Michigan hospital blazes trail in fight against fungal meningitis

CHICAGO (Reuters) – After his first day working at St Joseph Mercy Ann Arbor hospital’s newly created Fungal Outbreak Clinic, Dr David Vandenberg struggled to describe to his boss the enormity of what lay ahead. He settled on a line from the movie Jaws.

“We’re going to need a bigger boat,” Vandenberg told Dr Lakshmi Halasyamani, chief medical officer of the Michigan hospital, echoing the film’s local police chief after he first eyes a 25-foot (7.5-metre) killer shark.

The St Joseph Mercy clinic has been at the front line of the fight against one of the biggest ever U.S. outbreaks of fungal meningitis, a killer infection that has been traced to tainted steroid shots from a Massachusetts pharmacy.

So far, 620 Americans have developed serious infections related to the outbreak, including 367 cases of deadly meningitis, and 39 people have died. Of the 19 U.S. states affected, Michigan has been worst hit, handling more than one third of the total cases in the outbreak.

St Joseph Mercy – a 537-bed Catholic hospital located in Ypsilanti, on the doorstep of the University of Michigan – has treated 169 of the state’s 223 cases of infections that can cause meningitis, including 7 people who died.

At one point it was so overrun that 87 of its 537 beds, which are usually occupied by patients with cancer or heart ailments and the like, were occupied by patients with fungal meningitis and related infections.

Dr Tom Chiller, the fungal disease expert at the U.S. Centers for Disease Control and Prevention, who has been overseeing the outbreak, praised the work of the hospital in helping to limit deaths from the outbreak.

“They have been incredibly creative in dealing with these complicated patients,” he said.

In all, almost 14,000 people seeking relief from back and joint pain received injections from moldy steroid shots made at the now-bankrupt New England Compounding Center in Massachusetts before they were recalled in late September.

CDC experts initially feared death rates in the 40 to 50 percent range; instead, only about 6 percent of those infected have died, and the CDC credits the creative and dogged efforts of state and local health officials for keeping the death rates so low.

The first wave of the outbreak involved the most severe cases of meningitis – an inflammation of the membranes that cover the brain and spinal cord. But starting in mid-October, patients who had been recovering from meningitis were developing potentially fatal localized infections near the site where contaminated drug was injected to treat back or neck pain.

As they started seeing more cases of these local, secondary infections, the staff at St Joseph‘s devised a bold plan to screen all patients in their database looking for potential new infections that might have been missed in the first wave.

On December 20, the CDC issued an alert to doctors incorporating some of lessons learned by the efforts of doctors at St Joseph’s and other hospitals, calling for increased screening of patients who may be harboring localized infections.

A BEWILDERING FUNGI

Among the patients who developed secondary infections was Bonita Robbins, a 72-year-old retired nurse from Pinckney, Michigan, who received doses of the tainted drug at the Michigan Pain Specialists clinic in the nearby town of Brighton while seeking relief for lower-back pain.

The first shot brought some relief, the second did little to ease her aches, and the third was contaminated. In October, Robbins went to St Joseph’s with a severe headache, back pain and pain in her thighs.

She spent 37 days in the hospital taking two kinds of antifungal drugs.

Dr Anurag Malani, an infectious disease specialist treating Robbins, said the challenge with the outbreak was that there was no medical literature to fall back on.

“No one has ever seen anything of this magnitude related to fungal infections, ever,” he said.

Chiller said U.S. doctors had never treated meningitis caused by Exserohilum rostratum, the environmental mold causing most of the infections.

“It’s just a rare, rare cause of infection.” Seeing that mold in the meninges – membranes covering the brain and spinal cord – is “completely new.”

Initially, St Joseph’s Fungal Outbreak Clinic was started in order to coordinate the care of patients after their discharge, which included overseeing the administration of a complex regime of anti-fungal drugs.

It morphed into something bigger when some of its 53 patients with meningitis started returning with infections near the site in their back or neck where the contaminated drug was injected.

Then came a wave of patients like Robbins, who had been ruled out for meningitis with a spinal tap, but were still complaining of pain near their injection site.

