I was wondering, would I benefit upgrading to a cable higher than cat 5 for my mini pc? I use nordvpn and with that, my pc gets ~600mbps down, ~850mbps without the vpn. My mini pc sit right next to the router and has a link speed of 1gbps. With the vpn on, would I be able to get a decent bit closer to the cap if I upgraded the cable? 

I currently have the xfi unlimited plan with their provided XB8-T. When testing the gateway through the app it tends to average around 1.4gbps.
Also, if anyone happens to know, how is Xfinity on their unlimited plan? Is there a specific monthly limit I should try to keep my usage under? Let me know if you have any questions, thank you!

Disclaimer:
This post has heavy spoilers to the story of the version 2.2 and maybe to something else. Good luck to read all of this. I yap for Ena and maybe repeat myself little too much. Mentioned characters:
Sunday
Robin
Aventurine
Dreammaster
Bronya
Seele
Cocolia
Mentioned Aeons:
Ena
Xipe
Hooh
Long
Oroboros
Qlipoth
Mentioned organisations:
Beyond the Sky Choir
Astral Express
Family
In loving memory: Ena the Order “The one who transcends the many”
In loving memory of Tazzyrronth the Propagation “The Sand king”
In loving memory of the Great Tatalov “The Garbage King”
So, the original intent behind this post was to create a lot of puns about Order and Sunday (for example something like Golden Order Radagon Sunday, “I will have order” with Sunday and a falling train instead, Sunday working in a delivery and saying that someone’s order was cancelled).
But then I started remembering all parts of Penacony storyline that have fascinated me. And one particular part master stroked me. When Sunday used his “tell the truth or die in 24 hours voice magic” he used not the power of Order, but Harmony – the Path he supposedly deliberately left behind and betrayed.
How can I be so sure, that he didn’t use the power of Order, making it look like the power of Harmony? Well, nor Dr. Ratio, nor Aventurine, nor Welt, nor (most importantly) Robin didn’t notice any sign that the Order was used and that the power on display did in fact belong to Harmony. And mind you, all of them are quite clever, experienced and hard to deceive. And in Aventurine’s conversation with Acheron in the Horizon of existence, Acheron (who as Self-Annihilator isn’t affected by the illusions of Order and can see through them) referred to the brand, used on Aventurine as the “brand of Harmony”. And the last proof is that when Sunday uses this power, he makes a call (or if you are a pun enjoyer like me, “an order”) to Xipe, referring to THEM as “Triple-faced soul”.
So, this was a really long and a roundabout way to prove that even with his supposed devotion to Order, Sunday still remains the Pathstrider of Harmony (and the laws of the HSR universe dictate, that you become a Pathstrider by following a philosophy of a particular Path). While being a Pathstrider of two Paths is not called impossible in the game, and Harmony and Order mostly overlap, there are some key differences between them. It means, that Sunday to some extant still believes in a philosophy of Harmony and is not a complete devotee of Order, how some people could have believed.
So, the goal of this post is to delve on the philosophy of Ena and Harmony through Sunday’s story, words, thoughts and actions. And to make some obnoxious theories, but that’s later.
So, let’s begin!
Ⅰ
In his childhood, Sunday alongside Robin, was called by the Dreammaster “two best interpreters of the Great One”. That means, that as a child, Sunday was extremely close to the philosophy of Harmony.
Let’s remember what Harmony embodies as a philosophy:
“Then, they say, O you who have reached the end, enter into the paradise that envelops all! Join this great choir and feast, listen to the beating of billions upon billions of hearts, holding you in THEIR embrace...”
“To battle the brutality of the laws of the universe, intelligent lifeforms must discard their cowardly selfishness and the differences between individuals, fusing into one singular melody — to have the strong help the weak, and to protect life with death.”
That is what Harmony preaches and Sunday was a follower of this ideology. Harmony preaches selfless people not only helping and uplifting each other to build “the paradise” (a prominent theme in Sunday’s thoughts) bit also welcoming every other willing person. Harmony philosophy is about acceptance, forgiveness, cooperation, that no person is beyond redemption, that in every person has inside of them the force that genuinely cares for others and strives for good. Harmony preaches something like this: “Because if it is possible for every person to become a member of Family’s shared paradise, then we should at lest try to welcome them in it.” That’s why Harmonic Strings (Emanators of Xipe) are not people and are actually manifestations materialized as the responses to the Hive Mind’s demands. It is a seemingly naïve and romantic ideal for the sometimes and indifferent brutal universe of HSR that requires great kindness, compassion, understanding, belief in other people, ability to see the better in other people and uplift them. And Sunday-follower of Order reflects on that:
"When I appeared as a child, my speech, mindset, and soul reflected immaturity and innocence."
"As I grew into adulthood, I left behind my childlike side."
Sunday (as shown in the quest) was a person of great understanding, compassion, and love for other living beings, full of desire to protect them (bird, Robin, other people). He was able to embrace even the worst people if they would show even the slightest glimpse of desire to redeem themselves and change for the better, like people who allegedly sold their own children. It is notable that he both acts as a follower of Harmony and an enforcer of Order conspiracy because of these very character traits. The motivation is the same, just the choice how to act based on this motivation is different between him and Robin because of different experiences.
As the ardent believer of Harmony, the seed of doubt in his mind was planted ironically by the very followers of the Harmony -the Family. And the disillusionment about Harmony also began, when his belief in other people was tested. When asking Xipe to clear his doubts, Sunday asks three questions:
“Who can judge the strong when their power hides their crimes?”
“Who can vouch for the weak when they will pay any price to survive?”
“If "the strong defending the weak" is truly the foundation of paradise, then who is responsible for the suffering and anguish in this wretched world?”
The questions display that the preached Harmony doesn’t work as intended. The extremely hard ideal to follow was exactly too demanding for numerous people who couldn’t stand up to the responsibility that came with upholding it. Also, as displayed both in the main quest of Penacony and in numerous events and side quests, flaws and imperfections of Family(note: of the Family on Penacony) are numerous. We have an entire “Ode to Fool” in the Grand Theatre about internal bloodthirsty war between the Family, where two of the seven families of Penacony ceased to exist. When even Family: those who preach the Odes of Harmony don’t act as they preach, are not harmonious, don’t show compassion and forgiveness, it is extremely hard to still believe in its teachings. And from that, the belief in people starts to slowly crumble as the very belief in a possibility of a paradise preached by the Xipe, is tested.
That is what turns him to Order. The feeling that while the paradise of Harmony is theoretically possible, how much suffering must people experience before it actually arrives. And when will it arrive? And IF it will arrive? These doubts in human inherent desire to change for the better leads to the idea: “And what if they don’t change? Then why take the risks? Why not to create something that guarantees their safety, happiness and protection?” His desire for Order is still born from his love for humanity.
Ⅱ
And while the shift in beliefs did in fact happen, it wasn’t completed and some beliefs in Harmony remain, alongside doubts about the philosophy of Order.
To prove that, let’s remember the Grand Theatre part of the quest (“Everything that Rises Must Converge”).
Before that Dreammaster has a particularly interesting conversation with Sunday. Sunday not only changes their plan, taking Robin’s place in the plan and then he asks Dreammaster why Penacony was the chosen planet to bring “paradise” of the Order. If he was completely convinced, why would he pose these questions?
Sunday several times brings the part of 107,336 souls of the Oak Family in his monologues. Why? Because he uses them to give self-validation to his beliefs. It comes not only from his desire to grant “paradise” to everyone (and this guys as stated dreamed about the paradise of Order), but also from his self-perceived responsibility as the Head of the Oak Family to stand up to wishes and desires of his subordinates, to protect them, and as the man with greatest position among them, to fulfil the hardest task. Because if people he is in charge of follow and support his views, not only it gives him more belief in his set of beliefs(ha), but also gives him even greater responsibility to prove that their faith in him, in Order is not misplaced.
In first two acts he displays before us shortcomings of the Harmony, trying to display himself as the ardent believer of the Order:
In the first act “Ode to Prisoner” he says that the freedom was not really achieved in Penacony’s great Independence War, posing a doubt that the ideal of Harmony even existed in Penacony since the very beginning.
In the second act “Ode to Fool” the theme of not so harmonic Harmony remains. Sunday talks about internal civil war between the Family, that eradicated two of the seven families on Penacony. How “harmonic” it is!
But in the last and most important act “Ode to Order” has a surprisingly different theme, hidden in it.
It is supposedly talking about the future of Penacony, but there is something more if you listen to its content once again:
General: “Without a ruler who would protect the weak and fight back against the tyrants?”
Chansellor: “We must assist each other in protecting the weak, just as we must assist each other in opposing the tyrannical.”
This dialogue argues that the very measures Sunday preaches, are not required for the coexistence and unification are also an option. Case of how differently Order and Harmony solve one problem.
Jester: “Without a ruler, who will make the stars follow their paths, the tides rise and fall, and allow life to grow?”
C: “These things did as they will long before the ruler appeared, just as they will continue to do with rulers gone.”
Where the Order requires an all-mighty divine king, controlling the world (like God-Emperor of Mankind from Warhammer), Harmony simply says that actually such beings are not needed.
Minister: “However, now that we have bid farewell to our ruler. Who shall take their place?”
C: “We no longer require a ruler, for we were originally all rulers who stand above all things.”
Once again, order preaches about the ruler on the top of everything, the one who has all of the rights and makes all of decisions. But harmony doesn’t work that way. Harmony preaches that if every person has equal rights to enter its paradise, then they are essentially equal. Where Order differentiates people and treats them differently according to THEIR criteria, harmony does not as THEY are all-embracing.
The choice of the position of Chansellor as the one giving answers is deliberate. It is another innuendo on differences between Harmony and Order. In Order king takes the power and pushes everyone under his control. Chancellor, as the representation of Harmony in this argument, is a position not a person. He is subject to change, unlike king. Unlike king, Chancellor is chosen among the people, by the people. He serves as one man being the voice of many people, for they have chosen him as a Chancellor because their ideals are the same and thus, they have entrusted him to fulfil their ideals in reality in their stead.
