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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State of the Union: Obama Pushes Job Creation

Pursuing an aggressive and diverse early second-term agenda, President Obama turned his focus Tuesday night squarely to the economy, using his State of the Union address to unveil new government initiatives aimed at creating jobs.

The defining duty of the new Congress and new administration is to "reignite the true engine of America's economic growth -- a rising, thriving middle class," Obama said Tuesday night from the House chamber.

"That must be the North Star that guides our efforts," he said.

Obama's proposals had a familiar ring, including re-packaged economic ideas but also offering several bold new measures aimed at boosting the middle class.

None of the proposals would add to the deficit "by a single dime," Obama pledged, with costs offset by savings carved out in the budget and from money saved from ending two wars.

"It's not a bigger government we need, but a smarter government that sets priorities and invests in broad-based growth," Obama said.

For the first time as president, Obama called for raising the minimum wage from $7.25 to $9.00 an hour by 2015. He proposed to ensure future increases by indexing the minimum wage to inflation.

He proposed a national goal of universal pre-school education, an effort to help states provide tens of thousands of low- to middle-income four-year-old children access to quality public education from an earlier age.

Charles Dharapak/Pool/AP Photo

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And, to heal the nation's crumbling roads and bridges, Obama offered a $50 billion "fix it first" infrastructure program that would prioritize repair of existing structures before building new ones.

"Every day, we should ask ourselves three questions as a nation," Obama said. "How do we attract more jobs to our shores? How do we equip our people with the skills needed to do those jobs? And how do we make sure that hard work leads to a decent living?"

Answers to those questions, the president suggested, include redoubling investments in clean energy technologies -- a step which he said would both benefit the environment and reduce U.S. dependence on foreign oil.

"For the sake of our children and our future, we must do more to combat climate change," he said.

He called for doubling the amount of renewable electricity generation in the U.S. by 2020, and announced an energy version of his "Race to the Top" education program that would give states grants for the best energy efficiency programs.

Related: 7 Things Obama Says at Every State of the Union

In tandem with his economic focus, Obama announced the withdrawal of 34,000 U.S. troops from Afghanistan by this time next year, cutting in half the current force and marking a quickened pace for the final exit of U.S. combat forces by a 2014 deadline.

There are currently 66,000 U.S. troops serving in Afghanistan. Obama has vowed to bring nearly all of them home by the end of next year, though a small contingent will likely remain to train Afghan forces and assist counterterrorism operations, officials have said.

Obama touched briefly on his recently-unveiled proposals to overhaul the nation's immigration system, expand rights for gay and lesbian Americans and curb an epidemic of gun violence.

With dozens of victims of gun violence looking on from the House gallery, including former Rep. Gabby Giffords, and families of victims from shootings at Newtown, Conn., Oak Creek, Wisc., and Aurora, Colo., Obama made an emotional plea for an up-or-down vote on his gun control plan.

"Each of these proposals deserves a vote in Congress," he said of proposed restrictions on assault-style weapons and high capacity magazines, and enhanced background checks, among other measures.

"If you want to vote no, that's your choice," he said. "But these proposals deserve a vote. Because in the two months since Newtown, more than a thousand birthdays, graduations and anniversaries have been stolen from our lives by a bullet from a gun."

Read More: President Obama's Past State of the Union Promises

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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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Benedict's resignation renews calls for an African pope

LAGOS: Pope Benedict XVI's resignation has sparked calls for his successor to come from Africa, home to the world's fastest-growing population and the front line of key issues facing the Roman Catholic Church.

Around 15 per cent of the world's 1.2 billion Catholics live in Africa and the percentage has expanded significantly in recent years in comparison to other parts of the world.

Much of the Catholic Church's recent growth has come in the developing world, with the most rapid expansions in Africa and Southeast Asia.

Names such as Ghana's Peter Turkson and Nigerian John Onaiyekan have been mentioned as potential papal material, as has Francis Arinze, also from Nigeria and considered a possibility when Benedict was elected, but who is now 80.

Some analysts see the issue as one of justice since Africa has contributed to the Catholic Church to such a large degree, as well as a reflection of a changing world.

"I think that, with the black community's representation in the larger Catholic community, it is legitimate that we have a black pope," said Rene Legre Hokou, head of the Ivory Coast League of Human Rights.

"An African pope could give more vitality to the Catholic Church in the black world. It would demonstrate the universal character of the religion."

A number of African Catholic Church members had a mixed view however, saying they would like to see a fellow African elected pope, but wanted the most qualified person, no matter where he is from.

Pat Utomi, a prominent Catholic in Nigeria who is an economist and former presidential candidate, said he would take pride in seeing an African elected, "but we must take that away."

"I think what matters is the right person with the vision for the moment," Utomi said.

At the same time, he said Africa in several ways was representative of major challenges facing the Church, particularly its relationship with an evangelical movement with explosive growth on the continent as well as with Islam.

