U.S. Sees Hazy Threat From Mali Militants





WASHINGTON — As Islamic militants methodically carved out a base in the desert of northern Mali over the past year, officials in Washington, Paris and African capitals struggling with military plans to drive the Islamists out of the country agreed on one principle: African troops, not European or American soldiers, would fight the battle of Mali.




But the surprise French assault last Friday to blunt the Islamists’ advance upended those plans and set off a cascading series of events, culminating in a raid on Wednesday by militants on a foreign-run gas field in Algeria. That attack threatens to widen the violence in an impoverished region and drag Western governments deeper into combating an incipient insurgency.


And yet the rush of events has masked the fact that officials in Washington still have only an impressionistic understanding of the militant groups that have established a safe haven in Mali, and they are deeply divided about whether some of these groups even pose a threat to the United States.


Moreover, the hostage situation in Algeria has only heightened concerns that a Western military intervention could transform militant groups that once had only a regional focus into avowed enemies of the United States — in other words, that the backlash might end up being worse than the original threat.


Largely for these reasons, the Obama administration adopted a strategy over the past year to contain the Islamists in Mali until African troops were ready to confront them, rather than to challenge them directly with an American military campaign of drone strikes or commando raids.


During Congressional testimony in June, Johnnie Carson, the assistant secretary of state for African affairs, played down the terrorist threat to the United States from Mali, saying that the Qaeda affiliate operating there “has not demonstrated the capability to threaten U.S. interests outside of West or North Africa, and it has not threatened to attack the U.S. homeland.”


Some Pentagon officials have long taken a more hawkish stance, and they cite intelligence reports that fighters with ties to Al Qaeda in the Islamic Maghreb, which has a loose affiliation to the remnants of Osama bin Laden’s terrorist network, played a role in the deadly attack in September on the American diplomatic compound in Benghazi, Libya. They have pushed for targeted strikes against Islamist leaders in northern Mali, arguing that killing the leadership could permanently cripple the strength of the militants.


The administration has embraced a targeted killing strategy elsewhere, notably in Pakistan, Yemen and Somalia, after top White House, Pentagon and C.I.A. officials determined that militants in those countries were bent on attacking the United States.


Asked if fighters from Al Qaeda in the Islamic Maghreb posed such an imminent threat, Gen. Carter F. Ham, the top American commander in Africa, said, “Probably not.” But, he said in an interview, “they subscribe to Al Qaeda’s ideology” and have said that their intent is to attack Westerners in Europe and, “if they could, back to the United States.”


Defense Secretary Leon E. Panetta made it clear on Wednesday that he considered the group a serious danger. “This is an Al Qaeda operation,” he told reporters while traveling in Italy, “and it is for that reason that we have always been concerned about their presence in Mali, because they would use it as a base of operations to do exactly what happened in Algeria.”


It is too early to judge the impact of the French-led offensive in Mali, which came after an urgent plea by Mali’s government for help in repelling Islamist fighters who were rapidly moving south. But on Wednesday, some American officials said that the hostage episode in Algeria could be just the beginning of a wave of attacks against foreigners in the region. And there is a chance that if the Americans taken hostage on Wednesday are killed by their captors, American officials might reconsider their pledges not to commit ground troops to the battle.


Elisabeth Bumiller and Michael R. Gordon contributed reporting.



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Tablet shipments in 2013 could be lower than previously expected









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The Bachelor Celebrates 25 Seasons






The Bachelor










01/15/2013 at 07:50 PM EST







Sean Lowe and past stars and contestants of The Bachelor


Warner Bros.


Happy anniversary!

The Bachelor's current star, Sean Lowe, was joined by past franchise favorites on Jan. 11 to celebrate 25 seasons of the hit ABC reality dating show.

The Texas hunk clinked glasses at the famed Agoura Hills, Calif., Bachelor mansion with series creator Mike Fleiss and past Bachelorettes Ali Fedotowsky, Trista Sutter, Jillian Harris, DeAnna Pappas and the show's most recent star, Emily Maynard.

Also on hand were former Bachelor Jason Mesnick and his wife, Molly, who is expecting the couple's first child in March, as well as former contestants Courtney Robertson, Michael and Stephen Stagliano, Erica Rose and Casey Shteamer.

Jake Pavelka was also there, though he didn't appear in a group photo (above).

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Risk to all ages: 100 kids die of flu each year


NEW YORK (AP) — How bad is this flu season, exactly? Look to the children.


