Mammograms: For 1 life saved, 3 women overtreated

LONDON (AP) — Breast cancer screening for women over 50 saves lives, an independent panel in Britain has concluded, confirming findings in U.S. and other studies.


But that screening comes with a cost: The review found that for every life saved, roughly three other women were overdiagnosed, meaning they were unnecessarily treated for a cancer that would never have threatened their lives.


The expert panel was commissioned by Cancer Research U.K. and Britain's department of health and analyzed evidence from 11 trials in Canada, Sweden, the U.K. and the U.S.


In Britain, mammograms are usually offered to women aged 50 to 70 every three years as part of the state-funded breast cancer screening program.


Scientists said the British program saves about 1,300 women every year from dying of breast cancer while about 4,000 women are overdiagnosed. By that term, experts mean women treated for cancers that grow too slowly to ever put their lives at risk. This is different from another screening problem: false alarms, which occur when suspicious mammograms lead to biopsies and follow-up tests to rule out cancers that were not present. The study did not look at the false alarm rate.


"It's clear that screening saves lives," said Harpal Kumar, chief executive of Cancer Research U.K. "But some cancers will be treated that would never have caused any harm and unfortunately, we can't yet tell which cancers are harmful and which are not."


Each year, more than 300,000 women aged 50 to 52 are offered a mammogram through the British program. During the next 20 years of screening every three years, 1 percent of them will get unnecessary treatment such as chemotherapy, surgery or radiation for a breast cancer that wouldn't ever be dangerous. The review was published online Tuesday in the Lancet journal.


Some critics said the review was a step in the right direction.


"Cancer charities and public health authorities have been misleading women for the past two decades by giving too rosy a picture of the benefits," said Karsten Jorgensen, a researcher at the Nordic Cochrane Centre in Copenhagen who has previously published papers on overdiagnosis.


"It's important they have at least acknowledged screening causes substantial harms," he said, adding that countries should now re-evaluate their own breast cancer programs.


In the U.S., a government-appointed task force of experts recommends women at average risk of cancer get mammograms every two years starting at age 50. But the American Cancer Society and other groups advise women to get annual mammograms starting at age 40.


In recent years, the British breast screening program has been slammed for focusing on the benefits of mammograms and downplaying the risks.


Maggie Wilcox, a breast cancer survivor and member of the expert panel, said the current information on mammograms given to British women was inadequate.


"I went into (screening) blindly without knowing about the possibility of overdiagnosis," said Wilcox, 70, who had a mastectomy several years ago. "I just thought, 'it's good for you, so you do it.'"


Knowing what she knows now about the problem of overtreatment, Wilcox says she still would have chosen to get screened. "But I would have wanted to know enough to make an informed choice for myself."

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Dozens killed, millions without power in Sandy's wake

PITTSBURGH (AP) — The most devastating storm in decades to hit the country's most densely populated region upended man and nature as it rolled back the clock on 21st-century lives, cutting off modern communication and leaving millions without power Tuesday as thousands who fled their water-menaced homes wondered when — if — life would return to normal.

A weakening Sandy, the hurricane turned fearsome superstorm, killed at least 48 people, many hit by falling trees, and still wasn't finished. It inched inland across Pennsylvania, ready to bank toward western New York to dump more of its water and likely cause more havoc Tuesday night.  Behind it: a dazed, inundated New York City, a waterlogged Atlantic Coast and a moonscape of disarray and debris — from unmoored shore-town boardwalks to submerged mass-transit systems to delicate presidential politics.

"Nature," said New York City Mayor Michael Bloomberg, assessing the damage to his city, "is an awful lot more powerful than we are."

More than 8.2 million households were without power in 17 states as far west as Michigan. Nearly 2 million of those were in New York, where large swaths of lower Manhattan lost electricity and entire streets ended up under water — as did seven subway tunnels between Manhattan and Brooklyn at one point, the Metropolitan Transportation Authority said. The New York Stock Exchange was closed for a second day from weather, the first time that has happened since a blizzard in 1888. The city's subway system, the lifeblood of more than 5 million residents, was damaged like never before and closed indefinitely, and Consolidated Edison said electricity in and around New York could take a week to restore.

"Everybody knew it was coming. Unfortunately, it was everything they said it was," said Sal Novello, a construction executive who rode out the storm with his wife, Lori, in the Long Island town of Lindenhurst, and ended up with 7 feet of water in the basement.

The scope of the storm's damage wasn't known yet. Though early predictions of river flooding in Sandy's inland path were petering out, colder temperatures made snow the main product of Sandy's slow march from the sea. Parts of the West Virginia mountains were blanketed with 2 feet of snow by Tuesday afternoon, and drifts 4 feet deep were reported at Great Smoky Mountains National Park on the Tennessee-North Carolina border.

With Election Day a week away, the storm also threatened to affect the presidential campaign. Federal disaster response, always a dicey political issue, has become even thornier since government mismanagement of Hurricane Katrina in 2005. And poll access and voter turnout, both of which hinge upon how people are impacted by the storm, could help shift the outcome in an extremely close race.

