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PED-EM-L  February 2018

PED-EM-L February 2018

Subject:

Re: PED-EM-L Digest - 19 Feb 2018 to 20 Feb 2018 - Special issue (#2018-48)

From:

Mick C <[log in to unmask]>

Reply-To:

Mick C <[log in to unmask]>

Date:

Tue, 20 Feb 2018 08:48:31 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (4093 lines)

I think people politicize issues to hide behind the government and wait for
"them" to act and/or place "blame".

One also doesn't have to listen to other views you just pick the political
news channel that validates your thoughts.
No need to listen to the other side.

Instead we say guns are evil or guns protect.  Remove the second amendment
or double down.
Many think that only their side should have the first amendment right as
well.   Little about all the cracks this person
fell through.

After these events, we learn of people who knew the shooter but chose to
ignore their actions or isolate them further.
We have folks who sell someone countless guns but say nothing.  Neighbors
or family that are totally shocked that this person
was suffering and/or had any potential for harm.

Root cause analysis rarely if ever identify the syringe, the medical device
or a failed policy.   What they typically come down to
is someone's failure to speak up, listen, and double check or one's failure
to be offered or asked for help when stressed, busy or focused
on the wrong thing.

Seems to me we should try harder to ponder the root cause as you suggest.

Mick Connors

On Tue, Feb 20, 2018 at 6:39 AM, PED-EM-L automatic digest system <
[log in to unmask]> wrote:

> There are 3 messages totaling 18544 lines in this issue.
>
> Topics in this special issue:
>
>   1. Gun "Safety" from an HRO perspective
>   2. PED-EM-L Digest - 18 Feb 2018 to 19 Feb 2018 - Special issue
> (#2018-42)
>      (2)
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
>
> ----------------------------------------------------------------------
>
> Date:    Tue, 20 Feb 2018 07:31:58 +0000
> From:    Beech Burns <[log in to unmask]>
> Subject: Re: Gun "Safety" from an HRO perspective
>
> Hear hear rick.  Very well put.
>
>
> [OHSU email via VMware Boxer]
>
> On February 19, 2018 at 6:44:02 PM PST, Rick Place <[log in to unmask]>
> wrote:
> I am struck by the fact that the conversation, here and nationally, is
> emotional and derives from one's political beliefs. For fair disclosure, I
> find the whole concept of owning a gun for the purpose of killing people
> (even if in "self defense") simply unfathomable. I just don't get it.
>
> As a member of a professional obsessed with the concept of safety and
> steeped in the philosophy of high-reliability principles, I find some of
> the recommended "solutions" to be jaw dropping.
>
> In our profession, we have moved well past the concept of "Try Harder".
>
> "Try Harder" is essentially what it means to hold the FBI accountable for
> picking up every low amplitude signal presented to it in a country of 320
> million people, where it only takes 1 unhinged person who is otherwise like
> 10,000 others to wreak such devastation.
>
> "Try Harder" is what it means to "solve" the problem by asking a grossly
> (and deliberately) underfunded mental health system to either identify all
> of these individuals in advance or more unrealistically to "help" them so
> that they never reach the point of mass murder.
>
> As an approach to safety, this is nonsense and we would be fired from our
> jobs if we approached medicine this way.
>
> If we conducted a scientific Root Cause Analysis, the solutions become
> obvious. And not emotional. Just plain obvious.
>
> I would rather we as a society stop obfuscating and dissembling. Say it
> like it is.
>
> When I hear someone say that the solution to the increasing number of mass
> murder events is to "Try Harder" or worse, to weaponize the entire
> population, what I really hear is:
>
> This is the "cost" of having the second amendment and we just need to deal
> with it.
>
> Of course, it is not acceptable to say this, but at least we could speak
> more clearly from our relative positions.
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> http://listserv.brown.edu/ped-em-l.html
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
>
> ------------------------------
>
> Date:    Tue, 20 Feb 2018 04:48:04 +0000
> From:    "Chen, Lei" <[log in to unmask]>
> Subject: Re: PED-EM-L Digest - 18 Feb 2018 to 19 Feb 2018 - Special issue
> (#2018-42)
>
> I love buckyballs.  I believe I am entitled to own buckyballs.  I believe
> they have educational and entertainment values.  I believe I am a
> responsible owner of buckyballs.
>
> What about others?  Well,  some others stockpile them, and may even misuse
> them, to the harm of themselves and others.  Each year buckyballs cause
> 13,000 to 15,000 deaths in the US.
>
> When I am out of the country people always ask me to explain two things
> when they find out that I am American.  "What's it with Trump and
> buckyballs?" With regard to Trump I tell them to read JD Vance's book.
>
> Members of this listserv know what happened with the buckyballs.
>
>
>
> Lei Chen, MD MHS
>
> Associate Professor of Pediatrics
> Section of Emergency Medicine
> Department of Pediatrics
> Faculty, Global Health Initiative
> Yale University School of Medicine
>
>
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]> on behalf of Martin Herman <
> [log in to unmask]>
> Sent: Monday, February 19, 2018 2:43 PM
> To: [log in to unmask]
> Subject: Re: PED-EM-L Digest - 18 Feb 2018 to 19 Feb 2018 - Special issue
> (#2018-42)
>
> so glad I stopped sending my money to this left ist organization.
>
>
>
>
>
> there are mean people in this world.
>
> they do bad things
>
>
>
> you can’t legislate bad things away
>
>
>
> want to do something to prevent school shootings?
>
>
>
> Try finding those kids in your community that are being bullied and help
> them!
>
>
>
> do something to prevent gangs.
>
>
>
> let me defend myself, my family and home as I see fit. you aren’t going to
> help me if I am mugged, you aren’t going to be there if my home is invaded,
> and the police won’t be able to help for at least 6-7 minutes, if I can
> make the call.
>
>
>
> doubt me? call 911 and see how long it takes to get through the questions
> and then get a car to your home.  a lot of bad things can happen in the
> time it takes to get help.
>
>
>
> btw, assault weapons are already banned.
>
>
>
> Focus on mental health, finding those who are abused, bullied,
> marginalized and those who are deranged. they live among us, find them!
>
>
>
>
>
>
>
>
>
> [X]
>
>
>
> Martin (Marty) Herman
>
> USAPA Ambassador for Pickleball , North Mississippi.
>
> Tupelo Pickleball ( facebook)
>
> [log in to unmask]<mailto:[log in to unmask]>
>
> 901 219 9202
>
> Sent from my iPhone
>
>
>
>
>
> On Feb 19, 2018, at 10:03 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
>
> There are 4 messages totaling 10581 lines in this issue.
>
>
>
> Topics in this special issue:
>
>
>
>  1. School shootings.......
>
>  2. PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41) (3)
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                 https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ----------------------------------------------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 22:08:25 -0700
>
> From:    Julian Orenstein <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: School shootings.......
>
>
>
> Exactly, Jill. The anti-gun movement needs a Lincoln, a King.... and if I
> had my wish it’d be for Obama. Either one of them.
>
>
>
> Jb0
>
>
>
>
>
> On Feb 18, 2018, at 6:03 PM, Jill C Obremskey <[log in to unmask]
> <mailto:[log in to unmask]>> wrote:
>
>
>
> Great discussion but what are WE going to do about it as an organization?
>
> How do we become relentless about the need for gun control, the need for
> mental health services, and for preventing toxic stress in children.
>
>
>
> We need to ask leaders in the AAP and AAEM to organize us into a uniified
> voice that will not quit.
>
>
>
> On February 18, 2018 at 5:05 PM "Chamberlain, James" <
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
>
>
>
>
> I'd be happy with sensible regulations, required training, and licensure
> so that guns don't get into the hands of criminals and people with mental
> illness.
>
>
>
> But the NRA is against sensible regulations.
>
>
>
>
>
>
>
> Sent from my Verizon, Samsung Galaxy smartphone
>
>
>
>
>
> -------- Original message --------
>
> From: Robert Finkelstein <[log in to unmask]<mailto:robert.
> [log in to unmask]>>
>
> Date: 2/18/18 12:17 (GMT-05:00)
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: Re: School shootings.......
>
>
>
> Just because people will find a way to break laws does not mean that we
> shouldn’t have them. By that logic, we expect that all of us who are
> currently law abiding don’t need any laws to make us so. Human nature being
> what it is, we all need laws and structure. Yes, gun regulation would not
> stop all gun violence, but it could reduce it. Also, I don’t think the
> majority want prohibition of guns, just regulation; the same way alcohol is
> regulated by age and penalties for driving under the influence. Or, the way
> cars are regulated with licensing, registration, having to pass a driving
> test and citations for violations.
>
>
>
>
>
>
>
> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> [log in to unmask]<mailto:
> [log in to unmask]>> wrote:
>
>
>
>
>
>
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'. Nobody gets to the meat of the matter: If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand. This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'. Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem. So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
>
>
>
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve. Horst D. Weinberg, MD
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
>
>
> The URL for the PED-EM-L Web Page is:
>
>
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
>
>
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
>
>
> The URL for the PED-EM-L Web Page is:
>
>
>
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
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> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
>
>
>
> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>
> Confidentiality Notice: This e-mail message, including any attachments, is
> for the sole use of the intended recipient(s) and may contain confidential
> and privileged information. Any unauthorized review, use, disclosure or
> distribution is prohibited. If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of the original
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> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                 https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Mon, 19 Feb 2018 09:25:18 -0500
>
> From:    Mick Work <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
>
>
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__apps.
> chicagotribune.com_news_local_young-5Fvictims_&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=X2M--MDdYYwsGrfHTv88WzYo6_
> er5JmsO6XsSZCiN0o&e=
>
>
>
> 10x the number of kids dying and they have stricter gun laws.   Why do
> these deaths draw so little attention?  Yet suburban school shootings  and
> the shooter gets major coverage.