Twenty flu-related deaths have been reported in kids so far this winter, one of the worst tolls this early in the year since the government started keeping track in 2004.


But while such a tally is tragic, that does not mean this year will turn out to be unusually bad. Roughly 100 children die in an average flu season, and it's not yet clear the nation will reach that total.


The deaths this year have included a 6-year-old girl in Maine, a 15-year Michigan student who loved robotics, and 6-foot-4 Texas high school senior Max Schwolert, who grew sick in Wisconsin while visiting his grandparents for the holidays.


"He was kind of a gentle giant" whose death has had a huge impact on his hometown of Flower Mound, said Phil Schwolert, the Texas boy's uncle.


Health officials only started tracking pediatric flu deaths nine years ago, after media reports called attention to children's deaths. That was in 2003-04 when the primary flu germ was the same dangerous flu bug as the one dominating this year. It also was an earlier than normal flu season.


The government ultimately received reports of 153 flu-related deaths in children, from 40 states, and most of them had occurred by the beginning of January. But the reporting was scattershot. So in October 2004, the government started requiring all states to report flu-related deaths in kids.


Other things changed, most notably a broad expansion of who should get flu shots. During the terrible 2003-04 season, flu shots were only advised for children ages 6 months to 2 years.


That didn't help 4-year-old Amanda Kanowitz, who one day in late February 2004 came home from preschool with a cough and died less than three days later. Amanda was found dead in her bed that terrible Monday morning, by her mother.


"The worst day of our lives," said her father, Richard Kanowitz, a Manhattan attorney who went on to found a vaccine-promoting group called Families Fighting Flu.


The Centers for Disease Control and Prevention gradually expanded its flu shot guidance, and by 2008 all kids 6 months and older were urged to get the vaccine. As a result, the vaccination rate for kids grew from under 10 percent back then to around 40 percent today.


Flu vaccine is also much more plentiful. Roughly 130 million doses have been distributed this season, compared to 83 million back then. Public education seems to be better, too, Kanowitz observed.


The last unusually bad flu season for children, was 2009-10 — the year of the new swine flu, which hit young people especially hard. As of early January 2010, 236 flu-related deaths of kids had been reported since the previous August.


It's been difficult to compare the current flu season to those of other winters because this one started about a month earlier than usual.


Look at it this way: The nation is currently about five weeks into flu season, as measured by the first time flu case reports cross above a certain threshold. Two years ago, the nation wasn't five weeks into its flu season until early February, and at that point there were 30 pediatric flu deaths — or 10 more than have been reported at about the same point this year. That suggests that when the dust settles, this season may not be as bad as the one only two years ago.


But for some families, it will be remembered as the worst ever.


In Maine, 6-year-old Avery Lane — a first-grader in Benton who had recently received student-of-the-week honors — died in December following a case of the flu, according to press reports. She was Maine's first pediatric flu death in about two years, a Maine health official said.


In Michigan, 15-year-old Joshua Polehna died two weeks ago after suffering flu-like symptoms. The Lake Fenton High School student was the state's fourth pediatric flu death this year, according to published reports.


And in Texas, the town of Flower Mound mourned Schwolert, a healthy, lanky 17-year-old who loved to golf and taught Sunday school at the church where his father was a youth pastor.


Late last month, he and his family drove 16 hours to spend the holidays with his grandparents in Amery, Wis., a small town near the Minnesota state line. Max felt fluish on Christmas Eve, seemed better the next morning but grew worse that night. The family decided to postpone the drive home and took him to a local hospital. He was transferred to a medical center in St. Paul, Minn., where he died on Dec. 29.


He'd been accepted to Oklahoma State University before the Christmas trip. And an acceptance letter from the University of Minnesota arrived in Texas while Max was sick in Minnesota, his uncle said.


Nearly 1,400 people attended a memorial service for Max two weeks ago in Texas.


"He exuded care and love for other people," Phil Schwolert said.


"The bottom line is take care of your kids, be close to your kids," he said.


On average, an estimated 24,000 Americans die each flu season, according to the Centers for Disease Control and Prevention. People who are elderly and with certain chronic health conditions are generally at greatest risk from flu and its complications.


The current vaccine is about 60 percent effective, and is considered the best protection available. Max Schwolert had not been vaccinated, nor had the majority of the other pediatric deaths.


Even if kids are vaccinated, parents should be watchful for unusually severe symptoms, said Lyn Finelli of the CDC.


