Longer tamoxifen use cuts breast cancer deaths


Breast cancer patients taking the drug tamoxifen can cut their chances of having the disease come back or kill them if they stay on the pills for 10 years instead of five years as doctors recommend now, a major study finds.


The results could change treatment, especially for younger women. The findings are a surprise because earlier research suggested that taking the hormone-blocking drug for longer than five years didn't help and might even be harmful.


In the new study, researchers found that women who took tamoxifen for 10 years lowered their risk of a recurrence by 25 percent and of dying of breast cancer by 29 percent compared to those who took the pills for just five years.


In absolute terms, continuing on tamoxifen kept three additional women out of every 100 from dying of breast cancer within five to 14 years from when their disease was diagnosed. When added to the benefit from the first five years of use, a decade of tamoxifen can cut breast cancer mortality in half during the second decade after diagnosis, researchers estimate.


Some women balk at taking a preventive drug for so long, but for those at high risk of a recurrence, "this will be a convincer that they should continue," said Dr. Peter Ravdin, director of the breast cancer program at the UT Health Science Center in San Antonio.


He reviewed results of the study, which was being presented Wednesday at a breast cancer conference in San Antonio and published by the British medical journal Lancet.


About 50,000 of the roughly 230,000 new cases of breast cancer in the United States each year occur in women before menopause. Most breast cancers are fueled by estrogen, and hormone blockers are known to cut the risk of recurrence in such cases.


Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors — sold as Arimidex, Femara, Aromasin and in generic form — do the job with less risk of causing uterine cancer and other problems.


But the newer drugs don't work well before menopause. Even some women past menopause choose tamoxifen over the newer drugs, which cost more and have different side effects such as joint pain, bone loss and sexual problems.


The new study aimed to see whether over a very long time, longer treatment with tamoxifen could help.


Dr. Christina Davies of the University of Oxford in England and other researchers assigned 6,846 women who already had taken tamoxifen for five years to either stay on it or take dummy pills for another five years.


Researchers saw little difference in the groups five to nine years after diagnosis. But beyond that time, 15 percent of women who had stopped taking tamoxifen after five years had died of breast cancer versus 12 percent of those who took it for 10 years. Cancer had returned in 25 percent of women on the shorter treatment versus 21 percent of those treated longer.


Tamoxifen had some troubling side effects: Longer use nearly doubled the risk of endometrial cancer. But it rarely proved fatal, and there was no increased risk among premenopausal women in the study — the very group tamoxifen helps most.


"Overall the benefits of extended tamoxifen seemed to outweigh the risks substantially," Dr. Trevor Powles of the Cancer Centre London wrote in an editorial published with the study.


The study was sponsored by cancer research organizations in Britain and Europe, the United States Army, and AstraZeneca PLC, which makes Nolvadex, a brand of tamoxifen, which also is sold as a generic for 10 to 50 cents a day. Brand-name versions of the newer hormone blockers, aromatase inhibitors, are $300 or more per month, but generics are available for much less.


The results pose a quandary for breast cancer patients past menopause and those who become menopausal because of their treatment — the vast majority of cases. Previous studies found that starting on one of the newer hormone blockers led to fewer relapses than initial treatment with tamoxifen did.


Another study found that switching to one of the new drugs after five years of tamoxifen cut the risk of breast cancer recurrence nearly in half — more than what was seen in the new study of 10 years of tamoxifen.


"For postmenopausal women, the data still remain much stronger at this point for a switch to an aromatase inhibitor," said that study's leader, Dr. Paul Goss of Massachusetts General Hospital. He has been a paid speaker for a company that makes one of those drugs.


Women in his study have not been followed long enough to see whether switching cuts deaths from breast cancer, as 10 years of tamoxifen did. Results are expected in about a year.


The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.


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


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NASA lost in space, expert panel says




WASHINGTON (AP) -- NASA is adrift without a coherent vision for where it should be going, an independent panel of space, science and engineering experts says.


But the report by the National Academy of Sciences doesn't blame the space agency. It faults the president, Congress and the nation for not giving NASA clear direction. At the same time, the report said NASA is doing little to further the stated goal of the White House to send astronauts to a nearby asteroid.


