so i went to the gyno Again yesterday. she did prescribe me an additional fluconazole for my boyfriend to take alongside mine. she did a swab for bv so i’m waiting for the results to come back, but in the meantime she prescribed me nystatin topical powder that she said to use down there and hopefully that’ll keep it dry. has anyone used this before?? i’m not sure where to even put it to be honest?

I had a call into my Dr and when he called back I missed his call while at work. Apparently the uti is Ecoli and it's only susceptible to 4 antibiotics. Ammoxicillin, Cipro, Levaquin, Sulfa and IV antibiotics. I'm allergic to Sulfa, Cipro and Levaquin so my only hope is the Ammoxicillin because who wants to do IV antibiotics, right? I'm currently taking flagyl for bacterial vaginosis, but he said I could take them together. Is there any hope for this situation? I'm so down and upset.

My father had purchased "Long Term Infrastructure Bonds" from "India Infrastructure Finance Company Limited" back in 2012 Series-5 . It seems that there was a Rs. 20000 exemption under Section 80CCF back then for these bonds.
The bonds were issued on 26/06/2012 and they matured recently on 31/03/2024 after 12 years. My dad has a certificate from IIFCL, so I'm assuming that these bonds are held in non-demat form.
The bond certificate has "Instructions" on the backside, which says:
7.4 Payment on Maturity, Redemption or Buyback:
The procedure for payment in maturity, redemption and buyback is set out below:
...
7.4.2: Bonds held in physical form:
The company may require the Consolidated Bond Certificate(s), duly discharged by the sole holder or all the joint-holders (signed on the reverse of the Consolidated Bond Certificate(s)) to be surrendered for redemption on Maturity Date and sent by the Bondholders by registered post with acknowledgment due or by the delivery to the Registrar to the Issue or Company or to such persons at such addresses as may be notified by the Company from time to time. Bondholders may be requested to surrender the Consolidated Bond Certificate(s) in the manner stated above, not more than three months and not less than one month prior to the Maturity Date so as to facilitate timely payment.
I have some questions:
Instructions quoted above say that I need to surrender the bond certificate 1-3 months before maturity. But the bond had matured. If I surrender now, would this delay cause any issues?
How should I surrender? Shall I send the certificate by postal mail? Or shall I visit their office (either IIFCL or registrar Karvy) and surrender in-person?
Anything else I need to take care of?
Thanks!

Ive always had very normal discharge and never any crazy issues down there. i got the nexplanon implant in early february which was then when i started having changes in my discharge (brownish).
within this last week, i started taking boric acid suppositories and cranberry pills to help out down there as ive been having a bit of smell and frequent UTs (have taken prescription meds for those as well but not in the last 2 months). furthermore, i also started the pill last week to fix the spotting issue nexplanon brought.
however as of last night, my discharge has been VERY chunky and cottage cheese looking which i have never experienced before. it is also unscented. what could be the cause of this? the boric acid? the pill? and could this be an infection or just response to things my body is undergoing?

Im 8dpo (31F lap turned abdominal. Kept ovaries and cervix) and i think im past the worst of it. While im still pretty much couch ridden, I figured I would put this out there to maybe help someone else preparing for their surgery! Obviously we all know these experiences are highly personal and will not be exactly like anyone elses experience, but I personally found it helpful gathering peoples experiences and reflecting based on what I know about myself so I thought id write the kind of post Id want to read! I tried to make easy to skim but also included plenty of details!
Heres some things Im glad I did beforehand

• washed and changed my bed sheets -cleaned my bathroom well
• moved things i knew i would need to a hight where I don’t have to bend down to get them. I moved my toilet paper to easy accessible places, my pj shirts and underwear on top of my dresser. Set up a bed stand for water and meds. Also moved my fridge around.
• as for buying stuff, i mostly had everything i needed but was glad to have comfy sweat pants, backless slippers and highwasted underwear. Also those rechargeable battery bricks were handy for charging my phone in the hospital or sitting somewhere not near an outlet. -exercised. Dont stress about this one, i know chronic pain is often the reason for this surgery. I had to stop my routine months before surgery for this reason. But I was glad to be familiar with proper squat form and have strong arms and legs to help get myself up and down without using my core. I also did yoga therapy that helped me understand how to transfer my weight to different parts of my body which helped too!

