ER visits tied to energy drinks double since 2007

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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NRA Ad Calls Obama 'Elitist Hypocrite'

Pablo Martinez Monsivais/AP Photo

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

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

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

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

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

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

An NRA spokesman said the video is airing on the Sportsman Channel and on the web for now but may appear in other broadcast markets at a later date.

The White House had no comment on the NRA ad.

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

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

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

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

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

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

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

ABC News’ Arlette Saenz, Mary Bruce and Jay Shaylor contributed reporting. 

This post was updated at 9:32 am on Jan. 16 to reflect include comment from an NRA spokesman.

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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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Panel makes recommendations to raise quality of financial advisory industry

SINGAPORE : Singaporeans planning to buy insurance products can look forward to paying lower costs.

This comes after the Financial Advisory Industry Review Panel made a slew of recommendations to raise the quality and efficiency of the financial advisory industry.

They include proposals aimed at lowering the distribution costs of insurance products.

The panel reviewing the financial advisory industry has recommended measures that include raising the minimum education qualification of new financial advisers.

They also propose that a website be set up to make it easier for consumers to shop for financial products.

Lee Chuan Teck, assistant managing director for Capital Markets at the Monetary Authority of Singapore (MAS), said: "The panel recommends that MAS work with the industry to develop a web aggregator that allows consumers to easily compare pricing, benefits and other features of similar products offered by different insurers."

A survey by MAS found that 80 per cent of Singaporeans are not prepared to pay an upfront fee for financial advice.

This led the panel to focus on how to lower distribution costs for insurance-based products.

It has proposed the introduction of a direct channel for consumers to buy basic insurance products directly from the insurers.

Tan Hak Leh, president of the Life Insurance Association, Singapore, said: "Any measures that lead to greater transparency would increase competitiveness and each player would then need to find ways to stay competitive in the market."

However, the financial adviser's role will not be displaced.

A financial adviser's services would still be required to sell some products.

Augustine Lee, president of the Association of Financial Advisers (Singapore), said: "Insurance (products) normally are sold and not bought, so you still need to have independent financial advisers to help you in terms of decision making and choosing the right product."

The Consumers Association of Singapore has welcomed the latest recommendations.

It said the main beneficiaries would ultimately be the consumers.

Seah Seng Choon, executive director of the Consumers Association of Singapore, said: "The issue about under insurance for Singaporeans may be addressed, now that the distribution costs can be lowered through competition."

MAS said it will consult the public on these recommendations and then decide on their implementation.

- CNA/ms

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Undermining peace not conducive for trade ties: India to Pak

NEW DELHI: In a clear message that current strain could impact trade ties, India on Wednesday told Pakistan economic engagement can be enhanced in an environment of peace and stability and asserted "anything which undermines that environment is not conducive" for economic relations.

The remarks by commerce and industry minister Anand Sharma came a day after Prime Minister Manmohan Singh's tough message to Pakistan that it cannot be "business as usual" in the aftermath of the beheading of an Indian soldier on the line of control last week.

Sharma's comments, ahead of the Annual Partnership Summit to be held in Agra from January 27, also assume significance given the fact that no bilateral meeting is scheduled between Sharma and his Pakistani counterpart Makhdoom Amin Fahim, who is travelling to India for the business meet.

"As of now, we have not given any consideration to this matter in a negative sense. (But) yes, what has happened is horrific, its unacceptable, highly provocative. And this is for Pakistan to realise that where the well being of the economy of the country lies," Sharma told reporters here.

The minister was asked whether he believes that the recent development along the line of control (LoC) in Jammu and Kashmir could impact bilateral trade ties.

The economic engagement can be enhanced only in an environment of peace and stability and there was no other way forward for this region, he said and asserted that "anything which undermines that environment is not conducive".

Demanding that Islamabad should take action against those who are responsible for brutal killing of Indian soldiers, he said,"... that would be in Pakistan's own interest, not only for bilateral relations but its global image as a responsible nation state." Meanwhile, official sources have indicated that the 10- member Pakistan business delegation, which was supposed to participate in the Annual Partnership Summit in Agra, has cancelled its visit.