"I think in some ways a John Paul II was a response to the Soviet Union," Utomi said. "In some ways the challenge of the Church must be to reach an accommodation ... an understanding with Islam and the Pentecostal movement."

Africans have flocked to evangelical religions, with many seeing them as more relevant to their daily lives, posing a challenge to the Catholic Church.

Also in countries like Nigeria, roughly divided between a mainly Muslim north and predominately Christian south, religious and ethnic tensions have led to violence.

Onaiyekan, nominated as a cardinal in October and also the archbishop of the Nigerian capital Abuja, has made efforts to foster unity between Christians and Muslims in his country.

"It would take a skilled leader of the church -- in the kind of way that a John Paul II reached out to the Eastern church, to the Orthodox churches of the east," Utomi said.

Vatican watchers say the college of cardinals may seize the moment to elect a Latin-American, African or Asian pope.

Others say 85-year-old Benedict -- who is resigning for age reasons -- may call on the cardinals to elect someone younger, who is less likely to suffer failing health early in his mandate.

Benedict visited Africa twice, most recently the West African nation of Benin in 2011, while before that Angola and Cameroon in 2009. His Benin visit came 150 years after what is considered the evangelisation of the country by missionaries.

Archbishop of Lagos Alfred Adewale Martins said Benedict should be lauded for his efforts in Africa.

"I believe he is one man that we should be grateful to God for the attitude to the church in general and also the solicitude that he has demonstrated in very many ways to the church in Africa in particular," said Martins.

But Benedict's outreach on the continent notwithstanding, there were still doubts over whether an African would be put at the head of the Vatican.

At Saint Antonio da Polana Church in the Mozambique capital Maputo after Benedict's announcement, parishioner Zeb Renardo said he did not think the time had come.

"I will say categorically that I doubt we will have an African pope," he said. "I think the moment hasn't come for us to see an African pope."

But the rector at Ivory Coast's Basilica of Our Lady of Peace of Yamoussoukro, a semi-replica of St. Peter's in Rome and the largest Christian shrine in Africa, said "why not a non-Western pope?"

"The world is now multi-colour," Polish priest Stanislaw Skuza said.

- AFP/ck

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Afzal Guru hanging: Fourth day of curfew in tension torn Kashmir

SRINAGAR: Uninterrupted curfew restrictions continued for the fourth day on Tuesday in Kashmir Valley to prevent violence in the wake of Afzal Guru's hanging in New Delhi's Tihar jail. Chief Minister Omar Abdullah said he would help arrange a visit to the parliament attack convict's family to offer prayers at his grave.

While speaking to a radio channel on Monday evening, Omar said that if Afzal Guru's family approached him, he would do everything possible to help.

Three people have died so far during protests in the Kashmir Valley after news of December 2001 Parliament attack plotter's hanging spread in Srinagar.

Residents in Batwina village of north Kashmir's Ganderbal district said two youths were drowned after they were chased by the security forces during protests, while police said the deaths had occurred because of a boat capsize in the Jhelum river.

A teenaged boy belonging to Watergam (Rafiabad) area of Baramulla district succumbed to critical injuries in a city hospital on Monday morning.

He had reportedly sustained a bullet injury from the security forces during protests in the village.

Another injured youth is battling for life in Srinagar's super specialty Sher-e-Kashmir Institute of Medical Sciences Soura.

The state government has ordered a magisterial probe into both these incidents and an ex-gratia relief to the next of kin of the deceased person.

Strict orders has been given to exercise maximum restraint while handling the law and order situation in the valley, the chief minister said.

Reports indicate 14 companies of border security force (BSF) and 10 additional companies of central reserve police force (CRPF) have been rushed to assist the state administration in maintaining law and order.

For the third day on Tuesday Kashmir went without any print editions of the local newspapers.

Local editors said they had been unofficially told by the authorities to suspend publications of their newspapers till Friday.

"If this has been done to check the spread of wild rumours then it is a very bad decision," said Bashir Manzar, editor of daily 'Kashmir Images'.

Cable television operations and Internet facilities also remained shut in the summer capital Srinagar, although BSNL broadband users said their facility was still working.

Those using dongle appliances and mobile phones to access the Internet have been unable to do so for the last four days.

A senior police officer said curfew imposed on Saturday would remain in place till further orders.

Asked whether the authorities were planning some relaxation in the imposed curfew, the officer said the situation was being monitored on a regular basis.

Authorities have made announcements through the local radio and television broadcasts that additional round-the-clock ambulances have been made available to ferry sick people to hospitals from areas under curfew.

Security forces have been advised to treat the identity cards of those maintaining essential services like healthcare, water supplies and electricity as curfew passes and allow their movements through those areas.

Separatist Hurriyat group headed by Syed Ali Geelani has asked people to continue the protest shutdown till Friday when a march to the Eidgah grounds has been announced.

"We will demand that the mortal remains of Afzal Guru be returned to his family," a spokesman of the group told media here.

