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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Oprah Describes Intense Armstrong Interview

Oprah Winfrey said today that disgraced cyclist Lance Armstrong came well prepared for their highly anticipated interview, although he "did not come clean in the manner [she] expected."

Winfrey, who discussed the interview on "CBS This Morning" today, said, "We were mesmerized and riveted by some of his answers. I feel that he answered the questions in a way that he was ready. … He certainly had prepared himself for this moment. … He brought it. He really did."

Armstrong had apologized to staffers at the Livestrong Foundation before the Monday interview with Winfrey at a hotel in Austin, Texas, and reportedly admitted to them that he used performance-enhancing drugs throughout his storied career.

Armstrong also confessed to Winfrey to using the drugs, sources have told ABC News. Winfrey said this morning that the entire interview, for which she had prepared 112 questions, was difficult.

"I would say there were a couple of times where he was emotional," she said. "But that doesn't describe the intensity at times."

As for the cyclist's sense of remorse, Winfrey said that will be for viewers to decide.
"I would rather people make their own decisions about whether he was contrite or not," she said.

The interview will air on the OWN network for two nights, starting at 9 p.m. ET Thursday and continuing Friday.

Meanwhile, the federal government is likely to join a whistle-blower lawsuit against Armstrong, originally filed by his former cycling teammate Floyd Landis, sources told ABC News.

The government is seeking to recoup millions of dollars from Armstrong after years of his denying that he used performance-enhancing drugs, the sources said. The U.S. Postal Service, which is an independent agency of the federal government, was a longtime sponsor of Armstrong's racing career.

Joel Saget/AFP/Getty Images

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The deadline for the government's potentially joining in the matter was a likely motivation for Armstrong's interview with Winfrey, sources told ABC News.

The lawsuit remains sealed in federal court.

Armstrong is now talking with authorities about possibly paying back some of the Postal Service sponsorship money, a government source told ABC News Monday.

The deadline for the department to join the case is Thursday, the same day Armstrong's much-anticipated interview with Winfrey is set to air.

Armstrong is also talking to authorities about confessing and naming names, giving up others involved in illegal doping. This could result in a reduction of his lifetime ban, according to a source, if Armstrong provides substantial and meaningful information.

As for the Winfrey interview, it was Armstrong's first since officials stripped him of his world cycling titles in response to doping allegations.

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

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

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

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

Armstrong then took questions from the staff.

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

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

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

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Syria war envelops region in "staggering" crisis: aid agency

BEIRUT (Reuters) - Syria's civil war is unleashing a "staggering humanitarian crisis" on the Middle East as hundreds of thousands of refugees flee violence including gang rape, an international aid agency said on Monday.

Opposition activists said an air strike on rebel-held territory southwest of Damascus killed 20 people, including women and children, adding to the more than 60,000 people estimated to have been killed in the 21-month-old conflict.

Over 600,000 Syrians have fled abroad - many to neighboring Turkey, Lebanon and Jordan - as violence has spread and international efforts to find a political solution have sagged.

Refugees interviewed by the International Rescue Committee (IRC) cited sexual violence as a major reason they fled the country, the New York-based organization said in a 23-page report on the crisis published on Monday.

Gang rapes often happened in front of family members and women had been kidnapped, raped, tortured and killed, it said.

"After decades of working in war and disaster zones, the IRC knows that women and girls suffer physical and sexual violence in every conflict. Syria is no exception," the group added.

Rebels and government forces have both been accused of human rights abuses during the conflict, which began with peaceful protests against President Bashar al-Assad in March 2011.

The unrest turned violent after government forces fired on demonstrators and has since become a full-scale civil war.

Fierce winter weather has worsened the plight of hundreds of thousands of refugees. The IRC urged donors to step up planning and funding in the expectation that more Syrians will flee.

"Nearly two years into Syria's civil war, the region faces a staggering humanitarian disaster," the IRC report said.

AIR POWER

Despite advancing in Syria's north and east and winning support from regional powers like Turkey and Saudi Arabia, the Syrian rebels have been unable to break a military stalemate with government forces elsewhere.

They have struggled to counter government air power in particular, making it hard for them to take and hold territory crucial to Assad's grip on power, including major cities.

