ER visits tied to energy drinks double since 2007


SAN FRANCISCO (AP) — The young man stumbled into the emergency room late one night after a house party, saying his heart wouldn't stop pounding and he could barely breathe after downing liquor mixed with energy drinks.


Emergency physician Steve Sun soon found the patient was so dehydrated he was going into kidney failure — one of many troubling cases Sun says he has treated in recent years tied to energy drink consumption.


Sun's changing caseload appears in line with a new government survey that 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.


"Five years ago, perhaps I would see one or two cases every three months or so. Now we're consistently seeing about two cases per month," said Sun, assistant medical director of the emergency department at St. Mary's Medical Center, on the edge of San Francisco's Golden Gate Park.


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 the cases involved teens or young adults, according to the survey of the nation's hospitals released late last week by the Substance Abuse and Mental Health Services Administration.


More than half of the patients considered in the survey told doctors they had consumed 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.


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


The report doesn't specify which symptoms brought people to the emergency room, but it 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.


"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 and so-called energy shots — including a 14-year-old Maryland girl whose family filed a lawsuit after she drank two large cans of Monster Energy drinks and died. Monster says its products were not responsible for the death.


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


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.


___


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


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S&P 500 ends flat as bank profits temper growth concerns

NEW YORK (Reuters) - The S&P 500 ended nearly flat on Wednesday as solid earnings from two major banks and a bounceback in Apple shares offset concerns about a lower forecast for global growth in 2013.


Shares of Goldman Sachs hit their highest since May 2011 as earnings nearly tripled on increased revenue from dealmaking and lower compensation expenses. JPMorgan Chase said fourth-quarter net income jumped 53 percent and earnings for 2012 set a record.


JPMorgan shares rose 1 percent to $46.82, while Goldman climbed 4.1 percent to $141.09.


They were among the first big banks to report results and helped to lift estimates for S&P 500 corporate earnings slightly, to a 2.2 percent gain, Thomson Reuters data showed.


"Pretty solid numbers from both JPMorgan and Goldman Sachs are putting a lot of momentum behind the financials, with a lot more names to report this week. But I think that's helping to put a better bid to the market overall," said Michael James, senior trader at Wedbush Morgan in Los Angeles.


Apple rebounded after three days of losses, helping the Nasdaq outperform the S&P 500 and Dow. Apple rose 4.2 percent to $506.09. It closed below $500 on Tuesday for the first time since February.


"There could not have been more negativity around Apple going into today. So was it due for an oversold bounce on a trading basis? Absolutely," James said.


A slow economic recovery in developed nations is holding back the global economy, the World Bank said on Tuesday, as it sharply scaled back its forecast for world growth in 2013 to 2.4 percent from an earlier forecast of 3.0 percent.


The Dow Jones industrial average <.dji> was down 23.66 points, or 0.17 percent, at 13,511.23. The Standard & Poor's 500 Index <.spx> was up 0.29 points, or 0.02 percent, at 1,472.63. The Nasdaq Composite Index <.ixic> was up 6.77 points, or 0.22 percent, at 3,117.54.


The biggest drag on the Dow was Boeing , whose shares fell 3.4 percent to $74.34 on concerns about its new Dreamliner passenger jets. Japan's two leading airlines grounded their fleets of 787s after an emergency landing, adding to safety concerns triggered by a series of recent incidents.


After the bell, shares of eBay were trading up 0.7 at $53.28, reversing an initial decline following the release of its results. Also after the close, shares of CBS rose 8.3 percent to $41.10 after it said it will convert its Outdoor Americas division into a real estate investment trust. [ID:nL4N0AL98X]


Earlier in the day, U.S. economic data showed consumer prices were flat in December, pointing to muted inflation pressures that should give the Federal Reserve room to prop up the economy by staying on its ultra-easy monetary policy path.


Other data showed U.S. homebuilder confidence in the market for single family homes held steady near seven year highs in January, suggesting the outlook for the housing market remained upbeat.


