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Bringing hope, help—and dresses—to Cambodia

OM Ships partners with Christian ministries and celebrates four years of service for Logos Hope.




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Strength in weakness

Name: Oliviana Tugui Home: Bucharest, Romania Born in: August 1984 Joined OM Ships: February 2013 Previous employment: Teacher’s Assistant and ESL/Spanish Teacher for Primary Students Current job on board: International Café team member




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Powering up for millions more

OM Ships is in final preparations for the Power Up Logos Hope technical project as the four millionth visitor comes aboard in Kaohsiung, Taiwan.




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Bringing hope and healing to South Korea

From 21 July - 19 August, Logos Hope brought the hope of the Gospel to over 50,000 people who visited the ship in Incheon, South Korea.




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A marine engineer’s heartbeat

Four Nigerian marine engineering students studying in Cebu, Philippines, receive practical training and spiritual encouragement through a Logos Hope engineer.




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Lasting memories

Logos Hope :: A tribute to Clive Musendami




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Training Sowers

Lima, Peru- In June four members from OM Peru led a day-long training seminar in Lima. The seminars were attended by over 50 believers from five different churches.




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A walking cane and a wooden cross

OM Peru completed their summer medical outreach in Trujillo, Peru. They saw over 350 patients and 60 people commit to the Lord.




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Many reached during medical clinic in Chincha

A team of volunteers and doctors attended to over 300 people in a town almost destroyed by an earthquake in 2007.




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Saying thank you with eggs

After preaching in a church and serving the community, team members each receive an egg as a gift from a local woman.




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Freedom Challenge climbs Machu Picchu

Forty women climb Machu Picchu to raise awareness about human trafficking during a five-day Freedom Challenge trek in Peru.




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RingCentral Fax

RingCentral Fax offers lots of pages per month and a modern multi-platform experience, but it costs a lot per month and its fax quality could be better.




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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 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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Swiss Guards postpone swearing-in of new recruits due to coronavirus

Vatican City, May 6, 2020 / 11:47 am (CNA).- The annual swearing-in of new Swiss Guards, which would usually take place May 6, was moved to Oct. 4 because of the coronavirus.

Instead, the Pontifical Swiss Guards marked Wednesday’s anniversary of the Sack of Rome with private, more muted celebrations, lacking the presence of guests and streamed over the internet.

The Swiss Guards marked the 493rd anniversary of the May 6, 1527 battle with Mass in the church of Santa Maria of the Pieta in the Teutonic College, followed by the “laying of the wreath,” in the Square of the Roman Protomartyrs in Vatican City.

Afterward, the commander of the Swiss Guards conferred papal honorifics on 15 guards.

After Mass, all but the newest members of the world’s smallest-but-oldest standing army marched to Square of the Roman Protomartyrs, so-named for being the site of the death of several early Christian martyrs, including St. Peter.

The Commander of the Swiss Guards, Christoph Graf, gave a speech at the ceremony in which he recounted the story of the 1527 battle known as the Sack of Rome, when 147 guards lost their lives defending Pope Clement VII from mutinous troops of the Holy Roman Empire.

During the battle, the pope was able to escape from the Vatican to Castel Sant’Angelo via a secret passageway connecting the two. It is the most significant and deadly event in the history of the Swiss Guards.

After the speech, a large wreath was placed in the square in commemoration of the guards who died during the battle.

The anniversary is usually marked by a whole weekend of events attended by representatives of the Swiss army, Swiss government, and Swiss bishops’ conference. Family and friends of the guards, and former guards who return for a visit, also participate.

In past years, the festivities have also included a concert and an audience with Pope Francis.

The main celebrant of the May 6 Mass was the assessor of the Secretariat of State, Msgr. Luigi Roberto Cona. In his homily, Cona said he wishes the guards may “truly experience Christ.”

“May you encounter a Church that is not only an institution, an institution to be defended, to be protected, which you have wisely done for 500 years now, but also a community, a believing community which has met the living and true Christ, which loves him, and intends to serve him in everyday life,” he said.

“Because every day we too, in imitation of the first Christian martyrs – and your brother guards who offered themselves at that very important moment in 1527 – we too, without the heroism of those, can offer ourselves day after day in the services we are called to perform.”