"If they have influenza-like illness and are lethargic, or not eating, or look punky — or if a parent's intuition is the kid doesn't look right and they're alarmed — they need to call the doctor and take them to the doctor," she advised.


___


CDC advice on kids: http://www.cdc.gov/flu/protect/children.htm


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Dow, S&P 500 inch up with retailers but Apple drags again

NEW YORK (Reuters) - The Dow and S&P 500 edged higher on Tuesday after stronger-than-expected retail data, though tech heavyweight Apple dragged on the market for a third day.


Apple was the biggest weight on both the S&P 500 and Nasdaq 100 <.ndx> after reports on Monday of cuts to orders for iPhone parts. Shares declined 3.2 percent to $485.92 and closed below $500 for the first time since February.


Retail stocks advanced after a government report showing retail sales rose more than expected in December was seen as a favorable sign for fourth-quarter growth. A separate report showed manufacturing activity in New York state contracted for the sixth month in a row in January.


"A little better-than-expected news on retail sales once again reinforces that the consumer remains alive and reasonably well," said Mark Luschini, chief investment strategist at Janney Montgomery Scott in Philadelphia, which manages about $54 billion in assets.


Among retailers, American Eagle Outfitters Inc gained 4.8 percent to $20.58 and Gap Inc rose 3.4 percent to $32.46. The Morgan Stanley retail index <.mvr> advanced 1.5 percent.


Express Inc surged 23.8 percent to $17.40 after the apparel retailer raised its fourth-quarter and full year 2012 outlook.


The Dow Jones industrial average <.dji> was up 27.57 points, or 0.20 percent, at 13,534.89. The Standard & Poor's 500 Index <.spx> was up 1.66 points, or 0.11 percent, at 1,472.34. The Nasdaq Composite Index <.ixic> was down 6.72 points, or 0.22 percent, at 3,110.78.


Apple's stock has lost about 7 percent in the last three sessions and is down 8.7 percent since the start of the year.


"It's tough to discern exactly what's putting the pressure on it. But at the end of the day, its influence, considering it's still 3 1/2 to 4 percent of the S&P 500 index, is being felt," Luschini said.


"I attribute (it) to just some of the bloom coming off of the rose. They haven't necessarily done anything wrong, as much as others have caught up."


Also keeping investors on edge is the looming debt ceiling debate. On Monday, President Barack Obama rejected any negotiations with Republicans over raising the U.S. debt ceiling. The United States could default on its debt if Congress does not increase the borrowing limit.


Resolving the debt ceiling is more a question of how than if. Investors don't expect a U.S. default, but they are also wary of another eleventh-hour agreement like the one in August 2011.


An expected lackluster earnings season, too, kept investors from taking aggressive bets. Analyst estimates for the quarter have fallen sharply since October. S&P 500 earnings growth is now seen up just 1.8 percent from a year ago, Thomson Reuters data showed.


Homebuilder Lennar reported a sharp rise in quarterly profit, but the stock declined 0.8 percent to $40.68 on worries that growth in orders was slowing.


Dell Inc shares added to Monday's gains, ending up 7.2 percent to $13.17 after sources said talks to take the computer maker private are in an advanced stage.


On the down side, shares of Facebook dropped 2.7 percent to $30.10. The company unveiled a "graph search" feature that CEO Mark Zuckerberg said would help its billion-plus users sort through content within the social network and its content feeds.


Volume was roughly 5.8 billion shares traded on the New York Stock Exchange, the Nasdaq and the NYSE MKT, compared with the 2012 average daily closing volume of about 6.45 billion.


Advancers outpaced decliners on the NYSE by about 17 to 12 and on the Nasdaq by about 13 to 11.


(Additional reporting by Chuck Mikolajczak; Editing by Kenneth Barry and Nick Zieminski)



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Syrian Opposition Finds Hearts and Minds Are Elusive


Goran Tomasevic/Reuters


Rebel fighters in a neighborhood of Damascus on Tuesday. Many Syrians remain wary of the opposition and its assurances of how it would govern the country.







BEIRUT, Lebanon — As the Syrian civil war nears the two-year mark, the opponents of President Bashar al-Assad and their international backers have failed to win the backing of many government supporters, including minorities, a slice of the population whose help is essential not only to resolve the conflict, but also to keep Syria from becoming a failed state, analysts say.




