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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Stock futures point to modest gains at open

NEW YORK (Reuters) - Stock index futures pointed to slight gains at the open on Wednesday, suggesting the market would continue a recent advance that lifted benchmark indexes to multi-year highs.

Equities have been strong performers of late, buoyed largely by healthy growth in corporate earnings, with the S&P 500 gaining 6.5 percent so far this year. The Dow is about 1 percent from an all-time intraday high, reached in October 2007.

Those gains could leave the market vulnerable to a pullback as investors take profit amid a dearth of new trading catalysts. While analysts continue to see an upward bias in markets, recent daily moves have been small and trading volumes have been light, with the S&P near its highest since November 2007.

"This is a market that refuses to go down, and the trend suggests that we'll not only hit a new high on the Dow, but move well beyond it," said Adam Sarhan, chief executive of Sarhan Capital in New York.

The S&P 500 was well over its 50-day moving average of 1,460.92, which was a sign the market was overbought, he said.

"A light-volume pullback should be expected and embraced at these levels," Sarhan said.

Industrial and construction shares will be in focus following President Barack Obama's State of the Union address on Tuesday, during which he called for a $50 billion spending plan to create jobs by rebuilding degraded roads and bridges. He also backed higher taxes for the wealthy.

Investors have cheered strength in recent company results, even as economic data, including recent reads on gross domestic product, have indicated weakening conditions.

Deere & Co reported earnings that beat expectations and raised its full-year profit outlook. After initially rallying in premarket trading, the stock turned 0.9 percent lower to $93.15.

S&P 500 futures rose 2.5 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures added 13 points and Nasdaq 100 futures rose 8 points.

Comcast Corp agreed late Tuesday to buy General Electric Co's remaining 49 percent stake in NBC Universal for $16.7 billion. Comcast jumped 8.9 percent to $42.43 in premarket trading while Dow component GE was up 3.1 percent to $23.27.

Yahoo Inc Chief Executive Marissa Mayer said Tuesday the company's search partnership with Microsoft Corp was not delivering the market share gains or the revenue boost that it should.

Companies scheduled to report quarterly results on Wednesday include MetLife Inc , Applied Materials and Whole Foods Market .

According to the latest Thomson Reuters data, of 353 companies in the S&P 500 that have reported results, 70.3 percent have exceeded analysts' expectations, above a 62 percent average since 1994 and 65 percent over the past four quarters.

Fourth-quarter earnings for S&P 500 companies are estimated to have risen 5.3 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Retail sales rose 0.1 percent in January, as expected, as tax increases and higher gasoline prices restrained spending. The data barely moved the futures market.

Also in economic news, business inventories are seen rising 0.3 percent in December, a repeat of the November increase. The data will be released at 10:00 a.m. ET (1500 GMT).

U.S. stocks closed modestly higher Tuesday as investors awaited President Barack Obama's State of the Union address.

(Editing by Bernadette Baum)

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China joins U.S., Japan in condemning North Korea nuclear test

SEOUL (Reuters) - North Korea conducted its third nuclear test on Tuesday in defiance of existing U.N. resolutions, drawing condemnation from around the world, including from its only major ally, China, which summoned the North Korean ambassador to protest.

The reclusive North said the test was an act of self-defense against "U.S. hostility" and threatened further, stronger steps if necessary.

It said the test had "greater explosive force" than the 2006 and 2009 tests. 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 year in power, pursuing policies that have propelled his impoverished and malnourished country closer to becoming a nuclear weapons power.

China, which has shown signs of increasing exasperation with the recent bellicose tone of its neighbor, summoned the North Korean ambassador in Beijing and protested sternly, the Foreign Ministry said.

Foreign Minister Yang Jiechi said China was "strongly dissatisfied and resolutely opposed" to the test and urged North Korea to "stop any rhetoric or acts that could worsen situations and return to the right course of dialogue and consultation as soon as possible".

China is a permanent member of the Security Council.

U.S. President Barack Obama labeled the test a "highly provocative act" that hurt regional stability and pressed for new sanctions.

"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 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.

Russian Foreign Minister Sergei Lavrov urged North Korea to abandon its nuclear arms program and return to talks. NATO condemned the test as an "irresponsible act" that posed a grave threat to world peace.

