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To the ends of the world - part 1

In April 2016, Logos Hope crew members travelled to over 30 different destinations around the world, involving themselves in presentations, church mobilisation, practical work and other ministry projects.




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To the ends of the world - part 2

In April 2016, Logos Hope crew members travelled to over 30 different destinations around the world, involving themselves in presentations, church mobilisation, practical work and other ministry projects.




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To the ends of the world - part 3

In April, Logos Hope crewmembers travelled to over 30 destinations around the world, involving themselves in presentations, church mobilisation, practical work and other projects.




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The 'bondservant' boys

In the 1980s, two babies were named after OM’s second ship. Both young men are now living out the ethos of the ministry, as servants of Christ.




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The family business

Nassau, Bahamas :: The Esposito family from Argentina enjoys serving God together on board Logos Hope, bringing professional skills and supporting each other.




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Doctors and therapists point to Jesus

On a recent outreach to several towns in the Amazon jungle, OM Peru worked with the Presbyterian Church of Moyabamba and its annexes.




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Peru in the plan of God

OM Peru medical outreach occurs simultaneously with a Global Missions Council meeting to mobilise Peruvians for missions in the Muslim World, and at home.




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The Best Business Messaging Apps for 2020

If the coronavirus breaks as bad we fear, a lot more people are going to be working from home. These business messaging apps can help teams stay in touch, and stay productive, even if they can't come in to the office.




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Pope asks God to free Catholics from the 'disease' of division

Vatican City, May 4, 2020 / 07:29 am (CNA).- Jesus died for everyone, but disordered attachment to one’s own ideas can cause divisions which break the unity of God’s people, Pope Francis said at Mass on Monday.

“There are ideas, positions that create division, to the point that the division is more important than unity,” the pope said May 4. People think “my idea is more important than the Holy Spirit who guides us.”

Francis called division a “disease of the Church, a disease which arises from ideologies or religious factions…”

Throughout the Church’s history there has always been a spirit of thinking one’s self to be righteous and others to be sinners, he said, describing it as an “us and the others” attitude, which says others are already condemned, while “we have the right position before God.”

Speaking from the chapel of his Vatican residence, the Casa Santa Marta, Francis emphasized that Jesus died for everyone.

Imagining a dialogue with someone questioning the statement, he said, “‘But did [Jesus] also die for that low-life who made my life impossible?’ He died for him too. ‘And for that crook?’ He died for him.”

“For everyone,” Francis underlined. “And also for people who do not believe in him or are of other religions: he died for everyone.”

Without using a name, the pope referenced a retired cardinal living inside the Vatican, who, he said, likes to say “the Church is like a river,” with different people being like different parts of the river.

“But the important thing is that everyone is inside the river,” the pope said. “This is the unity of the Church.”

The Church is a wide river, “because the Lord wants it so.”

Pope Francis quoted a verse from the day’s Gospel reading, John 10:11-18, when Jesus says: “I have other sheep that do not belong to this fold. These also I must lead, and they will hear my voice, and there will be one flock, one shepherd.”

Jesus is saying “I am Shepherd of everyone,” the pope explained. “Everyone: Big and small, rich and poor, good and bad.”

Pointing to the divisions in the Church after the Second Vatican Council, he said it is permissible to think differently from one another, but always “in the unity of the Church, under Jesus the Shepherd.”

He prayed that the Lord would free Catholics from the illness of division and help them to see “this great thing from Jesus, that in him we are all brothers and he is the Shepherd of all.”

Pope Francis offered the day’s Mass for families, that in this time of quarantine because of the coronavirus pandemic they will continue to try new and creative things together and with their children.

He also acknowledged the reality of domestic violence, asking for prayers for families “to continue in peace with creativity and patience in this quarantine.”

After Mass the pope led those following the Mass via livestream in an act of spiritual communion. He concluded with Eucharistic adoration and benediction.

 




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CDF: Belgian Brothers of Charity hospitals must drop Catholic identity over euthanasia

CNA Staff, May 4, 2020 / 12:01 pm (CNA).- The Congregation for the Doctrine of the Faith has ordered 15 psychiatric hospitals in Belgium which belong to the Brothers of Charity to cease identifying as Catholic institutions after they allowed the euthanization of patients in 2017.

The hospitals are managed by a civil non-profit corporation with the same name as the Brothers of Charity religious congregation which owns them.

The CDF decision was communicated in a letter dated March 30, stating that "with deep sadness" the "psychiatric hospitals managed by the Provincialate of the Brothers of Charity association in Belgium will no longer be able to consider themselves Catholic institutions."

In a statement responding to the CDF's decision, the superior general of the Brothers of Charity, Br. René Stockman, said that "with a heavy heart" the religious congregation "must let go of its psychiatric centers in Belgium."

