U.S. to give Syrian rebels medical, food aid, not arms

ROME (Reuters) - The United States will send non-lethal aid directly to Syrian rebels for the first time, Secretary of State John Kerry said on Thursday, disappointing opponents of President Bashar al-Assad who are clamoring for Western weapons.

But in a change of emphasis, the mainly Western and Arab "Friends of Syria" group meeting in Rome "underlined the need to change the balance of power on the ground".

A final communique said participants would "coordinate their efforts closely so as to best empower the Syrian people and support the Supreme Military Command of the (rebel) Free Syrian Army in its efforts to help them exercise self-defense".

More than 70,000 Syrians have been killed in a fierce conflict that began with peaceful anti-Assad protests nearly two years ago. Some 860,000 have fled abroad and several million are displaced within the country or need humanitarian assistance.

Kerry, after the talks in Rome, said Washington would more than double its aid to the Syrian civilian opposition, giving it an extra $60 million to help provide food, sanitation and medical care to devastated communities.

The United States would now "extend food and medical supplies to the opposition, including to the Syrian opposition's Supreme Military (Council)", Kerry said.

In their communique, the "Friends of Syria" pledged more political and material support to the Syrian National Coalition, a fractious Cairo-based group that has struggled to gain traction inside Syria, especially among disparate rebel forces.

Riad Seif, a coalition leader, said before the Rome meeting that the opposition would demand "qualitative military support".

Another coalition official welcomed the result of the talks. "We move forward with a great deal of cautious optimism. We heard today a different kind of discourse," Yasser Tabbara said.

But the continued U.S. refusal to send weapons may compound the frustration that prompted the coalition to say last week it would shun the Rome talks. It attended only under U.S. pressure.

Many in the coalition say Western reluctance to arm rebels only plays into the hands of Islamist militants now widely seen as the most effective forces in the struggle to topple Assad.

However, a European diplomat held out the possibility of Western military support, saying the coalition and its Western and Arab backers would meet in Istanbul next week to discuss military and humanitarian support to the insurgents.

MEALS READY TO EAT

Kerry's offer of medical aid and Meals Ready to Eat (MREs), the U.S. army's basic ration, fell far short of rebel demands for sophisticated anti-tank and anti-aircraft weapons to help turn the tables against Assad's mostly Russian-supplied forces.

It also stopped short of providing other forms of non-lethal assistance such as bullet-proof vests, armored personnel vehicles and military training to the insurgents.

Last week the European Union opened the way for direct aid to Syrian rebels, but did not lift an arms embargo on Syria.

The Rome talks again signaled the lack of appetite among the United States and its allies for direct military intervention in Syria, after the withdrawal of U.S.-led troops from Iraq and the drawdown under way in Afghanistan.

The communique called for an immediate halt to "unabated" arms supplies to Damascus by third countries, referring mostly to Assad's allies Russia and Iran.

It also said Syria must immediately stop indiscriminate bombardment of populated areas, which it described as crimes against humanity. NATO officials say Assad's military has fired ballistic missiles within Syria, which the government denies.

Human Rights Watch has reported that at least 171 civilians were killed in four Scud missile strikes last week.

The "Friends of Syria" pledged "more political and material support to the coalition as the sole legitimate representative of the Syrian people and to get more concrete assistance inside Syria", but gave no details on exactly what would be provided.

Kerry said earlier this week he would not leave the Syrian opposition "dangling in the wind", unsure of getting support.

But the White House continues to resist providing weaponry to the rebel forces, arguing there is no way to guarantee the arms might not fall into the hands of Islamist militants who might eventually use them against Western or Israeli targets.

"HUGE DEBATE"

U.S. officials have said that the U.S. Defense and State departments, under former Secretary of Defense Leon Panetta and former Secretary of State Hillary Clinton, privately recommended that the White House arm the rebels, but were overruled.

"It's a huge debate inside the administration between those that have to deal with Syria on an everyday basis, the State Department and DoD (Defense) particularly, and the White House, which ... until now has vetoed any kind of outreach to the armed groups," said Andrew Tabler, senior fellow at the Washington Institute for Near East Policy, a think-tank.

The United States says it has already provided more than $50 million in non-lethal assistance such as communications gear and governance training to Syria's civilian opposition.

A source in the Syrian coalition, however, said even the extra $60 million promised by Washington was a pittance compared to what he said was the $40 million a day in humanitarian aid needed for Syrian refugees and internally displaced persons.

The United States has provided some $365 million in humanitarian aid for Syrian refugees in countries such as Turkey, Jordan and Lebanon and for internally displaced people, channeling this money through non-governmental organizations.

More than 40,000 people a week are fleeing Syria and the total number of refugees will likely pass 1 million in less than a month, far sooner than the United Nations had forecast, a senior U.N. official told the Security Council on Wednesday.

