Children with special health care needs (CSHCN) account for more than one-third of pediatric health care costs. Little is known regarding the impact of shared decision-making (SDM) over time on child health care expenditures and utilization.

In a national sample, we found that increasing SDM was associated with decreased health care costs and utilization for CSHCN. Results support prospective studies to determine if pediatric interventions to foster SDM reduce the financial burden of caring for CSHCN. (Read the full article)

Extreme preterm birth is associated with developmental shortcomings that may reduce exercise capacity and participation in physical activities in later life. The number of studies addressing these issues in adolescent populations is limited, test methods differ, and results are diverging.

Exercise capacity after preterm birth was in the same range as in term-born control subjects. Participation in physical activity was lower in preterm subjects compared with control subjects; however, the response to exercise in terms of increased aerobic capacity was similar. (Read the full article)

Although it has been shown that cystic fibrosis newborn screening is beneficial, the strategies vary widely, and there has been uncertainty about the costs and consequences of different algorithms and whether screening methods/decisions should be based on assumed cost differences.

This study contributes by offering a comparison of both costs, assessed comprehensively, and the consequences associated with the 2 most popular screening methodologies, immunoreactive trypsinogen/immunoreactive trypsinogen and immunoreactive trypsinogen/DNA, by using a decision-tree framework allowing variation in the model parameters. (Read the full article)

The social and emotional burdens of ostracism are well known, but few studies have tested whether ostracism adversely alters physical activity behaviors that may result in maintenance of childhood obesity.

This is the first study to experimentally assess the effect of simulated ostracism, or social exclusion, on physical activity behavior in children. Ostracism reduced accelerometer counts by 22% and increased time allocated to sedentary behaviors by 41%. (Read the full article)

Studies have found that the degree of detail with which palliative care is described and the order in which options are presented can affect end-of-life decisions. None of these studies, though, involved decisions regarding very premature infants.

Unlike other end-of-life decisions, those regarding extremely premature infants are influenced neither by the degree of detail nor order of presentation of management options. Deep-seated values embodied in the reasons given for these choices suggest why they are so robust. (Read the full article)

Valid parental permission requires that the decision be both informed and voluntary. Previous research has focused on the informational components of decision-making (eg, disclosure and understanding), with little empirical attention to the voluntariness of decisions.

We address this gap by examining the voluntariness of parents making research or treatment decisions in pediatric oncology. We identify demographic and contextual correlates of voluntariness and highlight the clinical implications of the findings for physicians and investigators. (Read the full article)

Observation studies and short-term prospective intervention studies have shown that physical activity positively affects the accrual of bone mass and size during growth; however, fracture risk has not been evaluated.

This study reports the long-term results of a prospective intervention with increased physical activity at a population-based level and for the first time evaluated the clinical relevant end point, fracture risk. (Read the full article)

Male circumcision reduces risk of HIV acquisition in men by 60% and is associated with other health benefits. Compared with adult circumcision, infant male circumcision is safer, less expensive, and represents a cost-saving intervention for HIV prevention in many settings.

IMC is little known in East Africa and is not routinely practiced. This is the first study to assess acceptability and uptake of IMC in East Africa among parents who were actually offered the procedure. (Read the full article)

The prevalence of asthma and associated urgent medical visits vary dramatically across neighborhoods in New York City. Some, but not all, children with asthma wheeze when they exercise.

Exercise-induced wheeze was more common for asthmatic children living in neighborhoods with higher versus lower asthma prevalence. Because exercise-induced symptoms indicate a propensity for rapid-onset symptoms, this increased prevalence may contribute to the observed increase in urgent medical visits. (Read the full article)

Heuristics are decision-making aids or shortcuts that ease the task of making a wide variety of decisions in diverse contexts. Little is known about the heuristics that parents of children with serious illness use when confronting difficult decisions.

Parents of children with life-threatening illnesses use several different types of heuristics, explicitly, in making sense of complex situations, making decisions, and communicating these decisions to others. Better understanding of these heuristics may improve communication and decision support. (Read the full article)

Expectations are high that electronic health record–based clinical decision support and performance feedback will improve adherence to guidelines by delivering relevant and actionable information to clinicians. Few studies have evaluated these assertions or examined the combined effects of decision support and feedback.

