US troops in Afghanistan celebrate Thanksgiving

KABUL, Afghanistan (AP) — It was Army Sgt. Keith Wells' first Thanksgiving Day away from his family and despite a cornucopia of food provided for the troops, his taste buds were craving his wife's macaroni and cheese back home.

"My wife's a foodie — you know the Food Network, cooking shows. Everything she makes is golden," Wells of Charlotte, N.C., said Thursday at a large international military base in the Afghan capital, Kabul.

The dining hall served up mac-and-cheese along with traditional Thanksgiving Day fixings. Wells was thankful for the good food, but he still missed his wife's home-cooking.

Huge hunks of beef greeted the estimated 2,500 diners as soldiers lined up in the dining hall. Red-white-and-blue decorations filled the room. Brochures titled "Learn about combat stress" served as table centerpieces.

There was roast turkey, sliced turkey, ham and rib-eye steaks. The troops were served steaming side dishes of dressing, corn, collard greens, yams and mashed potatoes and gravy that some lapped up with spoons. For dessert, there was a massive cake with a turkey etched in icing, pumpkin spice cookies and scores of pies.

A short walk from the dining hall, service members were playing a modified version of American football.

Parts of the scene could have come from a snapshot of any U.S. city: American guys in sweats tossing the pigskin, a scoreboard, a coin toss to start the game.

But on this military base, concrete barriers surrounded the field. The referees wore camouflaged shirts and the spectators carried rifles. The artificial turf was frayed and so dusty that when one player spiked the football, a puff of dirt rose from the field.

The players used a regulation football, but the game was a mix of football, soccer and rugby to fit the short field.

Some soldiers commented about the 11-year-old war that has claimed the lives of 2,029 American service members.

Army Chief Warrant Officer 4 Chuck Minton of Monroe, Ga., who has traveled extensively across Afghanistan, was optimistic. "It's been progressing here, getting better. The Afghans have taken over more missions," Minton said.

President Barack Obama pulled 10,000 troops out of Afghanistan in 2011 and 23,000 more this year, leaving about 66,000 American service members still deployed in the country. Nearly all international combat troops are to withdraw by the end of 2014 when Afghan forces will be fully in charge of securing the nation.

Army Maj. Rodney Gehrett of Colorado Springs, Colo., said he was surprised that the war was barely mentioned during the last U.S. presidential election — evidence that some Americans had tuned out the news from the front line a half a world away.

"The war in Afghanistan wasn't even brought up as a topic of conversation" during the election, Gehrett said. "It was a little surprising to me. Hopefully, that will change and people will realize that we still have troops here and they are fighting every day."

Army Sgt. Adam Draughn of Denver, Colo., said some people back home have the impression that the Afghan people don't want American troops in their country.

"Honestly, I think the biggest misconception in my opinion is that, you know, we actually are loved here," Draughn said. "The nationals do care about us. They do want us here to help them. We're not here uninvited."

Most of the holiday chatter, however, was focused on family.

Taking a break from the game, Army Capt. Robert Mikyska of North Aurora, Ill., pulled out a photocopied photo that was taken of he and his wife just before he deployed to Afghanistan nine months ago.

"Hi, honey!" Mikyska said, looking at the picture. "In a couple weeks, I'll be home. I can't wait to be back."

"My family's here," Army Spc. Ricky Clay, also of Monroe, Ga., said as he smiled and embraced his teammates on the sidelines of the football field.

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Promoter: Chris Brown cancels Guyana show

GEORGETOWN, Guyana (AP) — Organizers say American R&B star Chris Brown has canceled a stadium concert in Guyana after local protests over his 2009 beating of then-girlfriend Rihanna.

Brown was billed to headline a Dec. 26 show. But he drew the ire of women's rights groups and opposition lawmakers who said Brown would not be welcome in Guyana three years after his assault of Barbadian superstar Rihanna.

Concert promoter Hits & Jams Entertainment said Thursday that Brown backed out, citing discomfort with the protests.

In 2009, Brown hit, choked and bit Rihanna during an argument in Los Angeles. He later pleaded guilty to assault.

Since then, Brown has worked to repair his image, undergoing violence counseling and putting out a new album. He has a duet with Rihanna on her recently released record.

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Study finds mammograms lead to unneeded treatment

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.

