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March 8th, 2012 posted by Paul Rega, MD, FACEP March 8, 2012 @ 4:20 pm

Pittsburgh psych hospital shooting

Mar 08, 2012

2 dead, 7 wounded in Pittsburgh psych hospital shooting

By Michael Winter, USA TODAY
Updated 6m ago

“Two people were killed, including a gunman, and seven others were wounded this afternoon in a shooting a University of Pittsburgh psychiatric hospital….”

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 6:15 am

If letter grades work for restaurants in NYC, why not for bordellos in Nevada?


CRISTIAN SALAZAR Associated Press12:06 a.m. EST, March 7, 2012

NEW YORK (AP) — “Giving letter grades to the thousands of restaurants in New York City — from humble delis to celebrity chef-powered eateries — has been a boon to business and has led to a decline in the number of cases of salmonella food poisoning, the mayor and health officials said…….Mayor Michael Bloomberg, Health Commissioner Dr. Thomas A. Farley and other health officials announced initial data Tuesday showing salmonella infections decreased by 13.5 percent over the first full year the city has used letter grades. The Health Department said 1,296 cases of salmonella were reported in 2010 and preliminary data show 1,121 cases in 2011……”

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 6:07 am

Maryland Department of Health and Mental Hygiene on cluster deaths : It was flu!


Influenza Confirmed in Two Calvert County Cases

BALTIMORE (March 7, 2012) – The Maryland Department of Health and Mental Hygiene (DHMH) is working with the Calvert County Health Department to investigate four cases of severe respiratory illnesses in the same immediate family. Three have died. Testing by the DHMH Laboratories Administration has confirmed that two of the cases had Influenza H3, a strain of Influenza A that has been circulating this season. These cases were complicated by bacterial co-infections, a known complication of influenza infection.

Additional laboratory evaluation and investigation are ongoing. At this time, there is no indication of any other clusters of severe respiratory illness in the state. DHMH continues to coordinate with the Maryland Emergency Management Administration (MEMA) to update the Governor and local health and Emergency Medical Services (EMS) partners.

The ‘flu’ season typically can last as late as May. Vaccination is the best way to prevent influenza and its related complications that can lead to hospitalization and even death. DHMH recommends all individuals over the age of six months get vaccinated. In addition, DHMH reminds Marylanders to take other precautionary measures, such as hand washing and staying home if sick. Individuals with influenza-like illness (fever and sore throat or cough) should consult their healthcare providers for evaluation.

More information regarding the Calvert County investigation will be provided as it becomes available.

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 6:05 am

One hospital in the tornado’s path: “…A gust of wind hit and in an instant blew the nurse and patient back 20 feet….”


Chicago Tribune, 3/2/12

Harrisburg hospital in tornado’s path stands its ground

Staff got patients out of harm’s way as building suffered major damage

Alissa Groeninger, Chicago Tribune reporter

HARRISBURG, Ill. — — “Danny Lampley……heard a call over the intercom saying a tornado was coming. It was set to strike in about 15 minutes.  Lampley, vice president of administrative services at the hospital, raced out of his office to find nurses already moving some of the facility’s 42 patients. Those who could get out of bed and into chairs were moved into the hallways. Others had their beds pushed either into the halls or as far from windows as possible……”

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 5:49 am

CDC MMWR: Gang Homicides — Five U.S. Cities, 2003–2008


January 27, 2012 / 61(03);46-51

Gang homicides account for a substantial proportion of homicides among youths in some U.S. cities; however, few surveillance systems collect data with the level of detail necessary to gang homicide prevention strategies. To compare characteristics of gang homicides with nongang homicides, CDC analyzed 2003–2008 data from the National Violent Death Reporting System (NVDRS) for five cities with high levels of gang homicide. This report describes the results of that analysis, which indicated that, consistent with similar previous research, a higher proportion of gang homicides than other homicides involved young adults and adolescents, racial and ethnic minorities, and males. Additionally, the proportion of gang homicides resulting from drug trade/use or with other crimes in progress was consistently low in the five cities, ranging from zero to 25%. Furthermore, this report found that gang homicides were more likely to occur with firearms and in public places, which suggests that gang homicides are quick, retaliatory reactions to ongoing gang-related conflict. These findings provide evidence for the need to prevent gang involvement early in adolescence and to increase youths’ capacity to resolve conflict nonviolently.

NVDRS is an active, state-based surveillance system that collects violent death data from multiple sources, such as death certificates, coroner/medical examiner records, and various law enforcement reports (e.g., police reports and supplementary homicide reports [SHRs]). As of 2008, NVDRS has operated in 17 U.S. states.* This report includes 2003–2008 data from large cities in NVDRS states. Only cities ranked within the 100 largest in the United States were examined because gang problems more frequently occur in large cities (1–2). Cases of gang homicide were defined as homicides reported to have been either precipitated by gang rivalry or activity† or perpetrated by a rival gang member on the victim.