GETTING THE ‘BIGGER BOAT’

“When it became obvious that the number of patients would be a much higher percentage than anticipated by the CDC, we expanded our clinic and started enlisting the help of several other hospitals,” Vandenberg said.

Many of the patients had spinal abscesses, an infection in the space between the outside covering of the spinal cord and the bones of the spine. Others developed arachnoiditis, an infection of nerves within the spinal canal.

The decision to screen all patients in the hospital database who might have received tainted injections was not taken at the recommendation of the CDC.

“That was our own decision,” said Vandenberg, a specialist in internal medicine overseeing the screening effort.

He admitted that the strategy was aggressive, but said that, especially early on, doctors feared the local infections might be precursors to meningitis, making catching them early a potentially life-saving move.

Excluding patients who had already been screened and those who had injections in areas other than the spine, the hospital targeted about 500 patients for MRI scans.

Most so far have had private insurance that covers the screening. For the uninsured, the hospital’s Patient Financial Services department has been helping them to apply for financial support.

“We did over 400 MRIs in about a 4-week period,” Vandenberg said. The hospital screened so many patients, in fact, that the state of Michigan sent in an emergency mobile MRI unit to help.

Vandenberg got the task of reading stacks of MRI reports, sometimes as many as 30 a day.

So far, about 20 percent of the MRIs have shown up as abnormal, meaning that patients have to come back for surgery and treatment.

Vandenberg makes all of those calls personally. Not all of them go smoothly. He likens the gravity of the conversation – learning you have a potentially deadly new disease that requires months of treatment with risky drugs – to telling someone they have cancer.

After one especially tough call, in which a heart patient feared he would not survive the surgery he would need to clear his infection, Vandenberg cracked.

“I started crying. I probably haven’t cried for 15 years.”

SIGNS OUTBREAK IS EASING

But at last, after months of onslaught, there are signs the outbreak is easing.

Attendance at the hospital’s daily support group has begun to taper off. And since the beginning of December, more than 50 patients with fungal infections have been discharged, while only 20 have been admitted, bringing the total number of fungus-related inpatient to 30.

Vandenberg nevertheless cautions that the outbreak is still far from over.

“Every single day of this screening program, we’re finding one or two cases that are abnormal and need to be admitted,” he said.

Vandenberg gave the CDC access to the clinic’s database so the agency could see how the effort turned out, and this month, the CDC issued the alert to doctors incorporating some of the results of the MRI screening program.

The alert warned that some patients who got tainted injections but did not develop meningitis may still be at risk of localized infections.

And it urged doctors to consider ordering an MRI for all patients who still have pain, even if the pain is similar to what sent them in for treatment in the first place.

Chiller said the United States had not yet reached the end of the outbreak.

“Unfortunately, with fungi, the incubation periods are so long and they can remain indolent. I’m definitely concerned that we’re going to continue to see more cases.”

(Reporting by Julie Steenhuysen; Editing by Jilian Mincer, Mary Milliken and David Brunnstrom)

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Last-minute fiscal cliff talks in Senate

WASHINGTON (AP) — Senate leaders groped for a last-minute compromise Saturday to avoid middle-class tax increases and possibly prevent deep spending cuts at the dawn of the new year as President Barack Obama warned that failure could mean a "self-inflicted wound to the economy."

Obama chastised lawmakers in his weekly radio and Internet address for waiting until the last minute to try and avoid a "fiscal cliff," yet said there was still time for an agreement. "We cannot let Washington politics get in the way of America's progress," he said as the hurry-up negotiations unfolded.

For all the recent expressions of urgency, bargaining took place by phone, email and paper in a Capitol nearly empty except for tourists. Alone among top lawmakers, Senate Republican leader Mitch McConnell spent the day in his office.

In the Republicans' weekly address, Sen. Roy Blunt of Missouri cited a readiness to compromise. "Divided government is a good time to solve hard problems — and in the next few days, leaders in Washington have an important responsibility to work together and do just that," he said.

Even so, there was no guarantee of success, and a dispute over the federal tax on large estates emerged as yet another key sticking point alongside personal income tax rates.

