10 California hospitals fined for serious errors









Ten California hospitals received fines Thursday for errors that resulted in either serious injury or death to a patient.


The California Department of Public Health issued a total of $785,000 in penalties for errors that include removing the wrong kidney, leaving surgical objects behind and failing to call for assistance when a patient began bleeding excessively.


The civil fines, ranging from $10,000 to $100,000, were issued to hospitals throughout the state for errors that occurred in 2010 and 2011. Two facilities in Los Angeles County and two in Orange County were among those fined.








Hospitals are required to report certain errors to the state. The goal of issuing the penalties and making them public is to reduce surgical and medication mistakes, said Debby Rogers, deputy director of the department's Center for Healthcare Quality.


"The value of the fines is bringing awareness both to the healthcare industry and healthcare providers but also to consumers," she said in a call to reporters.


Four of the hospitals fined were Kaiser facilities. At Kaiser's South Bay Medical Center, a patient died after mistakenly being given a blood thinner instead of medication to stop bleeding in the digestive tract. The state fined the facility $50,000. At the Kaiser's Oakland Medical Center, a 29-year-old woman died during a laser surgery to remove a congenital birth defect from her upper lip. The state fined the hospital $100,000.


An official with Kaiser Foundation Hospitals and Health Plan in Northern California said in a statement that she deeply regretted what occurred at its Oakland facility. "This should never have happened and we have taken steps to prevent it from happening again," said Barbara Crawford, vice president of quality and regulatory services.


Kaiser's Southern California office also submitted a statement saying that patient safety is "paramount" and that the facility took the errors very seriously and put in additional safeguards to prevent future problems.


A few of the penalties were due to surgical items being left behind in patients during operations. At Methodist Hospital of Southern California in Arcadia, surgeons left in a sponge when doing a gallbladder surgery and had to do another operation to remove it. The fine was $50,000.


Hospital spokesman Rick Miller said it was a "one-time" incident. "Since that time, we revamped our policies and procedures," he said. "There have been no other cases like this."


One facility, UC San Francisco Medical Center, received its sixth fine since 2007. In 2010, a nurse practitioner prescribed a cancer patient a medication that she was allergic to, resulting in her spending time in the intensive care unit and a skilled nursing facility.


The fact that the hospital has had so many fines is "obviously concerning to us," Rogers said.


After the error, the medical center re-trained staff on procedures regarding allergies and evaluated the nurse practitioner workload. The hospital also now has a comprehensive electronic health records system that makes it easier to access patient information, said Josh Adler, chief medical officer of UCSF Medical Center.


Rogers said the state recently proposed regulations that would raise the amount of penalties, making the initial fine $75,000, the second $100,000 and the third $125,000. The regulations also would allow the state to issue fines for errors that do not rise to the level of "immediate jeopardy" to patient health and safety.


The two Orange County hospitals that were fined were Mission Hospital Regional Medical Center in Mission Viejo and Orange Coast Memorial Medical Center in Fountain Valley.


Since 2007, the state has fined 141 hospitals a total of $9.6 million in penalties. The state has collected $7.5 million of that amount.


anna.gorman@latimes.com





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Family Is Jailed in England Over Forced Labor





DUBLIN — Five members of an Irish family who enjoyed lavish lifestyles from the proceeds of forced labor were jailed in England on Wednesday after a three-month trial.




Bristol Crown Court heard harrowing details of how the family enticed mentally ill, alcoholic and homeless men to work in their paving and patio business based in Bedford, England, for as little as $8 a day. They kept the men in filthy trailers and forced them to perform menial tasks like cleaning the family’s toilets. At times, the men were so hungry they resorted to scavenging for food in supermarket garbage and were subjected to threats and beatings if they tried to leave.


Some had worked in such circumstances for two decades. However, the judge ordered the jury to drop a second charge of conspiracy to hold a person in servitude.


William Connors, 52, was sentenced to six and a half years, and his wife, Mary, 48, was sentenced to two years and three months. One of their sons, John, 29, received four years, and another son, James, 20, was sent to a juvenile detention center for three years. A son-in-law, Miles Connors, 24, was given a three-year prison sentence.


The court heard testimony that the Connors family had made a fortune from the proceeds of their crimes. They drove expensive cars and went on luxury vacations. Some of the family lived in houses worth millions, had millions in bank accounts and owned several properties in Ireland. These are now subject to possible seizure as criminal assets.


