Benedict XVI Begins Final Day as Pope

VATICAN CITY — A day after blessing the faithful for the last time as pope, Benedict XVI prepared on Thursday to meet the cardinals who will elect his successor. After a nearly eight-year papacy that he said was filled with “light and joy” but also darker moments, Benedict will later leave the Vatican by helicopter for the papal summer residence where his retirement will formally take effect at 8 p.m. local time.

Benedict, the first pope to step down willingly for six centuries, was expected to greet the cardinals individually, but not offer any public remarks.

In an emotional and unusually personal message on Wednesday, his final public audience in St. Peter’s Square, Benedict said that sometimes he felt that “the waters were agitated and the winds were blowing against” the church, and other days when “the Lord seemed to be sleeping.”

Benedict shocked the world on Feb. 11 when he announced that, feeling his age and diminishing strength, he would retire, a dramatic step that sent the members of the Vatican hierarchy into a tailspin. He reassured the faithful on Sunday that he was not “abandoning” the church, but would continue to serve, even in retirement.

Starting Thursday night, Benedict will be called “pope emeritus” and will don a white cassock and brown shoes from Mexico, replacing the red slippers that he and other popes have traditionally worn, the red symbolizing the blood of the martyrs.

The conclave to elect the next pope, which is expected to start by mid-March, will begin amid a swirl of scandal. On Monday, Cardinal Keith O’Brien, Britain’s senior Roman Catholic cleric said that he would not participate in the conclave, after having been accused of “inappropriate acts” with several priests, charges that he denies. Other cardinals have also come under fire in sex abuse scandals, but only Cardinal O’Brien has recused himself.

On Monday, Benedict met with three cardinals he had asked to conduct an investigation into the “VatiLeaks” scandal in which hundreds of confidential documents were leaked to the press and published in a tell-all book last May, the worst security breach in the church’s modern history. The three cardinals compiled a hefty dossier on the scandal, which Benedict has entrusted only to his successor, not to the cardinals entering the conclave, the Vatican spokesman said earlier this week.

On Thursday, Panorama, a weekly magazine, reported that the Vatican secretary of state, Cardinal Tarcisio Bertone, had been conducting his own investigation into the leaks scandal, including requesting wiretaps on the phones of some members of the Vatican hierarchy.

A shy theologian who appeared to have little interest in the internal politics of the Vatican, Benedict has said that he is retiring “freely, and for the good of the church,” entrusting it to a successor who has more strength than he. But shadows linger. The next pope will inherit a hierarchy buffeted by crises of governance as well as power struggles over the Vatican Bank, which has struggled to conform to international transparency norms.

Many faithful have welcomed Benedict’s gesture as a sign of humility and humanity, a rational decision taken by a man who no longer feels up to the job.

As he stood near St. Peter’s Square on Wednesday after attending the pope’s last public audience, Vincenzo Petrucci, 26, said he had come to express “not so much solidarity, but more like closeness” to the pope. “At first we felt astonished, shocked and disoriented,” he said. “But then we saw what a weighty decision it must have been. He seemed almost lonely.”

Many in the Vatican hierarchy, known as the Roman Curia, are still reeling from the news. Many are bereaved and others seem almost angry. “We are terribly, terribly, terribly shocked,” one senior Vatican official said, speaking on condition of anonymity.

There is also hushed concern about what it will mean to have two popes residing in the Vatican. On Thursday evening, Benedict will initially reside in Castel Gandolfo, a hilltop town outside Rome where popes have summered for centuries.

He is expected to stay there for several months before returning to the Vatican, where he will live in a convent with a fountain and gardens that look out with a perfect view of the dome of St. Peter’s Basilica.

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American Idol Reveals Its Top 10 Women

TV Watch

American Idol

02/27/2013 at 10:45 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj, Keith Urban

Michael Becker/FOX

American Idol's's list of the top 10 women is complete!

After the first week of sudden-death rounds, the judges gave their stamp of approval to five more female singers Wednesday night. And they sent five others home.

Keep reading to find out who's in and who's out on Idol ...

Here are the five contestants who are moving on in the competition:

1. Zoanette Johnson: The Tulsa resident, 20, was the first to be put through by the judges, who showered her with praise for singing a spirited version of "Circle of Life" from The Lion King. Keith Urban declared her "queen of the jungle." Nicki Minaj told Zoanette, "You make me so emotional ... You're the person we're going to remember tonight."

2. Aubrey Cleland: After singing a slowed-down version of Beyoncé's "Sweet Dreams," Mariah Carey told Cleland, 19, "You're limitless." Nicki and Randy Jackson pointed out her commercial appeal. "Lookin' like a current artist, soundin' like one, feelin' like one," said Nicki of the performance.

3. Candice Glover: Taking on Aretha Franklin's "(You Make Me Feel Like) A Natural Woman" paid off for the singer, 23, who earned a standing ovation from Keith. Randy said she was "one of my favorite singers in the whole competition."

