Archive For The “News” Category

Trump Administration Restricts H-1B Worker Visas Coveted By High Tech

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Trump Administration Restricts H-1B Worker Visas Coveted By High Tech

The Trump administration is tightening the rules for companies that contract out high-skilled workers who are in this country on H-1B visas.

The U.S. Citizenship and Immigration Services agency issued a new policy memo on Thursday that requires “detailed statements of work or work orders” about the work that will be performed when an H-1B visa worker is employed at a third-party work site. Employers will have to file more details that support the need for foreign talent.

H-1B visas are controversial. American tech companies use them to hire highly skilled foreign workers, such as engineers, IT specialists, architects among others, in situations in which they say there is a shortage of U.S.-born talent. The visas are good for three years and renewable for another three-year term.

Critics of the visas — 85,000 of which are issued every year — say American workers are aced out of competition with workers who can be paid less.

As CNN reports, “Indian outsourcing firms will be the hardest hit. Indian workers receive more than 70% of all H-1B visas.”

The USCIS memo says that if a visa beneficiary will be placed at one or more third-party worksites, the employer “has specific and non-speculative qualifying assignments in a specialty occupation for the beneficiary for the entire time requested in the petition; and the employer will maintain an employer-employee relationship with the beneficiary for the duration of the requested validity period.”

The memo says USCIS recognizes that visa-holders may wind up earning less money than promised or might perform “non-specialty” jobs when they are contracted out to third-party worksites.

The policy change comes as the Trump administration has signaled its desire to change the visa program with a “Buy American, Hire American” policy outlined in an executive order signed in April 2017. The order promised to root out fraud and abuse in the program.

As the Mercury News reports, the H-1B program has come under intense federal scrutiny.

“A Bay Area News Group report earlier this week found a sharp rise in the number of reviews immigration officials were conducting on H-1B applications. From January to August 2017, the U.S. Citizenship and Immigration Services sent 85,265 requests for evidence in response to H-1B visa applications, a 45 percent increase compared to the same period a year earlier, agency data show. Such requests are made when an application is missing required documents or when the agency determines it needs more proof to decide if a worker is eligible for the visa. Immigration lawyers say the extra enforcement could discourage companies and individuals from seeking an H-1B visa in the first place.”

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Director Of Oscar-Nominated Aleppo Doc Wants His Film To Serve As Witness

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Director Of Oscar-Nominated Aleppo Doc Wants His Film To Serve As Witness

White Helmet Khaled Omar Harrah was killed during an airstrike in 2016. He’s part of a group of volunteer rescue workers featured in the documentary Last Men in Aleppo (available on Netflix).

Courtesy of Grasshopper Film

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Courtesy of Grasshopper Film

This winter, the Syrian government regained control over the entire city of Aleppo. For years before that, it was the largest urban stronghold of anti-regime rebels. Over those years, there were countless government bombings, and the city was reduced to rubble.

The documentary Last Men In Aleppo, by Syrian filmmaker Feras Fayyad, takes viewers inside the city. “I grew up in the countryside of Aleppo,” he says. “And Aleppo — it’s my city, where I know every single street and every single store.”

In 2015 and 2016, Fayyad and his crew followed a group of self-appointed rescue workers called White Helmets. The film has been nominated for an Oscar in the documentary category, making it the first Syrian film to receive that honor.


Interview Highlights

On the experience of filming his city while it was being destroyed

It’s very painful on one level, but on [another] level it’s put me in the position of responsibility. … This is a story [that] could be writing the history and save the evidence for what’s happened in this period of time in our human history.

On the deliberate, repetitive nature of some scenes

I tried to tell the story as a nightmare for this people — like, sleeping, waking up, seeing the same things and there’s no solution. And they try different ways to face that. You see that it’s like the bomb is repetition, again and again. And I try to [use] the camera … to witness what they saw, and the ugly side and the [beautiful] side. But watching the [beautiful] side, it’s kind of discovering through the eyes of the character what’s making them stay, from where they get their inspiration to [resist] and stay in this city.

On why the White Helmets stay

Actually, it’s like a philosophy question, a big philosophy question for all of us when we face a lot of pressure from our government, from the war, from anything. We find ourselves under pressure to leave. But there’s something … [that makes] them resist this decision of leaving. And this is a story — it’s about the common inner-conflict between your personal survival and what you can do for your community through what you have. They stay because they feel that, what they can do, it makes sense. They save almost 100,000 civilians. Just imagine if these people left … their city.

On what happened to the family of White Helmet Khaled Omar Harrah after he died

After he [was] killed, his wife with his two daughters, they moved outside of Aleppo to [another] part of Syria, and hopefully they are safe. There’s no real safe place in Syria, but there’s a place less dangerous than the others. And the wife of Khaled, she was pregnant, and she had the baby and called it Khaled also.

Fatma Tanis and Jessica Deahlproduced and edited the audio of this interview. Sydnee Monday and Nicole Cohen adapted it for the Web.

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No One's Quite Sure Why Lassa Fever Is On The Rise In Nigeria

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No One's Quite Sure Why Lassa Fever Is On The Rise In Nigeria

A vendor in Lagos pushes his cart past a tray of garri, a powdery foodstuff made from cassava that can be eaten or drunk. During dry season, rats scavenge for food and can spread Lassa fever by defecating or urinating in foods like garri.

Pius Utomi Ekpei /AFP/Getty Images

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Pius Utomi Ekpei /AFP/Getty Images

Nigeria is tough on diseases.

With help from a few partners, it stopped Ebola’s spread. It wrestled guinea-worm disease into a headlock, with no new cases since 2013. And it’s nearly eradicated the transmission of polio.

But now a disease that usually just lurks in the background has roared into headlines. Since the beginning of the year, there’s been a particularly large outbreak of Lassa fever in Nigeria’s southern provinces.

As of February 18, the Nigeria Centre for Disease Control (NCDC) reports 913 cases of Lassa fever and 73 deaths. That’s compared with 733 cases and 71 deaths in all of 2017.

“Everyone is scared,” says Oyewale Tomori, a retired professor of virology who chairs the Lassa Fever Eradication Committee of Nigeria.

Lassa fever, named for the Nigerian town where it was discovered in 1969, generally breaks out during the dry season, between October and early March. It’s not clear why this year’s outbreak is bigger than usual.

