The safeguarding capability of adults in Catholic Church ministries: A global perspective.

BACKGROUND: In the wake of historical sexual abuse across the Catholic Church globally, the Church continues to develop policies and processes to prevent and respond to child sexual abuse, including supporting the skills, knowledge, and confidence of members of the Church. OBJECTIVE: We investigated the safeguarding capabilities of a range of people with different roles within Catholic Church ministries in various countries. PARTICIPANTS AND SETTING: Our 184 participants included lay people, religious men and women, school staff, safeguarding officers and tertiary students associated with the Catholic Church. Data were collected across seven different countries. METHODS: We measured the awareness, confidence, attitudes, and knowledge of participants and examined differences between participants in different roles within the Church and different countries through General Linear Models. RESULTS: We found varying levels of awareness, confidence, attitudes, and knowledge regarding sexual abuse prevention and safeguarding. We pinpointed the significant differences in three of these domains (confidence, attitudes, and knowledge) both between people with different roles in the church worldwide, but also between the countries from which participants came from. CONCLUSIONS: We found that people in various countries and roles within the Church are at different stages of their safeguarding journey. Some are still understanding their roles (attitudes), some are still learning about how it is operationalised (awareness), and others are acquiring skills that will prepare them for enacting safeguarding policies and practices (confidence).

A Rapid Evidence Assessment on The Effectiveness of Interventions for Autistic Adolescents with Harmful Sexual Behaviors.

The management and treatment of harmful sexual behaviors (HSBs) in autistic adolescents is a complex area of research and clinical practice. Autistic adolescents face unique challenges in understanding social and sexual interactions, putting them at a higher risk of engaging in HSBs. Existing research on interventions for HSBs among autistic adults is growing, but evidence for adolescents is not well understood. Thus, understanding the effectiveness of interventions targeting HSBs in autistic adolescents is crucial. We conducted a rapid evidence assessment to review peer-reviewed research on the effectiveness of interventions for autistic adolescents at risk of or engaging in HSBs. In all, 12 studies met the criteria for review. Inclusion criteria required articles to be published in a peer-reviewed journal, be related to HSB prevention and intervention in adolescents aged 12 to 18 with autism spectrum disorder, be written in English, and include original data. Six databases were used, and we screened the titles and abstracts of 34 studies. The reviewed studies described cognitive-behavioral therapy, pharmacological interventions, family involvement, and multidisciplinary team approaches in addressing HSBs. However, the literature has significant limitations and we suggest that the literature is not robust enough to indicate a promising evidence-based approach for interventions for autistic adolescents who are at risk of or who display and engage in HSBs, and the findings are not transferable to practice. Additional research is required to better prepare healthcare professionals for addressing HSBs in autistic adolescents.

Engaging Parents in Child-Focused Child Sexual Abuse Prevention Education Strategies: A Systematic Review.

Parents are their children's first teachers and there are long-standing calls for their involvement in child sexual abuse prevention. In this rapid systematic review, we asked the following questions: what rationales are used to justify parental involvement in child-focused child sexual abuse (CSA) prevention programs? what approaches are used for parental engagement in child-focused CSA prevention programs? and what are the facilitators and barriers to parental involvement in child-focused CSA prevention programs? We searched CINAHL, Cochrane, ERIC, Medline, PsycInfo, Scopus, and SocINDEX in May 2021. A total of 57 papers met our inclusion criteria, comprised of 50 empirical studies, and 7 program descriptions. Rationales for parental involvement included monitoring and shaping parental attitudes toward CSA program delivery in schools; reinforcing children's learning at home; promoting parent-child communication about CSA prevention; building parent capacity to respond to child disclosures; and supporting program delivery for preschoolers. Types of parental involvement included the following: communication, learning at home, volunteering, decision-making, and collaboration with the community. Barriers to parent involvement included ineffective program engagement modalities, and parental fears and misconceptions.

Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth.

First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies.