An activist in Moadamiyeh, a rebel-held town southwest of Damascus, said an air strike there killed 20 people on Monday.

Activist video footage showed images of the limp body of a boy being pulled out from broken concrete, his back covered in dust and his front in blood.

The Syrian Observatory for Human Rights, a Britain-based monitoring group, said at least 13 people had died in the air raid but the toll was likely to rise.

Syrian state television said "terrorists" - its word for rebels - had fired a mortar from the Damascus suburb of Daraya on a civilian building in Moadamiyeh, killing women and children.

The reports could not be independently verified because of government restrictions on independent media in Syria.

Syrian warplanes also bombarded the strategic Taftanaz air base that rebels seized last week, the Observatory said.

In another sign of escalating bloodshed, Human Rights Watch said it had evidence that government forces had used multi-barrel rocket launchers to deliver Egyptian-made cluster munitions in recent attacks.

"Syria is escalating and expanding its use of cluster munitions, despite international condemnation of its embrace of this banned weapon," it said.

DEADLOCK

Syria's rising death toll has brought international intervention no closer. The United States and Russia have been deadlocked over how to resolve the crisis.

Moscow - which has continued to back its long-standing ally and arms client Assad - urged the opposition on Sunday to make its own proposals in response to a speech by Assad a week ago.

The speech, which offered no concessions, was criticized by the United Nations and United States. Syrian rebels described it as a renewed declaration of war.

Talks between Russia and the United States in Geneva on Friday failed to produce a breakthrough.

As diplomatic efforts have stalled, the conflict has continued to draw in Syria's neighbors.

A mortar round apparently fired from Syria crashed in a field in Turkey overnight close to a refugee camp housing thousands of Syrians along the border, Turkish state media said.

NATO troops have begun deploying Patriot defense missiles in Turkey against a potential attack from its southern neighbor. The missiles are expected to be operational by the end of the month. Turkey is a strong supporter of the Syrian rebels.

NATO said Syrian government forces had launched a short-range, Scud-style ballistic missile on Sunday, bringing to more than 20 the number launched in the past month.

The missiles, apparently fired against opposition targets, landed in Syrian territory, mostly in northern Syria, a NATO spokeswoman said in Brussels, but some of the missiles landed "quite close" to the Turkish frontier.

(Additional reporting by Laila Bassam in Beirut and Adrian Croft in Brussels; Writing by Alexander Dziadosz; Editing by Mark Heinrich)

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Temporary sheltered linkways to be provided at Marina Bay

SINGAPORE: The Land Transport Authority (LTA) will be providing temporary sheltered pedestrian linkways along the roads between Marina Bay Financial Centre and Marina Bay Station.

Transport Minister Lui Tuck Yew said this in response to Mr Gan Thiam Poh's parliamentary question on whether the transport ministry will provide a sheltered or underground pedestrian walkway.

Mr Lui addded that the Urban Redevelopment Authority plans to build an extensive underground pedestrian network (UPN).

This is to link the developments in Marina Bay to the nearby MRT stations, including Marina Bay Station.

- CNA/xq

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India to start visa-on-arrival for Pakistani elders at Attari

AMRITSAR: Indian authorities are all set for a historic move to issue visas on arrival to Pakistani nationals aged 65 and above, from Tuesday, immigration officials said here Monday.

This is the first time that Pakistani nationals will be allowed the facility of visa on arrival at the Attari-Wagah land border joint check post, 30 km from here.

However, the facility will only be for senior citizens 65 and above. They will be allowed to cross the border gates on foot, and can stay in India for 45 days during one visit. Two visits are proposed to be allowed for each person under the new rules.

India and Pakistan had signed a visa agreement September last year under which rules to issue visas to nationals of both countries were eased a little. It was under this agreement that both sides agreed to allow visa on arrival for senior citizens at the Attari-Wagah border.

However, those who are issued the visa on arrival will be allowed to go only to those places or states which are mentioned in the visa. They will not be allowed to stay in Punjab and can only transit from the state. Such people will also not be allowed to enter Jammu and Kashmir and some other states.

Those availing the visa on arrival will have to go back the same way (on foot) and cannot change the mode of travel.

