Culture

A case of pink eye is now reason to be tested for COVID-19, according to University of Alberta researchers.

Coughing, fever and difficulty breathing are common symptoms of the illness, but a recent case study involving an Edmonton woman and published in the Canadian Journal of Ophthalmology has determined that conjunctivitis and keratoconjunctivitis can also be primary symptoms.

In March, a 29-year-old woman arrived at the Royal Alexandra Hospital's Eye Institute of Alberta with a severe case of conjunctivitis and minimal respiratory symptoms. After the patient had undergone several days of treatment with little improvement--and after it had been determined that the woman had recently returned home from Asia--a resident ordered a COVID-19 test. The test came back positive.

"What is interesting in this case, and perhaps very different to how it had been recognized at that specific time, was that the main presentation of the illness was not a respiratory symptom. It was the eye," said Carlos Solarte, an assistant professor of ophthalmology at the U of A.

"There was no fever and no cough, so we weren't led to suspect COVID-19 at the beginning. We didn't know it could present primarily with the eye and not with the lungs."

According to Solarte, academic studies at the outset of the pandemic identified conjunctivitis as a secondary symptom in about 10 to 15 per cent of COVID-19 cases. Since then, scientists have gained greater knowledge of how the virus can transmit through and affect the body's mucous membrane system, of which the conjunctiva--the clear, thin membrane that covers the front surface of the eye--is an extension.

While the finding provides important new health information for the public, it also makes eye exams more complicated for ophthalmologists and staff.

"The patient in this case eventually recovered well without any issues. But several of the residents and staff who were in close contact with the patient had to be under quarantine," said Solarte. "Fortunately, none who were involved in her care also tested positive."

Patients coming into an eye clinic with conjunctivitis and keratoconjunctivitis are now treated as potential cases of COVID-19 and extra precautions are taken by staff. Workers performing an eye exam are strongly advised to wear personal protective equipment to minimize potential exposure to the illness.

"It's important to ensure that everyone is well protected. Our residents are now using gloves, gowns and facial masks every time they see one of these patients," said Solarte. "We need to be really careful about protective measures to examine these patients."

Over the past few decades, computers have seen dramatic progress in processing power; however, even the most advanced computers are relatively rudimentary in comparison with the complexities and capabilities of the human brain.

Researchers at the U.S. Army Combat Capabilities Development Command's Army Research Laboratory say this may be changing as they endeavor to design computers inspired by the human brain's neural structure.

As part of a collaboration with Lehigh University, Army researchers have identified a design strategy for the development of neuromorphic materials.

"Neuromorphic materials is a name given to the material categories or combination of materials that provide both computing and memory capabilities in devices," said Dr. Sina Najmaei, a research scientist and electrical engineer with the laboratory.

Najmaei and his colleagues published a paper, Dynamically reconfigurable electronic and phononic properties in intercalated Hafnium Disulfide (HfS2), in the May 2020 issue of Materials Today.

The neuromorphic computing concept is an in-memory solution that promises orders of magnitude reductions in power consumption over conventional transistors, and is suitable for complex data classification and processing. The limited power efficiency in conventional transistors is a fundamental technology shortcoming impeding future progress in computing.

Neuromorphic materials research conducted over the past 10 years has focused on understanding the unique properties of 2-D materials and their van der Waals multilayered structures.

"The findings show great promise for these materials in electronic applications, but also show the unique interfaces in these materials provide an unprecedented opportunity for design of material properties," Najmaei said.

Over the past four years, the team conducted an effort focused on the design of material properties for high-performance electronic applications.

"Our research led to our Materials Today paper, which expands this effort to design of reconfigurable properties in these materials based on van der Waal/organometallic hybrid systems and neuromorphic material design," Najmaei said.

Neuromorphic computing processes information using new models of computing similar to the brain's cognitive processes.

"In order to process and make rational inferences from the input, information and a new paradigm of computing is needed," Najmaei said. "Neuromorphic hardware with in-memory computer capabilities promises to bridge this ever-growing technology gap."

This research is an important stepping stone towards development of in-memory computing in hybrid devices with unique functional properties for integration in cognitive sensory devices and overcomes significant technical challenges that impede a bottom up approach for streamlining of brain-inspired computing hardware, he said.

If the researchers can ultimately develop a computer that can behave like the brain, it would be extremely useful to the warfighter, Najmaei said.

Neuromorphic computing, like a neural system, would offer computing capability complete with perks, such as robustness to damage, ability to learn, adaptability to change and others. It would have the potential to reduce operational power by a magnitude of 1,000 to 1 million times in comparison to today's computing paradigms.

This level of processing would be highly desirable for image recognition in autonomous systems, and for artificial intelligence in general. Given the significance of AI and autonomous systems in modern day warfare, neuromorphic computing may very well be a cornerstone for a wide range of future leap-ahead warfighting capabilities, Najmaei said.

Plant experts at UC Davis have defined the genetic basis of sex determination in grapevines, one of the oldest and most valuable crops worldwide.

In new research published in the journal Nature Communications, viticulture and enology professor Dario Cantu and Mélanie Massonnet, lead author and postdoctoral researcher in Cantu's lab, propose a novel model of sex evolution before and during grapevine domestication nearly 8,000 years ago. Their work could have broad application in breeding grapes and other plant species.

All wild species of grapes (genus Vitus) are dioecious, which means that male and female flowers are located on separate plants. Male individuals bear flowers with reduced pistils and female vines have flowers with reflexed anthers and stamens that produce sterile pollen grains.

Just one Vitis species, the cultivated grapevine Vitis vinifera ssp. vinifera, has reverted to hermaphroditism, leading to the advent of vines bearing perfect flowers with both functional pistils and stamens.

"It has always been a major challenge to identify the genes and mutations that lead to plant sexual differentiation," Cantu noted. "We show how the pivotal domestication trait of hermaphroditic flowers in grapevine is likely determined by the action of two separate genes contained within a sex-linked locus."

Comparing sex determination genes in wild and domestic grapes

To unveil the molecular mechanisms associated with sex determination, researchers constructed the genomes of two female and three male wild grapes, and five hermaphroditic domesticated accessions, including the chromosome-scale genome of Cabernet Sauvignon (the most widely planted wine grape cultivar in the world). They compared the structure of the sex determination locus, its sequence and genes between male, female and hermaphrodite individuals.

