Proverbs 31 study

I just passed both A+ tests, I'm not currently working in the industry but I would like to continue to get my certifications as a backup for a career change if I decide to do that in the next 5 years (I just turned 31).
I tend to over study so I don't feel like I'm know throwing away my money ; for reference it took me 5 months roughly for core 1 and core 2.
I know net + is retiring soon, am I better trying to hunker down and study for it before the retirement or should I go for sec+ and wait for the new revision? I tend to use Messer's videos and practice tests so I would also have to wait for either him or Dion to create the new course as well.
I know many people consider net + to be one of the more difficult starter certifications and with no frame of reference because I'm not in the industry, I'm not sure I would be able to pass by its retirement date. I also don't know if I want the extra stress of having to pass by x date or else some of the content I'm studying isnt applicable (at least for the test).
Would love to hear your opinions.

Use these to draft one page short stories that can be used to give life to emotional reactions.

1. How do you feel when you find out your favorite book has a sequel?
   1. Describe the emotion when you receive a surprise gift from a friend.
   2. What emotions arise when you lose a game you were really looking forward to winning?
   3. Share the feelings you experience on the first day of a new school year.
   4. How do you react when you have to speak in front of the class unexpectedly?
   5. Describe the mix of emotions when you meet a new friend for the first time.
   6. What's your emotional response when you get a good grade on a test you studied hard for?
   7. Express your feelings when you have to apologize to someone.
   8. How does it feel when you successfully solve a challenging puzzle or riddle?
   9. Describe the emotions when you witness an act of kindness in your school.
   10. Share your reaction when your parents surprise you with a fun outing.
   11. How do you feel when you receive a compliment from a teacher?
   12. Express the emotions when you face a fear and overcome it.
   13. Describe the mix of emotions when your best friend moves away.
   14. How does it feel when you achieve a personal goal you've been working on?
   15. Share your emotional response when you receive constructive criticism.
   16. What are your feelings when you have to say goodbye to someone you care about?
   17. Describe the emotions when you create something artistic that you're proud of.
   18. How do you react when you encounter a challenge you've never faced before?
   19. Express the feelings when you win a competition against your classmates.
   20. What emotions arise when you have to admit you made a mistake?
   21. Share your reaction when you successfully make someone else laugh.
   22. How do you feel when you see someone being unfairly treated?
   23. Describe the mix of emotions when you receive recognition for your hard work.
   24. Express your feelings when you have to confront a difficult situation.
   25. How does it feel when you help someone who is struggling?
   26. Share your emotional response when you receive a genuine apology.
   27. What are your feelings when you witness an act of generosity in your community?
   28. Describe the emotions when you receive unexpected praise from a peer.
   29. How do you react when you experience a moment of pure joy?
   30. Express the feelings when you have to deal with a disappointment.
   31. Share your reaction when you successfully navigate a new environment.
   32. What emotions arise when you make a new friend during a group activity?
   33. Describe the mix of emotions when you have to share something important with others.
   34. How do you feel when you achieve a milestone in a personal project?
   35. Express your feelings when you have to confront a situation that makes you nervous.
   36. How does it feel when you receive support from unexpected sources?
   37. Share your emotional response when you witness an act of bravery.
   38. What are your feelings when you receive constructive feedback on your creative work?
   39. Describe the emotions when you discover a new hobby that you love.
   40. How do you react when you have to face a rule or consequence you disagree with?
   41. Express the feelings when you overcome a physical challenge or obstacle.
   42. Share your reaction when you meet someone who shares your interests.
   43. What emotions arise when you have to work in a group and contribute your ideas?
   44. How do you feel when you witness an act of perseverance in someone else?
   45. Describe the mix of emotions when you learn a valuable lesson from a mistake.
   46. Express your feelings when you receive encouragement from a mentor.
   47. How does it feel when you are asked to take on a leadership role?
   48. Share your emotional response when you make amends with someone after a disagreement.
   49. What are your feelings when you have to adapt to a sudden change in plans?
   50. Describe the emotions when you receive unexpected assistance from a classmate.
   51. How do you react when you have to share your personal achievements with others?
   52. Express the feelings when you successfully navigate a social situation.
   53. Share your reaction when you find out your favorite activity is canceled.
   54. What emotions arise when you have to admit you need help with something?
   55. Describe the mix of emotions when you receive positive feedback from a teacher.
   56. How do you feel when you are chosen for a special role or task?
   57. Express your feelings when you witness an act of fairness in a game or competition.
   58. How does it feel when you learn something new that challenges your perspective?
   59. Share your emotional response when you have to comfort a friend in need.
   60. What are your feelings when you participate in a community service project?
   61. Describe the emotions when you receive recognition for your kindness towards others.
   62. How do you react when you have to navigate a situation where you feel misunderstood?
   63. Express the feelings when you successfully resolve a conflict with a friend.
   64. Share your reaction when you discover a hidden talent or skill.
   65. What emotions arise when you have to stand up for what you believe in?
   66. How do you feel when you experience a moment of gratitude towards someone else?
   67. Describe the mix of emotions when you have to say goodbye to a beloved pet.
   68. Express your feelings when you overcome a fear and try something new.
   69. How does it feel when you receive support during a challenging time?
   70. Share your emotional response when you witness an act of sportsmanship.
   71. What are your feelings when you participate in a team-building activity?
   72. Describe the emotions when you have to navigate a situation where you feel left out.
   73. How do you react when you receive constructive criticism from a peer?
   74. Express the feelings when you successfully complete a long-term project.
   75. Share your reaction when you witness an act of environmental stewardship.
   76. What emotions arise when you have to cope with the loss of a valuable possession?
   77. How do you feel when you are entrusted with a responsibility by a teacher?
   78. Describe the mix of emotions when you participate in a cultural exchange activity.
   79. Express your feelings when you help organize a surprise for someone else.
   80. How does it feel when you receive unexpected encouragement from a family member?
   81. Share your emotional response when you witness an act of compassion in your community.
   82. What are your feelings when you have to navigate a situation where you feel underestimated?
   83. Describe the emotions when you receive a heartfelt letter or note from a friend.
   84. How do you react when you have to confront a situation where you feel pressured?
   85. Express the feelings when you successfully teach someone a new skill.
   86. Share your reaction when you witness an act of creativity in your school.
   87. What emotions arise when you have to cope with the end of a school year?
   88. How do you feel when you participate in a group project and everyone contributes?
   89. Describe the mix of emotions when you receive an unexpected apology.
   90. Express your feelings when you successfully negotiate a compromise with a friend.
   91. How does it feel when you discover a new way to express yourself creatively?
   92. Share your emotional response when you witness an act of selflessness.
   93. What are your feelings when you have to navigate a situation where you feel proud of yourself?
   94. Describe the emotions when you receive positive feedback for your efforts.
   95. How do you react when you have to face a situation where you feel out of place?

