Bad Days Research Articles

Evaluation of Gastroesophageal Reflux Disease in Children on the Autism Spectrum: A Study Evaluating the Tolerance and Utility of the BRAVO Wireless pH Monitoring.

Children on the autism spectrum disorder (ASD) may express pain or discomfort through stereotypic or self-injurious behaviors. Gastroesophageal reflux disease (GERD) may be challenging to diagnose in a child who is non-verbal or has impaired communication skills, diagnostic testing for GERD may be the only way to establish the diagnosis. We report our experience using the BRAVO wireless pH monitoring device for the evaluation of GERD in this patient population. Tolerance and feasibility as well as pH parameters and symptom correlation of the BRAVO pH were evaluated retrospectively in ASD children and compared it to a large cohort of non-ASD children. Only patients with studies lasting >24 hours were included. A total of 172 patients were included, 27 of those were diagnosed with autism (median age 11 years, 17 male). We found no difference in age and weight between both groups but there was a male predominance in the autism group ( P = 0.007). We found no difference in the ability to complete at least 24 hours of study duration between both groups (24/27 or 89% in ASD vs 133/145 or 92% non-ASD patients, P = 0.632). We also found no difference in the median reflux index on the worst day ( P = 0.27) or the average of both days ( P = 0.75), BRAVO pH parameters and the proportion of abnormal studies between ASD and non-ASD children. When evaluating the overall symptom correlation with GER episodes, we did not find a difference between both groups, but we did find a higher symptom correlation for GER symptom during supine position in ASD children. Study was performed for behavioral indication in 11 ASD children, all had normal esophageal mucosa but 4 of those had an abnormal BRAVO pH study. No significant side effects were reported during the study, only 2 patients (1 non-ASD and 1 ASD) complained of self-limited chest pain. BRAVO wireless pH is well tolerated and feasible in evaluating GER and behavioral symptoms in ASD children and provides a reasonable alternative to standard trans-nasal pH monitoring.

Commodity Prices after COVID-19: Persistence and Time Trends

Since December 2019 we have been living with the virus known as SARS-CoV-2, a situation which has led to health policies being given prevalence over economic ones and has caused a paralysis in the demand for raw materials for several months due to the number confinements put in place around the world. Since the worst days of the pandemic caused by COVID-19, most commodity prices have been recovering. The main objective of this research work is to learn about the evolution and impact of COVID-19 on the prices of raw materials in order to understand how it will affect the behavior of the economy in the coming quarters. To this end, we use fractionally integrated methods and an Artificial Neural Network (ANN) model. During the COVID-19 pandemic episode, we observe that commodity prices have a mean reverting behavior, indicating that it will not be necessary to take additional measures since the series will return, by themselves, to their long term projections. Moreover, in our forecast using ANN algorithms, we observe that the Bloomberg Spot Commodity Index will recover its upward trend, increasing some 56.67% to the price from before the start of the COVID-19 pandemic episode.

Evaluating Energy Efficiency in a Hospital Building with Reference to GRIHA: Case of Trauma Centre at Aligarh, India

With the rise in problems mainly ecological as well as energy crises that are intensifying today, the concept of green has become essential concerning sustainable development. The hospital building consumes much more energy and generates more waste, as compared to the other types of buildings. The climate change, contamination of chemicals, and use of unsustainable resources are all making health worse day by day over the world. The health sectors are themselves causing these problems on a broad scale. So, hospitals, health sectors must be green, there must be proper management of resources, waste etc., which means that it must have a minimum negative impact on the environment. The term Green Hospital has evolved as a way of addressing environmental issues, overcoming them and meeting society’s need. In India, Green Rating for Integrated Habitat Assessment (GRIHA) is one of the tools that provides green building certification to hospital buildings also. This paper aims at analyzing and investigating a hospital building (Trauma centre), Jawaharlal Nehru Medical College, Aligarh, based on major criteria of the GRIHA variant for existing buildings. This hospital building had been provisionally-rated by GRIHA in the year 2016 as 3 stars. This paper includes the analysis of building based on various calculations and in depth study of how this 3 star rating was provisionally achieved. This paper involves two main calculations, one regarding peak heat gain and the other is EPI.