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Updated: Cardinal Sarah says he did not sign letter claiming coronavirus exploited for one-world government

CNA Staff, May 7, 2020 / 03:45 pm (CNA).- Hours after the publication of a controversial open letter regarding the coronavirus pandemic, the prefect of the Church’s dicastery for liturgy and sacraments, listed among the signers of the letter, said he did not sign it.

The letter, titled “Appeal for the Church and the World,” says the coronavirus pandemic has been exaggerated to foster widespread social panic and undercut freedom, as a preparation for the establishment of a one-world government.

Cardinal Robert Sarah, prefect of the Vatican's Congregation for Divine Worship and Sacraments, tweeted: “I share on a personal basis some of the questions or concerns raised with regard to restrictions on fundamental freedoms, but I have not signed this petition.”

“A cardinal prefect of the Roman Curia must observe a certain reserve in political matters, Sarah wrote in another tweet, “so I explicitly asked this morning the authors of the petition titled ‘for the Church and for the world’ not to mention me.”

Sarah was listed as a signatory of the letter when it was published May 7 by the National Catholic Register, LifeSiteNews, and other websites. Sarah's denial raises questions about the legitimacy of other reported signatories to the letter.

Jeanette DeMelo, editor of the National Catholic Register, told CNA that the principal author of the letter is Archbishop Carlo Vigano, a former papal emissary to the United States.

Vigano made headlines for an August 2018 letter that alleged Vatican officials had ignored warnings about the sexual abuse of disgraced former cardinal Theodore McCarrick. Since that time, Vigano has released numerous letters expressing his viewpoints on matters in the Church, which include criticisms of Pope Francis and other curial officials.

DeMelo said that Vigano had vouched for the authenticity of Sarah's signature.

“The Register contacted Archbishop Vigano, the principal author, and asked him specifically about the authenticity of the signature of Cardinal Sarah and he said ‘I can confirm 100% that Cardinal Sarah signed it.,” DeMelo told CNA.

The letter laments the social distancing and stay-at-home orders issued to slow the spread of the coronavirus pandemic, suggesting they are contrived mechanisms of social control, with a nefarious purpose.

“We have reason to believe, on the basis of official data on the incidence of the epidemic as related to the number of deaths, that there are powers interested in creating panic among the world’s population with the sole aim of permanently imposing unacceptable forms of restriction on freedoms, of controlling people and of tracking their movements,” the letter said.

“The imposition of these illiberal measures is a disturbing prelude to the realization of a world government beyond all control,” it added. (bold original)

Among the letter’s reported signatories are four cardinals: Sarah, who has now indicated he is not a signatory; Cardinal Gerhard Muller, former prefect of the Congregation for the Doctrine of the Faith, Cardinal Joseph Zen, emeritus bishop of Hong Kong, and Cardinal Janis Pujats, emeritus archbishop of Riga, Latvia.

Two U.S. bishops are also alleged signatories: Bishop Rene Gracida, emeritus bishop of Corpus Christi, and Bishop Joseph Strickland, the Bishop of Tyler, Texas. 

Strickland told CNA by email May 7 that he “did sign off on this letter.”

Along with several other bishops, the well-known auxiliary bishop of Astana, Kazakhstan, Bishop Athanasius Schneider, is listed as a signer of the letter.

Another reported signatory is Fr. Curzio Nitoglia, a priest of the Society of St. Pius X, a traditionalist group in “irregular communion” with the Church. Nitoglia is the author of “The Magisterium of Vatican II,” a 1994 article that claims that “the church of Vatican II is therefore not the Apostolic and Roman Catholic Church instituted by our Lord Jesus Christ.”

The May 7 letter argued that the coronavirus pandemic has been sensationalized and exploited, to impede civil rights and exact government control over individuals and families.

The letter said that “the facts have shown that, under the pretext of the Covid-19 epidemic, the inalienable rights of citizens have in many cases been violated and their fundamental freedoms, including the exercise of freedom of worship, expression and movement, have been disproportionately and unjustifiably restricted.”

“Many authoritative voices in the world of science and medicine confirm that the media’s alarmism about Covid-19 appears to be absolutely unjustified.”