~RIGL Thesis – 5/18/2024~
Outstanding Shares 175M
131 Institutional Holders
111,129,461 Total Shares Held
63.36% Institutional Ownership
Total Cash on Hand 3/31/2024 = $49.6M
Total Debt: $101.5M
Cash Burn Approximate = $8M per quarter (6 quarters of cash without any increases in revenue)
Q12023 REV = $26M
Q22023 REV = $26.8M
Q32023 REV = $28.1M
Q42023 REV = $35.8M
Q12024 REV = $29.5M (Decline from Q4 likely from end of year versus new-year tracking of Rx and shipments of drugs, resetting of Copays)
Most Recent EPS -$0.05 per share
May 22, 2024 - Vote on S will take place, caution
~Statistics Applicable To Thesis~
333.3 million US Population (2022)
8,109,679,892 Global Population (2024)
~Drugs On Market~
~Tavalisse – Treatment for ITP, FDA Approved April 17, 2018~
~What is ITP?~
Immune thrombocytopenia (ITP) is an illness that can lead to bruising and bleeding. Low levels of the cells that help blood clot, also known as platelets, most often cause the bleeding.
Once known as idiopathic thrombocytopenic purpura, ITP can cause purple bruises. It also can cause tiny reddish-purple dots on the skin that look like a rash.
Children can get ITP after a virus. They most often get better without treatment. In adults, the illness often lasts months or years. People with ITP who aren't bleeding and whose platelet count isn't too low might not need treatment. For worse symptoms, treatment might include medicines to raise platelet count or surgery to remove the spleen. Immune thrombocytopenia (ITP) - Symptoms and causes - Mayo Clinic
~What is Tavalisse?~
TAVALISSE is a prescription medication used to treat adults with low platelet counts due to chronic immune thrombocytopenia (ITP) when a prior treatment for ITP has not worked well enough. It is not known if TAVALISSE is safe and effective in children.
The cost for Tavalisse oral tablet 100 mg is around $15,404 for a supply of 60 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Tavalisse Prices, Coupons, Copay & Patient Assistance - Drugs.com
TAVALISSE IS AN ORAL MEDICATION TAKEN TWICE DAILY WITH OR WITHOUT FOOD¹
A 12-week evaluation period is recommended
60 tablets = 1 month supply, evaluation period = 3 months, Cost for 3 months = $46,212 Cash, assuming cheaper through wholesale, insurance, discount cards, etc.
Dosing TAVALISSE® (fostamatinib disodium hexahydrate) tablets (tavalissehcp.com)
~Addressable Market~
“Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.”
Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis - PubMed (nih.gov)
The estimated prevalence of ITP in the United States is 9.5 per 100,000 people, with a global prevalence of over 200,000 people at any given time [1].
Immune thrombocytopenia. [ Oct; 2022 ]. 2022. https://rarediseases.org/rare-diseases/immune-thrombocytopenia
~Author Calculations/Estimates~
ITP estimated cases based on measured statistics 31,635 cases a year in the US and 770,355 cases globally each year.
~Rezlidhia – R Acute Myeloid Leukemia, FDA Approved December, 22, 2022~
~What is Relapsed or Refractory Acute Myeloid Leukemia?~
Relapsed, or recurrent, acute myeloid leukemia (AML) means the leukemia has come back after treatment and remission.
Refractory AML means the leukemia did not respond to treatment. Complete remission has not been reached because the chemotherapy drugs did not kill enough leukemia cells.
Both relapsed and refractory AML need more treatment to reach complete remission.
Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Some factors considered for your treatment include:
your age
your health
how long the leukemia was in remission
treatments you had before
where the leukemia comes back
Treatment options usually include chemotherapy and a stem cell transplant if possible. Targeted therapy may also be used.
Treatments for relapsed or refractory acute myeloid leukemia Canadian Cancer Society
~What is IDH1?~
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult Acute myeloid leukemia (AML) and less commonly in pediatric AML… Enhanced genomic and epigenomic profiling of acute myeloid leukemia (AML) has led to identification of recurrent mutations that are prognostic and are candidates for targeted therapy. Somatic mutations in isocitrate dehydrogenase (IDH) genes, IDH1 and IDH2, occur in ∼6% to 16% and ∼8% to 19% of adult patients with AML, respectively.^1-5 In pediatric AML, IDH mutations are rare, occurring in <4% of patients.^6-11
Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis Blood Advances American Society of Hematology (ashpublications.org)
~What is Rezlidhia?~
REZLIDHIA is a prescription medicine used to treat adults with acute myeloid leukemia (AML) with an isocitrate dehydrogenase-1 (IDH1) mutation when the disease has come back or has not improved after previous treatment(s).
Targeted Treatment REZLIDHIA® (olutasidenib) capsules
The cost for Rezlidhia oral capsule 150 mg is around $17,468 for a supply of 30 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
Rezlidhia Prices, Coupons, Copay & Patient Assistance - Drugs.com%20is%20a%20member,on%20the%20pharmacy%20you%20visit.)
~Addressable Market~
The annual incidence of new cases in both men and women is approximately 4.3 per 100,000 population, totaling over 20,000 cases per year in the United States alone.[13] The median age at the time of diagnosis is about 68, with a higher prevalence observed among non-Hispanic Whites. Furthermore, males exhibit a higher incidence compared to females, with a ratio of 5:3.
Acute Myeloid Leukemia - StatPearls - NCBI Bookshelf (nih.gov)
~Author Calculations/Estimates~
Cases of AML with IDH1 would be 11% based on the median of statistics above (6% to 16%) leaving approximately 1500 to 2000 cases a year in the US. Appling the same calculations to world population would amount to approximately 38,500 cases a year globally.
~Gavreto – Treats RET+ Non-Small Cell Lung Cancer In Adults and RET+ Thyroid Cancer in Kids and Adults, FDA Approved August 9, 2023~
For the sake of common ground, I am going to assume these types of cancers do not need to be elaborated on as we all likely have a basic understanding of what they are. The medical conditions treated by Tavalisse and Rezlidhia I felt needed a more in-depth explanation because they are not common. I will elaborate on RET+ a little later in this writing.
~What is Gavreto?~
GAVRETO is an oral once daily prescription medicine used to treat certain cancers caused by abnormal rearranged during transfection ~(RET+)~ genes in:
Adults with non-small cell lung cancer (NSCLC) that has spread
Adults and children 12 years of age and older with advanced thyroid cancer or thyroid cancer that has spread who require a medicine by mouth or injection (systemic therapy) and who have received radioactive iodine and it did not work or is no longer working*
It is not known if GAVRETO is safe and effective when used to treat cancers caused by abnormal RET genes in children for the treatment of NSCLC or in children younger than 12 years of age for the treatment of thyroid cancer.
Home GAVRETO® (pralsetinib)
The cost for Gavreto oral capsule 100 mg is around $11,745 for a supply of 60 capsules, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.
The recommended dosage for adults and children 12 and over is 400mg orally once daily. Each capsule is 100mg, which means you will take 4 capsules. Gavreto should be taken on an empty stomach, at least 1 hour before or 2 hours after a meal.
Gavreto Prices, Coupons, Copay & Patient Assistance - Drugs.com
~What is Rearranged During Transfection Positive (RET+)?~
RET-positive cancer is caused by a mutation or abnormal re-arrangement of the RET gene. It occurs most commonly in lung cancer and several types of inherited and sporadic thyroid cancers. RET alterations also occur in an estimated 1-2% of multiple other cancers, including ovarian, pancreatic, salivary, breast, and colorectal cancers.
RETpositive Empowering Patients and Driving Research
Rearranged during transfection (RET) rearrangements were first identified as oncogenic drivers in NSCLC in 2012. The proportion of patients with NSCLC who have RET rearrangements (ie, fusion-positive disease) is approximately 1%-2%.
RET Fusion-Positive Non-small Cell Lung Cancer: The Evolving Treatment Landscape The Oncologist Oxford Academic (oup.com)
RET alterations occur most commonly in lung cancer (non-small cell lung cancer (NSCLC)) and the number of new cases diagnosed each year is considerable, accounting for approximately 37,500 [IG1] cases worldwide and 4,000 cases in the US (2% of NSCLC) (2,3). RET alterations are also common in several types of inherited and sporadic thyroid cancers and can occur in other types of cancers like ovarian, breast, pancreatic, and colorectal cancers, among others (4-8) adding >110,000 cases yearly worldwide (9).
What is RET Positive Lung Cancer? - The Happy Lungs Project
(2) Although medullary thyroid carcinoma represents 5-10% of all thyroid cancers, activating RET gene abnormalities occur in over 90% of hereditary and approximately 40%-60% of sporadic medullary thyroid carcinoma cases.
Patients – RETpositive%20Although%20medullary%20thyroid%20carcinoma,sporadic%20medullary%20thyroid%20carcinoma%20cases.)
~Prevalence of Non-Small Cell Lung Cancer~
Most lung cancer statistics include both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). In general, about 10% to 15% of all lung cancers are SCLC, and about 80% to 85% are NSCLC.
Lung cancer (both small cell and non-small cell) is the second most common cancer in both men and women in the United States (not counting skin cancer). In men, prostate cancer is more common, while breast cancer is more common in women.
The American Cancer Society’s estimates for lung cancer in the US for 2024 are:
About 234,580 new cases of lung cancer (116,310 in men and 118,270 in women)
About 125,070 deaths from lung cancer (65,790 in men and 59,280 in women)
Lung Cancer Statistics How Common is Lung Cancer? American Cancer Society
Worldwide, an estimated 2,206,771 people were diagnosed with lung cancer in 2020. These statistics include both small cell lung cancer and NSCLC.
Lung Cancer - Non-Small Cell: Statistics Cancer.Net
~Author Calculations/Estimates~
Approximately 187,664 cases of NSCLC in the US based on an 80% factor.
Approximately 1,765,416 cases of NSCLC worldwide based on an 80% factor.
~Prevalence of Thyroid Cancer~
Rate of New Cases and Deaths per 100,000: The rate of new cases of thyroid cancer was 13.5 per 100,000 men and women per year. The death rate was 0.5 per 100,000 men and women per year. These rates are age-adjusted and based on 2017–2021 cases and 2018–2022 deaths.
Lifetime Risk of Developing Cancer: Approximately 1.2 percent of men and women will be diagnosed with thyroid cancer at some point during their lifetime, based on 2017–2019 data. Lifetime risk based on data through 2022 will available soon.
Prevalence of This Cancer: In 2021, there were an estimated 979,295 people living with thyroid cancer in the United States.
Thyroid Cancer — Cancer Stat Facts
About 44,020 new cases of thyroid cancer (12,500 in men and 31,520 in women)
About 2,170 deaths from thyroid cancer (990 in men and 1,180 in women)
Thyroid cancer is often diagnosed at a younger age than most other adult cancers. The average age when a person is diagnosed with thyroid cancer is 51.
This cancer is about 3 times more common in women than in men. It is about 40% to 50% less common in Black people than in any other racial or ethnic group.
Key Statistics for Thyroid Cancer American Cancer Society)
Addressable Market
Given Gavreto’s dual treatment capacity, the total amount of potential patients with NSCLC with RET+ indications would be approximately 2,800 cases in the US and approximately 26,500 cases worldwide each year using a factor of 1.5% of total NSCLC cases. The total amount of treatable cases for Thyroid Cancer would be approximately 650 in the US and 16,500 cases worldwide respectively each year applying the same 1.5% RET+ percentage rate. DOUBLE CHECK MATH…
~Rigel Pharmaceuticals Pipeline~
~IRAK/4 – Clinical Trials~
Rigel’s investigational candidate, R289, is an oral, potent and selective inhibitor of interleukin receptor-associated kinases 1 and 4 (IRAK1/4).
Toll like receptors (TLRs) and the interleukin 1 receptor family (IL-1Rs) play a critical role in the innate immune response and dysregulation of these pathways can lead to a variety of inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease. Chronic stimulation of both receptor systems has also been implicated in causing a pro-inflammatory bone marrow environment leading to persistent cytopenias in lower-risk myelodysplastic syndrome (LR-MDS) patients1.
R835 is a selective dual inhibitor of IRAK1/4 that blocks TLR4 and IL-1R-dependent systemic cytokine release. In preclinical studies, R835 demonstrated activity in multiple animal models of inflammatory disease2,3 and showed that dual inhibition of IRAK1 and IRAK4 provided more complete suppression of inflammatory cytokines when compared to an IRAK4-selective inhibitor4.
Development of R289:
In a Phase 1 clinical trial, R835 was well tolerated and inhibited LPS-induced inflammatory cytokine production in healthy volunteers, demonstrating proof-of-mechanism.5 Phase 1 clinical studies of R289 (an oral prodrug that is rapidly converted to R835 in the gut) are also complete.
A Phase 1b open-label, multicenter trial of R289 in patients with relapsed/refractory lower-risk MDS is currently enrolling (NCT05308264). The primary endpoint for this trial is safety with key secondary endpoints including preliminary efficacy and evaluation of pharmacokinetic properties.
~Bemcentinib – Bergenbio Partnership~
In June 2011, Rigel entered into an exclusive, worldwide research, development and commercialization agreement with BerGenBio for its investigational AXL receptor tyrosine kinase (AXL) inhibitor, R428 (now referred to as bemcentinib).
Bemcentinib is a potent, selective and orally bioavailable AXL inhibitor and the furthest along in clinical trials. In preclinical studies, bemcentinib was shown to have an effect as a single agent therapeutic in the prevention and reversal of acquired resistance to standard of care cytotoxics and targeted therapies and may also slow or prevent tumor metastasis.
Rigel received an upfront payment and is eligible for milestone payments and potential sublicensing revenue, as well as tiered royalty payments on any future net sales of products emerging from the collaboration.
~R552 Systemic – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies.
~Milademetan – Daiichi Sankyo Partnership~
Rigel has a long-standing collaboration with Daiichi-Sankyo for developing murine double minute 2 (MDM2) protein inhibitors in cancer, which were discovered in Rigel’s laboratories.
Preliminary safety and efficacy data from an early Phase 1 study of milademetan (formerly DS-3032), an oral selective MDM2 inhibitor, in hematological malignancies suggests that it may be a promising potential treatment for oncology indications.
Rigel received an upfront payment and is eligible for milestone payments, as well as tiered royalty payments on any future net sales of any products emerging from the collaboration.
~Rxxx (CNS Penetrant) – Eli Lilly Partnership~
Rigel’s investigational candidates are oral, potent and selective inhibitors of receptor-interacting serine/threonine-protein kinase 1 (RIPK1).
RIPK1 is a critical signaling protein implicated in a broad range of key inflammatory cellular processes including necroptosis, a type of regulated cell death, and cytokine production. In necroptosis, cells rupture leading to the dispersion of cell contents, which can trigger an immune response and enhance inflammation. RIPK1 inhibition has therapeutic potential in treating autoimmune, inflammatory, and neurodegenerative disorders.
Rigel’s RIPK1 inhibitor program includes R552, a systemic molecule being developed for the treatment of autoimmune and inflammatory disorders, and brain penetrating RIPK1 inhibitors for central nervous system (CNS) diseases. In preclinical studies, R552 demonstrated prevention of joint and skin inflammation in a RIPK1-mediated murine model of inflammation and tissue damage.
Development of R552:
In Q2 2023, the initial Phase 2a trial (NCT05848258) in moderately to severely active rheumatoid arthritis (RA) was initiated by partner Eli Lilly.
Development CNS-penetrating RIPK1 inhibitors:
Currently in preclinical studies. Pipeline :: Rigel Pharmaceuticals, Inc. (RIGL)
~Summary and Prediction~
The current share price of sub $1 does not feel justified. I would anticipate financial breakeven by the end of 2024 or potentially in Q1 or Q2 of 2025. The robust pipeline, progress, and expected revenue growth are enough to justify a much higher valuation. The debt load is manageable, but the potential for S is concerning. I believe that the S is not necessary and revenue growth and progress should speak for itself. I am not as bullish as the analysts at HC Wainright for a $15 PT, but the valuation should be at least 3x to 5x from the current value. This thesis does not highlight the patents surrounding their drugs either which some extend into 2035 and beyond. Perhaps what Wall Street is discounting is the fact that most of the drugs are very niche. However, the currently available drugs have an addressable market, albeit less universal than some, but you should value it in the sense of multiple facets (a 1000 headed snake is the phrase I wanted to use). I believe the company should be valued with specialty drugs in mind which would command a higher PE ratio. At the current day and time of writing, the value should be at least $1.50 to $1.75 ~at a minimum~ with a 12 month price target of $3 to $5+. I will be looking for continued revenue growth in each quarter this year and realization of revenue from Gavreto in Q2 or Q3 this year. The partnerships should not be discounted either and the current share price if it lingers here perhaps may attract a merger or acquisition. I initially began the research thinking that perhaps the drugs were too niche, but given the multiple drugs they are working with, I believe their revenue sources will continue to grow if you do not focus on one particular drug as the main performer. With the most recent inflation report being cooler than expected, I would suspect larger funds and institutions will be circling back to riskier assets.

One of Christianity's core beliefs is the belief of predestination and free will. Not only are these the cornerstone of christianity but also one of the most debated viewpoints for theologians. Most Protestant denominations follow the views of predestination and the elect, while free will is the belief of Catholics. The Webster dictionary defines free will as the “freedom of humans to make choices that are not determined by prior causes or by divine intervention” while predestination is defined as “the doctrine that God in consequence of his foreknowledge of all events infallibly guides those who are destined for salvation”. Scripture shows that God is Omnipresent, Omniscient, and Omnipotent. Scripture also tells of God’s preaching of predestination and to humanities free will. In the Gospel Jesus Christ is shown to teach free will to humanity. This evidence proves that Predestination can exist in the world simultaneously with our own free will.
In Genesis 1:1-3, God created the heavens and the earth. In this scripture we can understand that God is all powerful. He is not held by matter and space, because he makes the matter and rules over the space. As well, he is the beginning and the end as seen in Revelation 22:12-13, “he is the Alpha and the Omega”. This refers to the beginning and end of the Greek alphabet and is a metaphor for God's unlimited age. He does not die and has been around for ever and ever. He is not held by time meaning he can be in the past, present, and future. Because God can see all, this means he knows all and knows the ends of our life (either salvation or damnation).
Not only does the bible prove that Predestination exists, it also proves free will exists through scripture. In Galatians 5:13, Jesus says, you my brothers were called to be free. Jesus means that we as God’s people are free from restraints and our lives are not scripted or shaped to God's will, it is our own will. This scripture can be confusing because of other biblical verses like 1 Corinthians 6:19–20, which states that God owns us in body and spirit, but this is referring to our physical bodies and spiritual souls which he has created and thus owns. We can look at the word owns being synonymous with the word creator. God created us from dust and dust we shall return but our lives in between are our own destiny. Likewise, Jesus preaches to the Jews in John 8:31-32, “If you hold to my teaching, you are really my disciples. 32 Then you will know the truth, and the truth will set you free.” We see Jesus showing the true nature and belief of God which is free will because Jesus is God's true nature. No matter if Jesus and God teach of two different things, they can never contradict each other because they are one alone. As Christians we try to make a human-like connection between these beliefs and come to the point of confusion but as humans were created to have confusion. Although harsh, God says, “For my people are foolish; they know me not; they are stupid children; they have no understanding.” in part of Jeremiah 4:22.
The Bible directly shows that God teaches predestination to his people through his divine revelation of scripture. The Bible also shows that Jesus preaches free will to his people through parables, sermons, and real life applications. Neither of them are lying or teaching heresy but instead display their own perspective to those who would believe. In the time of Jesus, people wanted to hear that they have free will (which they do) so Jesus preached of free will more often, which grew his supporters. God’s predestination would be heard by the original writers of the Bible through divine inspiration and revelation but as well hundreds of thousands of years later in the Bible. These two beliefs were able to come together through the old testament and the new testament to agree with one another instead of contradicting each other.
One argument against the previous statement is that the new testament is the fulfillment of the old testament, meaning predestination would be irrelevant and free will would be the fulfilled and true belief. I would say that if this was true, then every other belief we have like the 10 commandments in the old testament would be irrelevant as well and should not be taught. As well this would mean we should just read the new testament and ignore the old testament entirely. We have both for a reason, whether that be for reference or for historical truths.
In conclusion, even though they are frequently perceived as contradicting, the ideas of predestination and free choice are essential to Christian theology. Catholics emphasize free will, while Protestants usually emphasize predestination. Scripture, however, affirms both positions: Jesus' teachings in the Gospels support free will, while God's omniscience and omnipotence imply predestination. This apparent contradiction strengthens God's nature and His relationship with humanity and shows that human freedom and divine sovereignty can coexist accordingly with Christian beliefs. I would like to end with the verse Proverbs 16:9 stating, “In their hearts humans plan their course, but the Lord establishes their steps.” This one verse can single handedly solve this whole argument, so I would like you to ponder this verse as I end this thesis.

