CDC: Flu Outbreak Could Be Waning

The flu season appears to be waning in some parts of the country, but that doesn't mean it won't make a comeback in the next few weeks, according to the Centers for Disease Control and Prevention.

Five fewer states reported high flu activity levels in the first week of January than the 29 that reported high activity levels in the last week of December, according to the CDC's weekly flu report. This week, 24 states reported high illness levels, 16 reported moderate levels, five reported low levels and one reported minimal levels, suggesting that the flu season peaked in the last week of December.

"It may be decreasing in some areas, but that's hard to predict," CDC Director Dr. Thomas Frieden said in a Friday morning teleconference. "Trends only in the next week or two will show whether we have in fact crossed the peak."

The flu season usually peaks in February or March, not December, said Dr. Jon Abramson, who specializes in pediatric infectious diseases at Wake Forest Baptist Health in North Carolina. He said the season started early with a dominant H3N2 strain, which was last seen a decade ago, in 2002-03. That year, the flu season also ended early.

Click here to see how this flu season stacks up against other years.

Cheryl Evans/The Arizona Republic/AP Photo

Increasing Flu Cases: Best Measures to Ensure Your Family's Health Watch Video

Because of the holiday season, Frieden said the data may have been skewed.

For instance, Connecticut appeared to be having a lighter flu season than other northeastern states at the end of December, but the state said it could have been a result of college winter break. College student health centers account for a large percentage of flu reports in Connecticut, but they've been closed since the fall semester ended, said William Gerrish, a spokesman for the state's department of public health.

The flu season arrived about a month early this year in parts of the South and the East, but it may only just be starting to take hold of states in the West, Frieden said. California is still showing "minimal" flu on the CDC's map, but that doesn't mean it will stay that way.

Click here to read about how flu has little to do with cold weather.

"It's not surprising. Influenza ebbs and flows during the flu season," Frieden said. "The only thing predictable about the flu is that it is unpredictable."

Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn., said he was expecting California's seeming good luck with the flu to be over this week.

"Flu is fickle, we say," Schaffner said. "Influenza can be spotty. It can be more severe in one community than another for reasons incompletely understood."

Early CDC estimates indicate that this year's flu vaccine is 62 percent effective, meaning people who have been vaccinated are 62 percent less likely to need to see a doctor for flu treatment, Frieden said.

Although the shot has been generally believed to be more effective for children than adults, there's not enough data this year to draw conclusions yet.

"The flu vaccine is far from perfect, but it's still by far the best tool we have to prevent flu," Frieden said, adding that most of the 130 million vaccine doses have already been administered. "We're hearing of shortages of the vaccine, so if you haven't been vaccinated and want to be, it's better late than never."

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String of bombings kill 101, injure 200 in Pakistan

QUETTA, Pakistan (Reuters) - At least 101 people were killed in bombings in two Pakistani cities on Thursday in one of the country's bloodiest days in recent years, officials said, with most casualties caused by sectarian attacks in Quetta.

The bombings underscored the myriad threats Pakistani security forces face from homegrown Sunni extremist groups, the Taliban insurgency in the northwest and the less well-known Baloch insurgency in the southwest.

On Thursday evening, two coordinated explosions killed at least 69 people and injured more than 100 in Quetta, the provincial capital of Balochistan, said Deputy Inspector of Police Hamid Shakil.

The first attack, in a crowded snooker hall, was a suicide bombing, local residents said. About ten minutes later, a car bomb exploded, they said. Five policemen and a cameraman were among the dead from that blast.

The attacks happened in a predominately Shia neighborhood and banned sectarian group Lashkar-e-Jhangvi claimed responsibility. The extremist Sunni group targets Shias, who make up about 20 percent of Pakistani's population.

Targeted killings and bombings of Shia communities are common in Pakistan, and rights groups say hundreds of Shia were killed last year. Militant groups in Balochistan frequently bomb or shoot Shia passengers on buses travelling to neighboring Iran.

The killers are rarely caught and some Shia activists say militants work alongside elements of Pakistan's security forces, who see them as a potential bulwark against neighboring India.

