Sunday, October 12, 2014

The USA is not working in a vacuum regarding Ebola.

More tomorrow, okay?

The CDC policy is correct regarding Ebola. Those infected with it are being found. The CDC policy has the potential for more far ranging quarantines, but, the last thing the people of the USA and Canada for that matter want is to drive people underground.

The Public Health Agency of Canada (PHAC) (click here) is working with all levels of government to prevent the spread of Ebola to Canada. These steps include:
  • issuing travel health notices to advise Canadians of the risks of travelling to countries that are dealing with Ebola outbreaks;
  • enforcing the Quarantine Act at all international points of entry into Canada. This will help us to identify any sick travellers arriving, and to apply public health measures as appropriate;
  • monitoring the Ebola outbreak by working with international partners. These partners include the:
    • World Health Organization (WHO),
    • United States Centers for Disease Control and Prevention, and
    • Global Public Health Intelligence Network.
  • supporting the infection control systems already in Canadian hospitals;...
The Michigan Governor Debate (click here)

February 4, 2014
By Jonathan Oosting

...As you'll see below, (click here) both Snyder and Schauer can make the math work to suit their arguments. But apparently not all schools can make current funding levels work for their students. As of September, state Superintendent Mike Flanagan said that 56 districts and public charters were operating with budget deficits....

The question is not what is being done to protect and promote higher education in Michigan, besides the usual complaint of student loan debt. The question is what is Snyder doing to keep the Michigan brain trust at home by building a bridge from university education to Michigan jobs. Snyder has outsourced more and more of Michigan's brain trust to the rest of the country and abroad than any other governor in history.

Enrollment and recruitment of students to the university system is not the problem. Michigan has excellent higher education, the problem is the students' education doesn't translate into Michigan jobs.

Michigan was in crisis because of the old auto paradigm and the outsourcing of jobs to places like Mexico. The corporate income tax was not the problem, it was the loss of jobs due to outsourcing. As less and less Americans could afford American made cars as well as cars that weren't really desirable to the American landscape, the auto industry crashed. Snyder came in as Washington was bailing out the auto industry, this is not rocket science and he had absolutely nothing to do with the upward movement of the auto industry.

Construction down, (click here) retail jobs down, information systems jobs down, leisure and hospitality down, arts, entertainment and recreation down (budget cuts), government jobs down.

January 12, 2013
By Kristen M. Daum

Job creation (click here) and economic growth have been the primary mission of Gov. Rick Snyder’s tenure so far, but there’s room for interpretation as to whether Michigan is seeing the results he’s promised.
Since 2011, the Republican and his legislative counterparts have ushered through several major reforms — mostly by cutting billions of dollars in business taxes — with the promise of adding jobs. Michigan jobs are increasing, but exactly how many have been added during the past two years depends on the source and type of data consulted.
Regardless, economists and experts agree there’s no way to prove Snyder’s tax reforms are the specific catalyst behind the growth....

The Grand Bargain was a sell out of pensioners. Not only did they take cuts, but, they were never reassured as Detroit's income increases the pensioners would be returned their pension funds.

...Only one bill -- (click here) a proposal to prohibit the DIA from seeking renewal of a 10-year operating millage after the city-owned museum transitions to a charitable trust -- proved especially controversial. Democrats said the legislation was "outside the scope" of the grand bargain and argued it would disenfranchise voters in Wayne, Macomb and Oakland counties who chose to approve the millage in 2012.

"The core of this bill is taking away the rights of voters to decide whether they want to pay a millage or not," said state Rep. Sarah Roberts (D-St. Clair Shores), calling it a "slap in the face" to DIA benefactors who raised funds for the grand bargain. Only six Democrats voted for the bill, which passed in a 66-44 vote....

Michigan has a bigger hole in the water for new jobs to be developed. The federal trend alone was enough to bring about an economic revitalization.

The Midwest (click here) was second in the nation in building employment only behind the Northeast.

Every Republican Governor in the Midwest claims they have the greatest job growth in the region and the country. Bulloney.

Mr. Schauer has been listening to the people and the petitioners in the state. He has championed their causes. Snyder doesn't agree with the people and have not come to their side.