>
>
>
> Is the media effectively and wisely moving public opinion around guns or
> opioids etc or is it about reaction and ratings?
>
>
>
> The government can’t solve issues any more than the c-suite can claim to
> provide better care in hospitals through policy alone.    Just my opinion.
>
>
>
> Real solutions won’t come from laws or policy especially from those
> distant from the problem and solely developed to satisfy media hype or
> check a regulatory box.
>
>
>
>
>
>
>
> Mick Connors
>
>
>
>
>
>
>
> On Feb 19, 2018, at 12:00 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
>
> There are 17 messages totaling 3381 lines in this issue.
>
>
>
> Topics of the day:
>
>
>
> 1. School shootings....... (4)
>
> 2. PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39) (3)
>
> 3. The shooting in Florida (9)
>
> 4. A second, more settled, reflection on the Florida shooting
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ----------------------------------------------------------------------
>
>
>
> Date:    Sat, 17 Feb 2018 21:57:25 -0500
>
> From:    "Horst D. Weinberg, MD"
>
>        <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: School shootings.......
>
>
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand.  This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'.  Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem.  So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
>
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve.     Horst D. Weinberg, MD
>
>
>
>
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 06:13:44 -0500
>
> From:    Mick Work <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
>
>
> I respect the need for debate around guns.   However, I think we are
> remiss as pediatric emergency physicians to not raise a deeper discussion
> around the mental illness crisis.
>
>
>
> We all see kids who meet this persons profile across the country. We see
> disturbing mental illness and the many factors (including social media,
> broken families, child abuse) that lead a child to buy a gun to do harm.
> Or if not gun an explosive device etc..
>
>
>
> We see kids who are socially isolated and warning signs ignored.  Anyone
> else concerned that the kids we see with mental illness are recognized by
> schools or pediatric visit screening more often than by their own parents,
> friends or neighbors.
>
>
>
> This persons desire to be a “school shooter” should raise attention around
> how the media covers these events.  The fame brought to these shooters
> should be called into question.  Are we fostering this copycat mentality?
>
>
>
> The lack of respect for human life should call us to question more than
> the how but why.
>
>
>
> A focus only on guns and gun laws is remiss to the bigger picture in my
> opinion and experience.
>
>
>
> Mick
>
>
>
>
>
>
>
> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
>
> There are 4 messages totaling 391 lines in this issue.
>
>
>
> Topics of the day:
>
>
>
> 1. Peds EM talk (2)
>
> 2. Bacterial meningitis
>
> 3. The shooting in Florida
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ----------------------------------------------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>
> From:    Purva Grover <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: Peds EM talk
>
>
>
> Thanks all for your help on this.
>
> Best
>
> Purva
>
>
>
> Purva Grover , MD
>
> Medical Director
>
> Pediatric Emergency Department
>
> Cleveland Clinic Health System
>
> Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> [log in to unmask]>>g
>
>
>
> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> [log in to unmask]>> wrote:
>
>
>
> Hi All
>
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
>
> cover ALL or even most. Any thoughts / talks / power points- you could
>
> share would be appreciated.
>
> Thanks
>
> Purva
>
>
>
> Sent from my mobile device
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>
> From:    "Chamberlain, James" <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: Peds EM talk
>
>
>
> I would also cover unusual cases that you can't afford to miss, e.g.
>
>
>
> Sternoclavicular dislocation
>
> Conjunctivitis caused by penetrating FB
>
> Septic joint presenting with only low-grade fever (we've had several Staph
> infections where temp was only 37.6 or 37.7 orally)
>
> Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> patients need a through cardiac exam, including distal pulses
>
> NAT
>
> The "sleepy" baby who has hypoglycemia
>
> The "sleepy" baby who has intussusception
>
> The appendicitis patient who presents with vomiting and diarrhea (not all
> that unusual, actually)
>
> Etc.
>
>
>
> To me, this is the challenge of PEM. Finding the needle in the haystack,
> that one sick kid who is different than all the usual low acuity illness...
>
>
>
> Jim
>
>
>
> James Chamberlain
>
> Division Chief, Emergency Medicine
>
> Children’s National Health System
>
> (202) 476-4177
>
>
>
> -----Original Message-----
>
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Mojica, Michael
>
> Sent: Thursday, February 15, 2018 5:29 PM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: Re: Peds EM talk
>
>
>
> Purva
>
>
>
>
>
>
>
> I would recommend "the critically ill infant".
>
>
>
>
>
>
>
> It is the topic that scares the most people and you can cover a lot of
> causes through cases.
>
>
>
>
>
>
>
> I like to use cases that include common presenting complaints (e.g.
> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>
>
>
>
>
>
>
> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>
>
>
>
>
>
>
> My goal is for them to develop a mental checklist of potentially
> life-saving interventions.
>
>
>
>
>
>
>
> Michael
>
>
>
>
>
>
>
> Michael Mojica, M.D
>
>
>
> Director of Education, Division of Pediatric Emergency Medicine
>
>
>
> Director, Pediatric Emergency Medicine Fellowship
>
>
>
> Bellevue Hospital Center
>
>
>
> Administration Building Room A528
>
>
>
> New York, N.Y. 10016
>
>
>
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
> 212-562-8147
>
>
>
>
>
>
>
>
>
>
>
> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> behalf of Purva Grover" <[log in to unmask]<mailto:
> [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> [log in to unmask]>> wrote:
>
>
>
>
>
>
>
>  Hi All
>
>
>
>  I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
>
>
>
>  Thanks
>
>
>
>  Purva
>
>
>
>
>
>
>
>  Sent from my mobile device
>
>
>
>  For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
>
>
>  The URL for the PED-EM-L Web Page is:
>
>
>
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>
>
>
>
>
>
>
>
>
>
>
>
>
> ------------------------------------------------------------
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> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>
> From:    Aline Baghdassarian <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: Bacterial meningitis
>
>
>
> Scott,
>
>
>
> Would love to hear more about the cases. How did they present? What was the
>
> decision making process?
>
>
>
> Thank you,
>
>
>
> Aline
>
>
>
> Aline Baghdassarian, MD, MPH, FAAP
>
> Director, Pediatric Emergency Medicine Fellowship Program
>
> Assistant Professor, Department of Emergency Medicine
>
> Virginia Commonwealth University School of Medicine
>
>
>
> Children's Hospital of Richmond at VCU
>
> Email [log in to unmask]<mailto:aline.
> [log in to unmask]>
>
>
>
>
>
> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> <mailto:[log in to unmask]>>
>
> wrote:
>
>
>
> In a recent case at our institution, there was a present but subtle degree
>
> of meningismus — I’ve found over the years there is always some elicitable
>
> sign — but as importantly there’s a degree of irritability or altered
>
> behavior that has everyone concerned: mom, RN’s, me.
>
> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
>
> cerebritis or encephalopathic behavior until there’s a consent signed.
>
>
>
> I’m not such a good scientist anymore, but I’ve tried to be an attentive
>
> clinician.
>
>
>
> Julian Orenstein
>
>
>
>
>
> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> [log in to unmask]>> wrote:
>
>
>
> Scott - Bacterial meningitis is alive and well here in LV - we have seen
>
> it in a variety of age groups. There is good evidence that there has been
>
> an increase in pneumococcal serotypes not covered by the polyvalent
>
> vaccines since there widespread use, such that the burden of pneumococcal
>
> meningitis (as opposed to H. flu type b) has not decreased nearly as much.
>
>
>
> Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
>
> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>
>
>
> Also, the absence of meningismus in older kids with bacterial meningitis
>
> is well described and occurs in a substantial subset.
>
>
>
> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
>
> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>
>
>
> Much of the data on the sensitivity of the neck exam is of the
>
> retrospective variety. I have only read one really good prospective study
>
> on the sensitivity of PE for bacterial meningitis and it was a single
>
> center variety as I recall.
>
>
>
> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
>
> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
>
> 1992;21(8):910-914.
>
>
>
> Tough case.
>
>
>
>
>
> Jay
>
>
>
> Jay D. Fisher MD FAAP FACEP
>
> Medical Director, Pediatric EM
>
> Children's Hospital of Nevada at UMC
>
> Clinical Professor of Emergency Medicine and Pediatrics
>
> UNLV School of Medicine
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
>
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
>
>
>
> I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
>
> out that bacterial meningitis appears at this time of year as a
>
> complication of influenza:
>
