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.

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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

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

The dangers of texting while driving gets more headlines and drunk driving remains one of the main causes of automobile accidents, but a large, new study published Monday helps explain why so many teens and young adults are involved in motor accidents.

Indiana State Police/AP

Motor Carrier Inspector Master Trooper Mike Probasco, left, looks over the remains of a box truck with its driver Dagoberto Perez, of Cicero, Ill. in November 2010. Perez, who said he fell asleep and veered off the road, was cited for being a fatigued driver. Both drivers received non-life threatening injuries.

They're sleepy.

Report after report shows it -- sleepy drivers cause car crashes. In the new study, researchers at The George Institute for Global Health in Sydney, Australia suggest that a long-term lack of sleep may not only cause immediate drowsiness at the wheel, but may affect a young driver’s judgment over time.

“Less sleep per night significantly increased the risk for crash for young drivers,” the researchers wrote in the American Medical Association journal JAMA Pediatrics.

Alexandra Martiniuk and colleagues studied the driving records of more than 19,000 young men and women, aged 17 to 24, who had just received their driver’s licenses. These new drivers had filled out questionnaires that included specific details about how many hours sleep they got each night in the previous month.

Then the researchers went through police records on road crashes for the next two years after the drivers were licensed.

 “Those who reported sleeping six or fewer hours per night had an increased risk for crash compared with those who reported sleeping more than six hours,” they wrote. The people who slept the least were 21 percent more likely to have been involved in a crash than those who got more sleep, Martiniuk’s team found.

On the weekends, the risk rose even more. Those who got six hours or less sleep on the weekend were 55 percent more likely to be in a crash than those who slept more.

It’s a global problem affecting not only young drivers, they noted. “For drivers of all ages, estimates in the United States, United Kingdom, and Australia report that between 5 percent and 30 percent of crashes are attributed to fatigue,” the researchers noted. “Not only are they more likely to have sleep-related crashes; these crashes are more likely to be fatal compared with other crash causes.”

 The AAA Foundation published a survey last year that found one in seven licensed drivers ages 16-24 admits they had fallen sleep at least once while driving in the past year and that 10 percent of all drivers say they’ve dozed off at the wheel. The Centers for Disease Control and Prevention found that 5 percent of adults aged 18 to 44 admitted to nodding off at the wheel.

One in six crashes with a fatality was caused by a drowsy driver, according to the National Highway Traffic Safety Administration (NHTSA).

The NHTSA says sleepy driving is involved in 100,000 crashes serious enough to generate a police report each year. Such crashes have killed more than 1,500 Americans and injured 71,000.

Sabrina Birch was one of those victims. According to the Daily Oklahoman and other media reports, Birch, 17, was thrown out of the pickup truck when her boyfriend, Colby Ruthardt, also 17, fell asleep at the wheel and crashed last November.  The Gracemont, Okla. teen died from her injuries.

Martiniuk’s team found some suggestion that a lack of sleep may affect other behaviors, too.

“Risky driving, sensation seeking, self harm ... and greater drug and alcohol intake were reported more often by individuals who obtained less sleep,” they reported. It’s not clear whether a lack of sleep was a cause or a symptom, but they said the finding  points the way to doctors, parents and others trying to help.

They also noted direct measures that can help prevent crashes caused by sleepy drivers. “Changes to road design (eg, tactile road edges and divided highways), as well as education campaigns, may help reduce crash risk,” they wrote.

“Using a rest stop, drinking coffee, and playing the radio while driving have been shown to be significantly protective against crashes, at least in the short term,” they added.

Related:

• Automakers look to curb drowsy driving
• One in 24 admits to nodding off at the wheel
• The dangers of drowsy teen drivers

Cynthia Goldsmith / Maureen Metc / CDC

Novel MERS coronavirus particles as seen by negative stain electron microscopy.

Every virus needs a catchy name, and now the new coronavirus linked to the Middle East that has infected 40 people and killed half of them has one: Middle East Respiratory Syndrome Coronavirus or (MERS-CoV).

Various scientists have been calling it MERS, but the Coronavirus Study Group, which groups experts from around the world, made it official on Thursday.