Hello redditors of antiMLM,
Just this week, I received an email from a relation advertising FOREVER—not to be confused with Forever Living. Searching through this sub, I found a few short references over the last years with little detail. In one, a commentor described FOREVER stating "as mlms go, it seems ethical." Every red light went off while I looked into these “FOREVER Ambassadors.” I then began a search, with much of the ultimate work done by my spouse. It took longer than seemed acceptable to identify this MLM for people who glanced over the internet. FOREVER is not listed on any of the MLM databases I could find from this sub or elsewhere. Based on the mandatory “FOREVER Ambassador Community” on Facebook, now 8 years old, at least 2,500 people have gotten into their clutches at some point (I haven’t linked because I think it might be against the sub rules).
Thus, for the benefit and enjoyment of the people, here are references for the community to identify a yet-another-multi-level-marketing scheme. I am a sarcastic person, so be forewarned. All sources were publicly available and required no logins or access.
TABLE OF CONTENTS
(1) Background of the FOREVER business model
(2) The FOREVER Ambassador program
(3) Costs of serving as an Ambassador
(4) Compensation advertised for Ambassadors
(4a) Income in cash from personal sales
(4b) The downline system used by FOREVER
(4c) Non-monetary-achievement compensation
(5) FOREVER Ambassador Business Training
(6) Conclusion down to brass tax on FOREVER
STUDY OF FOREVER
(1) Background of the FOREVER business model
FOREVER is an online service that advertises it can be a “permanent digital home that lasts for many generations.”[1] This is to be accomplished via a so-called “FOREVER Guarantee Fund” that invests to pay for digital storage for over 100 years.[1] Their website promises me that “permanent” is “not a buzzword”—I think that’s the Platonian ideal of a buzzword.[1] Regardless, this is not a quality review post.
(2) The FOREVER Ambassador program
The sellers used by FOREVER are called “FOREVER Ambassadors.”[2] As advertised, it looks like a classic MLM pitch. You can “earn up to 35%” commission” while having “the freedom to work from home, and the flexibility to make money on your own schedule.”[2] FOREVER lists various opportunities, such as “trainings” and the ability to “learn and grow with friends,” as well as “make life-long friends.”[2] As part of the “Meet our Team” webpage for corporate FOREVER, there are multiple “Executive Ambassadors” listed.[3] There is no barrier to entry on experience required to become an Ambassador.[4] I observed that, throughout the internet and on the FOREVER website, the vast majority of Ambassadors are women—as you know, many MLMs target women and moms.
(3) Costs of serving as an Ambassador
FOREVER has, at minimum, an “Annual Ambassador Fee” that is the primary cost to entry of the program.[2] For $179 a year, one would receive “back office tools,” various marketing materials, and “countless opportunities”—maybe money, but more on that soon.[2] There is a link to an Ambassador’s own selling website.[5, at 22] This Ambassador fee “is subject to change over time.”[5, at 25] There is also a FOREVER Merchandise store where Ambassadors can get their supplies.[6] These include a 40-pack set of catalogs for $44.99 and a $144.99 tablecloth for potential customers during in-person events.[6]
For Ambassadors, FOREVER advertises there are “free training events.”[5, at 25] Each year, for $399 in 2024, Ambassadors can attend the 3-day “FOREVER Live!” event.[7] It is in the destination getaway of… next to their headquarters in Pittsburgh, PA (I’m sorry Pittsburgh, you’re a beautiful city).[5, at 24] It is also possible to pay for a “p2P Virtual Party” and “p2P Live Events,” but is unclear what those mean.[5, at 5] Various “ranks” of Ambassadors receive a “monthly stipend” starting at $25 a month after $15,000 total in personal plus team sales a year.[5, at 9]
(4) Compensation advertised for Ambassadors
(4a) Income in cash from personal sales
FOREVER pays its Ambassadors based on a “cash sales” versus “full sales” system.[5, at 5] The too-long-didn’t-read summary is that some products are paid less commission than others because of “margin” of different products.[5, at 5–6] Critically, the Personal Commission Rate is where our story kicks into gear. At the bottom, an Ambassador who sells less than $2,000 a year in sales receives the windfall of a 15% commission.[5, at 7] The number rises to 34% once sales are $90,000 or greater in one year (I don’t know where the 35% from earlier went).[5, at 7] However, to earn the 20% commission or more once one passes the $2,000 sales amount requires completion of the “FOREVER Ambassador Business (FAB) Training.”[5, at 7] I read it, more on that later.
You might ask, “Is there a sales quota for FOREVER® Ambassadors?” FOREVER says “no.”[8] However, the less one does the less FOREVER pays Ambassadors for what they do (this chart is older than the Compensation Guide cited).[8]
(4b) The downline system used by FOREVER
Of course, while it took forever to reach here, we come to the “downline” process—FOREVER’s words, not mine.[9] FOREVER immediately identified that new Ambassadors “choose another Ambassador to mentor you as you grow your business” (I do not know if this means an upline).[2] Nevertheless, “Team Sales” are compensated by FOREVER down to the 5th Line.[5, at 9] If an Ambassador does not build a team, then they do not earn Team Commissionable Cash Sales Commissions.[5, at 9] FOREVER states that getting new Ambassadors “to sign up under your name” is how you help “further your business.”[9]
However, even if an Ambassador builds a team, they receive a very restricted downline compensation if they do not make a minimum of personal sales.[5, at 9] For future reference, an “Associate Ambassador,” the bottom, makes less than $2,000 and earns no downline sales.[5, at 9] An “Ambassador,” second to last, is the first rank with a downline commission (4% for 1st Line), requiring $2,000/personal a year.[5, at 9] To reach “Senior Ambassador,” third to last, and above, a FOREVER Ambassador must start earning exponentially greater amounts of personal plus team sales to rise in the “ranks.”[5, at 9] A Senior Ambassador requires $8,000/personal but $15,000/gross, and is the first to get 2nd Line commission (4% for 1st Line and 2% for 2nd Line).[5, at 9] It is unclear to me if “new members” must be recruited “each month” to rankup—the website says so, but I see it nowhere in the Compensation Guide.[8]
At the top of hierarchy, there become two “Executive Ambassadors.”[5, at 9–10] These ranks start at $28,000/personal and $250,000/gross a year.[5, at 9] As well, one must have at least three “Team Leaders” in their 1st Line.[5, at 10] Team Leaders refers to Ambassadors who have themselves reached the rank of “Associate Lead Ambassador” ($12,000/personal and $30,000/gross).[5, at 9] FOREVER advertises that the Executive ranks are for—and I am not making this up—those Ambassadors who are “grooming FOREVER Leaders on your team below you.”[5, at 10] Irony is dead folks.
(4c) Non-monetary-achievement compensation
Because being paid to work is overrated, FOREVER will also provide “Additional Benefits” to its various ranks. As an Associate Ambassador, you can join the aforementioned Facebook Group and hear the CEO talk on a monthly phone call.[5, at 11] Regular Ambassadors also get a certificate to put on their wall.[5, at 11] Senior Ambassadors get a standing ovation at FOREVER Live!—you can even be ovated on stage as an Associate Lead Ambassador (I would pay $179 a year to not).[5, at 13–14] My observation is that a lot of ranks mostly provide additional types of standing ovations at FOREVER Live! and reserved seats for dinners there.
But then you can reach the pinnacle of Everest (that much like the real one, other people just carry you up there): the Million Dollar Club.[5, at 20] For making $1 million in personal and team sales in a year, one will earn a single $10,000 dollar bonus.[5, at 20] If you are then a “top-performing Ambassador,” one can be taken on the “Achievement Gathering,” to Jamaica in 2024, to mill around with other top-performing Ambassadors—and the corporate staff.[5, at 24] There is no mention how many people earn it or how much must be earned.[5, at 24]
(5) FOREVER Ambassador Business Training
I mentioned earlier that Ambassadors must complete a “FAB” training to receive more than 15% in commissions.[5, at 7] To hit this post home, I wanted to identify some highlights. The FAB training has 5 Steps to reach regular Ambassador status.[10, at 4] These Steps include such activities as “Meet with your Upline” (Step 1), “Connect with your Upline” (Step 2), “Meet with your Upline” (Step 3), “Meet with your Upline” (Step 4), and “Meet with your Upline” (Step 5).[10, at 7, 10, 12, 14, 16] You also have to join the FOREVER Facebook group and any created by your Team (just “ask your Upline” to find it).[10, at 6–7] There’s a task in Step 2 to create an introductory “Share List,” with five lines each for “Friends,” “Teachers,” and your own “Parents/Grandparents.”[10, at 7–9] For an unclear number of hours, you must attend multiple weekly and monthly “training opportunities” and “calls.”[10, at 6–7, 10] And one last item, to rank up in FOREVER, you must register for an upcoming event.[10, at 12] As of writing, the only one listed on the linked webpage is the $399 FOREVER Live! conference.[11]
(6) Conclusion down to brass tax on FOREVER
I was unable to find an Income Disclosure Statement for FOREVER. However, basic math tells us that an Associate Ambassador, the bottom, can only earn up to $300 a year.[5, at 11] To reach regular Ambassador, which includes signing up and beginning all the time sinks listed above, the maximum personal commission is $1,200, in addition to whatever downline (however big those are on average).[5, at 11] Without a downline, even the top-bracket personal sellers are the only ones to earn more than $30,000 a year.[5, at 7] The Federal Reserve Bank of St. Louis estimates that the Real Median Personal Income in the United States for 2022 was $40,480.[12]
There is one way to make it with FOREVER: to build a downline. It’s a multi-level-marketing scheme, and no one should join it. Unless of course, you want to join my downline—I promise you'll be rich just like me.
LIST OF REFERENCES
[1] “Our Story,” FOREVER.com (accessed May 18, 2024), https://www.forever.com/our-story
[2] “Become a FOREVER Ambassador,” FOREVER.com (accessed May 18, 2024), https://www.forever.com/opportunity
[3] “Meet Our Team,” FOREVER.com (accessed May 18, 2024), https://www.forever.com/our-story/team
[4] “What is required of me as a FOREVER Ambassador?,” FOREVER.com Support (accessed May 18, 2024 [updated “2 years ago”]), https://support.forever.com/hc/en-us/articles/215823437-What-is-required-of-me-as-a-FOREVER-Ambassador
[5] Ambassador Compensation Guide, FOREVER (Jan. 31, 2024), https://www.forever.com/app/users/forevealbums/ambassador-kit/f3ii4wzeewd0nfwg4nb40kyw1/files/1043b0c6-de01-4aff-a1e3-83db7e6b1b17
[6] “FOREVER Merchandise,” FOREVER.com Ambassador Training (accessed May 18, 2024), https://www.training.forever.com/store
[7] “FOREVER Live! 2024,” FOREVER.com (accessed May 18, 2024), https://www.forever.com/events/forever-live-2024
[8] “Is there a sales quota for FOREVER® Ambassadors?,” FOREVER.com Support (accessed May 18, 2024 [updated “2 years ago”]), https://support.forever.com/hc/en-us/articles/215142548-Is-there-a-sales-quota-for-FOREVER-Ambassadors
[9] “Downline,” FOREVER.com Support (accessed May 18, 2024 [updated “2 years ago”]), https://support.forever.com/hc/en-us/articles/221072448-Downline
[10] FOREVER Ambassador Business Training, FOREVER (May 14, 2024), https://www.forever.com/app/users/ambassador-training/albums/02-forever-ambassador-business-training-booklet/qcg622q43zy6835w9ojq3wkw/files/f0bd2387-bb14-43a2-a46d-344a91470147
[11] “Events,” FOREVER.com (accessed May 18, 2024), https://www.forever.com/events
[12] “Real Median Personal Income in the United States,” Federal Reserve of St. Louis (accessed May 18, 2024), https://fred.stlouisfed.org/series/MEPAINUSA672N
POST EDITS
A few formatting errors and a minor phrasing correction.

