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PED-EM-L  February 2018

PED-EM-L February 2018

Subject:

Re: PED-EM-L Digest - 20 Feb 2018 - Special issue (#2018-49)

From:

Robert Acosta <[log in to unmask]>

Reply-To:

Robert Acosta <[log in to unmask]>

Date:

Tue, 20 Feb 2018 19:57:09 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (2472 lines)

https://academic.oup.com/qje/article-abstract/116/2/379/1904158




On Feb 20, 2018 5:55 PM, "A Pohlgeers" <
[log in to unmask]> wrote:

I would like to contribute to the most recent discussion that has morphed
away from 'simple gun control/regulation' and the horrible tragedy in South
Florida into more basic science discussion of 'when life begins' and the
'abortion issue'.


First off I have to say, I can not speak for the 'vast majority', whatever
that is, but I can say that my anti-abortion pro-life view stems from
science. I learned that life begins at conception from my 5th grade public
school science text book during the 1972-1973 school year (I know, no one
thinks I'm that old...thank you.) This is important, because at that time
there was lot of debate surrounding the pending Roe v Wade decision in the
Supreme Court. In fact, Mr Layne, my fifth grade teacher, had us 5th
graders debate the abortion issue in the public school class room. We set
up teams, did our research, then set aside an entire day and had an
excellent debate. I still remember this. Our overwhelming class room
conclusion at the end of our lively debate was that it is a scientific fact
that life begins at conception, the declaration of independence of the
United States of America states, in this order, that everyone has the right
to life, liberty, and the pursuit of happiness; and, that 'life'
essentially 'trumps' the other two. We concluded that life was the most
basic and fundamental of all 'rights'. Period. Subsequently, because of
complaints from some of our parents the abortion issue was never brought up
again the rest of the school year.....and to my knowledge, was never
debated again the remainder of my educational career in any school setting.
Amazing.


As I continued in my educational pursuits and career I realized that
several organizations spend millions of dollars a year on research
concerning the unborn human being. This amazing research has even shown
that vitamin supplementation helps to prevent certain birth defects when
started even before conception. This is incredible stuff. Just don't tell
the unborn human being who really isn't a 'life'. I mean, why bother with
all the research if we don't think life begins at conception?


Now, as I matured (still a work in progress) I have become more engrossed
in my Catholic Faith. To a cradle Catholic this means I started to 'take my
religion more seriously'. Believe me, we Catholics don't hold the corner on
the market when it comes to this phenomenon; several of my Jewish friends
and non-Catholics have done this as well.  But, this has not changed or
altered the scientific fact that life begins at conception; it has however
'illuminated' it. I believe, through my Catholic Faith, that there is a
certain sanctity to human life; all human life, not that human life is
divine, but that it is very special and deserves our protection, it is a
gift. And, this human life deserves are protection especially  from the
very beginning, when the human being is most vulnerable; we even know it is
most vulnerable at the very beginning from all the research. This, by the
way, was also the view of the AAP prior to Roe v Wade.


In conclusion, tying this into violence in our society: Do I think that the
pro-abortion view in our country has ramifications on society? Yes I do.
First of all children are not stupid. They get it. How can we stand around
and wipe out a million of their friends and have this not eventually affect
them. Our country looks our children in the eye and tells them they are
loved, accepted, and they will be protected; and, at the same time, holds
up the abortion banner? Oh they understand, loud and clear.


The issue with violence in our society is multi-factorial. Just reading the
last two to three days of PEM list serve is proof enough for me of that.
Does the abortion issue and it's underlying theme have something to do with
that issue? Yes.


The violence in our society is obviously very complicated. The 'when does
life begin question' in our society is not complicated. The scientific
answer is 'at conception', it is us adults who have made that question
complicated. Just ask a 5th grader, if you're not censored first.


Thank you for your time.



