Westminster Names Affenpinscher Banana Joe Best in Show

People Pets

By Kiran Hefa & Alison Schwartz

02/12/2013 at 11:55 PM EST

Westminster has its top dog!

After two days of meticulous primping, prizes and the less-pretty realities of any spirited championship, the 137th Annual Westminster Kennel Club Dog Show came to its finale Tuesday night, declaring Affenpinscher Banana Joe the best in show.

The competition proved fur-rocious as the pint-sized, black-haired furball bested six other finalists (and 2,721 entries total) for the honor, including Old English Sheepdog Swagger, who was named the reserve best in show. It’s the first time the breed has ever taken home the top prize in Westminster history.

Earning top marks at Westminster is the latest accolade in Banana Joe's storied run. The paw-dorable pooch, who is 5 years old, has been named best in show 86 times in his career, and his Westminster win will go down as his last.

"It's all so indescribable. It's just a wonderful thing as a tribute for a small breed with such a big heart," handler Ernesto Lara said post-victory. "The plans for him now is for him to retire back home where he was born, and that's in the Netherlands."

Describing his little buddy, Lara praised the breed for its commendable qualities as a canine companion.

"An Affenpinscher is a very human-like dog," he said. "It's definitely a breed you don’t want to tame or train, in the proper sense."

"You want to befriend it," Lara continued. "Once you gain the friendship, they're loyal just like a human friend."

As for Banana Joe's big victory, "Nobody told him he's small," said Lara, "and I don't think he'll believe that."

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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.

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Online:

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

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

Study: http://gucasym.org

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

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Dorner manhunt leads to deadly standoff

When authorities hemmed in the man they suspected of killing three people in a campaign of revenge that has gripped Southern California, he responded as they had feared: with smoke bombs and a barrage of gunfire.

The suspect, who police believe is fugitive ex-cop Christopher Dorner, shot to death one San Bernardino County sheriff's deputy and injured another Tuesday. He then barricaded himself in a wood cabin outside Big Bear in the snow-blanketed San Bernardino Mountains, police said.

Just before 5 p.m., authorities smashed the cabin's windows, pumped in tear gas and called for the suspect to surrender. They got no response. Then, using a demolition vehicle, they tore down the cabin's walls one by one. When they reached the last wall, they heard a gunshot.

Then the cabin burst into flames. By late Tuesday evening, the smoldering ruins remained too hot for police to enter, but authorities said they believed Dorner's body was inside.

The standoff appeared to end a weeklong hunt for the former L.A. police officer and Navy reserve lieutenant, who is also suspected of killing an Irvine couple and a Riverside police officer. But Los Angeles Police Chief Charlie Beck said he would not consider the manhunt over until a body was recovered and identified as Dorner.

"It is a bittersweet night," said Beck as he drove to the hospital where the injured deputy was undergoing surgery. "This could have ended much better, it could have ended worse. I feel for the family of the deputy who lost his life."

According to a manifesto Dorner allegedly posted on Facebook, he felt the LAPD unjustly fired him in 2009, when a disciplinary panel determined that he lied in accusing his training officer of kicking a mentally ill man during an arrest. Beck has promised to review the case.

Dorner, 33, vowed to wage "unconventional and asymmetrical warfare" against law enforcement officers and their families, the manifesto said. "Self-preservation is no longer important to me. do not fear death as I died long ago."

Last week, authorities had tracked Dorner to a wooded area near Big Bear Lake. They found his torched gray Nissan Titan with several weapons inside. The only trace of Dorner was a short trail of footprints in newly fallen snow.

On Tuesday morning two maids entered a cabin in the 1200 block of Club View Drive and ran into a man who they said resembled the fugitive, a law enforcement official said. The cabin was not far from where Dorner's singed truck had been found and where police had been holding press conferences about the manhunt.

The man tied up the maids, and he took off in a purple Nissan parked near the cabin. About 12:20 p.m., one of the maids broke free and called police.

Nearly half an hour later, officers with the California Department of Fish and Wildlife spotted the stolen vehicle and called for backup. The suspect turned down a side road in an attempt to elude the officers but crashed the vehicle, police said.

A short time later, authorities said the suspect carjacked a light-colored pickup truck. Allan Laframboise said the truck belonged to his friend Rick Heltebrake, who works at a nearby Boy Scout camp.