November 18, 2013
DETROIT, MI – Mark Schauer, (click here) a Democratic candidate for governor, proposed raising Michigan's minimum wage to $9.25 an hour over three years in a press conference at Avalon International Breads on Monday.
Speaking alongside a Michigan State University professor who supported his claims, Schauer said he believes a minimum wage hike wouldn't have a significant negative impact on employment numbers, but would lift families out of poverty and boost economic growth.
"I believe that it would take grassroots activity to get it through the legislature," Schauer said. "This is about people. It's a measure that will help drive economic growth."
Schauer is expected to run against Gov. Rick Snyder in November 2014. Snyder's spokesperson Sara Wurfel told the Associated Press that the governor hasn't taken a position on raising minimum wage, but said such a move could lead to lost jobs....

Mr. Schauer has never had to work behind closed doors, he goes to the people.

The social issues regarding equality rights is over when Schauer takes office. It is over at the federal level and it needs to end in every state in the country.

DeBoer v. Snyder is a lawsuit filed by a lesbian couple on January 23, 2012 infederal district court, challenging Michigan's ban on adoption by same-sex couples so they can jointly adopt their children.

Caspar v. Snyder (click here)

On April 14, 2014, the American Civil Liberties Union of Michigan filed a lawsuit in state court on behalf of eight same-sex couples who received marriage licenses on the first day of the freedom to marry in Michigan. More than 300 couples received marriage licenses on March 22, after a federal judge struck down the state's ban on marriage for same-sex couples. The ruling was stayed later that afternoon, and although the federal government said that it would respect the Michigan marriage licenses for all purposes, Governor Rick Snyder said that the state would, for now, deny respect to the licenses as the 6th Circuit Court of Appeals considers arguments in the original federal lawsuit.

Morgan v. Snyder

On June 11, 2014, private lawyers filed a federal lawsuit in Grand Rapids, Michigan seeking respect for their marriage, legally performed in a different state. The suit is being filed by the Grand Rapids law firm Rhoades McKee.
Blankenship v. Snyder
On June 5, 2014, private lawyers filed a federal lawsuit in Genessee County, Michigan seeking respect for their marriage, legally performed in a different state. The suit is being filed by attorney Jessica Hammon.

June 25, 2014
By Brian Smith
LANSING -- If Michigan were a country, (click here) it would put people in prison more often than Russia does.
That's one of the takeaways from a new analysis of incarceration rates by the Prison Policy Initiative that breaks the U.S. rate out by all 50 states. The U.S. leads the world in the percentage of citizens behind bars as a whole, but some states are far above that mark.
The U.S. imprisons people at a rate of 716 people per 100,000 of population, but 22 states actually exceed that rate, with Louisiana's rate being the highest at 1,341 people per 100,000.
Michigan's rate is below the national rate, at 628 inmates per 100,000, but that's still high enough to exceed every other country in the world....

The first fracking leak in Michigan occurred after Snyder became Governor. Governor Snyder has gotten by with his 'geek' demeanor as someone unable to engage the public well. As a result the Michigan brain trust is outsourced on a regular basis to Wall Street firms outside the state. His geek status might be an interesting persona to try to 'deal with the public,' but his policies speak loudly to his disinterest of citizens' interests.

February 10. 2011
Operations at a more than 1,000-foot-deep natural gas well (click here) being drilled in Michigan's northwestern Lower Peninsula with a technique called hydraulic fracturing were shut down after a leak was detected earlier this week, the state reported Thursday.
The leak at the well in Benzie County's Joyfield Township was detected late Monday or early Tuesday, and the leak was contained Tuesday, the state Department of Natural Resources and Environment said. The department said there was no imminent danger from the leak and an initial review found any environmental impacts limited to the immediate area of the well.
"The company had just installed a new well," said DNRE spokesman Brad Wurfel. "They turned it on and found liquid bubbling."...
I find it interesting that tourism is on the decline in Michigan while Snyder wants more and more fracking. The two in a Great Lakes doesn't mix. Any fracking chemicals that leak from wells has the direct threat of contaminating the Great Lakes. These are deep wells. The depth of Lake Michigan alone is nearly 1000 feet. How is anyone going to stop the leaks from destroying the lakes environment again? 

These are the people Michigan has to deal with so why do it the first place? Fracking companies are grabbing land and later deciding what to do with it.
October 2, 2012
...Faux deals? (click here)Extricating itself from land leases has sometimes proved as important to Chesapeake as obtaining them.
In lawsuits in Texas, Pennsylvania and North Dakota, land owners allege Chesapeake has treated signed leases as mere placeholders for deals that it may later choose not to honor.
Two state court judges in Michigan ruled early this year that Chesapeake had the right to reject leases at any time before title to the minerals was finalized....

Nigeria's outbreak was contained as quickly as it erupted.

