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Speaking out of my heart Bob Flood
Thank you!

On Wed, Feb 21, 2018 at 3:22 AM, Robert Flood <[log in to unmask]>
wrote:

> Just a couple of points:
>
> While we all don’t agree that life begins at conception, and we all have
> very, very personal views on abortion which I would never, ever debate
> because of one very simple practical fact: many of us are more horrified by
> a government forcing a women to carry an unwanted pregnancy to term then
> their personal decision to have an elective abortion. That is called
> pro-choice Not pro-abortion.
>
> Still I must completely disagree with the abortion issue being tagged onto
> the clear and present horrors of gun violence, which is uniquely American.
>
> Perhaps we can start at a point of agreement and work backwards: death.
>
> More specifically the tragic and senseless deaths of these children and
> teachers at the hands of a disturbed young person who was able to legally
> purchase an urban assault rifle with unlimited bullets even though he
> legally could not buy a beer.
>
> If we continue to confuse end of life issues with beginning of life
> issues, we will continue fail the children born in this country and who are
> in our schools.
>
> I for one, as a physician scientist, will continue to try to find
> solutions and will always respect everyone’s very personal beliefs
> regarding the beginning of life.
>
> Bob Flood
>
> Get Outlook for iOS<https://aka.ms/o0ukef>
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]> on behalf of A Pohlgeers <
> [log in to unmask]>
> Sent: Tuesday, February 20, 2018 4:26:39 PM
> To: [log in to unmask]
> Subject: Re: PED-EM-L Digest - 20 Feb 2018 - Special issue (#2018-49)
>
> 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:
>          https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Pk_HpaIpE_
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> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
>
> ----------------------------------------------------------------------
>
> 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__
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> >>>
> >>>
> >>>
> >>>
> >>>
> >>>
> >>> ------------------------------------------------------------
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
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> YuD0cY4QPsIIUqjaql9agkSHH8&s=jLXcVKFGHNLAQ-y3T0bMic8mmMkKMtSnWoO5UdsCqvM&
> e=
> >>>
> >>>
> >>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >>> Confidentiality Notice: This e-mail message, including any
> attachments, is for the sole use of the intended recipient(s) and may
> contain confidential and privileged information. Any unauthorized review,
> use, disclosure or distribution is prohibited. If you are not the intended
> recipient, please contact the sender by reply e-mail and destroy all copies
> of the original message.
> >>>
> >>>
> >>> 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 18:29:38 -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-
> 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=
> >>>>>>
> >>>>>> ________________________________
> >>>>>>
> >>>>>> 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=
> 3zvB2EwPZIFiqexyruext2bXYQ727znpC_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
> >> message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> >> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=
> Zoipt4Nmcnjorr_6TBHi1A&r=
> >> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_
> a1kDlfTJH0FA02j_
> >> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
> >>
> >> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >> Confidentiality Notice: This e-mail message, including any attachments,
> is
> >> for the sole use of the intended recipient(s) and may contain
> confidential
> >> and privileged information. Any unauthorized review, use, disclosure or
> >> distribution is prohibited. If you are not the intended recipient,
> please
> >> contact the sender by reply e-mail and destroy all copies of the
> original
> >> message.
> >>
> >>
> >> 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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> >> The URL for the PED-EM-L Web Page is:
> >>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=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 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=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 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-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> 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:
> >>                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 17:09:24 +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=
> 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=
> >>>>
> >>>>
> >>>>
> >>>>
> >>>>
> >>>>
> >>>> ------------------------------------------------------------
> >>>> This email message, including any attachments, is for the sole use of
> the intended recipient(s) and may contain information that is proprietary,
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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:
> >>>>
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> >>>>
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> >>>> Confidentiality Notice: This e-mail message, including any
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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-
> 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-
> 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=
> >>>>>>>
> >>>>>>> ________________________________
> >>>>>>>
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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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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
> >>>>>>
> >>>>>> For more information, send mail to [log in to unmask]
> with the
> >>>>> message: info PED-EM-L
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> 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-
> 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=
> >>
> >> 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 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=
> YJHVOvAtlms92ZuRba0rQCi4WeVg3Jg7YqcvpI04608&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 victim of
> that weapon. Rather, these often well intentioned families in the suburban
> and rural areas, who honestly believe that having a loaded gun will protect
> their families from the very, very unlikely chance of a home invasion, will
> actually endanger their loved ones simply by bringing guns into the home.
> On the other hand, in the inner city where gun violence is part of everyday
> life, families believe having the loaded gun readily available (unlocked,
> fully loaded) allows them to better protect their loved ones from the
> reality of their situation. So, when we, as healthcare providers, care for
> the young children who "accidentally" shoot themselves, we are particularly
> frustrated and angered by the tragedy of the entire plight of these
> families. The point is this: these very different groups may require very
> different approaches with respect to interventions.
> >>
> >>
> >>
> >> I look forward to the continued dialogue, and, more importantly,
> continued research in these areas.
> >>
> >>
> >> Bob Flood
> >>
> >> Saint Louis University
> >>
> >>
> >>
> >> ________________________________
> >> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]> on behalf of Nathan Kuppermann <
> [log in to unmask]>
> >> Sent: Sunday, February 18, 2018 8:04:25 AM
> >> To: [log in to unmask]
> >> Subject: Re: The shooting in Florida
> >>
> >> Jeffrey and colleagues:
> >>
> >>
> >>
> >> My colleague Garen Wintemute is an EM physician at UC Davis and has
> been doing seminal work on firearm violence prevention for decades -
> doggedly and with great impact
> >>
> >>
> >>
> >> He is the director of the Violence Prevention Research Program (VPRP)
> at UC Davis, and has been named a "hero of medicine" by Time Magazine in
> the past for his work. He is as smart and accomplished as they come, and
> there is nobody in the country who has been doing this longer or with
> greater impact. And he has weathered the political and funding crises for
> this type of work for years, frequently funding his own work when the
> political climate for this work was bleak. But he has also received
> substantial foundation money and federal grants during more supportive
> political times.
> >>
> >>
> >>
> >> He recently received $5 million from the California state legislature
> to lead the University of California Firearm Violence Research Center, the
> first state-funded gun violence research center in the country.
> >>
> >>
> >>
> >> Here is his entry in Wikipedia: https://urldefense.proofpoint.
> com/v2/url?u=https-3A__en.wikipedia.org_wiki_Garen-
> 5FWintemute&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=MwtCq_L-kQIs3_poo8ESXJUfQXyAfM2mv3_BCZ2sBPo&e=
> >>
> >>
> >>
> >> If you are interested in his program or donating, here is the link:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> ucdmc.ucdavis.edu_vprp_&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=km0yMXq80C4DGUQlje9yL-_xAQ5OiKQNooiyry9xUC0&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=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=3Oc_7pCeJFj4KZ9QlF0MpVKwh-Xixr5f2-x4dFOOgHk&e=>
> >>
> >> <https://urldefense.proofpoint.com/v2/url?u=https-
> 3A__linkprotect.cudasvc.com_url-3Fa-3Dhttp-3A__www.
> mmsend70.com_link.cfm-253fr-253dP1AWQRX2DH6KpZKp05dazA-7E-
> 7E-2526pe-253dBH4KXYJXftdV7-5FOrPTTyUbVAzQsfgoRvleBm2XUVQ6
> AiEVwuBNacQ0AWbz2OcXguY6Y2i1bNdCMkiPdWG-2DfHRg-7E-7E-2526t-
> 253dP2O93UltqkjSP1tT62-5FPaA-7E-7E-26c-3DE-2C1-
> 2CEDnzTesKajviC9Rbq687pz7yfFyRgC2WBFw6mF1beQyzL2WYF-
> 5FfPWMjWxOixG1eagtp40GaUhhxZ8IL4zNcR4weeC1DLvkbbpHQsmMSnszDC
> -26typo-3D1&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=IjSKeAbtNO1UyfAxfonG3YrPW35X2WKiPCyGj3YfSnQ&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
> >>
> >> message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >>
> >>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> >>
> >> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=
> Zoipt4Nmcnjorr_6TBHi1A&r=
> >>
> >> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_
> a1kDlfTJH0FA02j_
> >>
> >> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
> >>
> >>
> >>
> >> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >>
> >> Confidentiality Notice: This e-mail message, including any attachments,
> is
> >>
> >> for the sole use of the intended recipient(s) and may contain
> confidential
> >>
> >> and privileged information. Any unauthorized review, use, disclosure or
> >>
> >> distribution is prohibited. If you are not the intended recipient,
> please
> >>
> >> contact the sender by reply e-mail and destroy all copies of the
> original
> >>
> >> message.
> >>
> >>
> >>
> >>
> >>
> >> 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=DwIGaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&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=DwIGaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&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=DwIGaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&e=
> >>
> >>
> >>
> >> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> >>
> >> The URL for the PED-EM-L Web Page is:
> >>
> >>   https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&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=DwIGaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=Ow11-
> rbJQjUhFQeEocHhTmlmSYtinw81eMl15NzZwq8&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 12:18:07 -0500
> >> From:    Jeff Pender <[log in to unmask]>
> >> Subject: Re: The shooting in Florida
> >>
> >> I have a desire to put in my 2 cents as well, considering this is
> perhaps one of the issues I feel most passionately about.   This is a
> multi-factorial problem, obviously.   Not only is it a problem with
> “quality and quantity”, but also with “culture".
> >>
> >> By quality and quantity, I am speaking about what people own, and how
> much they own.  Does anyone outside the military need a semi automatic
> weapon for anything?  No.  Does anyone need a bump stock?  No.  Does anyone
> need an extended magazine?  No. If you require any of these things for the
> lame ass excuse of “home defense”, you either need to move, or take some
> classes and become a far better shot with a handgun.    Further, do people
> need the insane quantity of weapons and ammunition they tend to
> accumulate?  No, but this is a secondary problem to the types of weapons
> they own.    We can’t own a bazooka, so “we” understand that limits can
> exist, so we need to extend those limits to the things listed above.
> >>
> >> The culture issue, to me, is even worse.  In the spirit of full
> disclosure, I despise guns. I don’t own one, and have no plans on ever
> owning one.  I won’t allow one in my home, period.  I feel pretty damn safe
> with my 3 large dogs, thank you. I will admit that I pull away socially
> from people once I learn they are big time gun enthusiasts.  I won’t spend
> time with people that I know are carrying a gun on their person, or in
> their car.  I can’t help it, and I don’t feel bad about it for even 1
> second.  We just see the world too differently, although I don’t think it
> makes them a bad person.  In my anecdotal experience, these serious
> “enthusiasts” share some similar traits - they own a shit ton of guns,
> ridiculous ammunition that no target shooter or home defense person really
> needs, but most importantly perhaps, a “macho” response to their guns.
> This is the thing that needs to change.
> >>
> >> Guns are celebrated in our country as both cool and macho.  Decide
> where to place the blame - video games, movies, athletes, musicians, etc.
>  But, our politicians are part of this problem, and perhaps the largest
> part.  Since they are the ones that make the laws (and take the
> bribes…err…donations), we need them to stop believing this more than anyone
> else. They will never change the gun laws until the culture of how we view
> guns changes.  Think back to that insane video Ted Cruz made where he
> wrapped bacon around the muzzle of an AR-15, and after shooting for a
> while, ate the bacon that the hot muzzle cooked.  It was horrifying how he
> celebrated that AR-15….just so he could get another donation from gun
> lovers.  Change the culture of how they are viewed (and then campaign
> finance laws) and the needle can be moved on this issue.
> >>
> >> Israel and Swiss citizens own guns at incredibly high rates, but they
> are viewed as a fact of life, not as a point of pride or machismo.
>  Culture changes are very slow to occur, but that is what is needed first,
> I think.  Without it, laws won’t change, and neither will the desire to own
> these weapons and accessories.   Think of other social
> changes/regulations….they were slow — seat belt laws, speed limits, voting
> rights, marriage equality, marijuana legalization, etc etc.   They take
> decades, sadly. We are a country that seems to have extreme difficulty
> doing the right thing without it taking insanely long. It drives me crazy.
> >>
> >> I truly hope that this school shooting has occurred around student’s
> ages that can possibly make a difference in that these students are at an
> age to become true activists, unlike when it happens to younger children.
> A wave has to start, and I think it is most likely to start with these
> young people, as long as we “older” people support them…both financially
> and vocally…and in our voting patterns.
> >>
> >> Jeff
> >>
> >>
> >>
> >>
> >>
> >>> On 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:[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 12:34:05 -0500
> >> From:    Michael Falk <[log in to unmask]>
> >> Subject: Re: The shooting in Florida
> >>
> >> Friend just posted this interesting rebuttal to the "mental illness"
> >> response whenever there is a mass shooting:
> >>
> >> "Believing that mental illness causes mass shootings can feel
> reassuring.
> >> It helps to believe that only a mentally ill person could do something
> so
> >> horrific. We also think that if someone is mentally ill, they can be
> >> identified. But the evidence suggests that mental illness only causes a
> >> small fraction of gun violence. And even if some shooters have
> undiagnosed
> >> mental illness, there is no evidence to suggest that they could have
> been
> >> diagnosed prior to their gun violence or that such a diagnosis would
> >> increase the predictive validity of a diagnosis on gun violence."
> >>
> >> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> behavioralscientist.org_myth-2Dmental-2Dillness-2Dcauses-
> 2Dmass-2Dshootings_&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=V_
> f2zmvLFf5PgNaVQDiutK2FZDTtoAlYpbWRLpGaDfw&e=
> >>
> >> I will add few links of my own:
> >>
> >> https://urldefense.proofpoint.com/v2/url?u=https-3A__www.
> theatlantic.com_health_archive_2017_10_why-2Dbetter-
> 2Dmental-2Dhealth-2Dcare-2Dwont-2Dstop-2Dmass-
> 2Dshootings_541965_&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=3gGnZ_xIppMhvqvP4U0nyeY_
> Zqy3HQIz622HbLrsOh4&e=
> >>
> >> https://urldefense.proofpoint.com/v2/url?u=https-3A__www.
> vox.com_policy-2Dand-2Dpolitics_2017_11_9_16618472_mental-2Dillness-2Dgun-
> 2Dhomicide-2Dmass-2Dshootings&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=
> smP0aohYRruS54vVLUGS58m4XNjyJ5ZxMVixEN71qp8&e=
> >>
> >> The mentally ill are stigmatized enough, blaming them for these killings
> >> seems unfair.
> >>
> >> Mike Falk
> >>
> >>> On Sun, Feb 18, 2018 at 12:18 PM, Jeff Pender <[log in to unmask]>
> wrote:
> >>>
> >>> I have a desire to put in my 2 cents as well, considering this is
> perhaps
> >>> one of the issues I feel most passionately about.   This is a
> >>> multi-factorial problem, obviously.   Not only is it a problem with
> >>> “quality and quantity”, but also with “culture".
> >>>
> >>> By quality and quantity, I am speaking about what people own, and how
> much
> >>> they own.  Does anyone outside the military need a semi automatic
> weapon
> >>> for anything?  No.  Does anyone need a bump stock?  No.  Does anyone
> need
> >>> an extended magazine?  No.  If you require any of these things for the
> lame
> >>> ass excuse of “home defense”, you either need to move, or take some
> classes
> >>> and become a far better shot with a handgun.    Further, do people
> need the
> >>> insane quantity of weapons and ammunition they tend to accumulate?
> No, but
> >>> this is a secondary problem to the types of weapons they own.    We
> can’t
> >>> own a bazooka, so “we” understand that limits can exist, so we need to
> >>> extend those limits to the things listed above.
> >>>
> >>> The culture issue, to me, is even worse.  In the spirit of full
> >>> disclosure, I despise guns. I don’t own one, and have no plans on ever
> >>> owning one.  I won’t allow one in my home, period.  I feel pretty damn
> safe
> >>> with my 3 large dogs, thank you. I will admit that I pull away socially
> >>> from people once I learn they are big time gun enthusiasts.  I won’t
> spend
> >>> time with people that I know are carrying a gun on their person, or in
> >>> their car.  I can’t help it, and I don’t feel bad about it for even 1
> >>> second.  We just see the world too differently, although I don’t think
> it
> >>> makes them a bad person.  In my anecdotal experience, these serious
> >>> “enthusiasts” share some similar traits - they own a shit ton of guns,
> >>> ridiculous ammunition that no target shooter or home defense person
> really
> >>> needs, but most importantly perhaps, a “macho” response to their guns.
> >>> This is the thing that needs to change.
> >>>
> >>> Guns are celebrated in our country as both cool and macho.  Decide
> where
> >>> to place the blame - video games, movies, athletes, musicians, etc.
>  But,
> >>> our politicians are part of this problem, and perhaps the largest part.
> >>> Since they are the ones that make the laws (and take the
> >>> bribes…err…donations), we need them to stop believing this more than
> anyone
> >>> else. They will never change the gun laws until the culture of how we
> view
> >>> guns changes.  Think back to that insane video Ted Cruz made where he
> >>> wrapped bacon around the muzzle of an AR-15, and after shooting for a
> >>> while, ate the bacon that the hot muzzle cooked.  It was horrifying
> how he
> >>> celebrated that AR-15….just so he could get another donation from gun
> >>> lovers.  Change the culture of how they are viewed (and then campaign
> >>> finance laws) and the needle can be moved on this issue.
> >>>
> >>> Israel and Swiss citizens own guns at incredibly high rates, but they
> are
> >>> viewed as a fact of life, not as a point of pride or machismo.
>  Culture
> >>> changes are very slow to occur, but that is what is needed first, I
> think.
> >>> Without it, laws won’t change, and neither will the desire to own these
> >>> weapons and accessories.   Think of other social
> changes/regulations….they
> >>> were slow — seat belt laws, speed limits, voting rights, marriage
> equality,
> >>> marijuana legalization, etc etc.   They take decades, sadly. We are a
> >>> country that seems to have extreme difficulty doing the right thing
> without
> >>> it taking insanely long. It drives me crazy.
> >>>
> >>> I truly hope that this school shooting has occurred around student’s
> ages
> >>> that can possibly make a difference in that these students are at an
> age to
> >>> become true activists, unlike when it happens to younger children.  A
> wave
> >>> has to start, and I think it is most likely to start with these young
> >>> people, as long as we “older” people support them…both financially and
> >>> vocally…and in our voting patterns.
> >>>
> >>> Jeff
> >>>
> >>>
> >>>
> >>>
> >>>
> >>>> On 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:[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=
> >>>
> >>
> >> 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 12:52:28 -0500
> >> From:    Mick Work <[log in to unmask]>
> >> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
> >>
> >> I appreciate the passion around gun legislation and not opposed.  I
> don’t think laws will end this countries obsession with guns or limit
> access to those who want to perform unlawful acts.  But again I am not
> arguing against reasonable legislation.
> >>
> >> I have heard proposed that we need to arm principals and add more
> security in schools.   I just wonder if we added mental health counselors
> instead if we wouldn’t make a greater impact.
> >>
> >> My point is our prevention should be multi-modal like all effective
> strategies.
> >>
> >>
> >> Mick
> >>
> >>
> >>
> >>> On Feb 18, 2018, at 12:09 PM, Robert Finkelstein <
> [log in to unmask]> wrote:
> >>>
> >>> 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=
> 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=
> >>>>>
> >>>>>
> >>>>>
> >>>>>
> >>>>>
> >>>>>
> >>>>> ------------------------------------------------------------
> >>>>> This email message, including any attachments, is for the sole use
> of the intended recipient(s) and may contain information that is
> proprietary, confidential, and exempt from disclosure under applicable law.
> Any unauthorized review, use, disclosure, or distribution is prohibited. If
> you have received this email in error please notify the sender by return
> email and delete the original message. Please note, the recipient should
> check this email and any attachments for the presence of viruses. The
> organization accepts no liability for any damage caused by any virus
> transmitted by this email.
> >>>>> =================================
> >>>>>
> >>>>>
> >>>>>
> >>>>>
> >>>>> 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=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=ZQaRUYHlbNuSLlAi-
> YuD0cY4QPsIIUqjaql9agkSHH8&s=jLXcVKFGHNLAQ-y3T0bMic8mmMkKMtSnWoO5UdsCqvM&
> e=
> >>>>>
> >>>>>
> >>>>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> ,,,,,,,,,,
> >>>>> Confidentiality Notice: This e-mail message, including any
> attachments, is for the sole use of the intended recipient(s) and may
> contain confidential and privileged information. Any unauthorized review,
> use, disclosure or distribution is prohibited. If you are not the intended
> recipient, please contact the sender by reply e-mail and destroy all copies
> of the original message.
> >>>>>
> >>>>>
> >>>>> 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 18:29:38 -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-
> 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=
> >>>>>>>>
> >>>>>>>> ________________________________
> >>>>>>>>
> >>>>>>>> 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=
> >>
> >> 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 23:05:03 +0000
> >> From:    "Chamberlain, James" <[log in to unmask]>
> >> Subject: Re: School shootings.......
> >>
> >> I'd be happy with sensible regulations, required training, and
> licensure so that guns don't get into the hands of criminals and people
> with mental illness.
> >>
> >> But the NRA is against sensible regulations.
> >>
> >>
> >>
> >> Sent from my Verizon, Samsung Galaxy smartphone
> >>
> >>
> >> -------- Original message --------
> >> From: Robert Finkelstein <[log in to unmask]>
> >> Date: 2/18/18 12:17 (GMT-05:00)
> >> To: [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=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&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=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
> >>
> >> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >> Confidentiality Notice: This e-mail message, including any attachments,
> is for the sole use of the intended recipient(s) and may contain
> confidential and privileged information. Any unauthorized review, use,
> disclosure or distribution is prohibited. If you are not the intended
> recipient, please contact the sender by reply e-mail and destroy all copies
> of the original message.
> >>
> >> 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 19:03:20 -0600
> >> From:    Jill C Obremskey <[log in to unmask]>
> >> Subject: Re: School shootings.......
> >>
> >> Great discussion but what are WE going to do about it as an
> organization?
> >> How do we become relentless about the need for gun control, the need
> for mental health services, and for preventing toxic stress in children.
> >>
> >> We need to ask leaders in the AAP and AAEM to organize us into a
> uniified voice that will not quit.
> >>
> >>> On February 18, 2018 at 5:05 PM "Chamberlain, James" <
> [log in to unmask]> wrote:
> >>>
> >>>
> >>> I'd be happy with sensible regulations, required training, and
> licensure so that guns don't get into the hands of criminals and people
> with mental illness.
> >>>
> >>> But the NRA is against sensible regulations.
> >>>
> >>>
> >>>
> >>> Sent from my Verizon, Samsung Galaxy smartphone
> >>>
> >>>
> >>> -------- Original message --------
> >>> From: Robert Finkelstein <[log in to unmask]>
> >>> Date: 2/18/18 12:17 (GMT-05:00)
> >>> To: [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=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&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=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
> >>>
> >>> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >>> Confidentiality Notice: This e-mail message, including any
> attachments, is for the sole use of the intended recipient(s) and may
> contain confidential and privileged information. Any unauthorized review,
> use, disclosure or distribution is prohibited. If you are not the intended
> recipient, please contact the sender by reply e-mail and destroy all copies
> of the original message.