Many Pakistanis fear their nation could become the site of a regional power struggle between Saudi Arabia, source of funding for Sunni extremist groups, and Iran, which is largely Shia.

But sectarian tensions are not the only source of violence.

The United Baloch Army claimed responsibility for a blast in Quetta's market earlier in the day. It killed 11 people and injured more than 40, mostly vegetable sellers and secondhand clothes dealers, police officer Zubair Mehmood said. A child was also killed.

The group is one of several fighting for independence for Balochistan, an arid, impoverished region with substantial gas, copper and gold reserves, which constitutes just under half of Pakistan's territory and is home to about 8 million of the country's population of 180 million.

SWAT BOMBING

In another incident Thursday, 21 were killed and more than 60 injured in a bombing when people gathered to hear a religious leader speak in Mingora, the largest city in the northwestern province of Swat, police and officials at the Saidu Sharif hospital said.

"The death toll may rise as some of the injured are in critical condition and we are receiving more and more injured people," said Dr. Niaz Mohammad.

It has been more than two years since a militant attack has claimed that many lives in Swat.

The mountainous region, formerly a tourist destination, has been administered by the Pakistani army since their 2009 offensive drove out Taliban militants who had taken control.

But Talibans retain the ability to attack in Swat and shot schoolgirl campaigner Malala Yousufzai in Mingora last October.

A Taliban spokesman said they were not responsible for Thursday's bombing.

(Additional reporting by Jibran Ahmad in Peshawar, Pakistan; Writing by Katharine Houreld; Editing by Mark Heinrich and Jason Webb)

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Stop praising Modi, look at Maharashtra: Congress to Opposition

MUMBAI: With Maharashtra attracting one-third of all FDI in the country since 2000, the Maharashtra Congress Thursday urged Opposition parties to stop praising Gujarat Chief Minister Narendra Modi and "speak of Maharashtra".

In an open letter to all Opposition parties, state Congress spokesperson Sachin Sawant said that as per official figures released by the centre recently, in the past 12 years (between 2000-2012), Maharashtra attracted a total of Rs.2,81,565 crore FDI.

This stood at 33 per cent Foreign Direct Investment in the country for all the states, with New Delhi at 19 per cent, Karnataka at six per cent, and Gujarat and Tamil Nadu way behind at just five per cent each.

"The state also achieved a growth of 11.8 per cent in the past five years, against a target of 10 per cent, and more importantly, helped generate 1.80 million new jobs," Sawant pointed out.

However, Sawant lamented that in the wake of "drumbeating" of Gujarat's development by Modi, the opposition seem to have forgotten Maharashtra completely.

"Perhaps, this is the reason why the state's unprecedented achievement has gone unnoticed and there has not been any response from you so far," he said.

"As a responsible Opposition, now you must stand with the government and highlight the state's achievements at the international level to attract even more FDI. This would be in the interest of the state and in tune with public sentiments," Sawant said.

The Congress's open letter has been written to Shiv Sena executive president Uddhav Thackeray, Bharatiya Janata Party state president Sudhir Mungantiwar, Maharashtra Navnirman Sena chief Raj Thackeray and the BJP's leaders of opposition in the state assembly and council, Eknath Khadse and Vinod Tawade, respectively.

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Flu season strikes early and, in some places, hard

NEW YORK (AP) — From the Rocky Mountains to New England, hospitals are swamped with people with flu symptoms. Some medical centers are turning away visitors or making them wear face masks, and one Pennsylvania hospital set up a tent outside its ER to deal with the feverish patients.

Flu season in the U.S. has struck early and, in many places, hard.

While flu normally doesn't blanket the country until late January or February, it is already widespread in more than 40 states, with about 30 of them reporting some major hot spots. On Thursday, health officials blamed the flu for the deaths of 20 children so far.

Whether this will be considered a bad season by the time it has run its course in the spring remains to be seen.

"Those of us with gray hair have seen worse," said Dr. William Schaffner, a flu expert at Vanderbilt University in Nashville.

