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June 2017, VOLUME 7 / ISSUE 6
Pediatric Firearm-Related Injuries in the United States
Kavita Parikh, Alyssa Silver, Shilpa J. Patel, Sabah F. Iqbal, Monika Goyal
Pediatric firearm-related deaths and injuries are a national public health crisis. In this Special Review Article, we characterize the epidemiology of firearm-related injuries in the United States and discuss public health programs, the role of pediatricians, and legislative efforts to address this health crisis. Firearm-related injuries are leading causes of unintentional injury deaths in children and adolescents. Children are more likely to be victims of unintentional injuries, the majority of which occur in the home, and adolescents are more likely to suffer from intentional injuries due to either assault or suicide attempts. Guns are present in 18% to 64% of US households, with significant variability by geographic region. Almost 40% of parents erroneously believe their children are unaware of the storage location of household guns, and 22% of parents wrongly believe that their children have never handled household guns. Public health interventions to increase firearm safety have demonstrated varying results, but the most effective programs have provided free gun safety devices to families. Pediatricians should continue working to reduce gun violence by asking patients and their families about firearm access, encouraging safe storage, and supporting firearm-related injury prevention research. Pediatricians should also play a role in educating trainees about gun violence. From a legislative perspective, universal background checks have been shown to decrease firearm homicides across all ages, and child safety laws have been shown to decrease unintentional firearm deaths and suicide deaths in youth. A collective, data-driven public health approach is crucial to halt the epidemic of pediatric firearm-related injury.
Firearm-related injuries and fatalities are a dangerous reality for children and adolescents in the United States. The firearm-related fatality rate is 49 times higher for 15- to 24-year-olds in the United States than in other high-income countries.1 Globally, 9 out of 10 children <15 years of age killed by firearms reside in the United States.1 Data from the Centers for Disease Control and Prevention (CDC) reveal that firearm-related injuries are leading causes of injury deaths in youth.2 Homicide by firearms is the fourth leading cause of injury death in 5- to 9-year-olds and 10- to 14-year-olds and the second leading cause in 15- to 19-year-olds. In addition, suicide by firearm ranks as the third most common cause of death in children 10 to 14 and 15 to 19 years of age.2 Across all ages, in 2014 firearm injuries were responsible for the same number of deaths in the United States as motor vehicle crashes.3
The morbidity, mortality, and financial costs of firearm-related violence demonstrate why guns have become a public health issue. The rate of firearm-related injuries in the United States has remained stable since the 1990s, whereas this rate in other countries has decreased during the same time period.4 Firearm-related injuries were responsible for >35 000 deaths (all ages, 2015 data) in the United States, and the medical cost of treating firearm-related injuries in children and young adults <21 years old was >$330 million (2010 cost data)2 (Table 1). This review discusses the available evidence on the epidemiology of firearm-related injuries in pediatrics and the public health interventions, the role of pediatricians, and the impact of legislation.
Total Medical Cost and Number of Nonfatal and Fatal Firearm Injuries for Ages 0–21 in the United States, 2010
Pediatric Firearm-Related Injuries and Health Care Utilization
In 2015, there were 4500 deaths from firearm violence in children and young adults <21 years of age.2 Firearm-related mortality is one of the top 4 causes of death in American youth.2 In pediatric firearm injuries presenting to US emergency departments (EDs) or ambulatory care centers from 2001 to 2010, one-third were related to homicide or suicide, but the majority of firearm-related injuries were unintentional or accidental injuries.5 Younger children are more likely to be unintentionally injured, and the majority of these accidental shootings occur in the home.6 Homicide and suicide by firearms are the second and third leading causes of death, respectively, for adolescents 15 to 19 years of age.2
EDs are an important point of entry into the health care system for victims of firearm-related injuries. Approximately 20 000 children present for care to the ED for firearm-related injuries every year.5 Children <12 years of age account for 10% of all firearm-related ED visits by children and adolescents, and those 12 to 19 years of age account for the remaining 90%.5 For every child killed, a substantially greater number are seriously injured, and ∼50% of children hospitalized for a firearm-related injury are discharged from the hospital with a disability.7
Pediatric ED evaluations and hospitalizations due to firearm-related injuries are a health care and financial burden.5 Hospitalization data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids' Inpatient Database revealed that there were >7000 hospitalizations for firearm-related injuries in US children and adolescents in 2009.8 On average, 20 US children and adolescents were hospitalized each day for firearm-related injuries. Hospitalizations due to injuries from assault were the most frequent (61.7%), whereas hospitalizations due to suicide attempt were infrequent (3.7%). In children <10 years of age, hospitalization due to unintentional firearm injuries was most common (74.2%); in contrast, in adolescents (ages 15–19 years), the majority of hospitalizations were related to assault (66.8%).8
Firearm Access in Children and Adolescents
An understanding of routes of firearm access in the pediatric population is important to help guide interventions. Surveys conducted in different parts of the United States demonstrate significant variability in firearm ownership among families with children.9–11 In a survey of 424 parents of children 4 to 12 years of age in suburban areas by Atlanta, Georgia, >25% of parents reported having firearms in their homes; however, <50% reported storing them safely.10 In another survey of 314 families with children 5 to 14 years of age in rural Alabama, 64% reported the presence of ≥1 firearm in the home.11 In a larger survey of >5000 fifth-graders and their caregivers from 3 different US metropolitan areas (conducted 2004–2006), 18% of surveyed families reported firearms in their homes.9 According to that survey, families with African American and Hispanic children had lower odds of firearm ownership than families of non-Hispanic white children, and only 6% of families with firearms stored firearms safely (locked, unassembled, with trigger locks, and with ammunition locked up). Families of non-Hispanic white children were less likely than families with African American children to engage in safer storage practices. Protection from crime and hunting were reported as the most common reasons for ownership.9
A few surveys have also reported on the behavior of young children who encounter household guns. In 1 survey, when asked what their child would do if he or she encountered a gun, nearly 75% of parents reported that the child would not touch the gun.10 However, in another observational study of gun behavior among school-age boys, the majority of the boys handled a gun after discovering it hidden in a drawer, and almost 50% pulled the trigger.12 In another study, 73% of children <10 years old living in homes with guns reported knowing the location of their parents' firearms, and 36% admitted they had handled the weapons.11 Of note, 39% of parents from that study who reported that their children did not know the storage location of household guns and 22% of parents who reported that their children had never handled a household gun were contradicted by their child's report. These studies reinforce the need for safe storage practices for household guns and the need for parents to talk to their children about firearms.
The 2011 National Youth Risk Behavior Surveillance reported that ∼5% of students in grades 9 through 12 had carried a gun in the past month.13 Furthermore, a recent survey of >3000 high school seniors found that 65% reported having ≥1 gun in their household. The likelihood of gun ownership was higher among white men and boys, and gun access was not associated with mental health status.14 There have been few studies evaluating screening practices and firearm access among adolescents in the health care setting. One study of pediatric residents from various residency programs found that only 50% reported screening for firearm access during routine adolescent health visits.15 An ED-based survey that enrolled 300 adolescents presenting for care regardless of presenting complaint found that 16% reported having a gun in their home, and 28% stated they could access a loaded gun within 3 hours.16 Furthermore, >50% of adolescents screened for firearm access stated that they had a friend or relative who owned a gun, and almost 50% reported that they knew someone who had previously been shot.16 Interestingly, a study evaluating differences in firearm accessibility between patients in the ED who presented for violence-related injuries and non–violence-related concerns found no difference in access to firearms between the 2 groups.17 Given the high prevalence of firearm access among adolescents, universal screening for access to firearms in adolescents may be a beneficial strategy.