Br. Stockman pointed out that it is "painful" that the psychiatric centers of the Brothers of Charity in Belgium have lost their Catholic status, considering also that the brothers "were among the pioneers in the field of mental health care in Belgium."

At the same time, Stockman said he recognizes that "the congregation [the Brothers of Charity] has no choice but to remain faithful to the charism of charity, which cannot be reconciled with the practice of euthanasia on psychiatric patients."

The decision by the Vatican's doctrinal office ends three years of disputes between the Brothers of Charity and the corporation which manages their hospitals in Belgium.

In 2017, the board decided to allow euthanasia to be carried out in its hospitals in Belgium, where the euthanasia law is among the most broad.

At the time of the decision, the board of the corporation was composed of 15 members, with only three of them religious brothers of the congregation. 

Two of the three religious brothers among the board members, Luc Lemmens, 61, and Veron Raes, 57, supported the euthanasia decision. Their terms on the board ended at the end of September 2018 and were not renewed.

The religious congregation, especially Stockman, protested the decision, reiterating the Brothers of Charity's rejection of euthanasia in their hospitals.

The brothers appealed to the Vatican, which asked the psychiatric hospitals to change their protocol allowing euthanasia as “a medical act” under certain conditions.

The hospital management responded with a long statement in September 2017, in which it contested a lack of dialogue and maintained the hospital was "perfectly consistent" with Christian doctrine.

The CDF's direction that the hospitals must no longer identify as Catholic was communicated in a letter signed by CDF prefect Cardinal Luis Francisco Ladaria Ferrer and secretary Archbishop Giacomo Morandi.

The letter retraced the developments of the story, recalling that the document allowing euthanasia in the brothers' hospitals "refers neither to God, nor to Holy Scripture, nor to the Christian vision of Man."

According to the letter, the CDF had spoken with the Brothers of Charity and had also informed Pope Francis of the gravity of the situation.

Other audiences had also taken place beginning June 2017, including with the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life, the Secretariat of State, the representatives of the Brothers of Charity and the managing corporation, as well as representatives of the Belgian bishops' conference.

The Holy See also sent Bishop Jan Hendriks, auxiliary of Amsterdam, as an apostolic visitor, but he did not register any steps forward nor a desire to find "a viable solution that avoids any form of responsibility of the institution for euthanasia."

The request of the CDF to the Brothers of Charity and to the managing corporation was clear: “affirm in writing and in an unequivocal way their adherence to the principles of the sacredness of human life and the unacceptability of euthanasia, and, as a consequence, the absolute refusal to carry it out in the institutions they depend on."

The corporation "did not give assurance on these points."

The CDF therefore reiterated that "euthanasia remains an inadmissible act, even in extreme cases," and strengthened the statement by citing St. John Paul II's 1995 encyclical Evangelium vitae, and a Jan. 30 speech by Pope Francis to the CDF.

The CDF stressed that "Catholic teaching affirms the sacred value of human life," the "importance of caring for and accompanying the sick and disabled," as well as "the Christian value of suffering, the moral unacceptability of euthanasia" and "the impossibility of introducing this practice in Catholic hospitals, not even in extreme cases, as well as of collaborating in this regard with civil institutions."

The Brothers of Charity is a religious congregation of lay brothers founded in 1807 in Belgium, whose specialization is care for the sick and those with psychiatric diseases.

At the congregation's July 2018 general chapter the group stressed that the Brothers of Charity "believes in sacredness and absolute respect for every human life, from conception to natural death. The general chapter requires that each brother, associate member and others associated with the mission of the congregation adhere to the doctrine of the Catholic Church on ethical issues."




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Pope Francis prays for coronavirus victims dying without their loved ones

Vatican City, May 5, 2020 / 03:30 am (CNA).- Pope Francis prayed for those who have died alone during the coronavirus pandemic at his morning Mass Tuesday.

At the start of Mass in the chapel at Casa Santa Marta, his Vatican residence, he said May 5: "Today we pray for the deceased who have died because of the pandemic. They have died alone, without the caresses of their loved ones. So many did not even have a funeral. May the Lord welcome them in His glory."

More than 250,000 people have died of COVID-19 worldwide as of May 5, according to Johns Hopkins University Coronavirus Resource Center.

In his homily, the pope reflected on the day’s Gospel reading (John 10:22-30), in which Jesus is asked to declare openly whether he is the Christ. Jesus replies that he has already told his listeners, but they have not believed him because they are not among his sheep.  

Pope Francis urged Catholics to ask themselves: “What makes me stop outside the door that is Jesus?”

One major obstacle is wealth, the pope said.

“There are many of us who have entered the door of the Lord but then fail to continue because we are imprisoned by wealth,” he said, according to a transcript by Vatican News. 