Nobody’s Perfect

This paper challenges the cross-linguistic validity of the tense–aspect category ‘perfect’ by investigating 15 languages from eight different families (Atayal, Brazilian Portuguese, Dutch, English, German, Gitksan, Japanese, Javanese, Korean, Mandarin, Niuean, Québec French, St’át’imcets, Swahili, and Tibetan). The methodology involves using the storyboard ‘Miss Smith’s Bad Day’ to test for the availability of experiential, resultative, recent-past, and continuous readings, as well as lifetime effects, result-state cancellability, narrative progression, and compatibility with definite time adverbials. Results show that the target forms in these languages can be classified into four groups: (a) past perfectives; (b) experientials; (c) resultatives; and (d) hybrids (which allow both experiential and resultative readings). It is argued that the main division is between past perfectives, which contain a ‘pronominal’ tense, on the one hand, and the other three groups on the other, which involve existential quantification, either over times (experiential) or over events (resultative). The methodological and typological implications of the findings are discussed. The main conclusion of the study is that there is no universal category of ‘the perfect’, and that instead, researchers should focus on identifying shared semantic components of tense–aspect categories across languages.

Bad Days at New Day Products

ABSTRACT This instructional case describes an embezzlement committed by the former executive director of a Southeast Idaho nonprofit organization, New Day Products. The case, based on an organization that helps people with disabilities, provides a rich context for students to learn about the important roles and responsibilities of nonprofit organizations' boards of directors. Highlighting the challenges faced by nonprofit boards of directors, the case asks students to consider how New Day Products' board of directors' governance decisions, including choosing financial statement reviews rather than audits, increased the executive director's opportunities to commit fraud.

Component-dependent thermal properties of molten salt eutectics for solar thermal energy storage: Experiments, molecular simulation and applications

Molten salts have been used in solar thermal energy storage due to their high energy storage density, low cost and excellent chemical stability. However, their application is limited by “bad days” such as cloudy days and winter because the weak concentrated solar radiation cannot melt the salt. The current study indicates that through mixing pure salts, the melting point of molten salt can be decreased significantly while the latent heat is not impaired. This is very important for solar thermal energy storage systems on “bad days” because the system using the low-melting-point salt is still possible to work on these days. The case study was performed in Nottingham, the United Kingdom and Dezhou, China respectively. The pure salt and salt mixture were used as the heat transfer fluid and energy storage medium in the solar tower power plant. It is found that by using the low-melting-point salt eutectic, the yearly operation time of the plant is increased by 75 days for Dezhou and 33 days for Nottingham. In addition, a molecular simulation was performed to reveal the mechanism underlying the component-dependent thermal properties. Mixing pure salts is proved to be a simple method to improve the utilization efficiency of the solar power plant.

“Inside Out”: A Regional Inpatient Joy in Work Project

AimsInpatient admissions during the COVID-19 pandemic went up in the regional unit by 18%. This included a 50% increase in Eating Disorder Presentations and more complex SMI requiring admission to Beechcroft. Beechcroft is the regional inpatient unit for CAMHS in Northern Ireland. This project aimed to improve staff joy in work by 30% by June 2021, following what was one of the most difficult years to be a health professional with the COVID-19 pandemic.MethodsWe used the IHI Joy in Work methodology along with our own rating scales in the inpatient unit.Several PDSA cycles were carried out including focus groups, gathering baseline data from different wards, and our change ideas- Beechcroft stars nominations, Virtual Quizzes and Staff recognition certificates.ResultsBaseline data on our run chart demonstrated a bad day median in Beechcroft with 4.3 being the score.With the PSDA cycle we demonstrated a 33% improvement in good day scores with a median of 1.4.We have learnt that Joy in work comes from recognising the work already being done and rewarding the efforts our staff go to.Spread and scale with Beechcroft stars now part of fortnightly MDT meeting and management meeting. Also rolled out to a community mental health team.ConclusionJoy in Work comes from the team. Recognising the efforts of the team is central to this. In particular during a pandemic.

