ER visits tied to energy drinks double since 2007


SAN FRANCISCO (AP) — A new government survey suggests the number of people seeking emergency treatment after consuming energy drinks has doubled nationwide during the past four years, the same period in which the supercharged drink industry has surged in popularity in convenience stores, bars and on college campuses.


From 2007 to 2011, the government estimates the number of emergency room visits involving the neon-labeled beverages shot up from about 10,000 to more than 20,000. Most of those cases involved teens or young adults, according to a survey of the nation's hospitals released late last week by the Substance Abuse and Mental Health Services Administration.


The report doesn't specify which symptoms brought people to the emergency room but calls energy drink consumption a "rising public health problem" that can cause insomnia, nervousness, headache, fast heartbeat and seizures that are severe enough to require emergency care.


Several emergency physicians said they had seen a clear uptick in the number of patients suffering from irregular heartbeats, anxiety and heart attacks who said they had recently downed an energy drink.


More than half of the patients considered in the survey who wound up in the emergency room told doctors they had downed only energy drinks. In 2011, about 42 percent of the cases involved energy drinks in combination with alcohol or drugs, such as the stimulants Adderall or Ritalin.


"A lot of people don't realize the strength of these things. I had someone come in recently who had drunk three energy drinks in an hour, which is the equivalent of 15 cups of coffee," said Howard Mell, an emergency physician in the suburbs of Cleveland, who serves as a spokesman for the American College of Emergency Physicians. "Essentially he gave himself a stress test and thankfully he passed. But if he had a weak heart or suffered from coronary disease and didn't know it, this could have precipitated very bad things."


The findings came as concerns over energy drinks have intensified following reports last fall of 18 deaths possibly tied to the drinks — including a 14-year-old Maryland girl who died after drinking two large cans of Monster Energy drinks. Monster does not believe its products were responsible for the death.


Two senators are calling for the Food and Drug Administration to investigate safety concerns about energy drinks and their ingredients.


The energy drink industry says its drinks are safe and there is no proof linking its products to the adverse reactions.


Late last year, the FDA asked the U.S. Health and Human Services to update the figures its substance abuse research arm compiles about emergency room visits tied to energy drinks.


The Substance Abuse and Mental Health Services Administration's survey was based on responses it receives from about 230 hospitals each year, a representative sample of about 5 percent of emergency departments nationwide. The agency then uses those responses to estimate the number of energy drink-related emergency department visits nationwide.


The more than 20,000 cases estimated for 2011 represent a small portion of the annual 136 million emergency room visits tracked by Centers for Disease Control and Prevention.


The FDA said it was considering the findings and pressing for more details as it undertakes a broad review of the safety of energy drinks and related ingredients this spring.


"We will examine this additional information ... as a part of our ongoing investigation into potential safety issues surrounding the use of energy-drink products," FDA spokeswoman Shelly Burgess said in a statement.


Beverage manufacturers fired back at the survey, saying the statistics were misleading and taken out of context.


"This report does not share information about the overall health of those who may have consumed energy drinks, or what symptoms brought them to the ER in the first place," the American Beverage Association said in a statement. "There is no basis by which to understand the overall caffeine intake of any of these individuals — from all sources."


Energy drinks remain a small part of the carbonated soft drinks market, representing only 3.3 percent of sales volume, according to the industry tracker Beverage Digest. Even as soda consumption has flagged in recent years, energy drinks sales are growing rapidly.


In 2011, sales volume for energy drinks rose by almost 17 percent, with the top three companies — Monster, Red Bull and Rockstar — each logging double-digit gains, Beverage Digest found. The drinks are often marketed at sporting events that are popular among younger people such as surfing and skateboarding.


From 2007 to 2011, the most recent year for which data was available, people from 18 to 25 were the most common age group seeking emergency treatment for energy drink-related reactions, the report found.


"We were really concerned to find that in four years the number of emergency department visits almost doubled, and these drinks are largely marketed to younger people," said Al Woodward, a senior statistical analyst with the Substance Abuse and Mental Health Services Administration who worked on the report.