“Jesus takes a hard line regarding wealth… Wealth keeps us from going ahead. Do we need to fall into poverty? No, but, we must not become slaves to wealth. Wealth is the lord of this world, and we cannot serve two masters.”

The pope added that another barrier to progress towards Jesus is rigidity of heart.  

He said: “Jesus reproached the doctors of the law for their rigidity in interpreting the law, which is not faithfulness. Faithfulness is always a gift of God; rigidity is only security for oneself.”

As an example of rigidity, the pope recalled that once when he visited a parish a woman asked him whether attending a Saturday afternoon nuptial Mass fulfilled her Sunday obligation. The readings were different to those on Sunday so she worried that she might have committed a mortal sin. 

Rigidity leads us away from the wisdom of Jesus and robs us of our freedom, he said.

The pope named two further obstacles: acedia, which he defined as a tiredness that “takes away our desire to strive forward” and makes us lukewarm, and clericalism, which he described as a disease that takes away the freedom of the faithful. 

He identified worldliness as the final obstacle to approaching Jesus. 

“We can think of how some sacraments are celebrated in some parishes: how much worldliness there is there,” he said. 

“These are some of the things that stop us from becoming members of Jesus’s flock. We are ‘sheep’ of all these things -- wealth, apathy, rigidity, worldliness, clericalism, ideologies. But freedom is lacking and we cannot follow Jesus without freedom. ‘At times freedom might go too far, and we might slip and fall.’ Yes, that’s true. But this is slipping before becoming free.”

After Mass, the pope presided at adoration and benediction of the Blessed Sacrament, before leading those watching via livestream in an act of spiritual communion.

The congregation then sang the Easter Marian antiphon "Regina caeli."

At the end of his homily, the pope prayed: “May the Lord enlighten us to see within ourselves if we have the freedom required to go through the door which is Jesus, to go beyond it with Jesus in order to become sheep of His flock.”




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Pope Francis: ‘Jesus saves us from the darkness’

Vatican City, May 6, 2020 / 07:00 am (CNA).- Pope Francis said Wednesday that Christ’s light illuminates the darkness of sin in our world and in ourselves.

“It is the mission of Jesus to bring light. And the mission of the apostles is to bring the light of Jesus,” Pope Francis said in his morning Mass homily on May 6.

“The Lord saves us from the darkness that we have inside, from the darkness of everyday life, of social life, of political life, of national, international life,” he said.

Speaking from the chapel of his Vatican City residence, Casa Santa Marta, Pope Francis quoted chapter 12 of the Gospel of John: “I came into the world as light, so that everyone who believes in me might not remain in darkness.”

The pope said that “the drama is that the light of Jesus has been rejected” by many who are blinded by sin. 

“Sin blinds us and we cannot tolerate light,” he said. “It is not easy to live in the light. The light makes us see so many bad things inside us that we do not want to see: the vices, the sins.”

He continued: “We think of our pride. We think of our worldly spirit. These things blind us. They distance us from the light of Jesus.”

Conversion is an experience of moving from this darkness of the “slavery” of sin to the light of Christ, the pope said.

“Paul had this experience of the passage from darkness to light, when the Lord met him on the road to Damascus. He was blinded. Blind. The light of the Lord blinded him. And then, after a few days, with baptism, the light was restored,” he said. 

“He had this experience of the passage from the darkness, in which he was, to the light. It is also our passage, which we sacramentally received in Baptism … This is why in the baptism liturgy we receive a lit candle … because the child is illuminated,” he added.

Pope Francis said that the Lord asks us to “have the courage to see our darkness so that the light of the Lord may come in and save us.” He added that there is no reason to be afraid of the light of Jesus because he is gentle and good, and “he came to save us.”

“And this will be the struggle of Jesus. He continues to illuminate, to bring the light that shows things as they are,” the pope said. 

“He shows freedom. He shows the truth. He shows the way to go with the light of Jesus.”




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Pope Francis: ‘Pass down the history of our salvation’

Vatican City, May 7, 2020 / 08:00 am (CNA).- It is important for Catholics to remember the whole of salvation history, and our belonging to the people of God’s covenant with Abraham, Pope Francis said at Mass Thursday.

During daily Mass in the chapel of his Vatican residence, the Casa Santa Marta, Pope Francis reflected on an aspect of the day’s first reading from the Acts of the Apostles, when St. Paul is invited to speak in the synagogue in Antioch.

Instead of speaking directly about Jesus, the apostle begins by telling the history of salvation, the pope noted May 7.

“What is behind Jesus? There is a story. A story of grace, a story of election, a story of promise. The Lord chose Abraham and went with his people,” he said.

“There is a story of God with his people. And for this reason, when Paul is asked to explain the reason for faith in Jesus Christ, he does not start from Jesus Christ: he begins from history.”