So along with treating the mounting numbers of patients, Nigeria is trying to prevent the disease’s spread. The NCDC is following up with 1,747 people who encountered patients ill with Lassa fever to try to diagnose cases early and prevent more infections.

The World Health Organization has also stepped in. “The high number of Lassa fever cases is concerning. We are observing an unusually high number of cases for this time of year,” Dr. Wondimagegnehu Alemu, WHO representative to Nigeria, said in a statement. WHO has sent 20 people to Nigeria to support NCDC and shipped 40 boxes of face masks and goggles to hospitals to protect anyone in close contact with patients, says Tarik Jasarevic, a WHO spokesperson.

True to its name, Lassa fever starts out with a fever, along with a general feeling of weakness. Symptoms come on gradually and can include headache, sore throat, muscle and chest pain, vomiting, diarrhea, coughing and stomach pain.

The most severe cases can cause facial swelling, fluid in the lungs and bleeding from the mouth, nose, vagina or gastrointestinal tract.

Of patients who are hospitalized, 10 to 15 percent die from the virus. But many people contract the Lassa virus and develop antibodies against it without becoming ill.

The seasonal outbreaks reflect the source of the disease: It’s a virus that jumps from the rat Mastomys natalensis to humans. West Africa’s dry winters push rodents closer to people to scavenge for food. Virus-carrying rats may defecate or urinate in grains and other food; people can pick up the virus from contact with contaminated products. The virus can also spread between people via bodily fluids.

And there are a lot of rats – which means there’s a lot of potential for outbreaks, says Lina Moses, a global health researcher at Tulane University. “If you compare this to the Ebola epidemic from 2014-2016, that likely came from one animal to spill over into the human population,” Moses says. “So in terms of control [Lassa fever] is much more challenging.”

Nigeria isn’t the only country that’s worried. The rats that spread Lassa fever are native to many regions of West Africa. Nigeria’s news has pushed Ghana’s Health Services to caution health-care providers about Lassa fever, but no cases have appeared there. On February 8, Guinea reported the first death from Lassa fever since 1996. The Guinean victim, who didn’t appear to infect anyone else, died after traveling into Liberia – a reminder of how easily diseases can cross borders.

A general uptick in Lassa fever cases isn’t totally surprising, Moses says. The Ebola epidemic led to improved labs and diagnostic testing across West Africa. Doctors use the same blood tests to identify Ebola as they do for Lassa fever.

But better diagnostics don’t entirely explain the 2018 caseload. With about a month left in the dry season, reported cases have increased each week so far.

The faster diagnoses do, however, give health workers a chance to start the treatment that generally works against Lassa fever — IV infusions of the antiviral drug Ribavirin. That works best when administered within the first six days of the fever’s onset.

The IV treatment requires patients to stay in a hospital for around a week, which puts health-care workers at risk of infection. In the current outbreak, 18 health-care workers have been diagnosed with Lassa fever, and four have died.

To protect Nigerians, health officials are urging people to keep food in sealed containers so rats can’t get to it and to keep garbage as far from homes as possible to keep rats away.

Moses is concerned that the rise in cases could be part of a trend. In a paper she published in 2016, she looked at the way the rat that carries Lassa fever interacts with humans. Examining data on climate change, population growth and land use, she suggests that the annual number of Lassa fever cases could potentially double by 2070.

In order to handle future outbreaks, it’s important to investigate the causes of this current outbreak, she says. But there’s a concern among public health officials that momentum will fade once the rainy season begins.

“When the rains come, the numbers go way down and people forget about it again,” says the virology professor Oyewale Tomori.

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Trump Declares New Shipping Sanctions On North Korea

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Trump Declares New Shipping Sanctions On North Korea

President Trump speaks on the South Lawn of the White House on Friday shortly before he announced new sanctions against North Korea. The measures are designed to prevent shipping companies from evading existing measures by sending prohibited goods to the country.

Andrew Harnik/AP

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Andrew Harnik/AP

President Trump on Friday announced a fresh round of sanctions against North Korea in an attempt to block oil and other prohibited products from getting to the Asian nation.

“We have imposed the heaviest sanctions ever imposed,” Trump said at the conclusion of his speech to the Conservative Political Action Conference in Oxen Hill, Md., just outside Washington. “Hopefully, something positive can happen. We will see.”

More than 50 ships and shipping companies were cited by the Treasury Department for evading existing U.S. and international sanctions. While most of those name were based in North Korea, companies and ships from China, Singapore, Taiwan, Panama, Tanzania, the Marshall Islands and the Comoros were also included.

The measures are part of the administration’s “maximum pressure campaign” on North Korea and are designed to put pressure on the country for its expanding nuclear weapons program.

Despite the ongoing efforts by the U.S. administration, North Korean leader Kim Jong Un has insisted his country will never give up the nuclear program and has been making rapid advances over the past year.

The latest U.S. steps come at a moment when North Korea and South Korea have experienced a slight thaw in relations linked to the Winter Olympics in Pyeongchang, South Korea. Senior North Korean figures have visited and met South Korean leaders.

Trump’s daughter and adviser, Ivanka Trump, is in South Korea for the closing ceremonies this weekend, but is not scheduled to meet any North Korean officials. Vice President Mike Pence attended the opening ceremonies two weeks ago, but pointedly ignored Kim’s sister, who was representing North Korea and seated right behind him.

In this photo released by the U.S. Treasury Department, the North Korean vessel KUM UN SAN 3 (left) conducts a ship-to-ship transfer with the Panama-flagged KOTI on Dec. 9. The Treasury Department, which announced new sanctions on Friday, says this transfer shows North Korea’s efforts to evade sanctions.

U.S. Treasury Department

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U.S. Treasury Department

Because North Korea is so heavily sanctioned, it was not immediately clear what impact additional punitive measures might have.

However, United Nations measures in recent months have ramped up economic pressure and made it more difficult for North Korea to import oil and other essential products. For example, North Korea now faces a cap on the oil it can import.

Senior administration officials who briefed reporters said North Korean oil imports are down by nearly 90 percent in recent months.

North Korea was attempting to make up the difference and evade sanctions by hiding the identity of its ships and conducting ship-to-ship transfers on the open seas, officials said.

