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.

___

Online:

Kidney cancer info: http://www.cancer.net/cancer-types/kidney-cancer

and http://www.cancer.gov/cancertopics/types/kidney

Study: http://gucasym.org

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Firmer yen boosts Korean shares, underpins Asia stocks

TOKYO (Reuters) - Asian shares outside of Japan rose on Wednesday, led by South Korean exporters as the yen firmed amid conflicting interpretations of G7 comments about the currency's recent weakness.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> gained 0.9 percent.

Seoul shares <.ks11> outperformed with a 1.5 percent jump while Australian shares jumped 0.9 percent after record first-half earnings from the Commonwealth Bank of Australia boosted sentiment.

The Nikkei stock average <.n225> slumped 1.1 percent as the firming yen prompted investors to take profits on exporters. <.t/>

China, Taiwan and Hong Kong markets remain closed for the Lunar New Year holiday.

European markets will be mixed, with financial spreadbetters predicting London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> would open between a 0.1 percent fall and a 0.4 percent gain. U.S. stock futures were up 0.1 percent to suggest a somewhat firmer Wall Street open. <.l><.eu><.n/>

Investors continued to seek cues from currency markets before a meeting of the Group of 20 finance ministers and central bankers in Moscow on Friday and Saturday, with growing international tensions over exchange rates.

At the center of the debate is Japan, where Prime Minister Shinzo Abe's government has made it clear that it will push for aggressive policies to beat stubborn deflation through drastic monetary expansion. Anticipation of much bolder Bank of Japan monetary policy has sent the yen into a steady decline, helping boost Japanese stocks to 33-month highs.

"The Japanese stock market may have rallied too strongly on expectations alone. I don't believe the Japanese government is manipulating currency rates, but it is maybe time that an equilibrium point may be sought for the yen's level given that some other countries may see weaker currencies as beneficial to their economies," said Yuuki Sakurai, CEO at Fukoku Capital Management in Tokyo.

The yen's respite from heavy selling eased concerns for investors in South Korea.

"The main board's rebound was driven by a break in the yen's weakness, following signs that the won's strength has abated somewhat," said Lim Dong-rak, an analyst at Hanyang Securities in Seoul.

The yen rallied on Tuesday, reversing the previous day's late selloff against the dollar and euro, after an official with the Group of Seven said it is worried about excess moves in the Japanese currency.

G7 governors and ministers reaffirmed their commitment that fiscal and monetary policies would not be directed at devaluing currencies, a statement meant to reassure investors that Tokyo was not aiming to guide the yen lower with its aggressive expansion of monetary policy.

"All these comments are merely stating the obvious and are not to be taken in the context of whether they are endorsing a weaker yen or not," said Yuji Saito, director of foreign exchange at Credit Agricole in Tokyo.

"What is being said is that monetary policy should be used to achieve domestic objectives and Japan is undertaking reflationary policies, not manipulating currency rates, and the result of that is a weak yen. What is asked for from Japan is to explain its policy clearly at the G20," Saito said.

The dollar dropped 0.6 percent to 92.95 yen after marking its highest level since May 2010 of 94.465 on Monday. The euro tumbled 0.6 percent to 125.01 yen, moving further away from its highest since April 2010 of 127.71 yen touched last week.

The BOJ ends a two-day policy meeting on Thursday, with markets expecting no fresh easing steps this time. But expectations are running high that further unprecedented measures will be taken under a new BOJ regime due to start next month after the terms of current top officials end.

"So far, the yen has been weakening on expectations for a bold monetary policy, and from now, Japan has to implement actual policy to justify such expectations," said Naohiko Baba, Japan chief economist at Goldman Sachs.

The euro steadied around $1.3450, keeping overnight gains made after European Central Bank President Mario Draghi said talk of a currency war was overdone, and that Spain was on the right track toward economic recovery.

In his annual State of the Union address, U.S. President Barack Obama proposed on Tuesday to hike the minimum wage by more than 20 percent, invest $50 billion on crumbling roads and bridges and spend $15 billion on a construction jobs program in a bid to boost economic growth.

U.S. crude was up 0.1 percent to $97.60 a barrel and Brent was steady around $118.61.

Palladium extended gains to a 17-month high as supply concerns sparked speculative buying, while gold edged up on demand from jewellers.