Panel member Bob Crippen, a retired NASA manager and astronaut who piloted the first space shuttle mission, said he has never seen the space agency so adrift. He said that includes the decade between the end of the Apollo moon landings and the beginning of the space shuttle program.


"I think people (at NASA) want to be focused a little more and know where they are going," Crippen told The Associated Press.


President Barack Obama in 2010 told the space agency to plan to send astronauts to an asteroid by 2025 as a training ground for an eventual Mars landing. But the 80-page report from the national academy and its authors say that there is little support for that idea within NASA and the international space community. Also, NASA hasn't allocated much money for it. Nor has it done much to locate an asteroid target. The agency's vague strategic plan avoids mention of an asteroid mission.


Crippen said an asteroid mission just doesn't make sense, technically or politically.


"I hate to use the word credible, but people don't buy it," said academy panel member Marcia Smith, president of Space and Technology Policy Group. "They don't feel that the asteroid mission is the right one."


NASA chief spokesman David Weaver said in an emailed statement that the agency has clear and challenging goals.


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Powerful typhoon kills at least 74 in Philippines


MANILA, Philippines (AP) — At least 43 villagers and soldiers drowned in a southern Philippine town Tuesday when torrents of water dumped by a powerful typhoon cascaded down a mountain, engulfing emergency shelters and an army truck, officials said. The deaths raised the toll from one of the strongest storms to hit the country this year to at least 74.


Gov. Arturo Uy said rain from Typhoon Bopha accumulated atop a mountain and then burst down on Andap village in New Bataan town in hard-hit Compostela Valley province. The victims included villagers who had fled from their homes to a school and village hall, which were then swamped by the flash flood. An army truck carrying soldiers and villagers was washed away, according to Uy and army officials.


"They thought that they were already secure in a safe area, but they didn't know the torrents of water would go their way," Uy told DZBB radio.


He said the confirmed death toll in the town was likely to rise because several other bodies could not immediately be retrieved from floodwaters strewn with huge logs and debris.


Bopha slammed into Davao Oriental province region at dawn, its ferocious winds ripping roofs from homes and its 500-kilometer (310-mile) -wide rain band flooding low-lying farmland.


The storm, packing winds of 140 kilometers (87 miles) per hour and gusts of up to 170 kph (106 mph), toppled trees, triggered landslides and sent flash floods surging across the region's mountains and valleys.


Two entire provinces lost power and more than 100 domestic flights were canceled. About 60,000 people fled to emergency shelters.


Twenty-three people drowned or were pinned by fallen trees or collapsed houses in Davao Oriental province's coastal town of Cateel, which had the most deaths after New Bataan, Davao Oriental Gov. Corazon Malanyaon told the ABS-CBN TV network, citing police reports.


Some towns in the province were so battered that no roofs remained on buildings, Malanyaon said.


The other deaths included three children who were buried by a wall of mud and boulders that plunged down a mountain in Marapat village, also in Compostela Valley. Their bodies were wrapped in blankets by their grieving relatives and placed on a stage in a basketball court.


"The only thing we could do was to save ourselves. It was too late for us to rescue them," said Valentin Pabilana, who survived the landslide.


In Davao Oriental, a poor agricultural and gold-mining province about 1,000 kilometers (620 miles) southeast of Manila, an elderly woman was killed when her house was struck by a falling tree, said Benito Ramos, who heads the government's disaster-response agency.


The other victims either drowned or were hit by trees, he said, adding that the death toll was expected to rise.


While some 20 typhoons and storms normally lash the archipelago nation annually, the southern provinces battered by Bopha are unaccustomed to fierce typhoons, which normally hit the northern and central Philippines.


A rare storm last December killed more than 1,200 people and left many more homeless and traumatized, including in Cagayan de Oro city, where church bells pealed relentlessly on Tuesday to warn residents to scramble to safety as a major river started to swell.


Officials were taking no chances this year, and President Benigno Aquino III appealed on national TV on Monday for people in Bopha's path to move to safety and take storm warnings seriously.


In Compostela Valley, authorities halted mining operations and ordered villagers to evacuate to prevent a repeat of deadly losses from landslides and the collapse of mine tunnels in previous storms.


Bopha, a Cambodian word for flower or a girl, is the 16th weather disturbance to hit the Philippines this year. Forecasters say at least one more storm may strike the country before Christmas.