The pope pointed to the first part of the entrance antiphon recited at the start of that Mass: “O God, when you went forth before your people, marching with them and living among them...”

He urged Catholics to remember to “pass down the history of our salvation,” and to ask the Lord to help them have the awareness of being children of Abraham, as the Virgin Mary says in the Magnificat and Zechariah in his Benedictus, canticles which are recited or sung in the Liturgy of the Hours.

Christianity, the pope said, is belonging to the people with whom the Lord made his covenant.

Pope Francis also spoke in his homily about what he thinks Christianity is not.

“Christianity is a doctrine, yes, but not only,” he stated. “Christianity is not just an ethic. Yes, indeed, it has moral principles,” but it is not just having an ethical viewpoint.

Francis went on to say that Christianity is also more than an exclusionary vision of an “‘elite’ of people chosen for the truth.” He criticized when this attitude comes into the Church as a belief in the damnation of others.

It is good to be a moral people, he said, but “Christianity is belonging to a people, to a people freely chosen by God.”

“If we do not have this awareness of belonging to a people we would be ideological Christians,” he said.

The pope explained that this is why, in order to speak about Jesus, St. Paul starts by explaining “from the beginning, from belonging to a people.”

He warned that when Christians lose the sense of belonging to the people of God’s covenant, they often fall into “partialities,” whether dogmatic, moral, or elitist.

Francis called this “the most dangerous deviation” Christians can fall into today.

Before Mass, Pope Francis noted that he had received a letter from a group of artists, thanking him for remembering them in prayer in April.

He added that he “would like to ask the Lord to bless them because artists make us understand what beauty is and without beauty the Gospel cannot be understood.”

“Let’s pray for artists again,” he urged.

After Mass, the pope concluded the livestream with Eucharistic adoration, benediction, and the Marian antiphon “Regina coeli.”




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Pope Francis: the devil seeks to destroy the Church through envy

Vatican City, May 9, 2020 / 04:00 am (CNA).- The devil uses envy to try to thwart the proclamation of the Gospel, Pope Francis said at his morning Mass Saturday.

In his homily in the chapel at Casa Santa Marta, May 9, the pope reflected on the day’s first reading, Acts 13:44-52, in which the Jewish community at Antioch rejects St. Paul’s preaching about Jesus. 

He said: “On the one hand there is the Lord, there is the Holy Spirit who makes the Church grow, and it grows ever more: this is true. But on the other hand, there is the evil spirit that seeks to destroy the Church.” 

After citing other examples in the Acts of the Apostles where the apostles faced rejection, the pope asked: “And what is the devil's instrument to destroy the Gospel proclamation? Envy. The Book of Wisdom [2:24] says it clearly: ‘Through the devil's envy sin has entered the world’ -- envy, jealousy, here. Always this bitter, bitter feeling.” 

Reflecting on this enduring struggle, Pope Francis quoted St. Augustine of Hippo, who wrote in “The City of God” that “the Church progresses on her pilgrimage amidst this world's persecutions and God's consolations.”

“A Church that has no difficulty lacks something,” he said. “The devil is too calm. And if the devil is calm, things are not going well. Always the difficulty, the temptation, the struggle... the jealousy that destroys. The Holy Spirit creates the harmony of the Church, and the evil spirit destroys. Until today.” 

The pope noted that in the first reading the community at Antioch turned the leading women and men of the city against the apostles. He observed that temporal powers are often an instrument through which envy is stirred up against Christians. 

He said: “Let us be careful with the preaching of the Gospel: never to fall, to put our trust in temporal powers and money. The trust of Christians is Jesus Christ and the Holy Spirit that He sent, and it is precisely the Holy Spirit who is the leaven, it is the strength that makes the Church grow.” 

“Yes, the Church goes ahead, in peace, with resignation, joyful: between ‘the consolations of God and the persecutions of the world.’”

The pope led those watching via livestream in an act of spiritual communion, composed by St. Alphonsus Liguori, founder of the Redemptorists.

He prayed: “My Jesus, I believe that you are present in the most Blessed Sacrament. I love You above all things and I desire to receive You into my soul. Since I cannot now receive You sacramentally, come at least spiritually into my heart. I embrace You as if You were already there, and unite myself wholly to You. Never permit me to be separated from You.”

The pope ended the celebration with adoration and benediction of the Blessed Sacrament. The congregation then sang the Easter Marian antiphon “Regina caeli.”

At the start of Mass, the pope noted that May 9 is the feast day of St. Louise de Marillac, the French founder of the Daughters of Charity. Her feast normally falls on March 15 but was transferred this year because it fell on a Sunday in Lent. A painting of the 17th-century saint was brought to the pope’s chapel to mark the occasion. 

The Daughters of Charity belong to the Vincentian family. Vincentian nuns live at the Casa Santa Marta, the pope’s residence, and run a pediatric dispensary at the Vatican.

