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#and it led to social services monitoring me before i was even born
thetimelordbatgirl · 3 months
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Tfw you learn your brother studied at the same college as you:
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tennessoui · 3 years
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this is probably too many prompts lol but uhhh obikin: #6 meeting at a coffee shop au; #24 literally bumping into each other au; #40 exes meeting again after not speaking for years au (i'm a sucker for breaking up and getting back together again lol); #42 star-crossed lovers au; #48 meeting again at a high school reunion au
hi!! you probably forgot you sent this at all and I wouldn't blame you in the slightest. I'm pretty sure someone else already asked for 24, 40, and 42, so I wrote #6 instead! warnings for this one: bittersweet in that both anakin and obi-wan are sad, also the author is sad, also this takes place in the midwest in america (this is the first fic that is obviously set in america!!! wow!!)
6. Meeting At A Coffee Shop Diner AU (1.9k)
“Have a seat anywhere you want,” the hostess tells Obi-Wan without looking up from her phone.
Obi-Wan blinks and then looks around the deserted seating area. “Thank you, uh.” She’s not wearing a name tag.
“Angel’ll bring you the menu and take care of you, thanks for coming in,” she says, glancing up at him and then away.
Well then. Obi-Wan reminds himself that customer service isn’t everyone’s strong suit, that she might have had a rough day, that he’s here for the quick food on his way through town, that his ego isn’t fragile enough that he needs to be led to a table with a smile.
The restaurant is almost completely deserted. There’s two truckers eating their weight in bacon and eggs at the counter, and a family of four seated around a table, resolutely picking at their food instead of talking to each other. And then there’s Obi-Wan.
He chooses a booth by the window, one that overlooks the absolute nothingness of midwestern American scenery. If he cranes his neck, he can probably see corn.
God, Obi-Wan’s sick of seeing corn, and he’s only been in this part of the country for a few hours. He needs to go right through most of it to get where he’s headed. He’s not sure how he won’t die of boredom.
The thought sends a pang through his chest. It’s too soon to think of death even in an offhand way. He taps his fingers on the cover of his leather journal, before a line of dark brown under one of them catches his eye. He studies his hand critically.
It’s been two days since the funeral. Surely he wouldn’t still have grave dirt under his nails. Surely things like that wash away eventually.
“Hey,” a voice says from in front of him. A man is turned around and kneeling up in the booth in front of Obi-Wan’s, leaning over the garishly red vinyl of the empty seat with a menu clutched in one hand. His hair is short and dark blond, an undercut with a long fringe settling over his forehead. He has a nice sort of smile, one that looks genuine but doesn’t touch his eyes. Obi-Wan notices how long the man’s neck is and how predominant his collarbones appear in the loose white shirt he’s wearing, before he forces himself to focus only on his face. “I’m Angel,” the guy says, passing over the menu. “Can I get you anything to drink?”
Obi-Wan accepts it gingerly. It looks like something that’s perpetually sticky. “Water is fine,” he says politely. “Thank you.”
“Will do,” Angel salutes him and ambles away. Obi-Wan watches him go before shaking his head to rid himself of any sort of thought, and opening the menu.
It’s standard food fare, of course. Breakfast options served all day if anyone were to come in and request them. Lunch and dinner options are also served all day, probably for the same reason: a diner like this can’t afford to turn anyone away, even if they want a hamburger at nine in the morning.
A glass of water clinks down onto the table next to him, making him look up at Angel, who’s looking at him curiously.
“You ready to order?” he asks, even though Obi-Wan is still very much looking at the menu and it’s also only been a few minutes at most since Angel gave it to him in the first place.
“Do you have any suggestions?” Obi-Wan asks politely. “I’ve never been here before. What’s good?”
“The water,” Angel says and then laughs like he’s said something funny. Obi-Wan finds his own mouth curling up at the sound. Sometimes people’s laughter is contagious, like a yawn.
And then Angel says, “You’re not from around here, are you?”
“No,” Obi-Wan admits. “North of Boston.”
Angel whistles, like Obi-Wan has said something impressive. “Boston, huh? What are you doing all the way out here?”
The pit in his stomach intensifies. He does his best not to look at his nails and the grave dirt that might still be under them. “Driving,” he finally says. “And are you...from around here?”
Angel’s eyes grow distant for a second, and when he focuses again on Obi-Wan, they’re cold. “Born and raised,” he tells him flatly. “Never got out.”
“Oh,” Obi-Wan doesn’t know what to do with the sort of bitterness in Angel’s tone. It complements his own well enough.
“If you like eggs, I’ll put you in for the house special omelette,” Angel declares suddenly, all business again. “It’s four eggs, tomatoes, peppers, cheese. The usual.”
“What makes it special?” Obi-Wan asks, closing his menu and setting it down on the table in front of him.
“For you?” Angel drawls, “I’ll watch the cook to make sure he doesn’t get any egg shells in it,” and then he winks, holding out his hand.
Naturally, Obi-Wan shakes it. Naturally, Obi-Wan realizes a second after feeling Angel’s warm, calloused rough palm against his own that the man had meant to take the menu from Obi-Wan.
He can’t remember the last time he’s blushed this red, but he is absolutely regretting everything about this road trip. God, he’d pay money just to be able to leave now.
He should get in his car and drive back to Boston. It had been a stupid idea to come out here anyway, a result of stir-craziness and a desire to outrun the death of his father.
And now look what he’s doing. Shaking hands with his handsome waiter, as if he isn’t thirty-nine and perfectly aware of social norms.
Thankfully, miraculously, Angel laughs and this time it sounds real. “It’s okay,” he tells him, reaching out to pick up the menu.
Luckily for everyone involved, Obi-Wan finds it very easy to laugh at himself. “Well. It’s nice to meet you, Angel, I’m Obi-Wan.”
“I’ll go put the order in,” Angel says, “Obi-Wan.”
He’s back within five minutes, sliding into the seat across from Obi-Wan. So much for no eggshells in his omelette, but he can’t bring himself to be disappointed. There’s something magnetically fascinating about Angel. He’d like to know more.
“So you’re driving?” Angel asks, picking up a thread of conversation from several minutes ago. “Where are you going?”
“I was thinking of Alaska,” Obi-Wan says. “I’ve--I’ve always wanted to go.”
“You’re driving from Boston to Alaska?” Angel whistles, raising his eyebrows in shock. “I think the gas money alone would cost me two months of work.”
Obi-Wan shrugs. It’s not like he makes much himself as a teacher in Massachusetts. “My father was a lifelong gambler,” he discloses without really knowing why he’s telling this to a stranger. “He came into a bit of luck near the end. A bit of a fortune as well. And when he...died, I inherited it and his house.”
Angel touches his hand softly. “I’m sorry,” he says. “When did he pass?”
Obi-Wan huffs out what might be a chuckle. “A week ago, actually. It’s summer break in Massachusetts--I’m a teacher--and I suddenly had nothing to stay for, for a bit. It was either leave for Alaska or find some other way to cope.”
He runs a hand--his free hand, the one Angel isn’t touching--over his beard as he gives the man a rueful smile. “Dad always wanted me to see more of the world.”
“My mom was the same way,” Angel leans forward to tell him, as if it’s a secret. Obi-Wan feels like it is a secret, that there’s something delicate and fragile in the air. Something that matches whatever emotion is filling up Angel’s eyes. “Always telling me to leave, go get famous, go get happy, come back and tell her about it.”
“You didn’t?” Obi-Wan asks, his chest tightening at the thought that the man before him could be unhappy.
“I couldn’t,” Angel sneers, looking out the window and propping his chin on his hand. Some things must be too close to the heart to tell someone to their face. “Mom got sick. I wanted to get out, I was so close. Graduated high school, packed my stuff. I was going to go to California. To Los Angeles, really make it big.” He rolls his eyes and scoffs, as if there’s something inherently funny about the dreams he must have cherished for so long.
“Then mom collapsed going down the stairs. Just passed out in the middle of the day. Doctors told us she was sick. Then life became all about treatment plans and monitoring symptoms and getting the money for the medicines and I never left. Got a job here when I was eighteen years old, right before I graduated high school. It’s all I’ve ever known, I guess.”
“And your mother?” Obi-Wan asks, mouth dry and heart all tangled up in itself for this stranger man, for Angel with the hard, sad eyes.
“Died a year and a half ago or so,” Angel says flatly like he’s repeated the words so often in his head that the truth digs no barbs into his flesh. Obi-Wan knows that voice is a lie. How often has he looked in the mirror this past week and told himself, ‘Qui-Gon Jinn is dead’? He can’t imagine a year and a half would make the pain go away.
“I’m sorry,” Obi-Wan says seriously, reaching across the table to touch Angel’s hand this time.
Angel shrugs but doesn’t pull away. “Is what it is, I guess,” he says. “I’ve made my peace with it. And the fact that I’ll never leave this godforsaken town.”
“You could,” Obi-Wan points out hesitantly. “You could leave tomorrow.”
For a second, a wild and previously undiscovered part of Obi-Wan wonders what it would be like, if Angel did leave tomorrow--with him. If they got into the same car and headed to Alaska together and Obi-Wan wasn’t alone at the wheel and Angel wasn’t alone in this town. If Obi-Wan could look over at the man in the passenger seat, asleep against the doorway as they crossed into Canada.
Obi-Wan wonders. Obi-Wan aches.
“I could,” Angel says, laughing once. “I guess I could. I guess I just can’t think of a good enough reason to.”
There’s a call of his name from the kitchen, and Angel stands and stretches, checking the time on his watch. “That’ll be your omelette, sir, which is perfect timing considering I’m off shift as of five minutes ago.”
“Thank you then,” Obi-Wan replies, ignoring the pang in his gut at the knowledge he won’t be able to keep talking to him. “It was nice meeting you, Angel.”
Angel’s face grows dark for a second as his jaw clenches. “That’s not my name,” he finally says, scratching at his neck with one hand. “That’s just what they called me when I started working here. Angel, like Los Angeles. Cause I told everyone for weeks this was a temporary thing, you know? I’d be going to California soon as mom got better. Guess they knew better than I did.”
Obi-Wan has never wanted to kidnap a grown man away from a place more, so he hides his hands under the table instead. “Would you tell me your name then?” he asks, wondering if he’s overstepping but needing to know too much to censor himself.
“It’s Anakin,” his waiter says, sticking his hand out, no menu to grab.
Obi-Wan takes it gently, turns it over, and cradles it between both of his hands. “Then it’s nice to meet you, Anakin.”
Maybe, he thinks as he picks at his omelette and watches Anakin shoulder his way through the front doors of the diner before disappearing down the street, maybe he can stay a day in this nowhere town. Just an extra day.
Yes, he thinks, taking a sip of his water. He’ll try the pancakes next.
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arinaco · 4 years
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The story of Pidge or Dark Youth as the main character
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Translated and edited by @Nadezhda932 
First warning: Plance
Second warning: before reading this meta, I strongly advise you to read the previous metas about Lance and Pidge. Because I won’t repeat the thoughts expressed there, but I will refer to them.
Not so long ago (at the time of writing), a 200th Let’s Voltron podcast took place, where the voicers gathered together and remembered the glorious past when they voiced the series together. And Bex – the voice of Pidge – remembered Plance and compared it to a wonderful little garden. Naturally, this led to the beginning of the discussion, where we analyzed the characters and their interaction with each other. And the idea came up to try to pull the Pidge storyline on Heroine’s Journey. Well, I mean to try to check whether there are those necessary components in her story that allow us to say that yes, this is the real Heroine’s Journey. And, to my pleasure, I suddenly realized that the story arc of Pidge really suits these requirements, and it’s even more interesting in its nuances than the Journey of Allura. Why? Because Allura has a classic story – a girl must become more confident in herself, go against society, save her prince, defeat the evil queen, etc.. Pidge… her situation is the opposite. And I’ll try to explain why.
I’ll begin by describing how the attempt to “pull” the story into the stages of the journey actually takes place. To do this, you need to determine that the storyline of the character doesn’t consist of separate episodes, but has a single common outline that runs through the series, and find several important components in this outline:
A) The drawback of the main character, preventing her from gaining inner balance and harmony;
B) The lowest point of the Journey. The moment when the heroine realizes this shortcoming and begins her work to fix it.
These two things also make it possible to determine what becomes an imaginary reward for a heroine and what becomes a real reward, and thus we begin to perceive individual scenes with the heroine as a single construct – a story about self-digging, which is the Heroine’s Journey.
And the main drawback of Pidge is not only her egoism, because there are a lot of happy egoists in life. The main disadvantage of Pidge is the zero ability for social interaction that developed as a result of this egoism.
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As well as an absolute lack of understanding of what is “criminal liability”.
The Holts adored their daughter with blind love, were proud of her mind and indulged in everything, and thereby served her very evil service, because the parents should not only love their child, they should prepare the child for adulthood and set the right moral compass. And, alas, Pidge has serious problems with this. In the series, she appears as a brilliant teenager, but at the same time lagging behind in social development. Not because she’s mentally ill, but because she grew up in an environment where that metaphorical muscle responsible for social skills simply wasn’t trained.
 Honestly, there are not so many ideal parents in the series. These are the parents of Hunk and Dayak, who performed a miracle, having managed to raise a mentally healthy person in an environment that clearly didn’t contribute to such a development of events. The classical educational school of ancient Daibazaal showed a real master class, and it’s a pity that the main characters cost only an orientation course.
The Pidge’s storyline isn’t the main one in the series, but it’s important enough to make an integral picture of her behavior if desired. You need to understand that social interactions are not just “hello – bye” or “let’s be friends against a common enemy” – I would even say that in such situations, skill isn’t required. The skill of social interaction is necessary in order to join the society where you’re only a drop in the ocean of people, and to learn how to live in it, avoiding conflicts. This is the ability to please, and the ability to circumvent sharp corners in communication… and this all needs to be learned. A person isn’t born with these skills, they learns them in the family and in society, and … by the age of 14, Pidge didn’t possess these skills. She often behaved rudely with others, if not boorishly, completely ignoring the status of these people, and this can no longer be attributed to a simple straightforwardness of character.
You may ask: where did all this come from? It’s easy to imagine.
Pidge had greenhouse conditions at home. Parents loved and understood each other and pampered their beloved daughter. The brother was much older, and Pidge didn’t have to be jealous or fight with him for a favorite toy. In addition, the Holt family was united by a love of science and lived, as they say, on the same wavelength. The absence of conflicts and acute angles in the family is wonderful, but alas, it doesn’t at all contribute to the ability to solve the conflicts and circumvent acute angles.
Another teacher is the surrounding society. The child looks at this society, observes and begins to repeat. The child tries to communicate, with alternating success, and draws certain conclusions from the result. And the problem of Pidge is that all her conclusions boiled down to the fact that “they love me because I’m special and smarter than all of them.” She considered herself the smartest and didn’t strive at all, not only to observe how others communicate, but also to try to adapt herself to other people. She didn’t hesitate to interrupt the teacher and make her incompetent, although at the age of 14 you can already understand that this is simply ill-mannered. Moreover, judging by the behavior in the classroom, it wasn’t the first time she acted in this way, but which is characteristic – none of those present was imbued with respect for her knowledge. Because social interaction doesn’t work unilaterally. You can demand only for submission, respect or acceptance is always a two-way work.
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Pidge didn’t even realize that she was doing something wrong. She sincerely shared knowledge…
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…but you must also be able to share knowledge, so as not to make yourself an arrogant pride.
And the problem is that the Holts didn’t attach any importance to this. After all, they also believed that “Katie is just a special and brilliant girl, and this civilians aren’t able to understand her because of their earthliness, but when she enters the Garrison …”. She entered the Garrison, so what? Her environment consisted only of extremely condescending and patient people – Hunk and Lance, and she rejected their friendship at the first meeting.
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You see these people for the first time and don’t even want to spend a couple of minutes getting to know each other.
School is that litmus test that shows how the child will get along in society, and you can’t turn a blind eye for the fact that your child isn’t accepted in this micro-society. You need to work, you need to try to understand what’s wrong, and keep in mind that the problem can be not only in evil peers, but also in your own child, who is an innocent angel only for you.
Because a person is a social animal, and we have a psychological need for respect and recognition. While Pidge was a child, she was fine with her parents, brother and dog, but now a new adult life is knocking on the door, where she wants something more. She’s already 14 years old, even though psychologically she’s 11-13 years old, but she’s already a teenager. And she has a completely positive example of a motherly figure – successful professionally and in her personal life, and she probably wants the same for herself.
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Nothing prevented Colleen from being both a brilliant scientist and a charming woman at the same time.
Moreover: Mrs. Holt has a short haircut, which means that having long hair is a personal desire of Pidge. Yes, she doesn’t get along with other children, but she tries to wear beautiful dresses and looks after her magnificent hair. She doesn’t say it out loud, but she clearly feels the need to be accepted not just as a child, but also as a young woman.
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And she feels upset when she can’t get in contact with peers.
And here your parents won’t help you.