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Associated Press writer Teresa Cerojano contributed to this report.


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Swiss spy agency warns U.S., Britain about huge data leak












ZURICH (Reuters) – Secret information on counter-terrorism shared by foreign governments may have been compromised by a massive data theft by a senior IT technician for the NDB, Switzerland‘s intelligence service, European national security sources said.


Intelligence agencies in the United States and Britain are among those who were warned by Swiss authorities that their data could have been put in jeopardy, said one of the sources, who asked for anonymity when discussing sensitive information.












Swiss authorities arrested the technician suspected in the data theft last summer amid signs he was acting suspiciously. He later was released from prison while a criminal investigation by the office of Switzerland’s Federal Attorney General continues, according to two sources familiar with the case.


The suspect’s name was not made public. Swiss authorities believe he intended to sell the stolen data to foreign officials or commercial buyers.


A European security source said investigators now believe the suspect became disgruntled because he felt he was being ignored and his advice on operating the data systems was not being taken seriously.


Swiss news reports and the sources close to the investigation said that investigators believe the technician downloaded terrabytes, running into hundreds of thousands or even millions of printed pages, of classified material from the Swiss intelligence service’s servers onto portable hard drives. He then carried them out of government buildings in a backpack.


One of the sources familiar with the investigation said that intelligence services like the U.S. Central Intelligence Agency and Britain’s Secret Intelligence Service, also known as MI6, routinely shared data on counter-terrorism and other issues with the NDB. Swiss authorities informed U.S. and British agencies that such data could have been compromised, the source said.


News of the theft of intelligence data surfaced with Switzerland’s reputation for secrecy and discretion in government and financial affairs already under assault.


Swiss authorities have been investigating, and in some cases have charged, whistleblowers and some European government officials for using criminal methods to acquire confidential financial data about suspected tax evaders from Switzerland’s traditionally secretive banks.


The suspect in the spy data theft worked for the NDB, or Federal Intelligence Service, which is part of Switzerland’s Defense Ministry, for about eight years.


He was described by a source close to the investigation as a “very talented” technician and senior enough to have “administrator rights,” giving him unrestricted access to most or all of the NDB’s networks, including those holding vast caches of secret data.


Swiss investigators seized portable storage devices containing the stolen data after they arrested the suspect, according to the sources. At this point, they said, Swiss authorities believe that the suspect was arrested and the stolen data was impounded before he had an opportunity to sell it.


However, one source said that Swiss investigators could not be positive the suspect did not sell or pass on any of the information before his arrest, which is why Swiss authorities felt obliged to notify foreign intelligence partners their information may have been compromised.


Representatives of U.S. and British intelligence agencies had no immediate response to detailed queries about the case submitted by Reuters, although one U.S. official said he was unaware of the case.


SECURITY PROCEDURES QUESTIONED


Swiss Attorney General Michael Lauber and a senior prosecutor, Carolo Bulletti, announced in September that they were investigating the data theft and its alleged perpetrator. A spokeswoman for the attorney general said she was prohibited by law from disclosing the suspect’s identity.


A spokesman for the NDB said he could not comment on the investigation.


At their September press conference, Swiss officials indicated that they believed the suspect intended to sell the data he stole to foreign countries. They did not talk about the possible compromise of information shared with the NDB by U.S. and British intelligence.


A European source familiar with the case said it raised serious questions about security procedures and structures at the NDB, a relatively new agency which combined the functions of predecessor agencies that separately conducted foreign and domestic intelligence activities for the Swiss government.


The source said that under the NDB’s present structure, its human resources staff – responsible for, among other things, ensuring the reliability and trustworthiness of the agency’s personnel – is lumped together organizationally with the agency’s information technology division. This potentially made it difficult or confusing for the subdivision’s personnel to investigate themselves, the source said.


According to the source, investigators now believe that in the months before his arrest, the data theft suspect displayed warning signs that should have been spotted by his bosses or by security officials.


The source said that the suspect became so disgruntled earlier this year that he stopped showing up for work.


However, according to Swiss news reports, the NDB did not realize that something was amiss until the largest Swiss bank, UBS, expressed concern to authorities about a potentially suspicious attempt to set up a new numbered bank account, which then was traced to the NDB technician.


