Group releases list of 90 medical ‘don’ts’

Don’t use feeding tubes in patients with advanced dementia. Don’t use drugs to aggressively treat diabetes in those older than 65. Don’t automati­cally use imaging technology for minor head injuries in children and headaches in adults. And don’t give antacids to babies with reflux.

Those are among the 90 medical “don’ts” on a list being released Thursday by a coalition of doctor and consumer groups. They are trying to discourage the use of tests and treatments that have become common practice but may cause harm to patients or unnecessarily drive up the cost of health care.

It is the second set of recommendations from the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, which launched last year amid nationwide efforts to improve medical care in the United States while making it more affordable.

The recommendations run the gamut, from geriatrics to opthalmology to maternal health. Together, they are meant to convey the message that in medicine, “sometimes less is better,” said Daniel Wolfson, executive vice president of the foundation, which funded the effort.

“Sometimes, it’s easier [for a physician] to just order the test rather than to explain to the patient why the test is not necessary,” Wolfson said. But “this is a new era. People are looking at quality and safety and real outcomes in different ways.”

The guidelines were penned by more than a dozen medical professional organizations, including the American Academy of Pediatrics and the American College of Obstetricians and ­Gynecologists.

The groups discourage the use of antibiotics in a number of instances in which they are commonly prescribed, such as for sinus infections and pink eye. They caution against using certain sedatives in the elderly and cold medicines in the very young.

In some cases, studies show that the test or treatment is costly but does not improve the quality of care for the patient, according to the groups.

But in many cases, the groups contend, the intervention could cause pain, discomfort or even death. For example, feeding tubes are often used to provide sustenance to dementia patients who cannot feed themselves, even though oral feeding is more effective and humane. And CT scans that are commonly used when children suffer minor head trauma may expose them to cancer-causing radiation.

While the recommendations are aimed in large part at physicians, they are also designed to arm patients with more information in the exam room.

“If you’re a healthy person and you’re having a straightforward surgery, and you get a list of multiple tests you need to have, we want you to sit down and talk with your doctor about whether you need to do these things,” said John Santa, director of the health ratings center at Consumer Reports, which is part of the coalition that created the guidelines.

Health-care spending in the United States has reached 17.9 percent of the nation’s gross domestic product and continues to rise, despite efforts to contain costs. U.S. health-care spending grew 3.9 percent in 2011, reaching $2.7 trillion, according to the journal Health Affairs.

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Man charged with outraging modesty of girl

SINGAPORE: A man has been charged with outraging the modesty of a 16-year-old girl.

Toh Boon Cheong, 52, is accused of rubbing his groin area against the girl's hip on board the MRT train travelling from Choa Chu Kang station to Bukit Gombak station.

The alleged incident occurred on 15 January, at about 6:50am.

If convicted, Toh faces up to two years' jail and caning.

- CNA/ck

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Hyderabad bomb blast: Rajnath to meet families of blast victims

NEW DELHI: BJP president Rajnath Singh will visit Hyderabad on Friday to meet the injured and family members of those killed in the twin blasts in the city.

Rajnath, accompanied by BJP MP and spokesperson Shahnawaz Hussain and party secretary Murlidhar Rao, is likely to visit the Dilsukhnagar area of Hyderabad where the two blasts took place on Thursday evening.

The BJP leaders will also visit the hospitals where the injured are being treated and later meet the kin of those killed.

In a statement issued on Thursday, Singh had condoled the death of innocent people in the blast and demanded that immediate steps be taken to provide relief to the injured.

14 people were killed and 110 injured, six of them critically when two powerful near simultaneous blasts ripped through a crowded area close to a cluster of bus stands in Dilsukhnagar area in Hyderabad on Thursday.

The blasts triggered by improvised explosive devices (IED) tied to two bicycles took place at two sites 100 metres apart outside a roadside eatery near Konark and Venkatadiri theatres in the area located on the Hyderabad-Vijaywada National Highway in Cyberabad police limits.

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Oldest Known Wild Bird Hatches Chick at 62

Wisdom, the oldest known wild bird, has yet another feather in her cap—a new chick.