This comes in the backdrop of increasing tensions between the two countries. However, Pakistan commerce minister fahim and secretary Munir Qureshi have confirmed their participation in the three -day summit, organized by CII, commerce and industry ministry and Uttar Pradesh government.

In Islamabad, Amjad Baloch, Staff Officer to the Commerce Minister, denied that Fahim has called off the visit. He told that a formal proposal regarding the visit of the minister and commerce secretary has been sent to the Prime Minister's Office. The bilateral trade between the countries stood at about $2 billion in 2011-12.

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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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Pakistan turmoil deepens as court orders PM's arrest

ISLAMABAD (Reuters) - Pakistan's Supreme Court ordered the arrest of the prime minister on Tuesday on corruption allegations, ratcheting up pressure on a government that is also facing a massive street protest led by a cleric who has a history of ties to the army.

The combination of the arrest order and the mass protest in the capital Islamabad led by Muslim cleric Muhammad Tahirul Qadri raised fears among politicians that the military was working with the judiciary to force out a civilian leader.

"There is no doubt that Qadri's march and the Supreme Court's verdict were masterminded by the military establishment of Pakistan," Fawad Chaudhry, an aide to Prime Minister Raja Pervez Ashraf, told Reuters.

"The military can intervene at this moment as the Supreme Court has opened a way for it."

However, the ruling coalition led by the Pakistan Peoples' Party (PPP) has a majority in parliament and lawmakers can simply elect another prime minister if Ashraf is ousted. In June, Ashraf replaced Prime Minister Yusuf Raza Gilani, who was disqualified by the Supreme Court in a previous showdown between the government and the judiciary.

Also, elections are due in a few months and President Asif Ali Zardari hopes to lead the first civilian government in Pakistan's 65 years as an independent nation that will complete its full term.

But power struggles will distract the unpopular government from tackling an array of problems - a Taliban insurgency, economic stagnation and growing sectarian tensions triggered by bomb attacks and tit-for-tat shootings.

The military, which sees itself as the guarantor of Pakistan's stability, has long regarded the PPP-led government as corrupt, incompetent and unable to prevent the nuclear-armed country from falling apart.

Pakistan's powerful army has a long history of coups and intervening in politics. These days generals seem to have little appetite for a coup but many believe they still try to exert behind-the-scenes influence.

Some politicians believe the military will try to dominate the caretaker administration that will oversee the run-up to the polls after parliament is dissolved, which is due to happen in March. An election date has yet to be announced.

The protest by Qadri and his followers has also been seen by commentators as being orchestrated by the military to add to the pressure on Zardari's government, although the military has denied any involvement.

Thousands of followers of the populist cleric camped near the federal parliament cheered and waved Pakistani flags as television channels broadcast news of the Supreme Court's order to arrest Ashraf on charges of corruption.

"We don't want any of those old politicians. They just take all the people's money," said 19-year-old student Mohammed Wasim. "We congratulate the whole nation (on the Supreme Court's order). Now we have to take the rest of the thieves to court."

BAFFLED

Government officials said they were baffled by the arrest order, which came hours after Chief Justice Iftikhar Chaudhry said elections should go ahead as scheduled.

"This was totally unexpected," an official in Ashraf's office told Reuters. "The prime minister and two or three of his friends were watching Qadri speak on television and this suddenly happened."

Pakistan's stock exchange fell by more than 500 points, or nearly three percent, on news of the court order, due to fears over fresh political turmoil, which comes against a backdrop of militant bombings and tension on the border with India.

Qadri, who played a role in backing a military coup in 1999, threatened to remain camped out near the federal parliament with thousands of supporters until his demands for the resignation of the government were met.

The fiery orator returned home from Canada less than a month ago to lead a call for electoral reforms to bar corrupt politicians from office that has made him an instant hit among Pakistanis disillusioned with the state.