As organized civilization came roaring back Tuesday in the form of emergency response, recharged cellphones and the reassurance of daylight, harrowing stories and pastiches emerged from Maryland north to Rhode Island in the hours after Sandy's howling winds and tidal surges shoved water over seaside barriers, into low-lying streets and up from coastal storm drains.

Images from around the storm-affected areas depicted scenes reminiscent of big-budget disaster movies. In Atlantic City, N.J., a gaping hole remained where once a stretch of boardwalk sat by the sea. In Queens, N.Y., rubble from a fire that destroyed as many as 100 houses in an evacuated beachfront neighborhood jutted into the air at ugly angles against a gray sky. In heavily flooded Hoboken, N.J., across the Hudson River from Manhattan, dozens of yellow cabs sat parked in rows, submerged in murky water to their windshields. At the ground zero construction site in lower Manhattan, sea water rushed into a gaping hole under harsh floodlights.

One of the most dramatic tales came from lower Manhattan, where a failed backup generator forced New York University's Tisch Hospital to relocate more than 200 patients, including 20 babies from neonatal intensive care. Dozens of ambulances lined up in the rainy night and the tiny patients were gingerly moved out, some attached to battery-powered respirators as gusts of wind blew their blankets.

In Moonachie, N.J., 10 miles north of Manhattan, water rose to 5 feet within 45 minutes and trapped residents who thought the worst of the storm had passed. Mobile-home park resident Juan Allen said water overflowed a 2-foot wall along a nearby creek, filling the area with 2 to 3 feet of water within 15 minutes. "I saw trees not just knocked down but ripped right out of the ground," he said. "I watched a tree crush a guy's house like a wet sponge."

In a measure of its massive size, waves on southern Lake Michigan rose to a record-tying 20.3 feet. High winds spinning off Sandy's edges clobbered the Cleveland area early Tuesday, uprooting trees, closing schools and flooding major roads along Lake Erie.

Most along the East Coast, though, grappled with an experience like Bertha Weismann of Bridgeport, Conn.— frightening, inconvenient and financially problematic but, overall, endurable. Her garage was flooded and she lost power, but she was grateful. "I feel like we are blessed," she said. "It could have been worse."

The presidential candidates' campaign maneuverings Tuesday revealed the delicacy of the need to look presidential in a crisis without appearing to capitalize on a disaster. President Barack Obama canceled a third straight day of campaigning, scratching events scheduled for Wednesday in swing-state Ohio, in Sandy's path. Republican Mitt Romney resumed his campaign with plans for an Ohio rally billed as a "storm relief event."

And the weather posed challenges a week out for how to get everyone out to vote. On the hard-hit New Jersey coastline, a county elections chief said some polling places on barrier islands will be unusable and have to be moved.

 "This is the biggest challenge we've ever had," said George R. Gilmore, chairman of the Ocean County Board of Elections.

By Tuesday afternoon, there were still only hints of the economic impact of the storm. Airports remained closed across the East Coast and far beyond as tens of thousands of travelers found they couldn't get where they were going.

Forecasting firm IHS Global Insight predicted the storm will end up causing about $20 billion in damages and $10 billion to $30 billion in lost business. Another firm, AIR Worldwide, estimated losses up to $15 billion — big numbers probably offset by reconstruction and repairs that will contribute to longer-term growth.

"The biggest problem is not the first few days but the coming months," said Alan Rubin, an expert in nature disaster recovery.

Sandy began in the Atlantic and knocked around the Caribbean — killing nearly 70 people — and strengthened into a hurricane as it chugged across the southeastern coast of the United States. By Tuesday night it had ebbed in strength but was joining up with another, more wintry storm — an expected confluence of weather systems that earned it nicknames like "superstorm" and, on Halloween eve, "Frankenstorm."

It became, pretty much everyone agreed Tuesday, the weather event of a lifetime — and one shared vigorously on social media by people in Sandy's path who took eye-popping photographs as the storm blew through, then shared them with the world by the blue light of their smartphones. 

On Twitter , Facebook and the photo-sharing service Instagram, people tried to connect, reassure relatives and make sense of what was happening — and, in many cases, work to authenticate reports of destruction and storm surges. They posted and passed around images and real-time updates at a dizzying rate, wishing each other well and gaping, virtually, at scenes of calamity moments after they unfolded. Among the top terms on Facebook through the night and well into Tuesday, according to the social network: "we are OK," ''made it" and "fine."

Around midday Tuesday, Sandy was about 120 miles east of Pittsburgh, pushing westward with winds of 45 mph, and was expected to turn toward New York State on Tuesday night. Although weakening as it goes, the storm will continue to bring heavy rain and flooding, said Daniel Brown of the National Hurricane Center in Miami.

Atlantic City's fabled Boardwalk, the first in the nation, lost several blocks when Sandy came through, though the majority of it remained intact even as other Jersey Shore boardwalks were dismantled. What damage could be seen on the coastline Tuesday was, in some locations, staggering — "unthinkable," New Jersey Gov. Chris Christie said of what unfolded along the Jersey Shore, where houses were swept from their foundations and amusement park rides were washed into the ocean. "Beyond anything I thought I would ever see."

