Calif. city plans to provide transgender surgeries

SAN FRANCISCO (AP) — San Francisco is preparing to become the first U.S. city to provide and cover the cost of sex reassignment surgeries for uninsured transgender residents.

The city's Health Commission voted Tuesday to create a comprehensive program for treating transgender people experiencing mental distress because of the mismatch between their bodies and their gender identities. San Francisco already provides transgender residents with hormones, counseling and routine health services, but has stopped short of offering surgical interventions, Public Health Director Barbara Garcia said Thursday after the vote was announced.

The idea for a new program that included surgeries came out of conversations between public health officials and transgender rights advocates who wanted mastectomies, genital reconstructions and other surgeries that are recommended for some transgender people covered under San Francisco's 5-year-old universal health care plan.

At the urging of the San Francisco Board of Supervisors and the San Francisco-based Transgender Law Center, the commission agreed this week to drop sex reassignment surgery from the list of procedures specifically excluded from the Healthy San Francisco plan.

But Garcia described the move as "a symbolic process" for now because the city currently does not have the expertise, capacity or protocols in place to provide the surgeries through its clinics and public hospital.

"The community felt the exclusion on Healthy San Francisco was discriminatory and we wanted to change that as the first step," she said.

Instead of expanding the existing plan, the Health Commission approved the establishment of a separate program that covers all aspects of transgender health, including gender transition. Garcia hopes to have it running by late next year, but said her department first needs to study how many people it would serve, how much it would cost, who would perform the surgeries and where they would be performed.

"Sex reassignment surgery is not the end all. It's one service that some transgender people want and some don't," she said. "We can probably manage this over the next three years without much of a budget increase because we already have these (other) services covered."

San Francisco in 2001 became the first city in the country to cover sex reassignment surgeries for government employees. Last year, Portland, Ore. did the same. The number of major U.S. companies covering the cost of gender reassignment surgery for transgender workers also doubled last year, reflecting a decades-long push by transgender activists to get insurance companies to treat such surgeries as medically necessary instead of elective procedures.

Kathryn Steuerman, a member of a transgender health advocacy group in San Francisco, said the city's latest move would help residents avoid going into debt to finance operations related to gender transition, as she did.

"I am filled with hope and gratitude that we are achieving this level of support for the well-being of the transgender community," Steuerman said.

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Obama breaks down while speaking to staff, volunteers

The morning after he won re-election, an emotional President Barack Obama credited his youthful staff of several hundred with running a campaign that will "go on in the annals of history."

"What you guys have accomplished will go on in the annals of history and they will read about it and they'll marvel about it," said Obama told his team Wednesday morning inside the Chicago campaign headquarters, tears streaming down his face.

"The most important thing you need to know is that your journey's just beginning. You're just starting. And whatever good we do over the next four years will pale in comparison to whatever you guys end up accomplishing in the years and years to come," he said.

The moment, captured by the Obama campaign's cameras and posted online, offers a rare glimpse at the president unplugged and emotional. During the first four years of his presidency, Obama has never been seen publicly crying.

He first came to Chicago, he told the campaign staff, "knowing that somehow I wanted to make sure that my life attached itself to helping kids get a great education or helping people living in poverty to get decent jobs and be able to work and have dignity. And to make sure that people didn't have to go to the emergency room to get health care."

"The work that I did in those communities changed me much more than I changed those communities because it taught me the hopes and aspirations and the grit and resilience of ordinary people," he said, as senior strategist David Axelrod and campaign manager Jim Messina looked on. "And it taught me the fact that under the surface differences, we all have common hopes and we all have common dreams. And it taught me something about how I handle disappointment and what it meant to work hard on a common endeavor, and I grew up."

"So when I come here and I look at all of you, what comes to mind is, it's not that you guys remind me of myself, it's the fact that you are so much better than I was in so many ways. You're smarter, you're so better organized, you're more effective," he said.