The U.S. is working with allies, including South Korea and Japan, as well as the global shipping community. The new measures are designed to disrupt the current sanctions-busting efforts and impose additional costs on North Korea, the U.S. officials said.

North Korea depends on oil imports, while coal is its most valuable export.

China is North Korea’s largest trading partner, and Beijing has agreed to scale back some economic ties. However, several Chinese companies were cited for busting sanctions on the latest U.S. list.

The Treasury Department released photos showing what it said was false identification information painted on North Korean ships, and examples of ship-to-ship transfers.

The companies and ships named by the Treasury Department are barred from doing business with the United States.

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Amnesty International Finds Human Rights Deteriorating Around The World

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Amnesty International Finds Human Rights Deteriorating Around The World

Bangladesh’s Home Minister Asaduzzaman Khan (second from right) receives Myanmar’s Home Minister Kyaw Swe (second from left) in Dhaka on Feb. 16. A human rights report criticizes Myanmar’s treatment of Rohingya Muslims. But in presenting the findings, Amnesty officials said Bangladesh’s action to accept the Rohingya refugees, a rare bright light in a year of worsening human rights violations.

AP

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AP

Amnesty International released its annual report Thursday, highlighting a worsening of human rights worldwide.

The report covering 159 countries claims that increasingly world leaders are “undermining the rights of millions,” either by turning a blind eye to violations of human rights or by perpetrating them.

Amnesty cites Philippines President Rodrigo Duterte whose anti-drug campaign has left thousands of people dead; Russian President Vladimir Putin whose government has tried anti-corruption protestors on “politically motivated charges;” and President Xi Jinping of China where Nobel Laureate Liu Xiaobo died in custody, Internet controls were strengthened, and “repression” conducted under ‘counter-terrorism’ campaigns remained “particularly severe” against the Uighur minority and Tibetans.

Amnesty decried a lack of leadership on human rights, pointing to the “feeble response” to war crimes and crimes against humanity from Syria to South Sudan.

It warned that the U.S. had taken “a step backward,” saying that the Trump administration’s early attempts in 2017 to ban all citizens of several Muslim majority countries was “transparently hateful,” and “set a dangerous precedent” for other governments to follow.

Amnesty Senior Director for Global Operations Minar Pimple, however, noted that populism and the “politics of demonization” is a trend that began before Trump took office. Brexit and Turkey’s crackdown on dissent preceded the 2016 U.S. election.

Across Europe, countries saw a gathering storm against refugees, migrants, and religious minorities and the use of counterterrorism measures “disproportionately restricting” rights in the name of security.

2017 saw France clamp down on protests. Poland threatened the independence of the judiciary. Hungry “reached a new low” automatically detaining asylum seekers, in breach of EU law. Germany, grappling with an influx of refugees from the Middle East and Afghanistan, reported more than 1,000 criminal offenses against refugees and asylum seekers.

But the epicenter of human tragedy this past year has been Myanmar in South East Asia. A society was “encouraged to hate, scapegoat and fear minorities,” culminating in the military “ethnic cleansing” of Rohingya Muslims, according to the report.

Rohingya fled the state of Rakhine, and streamed into Bangladesh in what was the “fastest growing crisis of 2017.” Estimates of the number of people displaced range from 655,000 to more than 800,000.

Across the globe, Amnesty said the past year showed what happens when the “politics of demonization become mainstream.”

In India, Amnesty notes that religious minorities, especially Muslims faced “increasing demonization by hardline Hindu groups, pro-government media, and some state officials.” Mob violence by cow vigilantes intensified.

Amnesty said India, considered a “beacon” of democracy in the region, saw the space for its civil society continue to shrink, as authorities used repressive laws to stifle dissent, and press freedoms came under increasing attack.

Journalist Gauri Lankesh, a vocal critic of Hindu nationalism, was shot dead outside her home. Freedom of expression on college campuses “remained under threat.”

The report states that India made efforts to expel an estimated 40,000 Rohingya refugees and send them back to Myanmar.

Bangladesh, however, was called a hopeful sign in a year when the global human rights record deteriorated. The tiny, impoverished South Asian nation welcomed the great mass of Rohingya refugees into the country. However, the report also says many of the refugees lived in squalid conditions, malnutrition was rife, and inadequate protection exposed woman and girls to heightened risk of sexual violence and human trafficking.

The crisis continues: new satellite images show that Myanmar authorities are bulldozing “scores of depopulated Rohingya villages,” according to Human Rights Watch, and it calls on the country’s donors to demand it stop. HRW says the areas must be preserved, in order that investigators can “properly evaluate the evidence” to help identify those responsible for the “atrocities.”

Amnesty’s Regional Director for South Asia Biraj Patnaik says India “has lost the moral high ground,” and that China has stepped in to fill the vacuum left by India’s retreat on human rights. For example, he says it was China that ultimately helped Myanmar and Bangladesh negotiate an agreement under which the Rohingya would be repatriated.

But China has said that there is no one-size-fits-all standard for human rights, that countries are free to follow their own standards. “Countries can find their own models of human rights protection in light of their national conditions and people’s needs,” Chinese Foreign Minister Wang Yi recently said.

Accordingly, Patnaik sharply criticized the Beijing-brokered accord for failing to adequately safeguard the Rohingya in line with human rights principles: “It does not guarantee safe, dignified, voluntary, or sustainable returns. It does not guarantee that the Rohingya would not be sent back to the same conditions that they fled from.”

Amnesty points out that China has managed to head off criticism inside the U.N. of its own crackdown on lawyers and activists. In June, Greece, a recipient of Chinese investment, blocked an EU statement critical of China’s rights record, calling it “unconstructive.”

As the report documents the “bitter fruit” of deteriorating worldwide human rights, the year was not without human rights victories.

Amnesty says the #MeToo has elevated the issue of harassment and discrimination against women into a global phenomenon.

Young people have showcased the growing influence of social movements, be it raising their voices against attacks on minorities in India or marching against gun violence in the United States.

Secretary General of Amnesty International Salil Shetty said, “There is a palpable sense that protest movements are on the rise globally.”

