Costlier robotic surgery soars for hysterectomies


CHICAGO (AP) — Robotic surgery is increasingly being used for women's hysterectomies, adding at least $2,000 to the cost without offering much benefit over less high-tech methods, a study found.


The technique was used in just 0.5 percent of operations studied in 2007, but that soared to almost 10 percent by early 2010. Columbia University researchers analyzed data on more than 260,000 women who had their wombs removed at 441 U.S. hospitals for reasons other than cancer. The database covered surgeries performed through the first few months of 2010.


Women who had the robotic operations were slightly less likely to spend more than two days in the hospital, but hospital stays were shorter than that for most women. Also, complications were equally rare among robotic surgery patients and those who had more conventional surgeries. Average costs for robotic hysterectomies totaled nearly $9,000, versus about $3,000 for the least expensive method, a different type of minimally invasive technique using more conventional surgery methods.


Traditionally hysterectomies were done by removing the womb through a large abdominal incision. Newer methods include removing the uterus through the vagina and minimally invasive "keyhole" abdominal operations using more conventional surgery methods, or surgeon-controlled robotic devices.


Robotic operations involve computer-controlled long, thin robot-like "arms" equipped with tiny surgery instruments. Surgeons operate the computer and can see inside the body on the computer screen, through a tiny camera attached to the robotic arms. The initial idea was for surgeons to do these operations miles away from the operating room, but robotic operations now are mostly done with the surgeon in the same room as the patient.


Theoretically, robotic surgeries make it easier to maneuver inside the patient, and are increasingly used for many types of operations, not just hysterectomies.


The main explanation for the big increase "is that robotic surgery has been marketed extensively to not only hospitals and physicians, but also directly to patients. There is minimal data in gynecology that it is advantageous," said Dr. Jason Wright, an assistant professor of women's health and the study's lead author.


The study was published Tuesday in the Journal of the American Medical Association.


"Our findings highlight the importance of developing rational strategies to implement new surgical technologies," the researchers wrote.


They note that 1 in 9 U.S. women will undergo a hysterectomy, usually after the age of 40. Reasons include fibroids and other non-cancerous growths, abnormal bleeding, and cancer.


Traditional abdominal operations remain common and more than 40 percent of women studied had them, costing on average about $6,600.


A JAMA editorial says the study doesn't answer whether the robotic method might be better for certain women, and says more research comparing methods is needed. Still, it says doctors and hospitals have a duty to inform patients about costs of different surgery options.


Dr. Myriam Curet of manufacturer Intuitive Surgical of Sunnyvale, Calif., said surgical robots can help surgeons overcome the limitations of other minimally invasive methods for very overweight patients, those with scarring from other surgeries and other complexities.


___


JAMA: http://www.jama.ama-assn.org


Robotic surgery: http://tinyurl.com/byuljds


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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


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Yen resumes fall after G20, U.S. holiday thins trade

LONDON (Reuters) - The yen resumed falling on Monday after Japan signaled it would push ahead with expansionist monetary policies having escaped criticism from the world's 20 biggest economies at the weekend.


Industrial metals also dipped and European shares were soft on lingering worries about the economic outlook, especially for the euro zone. While the risk of an inconclusive outcome in Italy's forthcoming election added to investor concerns.


However, activity was curtailed by the closure of markets in the United States for the Presidents' Day holiday.


The yen, which has dropped 20 percent against the dollar since mid-November, fell further after financial leaders from the G20 promised not to devalue their currencies to boost exports and avoided singling out Japan for any direct criticism.


The dollar rose 0.5 percent to 93.95 yen, near a 33-month peak of 94.47 yen set a week ago. The euro added 0.3 percent to 125.40 yen, to be midway between Friday's two-week low of 122.90 and a 34-month high of 127.71 yen hit earlier this month.


Strategists said the yen was likely to stay weak, though its decline could lose momentum until it becomes clear who will be taking the helm at the Bank of Japan when the current governor steps down on March 19.