4. Breanna Steer: "You're extremely marketable and gorgeous and talented," Mariah told the singer, 18, after she sang a dramatic version of Jazmine Sullivan's "Bust Your Windows" that had Randy wanting to sign her up for a recording contract. "You got the whole package," he said. "You brought so much drama."

5. Janelle Arthur: She beat out the other country singer in the competition, Rachel Hale, for the final spot in the women's top 10 after singing Lady Antebellum's "Just a Kiss." Though Randy called Arthur, 23, his "favorite country singer in this competition," the other judges questioned her song choice. "[The song] doesn't give you a chance to really soar," Keith said. "The melody kept pulling you back."

These five will join the five female finalists announced last week – Kree Harrison, Amber Holcomb, Adriana Latonio, Angela Miller and Tenna Torres – as well as the five men – Charlie Askew, Curtis Finch Jr., Paul Jolley, Elijah Liu and Devin Velez. Ten more guys will sing Thursday (8 p.m. ET) and five will move on to round out season 12's top 20.

Did the judges make the right decisions? Sound off in the comments below.

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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.

___

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

___

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

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Iran and Six Nations Agree to Two More Rounds of Nuclear Talks

Pool photo by

The European Union foreign policy chief, Catherine Ashton, and Iran’s chief negotiator, Saeed Jalili, at the start of the talks.

ALMATY, Kazakhstan — Talks between Iran and six world powers over its nuclear program ended on Wednesday with an agreement to convene technical experts in Istanbul on March 18 and return to Almaty for full negotiations among the delegations on April 5 and 6, a senior Western diplomat said.

Iran’s chief negotiator, Saeed Jalili, said that modest progress had been achieved. The participants “had come back with more realistic proposals that come a little closer to Iran’s position,” he said. “Their proposals seem more realistic and positive.” He added that there have been “some changes in their viewpoint.”

The two days of talks here had been convened to to get a clear response from Tehran to an offer of step-by-step sanctions relief in return for confidence-building measures from Iran, Western diplomats said.

They cautioned that there was little substantive progress other than Iran’s willingness to study the proposals delivered here and added that the technical meeting in Istanbul is to explain the proposals in detail before returning to Almaty to hear Iran’s response. Senior Western diplomats have said that this week’s meeting would be a low-level success if it produced a specific agreement to meet again soon so that there would be an element of momentum to the negotiations. The talks have been intermittent since beginning in October 2009, with the last meeting eight months ago in Moscow.

The six powers want Iran, as a first step, to stop enriching uranium to 20 percent and to export its stockpile of that more highly enriched uranium, which can be more quickly turned into bomb-grade material. The six also want Iran to shut down its Fordo enrichment facility, built deep into a mountain, which Iran has steadily refused to do. In return, the six — the five permanent members of the Security Council, plus Germany — have offered Iran further sanctions relief, reportedly including permission to resume its gold and precious metals trade as well as some international banking activity and petroleum trade.

The ultimate goal of talks with Iran is to get the country to comply with Security Council resolutions demanding that it stop enrichment altogether until it can satisfy the International Atomic Energy Agency that it has no weapons program and no hidden enrichment sites. In return, all sanctions — which have so far cost Iran 8 percent of its gross domestic product, sharply increased inflation and collapsed the value of the Iranian currency, the rial — would be lifted.

No one expected that kind of breakthrough in this round, especially with Iranian presidential elections coming in June and any major concession likely to be perceived as weakness. But the hope was for an incremental movement toward Iranian compliance in return for a modest lifting of sanctions.

The six nations talking with Iran have remained united and share an impatience over what they perceive to be its delaying tactics. The Russian envoy, Deputy Foreign Minister Sergei Ryabkov, who has been most opposed to increasing sanctions, said Tuesday that time was running out for the talks. He told the Interfax news agency that easing sanctions would be possible only if Iran could assure the world that its nuclear program was for exclusively peaceful purposes.

“There is no certainty that the Iranian nuclear program lacks a military dimension, although there is also no evidence that there is a military dimension,” he said.

He said Moscow hoped the talks would now move into a phase of “bargaining,” rather than just offering proposals. “There needs to be a political will to move into that phase,” Mr. Ryabkov said. “We call on all participants not to lose any more time.”

Tuesday’s talks began at 1:30 p.m. with a plenary session that lasted about 2 hours, 30 minutes, largely taken up with the six laying out their latest modified proposal to the Iranians. The European Union’s foreign policy chief, Catherine Ashton, is the chairwoman and speaks for the six. There was also discussion of the proposal by the Iranians and some questions asked, the diplomats said.

There were a few brief bilateral meetings with the Iranian delegation by the Russians, British and Germans, diplomats said, but not with the French or the Americans. The one and only bilateral meeting between the Americans and the Iranians in the course of the talks was in October 2009 in Geneva, although the chief American negotiator now, Wendy R. Sherman, the under secretary for political affairs in the State Department, has repeatedly said that she is open to another such meeting.