The Laysan albatross (Phoebastria immutabilis)—62 years old at least—recently hatched a healthy baby in the U.S. Midway Atoll National Wildlife Refuge, her sixth in a row and possibly the 35th of her lifetime, according to the U.S. Geological Survey's (USGS) North American Bird Banding Program. (Related: "51-Year-Old Albatross Breaks N. American Age Record [2003].")

But Wisdom's longevity would be unknown if it weren't for a longtime bird-banding project founded by USGS research wildlife biologist Chandler Robbins.

Now 94, Robbins was the first scientist to band Wisdom in 1956, who at the time was "just another nesting bird," he said. Over the next ten years, Robbins banded tens of thousands of black-footed albatrosses (Phoebastria nigripes) and Laysan albatrosses as part of a project to study the behavior of the large seabirds, which at the time were colliding with U.S. Navy aircraft.

Robbins didn't return to the tiny Pacific island—now part of the U.S. Papahānaumokuākea Marine National Monument—until 2002, when he "recaptured as many birds as I could in hopes that some of them would be the old-timers."

Indeed, Robbins did recapture Wisdom—but he didn't know it until he got back to his office at the Patuxent Wildlife Research Center in Laurel, Maryland, and checked her band number in the database.

"That was real exciting, because we didn't think the chances of finding one that old would be that good," Robbins said Wednesday in an interview from his office at the Patuxent center, where he still works.

Chandler Robbins counts birds in Maryland's Patuxent Research Refuge.

Photograph by David H. Wells, Corbis

Albatrosses No Bird Brains

Bigger birds such as the albatross generally live longer than smaller ones: The oldest bird in the Guinness Book of Animal Records, a Siberian white crane (Leucogeranus leucogeranus), lived an unconfirmed 82 years. Captive parrots are known to live into their 80s. (See National Geographic's bird pictures.)

The Laysan albatross spends most of the year at sea, nesting on the Midway Atoll (map) in the colder months. Birds start nesting around five years of age, which is how scientists knew that Wisdom was at least five years old in 1956.

Because albatrosses defend their nests, banding them doesn't require a net or a trap as in the case of other bird species, Robbins said—but they're far from tame.

"They've got a long, sharp bill and long, sharp claws—they could do a job on you if you're not careful how to handle them," said Robbins, who estimates he's banded a hundred thousand birds.

For instance, "when you're not looking, the black-footed albatross will sneak up from behind and bite you in the seat of the pants."

But Robbins has a fondness for albatrosses, and Wisdom in particular, especially considering the new dangers that these birds face.

Navy planes are no longer a problem—albatross nesting dunes were moved farther from the runway—but the birds can ingest floating bits of plastic that now inundate parts of the Pacific, get hooked in longlines meant for fish, and be poisoned by lead paint that's still on some of Midway Atoll's buildings. (Also see "Birds in 'Big Trouble' Due to Drugs, Fishing, More.")

That Wisdom survived so many years avoiding all those hazards and is still raising young is quite extraordinary, Robbins said.

"Those birds have a tremendous amount of knowledge in their little skulls."

"Simply Incredible"

Wisdom's accomplishments have caught the attention of other scientists, in particular Sylvia Earle, an oceanographer and National Geographic Explorer in Residence, who said by email that Wisdom is a "symbol of hope for the ocean." (National Geographic News is part of the National Geographic Society.)

Earle visited Wisdom at her nest in January 2012, where she "appeared serenely indifferent to our presence," Earle wrote in the fall 2012 issue of the Virginia Quarterly Review.

"I marveled at the perils she had survived during six decades, including the first ten or so years before she found a lifetime mate. She learned to fly and navigate over thousands of miles to secure enough small fish and squid to sustain herself, and every other year or so, find her way back to the tiny island and small patch of grass where a voraciously hungry chick waited for special delivery meals."

Indeed, Wisdom has logged an estimated two to three million miles since 1956—or four to six trips from Earth to the moon and back, according to the USGS. (Related: "Albatross's Effortless Flight Decoded—May Influence Future Planes.")

Bruce Peterjohn, chief of the North American Bird Banding Program, called Wisdom's story "simply incredible."

"If she were human, she would be eligible for Medicare in a couple years—yet she is still regularly raising young and annually circumnavigating the Pacific Ocean," he said in a statement.