"The yen probably will weaken a little further in anticipation of more aggressive easing under a new leadership team at the Bank of Japan," said Julian Jessop, chief global economist at Capital Economics.


Japan's Prime Minister Shinzo Abe is poised to nominate the new governor in the next few days. Sources have told Reuters that former financial bureaucrat Toshiro Muto, considered likely to be less radical than other candidates, was leading the field.


Meanwhile the euro dipped slightly against the dollar when European Central Bank president Mario Draghi said the currency's recent gains made any rise in inflation less likely and added that he had yet to see any improvement in the euro zone economy.


Speaking before the European Parliament, Draghi said the euro's exchange rate was not a policy target but was important for growth and stability, adding that appreciation of the euro "is a risk".


The comments left the euro down 0.2 percent at $1.3334.


Elsewhere in the currency market, sterling hit a seven-month low against the dollar, after a key policymaker made comments about the need for further weakness and recent poor data which has kept alive worries of another British recession.


Sterling fell 0.25 percent to $1.5476 having earlier touched $1.5438, its lowest since July 13.


DATA LOOMS


A big week for data on the outlook for the world's economy weighed on other riskier asset markets following the recent dire fourth-quarter growth numbers for the euro zone and Japan, along with Friday's soft U.S. manufacturing figures.


In European markets, attention is focused on the euro area Purchasing Managers' Indexes for February and German sentiment indices due later in the week which could affect hopes for a recovery this year.


Analysts expect Thursday's euro area flash PMI indices, which offer pointers to economic activity around six months out, to show growth stabilizing across the recession-hit region, leaving intact hopes for a recovery in the second half of 2013.


Concerns over an inconclusive outcome in the Italian election on Sunday and Monday have added to the weaker sentiment as a fragmented parliament could hamper a future government's efforts to reform the struggling economy.


The worries about the outlook for Italy were encouraging investors back into safe-haven German government bonds on Monday, with 10-year Bund yields easing 3.5 basis points to be around 1.63 percent.


"Political uncertainty will keep Bunds well bid this week," ING rate strategist Alessandro Giansanti said, adding that only better than expected economic data could create selling pressure on German debt in the near term.


Italian 10-year yields were 4 basis points higher on the day at 4.41 percent.


EARNINGS HIT


European equity markets were taking their lead from corporate earnings reports which have been reflecting the sluggish economic conditions across the region.


Danish brewer Carlsberg , which generates just over 60 percent of its sales in western Europe, became the latest to report a weaker-than-expected quarterly profit, sending its shares to their lowest level in almost a month.


The 5.8-percent drop for shares in the world's fourth biggest brewery helped send the FTSEurofirst 300 index <.fteu3> of top European shares down 0.2 percent. Germany's DAX <.gdaxi>, France's CAC-40 <.fchi> and Britain's FTSE-100 <.ftse> ranged between 0.4 percent up and 0.15 percent lower.


Earlier, the G20 statement and subsequent comment from Prime Minster Abe indicating a renewed drive to stimulate the Japanese economy lifted the Nikkei stock index <.n225> by 2.1 percent, near to its highest level since September 2008.


MSCI's world equity index <.miwd00000pus> was flat as markets extended a two-week period of consolidation that has followed the big run-up in January, when demand was buoyed by the efforts of central banks to stimulate the world economy.


Data from EPFR Global, a U.S.-based firm that tracks the flows and allocations of funds globally, shows investors pulled $3.62 billion from U.S. stock funds in the latest week, the most in 10 weeks after taking a neutral stance the prior week.


But demand for emerging market equities remained strong, with investors putting $1.81 billion in new cash into stock funds, the fund-tracking firm said.


CHINA RETURN


In the commodity markets, traders played catch-up after a week-long holiday last week in China, the world's second biggest consumer of many raw materials, which had kept activity subdued, with worries about the economic outlook weighing on sentiment.


