App for mobile phones helps diagnose concussions (AP)

CHAPEL HILL, N.C. � The next tool in the campaign against concussions might be your smartphone.

A doctor at the University of North Carolina teamed with other head-trauma researchers to develop an application for mobile devices that helps determine whether someone may have suffered a concussion.

Jason Mihalik of UNC's brain injury research center joined Justin Smith of Psychological Assessment Resources Inc. and the Children's National Medical Center in developing the program.

Smith says it's the first observer-based concussion app. After the user answers a series of questions, the app determines the likelihood of a concussion and can email information to a doctor. Mihalik said Thursday that the basis for the app's question flow comes from materials provided by the Centers for Disease Control.

The introduction of the app is just one way to speed the response to possible concussions. One of the key issues discussed during the National Sports Concussion Cooperative's daylong seminar was how to most effectively bridge the communication gap between team doctors and the team athletic trainers, who often are the first to act when players suffer concussion-like symptoms.

"The documentation (of immediate symptoms) is very important, from, 'How did they get hurt?' to the mechanism of injury through those initial signs and symptoms, to 'How did they progress over time?'" said Bill Griffin of the National Athletic Trainers' Association. "It's not only what happens at the time of the injury, but how things change."

The cooperative consists of coaches, doctors, equipment manufacturers and parents, and the group was formed in March to study concussions and brain trauma injuries in an attempt to make sports safer.

"We're trying to do more. We think there is an opportunity to do more," said Art Chou, Rawlings' vice president of research and development. "The caution that we have as manufacturers is, are we ready to draw definitive conclusions? ... There's a balance there, and I think it's up to the research community to determine whether it is ready for prime time or not, because the issue is going to be one of public perception.

"The issue is, have we confused the public? ... I would like to see more consensus from the research community that supports that, because we need more data. We need to move the needle. ... The last thing we need, I think now, as a whole football community, is going back and forth and confusing the issue any more."

Mike Oliver, the executive director of the National Operating Committee on Standards for Athletic Equipment, continued to express a longstanding desire to come up with a safety standard for youth helmets.

But he cautioned that it's dangerous to rush to a conclusion before the scientific research is complete. NOCSEA, a nonprofit corporation, formed in 1969 in response to a need for a performance test standard for helmets.

"You want to have an answer. You want to have a solution to the problem," Oliver said. "You want to be able to say ... 'We do have a solution to the problem and you can have a level of confidence (that) you will have a level of protection. ... But we can't do that until we have the science behind it."

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E. coli outbreak points to gaps in US food system (AP)

WASHINGTON � The nasty form of E. coli hitting Europe points out gaps in the U.S. food safety system that raise concern that similar outbreaks might happen here.

It's impossible to test for every illness-causing form of E. coli, even the kinds we already know about.

Today, the food industry and health authorities focus mostly on a single strain of the bacteria that until now was considered the most dangerous. But some different strains collectively known as "the other E. colis" were sickening more and more people well before this extra-deadly European bug burst on the scene.

"It's a wake-up call around the world," said Dr. Robert Tauxe of the Centers for Disease Control and Prevention, which has long been concerned about the lesser known strains.

Authorities don't yet know the source of the European infection, but cucumbers, tomatoes and leafy lettuce grown there are suspected.

There's no reason to stop eating fresh vegetables in the United States, but officials are monitoring the situation carefully. The Food and Drug Administration has stepped up testing of those foods imported from affected countries as a precaution, although very little is imported.

And Agriculture Secretary Tom Vilsack said Thursday there's no immediate threat from what's happening in Europe. "We have to constantly look for ways to improve food safety, and that requires us to make sure that we're testing for the right things," he said.

USDA, under pressure from consumer groups, already was working on a measure to address some of the other E. colis in beef, a policy being reviewed by the Obama administration. Researchers created tests to screen for the six strains considered most prevalent, before the toll in Europe revealed a seventh.