Interventions to Improve Firearm Safety
Firearms are common in US households with children, and some studies have shown that counseling parents can improve gun safety in the home.18,19 Most families are willing to discuss gun safety with health care providers,20 and counseling by health care providers results in safer storage practices in the home.21 Interventions targeting counseling can take place in the ED, outpatient, or inpatient settings, and Tables 2 and 3 describe interventions focused on improving gun safety. Table 2 describes 6 studies with positive impact on increased gun safety in the home, and Table 3 describes 7 studies with null findings. Of note, 3 of the 6 interventions with positive findings provided free gun safety devices (locks or cabinets) to families, whereas the null studies involved interventions focused on verbal and written counseling for firearm safety.
Studied Interventions With Positive Findings (ie, Improved Gun Safety)
Studied Interventions With Null Findings (ie, Did Not Improve Gun Safety)
Many ED-based public health interventions have capitalized on the notion of a "teachable moment," or an event that motivates people to adopt risk-reducing behaviors. In a random sample of emergency physicians, the majority surveyed did not believe that their patients would be receptive to firearm safety counseling.22 However, studies demonstrate that parents who are advised by ED clinicians or mental health clinicians to restrict access to firearms after a child presents with a mental health concern are more likely to do so than parents who are not advised to restrict access.23,24 Furthermore, several ED and inpatient-instituted youth violence intervention and counseling programs have been successful in decreasing the frequency of violent aggression and criminal justice involvement.25–27
Community and clinic-based interventions have also been successful at improving firearm safety. Table 2, adapted from a systematic review that analyzed community and clinic-based studies examining safe firearm storage interventions,28 describes a few of these studies. Barkin et al21 conducted a large cluster randomized controlled multicenter study via the Pediatric Research in Office Settings network to analyze the efficacy of office-based counseling focused on violence prevention, specifically media use, corporal punishment, and firearm access. These authors highlighted health care clinicians' struggles with their role in addressing violence prevention, specifically lack of time, inadequate training, and uncertainty of impact. In response, the investigators conducted a study to compare a bundle of interventions focusing on violence prevention with usual care. The interventions included the use of a previsit summary by parents to assess behaviors and concerns about media use, discipline strategies, and children's exposure to firearms; brief motivational interviewing by clinicians; the provision of tangible tools for parents (ie, gun cable locks); and referral to local agencies for behavioral or aggression concerns.21 The authors reported that the odds of storing all firearms with a gun lock in the intervention group was twice that of the nonintervention group.21 In addition, investigations by Carbone et al29 and Grossman et al30 reported increased gun safety after family education and provision of gun safety devices. Interventions in high-risk populations (eg, children with mental health disorders or families who own guns) by Kruesi et al,23 Albright and Burge,31 and Zatzick et al32 showed increased gun safety through verbal or written counseling alone. Although the heterogeneity of these studies makes some conclusions difficult, 3 of these studies provided free safe firearm storage devices to participants. This finding suggests that combining both counseling interventions with provision of free safe storage devices may be a successful method by which to increase the safe storage of firearms.28 Table 3 describes interventions that focused on verbal and written counseling and 1 that provided coupons for discounts on gun safety devices; none of these studies demonstrated significant changes in gun safety practices. More studies in this area are necessary to better understand why some interventions work in certain settings and others fail to improve firearm safety in the homes with children.
The interventions above targeted parents and caregivers rather than the children themselves. Although programs designed to educate children and adolescents on firearm safety exist, these programs have failed to demonstrate a reduction in risky behaviors.33,34 One explanation for the lack of efficacy is that these programs focus on gun safety instruction but not behavioral skills. The National Rifle Association sponsored a program to instruct children on gun safety; however, a 2004 study showed that although children in this program were able to talk about gun safety, they failed to demonstrate gun safety in a simulation exercise.33 The risk of these programs is that by relying on a child's verbal report of gun safety knowledge, parents may overestimate their child's understanding of gun safety in practice.
Although the previously mentioned studies were conducted mainly in ED, outpatient, or community settings, to our knowledge interventions related to firearm safety have yet to be studied in the inpatient setting. As with other educational initiatives in the inpatient setting, such as smoking cessation,35,36 hospitalists often have different availability of time and resources to engage patients and caregivers on topics such as gun safety. Given the results of studies conducted in the outpatient setting, an effective inpatient intervention would include verbal and written counseling coupled with the provision of safe storage devices.
Role of Pediatricians in Curtailing Firearm-Related Injuries
The American Academy of Pediatrics (AAP) strongly supports the prevention of firearm-related injuries with an emphasis on safety counseling during routine health maintenance visits, reduced access, safe storage, and stronger regulations on the sale and purchase of firearms.37
Educating Physicians and Trainees
The AAP encourages the education of physicians on gun violence prevention, including gun safety and strategies for anticipatory guidance with patients and families.37 However, a recent systematic review found that students and trainees rarely receive training on firearm-related injury prevention and firearm safety.38 Although there are limited studies on pediatric resident perspectives, 1 study reported that the likelihood of residents asking parents about guns and providing counseling relates to level of comfort and previous education on the topic.15 Pediatricians have an opportunity to educate trainees about gun safety strategies and model ways to speak with patients and families about firearm safety. One study found that a Web-based gun violence curriculum for pediatric residents successfully increased feelings of self-efficacy in providing firearm injury prevention guidance.39 Given that increased confidence on the topic increases the likelihood that residents will provide gun safety counseling,40 incorporating such curricula for pediatric residents at the national level may be a promising strategy to improve counseling for families.
Discussing Anticipatory Guidance With Families
The lack of training on firearm safety in medical education has affected practice. In the audio recordings of >170 well child visits with pediatric residents, firearms were not discussed in a single encounter.41 Pediatricians discuss a variety of safety and injury prevention topics at routine visits, including risks of lead paint exposure, bicycle helmet safety, and substance abuse, but discussion of firearm safety remains nonexistent, a surprising finding given the magnitude of the public health threat posed by gun violence. In addition to education about safe storage, several advocacy groups, including the AAP,37 recommend encouraging parents to ask about guns in the homes of others when their children spend time in someone else's home. Encouraging parents not only helps ensure the safety of their own child but also promotes community dialogue surrounding gun safety.
The AAP also recommends that physicians screen for access to firearms in all patients with mood disorders, substance abuse, or history of suicide attempts.37 Several states, including Florida, Montana, Missouri, and Minnesota, enacted legislation limiting how and when patients can be asked about gun ownership or limiting how much they are to document in the medical record. However, they do allow physicians to ask if medically necessary and if a patient is at risk.42 Access to firearms is an obvious risk factor for suicide completion.43 Legislation that restricts a physician's ability to counsel could prevent a physician from obtaining life-saving information from a depressed adolescent who has access to firearms in his or her home. Restrictive legislation has been challenged in several state courts, and in Florida it has also involved the federal courts. The issue remains dynamic, and federal involvement may affect future legislation in other states. It is important to consider the context from which this legislation and cases evolved. In Florida, in a well-publicized case, a pediatrician discharged a family from his practice after the mother refused to answer questions about access to firearms. This case along with other complaints led to the passage of Florida's physician gag law.19,44,45, The Florida chapters of the AAP, the American Academy of Family Physicians, and the American College of Physicians challenged the law. As this issue continues to evolve, pediatricians must remain involved and aware of any legislation that restricts their ability to keep children safe.
Leading Research Efforts to Study Firearm-Related Injury Prevention
Progress in firearm injury prevention has been limited in the United States by a lack of scientific inquiry, knowledge, and publications on this topic, primarily because of lack of funding. According to a 2013 report published by the Institute of Medicine, "the scarcity of research on firearm-related violence limits policymakers' ability to propose evidence-based policies that reduce injuries and death and maximize safety."46 In the 1980s, the CDC launched efforts to promote scientific inquiries about firearm-related injuries; however, in 1996 Congress restricted the agency from funding work "to advocate or promote gun control."46 An executive order in 2013 by President Obama sought to increase firearm-related funding to the CDC, but Congress did not give full support. Journal publications are the cornerstone of dissemination of scientific knowledge and can provide evidence for intervention development and policymaking. However, given the dearth of funding in this area, publications on this topic have plateaued. Between 1985 and 1999, the annual number of publications about gun violence increased markedly, but then they plateaued through 2012 at about 90 articles annually.46 When researchers accounted for the growth of scientific literature as a whole over the time period, publications on firearm-related injury prevention declined 64% in 2012, compared with an increase in firearm-related publications between 1985 and 1999; in addition, there are few active career researchers in this area.46 Adding scientific inquiry and evidence in this area can help promote change at the local level, with more interventions or program development, and at the national level, providing policymakers with evidence. A more nuanced understanding of pediatric firearm-related injury through rigorous, well-conducted research will inform the work of public health agencies, policymakers, and pediatricians to effectively intervene legislate and counsel.
