Study questions kidney cancer treatment in elderly

In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.

Even though nearly all of these tumors turned out to be cancer, they rarely proved fatal. And surgery roughly doubled patients' risk of developing heart problems or dying of other causes, doctors found.

After five years, 24 percent of those who had surgery had died, compared to only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.

The study only involved people 66 and older, but half of all kidney cancers occur in this age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.

The study also was observational — not an experiment where some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.

"I think it should change care" and that older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center. "If the treatment doesn't improve cancer outcomes, then we should consider leaving them alone."

He led the study and will give results at a medical meeting in Orlando, Fla., later this week. The research was discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.

In the United States, about 65,000 new cases of kidney cancer and 13,700 deaths from the disease are expected this year. Two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90 percent.

However, most kidney tumors these days are found not because they cause symptoms, but are spotted by accident when people are having an X-ray or other imaging test for something else, like back trouble or chest pain.

Cancer experts increasingly question the need to treat certain slow-growing cancers that are not causing symptoms — prostate cancer in particular. Researchers wanted to know how life-threatening small kidney tumors were, especially in older people most likely to suffer complications from surgery.

They used federal cancer registries and Medicare records from 2000 to 2007 to find 8,317 people 66 and older with kidney tumors less than 1.5 inches wide.

Cancer was confirmed in 7,148 of them. About three-quarters of them had surgery and the rest chose to be monitored with periodic imaging tests.

After five years, 1,536 had died, including 191 of kidney cancer. For every 100 patients who chose monitoring, 11 more were alive at the five-year mark compared to the surgery group. Only 6 percent of those who chose monitoring eventually had surgery.

Furthermore, 27 percent of the surgery group but only 13 percent of the monitoring group developed a cardiovascular problem such as a heart attack, heart disease or stroke. These problems were more likely if doctors removed the entire kidney instead of just a part of it.

The results may help doctors persuade more patients to give monitoring a chance, said a cancer specialist with no role in the research, Dr. Bruce Roth of Washington University in St. Louis.

Some patients with any abnormality "can't sleep at night until something's done about it," he said. Doctors need to say, "We're not sticking our head in the sand, we're going to follow this" and can operate if it gets worse.

One of Huang's patients — 81-year-old Rhona Landorf, who lives in New York City — needed little persuasion.

"I was very happy not to have to be operated on," she said. "He said it's very slow growing and that having an operation would be worse for me than the cancer."

Landorf said her father had been a doctor, and she trusts her doctors' advice. Does she think about her tumor? "Not at all," she said.

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Online:

Kidney cancer info: http://www.cancer.net/cancer-types/kidney-cancer

and http://www.cancer.gov/cancertopics/types/kidney

Study: http://gucasym.org

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

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North Korea conducts third nuclear test, drawing new sanctions threat

SEOUL (Reuters) - North Korea conducted its third nuclear test on Tuesday in defiance of existing U.N. resolutions, angering the United States and Japan and prompting its only major ally, China, to call for calm.

The North said the test had "greater explosive force" than the 2006 and 2009 tests that were widely seen as small-scale. Its KCNA news agency said it had used a "miniaturized" and lighter nuclear device, indicating that it had again used plutonium which is more suitable for use as a missile warhead.

North Korean leader Kim Jong-un, the third of his line to rule the country, has presided over two long-range rocket launches and a nuclear test during his first a year in power, pursuing policies that have propelled his impoverished and malnourished country closer to becoming a nuclear weapons power.

U.S. President Barack Obama labeled the test a "highly provocative act" that hurt regional stability and he and other states that are members of U.N. Security Council pressed for new sanctions on the isolated country.

"The danger posed by North Korea's threatening activities warrants further swift and credible action by the international community. The United States will also continue to take steps necessary to defend ourselves and our allies," Obama said in a statement.

The Security Council will meet later on Tuesday to discuss its reaction to the test, although North Korea is already one of the most heavily sanctioned states in the world and has few external economic links that can be targeted.

Japanese Prime Minister Shinzo Abe said the test was a "grave threat" that could not be tolerated. U.N. Secretary-General Ban Ki-moon said the test was a "clear and grave violation" of U.N. Security Council resolutions.