Yes, mother can say a hundred times that you’re beautiful, but this is not the same as the approval of your friends and the attention of the boys. And Pidge had problems with this, because she pushed peers away and couldn’t even get respect from them for her intellect and knowledge, which, with different behavior, could earn the approval of the teacher and admiration from other children. Because social skills in society are like traffic rules in a stream of cars. You can be a brilliant driver, but you will still be cursed by others if you turn without turning on the turn signal, or if you don’t miss a pedestrian.
But to solve a problem, you need to know about its existence. You need to understand that it’s here, and you need to solve it. And since her beloved relatives assured that everything was fine, Pidge didn’t realize what was wrong until she faced the real consequences of her actions. And this is exactly what the Heroine’s Journey tells. Moreover, the Journey of the Dark Heroine, because Pidge is the real Dark Youth, traveling in a group of the main characters of the series. 
It’s actually not so difficult to distinguish Dark Youth from Light Youth. You just need to look at what’s the main motive for a person to start a journey. Allura traveled for the desire to become the winner of evil, Lance – for the recognition of loved ones, Pidge… for her selfishness. Yes, because her love for relatives is very selfish, and we can clearly see how she treats the love of her relatives in a consumer way when she easily abandons her mother to regain her “property” – her father and brother.
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Look at this poor woman. How she got older, how her hair grew – having lost her children and husband, she even stopped monitoring her appearance. But what does Pidge think about in S7 when they prepare to return to Earth? About how she’ll be punished. She doesn’t think about WHAT her mother experienced during all this time. Sorry, but for some reason I’m not too lazy to call my family at the age of 30 and say that everything is fine. And Pidge isn’t a toddler or even 10 years old to behave in this way.
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But if Pidge is Dark Youth, then who is our Light Youth and where is our Animus? And here we get a very interesting point: the fact is that the series forms a whole bunch of heroes, where one character has two Dark Youths at once, and the other has two Light ones.
And these ligaments look like this: Lotor-Allura-Pidge and Allura-Pidge-Lance. Funny huh? A sort of love quadrangle.
In the case of Allura and her Dark Youths, the question arises of contrasting the common good and personal desires. Lotor and Pidge are two opposing sides of personality development that pull Allura like a rope in a competition.
Lotor is not just the Dark Youth of Allura. He’s an allusion to her ideal, to which she aspired. Lotor is not a teenager with personality problems, no, he’s a mature – even old – man. He’s a great diplomat and speaker, he’s polite and ready to compromise with everyone, but he never trusts anyone, because he’s constantly stabbed in the back. He’s ready to sacrifice all desires and affections for the fulfillment of the plan for the salvation of the universe, which he once set for himself. He’s confident in himself, he knows what he’s doing, he calculates everything in advance, but at the same time he improvises very well. An ideal politician and strategist with the most noble intentions. And he’s not a friend of the Alteans, not a commander or a king, but the Holy Savior Lotor. An example to follow, who took the cross upon himself – to atone for the sins of his father – and carried it, pushing aside everything personal for the sake of the greater good. He doesn’t allow himself to be angry at people or become attached to them, because all this can ruin his important mission.
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So perfect and lifeless…
This is what Allura’s dream of becoming a ray of light for the universe could turn into. Nothing for yourself – everything for others. A lifeless holy idol who has long forgotten about love and personal wishes. The Alteans with their cult of sacrifice will fully approve it.
And Pidge really turns out to be his complete antipode.
Lotor is old, she’s almost a child. Lotor is polite and eloquent, she’s straightforward and often rude. Lotor doesn’t trust anyone, she completely believes her loved ones. Lotor acts for the common good, Pidge – exclusively for personal purposes. Lotor turned his back on his family, because he considered their actions immoral, Pidge fully and completely supports her family, no matter what happens. They can only be united by confidence in what they’re doing is right, but this is not much in which they agree.
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An ancient man who wants to save the universe and a little girl demanding to return her dad.
And this pulls Allura in different directions – the dream of serving others and her own desires. None of it can be put on a pedestal, as the path of Allura is the path to a balance between these two aspirations. In the end, it was for a reason that Lotor reached out to her – the lifeless Saint figure really wanted to feel alive again, to love and trust someone. The savior wanted someone to save him.
Pidge’s parallels appear a little different. They say that all families are equally happy, but each suffers in its own way. And how much Lotor and Pidge differ in the role of Dark Youth, so much in the role of Bright Youth are Lance and Allura alike.
The Red Paladin, which should be Blue, and the Blue Paladin, which should become Red. As brother and sister, they go hand in hand in their insecurity, albeit regarding various aspects of life.
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And you know, it's funny when you think that the Blue Lion is the right leg and the Green Lion is the left arm. Indeed, opposites.
I've already written about Lance and Pidge. Here I will say that the question of Lance and Pidge's relationship is a question of selfishness. Lance and Pidge both wanted public acceptance. But if Pidge, in pursuit of her family, abandons the idea of ​​establishing contact with others and achieves her goals through conflict and breaking the rules, then Lance, on the contrary, goes out of his way to achieve what he wants, almost pursuing people in attempts to get attention from them.
Funny contrast: Pidge completely neglects her appearance at the start of her journey, while Lance is the only one on the show who takes the time to look after his appearance even in the middle of a war. Beauty is one of the most affordable ways to gain recognition. And if Pidge refuses even it, then Lance clings to attractiveness with his legs and arms, considering it a measure of a person's level of happiness.
Lance is a very compassionate selfless person, but in pursuit of status, he went against his own nature - he began to consider loved ones from a consumer point of view. And crossing with Pidge on this subject should have made him stop, take a look at himself and what he was doing. Take a look and think about it at last.
On the other hand, Lance is also a subject of interest. This is a childlike innocent affection that Katie developed towards the end of the story. Lance may not be the most attractive man, but he's an open and cheerful person who gave Pidge exactly what she lacked in school - sincere friendship and acceptance with all her flaws. Katie is still quite small in this regard, this is not some kind of serious romantic love, but this is a strong feeling, which over time, over the years, can turn into something more mature.
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Having fun with friends is what Katie has dreamed of since school.
He is Pidge's Animus. A person with similar problems, but with the opposite approach to solving them.
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It’s interesting that at the beginning of the journey it was Lance who didn’t notice until the last moment that Katie was a girl.
Everything is a little more complicated with Allura: Allura doesn’t appeal primarily to Pidge’s egoism, but to social skills. Yes, the idea of sacrifice is close to Allura as an Altean, and it is opposed to the egoism of the Green Paladin. But the main thing is different: Allura is polite, educated, diplomatic and, in the end, accepted and loved by society as an amazingly beautiful woman. And this is what Pidge would like for herself, without even realizing this need. On the other hand, Allura’s professional skills are forgotten by S8, those around her begin to perceive her only as a pretty alien girl, against the backdrop of the triumph of Pidge, whose ingenious mind is recognized in the professional circle of scientists.
And if Allura in the changed S8 turns into a damsel in distress for a noble knight who will worship her like the Virgin Mary, then Pidge becomes that very caricatured strong and independent woman, only instead of 40 cats she has robots. It’s caricatured, because it’s the image of a woman who declares that she doesn’t need anyone, and then, in longing for human warmth, she turns herself on to a pet in order to sublimate her psychological needs. In the case of Pidge, she builds herself a metal brother. And in ten years she’ll also build a metal lover, why not.
The truth is that a person is happy only when they realize themselves both professionally and personally. There’s a huge number of people who put their lives on the altar of some important mission, but later not so much of them could call themselves happy. On the other hand, there are a lot of women who abandoned their ambitions for the sake of marriage, and then regret it until their death.
So what is it – Pidge’s Heroine Journey? Let’s look at it in stages.
Stage 1 – Separation from the feminine.
Pidge is a teenager of 14 years old. She has problems with her peers, she can’t find a common ground with them, and therefore clings to her family – her cozy mini-world, comfort zone. But here a tragedy occurs: father and brother disappear on an expedition. Pidge finds out that something is unclear in this case, but the father’s authorities refuse to explain the situation, and she decides to find the answers in a not too legal way – secretly, despite all the prohibitions.
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Feminine figure and beautifully decorated room…
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…all this was left in the past.
This is very symbolic: Pidge leaves her mother alone to experience the tragedy and cuts off her hair – a symbol of her femininity.
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Katie is not at all happy to lose her beautiful curls
Stage 2 – Identification with the masculine and gathering of allies
Pidge studies at the Garrison in the company of Hunk and Lance, hiding under the guise of a homely boy. At first she repels them, but since they’re a team, she has to communicate with them. But instead of making friends and learning to communicate, Pidge spends all her efforts looking for information about the family. Meanwhile, she begins to have confidence in Hunk and Lance, finds common interests with them, and gradually these two in her eyes pass from the category of strangers into the category of the ones whom she can even tell her secret.
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And when Pidge once again can’t keep her mouth shut…
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…it’s Lance who protects her.
Stage 3 – Road of trials, meeting ogres and dragons
Shiro's return and the beginning of their journey. Pidge grabs any lead to find her father and brother, and is even ready to give up everything and everyone for the ghostly opportunity to save the family. On the other hand, one way or another, she begins to become attached to the people around her. True, this attachment is selfish. Pidge worries about the safety of her friends, but she isn't interested in what they grieve and worry about. Her fixation on the family is in stark contrast to the fact that the main leadership backbone of the team - Allura, Shiro, Keith and Koran - are orphans who have no loved ones except for each other and a common cause.
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Keith with his desire to save Shiro is certainly disingenuous, but he described Pidge's problem correctly...
Stage 4 – Finding the boon of success
Pidge finds her brother and saves his father. But at what cost? The height of selfishness is to send a person to certain death, without even trying to give him a chance for being rescued. And personally for Pidge, this person is only to blame for the fact that he's not included in the circle of her loved ones - the circle of those whom she considers her "property". But she still gets her way, she saves her family, without any remorse. And then she has fun with friends who have already become family members for her - part of that very micro-world.
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And it was during this period that Pidge appeared in the game as the most closed character, fenced off by armor from other people.
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And the mess in her room as an indicator that Pidge wasn’t going to invite guests at her place…
Stage 5 – Awakening to feelings of spiritual aridity; death
Homecoming. As people say, be careful of what you wish for. Pidge constantly tried to leave friends and other people behind, in the pursuit of saving the family; as a result, when she returns home, she’s grounded. Now, her circle of loved ones is forcibly composed only of her parents and brother. Moreover, the most annoying thing happens: Lance invites Allura on a date. Lance complained to Hunk for several weeks about being unworthy of Allura, while Hunk listened sympathetically. And there was no one who could interrupt the flow of this whining, because this someone was sitting at home. As a result, Hunk persuades Lance to go out and invite Allura on a date, and she unexpectedly agrees.
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And after so many days of isolation, Pidge is free only to find out that Lance is going on a date with Allura. Pidge liked Lance, she even tried to compliment him, although unsuccessfully – and now he sailed away to a beautiful princess, and Pidge could only watch this process.
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A scene called “She tried”.
She even helps to arrange this date: to get Allura the dress for which she gives the game – the subject of their common interest with Lance. But that’s where her altruism ends: she doesn’t stand it and decides to follow them, because until the last she hopes that Allura will refuse Lance, but this doesn’t happen.
Yes, Pidge is respected as a scientist, but how much does it mean if the person dear to her, whose attention she values, is now fully devoted to his new girlfriend? You can say as much as you like that they’re a team of paladins, but we know very well that couples are always a little apart, as they feel like spending time together.
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And Katie knew perfectly well that now Lance is unlikely to find time to play with her.
Stage 6 – Initiation and Descent to the Goddess
Here’s a difficult moment. The fact is that this moment takes place in S8, in an episode that was originally intended for S7. And I can’t help but wonder if it should have taken place in the earlier version of the script, because according to the logic of the travel, Pidge should have it. This conversation takes place in a dead forest, where Pidge and Allura are left alone at some point, and Pidge, who saw how Allura saved the tree, asks if she can help Olkarion. After this, Katie has to admit that yes – she followed them, and naturally the question of Lance’s feelings will be raised.
Allura is Pidge’s Light Youth. She agreed to a date with Lance out of feeling guilty and out of gratitude for his concern. Her consent is pure sacrifice, altruism. And she admits it while talking to Pidge. That yes, she doesn’t have feelings for him, but he loves her. Remember the first episodes, where Pidge confidently says that a princess in her place would do the same. But now she sees that Allura, on the contrary, is ready to sacrifice the personal for the sake of someone else’s good. And this makes her think, because Lance chose Allura.
Throughout the series, Pidge was not very friendly with the princess. When Allura found out that Pidge was by no means a boy, she was the first to welcome Pidge as a girl, because having only men in her social circle wasn’t very comfortable for a girl. But then Pidge kept in mind only the search for a family and simply didn’t understand that she was offered girlish friendship. But now, in this situation, Katie was the only one to whom Allura entrusted her “female” secret, and the Green Paladin saw her tragedy and in some ways even managed to share it. Pidge saw in her not a rival, but a person who had lost absolutely everything and was ready to sacrifice the little that was left of her.
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You know, at the first meeting with the Olkari, Pidge says that she’s very far from nature, she’s closer to technology and robots, to which she doesn’t need to adapt. This can be considered a metaphor for how she pushes living people away from her, how she turns away from a simple human desire to realize herself socially. 
And it is very symbolic that the bottom point of the journey occurs precisely in the middle of the dead Olkarion.
Stage 7 – Urgent yearning to reconnect with the feminine
After talking with Allura, Pidge begins to look at the situation in a new light. She’s still upset that Lance is now devoting all his time to his new girlfriend, but now sees him not as an “escaped property”. Now for her he’s a really unhappy guy deserving of support, not ridicule. She generally begins to reconsider her position towards people, although this is a very slow process.
When they leave to celebrate Clear Day, she leaves her family — which she saved with such zeal — for the sake of helping Lance get a present for Allura. For the sake of the opportunity to stay with a loved one and find a gift for his girlfriend. And she sincerely seeks to please Allura, because she really imbued with sympathy for her. And when Lance tells her how useless he feels, Katie tries to support him, inspire, and somehow help him solve the problem of relations with another girl. And for a spoiled egoist, this is a very serious step towards change.
By the way, did you notice that in Clear Day episode there’s not a single scene of the interaction between Pidge and Lance, although Katie knows from somewhere that Allura asked for a present? It was cut out while editing S8.
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What kind of torment would you go for friends?
Unfortunately, I can only assume what the next steps should look like, too much has been cut.
We know that Allura will decide to announce to the paladins that she’s going to save Lotor, and perhaps Pidge will be the second after Lance to support her in this. Maybe she will even play a role in ensuring that the conversation between Allura and Lance takes place.
She will be next to Lance after the return of the prodigal prince and will morally support him. Perhaps they will even play the game as they dreamed in their podcasts. They’re still children who are just entering adulthood, and after everything they have experienced, they must find a place for joy.
In addition, Pidge has guilt before Lotor, and after her selfish behavior it’ll be important that she realize this and apologize. In general, this will be a lesson for her: a lesson in acknowledging her wrong, and a lesson in humility. The beginning of a long journey of working on oneself, which will allow Pidge to finally realize herself not only professionally, but also personally. It’ll allow her to stop repelling the world, accept it, and learn to swim with everyone in a single stream of the river called “life”.
After all, green is the color of life. As well as blue.