Some people were not satisfied that the arguments were not posed against Sunday by the Astral Express. Well, this entire act serves as a counter to his arguments, showing the point of view of Harmony arguing against the necessity of ideals of Order. Most importantly, they don’t disprove hid arguments completely, but rather pose a possible alternative take on things.
The Clockwork doesn’t work on puppets because they are “satisfied”. But what gives satisfaction: Order or Harmony? In my opinion, Harmony. Remember: in THEIR paradise there is “peace bestowed, sorrows and strife released.”
The “king” in the text obviously refers to Ena the Order, and the last talk from the “Future” in the act is about “final rites” to the king, that there is no need to seek THEIR existence, nor remember THEM. It illustrates the final confusion of Sunday: if Ena didn’t fight back while being consumed, if the philosophy of Harmony prevailed in the confrontation among the Paths, why try to restore the Order?
And after that particular act he chose to reveal to us the finale of Ena’s story. That THEY were banished to oblivion by the united will of the people who defied Order. And THEIR death was praised alongside praises for the appearance of Harmony – the ideal that prevailed on Penacony in the end.
And that is what actually 3 is actually about. Puppets(Members of the Beyond the Sky Choir) ask what they and everyone else should do after the “king(Ena)” disappeared.
They feel no safety and out of their comfort zone when the one that controlled everything about their lives suddenly disappeared. And Chancellor’s answers are the representation of the ideology of Harmony, that you don’t need to be controlled to strive in life, for that there is more to universe and that the “king” is not actually required for betterment of society, that society can harmonize and evolve on their own, that the unity of people can replace the “king”. Ironically, “the Ode to Order” doesn’t glorify Order but rather disproves it from being the one and only universal truth.
In this act Sunday actually reveals, intended or not, that he doesn’t disprove Harmony’s ideal, that he subconsciously feels that it can stand on par with the ideal of Order.
Then, Sunday poses between us three questions, each one has different answers depending on your set of believes: order or Harmony. Notice, that Sunday doesn’t give his own answers to the questions.
“Is darkness equal to daylight?”
This question is very metaphorical. Radiance and light, eradicating darkness and giving protection to those under the light are a repeated theme in the ideology of the Order (“I shall ascend to the heavens, becoming the scorching sun. Bathed in my light, my people shall flourish, while all evil shall be eradicated” / “Those who live in the shadows do not bear the right to tread the illuminated stage.” / “I now permit you to gaze into the sun [hardest line in the game btw]”) But radiance is also a term sometimes used to describe Xipe. The greatest difference lies in the fact that what Order will not tolerate (“darkness”), harmony will be able to co-exist with and eventually embrace. So for Order they are different, but for Harmony not at all.
“Are sinners equal to the righteous?”
Order punishes the unjust and uplifts the righteous. For it, they are not equal. But for Harmony they are, mostly because before Xipe the very concept of sinners doesn’t exist. Harmony is all-embracing, for everyone can change for the better and be redeemed.
It is a discourse in philosophy: first question was about whether are you able to tolerate something that goes against you. While Harmony can, Order cannot (Sunday can as literally shown in the quest so he leans more to Harmony in that part). Second question was about whether people can change for the better and be redeemed. Order doesn’t believe in it, Harmony does.
“If you are born weak, which god should you turn for solace?”
It is another question to choose between philosophies because Sunday struggles to choose himself. If you are weak and you bow before someone(“king”) for the protection then this is a choice befitting Order, but if you choose to cooperate with others, uplift one another and “listen beating of billions of hearts holding you on their embrace” then this is the choice of Harmony.
Notice, that Sunday doesn’t consider us as enemies at all. As he says: “I genuinely wish to avoid a violent clash with my esteemed guests from afar.” When Astral Express team asks Sunday why did he invite us to the duel, he responds: “Because our shared goals give equal weight to the beliefs we strive for.” He regards everything happening more like a debate of two equally valid philosophies. Even in the fight with him (second one) he still invites us to join his chorus of Order. And he says “our final talk is concluded” only when he turns into his Embryo of Philosophy form, when literally everyone who could has risen against him. And then he reveals his true emotions:
“If your ‘paradise’ can save more people, sever my path with your hands”
He knows he is not infallible, that his plan can be wrong, that there is a possibility of making better choices, better decisions. And he asks us to prove, that Harmony after all is a stronger concept then that of Order. And his quote before that really makes everything extremely ironic:
“If we had never experienced solitude, how could we embark on different paths?”
Once again, this solitude refers to the times when he still completely followed Harmony. Yet he was the only person on the entire Penacony because of his great compassion, who actually followed what Xipe preached. Yet, in this he was alone. How can you be in Harmony with anyone, if you are alone. The irony is in the fact, that if Robin didn’t leave Penacony, of if he met another genuine believer, he wouldn’t have turn to Order and he would remain under Xipe. With many similarities of Order and Harmony: the epitome of Order is loneliness, being a sole ruler of everything, the epitome of Harmony is a unity of numerous people.
“And thus, my talk about Sunday has concluded. Next part is about Ena.”
Ⅲ
While his monologue about history of Ena can also be interpreted as parts above, it is much more interesting to discuss it when talking about Ena THEMSELVES.
“Let us commence with the dawning of the world… After the Dusk Wars, darkness veiled the sky, and chaos consumed the earth. Ena the Order emerged, destined to restore all existence. That marked the first day.”
The Dusk Wars are one of the most ancient (if not the most) periods of history we know about. Ena emerging at that time, makes THEM one of the oldest Aeons alongside Long, Hooh, Qlipoth and Oroboros.
” THEY gathered nebulae and forged them into picks, thus creating a grand lyre with black and white keys. Strike the white keys, and the sun rose. Strike the black keys moon and the rose. And so the cycle of day and night arose. That marked the second day. “
“THEY transmuted streams of stars into inked nibs, creating symbols to be pronounced and counted. THEY molded stardust into flowing rivers, assigning the righteous upstream and the unjust downstream. Thus, all things were marked and the world learned to discern between good and evil. That marked the third and fourth days. “
“THEY used the planetary rings to establish the law, forging a code of conduct among the masses. A grand lyre with black and white symbols of articulation and numerical notation took the form of musical notes. The downward-flowing river became a melody, and the cannon of law dictated the form. Thus, all mortals found their unique place within this symphony. That marked the fifth and sixth days. “
Ena, as we know was a control freak, at much bigger scale and extent, then Sunday could have ever hoped to become. We know that «Ena's harmonic songs seems to align within a three-dimensional framework, akin to an emperor maintaining hierarchical order among all creatures» Not only people, but the movement of celestial bodies were under THEIR control. THEY wanted to and almost controlled everything in the known cosmos. So, THEY were the only person responsible for everything. And when THEY were consumed, the manager of everything disappeared and the scales of order and discord lost their balance. That is why Hooh intervened and took THEIR responsibilities.
“THEY imbued world with meaning, perfecting all things in the heavens and earth. Then, THEY rested from the labors of creation. Yet, all beings cried to Ena – ‘Under the banner of the Order, you have defined all things in the Cosmos… but this made us realize that we are but puppets in your hands!’ – Thus, on that day, all beings united and cast the Aeon into the abyss of oblivion. That marked the seventh day. “
And this is the most interesting part. We know that Ena was consumed by Xipe, so why does Sunday refer to THEIR death as an action, made by humans?
As we know, Xipe “hails from multiple harmonious celestial words”, “a plural Aeon” and “THEY are the amalgamation of thousands of entities”. Thus, I pose that Xipe ascension was not a process of accension of a one person who somehow become an Aeon, but rather that several beings in a moment of unity (of “harmony”) were ascending as one. Next bit is purely theoretical:
But who could provide such unity before the existence of Harmony? Only the Beyond the Sky Choir – followers of Ena could understand the true extent of Ena’s control over everything and unify to create a change. Thus, mortals ascended into Aeon, befitting their shared beliefs, and from the Beyond the Sky Choir, Xipe arose with a new symphony of Harmony.
ⅠⅤ
Also, some other interesting bits from 2.2. storyline:
The most overlooked part of 2.2 quest for me is that part before boss battle when Sunday says that he doesn’t intend to either resurrect Ena or become a new Aeon of Order. While the actual possibility of such actions remains “enigmatic, we can now speculate that it could be possible to take control of a masterless Path or revive its master. I speculate that when we finally reach strongest Emanators level of poweallies/etc. the enemies we will be facing before actual Aeons will be unique beings like that: fallen Aeons in the process of resurrection or people in the process of becoming a new Aeon of a Path without one.
Another interesting bit of lore about Ena is that while she was “consumed” by Xipe, her Path still lingers in the cosmos masterless. While it was known about Paths of other fallen Aeons it is interesting that even assimilation by a broader concept Aeon isn’t enough to completely eradicate the Path from the face of the cosmos.
Some other connections that I noticed about Sunday while rewatching 2.2 quest were surprising even for me. Name a planet where the ruler intentionally left their subordinates in ignorance about the truth about the events for the sole reason of protecting them? It’s Belobog with Bronya and Seele (I could talk about similarities and differences of Bronya and Sunday but that would make already long post even longer). And this is why Ena was able to persuade Qlipoth. Because Qlipoth shares with THEM that general theme of protection. Because their Paths partly overlap. Because Preservation is about keeping everything dangerous behind the walls (in this case dangerous information about Cocolia), and everything inside the walls is safe, protected, or you could say “in Order”.
Ⅴ
P.S. I feel like in this quest there is still so much more to discuss(and I could write EVEN MORE), but this long wall of text is already too out of character from me as a humble follower of Enigmata.