Syrian opposition leaders in exile have repeatedly offered promises that a future Syria will guarantee equal rights to all citizens regardless of religion and ethnicity, including members of President Assad’s minority Alawite sect, and that government officials without “blood on their hands” will be safe. But that has done little to win the allegiance of a significant bloc of Syrians who are wary of the uprising.


“The opposition is in fact helping to hold the regime together,” said Peter Harling, an analyst with the International Crisis Group who meets in Syria with people on all sides of the conflict. “It seems to have no strategy to speak of when it comes to preserving what’s left of the state, wooing the Alawites within the regime or reaching out to those who don’t know who to hate most, the regime or the opposition.”


Analysts with contacts in Syria said that the opposition had failed to spell out how it would handle challenging political issues like the fate of the Baath Party, the army rank and file, and the public sector — which employs at least 1.2 million Syrians — or how it would curb sectarian violence and revenge killings. The opposition, critics say, has missed opportunities to split government support from within and has allowed Mr. Assad to portray himself to fence-sitters as the best bet to keep the Syrian state intact.


That vacuum, some analysts say, was the backdrop for Mr. Assad’s confident tone in a speech he gave on Jan. 6, when he offered to engage in political dialogue with opponents he considers acceptable.


Mr. Harling said the speech allowed Mr. Assad to try to persuade the undecided that he is still a plausible choice, and reflected a belief in the president’s circle — perhaps mistaken — that “people will ultimately come back to them, because they offer more of the prospect of a state.”


On Sunday, Russia’s foreign minister pointedly called on the opposition to offer specific counterproposals for a political solution rather than complain about Mr. Assad’s refusal to negotiate. And on Monday, Kofi Annan, the former United Nations secretary general, chided the United States and Russia for not working harder to bring the sides together, warning that the opposition’s insistence that Mr. Assad step down before any negotiations begin is perpetuating a stalemate and risking a descent into chaos.


The concerns come not only from Russia, Mr. Assad’s strongest ally, and Mr. Annan, who resigned as international envoy to Syria when his mediation efforts went nowhere. They are shared by a growing chorus of Middle East analysts, Syrian intellectuals and a former Syria adviser to the Obama administration, which has recognized the opposition as the country’s legitimate representative.


The former Syria adviser, Frederic C. Hof, wrote last month that although the opposition has offered general assurances to the one-third of Syrians who belong to minority groups, “probably no more than a handful” believe it, especially as jihadist groups grow more prominent on the battlefield and issue videotaped calls for the restoration of the Islamic caliphate.


“And why should they?” he wrote in an article published by the Atlantic Council, a research institute in Washington. “What would weigh heavier on the brain of a non-Sunni Arab (or a Sunni Arab committed to secular governance): the occasional word about the primacy of citizenship, or the televised chanting of hirsute warriors?”


Part of the problem is that the opposition, unlike the government, does not speak with one voice. It is divided among secular and religious members, exiles and those fighting inside Syria, and supporters and opponents of armed struggle. Even after reorganizing under pressure from the West, the coalition has yet to agree on a government in exile.


Yet, the coalition understands the danger, Samir Nachar, a member, said in an interview from Turkey.


“Everyone feels and knows that there is a real dilemma and danger when it comes to the morale of the Syrian citizen,” he said. “Unfortunately, we don’t have anything on the ground that can truly relieve the fears and the anxieties that are plaguing minorities at this time. Sadly, the Alawite sect has been taken hostage by this regime.”


Hania Mourtada and Kareem Fahim contributed reporting.



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Apple stock wilts on worries about iPhone demand






SAN FRANCISCO (AP) — Apple‘s stock slipped below $ 500 for the first time in 11 months on Monday as investors reacted to reports signaling the company’s latest iPhone is falling further behind a slew of sleek alternatives running Google’s Android software.


The latest indication that Apple, the world’s most valuable company, is seeing sluggish demand for its iPhone 5 emerged in separate stories published Monday in the Japanese newspaper Nikkei and The Wall Street Journal. Both publications cited unnamed people familiar with the situation saying Apple has dramatically reduced its orders for the parts needed to build the newest iPhone because the device isn’t selling as well as the company hoped.






The adjustment means Apple will buy about half as many display screens for the iPhone as management originally planned for the opening three months of the year, according to the newspapers.


Apple Inc., which is based in Cupertino, Calif., declined to comment Monday. Spokeswoman Natalie Kerris said Apple executives would share their views on market conditions Jan. 23 when the company is scheduled to release its financial results for the final three months of 2011. The period covers the first full quarter that the iPhone 5 was on sale.