Anthony Pohlgeers, MD, FAAP
Chief, Section of Pediatric Emergency Medicine
Medical Director, Pediatric Emergency Department
Wolfson Children's Hospital
Jacksonville, Florida




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-----Original Message-----
From: PED-EM-L automatic digest system <[log in to unmask]>
To: PED-EM-L <[log in to unmask]>
Sent: Tue, Feb 20, 2018 9:19 am
Subject: PED-EM-L Digest - 20 Feb 2018 - Special issue (#2018-49)

There are 3 messages totaling 10192 lines in this issue.

Topics in this special issue:

  1. PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41) (2)
  2. PED-EM-L Digest - 19 Feb 2018 to 20 Feb 2018 - Special issue (#2018-48)

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 02:55:22 +0000
From:    "Goetz, Kathleen" <[log in to unmask]>
Subject: Re: PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)

Very well put Jeff, thank you.

I would add that our legislators contribute to the abortion rate, the teen
pregnancy rate, the prematurity rate and the infant mortality rate by
legislating against women's access to reproductive health care.  Access to
accurate science based information and medical care for contraception and
family planning reduces all of these  "complications".

Another example of our elected officials not representing the majority of
their constituents who approve of (and largely partake of) safe, legal
contraception.

Kathey Goetz


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:
[log in to unmask]] On Behalf Of Jeff Pender
Sent: Monday, February 19, 2018 8:58 AM
To: [log in to unmask]
Subject: Re: PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)

Joe,

It could be that people are shying away from it not only b/c it is a very
contentious subject, but also b/c the analogy is perhaps a bit muddled.…at
least to me.

It seems that the vast majority of people that are opposed to a woman’s
right to choose have that position based on firmly held religious beliefs.
 People that are supportive of a woman’s right to choose tend to feel that
way without influence of, or in spite of, religious beliefs.  They believe
a woman’s right to choose outweighs outside opinions/influences from
legislators, religious leaders, or an unborn fetus.   Further, there is not
universal agreement (far from it) on when a life begins.  Further, even
supporters of a woman’s right to choose typically believe that abortions
should ideally be as infrequent as possible.   Both sides are quite “dug
in”.   Regardless, religion clearly plays a huge part in this debate.  I
appreciate the arguments on both sides of the issue, even if I have my own
personal opinion.

Religion doesn’t appear to directly, or indirectly, impact gun ownership,
or the desire to buy assault weapons.  I have never heard anyone claim
their book of faith commands them to purchase any sort of firearm, let
alone an assault rifle, an extended magazine, armor piercing rounds, etc.
 Also, and obviously, there is no debate if the victim of gun violence is
“a life” yet or not.  At least that part has 100% agreement.   Further, the
vast majority of the US population (even gun owners) are in favor of some
restrictions on gun ownership, background checks, etc.  So, both sides
agree on a fair amount here.  It is the NRA (and politicians through
financial influence of the NRA) that is opposing the citizenry.

Broadly, based on how each issue affects the total number of people on
earth, they are related.  They are also both political minefields.  Other
than that, personally, I am not sure I see the point of the comparison.
As a PEM doc, or a person with any sense of compassion, it is easy to speak
up in support of gun violence victims and look to enact changes to improve
the horror we keep experiencing in this country.   But, I am not sure that
the AAP, or PEM docs as a singular entity, have a role in changing the
religious views of hundreds of millions of people, and make a clear change
in abortion policy.   That feels more like a crusade that one takes on
personally, but outside the AAP, ABEM, ACEP, etc.


