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.

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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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China's 2012 trade surplus surges 48%

BEIJING: China's trade surplus surged 48.1 percent to $231.1 billion in 2012 from the previous year, though total trade volume grew at a much slower pace, official data showed on Thursday.

Exports from the world's second-largest economy rose 7.9 percent to $2.05 trillion, while imports increased 4.3 percent to $1.82 trillion, the national customs bureau said.

China's trade volume, or the total of exports and imports, grew 6.2 percent in 2012, well below the government's target of about 10 percent.

Customs spokesman Zheng Yuesheng said 2012's performance came "despite a sharply slowing world economic recovery, weak international market demand and rather big downside pressure on the domestic economy".

Zheng told reporters: "China's foreign trade continued to grow steadily and made further progress in improving quality, increasing profits and optimising structure."

- AFP/al

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TOI Social Impact Awards: Wheeling healthcare to remote corners

Mental health and trauma — two of India's top killers — have seldom received the attention they deserve from the government. But the awards jury turned the spotlight squarely on these problems. This year, it awarded organizations that provide emergency care or work for the welfare of persons with mental disabilities.

In the corporate category, Ziqitza Health Care, which operates over 860 ambulances in Rajasthan, Punjab, Bihar , Kerala and Mumbai, and says it has transported more than 1.8 million people, has won the award.

Ziqitza was set up to help establish an ambulance service that's accessible and affordable to all sections of society in medical emergencies, irrespective of the affected person's capacity to pay for it. It conceived a cross-subsidy , fee-based service using differential pricing where wealthier customers would pay the full rate for the ambulance service while the poor get hefty discounts and free service.

In the government category, the jury unanimously approved the National Trust for the Welfare of Persons with Autism Cerebral Palsy Mental Retardation and Multiple Disabilities. The organization provides health insurance for people with intellectual and developmental disabilities . Under the ministry of social justice & empowerment, this centre was started in 2007 when no health insurance products were available for people with intellectual and developmental disabilities.

The scheme does not discriminate on severity of any pre-insurance condition and is for all ages. It provides for a bouquet of services, including therapy, surgery and even alternative medicine up to Rs 1 lakh per annum at a nominal premium of Rs 250 per annum for those earning just Rs 15,000 per month and a premium of Rs 500 per annum for those earning more. Over 800 NGOs across India are involved in rolling out the scheme.

In the NGO category, the Karuna Trust that provides free primary healthcare in remote, tribal and insurgency-prone regions in partnership with the government left behind all other claimants. The trust was started by Dr H Sudarshan in BR Hills, Karnataka for the integrated development of tribal people. Karuna Trust has worked to "reach the unreached" and provide free primary healthcare for the past 26 years.

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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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Flu Kills 4 Seniors, Sickens 700 in Boston

An early and nasty flu season has prompted a public health emergency in Boston, where health officials say 700 people have been diagnosed with the cold-weather virus. Four Bostononians -- all elderly -- have died from flu.

"This is the worst flu season we've seen since 2009, and people should take the threat of flu seriously," Boston Mayor Thomas Menino said in a statement.

This time last year the city had seen only 70 cases of influenza, The Associated Press reported. And with flu activity likely to extend into March or even April, the number will only grow.

Menino said the city is working with health care centers to offer free flu vaccines, and he urged anyone with flu-like symptoms to stay home from work or school.

"This is not only a health concern, but also an economic concern for families," he said in the statement. "I'm urging residents to get vaccinated if they haven't already."

Eighteen people have died from flu in Massachusetts, one of 41 states battling widespread influenza outbreaks. Emergency rooms across the country have been overwhelmed with flu patients, turning away some of them and others with non-life-threatening conditions for lack of space.

The proportion of people seeing their doctor for flu-like symptoms jumped to 5.6 percent from 2.8 percent in the past month, according to the CDC.

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Northwestern Memorial Hospital in Chicago reported a 20 percent increase in flu patients every day. Northwestern Memorial was one of eight hospitals on bypass Monday and Tuesday, meaning it asked ambulances to take patients elsewhere if they could do so safely.

Dr. Besser's Tips to Protect Yourself From the Flu

Most of the hospitals have resumed normal operations, but could return to the bypass status if the influx of patients becomes too great.

"Northwestern Memorial Hospital is an extraordinarily busy hospital, and oftentimes during our busier months, in the summer, we will sometimes have to go on bypass," Northwestern Memorial's Dr. David Zich said. "We don't like it, the community doesn't like it, but sometimes it is necessary."

A tent outside Lehigh Valley Hospital in Salisbury Township, Pa., was set up to tend to the overflowing number of flu cases.

A hospital in Ohio is requiring patients with the flu to wear masks to protect those who are not infected.

State health officials in Indiana have reported seven deaths. Five of the deaths occurred in people older than 65 and two younger than 18. The state will release another report later today.