“This name is endorsed by the discoverers of the virus and other researchers that pioneered MERS-CoV studies, by the World Health Organization and by the Saudi Ministry of Health. We strongly recommend the use of this name in scientific and other communications,” the group, led by Raoul de Groot of Utrecht University in the Netherlands, wrote in the Journal of Virology.

The issue of naming viruses can be touchy. Usually, countries don’t want their names associated with diseases, and often geographical regions don’t either. That’s why names such as the “Hong Kong flu” aren’t used any more -- now influenza viruses carry genetic names such as H1N1 or H7N9.

The MERS coronavirus is clearly linked to the Middle East, however. All patients have either been in, or have traveled to, Jordan, Qatar or Saudi Arabia -- or they have been infected by travelers from those countries. Cases have been seen in France, Germany and Britain.

Researchers worried about what to name SARS when it broke out in 2003. It was first seen in China, but the World Health Organization finally settled on the name severe acute respiratory syndrome, or SARS. At the time it was named, expert had not yet figured out precisely what type of virus it was.

The new MERS virus is a distant cousin of SARS. Coronaviruses are a big family and they usually cause common cold-like symptoms in people. MERS appears to have come from bats, de Groot’s group reports.

“The novel coronavirus seems most closely related to as yet unclassified viruses from insectivorous European and African bats in the Vespertilionidae and Nycteridae families, respectively,” they write.  It’s unlikely most patients were directly infected by bats, however, the Coronavirus Study Group said.  Bats have probably infected some other animal, which in turn is infecting humans, they said.

But the virus can transmit from person to person, especially in hospitals, and that worries health officials. SARS spread easily in hospitals when it flashed around the world, infecting close to 8,000 people and killing 775 of them, before it was stopped.

There’s no vaccine against MERS and antiviral drugs don’t appear to be of much use against it, either. The Centers for Disease Control and Prevention has told U.S. hospitals to take strict precautions if someone shows up with symptoms and has recently traveled to the Middle East. Health care workers in contact with such patients should wear special face masks, gloves and gowns and follow other protocols to protect themselves and other patients.

The World Health Organization says there are more questions than answers about MERS. “We know this virus has infected people since 2012, but we don't know where this virus lives,” WHO says in a statement on its website.

“We know that when people get infected, many of them develop severe pneumonia. What we don't know is how often people might develop mild disease. We also know that most of the persons who have been infected so far have been older men, often with other medical conditions. We are not sure why we are seeing this pattern and if it will change over time,” WHO added.

“The greatest global concern, however, is about the potential for this new virus to spread.”

Related:

• SARS-like virus spread to health workers
• Saudi Arabia confirms four new coronavirus cases
• New virus likely spreads person to person
• US safe so far from two new viruses

Getty Images via CDC

CDC's most comprehensive look yet at mental health shows ADHD affects close to 7 percent of US kids.

The most comprehensive report on specific mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in kids aged 3-17, with close to 7 percent of kids having a diagnosis.

Another 3.5 percent have behavioral problems, 3 percent have anxiety and 1.1 percent have autism. For teenagers, addiction to drugs, alcohol and tobacco are the most common issues, the Centers for Disease Control and Prevention reported on Thursday.

These percentages translate into millions of children, said CDC’s Ruth Perou, who put the study together. She found that 6.8 percent of U.S. children have ADHD. “That’s about 4.18 million children,” Perou told NBC News.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC director Dr. Tom Frieden said in a statement.

“No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

It adds up to a lot of kids. “It is estimated that 13 –20 percent of children living in the United States (up to 1 out of 5 children) experience a mental disorder in a given year and an estimated $247 billion is spent each year on childhood mental disorders,” the report reads.

The report takes data from many other surveys. The estimates on autism spectrum disorder might not be quite up to date. In March, CDC published a survey showing 2 percent of U.S. schoolkids – or about a million children – have been diagnosed with some sort of autism.

Thursday’s report was finished before that latest data came out, Perou said.

Behavioral disorders affect 2.1 million children, Perou says. “We are not looking at whether kids misbehave or are having a bad day,” she said. “What we are talking about is a child incapable of behaving well or playing well with others.”