Systematic Review and Meta-Analyses: Safety and Efficacy of Complementary and Alternative Treatments for Pediatric Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Complementary and alternative treatments (CATs) for ADHD have proliferated over the past decade; however, their safety and efficacy remain uncertain. We completed a systematic review and meta-analyses across CAT domains. METHODS: Systematic search and data extraction identified randomized controlled trials for pediatric ADHD (ages 3-19 years) that included probably blind ADHD symptom outcome measures. We evaluated basic (RCT of a CAT compared with sham/placebo, attention/active control, treatment as usual, and waitlist control), complementary (RCTs comparing an evidence-based treatment with a CAT and the same evidence-based treatment), and alternative (evidence-based treatment to CAT) efficacy. Random-effect meta-analyses were conducted when at least 3 blinded studies were identified for a specific CAT domain. RESULTS: Eighty-seven of 2253 nonduplicate screened manuscripts met inclusion criteria. No study reported significantly greater adverse effects for CATs than controls; naturopathy reported fewer adverse effects than evidence-based treatments but did not demonstrate basic efficacy. In the systematic review of basic efficacy, evidence of effectiveness was mixed but replicated previous evidence for the possible efficacy of cognitive training, neurofeedback, and essential fatty acid supplementation for certain patients. With respect to alternative and complementary efficacy, no CAT outperformed or enhanced evidence-based treatments (stimulant medications and behavioral therapy) when replication was required. Individual meta-analyses indicated that cognitive training was the only CAT that demonstrated overall basic efficacy ( SMD = 0.216; p = 0.032). CONCLUSION: Clinicians may cautiously recommend (but monitor) cognitive training when evidence-based treatments are not feasible or effective for a patient. Additional studies are needed to further understand the potential of CAT domains.

Safeguarding in Church: Children and Young People's Perceptions of Safety in Religious and Other Faith-Based Settings.

Organizations that interact with children and young people have a duty of care to ensure the safety of those children and young people from any manner of abuse, particularly from child sexual abuse. Faith-based ("religious") organizations are of particular interest due to the number of victims/survivors speaking out about their experiences of grooming, child sexual abuse, and other forms of harm in religious organizations. Focusing on addressing the risks and improving safeguarding efforts, prevention activities benefit from giving children agency and a voice. We conducted a study using two focus groups with children and young people involved with two different Christian denominations. We conducted activities and led discussions regarding their views about safety in the context of the faith-based organization with which they engage. Children and young people described different potentially unsafe situations, their likely frequency, and the level of impact such situations would have from their own point of view. They also described how they thought adults in their faith-based organization would see them. Thematic analysis of the data supported four themes related to young people's sense of safety: concerning behavior of adults and other young people, fear of judgment by others (adults and peers), sense of or lack of empowerment due to power dynamics, and the importance of a sense of "familiarity." Visual comparisons of the data on scatterplots suggested differences not only in the level of impact and frequency of potentially unsafe situations between young people and adults but also between the two denominations. Children and young people can provide a wealth of information regarding their safety concerns when involved in programs and services at faith-based organizations. Clergy and other faith-based organizational leaders should consider how the context in which young people are involved (including interdenominational and interfaith difference, as well as the diverse types of activities young people are involved with) can affect their safety concerns.

Stitching and registering highly multiplexed whole-slide images of tissues and tumors using ASHLAR.

MOTIVATION: Stitching microscope images into a mosaic is an essential step in the analysis and visualization of large biological specimens, particularly human and animal tissues. Recent approaches to highly multiplexed imaging generate high-plex data from sequential rounds of lower-plex imaging. These multiplexed imaging methods promise to yield precise molecular single-cell data and information on cellular neighborhoods and tissue architecture. However, attaining mosaic images with single-cell accuracy requires robust image stitching and image registration capabilities that are not met by existing methods. RESULTS: We describe the development and testing of ASHLAR, a Python tool for coordinated stitching and registration of 103 or more individual multiplexed images to generate accurate whole-slide mosaics. ASHLAR reads image formats from most commercial microscopes and slide scanners, and we show that it performs better than existing open-source and commercial software. ASHLAR outputs standard OME-TIFF images that are ready for analysis by other open-source tools and recently developed image analysis pipelines. AVAILABILITY AND IMPLEMENTATION: ASHLAR is written in Python and is available under the MIT license at https://github.com/labsyspharm/ashlar. The newly published data underlying this article are available in Sage Synapse at https://dx.doi.org/10.7303/syn25826362; the availability of other previously published data re-analyzed in this article is described in Supplementary Table S4. An informational website with user guides and test data is available at https://labsyspharm.github.io/ashlar/. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Vulnerable yet forgotten? A systematic review identifying the lack of evidence for effective suicide interventions for young people in contact with child protection systems.