"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

___

Online:

Study: http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Screening advice: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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U.S. troops in Afghanistan celebrate Thanksgiving

KABUL, Afghanistan (AP) — It was Army Sgt. Keith Wells' first Thanksgiving Day away from his family and despite a cornucopia of food provided for the troops, his taste buds were craving his wife's macaroni and cheese back home.

"My wife's a foodie — you know the Food Network, cooking shows. Everything she makes is golden," Wells of Charlotte, N.C., said Thursday at a large international military base in the Afghan capital, Kabul.

The dining hall served up mac-and-cheese along with traditional Thanksgiving Day fixings. Wells was thankful for the good food, but he still missed his wife's home-cooking.

Huge hunks of beef greeted the estimated 2,500 diners as soldiers lined up in the dining hall. Red-white-and-blue decorations filled the room. Brochures titled "Learn about combat stress" served as table centerpieces.

There was roast turkey, sliced turkey, ham and rib-eye steaks. The troops were served steaming side dishes of dressing, corn, collard greens, yams and mashed potatoes and gravy that some lapped up with spoons. For dessert, there was a massive cake with a turkey etched in icing, pumpkin spice cookies and scores of pies.

A short walk from the dining hall, service members were playing a modified version of American football.

Parts of the scene could have come from a snapshot of any U.S. city: American guys in sweats tossing the pigskin, a scoreboard, a coin toss to start the game.

But on this military base, concrete barriers surrounded the field. The referees wore camouflaged shirts and the spectators carried rifles. The artificial turf was frayed and so dusty that when one player spiked the football, a puff of dirt rose from the field.

The players used a regulation football, but the game was a mix of football, soccer and rugby to fit the short field.

Some soldiers commented about the 11-year-old war that has claimed the lives of 2,029 American service members.

Army Chief Warrant Officer 4 Chuck Minton of Monroe, Ga., who has traveled extensively across Afghanistan, was optimistic. "It's been progressing here, getting better. The Afghans have taken over more missions," Minton said.

President Barack Obama pulled 10,000 troops out of Afghanistan in 2011 and 23,000 more this year, leaving about 66,000 American service members still deployed in the country. Nearly all international combat troops are to withdraw by the end of 2014 when Afghan forces will be fully in charge of securing the nation.

Army Maj. Rodney Gehrett of Colorado Springs, Colo., said he was surprised that the war was barely mentioned during the last U.S. presidential election — evidence that some Americans had tuned out the news from the front line a half a world away.

"The war in Afghanistan wasn't even brought up as a topic of conversation" during the election, Gehrett said. "It was a little surprising to me. Hopefully, that will change and people will realize that we still have troops here and they are fighting every day."

Army Sgt. Adam Draughn of Denver, Colo., said some people back home have the impression that the Afghan people don't want American troops in their country.

"Honestly, I think the biggest misconception in my opinion is that, you know, we actually are loved here," Draughn said. "The nationals do care about us. They do want us here to help them. We're not here uninvited."

Most of the holiday chatter, however, was focused on family.

Taking a break from the game, Army Capt. Robert Mikyska of North Aurora, Ill., pulled out a photocopied photo that was taken of he and his wife just before he deployed to Afghanistan nine months ago.

"Hi, honey!" Mikyska said, looking at the picture. "In a couple weeks, I'll be home. I can't wait to be back."

"My family's here," Army Spc. Ricky Clay, also of Monroe, Ga., said as he smiled and embraced his teammates on the sidelines of the football field.

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3 bomb blasts kill 6 in 2 main Pakistani cities

QUETTA, Pakistan (AP) — A bomb blast targeting an army vehicle killed three soldiers and two civilians in the southwestern city of Quetta on Wednesday, police said.

Hours later, two bombs went off minutes apart outside a Shiite mosque in the southern city of Karachi, killing at least one person and wounding several others.

The explosions demonstrated the underlying tensions in Pakistan between insurgents and security forces on the one hand Sunni and Shiite Muslims on the other. The relatively low level of attacks does not appear to be endangering the nation's stability.

In the first attack, an improvised explosive device was used to detonate the bomb by remote control in Quetta, police commissioner Qambar Dashti said. He said eight people were wounded in the attack, some critically.

There was no immediate claim of responsibility for the bombing.

