India Ink: India’s Slowing Economy Forces Budget Decisions

NEW DELHI — Not too long ago, when India’s economy was roaring amid predictions of high growth rates for years to come, the finance minister could be forgiven for strutting during budget week. He got to march into India’s Parliament with the ceremonial briefcase bearing a budget stuffed with goodies.

But on Thursday, when the current finance minister, Palaniappan Chidambaram, arrives in Parliament, his steps will be heavier, and the mood is likely to be, too. Faced with slowing growth, persistent inflation and sagging investor confidence, India’s government is pinned between conflicting pressures: economists warn that tough steps are needed to avoid long-term fiscal problems, even as political leaders are leery of introducing unpopular measures before important elections this year.

On Wednesday, the government sought to change the pessimistic narrative, as the Finance Ministry released its annual economic survey and projected that economic growth would jump somewhere above 6 percent during the next fiscal year, predicting that the downturn was “more or less over and the economy is looking up.” Some economists were skeptical, given that similar rosy predictions in recent budgets have proved wrong.

“Let me remind you that last year the economic survey spoke of about 7.6 percent projected growth — and what we had was 5 percent growth,” said Ajay Bodke, head of investment strategy and advisory at Prabhudas Lilladher, a Mumbai brokerage. “That is not just a miss but a humongous miss.”

The consequences of the budget plans are especially high because India, once a darling of global investors and an anointed power-in-waiting, is struggling to regain its lost luster.

India’s estimated 5 percent growth rate for the current fiscal year compares with 8 percent in 2010. Ratings agencies have threatened to downgrade the country’s investment rating to “junk” status. Meanwhile, India’s political class has spent more than three years enmeshed in scandals, as a bickering Parliament has accomplished almost nothing.

“It’s a supercritical moment, actually,” said Rajiv Kumar, an economist with the Center for Policy Research in New Delhi. “If you get it right, and this is a budget that can shore up the government’s credibility, they can turn it around.”

For investors and business leaders, the question is whether the government will make tough calls to address the country’s large fiscal and account deficits, curb huge subsidies for diesel fuel and petroleum products, unclog bureaucratic bottlenecks on stalled manufacturing, energy and infrastructure projects and create incentives to entice new investment.

Only a year ago, Pranab Mukherjee, then finance minister, unveiled a budget now regarded by many analysts as a major mistake. Desperate to increase revenues, the government spooked investors by giving broad latitude for tax collectors to pursue multinationals for billions of dollars in new, unexpected taxes. Investment slowed markedly, while investors and political opponents complained that India’s coalition government, led by the Indian National Congress Party, was endangering one of the world’s fastest-growing economies.

“The economy is in a deep crisis at the moment,” said Yashwant Sinha of the opposition Bharatiya Janata Party, a former finance minister, “and I only hope the crisis doesn’t become any deeper with more pre-election sops.”

Mr. Sinha and many independent economists warn that the economy cannot afford a repeat of 2008, when the government was preparing for national elections the following year. Then, the pre-election budget was filled with big spending measures, including pay raises for government workers and the forgiveness of billions of dollars in loans to farmers. The government was easily re-elected in 2009, but the new spending contributed to a fiscal deficit that rose to roughly 6 percent, from about 2 percent the previous year.

Neha Thirani Bagri contributed reporting from Mumbai, India.

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American Idol Reveals Its Top 10 Women

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American Idol

02/27/2013 at 10:45 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj, Keith Urban

Michael Becker/FOX

American Idol's's list of the top 10 women is complete!

After the first week of sudden-death rounds, the judges gave their stamp of approval to five more female singers Wednesday night. And they sent five others home.

Keep reading to find out who's in and who's out on Idol ...

Here are the five contestants who are moving on in the competition:

1. Zoanette Johnson: The Tulsa resident, 20, was the first to be put through by the judges, who showered her with praise for singing a spirited version of "Circle of Life" from The Lion King. Keith Urban declared her "queen of the jungle." Nicki Minaj told Zoanette, "You make me so emotional ... You're the person we're going to remember tonight."

2. Aubrey Cleland: After singing a slowed-down version of Beyoncé's "Sweet Dreams," Mariah Carey told Cleland, 19, "You're limitless." Nicki and Randy Jackson pointed out her commercial appeal. "Lookin' like a current artist, soundin' like one, feelin' like one," said Nicki of the performance.