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arnorcttos · 5 years
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( ludovico tersigni + 22 + muse 59 ) isn’t that apollo amoretto over there? i heard HE joined faction: nomads after they got back to west ham. it’s funny, ‘cause they were only on the service trip to terrorize his peers. hopefully they fit in there – they’re ADROIT, but also INDELICATE. oh, i’m sure they’ll be fine. ( james, she/they, 20, EST )
okay hi i’m james and this is my baby apollo, who is actually a brand new spankin’ muse of mine so !! we’ll see how this goes b/c i’ve literally never rp’d him before !! and i’ll b frank. his background is inspired by logan in veronica mars. sue me. actually don’t i’m already in college debt but sudfjkfg PLEATHE plot w/ him. leave a like. two likes. that’s not even possible. i may change his fc in the future b/c like ... i’m currently making his gif icons as i go and to b frank ,,, it’s rly hard sdjfkgh but i love him. so we’ll see. sdjnfkmgh
TRIGGER WARNING - DEATH, MURDER, MENTAL HEALTH ISSUES, DOMESTIC VIOLENCE
a e s t h e t i c s
fingers across keyboards and piano keys, m&m’s scattered, vintage gaming consoles and tangled wires, worn vans and broken skateboards, banging of drums and splintering drumsticks, deep rhythms beating with your heart, the hum of a hefty computer and the buzz of a monitor, green text against black screens, unruly hair unkempt, flannels filling closets, bloody baseball bats, posters lining up and down walls, loud punk music shaking the walls, glares and whispers, the suffocation that comes with loneliness, pills rattling in their bottles, unmade beds.
general info !!
full name: apollo casimir amoretto
nickname(s): caz, polly, lover boy, 2000 (b/c of his screen names lmaoo)
b.o.d. - january 31st, aquarius boi
label(s): the escapist, the hellion, the insurgent, the netizen, etc. etc.
height: hitting 6′0″
hometown: west ham, kansas !
sexuality: bi...? fucking. it’s pride month ofc he’s bi.
his stats are TBD but his pinterest is HERE !
biography !!
cristian amoretto and camilla silvestri had a romance that could be described turbulent at best, and down right explosive at worst
cristian, a native italian actor whose career began before he could walk, and camilla, the daughter of two italian immigrants with big dreams in a small town, met on the set of a coffee shop. their love story began quickly, dating within only a few months of knowing each other and engaged before the year was up
camilla walked down the aisle 6 months pregnant with lil’ baby apollo, who was then born in west ham, kansas, aka the town that camilla’s family had settled in
was raised primarily by his mother and grandparents! his father was often off shooting movies, leaving camilla to take on the role of stay-at-home mom despite her own dreams of making it big as an actress
apollo grew up as a huge momma’s boy -- i mean, god, he just really loved this mother, y’know? his relationship with his father was much rockier because of his ... lack of being around.
when his grandparents died around the age of eight, that’s when things got...worse. it felt as if camilla’s parents were the only barrier between camilla and cristian’s budding wrath.
it became more apparent that cristian was not meant for the family life, his anger quick and his fists quicker, stinging words and venomous glares. a control freak who couldn’t handle camilla being an independent woman.
this wasn’t apparent to the neighbors, or much of the town in general, because the amorettos were such a prominent family up in their mini-mansion in oak ridge -- it was hard to imagine that their life was anything but exquisite and dreamlike.
this was, of course, up until camilla filed for divorce and a restraining order in the same day, face bruised and nearly unrecognizable. she, obviously, got custody of apollo.
at this point in time, apollo was fourteen and...pretty stoked for them to get away from his father. they holed up in southside and life continued as normal. for the time being. gossip swarmed apollo at school surrounding the circumstance which was annoying, to say the least. it led to him becoming withdrawn from the other students, not getting the whole ... gossip appeal.
in hindsight, they should’ve moved out of west ham. death threats in the form of letters and the eerie feeling of eyes constantly being on them came to a halt on apollo’s graduation day: the day that his father also, coincidentally, murdered his mother.
for making me miss out on years of my son’s life, was cristian’s excuse as he was escorted from the bloody crime scene at their apartment and into the police car.
obviously, cristian was convicted and sentenced to prison. apollo still has dreams about testifying in court against his father.
and then apollo became known not as the son of two celebrities, but the son of a murderer. total bummer !
became even more withdrawn and almost dropped out of college a few good times! the only thing that kept him rooted to west ham was his band.
and now he can’t leave, and he’s surrounded by people who all look at him weird and he feels like they’re all expecting him to be like his father, and he’s not, but god -- when people expect you to be one way, it’s so hard to act otherwise. it’s just not a good time !
pretty much why he went on the service trip tbh ... like, y’know ... if ppl want to believe that he’s just as bad as his dad then damn ! he was gonna wreck sm havoc on the trip, just being an absolute nuisance. 
personality !!
his main focuses are computers / video games, drums / his band, and like ... skating ... vaping ... gamer things, y’know.
from a young age he’d always been very fascinated by video games, and being the Rich Boi (tm) that he was, ended up with a whole lot of them to play, on a whole bunch of consoles.
but like ... he’s a PC guy :/ he may have a super rare nintendo 64 console or two but nothing can beat his dual-monitor set up with his hand-build computer !
he also got real into hacking, y’know, just small things like watching security cameras in different cities and occasionally changing his grades b/c like ... who wouldn’t ? also ... cheated in dark souls. fucking loser.
his favorite games to play were always multiplayer games online like WoW and overwatch so !! he’s pretty fucking mad he can’t play them anymore. like. so mad. genuinely furious. he’s been trying to hack his way into like ... wifi or something dumb, ever since they got stranded in new west ham, but he’s had no luck !
he joined a band in high school because he was angsty and young, and like, turned out to be really good on drums ?? they had like ... some real big jimmy eat world / green day / say anything / old school fall out boy vibes. just a whole bunch of ‘fuck the government, fuck the authority, anarchy, rebellion, revolt revolt revolt’ angry rock music that got a buuunch of noise complaints during practice.
his role in the band was essentially the ~nerdy~ one, because he was a gamer, but like he was also Edgy and Angry and wore all black like Constantly (he still does who are we kidding)
probably paints his nails black and has a nose ring b/c gamers can be edgy too !!
huuuuuge junk food junkie. like ... he will consume Everything and Anything unhealthy. has a huge sweet tooth, he can’t remember the last time he’s drank straight up water.
but like ... he’s a loner pretty much. only friends he really bothered keeping were his bandmates and like ! half of them went missing along with the rest of the town so ! he’s feeling a lil’ lost
but not lost enough to do Nothing, y’know ?? coming back to west ham to an empty town awoke his little baby survivalist in him, probably due to a lot of survival games he played online, and he immediately took over his old home in oak ridge ! it was pretty much rotting there with his dad in jail, but not anymore !!
has also probably broken into a few homes already tbh b/c he’s just. ruthless. impulsive. if it feels like the end of the world then he’s yolo’ing, he’s peace-ing out, u cannot stop him.
uuhhh so he’s got this fucking...pomsky, right? her name is tulip. she was camilla’s before she passed away and like, what is apollo gonna do, huh ? put the dog in a shelter ? hell fucking nah. that’s his dog now.
unfortunately tulip isn’t the most .... tough looking dog. apollo set up a bunch of fucking speakers around the property of his dad’s house and plays large barking noises whenever somebody gets too close, just to ward off intruders, but like ... there’s no fucking big dogs man. it’s just apollo and tulip.
this isn’t like a Personality Trait but idk where to put it so ! apollo’s on antidepressants b/c like ... y’know ... the whole dad-murdering-mom thing sort of fucked him up a lot ! they make him feel pretty blah and diminished his sex drive so like ... hook ups aren’t really an option for him atm !
besides that he smokes a lot of weed b/c self medication
he’s ... sort of an asshole. like ... he can be rude and he doesn’t have much of a filter and i don’t know if there’s any softness left to him ! he just really misses his mom and his bandmates and has a lot of wishes involving changing the past and he reacts badly to things because he’s so defensive and on edge constantly.
he misses twitter the most, tho.
no but he’s just like. .. sad gamer boi ... a man and his dog ... who also carries like five knives on him and definitely knows where his dad kept his gun.
like he’s not socially awkward or necessarily Bad with people .. he’s just bad with people :/ doesn’t try hard enough ! is a little too apathetic ! chaotic to true neutral
wanted connections !!
i envision his band to have like ... four or five members including him. two guitar electric guitar, one bass, one drums / keyboard, any of them singing idk that’s not important. and since two of them have Disappeared, i’d like the One (or two) that Remains ! anarchy boys !
generally .. anybody else who is tryn to survive, that maybe he can bond with or completely clash with ??
i’d love enemies, just ppl he Refuses to get along with or they are just on bad terms for whatever reason
people he’s trying to not ! not get along with ! but it just doesn’t work out b/c like ... lbr, apollo’s pretty bad with other people.
just any falling outs.
uuhh ... maybe a few somewhat-friendships ! like... awkward acquaintances
ppl he knew primarily from high school / haven’t spoken to since
maybe one or two ppl who’s soft towards him or he’s soft towards or vice versa b/c like ! i’ll b real .. it’s pretty nice to have !
ex-flings, ex-somethings, ex-gfs, bfs, anything from the past.
hookup gone bad b/c he couldn’t get it up b/c antidepressants be like that (this is based off of a true story can we get a sad yeehaw in here)
gaming pals from before no wifi.
skater buds. vaping buds. b/c i can confirm that apollo owns like three juuls. stoner buds.
someone he’s like ... hesitantly forming an alliance with b/c sometimes it’s easier when you have someone on ur team ! b/c then drama when one of them betrays the other uwu
somebody trying 2 break into his house b/c u Know it’s got some good shit in there but he’s just like ‘alexa play dogs barking audio’ and then ur muse is like ... there’s no fucking dogs
juul pod dealer. that’s all.
i’m down for anything rly !! pleathe hmu !!
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lilacskyent-blog · 5 years
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Breakfast with Alex Wex
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People have a million opinions and false facts about the digital world we live in today, and even more about social media. For a lot of people, they use platforms like Instagram and Twitter to follow celebrities, and some use it to bully celebrities. Most forget that that connection can also be used for good. We live in a world of amazing accessibility and, when used properly, could foster a wonderful connection between people. A prime example of this is the Will Smith Jump event that took the internet by storm, that all started with a video message. It’s incredible what can happen when you reach out to people. That was the main thought in my mind before sitting down with Alex Wex yesterday. Alex Wex is an amazing Twitch streamer, and until recently, was a producer for FBE and REACT on Youtube. As of this interview, Alex Wex has fostered a wonderful community through Twitch and Discord known as the Jank Squad, and recently broke his view count record at 210 viewers for his birthday stream, also hitting close to 600 subscribers. Given that I was in Atlanta and he was in LA we couldn’t actually meet for breakfast like I usually do so we had an amazing video chat instead.
So for starters, I just want to thank you for sitting down with me. I’ve been following your work since I first saw you on FBE and I think you’re an awesome dude so thanks. I wanna start at the very beginning because I’m really interested in your story. So, I know you went to high school in Atlanta, GA. What can you tell me about that?
I was actually born in Manhattan, my family moved to Atlanta around pre-K and I lived there up until I graduated from Riverwood High School. All my friends wanted to go to UGA or Georgia Tech but I was really interested in traveling and branching out, so I went to Ohio for college, and now I live in L.A. I made some truly amazing friends in Atlanta, and having this kind of east coast, south culture mixture has made life pretty interesting.
When did you know you wanted to work in entertainment, and what led to you becoming a producer?
When I was a kid, my family liked to record family videos, and I always wanted to see the recording. I had the eye for production pretty early. Once I started high school I got involved in performing, did Grease, The Wiz, and a few other school plays that got me interested in the performance aspect as well. In college, I majored in video production with a minor in film and sociology so I gained real knowledge of the art that happens behind the camera.
How does one go from school in Atlanta to working at FBE?
As I mentioned before I went to college at Ohio University, what got me was their video production department. I actually still work with the head of the department and speak to the alumni when they come here, advising them on some dos and don'ts. As a graduation gift, my Dad gave me an all expense paid trip to anywhere I wanted to go in the U.S for a few days and I chose L.A. So I was here, hanging out with my current roommate Johnny and we just decided to come out here permanently and live the dream. So I packed up my car and drove from Atlanta to LA and started looking for internships while working at Chipotle.I first joined FBE as an intern, then got hired as a PA and eventually was a writer for some of their scripted shows, and I worked my way up until I was offered the producer position. I loved producing because that involved every aspect of working behind the camera, from writing to filming to editing and seeing the baby from birth to fully grown. Being in front of the camera came back when FBE launched the community team and started streaming on Twitch.
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Watching Alex grow on YouTube, putting reactors in hilarious challenges, eat crazy concoctions and brave some insane hot sauces that would make Sean Evans proud, his personality radiates through the screen. His passion for both sides of the camera is clear in the quality of every video he makes. However, taking part in one of his Twitch streams gives you an even more full experience. It’s like the difference between a teaser trailer and a full film.
Freddy or Jason?
Freddy is my favorite in Dead By Daylight but I love Jason, in fact, Friday the 13th was the first game I ever streamed. I’d have to say, Jason.
So, we were in high school in the baby years of YouTube, I mostly used it for music videos and anime, I think back then I only followed Phil Defranco and Timothy Delaghetto consistently. Back then, did you ever look at YouTube and think “this is going to revolutionize the world and turn traditional media on its head?”
Yeah, it’s changed everything. Almost every network has a YouTube channel now. Late night shows and things like SNL upload segments that get massive amounts of views. YouTube is still growing, testing out its premium service and channel enrollment and things like that, but it’s exciting to see where it’s going to end up.
It’s even crazier when you think about how much Twitch has already changed the game.
Definitely, I mean we’ve seen what happens when some of the top YouTube creators come over to Twitch and realize that it’s completely different from what they’re used to. It’s more like an improv radio show, you have to be on for two or three hours and avoid dead air, rather than being able to edit something together. It’s hard to be constantly entertaining when you're used to delivering a finished edit rather than a live audience. For example, Logan Paul had over 100,000 people in his first stream but after that, the numbers dropped just cause that’s not his world. Live Streaming is a constant conversation. It’s the opposite of YouTube.
I remember seeing YouTubers flood to Twitch after the adpocalypse and feeling like it made no sense. A lot of vloggers and creators who never expressed any interest in video games were all suddenly obsessed with Fortnite. However, when people like Alex Wex came to Twitch they brought genuine love of gaming, skill, and a great sense of community.
What insight can you give into the world of a producer? Especially on the internet, how to figure out what videos are gonna get views or go viral?
It’s a case by case basis depending on what you make. With Challenge Chalice, we made it during the high point of internet challenges and we had consistent challenges to make content with constantly, but this past year challenges have kinda quieted down so that got more difficult. We revisited and revised a lot of earlier challenges to make them more interesting, and that has to do with being present during every step of the process. You can’t slack off on anything, from script to editing. Being organized is key, and definitely take on the ideas and criticisms of the people working with you. Be flexible and open-minded. It’s not about balance, it’s about harmony.
3 Breakfast must haves?
Bacon
Grits
Belgian Waffles are incredible
Hack-n-slash? RPG? Or FPS? And why?
That’s complicated. Overwatch is one of my favorite games but it doesn’t play exactly like an FPS. For me, hack-n-slash for games like Dead Cells, Rogue Lights, I love games with massive replay value. I’m playing Diablo 3 on switch right now and I love it.
What games are best for streaming? Does the game you play matter?
A little, but it shouldn’t be everything. You want your audience to gravitate towards your personality. Never play something you don’t enjoy playing. I love Overwatch and it’s not one of the current hot stream games but I love playing it. Story games are complicated. If people miss parts of story mode games they tune it out cause they won’t know what’s going on. More than anything put your own spin on what you’re doing. For example, when I do Dead By Daylight I do stream vs chat where my chat helps the survivors escape if I’m playing the killer. In fact, chatting streams are starting to really blow up. It’s more about the person playing than the game they play.
What game has you hype for 2019?
That’s tough, but probably Kingdom Hearts 3. I’m excited for Smash Bros for my last game of 2018 too.
What led you to Twitch?
I’d seen some of it, but Tom had been doing it for 6 months and kept suggesting it until one day I finally did. I had a decent setup with an ultra-wide monitor and Tom’s old video capture device and I started streaming Dead by Daylight. We actually came into the name Jank Squad because of how janky the streams were in the beginning.
What led you to leave FBE and what are you working on now?
I wanted to focus more on my Twitch, and it was exhausting streaming at work on the days when I’m also streaming at home. I wanted to give my audience the most energy I could and be more involved with them as a community. I’m creating new ways to interact with my audience, more active in my Discord, and after working there for 5 years I felt stuck. There wasn’t any new learning experience and things felt a little sour and monotonous with the new direction things were going in. I’m actually getting a new camera and a green screen to upgrade the stream quality. I’d love to make partner with Twitch.
What’s the dream?
I take things to step by step. I’m definitely in a transition right now. I’m looking for another good full-time job at the moment. I’d love to be a full-time streamer but I’d also love to produce my own stuff and then stream after work. Streaming is probably one of the most consistent things I’ve ever done. Funny enough, that’s part of what got me into it cause Tom knew my leisure activity was video games, and streaming just takes that to another level. It definitely takes work, but the community you foster on this platform is unlike any other with the rating system and how everything is set up.
Alright so the zombie apocalypse is upon us and you can have 1 mortal character, one god tier video game character, and one Reactor in your survival squad, who you got?
Kratos from God of War 2 causes his chain blades would tear through everything, my regular would be Leon from Resident Evil 4 cause his aim is amazing and he’s used to zombies, and my Reactor would be Chelsea cause she knows so much about The Walking Dead. That’s my squad.
East Coast or West Coast
East, it’s where I was born and bred.
Top 10 songs or artists on your playlist right now?
Meek Mill- Intro with the amazing Phil Collins sample
Tyler the Creator’s Grinch is great for the holidays
The Cool-Lupe Fiasco
Chance The Rapper’s new songs
Paramore- Ain’t It Fun
You come from the same city I did with only a two year age difference, and you’re the first brown face I saw in relation to FBE and now you’re killing it on Twitch. Do you know how dope you are?
I appreciate that. I like to think I’m dope in some ways but I also do my best to keep it real, keep myself humble, and not letting the numbers get to my head. I hope everyone thinks they’re fucking awesome, cause they are. I have my good and bad days but I like to look at what has been built and keep grinding. Everyone is on a different time stream. I don’t want to rush things, I’m on my own path, and right now I just wanna build this community.
I for one, am excited to see what comes next from Alex Wex, including his stream later this week. You can find him @ItsMrWex
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-Strawberry Smirk of Lilac Sky Entertainment
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lauramalchowblog · 4 years
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Can Startups Save Primary Care?
