A dog may not only fill a home with joy, it fills a home with a whole lot of bacteria, new research suggests.  But that doesn't mean you have to kick your pooch out of the bed.

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This adorable puppy is loaded with bacteria, but those germs may actually be beneficial.

Research from North Carolina State University published Wednesday in the journal PLoS ONE found homes with dogs have both a greater number of bacteria and more types of bacteria than homes without dogs. 

The findings were part of a larger study that analyzed the types of microbes living in 40 homes in the Raleigh-Durham area of N.C.  Participants swabbed nine areas of their homes and informed researchers about aspects that could influence bacterial life, such as whether there were dogs or cats and how many people lived in the home. 

“The project was a first step toward making an atlas of microbes found in the entire home and how they may affect our health and well-being” said Holly Menninger, a co-author and director of public science at NC State’s Your Wild Life program.

Of the places where household bacteria were found, pillowcases and television screens had the most detectable dog-related microbes.

“Some of the microbes we know come from dogs themselves,” said Menninger. “Some of these bacteria come from the outdoor environment, such as dogs bringing bacteria from the soil and into homes.” 

The researchers were able to identify a few classes of bacteria linked to dogs, and certain microbial classes that may cause disease in humans, such as gingivitis and pneumonia.  However, genetic testing of the bacteria was not specific enough to determine whether any harmful strains were there.

All those germs tracked in on dirty paws don’t mean dog-free homes are necessarily healthier, though. While the researchers did not identify the specific species of bacteria living in each household, they were able to say that most of the organisms they found are not disease-causing – and may actually provide some benefits.

“We co-exist with bacteria and healthy, small exposures to bacteria do not pose any risk and might, on the other hand, be beneficial, as long as we keep a good hygienic environment,” said Dr. Rani Gereige, director of medical education at Miami Children's Hospital.  Gereige was not involved in the research.

A recent study found that exposure to a microorganisms from a pet during a child’s first year of life of life may help ramp up the immune system, lowering the risk of developing allergies later. 

“Research has actually shown that mothers who live with dogs while pregnant are less likely to have children with conditions like atopic dermatitis or to develop allergies,” said veterinarian Dr. Andy Roark of Greenville, S.C. 

Certain bacteria from dogs – such as salmonella and listeria -- can cause infections in humans, however, so it is important to be vigilant, he cautions.

“It is always a good idea for both adults and children to wash hands after playing with pets, especially before eating,” said Roark.

The study did not control for certain factors that could affect bacterial growth, such as household climate and cleanliness, and there were not enough homes with cats to accurately analyze the feline contribution to residential bacteria.  The researchers did not analyze whether certain dog breeds harbor more bacteria than others.

The microbes found throughout the different homes fell into three general groups: those that come from skin and live on surfaces we touch, such as door knobs and toilet seats; bacteria linked to food found in kitchens; and organisms found in places where dust gathers, such as television screens and moldings.

Menninger added that the research team is in the process of analyzing samples and other data from a total of 1,300 homes across the United States. 

“We know we have all these bacteria in our home,” said Menninger.  “Let’s learn to live with them.” 

 Related: 

Your skin microbes prove you're a 'dog person'

By Matthew Perrone
Associated Press

A federal panel of medical experts said that an experimental insomnia drug from Merck & Co. Inc. appears safe and effective, despite evidence from company trials that the pill can cause daytime sleepiness and difficulty driving. 

A majority of Food and Drug Administration panelists voted Wednesday that Merck's sleeping aid, suvorexant, helped patients get to sleep and stay asleep. In a separate set of votes, the panel voted that the drug appears safe at the starting doses proposed by the company.

The FDA is not required to follow the recommendations of its experts, though it often does.

The panel opinion was somewhat at odds with the agency's own scientists, who issued a negative review of the drug earlier in the day. FDA staff pointed out that suvorexant was associated with daytime drowsiness, driving difficulties and suicidal thinking in trials conducted by Merck.

"How much is it worth to try and make the drug safer? How many people are you willing to risk versus how much effort are you willing to make?" said Dr. Ronald Farkas, who presented the FDA's findings.

The FDA drew attention to five women, or roughly 5 percent of patients, who had to stop a supervised driving test because they were too sleepy to continue. In another case, a 59-year-old man reportedly fell asleep at a traffic light and later veered off the road while taking the drug.

The FDA suggested that a lower dose of 10 milligrams might be safer for patients than the higher doses proposed by Merck.

But a majority of panelists endorsed the safety of initial doses proposed by Merck: 15 milligrams or 20 milligrams a day for elderly patients or non-elderly patients, respectively. The panel backed their safety in a vote of 13-3, with one abstention.

"Start low and go slow is likely to be effective," said Dr. Matthew Rizzo of the University of Iowa. "I also think the safety profile of this drug is not any worse and likely better than the drugs we are already using."

Much the meeting's discussion focused on the shortcomings of sleeping pills already on the market, most of which are also associated with lingering drowsiness.