A Swiss parliamentary committee is now conducting its own investigation into the data theft and is expected to report next spring. Investigators are known to be concerned that the NDB lacks investigative powers, such as to search premises or conduct wiretaps, which are widely used by counter-intelligence investigators in other countries.


(Reporting by Mark Hosenball; Editing by Mark Heinrich)


Tech News Headlines – Yahoo! News


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Fleetwood Mac readies tour and new music


NEW YORK (AP) — Fleetwood Mac is heading back on the road, and that means the top-selling group will release new music — sort of.


On its 34-city North American tour, which kicks off April 4 in Columbus, Ohio, the band will perform two new songs, and it could mean a new album will follow. Or not.


Stevie Nicks recently sang on tracks that Lindsey Buckingham, Mick Fleetwood and John McVie worked on, calling the sessions "great." But Nicks also says she's not sure where the band fits in today's music industry.


"Whether or not we're gonna do any more (songs), we don't know because we're so completely bummed out with the state of the music industry and the fact that nobody even wants a full record," she said. "Everybody wants two songs, so we're going to give them two songs."


Nicks said depending on the response to the new tracks — which Buckingham calls "the most Fleetwood Mac-y stuff ... in a long time" — more material could come next.


"Maybe we'll get an EP out of it or something," Buckingham said.


Nicks will continue to record solo albums, though. The group is celebrating the 35th anniversary of the best-selling "Rumours" album, which has moved some 20 million units in the United States. She knows that's not possible again, despite the success of Adele's "21," which has sold 10 million units in America in less than two years.


"This is Adele's 'Rumours,'" Nicks said. "She had a baby, she's going to take a year off to take care of her baby — that's why I never had any kids. She's going to go back and start writing again, you never know what the next record's going to be. Is it going to sell 10 million records? You don't know," she said.


Buckingham said he initially wanted to record a new album, but Nicks "wasn't too into that." But the guitarist and singer knows that new music isn't a priority for the band's fans.


"It wouldn't matter if they didn't hear anything new. In a way there's a freedom to that — it becomes not what you got, but what you do with what you got. Part of the challenge of this tour is figuring out a presentation that has some twists and turns to it without having a full album," he said.


Fleetwood Mac, which was formed in 1967, last released an album in 2003, though they hit the road in 2009. Nicks and Buckingham — who originally joined the band in 1974 as a couple — both released solo albums and toured last year. Buckingham had suggested that Fleetwood Mac tour last year, but says getting everyone to agree was tough.


"If you look at Fleetwood Mac as a group, you can make the case of saying we're a bunch of individuals who don't necessarily belong in the same group together, but it's the synergy of that that makes us so good. But it also makes the politics a little more tenuous," he said. "You can say that not only can it be a political minefield, someone's always causing trouble, right? I caused trouble for years so I can't point any fingers."


The tour also includes cities such as New York, Chicago, Boston, Las Vegas and Los Angeles, and will end June 12 in Detroit.


_____


Online:


http://www.fleetwoodmac.com/


You can follow Music Writer Mesfin Fekadu on Twitter at twitter.com/MusicMesfin


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Tapping citizen-scientists for a novel gut check


WASHINGTON (AP) — The bacterial zoo inside your gut could look very different if you're a vegetarian or an Atkins dieter, a couch potato or an athlete, fat or thin.


Now for a fee — $69 and up — and a stool sample, the curious can find out just what's living in their intestines and take part in one of the hottest new fields in science.


Wait a minute: How many average Joes really want to pay for the privilege of mailing such, er, intimate samples to scientists?


A lot, hope the researchers running two novel citizen-science projects.


One, the American Gut Project, aims to enroll 10,000 people — and a bunch of their dogs and cats too — from around the country. The other, uBiome, separately aims to enroll nearly 2,000 people from anywhere in the world.


"We're finally enabling people to realize the power and value of bacteria in our lives," said microbiologist Jack Gilbert of the University of Chicago and Argonne National Laboratory. He's one of a team of well-known scientists involved with the American Gut Project.


Don't be squeamish: Yes, we share our bodies with trillions of microbes, living communities called microbiomes. Many of the bugs, especially those in the intestinal tract, play indispensable roles in keeping us healthy, from good digestion to a robust immune system.


But which combinations of bacteria seem to keep us healthy? Which ones might encourage problems like obesity, diabetes or irritable bowel syndrome?


