Diabetes rates rocket in Oklahoma, South

NEW YORK (AP) — The nation's diabetes problem is getting worse, and the biggest jump over 15 years was in Oklahoma, according to a new federal report issued Thursday.

The diabetes rate in Oklahoma more than tripled, and Kentucky, Georgia and Alabama also saw dramatic increases since 1995, the study showed.

The South's growing weight problem is the main explanation, said Linda Geiss, lead author of the report by the Centers for Disease Control and Prevention study.

"The rise in diabetes has really gone hand in hand with the rise in obesity," she said.

Bolstering the numbers is the fact that more people with diabetes are living longer because better treatments are available.

The disease exploded in the United States in the last 50 years, with the vast majority from obesity-related Type 2 diabetes. In 1958, fewer than 1 in 100 Americans had been diagnosed with diabetes. In 2010, it was about 1 in 14.

Most of the increase has happened since 1990.

Diabetes is a disease in which the body has trouble processing sugar; it's the nation's seventh leading cause of death. Complications include poor circulation, heart and kidney problems and nerve damage.

The new study is the CDC's first in more than a decade to look at how the nationwide boom has played out in different states.

It's based on telephone surveys of at least 1,000 adults in each state in 1995 and 2010. Participants were asked if a doctor had ever told them they have diabetes.

Not surprisingly, Mississippi — the state with the largest proportion of residents who are obese — has the highest diabetes rate. Nearly 12 percent of Mississippians say they have diabetes, compared to the national average of 7 percent.

But the most dramatic increases in diabetes occurred largely elsewhere in the South and in the Southwest, where rates tripled or more than doubled. Oklahoma's rate rose to about 10 percent, Kentucky went to more than 9 percent, Georgia to 10 percent and Alabama surpassed 11 percent.

An official with Oklahoma State Department of Health said the solution is healthier eating, more exercise and no smoking.

"And that's it in a nutshell," said Rita Reeves, diabetes prevention coordinator.

Several Northern states saw rates more than double, too, including Washington, Idaho, Montana, Wyoming, South Dakota, Minnesota, Missouri, Ohio and Maine.

The study was published in CDC's Morbidity and Mortality Weekly Report.

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Associated Press writer Ken Miller in Oklahoma City contributed to this report.

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Online:

CDC report: http://tinyurl.com/cdcdiabetesreport

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Signs mount of possible Israeli invasion of Gaza

JERUSALEM (AP) — Israeli aircraft targeted rocket launching operations of Gaza militants early Friday as troops, tanks and armored personnel carriers massed near the Palestinian territory, signaling a ground invasion might be growing near.

Fighting between the two sides escalated sharply Thursday with a first-ever militant attack on the Tel Aviv area, menacing Israel's heartland. No casualties were reported there, but three people died in the country's rocket-scarred south when a projectile slammed into an apartment building.

The death toll in the densely populated Palestinian territory climbed to 19, including five children, according to Palestinian health officials, as waves of Israeli fighter planes and drones sent missiles hurtling down on suspected weapons stores and rocket-launching sites.

Early Friday, 85 missiles exploded within 45 minutes in Gaza City, sending black pillars of smoke towering above the coastal strip's largest city. The military said it was targeting underground rocket launching sites.

One missile hit the Interior Ministry, a symbol of Hamas power, and another hit an empty house belonging to a senior Hamas commander. Those strikes, together with an attack on a generator building near the home of Gaza's Hamas prime minister, Ismail Haniyeh, signaled that Israel was expanding its offensive beyond military targets.

The fighting has already widened the instability gripping a region in the throes of war and regime upheavals. It has straining already frayed relations with Egypt, which was sending its prime minister to Gaza later Friday in a show of solidarity with its militant Hamas rulers.

Israel and Hamas had largely observed an informal truce since Israel's devastating incursion into Gaza four years ago, but rocket fire and Israeli airstrikes on militant operations didn't halt entirely. The latest flare-up exploded into major violence Wednesday when Israel assassinated Hamas' military chief, following up with a punishing air assault meant to cripple the militants' ability to terrorize Israel with rockets.