Children with a diagnosed behavioral disorder, such as oppositional defiance disorder, have constant conflicts with authority that affect their ability to attend school. “They are having such challenges in how they are dealing with emotions or behavior that it impairs their ability to lead their day-to-day lives,” Perou said.

The survey confirms a lot of what experts already knew: autism, conduct disorders and ADHD are more common among boys; depression is more common among girls. More children were diagnosed as they got older.

The data on adolescents aged 12 to 17 show a million teenagers are drug or alcohol abusers, and more than 695,000 are addicted to tobacco. This doesn’t mean casual use or experimentation, but serious addiction, Perou said. “You are looking at something that is debilitating and really impairs their ability to function day to day,” she said.

The good news is that there are treatments for all the disorders, Perou said, and CDC is working to help come up with more approaches that work. “We can make a difference in their lives,” she said.

CDC has information for teachers and parents on spotting mental illness in kids.

The definitions for all the disorders come from the DSM-IV, the guide used by mental health professionals to diagnose and classify disease. A new version, the DSM-V, comes out Friday, and many of the changes have been widely leaked.

Thursday’s report will set a baseline, so that changes in classifying mental health issues that come from changes in the DSM-V can be tracked, Perou said.

Related:

• Psychiatrists face off over new DSM
• No more crazy cat ladies?
• Kids at risk of suicide can get guns
• Depressed kids earn less money later

Mario Tama / Getty Images

A lifeguard keeps watch on opening day of the McCarren Park Pool, June, 2012 in Brooklyn. CDC researchers found evidence of feces in many US pools.

People always worry about pee in the pool, but number two is the No. 1 problem, government health experts say. They found plenty of evidence that someone’s pooping in the pool.

It’s not only disgusting, but it’s evidence that people are not following basic hygiene rules, says Michele Hlavsa, chief of the Centers for Disease Control and Prevention’s Healthy Swimming Program.

“It is time to stop treating the swimming pool as a toilet,” Hlavsa told NBC News. “Nowhere else except for the pool is it acceptable to poop in public or pee in public. In other places if we did this in public, we’d be arrested.”

CDC and county health officials tested the pools in four Georgia counties last summer for the study. They got water out of the pool filters and ran tests for microbes – especially E. coli, which lives inside the bodies of animals and which is carried in feces. If E. coli is somewhere, it likely got there via feces.

“Escherichia coli, a fecal indicator, was detected in 93 (58 percent) samples; detection signifies that swim­mers introduced fecal material into pool water,” Hlavsa’s team wrote in CDC’s weekly report on disease and death.

“We don’t know how it got in there. It either washed off somebody’s body or somebody had a bowel movement in the pool,” Hlavsa said.

Regular bowel movements – what CDC delicately refers to as a “formed fecal incident” – isn’t so much a worry. But diarrhea is. Diarrhea carries the germs that caused the illness right into the water, and the chlorine doesn’t kill it instantly.

The good news is that there were no reports of sickness outbreaks at any of the pools tested last summer – or anywhere else in Georgia last summer, for that matter, Hlavsa says. But every year there are between 20 and 80 disease outbreaks associated with public pools – and those are just the ones that get reported, Hlavsa says.

The other piece of good news is that there weren’t too many other pathogens in the pools. Only one sample of Cryptosporidium, a common cause of diarrhea, showed up. Two samples of a parasite called Giardia were found – that one can cause a very uncomfortable stomach upset. Viruses such as adenovirus, which causes colds, and norovirus, which causes "stomach flu," can survive in swimming pools.

The E. coli in the pool didn’t necessarily come from a bowel movement, Hlavsa said -- and this is why it’s important to actually obey the signs that virtually everyone ignores about showering before going into the pool.

“The average person has about .14 grams of feces on their rear end,” Hlavsa said. “If that rinses off into the water, the amount from one person might not be that much. But as more and more swimmers introduce it that much, it does become an issue.”

She’s actually done the math.