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By ANDY MYCHKOVSKY
Today, primary care is considered the bee’s knees of value-based care delivery. Instead of being viewed as the punter of the football team, the primary care physician (PCP) has become the quarterback of the patient’s care team, calling plays for both clinical and social services. The entire concept of the accountable care organization (ACO) or patient-centered medical home (PCMH) crumbles without financially- and clinically-aligned PCPs. This sea change has resulted in rapid employment or alignment to health systems, as well as a surge in venture capital being invested into the primary care space.
Before we get too far in the weeds, let’s first begin with the definition of primary care. The American Academy of Family Physicians (AAFP) defines a primary care physician as a specialist typically trained in Family Medicine, Internal Medicine, or Pediatrics. Some women do use their OB/GYN as their PCP, but these specialists are not traditionally considered PCPs. Now if you’ve gone to your local PCP and noticed that your care provider is not wearing a white coat with the “MD” or “DO” credentials, you are either receiving treatment from a hipster physician, nurse practitioner (NP), or physician assistant (PA). Two of the three professionals are trained in family medicine and can provide primary care services under the responsibility of an associated PCP. At least one of the three has a beard.
The crazy thing is, despite the industries heightened focus on the importance of PCPs, we’re still expecting a shortage of primary care providers. In April 2019, the Association of American Medical Colleges (AAMC) released a report estimating a shortage of between 21,100 and 55,200 PCPs by 2032. Given we just passed 2020, this not that far off. The primary reason for the shortage is the growing and aging population. Thanks mom and dad. Digging into the numbers will really knock your socks off, with the U.S. Census estimating that individuals over the age of 65 will increase 48% over that same time period. Like a double-edged sword, the issue is not just on the patient demand side though. One-third of all currently active doctors will be older than 65 in the next decade and could begin to retire. Many of these individuals are independent PCPs who have resisted employment by large health systems.
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Now the easiest solution would be to wave a magic wand and dramatically increase the supply of medical students selecting primary care versus other specialties. However, in the absence of any Hogwarts-trained healthcare enthusiasts, we have to face the realities of today’s medical school situation. 75% of medical school students in the class of 2018 graduated with student debt, with the average loan debt of $196,520. With that loan balance, you’d owe approximately $2,212 a month on a standard, 10-year federal repayment plan. If you compare that with the earning potential, pediatrics and family medicine are consistently among the lowest paid specialties. According to Medscape, in 2019 PCPs earned an average of $237,000, while specialists earned an average of $341,000. That is a big difference. This all despite the fact that according to a Merritt Hawkins report estimating PCPs generated $2.1 million for their affiliated hospitals in the previous 12 months. This referral value to the hospital even exceeded Otolaryngology ($1.9 million), despite the fact the average annual physician compensation for an Otolaryngologist is $471,000.
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The other important characteristic that healthcare economists and researchers have closely monitored is increase in hospital employment and alignment of PCPs versus physicians who own their own independent practices. The fear being that employed PCPs have the potential to refer testing, therapies, and services back to the mothership hospital, as opposed to independent specialists, labs, ambulatory surgical centers, or imaging centers. These hospitals charge considerably higher professional and facility fees, particularly for commercially insured patients. The crazy part of value-based care is that some of the clinically integrated network (CIN) provisions and waivers associated with primary care allow hospitals to align networks of independent PCPs and ensure they receive much higher negotiated rates. Aligning PCP networks to highly motivated and sophisticated health systems who are actively involved in significant downside risk contracts has clear benefits, but the potential for inefficiency and shoring up referral patterns does exist.
Now back to the world of healthcare startups as they relate to primary care. I’ve said it before and I’ll say it again, the successful One Medical (NASDAQ: ONEM) IPO was the single best thing for primary care startups. Yes, they focus on a particular clientele (commercially insured in urban markets). Yes, they are charging a $199 annual fee for access to their care that many Americans cannot afford. Yes, they will likely grow revenue through higher volume and negotiated reimbursement contracts by partnering with health systems, referred to as health networks. However, 3 weeks after the IPO, the company maintains a market valuation cap of $2.8 billion with nine months of net revenue equaling $199 million and $34 million is losses during the same time period. That is impressive and should be encouraging for current PCP startups.
Tumblr media
There are a ton of other primary care focused startups and companies that should not be overshadowed. Each takes on a slightly different approach, whether they focus on a specific population (e.g., Medicare Advantage), actually employ physicians themselves, or serve as administratively- and clinically-aligned vendors for networks of PCPs. I strongly believe in the value of these organizations using technology-driven communication, remote monitoring, home care, and intensive wrap-around care management services for complex populations to offer a new model of care.
If there was ever a downside for creating the primary care-led revolution towards value-based care, I believe it would be the production of charlatans claiming to “primary care consultants” or point-solutions that only affect a sliver of the problem. I see lots of claims related to SAAS startups who utilize an AI-based, machine learning analytics program that spits out a list of high-risk patients. After many years trying to squeeze clinical and financial value out of total-cost-of-care models, that is no longer enough. In my opinion, PCPs should seek partners who can not only provide technology, but also have clinical resources and are willing to stand by their performance in terms of compensation. No guaranteed PMPMs if performance doesn’t add measurable and definitive value, unless the organization is willing to take downside risk exposure. They also need to help your PCP organization understand how to set the rules of the game in your advantage. Otherwise, you will never win regardless of performance (e.g., trend rates, minimum savings thresholds, rebasing, shared savings, etc.).
Now I’m not claiming I know everything, but my experience was borne out of helping health systems and physician groups across the country manage total-cost-of-care contracts in Medicare fee-for-service (FFS), Medicare Advantage, Commercial, and Medicaid managed care while at Evolent Health. For those unaware, Evolent Care Partners is a solution focused on enabling independent PCPs with the capital and resources needed to participate and succeed within two-sided contracts. In addition to Evolent Health, there are a bunch of other primary care startups that I appreciate. They did not pay me (although I should’ve asked before), but here are a few startups that I would research before thinking about primary care in a value-based care world.
One Medical: Provider for Commercial
Iora Health: Provider for Medicare
Oak Street Health: Provider for Medicare
ChenMed: Provider for Medicare
Privia Health: Population health management partner for primary care
VillageMD: Population health management partner for primary care / provider
Aledade: Population health management partner for independent primary care
At the end of the day, primary care still receives a pitiful amount of the total spend in healthcare. The best estimates believe only 5-7% of healthcare spending devoted to primary care. In a RAND Corporation study, researchers predicted 2.12-4.88% of total Medicare fee-for-service medical and prescription drug spending. However, the power of referral, care management, and addressing the social determinants of health (e.g., housing, food, transportation, etc.) holds the promise of a better tomorrow. I am hopeful that the trends over the past few years will continue and new startups will be developed that further innovate on the $260 billion primary care market in the U.S..
Andy Mychkovsky is the creator of Healthcare Pizza, where this article first appeared.
The post Can Startups Save Primary Care? appeared first on The Health Care Blog.
Can Startups Save Primary Care? published first on https://venabeahan.tumblr.com
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kristinsimmons · 4 years
Text
Can Startups Save Primary Care?
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By ANDY MYCHKOVSKY
Today, primary care is considered the bee’s knees of value-based care delivery. Instead of being viewed as the punter of the football team, the primary care physician (PCP) has become the quarterback of the patient’s care team, calling plays for both clinical and social services. The entire concept of the accountable care organization (ACO) or patient-centered medical home (PCMH) crumbles without financially- and clinically-aligned PCPs. This sea change has resulted in rapid employment or alignment to health systems, as well as a surge in venture capital being invested into the primary care space.
Before we get too far in the weeds, let’s first begin with the definition of primary care. The American Academy of Family Physicians (AAFP) defines a primary care physician as a specialist typically trained in Family Medicine, Internal Medicine, or Pediatrics. Some women do use their OB/GYN as their PCP, but these specialists are not traditionally considered PCPs. Now if you’ve gone to your local PCP and noticed that your care provider is not wearing a white coat with the “MD” or “DO” credentials, you are either receiving treatment from a hipster physician, nurse practitioner (NP), or physician assistant (PA). Two of the three professionals are trained in family medicine and can provide primary care services under the responsibility of an associated PCP. At least one of the three has a beard.
The crazy thing is, despite the industries heightened focus on the importance of PCPs, we’re still expecting a shortage of primary care providers. In April 2019, the Association of American Medical Colleges (AAMC) released a report estimating a shortage of between 21,100 and 55,200 PCPs by 2032. Given we just passed 2020, this not that far off. The primary reason for the shortage is the growing and aging population. Thanks mom and dad. Digging into the numbers will really knock your socks off, with the U.S. Census estimating that individuals over the age of 65 will increase 48% over that same time period. Like a double-edged sword, the issue is not just on the patient demand side though. One-third of all currently active doctors will be older than 65 in the next decade and could begin to retire. Many of these individuals are independent PCPs who have resisted employment by large health systems.
Tumblr media
Now the easiest solution would be to wave a magic wand and dramatically increase the supply of medical students selecting primary care versus other specialties. However, in the absence of any Hogwarts-trained healthcare enthusiasts, we have to face the realities of today’s medical school situation. 75% of medical school students in the class of 2018 graduated with student debt, with the average loan debt of $196,520. With that loan balance, you’d owe approximately $2,212 a month on a standard, 10-year federal repayment plan. If you compare that with the earning potential, pediatrics and family medicine are consistently among the lowest paid specialties. According to Medscape, in 2019 PCPs earned an average of $237,000, while specialists earned an average of $341,000. That is a big difference. This all despite the fact that according to a Merritt Hawkins report estimating PCPs generated $2.1 million for their affiliated hospitals in the previous 12 months. This referral value to the hospital even exceeded Otolaryngology ($1.9 million), despite the fact the average annual physician compensation for an Otolaryngologist is $471,000.
Tumblr media
The other important characteristic that healthcare economists and researchers have closely monitored is increase in hospital employment and alignment of PCPs versus physicians who own their own independent practices. The fear being that employed PCPs have the potential to refer testing, therapies, and services back to the mothership hospital, as opposed to independent specialists, labs, ambulatory surgical centers, or imaging centers. These hospitals charge considerably higher professional and facility fees, particularly for commercially insured patients. The crazy part of value-based care is that some of the clinically integrated network (CIN) provisions and waivers associated with primary care allow hospitals to align networks of independent PCPs and ensure they receive much higher negotiated rates. Aligning PCP networks to highly motivated and sophisticated health systems who are actively involved in significant downside risk contracts has clear benefits, but the potential for inefficiency and shoring up referral patterns does exist.
Now back to the world of healthcare startups as they relate to primary care. I’ve said it before and I’ll say it again, the successful One Medical (NASDAQ: ONEM) IPO was the single best thing for primary care startups. Yes, they focus on a particular clientele (commercially insured in urban markets). Yes, they are charging a $199 annual fee for access to their care that many Americans cannot afford. Yes, they will likely grow revenue through higher volume and negotiated reimbursement contracts by partnering with health systems, referred to as health networks. However, 3 weeks after the IPO, the company maintains a market valuation cap of $2.8 billion with nine months of net revenue equaling $199 million and $34 million is losses during the same time period. That is impressive and should be encouraging for current PCP startups.
Tumblr media
There are a ton of other primary care focused startups and companies that should not be overshadowed. Each takes on a slightly different approach, whether they focus on a specific population (e.g., Medicare Advantage), actually employ physicians themselves, or serve as administratively- and clinically-aligned vendors for networks of PCPs. I strongly believe in the value of these organizations using technology-driven communication, remote monitoring, home care, and intensive wrap-around care management services for complex populations to offer a new model of care.
If there was ever a downside for creating the primary care-led revolution towards value-based care, I believe it would be the production of charlatans claiming to “primary care consultants” or point-solutions that only affect a sliver of the problem. I see lots of claims related to SAAS startups who utilize an AI-based, machine learning analytics program that spits out a list of high-risk patients. After many years trying to squeeze clinical and financial value out of total-cost-of-care models, that is no longer enough. In my opinion, PCPs should seek partners who can not only provide technology, but also have clinical resources and are willing to stand by their performance in terms of compensation. No guaranteed PMPMs if performance doesn’t add measurable and definitive value, unless the organization is willing to take downside risk exposure. They also need to help your PCP organization understand how to set the rules of the game in your advantage. Otherwise, you will never win regardless of performance (e.g., trend rates, minimum savings thresholds, rebasing, shared savings, etc.).
Now I’m not claiming I know everything, but my experience was borne out of helping health systems and physician groups across the country manage total-cost-of-care contracts in Medicare fee-for-service (FFS), Medicare Advantage, Commercial, and Medicaid managed care while at Evolent Health. For those unaware, Evolent Care Partners is a solution focused on enabling independent PCPs with the capital and resources needed to participate and succeed within two-sided contracts. In addition to Evolent Health, there are a bunch of other primary care startups that I appreciate. They did not pay me (although I should’ve asked before), but here are a few startups that I would research before thinking about primary care in a value-based care world.
One Medical: Provider for Commercial
Iora Health: Provider for Medicare
Oak Street Health: Provider for Medicare
ChenMed: Provider for Medicare
Privia Health: Population health management partner for primary care
VillageMD: Population health management partner for primary care / provider
Aledade: Population health management partner for independent primary care
At the end of the day, primary care still receives a pitiful amount of the total spend in healthcare. The best estimates believe only 5-7% of healthcare spending devoted to primary care. In a RAND Corporation study, researchers predicted 2.12-4.88% of total Medicare fee-for-service medical and prescription drug spending. However, the power of referral, care management, and addressing the social determinants of health (e.g., housing, food, transportation, etc.) holds the promise of a better tomorrow. I am hopeful that the trends over the past few years will continue and new startups will be developed that further innovate on the $260 billion primary care market in the U.S..
Andy Mychkovsky is the creator of Healthcare Pizza, where this article first appeared.
The post Can Startups Save Primary Care? appeared first on The Health Care Blog.
Can Startups Save Primary Care? published first on https://wittooth.tumblr.com/
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cleopatrarps · 6 years
Text
Reliving a Deadly Day at a U.N. Compound in Mogadishu
The blast wave thundered through the compound, ripping the expletive on my lips in two and cramming half of it back down my throat. The radio-room supervisor, Hassan Osman, and I stumbled to the balcony. In that cathedral-quiet moment between the detonation of the car bomb and the staccato barrage of gunfire, we knew they were coming. Shabab militants were storming the compound, squeezing off bursts from the Kalashnikovs at their hips, leaping the gate’s smoking wreckage. It was June 19, 2013.
“Dewaine. Dewaine.” Hassan’s voice was steady, his hand on my shoulder. “Do the public announcement.”
Over the P.A., I instructed the several dozen United Nations staff members to duck and cover and then tried to figure out what to do next. With every rifle crack, my world flashed in a monochrome of stark, tactical decisions, like life and death reduced to their lowest common denominators. Even in the moment, the irony of stumbling into my first firefight more than a decade after leaving the Marine Corps was not lost on me. Since leaving the military, I’d grown used to my buddies shaking their virtual heads, via social media, at the fundamental insanity of inserting yourself into war without having the good sense to engage in combat.
Mogadishu was a study in violent coexistence, a brutal ecosystem where new conflicts sprouted up without ever quelling the old. The Somali capital’s recent history included warlords, the Islamic Courts Union, the Ethiopian military, the Shabab and a shaky Western-backed government. This attack on the United Nations Common Compound — 10,000 square meters split between offices and living quarters, just off Mogadishu’s airport road — felt like the city’s fiercest predator had finally decided to take our measure.
After the initial blast, our Somali guards immediately returned fire, dropping the first two Shabab gunmen who came through the breach. Between clipped radio transmissions from the African Union Mission and the Somali government, four more militants unhesitatingly charged over the bodies of their companions. The guards’ gunfire funneled the attackers onto the accommodation side of the compound.
Under cover of suppressive fire from the towers, several of the guards and I leapfrogged the buildings on the accommodation side to herd staff members to the safe rooms on the opposite end of the compound. Pulling back the bolt on the office Kalashnikov to reveal brass bolstered my courage before our mad dash through the compound, but it was the valor and tenacity of our Somali allies that actually saved lives.
Mogadishu left a permanent scratch on my heart, but talking about the attack remains difficult. I’ve never wanted to risk implying that I’d done more than I did, or to say what I really feared: that I hadn’t done enough. The Shabab murdered 15 civilians, aid workers and contractors at the compound that day, including four of our Somali guards.
In Mogadishu, I led a United Nations Department of Safety and Security office consisting of three other international field security coordination officers — a Russian, a Ugandan and a Bulgarian — and about 20 local advisers, drivers and radio operators. Save for an unauthorized Chinese-made Kalashnikov, purchased by one of my predecessors and handed down to every senior field security coordination officer since, we were armed with nothing more than our wits.