Heltebrake was driving on Glass Road with his Dalmatian, Suni, when a hulking African American man stepped into the road, Laframboise said. Heltebrake stopped. The man told him to get out of the truck.

"Can I take my dog?" Heltebrake asked, according to his friend.

"You can leave and you can take your dog," the man said. He then sped off in the Dodge extended-cab pickup — and quickly encountered two Department of Fish and Wildlife trucks.

As the suspect zoomed past the officers, he rolled down his window and fired about 15 to 20 rounds. One of the officers jumped out and shot a high-powered rifle at the fleeing pickup. The suspect abandoned the vehicle and took off on foot.

Police said he ended up at the Seven Oaks Mountain Cabins, a cluster of wood-frame buildings about halfway between Big Bear Lake and Yucaipa. The suspect exchanged gunfire with San Bernardino County sheriff's deputies as he fled into a cabin that locals described as a single-story, multi-room structure.

The suspect fired from the cabin, striking one deputy, law enforcement sources said. Then he ducked out the back of the cabin, deployed a smoke bomb and opened fire again, hitting a second deputy. Neither deputy was identified by authorities. The suspect retreated back into the cabin.

The gun battle was captured on TV by KCAL 9 reporter Carter Evans, who said he was about 200 feet from the cabin. As Evans described on air how deputies were approaching the structure, he was interrupted by 10 seconds of gunfire.

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North Korea Conducts 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 confirmed on Tuesday that it had conducted its third, long-threatened nuclear test, according to the official KCNA news service, posing a new challenge for the Obama administration in its effort to keep the country from becoming a full-fledged nuclear power.

The KCNA said it used a “miniaturized and lighter nuclear device with greater explosive force than previously” and that the test “did not pose any negative impact on the surrounding ecological environment.”

The test led to a crescendo of international condemnation Tuesday, with President Obama calling for “swift and credible action by the international community” against North Korea, and Russia, Britain, South Korea and the United Nations echoing the U.S. tone. The United Nations Security Council scheduled an emergency meeting at 9 a.m. New York time to take up the matter.

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. The Russian defense ministry was quoted as saying the blast surpassed 7 kilotons; the Hiroshima bomb had an explosive yield of 15 kilotons.

The test is 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 would “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 scheduled an emergency session as news of the blast played out.

The United Nations secretary-general Ban Ki-moon, condemned the test in a statement Tuesday.

The Obama administration has already threatened to take additional action to penalize the North through the United Nations in the event of a test. 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 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 independently if the test, 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. Jane Perlez contributed reporting from Beijing and Hiroko Tabuchi from Tokyo.

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It's a Girl for John Cho

Mom & Babies
Celebrity Baby Blog

02/11/2013 at 06:30 PM ET

Paul Drinkwater/NBC

Surprise: Actor John Cho is a dad again!

The Go On star and his wife welcomed a daughter recently, Cho’s rep confirms to PEOPLE exclusively.

Baby girl is the second child for the couple, who are also parents to a son. No further details are available.

Cho currently stars alongside Jason Bateman in Identity Thief and will reprise his role as Hikaru Sulu in Star Trek Into Darkness in May.

He is also well known for his roles in American Pie and the Harold and Kumar films.

– Anya Leon with reporting by Julie Jordan

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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.

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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.

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

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Metrolink executive quits after report cites accounting problems

A high-ranking Metrolink executive resigned over the weekend following a scathing report that revealed accounting irregularities, poor management and record-keeping that made it difficult for board members to understand the railroad's financial situation.

Metrolink officials said Monday that Nancy Weiford, the regional commuter line's chief financial officer, stepped down after a special committee assigned to look into the railroad's business practices revealed its findings at Friday's board meeting. They declined to comment further on Weiford's departure, saying that personnel matters are confidential.

In a statement, railroad officials said: "Metrolink takes very seriously the recent findings of Metrolink's Ad Hoc Finance Committee regarding the agency's financial management. As one of the nation's largest commuter rail systems, Metrolink has been, and continues to be, committed to sound financial practices."

Reached by The Times, Weiford declined to comment.

Describing the accounting system as a "morass," the internal report found that Metrolink has inadequate cash reserves to meet its current obligations and that another cash account was underfunded by an estimated $66 million. Certain funds were improperly commingled and poor record-keeping made it hard to track the railroad's cash flows, according to the committee findings.