3. Candice Glover: Taking on Aretha Franklin's "(You Make Me Feel Like) A Natural Woman" paid off for the singer, 23, who earned a standing ovation from Keith. Randy said she was "one of my favorite singers in the whole competition."

4. Breanna Steer: "You're extremely marketable and gorgeous and talented," Mariah told the singer, 18, after she sang a dramatic version of Jazmine Sullivan's "Bust Your Windows" that had Randy wanting to sign her up for a recording contract. "You got the whole package," he said. "You brought so much drama."

5. Janelle Arthur: She beat out the other country singer in the competition, Rachel Hale, for the final spot in the women's top 10 after singing Lady Antebellum's "Just a Kiss." Though Randy called Arthur, 23, his "favorite country singer in this competition," the other judges questioned her song choice. "[The song] doesn't give you a chance to really soar," Keith said. "The melody kept pulling you back."

These five will join the five female finalists announced last week – Kree Harrison, Amber Holcomb, Adriana Latonio, Angela Miller and Tenna Torres – as well as the five men – Charlie Askew, Curtis Finch Jr., Paul Jolley, Elijah Liu and Devin Velez. Ten more guys will sing Thursday (8 p.m. ET) and five will move on to round out season 12's top 20.

Did the judges make the right decisions? Sound off in the comments below.

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Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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On the Web:

http://1.usa.gov/VaztQm

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Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

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India Ink: A Difficult Budget Balancing Act for India

India’s fiscal budget will be announced on Thursday amid slowing economic growth, soaring inflation, a growing fiscal deficit and flagging investor confidence. But with national elections only a year away, analysts fear that instead of cutting the deficit, the government will buckle under political pressure and increase spending on social programs.

“As the country is going into an election period, there is a tendency to try to create a feel-good factor amongst the electorate by enhancing access to welfare schemes and income growth for the masses,” said Sujan Hajra, chief economist and executive director at Anand Rathi Financial Services.

The government has been under pressure to rein in spending as ratings agencies have warned that a failure to cut the deficit could result in a crippling downgrade to India’s sovereign debt.

“The need of the hour is a growth-supportive budget that reinforces reform initiatives and minimizes populist impulses that may act as a drain on the already stretched fiscal condition and raise a red flag for the ever-watchful rating agencies,” said Ajay Bodke, the head of investment strategy and advisory at Prabhudas Lilladher, a Mumbai brokerage.

India’s economy has slowed considerably in recent quarters. On Feb. 7, advance estimates released by India’s Central Statistics Office pegged the growth rate for the current fiscal year, which ends in March, at 5 percent, a significant drop from the central bank’s earlier projections of 5.5 percent and 5.8 percent, and down from over 8 percent in 2010.

In the second quarter of this financial year, the current account deficit reached a record high of $22.4 billion, or 5.4 percent of the gross domestic product, according to data released by the Reserve Bank of India in December.

Prime Minister Manmohan Singh attributed the slowdown to outside forces. “We are meeting against the background of global slowdown of economic activity which has also affected us,” he said in Parliament on Feb. 21. “The way we conduct the financial business now before Parliament will be a crucial determinant of our country’s ability to cope with the formidable challenges that our country faces.”

The government has introduced a series of measures to narrow the deficit, including a rise in passenger rail fares, an increase in fuel prices and the opening of the aviation and retail sectors for foreign direct investment.

Reducing the fiscal deficit has been a priority for the government in recent months. In October, India’s finance minister, Palaniappan Chidambaram, presented a plan  aimed at reducing the fiscal deficit over the next five years, which included a significant reduction in subsidies and tight controls on government expenditure.

In an interview with The Financial Times in January while in England to promote India to investors, Mr. Chidambaram said that the coming budget would be “responsible,” adding, “The red lines are that the fiscal deficit for the current year will be no more than 5.3 percent and the fiscal deficit for the next year will be no more than 4.8 percent.”

Additional measures to overhaul the economy are necessary to reach that target, analysts said. The government is likely to rely on a mix of revenue and spending measures, including proceeds from the divestment of state-run companies and telecom spectrum sales, an increase in indirect taxes and improved tax administration, predicted Leif Lybecker Eskesen, the chief economist for India at HSBC Global Research.