> >>>
> >>> 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=
> >>
> >> ------------------------------
> >>
> >> End of PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
> >> **************************************************************
> >
> > 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=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
>
> ------------------------------
>
> Date: Tue, 20 Feb 2018 13:12:15 +0000
> From:    Halim Hennes <[log in to unmask]>
> Subject: Re: PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
>
> All please watch this video. What a great and thoughtful man
>
> https://urldefense.proofpoint.com/v2/url?u=https-3A__www.
> facebook.com_permalink.php-3Fstory-5Ffbid-3D1993509594242800-26id-
> 3D100007513365065&d=DwIFaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=eacE1u355w4wQKZ8Zh7E9jp85QBWM7
> T2Kf9kCQerxcE&s=jCaOxRwBA5OzXRXuPmhvQ6GyOQfG2b5B9i9fNKG18qo&e=
> Halim
> Halim Hennes
> Sent from my iPhone
>
> On Feb 20, 2018, at 5:40 AM, Goetz, Kathleen <[log in to unmask]<
> mailto:[log in to unmask]>> wrote:
>
> 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]<mailto:[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]<mailto:
> [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]<mailto:[log in to unmask]>> on
> behalf of Mick Work <[log in to unmask]<mailto:[log in to unmask]>>
> Sent: February 19, 2018 9:25 AM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__apps.
> chicagotribune.com_news_local_young-5Fvictims_&d=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]<mailto:[log in to unmask]>> wrote:
>
> There are 17 messages totaling 3381 lines in this issue.
>
> Topics of the day:
>
> 1. School shootings....... (4)
> 2. PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39) (3)
> 3. The shooting in Florida (9)
> 4. A second, more settled, reflection on the Florida shooting
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]>>
> Subject: School shootings.......
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand. This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'.  Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem.  So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve.     Horst D. Weinberg, MD
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:[log in to unmask]>>
> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
> I respect the need for debate around guns. However, I think we are remiss
> as pediatric emergency physicians to not raise a deeper discussion around
> the mental illness crisis.
>
> We all see kids who meet this persons profile across the country. We see
> disturbing mental illness and the many factors (including social media,
> broken families, child abuse) that lead a child to buy a gun to do harm.
> Or if not gun an explosive device etc..
>
> We see kids who are socially isolated and warning signs ignored.  Anyone
> else concerned that the kids we see with mental illness are recognized by
> schools or pediatric visit screening more often than by their own parents,
> friends or neighbors.
>
> This persons desire to be a “school shooter” should raise attention around
> how the media covers these events.  The fame brought to these shooters
> should be called into question.  Are we fostering this copycat mentality?
>
> The lack of respect for human life should call us to question more than
> the how but why.
>
> A focus only on guns and gun laws is remiss to the bigger picture in my
> opinion and experience.
>
> Mick
>
>
>
> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> There are 4 messages totaling 391 lines in this issue.
>
> Topics of the day:
>
> 1. Peds EM talk (2)
> 2. Bacterial meningitis
> 3. The shooting in Florida
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:[log in to unmask]>>
> Subject: Re: Peds EM talk
>
> Thanks all for your help on this.
> Best
> Purva
>
> Purva Grover , MD
> Medical Director
> Pediatric Emergency Department
> Cleveland Clinic Health System
> Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> [log in to unmask]>>g
>
> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> [log in to unmask]>> wrote:
>
> Hi All
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
> Thanks
> Purva
>
> Sent from my mobile device
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]>>
> Subject: Re: Peds EM talk
>
> I would also cover unusual cases that you can't afford to miss, e.g.
>
> Sternoclavicular dislocation
> Conjunctivitis caused by penetrating FB
> Septic joint presenting with only low-grade fever (we've had several Staph
> infections where temp was only 37.6 or 37.7 orally)
> Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> patients need a through cardiac exam, including distal pulses
> NAT
> The "sleepy" baby who has hypoglycemia
> The "sleepy" baby who has intussusception
> The appendicitis patient who presents with vomiting and diarrhea (not all
> that unusual, actually)
> Etc.
>
> To me, this is the challenge of PEM. Finding the needle in the haystack,
> that one sick kid who is different than all the usual low acuity illness...
>
> Jim
>
> James Chamberlain
> Division Chief, Emergency Medicine
> Children’s National Health System
> (202) 476-4177
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Mojica, Michael
> Sent: Thursday, February 15, 2018 5:29 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Peds EM talk
>
> Purva
>
>
>
> I would recommend "the critically ill infant".
>
>
>
> It is the topic that scares the most people and you can cover a lot of
> causes through cases.
>
>
>
> I like to use cases that include common presenting complaints (e.g.
> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>
>
>
> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>
>
>
> My goal is for them to develop a mental checklist of potentially
> life-saving interventions.
>
>
>
> Michael
>
>
>
> Michael Mojica, M.D
>
> Director of Education, Division of Pediatric Emergency Medicine
>
> Director, Pediatric Emergency Medicine Fellowship
>
> Bellevue Hospital Center
>
> Administration Building Room A528
>
> New York, N.Y. 10016
>
> [log in to unmask]<mailto:[log in to unmask]>
>
> 212-562-8147
>
>
>
>
>
> ?On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> behalf of Purva Grover" <[log in to unmask]<mailto:
> [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> [log in to unmask]>> wrote:
>
>
>
> Hi All
>
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
>
> Thanks
>
> Purva
>
>
>
> Sent from my mobile device
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
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> uVUSwDIF0s52hEnO0EzoINmOqevlfnirF7YJ_EXiAQ&m=c2wlkkLWVP009LBCXl-
> k6T4PNiNn1YYHTaSvJRCvGWo&s=7bcGZM66nE4BJGdqQQrjhL6fNRMBTCzuSv96wXa91qc&e=
>
>
>
>
>
>
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> For more information, send mail to [log in to unmask]<mailto:
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>
> ------------------------------
>
> Date: Fri, 16 Feb 2018 18:29:38 -0500
> From:    Aline Baghdassarian <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: Bacterial meningitis
>
> Scott,
>
> Would love to hear more about the cases. How did they present? What was the
> decision making process?
>
> Thank you,
>
> Aline
>
> Aline Baghdassarian, MD, MPH, FAAP
> Director, Pediatric Emergency Medicine Fellowship Program
> Assistant Professor, Department of Emergency Medicine
> Virginia Commonwealth University School of Medicine
>
> Children's Hospital of Richmond at VCU
> Email [log in to unmask]<mailto:aline.
> [log in to unmask]>
>
>
> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> <mailto:[log in to unmask]>>
> wrote:
>
> In a recent case at our institution, there was a present but subtle degree
> of meningismus — I’ve found over the years there is always some elicitable
> sign — but as importantly there’s a degree of irritability or altered
> behavior that has everyone concerned: mom, RN’s, me.
> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
> cerebritis or encephalopathic behavior until there’s a consent signed.
>
> I’m not such a good scientist anymore, but I’ve tried to be an attentive
> clinician.
>
> Julian Orenstein
>
>
> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> [log in to unmask]>> wrote:
>
> Scott - Bacterial meningitis is alive and well here in LV - we have seen
> it in a variety of age groups. There is good evidence that there has been
> an increase in pneumococcal serotypes not covered by the polyvalent
> vaccines since there widespread use, such that the burden of pneumococcal
> meningitis (as opposed to H. flu type b) has not decreased nearly as much.
>
> Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>
> Also, the absence of meningismus in older kids with bacterial meningitis
> is well described and occurs in a substantial subset.
>
> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>
> Much of the data on the sensitivity of the neck exam is of the
> retrospective variety. I have only read one really good prospective study
> on the sensitivity of PE for bacterial meningitis and it was a single
> center variety as I recall.
>
> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
> 1992;21(8):910-914.
>
> Tough case.
>
>
> Jay
>
> Jay D. Fisher MD FAAP FACEP
> Medical Director, Pediatric EM
> Children's Hospital of Nevada at UMC
> Clinical Professor of Emergency Medicine and Pediatrics
> UNLV School of Medicine
>
>
>
>
>
>
>
>
> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
> I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
> out that bacterial meningitis appears at this time of year as a
> complication of influenza:
> "Both pneumococcal and meningococcal meningitis can occur post flu as
> well as GAS and S aureus invasive disease and TSS."
>
> She also addressed Jim's question:  "We do know that new serotypes [of
> pneumococcus] have emerged but this is not waning immunity because the teen
> only got PCV7".
>
>
> Greg Conners
>
> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>
> Director, Division of Emergency Medicine
> Associate Chair of Pediatrics
> Professor of Pediatrics and Emergency Medicine
> Children’s Mercy Hospital, Kansas City
> University of Missouri, Kansas City
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of 000001679b145c30-dmarc-
> [log in to unmask]<mailto:[log in to unmask]>
> Sent: Wednesday, February 14, 2018 2:25 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Bacterial meningitis
>
> *** This message was sent to you from an External Source. Please do not
> open untrusted links or attachments. ***
>
> ________________________________
>
>
> Could you share with us the clinical findings and history that prompted
> the LP?
>
>
> Shiu-Lin
>
>
>
>
> Shiu-Lin Tsai, MD
> Division of Pediatric Emergency Medicine
>
> Department of Emergency Medicine
> Columbia University Medical Center
>
>
>
> -----Original Message-----
> From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
> To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> BROWN.EDU>>
> Sent: Wed, Feb 14, 2018 2:44 pm
> Subject: Bacterial meningitis
>
> ALL:
> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
> *Neisseria meningiditis*.  All 3 were in older children/ teens who received
> their Prevnar 13  vaccines as well as the Menactra series in the patient
> with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3
> cases of bacterial meningitis in older kids in a community setting such as
> ours in quite a long time.  Is this random bad luck or do  we all need to
> be more vigilant?  Incidentally, none had neck pain or meningismus as a
> clinical finding.
>
> --
> Kind regards,
>
> Scott
> Scott Freedman, MD
> Medical Director,  Pediatric Emergency Dept Rockville MD
>
> For more information, send mail to [log in to unmask]<mailto:
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> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Fri, 16 Feb 2018 18:29:08 -0500
> From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: The shooting in Florida
>
> Hi colleagues,
>
> As I sit in my office late on a Friday, I've gotten myself into a state
> about the 17 children gunned down in a school.  For the umpteenth time.
>
> I think the thing that has me so upset, is that this state of gun
> complaisance is an affront to everything a pediatric emergency physician
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
> burnout inducing conditions so that we can personally save, say, one life a
> year.
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
> years of my work. In minutes.  I want to cry.  We SHOULD cry.  Try and
> watch that Parkland mother on CNN.  I dare you.
>
> Today is not a day like all the others.  It's just not.
>
> --Martin Pusic
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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> 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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> Hi Joe
>
> I disagree about ‘strict gun control laws’ here having anything to do with
> it .  Either you or I could have a new hunting rifle in a week or two in
> Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
> We have a different culture here in Canada.  Guns are not toted around in
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
> I have lots of questions, but I don’t know the answers.
>
> Terence
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:[log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> Repeal and replace the second amendment with a clear and contemporary
> document. Dave Habib
>
> ________________________________________
> From: Pediatric Emergency Medicine Discussion List [
> [log in to unmask]<mailto:[log in to unmask]>] on
> behalf of Terence Bergmann [[log in to unmask]<mailto:
> [log in to unmask]>]
> Sent: Sunday, February 18, 2018 7:42 AM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: The shooting in Florida
>
>
>
> Hi Joe
>
> I disagree about ‘strict gun control laws’ here having anything to do with
> it .  Either you or I could have a new hunting rifle in a week or two in
> Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
> We have a different culture here in Canada.  Guns are not toted around in
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
> I have lots of questions, but I don’t know the answers.
>
> Terence
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=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]<mailto:
> [log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> Jeffrey and colleagues:
>
> My colleague Garen Wintemute is an EM physician at UC Davis and has been
> doing seminal work on firearm violence prevention for decades - doggedly
> and with great impact
>
> He is the director of the Violence Prevention Research Program (VPRP) at
> UC Davis, and has been named a "hero of medicine" by Time Magazine in the
> past for his work. He is as smart and accomplished as they come, and there
> is nobody in the country who has been doing this longer or with greater
> impact. And he has weathered the political and funding crises for this type
> of work for years, frequently funding his own work when the political
> climate for this work was bleak. But he has also received substantial
> foundation money and federal grants during more supportive political times.
>
> He recently received $5 million from the California state legislature to
> lead the University of California Firearm Violence Research Center, the
> first state-funded gun violence research center in the country.
>
> Here is his entry in Wikipedia: https://urldefense.proofpoint.
> com/v2/url?u=https-3A__en.wikipedia.org_wiki_Garen-5FWintemute&d=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=
> 3zvB2EwPZIFiqexyruext2bXYQ727znpC_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]><mailto:[log in to unmask]>> wrote:
>
> Thanks for this cathartic thread, Dr. Pusic and others. Hope fellows are
> allowed to chime in. Like many on here my gut reaction is to focus on
> politics, ie an assault weapons ban, the 2nd amendment etc. If Americans
> were being killed by the same type of airplane that kept crashing, congress
> would act. Why the same isn’t done with the AR-15 given that it keeps being
> used to murder kids (in Sandy Hook, Aurora, Orlando, Las Vegas and now
> Parkland) is maddening. But I wonder if we could do more by taking the lead
> on another key gun violence issue on which physicians are experts. The
> problem was encapsulated by the first few hours after the parkland shooting
> when media outlets were literally arguing over how many school shootings
> there have been in 2018. We don't even know! We don't know because there
> are very little data on firearm injury/death in this country on account of
> Congress blocking gun violence research funding since 1996. And this
> funding block (the "Dickey amendment," named for the NRA point person in
> Congress at the time) has created a political chill on research that has
> trickled down even to academic medical centers. When I tried to examine NY
> EMS data to look at pre-hospital intervention in pediatric firearm injury,
> the city blocked it on account of the study being "too political." Where is
> the research? When SIDs reached epidemic numbers in the 70’s, Congress
> allocated funds for aggressive research leading to Back to Sleep campaign
> and SIDS rates plummeted. Similar research campaigns produced life-saving
> interventions for lead poisoning and car crashes. Yet no research crusade
> has been directed at the epidemic of pediatric firearm death because
> Congress essentially prohibits it. The hard part is trying to figure out
> what to do about it. In my state of New York, A.2977/S.4363, sponsored by
> New York State Assemblymember Jo Anne Simon and Senator Roxanne Persaud,
> would create a Firearm Violence Research Institute in New York and I along
> with some colleagues are trying to support this in a few different ways; if
> others on here want to discuss or have other ideas pls be in touch. This is
> not meant to discourage us from yelling from rooftops and writing senators
> about background checks, assault weapons ban etc. That is so important. But
> we have a unique vantage point with regard to public health research and
> we're allowed to do it for every other public health problem except this
> one.  Thanks so much for allowing me to add my 2 cents
>
> Sent from my iPhone
>
> On Feb 17, 2018, at 3:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
> Martin,
>
> As I sit in my living room on this Saturday morning, I’ve also gotten my
> self in a state about how we tend to focus in on the small picture and
> neglect an exponentially bigger one.
>
> Spoiler Alert: this will NOT be a politically laced nor personally biased
> post...as opposed to some of the previous posts on this issue - I'm
> actually quite disappointed that politics had to rear its ugly head.
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>               Don't claim to be a gun control policy expert
>
> Now, allow me to expound:
>
> 1. A troubled young man AND inappropriate access to crazy weapons is what
> caused this catastrophe.
>
> Colleagues, I think we all agree that it would be too simplistic and
> frankly naive to think that stricter gun control would solve all of these
> gun related deaths...many examples of this false and misleading association
> of tighter gun control means safer society here are just a few below...many
> more:
> -explore New Hampshire and Illinois...NH has very liberal gun control,
> Chicago instead has very strict ones...look up who has more gun related
> violent crime per capita...
> -the Swiss gov't actually encourages gun ownership.. has one of the
> highest rates of gun ownership in the world, but little gun-related street
> crime
> -Britain has more violent crime then the US (ban on guns since 1997)
>
> From my viewpoint, attention is being focused in the wrong direction. I
> think we as powerful respected advocates of "public health" should focus at
> the root causes of the problem, starting with the breakdown of the family
> (young males who are deprived of an active father figure are far more
> likely to commit violent crimes), the relentless stream of violent
> promoting behaviour from Hollywood, the exponential increase in mental
> illness in youth to start with.
>
> How come we don't lambast the horrendous violence coming out of Hollywood
> which our youth are imbibing with negative consequences?
>
> 2. As per the CDC, in 2016, ~900 000 legal induced abortions were reported
> from 49 reporting areas...likely a significant underestimate since CA among
> other states does not report its numbers  (BTW ~ 1.5% for rape/incest, 3%
> for fetal health issues).
>
> Without going into the classic arguments re pro/con, how can we not, how
> do we not stand up for these children? I agree with the AAP's stance on gun
> control but what I have trouble understanding is how the AAP does not weigh
> in on the abortion issue (~10% of abortions are reported in females <19)?
>
> 17 children violently, meaninglessly murdered. An incredible tragedy. How
> is this different then close to 1 million kids per year mentioned above.
>
> I agree with the AAP's stance on gun control but what I have trouble
> understanding is how the AAP does not weigh in on the abortion issue?
>
>
> Joe
>
>
>
>
>
> Joe Nemeth MD FCFP EM
> Associate Professor
> McGill University
>
>
> ________________________________________
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]<mailto:[log in to unmask]><mailto:
> [log in to unmask]>> on behalf of Barry Nathan <
> [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
> Sent: February 17, 2018 7:23:57 AM
> To: [log in to unmask]<mailto:[log in to unmask]
> ><mailto:[log in to unmask]>
> Subject: Re: The shooting in Florida
>
> In case you don't get emails from the AAP:
>
> [image: AAP_400_61.jpg]
>
>
>
> *Statement on School Shooting in Parkland, Florida*
>
> from *Colleen A. Kraft, MD, FAAP, President, American Academy of
> Pediatrics*
>
> "Yesterday just before the dismissal bell rang, 17 children and adults were
> shot and killed and 15 were injured inside Marjory Stoneman Douglas High
> School in Parkland, Fla. We find ourselves once again filled with grief and
> horror, and we mourn alongside all those impacted by the shooting. As our
> hearts are in Parkland, our eyes are on Congress.
>
> "This is the eighteenth school shooting in 2018, the equivalent of one
> every two and a half days so far this year. Shootings have an indelible
> impact on entire communities, on the families who lost children and loved
> ones, and on the children who survived. Columbine. Virginia Tech. Newtown.
> Orlando. Las Vegas. And now, Parkland. Children are dying from gun violence
> and Congress is failing to act. Every one of our 100 U.S. senators, and all
> 435 U.S. representatives bear a responsibility to take meaningful action to
> protect our children, our families, and our communities. Our elected
> leaders cannot continue to fail at this most essential task.
>
> "We can start by working to advance meaningful legislation that keeps
> children safe. The American Academy of Pediatrics advocates for stronger
> state and federal gun laws that protect children, including a ban on
> assault weapons like the one used in yesterday's school shooting. We also
> call for stronger background checks, solutions addressing firearm
> trafficking, and encouraging safe firearm storage. We will also continue to
> work to ensure that children and their families have access to appropriate
> mental health services, particularly to address the effects of exposure to
> violence.
>
> "Although these mass shootings command our attention, our children remain
> at risk daily for suicide, homicide, and unintentional injury because of
> the current policy regarding access to guns in the United States. Gun
> violence is a public health threat to children, and one the American
> Academy of Pediatrics will continue to take on, in state capitals across
> the country and in the halls of Congress. Parents across the United States
> send their children to school every day, and hope and trust they will be
> safe. As long as children continue to be injured and killed by guns in this
> country, pediatricians will not rest in our pursuit to keep them safe."
>
> *The American Academy of Pediatrics is an organization of 66,000 primary
> care pediatricians, pediatric medical subspecialists and pediatric surgical
> specialists dedicated to the health, safety and well-being of infants,
> children, adolescents and young adults. For more information, visit *
> www.aap.org<https://urldefense.proofpoint.com/v2/
> url?u=http-3A__www.aap.org&d=DwIFaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=eacE1u355w4wQKZ8Zh7E9jp85QBWM7
> T2Kf9kCQerxcE&s=WSoLIZ6NQ9r1enGl8xags2OLhTgc4W5K1c2drXjlo5c&e=><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]<mailto:[log in to unmask]>>
> wrote:
>
> I think we need to move to repeal the second amendment. It's the only way
> the NRA can be stopped. They resist all reasonable attempts to limit the
> carnage and then hide behind a misinterpretation of the second amendment.
>
> Very well, let's repeal it. I know many people agree that we don't need
> militias any longer.
>
> Jim Chamberlain
>
>
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of Martin Pusic
> Sent: Friday, February 16, 2018 6:29 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: The shooting in Florida
>
> Hi colleagues,
>
> As I sit in my office late on a Friday, I've gotten myself into a state
> about the 17 children gunned down in a school.  For the umpteenth time.
>
> I think the thing that has me so upset, is that this state of gun
> complaisance is an affront to everything a pediatric emergency physician
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
> burnout inducing conditions so that we can personally save, say, one life a
> year.
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
> years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
> watch that Parkland mother on CNN.  I dare you.
>
> Today is not a day like all the others.  It's just not.
>
> --Martin Pusic
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the
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> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
>
> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
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>
>
> For more information, send mail to [log in to unmask]<mailto:
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> [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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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
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>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]><mailto:[log in to unmask]> with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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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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> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 10:20:42 -0500
> From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: A second, more settled, reflection on the Florida shooting
>
> After my amygdala-based email of Friday, a clarification:
>
> It is right and fit and proper that Pediatric Emergency Medicine
> physicians bring the full force of our research and clinical armementarium
> to bear on the problems of our patients.  That means sweating thresholds of
> WBC for their predictive value in infections.  That means mounting massive
> 10 year PECARN/PERC/PERN level research efforts to understand in detail the
> mechanisms of our patients' problems in order to benefit them in any way we
> can.  That's our  laudable job.  We should be proud of taking on the
> problem of brain tumours 30 years from now.  In no way did I mean to
> denigrate those efforts.  Instead, the complete opposite  -- I think they
> provide us with the moral authority to speak out against government
> policies that harm children.
>
> What is neither right nor fit nor proper is the ease with which a gun
> violence proponent can wreak havoc at a scale that, on a given schoolday,
> trivializes my efforts and those of my PEM colleagues.  It feels like a
> personal affront that we live in a nation in which somehow the NRA has
> better government support than CHIP does.  My point is not to devalue our
> day/evening/night/weekend job.... we are doing MORE than our part in
> society.......but rather to express that I, as a PEM physician, am rocked
> to the core by the moral imbalance that makes it possible to routinely
> leave 17 children dead.  And that this is some sort of normal.
>
> Some notes:
> If you need an example of how routine this has become, one PEM colleague
> wrote that he is going to his son's elementary school next week to instruct
> the teachers on external control of hemorrhage
> A Scot described the positive example of the way the Dunblane massacre
> provoked a re-writing of their laws.  They haven't had another in 22 years
> since.
