OBJECTIVES:

To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings.

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.

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.

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.

Almost 1 in 4 adolescents have a sexually transmitted infection (STI). These infections are preventable through safe sexual practices and routine screening. Pediatricians are the first line of clinical care for adolescents and are well positioned to offer sexual and reproductive health care counseling and services to their patients; yet, there is a paucity of sexual health screening provided at routine health supervision visits. This article addresses the epidemiology of STIs in adolescents, reviews the evidence of current clinical practice, presents recommended STI screening from government and medical agencies, and offers strategies to address barriers to providing care for adolescents and for sexual health screening in primary care.

Youth suicide is a national and global public health crisis. Pediatricians can use primary and secondary prevention strategies to intervene with youth before or after the onset of suicidal behaviors. Universal suicide risk screening programs can be used to identify youth in medical settings who may otherwise pass through the health care setting with undetected suicide risk. Pediatricians are uniquely positioned to help foster resilience in their young patients and equip families of at-risk youth with safety plans and lethal means safety counseling. Pediatricians on the frontlines of this critical public health crisis require education and training in detecting suicide risk, managing those who screen positive, and connecting their patients to much needed mental health interventions and treatments. Evidence-based suicide risk screening and assessment tools, paired with interventions, are feasible and potentially life-saving in the medical setting.

Adolescent use of electronic cigarettes (e-cigarettes) has increased dramatically, with younger and nicotine-naive adolescents starting to use these devices and use them more frequently than combustible cigarettes. In emerging evidence, it is shown that e-cigarettes are not effective in helping adult smokers quit and that youth using e-cigarettes are at risk for becoming nicotine dependent and continuing to use as adults. Important gaps in our knowledge remain regarding the long-term health impact of e-cigarettes, effective strategies to prevent and reduce adolescent e-cigarette use, and the impact of provider screening and counseling to address this new method of nicotine use.

Various states have legalized marijuana for medical purposes and/or decriminalized recreational marijuana use. These changes coincide with a decrease in perceived harmfulness of the drug and an increase in its use among youth. This change is of critical concern because of the potential harmful impact of marijuana exposure on adolescents. Marijuana use has been associated with several adverse mental health outcomes, including increased incidence of addiction and comorbid substance use, suicidality, and new-onset psychosis. Negative impacts on cognition and academic performance have also been observed. As the trend toward legalization continues, the pediatric community will be called on to navigate the subsequent challenges that arise with changing policies. Pediatricians are uniquely positioned to provide innovative care and educate youth and families on the ever-evolving issues pertaining to the impact of marijuana legalization on communities. In this article, we present and analyze the most up-to-date data on the effects of legalization on adolescent marijuana use, the effects of adolescent use on mental health and cognitive outcomes, and the current interventions being recommended for use in pediatric office settings.

In response to the growing impact of the current opioid public health crisis in the United States on adolescents and young adults, pediatricians have an expanding role in identifying opioid use early, preventing escalation of risky use, reducing opioid-related harms, and delivering effective therapies. Research and expert consensus suggest the use of brief interventions focused on reducing risks associated with ongoing opioid use and using motivational interviewing strategies to engage youth in treatment. Because fatal opioid overdose remains a major cause of opioid-related mortality among youth, delivering overdose education as part of any visit in which a youth endorses opioid use is one evidence-based strategy to decrease the burden of opioid-related mortality. For youth that are injecting opioids, safe injection practices and linkage to needle or syringe exchanges should be considered to reduce complications from injection drug use. It is crucial that youth be offered treatment at the time of diagnosis of an opioid use disorder (OUD), including medications, behavioral interventions, and/or referral to mutual support groups. The 2 medications commonly used for office-based OUD treatment in adolescents are extended-release naltrexone (opioid antagonist) and buprenorphine (partial opioid agonist), although there is a significant treatment gap in prescribing these medications to youth, especially adolescents <18 years of age. Addiction is a pediatric disease that pediatricians and adolescent medicine physicians are uniquely poised to manage, given their expertise in longitudinal, preventive, and family- and patient-centered care. Growing evidence supports the need for integration of OUD treatment into primary care.

