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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Who's Next? A Look at Likely Successors to Benedict

With 1 billion Catholics worldwide, the face of the church is changing.

It's something the cardinal electors may keep in mind when the conclave to elect a new pontiff begins in late March, said Matthew Bunson, general editor of the Catholic Almanac and author of "We Have a Pope! Benedict XVI."

RELATED: Pope Benedict XVI Resigns: The Statement

The 117 cardinals who are eligible to vote for the new pontiff hail from approximately 50 different countries, and they almost always elect one of their own.

Joseph Ratzinger, an intellectual and respected cardinal from Germany, was the frontrunner for the papacy in 2005, Bunson said. When elected, he became Pope Benedict XVI.

This year, there are no strong favorites.

"The door, in a way, is very much open," Bunson said.

FULL COVERAGE: Pope Benedict XVI Resignation

Here's a quick look at some of the possible picks for pope:

Angelo Cardinal Scola, 71, Italy

Scola was named the Archbishop of Milan in 2011, a prominent post in the Roman Catholic church.

"If we had to pick a frontrunner, it's him," Bunson said. "He first is a brilliant theologian and has the intellectual heft to be pope, which is crucial. He has the clear favor of Pope Benedict.

Milan and Venice together have produced five popes in the past century.

Scola is also committed to promoting an understanding across faiths.

He started the Oasis Foundation in 2004, which helps bridge a dialogue between Christians and Muslims.

Helen Alvaré, a professor of law at George Mason University and an advisor to Pope Benedict XVI's Pontifical Council for the Laity, agreed that Scola will be considered papabili -- an Italian word for someone highly qualified for the papacy.

"It would not be surprise me if a Scola, or another great European mind also was determined to be what was needed for the times," she said.

Marc Cardinal Ouellet, 68, Canada

The former Archbishop of Quebec, who now heads the Congregation of Bishops, has a deep knowledge of the global workings of the church, Bunson said.

"He has had a major role in the appointment of the church's leaders around the world," Bunson said.

And he points out that at 68 years old, Ouellet has age on his side.

Ouellet is someone who could have "worldwide reach," Alvaré said.

"The man who is chosen for the position he has is someone who is understood to have the presence and the future of the church in mind," she said.

Peter Cardinal Turkson, 64, Ghana

Turkson, who hails from Ghana, may be in the running.

He is currently the president of the Pontifical Council for Justice and Peace, a post he was appointed to by Pope Benedict XVI in 2009.

The job has sent Turkson, who speaks six languages, around the world to handle mediations.

"The fact that an African cardinal is a candidate to be elected pope is the statement to the diversity of the church and the remarkable growth around the world," Bunson said.

Turkson discussed the possible of a black pope at a press conference in 2009, following the U.S. presidential election.

"And if by divine providence -- because the church belongs to God -- if God would wish to see a black man also as Pope, thanks be to God," he said.

Francis Cardinal Arinze, from Nigeria, has also been discussed as a potential pope.

Leonardo Cardinal Sandri, 69, Argentina

With a large center of Catholic faithful in Latin America, Sandri could become the first pope from the region.

The 69-year-old, who was born in Argentina to Italian parents, served as a chief of staff in the Vatican, often reading public message when Pope John Paul II was in declining health.

It was Sandri who announced the passing of the pontiff in St. Peter's Square on April 2, 2005.

"He's well-liked around the world," Bunson said.

He currently serves on the Congregation for the Oriental Churches, acting as a liason with Eastern European Catholic churches.

Sandri is fluent in English, Spanish, Italian, German and French.

Angelo Cardinal Bagnasco, 70, Italy

The Archbishop of Genoa has a "reputation for intellectual heft," Bunson said.

Bagnasco, two-time president of the Italian Bishops Conference, has a history of taking a strong stance on church doctrine.

In 2007, he was the subject of death threats after he led a campaign against proposed Italian legislation to grant some legal rights to unmarried couples, including people in same-sex relationships.

Italians form the largest voting block in the College of Cardinals, with 25 percent of the seats, and could help propel Bagnasco into the papacy.