Copper, for which China is the world's largest consumer, dipped to a near three-week low at $8,125.25 a metric ton (1.1023 tons) on the London futures market. Benchmark tin and nickel also touched three-week lows.


Gold managed to edge away from six-month lows as jewelers in China returned to the physical market after the Lunar New Year holiday but a lack of demand from U.S. markets saw the precious metal slip back to be down 0.1 percent to $1,607.06 an ounce.


Crude oil markets were mostly steady after the weak U.S. industrial production data on Friday [ID:nL1N0BF44A] was seen dampening demand, while tensions in the Middle East lent some support.


"We continue to see a mixed picture out of the United States. Industry output was lower than expected but that shouldn't affect the general upward direction," Olivier Jakob, analyst at Geneva-based Petromatrix, said.


Brent crude was down 20 cents at $117.46 a barrel after posting its first weekly loss since the first half of January. U.S. crude slipped 24 cents to $95.62.


(Additional reporting by Marius Zaharia and Ron Bousso; Editing by Philippa Fletcher and Alastair Macdonald)



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Time to refer Syrian war crimes to ICC: U.N. inquiry


GENEVA (Reuters) - United Nations investigators said on Monday that Syrian leaders they had identified as suspected war criminals should face the International Criminal Court (ICC).


The investigators urged the U.N. Security Council to "act urgently to ensure accountability" for violations, including murder and torture, committed by both sides in an uprising and civil war that has killed about 70,000 people since March 2011.


"Now really it's time ... We have a permanent court, the International Criminal Court, who would be ready to take this case," Carla del Ponte, a former ICC chief prosecutor who joined the U.N. team in September, told a news briefing in Geneva.


But because Syria is not party to the Rome Statute that established the ICC, the only way the court can investigate the situation is if it receives a referral from the Security Council. Russia, Assad's long-standing ally and a permanent veto-wielding member of the council, has opposed such a move.


"We cannot decide. But we pressure the international community to decide because it's time to act," del Ponte said.


Brazilian expert Paulo Pinheiro, who leads the U.N. inquiry set up in 2011, said: "We are in very close dialogue with all the five permanent members and with all the members of the Security Council, but we don't have the key that will open the path to cooperation inside the Security Council."


His team of some two dozen experts is tracing the chain of command in Syria to establish criminal responsibility and build a case for eventual prosecution.


"Of course we were able to identify high-level perpetrators," del Ponte said, adding that these were people "in command responsibility...deciding, organizing, planning and aiding and abetting the commission of crimes".


She said it was urgent for the Hague-based war crimes tribunal to take up cases of "very high officials", but did not identify them, in line with the inquiry's practice.


"We have crimes committed against children, rape and sexual violence. We have grave concerns. That is also one reason why an international body of justice must act because it is terrible."


Del Ponte, who tried former Yugoslav President Slobodan Milosevic at the International Criminal Tribunal for the Former Yugoslavia on war crimes charges, said the ICC prosecutor would need to deepen the investigation on Syria before an indictment could be prepared.


Karen Koning AbuZayd, an American member of the U.N. team, told Reuters it had information pointing to "people who have given instructions and are responsible for government policy, people who are in the leadership of the military, for example".


The inquiry's third roster of suspects, building on lists drawn up in the past year, remains secret. It will be entrusted to U.N. High Commissioner for Human Rights Navi Pillay upon expiry of its mandate at the end of March, the report said.


Pillay, a former ICC judge, said on Saturday Assad should be investigated for war crimes, and called for outside action on Syria, including possible military intervention.


Pinheiro said the investigators would not speak publicly about "numbers, names or levels" of suspects.


SEVEN MASSACRES IDENTIFIED


The investigators' latest report, covering the six months to mid-January, was based on 445 interviews conducted abroad with victims and witnesses, as they have not been allowed into Syria.


"We identified seven massacres during the period, five on the government side, two on the armed opponents' side. We need to enter the sites to be able to confirm elements of proof that we have," del Ponte said.