In a blunt challenge to Republicans, Obama said that barring a bipartisan agreement, he expected both houses to vote on his own proposal to block tax increases on all but the wealthy and simultaneously preserve expiring unemployment benefits.

Political calculations mattered as much as deep-seated differences over the issues, as divided government struggled with its first big challenge since the November elections.

Speaker John Boehner remained at arms-length, juggling a desire to avoid the fiscal cliff with his goal of winning another term as speaker when a new Congress convenes next Thursday. Any compromise legislation is certain to include higher tax rates on the wealthy, and the House GOP rank and file rejected the idea when he presented it to them as part of a final attempt to strike a more sweeping agreement with Obama.

Lawmakers have until the new Congress convenes to pass any compromise, and even the calendar mattered. Democrats said they had been told House Republicans might reject a deal until after Jan. 1, to avoid a vote to raise taxes before they had technically gone up and then vote to cut taxes after they had risen.

Nor was any taxpayer likely to feel any adverse impact if legislation is signed and passed into law in the first two or three days of 2013 instead of the final hours of 2012.

Gone was the talk of a grand bargain of spending cuts and additional tax revenue in which the two parties would agree to slash deficits by trillions of dollars over a decade.

Now negotiators had a more cramped goal of preventing additional damage to the economy in the form of higher taxes across the board — with some families facing increases measured in the thousands of dollars — as well as cuts aimed at the Pentagon and hundreds of domestic programs.

Republicans said they were willing to bow to Obama's call for higher taxes on the wealthy as part of a deal to prevent them from rising on those less well-off.

Democrats said Obama was sticking to his campaign call for tax increases above $250,000 in annual income, even though he said in recent negotiations he said he could accept $400,000. There was no evidence of agreement even at the higher level.

There were indications from Republicans that estate taxes might hold more significance for them than the possibility of higher rates on income.

One senior Republican, Sen. Jon Kyl of Arizona, said late Friday he was "totally dead set" against Obama's estate tax proposal, and as if to reinforce the point, Blunt mentioned the issue before any other in his broadcast remarks. "Small businesses and farm families don't know how to deal with the unfair death tax_a tax that the president and congressional leaders have threatened to expand to include even more family farms and even more small businesses," he said.

Several officials said Republicans want to leave the tax at 35 percent after exempting the first $5 million in estate value. Officials said the White House wants a 45 percent tax after a $3.5 million exemption. Without any action by Congress, it would climb to a 55 percent tax after a $1 million exemption on Jan. 1.

Democrats stressed their unwillingness to make concessions on both income taxes and the estate tax, and said they hoped Republicans would choose which mattered more to them.

Officials said any compromise was likely to ease the impact of the alternative minimum tax, originally designed to make sure that millionaires did not escape taxation. If left unchanged, it could hit an estimated 28 million households for the first time in 2013, with an average increase of more than $3,000.

Taxes on dividends and capital gains are also involved in the talks, as well as a series of breaks for businesses and others due to expire at the first of the year.

Obama and congressional Democrats are insisting on an extension of long-term unemployment benefits that are expiring for about 2 million jobless individuals.

Leaders in both parties also hope to prevent a 27 percent fee cut from taking effect on Jan. 1 for doctors who treat Medicare patients.

There was also discussion of a short-term extension of expiring farm programs, in part to prevent a spike in milk prices at the first of the year. It wasn't clear if that was a parallel effort to the cliff talks or had become wrapped into them.

Across-the-board spending cuts that comprise part of the cliff were a different matter.

Republicans say Boehner will insist that they will begin to take effect unless negotiators agreed to offset them with specified savings elsewhere.

That would set the stage for the next round of brinkmanship — a struggle over Republican calls for savings from Medicare, Medicaid and other federal benefit programs.

The Treasury's ability to borrow is expected to expire in late winter or early spring, and without an increase in the $16.4 trillion limit, the government would face its first-ever default. Republicans have said they will use administration requests for an extension as leverage to win cuts in spending.

Ironically, it was just such a maneuver more than a year ago that set the stage for the current crisis talks over the fiscal cliff.

