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.

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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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Report Fingers Chinese Military Unit in US Hacks

A Virginia-based cyber security firm has released a new report alleging a specific Chinese military unit is likely behind one of the largest cyber espionage and attack campaigns aimed at American infrastructure and corporations.

In the report, released today by Mandiant, China's Unit 61398 is blamed for stealing "hundreds of terabytes of data from at least 141 organizations" since 2006, including 115 targets in the U.S. Twenty different industrial sectors were targeted in the attacks, Mandiant said, from energy and aerospace to transportation and financial institutions.

Mandiant believes it has tracked Unit 61398 to a 12-story office building in Shanghai that could employ hundreds of workers.

"Once [Unit 61398] has established access [to a target network], they periodically revisit the victim's network over several months or years and steal broad categories of intellectual property, including technology blueprints, proprietary manufacturing processes, test results, business plans, pricing documents, partnership agreements, and emails and contact lists from victim organizations' leadership," the report says.

The New York Times, which first reported on the Mandiant paper Monday, said digital forensic evidence presented by Mandiant pointing to the 12-story Shangai building as the likely source of the attacks has been confirmed by American intelligence officials. Mandiant was the firm that The Times said helped them investigate and eventually repel cyber attacks on their own systems in China last month.

Peter Parks/AFP/Getty Images

The Chinese government has repeatedly denied involvement in cyber intrusions and Chinese Foreign Ministry spokesperson Hong Lei said today that the claims in the Mandiant report were unsupported, according to a report by The Associated Press.

"To make groundless accusations based on some rough material is neither responsible nor professional," he reportedly said.

Mandiant's report was released a week after President Obama said in his State of the Union address that America must "face the rapidly growing threat from cyber attack."

"We know hackers steal people's identities and infiltrate private e-mail. We know foreign countries and companies swipe our corporate secrets. Now our enemies are also seeking the ability to sabotage our power grid, our financial institutions, and our air traffic control systems. We cannot look back years from now and wonder why we did nothing in the face of real threats to our security and our economy," he said.

Though Obama did not reference China or any country specifically, U.S. officials have previously accused the Asian nation of undertaking a widespread cyber espionage campaign.

Referring to alleged Chinese hacking in October 2011, House Intelligence Committee Chairman Rep. Mike Rogers (R-Mich.) said in an open committee meeting that he did not believe "that there is a precedent in history for such a massive and sustained intelligence effort by a government agency to blatantly steal commercial data and intellectual property."

Rogers said that cyber intrusions into American and other Western corporations by hackers working on behalf of Beijing -- allegedly including attacks on corporate giants like Google and Lockheed Martin -- amounted to "brazen and widespread theft."

"The Chinese have proven very, very good at hacking their way into very large American companies that spend a lot of money trying to protect themselves," cyber security expert and ABC News consultant Richard Clarke said in an interview last week.

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Yemen military aircraft crashes in Sanaa, kills 12

SANAA: A Yemeni military aircraft ploughed into a building in a residential neighbourhood of Sanaa on Tuesday, killing the pilot and at least 11 civilians, medics and witnesses said.

Medics said the toll, which included two children and three women and left another 22 injured, was expected to rise

Several hours after the crash rescue teams were still sifting through the rubble in search of any survivors in the Qadissiya area of homes and shops near Change Square, epicentre of the 2011 uprising that ousted president Ali Abdullah Saleh.

A military source identified the plane as a Russian-made Sukhoi SU-22 attack aircraft, but was unable to say what caused the crash that he said killed pilot Mohammed Shaker.

The defence ministry said the pilot was returning to his base after a training mission and had asked authorisation to land when suddenly the aircraft lost altitude and crashed. An investigation is underway.

"I saw the plane drop and we were afraid it would crash on Sanaa University, but the pilot crashed on nearby buildings," said Mohammed al-Sabri.

The aircraft hit one building on Rabat Avenue in eastern Sanaa, then smashed into another before finally crashing on top of a third, witnesses said.

An AFP correspondent said the building was badly damaged and that several ambulances rushed to the scene as helicopters hovered overhead.

A loud explosion shook the area when the crash occurred, witnesses said. Thick black smoke billowed over the district, where several cars were ablaze.