Emergency physician Steve Sun said he had seen an increase in such cases at the Catholic hospital where he works on the edge of San Francisco's Golden Gate Park.


"I saw one young man who had mixed energy drinks with alcohol and we had to admit him to the hospital because he was so dehydrated he had renal failure," Sun said. "Because he was young he did well in the hospital, but if another patient had had underlying coronary artery disease, it could have led to a heart attack."


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


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Director defends 'Zero Dark Thirty' torture scenes


LOS ANGELES (AP) — Director Kathryn Bigelow defends torture scenes in her Oscar-nominated film "Zero Dark Thirty," saying torture was an undeniable part of the hunt for Osama bin Laden after the terrorist attacks on Sept. 11, 2001.


The film opens by declaring it's based on firsthand accounts of actual events.


But Sen. Dianne Feinstein, D-Calif., and other lawmakers criticized the film as misleading for suggesting torture led to the location of bin Laden. Lawmakers asked Sony Pictures to attach a disclaimer that the film is fictional.


"Experts disagree sharply on the facts and particulars of the intelligence hunt, and doubtlessly that debate will continue," Bigelow wrote in the Los Angeles Times on Wednesday.


The comments were Bigelow's most explicit reaction to the controversy so far.


"As for what I personally believe, which has been the subject of inquiries, accusations and speculation, I think Osama bin Laden was found due to ingenious detective work," she continued. "Torture was, however, as we all know, employed in the early years of the hunt. That doesn't mean it was the key to finding bin Laden. It means it is a part of the story we couldn't ignore."


"War, obviously, isn't pretty, and we were not interested in portraying this military action as free of moral consequences," she added.


Bigelow wrote that torture was part of the story and the backlash may be misdirected.


"I do wonder if some of the sentiments alternately expressed about the film might be more appropriately directed at those who instituted and ordered these U.S. policies, as opposed to a motion picture that brings the story to the screen," she wrote.


Last week, Sony Pictures co-chair Amy Pascal responded forcefully to a "Zero Dark Thirty" anti-Oscar campaign waged by Ed Asner and other Hollywood actors, saying "to punish an artist's right of expression is abhorrent."


Bigelow and "Zero Dark Thirty" screenwriter Mark Boal had said previously that they "depicted a variety of controversial practices and intelligence methods that were used in the name of finding bin Laden.


"The film shows that no single method was necessarily responsible for solving the manhunt, nor can any single scene taken in isolation fairly capture the totality of efforts the film dramatizes," they said.


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Japanese airlines ground Dreamliners









Japan's two leading airlines grounded their fleets of Boeing 787s on Wednesday after one of the Dreamliner passenger jets made an emergency landing, the latest in a series of incidents to heighten safety concerns over a plane many see as the future of commercial aviation.

Shares in the Chicago-based Boeing Co. were down 4.4 percent in premarket trading on the news.


All Nippon Airways Co. said instruments aboard a domestic flight indicated a battery error, triggering emergency warnings to the pilots. Shigeru Takano, a senior safety official at the Civil Aviation Bureau, said a second warning light indicated smoke.





Wednesday's incident, described by a transport ministry official as "highly serious" - language used in international safety circles as indicating there could have been an accident -- is the latest in a line of mishaps -- fuel leaks, a battery fire, wiring problem, brake computer glitch and cracked cockpit window - to hit the world's first mainly carbon-composite airliner in recent days.


"I think you're nearing the tipping point where they need to regard this as a serious crisis," said Richard Aboulafia, a senior analyst with the Teal Group inFairfax, Virginia. "This is going to change people's perception of the aircraft if they don't act quickly."


ANA, which said the battery in the forward cargo hold was the same lithium-ion type as one involved in a fire on another Dreamliner at a U.S. airport last week, grounded all 17 of its 787s, and Japan Airlines Co suspended its 787 flights scheduled for Wednesday and Thursday.


