Asian shares fall on growth caution, Nikkei hit as yen gains

TOKYO (Reuters) - Asian shares fell on Wednesday as cautious investors waited for crucial economic data from China later this week, while the yen's extended gains spurred profit taking in Japanese equities after their recent rally.

Japan's benchmark Nikkei average <.n225> shed 2.6 percent for its largest daily decline in eight months, sharply reversing Tuesday's rally that lifted the index to a 32-month closing high, as the yen paused from its recent heavy selling and extended gains for two days in a row. <.t/>

The weak yen has been a catalyst for the Nikkei's 24 percent gain over the past two months.

"It's a correction. Some exporters' gains are legitimate, but others aren't, so I am selling exporters which have gained while their fundamentals are still poor such as Panasonic," said Makoto Kikuchi, Chief Executive of Myojo Asset Management in Tokyo.

Many other markets which had rallied opted to trim long positions ahead of a slew of reports due on Friday from China, the world's second-largest economy and top consumer of most commodities.

The MSCI's broadest index of Asia-Pacific shares outside Japan <.miapj0000pus> wiped out earlier modest gains to fall 0.4 percent, dragged lower by a 1.5 percent drop in the index's worst performer, Shanghai shares <.ssec>. Hong Kong shares <.hsi> shed 0.6 percent.

Bucking the risk-off trend, Australian shares and Brent futures gained, encouraged by Tuesday's stronger-than-expected U.S. retail sales data in December.

European markets are seen rising modestly, with financial spread-betters predicting London's FTSE 100 <.ftse>, Paris's CAC-40 <.fchi> and Frankfurt's DAX <.gdaxi> would open up as much as 0.3 percent. A 0.2 percent fall in U.S. stock futures hinted at a weak start on Wall Street. <.l><.eu><.n/>

Data showing China's foreign direct investment inflows falling by a smaller percentage in December than the month before helped trim losses in Chinese stocks, ahead of fourth-quarter GDP and December industrial output, retail sales and house price data expected on Friday.

The data from China will be keenly watched by investors for clues on the health of the Asia's biggest economy and global growth prospects.

Being Asia's sole outperformer, Australian shares <.axjo> advanced 0.5 percent, led by banks and defensives after Wall Street posted modest gains on the retail sales data.

"It would appear that a number of traders are waiting to see how Friday's Chinese GDP data pans out before buying with more conviction and this is particularly true of the mining sector," said Tim Waterer, senior trader at CMC Markets in Sydney.

Selling in the dollar and the euro against the yen in what traders say is a short-term corrective move was sparked by a Japanese official on Tuesday warning of damage from excessive yen weakness through rising import prices.

The yen had steadily fallen over the past two months on expectations the new government would embark on aggressive fiscal stimulus while pushing the Bank of Japan to take bold monetary easing steps.

Data on Wednesday showed Japan's core machinery orders rose 3.9 percent in November from October, exceeding a forecast 0.3 percent rise, but another report showed consumer confidence worsened in December.

The dollar fell 0.7 percent to 88.13 yen, after scaling its peak since June 2010 of 89.67 on Monday.

The euro slumped 0.9 percent to 117.09 yen, after surging to its highest since May 2011 of 120.13 yen on Monday.

REALLOCATION UNDERWAY?

The euro eased 0.2 percent against the dollar to $1.3281, after reaching an 11-month high of $1.3404 on Monday.

The euro was pressured by a weak economic report from Germany as well as comments from the chairman of the euro zone finance ministers, Jean-Claude Juncker, who on Tuesday said the euro was "dangerously high" without elaborating.

The single currency eased 0.1 percent against the Swiss franc at 1.2385, off Tuesday's 13-month high of 1.2413 francs. The Swiss franc has been hit by receding safe-haven bids as falling yields in deeply indebted countries such as Spain and Italy eased concerns about the euro zone's debt crisis.

Reversals in the strengthening trend for the Swiss franc and the yen may suggest asset reallocations are taking place.

