European auto sector hits 17-year low

PARIS: European auto sales plunged to their lowest point in 17 years in 2012, trade data revealed Wednesday after Renault announced the latest job cuts to hit the beleaguered sector.

New car registrations in the European Union fell by 8.2 percent from their 2011 level to 12.05 million units last year, the European Automobile Manufacturers' Association said.

Sales in December fell for the 15th month in a row by 16.3 percent on a 12-month basis, even slipping slightly in Germany despite the global strength of top German brands.

French automakers in particular are being hard hit with Renault announcing 7,500 job cuts late on Tuesday.

PSA Peugeot Citroen, the second-biggest carmaker in Europe after the booming German VW group, has just been rescued by the state. The group is restructuring with 8,000 job cuts and targets development abroad after a government report said its strategy had missed the bus of globalisation.

And on Wednesday French car parts maker Faurecia reported weak results causing its shares to plunge.

By contrast the VW group has reported record global sales for 2012 with a rise of 11.0 percent to 9.07 million units and aspires to being the biggest manufacturer globally, ahead of Japanese Toyota, by 2018. German Daimler said at the Detroit auto show this week that it is on track to be the world's top luxury carmaker by the end of the decade.

The second-biggest manufacturer globally is General Motors, which struck a strategic partnership with PSA this year, but GM's sales across the whole of Europe fell by 8.2 percent last year, the US group said in Detroit.

These companies, and European manufacturers in general, are looking to growth in emerging markets to compensate for what they expect to be a lasting weaker trend in Europe, but these markets are also the home base for new competitors notably in China.

The European trade association said in its report on the European market: "Demand for new cars reached the lowest level recorded since 1995, totalling 12,053,904 units" in 2012.

Last year's 8.2 percent shrinkage was the worst since a downturn of 16.9 percent in 1993, the association said.

The trend was aggravated by exceptionally bad figures for December in debt-stricken Europe.

"In December, new car registrations declined by a sharp 16.3 percent in the EU, continuing a downward trend commenced 15 months ago. The decline is the steepest recorded in a month of December since 2008," the statement said.

With the eurozone struggling to cope with the tax rises and cuts in state spending imposed to correct its debt crisis, businesses and consumers have cut down their spending on vehicles.

In some countries the market, and employment, were supported after the financial crisis hit economies in 2008 by government subsidies for the replacement of old vehicles with new ones. But these schemes have run out and many European groups have announced job cuts and plant closures similar to, albeit less dramatic, those that occurred immediately in the US auto industry.

The latest came late on Tuesday from Renault which said it would shed 7,500 French jobs, or about 17.0 percent of its workforce by 2016, but by means of not replacing normal departures.

Renault, which has diversified its manufacturing into low-cost countries close to western Europe in recent years, notably in Romania where it builds its Dacia-branded vehicles, said that an agreement with unions on the cutbacks would save it 400 million euros ($534 million) in overheads and would avert any plant closures.

"On the basis of a progressive recovery of the European market, establishing such an agreement would allow for growth in French output that is more sustained than that of the European market," Renault said.

However the European trade data for the year showed big differences between countries.

Car sales rose only in Britain, by 5.3 percent from the level in 2011.

In Germany, a fall in sales on the home market was contained to 2.9 percent but in France sales slumped by 13.9 percent, in Spain by 13.4 percent and in Italy by 19.9 percent.

In terms of brands, sales in western Europe by PSA Peugeot Citroen fell by 12.9 percent, by Renault 18.9 and by Fiat of Italy by 15.8 percent.

Sales by Opel, based in Germany but owned by US group General Motors which has recovered strongly from bankruptcy, fell by 15.6 percent.

However, other German brands did far better. Sales by Audi rose by 3.7 percent, and by BMW they fell by 0.1 percent and by Mercedes-Benz by 0.9 percent.