Bird's-Eye View

As for Robbins, he said he'd "love to get out to Midway again." But in the meantime, he's busy going through thousands of bird records in an effort to trace their life histories.

There's much more to learn: For instance, no one has ever succeeded in putting a radio transmitter on an albatross to follow it throughout its entire life-span, Robbins noted.

"It would be [an] exciting project for someone to undertake, but I'm 94 years old," he said, chuckling. "It wouldn't do much for me to start a project at my age."

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Arias Challenged On Pedophilia Claim

Accused murderer Jodi Arias was challenged today by phone records, text message records, and her own diary entries that appeared to contradict her claim that she caught her ex-boyfriend, Travis Alexander, looking at pictures of naked boys.

Arias had said during her testimony that one afternoon in January 2008, she walked in on Alexander masturbating to pictures of naked boys. She said she fled from the home, threw up, drove around aimlessly, and ignored numerous phone calls from Alexander because she was so upset at what she had seen.

The claim was central to the defense's accusation that Alexander was a "sexual deviant" who grew angry and abusive toward Arias in the months after the incident, culminating in a violent confrontation in June that left Alexander dead.

Arias claimed she killed him in self-defense. She could face the death penalty if convicted of murder.

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

Today, prosecutor Juan Martinez, who has been aggressive in questioning witnesses throughout the trial, volleyed questions at her about the claim of pedophilia, asking her to explain why her and Alexander's cell phone records showed five calls back and forth between the pair throughout the day she allegedly fled in horror. Some of the calls were often initiated Arias, according to phone records.

Jodi Arias Doesn't Remember Stabbing Ex-Boyfriend Watch Video

Jodi Arias Murder Trial: Testimony About Ex's Death Watch Video

Arias on Ex-Boyfriend's Death: 'I Don't Remember' Watch Video

She and Alexander also exchanged text messages throughout the afternoon and evening at a time when Arias claims the pedophilia incident occurred. In those messages they discuss logistics of exchanging one another's cars that night. Alexander sends her text messages about the car from a church social event he attended that night that she never mentioned during her testimony.

Arias stuck by her claim that she saw Alexander masturbating to the pictures, and her voice remained steady under increasingly-loud questioning by Martinez.

But Martinez also sparred with Arias on the stand over minor issues, such as when he asked Arias detailed questions about the timing and order of events from that day and Arias said she could not remember them.

"It seems you have problems with your memory. Is this a longstanding thing? Since you started testifying?" Martinez asked.

"No it goes back farther than that. I don't know even know if I'd call it a problem," Arias said.

"How far back does it go? You don't want to call them problems, are they issues? Can we call them issues? When did you start having them?" he asked in rapid succession. "You say you have memory problems, that it depends on the circumstance. Give me the factors that influence that."

"Usually when men like you or Travis are screaming at me," Arias shot back from the stand. "It affects my brain, it makes my brain scramble."

"You're saying it's Mr. Martinez's fault?" Martinez asked, referring to himself in the third person.

"Objection your honor," Arias' attorney finally shouted. "This is a stunt!"

Timeline of the Jodi Arias Trial

Martinez dwelled at one point about a journal entry where Arias wrote that she missed the Mormon baptism of her friend Lonnie because she was having kinky sex with Alexander. He drew attention to prior testimony that she and Alexander used Tootsie Pops and Pop Rocks candy as sexual props.

"You're trying to get across (in the diary entry) that this involved a sexual liaison with Mr. Alexander right?" he asked. "And you're talking about Tootsie Pops and Pop Rocks?"

"That happened also that night," Arias said.

"You were there, enjoying it, the Tootsie Pops and Pop Rocks?" he asked again, prompting a smirk from Arias.

"I enjoyed his attention," Arias said.

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Group releases list of 90 medical ‘don’ts’

Don’t use feeding tubes in patients with advanced dementia. Don’t use drugs to aggressively treat diabetes in those older than 65. Don’t automati­cally use imaging technology for minor head injuries in children and headaches in adults. And don’t give antacids to babies with reflux.

