Wellness Section Newsletter - May 2010, Vol 14, #1
Lori Weichenthal, MD, FACEP
Hello to all our members! I hope that this newsletter finds you all well (no pun intended) or at least seeking the resources you need to be well. I write this letter coming off a shift during which it was hard to believe in well being for my patients or myself. The ED I work in was overcrowded with many boarded patients and chaos always a moment away. Yes, I work in an inner city, level one trauma center that is the last resort for many members of our community but I know that you all work in situations that are filled with stress. My hope is that we all can learn ways to create our own wellness as we seek to promote wellness in our patients.
In review, during the 2009-2010 year, the section continued to sponsor the Wellness Booth at the annual meeting. This year, over 600 individuals participated in the booth, which was an increase from the year prior. Participants engaged in basic screening, blood tests and a wellness survey. The section also sponsored a daily meditation and yoga hour during the annual meeting. The section received two awards at the meeting presented to Dr. Huber and Dr. Totten for their service to the section and the college.
In the upcoming year, the section will focus on providing more service to the section and the College by increasing the number of newsletters provided and by improving awareness to college members of the offerings of the section. It was discussed at this year’s section meeting that there was a lack of advertising of wellness opportunities at the annual meeting. Those who engaged in the activities provided expressed a profound appreciation of the wellness booth, meditation, and yoga. We wish to increase the awareness of these activities through more aggressive advertisement prior to the assembly and increased signage at the meeting. We also wish to focus on recruiting more young members of the College. Wellness becomes a more pertinent issue as emergency physicians age. It is our desire to engage younger members in this section to encourage awareness of this issue early in physicians’ career.
I encourage you all to become involved, to share your stories and strategies for being and remaining well. Our health care systems remains very broken and many of us are on the front line every day as we seek to provide care to an increasing number of patients whose only access to care is through our emergency departments. As our stresses increase, it is important for us to share have we cope and to continue to strive for wellness for ourselves, those we love and our patients.
Thank you for being involved and please share your thoughts and experiences.
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Edd D. Thomas, MD
Hello friends and fellow travelers along this, one of the paths “less travelled.” This life, in medicine, is an adventure which turns out to be somewhat more complex and interactive with other parts of life, than most of us ever expected, those many years ago as we struggled over essays and interviews and long waits to “acceptance.”
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Janet Goldberg, wife of emergency physician Dr. Dick Goldberg, was awarded honorary membership in the College in recognition of her commitment to physician wellness. Janet has been involved in the Wellness Booth since its inception and annually serves as a volunteer at the Booth. She also grades and provides reports on the burnout survey.
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|632 members received services at the ACEP member Wellness Booth last fall during Scientific Assembly.
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Lori Weichenthal, MD, FACEP
When I discuss wellness for physicians with colleagues that are my own age or younger, I frequently get a lot of push back. Why are you worried about this at your age? This is something that older physicians worry about when working night shifts becomes too hard, when cynicism sets in, or when thoughts of an alternative career comes to the forefront.
From my own perspective, wellness should be a primary concern from the beginning of our careers as physicians. To have a healing influence on others, we first must be well. However, to speak from my own perspective, I need to let you know where I am coming from.
I believe I went into medicine for all of the right reasons. From junior high on, when I was inspired by my science teacher who was a medic in Korea, I wanted to be involved in the medical field. My pursuit of medicine was my focus throughout high school, undergraduate and medical school. I finally settled on emergency medicine as my specialty and was happily settled into my residency when tragedy struck.
One night, after working a shift in the emergency department, I came home to find my fiancée dead. He had committed suicide using carbon monoxide. I called 911, who kindly instructed me on how to perform CPR, which I knew was beyond the point, and waited for emergency personnel to arrive, knowing that many of those who arrived would be friends of my fiancée, a firefighter who had just gotten off shift the day before from the station nearest our home. I struggled through the task of calling his family and my own family and then, perhaps strangely enough, was fortunate to have a paramedic supervisor drive me back to work, my second home.