"The unprecedented amount of data generated here supports a model for sex determination in which recessive male- and dominant female-sterility mutations in ancestral hermaphrodite individuals gave rise to dioecious extant wild species, and a rare recombination event during domestication that led to hermaphroditism in cultivated grapevines," Cantu said. "From our findings, we propose that female individuals arise from a recessive deletion in a gene necessary for pollen germination, while male vines emerge from a dominant mutation in a second gene, resulting in female sterility."

The findings and the methods applied are particularly valuable for grape breeding efforts and to advance the understanding of sex determination in grapes and other plant species.

As nuclear fusion engines, most stars live placid lives for hundreds of millions to billions of years. But near the end of their lives they can turn into crazy whirligigs, puffing off shells and jets of hot gas. Astronomers have employed Hubble's full range of imaging capabilities to dissect such crazy fireworks happening in two nearby young planetary nebulas. NGC 6302 is dubbed the Butterfly Nebula because of its wing-like appearance. In addition, NGC 7027 resembles a jewel bug, an insect with a brilliantly colorful metallic shell.

The researchers have found unprecedented levels of complexity and rapid changes in jets and gas bubbles blasting off of the stars at the centers of both nebulas. Hubble is allowing the researchers to converge on an understanding of the mechanisms underlying the chaos.

"When I looked in the Hubble archive and realized no one had observed these nebulas with Hubble's Wide Field Camera 3 across its full wavelength range, I was floored," said Joel Kastner of Rochester Institute of Technology, Rochester, New York, leader of the new study. "These new multi-wavelength Hubble observations provide the most comprehensive view to date of both of these spectacular nebulas. As I was downloading the resulting images, I felt like a kid in a candy store."

By examining this pair of nebulas with Hubble's full, panchromatic capabilities -- making observations in near-ultraviolet to near-infrared light -- the team has had several "aha" moments. In particular, the new Hubble images reveal in vivid detail how both nebulas are splitting themselves apart on extremely short timescales -- allowing astronomers to see changes over the past couple decades. Some of this rapid change may be indirect evidence of one star merging with its companion star.

"The nebula NGC 7027 shows emission at an incredibly large number of different wavelengths, each of which highlights not only a specific chemical element in the nebula, but also the significant, ongoing changes in its structure," said Kastner. The research team also observed the Butterfly Nebula, which is a counterpart to the "jewel bug" nebula: Both are among the dustiest planetary nebulas known and both also contain unusually large masses of gas because they are so newly formed. This makes them a very interesting pair to study in parallel, say researchers.

Hubble's broad multi-wavelength views of each nebula are helping the researchers to trace the nebulas' histories of shock waves. Such shocks typically are generated when fresh, fast stellar winds slam into and sweep up more slowly expanding gas and dust ejected by the star in its recent past, generating bubble-like cavities with well-defined walls.

Researchers suspect that at the hearts of both nebulas are -- or were -- two stars circling around each other, like a pair of figure skaters. Evidence for such a central "dynamic duo" comes from the bizarre shapes of these nebulas. Each has a pinched, dusty waist and polar lobes or outflows, as well as other, more complex symmetrical patterns.

A leading theory for the generation of such structures in planetary nebulas is that the mass-losing star is one of two stars in a binary system. The two stars orbit one another closely enough that they eventually interact, producing a gas disk around one or both stars. The disk is the source of outflowing material directed in opposite directions from the central star.

Similarly, the smaller star of the pair may merge with its bloated, more rapidly evolving stellar companion. This also can create outflowing jets of material that may wobble over time. This creates a symmetric pattern, perhaps like the one that gives NGC 6302 its "butterfly" nickname. Such outflows are commonly seen in planetary nebulas.

"The suspected companion stars in NGC 6302 and NGC 7027 haven't been directly detected because they are next to, or perhaps have already been swallowed by, larger red giant stars, a type of star that is hundreds to thousands of times brighter than the Sun," said team member Bruce Balick of the University of Washington in Seattle. "The hypothesis of merging stars seems the best and simplest explanation for the features seen in the most active and symmetric planetary nebulas. It's a powerful unifying concept, so far without rival."

The Butterfly Nebula

Imagine a lawn sprinkler spinning wildly, tossing out two S-shaped streams. At first it appears chaotic, but if you stare for a while, you can trace its patterns. The same S-shape is present in the Butterfly Nebula, except in this case it is not water in the air, but gas blown out at high speed by a star. And the "S" only appears when captured by the Hubble camera filter that records near-infrared emission from singly ionized iron atoms.

"The S-shape in the iron emission from the Butterfly Nebula is a real eye-opener," Kastner said. The S-shape directly traces the most recent ejections from the central region, since the collisions within the nebula are particularly violent in these specific regions of NGC 6302. "This iron emission is a sensitive tracer of energetic collisions between slower winds and fast winds from the stars," Balick explained. "It's commonly observed in supernova remnants and active galactic nuclei, and outflowing jets from newborn stars, but is very rarely seen in planetary nebulas."

"The fact that the iron emission is only showing up along these opposing, off-center directions implies that the source of the fast flows is wobbling over time, like a spinning top that's about to fall," added Kastner. "That's another tell-tale sign of the presence of a disk, which directs the flow, and also a binary companion."

The 'Jewel Bug' Nebula

The planetary nebula NGC 7027 had been slowly puffing away its mass in quiet, spherically symmetric or perhaps spiral patterns for centuries -- until relatively recently. "In some respects, the changes within this nebula are even more dramatic than those within the Butterfly," Kastner said. "Something recently went haywire at the very center, producing a new cloverleaf pattern, with bullets of material shooting out in specific directions."

The research team's new images of NGC 7027 show emission from singly ionized iron that closely resembles observations made by NASA's Chandra X-ray Observatory in 2000 and 2014 as part of earlier research by Kastner, team member Rodolfo Montez Jr. of the Center for Astrophysics | Harvard & Smithsonian, and collaborators. The iron emission traces the southeast-to-northwest-oriented outflows that also produce the X-ray-emitting shocks imaged by Chandra. "We have a sneaking suspicion that this nebula is a great example of what happens when a red giant star abruptly swallows a companion," Montez Jr. said.

Sports leagues may want to consider calling a timeout on reopening their doors to fans, based on new West Virginia University-led research that links an uptick in seasonal flu deaths to U.S. cities with pro sports teams.

Analyzing Centers for Disease Control and Prevention data from 1962 to 2016, WVU economists found that flu deaths increased by between 5 and 24 percent during the NFL, NBA, NHL and MLB seasons, with the largest increase for NHL games.