> Fahd Ahmad from WashU had already written on this:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> roguedadmd.com_2018_02_how-2Dmany-2Dpeople-2Dand-2Dwhich-
> 2Dpeople-2Dshould-2Ddie-2Dfor-2Dwhich-2Drights_&d=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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 16:56:19 +0000
> From:    Doc Holiday <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> Before I continue, I must say how much more comfortable this on-line
> debate feels as compared to previous ones on other ListServs. I know it's a
> generalising comment, but I keep finding that the insertion into the mix of
> people who work with children makes everything so much more polite and
> patient. If I recall correctly, there was a lot of anger and short
> sentences last time I was involved in a debate on this topic on an "adult"
> list....
>
>
> From: Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]>>
> As I sit in my living room on this Saturday morning
>
>
> --> My living room. Sunday afternoon. What else is there to do on a
> weekend, eh?
>
>
> I live in Canada and  love our very strict gun control laws
>
>
> --> As people know, I live in the UK at this time and I also like the gun
> laws here (as well as ones on knives, etc). I don't feel as positive about
> drug laws, but that's a different thread. Still, the point I made before
> and make again now is that I don't think our gun laws are THE cause of our
> statistics. I think they are but one (be it major) factor contributing, but
> on the background of a culture which rejects gun violence! I don't think
> that any society will change sufficiently merely by their introduction - no
> matter how strict. I have lived for many years in more than one country in
> which guns were far more common than they are in the UK and these countries
> differed markedly in terms of gun violence. One was actually on the same
> scale as the USA!
>
>
> A troubled young man AND inappropriate access to crazy weapons is what
> caused this catastrophe... too simplistic and frankly naive to think that
> stricter gun control would solve all of these gun related deaths
>
>
> --> I agree. And I would add that there are factors beyond the two you
> mentioned. It's not even ONLY two factors. We can probably add to this:
> - the lack of major societal backlash to inappropriate comments
> - the tolerance of lack of free psychiatric care
> - the overwhelming number of similar cases which will "drown" the efforts
> of law enforcement to identify the cases which eventually go on to this
> sort of event from among so many others, etc
> - there will be more factors identified as this case gets investigated
>
>
> One more point, though - a HUGE factor might be, as in past cases, if the
> outrage dies down! The NRA and those who profit from guns will push their
> politicians, including some of the more publicly-prominent ones and they
> will keep things as quiet as possible. Possibly, even the next similar
> event somehow will be used to make this one "disappear". You can recognise
> the "silencing tactics" by indicator phrases such as:
> - "Now is not the time..."
> - "Country/state/city X ... bla-bla-bla ... And they have more/fewer guns
> and more/fewer gun deaths and this random statistic thus means we should
> stop looking into gun control"
> - "My child just falls a lot" (sorry - had to put that in, as it's on the
> same level)
> - "The USA is a unique country and yet, when it suits me, I will find some
> other one with which to make comparisons to prove my point"
>
>
> Britain has more violent crime then the US (ban on guns since 1997)
>
>
> --> I realise that I am picking up just one of the many points which were
> listed together. I am only choosing this one because it's one I have been
> familiar with for a very long time. It has been much "used" in order to
> "prove" to Americans how the introduction of gun laws in the UK has left it
> with a higher violent crime rate than the USA and should thus be avoided by
> the USA. Now, I won't trouble the List by arguments about this. Instead, I
> would appreciate it if y'all satisfy your own curiosities, each to his/her
> own level, by going to a favourite search engine and searching for the
> phrase "Britain has more violent crime then the US". You can read for
> yourselves and save me from having to type up the actual facts...
>
>
> But I can't stop myself from mentioning something which has come up in a
> past discussion I was accidentally drawn into on a visit to the USA 3-4
> years ago. This same myth was raised. That, in itself, was no surprise, but
> it had been raised by someone who had already impressed me with how many
> "facts" he had absorbed from social media sources and how confidently he
> spoke of these despite appearing to be far less eloquent whenever
> questioned in detail about anything. I.e., he appeared to me to have been
> "brainwashed". Despite knowing better, I challenged him on why he thought
> the USA was "doing so much better" than the UK in terms of violent crime.
> He gave me the answer. He then mistook my look of disbelief to indicate I
> did not believe the facts he had mentioned. He was wrong - what I did not
> believe is that someone could be that easy to "sell" to. He pulled out his
> phone and showed me the "evidence". No idea what you're sitting on as you
> read this, but I hope it has handles for you to hang onto, so that you
> don't fall to the ground laughing. The reason, according to this "expert"
> for how the USA got to have what he claimed was 10 times less violent crime
> than the UK is because the USA has taken the excellent pre-emptive step of
> imprisoning those who would otherwise have engaged in violent crime! I kid
> you not - he attributed the high level of violent crime he believed the UK
> had, not to the fact that the UK records a huge number of offences which
> the USA does not include in its statistics. What he showed me was:
> https://urldefense.proofpoint.com/v2/url?u=https-3A__en.
> wikipedia.org_wiki_List-5Fof-5Fcountries-5Fby-5Fincarceration-5Frate&d=
> 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=
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>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 12:00:26 -0500
> From:    Michael Falk <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> While I get the despair and anger given the lose of 17 people in another
> senseless mass shooting, I would caution people to not give up hope.  When
> I first came to New York City in 1989, it was averaging about 2,000
> homicides a year.  If take our statistics for nonlethal injuries per
> homicide, roughly 7:1, the city was seeing another 10,000 plus penetrating
> traumas and I have not even mentioned the assaults with fists or blunt
> objects.  Last year in NYC, we had less than 400 homicides and the city is
> safer than it has been in years.  Why?  Well, there was a concerted effort
> to change the culture of policing and law enforcement in the city, and
> there was a massive crackdown on guns and getting them off the streets.
> The laws were changed around gun ownership and licensing, and there you
> have it....
>
> Also, many of you are forgetting that we had an assault weapons law in the
> US and Bush/Congress let it lapse in 2003.  Now it's record is a mixed bag
> but I think that if we learn from the mistakes we made the last time, and
> write a better law, we can actually have a significant impact.
>
> Just my two cents..
> Mike Falk
> NYC.
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> 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 17:09:24 +0000
> From:    Robert Finkelstein <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
> Other countries have the same level of mental illness as the United
> States, but not nearly the number of gun deaths. The mental health issue is
> important but access to weapons that can kill a large number of people in
> seconds allows the results we see. In addition, access to guns plays  a
> huge role in suicides since many who attempt suicide and do not succeed
> will get help and not attempt again. However, access to a gun makes it much
> more likely that the first attempt will result in death.
>
> Robert Finkelstein
>
> On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]<mailto:sed8m
> [log in to unmask]>> wrote:
>
> I respect the need for debate around guns.   However, I think we are
> remiss as pediatric emergency physicians to not raise a deeper discussion
> around the mental illness crisis.
>
> We all see kids who meet this persons profile across the country. We see
> disturbing mental illness and the many factors (including social media,
> broken families, child abuse) that lead a child to buy a gun to do harm.
> Or if not gun an explosive device etc..
>
> We see kids who are socially isolated and warning signs ignored.  Anyone
> else concerned that the kids we see with mental illness are recognized by
> schools or pediatric visit screening more often than by their own parents,
> friends or neighbors.
>
> This persons desire to be a “school shooter” should raise attention around
> how the media covers these events.  The fame brought to these shooters
> should be called into question.  Are we fostering this copycat mentality?
>
> The lack of respect for human life should call us to question more than
> the how but why.
>
> A focus only on guns and gun laws is remiss to the bigger picture in my
> opinion and experience.
>
> Mick
>
>
>
> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> There are 4 messages totaling 391 lines in this issue.
>
> Topics of the day:
>
> 1. Peds EM talk (2)
> 2. Bacterial meningitis
> 3. The shooting in Florida
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> 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]<mailto:[log in to unmask]>>
> Subject: Re: Peds EM talk
>
> Thanks all for your help on this.
> Best
> Purva
>
> Purva Grover , MD
> Medical Director
> Pediatric Emergency Department
> Cleveland Clinic Health System
> Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> [log in to unmask]>>g
>
> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> [log in to unmask]>> wrote:
>
> Hi All
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
> Thanks
> Purva
>
> Sent from my mobile device
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]>>
> Subject: Re: Peds EM talk
>
> I would also cover unusual cases that you can't afford to miss, e.g.
>
> Sternoclavicular dislocation
> Conjunctivitis caused by penetrating FB
> Septic joint presenting with only low-grade fever (we've had several Staph
> infections where temp was only 37.6 or 37.7 orally)
> Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> patients need a through cardiac exam, including distal pulses
> NAT
> The "sleepy" baby who has hypoglycemia
> The "sleepy" baby who has intussusception
> The appendicitis patient who presents with vomiting and diarrhea (not all
> that unusual, actually)
> Etc.
>
> To me, this is the challenge of PEM. Finding the needle in the haystack,
> that one sick kid who is different than all the usual low acuity illness...
>
> Jim
>
> James Chamberlain
> Division Chief, Emergency Medicine
> Children’s National Health System
> (202) 476-4177
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Mojica, Michael
> Sent: Thursday, February 15, 2018 5:29 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Peds EM talk
>
> Purva
>
>
>
> I would recommend "the critically ill infant".
>
>
>
> It is the topic that scares the most people and you can cover a lot of
> causes through cases.
>
>
>
> I like to use cases that include common presenting complaints (e.g.
> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>
>
>
> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>
>
>
> My goal is for them to develop a mental checklist of potentially
> life-saving interventions.
>
>
>
> Michael
>
>
>
> Michael Mojica, M.D
>
> Director of Education, Division of Pediatric Emergency Medicine
>
> Director, Pediatric Emergency Medicine Fellowship
>
> Bellevue Hospital Center
>
> Administration Building Room A528
>
> New York, N.Y. 10016
>
> [log in to unmask]<mailto:[log in to unmask]>
>
> 212-562-8147
>
>
>
>
>
> ?On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> behalf of Purva Grover" <[log in to unmask]<mailto:
> [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> [log in to unmask]>> wrote:
>
>
>
> Hi All
>
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
>
> Thanks
>
> Purva
>
>
>
> Sent from my mobile device
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
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>
>
>
>
>
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>
> ------------------------------
>
> Date: Fri, 16 Feb 2018 18:29:38 -0500
> From:    Aline Baghdassarian <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: Bacterial meningitis
>
> Scott,
>
> Would love to hear more about the cases. How did they present? What was the
> decision making process?
>
> Thank you,
>
> Aline
>
> Aline Baghdassarian, MD, MPH, FAAP
> Director, Pediatric Emergency Medicine Fellowship Program
> Assistant Professor, Department of Emergency Medicine
> Virginia Commonwealth University School of Medicine
>
> Children's Hospital of Richmond at VCU
> Email [log in to unmask]<mailto:aline.
> [log in to unmask]>
>
>
> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> <mailto:[log in to unmask]>>
> wrote:
>
> In a recent case at our institution, there was a present but subtle degree
> of meningismus — I’ve found over the years there is always some elicitable
> sign — but as importantly there’s a degree of irritability or altered
> behavior that has everyone concerned: mom, RN’s, me.
> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
> cerebritis or encephalopathic behavior until there’s a consent signed.
>
> I’m not such a good scientist anymore, but I’ve tried to be an attentive
> clinician.
>
> Julian Orenstein
>
>
> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> [log in to unmask]>> wrote:
>
> Scott - Bacterial meningitis is alive and well here in LV - we have seen
> it in a variety of age groups. There is good evidence that there has been
> an increase in pneumococcal serotypes not covered by the polyvalent
> vaccines since there widespread use, such that the burden of pneumococcal
> meningitis (as opposed to H. flu type b) has not decreased nearly as much.
>
> Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>
> Also, the absence of meningismus in older kids with bacterial meningitis
> is well described and occurs in a substantial subset.
>
> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>
> Much of the data on the sensitivity of the neck exam is of the
> retrospective variety. I have only read one really good prospective study
> on the sensitivity of PE for bacterial meningitis and it was a single
> center variety as I recall.
>
> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
> 1992;21(8):910-914.
>
> Tough case.
>
>
> Jay
>
> Jay D. Fisher MD FAAP FACEP
> Medical Director, Pediatric EM
> Children's Hospital of Nevada at UMC
> Clinical Professor of Emergency Medicine and Pediatrics
> UNLV School of Medicine
>
>
>
>
>
>
>
>
> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>
> I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
> out that bacterial meningitis appears at this time of year as a
> complication of influenza:
> "Both pneumococcal and meningococcal meningitis can occur post flu as
> well as GAS and S aureus invasive disease and TSS."
>
> She also addressed Jim's question:  "We do know that new serotypes [of
> pneumococcus] have emerged but this is not waning immunity because the teen
> only got PCV7".
>
>
> Greg Conners
>
> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>
> Director, Division of Emergency Medicine
> Associate Chair of Pediatrics
> Professor of Pediatrics and Emergency Medicine
> Children’s Mercy Hospital, Kansas City
> University of Missouri, Kansas City
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of 000001679b145c30-dmarc-
> [log in to unmask]<mailto:[log in to unmask]>
> Sent: Wednesday, February 14, 2018 2:25 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Bacterial meningitis
>
> *** This message was sent to you from an External Source. Please do not
> open untrusted links or attachments. ***
>
> ________________________________
>
>
> Could you share with us the clinical findings and history that prompted
> the LP?
>
>
> Shiu-Lin
>
>
>
>
> Shiu-Lin Tsai, MD
> Division of Pediatric Emergency Medicine
>
> Department of Emergency Medicine
> Columbia University Medical Center
>
>
>
> -----Original Message-----
> From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
> To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> BROWN.EDU>>
> Sent: Wed, Feb 14, 2018 2:44 pm
> Subject: Bacterial meningitis
>
> ALL:
> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
> *Neisseria meningiditis*.  All 3 were in older children/ teens who received
> their Prevnar 13  vaccines as well as the Menactra series in the patient
> with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3
> cases of bacterial meningitis in older kids in a community setting such as
> ours in quite a long time.  Is this random bad luck or do  we all need to
> be more vigilant?  Incidentally, none had neck pain or meningismus as a
> clinical finding.
>
> --
> Kind regards,
>
> Scott
> Scott Freedman, MD
> Medical Director,  Pediatric Emergency Dept Rockville MD
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with
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>
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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Fri, 16 Feb 2018 18:29:08 -0500
> From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: The shooting in Florida
>
> Hi colleagues,
>
> As I sit in my office late on a Friday, I've gotten myself into a state
> about the 17 children gunned down in a school.  For the umpteenth time.
>
> I think the thing that has me so upset, is that this state of gun
> complaisance is an affront to everything a pediatric emergency physician
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
> burnout inducing conditions so that we can personally save, say, one life a
> year.
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
> years of my work. In minutes.  I want to cry.  We SHOULD cry.  Try and
> watch that Parkland mother on CNN.  I dare you.
>
> Today is not a day like all the others.  It's just not.
>
> --Martin Pusic
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 10:17:05 -0500
> From:    Deepti Thomas-Paulose <[log in to unmask]<mailto:dt
> [log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> The year speed limit laws went into effect-->traffic deaths down 17%.
> Mothers against Drunk Driving, stricter DUI enforcement  laws-->cut deaths
> due to drunk driving by half every year since 1980. Seat belt safety laws,
> traffic laws-all created to protect the public.  As a public health trained
> physician, it seems so illogical to me that we would not create stricter
> gun laws especially against military style guns for the civilian
> population.  Let's start there.
>
> Problem- Mass shootings
> Prevention- Ban assault rifles
>
>
> On Sun, Feb 18, 2018 at 7:42 AM, Terence Bergmann <
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
> Hi Joe
>
> I disagree about ‘strict gun control laws’ here having anything to do with
> it .  Either you or I could have a new hunting rifle in a week or two in
> Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
> We have a different culture here in Canada.  Guns are not toted around in
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
> I have lots of questions, but I don’t know the answers.
>
> Terence
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:j
> [log in to unmask]<mailto:[log in to unmask]>>> wrote:
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              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=
> YJHVOvAtlms92ZuRba0rQCi4WeVg3Jg7YqcvpI04608&e=
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]>>
> Subject: Re: School shootings.......
>
> Just because people will find a way to break laws does not mean that we
> shouldn’t have them.   By that logic, we expect that all of us who are
> currently law abiding don’t need any laws to make us so.  Human nature
> being what it is, we all need laws and structure.  Yes, gun regulation
> would not stop all gun violence, but it could reduce it. Also, I don’t
> think the majority want prohibition of guns, just regulation; the same way
> alcohol is regulated by age and penalties for driving under the influence.
> Or, the way cars are regulated with licensing, registration, having to pass
> a driving test and citations for violations.
>
> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> [log in to unmask]<mailto:
> [log in to unmask]>> wrote:
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand.  This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'.  Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem.  So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve.     Horst D. Weinberg, MD
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=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]<mailto:
> [log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> Dear Colleagues:
>
>
> This conversation gives me some hope that we can and will address the
> issue of gun violence through the scientific approach, rather than
> "beliefs" and "feelings", similar to the way that Dr. Wintemute has done
> for the past several decades. While I fully support a
> "re-evaluation/clarification" of the second amendment, a "Children's Rights
> Amendment", and other legislation to help curb gun violence in the US, we
> can and and should evaluate potential interventions now in the context of
> over 350 million guns, with unlimited ammunition, available to the US
> public.
>
>
> So, if we are going to use the scientific approach to this 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 victim of
> that weapon. Rather, these often well intentioned families in the suburban
> and rural areas, who honestly believe that having a loaded gun will protect
> their families from the very, very unlikely chance of a home invasion, will
> actually endanger their loved ones simply by bringing guns into the home.
> On the other hand, in the inner city where gun violence is part of everyday
> life, families believe having the loaded gun readily available (unlocked,
> fully loaded) allows them to better protect their loved ones from the
> reality of their situation. So, when we, as healthcare providers, care for
> the young children who "accidentally" shoot themselves, we are particularly
> frustrated and angered by the tragedy of the entire plight of these
> families. The point is this: these very different groups may require very
> different approaches with respect to interventions.
>
>
>
> I look forward to the continued dialogue, and, more importantly, continued
> research in these areas.
>
>
> Bob Flood
>
> Saint Louis University
>
>
>
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]<mailto:[log in to unmask]>> on
> behalf of Nathan Kuppermann <[log in to unmask]<mailto:
> [log in to unmask]>>
> Sent: Sunday, February 18, 2018 8:04:25 AM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: The shooting in Florida
>
> Jeffrey and colleagues:
>
>
>
> My colleague Garen Wintemute is an EM physician at UC Davis and has been
> doing seminal work on firearm violence prevention for decades - doggedly
> and with great impact
>
>
>
> He is the director of the Violence Prevention Research Program (VPRP) at
> UC Davis, and has been named a "hero of medicine" by Time Magazine in the
> past for his work. He is as smart and accomplished as they come, and there
> is nobody in the country who has been doing this longer or with greater
> impact. And he has weathered the political and funding crises for this type
> of work for years, frequently funding his own work when the political
> climate for this work was bleak. But he has also received substantial
> foundation money and federal grants during more supportive political times.
>
>
>
> He recently received $5 million from the California state legislature to
> lead the University of California Firearm Violence Research Center, the
> first state-funded gun violence research center in the country.
>
>
>
> Here is his entry in Wikipedia: https://urldefense.proofpoint.
> com/v2/url?u=https-3A__en.wikipedia.org_wiki_Garen-
> 5FWintemute&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=MwtCq_L-kQIs3_poo8ESXJUfQXyAfM2mv3_BCZ2sBPo&e=
>
>
>
> If you are interested in his program or donating, here is the link:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> ucdmc.ucdavis.edu_vprp_&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=km0yMXq80C4DGUQlje9yL-_xAQ5OiKQNooiyry9xUC0&e=
>
>
>
> Full disclosure: I serve as the Chair of EM at UC Davis where Garen works,
> but the only benefit to me for getting Garen more exposure or money to the
> VPRP program that he oversees is my children and family whom I desperately
> want to protect, my many friends throughout this great country about whom I
> deeply care, and a country about which I am deeply concerned.
>
>
>
> Nate Kuppermann
>
> UC Davis
>
>
>
>
>
>
>
> On Feb 17, 2018, at 3:03 PM, Jeffrey Oestreicher <[log in to unmask]<
> mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:
>
>
>
> Thanks for this cathartic thread, Dr. Pusic and others. Hope fellows are
> allowed to chime in. Like many on here my gut reaction is to focus on
> politics, ie an assault weapons ban, the 2nd amendment etc. If Americans
> were being killed by the same type of airplane that kept crashing, congress
> would act. Why the same isn’t done with the AR-15 given that it keeps being
> used to murder kids (in Sandy Hook, Aurora, Orlando, Las Vegas and now
> Parkland) is maddening. But I wonder if we could do more by taking the lead
> on another key gun violence issue on which physicians are experts. The
> problem was encapsulated by the first few hours after the parkland shooting
> when media outlets were literally arguing over how many school shootings
> there have been in 2018. We don't even know! We don't know because there
> are very little data on firearm injury/death in this country on account of
> Congress blocking gun violence research funding since 1996. And this
> funding block (the "Dickey amendment," named for the NRA point person in
> Congress at the time) has created a political chill on research that has
> trickled down even to academic medical centers. When I tried to examine NY
> EMS data to look at pre-hospital intervention in pediatric firearm injury,
> the city blocked it on account of the study being "too political." Where is
> the research? When SIDs reached epidemic numbers in the 70’s, Congress
> allocated funds for aggressive research leading to Back to Sleep campaign
> and SIDS rates plummeted. Similar research campaigns produced life-saving
> interventions for lead poisoning and car crashes. Yet no research crusade
> has been directed at the epidemic of pediatric firearm death because
> Congress essentially prohibits it. The hard part is trying to figure out
> what to do about it. In my state of New York, A.2977/S.4363, sponsored by
> New York State Assemblymember Jo Anne Simon and Senator Roxanne Persaud,
> would create a Firearm Violence Research Institute in New York and I along
> with some colleagues are trying to support this in a few different ways; if
> others on here want to discuss or have other ideas pls be in touch. This is
> not meant to discourage us from yelling from rooftops and writing senators
> about background checks, assault weapons ban etc. That is so important. But
> we have a unique vantage point with regard to public health research and
> we're allowed to do it for every other public health problem except this
> one.  Thanks so much for allowing me to add my 2 cents
>
>
>
> Sent from my iPhone
>
>
>
> On Feb 17, 2018, at 3:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
>
>
> Martin,
>
>
>
> As I sit in my living room on this Saturday morning, I’ve also gotten my
> self in a state about how we tend to focus in on the small picture and
> neglect an exponentially bigger one.
>
>
>
> Spoiler Alert: this will NOT be a politically laced nor personally biased
> post...as opposed to some of the previous posts on this issue - I'm
> actually quite disappointed that politics had to rear its ugly head.
>
>
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>               Don't claim to be a gun control policy expert
>
>
>
> Now, allow me to expound:
>
>
>
> 1. A troubled young man AND inappropriate access to crazy weapons is what
> caused this catastrophe.