“Debt dynamics depend importantly on broader structural reforms progress, which is needed to raise the economy’s growth potential,” he said. “It is, therefore, imperative to continue and step up the reform push.”

What worries analysts in particular is the National Food Security Bill 2011, which aims to lower the cost of food for the poor.

“If the bill is passed by Parliament, the total food subsidy expense alone would be approximately $14.6 billion per year, or 12 percent of the annual budget,” said Akshay Mathur, head of research at Gateway House, a research institution in Mumbai. Total subsidy expenses, including fuel and fertilizer would be almost 20 percent of the budget, he added.

Critics of the bill argue that the legislation is being introduced with the sole intention of garnering votes for the Congress party in the national elections in 2014.

“There is definitely a political impetus behind the Food Security Bill, but the need is not only a political one,” said Mr. Mathur. “However, the question is how we can pay for it. At this point, given that we have a fiscal deficit and a current account deficit, any added expenditure is a pure drain on the government.”

Meanwhile, fear of a sovereign ratings downgrade by international credit rating agencies is haunting the government. “Rating agencies are also closely watching out for any further fiscal slippage,” said Dipen Shah, head of private client group research at Kotak Securities.

Ratings agencies are looking to the budget for signs of the Indian government’s commitment to fiscal consolidation and structural reform.

“The Union budget will be an important gauge of the government’s commitment to fiscal consolidation and reform in general,” said a report by Fitch Ratings on Feb. 4. “India’s patchy performance on policy implementation, and the approach of elections in 2014 could impede fiscal consolidation, suggesting political and implementation risk remain significant.”

Lalit Thakkar, a managing director at Angel Broking, said that perhaps the ratings agencies’ scrutiny will compel the government to act responsibly.

“We believe that the government cannot afford any adverse economic developments at this juncture on the back of the still-looming threat of sovereign ratings downgrade by credit rating agencies,” he said.

Given that a ratings downgrade from the lowest investment grade to junk status could significantly hamper capital flow, have an adverse impact on the currency, business confidence and the availability of international finance for the corporate sector, perhaps it is this threat that will prove pivotal.

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Bobby Brown Sentenced to 55 Days in Jail in Drunk Driving Case

02/26/2013 at 09:30 PM EST

Bobby Brown has been sentenced to 55 days in jail and four years probation in his most recent drunk driving arrest.

Brown, 44, was pulled over in Studio City, Calif., on Oct. 24 for driving erratically and was arrested when the officer detected "a strong scent of alcohol." He was charged with DUI and driving on a suspended license.

He was also arrested for driving under the influence in March of 2012.

Brown pled no contest to the charges on Tuesday, reports TMZ. He was also ordered to complete an 18-month alcohol treatment program.

The singer, who married Alicia Etheredge in Hawaii in June of 2012, must report to jail by March 20.

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Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

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

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

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Online:

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

CDC: http://www.cdc.gov/cancer/breast/index.htm

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IHT Rendezvous: Thank you, Xiexie, Namaste: a Movie Undercuts Old Rivalries

BEIJING — After the Taiwan-born film director Ang Lee won big at the Oscars on Sunday evening in Los Angeles, including scooping Best Director for “Life of Pi,” he effusively thanked his place of birth. But his thanks didn’t make it into China, at least not via the official media.

Why? At almost the same time as Mr. Lee’s speech there was a meeting in Beijing between Xi Jinping, the head of China’s Communist Party, and Lien Chan, the honorary chairman of Taiwan’s Kuomintang party, the latest twist in a political rivalry now dating back 64 years to the end of the Chinese civil war in 1949, when the Kuomintang fled to Taiwan and set up the Republic of China. Communist Party-run China, the People’s Republic of China, still claims Taiwan and has not dropped threats to take it by force, if necessary. Even for Xinhua to quote Mr. Lee thanking Taiwan would be to unacceptably recognize the de facto reality that Taiwan is a separate state.

It’s all deep politics, with Mr. Lee’s victory bound to lead to a debate about whether Mr. Lee is “Chinese or not.” Mr. Lee, who has never denied he is culturally Chinese and appears keen to work in and with the mainland of China, is known to be proud of his Taiwan roots and sees himself as an internationalist.