> "Both pneumococcal and meningococcal meningitis can occur post flu as
>
> well as GAS and S aureus invasive disease and TSS."
>
>
>
> She also addressed Jim's question:  "We do know that new serotypes [of
>
> pneumococcus] have emerged but this is not waning immunity because the teen
>
> only got PCV7".
>
>
>
>
>
> Greg Conners
>
>
>
> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>
>
>
> Director, Division of Emergency Medicine
>
> Associate Chair of Pediatrics
>
> Professor of Pediatrics and Emergency Medicine
>
> Children’s Mercy Hospital, Kansas City
>
> University of Missouri, Kansas City
>
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
>
>
>
>
>
>
> -----Original Message-----
>
> From: Pediatric Emergency Medicine Discussion List [mailto:
>
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of 000001679b145c30-dmarc-
>
> [log in to unmask]<mailto:[log in to unmask]>
>
> Sent: Wednesday, February 14, 2018 2:25 PM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: Re: Bacterial meningitis
>
>
>
> *** This message was sent to you from an External Source. Please do not
>
> open untrusted links or attachments. ***
>
>
>
> ________________________________
>
>
>
>
>
> Could you share with us the clinical findings and history that prompted
>
> the LP?
>
>
>
>
>
> Shiu-Lin
>
>
>
>
>
>
>
>
>
> Shiu-Lin Tsai, MD
>
> Division of Pediatric Emergency Medicine
>
>
>
> Department of Emergency Medicine
>
> Columbia University Medical Center
>
>
>
>
>
>
>
> -----Original Message-----
>
> From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
>
> To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> BROWN.EDU>>
>
> Sent: Wed, Feb 14, 2018 2:44 pm
>
> Subject: Bacterial meningitis
>
>
>
> ALL:
>
> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
>
> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
>
> *Neisseria meningiditis*.  All 3 were in older children/ teens who received
>
> their Prevnar 13  vaccines as well as the Menactra series in the patient
>
> with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3
>
> cases of bacterial meningitis in older kids in a community setting such as
>
> ours in quite a long time.  Is this random bad luck or do  we all need to
>
> be more vigilant?  Incidentally, none had neck pain or meningismus as a
>
> clinical finding.
>
>
>
> --
>
> Kind regards,
>
>
>
> Scott
>
> Scott Freedman, MD
>
> Medical Director,  Pediatric Emergency Dept Rockville MD
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with
>
> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
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>
>
>
>
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>
>
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>
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> For more information, send mail to [log in to unmask]<mailto:
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>
>
>
> ------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>
> From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: The shooting in Florida
>
>
>
> Hi colleagues,
>
>
>
> As I sit in my office late on a Friday, I've gotten myself into a state
> about the 17 children gunned down in a school.  For the umpteenth time.
>
>
>
> I think the thing that has me so upset, is that this state of gun
> complaisance is an affront to everything a pediatric emergency physician
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
> burnout inducing conditions so that we can personally save, say, one life a
> year.
>
>
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
> years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
> watch that Parkland mother on CNN.  I dare you.
>
>
>
> Today is not a day like all the others.  It's just not.
>
>
>
> --Martin Pusic
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
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>
>
>
> ------------------------------
>
>
>
> End of PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
> **************************************************************
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 12:42:58 +0000
>
> From:    Terence Bergmann <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> Hi Joe
>
>
>
> I disagree about ‘strict gun control laws’ here having anything to do with
> it .  Either you or I could have a new hunting rifle in a week or two in
> Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
>
>
> We have a different culture here in Canada.  Guns are not toted around in
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
>
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
>
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
>
>
> I have lots of questions, but I don’t know the answers.
>
>
>
> Terence
>
>
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
>
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 14:31:22 +0000
>
> From:    "Habib, David" <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> Repeal and replace the second amendment with a clear and contemporary
> document. Dave Habib
>
>
>
> ________________________________________
>
> From: Pediatric Emergency Medicine Discussion List [
> [log in to unmask]<mailto:[log in to unmask]>] on
> behalf of Terence Bergmann [[log in to unmask]<mailto:
> [log in to unmask]>]
>
> Sent: Sunday, February 18, 2018 7:42 AM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: Re: The shooting in Florida
>
>
>
>
>
>
>
> Hi Joe
>
>
>
> I disagree about ‘strict gun control laws’ here having anything to do with
> it .  Either you or I could have a new hunting rifle in a week or two in
> Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
>
>
> We have a different culture here in Canada.  Guns are not toted around in
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
>
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
>
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
>
>
> I have lots of questions, but I don’t know the answers.
>
>
>
> Terence
>
>
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
>
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 14:04:25 +0000
>
> From:    Nathan Kuppermann <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> Jeffrey and colleagues:
>
>
>
> My colleague Garen Wintemute is an EM physician at UC Davis and has been
> doing seminal work on firearm violence prevention for decades - doggedly
> and with great impact
>
>
>
> He is the director of the Violence Prevention Research Program (VPRP) at
> UC Davis, and has been named a "hero of medicine" by Time Magazine in the
> past for his work. He is as smart and accomplished as they come, and there
> is nobody in the country who has been doing this longer or with greater
> impact. And he has weathered the political and funding crises for this type
> of work for years, frequently funding his own work when the political
> climate for this work was bleak. But he has also received substantial
> foundation money and federal grants during more supportive political times.
>
>
>
> He recently received $5 million from the California state legislature to
> lead the University of California Firearm Violence Research Center, the
> first state-funded gun violence research center in the country.
>
>
>
> Here is his entry in Wikipedia: https://urldefense.proofpoint.
> com/v2/url?u=https-3A__en.wikipedia.org_wiki_Garen-5FWintemute&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> NLb0pWX2zSNtCCtxb8sbfq2eU5kwLSJ1K01CUSRclBU&e=
>
>
>
> If you are interested in his program or donating, here is the link:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> ucdmc.ucdavis.edu_vprp_&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=y6AkLoGvtzbgZgJDAeqhImP2Ae_
> P1GrSzIOuDmcuDyo&e=
>
>
>
> Full disclosure: I serve as the Chair of EM at UC Davis where Garen works,
> but the only benefit to me for getting Garen more exposure or money to the
> VPRP program that he oversees is my children and family whom I desperately
> want to protect, my many friends throughout this great country about whom I
> deeply care, and a country about which I am deeply concerned.
>
>
>
> Nate Kuppermann
>
> UC Davis
>
>
>
>
>
>
>
> On Feb 17, 2018, at 3:03 PM, Jeffrey Oestreicher <[log in to unmask]<
> mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:
>
>
>
> Thanks for this cathartic thread, Dr. Pusic and others. Hope fellows are
> allowed to chime in. Like many on here my gut reaction is to focus on
> politics, ie an assault weapons ban, the 2nd amendment etc. If Americans
> were being killed by the same type of airplane that kept crashing, congress
> would act. Why the same isn’t done with the AR-15 given that it keeps being
> used to murder kids (in Sandy Hook, Aurora, Orlando, Las Vegas and now
> Parkland) is maddening. But I wonder if we could do more by taking the lead
> on another key gun violence issue on which physicians are experts. The
> problem was encapsulated by the first few hours after the parkland shooting
> when media outlets were literally arguing over how many school shootings
> there have been in 2018. We don't even know! We don't know because there
> are very little data on firearm injury/death in this country on account of
> Congress blocking gun violence research funding since 1996. And this
> funding block (the "Dickey amendment," named for the NRA point person in
> Congress at the time) has created a political chill on research that has
> trickled down even to academic medical centers. When I tried to examine NY
> EMS data to look at pre-hospital intervention in pediatric firearm injury,
> the city blocked it on account of the study being "too political." Where is
> the research? When SIDs reached epidemic numbers in the 70’s, Congress
> allocated funds for aggressive research leading to Back to Sleep campaign
> and SIDS rates plummeted. Similar research campaigns produced life-saving