Obama said he expected many of those who helped to re-elect him will assume new roles in progressive politics, calling that prospect a "source of my strength and inspiration."

Senior campaign officials said Thursday that the Obama campaign infrastructure - the field offices and network of hundreds of thousands of volunteers - would undergo a period of transition in the coming weeks to determine how to remain sustainable and influential.

"We have remarkable staff, and the campaign that Jim [Messina] put together, you know, is the best in history," said senior Obama adviser David Plouffe. "But the reason those people got involved was because they believed in Barack Obama. It was the relationship between them and our candidate."

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Oil recoups some lost ground after big drop

BANGKOK (AP) — The price of oil recouped some lost ground Thursday, a day after its biggest decline of the year.

Benchmark crude for December delivery was up 54 cents to $84.98 per barrel at midday Bangkok time in electronic trading on the New York Mercantile Exchange. The contract fell $4.27, or 5 percent, to finish at $84.44 per barrel in New York. It was the lowest price since July 10.

Traders say the U.S. has ample oil stocks because of increased output and reduced demand in the aftermath of Hurricane Sandy. The government reported another increase in supply last week, reminding traders that crude inventories are nearly 11 percent above year-ago levels while demand remains anemic.

However, data from American Petroleum Institute showed that weekly crude oil inventories fell 27,000 barrels to 371.7 million for the week ending Nov. 2. That might have tipped prices higher.

A day after President Barack Obama won re-election, concerns about global economic growth still dominate commodities markets.

In the U.S., investors worried that Washington may not be able to avoid the deep spending cuts and tax hikes set to automatically take place in January unless the politically divided Congress acts.

Meanwhile, the European Commission cut its forecasts for the region's economic growth through 2013. German industrial orders fell by more than expected in September, portending possible tough times ahead for Europe's largest economy.

Brent crude rose 50 cents to $107.32 per barrel in London.

In other energy futures trading in New York:

— Wholesale gasoline rose 2.2 cents to $2.611 per gallon.

— Heating oil rose 1.5 cents to $2.978 per gallon.

— Natural gas dropped 3.2 cents to $3.546 per 1,000 cubic feet.

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Apple slides to five-month low, uncertainty grows

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Rihanna a rock star on Victoria's Secret catwalk

NEW YORK (AP) — Rihanna rocked the lingerie look at Wednesday night's Victoria's Secret fashion show in New York, providing the highlight of the live-music soundtrack and holding her own on the catwalk with some of the world's top models.

And those models even had props, including Adriana Lima's ringmaster wand, Doutzen Kroes' body cage and several pairs of the oversized wings that the retailer has made its signature. It would be a close contest who got the biggest wings: Toni Garrn's giant poppy pair or Miranda Kerr's swan-style feathered pouf. Only Lily Aldridge could boast star-spangled wings that shot out silver sparkles.

Alessandra Ambrosio's orchid-petal wings might have lacked a little grandeur, but she made up for it with a $2.5 million jeweled "floral fantasy bra."

Still, wearing a sheer pink mini that gave glimpses of her bra, Rihanna sang "Fresh Out the Runway" at the end of the corset-and-garter parade and she was the one to grab the audience's biggest applause.

The fashion show has become a pre-holiday season tradition for the retailer. CBS will turn it into a one-hour special, which also had performances from Justin Bieber and Bruno Mars, to be shown on Dec. 4.

This year's event had a slight twist. It started with an announcer noting that Victoria's Secret and CBS had each made a donation to relief efforts for Superstorm Sandy, and a thank you to the National Guard members who are based out of the Lexington Avenue Armory that has for years been home to the show.

Mostly, though, models are encouraged to smile, ham it up and show off the extra time at the gym that most admit to in the weeks beforehand. "It's highly televised, and you take that into consideration," said model Joan Smalls ahead of the show. "This is kind of not the same as other runways. You have to prepare your body: No. 1 is the wings are heavy, and No. 2 is you have to be comfortable with your body because the camera will pick up on it if you're not comfortable and confident."

