Health officials fear they have another outbreak of infections linked to pain injections -- this one because at least seven people in two states developed abscesses after getting injections of steroid drugs. They're all linked to a single pharmacy: Main Street Family Pharmacy, a compounding pharmacy in Newbern, Tenn.

Tennessee state officials say the facility distributed the products to 13 states: Alabama, Arkansas, California, Florida, Kentucky, Illinois, Louisiana, Mississippi, New Mexico, North Carolina, South Carolina, Tennessee and Texas.

"Fortunately, we are aware of no serious events like meningitis, stroke or death in association with this cluster, but still our hearts go out to those affected by this event," Tennessee state health commissioner Dr. John Dreyzehner told reporters in a telephone briefing.

"Out of an abundance of caution, the FDA recommends that health care providers not administer any products labeled as sterile from Main Street and quarantine them until further guidance is provided," the Food and Drug Administration said in a statement.

"The reports of adverse events are all from patients who received preservative free methylprednisolone acetate (80 mg/mL) by injection. To date, the FDA has received seven reports," it added.

"Complications identified thus far are skin abscesses," the North Carolina Department of Health and Human Services said in a statement. "Health officials have not had any reports of meningitis, stroke, or death." North Carolina officials are investigating the cases of two patients injected with steroids from the Tennessee pharmacy.

The injections contain the same drug at the center of last year's deadly outbreak of fungal meningitis. More than 55 people have died and more than 740 others developed infections after receiving contaminated injections from the New England Compounding Center in Massachusetts.

The FDA says that at least one of the seven cases appears to be a fungal infection. The government recommends doctors stop using any sterile drugs distributed by the pharmacy. 

Illinois officials said they were checking on five patients who developed abcesses after getting the injections. They were given the steroids between January 3 and February 21, and diagnosed in April and May.

Tennessee officials say they are acting to track down anyone who may have received an injection from the pharmacy. "We are double checking and triple-checking to ensure that we have a good understanding of which products went to which facilities in which states," said Dr. Marion Kainer of Tennessee's state health department.

Dreyzehner said it's not clear whether any of the steroid injections from the pharmacy are actually contaminated. "We are acting as if they are," he said.

"Main Street Family Pharmacy, LLC, was licensed by the Tennessee Board of Pharmacy in 1985. It is currently on probation as a result of a recent inspection," the Tennessee Department of Health said. Officials said the problems had to do with drugs that were past their use-by date, as well as at least one unregistered technician.

The FDA has asked Congress to pass legislation giving it more power to regulate large-scale compounding pharmacies that ship products in bulk. The House and Senate both have measures in the works and leaders say they hope to have a bill ready soon.

FDA officials have repeatedly warned that it's a matter of when, not if, a new outbreak will occur because of poor regulation of compounding pharmacies.

Traditionally, compounding pharmacies mixed up drugs on a patient by patient basis, following a doctor's prescription. But in part because there's so much demand for specialty formulations, and because it's a lucrative business, large-scale compounders now mix up giant batches and ship them to hospitals and clinics ahead of anticipated need. Many operate across state lines.

"There’s no regulation that fits this new industry that’s grown up," FDA's Dr. Janet Woodcock told a House committee hearing on the issue on Thursday.

Woodcock says the FDA is often powerless to police these new, large compounders until there is a problem. Some members of Congress and consumer groups have accused the FDA of failing to do its job.

Since the outbreak linked to the Massachusetts pharmacy, FDA and state officials have stepped up inspections of compounding pharmacies, and found many operating with unsterile conditions.

Main Street Family Pharmacy said it was cooperating with the investigation. "As the FDA reported, an investigation into the exact source of the potential adverse effects from methylprednisolone acetate is inconclusive and ongoing. The company is fully supportive and compliant with the FDA’s recommendation that patients not be administered this compounded medicine until the investigation is complete," the company said in a statement.

Related stories:

• Senate moves closer to law to prevent more pharmacy outbreaks
• Months after outbreak, patients still being newly diagnosed
• FDA inspection prompts Fla. pharmacy recall

Do you know how many calories are in this cheeseburger? A survey suggests most people don't.

People may realize that fast food isn’t health food, but they don’t realize just how fattening it really is, researchers report.

They surveyed people eating at 10 burger, chicken, sandwich and doughnut chains and found they greatly underestimated just how much they were chowing down. The worst was Subway, which promotes itself as a healthier alternative, the researchers at Harvard Medical School found.

“At least two thirds of all participants underestimated the calorie content of their meals, with about a quarter underestimating the calorie content by at least 500 calories,” Harvard’s Jason Block and colleagues wrote in the British Medical Journal.

They interviewed more than 3,000 adults, children and teens visiting six different fast-food chains in Boston; Providence, Springfield, Mass. and Hartford, Ct., asking  them how much they ordered and how many calories they thought they were getting. The surveys were done in 2010 and 2011, before some regulations about calorie labeling came into effect.

People ate a lot. Checks of the receipts showed adults ate on average 836 calories in a meal, while teens and children ate more than 700.  But they estimated, on average that they were getting 175 calories less.

“The mean underestimation of calorie content was larger among Subway diners than those at other chains for adults,” Block’s team wrote.