For armed security, we depended on a Somali-owned private security company and the host government, with whom we carried out United Nations program delivery — agriculture and sanitation projects, polio monitoring, shelter programs — in and around the city. Armed security arrangements with private companies tend to unnerve humanitarians, who rightly worry about violating the principles of their profession. But my four postings with the United Nations taught me that in areas of conflict you could have a clean humanitarian conscience or deliver aid, but rarely both. Despite the inherent tension between United Nations agencies and the armed entities they relied on, our security system in Mogadishu worked. My team got aid personnel to some of the toughest locations in and around the capital.
I fell right in with my Somali security counterparts. I chewed bitter khat, a leaf with effects similar to amphetamine, with these guys, screeched through Mogadishu’s 17 districts behind their escort vehicles, and kicked up red dust while waiting for them during prayer stops on the roads to towns so recently vacated by the Shabab that you might still find the militants’ dirty dishes in the sink. Colonized but never broken, the Somalis were a wiry, arrogant and daring people for whom friendship ran deep. For all of Somalia’s trouble, I met fewer dispirited men in Mogadishu than I did in Manhattan.
After the attack, the personnel based at the compound, including me and the other foreign staff members on my team, relocated to the United Nations’ main compound in Somalia on the sprawling grounds of Mogadishu international airport. Protected by Ugandan and Burundian troops, displaced internationals could now join the mission staff, hacks, military officers and contractors who converged at the United Nations Mine Action Service’s “Little Kruger Bar” — foreigners with faces crimsoned by alcohol and the sun, many of whom could spend the weeks in country without ever leaving the airport or speaking to a Somali.
The new mission in Somalia was officially established only two weeks before the attack and had barely started moving into the compound on the grounds of the Mogadishu airport. The United Nations’ only unified radio room in Mogadishu — which maintained contact with its humanitarian and development convoys throughout the area — remained at our now-abandoned compound. I knew I couldn’t ask Hassan and his fellow radio operators to return to work at the hollowed-out buildings of an organization that the Shabab claimed were thwarting “Allah’s Law on earth & must therefore be dislodged.” But when I conducted my morning radio check from within the airport grounds the next day, it was Hassan’s voice that responded.
“Sierra 1, this is Mike Sierra Base, you’re five by five.”
In “War Games: The Story of Aid and War in Modern Times,” the journalist Linda Polman says that “the job of humanitarian aid worker is No. 5 on the Top 10 list of dangerous occupations, after lumberjack, pilot, fisherman and structural iron- or steelworker. It’s the only job on the list where most of the fatalities are caused by intentional violence.” From Chechnya to Dadaab refugee camp to Mogadishu to Gaza, I consistently found that most of this risk is borne by local staff — the polio-vaccination monitors, the convoy drivers, the project officers, the guards and the radio operators — who make up the backbone of international aid organizations.
Yes, the average international aid worker in Somalia is there to do good, but also (whether admittedly or not) for the buzz of life in a conflict zone. We decided to leave our own countries to be in Mog, were paid good money to be there and had our careers enhanced as a result. The risk for someone like Hassan — paid a fraction of our salaries in the town where all his family lived and the entire community knew he worked for the United Nations — differed on a galactic scale. Born and raised in Mogadishu, Hassan drew from the same wellsprings of hope and despair as the militants who rushed into certain death at the compound. But there are no Gettysburgs or Omaha Beaches for people like him — no heroic charge with his comrades by his side — nor even a decisive Alamo-style defeat. Nevertheless, men like Hassan resolve to endure.
As weeks turned into months, Hassan never mentioned that he reported to work every day in the place the foreign staff had evacuated. Or how the United Nations field operations that couldn’t discontinue without people dying would cease if not for his crew’s tracking our convoys and keeping our communications running. They knew the risk of working in the highly exposed compound of an organization that the Shabab referred to as “a merchant of death & a satanic force of evil.” Hassan and his crew exhibited grace under the most dangerous of circumstances and never felt the need to bring it up. I guess danger ceases to be an interesting topic after you’ve committed to facing it.
Occasionally, something — unexpected fireworks or the pressure wave from subwoofers at a concert — thrusts me back into that day, five years gone. When it happens, I crowd out the image of Shabab fighters storming our compound with those of Hassan and the other Somalis I worked with in Mogadishu, women and men who exemplified Plato’s definition of courage, “endurance of the soul.”
Courage is more than the charge.
Dewaine Farria is a former Marine and present M.F.A. candidate at the Vermont College of Fine Arts who served as a United Nations field security officer in East Jerusalem, Somalia, Kenya and the Russian North Caucasus. He received the United Nations Department of Safety and Security’s Bravery Award for his actions during the attack in Mogadishu.
Sign up for our newsletter to get the best of The New York Times Magazine delivered to your inbox every week. For more coverage of conflict, visit nytimes.com/atwar.
The post Reliving a Deadly Day at a U.N. Compound in Mogadishu appeared first on World The News.
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dragnews · 6 years
Text
Reliving a Deadly Day at a U.N. Compound in Mogadishu
The blast wave thundered through the compound, ripping the expletive on my lips in two and cramming half of it back down my throat. The radio-room supervisor, Hassan Osman, and I stumbled to the balcony. In that cathedral-quiet moment between the detonation of the car bomb and the staccato barrage of gunfire, we knew they were coming. Shabab militants were storming the compound, squeezing off bursts from the Kalashnikovs at their hips, leaping the gate’s smoking wreckage. It was June 19, 2013.
“Dewaine. Dewaine.” Hassan’s voice was steady, his hand on my shoulder. “Do the public announcement.”
Over the P.A., I instructed the several dozen United Nations staff members to duck and cover and then tried to figure out what to do next. With every rifle crack, my world flashed in a monochrome of stark, tactical decisions, like life and death reduced to their lowest common denominators. Even in the moment, the irony of stumbling into my first firefight more than a decade after leaving the Marine Corps was not lost on me. Since leaving the military, I’d grown used to my buddies shaking their virtual heads, via social media, at the fundamental insanity of inserting yourself into war without having the good sense to engage in combat.
Mogadishu was a study in violent coexistence, a brutal ecosystem where new conflicts sprouted up without ever quelling the old. The Somali capital’s recent history included warlords, the Islamic Courts Union, the Ethiopian military, the Shabab and a shaky Western-backed government. This attack on the United Nations Common Compound — 10,000 square meters split between offices and living quarters, just off Mogadishu’s airport road — felt like the city’s fiercest predator had finally decided to take our measure.
After the initial blast, our Somali guards immediately returned fire, dropping the first two Shabab gunmen who came through the breach. Between clipped radio transmissions from the African Union Mission and the Somali government, four more militants unhesitatingly charged over the bodies of their companions. The guards’ gunfire funneled the attackers onto the accommodation side of the compound.
Under cover of suppressive fire from the towers, several of the guards and I leapfrogged the buildings on the accommodation side to herd staff members to the safe rooms on the opposite end of the compound. Pulling back the bolt on the office Kalashnikov to reveal brass bolstered my courage before our mad dash through the compound, but it was the valor and tenacity of our Somali allies that actually saved lives.
Mogadishu left a permanent scratch on my heart, but talking about the attack remains difficult. I’ve never wanted to risk implying that I’d done more than I did, or to say what I really feared: that I hadn’t done enough. The Shabab murdered 15 civilians, aid workers and contractors at the compound that day, including four of our Somali guards.
In Mogadishu, I led a United Nations Department of Safety and Security office consisting of three other international field security coordination officers — a Russian, a Ugandan and a Bulgarian — and about 20 local advisers, drivers and radio operators. Save for an unauthorized Chinese-made Kalashnikov, purchased by one of my predecessors and handed down to every senior field security coordination officer since, we were armed with nothing more than our wits.
For armed security, we depended on a Somali-owned private security company and the host government, with whom we carried out United Nations program delivery — agriculture and sanitation projects, polio monitoring, shelter programs — in and around the city. Armed security arrangements with private companies tend to unnerve humanitarians, who rightly worry about violating the principles of their profession. But my four postings with the United Nations taught me that in areas of conflict you could have a clean humanitarian conscience or deliver aid, but rarely both. Despite the inherent tension between United Nations agencies and the armed entities they relied on, our security system in Mogadishu worked. My team got aid personnel to some of the toughest locations in and around the capital.
I fell right in with my Somali security counterparts. I chewed bitter khat, a leaf with effects similar to amphetamine, with these guys, screeched through Mogadishu’s 17 districts behind their escort vehicles, and kicked up red dust while waiting for them during prayer stops on the roads to towns so recently vacated by the Shabab that you might still find the militants’ dirty dishes in the sink. Colonized but never broken, the Somalis were a wiry, arrogant and daring people for whom friendship ran deep. For all of Somalia’s trouble, I met fewer dispirited men in Mogadishu than I did in Manhattan.
After the attack, the personnel based at the compound, including me and the other foreign staff members on my team, relocated to the United Nations’ main compound in Somalia on the sprawling grounds of Mogadishu international airport. Protected by Ugandan and Burundian troops, displaced internationals could now join the mission staff, hacks, military officers and contractors who converged at the United Nations Mine Action Service’s “Little Kruger Bar” — foreigners with faces crimsoned by alcohol and the sun, many of whom could spend the weeks in country without ever leaving the airport or speaking to a Somali.
The new mission in Somalia was officially established only two weeks before the attack and had barely started moving into the compound on the grounds of the Mogadishu airport. The United Nations’ only unified radio room in Mogadishu — which maintained contact with its humanitarian and development convoys throughout the area — remained at our now-abandoned compound. I knew I couldn’t ask Hassan and his fellow radio operators to return to work at the hollowed-out buildings of an organization that the Shabab claimed were thwarting “Allah’s Law on earth & must therefore be dislodged.” But when I conducted my morning radio check from within the airport grounds the next day, it was Hassan’s voice that responded.
“Sierra 1, this is Mike Sierra Base, you’re five by five.”
In “War Games: The Story of Aid and War in Modern Times,” the journalist Linda Polman says that “the job of humanitarian aid worker is No. 5 on the Top 10 list of dangerous occupations, after lumberjack, pilot, fisherman and structural iron- or steelworker. It’s the only job on the list where most of the fatalities are caused by intentional violence.” From Chechnya to Dadaab refugee camp to Mogadishu to Gaza, I consistently found that most of this risk is borne by local staff — the polio-vaccination monitors, the convoy drivers, the project officers, the guards and the radio operators — who make up the backbone of international aid organizations.
Yes, the average international aid worker in Somalia is there to do good, but also (whether admittedly or not) for the buzz of life in a conflict zone. We decided to leave our own countries to be in Mog, were paid good money to be there and had our careers enhanced as a result. The risk for someone like Hassan — paid a fraction of our salaries in the town where all his family lived and the entire community knew he worked for the United Nations — differed on a galactic scale. Born and raised in Mogadishu, Hassan drew from the same wellsprings of hope and despair as the militants who rushed into certain death at the compound. But there are no Gettysburgs or Omaha Beaches for people like him — no heroic charge with his comrades by his side — nor even a decisive Alamo-style defeat. Nevertheless, men like Hassan resolve to endure.
As weeks turned into months, Hassan never mentioned that he reported to work every day in the place the foreign staff had evacuated. Or how the United Nations field operations that couldn’t discontinue without people dying would cease if not for his crew’s tracking our convoys and keeping our communications running. They knew the risk of working in the highly exposed compound of an organization that the Shabab referred to as “a merchant of death & a satanic force of evil.” Hassan and his crew exhibited grace under the most dangerous of circumstances and never felt the need to bring it up. I guess danger ceases to be an interesting topic after you’ve committed to facing it.
Occasionally, something — unexpected fireworks or the pressure wave from subwoofers at a concert — thrusts me back into that day, five years gone. When it happens, I crowd out the image of Shabab fighters storming our compound with those of Hassan and the other Somalis I worked with in Mogadishu, women and men who exemplified Plato’s definition of courage, “endurance of the soul.”
Courage is more than the charge.
Dewaine Farria is a former Marine and present M.F.A. candidate at the Vermont College of Fine Arts who served as a United Nations field security officer in East Jerusalem, Somalia, Kenya and the Russian North Caucasus. He received the United Nations Department of Safety and Security’s Bravery Award for his actions during the attack in Mogadishu.
Sign up for our newsletter to get the best of The New York Times Magazine delivered to your inbox every week. For more coverage of conflict, visit nytimes.com/atwar.
The post Reliving a Deadly Day at a U.N. Compound in Mogadishu appeared first on World The News.
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newestbalance · 6 years
Text
Reliving a Deadly Day at a U.N. Compound in Mogadishu
The blast wave thundered through the compound, ripping the expletive on my lips in two and cramming half of it back down my throat. The radio-room supervisor, Hassan Osman, and I stumbled to the balcony. In that cathedral-quiet moment between the detonation of the car bomb and the staccato barrage of gunfire, we knew they were coming. Shabab militants were storming the compound, squeezing off bursts from the Kalashnikovs at their hips, leaping the gate’s smoking wreckage. It was June 19, 2013.
“Dewaine. Dewaine.” Hassan’s voice was steady, his hand on my shoulder. “Do the public announcement.”
Over the P.A., I instructed the several dozen United Nations staff members to duck and cover and then tried to figure out what to do next. With every rifle crack, my world flashed in a monochrome of stark, tactical decisions, like life and death reduced to their lowest common denominators. Even in the moment, the irony of stumbling into my first firefight more than a decade after leaving the Marine Corps was not lost on me. Since leaving the military, I’d grown used to my buddies shaking their virtual heads, via social media, at the fundamental insanity of inserting yourself into war without having the good sense to engage in combat.
Mogadishu was a study in violent coexistence, a brutal ecosystem where new conflicts sprouted up without ever quelling the old. The Somali capital’s recent history included warlords, the Islamic Courts Union, the Ethiopian military, the Shabab and a shaky Western-backed government. This attack on the United Nations Common Compound — 10,000 square meters split between offices and living quarters, just off Mogadishu’s airport road — felt like the city’s fiercest predator had finally decided to take our measure.
After the initial blast, our Somali guards immediately returned fire, dropping the first two Shabab gunmen who came through the breach. Between clipped radio transmissions from the African Union Mission and the Somali government, four more militants unhesitatingly charged over the bodies of their companions. The guards’ gunfire funneled the attackers onto the accommodation side of the compound.
Under cover of suppressive fire from the towers, several of the guards and I leapfrogged the buildings on the accommodation side to herd staff members to the safe rooms on the opposite end of the compound. Pulling back the bolt on the office Kalashnikov to reveal brass bolstered my courage before our mad dash through the compound, but it was the valor and tenacity of our Somali allies that actually saved lives.
Mogadishu left a permanent scratch on my heart, but talking about the attack remains difficult. I’ve never wanted to risk implying that I’d done more than I did, or to say what I really feared: that I hadn’t done enough. The Shabab murdered 15 civilians, aid workers and contractors at the compound that day, including four of our Somali guards.
In Mogadishu, I led a United Nations Department of Safety and Security office consisting of three other international field security coordination officers — a Russian, a Ugandan and a Bulgarian — and about 20 local advisers, drivers and radio operators. Save for an unauthorized Chinese-made Kalashnikov, purchased by one of my predecessors and handed down to every senior field security coordination officer since, we were armed with nothing more than our wits.
For armed security, we depended on a Somali-owned private security company and the host government, with whom we carried out United Nations program delivery — agriculture and sanitation projects, polio monitoring, shelter programs — in and around the city. Armed security arrangements with private companies tend to unnerve humanitarians, who rightly worry about violating the principles of their profession. But my four postings with the United Nations taught me that in areas of conflict you could have a clean humanitarian conscience or deliver aid, but rarely both. Despite the inherent tension between United Nations agencies and the armed entities they relied on, our security system in Mogadishu worked. My team got aid personnel to some of the toughest locations in and around the capital.
I fell right in with my Somali security counterparts. I chewed bitter khat, a leaf with effects similar to amphetamine, with these guys, screeched through Mogadishu’s 17 districts behind their escort vehicles, and kicked up red dust while waiting for them during prayer stops on the roads to towns so recently vacated by the Shabab that you might still find the militants’ dirty dishes in the sink. Colonized but never broken, the Somalis were a wiry, arrogant and daring people for whom friendship ran deep. For all of Somalia’s trouble, I met fewer dispirited men in Mogadishu than I did in Manhattan.
After the attack, the personnel based at the compound, including me and the other foreign staff members on my team, relocated to the United Nations’ main compound in Somalia on the sprawling grounds of Mogadishu international airport. Protected by Ugandan and Burundian troops, displaced internationals could now join the mission staff, hacks, military officers and contractors who converged at the United Nations Mine Action Service’s “Little Kruger Bar” — foreigners with faces crimsoned by alcohol and the sun, many of whom could spend the weeks in country without ever leaving the airport or speaking to a Somali.
The new mission in Somalia was officially established only two weeks before the attack and had barely started moving into the compound on the grounds of the Mogadishu airport. The United Nations’ only unified radio room in Mogadishu — which maintained contact with its humanitarian and development convoys throughout the area — remained at our now-abandoned compound. I knew I couldn’t ask Hassan and his fellow radio operators to return to work at the hollowed-out buildings of an organization that the Shabab claimed were thwarting “Allah’s Law on earth & must therefore be dislodged.” But when I conducted my morning radio check from within the airport grounds the next day, it was Hassan’s voice that responded.