Resident Carol Mason returned to her bayfront home to carpets that squished as she stepped on them. She made her final mortgage payment just last week. Facing a mandatory evacuation order, she had tried to ride out the storm at first but then saw the waters rising outside her bathroom window and quickly reconsidered.

"I looked at the bay and saw the fury in it," she said. "I knew it was time to go."

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Contributing to this report were Katie Zezima in Atlantic City, N.J.; Alicia Caldwell and Martin Crutsinger in Washington; Colleen Long, Jennifer Peltz, Tom Hays, Larry Neumeister, Ralph Russo and Scott Mayerowitz in New York; Meghan Barr in Mastic Beach, N.Y.; Christopher S. Rugaber in Arlington, Va.; Marc Levy in Harrisburg, Pa.: John Christoffersen in Bridgeport, Conn.; Vicki Smith in Elkins, W.Va.; David Porter in Newark, N.J.; Joe Mandak in Pittsburgh; and Dave Collins in Hartford, Conn.

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Follow Ted Anthony on Twitter at http://twitter.com/anthonyted

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China wants to stop profiteering at temple sites

BEIJING (AP) — China is telling tourist-favored Buddhist temples: Don't let money be your mantra.

Authorities announced a ban this week on temples selling shares to investors after leaders of several popular temples planned to pursue stock market listings for them as commercial entities. Even the Shaolin Temple of kung fu movie fame was once rumored to be planning a stock market debut — and critics have slammed such plans as a step too far in China's already unrestrained commercial culture.

"Everywhere in China now is about developing the economy," complained Beijing resident Fu Runxing, a 40-year-old accountant who said he recently went to a temple where incense was priced at 300 yuan ($50) a stick.

"It's too excessive. It's looting," she said.

Centuries-old Buddhist pilgrimage sites Mount Wutai in Shanxi province, Mount Putuo in Zhejiang and Mount Jiuhua in Anhui all were moving toward listing on stock markets in recent months to finance expansions, according to state media.

The government's religious affairs office called on local authorities to ban profiteering related to religious activity and told them not to allow religious venues to be run as business ventures or listed as corporate assets.

Companies that manage temple sites may be able to bypass the prohibition on listing shares simply by excluding the temples themselves from their lists of assets. A Buddhist site at Mount Emei in Sichuan already has been on the Shenzhen stock exchange since 1997 but its listed assets include a hotel, cable car company and ticket booths — not the temples, which date back several hundred years. Shanghai lawyer Wang Yun said the new prohibition wouldn't likely affect Emei, but might make additional companies think twice before listing.

Turning religious sites into profit-making enterprises is certainly not limited to China, but it illustrates just how commercialized this communist country has become in the past couple of decades, with entrepreneurs seizing on every opportunity to make money. One businessman has started selling canned "fresh air" in polluted Beijing.

No one could have anticipated that the poor and egalitarian China of Mao Zedong's time would become a "Wild West" of commercialism, said Mary Bergstrom, founder of The Bergstrom Group, a marketing consultancy in Shanghai.

"There aren't the established checks and balances in China that exist in other countries ,so people are more willing and able to test the boundaries of what is acceptable, especially if the end result of these tests is potential profit," she said.

The Chinese government has strict controls on religion, with temples, churches and mosques run by state-controlled groups. Even so, religion is booming, along with tourism, giving some places a chance to cash in.

The ban on profiteering from religious activity is "just a reflection of the terrible reality of the over-commercialization in recent years of temples and other places," the Southern Metropolis Daily said in an editorial Wednesday. "People who have been to famous religious places should be familiar with expensive ticket prices and donations for all kinds of things."

Chinese entities from nature parks to religious sites are increasingly turning to commercial activities to pay expenses as government support dwindles in a society with little charitable giving. Temples face heavy costs to maintain centuries-old buildings and gardens.

But the State Administration for Religious Affairs says some local governments, businesses and individuals have built religious sites for profit, hired fake monks and tricked visitors into handing over money.

A notice on its website Monday, issued jointly with the police ministry and other authorities, warned of serious punishment for officials found to be involved in religious profiteering.

The new rules leave open when commercialism crosses the line to profiteering. No matter where the line might be, entrepreneurial officials and religious groups may not heed it.

An employee of the Wutai Scenic District Administration's propaganda office confirmed Wednesday that the local government was planning to pursue a stock market listing but said he couldn't give details. The man, who would give only his surname, Bai, said he didn't know whether the latest notice would affect that plan.

The notion that some temples were becoming more about dollars than dharma first came to the fore in 2009 with reports that the legendary Shaolin monastery and martial arts center might sell shares to investors on a mainland or Hong Kong stock market.

The 1,500-year-old temple has become a lucrative business enterprise and holds registered trademarks, but its managers have denied rumors of floating shares and reiterated that denial Wednesday.

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Associated Press researcher Flora Ji contributed to this report.