Clinical decision support customized to a patient’s history and presentation and performance feedback are both effective for improving adherence to guidelines for otitis media. However, the combination of the 2 interventions is no better than either delivered alone. (Read the full article)

Medications used to treat gastroesophageal reflux disease (GERD) are some of the most widely used medications in children younger than 1 year. There are strong indications that GERD is overdiagnosed and overtreated.

The factors that drive overtreatment of GERD are not well understood, but it has been proposed that the use of the GERD disease label could perpetuate use of medication. In this study we find evidence for this possibility. (Read the full article)

Previous studies have suggested that health care providers, family members, friends, and others play a role in shaping parents’ vaccination decisions. Other research has suggested that the media can influence whether parents decide to vaccinate their children.

Through the application of social network analysis, this study formally examines and quantifies how parents are influenced by the people and sources around them. Its findings suggest that social networks are important, particularly for parents who do not completely vaccinate. (Read the full article)

Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous large-scale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context.

We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt. (Read the full article)

Infants aged <2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy.

This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness. (Read the full article)

Despite the existence of authoritative guidelines to assist primary care physicians in identifying and managing attention-deficit/hyperactivity disorder (ADHD), ample evidence demonstrates that they continue to diagnose and treat this disorder suboptimally.

The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. (Read the full article)

Neonatal circumcision in the United States has been estimated to be performed in ~58% of all neonates, and varies by US geographic region.

This study estimates neonatal and postneonatal circumcision rates among commercially insured males aged 0 to 18 years that were performed in both inpatient and outpatient settings. This study also estimates indications and payments for the procedure. (Read the full article)

Retrospective studies have shown that the majority of parents, independent of their country of origin, prefer a shared approach over a paternalistic approach or an informed approach when an end-of-life decision must be made for their children.

In actual conversations parents act in line with their preference for a shared approach. This behavior contrasts with the "some sharing" approach of physicians who carefully prepare parents for an end-of-life decision already being made by the medical team. (Read the full article)

Menu labels depicting physical activity calorie equivalents may lead to ordering of fast food meals totaling fewer calories for adults. The effects of physical activity calorie equivalent labeling on parents’ fast food decisions for their children have not been examined.

Parents shown menus with any type of caloric content label may order fast food meals totaling fewer calories for their children. Menu labels showing physical activity equivalents may be more likely to influence parents to encourage their children to exercise. (Read the full article)

Adolescent obesity is characterized by endothelial dysfunction at the macrovascular and microvascular level; high endothelial microparticle (EMP) and low endothelial progenitor cell (EPC) counts contribute to these processes. Although reversal of macrovascular endothelial dysfunction is feasible, clinical evidence regarding microvascular endothelial dysfunction is scarce.

Ten months of diet and exercise training improves microvascular endothelial function (peak response) in obese adolescents. EPC and EMP displayed a biphasic response, with an increase in EPC at 5 months and a decrease in EMP at the end of the treatment. (Read the full article)

Strategies are needed to engage families of chronically ill children at home in an ongoing process of shared decision-making regarding treatment that is responsive to families’ concerns and goals and children’s evolving symptoms.

This study evaluated a novel patient portal that facilitates shared decision-making in asthma. The portal was feasible and acceptable to families, improved outcomes, and provides a model for improving care through an electronic health record portal. (Read the full article)

Central apnea sometimes complicates bronchiolitis. Because apnea tends to occur early in the course of bronchiolitis, there is a danger that infants may be discharged from the emergency department only to subsequently develop apnea at home.

This study prospectively derived clinical decision rules to help emergency physicians admit infants at risk for apnea while discharging those not at risk. (Read the full article)

Rangers vice-chairman John Bennett has criticised the SPFL for their 'cynical tactics' over their labelling of the club's dossier as a "smoking gun" - and insists the issue is not merely Gers vs the governing body.

Partick Thistle have released, in full, a letter sent by the club to SPFL chiefs following the news that league reconstruction has been scrapped - confirming the Jags' relegation.

The injunction means all major online retailers—including Amazon and eBay—can no longer sell Cisco-branded products offered by four Chinese companies.