Given that COVID-19 is believed to be more contagious and deadlier, Economics Professor Brad Humphreys has a message for sports leagues until a vaccine is available or herd immunity exists: "Don't let the fans back into the games."

"Opening pro sports games to fans is probably a terrible idea, in terms of public health," said Humphreys, one of the authors of the paper "Professional Sporting Events Increase Seasonal Influenza Mortality in U.S. Cities." "You're right on top of people and everybody's yelling, screaming, high-fiving and hugging. And you've got people eating and drinking. You could be putting the virus right into your mouth. The bottom line is we need to be very careful if we're considering opening up games to the fans."

Humphreys' WVU co-authors include Jane Ruseski, associate professor of economics, and Alexander Cardazzi, a Ph.D. student.

Researchers examined cities that introduced a new sport franchise from the big four leagues over the 54-year timeframe. Welcoming new teams in all leagues led to an increase in flu mortality, according to the report.

"We found data that reported flu mortality by city by week dating back to the 1960s," Humphreys said. "We decided the best experiment was to try to look at what happened when a city got a new pro sports team compared to cities that didn't. As it turned out, after a new professional sports team came into a city, that flu season and every flu season afterward had more people dying of the flu.

"It isn't one or two people dying. This is closer to 30 or 40 additional flu deaths over the course of flu season. When you blow it up to a virus that's more fatal like COVID-19, we could be talking about hundreds of additional deaths because of these games."

The study also showed a decline in flu deaths in U.S. cities during season stoppages. That means cities reported fewer flu deaths during the 2011 NBA lockout and the 1982 NFL strike.

Research began in March when organizations, such as the NBA, suspended play due to the COVID-19 outbreak in the U.S. Humphreys was further intrigued after reading about a soccer game in Italy that was believed to have been a catalyst in spiking that country's positive cases.

On Feb. 19, the day of a soccer match between Atalanta and Valencia, there were only three confirmed cases in the country of Italy. Two weeks later, that number jumped to 997 - just in Bergamo, northeast of Milan and home to the Atalanta team.

"At the time, they had the highest death rate anywhere in the world," Humphreys said. "That game served as a super-spreader event."

The NBA and NHL both plan to resume their seasons this summer, but without fans in attendance. In fact, NBA players will have the option of wearing an Oura smart ring that detects early signs of the novel coronavirus - which is part of research from the WVU Rockefeller Neuroscience Institute.

Details of the upcoming MLB and NFL seasons remain uncertain.

The economists hope this timely research will not only help inform sports league reopening policy decisions, but mass gatherings in general such as concerts, conferences and conventions.

"You'll have some people say, 'Oh, but everybody can wear a mask,'" Humphreys said. "But you've seen how people are complying with that, right? And if these arenas are at full capacity, social distancing isn't happening."

A COVID-19 model formerly used by the White House projects that more than 200,000 American could die from the virus by October. As of late Wednesday, 119,000 people have died of the novel coronavirus in the U.S., with a total of 2.2 million positive cases.

"Our results reveal that bringing fans back to games would be a huge mistake," Humphreys said. "Imagine someone going to a game and sitting in the stands and then they go see grandma at the nursing home. Let's wait til we have a vaccine or reach herd immunity."

DURHAM, N.C. -- A single press release naming a company that has violated workplace health and safety regulations can result in a 73 percent improvement in compliance by other facilities, a Duke researcher finds.

The study appears in the June issue of American Economic Review.

Beginning in 2009, the federal Occupational Health and Safety Administration (OSHA) sent press releases to the local newspaper near a facility, detailing serious health and safety violations found during an inspection.

The study found that after one of these press releases was sent to the local newspaper, compliance by other nearby facilities improved more than if OSHA had inspected each of those facilities directly.

"OSHA would have to conduct an additional 210 inspections to elicit the same improvement in compliance as sparked by a single press release about severe violations," said researcher Matthew S. Johnson, assistant professor at Duke's Sanford School of Public Policy.

Workplace injuries cost an estimated $250 billion each year. There were 3.7 million work-related injuries and illnesses in 2015. Concerns about worker safety and health have become especially pronounced during the COVID-19 pandemic: Many workers are facing elevated health risks, but numerous reports indicate that employers are not providing the protective measures workers need.

Ratings and scores of a company's performance are increasingly common. Some are created by media or advocacy groups, while others are created by regulatory agencies. Revealing poor performance, or "shaming" a company, creates pressure for the company to improve its behavior.

"We have lots of evidence that these ratings and scores motivate companies to do better," Johnson said. "But this is one of the first papers to show that these kinds of disclosures have a ripple effect on the behavior of other companies and to provide new insight into what drives companies to comply with regulations."

Traditionally, OSHA -- like other regulatory agencies -- relied on inspections as its main tool to promote compliance and safety. Inspections are effective: Prior studies have shown that facilities go on to improve their compliance after being inspected. However, inspections are costly, and the agency's resources enable it to inspect only a tiny fraction of the facilities it regulates.

In 2009, OSHA began issuing press releases following an inspection with a large fine of more than $40,000.

The policy was intended to both publicize OSHA's enforcement activity and to reveal to the public those companies with high violations. OSHA sent the press releases to local media and trade publications; as a result, other local companies in the same industry were made aware of the fines and the publicity.

Johnson linked the archive of OSHA's press releases to data on OSHA inspections to analyze the extent to which press releases about one facility affected the subsequent compliance and safety behavior of nearby facilities in the same industry.

Johnson found that the press releases had a strikingly large effect:

A press release leads to 73 percent fewer OSHA violations at peer facilities within a 3 mile radius (5 kilometers) of the publicized facility.

A press release has a smaller effect on compliance of facilities located further away, but effects persist for facilities up to 31 miles (50 kilometers) away.

Press releases also led to fewer workers getting injured and killed on the job.

The press releases might have created pressure on peer companies to proactively improve their safety performance.

For example, one week after a flavoring manufacturer was the subject of an OSHA press released that detailed widespread safety violations, Starbucks ended its relationship with that manufacturer.

"Presumably, other flavoring manufacturers -- seeing the costs of being the subject of a press release -- would seek to avoid such a fate," said Johnson.

"The former director of OSHA said that company lawyers told him their clients were more worried about seeing their names in an OSHA press release than about being fined," he said.

Publicizing severe violations is a powerful tool for regulatory agencies that can increase the impact of inspections, he said.