I have a student who is repeating my phd course. She failed because she did not study and continuously submitted her work late (which has penalties). It was not even a close call.
My course has a lot of assignments (homework, quizzes online, pieces of papers, a big paper, a presentation), and several tests and remediation tests.
The student has badgered me for a copy of her exams with the answers; I of course said no, but invited her to come in to look the exam over. Student is the type to take copious notes for hours, so I am expecting that to happen.
We have very small class sizes and we are pretty new, so I do not yet have a large database of questions to pick from. I need to balance them carefully as to not make it harder for one class over another.
That also leads me to wonder if I should make all new quizzes, homework, and tests?
It does not seem fair that this student is able to reuse her paper (however horrendous it was, it would still be a lot less work reworking it), and she could reuse the homework solutions (I post those online after going over them in class) and quiz solutions (I open all those up before the exams). She could even recycle her presentation.
Do I demand she write a paper on a different topic than before? If so, what do I base that decision on? We have no guidance in writing about this; she slipped through the mazes of the net TBH.
What do you normally do?

Hi! My husband (28M) and I (28F) will be seeing an RE for the first time next Wednesday. We have experienced two back to back miscarriages in the last 6 months (no LC). We have no idea what to expect nor did we ever expect to be in this situation. I seem to have no issue getting pregnant, but I can’t seem to stay pregnant. Do any of you have advice on questions I should bring up to my RE during our initial visit?
My pathology report from my first miscarriage (d&c) came back genetically normal. The contents of my second miscarriage were not tested due to using miso to pass at home.
I haven’t had any other testing done, but I know that will be the first step. The only thing that has come up during routine doctors appointments is endometriosis, but my symptoms are not severe enough to get further testing according to doctors. I have had pain with any sort of penetration from the time I got my period around age 12/13. That and bloating/constipation seem to be my only symptoms. Should this be something I push to find out?
Thank you all in advance! I feel so lucky to have found a group of others who are going through similar situations.

Hey yall, currently running a somewhat remixed version of abomination vaults for some close friends while also being a player in a separate group. We've been having a lot of fun so far in both groups, but one thing that comes up a lot is that there's a lot of "nothingburger" fights. We're using milestone leveling, and so as a GM, I've been removing or replacing some fights as needed.
For example, we're slowly exploring floor 3 right now, and I removed the>! violet fungus fight and replaced it with a plothook involving a buried alive osprey thieves guild member, and I made the Lurker in the Light an actual NPC the group can converse with and possibly recruit for the floor 4 voidgutton fight (who it hates with a burning passion). I also plan on replacing the wood golem fight on floor 3 because golem anti-magic has always been kinda unfun, and I have an excuse to shoehorn in a pesudo-crossover with another game I'm running in the same server via a volatile teleport spell, ending in a fight against a custom monster I made for that game (gotta get that testing data somehow...).!<
My question, as the title suggests, is that, as a player or a GM, what fights would you have edited, replaced, or outright removed? We ARE using milestone leveling as a reminder, so experience points are not a concern.