Because of a lack of sound business practices, the report stated that board members were unable to make informed decisions or accurately understand the financial situation of Metrolink, which serves more than 40,000 riders a day from six Southern California counties.

"These are very significant issues. The committee shows deficiencies in the fundamental operating systems for our financial management," said Mike Hennessey, vice chairman of the Metrolink board and a board member for the Orange County Transportation Authority, one of Metrolink's member agencies.

Metrolink formed the finance committee in early 2012 at the request of Richard Katz, who serves on the boards of Metrolink and the Los Angeles County Metropolitan Transportation Authority.

Some of the accounting problems, Katz said, date back to the tenure of former Metrolink Chief Executive David Solow, who resigned after the deadly 2008 Metrolink crash in Chatsworth. Solow's replacement, John Fenton, identified some of the problems before he stepped down in May.

"The past couple of years, we've been focused on developing our safety culture," Katz said. "But we also have to be careful stewards of the taxpayers' and our customers' money. What has been going on has been unacceptable and it will be fixed."

The report recommended a variety of solutions: adopting basic accounting practices, maintaining adequate cash reserves, improvements in record-keeping, hiring financial consultants and working with the five county transportation agencies that help fund Metrolink.

Committee members concluded that if their findings and recommendations are not addressed, they could not recommend that Metrolink's member agencies provide the railroad additional funding.

Their report requested that Metrolink's new chief executive, Michael DePallo, who started in October, provide the board accurate financial statements going back two years, an assessment of the railroad's financial condition and a response to the committee findings within 30 days.

"A lot of work has to be done at Metrolink," said Carolyn Cavecche, a Metrolink board member from Orange County who served on the committee. "Changes need to be made on how we do business internally."

dan.weikel@latimes.com

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IHT Rendezvous: IHT Quick Read: Feb. 11

NEWS For months, Damascus has hunched in a defensive crouch as fighting raged in suburbs, but a rebel advance has created a new level of alarm and disorder. An employee of the New York Times reports from Damascus and Anne Barnard reports from Beirut.

President Obama will use his State of the Union speech on Tuesday to reinvigorate one of his signature national security objectives — drastically reducing nuclear arsenals around the world — after securing agreement in recent months with the United States military that the American nuclear force can be cut in size by roughly a third. David E. Sanger reports from Washington.

Scotland would have to renegotiate membership in the European Union and other international organizations if it votes for independence in a referendum next year, according to legal advice expected to be published Monday by the British government. Stephen Castle reports from London.

A Hong Kong television series has tapped into the tensions between the city’s residents and mainland Chinese visitors, striking a nerve on both sides of the border and drawing the attention of Chinese censors. Gerry Mullany reports from Hong Kong.

Several journalists who cover Myanmar said Sunday that they had received warnings from Google that their email accounts might have been hacked by “state-sponsored attackers.” Thomas Fuller reports from Bangkok.

The Financial Times is celebrating its 125th birthday Wednesday. While the print editions are fading, The F.T. has figured out how to make money from new outlets. Eric Pfanner reports.

EDUCATION The use of part-time faculty who have little possibility of tenure or permanent employment is increasingly common at U.S. colleges and universities. But European law gives workers more rights, and French workers are among the most protected in Europe — unless, it seems, they work for an American university. D. D. Gutenplan reports from Paris.

ARTS An exhibition at the Museo del Novecento in Milan celebrates Olivetti’s contribution to the design culture of the modern industrial era. Alice Rawsthorn reviews from Milan.

FASHION The blizzard kept Suzy Menkes from getting to the early New York fashion shows, so she pulled out her iPad to watch them online. Suzy Menkes writes from the virtual front row.

SPORTS England was the big winner of a second weekend of the 2013 European Six Nations rugby championship that ended with the perennial power France at the bottom of the table. Huw Richards reports from Paris.

As Gareth Bale of Tottenham and Cristiano Ronaldo of Madrid led their teams to victories this weekend, some wonder if they will be playing together next season. Rob Hughes reports from London.

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

Stylewatch
Style News Now

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

PHOTOS: SEE MORE GRAMMY RISK-TAKERS!

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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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Online:

Pediatrics: http://www.pediatrics.org

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