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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M&A deals lift Wall Street shares nearer a record high

NEW YORK (Reuters) - U.S. stocks rose on Tuesday as this year's ongoing surge in merger activity suggested investors were still finding value in the market even as indexes closed in on all-time highs.

Office Depot Inc surged 9.4 percent to $5.02 after a person familiar with the matter said the No. 2 U.S. office supply retailer was in advanced talks to merge with smaller rival OfficeMax Inc , which jumped more than 20 percent.

News of the potential move came just days after Berkshire Hathaway and a partner agreed to acquire H.J. Heinz Co for $23 billion, and following a revised $20 billion takeover of Mexican brewer Grupo Modelo by Anheuser-Busch InBev .

Deal activity has helped equities resist a pullback as investors use dips in stocks as buying opportunities. The S&P is up about 7 percent so far in 2013 and has climbed for the past seven weeks in its longest weekly winning streak since January 2011, though most of the weekly gains have been slim.

The Dow industrials closed 0.9 percent away from their record high while S&P 500 was 2.2 percent off its peak.

"Deals are good for the market," said Frank Lesh, a futures analyst and broker at FuturePath Trading LLC in Chicago. "The fact that they're being done is a positive."

More than $158 billion in deals has been announced so far in 2013, more than double the activity in the same period last year and accounting for 57 percent of global deal volumes, according to Thomson Reuters Deals Intelligence.

The Dow Jones industrial average <.dji> gained 53.91 points, or 0.39 percent, to 14,035.67. The Standard & Poor's 500 Index <.spx> gained 11.15 points, or 0.73 percent, to 1,530.94. The Nasdaq Composite Index <.ixic> gained 21.56 points, or 0.68 percent, to 3,213.59.

Other stocks in the office supplies sector also rose. Larger rival Staples Inc shot up 13.1 percent to $14.65 as the best performer on the S&P 500.

"Equity investors have to be encouraged by M&A since, if the number crunchers are offering large premiums, that shows how much value is still in the market," said Mike Gibbs, co-head of the equity advisory group at Raymond James in Memphis, Tennessee.

On the downside, health insurance stocks tumbled, led by a 6.4 percent drop in Humana Inc to $73.01. The company said the government's proposed 2014 payment rates for Medicare Advantage participants were lower than expected and would hurt its profit outlook.

UnitedHealth Group lost 1.2 percent to $56.66. The Morgan Stanley healthcare payor index <.hmo> dropped 1.2 percent.

Wall Street's strong start to the year was fueled by better-than-expected corporate earnings, as well as a compromise in Washington that temporarily averted automatic spending cuts and tax hikes that are predicted to damage the economy.

The compromise on across-the-board spending cuts postponed the matter until March 1, at which point the cuts take effect. Ahead of the debate over the cuts, known as sequestration, further gains for stocks may be difficult to come by.

Some investors say the debate could be the catalyst for a long anticipated sell-off after the market's recent strong run.

Carter Worth, a technical analyst at Oppenheimer, pointed to the "especially complacent action of the past six weeks," noting that, as of Friday, stocks have gone 33 sessions without a dip of more than 1.5 percent.

"We would be selling aggressively into the market's current strength," he said in a research note.

Economic data showed the NAHB/Wells Fargo Housing Market index unexpectedly edged down to 46 in February from 47 in the prior month as builders faced higher material costs.

According to the Thomson Reuters data through Monday morning, of the 391 companies in the S&P 500 that have reported results, 70.1 percent have exceeded analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters.

Fourth-quarter earnings for S&P 500 companies have risen 5.6 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Express Scripts rose 2.5 percent to $56.98 after the pharmacy benefits manager posted fourth-quarter earnings.

About two stocks rose for everyone that fell on the New York Stock Exchange and Nasdaq. About 6.48 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, in line with the daily average so far this year.

(Additional reporting by Chuck Mikolajczak Ryan Vlastelica and Rodrigo Campos; Editing by Chizu Nomiyama, Kenneth Barry and Nick Zieminski)

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Mikhail Pakhomov’s Body Is Found Near Moscow in Cement-Filled Barrel

MOSCOW — The body of a missing city legislator and construction tycoon has been found in a private basement garage on the city’s outskirts, inside a rusted metal barrel filled with cement, the police said Monday.