Hello everyone!
Pardon my English, it is not my first language, but I don’t know what else to do. I’ve had colitis since I was 13 and right now I am 22, turning 23 in June. My colitis has been kind of mild to moderate with it’s ups and downs, but since autumn 2023 I have had more flare ups than ever and they usually cause me lower abdominal pain, diarrhea, nausea and bloating. Lately my overall gut health has been worse, I have upper abdominal pain as well and I feel most of the time like I need to vomit, but never do. I bloat, I need to use bathroom more frequently. Why am I telling this? I got my stool and blood tests done a few weeks ago, last colonoscopy in September and the doctors said despite the small inflammation, everything looks fine and blood work is the best I have had in years. So my question - why do I feel so shit if everything is supposedly nice and exceptional? In addition to this, my gastroenterologist booked me another visit in the end of May for gastroscopy and colonoscopy to figure out, what is going on, she said “Maybe you have Crohn’s, but who knows?” I have been using mesalamine tablets all my colitis life, nothing else.
I have many questions and since I come from a small place, I have no support system, no one who understands the pain and the fears I have regarding this disease.
Does anyone have any experience with misdiagnosis or thinking having colitis, but actually has Crohn’s? Is it worse? Also - are other, stronger drugs actually worse and more damaging? I think mesalamine is kind of the mildest drug out there for colitis and I am scared to use anything else. I am a big fan of eastern and herbal medicine, so if anyone has any recommendations I am really open to this as well in addition to western medicine and pharmaceuticals.
Sorry for the long text. I feel like I am really alone in this although I have an amazing family and boyfriend, but they will never understand the pain of having IBD while you are supposed to be young, healthy and social young adult enjoying her 20s.
Thanks for any help and thoughts, this group has given me a lot of food for thought and helped me realise that I am not so alone in this.

So I had a terrible lesson today with my year 8 top set class as I had mixed up some properties of hydrocarbons (i’m teaching science) and i completely blanked out as to which are the correct answers. This was a revision lesson before a test I’m a PGCE btw and i have a job lined up in the school i’m at placement at. Anyways, I got really confused and tried to pause and think by myself but i still felt so confused and started to get overwhelmed as the kids were making fun by saying I didn’t know what i was doing.
I then tried to show them which answers were correct but I got them wrong and The actual class teacher who sits with the class told me I got it wrong and if she should get me a textbook. I then had to copy from the textbook to ensure the kids got the correct answers. Needless to say, she was very stern with me afterward and told me it’s unacceptable to turn up to a lesson and “wing it” - bare in mind i was super tense and felt like i couldn’t think in that moment. I told her i didn’t wing it and i did my research before teaching I just got confused in that moment, she told me i should’ve kept cue cards with me. She then told me my subject knowledge is too weak and they’re a top set class who will hold it against me and question whatever i teach them. She seemed very angry.
I was just wondering what i can do further on as I am quite concerned. I have 3 weeks till my course finishes and a mistake like this might affect if i pass! I also know she will inform my mentor who already has concerns with my pace of lessons with my top set classes. I really don’t want it to affect my course as I only have a few more weeks to prove myself. How can I improve and make a big turnaround in 3 weeks? And how should I adress this mistake in future lessons?

I spoke with our geneticist already but wanted to hear if anyone has gone through something similar before or if any genetic specialists can help me interpret the situation.
Our microarray results came back normal HOWEVER the geneticist called us to explain that :

• when they initially ran the test with the direct cells taken from the amnio, "There was a 400kb deletion of a clinically significant gene (NBEA), but the log ratio is not as deep as we would typically expect." < in other words, not a clear deletion but system did flag it
  
• they cultured the cells and ran the array test again as well as a FISH on that specific region and both tests were normal. Notes say: "We do see a region of absence of heterozygosity at this locus in both the fetus and mother, which we think may have triggered the software to overcall it as a deletion"
  
• based on this, they reported back a "Normal" result but wanted to let us know of the earlier finding because it's a genetically significant finding associated with a rare but severe neurological condition. Also, technically there could be a difference between the cells in the direct sample vs the cultured one.
  

The only option they gave us to get more assurance on this is to do another amnio so they can run a FISH on that specific area.
My thinking/questions: - it sounds like the genetics team has already done a lot of due diligence to confidently say its a false positive, so the chance this is a true positive is very low (probably lower than risk of another amnio?) - on the chance of direct cells giving a different result than the cultured cells, don't a lot of microarrays get done based on cultured cells anyway? - should we even be worrying about this based on everything we know already? For context - 4.6mm NT, normal expanded NIPT, normal 16 and 20wk anatomy scans and fetal echos, normal FISH results on the 3 trisomys and sex chromosome
Any thoughts/opinions would be appreciated!

About two months ago I started having stomach aches/cramping, changes in bowel habits and a feeling like something was stuck or like I wasn’t done even if I’d just gone to the bathroom or knew I didn’t need to go. I went to a GI about two weeks later and she said it could be colitis or IBS, she called for a FIT test and blood work (both came back normal) and a six week diet (two weeks gluten free, two lactose free and two fodmap). While the stomach pains went away, the changes in bowel and the feeling of something stuck or incomplete did not go away. I had a follow up yesterday and now she has ordered a colonoscopy for a month from now. She mentioned it could be internal hemorrhoids or colitis and also said she’s not worried but still wants to go in and look. Even though she seems unconcerned I am terrified. My worst fear is that it could be something much more serious and that diagnosis is taking too long. My question is do those of you who have experienced similar symptoms agree with her assessment or could my fears be valid and I should do more to get answers sooner? All thoughts welcome, thank you in advance.

Hello Folks. I am planning to apply this application cycle and find myself in a predicament after receiving my mcat results recently. To provide you context, I was a psychology major in college and completed all the standard pre-medical classes except for biochem which I self-studied for mcat prep. I went to a small liberal arts school where I had a GPA of 3.78. I generally did very well in my pre-med courses except for gen Chem where I struggled early in my college career. My mcat prep spanned a 6 month period with total hours studied at 760 hours. Below are my results of my practice exams in order:
11/18/23: Blueprint diagnostic: 502 ; 12/1: BP FL 1: 504 (126/125/125/128); 12/8: AAMC FL1 505 (124/127/125/129); 12/15: AAMC free scored: 502 (125/124/124/129); 12/29 BP FL 2: 505 (126/125/126/128); 1/5: BP FL3 504 (125/126/126/127); 1/19 AAMC FL2: 504 (125/124/126/129); 2/9 BP FL4 503 (125/125/125/128); 2/16: BP FL5: 505 (124/127/127/127); 2/23 Princeton demo 499 (123/125/123/128); 3/13 BP FL6: 502 (125/124/125/128); 3/22: AAMC FL 3: 509 (126/127/127/129); 4/5 AAMC FL4: 505 (126/125/125/129); 4/7 AAMC FL unscored: B/B (127 concerted), CP (127 converted)
Actual Mcat 4/12: 501 (127/123/125/126)
After each practice exam, I took the advice of many successful test takers and recorded the questions I got wrong and added new flashcards to the milesdown Anki deck. I also purchased the uplanet mcat q-bank and did every single question and re-did every question until I got 100% correct for all sections (except for orgo since I ran out of time). I generally studied like it was a full time job, around 5 hours each day over this 6 month period. Also, I did all the AAMC question packs. For section banks, I was around 65% for all 3. And for the bio volume 1 and 2 questions I was at high 70 % on both. For the independent Q's I got >80% on all sections. For chem and phys practice q's I was at about 70-80%.
My goal entering mcat prep was to study extremely hard to try to achieve my goal score of 515. I'm honestly shocked at my actual mcat score and don't really know where to go here given how much time and financial investment into preparing.
I am considering retaking the exam, but wanted to gauge opinions and when would be the latest I could retake with this current application cycle. I essentially have my primary finished already and was planning to submit in the first week of June once I got my mcat back. Thank you for any advice.