The average U.S. adult needs about 2,000 calories a day, and kids need less. So people were getting more than a third of their day's calories in a single fast-food visit. And studies show that eating just 100 calories in excess a day can add up to several pounds of extra fat over a year.

Many states and cities have passed tough calorie and fat-labeling laws. The 2010 health reform law will require major restaurant chains to provide clear calorie labels on menu boards.

Consumer advocates have complained for years that Americans don’t get the information they need to make healthy food choices. Not only are fatty, sugary foods everywhere, but it’s often hard to find out how many calories and how much fat  and sugar these foods pack.

Chain restaurants often list their nutritional information on websites or on menus kept behind the counter. What advocates want – and what governments are starting to require – is information listed right next to the food items on the menu board, so people are forced to see it when they order.

Block’s team looked at the biggets national chains: McDonald’s, Burger King, Wendy’s, KFC, Dunkin’ Donuts  and Subway. “We excluded pizza restaurant chains (such as Pizza Hut) because of the difficulty in determining the quantity that an individual bought for personal consumption,” they wrote.

About two-thirds of the adults taking part were overweight or obese – reflecting the actual U.S. population, the researchers found.  About a third of the teens were, while 57 percent of the school-age children were.

“Over 40 percent of participants in each sample ate at the chain restaurant where they were interviewed at least once a week,” the researchers wrote.

Fewer than one in five had even noticed any calorie information, and only 5 percent said they used that information to help them choose meals.

Subway advertises itself as a healthier option. “Branding could be an important component of Subway’s ‘health halo’,” the researchers said.

They believe the new labeling requirements will do a lot to help people understand how much food they really are getting in a fast-food restaurant. “Previous research has found that information can be most powerful when it contradicts previous expectations (in this case, improper estimation of calorie content of foods with a ‘health halo’),” they wrote.

Related:

• Latino kids see more fast-food ads
• CSPI's 'food porn' list
• Small restaurants serve up big calories

Mike Segar / Reuters file

The remains of a home swept away by flooding from Superstorm Sandy on Staten Island in New York on Nov. 13, 2012.

As many as a third of the people who were killed by Superstorm Sandy or its aftermath drowned, government health officials report. And nearly half of those who drowned had stayed behind despite evacuation orders, the team at the Centers for Disease Control and Prevention says.

That means government warnings for people to get out a full day before the storm hit either didn’t sink in, or people willfully ignored them, the CDC team said. There’s also an indication that some wanted to leave but couldn’t – something emergency planners need to take into consideration as the 2013 hurricane season approaches.

Hurricane Sandy hit the U.S. northeast on October 29, colliding with a winter storm to make a monumental tempest.

“Sandy’s tropical storm winds stretched over 900 miles, causing storm surges and destruction over a larger area than that affected by hurricanes with more intensity but narrower paths,” the CDC team, led by Michelle Murti, wrote in the agency’s weekly report on death, injury and illness.

Her team examined data on 117 of the deaths – media reports have the toll as high as 131 – to see how, when and where people died. They used the Red Cross reporting system, which collates data from sources such as funeral home directors, the Federal Emergency Management Agency (FEMA), hospitals, and news reports. Volunteers then questioned medical examiners, doctors, fire departments, police and families for more detail.

“Of the directly related deaths, the most common mechanism was drowning, followed by trauma from being crushed, cut, or struck,” the CDC team wrote. They found nearly 60 percent of the people killed directly by the storm itself drowned, and another 28 percent were crushed, hit or cut.

“Poisoning was the most common indirectly related cause of death; of the 10 poisonings, nine were caused by carbon monoxide. Most directly related deaths occurred during the first few days of the storm, whereas indirectly related deaths continued from the day before the storm into the middle of November.”

People can die from carbon monoxide poisoning as they use gas grills to cook indoors or use gas ovens or stoves for heat. Gasoline-powered generators can also produce the odorless, toxic gas and it can drift indoors if the generator is not vented properly.

More than half of those who drowned were in their own homes, the researchers found. “One person drowned in a flooded commercial building lobby, and another person drowned while intentionally swimming off a storm-affected beach,” they wrote.

Ninety percent of the New Yorkers who drowned had lived in the main evacuation zone, they said. “Notes written by Red Cross volunteers on these 20 deaths captured decedents’ reasons for not evacuating, such as ‘afraid of looters,’ ‘thought Hurricane Irene was mild,’ and ‘unable to leave because did not have transportation’.” Hurricane Irene had hit the region in August 2011.

Drowning had been the traditional cause of death from hurricanes, but by the 1970s, officials had good early warning and evacuation plans, the researchers noted.

“Since that time, hur­ricanes have had other leading causes of death, such as trauma for the Florida hurricanes in 2004 and 2005, and carbon monoxide poisoning for Hurricane Ike in 2008. However, drowning continues to be an important cause of death, and was the leading cause for Hurricane Katrina (2005) and Sandy,” they wrote.

“Given the inability and unwillingness of some residents to evacuate, additional research is needed to identify barriers and motivators for persons during an evacua­tion and the effectiveness of interventions designed to assist these persons.”

Related:

• Jersey Shore kicks off the summer season post-Sandy
• Staten Island was storm's deadliest zone
• Millions without power after Sandy

California has unveiled prices that consumers will pay for a selection of health plans offered through the state under the Affordable Care Act, providing a glimpse into how health care reform may look as it is rolled out across the nation.