The nurse supervisor greeted me and brought me into the quiet room where one of our patient care providers was stocking the room with Kleenex and water. My faculty member came in and gave me a hug and told me he had already reserved rooms at a local hotel, using his credit card, for me and my family who was driving through the night to support me. And my senior resident, who was always a bit reserved, came and let me know that he would cover any shifts I needed.
I will never be able to say that my experience that night was easy, but in retrospect, it taught me many things about wellness. First and foremost, there is nothing so bad in the moment that cannot be survived. The most certain part of life is change, thus no matter how bad (or how good) what you face in the present moment is, it too will pass. Having said this, make sure to build yourself up, to make yourself well in every way you can so that when tragedy strikes, as it inevitably will in this life, you will have the inner resources to cope.
In the end, however, it is relationship that will support you in the most difficult times. It is relationship that is the core of our existence as human beings. Without the support of many, the paramedic supervisor, Rusty, who drove me back to the hospital that night, my faculty, Doug Kartel, my senior resident, Glen Zemeski, my family, and so many others that night and beyond who supported me, I could not have recovered, continued in my residency and continued to build my life form there and beyond. Yes, some of my survival came from within, but the support of others was huge.
So, when you think of wellness, definitely work on yourself. Exercise, eat well, take time for yourself, but never forget to build relationships, for it is the web of interdependence that we live within that supports us and keeps us strong, even in the most difficult of situations.
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Edd D. Thomas, MD
After seeing the press release, “Heart Disease Patients Who Practice Transcendental Meditation Have Nearly 50% Lower Rates of Heart Attack, Stroke, and Death” http://www.mcw.edu/Releases/2009Releases/TranscendentalMeditation.htm from the Medical College of Wisconsin, I thought I would write up my experience on this.
My personal experience is quite real. In college I learned how to lower my resting heart rate into the 40s. While it’s not a good idea in the middle of a trauma code or crash C-section, it is a useful skill not only for the medical provider but also for patients.
The point being is not to drop to the floor in the lotus position but rather visa vi mastering some of these basics, one can actually decrease cardiac contractility & rate through the SNS.
It takes practice, but eventually you do not even realize that you did it. It becomes almost like a lost primitive reflex for self preservation AND probably saved my life since when they put in my stents, they found the PDA 100% blocked and my posterior circulation had no supply from the right side circulation. I was dependent on 100% supply from the left. The problem lay in what was the need for two stents, a 75% main left circ and the 100% PDA.
My ejection fraction was 35% and is now 60+%. No myocardial damage found either then, or in subsequent nuclear studies.
Now, I firmly believe in several other factors that were critical to my blessed result. When that heavy pain occurred over my gallbladder (Yep, not at all your typical location and the cath occurred only after 24 hours and an EGD and GB ultrasound), I was able to sit and concentrate on calm rather than allow the fight or flight to turn my SNS into overdrive pushing up O2 consumption in myocardium already severally challenged just for calm cardiac output.
Meditation works. Give it a try. Tell your colleagues. Maybe at Scientific Assembly we can sit down and share techniques.
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David M. Toor ,MD
On my run tonight, I turned off my iPod. I was running through some quiet streets and the air was cool. It had been raining. The sun was set and the last shadows were fading. With my iPod off I could hear the crunch of each foot fall as I ran. I felt very centered. Settled. Even when I got back to the busy streets, the cars were just white noise, all the sound somehow dampened by the rain. On that run the day’s stresses and battles were nonexistent. On a good run somehow things in life can just make sense.
I am in my second year at a four year EM program and the learning curve has gotten steep this year. It is easy to doubt and question, easy to be uncertain of my abilities and faculties, easy to have moments of feeling jaded. It is easy to fall into thinking the worst of people. Emergency medicine is demanding. Training as an EM resident and striving to learn how to be a great EM physician is challenging. Our environment can be unforgiving. Monitors blare, patients can be belligerent or tearful, colleagues and staff can be difficult. It is easy to lose sight of the goal of caring for patients and learning the practice. Stepping back can help. For me, running helps to do that. It helps clear my mind, helps me to look at things from a better vantage point.