"Old regimes are dying and FX is the first sign of this process. We are seeing this in JPY, are starting to see this in CHF," Sebastien Galy, strategist at Societe Generale, said in a note to clients.

Spot gold rose 0.2 percent to $1,681.55 an ounce, underpinned by wariness about U.S. default risks.

But platinum fell 0.7 percent to $1,666.75 an ounce after hitting a three-month high of $1,699.50 on Tuesday on supply fears. It traded at a premium to gold on Tuesday for the first time since March 2012.

The benchmark gold futures contract on the Tokyo Commodity Exchange hit a record high for a third consecutive session, rising to 4,828 yen a gram.

U.S. crude was up 0.2 percent to $93.44 a barrel while Brent was up 0.3 percent to $110.61.

A falling stock market weighed on Asian credit markets, pushing the spread on the iTraxx Asia ex-Japan investment-grade index wider by 2 basis points.

(Additional reporting by Ayai Tomisawa in Tokyo and Thuy Ong in Sydney; Editing by Shri Navaratnam)

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Bomb Strikes Disputed Iraqi City of Kirkuk

BAGHDAD (AP) — A powerful suicide car bomb struck the local headquarters for the party of a key Kurdish leader early Wednesday in the disputed Iraqi city of Kirkuk, killing at least four and wounding dozens, according to officials.

The blast outside the offices of the Kurdistan Democratic Party caused widespread damage, mangling cars and tearing apart storefronts. The KDP is led by Massoud Barzani, the president of Iraq's largely autonomous Kurdish region, who has frequently sparred with Iraq's central governor in Baghdad.

Kirkuk provincial council chairman Hassan Torhan said 90 people have been wounded, suggesting the death toll could rise.

The blast comes amid rising tensions along Iraq's ethnic and sectarian divide.

Kirkuk, 290 kilometers (180 miles) north of Baghdad, is home to a mix of Arabs, Kurds and Turkomen, who all have competing claims to the oil-rich area. The Kurds want to incorporate it into their self-ruled region in Iraq's north, but Arabs and Turkomen are opposed.

The city is at the heart of a snaking swath of territory disputed between the Kurds, who have their own armed fighting force, and Iraq's central government. A shootout in another area along the contested area prompted both sides to rush troops and heavy weapons to the area in November.

Violence has fallen since the peak of insurgency several years ago, but lethal attacks still occur frequently.

There was no immediate claim of responsibility for Tuesday's attacks, but car bombs are the hallmark of Sunni insurgents such as al-Qaida in Iraq.

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Apple scoops PBS on “Downton Abbey” episodes, but PBS is cool with it

NEW YORK (TheWrap.com) – Apple is making the entire third season of “Downton Abbey” available on iTunes before every episode airs on PBS – and that’s just fine with PBS.

Fans who buy a season pass on iTunes beginning January 29 will get to see three episodes before they air on PBS. The Season 3 finale airs February 17.

But PBS CEO Paula Kerger isn’t worried that viewers will watch the show online, then tune out PBS. In fact, she says, Apple isn’t the only place Americans can see “Downton” before they can see it on her network.

“You can also buy the DVD sets. They’re being shipped at the end of January, and the DVD sets and Apple are going up at the same time,” Kerger told TheWrap. “I think that for people who are really passionate and want to have it, it’s a great thing.”

Kerger says she hopes more viewers will discover “Downton” on whatever format they like best – and then watch it on PBS next season.

“At the end of the day, my interest is just in seeing it get to the widest possible audience, and there are people that would pick it up on Apple that may not pick it up anywhere else,” she said.

The first episode of the third season premiered to a record 7.9 million viewers earlier this month. Many of those viewers, no doubt, caught up on the previous seasons online or through DVD viewing.

“Downton” airs in the U.K. in the fall but on PBS in January, which means PBS viewers must shield themselves from spoilers. That has led to some grumbling from American fans.

But Kerger said airing the show in January allows the show to get more attention domestically than it might otherwise receive in the crowded fall season.