Firearm Legislation
There are >300 federal gun laws in the United States that regulate the sale and possession of firearms and ammunition. However, because of different state and local laws, there is tremendous variation in the implementation of these federal laws at the local level.47,48 A 2016 study evaluating individual laws (through 2009) compared their effectiveness in reducing firearm-related mortality.49 Only 3 laws were found to be strongly associated with reduced deaths from firearms in this study: universal background checks before the purchase of guns, universal background checks before the purchase of ammunition, and firearm identification (microstamping or ballistic fingerprinting) requirements.49 More recently, in a 2017 systematic review focusing on firearm homicide, US firearm laws were divided into 5 categories: those that curb gun trafficking, strengthen background checks, improve child safety, ban military-style assault weapons, and restrict firearms in public places.50 These researchers found that laws that strengthen background checks and that require a permit to purchase a firearm are associated with decreased firearm homicide rates across all ages. However, specific laws directed to improve child safety were not associated with decreases in firearm homicide rates.50 These findings are in contrast to other studies that focus on unintentional shooting deaths or suicide deaths (not only firearm homicides), which show a reduction in firearm-related death in children when laws aimed to improve child safety are associated with felony prosecution or broader firearm legislation to promote responsible ownership.51–53
The Brady Handgun Violence Prevention Act of 1993 (Brady Act) is one of the most significant pieces of legislation that exists to control firearm access by strengthening background checks. The Brady Act mandates that federally licensed firearm dealers perform federal background checks. The original legislation instituted a 5-day waiting period for all people purchasing a handgun; however, this requirement ended in 1998, and currently there is no federally mandated waiting period. Once the background check is complete, the gun can be transferred to the purchaser. Although a federally licensed firearm dealer is required to wait 3 business days to complete the background check, a gap in the law allows unlicensed sellers, perhaps online or at gun trade shows, to sell firearms without background checks. Background checks blocked almost 2.8 million prohibited people from purchasing or receiving a permit to purchase or carry a firearm between 1994 and 2014.54 It is important to note that unless local or state laws exist to regulate private sales, only federally licensed firearm dealers are required to conduct background checks before sales. This variability in firearm regulation at the state and local level makes evaluating the effectiveness of different categories of firearm legislation difficult.
Child safety laws include requiring the sale of guns with mechanical trigger locks and mandating age restrictions for gun purchases. Child access prevention laws regulate the safe storage of firearms to prevent access by minors and impose criminal liability on adults who allow children unsupervised access to firearms.50,51,55 No federal child access prevention law exists, and as of 2013, only 27 states and the District of Columbia have enacted child access prevention laws.56 Whereas Lee et al50 concluded in their systematic review that the overall evidence from the 9 studies related to laws improving child safety does not support the effectiveness of child protection laws in reducing firearm homicide deaths, other studies have shown that stronger firearm legislation and child safety laws are associated with safer firearm storage in families with preschool-aged children57 and that child safety laws are effective in reducing unintentional firearm and suicide deaths among children.51–53 For example, 1 study evaluated the impact of the child access prevention laws in 12 states and found that unintentional firearm deaths fell by 23% from 1990 to 1994 for children <15 years of age, but only in the subgroup of 3 states in which violation of the law was a felony.51 Other studies noted that child access prevention laws were associated with an 8.3% decrease in suicide among 14- to 17-year-olds52 and a decrease in unintentional pediatric firearm-related injuries in states with very aggressive, felony prosecution for violators (eg, Florida and California).53 Overall, child safety laws have shown reductions in unintentional firearm deaths and suicide deaths in youth, and their role in overall firearm homicide by age group may warrant more study.
Other available research examines the overall strictness of firearm regulation based on state-based legislation in relation to firearm-related injury or mortality. The Brady Campaign to Prevent Gun Violence and the Law Center to Prevent Gun Violence annually assess and compare each state's legislation on gun laws and assign a score based on various policy points including strength of background checks, limitation of military-style assault weapons, and limitation on firearms in public places.47 Although it is not a validated score, studies have used the Brady score to account for variability in state-based firearm legislation when studying firearm-related injuries. A study that examined gun laws and firearm-related injuries across 18 states revealed that states with the strictest gun laws had the lowest numbers of hospital visits for nonfatal firearm-related injuries.58 In particular, among children, stricter states also had lower rates of hospital admissions and visits for firearm-related injuries than states with less strict firearm legislation.58 Additionally, in a national sample, mean firearm-related injury rates among trauma patients were higher in states with less strict firearm legislation than in states with strict firearm legislation.48 Stricter firearm laws have also been associated with fewer high school students reporting firearm carriage in the past 30 days.59
Although the data suggest that individual review of gun laws is sufficient to evaluate their effectiveness, important interactions between laws must not be overlooked. There are hundreds of state-level laws that regulate firearms. Attention should be focused on supporting the laws, or combination of laws, that have been shown to be effective.
Firearm-related injuries are a pediatric public health crisis with significant morbidity and mortality in the United States. Of 20 000 firearm-related pediatric injuries every year, injury in younger children is generally caused by accidental access, whereas adolescent injury is most often intentional, from suicide attempts and violence. Legislation to combat firearm-related injuries has existed since the signing of the Brady Act in 1993. Since then, research has emerged clearly demonstrating that universal background checks and firearm identification are the most effective pieces of legislation to prevent firearm injuries.49,50 Child access prevention laws with felony prosecution of violators may also play an important role in the legislative environment.
Rigorous investigations, with the use of validated scoring systems, large comprehensive databases, and accurate detailed reporting and surveillance of firearm access and related injury, are urgently needed. Firearm research by the CDC has been limited by constant threats by Congress to reduce funding, and recent efforts to increase funding have been unsuccessful.60 A collective, data-driven public health approach is crucial to halt the epidemic of pediatric firearm-related injury.
Accepted March 2, 2017.