> interventions for lead poisoning and car crashes. Yet no research crusade
> has been directed at the epidemic of pediatric firearm death because
> Congress essentially prohibits it. The hard part is trying to figure out
> what to do about it. In my state of New York, A.2977/S.4363, sponsored by
> New York State Assemblymember Jo Anne Simon and Senator Roxanne Persaud,
> would create a Firearm Violence Research Institute in New York and I along
> with some colleagues are trying to support this in a few different ways; if
> others on here want to discuss or have other ideas pls be in touch. This is
> not meant to discourage us from yelling from rooftops and writing senators
> about background checks, assault weapons ban etc. That is so important. But
> we have a unique vantage point with regard to public health research and
> we're allowed to do it for every other public health problem except this
> one.  Thanks so much for allowing me to add my 2 cents
>
>
>
> Sent from my iPhone
>
>
>
> On Feb 17, 2018, at 3:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
>
>
> Martin,
>
>
>
> As I sit in my living room on this Saturday morning, I’ve also gotten my
> self in a state about how we tend to focus in on the small picture and
> neglect an exponentially bigger one.
>
>
>
> Spoiler Alert: this will NOT be a politically laced nor personally biased
> post...as opposed to some of the previous posts on this issue - I'm
> actually quite disappointed that politics had to rear its ugly head.
>
>
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>                Don't claim to be a gun control policy expert
>
>
>
> Now, allow me to expound:
>
>
>
> 1. A troubled young man AND inappropriate access to crazy weapons is what
> caused this catastrophe.
>
>
>
> Colleagues, I think we all agree that it would be too simplistic and
> frankly naive to think that stricter gun control would solve all of these
> gun related deaths...many examples of this false and misleading association
> of tighter gun control means safer society here are just a few below...many
> more:
>
> -explore New Hampshire and Illinois...NH has very liberal gun control,
> Chicago instead has very strict ones...look up who has more gun related
> violent crime per capita...
>
> -the Swiss gov't actually encourages gun ownership.. has one of the
> highest rates of gun ownership in the world, but little gun-related street
> crime
>
> -Britain has more violent crime then the US (ban on guns since 1997)
>
>
>
> From my viewpoint, attention is being focused in the wrong direction. I
> think we as powerful respected advocates of "public health" should focus at
> the root causes of the problem, starting with the breakdown of the family
> (young males who are deprived of an active father figure are far more
> likely to commit violent crimes), the relentless stream of violent
> promoting behaviour from Hollywood, the exponential increase in mental
> illness in youth to start with.
>
>
>
> How come we don't lambast the horrendous violence coming out of Hollywood
> which our youth are imbibing with negative consequences?
>
>
>
> 2. As per the CDC, in 2016, ~900 000 legal induced abortions were reported
> from 49 reporting areas...likely a significant underestimate since CA among
> other states does not report its numbers  (BTW ~ 1.5% for rape/incest, 3%
> for fetal health issues).
>
>
>
> Without going into the classic arguments re pro/con, how can we not, how
> do we not stand up for these children? I agree with the AAP's stance on gun
> control but what I have trouble understanding is how the AAP does not weigh
> in on the abortion issue (~10% of abortions are reported in females <19)?
>
>
>
> 17 children violently, meaninglessly murdered. An incredible tragedy. How
> is this different then close to 1 million kids per year mentioned above.
>
>
>
> I agree with the AAP's stance on gun control but what I have trouble
> understanding is how the AAP does not weigh in on the abortion issue?
>
>
>
>
>
> Joe
>
>
>
>
>
>
>
>
>
>
>
> Joe Nemeth MD FCFP EM
>
> Associate Professor
>
> McGill University
>
>
>
>
>
> ________________________________________
>
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]<mailto:[log in to unmask]><mailto:
> [log in to unmask]>> on behalf of Barry Nathan <
> [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
>
> Sent: February 17, 2018 7:23:57 AM
>
> To: [log in to unmask]<mailto:[log in to unmask]
> ><mailto:[log in to unmask]>
>
> Subject: Re: The shooting in Florida
>
>
>
> In case you don't get emails from the AAP:
>
>
>
> [image: AAP_400_61.jpg]
>
>
>
>
>
>
>
> *Statement on School Shooting in Parkland, Florida*
>
>
>
> from *Colleen A. Kraft, MD, FAAP, President, American Academy of
> Pediatrics*
>
>
>
> "Yesterday just before the dismissal bell rang, 17 children and adults were
>
> shot and killed and 15 were injured inside Marjory Stoneman Douglas High
>
> School in Parkland, Fla. We find ourselves once again filled with grief and
>
> horror, and we mourn alongside all those impacted by the shooting. As our
>
> hearts are in Parkland, our eyes are on Congress.
>
>
>
> "This is the eighteenth school shooting in 2018, the equivalent of one
>
> every two and a half days so far this year. Shootings have an indelible
>
> impact on entire communities, on the families who lost children and loved
>
> ones, and on the children who survived. Columbine. Virginia Tech. Newtown.
>
> Orlando. Las Vegas. And now, Parkland. Children are dying from gun violence
>
> and Congress is failing to act. Every one of our 100 U.S. senators, and all
>
> 435 U.S. representatives bear a responsibility to take meaningful action to
>
> protect our children, our families, and our communities. Our elected
>
> leaders cannot continue to fail at this most essential task.
>
>
>
> "We can start by working to advance meaningful legislation that keeps
>
> children safe. The American Academy of Pediatrics advocates for stronger
>
> state and federal gun laws that protect children, including a ban on
>
> assault weapons like the one used in yesterday's school shooting. We also
>
> call for stronger background checks, solutions addressing firearm
>
> trafficking, and encouraging safe firearm storage. We will also continue to
>
> work to ensure that children and their families have access to appropriate
>
> mental health services, particularly to address the effects of exposure to
>
> violence.
>
>
>
> "Although these mass shootings command our attention, our children remain
>
> at risk daily for suicide, homicide, and unintentional injury because of
>
> the current policy regarding access to guns in the United States. Gun
>
> violence is a public health threat to children, and one the American
>
> Academy of Pediatrics will continue to take on, in state capitals across
>
> the country and in the halls of Congress. Parents across the United States
>
> send their children to school every day, and hope and trust they will be
>
> safe. As long as children continue to be injured and killed by guns in this
>
> country, pediatricians will not rest in our pursuit to keep them safe."
>
>
>
> *The American Academy of Pediatrics is an organization of 66,000 primary
>
> care pediatricians, pediatric medical subspecialists and pediatric surgical
>
> specialists dedicated to the health, safety and well-being of infants,
>
> children, adolescents and young adults. For more information, visit *
>
> www.aap.org<https://urldefense.proofpoint.com/v2/
> url?u=http-3A__www.aap.org&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> GYHJ2Trg6KbD5HWur2hhBM8okfIlyE-J85UX7orhmA4&e=><https://
> urldefense.proofpoint.com/v2/url?u=http-3A__www.aap.org&d=
> DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7
> OHtbhTpnjKXBI&m=t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> GYHJ2Trg6KbD5HWur2hhBM8okfIlyE-J85UX7orhmA4&e=>
>
> <https://urldefense.proofpoint.com/v2/url?u=https-
> 3A__linkprotect.cudasvc.com_url-3Fa-3Dhttp-3A__www.
> mmsend70.com_link.cfm-253fr-253dP1AWQRX2DH6KpZKp05dazA-7E-
> 7E-2526pe-253dBH4KXYJXftdV7-5FOrPTTyUbVAzQsfgoRvleBm2XUVQ6
> AiEVwuBNacQ0AWbz2OcXguY6Y2i1bNdCMkiPdWG-2DfHRg-7E-7E-2526t-
> 253dP2O93UltqkjSP1tT62-5FPaA-7E-7E-26c-3DE-2C1-
> 2CEDnzTesKajviC9Rbq687pz7yfFyRgC2WBFw6mF1beQyzL2WYF-
> 5FfPWMjWxOixG1eagtp40GaUhhxZ8IL4zNcR4weeC1DLvkbbpHQsmMSnszDC
> -26typo-3D1&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=nx187qR_
> lU1zgduq5D6pufobUc2LvOfMjUy_CKFqY-w&e=>*
>
> and
>
> follow us on Twitter @AmerAcadPeds.*
>
>
>
> On Fri, Feb 16, 2018 at 9:22 PM, Chamberlain, James <
>
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
>
>
> I think we need to move to repeal the second amendment. It's the only way
>
> the NRA can be stopped. They resist all reasonable attempts to limit the
>
> carnage and then hide behind a misinterpretation of the second amendment.
>
>
>
> Very well, let's repeal it. I know many people agree that we don't need
>
> militias any longer.
>
>
>
> Jim Chamberlain
>
>
>
>
>
>
>
> -----Original Message-----
>
> From: Pediatric Emergency Medicine Discussion List [mailto:
>
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of Martin Pusic
>
> Sent: Friday, February 16, 2018 6:29 PM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: The shooting in Florida
>
>
>
> Hi colleagues,
>
>
>
> As I sit in my office late on a Friday, I've gotten myself into a state
>
> about the 17 children gunned down in a school.  For the umpteenth time.
>
>
>
> I think the thing that has me so upset, is that this state of gun
>
> complaisance is an affront to everything a pediatric emergency physician
>
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
>
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
>
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
>
> burnout inducing conditions so that we can personally save, say, one life a