“Let’s imagine 1,000 kids go to a water park. They have as much as 10 grams of feces on their rear ends,” she said.  “We are now talking about 10,000 grams or 10 kg. That translates to 24 pounds of poop in the water.”

So one important rule – never swallow the water from a swimming pool. “Basically, these pools are big bathtubs we all share together,” Hlavsa said.

She doesn’t want to scare anyone away from swimming, which is, after all, a great way to exercise. “As soon as the weather gets warm enough here in Atlanta, I plan to swim,” Hlavsa said.

Related:

• One in eight pools closed for filth
• Cruise ships see rise in norovirus outbreaks
• Colds nastier in summer

Nurse practitioners are staffing retail health clinics, diagnosing and treating ills from strep throat to conjunctivitis. They’re giving flu shots and prescribing drugs. And the influential Institute of Medicine says they should not only work side by side with physicians, but replace them in some cases.

But a survey published on Wednesday shows a huge gap between what nurse practitioners think they can and should do, and what doctors think. And that’s bad news for patients, Karen Donelan of the Mongan Institute for Health Policy at Massachusetts General Hospital says.

“We were surprised by the level of disagreement reported between these two groups of professionals," says Donelan, who led the survey published in the New England Journal of Medicine.

Her team’s survey of 467 nurse practitioners and 505 physicians found both groups agree that nurse practitioners should practice “to the full extent of their education and training.” Where the disconnect comes is just what this training should allow them to do, and how much they should get paid for it.

Only 17 percent pf physicians agreed that nurse practitioners should coordinate a patient’s care as a leader of a “medical home”, versus more than 82 percent of the nurse practioners, the survey found. And only 3.8 percent of doctors felt that a nurse practitioner should be paid the same for providing the same service as a physician, compared to 64 percent of the nurse-practitioners.

“At the core of the controversy is whether nurse practitioners have the education and experience to provide high-quality services and lead clinical practices without supervision by a physician,” Donelan’s team wrote.

The Institute of Medicine tried to settle that question in a 2010 report, saying that nurses can handle much of the strain on the health care system and should be given both the education and the authority to take on more medical duties.

But the American Medical Association, which represents about 120,000 practicing physicians and students, rejected the idea immediately.

"Nurses are critical to the health care team, but there is no substitute for education and training," the AMA said at the time.

The Association of American Medical Colleges estimates that by 2015, the United States will be short about 62,100 physicians. Many experts are looking to the 180,000 nurse practitioners now in the field to help cover the gaps.

When the Robert Wood Johnson Foundation set up a series of meetings among doctors’ and nurses’ guilds to try to smooth out the disagreements in 2011, things looked up until the organizers issued a report urging less hierarchy, says John Iglehart of the journal Health Affairs in a separate commentary in the New England Journal. “The `captain of the ship' notion  … needs to be eliminated, focusing on the patient as the driver of care,” the report read. “A physician, nurse, social worker or other provider may take the lead in a given situation.’

The American Academy of Family Physicians,  American Osteopathic Association and the American Academy of Pediatrics pulled out and the whole attempt collapsed, Iglehart says.

Dr. David Blumenthal and Melinda Abrams of the Commonwealth Fund said the survey confirmed that doctors and nurse practitioners often “inhabit different universes”.  And clearly they have different training and skills. Nurse practitioners, often referred to as advanced practice registered nurses, usually have a four-year bachelor's degree with at least a master's degree and sometimes a doctorate beyond that, depending on the requirements of their state.

But nurse practitioners can fill the growing gap in the supply of health care prviders for the U.S., they argued. “The existing literature shows that nurse practitioners provide care similar to that of physicians with respect to health outcomes, resource utilization, and cost, and the same studies show that nurse practitioners get higher grades than physicians with respect to communication with patients seeking urgent care,” they wrote.

Jan Towers, policy director for the American Association of Nurse Practitioners, saw it coming. “There is nothing surprising there,” she said in a telephone interview. “The disconnect has been there a long time.”

She thinks relationships will improve as doctors and nurse practitioners work together more. A bigger issue, Towers says, is the way the U.S. healthcare system pays for care. “How do we institute value-based purchasing so that we look at outcomes rather than who is performing the task?” she asked.