China, which has shown signs of increasing exasperation with its neighbor, repeated calls for the "denuclearization" of the Korean peninsula and urged its client state and others to react calmly, while pressing Pyongyang not to ramp up tension further, something the North had threatened in the run-up to the test.

"We strongly urge North Korea to abide by its non-nuclear commitment and not to take any further actions that would worsen the situation", it said in a statement.

China is a permanent member of the Security Council.

South Korea, still technically at war with the North after the 1950-53 civil war ended in a mere truce, said the size of the seismic activity indicated a nuclear explosion slightly larger than the North's two previous tests at 6-7 kilotons, although that is still relatively small. The Hiroshima bomb was around 20 kilotons.

The U.S. Geological Survey said that a seismic event measuring 5.1 magnitude had occurred on Tuesday, with North Korea later confirming the nuclear test.

"It was confirmed that the nuclear test that was carried out at a high level in a safe and perfect manner using a miniaturized and lighter nuclear device with greater explosive force than previously did not pose any negative impact on the surrounding ecological environment," KCNA said.

Despite China's tame response, it likely to be a major embarrassment for Beijing, the North's sole major economic and diplomatic ally.

"The test is hugely insulting to China, which now can be expected to follow through with threats to impose sanctions," said Mark Fitzpatrick of the International Institute for Strategic Studies think tank.

North Korea trumpeted the announcement on its state television channel to patriotic music against the backdrop of an image of its national flag.

It linked the test to its technical prowess in launching a long-range rocket in December, a move that triggered the U.N. sanctions, backed by China, that Pyongyang said prompted it to take Tuesday's action.

The North's ultimate aim, Washington believes, is to design an intercontinental ballistic missile capable of carrying a nuclear warhead that could hit the United States. North Korea says the program is aimed merely at putting satellites in space.

North Korea used plutonium in previous nuclear tests and prior to Tuesday there had been speculation it would use highly enriched uranium so as to conserve its plutonium stocks as testing eats into its limited supply of the material that could be used to construct a nuclear bomb.

"VICIOUS CYCLE"

Despite its three nuclear tests and long-range rocket tests, North Korea is not believed to be close to manufacturing a nuclear missile capable of hitting the United States.

South Korea's Yonhap news agency said Pyongyang had informed China and the United States of its plans to test on Monday, although this could not be confirmed.

When North Korean leader Kim, 30, took power after his father's death in December 2011, there were hopes the he would bring reforms and end Kim Jong-il's "military first" policies.

Instead, the North, whose economy is smaller than it was 20 years ago and where a third of children are believed to be malnourished, appears to be trapped in a cycle of sanctions followed by further provocations.

"The more North Korea shoots missiles, launches satellites or conducts nuclear tests, the more the U.N. Security Council will impose new and more severe sanctions," said Shen Dingli, a professor at Shanghai's Fudan University. "It is an endless, vicious cycle."

But options for the international community appear to be in short supply, as North Korea is already one of the most heavily sanctioned states on earth.

Tuesday's action appeared to have been timed for the run-up to February 16 anniversary celebrations of Kim Jong-il's birthday, as well as to achieved maximum international attention.

Significantly, the test comes at a time of political transition in China, Japan and South Korea, and as Obama begins his second term. He will likely have to tweak his State of the Union address due to be given on Tuesday.

Japanese Prime Minister Shinzo Abe is bedding down a new government and South Korea's new president, Park Geun-hye, prepares to take office on February 25.

China too is in the midst of a once-in-a-decade leadership transition to Xi Jinping, who takes office in March. Both Abe and Xi are staunch nationalists.

The longer-term game plan from Pyongyang may be to restart talks aimed at winning food and financial aid. China urged it to return to the stalled "six-party" talks, hosted by China and including the two Koreas, the United States, Japan and Russia.

Its puny economy and small diplomatic reach mean the North struggles to win attention on the global stage - other than through nuclear tests and attacks on South Korea, last made in 2010.

"Now the next step for North Korea will be to offer talks... - any form to start up discussion again to bring things to their advantage," said Jeung Young-tae, senior research fellow at the Korea Institute for National Unification in Seoul.

EU member Denmark called on China to step up to the plate and use its influence at the Security Council to rein in its ally, using unusually blunt language.

"This deserves only one thing and that is a one-sided condemnation," said Foreign Minister Villy Sovndal.