The Israeli military reported early Friday that its aircraft had struck more than 350 targets since the beginning of its operation against Hamas' rocket operations.

After nightfall Thursday, several explosions shook Gaza City several minutes apart, a sign the strikes were not letting up. The military said the targets were about 70 underground rocket-launching sites.

The Israeli offensive has not deterred the militants from striking back with more than 400 rockets aimed at southern Israel. For the first time, they also unleashed the most powerful weapons in their arsenal — Iranian-made Fajr-5 rockets capable of reaching Tel Aviv.

The two rockets that struck closest to Tel Aviv appear to have landed in the Mediterranean Sea, defense officials said, and another hit an open area on Tel Aviv's southern outskirts.

No injuries were reported, but the rocket fire — the first in the area from Gaza — sowed panic in Tel Aviv and made the prospect of a ground incursion more likely. The government later approved the mobilization of up to 30,000 reservists for a possible invasion.

Israeli Prime Minister Benjamin Netanyahu said the army was hitting Hamas hard with what he called surgical strikes, and warned of a "significant widening" of the Gaza operation. Israel will "continue to take whatever action is necessary to defend our people," said Netanyahu, who is up for re-election in January.

At least 12 trucks were seen transporting tanks and armored personnel carriers toward Gaza late Thursday, and buses carrying soldiers headed toward the border area. Israeli TV stations said a Gaza operation was expected on Friday, though military officials said no decision had been made.

"We will continue the attacks and we will increase the attacks, and I believe we will obtain our objectives," said Lt. Gen. Benny Gantz, Israel's military chief.

An Israeli ground offensive could be costly to both sides. In the last Gaza war, Israel devastated large areas of the territory, setting back Hamas' fighting capabilities but also paying the price of increasing diplomatic isolation because of a civilian death toll numbering in the hundreds.

The current round of fighting is reminiscent of the first days of that three-week offensive against Hamas. Israel also caught Hamas off guard then with a barrage of missile strikes and threatened to follow up with a ground offensive.

Much has changed since then.

Israel has improved its missile defense systems, but it is facing a more heavily armed Hamas. Israel estimates the militants have 12,000 rockets, including more sophisticated weapons from Iran and from Libyan stockpiles plundered after the fall of Moammar Gadhafi's regime there last year.

Also, regional alignments have changed dramatically since the last Gaza war. Hamas has emerged from its political isolation as its parent movement, the region-wide Muslim Brotherhood, has risen to power in several countries in the wake of last year's Arab uprisings, particularly in Egypt.

Egypt recalled its ambassador to protest the Israeli offensive and ordered its prime minister to lead a senior delegation to Gaza on Friday in a show of support for Hamas.

At the same time, while relations with Israel have cooled since the toppling of longtime Egyptian leader Hosni Mubarak, Islamist President Mohammed Morsi has not brought a radical change in Egypt's policy toward Israel. He has promised to abide by Egypt's 1979 peace deal with Israel and his government has continued contacts with Israel through its non-Brotherhood members.

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Laub reported from Gaza City, Gaza Strip.

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Japan set for polls, no clear winner likely

TOKYO (AP) — Prime Minister Yoshihiko Noda was poised to dissolve Japan's parliament Friday, setting the stage for elections next month that will likely result in a weak coalition government with differing policies on how to fix the country's myriad problems.

Polls show that nearly half of the electorate is undecided on which party to support but it's clear that the ruling Democrats — in power for the last three years — are very likely to lose. Media reports say the elections will be held on Dec. 16.

Although the opposition Liberal Democratic Party, which led Japan for most of the post-World War II era, would win the most seats in the 480-seat lower house it will fall far short of a majority, according to the polls.