Once the medical system evolves toward taking care of a patient’s health, instead of the current system of paying for each individual test, treatment or consultation, the differences should even out, she predicts.

Donelan isn’t so hopeful. “Our findings suggest that a substantial number of primary care physicians are unlikely to embrace policy recommendations aimed at further expansion of the roles and supply of nurse practitioners,” her team wrote.

“In particular, physicians' concerns about the likely effect of an expanded workforce of nurse practitioners on several aspects of health care quality need to be addressed in discussions of strategy for the development of the U.S. health care workforce.”

Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University and a registered nurse with a Ph.D who worked on the survey team, agreed.

"It is unsettling that primary care physicians and nurse practitioners, who have been practicing together for several decades, seem so far apart in their perceptions of each other's contributions. I am concerned that these large gaps in perceptions will inhibit efforts to redesign care delivery and to improve the productivity and configuration of the primary care workforce,” Buerhaus said in a statement.

Related:

• Nurses need a more independent role, report argues
• Major doctor shortage coming
• Shortage of family doctors predicted by 2020

Oregon Health&Science University

Donor egg held by pipette prior to nuclear extraction.

Researchers say they have finally managed to use cloning technology to make human embryos and grow stem cells from them in the hopes of making perfectly matched grow-your-own tissue transplants.

They used a human egg cell and parts of a human skin cell to grow a very early human embryo, then transformed cells from this ball of cells into beating heart cells and skin cells. The process may eventually help treat a range of diseases, from Parkinson’s to rare inherited conditions, they reported Wednesday in the journal Cell.

The researchers, at Oregon Health & Science University, say their embryos almost certainly could not grow into living human babies or even start a pregnancy – they’re deficient in a key way. But they admit also that they haven’t quite overcome ethical qualms about working with human embryos.

However, the work opens another route to treatments using human embryonic stem cells, the body’s master cells. “These stem cells are kind of very early unprogrammed cells but they have the capacity to become any other cell type,” says Shoukhrat Mitalipov, who led the research.

These cells are very different from so-called adult stem cells, like those taken from bone marrow. Adult stem cells cannot give rise to cells of other tissue types -- blood cells cannot be used to make brain cells, for instance.

Dr. George Daley, a stem cell expert at Harvard Medical School, called it a "beautiful piece of work".

When human embryonic stem cells were first discovered in 1998, scientists immediately dreamed of using cloning technology to help people grow their own organ and tissue transplants, and to use them to study disease. They’d be perfect genetic matches for each patient, meaning an end to a lifetime of taking dangerous immune-suppressing drugs after an organ transplant.

But in the many years since, no lab’s been able to do the work easily. It seems it is much harder to clone a human being than it is to clone a sheep, a frog or a mouse. And then there are the ethical concerns, not only concerns about cloning human beings but over working with human embryos. A federal court has only just ruled in the past year that government funds may be used in the research.

Scientists have found several other routes to harnessing the power of these master cells, which can give rise to any tissue type in the body, from nerve cells to muscle, bone and skin. There are cells taken from embryos left over at fertility clinics – currently being tested as treatments for blindness by a company, Advanced Cell Technology of Massachusetts.

Oregon Health & Science University

Researchers at Oregon Health & Science University have successfully developed a method for converting human skin cells into embryonic stem cells.

Other groups have learned how to “trick” ordinary skin cells into re-modeling themselves into different tissues. These so-called induced pluripotent stem cells, iPS cells for short, might also some day be used to grow transplants perfectly matched to a patient. But again, the technique isn’t easy and there have been many stumbling blocks.

Several other scientists said the science was sound, but said the field had mostly moved on from the pursuit of cloning technology. "IPS cells are easier to produce and have wide applications in research and regenerative medicine, and it remains to be shown whether (cloned embryonic stem cells) have advantages over iPS cells," Daley said by e-mail.

Cloning almost got left in the dust with the work on the other techniques. But the team at OHSU had been perfecting the technique in monkeys, and now they’ve managed to make it work with human cells. The advantage, they say, is that the donated human egg provides fresh and rejuvenating DNA.