The test "was only the first response we took with maximum restraint", an unnamed spokesman for the North Korean Foreign Ministry, which acts as Pyongyang's official voice to the outside world, said in a statement carried by the official KCNA news agency.

"If the United States continues to come out with hostility and complicates the situation, we will be forced to take stronger, second and third responses in consecutive steps."

North Korea often threatens the United States and its "puppet", South Korea, with destruction in colorful terms.

North Korea told the U.N. disarmament forum in Geneva that it would never bow to resolutions on its nuclear program and that prospects were "gloomy" for the denuclearization of the divided Korean peninsula because of a "hostile" U.S. policy.

South Korea, still technically at war with the North after the 1950-53 civil war ended in a mere truce, also denounced the test.

The magnitude was roughly twice as large as that of 2009, Lassina Zerbo, director of the international data centre division of the Vienna-based Comprehensive Nuclear-Test Ban Treaty Organization, said. The U.S. Geological Survey said that a seismic event measuring 5.1 magnitude had occurred.

"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 strong response, the test is 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.

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 on its nuclear program, 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.

The European Union's foreign policy chief, Catherine Ashton, urged North Korea to refrain from further provocation.

EU member Denmark called on China to step up to the plate and use its influence to rein in its ally.

"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 and Chen Aizhu in BEIJING; Mette Fraende in COPENHAGEN; Adrian Croft, Charlie Dunmore and Justyna Pawlak in BRUSSELS; Editing by Nick Macfie)

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The Bachelor's Sean Lowe Blogs About His Dates in St. Croix

Sean Lowe and Tierra on The Bachelor

Sean Lowe is the star of season 17 of The Bachelor, which airs Mondays on ABC. The hunky Dallas businessman and entrepreneur is blogging about his romantic journey for PEOPLE.com.

I'd developed really strong feelings for the final six women on The Bachelor – and I could hardly wait to take them to St. Croix. Our previous week in Canada was great! My heart and head were back on track, and I felt as though the women put their focus back on me. And because of that, each of my relationships grew stronger.

But it was time to leave the cold weather behind and move on to some sandy beaches. This was a huge week for all of us because I would have to decide whose family I was ready to meet.

I had three one-on-one dates and one group date in St. Croix. I decided to give the one-on-one dates to women I had questions for – and the group date went to the women whose hometowns I was ready to visit.

My first date was with AshLee, who was a front-runner in my mind since we visited the theme park back in Los Angeles. She is sweet, loving and compassionate, and I knew she truly wanted to give her heart over to me. But I was still left with doubts about our relationship because I didn't seem to have as much fun with her as I did with the other women.

Given her traumatic childhood, it's understandable why AshLee has control issues. But I think that was preventing her from really letting go and allowing herself to have fun. I really want a partner that I can laugh uncontrollably with and someone who can make even mundane tasks feel exciting. I hoped AshLee had that quality in her, or that I brought it out in her, and I was ready to find out.

After taking the catamaran to the island, AshLee decided to take one for the team and tell me everything I needed to know about Tierra. Until that point, I had only heard the women say they didn't like Tierra, but they never gave specific reasons. It was actually a huge relief to hear all that AshLee had to say. It took a lot of courage for her to bring it up.

That evening, we ended our date with an oceanside dinner where she screamed her love for me while standing on a chair. For the first time, I felt like AshLee was finally letting go and stepping out of her comfort zone for me. I left that date thinking once again that AshLee might be the woman for me.

Connecting with Tierra

Next was my long-awaited date with Tierra. I had a lot of fun with her that day walking around the streets of St. Croix, but I couldn't shake what AshLee had told me. That night, as we had a romantic dinner in an old sugar mill, I tried to really figure out what my feelings were for Tierra, and if I could see a future for us.

I was nervous that if I ended up with Tierra, drama would follow her into our everyday lives. But when she told me she was falling in love with me, I softened a bit. She was always kind when she was with me, and I wanted to believe that the drama was circumstantial and that once she wasn't around a bunch of girls dating the same guy, she would be drama-free. I still ended the evening with questions, but remembering that my connection with Tierra was strong.

Group Date

The following day was the group date with Des, Lindsay and Catherine. I didn't have a lot of questions for these three women. They all have one thing in common: I always have fun with them. Since the beginning I've said that I want to marry my best friend, and they definitely fit that criterion.