With no party a clear winner, Japan will end up with a coalition government made up of parties with differing policies and priorities. This could hinder decision-making as Japan wrestles with a two-decade economic slump, clean-up from last year's nuclear disaster, growing national debt and a rapidly aging population — not to mention a festering territorial dispute with China that is hurting business ties with its biggest trading partner.

"It's unlikely that the election will result in a clear mandate for anybody," said Koichi Nakano, a political science professor at Sophia University. "So in that sense, there's still going to be a lot of muddling through."

Japan must also decide whether it will follow through with plans to phase out nuclear power by 2040 — a move that many in the LDP oppose.

In a sudden turn of events, Noda abruptly said Wednesday in a one-on-one debate with LDP chief Shinzo Abe that he would dissolve parliament Friday if the opposition would agree to key reforms, including shrinking the size of parliament.

Abe, who said his party would go along with the measures, could get a second stab at being prime minister after his one-year stint in 2006-2007 if the LDP wins the most seats in the election. He would become Japan's seventh prime minister in seven years.

A staunch nationalist, Abe has taken a strong stance against China in the dispute over a cluster of uninhabited islands in the East China Sea controlled by Japan but also claimed by China and Taiwan. Abe suddenly quit as prime minister in 2007, citing health problems that he says are no longer an issue.

Noda's Democratic Party of Japan won a landslide victory in 2009 elections amid high hopes for change, ousting the conservative, business-friendly LDP, which had ruled Japan nearly continuously since 1955.

But those hopes have been dashed amid widespread disgust with the DPJ's failure to keep campaign promises and the government's handling of the Fukushima nuclear crisis triggered by the March 11, 2011, earthquake and tsunami.

Voters are also unhappy with Noda's centerpiece achievement during his nearly 15 months in office: passing legislation to double the nation's 5 percent sales tax by 2015 — a move he says is necessary to meet growing social security costs as the country grays.

Recent polls show about 25-30 percent of voters back the LDP, while support for the DPJ is in the low teens. With scattered support for a few other parties, that leaves nearly half of the public undecided, meaning the outcome is still quite unclear.

"I really don't know who to vote for," said 62-year-old taxi driver Tetsuo Suzuki. "I voted for the DPJ in the last election, but they couldn't seem to get things done. I don't really want to go back to the LDP, either."

"Japan doesn't seem as perky as it used to be," he said, ticking off the economy and territorial dispute with China as the two most pressing issues. "We want a strong leader who won't bend his principles."

Tapping into that voter dismay, outspoken leaders in the two biggest cities in Japan have decided to form their own national political parties, but they may not have enough time to get organized for the election.

The nationalistic governor of Tokyo, Shintaro Ishihara — who stirred up the flap with China by saying the Tokyo government would buy and develop the disputed islands called Senkaku by Japan and Diaoyu by China — resigned recently to create the Sunrise Party.

Toru Hashimoto, the brash, young mayor of Osaka, is working to draw up candidates for the newly formed Japan Restoration Party, although he said he himself will not run in the elections. Recent polls show his party has support in the 5 percent range.

The two men are reportedly in discussions to merge their parties and form a so-called "third force" to counter the LDP and DPJ, but it appears they are having difficulty reconciling some of their differing policy views, including on nuclear power.

Japan is going through a messy period of political transition with its merry-go-round of prime ministers and the emergence of various parties to challenge the long-dominant LDP, experts say.

"The era of one-party dominance is clearly over and behind us," said the professor, Nakano. "We know what we are transiting from, but we don't know where we are going."

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Juan Luis Guerra, Jesse & Joy win at Latin Grammys

LAS VEGAS (AP) — With their hit "Corre!" Mexican brother-sister pop duo Jesse & Joy ran away from the pack with four awards, including best song and best recording, at the 13th Annual Latin Grammys in Las Vegas on Thursday night.

Hosted by actors Cristian De La Fuente and Lucero, the ceremony attracted super-stars new and old, from across the world and from every Latin musical genre to the Mandalay Bay Events Center.