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Amnesty International Finds Human Rights Deteriorating Around The World

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Amnesty International Finds Human Rights Deteriorating Around The World

Bangladesh’s Home Minister Asaduzzaman Khan (second from right) receives Myanmar’s Home Minister Kyaw Swe (second from left) in Dhaka on Feb. 16. A human rights report criticizes Myanmar’s treatment of Rohingya Muslims. But in presenting the findings, Amnesty officials said Bangladesh’s action to accept the Rohingya refugees, a rare bright light in a year of worsening human rights violations.

AP

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AP

Amnesty International released its annual report Thursday, highlighting a worsening of human rights worldwide.

The report covering 159 countries claims that increasingly world leaders are “undermining the rights of millions,” either by turning a blind eye to violations of human rights or by perpetrating them.

Amnesty cites Philippines President Rodrigo Duterte whose anti-drug campaign has left thousands of people dead; Russian President Vladimir Putin whose government has tried anti-corruption protestors on “politically motivated charges;” and President Xi Jinping of China where Nobel Laureate Liu Xiaobo died in custody, Internet controls were strengthened, and “repression” conducted under ‘counter-terrorism’ campaigns remained “particularly severe” against the Uighur minority and Tibetans.

Amnesty decried a lack of leadership on human rights, pointing to the “feeble response” to war crimes and crimes against humanity from Syria to South Sudan.

It warned that the U.S. had taken “a step backward,” saying that the Trump administration’s early attempts in 2017 to ban all citizens of several Muslim majority countries was “transparently hateful,” and “set a dangerous precedent” for other governments to follow.

Amnesty Senior Director for Global Operations Minar Pimple, however, noted that populism and the “politics of demonization” is a trend that began before Trump took office. Brexit and Turkey’s crackdown on dissent preceded the 2016 U.S. election.

Across Europe, countries saw a gathering storm against refugees, migrants, and religious minorities and the use of counterterrorism measures “disproportionately restricting” rights in the name of security.

2017 saw France clamp down on protests. Poland threatened the independence of the judiciary. Hungry “reached a new low” automatically detaining asylum seekers, in breach of EU law. Germany, grappling with an influx of refugees from the Middle East and Afghanistan, reported more than 1,000 criminal offenses against refugees and asylum seekers.

But the epicenter of human tragedy this past year has been Myanmar in South East Asia. A society was “encouraged to hate, scapegoat and fear minorities,” culminating in the military “ethnic cleansing” of Rohingya Muslims, according to the report.

Rohingya fled the state of Rakhine, and streamed into Bangladesh in what was the “fastest growing crisis of 2017.” Estimates of the number of people displaced range from 655,000 to more than 800,000.

Across the globe, Amnesty said the past year showed what happens when the “politics of demonization become mainstream.”

In India, Amnesty notes that religious minorities, especially Muslims faced “increasing demonization by hardline Hindu groups, pro-government media, and some state officials.” Mob violence by cow vigilantes intensified.

Amnesty said India, considered a “beacon” of democracy in the region, saw the space for its civil society continue to shrink, as authorities used repressive laws to stifle dissent, and press freedoms came under increasing attack.

Journalist Gauri Lankesh, a vocal critic of Hindu nationalism, was shot dead outside her home. Freedom of expression on college campuses “remained under threat.”

The report states that India made efforts to expel an estimated 40,000 Rohingya refugees and send them back to Myanmar.

Bangladesh, however, was called a hopeful sign in a year when the global human rights record deteriorated. The tiny, impoverished South Asian nation welcomed the great mass of Rohingya refugees into the country. However, the report also says many of the refugees lived in squalid conditions, malnutrition was rife, and inadequate protection exposed woman and girls to heightened risk of sexual violence and human trafficking.

The crisis continues: new satellite images show that Myanmar authorities are bulldozing “scores of depopulated Rohingya villages,” according to Human Rights Watch, and it calls on the country’s donors to demand it stop. HRW says the areas must be preserved, in order that investigators can “properly evaluate the evidence” to help identify those responsible for the “atrocities.”

Amnesty’s Regional Director for South Asia Biraj Patnaik says India “has lost the moral high ground,” and that China has stepped in to fill the vacuum left by India’s retreat on human rights. For example, he says it was China that ultimately helped Myanmar and Bangladesh negotiate an agreement under which the Rohingya would be repatriated.

But China has said that there is no one-size-fits-all standard for human rights, that countries are free to follow their own standards. “Countries can find their own models of human rights protection in light of their national conditions and people’s needs,” Chinese Foreign Minister Wang Yi recently said.

Accordingly, Patnaik sharply criticized the Beijing-brokered accord for failing to adequately safeguard the Rohingya in line with human rights principles: “It does not guarantee safe, dignified, voluntary, or sustainable returns. It does not guarantee that the Rohingya would not be sent back to the same conditions that they fled from.”

Amnesty points out that China has managed to head off criticism inside the U.N. of its own crackdown on lawyers and activists. In June, Greece, a recipient of Chinese investment, blocked an EU statement critical of China’s rights record, calling it “unconstructive.”

As the report documents the “bitter fruit” of deteriorating worldwide human rights, the year was not without human rights victories.

Amnesty says the #MeToo has elevated the issue of harassment and discrimination against women into a global phenomenon.

Young people have showcased the growing influence of social movements, be it raising their voices against attacks on minorities in India or marching against gun violence in the United States.

Secretary General of Amnesty International Salil Shetty said, “There is a palpable sense that protest movements are on the rise globally.”

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Synergy Between Nurses And Automation Could Be Key To Finding Sepsis Early

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Synergy Between Nurses And Automation Could Be Key To Finding Sepsis Early

Rosemary Grant is a registered nurse and helps coordinate sepsis care at Harborview Medical Center in Seattle. The center’s goal, she says, is to get a patient who might be developing sepsis antibiotics within three hours.

Ian C. Bates for NPR

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Ian C. Bates for NPR

A quarter of a million Americans die every year from sepsis, which is the body’s reaction to overwhelming infection. This cascade of organ failure can be nipped in the bud if health care workers know it’s ramping up, but that’s often not easy to do.

“Sepsis is a really frustrating disease,” says Dr. David Carlbom, a critical care pulmonologist, and medical director of the sepsis program at the Harborview Medical Center in Seattle. “There’s no blood test for sepsis,” he says. “There’s nothing you can look at under the microscope and say ‘this is sepsis.’ “

So a few years ago, Carlbom set out to devise a system that uses more subtle clues from a patient’s day-to-day electronic health records to send up warning flags of impending sepsis.