(Additional reporting by Joyce Lee in Seoul; Editing by Eric Meijer & Kim Coghill)

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Thai Soldiers Repel Attack in Major Blow to Insurgents

BANGKOK — Thai soldiers repelled an attack on a military outpost early Wednesday, killing at least 16 gunmen in what appeared to be a significant setback for ethnic insurgent groups leading a bloody uprising now in its ninth year.

Col. Pramote Promin, the spokesman of the army’s southern command, said the army had been expecting the attack after being tipped off by villagers and “former insurgents fed up with the violence.”

“This helped us to be fully prepared,” Colonel Pramote said.

Thai authorities said that one of the men killed in the attack, Maroso Jantarawadee, was an important leader of the insurgency.

Srisompob Jitpiromsri, the associate dean at Prince of Songkla University in the southern city of Pattani and one of the foremost experts on the insurgency, described Wednesday’s failed insurgent attack as a “tactical defeat” for them.

“This operation failed but that doesn’t mean they will fail in the long term,” Mr. Srisompob said. “They will try again and again.”

About 50 insurgents, who wore ballistic vests and military-style uniforms and had military assault weapons, attacked the outpost soon after midnight Wednesday, Colonel Pramote said. The attack lasted 20 minutes and those not killed fled into the jungles, some leaving trails of blood. Thai authorities declared a curfew in the area and said they were checking hospitals and clinics for the injured attackers.

Colonel Promote said no Thai soldiers were wounded or killed in the attack. “All the soldiers are safe,” he said.

Thailand’s southern insurgency, one of Asia’s most deadly and intractable ethnic conflicts, has left more than 5,000 people dead since the upswing of violence in 2004.

The precise motives of the insurgents remained unclear but centered on longstanding resentment by Malay Muslims toward the majority Thai Buddhists in the country.

Insurgents often target symbols of the Thai state, including the police, soldiers, government officials and teachers.

More than 150 teachers have been killed since 2004 and many schools have been burned. A school near the site of Wednesday’s attack was set afire just before dawn.

Thai authorities said Mr. Maroso, the insurgent leader killed in the attack, was a suspect in the killing of a teacher on Jan. 23.

Mr. Srisompob of Prince of Songkla University said there were two competing trends in the three violence-wracked provinces.

The insurgents are picking higher profile targets, including conducting an attack on a shopping mall last year in the city of Hat Yai that killed 5 people and injured 354, including many Malaysian tourists.

The number of overall attacks increased last year, according to data compiled by Mr. Srisompob. At the same time Mr. Srisompob said he saw impatience escalating with the insurgency among Malay Muslims.

“An increasing number of Malay Muslims are fed up with the violence,” he said. “The voices of the community are getting stronger.”

The number of militants involved in the insurgency was not clear. The military had a list of about 9,000 people it considered likely insurgents.

Thailand has flooded the area with soldiers in recent years. There are about 150,000 security personnel in the three provinces, including military, police and village protection volunteer forces.

Poypiti Amatatham contributed reporting.

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Facebook stock slides after analysts’ downgrades

NEW YORK (AP) — Shares of Facebook Inc. fell Tuesday after two analysts downgraded the stock amid concerns about the company’s ability to grow ad revenue quickly enough, especially on mobile devices.

THE SPARK: Bernstein Research analyst Carlos Kirjner said that while Facebook’s advertising business still presents “significant untapped” opportunities, mobile ad revenue in the most recent quarter didn’t grow as fast as he’d expected. He cut his rating on the world’s largest online social network to “Market-Perform” from “Outperform” and lowered his target price to $ 27 from $ 33.

BTIG analyst Richard Greenfield, meanwhile, downgraded the stock to “Sell” from “Neutral.” He has a target price of $ 22.

ANALYST COMMENT: “Facebook management continues to focus investors on the increased ‘engagement’ with Facebook, as consumers shift from desktop usage to mobile usage,” Greenfield wrote in a note to investors.

That means people end up “touching” Facebook far more as they move to mobile use, since the Facebook app sends many of them notifications when their friends respond to their posts or for other reasons.

“Yet, the question Facebook has yet to answer is how mobile is affecting aggregate engagement, meaning total time spent on a monthly basis,” Greenfield added. “We suspect the more consumers shift to mobile, the less total time they are spending with Facebook.”

Facebook declined to comment. The company says it does not comment on stock price movements or analyst reports.

STOCK MOVEMENT: Facebook shares fell 89 cents, or 3.2 percent, to close at $ 27.37. The stock has lost close to 12 percent so far this month after enjoying an upswing since last October. Facebook went public at $ 38 last May and has not hit that price since.