Quetta is the provincial capital of Baluchistan. The province has long been a scene of low-level insurgency by nationalist groups demanding more of a share in the region's natural resources.

Taliban and the al-Qaida-linked Pakistani militant group Lashkar-e-Jhangvi has also been active in Baluchistan, mainly focusing on targeting Shiite Muslims, whom it considers heretics.

Also Wednesday, two bombs exploded outside a Shiite mosque in the southern city of Karachi, killing one person and wounding seven people, senior police official Javed Odho said. He said the first appeared to be a suicide attack.

As the security forces and rescue workers were transporting victims of the first attack in Karachi to hospitals, a second bomb exploded at the same place, wounding several people, including security forces, rescue workers and journalists, senior police officer Omer Khitab said.

The twin bombings came as minority Shiites were celebrating the holy month of Muharram.

Pakistan has a long history of sectarian violence by extremist Sunni and Shiite Muslims in Karachi and other parts of the country.

The Sunni-Shiite schism over the true heir to Islam's Prophet Muhammad dates back to the seventh century.

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Associated Press Writer Adil Jawad contributed to this report from Karachi.

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Elmo left behind on 'Sesame Street' as actor exits

NEW YORK (AP) — Even on "Sesame Street," where everything is famously A-OK, problems can arise for its residents.

And that includes the Muppets. Cookie Monster grapples with an eating disorder. Oscar the Grouch gets cranky. Mr. Snuffleupagus gets the blues.

But Elmo seemed immune to any of that. Since enjoying his breakout success more than two decades ago, the 3 1/2-year-old red monster has radiated good cheer, love and trilling giggles. No wonder everyone — adults as well as children — adores him.

The key to Elmo is "his innocence, his positiveness and his sweetness," according to Kevin Clash, the man who created him and once told The Associated Press, "I would love to be totally like Elmo."

Now Clash has been scandalously separated from Elmo and from "Sesame Street," the TV series where he reigned behind the scenes for 28 years.

Clash spoke of "personal matters" as the cause of his resignation Tuesday after an unthinkable nine-day stretch that began with an unnamed man in his 20s claiming he had sex with Clash at age 16. That allegation was quickly recanted. But then came another accusation of sexual abuse, and a lawsuit.

That second accuser, a 24-year-old college student named Cecil Singleton, said the actor had engaged in sexual behavior with him when he was 15. He is suing Clash for $5 million.

"I am deeply sorry to be leaving," said Clash in his parting statement, "and am looking forward to resolving these personal matters privately."

But privacy may no longer be possible for Clash, the 52-year-old divorced father of a grown daughter who acknowledged last week that he is gay. Singleton's lawyer, Jeff Herman, said he has been contacted by two other potential victims of Clash and expects additional legal action.

At a news conference Tuesday, Singleton said he and Clash met on a gay chat line and then, for a two-week period, they engaged in sexual contact, though not intercourse. Sex with a person under 17 is a felony in New York if the perpetrator is 21 or older.

Singleton said he didn't know Clash's profession until years later, when he Googled the man's name.

"I was shocked when I found out what he did for a living," said Singleton.

Now that career has ended for Clash, who, in his dream job as a puppeteer for "Sesame Street," was assigned a little-used puppet now known as Elmo, then turned him into a star. In the process, Clash won 23 daytime Emmy awards and one prime-time Emmy. He published his 2006 autobiography, "My Life as a Furry Red Monster," and was the subject of the 2011 documentary "Being Elmo: A Puppeteer's Journey."

Elmo overshadowed Big Bird and other "Sesame" Muppets in popularity and screen time, while marginalizing the cast of live actors. Since 1998, he has had his own show-within-a-show on "Sesame Street" in addition to appearances elsewhere in the hour.

He is also a major moneymaker for Sesame Workshop, the New York-based company that produces the show, and for licensees. At his merchandising height in 1996, he inspired the Tickle Me Elmo doll, which became a cultural phenomenon and that Christmas season's hottest toy.

This year's Elmo dolls, "LOL Elmo," which giggles, and "Let's Rock! Elmo," which sings and comes with a microphone and drum set, haven't made any of this year's hot toy lists. Even so, Elmo toys probably account for one-half to two-thirds of the $75 million in annual sales the "Sesame Street" toy line generates for toy maker Hasbro, estimates BMO Capital Markets analyst Gerrick Johnson.