Respectfully,


Jeff





> On Feb 19, 2018, at 10:07 AM, Joe Nemeth, Dr <[log in to unmask]> wrote:
>
> Mick-
>
>
> Thank you.
>
>
> This exactly was the point of my post. We see only what we want to see,
what falls into our political agenda sadly.
>
>
> BTW, wasn't going to write a separate post about this but since I'm
"here"...
>
>
> I am flabbergasted at the lack of ANY (pro or con) response to my
abortion corollary...
>
>
> More than ~3000 children "aborted" per day.
>
>
>
> joe
>
>
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <
[log in to unmask]> on behalf of Mick Work <[log in to unmask]>
> Sent: February 19, 2018 9:25 AM
> To: [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=DwIFaQ&c=
KoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-
VYRa6Oqu06_mEwnc9MEzSg&m=YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=
IPD94fGw421w9nrvqFhUp-0rTcT2hFVJobDpAeQkabQ&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]> 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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ----------------------------------------------------------------------
>>
>> Date:    Sat, 17 Feb 2018 21:57:25 -0500
>> From:    "Horst D. Weinberg, MD"
>>        <[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 06:13:44 -0500
>> From:    Mick Work <[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]> 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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>
>>> ----------------------------------------------------------------------
>>>
>>> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>>> From:    Purva Grover <[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] <[log in to unmask]>g
>>>
>>>> On Thu, Feb 15, 2018 at 2:18 PM, <[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>
>>> ------------------------------
>>>
>>> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>>> From:    "Chamberlain, James" <[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]
>>> 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]
>>>
>>> 212-562-8147
>>>
>>>
>>>
>>>
>>>
>>> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
behalf of Purva Grover" <[log in to unmask] on behalf of
[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] 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=DwIFAg&c=
j5oPpO0eBH1iio48DtsedbOBGmuw5jHLjgvtN2r4ehE&r=-
uVUSwDIF0s52hEnO0EzoINmOqevlfnirF7YJ_EXiAQ&m=c2wlkkLWVP009LBCXl-
k6T4PNiNn1YYHTaSvJRCvGWo&s=7bcGZM66nE4BJGdqQQrjhL6fNRMBTCzuSv96wXa91qc&e=
>>>
>>>
>>>
>>>
>>>
>>>
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>>>
>>>
>>>
>>>
>>> For more information, send mail to [log in to unmask] with the
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>>>
>>> The URL for the PED-EM-L Web Page is:
>>>
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>>> For more information, send mail to [log in to unmask] with the
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>>> 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>
>>> ------------------------------
>>>
>>> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>>> From:    Aline Baghdassarian <[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]
>>>
>>>
>>> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[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]> 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]> 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]
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>> -----Original Message-----
>>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>>>> [log in to unmask]] On Behalf Of 000001679b145c30-dmarc-
>>>> [log in to unmask]
>>>>>> Sent: Wednesday, February 14, 2018 2:25 PM
>>>>>> To: [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]>
>>>>>> To: PED-EM-L <[log in to unmask]>
>>>>>> 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] 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=KoC5GYBOIefzxGAm2j6cjFf-
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YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>>>
>>>>>>
>>>>>> 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:
>>>>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>>>
>>>>>> ________________________________
>>>>>>
>>>>>> Electronic mail from Children's Mercy Kansas City. This communication
>>>> is intended only for the use of the addressee. It may contain
information
>>>> that is privileged or confidential under applicable law. If you are
not the
>>>> intended recipient or the agent of the recipient, you are hereby
notified
>>>> that any dissemination, copy or disclosure of this communication is
>>>> strictly prohibited. If you have received this communication in error,
>>>> please immediately forward the message to the Children's Mercy
Information
>>>> Security Officer via return electronic mail at
informationsecurityofficer@
>>>> cmh.edu and expunge this communication without making any copies. Thank
>>>> you for your cooperation.
>>>>>>
>>>>>> 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:
>>>>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>>
>>>>> 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:
>>>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>
>>>> 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:
>>>>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>
>>>
>>> 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:
>>>       https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>
>>> ------------------------------
>>>
>>> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>>> From:    Martin Pusic <[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>
>>> ------------------------------
>>>
>>> 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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 12:42:58 +0000
>> From:    Terence Bergmann <[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:
[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 14:31:22 +0000
>> From:    "Habib, David" <[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]] on behalf of Terence Bergmann [
[log in to unmask]]
>> Sent: Sunday, February 18, 2018 7:42 AM
>> To: [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:
[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> 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:
>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 14:04:25 +0000
>> From:    Nathan Kuppermann <[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=DwIFaQ&c=
KoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-
VYRa6Oqu06_mEwnc9MEzSg&m=YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=
3VV37tj3NV9_PZnUe2IWdSZjEsO8imdiDURVOqPyU-U&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=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=3zvB2EwPZIFiqexyruext2bXYQ727z
npC_x-mU6Zs8E&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]>> 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:
[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]>> on behalf
of Barry Nathan <[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]>
>> 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=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=cufR_QcT3laqXfrJvBsP_
v09iHqGzGB4CWfSOcTggps&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=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs&r=
5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=YYJSIn-l8tZNZ9Hc02-
3ACP2YXbWju0kwdJysuHC2vQ&s=Te938jjwxBr84XlrwhyWdjBIvoQ8OMhAHvjXCNxEH4A&e=>*
>> and
>> follow us on Twitter @AmerAcadPeds.*
>>
>> On Fri, Feb 16, 2018 at 9:22 PM, Chamberlain, James <
>> [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]] On Behalf Of Martin Pusic
>> Sent: Friday, February 16, 2018 6:29 PM
>> To: [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] with the
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>> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_a1kDlfTJH0FA02j_
>> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
>>
>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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>>
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>> The URL for the PED-EM-L Web Page is:
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listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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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:
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>>
>>
>> For more information, send mail to [log in to unmask] with the
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>> The URL for the PED-EM-L Web Page is:
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listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 10:20:42 -0500
>> From:    Martin Pusic <[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=DwIFaQ&c=
KoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-
VYRa6Oqu06_mEwnc9MEzSg&m=YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=
LULe0rLWFltqjJQJ8gXiJIXj1KIySK-xTITCa9ycB7A&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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 16:56:19 +0000
>> From:    Doc Holiday <[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]>
>>> 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=
DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-
VYRa6Oqu06_mEwnc9MEzSg&m=YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=
aU564tsgCWHPsGAk6ydlYLcTc7RWMOC9B0bS3LQUV08&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=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=>
>>
>> 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:
>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 12:00:26 -0500
>> From:    Michael Falk <[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] 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=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 17:09:24 +0000
>> From:    Robert Finkelstein <[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]> 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]> 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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>
>>>> ----------------------------------------------------------------------
>>>>
>>>> Date:    Fri, 16 Feb 2018 11:50:44 -0500
>>>> From:    Purva Grover <[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] <[log in to unmask]>g
>>>>
>>>>> On Thu, Feb 15, 2018 at 2:18 PM, <[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>
>>>> ------------------------------
>>>>
>>>> Date:    Fri, 16 Feb 2018 14:34:20 +0000
>>>> From:    "Chamberlain, James" <[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]
>>>> 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]
>>>>
>>>> 212-562-8147
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
behalf of Purva Grover" <[log in to unmask] on behalf of
[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] 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__
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>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
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>>>>
>>>>
>>>>
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>>>> For more information, send mail to [log in to unmask] with
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>>>>
>>>> ------------------------------
>>>>
>>>> Date:    Fri, 16 Feb 2018 18:29:38 -0500
>>>> From:    Aline Baghdassarian <[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]
>>>>
>>>>
>>>> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[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]> 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]> 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]
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>> -----Original Message-----
>>>>>>> From: Pediatric Emergency Medicine Discussion List [mailto:
>>>>> [log in to unmask]] On Behalf Of 000001679b145c30-dmarc-
>>>>> [log in to unmask]
>>>>>>> Sent: Wednesday, February 14, 2018 2:25 PM
>>>>>>> To: [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]>
>>>>>>> To: PED-EM-L <[log in to unmask]>
>>>>>>> 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] 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__
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>>>>>>>
>>>>>>>
>>>>>>> For more information, send mail to [log in to unmask] with
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>>>>>>>
>>>>>>> ________________________________
>>>>>>>
>>>>>>> Electronic mail from Children's Mercy Kansas City. This