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


Decliners outpaced advancers on the NYSE by nearly 8 to 7 and on the Nasdaq by almost 7 to 5.


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



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The Lede Blog: Video of Aleppo University Bombing

Last Updated, 4:47 p.m. Video posted online by Syrian opposition activists appeared to show the moment one in a series of deadly explosions struck the campus of Aleppo University on Tuesday.

Video said to capture an explosion on the campus of Aleppo University in Syria on Tuesday, uploaded to the Web by opposition activists.

The brief clip, uploaded to the YouTube channel of the ANA New Media Association (formerly the Syrian Activists News Association), begins with a view of smoke rising from a university building as students mill about. Moments later, following a very loud explosion close to the camera, students run for cover and a much larger plume can be seen above the building.

A description of the video posted on YouTube by ANA, which is run from Cairo by the British-Syrian activist Rami Jarrah, said that the video was filmed by an activist just after the university was hit by a missile fired from a Syrian Air Force MIG fighter jet, and captured the impact of a second airstrike.

Another video clip, uploaded to the Web earlier in the day, appeared to offer a more distant view of the plumes of smoke above the campus. Mr. Jarrah, who blogs as Alexander Page, suggested that one part of the video showed the fighter jet’s contrail in the sky over the damaged buildings.

While opposition activists insisted that the blasts, which killed more than 80 people according to the government, were the result of airstrikes by President Bashar al-Assad’s air force, state-controlled television channels claimed that “terrorists” had fired rockets at the campus.

The pro-Assad satellite channel al-Ikhbaria broadcast video of the aftermath, showing extensive damage to the campus and victims being rushed from the scene as on-screen text blamed the attack on rebel forces.

Video from the pro-government Syrian satellite channel al-Ikhbaria showed the aftermath of bombings at Aleppo University on Tuesday

A blogger in Aleppo who supported peaceful protests against the Assad government but has been fiercely critical of the armed rebellion, Edward Dark, described the carnage as a result of an air attack that was “probably a mistake, not an intentional bombing.”

Restrictions on independent reporting in Syria make it hard to confirm who was responsible for the explosions, but the university is in a government-controlled area of the city and large anti-Assad demonstrations there last May were harshly dealt with by the security forces, despite the presence of United Nations observers.

A pair of video clips posted on YouTube shortly after the bombings showed extensive damage to what was described as the university’s architecture school. In one of the clips, dazed students made their way through shattered glass, carrying a wounded man on a table, in the entrance hall to the architecture faculty pictured on the university’s Web site.

Video said to show the badly damaged school of architecture at Aleppo University on Tuesday.

Video of a wounded man being evacuated from Aleppo University’s school of architecture on Tuesday.

Another pro-Assad satellite channel, Addounia, broadcast a report blaming “a terrorist group” for the bombings — which was uploaded, with English subtitles, to YouTube.

A video report on bombings at Aleppo University from Addounia, a pro-Assad satellite channel.

Writing on Twitter, a Syrian-American from Aleppo who uses the pen name Amal Hanano posted links to photographs of three people identified as victims of the bombings by activists on social networks.

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Lance's Doping Drama Explained in 5 Clicks





Before the cyclist tells all to Oprah Winfrey, see how multiple allegations got his Tour de France titles revoked








Credit: AP



Updated: Friday Aug 24, 2012 | 02:30 PM EDT
By: Kiran Hefa




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Vegas woman who couldn't stop growing dies at 34


LAS VEGAS (AP) — As a teenager growing up in Las Vegas, Tanya Angus strutted along fashion runways. She was 5 feet 8 inches, and people told her she had a perfect body.


But at the time of her death Monday, the 34-year-old Angus stood 7 feet 2 inches and weighed about 400 pounds. She was a victim of a rare disorder called acromegaly — or gigantism — that wouldn't let her stop growing.