Grinshteyn E,
Hemenway D
. Violent death rates: the US compared with other high-income OECD countries, 2010. Am J Med. 2016;129(3):266–273
Centers for Disease Control and Prevention. Injury prevention and control: data and statistics (WISQARS) National Center for Health Statistics, National Vital Statistics system. Available at: www.cdc.gov/injury/wisqars/index.html. Accessed February 6, 2017
Steinbrook R,
Stern RJ,
Redberg RF
. Firearm violence: a JAMA internal medicine series. JAMA Intern Med. 2017;177(1):19–20
Wintemute GJ. The epidemiology of firearm violence in the twenty-first century United States. Annu Rev Public Health. 2015;36:5–19
Srinivasan S, Mannix R, Lee LK. Epidemiology of paediatric firearm injuries in the USA, 2001–2010. Arch Dis Child. 2014;99(4):331–335
Choi PM,
Hong C,
Bansal S,
Lumba-Brown A,
Fitzpatrick CM,
Keller MS
. Firearm injuries in the pediatric population: a tale of one city. J Trauma Acute Care Surg. 2016;80(1):64–69
DiScala C,
Sege R
. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics. 2004;113(5):1306–1312
Leventhal JM,
Gaither JR,
. Hospitalizations due to firearm injuries in children and adolescents. Pediatrics. 2014;133(2):219–225
Schwebel DC,
Lewis T,
Simon TR,
. Prevalence and correlates of firearm ownership in the homes of fifth graders: Birmingham, AL, Houston, TX, and Los Angeles, CA. Health Educ Behav. 2014;41(3):299–306
Farah MM,
Simon HK,
Kellermann AL
. Firearms in the home: parental perceptions. Pediatrics. 1999;104(5 pt 1):1059–1063
Baxley F,
Miller M
. Parental misperceptions about children and firearms. Arch Pediatr Adolesc Med. 2006;160(5):542–547
Jackman GA,
Kellermann AL,
Simon HK
. Seeing is believing: what do boys do when they find a real gun? Pediatrics. 2001;107(6):1247–1250
Eaton DK,
Kann L,
Kinchen S,
; Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance: United States, 2011. MMWR Surveill Summ. 2012;61(4):1–162
Coker AL,
Bush HM,
Follingstad DR,
Brancato CJ
. Frequency of guns in the households of high school seniors. J Sch Health. 2017;87(3):153–158
Solomon BS,
Duggan AK,
Webster D,
Serwint JR
. Pediatric residents' attitudes and behaviors related to counseling adolescents and their parents about firearm safety. Arch Pediatr Adolesc Med. 2002;156(8):769–775
Pelucio M,
Roe G,
Fiechtl J,
. Assessing survey methods and firearm exposure among adolescent emergency department patients. Pediatr Emerg Care. 2011;27(6):500–506
Downey LV,
Zun LS,
Burke T,
Jefferson T
. Does gun accessibility lead to violence-related injury? South Med J. 2013;106(2):161–172
Betz ME,
Wintemute GJ
. Physician counseling on firearm safety: a new kind of cultural competence. JAMA. 2015;314(5):449–450
Parmet WE,
Smith JA,
Miller MJ
. Wollschlaeger v. Governor of Florida: the First Amendment, physician speech, and firearm safety. N Engl J Med. 2016;374(24):2304–2307
Webster DW,
Wilson ME,
Pakula LC
. Parents' beliefs about preventing gun injuries to children. Pediatrics. 1992;89(5 pt 1):908–914
Barkin SL,
Finch SA,
Ip EH,
. Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics. 2008;122(1). Available at: www.pediatrics.org/cgi/content/full/122/1/e15
Price JH,
Thompson A,
Khubchandani J,
Wiblishauser M,
Dowling J,
Teeple K
. Perceived roles of emergency department physicians regarding anticipatory guidance on firearm safety. J Emerg Med. 2013;44(5):1007–1016
Kruesi MJ,
Grossman J,
Pennington JM,
Woodward PJ,
Duda D,
Hirsch JG
. Suicide and violence prevention: parent education in the emergency department. J Am Acad Child Adolesc Psychiatry. 1999;38(3):250–255
Runyan CW,
Becker A,
Brandspigel S,
Barber C,
Trudeau A,
Novins D
. Lethal means counseling for parents of youth seeking emergency care for suicidality. West J Emerg Med. 2016;17(1):8–14
Carter PM,
Walton MA,
Zimmerman MA,
Chermack ST,
Roche JS,
Cunningham RM
. Efficacy of a universal brief intervention for violence among urban emergency department youth. Acad Emerg Med. 2016;23(9):1061–1070
Shope JT,
. Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. JAMA. 2010;304(5):527–535
Shibru D,
Zahnd E,
Becker M,
Bekaert N,
Calhoun D,
Victorino GP
. Benefits of a hospital-based peer intervention program for violently injured youth. J Am Coll Surg. 2007;205(5):684–689
Rowhani-Rahbar A,
Simonetti JA,
Rivara FP
. Effectiveness of interventions to promote safe firearm storage. Epidemiol Rev. 2016;38(1):111–124
Carbone PS,
Clemens CJ,
Ball TM
. Effectiveness of gun-safety counseling and a gun lock giveaway in a Hispanic community. Arch Pediatr Adolesc Med. 2005;159(11):1049–1054
Grossman DC,
Stafford HA,
Koepsell TD,
Hill R,
Retzer KD,
Jones W
. Improving firearm storage in Alaska native villages: a randomized trial of household gun cabinets. Am J Public Health. 2012;102(suppl 2):S291–S297
Albright TL,
Burge SK
. Improving firearm storage habits: impact of brief office counseling by family physicians. J Am Board Fam Pract. 2003;16(1):40–46
Zatzick D,
Russo J,
Lord SP,
. Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial. JAMA Pediatr. 2014;168(6):532–539
Himle MB,
Miltenberger RG,
Gatheridge BJ,
Flessner CA
. An evaluation of two procedures for training skills to prevent gun play in children. Pediatrics. 2004;113(1 pt 1):70–77
Hardy MS
. Teaching firearm safety to children: failure of a program. J Dev Behav Pediatr. 2002;23(2):71–76
Ralston S,
Grohman C,
Word D,
Williams J
. A randomized trial of a brief intervention to promote smoking cessation for parents during child hospitalization. Pediatr Pulmonol. 2013;48(6):608–613
Roohi M
. A randomized, controlled trial of smoking cessation counseling provided during child hospitalization for respiratory illness. Pediatr Pulmonol. 2008;43(6):561–566
Dowd MD,
Sege RD
; Council on Injury, Violence, and Poison Prevention Executive CommitteeAmerican Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5). Available at: www.pediatrics.org/cgi/content/full/130/5/e1416
Puttagunta R,
Coverdale TR,
Coverdale J
. What is taught on firearm safety in undergraduate, graduate, and continuing medical education? A review of educational programs. Acad Psychiatry. 2016;40(5):821–824
Dingeldein L,
Sheehan K,
Krcmarik M,
Dowd MD
. Evaluation of a firearm injury prevention Web-based curriculum. Teach Learn Med. 2012;24(4):327–333
Cheng TL,
DeWitt TG,
Savageau JA,
O'Connor KG
. Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues. Arch Pediatr Adolesc Med. 1999;153(6):629–635
Gielen AC,
McDonald EM,
Forrest CB,
Harvilchuck JD,
Wissow L
. Injury prevention counseling in an urban pediatric clinic. Analysis of audiotaped visits. Arch Pediatr Adolesc Med. 1997;151(2):146–151
Wintemute GJ,
Ranney ML
. Yes, you can: physicians, patients, and firearms. Ann Intern Med. 2016;165(3):205–213
Brent DA,
Perper JA,
Allman CJ,
Moritz GM,
Wartella ME,
Zelenak JP
. The presence and accessibility of firearms in the homes of adolescent suicides. A case–control study. JAMA. 1991;266(21):2989–2995
Wollschlaeger et al v. Farmer et al. 880 F Supp 2d 1251 (SD Fla 2012).
Wollschlaeger et al v Governor of Florida et al. 760 F3d 1195 (11th Cir 2014).
