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April 4th, 2012 posted by Paul Rega, MD, FACEP April 4, 2012 @ 8:10 pm

CDC: Multistate Outbreak of Salmonella Bareilly Infections; Sushi?????




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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 8:00 pm

Kenya Travel Warning



April 04, 2012

The U.S. Department of State warns U.S. citizens of the risks of travel to Kenya. U.S. citizens in Kenya, and those considering travel to Kenya, should evaluate their personal security situation in light of continuing and recently heightened threats from terrorism and the high rate of violent crime in some areas. The levels of risk vary throughout the country. This replaces the Travel Warning of November 4, 2011, to update information about the current security situation, and the potential impact of the refugee influx.

The U.S. government continues to receive information about potential terrorist threats aimed at U.S., Western, and Kenyan interests in Kenya, particularly after the death of Osama Bin Laden. Terrorist acts can include suicide operations, bombings, kidnappings, attacks on civil aviation, and attacks on maritime vessels in or near Kenyan ports. Although there have been recent gains in the pursuit of those responsible for previous terrorist activities, many of those involved remain at large and continue to operate in the region. Travelers should consult the Worldwide Caution for further information and details.

On September 11, 2011, a British national couple was kidnapped – and the husband murdered – at a coastal resort near the Kenya-Somali border. The motivation for these kidnappings is unclear, but the perpetrators took all of the hostages into areas of Somalia controlled by al-Shabaab, a designated terrorist organization, with links to al-Qaida. The British hostage was released unharmed on March 21, 2012. On October 1, 2011, a French national was kidnapped from a private residence on the popular tourist destination of Lamu Island on Kenya’s north coast. She died while in captivity in Somalia. On October 14, 2011, two Spanish nationals working for an NGO were kidnapped in Dadaab refugee camp, in northeastern Kenya. Kenya initiated military action against al-Shabaab by crossing into Somalia on October 16, 2011. Kenyan troops are now actively pursuing al-Shabaab in southeastern Somalia. Al-Shabaab has responded to the Kenyan incursion into Somalia by threatening retaliation against civilian targets in Kenya.

On October 24, 2011, a grenade exploded at a crowded Nairobi bus stop, leaving two dead and 16 injured. Another grenade exploded that night at a night club in downtown Nairobi, injuring 14 Kenyan patrons. On October 27, in northeastern Kenya, a vehicle carrying officials from the Ministry of Education was attacked, leaving four dead, and on October 28 a police vehicle was heavily damaged after driving over an explosive device. Responsibility for these incidents has not been determined, though an individual was sentenced on October 28 for his role in the grenade attack on the night club. On March 10, 2012, assailants threw four grenades at a busy bus station in Nairobi, killing nine and injuring more than 50 Kenyans.

As a result of these recent events and threats, U.S. government employees, contractors, grantees, and their dependents are prohibited from traveling to the Northeastern Province, including El Wak, Wajir, Garissa, Dadaab, Mandera, and Liboi. The travel restriction for Lamu has been lifted. However, the restriction remains in place for the coastal area north of Pate Island, including Kiwayu and north to Kiunga located on the Kenya/Somalia border.

Although these restrictions do not apply to travelers not associated with the U.S. government, U.S. citizens already in Kenya should take these restrictions into account when planning travel. The Embassy regularly reviews the security of these areas for possible modification.

Violent and sometimes fatal criminal attacks, including armed carjackings, home invasions/burglaries, and kidnappings can occur at any time and in any location, most particularly in Nairobi. U.S. citizens have fallen victim to such crimes within the past year. U.S. citizens in Kenya should be extremely vigilant with regard to their personal security, particularly in public places frequented by foreigners such as clubs, hotels, resorts, upscale shopping centers, restaurants, and places of worship. U.S. citizens should also remain alert in residential areas, at schools, and at outdoor recreational events.

U.S. citizens should use common-sense precautions, such as avoiding crowded bus stops or stations, visiting only legitimate businesses and tourist areas during daylight hours, using well-marked taxis, locking vehicles and lodging doors, carrying small amounts of cash and credit cards, wearing small amounts of jewelry, knowing emergency phone numbers, and being aware of your surroundings. These measures can help ensure your travel to Kenya is safe and enjoyable.

The drought affecting the Horn of Africa is causing thousands of people to pour across Kenya’s porous borders each week. With Kenya’s endemic poverty and the availability of weapons in the area, the result could be an increase in crime, both petty and violent. Kenyan authorities have limited capacity to deter or investigate such acts or prosecute perpetrators. Sporadic violence, protests, and clashes occur in and around Isiolo and Moyale, both in Eastern province. While this violence is not directed at foreigners, protests and tribal clashes are unpredictable, and U.S. citizens are advised to check conditions before traveling to these areas.