>
>
>
> Colleagues, I think we all agree that it would be too simplistic and
> frankly naive to think that stricter gun control would solve all of these
> gun related deaths...many examples of this false and misleading association
> of tighter gun control means safer society here are just a few below...many
> more:
>
> -explore New Hampshire and Illinois...NH has very liberal gun control,
> Chicago instead has very strict ones...look up who has more gun related
> violent crime per capita...
>
> -the Swiss gov't actually encourages gun ownership.. has one of the
> highest rates of gun ownership in the world, but little gun-related street
> crime
>
> -Britain has more violent crime then the US (ban on guns since 1997)
>
>
>
> From my viewpoint, attention is being focused in the wrong direction. I
> think we as powerful respected advocates of "public health" should focus at
> the root causes of the problem, starting with the breakdown of the family
> (young males who are deprived of an active father figure are far more
> likely to commit violent crimes), the relentless stream of violent
> promoting behaviour from Hollywood, the exponential increase in mental
> illness in youth to start with.
>
>
>
> How come we don't lambast the horrendous violence coming out of Hollywood
> which our youth are imbibing with negative consequences?
>
>
>
> 2. As per the CDC, in 2016, ~900 000 legal induced abortions were reported
> from 49 reporting areas...likely a significant underestimate since CA among
> other states does not report its numbers  (BTW ~ 1.5% for rape/incest, 3%
> for fetal health issues).
>
>
>
> Without going into the classic arguments re pro/con, how can we not, how
> do we not stand up for these children? I agree with the AAP's stance on gun
> control but what I have trouble understanding is how the AAP does not weigh
> in on the abortion issue (~10% of abortions are reported in females <19)?
>
>
>
> 17 children violently, meaninglessly murdered. An incredible tragedy. How
> is this different then close to 1 million kids per year mentioned above.
>
>
>
> I agree with the AAP's stance on gun control but what I have trouble
> understanding is how the AAP does not weigh in on the abortion issue?
>
>
>
>
>
> Joe
>
>
>
>
>
>
>
>
>
>
>
> Joe Nemeth MD FCFP EM
>
> Associate Professor
>
> McGill University
>
>
>
>
>
> ________________________________________
>
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]<mailto:[log in to unmask]><mailto:
> [log in to unmask]>> on behalf of Barry Nathan <
> [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>>
>
> Sent: February 17, 2018 7:23:57 AM
>
> To: [log in to unmask]<mailto:[log in to unmask]
> ><mailto:[log in to unmask]>
>
> Subject: Re: The shooting in Florida
>
>
>
> In case you don't get emails from the AAP:
>
>
>
> [image: AAP_400_61.jpg]
>
>
>
>
>
>
>
> *Statement on School Shooting in Parkland, Florida*
>
>
>
> from *Colleen A. Kraft, MD, FAAP, President, American Academy of
> Pediatrics*
>
>
>
> "Yesterday just before the dismissal bell rang, 17 children and adults were
>
> shot and killed and 15 were injured inside Marjory Stoneman Douglas High
>
> School in Parkland, Fla. We find ourselves once again filled with grief and
>
> horror, and we mourn alongside all those impacted by the shooting. As our
>
> hearts are in Parkland, our eyes are on Congress.
>
>
>
> "This is the eighteenth school shooting in 2018, the equivalent of one
>
> every two and a half days so far this year. Shootings have an indelible
>
> impact on entire communities, on the families who lost children and loved
>
> ones, and on the children who survived. Columbine. Virginia Tech. Newtown.
>
> Orlando. Las Vegas. And now, Parkland. Children are dying from gun violence
>
> and Congress is failing to act. Every one of our 100 U.S. senators, and all
>
> 435 U.S. representatives bear a responsibility to take meaningful action to
>
> protect our children, our families, and our communities. Our elected
>
> leaders cannot continue to fail at this most essential task.
>
>
>
> "We can start by working to advance meaningful legislation that keeps
>
> children safe. The American Academy of Pediatrics advocates for stronger
>
> state and federal gun laws that protect children, including a ban on
>
> assault weapons like the one used in yesterday's school shooting. We also
>
> call for stronger background checks, solutions addressing firearm
>
> trafficking, and encouraging safe firearm storage. We will also continue to
>
> work to ensure that children and their families have access to appropriate
>
> mental health services, particularly to address the effects of exposure to
>
> violence.
>
>
>
> "Although these mass shootings command our attention, our children remain
>
> at risk daily for suicide, homicide, and unintentional injury because of
>
> the current policy regarding access to guns in the United States. Gun
>
> violence is a public health threat to children, and one the American
>
> Academy of Pediatrics will continue to take on, in state capitals across
>
> the country and in the halls of Congress. Parents across the United States
>
> send their children to school every day, and hope and trust they will be
>
> safe. As long as children continue to be injured and killed by guns in this
>
> country, pediatricians will not rest in our pursuit to keep them safe."
>
>
>
> *The American Academy of Pediatrics is an organization of 66,000 primary
>
> care pediatricians, pediatric medical subspecialists and pediatric surgical
>
> specialists dedicated to the health, safety and well-being of infants,
>
> children, adolescents and young adults. For more information, visit *
>
> www.aap.org<https://urldefense.proofpoint.com/v2/
> url?u=http-3A__www.aap.org&d=DwIFaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=eacE1u355w4wQKZ8Zh7E9jp85QBWM7
> T2Kf9kCQerxcE&s=WSoLIZ6NQ9r1enGl8xags2OLhTgc4W5K1c2drXjlo5c&e=><https://
> urldefense.proofpoint.com/v2/url?u=http-3A__www.aap.org&d=
> DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-
> w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2TVpCIOAggcCW0&s=3Oc_
> 7pCeJFj4KZ9QlF0MpVKwh-Xixr5f2-x4dFOOgHk&e=>
>
> <https://urldefense.proofpoint.com/v2/url?u=https-
> 3A__linkprotect.cudasvc.com_url-3Fa-3Dhttp-3A__www.
> mmsend70.com_link.cfm-253fr-253dP1AWQRX2DH6KpZKp05dazA-7E-
> 7E-2526pe-253dBH4KXYJXftdV7-5FOrPTTyUbVAzQsfgoRvleBm2XUVQ6
> AiEVwuBNacQ0AWbz2OcXguY6Y2i1bNdCMkiPdWG-2DfHRg-7E-7E-2526t-
> 253dP2O93UltqkjSP1tT62-5FPaA-7E-7E-26c-3DE-2C1-
> 2CEDnzTesKajviC9Rbq687pz7yfFyRgC2WBFw6mF1beQyzL2WYF-
> 5FfPWMjWxOixG1eagtp40GaUhhxZ8IL4zNcR4weeC1DLvkbbpHQsmMSnszDC
> -26typo-3D1&d=DwIGaQ&c=Pk_HpaIpE_jAoEC9PLIWoQ&r=PgyaJu_-
> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=kjmFQ1KpfStKxhcvfi4QpgjqumdRH2
> TVpCIOAggcCW0&s=IjSKeAbtNO1UyfAxfonG3YrPW35X2WKiPCyGj3YfSnQ&e=>*
>
> and
>
> follow us on Twitter @AmerAcadPeds.*
>
>
>
> On Fri, Feb 16, 2018 at 9:22 PM, Chamberlain, James <
>
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
>
>
> I think we need to move to repeal the second amendment. It's the only way
>
> the NRA can be stopped. They resist all reasonable attempts to limit the
>
> carnage and then hide behind a misinterpretation of the second amendment.
>
>
>
> Very well, let's repeal it. I know many people agree that we don't need
>
> militias any longer.
>
>
>
> Jim Chamberlain
>
>
>
>
>
>
>
> -----Original Message-----
>
> From: Pediatric Emergency Medicine Discussion List [mailto:
>
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of Martin Pusic
>
> Sent: Friday, February 16, 2018 6:29 PM
>
> To: [log in to unmask]<mailto:[log in to unmask]>
>
> Subject: The shooting in Florida
>
>
>
> Hi colleagues,
>
>
>
> As I sit in my office late on a Friday, I've gotten myself into a state
>
> about the 17 children gunned down in a school.  For the umpteenth time.
>
>
>
> I think the thing that has me so upset, is that this state of gun
>
> complaisance is an affront to everything a pediatric emergency physician
>
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
>
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
>
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
>
> burnout inducing conditions so that we can personally save, say, one life a
>
> year.
>
>
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
>
> years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
>
> watch that Parkland mother on CNN.  I dare you.
>
>
>
> Today is not a day like all the others.  It's just not.
>
>
>
> --Martin Pusic
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the
>
> message: info PED-EM-L The URL for the PED-EM-L Web Page is:
>
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
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>
> Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
>
>
>
> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
>
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
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>
>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
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>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]><mailto:[log in to unmask]> with the
> message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>      https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
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>
>
>
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> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Pk_HpaIpE_
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>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 12:18:07 -0500
> From:    Jeff Pender <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> I have a desire to put in my 2 cents as well, considering this is perhaps
> one of the issues I feel most passionately about.   This is a
> multi-factorial problem, obviously.   Not only is it a problem with
> “quality and quantity”, but also with “culture".
>
> By quality and quantity, I am speaking about what people own, and how much
> they own.  Does anyone outside the military need a semi automatic weapon
> for anything?  No.  Does anyone need a bump stock?  No.  Does anyone need
> an extended magazine?  No.  If you require any of these things for the lame
> ass excuse of “home defense”, you either need to move, or take some classes
> and become a far better shot with a handgun.    Further, do people need the
> insane quantity of weapons and ammunition they tend to accumulate?  No, but
> this is a secondary problem to the types of weapons they own.    We can’t
> own a bazooka, so “we” understand that limits can exist, so we need to
> extend those limits to the things listed above.
>
> The culture issue, to me, is even worse.  In the spirit of full
> disclosure, I despise guns. I don’t own one, and have no plans on ever
> owning one.  I won’t allow one in my home, period.  I feel pretty damn safe
> with my 3 large dogs, thank you. I will admit that I pull away socially
> from people once I learn they are big time gun enthusiasts.  I won’t spend
> time with people that I know are carrying a gun on their person, or in
> their car.  I can’t help it, and I don’t feel bad about it for even 1
> second.  We just see the world too differently, although I don’t think it
> makes them a bad person.  In my anecdotal experience, these serious
> “enthusiasts” share some similar traits - they own a shit ton of guns,
> ridiculous ammunition that no target shooter or home defense person really
> needs, but most importantly perhaps, a “macho” response to their guns.
> This is the thing that needs to change.
>
> Guns are celebrated in our country as both cool and macho.  Decide where
> to place the blame - video games, movies, athletes, musicians, etc.   But,
> our politicians are part of this problem, and perhaps the largest part.
> Since they are the ones that make the laws (and take the
> bribes…err…donations), we need them to stop believing this more than anyone
> else. They will never change the gun laws until the culture of how we view
> guns changes.  Think back to that insane video Ted Cruz made where he
> wrapped bacon around the muzzle of an AR-15, and after shooting for a
> while, ate the bacon that the hot muzzle cooked.  It was horrifying how he
> celebrated that AR-15….just so he could get another donation from gun
> lovers.  Change the culture of how they are viewed (and then campaign
> finance laws) and the needle can be moved on this issue.
>
> Israel and Swiss citizens own guns at incredibly high rates, but they are
> viewed as a fact of life, not as a point of pride or machismo.   Culture
> changes are very slow to occur, but that is what is needed first, I think.
> Without it, laws won’t change, and neither will the desire to own these
> weapons and accessories.   Think of other social changes/regulations….they
> were slow — seat belt laws, speed limits, voting rights, marriage equality,
> marijuana legalization, etc etc.   They take decades, sadly. We are a
> country that seems to have extreme difficulty doing the right thing without
> it taking insanely long. It drives me crazy.
>
> I truly hope that this school shooting has occurred around student’s ages
> that can possibly make a difference in that these students are at an age to
> become true activists, unlike when it happens to younger children.  A wave
> has to start, and I think it is most likely to start with these young
> people, as long as we “older” people support them…both financially and
> vocally…and in our voting patterns.
>
> Jeff
>
>
>
>
>
> On Feb 18, 2018, at 7:42 AM, Terence Bergmann <
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
> Hi Joe
>
> I disagree about ‘strict gun control laws’ here having anything to do with
> it .  Either you or I could have a new hunting rifle in a week or two in
> Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
> We have a different culture here in Canada.  Guns are not toted around in
> public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
> I have lots of questions, but I don’t know the answers.
>
> Terence
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]><mailto:[log in to unmask]>> wrote:
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 12:34:05 -0500
> From:    Michael Falk <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: The shooting in Florida
>
> Friend just posted this interesting rebuttal to the "mental illness"
> response whenever there is a mass shooting:
>
> "Believing that mental illness causes mass shootings can feel reassuring.
> It helps to believe that only a mentally ill person could do something so
> horrific. We also think that if someone is mentally ill, they can be
> identified. But the evidence suggests that mental illness only causes a
> small fraction of gun violence. And even if some shooters have undiagnosed
> mental illness, there is no evidence to suggest that they could have been
> diagnosed prior to their gun violence or that such a diagnosis would
> increase the predictive validity of a diagnosis on gun violence."
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> behavioralscientist.org_myth-2Dmental-2Dillness-2Dcauses-
> 2Dmass-2Dshootings_&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=V_
> f2zmvLFf5PgNaVQDiutK2FZDTtoAlYpbWRLpGaDfw&e=
>
> I will add few links of my own:
>
> https://urldefense.proofpoint.com/v2/url?u=https-3A__www.
> theatlantic.com_health_archive_2017_10_why-2Dbetter-
> 2Dmental-2Dhealth-2Dcare-2Dwont-2Dstop-2Dmass-
> 2Dshootings_541965_&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=3gGnZ_xIppMhvqvP4U0nyeY_
> Zqy3HQIz622HbLrsOh4&e=
>
> https://urldefense.proofpoint.com/v2/url?u=https-3A__www.
> vox.com_policy-2Dand-2Dpolitics_2017_11_9_16618472_mental-2Dillness-2Dgun-
> 2Dhomicide-2Dmass-2Dshootings&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=
> smP0aohYRruS54vVLUGS58m4XNjyJ5ZxMVixEN71qp8&e=
>
> The mentally ill are stigmatized enough, blaming them for these killings
> seems unfair.
>
> Mike Falk
>
> On Sun, Feb 18, 2018 at 12:18 PM, Jeff Pender <[log in to unmask]<mailto:
> [log in to unmask]>> wrote:
>
> I have a desire to put in my 2 cents as well, considering this is perhaps
> one of the issues I feel most passionately about.   This is a
> multi-factorial problem, obviously.   Not only is it a problem with
> “quality and quantity”, but also with “culture".
>
> By quality and quantity, I am speaking about what people own, and how much
> they own.  Does anyone outside the military need a semi automatic weapon
> for anything?  No.  Does anyone need a bump stock?  No.  Does anyone need
> an extended magazine?  No.  If you require any of these things for the lame
> ass excuse of “home defense”, you either need to move, or take some classes
> and become a far better shot with a handgun.    Further, do people need the
> insane quantity of weapons and ammunition they tend to accumulate?  No, but
> this is a secondary problem to the types of weapons they own.    We can’t
> own a bazooka, so “we” understand that limits can exist, so we need to
> extend those limits to the things listed above.
>
> The culture issue, to me, is even worse.  In the spirit of full
> disclosure, I despise guns. I don’t own one, and have no plans on ever
> owning one.  I won’t allow one in my home, period.  I feel pretty damn safe
> with my 3 large dogs, thank you. I will admit that I pull away socially
> from people once I learn they are big time gun enthusiasts.  I won’t spend
> time with people that I know are carrying a gun on their person, or in
> their car.  I can’t help it, and I don’t feel bad about it for even 1
> second.  We just see the world too differently, although I don’t think it
> makes them a bad person.  In my anecdotal experience, these serious
> “enthusiasts” share some similar traits - they own a shit ton of guns,
> ridiculous ammunition that no target shooter or home defense person really
> needs, but most importantly perhaps, a “macho” response to their guns.
> This is the thing that needs to change.
>
> Guns are celebrated in our country as both cool and macho.  Decide where
> to place the blame - video games, movies, athletes, musicians, etc.   But,
> our politicians are part of this problem, and perhaps the largest part.
> Since they are the ones that make the laws (and take the
> bribes…err…donations), we need them to stop believing this more than anyone
> else. They will never change the gun laws until the culture of how we view
> guns changes.  Think back to that insane video Ted Cruz made where he
> wrapped bacon around the muzzle of an AR-15, and after shooting for a
> while, ate the bacon that the hot muzzle cooked.  It was horrifying how he
> celebrated that AR-15….just so he could get another donation from gun
> lovers.  Change the culture of how they are viewed (and then campaign
> finance laws) and the needle can be moved on this issue.
>
> Israel and Swiss citizens own guns at incredibly high rates, but they are
> viewed as a fact of life, not as a point of pride or machismo.   Culture
> changes are very slow to occur, but that is what is needed first, I think.
> Without it, laws won’t change, and neither will the desire to own these
> weapons and accessories.   Think of other social changes/regulations….they
> were slow — seat belt laws, speed limits, voting rights, marriage equality,
> marijuana legalization, etc etc.   They take decades, sadly. We are a
> country that seems to have extreme difficulty doing the right thing without
> it taking insanely long. It drives me crazy.
>
> I truly hope that this school shooting has occurred around student’s ages
> that can possibly make a difference in that these students are at an age to
> become true activists, unlike when it happens to younger children.  A wave
> has to start, and I think it is most likely to start with these young
> people, as long as we “older” people support them…both financially and
> vocally…and in our voting patterns.
>
> Jeff
>
>
>
>
>
> On Feb 18, 2018, at 7:42 AM, Terence Bergmann <
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
> Hi Joe
>
> I disagree about ‘strict gun control laws’ here having anything to do
> with it .  Either you or I could have a new hunting rifle in a week or two
> in Canada.  If you look at the school shootings or the Vegas massacre these
> are not people who acquired their guns and went slaughtering.  These guns
> were acquired and the armamentarium prepped and the plans made.  Canadian
> laws would not stop this.
>
> We have a different culture here in Canada.  Guns are not toted around
> in public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> from flourishing on our side of the border.  I don’t know why.
>
> The challenge to end ‘their’ problem is that once the bad guys are armed
> with illegal guns how do you stop the populace from wanting to have legal
> guns?
>
> Somehow other countries can have legal weapons, such as Swiss adults all
> keeping their weapons at home after their years of mandatory service, yet
> they don’t kill each other with them.  Somehow a well armed militia there
> does not lead to violence.
>
> I have lots of questions, but I don’t know the answers.
>
> Terence
>
> On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]<mailto:j
> [log in to unmask]>
> <mailto:[log in to unmask]>> wrote:
>
> Disclaimer: I live in Canada and  love our very strict gun control laws.
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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>
>
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> [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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 12:52:28 -0500
> From:    Mick Work <[log in to unmask]<mailto:[log in to unmask]>>
> Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
>
> I appreciate the passion around gun legislation and not opposed.  I don’t
> think laws will end this countries obsession with guns or limit access to
> those who want to perform unlawful acts.  But again I am not arguing
> against reasonable legislation.
>
> I have heard proposed that we need to arm principals and add more security
> in schools.   I just wonder if we added mental health counselors instead if
> we wouldn’t make a greater impact.
>
> My point is our prevention should be multi-modal like all effective
> strategies.
>
>
> Mick
>
>
>
> On Feb 18, 2018, at 12:09 PM, Robert Finkelstein <[log in to unmask]
> mcgill.ca<mailto:[log in to unmask]>> wrote:
>
> Other countries have the same level of mental illness as the United
> States, but not nearly the number of gun deaths. The mental health issue is
> important but access to weapons that can kill a large number of people in
> seconds allows the results we see. In addition, access to guns plays  a
> huge role in suicides since many who attempt suicide and do not succeed
> will get help and not attempt again. However, access to a gun makes it much
> more likely that the first attempt will result in death.
>
> Robert Finkelstein
>
> On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]<mailto:sed8m
> [log in to unmask]>> wrote:
>
> I respect the need for debate around guns.   However, I think we are
> remiss as pediatric emergency physicians to not raise a deeper discussion
> around the mental illness crisis.
>
> We all see kids who meet this persons profile across the country. We see
> disturbing mental illness and the many factors (including social media,
> broken families, child abuse) that lead a child to buy a gun to do harm.
> Or if not gun an explosive device etc..
>
> We see kids who are socially isolated and warning signs ignored.  Anyone
> else concerned that the kids we see with mental illness are recognized by
> schools or pediatric visit screening more often than by their own parents,
> friends or neighbors.
>
> This persons desire to be a “school shooter” should raise attention around
> how the media covers these events.  The fame brought to these shooters
> should be called into question.  Are we fostering this copycat mentality?
>
> The lack of respect for human life should call us to question more than
> the how but why.
>
> A focus only on guns and gun laws is remiss to the bigger picture in my
> opinion and experience.
>
> Mick
>
>
>
> On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> [log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> There are 4 messages totaling 391 lines in this issue.
>
> Topics of the day:
>
> 1. Peds EM talk (2)
> 2. Bacterial meningitis
> 3. The shooting in Florida
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> 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]<mailto:[log in to unmask]>>
> Subject: Re: Peds EM talk
>
> Thanks all for your help on this.
> Best
> Purva
>
> Purva Grover , MD
> Medical Director
> Pediatric Emergency Department
> Cleveland Clinic Health System
> Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> [log in to unmask]>>g
>
> On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> [log in to unmask]>> wrote:
>
> Hi All
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
> Thanks
> Purva
>
> Sent from my mobile device
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>            https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]>>
> Subject: Re: Peds EM talk
>
> I would also cover unusual cases that you can't afford to miss, e.g.
>
> Sternoclavicular dislocation
> Conjunctivitis caused by penetrating FB
> Septic joint presenting with only low-grade fever (we've had several Staph
> infections where temp was only 37.6 or 37.7 orally)
> Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> patients need a through cardiac exam, including distal pulses
> NAT
> The "sleepy" baby who has hypoglycemia
> The "sleepy" baby who has intussusception
> The appendicitis patient who presents with vomiting and diarrhea (not all
> that unusual, actually)
> Etc.
>
> To me, this is the challenge of PEM. Finding the needle in the haystack,
> that one sick kid who is different than all the usual low acuity illness...
>
> Jim
>
> James Chamberlain
> Division Chief, Emergency Medicine
> Children’s National Health System
> (202) 476-4177
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Mojica, Michael
> Sent: Thursday, February 15, 2018 5:29 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Peds EM talk
>
> Purva
>
>
>
> I would recommend "the critically ill infant".
>
>
>
> It is the topic that scares the most people and you can cover a lot of
> causes through cases.
>
>
>
> I like to use cases that include common presenting complaints (e.g.
> vomiting) that are associated with very bad things (e.g. midgut volvulus).
>
>
>
> I'm attaching a ppt file for a talk I did a few years ago on this topic.
>
>
>
> My goal is for them to develop a mental checklist of potentially
> life-saving interventions.