"North Korea is likely the most horrible country on this planet."

(Additional reporting by Jack Kim, Christine Kim and Jumin Park in SEOUL; Linda Sieg in TOKYO; Louis Charbonneau at the UNITED NATIONS; Fredrik Dahl in VIENNA; Michael Martina in BEIJING; Mette Fraende in COPENHAGEN; Editing by Nick Macfie)

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Shocked world media speculates on pope's successor

MANILA: The world's media speculated on whether the next pontiff may come from the developing world, while paying mixed tributes to Pope Benedict XVI following his shock resignation announcement.

The 85-year-old Benedict said on Monday that he would step down at the end of this month because of health reasons, becoming the first leader of the Catholic Church to resign of his own free will in 700 years.

Argentina's largest selling newspaper, Clarin, ran a headline on its website asking whether the next pope might hail from the Americas, Asia or Africa rather than Europe, where all popes have come from through the centuries.

"After the virtually unprecedented decision by the head of the church to resign, there is a growing possibility that deeply established traditions and criteria might change in the next choosing of the pope and there could be a surprise," the report said.

Clarin said this was not just a matter of geography but something that went much deeper.

Catholicism is in serious decline in Europe but growing robustly in Africa and Asia. And Latin America, despite fervent adherence to the faith being patchy, is home to 40 percent of the world's Catholics, the paper noted.

In the Philippines, the Catholic Church's stronghold in Asia, the pope's decision dominated the front pages of newspapers, while major Internet news sites focused on whether Filipino Cardinal Luis Antonio Tagle may succeed him.

"He has the rare chance, like 116 others, to choose the leader of the world's 1.2 billion Catholics. And who knows? He himself may become Pope Benedict XVI's successor," news portal Rappler wrote of Cardinal Tagle.

The pope's resignation made the front pages of most British newspapers, which largely praised his personal qualities, but they also called for the next pope, whether he is from Europe, Asia, Africa or the Americas, to bring about reform.

In an editorial, The Guardian said that Benedict's papacy was "theologically, politically and organisationally a continuation of that of John Paul II, with all its defects and its virtues".

It painted a sober picture of the future, saying that "not a single liberal candidate to succeed Benedict can be identified".

The Times described Benedict's resignation in an editorial as a "noble and selfless decision" but said his successor should try to make the Catholic church "a more collegial venture".

The Independent newspaper focused on the future with the headline "Situation Vacant: New leader wanted for 1.2 billion Roman Catholics".

It added that Benedict's announcement "plunges his Church into turmoil".

In France, daily Catholic newspaper La Croix praised Benedict for making a tough decision.

"This is a man of faith who has decided to resign with the consciousness of having given everything he could for the good of the Church," the newspaper said.

Conservative French newspaper Le Figaro published a special edition in which it welcomed the "humility" of Benedict XVI, who "felt that the challenges of the contemporary church exceeded its powers".

The pope's resignation also made the front pages in Australia, with Rupert Murdoch's national daily newspaper The Australian carrying a headline that said: "Pope Benedict surrenders: too old, too frail to lead a billion people".

In an opinion piece, the newspaper's foreign editor said Benedict was "a good man but a poor pope".

"Benedict was always going to have a hard time following in the footsteps of John Paul II, the most charismatic, and perhaps the most influential, pope in the 20th century," wrote Greg Sheridan.

"But he disappointed even his closest supporters."

- AFP/al

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Suryanelli gang-rape case: Kurien writes to Sonia Gandhi, Hamid Ansari

NEW DELHI: Facing the heat after fresh twists in the Suryanelli gang-rape case, Rajya Sabha Deputy Chairman P J Kurien has written to Congress president Sonia Gandhi and Chairman of the Upper House Hamid Ansari explaining his position.

Sources said he has explained his position to the party president and Ansari amid the Opposition demand for his resignation.

He is understood to have explained in the letter the judgements of various courts, which "exonerated" him in the case.

When contacted, Kurien said he cannot speak to the media on any communication between him and the Congress President.

The lone convict in the Suryanelli gang-rape case had yesterday alleged that Kurien was involved in it as claimed by the victim.

Dharmarajan, the convict who is absconding after obtaining bail, had told a television channel that the principal investigator in the case had allegedly pressurised him not to mention Kurien's alleged involvement in the case.