Panicked residents took to the streets, many screaming.

"We heard a loud explosion and we thought it was a mortar shell that landed on the neighbourhood," one of the residents, Taha al-Inad, told AFP.

An air base is located near the Sanaa international airport, just 15 kilometres (nine miles) north of the capital.

Tuesday's crash was the latest in a series of air accidents in the impoverished Arabian Peninsula country.

In November, a Yemeni air force Antonov M26 crashed during a training mission in a northern district of Sanaa, killing all 10 on board.

A fighter jet crashed on takeoff on a routine training mission in the south in October, killing the pilot and injuring another crew member, after what the defence ministry described as a "technical failure."

And in October 2011, four people were killed when an Antonov crashed on landing at Al-Anad air base in southern Yemen.

Sanaa was gripped by violent clashes between rival military groups during the 2011 uprising to oust Saleh, who finally stepped down a year ago under a UN-backed power transition agreement brokered by the Gulf Cooperation Council.

-AFP/ac

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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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Afzal Guru's hanging: Bring-back-body clamour set to rise in Valley

SRINAGAR: The immediate response to Parliament attack convict Afzal Guru's hanging may have been relatively lukewarm in the state, but the demand for the return of his mortal remains seems to be galvanizing politicians and separatist groups again.

Engineer Sheikh Abdul Rashid, the independent MLA from Langate in north Kashmir, has already filed a resolution in the state assembly asking for a discussion the matter.

"I had invited mainstream parties, including the ruling National Conference (NC), for an all-party meeting on Monday to chalk out a joint strategy to a send a team of legislators and political leaders to the Centre to convey the sentiments of the people of Kashmir for the return of Afzal's body to his family," Rashid told TOI.

He urged the NC and the People's Democratic Party to bury their differences for some time and work together to ensure Afzal's body is handed over to his family members. "We should go to Delhi as a united front and ask for Afzal's mortal remains," Rashid said.

Rashid, who was detained soon after Afzal's execution in Delhi's Tihar Jail on February 9, was released last Friday.

Most observers feel Afzal's hanging evoked a tepid response because he had been a "police informer" in the early 1990s. Three people died in the anti-execution protests in the Valley over the past 10 days.

On Monday, some separatist groups—including the JKLF and the Hurriyat Conference faction led by Syed Ali Shah Geelani —issued a fresh protest calendar for Wednesday, Thursday (after evening prayers) and Friday (after noon). "The protest is meant to press for the mortal remains of Afzal Guru," a Hurriyat press release said. "The protest will continue till the Centre returns the mortals remains of Guru to the family and allow [them] to bury him in the Srinagar graveyard."

The state home ministry, headed by chief minister Omar Abdullah himself, has already forwarded the plea of Afzal's family for the return of his body to central home secretary R K Singh. Sources said the UPA government may consider their demand. Omar, too, has asked for Afzal's body to be returned to the Sopore-based family.

Sources said Union home ministry officials are likely to invite Omar to New Delhi next week for discussions on the matter. They said Omar is also likely to hold discussions with home minister Sushilkumar Shinde.

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Hip replacements more likely to fail in women

CHICAGO (AP) — A new study shows that hip replacements are more likely to fail in women than in men.

Researchers found that a small number of the hip implants failed overall, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The study is being published Monday in JAMA Internal Medicine. It was funded by the U.S. Food and Drug Administration.

Some experts say more research is needed to determine which models of hip implants perform best in women.

Women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year.

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Online:

Journal: http://www.jamainternalmed.com

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ChristianMingle Date Rape Victims Sought by Cops

A suspected rapist accused of sexually assaulting a woman he met on ChristianMingle.com may have used the dating site to prey on women while he traveled across the country, California police said today.

Sean Patrick Banks, 37, a former Navy sailor, used a fake name to contact a woman who he allegedly raped in November, cops in La Mesa, Calif., said. Investigators believe that he used additional aliases to contact other women on the popular website and police hope that if there are additional victims they will recognize Banks.

Banks lives in Del Mar, Calif., and is currently unemployed but previously "travelled frequently around various spots in the U.S." for work, widening the search for potential victims from Southern California to across the country, said La Mesa Police spokesman Lt. Matt Nicholass.