"Given the enormous social costs of workplace injuries, these estimates reveal that press releases created a large social benefit for a small cost," Johnson said.

Imagine if scientists could stop the coronavirus infection in its tracks simply by diverting its attention away from living lung cells? A new therapeutic countermeasure, announced in a Nano Letters study by researchers from Boston University's National Emerging Infectious Diseases Laboratories (NEIDL) and the University of California San Diego, appears to do just that in experiments that were carried out at the NEIDL in Boston.

The breakthrough technology could have major implications for fighting the SARS-CoV-2 virus responsible for the global pandemic that's already claimed nearly 450,000 lives and infected more than 8 million people. But, perhaps even more significantly, it has the potential to be adapted to combat virtually any virus, such as influenza or even Ebola.

"I was skeptical at the beginning because it seemed too good to be true," says NEIDL microbiologist Anna Honko, one of the co-first authors on the study. "But when I saw the first set of results in the lab, I was just astonished."

The technology consists of very small, nanosized drops of polymers--essentially, soft biofriendly plastics--covered in fragments of living lung cell and immune cell membranes.

"It looks like a nanoparticle coated in pieces of cell membrane," Honko says. "The small polymer [droplet] mimics a cell having a membrane around it."

The SARS-CoV-2 virus seeks out unique signatures of lung cell membranes and latches onto them. When that happens inside the human body, the coronavirus infection takes hold, with the SARS-CoV-2 viruses hijacking lung cells to replicate their own genetic material. But in experiments at the NEIDL, BU researchers observed that polymer droplets laden with pieces of lung cell membrane did a better job of attracting the SARS-CoV-2 virus than living lung cells.

By fusing with the SARS-CoV-2 virus better than living cells can, the nanotechnology appears to be an effective countermeasure to coronavirus infection, preventing SARS-CoV-2 from attacking cells.

"Our guess is that it acts like a decoy, it competes with cells for the virus," says NEIDL microbiologist Anthony Griffiths, co-corresponding author on the study. "They are little bits of plastic, just containing the outer pieces of cells with none of the internal cellular machinery contained inside living cells. Conceptually, it's such a simple idea. It mops up the virus like a sponge."

That attribute is why the UC San Diego and BU research team call the technology "nanosponges." Once SARS-CoV-2 binds with the cell fragments inside a nanosponge droplet--each one a thousand times smaller than the width of a human hair--the coronavirus dies. Although the initial results are based on experiments conducted in cell culture dishes, the researchers believe that inside a human body, the biodegradable nanosponges and the SARS-CoV-2 virus trapped inside them could then be disposed of by the body's immune system. The immune system routinely breaks down and gets rid of dead cell fragments caused by infection or normal cell life cycles.

There is also another important effect that the nanosponges have in the context of coronavirus infection. Honko says nanosponges containing fragments of immune cells can soak up cellular signals that increase inflammation. Acute respiratory distress, caused by an inflammatory cascade inside the lungs, is the most deadly aspect of the coronavirus infection, sending patients into the intensive care unit for oxygen or ventilator support to help them breathe.

But the nanosponges, which can attract the inflammatory molecules that send the immune system into dangerous overdrive, can help tamp down that response, Honko says. By using both kinds of nanosponges, some containing lung cell fragments and some containing pieces of immune cells, she says it's possible to "attack the coronavirus and the [body's] response" responsible for disease and eventual lung failure.

At the NEIDL, Honko and Griffiths are now planning additional experiments to see how well the nanosponges can prevent coronavirus infection in animal models of the disease. They plan to work closely with the team of engineers at UC San Diego, who first developed the nanosponges more than a decade ago, to tailor the technology for eventual safe and effective use in humans.

"Traditionally, drug developers for infectious diseases dive deep on the details of the pathogen in order to find druggable targets," said Liangfang Zhang, a UC San Diego nanoengineer and leader of the California-based team, according to a UC San Diego press release. "Our approach is different. We only need to know what the target cells are. And then we aim to protect the targets by creating biomimetic decoys."

When the novel coronavirus first appeared, the idea of using the nanosponges to combat the infection came to Zhang almost immediately. He reached out to the NEIDL for help. Looking ahead, the BU and UC San Diego collaborators believe the nanosponges can easily be converted into a noninvasive treatment.

"We should be able to drop it right into the nose," Griffiths says. "In humans, it could be something like a nasal spray."

Honko agrees: "That would be an easy and safe administration method that should target the appropriate [respiratory] tissues. And if you wanted to treat patients that are already intubated, you could deliver it straight into the lung."

Griffiths and Honko are especially intrigued by the nanosponges as a new platform for treating all types of viral infections. "The broad spectrum aspect of this is exceptionally appealing," Griffiths says. The researchers say the nanosponge could be easily adapted to house other types of cell membranes preferred by other viruses, creating many new opportunities to use the technology against other tough-to-treat infections like the flu and even deadly hemorrhagic fevers caused by Ebola, Marburg, or Lassa viruses.

"I'm interested in seeing how far we can push this technology," Honko says.

DALLAS, June 18, 2020 -- People living in rural areas are less likely to get the most advanced treatments for stroke and are more likely to die in the hospital than those treated for stroke at hospitals in urban areas, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

"There are so many challenges facing rural America right now - higher rates of chronic disease, poverty and joblessness - and cardiovascular and other health outcomes are much worse in rural areas. This study shines light on one area where changes in care, such as the introduction of telehealth or other programs, could really make a difference," said Karen E. Joynt Maddox, M.D., M.P.H., senior author of the study and assistant professor of medicine at Washington University School of Medicine in St. Louis, Missouri.

Researchers examined national data on more than 790,000 adults (the majority over age 64, 53% female) hospitalized with stroke between 2012-2017, from the National Inpatient Sample (NIS) database, the largest publicly available, all-payer inpatient health care database in the U.S. Compared with patients living in urban areas, stroke patients treated at rural hospitals were:

about half as likely to receive clot-busting medication (such as intravenous alteplase) to treat clot-caused strokes;

about one-third less likely to undergo a procedure (such as an endovascular thrombectomy) to remove a stroke-causing clot; and

more likely to die of any type of stroke before leaving the hospital (6.87% vs 5.82%), with no improvement in the rural-urban disparity over the 5-year period.

"The magnitude of the differences in risk of death and the lack of improvement over time were striking. One would think that recent improvements in technology and in telehealth would mean that we could, as a system, deliver optimal care no matter where people live. That turns out to not yet be the case for stroke care," Joynt Maddox said.