The technique they use is called somatic cell nuclear transfer – the same method used to make Dolly, the sheep who was the first mammal cloned from the cell of another adult mammal, in 1996. Scientists remove the nucleus from a normal cell, usually a type of skin cell. They do the same with a human egg cell, then inject the nucleus from the skin cell into the egg.

Various chemical or electrical tricks can be used to start the egg growing as if it had been fertilized by sperm. The method’s been used to make sheep, dogs, horses, and mice – but never human beings.

None of these clones are precise copies because the egg contains an important source of DNA, called mitochondrial DNA. And defects in this DNA cause many diseases, including diabetes and a condition called Leigh syndrome, which causes seizures and dementia.

Mitalipov hopes that replacing the mitochondrial DNA as part of the cloning process might help make tissue that could correct these diseases. His team tested cells taken from a patient with Leigh syndrome, a neurological disorder, and made stem cells using the technique.

“It allows you to produce genetically corrected cells,” he said. “There are a variety of age-related diseases that we believe are caused by acquired mitochondrial mutations.”

Lots of testing lies ahead and because of laws banning the use of federal money to directly make human embryos, Mitalipov’s lab uses private funds instead. But he believes the method cannot be used to make human babies.

“We have been doing it for years in primates and the embryos never implant,” he said. The blastocysts appear to lack a key layer of cells, he said, that give rise to the placenta and that are needed for a normal pregnancy.

Nonetheless, he admits that is unlikely to reassure people who object to experimenting on human embryos. “They’ll say ‘oh, you are just creating a disabled embryo’,” he said.

O. Carter Snead, a bioethicist and professor of law at the University of Notre Dame, called it sad news. “The use and destruction of living human beings – at any stage of biological development – for scientific research is a terrible injustice.  Human cloning for biomedical research is a particularly aggravated form of this harm," Snead said in a statement.

Another barrier --- human eggs are not easy to come by and there are also ethical questions about whether women should be paid to donate their eggs for this kind of research.

The work will almost certainly be used to study diseases in lab dishes at first. But Daley, who heads the bone marrow transplant program at Boston Children's Hospital, said using a patient's own cells offers potentially huge advantages. "A lot of patients don't have an optimal donor," he said. So bone marrow transplants are done only for the patients in the most dire need.

"If we could make every patient their own donor ... we would bypass the transplant barrier," he said. "Everyone could be a donor for themselves."

Related:

• Ethicist: Cloning offers more cause for excitement, not concern
• Supreme Court lets embryonic stem cell research go forward
• Court rules on controversial human research
• Stephen Hawking visits stem cell lab

An unusual medical brawl erupted on Tuesday when the influential Institute of Medicine issued a report questioning the basis of years of advice for Americans to cut their salt intake in half.

The Institute, which advises the federal government on medical issues, concluded that the studies have answered the question poorly.  A panel of experts looked at studies showing the medical effects of eating too much salt, as well as at studies that have been used to suggest that some people may suffer form eating too little salt.

Its finding: There’s enough evidence to support advising Americans to keep sodium to 2,300 milligrams a day or less, but there’s not enough to support the current, lower target of 1,500 milligrams a day.

“There is evidence to lower excessive salt intake,” Dr. Brian Strom, a professor of medicine, epidemiology and biostatistics at the University of Pennsylvania, who chaired the panel, told reporters.

There is also good evidence that lowering intake to around 2,300 milligrams a day decreased the risk of heart disease,” Strom said. But he said that the evidence was absent to support recommendations of taking it as low as 1,500 milligrams a day. And, he said, there were some studies suggesting this could harm some people -- although those studies are also flawed.

This infuriated the American Heart Association.

“While the American Heart Association commends the IOM for taking on the challenging topic of sodium consumption, we disagree with key conclusions,” Heart Association CEO Nancy Brown said in a statement.

“The report is missing a critical component -- a comprehensive review of well-established evidence which links too much sodium to high blood pressure and heart disease.”

The Institute agrees that Americans eat far too much salt -- more than 3,400 milligrams a day on average. Most is “hidden” salt, in processed foods such as bread and cereal, restaurant meals and especially fast food.