Alcorn T
. Trends in research publications about gun violence in the United States, 1960 to 2014. JAMA Intern Med. 2017;177(1):124–126
Brady Campaign to Prevent Gun Violence. State scorecard. Available at: www.bradycampaign.org/2013-state-scorecard. Accessed August 30, 2016
Safavi A,
Rhee P,
Pandit V,
. Children are safer in states with strict firearm laws: a National Inpatient Sample study. J Trauma Acute Care Surg. 2014;76(1):146–150; discussion 150–141
Kalesan B,
Mobily ME,
Keiser O,
Fagan JA,
Galea S
. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016;387(10030):1847–1855
Lee LK,
Fleegler EW,
Farrell C,
. Firearm laws and firearm homicides: a systematic review. JAMA Intern Med. 2017;177(1):106–119
Cummings P,
Rivara FP,
Koepsell TD
. State gun safe storage laws and child mortality due to firearms. JAMA. 1997;278(13):1084–1086
Vernick JS,
Zeoli AM,
Manganello JA
. Association between youth-focused firearm laws and youth suicides. JAMA. 2004;292(5):594–601
Hepburn L,
Azrael D,
Miller M,
. The effect of child access prevention laws on unintentional child firearm fatalities, 1979–2000. J Trauma. 2006;61(2):423–428
Karberg JC, Frandsen RJ, Durso JM, Buskirk TD, Lee AD. Background Checks for Firearm Transfers, 2013–2014: Statistical Tables. Washington, DC: U.S. Department of Justice; 2016
Monuteaux MC,
Hemenway D,
Mannix R
. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med. 2013;173(9):732–740
Law Center to Prevent Gun Violence. Child access prevention policy statement. Available at: http://smartgunlaws.org/gun-laws/policy-areas/consumer-child-safety/child-access-prevention/. Accessed September 3, 2016
Prickett KC,
Martin-Storey A,
Crosnoe R
. State firearm laws, firearm ownership, and safety practices among families of preschool-aged children. Am J Public Health. 2014;104(6):1080–1086
Mills B,
Young B,
. State firearm legislation and nonfatal firearm injuries. Am J Public Health. 2015;105(8):1703–1709
Xuan Z,
. State gun law environment and youth gun carrying in the United States. JAMA Pediatr. 2015;169(11):1024–1031
Rubin R
. Tale of 2 agencies: CDC avoids gun violence research but NIH funds it. JAMA. 2016;315(16):1689–1691
Roszko PJ,
Ameli J,
Cunningham RM,
. Clinician attitudes, screening practices, and interventions to reduce firearm-related injury. Epidemiol Rev. 2016;38(1):87–110
Oatis PJ,
Fenn Buderer NM,
Fleitz R
. Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program. Inj Prev. 1999;5(1):48–52
Baugher M,
Birmaher B,
Kolko DJ,
Bridge J
. Compliance with recommendations to remove firearms in families participating in a clinical trial for adolescent depression. J Am Acad Child Adolesc Psychiatry. 2000;39(10):1220–1226
. Firearm safety counseling in primary care pediatrics: a randomized, controlled trial. Pediatrics. 2000;106(1 Pt 1):22–26
Stevens MM,
Gaffney CA,
Tosteson TD,
. Children and guns in a well child cohort. Prev Med. 2001;32(3):201–206
Johnston BD,
Droesch Rm,
Dunn C,
Copass MK
. Behavior change counseling in the emergency department to reduce injury risk: a randomized, controlled trial. Pediatrics. 2002;110(2 PT 1):267–274
You are going to email the following Pediatric Firearm-Related Injuries in the United States
Hospital Pediatrics Jun 2017, 7 (6) 303-312; DOI: 10.1542/hpeds.2016-0146


System Description: TTT YM Swing is a mean reversion swing system that tries to take advantage of the mean reversion tendencies of the Indexes. It tries to take advantage of higher probability set ups when the market is over stretched in one direction. This is reflected in the system having a high win rate. The average time in a trade is 3-5 bars and does trade long and short. It does use a stop but it varies based upon the market volatility.


Canada's most influential sport, wellness and health organizations have offered unprecedented support to Canada's provincial and territorial governments in order to inject an hour of daily physical activity into Canada's schools. The group of more than 60 private sector and not-for-profit organizations offered to share responsibility to get Canada's kids active at school — representing a historical and unrivaled movement to solve the overwhelming problem of inactive youth in Canada.
The "Active At School" initiative announced recently represents a multi-year movement by the organizations involved to work with governments and offer access to their considerable networks, resources, investments and marketing efforts to reverse the staggering trend of inactivity amongst millions of Canadian children and youth.
The group initiated meetings with governments over the past two months and will seek meetings with premiers, education and health ministers from all governments in the next 90 days to detail the breadth of what the group is offering to make an hour a day of activity in schools a reality.
Canada's children and youth are more inactive today than at any time in our country's history — a fact articulated by numerous studies and clearly recognized by Canada's concerned parents. A survey of more than 5,000 households has shown that 88 per cent of Canadian families know that being active is the right thing to do but have difficulty doing it, citing a lack of time, safety and financial resources as barriers to greater activity. The same study showed that more than 85 per cent of Canadians agree that schools should have daily physical activity for all students.
• improve concentration and academic performance.
Schools represent a safe and structured environment where all students, regardless of background or means, have the opportunity to succeed. Canada's school system, however, is facing extraordinary pressures and competing priorities.
More than 60 partners have rallied together to support an hour a day of activity at school. Inevitably more partners will join the movement in the coming months.
By working together, Active At School will raise awareness of the issue and the solution, as well as work with governments, school boards and industry partners to determine how best to achieve one hour a day of quality physical activity. Active At School partners expect to be making additional announcements in the days, weeks and months to come related to campaign successes and progress.
Join them on Facebook at Facebook.com/activeatschool.
Follow the conversation on Twitter, #activeatschool.


Series: Friends Serving Abroad (1), The Teachings of Jesus (17), Testimonies (1), Advent 2013 (2), James and Peter (9), Weekly Sermons (19).
Preached by Gil George on December 28, 2014 (Sunday Morning).
John 19:38-42 (Part of the Weekly Sermons series).
Preached by Price Northcutt on December 7, 2014 (Sunday Morning).
Ecclesiastes 3:9-14 (Part of the Weekly Sermons series).
Preached by Price Northcutt on November 30, 2014 (Sunday Morning).
Preached by Kathy Hjelm on November 23, 2014 (Sunday Morning).
Matthew 7:21-29 (Part of the The Teachings of Jesus series).
Preached by Gil George on November 2, 2014 (Sunday Morning).
John 4:1-26 (Part of the The Teachings of Jesus series).
Preached by Price Northcutt on October 26, 2014 (Sunday Morning).
Matthew 7:15-20 (Part of the The Teachings of Jesus series).
Preached by Gil George on October 19, 2014 (Sunday Morning).


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Food addiction affects us physically, mentally, behaviorally, emotionally, and even spiritually. The diseases associated with chronic over-consumption of processed foods are extensive. Food addiction may be common and you can find a Handout here that will help you find food addiction recovery programs.
Welcome to Food Addiction Recovery Programs!
about the ONLY textbook ever about food addiction!
Simple short Handouts help practitioners and clients learn about the causes of food addiction and how to keep it in remission.


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Senior Ruby Brayton receives award for student activist efforts
January 4, 2019 February 24, 2020 Former Staff Member	Blake High School, Ruby Brayton, Student activism
Senior and student activist Ruby Brayton and 19 other Maryland students were awarded the Pax Christi Metro DC-Baltimore (PCMDCB) "Peacemaker of the Year" award at Stone Ridge, November 18.
Pax Christi USA promotes Peace by exploring, living, and articulating the vocation of nonviolent peacemaking. The PCMDCB serves as a peace witness in the Metro DC and Baltimore area. The award was given to Brayton and the other students in light of their political activism.
An example of Brayton taking part in student activism is her role in MoCo Students for Change as one of the founders and vice presidents. On March 14 last school year, the group led students from Blake and over a dozen other high schools in Montgomery County to the capitol to protest gun violence.
Some other notable protests Brayton has planned or taken part in are the March for Our lives, the Columbine 19th anniversary walkout, the walkout in Annapolis at the state house and the anti-Brett Kavanaugh protest at the Supreme Court.
Brayton expresses that activism is difficult but worth the time she dedicates to it. "Being a student activist is simultaneously one of the most frustrating, emotionally challenging and rewarding things I have ever done," she says. "Knowing that the efforts of my peers and I have encouraged change from a local to a national level is, without a doubt, one of the most gratifying feelings I have ever experienced."
Student activism is not the only thing Brayton plays a part in at Blake. She says, "Within Blake I'm your average senior involved in a number of clubs." Some of the clubs she is involved in include Allies for Equality, Black Student Union, Jewish Culture Club and FAME.
One club Brayton is a leader of Allies for Equality (A4E). The club provides a safe environment for students to support each other and discuss topics relevant to the LGBTQ+ community.
Allies' key focus is to promote equality in the Blake environment. Brayton elaborates on the importance of that. She says, "When I see injustice taking place at any level, it's practically subconscious at this point for me to shed my fear and stand up for what I know is right."
Brayton gives some advice to other future student activists. "Many of my peers have asked me how to get involved," she adds. "It's not as hard as it looks."