In January, the FDA required drugmakers of Ambien and similar sleeping pills to lower the doses of their medications, based on studies showing that the drugs remain in the bloodstream at levels high enough to interfere with driving.

The panel narrowly voted 8-7, with one abstention, against doses as high as 30 milligrams and 40 milligrams, saying they could exacerbate problems with drowsiness and narcolepsy.

"I think the risks are substantial and it seemed to go up with the higher dose," said Natalie Portis, the panel's patient representative.

Merck has suggested raising patients' prescriptions to the higher levels if they do not respond to lower doses.

If the FDA ultimately approves suvorexant, it will be the first in a new group of drugs that aid sleep by blocking chemical messengers that keep people awake.

A Merck spokeswoman said Wednesday the FDA is expected to issue a decision on suvorexant by mid-year. If approved the drug will have to be scheduled as a controlled substance by the Drug Enforcement Administration.

Shares of the Whitehouse Station, N.J., company fell 62 cents to close at $46.71. 

Family photo via University of Michican

Kaiba Gionfriddo of Youngstown, Ohio, has a bioprinted splint holding his airways open. Without it, he wouldn't be able to breathe.

The Youngstown, Ohio, baby turned blue again and again as his little airways collapsed and kept air from reaching his lungs. But doctors used a 3-D bioprinter to custom-make a splint that is holding his airway open and helping him breathe.

Now 19-month-old Kaiba Gionfriddo is “into everything”,  says his mother, April Gionfriddo.

"Quite a few doctors said he had a good chance of not leaving the hospital alive," she adds.

Kaiba’s life was saved by a brand-new field of regenerative medicine based on plastics and inkjet printers. Doctors at the University of Michigan used CT scans of Kaiba’s little airways to custom-design a scaffolding to pull open the passages and hold them open until they could grow strong and healthy on their own.

Kaiba was born with a rare condition called tracheobronchomalacia. This deformity affects about one in 2,200 babies and causes the airways to be weak and prone to collapse. In tiny babies, it can look like asthma and it can take a while to diagnose.

University of Michigan.

Doctors at the University of Michigan bioprinted this splint, custom designed for Kaiba Giofriddo's trachea. It fits around the outside and supports the windpipe.

Kaiba showed early symptoms. “At 6 weeks of age, he had chest-wall retractions and difficulty feeding,” the researchers wrote in this week’s issue of the New England Journal of Medicine. April Gionfriddo says it wasn’t immediately clear what was wrong, until one morning the family was eating out when Kaiba was 2 months old.

“We went to the Waffle House,” she said in a telephone interview. “He ended up turning blue and stopped breathing on us.” They rushed to the emergency room, where doctors said the baby had just aspirated something, and sent him home.

“Two days later, he ended up turning blue on us again,” says Gionfriddo, a 32-year-old mail room worker in Youngstown, Ohio. “He ended up spending four months in the hospital.”

Kaiba needed a ventilator to breathe, and wasn’t going to be able to survive without it. Worse, he struggled and had to be sedated to tolerate the breathing tube.

“Some of the arteries, especially those coming off the aorta, are malformed,” said Scott Hollister, a professor of biomedical engineering at Michigan. “They almost form a ring around the trachea. If it’s too tight, they actually compress the airway, which happened in Kaiba’s case.”

Again and again, Kaiba’s floppy airways collapsed.

"Even with the best treatments available, he continued to have these episodes. He was imminently going to die,” said Dr. Glenn Green, a pediatric ear, nose and throat specialist at the University of Michigan “The physician treating him in Ohio knew there was no other option, other than our device in development here.”

Green had been working with Hollister to develop exactly what Kaiba needed – support for his growing bronchial tubes.

“Our laboratory has been working on this area for a long time,” Hollister said in a telephone interview. “It was a little bit intimidating as well. We had been developing the prototype and gearing it toward this application.”

Family photo/ Via University of Michigan

Kaiba Gionfriddo can't walk yet, but he can scoot around, his mom says.

Replacing the entire trachea is complex. “We felt the simplest solution was to build a device that would go around the trachea,” says Hollister.

They developed a program that would design the horseshoe-shaped device, complete with small holes to allow a surgeon to suture it into place. “Then we made a model of his trachea,” says Hollister. “Just to be sure, we made it in a range of sizes.”

Hollister’s team used a bioplastic powder called polycaprolactone.  “It’s a polymer that is approved by the Food and Drug Administration to fill small holes in the skull,” Hollister says. The bioprinting machine melts the powder, and builds the desired shape layer by layer.

The University of Michigan team got special permission from the school’s advisory board and the FDA to go ahead. “I was a little scared at first because the doctor said he wasn’t sure it was going to work at first,” Gionfriddo says.

“But we decided to go ahead and try it. It gave him a chance. We were pretty happy they had at least something. It kind of seemed kind of cool and the other part was science fiction.”

In February of 2012, a surgical team re-arranged Kaiba’s twisted heart arteries and trachea, and then carefully placed the splint.