029 - Six clubs fulfil conditions set out by CFCB

Gibraltar becomes UEFA’s 54th member association

Dell's Precision 7920 Tower workstation is a dual-CPU monster for tasks that can leverage its server-grade hardware and require maximum reliability. Just be prepared for sticker shock if you go all-in like on our test model.

A partnership works to create and implement a district-wide NGSS-aligned science curriculum and instructional model.

A new survey of school districts and CMOs will provide new insights into trends, and complement other data on teachers and principals.

To view more press releases, please visit http://ir.wintrust.com/news.aspx?iid=1024452.

By Bishop Arthur Serratelli

In The Innocents Abroad, published in1869, Mark Twain humorously narrates his travels thorough Europe and the Holy Land. He goes out of his way to praise the great hospitality that Catholic priests offered to any pilgrim traveling through 19th century Palestine. They readily welcomed all, whether they came “in rags or clad in purple.” Twain was pleasantly surprised by this, because, as he readily confesses, he had been “educated to enmity toward everything that is Catholic.” Enmity toward everything Catholic! Not a thing of the past.

Most recently, the hatred was aimed at one of the most charitable and benevolent group of individuals in this country, the Knights of Columbus. During the Senate Judiciary Committee’s review of Omaha-based lawyer Brian C. Buescher for the position of judge on the United States District Court for the District of Nebraska, Senators Mazie Hirono, a democrat from Hawaii, and Kamala Harris, a democrat from California, grilled Buescher on his membership in the Knights of Columbus. In their questions, they boldly gave voice to an anti-Catholic prejudice in our society.

Hirono accused the Knights of having “taken a number of extreme positions.” And, what are those extreme positions to which she is so vehemently opposed? The Catholic teaching on marriage as a union established by God. The sanctity of human life. The rights of a child in the womb to take his or her place at the banquet of life. For many, when it comes to birthing a child, only a woman has rights. And, when it comes to marriage, only what an individual wants matters. In their eyes, God’s design for his creation cannot limit the freedom of anyone to choose as they wish. 

Holding to what the Catholic Church has always taught, according to their line of questioning, now disqualifies someone from public office. In effect, both senators were applying a religious test as a qualification for public office. Responding to this blatant attack on a man’s religion, on January 17, 2018, the United States Senate unanimously passed the resolution that disqualifying a member of the Knights of Columbus for a federal office actually violates the Constitution of the United States. Article VI of the Constitution states that “no religious test shall ever be required as qualification to any office or public trust under the United States.”

Sadly, this recent attack on Catholicism is not an isolated incident. Last September, Senator Dianne Feinstein expressed serious concern about the qualifications of Amy Barrett for a judgeship on the 7th Circuit. Feinstein is an unflinching supporter of abortion. It was no surprise that she zeroed in on Barrett’s position on Roe v. Wade. Because Barrett is a practicing Catholic who faithfully holds to Catholic teaching on this and other hot button issues, Feinstein remarked “in your case, professor…the dogma lives loudly within you, and that’s of concern when you come to big issues that large numbers of people have fought for years in this country.” Clearly, the Senator sees no place for what the Catholic Church teaches on major moral and societal issues. 

It is becoming more and more obvious that the Catholic Church is being targeted as the public enemy of our society. Talk shows and news media attack the Catholic position on the right to life as misogyny and the Catholic teaching on marriage as intolerance and hatred. One can only wonder why those States that are investigating the Catholic Church on its record of protecting children are not looking into other public institutions. Why is there not a comparable investigation into their own school systems or other religious groups? Is the terrible crime of child abuse limited only to Catholics? Today’s media would even have people believe that abuse of minors is becoming more frequent within the Church. Patently false. But, too often facts do not matter when a villain is needed.

Those who advocate for the radical autonomy of the individual find in the Church an indomitable opponent. The Catholic Church stands firm in her teaching on contraception, abortion, stem cell research, in-vitro fertilization, marriage and divorce. The Church teaches that every choice that touches on the gift of life and the beauty of marriage is judged by a law higher than the autonomy of the individual. And, for this reason, today’s secularists judge Catholics as public enemies to the good of the society they wish to construct. A society without God. A society without a future.