In terms of sales in Europe by foreign manufacturers, the South Korean group Hyundai-Kia raised sales under the Hyundai name by 9.4 percent and under the Kia brand by 14.6 percent.

- AFP/ir

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Showrooming is a growing trend in India: Study

BANGALORE: A new IBM study of 26,000 global consumers released today at the 2013 National Retail Federation convention found they are diversifying the way they shop for and acquire goods, becoming increasingly open to buying both online and in-store depending on their needs at time of purchase. While more than 80% of shoppers chose the store to make their last non-grocery purchase, only half are committed to returning there next time they buy.

IBM's research finds that consumers are in a transitional state. According to the study, 35%t of the respondents are unsure whether they would next shop at a store or online. Nine percent are ready to commit to making future purchases online. Of all eight product categories tracked in the survey, the two most popular categories chosen by consumers for an online shift are consumer electronics and luxury items, including jewelry and designer apparel.

"Today's consumer is sophisticated and opportunistic, navigating between store and online environments interchangeably to meet their shopping needs of the moment," said Jill Puleri, global retail leader, IBM Global Business Services.

"To satisfy clients, retailers must deliver a consistent, convenient shopping experience across each consumer touch point, extending from the store to online and back again. The key is using data and analytics to better understand the behavior and preferences of shoppers to close the sale,'' he said.

The IBM study also found that nearly half of online purchases in studied categories resulted from "showrooming," a burgeoning trend in which consumers browse goods at a store, but ultimately buy them online. Significantly, nearly a quarter of these online shoppers intended to buy their item in the store, but ultimately purchased online - primarily due to price and convenience.

Retailers must better connect their store and online presence to capture the sale to showroomers. Today, online-only retailers account for one-third of showroomer purchases. Younger, male and affluent shoppers are most likely to showroom. Although a global phenomenon, there is a higher incidence of showrooming in China (26%) and India (13% than the U.S. (7%), for example.

The IBM study reveals that consumers are seeking a truly integrated shopping experience. Retailers must better connect their online and physical stores, blending benefits into both at various points in the shopping cycle -- from research to purchase -- to build brand loyalty and repeat sales. In the store, retailers must infuse digital experiences, enable store associates with the technology to save the sale and embrace consumer-owned technology. Online, retailers most optimize their websites for various devices. The IBM Digital Analytics benchmach found that 70 percent more consumers used a mobile device to visit a retailer's site on Cyber Monday in 2012 than 2011. However, today's study found that only 3 percent of shoppers are using retailers' mobile apps.

IBM Retail Analytics solutions can provide the fact-based insight retailers need to treat each consumer as an individual, meeting their growing expectation for personalization.Analytics can also be used to identify why showroomers are shifting purchases online so retailers can act and adjust accordingly.

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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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NRA Ad Calls Obama 'Elitist Hypocrite'

Jan 16, 2013 12:04am

Pablo Martinez Monsivais/AP Photo

As the White House prepares to unveil a sweeping plan aimed at curbing gun violence, the National Rifle Association has launched a preemptive, personal attack on President Obama, calling him an “elitist hypocrite” who, the group claims, is putting American children at risk.

In 35-second video posted online Tuesday night, the NRA criticizes Obama for accepting armed Secret Service protection for his daughters, Sasha and Malia, at their private Washington, D.C., school while questioning the placement of similar security at other schools.

“Are the president’s kids more important than yours? Then why is he skeptical about putting armed security in our schools, when his kids are protected by armed guards at their school?” the narrator says.

“Mr. Obama demands the wealthy pay their fair share of taxes, but he’s just another elitist hypocrite when it comes to a fair share of security,” it continues. “Protection for their kids and gun-free zones for ours.”

The immediate family members of U.S. presidents – generally considered potential targets – have long received Secret Service protection.

The ad appeared on a new website for a NRA advocacy campaign – “NRA Stand and Fight” — that the gun-rights group appears poised to launch in response to Obama’s package of gun control proposals that will be announced today.