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Apple software, retail chiefs out in overhaul

SAN FRANCISCO (Reuters) - Apple Inc CEO Tim Cook on Monday replaced the heads of its software and retail units in the company's biggest executive shake-up in a decade following embarrassing problems with its new mapping program and unpopular store-related decisions.


Software chief Scott Forstall, who oversaw the launch of the flawed mapping software and much criticized Siri voice-enabled assistant, will leave Apple next year.


Forstall, seen as a polarizing figure inside Apple, had been billed as one of the future candidates to take the top job at Apple. He was the executive behind the panned Apple Maps app that the company announced with much fanfare in summer.


Apple said in a statement that retail chief John Browett "is leaving," without elaborating; that a search for his replacement is underway; and the retail team would report directly to Cook. Browett had riled up the retail store staff when he reduced the number of employees in his unit.


The departures come a little more than a year into Cook's tenure as chief executive. Cook replaced the late Apple founder Steve Jobs, considered one of the best executives of all times by many analysts and investors.


"These changes show that Tim Cook is stamping his authority on the business," Ben Wood, analyst with CCS Insight, said. "Perhaps disappointed with the Maps issues, Forstall became the scapegoat."


Apple upended the tech industry with the release of its iPhone smartphone in 2007. But the company is facing increasing competition from search giant Google, whose Android has become the world's most popular mobile software, as well as from Amazon.com Inc, Microsoft and Samsung.


"Competition is moving much faster to be more Apple-like," said Tim Bajarin, president of technology research and consulting firm Creative Strategies. "They're finding they need to streamline the management team in order to get things going faster."


Apple's launch of its own mapping service in September, when it began selling the iPhone 5 and rolled out its updated iOS 6 software, led to widespread user complaints, particularly since it replaced the popular Google Inc Maps.


Apple's Siri personal assistant software also came under a lot of criticism, including for not providing information on business location, when it was launched last year.


Both the services were introduced with much fanfare by Forstall, who had supervised their development as senior vice president of iOS software.


The executive changes hand over substantially more responsibility to Eddy Cue, the head of Internet Software and Services who helped create the iTunes music store and App Store. The 23-year Apple veteran already is in charge of Cloud services and will take on Apple Maps and Siri. Craig Federighi will oversee Apple's mobile iOS software as well as its OS X Mac software, Apple said.


Putting the mobile and personal computer software teams under the same manager could improve operations within the company, particularly as the capabilities and features of smartphones and PCs increasingly converge, said analysts.


"If you have two different heads, you have two different fiefdoms," said BGC Partners analyst Colin Gillis.


Another executive who will get extra responsibility under the shake-up is Jonathan Ive, Apple's head of industrial design, who has played a key role in Apple's success by imbuing its gadgets with a distinct look and feel.


That magic touch could help reinvigorate the look of Apple's software, which has been criticized by some technology observers, Gillis said.


RETAIL SWITCH


Shares of Apple, the world's largest publicly traded company by market value, have declined 14 percent in the past month since reaching a 52-week high of $705.07 in September.


Browett, former CEO of British electronics retailer Dixons, took over as senior vice president of Apple's retail stores earlier this year, replacing Ron Johnson, who went on to become the CEO of JCPenney.


"I think ultimately they probably discovered that his experience with Dixons didn't translate that well to the Apple stores and he just probably wasn't the right fit," Bajarin of Creative Strategies said.


Apple, which described Monday's moves as a way to increase "collaboration" across its hardware, software and services business, said Forstall will serve as an advisor to Cook until his departure.


Last week Apple delivered a second straight quarter of disappointing financial results, and iPad sales fell short of Wall Street's targets, marring its record of consistently blowing past investors' expectations.


(Reporting by Alexei Oreskovic; Editing by Richard Chang)


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China passes law to curb abuse of mental hospitals

BEIJING (AP) — China's legislature on Friday passed a long-awaited mental health law that aims to prevent people from being involuntarily held and unnecessarily treated in psychiatric facilities — abuses that have been used against government critics and triggered public outrage.

The law standardizes mental health care services, requiring general hospitals to set up special outpatient clinics or provide counseling, and calls for the training of more doctors.

Debated for years, the law attempts to address an imbalance in Chinese society — a lack of mental health care services for a population that has grown more prosperous but also more aware of modern-day stresses and the need for treatment. Psychiatrists who helped draft and improve the legislation welcomed its passage.

"The law will protect the rights of mental patients and prevent those who don't need treatment from being forced to receive it," said Dr. Liu Xiehe, an 85-year-old psychiatrist based in the southwestern city of Chengdu, who drafted the first version of the law in 1985.

"Our mental health law is in line with international standards. This shows the government pays attention to the development of mental health and the protection of people's rights in this area," Liu told The Associated Press by phone.

Pressure has grown on the government in recent years after state media and rights activists reported cases of people forced into mental hospitals when they did not require treatment. Some were placed there by employers with whom they had wage disputes, some by their family members in fights over money, and others — usually people with grievances against officials — by police who wanted to silence them.