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Bobby Brown Sentenced to 55 Days in Jail in Drunk Driving Case

02/26/2013 at 09:30 PM EST

Bobby Brown has been sentenced to 55 days in jail and four years probation in his most recent drunk driving arrest.

Brown, 44, was pulled over in Studio City, Calif., on Oct. 24 for driving erratically and was arrested when the officer detected "a strong scent of alcohol." He was charged with DUI and driving on a suspended license.

He was also arrested for driving under the influence in March of 2012.

Brown pled no contest to the charges on Tuesday, reports TMZ. He was also ordered to complete an 18-month alcohol treatment program.

The singer, who married Alicia Etheredge in Hawaii in June of 2012, must report to jail by March 20.

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Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

____

Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

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Shares, euro rebound, Italy bond sale in focus

LONDON (Reuters) - Reassurance from the U.S. Federal Reserve about its stimulus program helped stabilize the euro and European shares on Wednesday, as Italy prepared to test the reaction to its inconclusive election in the bond market.

Italy will auction up to 6.5 billion euros of new 5- and 10-year bonds at around 1000 GMT after gridlocked elections reignited fears about the euro zone debt crisis.

"Markets have started to price in risks of ungovernability of the country in the coming months, with possible domino effects on the rest of the euro area," said Newedge economist Annalisa Piazza.

"Political instability is expected to prevail ...and even a grand coalition government would be seen only as a temporary option, probably not able to continue the so-much needed reforms process."

Having fallen sharply on Tuesday following the Italian stalemate, European shares <.fteu3> rebounded 0.4 percent as trading resumed with 0.8 percent rises in Milan's FTSE MIB <.ftmib> and Spain's IBEX <.ibex> the leading the gains.

The mood was helped after Federal Reserve Chairman Ben Bernanke defended the U.S. central bank's monetary stimulus on Tuesday, easing financial market worries over a possible early retreat from bond purchases.

The euro also regained ground, rising 0.2 percent to $1.3085 having hit a seven-week low of $1.3017 on Tuesday.

In the bond market Italian yields, which rise as prices fall, inched up again, while German government bonds , a favourite of risk-adverse investors, also added to this week's hefty gains.

"Italy remains the centre of attention and I can't see it getting any better," one trader said. "Supply will be the main focus and ... it could be a bit of a problem."

(Editing by Anna Willard)

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India Ink: What the Rail Budget 2013-14 Means for Passengers

Indian Railways Minister Pawan Kumar Bansal presented the railways budget for the financial year 2013-14 in Parliament in New Delhi on Tuesday.

This was the first time in 17 years that a politician from the Indian National Congress made the railways budget speech, as the ministry has frequently been offered to allies in coalition governments.

The minister did not announce additional unpopular passenger fare hikes, as the fares were hiked last month, but he did announce increases to a score of other charges, which mean the overall price many passengers pay will increase.

Here are some of the measures which could impact the estimated 25 million people who ride the trains every day.

Supplementary fare charges will be increased, including ticket cancellation charges, tatkal (or last-minute booking) charges and super fast train reservation charges.

26 new passenger trains will be introduced.

67 new express trains will be introduced.

Frequency of 24 trains will be increased.

Online railway bookings will now be available nearly round-the-clock on the Indian Railways website, or from 12:30 a.m. until 11:30 p.m.

Improved online service support will allow 7,200 tickets to be booked per minute.

120,000 users will be able to access the online system at any one time, an improvement over the existing 40,000 users.

Green initiatives on trains, including “bio toilets,” will be introduced.

There will be improvements in infrastructure and quality of food. Some trains will have wi-fi facilities.

The 152,000 positions now vacant in the railways will be filled.

Eight new units of the railway protection force, or R.P.F., will be introduced to improve the safety of women on trains, and 10 percent of the recruits will be women.

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The Bachelor's Sean Lowe Reveals Final Two

TV Watch

The Bachelor

02/25/2013 at 10:30 PM EST

From left: AshLee, Lindsay and Catherine

Kevin Foley/ABC(3)

And then there were two.

After three incredible dates in Thailand with the remaining women, The Bachelor's Sean Lowe faced a difficult decision at the end of Monday's episode: Would he send home AshLee, Catherine or Lindsay?

Keep reading to find out who got a rose – and who was left heartbroken ...

Sean said goodbye to early favorite AshLee in a surprising elimination that left her virtually speechless.

Visibly upset, AshLee left Sean's side without saying goodbye. She even asked him to not walk her to the waiting car that would take her away.

But Sean did get to explain. "I thought it was you from the very beginning," he said. "This was honestly the hardest decision I've ever had to make ... I think the world of you. I did not want to hurt you."

"This wasn't a silly game for me," AshLee said as the car drove away. "This wasn't about a joy ride. It wasn't about laughing and joking and having fun."

She added: "It's hard to say goodbye to Sean because I let him in ... It's the ultimate [rejection]."

Check back Tuesday morning for Sean Lowe's blog post to read all about his Thailand dates and why he chose to send AshLee home

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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."

___

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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