Nearly 4 million people worldwide have tested positive for the coronavirus, and at least 270,000 have died. In some countries, death rates in the months of the coronavirus pandemic have far exceeded death rates over the same months in previous years, suggesting to some demographers and epidemiologists that coronavirus deaths have been dramatically undercounted.

The pandemic, and the social distancing and stay-at-home orders issued to slow its spread, have become a source of considerable controversy in recent weeks. In the U.S., protests in several state capitals have gathered demonstrators in close proximity to one another, a move public health experts say could lead to new outbreaks of the disease.

The letter said that the economic crisis occasioned by the global pandemic “encourages interference by foreign powers and has serious social and political repercussions. Those with governmental responsibility must stop these forms of social engineering, by taking measures to protect their citizens whom they represent, and in whose interests they have a serious obligation to act.”

“The criminalization of personal and social relationships must likewise be judged as an unacceptable part of the plan of those who advocate isolating individuals in order to better manipulate and control them,” the authors added.

No cure or therapeutic treatment has yet been identified for the virus. In early weeks of the pandemic, President Donald Trump hypothesized that hydroxychloroquine, an inexpensive anti-malarial medication, could help treat the disease. U.S. researchers have largely moved away from the medication, especially after a study by the Veterans’ Administration found that administering the drug leads to higher death rates among patients receiving it.

Some, including television hosts Laura Ingraham and Sean Hannity have alleged that the study is inaccurate. Some protestors have suggested the VA study was intended to discredit Trump or profit vaccine manufacturers.

In an apparent reference to the hydroxychloroquine controversy, the letter said that: “Every effort must be made to ensure that shady business interests do not influence the choices made by government leaders and international bodies. It is unreasonable to penalize those remedies that have proved to be effective, and are often inexpensive, just because one wishes to give priority to treatments or vaccines that are not as good, but which guarantee pharmaceutical companies far greater profits, and exacerbate public health expenditures.” 

“Let us also remember, as Pastors, that for Catholics it is morally unacceptable to develop or use vaccines derived from material from aborted fetuses,” the letter added.

The U.S. bishops conference has also said vaccine development should avoid unethical links to abortion.

The letter argues that governments do not have the right to ban or restrict public worship or other kinds of ministry, and asks that any such restrictions be rescinded.

On the sacraments, which have been subject both to voluntary restrictions and public health orders in some states, the letter noted that “the Church firmly asserts her autonomy to govern, worship, and teach.”

“The State has no right to interfere, for any reason whatsoever, in the sovereignty of the Church. Ecclesiastical authorities have never refused to collaborate with the State, but such collaboration does not authorize civil authorities to impose any sort of ban or restriction on public worship or the exercise of priestly ministry. The rights of God and of the faithful are the supreme law of the Church, which she neither intends to, nor can, abdicate. We ask that restrictions on the celebration of public ceremonies be removed.”

While restrictions on public worship have been met with public criticism in many places, the objections have been most pronounced in Italy.

After Italy’s prime minister announced in late April new health measures that would continue prohibiting religious gatherings, the Italian bishops released a statement denouncing the decision, which the bishops criticized as “arbitrary.” Two days later, Pope Francis seemed to signal his own view, praying while celebrating Mass that Christians would respond to the lifting of lockdown restrictions with “prudence and obedience.”

Along with cardinals, bishops, and priests, the letter’s signatories also included some academics, journalists, and scientists. Included among them are Vatican journalists Marco Tosatti and Robert Moynihan, Lifesitenews editor John-Henry Westen, Stephen Mosher, president of the Virginia-based Population Research Institute, and the leaders of pro-life groups in Texas and Ohio.

The letter’s signatories encouraged Catholics, and “all men and women of good will” to “assess the current situation in a way consistent with the teaching of the Gospel. This means taking a stand: either with Christ or against Christ.” (bold original)
 
“Let us not allow centuries of Christian civilization to be erased under the pretext of a virus, and an odious technological tyranny to be established, in which nameless and faceless people can decide the fate of the world by confining us to a virtual reality. If this is the plan to which the powers of this earth intend to make us yield, know that Jesus Christ, King and Lord of History, has promised that ‘the gates of Hell shall not prevail’ (Mt 16:18).”

The Holy See has not yet commented on the letter.
 

This story has been updated since its original publication. It is developing and will continue to be updated.