I think the title explains it. Here are the facts:

• on 11th May my partner tested for pregnancy and was positive. Same day we went to the doc got the consultation done and ultrasounds shows the gestation period as 6week 2days.
  
• according to my partner her last period was around the date April 10th (I witnessed the bleeding as I was with her)
  
• According to the ultrasound the date comes as 28th or 29th March
  
• my partner was not with me from March 21st night till April 3rd
  

My questions:
1) How accurate is the ultrasound? 2) What could I be missing here? 3) I don't want to jump to conclusions but what is the likelihood of it being mine vs someone else
I encourage you to also highlight to me the points for both it being mine and it not being mine. Thanks in advance.

About two months ago I started having stomach aches/cramping, changes in bowel habits and a feeling like something was stuck or like I wasn’t done even if I’d just gone to the bathroom or knew I didn’t need to go. I went to a GI about two weeks later and she said it could be colitis or IBS, she called for a FIT test and blood work (both came back normal) and a six week diet (two weeks gluten free, two lactose free and two fodmap). While the stomach pains went away, the changes in bowel and the feeling of something stuck or incomplete did not go away. I had a follow up yesterday and now she has ordered a colonoscopy for a month from now. She mentioned it could be internal hemorrhoids or colitis and also said she’s not worried but still wants to go in and look. Even though she seems unconcerned I am terrified. My worst fear is that it could be something much more serious and that diagnosis is taking too long. My question is do those of you who have experienced similar symptoms agree with her assessment or could my fears be valid and I should do more to get answers sooner? All thoughts welcome, thank you in advance.

My details:
35M, 5’11, 280lbs, Caucasian, confirmed diagnosis of hypertrophic cardiomyopathy (apical variety) and essential hypertension (controlled), currently taking 2.5mg bisoprolol and 7.5mg ramipril, I do not nor have ever smoked, I do not drink alcohol, I do not nor have ever used recreational or performance enhancing drugs, UK.
Context:
I was diagnosed with apical HCM after several heart tests. My ECG is here if it helps. To manage my hypertension and HCM symptoms, I’m on bisoprolol (2.5mg) and ramipril (7.5mg).
I don’t have syncope. I do not suffer from breathlessness during regular activities (but obviously get out of breath if I'm exercising). I sometimes experience chest tightness (not pain) while exercising, however this does not occur if I train in a fasted state (which I find odd). I occasionally get palpitations but no other known heart rhythm issues.
My cardiologist’s care is slow-moving, and I don't have direct access for queries. I need advice on safe exercise with HCM. Post-diagnosis, the cardiologist advised ‘light to moderate’ exercise, but I’m unclear on specifics.
Although overweight, I was previously very active. I did hiking, sprinting, e-biking, and powerlifting. However, since my diagnosis, I've been seriously put off exercise given the risk of SCD with HCM. It is my understanding that walking, hiking, and biking are fine if I keep an eye on my heart rate (target under 140 BPM). I also understand powerlifting and sprinting is out as these are high intensity. However, I’m unsure about resistance training more broadly and would love some advice.
Questions:

1. Is it advisable for me to perform any form of resistance training, considering my age (35) and desire to maintain strength and mobility into older age? While I understand that powerlifting (high weight, low rep, with Valsalva manoeuvre) is off-limits, could I participate in high repetition, lower weight resistance exercises without Valsalva manoeuvre?
2. I’m puzzled about why maintaining an average heart rate of 130bpm during a 30-minute bike ride or walk is deemed safer than a light whole-body weightlifting session that also keeps my heart rate at 130bpm. Am I overlooking a factor other than heart rate that makes certain exercises riskier for someone with HCM? If so, what is it?
3. I appreciate this forum may not be able to provide me an answer at all. However, if you cannot provide an answer to the above two questions, would you be able to tell me if there specific tests or tools that could clarify whether I can safely continue weightlifting with HCM? I’ve heard of athletes with HCM who still compete, suggesting there are methods to assess this. Knowing about these could facilitate a productive discussion with my cardiologist and allow me to request a referral.

I would be grateful for any help you can offer. Thank you.