We spent the day traveling and touring the island in a Jeep. At the end of the day, I really didn't know who I would give the rose to because they were all so deserving. But I decided to give it to Lindsay because she was so supportive, patient and encouraging throughout this entire journey.

My last date of the week was with Lesley. She was another person who fit the best-friend criteria, but I needed to see more from her. Lesley had a wall up and I always felt like she couldn't be completely vulnerable with me.

Our date was fun, but I needed more than fun. I desperately wanted to see her open up emotionally and allow me to see her true feelings, but that never happened. I was shocked to hear her say on TV that she loved me, and I was left confused as to why she didn't tell me that during our date. Had she told me, it could have changed everything.

Sisterly Advice

I flew my sister, Shay, to St. Croix for her birthday. She loves the show (she signed me up for The Bachelorette!), and I thought it would be a cool present for her. She is also a great judge of character and she knows me better than anyone else.

My sister's advice before I left Dallas for L.A. was to avoid the girl whom drama surrounded. After hearing everything that AshLee had to say about Tierra, I thought it would be a good idea to have my sister sit down and visit with Tierra so I could get her opinion.

I had no idea what I was walking into upon entering the women's suite. I was not aware of the big blowout AshLee and Tierra just had. I found Tierra crying on her bed with her head in her hands. I had already figured by this point that Tierra was not the woman I was going to marry, so when I saw how distraught she was, I knew I had to end it right then and there.

I still believe Tierra has more good in her than people see, but I also recognize that she doesn't have the maturity or social skills necessary to make it on The Bachelor.

When it came time to send someone home at the rose ceremony, I felt confident in my decision. As much as I enjoyed spending time with Lesley, I knew I had to send her home because she never allowed herself to open up emotionally.

I was sad to see Lesley leave, but I felt so confident in my final four. Knowing hometown dates were right around the corner, I was incredibly excited. I loved bringing Emily home to meet my family, and it changed everything for me, so I had really high hopes for the coming week. On to hometowns!

Thanks for watching!
Sean

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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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Stock futures dip before Obama speech, Coca-Cola shares off

NEW YORK (Reuters) - Stock futures dipped in low volume on Tuesday, hovering near multi-year highs as traders awaited President Barack Obama's State of the Union address.

The economy will be one of the main themes of Obama's speech at 9 p.m. (0200 GMT Wednesday). Investors will listen for any clues on a deal with Republicans in Congress to avert automatic spending cuts due to take effect March 1.

"Things are really quiet, waiting to see what the marching orders are for the next four years," said Kim Forrest, senior equity research analyst at Fort Pitt Capital Group in Pittsburgh.

Equities were mostly flat on Monday but the trend for the S&P 500, after six straight weeks of gains, has been upward. The index is up 6.4 percent so far this year.

S&P 500 futures fell less than 1 point and were below fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures dipped 4 point and Nasdaq 100 futures fell 3 points.

Coca-Cola Co shares dipped 0.5 percent to $38.42 in premarket trading after the world's largest soft drink maker reported quarterly earnings that were slightly better than expected as strength in emerging markets offset a decline in its European business.

Goodyear Tire & Rubber shares fell 1.9 percent in premarket trading after it posted a stronger-than-expected quarterly profit but cut its 2013 forecast due to weakness in the European automotive market.

Fossil Inc shares rose 3.5 percent after the fashion accessory maker and retailer reported a rise in quarterly profit.

On Monday, the Dow Jones industrial average <.dji> fell 21.81 points, or 0.16 percent, to 13,971.16. The S&P 500 <.spx> dipped 0.92 points, or 0.06 percent, to 1,517.01 and the Nasdaq Composite <.ixic> edged down 1.87 points, or 0.06 percent, to 3,192.00.

(Reporting by Rodrigo Campos; Editing by Chizu Nomiyama and Kenneth Barry)

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Pope Benedict stepping down, cites poor health

VATICAN CITY (Reuters) - Pope Benedict shocked the world on Monday by saying he no longer had the mental and physical strength to cope with his ministry, in an announcement that left his aides "incredulous" and will make him the first pontiff to step down since the Middle Ages.

The German-born Pope, 85, hailed as a hero by conservative Roman Catholics and viewed with suspicion by liberals, told cardinals in Latin that his strength had deteriorated recently. He will step down on February 28 and the Vatican expects a new Pope to be chosen by the end of March.