The police began investigating the family after the body of one of their workers, Christopher Nicholls, 40, was discovered in 2008. They were placed under surveillance in August 2010, and evidence was recorded of men being assaulted. In April 2010, the Coroners and Justice Act was introduced, making it an offense to conspire to hold someone in servitude and require that individual to carry out forced or compulsory labor.


After sentencing, the officer who had led the investigation, Detective Chief Inspector Dave Sellwood, described the Connors family as “greedy, arrogant people” who preyed on the weak.


“This was a criminal enterprise from beginning to end,” he told RTE, the Irish national broadcaster. “They picked up vulnerable people, they offered them a new life and hope when they didn’t have any, and then they dashed that.”


The family maintained that the men were “free agents” able to come and go as they pleased. The family said they had acted as “good Samaritans” by providing them with food, work and housing.


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New Online Privacy Loophole Lets Facebook Advertise to Kids






Mark Zuckerberg‘s been eager to find a way to get more kids on Facebook for years, and on Wednesday, the Federal Trade Commission handed it to him on a platter. That might be overstating it a little bit. It’s more like the FTC served it to him on a platter covered in plastic wrap with a note attached that says “Do not open.” Nevertheless, should Facebook decided to see what’s inside, experts in online privacy for children say the social network could legally start peddling everything from kids’ bicycles to that new gender-neutral Easy Bake Oven.


RELATED: German Official Urges Citizens to Stop Using Facebook






After months of deliberating and plenty of lobbying on both sides of the issue, the FTC updated the controversial Children’s Online Privacy Protection Act (COPPA) this week. The changes were absolutely designed to better protect children in the privacy-invading era of social media, especially from the data-hungry advertisers who want to sell them things. Websites like Facebook don’t allow kids to sign up without their parents permission, generally because COPPA has prohibited them from collecting the kinds of information they need to serve them ads. And why would they want a user to whom they couldn’t serve ads? Under the new FTC rules, parental permission is required for just about anything a kid would do on Facebook, including uploading photos, videos and geolocational information. Tracking tools like cookies are also verboten without a parent’s permission.


RELATED: What Police Learn About You When They Subpoena Your Facebook Account


But there’s a loophole. The new rules say very plainly that no parental permission is needed “for the sole purpose of supporting the website or online service’s internal operations, such as contextual advertising, frequency capping, legal compliance, site analysis, and network communications.” The key phrase there is “contextual advertising,” which is an ad product Facebook has been working on for a while. Facebook’s version basically reads your News Feed and shows you ads that are relevant, or contextual, to what you’re reading. As a few people have pointed out, this opens a door for Facebook to start exploring the idea of ad-supported profiles for kids. Alan Simpson, the vice president of child privacy advocacy group Common Sense, isn’t happy about this idea. “Common Sense doesn’t like this part, and the industry lobbyists probably do,” he told TechCrunch Monday evening.


RELATED: What Facebook Does to Kids’ Brains


Now, there are a lot of ifs in this scenario. Based on the magnitude and sensitivity of the issue, Facebook probably doesn’t want to go scaring a bunch of parents by sneaking through loopholes to show their kids Easy Bake Oven ads. It has been nearly a decade and a half since COPPA got an update, though, and Mark Zuckerberg isn’t really known for his patience. Of course, Facebook could do what they’ve been doing for ages, which is look over their shoulder while kids lie about having permission and sign up anyways.


Social Media News Headlines – Yahoo! News





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The X Factor: Finalists Sing for Votes One Last Time






The X Factor










12/19/2012 at 10:40 PM EST







from left: Fifth Harmony, Tate Stevens and Carly Rose Sonenclar


Ray Mickshaw/FOX


Who's going to get a $5 million recording contract?

The X Factor's season 2 finale got underway Wednesday night with the finalists performing three songs each – including a duet with a music superstar.

Britney Spears's contestant, Carly Rose Sonenclar, has been a favorite, trading the No. 1 spot with her fellow finalist, L.A. Reid's country singer Tate Stevens, through out the competition.

Carly first reprised "Feeling Good," and sang it better than the first time she performed it during her audition, according to judge Simon Cowell. "It's shocking how bright your star is," Spears said. She performed her duet with Leann Rimes, singing the country star's hit, "How Do I Live." Her final performance – of Leonard Cohen's "Hallelujah" – had the judges gushing. "You looked like an angel," Demi Lovato said. "You sang like a ridiculously talented angel."