Goedenavond,
Ik twijfel behoorlijk tussen deze twee studies… ik heb mij voor allebei ingeschreven maar moet er voor 31 augustus toch echt eentje kiezen. Is er iemand die mij de belangrijkste verschillen tussen econometrie en tw uit kan leggen? tw lijkt me misschien iets interessanter vanwege de verschillende toepassingsgebied en diepgang in de wiskunde, maar werken in bijvoorbeeld de financiële wereld trekt me ook wel. Is het dan handiger om econometrie gedaan te hebben? Ofwel: hoe zit het qua baankansen?
En hoe tevreden zijn jullie over studeren aan de TU Delft of de VU Amsterdam? (Econometrie wordt namelijk aan de VU, TW wordt TUD)
Stuur eventueel een privéberichtje als je open staat voor nog wat vragen / informatie kan bieden!!
Bedankt! 🙏

I am in recovery from my ureteroscopy on a calyceal diverticulum, and while I found some journal articles and a few stray posts on here about them, I want to paint a bigger picture about my actual experience and what I felt.
This is a very long post because I wanted to err on the side of more information so that other may feel much less alone than I have felt. I have included subheadings so you can read only what is useful to you.
To start, I am a 31-year-old female with endometriosis (I explain the implications of that in one of my subsections.). I live in New York City and was operated on by a surgeon at Smith Institute for Urology at Lenox Hill Hospital, which specializes in “complex anatomy” and kidney stones.
TL;DR Calyceal diverticula are pockets on the kidneys affecting 0.5% of the population. Stones can form and get trapped due to their narrow opening (infundibulum). As a result, their pain pattern is different and diagnosis can be delayed. To resolve the problem, you will need a surgeon to remove stones and expand the opening and/or ablate the lining of the diverticulum via ureteroscopy or percutaneous nephrolithotomy.
What is a calyceal diverticulum?
For a good scientific review of what calyceal (kay-luh-SEE-uhl) diverticula are, there is a review study from 2014 with primary author Nikhil Waingankar. In short, these are pockets within the kidneys that have much narrower entry points (“infundibula”) than a normal calyx, and they are theorized to only occur in 0.5% of the human population, with an estimated 96% of those who have them forming stones inside them.
They are often found incidentally on imaging because many people remain asymptomatic. In my case, we saw “a cyst requiring further imaging to rule out neoplasm” (cancer) when I was having my appendectomy in 2022 and had a CT scan in the ER.
They will look like cysts until you either get a radiologist who knows what to look for and sees a stone inside, or until you do a CT urogram, which is a more involved CT scan where you can see if the urinary system communicates with the “cyst.” Simple cysts and neoplasms will not show urine entering the mass; a calyceal diverticulum will, because it has an entrance.
Important stipulation in my experience: endometriosis and its surgeries
My story is complicated by the fact that I have endometriosis, which is a disease wherein cells resembling uterine cells occur outside the uterus. This is an extraordinarily painful condition that causes widespread inflammation due to the uterus-like cells’ having “menstrual periods” outside the uterus. It that can occur anywhere in the body; while most people’s disease presents primarily in the ovaries, uterus, and Fallopian tubes, the disease has been found in every organ in the body. In my case, my disease was confirmed to be extrapelvic as soon as my appendix pathology report revealed that my appendix had endometriosis on it; the cells existed beyond the typical pelvic organs.
I have already had two laparoscopies for endometriosis, and while these were immensely helpful in restoring my quality of life, every abdominal surgery comes with the risk of adhesions. Adhesions are bands of tissue that the body forms when it experiences inflammation or trauma. Endometriosis forms adhesions by itself, and surgery to remove it risks further adhesions. In 2020, when I had my radical excision surgery, my surgeon had to perform ureterolysis to cut my ureters free: whether from previous surgery in 2016 or the disease, my ureters were stuck to my uterus due to adhesions.
I share this because having endometriosis and its surgeries in my history affected my path to diagnosis and probably my pain pattern. (Endometriosis forms its own nerve endings, too!) But for the record, the kidney stones and the kidney surgery in my case were more painful than endometriosis…probably because they freaked out any remaining endometriosis.
(Sorry for no source on this endometriosis information. I am unfortunately very well-read on the disease! If you want to learn more, I recommend The Center for Endometriosis Care website and the book Beating Endo.)
What did the calyceal diverticulum feel like at first?
On a Tuesday in January 2024, I was trialing prazosin, an alpha blocker related to Flomax (tamsulosin) due to PTSD nightmares.
One day after taking this drug, I woke up with 8/10 pain muscle spasms in my “iliac crest,” which is the top edge of my pelvis, on the right side. I thought I had “slept funny” and the pain subsided after about 3 hours. I tried to roll around on a lacrosse ball, thinking it was a muscle spasm.
I took the prazosin for two more days. By that Thursday, the pain lasted more like 6 hours and did not go away; I had the muscle spasms as well as a feeling that there was “trapped gas” right at my waist, right on the side of my body. Because the pain stayed at 8/10, nothing would calm it down, and I couldn’t focus on work, I went to the ER. We did a CT scan and saw nothing different from my last CT for my appendectomy. They decided it was probably a kidney infection with strange presentation due to my endometriosis and sent me home with cefpodoxime, an antibiotic.
I finished the course of the antibiotic over 7 days and felt better.
But then the “trapped gas” feeling returned and lasted 18 hours. I went back to the ER, mostly concerned that I had failed antibiotics and the “infection” was getting worse. I made a urologist appointment while I was waiting in the ER because I suspected this might be beyond their mandate of ruling out anything life-threatening. We did another CT, and this time I really carefully read the results: inside what we had identified as a calyceal diverticulum in 2022 during my appendectomy CT scan were two kidney stones, each about 0.2mm. Because there was not much change from my last ER visit, the doctor at the ER did not think this explained how I was feeling. He did not want to send me home with antibiotics because he thought his colleagues were too cavalier with testing, but he did send for a urine culture and sent me home at least assured there was no emergency.
The culture came back, and I did test positive for E. Faecalis, which is a rarer bacteria to have, so the doctor at the ER urged me to get on Levaquin, an antibiotic, as soon as possible. (My endourologist later theorized this bacterium was an incidental finding; he thinks I just happened to be colonized with it and it was not causing symptoms. Regardless, it was not present in my culture before surgery.)
Again, I took almost the full course of the antibiotic and was feeling better and safer. I also saw a urologist, and she was skeptical it was an infection but told me to continue the course. She was pretty sure it was endometriosis-related but saw that I had seen my gynecologist, who has been treating me for 5 years, days prior who was pretty sure this was NOT consistent with what she had seen when we operated in 2020. The urologist said she felt this might be beyond her skills and referred me to one of her medical school colleagues who is a specialist in “complex anatomy” like calyceal diverticula as an endourologist professor at Lenox Hill in NYC.
But before I could see the endourologist, only one week after my last ER visit, I was in 9/10 pain for 7 hours overnight. I really did not want to go to the ER again, but I was vomiting, sweating, using the bathroom (both ways) constantly. After 7 hours not being able to get it to calm down, I went back to the ER.
The first thing they did was test me for sepsis, because I was being treated for an infection. They also did a CT scan again and then we saw it: one of the kidney stones had left the calyceal diverticulum and was stuck in the ureterovesicular junction (“UVJ”). By the time I was diagnosed, I was in 9/10 pain for 18 hours, so what we now know to be the renal colic phase lasted for 18 hours. They admitted me overnight to the hospital to observe and had me on ketorolac (Toradol) and oxycodone/acetaminophen (Percocet) every 6 hours alternating. The pain subsided the next morning.
Confirmation and surgery
Luckily, I had the endourologist appointment on the books already, and I got all of my images from the ER to bring to this doctor, letting him know I was confirmed to have passed the stone.
What he was able to do for me I will never forget: he showed me exactly why I was in enough pain for the ER each of the three weeks I went. Unlike a normal stone situation, a stone in a calyceal diverticulum has far more opportunities to get stuck. Also unlike a normal stone, you can feel the stone passing before it reaches the ureter because it has to leave via the narrow opening of the diverticulum. This means the pain can feel different and, due to its location within the kidney is more prone to being referred pain (pain you feel in a place other than where it originates). This is why I did not feel the pain in the classic place and why it felt much more like trapped gas. Furthermore, most radiologists do not have the same training as he did to identify where in the opening the stone was, which explained why they believed the stone was in the same place each time.
We wanted to take a “wait and see” approach on the second stone, but my body did not want to wait. As I was falling asleep one night in early March 2024, I felt that familiar “trapped gas” feeling, way too far right to be my intestines. This is 6/10 pain, so I could go to work for an important meeting, but I called to get an ultrasound and appointment right away. (We have since found that for my specific diverticulum, ultrasounds are not useful. I will need a CT urogram any time we want to visualize the kidney post-op.)
My doctor said that he wanted to attempt ureteroscopy before percutaneous nephrolithotomy because it is a less-invasive modality and we were worried about impacting any endometriosis. He had me sign paperwork consenting to either method, and it was a “game time” decision based on what he saw with the camera.
In the two-and-half week wait til surgery, his hypothesis gained traction: I would have days “on” with the pain and “off,” suggesting the stone was able to enter the diverticular opening and then flow back into the diverticulum. When I was in pain this time, I would also feel a lot of fatigue and brain fog that made it hard to work. This could be consistent with a kidney blockage, but it is hard to say for sure with an area so small.
The surgery, the stent, and the pain after the stent
The surgery itself went pretty well and only lasted 1.5 hours. The surgeon let me know that it was not easy to get into the diverticulum because the opening was not straight, as expected. He was, however, able to complete the surgery with only ureteroscopy. He removed a 0.2mm stone and observed that the stone was exactly the width of the opening, meaning it could absolutely flow into and out of it and get stuck for days. He widened the opening with laser to be “wider than a normal calyx” to allow for scarring, and, at my request to avoid further operations, ablated as much of the lining of the diverticulum as he could, encouraging it to close up.
While the surgery was uneventful, I am one of the unlucky ones who cannot tolerate a stent. This is probably due to my endometriosis, which leaves me in a heightened baseline of inflammation and nerve arousal, as well as the fact that, for me, the stent had to go into the diverticulum, which had been lasered and burned, in order for it to heal. I spent four hours in the recovery room while we tried to get my pain down to my goal of 7, which meant we needed to dose me, as we did in the ER, with ketorolac (Toradol) and oxycodone every 6 hours with no gaps in between.
I only had the stent in for 3 full days, and unfortunately, due to my specific circumstances, that was the worst pain I have ever been in. I was agnostic about 10/10 pain until this time, in which I felt like I was passing a stone and experiencing my worst endometriosis cramps at the same time. I was in 8-10/10 pain despite the painkiller regimen, and since we found that dilaudid does not work for me, this was good as they could do for me.
Thankfully, my surgeon listened to my experience and agreed to take the stent out as soon as was responsible: 72 hours later. The actual removal was uncomfortable but not painful beyond a “scrape” sensation in the urethra, and as soon as it was out, my husband noticed I could move as normal and was talking more like myself.
However, 1 out of 4 people will experience pain after the stent is removed, and risk factors include female anatomy, being “younger” (I am 31.) and having a stent in for less than or equal to 7 days.
The day of the removal I had some muscle spasms but was mostly so relieved that I slept all day.
34 hours after the removal, I experienced a feeling like I was passing a kidney stone. I was in 9/10 pain for 6 hours, feeling like I needed to move my bowels (which was not easy after opioids!) and having unrelenting spasms above my right iliac crest (top of pelvis). I was on ketorolac (Toradol) during this and knew what it was, but I otherwise may have gone back to the ER. I refused to take more opioids because my bowel was upset as well.
Today, I have had one episode of the iliac crest muscle spasms lasting an hour. I have found that crouching on the floor, against a wall, and/or going into “reclined butterfly pose” may help. It may just make me feel like I have more control over the situation.
I will update this post if I feel more pain in the coming days.
What’s next?
My endourologist/surgeon thinks it is very unlikely that I am “a stone-former” because the stones were only in the diverticulum and likely formed due to the urine reflux of that structure.
We will follow up in 3 weeks to see if the sensation I felt in March of the “trapped gas” recurs. If it does, only then would we do a CT urogram to see if the diverticular opening closer up to anywhere near its former width of 0.2mm.
This is unlikely because the surgeon lasered the opening very wide, “wider than a normal calyx,” to allow for scarring to take place. The ablation of the lining of the diverticulum should also take care of its tendency to collect urine.
I am not expected to have further stones or need for surgery, but he has seen cases of recurrence, so we need to manage my expectations.
Despite the extreme pain of the stent, I am content with my decision and hope that I do not have to go through this again. The one blessing in my case is, if this surgery succeeds, I should not have any further kidney stones.

Hello, me and my girlfriend are doing a Bible study, and we have quite a ways to go. I myself fall into the KJV Onlyist camp, however my girlfriend uses a CSB. So I'm looking for a quality CSB that is cheap, but not bad quality for myself. I went to my book store, and the cheapest I could find was $25. I'm even okay with paperback.
We are doing:
Genesis
Exodus 1-35
Isaiah 1-12
John
Mark
Acts
Romans
Philemon
Revelation
Proverbs
And we are only a decent ways through Genesis so far.

I am an international medical school graduate from Germany, I have dedicated the past six months to preparing for the USMLE. However, despite my efforts, I find myself facing a significant challenge. My NBME and UWorld performance have remained stagnant around the 60% mark, leaving me feeling frustrated and uncertain about how to proceed. To add to the complexity of the situation, I failed USMLE Step 1 once in the beginning due to a lack of preparation and the wrong approach.
I have completed 78% of Uworld QBank, NBME assessments 25, 27, 29, 30, and 31, all yielding scores between 59% and 67%. My latest UWorld assessment was at 62%. I particularly struggle with pharmacology and arrow questions. Mentally, I am struggling a lot with the feeling of not making any further progress at the moment. Additionally, I find myself lacking confidence when I take the mock exams, further exacerbating my concerns.
Compounding these challenges is the fact that I don't have any medical colleagues in the States whom I can turn to for advice and experience. I feel isolated and unsure of how to navigate this journey without a support system.
I am reaching out to this community in the hopes of receiving guidance and insights from those who may have experienced similar struggles or have valuable advice to offer. Any suggestions on study strategies, resources, or ways to improve my confidence would be greatly appreciated.