>
>
>
> Michael
>
>
>
> Michael Mojica, M.D
>
> Director of Education, Division of Pediatric Emergency Medicine
>
> Director, Pediatric Emergency Medicine Fellowship
>
> Bellevue Hospital Center
>
> Administration Building Room A528
>
> New York, N.Y. 10016
>
> [log in to unmask]<mailto:[log in to unmask]>
>
> 212-562-8147
>
>
>
>
>
> ?On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> behalf of Purva Grover" <[log in to unmask]<mailto:
> [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> [log in to unmask]>> wrote:
>
>
>
> Hi All
>
> I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> cover ALL or even most. Any thoughts / talks / power points- you could
> share would be appreciated.
>
> Thanks
>
> Purva
>
>
>
> Sent from my mobile device
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
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>
>
>
>
>
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>
> ------------------------------
>
> Date: Fri, 16 Feb 2018 18:29:38 -0500
> From:    Aline Baghdassarian <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: Bacterial meningitis
>
> Scott,
>
> Would love to hear more about the cases. How did they present? What was the
> decision making process?
>
> Thank you,
>
> Aline
>
> Aline Baghdassarian, MD, MPH, FAAP
> Director, Pediatric Emergency Medicine Fellowship Program
> Assistant Professor, Department of Emergency Medicine
> Virginia Commonwealth University School of Medicine
>
> Children's Hospital of Richmond at VCU
> Email [log in to unmask]<mailto:aline.
> [log in to unmask]>
>
>
> On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> <mailto:[log in to unmask]>>
> wrote:
>
> In a recent case at our institution, there was a present but subtle degree
> of meningismus — I’ve found over the years there is always some elicitable
> sign — but as importantly there’s a degree of irritability or altered
> behavior that has everyone concerned: mom, RN’s, me.
> If mama ain't happy, I ain't happy. I’ll make liberal use of the term
> cerebritis or encephalopathic behavior until there’s a consent signed.
>
> I’m not such a good scientist anymore, but I’ve tried to be an attentive
> clinician.
>
> Julian Orenstein
>
>
> On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> [log in to unmask]>> wrote:
>
> Scott - Bacterial meningitis is alive and well here in LV - we have seen
> it in a variety of age groups. There is good evidence that there has been
> an increase in pneumococcal serotypes not covered by the polyvalent
> vaccines since there widespread use, such that the burden of pneumococcal
> meningitis (as opposed to H. flu type b) has not decreased nearly as much.
>
> Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
> meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
>
> Also, the absence of meningismus in older kids with bacterial meningitis
> is well described and occurs in a substantial subset.
>
> Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
> meningeal irritation. . Southern Med J 1982;75(4):448-450.
>
> Much of the data on the sensitivity of the neck exam is of the
> retrospective variety. I have only read one really good prospective study
> on the sensitivity of PE for bacterial meningitis and it was a single
> center variety as I recall.
>
> Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
> bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
> 1992;21(8):910-914.
>
> Tough case.
>
>
> Jay
>
> Jay D. Fisher MD FAAP FACEP
> Medical Director, Pediatric EM
> Children's Hospital of Nevada at UMC
> Clinical Professor of Emergency Medicine and Pediatrics
> UNLV School of Medicine
>
>
>
>
>
>
>
>
> On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
> [log in to unmask]<mailto:gpc[log in to unmask]>> wrote:
>
>
> I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
> out that bacterial meningitis appears at this time of year as a
> complication of influenza:
> "Both pneumococcal and meningococcal meningitis can occur post flu as
> well as GAS and S aureus invasive disease and TSS."
>
> She also addressed Jim's question:  "We do know that new serotypes [of
> pneumococcus] have emerged but this is not waning immunity because the teen
> only got PCV7".
>
>
> Greg Conners
>
> Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
>
> Director, Division of Emergency Medicine
> Associate Chair of Pediatrics
> Professor of Pediatrics and Emergency Medicine
> Children’s Mercy Hospital, Kansas City
> University of Missouri, Kansas City
> [log in to unmask]<mailto:[log in to unmask]>
>
>
>
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]<mailto:[log in to unmask]>] On
> Behalf Of 000001679b145c30-dmarc-
> [log in to unmask]<mailto:[log in to unmask]>
> Sent: Wednesday, February 14, 2018 2:25 PM
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: Bacterial meningitis
>
> *** This message was sent to you from an External Source. Please do not
> open untrusted links or attachments. ***
>
> ________________________________
>
>
> Could you share with us the clinical findings and history that prompted
> the LP?
>
>
> Shiu-Lin
>
>
>
>
> Shiu-Lin Tsai, MD
> Division of Pediatric Emergency Medicine
>
> Department of Emergency Medicine
> Columbia University Medical Center
>
>
>
> -----Original Message-----
> From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
> To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> BROWN.EDU>>
> Sent: Wed, Feb 14, 2018 2:44 pm
> Subject: Bacterial meningitis
>
> ALL:
> Since Jan 1st this year, we have seen 3 cases of culture + bacterial
> meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
> *Neisseria meningiditis*.  All 3 were in older children/ teens who received
> their Prevnar 13  vaccines as well as the Menactra series in the patient
> with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3
> cases of bacterial meningitis in older kids in a community setting such as
> ours in quite a long time.  Is this random bad luck or do  we all need to
> be more vigilant?  Incidentally, none had neck pain or meningismus as a
> clinical finding.
>
> --
> Kind regards,
>
> Scott
> Scott Freedman, MD
> Medical Director,  Pediatric Emergency Dept Rockville MD
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with
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>
>
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>
> ________________________________
>
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> 6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=eacE1u355w4wQKZ8Zh7E9jp85QBWM7
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> you for your cooperation.
>
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> [log in to unmask]> with
> the message: info PED-EM-L
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> 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]<mailto:
> [log in to unmask]> with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]> with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>            https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:[log in to unmask]>>
> Subject: The shooting in Florida
>
> Hi colleagues,
>
> As I sit in my office late on a Friday, I've gotten myself into a state
> about the 17 children gunned down in a school.  For the umpteenth time.
>
> I think the thing that has me so upset, is that this state of gun
> complaisance is an affront to everything a pediatric emergency physician
> stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> risk of a maybe brain tumor 30 years from now.  We work in difficult,
> burnout inducing conditions so that we can personally save, say, one life a
> year.
>
> Today it feels to me like someone with an AK-whatever just wiped out 17
> years of my work. In minutes.  I want to cry.  We SHOULD cry.  Try and
> watch that Parkland mother on CNN.  I dare you.
>
> Today is not a day like all the others.  It's just not.
>
> --Martin Pusic
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> 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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 23:05:03 +0000
> From:    "Chamberlain, James" <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: School shootings.......
>
> I'd be happy with sensible regulations, required training, and licensure
> so that guns don't get into the hands of criminals and people with mental
> illness.
>
> But the NRA is against sensible regulations.
>
>
>
> Sent from my Verizon, Samsung Galaxy smartphone
>
>
> -------- Original message --------
> From: Robert Finkelstein <[log in to unmask]<mailto:robert.
> [log in to unmask]>>
> Date: 2/18/18 12:17 (GMT-05:00)
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: School shootings.......
>
> Just because people will find a way to break laws does not mean that we
> shouldn’t have them.   By that logic, we expect that all of us who are
> currently law abiding don’t need any laws to make us so.  Human nature
> being what it is, we all need laws and structure.  Yes, gun regulation
> would not stop all gun violence, but it could reduce it. Also, I don’t
> think the majority want prohibition of guns, just regulation; the same way
> alcohol is regulated by age and penalties for driving under the influence.
> Or, the way cars are regulated with licensing, registration, having to pass
> a driving test and citations for violations.
>
>
>
> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> [log in to unmask]<mailto:
> [log in to unmask]>> wrote:
>
>
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'.  Nobody gets to the meat of the matter:  If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand.  This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'.  Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem.  So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
>
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve.     Horst D. Weinberg, MD
>
>
>
>
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
>
> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> Confidentiality Notice: This e-mail message, including any attachments, is
> for the sole use of the intended recipient(s) and may contain confidential
> and privileged information. Any unauthorized review, use, disclosure or
> distribution is prohibited. If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of the original
> message.
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> Date: Sun, 18 Feb 2018 19:03:20 -0600
> From:    Jill C Obremskey <[log in to unmask]<mailto:
> [log in to unmask]>>
> Subject: Re: School shootings.......
>
> Great discussion but what are WE going to do about it as an organization?
> How do we become relentless about the need for gun control, the need for
> mental health services, and for preventing toxic stress in children.
>
> We need to ask leaders in the AAP and AAEM to organize us into a uniified
> voice that will not quit.
>
> On February 18, 2018 at 5:05 PM "Chamberlain, James" <
> [log in to unmask]<mailto:[log in to unmask]>>
> wrote:
>
>
> I'd be happy with sensible regulations, required training, and licensure
> so that guns don't get into the hands of criminals and people with mental
> illness.
>
> But the NRA is against sensible regulations.
>
>
>
> Sent from my Verizon, Samsung Galaxy smartphone
>
>
> -------- Original message --------
> From: Robert Finkelstein <[log in to unmask]<mailto:robert.
> [log in to unmask]>>
> Date: 2/18/18 12:17 (GMT-05:00)
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: School shootings.......
>
> Just because people will find a way to break laws does not mean that we
> shouldn’t have them. By that logic, we expect that all of us who are
> currently law abiding don’t need any laws to make us so. Human nature being
> what it is, we all need laws and structure. Yes, gun regulation would not
> stop all gun violence, but it could reduce it. Also, I don’t think the
> majority want prohibition of guns, just regulation; the same way alcohol is
> regulated by age and penalties for driving under the influence. Or, the way
> cars are regulated with licensing, registration, having to pass a driving
> test and citations for violations.
>
>
>
> On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> [log in to unmask]<mailto:
> [log in to unmask]>> wrote:
>
>
>
> Yes, automatic weapons should be banned by our government, but most of the
> discussions posted blame the guns, the NRA, the 2nd amendment and our
> 'laws'. Nobody gets to the meat of the matter: If there is a demand (for
> guns), regardless of the laws passed, someone will fill that demand. This
> is no different from Prohibition, where there was no shortage of available
> booze or the 'war' on drugs, where you can get them at most street corners
> in any city. What needs to change: There has been a steady decline over the
> past 20 or so years in our country's moral fiber, personal and work ethic,
> and yes, child rearing. Cause: unmarried or one parent families, poverty,
> and absence of any discipline both in the home and in the schools, for
> 'political correctness'. Parents want to be friends with their children
> rather than running their homes like 'benevolent dictator ships'. Nothing
> is denied the child: the child wants $150.00 sneakers or a new cell-phone:
> no problem. So you can blame the gun all you want, but unless there is a
> real change in the populations personal morality and ethics, these school
> tragedies will continue.
>
> We pediatricians should look at our own practices in teaching good child
> rearing ways to the families we serve. Horst D. Weinberg, MD
>
>
>
>
>
>
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
>
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
>
> The URL for the PED-EM-L Web Page is:
>
> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=Zoipt4Nmcnjorr_6TBHi1A&r=
> OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_iD8pKg2CtCFCFLD8pQBwDDZ_
> PA30um4cACI1FYE&e=
>
> ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> Confidentiality Notice: This e-mail message, including any attachments, is
> for the sole use of the intended recipient(s) and may contain confidential
> and privileged information. Any unauthorized review, use, disclosure or
> distribution is prohibited. If you are not the intended recipient, please
> contact the sender by reply e-mail and destroy all copies of the original
> message.
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=KoC5GYBOIefzxGAm2j6cjFf-
> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> Gz7ANghQIP9aFG9DuBs&r=5VWDAWFUrPGbCkItuTPJ-VYRa6Oqu06_mEwnc9MEzSg&m=
> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> ------------------------------
>
> End of PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
> **************************************************************
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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> listserv.brown.edu_ped-2Dem-2Dl.html&d=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]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 https://urldefense.proofpoint.com/v2/url?u=http-3A__
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> YYJSIn-l8tZNZ9Hc02-3ACP2YXbWju0kwdJysuHC2vQ&s=bsWJL2_
> 9qlGmCuUFyapRv3sV4UL7vf8fD0mJ5BiBSW0&e=
>
> For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
>
> ________________________________
>
> UT Southwestern
>
>
> Medical Center
>
>
>
> The future of medicine, today.
>
>
> 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=Pk_HpaIpE_
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> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
>
> ------------------------------
>
> Date: Tue, 20 Feb 2018 08:48:31 -0500
> From:    Mick C <[log in to unmask]>
> Subject: Re: PED-EM-L Digest - 19 Feb 2018 to 20 Feb 2018 - Special issue
> (#2018-48)
>
> I think people politicize issues to hide behind the government and wait for
> "them" to act and/or place "blame".
>
> One also doesn't have to listen to other views you just pick the political
> news channel that validates your thoughts.
> No need to listen to the other side.
>
> Instead we say guns are evil or guns protect.  Remove the second amendment
> or double down.
> Many think that only their side should have the first amendment right as
> well.   Little about all the cracks this person
> fell through.
>
> After these events, we learn of people who knew the shooter but chose to
> ignore their actions or isolate them further.
> We have folks who sell someone countless guns but say nothing.  Neighbors
> or family that are totally shocked that this person
> was suffering and/or had any potential for harm.
>
> Root cause analysis rarely if ever identify the syringe, the medical device
> or a failed policy.   What they typically come down to
> is someone's failure to speak up, listen, and double check or one's failure
> to be offered or asked for help when stressed, busy or focused
> on the wrong thing.
>
> Seems to me we should try harder to ponder the root cause as you suggest.
>
> Mick Connors
>
> On Tue, Feb 20, 2018 at 6:39 AM, PED-EM-L automatic digest system <
> [log in to unmask]> wrote:
>
> > There are 3 messages totaling 18544 lines in this issue.
> >
> > Topics in this special issue:
> >
> >   1. Gun "Safety" from an HRO perspective
> >   2. PED-EM-L Digest - 18 Feb 2018 to 19 Feb 2018 - Special issue
> > (#2018-42)
> >      (2)
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >        https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
> >
> > ----------------------------------------------------------------------
> >
> > Date:    Tue, 20 Feb 2018 07:31:58 +0000
> > From:    Beech Burns <[log in to unmask]>
> > Subject: Re: Gun "Safety" from an HRO perspective
> >
> > Hear hear rick.  Very well put.
> >
> >
> > [OHSU email via VMware Boxer]
> >
> > On February 19, 2018 at 6:44:02 PM PST, Rick Place <[log in to unmask]>
> > wrote:
> > I am struck by the fact that the conversation, here and nationally, is
> > emotional and derives from one's political beliefs. For fair disclosure,
> I
> > find the whole concept of owning a gun for the purpose of killing people
> > (even if in "self defense") simply unfathomable. I just don't get it.
> >
> > As a member of a professional obsessed with the concept of safety and
> > steeped in the philosophy of high-reliability principles, I find some of
> > the recommended "solutions" to be jaw dropping.
> >
> > In our profession, we have moved well past the concept of "Try Harder".
> >
> > "Try Harder" is essentially what it means to hold the FBI accountable for
> > picking up every low amplitude signal presented to it in a country of 320
> > million people, where it only takes 1 unhinged person who is otherwise
> like
> > 10,000 others to wreak such devastation.
> >
> > "Try Harder" is what it means to "solve" the problem by asking a grossly
> > (and deliberately) underfunded mental health system to either identify
> all
> > of these individuals in advance or more unrealistically to "help" them so
> > that they never reach the point of mass murder.
> >
> > As an approach to safety, this is nonsense and we would be fired from our
> > jobs if we approached medicine this way.
> >
> > If we conducted a scientific Root Cause Analysis, the solutions become
> > obvious. And not emotional. Just plain obvious.
> >
> > I would rather we as a society stop obfuscating and dissembling. Say it
> > like it is.
> >
> > When I hear someone say that the solution to the increasing number of
> mass
> > murder events is to "Try Harder" or worse, to weaponize the entire
> > population, what I really hear is:
> >
> > This is the "cost" of having the second amendment and we just need to
> deal
> > with it.
> >
> > Of course, it is not acceptable to say this, but at least we could speak
> > more clearly from our relative positions.
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&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=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=3v1BMq7bS9pK_
> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
> >
> > ------------------------------
> >
> > Date:    Tue, 20 Feb 2018 04:48:04 +0000
> > From:    "Chen, Lei" <[log in to unmask]>
> > Subject: Re: PED-EM-L Digest - 18 Feb 2018 to 19 Feb 2018 - Special issue
> > (#2018-42)
> >
> > I love buckyballs.  I believe I am entitled to own buckyballs.  I believe
> > they have educational and entertainment values.  I believe I am a
> > responsible owner of buckyballs.
> >
> > What about others?  Well,  some others stockpile them, and may even
> misuse
> > them, to the harm of themselves and others.  Each year buckyballs cause
> > 13,000 to 15,000 deaths in the US.
> >
> > When I am out of the country people always ask me to explain two things
> > when they find out that I am American.  "What's it with Trump and
> > buckyballs?" With regard to Trump I tell them to read JD Vance's book.
> >
> > Members of this listserv know what happened with the buckyballs.
> >
> >
> >
> > Lei Chen, MD MHS
> >
> > Associate Professor of Pediatrics
> > Section of Emergency Medicine
> > Department of Pediatrics
> > Faculty, Global Health Initiative
> > Yale University School of Medicine
> >
> >
> > ________________________________
> > From: Pediatric Emergency Medicine Discussion List <
> > [log in to unmask]> on behalf of Martin Herman <
> > [log in to unmask]>
> > Sent: Monday, February 19, 2018 2:43 PM
> > To: [log in to unmask]
> > Subject: Re: PED-EM-L Digest - 18 Feb 2018 to 19 Feb 2018 - Special issue
> > (#2018-42)
> >
> > so glad I stopped sending my money to this left ist organization.
> >
> >
> >
> >
> >
> > there are mean people in this world.
> >
> > they do bad things
> >
> >
> >
> > you can’t legislate bad things away
> >
> >
> >
> > want to do something to prevent school shootings?
> >
> >
> >
> > Try finding those kids in your community that are being bullied and help
> > them!
> >
> >
> >
> > do something to prevent gangs.
> >
> >
> >
> > let me defend myself, my family and home as I see fit. you aren’t going
> to
> > help me if I am mugged, you aren’t going to be there if my home is
> invaded,
> > and the police won’t be able to help for at least 6-7 minutes, if I can
> > make the call.
> >
> >
> >
> > doubt me? call 911 and see how long it takes to get through the questions
> > and then get a car to your home.  a lot of bad things can happen in the
> > time it takes to get help.
> >
> >
> >
> > btw, assault weapons are already banned.
> >
> >
> >
> > Focus on mental health, finding those who are abused, bullied,
> > marginalized and those who are deranged. they live among us, find them!
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > [X]
> >
> >
> >
> > Martin (Marty) Herman
> >
> > USAPA Ambassador for Pickleball , North Mississippi.
> >
> > Tupelo Pickleball ( facebook)
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> > 901 219 9202
> >
> > Sent from my iPhone
> >
> >
> >
> >
> >
> > On Feb 19, 2018, at 10:03 AM, PED-EM-L automatic digest system <
> > [log in to unmask]<mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > There are 4 messages totaling 10581 lines in this issue.
> >
> >
> >
> > Topics in this special issue:
> >
> >
> >
> >  1. School shootings.......
> >
> >  2. PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41) (3)
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ----------------------------------------------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 22:08:25 -0700
> >
> > From:    Julian Orenstein <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: School shootings.......
> >
> >
> >
> > Exactly, Jill. The anti-gun movement needs a Lincoln, a King.... and if I
> > had my wish it’d be for Obama. Either one of them.
> >
> >
> >
> > Jb0
> >
> >
> >
> >
> >
> > On Feb 18, 2018, at 6:03 PM, Jill C Obremskey <[log in to unmask]
> > <mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > Great discussion but what are WE going to do about it as an organization?
> >
> > How do we become relentless about the need for gun control, the need for
> > mental health services, and for preventing toxic stress in children.
> >
> >
> >
> > We need to ask leaders in the AAP and AAEM to organize us into a uniified
> > voice that will not quit.
> >
> >
> >
> > On February 18, 2018 at 5:05 PM "Chamberlain, James" <
> > [log in to unmask]<mailto:[log in to unmask]>>
> > wrote:
> >
> >
> >
> >
> >
> > I'd be happy with sensible regulations, required training, and licensure
> > so that guns don't get into the hands of criminals and people with mental
> > illness.
> >
> >
> >
> > But the NRA is against sensible regulations.
> >
> >
> >
> >
> >
> >
> >
> > Sent from my Verizon, Samsung Galaxy smartphone
> >
> >
> >
> >
> >
> > -------- Original message --------
> >
> > From: Robert Finkelstein <[log in to unmask]<mailto:
> robert.
> > [log in to unmask]>>
> >
> > Date: 2/18/18 12:17 (GMT-05:00)
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: Re: School shootings.......
> >
> >
> >
> > Just because people will find a way to break laws does not mean that we
> > shouldn’t have them. By that logic, we expect that all of us who are
> > currently law abiding don’t need any laws to make us so. Human nature
> being
> > what it is, we all need laws and structure. Yes, gun regulation would not
> > stop all gun violence, but it could reduce it. Also, I don’t think the
> > majority want prohibition of guns, just regulation; the same way alcohol
> is
> > regulated by age and penalties for driving under the influence. Or, the
> way
> > cars are regulated with licensing, registration, having to pass a driving
> > test and citations for violations.
> >
> >
> >
> >
> >
> >
> >
> > On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> > [log in to unmask]<mailto:
> > [log in to unmask]>> wrote:
> >
> >
> >
> >
> >
> >
> >
> > Yes, automatic weapons should be banned by our government, but most of
> the
> > discussions posted blame the guns, the NRA, the 2nd amendment and our
> > 'laws'. Nobody gets to the meat of the matter: If there is a demand (for
> > guns), regardless of the laws passed, someone will fill that demand. This
> > is no different from Prohibition, where there was no shortage of
> available
> > booze or the 'war' on drugs, where you can get them at most street
> corners
> > in any city. What needs to change: There has been a steady decline over
> the
> > past 20 or so years in our country's moral fiber, personal and work
> ethic,
> > and yes, child rearing. Cause: unmarried or one parent families, poverty,
> > and absence of any discipline both in the home and in the schools, for
> > 'political correctness'. Parents want to be friends with their children
> > rather than running their homes like 'benevolent dictator ships'. Nothing
> > is denied the child: the child wants $150.00 sneakers or a new
> cell-phone:
> > no problem. So you can blame the gun all you want, but unless there is a
> > real change in the populations personal morality and ethics, these school
> > tragedies will continue.
> >
> >
> >
> > We pediatricians should look at our own practices in teaching good child
> > rearing ways to the families we serve. Horst D. Weinberg, MD
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> >
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >
> >
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> Zoipt4Nmcnjorr_6TBHi1A&r=
> > OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> > rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_
> iD8pKg2CtCFCFLD8pQBwDDZ_
> > PA30um4cACI1FYE&e=
> >
> >
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> >
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >
> >
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> Zoipt4Nmcnjorr_6TBHi1A&r=
> > OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=
> > rSfbyol4kw9JxcRoMdcuRNn3fHWj1wO7gwi6GpHogrU&s=iZE_
> iD8pKg2CtCFCFLD8pQBwDDZ_
> > PA30um4cACI1FYE&e=
> >
> >
> >
> > ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >
> > Confidentiality Notice: This e-mail message, including any attachments,
> is
> > for the sole use of the intended recipient(s) and may contain
> confidential
> > and privileged information. Any unauthorized review, use, disclosure or
> > distribution is prohibited. If you are not the intended recipient, please
> > contact the sender by reply e-mail and destroy all copies of the original
> > message.