"Don't be afraid to cause a little trouble," she adds. "As the timeless John Lewis so eloquently said, 'Never, ever be afraid to make some noise and get in good trouble, necessary trouble.'"
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Quantum has achieved 214% growth in Scotland during 2018 with 24 new Drive Maintenance Contract Partnerships in place. With a current run rate of three new contracts a month, this expansion see's our existing team in Scotland move into a new bespoke Variable Speed Drive Service Centre at Hillington Industrial Estate near Glasgow.
The new facility will see jobs created in Scotland, based at the new Drive Service Centre. We are currently recruiting for Drive Service Engineers, Office Administrators and Technical Support Engineers.
This year we have been the winner of Global 100's Best ABB Drives Service Supplier of the Year, Business Excellence Drives and Motors Supplier of the Year and Corporate Livewire Drive Rental Company of the Year. This success and our growth has made 2018 one of our biggest years.
All manufacturing facilities use motors as the workhorse for their various processes, these motors are now most commonly controlled by Variable Speed Drive technology. While there are some companies that can offer support on one particular make of drive, we feel this does not offer what the modern market place demands. While a company may prefer a brand of drive there is not one plant in Scotland that we know of that does not have different makes and power ratings installed, all of which need maintaining and supporting.
Quantum Controls have been an ABB Drive Service Partner for over 25 years, in 2018 we formed new partnerships with all major Drive Suppliers in the UK and are the Official Service Partner for Schneider, Danfoss, Vacon, Mitsubishi and Control Techniques Nidec, and have engineers fully trained on Siemens Drives.
The fact that Quantum can offer unique Drive Maintenance Partnerships that cover ALL the drives you have on site have led to our exceptional growth in Scotland.
"With all these factors considered we have decided to make this investment in our business in Scotland. The New Drive Service Centre near Glasgow creates local 24/7 support for all of our clients based throughout Scotland and creates new jobs locally" say Kevin Brown, Managing Director, Quantum Controls.
Quantum Controls, established in 2009, have grown from a staff of 12 to currently employing 69 people with a turnover more than £10 million in 2018. With existing Head Offices at Prudhoe near Newcastle and Service Centres at Birtley, Thetford, Leeds and now Glasgow.
The new facility will be up and running in December 2018. We will be looking to recruit immediately, so if you would like to be part of this exciting new facility, get in touch with us hr@quantum-controls.co.uk.


One client loved cooking, yet had only a small, odd assortment of pots and pans. Another client didn't like to cook, yet had numerous pots and pans, yet all were old and dented.
Fortunately both women laughed as they described their cookware as "good enough."
Both homes were clean, even beautiful. Both women were productive and self-aware. And both were recovering from serious illness, requiring careful, healthy food preparation.
The cookware wasn't good enough anymore - it may have at one time, but now it didn't fit they're current aesthetic or the importance food had become in their present need to heal. It had become clutter.
We cleared out most of the cookware, and voila! Lots of room for new stuff. We took an inventory, deciding what really was needed now. One woman shopped at a high-end kitchen store, the other at a high-end consignment shop.
After de-cluttering, we organized the cabinets to make it easy to reach and use the pots and pans. No more struggle!
Now the minute they touch the pan they love, they feel good, contributing their enjoyment of cooking and healing. Now good enough is enough.
In principal, it's a great idea to donate your clutter to an organization or a friend, but do so with awareness.
Every good intention takes your precious time and energy. Without planning, all your good intentions can get stuck for weeks at your front door or in your car, which can be very frustrating, and make you feel bad.
Ask yourself whether it is worth your effort: holding the intention, calling to make donation arrangements, schleping it into the car, making time to deliver it.
To use your time and energy well, call ahead to ask whether they take what you have to give, and what days they take donations. Clear your clutter the day before and make a weekly routine, clearly a little bit at a time. If giving your stuff away to a friend, ask first. You don't want to add to their clutter just because they dont know how to say, "No thanks."
With awareness and planning, you'll ge the clutter out of your house, and prevent feeling overwhelmed by your pile of good intentions.
A f rustrated client thought moving would solve the trouble with her house. Everything seemed wrong to her and she rarely invited people over. She "wanted out of her messy house." What I saw was a nice house with potential. She needed to make the social rooms more comfortable, and get a proper desk and file storage.
We sold and bought furniture on consignment and rearranged the rooms and decor. In two visits, she eased into a cozy chair, and put her feet up.
We next got to work in creating new space for her home office. While we cleared, I showed her what papers to keep, what to shred, and how. Though she felt buried by her papers, there wasn't as many as she first thought.
What a relief! The house looked and felt great, and she had a party to celebrate. Without "getting rid of" her house, she felt right at home.
Clearing clutter is much more than simply organizing and "getting rid of stuff." Good tips are sustainable only when you take care of what's under the clutter – your unique thinking and the subsequent emotions that get in the way. For sustainable relief, tips and techniques need to be adapted to your unique home, lifestyle and thinking.
It's easier to think there is something wrong with you than to ask for help. Brain surgery isn't necessary, but most of us do need help to learn what adjustments will make your clutter-clearing easier. This is different for everyone. Once you're thinking clearly, it's easy to sustain new habits and routines over time.
It's very easy to get into our mess by ourselves, but very hard to get out alone. By definition, you can't think clearly when overwhelmed. Being overwhelmed is not a sign that there's something wrong with you; it's a sign that you need help, clarity. When thinking clearly, you'll feel better, and the doing becomes easy.
Clearing clutter takes work and time, but it can be enjoyable. It's easier to stay overwhelmed and think there is something wrong with you than pick up the phone for help. Your significant other is not the person to turn to. It's likely you'll fight. No matter what your challenges, faults or failures - you can learn.


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BusinessPublic
Verano Revenue Rises, Trims Losses
Debra BorchardtAugust 16, 20224min2280
Verano Holdings
Verano Holdings Corp. (CSE: VRNO) (OTCQX: VRNOF) announced its unaudited financial results for the second quarter ended June 30, 2022, with revenue increasing 12% to $224 million versus the same time period in 2021. This was slightly higher than the Yahoo Finance average analyst estimate for Verano revenues of C$280 million, which when roughly converted to today's exchange is $217 million and higher than the first quarter's revenues of $202 million. The company also trimmed its net losses to $10 million from last year's net loss of $30 million.
"I am very proud of our performance this quarter alongside the strategic investments we made to ensure our high operational standards touch every part of our business," said George Archos, Verano Founder, and Chief Executive Officer. "Despite ongoing macroeconomic headwinds, we achieved a number of wins throughout the quarter, including the successful launch of adult-use sales in New Jersey, exceeding a milestone of operating more than 100 dispensaries following the opening of seven new stores in Florida, West Virginia and Pennsylvania, announced a partnership with Mission Green to advance cannabis clemency and social equity initiatives, and launched mobile applications and rewards programs for our flagship Zen Leaf and MÜV dispensaries. I am proud of what we have accomplished since going public last year and remain confident that the strategy and plans we have in place will drive long term, sustainable growth for Verano."
Verano noted that it has surpassed the 50-store mark in the state of Florida. It has also started sales in the new market of New Jersey with locations in Elizabeth and Lawrence Townships. Following the close of the quarter, Verano maximized its New Jersey footprint with the start of adult-use sales at Zen Leaf Neptune on the Jersey Shore.
Also after the quarter closed Verano said it launched its signature flower branded products in four new core markets – Arizona, Florida, Massachusetts, and Pennsylvania. The company also announced the upcoming launch of Savvy in September 2022, a new brand featuring larger-format cannabis products that cater to more value-oriented patients and consumers, across seven core markets.
As of June 30, 2022, Verano said its current assets were $288 million, including cash and cash equivalents of $93 million. The company said it had working capital (deficit) of $(299) million and total debt, net of issuance costs, of $403 million.