And studies clearly show that salt raises blood pressure and that cutting salt can lower blood pressure. High blood pressure damages blood vessels and can lead to stroke, kidney failure and heart failure.

“We knew about all this data and it didn’t change our thinking,” said Dr. Elliott Antman of Brigham and Women’s Hospital and Harvard  Medical School . “We have to take the evidence that we have -- which is strong,” added Antman, a spokesman for the American Heart Association.

Several studies have suggested that about a quarter of Americans are salt-sensitive -- that their blood pressure is directly and immediately affected by how much salt they eat. But this doesn’t mean that the other 75 percent can pile on the salt with impunity, Antman said.

“About 90 percent of the population will ultimately develop hypertension as they age,” he said. “Part of this is almost certainly from years of eating too much salt, he added. Eating too much salt can also affect kidney function, he said.

“An aggressive reduction in sodium is the way to go,” he said.

Strom would not be drawn into an argument. “What we are saying is the available data is not consistent on outcomes,” he said. “We are not saying that one shouldn’t be lowering excessive salt intake in the general population,” he added.  “There is simply a lack of data showing it is beneficial.”

And, he said, it is not up to the panel to set a target. “It’s not that we are against (a target intake of) 1,500 milligrams,” he said. “The data are not consistent.”

The trouble with trying to measure salt intake is that it’s very hard to separate out salt from the rest of the  ingredients in food, said Antman.

A truly scientifically rigorous study would randomly assign people to eat diffferent amounts of salt daily and watch to see what kind of diseases they develop -- something that would be difficult to set up, police and also difficult to defend, ethically.

Antman says most Americans get their salt from prepared foods and from restaurants, not from at-home, scratch cooking. What’s needed, he said, is more encouragement for restaurants and food companies to lower sodium content of food.

The food industry argues that Americans have a taste for salt and they won’t buy products that are salt-free.  Antman agrees that it’s hard.  “We are used to a high sodium content in our food,” he said.

“But the data say that in just two to three weeks you can train person’s taste buds to become accustomed to a lower sodium content in food.”

The Center for Science in the Public Interest piled on, too.

"What the committee failed to emphasize is that most Americans are deep in the red zone, consuming 3,500 to 4,000 milligrams of sodium a day,' the group, which publicizes calorie counts and other food risks, said in a statement.

"It's clear that those excessive levels increase the risk of high blood pressure, heart attacks, and strokes. Whether we aim for 2,300 or 1,500 milligrams a day is irrelevant until we move down out of the red zone. At restaurants, you can get roughly 2,000 milligrams of sodium from just one burrito, a single-serve pizza, or an order of kung pao chicken, and at least 1,000 milligrams from a typical sandwich or burger."

The Centers for Disease Control and Prevention has a widget on salt intake here.

Related:

• Too much salt may trigger autoimmune disease
• US advises Americans to eat less salt
• Most teens well down the road to heart disease

The Obama administration filed its expected appeal on Monday of a judge's order to make the so-called "morning-after pill" available to anyone, without a prescription.

The federal government asked the 2nd U.S. Circuit Court of Appeals in New York to postpone federal judge Edward Korman’s ruling against the Health and Human Services Department’s requirement that anyone under 17 get a prescription for the emergency contraception.

Korman refused on Friday to stay his ruling while the appeals court considered the appeal, calling the government’s legal attempts “frivolous” and saying they were done in bad faith.

Women’s health groups had sued against the HHS decision, which had overruled the Food and Drug Administration’s original approval of Plan B birth control pills for women and girls of all ages. HHS Secretary Kathleen Sebelius had said she wasn’t comfortable seeing the pills freely available to girls as young as 11.

The FDA, which had protected against Sebelius’s decision, last month approved another drug application to make one brand available over the counter to girls as young as 15, but still requiring proof of age.

Korman railed against both decisions and has accused the government of simply trying to delay the inevitable.

For now, things are a bit confusing. The appeal, technically filed by the Food and Drug Administration, asks the appeals court to stop Korman's ruling from taking effect until the case is settled.