August 23, 2014

...Nigeria’s (click here) promise has made it a test-bed for the Africa strategies of consumer-goods firms. This is not only because of its size. It is also because of the spread of Nigerian culture—its music and movies—around Africa, says Yaw Nsarkoh of Unilever. The Anglo-Dutch company has been trading in Nigeria for nearly a century and is expanding its operations. Nestlé, a Swiss rival, plans to triple sales over the next decade. Procter & Gamble, another global consumer giant, has just completed a factory near Lagos, its second in Nigeria. SABMiller, the world’s second-largest beermaker, built a state-of-the-art brewery in Onitsha, in the Niger Delta, in 2012 and is already adding capacity....

April 13, 2014
Abuja and Lagos
Yet, since its 167m people (click here) make it twice as populous as any other Africancountry, Nigeria is plainly the giant of a fast-growing continent. The GDP of Lagos alone exceeds that of Kenya, east Africa’s beefiest economy. When Nigeria’s GDP is reassessed (“rebased”, in IMF jargon) by new criteria that include earnings not on the official balance-sheet, its gap with South Africa, the continent’s largest economy, will narrow. Nigeria’s GDP may rise, according to its own bureau of statistics, by 40% to around $350 billion, not far off South Africa’s $400-plus billion. If Nigeria goes on growing by 7% a year (as it is expected to in 2013) against South Africa’s present 3%, it will become Africa’s biggest economy within a decade. Together, the two economies already account for a good half of the GDP of sub-Saharan Africa’s 49 countries.

President Goodluck Jonathan takes as much credit as he can. “A new political culture has emerged,” he says, along with “a clear electoral process”, a reference to his victory in 2011. “Corruption and issues of governance are being vigorously tackled on all fronts.” He hails Nigeria as “the largest destination of FDI [foreign direct investment] in Africa”. Calling for a revival of the moribund farm sector, he promises that Nigeria will have “no imports of rice by 2015-2016”, whereas it is now the world’s largest buyer of it....

We may be looking at mandatory quarantine of anyone returning from West Africa.

It was found. This is by far the highest priority the USA has. It has to be contained. It isn't going to matter if the borders are closed, it will still get through. The country would still be going through these exercises anyway.

The USA needs to warn those traveling from the USA to West Africa, they may have to be maintained in quarantine before and/or after they return. It is the way it was always done before.

A man is isolated in the back of an ambulance at Harvard Vanguard Medical Center in Braintree Sunday afternoon for precautionary measures, officials said the man complained of medical issues and had recently traveled to West Africa. After more than an hour the victim was transported to an area hospital.

October 12, 2014
By Jack Encarnacao and Laural J. Sweet

A man claiming (click here) to have recently traveled to Liberia in West Africa who turned up at the Harvard Vanguard Medical Associates urgent-care offices in Braintree this afternoon complaining of a headache, muscle aches and other Ebola-like symptoms was quarantined and has been brought to one of Boston’s top hospitals under police escort, according to multiple authorities.
“Out of an abundance of caution we immediately notified authorities and the patient was securely removed from the building and put into an ambulance now headed to Beth Israel Deaconess Medical Center. The building was closed briefly but has now re-opened. We are working closely with the Department of Public Health who will determine next steps,” said Dr. Ben Kruskal, chief of infectious disease for Harvard Vanguard.
The driver of the Brewster Ambulance transporting the patient shortly before 4 p.m. was seen wearing a hazmat suit and face mask. Beth Israel is planning to hold a press conference shortly.
A second person was later brought out on a stretcher in a hazmat suit and placed in a second ambulance...

The question has to be asked, why are Americans coming and going from West Africa?
October 12, 2014
(Reuters) - A medical clinic outside of Boston (click here) was quarantined and a patient has been isolated outside the hospital with a possible case of Ebola, the Boston Globe reported on Sunday.
Police, fire officials and emergency medical services have arrived at the Harvard Vanguard Medical Center in Braintree, Massachusetts, Joe Zanca, with the Braintree Fire Department, told the Globe.
“Ebola protocol is in place,” Zanca said, noting that the patient in isolation recently traveled to West Africa.
Representatives of the hospital and Braintree fire and police departments could not immediately be reached for further comment.

This is exactly what the USA doesn't want and due to extreme control measures Ebola spread like wildfire in Guinea.