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Vigano accuses Cardinal Sarah of causing him ‘harm’ in row over coronavirus letter

CNA Staff, May 8, 2020 / 10:25 am (CNA).- Archbishop Carlo Maria Viganò has accused a Vatican cardinal of causing him “serious harm” in a bitter war of words over a controversial open letter regarding the coronavirus crisis.

In a statement published May 8, the archbishop criticized Cardinal Robert Sarah’s decision to distance himself from the letter, titled “Appeal for the Church and the World,” which argues that the coronavirus pandemic has been exploited in order to create a one-world government.

The statement details Vigano’s account of his interactions with Sarah beginning May 4. Viganò claims that on the evening of May 7, the prefect of the Vatican's Congregation for Divine Worship and Sacraments asked him to remove him from the list of signatories to the letter, which had by that time already been published.

“With surprise and deep regret,” he wrote, “I then learned that His Eminence had used his Twitter account, without giving me any notice, to make statements that cause serious harm to the truth and to my person.”

Viganò was referring to a series of three May 7 tweets from Sarah, which said: “A Cardinal Prefect, member of the Roman Curia has to observe a certain restriction  on political matters. He shouldn't sign petitions in such aereas [sic].”

“Therefore this morning I explicitely [sic] asked the authors of the petition titled ‘For the Church and for the world’ not to mention my name.”

“From a personal point of view, I may share some questions or preoccupations raised regarding restrictions on fundamental freedom but I didn't sign that petition,” Sarah added.

Viganò’s statement continued: “I am very sorry that this matter, which is due to human weakness, and for which I bear no resentment towards the person who caused it, has distracted our attention from what must seriously concern us at this dramatic moment.”

After Viganò issued his rebuke, Sarah tweeted May 8: “I will not speak to this petition, which today seems to occupy a lot of people. I leave to their conscience those who want to exploit it in one way or another. I decided not to sign this text. I fully accept my choice.”

In his statement, Viganò said he had chosen to publicize his private conversations with Sarah because he had a duty to tell the truth, and “also for the sake of fraternal correction.”

Vigano said Sarah had initially told him: “Yes, I agree to put my name to it, because this is a fight we must engage in together, not only for the Catholic Church but for all mankind.”

He confirmed that Sarah’s signature has now been removed from the open letter.

Vigano, a former papal nuncio made headlines in August 2018, for a letter that alleged Vatican officials had ignored warnings about the sexual abuse of disgraced former cardinal Theodore McCarrick. Since that time, Vigano has released numerous letters expressing his viewpoints on matters in the Church, which include criticisms of Pope Francis and other curial officials.

The appeal argued that as a result of the pandemic centuries of Christian civilization could be “erased under the pretext of a virus” and an “odious technological tyranny” established in its place.

It said: “We have reason to believe, on the basis of official data on the incidence of the epidemic as related to the number of deaths, that there are powers interested in creating panic among the world’s population with the sole aim of permanently imposing unacceptable forms of restriction on freedoms, of controlling people and of tracking their movements. The imposition of these illiberal measures is a disturbing prelude to the realization of a World Government beyond all control.”

Several bishops and cardinals are alleged to have signed the letter. Bishop Joseph Strickland of Tyler, Texas told CNA May 7 that he had signed it.

A press release on the appeal’s website May 8 claimed that Robert Kennedy Jr, son of the slain US. Presidential candidate Sen. Robert Kennedy, had signed the letter.

To date, nearly 4 million people have tested positive for the coronavirus, and at least 272,000 have died.




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Investing into relationships

OM New Zealand builds relationships with churches and cares for the 50-some New Zealanders serving in cross-cultural missions.




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Climbing for freedom in New Zealand

About 110 men, women and children climbed five volcanoes in Auckland in the Freedom Climb New Zealand on Saturday, 16 August.




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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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A thanksgiving sacrifice and feast

A man expresses thanks to God for good health after cancer by making a sacrifice to God and holding a feast for family and friends.




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Season of sowing

A church planting team shares their faith with Muslim friends and neighbours during a time set aside for sowing intentionally in people’s lives.




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Inviting guests in

Workers at a guest house in the mountains of Georgia share about a recent opportunity to reach the world for Christ from their quiet retreat.