U.N. High Commissioner for Refugees António Guterres said his agency had registered 936,000 Syrians across the Middle East and North Africa, nearly 30 times as many as in April last year.

"We expected to have 1.1 million Syrian refugees by June. If things continue to accelerate like this, it will take less than a month to reach that number," he told the 15-member council.

(Writing by Alistair Lyon; Editing by Mark Heinrich)

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Debbie Reynolds: Carrie Fisher Will Be 'Just Fine' After Hospitalization

By Elaine Aradillas

02/28/2013 at 08:40 AM EST

Carrie Fisher (left) and Debbie Reynolds

Ethan Miller/Getty

Carrie Fisher was briefly hospitalized last week for her bipolar disorder after a bizarre performance aboard a cruise ship, but her mother Debbie Reynolds says she'll be fine.

"She's had manic depression bipolar since she was 13. It's an illness, and she's doing much better," Reynolds told PEOPLE exclusively Wednesday night. "I'm very proud of her, and she's doing exceptionally well. She'll be just fine, just great, and continue her writing as she always does."

Fisher, 56, who has spoken openly about her mental illness, performed on the Holland American cruise liner Eurodam in the Caribbean. The actress and author gave a rambling performance, leaving many in the audience wondering what was wrong.

"She clearly had trouble remembering things," says Chris Smith, a guest on the cruise. "She tried to tell some stories about her parents and Hollywood, but was having a hard time."

After a video of the performance went viral, her publicist released the following statement: "There was a medical incident related to Carrie Fisher's bipolar disorder. She went to the hospital briefly to adjust her medication and is feeling much better now."

Reynolds, 80, who spoke Wednesday to a sold-out audience attending the Rancho Mirage Lecture Series at Eisenhower Medical Center in Rancho Mirage, Calif., talked about the effects of mental illness.

"[It's] really dreadful, and you are so alone because you're criticized, and people think you're doing it on purpose, and that you're misbehaving or having a spell because you want attention," she says. "It's not true. It's extremely difficult for everyone to deal with."

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Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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On the Web:

The OIG report: http://1.usa.gov/VaztQm

The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1

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Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

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Iran upbeat on nuclear talks, West wary

ALMATY (Reuters) - Iran gave an upbeat assessment of two days of nuclear talks with world powers that ended on Wednesday, but Western officials said Tehran must start taking concrete steps to ease mounting concerns about its atomic activity.

The first negotiations between Iran and six world powers in eight months ended without a breakthrough in Almaty, but they agreed to meet again at expert level in Istanbul next month and resume political discussions in the Kazakh city on April 5.

Israel, assumed to be the Middle East's only nuclear-armed power, is watching the talks closely. It has strongly hinted it might attack Iran if diplomacy and sanctions fail to stop it from acquiring nuclear weapons. Iran denies any such aim.

Iran's foreign minister said he was optimistic an agreement could be reached with the powers - the United States, France, Russia, Britain, Germany and China - on the country's disputed nuclear program.

"Very confident," Ali Akbar Salehi told Reuters when asked on the sidelines of a U.N. conference in Vienna how confident he was of a positive outcome.

The six powers offered at the February 26-27 Almaty meeting to lift some sanctions if Iran scaled back nuclear activity that the West fears could be used to build a bomb.

Tehran, which says its program is entirely peaceful, did not agree to do so and the sides did not appear any closer to a deal to resolve a decade-old dispute that could lead to another war in the Middle East if diplomacy fails.

But Iran still said the talks were a positive step in which the six powers tried to "get closer to our viewpoint".

Western officials had made clear they did not expect major progress in Almaty, aware that the closeness of Iran's presidential election in June is raising political tensions in Tehran and makes significant concessions unlikely.

"I hope the Iranian side is looking positively on the proposal we put forward," said European Union foreign policy chief Catherine Ashton, who led the talks on behalf of the powers. "We have to see what happens next."

The United States did not expect a breakthrough and "the result was clearly in line with those expectations," a senior U.S. official said.

The meeting was "useful" as the two sides agreed dates and venues for follow-up talks but there was a need for progress on confidence building measures, the official added.

UNDERGROUND NUCLEAR SITE

The West's immediate priority is that Iran halts higher-grade uranium enrichment and closes an underground facility, Fordow, where this work is carried out. The material is a relatively short technical step from bomb-grade uranium.

"What we care about at the end is concrete results," the U.S. official said.

One diplomat in Almaty said the Iranians appeared to be suggesting at the negotiations that they were opening new avenues, but that it was not clear if this was really the case.

Both sides said experts would meet for talks in the Turkish city of Istanbul on March 18 and that political negotiators would return to Almaty on April 5-6.

Russian negotiator Sergei Ryabkov confirmed that the powers had offered to ease sanctions on Iran if it stops enriching uranium to 20 percent fissile purity - a short technical step from weapons grade - at the Fordow underground site where it carries out its most controversial uranium enrichment work.