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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.

__

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.

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Yen near fresh lows versus dollar, Asian shares steady

TOKYO (Reuters) - The yen hovered near fresh lows against the dollar and Tokyo stocks jumped back near a 33-month high on Tuesday after markets took comments from a U.S. official as giving Japan the green light to pursue policies that weaken the yen as long as they help beat deflation.

Asian shares were steady, with many regional bourses shut for holidays. Encouraging trade data from China late last week was lending support but non-Japan markets lacked momentum as investors awaited key events such as the U.S. president's State of the Union address for trading cues.

While Japan has faced some criticism from German and other European officials that it is intentionally trying to weaken the yen with monetary easing, rhetoric about a so-called currency war was dialled back ahead of a Group of 20 meeting in Moscow on Friday and Saturday.

U.S. Treasury Undersecretary Lael Brainard said on Monday the United States supports Japanese efforts to end deflation. But she also mentioned that the G7 has long committed to exchange rates determined by market forces, "except in rare circumstances where excess volatility or disorderly movements might warrant cooperation.

European Central Bank council member Jens Weidmann also said the euro was not overvalued at current levels.

The dollar was trading at 94.22 yen after marking on Monday its highest level since May 2010 of 94.465. The euro was trading at 126.28 yen after the yen fell 2 percent against the euro on Monday, pushing it back towards 127.71 yen hit last week, its highest level since April 2010.

"I think the yen's weakening is a function of (playing)catch-up," and not Japan resorting to deliberate devaluation of its currency, said Andrew Wilkinson, chief economic strategist at Miller Tabak & Co. in New York.

"It's the market's way of saying: we're convinced there is a movement afoot to reinflate Japan."

The weaker yen in turn helped bolster sentiment for Japanese stocks, sending the Nikkei average <.n225> 2.6 percent higher. <.t/>

"While currency moves have been sensitive to officials' comments in general, people thought any comment from the G20 would trigger yen buying," said Hiroichi Nishi, an assistant general manager at SMBC Nikko Securities.

"But such worries are receding as she (Brainard) said she supports Japan's efforts to end deflation."

The yen is expected to stay under pressure on expectations that Prime Minister Shinzo Abe will endorse a far more dovish Bank of Japan regime when the current leadership's term ends next month. The BOJ is expected to refrain from taking fresh easing steps when it meets this week.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> was little changed. Australian shares inched up 0.1 percent led by financials, as investors waited for corporate earnings results.

Trading resumed in Japan and South Korea but markets remained closed in Singapore, Hong Kong, mainland China, Malaysia and Taiwan.

G20 officials said on Monday the Group of Seven nations are considering a statement this week reaffirming their commitment to "market-determined" exchange rates.

Currency and equities markets were also looking ahead to President Barack Obama's State of the Union address later on Tuesday, for any signs of a deal to avert automatic spending cuts due to take effect on March 1.

"We believe that the G20's take on currency wars, Mr. Obama's upcoming state of the union address, and data on the current condition of the US economy should help markets assess where the global recovery stands and where we are heading," Barclays Capital said in a research report.

Wall Street and world equity markets were little changed in light volume on Monday as a lack of major economic news gave investors little incentive to push prices higher after a robust performance last week.

U.S. and Chinese data last week lifted the tech-focused Nasdaq Composite Index <.ixic> to a 12-year closing high and the Standard & Poor's 500 Index <.spx> to a five-year peak on Friday.

U.S. crude futures edged down 0.2 percent to $96.88 a barrel while Brent steadied around $118.12.

Spot gold stayed near a one-month low.

(Additional reporting by Ayai Tomisawa and Lisa Twaronite in Tokyo; Editing by Edwina Gibbs)

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North Korea Is Suspected of Conducting 3rd Nuclear Test

Lee Jin-Man/Associated Press

A South Korean watched news reporting about a possible nuclear test conducted by North Korea on a TV screen in Seoul on Tuesday.

WASHINGTON — North Korea appeared to conduct its third, and probably largest, nuclear test on Tuesday, according to American and Asian officials, posing a new challenge for the Obama administration in its effort to keep the country from becoming a full-fledged nuclear power.

While North Korea’s official news outlets were silent about the test, many nations detected seismic activity centered near the same location where the North conducted tests in 2006 and 2009. The United States Geological Survey said it was only a kilometer underground, an indication consistent with a nuclear blast. And in Vienna, the organization that monitors the Comprehensive Nuclear Test Ban Treaty said that tremor had “clear explosionlike characteristics.”