In July, Verano told investors that it would have to restate its earnings due to accounting errors that were uncovered. The company's Audit Committee determined that its tax expense for the first quarter 2022 report was overstated due to a clerical error in the effective tax rate calculation, and accordingly, the company's tax obligation will be reduced.
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Home / All Blu-rays / The Sanctity of Space Blu-Ray
Blackfish Blu-ray
The Act of Killing Blu-ray
Gimme Danger Blu-ray
Mountain Blu-ray
Apollo 11 4K UHD
The Look of Silence Blu-ray
O.J.: Made in America Blu-ray
Hoop Dreams: 20th Anniversary Restoration Blu-ray
Matangi / Maya / M.I.A. Blu-ray
Lo and Behold, Reveries of the Connected World Blu-ray
Honeyland Blu-ray
Laura Poitras Collection Blu-ray
Maiden Blu-ray
Stray Blu-ray
George Best: All By Himself Blu-ray
Collective Blu-ray
Three Identical Strangers Blu-ray
Lynch/Oz Blu-ray
Spaceship Earth Blu-ray
Cunningham Blu-ray
MLK/FBI Blu-ray
RBG Blu-ray
Dionne Warwick: Don't Make Me Over Blu-ray
My Rembrandt Blu-ray
The Wonderful: Stories from the Space Station Blu-ray


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Home / News / Reviews / Speaker / Mission to Clear Space Junk Using Magnets Set for Launch
Mission to Clear Space Junk Using Magnets Set for Launch
March 21, 2021 News, Reviews, Speaker
A Japanese-made technology aimed at clearing low-Earth orbit of hazardous space debris is about to be put through its paces.
Space junk is a growing problem, with around 9,000 tons of the stuff currently orbiting our planet in millions of pieces. Much of the debris poses a serious threat to functioning satellites that provide important telecommunications services, weather information, and other data for daily life here on terra firma. The human-inhabited International Space Station isn't free of danger, either, as only last year it was forced to perform a swift maneuver to dodge a piece of junk that could've caused a catastrophic accident.
NASA defines space junk as "human-generated objects, such as pieces of spacecraft, tiny flecks of paint from a spacecraft, parts of rockets, satellites that are no longer working, or explosions of objects in orbit flying around in space at high speeds."
Japan-based Astroscale has developed a system that will use magnets to attract debris before carrying it toward the Earth's atmosphere where both the satellite and the junk will burn up.
Its first demonstration mission, called ELSA-d, will launch from Kazakhstan on the evening of Sunday, March 21 ET. You can watch it live in the embedded player below.
The test mission will use the main "servicer satellite" and also a "client satellite" that will act as piece of space junk. Once in low-Earth orbit, the servicer satellite will release the "junk" before attempting a rendezvous procedure using its magnetic docking technology.
The process of catching and releasing will be performed repeatedly over the next six months, with each procedure presenting a greater level of difficulty. The aim of the mission is to confirm the servicer satellite's ability to locate and dock with targeted pieces of space junk.
Notably, the satellite is not designed to capture pieces of junk that are currently in orbit, but instead satellites deployed in the future that are fitted with special docking plates compatible with Astroscale's system.
A NASA report published earlier this year highlighted the problem of space-based debris. It said there are currently at least 26,000 pieces of junk "the size of a softball or larger that could destroy a satellite on impact; over 500,000 the size of a marble big enough to cause damage to spacecraft or satellites; and over 100 million the size of a grain of salt that could puncture a spacesuit."
And with more satellites big and small heading to space, the problem is set to worsen unless technology like Astroscale's starts tackling it.
Indeed, a growing number of companies are developing various junk-busting technologies that include an iodine thruster system, a giant space harpoon, and a collision avoidance process that uses talcum powder and lasers.
Editors' Recommendations
Mission to Clear Space Junk Using Magnets Set for Launch Reviewed by Newsrust on March 21, 2021 Rating: 5


I cannot beleive it's been an entire year since sweet Dante made his grand entrance into the world, an especially my heart. Two ways to describe him: Gigantic (he looks like a two year old now!) and ever smiling (just my type of person, eh?).
Federico and Anastasia, I couldn't be happier for your little family and cannot wait to see Dante grow! For now, here's a flashback to his sweet newborn session we did in their home a year ago!


Seven Hills Motorcars is veryproud to offer this beautiful numbers matching 1972 Corvette Convertible with only 29,575 original miles, a 4-Speen manual transmission, and both hard and softtop. This Stingray looks nice, runs great, and drives awesome. It is finished in the highly desirable combination of Mille Miglia Red (973) over Black Vinyl (400). This is the correct and original color scheme as verified by the codes on the trim tag pictured below and the original "Corvette Order Copy" that is also still with the car. This Corvette is completely "Numbers Matching" with the last six digits of the VIN stamped on the engine pad, which is pictured below. The transmission is also original with the last six digits of the VIN stamped on the main case and pictured below. The very low mileage is verified as original not only by the condition of the car, but also the clear Ohio title pictured below that shows the mileage as "Actual."This Corvette came from the factory equipped with many sought-after options such as the convertible body style, auxiliary hardtop, tilt and telescopic steering column, power steering, power brakes, and the beautiful color combination.We have this car priced to sell and are offering an excellent opportunity to own a very desirable Corvette at an unbeatable value. It is exceptionally rare to find a Corvette from this era with this low mileage. One could easily buy this car now and sell it for more than the purchase price in years to come as the market on "chrome bumper" C3 Corvettes from 1968-1972 is absolutely red hot right now, out of those years we have found the 1969 and 1972 to be most desirable. Please peruse all of the photos, video, list of numbers, and other information below to get a true sense of this Corvette.
Mille Miglia Red Chevrolet Corvette with 78,279 Miles available now!
1973 Chevrolet Corvette, Mille Miglia Red with 78,279 Miles available now!
Chevrolet Corvette Mille Miglia Red with 78,279 Miles, for sale!


May's Lick, Kentucky is simply May's Lick, Kentucky. Or is it?
May's Lick is just south of the Ohio River. It is at that eastern edge of a state where many of the occupations appeared identical with those of its nearest neighboring state Ohio. The only difference was Kentucky had slavery, Ohio was against slavery. Depending on how you interpeted the geography of Drake's residency, he was either just south of a state of freedom for the African-American population. On the other hand he was just far enough to the south of the Ohio River to be living on the other side of those bars separating freedom from the lack thereof.
In terms of the medical geography of this region, similar very different conclusions could be drawn about Drake's home setting. To the north was the well defined cold portions of the Northern Temperate Zone. Travel south and you head into the deepest parts of a much warmer temperate zone climate, which in some places approached the humidity, heat and discomforts of the couthmost torrid-like settings of this zone. On a bad summer's night you might consider yourself too far into the south, and very susceptible to infection by the more vicious forms of fever striking these slave-rich states. As a result you may retreat into the cooler climates of nearby mountain settings, where poverty reigned along with diseases of a different form–due to fevers of a different form and geographical etiology.
Daniel Drake was an industrious and well-learned doctor, but he at times seemed to go well beyond his boundaries trying to discover what was just on the other side of the unknown. In the Midwest, as milk sickness began to strike numerous overland trail families, even killing some infants along the way due to the poison bore by the Europearium plant, Dr. Drake was busy contesting his theory that these deaths due to milk sickness were due to cattle and oxen grazing upon the numerous poison ivy plants residing in the same vicinity. One of Dr. Drake's other very interesting writings (penned much later, ca. 1845) was his geography of the Great Plains series, a massive three volume set that in part details the medical geography and geological findings for the time about how this part of the earth's surface had formed. Drake's summaries in these writings are at times informative, but not deserving perhaps of the lengthy amounts of text he produced building up to his final conclusions. Still, Drake's writings and history are overall very informative and very important in the history of disease mapping and medical geography.