In a speech from behind a bullet-proof shield in front of parliament, Qadri praised the military and the judiciary, the country's two other power centers.

"(The government) has wasted and brought a bad end to our armed forces, those armed forces who are highly sincere, highly competent and highly capable and highly professional," he said, alternating between Urdu and English.

"Even they can't do anything because the political government isn't able to deliver anything from this land. Judgments are being passed by our great, independent judiciary but the government is not ready to implement them."

Qadri is demanding that the government dissolve the legislature and announce the formation of a caretaker government to oversee the run-up to elections.

He told Reuters on Friday that the military could play a possible role in the selection of the interim administration, a stance which has sharpened fears he may be working at the army's behest. The military denies any ties to him.

One senior military officer, who said he was speaking in a purely personal capacity, said there was no appetite in the military to repeat the coups seen in Pakistan's past, but added the stand-off could be resolved if the army played a role in the formation of a caretaker government as a "moderator".

"We should try as far as possible to abide by the constitution and law in looking for change. The army chief has made this clear," the officer told Reuters.

"But things seem to be moving beyond control," the officer added. "It is totally incorrect to say the army is behind Qadri. But if he brings thousands of people to the streets and things get worse, there may be very few options."

(Additional reporting by Matthew Green and Mubasher Bukhari in ISLAMABAD and Jibran Ahmad in PESHAWAR; Writing by Michael Georgy; Editing by Raju Gopalakrishnan)

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Bidding showdown over F&N expected on Jan 21

SINGAPORE: A corporate shoot out over Fraser & Neave is expected on January 21.

The Securities Industry Council (SIC) has said the final time by which TCC Assets or OUE Baytown can revise its offer is 5.30pm on January 21. Each party will either announce any revision to their current takeover bids or walkaway from the deal.

In a statement issued on Tuesday, SIC said that "given that neither TCC nor OUE Baytown has declared its offer final, the council considers that the company's shareholders should be provided with certainty to make their investment decisions in respect of the competing offers."

If either TCC or OUE makes a revised offer on January 21, then an "auction procedure" will kick-in.

TCC Assets on Tuesday extended its S$8.88 per share offer for F&N for the seventh time to January 21, the very same day that rival bidder OUE's offer expires. A consortium led by OUE made a S$9.08 per share bid for F&N in November 2012.

This, after a first bid by Thai tycoon Charoen Sirivadhanabhakdi through his investment assets, TCC and Thai Beverage, in September.

But given that the tug-of-war has been ongoing for several months, some experts said that the Securities Industry Council will not allow for an indefinite period of market uncertainty.

Shares of F&N have been trading above the offers made by TCC Assets and OUE, indicating that shareholders are expecting higher bids.

Fraser & Neave shares ended Tuesday up 0.1 per cent at S$9.70.

-CNA/ac

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Why it took so long for PM to react? asks BJP

NEW DELHI: The BJP wondered why it took "so long" for the Prime Minister to respond to the "barbaric" beheading of an Indian soldier along the line of control and asked if his reaction on Tuesday was out of conviction or compulsion.

The opposition party said it was able to make the government understand the mood of the nation seeking tough measures against Pakistan in the wake of the barbaric incident.

"The fact that it has taken so long for PM to react makes me wonder if today's reaction is out of conviction or out of compulsion. I hope this marks the burial of the Sharm-al- Sheikh line," BJP leader Arun Jaitley said expressing skepticism over the Prime Minister's statement.

Expressing satisfaction over the talks with National Security Adviser Shivshankar Menon, BJP leader Sushma Swaraj said, "I can say that the meeting was successful...we were able to make the Prime Minister understand the mood of the nation."

Talking about Prime Minister Manmohan Singh's tough message to Pakistan that there cannot be business as usual with it in the aftermath of the "barbaric" beheading of an Indian soldier, Swaraj said, "I felt happy, even if it is late, the Prime Minister has understood the mood of the nation and what the opposition had talked about."

The Prime Minister had earlier deputed NSA Shivshankar Menon to brief leaders of Opposition in Parliament on the situation arising out of the incident along the LoC and the latter had an hour-long meeting with the two in the morning.