It’s unclear whether the video will air on TV or only on the web. The NRA did not respond to ABC News’ request for comment.  The domain for the website is registered to Ackerman McQueen, the NRA’s long-standing public relations firm.

The White House had no comment on the NRA ad.

In the wake of last month’s mass shooting at Sandy Hook Elementary School, the Obama administration has met with a cross-section of advocacy groups on all sides of the gun debate to formulate new policy proposals.

The NRA, which met with Vice President Joe Biden last week, has opposed any new legislative gun restrictions, including expanded background checks and limits on the sale of assault-style weapons, instead calling for armed guards at all American schools.

Obama publicly questioned that approach in an interview with “Meet the Press” earlier this month, saying, “I am skeptical that the only answer is putting more guns in schools. And I think the vast majority of the American people are skeptical that that somehow is going to solve our problem.”

Still, the White House has been considering a call for increased funding for police officers at public schools and the proposal could be part of a broader Obama gun policy package.

Fifty-five percent of Americans in the latest ABC News/Washington Post poll say they support adding armed guards at schools across the country.

“The issue is, are there some sensible steps that we can take to make sure that somebody like the individual in Newtown can’t walk into a school and gun down a bunch of children in a shockingly rapid fashion.  And surely, we can do something about that,” Obama said at a news conference on Monday.

“Responsible gun owners, people who have a gun for protection, for hunting, for sportsmanship, they don’t have anything to worry about,” he said.

ABC News’ Mary Bruce and Jay Shaylor contributed reporting. 

SHOWS: Good Morning America World News

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France keeps up Mali air strikes, African troop plan advances

BAMAKO (Reuters) - France kept up its air strikes against Islamist rebels in Mali as plans to deploy African troops gathered pace on Tuesday amid concerns that delays could endanger a wider mission to dislodge al Qaeda and its allies.

France has already poured hundreds of troops into Mali and carried out days of air strikes since Friday in a vast desert area seized last year by an Islamist alliance that combines al Qaeda's north African wing AQIM with Mali's home-grown MUJWA and Ansar Dine rebel groups.

Western and regional powers are concerned the insurgents will use Mali's north as a launchpad for international attacks.

West African defense chiefs were to meet in Bamako on Tuesday to approve plans to speed up the deployment of 3,300 regional troops foreseen in a U.N.-backed intervention plan to be led by Africans.

Speaking from a French military base in Abu Dhabi at the start of a day-long visit to the United Arab Emirates, President Francois Hollande said French forces in Mali had carried out further strikes overnight "which hit their targets."

"We will continue the deployment of forces on the ground and in the air," Hollande said. "We have 750 troops deployed at the moment and that will keep increasing so that as quickly as possible we can hand over to the Africans."

He saw the African troop deployment taking "a good week".

France plans to field a total 2,500 soldiers in its former colony to bolster the Malian army and work with the intervention force provided by the ECOWAS grouping of West African states.

Foreign Minister Laurent Fabius - accompanying Hollande on a visit aimed at firming up trade relations and making progress on a possible sale of 60 French Rafale fighter jets - said he was confident Gulf Arab states would also help the Mali campaign.

Fabius said there would be a meeting of donors for the Mali operation most likely in Addis Ababa at the end of January.

He predicted the current level of the French involvement in Mali would go on for "a matter of weeks".

ECOWAS mission head in Bamako Aboudou Toure Cheaka said the West African troops would be on the ground in a week. Their immediate mission would be to help stop the rebel advance while preparations for a full intervention plan continued.

The original timetable for the 3,300-strong U.N.-sanctioned African force - backed by western logistics, money and intelligence services - did not initially foresee full deployment before September due to logistical constraints.

Senegal, Burkina Faso, Niger, Nigeria and Guinea have all offered troops. But regional powerhouse Nigeria, which is due to lead the mission, has cautioned that even if some troops arrive in Mali soon, training will take more time.