>
> year.
>
>
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
>
> years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
>
> watch that Parkland mother on CNN.  I dare you.
>
>
>
> Today is not a day like all the others.  It's just not.
>
>
>
> --Martin Pusic
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the
>
> message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
>
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
>
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_a1kDlfTJH0FA02j_
>
> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
>
>
>
> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>
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>
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>
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> For more information, send mail to [log in to unmask]<mailto:
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>
> The URL for the PED-EM-L Web Page is:
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> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]><mailto:[log in to unmask]> with the
> message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 10:20:42 -0500
>
> From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: A second, more settled, reflection on the Florida shooting
>
>
>
> After my amygdala-based email of Friday, a clarification:
>
>
>
> It is right and fit and proper that Pediatric Emergency Medicine
> physicians bring the full force of our research and clinical armementarium
> to bear on the problems of our patients.  That means sweating thresholds of
> WBC for their predictive value in infections.  That means mounting massive
> 10 year PECARN/PERC/PERN level research efforts to understand in detail the
> mechanisms of our patients' problems in order to benefit them in any way we
> can.  That's our  laudable job.  We should be proud of taking on the
> problem of brain tumours 30 years from now.  In no way did I mean to
> denigrate those efforts.  Instead, the complete opposite  -- I think they
> provide us with the moral authority to speak out against government
> policies that harm children.
>
>
>
> What is neither right nor fit nor proper is the ease with which a gun
> violence proponent can wreak havoc at a scale that, on a given schoolday,
> trivializes my efforts and those of my PEM colleagues.  It feels like a
> personal affront that we live in a nation in which somehow the NRA has
> better government support than CHIP does.  My point is not to devalue our
> day/evening/night/weekend job.... we are doing MORE than our part in
> society.......but rather to express that I, as a PEM physician, am rocked
> to the core by the moral imbalance that makes it possible to routinely
> leave 17 children dead.  And that this is some sort of normal.
>
>
>
> Some notes:
>
> If you need an example of how routine this has become, one PEM colleague
> wrote that he is going to his son's elementary school next week to instruct
> the teachers on external control of hemorrhage
>
> A Scot described the positive example of the way the Dunblane massacre
> provoked a re-writing of their laws.  They haven't had another in 22 years
> since.
>
> Fahd Ahmad from WashU had already written on this:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> roguedadmd.com_2018_02_how-2Dmany-2Dpeople-2Dand-2Dwhich-
> 2Dpeople-2Dshould-2Ddie-2Dfor-2Dwhich-2Drights_&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=gBTmwrSDR2Xj4YokS_
> BOxGaLGBc1Xiq3jhEmCjkra6M&e=
>
> I learned of the positive examples of EM physicians taking this on
> including Garen Wintemute of UC Davis and Eric Fleegler/Lois Lee at Boston
> Children's.
>
> thank you posting the AAP statement which properly represents our values
>
> The majority of people who wrote back are mothers.
>
>
>
> Finally, I commit to writing back, constructively, every 3 months on this
> topic until there's nothing to write about
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 16:56:19 +0000
>
> From:    Doc Holiday <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> Before I continue, I must say how much more comfortable this on-line
> debate feels as compared to previous ones on other ListServs. I know it's a
> generalising comment, but I keep finding that the insertion into the mix of
> people who work with children makes everything so much more polite and
> patient. If I recall correctly, there was a lot of anger and short
> sentences last time I was involved in a debate on this topic on an "adult"
> list....
>
>
>
>
>
> From: Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]>>
>
> As I sit in my living room on this Saturday morning
>
>
>
>
>
> --> My living room. Sunday afternoon. What else is there to do on a
> weekend, eh?
>
>
>
>
>
> I live in Canada and  love our very strict gun control laws
>
>
>
>
>
> --> As people know, I live in the UK at this time and I also like the gun
> laws here (as well as ones on knives, etc). I don't feel as positive about
> drug laws, but that's a different thread. Still, the point I made before
> and make again now is that I don't think our gun laws are THE cause of our
> statistics. I think they are but one (be it major) factor contributing, but
> on the background of a culture which rejects gun violence! I don't think
> that any society will change sufficiently merely by their introduction - no
> matter how strict. I have lived for many years in more than one country in
> which guns were far more common than they are in the UK and these countries
> differed markedly in terms of gun violence. One was actually on the same
> scale as the USA!
>
>
>
>
>
> A troubled young man AND inappropriate access to crazy weapons is what
> caused this catastrophe... too simplistic and frankly naive to think that
> stricter gun control would solve all of these gun related deaths
>
>
>
>
>
> --> I agree. And I would add that there are factors beyond the two you
> mentioned. It's not even ONLY two factors. We can probably add to this:
>
> - the lack of major societal backlash to inappropriate comments
>
> - the tolerance of lack of free psychiatric care
>
> - the overwhelming number of similar cases which will "drown" the efforts
> of law enforcement to identify the cases which eventually go on to this
> sort of event from among so many others, etc
>
> - there will be more factors identified as this case gets investigated
>
>
>
>
>
> One more point, though - a HUGE factor might be, as in past cases, if the
> outrage dies down! The NRA and those who profit from guns will push their
> politicians, including some of the more publicly-prominent ones and they
> will keep things as quiet as possible. Possibly, even the next similar
> event somehow will be used to make this one "disappear". You can recognise
> the "silencing tactics" by indicator phrases such as:
>
> - "Now is not the time..."
>
> - "Country/state/city X ... bla-bla-bla ... And they have more/fewer guns
> and more/fewer gun deaths and this random statistic thus means we should
> stop looking into gun control"
>
> - "My child just falls a lot" (sorry - had to put that in, as it's on the
> same level)
>
> - "The USA is a unique country and yet, when it suits me, I will find some
> other one with which to make comparisons to prove my point"
>
>
>
>
>
> Britain has more violent crime then the US (ban on guns since 1997)
>
>
>
>
>
> --> I realise that I am picking up just one of the many points which were
> listed together. I am only choosing this one because it's one I have been
> familiar with for a very long time. It has been much "used" in order to
> "prove" to Americans how the introduction of gun laws in the UK has left it
> with a higher violent crime rate than the USA and should thus be avoided by
> the USA. Now, I won't trouble the List by arguments about this. Instead, I
> would appreciate it if y'all satisfy your own curiosities, each to his/her
> own level, by going to a favourite search engine and searching for the
> phrase "Britain has more violent crime then the US". You can read for
> yourselves and save me from having to type up the actual facts...
>
>
>
>
>
> But I can't stop myself from mentioning something which has come up in a
> past discussion I was accidentally drawn into on a visit to the USA 3-4
> years ago. This same myth was raised. That, in itself, was no surprise, but
> it had been raised by someone who had already impressed me with how many
> "facts" he had absorbed from social media sources and how confidently he
> spoke of these despite appearing to be far less eloquent whenever
> questioned in detail about anything. I.e., he appeared to me to have been
> "brainwashed". Despite knowing better, I challenged him on why he thought
> the USA was "doing so much better" than the UK in terms of violent crime.
> He gave me the answer. He then mistook my look of disbelief to indicate I
> did not believe the facts he had mentioned. He was wrong - what I did not
> believe is that someone could be that easy to "sell" to. He pulled out his
> phone and showed me the "evidence". No idea what you're sitting on as you
> read this, but I hope it has handles for you to hang onto, so that you
> don't fall to the ground laughing. The reason, according to this "expert"
> for how the USA got to have what he claimed was 10 times less violent crime
> than the UK is because the USA has taken the excellent pre-emptive step of
> imprisoning those who would otherwise have engaged in violent crime! I kid
> you not - he attributed the high level of violent crime he believed the UK
> had, not to the fact that the UK records a huge number of offences which
> the USA does not include in its statistics. What he showed me was:
> https://urldefense.proofpoint.com/v2/url?u=https-3A__en.
> wikipedia.org_wiki_List-5Fof-5Fcountries-5Fby-5Fincarceration-5Frate&d=
> DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7
> OHtbhTpnjKXBI&m=t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> U4gHJAeNgKwFDK4WRfsLUPol7JAm8n3364MaZLG1Co4&e= (the version which was on
> line then). He had been "educated" to believe that the fact that the USA
> had around a 10-time higher number of prisoners than the UK per million of
> population correlated with how it achieved a 10-time lower rate of violent
> crime...
>
>
>
>
>
> I expect one requires whole armies of people who can be thus educated in
> order to perpetuate certain "facts"... Such people can be convinced of many
> things...
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> <https://urldefense.proofpoint.com/v2/url?u=http-
> 3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 12:00:26 -0500
>
> From:    Michael Falk <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> While I get the despair and anger given the lose of 17 people in another
>
> senseless mass shooting, I would caution people to not give up hope.  When
>
> I first came to New York City in 1989, it was averaging about 2,000
>
> homicides a year.  If take our statistics for nonlethal injuries per
>
> homicide, roughly 7:1, the city was seeing another 10,000 plus penetrating
>
> traumas and I have not even mentioned the assaults with fists or blunt
>
> objects.  Last year in NYC, we had less than 400 homicides and the city is
>
> safer than it has been in years.  Why?  Well, there was a concerted effort
>
> to change the culture of policing and law enforcement in the city, and
>
> there was a massive crackdown on guns and getting them off the streets.
>
> The laws were changed around gun ownership and licensing, and there you
>
> have it....
>
>
>
> Also, many of you are forgetting that we had an assault weapons law in the
>
> US and Bush/Congress let it lapse in 2003.  Now it's record is a mixed bag
>
> but I think that if we learn from the mistakes we made the last time, and
>
> write a better law, we can actually have a significant impact.
>
>
>
> Just my two cents..
>
> Mike Falk
>
> NYC.
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 17:09:24 +0000
>
> From:    Robert Finkelstein <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
>
>
> Other countries have the same level of mental illness as the United
> States, but not nearly the number of gun deaths. The mental health issue is
> important but access to weapons that can kill a large number of people in
> seconds allows the results we see. In addition, access to guns plays  a
> huge role in suicides since many who attempt suicide and do not succeed
> will get help and not attempt again. However, access to a gun makes it much
> more likely that the first attempt will result in death.
>
>
>
> Robert Finkelstein
>
>
>
> On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]<mailto:sed8m
> [log in to unmask]>> wrote:
>
>
>
> I respect the need for debate around guns.   However, I think we are
> remiss as pediatric emergency physicians to not raise a deeper discussion
> around the mental illness crisis.
>
>
>
> We all see kids who meet this persons profile across the country. We see
> disturbing mental illness and the many factors (including social media,
> broken families, child abuse) that lead a child to buy a gun to do harm.
> Or if not gun an explosive device etc..
>
>
>
> We see kids who are socially isolated and warning signs ignored.  Anyone
> else concerned that the kids we see with mental illness are recognized by
> schools or pediatric visit screening more often than by their own parents,
> friends or neighbors.
>
>
>
> This persons desire to be a “school shooter” should raise attention around
> how the media covers these events.  The fame brought to these shooters
> should be called into question.  Are we fostering this copycat mentality?
>
>
>
> The lack of respect for human life should call us to question more than
> the how but why.
>
>
>
> A focus only on guns and gun laws is remiss to the bigger picture in my
> opinion and experience.
>
>
>
> Mick
>
>
>
>
>
>
>
> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
>
> There are 4 messages totaling 391 lines in this issue.
>
>
>
> Topics of the day:
>
>
>
> 1. Peds EM talk (2)
>
> 2. Bacterial meningitis
>
> 3. The shooting in Florida
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ----------------------------------------------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>
> From:    Purva Grover <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: Re: Peds EM talk
>
>
>
> Thanks all for your help on this.
>
> Best
>
> Purva
>
>
>
> Purva Grover , MD
>
> Medical Director
>
> Pediatric Emergency Department
>
> Cleveland Clinic Health System
>
> Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> [log in to unmask]>>g
>
>
>
> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> [log in to unmask]>> wrote:
>
>
>
> Hi All
>
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
>
> cover ALL or even most. Any thoughts / talks / power points- you could
>
> share would be appreciated.
>
> Thanks
>
> Purva
>
>
>
> Sent from my mobile device
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>
> From:    "Chamberlain, James" <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: Peds EM talk
>
>
>
> I would also cover unusual cases that you can't afford to miss, e.g.
>
>
>
> Sternoclavicular dislocation
>
> Conjunctivitis caused by penetrating FB
>
> Septic joint presenting with only low-grade fever (we've had several Staph
> infections where temp was only 37.6 or 37.7 orally)
>
> Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> patients need a through cardiac exam, including distal pulses
>
> NAT
>
> The "sleepy" baby who has hypoglycemia
>
> The "sleepy" baby who has intussusception
>
> The appendicitis patient who presents with vomiting and diarrhea (not all
> that unusual, actually)
>
> Etc.
>
>
>
> To me, this is the challenge of PEM. Finding the needle in the haystack,
> that one sick kid who is different than all the usual low acuity illness...
>
>
>
> Jim
>
>
>
> James Chamberlain
>
> Division Chief, Emergency Medicine
>
> Children’s National Health System
>
> (202) 476-4177
>
>
>
> -----Original Message-----
>
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Mojica, Michael
>
> Sent: Thursday, February 15, 2018 5:29 PM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: Re: Peds EM talk
>
>
>
> Purva
>
>
>
>
>
>
>
> I would recommend "the critically ill infant".
>
>
>
>
>
>
>
> It is the topic that scares the most people and you can cover a lot of
> causes through cases.
>
>
>
>
>
>
>
> I like to use cases that include common presenting complaints (e.g.
> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>
>
>
>
>
>
>
> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>
>
>
>
>
>
>
> My goal is for them to develop a mental checklist of potentially
> life-saving interventions.
>
>
>
>
>
>
>
> Michael
>
>
>
>
>
>
>
> Michael Mojica, M.D
>
>
>
> Director of Education, Division of Pediatric Emergency Medicine
>
>
>
> Director, Pediatric Emergency Medicine Fellowship
>
>
>
> Bellevue Hospital Center
>
>
>
> Administration Building Room A528
>
>
>
> New York, N.Y. 10016
>
>
>
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
> 212-562-8147
>
>
>
>
>
>
>
>
>
>
>
> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> behalf of Purva Grover" <[log in to unmask]<mailto:
> [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> [log in to unmask]>> wrote:
>
>
>
>
>
>
>
> Hi All
>
>
>
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
>
>
>
> Thanks
>
>
>
> Purva
>
>
>
>
>
>
>
> Sent from my mobile device
>
>
>
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> [log in to unmask]> with the message: info PED-EM-L
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>
>
> ------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>
> From:    Aline Baghdassarian <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: Bacterial meningitis
>
>
>
> Scott,
>
>
>
> Would love to hear more about the cases. How did they present? What was the
>
> decision making process?
>
>
>
> Thank you,
>
>
>
> Aline
>
>
>
> Aline Baghdassarian, MD, MPH, FAAP
>
> Director, Pediatric Emergency Medicine Fellowship Program
>
> Assistant Professor, Department of Emergency Medicine
>
> Virginia Commonwealth University School of Medicine
>
>
>
> Children's Hospital of Richmond at VCU
>
> Email [log in to unmask]<mailto:aline.
> [log in to unmask]>
>
>
>
>
>
> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> <mailto:[log in to unmask]>>
>
> wrote:
>
>
>
> In a recent case at our institution, there was a present but subtle degree
>
> of meningismus — I’ve found over the years there is always some elicitable
>
> sign — but as importantly there’s a degree of irritability or altered
>
> behavior that has everyone concerned: mom, RN’s, me.
>
> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
>
> cerebritis or encephalopathic behavior until there’s a consent signed.
>
>
>
> I’m not such a good scientist anymore, but I’ve tried to be an attentive
>
> clinician.
>
>
>
> Julian Orenstein
>
>
>
>
>
> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> [log in to unmask]>> wrote:
>
>
>
> Scott - Bacterial meningitis is alive and well here in LV - we have seen
>
> it in a variety of age groups. There is good evidence that there has been
>
> an increase in pneumococcal serotypes not covered by the polyvalent
>
> vaccines since there widespread use, such that the burden of pneumococcal
>
> meningitis (as opposed to H. flu type b) has not decreased nearly as much.
>
>
>
> Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
>
> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>
>
>
> Also, the absence of meningismus in older kids with bacterial meningitis