At the start of Mass, the pope said: “Today is the commemoration of St. Louise de Marillac: let us pray for the Vincentian sisters who have run this clinic, this hospital, for almost 100 years and have worked here, in Santa Marta, for this hospital. May the Lord bless the sisters.”




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Off the GRID

OM New Zealand’s new Off The GRID discipleship programme aims to inspire young adults to live for God and to serve others.




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Going Off The GRID to learn about God

A French couple attended the Off The GRID discipleship programme in New Zealand, where they learned about missions and God.




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Hope for the Caucasus

An overview of the Caucasus region and a call to participate.




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Putting the Caucasus on the map

OMers share how God is moving among unreached people in their remote village in the Caucasus.




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Service Use Classes Among School-aged Children From the Autism Treatment Network Registry

BACKGROUND AND OBJECTIVES:

Use of specific services may help to optimize health for children with autism spectrum disorder (ASD); however, little is known about their service use patterns. We aimed to (1) define service use groups and (2) determine associations of sociodemographic, developmental, behavioral, and health characteristics with service use groups among school-aged children with ASD.

METHODS:

We analyzed cross-sectional data on 1378 children aged 6 to 18 years with an ASD diagnosis from the Autism Speaks Autism Treatment Network registry for 2008–2015, which included 16 US sites and 2 Canadian sites. Thirteen service use indicators spanning behavioral and medical treatments (eg, developmental therapy, psychotropic medications, and special diets) were examined. Latent class analysis was used to identify groups of children with similar service use patterns.

RESULTS:

By using latent class analysis, school-aged children with ASD were placed into 4 service use classes: limited services (12.0%), multimodal services (36.4%), predominantly educational and/or behavioral services (42.6%), or predominantly special diets and/or natural products (9.0%). Multivariable analysis results revealed that compared with children in the educational and/or behavioral services class, those in the multimodal services class had greater ASD severity and more externalizing behavior problems, those in the limited services class were older and had less ASD severity, and those in the special diets and/or natural products class had higher income and poorer quality of life.

CONCLUSIONS:

In this study, we identified 4 service use groups among school-aged children with ASD that may be related to certain sociodemographic, developmental, behavioral, and health characteristics. Study findings may be used to better support providers and families in decision-making about ASD services.




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Therapy and Psychotropic Medication Use in Young Children With Autism Spectrum Disorder

BACKGROUND AND OBJECTIVES:

Guidelines suggest young children with autism spectrum disorder (ASD) receive intensive nonpharmacologic interventions. Additionally, associated symptoms may be treated with psychotropic medications. Actual intervention use by young children has not been well characterized. Our aim in this study was to describe interventions received by young children (3–6 years old) with ASD. The association with sociodemographic factors was also explored.

METHODS:

Data were analyzed from the Autism Speaks Autism Treatment Network (AS-ATN), a research registry of children with ASD from 17 sites in the United States and Canada. AS-ATN participants receive a diagnostic evaluation and treatment recommendations. Parents report intervention use at follow-up visits. At follow-up, 805 participants had data available about therapies received, and 613 had data available about medications received.

RESULTS:

The median total hours per week of therapy was 5.5 hours (interquartile range 2.0–15.0), and only 33.4% of participants were reported to be getting behaviorally based therapies. A univariate analysis and a multiple regression model predicting total therapy time showed that a diagnosis of ASD before enrollment in the AS-ATN was a significant predictor. Additionally, 16.3% of participants were on ≥1 psychotropic medication. A univariate analysis and a multiple logistic model predicting psychotropic medication use showed site region as a significant predictor.

CONCLUSIONS:

Relatively few young children with ASD are receiving behavioral therapies or total therapy hours at the recommended intensity. There is regional variability in psychotropic medication use. Further research is needed to improve access to evidence-based treatments for young children with ASD.




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Patient- and Family-Centered Care in the Emergency Department for Children With Autism

BACKGROUND:

Emergency department (ED) care processes and environments impose unique challenges for children with autism spectrum disorder (ASD). The implementation of patient- and family-centered care (PFCC) emerges as a priority for optimizing ED care. In this article, as part of a larger study, we explore PFCC in the context of ASD. Our aims were to examine how elements of PFCC were experienced and applied relative to ED care for children with ASD.

METHODS:

Qualitative interviews were conducted with parents and ED service providers, drawing on a grounded theory approach. Interviews were audio recorded, transcribed verbatim, and analyzed by using established constant comparison methods. Data were reviewed to appraise the reported presence or absence of PFCC components.