Heres some things i was extremely stressed about but ended up not being a problem
-Food. My mom came and cooked me some large portion of meals. I ended up throwing most of it away. The idea was to freeze some of it but it was too much of a hassle. I didn’t have much of an appetite and definitely gravitated towards things in the BRAT diet especially bread. I spent the first few days eating like i had the flu and was really sensitive to grease. My mom made wedding soup and it was too greasy. I think i could have survived this week just on a package of bagels and different spreads.
-cleaning and chores. Im pretty sure I have OCD.. this experience has confirmed it. I looked out at my thriving garden yesterday and said to my partner absent mindedly “wow. Things really thrive when im not out there being over involved “ and like wow that is a lesson i did not expect to learn. My partner has been clearing the dishes each day and did some more involved chores once this week. So if you live alone I would advise paper plates and maybe some to help ya once a week for the first week at least.
-in terms of my surgery i was really scared of having a catheter which i did end up needing to have for a day. It was weird but not at all painful. Honestly it was kind of the worst part of my recovery so far just because i felt i had to pee so bad while it was in. Idk if thats typical. Taking it out was not at all painful but also weird. They used the catheter to put sterile water back in my bladder. As soon as i felt a twinge of uncomfortable full feeling i told my nurse. She removed the catheter and i peed it back out no problem.
-being bored. This week has felt like one day. Since it takes me 10x as long to do anything, the days are flying by. I got myself plenty of low key things to do (crafts, activity books, ect) and haven’t even had time to do any of them yet! I still have a feeling this will change in the coming weeks though..
-having enough help. I secretly wished one of my friends or family members would stay with me for a while just so I could be the solo focus of their attention. I live with my partner and two dogs and he has been totally enough support. I needed help getting up and down up until about day 5. He also makes my meals and cleans them up for me and would bring me my meds and water the first few days. I think it makes sense if you live alone to have someone stay a week with you, but ive been fine and honestly anytime someone has come to “help” its just felt draining. I didn’t know how much of a hermit I would wana be.
-my dogs. I piled myself in pillows if i was sitting on the couch with them. I also had a no chew spray near by that we used when they were pups but only had to use it one time. My partner helped to coral them the first few days too. I have not yet been puppy stomped
-the stairs. Its been fine I just have to go slow.
Heres some things I found out along the way that were helpful

• keep cough drops in your pocket. Coughing aint fun and my throat was irritated from being intubated for about 4 days after surgery. Also keep the paper so you can spit em out when they’ve done the job if you want. I started getting a tummy ache from having too many.

-keep lil pillows by your toilet. The hospital gave me one that was plasticy and easy to wipe off (like an outdoor pillow insert). Or even a balled up towel would work. I couldn’t wear a binder because of all my incisions but this helped take the pressure off my stomach/incisions when i needed to have a bowel movement.
-if you stack pillows on either side of you, they can act as “arms” that are handy to push down on when you get up.
-sip your water and take your stool softeners as soon as they say you can! It took me until day 4 to poop but it was no problem when it happened.
-lots of deep slow breaths to calm your nerves and pain.

• those squeezable applesauce packs. Great for when you take your pain pills.

Heres some challenges I encountered that surprised me.
-my throat was so sore! For the first 4 days my throat was irritating, it felt like I had a flap of skin sticking down. The first day it hurt but the rest was just so annoying.

• breathing was a challenge. The first few days i was in bed, it was hard to breathe. I couldn’t take a Deep belly breath because of my incisions. I tried to regularly take a big breath filling my lungs though. Once i started being able to get up and walk around it became less of a problem. I think they have a tool for this at the hospital too but i was not offered it and forgot to ask.

-always laying on my back is getting old. I haven’t quite figured it out yet but im getting there.
-not really a challenge but my lower belly is numb. Apparently that can just happen (even long term). Which has actually been helpful since I can’t feel my lower abdominal incision at all
Lastly!! The pain/symptom scale: Day 0: honestly don’t remember much except feeling i need to pee and my throat being sore. Day 1: was still in the hospital. Pain like cramps and burning pain near certain incisions. I was able to walk the hall but very tired after. Sore throat. Day 2: burning pain near bellybutton incisions. Heavy lung feeling. Left the hospital. Day 3: heavy lung feeling. Pinching pain in incisions whenever I stood or sat. Had some moderate discharge that was yellowish with red and brown. Otherwise no pain Day 4: more like a sharp ache when i stood/sat. Discharge again but a very light amount. Day 5: felt strides..any pain was mild cramping. Tried to shower myself and make myself breakfast which led me to be very tired for the rest of the day. Day 6: most tired yet. Pain the same Day 7: felt like turning a page. Pain very little and energy very good.