Preliminary estimates suggested a test far larger than the previous two conducted by the North, though probably less powerful than the first bomb the United States dropped on Japan, in Hiroshima, in 1945.

If confirmed, the test would be the first under the country’s new leader, Kim Jong-un, and an open act of defiance to the Chinese, who urged the young leader not to risk open confrontation by setting off the weapon. In the past few days a Chinese newspaper that is often reflective of the government’s thinking said the North must “pay a heavy price” if it proceeded with the test. But it was unclear how China would act at the United Nations Security Council, which was heading into emergency session as news of the suspected blast played out.

The Obama administration has already threatened to take additional action to penalize the North if it conducts a test, through the United Nations. But the fact is that there are few sanctions left to apply against the most unpredictable country in Asia. The only penalty that would truly hurt the North would be a cutoff of oil and other aid from China. And until now, despite issuing warnings, the Chinese have feared instability and chaos in the North more than its growing nuclear and missile capability, and the Chinese leadership has refused to participate in sanctions.

Mr. Kim, believed to be about 29, appears to be betting that even a third test would not change the Chinese calculus.

The apparent test set off a scramble among Washington’s Asian allies to assess what the North Koreans had done.

The United States sent aloft aircraft equipped with delicate sensors that may, depending on the winds, be able to determine whether it was a plutonium or uranium weapon. The Japanese defense minister, Itsunori Onodera, said Japan had ordered the dispatch of an Air Self-Defense Force jet to monitor for radioactivity in Japanese airspace.

Japan’s new prime minister, Shinzo Abe, told Parliament that “based on precedents, Japan believes that this quake was triggered by a North Korean nuclear test,” and said the country was considering “its own actions, including sanctions, to resolve this and other issues.”

But the threat may be largely empty, because trade is limited and the United States and its allies have refrained from a naval blockade of North Korea or other steps that could revive open conflict, which has been avoided on the Korean Peninsula since an armistice was declared 60 years ago.

It may take days or weeks to determine if the test, if that is what it proves to be, was successful. American officials will also be looking for signs of whether the North, for the first time, conducted a test of a uranium weapon, based on a uranium enrichment capability it has been pursuing for a decade. The past two tests used plutonium, reprocessed from one of the country’s now-defunct nuclear reactors. While the country has only enough plutonium for a half-dozen or so bombs, it can produce enriched uranium well into the future.

No country is more interested in the results of the North’s nuclear program, or the Western reaction, than Iran, which is pursuing its own uranium enrichment program. The two countries have long cooperated on missile technology, and many intelligence officials believe they share nuclear knowledge as well, though so far there is no hard evidence.

David E. Sanger reported from Washington, and Choe Sang-hun reported from Seoul, South Korea.

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Tweet-to-buy? American Express says yes

NEW YORK (AP) — A new program from American Express lets Twitter users post special hashtags to buy gift cards and things like Xbox 360 gaming consoles or a Kindle Fire HD from Amazon.

The credit card issuer said Monday that holders of eligible American Express cards will first have to link their cards with their Twitter accounts. Then they can tweet special hashtags, such as “BuyAmexGiftCard25,” wait for a confirmation from Amex and re-tweet the confirmation within 15 minutes to make the purchase. The extra step is there to help make sure that people don’t accidentally buy things with one Tweet.

Once the tweet is sent, the products are sent to the cardholder’s billing address, the company said.

On the safety front, American Express said people’s credit card information is not shared with Twitter or merchants, so even if hackers gain access to someone’s Twitter account they won’t be able to get their credit card information.

Leslie Berland, senior vice president of digital partnerships and development at the American Express, said the company has been “going very deep into social commerce” over the past couple of years. But past efforts have focused on discount offers, not actual purchases through Twitter.

Amex customers can buy gift cards starting Monday and other items beginning on Wednesday.

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How'd They Make Carrie Underwood's Glowing Gown?

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02/11/2013 at 12:25 AM ET

Kevork Djansezian/Getty; John Shearer/Invision/AP (2)

We can’t say we were surprised to see that Carrie Underwood had ditched her form-fitting Roberto Cavalli number for a princess-y silver gown to perform her song “Blown Away” at the Grammys Sunday night. When glowing paisley details began to unscroll across her full skirt, however? We definitely didn’t see that coming.