Teva Pharmaceutical’s single-pill option, called Plan B One-Step, is available with ID to anyone 15 and older. Anyone younger needs a prescription to get it.

Other versions of the medication are available to anyone 17 and older with proof of age, and to anyone younger with a prescription.

"You have to show an ID either way," said Judy Waxman of the National Women's Law Center. Waxman  predicts the appeals court will stay Korman's decision until a hearing can be scheduled on the appeal. "This could take months again until we get the Second Circuit decision," Waxman said in a telephone interview.

Related:

Judge refuses to delay Plan B ruling, has choice words for HHS

Judge: Make 'morning-after pill' available to all girls without prescription

West Nile virus killed 286 people in the United States last year, making it the deadliest year yet for the virus, the federal government reported on Monday.

Texas was especially hard hit by the virus, which is carried by mosquitoes and which only arrived in the United States in 1999, the Centers for Disease Control and Prevention reports.

“A total of 5,674 cases of West Nile virus disease in people, including 286 deaths, were reported to CDC from 48 states (excluding Alaska and Hawaii),” the CDC said in a statement.

West Nile virus is widespread in Africa, Asia and parts of Europe. It causes fever and aches and usually isn’t serious.  But in some people it can spread to the brain or spinal cord, killing them or causing paralysis.

No one’s sure precisely how West Nile arrived in North America, but it was first reported in New York in 1999. It’s now been reported in all 48 contiguous states, as well as parts of Canada and Mexico and all the way to Argentina.

The CDC's Dr. Lyle Petersen says it's impossible to know what West Nile will do this summer. "It is very hard to predict," he said in a telephone interview. "I can't tell you what the weather is going to be like this summer, for example." The virus is driven by weather; it's worse during hot, wet summers in temperate climates.

"What last summer's outbreak tells us is that West Nile is not going to go away," Petersen said. "Most places in the United States are at risk of having outbreaks."

The virus has a life cycle that takes it from mosquitoes to birds and back into mosquitoes that bite people. Its severity varies from year to year. In some years, only a few cases are reported, and in others, like 2012, it infects many people.

In 2011, CDC reported 712 cases of West Nile virus, and 43 deaths. The worst previous year was 2003, when 9,862 cases were reported with 264 deaths. Only severe cases are reported to CDC -- health experts say most people who are infected don’t even know it. People over 50 and people with underlying illnesses are the most vulnerable.

“Last summer’s outbreak likely resulted from many factors, including higher-than-normal temperatures that influenced mosquito and bird abundance, the replication of the virus in its host mosquitoes, and interactions of birds and mosquitoes in hard-hit areas,” the CDC said in a statement.

“Because the factors that lead to West Nile virus disease outbreaks are complex, CDC cannot predict where and when they will occur."

There’s no vaccine against West Nile virus for people, but there is one for horses. There’s also no specific antiviral drug that can help infected people -- those who are seriously ill get what’s called supportive treatment in the hospital.

The CDC recommends that people avoid being bitten by mosquitoes, which can carry other diseases, also, from Eastern equine encephalitis to, in very rare cases, dengue fever. Standing water, even in extremely small containers, can breed mosquitoes. People should wear long sleeves and use insect repellent that contains DEET, picaridin, IR3535, and para-menthane-diol (PMD), CDC advises.

Petersen says scientists don't quite understand why, but West Nile tends to cause more human outbreaks in temperate climates than in tropical zones. Female mosquitoes carry the infection over from one summer to another, he said. "Infected female mosquitoes find a warm place to live and they just hang out all winter," he said. They often overwinter in sewers or basements, he said.

"These infected mosquitoes come out in the spring and then they look for a blood meal and they bite birds and infect birds. During spring and summer you get more and more infected mosquitoes and birds," Petersen added.

"By the middle of summer there are so many infected mosquitoes that it starts to present a human infection risk."

And because the virus can live in both mosquitoes and birds, it would be much more difficult to eradicate than malaria, which mostly infects people, Petersen said. The CDC helped eradicate malaria in the United States in 1951.

Related:

• Is spraying for West Nile safe?
• Don't expect hurricane effect from West Nile