My father had purchased "Long Term Infrastructure Bonds" from "India Infrastructure Finance Company Limited" back in 2012 Series-5 . It seems that there was a Rs. 20000 exemption under Section 80CCF back then for these bonds.
The bonds were issued on 26/06/2012 and they matured recently on 31/03/2024 after 12 years. My dad has a certificate from IIFCL, so I'm assuming that these bonds are held in non-demat form.
The bond certificate has "Instructions" on the backside, which says:
7.4 Payment on Maturity, Redemption or Buyback:
The procedure for payment in maturity, redemption and buyback is set out below:
...
7.4.2: Bonds held in physical form:
The company may require the Consolidated Bond Certificate(s), duly discharged by the sole holder or all the joint-holders (signed on the reverse of the Consolidated Bond Certificate(s)) to be surrendered for redemption on Maturity Date and sent by the Bondholders by registered post with acknowledgment due or by the delivery to the Registrar to the Issue or Company or to such persons at such addresses as may be notified by the Company from time to time. Bondholders may be requested to surrender the Consolidated Bond Certificate(s) in the manner stated above, not more than three months and not less than one month prior to the Maturity Date so as to facilitate timely payment.
I have some questions:
Instructions quoted above say that I need to surrender the bond certificate 1-3 months before maturity. But the bond had matured. If I surrender now, would this delay cause any issues?
How should I surrender? Shall I send the certificate by postal mail? Or shall I visit their office (either IIFCL or registrar Karvy) and surrender in-person?
Anything else I need to take care of?
Thanks!