Those are among the 90 medical “don’ts” on a list being released Thursday by a coalition of doctor and consumer groups. They are trying to discourage the use of tests and treatments that have become common practice but may cause harm to patients or unnecessarily drive up the cost of health care.

It is the second set of recommendations from the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, which launched last year amid nationwide efforts to improve medical care in the United States while making it more affordable.

The recommendations run the gamut, from geriatrics to opthalmology to maternal health. Together, they are meant to convey the message that in medicine, “sometimes less is better,” said Daniel Wolfson, executive vice president of the foundation, which funded the effort.

“Sometimes, it’s easier [for a physician] to just order the test rather than to explain to the patient why the test is not necessary,” Wolfson said. But “this is a new era. People are looking at quality and safety and real outcomes in different ways.”

The guidelines were penned by more than a dozen medical professional organizations, including the American Academy of Pediatrics and the American College of Obstetricians and ­Gynecologists.

The groups discourage the use of antibiotics in a number of instances in which they are commonly prescribed, such as for sinus infections and pink eye. They caution against using certain sedatives in the elderly and cold medicines in the very young.

In some cases, studies show that the test or treatment is costly but does not improve the quality of care for the patient, according to the groups.

But in many cases, the groups contend, the intervention could cause pain, discomfort or even death. For example, feeding tubes are often used to provide sustenance to dementia patients who cannot feed themselves, even though oral feeding is more effective and humane. And CT scans that are commonly used when children suffer minor head trauma may expose them to cancer-causing radiation.

While the recommendations are aimed in large part at physicians, they are also designed to arm patients with more information in the exam room.

“If you’re a healthy person and you’re having a straightforward surgery, and you get a list of multiple tests you need to have, we want you to sit down and talk with your doctor about whether you need to do these things,” said John Santa, director of the health rating center at Consumer Reports, which is part of the coalition that created the guidelines.

Health-care spending in the United States has reached 17.9 percent of the nation’s gross domestic product and continues to rise, despite efforts to contain costs. U.S. health-care spending grew 3.9 percent in 2011, reaching $2.7 trillion, according to the journal Health Affairs.

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Del Piero signs for second season Down Under

MELBOURNE: Italian World Cup winner Alessandro Del Piero has signed on for a second season in Australia's A-League as his Sydney FC side push for a play-off place.

"I'm very happy about this news," the Juventus and Italy legend told a press conference after agreeing to activate the second year of a reported US$2 million-a-season contract.

"For sure it's a great moment for me, for Sydney FC," he said, thanking the club for trusting him.

The 38-year-old said he would not carry on if he could not play at a high level.

"In my age, I want to be very honest. We have to see year by year."

Del Piero has already scored 11 goals in 18 matches, a record haul by a Sydney FC player in a single season and been a hit off the pitch too, helping to boost crowds, shirt sales and television ratings.

Sydney FC has fought back from the bottom of the league to fifth place -- within reach of qualification for the playoffs, largely thanks to Del Piero's goals.

"We have a good position but it's not enough, we have six games remaining but we have to push our energy to take a play-off," he said.

"We want to improve for the next year and do better and better every week," he added.

The team's charge for the finals gathered steam, with a 2-1 win over Adelaide United following the signing of Socceroos captain Lucas Neill on Saturday.

An early-season collapse was halted by the December arrival of former Australia coach Frank Farina, quickly turning Sydney FC into the form team.

- AFP/sf

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Day 2 of nationwide strike: Cops on alert in Noida; several states affected

NEW DELHI: Normal life in several parts of the country continued to remain affected on Day 2 of the nationwide strike called by the trade unions.

Cops in Noida are on high alert, after widespread violence on the first day of the strike. According to TV reports, several schools and offices in Noida have been closed.

The UP government has formed a two-member panel to probe the violence in Noida on the first day of the two-day nationwide shutdown.

The state government late on Wednesday named additional director general of police (Law and Order) Arun Kumar and home secretary Rakesh as members of the probe committee and asked them to submit a fact finding report within three days.

Principal secretary (Home) RM Srivastava told IANS that "toughest action" would be taken against those found guilty of violence.

The committee has been asked to look into the state of preparedness of the Noida police to handle the shutdown and identify district officials guilty of dereliction of duty.