The two airlines, which operate around half of the 50 Dreamliners delivered to date, said they would decide on Thursday whether to resume Dreamliner flights the following day.


COMPREHENSIVE REVIEW


The 787, which has a list price of $207 million, represents a leap in the way planes are designed and built, but the project has been plagued by cost overruns and years of delays. Some have suggested Boeing's rush to get planes built after those delays resulted in the recent problems, a charge the company strenuously denies.


Both the U.S.Federal Aviation Administration (FAA) and the National Transportation Safety Board (NTSB) said they were monitoring the latest incident as part of a comprehensive review of the Dreamliner announced late last week.


ALARM TRIGGERED


ANA flight 692 left Yamaguchi in western Japan shortly after 8 a.m. local time (2300 GMT Tuesday) bound for Haneda Airport near Tokyo, a 65-minute flight. About 18 minutes into the flight, the plane descended and made an emergency landing 16 minutes later, according to flight-tracking website Flightaware.com.


A spokesman for Osaka airport authority said the plane landed at Takamatsu at 8:45 a.m. All 129 passengers and eight crew evacuated via the plane's inflatable chutes. Chief Cabinet Secretary Yoshihide Suga said five people were slightly injured.


At a news conference - where ANA's vice-president Osamu Shinobe bowed deeply in apology - the carrier said a battery in the forward cargo hold triggered emergency warnings to the pilots, who decided on the emergency action. "There was a battery alert in the cockpit and there was an odd smell detected in the cockpit and cabin, and (the pilot) decided to make an emergency landing," Shinobe said.


In a statement later, ANA said the main battery in the forward electrical equipment bay was discolored and there were signs of leakage.


Passengers leaving the flight told local TV there was an odor like burning plastic on the plane as soon as it took off. "There was a bad smell as soon as we started and before we made the emergency landing there was an announcement and the stewardess' voice was shaking, so I thought this was serious," one passenger toldTBS TV.


Another man told a local broadcaster: "There was a strong, burning smell, but the smoke appeared after they opened the emergency doors, after we landed."


Marc Birtel, a Boeing spokesman, told Reuters: "We've seen the reports, we're aware of the events and are working with our customer."


Robert Stallard, analyst at RBC Capital Markets, said lost revenue at the Japanese airlines could prompt compensation from Boeing. "What started as a series of relatively minor, isolated incidents now threatens to overhang Boeing until it can return confidence, and this looks to be a near-term challenge given the media's draw to all things 787," he said.


UNDER REVIEW





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City seeks to settle cop misconduct cases for nearly $33 million

Chicago Tribune reporter David Heinzmann on news that Mayor Rahm Emanuel seeks to settle two notorious cases of alleged police misconduct. (Posted Jan. 14th, 2013)









Nearly seven years after Christina Eilman wandered out of a South Side police station and into a catastrophe, her tragic entanglement with the Chicago Police Department began to come to an end Monday — with a proposed $22.5 million legal settlement that may be the largest the city ever offered to a single victim of police misconduct.


Though the settlement is a staggering sum on its own, Mayor Rahm Emanuel's administration has placed a second eight-figure police settlement on today's City Council Finance Committee agenda. A $10.2 million settlement is proposed for one of the victims of notorious former police Cmdr. Jon Burge, bringing to nearly $33 million the amount aldermen could vote to pay victims of police misconduct in a single day.


The latest Burge settlement would be for Alton Logan, who spent 26 years in prison for a murder he did not commit and who alleged in a federal lawsuit that Burge's team of detectives covered up evidence that would have exonerated him — a departure from previous cases that documented torture used by Burge's team to extract false confessions. The Logan case would bring the tab on Burge cases to nearly $60 million when legal fees are counted. Burge is serving 41/2 years in federal prison for lying about the torture and abuse of suspects.