People from both countries can travel by bus, train, air or through the sea route. A restricted number of people are allowed to cross the border on foot through the land route.

On an average, nearly 100 people cross the land border at Attari-Wagah on foot. Others travel by the Delhi-Lahore bus service or the Samjhauta Express peace train between both countries.

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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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Golden Globe Moments: A Night of Laughs, Surprises

Let's finally bury this idea that women can't be funny once and for all. Fey and Poehler were undeniably hilarious throughout the Globes, so much so that many fans on Twitter demanded more of them during the ceremony. From their opening bit -- Poehler: "Meryl Streep is not here tonight, she has the flu. And I hear she's amazing in it." -- to their pseudo drunk heckling of best TV comedy actress winner Lena Dunham, they were radiant, energetic, and above all, funny. More please.

Foster made her acceptance of the Cecil B. DeMille lifetime achievement award a coming out, of sorts. She first shocked the audience by leading them to think that she was about to make a huge public statement about her sexuality. Instead, she said she was single, adding "I already did my coming out in the stone age."

"Now, apparently, I'm told that every celebrity is expected to honor the details of their private life with a press conference ... You guys might be surprised, but I'm not Honey Boo Boo child," she said, to a flurry of laughter and applause.

"If you had been a public figure from the time that you were a toddler ... then maybe you too might value privacy above all else," she said. "Privacy."

But Foster did specifically thank her ex-partner Cydney Bernard, with whom she has two kids. Both boys gestured to her from the audience.

She also implied that she was retiring from acting when she said she would not be returning to the Globes stage or any stage. "It's just that from now on, I may be holding a different talking stick," Foster said, bringing many in the audience to tears.

But backstage, Foster clarified to reporters that she was not retiring from acting. "Oh that's so funny," she responded to reporters. "You couldn't drag me away. And I'd like to be directing tomorrow."

It takes a lot to make Hollywood star struck. Bill Clinton did it when he strutted on stage to introduce a clip of "Lincoln," which was up for best drama. He brought the crowd of A-listers to its feet and commended the 16th president. "We're all here tonight because he did it," he said of Lincoln's battle to end slavery.

If there was any doubt that Lena Dunham wasn't Hollywood's next big thing, it was obliterated Sunday night. The star and creator of HBO's "Girls" went home with two awards, best actress in a TV comedy and best TV comedy. Her heartfelt acceptance speech for best actress struck a chord: "This award is for everyone who feels like there wasn't a place for her," she said. "This show made a space for me."

Jessica Chastain won the Globe for best actress in a drama for "Zero Dark Thirty." She offered a moving tribute to director Kathryn Bigelow, the first woman to win a best director Oscar who failed to get a nomination for that award this year, though "ZDT" was up for a slew of other awards, including best picture. "I can't help but compare my character of Maya to you," Chastain said to Bigelow. "When you make a film that allows your character to disobey the conventions of Hollywood, you've done more for women in cinema than you take credit for."

Blame it on nerves, the spirit of spontaneity, or the a-a-a-a-alcohol (apologies to Jamie Foxx), but Jennifer Lawrence's acceptance speech was a tad insulting to a Hollywood icon, if totally hilarious. "Oh what does it say?" she asked, looking at her trophy. "I beat Meryl." She meant Meryl Streep, who was also up for the award.

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France bombs Mali rebels as more troops arrive in Bamako

BAMAKO/PARIS (Reuters) - French fighter jets bombed Islamist rebels in Mali for a third day on Sunday as Paris poured more troops into the capital Bamako, awaiting the arrival of a West African force to dislodge al Qaeda-linked insurgents from the country's north.

French Defence Minister Jean-Yves Le Drian said France's dramatic intervention on Friday to bomb a convoy of heavily armed Islamist fighters sweeping southwards had stopped them from seizing Mali's capital Bamako within days.

Western countries fear Islamists could use Mali as a base for attacks on the West, forming a link with al Qaeda militants in Yemen, Somalia and North Africa.

Le Drian said former colonial power France was carrying out continuous bombing raids against the alliance of rebel groups, which seized the country's vast desert north in April.

"There are raids going on now: there were some last night, and there will be more tomorrow," Le Drian told French television. "The president is totally determined that we must eradicate these terrorists who threaten the security of Mali, our own country and Europe."