Under the federal health care reform law, people who do not get or cannot afford health insurance through their jobs can buy coverage through an exchange, at a group rate negotiated by state regulators.

The cost to a 40-year-old who needs coverage would vary from about $40 to $300 per month for a mid-level plan in California, depending on income. Some young adults, who are less expensive to cover, could pay nothing, depending on how much they earn.

The prices in California, along with those announced in Washington, Vermont and other states, show that premiums under "Obamacare" can be more affordable than had previously been thought. Consumer advocates welcomed the new exchange.

"It's a revolutionary improvement to move from a broken market where people are charged by how sick they are, to a competitive market where people pay what they can afford, based on a percentage of their income, on a sliding scale," said Anthony Wright, executive director of advocacy group Health Access.

"Most consumers buying coverage in the individual market will get financial help and see their premiums go down," he said.

The sweeping federal reform law seeks to extend health insurance to many of the 49 million Americans without it, and alter how care is delivered so as to curb what has been an inexorable rise in healthcare spending.

Republicans who oppose the law had predicted that high premiums would sink Obamacare as the uninsured would not be able to afford coverage even with federal subsidies.

Even the modest rates announced Thursday do not really signal that the program will work, said California Republican Assemblyman Dan Logue.

"This is like a shell game to me," said Logue, co-chair of the assembly health committee, who predicted that taxes would go up to pay for the subsidies, forcing other prices to rise.

"They're not going to tell you that you're going to pay for it in your gas or your food or going to the show," he said.

About a dozen states have set up these exchanges, or large group plans, which are a key element of the giant national health reform effort. Several have already released rates for monthly premiums, and most say the cost will not go up as high as skeptics had feared.

In California, a 40-year-old who makes less than four times the federal poverty level - that is, $95,000 for a family of four or $46,000 for an individual - would pay as little as $40 per month for a mid-level plan in which about 70 percent of medical costs and all preventive care is covered. This excludes additional costs to cover children or a spouse.

The same plan for a person who makes too much to qualify for a subsidy would run about $300 per month on average, the state said. In addition, the total amount consumers would have to pay each year for co-payments and other out of pocket costs would be limited to $6,350 or less, depending on income.

Patients could choose plans that offer lower co-pays if they wished, but would pay higher premiums. In some cases, particularly for low and moderate income workers in their 20s, the premiums are free once a federal subsidy is factored in.

The exchange will also offer what it calls platinum plans, in which co-payments are very low or non-existent. These plans would cost $500 for those who do not qualify for subsidies, but as little as $300 per month for low-wage earners.

The biggest subsidies go to people who make less than 150 percent of the federal poverty level, or about $17,000 for a single person.

Peter V. Lee, a longtime health advocate recruited by the state to help set up and run its program, said costs had been expected to skyrocket because the Affordable Care Act requires health plans to offer more benefits and cover more people than they might otherwise have done.

For example, the plans must cover people with or without pre-existing conditions that would make their care more expensive. The actuarial firm Millman had predicted a 30 percent rise in the cost of monthly premiums for individuals in California under the new exchange.

But Lee said that did not happen. While rates without subsidies may be moderately higher for some consumers next year, most will pay less, he said. The rates announced on Thursday must still be approved by state regulators.

Democratic Congressman Henry Waxman, who backed the health reform act, said the program would protect millions from bankruptcy due to medical costs.

"Californians buying coverage on their own will now have access to the same quality coverage that people get through their employers at the same or lower rates," he said.

California's exchange will offer coverage from 13 insurers; more than 30 had applied to participate.

Among them are some of the biggest names, including Anthem Blue Cross, Blue Shield and Kaiser Permanente. Coverage will also be offered by some companies that had previously limited their activity to the Medicare and Medicaid markets.

Paul Markovich, president of Blue Shield of California, which is offering coverage under the plan, said that to keep prices low, doctors and hospitals had lowered some of their rates. Some insurers also agreed to limit profits, Lee said.

The policies vary in their provider networks, but Lee said consumers would have access to about 80 percent of doctors in the state, and some of its premier medical centers.

Consumers will be able to begin signing up on October 1 for plans that will go into effect in January. Next month, the California exchange will reveal plans and prices for insurance that small business owners can purchase for their employees.

Related:

• Health exchanges: Be ready to be overwhelmed
• Fewer than expected to be insured under health law
• Florida governor expands Medicaid

It sounded too good to be true and unfortunately it was.  Three research studies out Thursday severely diminish the hope that a cancer drug already on the market could be an Alzheimer’s treatment.

In February 2012 scientists at Case Western University Medical Center reported that a drug approved to treat skin cancer cured a mouse of a form of Alzheimer’s.  They reported the drug eliminated the plaque that is the hallmark of Alzheimer’s from the brains of the mice and that the mice seemed to recover from their memory and other cognitive problems.

The study, published in the journal Science, got doctors and patients alike excited.

If this were true it would have been a gigantic step.  Since the drug, Targretin, was already approved as a cancer treatment, doctors knew its safety profile and were free to prescribe it “off label” to treat any condition, including Alzheimer’s. 