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C. African Republic neighbors to send help

BANGUI, Central African Republic (AP) — Central African Republic’s neighbors agreed on Friday to dispatch a contingent of soldiers to intervene in the troubled country, where a coalition of rebel groups is seeking to overthrow the president of nearly a decade.

Representatives from the 10-nation Economic Community of Central African States meeting in Gabon, though, did not specify how many troops they could contribute nor did they outline how quickly the military assistance would arrive.

President Francois Bozize had pleaded for international help Thursday as fears grew that the rebels would attack the capital of 600,000 next. Former colonial power France already has said that its forces in the country are there to protect French interests and not Bozize’s government.

“We are now thinking about the arrangements to make so that this mission can be deployed as quickly as possible, said Gabon’s Foreign Affairs Minister Emmanuel Issoze-Ngondet.

The announcement came as military officials in Central African Republic reported renewed fighting in the third largest city of Bambari, which fell under rebel control five days ago.

The military said it had taken country of the town, located about 385 kilometers (240 miles) from the capital, a claim that could not be immediately corroborated.

The ongoing instability prompted the United States to evacuate about 40 people, including the U.S. ambassador, on an U.S. Air Force plane bound for Kenya, said U.S. officials who insisted on anonymity because they weren’t authorized to discuss the operation.

The United States has special forces troops in the country who are assisting in the hunt for Joseph Kony, the fugitive rebel leader of another rebel group known as the Lord’s Resistance Army. The U.S. special forces remain in the country, the U.S. military’s Africa Command said from its headquarters in Stuttgart, Germany.

The evacuation of the U.S. diplomats came in the wake of criticism of how the U.S. handled diplomatic security before and during the attack on its consulate in Benghazi, Libya, on Sept. 11. The ambassador and three other Americans were killed in that attack.

French diplomats are staying despite a violent demonstration outside its embassy earlier this week. Dozens of protesters, angry about a lack of help against rebel forces, threw rocks at the French Embassy in Bangui and stole a French flag. French Foreign Minister Laurent Fabius spoke via phone with Bozize, asking him to take responsibility for the safety of French nationals and diplomatic missions in Central African Republic.

Bozize on Thursday urgently called on former colonial ruler France and other foreign powers to help his government fend off rebels who are quickly seizing territory and approaching the capital. But French President Francois Hollande said France wants to protect its interests in Central African Republic and not Bozize’s government.

This landlocked nation of some 4.4 million people has suffered decades of army revolts, coups and rebellions since gaining independence in 1960 and remains one of the poorest countries in the world. The current president himself came to power nearly a decade ago in the wake of a rebellion in this resource-rich yet deeply poor country.

Speaking to crowds in Bangui, a city of some 600,000, Bozize pleaded with foreign powers to do what they could. He pointed in particular to France. About 200 French soldiers are already in the country, providing technical support and helping to train the local army, according to the French defense ministry.

“France has the means to stop (the rebels) but unfortunately they have done nothing for us until now,” Bozize said.

Bozize’s government earlier reached out to longtime ally Chad, which pledged to send 2,000 troops to bolster Central African Republic’s own forces.

The rebels behind the most recent instability signed a 2007 peace accord allowing them to join the regular army, but insurgent leaders say the deal wasn’t fully implemented. The rebel forces have seized at least 10 towns across the sparsely populated north of the country, and residents in the capital now fear the insurgents could attack at any time, despite assurances by rebel leaders that they are willing to engage in dialogue instead of attacking Bangui.

The rebels have claimed that their actions are justified in light of the “thirst for justice, for peace, for security and for economic development of the people of Central African Republic.”

Despite Central African Republic’s wealth of gold, diamonds, timber and uranium, the government remains perpetually cash-strapped.

The rebels also are demanding that the government make payments to ex-combatants, suggesting that their motives may also be for personal financial gain.

Paris is encouraging peace talks between the government and the rebels, with the French Foreign Ministry noting in a statement that negotiations are due to “begin shortly in Libreville (Gabon).” But it was not immediately clear if any dates have been set for those talks.