Kurien, however, rubbished Dharmarajan's claim holding the statement of an accused after conviction has no legal validity.

Reacting to the charge, he said, "this is a settled position of the Supreme Court (that the statement of an accused after conviction has no legal validity).

"Secondly, every accused gets a chance to make a statement before the judge. He did not say this at that time. You (mediapersons) find out why he is making this claim now."

Kurien's colleague in Kerala and Congress spokesperson PC Chacko had on Sunday said that the party will take a decision on the demand for Kurien's removal as Deputy Chairman of Rajya Sabha before the Budget Session of Parliament.

However, Congress had distanced itself from Chacko's remarks. "Whatever Chacko has said is his personal opinion," party spokesperson Sandip Dikshit had said.

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Pope shows lifetime jobs aren't always for life

The world seems surprised that an 85-year-old globe-trotting pope who just started tweeting wants to resign, but should it be? Maybe what should be surprising is that more leaders his age do not, considering the toll aging takes on bodies and minds amid a culture of constant communication and change.

There may be more behind the story of why Pope Benedict XVI decided to leave a job normally held for life. But the pontiff made it about age. He said the job called for "both strength of mind and body" and said his was deteriorating. He spoke of "today's world, subject to so many rapid changes," implying a difficulty keeping up despite his recent debut on Twitter.

"This seemed to me a very brave, courageous decision," especially because older people often don't recognize their own decline, said Dr. Seth Landefeld, an expert on aging and chairman of medicine at the University of Alabama at Birmingham.

Age has driven many leaders from jobs that used to be for life — Supreme Court justices, monarchs and other heads of state. As lifetimes expand, the woes of old age are catching up with more in seats of power. Some are choosing to step down rather than suffer long declines and disabilities as the pope's last predecessor did.

Since 1955, only one U.S. Supreme Court justice — Chief Justice William Rehnquist — has died in office. Twenty-one others chose to retire, the most recent being John Paul Stevens, who stepped down in 2010 at age 90.

When Thurgood Marshall stepped down in 1991 at the age of 82, citing health reasons, the Supreme Court justice's answer was blunt: "What's wrong with me? I'm old. I'm getting old and falling apart."

One in 5 U.S. senators is 70 or older, and some have retired rather than seek new terms, such as Hawaii's Daniel Akaka, who left office in January at age 88.

The Netherlands' Queen Beatrix, who just turned 75, recently said she will pass the crown to a son and put the country "in the hands of a new generation."

In Germany, where the pope was born, Chancellor Angela Merkel, who is 58, said the pope's decision that he was no longer fit for the job "earns my very highest respect."

"In our time of ever-lengthening life, many people will be able to understand how the pope as well has to deal with the burdens of aging," she told reporters in Berlin.

Experts on aging agreed.

"People's mental capacities in their 80s and 90s aren't what they were in their 40s and 50s. Their short-term memory is often not as good, their ability to think quickly on their feet, to execute decisions is often not as good," Landefeld said. Change is tougher to handle with age, and leaders like popes and presidents face "extraordinary demands that would tax anybody's physical and mental stamina."

Dr. Barbara Messinger-Rapport, geriatrics chief at the Cleveland Clinic, noted that half of people 85 and older in developed countries have some dementia, usually Alzheimer's. Even without such a disease, "it takes longer to make decisions, it takes longer to learn new things," she said.

But that's far from universal, said Dr. Thomas Perls, an expert on aging at Boston University and director of the New England Centenarians Study.

"Usually a man who is entirely healthy in his early 80s has demonstrated his survival prowess" and can live much longer, he said. People of privilege have better odds because they have access to good food and health care, and tend to lead clean lives.

"Even in the 1500s and 1600s there were popes in their 80s. It's remarkable. That would be today's centenarians," Perls said.

Arizona Sen. John McCain turned 71 while running for president in 2007. Had he won, he would have been the oldest person elected to a first term as president. Ronald Reagan was days away from turning 70 when he started his first term as president in 1981; he won re-election in 1984. Vice President Joe Biden just turned 70.

In the U.S. Senate, where seniority is rewarded and revered, South Carolina's Strom Thurmond didn't retire until age 100 in 2002. Sen. Robert Byrd of West Virginia was the longest-serving senator when he died in office at 92 in 2010.