Residents said French aircraft bombed the northern town of Gao, and a Malian rebel spokesman said they bombed targets in the towns of Lere and Douentza.

Le Drian said France was deploying a further contingent of 80 soldiers to Mali on Sunday, bring the total to 550 soldiers , split between Bamako and the town of Mopti, some 500 km (300 miles) north. State-of-the-art Rafale fighter jets would be dispatched to reinforce the operation on Sunday, he said.

A Reuters cameraman reported seeing on Sunday more than 100 French troops disembarking from a military cargo plane at Bamako airport, just on the outskirts of the capital.

Bamako itself was calm on Sunday, with the sun streaking through the dust enveloping the city as the seasonal Harmattan wind blew from the Sahara. Some cars drove around with French flags draped from the windows to celebrate Paris's intervention.

Hours after opening one front against al Qaeda-linked Islamists, France mounted a commando raid to free a French hostage in Somalia held by al Shabaab militants allied to al Qaeda, but failed to stop him being killed along with a French commando.

A French pilot was killed on Friday when rebels in Mali shot down his helicopter.

President Francois Hollande has made it clear that France's aim in Mali is to support the deployment of a West African mission to retake the north, endorsed by the United Nations, the European Union and the United States.

The 15-nation West African bloc ECOWAS convened a summit for Saturday in Ivory Coast to discuss the military campaign.

With Paris pressing West African nations to deploy troops quickly, Ivory Coast President Alassane Ouattara, who holds the rotating ECOWAS chairmanship, has kick-started the operation to deploy some 3,300 African soldiers.

Ouattara was himself installed in power with French military backing in 2011 after a brief civil war triggered by former president Laurent Gbagbo's refusal to step aside after losing a late 2010 election.

"The troops will start arriving in Bamako today and tomorrow," Ali Coulibaly, Ivory Coast's African Integration Minister, said. "They will be convoyed to the front at Sevare."

HOUSE-TO-HOUSE SEARCHES

Under cover from French fighter planes and attack helicopters on Friday, Malian troops drove the Islamists out of the strategic central town of Konna, which they had seized a day earlier. A senior Malian army official said more than 100 rebel fighters had been killed.

Military analysts expressed doubt, however, that this was the start of a swift operation to retake the whole of northern Mali - a harsh, sparsely populated terrain the size of France - as neither equipment nor ground troops were ready.

In Nigeria, which will lead the ECOWAS force, a military official who asked not to be identified said it would take time to train and equip the troops.

In Konna, calm returned after three nights of combat.

"Soldiers are patrolling the streets and have encircled the town," one resident, Madame Coulibaly, told Reuters by phone. "They are searching houses for arms or hidden Islamists."

Another inhabitant said the army set up roadblocks along the route north from Sevare to Konna and was checking for rebels. President Diouncounda Traore declared a state of emergency on Friday giving the military sweeping powers to carry out searches and shut down parts of the country.

"The army is in Konna ... securing the town and to make sure it is safe," army spokesman Lieutenant Colonel Diarran Kone said.

A resident in the northern city of Gao, one of the Islamists' strongholds, had reported scores of rebel fighters were retreating northward in pickup trucks on Saturday. In Bamako, some civilians tried to contribute to the war effort.

"We are very proud and relieved that the army was able to drive the jihadists out of Konna. We hope it will not end there that is why I'm helping in my own way," said civil servant Ibrahima Kalossi, 32, one of over 40 people who queued to donate blood for wounded soldiers.

Concerned about reprisals on French soil, Hollande instructed Prime Minister Jean-Marc Ayrault to tighten security in France at public buildings and on public transport.

France advised its 6,000 citizens in Mali to leave. Thousands more French live across West Africa, particularly in Senegal and Ivory Coast.

Hollande's intervention in Mali could endanger eight French nationals being held by Islamists in the Sahara. A spokesman for one of Mali's rebel groups, Ansar Dine, said on Saturday there would be repercussions.

"There are consequences, not only for French hostages, but also for all French citizens, wherever they find themselves in the Muslim world," Sanda Ould Boumama told Reuters. "The hostages are facing death."