There's an emphasis on glitz, skin and dramatic production here, not wearable undergarment trends for typical Victoria's Secret shoppers. It was divided into six sections: Circus, complete with acrobats, contortionists and a sword eater; Dangerous Liaisons; Pink Is Us; Silver Screen Angels; Angels in Bloom; and Calendar Girls, which allowed Bruno Mars to serenade a model for each month of the year.

For his first song, "Beauty and the Beat," Bieber, wearing low-slung white pants and a white leather studded vest, sat alone with his guitarist in the mellowest part of the show. For "As Long As You Love Me," however, he brought in backup dancers and interacted with the models while moving around a giant makeshift pinball machine.

"It's like a dream come true," said Bieber on the pink carpet before the show. "I would rather be here than anywhere in the world."

___

AP reporter John Carucci contributed to this report.

___

Samantha Critchell tweets fashion at http://www.twitter.com/AP_Fashion

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How did America become so polarized?

WASHINGTON (AP) — The election laid bare a dual — and dueling — nation, politically speaking, jaggedly split down the middle on the presidency and torn over much else. It seems you can please only half of the people nearly all of the time.

Americans retained the fractious balance of power in re-electing President Barack Obama, a Republican House and a Democratic Senate, altogether serving as guarantors of the gridlock that voters say they despise. Slender percentages separated winner and loser from battleground to battleground, and people in exit polls said yea and nay in roughly equal measure to some of the big issues of the day.

Democracy doesn't care if you win big, only that you win. Tuesday was a day of decision as firmly as if Obama had run away with the race. Democrats are ebullient and, after a campaign notable for its raw smackdowns, words of conciliation are coming from leaders on both sides, starting with the plea from defeated Republican rival Mitt Romney that his crestfallen supporters pray for the president.

But after the most ideologically polarized election in years, Obama's assertion Wednesday morning that America is "more than a collection of red states and blue states" was more of an aspiration than a snapshot of where the country stands.

"It's going to take a while for this thing to heal," said Ron Bella, 59, a Cincinnati lawyer who lives in Alexandria, Ky. He is relieved Obama won, but some of his co-workers are in a "sour mood" about it.

"They feel like the vast majority of the country wanted Romney, and the East and the West coasts wanted Obama," he said. "I'm not sure exactly why that is, but there just seems to be such hatred for Obama out there."

Compromise was a popular notion in the hours after Obama's victory and an unavoidable one, given the reality of divided government. But the familiar contours of partisan Washington were also in evidence, especially the notion that compromise means you do things my way.

As Democratic Rep. Steve Israel of New York put it, "If you refuse to compromise, we are going to beat you." Israel, chairman of the Democratic Congressional Campaign Committee, said the election showed "if you are an extremist tea party Republican, you are going to lose."

Senate Republican Leader Mitch McConnell of Kentucky said pointedly that Republicans will meet Obama halfway "to the extent he wants to move to the political center" and propose solutions "that actually have a chance of passing."

In New York's bustling Times Square, hope, skepticism and the usual polarities were all to be found when people talked about the president. "He may not have done a great job in my mind but I kinda trust him," said Jerry Shul. "I have faith he will get with the Republicans and get something done."

A less-flattering George Dallemand called this "a moment of truth" for the country. "I guess we have to wish for the best now, but I still think he is socialism."

In Miami, Karen Fitzgerald, 55, wore a black dress and said she was in mourning over Romney's defeat.

"It's an upsetting day," she said. But she took some comfort from her Democratic friends on Facebook, who have stopped chiding the other side in their posts. "Now they're all saying we need to work together and be united," she said. "Maybe we can."

In Springfield, Ohio, an "elated" Frank Hocker, 67, hoped Republicans would get the message to get out of Obama's way. "There was a backlash," he said. "For this obstructionist House and those tea party people, I hope they learned their lesson. I hope they learned their lesson: Don't stop the progress of this country."