Okay, it all started 6 years when I first stumbled upon this:https://www.youtube.com/watch?v=RR1YcjfAddI then one of the Zero Hour episodes).
Notice in that MMD video there's High School Of The Dead and Terminator references/Easter eggs? That's what inspired me to start this mission making a Blender animation with this type of Easter egg(s). Vocaloid and anime characters - particularly my personal favourite cartoon and anime characters in place of the originals. This is all that was needed to set my dream of a parody video or Easter egg hunt involving my favorite fictional animated characters combined with existing media into motion.
But due to some power-happy mods/admins of certain websites who had no idea of this special mission of mine - as I was hiding it until it's complete (no spoilers), they had to act above and beyond and discipline me by either removing my posts regarding this question (E.G., "Where can I download this sound effect(s)?") or out-of-the-blue (perma)-banning me for "breaking the (site) rules"/"piracy efforts"!
Plus, it took me a whopping 8 years (as no keyword I used (at the time) yielded what I was expecting/requested for) just to determine/figure out it was Hollywood Edge, Hanna Barbera, Sound Ideas, etc., etc. that I had to refer to for the "common sound effects" we hear all the time in TV shows, movies, video games, and cartoons. This is a new realm of sound effects to me and now that I finally found it, I need a breather. But these mods/admins gave me anything but that.
Even the MMD community has rules to follow regarding downloading models others have "created" - those that were literally ripped from a video game. So to still respect the MMD model usage rules/be a law-biding citizen, I resorted to Blender as after watching a 3D remaster of Cars Community Service, I realized Blender is basically the entire package.
If you don't understand English, here's the simple version: I need help to streamline my 3D modelling process to obtain 3D models of things I’ll need for my Blender animation - with whatever strategy I can improvise. I need any readily available and already made 3D models for my Blender animation. I’m currently 28 years of age; I got this far in my life, but I’m not sure how much further I can go. But this is one case where I won’t accept “Too bad, so sad” that easily.
Whether it’s requesting for the thing for this game via the game dev team’s email by emailing them what you request for in the game and once they do make it for the game and upload it to their client and I update my copy of the game via patching, I then decompile the game from my end and presto. I obtain that game’s new model.
It’s faster to rip them from a game as they’re already made for that game.
Sadly, I have yet to find a high graphic Columbine High School in it’s original floor plan as a 3D model via any game. So I have to fall back to Plan B and make it via Blender. But that (learning to use Blender) takes time and I’m not that skilled at using Blender yet. So I have to seek help from someone who’s already an expert and fluent with using Blender or any other 3D modelling software to make it for me to streamline that process.
But some people have died earlier than anticipated like Terry Fox when he died of cancer at 22 and Wowaka when he died of heart failure at 31. So I’m not taking any chances and need to streamline the modelling process with any measure or strategy I can think up before I meet a similar early fate like they did.
Is that the way you want to go? To leave your fan base hanging in suspense for the rest of their lives while you head for your eternal place in the who-knows-where's? Every millisecond counts. - Especially for those who have a terminal illness and are literally living on borrowed time. Some of us must and will complete our goals no matter what obstacles we encountewhat gets in our way in any way possible. You really never know when your time is up. Age has no relation to when is the day you die; it could happen on any day and we need to get our goal done with whatever strategy we can whip up/improvise. I'm still bummed Wowaka missed out on the Project VOLTAGE collaboration with Miku.
Wouldn't you feel bummed if your family member or friend or relative died too soon if you were this close to letting them see something you made? So via the game dev's email and requests forum, I request for the said model, but make sure it's somehow related to the game's gameplay or storyline.
This is the strategy: get a game dev company to make the models for me, but via for the video game. That way, once it's released to the public, I work my magic from there and decompile the game for the said 3D model. Thanks to Payday 2 and it's Bundle Modder and Diesel Tool programs, it dramatically cuts down the amount of time I need to remodel the stuff I need for my Blender movie from scratch.
Plus, I can't just think about myself, I gotta think about others too. So I thought "What if everyone would enjoy my weapons and stuff in the said video game?" But since I don't work for the game dev company, I might as well write to them my request list of things to implement into the game via their email. Now that I submitted my ideas for their games, all I have to do is wait til they make it now while I finish up some unfinished personal matters on my end.
Columbine High School is going to play an important role in my Class of 1999 (starring Bradley Gregg) parody movie. But so many people are reluctant to help me due to this school building.
And also, you can’t imagine the heartache I endured while trying to seek assistance in searching for sound effects. They treated me like I’m some felon trying to “pirate” sound effects. So after 3 months of wasted time on my sound effects search quest, the least I can do right now is make up for that wasted time.
Finally, this is the whole reason Alvin Earthworm discontinued Super Mario Bros Z: "Us: HURRY UP WITH THE NEXT EPISODE ALREADY!", his project was merely intended to be a hobby. So to avoid comments like that, I'm going to finish my animations FIRST, then upload them later. So you can see what happens at the end before you pass away early.
So yes, is there anything wrong with thinking/planning ahead of YOURSELF as well as thinking about others before you do the same (stupid) thing they did? I even did my due diligence and stumbled upon things like this: Run Hide Fight (Isabel May). They clearly did their planning, due diligence, and studies before publishing this movie. So therefore, as long as I follow the same procedure, I should be able to publish my Blender vocaloid parody video while offending as little to no people in the process. I'm going to make a Class of 1999 (Bradley Gregg) parody video that involves several of the Zero Hour episodes mixed together as Easter eggs along with my favorite characters and things taking place of the original characters and props - while in the process, making a few changes to the story line.

Okay, it all started 6 years when I first stumbled upon this:https://www.youtube.com/watch?v=RR1YcjfAddI then one of the Zero Hour episodes).
Notice in that MMD video there's High School Of The Dead and Terminator references/Easter eggs? That's what inspired me to start this mission making a Blender animation with this type of Easter egg(s). Vocaloid and anime characters - particularly my personal favourite cartoon and anime characters in place of the originals. This is all that was needed to set my dream of a parody video or Easter egg hunt involving my favorite fictional animated characters combined with existing media into motion.
But due to some power-happy mods/admins of certain websites who had no idea of this special mission of mine - as I was hiding it until it's complete (no spoilers), they had to act above and beyond and discipline me by either removing my posts regarding this question (E.G., "Where can I download this sound effect(s)?") or out-of-the-blue (perma)-banning me for "breaking the (site) rules"/"piracy efforts"!
Plus, it took me a whopping 8 years (as no keyword I used (at the time) yielded what I was expecting/requested for) just to determine/figure out it was Hollywood Edge, Hanna Barbera, Sound Ideas, etc., etc. that I had to refer to for the "common sound effects" we hear all the time in TV shows, movies, video games, and cartoons. This is a new realm of sound effects to me and now that I finally found it, I need a breather. But these mods/admins gave me anything but that.
Even the MMD community has rules to follow regarding downloading models others have "created" - those that were literally ripped from a video game. So to still respect the MMD model usage rules/be a law-biding citizen, I resorted to Blender as after watching a 3D remaster of Cars Community Service, I realized Blender is basically the entire package.
If you don't understand English, here's the simple version: I need help to streamline my 3D modelling process to obtain 3D models of things I’ll need for my Blender animation - with whatever strategy I can improvise. I need any readily available and already made 3D models for my Blender animation. I’m currently 28 years of age; I got this far in my life, but I’m not sure how much further I can go. But this is one case where I won’t accept “Too bad, so sad” that easily.
Whether it’s requesting for the thing for this game via the game dev team’s email by emailing them what you request for in the game and once they do make it for the game and upload it to their client and I update my copy of the game via patching, I then decompile the game from my end and presto. I obtain that game’s new model.
It’s faster to rip them from a game as they’re already made for that game.
Sadly, I have yet to find a high graphic Columbine High School in it’s original floor plan as a 3D model via any game. So I have to fall back to Plan B and make it via Blender. But that (learning to use Blender) takes time and I’m not that skilled at using Blender yet. So I have to seek help from someone who’s already an expert and fluent with using Blender or any other 3D modelling software to make it for me to streamline that process.
But some people have died earlier than anticipated like Terry Fox when he died of cancer at 22 and Wowaka when he died of heart failure at 31. So I’m not taking any chances and need to streamline the modelling process with any measure or strategy I can think up before I meet a similar early fate like they did.
Is that the way you want to go? To leave your fan base hanging in suspense for the rest of their lives while you head for your eternal place in the who-knows-where's? Every millisecond counts. - Especially for those who have a terminal illness and are literally living on borrowed time. Some of us must and will complete our goals no matter what obstacles we encountewhat gets in our way in any way possible. You really never know when your time is up. Age has no relation to when is the day you die; it could happen on any day and we need to get our goal done with whatever strategy we can whip up/improvise. I'm still bummed Wowaka missed out on the Project VOLTAGE collaboration with Miku.
Wouldn't you feel bummed if your family member or friend or relative died too soon if you were this close to letting them see something you made? So via the game dev's email and requests forum, I request for the said model, but make sure it's somehow related to the game's gameplay or storyline.
This is the strategy: get a game dev company to make the models for me, but via for the video game. That way, once it's released to the public, I work my magic from there and decompile the game for the said 3D model. Thanks to Payday 2 and it's Bundle Modder and Diesel Tool programs, it dramatically cuts down the amount of time I need to remodel the stuff I need for my Blender movie from scratch.
Plus, I can't just think about myself, I gotta think about others too. So I thought "What if everyone would enjoy my weapons and stuff in the said video game?" But since I don't work for the game dev company, I might as well write to them my request list of things to implement into the game via their email. Now that I submitted my ideas for their games, all I have to do is wait til they make it now while I finish up some unfinished personal matters on my end.
Columbine High School is going to play an important role in my Class of 1999 (starring Bradley Gregg) parody movie. But so many people are reluctant to help me due to this school building.
And also, you can’t imagine the heartache I endured while trying to seek assistance in searching for sound effects. They treated me like I’m some felon trying to “pirate” sound effects. So after 3 months of wasted time on my sound effects search quest, the least I can do right now is make up for that wasted time.
Finally, this is the whole reason Alvin Earthworm discontinued Super Mario Bros Z: "Us: HURRY UP WITH THE NEXT EPISODE ALREADY!", his project was merely intended to be a hobby. So to avoid comments like that, I'm going to finish my animations FIRST, then upload them later. So you can see what happens at the end before you pass away early.
So yes, is there anything wrong with thinking/planning ahead of YOURSELF as well as thinking about others before you do the same (stupid) thing they did? I even did my due diligence and stumbled upon things like this: Run Hide Fight (Isabel May). They clearly did their planning, due diligence, and studies before publishing this movie. So therefore, as long as I follow the same procedure, I should be able to publish my Blender vocaloid parody video while offending as little to no people in the process. I'm going to make a Class of 1999 (Bradley Gregg) parody video that involves several of the Zero Hour episodes mixed together as Easter eggs along with my favorite characters and things taking place of the original characters and props - while in the process, making a few changes to the story line.

Hi I had some questions about cougar promise, and how it works. I’m currently a senior, entering UH for the 2024-2025 school year. I received almost 20k in aid from scholarships, and FAFSA, and if I decide to work( work study) and take out loans, I’m getting around 31,000 this year. I’m planning on living on campus, as well as getting a meal plan (mandatory anyways). The tuition (around 14k), meal plan(4k) , and housing( 8k) would total around 26 thousand just this year. (I’m rounding up). I heard somewhere that cougar promise works with the grants and FAFSA to cover tuition, but I already have a lot of aid already so I’m wondering if it would even make a difference? I currently have a full time job and I’m planning on saving up for the meal plan because that’s the only thing that I’m short for. I live around 44 miles away from Houston, so I kind of HAVE to live on campus. I’m also not trying to depend on work study (in case I don’t get a job in time on campus) as well as taking out loans. I also JUST got the cougar promise email today, so I’m assuming they started to send them out.