...“Coercive measures, (click here) such as laws criminalizing the failure to report suspected cases and forced quarantines, are driving people underground, pushing the sick away from health systems,” Joanne Liu, the international president of Doctors Without Borders, said recently at a United Nations special briefing on Ebola. “These measures have served only to breed fear and unrest rather than contain the virus.”...

The difference between the USA and Guinea is the USA doesn't simply quarantine and allow people to die. People are treated. The USA doesn't have the problems West Africa inherently has. 

...Beth Bell, director of the CDC’s National Center for Emerging Zoonotic Infectious Diseases, told Congress in September, “The best way to protect the U.S. is to stop the outbreak in West Africa.”

I was waiting for this. Jihadies don't make good lifestyles.

Sebina Selimovic and Smara Kesinovic, both 17, left their homes in Austria to become Jihady Brides to ISIS. Ain't social media great, huh?

October 12, 2014
By Adam Withnall

Two teenage girls (click here) who left Austria to travel to Syria and become “jihadi brides” have reportedly grown disillusioned by life with Isis and told their families they want to return home....

"Mommy, I hate camp. You were right I shouldn't have gone in the first place."

A Jihadist's wife can be studied by 'episodes' with the Taliban. The Taliban ruled in Afghanistan for a long time before the USA invaded to kill bin Laden and his band of merry men. The women weren't so merry. As a rule anthropologists' studies of the Taliban found each woman had an average of eight children. 

Basically, it is a complete loss of self and complete devotion to the husband and the children. Then it is shared with other women within the same marriage as well. The Taliban and ISIS are not Sheiks with lots of money to make a woman's life opulent and carefree. It is poverty with all the trappings of hardship and denial of self and identity. Let's face it, women are required to wear veils in public, where do you think Fifth Avenue comes in? Weaving sheep's wool, maybe.

Am I surprised the ladies are now some of the most unhappy women on the planet? No. There are issues. If a husband becomes unhappy with a wife she can be divorced or worse. The Taliban had no court system. They let the public square take over where there are jails and divorce courts for both men and women in most First World nations. Break the law in Jihad Land and face death.

There are problems even in Europe when a bride becomes unhappy and wants to leave. The children. I have a friend who lived in Germany and gave birth to two children. Her life was not fun. She had servants to care for her every whim, but, she was limited in her social contact and even was limited to venturing out of the house. It became obvious to her she was trapped in being a sexual animal to her husband.

She eventually was able to leave to return to the USA because her husband was interested in having connections with the USA. He was a businessman and believed she could spark interest for him. The children, two boys, remained in Germany with the father being cared for by servants when she returned to her family in the USA. The bottom line is she lied about her ability to make business connections for him. She only wanted to get away. She filed for divorce and ultimately lost control of her two sons. It would be ten years before she was allowed to visit with them in Europe for a few days. She is waiting for them to come of age to be able to determine their own paths in life.

The lifestyle of women within the Muslim faith can vary a great deal. It literally depends on the man and his methods of making a living. There was a time in Afghanistan when women had a great deal of freedom. They attended school and became worldly. In the USA I have not met a Muslim woman, even those that where their traditional clothing, that are not powerful women. They are endeared differently. The laws in the USA empower the women differently than traditionally Muslim countries. I have enjoyed their conversations on many occasions. They have money and frequently their own money from their own education and/or professions. 

So, for a young and wonderful European woman to simply pick up and go to Syria with the idea the rest of her life will be wonderful is bizarre. I don't know what they were thinking. People are dying in Syria. What is there to know?

October 12, 2014
By Habib Toumi

...“I am a divorced woman, (click here) but I have no children. I am looking for a man who would love only me. I have SR100 million and much more that I have inherited from my late father, God bless his soul. I also own a company that I am managing. I want a husband who loves me and I will be devoted to him. I am 39 years old. I just want a baby,” the woman who called herself “Noora, a Divorcee Unfortunately”, said....

Nursing Research

Nurses are very rarely studied to improve their safety. They are expected to carry a lot of information in their practices. It is an extremely stressful job.

I would think with such a dangerous disease as Ebola there has to be a maximum safety level that can be maintained for health care workers. In particular working hours and conditions. I would expect nursing unions to consider a study whereby there is an understanding to the optimal hours worked by anyone in such an intensive setting. It might be 12 hours is far too long, 8 hours might be better or 6 hours optimal. There may be a maximum stress level of four hours that need to be maintained to protect the worker as well as the patient and ultimately the social environment health care workers live in.