The plan is being fast-tracked after a plea for help by Mali's government after mobile columns of Islamist fighters last week threatened the central garrison towns of Mopti and Sevare, with its key airport.

"SAFEGUARD MALI"

French Prime Minister Jean-Marc Ayrault said France's goals were to stop the Islamist rebels, to "safeguard the existence of Mali" and pave the way for the African-led military operation.

U.S. officials said Washington was sharing information with French forces in Mali and considering providing logistics, surveillance and airlift capability.

"We have made a commitment that al Qaeda is not going to find anyplace to hide," U.S. Defense Secretary Leon Panetta told reporters as he began a visit to Europe.

As French aircraft bombarded mobile columns of Islamist fighters, other insurgents launched a counter-attack further to the south, dislodging government forces from the town of Diabaly, 350 km (220 miles) from Bamako.

French intervention has raised the risk for eight French hostages held by al Qaeda allies in the Sahara and for 30,000 French expatriates living in neighboring, mostly Muslim states. Concerned about reprisals at home, France has tightened security at public buildings and on public transport.

The U.N. said an estimated 30,000 people had fled the latest fighting in Mali, joining more than 200,000 already displaced.

U.N. Secretary-General Ban Ki-moon on Monday welcomed the French-led military intervention in Mali and voiced the hope that it would halt the Islamist assault.

Amnesty International said at least six civilians were killed in recent fighting in the town of Konna, where French aircraft had earlier bombarded rebel positions, and called on both sides to spare non-combatants.

France, which has repeatedly said it has abandoned its role as the policeman of its former African colonies, is among the toughest proponents of a speedier deployment of the African troops, and convened a U.N. Security Council meeting Monday to discuss the crisis.

French U.N. Ambassador Gerard Araud told reporters after the meeting that the U.S., Canada, Belgium, Denmark and Germany had also offered logistical support for France's Mali operation.

"I felt that all the members of the Security Council were expressing their support (for) and understanding of the French decision," Araud told reporters.

No Europeans or other African Union members will be allowed in the defense chiefs meeting in Bamako on Tuesday, a western diplomat told Reuters, requesting not to be named.

"They don't want any French pressure at the meeting," the diplomat said.

(Additional reporting by Elizabeth Pineau and Raissa Kasolowsky in Abu Dhabi; Michelle Nichols and Louis Charbonneau at the United Nations; Richard Valdmanis in Dakar, Brian Love in Paris and David Alexander in Lisbon; Editing by Pascal Fletcher and Anna Willard)

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Asian stocks end mixed

HONG KONG - Asian shares were mixed Tuesday on a lack of direction from Wall Street, but Tokyo hit a 32-month high on hopes for new central bank easing despite giving up early gains as the yen rebounded.

Some bourses advanced early in the session on reassurances from Fed chief Ben Bernanke that quantitative easing was set to continue in the United States, only to lose ground later in the day.

Tokyo put on 0.72 percent, or 77.51 points, to 10,879.08 -- its highest level since April 30, 2010 -- and Shanghai added 0.60 percent to 2,325.68, as environmental firms rose on hopes they will benefit from recent bad pollution.

But Seoul was off 1.16 percent, or 23.30 points, to 1,983.74, led by falls in technology stocks due to a stronger won, and Hong Kong shed 0.14 percent, or 31.75 points, to 23,381.15.

Sydney closed flat, edging down 3.1 points to 4,716.6.

The Japanese currency, which has fallen in recent weeks as new Prime Minister Shinzo Abe vowed to push monetary easing, rebounded after the economy minister warned the weak yen could hurt consumers by making imports more expensive.

The US dollar, which changed hands at 89.56 yen in morning trade and 89.45 yen in New York on Monday, dropped to 88.84 yen after Amari's comments.

The rise in the yen pared some of the gains in Tokyo, which had earlier been up more than 1.2 percent.