Il 30 ottobre 1966 viene uccisa Cheri Josephine Bates una ragazza di 18 anni nata il 14 febbraio 1948 ad Omaha, Nebraska. Cheri era la più giovane dei due figli nati da Joseph e Irene Bates. La famiglia Bates si trasferì in California nel 1957, dove suo padre trovò lavoro come macchinista presso il Corona Naval Ordnance Laboratory. I suoi genitori avevano divorziato nel 1965. Cheri si era diplomata alla Ramona High school, dove era stata una cheerleader e una studentessa d’onore. Descritta dai suoi conoscenti come “una ragazza dolce ed estroversa” Aspirava di diventare un’assistente di volo. Era alta 1,60 m ed era molto atletica. Dopo Essersi diplomata alla Ramona High School, Bates si iscrisse al Riverside City College e trovò un lavoro part-time presso la Riverside National Bank. Con lo stipendio derivante da questo lavoro part-time comprò un Maggiolino Volkswagen verde lime del 1960. Bates viveva con suo padre al 4195 di Via San Jose. Anche la madre viveva a Riverside e suo fratello maggiore, Michael Bates, prestava servizio nella Marina degli Stati Uniti.
L’omicidio è avvenuto a Riverside, in California mentre la Bates era una matricola del Riverside City College.
La mattina del 30 ottobre 1966, Bates e suo padre parteciparono alla messa presso la chiesa cattolica di Santa Caterina d’Alessandria per poi fare colazione assieme in un ristorante locale. Nel primo pomeriggio telefonò due volte a una cara amica di nome Stephanie Guttman (alle 15:00 e alle 15:45) chiedendole se voleva accompagnarla in biblioteca per studiare e recuperare libri. In entrambe le telefonate la sua amica rifiutò.
Poco prima di lasciare casa, fece una telefonata ad un collega della Riverside National Bank chiedendole se avesse visto una bibliografia di una tesina che aveva smarrito. Il suo collega rispose di no e Bates disse: “Ora dovrò ricominciare tutto da capo con i miei biglietti“.
Bates si recò alla biblioteca del college da sola tra le 16:30 e le 17:00.
Un testimone oculare disse in seguito agli investigatori di Riverside che aveva visto la Bates guidare il suo Maggiolino in direzione dell’RCC intorno alle 18:10. Questo testimone oculare affermò anche che il Maggiolino era seguito da vicino da un modello Oldsmobile in bronzo del 1965 o 1966 .
Secondo molti testimoni oculari Cheri studiò nella biblioteca fino all’orario di chiusura, circa le 21.00. Un testimone riferì di aver visto un uomo alto circa 5 piedi e 11 pollici (180 cm) che era rimasto nascosto in una zona d’ombra dall’altra parte della strada rispetto a dove era parcheggiato il veicolo della Bates. Sembrava stesse fissando in direzione della sua macchina più o meno all’orario in cui la biblioteca chiudeva. Sebbene questo testimone non conoscesse l’individuo nascosto nelle zone d’ombra a lato della strada, mentre gli passava accanto i due si erano scambiati brevi convenevoli.
La polizia, in seguito, stabilì che l’assassino aveva disabilitato il cavo della bobina di accensione del Maggiolino Volkswagen della Bates in modo da simulare un guasto. Quando Cheri uscì dalla biblioteca non riuscendo a far partire la macchina probabilmente accettò l’aiuto di un uomo che si presentò a lei, magari offrendogli un passaggio con la sua auto. Quando il padre di Cheri tornò a casa trovò un biglietto attaccato al frigorifero con scritto: “Papà, sono andata alla Biblioteca RCC.” Il padre della ragazza aspettò buona parte della notte che sua figlia tornasse a casa. Nelle prime ore del mattino telefonò all’amica di sua figlia Guttman, solo per essere informato se sua figlia era a casa sua o avesse avuto intenzione di trascorrere la serata lontano da casa. Non avendo risposte esaustiva si recò al Dipartimento di Polizia di Riverside (RPD) per fare una denuncia di persona scomparsa, erano le 5:43 del mattino. Intorno alle 6:28 della mattina del 31 ottobre, un giardiniere di nome Cleophus Martin scoprì il corpo di Bates sul terreno dell’Riverside City College.
La Bates è stata trovata distesa a faccia in giù su un sentiero di ghiaia tra due case non occupate su Terracina Drive, vicino al parcheggio della biblioteca dove aveva parcheggiato il suo Maggiolino la sera prima. Indossava ancora una camicetta stampata giallo pallido a maniche lunghe e pantaloni capri rossi sbiaditi. La sua borsa di paglia intrecciata, contenente sia la sua carta di identità che 56 centesimi, giaceva accanto al suo corpo. I suoi vestiti erano intatti ma erano pieni di sangue. Era stata ripetutamente pugnalata al petto e alla spalla sinistra e aveva subito diverse ferite profonde al viso e al collo. A tre metri dal corpo di Bates, gli investigatori hanno scoperto un orologio da polso di marca Timex economico, schizzato di vernice, con una circonferenza di sette pollici insieme all’impronta di una scarpa che veniva prodotta per i militari della base di Leavenworth e venduta esclusivamente in punti vendita militari. La misura della scarpa era compresa tra otto e dieci pollici (da 40 a 42½).
L’esame della scena del crimine e la successiva autopsia di Bates hanno rivelato ampie prove di una feroce lotta fisica tra Bates e il suo assassino; lei evidentemente aveva graffiato le braccia, il viso e la testa del suo aggressore e gli aveva strappato l’orologio da polso.
Il Maggiolino di Bates era parcheggiato a soli 75 metri a est del luogo in cui è stato scoperto il suo corpo. Il cablaggio di accensione del veicolo era stato deliberatamente allentato, ma la chiave di accensione era al suo posto e sia il finestrino del conducente che quello del passeggero erano parzialmente abbassati. Sul sedile anteriore c’erano tre libri della biblioteca sul tema del governo degli Stati Uniti e sul veicolo sono state trovate diverse impronte di palme e impronte digitali. Gli investigatori avrebbero stabilito che queste impronte non appartenevano a Bates e a nessuno dei suoi amici o parenti e credevano che potessero appartenere al suo assassino.
L’autopsia ha rivelato che Bates era stata ripetutamente presa a calci alla testa oltre ad aver subito due coltellate al petto inflitte da un coltello stimato essere largo un pollice e mezzo e alto tre pollici e mezzo. Erano state colpite con la lama anche la guancia sinistra, il labbro superiore, le mani e le braccia, oltre tre tagli alla gola che le avevano reciso la vena giugulare e la laringe quasi decapitandola . Fu dedotto che la donna giaceva a terra quando aveva ricevuto le ferite da coltello alla scapola sinistra e al collo. Non era stata sottoposta ad alcuna forma di violenza sessuale o rapina durante questo attacco.
Numerosi frammenti di pelle e capelli castani furono rinvenuti anche sotto le unghie della mano destra, raccolte mentre si difendeva dal suo aggressore. Il terreno dove fu ritrovato il suo corpo è stato descritto, nel rapporto ufficiale dell’autopsia, come: “sembra un campo appena arato”.
Entro 24 ore dall’omicidio di Bates, gli investigatori avevano intervistato 75 persone, tra cui numerosi studenti dell’RCC, e avevano iniziato a interrogare il personale militare di stanza nella vicina base aeronautica di March . Entro il 6 novembre, tutte le persone note per essere state nel campus dell’RCC, tranne due, erano state rintracciate ed eliminate dall’inchiesta. Gli investigatori hanno anche ricevuto testimonianze da due individui che avevano sentito brevi urla femminili provenienti dalla direzione di Terracina Drive la sera dell’omicidio. Da questo, oltre alla conclusione del coroner , gli investigatori hanno stabilito che molto probabilmente la Bates era stata uccisa intorno alle 22.15.
Gli investigatori hanno teorizzato che l’assassino di Bates avesse probabilmente messo fuori uso il suo veicolo e poi aveva aspettato che la ragazza tornasse dai suoi studi nella biblioteca del college. Credono anche che l’autore del reato si sia avvicinato alla Bates dopo che lei aveva ripetutamente tentato di avviare la sua auto e gli abbia quindi offerto assistenza.
Su iniziativa del sergente investigativo dell’RPD David Bonine, nove giorni dopo il suo funerale è stata condotta una rievocazione delle ultime ore di studio di Bates all’interno della biblioteca dell’RCC, nella speranza di produrre testimoni oculari vitali. A questa rievocazione erano presenti 62 studenti, due bibliotecari e un custode che erano stati effettivamente nella biblioteca la sera del 30 ottobre. A tutti i partecipanti che possedevano un veicolo è stato chiesto di parcheggiare la propria auto esattamente nello stesso punto in cui si trovava la sera dell’omicidio, e tutti i partecipanti indossavano gli stessi vestiti che avevano la sera in questione. Questa iniziativa ha portato alla luce numerosi testimoni oculari, anche se non sono state ottenute piste fruttuose. Tuttavia, diverse persone hanno dichiarato di aver visto una Studebaker grigio-marrone nelle immediate vicinanze del campus dell’RCC la sera del 30 ottobre. Nonostante i numerosi appelli sia degli investigatori che della stampa locale, il proprietario di questo veicolo non è mai stato rintracciato. Il 4 novembre 1966, Bates fu sepolto al Crestlawn Memorial Park a Riverside. Alla cerimonia erano presenti i suoi genitori, il fratello maggiore e diverse centinaia di altre persone.
Il 29 novembre 1966, cica 1 mese dopo l’omicidio di Bates, arrivo una lettera dattiloscritta alla sede dell’RPD. Si trattava di una lettera di confessione dell’omicidio.Sei mesi dopo l’omicidio viene scoperta da un custode dell’università un’incisione su una scrivania contenuta in un magazzino dell’RCC. Il custode avverte la polizia e afferma che questa scrivania era, al tempo del delitto, nella biblioteca dell’università. La poesia presenta le iniziali minuscole ( rh ) inscritte sotto una poesia macabra. Questa poesia contiene riferimenti grafici a ripetute aggressioni a giovani donne con un’arma da taglio. La polizia ha fotografato l’iscrizione e ha aggiunto questa prova circostanziale al fascicolo del caso.
Valutazione della mentalità dell’assassino di Cheri Jo Bates, scritta dal capo psicologo del Patton State Hospital nel Luglio 1967: “È ossessionato e patologicamente preoccupato da un odio intenso contro le figure femminili, tanto più se vede la giovane donna attraente. A causa dei suoi sentimenti inconsci di inadeguatezza, è improbabile che esprima i suoi sentimenti sessualmente, ma nella fantasia. , di regola. La fantasia può assumere aspetti aggressivi… Vorrei sottolineare che esiste una possibilità reale che possa diventare di nuovo omicida.“
Nel luglio del 1969 la madre di Bates, Irene, morì per avvelenamento da stricnina.
Il detective Jim Simons Attuale investigatore assegnato all’omicidio irrisolto di Cheri Jo Bates nel Novembre 2013 ha detto: “Ho parlato personalmente con i precedenti investigatori [assegnati al] caso, e credono sinceramente che il caso Cheri Jo Bates non sia correlato agli omicidi di Zodiac … credono che si trattasse di un [suo conoscente], o di un amore disprezzato interesse.“ Nell’ottobre 2021, un gruppo di agenti di polizia in pensione, agenti dell’intelligence e giornalisti hanno affermato di aver risolto l’omicidio di Bates, che secondo loro era collegato agli omicidi di Zodiac e che l’autore in entrambi i casi era un uomo di nome Gary Francis Poste. Tra le prove citate come base per le loro affermazioni c’era il fatto che Poste era un pittore di professione, il che spiegherebbe gli schizzi di vernice sull’orologio Timex trovato sulla scena del crimine; che Poste stava ricevendo cure mediche alla base dell’aeronautica militare di marzo per una ferita da arma da fuoco “accidentale” intorno al momento della morte di Bates; che questo luogo era a quindici minuti dal luogo dell’omicidio di Bates; e che Poste aveva i capelli castani, che potrebbero corrispondere a quelli trovati sotto le unghie di Bates. Comunque la mia impressione è che Zodiac fosse responsabile di quest’omicidio e abbia imparato da questo. Non aveva il pieno controllo della situazione, lei ha reagito, lo ha graffiato, ha perso l’orologio, il suo coltello si è spezzato durante l’uccisione. Eppure non è stato catturato, il che gli avrà dato fiducia in sé stesso ma gli ha anche fatto capire di dover stare più attento in futuro. Infatti, a parte nel 3º delitto il suo modus operandi sarà un dentro e fuori velocissimo senza correre rischi inutili e tenendo sempre sottocontrollo la situazione, ma anche nel 3ºdelitto ha imparato che doveva impedire alle vittime di scappare o reagire perciò le farà legare e non farà mai capire loro cosa stava per succedere. La lettera che l’assassino voleva che tutti vedessero, l’affrancatura eccessiva, l’uso del linguaggio. Poi il fatto che fosse disposto ad assumersi la responsabilità del delitto, sapendo che se non fosse stato lui il responsabile, il vero colpevole avrebbe potuto essere catturato in qualsiasi momento e se fosse accaduto lo avrebbe reso meno credibile nelle sue future affermazioni o vanterie. Questa almeno è la mia impressione.

I got fired last year on a one-day notice at my company and started preparing for the GRE soon after that.
I am honestly now starting to realize that maybe the prep source I picked was wrong. I chose Target Test Prep and have taken two subscriptions of it - each of 06 months. The course is devastatingly long, so much so that each chapter has 10-12 tests which I have to review each and then move to next chapter but by the time I am 3 chapters ahead, I forget what I learned in the first chapter for example.
I did 2 weeks detailed study on TTP Probability chapter and even after that I scored 2/10 on Gregmat probability quiz!!!
This constant process of countless tests, extremely lengthy course material and constant reviewing of their insanely long course chapters has caused me to literally lose hope in my GRE preparation. I am beyond devastated that a year has gone by and my depression has gone up by ten times more.
Is there ANYONE who can help me here please? I am literally sitting here writing all this and trying to stop my brain from justifying suicide as the way out for me. I have to give my GRE by July 31 by any means possible or my entire future will be destroyed. I am living in a house where I am being forced for marriage to corrupted men, I am near financially bankrupt. I spent two savings on two GRE TTP subscriptions.
I am going through extreme depression and I am at a point where I have started having rage issues at the GRE prep. Target Test Prep has been a horrible resource for me in terms of time! Literally my whole year has gone to complete waste!!!!
I spend my mornings in bed dreading TTP course material. My body has literally started breaking down psychologically! I have become an insomniac, I have severe depression, constant nightmares and anxiety and have completely stopped socializing because TTP COURSE IS JUST NEVER ENDING!!!!!!!!!