In its account of the event, Xinhua, the official news agency, merely described him as “Coming from China’s Taiwan”, which fits into China’s ongoing claims.

Here’s what Mr. Lee said about Taiwan: “I cannot make this movie without the help of Taiwan. We shot there. I want to thank everybody there helped us. Especially the city of Tai Chong.” He went on to thank “My family in Taiwan.”

In another story, Xinhua also left out Mr. Lee’s thanks to Taiwan, quoting only this version of his words: “Thank you, movie God. I really need to share this with all 3,000, everybody who worked with me in ‘Life of Pi’, I want to thank you for, I really want to thank you for believing this story, and sharing this incredible journey with me. Thank you, Academy, xie xie, namaste.”

Readers of the Taipei Times, however, learned also that backstage, “Lee thanked his home country, where he said 90 percent of the film was shot. ‘They gave us a lot of physical help and financial help,’ he said. ‘I’m glad that Taiwan contribute this much to the film. I feel like this movie belongs to the world,’” he said in a story carried by the Taiwan newspaper.

As the Taipei Times cited Mr. Lien as saying in the meeting with Mr. Xi, “core issues” remain unresolved. Taiwan and China can work out a reasonable arrangement, Mr. Lian said, according to the newspaper, sounding pragmatic.

Mr. Xi’s had a different, more dramatic take of the situation, speaking of China and Taiwan working together for the “great rejuvenation of the Chinese nation,” in the China Daily’s words, reflecting speeches he has made frequently since becoming party leader.

Meanwhile, Mr. Lee offered something completely different in his speech: a multicultural, multilingual salutation that reflected the deeply globalized nature of his movie, which explores human survival, animals, and religions.

“Thank you, Academy. Xie xie, Namaste,” he said, in English, Mandarin Chinese and Hindi.

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The Bachelor's Sean Lowe Reveals Final Two

TV Watch

The Bachelor

02/25/2013 at 10:30 PM EST

From left: AshLee, Lindsay and Catherine

Kevin Foley/ABC(3)

And then there were two.

After three incredible dates in Thailand with the remaining women, The Bachelor's Sean Lowe faced a difficult decision at the end of Monday's episode: Would he send home AshLee, Catherine or Lindsay?

Keep reading to find out who got a rose – and who was left heartbroken ...

Sean said goodbye to early favorite AshLee in a surprising elimination that left her virtually speechless.

Visibly upset, AshLee left Sean's side without saying goodbye. She even asked him to not walk her to the waiting car that would take her away.

But Sean did get to explain. "I thought it was you from the very beginning," he said. "This was honestly the hardest decision I've ever had to make ... I think the world of you. I did not want to hurt you."

"This wasn't a silly game for me," AshLee said as the car drove away. "This wasn't about a joy ride. It wasn't about laughing and joking and having fun."

She added: "It's hard to say goodbye to Sean because I let him in ... It's the ultimate [rejection]."

Check back Tuesday morning for Sean Lowe's blog post to read all about his Thailand dates and why he chose to send AshLee home

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Koop, who transformed surgeon general post, dies

With his striking beard and starched uniform, former Surgeon General Dr. C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.

His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.

Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.

Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.

An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.

Dr. Richard Carmona, who served as surgeon general a decade ago under President George W. Bush, said Koop was a mentor to him and preached the importance of staying true to the science even if it made politicians uncomfortable.

"He set the bar high for all who followed in his footsteps," Carmona said.

Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."

A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.

Chris Collins, a vice president of amFAR, the Foundation for AIDS Research, said many people don't realize what an important role Koop played in the beginning of the AIDS epidemic.

"At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," Collins said.

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.

In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.

He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

Koop maintained his personal opposition to abortion, however. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day, but Reagan would not interfere.

Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was born in the New York City borough of Brooklyn, the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats.

He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

Koop received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it.

In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children, one of whom died in a mountain climbing accident when he was 20.

Koop was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine.

He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was by far the best-known surgeon general and for decades afterward was still a recognized personality.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."

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Ring reported from Montpelier, Vt. Cass reported from Washington. AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.