RESULTS:

Fifty-three stakeholders (31 parents of children with ASD and 22 ED service providers) participated in interviews. Results revealed the value of PFCC in autism-based ED care. Helpful attributes of care were a person-centered approach, staff knowledge about ASD, consultation with parents, and a child-focused environment. Conversely, a lack of staff knowledge and/or experience in ASD, inattention to parent expertise, insufficient communication, insufficient family orientation to the ED, an inaccessible environment, insufficient support, a lack of resources, and system rigidities were identified to impede the experience of care.

CONCLUSIONS:

Findings amplify PFCC as integral to effectively serving children with ASD and their families in the ED. Resources that specifically nurture PFCC emerge as practice and program priorities.




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Families Experiences With Family Navigation Services in the Autism Treatment Network

BACKGROUND AND OBJECTIVES:

Families of children with autism spectrum disorder (ASD) often experience challenges navigating multiple systems to access services. Family navigation (FN) is a model to provide information and support to access appropriate services. Few studies have been used to examine FN’s effectiveness for families of children with ASD. This study used mixed methods to (1) characterize FN services received by a sample of families in the Autism Treatment Network; (2) examine change in parent-reported activation, family functioning, and caregiver strain; and (3) explore families’ experiences with FN services.

METHODS:

Family characteristics and parent outcomes including parent activation, family functioning, and caregiver strain were collected from 260 parents in the Autism Treatment Network. Descriptive statistics and linear mixed models were used for aims 1 and 2. A subsample of 27 families were interviewed about their experiences with FN services to address aim 3.

RESULTS:

Quantitative results for aims 1 and 2 revealed variability in FN services and improvement in parent activation and caregiver strain. Qualitative results revealed variability in family experiences on the basis of FN implementation differences (ie, how families were introduced to FN, service type, intensity, and timing) and whether they perceived improved skills and access to resources.

CONCLUSIONS:

Findings suggest FN adaptations occur across different health care delivery systems and may result in highly variable initial outcomes and family experiences. Timing of FN services and case management receipt may contribute to this variability for families of children with ASD.




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Family Engagement in the Autism Treatment and Learning Health Networks

Family involvement in the Autism Intervention Research Network on Physical Health, the Autism Treatment Network, and the Autism Learning Health Network, jointly the Autism Networks, has evolved and grown into a meaningful and robust collaboration between families, providers, and researchers. Family involvement at the center of the networks includes both local and national network-wide coproduction and contribution. Family involvement includes actively co-authoring research proposals for large grants, equal membership of network committees and workgroups, and formulating quality improvement pathways for local recruitment efforts and other network initiatives. Although families are involved in every aspect of network activity, families have been the driving force of specifically challenging the networks to concentrate research, education, and dissemination efforts around 3 pillar initiatives of addressing comorbidities of anxiety, attention-deficit/hyperactivity disorder, and irritability in autism during the networks’ upcoming funding cycle. The expansion of the networks’ Extension for Community Healthcare Outcomes program is an exciting network initiative that brings best practices in autism care to community providers. As equal hub members of each Extension for Community Healthcare Outcomes team, families ensure that participants are intimately cognizant of family perspectives and goals. Self-advocacy involvement in the networks is emerging, with plans for each site to have self-advocacy representation by the spring of 2020 and ultimately forming their own coproduction committee. The Autism Treatment Network, the Autism Intervention Research Network on Physical Health, and the Autism Learning Health Network continue to be trailblazing organizations in how families are involved in the growth of their networks, production of meaningful research, and dissemination of information to providers and families regarding emerging work in autism spectrum disorders.




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Improving Behavior Challenges and Quality of Life in the Autism Learning Health Network

OBJECTIVES:

To summarize baseline data and lessons learned from the Autism Learning Health Network, designed to improve care and outcomes for children with autism spectrum disorder (ASD). We describe challenging behaviors, co-occurring medical conditions, quality of life (QoL), receipt of recommended health services, and next steps.

METHODS:

A cross-sectional study of children 3 to 12 years old with ASD receiving care at 13 sites. Parent-reported characteristics of children with ASD were collected as outcome measures aligned with our network’s aims of reducing rates of challenging behaviors, improving QoL, and ensuring receipt of recommended health services. Parents completed a survey about behavioral challenges, co-occurring conditions, health services, and the Patient-Reported Outcomes Measurement Information System Global Health Measure and the Aberrant Behavior Checklist to assess QoL and behavior symptoms, respectively.

RESULTS:

Analysis included 530 children. Challenging behaviors were reported by the majority of parents (93%), frequently noting attention-deficit/hyperactivity disorder symptoms, irritability, and anxiety. Mean (SD) scores on the Aberrant Behavior Checklist hyperactivity and irritability subscales were 17.9 (10.5) and 13.5 (9.2), respectively. The Patient-Reported Outcomes Measurement Information System Global Health Measure total score of 23.6 (3.7) was lower than scores reported in a general pediatric population. Most children had received recommended well-child (94%) and dental (85%) care in the past 12 months.