Almost every day, a politician or teacher or public speaker is lambasted for a statement that is judged to be homophobic, misogynistic, racist or anti-Semitic. In some cases, not even an apology can save their careers. Yet, a free pass is given by society to any anti-Catholic view or statement. Someone can make an insulting or slanderous remark about Catholics, Catholic teachings or the Church herself and emerge unscathed. In his essay on The Significance of Jacksonian Democracy, historian and Harvard professor Arthur Schlesinger, Sr., himself not a Catholic, made the often cited assertion that anti-Catholic prejudice is “the deepest bias in the history of the American people.” According to Baylor University professor Philip Jenkins, anti-Catholic prejudice is “the last acceptable prejudice.”
 

A new process to harness multiple disease models for outbreak management has been developed by an international team of researchers. The team will immediately implement the process to help inform policy decisions for the COVID-19 outbreak.

When it comes to 15.6-inch laptops, mobile workstations make gaming rigs look like wimps—and the new king of the hill is Dell's costly but colossal Precision 7540, tested in a maxed-out Xeon/Quadro RTX configuration.

Team members of AIDSLink Brazil conduct workshops on HIV and AIDS in Zambia.

Tesla Inc Chief Executive Elon Musk said in a podcast interview released on Thursday that the company's planned Roadster sports car would take a backseat to the development of other vehicle models.

Bangkok/New Delhi: Union Home Minister Amit Shah on Monday said India’s decision to not join China-backed mega Regional Comprehensive Economic Partnership (RCEP) deal is a result of "PM Narendra Modi's strong leadership & unflinching resolve" to ensure national interest in all circumstances, adding: “it shall ensure support to our

CISF के कोरोना वायरस से संक्रमित मामलों में दिल्ली हवाईअड्डे पर तीन, अहमदाबाद...

US President Donald Trump on Friday said that he will soon make an announcement on the World Health Organisation, which he alleged has become a puppet of China.

Senior Congress leader P Chidambaram today welcomed the Centre's decision to borrow additional 4.2 lakh crore and said it should be used to provide relief to the poor and re-start the economy.

A pharmacist died and his boss was left hospitalised after the pair drank a chemical concoction they had developed in an effort to treat coronavirus, police said Saturday. The men worked for a herbal...

Punjab cabinet ministers today walked out of a meeting with bureaucrats to decide a new excise policy, sources said. Finance Minister Manpreet Badal had an argument with Chief Secretary Karan Avatar...

DOVER – The Delaware Supreme Court, by decision dated Dec. 7, 2017 in the matter of Bridgeville Rifle & Pistol Club, LTD, overturned a Superior Court ruling and ended a ban on visitors’ possessing firearms in Delaware’s state parks and state forests. Pursuant to the ruling, visitors may now possess firearms unless they are prohibited by law due to a past conviction for a violent crime, active Protection from Abuse Order, or mental health commitment. Following the Court’s decision to invalidate the existing regulations limiting firearms in state parks and forests, and some Division of Fish & Wildlife properties, the Delaware Department of Natural Resources and Environmental Control and the Delaware Department of Agriculture (DDA) anticipate issuing interim firearm regulations. The interim regulations would respect the State Constitutional provisions on firearms cited by the Court, by implementing the State’s interest in ensuring the safety of the public in a less restrictive manner.

The U.S. Department of Agriculture (USDA) National Agricultural Statistics Service (NASS) Delaware office today announced the results of the 2017 Census of Agriculture with new information about 2,302 Delaware farms and ranches and those who operate them, including first-time data about on-farm decision making, down to the county level.

The Division of Public Health (DPH) will host a two-day, exercise on Tuesday, June 19, and Wednesday, June 20, at Sussex Central High School, Georgetown. The purpose is to test the division’s ability to operate a shelter for residents who may be displaced or unable to occupy their homes in the event of a disaster.

The Division of Public Health (DPH) is looking for volunteers to participate in an emergency preparedness exercise on Saturday, September 28, 2019, at two Delaware Technical Community College (Delaware Tech) campuses. The purpose of the exercise is to evaluate the state’s ability to set up Points of Dispensing and simulate the dispersal of life-saving medication in an emergency situation.

Kerry Cunningham of SiriusDecisions talks about how AI can power the B2B revenue engine

GDPR comes into force on May 25. Here's a timely look at its impact on B2B marketing and sales functions with Julian Archer of SiriusDecisions