Doctors are especially concerned about the elderly and children, where the flu can be deadly.

"Our office in the last two weeks has exploded with children," Dr. Gayle Smith, a pediatrician in Richmond, Va., said

It is the earliest flu season in a decade and, ABC News Chief Medical Editor Dr. Besser says, it's not too late to protect yourself from the outbreak.

"You have to think about an anti-viral, especially if you're elderly, a young child, a pregnant woman," Besser said.

"They're the people that are going to die from this. Tens of thousands of people die in a bad flu season. We're not taking it serious enough."

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Venezuela postpones inauguration for cancer-stricken Chavez

CARACAS (Reuters) - Venezuela will postpone the inauguration of President Hugo Chavez for a new term due to health problems, the government said on Tuesday, another sign the socialist leader's cancer may be bringing an end to his 14 years in power.

The 58-year-old former soldier who has dominated the South American OPEC nation since 1999 has not been heard from since surgery on December 11 in Cuba - his fourth operation since he was diagnosed with an undisclosed type of cancer in June 2011.

The announcement outraged opposition leaders who insist that Chavez must be sworn in before the National Assembly on January 10 as laid out in the constitution, or temporarily step aside and leave an ally in power.

"The commander president wants us to inform that, based on his medical team's recommendations, the post-operative recovery should extend past January 10," said Vice President Nicolas Maduro, Chavez's chosen successor, in a letter read to the legislature.

"As a result, he will not be able to be present at the National Assembly on that date."

The letter said authorities would seek another date for the inauguration ceremony but did not say when it would take place or give a time frame for Chavez's return from Havana.

Rather than being sworn in by the legislature, he would take his oath at a later date before the Supreme Court, the letter said, as allowed by the constitution.

Government leaders insist Chavez is completely fulfilling his duties as head of state, even though official medical bulletins say he has a severe pulmonary infection and has had trouble breathing.

The government has called for a massive rally outside the presidential palace on Thursday, and allied presidents including Uruguay's Jose Mujica and Bolivia's Evo Morales have confirmed they will visit Venezuela this week despite Chavez's absence.

Argentine President Cristina Fernandez has announced plans to visit Chavez in Havana on Friday.

But the unprecedented silence by the president - famous for regularly speaking for hours in meandering broadcasts - has left many convinced he could be in his last days.

His resignation or death would upend politics in the oil-rich nation, where he enjoys a deity-like status among poor supporters thankful for his social largesse.

His critics call him a fledgling dictator who has squandered billions of dollars from crude sales while dashing the independence of state institutions.

CONSTITUTION DISPUTE

The constitution does not specify what happens if the president does not take office on January 10.

The Supreme Court, controlled by Chavez allies, called a news conference for Wednesday. It is widely expected to announce an interpretation of the constitution that will give Chavez leeway to take office when he is fit to do so.

If he dies or steps aside, new elections would be called within 30 days. Before leaving for Havana in December, the president instructed his supporters to back Maduro in that vote if he were unable to continue.

Opposition leaders argue that Congress chief and Chavez ally Diosdado Cabello should take over, as mandated by the constitution if the president's absence is formally declared.

Cabello has ruled that out, saying the president continues to be in charge.

"Who could have believed the opposition would be screaming for Diosdado Cabello to be given the presidency of the republic?" he said during a rambunctious session of Congress. "That's crazy, the opposition is losing it."

Meanwhile opposition deputies accused the Socialist Party of failing to follow Chavez's instructions - a scene that would have been unimaginable before Chavez's prolonged absence.

"President Chavez is the only one among you who has spoken clearly," said opposition leader Julio Borges.

He was drowned out by pro-Chavez deputies clapping and chanting the socialist leader's name and rebuffed by Cabello, who had long been considered a potential successor to Chavez until he was passed over for Maduro.

"It's not my fault you weren't chosen, don't take your frustration out on me," Borges quipped.

Another opposition deputy complained that during the debate a copy of the constitution was thrown across the chamber from the direction of the Socialist Party's deputies.

Chavez's supporters have held near-daily vigils for his recovery, while opposition activists accuse the president's allies of a Cuban-inspired manipulation of the situation.

Maduro has taken over the day-to-day running of the government and looks set to continue in the role past Thursday.

The mustachioed former bus driver lacks Chavez's charisma, but he has sought to imitate the president's style with vituperative attacks on the opposition and televised ribbon-cutting ceremonies.

With the micro-managing Chavez away, major policy decisions in Venezuela, such as a widely expected devaluation of the bolivar currency, appear to be on hold.

Venezuelan bond prices, which had soared in recent weeks on Chavez's health woes, dipped on Monday and Tuesday as investors' expectations of a quick government change apparently dimmed.

"The 'regime change' euphoria seems excessive taking into account the unclear legal transition and perhaps, more importantly, the risk that regime change does not allow for policy change," New York-based Jefferies' managing director Siobhan Morden said in a note on the bonds.