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                 https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Mon, 19 Feb 2018 09:25:18 -0500
> >
> > From:    Mick Work <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: PED-EM-L Digest - 17 Feb 2018 to 18 Feb 2018 (#2018-41)
> >
> >
> >
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__apps.
> > chicagotribune.com_news_local_young-5Fvictims_&d=DwIGaQ&c=
> > cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=X2M--MDdYYwsGrfHTv88WzYo6_
> > er5JmsO6XsSZCiN0o&e=
> >
> >
> >
> > 10x the number of kids dying and they have stricter gun laws.   Why do
> > these deaths draw so little attention?  Yet suburban school shootings
> and
> > the shooter gets major coverage.
> >
> >
> >
> > Is the media effectively and wisely moving public opinion around guns or
> > opioids etc or is it about reaction and ratings?
> >
> >
> >
> > The government can’t solve issues any more than the c-suite can claim to
> > provide better care in hospitals through policy alone.    Just my
> opinion.
> >
> >
> >
> > Real solutions won’t come from laws or policy especially from those
> > distant from the problem and solely developed to satisfy media hype or
> > check a regulatory box.
> >
> >
> >
> >
> >
> >
> >
> > Mick Connors
> >
> >
> >
> >
> >
> >
> >
> > On Feb 19, 2018, at 12:00 AM, PED-EM-L automatic digest system <
> > [log in to unmask]<mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > There are 17 messages totaling 3381 lines in this issue.
> >
> >
> >
> > Topics of the day:
> >
> >
> >
> > 1. School shootings....... (4)
> >
> > 2. PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39) (3)
> >
> > 3. The shooting in Florida (9)
> >
> > 4. A second, more settled, reflection on the Florida shooting
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ----------------------------------------------------------------------
> >
> >
> >
> > Date:    Sat, 17 Feb 2018 21:57:25 -0500
> >
> > From:    "Horst D. Weinberg, MD"
> >
> >        <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: School shootings.......
> >
> >
> >
> > Yes, automatic weapons should be banned by our government, but most of
> the
> > discussions posted blame the guns, the NRA, the 2nd amendment and our
> > 'laws'.  Nobody gets to the meat of the matter:  If there is a demand
> (for
> > guns), regardless of the laws passed, someone will fill that demand.
> This
> > is no different from Prohibition, where there was no shortage of
> available
> > booze or the 'war' on drugs, where you can get them at most street
> corners
> > in any city. What needs to change: There has been a steady decline over
> the
> > past 20 or so years in our country's moral fiber, personal and work
> ethic,
> > and yes, child rearing. Cause: unmarried or one parent families, poverty,
> > and absence of any discipline both in the home and in the schools, for
> > 'political correctness'. Parents want to be friends with their children
> > rather than running their homes like 'benevolent dictator ships'.
> Nothing
> > is denied the child: the child wants $150.00 sneakers or a new
> cell-phone:
> > no problem.  So you can blame the gun all you want, but unless there is a
> > real change in the populations personal morality and ethics, these school
> > tragedies will continue.
> >
> > We pediatricians should look at our own practices in teaching good child
> > rearing ways to the families we serve.     Horst D. Weinberg, MD
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 06:13:44 -0500
> >
> > From:    Mick Work <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
> >
> >
> >
> > I respect the need for debate around guns.   However, I think we are
> > remiss as pediatric emergency physicians to not raise a deeper discussion
> > around the mental illness crisis.
> >
> >
> >
> > We all see kids who meet this persons profile across the country. We see
> > disturbing mental illness and the many factors (including social media,
> > broken families, child abuse) that lead a child to buy a gun to do harm.
> > Or if not gun an explosive device etc..
> >
> >
> >
> > We see kids who are socially isolated and warning signs ignored.  Anyone
> > else concerned that the kids we see with mental illness are recognized by
> > schools or pediatric visit screening more often than by their own
> parents,
> > friends or neighbors.
> >
> >
> >
> > This persons desire to be a “school shooter” should raise attention
> around
> > how the media covers these events.  The fame brought to these shooters
> > should be called into question.  Are we fostering this copycat mentality?
> >
> >
> >
> > The lack of respect for human life should call us to question more than
> > the how but why.
> >
> >
> >
> > A focus only on guns and gun laws is remiss to the bigger picture in my
> > opinion and experience.
> >
> >
> >
> > Mick
> >
> >
> >
> >
> >
> >
> >
> > On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> > [log in to unmask]<mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > There are 4 messages totaling 391 lines in this issue.
> >
> >
> >
> > Topics of the day:
> >
> >
> >
> > 1. Peds EM talk (2)
> >
> > 2. Bacterial meningitis
> >
> > 3. The shooting in Florida
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ----------------------------------------------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 11:50:44 -0500
> >
> > From:    Purva Grover <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: Peds EM talk
> >
> >
> >
> > Thanks all for your help on this.
> >
> > Best
> >
> > Purva
> >
> >
> >
> > Purva Grover , MD
> >
> > Medical Director
> >
> > Pediatric Emergency Department
> >
> > Cleveland Clinic Health System
> >
> > Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> > [log in to unmask]>>g
> >
> >
> >
> > On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> > [log in to unmask]>> wrote:
> >
> >
> >
> > Hi All
> >
> > I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> >
> > cover ALL or even most. Any thoughts / talks / power points- you could
> >
> > share would be appreciated.
> >
> > Thanks
> >
> > Purva
> >
> >
> >
> > Sent from my mobile device
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 14:34:20 +0000
> >
> > From:    "Chamberlain, James" <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: Peds EM talk
> >
> >
> >
> > I would also cover unusual cases that you can't afford to miss, e.g.
> >
> >
> >
> > Sternoclavicular dislocation
> >
> > Conjunctivitis caused by penetrating FB
> >
> > Septic joint presenting with only low-grade fever (we've had several
> Staph
> > infections where temp was only 37.6 or 37.7 orally)
> >
> > Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> > patients need a through cardiac exam, including distal pulses
> >
> > NAT
> >
> > The "sleepy" baby who has hypoglycemia
> >
> > The "sleepy" baby who has intussusception
> >
> > The appendicitis patient who presents with vomiting and diarrhea (not all
> > that unusual, actually)
> >
> > Etc.
> >
> >
> >
> > To me, this is the challenge of PEM. Finding the needle in the haystack,
> > that one sick kid who is different than all the usual low acuity
> illness...
> >
> >
> >
> > Jim
> >
> >
> >
> > James Chamberlain
> >
> > Division Chief, Emergency Medicine
> >
> > Children’s National Health System
> >
> > (202) 476-4177
> >
> >
> >
> > -----Original Message-----
> >
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> > [log in to unmask]] On Behalf Of Mojica, Michael
> >
> > Sent: Thursday, February 15, 2018 5:29 PM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: Re: Peds EM talk
> >
> >
> >
> > Purva
> >
> >
> >
> >
> >
> >
> >
> > I would recommend "the critically ill infant".
> >
> >
> >
> >
> >
> >
> >
> > It is the topic that scares the most people and you can cover a lot of
> > causes through cases.
> >
> >
> >
> >
> >
> >
> >
> > I like to use cases that include common presenting complaints (e.g.
> > vomiting) that are associated with very bad things (e.g. midgut
> volvulus).
> >
> >
> >
> >
> >
> >
> >
> > I'm attaching a ppt file for a talk I did a few years ago on this topic.
> >
> >
> >
> >
> >
> >
> >
> > My goal is for them to develop a mental checklist of potentially
> > life-saving interventions.
> >
> >
> >
> >
> >
> >
> >
> > Michael
> >
> >
> >
> >
> >
> >
> >
> > Michael Mojica, M.D
> >
> >
> >
> > Director of Education, Division of Pediatric Emergency Medicine
> >
> >
> >
> > Director, Pediatric Emergency Medicine Fellowship
> >
> >
> >
> > Bellevue Hospital Center
> >
> >
> >
> > Administration Building Room A528
> >
> >
> >
> > New York, N.Y. 10016
> >
> >
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> >
> >
> > 212-562-8147
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > ?On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> > behalf of Purva Grover" <[log in to unmask]<mailto:
> > [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> > [log in to unmask]>> wrote:
> >
> >
> >
> >
> >
> >
> >
> >  Hi All
> >
> >
> >
> >  I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> > cover ALL or even most. Any thoughts / talks / power points- you could
> > share would be appreciated.
> >
> >
> >
> >  Thanks
> >
> >
> >
> >  Purva
> >
> >
> >
> >
> >
> >
> >
> >  Sent from my mobile device
> >
> >
> >
> >  For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> >
> >
> >  The URL for the PED-EM-L Web Page is:
> >
> >
> >
> >                   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=7bcGZM66nE4BJGdqQQrjhL6fNRMBTC
> zuSv96wXa91qc&e=
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > ------------------------------------------------------------
> >
> > This email message, including any attachments, is for the sole use of the
> > intended recipient(s) and may contain information that is proprietary,
> > confidential, and exempt from disclosure under applicable law. Any
> > unauthorized review, use, disclosure, or distribution is prohibited. If
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> > have received this email in error please notify the sender by return
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> > =================================
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> >
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >
> >
> >               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
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> > OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=ZQaRUYHlbNuSLlAi-
> > YuD0cY4QPsIIUqjaql9agkSHH8&s=jLXcVKFGHNLAQ-
> y3T0bMic8mmMkKMtSnWoO5UdsCqvM&
> > e=
> >
> >
> >
> >
> >
> > ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >
> > Confidentiality Notice: This e-mail message, including any attachments,
> is
> > for the sole use of the intended recipient(s) and may contain
> confidential
> > and privileged information. Any unauthorized review, use, disclosure or
> > distribution is prohibited. If you are not the intended recipient, please
> > contact the sender by reply e-mail and destroy all copies of the original
> > message.
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 18:29:38 -0500
> >
> > From:    Aline Baghdassarian <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: Bacterial meningitis
> >
> >
> >
> > Scott,
> >
> >
> >
> > Would love to hear more about the cases. How did they present? What was
> the
> >
> > decision making process?
> >
> >
> >
> > Thank you,
> >
> >
> >
> > Aline
> >
> >
> >
> > Aline Baghdassarian, MD, MPH, FAAP
> >
> > Director, Pediatric Emergency Medicine Fellowship Program
> >
> > Assistant Professor, Department of Emergency Medicine
> >
> > Virginia Commonwealth University School of Medicine
> >
> >
> >
> > Children's Hospital of Richmond at VCU
> >
> > Email [log in to unmask]<mailto:aline.
> > [log in to unmask]>
> >
> >
> >
> >
> >
> > On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> > <mailto:[log in to unmask]>>
> >
> > wrote:
> >
> >
> >
> > In a recent case at our institution, there was a present but subtle
> degree
> >
> > of meningismus — I’ve found over the years there is always some
> elicitable
> >
> > sign — but as importantly there’s a degree of irritability or altered
> >
> > behavior that has everyone concerned: mom, RN’s, me.
> >
> > If mama ain't happy, I ain't happy. I’ll make liberal use of the term
> >
> > cerebritis or encephalopathic behavior until there’s a consent signed.
> >
> >
> >
> > I’m not such a good scientist anymore, but I’ve tried to be an attentive
> >
> > clinician.
> >
> >
> >
> > Julian Orenstein
> >
> >
> >
> >
> >
> > On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> > [log in to unmask]>> wrote:
> >
> >
> >
> > Scott - Bacterial meningitis is alive and well here in LV - we have seen
> >
> > it in a variety of age groups. There is good evidence that there has been
> >
> > an increase in pneumococcal serotypes not covered by the polyvalent
> >
> > vaccines since there widespread use, such that the burden of pneumococcal
> >
> > meningitis (as opposed to H. flu type b) has not decreased nearly as
> much.
> >
> >
> >
> > Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
> >
> > meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
> >
> >
> >
> > Also, the absence of meningismus in older kids with bacterial meningitis
> >
> > is well described and occurs in a substantial subset.
> >
> >
> >
> > Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
> >
> > meningeal irritation. . Southern Med J 1982;75(4):448-450.
> >
> >
> >
> > Much of the data on the sensitivity of the neck exam is of the
> >
> > retrospective variety. I have only read one really good prospective study
> >
> > on the sensitivity of PE for bacterial meningitis and it was a single
> >
> > center variety as I recall.
> >
> >
> >
> > Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
> >
> > bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
> >
> > 1992;21(8):910-914.
> >
> >
> >
> > Tough case.
> >
> >
> >
> >
> >
> > Jay
> >
> >
> >
> > Jay D. Fisher MD FAAP FACEP
> >
> > Medical Director, Pediatric EM
> >
> > Children's Hospital of Nevada at UMC
> >
> > Clinical Professor of Emergency Medicine and Pediatrics
> >
> > UNLV School of Medicine
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
> >
> > [log in to unmask]<mailto:[log in to unmask]>> wrote:
> >
> >
> >
> >
> >
> > I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
> >
> > out that bacterial meningitis appears at this time of year as a
> >
> > complication of influenza:
> >
> > "Both pneumococcal and meningococcal meningitis can occur post flu as
> >
> > well as GAS and S aureus invasive disease and TSS."
> >
> >
> >
> > She also addressed Jim's question:  "We do know that new serotypes [of
> >
> > pneumococcus] have emerged but this is not waning immunity because the
> teen
> >
> > only got PCV7".
> >
> >
> >
> >
> >
> > Greg Conners
> >
> >
> >
> > Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
> >
> >
> >
> > Director, Division of Emergency Medicine
> >
> > Associate Chair of Pediatrics
> >
> > Professor of Pediatrics and Emergency Medicine
> >
> > Children’s Mercy Hospital, Kansas City
> >
> > University of Missouri, Kansas City
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> >
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> >
> > [log in to unmask]<mailto:[log in to unmask]>] On
> > Behalf Of 000001679b145c30-dmarc-
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> > Sent: Wednesday, February 14, 2018 2:25 PM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: Re: Bacterial meningitis
> >
> >
> >
> > *** This message was sent to you from an External Source. Please do not
> >
> > open untrusted links or attachments. ***
> >
> >
> >
> > ________________________________
> >
> >
> >
> >
> >
> > Could you share with us the clinical findings and history that prompted
> >
> > the LP?
> >
> >
> >
> >
> >
> > Shiu-Lin
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > Shiu-Lin Tsai, MD
> >
> > Division of Pediatric Emergency Medicine
> >
> >
> >
> > Department of Emergency Medicine
> >
> > Columbia University Medical Center
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> >
> > From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> > BROWN.EDU>>
> >
> > Sent: Wed, Feb 14, 2018 2:44 pm
> >
> > Subject: Bacterial meningitis
> >
> >
> >
> > ALL:
> >
> > Since Jan 1st this year, we have seen 3 cases of culture + bacterial
> >
> > meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
> >
> > *Neisseria meningiditis*.  All 3 were in older children/ teens who
> received
> >
> > their Prevnar 13  vaccines as well as the Menactra series in the patient
> >
> > with Neisseria.  Anyone else seeing cases of this sort?  I do not recall
> 3
> >
> > cases of bacterial meningitis in older kids in a community setting such
> as
> >
> > ours in quite a long time.  Is this random bad luck or do  we all need to
> >
> > be more vigilant?  Incidentally, none had neck pain or meningismus as a
> >
> > clinical finding.
> >
> >
> >
> > --
> >
> > Kind regards,
> >
> >
> >
> > Scott
> >
> > Scott Freedman, MD
> >
> > Medical Director,  Pediatric Emergency Dept Rockville MD
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with
> >
> > the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with
> >
> > the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ________________________________
> >
> >
> >
> > 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
> >
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> >
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> >
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> >
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> > 3A__cmh.edu&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
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> >
> > you for your cooperation.
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with
> >
> > the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >     https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the
> >
> > message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the
> >
> > message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 18:29:08 -0500
> >
> > From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: The shooting in Florida
> >
> >
> >
> > Hi colleagues,
> >
> >
> >
> > As I sit in my office late on a Friday, I've gotten myself into a state
> > about the 17 children gunned down in a school.  For the umpteenth time.
> >
> >
> >
> > I think the thing that has me so upset, is that this state of gun
> > complaisance is an affront to everything a pediatric emergency physician
> > stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> > 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> > risk of a maybe brain tumor 30 years from now.  We work in difficult,
> > burnout inducing conditions so that we can personally save, say, one
> life a
> > year.
> >
> >
> >
> > Today it feels to me like someone with an AK-whatever just wiped out 17
> > years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
> > watch that Parkland mother on CNN.  I dare you.
> >
> >
> >
> > Today is not a day like all the others.  It's just not.
> >
> >
> >
> > --Martin Pusic
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&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]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 12:42:58 +0000
> >
> > From:    Terence Bergmann <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > Hi Joe
> >
> >
> >
> > I disagree about ‘strict gun control laws’ here having anything to do
> with
> > it .  Either you or I could have a new hunting rifle in a week or two in
> > Canada.  If you look at the school shootings or the Vegas massacre these
> > are not people who acquired their guns and went slaughtering.  These guns
> > were acquired and the armamentarium prepped and the plans made.  Canadian
> > laws would not stop this.
> >
> >
> >
> > We have a different culture here in Canada.  Guns are not toted around in
> > public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> > from flourishing on our side of the border.  I don’t know why.
> >
> >
> >
> > The challenge to end ‘their’ problem is that once the bad guys are armed
> > with illegal guns how do you stop the populace from wanting to have legal
> > guns?
> >
> >
> >
> > Somehow other countries can have legal weapons, such as Swiss adults all
> > keeping their weapons at home after their years of mandatory service, yet
> > they don’t kill each other with them.  Somehow a well armed militia there
> > does not lead to violence.
> >
> >
> >
> > I have lots of questions, but I don’t know the answers.
> >
> >
> >
> > Terence
> >
> >
> >
> > On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
> <mailto:j
> > [log in to unmask]><mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > Disclaimer: I live in Canada and  love our very strict gun control laws.
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 14:31:22 +0000
> >
> > From:    "Habib, David" <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > Repeal and replace the second amendment with a clear and contemporary
> > document. Dave Habib
> >
> >
> >
> > ________________________________________
> >
> > From: Pediatric Emergency Medicine Discussion List [
> > [log in to unmask]<mailto:[log in to unmask]>] on
> > behalf of Terence Bergmann [[log in to unmask]<mailto:
> > [log in to unmask]>]
> >
> > Sent: Sunday, February 18, 2018 7:42 AM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> >
> >
> >
> >
> > Hi Joe
> >
> >
> >
> > I disagree about ‘strict gun control laws’ here having anything to do
> with
> > it . Either you or I could have a new hunting rifle in a week or two in
> > Canada.  If you look at the school shootings or the Vegas massacre these
> > are not people who acquired their guns and went slaughtering.  These guns
> > were acquired and the armamentarium prepped and the plans made.  Canadian
> > laws would not stop this.
> >
> >
> >
> > We have a different culture here in Canada.  Guns are not toted around in
> > public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> > from flourishing on our side of the border.  I don’t know why.
> >
> >
> >
> > The challenge to end ‘their’ problem is that once the bad guys are armed
> > with illegal guns how do you stop the populace from wanting to have legal
> > guns?
> >
> >
> >
> > Somehow other countries can have legal weapons, such as Swiss adults all
> > keeping their weapons at home after their years of mandatory service, yet
> > they don’t kill each other with them.  Somehow a well armed militia there
> > does not lead to violence.
> >
> >
> >
> > I have lots of questions, but I don’t know the answers.
> >
> >
> >
> > Terence
> >
> >
> >
> > On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
> <mailto:j
> > [log in to unmask]><mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > Disclaimer: I live in Canada and  love our very strict gun control laws.
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 14:04:25 +0000
> >
> > From:    Nathan Kuppermann <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > Jeffrey and colleagues:
> >
> >
> >
> > My colleague Garen Wintemute is an EM physician at UC Davis and has been
> > doing seminal work on firearm violence prevention for decades - doggedly
> > and with great impact
> >
> >
> >
> > He is the director of the Violence Prevention Research Program (VPRP) at
> > UC Davis, and has been named a "hero of medicine" by Time Magazine in the
> > past for his work. He is as smart and accomplished as they come, and
> there
> > is nobody in the country who has been doing this longer or with greater
> > impact. And he has weathered the political and funding crises for this
> type
> > of work for years, frequently funding his own work when the political
> > climate for this work was bleak. But he has also received substantial
> > foundation money and federal grants during more supportive political
> times.
> >
> >
> >
> > He recently received $5 million from the California state legislature to
> > lead the University of California Firearm Violence Research Center, the
> > first state-funded gun violence research center in the country.
> >
> >
> >
> > Here is his entry in Wikipedia: https://urldefense.proofpoint.
> com/v2/url?u=https-3A__urldefense.proofpoint&d=DwIFaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
> eacE1u355w4wQKZ8Zh7E9jp85QBWM7T2Kf9kCQerxcE&s=
> ILUifQZ7pAXC2rEl0I62CrjpmMRARaz6zxX4Ikqqxjo&e=.
> > com/v2/url?u=https-3A__en.wikipedia.org_wiki_Garen-
> 5FWintemute&d=DwIGaQ&c=
> > cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > NLb0pWX2zSNtCCtxb8sbfq2eU5kwLSJ1K01CUSRclBU&e=
> >
> >
> >
> > If you are interested in his program or donating, here is the link:
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> > ucdmc.ucdavis.edu_vprp_&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> y6AkLoGvtzbgZgJDAeqhImP2Ae_
> > P1GrSzIOuDmcuDyo&e=
> >
> >
> >
> > Full disclosure: I serve as the Chair of EM at UC Davis where Garen
> works,
> > but the only benefit to me for getting Garen more exposure or money to
> the
> > VPRP program that he oversees is my children and family whom I
> desperately
> > want to protect, my many friends throughout this great country about
> whom I
> > deeply care, and a country about which I am deeply concerned.