I recently had the opportunity to be a patient. I found myself on my bathroom floor unwilling to leave the comfort that its proximity to the toilet provided. I had been taken down by some acute gastro and thankfully good friends, Zofran and IV fluids got me through. Looking back, something as simple and benign as acute gastro really sucks when you are the one dealing with it. It was a simple reminder that even with all my education and my clinical experience to this point, being a patient is hard. The experience made me reflect and think, maybe these patients are in pain. Maybe they really don't feel good and aren't just here to drive me crazy. I am educated, have good family support and am relatively free of psychiatric disturbance (although having chosen EM we all know there has to be at least a little bit wrong with me.) My patients often don't have half the blessings I have had in my life. Adjusting my expectation to account for that helps me feel better about treating them and realizing that I really can help them. It is a reminder of why I chose emergency medicine.
A good friend is graduating from an east coast EM program this year. She and I see a lot of things in similar ways. Talking with her about how she felt through her residency; her fears, triumphs, losses and battles, has helped me realize that we don’t go through this process alone. Others will go through it, others are in its midst and many have made it through to the other side. Talking to her helps me know that my path is good. She helps to validate my experience. Having someone who understands and sees the world through similar lenses is invaluable. And sometimes sharing with someone who thinks totally differently can help, too.
It turns out we haven’t chosen the easiest of career paths. I hope most of us didn’t think we had. By the same token we didn’t fully comprehend what we had taken on until we showed up and started as residents. The question is how we will deal with the difficulties we face, be they trying patients, bad outcomes, academic responsibilities or all the other things that come up in life that have nothing to do with emergency medicine. How do we stay well during residency? For me it turns out sweets (with a CAGE questionnaire failing passion), running, throwing up, and good friends who knew me when are what keep me well.
I think wellness means many things and certainly different things to different people. But one thing I believe it is, is perspective. Wellness is about what makes us step back. It is what makes us take that moment to reflect. It is what makes us realize the blessings in our lives, what makes us feel for our patients. It is what reminds us of why we went into medicine in the first place. Finding sources of wellness makes us better people and better doctors.
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Dr. Shay Bintliff, an ACEP member for over 25 years, recently published her poetry book, Soular Energy, A Collection of Poetry.
She had been writing poetry since an early age and was inspired to publish her book by her granddaughter, Ileiana, who died of cancer 5 years ago at age 11.
The first section of the book are poems that Shay wrote about Ileiana and each poem is accompanied by a piece of Ileiana's art work. The other sections contain lyrical poems that vibrate the beauty of nature and life; and the last two sections are dedicated to passion, love and the pain of heartbreak. Most everyone can identify with many of the poems, for without love, life would have no soul.
All proceeds from the sale of the book are being donated to Camp Anuenue, a summer camp in Hawaii for children with cancer. Ileiana attended for 3 summers and it so 'normalized' her life in the midst of the agony of cancer treatments. I wrote this book in celebration of Ileiana's life. The poems are very personal and autobiographical and are shared with sensitivity, energy and the zest for life that was Ileiana's. I think of her and all that her life taught me...Yesterday seems less painful, and I am unafraid of tomorrow.
The book can be ordered at: www.SoularWellness.com or from the ACEP Bookstore http://bookstore.acep.org/en/eCom/Soular-Energy-A-Collection-of-Poetry/479721-1.aspx.
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Lori Weichenthal, MD, FACEP
You are working a busy shift in the emergency department when you finally have a few minutes of down time while you wait to hear back from a consultant or wait for that final test result that will allow you to make a final disposition. Your shoulders hurt from wearing your stethoscope around your neck, your lower back aches and your feet are sore. What do you do? How about a few yoga poses that will ease your aches, energize you, and make you ready for the next challenge you face?