As well as their lack of access to advanced therapies, rural patients also had significantly lower rates of access to specialists.

"The lack of access to specialists is often a limiting factor in adequate care for rural stroke patients, and in this case, that could mean a neurologist to guide the initial care, an interventional neurologist or radiologist to do a procedure, or having a neurosurgeon available for backup in case of any complications," said Gmerice Hammond, M.D., M.P.H., first author of the study and a cardiology fellow at Washington University School of Medicine in St. Louis, Missouri. "Clinicians need to work to improve access to high-quality stroke care for individuals in rural areas. That means partnerships between hospitals for rapid transfer, as well as telehealth when appropriate. And clinical leaders and policymakers should prioritize improving access, care and outcomes for stroke in rural communities."

Meanwhile, residents in rural areas can take steps to protect themselves. "Be aware of signs and symptoms of stroke, and seek care urgently if any symptoms develop. To the extent possible, be as aggressive as you can with preventive efforts like blood pressure control. The best way to survive a stroke is to not have one in the first place," Hammond said.

According to the American Stroke Association, the most common symptoms of stroke are known as F.A.S.T., face drooping, arm weakness, speech and time to call 9-1-1. Bystanders should call 911 for immediate help even if the symptoms go away.

The study was limited in not having information on the severity of stroke or on factors that determine who is eligible for advanced therapies (such as the size of clot, where it is located, and the length of time between the onset of stroke and the patient arriving at the hospital).

"Future studies using more detailed clinical data will be important to follow up on our findings and to determine why patients in rural areas aren't receiving advanced therapies. Is it because their stroke severity is different? Or because delays in getting to the hospital meant they weren't eligible by the time they arrived? Those questions can't be answered with administrative data, but they're very important to look into so that we can develop effective solutions," Joynt Maddox said.

Glenview, IL, June 18, 2020 - A new study appearing in the journal CHEST®, published by Elsevier, documents an increased incidence of silicosis, which progressed rapidly to massive pulmonary fibrosis in a significant proportion of patients who had previously worked artificial stone (AS), also called artificial quartz agglomerate or conglomerate, a popular new countertop material, despite cessation of exposure after diagnosis.

AS is composed of finely crushed stone mixed with synthetic resins and has a high silica content. It emits respirable crystalline dust (RCS) while it is being fabricated and in cutting, shaping, and finishing in small industries, which can cause permanent and severe lung damage if it is inhaled.

The study reports on the results of follow-up exams of 106 AS workers in southern Spain who were diagnosed with silicosis or severe pulmonary fibrosis between 2009 and 2018. The investigators first reported the link between their illnesses and AS RCS in a study published in 2014.

"While 6.6 percent of the AS workers were initially diagnosed with massive pulmonary fibrosis, 37.7 percent had more advanced disease at the follow-up exam, even though they had left their jobs and were no longer exposed to the harmful dust. In a quarter of the patients, the rate of decline in lung capacity progressed very rapidly," explained lead investigator, Antonio León-Jiménez, PhD, Pulmonology, Allergy and Thoracic Surgery Department, Puerta del Mar University Hospital; and Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain. On a positive note, four years after exposure ended, the annual decrease of lung capacity appeared to slow down.

Silicosis, probably the most ancient occupational disease, has been traditionally related to mining or quarry work. It is caused by inhalation of crystalline silica dust that produces permanent lung scarring (pulmonary fibrosis). Its incidence had decreased in high income countries following the reduction of mining activities and implementation of better protective measures for workers and dust control.

However, over the past decade, the increasing popularity of AS for use in kitchen and bathroom countertops because of its design and attractive colors has supplanted traditional materials like granite and marble. Unfortunately, working with AS has resulted in a resurgence of cases of silicosis identified among fabricators. Despite following protective measures used for handling natural stone, these workers were nonetheless injured by the higher level of crystallized silica contained in AS (93 percent) than in natural stone (five percent-30 percent).

Measures adopted to reduce the concentration of respirable dust, such as the use of water suppression and exhaust ventilation techniques, have been implemented, but harmful levels of RCS are still documented in workplaces, generally in small factories

The investigators call for more aggressive engineering controls and new treatments to be developed and tested, "Avoiding the continued inhalation of silica is essential but is not enough. The majority of patients are young people and the progression of the disease, in a significant number of them, foreshadows an uncertain future. Our findings emphasize the need to maximize protective measures in active patients and to find new treatments that may delay or curb the progression of the disease," cautioned Dr. León-Jiménez.

The worldwide demand for engineered quartz countertops continues to soar (estimates project the 2013 levels will triple by 2024). Although the first patients were described ten years ago in Spain and Israel, the number of cases has been increasing throughout the world. In Australia, the situation was considered an occupational epidemic in 2019, and the emergence of new cases in the United States and China warns that it is a global problem that likely has only just begun.

In an accompanying editorial, Robert A. Cohen, MD, and Leonard H.T. Go, MD, both affiliated with the University of Illinois at Chicago School of Public Health, Chicago, IL, USA, add an even stronger cautionary note, "Given the toxicity of this material and the rising human cost of its use, if engineering controls cannot limit worker exposure to hazardous concentrations of RCS, a ban on AS needs to be considered. Colorful countertops are not worth the price paid by these workers."

WASHINGTON--Diabetic ketoacidosis is a common and potentially fatal complication in hospitalized patients with COVID-19, according to a new clinical perspective published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Diabetic ketoacidosis almost always requires special care in the hospital which usually takes place in the intensive care unit (ICU). It is caused by insufficient insulin circulating in the bloodstream, which is more likely to occur during a serious infection like COVID-19. Diabetic ketoacidosis causes a buildup of acids in the blood, leading to serious illness characterized by dehydration and sometimes difficulty breathing.

"People with diabetes who are infected with COVID-19 are at increased risk of severe disease, which in some cases is accompanied by diabetic ketoacidosis," said the paper's corresponding author Marie McDonnell, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, Mass. "Hospitals and clinicians need to be able to quickly identify and manage diabetic ketoacidosis in COVID patients to save lives. This involves determining the options for management (including when less intensive subcutaneous insulin is indicated) and understanding how to guide patients on avoiding this serious complication."

