Stock futures edge up as earnings, data awaited


NEW YORK (Reuters) - Stock index futures edged up on Thursday, helped by better-than-expected results from online marketplace eBay , ahead of a busy day of corporate earnings and economic data.


Among several financial companies due to release results, Bank of America reported its fourth-quarter profit fell from a year ago as it took more charges to clean up mortgage-related problems stemming from the financial crisis. Its shares slipped 0.5 percent to $11.72 in heavy premarket trading.


EBay's shares rose 3.2 percent to $54.60 in premarket trading, a day after it reported holiday quarter results that just beat Wall Street expectations. It gave a 2013 forecast that was within analysts' estimates.


Solid earnings from Goldman Sachs and JPMorgan Chase on Wednesday helped lift estimates for S&P 500 corporate earnings slightly to a 2.2 percent gain, Thomson Reuters data showed.


But expectations have come down significantly from where they were in October. With investors anticipating a lackluster earnings season, the focus will be on the corporate earnings outlook for the months ahead, analysts said.


"That gives you a bigger picture of where the economy might be headed. I think you have to stitch together all the information and get a true picture of how robust the economies of the world are," said Kim Forrest, senior equity research analyst at Fort Pitt Capital Group in Pittsburgh.


"We've all dismissed what's going to happen in this fourth quarter. Estimates are pretty low, the companies that can't step over the lower bar are probably going to get punished."


Shares of Boeing extended a recent slump after the United States and other countries grounded the new 787 Dreamliner following a second incident involving battery failure. Boeing was down 2.1 percent at $72.75.


S&P 500 futures rose 2.8 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures gained 8 points, while Nasdaq 100 futures added 5.75 points.


Investors were looking to the release of a batch of economic data for fresh trading incentives; these include weekly first time claims for unemployment benefits, housing starts for December and manufacturing activity in the U.S. mid-Atlantic region for January.


Shares of Cisco Systems slipped 1.8 percent to $20.66 after JPMorgan cut its rating to "underweight" from "neutral," according to flyonthewall.com.


AT&T is considering buying a telecoms company in Europe to offset growth constraints in its home market, the Wall Street Journal reported, citing unnamed people familiar with the company's thinking.


(Editing by Bernadette Baum)



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Some hostages reported to escape Sahara siege


ALGIERS (Reuters) - Some hostages were reported to have escaped from a remote Algerian gas plant on Thursday, where dozens of foreigners and scores of Algerians were seized by Islamist gunmen demanding a halt to a French military campaign in neighboring Mali.


Governments around the world were holding emergency meetings to respond to one of the biggest international hostage crises in decades, which sharply raises the stakes over the week-old French campaign against al Qaeda-linked rebels in the Sahara.


Algeria's Ennahar television said 15 foreigners, including two French citizens, had escaped the besieged plant deep in the Sahara desert. About 40 Algerians had also been freed, mainly women working as translators, it said.


An Algerian security source told Reuters the captors, encircled by Algerian troops, were demanding safe passage out with their prisoners. Algeria has refused to negotiate with what it says is a band of about 20 fighters.


The captors, who have been speaking regularly to media in neighboring Mauritania, told that country's ANI news agency that Algerian helicopters had fired on the compound, wounding two Japanese hostages. This could not be confirmed.


A group calling itself the "Battalion of Blood" says it seized 41 foreigners, including Americans, Japanese and Europeans, after storming a natural gas pumping station and employee barracks before dawn on Wednesday.


The attackers have demanded an end to the French military campaign in Mali, where hundreds of French paratroopers and marines are launching a ground offensive against rebels a week after Paris began firing on militants from the air.


Algerian Interior Minister Daho Ould Kablia said the raid was led by Mokhtar Belmokhtar, a veteran Islamist guerrilla fighter who fought Soviet forces in Afghanistan in the 1980s and had recently set up his own group in the Sahara after falling out with other local al Qaeda leaders.