When it comes to fresh produce, a sweeping new law requires the FDA to set standards to guard against contamination of all sorts. The rules are expected to address such things as properly processed compost, worker hygiene, and keeping animals and their runoff from fields or irrigation water.

It's not clear how quickly those rules will emerge; Republican-led efforts to cut FDA's budget would strain the work.

"There are no regulations in place today that would prevent this kind of outbreak from occurring" in the U.S., said food-safety expert Caroline Smith DeWaal of the Center for Science in the Public Interest.

But specialists say the broad focus promised by the food-safety law is critical to get ahead of the next emerging germ, rather than racing to develop tests for each new strain.

"You never know what's around the corner that's just waiting to bite you," said former FDA assistant commissioner Dr. David Acheson, now a food-safety consultant. "You cannot test your way to safety, you just can't do it."

The produce industry says it's not waiting on the FDA. Some growers in California and other areas, for example, have voluntarily adopted such standards as not harvesting leafy greens within 5 feet of feces or other animal activity in a field, said David Gombas of United Fresh Produce. What prevents the long-targeted E. coli strain should prevent these newly worrisome varieties, too, he said.

E. coli is incredibly common. Hundreds of strains, most of them harmless, live in the intestines of humans, cows and numerous other animals. But some produce toxins that can cause diarrhea, sometimes severe enough to trigger kidney failure, even death.

The most dangerous form in the U.S. has been the E. coli O157:H7 strain, notorious since a 1993 outbreak at a fast-food chain led to its classification as an adulterant in meat, requiring testing and recalls. A 2006 outbreak in spinach highlighted the threat to fresh produce, too. The CDC estimates that strain alone causes about 63,000 foodborne illnesses a year.

In Europe's unusually large outbreak, an emerging super-strain named O104:H4 has sickened at least 1,600 people and killed 18. Most surprising is that nearly 500 of those victims have that kidney damage, more than typical with other strains.

It's not clear why this particular strain is so virulent. But genetic testing suggests a toxin-spewing form of the bug combined with another strain that attaches to a patient's gut in a more aggressive way � the germs stacking in a brick-like pattern rather than individually, said Acheson. He has long studied E. coli and warned years ago that lesser known strains were "just accidents waiting to happen."

In fact, CDC's Tauxe says that other toxin-forming E. colis altogether cause more illnesses � about 112,000 U.S. cases a year � than the most targeted type. But the other E. colis got less attention because they tended to cause smaller outbreaks, like the one in romaine lettuce blamed for two dozen illnesses in five states last year.

That's why Bill Marler, a Seattle attorney who specializes in food poisoning cases, petitioned USDA to mandate beef testing for the other E. colis, knowing that other foods tend to follow the meat industry.

"If E. coli O157 is an adulterant in hamburger, then these other bugs should be, period," he said.

Tauxe cautions there's a lot to learn about these other E. colis. Later this year, the CDC will begin a study to identify risk factors, what foods and which people seem particularly vulnerable.

___

Associated Press writer Mary Clare Jalonick contributed to this report.

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Food pyramid out, 'My Plate' in for healthy eating (AP)

WASHINGTON � There's a new U.S. symbol for healthful eating: The Agriculture Department unveiled "My Plate" on Thursday, abandoning the food pyramid that had guided many Americans but merely confused others.

The new guide is divided into four slightly different-sized quadrants, with fruits and vegetables taking up half the space and grains and protein making up the other half. The vegetables and grains portions are the largest of the four.

Gone are the old pyramid's references to sugars, fats or oils. What was once a category called "meat and beans" is now simply "proteins," making way for seafood and vegetarian options like tofu. Next to the plate is a blue circle for dairy, which could be a glass of milk or a food such as cheese or yogurt.

Some critics, including congressional Republicans, have charged the Obama administration of reaching too far in trying to make Americans eat healthier, especially when it comes to new rules that tell schools what children can eat on campus.