Tarsicio Cardinal Bertone, 78, Italy

The current Cardinal Secretary of State is a strong candidate if the Holy Spirit wants another great European mind at the helm of the church, Alvaré said.

Bertone runs the day-to-day business of the Roman Curia, the Vatican's government.

He has reportedly been criticized by Vatican officials for his handling of issues ranging from sexual abuse in the church to Vatican finances.

In an open letter last year, Pope Benedict XVI acknowledged the in-fighting and pledged his support for his secretary of state.

"I've noted with regret the unjust criticism directed at your person," the pope wrote. "I intend to reaffirm my pledge of personal faith in you."

Although he's held in high regard by the pope, Bunson believes Bertone's age will keep him from the papacy.

"His age is against him," he said, pointing out that Bertone is the same age as his boss when he was elected.

Timothy Cardinal Dolan, 63, New York

While the thought of an American pope has long seemed impossible, Cardinal Dolan should not be ruled out, Alvaré said.

"History is changing," she said. "We've been at this a while here in the states, [although] not anywhere as long as Europe."

Dolan, an affable cardinal well-known by Catholics in the U.S. and abroad, "has been grappling with some of the leading questions that face the church for the future," Alvaré said.

In September 2012, along with comedian Stephen Colbert, he co-led a discussion on faith and humor at Fordham University.

"If I am elected pope, which is probably the greatest gag all evening, I'll be Stephen III," he told the crowd of students.

Despite Dolan's good standing, Bunson said he has some doubts.

"It strikes me as unlikely, simply because we are the world's last superpower," he said of the U.S. "So I think that might factor in."

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Pope's sudden resignation sends shockwaves through Church

VATICAN CITY (Reuters) - Pope Benedict stunned the Roman Catholic Church on Monday when he announced he would stand down, the first pope to do so in 700 years, saying he no longer had the mental and physical strength to carry on.

Church officials tried to relay a climate of calm confidence in the running of a 2,000-year-old institution, but the decision could lead to uncertainty in a Church already besieged by scandal for covering up sexual abuse of children by priests.

The soft-spoken German, who always maintained that he never wanted to be pope, was an uncompromising conservative on social and theological issues, fighting what he regarded as the increasing secularization of society.

It remains to be seen whether his successor will continue such battles or do more to bend with the times.

Despite his firm opposition to tolerance of homosexual acts, his eight year reign saw gay marriage accepted in many countries. He has staunchly resisted allowing women to be ordained as priests, and opposed embryonic stem cell research, although he retreated slightly from the position that condoms could never be used to fight AIDS.

He repeatedly apologized for the Church's failure to root out child abuse by priests, but critics said he did too little and the efforts failed to stop a rapid decline in Church attendance in the West, especially in his native Europe.

In addition to child sexual abuse crises, his papacy saw the Church rocked by Muslim anger after he compared Islam to violence. Jews were upset over rehabilitation of a Holocaust denier. During a scandal over the Church's business dealings, his butler was accused of leaking his private papers.

In an announcement read to cardinals in Latin, the universal language of the Church, the 85-year-old said: "Well aware of the seriousness of this act, with full freedom I declare that I renounce the ministry of Bishop of Rome, Successor of St Peter ...

"As from 28 February 2013, at 20:00 hours (1900 GMT) the See of Rome, the See of St. Peter will be vacant and a conclave to elect the new Supreme Pontiff will have to be convoked by those whose competence it is."

POPE DOESN'T FEAR SCHISM

Benedict is expected to go into isolation for at least a while after his resignation. Vatican spokesman Father Federico Lombardi said Benedict did not intend to influence the decision of the cardinals in a secret conclave to elect a successor.

A new leader of the world's 1.2 billion Roman Catholics could be elected as soon as Palm Sunday, on March 24, and be ready to take over by Easter a week later, Lombardi said.

Several popes in the past, including Benedict's predecessor John Paul, have refrained from stepping down over their health, because of the division that could be caused by having an "ex-pope" and a reigning pope alive at the same time.

Lombardi said the pope did not fear a possible "schism", with Catholics owing allegiances to a past and present pope in case of differences on Church teachings.