Children and young people in out-of-home care are at a higher risk of suicide than young people not involved with child protection systems. Despite this, there is a lack of evidence of effective suicide prevention interventions for this vulnerable population. We reviewed the types of suicide prevention interventions that have been used and evaluated with children and young people and staff and carers in out-of-home care/child protection systems. We conducted a systematic review of existing literature using PRISMA guidelines. Only five studies met the inclusion criteria. Two evaluated youth-focused interventions: emotional intelligence therapy; and multidimensional treatment foster care, while three evaluated adult-focused "gatekeeper training." Youth-focused interventions led to reductions in suicidal thoughts (suicidal ideation), and adult-focused interventions led to increased knowledge, skills, and behaviors such as referring youth to supports. Only one study, one of the youth-focused ones, evaluated the impact of the intervention in terms of suicide attempts but found no reduction. Large numbers of children enter into care with a high risk of suicide. With the considerable overlap between the trauma characteristics and mental health needs of young people in out-of-home care and suicide risk factors in the general population of young people, we recommend developing (and evaluating) new or adapted existing suicide prevention interventions designed specifically for the out-of-home care context. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Second-Opinion Program for the Care of Youths Prescribed Five or More Psychotropics in Washington State.

This retrospective study describes a second-opinion review program for the care of children in Washington State who received Medicaid coverage and who were prescribed five or more psychotropic medications, primarily by mental health specialists. In total, 136 second-opinion reviews from 2013 and 169 from 2018 were included in this study. Attention-deficit hyperactivity disorder (ADHD), behavioral difficulties, anxiety, and trauma were prevalent among these children, and participants were commonly prescribed ADHD medications, selective serotonin reuptake inhibitors, and second-generation antipsychotics. The incidence of reviews remained stable over the two periods, but psychosocial treatment increased significantly over this time. This study sheds light on the initiation, maintenance, and identification of polypharmacy psychotropic regimens and highlights psychosocial treatment as an intervention that increases best practice care for at-risk patients.

Minerva: a light-weight, narrative image browser for multiplexed tissue images.

Advances in highly multiplexed tissue imaging are transforming our understanding of human biology by enabling detection and localization of 10-100 proteins at subcellular resolution (Bodenmiller, 2016). Efforts are now underway to create public atlases of multiplexed images of normal and diseased tissues (Rozenblatt-Rosen et al., 2020). Both research and clinical applications of tissue imaging benefit from recording data from complete specimens so that data on cell state and composition can be studied in the context of overall tissue architecture. As a practical matter, specimen size is limited by the dimensions of microscopy slides (2.5 × 7.5 cm or ~2-8 cm2 of tissue depending on shape). With current microscopy technology, specimens of this size can be imaged at sub-micron resolution across ~60 spectral channels and ~106 cells, resulting in image files of terabyte size. However, the rich detail and multiscale properties of these images pose a substantial computational challenge (Rashid et al., 2020). See Rashid et al. (2020) for an comparison of existing visualization tools targeting these multiplexed tissue images.

Safeguarding Capabilities in Preventing Child Sexual Abuse: Exploratory Factor Analysis of a Scale Measuring Safeguarding Capabilities in Youth-Serving Organizations Workers.

Media reports and government enquiries have shone a spotlight on institutional child sexual abuse (CSA) globally. With youth-serving organizations seeking to identify how to improve policies and procedures developed to protect children, a gap exists in research and organizational quality assurance procedures. A new tool is needed to measure the capability of workers to implement and support effective child-safeguarding policies and practices. To address this, our aim was to develop the Safeguarding Capabilities in Preventing Child Sexual Abuse Scale. Participants (n = 345) from a range of youth-serving sectors in Australia answered 128 questions. Using exploratory factor analysis to assess the underlying factor structure and refine the item pool, items loaded onto four factors. Reliability coefficients ranged from .68 to .95. Results showed that knowledge, attitudes, self-efficacy to take action, and awareness are all key capabilities related to creating conditions of safety for children and young people and preventing CSA in youth-serving organizations.