A remarkable story which came to a climax on February 23 this year when OM Ireland took possession of the deeds to Lacken House as their new headquarters and ministry centre.

OM Ireland's community outreach team participates in one of Ireland's biggest events: the 2011 National Ploughing Championships in Athy, Co. Kildare from 20 -22 September.

When God directed Ellianna to Ireland instead of Austria, she discovered a new opportunity to meet refugees.

On 12 December, OM Australia settled on their first-ever permanent base after renting for over 20 years.

OM Ukraine's sports team equips and trains churches in using non-traditional sports in their summer camps.

A Ukrainian pastor responds to nearly 100 per cent unemployment in his village by starting biofuel and cash crop business enterprises.

Sunday School isn't just for Sundays anymore - it can be on any given day of the week in Ukraine.

Turning organic waste into bio-fuel and French-fry oil into bio-diesel; all these are innovative ways of building sustainable income for the church in Kaharlyk.

OM Panama team members struggle to continue ministry as the Gnöbe Buglé people protest and bring the country to a halt.

Following the recent protests and riots, OM Panama's Mission Extreme group helps clean the Volcán police station.

The OM Panama International Intensive School of Missions re-opens!

A man goes from being sought by gangsters to being sought by God.

Balboa, Panama :: Logos Hope's volunteers make an uplifting visit to a shelter for migrant men, testing their eyesight and handing out reading glasses.

Founded by Wendy H Gilmour in 2011, Thankfifi began as a fashion blog and has since grown to cover lifestyle, travel and interiors.

Words: Abbie Lyall

Topshop have announced their first ever vegan footwear collection, available from 10th April 2019.

Words: Abbie Lyall

Big firms are using political connections to keep their hands on pension fund surpluses, says the head of the Financial Services Board.

A retired Fin24 user is looking at investing in a retirement annuity to provide him with a cash payout of R500 000 to ensure that he lives within his means. An expert responds.

A Fin24 user set to retire in August this year is looking at options on where he can invest his pension payout.

A Thousand Moons

Need a virtual assistant that can work between your PC and mobile device? Cortana can handle your questions and requests on iOS, Android, and Windows 10.

Apple's Podcasts app is available on mobile and the desktop, but in macOS Catalina, a new standalone Podcasts app replaces iTunes. Here's how to subscribe, listen, and adjust settings on iOS, iPadOS, iTunes, and Mac.

Apple's stellar iOS 13 mobile OS brings new visuals and new privacy features to iPhones, with dark mode, improved efficiency, and a healthy dollop of machine learning on top.

Tristan Hugh-Jones, oyster farmer

It was the highest catwalk show on earth, 300 metres above Everest Base Camp - and the Herald was the only paper in Britain to have a front row seat.

This season's colours and cuts mix up the wardrobe-staple trench, says Prudence Wade.

Australia's central bank has predicted that the country is facing its biggest economic contraction on record.

The head of the International Monetary Fund said Friday that previous estimates for the world economy to contract by three percent this year were too optimistic.

Once the coronavirus pandemic is over, the tourism industry will probably find that older, more affluent travellers are more hesitant to do so.

It’s been a nerve-wracking few years for the traditional auto industry. One Silicon Valley VC firm speculates on its future in an interview with Bloomberg.

Anecdotal evidence suggests that institutional investors in South Africa and across the globe are starting to take their ownership rights more seriously.

"The Lord gave me a verse out of Isaiah 50:5...I started to understand that I had a lot to give, and that God’s ways for me might lead me differently than I had thought," said OMer Evelyn.

ANDY MURRAY may need to have another operation as he continues his bid to return to top-level tennis.

SIR Andy Murray has sent a heartfelt message to NHS staff for their heroic work during the coronavirus crisis.

Find out about the festival of football that has proceeded the UEFA Champions League final every year since 2006.

We investigate the system the Dutch use to unearth new talent.

We see how fair play and the integration of players from different backgrounds is reaping success in Schleswig-Holstein.

THE first cap is the sweetest. For hockey player Alan Forsyth it came on October 19, 2015: Great Britain versus Argentina at Bisham Abbey. He scored on his debut, too, teed up by fellow Scot Chris Grassick after 28 minutes.