He indicated the complex machinery of the process to elect a new pope would move quickly because the Vatican would not have to wait until after the elaborate funeral services for a pope.

It is not clear if Benedict will have a public life after he resigns. Lombardi said Benedict would first go to the papal summer residence south of Rome and then move into a cloistered convent inside the Vatican walls.

The resignation means that cardinals from around the world will begin arriving in Rome in March and after preliminary meetings, lock themselves in a secret conclave and elect the new pope from among themselves in votes in the Sistine Chapel.

There has been growing pressure on the Church for it to choose a pope from the developing world to better reflect where most Catholics live and where the Church is growing.

"It could be time for a black pope, or a yellow one, or a red one, or a Latin American," said Guatemala's Archbishop Oscar Julio Vian Morales.

The cardinals may also want a younger man. John Paul was 58 when he was elected in 1978. Benedict was 20 years older.

"We have had two intellectuals in a row, two academics, perhaps it is time for a diplomat," said Father Tom Reese, senior fellow at the Woodstock Theological Center at Georgetown University. "Rather than electing the smartest man in the room, they should elect the man who will listen to all the other smart people in the Church."

Liberals have already begun calling for a pope that would be more open to reform.

"The current system remains an 'old boy's club' and does not allow for women's voices to participate in the decision of the next leader of our Church," said the Women's Ordination Conference, a group that wants women to be able to be priests.

"GREAT COURAGE"

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.

Lombardi said Benedict's stepping aside showed "great courage". He ruled out any specific illness or depression and said the decision was made in the last few months "without outside pressure". But the decision was not without controversy.

"This is disconcerting, he is leaving his flock," said Alessandra Mussolini, a parliamentarian who is granddaughter of Italy's wartime dictator. "The pope is not any man. He is the vicar of Christ. He should stay on to the end, go ahead and bear his cross to the end. This is a huge sign of world destabilization that will weaken the Church."

Cardinal Stanislaw Dziwisz, secretary to the late Pope John Paul, said the former pope had stayed on despite failing health for the last decade of his life as he believed "you cannot come down from the cross."

While the pope had slowed down recently - he started using a cane and a wheeled platform to take him up the long aisle in St Peter's Square - he had given no hint recently that he was considering such a dramatic decision.

Elected in 2005 to succeed the enormously popular John Paul, Benedict never appeared to feel comfortable in the job.

"MIND AND BODY"

In his announcement, 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."

Before he was elected pope, the former Cardinal Joseph Ratzinger was known as "God's rottweiler" for his stern stand on theological issues. After a few months, he showed a milder side but he never drew the kind of adulation that had marked the 27-year papacy of his predecessor John Paul.

U.S. President Barack Obama extended prayers to Benedict and best wishes to those who would choose his successor.

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 Archbishop of Canterbury, leader of the worldwide Anglican communion, said he had learned of the pope's decision with a heavy heart but complete understanding.

CHEERS AND SCANDAL

Elected to the papacy on April 19, 2005, Benedict ruled over a slower-paced, more cerebral and less impulsive Vatican.

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.

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 showed the gentle side of a 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.

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.

Benedict 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, were killed there.

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.

(Additional reporting by James Mackenzie, Barry Moody, Cristiano Corvino, Alexandra Hudson in Berlin, and Dagamara Leszkowixa in Poland; Editing by Peter Graff)

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Australia central bank sells scandal-hit note firm stake

SYDNEY: Australia's central bank on Tuesday announced the sale of its stake in scandal-hit note printing firm Securency and said an independent governance review had cleared it of "inappropriate" insight.

The Reserve Bank of Australia sold its 50 per cent holding in Securency, accused of taking bribes to win contracts in Asia, to British venture partner Innovia Films for A$65 million (US$66.7 million).

"The sale of the bank's interest in Securency is in accordance with the bank's long-standing intention to exit from the joint venture once Securency had established itself as a viable long-term supplier in the international market," the RBA said in a statement.

Note Printing Australia, a second RBA firm implicated in the Asia bribery scandal which the media broke in 2009, would remain a "wholly-owned subsidiary of the bank", it added.

The RBA also released a review into the governance of Securency and NPA by independent consultancy Cameron Ralph which cleared it of serious oversight issues.