Just like at a big, multi-generational family party, new faces shared the spotlight with older generations, and traditional genres blended with electronica and hip-hop on stage.

Colombian rocker Juanes paired up with Carlos Santana, DJ trio and best new artist winner 3ball MTY threw down beats, and Pitbull rapped with dancers in gold spangled bikinis and hot pants.

Michel Telo, the Brazilian sertanejo or country music singer, performed with Las Vegas veterans Blue Man Group. Bachata heartthrob Prince Royce sang with veteran Mexican singer-songwriter Joan Sebastian.

Traditional Mexico met Las Vegas in a colorful number featuring Oaxaca native Lila Downs, Afro-Colombian singer Toto la Momposina and dancers in regional costumes.

Dominican musician Juan Luis Guerra, who came into the ceremony as the leading nominee with six bids, won producer of the year for Juanes' album "MTV Unplugged," which is also up for album of the year.

Guerra performed "En el Cielo No Hay Hospital," which brought the audience to its feet to dance, and for a standing ovation. He can only win four awards, since he is competing against himself in two categories.

Puerto Rican reggaeton singer Don Omar and Uruguayan alt rockers Cuarteto de Nos won two Latin Grammys each.

Oaxacan roots singer Lila Downs won best folkloric album for "Pecados y Milagros." Colombian singer Fonseca won for best tropical fusion album, and Los Tucanes de Tijuana won best norteno album for "365 Dias," the narco-corrido band's 32nd album.

Milly Quezada brought home best contemporary tropical album for "Aqui estoy yo."

"Long live merengue! Long live the Dominican Republic!" she said as she accepted the award.

If Colombian rocker Juanes wins in three of the four categories he's nominated in, he will become the most decorated Latin Grammy winner, breaking the record held by Puerto Rican rappers Calle 13.

Jazz trumpeter Arturo Sandoval brought three Latin Grammys for "Dear Diz (Every Day I Think of You)," but said it was just exciting as his first.

"The emotion is the same because one puts the same effort into each recording and the fact that the work is received well and respected by the public is a great satisfaction," he said.

The Latin Grammy celebration kicked off Wednesday by presenting its Person of the Year award to Caetano Veloso, one of the founders of the Tropicalismo movement.

The Brazilian singer, composer and activist was honored with performances by Juanes, Guerra, Nelly Furtado and Natalie Cole.

The event was broadcast live on Univision.

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Booze calories nearly equal soda's for US adults

NEW YORK (AP) — Americans get too many calories from soda. But what about alcohol? It turns out adults get almost as many empty calories from booze as from soft drinks, a government study found.

Soda and other sweetened drinks — the focus of obesity-fighting public health campaigns — are the source of about 6 percent of the calories adults consume, on average. Alcoholic beverages account for about 5 percent, the new study found.

"We've been focusing on sugar-sweetened beverages. This is something new," said Cynthia Ogden, one of the study's authors. She's an epidemiologist with the Centers for Disease Control and Prevention which released its findings Thursday.

The government researchers say the findings deserve attention because, like soda, alcohol contains few nutrients but plenty of calories.

The study is based on interviews with more than 11,000 U.S. adults from 2007 through 2010. Participants were asked extensive questions about what they ate and drank over the previous 24 hours.

The study found:

—On any given day, about one-third of men and one-fifth of women consumed calories from beer, wine or liquor.

—Averaged out to all adults, the average guy drinks 150 calories from alcohol each day, or the equivalent of a can of Budweiser.

—The average woman drinks about 50 calories, or roughly half a glass of wine.

—Men drink mostly beer. For women, there was no clear favorite among alcoholic beverages.

—There was no racial or ethnic difference in average calories consumed from alcoholic beverages. But there was an age difference, with younger adults putting more of it away.

For reference, a 12-ounce can of regular Coca-Cola has 140 calories, slightly less than a same-sized can of regular Bud. A 5-ounce glass of wine is around 100 calories.