In Chicago, Obama supporter Scherita Parrish, 56, predicted the president will reach out to Republicans but may not get much back.

"But the people have spoken," she said. "They need to lick their wounds, get on with it and start working with the president."

Unity is a challenge not just for Obama but for the Republicans, who won less than 30 percent of the growing Hispanic vote and not even one in 10 black voters. Obama built a strong Electoral College majority, if only a narrow advantage in the popular vote, despite losing every age group of non-Hispanic white voters.

Surveys of voters found Obama's health care law to be as divisive as ever, with just under 50 percent wanting it repealed in whole or part, and 44 percent liking it as is or wanting more of it.

But democracy doesn't care about exit polls, either, and the election almost certainly means Republicans can forget about trying to roll it back now.

In reaffirming divided government, though, Americans all but ensured colossal fights are ahead over the shape of government and Obama's agenda. He is out to break a wall of Republican opposition to tax increases on the wealthy — a move that about half the voters in exit polls thought was a good idea. And extraordinarily difficult negotiations are imminent as the president and Congress try to make a deal to avoid the "fiscal cliff" — steep spending cuts and a variety of tax increases in January.

In the end, voters split about equally on whether Obama or Romney would be better at handling the economy.

Then again, they were divided down the middle on whether Obama or his predecessor, George W. Bush, deserves most of the blame for the economy's problems.

So it goes in the 50-50 nation, give or take.

___

Associated Press writers Christine Armario in Miami, Michael Tarm in Chicago, David Martin in New York, Amanda Myers in Cincinnati and Ann Sanner in Columbus, Ohio, contributed to this report.

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China hauls away activists in congress crackdown

BEIJING (AP) — During her 30-hour train journey to Beijing, Wang Xiulan ducked into bathrooms whenever the conductors checked IDs. Later, as she lay low in the outskirts of the capital, unidentified men caught her in a nighttime raid and hauled her to a police station. She assumed a fake identity to get away, and is now in hiding again.

Wang's not a criminal. She's a petitioner.

She's among many people attempting to bring local complaints directly to the central government in an age-old Chinese tradition that has continued during the Communist Party era. But police never make that easy, and this week, as an all-important leadership transition begins, a dragnet is aimed at keeping anyone perceived as a threat or a troublemaker out of Beijing.

"There is no law in China, especially for us petitioners and ordinary folk," Wang, 50, said in an interview with The Associated Press. "Even common gangsters and hoodlums get to leave after they serve time for crimes, but for us, if we get locked up, we never know when we might be freed."

Authorities want no surprises as the handover of power begins in the capital Thursday. The transition already has been rocked by the party's messiest scandal in decades, involving a former high-flying politician now accused of engaging in graft and obstructing the investigation into his wife's murder of a British businessman.

Rights groups say the wide-ranging crackdown on critics bodes poorly for those who hope the incoming generation of leaders will loosen restrictions on activism.

"China's top political leaders are very nervous, as they have since early this year been consumed by one of the most destabilizing and disharmonious power struggles in decades," said Renee Xia, international director of the Chinese Human Rights Defenders. The group estimates that hundreds or thousands of people have come under some kind of restriction in preparation for the party congress.

Lawyers have been held under illegal house arrest, dissidents sent back to their hometowns and activists questioned. Internet users report difficulties accessing many websites and the failure of software meant to bypass Internet filters.

Veteran activist Huang Qi, who runs a website on petitioners like Wang, said nearly 1,000 people have contacted him over the past few weeks to complain that authorities have hired thugs to harass and beat them.

"I hope that the Chinese authorities will face up to the social problems," Huang said in an interview. "Using violence will only escalate the resistance."