"It was amazing. As soon as the splint was put in, the lungs started going up and down for the first time and we knew he was going to be OK," says Green. In three years, they expect the material will be completely reabsorbed and excreted by the body. By then, his own airways will be able to function on their own, doctors say. 

"Severe tracheobronchomalacia has been a condition that has bothered me for years," he added. "I've seen children die from it. To see this device work, it's a major accomplishment and offers hope for these children."

Three weeks after surgery, the ventilator was taken out and Kaiba was sent home. "He’s not walking yet, but he’s starting to learn how to scoot backwards on his little butt,” Gionfriddo says.

Now, Kaiba’s 6-year-old brother and 11-year-old sister spoil him, Gionfriddo says. “They sit there and laugh at him. They end up getting in trouble with them.”

Related:

Girl gets artificial trachea

Toddler is youngest to get new windpipe

Regenerative medicine - a 'growing' field

National Institute of Allergy and Infectious Diseases

A new flu vaccine is made out of self-assembling nanoparticles. This images shows what the particle looks like - to the immune system, it looks like a flu virus.

Researchers have developed a “stripped down” synthetic flu vaccine that they believe will not only work better than current vaccines, but might last longer, too -- saving people from having to get a fresh flu shot every year.

They say it’s the first step toward a new generation of influenza vaccines, designed entirely in the lab, using nanoparticles instead of the decades-old approach that uses chicken eggs. The nanoparticles assemble themselves into an imposter of the flu virus -- one that seems to excite the immune system far more than the real thing.

“This is, I believe, an important advance,” says Dr. Tony Fauci, head of the National Institute of Allergy and Infectious Diseases, where the research was done.

Current flu vaccines are clunky at best. Most are still grown in eggs, an uncertain technology that takes months. Entire factories full of vaccine can be shut down because of contamination. Researchers have figured out how to make synthetic versions of the flu virus to use as a basis for the vaccine, but many still use real viruses, either killed or weakened so they don’t make people sick.

And it’s never certain from one year to the next how well the vaccine will work. No one is precisely sure why, but the virus mutates every year, and a variety of strains circulate at any given time. The result is that some years the vaccine protects people well, and in others, it doesn’t.

For instance, this past season’s influenza vaccine reduced the chances of illness by just 9 percent in people older than 65, the Centers for Disease Control and Prevention says, and reduced illness for the population as a whole by 56 percent.

And then every few years, a new strain pops up to infect people. Health officials are currently keeping a wary eye on two strains of bird flu, H5N1 and H7N9, either of which could mutate just a bit more to cause a pandemic.

The new vaccine uses a key part of the flu virus, called hemagglutinin, which gives flu the “H” in its name.  Dr. Gary Nabel, who was at NIAID at the time, fused a bit of hemagglutinin to a piece of a compound called ferritin. Ferritin naturally makes itself into little nanoparticles, and the result was a nano-sized spiky ball that looked a lot like a natural bit of hemagglutinin.

Nabel says it’s a stripped-down version of flu virus that the immune system recognizes even better than it does real flu. Tests on animals showed the nanoparticles caused the body to produce 10 times as many virus-fighting antibodies as the current seasonal flu vaccine, Nabel’s team reports in the journal Nature.

“They look like flu. They react with antibodies like flu,” Nabel, who now works for vaccine maker Sanofi, said in a telephone interview.

The vaccine protected ferrets against H1N1 flu viruses, an H3 flu virus and an influenza B virus, too. Ferrets are the animals that react most like humans to flu.

Now researchers are working to make a version that can be tested in people.

Nabel thinks the vaccine will provide broader immunity than current vaccines, as well as a stronger immune response. But humans have unique immune systems and it’s not yet clear how it will work in people.

It may also speed up the convoluted process for making vaccines, which starts with growing the virus in the lab, something that can take months. “We don’t need the virus to replicate. We just put the gene into a cell and make the particle. It is rather an amazing process,” Nabel says.

“In theory it could be very fast.” If it takes three months now to make a “seed” virus for a vaccine, the new process would only take a week or two, he estimates.

It took months to make and roll out vaccine against H1N1 swine flu when it first broke out in 2009 and thousands of people died during the delay. CDC doesn’t count how many adults die from flu each year, because it’s so variable -- anywhere from 4,000 to 49,000 a year.

The new technology might not just work against flu. “This is a platform that could be used for other viruses,” Nabel said. That could include the AIDS virus or herpes, or even coronaviruses like the new MERS virus that has killed more than 20 people in Saudi Arabia and other middle east countries.

Fauci said in theory, a vaccine made from this new technology could last longer than the current seasonal flu vaccine. “To me, this is an important step toward the development of a universal flu vaccine,” Fauci said. “The definition of a universal flu vaccine is it covers wide range (of virus strains) and you wouldn’t necessarily need to get a new one each year.”