- Take a good seat at the edge of your chair. Make sure that your stethoscope and other weighted objects have been set aside. Place your feet hips distance apart and make sure that the four corners of your feet (mound of the first toe, inner heel, mound of the fifth toe and outer heel) are connected to the floor. From this connection, draw energy up through your legs, focusing on bringing your shins towards one another while drawing the thigh bones down and apart. Keeping the sitz bones (ischial tuberosities) firmly rooted into the chair, extend your spine up, as though there is a beam of light shining up through your spine through the top of your skull. Onto your lengthened spine, breathe into your thorax and bring your shoulder blades onto your spine. Breathe deeply.
- Keeping your seat, on an inhale, reach your hands toward the sky and on an exhale bring your arms back down to your sides. Focus on letting the breath lead the way. Let the inhale encourage your arms upward and only when the exhale begins allow your arms to follow a downward movement. Repeat six times
- Keeping a good seat, cross your right ankle over your left knee. With your breath, encourage your right knee to move toward a ninety degree angle with the ground. You should feel a nice stretch in your outer and back thigh. Breathe into this stretch for six breathes then switch sides.
- Returning to the right side, repeat all the actions in c, then on an exhale bend forward, keeping your spine long. The goal is to feel a good stretch in the outer thigh while keeping the spine long. Bend only as far forward as you are able to while achieving both. Repeat on the other side.
- Return to a good seat, while focusing on keeping your feet and sitz bones firmly planted, on an inhale lengthen your spine and on an exhale, twist to the right. With each inhale, focus on lengthening your spine and with each exhale, focus on twisting more deeply. Perform for six breathes on the first side and the switch to the other.
This series should take you less than 10 minutes and can help to reconnect you, ease aches and pains and prepare you for the next challenge that heads your way.
Additional Wellness Articles:
Burned Out, Depressed Surgeons More Likely to Commit Major Medical Errorshttp://www.hopkinsmedicine.org/Press_releases/2009/11_21_09.html Source: Johns Hopkins Medicine, November 23, 2009
Achieving work-life balance: More than just a juggling acthttp://medcolleges.washington.edu/icm2/sites/default/files/Work-Life%20Balance.pdf Sources: The Colleges of the University of Washington School of Medicine; Doug Couper, MD, Portland, Maine, internist; Iris Grimm, physician life coach; David Ballard, PsyD, director of the American Psychological Association's Psychologically Healthy Workplace program
Litigation Stress and Strategies for Surviving a Malpractice Suit http://www.epmonthly.com/features/current-features/the-acep-interviews-louise-b-andrew/ Source: Emergency Physicians Monthly featuring ACEPs Louise B. Andrew, MD, JD, FACEP
http://www.jacksoncoker.com/Newsletter/Articles/Motivating.aspx Source: Jackson & Coker Research Associates
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Hi to all,
I want to briefly report on the two projects that the Task Force has been working on:
Primer for Emergency Physicians in Pre-Retirement Years. Now in its sixth draft, we are waiting on the completion of our last two chapters (Financial Planning and Cruise Medicine as a Transition to Retirement).
Many thanks to all of you who have contributed to this project.
Research project: Use of Performance Criteria to Measure Quality of Care among Emergency Physicians: Correlation With Age and Utility of Practice Modifications.The research questions we hope to address are:
- Is there a correlation between certain performance deficiencies and age, and
- Are there practice modifications that might address these deficiencies?
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Harold A. Thomas, MD, FACEP
Louis A. Penner, PhD
Richard Goldberg, MD, FACEP
This survey was conducted in the fall of 2006 and winter of 2007. It was funded by a Section Grant from the American College of Emergency Physicians. Study subjects consisted of one thousand randomly selected members of the College, age 55 or greater. The survey instrument consisted of 30 questions, the last 4 of which were open-ended. A total of 802 responses were received (response rate 80%).