"The government has taken a serious note of the whole episode, wherein properties were gutted, people were beaten up and several vehicles were set on fire. There should be no doubt that the government would crack down on all found guilty," Srivastava said.

Violence erupted on Wednesday in Noida and Greater Noida where factories were targeted and set on fire. Violent clashes took place and several vehicles were set afire.

Officials have started screening the video footage of the violence in order to identify and book the perpetrators.

"We are also exploring possibilities of slapping the National Security Act (NSA) on the rioters," a senior official said.

State government sources said chief minister Akhilesh Yadav was particularly miffed at the Noida violence as he views it as a big blow to his efforts to create a pro-investment climate in Uttar Pradesh.

"The chief minister has taken a serious note of the clashes as it could send a wrong signal that industries are not safe in UP," an official said.

Bank operations hit

Normal banking operations were hit for the second day on Thursday as public sector bank employees continued their strike.

It is, however, business as usual at private sector banks like ICICI Bank and HDFC Bank.

Employees of public sector insurance companies, including LIC and New India Assurance, are also participating in the strike.

Shutdown in Kerala

In Kerala, workers from most sectors ranging from transport to banking keeping away from work.

Reports from across the state said buses and taxis were off the roads and markets remained shut. Train and air services were not affected.

Attendance in government offices was thin and educational institutions remained closed as pro-Left service and teachers unions joined the strike. Universities have cancelled examinations scheduled for the last two days.

Barring stray incidents of minor violence, the state has remained peaceful since Wednesday.

Police in their vehicles facilitated the short-distance travels of train and air passengers, who arrived in the state unaware of the hartal atmosphere.

Emergency services like healthcare, milk supply and media have been exempted from the strike.

Schools, colleges closed in Karnataka

The two-day nationwide strike by trade unions had no major impact in most parts of Karnataka on Thursday.

Though banking services were hit, many buses, taxis and autos plied and shops and hotels remained opened here. However, schools and colleges were closed.

No violence was reported from any part of the state, police said.

Services at many hospitals in the city were not hit, as also in IT companies. Several PSUs including HAL, BHEL and BEL, besides a host of other industrial units in Bangalore were functioning normally.
No impact in Mangalore

In Mangalore, however, there has been no effect of strike on Day 2. The buses are plying normally and the schools are functioning as usual.

(With inputs from PTI, IANS)

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NASA's Mars Rover Makes Successful First Drill

For the first time ever, people have drilled into a rock on Mars, collecting the powdered remains from the hole for analysis.

Images sent back from NASA's Mars rover Curiosity on Wednesday confirmed that the precious sample is being held by the rover's scoop, and will soon be delivered to two miniature chemical labs to undergo an unprecedented analysis. (Related: "Mars Rover Curiosity Completes First Full Drill.")

To the delight of the scientists, the rock powder has come up gray and not the ubiquitous red of the dust that covers the planet. The gray rock, they believe, holds a lot of potential to glean information about conditions on an early Mars. (See more Mars pictures.)

"We're drilling into rock that's a time capsule, rocks that are potentially ancient," said sampling-system scientist Joel Hurowitz during a teleconference from NASA's Jet Propulsion Laboratory in California.

A Place to Drill

The site features flat bedrock, often segmented into squares, with soil between the sections and many round gray nodules and white mineral veins.

Hurowitz said that the team did not attempt to drill into the minerals or the gray balls, but the nodules are so common that they likely hit some as they drilled down 2.5 inches (6.3 centimeters).

In keeping with the hypothesis that the area was once under water, Hurowitz said the sample "has the potential of telling us about multiple interactions of water and rock."

The drill, located at the end of a seven-foot (two-meter) arm, requires precision maneuvering in its placement and movement, and so its successful initial use was an exciting and welcome relief. The rover has been on Mars since August, and it took six months to find the right spot for that first drill. (Watch video of the Mars rover Curiosity.)

The flat drilling area is in the lower section of Yellowknife Bay, which Curiosity has been exploring for more than a month. What was previously identified by Curiosity scientists as the dry bed of a once-flowing river or stream appears to fan out into the Yellowknife area.