>
> is well described and occurs in a substantial subset.
>
>
>
> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
>
> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>
>
>
> Much of the data on the sensitivity of the neck exam is of the
>
> retrospective variety. I have only read one really good prospective study
>
> on the sensitivity of PE for bacterial meningitis and it was a single
>
> center variety as I recall.
>
>
>
> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
>
> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
>
> 1992;21(8):910-914.
>
>
>
> Tough case.
>
>
>
>
>
> Jay
>
>
>
> Jay D. Fisher MD FAAP FACEP
>
> Medical Director, Pediatric EM
>
> Children's Hospital of Nevada at UMC
>
> Clinical Professor of Emergency Medicine and Pediatrics
>
> UNLV School of Medicine
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
>
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
>
>
>
> I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
>
> out that bacterial meningitis appears at this time of year as a
>
> complication of influenza:
>
> "Both pneumococcal and meningococcal meningitis can occur post flu as
>
> well as GAS and S aureus invasive disease and TSS."
>
>
>
> She also addressed Jim's question:  "We do know that new serotypes [of
>
> pneumococcus] have emerged but this is not waning immunity because the teen
>
> only got PCV7".
>
>
>
>
>
> Greg Conners
>
>
>
> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>
>
>
> Director, Division of Emergency Medicine
>
> Associate Chair of Pediatrics
>
> Professor of Pediatrics and Emergency Medicine
>
> Children’s Mercy Hospital, Kansas City
>
> University of Missouri, Kansas City
>
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
>
>
>
>
>
>
> -----Original Message-----
>
> From: Pediatric Emergency Medicine Discussion List [mailto:
>
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of 000001679b145c30-dmarc-
>
> [log in to unmask]<mailto:[log in to unmask]>
>
> Sent: Wednesday, February 14, 2018 2:25 PM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: Re: Bacterial meningitis
>
>
>
> *** This message was sent to you from an External Source. Please do not
>
> open untrusted links or attachments. ***
>
>
>
> ________________________________
>
>
>
>
>
> Could you share with us the clinical findings and history that prompted
>
> the LP?
>
>
>
>
>
> Shiu-Lin
>
>
>
>
>
>
>
>
>
> Shiu-Lin Tsai, MD
>
> Division of Pediatric Emergency Medicine
>
>
>
> Department of Emergency Medicine
>
> Columbia University Medical Center
>
>
>
>
>
>
>
> -----Original Message-----
>
> From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
>
> To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> BROWN.EDU>>
>
> Sent: Wed, Feb 14, 2018 2:44 pm
>
> Subject: Bacterial meningitis
>
>
>
> ALL:
>
> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
>
> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
>
> *Neisseria meningiditis*.  All 3 were in older children/ teens who received
>
> their Prevnar 13  vaccines as well as the Menactra series in the patient
>
> with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3
>
> cases of bacterial meningitis in older kids in a community setting such as
>
> ours in quite a long time.  Is this random bad luck or do  we all need to
>
> be more vigilant?  Incidentally, none had neck pain or meningismus as a
>
> clinical finding.
>
>
>
> --
>
> Kind regards,
>
>
>
> Scott
>
> Scott Freedman, MD
>
> Medical Director,  Pediatric Emergency Dept Rockville MD
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with
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>
>
>
> ------------------------------
>
>
>
> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>
> From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
>
> Subject: The shooting in Florida
>
>
>
> Hi colleagues,
>
>
>
> As I sit in my office late on a Friday, I've gotten myself into a state
> about the 17 children gunned down in a school.  For the umpteenth time.
>
>
>
> I think the thing that has me so upset, is that this state of gun
> complaisance is an affront to everything a pediatric emergency physician
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
> burnout inducing conditions so that we can personally save, say, one life a
> year.
>
>
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
> years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
> watch that Parkland mother on CNN.  I dare you.
>
>
>
> Today is not a day like all the others.  It's just not.
>
>
>
> --Martin Pusic
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
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>
>
>
> ------------------------------
>
>
>
> End of PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
> **************************************************************
>
>
>
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>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 10:17:05 -0500
>
> From:    Deepti Thomas-Paulose <[log in to unmask]<mailto:dt
> [log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> The year speed limit laws went into effect-->traffic deaths down 17%.
>
> Mothers against Drunk Driving, stricter DUI enforcement  laws-->cut deaths
>
> due to drunk driving by half every year since 1980. Seat belt safety laws,
>
> traffic laws-all created to protect the public.  As a public health trained
>
> physician, it seems so illogical to me that we would not create stricter
>
> gun laws especially against military style guns for the civilian
>
> population.  Let's start there.
>
>
>
> Problem- Mass shootings
>
> Prevention- Ban assault rifles
>
>
>
>
>
> On Sun, Feb 18, 2018 at 7:42 AM, Terence Bergmann <
>
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
>
>
> Hi Joe
>
>
>
> I disagree about ‘strict gun control laws’ here having anything to do with
>
> it .  Either you or I could have a new hunting rifle in a week or two in
>
> Canada.  If you look at the school shootings or the Vegas massacre these
>
> are not people who acquired their guns and went slaughtering.  These guns
>
> were acquired and the armamentarium prepped and the plans made.  Canadian
>
> laws would not stop this.
>
>
>
> We have a different culture here in Canada.  Guns are not toted around in
>
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
>
> from flourishing on our side of the border.  I don’t know why.
>
>
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
>
> with illegal guns how do you stop the populace from wanting to have legal
>
> guns?
>
>
>
> Somehow other countries can have legal weapons, such as Swiss adults all
>
> keeping their weapons at home after their years of mandatory service, yet
>
> they don’t kill each other with them.  Somehow a well armed militia there
>
> does not lead to violence.
>
>
>
> I have lots of questions, but I don’t know the answers.
>
>
>
> Terence
>
>
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:j
>
> [log in to unmask]<mailto:[log in to unmask]>>> wrote:
>
>
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the
>
> message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
>
>
>
>
>
>
> --
>
> Deepti Thomas-Paulose, MD, MPH
>
> Fellowship Director
>
> Global Health Division
>
> Mt. Sinai St.Luke's Roosevelt Hospital Center
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> slredglobalhealth.org&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> D3bvjwGdQp2RN9jDOl4BSMlphh63sYQrLWvNUrRTFAY&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 17:15:53 +0000
>
> From:    Robert Finkelstein <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: School shootings.......
>
>
>
> Just because people will find a way to break laws does not mean that we
> shouldn’t have them.   By that logic, we expect that all of us who are
> currently law abiding don’t need any laws to make us so.  Human nature
> being what it is, we all need laws and structure.  Yes, gun regulation
> would not stop all gun violence, but it could reduce it. Also, I don’t
> think the majority want prohibition of guns, just regulation; the same way
> alcohol is regulated by age and penalties for driving under the influence.
> Or, the way cars are regulated with licensing, registration, having to pass
> a driving test and citations for violations.
>
>
>
> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> [log in to unmask]<mailto:
> [log in to unmask]>> wrote:
>
>
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand.  This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'.  Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem.  So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
>
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve.     Horst D. Weinberg, MD
>
>
>
>
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
>
>
>
> ------------------------------
>
>
>
> Date:    Sun, 18 Feb 2018 17:26:11 +0000
>
> From:    Robert Flood <[log in to unmask]<mailto:
> [log in to unmask]>>
>
> Subject: Re: The shooting in Florida
>
>
>
> Dear Colleagues:
>
>
>
>
>
> This conversation gives me some hope that we can and will address the
> issue of gun violence through the scientific approach, rather than
> "beliefs" and "feelings", similar to the way that Dr. Wintemute has done
> for the past several decades. While I fully support a
> "re-evaluation/clarification" of the second amendment, a "Children's Rights
> Amendment", and other legislation to help curb gun violence in the US, we
> can and and should evaluate potential interventions now in the context of
> over 350 million guns, with unlimited ammunition, available to the US
> public.
>
>
>
>
>
> So, if we are going to use the scientific approach to this hug...
>
> [Message clipped]

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

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