The automated system looks for patterns in symptoms like high temperature, low temperature, low blood pressure, fast breathing and high white-blood-cell counts. No single symptom signals sepsis, but certain patterns suggest this condition could be emerging.

Rosemary Grant, a registered nurse who coordinates sepsis care at Harborview, explains how it works as we stand at a nursing station in the hospital.

The previous day, a red box appeared on a computer screen next to the name of a patient who had been hospitalized for several weeks following a motorcycle accident. The computer prompted the nurse responsible for that patient to assess whether his constellation of symptoms was an early sign of sepsis.

“If the nurse says yes, then the provider is automatically paged, out of the computer system,” Grant says.

The doctor is supposed to respond within half an hour, she says, and the overall goal is to get a patient who might be developing sepsis antibiotics within three hours.

But faster breathing might also be due to a walk down the corridor, and having an elevated number of white blood cells is not a reliable sepsis indicator in someone with cancer. Given the general nature of these symptoms, most of the time the nurse will report that the alert is just a false alarm.

Once one alarm is triggered, nurses aren’t notified again for 12 hours, Grant adds — and that helps reduce the number of annoying false alarms the hospital staff must handle.

If the nurse says it’s not sepsis, Grant says, “then the computer system just asks ‘why do you think the patient has these abnormal vital signs?’ “

The nurse may type in that the patient’s heart rate was up because he was exercising, or has a high pulse because she’s in pain. It’s a partnership between the automation and the human being. And while systems like this are increasingly common in hospitals, the synergy between nurses and computers is a hallmark of the Seattle program.

“Just having the nurses really being in tune with their patients is really what makes the system work,” Grant says. And it is working, she says. Since the system was installed in 2011 — and updated in 2017 — hospital mortality has fallen.

We head over to the room of the injured 34-year-old motorcyclist to see how he’s doing. Matthew Clark says his world changed on Jan. 15, when he had an unfortunate encounter with a car.

“I was just on the way to make some chicken chili for my girlfriend,” he says, “and a young distracted driver who wasn’t looking kind of plowed into me.” Two big bones in his left leg were broken, requiring a series of operations to set right.

But nine days after the accident, Clark got a clue his recovery was taking a turn for the worse when a friend came into his hospital room and he had trouble waving to her.

“I noticed my hands were shaking,” he says, “and my blood started to leave my hands and feet. I just looked at her and said ‘I need some help.’ “

The hospital’s internal 911 system responded with a team that, among other things, provided intravenous antibiotics to prevent his apparent infection from raging out of control and becoming septic shock.

“My temperature dropped incredibly,” he says. “I’d never been so cold or shook so hard in my life.”

And 24 hours later, he says, he was back to his old self.

In this case, the patient’s alert actually popped up on the computer screen long after the medical team had stepped in.

Dr. David Carlbom, a critical care pulmonologist at UW Medicine’s Harborview Medical Center, says sepsis has long frustrated clinicians. “There’s no blood test,” he says. “There’s nothing you can look at under the microscope and say ‘this is sepsis.’ ”

Ian C. Bates for NPR

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Ian C. Bates for NPR

“I think his case is a great example of action happening before the computer catches up,” Carlbom says. “The vital signs are measured and dealt with at the bedside before they’re entered into the computer.”

In fact, that need to enter vital signs manually into the electronic medical record is a shortcoming of this system. The computer may be ever vigilant for signs of infection, but it only gets new data to crunch a few times a day.

This isn’t simply an issue for the system at Harborview — it’s a shortcoming for automated sepsis-detection programs elsewhere. Medical researchers are actively working to close that gap, says Dr. Matthew Churpek at the University of Chicago.

“We’re partnering now with a company that has a device that goes under a patient’s mattress and can continuously calculate their heart rate and respiratory rate in real time,” Churpek says.

His team and others are also working on more accurate computer algorithms, to reduce the number of false alarms that are a problem both in Seattle and in similar systems around the country.

Doctors have struggled to find a good treatment for sepsis. For example, last year Dr. Paul Marik announced that a protocol involving intravenous vitamin C, niacin and steroids dramatically reduced the number of sepsis deaths in his hospital’s intensive care unit in Norfolk, Va. That unproven treatment has just begun to be studied in a series of careful clinical trials.

Carlbom uses that experimental therapy sometimes, but says it would be much better to prevent the condition.

“We use all these therapies in the ICU as a rescue tool when people are very sick dying of septic shock,” he says, “but I think early discovery will probably affect mortality more.”

You can contact Richard Harris via email: rharris@npr.org.

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The Miracle Of Cataract Surgery: The Blind Can See Again

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The Miracle Of Cataract Surgery: The Blind Can See Again

Ahmed Ali, the day after his cataract surgery. He has just had the bandages removed from his eyes and can see again. Ali, 75, was blind for 5 years.

Jason Beaubien/NPR

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Jason Beaubien/NPR

The blind have descended in droves on the Bisidimo Hospital in Eastern Ethiopia.

The Himalayan Cataract Project is hosting a mass cataract surgery campaign at the medical compound that used to be a leper colony. For one week a team from the nonprofit has set up seven operating tables in four operating rooms and they’re offering free cataract surgery to anyone who needs it.

Dr. Bitania Asfaw, a general practitioner at Bisidimo Hospital in Ethiopia, gives a tour of the waiting area for cataract patients.

Source: NPR

Credit: Jason Beaubien/NPR

On the first day of the campaign it’s clear that the need is great.

“We have like 700 or 800 patients already in the compound and many more appointed for tomorrow and the day after and the day after that,” says Teketel Mathiwos, the Ethiopian program coordinator for the Himalayan Cataract Project.

After cataract surgery to restore his sight, this man can now read his medical chart. Other patients behind him are about to have the bandages removed from their eyes.

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People hoping to get their sight restored are jammed into the compound’s main courtyard. Others spill out of an office where optometrists are prepping patients for surgery. The line to get into the actual operating theater extends all the way out of the building, up along a covered walkway and then loops around the corner of another medical building. More still are standing outside the hospital gates.

Mathiwos says some patients may have to wait a day or two for the procedure.