And do diet and lifestyle affect those microbes in ways that we might control someday?


Answering those questions will require studying vast numbers of people. Getting started with a grassroots movement makes sense, said National Institutes of Health microbiologist Lita Proctor, who isn't involved with the new projects but is watching closely.


After all, there was much interest in the taxpayer-funded Human Microbiome Project, which last summer provided the first glimpse of what makes up a healthy bacterial community in a few hundred volunteers.


Proctor, who coordinated that project, had worried "there would be a real ick factor. That has not been the case," she said. Many people "want to engage in improving their health."


Scott Jackisch, a computer consultant in Oakland, Calif., ran across American Gut while exploring the science behind different diets, and signed up last week. He's read with fascination earlier microbiome research: "Most of the genetic matter in what we consider ourselves is not human, and that's crazy. I wanted to learn about that."


Testing a single stool sample costs $99 in that project, but he picked a three-sample deal for $260 to compare his own bacterial makeup after eating various foods.


"I want to be extra, extra well," said Jackisch, 42. Differing gut microbes may be the reason "there's no one magic bullet of diet that people can eat and be healthy."


It's clear that people's gut bacteria can change over time. What this new research could accomplish is a first look at how different diets may play a role, said American Gut lead researcher Rob Knight of the University of Colorado, Boulder.


One challenge is making sure participants don't expect that a map of their gut bacteria can predict their future health, or suggest lifestyle changes, anytime soon.


"I understand I'm not going to be able to say, 'Oh, my gosh, I'll be susceptible to this,'" said Bradley Heinz, 26, a financial consultant in San Francisco. He is paying uBiome $119 to analyze both his gut and mouth microbiomes; just the gut is $69.


"The more people that participate, the more information comes out and the more that everybody benefits," he added.


Participants can sign up for either project via the social fundraising site Indiegogo.com over the next month. They also can send scrapings from the skin, mouth and other sites, to analyze that bacteria. Sign up enough family members or body sites, or be tracked over time, and the price can rise into the thousands. American Gut researchers plan some free testing for those who can't afford the fees, to try to increase the experiment's diversity.


Don't forget the pets: "We sleep with them, play with them, they often eat our food," said American Gut co-founder Jeff Leach, an anthropologist. What bacteria we have in common is the next logical question.


Already, American Gut researchers are preparing to compare what they find in the typical U.S. gut with a few hundred people in rural Namibia, who eat what's described as hunter-gatherer fare. Also, Leach will spend three months living in Namibia next year, and is storing his own stool samples for before-and-after comparison.


But diet isn't the only factor. Your bacterial makeup starts at birth: Babies absorb different microbes when they're born vaginally than when they're born by C-section, a possible explanation for why cesareans raise the risk for certain infections. Taking antibiotics, especially in early childhood, can alter this teeming inner world, and it's not clear if there are lasting consequences.


Then there's your environment, such as the infections spread in hospitals. In February, a new University of Chicago hospital building opens and Gilbert will test the surfaces, the patients and their health workers to see how quickly bad bugs can move in and identify which bacteria are protective.


Whatever the findings, all the research marks "a huge teachable moment" about how we interact with microbes, Leach said.


___


EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


___


Online:


www.indiegogo.com/americangut


www.indiegogo.com/ubiome


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GOP senator: Boehner’s budget proposal ‘will destroy American jobs’


South Carolina Republican Sen. Jim DeMint (Win McNamee/Getty Images)


WASHINGTON—South Carolina Republican Sen. Jim DeMint just gave Democrats a shiny new talking point.


The tea party-backed senator on Tuesday slammed House Republican leaders for the fiscal cliff proposal they offered earlier this week.


"Speaker [John] Boehner's $800 billion tax hike will destroy American jobs and allow politicians in Washington to spend even more, while not reducing our $16 trillion debt by a single penny," DeMint said in a statement. "This isn't rocket science. Everyone knows that when you take money out of the economy, it destroys jobs, and everyone knows that when you give politicians more money, they spend it. This is why Republicans must oppose tax increases and insist on real spending reductions that shrink the size of government and allow Americans to keep more of their hard-earned money."