/uw Part four is here! Here's part one, part two, and part three! This one's probably a little more unpolished than the other ones, but I hope that doesn't ruin it! CW: Death, blood. I made a render in blender, but it got the post removed! Take two!
/rw
The end of the book, thin as it is, draws near. The text is overwritten dozens of times, always with the same phrase: "IT WAS AN ACCIDENT". Same as the other pages, though, it's easy enough to look past the bad coverup job. History cannot be erased, after all.
...
When I arrived at the hospital, I was in bad shape. I had a fractured skull, a missing eye, a lesion in my frontal lobe, and I was in hypovolemic shock. They didn't think I was going to make it.
It was a miracle that I even woke up from my two-week coma, but it wasn't all perfect. From the moment I opened my eye(s), I didn't know where I was. I had to relearn everything. My name, my address, my identity... They were all gone.
It was as if I was a new man who'd been transported into a stranger's body. Everyone talked to me as if they knew me, but I couldn't say the same for them. Especially that drow, Eldred. He claimed we were childhood friends. Every day, he'd tell me stories of our history together, but they were stories I never wanted to hear. It felt wrong listening to him talk, knowing there was a man who knew more about me than I did.
The moment I was discharged, I fled to my apartment. I drew the blinds, locked the door, and cut off all contact from the outside world. I wanted to run away from it all, to start a new life, not some travesty of another man's life.
After a few days of my isolation, Eldred (presumably) got worried about me, and came knocking on my door. I didn't answer. I wanted nothing to do with him—or anyone, for that matter. He was a remnant of my old life, and I couldn't let him influence me.
A couple days later, he did the same thing. He offered some kind, reassuring words through the door and left. He did this again, and again, and again, for weeks. I was running low on food and supplies, so I was faced with a choice: leave my safe haven, or starve to death in my own home. I didn't like either option. Although... there was another way.
After 17 days of his repeated attempts, I finally answered the door.
"Ith!" Eldred cheered. "You... you really answered!"
"Yeah."
"So uh... Have you been doing alright?"
"I'm fine."
He looked over my shoulder. "Have... you not left the house?"
"Not yet."
"Jesus, Ithael..." He pulled me in for a hug, but I didn't react. "Do you, uh, need anything?"
"Could... you go to the market for me?"
He let go of me. "Yeah, of course! I'll... I'll be back!"
"Alright."
I slammed the door in his face. Just another echo of my old life, that's all he was... A few hours later, he knocked on the door again. I almost didn't answer, but then I remembered he had my groceries.
He exclaimed with clearly-forced optimism, "Heyyyy! Hope you've been alright! So, I was thinking, and... I was wondering if you wanted to do dinner together?"
"Not out there. Never out there. Here. Please."
"I figured you'd say that... so I got ingredients! I found this recipe for some pan-seared chicken in the library earlier, and it sounded really good!"
"...Alright." I took the bags from him and walked over to the kitchen. "Come inside."
"I, uh, was going to make it for you—"
"It's fine," I interjected.
I rummaged through the bags for the cookbook he talked about and flipped through the pages. It didn't look too difficult to make, but I wasn't sure how I knew that. This was the first time I had cooked anything, after all.
Assumedly hearing the pans clattering, Eldred wandered over to the counter, sitting down in a chair across from me. "Need a hand?"
"I'm alright."
"Are you sure? I mean, you were just—"
"Shut it," I commanded. I didn't mean to be so stern. What had come over me? I decided to brush it off. The recipe called for a diced onion... I needed a knife.
He slumped down in his seat. "Sorry... I, uh, got these books for you, by the way."
I glanced up from the cutting board. "...'Healing trauma: a guide for survivors'? And... 'How to cure amnesia'?" I scoffed. "If they could have fixed it, they would have, Eldred. It's incurable."
"We can't know until we try!" He strolled over into the kitchen, flipping to a bookmarked page. "See? This one here says—"
"It doesn't matter."
"Ithael... I'm here for you, man. I'm just trying to help—"
"And I don't care."
I focused myself back to the task at hand, ignoring his look of disdain. The room fell uncomfortably silent. I needed to fillet the chicken. I rummaged through the bags, trying to find—
"Seriously?" Eldred huffed. "I put in all of this work, and you just... don't care?"
"Never asked for it." Now, where was I? Right, chicken—
"That doesn't mean anything! Let me help you, you're clearly struggling!"
"I could manage without you." I continued to avoid eye-contact.
"Why are you so dead-set on pushing me out of your life?!"
"You were never in it to begin with, Eldred. I'm not the Ithael you knew."
"And who cares that you aren't?! Can't we still be friends?"
I tried to explain, "You're just a remnant of my past—"
"And that's an excuse to treat me like shit?! You know what?" He grabbed the books. "I'm done trying to fix you."
"Fix me?" I scoffed. "So I'm a problem, then? Something to be solved?—"
"You're twisting my words! Why... Why do you hate me?!"
"Face it: I'm a different person! Move on with your life, already!"
"What gives you the right to say that?!"
"Oh, what gives me the right?!" I waved the knife around a little too recklessly. "Were you just in a coma for two weeks? Did you just get thrown into a world that knows you better than yourself?! Where's your excuse, huh?!"
"...What do you want from me, Ithael?"
"I want you to get out of my life!"
Time slowed to a crawl as a deep pit formed in my stomach. I yanked my hand back like I'd touched a hot stove, and the knife... clattered to the floor. That look in his eyes... I'd never forget it. I had never seen a man so afraid before.
He grasped at his neck, his face turning pale as his hands soaked with blood. He fell to his knees, mouthing some words at me, but the only sound that came out was a sickening gurgle. He struggled to keep his balance as he fell flat on his face. His breathing grew labored and shaky as he lay there, a crimson puddle forming around his neck.
I knew that I should have gotten help, but, no matter how hard I tried, all I could do was watch. He cried onto the tiled ground, his breathing growing quieter and quieter, until he finally went silent.
What had I done?
...
It seems that he forgot to put any kind of warding spell on this newspaper clipping, as if he didn't expect anyone to get this far. Or perhaps he was too preoccupied with deceiving himself.
"As rumors regarding the disappearance of Eldred Wyndorn continue to circulate, the enigmatic Ithael Ralich opens a new therapist's office. In response to the whispers, Ithael states, 'There's a profound lack of support in this world, and every person could stand to have someone like Eldred by their side. I hope I can step up and fulfill a role he would have approved of.'
In other news, authorities are taking steps to curb the rising number of missing persons cases. Officials urge citizens to adhere to newly-instated curfew until the threat is solved, but claim there's nothing to worr—"