“They have tents here,” Mathiwos says. “We give them the food to eat and we try to take care of them as best as we can.”

Some of the patients at the Bisidimo Hospital have only one milky eye. Others are blind in both eyes.

These patients underwent surgery as part of a campaign run by Himalayan Cataract Project at the Bisidimo Hospital in Ethiopia. The bandages are removed the day after the procedure. Surgeons performed more than 1,600 cataract surgeries during a six-day event in December.

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A cataract is a condition where the natural lens in a person’s eye grows opaque. There are various things that can cause cataracts including an injury to the eye or too much exposure to bright sunlight. Some research suggest vitamin deficiencies can be a factor. Cataracts usually develop slowly and are most common in people later in life. Surgery to repair cataracts consists of removing the damaged lens from a patient’s eye and replacing it with a clear, plastic one.

Dr. Matt Oliva, an ophthalmologist from Oregon, is peering through a microscope as he makes a small incision in the top of the eye of a patient on the operating table in front of him.

A look at the operating room where cataract surgery is taking place.

Credit: Jason Beaubien/NPR

“This is a gigantic one,” Oliva says he tries to maneuver the gray cataract out of the slit he just made in the patient’s eye. The cataract looks like an opaque contact lens as he plucks it out from behind the cornea. Oliva is decked out in the traditional green medical scrubs you’d expect to see in an operating room except he’s wearing the bathroom flip-flops from his hotel. Ethiopian customs seized his suitcase at the airport, accusing him of carrying too much medical equipment. Eventually the officials released his luggage but not until after he’d had to improvise his outfit for a few days.

A patient awaiting cataract surgery at the Bisidimo Hospital sits by a wall with strips of tape. After surgery, the tape, with the initials of the doctor, is used to hold the patient’s bandages in place. The number on the tape serves as a running tally of that doctor’s surgeries for the day.

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“The next thing is to put the new lens back into that exact same spot,” he says as he slides a tiny plastic lens into the incision.

“This is a lens that costs $4. It’s made out of a plastic material. It can’t go cloudy. The cataract can’t come back.”

The entire operation takes four minutes. Some more complicated cases take longer. It can be harder to work on a person with an extremely deep eye socket. Also if the patient has suffered from trachoma or some other eye disease in the past, the cataract surgery might take up to 20 minutes. But even then this is a relatively quick procedure.

Mohamed Arab raises his hand to indicate that he can see after his cataract surgery. He was previously blind in both eyes. Arab, who gives his age as 15, was one of the younger patients. Now that he can see he says he hopes to be able to go to school and study.

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“It doesn’t really cost very much money,” Oliva says, “and it’s insane that there’s so many people waiting around for cataract surgery, people that could have their sight restored by a simple and inexpensive operation.

Oliva has been a board member of the Himalayan Cataract Project for more than a decade. He regularly does mass surgical campaigns in Asia and parts of sub-Saharan Africa.

Three local surgeons are working in the adjacent rooms, and three residents are shadowing the team. Together they can remove and replace as many as 300 cataracts a day.

But Dr. Mulu Lisanekwork, an ophthalmologist from Addis Ababa who’s working on the campaign, says the number of people with untreated cataracts in Africa is huge. Ethiopia has just over 100 eye doctors — roughly 1 for every million residents. Lisanekwork says all this untreated blindness contributes to poverty in her country.

“People stop being productive when they get cataracts. And productive people are less productive because they have to take care of their blind family members,” Lisanekwork says.

Once the surgery is finished, the patient’s eye is covered with a gauze bandage. A family member or another caregiver leads the patient to a shaded part of the hospital grounds to rest and sleep off the local anesthesia.

The next morning all the post-op patients gather on long benches in the courtyard of the hospital. Doctors and nurses move from one patient to the next, removing bandages and checking the eyes to make sure there isn’t excessive bleeding or other complications.

As Dr. Oliva pulls off the gauze covering Alimi Hassen’s eyes, the 80-year-old leaps from the bench as if startled by an apparition, startled that this operation really worked.

Hassen twirls around to take in the scene in the courtyard. As Oliva laughs, Hassen hugs the doctor. Hassen had been blind for 7 years.

Alimi Hassen, 80, had been blind for 7 years. After his eyesight was restored, he hugs his surgeon, Dr. Matt Oliva from the Himalayan Cataract Project.

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The women next to him, their eyes still covered, begin ululating.

Women sing to celebrate successful cataract surgery.

Credit: Jason Beaubien/NPR

As more and more bandages are peeled off, family members of the patients start singing and dancing in the courtyard. Several patients experiment with putting a hand over one eye, then the other, checking out their restored sight.

Oliva says the entire cost for this event — including paying staff, renting equipment, transporting patients back and forth to their villages — breaks down to just $75 per patient.

He calls cataract surgery the low-hanging fruit of international health. The Himalayan Cataract Project started working in Nepal in the 1990s and now hopes to tackle the leading cause of blindness in sub-Saharan Africa.

The HCP was a semi-finalist last year for the MacArthur Foundation’s 100&Change competition, a search to find a group delivering bold solutions to one of the world’d most critical problems. (The $100 million prize went to Sesame Workshop and the International Rescue Committee to educate displaced kids in the Middle East.)

The World Health Organization estimates that more than 2 million people in Africa have lost their sight due to cataracts.

Amina Ahmed at home in Oromo, Ethiopia. Before having cataracts removed from both her eyes, she had been blind for four years.

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Amina Ahmed was one of them. For her cataract surgery was transformational. The 60-year-old Ahmed had been totally blind for four years. She heard about the mass cataract surgery campaign on the radio and decided to go.

“When I went to the hospital I couldn’t see and now I can see everything,” Ahmed beams after returning home. “I’m very happy. I can see the faces of everybody.”

She shares a one-room mud-walled structure with several generations of relatives. There’s no electricity. The kitchen is out front around an open fire pit. The toilet is a wooden latrine at the opposite end of the family’s small, dusty plot.

Her 2-year-old great-grandson, wearing a torn t-shirt and no pants, jumps into Ahmed’s lap to welcome her home.

“Initially I could only hear his voice and I knew him through his voice,” she says. “Now I can see his face.”

Ahmed’s grown children are overjoyed that she can see once again. Her daughter, Zeyneba, says it was very hard to take care of Ahmed in recent years.