Dr. John Treanor, a flu vaccine researcher at the University of Rochester Medical Center, said the approach resembled some newer-generation vaccines that use synthetic technology and that have been shown to work in people.  “It certainly is a very technically advanced approach,” said Treanor, who was not involved in the research.

Related:

• CDC says flu vaccine barely worked in seniors this year
• New technology speeds process against bird flu vaccine
• Doctors are making an H7N9 vaccine, just in case
• Ouch free vaccines in the works

Editors note: A graphic image of the patient post surgery is at the bottom of the page.

A 33-year-old Polish man received a life-saving total face transplant just three weeks after being disfigured in a workplace accident, in what his doctors said Wednesday is the fastest timeframe to date for such an operation.

Face transplants are extraordinarily complicated and relatively rare procedures that in the past have required extensive preparation, typically months or years. But medical officials said the Polish patient's condition was deteriorating so rapidly that a transplant was seen as the only option, though now he still faces a high risk of infection.

The patient worked at stonemason's workshop, where in April a machine used to cut stone severely damaged his face and crushed his upper jaw. The man, identified only as Grzegorz, received intensive treatment at a hospital in Wroclaw, but an attempt to replant his own face failed, doctors said.

/ AP

The skull of a 33-year-old Polish man after it was damaged in a work accident, right, alongside the healthy skull of another person.

So he was taken to the Cancer Center and Institute of Oncology in Gliwice, which is the only place in Poland licensed to do face transplants and has experience in facial reconstruction for patients disfigured by cancer. Doctors at the center said the 27-hour face and bone transplant was performed May 15 soon after a matching donor was found.

The surgery reconstructed the face, jaws, palate and the bottom of the man's eye sockets. Pictures show surgery stitches running from above the patient's right eye, under the left eye and around the face to the neck. The donor was also a young man.

The head of the team of surgeons and other specialists, Adam Maciejewski, said it was the world's first life-saving face transplant carried out so soon after the damage.

He and other doctors said the surgery was the patient's only shot at survival — prior to the operation the man faced danger from infections because of the tremendous damage to his mouth area and the skull bone. The man also could not breathe on his own nor eat.

"We assume the surgery will allow the patient to return to normal life," Maciejewski said. "He will be able to breathe, to eat, to see."

/ AP

A 33-year-old Polish man whose face was torn off by stone-cutting machinery is shown after undergoing a total face transplant. Picture provided by the Cancer Center and Institute of Oncology in Gliwice, Poland,

However, surgeon Michal Grajek told The Associated Press that the patient still runs a risk of infection because the team did not have time to cure any potential infections in the donor tissue. For now, the patient is in sterile isolation to protect him from infection, but he has already started the rehabilitation process.

He will stay on immunosuppression drugs for the rest of his life to keep his body from rejecting the donated face.

A picture of the patient taken Tuesday, six days after the surgery, showed him giving a thumbs-up sign from his hospital bed.

More than two dozen transplants of the face or parts of the face have been performed around the world. The first one was a partial face transplant in a woman maimed by her dog in France in 2005.

Related:

'A wonderful gift': Lye attack victim reveals new face after transplant

Two people have died and five others have been hospitalized in a mysterious cluster of respiratory illnesses in southeast Alabama, state health officials said. 

The victims, all adults, had symptoms including fever, cough and shortness of breath, but the cause of the illnesses is unknown, said Dr. Mary McIntyre, the acting state epidemiologist for the Alabama Department of Public Health. The hospital is using respiratory precautions, which include requiring staff to wear special N95 masks that reduce the chance of infection.

State health officials have collected and analyzed samples of specimens from all patients. So far, one sample has tested positive for H1N1 influenza A, but it's not clear that that is behind the unusual illnesses. There's no evidence of other kinds of flu, including the H7N9 strain that has caused illness and death in China, McIntyre said. 

Laboratory samples have been sent to the Centers for Disease Control and Prevention, but testing results are not yet available, officials said. 

There's no evidence that any of the victims had a connection or traveled outside the country, which would have put them at risk for unusual pathogens, including a deadly new coronavirus recently christened MERS or Middle East Respiratory Syndrome.

"At this point it's too early to tell," McIntyre told NBC News. "That's why we called it a respiratory illness of unknown origin."

State and federal health officials will continue to investigate the illnesses. 

Related: 

• New SARS cousin finally has a name: MERS

Maj. Geoff Legler/Oklahoma National Guard/Handout via Reuters

A rescue worker and his search dog sit outside the remains of the Plaza Towers Elementary School in Moore, Okla. Emergency workers have pulled more than 100 survivors from the rubble.

Search teams, including some with trained dogs, are scouring the rubble left behind by the monster tornado that flattened miles of homes, schools and businesses in Moore, Okla., and the nearby area Monday. More than 100 people had been found alive by rescuers as of Tuesday afternoon.

While it's uncertain exactly how many people are still missing, rescuers are up against the clock to find survivors, experts say.

The window of opportunity for someone to still be alive but out of sight under the wreckage is usually about 48 hours, says Bill Dotson, president of the Search Dog Organization of North America. 

