Bad Days Research Articles

Expect the unexpected: Adolescent and pre-teens' experience of diabetes technology self-management.

Only 17% of adolescents with type 1 diabetes (T1D) are currently meeting their glycemic targets despite advances in diabetes technologies. Self-management behaviors and challenges specific to use of diabetes technologies are insufficiently studied in adolescents. We aimed to describe the experience of diabetes technology self-management, including facilitators and barriers, among preteens/adolescents with low and high A1C. Youth (10-18 years of age) with T1D who use insulin pump therapy were recruited from the larger quantitative cohort of a mixed methods study for participation in semi-structured qualitative interviews. Maximum variability sampling was used to recruit youth with A1C <7.5% (n= 5) and A1C >9% (n= 5). Participants' personal insulin pump and continuous glucose monitoring data were downloaded and served as a visual reference. Interviews were analyzed using a qualitative descriptive approach. Participants were 50% female with a median age of 14.9 years and 80% used CGM. The sample was predominantly white (90.0%). Analysis produced four major themes, Bad Day, Expect the Unexpected, Nighttime Dependence, and Unpredictability, It's Really a Team and interconnecting subthemes. Youth characterized ''Bad Days'' as those requiring increased diabetes focus and self-management effort. The unpredictability (''Expect the Unexpected'') of glucose outcomes despite attention to self-management behaviors was considerable frustration. Diabetes devices such as insulin pumps are complex machines that rely heavily on individual proficiency, surveillance, and self-management behaviors to achieve clinical benefit. Our findings highlight the dynamic nature of self-management and the multitude of factors that feed youths' self-management behaviors.

Retrospective Application of Sinusoidal Obstruction Syndrome/Veno-occlusive Disease Diagnostic Criteria in a Pediatric Hematopoietic Stem Cell Transplant Cohort.

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) posthematopoietic stem cell transplantation (HSCT) is often diagnosed using the modified Seattle (MS) or European Society for Blood and Marrow Transplantation (EBMT) criteria. We hypothesized that strict application of these criteria could affect the timing of diagnosis and incidence of SOS/VOD. We collected data on 215 transplants performed in 184 patients at a single pediatric hematopoietic stem cell transplantation center, which were divided into 3 cohorts. Clinical diagnosis and treatment of SOS/VOD was documented in 13% of transplants (cohort 1). On retrospective review, 49% of transplant events met either MS and/or EBMT criteria, however, were not diagnosed with SOS/VOD (cohort 2); remaining 38% of transplant events did not meet MS or EBMT criteria and were not diagnosed with SOS/VOD (cohort 3). Day+100 overall survival was significantly inferior for cohort 1 (78%) compared with cohorts 2 or 3 (92% and 95%, P=0.01) with no difference between cohorts 2 and 3 (P=0.5). Patients diagnosed with SOS/VOD >day+13 had worse day+100 overall survival when compared with those diagnosed ≤day13 (64.3% and 100%, respectively, P=0.02). This study highlights the value of careful clinical assessment to guide diagnosis and the need to refine diagnostic criteria for SOS/VOD in children.

Healthcare Stereotype Threat and Health Outcomes Among LGB Individuals.

Health disparities between sexual minorities and heterosexuals are well documented and have been explained by differential access to healthcare as well as exposure to discrimination. The current research examines the role that healthcare stereotype threat, or the fear of being judged by healthcare providers based on negative group stereotypes, plays in the health of LGB individuals. LGB individuals (N = 1507) in three age cohorts were recruited via random digit dialing to participate in a larger study on sexual minority health. Participants completed measures assessing healthcare stereotype threat, lifetime health diagnoses, life satisfaction, and number of bad physical health days and personal distress in the past 30 days. Healthcare stereotype threat was associated with higher psychological distress and number of reported bad physical health days. Additionally, the Younger and Middle cohorts reported more stereotype threat than the Older cohort, but reported significantly higher levels of life satisfaction in the face of this threat than those in the Older cohort. Healthcare stereotype threat was related to poorer mental and physical health among LGB individuals; this was true when these outcomes were assessed over the past 30 days but not when they were assessed in general. Cohort differences in healthcare stereotype threat suggest potential important within group variation that needs further investigating. The research broadens the contexts to which stereotype threat is relevant and establishes a stressor related to LGB health.