Vatican spokesman Father Federico Lombardi said the Pope had not decided to resign because of "difficulties in the papacy" and the move had been a surprise, indicating that even his inner circle was unaware that he was about to quit.

The Pope does not fear schism in the Church after his resignation, the spokesman said.

The Pope's leadership of 1.2 billion Catholics has been beset by child sexual abuse crises that tarnished the Church, one address in which he upset Muslims and a scandal over the leaking of his private papers by his personal butler.

The pope told the cardinals that in order to govern "...both strength of mind and body are necessary, strength which in the last few months, has deteriorated in me to the extent that I have had to recognize my incapacity to adequately fulfill the ministry entrusted to me.

"For this reason, and well aware of the seriousness of this act, with full freedom I declare that I renounce the ministry of Bishop of Rome, Successor of Saint Peter."

He also referred to "today's world, subject to so many rapid changes and shaken by questions of deep relevance for the life of faith."

The last Pope to resign willingly was Celestine V in 1294 after reigning for only five months, his resignation was known as "the great refusal" and was condemned by the poet Dante in the "Divine Comedy". Gregory XII reluctantly abdicated in 1415 to end a dispute with a rival claimant to the papacy.

"NO OUTSIDE PRESSURE," JUST ADVANCING AGE

Before he was elected Pope, the former Cardinal Joseph Ratzinger was known by such critical epithets as "God's rottweiler" because of his stern stand on theological issues.

But after several years into his new job Benedict showed that he not only did not bite but barely even barked.

In recent months, the pope has looked increasingly frail in public, sometimes being helped to walk by those around him.

Lombardi ruled out depression or uncertainty as being behind the resignation, saying the move was not due to any specific illness, just advancing age.

The Pope had shown "great courage, determination" aware of the "great problems the church faces today", he said, adding the timing may have reflected the Pope's desire to avoid the exhausting rush of Easter engagements.

There was no outside pressure and Benedict took his "personal decision" in the last few months, he added.

Israel's Chief Rabbi praised Benedict's inter-faith outreach and wished him good health. The Archbishop of Canterbury, head of the Anglican Church, said he had learned of the Pope's decision with a heavy heart but complete understanding.

German Chancellor Angela Merkel said the Pope's decision must be respected if he feels he is too weak to carry out his duties. British Prime Minister David Cameron said: "He will be missed as a spiritual leader to millions."

The pontiff would step down from 2 p.m. ET on February 28, leaving the office vacant until a successor was chosen to Benedict who succeeded John Paul, one of history's most popular pontiffs, the spokesman said.

Elected to the papacy on April 19, 2005 when he was 78 - 20 years older than John Paul was when he was elected - Benedict ruled over a slower-paced, more cerebral and less impulsive Vatican.

MEEK DEMEANOUR, STEELY INTELLECT

But while conservatives cheered him for trying to reaffirm traditional Catholic identity, his critics accused him of turning back the clock on reforms by nearly half a century and hurting dialogue with Muslims, Jews and other Christians.

Under the German's meek demeanor lay a steely intellect ready to dissect theological works for their dogmatic purity and debate fiercely against dissenters.

After appearing uncomfortable in the limelight at the start, he began feeling at home with his new job and showed that he intended to be Pope in his way.

Despite great reverence for his charismatic, globe-trotting predecessor -- whom he put on the fast track to sainthood and whom he beatified in 2011 -- aides said he was determined not to change his quiet manner to imitate John Paul's style.

A quiet, professorial type who relaxed by playing the piano, he managed to show the world the gentle side of the man who was the Vatican's chief doctrinal enforcer for nearly a quarter of a century.

The first German pope for some 1,000 years and the second non-Italian in a row, he traveled regularly, making about four foreign trips a year, but never managed to draw the oceanic crowds of his predecessor.

The child abuse scandals hounded most of his papacy. He ordered an official inquiry into abuse in Ireland, which led to the resignation of several bishops.

STRING OF SCANDALS

Scandal from a source much closer to home hit in 2012 when the pontiff's butler, responsible for dressing him and bringing him meals, was found to be the source of leaked documents alleging corruption in the Vatican's business dealings, causing an international furor.

He confronted his own country's past when he visited the Nazi death camp at Auschwitz.