The U.N. report said the ICC was the appropriate institution for the fight against impunity in Syria. "As an established, broadly supported structure, it could immediately initiate investigations against authors of serious crimes in Syria."


Government forces have carried out shelling and air strikes across Syria including Aleppo, Damascus, Deraa, Homs and Idlib, the 131-page report said, citing corroborating satellite images.


"Government forces and affiliated militias have committed extra-judicial executions, breaching international human rights law. This conduct also constitutes the war crime of murder. Where murder was committed as part of a widespread or systematic attack against a civilian population, with knowledge of that attack, it is a crime against humanity," the report said.


Those forces have targeted bakery queues and funeral processions to spread "terror among the civilian population".


Rebels fighting to topple Assad have also committed war crimes including murder, torture, hostage-taking and using children under age 15 in hostilities, the U.N. report said.


"They continue to endanger the civilian population by positioning military objectives inside civilian areas" and rebel snipers had caused "considerable civilian casualties", it said.


George Sabra, a vice president of the opposition Syrian National Coalition, asked about the U.N. report, told Reuters at a conference in Stockholm: "We condemn all kind of crimes, regardless who did it.


"We can't ignore that some mistakes have been made and maybe still happen right now. But nobody also can ignore that the most criminal file is that of the regime."


(This story has been corrected to fix name of Milosevic tribunal in 11th paragraph)


(Reporting by Stephanie Nebehay; additional reporting by Anna Ringstrom in Stockholm; Editing by Mark Heinrich)



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Burger King plans apology after Twitter hack






Somebody hacked Burger King‘s Twitter account on Monday, posting obscene messages and changing its profile picture to a McDonald‘s logo.


The tweets stopped after a little more than an hour, and Burger King said it had reached out to Twitter to suspend the account. A Twitter spokesman did not immediately respond to a phone message left on Monday.






Burger King, which usually tweets several times a week, said it was working to get the account back up. Typical tweets promoted sales on chicken sandwiches, or asked how many bites it takes to eat a chicken nugget.


But just after noon EST on Monday, someone tweeted via Burger King’s account, “We just got sold to McDonalds!” They also changed the icon to rival McDonald Corp.‘s golden arches and the account’s background picture to McDonald’s new Fish McBites.


About 55 tweets and retweets followed over the next hour and a quarter, including some that contained racial epithets, references to drug use and obscenities. The account tweeted: “if I catch you at a wendys, we’re fightin!”


Monday’s appropriation of Burger King’s Twitter account was a relatively mild example of cybersecurity problems, which are causing increasing concern in Washington and for industry. Media outlets including The New York Times, The Wall Street Journal and The Washington Post have all said this year that their computer systems were breached, while several NBC websites were briefly hacked in November. White House officials and some lawmakers are pursuing legislation that would make it easier for the government and industry to share information on how to defend against hacking.


Burger King didn’t know who hacked the account, and no other social media accounts were affected, said Bryson Thornton, a spokesman for Miami-based Burger King Worldwide Inc. Its social media team and an outside agency manage the Twitter account, but Thornton declined to say how many people knew the account’s password. He said they hope to have it working again soon, and will post a statement on Facebook later Monday apologizing for the tweets.


Twitter acknowledged on Feb. 1 that cyber attackers may have stolen user names and passwords of 250,000 users. It said at the time that it notified users of the breach.


Competitors were sympathetic.


McDonald’s responded on Twitter that it empathized with its Burger King counterparts. “Rest assured, we had nothing to do with the hacking.”


“My real life nightmare is playing out” on Burger King’s twitter feed, wrote Wendy’s social media worker Amy Rose Brown.