CONCLUSIONS:

This baseline data (1) affirmed the focus on addressing challenging behaviors; (2) prioritized 3 behavior domains, that of attention-deficit/hyperactivity disorder, irritability, and anxiety; and (3) identified targets for reducing severity of behaviors and strategies to improve data collection.




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The Autism Treatment Network: Bringing Best Practices to All Children With Autism

The Autism Treatment Network and Autism Intervention Research Network on Physical Health were established in 2008 with goals of improving understanding of the medical aspects of autism spectrum disorders. Over the past decade, the combined network has conducted >2 dozen clinical studies, established clinical pathways for best practice, developed tool kits for professionals and families to support better care, and disseminated these works through numerous presentations at scientific meetings and publications in medical journals. As the joint network enters its second decade continuing this work, it is undergoing a transformation to increase these activities and accelerate their incorporation into clinical care at the primary care and specialty care levels. In this article, we describe the past accomplishments and present activities. We also outline planned undertakings such as the establishment of the Autism Learning Health Network, the increasing role of family members as co-producers of the work of the network, the growth of clinical trials activities with funding from foundations and industry, and expansion of work with primary care practices and autism specialty centers. We also discuss the challenges of supporting network activities and potential solutions to sustain the network.




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Pediatricians Are Perfectly Positioned to Help Mothers Reach Their Breastfeeding Goals




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Promoting Ideal Cardiovascular Health Through the Life Span




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The Costs and Benefits of Regionalized Care for Children




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Anaerobic Necrotizing Pneumonia: Another Potential Life-threatening Complication of Vaping?

An adolescent girl with a history of frequent electronic cigarette use of nicotine was hospitalized with severe necrotizing pneumonia. Blood cultures obtained before the administration of empirical broad-spectrum intravenous antibiotics had positive results for the growth of Fusobacterium necrophorum. The pathogen is an uncommon but well-known cause of anaerobic pneumonia with unique features that are collectively referred to as Lemierre syndrome or postanginal sepsis. The syndrome begins as a pharyngeal infection. Untreated, the infection progresses to involve the ipsilateral internal jugular vein, resulting in septic thrombophlebitis with direct spread from the neck to the lungs causing multifocal necrotizing pneumonia. The teenager we present in this report had neither a preceding pharyngeal infection nor Doppler ultrasonographic evidence for the presence of deep neck vein thrombi, leading us to explore alternative mechanisms for her pneumonia. We propose the possibility that her behavior of frequent vaping led to sufficient pharyngeal irritation such that F necrophorum colonizing her oropharynx was inhaled directly into her lungs during electronic cigarette use. Preexisting, but not yet recognized, vaping-related lung injury may have also contributed to her risk of developing the infection. The patient was hospitalized for 10 days. At follow-up one month later, she still became short of breath with minimal exertion.




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The History of the Personal Belief Exemption




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Can a Parent Refuse the Brain Death Examination?

The American Academy of Neurology believes that doctors have the right to do tests to evaluate whether a patient is brain dead even if the family does not consent. They argue that physicians have "both the moral authority and professional responsibility" to do such evaluations, just as they have the authority and responsibility to declare someone dead by circulatory criteria. Not everyone agrees. Truog and Tasker argue that apnea testing to confirm brain death has risks and that, for some families, those risks may outweigh the benefits. So, what should doctors do when caring for a patient whom they believe to be brain dead but whose parents refuse to allow testing to confirm that the patient meets neurologic criteria for death? In this article, we analyze the issues that arise when parents refuse such testing.




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Chronic Thrombocytopenia as the Initial Manifestation of STIM1-Related Disorders

Pediatric thrombocytopenia has a wide differential diagnosis, and recently, genetic testing to identify its etiology has become more common. We present a case of a 16-year-old boy with a history of chronic moderate thrombocytopenia, who later developed constitutional symptoms and bilateral hand edema with cold exposure. Laboratory evaluation revealed evidence both of inflammation and elevated muscle enzymes. These abnormalities persisted over months. His thrombocytopenia was determined to be immune mediated. Imaging revealed lymphadenopathy and asplenia, and a muscle biopsy was consistent with tubular aggregate myopathy. Ophthalmology evaluation noted photosensitivity, pupillary miosis, and iris hypoplasia. Genetic testing demonstrated a pathogenic variant in STIM1 consistent with autosomal dominant Stormorken syndrome. Our case is novel because of the overlap of phenotypes ascribed to both gain-of-function and loss-of-function pathogenic variants in STIM1, thereby blurring the distinctions between these previously described syndromes. Pediatricians should consider checking muscle enzymes when patients present with thrombocytopenia and arthralgia, myalgia, and/or muscle weakness. Our case highlights the importance of both multidisciplinary care and genetic testing in cases of chronic unexplained thrombocytopenia. By understanding the underlying genetic mechanism to a patient’s thrombocytopenia, providers are better equipped to make more precise medical management recommendations.