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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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Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT

BACKGROUND AND OBJECTIVES:

Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up.

METHODS:

Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time.

RESULTS:

Both groups improved during active treatment in all subdomains of parent stress (β = –1.42, –1.25, –0.92; P < 0.001), depressive symptoms, and anxiety symptoms (β = –0.62 and –0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (β = –1.91 and –1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (β = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems.

CONCLUSIONS:

Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.




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Parent Perceptions About Communicating With Providers Regarding Early Autism Concerns

BACKGROUND:

Long delays between parents’ initial concerns about their children’s development and a subsequent autism spectrum disorder (ASD) diagnosis are common. Although discussions between parents and providers about early ASD concerns can be difficult, they are critical for initiating early, specialized services. The principles of shared decision-making can facilitate these discussions. This qualitative study was designed to gain insights from parents of young children with ASD about their experiences communicating with primary care providers with the goal of identifying strategies for improving conversations and decision-making regarding the early detection of ASD.

METHODS:

Three 2-hour focus groups were conducted with 23 parents of children with ASD <8 years old. Qualitative analysis employed an iterative and systematic approach to identify key themes related to parents’ experiences.

RESULTS:

Eight themes related to communication about early ASD concerns emerged: characteristics of the child that caused parental concerns, the response of others when the parent brought up concerns, how concerns were brought up to the parent by others, parental responses when others mentioned concerns, information seeking, barriers to and facilitators of acting on concerns, and recommendations to providers. Parent responses suggest the need for increased use of shared decision-making strategies and areas for process improvements.

CONCLUSIONS:

Primary care providers can play a key role in helping parents with ASD concerns make decisions about how to move forward and pursue appropriate referrals. Strategies include responding promptly to parental concerns, helping them weigh options, and monitoring the family’s progress as they navigate the service delivery system.




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Screening Tools for Autism Spectrum Disorder in Primary Care: A Systematic Evidence Review

CONTEXT:

Recommendations conflict regarding universal application of formal screening instruments in primary care (PC) and PC-like settings for autism spectrum disorder (ASD).

OBJECTIVES:

We systematically reviewed evidence for universal screening of children for ASD in PC.

DATA SOURCES:

We searched Medline, PsychInfo, Educational Resources Informational Clearinghouse, and Cumulative Index of Nursing and Allied Health Literature.

STUDY SELECTION:

We included studies in which researchers report psychometric properties of screening tools in unselected populations across PC and PC-like settings.

DATA EXTRACTION:

At least 2 authors reviewed each study, extracted data, checked accuracy, and assigned quality ratings using predefined criteria.

RESULTS:

We found evidence for moderate to high positive predictive values for ASD screening tools to identify children aged 16 to 40 months and 1 study for ≥48 months in PC and PC-like settings. Limited evidence evaluating sensitivity, specificity, and negative predictive value of instruments was available. No studies directly evaluated the impact of screening on treatment or harm.

LIMITATIONS:

Potential limitations include publication bias, selective reporting within studies, and a constrained search.

CONCLUSIONS:

ASD screening tools can be used to accurately identify percentages of unselected populations of young children for ASD in PC and PC-like settings. The scope of challenges associated with establishing direct linkage suggests that clinical and policy groups will likely continue to guide screening practices. ASD is a common neurodevelopmental disorder associated with significant life span costs.1,2 Growing evidence supports functional gains and improved outcomes for young children receiving intensive intervention, so early identification on a population level is a pressing public health challenge.3,4




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Disparities in Service Use Among Children With Autism: A Systematic Review

CONTEXT:

Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services.

OBJECTIVE:

We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to children with autism by race, ethnicity, and/or socioeconomic status.

DATA SOURCES:

Medline, PsychInfo, Educational Resources Informational Clearinghouse, and the Cumulative Index to Nursing and Allied Health Literature were searched by using a combination of Medical Subject Headings terms and keywords related to autism, disparities, treatment, and services.

STUDY SELECTION:

Included studies addressed at least one key question and met eligibility criteria.

DATA EXTRACTION:

Two authors reviewed the titles and abstracts of articles and reviewed the full text of potentially relevant articles. Authors extracted information from articles that were deemed appropriate.