Calling himself "a son of Germany", he prayed and asked why God was silent when 1.5 million victims, most of them Jews, died there during World War Two.

Ratzinger served in the Hitler Youth during World War Two when membership was compulsory. He was never a member of the Nazi party and his family opposed Adolf Hitler's regime.

But his trip to Germany also prompted the first major crisis of his pontificate. In a university lecture he quoted a 14th century Byzantine emperor as saying Islam had only brought evil to the world and that it was spread by the sword.

After protests that included attacks on churches in the Middle East and the killing of a nun in Somalia, the Pope later said he regretted any misunderstanding the speech caused.

In a move that was widely seen as conciliatory, in late 2006 he made a historic trip to predominantly Muslim Turkey and prayed in Istanbul's Blue Mosque with a Turkish Mufti.

But months later, former Iranian President Mohammad Khatami met the Pope and said wounds between Christians and Muslims were still "very deep" as a result of the Regensburg speech.

(Writing by Peter Millership; editing by Janet McBride and Ralph Boulton)

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Pink Trades Grammys for Mommy Time with Daughter Willow

By Maggie Coughlan

02/11/2013 at 08:00 AM EST

Grammys, schammys!

Even though she was nominated for best pop vocal album, Pink was absent from the awards show on Sunday.

Instead, the 33-year-old singer spent the evening on Twitter, sharing her musings about the broadcast – and her busy day.

"I'm sorry honey @hartluck but every time Johnny Depp speaks with that low voice, I can't find my clothes. Oops there they are. #brrrrr," she Tweeted to her husband Carey Hart when the actor introduced Mumford & Sons.

Then, after Kelly Clarkson charmed the audience with an adorable acceptance speech for best pop vocal album, Pink offered her congratulations.

"Congrats to Kelly Clarkson for the award and that lovable speech. You made me laugh. Can't wait to hear that song with Miguel," she wrote.

While much of the music world spent the day getting primped for the Grammys, Pink shared she had spent it with her daughter, Willow.

"I had the most incredible day. Pancakes, willow, train rides, park, arts and crafts, nap time, baking, kisses. Dancing, music. Life is good," she Tweeted, sharing a photo.

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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.

___

Online:

Pediatrics: http://www.pediatrics.org

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Stock futures higher in low volume, Fed's Yellen to speak

NEW YORK (Reuters) - Stock index futures edged higher on Monday, suggesting equities will extend multiyear highs, while low volume and the absence of economic data could make trading volatile and exaggerate moves.

Upbeat U.S. and Chinese data last week helped extend the winning streak of the S&P 500 index to six weeks. The benchmark index is up 6.4 percent so far this year after a steep rally in January that has stalled as the index nears a record high.

No economic data or major earnings reports are scheduled, but Federal Reserve Vice Chairwoman Janet Yellen is due to speak about the economic recovery at 1 p.m.

Technical indicators are "looking very good" and could give the market a floor Monday, according to Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

He said the market will pay attention to Yellen's speech, but he doesn't expect any deviation from her traditionally dovish monetary policy stance.

S&P 500 futures rose 4 points but were slightly below fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures rose 36 points, and Nasdaq 100 futures added 4.25 points.

Google shares dipped 0.9 percent in premarket trading after it said in a filing former chief executive Eric Schmidt is selling roughly 42 percent of his stake in the Internet search company, a move that could potentially net him $2.51 billion.

Celgene Corp shares rose 2.1 percent in premarket trading to $102.21 after U.S. regulators approved its new drug for patients with multiple myeloma whose disease has worsened after being treated with other cancer drugs.

US Airways shares gained 2.9 percent to $15.18 as an $11 billion merger with AMR Corp appeared closer, people familiar with the matter said. A combination would create the world's largest airline by passenger traffic.

Opposition grew to the $24.4 billion buyout of Dell Inc , the No. 3 personal computer maker, as three of the largest investors joined Southeastern Asset Management on Friday in raising objections. Dell said in a regulatory filing it had considered many strategic options before opting to go private. The buyout is being led by Chief Executive Michael Dell.

Loews Corp could be hit after the hotels, energy and financial services conglomerate reported a fourth-quarter loss. CNA Financial Corp , its largest holding, suffered losses linked to superstorm Sandy.

(Reporting by Rodrigo Campos; Editing by Chizu Nomiyama and Kenneth Barry)

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