A pop up clinic at the Renaissance Milwaukee West Hotel is doing a heart disease research study May 29-31 that pays $45 for 15 minutes of your time. Get your blood drawn to test your Lp(a) levels and they give you a $45 visa gift card. The study is being done by a company called Care Access.
Lp(a) tests are normally around $100 so this is a great deal.
Sign up here if you're interested: https://friends.careaccess.com/6DzrGj

A pop up clinic at the Renaissance Milwaukee West Hotel is doing a heart disease research study May 29-31 that pays $45 for 15 minutes of your time. Get your blood drawn to test your Lp(a) levels and they give you a $45 visa gift card. The study is being done by a company called Care Access.
Lp(a) tests are normally around $100 so this is a great deal.
Sign up here if you're interested: https://friends.careaccess.com/6DzrGj

Emergency physicians, PAs & NPs are not the kings and queens of "burnout" because of a lack of yoga or insufficient grit. They are dissatisfied with jobs that don't allow them to deliver high-quality acute care (which they trained for years/decades to do) while their workplace's systems-level decision-making is handed to finance-first administrators.
Enter ACEP's new "Well Workplace" policy. It appropriately puts the onus on employers to create workplaces that work for emergency physicians and their patients. The policy:
Although the individual has responsibility for personal wellness, the primary emphasis should be on how the organization impacts the wellbeing of healthcare workers.¹ This includes, however is not limited to, fully sponsored initiatives directed at:
Organizational Influences

1. Provision of adequate site resources to meet patient needs at all times.^2,3,4
2. Attention to facilities, addressing essentials such as lactation rooms,⁵ break rooms,⁶ and charting space.³
3. Intentional policies addressing workplace safety and violence prevention for patients, families, and healthcare workers.³
4. Leadership strategies to enhance physician engagement, satisfaction, and retention.⁷
5. Fully transparent sick call, paid time off/vacation, bereavement, substantial family, parental and medical leave,⁸ and elder care policies consistent with state legislation.⁹
6. Supportive environment with adequate mental health Early recognition strategies to identify moral distress, physician impairment, mental health issues, and physician suicidality. These may include peer to peer¹⁰ and/or employee assistance programs.¹¹
7. Provide training in and address in real-time:
   1. Critical Incident Stress Management, Post-Traumatic Stress Disorder, adverse events, challenging cases.¹²
   2. Mitigation of Compassion Fatigue, Second Victim Syndrome.¹³

Practice Environment Influences

1. Full staffing of all workers in the department required for patient care, including ancillary staff and non-departmental employees such as transportation, environmental services, laboratory, radiological services, and security.^3,4,14
2. Directed critical efforts with institutional leadership at the highest level to measure, report, and solve boarding¹⁵ and overcrowding burden.¹⁶
3. Establishing physician-led on-site teams to adequately supervise non-physician providers if provided.^17,18
4. Prioritization of Diversity, Equity, and Inclusion for all.^19-21
5. Attention to improving operational flow through human factors engineering.^3,22
6. Best possible employee nutritional options available 24/7.⁶
7. Burden reduction of administrative tasks:
   1. Focused electronic medical record²³ systems optimization, with paid on-line training and paid off-shift chart completion.^24,25
8. Reduction of non-essential communications, meetings, and email.²⁶

Culture

1. Anonymous, comprehensive, and objective evaluation of wellness outcomes and departmental leadership by staff to ensure accountability to address, maintain, and improve workplace wellness.²⁷
2. Transparent and equitable compensation, promotion, due process policies and clearly defined reasonable and sustainable productivity metrics.²⁸
3. Establishment of effective departmental/hospital wellness committees.
4. Culture of teamwork, with expectation and enforcement of interdisciplinary respect, empathy, and collegiality.
5. Support programs that include, but are not limited to addressing:
   1. Recognition of the relevance of aging physicians in the workplace; retirement planning.²⁹
   2. Litigation stressors.³⁰
   3. Financial issues.³¹
   4. Mentoring and/or coaching.^19,20,21
6. Individualized schedule optimization.³²

References

1. Manfredi R, Krywko ~From Self to System: Being Well in~ ~Emergency Medicine.~ ACEP Wellness Guidebook. 2024.
2. Model of Clinical Practice of Emergency Medicine. ACEP Web site. Published June 2023. Accessed March 1, 2024.
3. Safer Working Conditions for Emergency Department Staff. ACEP Web site. Published April 2021. Accessed March 1, 2024.
4. Emergency Department Planning and Resource Guides. ACEP Web site. Originally published December 1985. Updated and approved April 2021. Accessed March 1, 2024.
5. Support for Nursing Mothers. ACEP Web site. Originally published February 2020. Updated and approved October 2013. Accessed March 1, 2024.
6. Food and Drink for Staff in the Emergency Department. ACEP Web site. Published April 2020. Accessed March 1, 2024.
7. Kase J, Doolittle B. Job and life satisfaction among emergency physicians: a qualitative study. PLoSOne. 2023;1892):e0279425.
8. Family and Medical Leave. ACEP Web site. Originally published June 1990. Updated and approved August 2022. Accessed March 1, 2024.
9. Assignment of Benefits. ACEP Web site. Originally published April 2006. Updated and approved January 2024. Accessed March 1, 2024.
10. Physician Wellness Hub. Peer to Peer. ACEP Web site. Published June 2020. Accessed March 1, 2024.
11. R. 1667 - Dr. Lorna Breen Health Care Provider Protection Act. Congress.gov Web site. Published March 18, 2022. Accessed March 1, 2024.
12. Disclosure of Medical Errors. ACEP Web site. Originally published September 2003. Updated and approved March 2023. Accessed March 1, 2024.
13. Physician Wellness Hub. Compassion Fatigue. ACEP Web site. Accessed March 1, 2024.
14. Emergency Department Nurse Staffing. ACEP Web site. Originally published June 1999. Updated and approved April 2022. Accessed March 1, 2024.
15. Boarding of Admitted and Intensive Care Patients in the Emergency Department. ACEP Web site. Originally published October 2000. Updated and approved February 2023. Accessed March 1, 2024.
16. Crowding. ACEP Web site. Originally published January 2006. Updated and approved April 2019. Accessed March 1, 2024.
17. State Board of Medicine Regulation of Non-Physician Practitioners Practicing Medicine. ACEP Web site. Published April 2023. Accessed March 1, 2024.
18. Guidelines Regarding the Role of Physician Assistants and Nurse Practitioners in the Emergency Department. ACEP Web site. Published June 2023. Accessed March 1, 2024.
19. Workforce Diversity in Health Care Settings. ACEP Web site. Originally published October 2001. Updated and approved June 2023. Accessed March 1, 2024.
20. Maximizing the Potential of Women in Emergency Medicine Women in Medicine. ACEP Web site. Originally published October 2014. Updated and approved February 2020. Accessed March 1, 2024.
21. Overcoming Barriers to Promotion of Women and Underrepresented in Medicine (URiM) Faculty in Academic Emergency Medicine. ACEP Web site. Published October 2020. Accessed March 1, 2024.
22. Wears R, Perry S. Human factors and ergonomics in the emergency department. Ann Emerg Med. 2022 Aug;40(2):206-12. doi: https://doi.org/10.1067/mem.2002.124900
23. Patient Medical Records in the Emergency Department. ACEP Web site. Originally published January 1997. Updated and approved June 2022. Accessed March 1, 2024.
24. CME Burden. ACEP Web site. Originally published April 2016. Updated and approved January 2022. Accessed March 1, 2024.
25. Compensated Time for Faculty Academic Administration and Teaching Involvement. ACEP Web site. Published June 2019. Accessed March 1, 2024.
26. Health Information Technology for Emergency Care. ACEP Web site. Originally published October 1998. Updated and approved April 2021. Accessed March 1, 2024.
27. FSMB Policy on Physician Wellness and Burnout. Federation of State Medical Boards Web site. Published April 2018. Accessed March 1, 2024.
28. Compensation Arrangements for Emergency Physicians. ACEP Web site. Originally published 1988. Updated and approved April 2021. Accessed March 1, 2024.
29. Considerations for Emergency Physicians in Pre-Retirement Years. ACEP Web site. Originally published June 2009. Reaffirmed January 2021. Accessed March 1, 2024.
30. Protection of Physicians and Other Health Care Professionals from Criminal Liability for Medical Care Provided. ACEP Web site. Published June 2022. Accessed March 1, 2024.
31. Medical Practice Review and the Practice of Medicine. ACEP Web site. Originally published May 2018. Updated and approved January 2024. Accessed March 1, 2024.
32. Emergency Physician Shift Work. ACEP Web site. Originally published September 1994. Updated and approved September 2003. Accessed March 1, 2024.

Continuing on from this post, this information also comes from Helen Hardacre's book Kurozumikyō and the New Religions of Japan, Princeton University Press, Princeton, New Jersey, 1986 - "Chapter Seven: The Unity of the New Religions" (pp. 188-193):

This study has identified a vitalist, spiritualist world view as the most fundamental factor unifying the new religions. Whereas prior studies have recognized a rather standardized list of traits as shared by a number of the new religions, this study has tried to show how those traits are unified in originating from a particular conceptualization of self in relation to other levels of existence coupled with regular patterns of thought, action, and emotion. The kingpin of the system is the idea that the self-cultivation of the individual determines destiny.

You can see this clearly expressed in this SGI saying:

"A great human revolution in just a single individual will help achieve a change in the destiny of a nation and, further, can even enable a change in the destiny of all humankind."

That's the belief, at least. We don't see SGI members having anything close to this kind of impact on society or the world at large, and they've had over 80 years to show us all, almost 65 years here in the US. Nothing.

The religious life consists of such cultivation and of repaying the benefice of deity.

Before anyone tries to say, "There's no 'god' in SGI!", remember that Ikeda HIMSELF defined the Soka Gakkai/SGI as a "monotheism". Considering that Ikeda is defined as "the world’s foremost authority on Nichiren Buddhism" and "the supreme theoretician" (with the only qualification apparently being the all-controlling leader of the Soka Gakkai/SGI), so whatever Icky says, goes.
And don't forget the SGI's emphasis on YOUR eternal gratitude.

Textual erudition, esoteric ritual, and the observance of abstinences will not serve as a basis for elevating the religious status of priests above that of the laity. The laity therefore tend to be central.

Hence the inherent tension in the relationship between the Soka Gakkai and Nichiren Shoshu, ultimately showing that the "new religions" and the "old religions" simply don't mix.

Since individual self-cultivation is the primary determiner of all affairs, fatalistic notions and ideas of pollution must be recast. Unhindered (or less hindered) by notions of pollution, women play key roles.

The "new religions" are so much better positioned to exploit this huge source of donations and free work! The Ikeda cult certainly has.

Because all problems can be traced to insufficient cultivation of the self, one cannot expect fundamental social change to occur through political action.

Even though, ironically, this attitude simply entrenches the status quo and creates no change at ALL. As explained here, this belief simply produces a conservative attitude that rejects society's efforts to collectively help those in need. How many times did you hear in SGI that such-and-so needy person didn't need actual help; they "just need to chant to change their karma!"?? The Rev. Dr. Martin Luther King Jr. put it succinctly:

Now the other myth that gets around is the idea that legislation cannot really solve the problem and that it has no great role to play in this period of social change because you’ve got to change the heart and you can’t change the heart through legislation. You can’t legislate morals. The job must be done through education and religion. Well, there’s half-truth involved here. Certainly, if the problem is to be solved then in the final sense, hearts must be changed. Religion and education must play a great role in changing the heart. But we must go on to say that while it may be true that morality cannot be legislated, behavior can be regulated. It may be true that the law cannot change the heart but it can restrain the heartless. It may be true that the law cannot make a man love me but it can keep him from lynching me and I think that is pretty important, also. So there is a need for executive orders. There is a need for judicial decrees. There is a need for civil rights legislation on the local scale within states and on the national scale from the federal government. Source

And civil rights legislation has done far MORE to advance the causes of equality and justice than ANY religion ever has. For example, the SGI still clings to its anachronistic, old-fashioned "4 divisional system" based in traditional Japanese patriarchal family norms, even though this is ill-fitting and inappropriate, even offensive, in Western cultures.

Similarly, attempting to cure disease through medical therapies alone can produce only a shallow healing.

As discussed here, this kind of selling point might've flown in the 1800s, even in the early 1900s, and in the chaos of post-WWII defeated/occupied Japan, when people didn't really have access to medical treatment that worked, but now? GTFO. There are very few who will go for this, and they tend to be uneducated. You'll notice this "faith-healing" is hardly a major selling point any more.
Keeping in mind that the focus of this book is on one of the oldest of Japan's "new religions", Kurozumikyō, to illustrate how very similar ALL Japan's "new religions" are to each other, with only minor differences, and this includes Soka Gakkai:

The code of ethics seen in Kurozumikyō is not solely its own invention but is generally shared by both new and established religions. It rests in principles of family solidarity, authority of elders, and a clear-cut division of labor between the sexes.

Is it still required in Japan that female Soka Gakkai employees retire as soon as they marry?
From the March 2022 paper, "‘Genderism vs. Humanism’: The Generational Shift and Push for Implementing Gender Equality within Soka Gakkai-Japan":

This paper investigates how young Japanese women in contemporary Soka Gakkai (SG) navigate Japan’s continuous gender stratified society that remains culturally rooted in the ‘salaryman-housewife’ ideology. How are young SG members reproducing or contesting these hegemonic gender norms that few seek to emulate? While SG has long proclaimed that it stands for gender equality, its employment structure and organization in Japan until recently reflected the typical male breadwinner ideology that came to underpin the post-war Japanese nation-state and systemic gender division of labor.
As an organization that has long claimed to support an internationalist/global ‘humanist’ agenda, driven by Daisaku Ikeda’s interpretation of Nichiren Buddhism, SG in Japan also rose to prominence in a society that culturally and ‘legally’ stratified men and women through a systematic gender division of labor.
According to the global gender gap index reported by the World Economic Forum, Iceland followed by Finland stood at the top of 156 countries as the most gender equal societies in 2021; Japan was ranked at 120 as one of the most unequal societies; the closest other OECD country was Italy, ranked as number 633. Even though the rate of female employment now mirrors other OECD countries, no significant change in women’s employment status and position in Japan has occurred. Women in management positions, economic participation and opportunity ranked 117, while their educational attainment stood as number 92, and political empowerment was close to the bottom, at number 147. Why would Japan, as an affluent, post-industrial society, find it so difficult to achieve gender equity on par with other OECD countries?

The Soka Gakkai (SG) certainly is not at ALL "progressive" on this issue! Ikeda blathered endlessly about "the century of women" and "empowering women", yet the organization HE CONTROLLED completely subjugates and exploits women! There ARE no female Soka Gakkai vice presidents.