Two good interview questions: Mobilizing the ‘good farmer’ and the ‘good day’ concepts to enable more‐than‐representational research

AbstractIn this paper, I assess the utility of two targeted qualitative interview questions: descriptions of a ‘good farmer’ and a ‘good day’, for eliciting rich textual data. Studies where farmers have been asked to describe or define a good farmer have been utilized across a growing range of international contexts in order to identify farmers’ cultural scripts, symbolic capital and social norms. The constitution of a ‘good day’ is new to rural studies but has been employed academically to assess perceptions of well‐being and job satisfaction. I employ document analysis to analyse the multiple uses of the ‘good farmer’ question in the rural studies literature and introduce a contrasting empirical application the ‘good day’ question in a rural case study in the United Kingdom. Findings demonstrate that both interview questions can generate rich textual descriptions of embodied performances. ‘Good farmer’ definitions may also include a moral judgement, whereas the ‘good day’ question specifically yields descriptions of affect. Farmers are reluctant to identify ‘bad farmers’, but asking about a ‘bad day’ can open up discussion of the vulnerabilities of farming life. Both questions are thus suited to more‐than‐representational research, gaining utility from their congruence between common parlance and academic conceptualization.

Good Days and Bad Days: Measuring Health-Related Quality of Life in People With Epilepsy

ObjectivesCost-effectiveness analyses typically require measurement of health-related quality of life (HRQoL) to estimate quality-adjusted life-years. Challenges with measuring HRQoL arise in the context of episodic conditions if patients are less likely—or even unable—to complete surveys when having disease symptoms. This article explored whether HRQoL measured at regular time intervals adequately reflects the HRQoL of people with epilepsy (PWE). MethodsFollow-up data from the Epilepsy Support Dog Evaluation study on the (cost-)effectiveness of seizure dogs were used in which HRQoL is measured in 25 PWE with the EQ-5D at baseline and every 3 months thereafter. Seizure count is recorded daily using a seizure diary. Regression models were employed to explore whether PWE were more likely to complete the HRQoL survey on a good day (ie, when seizures are absent or low in frequency compared with other days) and to provide an estimate of the impact of reporting HRQoL on a good day on EQ-5D utility scores. ResultsA total of 111 HRQoL measurements were included in the analyses. Regression analyses indicated that the day of reporting HRQoL was associated with a lower seizure count (P<.05) and that a lower seizure count was associated with a higher EQ-5D utility score (P<.05). ConclusionsWhen HRQoL is measured at regular time intervals, PWE seem more likely to complete these surveys on good days. Consequently, HRQoL might be overestimated in this population. This could lead to underestimation of the effectiveness of treatment and to biased estimates of cost-effectiveness.

Partnering With Families of Medically Complex Children Transitioning From the Hospital to Home.

Partnering With Families of Medically Complex Children Transitioning From the Hospital to Home.

Explorando el conocimiento, la conciencia y las prácticas de COVID-19 entre los dentistas en Bangladesh: una investigación transversal.

Background: COVID-19 pandemic has caused an unpre-cedented strike on humanity around the world . The scenario in Bangladesh is getting worse day by day, and every aspect of the society is observing its impact. Health care professionals are at a greater risk of contracting the disease while caring for patients. Objective: The research objective is to explore knowledge, awareness, and practices of registered dentists regarding COVID-19 epidemiology and transmission during the rapid outbreak of this highly contagious virus in Bangladesh. Material and Methods: A cross-sectional web-based survey was conducted among the dentists who were enrolled with their valid unique Bangladesh Medical and Dental Council (BMDC) registration number. A structured questionnaire was distributed among the dentists through different social media platforms. A total of 184 dentists participated in the survey between March and April 2020. Both descriptive analysis and multivariable logistic regression analysis was performed. Results: The dentists' mean age was 31.75 years, with a standard deviation of 6.5 years. About 29.3% of dentists completed their postgraduate qualification, and 76% of them were engaged in private practice at the time of data collection. Compared to the dentists with undergraduate education, the dentists with a postgraduate education are three times (OR=3.1, 95%CI 1.2-7.9 and over 5 times (OR=5.3, 95% CI: 1.2-23.3) more likely to have) better knowledge and practices toward COVID-19 respectively. Dentists aged 26-30 years are less likely to have good practices than the younger dentists (OR: .1; 95% CI: .01-.5). However, dentists with less than five years experience are 10.3 (1.6-68.9) times more likely to have good practices compared to the dentists with more experience. Conclusion: Majority of the dentists from Bangladesh have shown good knowledge, awareness, and practice regarding COVID-19. We recommend that the healthcare authorities, professional organizations, and hospitals coordinate, and conduct mandatory advanced infectious disease training for all the practicing dentists in the country.