Russian television showed investigators removing the body of the man, Mikhail Pakhomov, 36, on Sunday evening from the garage, 20 miles east of Moscow, where the police said he had been tortured and killed over an outstanding $80 million loan.

The killing recalled the brutal violence that routinely emerged from business disputes in the 1990s. Mr. Pakhomov, who was reported missing last Tuesday, was a promising young star in United Russia, the ruling party founded by President Vladimir V. Putin, and had served as head of a construction company that was reported to have won large contracts to develop utilities and infrastructure in several cities.

Sergei B. Ivanov, Mr. Putin’s chief of staff, last year called housing and utilities services one of Russia’s most corrupt sectors. Many lucrative contracts are doled out on the municipal level, and large sums of money are at stake.

Politicians who have tried to battle graft in the system have met with violence. In 2011, Yevgeny Dushko, the mayor of Sergiyev Posad, was gunned down in his driveway in a contract killing that investigators said was most likely linked to his disputes with the city’s utility contractors.

The police have identified the likely mastermind of Mr. Pakhomov’s killing as Yevgeny Kharitonov, a former deputy minister for housing and utilities services in the Moscow region. . They said Mr. Kharitonov had Mr. Pakhomov followed since last November and was pressing the legislator to repay a debt of $80 million. Mr. Kharitonov has been arrested, but so far, he has been charged only with kidnapping. Seven other people were also arrested.

Mr. Pakhomov was reported missing on Feb. 12 from Lipetsk, an industrial city 270 miles southeast of Moscow, where he served as a regional lawmaker. Witnesses said three men had dragged him from his car, and the police said they found traces of blood at the scene.

The search continued for almost a week, until people questioned by the police led investigators to the body.

“A similar event has never happened with a V.I.P. in our city,” read an editorial published in Gorod48, a news Web site based in Lipetsk. “Even in the ‘evil ’90s’ nobody disappeared: businessmen were killed right where they lived or worked, and bandits from competing groups shot or blew each other up wherever they happened to be.”

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

TV Watch

The Bachelor

By Carrie Bell

02/18/2013 at 04:25 PM EST

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

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

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

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

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

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

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

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

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

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

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Study: Better TV might improve kids' behavior

SEATTLE (AP) — Teaching parents to switch channels from violent shows to educational TV can improve preschoolers' behavior, even without getting them to watch less, a study found.

The results were modest and faded over time, but may hold promise for finding ways to help young children avoid aggressive, violent behavior, the study authors and other doctors said.

"It's not just about turning off the television. It's about changing the channel. What children watch is as important as how much they watch," said lead author Dr. Dimitri Christakis, a pediatrician and researcher at Seattle Children's Research Institute.

The research was to be published online Monday by the journal Pediatrics.

The study involved 565 Seattle parents, who periodically filled out TV-watching diaries and questionnaires measuring their child's behavior.

Half were coached for six months on getting their 3-to-5-year-old kids to watch shows like "Sesame Street" and "Dora the Explorer" rather than more violent programs like "Power Rangers." The results were compared with kids whose parents who got advice on healthy eating instead.

At six months, children in both groups showed improved behavior, but there was a little bit more improvement in the group that was coached on their TV watching.

By one year, there was no meaningful difference between the two groups overall. Low-income boys appeared to get the most short-term benefit.

"That's important because they are at the greatest risk, both for being perpetrators of aggression in real life, but also being victims of aggression," Christakis said.

The study has some flaws. The parents weren't told the purpose of the study, but the authors concede they probably figured it out and that might have affected the results.

Before the study, the children averaged about 1½ hours of TV, video and computer game watching a day, with violent content making up about a quarter of that time. By the end of the study, that increased by up to 10 minutes. Those in the TV coaching group increased their time with positive shows; the healthy eating group watched more violent TV.

Nancy Jensen, who took part with her now 6-year-old daughter, said the study was a wake-up call.

"I didn't realize how much Elizabeth was watching and how much she was watching on her own," she said.

Jensen said her daughter's behavior improved after making changes, and she continues to control what Elizabeth and her 2-year-old brother, Joe, watch. She also decided to replace most of Elizabeth's TV time with games, art and outdoor fun.

