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The US attorney based in Pittsburgh has started the process to seek the death penalty for the man accused of killing 11 worshippers at a synagogue Saturday, an assault during Shabbat services that reverberated across the country and around the world.On Monday, suspected gunman Robert Bowers was brought into federal court in a wheelchair for his first appearance. Wearing a blue shirt and handcuffs -- which US marshals removed so he could sign paperwork -- he spoke only to answer questions from the judge.The shooting struck the heart of historically Jewish Squirrel Hill and spurred sadness and anger as citizens learned the names of those gunned down by the killer."It's hard to understand how significant these losses are to our community unless you understand the significance and intimacy of Squirrel Hill," said Tree of Life congregant Jesse Rabner said."The community is knit so tight that one life affects thousands. It's a norm to be Jewish in Squirrel Hill, and it's a loving and peaceful community."Rabbi Hazzan Jeffrey Myers with Tree of Life said his synagogue will rebuild and "be back stronger and better than ever.""You can cut of some branches from our tree, but Tree of Life has been in Pittsburgh for 154 years. We're not going anywhere," the rabbi told CNN's "New Day" on Monday. "I will not let hate close down my building."Attorney General Jeff Sessions must ultimately give the OK to pursue the death penalty for the alleged gunman, Robert Bowers, the Justice Department said. The attack was the deadliest against Jews in US history."At this point in our investigation, we're treating it as a hate crime," Scott Brady, the US attorney for the Western District of Pennsylvania, said Sunday.When asked if the shooting could be considered an instance of domestic terrorism, Brady said there would need to be evidence the suspect tried to propagate a particular ideology through violence.In an address on Monday in Boston, Sessions labeled the assault a "murderous rampage" and said, "This was not just an attack on the Jewish faith. It was attack on all people of faith, and it was an attack on America's values of protecting those of faith. It cannot, it will not, be tolerated."Sessions said authorities will conduct the case "with vigor and integrity.""He'll be subjected to the death penalty perhaps," the attorney general said of the suspect.Bowers is expected back in court for a preliminary hearing Thursday morning. While two public defenders appeared with him in court Monday, the lawyer or lawyers who will handle his case going forward have yet to be appointed. He is being without bond.Brady will present the case to a federal grand jury within 30 days, he said.  2711

The way doctors treat asthma in both children and adults just got a major update.Speaking to the Journal of the American Medical Association, respiratory experts said the changes in guidelines focus on six key areas, including improving asthma diagnosis, management, and treatment.It’s the first published update in 13 years.“So, one of the goals of our update was to address the issue of who can use intermittent inhaled corticosteroids and when used, are they as effective as daily use,” said Michelle M. Cloutier, MD with UConn Health.One of the biggest changes is that many patients may not need to use an inhaler every day anymore.“Especially those families of young children who don’t necessarily buy into using daily medication when their children are having intermittent symptoms,” said Stephanie Lovinsky-Desir, MD, MS with Columbia University Irving Medical Center.The new recommendations for inhaler use vary by age and severity of asthma, so it’s important to talk to your doctor about the new guidelines.Asthma affects nearly 5% of adults and 10% of children.During the pandemic, because of the higher death rate of asthma patients from COVID-19, more people have been seeking treatment for the condition.The average annual cost of asthma per person is more than ,200. But research has also shown among other things, regular use of medication and flu vaccines can reduce the chances of someone with asthma being hospitalized, driving up those costs. 1472

The use of telehealth has become a common practice during the pandemic. Now, some doctors hope it continues to be an important tool in the healthcare industry."There are a number of bills have been proposed," said Dr. Tesh Monteith, a neurologist and fellow with the American Academy of Neurology.Dr. Monteith says Congress is considering several bills to keep telehealth, which allows patients to video conference with a doctor instead of going in for a physical appointment, around for the long run.When the pandemic hit, rules regarding telehealth changed, allowing for doctors to be financially reimbursed for the virtual appointments."It's allowed patients to access care. They're patients that would normally have to take days off, or to keep providers, multiple providers, and if they can do that, they may have childcare issues and not be able to get to a clinic," said Dr. Monteith.The bills would allow for everything from permanent reimbursement for physicians to allowing doctors to virtually see patients across state lines."Some of these bills are proposing that there are not limitations within states. For example, there are issues of licensing. A doctor licensed in New York should they be able to see a patient with a specialized disorder in Minnesota or does that patient have to come in Minnesota," explained Dr. Monteith.While telemedicine has been an important part of making sure people received medical care and diagnoses during the pandemic, doctors agree that the virtual visits in no way can replace seeing your physician in person."Because I know my patients well, I’m a pediatrician, I can do so much over telehealth with the kids I know. When they're sick I can look at them. I can watch them breathe. I can ask them to jump up and down and have the parents press on their tummy, but I can’t look in their ears. I can’t listen to their heart, and if it’s a family that I don’t know, there is concern that I might miss something," said Dr. Tanya Altmann, a pediatrician in California.Dr. Altmann says telehealth can also be a very valuable tool.As for reimbursement for physicians, Dr. Altmann says, "anyway that a physician or healthcare provider reaches out to a family to help with anything medical, it should be compensated."Dr. Altmann says pediatricians can sometimes spend hours on the phone with patients at night, work they don't get paid for. Getting reimbursed for telehealth visits with patients would be a plus."Patients need to empower themselves to learn about telemedicine, to learn what questions to ask a doctor. Have an advocate or family member there to even help with the physical examination," suggested Dr. Monteith.Dr. Monteith says medical professionals estimate there have been more than one billion telemedicine appointments since the pandemic began. She hopes Congress passes the telehealth-related bills to further expand medical access to people across the country. 2932