SOS to my followers! The role of marketing communications in reinforcing online travel community value during times of crisis

The context faced by online travel agencies (OTAs) during the pandemic is nothing short of dramatic. During the state of emergency, marketing communications have proven essential to maintain emotional ties with online communities even though sales have plummeted to zero. This study analyses the social network communication strategy during the worst days of the crisis of two OTAs specialized in selling flights and in distributing activities, excursions, and guided tours at the world's top tourist destinations. This qualitative study, based on the observation of online activity and personal interviews with marketing managers, shows how to respond to a crisis, maintain brand identity and strengthen the support of the online community. With the help of the community and co-creation processes, the sector has been able to reinvent itself and new services have emerged. From selling flights, one of the studied OTAs has now changed to planning trips around the regions.

APA’s Outgoing President Recalls Year of Accomplishments Despite Unsettled Times

APA’s Outgoing President Recalls Year of Accomplishments Despite Unsettled Times

Higher Fludarabine and Cyclophosphamide Exposures Lead to Worse Outcomes in Reduced-Intensity Conditioning Hematopoietic Cell Transplantation for Adult Hematologic Malignancy

Reduced-intensity conditioning regimens using fludarabine (Flu) and cyclophosphamide (Cy) have been widely used in hematopoietic cell transplantation (HCT) recipients. The optimal exposure of these agents remains to be determined. We aimed to delineate the exposure-outcome associations of Flu and Cy separately and then both combined on HCT outcomes. This is a single-center, observational, pharmacokinetic (PK)-pharmacodynamic (PD) study of Flu and Cy in HCT recipients age ≥18 years who received Cy (50 mg/kg in a single dose), Flu (150 to 200 mg/m2 given as 5 daily doses), and total body irradiation (TBI; 200 cGy). We measured trough concentrations of 9-β-D-arabinosyl-2-fluoradenine (F-ara-A), an active metabolite of Flu, on days -5 and -4 (F-ara-ADay-5 and F-ara-ADay-4, respectively), and measured phosphoramide mustard (PM), the final active metabolite of Cy, and estimated the area under the curve (AUC). The 89 enrolled patients had a nonrelapse mortality (NRM) of 9% (95% confidence interval [CI], 3% to 15%) at day +100 and 15% (95% CI, 7% to 22%) at day +180, and an overall survival (OS) of 73% (95% CI, 63% to 81%) at day +180. In multivariate analysis, higher PM area under the curve (AUC) for 0 to 8 hours (PM AUC0-8 hr) was an independent predictor of worse NRM (P < .01 at both day +100 and day +180) and worse day +180 OS (P < .01), but no associations were identified for F-ara-A trough levels. We observed lower day +100 NRM in those with both high F-ara-ADay-4 trough levels (≥40 ng/mL; >25th percentile) and low PM AUC0-8 hr (<34,235 hr ng/mL; <75th percentile), compared with high exposures to both agents (hazard ratio, 0.06; 95% CI, 0.01 to 0.48). No patients with low F-ara-ADay-4 (<40 ng/mL; <25th percentile) had NRM by day +100, regardless of PM AUC. The interpatient PK variability was large in F-ara-ADay-4 trough and PM AUC0-8 hr (29-fold and 5.0-fold, respectively). Flu exposure alone was not strongly associated with NRM or OS in this reduced Flu dose regimen; however, high exposure to both Flu and Cy was associated with a >16-fold higher NRM. These results warrant further investigation to optimize reduced-intensity regimens based on better PK-PD understanding and possible adaptation to predictable factors influencing drug clearance.

THE ESSENTIALITY OF THE NUSANTARA TRADITIONAL CALENDAR

Today, tomorrow, yesterday, and later is the time because this life will always talk about the time that can affect the pattern of life in an environment. So that the existence of time becomes important. Based on this, a time system was compiled using the circulation of celestial bodies. Previous people have inherited the traditional calendar in their respective regions. This adapts to the condition of the community and its environment. The research question in this research is how the interpretations of the traditional calendars in the archipelago. The purpose of this research is to explore the essential meaning of the traditional calendars in the archipelago. The method used in this research is library research. This method is used to describe the various existing sources. The results showed that the calendar in each region has its own meaning for the wearer. The Batak calendar is used to determine good and bad days, the Pranatamangsa calendar for season markers, the Saka calendar for marking religious rituals, the Islamic Javanese calendar for historical momentum markers and Islamic teachings, the Bugis calendar for guidelines for daily activities and the Maluku calendar for marking the time of manufacture boat.