A weaker Japanese unit boosts exporters by making their products cheaper overseas and increasing the value of their repatriated foreign income.

Nevertheless the bourse ended strongly after the Bank of Japan governor earlier in the day pledged "aggressive" easing to boost the moribund economy, fuelling speculation the bank could launch new measures after a meeting next week.

The BoJ has been under heavy pressure from Abe's government to adopt an annual two percent inflation target to fight chronic deflation that has haunted the world's third largest economy for years.

There was a note of relief on markets after US Federal Reserve chief Bernanke indicated on Monday, after Asian markets had closed, that the US central bank's latest round of quantitative easing would continue, dealers said.

Asian traders were also looking ahead to fourth-quarter Chinese growth data due to be released on Friday, which analysts hope will confirm that the world's number two economy is picking up following a slowdown.

There was no clear lead from Wall Street, with the Dow Jones Industrial Average gaining 0.14 percent, but the broad-based S&P 500 falling 0.09 percent and the Nasdaq Composite shedding 0.26 percent.

On forex markets in Asian afternoon trade, the euro slipped to 118.75 yen from 119.65 yen in New York. Against the dollar, the euro dipped to US$1.3367 from US$1.3376 in US trading.

Oil prices fell. New York's main contract, light sweet crude for delivery in February, slipped 32 cents to US$93.82 a barrel in the afternoon and Brent North Sea crude for February delivery dipped 23 cents to US$111.65.

Gold was at US$1,680.90 at 1100GMT compared with US$1,668.39 late Monday.

In other markets:

-- Singapore closed down 0.33 percent, or 10.52 points, at 3,196.07.

-- Kuala Lumpur closed flat, edging up 1.26 points to 1,685.89.

-- Bangkok fell 0.16 percent, or 2.21 points, to 1,422.86.

-- Jakarta gained 0.42 percent, or 18.33 points, to 4,400.82.

-- Taipei fell 0.75 percent, or 58.95 points, to 7,765.02.

-- Manila lost 0.10, or 6.23 points, to 6,087.67.

-- Mumbai rose 0.40 percent, or 80.41 points, to 19,986.82 on hopes of a rate cut as inflation eased.

- AFP/ir

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Odisha gang-rape rape victim dies

BHUBANESWAR: A minor girl, who was gang-raped in Odisha's Rayagada town about a week ago, died at a private hospital at Visakhapatanam on Tuesday.

"The girl passed away at about 3.45pm on Tuesday in a private hospital at Visakhapatanam," Rayagada district collector SS Padhi told over phone.

The 16-year-old orphan, unable to bear the ignominy, had tried to immolate herself and had suffered over 80 per cent burns. She succumbed to her burn injuries after battling for life for about eight days.

She was admitted to the Vishakhapatnam hospital on January 7.

The girl was forcibly taken away to a nearby jungle when she was returning home from work on the evening of January 2 and gang-raped by four persons, the police said adding she tried to immolate herself the next day.

The girl was staying with her grandmother.

Meanwhile, the police have arrested four persons in connection with the incident based on the statement given by the girl.

"Four youths have been arrested and lodged at jail in two phases. We will submit the charsgesheet within 30 days of the incident," Rayagada superintendent of police Rajesh Pandit said.

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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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Armstrong Admits Doping in Tour, Sources Say

Lance Armstrong today admitted to Oprah Winfrey that he used performance enhancing drugs to win the Tour de France, sources told ABC News.

A government source tells ABC News that Armstrong is now talking with authorities about paying back some of the US Postal Service money from sponsoring his team. He is also talking to authorities about confessing and naming names, giving up others involved in illegal doping. This could result in a reduction of his lifetime ban, according to the source, if Armstrong provides substantial and meaningful information.

Armstrong made the admission in what sources describe as an emotional interview with Winfrey to air on "Oprah's Next Chapter" on Jan. 17.