The crackdown reflects the leadership's nervousness as slowing economic growth exacerbates public outrage over corruption, social injustice, pollution and favoritism toward state-run agencies and the elite at the expense of ordinary people.

Under normal circumstances, petitioners are relatively safe once they reach Beijing's outskirts, though in their home provinces they are almost perpetually on the run from hostile local officials or thugs-for-hire who want to nab them before they can get an audience with central government agencies.

Now, however, even the capital's fringes are off limits.

Wang, a petite woman with shoulder-length hair neatly tied back, has been trying for two decades to draw central government attention to what she says was police mishandling of a serious assault she suffered in her native Harbin. Not only did her attacker go unpunished, but Wang ended up getting dismissed from her job years later.

Wang arrived in late October in Lu Village in Beijing's southwest, where petitioners have sought refuge for years. A police post guards the road into the village, and residents say officers have lately blocked petitioners from entering.

Wang had rented a bed — a wooden plank on bricks — in a tiny concrete room shared with two others. A gang of two dozen men barged in one night at 11 p.m., demanded to see her ID, searched her belongings and grabbed her cellphone.

"I was scared to death when they suddenly barged in here," Wang said, pointing at the door, where the lock had just been replaced.

The men refused to identify themselves and bundled her into a minivan with other petitioners. At another stop, she saw a couple dragged into the vans in their pajamas, the woman wearing only one shoe.

All were taken to a police station in nearby Jiujingzhuang village, where many petitioners say police process them for return to their hometowns. Using someone else's identity, Wang was able to evade police suspicion and was released. Many of the others were sent back, she said.

The raids are having an effect. The compound that houses her room and others now has only a handful of residents, down from about 30.

"They've all been chased away, caught or scared home," said Liu Zhifa, a 67-year-old petitioner from Henan province and one of the holdouts. Liu confirmed Wang's description of the Oct. 31 raid and described his own encounter with thugs breaking his lock and entering his room three times in one night in mid-October.

"I asked them to show their identifications, and they yelled at me, saying 'What right do you have to see our identification? Who do you think you are?" said Liu. "They were ruthless. The authorities and the police are working with people in the underworld."

A police officer who would only give his surname, Wei, answered the phone at a Jiujingzhuang police station (not 'the' because the police station has another name) and denied that authorities were raiding petitioners' villages. "We only act according to the law," Wei said. Questions about the broader crackdown were referred to the Beijing public security bureau, which did not respond to faxed questions.

The crackdown has extended to lawyers such as Xu Zhiyong. He said Beijing authorities have held him under informal house arrest since mid-October, stationing four or five guards outside his apartment in Beijing around the clock.

Xu has campaigned for years against Chinese authorities' use of "black jails," or unofficial detention centers run by local governments to hold petitioners. The government has denied the existence of such facilities, but even the tightly controlled state media have reported on them.

"The illegal restriction of a citizen's personal freedom for a long period of time is criminal behavior," Xu wrote in an email. "In an authoritarian state, this type of crime takes place everywhere."

Authorities in Shanghai also have ratcheted up pressure on critics, sentencing veteran women's rights activist Mao Hengfeng to a year and a half of labor camp. Mao, accused of disturbing social order, had been detained in Beijing in late September, said her husband, Wu Xuewei, who indicated she was being put away to silence her before the party congress.

Even dissidents' relatives have come under pressure. Beijing activist Hu Jia said he was warned by police to leave town, and that even his parents told him that police had told them to escort him to his hometown.

"My parents said to me: 'Hu Jia, you don't know what kind of danger you are in, but we know,'" he recounted in a phone interview from his parents' home in eastern Anhui province. "They said: 'Beijing is a cruel battlefield. If you stay here, you will be the first to be sacrificed. Don't do this.'"

___

Follow Gillian Wong on Twitter at twitter.com/gillianwong

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Exclusive - Amazon to win EU e-book pricing tussle with Apple

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The Civil Wars cancel tour using divorce language

NASHVILLE, Tenn. (AP) — Grammy-winning duo The Civil Wars have canceled their upcoming tour dates, citing irreconcilable differences.