Now the oldest U.S. senator is 89-year-old Frank Lautenberg of New Jersey. The oldest congressman is Ralph Hall of Texas who turns 90 in May.

The legendary Alan Greenspan was about to turn 80 when he retired as chairman of the Federal Reserve in 2006; he still works as a consultant.

Elsewhere around the world, Cuba's Fidel Castro — one of the world's longest serving heads of state — stepped down in 2006 at age 79 due to an intestinal illness that nearly killed him, handing power to his younger brother Raul. But the island is an example of aged leaders pushing on well into their dotage. Raul Castro now is 81 and his two top lieutenants are also octogenarians. Later this month, he is expected to be named to a new, five-year term as president.

Other leaders who are still working:

—England's Queen Elizabeth, 86.

—Abdullah bin Abd al-Aziz al-Saud, king of Saudi Arabia, 88.

—Sabah al-Ahmad al-Jaber al-Sabah, emir of Kuwait, 83.

—Ruth Bader Ginsburg, U.S. Supreme Court associate justice, 79.

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Associated Press writers Paul Haven in Havana, Cuba; David Rising in Berlin; Seth Borenstein, Mark Sherman and Matt Yancey in Washington, and researcher Judy Ausuebel in New York contributed to this report.

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

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North Korea Says it Has Conducted a Nuclear Test

North Korea says it has successfully tested a miniaturized nuclear device Tuesday, according to state media.

A large tremor measured at magnitude 4.9 was detected in North Korea and governments in the region scrambled to determine whether it was a nuclear test that the North Korean regime has vowed to carry out despite international protests.

Official state media said the test was conducted in a safe manner and is aimed at coping with "outrageous" U.S. hostility that "violently" undermines the North's peaceful, sovereign rights to launch satellites. Unlike previous tests, North Korea used a powerful explosive nuclear bomb that is smaller and lighter, state media reported.

President Obama called the test "a highly provocative act" in a statement Tuesday morning.

"The danger posed by North Korea's threatening activities warrants further swift and credible action by the international community. The United States will also continue to take steps necessary to defend ourselves and our allies,"Obama said.

"The United States remains vigilant in the face of North Korean provocations and steadfast in our defense commitments to allies in the region," he added.

The U.N. Security Council will hold an emergency meeting on North Korea's nuclear test later this morning.

Suspicions were aroused when the U.S. Geological Survey said it had detected a magnitude 4.9 earthquake Tuesday in North Korea.

The Comprehensive Test Ban Treaty Organization told ABC News, "We confirm that a suspicious seismic event has taken place in North Korea."

North Korea Threatens More Nuclear Tests, Warns U.S. Watch Video

"The event shows clear explosion-like characteristics and its location is roughly congruent with the 2006 and 2009 DPRK (North Korea) nuclear tests," said Tibor Toth, executive secretary of the organization.

"If confirmed as a nuclear test, this act would constitute a clear threat to international peace and security, and challenges efforts made to strengthen global nuclear disarmament and non-proliferation," Toth said in a statement on the organization's web site.

Kim Min-seok, a South Korean Defense Ministry spokesman, told reporters that North Korea informed United States and China that it intended to carry out another nuclear test, according to the AP. But U.S. officials did not respond to calls from ABC News Monday night.

The seismic force measured 6 to 7 kilotons, according to South Korea.

"Now that's an absolutely huge explosion by conventional terms. It's a smallish, but not tiny explosion by nuclear terms. It's about two-thirds the size of the bomb that the U.S. dropped on Hiroshima," James Acton, a Senior Associate at the Carnegie Endowment for International Peace, told ABC News.

North Korea threatened in January to carry out a "higher-level" test following the successful Dec. 12 launch of a long range rocket. At the time, North Korea's leader Kim Jong-Un said his country's weapons tests were specifically targeting the United States.

The suspicious tremor comes just hours before President Obama is to give the State of the Union address, and it marks the first diplomatic test in the region for new Secretary of State John Kerry.

Also, South Korea's new president, Park Geun-hye, is scheduled to be sworn in on Feb. 25. One of North Korea's biggest holidays, Kim Jong-il's birthday, falls on Feb. 16.

China, North Korea's main ally in the region, has warned North Korea it would cut back severely needed food assistance if it carried out a test. Each year China donates approximately half of the food North Korea lacks to feed its people and half of all oil the country consumes.