Tate, the competition's only country singer, first performed "Anything Goes" by Randy Houser. "I'm still obsessed with you," Demi said. Added Simon, "You are made in America. You are authentic." For his duet, he sang Little Big Town's cheeky party anthem, "Pontoon." And for his final performance in the competition, Tate sang Chris Young's "Tomorrow." "In a year's time," Simon said, "We're going to be hearing about your record sales."

"I'm almost crying because I realize it's the last time I'm going to see you perform on that stage," Demi said.

Simon's remaining act, girl group Fifth Harmony, may have had their best night yet in the competition, beginning with "Anything Can Happen." L.A. called it "magical," adding that they're "the one to beat." Britney said the colorful performance was "spectacular, girly and fun." Their duet, with The X Factor's own Demi Lovato, of "Give Your Heart a Break" was a highlight of the night.

"These girls are so easy to work with," the judge said. "They're so down to earth, so sweet and I love you guys. This was so much fun."

Their last song, "Let It Be" by the Beatles, proved how much the five members have "blossomed as a group," Britney said. Admitting his bias, their mentor Simon said, based on their performances on Wednesday, the girls of Fifth Harmony "deserve to win the competition."

Do you agree? Or is Tate or Carly your choice for the big prize? Tell us in the comments below.

The winner will be revealed Thursday in a two-hour show that will include a performance by One Direction.

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Experts: Kids are resilient in coping with trauma


WASHINGTON (AP) — They might not want to talk about the gunshots or the screams. But their toys might start getting into imaginary shootouts.


Last week's school shooting in Connecticut raises the question: What will be the psychological fallout for the children who survived?


For people of any age, regaining a sense of security after surviving violence can take a long time. They're at risk for lingering anxiety, depression, post-traumatic stress disorder.


But after the grief and fear fades, psychiatrists say most of Newtown's young survivors probably will cope without long-term emotional problems.


"Kids do tend to be highly resilient," said Dr. Matthew Biel, chief of child and adolescent psychiatry at MedStar Georgetown University Hospital.


And one way that younger children try to make sense of trauma is through play. Youngsters may pull out action figures or stuffed animals and re-enact what they witnessed, perhaps multiple times.


"That's the way they gain mastery over a situation that's overwhelming," Biel explained, saying it becomes a concern only if the child is clearly distressed while playing.


Nor is it unusual for children to chase each other playing cops-and-robbers, but now parents might see some also pretending they're dead, added Dr. Melissa Brymer of the UCLA-Duke National Center for Child Traumatic Stress.


Among the challenges will be spotting which children are struggling enough that they may need professional help.


Newtown's tragedy is particularly heart-wrenching because of what such young children grappled with — like the six first-graders who apparently had to run past their teacher's body to escape to safety.


There's little scientific research specifically on PTSD, post-traumatic stress disorder, in children exposed to a burst of violence, and even less to tell if a younger child will have a harder time healing than an older one.


Overall, scientists say studies of natural disasters and wars suggest most children eventually recover from traumatic experiences while a smaller proportion develop long-term disorders such as PTSD. Brymer says in her studies of school shootings, that fraction can range from 10 percent to a quarter of survivors, depending on what they actually experienced. A broader 2007 study found 13 percent of U.S. children exposed to different types of trauma reported some symptoms of PTSD, although less than 1 percent had enough for an official diagnosis.


Violence isn't all that rare in childhood. In many parts of the world — and in inner-city neighborhoods in the U.S., too — children witness it repeatedly. They don't become inured to it, Biel said, and more exposure means a greater chance of lasting psychological harm.


In Newtown, most at risk for longer-term problems are those who saw someone killed, said Dr. Carol North of the University of Texas Southwestern Medical Center, who has researched survivors of mass shootings.


Friday's shootings were mostly in two classrooms of Sandy Hook Elementary School, which has about 450 students through fourth-grade.


But those who weren't as close to the danger may be at extra risk, too, if this wasn't their first trauma or they already had problems such as anxiety disorders that increase their vulnerability, she said.


Right after a traumatic event, it's normal to have nightmares or trouble sleeping, to stick close to loved ones, and to be nervous or moody, Biel said.


To help, parents will have to follow their child's lead. Grilling a child about a traumatic experience isn't good, he stressed. Some children will ask a lot of questions, seeking reassurance, he said. Others will be quiet, thinking about the experience and maybe drawing or writing about it, or acting it out at playtime. Younger children may regress, becoming clingy or having tantrums.