Even if SG may be one of the biggest private organizations in Japan, the core work force by comparison is much smaller than the SG organization as a whole. Core regional or national male leaders were typically employed and remain employed as core workers on the general track, while until more recently the equivalent female leaders employed by the SGHQ would retire from paid employment upon marriage, and continue ‘unpaid’ leadership positions in the local area. ... SGHQ consists of the central leadership of the organization, but as an employer was built on the model of a typical Japanese company. This meant male employees were stratified as the core labor force and female employees as periphery, disposable labor. This thinking, on the one hand, reflected assumptions about women’s role as homemakers and mothers, which meant that SG female staff upon marriage would stop paid employment. In reality, this did not mean ‘retirement’ to become homemakers, but rather that married women continued ‘working’ for SG as leaders in the local voluntary organization. The vast majority of female and male members of SG never work for the organization as employees, including most of its women leaders. The organization throughout its post-war period relied heavily on the women’s division or fujinbu 婦人部 (see also McLaughlin 2019 who translates this more narrowly to refer to married women). However, particularly those women trained through working for the SGHQ moved onto become effectively unpaid staff and leaders in local areas once they had married and were economically supported by a husband. Women in SG, both those who were employed at the SGHQ and those that were in employment in other places before marriage—a much larger number—could be said to have been and still today remain the key driving force behind SG’s development in Japan: women organize, execute and lead a range of activities that involve the majority of members in the voluntary organization.

Yes, Soka Gakkai women work hard - just without pay. It's utterly exploitative. You can imagine how utterly dependent women are within this system and how vulnerable in cases of divorce. It's NOT AT ALL "humanistic" OR consistent with any "century of women"!

This family-centered ethic is found in established Buddhism and Shrine Shintō, and no new religion denies it. Some in fact go much further than Kurozumikyō to articulate it plainly and to implement it with a vengeance. The main difference in the familistic ethic between the established religions and the new lies in the sustained attention, systematic socialization, and organizational support available to the follower in the new religions. Specifically, counseling helps followers implement the world view's patterns of thought, action, and emotion, and rewards them for doing so.

Within the SGI, this is the whole "guidance" framework buttressing the (non)discussion meetings as a consistent source of indoctrination, I mean "support".

The question why this world view of the new religions arose as a pervasive orientation at the end of the Tokugawa period (1603–1867) is quite remarkable. In large part the new religions themselves are responsible for its propagation. In addition, however, it harmonized well with social institutions and mores prevalent before 1945. ... The family system as codified in the Meiji Civil Code of 1898 embodied a familistic ethic closely resembling that of the new religions. No doubt these religions were greatly supported by the promulgation of this ethic by the pre-1945 educational system. Even when compulsory education dropped morality courses from the curriculum, the new religions continued to preach much the same content, shorn of chauvinistic rhetoric about the divinity of the emperor and the sacrality of the Japanese nation.
In all the new religions, persons over about fifty years of age occupy most positions of leadership, and the consequences of this fact are weighty.

Indeed. In 1986, when this book was published, Icky was 58 years old. While the Soka Gakkai started out as a "young" movement, the fact that Ikeda held onto power as he aged and never ever "passed the baton" to a younger successor or "turned the reins over to the youth" meant that the Soka Gakkai was doomed to become old and stale. Perhaps it was only the fact of Toda's death at this same age (58) that enabled the Soka Gakkai new religion to ever gain a reputation as a "young movement"; Toda held onto all the power and control until his own death, though it seems more a function of his leadership and less akin to Ikeda's pathological grasping, and it was a lucky break for Icky that Toda cacked it so early. Otherwise, he'd have been left like poor Harada, who only became President of the Soka Gakkai when he was already retirement age, 65 years old. Soka Gakkai is now an elderly, declining organization, and that's because Ikeda chose to gather ALL power and control to himself and KEEP it until his own death. Hardly "progressive" or "visionary"!

These individuals were educated under the prewar system, and they have received as part of their primary education a view of the family as a microcosm of the nation, of its roles as pervaded with a sacred character, paralleling a view of Japan as a divine nation. They tend to see the family in terms of the ie rather than in terms of the nuclear family, and to regard its organizational principles as sharing the quality of sacredness.

This "ie" concept is unfamiliar; in the West, it is most closely approximated by Britain's noble families, such as the "House of Windsor".

when the ie or household system dominated in Japan. According to this system, the eldest son was responsible for the social and economic well-being of everyone living under his household, including parents, spouses, children, and siblings. This was considered particularly important in the years leading up and during World War II when “the government re-emphasized the virtue of the ie system by claiming strong family unions to be the basis of a nation ruled by the emperor, the head of all families.” During this time, almost all marriages were either arranged or approved of by the head of household. Source

This is an interesting angle, because perhaps you may recall the incident, immortalized in whatever form in the original "The Human Revolution" novel series, when Toda approached Ikeda's father and asked him to "give" Ikeda to him - Ikeda's father sounded quite overjoyed to be rid of Ikeda. It was Toda who arranged Ikeda's marriage. Toda was clearly acting as "the head of household" here.
Similarly, Ikeda claimed to be "father" of everyone in the Soka Gakkai/SGI, quite possibly in preparation for replacing Japan's Emperor with himself.
Here is a bit more on the "ie" system - you'll be able to see some of the aspects of SGI that seemed odd while you were "in", I think:

Thus it is not simply efficient or proprietous to obey elders, for women to defer to men, or to maintain clear role distinctions between men and women. It is sacred; failure to uphold these principles is immoral and worthy of censure.

This mentality is behind former SGI-USA national women's leader Akemi Bailey-Haynie's statements about the "ironclad" (as she put it) four divisional system. She knew which side her bread was buttered on, so naturally she was going to lean all the way in.

the SGI’s attempts to feign social progressivism.
SGI attracts many progressive leaning people, because the teachings appear to be democratic and universal. (How many of you heard that Nichiren Buddhism was the only school of Buddhism that held women could also attain enlightenment? I did, too many times to count.) Large gatherings in my area were notably diverse - racially, socioeconomically, and country of origin. The SGI also positions itself as an egalitarian organization without an elite Priesthood class. Everyone is a Buddha - and therefore a spiritual equal. The never-ending propagation focus is inclusive - much in the way of the Borg. Prepare to be assimilated!
All of this masks an utterly authoritarian, patriarchal, Japanese-controlled, socially regressive organization that says one thing and does quite another.

It's the Ikeda way...and of course Ikeda is THE ultimate "elite", the BETTER "Buddha" than any of YOU losers could ever hope to become. No one will ever equal the "eternal mentor", and don't even fantasize about surpassing him, because you can't. That's SGI DOCTRINE. It's Ikeda's game and no one else gets to play, even when he isn't here any more.

That the SGI would have an affinity group for LBGTQ members that simulates inclusion - and simultaneously maintain the divisional structure that is by definition exclusionary - is as dysfunctional as it gets. Source
For SGI to devise a special group for LBGTQNAA members ("Courageous Freedom", whatever THAT means) that is supposed to represent inclusion, while simultaneously maintaining a divisional structure that BY DEFINITION excludes them - proves that this show of "inclusion" is nothing more than a façade, window-dressing to promote itself and conceal its rotten core, while the "ironclad" dysfunction of the SGI remains unchanged. Source

Regarding the "ie" structure of Japan's hundreds-of-years-old family businesses:

The logic of the “ie” system can be described with the following points:

1. The primary objective of the parties in the “ie” relationship is to survive and prosper. The “ie” is neither a contractual venture whose objective is to maximize profit nor is it a venture which can be liquidated after squeezing it dry.
   
2. Ideally, the “ie” must last forever, and as the “ie” prospers so does the family. Therefore, if the “ie” does not exist, neither can the family.
   
3. It is the parents’ responsibility according to the “ie” to continue to have it prosper for the welfare of the family. In a certain sense, it is feudalistic, whereby the parents give children unconditional orders, and the children receive unconditional support.
   
4. The “ie” is an organization in which members will give their all for the benefit of the “ie” by sacrificing their own personal benefits.
   
5. Each “ie” has its specific precepts, habits, and culture. Members are brought up under the same philosophy, or religion, to create a strong team.
   

With regard to that last point, that was apparently the basis for counting all new converts as "households" - they were expected to convert everyone in their family to Soka Gakkai. The Ikeda cult took that as a given, which actually makes some sense, given the pre-war school indoctrination the leaders of the Soka Gakkai had all experienced; as stated above, it harmonized well with social institutions and mores prevalent before 1945.
Unfortunately for Ikeda and the Soka Gakkai, the appeal of this kind of structure was losing strength post-WWII; it's easy to see Toda's wisdom in declaring in the 1950s that, "If we don't achieve 𝘬𝘰̄𝘴𝘦𝘯-𝘳𝘶𝘧𝘶 within Japan within the next 25 or 26 years, it's game over." The Soka Gakkai's success in taking over Japan ("kosen-rufu") depended upon that conditioning that was no longer happening in the schools or in the family. Ikeda believed he was great enough that he'd be able to overcome the fading of that all-important cultural conditioning within the population after 1945, and somehow "win" against the odds. He didn't.

The new religions continue to think of the ie as the model for family relations. That is, the idea of a corporate body passed from generation to generation, engaged in a common means of subsistence, its eternality symbolically manifest in the cult of ancestors, continues to be the conceptual norm.
Conversion is almost entirely limited to urban areas.
Large corporations in Japan typically screen prospective employees to eliminate members of the new religions. There is an inherent conflict between these two types of organizaitions, based upon a paradoxical similarity. The company at its largest and most elaborate seeks to accommodate nearly every need of its employees until the time of retirement, with a corresponding claim upon their loyalties and to a lesser extent, those of their families. Thus individuals already committed to a creed and to an organization over which the company has no control are suspect and probably unable to commit themselves to the extent of someone who has no such commitment. But it is necessary to recall that only a small proportion of the work force is employed by large corporations. The new religions provide ladders of prestige and reward for achievement, and this is a potent source of their appeal. ... Much as a man rises through the ranks in a company, members of the new religions can win reward and recognition that might well be beyond their reach in secular society. Since secular success so often depends heavily upon education and personal connections, persons lacking these may find themselves barred from many opportunities.

And there you have it!

I am not really knowledgeable at reading these:
Procedure: The study was attended continuously by a sleep technologist. The monitored parameters included: left (E1-M2) and right (E2-M1) EOG, frontal (F3-M2 & F4-M1), central (C3-M2 & C4-M1) and occipital (O1-M2 & O2-M1) EEG, mental and submental EMG, left and right anterior tibialis, left and right flexor digitorum superficialis EMG, single ECG waveform, snoring, continuous airflow with thermistor, nasal pressure transducer, chest and abdominal effort, oxygen saturation, ETCO2, and body position via video monitoring. Hypopnea definition: The peak signal excursions drop by >= 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study) or an alternative hypopnea sensor (diagnostic study). The duration of the >= 30% drop in signal excursion is >= 10 seconds. There is a greater than or equal to 4% oxygen desaturation from pre-event baseline. Respiratory Effort Related Arousal (RERA) definition: 10 seconds characterized by increasing respiratory effort or by flattening of the nasal pressure or PAP flow waveform leading to arousal from sleep when the sequence of breaths does not meet criteria for an apnea or hypopnea. Respiratory Disturbance Index (RDI) definition: RDI = (#apneas + #hypopneas + #RERAs) x 60 / TST. If AHI is 0.0, then RDI = RERA index.
SLEEP ARCHITECTURE: The study started at 22:40:17 and ended at 04:58:00. Total sleep time (TST) was 336 minutes resulting in a sleep efficiency of 90.3% (total recording time (TRT) = 372 m). There were 14 awakenings with a total time awake after sleep onset of 14.5 minutes. The sleep latency was 21.5 minutes and the REM latency was 129 minutes. The patient spent 20.2% of sleep time in the supine position. The sleep stage percentages were 5.1% stage N1, 63.2% stage N2, 0.0% stage N3 and 31.8% REM sleep. There were 105 arousals, resulting in an arousal index of 18.7. There were 43 stage shifts.
RESPIRATORY DATA: Snoring was noted. There were 30 respiratory events consisting of 2 apneas [0 obstructive (0.0%), 0 mixed (0.0%), and 2 central (100.0%)], 5 hypopneas and 23 RERAs. The apnea-hypopnea index (AHI) was 1.2 and the central-apnea index (CAI) was 0.4. The respiratory effort related arousal (RERA) index was 4.1. The respiratory disturbance index (RDI) was 5.3. The mean oxygen saturation during the study was 96.0%, with a minimum oxygen saturation of 90.0%. The patient spent 0.7% (2.3 min) of sleep time with an oxygen saturation below 90% and 0.7% (2.3 min) of sleep time with an oxygen saturation at or below 88%. The wake supine end-tidal CO2 (ETCO2) value was 39 mmHg. The maximum ETCO2 was 47 mmHg. Cheyne-Stokes/Periodic Breathing was not present. Supplemental oxygen was not administered. REM-Time REM AHI NREM-Time NREM AHI Total-Time Total RDI Total AHI Supine 0.0 m -- 68.0 m 1.8 68.0 m 12.4 1.8 Off-Supine 107.0 m 2.2 161.5 m 0.4 268.5 m 3.6 1.1 Total 107.0 m 2.2 229.5 m 0.8 336.5 m 5.3 1.2
MOVEMENT DATA: No abnormal behavior was noted. There were 122 periodic limb movements during sleep, resulting in a PLM-index of 21.8. Of these, 2 movements were associated with arousals, resulting in a PLM-arousal index of 0.4. ECG DATA: The average heart rate during sleep was 55 beats per minute, with a range of 45 to 83. During wake, the heart rate ranged from 46 to 70 beats per minute. No arrhythmias were noted OTHER NOTABLE FINDINGS: Split-night protocol was not met due to low apnea-hypopnea index (AHI). The patient took Melationin prior to the sleep study.