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STEPP IN: Working Together to Keep Infants Warm in the Perioperative Period

OBJECTIVES:

Reduce postoperative hypothermia by up to 50% over a 12-month period in children’s hospital NICUs and identify specific clinical practices that impact success.

METHODS:

Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for maintaining perioperative euthermia that included the following: established euthermia before transport to the operating room (OR), standardized practice for maintaining euthermia on transport to and from the OR, and standardized practice to prevent intraoperative heat loss. Process measures were focused on maintaining euthermia during these time points. The outcome measure was the proportion of patients with postoperative hypothermia (temperature ≤36°C within 30 minutes of a return to the NICU or at the completion of a procedure in the NICU). Balancing measures were the proportion of patients with postoperative temperature >38°C or the presence of thermal burns. Multivariable logistic regression was used to identify key practices that improved outcome.

RESULTS:

Postoperative hypothermia decreased by 48%, from a baseline of 20.3% (January 2011 to September 2013) to 10.5% by June 2015. Strategies associated with decreased hypothermia include >90% compliance with patient euthermia (36.1–37.9°C) at times of OR arrival (odds ratio: 0.58; 95% confidence interval [CI]: 0.43–0.79; P < .001) and OR departure (odds ratio: 0.0.73; 95% CI: 0.56–0.95; P = .017) and prewarming the OR ambient temperature to >74°F (odds ratio: 0.78; 95% CI: 0.62–0.999; P = .05). Hyperthermia increased from a baseline of 1.1% to 2.2% during the project. No thermal burns were reported.

CONCLUSIONS:

Reducing postoperative hypothermia is possible. Key practices include prewarming the OR and compliance with strategies to maintain euthermia at select time points throughout the perioperative period.




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Current Issues in the Treatment of Acne Vulgaris

Acne vulgaris is an extraordinarily common skin condition in adolescents. The mainstays of acne treatment have remained largely unchanged over recent years. In the context of increasing antibiotic resistance worldwide, there is a global movement away from antibiotic monotherapy toward their more restrictive use. Classically reserved for nodulocystic acne, isotretinoin has become the drug of choice by dermatologists for moderate to severe acne. Given the virtually ubiquitous nature of acne in teenagers, there remains an appreciable need for novel therapies. In this article, we will cover the currently used acne treatments, evaluate the issues and data supporting their use, explore the issues of compliance and the mental health implications of acne care, and recommend directions for the field of acne management in adolescents in the years ahead.




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The Big Red Bus in Ballina

OM Ireland's Big Red Bus visited a housing estate in the town of Ballina in County Mayo.




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By the Spirit

Short-term participants from around the world joined OM for the Impact Ireland outreach to share Jesus with the people of Ireland.




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Golf and the gospel

OM Ireland and FCA Golf hold a four-day golf camp in Co. Westmeath, Ireland, to promote golf and the gospel.




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Camel and donkey preach the gospel to thousands

OM Ireland's two multi-media puppet shows perform over 75 times in schools around Ireland. The gospel message is expected to be heard by thousands.




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Children encouraged to 'Pass the Parcel'

To present the true meaning of Christmas, OM Ireland’s creative arts team performs a multimedia production in schools, churches and community centres around Ireland.




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The right people in the right place at the right time

OM Ireland's Mobilising director shares her thoughts about going "into all the world."




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Labourers together

Various OM ministries partner with the Irish Evangelistic Band to share the good news at Ireland's National Ploughing Championship.




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Ploughing with the Big Red Bus

After years of the team dreaming, the Big Red Bus finally joins the National Ploughing Championships during a windstorm.




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The story of Lacken House

In 2008, OM Ireland purchased Lacken House to be their headquarters. Ten years and hundreds of people later, the team continues to minister from the heart of Ireland.




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Reaching the community

The Bailie family serve with their local church as part of OM in Ireland's Philippian Project.




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The ‘butterfly effect’

Single mothers in Namibia experience life-changing opportunities, thanks to the work and care of one Namibian woman and the OM team.




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At the Chief's feet

A worker shares a story about becoming the fragrance of Christ as she and a team member wash the feet of a local village chief.




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The light in us

A woman once mentally ill walks in the light of Christ after five years living in spiritual, mental and physical darkness.




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The truth and rain

The Africa Trek team reaches out to the Damara people in Namibia.




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Minas for the unreached

Africa Trek Coordinator Eduard* reflects on God's gifts: his life, his wife and 13 participants sharing the Gospel with Topnaar and Himba peoples in Namibia.




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Standing on the Father's Rock

Young men from African nations find their identity and destiny through hiking in Namibia with the Wilderness Therapy Programme.