“Sierra 1, this is Mike Sierra Base, you’re five by five.”
In “War Games: The Story of Aid and War in Modern Times,” the journalist Linda Polman says that “the job of humanitarian aid worker is No. 5 on the Top 10 list of dangerous occupations, after lumberjack, pilot, fisherman and structural iron- or steelworker. It’s the only job on the list where most of the fatalities are caused by intentional violence.” From Chechnya to Dadaab refugee camp to Mogadishu to Gaza, I consistently found that most of this risk is borne by local staff — the polio-vaccination monitors, the convoy drivers, the project officers, the guards and the radio operators — who make up the backbone of international aid organizations.
Yes, the average international aid worker in Somalia is there to do good, but also (whether admittedly or not) for the buzz of life in a conflict zone. We decided to leave our own countries to be in Mog, were paid good money to be there and had our careers enhanced as a result. The risk for someone like Hassan — paid a fraction of our salaries in the town where all his family lived and the entire community knew he worked for the United Nations — differed on a galactic scale. Born and raised in Mogadishu, Hassan drew from the same wellsprings of hope and despair as the militants who rushed into certain death at the compound. But there are no Gettysburgs or Omaha Beaches for people like him — no heroic charge with his comrades by his side — nor even a decisive Alamo-style defeat. Nevertheless, men like Hassan resolve to endure.
As weeks turned into months, Hassan never mentioned that he reported to work every day in the place the foreign staff had evacuated. Or how the United Nations field operations that couldn’t discontinue without people dying would cease if not for his crew’s tracking our convoys and keeping our communications running. They knew the risk of working in the highly exposed compound of an organization that the Shabab referred to as “a merchant of death & a satanic force of evil.” Hassan and his crew exhibited grace under the most dangerous of circumstances and never felt the need to bring it up. I guess danger ceases to be an interesting topic after you’ve committed to facing it.
Occasionally, something — unexpected fireworks or the pressure wave from subwoofers at a concert — thrusts me back into that day, five years gone. When it happens, I crowd out the image of Shabab fighters storming our compound with those of Hassan and the other Somalis I worked with in Mogadishu, women and men who exemplified Plato’s definition of courage, “endurance of the soul.”
Courage is more than the charge.
Dewaine Farria is a former Marine and present M.F.A. candidate at the Vermont College of Fine Arts who served as a United Nations field security officer in East Jerusalem, Somalia, Kenya and the Russian North Caucasus. He received the United Nations Department of Safety and Security’s Bravery Award for his actions during the attack in Mogadishu.
Sign up for our newsletter to get the best of The New York Times Magazine delivered to your inbox every week. For more coverage of conflict, visit nytimes.com/atwar.
The post Reliving a Deadly Day at a U.N. Compound in Mogadishu appeared first on World The News.
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Saying Goodbye to Pioneering Diabetes Advocate David Mendosa
New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/saying-goodbye-to-pioneering-diabetes-advocate-david-mendosa/
Saying Goodbye to Pioneering Diabetes Advocate David Mendosa
We referred to him as a "father of the Diabetes Online Community," and anyone who’d ever known or connected with him felt the passion to help that burned beneath his kind and gentle spirit.
It’s no exaggeration to say that David Mendosa was one of the top diabetes writers in the world, a journey he began after his type 2 diagnosis in 1994.
Sadly, our D-Community is now mourning this lost friend from Boulder, CO, who passed away on May 8 as a result of an incurable form of cancer diagnosed in April. He was 81, and in his last email update sent out only a week before his passing he quipped, "I am glad to be able to write that this type of cancer is not one of the many complications of diabetes.”
A third-generation Californian who moved to Colorado in 2004, he was born in August 1935 under the name Richard Alexander Mendosa; he went by "Dick" until the mid-70s and later "Rick," until he legally changed his name to David in 2005.
Those who knew David on any level describe him as not only kind, gentle and compassionate, but informed and educated with a quick wit and a love for nature and the outdoors. His email newsletters over the years mixed diabetes info with reports on bird watching and reports on other animals and plants.
“David's knowledge and generosity are widely known and serve even after his passing as a model for all who would venture into the digital world to share their experiences with others,” said D-Dad Jeff Hitchcock in Ohio, founder of the Children With Diabetes organization and one of the original DOC’ers alongside David back in the mid-90s. “He was diligent in research, precise in language, and gentle in all his work. A tall man, he towered over most of us, but not because of his height -- rather, because of his kindness. David Mendosa's voice and spirit will live on forever in the digital world he helped to create.”
An Original Forefather of the DOC
As noted, David was a pioneer and a sort of godfather of the Diabetes Online Community (DOC), having started his patient-led informational site back when the Internet was still in its infancy.
Jeff Hitchcock describes the summer of 1995 as a time “when the World Wide Web was just emerging from the confines of university laboratories” and there were only four sites devoted to helping people with diabetes: the now-defunct Diabetes Knowledgebase at the University of Wisconsin, Madison; Jeff’s Children With Diabetes forum; the Diabetes Monitor by Dr. Bill Quick; and David Mendosa’s hailed On-line Diabetes Resources. (Yes, kids: there was a time when online was hyphenated!)
“In those early days... David, Bill, and I developed a unique kind of friendship -- a virtual friendship born of the Internet,” Jeff tells us. “We got to know each other first through email and only later in person when we would meet at diabetes conferences. Before all-knowing search engines like Google, we shared new finds like treasure, sending each other emails to help spread the word to the readers of our three web sites. Unknowingly, we laid the foundational bricks to what would become the Diabetes Online Community.”
David's Diabetes Directory remains online as one of the largest collections of its kind, comprised of all kinds of online diabetes sites and blogs and 1,000+ articles he's put his name to over the years.
You name it, David wrote about it on his own site, through his 12 years at HealthCentral and many more spots online and offline – writing on everything from diabetestechnology and new medications, to diet and complication stories and the mental health aspects of living with this condition, not to mention his own personal anecdotes. He always embodied the “Your Diabetes May Vary” mindset, embracing our D-Community’s differences, while happily sharing his own approaches and insights. And he was not afraid to change his mind and his approach if he felt it warranted.
Impressively, he actually lost an incredible amount of weight -- going from 312 pounds to 168 pounds, or nearly half his body mass! -- in the course of a couple years, and he was so impressed with the new drug Byetta that he wrote a book on it. That led to him also focusing on his diet, and becoming one of the early adopters of low-carb eating a decade ago after initial skepticism about the eating trend, and it was through his writings that many found the courage to at least try it out (myself included).
From his personal musings, it’s always funny to read David’s recollection that “the World Wide Web tricked me," as he didn’t think it would ever take off. It’s also fun to look back on how nearly 20 years ago, when he was writing for the few existing D-publications both online and offline, the American Diabetes Association once dubbed him “a noted Internet observer.”
Certainly, David was larger than life in our D-World and close to our hearts.
Connecting with People… and Finding Love!
Interestingly, it was through the early DOC (as it existed in forums and message boards back then) that David met his wife, Catherine. He shared that story a decade ago in a blog post, writing that he’d turned to the Internet just a month after his T2 diagnosis and eight months later through a message board, he connected with the woman who would eventually become his second wife. He also shared the heartbreaking story of Catherine’s death in 2007.
That blog post at HealthCentral was how longtime type 1 and diabetes journalist Ann Bartlett in the Washington D.C. region first met David, who would become a dear friend and mentor through the years.
As it turned out, her very first blog post set to publish was delayed – because David’s wife had passed away, and he wrote the tribute to her for that day. She remembers seeing the D-Community's response over someone they’d never met, and from that day she fell in love with not only the DOC but his writing style.
“I found myself laughing, feeling frustrated and completely in sync with many of his struggles and it became crystal clear that his view of living with type 2 diabetes had many similarities to my own dilemmas of living with type1 and I quickly got in his blog boat and grabbed an ore,” she said. “David greeted anyone willing to stand up and be a voice in the diabetes community with love and respect.”
Through it all, David’s love for writing abounded. He pondered retirement last year, Ann recalls, but said there was still so much he wanted to write about and wasn’t willing to give that up.
David greeted anyone willing to stand up and be a voice in the diabetes community with love and respect. Ann Bartlett, friend and fellow diabetes writer
Beyond Diabetes – Early Life, Outdoors
Beyond diabetes, David's life was just as amazing -- and like any proud journalist, he chronicled his own story in various articles and photo essays.
In his younger years during his late teens, he started out working for the Riverside, CA, Press-Enterprise newspaper as an assistant sports editor. He soon enlisted in the U.S. Army in his early 20s where he worked for their Public and Troop Information Office and as a correspondent for the Overseas Weekly briefly during his service. He then returned to California where he studied political science and served on the college paper at UC Riverside. After getting his master’s degree in government from Claremont Graduate University, he went to work for the U.S. government for as a foreign service officer in D.C. for 11 years and then four years in Africa.
After that, in what he dubs his "radical years," he dabbled in real estate sales and computer and small business consulting before turning back to journalism in the 1980s with the Hispanic Business Times – all before diabetes entered his life and he turned to that in the mid-90s.
Tied into his own diabetes management but also embracing his love for the outdoors and nature, David was an avid hiker and outdoorsman who snapped beautiful photos during his many travels -- and yes, he also wrote about that on a Fitness and Photography for Fun blog! Being a practicing Buddhist also gave David a unique mindfulness, and it was one that he often brought into his own diabetes writing when exploring meditation’s effects on BG management, or just embracing a calmness in approaching one’s health and life overall.
Thank You, David!
“His loss to our community is immeasurable, but he gave us a tremendous gift of leaving behind years of research, education and inspiration. He will always be a gift of inspiration for me,” Ann says.
Tributes to David have been popping up all over the DOC – from forums like dLife and TuDiabetes, tributes at HealthCentral and Diabetes UK, to a blog post by T2 peep Bob Fenton, and numerous comments being shared on his CaringBridge page, where David began writing about his cancer journey in April.
We echo the sentiments about his compassion and caring attitude and his institutional knowledge of anything related to diabetes.
Personally, I recall first stumbling across David’s writings back in the very late 90s during my college years. Once I began reading blogs and connecting with others, his name was always top of my daily reading list. And then, I recall reading about that very first Roche Social Media Summit in 2009 and eventually attending the second summit that following year, and being able to meet this rockstar IRL. I’m humbled and blessed to have kept in touch through the past several years, and share stories both personal and professional beyond just diabetes.
Another long-termer in the DOC, David Kliff in Chicago who began publishing Diabetic Investor in 1997, has known David through the years and recollects:
“What I remember about him most was that he was a true gentlemen and old-school journalist who didn’t mind helping a newbie,” Kliff says. “It was ironic that over the years our roles reversed and it was my turn to help him, which was a pleasure to do. David was a great guy and tireless advocate for patients with diabetes. He sought the truth and investigated everything fully before writing. David understood diabetes wasn’t about the toys we use or the drugs we take, but the people we are.”
In keeping with his wishes, David’s family updated his CaringBridge page to reflect that there will not be a service of any kind. However, anyone who has “journeyed with him” at any point is encouraged to donate to CaringBridge in his memory or to the Colorado-based TRU Hospice Care Center that took care of him in the later days.
David, we will miss you so incredibly much and are honored to have known you through the years. Thank you for all you did for this world and our D-Community! Rest in Peace, Brother.
Disclaimer: Content created by the Diabetes Mine team. For more details click here.
Disclaimer
This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.
Type 2 Diabetes Treatment Type 2 Diabetes Diet Diabetes Destroyer Reviews Original Article
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ongames · 7 years
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The Scary But Rare Risk Linked To Exclusive Breastfeeding
UNICEF’s worldwide campaign to emphasize breastfeeding for infants will celebrate its 27th anniversary this year. In the U.S., this effort led to the growth of “baby-friendly” hospitals that encourage breastfeeding as the norm, community breastfeeding support circles and more awareness about the benefits linked to breastfeeding, which include lower rates of diarrhea, infections, diabetes and Sudden Infant Death Syndrome. 
In many ways, this global awareness campaign, sparked in part by high rates of infant deaths in developing countries due to formula mixed with dirty water or dilution of the expensive formula product, has been a success for American parents, who generally had access to safe water and enough formula to begin with. 
In 1971, only 25 percent of American moms breastfed their infants. By 2016, 81 percent, or four out of five American newborns, start life on the breast, and 52 percent are still breastfeeding at six months.
But for some new parents who struggle to breastfeed at first, or who never manage to get the hang of it, the mantra “breast is best” can be judgmental and unhelpful. And in rare, extreme cases, the pressure to exclusively breastfeed has resulted in the accidental dehydration and starvation of infants who could not get enough nutrition from breastfeeding. 
The latest parent to tell this story is Jillian Johnson, who five years ago lost her son after he became so dehydrated that his heart stopped. He spent 15 days on life support before dying.
In an emotional essay published by the Fed is Best Foundation, a parent-led nonprofit founded to push back against the social pressure to exclusively breastfeed, Johnson writes that despite multiple consultations with lactation experts and nurses, no one caught on to the fact that her son was hungry, and that she wasn’t producing enough breastmilk. Instead, she and her partner were discharged from the hospital two and a half days after Landon was born. After less than 12 hours at home, where Landon continued to cry, scream and attempt to feed, he went into cardiac arrest. 
When Johnson had her second child, a daughter, she was puzzled that Stella didn’t scream and cry as much as Landon did. Nurses said there was nothing wrong with her, and that Stella was sleeping and eating as normal. 
“It was then that I realized that it wasn’t normal for a newborn to cry as much as Landon did,” she wrote. “He was just crying out from his hunger. But I didn’t know. I should’ve known. I still struggle daily feeling as though I failed him.”
Breastfeeding isn’t right for everyone
Johnson’s story is shocking, and the last thing one would expect from a breastfeeding effort that aims to do what’s best for mothers and babies. Thankfully, it’s rare, but it’s important to acknowledge that exclusive breastfeeding simply won’t be successful for all mother-baby pairs, says Dr. Alison Stuebe, a maternal-fetal medicine physician and medical director of lactation services at University of North Carolina Health Care.
Health care providers need to know that insufficient breast milk is a real problem for a minority of women, and if it isn’t caught in time, it can be discouraging to the mother and severely dangerous for a newborn baby.
“I think everyone in the system needs to look at [Johnson’s] piece and say, ‘How can we create a safe system for supporting optimal feeding so that moms and babies who want to breastfeed can do so safely and successfully, and moms and babies who don’t want to breastfeed can have good support to do that and know how to do that safely?’” said Stuebe, who is not affiliated with Fed is Best.
Stuebe in the past has pushed back against Fed Is Best’s campaign for all parents to be warned about rare brain damage risks that can result from insufficient breast milk supply, writing that it could threaten the effort to normalize exclusive breastfeeding and unnecessarily expose newborns to supplemental formula feeding, which could jeopardize the establishment of a consistent breastfeeding routine.
Severe dehydration in newborns is rare but can vary according to region, she noted in a 2016 post for the site Breastfeeding Medicine, a blog for doctors writing about breastfeeding.
A 2013 study among U.K. newborns found about seven to nine newborns per 100,000 live births will suffer from dehydration as a result of insufficient breast milk, which resulted in no long-term complications. Meanwhile, among mothers in Turkey, where most families are sent home within 24 hours of the birth, severe dehydration affected 14 percent of babies. Stuebe noted in her post that 24 hours is not enough time to assess if successful breastfeeding has been established.
Experts need to change the way they talk about breastfeeding
Taking into account all the different variables and unexpected things that could go wrong with breastfeeding in a minority of women, health care providers need to be less strident in the language they use with new moms who have just given birth, are feeling vulnerable and want to do the right thing for their children, Stuebe said. 
“There’s some proportion of moms for which breastfeeding just won’t work, just as there’s some proportion of babies that won’t come out vaginally, no matter what we do,” she said. “We need to be honest about that and point out that even if 100 percent of the milk doesn’t come from mom, she can still have a nurturing relationship with her baby at the breast.”
Mary S., a 34-year-old mom from Los Angeles, would have appreciated that approach from her clinicians when she gave birth to her daughter in 2014. Mary did what all lactation consultants recommended — she took a breastfeeding class through her hospital before birth and requested two lactation consultant visits at her hospital room after giving birth, during which she was reassured several times that “everything looked great.”
She even had a lactation consultant make a house call twice, and joined a breastfeeding support group through a local parenting store. The only hint she got that her breastfeeding plans might not go the way she wanted was during an OB/GYN’s physical exam the day after she gave birth, when the doctor examined her breasts and noticed that one of them didn’t seem to be making colostrum (a mother’s first breastmilk) yet. 
On the fourth day after giving birth, Mary noticed her normally calm and quiet baby would not stop crying. She took her to the pediatrician and found out that her daughter had developed jaundice because she was starving. Immediately, her doctor prescribed bilirubin lights to treat the jaundice, and told Mary to start supplementing with formula milk. Once at home, Mary breastfed for 15 minutes on both breasts, then fed a bottle of formula, and then pumped her breasts to see if her milk would come in. She switched exclusively to formula after two months of this grueling regimen.