Mast cell activation syndrome (MCAS) is the subject of heated debate. How are mast cell activation syndromes defined? Which diseases are included? What is the diagnosis and treatment of mast cell activation syndrome? Prof. Dr. Knut Brockow, Clinic and Polyclinic for Dermatology and Allergology at the Biederstein, Technical University of Munich answers these questions in an interview with MeinAllergiePortal.
Mast cell activation syndrome: The most important facts!
-The prototype of mast cell activation syndrome is recurrent anaphylaxis
-Other forms of idiopathic mast cell activation syndrome are being sought; however, there are mainly symptom descriptions where the diagnosis cannot be made
-Clinical suspicion of MCAS is based on recurring allergy-like symptoms on the skin, nose, respiratory tract, gastrointestinal tract and circulation
-The diagnosis of MCAS is made according to recognized international criteria based on three criteria
-MCAS is often suspected even when symptoms are inappropriate and the diagnosis is unclear; the suspicion is then not helpful for patients
-The same medications are used to treat MCAS as are used to treat allergies, in particular antihistamines and cromoglicic acid
Prof. Brockow, what kind of disease is MCAS?
Mast cell activation syndrome is not an established diagnosis, but rather a concept. Historically, this concept arose because an increasing number of patients came to the doctor's office with complaints that gave the impression of having been triggered by mast cells. These patients sometimes showed symptoms similar to those of allergic reactions, anaphylaxis or mastocytosis, but a clear diagnosis for these diseases could not be made. Nevertheless, it was suspected that there could at least be a connection with mast cell diseases. Unfortunately, the term MCAS created more uncertainty than understanding. This is because MCAS is now thrown around as a diagnosis for many patients with many symptoms and an unclear diagnosis. This is not helpful for patients and fuels short-term hope of diagnosis and cure, which cannot be fulfilled later.
Is MCAS an autoimmune disease?
No, in autoimmune diseases mast cells are not primarily involved and not as lead cells, but lymphocytes that attack the body's own structures, in some cases by forming antibodies.
Is there a connection between mast cell activation syndrome and autoimmune diseases?
No, there is no known connection between MCAS and autoimmune diseases. It has also been claimed by specific authors that other diseases, such as Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome (POTS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are related to mast cell activation syndrome. However, there are no good arguments for this. Unfortunately, such claims are easy to make and difficult to refute.
What is the cause of mast cell activation syndrome?
Mast cell activation syndrome is actually more of a symptom description than a diagnosis in its own right. Mast cell activation syndrome is fully applicable to recurrent anaphylaxis (severe allergic reactions in several organ systems such as the skin, respiratory tract, digestive tract and circulatory system), for example due to insect bites. All the criteria for mast cell activation syndrome are met here. Severe allergic reactions are the most common cause of MCAS. However, although the term MCAS is correct in this context, it does not provide any additional information, as patients with such events are better described as patients with a diagnosis of anaphylaxis or allergy, and the term MCAS is somewhat confusing.
Is mast cell activation syndrome genetic?
MCAS itself is not genetic, but patients with the genetic disease mastocytosis often suffer from anaphylaxis, particularly to insect venom, and therefore MCAS. In addition, it is currently being investigated whether people with genetically determined hereditary alpha-tryptasemia suffer more frequently from MCAS.
How did the term mast cell activation syndrome come about?
There were many patients without a clear diagnosis, some of whom predominantly showed the symptoms typical of mast cell diseases. Accordingly, the experts dealing with mast cell diseases saw the need to develop a concept that took into account the “undiagnosable” symptoms of the patients. In the course of this, the terms “mast cell activation” and “mast cell activation syndrome” were defined. In addition, an attempt was made to sort all mast cell diseases into a classification with regard to mast cell activation. However, the difficulty in classifying these complaints is that many of the complaints described by patients are subjective, relatively non-specific and can be both organic and psychosomatic.
How have you defined mast cell diseases and which diseases do they include?
Mast cell diseases are defined as recurring chronic symptoms that are compatible with mast cell activation.
Mast cell activation is classified on the basis of three criteria:
Recurrent typical clinical symptoms in at least two organ systems
An increase in mast cell mediators can be detected in the blood, most frequently by determining the serum tryptase level during an acute attack
Good response of symptoms to anti-mast cell mediator-directed therapy, especially H1 antihistamines
What types of mast cell disease are there?
The classification of mast cell diseases associated with mast cell activation syndromes defines three groups:
1. primary mast cell activation syndrome
Primary mast cell activation syndrome is explained by a clonal expansion of mutated overactive mast cells. It manifests as systemic or cutaneous mastocytosis. If these criteria are not completely fulfilled, but clonal mast cells have been detected, it is referred to as monoclonal mast cell activation syndrome.
2 Secondary mast cell activation syndrome
Secondary mast cell activation syndrome is present when clear triggers of mast cell activation are known. There are established terms for secondary mast cell activation syndrome that we are more familiar with, such as “anaphylaxis” to a known trigger. The classification in the second group of mast cell diseases is therefore merely a reclassification. Examples of mast cell activation are physical urticaria or cold urticaria. Allergies such as pollen allergies are also secondary mast cell activations, as hay fever also causes symptoms typical of mast cell diseases. In pollen allergies, mast cell mediators are found in the blood serum and drugs directed against mast cells have a good effect. If the symptoms recur in several organ systems, this is referred to as mast cell activation syndrome.
3. tertiary or idiopathic mast cell activation syndrome
Tertiary or idiopathic mast cell activation syndrome refers to mast cell diseases whose triggers are unknown. This group would include, for example, chronic spontaneous urticaria, which has additional symptoms in other organs. Here we know that mast cells are activated, but not by what. This group of idiopathic mast cell activation syndromes would also include patients with as yet undescribed clinical pictures who do not fulfill the diagnostic criteria of known mast cell diseases, e.g. allergy, anaphylaxis, but in whom the disease is triggered by mast cells. In these patients, however, the connection between the symptoms and the activities of the mast cells must be proven.
Does this mean that tertiary or idiopathic mast cell activation syndrome is a diagnosis of exclusion?
Idiopathic mast cell activation syndrome can be described as a diagnosis of exclusion insofar as the prerequisite for the diagnosis is that there is no other disease causing the symptoms. However, the symptoms described are often very, very unspecific and could also be caused by a variety of other diseases. However, there are the three criteria for mast cell activation syndrome already mentioned. If these are not all fulfilled, this diagnosis cannot be made.
How common is mast cell activation syndrome?
Anaphylaxis and severe recurrent allergies are not uncommon and represent the vast majority of appropriate cases for MCAS. In addition, mastocytosis patients often have multiple anaphylaxis and therefore also MCAS. However, our initial idea of finding a new disease, idiopathic mast cell activation syndrome, has not yet been confirmed. There are many patients with many symptoms for whom a clear organic diagnosis cannot yet be made. However, it is almost never possible to prove that a defect in the mast cells is primarily responsible for the symptoms. Many of these patients describe symptoms that could fit, and in some patients anti-allergic drugs also have a positive effect. But in only very few patients can an increase in mast cell mediators be detected during an acute attack. I now believe that somatic stress disorders could play a significant role in many of the patients examined.
Histamine intolerance is also a diagnosis of exclusion, is there a connection with mast cell activation syndrome?
Histamine intolerance can cause similar symptoms, but is not a mast cell disorder and has nothing to do with MCAS. When mast cells are activated, the messenger substance histamine is released, which in turn can cause symptoms. In histamine intolerance, the mast cell is not activated - it is not involved in any way. Rather, histamine intolerance describes patients with an increased sensitivity to histamine, which is supplied, for example, via the diet. This can lead to similar symptoms, but in contrast to mast cell activation syndrome, histamine intolerance has a clear trigger, histamine. As a result, the symptoms occur after eating histamine-rich foods, but disappear again if the patient follows a low-histamine diet. A test is also available to diagnose histamine intolerance.
So there are also patients with suspected mast cell activation syndrome who cannot be assigned to a classification group, even though they have corresponding symptoms?
There are many patients in whom no mast cell activation syndrome can be detected despite suspicion. They do not fit into one of the three groups. However, this also used to include monoclonal mast cell activation syndrome. These patients showed anaphylaxis and a KIT mutation, but not the full criteria for mastocytosis. In the meantime, a separate disease diagnosis has been created for these patients. The independent accepted disease of these patients therefore lies between mastocytosis and normal findings.
We thought that there might be other forms of idiopathic MCAS with clinical pictures that have not yet been described. However, this is not supported by the findings to date. There are patients who show symptoms but do not meet the necessary criteria for idiopathic mast cell activation syndrome. In these patients, the diagnosis remains unclear. In how many of these patients functional physical complaints play a role still needs to be investigated.
Are there risk factors that favor mast cell activation syndrome?
There are hardly any recognized studies on this. In a study conducted by Cem Akin in the USA, patients were examined who met the three criteria for idiopathic mast cell activation syndrome. They had the right symptoms, there was an increase in mediators and their symptoms improved with treatment. It was shown that many of these patients suffered from urticaria factitia, a scratch-induced urticaria, abdominal pain and flushing.
Recently, a genetic trait was discovered, hereditary alpha-tryptasemia with elevated basal serum tryptase levels. In patients with this trait and insect venom allergy, the severity of the allergic reaction appears to be increased. It is also discussed that the frequency of mast cell activation syndrome is increased in patients with this genetic trait. However, the published studies are not yet unanimous in this respect.
What symptoms can occur with MCAS?
The following symptoms could be signs of mast cell activation syndrome:
MCAS symptoms on the skin:
Appearance of sudden intense redness (flushing)
itching
wheal formation
Deep wheal formation (angioedema or Quincke's edema)
MCAS symptoms on the nose:
Nasal congestion
Nasal itching
MCAS symptoms in the airways:
Swelling of the upper airways
Wheezing
Shortness of breath
MCAS symptoms of the digestive tract:
Vomiting
abdominal pain
diarrhea
Systemic MCAS symptoms:
Syncope - where you suddenly lose consciousness, but only for a short time
Sudden drop in blood pressure
Allergic shock
These symptoms can occur together or individually. In principle, symptoms must occur in two or more organ systems for MCAS. These symptoms, together with the typical skin changes and anaphylaxis, are also typical of mastocytosis.
Are muscle pain and hair loss also symptoms of MCAS?
No, why would anyone think that these symptoms are primarily caused by a malfunction of mast cells? Mast cells are not important cells for muscle pain and hair loss.
How is MCAS diagnosed?
MCAS is a diagnosis of exclusion, i.e. there is no mast cell activation syndrome test. However, this does not mean that all other diseases must be ruled out before a diagnosis of MCAS can be made.
When testing directly for mast cell activation syndrome, three criteria would be examined, all of which must be met, not just two:
First, there must be a matching of symptoms to see if the above symptoms are leading, recurrent and occur in at least two organ systems.
Is there a substantial or complete improvement in the clinical symptoms when taking anti-allergic medication, antihistamines or cromoglicic acid? Then this criterion would apply.
The blood levels of tryptase in the serum can now be examined at two different points in time. This would check whether there is an increase in mast cell mediators or tryptase in the blood serum in a highly symptomatic phase or during a seizure compared to a time when there are no symptoms.
What does the tryptase level in the blood mean in the diagnosis of mast cell activation syndrome?
If the mast cell mediator tryptase rises by 20 percent of the basal value, i.e. the initial value, + 2 ng/ml during such an episode, the diagnosis of mast cell activation syndrome has been made without the need to rule out other diseases beforehand. However, taking blood samples to determine the tryptase levels is very time-consuming, because a blood sample should be taken in the normal state and then another blood sample should be taken during a seizure or a highly symptomatic episode. This means that the patient must see a doctor in good time for a blood test during the acute phase. If these tests are negative, mast cell activation syndrome cannot be confirmed.
Elevated tryptase levels also play a role in anaphylaxis, is there a connection with mast cell activation syndrome?
Anaphylaxis is an extremely strong mast cell activation, the “prototype” of mast cell activation, so to speak. The tryptase level rises, so that it is considered an indicator of anaphylaxis. Here too, the basal value is measured and compared with the value during an episode. The relevant factor is the resulting increase in the tryptase value. The therapy against mast cells is effective in this case. In this respect, anaphylaxis is the classic form of mast cell activation syndrome.
The tryptase value also plays a role in the diagnosis of mastocytosis, what are the correlations here?
Mastocytosis patients also have an elevated baseline tryptase level. This is therefore an indication of mastocytosis and an indication for a final diagnosis by means of a bone marrow biopsy. However, there is also a mastocytosis-independent correlation between tryptase and anaphylaxis. People who have a higher number of mast cells often develop more severe anaphylaxis than people with fewer mast cells. The tryptase basal value is therefore considered a kind of indicator for the total mast cells in the body. For example, insect venom anaphylactic patients with elevated basal mast cell tryptase levels in the blood are at increased risk of severe anaphylaxis.
What can be done against MCAS and which medications help?
The aim of treatment for mast cell activation syndrome is to slow down the effect of the overactivated mast cells and to calm the mast cells. In particular, the avoidance of allergic triggers is available for this purpose.
Histamine receptor blockers are tried as medication to block the effects of mast cell activation by histamine. Mast cell stabilizers or blockers of mast cell release, cromoglicic acid, can also calm the mast cells. Cromoglicic acid is also used in mastocytosis patients. It is important to know that the use of cromoglicic acid is not advisable if the attack has already run its course. On the other hand, many patients achieve a significant improvement in symptoms if cromoglicic acid is taken continuously as a preventive measure and in a sufficiently high dose. This has also been shown to be the case with antihistamines.
Another option would be leukotriene receptor antagonists and corticosteroids in the short term, but never over a longer period of time.
Unfortunately, many patients with previously unexplained complaints are given a suspected diagnosis of MCAS in the hope that this knowledge will lead to better treatment or perhaps a cure. However, apart from the drugs mentioned, which can also be used on a trial basis in cases of suspected MCAS, there are no other useful drugs available. In this respect, the suspicion of MCAS unfortunately does not offer patients any additional treatment options.
Are there foods that activate or deactivate mast cells?
No such foods are known in humans. Of course, it is possible to bombard mast cells in a test tube with high concentrations of food and measure whether the natural activation of mast cells is increased or reduced. However, such tests are generally not meaningful for humans when consumed.
Can naturopathy help with mast cell activation syndrome?
I don't know how it could help. Naturopathy is the attempt to achieve a positive effect through naturally occurring active substances. Is the avoidance of allergens in our natural environment already naturopathy?
Could certain vitamins, for example vitamin C, be beneficial for MCAS?
This is claimed by a few doctors without any convincing results. Vitamin C is also said to help against seasickness. After all, vitamin C, taken in normal amounts, is not harmful and is beneficial. Sometimes the conviction that a substance is good for you also helps. That's why the experiment doesn't bother me.
Is it possible to prevent mast cell activation syndrome?
Yes, by avoiding MCAS with a known trigger. This is the case with allergies. In the case of allergies and recurrent anaphylaxis as a form of MCAS, omalizumab, an antibody against immunoglobulin E, can also be used in individual patients.
Prof. Brockow, thank you very much for this interview!
https://www.mein-allergie-portal.com/mastozytose-mastzellaktivierungssyndrom-mcas/925-idiopathisches-mastzellenaktivierungssyndrom-ein-neues-krankheitsbild.html