> >
> >
> >
> > Nate Kuppermann
> >
> > UC Davis
> >
> >
> >
> >
> >
> >
> >
> > On Feb 17, 2018, at 3:03 PM, Jeffrey Oestreicher <[log in to unmask]
> <
> > mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > Thanks for this cathartic thread, Dr. Pusic and others. Hope fellows are
> > allowed to chime in. Like many on here my gut reaction is to focus on
> > politics, ie an assault weapons ban, the 2nd amendment etc. If Americans
> > were being killed by the same type of airplane that kept crashing,
> congress
> > would act. Why the same isn’t done with the AR-15 given that it keeps
> being
> > used to murder kids (in Sandy Hook, Aurora, Orlando, Las Vegas and now
> > Parkland) is maddening. But I wonder if we could do more by taking the
> lead
> > on another key gun violence issue on which physicians are experts. The
> > problem was encapsulated by the first few hours after the parkland
> shooting
> > when media outlets were literally arguing over how many school shootings
> > there have been in 2018. We don't even know! We don't know because there
> > are very little data on firearm injury/death in this country on account
> of
> > Congress blocking gun violence research funding since 1996. And this
> > funding block (the "Dickey amendment," named for the NRA point person in
> > Congress at the time) has created a political chill on research that has
> > trickled down even to academic medical centers. When I tried to examine
> NY
> > EMS data to look at pre-hospital intervention in pediatric firearm
> injury,
> > the city blocked it on account of the study being "too political." Where
> is
> > the research? When SIDs reached epidemic numbers in the 70’s, Congress
> > allocated funds for aggressive research leading to Back to Sleep campaign
> > and SIDS rates plummeted. Similar research campaigns produced life-saving
> > interventions for lead poisoning and car crashes. Yet no research crusade
> > has been directed at the epidemic of pediatric firearm death because
> > Congress essentially prohibits it. The hard part is trying to figure out
> > what to do about it. In my state of New York, A.2977/S.4363, sponsored by
> > New York State Assemblymember Jo Anne Simon and Senator Roxanne Persaud,
> > would create a Firearm Violence Research Institute in New York and I
> along
> > with some colleagues are trying to support this in a few different ways;
> if
> > others on here want to discuss or have other ideas pls be in touch. This
> is
> > not meant to discourage us from yelling from rooftops and writing
> senators
> > about background checks, assault weapons ban etc. That is so important.
> But
> > we have a unique vantage point with regard to public health research and
> > we're allowed to do it for every other public health problem except this
> > one.  Thanks so much for allowing me to add my 2 cents
> >
> >
> >
> > Sent from my iPhone
> >
> >
> >
> > On Feb 17, 2018, at 3:43 PM, Joe Nemeth, Dr <[log in to unmask]
> <mailto:j
> > [log in to unmask]><mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > Martin,
> >
> >
> >
> > As I sit in my living room on this Saturday morning, I’ve also gotten my
> > self in a state about how we tend to focus in on the small picture and
> > neglect an exponentially bigger one.
> >
> >
> >
> > Spoiler Alert: this will NOT be a politically laced nor personally biased
> > post...as opposed to some of the previous posts on this issue - I'm
> > actually quite disappointed that politics had to rear its ugly head.
> >
> >
> >
> > Disclaimer: I live in Canada and  love our very strict gun control laws.
> >
> >                Don't claim to be a gun control policy expert
> >
> >
> >
> > Now, allow me to expound:
> >
> >
> >
> > 1. A troubled young man AND inappropriate access to crazy weapons is what
> > caused this catastrophe.
> >
> >
> >
> > Colleagues, I think we all agree that it would be too simplistic and
> > frankly naive to think that stricter gun control would solve all of these
> > gun related deaths...many examples of this false and misleading
> association
> > of tighter gun control means safer society here are just a few
> below...many
> > more:
> >
> > -explore New Hampshire and Illinois...NH has very liberal gun control,
> > Chicago instead has very strict ones...look up who has more gun related
> > violent crime per capita...
> >
> > -the Swiss gov't actually encourages gun ownership.. has one of the
> > highest rates of gun ownership in the world, but little gun-related
> street
> > crime
> >
> > -Britain has more violent crime then the US (ban on guns since 1997)
> >
> >
> >
> > From my viewpoint, attention is being focused in the wrong direction. I
> > think we as powerful respected advocates of "public health" should focus
> at
> > the root causes of the problem, starting with the breakdown of the family
> > (young males who are deprived of an active father figure are far more
> > likely to commit violent crimes), the relentless stream of violent
> > promoting behaviour from Hollywood, the exponential increase in mental
> > illness in youth to start with.
> >
> >
> >
> > How come we don't lambast the horrendous violence coming out of Hollywood
> > which our youth are imbibing with negative consequences?
> >
> >
> >
> > 2. As per the CDC, in 2016, ~900 000 legal induced abortions were
> reported
> > from 49 reporting areas...likely a significant underestimate since CA
> among
> > other states does not report its numbers  (BTW ~ 1.5% for rape/incest, 3%
> > for fetal health issues).
> >
> >
> >
> > Without going into the classic arguments re pro/con, how can we not, how
> > do we not stand up for these children? I agree with the AAP's stance on
> gun
> > control but what I have trouble understanding is how the AAP does not
> weigh
> > in on the abortion issue (~10% of abortions are reported in females <19)?
> >
> >
> >
> > 17 children violently, meaninglessly murdered. An incredible tragedy. How
> > is this different then close to 1 million kids per year mentioned above.
> >
> >
> >
> > I agree with the AAP's stance on gun control but what I have trouble
> > understanding is how the AAP does not weigh in on the abortion issue?
> >
> >
> >
> >
> >
> > Joe
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > Joe Nemeth MD FCFP EM
> >
> > Associate Professor
> >
> > McGill University
> >
> >
> >
> >
> >
> > ________________________________________
> >
> > From: Pediatric Emergency Medicine Discussion List <
> > [log in to unmask]<mailto:[log in to unmask]><mailto:
> > [log in to unmask]>> on behalf of Barry Nathan <
> > [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]
> >>
> >
> > Sent: February 17, 2018 7:23:57 AM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]
> > ><mailto:[log in to unmask]>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > In case you don't get emails from the AAP:
> >
> >
> >
> > [image: AAP_400_61.jpg]
> >
> >
> >
> >
> >
> >
> >
> > *Statement on School Shooting in Parkland, Florida*
> >
> >
> >
> > from *Colleen A. Kraft, MD, FAAP, President, American Academy of
> > Pediatrics*
> >
> >
> >
> > "Yesterday just before the dismissal bell rang, 17 children and adults
> were
> >
> > shot and killed and 15 were injured inside Marjory Stoneman Douglas High
> >
> > School in Parkland, Fla. We find ourselves once again filled with grief
> and
> >
> > horror, and we mourn alongside all those impacted by the shooting. As our
> >
> > hearts are in Parkland, our eyes are on Congress.
> >
> >
> >
> > "This is the eighteenth school shooting in 2018, the equivalent of one
> >
> > every two and a half days so far this year. Shootings have an indelible
> >
> > impact on entire communities, on the families who lost children and loved
> >
> > ones, and on the children who survived. Columbine. Virginia Tech.
> Newtown.
> >
> > Orlando. Las Vegas. And now, Parkland. Children are dying from gun
> violence
> >
> > and Congress is failing to act. Every one of our 100 U.S. senators, and
> all
> >
> > 435 U.S. representatives bear a responsibility to take meaningful action
> to
> >
> > protect our children, our families, and our communities. Our elected
> >
> > leaders cannot continue to fail at this most essential task.
> >
> >
> >
> > "We can start by working to advance meaningful legislation that keeps
> >
> > children safe. The American Academy of Pediatrics advocates for stronger
> >
> > state and federal gun laws that protect children, including a ban on
> >
> > assault weapons like the one used in yesterday's school shooting. We also
> >
> > call for stronger background checks, solutions addressing firearm
> >
> > trafficking, and encouraging safe firearm storage. We will also continue
> to
> >
> > work to ensure that children and their families have access to
> appropriate
> >
> > mental health services, particularly to address the effects of exposure
> to
> >
> > violence.
> >
> >
> >
> > "Although these mass shootings command our attention, our children remain
> >
> > at risk daily for suicide, homicide, and unintentional injury because of
> >
> > the current policy regarding access to guns in the United States. Gun
> >
> > violence is a public health threat to children, and one the American
> >
> > Academy of Pediatrics will continue to take on, in state capitals across
> >
> > the country and in the halls of Congress. Parents across the United
> States
> >
> > send their children to school every day, and hope and trust they will be
> >
> > safe. As long as children continue to be injured and killed by guns in
> this
> >
> > country, pediatricians will not rest in our pursuit to keep them safe."
> >
> >
> >
> > *The American Academy of Pediatrics is an organization of 66,000 primary
> >
> > care pediatricians, pediatric medical subspecialists and pediatric
> surgical
> >
> > specialists dedicated to the health, safety and well-being of infants,
> >
> > children, adolescents and young adults. For more information, visit *
> >
> > www.aap.org<https://urldefense.proofpoint.com/v2/
> > url?u=http-3A__www.aap.org&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > GYHJ2Trg6KbD5HWur2hhBM8okfIlyE-J85UX7orhmA4&e=><https://
> > urldefense.proofpoint.com/v2/url?u=http-3A__www.aap.org&d=
> > DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7
> > OHtbhTpnjKXBI&m=t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > GYHJ2Trg6KbD5HWur2hhBM8okfIlyE-J85UX7orhmA4&e=>
> >
> > <https://urldefense.proofpoint.com/v2/url?u=https-
> > 3A__linkprotect.cudasvc.com_url-3Fa-3Dhttp-3A__www.
> > mmsend70.com_link.cfm-253fr-253dP1AWQRX2DH6KpZKp05dazA-7E-
> > 7E-2526pe-253dBH4KXYJXftdV7-5FOrPTTyUbVAzQsfgoRvleBm2XUVQ6
> > AiEVwuBNacQ0AWbz2OcXguY6Y2i1bNdCMkiPdWG-2DfHRg-7E-7E-2526t-
> > 253dP2O93UltqkjSP1tT62-5FPaA-7E-7E-26c-3DE-2C1-
> > 2CEDnzTesKajviC9Rbq687pz7yfFyRgC2WBFw6mF1beQyzL2WYF-
> > 5FfPWMjWxOixG1eagtp40GaUhhxZ8IL4zNcR4weeC1DLvkbbpHQsmMSnszDC
> > -26typo-3D1&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=nx187qR_
> > lU1zgduq5D6pufobUc2LvOfMjUy_CKFqY-w&e=>*
> >
> > and
> >
> > follow us on Twitter @AmerAcadPeds.*
> >
> >
> >
> > On Fri, Feb 16, 2018 at 9:22 PM, Chamberlain, James <
> >
> > [log in to unmask]<mailto:[log in to unmask]>>
> > wrote:
> >
> >
> >
> > I think we need to move to repeal the second amendment. It's the only way
> >
> > the NRA can be stopped. They resist all reasonable attempts to limit the
> >
> > carnage and then hide behind a misinterpretation of the second amendment.
> >
> >
> >
> > Very well, let's repeal it. I know many people agree that we don't need
> >
> > militias any longer.
> >
> >
> >
> > Jim Chamberlain
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> >
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> >
> > [log in to unmask]<mailto:[log in to unmask]>] On
> > Behalf Of Martin Pusic
> >
> > Sent: Friday, February 16, 2018 6:29 PM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: The shooting in Florida
> >
> >
> >
> > Hi colleagues,
> >
> >
> >
> > As I sit in my office late on a Friday, I've gotten myself into a state
> >
> > about the 17 children gunned down in a school.  For the umpteenth time.
> >
> >
> >
> > I think the thing that has me so upset, is that this state of gun
> >
> > complaisance is an affront to everything a pediatric emergency physician
> >
> > stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> >
> > 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> >
> > risk of a maybe brain tumor 30 years from now.  We work in difficult,
> >
> > burnout inducing conditions so that we can personally save, say, one
> life a
> >
> > year.
> >
> >
> >
> > Today it feels to me like someone with an AK-whatever just wiped out 17
> >
> > years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
> >
> > watch that Parkland mother on CNN.  I dare you.
> >
> >
> >
> > Today is not a day like all the others.  It's just not.
> >
> >
> >
> > --Martin Pusic
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the
> >
> > message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >
> >     https://urldefense.proofpoint.com/v2/url?u=http-3A__
> >
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=
> Zoipt4Nmcnjorr_6TBHi1A&r=
> >
> > OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=txqCyZ0Q4Y_
> a1kDlfTJH0FA02j_
> >
> > Op8nlDmuc3NLl9Kk&s=LCEbA3j7FkFKvJBa54LAl44ZTpZ431TWXx-0dUvQ7Xo&e=
> >
> >
> >
> > ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >
> > Confidentiality Notice: This e-mail message, including any attachments,
> is
> >
> > for the sole use of the intended recipient(s) and may contain
> confidential
> >
> > and privileged information. Any unauthorized review, use, disclosure or
> >
> > distribution is prohibited. If you are not the intended recipient, please
> >
> > contact the sender by reply e-mail and destroy all copies of the original
> >
> > message.
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the
> >
> > message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >     https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]><mailto:[log in to unmask]> with
> the
> > message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 10:20:42 -0500
> >
> > From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: A second, more settled, reflection on the Florida shooting
> >
> >
> >
> > After my amygdala-based email of Friday, a clarification:
> >
> >
> >
> > It is right and fit and proper that Pediatric Emergency Medicine
> > physicians bring the full force of our research and clinical
> armementarium
> > to bear on the problems of our patients.  That means sweating thresholds
> of
> > WBC for their predictive value in infections.  That means mounting
> massive
> > 10 year PECARN/PERC/PERN level research efforts to understand in detail
> the
> > mechanisms of our patients' problems in order to benefit them in any way
> we
> > can.  That's our  laudable job.  We should be proud of taking on the
> > problem of brain tumours 30 years from now.  In no way did I mean to
> > denigrate those efforts.  Instead, the complete opposite  -- I think they
> > provide us with the moral authority to speak out against government
> > policies that harm children.
> >
> >
> >
> > What is neither right nor fit nor proper is the ease with which a gun
> > violence proponent can wreak havoc at a scale that, on a given schoolday,
> > trivializes my efforts and those of my PEM colleagues.  It feels like a
> > personal affront that we live in a nation in which somehow the NRA has
> > better government support than CHIP does.  My point is not to devalue our
> > day/evening/night/weekend job.... we are doing MORE than our part in
> > society.......but rather to express that I, as a PEM physician, am rocked
> > to the core by the moral imbalance that makes it possible to routinely
> > leave 17 children dead.  And that this is some sort of normal.
> >
> >
> >
> > Some notes:
> >
> > If you need an example of how routine this has become, one PEM colleague
> > wrote that he is going to his son's elementary school next week to
> instruct
> > the teachers on external control of hemorrhage
> >
> > A Scot described the positive example of the way the Dunblane massacre
> > provoked a re-writing of their laws.  They haven't had another in 22
> years
> > since.
> >
> > Fahd Ahmad from WashU had already written on this:
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> > roguedadmd.com_2018_02_how-2Dmany-2Dpeople-2Dand-2Dwhich-
> > 2Dpeople-2Dshould-2Ddie-2Dfor-2Dwhich-2Drights_&d=DwIGaQ&c=
> > cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=gBTmwrSDR2Xj4YokS_
> > BOxGaLGBc1Xiq3jhEmCjkra6M&e=
> >
> > I learned of the positive examples of EM physicians taking this on
> > including Garen Wintemute of UC Davis and Eric Fleegler/Lois Lee at
> Boston
> > Children's.
> >
> > thank you posting the AAP statement which properly represents our values
> >
> > The majority of people who wrote back are mothers.
> >
> >
> >
> > Finally, I commit to writing back, constructively, every 3 months on this
> > topic until there's nothing to write about
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 16:56:19 +0000
> >
> > From:    Doc Holiday <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > Before I continue, I must say how much more comfortable this on-line
> > debate feels as compared to previous ones on other ListServs. I know
> it's a
> > generalising comment, but I keep finding that the insertion into the mix
> of
> > people who work with children makes everything so much more polite and
> > patient. If I recall correctly, there was a lot of anger and short
> > sentences last time I was involved in a debate on this topic on an
> "adult"
> > list....
> >
> >
> >
> >
> >
> > From: Joe Nemeth, Dr <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > As I sit in my living room on this Saturday morning
> >
> >
> >
> >
> >
> > --> My living room. Sunday afternoon. What else is there to do on a
> > weekend, eh?
> >
> >
> >
> >
> >
> > I live in Canada and  love our very strict gun control laws
> >
> >
> >
> >
> >
> > --> As people know, I live in the UK at this time and I also like the gun
> > laws here (as well as ones on knives, etc). I don't feel as positive
> about
> > drug laws, but that's a different thread. Still, the point I made before
> > and make again now is that I don't think our gun laws are THE cause of
> our
> > statistics. I think they are but one (be it major) factor contributing,
> but
> > on the background of a culture which rejects gun violence! I don't think
> > that any society will change sufficiently merely by their introduction -
> no
> > matter how strict. I have lived for many years in more than one country
> in
> > which guns were far more common than they are in the UK and these
> countries
> > differed markedly in terms of gun violence. One was actually on the same
> > scale as the USA!
> >
> >
> >
> >
> >
> > A troubled young man AND inappropriate access to crazy weapons is what
> > caused this catastrophe... too simplistic and frankly naive to think that
> > stricter gun control would solve all of these gun related deaths
> >
> >
> >
> >
> >
> > --> I agree. And I would add that there are factors beyond the two you
> > mentioned. It's not even ONLY two factors. We can probably add to this:
> >
> > - the lack of major societal backlash to inappropriate comments
> >
> > - the tolerance of lack of free psychiatric care
> >
> > - the overwhelming number of similar cases which will "drown" the efforts
> > of law enforcement to identify the cases which eventually go on to this
> > sort of event from among so many others, etc
> >
> > - there will be more factors identified as this case gets investigated
> >
> >
> >
> >
> >
> > One more point, though - a HUGE factor might be, as in past cases, if the
> > outrage dies down! The NRA and those who profit from guns will push their
> > politicians, including some of the more publicly-prominent ones and they
> > will keep things as quiet as possible. Possibly, even the next similar
> > event somehow will be used to make this one "disappear". You can
> recognise
> > the "silencing tactics" by indicator phrases such as:
> >
> > - "Now is not the time..."
> >
> > - "Country/state/city X ... bla-bla-bla ... And they have more/fewer guns
> > and more/fewer gun deaths and this random statistic thus means we should
> > stop looking into gun control"
> >
> > - "My child just falls a lot" (sorry - had to put that in, as it's on the
> > same level)
> >
> > - "The USA is a unique country and yet, when it suits me, I will find
> some
> > other one with which to make comparisons to prove my point"
> >
> >
> >
> >
> >
> > Britain has more violent crime then the US (ban on guns since 1997)
> >
> >
> >
> >
> >
> > --> I realise that I am picking up just one of the many points which were
> > listed together. I am only choosing this one because it's one I have been
> > familiar with for a very long time. It has been much "used" in order to
> > "prove" to Americans how the introduction of gun laws in the UK has left
> it
> > with a higher violent crime rate than the USA and should thus be avoided
> by
> > the USA. Now, I won't trouble the List by arguments about this. Instead,
> I
> > would appreciate it if y'all satisfy your own curiosities, each to
> his/her
> > own level, by going to a favourite search engine and searching for the
> > phrase "Britain has more violent crime then the US". You can read for
> > yourselves and save me from having to type up the actual facts...
> >
> >
> >
> >
> >
> > But I can't stop myself from mentioning something which has come up in a
> > past discussion I was accidentally drawn into on a visit to the USA 3-4
> > years ago. This same myth was raised. That, in itself, was no surprise,
> but
> > it had been raised by someone who had already impressed me with how many
> > "facts" he had absorbed from social media sources and how confidently he
> > spoke of these despite appearing to be far less eloquent whenever
> > questioned in detail about anything. I.e., he appeared to me to have been
> > "brainwashed". Despite knowing better, I challenged him on why he thought
> > the USA was "doing so much better" than the UK in terms of violent crime.
> > He gave me the answer. He then mistook my look of disbelief to indicate I
> > did not believe the facts he had mentioned. He was wrong - what I did not
> > believe is that someone could be that easy to "sell" to. He pulled out
> his
> > phone and showed me the "evidence". No idea what you're sitting on as you
> > read this, but I hope it has handles for you to hang onto, so that you
> > don't fall to the ground laughing. The reason, according to this "expert"
> > for how the USA got to have what he claimed was 10 times less violent
> crime
> > than the UK is because the USA has taken the excellent pre-emptive step
> of
> > imprisoning those who would otherwise have engaged in violent crime! I
> kid
> > you not - he attributed the high level of violent crime he believed the
> UK
> > had, not to the fact that the UK records a huge number of offences which
> > the USA does not include in its statistics. What he showed me was:
> > https://urldefense.proofpoint.com/v2/url?u=https-3A__en.
> > wikipedia.org_wiki_List-5Fof-5Fcountries-5Fby-5Fincarceration-5Frate&d=
> > DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7
> > OHtbhTpnjKXBI&m=t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > U4gHJAeNgKwFDK4WRfsLUPol7JAm8n3364MaZLG1Co4&e= (the version which was on
> > line then). He had been "educated" to believe that the fact that the USA
> > had around a 10-time higher number of prisoners than the UK per million
> of
> > population correlated with how it achieved a 10-time lower rate of
> violent
> > crime...
> >
> >
> >
> >
> >
> > I expect one requires whole armies of people who can be thus educated in
> > order to perpetuate certain "facts"... Such people can be convinced of
> many
> > things...
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > <https://urldefense.proofpoint.com/v2/url?u=http-
> > 3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> > cjytLXgP8ixuoHflwc-poQ&r=iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=>
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 12:00:26 -0500
> >
> > From:    Michael Falk <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > While I get the despair and anger given the lose of 17 people in another
> >
> > senseless mass shooting, I would caution people to not give up hope.
> When
> >
> > I first came to New York City in 1989, it was averaging about 2,000
> >
> > homicides a year.  If take our statistics for nonlethal injuries per
> >
> > homicide, roughly 7:1, the city was seeing another 10,000 plus
> penetrating
> >
> > traumas and I have not even mentioned the assaults with fists or blunt
> >
> > objects.  Last year in NYC, we had less than 400 homicides and the city
> is
> >
> > safer than it has been in years.  Why?  Well, there was a concerted
> effort
> >
> > to change the culture of policing and law enforcement in the city, and
> >
> > there was a massive crackdown on guns and getting them off the streets.
> >
> > The laws were changed around gun ownership and licensing, and there you
> >
> > have it....
> >
> >
> >
> > Also, many of you are forgetting that we had an assault weapons law in
> the
> >
> > US and Bush/Congress let it lapse in 2003.  Now it's record is a mixed
> bag
> >
> > but I think that if we learn from the mistakes we made the last time, and
> >
> > write a better law, we can actually have a significant impact.
> >
> >
> >
> > Just my two cents..
> >
> > Mike Falk
> >
> > NYC.
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 17:09:24 +0000
> >
> > From:    Robert Finkelstein <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: PED-EM-L Digest - 15 Feb 2018 to 16 Feb 2018 (#2018-39)
> >
> >
> >
> > Other countries have the same level of mental illness as the United
> > States, but not nearly the number of gun deaths. The mental health issue
> is
> > important but access to weapons that can kill a large number of people in
> > seconds allows the results we see. In addition, access to guns plays  a
> > huge role in suicides since many who attempt suicide and do not succeed
> > will get help and not attempt again. However, access to a gun makes it
> much
> > more likely that the first attempt will result in death.
> >
> >
> >
> > Robert Finkelstein
> >
> >
> >
> > On Feb 18, 2018, at 8:42 AM, Mick Work <[log in to unmask]<mailto:sed8m
> > [log in to unmask]>> wrote:
> >
> >
> >
> > I respect the need for debate around guns.   However, I think we are
> > remiss as pediatric emergency physicians to not raise a deeper discussion
> > around the mental illness crisis.