In September, New York City approved an unprecedented measure cracking down on giant sodas, those bigger than 16 ounces, or half a liter. It will take effect in March and bans sales of drinks that large at restaurants, cafeterias and concession stands.

Should New York officials now start cracking down on tall-boy beers and monster margaritas?

There are no plans for that, city health department officials said, adding in a statement that while studies show that sugary drinks are "a key driver of the obesity epidemic," alcohol is not.

Health officials should think about enacting policies to limit alcoholic intake, but New York's focus on sodas is appropriate, said Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, a public health advocacy group.

Soda and sweetened beverages are the bigger problem, especially when it comes to kids — the No. 1 source of calories in the U.S. diet, she said.

"In New York City, it was smart to start with sugary drinks. Let's see how it goes and then think about next steps," she said.

However, she lamented that the Obama administration is planning to exempt alcoholic beverages from proposed federal regulations requiring calorie labeling on restaurant menus.

It could set up a confusing scenario in which, say, a raspberry iced tea may have a calorie count listed, while an alcohol-laden Long Island Iced Tea — with more than four times as many calories — doesn't. "It could give people the wrong idea," she said.

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Online:

CDC report: http://www.cdc.gov/nchs/

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FBI terror expert started Petraeus probe

The FBI agent who investigated harassing emails to a Florida socialite, a probe that set off a chain of events leading to the resignation of CIA director David Petraeus over an extramarital affair, was a veteran investigator who has worked on high-profile terrorism cases.

The agent was identified as Frederick Humphries by a former federal agent, a source familiar with the Petraeus investigation and Humphries' attorney, Lawrence Berger.

Humphries, 47, received the initial complaint from Jill Kelley, 37, a Tampa, Fla., socialite, about "harassing" emails that an investigation traced back to Paula Broadwell, a 40-year-old author who co-wrote a biography of Petraeus, 60.

The investigation ultimately uncovered evidence of an affair between Broadwell and Petraeus, prompting Petraeus to resign last week.

Berger said his client's family "knew the Kelley family socially for several years." Jill Kelley asked Humphries for advice on what she perceived to be threatening e-mails and he "referred the matter to the bureau as appropriate."

Berger said his client has been wrongly characterized as a "whistleblower," but there is "no action pending against him, nor does he anticipate any future action."

Humphries "referred the matter to the FBI in accordance to proper protocol," Berger added, and the FBI investigation is taking its course.

AP Photo/Kevin P. Casey, AP Photo/Christopher Berkey, File

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Berger flatly declined to confirm or provide any details at all regarding Humphries' alleged contacts with the offices of either Rep. Dave Reichert, R-Wash., or House Majority Leader Rep. Eric Cantor, R-Va.

According to the New York Times, Humphries was allegedly concerned the case had been stalled for political reasons, and in late October contacted Reichert, whom he knew from his time working in Washington. The Times reported that Reichert put him in touch with Cantor, who then passed the message to FBI director, Robert Mueller.

An associate of Humphries told ABC News that it was hard to believe that Humphries had contacted elected officials about the case because "everyone knows that's professional suicide" and Humphries is "top notch."

Humphries has worked as a supervisor on Joint Terrorism Task Force in Tampa and has worked on high-profile terrorism cases.

In Seattle, Humphries worked the so-called Millenium terror plot in 1999, which prevented an Algerian al Qaeda member from bombing Los Angeles International Airport.

More recently, he testified in Florida in a terrorism case of Florida student Youssef Megahed and his associates.

In that case, back in 2007, a sheriff's deputy with the Berkeley County Sherriff's Office in South Carolina became suspicious when University of South Florida student Ahmed Mohamed and his companion, fellow USF student Megahed, did not initially stop when they were pulled over for speeding. The officer said he saw Megahed disconnect a power cord from a laptop computer as he approached the car. The deputy searched the vehicle. According to court records, he found safety fuses, several sections of cut PVC piping containing a potassium nitrate explosive mixture and containers filled with gasoline.