Because a city might be served by more than one law enforcement agency and each agency might have its own definition of gang-related crime, this analysis used only data from municipal police departments. Municipal police departments often have a jurisdiction congruent with city limits. Geographic areas matching municipal police jurisdictions were identified by geographic codes (either federal information processing standards or zip codes) for location of injury in NVDRS. U.S. Census Bureau 2000 population estimates were determined for each city using the Law Enforcement Agency Identifiers Crosswalk (3). For each of the 33 eligible large cities, gang homicide counts were averaged for the period 2003–2008 and divided by the population estimates to calculate an average annual gang-related mortality rate. Cities with gang-related mortality rates equal to or greater than one standard deviation above the average were selected for further analyses.

Five cities met the criterion for having a high prevalence of gang homicides: Los Angeles, California; Oklahoma City, Oklahoma; Long Beach, California; Oakland, California; and Newark, New Jersey. In these cities, a total of 856 gang and 2,077 nongang homicides were identified and included in the analyses. Comparisons of the characteristics of gang and nongang homicides were made using Fisher’s exact tests for all the variables except mean age, which required a t-test. The characteristics included basic demographics of the victims, descriptive information on the homicide event, and circumstances precipitating the event.

Gang homicide victims were significantly younger than nongang homicide victims in all five cities (Table 1). Whereas 27%–42% of the gang homicide victims were aged 15–19 years, only 9%–14% of the nongang homicide victims were in this age group. Approximately 80% of all homicide victims were male in each city; however, Los Angeles, Newark, and Oklahoma City still reported significantly higher proportions of male victims in gang homicide incidents compared with nongang homicide incidents. In Los Angeles and Oakland, a significantly higher proportion of gang victims were Hispanic and, in Oklahoma City, a significantly higher proportion of gang victims were non-Hispanic black compared with nongang victims.

In at least three of the five cities, gang homicides were significantly more likely than nongang homicides to occur on a street and involve a firearm (Table 2). More than 90% of gang homicide incidents involved firearms in each city. For nongang homicides, firearms were involved in 57%–86% of the incidents. Gang homicides also were most likely to occur in afternoon/evening hours in the majority of the five cities; however, comparisons were not examined because the data were missing for 23% of nongang homicide incidents. In Los Angeles, Oakland, and Oklahoma City, gang homicides occurred significantly more frequently on weekends than did nongang homicides.

With regard to the circumstances preceding the homicide, drive-by shootings were significantly more likely to contribute to gang homicides than other types of homicide in Los Angeles and Oklahoma City (Table 2). Nearly one quarter of gang homicides in these cities were drive-by shootings, compared with 1%–6% of nongang homicides. A significantly smaller proportion of gang versus nongang homicides were precipitated by another crime in progress in the California cities, ranging from zero to 3% of gang homicides, compared with 9% to 15% of nongang homicides. Further, in Los Angeles and Long Beach, less than 5% of all homicides were associated with known drug trade/use. Although data for Newark and Oklahoma City indicated that 20%–25% of gang homicides involved drug trade/use; Newark was the only city that had a significantly higher proportion of gang versus nongang homicides that involved drug trade/use.

Editorial Note

Homicide is the second leading cause of death among persons aged 15–24 years in the United States (4). In some cities, such as Los Angeles and Long Beach, gang homicides account for the majority of homicides in this age group (61% and 69%, respectively). The differences observed in gang versus nongang homicide incidents with regard to victim demographics, place of injury, and the use of drive-by shootings and firearms are consistent with previous reports (5). The finding that gang homicides commonly were not precipitated by drug trade/use or other crimes in progress also is similar to previous research; however, this finding challenges public perceptions on gang homicides (5). The public often has viewed gangs, drug trade/use, crime, and homicides as interconnected factors; however, studies have shown little connection between gang homicides and drug trade/use and crime (5). Gangs and gang members are involved in a variety of high-risk behaviors that sometimes include drug and crime involvement, but gang-related homicides usually are attributed to other circumstances (6). Newark was an exception by having a higher proportion of gang homicides being drug-related. A possible explanation of this divergent finding could be that Newark is experiencing homicides by gangs formed specifically for drug trade. Overall, these findings support a view of gang homicides as retaliatory violence. These incidents most often result when contentious gang members pass each other in public places and a conflict quickly escalates into homicide with the use of firearms and drive-by shootings.

The findings in this report are subject to at least two limitations. First, the accuracy of gang homicide estimates in NVDRS and other surveillance systems is unknown. As a point of reference, CDC compared NVDRS’s gang homicide counts to another independent surveillance system, the National Youth Gang Survey (NYGS). NYGS§ is a nationally representative annual survey of law enforcement agencies, including all large cities (2). Most cities included in this report also had high gang-related mortality rates in NYGS (Figure). Second, the gang homicide case definition can vary by law enforcement agency, which might introduce a misclassification bias. For instance, organized crime gangs, although distinct from youth street gangs are included in some but not all definitions of gang homicide. In addition, some agencies report according to a gang member–based definition (i.e., homicides involving a gang member) whereas others report according to a gang motive–based definition (i.e., the homicide further the goals of a gang) (7).