Now, three years later and about to give birth to her second child, there’s so much Mary wishes that she could have known about exclusive breastfeeding. 
“I wish someone had told me along the way that it doesn’t always work out — that you can have a smart and healthy child even if you supplement or formula feed,” she said. “No one along the way recommended or even offered us formula until my baby was in desperate need of it.”
Still, health care providers should not treat all families as if they are at high risk for insufficient breastmilk supply, according to Elizabeth Smith, a “baby-friendly” coordinator in charge of breastfeeding education policy for the University of Utah Health Care hospital system. Instead, they should look for signals from the infant that feeding isn’t going well, assess a mother’s risk factors before birth and set up a care plan for new parents to make sure someone is following up with them after short hospital stays. 
There’s no need to apply a one-size-fits-all approach to breastfeeding, as many hospitals have done in the past, Smith said. She pointed to a common but outdated misconception, which Johnson repeated in her blog post and said her NICU doctor told her as well, that breastfeeding sessions should be followed up with bottle supplementation to make sure the babies are properly fed. Unless a mother is at high risk of insufficient breast milk supply, or a baby exhibits signs of dehydration or starvation, there’s no reason to follow up with a bottle.
“We don’t want to go down that path, which is where hospitals used to be,” she said. “We as hospitals were sabotaging the ability for moms to have a successful breastfeeding relationships.”
According to Smith and Stuebe, there are several ways health care providers and parents can work together to make sure newborns are getting the nutrition they need in their first few days of life. 
1. Watch for signs of dehydration in babies
To safeguard against accidental dehydration, health care providers and parents should monitor the baby’s weight and intervene with a bottle or formula if weight loss starts to approach 10 percent, monitor the baby’s alertness and keep track of the color of its dirty diapers (feces should go from black to green to yellow over the course of a few days), Smith says. 
2. Assess risk factors in mothers
For mothers, risk factors for insufficient breastmilk supply include, but are not limited to, infertility or the use of reproductive treatments to conceive, premature birth, previous breast surgery and an inability to “hand express” breastmilk. 
“Every mom should be taught hand expression,” Smith said. “If she’s having a hard time with hand expression and not getting a good result, then we want to assess her even more carefully.”
3. Make a care plan 
After assessing individual risks of both mother and baby, it’s up to health care providers to come up with a plan to follow up with families after being discharged from the hospital ― as well as communicate that schedule with pediatricians, lactation consultants and anyone else involved in their care, says Stuebe. For some especially busy medical facilities, this is a huge logistical struggle, and sometimes systems can fail. 
Parents should also feel empowered to inquire after lactation consultant visits and lactation outpatient clinics and reach out to breastfeeding support groups in their community, in addition to lining up all the doctor’s visits that occur within the first weeks and months of their newborn’s life. 
This reporting is brought to you by HuffPost’s health and science platform, The Scope. Like us on Facebook and Twitter and tell us your story: [email protected]
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The Scary But Rare Risk Linked To Exclusive Breastfeeding published first on http://ift.tt/2lnpciY
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yes-dal456 · 7 years
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The Scary But Rare Risk Linked To Exclusive Breastfeeding
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UNICEF’s worldwide campaign to emphasize breastfeeding for infants will celebrate its 27th anniversary this year. In the U.S., this effort led to the growth of “baby-friendly” hospitals that encourage breastfeeding as the norm, community breastfeeding support circles and more awareness about the benefits linked to breastfeeding, which include lower rates of diarrhea, infections, diabetes and Sudden Infant Death Syndrome. 
In many ways, this global awareness campaign, sparked in part by high rates of infant deaths in developing countries due to formula mixed with dirty water or dilution of the expensive formula product, has been a success for American parents, who generally had access to safe water and enough formula to begin with. 
In 1971, only 25 percent of American moms breastfed their infants. By 2016, 81 percent, or four out of five American newborns, start life on the breast, and 52 percent are still breastfeeding at six months.
But for some new parents who struggle to breastfeed at first, or who never manage to get the hang of it, the mantra “breast is best” can be judgmental and unhelpful. And in rare, extreme cases, the pressure to exclusively breastfeed has resulted in the accidental dehydration and starvation of infants who could not get enough nutrition from breastfeeding. 
The latest parent to tell this story is Jillian Johnson, who five years ago lost her son after he became so dehydrated that his heart stopped. He spent 15 days on life support before dying.
In an emotional essay published by the Fed is Best Foundation, a parent-led nonprofit founded to push back against the social pressure to exclusively breastfeed, Johnson writes that despite multiple consultations with lactation experts and nurses, no one caught on to the fact that her son was hungry, and that she wasn’t producing enough breastmilk. Instead, she and her partner were discharged from the hospital two and a half days after Landon was born. After less than 12 hours at home, where Landon continued to cry, scream and attempt to feed, he went into cardiac arrest. 
When Johnson had her second child, a daughter, she was puzzled that Stella didn’t scream and cry as much as Landon did. Nurses said there was nothing wrong with her, and that Stella was sleeping and eating as normal. 
“It was then that I realized that it wasn’t normal for a newborn to cry as much as Landon did,” she wrote. “He was just crying out from his hunger. But I didn’t know. I should’ve known. I still struggle daily feeling as though I failed him.”
Breastfeeding isn’t right for everyone
Johnson’s story is shocking, and the last thing one would expect from a breastfeeding effort that aims to do what’s best for mothers and babies. Thankfully, it’s rare, but it’s important to acknowledge that exclusive breastfeeding simply won’t be successful for all mother-baby pairs, says Dr. Alison Stuebe, a maternal-fetal medicine physician and medical director of lactation services at University of North Carolina Health Care.
Health care providers need to know that insufficient breast milk is a real problem for a minority of women, and if it isn’t caught in time, it can be discouraging to the mother and severely dangerous for a newborn baby.
“I think everyone in the system needs to look at [Johnson’s] piece and say, ‘How can we create a safe system for supporting optimal feeding so that moms and babies who want to breastfeed can do so safely and successfully, and moms and babies who don’t want to breastfeed can have good support to do that and know how to do that safely?’” said Stuebe, who is not affiliated with Fed is Best.
Stuebe in the past has pushed back against Fed Is Best’s campaign for all parents to be warned about rare brain damage risks that can result from insufficient breast milk supply, writing that it could threaten the effort to normalize exclusive breastfeeding and unnecessarily expose newborns to supplemental formula feeding, which could jeopardize the establishment of a consistent breastfeeding routine.
Severe dehydration in newborns is rare but can vary according to region, she noted in a 2016 post for the site Breastfeeding Medicine, a blog for doctors writing about breastfeeding.
A 2013 study among U.K. newborns found about seven to nine newborns per 100,000 live births will suffer from dehydration as a result of insufficient breast milk, which resulted in no long-term complications. Meanwhile, among mothers in Turkey, where most families are sent home within 24 hours of the birth, severe dehydration affected 14 percent of babies. Stuebe noted in her post that 24 hours is not enough time to assess if successful breastfeeding has been established.
Experts need to change the way they talk about breastfeeding
Taking into account all the different variables and unexpected things that could go wrong with breastfeeding in a minority of women, health care providers need to be less strident in the language they use with new moms who have just given birth, are feeling vulnerable and want to do the right thing for their children, Stuebe said. 
“There’s some proportion of moms for which breastfeeding just won’t work, just as there’s some proportion of babies that won’t come out vaginally, no matter what we do,” she said. “We need to be honest about that and point out that even if 100 percent of the milk doesn’t come from mom, she can still have a nurturing relationship with her baby at the breast.”
Mary S., a 34-year-old mom from Los Angeles, would have appreciated that approach from her clinicians when she gave birth to her daughter in 2014. Mary did what all lactation consultants recommended — she took a breastfeeding class through her hospital before birth and requested two lactation consultant visits at her hospital room after giving birth, during which she was reassured several times that “everything looked great.”
She even had a lactation consultant make a house call twice, and joined a breastfeeding support group through a local parenting store. The only hint she got that her breastfeeding plans might not go the way she wanted was during an OB/GYN’s physical exam the day after she gave birth, when the doctor examined her breasts and noticed that one of them didn’t seem to be making colostrum (a mother’s first breastmilk) yet. 
On the fourth day after giving birth, Mary noticed her normally calm and quiet baby would not stop crying. She took her to the pediatrician and found out that her daughter had developed jaundice because she was starving. Immediately, her doctor prescribed bilirubin lights to treat the jaundice, and told Mary to start supplementing with formula milk. Once at home, Mary breastfed for 15 minutes on both breasts, then fed a bottle of formula, and then pumped her breasts to see if her milk would come in. She switched exclusively to formula after two months of this grueling regimen.
Now, three years later and about to give birth to her second child, there’s so much Mary wishes that she could have known about exclusive breastfeeding. 
“I wish someone had told me along the way that it doesn’t always work out — that you can have a smart and healthy child even if you supplement or formula feed,” she said. “No one along the way recommended or even offered us formula until my baby was in desperate need of it.”
Still, health care providers should not treat all families as if they are at high risk for insufficient breastmilk supply, according to Elizabeth Smith, a “baby-friendly” coordinator in charge of breastfeeding education policy for the University of Utah Health Care hospital system. Instead, they should look for signals from the infant that feeding isn’t going well, assess a mother’s risk factors before birth and set up a care plan for new parents to make sure someone is following up with them after short hospital stays. 
There’s no need to apply a one-size-fits-all approach to breastfeeding, as many hospitals have done in the past, Smith said. She pointed to a common but outdated misconception, which Johnson repeated in her blog post and said her NICU doctor told her as well, that breastfeeding sessions should be followed up with bottle supplementation to make sure the babies are properly fed. Unless a mother is at high risk of insufficient breast milk supply, or a baby exhibits signs of dehydration or starvation, there’s no reason to follow up with a bottle.
“We don’t want to go down that path, which is where hospitals used to be,” she said. “We as hospitals were sabotaging the ability for moms to have a successful breastfeeding relationships.”
According to Smith and Stuebe, there are several ways health care providers and parents can work together to make sure newborns are getting the nutrition they need in their first few days of life. 
1. Watch for signs of dehydration in babies
To safeguard against accidental dehydration, health care providers and parents should monitor the baby’s weight and intervene with a bottle or formula if weight loss starts to approach 10 percent, monitor the baby’s alertness and keep track of the color of its dirty diapers (feces should go from black to green to yellow over the course of a few days), Smith says. 
2. Assess risk factors in mothers
For mothers, risk factors for insufficient breastmilk supply include, but are not limited to, infertility or the use of reproductive treatments to conceive, premature birth, previous breast surgery and an inability to “hand express” breastmilk. 
“Every mom should be taught hand expression,” Smith said. “If she’s having a hard time with hand expression and not getting a good result, then we want to assess her even more carefully.”
3. Make a care plan 
After assessing individual risks of both mother and baby, it’s up to health care providers to come up with a plan to follow up with families after being discharged from the hospital ― as well as communicate that schedule with pediatricians, lactation consultants and anyone else involved in their care, says Stuebe. For some especially busy medical facilities, this is a huge logistical struggle, and sometimes systems can fail. 
Parents should also feel empowered to inquire after lactation consultant visits and lactation outpatient clinics and reach out to breastfeeding support groups in their community, in addition to lining up all the doctor’s visits that occur within the first weeks and months of their newborn’s life. 
This reporting is brought to you by HuffPost’s health and science platform, The Scope. Like us on Facebook and Twitter and tell us your story: [email protected]
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
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imreviewblog · 7 years
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The Scary But Rare Risk Linked To Exclusive Breastfeeding
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UNICEF’s worldwide campaign to emphasize breastfeeding for infants will celebrate its 27th anniversary this year. In the U.S., this effort led to the growth of “baby-friendly” hospitals that encourage breastfeeding as the norm, community breastfeeding support circles and more awareness about the benefits linked to breastfeeding, which include lower rates of diarrhea, infections, diabetes and Sudden Infant Death Syndrome. 
In many ways, this global awareness campaign, sparked in part by high rates of infant deaths in developing countries due to formula mixed with dirty water or dilution of the expensive formula product, has been a success for American parents, who generally had access to safe water and enough formula to begin with. 
In 1971, only 25 percent of American moms breastfed their infants. By 2016, 81 percent, or four out of five American newborns, start life on the breast, and 52 percent are still breastfeeding at six months.
But for some new parents who struggle to breastfeed at first, or who never manage to get the hang of it, the mantra “breast is best” can be judgmental and unhelpful. And in rare, extreme cases, the pressure to exclusively breastfeed has resulted in the accidental dehydration and starvation of infants who could not get enough nutrition from breastfeeding. 
The latest parent to tell this story is Jillian Johnson, who five years ago lost her son after he became so dehydrated that his heart stopped. He spent 15 days on life support before dying.
In an emotional essay published by the Fed is Best Foundation, a parent-led nonprofit founded to push back against the social pressure to exclusively breastfeed, Johnson writes that despite multiple consultations with lactation experts and nurses, no one caught on to the fact that her son was hungry, and that she wasn’t producing enough breastmilk. Instead, she and her partner were discharged from the hospital two and a half days after Landon was born. After less than 12 hours at home, where Landon continued to cry, scream and attempt to feed, he went into cardiac arrest. 
When Johnson had her second child, a daughter, she was puzzled that Stella didn’t scream and cry as much as Landon did. Nurses said there was nothing wrong with her, and that Stella was sleeping and eating as normal. 
“It was then that I realized that it wasn’t normal for a newborn to cry as much as Landon did,” she wrote. “He was just crying out from his hunger. But I didn’t know. I should’ve known. I still struggle daily feeling as though I failed him.”
Breastfeeding isn’t right for everyone
Johnson’s story is shocking, and the last thing one would expect from a breastfeeding effort that aims to do what’s best for mothers and babies. Thankfully, it’s rare, but it’s important to acknowledge that exclusive breastfeeding simply won’t be successful for all mother-baby pairs, says Dr. Alison Stuebe, a maternal-fetal medicine physician and medical director of lactation services at University of North Carolina Health Care.
Health care providers need to know that insufficient breast milk is a real problem for a minority of women, and if it isn’t caught in time, it can be discouraging to the mother and severely dangerous for a newborn baby.
“I think everyone in the system needs to look at [Johnson’s] piece and say, ‘How can we create a safe system for supporting optimal feeding so that moms and babies who want to breastfeed can do so safely and successfully, and moms and babies who don’t want to breastfeed can have good support to do that and know how to do that safely?’” said Stuebe, who is not affiliated with Fed is Best.
Stuebe in the past has pushed back against Fed Is Best’s campaign for all parents to be warned about rare brain damage risks that can result from insufficient breast milk supply, writing that it could threaten the effort to normalize exclusive breastfeeding and unnecessarily expose newborns to supplemental formula feeding, which could jeopardize the establishment of a consistent breastfeeding routine.
Severe dehydration in newborns is rare but can vary according to region, she noted in a 2016 post for the site Breastfeeding Medicine, a blog for doctors writing about breastfeeding.
A 2013 study among U.K. newborns found about seven to nine newborns per 100,000 live births will suffer from dehydration as a result of insufficient breast milk, which resulted in no long-term complications. Meanwhile, among mothers in Turkey, where most families are sent home within 24 hours of the birth, severe dehydration affected 14 percent of babies. Stuebe noted in her post that 24 hours is not enough time to assess if successful breastfeeding has been established.
Experts need to change the way they talk about breastfeeding
Taking into account all the different variables and unexpected things that could go wrong with breastfeeding in a minority of women, health care providers need to be less strident in the language they use with new moms who have just given birth, are feeling vulnerable and want to do the right thing for their children, Stuebe said. 
“There’s some proportion of moms for which breastfeeding just won’t work, just as there’s some proportion of babies that won’t come out vaginally, no matter what we do,” she said. “We need to be honest about that and point out that even if 100 percent of the milk doesn’t come from mom, she can still have a nurturing relationship with her baby at the breast.”
Mary S., a 34-year-old mom from Los Angeles, would have appreciated that approach from her clinicians when she gave birth to her daughter in 2014. Mary did what all lactation consultants recommended — she took a breastfeeding class through her hospital before birth and requested two lactation consultant visits at her hospital room after giving birth, during which she was reassured several times that “everything looked great.”
She even had a lactation consultant make a house call twice, and joined a breastfeeding support group through a local parenting store. The only hint she got that her breastfeeding plans might not go the way she wanted was during an OB/GYN’s physical exam the day after she gave birth, when the doctor examined her breasts and noticed that one of them didn’t seem to be making colostrum (a mother’s first breastmilk) yet. 
On the fourth day after giving birth, Mary noticed her normally calm and quiet baby would not stop crying. She took her to the pediatrician and found out that her daughter had developed jaundice because she was starving. Immediately, her doctor prescribed bilirubin lights to treat the jaundice, and told Mary to start supplementing with formula milk. Once at home, Mary breastfed for 15 minutes on both breasts, then fed a bottle of formula, and then pumped her breasts to see if her milk would come in. She switched exclusively to formula after two months of this grueling regimen.