Annie's Cat is Sad by Heather Smith

Reviewed by: Annie's Cat is Sad by Heather Smith Natalie Berglind Smith, Heather Annie's Cat is Sad; illus. by Karen Obuhanych. Feiwel, 2022 [32p] Trade ed. ISBN 9781250806840 $18.99 Reviewed from digital galleys R 3-6 yrs Annie comes home to her cat, Delilah, contentedly resting in a cat tree: "Are you okay? You look sad." Delilah saunters away and hides under the couch, but Annie is determined to improve her cat's mood with some warm milk (a "cattuccino"), TV, and yoga. These tactics seem to work until they don't, as Annie warns Delilah, "Just when you think you've forgotten your bad day, you will remember it again." It's clear that Annie is the sad one here, not Delilah, but when Annie stops distracting herself and accepts her need to cry out her feelings, Delilah is there for her with cuddles. Obuhanych utilizes negative space impactfully, gradually pulling [End Page 332] away background details in Annie's home to convey both her melancholic mood and her ownership of it. Mixed media art in paper collage, pencils, and paint gives each color blotchy textures, especially Annie's vibrant, swirling orange hair that crosses full-page spreads. The message is transparent but effective: sometimes we just have to feel our feelings, even when it's easier to project them onto someone else. Viewers who struggle to express their emotions in a healthy way may benefit from Annie's acceptance, or at least from her reliance on a trusty feline to make things better. Copyright © 2022 The Board of Trustees of the University of Illinois

A Qualitative Study of Older Adults' Experiences of Embedding Physical Activity Within Their Home Care Services in Ireland.

PurposePhysical activity has been shown to improve older adults’ functional capacity, independence, and quality of life. In a feasibility study, we embedded a movement approach within older adults existing home care services through “Care to Move” (CTM). The aim of this qualitative study is to explore older adults’ experiences of CTM within their home care support services and to identify the strengths and barriers of engaging in CTM from the perspective of the older recipient.Materials and MethodsWe conducted semi-structured telephone interviews with 13 older adults and one informal carer. Topics covered included participants’ overall experiences of CTM, changes to their overall activity and participation, aspects of CTM that they found valuable and issues that were challenging. Interview transcripts were coded and analyzed thematically to capture barriers and facilitators to the approach delivery.ResultsFour themes were developed: i) “I have good days and bad days”, ii) “safety and security is the name of the game”, iii) “we’re a team as it stands’, iv) “it’s [COVID-19] depressing for everybody at the moment”. Older adults identified benefits of CTM engagement including improvements in physical and psychological wellbeing. However, subjective frailty and self-reported multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of delivering CTM and competing care staff interests. The broader role of care staff in supporting CTM was highlighted, as well as the emotional support that staff provided to older adults. Care staff continuity was identified as a barrier to ongoing engagement. The impact of COVID-19 on older adults physical and mental health negatively impacted the delivery of the approach.ConclusionOur findings suggest that embedding CTM within home care services is feasible and that older adults enjoyed engaging in CTM. Addressing care staff continuity and adopting individual approaches to CTM delivery may enhance the implementation of services.

Because you had a bad day: the role of negative affect and justification in self-control failure

ABSTRACT Justification thinking (using excuses to “allow” giving into temptation) has been identified as a potential link between negative affect and self-control failure. We hypothesised that negative affect would prompt greater justification thinking, specifically deservingness thinking (i.e. “I deserve a treat”), and tested this for both inhibitory (temptation is to approach reward; self-control is to inhibit) and initiatory (temptation is to refrain from action, self-control is to initiate action) hypothetical self-control dilemmas. We found that only for inhibitory self-control (Study 1; N = 105) but not initiatory (Study 2; N = 116), negative affect resulted in greater deservingness thinking compared to neutral affect. We also hypothesised that negative mood coupled with justification would prompt greater likelihood of imagined self-control failure. We found that for inhibitory self-control (Study 3; N = 569), participants in negative affect (vs. neutral) and justification (vs. no justification) conditions were independently more likely to report they would fail at self-control. For initiatory self-control (Study 4; N = 321), we found an effect of negative affect on hypothetical self-control failure but no effect of justification. Overall, these studies confirm the role of negative affect in self-control processes and highlight differences between inhibitory and initiatory self-control situations.