The authors outline simpler methods of diabetic ketoacidosis management with the goal of keeping ICU beds available for severe COVID-19 cases. They advocate, in select cases, for diabetic ketoacidosis protocols that use subcutaneous insulin therapy outside of the ICU instead of IV insulin therapy in the ICU to protect nurses from having to deliver frequent bedside care to COVID-infected patients.

Other topics include the importance of recognizing euglycemic ketoacidosis in those taking SGLT2-inhibitor agents and the recognition that unique approaches, including telemedicine, may be needed to help the highest risk patients avoid ketoacidosis.

As the COVID-19 pandemic sweeps across the globe, people are beginning to understand, at a very personal level, the ways in which infectious diseases can devastate life. But disease outbreaks are not confined to just humans or to life on land.

"We are perhaps more alert than ever to the catastrophic impacts of infectious disease in both humans and animals. Our task now is to begin to understand what drives these events, particularly in species like marine mammals, where our knowledge is even more limited," said Claire Sanderson, a research associate in the Department of Fish and Wildlife Conservation within the College of Natural Resources and Environment and the research coordinator of the Center for African Resources: Animals, Communities, and Land Use (CARACAL).

In 2000, over 10,000 endangered Caspian seals died in less than a four-month span. Researchers later discovered that the culprit behind this devastating mass mortality event was canine distemper virus.

Infectious disease-induced mass mortality events are known to afflict a variety of species, including invertebrates, birds, fish, and both land and aquatic mammals. However, these events in aquatic mammals are understudied compared to their land-dwelling counterparts.

To help fill in the knowledge gaps, Sanderson worked with Kathleen Alexander, a professor in the Department of Fish and Wildlife Conservation and co-founder of CARACAL, to evaluate the factors influencing the occurrence of these events in marine mammals. They published their findings in Global Change Biology.

Sanderson and Alexander defined a mass mortality event as a "devastating number of fatalities within the same species over a brief period of time," which is also dependent on the species' conservation status and population size. Beyond the deaths of individual animals, mass mortality events can initiate a cascade of events with severe ecological repercussions. Affected populations are often at a greater risk of local extinction, and changes in community structure can upset an ecosystem's balance.

By conducting extensive literature searches, Sanderson and Alexander discovered that infectious disease-induced mass mortality events occurred in 14 percent of marine mammal species between 1955 and 2018. Viruses were responsible for 72 percent of these events and caused 20 times the number of deaths than bacterial outbreaks. Specifically, morbillivirus and influenza A outbreaks were the most commonly recorded. Due to their life cycles, both viruses can infect multiple hosts since they have the potential to be transmitted between various species.

To determine which factors influenced the occurrence of infectious disease-induced mass mortality events in marine mammals, Sanderson and Alexander evaluated key life history traits and environmental variables.

To evaluate the role of life history traits, they focused on sociality, trophic level (a species' position on the food chain), and habitat breadth. While sociality and trophic level did not appear to be associated with mass mortality events in marine mammals, habitat breadth did. More than half of the species experiencing mass mortality events were pinnipeds, an order of semi-aquatic species that includes seals, sea lions, and walruses.

"Pinnipeds bridge the terrestrial and aquatic interfaces and may have a greater exposure to pathogens that occur across these land types," Sanderson said. For instance, seals and sea lions are often observed on beaches, rocky shorelines, and docks, but they also spend a significant part of their lives in water.

In contrast to life history traits, environmental variables -- such as season and sea surface temperature anomalies -- were significantly associated with disease outbreaks in marine mammals.

One of the most indicative measures of climate change is fluctuating sea surface temperatures. Sanderson and Alexander found that 61 percent of mass mortality events in marine mammals occurred during periods in which regional sea surface temperature anomalies occurred. The study suggested that the incident rate of an infectious disease-induced mass mortality event increases by nearly 12 percent for "every unit increase in global sea surface temperature anomalies."

"As climate change intensifies, this may set off a complex chain of events that dramatically alter these ecosystems, affecting marine populations living in these environments," said Alexander an affiliated faculty member of the Fralin Life Sciences Institute. Climate change effects on sea ice and ocean salinity also have implications for the spread of disease.

In polar regions, sea ice is melting more quickly due to increasing air temperature, but various species of pinnipeds need sea ice to give birth, rest, mate, escape predators, and molt. As the ice melts away, pinnipeds are forced to congregate onto smaller, shrinking ice sheets. At higher densities, increased contact between individuals can allow pathogens to be transmitted more readily through a population and region.

The chemical balance of the ocean is also changing. In polar regions, melting sea ice dilutes the salty ocean water in a process called freshening. This can result in decreased prey abundance, since species like fish, mollusks, and crustaceans are sensitive to small changes in the environment. With less food to feed on, marine mammals may suffer from nutritional stress, resulting in decreased immune function and a greater susceptibility to disease.

"Marine mammals represent important sentinels of aquatic health by providing information essential for managing threats to these vulnerable ecosystems," said Sanderson. "Addressing the root causes of climate change will be of critical importance as we chart a path forward in managing these species."

Of all the marine mammal species that suffered an infectious disease-induced mass mortality event, the study found that 37 percent were listed as endangered or vulnerable to extinction.

"This work underscores the critical threat infectious disease can pose to marine species and the potential importance of climate change as a wide reaching driver of this process. Here, our role is complex as we contribute directly to our changing climate, increasing pathogen pollution, and habitat degradation. But we also have the power to change things, address climate change, protect species and environments through effort and innovation -- humanity at its best," Alexander said.

A new study shows that residents of long-term care facilities with lower nurse staffing levels, poorer quality scores, and higher concentrations of disadvantaged residents suffer from higher rates of confirmed COVID-19 cases and deaths.

"In nursing homes, quality and staffing are important factors, and there already exists system-wide disparities in which facilities with lower resources and higher concentrations of socio-economically disadvantaged residents have poorer health outcomes," said Yue Li, Ph.D., a professor in the University of Rochester Medical Center (URMC) Department of Public Health Sciences and lead author of the study which appears in the Journal of the American Geriatrics Society. "These same institutional disparities are now playing out during the coronavirus pandemic."

Residents of long-term care facilities have been shown to be highly vulnerable to respiratory disease outbreaks, such as influenza or other common human coronaviruses. Current evidence suggests that COVID-19 disproportionately impacts older adults and individuals with chronic health conditions. These factors are more concentrated in nursing homes where residents are characterized by advanced age, more frequent and complex chronic disease patterns, and highly impaired physical, cognitive, and immune system functions, putting these populations at greater risk for more severe COVID-19 infections.