Social Media News Headlines – Yahoo! News





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The Bachelor: AshLee Dishes on Her Connection with Sean - and Tierra






The Bachelor










02/18/2013 at 04:25 PM EST



For The Bachelor's AshLee Frazier, 32, the week spent with Sean Lowe in St. Croix was a series of emotional highs and lows, from coming clean with the final skeleton in her closet to a super-charged confrontation with Tierra. The Houston-based professional organizer spoke with reporters about what she sees in her show squeeze, how it felt to tell him she'd been married before (and in high school no less!), and if she really feared elimination.

Why wait so long to tell him about your high school marriage?
Obviously, I wasn't going to tell him on our very first date. I want to know somebody and make sure the vibe is there before I divulge my story. Every other time was either a group date or the rose ceremony and that just wasn't the appropriate time to talk. He had a few more questions about it [than aired on TV], but he was so loving and genuine about it. He made me feel like a huge weight lifted, like it was OK.

Can you explain how it ended?
The details are pretty simple. I got a divorce. I was young and I didn't handle [going through the rough patch with my family] the best way. It wasn't a bad breakup. It was more like I woke up and [realized], "Oops. What did I do?" We discussed it and both came to the conclusion that we made a bad decision.

You had a great date and said, "I love you." Yet you seemed convinced you would be eliminated. Why?
One hundred percent I was scared this might be the time I go home. I felt safe up until the argument happened and even until Sean came in before the rose ceremony and said that he didn't want anyone with these dramatic spells in his life. I was part of the [drama with Tierra]. I didn't get a chance to talk to him and explain my side of it because there was no cocktail party.

How'd it feel to hear Tierra mock your age and call you high school?
I laughed because what are you gonna do? Go back in time? I'm 32. I've never thought about my age so much in my life. It doesn't bother me. It speaks for itself who was being immature. It was not a very nice thing to say, but that's the difference between her character and mine.

Ever wonder how he could dig Tierra and you simultaneously?
I couldn't sit and wonder why he was keeping Tierra. You have to compartmentalize your feelings and focus on the end and your relationship with Sean. Sean is smart. I knew he'd eventually come to and realize it.

Why do you two mesh?
We come from the same background, have a very similar strong family upbringing and are compatible. He was classy, charismatic and a solid gentleman who made me laugh all the time. You have to balance each other out. I think it was a ying to a yang. He wants to adopt and [great for] my heart to hear. That's a solid foundation to build a perfect relationship.

People have said you might not be enough of a goofball to be the one.
When it came to our relationship. I took it more seriously because this is my future. This is marriage and that's not something I want to tread into lightly. But for the most part, I'm not sure where that comes from. I joked. I laughed. I played a lot of Apples to Apples. I had a blast.

Do you see connections between him and other girls?
I see the possibility. Lindsay is very fun. She's always cracking jokes. Catherine has a big heart. Desiree has a sense of stability. Sean said he wanted someone that was genuine, nice, ready for marriage and somebody with a good heart who loved family and if that's what he wanted, I'm the best match for that.

Is everyone left ready to get married?
If they say they are, I would take it at face value. I would hope that anybody who comes on the show is ready. I can only vouch for myself. I was 100 percent ready to give my heart to somebody and fall in love.

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Israeli lawmakers to investigate Australian spy mystery


JERUSALEM (Reuters) - Israeli lawmakers announced plans on Sunday to investigate the 2010 jailhouse death of a reported Australian immigrant recruit to the Mossad spy agency.


The statement by Parliament's Foreign Affairs and Defence Committee followed calls by Prime Minister Benjamin Netanyahu at a cabinet meeting to dim a growing media spotlight on the affair he saw as at risk of jeopardizing national security.


The case kept under wraps for two years then publicized by Australian television last Tuesday involves a 34-year-old immigrant, Ben Zygier, said to be a Mossad operative held on suspicion of security offences, who died of what has been labeled an apparent suicide behind bars.


In a terse communique, the legislative panel's subcommittee on intelligence said it has "decided to conduct an intensive examination of all aspects of the incident involving the prisoner found dead in his (prison) cell in December 2010."


While unlikely to have any immediate political consequences the investigation may lead to a wider inquiry with potentially broader repercussions.