“We have got probably until tomorrow night to be optimistic,” Dotson, who has been training search dogs since 1977, said in a telephone interview.  “There is an urgency to this. There is a time factor, but it is always possible that we are going to find somebody," added Dotson, who is not involved in the Oklahoma search and rescue effort.

Authorities said they were still searching Plaza Towers Elementary School in Moore, Oklahoma, where seven children died, but said search dogs had not found anyone else amid the shattered pieces of wood, metal and concrete. Among the searchers are dog units from Texas, Missouri and Nebraska.

Search and recovery experts know it’s possible to survive a building collapse. People have been pulled alive from impossibly small spaces after quakes, explosions and accidents. Most recently, a young mother was pulled alive from the pancaked remains of a Bangladesh clothing factory, 16 days after the disaster.

Slideshow: Tornadoes ravage Plains

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Destroyed vehicles lie in the rubble outside the Plaza Towers Elementary school in Moore, Okla., on Tuesday.

Launch slideshow

The keys to survival are that something must have protected the person from being crushed, they’ll need to be somewhat mobile, they’ll need air and, after a few days, water.

“Voids – we look for voids,”“We look at the wreckage to determine survivability,“ said Dotson, who's helped train dogs for mine rescue, rescues after disaster and to help look for people who are lost or missing.

Survivors will have to have escaped the worst of the flying debris and gotten stuck under a piece of the building’s frame, or something similarly strong and stable.

“Maybe they are buried pretty deep in a basement, a house collapsed on top of it, and nobody could get to them,” Dotson says. “We know from earthquakes that 48 hours is the optimal time to locate living persons and find them alive and get them to hospital.”

Even a minor injury can kill someone after a few days, Dotson notes. “Imagine someone has a cut to the leg. They’re fine, and it stops bleeding on their own,” he says. “Then a day goes by and they start having an infection. Then a second day goes by and the infection’s worse. The mere infection can kill a person who was alive when the tornado left.”

Being completely pinned can also cause what's known as crush syndrome, which severely damages the nerves and muscles. Releasing the victim can even precipitate a heart attack or a stroke, so rescuers must take care.

Specialized equipment can check for the carbon dioxide exhaled by survivors, but it’s usually quicker to use a trained dog.

“They are very successful and very efficient at locating people that you can’t see or hear,” Dotson says. “If someone’s five or six feet down in the rubble, it can be pretty hard to hear them.”

Rescue dogs are specially trained to detect people who are still alive. They can smell exhaled breath, for a start, says Dotson. “Imagine a picture of Pigpen from the Charlie Brown cartoons,” he said. “We all put off molecules that a dog can pick up. Their sense of smell is extremely acute.”

It takes years of training, however – people’s pets are very unlikely to help rescue anyone, even their own families. “They are absolutely, positively of no help whatsoever,” Dotson says.

If someone was trapped for longer than a few days, water would be the next immediate need, experts say. “People can last without water intake, if conditions are pretty good, for around five days or a week,” says Randall Packer, a professor of biology at George Washington University.

Some survivors have said hearing the sounds of the search have given them hope, and the will to hang on.

People can last for weeks without food, but looking at images of the devastation in Oklahoma, Dotson says he doubts any buildings have intact enough spaces for anyone to survive that long.

Fire and rescue officials said they would check every structure in Oklahoma from top to bottom.

“We are always optimistic that the next foot the dog puts down, he is going to say yes, we have got somebody here alive,” Dotson said.

Related:

• Crews comb devastation in Oklahoma
• School came apart; students had nowhere to hide
• Water secret to long-term survival

SAN FRANCISCO -- Thousands of healthcare workers walked off the job at the University of California's five medical centers on Tuesday, delaying surgeries, diagnostic procedures, treatments and emergency care throughout the state. 

The union representing nearly 13,000 vocational nurses, respiratory therapists and radiology technologists said they staged the strike -- scheduled to last two days -- to draw attention to staffing shortages that they say undermine patient care at the hospitals in San Francisco, Davis, Los Angeles, San Diego and Irvine.

Some of the public hospital system's estimated 3,400 pharmacists, social workers, psychologists, occupational therapists and lab scientists also walked out on Tuesday in a one-day sympathy strike at the five medical centers.

"The allegation is they're doing this for patient safety," UC spokeswoman Dianne Klein said. "If we had unsafe staffing levels, we wouldn't be in operation. I really don't understand how walking off the job and leaving patients stranded is helping them."

Todd Stenhouse, spokesman for the American Federation of State, County and Municipal Employees, which represents the striking workers, said the union's primary consideration was ensuring adequate staff for patient care.

"Our top concern is about safe staffing, and we need to put a stop to the diversion of resources away from patient care," he said. He said the workers have been working without a contract since September.

Klein said the sticking point in negotiations has been the union's unwillingness to agree to changes to a pension system that most of the university's other workers have already accepted. "What AFSCME wants is a special deal for them, and we don't think it's fair," she said.