The evidence so far points to a moderate season, Schaffner and others say. It looks bad in part because last year was unusually mild and because the main strain of influenza circulating this year tends to make people sicker and really lay them low.

David Smythe of New York City saw it happen to his 50-year-old girlfriend, who has been knocked out for about two weeks. "She's been in bed. She can't even get up," he said.

Also, the flu's early arrival coincided with spikes in a variety of other viruses, including a childhood malady that mimics flu and a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." So what people are calling the flu may, in fact, be something else.

"There may be more of an overlap than we normally see," said Dr. Joseph Bresee, who tracks the flu for the Centers for Disease Control and Prevention.

Most people don't undergo lab tests to confirm flu, and the symptoms are so similar that it can be hard to distinguish flu from other viruses, or even a cold. Over the holidays, 250 people were sickened at a Mormon missionary training center in Utah, but the culprit turned out to be a norovirus, not the flu.

Flu is a major contributor, though, to what's going on.

"I'd say 75 percent," said Dr. Dan Surdam, head of the emergency department at Cheyenne Regional Medical Center, Wyoming's largest hospital. The 17-bed emergency room saw its busiest day ever last week, with 166 visitors.

The early onslaught has resulted in a spike in hospitalizations. To deal with the influx and protect other patients from getting sick, hospitals are restricting visits from children, requiring family members to wear masks and banning anyone with flu symptoms from maternity wards.

One hospital in Allentown, Pa., set up a tent this week for a steady stream of patients with flu symptoms. But so far "what we're seeing is a typical flu season," said Terry Burger, director of infection control and prevention for the hospital, Lehigh Valley Hospital-Cedar Crest.

On Wednesday, Boston declared a public health emergency, with the city's hospitals counting about 1,500 emergency room visits since December by people with flu-like symptoms.

All the flu activity has led some to question whether this year's flu shot is working. While health officials are still analyzing the vaccine, early indications are that it's about 60 percent effective, which is in line with what's been seen in other years.

The vaccine is reformulated each year, based on experts' best guess of which strains of the virus will predominate. This year's vaccine is well-matched to what's going around. The government estimates that between a third and half of Americans have gotten the vaccine.

In New York City, 57-year-old Judith Quinones skipped getting a flu shot this season and suffered her worst case of flu-like illness in years. She was laid up for nearly a month with fever and body aches. "I just couldn't function," she said.

But her daughter got the vaccine. "And she got sick twice," Quinones said.

Europe is also suffering an early flu season, though a milder strain predominates there. Flu reports are up, too, in China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo. Britain has seen a surge in cases of norovirus.

On average, about 24,000 Americans die each flu season, according to the CDC. That's an estimate — the agency does not keep a running tally of adult flu deaths each year, only for children. Some state health departments do keep count, and they've reported dozens of flu deaths so far.

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 and can help themselves and protect others by staying home and resting. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Flu vaccinations are recommended for everyone 6 months or older. Of the 20 children killed by the flu this season, only two were fully vaccinated.

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AP Medical Writer Maria Cheng in London contributed to this report.

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Online:

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

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Judge: Holmes Can Face Trial for Aurora Shooting

Jan 10, 2013 8:45pm

(Arapahoe County Sheriff/AP Photo)

In a ruling that comes as little surprise, the judge overseeing the Aurora, Colo., theater massacre has ordered that there is enough evidence against James Holmes to proceed to a trial.

In an order posted late Thursday, Judge William Sylvester wrote that “the People have carried their burden of proof and have established that there is probable cause to believe that Defendant committed the crimes charged.”

The ruling came after a three-day preliminary hearing this week that revealed new details about how Holmes allegedly planned for and carried out the movie theater shooting, including how investigators say he amassed an arsenal of guns and ammunition, how he booby-trapped his apartment to explode, and his bizarre behavior after his arrest.

PHOTOS: Colorado ‘Dark Knight Rises’ Theater Shooting

Holmes is charged with 166 counts, including murder, attempted murder and other charges related to the July 20 shooting that left 12 people dead and 58 wounded by gunfire. An additional 12 people suffered non-gunshot injuries.