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It's a Boy for Elton John

Mom & Babies
Celebrity Baby Blog

01/15/2013 at 10:00 PM ET

George Pimentel/WireImage

Elton John is a father again!

The musician and David Furnish welcomed their second child, son Elijah Joseph Daniel Furnish-John, via surrogate on Friday, Jan. 11 in Los Angeles, the couple confirm to HELLO.

Born at 6:40 p.m., Elijah weighed in at 8 lbs., 4 oz.

John and Furnish, who married in 2005, are already parents to son Zachary Jackson Levon, 2.

“Both of us have longed to have children, but the reality that we now have two sons is almost unbelievable. The birth of our second son completes our family in a most precious and perfect way,” the couple say in a statement.

“It is difficult to fully express how we are feeling at this time; we are just overwhelmed with happiness and excitement.”

John, 65, has been open about his desire to expand their family.

“I know when he goes to school there’s going to be an awful lot of pressure, and I know he’s going to have people saying, ‘You don’t have a mummy,’” says the singer-songwriter of his decision to have another baby.

“It’s going to happen. We talked about it before we had him. I want someone to be at his side and back him up. We shall see.”

– Sarah Michaud

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

___

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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IHT Rendezvous: IHT Quick Read: Jan. 15

NEWS Despite intensive airstrikes by French warplanes, Islamist fighters overran a strategic village and military post in central Mali on Monday, indicating that the war against extremists who have carved out a jihadist state in the nation’s north could be a long and difficult one. Steven Erlanger, Alan Cowell and Adam Nossiter report.

President Barack Obama and Republican Congressional leaders dug in Monday on their conflicting positions over raising the U.S. debt limit, indicating that the president’s second term will open with a potentially perilous budget showdown. Jackie Calmes and Jonathan Weisman report from Washington.

The chief human rights official at the United Nations, Navi Pillay, called on Monday for an international inquiry into human rights offenses committed by the North Korean government over many decades. Nick Cumming-Bruce reports from Geneva.

The Chinese state news media on Monday published aggressive reports on what they described as the dangerous air pollution in Beijing and other parts of northern China, indicating that popular anger over air quality had reached a level where propaganda officials felt they had to let the officially sanctioned press address the issue. Edward Wong reports from Beijing.

Unidentified gunmen on Monday sprayed bullets into the headquarters of Greece’s governing New Democracy party in Athens, adding to a wave of politically motivated violence. Liz Alderman reports from Athens.

ARTS When “Kung Fu Panda 3” kicks its way into China’s theaters in 2016, the country’s vigilant film censors will find no nasty surprises — after all, they have already dropped in to monitor the movie at the DreamWorks Animation campus in Los Angeles. The lure of access to China’s fast-growing film market is entangling studios and moviemakers with the state censors of a country in which American notions of free expression simply do not apply. Michael Cieply and Brooks Barnes report from Los Angeles.

Yannick Nézet-Séguin, the Philadelphia Orchestra’s Quebec-born music director, is what the orchestra world is desperate for: a young, charismatic maestro who can win the respect of grizzled orchestra veterans, the enthusiasm of audiences and the praise of critics. Daniel J. Wakin reports from Montreal.

FASHION Something in the dank winter air or the chily economy is bringing out the tough side of the alpha male. Boots elevated on rubber soles and leather jackets padded with nylon and neoprene make men’s wear for winter 2013 look like it is designed to handle a hurricane. Suzy Menkes writes from Milan.

SPORTS Caroline Wozniacki, long No. 1 in women’s tennis, is now No. 10. Her plan for 2013 is to minimize the pain and the confusion; to restore clarity to her game and stability to her off-court structure. Christopher Clarey reports from Melbourne.

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Can We Trust CNET Again After a Scandal This Shady?

CNET, one of the Internet’s first and most influential authorities on gadgets and tech news, watched its editorial integrity spiral out of control Monday, with staffers quitting and editors left to explain themselves in the wake of explosive new charges over its annual Consumer Electronics Show awards — a scandal, it would appear, that goes all the way to the top of its corporate umbrella, and could shake the entire ecosystem of online tech journalism.