Netanyahu's government has restricted reporting in Israel on the case, now overshadowing his victory in a national election held last month, using court gag orders, military censorship and direct requests to news editors.


Such steps have done little to douse demands for the authorities to come clean about the circumstances of Zygier's imprisonment and how he was able to kill himself in a highly-supervised isolation cell.


Without citing the case specifically, Netanyahu said on Sunday he "absolutely trusts" Israel's security services and what he described as the independent legal monitoring system under which they operated.


"We are an exemplary democracy," Netanyahu said in remarks aired by Israeli broadcasters.


"But we are also more threatened, more challenged, and therefore we have to ensure the proper operation of our security branches," Netanyahu also said.


"Therefore I ask over everyone: Let the security services continue working quietly so that we can continue to live in safety and tranquility in the State of Israel."


The few Israeli officials who have spoken of Zygier's case have not denied that he was linked to Mossad, which in early 2010 was accused by Dubai of using Australian passport-holders to assassinate a Palestinian arms procurer in the Gulf emirate.


BETRAYED MOSSAD MISSIONS?


Media reports have speculated that Israel suspected the Melbourne-born Jew of betraying or threatening to divulge Mossad missions, perhaps to Australia's security services, as they probed passport fraud.


Civil liberties groups and some Israeli lawmakers have demanded to know whether Zygier's rights were violated by his months of incarceration under alias.


In an apparent reversal from previous statements, Australian Foreign Minister Bob Carr said on Thursday his ministry had known about Zygier's jailing as early as February 2010. On Wednesday he said Australian diplomats in Israel only found out about the detention after his death in custody later that year.


Avigdor Feldman, an Israeli lawyer with whom Zygier consulted in Ayalon prison, said last week that that meeting was arranged by a "Mossad liaison" and that his client had denied "grave charges" for which he awaited trial.


Feldman also said that Zygier's family, which has declined all comment on the affair, knew about his detention. The incarceration was approved by several Israeli courts.


Two senior cabinet members, Intelligence Minister Dan Meridor and Strategic Affairs Minister Moshe Yaalon, told Israeli media on Saturday the case was rare but lawful.


"There are extreme situations...to do with our security and even the need to preserve human life, when we need to take an extreme step such as this," Yaalon told Channel Two television.


Meridor said that publishing the prisoner's identity would have risked "serious harm to security." He did not elaborate.


Tzachi Hanegbi, a lawmaker from Netanyahu's conservative Likud party said he had never been informed of Zygier's arrest as chairman of the parliamentary defence panel at the time.


"This requires explanation," Hanegbi said. "Usually, every significant subject, whether it is impressive achievements or embarrassing failures, is laid out before the subcommittee."


Former Mossad director Danny Yatom told Reuters the agency was under no legal obligation to brief oversight lawmakers in such circumstances.


(Writing by Allyn Fisher-Ilan and Dan Williams; Editing by Jason Webb)



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Chrissy Teigen Goes on a Tour of Model Alyssa Miller's 'Flawless' Closet



Skin is in when it comes to being a Sports Illustrated model – and who better to show off a sexy wardrobe than the ladies themselves?

Chrissy Teigen, 27, – who recently gave PEOPLE.com a behind-the-scenes look at her trip-planning prep to Vegas – also gave viewers a peek into fellow SI model, Alyssa Miller's closet.

"Her style is impeccable, flawless and I can't wait to see what's in her closet," Teigen says before introducing Miller, 22.

Miller makes Teigen's heart melt as she pulls out a bedazzled pair of Jimmy Choo heels, which she calls "super sexy."

Next up is a blue peplum dress that Miller pulls out once Teigen says it is "calling" to her.

"This designer, she's not well known," Miller says. "She doesn't make very many pieces ... It's timeless."

Acknowledging just what Teigen pointed out at the very beginning of the video, Miller says, "I've got so many options. You're going to have to help me decide."