The bedrock of the site—named after deceased Curiosity deputy project manager John Klein—is believed to be siltstone or mudstone. Scientists said the veins of white minerals are probably calcium sulfate or gypsum, but the grey nodules remain something of a mystery.

Triumph

To the team that designed and operates the drill, the results were a triumph, as great as the much-heralded landing of Curiosity on the red planet. With more than a hundred maneuvers in its repertoire, the drill is unique in its capabilities and complexities. (Watch video of Curiosity's "Seven Minutes of Terror.")

Sample system chief engineer Louise Jandura, who has worked on the drill for eight years, said the Curosity team had made eight different drills before settling on the one now on the rover. The team tested each drill by boring 1,200 holes on 20 types of rock on Earth.

She called the successful drilling "historic" because it gives scientists unprecedented access to material that has not been exposed to the intense weathering and radiation processes that affect the Martian surface.

Mini-laboratories

The gray powder will be routed to the two most sophisticated instruments on Curiosity—the Sample Analysis at Mars (SAM) and Chemistry and Mineralogy (CheMin).

SAM, the largest and most complex instrument onboard, operates with two ovens that can heat the sample up to 1,800°F (982°C), turning the elements and compounds in the rock into gases that can then be identified. SAM can also determine whether any carbon-based organic material is present.

Organics are the chemical building blocks of life on Earth. They are known to regularly land on Mars via meteorites and finer material that rains down on all planets.

But researchers suspect the intense radiation on the Martian surface destroys any organics on the surface. Scientists hope that organics within Martian rocks are protected from that radiation.

CheMin shoots an X-ray beam at its sample and can analyze the mineral content of the rock. Minerals provide a durable record of environmental conditions over the eons, including information about possible ingredients and energy sources for life.

Both SAM and CheMin received samples of sandy soil scooped from the nearby Rocknest outcrop in October. SAM identified organic material, but scientists are still trying to determine whether any of it is Martian or the byproduct of organics inadvertently brought to Mars by the rover. (See "Mars Rover Detects Simple Organic Compounds.")

In the next few days, CheMin will be the first to receive samples of the powdered rock, and then SAM. Given the complexity of the analysis, and the track record seen with other samples, it will likely be weeks before results are announced.

The process of drilling and collecting the results was delayed by several glitches that required study and work-arounds. One involved drill software and the other involved a test-bed problem with a sieve that is part of the process of delivering samples to the instruments.

Lead systems engineer Daniel Limonadi said that while there was no indication the sieve on Mars was malfunctioning, they had become more conservative in its use because of the test bed results. (Related: "A 2020 Rover Return to Mars?")

Author of the National Geographic e-book Mars Landing 2012, Marc Kaufman has been a journalist for more than 35 years, including the past 12 as a science and space writer, foreign correspondent, and editor for the Washington Post. He is also author of First Contact: Scientific Breakthroughs in the Hunt for Life Beyond Earth, published in 2011, and has spoken extensively to crowds across the United States and abroad about astrobiology. He lives outside Washington, D.C., with his wife, Lynn Litterine.

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Arias Leaves Stand After Describing Killing, Her Lies

Jodi Arias stepped down from the witness stand today after mounting an emotional effort to save herself from death row, insisting to the Arizona jury that an explosive fight with ex-boyfriend Travis Alexander led to his death, and that her lies about killing him masked deep regret and plans to commit suicide.

Arias, 32, will now face what is expected to be a withering cross-examination beginning Thursday from prosecutor Juan Martinez, who has been aggressive to many witnesses throughout the trial and who is expected to go after Arias' claim that she was forced to kill Alexander or be killed herself.

She is charged with murder for her ex-boyfriend's death and could face the death penalty if convicted.

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

The day's dramatic testimony started with Arias describing the beginning of the fight on June 4, 2008 when she and Alexander were taking nude photos in his shower and she claims she accidentally dropped his new camera, causing Alexander to lose his temper. Enraged, he picked her up and body slammed her onto the tile floor, screaming at her, she told the jury.

Arias said she ran to his closet to get away from him, but could hear Alexander's footsteps coming after her down the hall. She grabbed a gun from his shelf and tried to keep running, but Alexander came after her, she said.