Yang Yamei, of the Inner Mongolian city of Hulunbuir, has been locked up at a local mental hospital for the last eight months in what her daughter says is retaliation for her attempts to seek compensation from the government for a court ruling that unfairly sentenced her to three years in a labor camp.

This is the third time in four years that she has been forcibly committed, her daughter Guo Dandan said by phone.

"It's because my mother has been petitioning for help, but the authorities don't want to solve her problems, so they put her in there," Guo said. "I have tried many times to persuade her doctors to release her, but they refuse."

Guo's claim could not be independently verified. Local government offices and the mental hospital could not immediately be reached for comment.

"I only hope that the law will be stricter," Guo said. "In the cases of petitioners, when the authorities can use their personal relationships with doctors to fake medical records, hospitals should not be allowed to accept such cases."

The law states for the first time that mental health examinations and treatment must be conducted on a voluntary basis, unless a person is considered a danger to himself or others. Only psychiatrists have the authority to commit people to hospitals for treatment, and treatment may be compulsory for patients diagnosed with a severe mental illness, according to the law.

Significantly, the law gives people who feel they have been unnecessarily admitted into mental health facilities the right to appeal.

But it will likely be a challenge for people to exercise that right once they are in the system, said Huang Xuetao, a lawyer who runs an organization in the southern city of Shenzhen that assists people who have been committed against their will.

Though questions remain over how the law will be enforced and whether sufficient government funding will be provided to enable the expansion of services, psychiatrists said the passage of the legislation marked a milestone.

"It's very exciting. I honestly believe this will start a new trajectory," said Dr. Michael Phillips, a Canadian psychiatrist who has worked in China for nearly three decades and now heads a suicide research center in Shanghai.

Phillips said the biggest change for the psychiatric system is the curb on involuntary admissions. At least 80 percent of hospital admissions are compulsory, he said.

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Associated Press researcher Flora Ji contributed to this report.

Follow Gillian Wong on Twitter: http://twitter.com/gillianwong

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Superstorm Sandy slams into New Jersey coast

ATLANTIC CITY, N.J. (AP) — Superstorm Sandy slammed into the New Jersey coastline with 80 mph winds and hurled a record-breaking 13-foot surge of seawater at New York City on Monday, roaring ashore after washing away part of the Atlantic City boardwalk and putting the presidential campaign on hold.

Just before its center reached land, the storm was stripped of hurricane status, but the distinction was purely technical, based on its shape and internal temperature. It still packed hurricane-force wind, and forecasters were careful to say it remained every bit as dangerous to the 50 million people in its path.

The National Hurricane Center announced at 8 p.m. that Sandy had come ashore about five miles from Atlantic City. The sea surged a record of nearly 13 feet at the Battery, at the foot of Manhattan.

In an attempt to lessen damage from the storm, New York City's main utility cut power to about 6,500 customers in lower Manhattan, which includes Wall Street. Authorities worried that seawater would seep into the subway and cripple it, along with the electrical and communications systems vital to the nation's financial center.

As it closed in, Sandy knocked out power to more than 1.5 million people and smacked the boarded-up big cities of the Northeast corridor — Washington, Baltimore, Philadelphia, New York and Boston, with stinging rain and gusts of more than 85 mph.

At least four deaths were blamed on the storm in Maryland, Pennsylvania, Connecticut and New York. Among them were two people killed by falling trees.

As Sandy made its way toward land, it converged with a cold-weather system out of the west that turned into a fearsome superstorm, a monstrous hybrid consisting not only of rain and high wind but of snow. Forecasters warned of 20-foot waves bashing into the Chicago lakefront and up to 3 feet of snow in West Virginia.

Airlines canceled more than 12,000 flights, disrupting the plans of travelers all over the world, and storm damage was projected at $10 billion to $20 billion, meaning it could prove to be one of the costliest natural disasters in U.S. history.

President Barack Obama and Republican challenger Mitt Romney canceled their campaign appearances at the very height of the race, with just over a week to go before Election Day. The president pledged the government's help and made a direct plea from the White House to those in the storm's path.

"When they tell you to evacuate, you need to evacuate," he said. "Don't delay, don't pause, don't question the instructions that are being given, because this is a powerful storm."

Sandy, which killed 69 people in the Caribbean before making its way up the Atlantic, began to hook left at midday toward the New Jersey coast.

The storm lost its status as hurricane because it no longer had a warm core center nor the convection — the upward air movement in the eye — that traditional hurricanes have, but it was still as dangerous as it was when it was considered a hurricane, according to National Hurricane Center spokesman Dennis Feltgen.

Pete Wilson, who owns an antiques shop in Cape May, N.J., at the state's southern tip and directly in Sandy's path, said the water was 6 inches above the bottom edge of the door. He had already taken a truckload of antiques out but was certain he would take a big hit.

"My jewelry cases are going to be toast," he said. "I am not too happy. I am just going to have to wait, and hopefully clean up."

New Jersey Gov. Chris Christie said people were stranded in Atlantic City, which sits on a barrier island and was mostly under water late Monday. He accused the mayor of allowing them to stay there.

