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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Spate of blasts killed 83 in Damascus' deadliest day

DAMASCUS: A spate of bombings across Damascus killed at least 83 people in the deadliest day for the capital since Syria's war erupted, a watchdog said Friday, as the opposition discussed a plan for peace talks with the regime.

Thursday's biggest bombing, which both the regime and its opponents blamed on "terrorists", killed 61 people and left a trail of destruction in the city centre, said the Syrian Observatory for Human Rights.

The attack, in Mazraa district, was carried out by a suicide bomber who detonated his explosives-laden car near the entrance of the Baath party's main offices, said the Britain-based monitor.

Gruesome images of charred bodies next to mangled vehicles were shown on state television, which said children were among the casualties in the explosion near a school.

The blast wounded more than 200 people in a wide radius, including Nayef Hawatmeh, the head of the Democratic Front for the Liberation of Palestine, which said he was hit by flying glass in his office 500 metres (yards) away.

Russian news agencies reported the windows of Moscow's embassy were blown out, although no staff was hurt.

Another 22 people were killed in an apparently coordinated triple bombing targeting security headquarters in the northern Damascus district of Barzeh on Thursday, including 19 members of the forces, said the Observatory.

Attacks have increasingly targeted government or security buildings in Damascus in recent months, many of them claimed by the jihadist Al-Nusra Front which Washington has designated as a "terrorist" organisation.

The attacks were condemned by both the regime of President Bashar al-Assad and the umbrella opposition National Coalition, as well as the United States, Russia and UN chief Ban Ki-moon.

There was no still claim of responsibility for the Mazraa blast.

The Syrian foreign ministry alleged the bombing was "carried out by armed terrorist groups linked to Al-Qaeda that receive financial and logistic help from abroad", using government terminology for rebels.

The opposition also denounced the bombers as "terrorists".

"Any acts targeting civilians with murder or human rights violations are criminal acts that must be condemned, regardless of the perpetrator or the justification," said the National Coalition.

Elsewhere, 38 people were killed Thursday in Daraa, birthplace of the revolt in the country's south, including 18 in an air raid on a medical centre, said the Observatory.

Also in Daraa, six women and a child all from the same family were killed in an explosion at Tsil, and 10 more civilians died in army shelling of Jassem town.

In the northwestern province of Idlib, where sectarian strife has been rising, 40 Shiites kidnapped by an armed group and 300 Sunnis abducted in reprisals last week were released after mediation talks between families.

The majority of the Syrian population fighting the Assad regime are Sunni Muslims, while the president and his clan belong to the Alawite branch of Shiite Islam.

The attacks added urgency to the National Coalition meeting in Cairo, where discussions will continue later on Friday focused on an offer by its chief to talk directly with the regime.

Coalition chairman Ahmed Moaz al-Khatib has offered to talk to regime officials without "blood on their hands" -- an initiative welcomed by the Arab League and the United States as well as Assad allies Iran and Russia.

But the Syrian National Council, a key part of the Coalition, has rejected any talks until Assad quits, and the regime says it will negotiate only without preconditions.

At the United Nations, Russia accused US diplomats of blocking a Security Council condemnation of the Mazraa attack. Other diplomats said however that Russia had refused to include language criticising Assad.

The UN says at least 70,000 people have been killed in the conflict which was sparked by a bloody regime crackdown on Arab Spring-inspired protests that broke out in March 2011.

-AFP/fl

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Bihar: Eight killed in landmine blast triggered by Maoists

GAYA (BIHAR): Eight persons, including six policemen, were killed in a landmine blast triggered by Maoists near a culvert at Majhaulia village in Bihar's Gaya district on Friday.

"One ASI (Assistant Sub Inspector), five constables, a village sarpanch and one special police officer (SPO) were killed in the blast," Gaya superintendent of police Akhtar Hussain said.

Maoists used improvised explosive devices (IED) to bomb a jeep at Koili culvert around 12.40pm, he said, adding the vehicle was ripped apart in the explosion.

The incident took place at Roshanganj in Sherghati sub-division, on the border of Bihar and Jharkhand.

The security forces were going for a campaign run by an NGO to build awareness among the people against Maoists, Hussain said.

There have been report of loot of arms of the security personnel in the incident.

In the state capital, director general of police Abhyanad said that senior police officers have been asked to visit the spot.

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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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Malaysian driver, Myanmar national arrested at Woodlands Checkpoint

SINGAPORE: A Malaysian driver and a Myanmar national have been arrested at Woodlands Checkpoint.

They were caught at about 12.25am on Thursday after immigration officers checked a Malaysian-registered car that was leaving Singapore.

When the driver opened the car boot, the officers found a man hiding inside.

The driver, 26, and the Myanmar national, 62, were arrested and are being investigated.

The vehicle used in the commission of the offences has been detained and is liable for forfeiture.

The penalties for overstaying or illegal entry are a jail term of up to six months plus a minimum of three strokes of the cane, while the penalties for illegal departure is a fine of up to $2,000, a jail term of up to six months, or both.

- CNA/de

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Praveen Togadia sent back from Jammu airport

JAMMU: VHP leader Praveen Togadia was on Thursday detained by the police at Jammu airport and sent back by authorities, fearing law and order disturbance.

"I have been detained at the Jammu Airport and not allowed to move out of the complex," the Vishwa Hindu Parishad leader told .

"I was served notice by the Additional Deputy Commissioner Jammu which said that I will not be allowed to enter Jammu as it will create law and order problem," Togadia said.

The VHP leader said, "They did not allow me to exercise my fundamental rights as a citizen of India".

Following the incident, VHP and Bajrang Dal activists protested outside the airport claiming the VHP leader was not even allowed to meet them.

The VHP leader said he told authorities there was not a single example where his visit or speech had triggered any law and order problem across the country or in Jammu and Kashmir.

"I was on two-day visit to Jammu and Kashmir to hear complaints of community about J&K government's discrimination in jobs, employment, education, trade, security and religious rights during the visit," he said.

Togadia, who arrived in Delhi-Jammu flight 'S241 Jet' plane around 11.20am, was served notice by the Additional Deputy Commissioner Jammu, Arya Sharma that he will not be allowed to enter by Jammu Police fearing law and order problem, District Development Commissioner Jammu, Sanjeev Verma said.

Verma said Togadia was not allowed to come out of the airport and has been sent back.

The step was taken by the state government in view of last year's visit of Togadia to Rajouri district, where his provocative speech triggered tension between two communities.

Police had booked Togadia for allegedly hurting the sentiments of a community at a public rally in Rajouri district of Jammu and Kashmir on March 4 last year.

Outside the Jammu Airport, activists of VHP and Bajrang Dal held anti-government protests for not allowing the Togadia to enter Jammu and raised anti-government slogans.

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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

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

Jodi Arias Describes Violent Sex Before Shooting Watch Video

Jodi Arias Testifies Ex Assaulted Her, Broke Her Fingers 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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