The U.N.’s most powerful body condemned the recent violence and expressed concern about the developments.

“The members of the Security Council reiterate their demand that the armed groups immediately cease hostilities, withdraw from captured cities and cease any further advance towards the city of Bangui,” the statement said.

___

Goma reported from Libreville, Gabon. Associated Press writers Krista Larson in Dakar, Senegal; and Jason Straziuso in Nairobi, Kenya contributed to this report.

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Windows Phone Store doubled in size this year

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McCartney, ‘God particle’ scientist get honors

LONDON (AP) — Stella McCartney, who designed the uniforms worn by Britain’s record-smashing Olympic team, and Scottish physicist Peter Higgs, who gave his name to the so-called “God particle,” are among the hundreds being honored by Queen Elizabeth II this New Year.

The list is particularly heavy with Britain’s Olympic heroes, but it also includes “Star Wars” actor Ewan McGregor, eccentric English singer Kate Bush, Roald Dahl illustrator Quentin Blake, and Jamie Lowther-Pinkerton, the royal aide who helped organize the watched-around-the-world wedding of Prince William to Kate Middleton.

McCartney was honored with the title of Officer of the Order of the British Empire, or OBE, in part for her work creating the skintight, red-white-and-blue uniforms worn by British athletes as they grabbed 65 medals during the 2012 games hosted by London. McCartney is the designer daughter of ex-Beatle Paul McCartney and his first wife Linda, and she has moved to make the family name almost as synonymous with fashion as it is with music, setting up a successful business and a critically-acclaimed label.

Higgs’ achievements, which made him a Companion of Honor, touch on the nature and the origins of the universe. The 83-year-old researcher’s work in theoretical physics sought to explain what gives things weight. He said it was while walking through the Scottish mountains that he hit upon the concept of what would later become known as the Higgs boson, an elusive subatomic particle that gives objects mass and combines with gravity to give them weight.

For decades, the existence of such a particle remained just a theory, but earlier this year scientists working at the European Organization for Nuclear Research, or CERN, said they’d found compelling evidence that the Higgs boson was out there. Or in there. Or whatever.

All of Britain’s gold medalists from this year’s games were on the list, with cyclist Bradley Wiggins and sailor Ben Ainslie honored with knighthoods. Sebastian Coe, who masterminded the games as chairman of the London organizing committee, was made a Companion of Honor — a prestigious title also awarded to Higgs.

Honors lists typically include a sprinkling of star power, and this year was no different. Ewan McGregor, who came to public attention through his role as the heroin-addled anti-hero of British drug drama “Trainspotting,” was awarded an OBE. The 41-year-old actor is also known for his turn as a young Obi-Wan Kenobi in the “Star Wars” prequels.

“Babooshka” singer Kate Bush said she was delighted to be made a Commander of the Order of the British Empire, or CBE, for a musical career which has resulted in a string of quirky hits including “Wuthering Heights,” ”Cloudbusting,” and “Man With The Child In His Eyes.”

Other art world honorees included artist Tracey Emin and Quentin Blake, whose spiky, exuberant illustrations are best known through the work of his collaborator Roald Dahl.

Politicians, policemen, and spies got honors too. Scotland Yard chief Bernard Hogan-Howe was awarded a knighthood; former British foreign minister Margaret Beckett was made a Dame Commander of the Order of the British Empire. Former Prime Minister Tony Blair’s wife Cherie was made a CBE for her charity work. MI5 chief Jonathan Evans was made a Knight Commander of the Order of Bath.

Also honored was the man credited with helping pull off the wedding of the decade: Jamie Lowther-Pinkerton, principal private secretary to the Duke and Duchess of Cambridge (as Prince William and his wife are formally known) was made a Lieutenant of the Royal Victorian Order.

Britain’s honors are bestowed twice a year by the monarch, at New Year’s and on her official birthday in June. Although the queen does pick out some lesser honors herself, the vast majority of recipients are selected by government committees from nominations made by officials and members of the public.