With the hurricane fast approaching, Christie warned it was no longer safe for rescuers, and advised people who didn't evacuate the barrier islands to "hunker down" until morning.

"I hope, I pray, that there won't be any loss of life because of it," he said.

While the hurricane's winds registered as only a Category 1 on a scale of five, it packed "astoundingly low" barometric pressure, giving it terrific energy to push water inland, said Kerry Emanuel, a professor of meteorology at MIT.

"We are looking at the highest storm surges ever recorded" in the Northeast, said Jeff Masters, meteorology director for Weather Underground, a private forecasting service. "The energy of the storm surge is off the charts, basically."

In New York City, authorities worried that salt water would seep through the boarded-up street grates and through the sandbags placed at subway entrances, damaging the electrical connections needed to operate the subway.

Hours before landfall, there was graphic evidence of the storm's power.

A construction crane atop a luxury high-rise in New York City collapsed in the wind and dangled precariously 74 floors above the street. Forecasters said the wind at the top the building may have been close to 95 mph.

Off North Carolina, a replica of the 18th-century sailing ship HMS Bounty that was built for the 1962 Marlon Brando movie "Mutiny on the Bounty" went down in the storm, and 14 crew members were rescued by helicopter from rubber lifeboats bobbing in 18-foot seas. Another crew member was found hours later but was unresponsive. The captain was missing.

At Cape May, water sloshed over the seawall, and it punched through dunes in other seaside communities. Sandy also tore away an old section of Atlantic City's historic boardwalk.

"When I think about how much water is already in the streets, and how much more is going to come with high tide tonight, this is going to be devastating," said Bob McDevitt, president of the main Atlantic City casino workers union. "I think this is going to be a really bad situation tonight."

In Maryland, at least 100 feet of a fishing pier at the beach resort of Ocean City was destroyed, and Gov. Martin O'Malley said there would be devastating flooding from the swollen Chesapeake Bay.

"There will be people who die and are killed in this storm," he said.

At least half a million people had been ordered to evacuate, including 375,000 from low-lying parts of New York City, and by the afternoon authorities were warning that it could be too late for people who had not left already.

Millions of people stayed home from work. Sheila Gladden evacuated her home in Philadelphia's flood-prone Eastwick neighborhood, which took on 5½ feet of water during Hurricane Floyd in 1999, and headed for a hotel.

"I'm not going through this again," she said.

Those who stayed behind had few ways to get out. New York's subways, which serve 5 million people a day, were shut down. The Holland Tunnel connecting New York to New Jersey was closed, as was a tunnel between Brooklyn and Manhattan, and the city planned to shut down the Brooklyn Bridge, the George Washington, the Verrazano-Narrows and several other spans because of high winds.

Stock and bond markets were closed Monday and Tuesday, the first shutdown since the days after the Sept. 11 attacks in 2001 and the first two-day closing of the stock market because of weather since a blizzard in 1888. The New York Stock Exchange is inside the mandatory evacuation zone in lower Manhattan, blocks from New York Harbor.

If the storm reaches the higher estimate of $20 billion in damage, that would put it ahead of Hurricane Irene, which raked the Northeast in August 2011 and caused $16 billion in damage. Hurricane Katrina, which killed 1,200 people, cost $108 billion.

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McClam reported from New York. AP Science Writer Seth Borenstein contributed to this report from Washington. Associated Press writers Allen G. Breed in Raleigh, N.C.; David Porter in Pompton Lakes, N.J.; Wayne Parry in Point Pleasant Beach, N.J.; and David Dishneau in Delaware also contributed.

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UN says 22,000 displaced in latest Myanmar unrest

SITTWE, Myanmar (AP) — Victims of Myanmar's latest explosion of Muslim-Buddhist violence fled to already packed displacement camps along the country's western coast, with a top U.N. official saying the unrest has forced more than 22,000 people from their homes.

State television reported the casualty toll has risen to 84 dead and 129 injured over the past week in nine townships in Rakhine state. The figures have not been broken down by ethnic group, but New York-based Human Rights Watch has said Rohingya Muslims bore the brunt of the unrest and the true death toll may be far higher.

On Sunday, wooden boats carrying some refugees arrived outside the state capital, Sittwe. The people trudged to the Thechaung camp, already home to thousands of Rohingya who took refuge there after a previous wave of violence in June.

"I fled my hometown, Pauktaw, on Friday because there is no security at all," said 42-year-old fisherman Maung Myint, who arrived on a boat carrying 40 other people, including his wife and six children. "My house was burned to ashes and I have no money left."

Another Muslim refugee said she fled her village, Kyaukphyu, on Thursday after attackers set her home on fire.

"We don't feel safe," said 40-year-old Zainabi, a fish seller who left with her two sons, aged 12 and 14. "I wish the violence would stop so we can live peacefully."

Human Rights Watch released dramatic satellite imagery of Kyaukphyu on Saturday showing a vast, predominantly Rohingya swath of the village in ashes. The destruction included more than 800 buildings and floating barges.