U.S. citizens should avoid demonstrations and political rallies of all kinds. Most political gatherings are peaceful, but they can turn violent without notice. In the run-up to the constitutional referendum in June 2010, six Kenyans were killed and 100 injured at a prayer meeting/political rally in Uhuru Park in downtown Nairobi. The next Kenyan presidential election is set to take place in early 2013.

U.S. citizens who travel to or reside in Kenya are urged to enroll in the Smart Traveler Enrollment Program (STEP) in order to receive the most up-to-date security information. By enrolling, U.S. citizens make it easier for the Embassy to contact them in case of emergency. U.S. citizens without Internet access may enroll directly with the U.S. Embassy in Nairobi.

The U.S. Embassy in Nairobi is located on United Nations Avenue, Gigiri, Nairobi, Kenya; telephone (+254) (20) 363-6000; fax (+254) (20) 363-6410. In the event of an after-hours emergency, the Embassy duty officer may be contacted at (+254) (20) 363-6000. Travelers may also consult the U.S. Embassy Nairobi website for more information.

U.S. citizens should also consult the Department of State’s Country Specific Information for Kenya, the Worldwide Caution, Travel Warnings, and Travel Alerts, which are all available on the U.S. Department of State’s, Bureau of Consular Affairs website. Travelers may obtain up-to-date information on security conditions by calling 1-888-407-4747 toll-free in the United States and Canada, or on a regular toll line at 1-202-501-4444 from other countries. Stay up to date by bookmarking our Bureau of Consular Affairs website which contains current Travel Warnings and Travel Alerts. Follow us on Twitter and the Bureau of Consular Affairs page on Facebook, and download our Smart Traveler iPhone App to have travel information at your fingertips.

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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 7:58 pm

Travel Warning for Mali



April 03, 2012

The U.S. Department of State warns U.S. citizens against all travel to Mali at this time because of current political instability in the country, an active rebellion in the north, and continuing threats of attacks and kidnappings of Westerners in the north of the country. The Department of State has authorized the departure of non-emergency personnel and all eligible family members of U.S. Embassy personnel. Malian mutineers have refused to return to their barracks, and rival rebel factions are battling each other for control in areas they have seized in the north. The situation in the country remains fluid and unpredictable. The U.S. Department of State urges U.S. citizens in Mali to consider their own personal security and contingency plans, including the option of temporarily departing Mali. This Travel Warning replaces the Travel Warning for Mali dated March 26, 2012, to update information on current events in Mali.

On April 2, The Economic Community of West African States (ECOWAS) imposed diplomatic, trade, financial, and border closure sanctions on Mali that will remain in place until further notice.

Senou International Airport in Bamako is currently open for business; however, the availability of flights in the future is unpredictable and depends on the overall security situation. U.S. citizens currently living in Mali are advised to temporarily depart the country in light of the current security situation. Persons wishing to depart the country should check with commercial airlines for the airport’s operational status and flight and seat availability before traveling to the airport.

U.S. citizens should note that the U.S. Embassy in Bamako has designated northern regions of Mali as “restricted without prior authorization” for purposes of travel by U.S. government employees, contractors, grantees, and their dependents. Prior to traveling to these areas, U.S. government employees in Mali are required to have the written approval of the U.S. Ambassador to Mali. This designation is based on an active Tuareg rebellion, the presence of Al-Qaeda in the Lands of the Maghreb (AQIM), as well as banditry in the region. These restrictions are in effect for the regions of Kidal, Gao, and Timbuktu, where separatist rebels now appear to have control.

U.S. citizens currently in Mali despite this Travel Warning are urged to enroll in the State Department’s Smart Traveler Enrollment Program (STEP). By enrolling, you make it easier for the U.S. Embassy to contact you in case of emergency.

U.S. citizens should consult the Country Specific Information for Mali and the Worldwide Caution, both located on the Department of State’s Bureau of Consular Affairs website. Current information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or a regular toll line at 1-202-501-4444 from other countries. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). You can also stay up to date by bookmarking our Bureau of Consular Affairs website, which contains the current Travel Warnings and Travel Alerts as well as the Worldwide Caution. Follow us on Twitter and the Bureau of Consular Affairs page on Facebook as well.

The U.S. Embassy in Bamako is located in ACI 2000 at Rue 243, Porte 297. The Embassy’s mailing address is B.P. 34, Bamako, Mali. The telephone number, including for after-hour emergencies, is +223 2070-2300. The consular fax number is +223 2070-2340.

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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 7:45 pm

EMS: Changing work shifts……Good idea?


Fla. EMS study: Change shifts to decrease overnight response times?

By Brent Batten
Naples Daily News

COLLIER COUNTY, Fla. — “An interesting fact comes up when you study the report of the Blue Ribbon Panel that looked at emergency medical response in Collier County.