In descending order, the honors are knighthoods, CBE, OBE, and MBE — Member of the Order of the British Empire. Knights are addressed as “sir” or “dame.” Recipients of the other honors, such as the Order of the Companions of Honor given to Higgs and Coe or the Royal Victorian Order personally picked out by the queen, receive no title but can put the letters after their names.

The New Year’s honors carried the usual batch of courtiers — even the royal household’s switchboard operator got a medal — as well as senior civil servants, soldiers, charity executives, successful entrepreneurs, established academics, volunteers, and community workers. Some of the more eclectic honors included the OBE handed to card game columnist Andrew Michael Robson “for services to the game of Bridge,” and OBE given to river conservationist Andrew Douglas-Home “for services to Fishing.”

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Humidity Levels Explain U.S. Flu Winter Peak

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All eyes on them, Senate leaders seek fiscal deal

WASHINGTON (AP) — Senate leaders rushed to assemble a last-ditch agreement to avoid middle-class tax increases and possibly delay steep spending cuts in an urgent attempt to find common ground after weeks of postelection gridlock.

An impatient President Barack Obama pressed top lawmakers to cut a deal, even one that falls short of the ambitions he and congressional leaders may once have harbored for a bigger deficit reduction package. Without a resolution, he warned, "every American's paycheck will get a lot smaller."

"Congress can prevent it from happening, if they act now," he said in his weekly Saturday radio and internet address.

Following a White House meeting Friday among Obama and congressional leaders, aides to Senate Republican leader Mitch McConnell of Kentucky and Senate Majority Leader Harry Reid, D-Nev., began racing against the clock for a bipartisan bargain. The leaders could present legislation to senators as early as Sunday, with a vote possible on Sunday or Monday.

The guest list for the White House meeting included Reid, McConnell, House Speaker John Boehner, R-Ohio, and House Democratic leader Nancy Pelosi, D-Calif. But the key players were clearly Reid and McConnell, both of whom stayed behind briefly at the White House and huddled with their staffs and Obama's top legislative aide, Rob Nabors, in the West Wing Cabinet Room just outside the Oval Office.

Neither side expected compromise to be easy. However, McConnell and Reid voiced unexpected optimism that they could work toward a deal that could win support in both their camps.

Warned Reid: "Whatever we come up with is going to be imperfect."

Looking to add pressure on negotiators, Obama said that absent a compromise he expects Reid to put legislation on the floor to prevent tax increases on the middle class and extend unemployment benefits — an implicit challenge to Republicans to dare to vote against what polls show is popular.

Speaking for Republicans in a Saturday radio address, Sen. Roy Blunt of Missouri sought to put the burden of a deal on Obama and Reid.

"We still can avoid going over the fiscal cliff if the president and the Democrat-controlled Senate step forward this week and work with Republicans to solve this problem and solve it now," he said.

Whatever manages to pass in the Senate, with its Democratic majority, would then face a second test in the Republican-controlled House.

Boehner, a Republican speaker who has struggled recently with anti-tax rebels inside his own party, said through an aide that he would await the results of the talks between the Senate and White House. A House vote could come as late as Wednesday, the final full day before a new Congress takes office.

Officials said there was a general understanding that any agreement would block scheduled income tax increases for middle-class earners while letting rates rise at upper-income levels.

Obama was sticking to his campaign call for increases above $250,000 in annual income, even though in recent negotiations he said he could accept $400,000.

The two sides also confronted a divide over estate taxes. Obama favors a higher tax than is currently in effect, but one senior Republican, Sen. Jon Kyl of Arizona, said he's "totally dead set" against it. Speaking of fellow GOP lawmakers, he said they harbor more opposition to an increase in the estate tax than to letting taxes on income and investments rise at upper levels.

But the estate tax was more likely to be used as a possible bargaining chip that Democrats could give away in exchange for higher rates for top earners and other Obama priorities.

Obama and Democrats want to prevent the expiration of unemployment benefits for about 2 million long-term jobless men and women, and there is widespread sentiment in both parties to shelter doctors from a 27 percent cut in Medicare fees.

Also likely to be included in the negotiations are taxes on dividends and capital gains, both of which are scheduled to rise with the new year. Also the alternative minimum tax, which, if left unchanged, could hit an estimated 28 million households for the first time and mean an average increase of more than $3,000.