Although Apple hailed the iPhone 5 as the best version yet of a product that has revolutionized the telecommunications and computing industry, the company’s stock has wilted since the device hit the market.


After peaking at $ 705.07 on the day of the iPhone 5′s Sept. 21 release, Apple’s stock has plunged nearly 30 percent. The shares fell $ 18.55, or 3.6 percent, to close Monday’s regular trading at $ 501.75, dragging the company’s market value nearly $ 190 billion below where it stood in late September. The stock traded at $ 498.51 earlier in the day, its lowest price since February.


The stock’s decline hasn’t been entirely caused by concerns about the iPhone 5′s sales performance. Industry analysts are also worried about the recent introduction of a smaller, less expensive iPad cutting into the company’s profits.


But the biggest fears hover around the iPhone because it has become Apple’s most valuable product since the company’s late CEO, Steve Jobs, unveiled the first model in 2007. Apple has sold more than 271 million of the devices since then, and in the company’s last fiscal year ending in September, the iPhone generated $ 80 billion in sales to account for more than half of the company’s total revenue.


But Apple’s upgrades of the iPhone in the past two years have disappointed gadget lovers who have been clamoring for Apple to do more to stay in front of device makers relying on the free Android software made by Google Inc. For instance, there were high hopes for a larger iPhone screen with the release of the 2011 model, but Apple waited until last September to take that leap. And when Apple moved to a larger display screen with the iPhone 5, it didn’t include a special chip to enable users to make mobile payments by tapping the handset on another device at the checkout stand. Such a mobile payment feature is available on some Android phones.


Finally, Apple has insisted that wireless carriers subsidize so much of the iPhone’s cost in exchange for customers’ two-year commitments on data plans that the carriers make little or no money by selling the devices. That has prompted more wireless carriers to tout less expensive Android phones in their stores, undercutting the demand for iPhones, said Darren Hayes, who has been studying the shifting market conditions as chairman of the computing systems program at Pace University in New York.


Through the third quarter of last year, Android devices represented 75 percent of smartphone shipments worldwide according to the research firm International Data Corp. That was up from 58 percent at the same point 2011. Meanwhile, Apple’s share of worldwide smartphone shipments has fallen from a peak of 23 percent in the fourth quarter of 2011 to 15 percent in the third quarter of last year.


Samsung Electronics, in particular, has been benefiting from the growing popularity of its Android-powered phones, led by its Galaxy S line. The company said Monday that it sold more than 100 million Galaxy S phones in less than three years. It took the iPhone nearly four years to reach that milestone.


“This is a real wake-up call for Apple,” Hayes said. “They need to be more flexible in how they do things.” Among other things, Hayes thinks Apple may have to reduce the financial burden on wireless carriers selling the iPhone and spend more money advertising the devices, especially with the recent wave of phones running on Microsoft Corp.’s Windows software. Apple’s efforts to sell more iPhones to companies also could be short-circuited if Research in Motion Ltd.’s upcoming release of a revamped BlackBerry proves to be a hit. The BlackBerry is due out Jan. 30.


In an attempt to regain its competitive edge, Apple already is considering the release of a less expensive version of the iPhone made of cheaper parts to boost sales in less affluent countries, according to a report last week in The Wall Street Journal. The company so far hasn’t commented on that speculation, either. The least expensive iPhone 5 without a wireless contract sells for $ 649. With the subsidy included with a two-year wireless service contract, the iPhone 5 sells for as little as $ 199.


Even as it loses ground to Android products, the iPhone remains a solid seller. Some analysts believe Apple sold more than 50 million iPhones in its last quarter ending in December, which would be far the most units that the company has ever shipped during any previous three-month period.


What’s more, the iPhone 5 got off to a torrid start in China, where Apple expects to eventually sell more devices than it does in the U.S. Apple said it sold more than two million iPhone 5s in the three days after its debut in China last month.


Wireless News Headlines – Yahoo! News





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Bachelor Sean Lowe: My Girl Must Love Dogs




For any of the 25 women looking to win over this season's Bachelor, Sean Lowe, here's a tip straight from the source: "The girl I'm dating must be into my dogs," he tells PEOPLE.

The proud pet parent to two pooches, a boxer named Lola and a chocolate Labrador named Ellie, Lowe says, "For so long it's just been me and my two dogs, and I'm certainly not going to replace them with any woman."