P038 Catastrophic antiphospholipid syndrome: a unique patient perspective

Abstract Background/Aims Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening manifestation of APS affecting 1:100 APS patients with a mortality of up to 50%. The rarity, severity, and rapid onset of the condition present significant challenges for clinicians, patients, and their families. Methods This is the case of a 59-year-old female who presented to A&E with severe anxiety and foreign body sensation in the left ear, following recent investigations for thrombocytopenia and suspected transient ischaemic attack. She rapidly deteriorated, becoming obtunded with a stage 3 acute kidney injury. Bloods revealed platelets 22, anticardiolipin IgG 398.9 and B2-glycoprotein 984.3. She was ANA positive (1:1280), Anti-Ro positive but ds-DNA negative. Within 48h she was intubated and ventilated, receiving renal replacement therapy, plasma exchange and methylprednisolone. Initial differentials included CAPS +/- undiagnosed systemic lupus erythematosus and thrombotic thrombocytopenic purpura. She was ultimately diagnosed with CAPS, complicated by Libman-Sacks endocarditis with severe aortic and mitral regurgitation, acute renal failure and multiple intracranial infarcts. She was given rituximab, IV immunoglobulins and enoxaparin titrated to platelet count. She suffered no new organ damage following the initial insult. However, she remained unresponsive as sedation was weaned and her potential for neurological recovery remained uncertain. Multiple palliative discussions took place with her family. However, after 6 weeks of intubation on ITU she began to respond, going on to make a surprising recovery. Results Four months on she is at her local acute stroke unit for neurorehabilitation. Her APS is managed with hydroxychloroquine and warfarin (target INR of 3-4). She remains quadriparetic, with several cognitive processing difficulties. She displays emotional lability and extreme anxiety at times and struggles with rational thinking. Dealing with the trauma of this experience remains a daily struggle. She and her husband have provided a written account of their experiences before, during and after her stay on intensive care. They give an honest and thought-provoking perspective on the personal impact of CAPS and the difficulties in dealing with prognostic uncertainty in rare, life-threatening conditions. Her husband reflects on the palliative discussion process and the ways in which this experience might have been made easier for him by our medical teams. In his own words “telling the boys that their mum was not coming home was the worst day of my life”. Though her recovery represents a significant success for all those involved in her care, their lives have been irreparably altered by the course of her illness. Conclusion This case provides a novel perspective on the diagnosis and management of CAPS. It also provides a unique opportunity for clinicians to reflect on how best to communicate with patients and their families in cases with significant prognostic uncertainty, via the eloquent perspectives of the patient and her husband. Disclosure J.E.S. Webster: None.

Good Days, Bad Days: A Cognitive Interview-Based Approach for Eliciting Parents’ Perspectives on Experiences with Pediatric Palliative and Hospice Care (S547)

Good Days, Bad Days: A Cognitive Interview-Based Approach for Eliciting Parents’ Perspectives on Experiences with Pediatric Palliative and Hospice Care (S547)

Effect of a Medication Disposal Pouch versus Usual Care on Post Discharge Disposal of Unused Opioids: A Randomized Controlled Trial