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UN warns risk of hepatitis E in S. Sudan grows


GENEVA (AP) — The United Nations says an outbreak of hepatitis E has killed 111 refugees in camps in South Sudan since July, and has become endemic in the region.


U.N. refugee agency spokesman Adrian Edwards says the influx of people to the camps from neighboring Sudan is believed to be one of the factors in the rapid spread of the contagious, life-threatening inflammatory viral disease of the liver.


Edwards said Friday that the camps have been hit by 6,017 cases of hepatitis E, which is spread through contaminated food and water.


He says the largest number of cases and suspected cases is in the Yusuf Batil camp in Upper Nile state, which houses 37,229 refugees fleeing fighting between rebels and the Sudanese government.


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G20 steps back from currency brink, heat off Japan


MOSCOW (Reuters) - The Group of 20 nations declared on Saturday there would be no currency war and deferred plans to set new debt-cutting targets, underlining broad concern about the fragile state of the world economy.


Japan's expansive policies, which have driven down the yen, escaped direct criticism in a statement thrashed out in Moscow by policymakers from the G20, which spans developed and emerging markets and accounts for 90 percent of the world economy.


Analysts said the yen, which has dropped 20 percent as a result of aggressive monetary and fiscal policies to reflate the Japanese economy, may now continue to fall.


"The market will take the G20 statement as an approval for what it has been doing -- selling of the yen," said Neil Mellor, currency strategist at Bank of New York Mellon in London. "No censure of Japan means they will be off to the money printing presses."


After late-night talks, finance ministers and central bankers agreed on wording closer than expected to a joint statement issued last Tuesday by the Group of Seven rich nations backing market-determined exchange rates.


A draft communiqué on Friday had steered clear of the G7's call for economic policy not to be targeted at exchange rates. But the final version included a G20 commitment to refrain from competitive devaluations and stated monetary policy would be directed only at price stability and growth.


"The mood quite clearly early on was that we needed desperately to avoid protectionist measures ... that mood permeated quite quickly," Canadian Finance Minister Jim Flaherty told reporters, adding that the wording of the G20 statement had been hardened up by the ministers.


As a result, it reflected a substantial, but not complete, endorsement of Tuesday's proclamation by the G7 nations - the United States, Japan, Britain, Canada, France, Germany and Italy.


As with the G7 intervention, Tokyo said it gave it a green light to pursue its policies unchecked.


"I have explained that (Prime Minister Shinzo) Abe's administration is doing its utmost to escape from deflation and we have gained a certain understanding," Finance Minister Taro Aso told reporters.


"We're confident that if Japan revives its own economy that would certainly affect the world economy as well. We gained understanding on this point."


Flaherty admitted it would be difficult to gauge if domestic policies were aimed at weakening currencies or not.


NO FISCAL TARGETS


The G20 also made a commitment to a credible medium-term fiscal strategy, but stopped short of setting specific goals as most delegations felt any economic recovery was too fragile.


The communiqué said risks to the world economy had receded but growth remained too weak and unemployment too high.


"A sustained effort is required to continue building a stronger economic and monetary union in the euro area and to resolve uncertainties related to the fiscal situation in the United States and Japan, as well as to boost domestic sources of growth in surplus economies," it said.


A debt-cutting pact struck in Toronto in 2010 will expire this year if leaders fail to agree to extend it at a G20 summit of leaders in St Petersburg in September.


The United States says it is on track to meet its Toronto pledge but argues that the pace of future fiscal consolidation must not snuff out demand. Germany and others are pressing for another round of binding debt targets.


"We had a broad consensus in the G20 that we will stick to the commitment to fulfill the Toronto goals," German Finance Minister Wolfgang Schaeuble said. "We do not have any interest in U.S.-bashing ... In St. Petersburg follow-up-goals will be decided."


The G20 put together a huge financial backstop to halt a market meltdown in 2009 but has failed to reach those heights since. At successive meetings, Germany has pressed the United States and others to do more to tackle their debts. Washington in turn has urged Berlin to do more to increase demand.