"'Mom, I don't know why I got it,'" Karen Strutynski recalled her daughter saying. "'But I guess God decided that I could handle it.'"


Handle it she did — by appearing on television specials and in the news, by being vulnerable about a condition that left her face misshapen and gave her chronic growing pains.


Acromegaly is a disorder in which there is too much growth hormone in the body. It's spurred by a non-cancerous tumor that grows on the pituitary gland, and causes growth of bones and organs.


The disorder affected just about everything for Angus. She couldn't pull even the largest of shirts over her head, because she couldn't fit through the collar. She needed specially made shoes, and jewelers stretched her rings to size 20.


"There's nothing made for giants," her mother explained.


Some people judged her daughter, Strutynski said, believing she used a wheelchair because she lacked the discipline to keep her weight down. What they didn't know is that she ate one meal a day, and her medications caused her face to swell.


"People were very cruel until she went into the media," Strutynski said.


After television appearances, Angus became an advocate for those with the disease, corresponding with people from some 60 countries to help them get the treatment they needed.


She saw her mission as helping others get diagnosed before it was too late and the disease got out of control, her mother said.


An autopsy is pending, but Strutynski said it appears Angus died after catching a cold and developing a tear in her big heart.


Her mother plans to keep up Angus' website and continue corresponding with patients struggling to deal with the disease.


"We can't let it end. It's just too important," Strutynski said, her voice cracking. "We can't just let it die with Tanya."


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

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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



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Leon Panetta Says U.S. Has Pledged to Help France in Mali





LISBON — In what could draw the United States into another conflict in North Africa, the Obama administration has pledged to help the French who are fighting Islamist militants in Mali, and that assistance could include air and other logistical support, Defense Secretary Leon E. Panetta said on Monday.







Jacquelyn Martin/Associated Press

Defense Secretary Leon E. Panetta boards a plane bound for Portugal on Monday.






The United States was already sharing intelligence with the French when their warplanes on Sunday struck camps, depots and other militant positions deep inside extensive Islamist-held territory in northern Mali. Defense officials said no decisions had been made on whether the United States would also offer help with midflight refueling planes and air transport, but they said those options were under review.


Defense officials would not rule out the possibility that American military transport planes might land in Mali, where the United States has been conducting an ambitious counterterrorism program for years. American spy planes and surveillance drones are in the meantime trying to get a sense of the chaos on the ground. The defense officials would not discuss whether the United States has armed drone aircraft over Mali.


But Mr. Panetta, who spoke to reporters on his plane en route to Portugal for a weeklong trip Europe, said that the chaos in Mali was of deep concern to the administration and praised the French for their actions. He also said “ what we have promised them is that we would work with them, to cooperate with them, to provide whatever assistance we can to try to help them in that effort.”


Mr. Panetta said that even though Mali is far from the United States, the Obama administration was deeply worried about extremist groups there, including Al Qaeda in the Islamic Maghreb, or AQIM. “We’re concerned that any time Al Qaeda establishes a base of operations, while they might not have any immediate plans for attacks in the United States and in Europe, that ultimately that still remains their objective,” he said.


For that reason, Mr. Panetta said, “we have to take steps now to make sure that AQIM does not get that kind of traction.”


The United States has spent between $520 million and $600 million over the last four years to try to combat Islamist militancy in the region, including in Mali, which was until recently considered a prime example of what could be accomplished with American military training. American Special Forces trained Malian troops in marksmanship, border patrol and ambush drills.


But the situation collapsed when heavily armed Islamist fighters returned from combat in Libya and teamed up with jihadist groups like Ansar Dine, or Defenders of the Faith, which have carried out a harsh repression in northern Mali. Elite Malian commanders defected to the enemy and took with them troops, guns and their American-taught skills. An American-trained officer then overthrew Mali’s elected government, paving the way for half of the country to fall to Islamic extremists.