The 90-minute interview at his home in Austin, Texas, was Armstrong's first since officials stripped him of his world cycling titles in response to doping allegations.

Word of Armstrong's admission comes after a Livestrong official said that Armstrong apologized today to the foundation's staff ahead of his interview.

The disgraced cyclist gathered with about 100 Livestrong Foundation staffers at their Austin headquarters for a meeting that included social workers who deal directly with patients as part of the group's mission to support cancer victims.

Armstrong's "sincere and heartfelt apology" generated lots of tears, spokeswoman Katherine McLane said, adding that he "took responsibility" for the trouble he has caused the foundation.

Riccardo S. Savi/Getty Images|Ray Tamarra/Getty Images

Lance Armstrong Stripped of Tour de France Titles Watch Video

Lance Armstrong Doping Charges: Secret Tapes Watch Video

McLane declined to say whether Armstrong's comments included an admission of doping, just that the cyclist wanted the staff to hear from him in person rather than rely on second-hand accounts.

Armstrong then took questions from the staff.

Armstrong's story has never changed. In front of cameras, microphones, fans, sponsors, cancer survivors -- even under oath -- Lance Armstrong hasn't just denied ever using performance enhancing drugs, he has done so in an indignant, even threatening way.

Armstrong, 41, was stripped of his seven Tour de France titles and banned from the sport for life by the U.S. Anti-Doping Agency in October 2012, after allegations that he benefited from years of systematic doping, using banned substances and receiving illicit blood transfusions.

"Lance Armstrong has no place in cycling and he deserves to be forgotten in cycling," Pat McQuaid, the president of the International Cycling Union, said at a news conference in Switzerland announcing the decision. "This is a landmark day for cycling."

The U.S. Anti-Doping Agency issued a 200-page report Oct. 10 after a wide-scale investigation into Armstrong's alleged use of performance-enhancing substances.

Armstrong won the Tour de France from 1999 to 2005.

According to a source, speaking to ABC News, a representative of Armstrong's once offered to make a donation estimated around $250,000 to the agency, as "60 Minutes Sports" on Showtime first reported.

Lance Armstrong's attorney Tim Herman denied it. "No truth to that story," Herman said. "First Lance heard of it was today. He never made any such contribution or suggestion."

Armstrong, who himself recovered from testicular cancer, created the Lance Armstrong Foundation (now known as the LIVESTRONG Foundation) to help people with cancer cope, as well as foster a community for cancer awareness. Armstrong resigned late last year as chairman of the LIVESTRONG Foundation, which raised millions of dollars in the fight against cancer.

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Decision on immunity for U.S. troops in Afghanistan by year-end: Karzai

KABUL (Reuters) - A decision on immunity for U.S. troops staying in Afghanistan after the 2014 planned withdrawal will be made by the end of the year, Afghan President Hamid Karzai said on Monday.

"The issue of immunity is under discussion (and) it is going to take eight to nine months before we reach agreement," Karzai told a news conference in the capital, Kabul, after returning from meetings with U.S. President Barack Obama in Washington.

The Afghan government rejected an initial U.S. proposal regarding the question of immunity and a second round of negotiations will take place this year in Kabul, he said.

Those negotiations could involve Afghanistan's Loya Jirga, a "grand assembly" of political and community leaders convened for issues of national importance, he added.

When asked if security would deteriorate in Afghanistan after the withdrawal of the NATO-led force, Karzai replied: "By no means... Afghanistan will be more secure and a better place."

The Obama administration has been considering a residual force of between 3,000 and 9,000 troops in Afghanistan to conduct counterterrorism operations while providing training and assistance for Afghan forces. But the administration said last week it did not rule out a complete withdrawal after 2014.

The United States is insisting on immunity from prosecution for any U.S. troops that remain.

(Reporting By Hamid Shalizi, writing by Amie Ferris-Rotman and Dylan Welch; Editng by Robert Birsel)

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