“It was very difficult to take care of her,” she says. “Even if we left her in the house she wouldn’t be able to see who is coming and going.”

Earlier at the hospital Dr. Oliva had mentioned that in Nepal blind people are at times called a “mouth with no hands” because they have to be fed but can’t work.

Ahmed’s niece, Asha Yussuf, says they had to watch Ahmed constantly and even keep the chickens away from her.

“The chickens come, they drink her tea, they steal her food,” she says with a laugh.

But the simple cataract surgery has changed all that. So those thieving chickens need to look out.

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U.S. Women's Hockey Trails Canada 2-1 In Gold Medal Final

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U.S. Women's Hockey Trails Canada 2-1 In Gold Medal Final

Canada’s Jennifer Wakefield tries to get the puck past USA’s goalie Maddie Rooney in the women’s gold medal ice hockey match between Canada and the U.S. at the Pyeongchang 2018 Winter Olympic Games.

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Updated at 12:35 a.m. ET

The U.S. women’s hockey team has their hands full in trying to break Canada’s grip on the gold medal at the Pyeongchang Winter Olympics. Facing their archrival, the U.S. struck first, late in the first period, and Canada tied it early in the second — and went ahead minutes later. After two periods, the score was 2-1.

The game began at 11:10 ET, Wednesday night. We’re updating this post with news from Gangneung Hockey Arena.

The first goal came on a laser shot by Hilary Knight. The U.S. brought the puck out from behind goal, and Knight worked her way up to the left faceoff circle before unleashing a low hard shot that glanced off a Canadian player and eluded Lacasse. It bounced inside off the far side of the netting and landed as the U.S. crowd erupted.

Canada’s Haley Irwin equalized the score minutes into the second period, putting away a breakaway that brought loud cheers from the Canadians’ fans.

Marie-Philip Poulin gave Canada the lead minutes later, scoring in a rush on the American goal. It was quick redemption for Poulin, who had emerged from the penalty box moments earlier. The score came with 13:05 left in the second period.

Knight nearly leveled the score with a hard and long shot from the right flank — but the puck was deflected and caught by Canada’s goalie, Genevieve Lacasse.

Canada had a chance to build a 3-1 lead moments later, after U.S. player Sidney Morin was penalized for an illegal hit. The Canadians worked the puck down around the goal, setting up a frenzy of shots and blocks — and the Americans managed to escape with the score intact.

The U.S. strategy, as preached by coach Robb Stauber, is to pound the goal with shots. The Americans did that from the start and finished the first two periods with a 22-16 lead in shots on goal.

The Americans got a power play opportunity nearly midway through the first period, but they were not able to convert it into a score. That came after Canada’s Jennifer Wakefield lowered her shoulder to level American Dani Cameranesi along the boards – a sign that this would indeed be a physical matchup. Wakefield was put in the penalty box for an illegal hit.

As happens between two rivals who know each other all too well, there were chippy moments. Away from the action late in the first period, Sarah Nurse slashed her stick down hard in the open ice, knocking the stick out of her U.S. opponent’s hands. The sizeable Canadian fanbase in attendance booed in protest as Nurse was put in the penalty box.

In the preliminary games before the start of the elimination round, Canada beat the U.S., 2-0 — despite the Americans firing more shots on goal, 45-23. That game was a very physical clash, including a scrum around the Canadian goal that took two referees to break up; before it was over, one of Canada’s players had lost her helmet.

In a bit of good news for the U.S. team, its star forward Hilary Knight broke her scoring drought at these Olympics in the semifinal against Finland that put them into this gold-medal match. But the U.S. will have to contend with Canada’s Meghan Agosta, who has 17 career goals at the Winter Games – second all-time. Agosta has won three gold medals.

The American women won the very first Olympic hockey tournament, in 1998. But that was 20 years ago. Since then, Canada has won every time. And often, it’s been at the Americans’ expense: today marks the fifth time the U.S. and Canada have met to decide who gets gold and who gets silver.

The U.S. women have had great success in the World Championships during Canada’s run in the Olympics. But the Americans suffered a heartbreaker in Sochi in 2014, when Canada won the gold medal match in overtime.

Players on both teams say things are different now, and that they’re hungry to win the title. They’re also saying this game will be intense and physical.

The U.S. and Canada are the only two teams to have ever won an Olympic gold medal in women’s hockey. And while the start time in the U.S. falls on Wednesday night, this year’s title game is taking place on Feb. 22 in South Korea — 38 years after the “Miracle on Ice” of 1980, when the U.S. men’s team upset the Soviet Union.

Canada’s streak of four consecutive team gold medals is second among all Olympic women’s events, trailing only the U.S. women’s basketball team, who have won six in a row (so far).

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After Long Drought, Has U.S. Olympic Long Track Speedskating Turned A Corner?

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After Long Drought, Has U.S. Olympic Long Track Speedskating Turned A Corner?

U.S. speedskaters Heather Bergsma, Brittany Bowe and Mia Manganello compete against Canada, winning bronze on Wednesday.

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When U.S. long track speedskaters Heather Bergsma, Brittany Bowe, Mia Manganello and Carlijn Schoutens won bronze Wednesday in the team pursuit event, they broke a Team USA drought. It was the first long track Olympic medal since the Vancouver Games of 2010.

U.S. speedskaters have always been a dominant force at competitions around the world, including the Olympics. But they performed poorly at the 2014 Sochi Games (some thought their suits might be partly to blame) — and got off to a slow start in Pyeongchang. With Wednesday’s bronze, coming after short track skater John-Henry Krueger’s silver in the 1,000-meter race on Saturday, hopes have grown for U.S. success at these games.

Before Pyeongchang, the U.S. earned a total of 67 Olympic long track speedskating medals, 29 of them gold. In fact, speedskating has produced more Olympic medals for the U.S. than any other winter sport. American speedskating legends include Eric Heiden, who took home five gold medals in 1980 alone; Bonnie Blair, who earned six medals over her Olympic career; and Dan Jansen, who had a dramatic gold medal victory in Lillehammer, Norway, in 1994.

U.S. successes continued through the early 2000s, as inline skaters came on the long track scene and brought home gold, silver and bronze. The drought began after Vancouver.