Republican House leaders on Monday sent a letter to the White House with a plan to avoid a series of automatic tax increases and spending cuts set to begin on Jan. 1, 2013. With a 10-year price tag of about $2.2 trillion, the Republican proposal would raise federal revenue by closing loopholes and capping deductions within the tax code and making changes to entitlement programs. The letter was signed by seven House leaders, including Budget Committee Chairman Paul Ryan of Wisconsin and Ways and Means Committee Chairman Dave Camp of Michigan.


Democrats dismissed it quickly, calling for a bill that would increase taxes on households earning more than $250,000 per year and more federal spending on infrastructure, which were not included in the Republican plan.


DeMint's comment may be a bit of a sideshow—he's not directly involved in the negotiations and he represents just a single vote in Congress—but it's representative of how conservatives feel about the Republican proposal, and it offers ample ammunition to President Barack Obama and Democrats in the fiscal cliff media relations war.



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Gunman severely wounds Swedish woman in Pakistan

LAHORE, Pakistan (AP) — Pakistani police say a gunman on a motorcycle has shot and critically wounded a Swedish woman in the eastern city of Lahore.

Police officer Malik Awais says the woman, Bargetta Emmi, was getting out of her car in front of her home when she was shot in the neck by an unknown assailant Monday. Her servants reported the incident to police.

Awais says Emmi was director of FGA Church (Full Gospel Assemblies of Pakistan).

The Swedish Embassy in Islamabad confirmed a Swedish woman was shot and has severe injuries but provided no other details.

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Nokia debunks rumor that it may be considering shift to Android












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Palace says Duchess of Cambridge expecting a baby

LONDON (AP) — Get the nursery ready: Prince William and his wife Catherine are expecting their first child.

St. James's Palace announced the pregnancy Monday, saying that the Duchess of Cambridge — formerly known as Kate Middleton — has a severe form of morning sickness and is currently in a London hospital. William is at his wife's side.

The palace said that since the pregnancy is in its "very early stages," the 30-year-old duchess is expected to stay in the hospital for several days and will require a period of rest afterward.

William is second in line to the throne after his father, Prince Charles, so the couple's first child would normally become monarch in due course.

In recent days, Middleton has kept up royal appearances — recently playing field hockey with schoolchildren at her former school.

The confirmation of her pregnancy caps a jam-packed year of highs and lows for the young royals, who were married in a lavish ceremony at Westminster Abbey last year.

They have traveled the world extensively as part of Queen Elizabeth II's diamond jubilee celebrations and weathered the embarrassment of a nude photos scandal, after a tabloid snapper published topless images of the duchess.

Joe Little, managing editor of Majesty magazine, said the news bookended a year that saw the royal family riding high in popular esteem after celebrations of Queen Elizabeth II's 60 years on the throne.

"We're riding on a royal high at the moment at the end of the diamond jubilee year," he said. "People enjoyed the royal romance last year and now there's this. It's just a good news story amid all the doom and gloom."

Speculation about when William and his bride would start a family has been rife since their wedding.

William's mother — the late Princess Diana — got pregnant just four months after her wedding in 1981. Like Kate, Diana reportedly suffered from morning sickness for months and complained of constant media attention.

"The whole world is watching my stomach", Diana once said.

American tabloid speculation of the pregnancy has been rampant for months. One newspaper even cited anonymous sources talking about Kate's hormone levels. Others have focused on the first signs of the royal bump.

News of the pregnancy drew congratulations from across the U.K. establishment.

The palace said the royal family was "delighted" by the news, while Prime Minister David Cameron wrote on Twitter that the royals "will make wonderful parents."

Not only are the attractive young couple popular — with William's easy common touch reminding many of his mother, the late Princess Diana — but their child is expected to play an important role in British national life for decades to come.

Whether boy or girl, the child will be next in line behind William in the line of succession to the throne, Cabinet Office officials have said.

Leaders of Britain and the 15 former colonies that have the monarch as their head of state agreed in 2011 to new rules which give females equal status with males in the order of succession.

Although none of the nations had legislated to make the change as of September 2012, the British Cabinet Office confirmed that this is now the de-facto rule.

On the couple's tour of Malaysia, Singapore, the Solomon Islands and Tuvalu in September, William reportedly said he hoped he and Kate would have two children.

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Associated Press writers Jill Lawless and Paisley Dodds contributed to this report.

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