Researchers quickly set up trials of the drug in people with Alzheimer’s. But some patients’ families did not want to wait for the human experiments.  They asked their doctors for prescriptions and in many cases, according to anecdotal reports, they got them.

But in this week’s edition of Science, three other teams of highly respected Alzheimer’s experts report they could not repeat the mouse results.

"It was hot stuff. It was the new miracle drug for Alzheimer's,’ said Sangram Sisodia, a professor of neuroscience at the University of Chicago.

Sisodia said he and fellow Alzheimer's colleagues, who included Dr. Rudolph Tanzi of Massachusetts General Hospital in Boston and Dr. David Holtzman of Washington University School of Medicine, wanted to see if they could replicate the stunning results in their own labs. Scientists don’t usually accept results as valid until they’ve been repeated several times.

It’s one of the main reasons researchers publish their findings – so that others can try them out and validate them.

The three labs failed to see any effects on Alzheimer's plaques in three strains of mice that were treated with Targretin.

"There is absolutely no reduction in amyloid levels in the brains of mice treated with this compound," Sisodia wrote in a technical comment in the journal Science. Teams at the University of Florida and researchers at the University of Leuven in Belgium published similar findings in the same journal.

"I was a fan of the original study," said Dr. Samuel Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York, who was not involved in any of the studies.

"It was very dramatic. It cut plaque loads by three-quarters over less than a week. No one had ever seen anything like it before."

Gandy has had several patients asking for the treatment, but he said the drug can damage the liver and requires very careful monitoring.

"I have universally declined and advised others to decline,” he told Reuters.

(Reuters contributed to this story)

Related:

• We saw Alzheimer's treatment as hope
• Brain pacemaker may slow Alzheimer's
• Alzheimer's numbers to triple by 2050

The H7N9 bird flu can spread from one mammal to another – meaning it could also spread person to person, an international team of researchers reported Thursday.

Researchers haven’t been exactly sure how H7N9 is spreading. They know it can infect people – it’s infected more than 130 people and killed more than 30 of them – but they have suspected most of the victims had some sort of contact with infected poultry.

The research team, led by Yi Guan of the University of Hong Kong, tried infecting ferrets – the animals closest to humans when it comes to catching flu.

The animals could infect one another by direct contact in cages. And one ferret kept in a separate cage was infected as well, they report in this week’s issue of the journal Science.

“Under appropriate conditions human-to-human transmission of the H7N9 virus may be possible,” they wrote.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, says he is not too worried by the findings. “We already know you can infect mammals,” said Fauci, who was not involved in the research.

“That is what influenza does. We know that. You are talking about a handful of ferrets. You can’t make major extrapolations.”

Officials are keeping a close eye on H7N9 because it has the potential to cause a human pandemic. So far, it doesn’t seem to infect people easily and people who are infected do not seem to spread it to others much, if at all. But influenza viruses change quickly and unpredictably and if one starts passing easily from one person to another, it could spread.

The experiment also showed that the ferrets could pass the infection before they started showing symptoms. Human flu does this too – that’s why it spreads so quickly and easily every year, because people are out and about, touching others, before they know they are sick.

“If this virus acquires the ability to efficiently transmit from human-to-human, extensive spread of this virus may be inevitable, as quarantine measures will lag behind its spread,” the researchers wrote in Science.

“Assuming that poultry is the source of the H7N9 virus, continued prevalence of this virus could lead to it becoming endemic in poultry as has occurred with the Asian highly pathogenic H5N1 and H9N2 virus lineages," they added. Endemic viruses are established and cause constant outbreaks.

"If so, the opportunities for the H7N9 virus to evolve to acquire human-to-human transmissibility, or to be introduced to pigs, would greatly increase. To prevent this happening, it may be advisable to reconsider the management of live poultry markets, especially in the urban areas.”

New H7N9 infections appear to have trailed off in China. World Health Organization officials say it might be because officials are closing poultry markets and cleaning them. Or it could be because it’s spring and influenza tends to die down in the spring.

Marc-Alain Widdowson of the U.S. Centers for Disease Control and Prevention says the virus doesn’t make poultry sick, so it could spread quietly and easily.

“One thing that we are particularly worried about is there is a tremendous amount of poultry that goes from China into Vietnam,” said Widdowson, who visited China with a CDC team to investigate the outbreak.

“One of the things we are looking at is ramping up surveillance in bird markers and in the population.”

People who buy an infected chicken won’t know, because H7N9 doesn’t make the birds sick they way H5N1 does, Widdowson says. “It worries me substantially,” he said.

“There’s absolutely no doubt it has got some very concerning mutations which suggest it may be adapting to human receptors. These make it closer to what we are all fearing, which is a virus that can spread sustainably humans to human and cause severe disease.”

Related:

Mystery illness in Alabama mostly colds and flu

H7N9 has cost billions

US safe so far from two new viruses

A cluster of mysterious respiratory illnesses that alarmed southeast Alabama turned out to be nothing more sinister than ordinary cold and seasonal flu, health officials said Thursday.

Lab tests by state and federal officials ruled out avian influenza and a novel coronavirus, now known as MERS, that has killed 22 people in the Middle East.