A holy warrior-cum-smuggler dubbed "The Uncatchable" by French intelligence and "Mister Marlboro" by some locals for his illicit cigarette-running business, Belmokhtar's links to those who seized towns across northern Mali last year are unclear.


The hostage takers appear to have allowed some prisoners to speak to the media to put pressure on Algerian forces not to storm the compound. An unidentified hostage who spoke to France 24 television said prisoners were being forced to wear explosive belts. Their captors were heavily armed and had threatened to blow up the plant if the Algerian army tried to storm it.


Two hostages, identified as British and Irish, spoke to Al Jazeera television and called on the Algerian army to withdraw from the area to avoid casualties.


"We are receiving care and good treatment from the kidnappers. The (Algerian) army did not withdraw and they are firing at the camp," the British man said. "There are around 150 Algerian hostages. We say to everybody that negotiations is a sign of strength and will spare many any loss of life."


The hostage identified as Irish told the Qatar-based channel the captives included French, American, Japanese, British, Irish and Norwegian citizens.


"The situation is deteriorating. We have contacted the embassies and we call on the Algerian army to withdraw ... We are worried because of the continuation of the firing."


After what it said was a phone interview with one of the hostage takers, the Mauritanian news agency ANI said Algerian security forces had tried to approach the facility at dawn.


"We will kill all the hostages if the Algerian army try to storm the area," it quoted the hostage taker as saying. Algeria has not commented on reports its troops tried to approach. The militants earlier said they repelled an assault after dark.


NUMBERS UNCONFIRMED


The precise number and nationalities of foreign hostages could not be confirmed, with some countries reluctant to release information that could be useful to the captors.


British Foreign Secretary William Hague confirmed one British citizen had been killed and "a number" of others were among those held. Algerian media said an Algerian was killed in the assault. Another local report said a Frenchman had died.


The militants said seven Americans were among their hostages, a figure U.S. officials said they could not confirm.


Norwegian oil company Statoil said nine of its Norwegian staff and three Algerian employees were captive. Britain's BP, which operates the plant with Statoil and Algerian state oil company Sonatrach, said some of its staff were held but would not say how many or their nationalities.


Japanese media said five workers from Japanese engineering firm JGC Corp. were held, a number the company did not confirm. France has not confirmed whether any French citizens were held. Vienna has said one hostage is Austrian.


So far, Western countries seem reluctant to intervene on the ground in the Algerian standoff directly. French Defence Minister Jean-Yves Le Drian said Paris had confidence in the Algerian government to handle it.


British Prime Minister David Cameron's spokesman said Cameron had spoken to the leaders of Japan and Norway, and all had concluded that the best course was to work through the Algerian authorities.


Paris said the Algeria attack demonstrated it was right to intervene in Mali: "We have the flagrant proof that this problem goes beyond just the north of Mali," French ambassador to Mali Christian Rouyer told France Inter radio.


"Northern Mali is at heart of the problem, of course, but the dimension is really national and international, which gives even more justification to the French intervention," he said.


Hollande has received public backing from Western and African allies who fear that al Qaeda, flush with men and arms from the defeated forces of Libya's Muammar Gaddafi, is building a desert haven in Mali, a poor country that was helpless to combat fighters who seized its northern cities last year.


However, there is some concern in Washington and other capitals that the French action in Mali could provoke a backlash worse than the initial threat by militants in the remote Sahara.


The militants, communicating through established contacts with media in neighboring Mauritania, said they had dozens of men armed with mortars and anti-aircraft missiles in the compound and had rigged it with explosives.


"We hold the Algerian government and the French government and the countries of the hostages fully responsible if our demands are not met, and it is up to them to stop the brutal aggression against our people in Mali," read one statement carried by Mauritanian media.


They condemned Algeria's secularist government for letting French warplanes fly over its territory to Mali and shutting its border to Malian refugees.


Regis Arnoux, head of CIS, a French catering firm operating at the site, told BFM television he had been in touch with a manager of some 150 Algerian workers there. Foreigners were being kept separate from Algerian hostages, he said.