Both of North Korea's previous tests used a plutonium-based method for making bomb fuel. The first was deemed a failure, the second only slightly less so. If the most recent test used HEU (highly enriched uranium), a far more difficult-to-detect method of producing bomb fuel, it would be a significant and worrisome step forward for North Korea's weapons program.

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Gunbattle rocks Gao after rebels surprise French, Malians

GAO, Mali (Reuters) - Islamist insurgents launched a surprise raid in the heart of the Malian town of Gao on Sunday, battling French and local troops in a blow to efforts to secure Mali's recaptured north.

Local residents hid in their homes or crouched behind walls as the crackle of gunfire from running street battles resounded through the sandy streets and mud-brick houses of the ancient Niger River town, retaken from Islamist rebels last month by a French-led offensive.

French helicopters clattered overhead and fired on al Qaeda-allied rebels armed with AK-47s and rocket-propelled grenades who had infiltrated the central market area and holed up in a police station, Malian and French officers said.

The fighting inside Gao was certain to raise fears that pockets of determined Islamists who have escaped the lightning four-week-old French intervention in Mali will strike back with guerrilla attacks and suicide bombings.

After driving the bulk of the insurgents from major northern towns such as Timbuktu and Gao, French forces are trying to search out their bases in the remote and rugged Adrar des Ifoghas mountains, far up in the northeast.

But with Mali's weak army unable to secure recaptured zones, and the deployment of a larger African security force slowed by delays and kit shortages, vast areas to the rear of the French forward lines now look vulnerable to guerrilla activity.

"They infiltrated the town via the river. We think there were about 10 of them. They were identified by the population and they went into the police station," said General Bernard Barrera, commander of French ground operations in Mali.

He told reporters in Gao that French helicopters had intervened to help Malian troops pinned down by the rebels, who threw grenades from rooftops.

Malian gendarme Colonel Saliou Maiga told Reuters the insurgents intended to carry out suicide attacks in the town.

SUICIDE BOMBERS

No casualty toll was immediately available. But a Reuters reporter in Gao saw one body crumpled over a motorcycle. Malian soldiers said some of the raiders may have come on motorbikes.

The gunfire in Gao erupted hours after French and Malian forces reinforced a checkpoint on the northern outskirts that had been attacked for the second time in two days by a suicide bomber.

Abdoul Abdoulaye Sidibe, a Malian parliamentarian from Gao, said the rebel infiltrators were from the MUJWA group that had held the town until French forces liberated it late last month.

MUJWA is a splinter faction of al Qaeda's North African wing AQIM which, in loose alliance with the home-grown Malian Islamist group Ansar Dine, held Mali's main northern urban areas for 10 months until the French offensive drove them out.

Late on Saturday, an army checkpoint in Gao's northern outskirts came under attack by a group of Islamist rebels who fired from a road and bridge that lead north through the desert scrub by the Niger River to Bourem, 80 km (50 miles) away.

"Our soldiers came under heavy gunfire from jihadists from the bridge ... At the same time, another one flanked round and jumped over the wall. He was able to set off his suicide belt," Malian Captain Sidiki Diarra told reporters.

The bomber died and one Malian soldier was lightly wounded, he added. In Friday's motorbike suicide bomber attack, a Malian soldier was also injured.

Diarra described Saturday's bomber as a bearded Arab.

Since Gao and the UNESCO World Heritage city of Timbuktu were retaken last month, several Malian soldiers have been killed in landmine explosions on a main road leading north.

French and Malian officers say pockets of rebels are still in the bush and desert between major towns and pose a threat of hit-and-run guerrilla raids and bombings.

"We are in a dangerous zone... we can't be everywhere," a French officer told reporters, asking not to be named.

One local resident reported seeing a group of 10 armed Islamist fighters at Batel, just 10 km (6 miles) from Gao.

OPERATIONS IN NORTHEAST

The French, who have around 4,000 troops in Mali, are now focusing their offensive operations several hundred kilometers (miles) north of Gao in a hunt for the Islamist insurgents.

On Friday, French special forces paratroopers seized the airstrip and town of Tessalit, near the Algerian border.