Before second grade, their brains also are at a developmental stage some refer to as magical thinking, when it's difficult to distinguish reality and fantasy. Parents may have to help them understand that a friend who died isn't in pain or lonely but also isn't coming back, Brymer said.


When problem behaviors or signs of distress continue for several weeks, Brymer says it's time for an evaluation by a counselor or pediatrician.


Besides a supportive family, what helps? North advises getting children back into routines, together with their friends, and easing them back into a school setting. Studies of survivors of the Sept. 11 terrorist attacks found "the power of the support of the people who went through it with you is huge," she said.


Children as young as first-graders can benefit from cognitive-behavioral therapy, Georgetown's Biel said. They can calm themselves with breathing techniques. They also can learn to identify and label their feelings — anger, frustration, worry — and how to balance, say, a worried thought with a brave one.


Finally, avoid watching TV coverage of the shooting, as children may think it's happening all over again, Biel added. He found that children who watched the 9/11 clips of planes hitting the World Trade Center thought they were seeing dozens of separate attacks.


___


EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


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Rogue pharmacists fuel addiction









Joey Rovero's quest for pills ended at Pacifica Pharmacy.


It was the same for Naythan Kenney,


Matt Stavron and Joseph Gomez.





All four were patients of a Rowland Heights


physician who was a prolific prescriber of narcotic painkillers and other addictive drugs. To get their fix, they needed more than a piece of paper.


They needed a pharmacist willing to dispense the drugs, and at Pacifica they found one.


All four died of drug overdoses after filling prescriptions at the tiny pharmacy in Huntington Beach, court and coroners' records show.


Pacifica's owner, Thang Q. "Frank" Tran, sold pain medications in large quantities. Particularly popular with his customers were high-dose, 80-milligram tablets of OxyContin. Tran filled nearly twice as many of those prescriptions as did nearby Walgreens, CVS and Sav-On pharmacies combined, according to state records.


Many of his customers traveled long distances and paid cash. Rovero drove more than 350 miles from Arizona State University in Tempe to get his prescriptions in Rowland Heights and then 33 more miles to the pharmacy.


"I thought to myself, 'Why in the world would these kids go that much farther out of their way?' " said April Rovero, whose son was 21 when he died. "Someone must have told them to go there."


Pharmacists are supposed to be a last line of defense against misuse of prescription medications. By law, they are required to scrutinize prescriptions, size up customers and refuse to dispense a drug when they suspect the patient has no medical need for it.


Some, however, provide massive amounts of painkillers and anti-anxiety drugs to addicts and dealers with no questions asked, according to state records, regulators and law enforcement officials.


Rogue pharmacists are key enablers of drug abuse and an important source of supply for the illegal market.


State officials who license and oversee pharmacies are overmatched by the scale of the problem.


Prescription drug abuse has increased sharply over the last decade, fueling a doubling of drug fatalities nationwide.


California's 42,000 pharmacists filled 318 million prescriptions last year.


Those for OxyContin, Dilaudid and other potent painkillers have increased 52% over the last five years, according to a review of prescription data collected by the state. The total dosage dispensed by pharmacies has also grown: by nearly 50%, the data show.


The task of identifying careless or corrupt pharmacists and initiating disciplinary action falls to 37 investigators for the California Board of Pharmacy.


"We are struggling to keep up because there are more pharmacies, more licensees, more places to go," said Virginia Herold, the agency's executive director. "We work really hard. But there's a limit to what we can do."


The board has added investigators in recent years. Even so, "we do have some pharmacies that seem to be able to help deliver unconscionable quantities of drugs to patients," Herold said.





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Inquiry Into Libya Attack Is Sharply Critical of State Department





WASHINGTON — An independent inquiry into the attack on the United States diplomatic mission in Libya that killed four Americans on Sept. 11 sharply criticized the State Department for a lack of seasoned security personnel and for relying on untested local militias to safeguard the compound, according to a report by the panel made public on Tuesday night.




The investigation into the attack on the diplomatic mission and the C.I.A. annex in Benghazi that resulted in the deaths of Ambassador J. Christopher Stevens and three other Americans also faulted State Department officials in Washington for ignoring requests from the American Embassy in Tripoli for more guards for the mission and for failing to make sufficient safety upgrades.


The panel also said American intelligence officials had relied too much on specific warnings of imminent attacks, which they did not have in the case of Benghazi, rather than basing assessments more broadly on a deteriorating security environment. By this spring, Benghazi, a hotbed of militant activity in eastern Libya, had experienced a string of assassinations, an attack on a British envoy’s motorcade and the explosion of a bomb outside the American Mission.