When Daniel Drake wrote this article, decades prior to his milk fever mistake and his verbiose midwestern study, more than a decade had passed since yellow fever first drew the attention of physicians towards the geography of disease and the influences of climate and topography on disease behaviors along the east coast. The 1793 epidemic was the first yellow fever epidemic to strike this region since the colonial years. As a result, Benjamin Rush and others published a number of writings trying to define the cause for this serious and deadly epidemic. These first epidemics of yellow fever in United States port cities infected only a handful of these population rich settings. Philadelphia was impacted, as well as New York perhaps, although the effects of this fever would have been barely noticeable in comparison with Philadelphia. It is also possible that several other large port cities like Providence, R.I. and several more southern ports were infected by this new version of what was commonly refered to as malignant fever.
With attention more focused by the time the second such epidemic struck Philadelphia, and this time most certainly New York City, physicians and others were ready and alert to the numerous potential causes out there for this severely bad example of fevers. Like many writers, Daniel Drake mentioned a number of possible observations that he felt were related to the yellow fever that struck May's Lick, Kentucky in 1807. He does not treat the inland epidemic in Kentucky as if it were the yellow fever epidemic. Were he familiar with the writings on Lake fever by Watkins of New York, then he most certainly could have included this "diagnosis" of the fever type in his essay. Fortunately and unfortunately, he does not.
But as for cause and geographical reasons for this disease, Drake does take some cautious steps in drawing his conclusions. Drake rightfully includes the mention of insects as a possible cause for this mysterious and most deadly illness. In the mind of contemporary disease geographers for his time, he perhaps resided to far inland to be suceptible to the famous yellow fever with its roots in the Caribbean. Much of the blame for this and other fevers like Watkins' "Lake Fever" are related more to local topography that to just the local plants or insecta. But Drake added a few more possible causes for these typhoid and swamp fevers.
Daniel Drake writes about a form of "typhous" or "typhoid" fever with "bilious symptoms." For the time, no distinction between typhoid (mosquitoes) and typhus (mice and rats) was known, and would not be even partially understood for decades to come. Drake notes the period when this fever struck as October "10th or 15th". Could geography and the definition of disease zones on the earth be a reason for Drake's conclusions and hesitancy to make an exact diagnosis?
Were he living in Ohio, just a few minutes north of Kentucky in terms of latitude, then he might be residing in a state where yellow fever did prevail, due to the latitude in combination with the heavily travelled Ohio River. Moreover, this is the peak period for yellow fever epidemics to commence its continuous epidemic like pattern in places like Ohio. To the south it should have initiated two to four weeks earlier. But since this is still within the mid-Atlantic states region, this disease was considered to be now well into its period of time when it was expected to create havoc along shoreline and inland shipping routes. Such was not the case for Drake's homestead setting, and so such was not the diagnosis for this May's Lick Fever.


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20 of the Most Impressive American Performance Models From the '90s
By vukasin
Ever since the '60s, the muscle car wars have been a part of the American automotive landscape. Although the '70s and early '80s weren't the best times for the domestic performance models, the late '80s brought a much-needed rise in power. And that is what rejuvenated the American muscle and performance market.
However, when the '90s came, Detroit was ready to greet a new decade with a host of performance, muscle and sports cars. And those cars sparked the imagination of the car-loving public. Some even say the '90s were the golden years of American performance. In fact, never before or since have there been so many great cars on offer. So, keep reading to learn more about 20 of the most impressive American Performance Models from the '90s.
Chevrolet 454 SS
After almost two decades of low compression engines, safety and environmental laws, and slow performance cars, in the early '90s, U.S. manufacturers finally started to produce faster, more powerful models. In fact, the wave of new-found performance was so overwhelming, every pickup brand had their own fast model, special version or a limited edition.
However, one of the most menacing and powerful models was the mighty Chevrolet 454 SS. The basic idea behind this model was to offer the biggest available engine in the lightest full-size truck. It was basically the muscle car philosophy in truck form. And that is why the Chevrolet engineers took the ordinary 1990 Chevy 1500 pickup truck with the short bed option and added a massive 454 V8 engine.
The enormous 7.2-liter V8 was good enough to produce 230 to 255 HP, which was a diminutive number. However, it also had 385 lb-ft of torque to make it fly down the road. They borrowed a big block engine from Chevrolet's heavy-duty truck lineup. Although the motor was durable, it was also a thirsty machine.
On the outside, the 454 SS was rather low key without any wild graphics or color choices. On the back of the bed, there was a model designation. In fact, the only difference was the blackout front grille. However, despite the big torque number, the 454 SS wasn't all that fast and it couldn't beat sports cars like the GMC Syclone, for example. Still, it was one of the fastest trucks around and a cool looking vehicle.


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Report: The NRA's Murder Insurance Program is a Financial Disaster
Written by JM Ashby
The National Rifle Association (NRA) filed a lawsuit against the state of New York and Governor Andrew Cuomo earlier this year claiming that Cuomo's public relations campaign against the NRA has driven them toward bankruptcy.
Reports about the NRA's demise were met with a reasonable amount of skepticism because the NRA was still spending lots of money, but Open Secrets recently published records that showed the NRA is putting it all on their credit card. The NRA's revenue has plummeted and they're running a deficit to fund their operations.
The Trace now reports that the NRA's Murder Insurance program, known as "Carry Guard," is at the center of the association's financial problems.
Based on their reporting, it also appears that the NRA official who created the Murder Insurance program is a fraudster. Sources who spoke to The Trace about the official, Joshua Powell, say his program is killing the group, but a followup investigation found that the NRA probably shouldn't have ever trusted him with anything.
"Carry Guard is Josh's baby," a source close to the NRA told The Trace. "It was his brainchild, billed by Josh as an integral part of securing the NRA's finances well into the future. But it's a huge fucking mess." [...]
A Trace investigation into Powell's business record, including a review of thousands of pages of legal documents and interviews with a dozen former associates, has uncovered a long history of mismanagement and financial irresponsibility. Prior to joining the gun group, Powell and his business ventures left a trail of defaulted debts, seized bank accounts, and jilted partners from Ireland to Montana, sparking more than 20 lawsuits for more than $400,000 from carpenters, modeling agencies, boutique gun-makers, and dozens of other vendors. (Of those, one is ongoing and one was dismissed; the rest ended either in a default judgment in favor of the creditors or an out-of-court settlement). Once, a lawyer he'd hired to represent him in a lawsuit over nonpayment sued him for nonpayment. [...]
To those who knew Powell from his former career, his travails at the NRA are unsurprising. What stunned them was that he was hired by the NRA at all. "When we heard he got the job," said Cheryl Klonoski, who worked for Powell for several years as a retail manager, "we were all like, 'Wow, didn't anyone fucking vet this guy?'"
Apparently not.
The Trace report goes into much further detail but suffice to say virtually everything Joshua Powell has ever touched in his life has turned to shit. Actually, you could swap his name for Trump's in this report and you'd be none the wiser if no one told you.
Maybe that makes him the perfect man for the job at this particular moment. The NRA got more than they bargained for when they conspired with Russian oligarchs to help Trump get elected. Their own Trump-lite character is running the organization into the ground.
I expect we'll see Powell resign in the near future.
The Bob Cesca Show Presented By BubbleGenius.com 10/2/18
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waspuppet
I can't wait to hear how this is all the liberals' fault.
Draxiar
Awww….thoughts and prayers mofos…thoughts and prayers…
HAHAHAHAHA!!
muselet
The NRA's board got took by a charismatic swindler with a good wardrobe, iffy personal grooming, a long history of cons big and small, and—apparently—a really good line of patter. I guess that's what happens when a group uses an irrelevant trait—professed enthusiasm for firearms, in this case—as a proxy for trustworthiness.
I'm trying hard not to laugh fit to bust a gut over this story. I can be petty that way.
Let the laughs fly, sir!
Aynwrong
" "Every great cause begins as a movement, becomes a business, and eventually degenerates into a racket." ~ Eric Hoffer
I suspect the modern NRA skipped the first two parts.
IrishGrrrl
This is one of the few bright spots in the news lately. I'm tickled pink the NRA got taken to the cleaners and I'll laugh them all the way out the door.
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