All examinations and interviews scheduled to be held up to Februay 17 have been postponed by the authorities.

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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 Korean Tremor Raises Fear of Nuke Test

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.

Japan's prime minister has called an urgent security meeting, according to chief government spokesman Yoshihide Suga, and South Korea raised its military alert level, the AP reported.

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." The agency said it was trying to confirm the nature of the tremor.

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.

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.

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.

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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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First Singaporean nominated for Grammy falls short

LOS ANGELES - The first Singaporean to be nominated for a Grammy came up short on Sunday, with guitarist Arun Shenoy losing out to top veteran trumpeter Chris Botti for best pop instrumental album.

Shenoy, who was born in the southern Indian state of Karnataka before moving to Singapore, received a Grammy nomination for his debut album "Rumbadoodle," which he recorded during live performances around the world.

Shenoy has described his guitar work as a new perspective on gypsy rumba flamenco, merging the genre with other global influences.

The Grammy ultimately went to "Impressions" by Botti, whose pop-influenced jazz works had won him four previous nominations.

The other contenders in the category -- saxophonist Dave Koz, for a live album recorded in Tokyo, and guitarist Larry Carlton -- also had previous Grammy nominations.

- AFP/ir

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Reeling under Qaida attacks, Mali to get Indian support

NEW DELHI: India gathered with European and African nations in Brussels this week to commit itself to stabilizing Mali which is reeling under al-Qaida attacks. It's the first time India will be involving itself in the political process as well as reconstruction of a country so far from its immediate sphere of influence. The move displays a growing confidence within the Indian foreign policy system.

India had promised to be part of the Support and Follow-Up Group (SFG) for Mali at last week's conference in Addis Ababa, headquarters of the African Union (AU). India has committed to giving $1 million for the upgrade of the Malian army with a pledge to ramp up contribution for reconstruction to $100 million after the situation stabilizes. The Malian army, which will remain in the frontlines after the French intervention is over, is poorly equipped and trained, and markedly different from the fighters of al-Qaida in Islamic Maghreb (AQIM).

After the meeting in Brussels, India, in a statement, said, "India strongly supports ongoing efforts aimed at restoring constitutional order in Mali and re-establishing a fully sovereign democratic government. We also believe that the fight against the scourge of terrorism must be unrelenting."

India's involvement in Mali is interesting given New Delhi's aversion to external intervention in foreign conflicts, like Syria or Libya, where it abstained on a crucial UN Security Council resolution authorizing the "no-fly" zone. The conflict in Mali evokes a very different reaction from India.

There appear to be three broad reasons. First, Indian support to the French operation in Mali is predicated on it being a primarily counter-terror operation. Syed Akbaruddin, MEA's spokesperson, said, "We unequivocally condemn terrorism in all its forms and manifestations. Wherever and by whosoever committed, regardless of their motivation, we consider it criminal and unjustifiable. We also believe that the fight against the scourge of terrorism must be unrelenting."

India's commitment to a continued fight against extremist terrorism would ring hollow if New Delhi shied away from taking responsibility in emerging conflicts. In Mali, the al-Qaida fighters teamed up with the Tuaregs to carve out a territory that could be under the control of Islamist extremists. From the Indian point of view, this would be profoundly dangerous.

Second, India's impetus to rush to the aid of Mali was also influenced by reports from the UN that some of the al-Qaida fighters may be from the Af-Pak region. In the Algerian hostage crisis at In Amenas recently, a number of fighters were found to be from different countries, including Canada.

Third, the lead role in the Mali intervention has been played by France. Indian officials said they have been "kept in the loop" by Paris from the beginning. In December 2012, during its last month at the UN Security Council, India co-sponsored a French resolution UNSCR 2085 that supported an African Union-ECOWAS military force in Mali. The French military intervention in Mali has not prompted the expected negative reaction from New Delhi.

And, the target this time around is al-Qaida and its affiliated groups in that region, where India, like others, is developing economic interests. India's reaction to the France-led operation in Libya in 2011 was much more negative. In fact, many in the Indian government believe that the Mali crisis was a natural blowback of the Libya conflict.

Off the record, Indian officials express fears that al-Qaida-fuelled unrest could spread in those difficult regions, because of what they believe is a deadly cocktail of Islamist extremist ideology, widespread poverty, lack of governance and vast amounts of arms and weapons. Most of these weapons were taken out of Libya after the fall of the Gaddafi regime.

This reinforces the support group's importance. India is expected to support a political process in Mali with elections in July, a goal already adopted by its national assembly, but questions have to be answered whether the country would be ready for elections by that time.

In its commitment to Mali, India said, "We have already implemented five projects in Mali, in diverse sectors such as agriculture, power and food processing through a concessional credit of over $150 million. We would be funding execution of another major power project in Mali through a line of credit of $100 million. We will strengthen our involvement in various capacity building activities in Mali through setting up of institutions, training of Malian nationals and economic support for infrastructural projects."

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