Cameron Ralph said the RBA "gave reasonable consideration as to the governance arrangements for the two companies, and put in place processes for their oversight and reporting which were broadly consistent with usual practice at the time".

It appointed people to the firms' boards that it was "entitled to believe could direct the affairs of the companies with due care, diligence and skill", received regular reports and responded in a "considered and deliberate way".

The bank took "appropriate action where the entities appeared not to be performing in line with expectations and/or standards", Cameron Ralph added.

"Clearly, with the benefit of hindsight, there could have been more oversight applied to the activities of the companies, which may have detected earlier the alleged illegal payments" it said.

"But that does not mean that the Bank's oversight at the time was inappropriate."

Eight executives from Securency and NPA are facing claims they conspired to bribe officials at foreign banks to secure contracts to make plastic banknotes.

Both companies have also been charged over the alleged racket, which involved contracts in Indonesia, Malaysia, Vietnam and Nepal.

- AFP/ck

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Kumbh stampede: Minister refutes callousness charge

NEW DELHI: The railways were caught off guard on Sunday after the Allahabad administration diverted a deluge of pilgrims towards the station complex which ultimately caused the stampede, sources said.

This happened all of a sudden as thousands of pilgrims poured in through the Civil Lines between 5pm and 6pm. It wasn't part of the plan shared with them and the railway authorities were stumped. In no time, the station complex was overflowing, platforms were packed, the foot overbridge and circulation area were teeming with jostling pilgrims.

A day after the stampede, a blame game began between the railways and the state government. The railways insisted they were kept in the dark on crowd management plans, but the administration blamed it on a lathicharge at the station. Railway minister Pawan Bansal, in Allahabad on Monday, strongly defended his department saying the stampede happened because of the rush and that all arrangements were in place. He denied a lathicharge triggered the panic.

Despite the railway effort to shift blame, one thing seems clear: It failed to estimate the likely crowd at the station. Not enough security men were at the station. Unlike CRPF, BSF and RAF, trained in crowd control, the Government Railway Police isn't . Allahabad can handle a maximum of 40,000 commuters at a time and it's now being asked why railway authorities allowed nearly 3lakh people to descend on its premises at a go. "Piligrims could have been diverted to smaller halts and informed about train movements over the public address system," Shiv Gopal Mishra, general secretary of the All India Railwaymen Federation said. Mishra was in Allahabad on Sunday.

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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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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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Missing 13-year-old-boy found

SINGAPORE: The 13-year-old boy who went missing on Friday has been reunited with his parents.

Aminiasi Tiritabuanira Shaw, a student of the Singapore American School (SAS), was found on Sunday night.

The school had earlier said that it's believed the boy had left on his own accord after a disagreement with his parents.

In its update on Monday, the school said: "The Shaw family would like to extend their sincere gratitude to the many, many people from the SAS community, the larger Singapore community, and other organizations, schools and groups, who have tirelessly supported the search efforts for Tiri over the past couple of days.

"Please help pass the word that Tiri has been found and is safely in the arms of his family."

- CNA/ir

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Death toll in Allahabad railway station stampede rises to 36

ALLAHABAD: The death toll in the stampede at Allahabad railway station reached 36 today, with 14 more people succumbing to their injuries.

The incident occurred near the foot overbridge on platform number 6. On Sunday, the railway authorities, had refused to confirm the deaths till the filing of the report. The stampede, which took place at around 8.00pm, also left many persons severely injured. Sources said majority of victims killed were elderly persons.

The tragic incident, reports said, took place when more than 1.5 lakh devotees thronged Allahabad junction to board return trains for their respective destinations after Mauni Amavasya Snan. The massive rush of devotees resulted in the breaking of railing on foot overbridge and subsequently the stampede.

NCR chief public relation officer Sandeep Mathur said due to sudden rush of passengers at Allahabad junction the railing of the foot overbridge near platform number 6 broke and in the process many passengers fell from the staircase of the foot overbridge, leading to stampede. He, however, refused to confirm the number of death or critically injured.