Having had both animals for the past six years, the hunk has developed a special bond with the duo – though he admits his quest for love has forced him to make some changes.

"For many years, my dogs would sleep in the bed with me," he says. "I'm a big guy and I've got two good-sized dogs, so it's a full bed. Then I just realized one day, 'Alright, if I get married and a woman's going to join me in the bed, there's not going to be enough room.' I had to break the dogs of the habit of sleeping in the bed."

Luckily for Lowe, the pair have taken to their new accommodations easily.

"They're very intelligent dogs; they pick up on things really quickly," he says. "They learn pretty fast."

To hear more from Sean Lowe – including how his dogs help him navigate the dating world – check out the video above.

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Hospitals crack down on workers refusing flu shots


CHICAGO (AP) — Patients can refuse a flu shot. Should doctors and nurses have that right, too? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.


"Where does it say that I am no longer a patient if I'm a nurse," wondered Carrie Calhoun, a longtime critical care nurse in suburban Chicago who was fired last month after she refused a flu shot.


Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.


Most doctors and nurses do get flu shots. But in the past two months, at least 15 nurses and other hospital staffers in four states have been fired for refusing, and several others have resigned, according to affected workers, hospital authorities and published reports.


In Rhode Island, one of three states with tough penalties behind a mandatory vaccine policy for health care workers, more than 1,000 workers recently signed a petition opposing the policy, according to a labor union that has filed suit to end the regulation.


Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will prevent flu in patients.


Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.


"We would all like to see stronger data," she said. But other evidence shows flu vaccination "significantly decreases" flu cases, she said. "It should work the same in a health care worker versus somebody out in the community."


Cancer nurse Joyce Gingerich is among the skeptics and says her decision to avoid the shot is mostly "a personal thing." She's among seven employees at IU Health Goshen Hospital in northern Indiana who were recently fired for refusing flu shots. Gingerich said she gets other vaccinations but thinks it should be a choice. She opposes "the injustice of being forced to put something in my body."


Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.


"If you don't want to do it, you shouldn't work in that environment," said Caplan, medical ethics chief at New York University's Langone Medical Center. "Patients should demand that their health care provider gets flu shots — and they should ask them."


For some people, flu causes only mild symptoms. But it can also lead to pneumonia, and there are thousands of hospitalizations and deaths each year. The number of deaths has varied in recent decades from about 3,000 to 49,000.


A survey by CDC researchers found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.


At Calhoun's hospital, Alexian Brothers Medical Center in Elk Grove Village, Ill., unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. She says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.


The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."


The government recommends flu shots for nearly everyone, starting at age 6 months. Vaccination rates among the general public are generally lower than among health care workers.


According to the most recent federal data, about 63 percent of U.S. health care workers had flu shots as of November. That's up from previous years, but the government wants 90 percent coverage of health care workers by 2020.


The highest rate, about 88 percent, was among pharmacists, followed by doctors at 84 percent, and nurses, 82 percent. Fewer than half of nursing assistants and aides are vaccinated, Bridges said.


Some hospitals have achieved 90 percent but many fall short. A government health advisory panel has urged those below 90 percent to consider a mandatory program.


Also, the accreditation body over hospitals requires them to offer flu vaccines to workers, and those failing to do that and improve vaccination rates could lose accreditation.


Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.


Several leading doctor groups support mandatory flu shots for workers. And the American Medical Association in November endorsed mandatory shots for those with direct patient contact in nursing homes; elderly patients are particularly vulnerable to flu-related complications. The American Nurses Association supports mandates if they're adopted at the state level and affect all hospitals, but also says exceptions should be allowed for medical or religious reasons.


Mandates for vaccinating health care workers against other diseases, including measles, mumps and hepatitis, are widely accepted. But some workers have less faith that flu shots work — partly because there are several types of flu virus that often differ each season and manufacturers must reformulate vaccines to try and match the circulating strains.


While not 100 percent effective, this year's vaccine is a good match, the CDC's Bridges said.


Several states have laws or regulations requiring flu vaccination for health care workers but only three — Arkansas, Maine and Rhode Island — spell out penalties for those who refuse, according to Alexandra Stewart, a George Washington University expert in immunization policy and co-author of a study appearing this month in the journal Vaccine.


Rhode Island's regulation, enacted in December, may be the toughest and is being challenged in court by a health workers union. The rule allows exemptions for religious or medical reasons, but requires unvaccinated workers in contact with patients to wear face masks during flu season. Employees who refuse the masks can be fined $100 and may face a complaint or reprimand for unprofessional conduct that could result in losing their professional license.