DAY: MAY 20 2024
5-20-2024

Why nightmares and ‘daymares’ could be early warning signs of autoimmune disease

An increase in nightmares and hallucinations—or ‘daymares’—could herald the onset of autoimmune diseases such as lupus, say an international team led by researchers at the University of Cambridge and King’s College London. The researchers argue that there must be greater recognition that these types of mental health and neurological symptoms can act as an early warning sign that an individual is approaching a “flare,” where their disease worsens for a period.
5-20-2024 Yoga and meditation-induced altered states of consciousness are common in the general population, study says
Yoga, mindfulness, meditation, breathwork, and other practices are gaining in popularity due to their potential to improve health and well-being. The effects of these practices are mostly positive and occasionally transformational, yet they are known to sometimes be associated with challenging altered states of consciousness. New research by a team including investigators from Massachusetts General Hospital reveals that altered states of consciousness associated with meditation practice are far more common than expected. Although many people reported positive outcomes, that were sometimes even considered transformational, from these experiences, for a substantial
5-20-2024 Examining the benefits of out-of-network care for pediatric moyamoya
Total in-episode expenses and resource use before the index surgery (preop) and including/after the surgery (postop). The comparisons are separated for analysis into (A) single institution cohorts (1 and 2) and (B) multi?institution cohorts (3 and 4). Moyamoya disease is a rare condition that affects the blood vessels in the brain, especially in children. Narrowing and blockage of vessels significantly increases the risk of stroke and requires surgical revascularization for treatment. Although research shows that outcomes of revascularization are better
5-20-2024 Study explores links between social media use, mental health and sleep quality
The more time you spend on social media, the greater the likelihood of having unpleasant social-media related dreams that cause distress, sleep disruption and impact our peace of mind. Flinders University’s Reza Shabahang says that the vast and rapid adoption of social media has the potential to influence various aspects of life, including the realm of dreaming. “As social media becomes increasingly intertwined with our lives, its impact extends beyond waking hours, and may influence our dreams,”
5-20-2024 How are asthma and heart health linked?
Although the heart and lungs are neighbors in your chest, people may think of them as separate entities with unrelated problems. But a growing body of evidence suggests that asthma—one of the most common lung disorders—is a risk factor for cardiovascular disease. Asthma is a serious chronic disease in which airways are inflamed, often in response to specific triggers. It affects about 25 million people in the U.S., including nearly 5 million children, causing millions of annual visits to doctors’ offices and emergency rooms. “We call these major changes
5-20-2024 STUDY EXPLORES PATIENT TRUST IN PHYSICIANS
Trust in one’s physician drives positive health practices. In a scoping review, SUNY Poly Professor of Sociology Dr. Linda R. Weber discovered new developments in the measurement of trust, identified those measures of trust that have known reliability and validity, and compared those instruments’ conceptualizations, dimensions, and indicators. The paper is published in the journal PLOS ONE. Weber explains that 10 dimensions emerged from the study: fidelity, technical competence, communicative competence, interpersonal competence (i.e., caring), honesty, confidentiality, global, behavioral, fairness, and system trust/accountability. In addition, these findings provide the foundation
5-20-2024 TIMESAVING TIPS FOR COOKING HEALTHY MEALS
Living a busy, fast-paced life can make it hard to find the motivation to cook a healthy meal at home. However, learning some shortcuts in the kitchen can keep your healthy eating goals on track and help you avoid grazing on unhealthy snacks, grabbing the first thing you see in the fridge or going out for fast food. Why cook at home? Research shows that maintaining a healthy weight is challenging when you eat out too frequently. Restaurant portions often are super-sized
5-20-2024 UNDERSTANDING PERIMENOPAUSE VS. MENOPAUSE
Menopause marks a significant transition for women, yet understanding its precursor, perimenopause, and its symptoms can be complex. Dr. Stephanie Faubion, director of Mayo Clinic’s Center for Women’s Health and medical director of The Menopause Society, says experiencing perimenopause and menopause can be confusing for some. She says it is not only patients who may find it confusing, but medical providers as well, due to lack of training in menopause management. “Menopause is defined by no menstrual cycle for a year,” says Dr. Faubion.
5-20-2024 LOW-DOSE IRON SUPPLEMENTATION HAS NO BENEFIT FOR BREASTFED INFANTS, SHOWS STUDY