The folk-pop duo Joy Williams and John Paul White released a statement Tuesday announcing that because of "internal discord and irreconcilable differences of ambition" they were unable to "continue as a touring entity at this time."

Although they used the language of divorce, the duo added, "Our sincere hope is to have new music for you in 2013."

Williams and White are both married, but to other people. Williams had a baby this summer with husband Nate Yetton, the duo's manager.

Earlier this year the pair canceled part of their European tour.

The duo found unexpected success with their 2011 debut album, "Barton Hollow." With backgrounds in gospel and rock, they met when they were both asked to contribute to a country project and found chemistry.

Back then, the pair framed their partnership in terms of courting. White told The Associated Press that after two songwriting sessions, "I finally got up the nerve to ask her out, as it were."

"In a musical way," Williams said.

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Study: Stem cells from strangers can repair hearts

LOS ANGELES (AP) — Researchers are reporting a key advance in using stem cells to repair hearts damaged by heart attacks. In a study, stem cells donated by strangers proved as safe and effective as patients' own cells for helping restore heart tissue.

The work involved just 30 patients in Miami and Baltimore, but it proves the concept that anyone's cells can be used to treat such cases. Doctors are excited because this suggests that stem cells could be banked for off-the-shelf use after heart attacks, just as blood is kept on hand now.

Results were discussed Monday at an American Heart Association conference in California and published in the Journal of the American Medical Association.

The study used a specific type of stem cells from bone marrow that researchers believed would not be rejected by recipients. Unlike other cells, these lack a key feature on their surface that makes the immune system see them as foreign tissue and attack them, explained the study's leader, Dr. Joshua Hare of the University of Miami.

The patients in the study had suffered heart attacks years earlier, some as long as 30 years ago. All had developed heart failure because the scar tissue from the heart attack had weakened their hearts so much that they grew large and flabby, unable to pump blood effectively.

Researchers advertised for people to supply marrow, which is removed using a needle into a hip bone. The cells were taken from the marrow and amplified for about a month in a lab at Baltimore's Johns Hopkins University, then returned to Miami to be used for treatment, which did not involve surgery.

The cells were delivered through a tube pushed through a groin artery into the heart near the scarred area. Fifteen patients were given cells from their own marrow and 15 others, cells from strangers.

About a year later, scar tissue had been reduced by about one-third. Both groups had improvements in how far they could walk and in quality of life. There was no significant difference in one measure of how well their hearts were able to pump blood, but doctors hope these patients will continue to improve over time, or that refinements in treatment will lead to better results.

The big attraction is being able to use cells supplied by others, with no blood or tissue matching needed.

"You could have the cells ready to go in the blood bank so when the patient comes in for a therapy — there's no delay," Hare said. "It's also cheaper to make the donor cells," and a single marrow donor can supply enough cells to treat as many as 10 people.

Dr. Elliott Antman of Harvard-affiliated Brigham and Women's Hospital in Boston who heads the heart conference, praised the work.

"That opens up an entire new avenue for stem cell therapy, like a sophisticated version of a blood bank," he said. There's an advantage in not having to create a cell therapy for each patient, and it could spare them the pain and wait of having their own marrow harvested, he said.

The study was sponsored by the National Institutes of Health. Hare owns stock in a biotech company working on a treatment using a mixture of cells.

Juan Lopez received his own cells in the study, and said it improved his symptoms so much that at age 70, he was able to return to his job as an engineer and sales manager for a roofing manufacturer and ride an exercise bike.

"It has been a life-changing experience," said Lopez, who lives in Miami. "I can feel day by day, week by week, month by month, my improvement. I don't have any shortness of breath and my energy level is way up there. I don't have any fluid in my lungs."

And, he said happily, "My sex drive has improved!"

___

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

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