The settlement in the Eilman case would avert a trial detailing the events of May 2006, when the then-21-year-old California woman was arrested at Midway Airport in the midst of a bipolar breakdown. She was held overnight and then released at sundown the next day without assistance several miles away in one of the city's highest-crime neighborhoods.


Alone and bewildered by her surroundings, the former UCLA student was abducted and sexually assaulted before plummeting from a seventh-floor window. She survived but suffered a severe and permanent brain injury, a shattered pelvis, and numerous other broken bones and injuries.


Her lawyer and family declined to comment Monday. The case, which has dragged in the courts for six years, was set to begin trial next week. Pretrial litigation had produced scathing rebukes from federal judges of the city's behavior toward Eilman — both on the street and in court.


The city's argument that it was not responsible for her injuries because she was assaulted by a gang member was blasted in a ruling from the 7th U.S. Circuit Court of Appeals this year. a ruling from the 7th U.S. Circuit Court of Appeals this year. Chief Judge Frank Easterbrook described the Police Department's release of Eilman, who is white, into a high-crime, predominantly African-American neighborhood by saying officers "might as well have released her into the lion's den at the Brookfield Zoo."


While Emanuel's Law Department endured some criticism for delays in the Eilman case since the mayor took office in 2011, he has noted repeatedly that the police misconduct highlighted in these and many other cases are legacies from the Richard M. Daley administration that he — and taxpayers — are stuck with.


The mayor's office referred calls to the city Law Department, but a spokesman there declined to comment.


If approved, the Eilman settlement would surpass the $18 million settlement paid to the family of LaTanya Haggerty, who was mistakenly shot and killed by police in 1999. It is frequently referred to as the city's biggest single-victim settlement.


Ald. Howard Brookins Jr., 21st, said city officials have not taken a hard enough line against police misconduct for years, and now taxpayers are footing the bill.


"We've known this was going to bust our budget, and here we are," Brookins said. "The administration (under Daley) should have made police conduct and behavior a higher priority. They didn't, and now we're seeing these costly settlements over and over, to pay for officers mistreating people."


The Logan case was set to go to trial last month, but on the first day of jury selection, city lawyers decided to settle the case. Logan's attorney Jon Loevy said the settlement includes about $1.5 million in legal fees.


Logan sat in prison for 26 years until a stunning 2008 revelation after another man, convicted murderer Andrew Wilson, died. Wilson had told his attorneys in 1982 that he committed the murder in which Logan was accused, but the lawyers said the attorney-client privilege kept them from going public with the admission until after Wilson's death.


Although relieved the city settled the case instead of battling on, Loevy said his client would gladly give up the $8.7 million to have nearly three decades of his life back.


"I don't know who would take that much money to lose their 20s, 30s and 40s," Loevy said. "From his perspective, no amount of money can make him whole and he'd rather have his life back."


While Logan lost the middle chunk of his life, Eilman dwells in a childlike mental state and feels as though she has lost the rest of her life, her family has told the Tribune.


Hobbled by a brain injury that has permanently impaired her cognitive function, she lives with her parents in suburban Sacramento. She requires constant medical treatment and therapy. Doctors have said she will not get better.


Eilman came to Chicago on May 5, 2006, at a time when her bipolar condition was worsening. When she tried to catch a return flight from Midway to California a couple of days later, she was ranting and screaming and appeared to be out of her mind.


Police officers eventually arrested her and took her to the Chicago Lawn district near Midway. Court records and depositions in the case show that officers were alarmed by Eilman's behavior.





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SAP fourth-quarter revenue misses expectations


FRANKFURT (Reuters) - Germany's SAP reported fourth-quarter revenue on Tuesday that missed expectations as the world's biggest business software maker failed to keep up with Oracle, its main competitor.


SAP said group revenue for the three months through December rose 12 percent to 5.06 billion euros ($6.8 billion), below analyst consensus of 5.17 billion, according to Reuters data.


Operating profit rose more slowly than revenues, gaining 10 percent to 1.96 billion euros, resulting in SAP's operating margin narrowing by 0.8 percentage points to 38.8 percent.