"They are tied up and are being filmed. Electricity is cut off, and mobile phones have no charge."


PRESSING ON


The attack in Algeria did not stop France from pressing on with its campaign in Mali. It said on Thursday it now had 1,400 troops on the ground in Mali, and combat was underway against the rebels that it first began targeting from the air last week.


"There was combat yesterday, on the ground and in the air. It happened overnight and is under way now," said Le Drian. Residents said a column of about 30 French Sagaie armored vehicles set off on Wednesday toward rebel positions from the town of Niono, 300 km (190 miles) from the capital, Bamako.


The French action last week came as a surprised but has received widespread international support. Neighboring African countries expected to provide ground troops for a U.N. force by September have said they will move faster to offer troops.


Germany, Britain and the Netherlands have offered transport aircraft to help ferry in African troops. Washington has said it is considering what support it can offer.


Many inhabitants of northern Mali have welcomed the French action, though some also fear being caught in the cross-fire. The Mali rebels who seized Timbuktu and other oasis towns in northern Mali last year imposed Islamic law, including public amputations and beheadings that angered many locals.


"There is a great hope," one man said from Timbuktu, where he said Islamist fighters were trying to blend into civilian neighborhoods. "We hope that the city will be freed soon."


The rebels include fighters from al Qaeda's mainly Algerian-based North African wing AQIM as well as home-grown Malian groups Ansar Dine and MUJWA. Islamists have warned Hollande that he has "opened the gates of hell" for all French citizens.


A day after launching the campaign in Mali, Hollande also ordered a raid in Somalia on Saturday to free a French hostage held there by al Qaeda-linked al Shabaab militants since 2009. That rescue was a failure, with two French commandos killed.


Al Shabaab said on Thursday it had executed its hostage, Denis Allex. France says it believes Allex died in the rescue attempt.


(Additional reporting by Bate Felix in Bamako; Pascal Fletcher, Andrew Callus and Dmitry Zhdannikov in London; Balazs Koranyi in Oslo; Laurent Prieur in Nouakchott; Daniel Flynn in Dakar; John Irish, Catherine Bremer, Marine Pennetier, and Nick Vinocur in Paris; David Alexander in Rome; Andrew Quinn in Washington; Jane Wardell in Sydney, Omar Fahmy in Cairo; Mirna Sleiman in Dubai and Kaori Kaneko in Tokyo; Writing by Peter Graff; Editing by Giles Elgood)



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“Banshee” head Greg Yaitanes: secrets galore, but hold the olives






NEW YORK (TheWrap.com) – Like many TV creators, Greg Yaitanes isn’t crazy about the alternate identities people adopt online – and the Emmy-winning former “House” executive producer gets to explore anonymity and becoming someone else in the new Cinemax series “Banshee.”


“I’ve been harassed by ‘House’ Twitter fans for years now. I’m always kind of surprised at people’s level of saying something that they would never say to my face – that they would never say to another human being’s face,” he said.






Not that Yaitanes has a problem with social media – he was an early investor in Twitter, and used a litany of apps and new technology to make his pulpy drama, executive produced by Alan Ball, as scrappy as a tech startup.


With “Banshee,” Yaitanes gets to explore “the best of the wish fulfillment that people have of reinventing themselves or being able to disappear. In a way, all the characters are reinventing themselves.”


Those characters include a thief who steals the identity of the sheriff in Banshee, Pa., his cat burglar ex-girlfriend, who has eked out a new life as a homemaker, and the villain, a man who becomes a criminal mastermind after he is ousted from his Amish community. Then there’s the identity thief – Job – who keeps changing which gender he appears to be.


We talked with Yaitanes about how he made his show look expensive, how to describe Job, and the importance of counting olives.


The Wrap: The show looks expensive – starting with a sequence in New York in which a bus falls over and skids through an intersection. Can you talk about how you kept costs down?