One of the next legal steps is an arraignment, at which Holmes will enter a plea. The arraignment was originally expected to take place Friday morning.

Judge Sylvester indicated through a court spokesman that he would allow television and still cameras into the courtroom, providing the outside world the first images of Holmes since a July 23 hearing. Plans for cameras in court, however, were put on hold Thursday afternoon.

“The defense has notified the district attorney that it is not prepared to proceed to arraignment in this case by Friday,” wrote public defenders Daniel King, Tamara Brady and Kristen Nelson Thursday afternoon in a document objecting to cameras in court.

A hearing in the case will still take place Friday morning. In his order, Judge Sylvester said it should technically be considered an arraignment, but noted the defense has requested a continuance.  Legal experts expect the judge will grant the continuance, delaying the arraignment and keeping cameras out of court for now.

Sylvester also ordered that Holmes be held without bail.

Holmes’ attorneys have said in court that the former University of Colorado neuroscience student is mentally ill. The district attorney overseeing the case has not yet announced whether Holmes, now 25, can face the death penalty.

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Analysis: Modi's Gujarat growth model might not work across India

SURAT, India (Reuters) - Turning a single Indian state with a long tradition of entrepreneurship and a solid political majority into an investor-friendly economic powerhouse is one thing.

Replicating that experience across a diverse country of 1.2 billion would be a tougher prospect for Narendra Modi, whose leadership of booming Gujarat state has led to his being touted as a potential candidate to become India's next prime minister.

While Modi wins praise even from critics for cutting red tape and making government more responsive and predictable, many ingredients for Gujarat's run of growth were in place well before he took office in 2001.

"It is like an icing on cake sort of thing. You have a nice cake and Modi has done a lot of good icing," said Rakesh Chaudhary, director of Pratibha Group, a textile manufacturer in Palsana on the outskirts of the Gujarat city of Surat.

Industry in Gujarat is helped by a long coastline and plenty of barren land that is easy to turn over to factory use.

The power that comes from a long-standing and heavy majority for his Bharatiya Janata Party (BJP) in the state also gives Modi an advantage that he would not enjoy on a national stage marked by fractious coalition politics.

Despite a controversial past - Modi is accused by critics of not doing enough to stop or of even quietly encouraging religious riots in 2002 that saw as many as 2,000 killed, most of them Muslims - he has established a reputation as an economic reformer in part by building on the strengths of Gujarat and marketing them heavily.

Modi's marketing savvy, aided by the Washington lobbying and public affairs firm APCO Worldwide, will be on display at the biennial "Vibrant Gujarat Summit" that begins on Friday.

Initiated by Modi in 2003 to attract investment after the violence and an earthquake in 2001, the event is attended by thousands of corporate officials who pledge billions in investment, although in reality only a fraction has seen the light of day. Of 12.4 trillion rupees ($225 billion) in investment proposed at the 2009 event, just 8.5 percent had been spent as of November 2011, according to state government data.

"Under Modi's regime, there has been significant improvement in infrastructure growth, significant improvement in industrialization, as well as agriculture," said Jahangir Aziz, senior Asia economist at JPMorgan. "But what has been overplayed is initial conditions were actually pretty decent in Gujarat."

HIGHER OFFICE?

The stocky Modi, who favors traditional Indian attire and a clipped white beard, plays down any prime ministerial ambitions.

But his popularity in Gujarat - the BJP won 115 of the state assembly's 182 seats in a December election - has fuelled speculation that he could lead his Hindu nationalist party in 2014 against India's ruling Congress party, which has been beset by corruption scandals and overseen a sharp economic slowdown.

"His economic record in Gujarat is obviously something which matters a lot to the middle classes. That, coupled with strong leadership," said Swapan Dasgupta, an analyst with links to the BJP who expects Modi to be the party standard-bearer in 2014.

Critics say that while Modi has indeed encouraged investment and helped bring reliable electricity and law and order, double-digit growth has not been shared broadly enough. In the five years through March 2010, some states - including Tamil Nadu and Karnataka - did better at bringing down poverty levels.