"I pointed it at him with both of my hands. I thought that would stop him, but he just kept running. He got like a linebacker. He got low and grabbed my waist, and as he was lunging at me the gun went off. I didn't mean to shoot. I didn't even think I was holding the trigger," she said.

"But he lunged at me and we fell really hard toward the tile wall, so at this point I didn't even know if he had been shot. I didn't see anything different. We were struggling, wrestling, he's a wrestler.

"So he's grabbing at my clothes and I got up, and he's screaming angry, and after I broke away from him. He said 'f***ing kill you bitch,'" she testified.

Asked by her lawyer whether she was convinced Alexander intended to kill her, Arias answered, "For sure. He'd almost killed me once before and now he's saying he was going to." Arias had earlier testified that Alexander had once choked her.

Timeline of the Jodi Arias Trial

Jodi Arias Describes Violent Sex Before Shooting Watch Video

Jodi Arias Testifies Ex Assaulted Her, Broke Her Fingers Watch Video

Jodi Arias Gives Explicit Details About Doomed Relationship Watch Video

But Arias' story of the death struggle ended there as she told the court that she has no memory of stabbing or slashing Alexander whose body was later found with 27 stab wounds, a slit throat and two bullets in his head. She said she only remembered standing in the bathroom, dropping the knife on the tile floor, realizing the "horror" of what had happened, and screaming.

"I have no memory of stabbing him," she said. "There's a huge gap. I don't know if I blacked out or what, but there's a huge gap. The most clear memory I have after that point is driving in the desert."

Arias said that she decided in the desert not to admit to killing Alexander, a decision that would last for two years as Arias lied to friends, family, investigators and reporters about what really happened in Alexander's bathroom.

During that time she initially claimed she got lost that night while driving to a friend's house and never went to Alexander's home in Mesa,Ariz. She later changed her story and said two masked people, a man and a woman, burst into the home and killed Alexander and threatened to kill her family if she told anyone what happened.

She eventually confessed to killing her ex-boyfriend, but insisted it was self defense.

"The main reason (for lying) is because I was very ashamed of what happened. It's not something I ever imagined doing. It's not the kind of person I was. It was just shameful," she said. "I was also very scared of what might happen. I didn't want my family to know that I had done that, and I just couldn't bring myself to say that I did that."

"From day one there was a part of me that always wanted to (tell the truth) but didn't dare do that. I would rather have gone to my grave than admit I had done something like that," she said.

Arias said that she continued to lie because she figured she would never get caught; she was planning to kill herself before trial.

"I was concerned with how it would affect my family. I wanted to die. I was going to definitely kill myself," she said. "That was my plan. You can purchase different things in jail and I bought a bunch of Advil... and took it all in the next few days so it was in my system. They have razors for shaving, so I got one and took it apart one night with intentions to slit my wrists."

Arias said she balked at slitting her wrists after accidentally cutting herself, but that she still planned to commit suicide sometime in the future. When she told news reporters that "no jury would convict her," she claims she said it believing that she would be dead before they'd have a chance to put her on trial, Arias testified.

Arias said support from the public and her family eventually led her to change her mind.

"My family remained very supportive, and told me 'it doesn't matter what happens, we love you anyway.' I realized even if I told the truth they would still be there and wouldn't walk away," she testified.

"By the time spring, 2010, rolled around, I confessed. I basically told everyone what I could remember of the day and that the intruder story was all BS pretty much."

She said that her testimony today, a third version of events, was the truth.

Arias was arrested a month after Alexander's death, and prosecutors have argued that her behavior during those weeks showed a lack of remorse for the killing and an attempt to get away with murder.

Arias said today that after she killed Alexander and drove away from his Mesa, Ariz., home in a panic, it dawned on her that police would soon be looking for Alexander's killer, and she decided that she would pretend the bloody confrontation had never happened.

"I knew that it was really bad, that my life was probably done now. I wished it was just a nightmare I could wake up from, but I knew I had messed up pretty badly and the inevitable was going to be something I could not really run from," she testified.

"I didn't want anyone to know that that had happened or that I did it, so I started taking steps in the aftermath to cover it up. I did a whole bunch of things to try to make it seem like I was never there," she said.

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