This phenomenon first came to light in a skilled nursing facility in the Seattle area in February during the early stages of the pandemic, where more than half of the residents in the facility became infected and a third died. Since that time, 50,000 coronavirus-related deaths, approximately 40 percent of the total, have been linked to nursing homes across the U.S.

The new study examined nursing home level data published on the Connecticut Department of Health and Human Services website. At the time of the study, Connecticut was one of the few states that made this information publically available. This information was compared to data from the Center for Medicare & Medicaid Service's (CMS) Nursing Home Compare website, which tracks quality, staffing, and health outcomes for nursing homes nationwide.

Analyses of the data showed that long-term care facilities with higher concentrations of disadvantaged residents, including Medicaid residents and racial and ethnic minorities, lower nurse staffing levels, particularly registered nurses (RN), and lower scores on CMS five-star quality measures, had higher rates of confirmed COVID-19 cases and deaths. Higher nurse staffing ratios in particular was strongly associated with fewer cases and deaths.

"In most nursing homes, RNs are the linchpin for the assessment and provision of medical care, including early identification of and response to emergencies and life threatening situations," said Li. "Our findings of the strong negative association between RN staffing and the number of COVID-19 cases and deaths in nursing homes are consistent with research that has demonstrated that increased nursing levels are key to an institution's ability to respond to outbreaks of emerging infections."

Similar patterns in nursing homes have since been observed in other states, including California. In April, the federal Centers for Disease Control and Prevention (CDC) required all nursing homes to submit COVID-19 data. A preliminary analysis of the CDC data showed similar associations between nursing home quality and staffing and coronavirus infection rates and deaths.

The authors suggest that the findings should be used to recalibrate the nation's efforts to control infection rates in nursing homes. Efforts to date have concentrated in facilities located in areas with high infection rates. The authors contend that, going forward, regulators and state nursing home inspectors should also target homes with lower RN staffing levels and quality ratings.

WASHINGTON, D.C. and SAN DIEGO, CA -- Nearly 9 in 10 U.S. adults are "very" (55%) or "somewhat" (33%) concerned that the pharmaceutical industry will leverage the COVID-19 pandemic to raise drug prices. Similarly, 84% are very or somewhat concerned that the general cost of care will rise, and 79% are very or somewhat concerned their health insurance premiums will go up in response to the pandemic. In each of the latter two scenarios, 41% of Americans are very concerned.

The new findings, released today by the nonprofit West Health and Gallup as part of ongoing research on the rising cost of healthcare in the U.S., come from a nationally representative survey of 1,016 U.S. adults. Amid a mounting death toll, the results underline the knife-edge fears associated with paying for care in the U.S.

Fears related to the cost impacts of the COVID-19 pandemic vary by demographic subgroup. Most Americans, regardless of gender, race, income or political identity, believe drug prices will rise. However, there is less consensus regarding rising insurance premiums and healthcare costs.

Among key demographic differences:

Fifty-seven percent of women are very concerned about rising drug prices, compared with 52% of men.

Nearly half of women (48%) are very concerned about the general cost of care rising, compared with 33% of men.

Fifty percent of nonwhites are very concerned about the general cost of care rising, compared with 36% of whites.

Forty-six percent of women are very concerned about rising insurance premiums, compared with 37% of men.

Forty-seven percent of nonwhites are very concerned about rising insurance premiums, compared
with 38% of whites.

Forty-nine percent of households making less than $40,000 a year are very concerned about rising insurance premiums, compared with 37% of those making between $40,000 and $100,000. However, those making more than $100,000 a year express greater concern (41%).

Democrats (66%) are more likely to say they are very concerned about rising drug prices than are independents (52%) or Republicans (49%).

"Concerns loom large that when the pandemic is all over, Big Pharma and insurance companies will revert to old patterns and behaviors and continue to squeeze Americans with ever-higher drug prices and insurance premiums," said Tim Lash, chief strategy officer for West Health. "If history is any guide, these concerns are well-founded, which is why promises to rein in prices are not enough. We need to retool our healthcare system and enact smart legislation now."

Amid concerns about how the COVID-19 pandemic could raise healthcare costs, a large majority of Americans support the federal government directly negotiating the price of a treatment for the disease with the drug manufacturer. Eighty-eight percent of U.S. adults support this intervention, with very little daylight between Democrats (91%), independents (87%) and Republicans (89%).

Perceptions of the U.S. Response to COVID-19

As countries, including the U.S., continue to grapple with the effects of the pandemic and look ahead to a potential second wave of infections, Americans hold dim views of how their country has responded so far. Relative to how much the U.S. spends on healthcare, 9% of respondents rate the U.S. response as "excellent" and another 14% as "very good." In contrast, 34% rate the response as "poor" and 23% as "fair."

These perceptions are inversely related to both education and income. For example, among those with postgraduate degrees, 72% evaluate the response as fair or poor, compared with 49% of those whose education was high school or less. Political identity also greatly informs perspectives, with 84% of Democrats evaluating the response as fair or poor, compared to 28% of Republicans.

"Americans are clearly worried about the impact of the coronavirus pandemic well beyond being exposed to or spreading the disease," said Dan Witters, Gallup senior researcher. "Still, their misgivings regarding pharmaceutical companies and general anxieties regarding the cost of care are tempered by a clear, bipartisan call to policymakers to get involved to ensure that the public will be able to afford a treatment for COVID-19."

The new findings come from a nationally representative survey of 1,016 U.S. adults conducted between May 11 and May 22, 2020. Respondents represent all 50 U.S. states and the District of Columbia.

Full results, including a complete methodology statement, can be found at the link below:
https://news.gallup.com/poll/312641/nine-concerned-rising-drug-costs-due-covid.aspx

For vessels that journey into the polar seas, keeping control of the spread of sea ice is critical, which means that large resources are spent to collect data and determine future developments to provide reliable sea ice warnings.

- As of now, large resources are needed to create these ice warnings, and most of them are made by The Norwegian Meteorological Institute and similar centres, Sindre Markus Fritzner tells us, who is a Doctoral Research Fellow at UiT The Arctic University of Norway.

He is employed at the Department of Physics and Technology and has recently submitted a doctoral thesis where he has looked at the option of using artificial intelligence to make ice warnings faster, better, and more accessible than they are today.

In need of supercomputers

The ice warnings used today are traditionally based on dynamic computer models that are fed with satellite observations of the ice cover, and whatever updated data can be gathered about ice thickness and snow depth. This generates considerable amounts of data, which then needs to be processed by powerful supercomputers to provide calculations.