Yaitanes: It’s a way of thinking from working with startups. They’re often one, two, three man operations when they first operate. Twitter was an example of that. You have to look at what is the simplest, most effective way to do this, to deliver to the consumer. We had a very specific box that “Banshee” could be made in, in terms of our budget.


The first thing that came to mind was what I call the “one olive.” The one olive is a story that originates with American Airlines back in the ’80s, when American Airlines took one olive out of their inflight meal – and saved $ 40,000. It’s all about challenging and making everybody their own producer and their own CEO and asking, ‘What is that one thing I can take out that either saves money or makes us that more efficient over the course of 100 days?’


Maybe $ 1,000 isn’t particularly exciting, but when you do it across a season, that’s an official day of shooting. That’s seven more minutes of content that we can get done that day.


We just looked for all these small ways that I feel put nearly an episode’s worth of saving back into the show, so we could make our show more robust and make the action scenes that much bigger and get the actor that we really want.


These are things that the audience gets to enjoy.


What are some of the cost-saving measures?


We also tried to find our olives by using the apps and technology that’s right in front of us, like Skype and Facetime and iChat so we don’t have to fly everybody around? I think probably 75 percent of the crew including directors were hired through some form of video conferencing. You saw the pilot, with the bus crash. We scouted all of that via Google Streetview. We could find blocks and circle around and look up and down and did all the legwork until we absolutely had to go to New York. So we saved on those flights, those hotels, those per diems.


You’ve invested in so many social media sites. Is there something that want to say on the show about the changing nature of identity when we can all take on different personalities online? Your main character, Lucas Hood (Antony Starr) actually takes on another person’s life.


Lucas does the most obvious adoption. A lot of people’s secrets and new identities and new lives are happening before the series starts, which is why we’ve shot an entire online series with our cast.


One of those characters, Job, is constantly in flux – even in terms of whether he appears male or female. Is he transgendered?


He’s straddling this line of androgyny. We specifically don’t want to answer questions about Job’s sexuality… he is a chameleon. He has something that he can tap into depending on his situation. By the time you get to the finale you won’t believe where Job goes.


Internet News Headlines – Yahoo! News





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GLAAD Award Nominees: Modern Family, Glee, The New Normal Make the Grade















01/16/2013 at 06:00 AM EST







Adam Lambert (left) and Frank Ocean


David Livingston/Getty; McCarten/PictureGroup


Last July when emerging R&B star Frank Ocean published an emotional letter detailing an early love affair with a man, his "coming out" story made headlines in the hip-hop world and beyond.

Now, the Grammy-nominated songwriter is being honored by GLAAD, the nation's lesbian, gay, bisexual and transgender media advocacy and anti-defamation organization.

Ocean is among the 120 nominees for the 24th Annual GLAAD Media Awards, the organization announced early Wednesday morning. He is being recognized for his critically-lauded Channel Orange album.

Other musician nominees include Adam Lambert (for his album Tresspassing).

Among the other familiar nominee names in the mix of 25 English-language and 33-Spanish language categories are: TV's Modern Family, Smash, Glee, The New Normal, Anderson Cooper 360, The Amazing Race and The Daily Show. For motion pictures, The Best Exotic Marigold Hotel, The Perks of Being a Wallflower and ParaNorman – plus the documentaries How to Survive a Plague and Vito – are nominated.

Also being recognized: PEOPLE (for outstanding magazine coverage overall) and PEOPLE En Español – for two magazine articles: "Amor genuine," by Cristina Saralegui, and "La lucha de Bamby," by Isis Sauceda.

For a complete list of nominees, click here.

"Images and stories from the LGBT community continue to push support for equality to historic levels," GLAAD president Herndon Graddick said in a statement with the announcement of the nominees. "Now more than ever, viewers not only accept gay and transgender characters and plot lines, they expect them – just as they both accept and expect LGBT people to be a valuable part of their everyday lives."

The GLAAD Media Awards ceremonies will be held in New York on March 16, at the New York Marriott Marquis; in Los Angeles on April 20, at the JW Marriott; and in San Francisco on May 11, at the Hilton Union Square.

