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.

Chronic sleep deprivation is a common, treatable condition among adolescents. Growing literature supports a myriad consequences that impact overall health, behavior, mood, and academic performance in this vulnerable age group during a time when there are rapid changes in physical development and emotional regulation. This article reviews the epidemiology and health effects of sleep deprivation in adolescents as well as common disorders leading to sleep loss and evidence to support treatment. Although a variety of important sleep disorders may disrupt quality of sleep in adolescents, such as obstructive sleep apnea, restless leg syndrome, and narcolepsy, this article will focus on common disorders that affect the quantity of sleep, such as poor sleep hygiene, circadian rhythm disorders, and insomnia.

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.

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.

OM Australia shares about mission opportunities at Australia’s leading three-day music festival in Toowoomba, Queensland, over Easter.

Extreme Leadership Training camps create unity in Ukraine.

A Fin24 user wants to know whether paying off a car loan or credit card will make her credit score 'look better.'

GREAT news. I think. Glasgow is a great place in which to be looking for love, with 44 per cent of the city single, according to an online dating company.Why does this matter? Flash back to Valentine’s Day. There I was, lying in a pool of poetical blood, having been shot in the heart with the killer question no single man over a certain age wants to hear: “How many Valentine’s cards did you get?” asked a friend.

THOSE last times.... we all of us have memories our minds keep running back to in these social distancing times. The last time we gathered, last time we swam together, the last drive to a beach. One of mine is the post-swim hot tub at the Scottish Winter Swimming Championships in the chilly waters of Loch Tay – around 30 of us crammed in there, many in fancy dress, some in swim make-up, a great, crowded bath of joy.

IT'S the day after May Day and perhaps you’re feeling you’ve missed out on a good, sweaty Scottish pagan spring ritual of the type done particularly well at Beltane on Edinburgh’s Calton Hill, though not in a year of quarantine. Never fear. There are still ways of channelling the fertility rites of spring, the chief one being, of course, the folk horror classic The Wicker Man. Put on a goat mask, get in touch with your inner Wicker – or even Wicca – and revel in a bit of self-isolation

Ingrid Newkirk isn’t sure exactly how many times she has been arrested. “Definitely a few dozen,” she’ll say, if you ask. I’ve just done exactly that, so right now the British-born founder of People for the Ethical Treatment of Animals (PETA) is running me through a sort of greatest hits of her law-baiting exploits and the jailtime they have brought her in the name of animal rights.

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

One week before Ramadan, 17 participants share God’s love with hundreds of Arab tourists in Zell am See, Austria.

WHILE almost every athlete has been affected by the global shutdown of sport, it is perhaps the old and the young who are feeling it the most.

Following yesterday´s Supervisory Board meeting and the meeting on 19 March 2020, yesterday´s FBB shareholders’ meeting dealt with the results of the meeting and confirmed its main decisions. The shareholders recognised the business plan approved by th...

North Korean leader Kim Jong Un did not undergo surgery or any other medical procedure, a South Korean official has said amid continued speculation about his health.

South Korea says its troops have exchanged fire with North Korea along their tense land border.

Dear Editor,The United States' debt is some US$25 trillion. This debt grew by US$1 trillion in 35 days (April 1 to May 5). The US will likely not be able to permanently stop quantitative easing (money creation). This level of debt is similar to the US debt after World War II, but the US is no longer the factory of the world.

THE people of Scotland have been offered a “light at the end of the tunnel” in the form of various potential relaxations to lockdown - but warned they will only get there if they double down on their compliance.

Big Zuu is headed back out on tour - but not as we know it.

In Arctic Russia, reindeer are the Nenets' life. Living among these people, ES longs for the Nenets to know Jesus, the true source of life.

On the potholed drive home from the pub the other night, a creature ran into the beam of our lights. Long, low and lean, for a moment it looked like an otter. One has occasionally been sighted in our village, though like Loch Ness’s fabled monster this is a source of some dispute. But in another second it was clear that this beast was not from the riverbank but the woods.

When I first moved to the country, I anticipated taking long sturdy walks every few days, filling my lungs with fresh air, and gradually – proudly – achieving the weathered complexion of a Norwegian fisherman. Such is the variation in outdoor complexions in rural parts, Farrow & Ball could start a new range: shepherd’s sunburn, builder’s brick red, farmer’s frozen snout.

One of the loveliest towns in Italy is the walled city of San Gimignano, an hour’s drive from Florence. When I first visited it was bleak midwinter and all but a few shops and cafes were shuttered against the sleet. Its claim to fame is a profusion of medieval towers, hence its hyperbolic label as the Manhattan of Tuscany. When I arrived these fortresses soared overhead, making shadowy streets even darker.

Mercy Teams International (MTI) strives to see local workers in each ministry field trained and equipped as leaders. MTI Cambodia is one example.

AN ENERGY-HARNESSING wave machine is set to begin sea trials later this year.

The American politician John Nance Garner is better remembered for something he said rather than anything he did as Franklin Roosevelt’s vice-president.

Readers have been quick to voice their opinion after it was reported that Nicola Sturgeon missed six emergency coronavirus Cobra meetings.

DISGRACED former finance secretary Derek Mackay will be entitled to a £12,000 golden goodbye payment this week – despite not being seen in public for three months.

DRAKE - DARK LANE DEMO TAPES

FACE it – we are going nowhere. Even if we had a particular place to venture the regulations would not permit. For the foreseeable we shall have to contract out our travelling to others. On the upside, no airport hassle. On the downside, no giant Toblerone.

Educators are struggling to learn how to use new tech tools—devices, apps, software, and online textbooks—in greater volume than ever before.

The top technology official for Virginia's Fairfax County schools resigned after the district struggled to handle some major technical glitches in its e-learning platforms.

Here are five takeaways on the teaching profession from the newly released 2017-18 National Teacher and Principal Survey.

In the wake of the 'Janus' Supreme Court case, teachers' unions are facing more than a dozen legal challenges backed by right-leaning groups that could further dampen their membership numbers and finances.

SCOTLAND’S Economy Secretary has penned a letter to the UK Government venting her frustration at being given “insufficient time” to consider workplace safety proposals.

NICOLA Sturgeon could issue a change to the Scottish Government's policy on allowing outdoor exercise over the weekend - after Wales indicated the guidance will be relaxed from Monday.

Dig into what two leading Democratic presidential candidates have to say in their platforms about charter schools with Education Week's detailed analysis.

The change to the Title II program will benefit Southern states, while Michigan, New York, and Pennsylvania, among others, will see their allocations shrink.

A report suggests that the $2.5 billion program should focus more on continuous improvement than on scattershot activities.

The version of the tax bill passed by the Republican-led Senate would double the amount teachers can deduct for classroom supplies.

Education Week's Andrew Ujifusa hashes out the details of the education budget with Prince George's County, Md., Schools CEO Kevin Maxwell.

While President Donald Trump signed executive orders this week that could have widespread impact on immigrant communities, many in K-12 education await word on his decision on Deferred Action for Childhood Arrivals.

While the Trump administration proposal would not strip student eligibility for Head Start, the federal school lunch program, or the Individual with Disabilities Education Act, it could still affect millions of school-aged children who live with immigrant parents.

Bernie Sanders' sweeping vision would establish a $60,000 minimum salary for teachers, while clamping down on charters and boosting efforts to desegregate schools. It's hard to see a lot of it becoming a reality.

Dougherty County, a largely black school district in an region heavily affected by coronavirus, is no longer subject to desegregation orders first imposed in 1963.

An appreciation by Maxwell Macleod

Lord Armstrong of Ilminster