“There is no evidence of any new or unexpected virus circulating,” said Dr. Don Williamson, the Alabama state health officer, who said he wanted to put "closure to this cluster."

Seven people fell ill and two died earier this month in southeast Alabama after coming down with symptoms that included shortness of fever, shortness of breath and cough. All of the patients were adults ages 32 to 87. The people who died were 34 and 55, Williamson said.

Of the seven patients whose specimens were tested, six were found positive for influenza A or rhinovirus or a combination of the two and three patients were found to have bacterial pneumonia. 

“There wasn’t anything unusual or strange,” Williamson noted. He added that flu often continues to circulate in the spring and summer in his state.

Increased worries over the spread of two bird deadly flu viruses -- H5N3 and H7N9 -- and the identification of the new coronavirus likely contributed to the concerns about this cluster, he added.

“Because everybody is really worried about the possibility of either this novel coronavirus or the H7N9 flu from China, there was heightened awareness,” he said.”

He praised doctors and clinicians who raised questions about unusual respiratory illnesses because next time, it might be a new and deadly germ.

“If people aren’t attentive, we’re going to miss it,” Williamson said.

Related: 

• Mysterious respiratory illness strikes 7 in Ala.; 2 dead

In the most prominent challenge of its kind, Hobby Lobby Stores Inc. is asking a federal appeals court Thursday for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill.

The Oklahoma City-based arts-and-crafts chain argues that businesses — not just the currently exempted religious groups — should be allowed to seek exception from that part of the health law if it violates their religious beliefs.

"They ought to be able — just like a church, just like a charity — to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who will argue before the 10th Circuit Court of Appeals on behalf of the Green family, the founders of Hobby Lobby Stores Inc. and a sister company, Christian booksellers Mardel Inc.

The Greens contend that emergency contraception is tantamount to abortion because it can prevent a fertilized egg from implanting in the womb. They also object to providing coverage for certain kinds of intrauterine devices.

Lower courts have rejected Hobby Lobby's claim, saying that for-profit businesses aren't covered by an exemption added to the law for religious organizations. That exemption applies to churches themselves, but not to affiliated nonprofit corporations, like hospitals, that do not rely primarily on members of the faith as employees.

In a decision issued late last year, a federal judge concluded simply, "Hobby Lobby and Mardel are not religious organizations."

But U.S. District Judge Joe Heaton in Oklahoma City also wrote that "the court is not unsympathetic" to Hobby Lobby's dilemma and that the question of compelling employer health coverage for certain procedures "involves largely uncharted waters."

Other businesses in multiple states are challenging the contraception mandate, too. Hobby Lobby is the most prominent company making the claim, and it is the first to be heard by a federal appeals court. The U.S. Justice Department will argue for the government that the contraception mandate should stay.

The 10th Circuit opted to hear the case before all nine judges, not the typical three-judge panel, indicating the case's importance.

In December, the 10th Circuit denied Hobby Lobby's request for an injunction to prevent it being subject to fines while its argument was on appeal. The U.S. Supreme Court also denied an injunction, with Justice Sonia Sotomayor writing that it was not "indisputably clear" that Hobby Lobby needed immediate protection.

In response, the company restructured its health insurance, Duncan said. But Hobby Lobby, which is self-insured, will face fines by July 1 if it does not provide the coverage, he said.

Hobby Lobby calls itself a "biblically founded business" and is closed on Sundays. Founded in 1972, the company now operates more than 500 stores in 41 states and employs more than 13,000 full-time employees who are eligible for health insurance.

The Hobby Lobby case has attracted broad interest from health groups and religious groups. A panel including reproductive rights organizations and the American Public Health Association banded together last year to ask the court to reject Hobby Lobby's claim. The groups argued it would be dangerous precedent to allow for-profit private businesses to use religious beliefs to deny coverage.

In a brief to the court filed last year, the health groups argued that allowing businesses not to cover some contraceptives would be like allowing businesses to tell employees they can't use wages to buy morning-after pills or other products that offend the employer's religious belief.

"Of course, no one would argue that (Hobby Lobby owners) could seek, on religious grounds, to preclude their employees from spending their wages on contraception. This same rationale requires rejecting employers' demands to impose their religious views on employees through restrictions on the use of health insurance benefits," the health groups argued.

Susan Polan, associate executive director of the American Public Health Association, said the Hobby Lobby case is an important test of how far businesses can go in seeking to exempt coverage of health procedures they don't like.

"We're talking about women's access to reproductive health. That should be a decision between a patient and her health care provider, not a patient and her employer," Polan said this week.

By Tom Miles and Stephanie Nebehay 
Reuters

The World Health Organization (WHO) warned countries with possible cases of the SARS-like novel coronavirus on Thursday that they must share information and not allow commercial labs to profit from the virus, which has killed 22 people worldwide.

Saudi Arabia, where the first case occurred, has said the development of diagnostic tests for the disease has been delayed by a foreign laboratory's patent rights on the SARS-like virus.

"Making deals between scientists because they want to take IP (intellectual property), because they want to be the world's first to publish in scientific journals, these are issues we need to address," WHO Director General Margaret Chan told health ministers attending the WHO's annual conference in Geneva.

"No IP will stand in the way of public health actions."