Proposed changes include raising employee pension contributions, revising eligibility rules for retiree health benefits, and creating a second tier of retirement benefits for new workers.

Tim Thrush picketed outside UC San Francisco, where he works as a diagnostic sonographer, holding a sign saying, "Striking for our patients, our family and our future."

"I'm very excited and energized to be in the middle of hundreds of my co-workers who are standing up to UC and letting them know that their messed-up priorities that are shortchanging patient care on a daily basis need to stop," said Thrush, 46.

University of California Vice President for Human Resources Dwaine Duckett said his organization had offered the workers a four-year contract with up to 3.5 percent annual wage increases. The average employee in the union earns $55,000 a year, he said.

GENEVA  - The H7N9 virus appears to have been brought under control in China largely due to restrictions at bird markets, but caused some $6.5 billion in losses to the economy, U.N. experts said on Tuesday. 

Health authorities worldwide must be on the lookout to detect the virus, the experts said, which could still develop the ability to spread easily among humans and cause a deadly influenza pandemic.

The new bird flu virus is known to have infected 130 people in mainland China since emerging in March, including 36 who died, but no cases have been detected since early May, Health Minister Li Bin told a meeting of the World Health Organization. One case was found in Taiwan in April, making a total of 131.

"The immediate outbreak has been controlled, but it is also unlikely that virus has simply disappeared. We believe we need go another autumn/winter/spring season to know," said Keiji Fukuda, WHO assistant director-general for health security.

"We also have high concern over the potential, I stress the potential, to gain the ability to sustain transmissibility."

There was no evidence of sustained spread among people and "most cases probably resulted from infected poultry or perhaps contamination related to live poultry markets," Fukuda said.

Li said local Chinese authorities had shut down live poultry markets "temporarily or permanently as needed" to control the source of outbreaks in 10 provinces. It standardized methods of transporting poultry to reduce spread among birds.

China's government had spent 600 million RMB or $97 million to support healthy development of the poultry industry, Li said.

"In view of the present situation, H7N9 is preventable and controllable. There has been no qualitative change in the epidemic. Cases are sporadic and there has been no genetic mutation (of the virus)," she said.

H7N9 is highly pathogenic in humans, causing severe respiratory disease, but is not virulent among birds, making it nearly impossible for farmers to detect, experts said.

"There have been no (human) cases since May 8, that is a good indication and means measures are being taken seriously. Now when the virus is found at market, all birds are killed, that is important too," Bernard Vallat, head of the World Organisation for Animal Health (OIE), told reporters.

Out of 60,000 samples taken from birds, 53 were found to carry the virus, Liang Wannian of China's health ministry said.

There is "no red flag" for H7N9 among poultry, unlike H1N1 which kills off flocks, said Juan Lubroth, chief veterinary officer at the U.N.'s Food and Agriculture Organization (FAO).

"Economic impacts of H7N9 have been astounding," he said.

"Over $6.5 billion has been lost in the agriculture sector because of prices, consumer confidence and trade. So poultry industry losses in China have been high," Lubroth said, later making clear it was an estimate by China's agriculture ministry.

SAN FRANCISCO -- A federal court in San Francisco Tuesday struck down Arizona's ban on abortions after 20 weeks of pregnancy.

The 9th U.S. Circuit Court of Appeals ruled that the law violates a string of U.S. Supreme Court rulings starting with Roe v. Wade that guarantees a woman's right to an abortion before a fetus is able to survive outside the womb. That's generally considered to be about 24 weeks. Normal pregnancies run about 40 weeks

Several states have enacted similar bans starting at 20 weeks. But the 9th Circuit's ruling is binding only in the nine Western states under the court's jurisdiction. Idaho is the only other state in the region covered by the 9th Circuit with a similar ban.

A trial judge had ruled that the ban could take effect. U.S. District Judge James Teilborg ruled it was constitutional, partly because of concerns about the health of women and possible pain for fetuses.

But abortion-rights groups appealed that decision, saying the 20-week ban would not give some women time to carefully decide whether to abort problem pregnancies.

The ban included an exception for medical emergencies.

Fuse / Getty Images

The decision to withdraw life-sustaining care varies widely in intensive care units, ICUs, across the U.S., a new study finds.

If you land in an intensive care unit sick enough for doctors to consider withdrawing life support, be warned. Whether and when to pull the plug may depend in large part on the practices and culture of the ICU itself -- perhaps more than your needs or wishes, a new study finds.

That may be especially true if you’re so ill or incapacitated that you can’t make decisions about your own care, according to research being presented Tuesday at the American Thoracic Society International Conference.

After accounting for patient factors such as age, function, gender and race, the probability of having life support withdrawn ranged from 3.5 percent in some ICUs across the nation to 20.6 percent in others -- a six-fold variance.

“The really important message for patients and their families is, before you end up in an ICU, talk to your loved ones about what you would want,” said Dr. Caroline M. Quill, lead author of the study by researchers at the Perelman School of Medicine at the University of Pennsylvania.