The global warfarin market is projected to experience substantial growth, with a notable compound annual growth rate (CAGR) of 2.4%, potentially reaching USD 2,732 million by 2027. This growth is primarily attributed to the rising prevalence of atrial fibrillation worldwide, contributing to an increased demand for warfarin. Additionally, the effective implementation of treatment guidelines related to the management of deep vein thrombosis/pulmonary embolism (DVT/PE) further amplifies the market's growth trajectory.
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I know this question gets asked all the time but I could not find something that was similar to my situation so I thought I'd ask.
In March I missed a period, took a home test and a blood test. Turns out I was pregnant. 3 days after that I started bleeding and a week later I had an ultrasound, they said everything seemed normal, and I was given progesterone pessaries which I used for 3 weeks. But the bleeding didn't stop.
I went in for another scan and found out I had miscarried the first pregnancy and there was a second but it was an ectopic which was about to rupture. I went in for surgery and they took my tube.
After all of this the bleeding stopped but, I was told I could not get pregnant for the next 3 months since my doctor had asked me to get the methotrexate injection before the surgery.
So to prevent pregnancy I started the combination pill on the 1st of May which was the first day of my period. I have been bleeding ever since... on the 9th day of bleeding I asked my Dr how to make it stop, she recommended 1gm of tranexamic acid 3 times a day.
But the bleeding still didn't stop. By the 11th day I raised my concerns again and was told to go off the pill and continue the Tranexamic.
It's been 3 days since I stopped the pill and I'm still bleeding... I don't know what to do! I've been married 4 months and bleeding for 3 of them!
I need help, I'm tired. Does anyone know when this bleeding will end? If I switch pill will this happen again? I've been told to switch to microgynon 30 on my next period.