There were no reports of new violence Sunday. It was unclear what sparked the latest clashes, but ill will between Muslims and Buddhists in Rakhine state goes back decades and has its roots in a dispute over the Rohingya's origins. Although many Rohingya have lived in Myanmar for generations, they are seen as foreign intruders who came from Bangladesh to steal scarce land.

Today, the Rohingya also face official discrimination, a policy encouraged by Myanmar's previous military regimes to enlist popular support among other groups. A 1984 law formally excluded them as one of the country's 135 ethnicities, meaning most are denied basic civil rights and are deprived of citizenship.

Neighboring Bangladesh, which also does not recognize the Rohingya as citizens, says thousands of Rohingya refugees have sought to flee there by boat. Its policy, however, is to refuse them entry.

Rights groups say Myanmar's failure to address the root causes of the crisis means the situation may worsen.

Over the weekend, Border Affairs Minister Lt. General Thein Htay traveled to the affected areas with the U.N. resident and humanitarian coordinator in Myanmar, Ashok Nigam.

Nigam said 22,587 were displaced and they included both Muslims and ethnic Rakhine Buddhists, but he gave no breakdown.

Speaking to The Associated Press on Sunday while visiting Thechaung camp, Nigam said getting aid to the new wave of displaced people will be a challenge as some fled on boats and others have sought refuge on isolated hilltops.

"The situation is certainly very grave and we are working with the government to provide urgent aid to these people," he said.

Some 4,600 homes were also destroyed, according to the U.N, which said it had begun distributing emergency food and shelter supplies to refugees.

The latest unrest pushes the total displaced to nearly 100,000 since the clashes in June, when at least 90 people died and 3,000 homes were destroyed. About 75,000 people, mostly Rohingya, have lived in refugee camps since then.

"It is critically important that the government ensures that the rule of law prevails, prevents any further spreading of this violence and continues to communicate strong messages of harmony," Nigam said in a statement later Sunday.

"The violence, fear and mistrust are contrary to the democratic transition and economic and social development that Myanmar is committed to," Nigam said. "It should not become an impediment to progress."

___

Associated Press writers Aye Aye Win in Yangon and Todd Pitman in Bangkok contributed to this report.

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SAP eyes "long" period of high sales growth: report

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FDA: Pharmacy tied to outbreak knew of bacteria

WASHINGTON (AP) — Staffers at a pharmacy linked to the deadly meningitis outbreak documented dozens of cases of mold and bacteria growing in rooms that were supposed to be sterile, according to federal health inspectors.

In a preliminary report on conditions at the pharmacy, the Food and Drug Administration said Friday that even when the contamination at New England Compounding Center exceeded the company's own safety levels, there is no evidence that staffers investigated or corrected the problem. The FDA uncovered some four dozen reports of potential contamination in company records, stretching back to January this year.

The report comes from an FDA inspection of the Framingham, Mass.-based company earlier this month after steroid injections made by the company were tied to an outbreak of fungal meningitis. FDA officials confirmed last week that the black fungus found in the company's vials was the same fungus that has sickened 338 people across the U.S., causing 25 deaths.

The New England Compounding Center's lawyer said Friday the pharmacy "will review this report and will continue our cooperation with the FDA."

Compounding pharmacies like NECC traditionally fill special orders placed by doctors for individual patients, turning out a small number of customized formulas each week. They have traditionally been overseen by state pharmacy boards, though the FDA occasionally steps in when major problems arise. Some pharmacies have grown into much larger businesses in the last 20 years, supplying bulk orders of medicines to hospitals that need a steady supply of drugs on hand.

The FDA report provides new details about NECC's conditions, which were first reported by state officials earlier this week. The drug at the center of the investigation is made without preservative, so it's very important that it be made under highly sterile conditions. Compounding pharmacies prepare their medications in clean rooms, which are supposed to be temperature-controlled and air-filtered to maintain sterility.

But FDA inspectors noted that workers at the pharmacy turned off the clean room's air conditioning every night. FDA regulators said that could interfere with the conditions needed to prevent bacterial growth.

Inspectors also say they found a host of potential contaminants in or around the pharmacy's clean rooms, including green and yellow residues, water droplets and standing water from a leaking boiler.

Additionally, inspectors found "greenish yellow discoloration" inside an autoclave, a piece of equipment used to sterilize vials and stoppers. In another supposedly sterile room inspectors found a "dark, hair-like discoloration" along the wall. Elsewhere FDA staff said that dust from a nearby recycling facility appeared to be drifting into the pharmacy's rooftop air-conditioning system.

The FDA on Friday declined to characterize the severity of the problems at NECC, or to speculate on how they may have led to contamination of the products made by the pharmacy. FDA emphasized that the report is based on "initial observations" and that the agency's investigation is ongoing.

The agency also provided new details about the pharmacy's handling of the steroids it recalled last month. The company recalled three lots of steroids made since May that totaled 17,676 single-dose vials of medicine — roughly equivalent to 20 gallons. The shots are mainly used to treat back pain.