A confidential internal review completed last July by the Pentagon’s Africa Command concluded that the coup had unfolded too quickly for American commanders or intelligence analysts to detect any clear warning signs, but other military officials disagreed, saying the intelligence analysts had grown complacent..


Mr. Panetta sought to make the case that the United States was not surprised by the recent events in Mali and said that the Obama administration had been watching militants there for a long time. “When they began offensive operations to actually take on some cities, it was clear to France and to all of us that could not be allowed to continue, and that’s the reason France has engaged and it’s the reason we’re providing cooperation to them,” he said.


Mr. Panetta also said that “the fact is, we have made a commitment that Al Qaeda is not going to find any place to hide.”


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Study Shows Gender Bias in Wikipedia, Linux






Today in the age of the “brogrammer,” whose frat boy tendencies are glorified and sought after by cutting-edge online startups, women in tech often find themselves objectified and excluded — especially in communities like Wikipedia and open-source software, where women make up even less of the population (around 13 percent and 1 percent, respectively) than in more mainstream technical fields.


That was one of the facts Joseph Reagle, an assistant professor at Northeastern University, drew on for his study about “Free culture and the gender gap.” He discovered that just because a community (like Wikipedia) says that it’s open doesn’t mean that it isn’t hostile to women.






Free for all?


The “Free Encyclopedia” Wikipedia’s claim to fame is that anyone can edit and contribute to it. To keep errors from cropping up, it has policies that let anyone flag part of an article for review, and allow trusted editors to decide how to present something.


The process by which those editors decide, however, is often highly combative and alienating to women, who “are socialized to not be competitive and avoid conflict” according to Reagle. Sue Gardner, the Executive Director of the Wikimedia Foundation (the project behind Wikipedia), wrote a list of “Nine Reasons Women Don’t Edit Wikipedia,” in which she noted Wikipedia’s “fighty” and “contentious” culture, where loud and assertive people drive others out regardless of their competence.


“Otherwise commendable features”


Reagle found that Wikipedia’s values of radical freedom and openness actually led to a culture that is more closed off to women. He noted that “implicit” power structures existed, even in the absence of formal ones; and that imposing few restrictions on how people treat each other can lead to “a chaotic culture of undisciplined vandals,” which disenfranchises women from participation just as surely as if there were rules against women participating.


Similar dynamics exist in popular open-source software projects like the Linux kernel. Open-source luminaries like Eric Raymond are legendarily combative and hostile to “idiots,” even while they they tolerate abusive personalities who drive female contributors away. Reagle’s study quoted numerous female writers with experience working in Linux and open-source software, who called its community “cliquish and exclusionary” as well as “more competitive and fierce than most areas of programming.”


How to achieve equality


Wikipedia’s new Teahouse page is “a friendly place to help new editors,” which is designed especially to encourage women to participate. Meanwhile, women like Denise Paolucci are creating their own startups like Dreamwidth, which are based on existing open-source programming code. Unlike most “proprietary” code, it’s still free for women to do what they want with it — if they can overcome the obstacles in their way.


Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.


Linux/Open Source News Headlines – Yahoo! News





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Britney Spears Steps Out in 'Love' Sweatshirt after Split















01/14/2013 at 03:50 PM EST



Britney Spears still believes in "love" – at least when it comes to wearing it.

The pop star, 31 – whose failed engagement to Jason Trawick, 41, was announced on Friday – grabbed coffee in L.A. on Monday, sporting a black and white sweatshirt with the four-letter word displayed in large letters across the front.

The former X Factor judge looked casual, wearing shades and her hair in a ponytail.

Once the split was official, a source told PEOPLE, "Britney had a lot of issues with Jason doing his own thing – in business and seeing his friends. In her perfect world he would have been home with her twenty-four/seven, so that was a point of contention; something they were always working on."

But she didn't seem too bent out of shape when she made her outing and grabbed two drinks to go, as she wore a happy grin the whole time.

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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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