Allahabad distict magistrate Raj Shekhar said assured all possible help and treatment to injured persons. Principal, MLN Medical College, Dr SP Singh said seven out of 13 critically injured persons who were earlier admitted at railway hospital were shifted to SRN hospital. He added that 17 injured persons were already undergoing treatment at the hospital.

Eyewitnesses told TOI that none of the senior railway police authorities nor NCR officials came to the spot even as victims cried for help.

Rohit, a passenger, told TOI that the incident was caused by mismanagement. He added that the railway police used light force to manage the crowd but it left an adverse impact and resulted in commotion.

"There was none to hear our grievances and aged people and children were the worst hit when the over-crowding resulted in commotion," said Gayatri, a native of Banda. She added that, "We kept urging GRP and railway authorities for help but none came."

Some angry passengers at the platform misbehaved with reporters when the latter reached the station. Following the incident, railway authorities restricted the entry of passengers at Allahabad Junction.

Rajesh Gupta, a native of Haryana, who lost his sister Babita, 37, in the stampede and himself sustained injuries, told TOI that there was a sudden push of passengers from behind which forced me and others fellow passengers on the staircase. Many fell and got trampled.

Beta Lal, whose wife suffered grave injuries and was shifted to SRN hospital, said, "Due to massive rush of passengers on the foot overbridge, police started chasing away passenger and that led to commotion on the bridge leading to stampede." He added that after the incident, railway authorities did not come to rescue the injured persons.

Another victim, Sunita Jha of Delhi, undergoing treatment at SRN hospital, said, "All of a sudden there was a heavy rush of passengers at the foot overbridge after which things went out of control leading to stampede."

(With inputs from PTI)

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After early start, worst of flu season may be over

NEW YORK (AP) — The worst of the flu season appears to be over.

The number of states reporting intense or widespread illnesses dropped again last week, and in a few states there was very little flu going around, U.S. health officials said Friday.

The season started earlier than normal, first in the Southeast and then spreading. But now, by some measures, flu activity has been ebbing for at least four weeks in much of the country. Flu and pneumonia deaths also dropped the last two weeks, the Centers for Disease Control and Prevention reported.

"It's likely that the worst of the current flu season is over," CDC spokesman Tom Skinner said.

But flu is hard to predict, he and others stressed, and there have been spikes late in the season in the past.

For now, states like Georgia and New York — where doctor's offices were jammed a few weeks ago — are reporting low flu activity. The hot spots are now the West Coast and the Southwest.

Among the places that have seen a drop: Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., which put up a tent outside its emergency room last month to help deal with the steady stream of patients. There were about 100 patients each day back then. Now it's down to 25 and the hospital may pack up its tent next week, said Terry Burger, director of infection control and prevention for the hospital.

"There's no question that we're seeing a decline," she said.

In early December, CDC officials announced flu season had arrived, a month earlier than usual. They were worried, saying it had been nine years since a winter flu season started like this one. That was 2003-04 — one of the deadliest seasons in the past 35 years, with more than 48,000 deaths.

Like this year, the major flu strain was one that tends to make people sicker, especially the elderly, who are most vulnerable to flu and its complications

But back then, that year's flu vaccine wasn't made to protect against that bug, and fewer people got flu shots. The vaccine is reformulated almost every year, and the CDC has said this year's vaccine is a good match to the types that are circulating. A preliminary CDC study showed it is about 60 percent effective, which is close to the average.

So far, the season has been labeled moderately severe.

Like others, Lehigh Valley's Burger was cautious about making predictions. "I'm not certain we're completely out of the woods," with more wintry weather ahead and people likely to be packed indoors where flu can spread around, she said.

The government does not keep a running tally of flu-related deaths in adults, but has received reports of 59 deaths in children. The most — nine — were in Texas, where flu activity was still high last week. Roughly 100 children die in an average flu season, the CDC says

On average, about 24,000 Americans die each flu season, according to the CDC.

According to the CDC report, the number of states with intense activity is down to 19, from 24 the previous week, and flu is widespread in 38 states, down from 42.

Flu is now minimal in Florida, Kentucky, Maine, Montana, New Hampshire and South Carolina.

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Online:

CDC: http://www.cdc.gov/flu/

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