According to the agency's report, the pharmacy began shipping vials from the August lot to customers on Aug. 17. That was nearly two weeks before the pharmacy received test results from an outside laboratory confirming the sterility of the drug. When FDA scientists went back and tested the same lot this month, they found contamination in 50 vials.

Outside experts said the report paints a picture of a dysfunctional operation.

"The entire pharmacy was an incubator of bacteria and fungus," said Sarah Sellers, a former FDA officer who left the agency in 2008 after unsuccessfully pushing it to increase regulation of compounding pharmacies. She now consults for drug manufacturers. "The pharmacy knew this through monitoring results, and chose to do nothing."

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Sandy: East Coast braces for epic hurricane, ‘life-threatening’ storm surge

Waves crash into a pier in Nags Head, N.C., Oct. 27, 2012. (Gerry Broome/AP)


[UPDATED: 8:00 p.m. ET]


"Superstorm." "The Perfect Storm." "Frankenstorm."


Whatever you want to call it, the East Coast is bracing for Hurricane Sandy, a "rare hybrid storm" that is expected to bring a life-threatening storm surge to the mid-Atlantic coast, Long Island Sound and New York harbor, forecasters say, with winds expected to be at or near hurricane force when it makes landfall sometime on Monday.


According to the National Hurricane Center, the Category 1 hurricane was centered about 280 miles southeast of Cape Hatteras, N.C., and 485 miles south of New York City early Sunday, carrying maximum sustained winds of 75 mph and moving northeast at 15 mph.


[Slideshow: Latest photos from Hurricane Sandy]


New York Mayor Michael Bloomberg ordered the immediate, mandatory evacuation for low-lying coastal areas, including Coney Island, the Rockaways, Brighton Beach, Red Hook and some parts of lower Manhattan along the East River.


"If you don't evacuate, you're not just putting your own life at risk," Mayor Bloomberg said at a news conference Sunday. "You're endangering first responders who may have to rescue you."


New Jersey Governor Chris Christie's message for residents was a bit more blunt. "Don't be stupid," Christie said Sunday afternoon, announcing the suspension of the state's transit system beginning at 12:01 a.m. Monday.


Earlier, New York Governor Andrew Cuomo announced the suspension of all MTA service--including subways, buses, Long Island Railroad and Metro North--beginning at 7 p.m. Sunday. New York City Public Schools will be closed on Monday, the mayor said. The New York Stock Exchange said its trading floor will be closed on Monday, too--the first such shutdown in 27 years, according to the Wall Street Journal.


[Related: Superstorm could impact 60 million]


Sandy is expected to continue on a parallel path along the mid-Atlantic coast later Sunday before making a sharp turn toward the northwest and southern New Jersey coastline on Monday--with the Jersey Shore and New York City in its projected path.


But the path is not necessarily the problem.


"Don't get fixated on a particular track," the Associated Press said. "Wherever it hits, the rare behemoth storm inexorably gathering in the eastern U.S. will afflict a third of the country with sheets of rain, high winds and heavy snow."


(FEMA)


A tropical storm warning has been issued between Cape Fear to Duck, N.C., while hurricane watches and high-wind warnings are in effect from the Virginia to Massachusetts. The hurricane-force winds extend 175 miles from the epicenter of the storm, while tropical storm-force winds extend 500 miles--or roughly 1,000 miles end to end, making Sandy one of the biggest storms to ever hit the East Coast.


"We're looking at impact of greater than 50 to 60 million people," Louis Uccellini, head of environmental prediction for the National Oceanic and Atmospheric Administration, told the Associated Press.


"The size of this alone, affecting a heavily populated area, is going to be history making," Jeff Masters wrote on the Weather Underground blog.


President Barack Obama received a briefing on the storm at Federal Emergency Management Agency headquarters in Washington on Sunday. "My main message to everybody involved is that we have to take this seriously," President Obama said. "[We will] respond big and respond fast."


[Also read: Big storm scrambles presidential race schedules]


"I can be as cynical as anyone," Christie said on Saturday, announcing a state of emergency. "But when the storm comes, if it's as bad as they're predicting, you're going to wish you weren't as cynical as you otherwise might have been."


Meanwhile, emergency evacuations were being mulled by state officials in Connecticut, Massachusetts, Vermont, New Hampshire and even Maine.


In Virginia, Governor Bob McDonnell said 20,000 homes there had already reported power outages.


(Weather.com)


"This is not a coastal threat alone," said FEMA director Craig Fugate said during a media briefing early Sunday. "This is a very large area."


Forecasters also fear the combination of storm surge, high tide and heavy rain--between 3 and 12 inches in some areas--could be life-threatening for coastal residents.


According to the National Hurricane Center summary, coastal water levels could rise anywhere between 1 and 12 feet from North Carolina to Cape Cod, depending on the timing of the "peak surge." A surge of 6 to 11 feet is forecast for Long Island Sound and Raritan Bay, including New York Harbor.


The storm surge in New York Harbor during Hurricane Irene in September 2011, forecasters noted, was four feet.


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