To determine frequency of disposal of unused opioids after surgical procedures based on medication disposal pouch use or usual care, and patient factors associated with disposal. Two-group experimental design and convenience sample. Same-day surgery adults who received opioid orders were randomized to usual care or usual care plus a medication disposal pouch for opioid disposal. Opioid disposal and pain characteristics were collected by telephone at 30±10 days post discharge. Other data were abstracted from a hospital database. Data were compared using Kruskal-Wallis, Pearson's Chi-Square and Fisher's exact tests. Logistic regression models were built to identify predictors of disposal of unused opioids. Of 221 adults, mean age was 58.5 years and 50.2% were female. Overall, 121 received medication disposal pouches and 100 received usual care. Among those with a filled prescription, there was no between-group difference in the number of patients who used all of their opioid medication (disposal pouch group, 29.5%; usual care group, 21.7%). Of 74 disposal pouch and 65 usual care patients who did not use all opioid medications, 23.0% and 13.8%, respectively, disposed of opioids, and of the 23.0% of patients who disposed of medications in the disposal pouch group, 94.1% used the medication disposal pouch. After controlling for 7 factors, the odds of disposal of unused opioids increased among patients who received the intervention, had lower pain scores on the worst day of postoperative pain, and had a history of renal diagnoses (versus those with gastrointestinal diagnoses). Although opioid medication disposal rates were higher in the medication disposal pouch group; overall rates of disposal of unused opioid medications were low. More research is needed to learn important factors and methods associated with opioid disposal.

Dealing with Low Quality Images in Railway Obstacle Detection System

Object recognition and classification as well as obstacle distance calculation are of the utmost importance in today’s autonomous driving systems. One such system designed to detect obstacle and track intrusion in railways is considered in this paper. The heart of this system is the decision support system (DSS), which is in charge of making complex decisions, important for a safe and efficient autonomous train drive based on the information obtained from various sensors. DSS determines the object class and its distance from a running train by analyzing sensor images using machine learning algorithms. For the quality training of these machine learning models, it is necessary to provide training sets with images of adequate quality, which is often not the case in real-world railway applications. Furthermore, the images of insufficient quality should not be processed at all in order to save computational time. One of the most common types of distortion which occurs in real-world conditions (train movement and vibrations, movement of other objects, bad weather conditions, and day and night image differences) is blur. This paper presents an improved edge-detection method for the automatic detection and rejection of images of inadequate quality regarding the blur level. The proposed method, with its improvements convenient for railway application, is compared with several other state-of-the-art methods for blur detection, and its superior overall performance is demonstrated.

Farmer perceptions of climate change and adaptation during the 2017–2020 Australian drought

ABSTRACT Despite being the most tangibly impacted by the first-order effects of a warming climate, much of Australia’s agricultural regions have remained relatively conservative in their views on climate change and the need for adaptation. This paper aims to understand how the experience of an extreme climate event like the 2017–2020 drought might shift opinions and values on these issues within agricultural communities. Through in-depth interviews with 20 graziers across Northwest NSW during the worst days of the drought, we found that various psychological lock-ins, historical memories of resilience, and local cultural values appeared to be undermining the perception of their vulnerability, while enhancing perceptions of their ability to endure. Such discursive constructions appear to explain why a jarring climatic event like the 2017–2020 drought was failing to produce a noticeable shift in their views.

What it Means.

To be the host of so much vibrancy. To be the shadow that watches over. To be the privileged to be immersed in so much thinking in the making, To wonder what you have not done yet. To doubt. To falter. To try again. To fail even better. To stay creative yourself. To be a leader. One has to. To write yet another grant. To hold your breath as you press submit. To work nights and weekends. Many. To not be allowed a bad day. To deal with everyone’s bad days.

Gemmology and Gupta Period: Context of Precious Stones Industry in Ancient India

India has always been rich in its natural resources and its products. All these rich resources offered scope for a large number of industries, handicrafts and many other professions [I]. Likewise, industrial works and other economic professions were encouraged during the Gupta period also since raw materials were abundant for industries. Gemstone is a piece of mineral crystal that in cut and polished form is used to make jewellery or other adornments. One of the most ancient Industries of India was the precious stone Industry which includes diamonds, pearls, ruby and emerald among many others. The Guptas were also skilled in craftsmanship. They got the credit for organizing the technical skill of the craftsmen under royal supervision and inducing them to be enterprising in their trade. They inherited the fine craftsmanship of the Indians from an earlier period [II]. The science of testing gems was so perfected in India in this period as to arouse the admiration of the later European travellers of the 16th century. In the Kamasutra ruparatnapariksha (testing and valuing of precious stones etc.) are included in the list of sixty-four arts [III]. The jewellers [IV] used scales and touchstones for weighing and testing the quality and quantity of stones and metals. Such a high level of culture and the enhanced standard of living of the rich were impossible without a well developed urbanization and trade network. It is a fact from the Gupta period, trade had started falling on bad days but localized economic formations started taking place. By the time of this period, the trade become luxury oriented, a fact attested by the frequency of references to such items in the Brihatsamhita and many other ancient Sanskrit literature [V].