Finally, the report blamed two major State Department bureaus — Diplomatic Security and Near Eastern Affairs — for failing to coordinate and plan adequate security. The panel also determined that a number of officials had shown poor leadership, but they were not identified in the unclassified version of the report that was released.


“Systemic failures and leadership and management deficiencies at senior levels within two bureaus,” the report said, resulted in security “that was inadequate for Benghazi and grossly inadequate to deal with the attack that took place.”


The attack in Benghazi and the Obama administration’s explanation of what happened and who was responsible became politically charged issues in the waning weeks of the presidential campaign, and Republicans have continued to demand explanations since then. Susan E. Rice, the United States ambassador to the United Nations, took herself out of consideration for secretary of state after Republican criticism of comments she made in the aftermath of the lethal attack threatened to become a divisive political battle.


The report affirmed there were no protests of an anti-Islamic video before the attack, contrary to what Ms. Rice had said on several Sunday talk shows days after the attack.


While the report focused on the specific attack in Benghazi, the episode cast into broader relief the larger question of how American diplomats and intelligence officers operate in increasingly unstable environments, like those in the Arab Spring countries across North Africa and the Middle East, without increased security.


In response to the panel’s findings, Secretary of State Hillary Rodham Clinton said in a letter to Congress that she was accepting all 29 of the panel’s recommendations, five of which are classified. “To fully honor those we lost, we must better protect those still serving to advance our nation’s vital interests and values overseas,” Mrs. Clinton said in the letter. She is already taking specific steps to correct the problems, according to officials.


They say the State Department is asking permission from Congress to transfer more than $1.3 billion from contingency funds that had been allocated for spending in Iraq. This includes $553 million for hundreds of additional Marine security guards worldwide; $130 million for diplomatic security personnel; and $691 million for improving security at installations abroad.


Noting that the Libyan militias in Benghazi proved unreliable, the report recommended that in the future the United States must be “self-reliant and enterprising.”


In recent weeks, teams of State Department and Pentagon security specialists have been sent to 19 “high threat” diplomatic posts around the world to conduct assessments.


The State Department last month for the first time also appointed a senior official — a deputy assistant secretary of state — to ensure that embassies and consulates in dangerous places get sufficient attention. To that end, the department is revamping deployment procedures to increase the number of experienced and well- trained personnel serving in those posts, and to reduce the high turnover rate that the panel identified as a problem.


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Leak reveals Polaroid’s Android-powered camera with interchangeable lenses






Samsung’s (005930) Galaxy Camera and Nikon’s (NINOY) Coolpix S800c are just the beginning of a swath of Android-powered cameras. Newly leaked images and specs point to Polaroid reviving its camera business with what could be the world’s first Android camera with interchangeable lenses. With no official name yet, the tentatively named IM1836 camera will reportedly feature a 18.1-megapixel sensor, 3.5-inch touchscreen, pop-up flash, Wi-Fi, HDMI and Android 4.0.


[More from BGR: A guide to all the insane predictions made by Google’s new engineering director]






The Galaxy Camera and Coolpix S800c do a fine job taking pictures that are considerably better than what you get from a smartphone, but they still can’t match a mirrorless camera with a good lens. At first glance, Polaroid’s camera looks to be a rebadged Nikon 1 J2, but the resemblance only runs skin deep, as PhotoRumors reports the camera only takes MicroSD cards.


[More from BGR: How not to fix Apple Maps]


Polaroid might not be a major player, but as more companies start incorporating Android into their cameras, there’s going to be a shift in the features consumers expect from them. In the next few years, novelty features such as Wi-Fi, cellular data and photo editing apps will be the norm and we’ll laugh at how we ever lived without them.


This article was originally published by BGR


Wireless News Headlines – Yahoo! News





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The Voice Crowns a Winner!















12/18/2012 at 11:20 PM EST







From left: Terry McDermott, Cassadee Pope, Nicholas David and host Carson Daly


Tyler Golden/NBC


The Voice has a new winner!

After several powerful performances the night before, the top three singers – Nicholas David (of Team Cee Lo) and Terry McDermott and Cassadee Pope (of Blake Shelton's team) – faced the music on Tuesday during the final results show of season 3.

Which one was the winner? Keep reading to find out ...

Cassadee Pope was named the winner of The Voice!

Pope thanked her fans who supported her throughout the competition. She was joined onstage by McDermott, who was the runner-up, and David, who came in third place.