RESULTS:

Treatment disparities exist for access to care, referral frequency, number of service hours, and proportion of unmet service needs. Evidence revealed that racial and ethnic minority groups and children from low-income families have less access to acute care, specialized services, educational services, and community services compared with higher-income and white families. We found no studies in which differences in intervention effectiveness were examined. Several studies revealed disparities such that African American and Hispanic families and those from low-income households reported lower quality of care.

LIMITATIONS:

The body of literature on this topic is small; hence it served as a limitation to this review.

CONCLUSIONS:

The documented disparities in access and quality of care may further identify groups in need of outreach, care coordination, and/or other interventions.




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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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Understanding Gaps in Developmental Screening and Referral




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Promoting Ideal Cardiovascular Health Through the Life Span




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Growing Evidence for Successful Care Management in Children With Medical Complexity




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Benzalkonium Chloride in Albuterol Solutions: Time for a Change?




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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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Eosinophilic Pneumonia and Lymphadenopathy Associated With Vaping and Tetrahydrocannabinol Use

Idiopathic acute eosinophilic pneumonia is a rare and potentially life-threatening condition that is defined by bilateral pulmonary infiltrates and fever in the presence of pulmonary eosinophilia. It often presents acutely in previously healthy individuals and can be difficult to distinguish from infectious pneumonia. Although the exact etiology of idiopathic acute eosinophilic pneumonia remains unknown, an acute hypersensitivity reaction to an inhaled antigen is suggested, which is further supported by recent public health risks of vaping (electronic cigarette) use and the development of lung disease. In this case, a patient with a year-long history of vaping in conjunction with tetrahydrocannabinol cartridge use who was diagnosed with idiopathic acute eosinophilic pneumonia with associated bilateral hilar lymphadenopathy is described.




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Perspectives on Informed Consent Practices for Minimal-Risk Research Involving Foster Youth




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Improving Antibiotic Prescribing for Pediatric Urinary Tract Infections in Outpatient Settings

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.

METHODS:

The study was conducted at Kaiser Permanente Colorado, a large health care organization with ~127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded.

RESULTS:

During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period.

CONCLUSIONS:

A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.




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Preventing Asthma Emergencies in Schools

Asthma is a significant public health issue, impacting quality of life, morbidity, and health care costs nationally. Stock asthma rescue medication policies authorize school districts to maintain unassigned albuterol and enable trained staff members to administer the medication in response to asthma symptoms, exercise premedication, and asthma emergencies. Stock asthma rescue (or reliever) medication laws serve as an important fail-safe measure. Such laws provide districts with the ability to respond if a student has an asthma emergency at school but either lacks a diagnosis or does not have access to their own medication. As of September 2019, 13 states have enacted either a law or regulation authorizing the stocking of asthma rescue medication in schools: Arizona, Colorado, Georgia, Illinois, Missouri, New Hampshire, New Jersey, New Mexico, Oklahoma, Ohio, Texas, Utah, and West Virginia. Three additional states provide stock albuterol asthma guidelines but do not have legislation: Indiana, New York, and Nebraska. Some states have found that these policies reduce the need for 911 calls and emergency medical services transports as a result of asthma exacerbations. Initial data also demonstrate that these policies reach populations in need and improve health outcomes. This case study will describe the current state of asthma in Illinois, an innovative policy solution to address asthma emergencies in schools, and the steps taken to advocate for stock asthma rescue medication in Illinois. Legislation for stock albuterol in Illinois was signed into law in August 2018.




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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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Office-Based Screening for Sexually Transmitted Infections in Adolescents

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.




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Screening for Problematic Internet Use

Problematic Internet use (PIU) by adolescents is of growing concern among both parents and pediatricians. Early controversies may have contributed to challenges in defining and measuring PIU. A variety of screening tools have evolved, aligned with different constructs of PIU, although a validated screening tool does exist. Current data and American Academy of Pediatrics policy reflect evidence-driven screening for PIU for all youth.




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Management of Opioid Misuse and Opioid Use Disorders Among Youth

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.




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Addressing Key Issues in Adolescent Health Care




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OM sows seeds at National Ploughing Championships

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.




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Donkey teaches Irish children true meaning of Christmas

The Creative Arts team perform their Christmas show for school children all over Ireland in the course of three weeks.