RELATED: CBS Puts CNET in an Ethically Questionable Spot at CES

Contrary to an already controversial move first reported last Friday, CNET parent company CBS didn’t just asked the site to remove Dish’s Slingbox Hopper from consideration for its Best of CES Awards amidst a lawsuit between CBS and Dish; the removal came after executives learned the gadget would take the top award, and that request came down from CBS CEO Leslie Moonves himself, sources tell The Verge’s Joshua Topolsky. Now, CNET’s corporate responsibilities appear to have made the long trusted site bend at will and, despite desperate pushback from some of its writers and editors, it appears CNET may have moved to cover up the series of events that led to the removal of the award.

RELATED: Following Time and CNN, The Washington Post Suspends Zakaria

For CNET, all of this looks very bad. How can readers trust the site for its famously unbiased reviews and industry news coverage if a media-conglomerate overlord is insisting that some things just “can’t exist”? The events that have unfolded since the scandal broke wide open haven’t exactly restored anyone’s faith. Greg Sandoval, a seven-year veteran of the site, announced his resignation Monday morning on Twitter, citing a lack of “editorial independence” from CBS as his motivation. In a separate tweet, he called CNET’s dishonesty about its parent company‘s involvement with Dish “unacceptable.” Since, both CNET and CBS have released not-too-convincing statements. 

RELATED: Does The Times’ Public Editor Regret Its Adventures in Social-Media Babysitting?

Following the Verge report and Sandoval’s resignation, CNET Editor in Chief Lindsay Turrentine explained how CNET editors did everything in their power to fend off corporate insistence on its editorial decisions, but found the power of a pending deal between two bigger media companies too intimidating. So the editors gave in, and waited. “We were in an impossible situation as journalists,” Turrentine wrote, adding that she thought about resigning. “I decided that the best thing for my team was to get through the day as best we could and to fight the fight from the other side.” 

RELATED: What Kind of David Brooks Hater Are You?

Speaking for many a media and tech pundit, Reuters’s Megan McCarthy questioned the front side of the internal debate: 

CNET’s editor-in-chief’s explains why she caved to CBS. Why didn’t she just refuse to award the Best in Show? : news.cnet.com/8301-30677_3-5…

— Megan McCarthy (@Megan) January 14, 2013

For her part, Turrentine seems to have one major regret: “I wish I could have overridden the decision not to reveal that Dish had won the vote in the trailer.” That doesn’t exactly scream editorial independence, as The Verge’s Sean Hollister pointed out on Twitter.

CNET doesn’t get it either. “I wish I could have overridden the decision not to reveal” is NOT editorial independence. cnet.co/VWBv5o

— Sean Hollister (@StarFire2258) January 14, 2013

Turrentinge went on to say that if she had to face this “dilemma” again, she would not quit. Meaning, if this turns into more than a one-time incident, she wouldn’t have a problem bending to CBS again? 

RELATED: Did Cops Target Journalist’s Wife’s Spa with Prostitution Raid as Payback?

CBS’s statement to The Verge hasn’t calmed the critics, either. “In terms of covering actual news, CNET maintains 100% editorial independence, and always will. We look forward to the site building on its reputation of good journalism in the years to come,” reads the CBS reply. But when you’re dealing with angry tech readers, their nerdfest of the year, and the corporate responsibilities  therein, 100 percent of trust is tough to build back.

While CNET struggles to emerge from this mess, the situation appears to be threatening the entire ecosystem of the technology press, which has a history of reinventing its standards on bias in product reviews. A number of gadget and tech-news sites fall under larger corporate umbrellas: AOL owns Engadget; NewsCorp owns The Wall Street Journal and its influential tech coverage; BuzzFeed FWD has to answer to its investors, who put money in all sorts of tech ventures; IAC invests in companies like Aereo but owns The Daily Beast. Turns out this wasn’t just a family feud — the CNET and CBS scandal at CES could set a precedent for years to come.

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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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