From here, the French, aided by around 1,000 Chadian troops in the northeast Kidal region, are expected to conduct combat patrols into the Adrar des Ifoghas mountains.

The remaining Islamists are believed to have hideouts and supply depots in a rugged, sun-blasted range of rocky gullies and caves, and are also thought to be holding at least seven French hostages previously seized in the Sahel.

The U.S. and European governments back the French-led operation as a defense against Islamist jihadists threatening wider attacks, but rule out sending their own combat troops.

To accompany the military offensive, France and its allies are urging Mali authorities to open a national reconciliation dialogue that addresses the pro-autonomy grievances of northern communities like the Tuaregs, and to hold democratic elections.

Interim President Dioncounda Traore, appointed after a military coup last year that plunged the West African state into chaos and led to the Islamist occupation of the north, has said he intends to hold elections by July 31.

But he faces splits within the divided Malian army, where rival units are still at loggerheads.

(Additional reporting by Tiemoko Diallo and Adama Diarra in Bamako; Writing by Joe Bavier and Pascal Fletcher; Editing by Kevin Liffey)

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Philippines' Aquino visits rebel stronghold

SULTAN KUDARAT, Philippines: Philippine President Benigno Aquino paid a historic visit Monday to Muslim rebel territory in a bid to speed up efforts to end one of Asia's longest and deadliest insurgencies.

Four months after his government agreed on a roadmap with the Moro Islamic Liberation Front for a final peace deal by 2016, Aquino travelled to the insurgents' stronghold in the far south as a confidence-building measure.

"We have just three years and four months left. We have to speed up everything we are doing now to make this (peace) permanent," Aquino said on a stage alongside MILF chief Murad Ebrahim just outside the rebels' main base.

The deadline for peace coincides with the end of Aquino's six-year term as president. The constitution limits him to one term and there are concerns that the next president may not be able, or may not want, to pursue the peace agenda.

The 12,000-strong MILF has been fighting since the 1970s for independence in Mindanao, the southern third of the mainly Catholic Philippines that the country's Muslim minority claim as their ancestral homeland.

An estimated 150,000 people have died in the conflict with Muslim rebels, although a ceasefire in place since 2003 has largely held.

In the "framework agreement" signed last October, the MILF said it would give up its quest for independence in exchange for significant power and wealth-sharing in a new autonomous region covering large parts of Mindanao.

Many of the toughest details have yet to be agreed, and there have been no major breakthroughs in ensuing negotiations between the two sides.

However Aquino expressed confidence that the negotiations would yield significant results within weeks, and that a final peace pact could be achieved by 2016.

"We're very close to agreements on all the points," he said.

The key event on Monday, held just outside the MILF's heavily fortified Camp Darapanan, was the launch of joint development projects seen by both sides as crucial to the peace process.

It was the first peace mission by a president to the MILF's powerbase.

Then-president Joseph Estrada travelled to the area in 2000 but only at a time of heavy fighting, shortly after government troops overran another base that was then the rebels' main camp.

Estrada infamously brought pork and beer to the Muslim areas so government troops could celebrate their victory.

Speaking at Monday's event, Murad said Aquino's trip was a highly symbolic and important boost to the peace process.

"Truly we are humbled by this grand gesture of the president of personally launching several socio-economic projects... on this hallowed ground which has seen many of the battles we have fought," he said.

Murad emphasised the need to bring prosperity to Mindanao, a fertile and resource-rich region that remains one of the country's poorest areas because of the conflict as well as corruption.

"Development is so important... this goal must therefore be the single most important task of this partnership," he said.

The programmes launched on Monday involve education scholarships, expanded health networks and job creation projects.

After the launch of the development projects, Aquino travelled to a military camp to watch a game of football between MILF fighters and government soldiers.

-AFP/ac

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Two days after hanging, speed post reaches Afzal Guru's family

SRINAGAR: The speed post sent by Tihar Jail superintendent to Afzal Guru's family in Kashmir Valley's Sopore town was delivered Monday, two days after he was hanged in the national capital. The letter reached postal authorities here Saturday evening, several hours after he was executed.

"A speed post letter has been delivered to us by postal authorities today. Tihar Jail authorities have sent this speed post to Afzal's family," Afzal Guru's cousin Yaseen told journalists in Daibgah (Jageer) village near Sopore town.