Starting Early: Promoting Emotional and Behavioral Well-Being in Infant and Toddler Well-Child Care.

A child's experiences during the first 3 years of life can have a profound impact on mental health outcomes later in childhood and across the lifespan. Safe and effective therapies for mental health concerns in early childhood exist, but access to them is limited. Pediatricians have a unique opportunity to identify risk and resilience factors and support healthy emotional, behavioral, and social development during infancy and toddlerhood. This article presents a developmentally focused approach to integrating the growing science of early childhood social-emotional development into primary care practice, providing both empiric and practical rationales. [Pediatr Ann. 2018;47(8):e317-e322.].

Robot-assisted Partial Cystectomy for Treatment of Inflammatory Myofibroblastic Tumor of the Bladder.

Inflammatory myofibroblastic tumors rarely occur in the urinary bladder. These masses follow an indolent course, but due to their histologic similarities to more malignant types of bladder masses, they must be differentiated with immunohistochemical staining. Once diagnosed, the mainstay of treatment for these masses is surgical resection. Due to advancements in robotic surgery, new surgical techniques can be employed to treat these masses with fewer perioperative complications. We report a case of inflammatory myofibroblastic tumor of the urinary bladder in a 29-year-old male treated with robot-assisted partial cystectomy.

Rare Occurrence of a Poorly Differentiated Neuroendocrine Tumor of the Bladder.

Neuroendocrine tumors rarely occur in the urinary bladder. They can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Review of the recent literature shows equivalent survival data for localized disease treated with chemoradiotherapy combined with either bladder sparing surgery or radical cystectomy. Patients with significant comorbidities are an additional challenge. We report a case of poorly differentiated neuroendocrine tumor of the bladder, which could not be classified as small or large cell carcinoma, complicated by significant comorbidities. After management with transurethral resection of the tumor, adjuvant chemotherapy, and radiation, the patient is alive and asymptomatic nearly 1 year after initial TURBT with no evidence of disease recurrence.

Implementing Integrated Care in Pediatric Mental Health: Principles, Current Models, and Future Directions.

Traditional models of health care delivery are inadequate for addressing all the needs of the child and adolescent population that has mental illness. The integrated care model seeks to partner pediatric mental health specialists with primary providers to better meet these needs. The authors outline the core principles guiding integrated care for youths and describe key characteristics of the team members involved. Three models of integrated care have emerged and have proven effective. Several representative programs are described, and the advantages and disadvantages of each are reviewed. The review concludes by identifying the challenges that have prevented wider dissemination of the integrated care model and by exploring potential future directions for the field.

Patients Willing to Wait: Arrival Time, Wait Time and Patient Satisfaction in an Ambulatory Urology Clinic.

INTRODUCTION: We evaluated the relationship of patient satisfaction to arrival and wait times. We also sought to determine factors that patients considered important to the visit experience. METHODS: A total of 361 participants completed a survey in clinic to record wait times in various areas of the clinic and then rate satisfaction levels with these times and with the care received. A total of 211 participants ranked 6 factors related to the patient experience in the order considered important. RESULTS: Early, on time and late arriving patients spent 26.0, 15.5 and 17.1 minutes in the waiting room and had a total visit duration of 82.5, 67.9 and 72.0 minutes, respectively. Significant differences existed between these times when the early group was compared with the on time and late groups. Early patients were significantly more satisfied with wait time in the waiting room and total clinic visit time compared to late patients. Receiving treatment or relief from a medical problem was the most important factor valued by this population. CONCLUSIONS: Surprisingly, patients with longer waits were more satisfied with the time in the waiting room and overall visit duration, indicating that other variables influence patient satisfaction with perceived wait times. This study provides evidence that wait time might not be as important to patients or impact patient satisfaction as previously thought. On average wait time was ranked fifth in regard to what was important. Longer wait times did not seem to impact patient satisfaction when asked about overall satisfaction with the care received.