CORR Insights®: People Prefer to Continue with Painful Activities Even if They Lead to Earlier Surgery.

CORR Insights®: People Prefer to Continue with Painful Activities Even if They Lead to Earlier Surgery.

Health and financial benefits of weatherizing low-income homes in the southeastern United States

The purpose of this research is to estimate the non-energy impacts that could be attributed to weatherizing low-income homes in Knoxville, Tennessee, USA. Commonly installed weatherization measures include insulation, air sealing, and heating system replacement. A hybrid quasi-experimental, cross-sectional research design was implemented. Under this design three samples of households were recruited for the project: Comparison homes that had been weatherized one-year previously; Treatment homes that were in the queue to be weatherized; and Control homes that were not going to be weatherized during the course of the project. Control homes were drawn from a lengthy waiting list. Homes were surveyed twice. The first phase occurred during four-month period when Treatment homes came up for weatherization. Comparison and Control homes were also surveyed during this four-month period. The second phase entailed surveying all households approximately one-year later. The phone survey contained questions about home conditions, health of occupants, and household finances. The cross-sectional analyses were much stronger, from a statistical significant viewpoint, than the quasi-experimental design approach because sample sizes were larger for the former and the latter was plagued by inexplicably large changes reported by the Control group. Post-weatherization homes were less likely to be kept at unhealthy temperatures, were less drafty and dusty, and had reduced levels of mold and intrusion of outdoor noise and odors. Respondents reported fewer bad days of physical and mental health. Households were better able to pay their energy bills and afford prescriptions.

Like being hit by a truck; pain metaphors in osteoarthritis patients’ narratives

Like being hit by a truck; pain metaphors in osteoarthritis patients’ narratives

Building a ‘Culture of Wellness’: Lessons for the Pandemic and Beyond

Building a ‘Culture of Wellness’: Lessons for the Pandemic and Beyond

Inside the Wolf

82 M. B. SMITH Inside the Wolf • eople at parties always want to hear the story. “How did you two meet?” they ask, giving the words an innocent lilt as if they don’t already know what happened. She doesn’t blame them. It is a good story, and her husband has turned out to be a natural storyteller. He begins at the beginning—the cloak, the basket, the mother’s warning—although of course he himself was not there until the end. He begins at the beginning and ends with the first time he saw her lovely face. And so the moral is no longer keep to the straight path but we were meant for each other. The way her husband tells it, he fell in love with her the very moment he pulled her out of the wolf. He does not mention that it was in fact the grandmother he pulled out first, or that she had soiled herself. Both she and the girl. And only when people specifically ask does he give even the most cursory account of the thing they all did after to the wolf, which at the time was still very much alive. They did it at her grandmother’s insistence. No one is proud. And never does the girl’s husband try to approximate the sound the creature made when it woke up. The girl still has the original red cloak. People kept asking about it, and at some point she took to wearing it again. It fits the same as it ever did, and the effect is simply terrific when she shows up to a party with the hood tugged low, a basket on one arm and her husband on the other, the famous hatchet dangling from his belt. When people see the pair of them they lose their minds. The girl and her husband are always happy to pose for photographs. Only on occasion does somebody ask the question that makes the girl wish she and her husband had some other story to tell. A simple, awful question. Most nights it does not come up. Still, she often senses that somewhere, in some corner of the party, somebody is slowly working up the nerve to ask it. There are nights she finds herself out on the lawn, watching through the lighted windows as within her husband entertains drunk p 83 strangers with the story of the worst day of her life. She can always tell by his gesticulations which part he has reached. By now it is a finely tuned routine, and its beats are quite consistent from performance to performance . On some of these nights she has a feeling that, ever since the wolf, her whole existence has been nothing but a chain of parties with no breaks in between for ordinary life. One night she gets so drunk she becomes convinced that there’s really just one single never-ending party from which somehow she cannot return. Feeling ill, she lies down on the cool grass. Above her the sky wobbles. Someone shouts, and the girl sits up. Through the trees she catches a pale, irregular movement. As she watches, the thing leaves the woods and flickers into the moonlight. It is an old woman. She is shouting, but the girl cannot make out the words. The old woman is stooped and scrawny, and she moves with alarming speed, juddering across the dark grass in the girl’s direction like a pull-toy on a string. The girl hauls herself to her feet. The old woman’s voice is shrill. The girl cannot tell what she is saying. “Is the music too loud?” the girl asks. She swings an arm out broadly toward the gleaming house, nearly throwing herself to the ground. She is drunker than she thought. Breathing heavily, hands resting on her knees, she tries to appease the old woman, who has not stopped shouting. “I don’t live here. I’m sorry. Hi, hello.” The girl takes note of each word as it comes out of her mouth, faintly aware that the sentences do not follow one another. All at once the old woman is upon...

