job losses had a 60 percent higher risk than those with none. Men and women faced equal risks.

Even though the odds linked with job loss weren’t huge, many participants already faced increased other risks for a heart attack because of obesity, high blood pressure or lack of exercise.

“Any significant additional risk is important,” Dupre said.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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Gazans in survival mode: Change houses, avoid windows, stock up on food

GAZA CITY, Gaza Strip (AP) — Sleep away from windows, stock up on food, get the family car off the street — these are the lessons Gazans have learned in previous rounds of fighting between Israel and the territory's Hamas rulers.

This time, some are adding "change houses" to the list as Israel increasingly targets homes of Hamas activists, making it difficult to guess where missiles might hit. Over the weekend, Israeli airstrikes struck the homes of some two dozen Hamas activists, killing 24 civilians.

For ordinary Gazans, moving sometimes doesn't help.

Pediatrician Sami Dawood moved twice. On Sunday, he evacuated his wife and three children from their high-rise apartment in Gaza City's Tel al-Hawa neighborhood after a missile hit the roof. Fearing Israel would strike the building again, the family moved to the home of his father-in-law near the Palestine Stadium in the center of the city. Early Monday, while the family was asleep, missiles hit the stadium as a suspected rocket-launching site.

"Now we are back home again," said the 40-year-old doctor.

Gaza City housewife Amal Lubbad lives across the street from a house flattened in an airstrike Sunday. The blast, which killed 11 members of the Daloo family, including a Gaza policeman, also blew out the windows of her home.

The 39-year-old Lubbad, her husband and eight children spent a restless night, sleeping on the floor in the room farthest away from the Daloo house, but there was no airstrike.

"We were afraid," she said, adding that the family has nowhere else to go. On Monday, she and her daughters swept up the glass shards as bulldozers in the alley below cleared away the ruins of the Daloo home.

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Ola Hani, a 31-year-old mother of four, said that since the last Gaza war four years ago, she's kept a week's worth of food and other supplies in her house. "Even in normal days, I don't touch any of it, only when I have a chance to replace it," she said.

Her stash includes canned food, lentils, rice, milk powder, two small radios and candles. Her husband, a banker, is away in Jordan for a training course, and she asked a friend to drive the family car to another friend's yard, to keep it out of harm's way. The Hani family lives in a high-rise and does not have a parking garage.

At a bakery, bank teller Jibril Alawi bought 250 pieces of pita bread for his clan of 35 — his immediate family and the wives and children of his four brothers who all live in the same building. He said they take turns going on vital errands to minimize exposure to risk.

Like others in Gaza, the Alawis have moved mattresses into inner hallways and rooms away from windows.

Still, sound sleep is impossible in Gaza these days. The massive booms from the airstrikes, often just minutes apart, rattle windows. The wailing of ambulances and the buzz of unmanned spy planes, or drones, make up the background noise.

Hani said she and her children feel scared when they hear the bombardment.

"But a few minutes after that, we start to cheer and laugh when we see another rocket landing in Tel Aviv," she said of attempts by Hamas to strike Israel's main metropolis.

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Photographers in white lab coats hanging around the emergency room of Gaza's largest hospital, Shifa, are part of a different type of Hamas battle: They are members of a Health Ministry team documenting deaths and injuries in the fighting.

The head of the group, Ashraf al-Kidra, keeps journalists updated with casualty figures — 106 dead as of Monday evening. In the long term, he hopes the information will serve as the basis for possible international legal action against Israel.

"We learned a lesson from the last war," said al-Kidra, referring to Israel's previous major offensive against Hamas targets in Gaza four years ago. Casualty figures at the time were hotly disputed, with Palestinians saying most of some 1,400 people killed were civilians, while Israel gave a lower figure and said most were militants.

In the chaos at the time, many Israeli attacks were not properly documented, al-Kidra said.

Now, he has two-member teams deployed at each of Gaza's 13 hospitals. They work in 12-hour shifts and update him with each new casualty. Equipped with two mobile phones and a walkie-talkie, the former physiotherapist and acupuncturist says he has barely slept since the offensive began Nov. 14.

One of his team members, Alaa Saraj, made the rounds in Shifa's emergency room Sunday. Amal Mattar, 38, was lying on a gurney, her face cut by shrapnel from an airstrike near her home in Tel al-Hawa, the Gaza City neighborhood. Saraj snapped her picture, and a doctor said she would need six stitches.

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After more than a decade of on-and-off fighting with Israel, Gazans are not easily shaken.

A warning in Arabic by Israel's military that "Hamas is gambling with your fate and playing with fire," delivered Sunday by briefly taking over the frequencies of local radio stations, elicited mostly amusement.

A group of men hanging around a Gaza City taxi office tried to outdo each other in making fun of the warning. "Let's get some warmth from the fire that Hamas is using to burn us," one of them joked.

Hamas appears to have solid popular support for continued rocket attacks on Israel, despite the new hardships it has brought. Many here expressed satisfaction that Israelis should get a taste of the fear Gazans know so well.

Scenes showing Israelis ducking for cover from rocket fire were discussed with relish, and jokes have popped up on social media, including Facebook. In one, an Egyptian broadcaster with a popular music program asks a listener what he would like to hear. Answer: "The sound of the air raid siren in Tel Aviv."

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Rebels in Congo reach door of Goma

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Africa News Headlines – Yahoo! News

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