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"We're looking to see if there are any other victims," Nicholass told ABCNews.com. "We're trying to locate other victims who recognize him by his face, because they may not know his real name is Sean."

Cops accuse Banks of posing on the site as "Rylan Butterwood" and "Rylan Harbough."

His alleged use of fake names complicated police efforts to track him down after a La Mesa woman accused him of rape at her home in November on their first face-to-face date.

"La Mesa police tried to identify him for a couple of months," Nicholass said, adding that a break in the case came after ChristianMingle.com turned over computer records that helped cops identify Banks.

Banks was charged with two counts of rape and pleaded not guilty. He posted bond of $500,000 and was released. Calls to several numbers associated with Banks were not returned. Authorities did not know if he had obtained an attorney.

"We continue to assist the La Mesa police department with its investigation in every way possible. The safety and security of our members is extremely important to us," ChristianMingle.com said in a statement through spokeswoman Arielle Schechtman. "In addition to having experts manually review all profile content and photos, we have developed several proprietary, automated tools to ensure the highest possible level of safety and privacy for our communities."

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Thai tycoon secures over 90% of F&N

SINGAPORE: A Thai tycoon on Monday acquired over 90 percent of Singapore conglomerate Fraser and Neave (F&N) as its takeover offer closed, breaching a threshold that allows him to delist the company.

TCC Assets, controlled by Thai billionaire Charoen Sirivadhanabhakdi, said in a statement issued late Monday that it owned 90.32 per cent of F&N at the conclusion of its offer, including acceptances by shareholders.

With the 90 per cent ownership threshold breached, Charoen has the option to delist F&N from the Singapore Exchange, but the statement was silent on the tycoon's next move.

"We cannot comment on that right now," a TCC spokeswoman told AFP when asked about plans to delist the company.

TCC Assets had offered to buy F&N shares it does not already own at S$9.55 ($7.71) apiece, valuing the drinks, property and publishing conglomerate at S$13.75 billion in what the local media described as the biggest takeover in Singapore's corporate history.

Shareholders had been given until Monday to accept the offer.

Indonesia-led property firm Overseas Union Enterprise (OUE) averted a bidding war last month when it declined to match the offer by the Thais. OUE is linked to Indonesian tycoon Mochtar Riady.

F&N became a takeover target after it sold off its most prized asset, Tiger Beer maker Asia Pacific Breweries, to Dutch giant Heineken in September last year.

It still has lucrative beverages, property and publishing operations.

Charoen's takeover bid got a major boost early this month when Japanese beverage giant Kirin decided to sell its entire 15 per cent stake in F&N to the Thais. Kirin had sided with OUE at the start of the bidding process.

While shareholders were accepting its offer, TCC Assets was also steadily snapping up F&N shares in the open market to increase its stake.

-AFP/ac

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Ecuadorean President Correa claims re-election victory

QUITO (Reuters) - Ecuadorean President Rafael Correa claimed victory in Sunday's presidential election, giving him a new four-year term to continue his socialist revolution and strengthen Latin America's alliance of leftist leaders.

"The victory belongs to each one of you," said a jubilant Correa from the balcony of the presidential palace above a crowd of supporters in Quito.

"Nobody can stop this revolution."

Correa won 61 percent of the vote compared with 21 percent for former banker Guillermo Lasso, the strongest showing of the seven opposition candidates in the race, according to a survey by polling firm Opinion Publica.

A separate exit poll by the firm Cedatos showed Correa winning 59 percent of the vote versus 20 percent for Lasso.

The electoral authority was expected to release an official quick-count by 7:00 p.m. EST (0000 GMT) based on 30 percent of the votes cast.

Correa, a pugnacious U.S.-trained economist, wants to continue boosting the state's role in the OPEC nation's economy and strengthening the leftist ALBA bloc of Latin American nations that openly oppose the United States.

The only Ecuadorean president in the past 20 years to complete a full term in office, Correa is admired for bringing political stability to a nation where leaders had been frequently toppled by violent street protests or military coups.

Opposition leaders call Correa a dictator in the making who is quashing free speech through hostile confrontation with the media and squelching free enterprise through heavy taxation and constant regulatory changes.