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Asian shares decline on deadlocked Italy election

TOKYO (Reuters) - Asian shares took their lead from overnight plunges in global equities to fall on Tuesday as an apparently inconclusive election outcome in Italy raised fears of a resurgent euro zone debt crisis.

Italy's centre-left coalition will win a majority in the lower house of parliament but the upper house will be deadlocked, the Interior Ministry said on Tuesday after almost all votes were counted. No party or coalition won a majority of seats in the Senate, which a government would need to pass legislation.

A split parliament in the euro zone's third-largest economy is seen as likely to paralyze any new government and potentially reignite the euro-zone debt crisis.

"There's a possibility that the Italians might be heading back to the polls. In the short term, investors and traders don't like the uncertainty," said Ben Le Brun, market analyst at OptionsXpress in Sydney.

The yen and the euro stabilized while London copper and gold gained, and Asia's overall equities losses were limited compared to their global peers, such as U.S. benchmark Standard & Poor's 500 Index <.spx> which suffered its worst one-day percentage decline since November 7 with a 1.8 percent tumble on Monday.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> fell 0.5 percent. Australian shares <.axjo> fell 0.7 percent, South Korean shares <.ks11> eased 0.4 percent while the Philippines stock market <.psi> plunged 1.2 percent after a record finish on Monday.

"There's an argument going on among traders at the moment. Was the Italian election result a cause or an excuse for something the market wanted to do? Because the market has run so hard we were due for a pull-back," said Michael McCarthy, chief market strategist at CMC Markets. Australian shares last week scaled a 4-1/2-year high.

The yen resumed its retreat after firming sharply on Monday when nervousness about Italy exposed the yen to sharp reversals from its recent steep losses on bets of aggressive reflationary monetary policy in Japan.

The yen traded down 0.6 percent against the dollar at 92.35 after gaining 2 percent to a three-week high of 90.85 on Monday from its intraday low of 94.77 touched earlier in the day, its lowest since May 2010. The yen was also down 0.5 percent against the euro to 120.87 after jumping more than 3 percent to 118.74 on Monday from its day's low of 125.36.

Traders said the plunge in the dollar and the euro against the Japanese currency has provided fresh opportunities to buy these currencies against the yen, with many market players still seeing a weak yen trend continuing.

But the euro's rebound was limited, putting the single currency near its more than six-week low of $1.3047 hit on Monday on jitters about political gridlock in Italy hampering the country's efforts to reform and slash its debts.

"Uncertainty over the Italian election outcome and its impact will certainty keep the euro under strong pressure for some time," said Yuji Saito, director of foreign exchange at Credit Agricole in Tokyo.

"A safety net has been provided over the past year in the euro zone and given the size of Italy's economy, I doubt that the situation will turn into a disaster, but we need to carefully monitor developments. It revives memories of risks in the euro zone," Saito added.

The focus will now be on an Italian treasury bill auction on Tuesday when borrowing costs could rise, given the Senate election result.

The yen's overnight appreciation hit Japan's Nikkei stock average, with the index <.n225> declining 1.4 percent after closing at a 53-month high the day before. <.t/>

Investors also await testimony later in the day from Federal Reserve Chairman Ben Bernanke for further clues of when the Fed intends to slow down or stop its bond-buying program.

Financial markets were rattled last week by minutes of the Fed's January meeting showing some Fed officials were mulling scaling back its strong monetary stimulus earlier than expected.

"Bernanke's testimony will likely drive global market sentiment tonight, as markets wait for clues on the Fed's exit strategy for its bond-buying stimulus program. Our house view is that Bernanke will remain dovish," ANZ said in a note.

Ahead of Bernanke's appearance, Dennis Lockhart, president of the Federal Reserve Bank of Atlanta, said on Monday that U.S. economic growth could surpass expectations this year, but an anemic labor market requires ongoing support from monetary policy.

The United States also faces downside risks to its economy if $85 billion in government-wide "sequestration" spending cuts go ahead on March 1.

U.S. crude slid 0.6 percent to $92.54 a barrel and Brent fell 0.5 percent to $113.86.

Spot gold inched up 0.2 percent to $1,596.56 an ounce.

(Additional reporting by Manolo Serapio Jr in Singapore and Thuy Ong in Sydney; Editing by Eric Meijer)

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