SAP shares slid on the news and were down 4.5 percent at the bottom of a 2.2 percent weaker sector index by 1340 GMT.


"Especially after their main competitor Oracle managed to beat estimates last month, many had hoped that SAP would follow suit," said Markus Huber at ETX Capital.


"Even by missing estimates by a very small margin, and despite having had an overall excellent 2012, investors are venting their disappointment by dumping the stock heavily," he added.


Oracle Corp, the world's No. 3 software maker, last month forecast strong sales for 2013 after posting a 17 percent jump in quarterly software revenue.


SAP is due to publish full financial results and a full-year outlook on January 23.


"Guidance could be slightly below current consensus and expectations may be revised lower," Barclays analyst Gerardus Vos said in a note.


($1 = 0.7482 euros)


(Reporting by Maria Sheahan)



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Oprah: Lance Armstrong admitted doping


AUSTIN, Texas (AP) — Lance Armstrong has finally come clean.


Armstrong confessed to doping during an interview with Oprah Winfrey taped Monday, just a couple of hours after a wrenching apology to staff at the Livestrong charity he founded and has now been forced to surrender.


The day ended with 2 1/2 hours of questions from Winfrey at a downtown Austin hotel, where she said the world's most famous cyclist was "forthcoming" as she asked him in detail about doping allegations that followed him throughout his seven Tour de France victories.


Speaking on "CBS This Morning," Winfrey said Tuesday she had not planned to address Armstrong's confession before the interview aired on her OWN network but, "by the time I left Austin and landed in Chicago, you all had already confirmed it."


"So I'm sitting here now because it's already been confirmed," she added.


The session was to be broadcast on Thursday but Winfrey said it will now run in two parts over two nights because there is so much material.


Winfrey would not characterize whether Armstrong seemed contrite but said he seemed ready for the interview. "I would say that he met the moment," she said.


"I don't think 'emotional' begins to describe the intensity or the difficulty he experienced in talking about some of these things."


The confession was a stunning reversal for a proud athlete and celebrity who sought lavish praise in the court of public opinion and used courtrooms to punish his critics.


For more than a decade, Armstrong dared anybody who challenged his version of events to prove it. Finally, he told the tale himself after promising over the weekend to answer Winfrey's questions "directly, honestly and candidly."


The cyclist was stripped of his Tour titles, lost most of his endorsements and was forced to leave Livestrong last year after the U.S. Anti-Doping Agency issued a damning, 1,000-page report that accused him of masterminding a long-running doping scheme.


The International Cycling Union, or UCI, issued a statement on Tuesday saying it was aware of the reports that Armstrong had confessed to Winfrey. The governing body for the sport urged Armstrong to tell his story to an independent commission it has set up to examine claims it covered up suspicious samples from the cyclist, accepted financial donations from him and helped him avoid detection in doping tests.


Armstrong started Monday with a visit to the headquarters of Livestrong, the charity he founded in 1997 and turned into a global force on the strength of his athletic dominance and personal story of surviving testicular cancer that had spread to his lungs and brain.


About 100 Livestrong staff members gathered in a conference room as Armstrong told them "I'm sorry." He choked up during a 20-minute talk, expressing regret for the long-running controversy tied to performance-enhancers had caused, but stopped short of admitting he used them.


Before he was done, several members were in tears when he urged them to continue the charity's mission, helping cancer patients and their families.


"Heartfelt and sincere," is how Livestrong spokeswoman Katherine McLane described his speech.


Armstrong later huddled with almost a dozen people before stepping into a room set up at a downtown Austin hotel for the interview with Winfrey. The group included close friends and lawyers. They exchanged handshakes and smiles, but declined comment.


Winfrey has promoted her interview, one of the biggest for OWN since she launched the network in 2011, as a "no-holds barred" session, and after the voluminous USADA report — which included testimony from 11 former teammates — she said she went into the session with 112 questions ready to go. Not all of them were asked, she said, but many were.