His success hinged in part on high oil prices that allowed for hefty government spending, including providing cash handouts to 2 million people, and spurred solid economic growth.

DIVERSIFY ECONOMY

Correa hopes to diversify the economy away from oil and win over investors who turned their backs on Ecuador after he defaulted on $3.2 billion in bonds and forced oil companies to sign contracts giving more revenue to the government.

Investors will be watching Correa's new term for signs he is willing to compromise to bring in investment needed to raise stagnant oil production, boost the promising but still nascent mining sector, and expand power generation.

The other six opposition candidates include former Correa ally Alberto Acosta, former President Lucio Gutierrez and banana magnate and five-time presidential candidate Alvaro Noboa.

Ecuadoreans also chose a new Congress on Sunday.

The ruling Alianza Pais party was expected to win a majority of the legislative seats, up from around 42 percent.

That would let Correa push ahead with controversial laws including a plan to create a state watchdog to regulate television and newspaper content, without having to negotiate with rivals.

The results of the vote for Congress are not expected to be known for several days.

Correa spent weeks on the campaign trail, from indigenous villages of the Andean highlands to urban slums in the bustling port city of Guayaquil, singing and dancing to play up an image of youthful energy.

An avid cyclist, Correa filmed one campaign spot showing him changing out of a sharp suit into biking clothes and then riding his bike over mountain peaks and past tropical fishing villages to show the improvement of roads under his leadership.

(Additional reporting by Jose Llangari and Eduardo Garcia in Quito and Yuri Garcia in Guayaquil; Editing by Kieran Murray and Eric Beech)

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Shinde's daughter traces brother-in-law's SUV

MUMBAI: Union home minister Sushilkumar Shinde's daughter tracked down her brother-in-law's vehicle on Saturday night, within 48 hours of it being stolen from Lower Parel on Thursday.

A large posse of cops, including those from the crime branch, had been assigned to find the missing SUV, but before they could make a headway, Shinde's daughter, Praniti, suddenly spotted the vehicle in Bandra; following a chase and high drama, the thieves abandoned the SUV near a slum in Bandra (W) from where it has been recovered.

Praniti, however, denied her presence during the chase. "Only my driver was there," she said. But the police claimed otherwise.

The Pajero belongs to Raj Shroff, a businessman and general secretary of the Mumbai Regional Congress Committee, who is married to Preeti, one of the daughters of Shinde. On Thursday night, the family's driver, Vijay Kharat, parked the vehicle near his home at Bawala Compound, Lower Parel. He had intended to drive it back to his employer's residence, but the next morning, he found it missing. Kharat lodged a theft complaint with the N M Joshi Marg police on Friday, following which all control rooms in the city were alerted with the missing vehicle's registration number.

While the cops hunted high and low for the SUV, Praniti, who is an MLA from Solapur, spotted it at the Lilavati Hospital signal on Saturday night. "Around 11pm, Praniti left the Shinde residence at Pali Hill in Bandra in her CRV. She was headed to Worli for some work and was accompanied by her police security officer, Abhang; the vehicle was driven by Kharat. As they reached the Lilavati Hospital signal, Praniti suddenly spotted the stolen Pajero a little ahead. Confirmed by Kharat that it was indeed their missing vehicle, Praniti decided that she and her security officer would confront the person driving it," a police officer said.

Praniti's SUV chased the Pajero, overtook it and blocked its path; Abhang knocked on the rolled-up windowpane. "The two men inside the SUV panicked and put the vehcile in reverse gear, heading back towards north. Praniti's vehicle also turned around and started chasing it," the officer said. Meanwhile, Abhang called up the police control room and informed them about the incident. Shortly, Praniti reportedly noticed a patrol van in the Bandra locality and alerted the policemen who also joined in the search.

A few minutes later, they found the Pajero abandoned near Lal Maati slums, but its occupants had vanished, said the police, adding that slippers, likely to belong to the accused, were found inside.

No CCTV camera covers the stretch but Abhang had had a look at the suspects. The NM Joshi Marg police, to whom the recovered vehicle has been handed over, will prepare identity sketches of the accused. Experts have found some fingerprints in the vehicle.

Police said the car could be traced easily as the accused hadn't changed its numberplate.

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