It was a night of music as Rihanna, newly engaged Kelly Clarkson, Bruno Mars and the Killers celebrated with the finalists by displaying their talents.

Season 4 of The Voice premieres March 25, 2013, with Shakira and Usher stepping in to take over for Christina Aguilera and Cee Lo Green.

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Experts: Kids are resilient in coping with trauma


WASHINGTON (AP) — They might not want to talk about the gunshots or the screams. But their toys might start getting into imaginary shootouts.


Last week's school shooting in Connecticut raises the question: What will be the psychological fallout for the children who survived?


For people of any age, regaining a sense of security after surviving violence can take a long time. They're at risk for lingering anxiety, depression, post-traumatic stress disorder.


But after the grief and fear fades, psychiatrists say most of Newtown's young survivors probably will cope without long-term emotional problems.


"Kids do tend to be highly resilient," said Dr. Matthew Biel, chief of child and adolescent psychiatry at MedStar Georgetown University Hospital.


And one way that younger children try to make sense of trauma is through play. Youngsters may pull out action figures or stuffed animals and re-enact what they witnessed, perhaps multiple times.


"That's the way they gain mastery over a situation that's overwhelming," Biel explained, saying it becomes a concern only if the child is clearly distressed while playing.


Nor is it unusual for children to chase each other playing cops-and-robbers, but now parents might see some also pretending they're dead, added Dr. Melissa Brymer of the UCLA-Duke National Center for Child Traumatic Stress.


Among the challenges will be spotting which children are struggling enough that they may need professional help.


Newtown's tragedy is particularly heart-wrenching because of what such young children grappled with — like the six first-graders who apparently had to run past their teacher's body to escape to safety.


There's little scientific research specifically on PTSD, post-traumatic stress disorder, in children exposed to a burst of violence, and even less to tell if a younger child will have a harder time healing than an older one.


Overall, scientists say studies of natural disasters and wars suggest most children eventually recover from traumatic experiences while a smaller proportion develop long-term disorders such as PTSD. Brymer says in her studies of school shootings, that fraction can range from 10 percent to a quarter of survivors, depending on what they actually experienced. A broader 2007 study found 13 percent of U.S. children exposed to different types of trauma reported some symptoms of PTSD, although less than 1 percent had enough for an official diagnosis.


Violence isn't all that rare in childhood. In many parts of the world — and in inner-city neighborhoods in the U.S., too — children witness it repeatedly. They don't become inured to it, Biel said, and more exposure means a greater chance of lasting psychological harm.


In Newtown, most at risk for longer-term problems are those who saw someone killed, said Dr. Carol North of the University of Texas Southwestern Medical Center, who has researched survivors of mass shootings.


Friday's shootings were mostly in two classrooms of Sandy Hook Elementary School, which has about 450 students through fourth-grade.


But those who weren't as close to the danger may be at extra risk, too, if this wasn't their first trauma or they already had problems such as anxiety disorders that increase their vulnerability, she said.


Right after a traumatic event, it's normal to have nightmares or trouble sleeping, to stick close to loved ones, and to be nervous or moody, Biel said.


To help, parents will have to follow their child's lead. Grilling a child about a traumatic experience isn't good, he stressed. Some children will ask a lot of questions, seeking reassurance, he said. Others will be quiet, thinking about the experience and maybe drawing or writing about it, or acting it out at playtime. Younger children may regress, becoming clingy or having tantrums.


Before second grade, their brains also are at a developmental stage some refer to as magical thinking, when it's difficult to distinguish reality and fantasy. Parents may have to help them understand that a friend who died isn't in pain or lonely but also isn't coming back, Brymer said.


When problem behaviors or signs of distress continue for several weeks, Brymer says it's time for an evaluation by a counselor or pediatrician.


Besides a supportive family, what helps? North advises getting children back into routines, together with their friends, and easing them back into a school setting. Studies of survivors of the Sept. 11 terrorist attacks found "the power of the support of the people who went through it with you is huge," she said.


Children as young as first-graders can benefit from cognitive-behavioral therapy, Georgetown's Biel said. They can calm themselves with breathing techniques. They also can learn to identify and label their feelings — anger, frustration, worry — and how to balance, say, a worried thought with a brave one.


Finally, avoid watching TV coverage of the shooting, as children may think it's happening all over again, Biel added. He found that children who watched the 9/11 clips of planes hitting the World Trade Center thought they were seeing dozens of separate attacks.


___


EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


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