So I'm supposed to be taking my road test toady and had a couple of question to ask as I'm unsure if I can as the instructor prior to the test. So I get the basic rules that you have to follow like having to stop at a stop sign for a couple seconds and hand position. What about parking and revesing? Can you use backup camera or 360 camera if it's automatic? Both for parallel and straigh reversing I never looked over my shoulder and used mirrors. The mirror dips automatically so it's always been good. Do they require you to look over your shoulder or can I rely on mirrors only?

First of all, thank you so much for this community and the people who have responded to my questions and provided helpful tips and tricks - I could not have passed without y'all's guidance. I do not have formal project management experience, I have a PhD in Social Sciences so I had experience managing research projects and am currently working in government, so I manage small and medium size projects. Here is my experience and some tips that may help you as you are preparing for the exam:
[These are all my personal experiences]

1. General: This is not an easy exam: Please study all the processes, abbreviations, specific contents within subtopics (such as what are the 5 ways to deal with negative risks, etc). Although everyone says you don't need to memorize, there are some things that memorizing will help you out a lot in addition to understanding.
2. Study Materials: Primarily used AR's Udemy course for preparation - he was my best friend for 3 months. I watched that course twice in 1.75 speed, and took detailed notes on processes. Got 75% on his mock exam. I bought study hall and I used it for the mock exams and practice questions. I scored 63% on the first mock and 67% on the second [with expert questions]. On the mini sections, I would score 65-70 with expert questions and 83-85 without expert. I realized that the expert questions just confused me, so I started ignoring them closer to the exam date. I have a long commute to work, so I also listened to Scott Payne's PMP prep book on Audible. This guy is so fun and incredible, and uses very engaging case studies to help you learn. If you're like me and are able to focus on audiobooks, I strongly recommend him. I only discovered David Maclachlan a week-ish before the exam date, so I would just look at his YouTube videos for 30 mins - 1 hour before going to bed.
3. Mindset: Nail this down. Even when questions seemed confusing, AR's mindset came to my rescue because I was at least able to eliminate choices that deal with escalating things to the management. Along with his mindset, here are some things that I learned by doing the questions again and again:

• Whenever there is a conflict, speak to BOTH parties, not just one.
• The answer almost always starts with “review,” “plan,” “assess,” “sit down with,” “evaluate” AS OPPOSED to with “perform,” “change,” conduct,” because you always want to evaluate the situation before jumping to action
• Removing team member should be the last resort UNLESS they do something unethical
• I know AR keeps saying that co location is the best option - IT IS NOT WHEN THERE ARE GEOGRAPHICAL AND BUDGET LIMITATIONS (This may be too obvious for most people but wasn't for me, LOL)

4. Exam day prep: EAT and hydrate please. I was so nervous, so I thought I wasn't hungry, but I downed a whole sandwich before the test (It was at 2 PM, I am not a morning person), and that helped me sustain my pace throughout the exam. I used the two breaks and drank water and did some stretches. I asked the test center people for a calculator and they gave it to me, although there was no question that required any calculation.

• Even if the section is on the easier side, DO NOT RELAX too much. I finished with 6 minutes to spare and was rushing towards the end.
• DO NOT LOSE HOPE if some questions are hard on a row. Keep going, keep flagging, keep using mindset. KEEP GOING.
• I suggest to not take any mock exam on the day of or even a day before the exam. These tests are so draining, so relax, do something fun, eat good, and give it your all at the exam.

1. Other: I blocked at least 2 hours per weekday for 3 months to study

I hope this note helps you as you are preparing for your certification, I am rooting for you!

was it only me that put b a fair amount of times in the test? I starting questioning myself if i was even right because surely they wouldn’t do that

Timestamp: https://imgur.com/a/sitrZwQ
Images: https://imgur.com/a/auRN2vJ
Disclaimer: some are untested. Let me know if you want me to test a specific one. Please buy something my M14 build is hungry lol.
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Make me a reasonable offer I’m flexible!!

GBB/C02 PISTOLS

Cybergun KWC Tanfoglio GBB race gun-$100 Compensator and rail(missing screws) C02 blowback. Some signs of wear. Missing fire selector.
Cybergun KWC Tanfoglio GBB-$90 No rails/comp. Has fire selector.
KWA Glock 17 Gen 3 untested -$80 RMR mounted plate
Dan Wesson “Evike Exclusive” 1911- $60 Silver with cool grips. No mag. Sounds cool asf.
KWC? S&W M&P9 C02 blowback-$75 Unsure the brand. Probably KWC.
APS SHARK Select Fire C02 Blowback-$70 Magazine has broken needle thing. $8-10 part
Black WE Hi Capa Caspian-$85
Silver Split Slide WE Hi-Capa Caspian $105 This thing is tight asf and I don’t really wanna sell it but that’s the way she goes.
WE 1911 Galaxy-$115 All silver short barrel. Top rail included.
KJWorks P226 w/ 1 mag $85 -more mags available
EMG Staccato C2 2011-$125 Comes with spare mag that leaks. Missing fire selector. Stipled hand grip.
Boneyard PPQ: $30 $25! poor guy. Missing a hammer assembly, inner barrel, outer barrel and magazine. But has frame, recoil spring and slide with BBH.
We Galaxy Glock-$200 $160 $115 with just gun+standard mag Comes with 1 extra standard mag and 1 extended mag. Also an evike carry case. Select fire, semi and full auto. Works no problems. Crazy high ROF. Standard trigger. I swapped out the flat one.
HFC Mac 11 is SOLD
2 Hi Capa magazines. One c02. One green gas. $30 each. Or $20 each w/ a gun

GBBR

WE MSK GBBR (needs parts) ~~$200 $170~~ SOLD!
WE SMG8 $160 $150!
Magazine holds gas and gun cycles and fires. Missing flash hider (it’s on my other mp7). Full size version of the MP7. Comparable to my VFC. Just don’t need it.

FREEBIES

Free with any purchase is a shot out red dot sight and a cheap plastic RMR sight. Pics
Okay that’s it! Feel free to message with questions or offers or if you want more pics. All prices are negotiable and I offer bundle deals Happy Shopping!

I know this question gets asked all the time, but I could not find something that was similar to my situation, so I thought I'd ask.
In March, I missed a period, took a home test, and had a blood test. Turns out I was pregnant. 3 days after that, I started bleeding, and a week later, I had an ultrasound. They said everything seemed normal, and I was given progesterone pessaries, which I used for 3 weeks. But the bleeding didn't stop.
I went in for another scan and found out I had miscarried the first pregnancy, and there was a second, but it was an ectopic which was about to rupture. I went in for surgery, and they took my tube.
After all of this, the bleeding stopped, but I was told I could not get pregnant for the next 3 months since my doctor had asked me to get the methotrexate injection before the surgery.
So, to prevent pregnancy, I started the combination pill on the 1st of May, which was the first day of my period. I have been bleeding ever since... on the 9th day of bleeding, I asked my Dr how to make it stop. She recommended 1 gm of tranexamic acid 3 times a day.
But the bleeding still didn't stop. By the 11th day, I raised my concerns again and was told to go off the pill and continue the Tranexamic.
It's been 3 days since I stopped the pill, and I'm still bleeding... I don't know what to do! I've been married 4 months and bleeding for 3 of them!
I need help, I'm tired. Does anyone know when this bleeding will end? If I switch the pill, will this happen again? I've been told to switch to microgynon 30 on my next period.