> >
> >
> >
> > We all see kids who meet this persons profile across the country. We see
> > disturbing mental illness and the many factors (including social media,
> > broken families, child abuse) that lead a child to buy a gun to do harm.
> > Or if not gun an explosive device etc..
> >
> >
> >
> > We see kids who are socially isolated and warning signs ignored.  Anyone
> > else concerned that the kids we see with mental illness are recognized by
> > schools or pediatric visit screening more often than by their own
> parents,
> > friends or neighbors.
> >
> >
> >
> > This persons desire to be a “school shooter” should raise attention
> around
> > how the media covers these events.  The fame brought to these shooters
> > should be called into question.  Are we fostering this copycat mentality?
> >
> >
> >
> > The lack of respect for human life should call us to question more than
> > the how but why.
> >
> >
> >
> > A focus only on guns and gun laws is remiss to the bigger picture in my
> > opinion and experience.
> >
> >
> >
> > Mick
> >
> >
> >
> >
> >
> >
> >
> > On Feb 17, 2018, at 12:01 AM, PED-EM-L automatic digest system <
> > [log in to unmask]<mailto:[log in to unmask]>> wrote:
> >
> >
> >
> > There are 4 messages totaling 391 lines in this issue.
> >
> >
> >
> > Topics of the day:
> >
> >
> >
> > 1. Peds EM talk (2)
> >
> > 2. Bacterial meningitis
> >
> > 3. The shooting in Florida
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ----------------------------------------------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 11:50:44 -0500
> >
> > From:    Purva Grover <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: Re: Peds EM talk
> >
> >
> >
> > Thanks all for your help on this.
> >
> > Best
> >
> > Purva
> >
> >
> >
> > Purva Grover , MD
> >
> > Medical Director
> >
> > Pediatric Emergency Department
> >
> > Cleveland Clinic Health System
> >
> > Email- [log in to unmask]<mailto:[log in to unmask]> <[log in to unmask]<mailto:
> > [log in to unmask]>>g
> >
> >
> >
> > On Thu, Feb 15, 2018 at 2:18 PM, <[log in to unmask]<mailto:drg
> > [log in to unmask]>> wrote:
> >
> >
> >
> > Hi All
> >
> > I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> >
> > cover ALL or even most. Any thoughts / talks / power points- you could
> >
> > share would be appreciated.
> >
> > Thanks
> >
> > Purva
> >
> >
> >
> > Sent from my mobile device
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 14:34:20 +0000
> >
> > From:    "Chamberlain, James" <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: Peds EM talk
> >
> >
> >
> > I would also cover unusual cases that you can't afford to miss, e.g.
> >
> >
> >
> > Sternoclavicular dislocation
> >
> > Conjunctivitis caused by penetrating FB
> >
> > Septic joint presenting with only low-grade fever (we've had several
> Staph
> > infections where temp was only 37.6 or 37.7 orally)
> >
> > Myocarditis presenting as wheezing. Remind them that all "bronchiolitis"
> > patients need a through cardiac exam, including distal pulses
> >
> > NAT
> >
> > The "sleepy" baby who has hypoglycemia
> >
> > The "sleepy" baby who has intussusception
> >
> > The appendicitis patient who presents with vomiting and diarrhea (not all
> > that unusual, actually)
> >
> > Etc.
> >
> >
> >
> > To me, this is the challenge of PEM. Finding the needle in the haystack,
> > that one sick kid who is different than all the usual low acuity
> illness...
> >
> >
> >
> > Jim
> >
> >
> >
> > James Chamberlain
> >
> > Division Chief, Emergency Medicine
> >
> > Children’s National Health System
> >
> > (202) 476-4177
> >
> >
> >
> > -----Original Message-----
> >
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> > [log in to unmask]] On Behalf Of Mojica, Michael
> >
> > Sent: Thursday, February 15, 2018 5:29 PM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: Re: Peds EM talk
> >
> >
> >
> > Purva
> >
> >
> >
> >
> >
> >
> >
> > I would recommend "the critically ill infant".
> >
> >
> >
> >
> >
> >
> >
> > It is the topic that scares the most people and you can cover a lot of
> > causes through cases.
> >
> >
> >
> >
> >
> >
> >
> > I like to use cases that include common presenting complaints (e.g.
> > vomiting) that are associated with very bad things (e.g. midgut
> volvulus).
> >
> >
> >
> >
> >
> >
> >
> > I'm attaching a ppt file for a talk I did a few years ago on this topic.
> >
> >
> >
> >
> >
> >
> >
> > My goal is for them to develop a mental checklist of potentially
> > life-saving interventions.
> >
> >
> >
> >
> >
> >
> >
> > Michael
> >
> >
> >
> >
> >
> >
> >
> > Michael Mojica, M.D
> >
> >
> >
> > Director of Education, Division of Pediatric Emergency Medicine
> >
> >
> >
> > Director, Pediatric Emergency Medicine Fellowship
> >
> >
> >
> > Bellevue Hospital Center
> >
> >
> >
> > Administration Building Room A528
> >
> >
> >
> > New York, N.Y. 10016
> >
> >
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> >
> >
> > 212-562-8147
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > ?On 2/15/18, 5:12 PM, "Pediatric Emergency Medicine Discussion List on
> > behalf of Purva Grover" <[log in to unmask]<mailto:
> > [log in to unmask]> on behalf of [log in to unmask]<mailto:drgr
> > [log in to unmask]>> wrote:
> >
> >
> >
> >
> >
> >
> >
> > Hi All
> >
> >
> >
> > I am giving an hour ppt to new PAs on Peds Emergencies. Clearly can not
> > cover ALL or even most. Any thoughts / talks / power points- you could
> > share would be appreciated.
> >
> >
> >
> > Thanks
> >
> >
> >
> > Purva
> >
> >
> >
> >
> >
> >
> >
> > Sent from my mobile device
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> >
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >
> >
> >                  https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFAg&c=
> > j5oPpO0eBH1iio48DtsedbOBGmuw5jHLjgvtN2r4ehE&r=-
> > uVUSwDIF0s52hEnO0EzoINmOqevlfnirF7YJ_EXiAQ&m=c2wlkkLWVP009LBCXl-
> > k6T4PNiNn1YYHTaSvJRCvGWo&s=7bcGZM66nE4BJGdqQQrjhL6fNRMBTC
> zuSv96wXa91qc&e=
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > ------------------------------------------------------------
> >
> > This email message, including any attachments, is for the sole use of the
> > intended recipient(s) and may contain information that is proprietary,
> > confidential, and exempt from disclosure under applicable law. Any
> > unauthorized review, use, disclosure, or distribution is prohibited. If
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> > have received this email in error please notify the sender by return
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> > and delete the original message. Please note, the recipient should check
> > this email and any attachments for the presence of viruses. The
> > organization accepts no liability for any damage caused by any virus
> > transmitted by this email.
> >
> > =================================
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> >
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> Zoipt4Nmcnjorr_6TBHi1A&r=
> > OEAcDBhKd1bBVBZ7Nc3Fw3kv26NKjEPV_b7vJcfJGSg&m=ZQaRUYHlbNuSLlAi-
> > YuD0cY4QPsIIUqjaql9agkSHH8&s=jLXcVKFGHNLAQ-
> y3T0bMic8mmMkKMtSnWoO5UdsCqvM&
> > e=
> >
> >
> >
> >
> >
> > ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
> >
> > Confidentiality Notice: This e-mail message, including any attachments,
> is
> > for the sole use of the intended recipient(s) and may contain
> confidential
> > and privileged information. Any unauthorized review, use, disclosure or
> > distribution is prohibited. If you are not the intended recipient, please
> > contact the sender by reply e-mail and destroy all copies of the original
> > message.
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 18:29:38 -0500
> >
> > From:    Aline Baghdassarian <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: Bacterial meningitis
> >
> >
> >
> > Scott,
> >
> >
> >
> > Would love to hear more about the cases. How did they present? What was
> the
> >
> > decision making process?
> >
> >
> >
> > Thank you,
> >
> >
> >
> > Aline
> >
> >
> >
> > Aline Baghdassarian, MD, MPH, FAAP
> >
> > Director, Pediatric Emergency Medicine Fellowship Program
> >
> > Assistant Professor, Department of Emergency Medicine
> >
> > Virginia Commonwealth University School of Medicine
> >
> >
> >
> > Children's Hospital of Richmond at VCU
> >
> > Email [log in to unmask]<mailto:aline.
> > [log in to unmask]>
> >
> >
> >
> >
> >
> > On Thu, Feb 15, 2018 at 12:40 PM, Julian Orenstein <[log in to unmask]
> > <mailto:[log in to unmask]>>
> >
> > wrote:
> >
> >
> >
> > In a recent case at our institution, there was a present but subtle
> degree
> >
> > of meningismus — I’ve found over the years there is always some
> elicitable
> >
> > sign — but as importantly there’s a degree of irritability or altered
> >
> > behavior that has everyone concerned: mom, RN’s, me.
> >
> > If mama ain't happy, I ain't happy. I’ll make liberal use of the term
> >
> > cerebritis or encephalopathic behavior until there’s a consent signed.
> >
> >
> >
> > I’m not such a good scientist anymore, but I’ve tried to be an attentive
> >
> > clinician.
> >
> >
> >
> > Julian Orenstein
> >
> >
> >
> >
> >
> > On Feb 14, 2018, at 3:30 PM, JAY FISHER <[log in to unmask]<mailto:jdfi
> > [log in to unmask]>> wrote:
> >
> >
> >
> > Scott - Bacterial meningitis is alive and well here in LV - we have seen
> >
> > it in a variety of age groups. There is good evidence that there has been
> >
> > an increase in pneumococcal serotypes not covered by the polyvalent
> >
> > vaccines since there widespread use, such that the burden of pneumococcal
> >
> > meningitis (as opposed to H. flu type b) has not decreased nearly as
> much.
> >
> >
> >
> > Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial
> >
> > meningitis. Curr Opin Infect Dis. 2018;31(1):78-84.
> >
> >
> >
> > Also, the absence of meningismus in older kids with bacterial meningitis
> >
> > is well described and occurs in a substantial subset.
> >
> >
> >
> > Geiseler J, Nelson, K.E. Bacterial meningitis without clinical signs of
> >
> > meningeal irritation. . Southern Med J 1982;75(4):448-450.
> >
> >
> >
> > Much of the data on the sensitivity of the neck exam is of the
> >
> > retrospective variety. I have only read one really good prospective study
> >
> > on the sensitivity of PE for bacterial meningitis and it was a single
> >
> > center variety as I recall.
> >
> >
> >
> > Walsh-Kelly C, Nelson DB, Smith DS, et al. Clinical predictors of
> >
> > bacterial versus aseptic meningitis in childhood. Ann Emerg Med.
> >
> > 1992;21(8):910-914.
> >
> >
> >
> > Tough case.
> >
> >
> >
> >
> >
> > Jay
> >
> >
> >
> > Jay D. Fisher MD FAAP FACEP
> >
> > Medical Director, Pediatric EM
> >
> > Children's Hospital of Nevada at UMC
> >
> > Clinical Professor of Emergency Medicine and Pediatrics
> >
> > UNLV School of Medicine
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > On February 14, 2018 at 4:18 PM "Conners, Gregory, P" <
> >
> > [log in to unmask]<mailto:[log in to unmask]>> wrote:
> >
> >
> >
> >
> >
> > I shared this with our ID director (Dr. Mary Anne Jackson), who pointed
> >
> > out that bacterial meningitis appears at this time of year as a
> >
> > complication of influenza:
> >
> > "Both pneumococcal and meningococcal meningitis can occur post flu as
> >
> > well as GAS and S aureus invasive disease and TSS."
> >
> >
> >
> > She also addressed Jim's question:  "We do know that new serotypes [of
> >
> > pneumococcus] have emerged but this is not waning immunity because the
> teen
> >
> > only got PCV7".
> >
> >
> >
> >
> >
> > Greg Conners
> >
> >
> >
> > Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP
> >
> >
> >
> > Director, Division of Emergency Medicine
> >
> > Associate Chair of Pediatrics
> >
> > Professor of Pediatrics and Emergency Medicine
> >
> > Children’s Mercy Hospital, Kansas City
> >
> > University of Missouri, Kansas City
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> >
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> >
> > [log in to unmask]<mailto:[log in to unmask]>] On
> > Behalf Of 000001679b145c30-dmarc-
> >
> > [log in to unmask]<mailto:[log in to unmask]>
> >
> > Sent: Wednesday, February 14, 2018 2:25 PM
> >
> > To: [log in to unmask]<mailto:[log in to unmask]>
> >
> > Subject: Re: Bacterial meningitis
> >
> >
> >
> > *** This message was sent to you from an External Source. Please do not
> >
> > open untrusted links or attachments. ***
> >
> >
> >
> > ________________________________
> >
> >
> >
> >
> >
> > Could you share with us the clinical findings and history that prompted
> >
> > the LP?
> >
> >
> >
> >
> >
> > Shiu-Lin
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > Shiu-Lin Tsai, MD
> >
> > Division of Pediatric Emergency Medicine
> >
> >
> >
> > Department of Emergency Medicine
> >
> > Columbia University Medical Center
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> >
> > From: Scott Freedman <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > To: PED-EM-L <[log in to unmask]<mailto:[log in to unmask]
> > BROWN.EDU>>
> >
> > Sent: Wed, Feb 14, 2018 2:44 pm
> >
> > Subject: Bacterial meningitis
> >
> >
> >
> > ALL:
> >
> > Since Jan 1st this year, we have seen 3 cases of culture + bacterial
> >
> > meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with
> >
> > *Neisseria meningiditis*.  All 3 were in older children/ teens who
> received
> >
> > their Prevnar 13  vaccines as well as the Menactra series in the patient
> >
> > with Neisseria.  Anyone else seeing cases of this sort?  I do not recall
> 3
> >
> > cases of bacterial meningitis in older kids in a community setting such
> as
> >
> > ours in quite a long time.  Is this random bad luck or do  we all need to
> >
> > be more vigilant?  Incidentally, none had neck pain or meningismus as a
> >
> > clinical finding.
> >
> >
> >
> > --
> >
> > Kind regards,
> >
> >
> >
> > Scott
> >
> > Scott Freedman, MD
> >
> > Medical Director,  Pediatric Emergency Dept Rockville MD
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with
> >
> > the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >
> >             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with
> >
> > the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
> >
> >             https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
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> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ________________________________
> >
> >
> >
> > Electronic mail from Children's Mercy Kansas City. This communication
> >
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> >
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> > please immediately forward the message to the Children's Mercy
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> >
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> > For more information, send mail to [log in to unmask]<mailto:
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> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
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> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
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> >
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> >
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> >
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> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the
> >
> > message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >              https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Fri, 16 Feb 2018 18:29:08 -0500
> >
> > From:    Martin Pusic <[log in to unmask]<mailto:[log in to unmask]>>
> >
> > Subject: The shooting in Florida
> >
> >
> >
> > Hi colleagues,
> >
> >
> >
> > As I sit in my office late on a Friday, I've gotten myself into a state
> > about the 17 children gunned down in a school.  For the umpteenth time.
> >
> >
> >
> > I think the thing that has me so upset, is that this state of gun
> > complaisance is an affront to everything a pediatric emergency physician
> > stands for.  We sweat whether it's too risky when the WBC is 15.1 and not
> > 14.9.  We study 40,000 children in order sort out who deserves the x-ray
> > risk of a maybe brain tumor 30 years from now.  We work in difficult,
> > burnout inducing conditions so that we can personally save, say, one
> life a
> > year.
> >
> >
> >
> > Today it feels to me like someone with an AK-whatever just wiped out 17
> > years of my work.  In minutes.  I want to cry.  We SHOULD cry.  Try and
> > watch that Parkland mother on CNN.  I dare you.
> >
> >
> >
> > Today is not a day like all the others.  It's just not.
> >
> >
> >
> > --Martin Pusic
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&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]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >               https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 10:17:05 -0500
> >
> > From:    Deepti Thomas-Paulose <[log in to unmask]<mailto:dt
> > [log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > The year speed limit laws went into effect-->traffic deaths down 17%.
> >
> > Mothers against Drunk Driving, stricter DUI enforcement  laws-->cut
> deaths
> >
> > due to drunk driving by half every year since 1980. Seat belt safety
> laws,
> >
> > traffic laws-all created to protect the public.  As a public health
> trained
> >
> > physician, it seems so illogical to me that we would not create stricter
> >
> > gun laws especially against military style guns for the civilian
> >
> > population.  Let's start there.
> >
> >
> >
> > Problem- Mass shootings
> >
> > Prevention- Ban assault rifles
> >
> >
> >
> >
> >
> > On Sun, Feb 18, 2018 at 7:42 AM, Terence Bergmann <
> >
> > [log in to unmask]<mailto:[log in to unmask]>>
> > wrote:
> >
> >
> >
> > Hi Joe
> >
> >
> >
> > I disagree about ‘strict gun control laws’ here having anything to do
> with
> >
> > it .  Either you or I could have a new hunting rifle in a week or two in
> >
> > Canada.  If you look at the school shootings or the Vegas massacre these
> >
> > are not people who acquired their guns and went slaughtering.  These guns
> >
> > were acquired and the armamentarium prepped and the plans made.  Canadian
> >
> > laws would not stop this.
> >
> >
> >
> > We have a different culture here in Canada.  Guns are not toted around in
> >
> > public.  Thankfully the 49th parallel prevented the ‘western’ mentality
> >
> > from flourishing on our side of the border.  I don’t know why.
> >
> >
> >
> > The challenge to end ‘their’ problem is that once the bad guys are armed
> >
> > with illegal guns how do you stop the populace from wanting to have legal
> >
> > guns?
> >
> >
> >
> > Somehow other countries can have legal weapons, such as Swiss adults all
> >
> > keeping their weapons at home after their years of mandatory service, yet
> >
> > they don’t kill each other with them.  Somehow a well armed militia there
> >
> > does not lead to violence.
> >
> >
> >
> > I have lots of questions, but I don’t know the answers.
> >
> >
> >
> > Terence
> >
> >
> >
> > On Feb 17, 2018, at 2:43 PM, Joe Nemeth, Dr <[log in to unmask]
> <mailto:j
> > [log in to unmask]><mailto:j
> >
> > [log in to unmask]<mailto:[log in to unmask]>>> wrote:
> >
> >
> >
> > Disclaimer: I live in Canada and  love our very strict gun control laws.
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the
> >
> > message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > --
> >
> > Deepti Thomas-Paulose, MD, MPH
> >
> > Fellowship Director
> >
> > Global Health Division
> >
> > Mt. Sinai St.Luke's Roosevelt Hospital Center
> >
> > https://urldefense.proofpoint.com/v2/url?u=http-3A__www.
> > slredglobalhealth.org&d=DwIGaQ&c=cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > D3bvjwGdQp2RN9jDOl4BSMlphh63sYQrLWvNUrRTFAY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 17:15:53 +0000
> >
> > From:    Robert Finkelstein <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: School shootings.......
> >
> >
> >
> > Just because people will find a way to break laws does not mean that we
> > shouldn’t have them.   By that logic, we expect that all of us who are
> > currently law abiding don’t need any laws to make us so.  Human nature
> > being what it is, we all need laws and structure.  Yes, gun regulation
> > would not stop all gun violence, but it could reduce it. Also, I don’t
> > think the majority want prohibition of guns, just regulation; the same
> way
> > alcohol is regulated by age and penalties for driving under the
> influence.
> > Or, the way cars are regulated with licensing, registration, having to
> pass
> > a driving test and citations for violations.
> >
> >
> >
> > On Feb 18, 2018, at 8:42 AM, Horst D. Weinberg, MD <
> > [log in to unmask]<mailto:
> > [log in to unmask]>> wrote:
> >
> >
> >
> > Yes, automatic weapons should be banned by our government, but most of
> the
> > discussions posted blame the guns, the NRA, the 2nd amendment and our
> > 'laws'. Nobody gets to the meat of the matter:  If there is a demand (for
> > guns), regardless of the laws passed, someone will fill that demand.
> This
> > is no different from Prohibition, where there was no shortage of
> available
> > booze or the 'war' on drugs, where you can get them at most street
> corners
> > in any city. What needs to change: There has been a steady decline over
> the
> > past 20 or so years in our country's moral fiber, personal and work
> ethic,
> > and yes, child rearing. Cause: unmarried or one parent families, poverty,
> > and absence of any discipline both in the home and in the schools, for
> > 'political correctness'. Parents want to be friends with their children
> > rather than running their homes like 'benevolent dictator ships'.
> Nothing
> > is denied the child: the child wants $150.00 sneakers or a new
> cell-phone:
> > no problem.  So you can blame the gun all you want, but unless there is a
> > real change in the populations personal morality and ethics, these school
> > tragedies will continue.
> >
> > We pediatricians should look at our own practices in teaching good child
> > rearing ways to the families we serve.     Horst D. Weinberg, MD
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >         https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> > [log in to unmask]> with the message: info PED-EM-L
> >
> > The URL for the PED-EM-L Web Page is:
> >
> >                https://urldefense.proofpoint.com/v2/url?u=http-3A__
> > listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=
> cjytLXgP8ixuoHflwc-poQ&r=
> > iiLqIGJPj43rFwhy0umXiLW2YeM4w7OHtbhTpnjKXBI&m=
> > t48oRvjGz5SVTSWYDRNskNM83f8PFATlPgGDaXkwwFA&s=
> > WbnKabvCDEZlGP3t3JnZVQzkVoGMTS4hApYsWUL2GLY&e=
> >
> >
> >
> > ------------------------------
> >
> >
> >
> > Date:    Sun, 18 Feb 2018 17:26:11 +0000
> >
> > From:    Robert Flood <[log in to unmask]<mailto:
> > [log in to unmask]>>
> >
> > Subject: Re: The shooting in Florida
> >
> >
> >
> > Dear Colleagues:
> >
> >
> >
> >
> >
> > This conversation gives me some hope that we can and will address the
> > issue of gun violence through the scientific approach, rather than
> > "beliefs" and "feelings", similar to the way that Dr. Wintemute has done
> > for the past several decades. While I fully support a
> > "re-evaluation/clarification" of the second amendment, a "Children's
> Rights
> > Amendment", and other legislation to help curb gun violence in the US, we
> > can and and should evaluate potential interventions now in the context of
> > over 350 million guns, with unlimited ammunition, available to the US
> > public.
> >
> >
> >
> >
> >
> > So, if we are going to use the scientific approach to this hug...
> >
> > [Message clipped]
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  https://urldefense.proofpoint.com/v2/url?u=http-3A__
> listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIFaQ&c=Pk_HpaIpE_
> jAoEC9PLIWoQ&r=PgyaJu_-6fURaaWELlGskCQzpkXWZSDQU-w6tbGwwMM&m=
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> btIQ3h2Dgk1zt9FdzG364qsEpDBkaY&e=
>
> ------------------------------
>
> End of PED-EM-L Digest - 20 Feb 2018 - Special issue (#2018-49)
> ***************************************************************
>
>
> 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:
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>

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