The White House has shown increased concern about a possible doubling of milk prices if a farm bill is not passed in the next few days, although it is not clear whether that issue too might be included in the talks.

One Republican who was briefed on the White House meeting said Boehner made it clear he would leave in place spending cuts scheduled to take effect unless alternative savings were included in any compromise to offset them. In previous White House proposals, Obama has suggested finding enough cuts in government spending to put off the steeper cuts for up to six months.

Obama, speaking to reporters following his meeting with the congressional leaders, faulted a system that left crucial decisions to the last minute, a way of governing that he said the public finds "mindboggling."

"Outside of Washington nobody understands how it is that this seems to be a repeat pattern, over and over again," he said.

Still, Obama himself is part of the negotiating process, and his meeting with all four top leaders Friday was the first since Nov. 16. A phone call he placed Wednesday night to McConnell was the first the Republican leader had received from a Democrat on the fiscal talks since Thanksgiving.

Looking to add pressure on negotiators, Obama said he expects Reid to put legislation on the floor to prevent tax increases on the middle class and extend unemployment benefits — an implicit challenge to Republicans to dare to vote against what polls show is popular.

The start of negotiations in the Senate marked a new endgame for discussions that have moved in fits and starts since the November election.

Boehner refused for weeks to accept any rate increases, and simultaneously accused Obama of skimping on the spending cuts he would support as part of a balanced deal to reduce deficits, remove the threat of spending cuts and prevent the across-the-board tax cuts.

Last week, the Ohio Republican presented a Plan B measure that would have let rates rise on million-dollar earners, well above Obama's latest offer for a $400,000 threshold.

Facing defeat, Boehner scrapped plans for a vote, leaving the economy on track for the cliff that political leaders in both parties had said they could avoid.

___

Associated Press writers Alan Fram and Andrew Taylor contributed to this report.

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C. African Republic president seeks foreign help

BANGUI, Central African Republic (AP) — The president of Central African Republic on Thursday urgently called on France and other foreign powers to help his government fend off rebels who are quickly seizing territory and approaching the capital, but French officials declined to offer any military assistance.

The developments suggest Central African Republic could be on the brink of another violent change in government, something not new in the history of this resource-rich, yet deeply impoverished country. The current president, Francois Bozize, himself came to power nearly a decade ago in the wake of a rebellion.

Speaking to crowds in Bangui, a city of some 600,000, Bozize pleaded with foreign powers to do what they could. He pointed in particular to France, Central African Republic’s former colonial ruler.

About 200 French soldiers are already in the country, providing technical support and helping to train the local army, according to the French defense ministry.

“France has the means to stop (the rebels) but unfortunately they have done nothing for us until now,” Bozize said.

French President Francois Hollande said Thursday that France wants to protect its interests in Central African Republic and not Bozize’s government. The comments came a day after dozens of protesters, angry about a lack of help against rebel forces, threw rocks at the French Embassy in Bangui and stole a French flag.

Paris is encouraging peace talks between the government and the rebels, with the French Foreign Ministry noting in a statement that negotiations are due to “begin shortly in Libreville (Gabon).” But it was not immediately clear what, if any, dates have been set for those talks.

French Foreign Minister Laurent Fabius, meanwhile, spoke via phone with Bozize, asking the president to take responsibility for the safety of French nationals and diplomatic missions in Central African Republic.

U.S. officials said Thursday the State Department would close its embassy in the country and ordered its diplomatic team to leave. The officials spoke on condition of anonymity because they were unauthorized to discuss the evacuation publicly.

The United Nations Security Council issued a press statement late Thursday reiterating its concern about the situation in the country and condemned the attacks.

“The members of the Security Council reiterate their demand that the armed groups immediately cease hostilities, withdraw from captured cities and cease any further advance towards the city of Bangui,” the statement reads.

Bozize’s government earlier reached out to longtime ally Chad, which pledged to send 2,000 troops to bolster Central African Republic’s own forces. But it was unclear if the Chadian troops had all arrived, and even then, it is far from certain if the combined government forces could withstand rebel attacks.