Are there showers and gowning rooms immediately available to use before and after a shift? Is the pay rate for such work sufficient to permit a valuable nurse to work only four hours per day or six hours per eighteen hour period. Is there a log book to maintain tract of nurses hours to know if they are approaching the optimal care level and then are they receiving rest enough before returning to that patient care?

I think there is a lot we can do to find the most optimal environment for patient care and health care safety. 
I can't help believe we need to rethink of the technology as Pre vs Post Ebola.

This is a suction container used in patient rooms and intensive care rooms to remove secretions from patients to maintain an open airway. It is necessary. Intubated patients especially have higher amounts of secretions as a rule. They are usually better hydrated through IV infusion.

But, this product is interesting. (click here) It is added to the secretions and normal saline to solidify the liquid and make it less likely to spill if a container is mishandled or the integrity fails along the way. It is called Safe Sorb. I am wondering if there can be such a product that also has a disinfectant that will kill the virus on contact. In other words, reduce any possibility a health care worker could be exposed to contamination while handling the virus intensive fluids.

I am sure there are decontaminates used and one of the most popular ones is a bleach solution. Can something like Safe Sorb be also an agent for decontamination? Can a health care worker add something to a full container to not only contain the body fluids but kill the virus at the same time.

In the case of Ebola I have to wonder if there isn't something that can be adapted to be added from hour to hour or procedure to procedure that would better kill the virus in a rapid fashion so things like droplet and/or blood spots could be decontaminated quicker. Of course, the best possible decontamination is at the point where secretions meet a disposable suction catheter, but, that may be too dangerously close to the patients body tissues to be effective or safe. If the patients own body tissues are compromised there is a great chance of death than if the body's membranes are intact.

I think it is best to realize the procedures and equipment being utilized by health care workers were developed Pre-Ebola. We might not be able to do any better than that, but, I think we can. I think we can help reduce health care worker exposure if we realize how the equipment they are working with becomes contaminated and later decontaminated and disposed. I would hope infectious disease MDs would be accessed by medical and pharmaceutical companies to make this an ongoing consulting dynamic for national emergencies that could occur. 

Infectious disease MDs are amazing. The CDC and FDA are magic if they are given the possibility of better opportunities to thwart disease.

This is what I believe I heard from the CDC.

What I heard from the CDC was extubation and dialysis were the culprits and both are highly invasive procedures. This contamination did not occur in a casual setting.

Every intensive care room has the capacity to provide ventilator assistance and dialysis to any patient. That means the equipment is in direct contact with bodily fluids with high concentrations of virus and especially the case with Mr. Duncan.

Mr. Duncan succumbed to Ebola infection with high levels of the microbe in his blood, therefore, the equipment he was sustained on was also highly contaminated. The equipment involved have two components, the disposable equipment that are in contact with the patient (primarily plastic) and the hardware that is expensive and decontaminated and reused.

The contaminated disposable equipment would have been properly contained in medical waste containers and the hardware might not have been and was most probably contaminated both outside the equipment as well as within. 

The extubation of any patient is fairly straight forward after a person expires, but, dialysis maintains a catheter in the patient to carry out the procedure which serves as a connection between the patient and the machine. Dialysis is more heavily a blood intensive procedure than extubation, however, there are secretions that are involved in extubation that can be droplet and miniscule. Both procedures can offer an opportunity to contaminate a room if not handled meticulously. YES. Meticulously is possible.

I don't know what the nurse may or may not have done to allow exposure of her skin or otherwise to the extubation procedure or dialysis procedure, but, I am curious to the extent these life support systems are used in West Africa. These are First World treatments for patients, however, they are found in a variety of places in the world. These are not exclusively First World treatments.

If this is the first time or at the very least the first time in the USA that Ebola has come in contact with these invasive and life sustaining procedures this may be the initial experience with Ebola in this setting. 

Again, I want to commend Dallas for all it's involvement in providing as intensive information and scrutiny this virus is receiving. I do not believe this is a breach in INITIAL diagnosis. The CDC stated the nurse reported her symptoms very early on and with a low population of virus in her blood test. I still believe we are carrying out good initial evaluation. This is a breach in protocol and/or an unknown source of contamination for the extensive amount of virus involved in Mr. Duncan's case.

There MAY be other exposures, but, we don't know that and can only be patient to maintain a vigilance. I do believe the USA is way ahead of any extensive exposure or outbreak. I have confidence in the CDC and it's vigilance. This has nothing to do with ports of entry into the country. This was a contamination of the internal room environment with the patient.

If I believed there was something questionable, I'd say so. I am in the USA along with everyone else.