Western officials said the offer of sanctions relief included a resumption of trade in gold and precious metals.

One diplomat said that lifting an embargo on imports of Iranian petrochemical products to Europe, if Iran responded, was also on the table. But a U.S. official said the world powers had not offered to suspend oil or financial sanctions.

The sanctions are hurting Iran's economy and its chief nuclear negotiator, Saeed Jalili, suggested Iran could discuss its production of higher-grade nuclear fuel, although he appeared to rule out shutting Fordow.

In comments in Persian translated into English, Jalili told a news conference Fordow was under the supervision of the U.N. nuclear watchdog and there was no justification for closing it.

MOOD "MORE OPTIMISTIC"

Asked about the production of 20-percent enriched fuel, he reiterated Iran's position that it needed this for a research reactor and had a right to produce it.

Iran says its enrichment program is aimed solely at fuelling nuclear power plants so that it can export more oil, and that Israel's assumed nuclear arsenal is the main threat to peace in the region.

But Jalili did indicate that Iran might be prepared to talk about the issue, saying: "This can be discussed in the negotiations ... in view of confidence building."

Iran has also previously suggested that 20-percent enrichment was up for negotiation if it received the fuel from abroad instead. It also wants sanctions lifted.

"While an agreement to meet again may not impress skeptics of diplomacy, an important development did occur," said Trita Parsi, an expert on Iran. "The parties began searching for a solution by offering positive measures in order to secure concessions from the other side.

Another expert, Dina Esfandiary of the International Institute for Strategic Studies, said: "I note that the mood is more optimistic and that's great, but a deal still hasn't been reached and in my view its unlikely to be reached before the Iranian elections have come and gone."

(Additional reporting Fredrik Dahl in Almaaty, Georgina Prodhan in Vienna, Zahra Hosseinian in Zurich, Gabriela Baczynska in Moscow, Dan Williams in Jerusalem and Marcus George in Dubai; Writing by Timothy Heritage and Fredrik Dahl; Editing by Jon Hemming)

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Titanic to Sail Again - But Will You Get Onboard?

By Stephen M. Silverman

02/27/2013 at 09:15 AM EST

Leonardo DiCaprio and Kate Winslet, in Titanic

Paramount Pictures/AP

It's the biggest Oscar winner of all time, but it's also a code word for disaster: Titanic.

Now, an Australian billionaire plans to recreate the legendary ship, and charge $1 million for a first-class cabin when his replica Titanic II re-traces the original 1912 route of the great ship that went down.

Once the new ship is built in China, its maiden voyage is scheduled for late 2016 and will hopefully go the full distance from England's Southampton to New York's West Side.

Its furnishings, said its financier Clive Palmer, will include a Turkish bath (just like on the original) and the ornate grand staircase which Leonardo DiCaprio and Kate Winslet descended in the 1997 James Cameron movie.

It will also have some things the original didn't: air-conditioning and enough lifeboats.

But will it be "unsinkable?" Unthinkable, Palmer said at a press conference in New York Tuesday.

"Anything will sink if you put a hole in it," he said. "I think it would be very cavalier to say it."

The ship will have three separate classes – with no mingling among them, like in the movie – and offer period costumes to its passengers.

Does that sound like fun to you?

The great ship, Titanic (1997)

Everett

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Vt. lye victim gets new face at Boston hospital

BOSTON (AP) — A Vermont woman whose face was disfigured in a lye attack has received a face transplant.

Doctors at Boston's Brigham and Women's Hospital say 44-year-old Carmen Blandin Tarleton underwent the surgery earlier this month.

A team worked 15 hours to transplant the facial skin, including the neck, nose, lips, facial muscles, arteries and nerves.

The 44-year-old Tarleton, of Thetford, Vt., was attacked by her former husband in 2007. He doused her with industrial strength lye. She suffered chemical burns over 80 percent of her body. The mother of two wrote a book about her experience that describes her recovery.

It was the fifth face transplant at the Boston hospital.

Physicians are planning to discuss the case Wednesday at the hospital.

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Wall Street little changed ahead of Bernanke testimony

NEW YORK (Reuters) - Wall Street opened little changed as investors awaited a second round of testimony in Congress by Federal Reserve Chairman Ben Bernanke for clarity on the longevity of the Fed's economic stimulus program.

Calming some jitters over the euro zone, Italian debt prices and European stocks rose on Wednesday after Italy sold the maximum amount of bonds it planned to offer in a debt auction though borrowing costs soared.

Bernanke will make his second appearance before the Financial Services Committee at 10:00 a.m. ET (1500 GMT).

"The market got what it wanted yesterday from the Fed, so, as long as (Bernanke) doesn't say anything new, the market is likely to remain as status quo," said Joe Saluzzi, co- of trading at Themis Trading in Chatham, New Jersey.