At least four different rebel groups are involved, though their overall numbers could not immediately be confirmed.

Central African Republic, a landlocked nation of some 4.4 million people, is roughly the size of France. It has suffered decades of army revolts, coups and rebellions since gaining independence in 1960 and remains one of the poorest countries in the world.

The rebels behind the most recent instability signed a 2007 peace accord allowing them to join the regular army, but insurgent leaders say the deal wasn’t fully implemented.

Already, the rebel forces have seized at least 10 towns across the sparsely populated north of the country, and residents in the capital now fear the insurgents could attack at any time, despite assurances by rebel leaders that they are willing to engage in dialogue instead of attacking Bangui.

The rebels have claimed that their actions are justified in light of the “thirst for justice, for peace, for security and for economic development of the people of Central African Republic.”

Despite Central African Republic’s wealth of gold, diamonds, timber and uranium, the government remains perpetually cash-strapped. Filip Hilgert, a researcher with Belgium-based International Peace Information Service, said rebel groups are unhappy because they feel the government doesn’t invest in their areas.

“The main thing they say is that the north of the country, and especially in their case the northeast, has always been neglected by the central government in all ways,” he said.

But the rebels also are demanding that the government make payments to ex-combatants, suggesting that their motives may also be for personal financial gain.

Bozize, a former military commander, came to power in a 2003 rebel war that ousted his predecessor, Ange-Felix Patasse. In his address Thursday, Bozize said he remained open to dialogue with the rebels, but he also accused them and their allies of financial greed.

Those allies, he implied, are outside Central African Republic.

“For me, there are individuals who are being manipulated by an outside hand, dreaming of exploiting the rich Central African Republic soil,” he said. “They want only to stop us from benefiting from our oil, our diamonds, our uranium and our gold.”

___

Larson reported from Dakar, Senegal. Associated Press writer Sarah DiLorenzo in Paris contributed to this report.

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So You Just Got a Wii U. Now What?

Pair It With Your TV

One of the most useful features of the Wii U — and what could make it a staple of our connected living rooms — is its ability to hook in to the entertainment ecosystem seamlessly. When you start up your Wii U for the first time, you’ll be prompted to enter your television and cable box brands. In a surprisingly painless process (you only need the brand name of your TV, not the model number), your Wii U GamePad becomes a very useful remote control. It will be the only thing you have to touch when turning your system and television on in the future. When the Wii U’s television and video on demand aggregation dashboard comes fully online, that remote will be even more useful as you use it select shows on your DVR, video-on-demand services like Netflix, or live TV.

Click here to view this gallery.

[More from Mashable: 10 iPad Cases With Convenient Hand Grips]

Since the holiday gift-giving period is over, many of you might be fortunate enough to have received a brand new Wii U.

Nintendo’s latest console is quite different from other gaming consoles, and there are lots of great ways for you to take advantage of it. There are already a wide variety of games coming out for the Wii U, so you have a plethora of entertainment options as soon as you take it out of the box.

[More from Mashable: 8 Startups to Watch in 2013]

We’ve compiled a list of tips for first-time Wii U owners that should make your setup and first few days much easier. We’ve included a few games to try, as well.

Are you setting up a Wii U for the first time? Share any of your thoughts and tips in the comments.

Thumbnail image courtesy nubobo, Flickr.

This story originally published on Mashable here.

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FBI removes many redactions in Marilyn Monroe file

LOS ANGELES (AP) — The FBI has re-issued files it kept on Marilyn Monroe, removing dozens of redactions from entries related to surveillance of the actress for communist ties.

A large section of the files obtained by The Associated Press focuses on Monroe’s 1962 trip to Mexico and her emerging friendship with Frederick Vanderbilt Field, who was disinherited from his wealthy family for leftist views. Field was Monroe’s guide on a trip in which she furniture-shopped for her new home.

The AP appealed the redactions in the file as part of a series of stories on the 50th anniversary of Monroe’s death in 1962, but the bureau previously said it no longer had access to the files. The bureau issued a new version after a request for details on the records’ locations.

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