Johnson said he wasn't sure how this week's news might affect sales of Elmo toys this holiday.

"How many people are going to want to explain to their kid why they're not getting an Elmo?" he asked.

On Tuesday, Hasbro issued a statement saying "We are confident that Elmo will remain an integral part of Sesame Street and that Sesame Street toys will continue to delight children for years to come."

Despite his resignation, Clash will remain an integral part of "Sesame Street" for the foreseeable future. Taping of season No. 44 will wrap by mid-December and will begin airing next September, according to someone close to the show who spoke on condition of anonymity because the person was not authorized to publicly discuss details of its production. That means new episodes with Clash performing as Elmo will presumably continue well into 2014.

As for who might take over as Elmo, other "Sesame Street" puppeteers were already being trained to serve as Clash's stand-in, Sesame Workshop said. It's part of an understudy policy being adopted for all the major Muppet characters.

But no one knows how Elmo will fare going forward. Will the jokes spurred by Clash's downfall leave a lasting mark on Elmo's image? Will there be parents who see him tainted by association with the man who brought him to life?

In the wake of a personal tragedy that may still be unfolding, Elmo's innocence, positiveness and sweetness will be put to the test.

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AP Television Writer David Bauder and AP Retail Writer Mae Anderson contributed to this report.

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OB/GYNs back over-the-counter birth control pills

WASHINGTON (AP) — No prescription or doctor's exam needed: The nation's largest group of obstetricians and gynecologists says birth control pills should be sold over the counter, like condoms.

Tuesday's surprise opinion from these gatekeepers of contraception could boost longtime efforts by women's advocates to make the pill more accessible.

But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance.

Still, momentum may be building.

Already, anyone 17 or older doesn't need to see a doctor before buying the morning-after pill — a higher-dose version of regular birth control that can prevent pregnancy if taken shortly after unprotected sex. Earlier this year, the Food and Drug Administration held a meeting to gather ideas about how to sell regular oral contraceptives without a prescription, too.

Now the influential American College of Obstetricians and Gynecologists is declaring it's safe to sell the pill that way.

Wait, why would doctors who make money from women's yearly visits for a birth-control prescription advocate giving that up?

Half of the nation's pregnancies every year are unintended, a rate that hasn't changed in 20 years — and easier access to birth control pills could help, said Dr. Kavita Nanda, an OB/GYN who co-authored the opinion for the doctors group.

"It's unfortunate that in this country where we have all these contraceptive methods available, unintended pregnancy is still a major public health problem," said Nanda, a scientist with the North Carolina nonprofit FHI 360, formerly known as Family Health International.

Many women have trouble affording a doctor's visit, or getting an appointment in time when their pills are running low — which can lead to skipped doses, Nanda added.

If the pill didn't require a prescription, women could "pick it up in the middle of the night if they run out," she said. "It removes those types of barriers."

Tuesday, the FDA said it was willing to meet with any company interested in making the pill nonprescription, to discuss what if any studies would be needed.

Then there's the price question. The Obama administration's new health care law requires FDA-approved contraceptives to be available without copays for women enrolled in most workplace health plans.

If the pill were sold without a prescription, it wouldn't be covered under that provision, just as condoms aren't, said Health and Human Services spokesman Tait Sye.

ACOG's opinion, published in the journal Obstetrics & Gynecology, says any move toward making the pill nonprescription should address that cost issue. Not all women are eligible for the free birth control provision, it noted, citing a recent survey that found young women and the uninsured pay an average of $16 per month's supply.

The doctors group made clear that:

—Birth control pills are very safe. Blood clots, the main serious side effect, happen very rarely, and are a bigger threat during pregnancy and right after giving birth.

—Women can easily tell if they have risk factors, such as smoking or having a previous clot, and should avoid the pill.

—Other over-the-counter drugs are sold despite rare but serious side effects, such as stomach bleeding from aspirin and liver damage from acetaminophen.

—And there's no need for a Pap smear or pelvic exam before using birth control pills. But women should be told to continue getting check-ups as needed, or if they'd like to discuss other forms of birth control such as implantable contraceptives that do require a physician's involvement.