USADA chief executive Travis Tygart, a longtime critic of Armstrong's, called the drug regimen practiced while Armstrong led the U.S. Postal Service team "the most sophisticated, professionalized and successful doping program that sport has ever seen." USADA did not respond to requests for comment about Armstrong's confession.


For years, Armstrong went after his critics ruthlessly during his reign as cycling champion. He scolded some in public and didn't hesitate to punish outspoken riders during the race itself. He waged legal battles against still others in court.


At least one of his opponents, the London-based Sunday Times, has already filed a lawsuit to recover about $500,000 it paid him to settle a libel case, and Dallas-based SCA Promotions, which tried to deny Armstrong a promised bonus for a Tour de France win, has threatened to bring another lawsuit seeking to recover more than $7.5 million awarded by an arbitration panel.


In Australia, the government of South Australia state said Tuesday it will seek the repayment of several million dollars in appearance fees paid to Armstrong for competing in the Tour Down Under in 2009, 2010 and 2011.


"We'd be more than happy for Mr. Armstrong to make any repayment of monies to us," South Australia Premier Jay Weatherill said.


Betsy Andreu, the wife of former Armstrong teammate Frankie Andreu, was one of the first to publicly accuse Armstrong of using performance-enhancing drugs. She called news of Armstrong's confession "very emotional and very sad," and choked up when asked to comment.


"He used to be one of my husband's best friends and because he wouldn't go along with the doping, he got kicked to the side," she said. "Lance could have a positive impact if he tells the truth on everything. He's got to be completely honest."


Betsy Andreu testified in SCA's arbitration case challenging the bonus in 2005, saying Armstrong admitted in an Indiana hospital room in 1996 that he had taken many performance-enhancing drugs, a claim Armstrong vehemently denied.


"It would be nice if he would come out and say the hospital room happened," Andreu said. "That's where it all started."


Former teammate Floyd Landis, who was stripped of the 2006 Tour de France title for doping, has filed a federal whistle-blower lawsuit that accused Armstrong of defrauding the U.S. Postal Service. An attorney familiar with Armstrong's legal problems told the AP that the Justice Department is highly likely to join the lawsuit. The False Claims Act lawsuit could result in Armstrong paying a substantial amount of money to the U.S. government. The deadline for the department to join the case is Thursday, though the department could seek an extension if necessary.


According to the attorney, who works outside the government, the lawsuit alleges that Armstrong defrauded the U.S. government based on his years of denying use of performance-enhancing drugs. The attorney spoke on condition of anonymity because the source was not authorized to speak on the record about the matter.


The lawsuit most likely to be influenced by a confession might be the Sunday Times case. Potential perjury charges stemming from Armstrong's sworn testimony in the 2005 arbitration fight would not apply because of the statute of limitations. Armstrong was not deposed during the federal investigation that was closed last year.


Armstrong is said to be worth around $100 million. But most sponsors dropped him after USADA's scathing report — at the cost of tens of millions of dollars — and soon after, he left the board of Livestrong.


After the USADA findings, he was also barred from competing in the elite triathlon or running events he participated in after his cycling career. World Anti-Doping Code rules state his lifetime ban cannot be reduced to less than eight years. WADA and U.S. Anti-Doping officials could agree to reduce the ban further depending on what information Armstrong provides and his level of cooperation.


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Litke reported from Chicago. Pete Yost in Washington also contributed to this report.


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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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AP NewsBreak: Rewrite for National Book Awards


NEW YORK (AP) — The National Book Awards are getting a rewrite.


New rules announced Tuesday include a "long list" of 10 nominees to be offered for each of the four competitive categories before being narrowed to the traditional five finalists. And the pool of judges will be expanded beyond writers to include critics, booksellers and librarians.


The changes are the most extensive since the mid-1990s for the awards, presented each fall by the National Book Foundation, as the major New York publishers attempt to broaden their appeal. The publishers have been unhappy with the selection of fiction finalists in recent years and the omission of such high-profile works as Jonathan Franzen's "Freedom" and Marilynne Robinson's "Gilead."