The virus was identified in September last year, three months after a scientist took a sample from Saudi Arabia to the Erasmus Medical Center in the Netherlands.

"There was a lag of three months where we were not aware of the discovery of the virus," Saudi Arabia's Deputy Health Minister Ziad Memish told the Geneva meeting.

He said it was taken out of the country without permission and Saudi Arabia only learned of its discovery from ProMED, a U.S.-based internet-based reporting system.

The Rotterdam-based Erasmus lab then patented the process for synthesising the virus, meaning that anyone else who wanted to use their method to study it would have to pay the lab.

The patenting had delayed the development of diagnostic kits and serologic tests for the disease, Memish said.

"The virus was sent out of the country and it was patented, contracts were signed with vaccine companies and anti-viral drug companies and that's why they have a MTA (Material Transfer Agreement) to be signed by anybody who can utilise that virus and that should not happen."

Earlier on Thursday, Saudi Arabia announced another death from the virus in its central al-Qassim region, bringing the total number of deaths in the kingdom to 17.

Jordan, Qatar, Tunisia, the United Arab Emirates, France and Britain have all had cases of the the virus.

"Burning House"  

Chan told the health ministers "you are the boss" and urged them to ensure scientists shared their specimens with WHO's network of collaborating laboratories.

The patent does not break WHO rules on sharing such information on a possible pandemic, which only apply to flu viruses, but there is a legal requirement for countries to notify WHO of any outbreak of disease of international concern.

Keiji Fukuda, WHO's assistant director-general for health security, said there was still a "huge amount" unknown about the virus and great concern about its potential to spread.

Among the gaps in the knowledge of the virus was information about its geographical spread, and many countries may only have minimal surveillance for the disease, he said.

The only test for the disease is the widely-available PCR (Polymerase Chain Reaction), but that is only useful while the patient has the virus. Once they beat the disease a serology test would be needed, but none has yet been developed to detect infection in communities.

"We think contact isolation needs to be applied, because some patients present with diarrhoea or vomiting, which we think could be the source of the transmission," Memish said.

Asked if he thought Erasmus had acted wrongly, Fukuda told reporters the WHO was completely focused on detecting the disease and preventing it from spreading further.

"When you have a house burning, you look at how you put the fire out, what do you do, where do you get the water from," he said. "That's what we're worried about right now. Then later on you might look at the neighbourhood and the other issues." (Reporting by Tom Miles and Stephanie Nebehay; editing by Andrew Roche) 

Across the nation fewer and fewer teens are giving birth, especially Hispanic girls, according to a new government report.

Researchers from the Centers for Disease Control and Prevention found that from 2007 to 2011, the overall rate of teen births plummeted a full 30 percent. The biggest decline was among Hispanic teens, whose birth rate dropped 34 percent. Among non-Hispanic black teens there was a decline of 24 percent. Among white, non-Hispanic teens, the rate decreased by 20 percent.

“The thing that surprised me most was the big decline in rates for Hispanics: at least 40 percent in 22 states and the District of Columbia,” said Brady Hamilton, a report co-author and a statistician at the CDC’s National Center for Health Statistics. “That was pretty impressive. It really caught my eye.”

Hamilton suspects that public service messages are starting to resonate with teens. “Teen births are the focus of many public policies,” he said. “I think this shows the message is getting out.”

That makes sense to Dr. Carlos Lerner, medical director of the Children’s Health Center at the University of California, Los Angeles. “In settings like ours, we make sure we provide information in a culturally sensitive way in the patient’s own language,” he explained. “As we’ve learned to do that better, I think the message has been becoming more and more effective.”

The most important part of counseling teens may be finding a way to give the information in a non-judgmental way, Lerner said.

Higher rates of secondary and college education might also play a role in the declining birth rates in Hispanics, experts said.

Based on U.S. Census data, “it does look like both high school and college graduation rates are going up more quickly for Latina women in the 2007-2010 period than for the general population,” said Stefanie Mollborn, an associate professor of sociology at the University of Colorado Boulder. “That would be really interesting potential explanation, since education tends to be strongly related to postponing childbearing.”

The decline could also be related to the growing number of second generation Hispanics in the U.S., said Rogelio Sáenz, a sociologist and demographer and dean of the College of Public Policy at the University of Texas at San Antonio.

“From a separate analysis based on the American Community Survey (2007-2011), the drop in [births] among Latinos is slightly higher among native-born Latinas compared to foreign-born Latinas,” Sáenz said.

Another factor, Sáenz suggested, could be the increasing numbers of young Latino women who choose to remain single. That demographic change may also affect the long range birth rate among these women, he said.

As for the overall decline in the teen birth rate, that might be related to the economy, Mollborn said.

“The drop in the teen birth rate mirrors a fairly large drop in the overall U.S. birth rate - to women of all ages - during the same period,” she explained. “This coincides with the Great Recession. Many people are less likely to have children when they're experiencing economic troubles. Since most teen mothers are in or near poverty and come from disadvantaged backgrounds, it's not surprising that they would be especially likely to have fewer births during these difficult economic times.”

Related stories:

One in five teen births are repeats, CDC says

Teen birth rates plummet to record low

When a devastating tornado touched down in Moore, Okla., on Monday afternoon, Shayla Taylor was on the upper floor of the local hospital, in active labor with her second child.