The World Health Organization is preparing for the "worst case scenario" as it continues to respond to the Ebola outbreak in the Democratic Republic of Congo.Peter Salama, deputy director-general of emergency preparedness and response at the WHO, said in Geneva, Switzerland, on Friday that it's "going to be tough and it's going to be costly to stamp out this outbreak."As of Wednesday, 32 people are suspected to have been infected with Ebola viral disease, including three health care workers. Eighteen of those have died, including one of the health care workers.Of the suspected cases, two have been confirmed as Ebola using laboratory tests, and 10 samples are awaiting results."The number of suspected, probable and confirmed cases is significant, so we are very concerned, and we are planning for all scenarios, including the worst-case scenario," Salama said.Ebola virus disease, which most commonly affects people and nonhuman primates such as monkeys, gorillas and chimpanzees, is caused by one of five Ebola viruses. On average, about 50% of people who become ill with Ebola die.The disease is endemic to the Democratic Republic of Congo, and this is the nation's ninth outbreak since the discovery of the virus in the country in 1976.The latest outbreak is occurring in the Bikoro health zone, 400 kilometers (about 250 miles) from Mbandaka, the capital of Equateur province.Bikoro health zone has a population of about 163,000, with three hospitals and 19 health centers, most with limited functionality, according to WHO.Given the remote location of the outbreak, Salama said, response efforts will be extremely challenging. "It is a dire scene in terms of infrastructure," he said."To give you a sense, we are talking about an area that is 280 kilometers even from the provincial capital of Equateur," he said.The WHO is working with authorities in Congo and is in discussions with the World Food Programme to arrange airlifting supplies to the affected areas. UNICEF is also making doctors available as well as sanitation and hygiene specialists to help contain the outbreak.The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission, either through direct contact with bodily fluids such as blood or secretions or contact with materials that are contaminated with these liquids.Personal protective equipment has been sent to the affected region, and the WHO is planning to have mobile laboratories running by the weekend, after receiving approval from the country's Ministry of Health.Initial control efforts are focusing on tools such as surveillance and monitoring, safe burials and case management.Vaccines along with doctors and epidemiologists are on standby in case they are needed, according to the UN.If they are needed, "WHO is in discussions with the government and, if pertinent, will seek approval from the national regulatory authority and the Ethics Review committee to use vaccines against Ebola as part of the response," spokesman Tarik Jasarevik said.The current vaccine against Ebola is experimental and not a licensed product. Salama pointed out that its use also comes with many challenges, as the vaccine needs to be stored long-term at temperatures between minus 60 to minus 80 degrees Celsius (minus 76 to minus 112 Fahrenheit)."This is not a simple logistical effort; it's not like doing a polio campaign with oral polio vaccines, where we get it immediately out to the field. This is a highly complex sophisticated operation in one of the most difficult terrains on Earth," Salama said.Nine neighboring countries are on high alert, Salama said, but the WHO says the current risk of disease spreading to them is low.West Africa experienced the largest recorded outbreak of Ebola over a two-year period beginning in March 2014; a total of 28,616 confirmed, probable and suspected cases were reported in Guinea, Liberia and Sierra Leone, with 11,310 deaths, according to the WHO.  3999

The strain of E. coli causing the current outbreak in romaine lettuce has been found in a reservoir on a farm in Santa Barbara County, California, the US Food and Drug Administration and Centers for Disease Control and Prevention announced Thursday.The agencies are continuing to investigate other possible sources, and the CDC still advises consumers not to eat romaine lettuce grown in California's Monterey, San Benito and Santa Barbara counties until investigations are complete."We cannot say how many cases are linked to this specific farm at this time," Ian Williams, chief of the CDC's outbreak response and prevention branch, said at a press briefing. "We have to do additional work at this farm and other farms that are being identified from our investigation."Properly labeled romaine grown outside those three counties and harvested after November 23, as well as romaine grown in greenhouses or hydroponically, should all be safe from contamination, the CDC said. The earlier warning against eating romaine from California's San Luis Obispo, Santa Cruz and Ventura counties has been lifted.The agency stressed that consumers should continue to avoid any romaine lettuce not labeled with the harvest date and location.The CDC has identified another seven illnesses since its update December 6, bringing the total people infected with E. coli to 59 across 15 states and Washington, D.C. The last reported illness was November 16. There have been 23 hospitalizations and two cases of hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.While calling it "premature" to call the outbreak over, Williams said it was a good sign that the most recently identified cases were in the same time period as the main outbreak."We're hopeful that it's moving in the right direction," Williams said. "It's still too early to tell."The first cases in this outbreak were identified in October. States with cases include California, Connecticut, Florida, Illinois, Louisiana, Massachusetts, Maryland, Michigan, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island and Wisconsin. 2141

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