(Editing by Daniel Wallis and Eric Beech)

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Relatives sob as US massacre 911 calls heard in court

CENTENNIAL, Colorado: Relatives wept in court Tuesday as frantic 911 calls were played from a US theater shooting that killed 12 people last year, as prosecutors closed their case for the alleged gunman to face trial.

The court heard how suspected killer James Holmes purchased more than 6,000 rounds of ammunition in the months before last July's shooting in Colorado, and rigged up elaborate booby-traps at his apartment.

Defense lawyers will call witnesses Wednesday, the third day of hearings, to decide if there is enough evidence for Holmes to go on trial. They are expected to highlight his mental instability as a possible reason he should not do so.

In the first of 41 harrowing emergency calls made in a 10-minute period in Colorado, 30 loud booms could be heard in less than half-a-minute, making it difficult for the 911 dispatcher to distinguish what was being said.

In another, six minutes after the first call was logged at 12:38 am, 14-year-old Kaylan Bailey told the emergency operator her two cousins had been shot, and that one of them did not appear to be breathing.

"We need to start CPR (cardio-pulmonary resuscitation) on your cousin who's not breathing," said the operator.

"I can't hear you," responded Bailey, as chaos unfolded in the theater in Aurora, where Holmes -- clad in body armor and a mask -- threw at least one smoke-bomb type device before opening fire in the early hours of July 20.

The hearings opened Monday with officers choking back tears as they recalled scenes after the slaughter, which left 12 dead and 58 injured by gunshots at a packed midnight screening of the Batman film "The Dark Knight Rises."

The Aurora massacre revived the perennial US debate over gun control -- an issue re-ignited even more intensely by last month's shooting of 20 young children at a Connecticut elementary school.

Tuesday's hearing heard testimony from federal firearms supervisor Steven Beggs that Holmes made at least 16 purchases from May to July 2012 including four firearms, incendiary devices and almost 6,300 rounds of ammunition.

Holmes's lawyers could argue that he is mentally unfit to stand trial.

Defense attorney Tamara Brady asked Beggs: "Is there any process in Colorado to screen out purchases by a severely mentally ill person?"

"No," replied Beggs, who detailed the purchases made online and in person by Holmes.

FBI bomb technician Garrett Gumbinner said Holmes told investigators after being arrested that he had booby-trapped his apartment, in an attempt to draw emergency responders away from the theater shooting site.

Officers found a trip wire at the door of his home, rigged to set off flame and sparks that would catch the gasoline-soaked carpet and go on fire.

There were six-inch fireworks shells filled with improvised thermite, a hot-burning explosive.

"You can't put it out with water," Gumbinner told judge William Sylvester. There were also three containers of improvised napalm, 11 bottles of gasoline and other chemicals intended to act as fire accelerants, he said.

There were three systems in the apartment intended to initiate the explosive devices, including one linked to a trash bag near the apartment dumpster by a remote control.

Curious behavior by Holmes during police questioning was also recounted: At one point he tried to stick a metal staple into a power socket. At another he played hand puppets with gloves that had been put on him to preserve evidence.

Prosecutors are trying to build up their case that the shootings were a premeditated act of mass murder, and identifying Holmes as the lone shooter.

Supporting that strategy, Aurora police officer Tom Welton testified that Holmes made postings on two dating websites earlier in July, asking "Will you visit me in prison?"

Prosecutors wrapped up their evidence in the hearing by listing all the victims by name, the injuries they suffered and the charges -- more than 160 in all -- filed on behalf of each.

-AFP/ac

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Hate speech case: MIM MLA Akbaruddin Owaisi sent to 14- day judicial custody

HYDERABAD: Majlis-e-Ittehadul Muslimeen MLA Akbaruddin Owaisi, facing multiple cases for his alleged " hate speech", was today remanded to 14-day judicial custody by a magistrate in Nirmal town of Adilabad district.

Akbaruddin was reportedly questioned and produced before the magistrate at 5:30am, after which he was sent to judicial custody.

The Magistrate also asked the police to produce the MLA before the court later today at 10:30 am.

Owaisi has been taken to the Nirmal town police station, and his petition is expected to be listed at the Andhra Pradesh high court today.

Owaisi was arrested yesterday, a day after he returned from London and was admitted to a hospital for a medical check up, before being taken into custody.

Following the arrest of the MIM leader, the state government has imposed a prohibitory orders in the town to maintain law and order.

Additional security forces have been deployed in Hyderabad and Adilabad as a precautionary measure.

Owaisi, the floor leader of his party in the Andhra Pradesh Assembly, is facing a case against him in Adilabad for alleged provocative speeches regarding the disputed Bhagyalakshmi shrine in the Charminar area.

Complaints have been filed against him in regard to the same speeches in various police stations in Hyderabad and other parts of the state.

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