- Dynamic models are physical models and require a lot of data to be processed. If you are going to make warnings about future events, you need to use a supercomputer, Fritzner explains.

This is a limited and costly resource, which makes these warnings impossible to do without access to the right resources.

Artificial intelligence makes calculations accessible on a regular laptop

Fritzner has looked at how artificial intelligence can be used to provide these sea ice warnings faster, better, and cheaper than ever - on a regular laptop.

Machine learning is a specialized field within artificial intelligence, where statistical methods are used to let computers find patterns and coherences in large sets of data. The machine learns instead of being programmed, and it all comes down to developing algorithms that enable computers to learn from and make calculations, based on empirical data.

In Fritzner's work, for example, he has loaded in data to see how one specific week will unfold, and then data for how it will look one week later on.

- Thus, it is the coherence in the development between these weeks that the machines learn itself, and in this way it can predict how it evolves, Fritzner says.

When fully developed, such an algorithm will demand far less computing power than the traditional physical model.

- If you use artificial intelligence and have a fully trained model, you can run such a calculation on a regular laptop, Fritzner says.

Every vessel can make calculations on their own

This opens up for several fields of usage, one of them being more precise weather reports in The High North. Fritzner also points out that this can be used by the shipping industry that operate close to the marginal ice zone, and that this is a form of traffic that will only increase.

- One example is cruise traffic, where it will be very important for the cruise vessels to know where the ice is, and where it will move in the next couple of days, Fritzner says.

As it stands, high-resolution models can not be run on the vessel. They have to contact The Norwegian Meteorological Institute, who then needs to run the model on a supercomputer before they transmit the data back to the vessel.

- If you are on a vessel in The Barents Sea, you are dependent on being connected to a network to download the warnings from The Norwegian Meteorological Institute.

If equipped with the right program and artificial intelligence, this can be done from the vessel itself, with nearly no computing power required at all, Fritzner says.

More development needed

Although the research so far looks promising, the results are still not as good as the traditional methods, but the evolution of machine learning/artificial intelligence is reaching full steam, and Fritzner has no doubts about its potential.

- The experiences so far are good, but not perfect. What I observed when comparing machine learning and the traditional physical models was that they were much faster, and as long as the changes in the ice were small, the machine learning functioned quite well. When the changes were greater, with a lot of melting, the models struggled more than the physical models, Fritzner explains.

He points to the challenge of the models running on artificial intelligence only relying on historical data, while the physical models constantly are adapted to large geophysical changes like increased melting and rapid changes to the weather.

In his experiments, Fritzner used data like temperature, the concentration of sea ice, and sea temperature. He believes the preciseness can be increased by adding more data to the model so that it has a larger set of data for the warnings it provides.

- Especially if you add wind and ice thickness, the machine learning will work much better, he says.

He believes further research and development will release the great potential that lies in this form of machine learning.

California's most vulnerable premature babies are now healthier when they go home from the hospital, according to a new study led by researchers at the Stanford University School of Medicine and the California Perinatal Quality Care Collaborative.

Between 2008 and 2017, the proportion of the smallest and most premature California infants who survived until hospital discharge without major complications of their early birth increased from roughly 62% to 67%, and those with major complications had fewer of them.

The study will be published online early June 18 Eastern time in Pediatrics.

"When a family takes their baby home from the hospital, we want them to have an infant that's as healthy as possible," said the study's lead author, Henry Lee, MD, associate professor of pediatrics at Stanford. "Survival without major complications is one way we take into account that survival alone isn't our only goal."

The senior author is Jeffrey Gould, MD, professor of pediatrics and the Robert L Hess Endowed Professor.

About 1 in 12 California babies are born prematurely, arriving at least three weeks early, and about 1 in 100 are born 10 or more weeks before their due date. In the last 50 years, survival rates for very premature babies have greatly improved, Lee said, but some preemies continue to experience severe complications after birth, such as lung problems, infections, digestive disease, brain injury, brain hemorrhage and vision loss. Although prior studies had examined changes in the rates of individual complications of prematurity, none had addressed whether complications as a whole were declining among a large population of preemies in California.

Hospitals working together

California hospitals have been working together since 2007 to help neonatal intensive care units improve outcomes for babies. To promote this goal, they formed the California Perinatal Quality Care Collaborative. Headquartered at Stanford, the collaborative has conducted many projects to improve preemies' health, such as studying best practices for resuscitating preemies in the delivery room and figuring out how to support breast-milk expression for mothers who deliver prematurely.

The new study focused on the smallest and most premature babies, those born 11 to 18 weeks early or who weighed 0.88 to 3.3 pounds at birth. It included 49,333 infants who were in the NICUs of 143 California hospitals between 2008 and 2017. The study did not include infants who died at birth or who had severe congenital abnormalities.

The researchers analyzed the infants' medical records to look for the presence of major complications of premature birth. Between 2008 and 2017, the percentage of very premature or very small infants in California who survived without major complications improved from 62.2% to 66.9%. There was a significant decline in mortality of these infants over the same period. The complications whose incidence decreased most were necrotizing enterocolitis, a disease in which intestinal tissue dies, which declined 45.6%; and infections, which declined 44.7%.

Fewer complications per infant

Among preemies who did have complications, they had fewer of them. The number of infants in the study with four or more separate complications declined 40.2% between 2008 and 2017, the number with three complications declined 40.0% and the number with two complications declined 18.7%.

"It was really encouraging to me that we found that babies were less likely to have multiple morbidities," Lee said, adding that this means care is improving across the board, even for the sickest preemies.

The performance of California's neonatal intensive care units became more uniform for most complications of prematurity, with less variation between hospitals. However, there is still room for improvement; the study estimates that if all hospitals matched the performance of the top 25% of the state's NICUs, an additional 621 California preemies would go home from the hospital without major complications each year.

The California Perinatal Quality Care Collaborative is helping health care providers at all NICUs learn from each other, Lee said. "We've started trying to see which hospitals are having very good outcomes, or have perhaps improved significantly over the last few years, so that we can disseminate the knowledge they have gained from their experience," he said.

For families of premature babies, the new findings have a hopeful message. "It's a hard situation when a family suddenly faces premature birth," Lee said. "But we can tell them that we have taken care of many babies born at this age, and we've gotten better. That would hopefully be something of a reassurance."