The new plate is simply guidance for those looking to improve their diet, however. It's supposed to be a suggestion, not a direction, said Agriculture Secretary Tom Vilsack.

"We are not telling people what to eat, we are giving them a guide," he said. "We're not suggesting they should not have a cookie or dessert, that's not what it's about."

Vilsack said the new round chart shows that nutrition doesn't have to be complicated. After almost 20 years of leaders preaching good eating through a food pyramid the department now says was overly complex, obesity rates have skyrocketed. He showed off the new plate with first lady Michelle Obama, who has made healthful diets for children a priority through her "Let's Move" campaign.

"Parents don't have the time to measure out exactly three ounces of protein," Mrs. Obama said as she introduced the new graphic. "We do have time to look at our kids' plates."

The department is planning to use social media � posting advice every day on Twitter, for example. The address of the accompanying website, choosemyplate.gov, is written on the chart. That website will eventually feature interactive tools that help people manage their weight and track their exercise.

The new chart is designed to be "more artistic and attractive" and to serve as a visual cue for diners, said Robert Post of the Agriculture Department's Center for Nutrition Policy and Promotion. He has spent two years developing the plate and the website.

Even though the plate is divided into four different-sized sections, the servings don't have to be proportional, Post says. Every person has different nutritional needs, based on age, health and other factors.

The graphic is based on new department dietary guidelines released in January. Those guidelines, which are revised every five years, tell people to drastically reduce salt and continue limiting saturated fats. They say diners can enjoy food but should balance calories by eating less. The guidelines also suggest making half of your plate fruits and vegetables � a message easily translated on the dinner plate.

"We know Americans want to be healthy, but making those healthy choices is not easy, it's hard," said Surgeon General Regina Benjamin, who joined Mrs. Obama and Vilsack to unveil the plate. "We're trying to make it easier."

The guidelines and the icon were subject of lobbying by food industries who want to see their products promoted and not discouraged. Fruit and vegetable growers were celebrating their victory over half of the plate Thursday, while dairy producers said they were also pleased with the cup beside it. The president of the beef industry group National Cattleman's Beef Associaton, Bill Donald, said he is not concerned about the elimination of the word "meat" because beef is so associated with the word "protein."

The first food pyramid was introduced in 1992, with detailed descriptions of recommended foods and their portion sizes. The tip of the pyramid represented fats, oils and sweets, cautioning diners to "use sparingly."

After research showed the pyramid wasn't working, the department worked with a public relations firm and came up with an all-new pyramid in 2005 that was characterized by vertical lines of color and a stick figure walking up a staircase to symbolize exercise. At the time, officials said they wanted something motivational and recognizable. But the Obama administration eventually ditched that model, opting for something fresher.

Many nutritionists and nutrition groups praised the newest effort, crossing their fingers that people will listen.

Marion Nestle, professor of nutrition, food studies, and public health at New York University, said there are already a lot of symbols out there telling people what to eat. She said the new model isn't perfect, it's a good step forward.

"This brings it all together," she said. ___

Online:

USDA website: http://www.usda.gov

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CDC: More have HIV as treatment prolongs lives (AP)

ATLANTA � New government statistics show about 1.1 million Americans were living with the AIDS virus in 2008, an increase of about 71,000 from 2006.

An increase was expected because people with HIV are living longer and healthier lives thanks to treatment.

The Centers for Disease Control and Prevention released the numbers Thursday in a publication called Morbidity and Mortality Weekly Report.

More than half of new HIV infections are in gay and bisexual men. The CDC released a second study, of gay and bisexual men in 21 U.S. cities, that found 61 percent said they were tested for HIV in the previous year. Seven percent were found to be newly infected. Other studies say that overall, about 10 percent to 20 percent of U.S. adults are tested annually.