Now, three years later and about to give birth to her second child, there’s so much Mary wishes that she could have known about exclusive breastfeeding. 
“I wish someone had told me along the way that it doesn’t always work out — that you can have a smart and healthy child even if you supplement or formula feed,” she said. “No one along the way recommended or even offered us formula until my baby was in desperate need of it.”
Still, health care providers should not treat all families as if they are at high risk for insufficient breastmilk supply, according to Elizabeth Smith, a “baby-friendly” coordinator in charge of breastfeeding education policy for the University of Utah Health Care hospital system. Instead, they should look for signals from the infant that feeding isn’t going well, assess a mother’s risk factors before birth and set up a care plan for new parents to make sure someone is following up with them after short hospital stays. 
There’s no need to apply a one-size-fits-all approach to breastfeeding, as many hospitals have done in the past, Smith said. She pointed to a common but outdated misconception, which Johnson repeated in her blog post and said her NICU doctor told her as well, that breastfeeding sessions should be followed up with bottle supplementation to make sure the babies are properly fed. Unless a mother is at high risk of insufficient breast milk supply, or a baby exhibits signs of dehydration or starvation, there’s no reason to follow up with a bottle.
“We don’t want to go down that path, which is where hospitals used to be,” she said. “We as hospitals were sabotaging the ability for moms to have a successful breastfeeding relationships.”
According to Smith and Stuebe, there are several ways health care providers and parents can work together to make sure newborns are getting the nutrition they need in their first few days of life. 
1. Watch for signs of dehydration in babies
To safeguard against accidental dehydration, health care providers and parents should monitor the baby’s weight and intervene with a bottle or formula if weight loss starts to approach 10 percent, monitor the baby’s alertness and keep track of the color of its dirty diapers (feces should go from black to green to yellow over the course of a few days), Smith says. 
2. Assess risk factors in mothers
For mothers, risk factors for insufficient breastmilk supply include, but are not limited to, infertility or the use of reproductive treatments to conceive, premature birth, previous breast surgery and an inability to “hand express” breastmilk. 
“Every mom should be taught hand expression,” Smith said. “If she’s having a hard time with hand expression and not getting a good result, then we want to assess her even more carefully.”
3. Make a care plan 
After assessing individual risks of both mother and baby, it’s up to health care providers to come up with a plan to follow up with families after being discharged from the hospital ― as well as communicate that schedule with pediatricians, lactation consultants and anyone else involved in their care, says Stuebe. For some especially busy medical facilities, this is a huge logistical struggle, and sometimes systems can fail. 
Parents should also feel empowered to inquire after lactation consultant visits and lactation outpatient clinics and reach out to breastfeeding support groups in their community, in addition to lining up all the doctor’s visits that occur within the first weeks and months of their newborn’s life. 
This reporting is brought to you by HuffPost’s health and science platform, The Scope. Like us on Facebook and Twitter and tell us your story: [email protected]
-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.
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superprofitz · 7 years
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Tools of the ‘Trade’ – How I Invest (2017 Edition)
Each year I do a deep dive post into my personal trading results and the tools I use for conducting research. This is the seventh edition (see: 2016, 2015, 2014).
Before we get to the results, here’s a quick summary of what’s happened here at StockTrader.com over the past year.
StockTrader.com Year in Review
For StockTrader.com, we launched a new ETFs directory and made a big transition last year from providing free nightly market recaps to weekly market recaps. While the nightly recaps were great, readership had stagnated. With our new weekly market recaps, writer Mark Hanna is able to take a much deeper dive and cover the macro picture in more detail.
The results have exceeded our expectations. Email subscribers currently stands at a record of 18,724 and the number of opens each week has increased by ~50%. Needless to say, quality over quantity is a winning formula. (Not signed up yet? Fill in your email using the form on the sidebar!)
Meanwhile, Trade Journal continues to be an excellent free tool for analyzing completed trades. We had another record of monthly active users (MAU); currently around 600 users sign in each month to analyze trades. Several thousand trades are logged, by hand, each month. See: The 3 Phases of Trade Analysis & The Big Secret Few Know.
Last but not least, site traffic had another record finish as we wrapped up 2016 with 2,744,105 visits from 1,989,478 unique visitors with 4,350,880 total pageviews. Awesome.
Trading Computer Setup
First, it’s extremely important to note: do NOT get suckered into paying several thousand dollars for a trading computer from a day trading / professional trading website you’ve never heard of. You will be ripped off. You can spend around $1000, or less (building your own rig or finding a sale helps), and get a fine desktop that supports, at the least, dual monitors. Most mid-tier gaming rigs work great for trading. Here’s a pre-filtered list of desktop computers with recommended specs from Amazon.com.
That aside, I purchased an UpLift standing desk in 2014 and have fully embraced the health benefits of standing during the day. I currently stand around 75% of the day.
Overall, my trading station setup at work and at home are identical. Same desk, similar spec machines, same monitor stand, same monitors, mice, keyboard, etc. This makes it seamless if I ever trade from home. While my desktops are a bit older, built back in late 2013, they still get the job done just fine.
PC Specs (rig originally built in 2012) – Six ASUS 24″ LED Monitors, Intel Core i7-3770 Processor, 8 GB Corsair Vengeance DDR3 1600 MHz memory, 2 AMD Radeon HD 7770 video cards, and a 120 GB ADATA S510 SSD Hard Drive.
Trading Results
My day job is running our portfolio of websites including StockTrader.com as well as StockBrokers.com, InvestingTeacher.com, and new addition ForexBrokers.com. Because of this, I trade only when I have free time.
More specifically, trading is strictly a passion and hobby. I do not trade for a living. 100% of my retirement savings and over 90% of my personal portfolio simply is invested in the S&P 500 Vanguard index fund (VOO). I buy each month and forget about it. See: How to Build a Warren Buffett Portfolio.
I did try full-time trading when I was 19, however it ended in failure. My portfolio size was too small and despite an impressive win streak, one bad trade nearly wiped me out. Now that I am 30 and have 16 years of market “wisdom” under my belt, and I’ve learned a thing or two. See: 10 Trading Secrets I Wish I Knew When I Got Started.
For one, I invest my retirement assets and any extra personal funds in the S&P 500 with Vanguard and keep my personal trading portfolio small. In 2015 I had ~$60,000 allocated to trading. This remained the same for 2016. Thus, $60,000 is the number I used to calculate my performance returns against the S&P 500 below. 
I ended 2016 with a realized portfolio return of +$4,906.52 after commissions or +8.18% vs the S&P 500 Return of +9.54%. I did not have any commission spend for 2016 thanks to taking advantage of a free trades offer at Fidelity in late 2015 (read my Fidelity review). Like thousands of other users here on the site, I manually enter my trades using the free StockTrader.com Trade Journal.
For those that read this post each year, you will quickly notice how little I traded last year. This was one of my big, multi-year goals. TRADE LESS. In 2014 I made a whopping 443 round trips. In 2015 I cut that number down to 45. Now in 2016, I set a personal best of only 15 trades.
Cutting back on trade frequency was no easy task for me. For years I struggled with over-trading which not only leads to expensive mistakes but hefty commission charges as well. Here’s a summary of 2016 trades,
One final note on returns. I invested about half my portfolio in Wells Fargo (WFC) as the whole sales-tactics scandal unfolded. I was expecting a bounce back over the next few months as things blew over. Lucky me though, Trump was elected and bank stocks exploded higher on expectations of higher US growth and thus higher interest rates in 2017, and beyond. I still hold the position, which has been a nice winner thus far.
Investment Sites, Services, Subscriptions
The below services and subscriptions are part of my investment routine. It should be noted that several of these services are provided for me at no cost since we occasionally include research from the products in our market recaps. That said, I personally use all of these services for my trading.
Trade Journal – Free – Inspired by my passion for post trade analysis alongside a goal to bring my personal excel trade log to the web, the StockTrader.com Trade Journal was born. This is where I log all my trades, notes, chart images, and analyze performance.
Evernote.com – Free – I love Evernote. Evernote is a journaling and note taking app. My “Stock Research” notebook within Evernote currently has over 350 entries. Journaling has been a critical part of my growth as a trader.
Briefing.com – Subscriptions start at $50 per month – Briefing.com (read my full Briefing.com review) is a 24/7 research service that monitors the markets, social sphere, and beyond to deliver real-time news and a slew of research reports. I started using Briefing.com in 2014 and have loved the service since.
Bespoke Investment Research – ~$400 per year up to ~$2,000 per year –  Bespoke Premium produces institutional market research reports. If you want to make sense of historical data to help breakdown the noise of the market and bring clarity, then Bespoke will serve you well. The Bespoke blog is a good feeler for the content provided to paid subscribers.
StockCharts.com – Free and paid (basic package $14.95 p/m) – StockCharts.com is the site we use to produce all the stock charts for the weekly market recaps here on StockTrader.com. The primary reason we have the basic package is so we can have access to more than three years of chart data and save chart layouts. The free version is the exact same as any paid package less a handful of features. See: 5 Best Free Stock Chart Websites
FINVIZ Stock Screener – Free – FINVIZ’s stock screener is my favorite screener available on the web. See: 5 Best Free Stock Screeners
MarketSmith –  MarketSmith ($999 per year) – MarketSmith is a browser based charting software provider powered by Investors.com CANSLIM data. Besides the easy to read charts and optional auto pattern recognition, the real value drivers are the IBD metrics that display with each chart.
MarketSmith Screenshot
ChartPattern.com – $125 per month – ChartPattern.com is home to Dan Zanger. Read my full Dan Zanger review. Dan has a chat room and sends out a nightly newsletter several times a week with technical analysis and personal notes.
Closing Thoughts
I see investing as a life long game. Every trade is another lesson to be learned and even though I have over a decade of “experience”, I am still learning something new each day. See: 10 Trading Secrets I Wish I Knew When I Got Started.
How was your 2016 in the stock market? What tools and services do you use for your trading? Feel free to email me, “blain (AT) stocktrader (DOT) com” and let me know!
Original article: Tools of the ‘Trade’ – How I Invest (2017 Edition).
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kristinsimmons · 4 years
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Can Startups Save Primary Care?
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By ANDY MYCHKOVSKY
Today, primary care is considered the bee’s knees of value-based care delivery. Instead of being viewed as the punter of the football team, the primary care physician (PCP) has become the quarterback of the patient’s care team, calling plays for both clinical and social services. The entire concept of the accountable care organization (ACO) or patient-centered medical home (PCMH) crumbles without financially- and clinically-aligned PCPs. This sea change has resulted in rapid employment or alignment to health systems, as well as a surge in venture capital being invested into the primary care space.
Before we get too far in the weeds, let’s first begin with the definition of primary care. The American Academy of Family Physicians (AAFP) defines a primary care physician as a specialist typically trained in Family Medicine, Internal Medicine, or Pediatrics. Some women do use their OB/GYN as their PCP, but these specialists are not traditionally considered PCPs. Now if you’ve gone to your local PCP and noticed that your care provider is not wearing a white coat with the “MD” or “DO” credentials, you are either receiving treatment from a hipster physician, nurse practitioner (NP), or physician assistant (PA). Two of the three professionals are trained in family medicine and can provide primary care services under the responsibility of an associated PCP. At least one of the three has a beard.
The crazy thing is, despite the industries heightened focus on the importance of PCPs, we’re still expecting a shortage of primary care providers. In April 2019, the Association of American Medical Colleges (AAMC) released a report estimating a shortage of between 21,100 and 55,200 PCPs by 2032. Given we just passed 2020, this not that far off. The primary reason for the shortage is the growing and aging population. Thanks mom and dad. Digging into the numbers will really knock your socks off, with the U.S. Census estimating that individuals over the age of 65 will increase 48% over that same time period. Like a double-edged sword, the issue is not just on the patient demand side though. One-third of all currently active doctors will be older than 65 in the next decade and could begin to retire. Many of these individuals are independent PCPs who have resisted employment by large health systems.
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Now the easiest solution would be to wave a magic wand and dramatically increase the supply of medical students selecting primary care versus other specialties. However, in the absence of any Hogwarts-trained healthcare enthusiasts, we have to face the realities of today’s medical school situation. 75% of medical school students in the class of 2018 graduated with student debt, with the average loan debt of $196,520. With that loan balance, you’d owe approximately $2,212 a month on a standard, 10-year federal repayment plan. If you compare that with the earning potential, pediatrics and family medicine are consistently among the lowest paid specialties. According to Medscape, in 2019 PCPs earned an average of $237,000, while specialists earned an average of $341,000. That is a big difference. This all despite the fact that according to a Merritt Hawkins report estimating PCPs generated $2.1 million for their affiliated hospitals in the previous 12 months. This referral value to the hospital even exceeded Otolaryngology ($1.9 million), despite the fact the average annual physician compensation for an Otolaryngologist is $471,000.
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The other important characteristic that healthcare economists and researchers have closely monitored is increase in hospital employment and alignment of PCPs versus physicians who own their own independent practices. The fear being that employed PCPs have the potential to refer testing, therapies, and services back to the mothership hospital, as opposed to independent specialists, labs, ambulatory surgical centers, or imaging centers. These hospitals charge considerably higher professional and facility fees, particularly for commercially insured patients. The crazy part of value-based care is that some of the clinically integrated network (CIN) provisions and waivers associated with primary care allow hospitals to align networks of independent PCPs and ensure they receive much higher negotiated rates. Aligning PCP networks to highly motivated and sophisticated health systems who are actively involved in significant downside risk contracts has clear benefits, but the potential for inefficiency and shoring up referral patterns does exist.
Now back to the world of healthcare startups as they relate to primary care. I’ve said it before and I’ll say it again, the successful One Medical (NASDAQ: ONEM) IPO was the single best thing for primary care startups. Yes, they focus on a particular clientele (commercially insured in urban markets). Yes, they are charging a $199 annual fee for access to their care that many Americans cannot afford. Yes, they will likely grow revenue through higher volume and negotiated reimbursement contracts by partnering with health systems, referred to as health networks. However, 3 weeks after the IPO, the company maintains a market valuation cap of $2.8 billion with nine months of net revenue equaling $199 million and $34 million is losses during the same time period. That is impressive and should be encouraging for current PCP startups.
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There are a ton of other primary care focused startups and companies that should not be overshadowed. Each takes on a slightly different approach, whether they focus on a specific population (e.g., Medicare Advantage), actually employ physicians themselves, or serve as administratively- and clinically-aligned vendors for networks of PCPs. I strongly believe in the value of these organizations using technology-driven communication, remote monitoring, home care, and intensive wrap-around care management services for complex populations to offer a new model of care.
If there was ever a downside for creating the primary care-led revolution towards value-based care, I believe it would be the production of charlatans claiming to “primary care consultants” or point-solutions that only affect a sliver of the problem. I see lots of claims related to SAAS startups who utilize an AI-based, machine learning analytics program that spits out a list of high-risk patients. After many years trying to squeeze clinical and financial value out of total-cost-of-care models, that is no longer enough. In my opinion, PCPs should seek partners who can not only provide technology, but also have clinical resources and are willing to stand by their performance in terms of compensation. No guaranteed PMPMs if performance doesn’t add measurable and definitive value, unless the organization is willing to take downside risk exposure. They also need to help your PCP organization understand how to set the rules of the game in your advantage. Otherwise, you will never win regardless of performance (e.g., trend rates, minimum savings thresholds, rebasing, shared savings, etc.).
Now I’m not claiming I know everything, but my experience was borne out of helping health systems and physician groups across the country manage total-cost-of-care contracts in Medicare fee-for-service (FFS), Medicare Advantage, Commercial, and Medicaid managed care while at Evolent Health. For those unaware, Evolent Care Partners is a solution focused on enabling independent PCPs with the capital and resources needed to participate and succeed within two-sided contracts. In addition to Evolent Health, there are a bunch of other primary care startups that I appreciate. They did not pay me (although I should’ve asked before), but here are a few startups that I would research before thinking about primary care in a value-based care world.
One Medical: Provider for Commercial
Iora Health: Provider for Medicare
Oak Street Health: Provider for Medicare
ChenMed: Provider for Medicare
Privia Health: Population health management partner for primary care
VillageMD: Population health management partner for primary care / provider
Aledade: Population health management partner for independent primary care
At the end of the day, primary care still receives a pitiful amount of the total spend in healthcare. The best estimates believe only 5-7% of healthcare spending devoted to primary care. In a RAND Corporation study, researchers predicted 2.12-4.88% of total Medicare fee-for-service medical and prescription drug spending. However, the power of referral, care management, and addressing the social determinants of health (e.g., housing, food, transportation, etc.) holds the promise of a better tomorrow. I am hopeful that the trends over the past few years will continue and new startups will be developed that further innovate on the $260 billion primary care market in the U.S..
Andy Mychkovsky is the creator of Healthcare Pizza, where this article first appeared.
The post Can Startups Save Primary Care? appeared first on The Health Care Blog.
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