The expansion to 10 mirrors a recent change in the Oscars, but foundation board members said they had been looking to Britain's popular Man Booker Prize as a model.


"We just basically borrowed some of their ideas," said foundation board vice president and Grove/Atlantic CEO Morgan Entrekin, citing the Bookers' use of long lists and non-writers as judges. "The Bookers do a fantastic job at getting a conversation going about good books. With the long list, for instance, you get this conversation bubbling up about what made it and then about what doesn't get on the short list."


Entrekin said that some of the recent National Book Award fiction lists, which usually get the most attention, had been "very eccentric" and that allowing critics and booksellers as judges could open up the process. The results, he thinks, will be a "little more mainstream," and less likely to include "a collection of stories by a university press."


"I think there are plenty of awards that recognize those kinds of books," Entrekin said. "If one of those books is truly the best book of the year, that's no problem. But it seemed like the judges had been recognizing lesser-known authors for the sake of choosing lesser-known authors."


The revisions cap a year-long process during which the book foundation hired an independent consulting firm to discuss the awards with booksellers, editors, writers and others in the literary community. Some ideas were rejected, such as allowing celebrities to be judges. The board also voted not to limit the number of books a publisher could submit, a suggested solution to the complaint that the time commitment needed to read hundreds of new works had made it difficult to find judges.


"We're asking people to read a lot of books, but some of these librarians and booksellers we hope to bring in are reading a lot of books anyway," Entrekin said.


"Our mission is to celebrate literature and expand its audience and we chose the path most consistent with our mission," said David Steinberger, chairman of the foundation's board and CEO of the Perseus Books Group.


This fall's long list will be announced Sept. 12, followed by the short list on Oct. 15 and the winners on Nov. 20.


The National Book Awards have changed several times since being founded in 1950. Winners, who have included William Faulkner, Ralph Ellison and Saul Bellow, were originally announced in advance of the ceremony. The number of categories and nominees have expanded and contracted, with 17 finalists for nonfiction in 1957 and more than 20 competitive categories in the early 1980s.


Awards for translation, "contemporary thought" and first novel have been added, then dropped. For a brief time, even the awards' name was changed, to the American Book Awards.


The format had been stable in recent years: competitive awards given for fiction, nonfiction, poetry and young people's literature, and five finalists announced for each category, picked by five-judge panels of writers that change annually. Over the past two decades, the National Book Foundation has attempted to draw more attention to the actual ceremony, bringing in such celebrities as Steve Martin and Andy Borowitz to host and moving the venue from a Marriott hotel ballroom to the more upscale Cipriani Wall Street.


Like the Academy Awards or the Grammys, the National Book Awards ceremony is an industry's showcase for itself, a balance between rewarding excellence and increasing sales that ideally achieves both. Major publishers are directly invested. They're represented on the board of the National Book Foundation and pay thousands of dollars for tables at the ceremony.


Ironically, publishers were happy with the fiction nominees of 2012, the last group to be voted on under the old rules. The finalists included a mix of well-known writers (Louise Erdrich, Junot Diaz, Dave Eggers) and debut novelists (Ben Fountain and Kevin Powers).


For years, foundation executive director Harold Augenbraum has issued oral instructions to judges that they should not pick books based on the publisher or commercial success or the author's reputation. In 2012, the point was reinforced in written guidelines that stated "fame or obscurity, small press or large, should have no bearing" on their decisions.


"I have no idea if that made any difference," Augenbraum said. "In fact, one judge thought the rules meant not to overlook the smaller presses."


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Deadly West Side shooting spills over onto Eisenhower




















A man was shot and killed at a gas station, but was found inside a mini-van along the Eisenhower Expressway.




















































A Forest Park man was shot and killed at a gas station near the Eisenhower Expressway on the West Side this morning, officials said.