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UAE bans cucumbers from 4 European countries (AP)

DUBAI, United Arab Emirates � The United Arab Emirates has issued a temporary ban on cucumbers from Spain, Germany, Denmark and the Netherlands because of concerns about the deadly E. coli bacteria outbreak in Europe.

State news agency WAM says the Gulf nation's Minister of Environment and Water issued the order Wednesday based on information "from international food safety agencies and news reports."

Other produce from the countries will be allowed in if importers can provide documentation that it is free of E. coli.

The Gulf federation's foreign affairs ministry is also warning its citizens living or traveling in Europe to avoid eating vegetables altogether.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

BRUSSELS (AP) � The European Union says a Russian ban on imports of vegetables from the 27-country bloc meant to prevent a deadly bacterial outbreak from entering is disproportionate.

The statement comes as Germany says one person died overnight from the illness, bringing the death toll from the outbreak to 18.

Frederic Vincent, a spokesman for the EU's Health and Consumer Policy Commissioner John Dalli, said Thursday that the European Commission would write to the Russian Agency for the Supervision of Consumer Rights to demand further clarification of the ban.

Vincent said the EU would also set up meetings with Russian authorities over the coming days.

Russia gets about 30 percent to 40 percent of its fruit and vegetables from the EU.

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Russia bans vegetable imports from EU (AP)

MOSCOW � Russia on Thursday extended its ban on vegetable imports to all of the EU in a bid to prevent a deadly European bacterial outbreak that has left 17 people dead from spreading into the country.

Researchers are still unable to pinpoint the cause of the outbreak that has hit Germany and other European nations, which has infected 1,500 people.

Lyubov Voropayeva, spokeswoman for the Russian Agency for the Supervision of Consumer Rights, told the Associated Press Thursday that the ban has been imposed immediately for no definite period of time.

The agency's chief Gennady Onishchenko told Russian news agencies that this "unpopular measure" would be in place until European officials inform Moscow of the cause of the disease and how it is being spread.

"How many more lives of European citizens does it take for European officials to tackle this problem?" he told the state-owned RIA Novosti news agency.

Russia banned fresh imports from Spain and Germany on Monday, warning of a possible spread of the sanction. No fatalities or infections have yet been reported in the country.

The outbreak has hit at least nine European countries, but nearly all the sick people either live in Germany or recently traveled there. Two people who were sickened are now in the United States, and both had recently traveled to Hamburg, Germany, where many of the infections occurred.

Medical authorities appeared late Wednesday no closer to discovering the source of the infection. Germany's national health agency said that more than 1,530 people there had been sickened by the dangerous E. coli germ, including 470 suffering from a kidney failure complication that was previously considered extremely rare.

The outbreak is already considered the third-largest involving E. coli in recent world history, and it may be the deadliest. Twelve people died in a 1996 Japanese outbreak that reportedly sickened more than 12,000, and seven died in a 2000 Canadian outbreak.

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Smoking gun elusive in deadly E. coli outbreak (AP)

BERLIN � European health officials tracking one of the worst E. coli outbreaks on record might never know where it came from. It's a sad fact of life in food poisoning cases: There often is no smoking gun.

The germ has sickened more than 1,500 people, mostly in Germany. Most patients who have been interviewed said they ate lettuce, tomatoes or cucumbers, but officials testing produce across the continent have yet to find any vegetables with the particular strain involved.

Illnesses can occur days after tainted food is eaten and leftovers thrown out, so "the trail gets cold pretty quick," said Bill Marler, a Seattle attorney who specializes in food poisoning cases.

"They might never find the cause of the outbreak," said Paul Hunter, professor of health protection at England's University of East Anglia. "In most foodborne outbreaks, we don't know definitively where the contaminated food came from."

Germany's national health agency said Wednesday that more than 1,530 people there had been sickened by a dangerous E. coli germ, including 17 dead and 470 suffering from a kidney failure complication that was previously considered rare.