"Big business people get a lot from the government and scheduled caste people (minorities) get a lot, but people like us who are in between get nothing," said Bhupendra Thakkar, 50, who earns 6,000 rupees ($109) a month selling fruit near Surat's decrepit railway station.

FRIEND OF BUSINESS

Modi lured Tata Motors to the state in 2008 after the company's plans to build a factory for its low-cost Nano car were thwarted by farmers in West Bengal.

Ford Motor Co and Maruti Suzuki are also building plants in the western state - high profile investments that carry the added benefit of acting as marketing tools.

In the seven years through March 2011, Gujarat's economy grew an annual 10.08 percent at constant prices, against 6.45 percent in the eight years through March 2002 (Modi took office in October 2001), which was still ahead of the all-India average of 6.16 percent. A handful of states, including Maharashtra and Tamil Nadu, clocked bigger gains over the same recent period.

By comparison, policy gridlock at the national level has contributed to a drop-off in corporate investment, putting India on track to record its slowest annual growth rate in a decade.

Accustomed to getting his way, Modi, 62, could struggle to negotiate the coalition politics that have become the norm at the national level and have hindered attempts at reform by Prime Minister Manmohan Singh's Congress-led administration.

"Policymaking has benefited from the fact that the BJP has had absolute majority in the state legislature - an advantage it certainly will not enjoy in the federal parliament," said Anjalika Bardalai, an analyst with the Eurasia Group in London.

Modi has also been able to leverage the business acumen of Gujaratis, a group that has long been known for trading and entrepreneurship and includes a prosperous global diaspora as well as billionaires such as Adani Group chief Gautam Adani and Mukesh Ambani, who controls Reliance Industries, India's most valuable company.

"Modi might not be as successful as he has been here because the business mentality is unique to Gujarat," said Chandrakant Sanghavi, chairman of Sanghavi Exports International, a diamond trader and processor. "It could be prevalent in other states but the ratio may be less." ($1 = 55.0700 Indian rupees)

(Editing by John Chalmers and Alex Richardson)

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Google's Schmidt urges North Korea Internet freedom

BEIJING: Google chairman Eric Schmidt told North Korean officials their country would never develop unless it embraced Internet freedom, he said on Thursday as he returned from a visit to Pyongyang.

Former US ambassador to the United Nations Bill Richardson, who led the trip, urged North Korea to adopt a moratorium on ballistic missiles and nuclear tests following the communist state's widely criticised rocket launch last month.

Schmidt said he told North Korean officials they should open up the country's Internet "or they will remain behind".

"As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their physical world, their economic growth and so forth, and it will make it harder for them to catch up economically," he said.

"Once the Internet starts, citizens in a country can certainly build on top of it. The government has to do something. It has to make it possible for people to use the Internet which the government in North Korea has not yet done."

Richardson, also a former governor of New Mexico, said: "We strongly urged the North Koreans to proceed with a moratorium on ballistic missiles and possible nuclear test."

The pair told reporters at Beijing airport that they did not meet North Korean leader Kim Jong-Un on the trip, or US citizen Kenneth Bae.

Bae was arrested in November after entering the country as a tourist, according to the North's official news agency, which said he had admitted committing a crime against the state.

- AFP/al

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Some sort of goondaism going on in West Bengal, says governor

KOLKATA: West Bengal Governor M K Narayanan on Wednesday virtually rapped the Mamata Banerjee-led government over the clashes between CPM and Trinamool Congress workers, saying it was akin to "some sort of goondaism" which was "not acceptable".

He asked the police and the administration to function impartially in arresting the guilty.

"This is not a good political culture. I think some sort of goondaism is going on here," Narayanan told mediapersons on the sidelines of a programme here.

"The last two-three days have been very disturbing and distressing. This violence should not have taken place. We should not tolerate the violence that is taking place. This is not acceptable," Narayanan said.

"It is the duty of the administration and the police to take action against those who are responsible. There is clear evidence against the guilty. The police and the administration have to be impartial," the governor said when reporters sought his reaction on the issue.

Trouble flared up in Bhangar in South 24 Parganas district late last week after one party office each of the Communist Party of India-Marxist (CPM) and Trinamool Congress were damaged and set afire respectively.