The group didn't address teen use of contraception. Despite protests from reproductive health specialists, current U.S. policy requires girls younger than 17 to produce a prescription for the morning-after pill, meaning pharmacists must check customers' ages. Presumably regular birth control pills would be treated the same way.

Prescription-only oral contraceptives have long been the rule in the U.S., Canada, Western Europe, Australia and a few other places, but many countries don't require a prescription.

Switching isn't a new idea. In Washington state a few years ago, a pilot project concluded that pharmacists successfully supplied women with a variety of hormonal contraceptives, including birth control pills, without a doctor's involvement. The question was how to pay for it.

Some pharmacies in parts of London have a similar project under way, and a recent report from that country's health officials concluded the program is working well enough that it should be expanded.

And in El Paso, Texas, researchers studied 500 women who regularly crossed the border into Mexico to buy birth control pills, where some U.S. brands sell over the counter for a few dollars a pack. Over nine months, the women who bought in Mexico stuck with their contraception better than another 500 women who received the pill from public clinics in El Paso, possibly because the clinic users had to wait for appointments, said Dr. Dan Grossman of the University of California, San Francisco, and the nonprofit research group Ibis Reproductive Health.

"Being able to easily get the pill when you need it makes a difference," he said.

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Online:

OB/GYN group: http://www.acog.org

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Clinton, White House denounce bus bombing

U.S. Secretary of State Hillary Rodham Clinton and Israel's Prime Minister Benjamin Netanyahu deliver joint statements …Secretary of State Hillary Clinton denounced a bomb attack on a bus in Tel Aviv that wounded at least 10 people even as she worked to help cobble together a truce between Israel and the Palestinians' Islamist Hamas movement that rules Gaza.

"The United States strongly condemns this terrorist attack, and our thoughts and prayers are with the victims and the people of Israel," said Clinton, who has been meeting with leaders of Israel and Egypt as well as Palestinian Authority President Mahmoud Abbas. Abbas' government runs the West Bank.

"As I arrive in Cairo, I am closely monitoring reports from Tel Aviv, and we will stay in close contact with Prime Minister Netanyahu's team. The United States stands ready to provide any assistance that Israel requires," Clinton said in a written statement.

Hamas has welcomed the attack, even as the White House joined in the denunciations.

"The United States condemns today's terrorist attack on a bus in Tel Aviv," press secretary Jay Carney said in a statement. "Our thoughts and prayers are with the families of those injured and with the people of Israel.

"These attacks against innocent Israeli civilians are outrageous. The United States will stand with our Israeli allies and provide whatever assistance is necessary to identify and bring to justice the perpetrators of this attack," Carney said. "The United States reaffirms our unshakeable commitment to Israel's security and our deep friendship and solidarity with the Israeli people."

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Obama sends Clinton to Mideast amid Gaza crisis

PHNOM PENH, Cambodia (AP) — President Barack Obama dispatched Secretary of State Hillary Rodham Clinton to the Middle East on Tuesday as the U.S. urgently seeks to end a conflict between Israel and Hamas that has killed more than 100 in the last week.

Clinton hastily departed for the region from Cambodia, where she had joined Obama for a summit with Asian leaders. The White House said she would make three stops, meeting with Israeli Prime Minister Benjamin Netanyahu in Jerusalem, Palestinian officials in Ramallah, in the West Bank, and Egyptian leaders in Cairo. Clinton was expected to arrive in Israel on Tuesday night and return to Washington late Wednesday or very early Thursday after making all three stops.

Clinton's trip marks the Obama administration's most forceful engagement in the conflict that has killed more than 100 Palestinians and three Israelis, with hundreds more wounded. While the U.S. has backed Israel's right to defend itself against rocket fire from Gaza, Washington has warned its ally against pursuing a ground assault that would further escalate the violence and could dramatically increase casualties on both sides.

Ahead of Clinton's arrival, Obama spoke by telephone for almost a half-hour with Egyptian President Mohammed Morsi, commending the Islamist leader's efforts to de-escalate tensions, said Ben Rhodes, deputy national security adviser. It was their third conversation in 24 hours.

Obama wants a diplomatic solution urgently because "there would be significant loss of life associated with further conflict," Rhodes told journalists traveling with the president from Cambodia to Japan.