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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."


___


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


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Stock futures dip on growth concerns, bank earnings eyed


NEW YORK (Reuters) - Stock index futures slipped on Wednesday, pressured by low growth expectations and ahead of earnings from major financials including Goldman Sachs.


JPMorgan Chase & Co reported an increase in fourth-quarter profits as the biggest U.S. bank made more home loans.


Shares of Dow component Boeing fell 4.2 percent in premarket trading on concerns about the safety of its Dreamliner passenger jets. Japan's two leading airlines grounded their fleets of 787s on Wednesday after one of the jets made an emergency landing.


A slow economic recovery in developed nations is holding back the global economy, the World Bank said on Tuesday, as it sharply cut its outlook for world growth in 2013. Global gross domestic product will rise 2.4 percent this year, the bank said, down from its June forecast that global growth would reach 3.0 percent in 2013.


S&P 500 futures fell 2 points and were below fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures fell 37 points, and Nasdaq 100 futures lost 1.5 points.


Talks to take Dell Inc private are at an advanced stage with at least four major banks lined up to provide financing, two sources with knowledge of the matter told Reuters.


This earnings season the U.S. technology industry is in the unusual position of dragging corporate America down.


(Reporting by Rodrigo Campos; Editing by Chizu Nomiyama)



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Syrian army on offensive in Aleppo after university blast


BEIRUT (Reuters) - Syrian armed forces launched a renewed offensive in the northern city of Aleppo on Wednesday, state media said, a day after 87 people were killed in explosions at the city's university.


The state news agency SANA said the military had killed dozens of "terrorists" - a term Damascus uses for rebels trying to overthrow President Bashar al-Assad - in the new fighting.


Reuters cannot independently verify reports due to media restrictions in Syria.


"The Armed Forces carried out several special operations against the mercenary terrorists in Aleppo and its countryside, inflicting heavy losses upon them in several areas," SANA said.


Aleppo is split roughly in half between government and rebel forces. SANA said dozens of "terrorists" were killed in the rebel strongholds of Sukari, Bab al-Hadeed and Bustan al-Qasr.


Government forces also killed militants in al-Laramon, a area of Aleppo from which Damascus says two rockets were fired into the University of Aleppo on Tuesday, it added.


If confirmed, the government's report of a rocket attack would suggest rebels in the area had been able to obtain and deploy more powerful weapons than previously used.


The Syrian Observatory for Human Rights, a Britain-based monitoring group, said 87 people were killed and dozens wounded in the explosions, but it could not identify the source of the blasts. It said the toll could rise to more than 100 as there were still body parts that were unaccounted for.


State television showed a body lying on the street and burning cars. An entire facade of a multi-story university building had crumbled and cars were overturned. An interior shot of a corridor showed that the ceiling had caved in.


Amateur video footage showed students carrying books out of the university after one of the explosions, walking quickly away from rising smoke. The camera then shakes to the sound of another explosion and people begin to run.


Syria has been plunged into bloodshed since a violent government crackdown in early 2011 on peaceful demonstrations for democratic reform which turned the unrest into an armed insurgency bent on overthrowing Assad.


Each side in the 22-month-old conflict blamed the other for Tuesday's blasts at the university, located in a government-held area of Syria's most populous city.


Some activists in Aleppo said a government air strike caused the explosions, while state television accused terrorists of firing two rockets at the university. A rebel fighter said the blasts appeared to have been caused by surface-to-surface missiles.


The nearest rebel-controlled area, Bustan al-Qasr, is more than a mile away from the university.


The Observatory said rebel sources on the ground reported they were fighting with government forces in the early hours of Wednesday around Bustan al-Qasr, implying a renewed push by government forces to expel the insurgents.


(Reporting by Oliver Holmes; Editing by Jon Boyle)



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Verizon may be prepping a new mid-range Samsung smartphone with a 720p display








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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."


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Online:


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


CDC: http://www.cdc.gov


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


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