Backing in the communiqué for the use of domestic monetary policy to support economic recovery reflected the U.S. Federal Reserve's commitment to monetary stimulus through quantitative easing, or QE, to promote recovery and jobs.


QE entails large-scale bond buying -- $85 billion a month in the Fed's case -- that helps economic growth but has also unleashed destabilising capital flows into emerging markets.


A commitment to minimize such "negative spillovers" was an offsetting point in the text that China, fearful of asset bubbles and lost export competitiveness, highlighted.


"Major developed nations (should) pay attention to their monetary policy spillover," Vice Finance Minister Zhu Guangyao was quoted by state news agency Xinhua as saying in Moscow.


Russia, this year's chair of the G20, admitted the group had failed to reach agreement on medium-term budget deficit levels and expressed concern about ultra-loose policies that it and other emerging economies say could store up trouble for later.


On currencies, the G20 text reiterated its commitment last November, "to move more rapidly toward mores market-determined exchange rate systems and exchange rate flexibility to reflect underlying fundamentals, and avoid persistent exchange rate misalignments".


It said disorderly exchange rate movements and excess volatility in financial flows could harm economic and financial stability.


(Additional reporting by Gernot Heller, Lesley Wroughton, Maya Dyakina, Tetsushi Kajimoto, Jan Strupczewski, Lidia Kelly, Katya Golubkova, Jason Bush, Anirban Nag and Michael Martina. Writing by Douglas Busvine. Editing by Timothy Heritage/Mike Peacock)



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Bomb kills 64 in Pakistan's Quetta


QUETTA, Pakistan (Reuters) - Sixty-four people including school children died on Saturday in a bomb attack carried out by extremists from Pakistan's Sunni Muslim majority, police said.


A spokesman for Lashkar-e-Jhangvi, a Sunni group, claimed responsibility for the bomb in Quetta, which caused casualties in the town's main bazaar, a school and a computer center. Police said most of the victims were Shi'ites.


Burned school bags and books were strewn around.


"The explosion was caused by an improvised explosive device fitted to a motorcycle," said Wazir Khan Nasir, deputy inspector general of police in Quetta.


"This is a continuation of terrorism against Shi'ites."


"I saw many bodies of women and children," said an eyewitness at a hospital. "At least a dozen people were burned to death by the blast."


Most Western intelligence agencies have regarded the Pakistani Taliban and al Qaeda as the gravest threat to nuclear-armed Pakistan, a strategic U.S. ally.


But Pakistani law enforcement officials say Lashkar-e-Jhangvi has become a formidable force.


TENSIONS


Last month the group said it carried out a bombing in Quetta that killed nearly 100 people, one of Pakistan's worst sectarian attacks. Thousands of Shi'ites protested in several cities after that attack.


Pakistani intelligence officials say extremist groups, led by Lashkar-e-Jhangvi, have escalated their bombings and shootings of Shi'ites to trigger violence that would pave the way for a Sunni theocracy in U.S.-allied Pakistan.


More than 400 Shi'ites were killed in Pakistan last year, many by hitmen or bombs, and the perpetrators are almost never caught. Some hardline Shi'ite groups have hit back by killing Sunni clerics.


The growing sectarian violence has hurt the credibility of the government, which has already faced criticism ahead of elections due in May for its inability to tackle corruption and economic stagnation.


The schism between Sunnis and Shi'ites developed after the Prophet Muhammad died in 632 when his followers could not agree on a successor.


Emotions over the issue are highly potent even today, pushing some countries, including Iraq five years ago, to the brink of civil war.


Pakistan is nowhere near that stage but officials worry that Sunni extremist groups have succeeded in dramatically ratcheting up tensions and provoking revenge attacks in their bid to destabilize the country.


(Reporting by Jibran Ahmed; Writing by Michael Georgy; Editing by Stephen Powell)



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