Quill and her team analyzed records of more than 269,000 patients treated in 153 ICUs in the United States between 2001 and 2009. Overall, nearly 12 percent of patients had a decision made to go from a “full code” -- an all-out effort to save lives -- to some kind of limit on care.

That could have included: a DNR or do-not-resuscitate order; an order to withhold CPR or cardio-pulmonary resuscitation plus removing mechanical ventilation; dialysis or other life-saving treatments; or simply an order to provide only comfort measures or hospice care. About 59 percent of the patients died in the ICU and another 41 percent survived to discharge, the study found.

Particular patient characteristics accounted for most of the variability in decisions to withdraw life support, Quill acknowledged. But even after age, illness, functional status and other factors were analyzed, the variation among ICUs to authorize a DFLST -- decision to forgo life-sustaining therapy -- was striking.

“The finding of a six-fold variability among ICUs strongly suggests that the ICU to which a given patient is admitted strongly influences his or her odds of having a DFLST, regardless of personal or clinical characteristics,” the authors write.

The study didn't find particular variance by geography and the decision to withdraw care wasn't related to regional differences in cutting costs, Quill said.

End-of-life experts have known for years that individual doctor and ICU practices can affect the decision to withhold care, said Dr. J. Randall Curtis, director of the Palliative Care Center of Excellence at the University of Washington in Seattle.

In some ICUs, there’s a kind of heroic standard, an atmosphere in which doctors don’t talk about dying and every effort is made to sustain life, he said. In others, there’s an early effort to acknowledge the likelihood of death and to talk about the risks and benefits of care and how it fits into what a patient would want.

“I think there are still parts of our medical culture that say it’s our job to keep people alive no matter what,” he said. “As opposed to talking with patients and families about their values.

In the absence of instructions from the patient or their family members, the ICU’s culture is more likely to sway the decision about whether to prolong care -- or not.

Quill emphasizes that the study didn’t draw any conclusions about the rates of ICU decisions to withdraw support. “We don’t necessarily think that the 3.5 percent rate is too low or the 20.6 percent rate is too high,” she said.

Surprisingly, perhaps, there actually are no hard-and-fast guidelines in the critical care field about when to withdraw life support. That’s mostly because it would be too hard to envision every potential scenario, said Dr. Douglas White, an associate professor of critical care medicine and director of the program on ethics and decision making in critical illness at the University of Pittsburgh.

“These decisions about whether and when to withdraw life support are not scientific decisions,” he said.

In an ideal scenario, a patient would have made his or her wishes about end-of-life care known well in advance. In practice, however, although the number of people who spell out their wishes is growing, only about 10 percent of the general public has completed an advance directive or obtained a durable power of attorney for health care, Curtis noted.

That means that the final decision often is left to family members or other “surrogate” decision makers, and to doctors and clinicians.

“If the patient hasn’t articulated a clear preference, it’s very, very hard for doctors and families to work together to make the decision, “ White said. “(They’re) left to do the best that they can that generally reflects who the patient is as a person.”

It would be far better, experts agree, if more people anticipated the possibility of end-of-life decisions and left clear instructions. Ten years ago, that might have been preferences for -- or rejection of -- specific treatments such as CPR or mechanical ventilation, experts say.

Today, the discussion centers much more on the overall goals of care and the values of the patient. Take the end-of-life instructions drafted by Dr. John Luce, an emeritus professor of anesthesiology and medicine at the University of California, San Francisco.

Luce, who has researched and written about end-of-life care, said he values a “sentient existence” in which he retains the ability to  “think, read, speak, write and communicate with people.”

“Anything that could not restore me to this, I would not want it,” he said.

So that’s how Luce’s advance directive reads, if, heaven forbid, he should need it. The new research that underscores the variability of ICU practices should also emphasize the need for ordinary people to make their wishes known, Luce said.

“The really important thing is to get people talking with those who could become their surrogates,” he said. “The written document is less important than the conversation that leads up to the directive.”

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• Americans in denial about long-term care

The Oklahoman via AP

Children wait for their parents to arrive at Briarwood Elementary school after a tornado destroyed the school in south Oklahoma City, Okla., on Monday. One student there died.

Parents across the country took a collective deep breath on Tuesday as they prepared their children for school. It's been a traumatic year -- the shootings in Newtown, Conn., the Boston marathon bombings, and now a devastating tornado in Oklahoma that has killed 24 people and buried a school full of cowering youngsters, killing seven. 

It’s understandable that children and parents are affected by these events, even those living far away, psychologists say.

“It’s that fear of the unknown – the ‘my God, that could happen to me’,” says Katey Smith , who heads the trauma response team at The Center of Hope, a nonprofit family support center in Greenwich, Conn. “This time, it was an act of God or a natural disaster, which can be just as scary if not scarier, because there is nothing you can do to stop it. You can’t stop a tornado. People are feeling powerless."