- Average Age: 57.5 years
- Average Length of Practice: 26 years
- Average Clinical Hours Worked/Week: 30
- Average Non-Clinical Hours Worked/Week: 12
- Average Plan to Continue Current Work Load: 5.4 years
- Average Plan to Continue Work at All: 7.8 years
Age/Experience=Related Positive Findings
- Ability to Perform Common Procedures: 83% Same or Better
- Ability to Manage Complicated Clinical Problem: 92% Same or Better
- Ability to Handle Difficult Personalities: 36% Better
- Ability to Empathize: 49% Better
Age-Related Negative Findings
- Have Identity Concerns about Retirement: 44%
- Feel Financial Preparations for Retirement are Inadequate: 42
- Health Limitations on Ability to Practice: 28%
- Less Ability to Manage Heavy Patient Volume: 40%
- Memory Somewhat or Considerably Worse: 28%
- Less Ability to Incorporate New Modalities of Diagnosis and Treatment: 25%
- Less Ability to Handle Stresses of Emergency Medicine: 36%
- Higher Level of Emotional Exhaustion at End of Shift: 44%
- Less Ability to Recover From A Night Shift: 74%
Responses to Open-Ended Questions*
Compared to earlier years in practice, the following aspects of my current practice are more enjoyable:
- Relating to Patients
- New Technology
- No Nights
Compared to earlier years in practice, my skill as a practitioner has improved in the following ways:
- Relate Better to Patients and Staff
- Improved Clinical/Diagnostic Skills
- Improved Use of Available Technology
The following changes in my practice environment would enhance my career in emergency medicine:
- Fewer or No Night Shifts
- Fewer Hours
- More Physician and Support Staff Coverage
What can ACEP do to help members deal with issues regarding retirement and career longevity:
- Address the Economics of Retirement
- Advocate for Issues of Concern to Senior Physicians
- Issues Guidelines Regarding Fewer Night Shifts for Senior Physicians
* The three most common categories of response, in order of frequency.
The survey results suggest that older emergency physicians generally view themselves as competent clinicians, with little decline in procedural skills, and improved ability to relate to patients and staff. It would also appear that a substantial percentage of the respondents acknowledge at least some degree of cognitive decline and/or physical limitation. Additionally, the responses indicate that many senior physicians could benefit from modifications of their work load with respect to hours, patient load, physician and support staffing, and, most particularly, night shifts. Efforts by the College to advocate for the concerns of its older members are recommended as a means of prolonging their careers, as well as easing their transition to retirement.
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For many members of the American College of Emergency Physicians (ACEP), issues of aging and retirement are now surfacing. ACEP enrollment data indicate the percentage of members over the age of 50 has increased from 28% to 31% in the past two years. In September of 2005, the Well-being Committee of the College formed a Task Force to promote dialogue and research on the aging emergency physician.
In 2007, the Task Force distributed a survey regarding issues of concern to 1000 randomly selected emergency physicians over the age of 55.1
- Goldberg R, Thomas H, Penner L. Issues of concern to emergency physicians in pre-retirement years: a survey. In press: J Emerg Med. (In press) http://www.jem-journal.com/article/S0736-4679(09)00745-8/abstract
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American College of Emergency Physicians
Tuesday, October 6, 2009
Lori Weichenthal, MD, FACEP, Chair, and twelve members and guests were in attendance.
Board Liaison: Alex Rosenau, DO, FACEP
Staff Liaison: Marilyn Bromley, RN
- Greetings/opening statement/introduction of attendees
- Wellness booth update
- Update from Dr. Goldberg regarding the Task Force on the Aging Physician
- Update on this year’s activities
- Section Awards:
- Newsletter Award of Distinction
- Service to the College
- Other issues
Major Points Discussed
Lori Weichenthal, MD, FACEP began the meeting with introduction of attendees. A member that had taken advantage of the peer-to-peer counseling stopped in to briefly express her thanks to the members that had provided support as she deals with a professional issue.
Dr. Rosenau informed the section that the College was grateful for the service of the section and how it has promoted wellness among the membership as evidenced by the section’s service to the College award.