When CPM legislator Abdur Rezzak Mollah went to the area, he was attacked by allegedly Trinamool workers, led by former lawmaker Arabul Islam.

Mollah has been admitted to a hospital.

Then Tuesday, many people were injured in firing and stone pelting in clashes between Trinamool Congress and CPM workers in Bamanghata in Bhangar.

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Retooling Pap test to spot more kinds of cancer

WASHINGTON (AP) — For years, doctors have lamented that there's no Pap test for deadly ovarian cancer. Wednesday, scientists reported encouraging signs that one day, there might be.

Researchers are trying to retool the Pap, a test for cervical cancer that millions of women get, so that it could spot early signs of other gynecologic cancers, too.

How? It turns out that cells can flake off of tumors in the ovaries or the lining of the uterus, and float down to rest in the cervix, where Pap tests are performed. These cells are too rare to recognize under the microscope. But researchers from Johns Hopkins University used some sophisticated DNA testing on the Pap samples to uncover the evidence — gene mutations that show cancer is present.

In a pilot study, they analyzed Pap smears from 46 women who already were diagnosed with either ovarian or endometrial cancer. The new technique found all the endometrial cancers and 41 percent of the ovarian tumors, the team reported Wednesday in the journal Science Translational Medicine.

This is very early-stage research, and women shouldn't expect any change in their routine Paps. It will take years of additional testing to prove if the so-called PapGene technique really could work as a screening tool, used to spot cancer in women who thought they were healthy.

"Now the hard work begins," said Hopkins oncologist Dr. Luis Diaz, whose team is collecting hundreds of additional Pap samples for more study and is exploring ways to enhance the detection of ovarian cancer.

But if it ultimately pans out, "the neat part about this is, the patient won't feel anything different," and the Pap wouldn't be performed differently, Diaz added. The extra work would come in a lab.

The gene-based technique marks a new approach toward cancer screening, and specialists are watching closely.

"This is very encouraging, and it shows great potential," said American Cancer Society genetics expert Michael Melner.

"We are a long way from being able to see any impact on our patients," cautioned Dr. Shannon Westin of the University of Texas MD Anderson Cancer Center. She reviewed the research in an accompanying editorial, and said the ovarian cancer detection would need improvement if the test is to work.

But she noted that ovarian cancer has poor survival rates because it's rarely caught early. "If this screening test could identify ovarian cancer at an early stage, there would be a profound impact on patient outcomes and mortality," Westin said.

More than 22,000 U.S. women are diagnosed with ovarian cancer each year, and more than 15,000 die. Symptoms such as pain and bloating seldom are obvious until the cancer is more advanced, and numerous attempts at screening tests have failed.

Endometrial cancer affects about 47,000 women a year, and kills about 8,000. There is no screening test for it either, but most women are diagnosed early because of postmenopausal bleeding.

The Hopkins research piggybacks on one of the most successful cancer screening tools, the Pap, and a newer technology used along with it. With a standard Pap, a little brush scrapes off cells from the cervix, which are stored in a vial to examine for signs of cervical cancer. Today, many women's Paps undergo an additional DNA-based test to see if they harbor the HPV virus, which can spur cervical cancer.

So the Hopkins team, funded largely by cancer advocacy groups, decided to look for DNA evidence of other gynecologic tumors. It developed a method to rapidly screen the Pap samples for those mutations using standard genetics equipment that Diaz said wouldn't add much to the cost of a Pap-plus-HPV test. He said the technique could detect both early-stage and more advanced tumors. Importantly, tests of Paps from 14 healthy women turned up no false alarms.

The endometrial cancers may have been easier to find because cells from those tumors don't have as far to travel as ovarian cancer cells, Diaz said. Researchers will study whether inserting the Pap brush deeper, testing during different times of the menstrual cycle, or other factors might improve detection of ovarian cancer.

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U.S. does not rule out removing all troops from Afghanistan

WASHINGTON (Reuters) - The Obama administration does not rule out a complete withdrawal of U.S. troops from Afghanistan after 2014, the White House said on Tuesday, just days before President Barack Obama is due to meet Afghan President Hamid Karzai.