communication
>>>>> is intended only for the use of the addressee. It may contain
information
>>>>> that is privileged or confidential under applicable law. If you are
not the
>>>>> intended recipient or the agent of the recipient, you are hereby
notified
>>>>> that any dissemination, copy or disclosure of this communication is
>>>>> strictly prohibited. If you have received this communication in error,
>>>>> please immediately forward the message to the Children's Mercy
Information
>>>>> Security Officer via return electronic mail at
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Thank
>>>>> you for your cooperation.
>>>>>>>
>>>>>>> For more information, send mail to [log in to unmask] with
>>>>> the message: info PED-EM-L
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>>>>>>
>>>>>> 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:
>>>>>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
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>>>>>
>>>>> 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:
>>>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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>>>>>
>>>>
>>>> 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:
>>>>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>
>>>> ------------------------------
>>>>
>>>> Date:    Fri, 16 Feb 2018 18:29:08 -0500
>>>> From:    Martin Pusic <[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] 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=KoC5GYBOIefzxGAm2j6cjFf-
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>>>
>>>> ------------------------------
>>>>
>>>> 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] with the
message: info PED-EM-L
>>> The URL for the PED-EM-L Web Page is:
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>>
>> 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:
>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 10:17:05 -0500
>> From:    Deepti Thomas-Paulose <[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]> 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]>> wrote:
>>>
>>> Disclaimer: I live in Canada and  love our very strict gun control laws.
>>>
>>>
>>> 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:
>>>                https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&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=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=YJHVOvAtlms92ZuRba0rQCi4WeVg3J
g7YqcvpI04608&e=
>>
>> 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:
>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 17:15:53 +0000
>> From:    Robert Finkelstein <[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]> 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] 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=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> 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:
>>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>>
>> ------------------------------
>>
>> Date:    Sun, 18 Feb 2018 17:26:11 +0000
>> From:    Robert Flood <[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 huge public
health emergency that clearly endangers our children, we really should
break up the huge scope of "gun violence" into unique subsets, including
but not limited to the following:
>>
>>
>> 1) Mass Shootings: Unfortunately, the US leads the entire world in the
number of mass shootings, which may be more properly categorized as "mass
suicides" since these shooters usually have no intention of surviving their
murderous rampages. Clearly, the evidence shows a direct correlation with
the elimination on the band on assault rifles and the increase in the
number and deaths in these incidents. So, everyone's comments on the access
to better mental health should be just one aspect of the study of all
potential interventions. For instance, even pediatricians must admit that
if we had armed security in every school, perhaps with the national guard,
we would likely decrease the number of gun related deaths/year in our
schools. However, we would need to study that model to prove our hypothesis
rather than saying "I believe this will work".  Still, Mass Shooting Deaths
are only a tiny percentage of gun deaths in the US in any given year. In
fact, if we eliminated every single mass shooting gun death and injury in
the US, it would have a negligible impact on gun related death and injury
rates.
>>
>>
>> 2) Intentional Hand Gun Violence: We continue to have disturbing data
regarding intentional handgun injuries, especially in the inner city
African American communities. With over 100 K gun related injuries/year,
and over 10 k non-suicidal gun related deaths/year, this is a very
different problem than "Mass Shootings" and needs to be studied in very
different ways. Within this category there are both domestic (ie, in the
home) and non-domestic sub-categories, which will likely require very
different interventions. For instance, in Saint Louis, MO, we are
participating in a 4 hospital (all level 1 trauma centers), 2 university
intervention program whereby social worker mentors will be paired with
willing participants who present as victims of gun violence with the goal
of preventing recidivism as either a victim or a perpetrator.
>>
>>
>> 3) Suicides: The data is consistent and very alarming: over 20 K
deaths/year from suicides with a gun. The overwhelming majority of these
deaths are due to access to handguns and ammunition in the homes. So, while
our limited data allows us to recommend that guns and ammunition be stored
and locked separately, we don't know for sure whether this would have
significant impact on intentional suicides by teenagers, who often have
access to both of these locked items. So, we need to study this in much
greater detail, and offer viable solutions to well intentioned individuals
who are trying to "protect their families".
>>
>>
>> 4) Accidental Shootings: As we all have friends who own one or more
weapons, it is often difficult to convince them that the weapon in the home
greatly increases the risk of one of their loved ones being the vict...

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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