“We wanted it to be artful and dramatic,” Underwood told reporters backstage. “I just like to stand still and sing sometimes, so this seemed like the best way I could do that and still create something visually attention-capturing.” On the technology behind it, she was a little more tight-lipped, saying “I guess I probably shouldn’t tell my secret, should I?” — but luckily, we’ve already got the inside info.

To perform the song that won her best solo country performance, the superstar donned a custom Theia gown designed specifically for the vivid light show. The line’s creative director Don O’Neill sourced fabric for the 4 feet 5 inches-wide skirt that had to be approved by both Underwood’s stylist, Trish Townsend, as well as the video team creating the special effects.

With only three days to create the gown, O’Neill’s team worked around the clock, stitching together 10 yards of Duchesse satin, 100 yards of tulle and crinoline and thousands of Swarovski crystals onto the bodice. Meanwhile, the production team created the effects that were projected onto her gown, including sparkling stars, rose petals and butterflies.

And was all that work worth it? Judging by your overwhelmingly positive reactions on Twitter, absolutely. And O’Neill was thrilled with the result too, especially because he took the line’s name from the Greek goddess of light. “There couldn’t be a more perfect opportunity to fuse light in a literal sense with one of my gowns,” he says in a statement, “and have it showcased on a national stage by Carrie Underwood, the first celebrity to wear a Theia dress four years ago when we launched.”

Tell us: What did you think of Underwood’s high-tech couture?

–Alex Apatoff

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What heals traumatized kids? Answers are lacking

CHICAGO (AP) — Shootings and other traumatic events involving children are not rare events, but there's a startling lack of scientific evidence on the best ways to help young survivors and witnesses heal, a government-funded analysis found.

School-based counseling treatments showed the most promise, but there's no hard proof that anxiety drugs or other medication work and far more research is needed to provide solid answers, say the authors who reviewed 25 studies. Their report was sponsored by the federal Agency for Healthcare Research and Quality.

According to research cited in the report, about two-thirds of U.S. children and teens younger than 18 will experience at least one traumatic event, including shootings and other violence, car crashes and weather disasters. That includes survivors and witnesses of trauma. Most will not suffer any long-term psychological problems, but about 13 percent will develop symptoms of post-traumatic stress, including anxiety, behavior difficulties and other problems related to the event.

The report's conclusions don't mean that no treatment works. It's just that no one knows which treatments are best, or if certain ones work better for some children but not others.

"Our findings serve as a call to action," the researchers wrote in their analysis, published online Monday by the journal Pediatrics.

"This is a very important topic, just in light of recent events," said lead author Valerie Forman-Hoffman, a researcher at the University of North Carolina-Chapel Hill.

She has two young children and said the results suggest that it's likely one of them will experience some kind of trauma before reaching adulthood. "As a parent I want to know what works best," the researcher said.

Besides the December massacre at Sandy Hook Elementary School in Connecticut, other recent tragedies involving young survivors or witnesses include the fatal shooting last month of a 15-year-old Chicago girl gunned down in front of a group of friends; Superstorm Sandy in October; and the 2011 Joplin, Mo., tornado, whose survivors include students whose high school was destroyed.

Some may do fine with no treatment; others will need some sort of counseling to help them cope.

Studying which treatments are most effective is difficult because so many things affect how a child or teen will fare emotionally after a traumatic event, said Dr. Denise Dowd, an emergency physician and research director at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who wrote a Pediatrics editorial.

One of the most important factors is how the child's parents handle the aftermath, Dowd said.

"If the parent is freaking out" and has difficulty controlling emotions, kids will have a tougher time dealing with trauma. Traumatized kids need to feel like they're in a safe and stable environment, and if their parents have trouble coping, "it's going to be very difficult for the kid," she said.

The researchers analyzed 25 studies of treatments that included anti-anxiety and depression drugs, school-based counseling, and various types of psychotherapy. The strongest evidence favored school-based treatments involving cognitive behavior therapy, which helps patients find ways to cope with disturbing thoughts and emotions, sometimes including talking repeatedly about their trauma.

This treatment worked better than nothing, but more research is needed comparing it with alternatives, the report says.

"We really don't have a gold standard treatment right now," said William Copeland, a psychologist and researcher at Duke University Medical Center who was not involved in the report. A lot of doctors and therapists may be "patching together a little bit of this and a little bit of that, and that might not add up to the most effective treatment for any given child," he said.

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