Or maybe it would be better to say an interesting fact goes up.

The study found that emergency medical response times go up in the wee hours of the morning, when traffic is the lightest….”

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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 7:43 pm

FDA versus The White House


NY Times


April 2, 2012
White House and the F.D.A. Often at Odds

“Nancy-Ann DeParle, the whip-smart and sometimes caustic White House deputy chief of staff, picked up The Wall Street Journal one summer day in 2010 and got an unwelcome shock. The Food and Drug Administration was proposing as part of the new health care law to require that movie theaters post calorie counts for popcorn — and this was the first she had heard of it.

In the F.D.A.’s view, the law called for moviegoers to know that many a buttery bucket of popcorn had more calories than two Big Macs, but Ms. DeParle, President Obama’s chief health adviser, thought the requirement was unnecessary and would probably be lampooned on Fox News as an especially silly example of the government intrusions that conservatives often mocked as the nanny state.

Dr. Margaret A. Hamburg, the F.D.A. commissioner appointed by Mr. Obama, soon heard about the White House’s displeasure and called Ms. DeParle at home one evening, people with knowledge of the call confirmed. The women had a decidedly chilly conversation. Within days, the F.D.A., an agency charged with protecting public health, backed down and dropped the notion of calorie counts for foods served in movie theaters and on airplanes.

Similar tussles have erupted between top administration officials and the F.D.A. over issues from the regulation of sunscreens and asthma inhalers to the enforcement of an agency decision on a drug to prevent premature births…..”

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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 7:41 pm

Paramedics sickened by pesticide vomitus from an attempted suicide


Poison from suicide attempt sickens 3 Fla. paramedics



COCONUT CREEK, Fla. — “The emergency room at a Florida hospital was temporarily shut down Sunday morning after a man who had attempted suicide vomited up poison, sickening three paramedics.

Emergency rescue workers responded to the Coconut Creek home of a man who tried to kill himself by drinking the pesticide malathion at around 1:30am local time, the South Florida Sun-Sentinel reported…..”

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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 7:38 pm

Fewer Tests for Patients; More Lawsuits Against Physicians?


NY Times

April 4, 2012
 Doctor Panels Recommend Fewer Tests for Patients

“In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often….The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis— all quite common…….”

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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 12:56 pm

FEMA: 4/4/12 Briefing on the Nation



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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 5:37 am

(Audio) The Akron Air Disaster, 4/4/1933


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April 4th, 2012 posted by Paul Rega, MD, FACEP @ 5:32 am

Mali’s descent into chaos?



Mali Islamist advance alarms world leaders

By Coumba Sylla (AFP)–

BAMAKO — “World leaders scrambled to stop Mali’s descent into chaos Wednesday, two weeks after a coup in Bamako touched off a sequence which saw Tuareg rebels backed by radical Islamists conquer half the country.

The United Nations Security Council was to make a statement on the crisis amid warnings Al-Qaeda-linked militants were on the verge of creating an Islamic state on a territory larger than France….”


Area: 1,240,278 sq. km. (474,764 sq. mi.); about the size of Texas and California combined.
Cities: Capital–Bamako (pop. 1,728,444). Other cities–Segou (200,000), Sikasso (192,000), Mopti (103,428), Gao (65,000), Kayes (65,000), Timbuktu (38,000).
Terrain: Savannah and desert.
Climate: Semitropical in the south; arid in the north.

Nationality: Noun and adjective–Malian(s).
Population (2011 est.): 14.1 million.
Annual population growth rate (2011 est.): 2.61%.
Ethnic groups: Manding (Bambara or Bamana, Malinke) 52%, Fulani 11%, Saracole 7%, Mianka 4%, Songhai 7%, Tuareg and Maur 5%, other 14%.
Religions: Islam 90%, indigenous 6%, Christian 4%.
Languages: French (official) and Bambara (spoken by about 80% of the population).
Education: Enrollment–91% (primary, 2008). Literacy–26%.
Health: Infant mortality rate–111/1,000. Life expectancy (2011 est.)–52 years.
Work force (4 million): Agriculture 70%; services 15%; industry and commerce 15%.

Type: Republic.
Independence: September 22, 1960.
Constitution: Approved by referendum January 12, 1992.
Branches: Executive–president (chief of state and commander in chief of the armed forces), prime minister (head of government). Legislative–National Assembly is the sole legislative arm of the government; currently consisting of 147 members. Judicial–Supreme Court with both judicial and administrative powers.
Political parties: Mali is a multiparty democracy. Sixteen political parties are represented in the National Assembly; others are active in local government.
Suffrage: Universal at 18.
Administrative subdivisions: Eight regions and capital district.
Central government budget (2009): Revenues–$1.451 billion; expenditures–$2.232 billion; $781 million deficit.


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