In conclusion, gang homicides are unique violent events that require prevention strategies aimed specifically at gang processes. Preventing gang joining and increasing youths’ capacity to resolve conflict nonviolently might reduce gang homicides (8). Rigorous evaluation of gang violence prevention programs is limited; however, many promising programs exist (9). In terms of primary prevention, the Prevention Treatment Program, which includes child training in prosocial skills and self-control, has shown reductions in gang affiliation among youths aged 15 years (10). Secondary prevention programs that intervene when youths have been injured by gang violence, such as hospital emergency department intervention programs, might interrupt the retaliatory nature of gang violence and promote youths leaving gangs. Finally, promising tertiary prevention programs for gang-involved youths might include evidence-based programs for delinquent youths that provide family therapy to increase the youths’ capacity to resolve conflict.


  1. US Census Bureau. Cities with 100,000 or more population in 2000 ranked by population. County and city data book 2000. Washington, DC: US Census Bureau; 2011. Available at Web Site Icon. Accessed January 17, 2012.
  2. Egley A Jr, Howell JC. Highlights of the 2009 National Youth Gang Survey: fact sheet. Washington, DC: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention; 2011. Available at Adobe PDF fileExternal Web Site Icon. Accessed January 17, 2012.
  3. Inter-University Consortium for Political and Social Research. Law enforcement agency identifiers crosswalk [United States], 2005. Ann Arbor, MI: Inter-University Consortium for Political and Social Research; 2005. Available at Adobe PDF fileExternal Web Site Icon. Accessed January 17, 2012.
  4. CDC. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at Accessed January 17, 2012.
  5. Howell JC. Youth gang homicides: a literature review. Crime Delinquency 1999;45:208–41.
  6. Bjerregaard B. Gang membership and drug involvement: untangling the complex relationship. Crime Delinquency 2010;56:1–32.
  7. Klein M, Maxson C. Street gang patterns and policies. New York, NY: Oxford University Press; 2006.
  8. McDaniel, DD. Risk and protective factors associated with gang affiliation among high-risk youth: a public health approach. Inj Prev [Epub ahead of print, January 11, 2012].
  9. Howell JC. Gang prevention: an overview of research and programs. Washington, DC: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention; 2010. Available at Adobe PDF fileExternal Web Site Icon. Accessed January 17, 2012.
  10. Tremblay R, Masse L, Pagani L, Vitaro F. From childhood physical aggression to adolescent maladjustment: the Montreal prevention experiment. In: Peters RD, McMahon RJ, eds. Preventing childhood disorders, substance abuse, and delinquency. Thousand Oaks, CA: Sage; 1996:268–98.

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 5:46 am

Kids hospitalized with community-acquired pneumonia (CAP).


Impact of a Guideline on Management of Children Hospitalized With
Community-Acquired Pneumonia
Ross E. Newman, Erin B. Hedican, Joshua C. Herigon, David D. Williams,
Arthur R. Williams, and Jason G. Newland
Pediatrics 2012;129 e597-e604


CONCLUSIONS: A CPG (clinical practice guideline) and ASP (antimicrobial stewardship program) led to the increase in use of ampicillin for children hospitalized with CAP (COMMUNITY-ACQUIRED PNEUMONIA). In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 5:40 am

Phenytoin in children presenting with febrile status epilepticus


Lack of efficacy of phenytoin in children presenting with febrile status
Published online: 02 March 2012
Salima Ismail, Arielle Lévy, Helena Tikkanen, Marcel Sévère, Franciscus Johannes
Wolters, Lionel Carmant
DOI: 10.1016/j.ajem.2011.11.007
American Journal of Emergency Medicine, The,

Phenytoin is rarely effective in controlling febrile status epilepticus. Children exposed to phenytoin have more prolonged febrile seizures, increasing the risk of brain injury.

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 5:22 am

Alleged malpractice in Romania when a girl dies from rabies


5-year-old Girl dies of rabies in Romania


BUCHAREST, Romania (AP) — “Romanian doctors are being investigated for malpractice after a 5-year-old girl in their care died of rabies.

Health officials have said the girl was bitten by a stray dog in December in a village in eastern Romania and initially received an anti-tetanus jab from the doctors.

In February, she was hospitalized at a unit that treats infectious diseases in the city of Iasi where she died on Feb. 27.

Veterinary health spokesman….said…..dogs were being examined for rabies in the village where the girl was bitten….”

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March 8th, 2012 posted by Paul Rega, MD, FACEP @ 5:13 am

WHO: Water & Sanitation Progress Report, 2012



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