The shooting occurred around 4:30 a.m. after the victim, a 28-year-old man, got into an argument with another person at the gas station in the 5200 block of West Jackson Boulevard, according to Police News Affairs Officer Hector Alfaro.






The victim then drove or was driven to the 600 block of South Kostner Avenue, near the entrance to the Eisenhower Expressway.

He was taken to Mount Sinai Hospital, where he was pronounced dead at 5:03 a.m., according to the Cook County medical examiner's office. The man's name is not being released pending notification of his family, according to the office.

At least one lane of the inbound Eisenhower was closed for about a half hour after the shooting, according to Illinois State Police officials.

chicagobreaking@tribune.com


Twitter: @ChicagoBreaking







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Apple cuts orders for iPhone 5 parts on weak demand: Nikkei


(Reuters) - Apple Inc has cut orders for LCD screens and other parts for the iPhone 5 this quarter due to weak demand, the Nikkei reported on Monday, in a further sign the U.S. firm is losing ground to Asian smartphone rivals.


Shares of the Cupertino, California-based company fell more than 4 percent to $498.20 before the bell on Monday. They closed at $520.30 on Friday on the Nasdaq. The news also dragged shares of Apple suppliers such as Cirrus Logic Inc and Qualcomm Inc.


Apple has asked Japan Display Inc, Sharp Corp and South Korea's LG Display Co Ltd to roughly halve supplies of LCD panels from an initial plan for about 65 million screens in January-March, the Japanese daily said, citing people familiar with the situation, adding the U.S. firm also cut orders for other iPhone components.


The move, if confirmed, would tally with analysts saying that sales of the new iPhone 5, which was released in September, have not been as strong as anticipated.


Apple was not immediately available for comment outside regular U.S. business hours. No one at Sharp was immediately available to comment on Monday - a national holiday in Japan - and parts suppliers to Apple in Taiwan declined to comment.


Apple has lost ground in the $200 billion plus global smartphone market to South Korean rival Samsung Electronics and smaller Chinese rivals such as Huawei Technologies Co Ltd and ZTE Corp.


Jefferies analyst Peter Misek trimmed his iPhone shipment estimates for the January-March quarter on December 14, saying that the technology company had started cutting orders to suppliers to balance excess inventory.


Apple also cut its orders for memory chips for its new iPhone from its main supplier and competitor Samsung, Reuters reported in September, quoting sources with direct knowledge of the matter.


The company has been cutting back its orders from Samsung as it seeks to diversify its memory chip supply lines.


SAMSUNG OVERTAKES APPLE


Samsung said on Monday that global sales of its flagship Galaxy S smartphones had topped 100 million since the first model was launched in May 2010. The Galaxy S3, launched last May, sold more than 40 million in seven months.


The new Galaxy S IV is widely expected to be released within months, and may have an unbreakable screen, full high-definition quality resolution boasting 440 pixels per inch, and a more powerful processor.


Samsung has overtaken Apple, helped in part by the popularity of its Galaxy Note II phone-cum-tablet, reinforcing the benefits of offering a wider range of handheld devices at most price points, while Apple rolled out just a single new smartphone last year globally, analysts have said.


Samsung is expected to increase its smartphone sales by more than a third this year, and widen its lead over Apple, according to researcher Strategy Analytics, which has forecast Samsung will sell 290 million smartphones in 2013 versus iPhone sales of 180 million.


Kim Sung-in, an analyst at Kiwoom Securities in Seoul, sees Samsung shipping 320 million smartphones this year and doubling sales of its tablets to 32 million.


Japan Display's plant in Nomi, southwest Japan, where Apple has invested heavily, is expected to temporarily reduce output by up to 80 percent from October-December levels, the Nikkei reported, while Sharp's dedicated facility for iPhone 5 LCD panels will trim production in January-February by about 40 percent.


(Reporting by Tokyo bureau, Avik Das and Sayantani Ghosh in Bangalore and Clare Jim in Taipei; Editing by Ian Geoghegan, Supriya Kurane)



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