But perhaps the speedskaters have turned a corner. Here’s a closer look at what it’s like for U.S. athletes to compete in this uniquely demanding sport.

Crouching over while skating at 30 mph

Brittany Bowe of the United States (left) trails behind Ireen Wust of the Netherlands in the women’s 1,000-meter speedskating race in Sochi, Russia, in 2014. The U.S. team won no medals at Sochi.

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Speedskaters have to learn to skate in a deep crouch, balancing their entire weight on a long metal blade that is just 1.1 millimeters thick — about 4/100 of an inch, the thinnest blade of all sports on ice.

The burning pain in the legs and lower back after skating even one lap is enough to dissuade many enthusiasts from trying this sport again, much less clocking in a lap at under 40 seconds.

“It does feel exactly like you’re on fire,” John Coyle, a short track speedskater who won silver in the 1994 Winter Games, told NPR.

Imagine doing 25 laps crouched over for the 10,000-meter event.

The suits aren’t everything

Four years ago, in Sochi, U.S. speedskaters blamed their disappointing performance, in part, on their special skinsuits made by Under Armour. But those who watch the sport closely believe there were a number of other factors affecting performance, including the athletes’ worldwide travel schedule to compete at events at various altitudes and their overall fatigue leading up to the Sochi Games.

As soon as the team returned from Sochi, the skaters went back to the drawing board with Under Armour to redesign a suit that would cut out the doubt and give them an edge to win more races.

Together, they came up with the most aerodynamic, lightest, thinnest, most flexible skintight suit they could think of. They tweaked, ran multiple wind tests and came up with a design everyone was happy with well before entering the 2017-2018 season. The skaters have been wearing the new and improved skin suits for the better part of one year (though the suits’ crotch-highlighting design has raised eyebrows).

You can’t practice at the local rink

To be competitive in long track speedskating at an international level, you have to skate on a 400-meter track every day for at least nine to 10 months out of the year. Building technique and endurance is not achievable by going to the neighborhood skating rink or a nearby frozen pond.

Short track skating opportunities abound in many cities, but there are just a handful of long track ovals in the entire U.S. Two are indoors and are open most of the year; the rest are outdoors and open only during the winter months. The small number of rinks limits the number of people who might want to give the sport a try, much less pursue it seriously.

John-Henry Krueger of the United States (left), Yira Seo of Korea, Charles Hamelin of Canada and Samuel Girard of Canada compete in the short track 1,000-meter semifinals on Feb. 17. Krueger won silver.

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And that’s important, says former Olympic speedskater KC Boutiette, because “people don’t know what they’re good at until they’ve tried it.”

In 1993, Boutiette moved to Milwaukee to try long track speedskating at the Pettit National Ice Center. Four months later, he earned a spot on the U.S. Olympic team for the 1994 Lillehammer Games, and he went on to compete in the next three Olympics.

Someone who is committed to becoming a U.S. speedskater and getting a chance to compete in the Olympics must do what Boutiette did — move to either Milwaukee or Salt Lake City. The outdoor rinks are in Butte, Mont.; Lake Placid, N.Y.; and Roseville, Minn., but they are not facilities that tend to attract elite skaters.

“That is the break in the system,” says Patrick Quinn, a retired U.S. speedskater now with Chicago Sports and Entertainment, a consulting firm that also represents athletes.

A small talent pool

Since the last Winter Games, U.S. Speedskating adjusted its training strategy and travel schedule and invested in building state-of-the-art, data-driven training facilities in Salt Lake City and Milwaukee that closely monitor the athletes’ performance and recovery.

In preparation for the Pyeongchang Games, the U.S. Speedskating governing body also moved Olympic trials from the Utah Olympic Oval to the Pettit Center — a strategy that would better prepare the skaters to compete at lower altitudes, mirroring the Gangneung Oval in South Korea.

“U.S. Speedskating is doing everything they can within their power to make these athletes succeed,” says Boutiette. “Everyone is doing what they think is the right thing to do so they can be at their best.”

Still, “the biggest challenge is lack of depth in the talent pool,” says Quinn. “The limited resources at the grass-roots level limits the talent pool that can ultimately get to places where there are amazing facilities to become the best in the world.”

To date, the most successful recruitment of U.S. speedskating talent has been among inline skaters. Team USA in Pyeongchang includes six world-class inline skaters turned speedskaters.

But there’s starting to be a deficit in that talent pool, too.

“The majority of the new, young inline skaters who are crossing over to the ice have never been to an inline world championship or competed at an elite level,” says Derek Parra, who earned multiple world titles as an inline skater before making the transition to ice — and winning silver and gold in the 2002 Salt Lake City Olympics.

He now serves as sports director at the Utah Olympic Legacy Foundation, where he is working closely with U.S. Speedskating on programs to help increase the talent pool with more elite inline skaters. But, he warns, with declining popularity, “the inline talent pool is starting to dry out.” The U.S. did not win any medals at the world championship this past fall in Nanjing, China.

Limited public interest and sponsorship

In the U.S., public interest in long track speedskating tends to be at its highest every four years — during the Olympics. Usually, other sports like figure skating, snowboarding and short track speedskating, which are more exciting to watch, attract much more attention.

But indifference during the off years means it’s harder to lure sponsors to provide financial support for speedskaters — unlike, say, in the Netherlands, where there are up to eight professional teams and four times as many 400-meter ovals as in the U.S. In Holland, some 80 speedskaters train full time.

“The saying goes, the Dutch get paid on their way to possibly earning a medal and a U.S. skater might get some endorsements after winning a medal,” says Parra, who had to work at Home Depot part time to help fund his speedskating expenses while he was training for the Olympics.

“Top 10 is not a failure”

Despite the barriers of entry to the sport, limited funding and the small talent pool, “Our skaters routinely end up in the top 10, which is not bad, given the resources,” says Boutiette. “Top 10 is not a failure.”

The U.S. team has two long track events left in Pyeongchang. Shani Davis will compete Friday in the men’s 1,000-meter race. And on Saturday, all eyes will be on world record holder Joey Mantia, who is set to compete in the Mass Start — a new Olympic event with two dozen speedskaters all pushing and jostling through 16 laps around the track. Mantia has described it as “NASCAR on ice.”

Rolando Arrieta, a former inline skater turned long track speedskater, is NPR’s news production and operations manager.

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