The American Pediatric Association recommends iron supplements to all healthy infants who breastfeed longer than four months, while its European counterpart, Society of Gastroenterology, Hepataology and Nutrition, does not recommend it. These deviating guidelines stimulated researchers to design a new study. Breastfeeding is strongly recommended, and the proportion of children are breastfed during the first half of life is high. The researchers wanted to determine whether breastfeeding babies could benefit from extra iron.
5-20-2024 ALLERGY MEDICATIONS COME WITH HAZARDS: BE AWARE
People with seasonal allergies often turn to over-the-counter and prescription medicines to relieve symptoms like coughing, sneezing, runny nose, congestion and itchy eyes, nose or throat. But they often aren’t aware that these meds—including antihistamines—have as much risk for potential side effects, drug interactions and overdose as other drugs. “All medicines have side effects associated with them even when they are taken appropriately and according to dosing directions on the label,”
5-20-2024 I CAN’T AFFORD OLIVE OIL—WHAT ELSE CAN I USE?
If you buy your olive oil in bulk, you’ve likely been in for a shock in recent weeks. Major supermarkets have been selling olive oil for up to A$65 for a four-liter tin, and up to $26 for a 750 milliliter bottle. We’ve been hearing about the health benefits of olive oil for years. And many of us are adding it to salads, or baking and frying with it. But during a cost-of-living crisis, these high prices can put olive oil out of reach. Let’s take a look at why
5-20-2024 Researchers uncover biological trigger of early puberty
Heather Brenhouse, associate professor of psychology, says disrupting the caretaker relationship can really traumatize a child or a developing rodent. Credit: Ruby Wallau/Northeastern University New research conducted by the Brenhouse Lab reveals how early life adversity triggers early puberty and late-life anxiety, paving the way for potential interventions. The onset of puberty has been creeping downward for decades. In the United States, the average age of girls reaching puberty ranges from 8.8 to 10.3 years old. The early start of puberty, which is associated with many health risks, can be
5-20-2024 Bioluminescence and 3D-printed implants shed light on brain–spinal interactions
Brain-spinal cord duet’s neurodynamic symphony is now accessible to scientists via novel multi-organ implants. Credit: Dmitrijs Celinskis A sensory process such as pain is no ordinary phenomenon—it’s a symphony of neural and vascular interactions orchestrated by the brain and spinal cord. Attempting to dissect this symphony by focusing on a single region is like trying to understand a complex melody by listening to just one instrument. It’s incomplete, potentially misleading, and may result in erroneous conclusions. Enter the Carney Institute’s team of visionaries. Their mission? To develop tools that allow
5-20-2024 New thesis explores cancer treatment that can prevent relapse
. What is the main focus of your thesis? Relapse following initial treatment efficacy remains a major clinical challenge for many cancers. The focus of my thesis has been to explore the therapeutic impact of immune cells in patients with blood cancer (leukemia), by first investigating which cells
5-20-2024 New study reveals health and social benefits of car-free living
Participating in a three-week car-free challenge has enhanced the health and well-being of Oxford residents, according to research conducted by The University of Bath’s Centre for Climate Change and Social Transformations (CAST), in partnership with climate charity Possible and Low Carbon Oxford North (LCON), conducted this research project. After ditching their cars for three weeks, 10 out of the 12 drivers across Oxford who participated said they plan to continue with reduced car use beyond the project. The findings of this research project show that: Day-to-day transport emissions were slashed
5-20-2024 Research shows linked biological pathways driving skin inflammation
A certain biological pathway—a set of linked reactions in the body—drives the inflammation seen in the skin disease psoriasis, a new study finds. The work could lead to improved therapies for all inflammatory skin diseases, including atopic and allergic dermatitis and a type of boil called hidradenitis suppurativa, say the study authors. The findings are published in the journal Immunity. Inflammation is the body’s natural response to irritation and infection, but when out of control, it can lead to the reddish, flaky, itchy lesions that
5-20-2024 Prescription co-payments linked to more hospital admissions in New Zealand, study finds
A new study from researchers cautions that bringing back the $5 co-payment for prescription medicines could see a jump in hospital admissions. The study analyzed health data for 71,502 people and found those who didn’t pick up a prescription because they couldn’t afford the $5 fee had a 34% higher rate of being admitted to hospital.
5-20-2024 How a simulation is informing COVID-19 vaccine policy after our ‘return to normal’