The comments by U.S. Deputy National Security Adviser Ben Rhodes were the clearest signal yet that, despite initial recommendations by the top military commander in Afghanistan to keep as many as 15,000 troops in the country, Obama could opt to remove everyone, as happened in Iraq in 2011.

Asked about consideration of a so-called zero-option once the NATO combat mission ends at the end of 2014, Rhodes said: "That would be an option that we would consider."

Rhodes made clear that a decision on post-2014 troop levels is not expected for months and will be made based on two U.S. security objectives in Afghanistan - denying a safe haven to al Qaeda and ensuring Afghan forces are trained and equipped so that they, and not foreign forces, can secure the nation.

"There are, of course, many different ways of accomplishing those objectives, some of which might involve U.S. troops, some of which might not," Rhodes said, briefing reporters to preview Karzai's visit.

In Iraq, Obama decided to pull out all U.S. forces after failing in negotiations with the Iraqi government to secure immunity for any U.S. troops who would remain behind.

The Obama administration is also insisting on immunity for any U.S. troops that remain in Afghanistan, and that unsettled question will figure in this week's talks between Obama and Karzai and their aides.

"As we know from our Iraq experience, if there are no authorities granted by the sovereign state, then there's no room for a follow-on U.S. military mission," said Douglas Lute, special assistant to Obama for Afghanistan and Pakistan.

Jeffrey Dressler, an Afghanistan expert at the Washington-based Institute for the Study of War who favors keeping a larger presence in Afghanistan, questioned whether the White House comments might be part of a U.S. bargaining strategy with Kabul.

"I can't tell that they're doing that as a negotiating position ... or if it is a no-kidding option," Dressler said. "If you ask me, I don't see how zero troops is in the national security interest of the United States."

SHOULDN'T JUST "LEAVE THEM"

U.S. officials have said privately that the White House had asked for options to be developed for keeping between 3,000 and 9,000 troops in the country, a lower range than was put forward initially by General John Allen, the top U.S. and NATO commander in Afghanistan.

Allen suggested keeping between 6,000 and 15,000 troops in Afghanistan.

Retired General Stanley McChrystal, a former U.S. commander of the Afghan mission who resigned in 2010, said in an interview with Reuters on Monday there was a value to having an overt U.S. military presence in Afghanistan after 2014 - even if it wasn't large.

"The art, I would say, would be having the smallest number so that you give the impression that you are always there to help, but you're never there either as an unwelcome presence or an occupier - or any of the negatives that people might draw," he said, without commenting on any specific numbers.

The United States now has about 66,000 troops in Afghanistan and Rhodes confirmed there would be steady reductions in troop levels through 2014.

Also on the agenda for the Obama-Karzai talks are tentative reconciliation efforts involving Taliban insurgents. Those efforts have shown flickers of life after nearly 10 months of limbo.

Still, hopes for Afghan peace talks have been raised before, only to be dashed. Last March, the Taliban suspended months of quiet discussions with Washington aimed at getting the insurgents and the Karzai government to the peace table.

Washington has also had a strained relationship with Karzai, who in October accused the United States of playing a double game in his country by fighting the war in Afghan villages instead of going after those in Pakistan who support insurgents.

Karzai will give a joint press conference with Obama on Friday and will visit the Pentagon on Thursday, meeting with Defense Secretary Leon Panetta and the U.S. top military officer, General Martin Dempsey.

Still, it is unclear what, if any, concrete agreements might emerge from Karzai's visit to Washington.

Michael O'Hanlon, a defense analyst at Brookings, cautioned against expecting too much from the visit, which he said is best seen as an opportunity for Washington and Kabul to "shore up this partnership that has had such a troubled status and a weak foundation."

"There are a lot of scars in this relationship. There are a lot of hurt feelings," O'Hanlon said. "It's sort of like a bad marriage and it's very easy for just the wrong word to immediately set people off in an emotional way."

(Additional reporting by David Alexander.; Editing by Eric Beech and Christopher Wilson)

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