As the floor shook “like an earthquake” beneath her and ceiling tiles and insulation fell overhead, the 25-year-old huddled with four nurses, braving both the peak contractions of childbirth and the wrath of the worst twister the veteran Oklahoman had ever endured.

“We were all just sitting there holding each other’s hands and praying,” Taylor told NBC News.

Norman Regional Health System

Jerome Taylor, left, Shayla Taylor, center, and Shaiden Taylor, right, welcomed baby Braeden Immanuel at the height of Monday's killer tornado in Moore, Okla.

Moore Medical Center, a 46-bed acute care hospital at 700 S. Telephone Road, took a direct hit from the F-5 tornado, with wind speeds that topped 200 miles per hour.

The blow devastated the hospital, as news photos plainly show, ripping away the roof and walls.

After the chaos, Taylor said she heard not the freight train sound described by so many witnesses, but the absolute silence of the storm’s center. Then she opened her eyes.

“All of a sudden I could see daylight and the wall was gone,” she said. “I look out and I see I-35 and part of the Warren theater,” which later became the triage center for victims of the tornado that killed 24 and injured more than 230 people.

Rick Wilking / Reuters

An aerial view of damage at the Moore Medical Center is shown in Moore, Okla., on May 21, after a tornado ravaged the suburb of Oklahoma City.

She had been dilated to 9 centimeters, nearly ready to deliver the baby, when nurses gave her a quick shot to slow labor during the height of the storm. 

Taylor was quickly reunited with her husband, Jerome Taylor, 29, who had taken their 4-year-old son, Shaiden, to wait out the tornado with others in the hospital cafeteria. With the help of hospital workers, she was carefully carried through the destroyed building and out to a waiting ambulance, which whisked her 5 miles to another hospital in the Norman Regional Health System.

Three hours later, after doctors determined that the petite Taylor would need a cesarean section due to the baby's size, she delivered Braeden Immanuel, a healthy 8-pound, 3-ounce boy.

“His middle name means ‘God is with us,’” said Taylor. “The name had been picked out for months. Now I know why.”

Taylor is among 30 patients and staffers at Moore Medical Center who survived the tornado, which destroyed the hospital, said Kelly Wells, a health system spokeswoman. No decision has been made yet about whether to rebuild or simply raze the site.

Two days after the storm, Taylor and her family are recovering from the trauma of the chaotic birth. The family can’t locate their car, a Toyota Camry, which had been parked in the hospital lot and is now nowhere to be found.

Sossy Dombourian / NBC News

Newborn Braeden Immanuel Taylor is fine after his harrowing birth, his mother says.

“I don’t know if it ended up inside the hospital or down the street,” she said.

Their home is safe, however, and Jerome Taylor, who works for The Hartford insurance company, has been overwhelmed trying to help his neighbors cope.

Oklahomans are used to tornado warnings and Taylor said she wasn’t particularly alarmed before Monday’s storm.

“I’m used to sirens,” she said. “If you panicked, you’d be in a constant panic.”

Now, however, she’s thinking twice about living in Tornado Alley.

“The tornadoes always track through here,” she said. “It’s not to say everybody’s going to pack and leave tomorrow, but they start to reconsider things.”

Related: 

• Post-tornado peril: Victims could face deadly fungal infections
• Tornado victims identified

CDC

The Mucor fungus was responsible for infections that sickened 13 patients, including five who died, after a 2011 tornado in Joplin, Mo. Health officials are urging Oklahoma doctors to be on the alert for similar infections after Monday's twister.

Doctors treating victims hurt badly in Monday’s devastating Moore, Okla., tornado should be alert for a rare but deadly complication of wind-whipped debris: fungal infections like those that killed five people after the Joplin, Mo., twister in 2011.

That’s the word from government experts in fungal infections, who documented 13 serious cases of necrotizing cutaneous mucormycosis -- terrible soft tissue infections -- after the Joplin tornado, including instances when visible mold started growing from the patients’ wounds.

“We want to encourage clinicians to be aware that these infections can happen,” said Dr. Benjamin Park, chief epidemiologist with the mycotic diseases branch at the Centers for Disease Control and Prevention.

It's not yet clear whether any fungal infections are suspected in the victims of this week's disaster. In Joplin, it took five days for the first infections to show up; within 10 days, 10 patients had been identified. 

"In the chaos of everything, it's very hard," said Dr. Gary Wells, medical director for the Norman Regional Health System emergency department, who was at the initial triage site during Monday's storm. "It is something you keep in the back of your mind."

Early detection and diagnosis are key to treating the infections, which occur when molds usually found in dirt, decaying wood and other matter become airborne during a heavy storm.  

“When they are picked up out of their natural environment and injected into the skin, we’re always concerned about infection,” Park said.

The molds can contaminate the wounds that occur after the blunt trauma, fractures and penetrating injuries common in tornadoes. The resulting infections can lead to serious illness and death. “The case fatality rate can be very high -- 50 percent,” Park noted.

The Joplin tornado struck at 5:34 p.m. on May 22, 2011, a monster of a storm rated EF-5, with winds exceeding 200 miles per hour on the Enhanced Fujita Scale used to measure tornadoes. More than 1,000 people were hurt and 162 died.