The outbreak has hit at least nine European countries, but virtually all the sick people either live in Germany or recently traveled there. Two people who were sickened are now in the U.S., and both had recently traveled to Hamburg, Germany, where many of the infections occurred.

The outbreak is already considered the third-largest involving E. coli in recent world history, and it may be the deadliest. Twelve people died in a 1996 Japanese outbreak that reportedly sickened more than 12,000, and seven died in a 2000 Canadian outbreak that also made thousands ill.

Nearly all cases are linked to northern Germany, "so it seems to be a common exposure there. But we don't yet know what was this exposure," said Dr. Hilde Kruse, the World Health Organization's food safety program manager for Europe.

"It's like a puzzle. But unfortunately the puzzle is not complete."

Where the dangerous germ came from is just one of the questions health officials have. Another is why patients are suffering from life-threatening kidney complications in an unusually high percentage of cases. It might mean the strain is particularly virulent, but it's also possible that thousands of less serious cases of food poisoning have gone unreported.

People with less severe symptoms may contact health authorities later, or not at all, Kruse said.

Kruse also said the outbreak is "different in that it mainly affects adults and predominantly women." Some experts say that likely has to do with diet � women tend to eat more fresh produce.

Experts are cautious about trying to explain what's happening at the moment. "An epidemic is like a battle � it's not clear where everything is coming from and what is going on," said Dr. Phillip Tarr, an E. coli expert at the Washington University School of Medicine.

The bacteria being investigated is one of the few dangerous types among the hundreds of different E. coli bugs. People and animals carry various E. coli in their intestines. But only a very small percentage are deadly. One of the most notorious was a strain that killed four U.S. children in 1993 and was linked to contaminated hamburgers at a fast-food chain.

Some experts said the sheer scope of the German outbreak may help eventually solve it. With more cases, there are better odds that the source can be found. That helped in the Japanese outbreak in 1996, which was blamed on radish sprouts, and the 2000 Canadian outbreak, which was traced to drinking water.

"Public health investigations are not always successful. But a big one with a lot of investigation around it is usually successful," said Dr. Robert Tauxe, a foodborne disease expert at the U.S. Centers for Disease Control and Prevention.

To nail down the source, scientists will have to match the strain found in patients to one in vegetables or other sources by using DNA sequencing, said Brendan Wren, professor of pathogen molecular biology at the London School of Hygiene and Tropical Medicine.

But it can be difficult to find the strain in vegetables, and Wren doubts cucumbers are responsible. "As in many foodborne disease outbreaks, the culprit may never be identified and the epidemic just fades away," he said.

Meanwhile, investigators will increase efforts to find the food distributors and producers where the vegetables originated.

That can take weeks or even months, and can be complicated by the fact that different vegetables are often eaten together, as in salads, Tauxe said.

In the U.S., the government said it would step up testing of any imports of cucumbers or other possibly implicated produce from affected countries � but the nation gets very little fresh produce from Europe, especially this time of year. There was just one shipment of cucumbers from Spain in May, for instance, and no cucumbers, tomatoes or lettuce from Germany since January.

Another challenge for health officials: Catching and preventing future outbreaks of this strain.

According to an expert panel of the European Food Safety Authority, there is limited data on the presence of dangerous E. coli strains across Europe.

Current surveillance systems aren't well coordinated across Europe, the group said. It recommends monitoring a number of dangerous E. coli strains � but not the one that is responsible for the current outbreak.

In Germany, there are no spot checks of imported food coming from the 25 countries that are part of a zone that lacks internal border controls.

In the United States, labs regularly test for a dangerous E. coli type in stool samples from people with food-poisoning symptoms, but only a small percentage of the labs test for other forms of E. coli that make people sick. In recent years, investigators have found that a wider variety of E. coli bugs are also causing illness.

___

Stobbe reported from Atlanta. Medical Writer Maria Cheng in London and Karl Ritter in Stockholm contributed to this report.

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