Worse, the children were killed and injured in schools, places where they are supposed to be protected and safe. Parents drop their children off in the morning believing they'll be well taken care of until they pick them up - not that they'll be waiting in the rubble of the parking lot to find out if their child is alive or dead, as parents of children at Plaza Towers Elementary School in Moore, Okla., did on Monday. Nearby Briarwood Elementary was also destroyed and one child was killed there. 

But there are ways to cope and they often involve facing the facts; limiting exposure to endless media reports about the disasters; and giving people something to do.

Looking at the real facts about a disaster can be reassuring, says Steve Brock, director of the school psychology graduate training program at California State University, Sacramento.

“Be honest and factual with your children,” Brock said in a telephone interview. “The truth is that what happened in Moore, Okla., and especially what happened at Sandy Hook elementary school are extraordinarily rare events.”

“Statistically, these situations are so incredibly rare,” agrees Eric Rossen, director of professional development and standards for the National Association of School Psychologists. He headed a team looking for information on school killings after the Newtown shootings, in which 20 first-graders were killed. “We were able to find statistics that showed there would be one homicide in each (U.S.) school every 5,000 years,” Rossen said.

Even when parents may be feeling worried themselves, they need to help their children feel safe, experts say.

 “I think it’s our job as adults to put it in the proper perspective,” Rossen added. “We want to give them the objective facts that help them understand the threat.” Older children and teenagers benefit from hearing the statistics. While two terrible events have affected schools in a single year, Rossen points out there are thousands of schools and tens of millions of schoolchildren.

“Try not to sidestep this. You don’t want to lie,” says Rossen. “You want to say there was a tornado and people were hurt by it.” But then it’s time to reassure children they are safe, now.

Parents should focus on being calm, because kids pick up on emotional responses.

“One thing I would tell the parents – their reactions are powerful,” Rossen said. “You see this all the time in younger children – something or frightening happens and they immediately refer back to Mom and Dad. Be careful about how you act and how you respond in front of the children.”

Another rule: Watch what the kids are watching. “You want to limit their exposure to the coverage of the event,” says Rossen. “As a caring adult, be present if they are watching it.”

Smaller children probably should not watch or hear such news at all -- they cannot process it, the experts agreed. But even older children need help managing the overload. "In today’s society you can be viewing this stuff literally 24/7," Brock said.

And there's no reason to bring it up if a child seems unaware or uninterested. "I am not saying we put our kids on an island and pretend these bad things don’t happen. They do," Brock added.

People were traumatized by the media images of the 1995 bombing of a federal building in Oklahoma City, Brock says. “After the Oklahoma City bombing, kids who watched more television were more anxious and more stressed than kids who watched less television. Monitor their viewing and in some cases, perhaps, restrict it,” he advised.

“Too much media exposure of this kind can really heighten their anxiety,” agreed Cindy Dickinson, crisis intervention manager for the Fairfax County, Va., public schools and a head of the National Association for School Psychologists.

Even in adults, watching the images over and over can provoke anxiety and what’s known as vicarious trauma. “It’s something in my living room. I can go turn on my TV now and see that tornado,” Brock said said. “Imagine what it is doing to young, impressionable kids who don’t have world experience -- they haven’t flown across the country a couple of times and don’t realize how far away these events may be.”

All the experts agreed that it’s best to direct kids and children alike to the positive things that are happening – police, firefighters and neighbors rushing to help the victims and one another. "Remind them who the helpers are in the school community," says Dickinson. Like the teacher in Moore, who draped herself over six children to protect them.

Rule number three – give people something to do.

“One of the messages that is very empowering is knowing how to reach those you care about in an emergency,” Dickinson said. A disaster like this one offers an opportunity to rehearse emergency preparations. “Kids need to know who to call if you can’t reach your parents so you can say you are OK,” she said.

If done at a calm time, such rehearsals don’t worry children but give them a sense of control, Dickinson says. “That is why we have fire drills and so forth in schools,” she said. “When the real thing comes, they save lives. That’s the message.” Memorizing cellphone numbers is a helpful exercise and can pay off in times of confusion.

Older children and teenagers benefit from even more. “Tell them, ‘let’s talk about some ways we can help each other if there’s an emergency, how we can alert people and help them stay safe’,” Dickinson says.

“Eleven to 12-year-olds really have a sense of moral responsibility and of  trying to help others. They really take things on like this.”

And helping the victims can help everyone cope, Dickinson says. “We want to remind them the nation cares,” she said.

“Like with Newtown, so many people just want to help,” Smith agreed. “That’s a great way to feel you are doing something.” It’s important to work through organizations – Newtown officials had to deal with piles of stuffed animals that ended up being more of a problem than a help.

Memorials can also help – religious ceremonies, candle-lighting events, moments of silence.  Acts of public ritual are also helpful because they allow action to be taken, they require organization and they reaffirm community structure,” Smith said.

Related:

• Tornado sounded like a train coming
• Children among the victims
• How to help: Red Cross, food banks
• What you can do to help after the tornado