Swaraj said during their meeting with Menon, they had conveyed to him that protests and displeasure was fine, but the government should understand the anger of the nation and sought tough measures against the neighbouring country.

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Flu more widespread in US; eases off in some areas

NEW YORK (AP) — Flu is now widespread in all but three states as the nation grapples with an earlier-than-normal season. But there was one bit of good news Friday: The number of hard-hit areas declined.

The flu season in the U.S. got under way a month early, in December, driven by a strain that tends to make people sicker. That led to worries that it might be a bad season, following one of the mildest flu seasons in recent memory.

The latest numbers do show that the flu surpassed an "epidemic" threshold last week. That is based on deaths from pneumonia and influenza in 122 U.S. cities. However, it's not unusual — the epidemic level varies at different times of the year, and it was breached earlier this flu season, in October and November.

And there's a hint that the flu season may already have peaked in some spots, like in the South. Still, officials there and elsewhere are bracing for more sickness

In Ohio, administrators at Miami University are anxious that a bug that hit employees will spread to students when they return to the Oxford campus next week.

"Everybody's been sick. It's miserable," said Ritter Hoy, a spokeswoman for the 17,000-student school.

Despite the early start, health officials say it's not too late to get a flu shot. The vaccine is considered a good — though not perfect — protection against getting really sick from the flu.

Flu was widespread in 47 states last week, up from 41 the week before, the Centers for Disease Control and Prevention said on Friday. The only states without widespread flu were California, Mississippi and Hawaii.

The number of hard-hit states fell to 24 from 29, where larger numbers of people were treated for flu-like illness. Now off that list: Florida, Arkansas and South Carolina in the South, the first region hit this flu season.

Recent flu reports included holiday weeks when some doctor's offices were closed, so it will probably take a couple more weeks to get a better picture, CDC officials said Friday. Experts say so far say the season looks moderate.

"Only time will tell how moderate or severe this flu season will be," CDC Director Dr. Thomas Frieden said Friday in a teleconference with reporters.

The government doesn't keep a running tally of adult deaths from the flu, but estimates that it kills about 24,000 people in an average year. Nationally, 20 children have died from the flu this season.

Flu vaccinations are recommended for everyone 6 months or older. Since the swine flu epidemic in 2009, vaccination rates have increased in the U.S., but more than half of Americans haven't gotten this year's vaccine.

Nearly 130 million doses of flu vaccine were distributed this year, and at least 112 million have been used. Vaccine is still available, but supplies may have run low in some locations, officials said.

To find a shot, "you may have to call a couple places," said Dr. Patricia Quinlisk, who tracks the flu in Iowa.

In midtown Manhattan, Hyrmete Sciuto got a flu shot Friday at a drugstore. She skipped it in recent years, but news reports about the flu this week worried her.

During her commute from Edgewater, N.J., by ferry and bus, "I have people coughing in my face," she said. "I didn't want to risk it this year."

The vaccine is no guarantee, though, that you won't get sick. On Friday, CDC officials said a recent study of more than 1,100 people has concluded the current flu vaccine is 62 percent effective. That means the average vaccinated person is 62 percent less likely to get a case of flu that sends them to the doctor, compared to people who don't get the vaccine. That's in line with other years.

The vaccine is reformulated annually, and this year's is a good match to the viruses going around.

The flu's early arrival coincided with spikes in flu-like illnesses caused by other bugs, including a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." Those illnesses likely are part of the heavy traffic in hospital and clinic waiting rooms, CDC officials said.

Europeans also are suffering an early flu season, though a milder strain predominates there. China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo have also reported increasing flu.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Some shortages have been reported for children's liquid Tamiflu, a prescription medicine used to treat flu. But health officials say adult Tamiflu pills are available, and pharmacists can convert those to doses for children.

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Associated Press writers Dan Sewell in Cincinnati, Catherine Lucey in Des Moines, and Malcolm Ritter in New York contributed to this report.

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Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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