Some Rhode Island hospitals post signs announcing that workers wearing masks have not received flu shots. Opponents say the masks violate their health privacy.


"We really strongly support the goal of increasing vaccination rates among health care workers and among the population as a whole," but it should be voluntary, said SEIU Healthcare Employees Union spokesman Chas Walker.


Supporters of health care worker mandates note that to protect public health, courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.


Cases involving flu vaccine mandates for health workers have had less success. A 2009 New York state regulation mandating health care worker vaccinations for swine flu and seasonal flu was challenged in court but was later rescinded because of a vaccine shortage. And labor unions have challenged individual hospital mandates enacted without collective bargaining; an appeals court upheld that argument in 2007 in a widely cited case involving Virginia Mason Hospital in Seattle.


Calhoun, the Illinois nurse, says she is unsure of her options.


"Most of the hospitals in my area are all implementing these policies," she said. "This conflict could end the career I have dedicated myself to."


__


Online:


R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf


CDC: http://www.cdc.gov


___


AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner


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Apple drags on S&P, Nasdaq; Dell jumps after report

NEW YORK (Reuters) - The S&P 500 and Nasdaq ended lower on Monday as worries over demand for Apple products drove down its shares and investors braced for earnings disappointments.


Running counter to that was Dell Inc's stock which jumped 13 percent to about a five-month high at $12.29 after Bloomberg reported the No. 3 personal computer maker is in talks with private equity firms to go private. Dell's gains offset some tech-sector weakness.


Tech heavyweight Apple lost 3.6 percent to $501.75 and was the biggest weight on both the S&P 500 and Nasdaq 100 <.ndx> indexes after reports the company has cut orders for LCD screens and other parts for the iPhone 5 this quarter due to weak demand. The stock hit a session low of $498.51, the first dip below $500 since February 16.


"With Apple, it seems as if the sentiment has shifted from this being the one stock that everybody wanted to own to people beginning to look at it as a company (whose) business is slowing down somewhat," said Eric Kuby, chief investment officer of North Star Investment Management Corp in Chicago.


Adding to investor unease, fourth-quarter earnings kick into high gear this week. Analyst estimates for the quarter have fallen sharply since October. S&P 500 earnings growth is now seen up just 1.9 percent from a year ago, Thomson Reuters data showed.


The Dow Jones industrial average <.dji> was up 18.89 points, or 0.14 percent, at 13,507.32. The Standard & Poor's 500 Index <.spx> was down 1.37 points, or 0.09 percent, at 1,470.68. The Nasdaq Composite Index <.ixic> was down 8.13 points, or 0.26 percent, at 3,117.50.


Apple suppliers also lost ground, with Cirrus Logic off 9.4 percent at $28.62 and Qualcomm down 1 percent at $64.24.


The Dow fared better than the other two indexes, helped in part by Hewlett-Packard shares, which rose 4.9 percent to $16.95. The stock, up early in the session after JPMorgan upgraded its rating on the shares and raised its price target to $21 from $15, added to gains following the Dell report.


Tech has "become the arena for private equity or other capital-restructuring type of maneuvers because of the way their valuations and their balance sheets are," Kuby said.


Appliance and electronics retailer Hhgregg Inc slumped 5.7 percent to $7.44 after the company cut its same-store sales forecast for the full year.


Earnings reports are due this week from Goldman Sachs , Bank of America , Intel and General Electric , among other companies. Third-quarter reports ended with a gain of just 0.1 percent, the worst for an S&P 500 profit period in three years, according to Thomson Reuters data.


President Barack Obama warned Congress at a news conference on Monday that a refusal to raise the U.S. debt ceiling next month could mean a government shutdown and trigger economic chaos.


S&P futures had little reaction to comments after the bell by Federal Reserve Chairman Ben Bernanke, who urged lawmakers to lift the country's borrowing limit to avoid a debt default.


Volume was roughly 5.6 billion shares traded on the New York Stock Exchange, the Nasdaq and the NYSE MKT, compared with the 2012 average daily closing volume of about 6.45 billion.


Decliners were about even with advancers on the NYSE while decliners outpaced advancers on the Nasdaq by about 12 to 11.


(Additional reporting by Chuck Mikolajczak; Editing by Kenneth Barry, Nick Zieminski and Andrew Hay)



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