The pair was arrested that night for transporting explosives. Following the arrest, the FBI in Tampa and South Carolina began an investigation with the Joint Terrorism Task Force.

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Xi Jinping takes helm of China amid reform calls

BEIJING (AP) — Xi Jinping became China's new leader Thursday, assuming the top posts in the Communist Party and the powerful military in a political transition unbowed by scandals, a slower economy and public demands for reforms.

Xi was introduced as the new party general secretary at Beijing's Great Hall of the People a day after the close of a weeklong party congress that underlined the communists' determination to remain firmly in power. He and the six other men who will form China's new collective leadership, all dressed in dark suits, walked in line onto the red-carpeted stage.

Xi's appointment as chairman of the military commission, announced by the state Xinhua News Agency, marked a break from the recent tradition of retiring leaders holding onto the post for a transitional period to extend their influence. It meant outgoing leader Hu Jintao would relinquish all positions of power, giving Xi broader leeway to consolidate his authority.

The once-a-decade leadership change was carefully choreographed. It became clear Xi would lead China five years ago, when he was appointed to the Standing Committee — the nation's apex of power — as the highest-ranked member who would not be of retirement age this year.

Xi's colleagues in the new Standing Committee are Li Keqiang, the presumptive premier and chief economic official; Vice Premier Zhang Dejiang; Shanghai party secretary Yu Zhengsheng; propaganda chief Liu Yunshan; Vice Premier Wang Qishan; and Tianjin party secretary Zhang Gaoli.

In a speech broadcast live on Chinese state TV and worldwide, Xi said, "We shall do everything we can to live up to your trust and fulfill our mission."

"There are also many pressing problems within the party that need to be resolved, particularly corruption," Xi said. "We must make every effort to solve these problems. The whole party must stay on full alert."

The other six leaders were expressionless with their arms at their sides during Xi's 20-minute speech, then smiled to the audience when they walked off stage.

The son of a party elder, and vice president for the past five years, Xi will lead the world's No. 2 economy and newest diplomatic and military power amid increasingly vocal calls for economic and political reform — including from within the 82-million-member party itself.

At ease in front of people and with colleagues, Xi takes over the party leadership from the stiff, technocratic Hu, and is expected to assume the largely ceremonial presidency in March.

The ascent of Xi and Li, the premier-in-waiting, represents a generational change. Though they spent their youths laboring on farms, their university years and early careers took place when China was casting off the planned economy and turning to the free market and to the West. They are thought to be more open to new ideas than their predecessors, but nonetheless bound by China's consensus-oriented politics.

Thursday marked only the second tidy transition since communist rule was established in 1949, despite a turbulent political year that saw the downfall in a murder and corruption scandal of rising populist Bo Xilai, who had been seen as a key contender for the new leadership slate.

The outgoing Hu oversaw a decade of turgid economic growth and urban development and tried to make concern for ordinary people the hallmark of his tenure, but he also will be remembered for harshly stifling dissent and rolling back civil liberties.

At the same time, increased social freedoms have created a generation of Chinese who are more aware of their rights and more vocal about demanding them.

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Verizon says 1.4 million customers back on its fiber optic network

(Reuters) – Verizon Communications said fiber optic services have been restored to more than 1.4 million customers hurt by Hurricane Sandy.

The provider of telephone, Internet and television services said on November 1 that it may take another two weeks to restore telecommunication services for its customers after flooding and power outages knocked out services.

The company said it completed 364,000 repairs across the mid-Atlantic and northeast regions.

Verizon said it will provide credits for landline customers and fix equipment damaged due to the hurricane.

Verizon shares were up at $ 42.39 after the bell on Wednesday. They closed at $ 42.24 on the New York Stock Exchange.