(Additional reporting Adama Diarra, Tiemoko Diallo and Rainer Schwenzfeier in Bamako, Joe Bavier in Abidjan and Leila Aboud in Paris; Writing by Daniel Flynn; Editing by Alison Williams)

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Football: Man Utd beat Liverpool to move 10 points clear

LONDON: Manchester United went 10 points clear at the top of the Premier League, for a few hours at least, after a 2-1 win over Liverpool at Old Trafford on Sunday.

Goals from Robin van Persie and Nemanja Vidic gave United a 2-0 lead before Liverpool substitute Daniel Sturridge pulled one back for the visitors in this latest clash between England's two most successful clubs.

Reigning champions Manchester City, currently in second place, will reduce the gap on local rivals United to seven points if they win away to Arsenal in a match kicking off at 4pm local time (1600GMT) on Sunday.

Van Persie gave United a 19th minute lead when he swept in Patrice Evra's cross from eight yards out.

It was the Dutch striker's 17th Premier League goal this term, and 21st in all competitions, since he arrived at Old Trafford in a 24 million pounds pre-season move from top-flight rivals Arsenal.

United made it 2-0 nine minutes after half-time when full-back Evra's header from van Persie's free-kick deflected in off centre-half Vidic.

But three minutes later Sturridge, on at the start of the second half for Lucas Leiva, marked his Premier League debut for Liverpool with a goal when he followed up the rebound after David de Gea saved skipper Steven Gerrard's shot from outside the box.

It was Sturridge's second goal in as many games for Liverpool following his move from European champions champions Chelsea after he was on target in the 2-1 FA Cup win over Mansfield last weekend.

However, Sturridge failed to make the most of two more chances and United held on for a victory that gave them a league double over Liverpool, who remained in eighth place, this season.

- AFP/fa

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Fresh firing by Pak troops ahead of flag meeting

JAMMU: Ahead of Monday's Indo-Pak flag meeting to defuse tension along line of control (LoC), Pakistani troops on Sunday evening violated the ceasefire again, targeting Indian posts in Poonch sector of Jammu and Kashmir.

Earlier today, Pakistan agreed to hold a 'brigade commander' level flag meeting along the LoC in Poonch to discuss the recent intrusion and brutal killing of jawans besides continued ceasefire violations by its soldiers that have flared tension in the region.

Pakistan troops fired on the Indian posts in Nangitikri forward area along LoC in Poonch district around 4.30pm, after heavy overnight firing in Krishnagati sub-sector in Poonch, a Army officer said.

The overnight heavy exchange of fire came after a 48-hour lull on the LoC.

Pakistani posts opposite Nangitikri targeted the Indian side on Sunday evening and Indian troops guarding the borderline retaliated, he said.

The exchange continued for a brief period before coming to a halt, he said, adding there was no loss of life or injury to anyone on the Indian side.

There was firing on five Indian posts --Kranti, Kripan, Gordha, Chajjaman and Dogra from Pakistan posts- Daku, Chooha, Roza and Battal. Mortars were fired intermittently from Pakistan side.

The ceasefire violation was the fourth by Pakistan troops along Poonch sector after the killing of two jawans.

On the overnight firing, defence spokesman Col R K Palta said movement of six to seven persons was detected close to LoC opposite Krishnagati sub-sector in Poonch sector around 9.45pm yesterday.

Troops guarding the border line with Pakistan opened fire on them, the spokesman said adding that thereafter heavy firing exchanges took place between two sides.

After 30 minutes, the group of suspected infiltrators disappeared, Col Palta said.

It is believed that either a group of militants or Border Action Team (BAT) could have been undertaking movement close to LoC opposite Krishnagati sub-sector in Poonch.

Pakistani troops had also violated the ceasefire by firing mortars shells and from small arms on Indian posts along LoC in Krishnagati sector of Poonch district from 5pm to 9.30pm on Thursday.

Indian troops had retaliated resulting in the exchange of fire. There was no casuality or injury to any one in the Pak firing.

Thursday's was the third ceasefire violation by Pakistan troops along Poonch sector.

"The border with Pakistan is tense but the situation is under control along the Line of Control in Jammu and Kashmir. The Army is maintaining utmost vigilance along the border with Pakistan," the spokesman said.

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