Senior postal officials in Srinagar said the speed post was received Saturday evening - Afzal Guru was executed at 8am on Saturday - but delivered Monday as Sunday was a public holiday.

"We received the speed post by air Saturday evening. It was addressed to Tabassum Guru (his wife). Sunday being a public holiday, the speed post has been delivered today," John Samuel, chief post master general (Jammu and Kashmir), told journalists.

Afzal Guru, hanged for his role in the 2001 attack on parliament, last met his Tabassum and son Ghalib in August 2012.

His family has said they heard the news of his execution from a television channel as they had received no communication from jail authorities about the hanging.

Home Secretary R.K. Singh said Saturday: "The family was informed earlier. I checked from the jail authorities and they informed me that two letters had been sent by speed post. The DGP Kashmir was asked to crosscheck too. It is not correct that the family was not informed."

Jammu and Kashmir Chief minister Omar Abdullah has been highly critical of the Jail authorities for having used speed post for intimating Afzal's family.

"As a human being, I find it very difficult to reconcile myself to the fact that we executed a person who was not given the opportunity to see his family for the last time. If in this day and age, we are relying on speed post to inform a family that their loved one is going to be executed, there is something seriously wrong. I wish we were the ones who were authorised to inform the family," he told a TV channel.

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What heals traumatized kids? Answers are lacking

CHICAGO (AP) — Shootings and other traumatic events involving children are not rare events, but there's a startling lack of scientific evidence on the best ways to help young survivors and witnesses heal, a government-funded analysis found.

School-based counseling treatments showed the most promise, but there's no hard proof that anxiety drugs or other medication work and far more research is needed to provide solid answers, say the authors who reviewed 25 studies. Their report was sponsored by the federal Agency for Healthcare Research and Quality.

According to research cited in the report, about two-thirds of U.S. children and teens younger than 18 will experience at least one traumatic event, including shootings and other violence, car crashes and weather disasters. That includes survivors and witnesses of trauma. Most will not suffer any long-term psychological problems, but about 13 percent will develop symptoms of post-traumatic stress, including anxiety, behavior difficulties and other problems related to the event.

The report's conclusions don't mean that no treatment works. It's just that no one knows which treatments are best, or if certain ones work better for some children but not others.

"Our findings serve as a call to action," the researchers wrote in their analysis, published online Monday by the journal Pediatrics.

"This is a very important topic, just in light of recent events," said lead author Valerie Forman-Hoffman, a researcher at the University of North Carolina-Chapel Hill.

She has two young children and said the results suggest that it's likely one of them will experience some kind of trauma before reaching adulthood. "As a parent I want to know what works best," the researcher said.

Besides the December massacre at Sandy Hook Elementary School in Connecticut, other recent tragedies involving young survivors or witnesses include the fatal shooting last month of a 15-year-old Chicago girl gunned down in front of a group of friends; Superstorm Sandy in October; and the 2011 Joplin, Mo., tornado, whose survivors include students whose high school was destroyed.

Some may do fine with no treatment; others will need some sort of counseling to help them cope.

Studying which treatments are most effective is difficult because so many things affect how a child or teen will fare emotionally after a traumatic event, said Dr. Denise Dowd, an emergency physician and research director at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who wrote a Pediatrics editorial.

One of the most important factors is how the child's parents handle the aftermath, Dowd said.

"If the parent is freaking out" and has difficulty controlling emotions, kids will have a tougher time dealing with trauma. Traumatized kids need to feel like they're in a safe and stable environment, and if their parents have trouble coping, "it's going to be very difficult for the kid," she said.

The researchers analyzed 25 studies of treatments that included anti-anxiety and depression drugs, school-based counseling, and various types of psychotherapy. The strongest evidence favored school-based treatments involving cognitive behavior therapy, which helps patients find ways to cope with disturbing thoughts and emotions, sometimes including talking repeatedly about their trauma.

This treatment worked better than nothing, but more research is needed comparing it with alternatives, the report says.

"We really don't have a gold standard treatment right now," said William Copeland, a psychologist and researcher at Duke University Medical Center who was not involved in the report. A lot of doctors and therapists may be "patching together a little bit of this and a little bit of that, and that might not add up to the most effective treatment for any given child," he said.

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Online:

Pediatrics: http://www.pediatrics.org

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