(Reporting By Pallavi Ail in Bangalore; Editing by Maju Samuel)

Internet News Headlines – Yahoo! News

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Erdrich wins National Book Award for fiction

NEW YORK (AP) — The National Book Awards on Wednesday honored both longtime writers and new authors, from Louise Erdrich for "The Round House" to Katherine Boo for her debut work, "Beyond the Beautiful Forevers."

Erdrich, 58, has been a published and highly regarded author for nearly 30 years but had never won a National Book Award until being cited Wednesday for her story about an Ojibwe boy and his quest to avenge his mother's rape. A clearly delighted and surprised Erdrich, who's part Ojibwe, spoke in her tribal tongue and then switched to English as she dedicated her fiction award to "the grace and endurance of native people."

Boo's nonfiction book, set in a Mumbai slum, also is a story of a boy and his harsh and illuminating education in the consequences of crime or perceived crime. The author, a Pulitzer Prize-winning journalist currently on staff with The New Yorker, said she was grateful for the chance to live in a world she "didn't know" and for the chance to tell the stories of those otherwise ignored. She praised a fellow nominee and fellow Pulitzer-winning reporter, the late Anthony Shadid, for also believing in stories of those without fame or power.

Poetry winner David Ferry is a year older than one of the night's honorary recipients, Elmore Leonard. Ferry, 88, won for "Bewilderment: New Poems and Translations," a showcase for his versatile style. He fought back tears as he confided that he thought there was a chance for winning because he "was so much older" than the other nominees. He called the award a "pre-posthumous" honor.

The other competitive prize Wednesday went to William Alexander, whose "Goblin Secrets" won for young people's literature.

Alexander quoted fellow fantasy writer Ursula Le Guin in highlighting the importance of stories for shaping kids' imaginations and making the world a larger place than the one they live in.

"We have to remember that," Alexander said.

The ceremony went smoothly even though Superstorm Sandy badly damaged the offices of the award's organizer, the National Book Foundation, whose staffers had to work with limited telephone and mail access.

Winners, chosen by panels of fellow writers, each received $10,000. Judges looked through nearly 1,300 books.

Honorary prizes were given to Leonard and New York Times publisher and chairman Arthur O. Sulzberger Jr.

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Report: FDA wanted to close Mass pharmacy in 2003

WASHINGTON (AP) — Nearly a decade ago, federal health inspectors wanted to shut down the pharmacy linked to a recent deadly meningitis outbreak until it cleaned up its operations, according to congressional investigators.

About 440 people have been sickened by contaminated steroid shots distributed by New England Compounding Center, and more than 32 deaths have been reported since the outbreak began in September, according to the Centers for Disease Control and Prevention. That has put the Framingham, Mass.-based pharmacy at the center of congressional scrutiny and calls for greater regulation of compounding pharmacies, which make individualized medications for patients and have long operated in a legal gray area between state and federal laws.

The House Energy and Commerce Committee released a detailed history of NECC's regulatory troubles on Monday, ahead of a meeting Wednesday meeting to examine how the outbreak could have been prevented. The 25-page report summarizes and quotes from FDA and state inspection memos, though the committee declined to release the original documents.

The report shows that after several problematic incidents, Food and Drug Administration officials in 2003 suggested that the compounding pharmacy be "prohibited from manufacturing" until it improved its operations. But FDA regulators deferred to their counterparts in Massachusetts, who ultimately reached an agreement with the pharmacy to settle concerns about the quality of its prescription injections.

The congressional report also shows that in 2003 the FDA considered the company a pharmacy. That's significant because in recent weeks public health officials have charged that NECC was operating more as a manufacturer than a pharmacy, shipping thousands of doses of drugs to all 50 states instead of small batches of drugs to individual patients. Manufacturers are regulated by the FDA and are subject to stricter quality standards than pharmacies.

The report offers the most detailed account yet of the numerous regulatory complaints against the pharmacy, which nearly date back to its founding in 1998. Less than a year later, the company was cited by the state pharmacy board for providing doctors with blank prescription pads with NECC's information. Such promotional items are illegal in Massachusetts and the pharmacy's owner and director, Barry Cadden, received an informal reprimand, according to documents summarized by the committee.