Validation of the Lyon classification for GORD diagnosis: acid exposure time assessed by prolonged wireless pH monitoring in healthy controls and patients with erosive oesophagitis

ObjectiveAcid exposure time (AET) from ambulatory pH studies and reflux oesophagitis are independent measurements used by the Lyon classification to diagnose GORD. This study aimed to validate AET reference ranges...

Tail Risk and Extreme Events: Connections between Oil and Clean Energy

Do tail events in the oil market trigger extreme responses by the clean-energy financial market (and vice versa)? This paper investigates the relationship between oil price and clean-energy stock with a novel methodology, namely extreme events study. The aim is to investigate an asymmetry effect between the response to good versus bad days. The results show how the two markets influence each other more negatively, i.e., extreme negative events significantly impact the other market. Furthermore, we document how the impact of the shock transmitted by oil prices to clean-energy stocks is less than the amount of shock transmitted oppositely. These findings have important implications for investor and renewable energy policies.

WISATA OUTBOUND DI KOTA SINGKAWANG

The decline in performance of both private and public employees is getting worse day by day. The worsening of the employee's performance had a big impact on the agency. There are various ways that can be done to improve the performance, one of the effective ways to do is to conduct training as well as travel tours. This training and tour is usually known as outbound. Apart from being able to be done by employees or outbound employees, it is usually also carried out from various circles, from school and college children as well as from the general public. Outbound is a form of learning all applied sciences that is simulated and carried out in an open or closed environment with an effective form of play, which combines intelligence, physical and mental. Outbound is a management training which is a combination of outdoor sports, dexterity and adventure games with the concept of nature which aims to shape, direct, convey a vision, as well as have recreation for the participants. Singkawang City is a city famous for its various tourist destinations. In addition, in Singkawang City, there are areas that have the potential to be built for Outbound Tourism. Outbound tourism in Singkawang City not only facilitates games, but there are camping and other supporting facilities.

A COVID-19 Obituary.

I read obituaries. I read obituaries every day. I have read obituaries every day since I was 11 years old. I wake up in the morning, and before I start my day I go to the front door, open it, and retrieve the New York Times that has been delivered to my home. I retreat to the bathroom and I open the paper to read the obituaries. Before I dress. Before my coffee. Before breakfast. I read obituaries. I check the ages of those who have died. 98, 102, and 89, perhaps there is hope. 62, 49, and 34, looks like it will be a bad day. I read the causes and circumstances of death. Died in his sleep of natural causes — a sigh of relief. I notice so many more musicians and artists and drummers for obscure rock groups of the 60s seem to die and get featured obituaries than doctors, psychiatrists, psychologists, and palliative care clinicians. Perhaps it’s a biased sample — those people who get that special obituary for noteworthy deaths with that special picture when they were younger in their prime. Why do I read obituaries so compulsively? Well, the answer is of course multi-layered. On the most accessible level, I am fascinated by the stories of peoples lives. The narratives of lives lived in all their variety, length, scope, and focus. They are dramas that have the potential to aid us all in the search for who we want to become and examples to measure ourselves against. As the Talmud taught us, “What is truer than the truth? The story.” However, on a perhaps deeper level, reading obituaries, for me, is an inquiry in how to create an attitude and a perspective to death. It is a re-confirmation, each day, that death is real, an inevitable part of life, and that, in fact, we live with death every moment. In creating the story of our life, we create a story of a life lived and a death that is ever present and can occur at any moment. It is a reminder that death is at the essence of life, reconfirms life, and that death punctuates life. Reading obituaries allows me to maintain a sense of mortality salience as I live each moment of life. Death is always present in our lives. It is a constant. But now, in the Age of the COVID-19 pandemic, death is even more constantly present. In fact, there are more deaths each day, and more deaths this past year, that at any time in our recent history. It is January 22, 2021, 1 year since the start of this global pandemic. The COVID-19 pandemic “Numbers” are unfathomable: 100 million COVID-19 cases worldwide and 2.1 million deaths globally. In the United States alone, we have almost 24 million COVID-19 cases and more than 420,000 deaths. This excess mortality due to COVID-19 has resulted in more obituaries being printed in our newspapers than at any time in the recent past. And so I am reading more obituaries; more COVID-19 obituaries.