State Department spokeswoman Victoria Nuland said Clinton's diplomacy in the Middle East "will emphasize the United States' interest in a peaceful outcome that protects and enhances Israel's security and regional stability; that can lead to improved conditions for the civilian residents of Gaza; and that can reopen the path to fulfill the aspirations of Palestinians and Israelis for two states living in peace and security."

The secretary of state isn't heading to the Middle East with any specific proposal to broker a peace deal, U.S. officials said. She'll reassure Israel it has full American support while urging it to limit civilian casualties, and she will press members of the Western-backed Palestinian government in the West Bank to influence its brethren in Gaza to halt the rocket fire.

In Cairo, Clinton will strike a similar note by reminding the Egyptian government of its peace obligations with Israel under a treaty they share, said officials who spoke on condition of anonymity because they weren't authorized to talk publicly about the matter.

Rhodes said the U.S. and Israel want to see the conflict ended "diplomatically and peacefully." But he said Washington understands the Jewish state's need for a "durable outcome that ends the rocket attacks on Israeli cities and restores a broader calm in the region" — a reference to Israel's concerns that its cease-fires with Hamas have become ever shorter in duration and increasingly tenuous.

Obama and Clinton have consulted about the widening crisis throughout their three-day tour of Southeast Asia, their final joint trip before Clinton leaves her post as the top U.S. diplomat. They spoke again about the situation Tuesday morning, aides said, and made the decision for her to travel to the region.

Still, it was unclear what impact Clinton's presence would have on the spiraling violence or whether she was heading to the Mideast with any specific overtures from the U.S.

Rhodes said "there are a number of ideas that are in play," but offered no further details. And he insisted the ramped up U.S. involvement was "a matter of what's in everybody's best interests", not a matter of "leverage."

Obama and Clinton each have held multiple telephone calls with their counterparts in Israel and Egypt, which is at the center of negotiations to quell the violence. Because the U.S. considers Hamas a terrorist organization and prohibits contact between its members and American officials, it is relying on Egypt, as well as Turkey and Qatar, to deliver its message to the Hamas leadership in Gaza.

Israel and Hamas say they are open to diplomatic mediation efforts being led by Egypt, but they remained apart in their demands. Hamas officials said a deal was close.

Hamas wants Israel to halt all attacks on Gaza and lift tight restrictions on trade and movement in and out of the territory that have been in place since Hamas seized Gaza by force in 2007. Israel demands an end to rocket fire from Gaza and a halt to weapons smuggling into Gaza through tunnels under the border with Egypt.

The widening conflict has threatened to overshadow Obama's three-country tour of Southeast Asia, his first overseas trip after winning re-election. The president, after a marathon day that took him from Thailand to Myanmar to Cambodia, worked the phones with Mideast leaders into the early hours of Tuesday morning, aides said.

The White House said Obama would stay in contact with the key players in the conflict while Clinton was on the ground. The president is scheduled to depart Cambodia later Tuesday, arriving back in Washington before dawn Wednesday.

___

Associated Press writer Matthew Lee and Bradley Klapper in Washington contributed to this report.

___

Follow Julie Pace at http://twitter.com/jpaceDC

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Elmo actor Kevin Clash resigns amid sex allegation

NEW YORK (AP) — Elmo puppeteer Kevin Clash has resigned from "Sesame Street" in the wake of an allegation that he had sex with an under-aged youth.

In its statement Tuesday, Sesame Workshop said "the controversy surrounding Kevin's personal life has become a distraction that none of us want," leading Clash to conclude "that he can no longer be effective in his job."

"This is a sad day for Sesame Street," the statement said.

As the announcement was made, a lawsuit was being filed in federal court in New York charging Clash with sexual abuse of a second youth. The lawsuit alleges that Cecil Singleton, then 15 and now an adult, was persuaded by Clash to meet for sexual encounters.

Clash, who had been on "Sesame Street" for 28 years, created the high-pitched voice and child-like persona for Elmo, a furry, red Muppet that became one of the most popular characters on the show and one of the company's most lucrative properties.

Clash's exit from Sesame Workshop followed a tumultuous week that began on Nov. 12 with a statement from the company that Clash had requested a leave of absence following the charge by a man in his early 20s that he had had a relationship with Clash when he was 16.

Clash denied the charge from that man, who has not been publicly identified, calling it "false and defamatory." Days later the man recanted his charge.

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