During a recent visit to their Seattle home, the children seemed more interested in playing with blocks and running around outside than watching TV.

Another researcher who was not involved in this study but also focuses his work on kids and television commended Christakis for taking a look at the influence of positive TV programs, instead of focusing on the impact of violent TV.

"I think it's fabulous that people are looking on the positive side. Because no one's going to stop watching TV, we have to have viable alternatives for kids," said Dr. Michael Rich, director of the Center on Media and Child Health at Children's Hospital Boston.

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Online:

Pediatrics: http://www.pediatrics.org

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Contact AP Writer Donna Blankinship through Twitter (at)dgblankinship

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DATA LOOMS

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

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

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

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

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

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

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

EARNINGS HIT

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

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

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

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

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

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

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

CHINA RETURN

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

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

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

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

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

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

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

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IHT Rendezvous: Taming the Runaway U.S. Budget

WASHINGTON — If Democrats and Republicans can’t agree on a deficit reduction plan, in two weeks automatic budget cuts will kick in that could severely weaken the U.S. economy and the American military.

As I write in my latest Letter From Washington, there are sensible ways to avoid this, though it is far from certain dysfunctional Washington can achieve them.

One reason is that so much of spending is now hard-wired into the system.

Representative John Dingell of Michigan is the only current member of Congress who served in 1962. Yet he would hard-pressed to recall the federal budget of a half century ago.
In those days, more than two-thirds, 67.5 percent, of spending was discretionary, meaning it had had to be appropriated annually. Almost half the budget went to defense and about 18 percent went to discretionary domestic programs.
Mandatory spending, or entitlements, was only a little more than a quarter of the budget, and more than half of that went for Social Security.
That picture is turned upside down in the current fiscal year. Almost 60 percent of the budget is mandatory spending with one $1 of every $5 going to Social Security and $1 in $7 to Medicare and Medicaid. Defense is almost 19 percent, a fraction of what it was in 1962, and domestic discretionary programs, at a little more than 16 percent, takes a smaller proportional bite out of the federal budget than they did a half century ago despite the creation of so many new initiatives.
This isn’t going to change. “Regardless of who is president, what will be spent in any given year will be determined by laws that are already set, some decades earlier,” says Stan Collender, an expert on the federal budget.
Despite the large budget deficits in recent years, interest on the debt payments, at 6.5 percent this year, is almost precisely what it was a half century ago. These payments, however, are expected to climb steadily over the next 50 years. Under current projections, Mr. Collender says, they are on track to become the fastest-growing area of the federal budget.

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Downton Abbey-Inspired Cocktail Is Perfect Way to Toast the Crawleys

Celebrity Diners Club

By Aaron Parsley

02/17/2013 at 05:00 PM EST

The Crawley Classic

Courtesy Nick Van Tiel; Inset: Matthew Lloyd

Here's to Downton!

Season 3 of Downton Abbey is coming to a close on Sunday – and in case you need something to soothe your soul while you watch the final episode alone in the dark next to a box of tissues, we've got the perfect drink.

Then again, this fruity and bubbly concoction packs a punch, making it a delicious refreshment to serve at a festive viewing party. Just designate a guest your head butler, hand him the recipe and call out, "Carson, bring me another Crawley Classic!"

The gin cocktail – created by Nick Van Tiel, U.S. brand ambassador for Plymouth and Beefeater in honor of the PBS's award-winning drama – is something Lady Mary might sip upon whilst picking out the perfect pair of gloves for dinner. It's also fit for Thomas to enjoy on his day off or while he seethes behind close doors, plotting against O'Brien.

However you wish to enjoy the drink, do so in good company whether upstairs or down.

The Crawley Classic:

1 part gin
½ part sloe gin
½ part fresh grapefruit juice
½ part fresh lemon juice
½ part Turbinado simple syrup
Drizzle of black raspberry liqueur (float on top)
Splash soda/seltzer water

Shake and strain the first 5 ingredients into a long sling glass over fresh ice. Top with a little cracked ice, add a splash of soda and a drizzle of raspberry liqueur.

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UN warns risk of hepatitis E in S. Sudan grows

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

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

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

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

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G20 steps back from currency brink, heat off Japan

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

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

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

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

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

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

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

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

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

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

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

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

NO FISCAL TARGETS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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