A day earlier, Bernanke strongly defended the Fed's monetary stimulus efforts before Congress, easing financial market worries over an early retreat from the Fed's bond buying program, which had been triggered by minutes of the Fed's January meeting released a week ago.

His remarks, along with data showing sales of new homes hit a 4 1/2-year high, helped U.S. stocks rebound Tuesday from their worst decline since November.

Despite the bounce, the S&P 500 was unable to move back above 1,500, a closely watched level that had been technical support until recently, but may now prove a resistance point.

The Dow Jones industrial average <.dji> gained 1.76 points, or 0.01 percent, to 13,901.89. The Standard & Poor's 500 Index <.spx> dropped 0.36 points, or 0.02 percent, to 1,496.58. The Nasdaq Composite Index <.ixic> gained 0.70 points, or 0.02 percent, to 3,130.34.

The benchmark S&P 500, up 6 percent for the year, was within reach of record highs a week ago, before the minutes from the Fed's January meeting were released. Since then, the index has shed 1 percent as the minutes raised questions about whether the Fed may slow or halt its economy-stimulating measures soon.

Economic data was in focus with homes data due out at 10:00 a.m. ET (1500 GMT).

Earlier, separate data showed non-defense capital goods orders excluding aircraft, a closely watched proxy for business spending plans, jumped 6.3 percent, the biggest gain since December 2011. The market's reaction was muted.

In earnings news, discount retailer Target Corp appeared poised for a solid showing in the first quarter and forecast a higher profit for the full year after a weak performance in the key holiday season. The stock was off 3.3 percent at $61.92 in early trading.

Dollar Tree Inc reported a higher quarterly profit as shoppers spent more and the chain controlled costs. The stock jumped 10 percent to $45.00.

Shares of Boyd Gaming jumped 3.8 percent to $6.75 after New Jersey Governor Chris Christie signed a revised online gaming bill.

In Europe, shares rose, steadying after the previous session's sharp losses, though jitters over the euro zone kept a lid on gains.

Italy's 10-year debt costs rose more than half a percentage point at the first longer-term auction since an inconclusive parliamentary election, although they remained below the psychologically important level of 5 percent.

(Editing by Bernadette Baum)

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Jennifer Lawrence Dyes Her Hair Jet Black

By Tim Nudd

02/26/2013 at 09:15 AM EST

Jennifer Lawrence, blonde (left) and brunette

Jason Merritt/Getty; AKM-GSI

Oscar's golden girl, Jennifer Lawrence, has gone brunette – almost jet black, in fact!

The day after winning Best Actress for her role in Silver Linings Playbook, Lawrence, 22, was right back at work – emerging from a Beverly Hills salon with newly dyed black hair as she prepares to play Katniss Everdeen in reshoots for the next Hunger Games movie.

The actress was dressed mostly in black, too – with a black cardigan and black skirt to go along with a gray T-shirt.

It was quite a contrast to her dazzling look on Sunday, with her golden hair and Dior Haute Couture dress with Chopard jewels, a Roger Vivier clutch and Brian Atwood shoes.

One thing she was still sporting, though, was her glowing smile.

Reshoots for The Hunger Games: Catching Fire are expected to begin as soon as this week, reportedly in Hawaii. The movie is due in theaters at Thanksgiving.

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Koop, who transformed surgeon general post, dies

With his striking beard and starched uniform, former Surgeon General Dr. C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.

His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.

Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.

Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.

An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.

Dr. Richard Carmona, who served as surgeon general a decade ago under President George W. Bush, said Koop was a mentor to him and preached the importance of staying true to the science even if it made politicians uncomfortable.

"He set the bar high for all who followed in his footsteps," Carmona said.

Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."

A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.

Chris Collins, a vice president of amFAR, the Foundation for AIDS Research, said many people don't realize what an important role Koop played in the beginning of the AIDS epidemic.

"At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," Collins said.

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.

In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.

He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

Koop maintained his personal opposition to abortion, however. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day, but Reagan would not interfere.

Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was born in the New York City borough of Brooklyn, the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats.

He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

Koop received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it.

In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children, one of whom died in a mountain climbing accident when he was 20.

Koop was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine.

He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was by far the best-known surgeon general and for decades afterward was still a recognized personality.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."

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Ring reported from Montpelier, Vt. Cass reported from Washington. AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.

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Wall Street opens higher after drop on Italian vote

DEAR ABBY: "Harold" and I have been married for more than 20 years and have three children ranging in age from teen to toddler. We are both college graduates and held middle-management jobs until recently.Two years ago, Harold was offered a temporary job in an exotic location in another country. We jumped at the chance. I can't work due to the regulations here, but the money is good.Now that I'm not working, Harold suddenly believes he has the right to tell me what to do, how to manage daily activities, how to care for the children, etc. ...

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