Cadden was subject to several other complaints involving unprofessional conduct in coming years, but first came to the FDA's attention in 2002. Here are some key events from the report highlighting the company's early troubles with state and federal authorities:

__ In March of 2002 the FDA began investigating reports that five patients had become dizzy and short of breath after receiving NECC's compounded betamethasone repository injection, a steroid used to treat joint pain and arthritis that's different from the one linked to the current meningitis outbreak.

FDA inspectors visited NECC on April 9 and said Cadden was initially cooperative in turning over records about production of the drug. But during a second day of inspections, Cadden told officials "that he was no longer willing to provide us with any additional records," according to an FDA report cited by congressional investigators. The inspectors ultimately issued a report citing NECC for poor sterility and record-keeping practices but said that "this FDA investigation could not proceed to any definitive resolution," because of "problems/barriers that were encountered throughout the inspection."

__ In October of 2002, the FDA received new reports that two patients at a Rochester, N.Y., hospital came down with symptoms of bacterial meningitis after receiving a different NECC injection. The steroid, methylprednisolone acetate, is the same injectable linked to the current outbreak and is typically is used to treat back pain. Both patients were treated with antibiotics and eventually recovered, according to FDA documents cited by the committee.

When officials from the FDA and Massachusetts Board of Pharmacy visited NECC later in the month, Cadden said vials of the steroid returned by the hospital had tested negative for bacterial contamination. But when FDA scientists tested samples of the drug collected in New York they found bacterial contamination in four out of 14 vials sampled. It is not entirely clear whether FDA tested the same lot shipped to the Rochester hospital.

__ At a February 2003 meeting between state and federal officials, FDA staff emphasized "the potential for serious public consequences if NECC's compounding practices, in particular those relating to sterile products, are not improved." The agency issued a list of problems uncovered in its inspection to NECC, including a failure to verify if sterile drugs met safety standards.

But the agency decided to let Massachusetts officials take the lead in regulating the company, since pharmacies are typically regulated at the state level. It was decided that "the state would be in a better position to gain compliance or take regulatory action against NECC as necessary," according to a summary of the meeting quoted by investigators.

The FDA recommended the state subject NECC to a consent agreement, which would require the company to pass certain quality tests to continue operating. But congressional investigators say Massachusetts Board of Pharmacy did not take any action until "well over a year later."

__ In October 2004, the board sent a proposed consent agreement to Cadden, which would have included a formal reprimand and a three-year probationary period for the company's registration. The case ended without disciplinary action in 2006, when NECC agreed to a less severe consent decree with the state.

Massachusetts officials indicated Tuesday they are still investigating why NECC escaped the more severe penalty.

"I will not be satisfied until we know the full story behind this decision," the state's interim health commissioner Lauren Smith said in a transcript of her prepared testimony released a day ahead of delivery. Smith is one of several witnesses scheduled to testify Wednesday, including FDA Commissioner Margaret Hamburg.

The committee will also hear from the widow of 78-year-old Eddie C. Lovelace, a longtime circuit court judge in southern Kentucky. Autopsy results confirmed Lovelace received fungus-contaminated steroid injections that led to his death Sept. 17.

Joyce Lovelace will urge lawmakers to work together on legislation to stop future outbreaks caused by compounded drugs, according to a draft of her testimony.

"We now know that New England Compounding Pharmacy, Inc. killed Eddie. I have lost my soulmate and life's partner with whom I worked side by side, day after day for more than fifty years," Lovelace states.

Barry Cadden is also scheduled to appear at the hearing, after lawmakers issued a subpoena to compel him to attend.

The NECC has been closed since early last month, and Massachusetts officials have taken steps to permanently revoke its license. The pharmacy has recalled all the products it makes, including 17,700 single-dose vials of a steroid that tested positive for the fungus tied to the outbreak.

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