Association of Iatrogenic Infarcts With Clinical and Cognitive Outcomes in the Evaluating Neuroprotection in Aneurysm Coiling Therapy Trial.

Small iatrogenic brain infarcts are often seen on diffusion-weighted MRI (DWI) following surgical or endovascular procedures, but there are few data on their clinical effects. We examined the association of iatrogenic infarcts with outcomes in the ENACT (Evaluating Neuroprotection in Aneurysm Coiling Therapy) randomized controlled trial of nerinetide in patients undergoing endovascular repair of intracranial aneurysms. In this post hoc analysis, we used multivariable models to evaluate the association of the presence and number of iatrogenic infarcts on DWI with neurologic impairment (NIH Stroke Scale [NIHSS]), functional status (modified Rankin Scale [mRS]), and cognitive and neuropsychiatric outcomes (30-minute test battery) at 1-4 days and 30 days postprocedure. We also related infarct number to a z score-derived composite outcome score using quantile regression. Among 184 patients (median age 56 years [interquartile range (IQR) 50-64]), 124 (67.4%) had postprocedural DWI lesions (median 4, IQR 2-10.5). Nerinetide treatment was associated with fewer iatrogenic infarcts but no overall significant clinical treatment effects. Patients with infarcts had lower Mini-Mental State Examination (MMSE) scores at 2-4 days (median 28 vs 29, adjusted coefficient [acoef] -1.11, 95% CI -1.88 to -0.34, p = 0.005). Higher lesion counts were associated with worse day 1 NIHSS (adjusted odds ratio for NIHSS ≥1: 1.07, 1.02-1.12, p = 0.009), day 2-4 mRS (adjusted common odds ratio [acOR] 1.05, 1.01-1.09, p = 0.005), and day 2-4 MMSE (acoef -0.07, -0.13 to -0.003, p = 0.040) scores. At 30 days, infarct number remained associated with worse mRS (acOR 1.04, 1.01-1.07, p = 0.016) and Hopkins Verbal Learning Test (HVLT) delayed recall scores (acoef -0.21, -0.39 to -0.03, p = 0.020). Patients with infarcts trended towards lower 30-day Digit Symbol Substitution Test (DSST) scores (acoef -3.73, -7.36 to -0.10, p = 0.044). Higher lesion count was associated with worse composite outcome scores at both 1-4 days and 30 days (30-day acoef -0.12, 95% CI -0.21 to -0.03, p = 0.008). Among those with infarcts, day 1 NIHSS and day 2-4 mRS correlated with 30-day NIHSS, DSST, HVLT, and mRS scores, whereas day 2-4 MMSE correlated with 30-day NIHSS and DSST scores (Spearman ρ 0.47, p = 0.001). Iatrogenic brain infarcts were associated with subtle differences in postprocedural (1-4 days) and 30-day outcomes on different measures in this middle-aged cohort, with earlier dysfunction correlating with later differences. Clinical trials registration NCT00728182.

Carmela Curto: The Story of One Italian Immigrant, the History of Millions

Carmela Curto: The Story of One Italian Immigrant, the History of Millions

KENDALA PEMBELAJARAN SISTEM BERGELOMBANG DI SMP PAB 5 PATUMBAK 1

Teaching and learning activities in Indonesia during COVID-19 Pandemics are getting worse day by day due to the implementation of online schools from their respective homes and even face-to-face schools, but using the wave system is a big obstacle for teachers and guardians in general. With online schools, all teaching and learning activities should be delivered in totality. This also imposes distance learning (PJJ) which makes students' interest in learning decrease.