There was discussion regarding the operation and offerings at the Wellness Booth. It was suggested that the display of wellness articles would be enhanced by being on shelves with buckets additionally if there are any wellness abstracts at research forum it would be helpful to have those available. Staff is requested to determine the feasibility of offering A1C next year. Having an electronic banner hung at the back of the booth offering wellness information was discussed. The cost and feasibility will be investigated. It was recommended that the onsite purchase of tickets process be reviewed. Some felt it was not clear on how to purchase tickets at the exhibit hall and it wasn’t convenient to purchase tickets at the exhibit hall. All were in agreement that there would be merit to advertising or promoting the burnout survey in a more positive manner. It was recognized that while the name of the survey instrument is copyrighted and cannot be changed, if it was promoted in a manner that reflected something along the lines of ‘check your level of wellness’ it may be more appealing. It was felt ‘burnout’ was pejorative and may be off-putting for some that would benefit by taking the survey.
There was some disappointment expressed in the signage for the meditation room, the fact that a room assignment had been made for yoga and was in all the onsite materials, then changed. There was concern that the signage reflecting that change it was believed it was not clear and further it wasn’t clear that yoga was moved to the meditation room and the when yoga was held. There was a suggestion that next year perhaps a standing sign at the Wellness Booth noting the meditation room and yoga would be beneficial.
Dr. Richard Goldberg reported on the work done by the Aging Physician Task Force and the policy that was approved by the Board of Directors in June on the physician in pre-retirement years.
Dr. Mitch Cordover reported on the Council meeting and work done as a result of Sanofi’s underwriting of the Wellness Booth last year.
The Section also received an award for its newsletter. This was presented to Dr. Julia Huber, immediate past chair and Dr. Vicken Totten, newsletter editor. Dr. Huber, on behalf of the section, also received the award for service to the College.
Dr. Weichenthal agreed to serve another 2 year term as section chair. Dr. Totten asked to be relieved of her duties as newsletter editor. There were no volunteers to serve as secretary/newsletter editor. As a result Dr. Weichenthal will seek to fill that position by posting a request on the elist for a volunteer. Dr. Cordover will continue to serve another year as Councilor and Dr. Rachelle Greenman, will serve another year as alternate councilor, moving to councilor position for the 2011 Council meeting.
The meeting adjourned at 5:15pm.
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Andrew I. Bern, MD, FACEP
Board Liaison to the Section Grant Task Force, Critical Care Section, and EMS Section
It is hard to imagine that we are already entering the seventh month of this activity year. If you were the CEO of a corporation preparing your stockholders report of your first two quarters where corporate leadership is analogous to section leadership and your stockholders are your section members, how did you do? For a stockholder, one's return on investment is the measurement of success. For sections, success is measured by a return of value to the membership. This can take the form of section strategic planning, the development of a communication’s plan, and a focus of activity in projects including submission of a letter of intent to the section grant task force for this year's grants. Does everyone in your section have a clear focus on what is to be accomplished this year? Has a section produced two newsletters to date? Have you engage your section members with your section’s website and your e-list? Has your section provided the opportunities for professional development and leadership development for your section members? Have you promoted the committee interest forms to your members? And, what of advocacy?
We were now heading towards the political season of our activity year. Not only are we focused on advocacy in Washington DC, but we are also looking at the College and its direction and our ability to affect that direction through the development of resolutions that will be submitted through June of this year. The resolution process is a direct connection between the membership and the College leadership. It is the democratic process by which the membership can help focus the College and directions that matter most to them and their patients. It is also important for section leadership to begin planning for their Scientific Assembly annual meetings, strategic planning, and develop plans to expand and increase membership. For some, this will mean increased attention and collaboration with EMRA.
Sections can be nimble and responsive to the membership. This makes sections a real grassroots operation with the ability to take on projects and tasks driven by the membership.
In just a short time, best practices amongst the sections have produced textbooks, white papers, award-winning newsletters, and the expansion of knowledge in many areas.
What will your section due to expand the opportunities for your membership and the knowledge base of emergency medicine? Only your section can provide these answers.
We are all waiting to see what you produce. The ACEP Board of Directors and I look forward to support you and recognize your efforts.
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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.