The Moore tornado was upgraded to an EF-5 late Tuesday. At least 24 deaths and 237 injuries have been reported. The injuries are typical of tornadoes: crush injuries, impalements and major cuts, according to NBC’s Dr. Nancy Snyderman, who spoke to trauma officials in Oklahoma.

Doctors and other health workers have been swamped caring for the victims, so it’s not clear what steps they’re taking to detect or treat potential fungal infections.

“I’m not sure that they’ve gotten that far yet,” said Pamela Williams, spokeswoman for the Oklahoma Department of Health.

The need for vigilance is clear, according to a 2012 review of the Joplin infections published in the New England Journal of Medicine. Skin-related Mucormycosis infections have been reported after other natural disasters, including a 1985 volcanic eruption in Colombia and after the 2004 Indian Ocean tsunami.

“The risk of complex wounds with foreign-body contamination during natural disasters is high, and wound management can pose considerable clinical challenge in post-disaster settings, especially when the local health care infrastructure has been damaged,” wrote authors from the CDC.

Related: 

• Joplin victims had rare fungus from dirt
• Okla. tornado injuries: Even the doctors are 'crying'
• Latest NBC coverage of the Oklahoma tornado

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.

featurepics.com

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.”

Related: 

• Good news about aging: Get older, feel better, study finds
• Doctor-assisted death: A dad's choice sheds light on a national issue
• 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

Newscom

A new study shows adding olive oil or nuts to that healthy diet can protect your brain.

It might seem against all logic, but adding a little olive oil or a handful of nuts to your diet each day may help keep your mind clear, researchers reported on Monday. It’s the same diet that’s also been shown to reduce deaths from heart attacks and strokes.

The researchers found that people who ate these healthy fats were less likely to show the early signs of  dementia than those who stuck to a more traditional diet.  And this was done in Spain -- where people are already eating a so-called Mediterranean diet.

“Our findings support increasing evidence on the protective effects of the Mediterranean Diet on cognitive function,” Miguel Martinez-Gonzalez of the University of Navarra in Spain and colleagues reported in the Journal of Neurology, Neurosurgery and Psychiatry.

The findings come from a large and well-publicized trial that showed the Mediterranean diet rich in fruits, vegetables, olive oil and a little wine can cut the risk of heart attacks and strokes by 30 percent. Martinez and colleagues took a part data on 500 volunteers from their own study center, who were followed for more than six and a half years after starting the diet.

A Mediterranean diet includes lots of salad, fruit, vegetables, nuts, a little fish, a little lean meat, a small amount of cheese and olive oil.  Wine is also served at meals. In the main study, 7,400 volunteers got extra counseling, and either a weekly supply of extra-virgin olive oil or mixed nuts -- walnuts, almonds and hazelnuts.

The volunteers, aged 55 to 80, were all at high risk of heart disease because of diabetes, a family history of the disease, high blood pressure, unhealthy cholesterol levels -- or they were overweight or smokers. They were randomly assigned to either add more extra-virgin olive oil to their daily diets, a daily handful of the mixed nuts, or just a standard diet with advice to cut fat.

Such “randomized” studies are considered more powerful, because people don’t choose which diet to adopt -- and so other outside factors don’t interfere with the results. For instance, people who choose to eat nuts might also dislike meat, or they might like sweets, or they might exercise more or less than people who don’t think much about eating nuts.

Six years after starting on the diet, the 500 Navarra volunteers took two standardized tests for dementia and the confused thinking, called cognitive impairment, that often leads to dementia.

The researchers found that 60 volunteers had developed mild cognitive impairment. Eighteen had been told to eat more olive oil, 19 had been on the diet with added mixed nuts and 23 of them had been advised to eat a low-fat diet. And 35 people developed dementia: 12 on the added olive oil diet; six who got nuts and 17 on the low-fat diet.

There are several ways that adding olive oil or nuts to the diet might protect the brain, the researchers said. Olive oil and nuts contain monounsaturated fats, which are better for artery health than the saturated fats found in butter, meat and lard. These foods are also high in fiber and vitamin E, as well as minerals. Walnuts are rich in omega-3 fatty acids.

The diet could reduce damaging inflammation, Martinez says. And some studies have suggested that virgin olive oil -- which is cold-pressed and unrefined -- might fight the beta amyloid "plaques" found clogging the brains of Alzheimer's patients. "A third mechanism may be that an improvement in vascular health leads to better brain blood flow," Martinez said by e-mail.

These nutrients protect against the oxidative damage that can cause heart disease, cancer and Alzheimer’s. Various studies have shown little benefit from taking vitamins alone, but this study shows the combination of the factors in a healthful diet does seem to have an effect.

Groups like the Alzheimer’s Association have been warning that the U.S. will have to cope with a tsunami of Alzheimer’s disease as the population ages, with projections that the number of patients with this untreatable form of dementia will triple in the next 40 years, to 13.8 million in 2050.

“Currently, there is no effective therapy to delay the onset or halt the progression of dementia,” the researchers noted.

Related:

• Tasty diet cuts heart disease
• Alzheimer’s rates accelerating
• Alzheimer's fastest-growing health threat
• Healthy diet may delay Alzheimer's