As the saying goes “There is no such thing as normal” and this has been especially true after the pandemic. Before the emergence of the omicron COVID-19 variant, countries like the U.K. had high vaccination coverage along with widespread exposure to COVID-19 in the population. This combination of vaccine and infection-derived immunity is termed hybrid immunity and is different to vaccine immunity or infection immunity alone. In contrast, other countries, including Australia, New Zealand and those in the Western Pacific, had a very different pandemic experience.
5-20-2024 Researchers find intriguing connections between Alzheimer’s disease and other common conditions
A study has found that while some medical conditions appear to increase our likelihood of developing Alzheimer’s disease, others appear to decrease the odds. The study, led by Dr. Yijun (Nicholas) Pan and Dr. Liang Jin, analyzed data from 2,443 older Australians living in Melbourne or Perth who are part of the Australian Imaging, Biomarker and Lifestyle (AIBL) study, an internationally recognized cohort for dementia research. “We found anxiety and other neurological disorders are associated with increased likelihood of Alzheimer’s disease,” Dr. Pan said.
5-20-2024 Prepping autistic or sound-sensitive kids for cicada noise
As Chicagoans await the emergence of the cicadas, parents of children on the autism spectrum and/or who have sensitivities to sound can take a few steps to prepare for what is expected to be a loud summer. “Some children on the spectrum can struggle with loud or unexpected noises, such as toilets that automatically flush, fireworks around the Fourth of July or the emergence of a large number of cicadas,”
5-20-2024 Study highlights importance of screening for rare inherited iron metabolism defects
Over 40% of cases curated based on stringent clinical and laboratory criteria from the Indian subcontinent have an inherited iron metabolism defect on comprehensive genomic evaluation, report investigators in The Journal of Molecular Diagnostics. Although iron deficiency anemia is the most prevalent form of anemia globally,
5-20-2024 Study finds tyrosine kinase Csk promotes germinal center B cell survival and affinity maturation
The authors found that Csk (a tyrosine kinase that attenuates B cell receptor signaling) is required for germinal center maintenance and efficient antibody maturation. The immune system strikes a fine balance by identifying and neutralizing disease-causing agents while carefully avoiding destruction of healthy tissues and cells. Now, researchers from Japan have shed new light on one of the processes that helps train immune cells to act only against genuine threats.
5-20-2024 Significant gaps between science of obesity and the care patients receive, say experts
As research continues to produce evidence about the underlying causes of obesity and optimal strategies to treat and manage obesity have evolved, there are disparities in application of the latest scientific advances in the clinical care that people with obesity receive. Widespread adoption of current findings, consistency of care and expertise in obesity care varies by health care professional and institution.
5-20-2024 Improving online depression treatment
Symptom course of depression for individuals who dropped out of treatment and those who completed treatment. In the dropout group, there is an initial decrease in symptoms while the patients were still in treatment, which tapers off as they drop out. For completers, there is close to a linear change over time. This suggests there is a relation between the more that an individual continues to participate in ICBT and their depressive symptom improvement.
5-20-2024 Women face worse chronic kidney disease management in primary care
Women receive worse primary care-based chronic kidney disease (CKD) management than men, according to a research letter adult patients with CKD receiving primary care at 15 practices using electronic health record data to examine sex disparities in guideline-based CKD management
5-20-2024 Bisoprolol does not reduce exacerbations in at-risk COPD patients
For patients with chronic obstructive pulmonary disease (COPD), bisoprolol does not reduce the number of self-reported exacerbations treated with oral corticosteroids, antibiotics, or both, according to a study
5-20-2024 Anticancer potential of CLK kinase inhibitors 1C8 and GPS167 via EMT and antiviral immune response
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5-20-2024 New AI model uses federated learning for multi-organ segmentation based on medical image data
Researchers have successfully developed the technology that can accurately segment different body organs by effectively learning medical image data used for different purposes in different hospitals, which is expected to greatly contribute to the development of large-scale medical AI models in the future.
5-20-2024 Second Phase 3 clinical trial again shows dupilumab lessens disease in COPD patients with type 2 inflammation
Chronic obstructive pulmonary disease patients with type 2 inflammation may soon gain access to a new drug—dupilumab—that showed rapid and sustained improvements in patients in a pivotal Phase 3 clinical trial, researchers report in the New England Journal of Medicine. This monoclonal antibody is the first biologic shown to improve clinical outcomes in COPD. The data supporting the use of dupilumab in COPD will be reviewed by the United States Food and Drug Administration in June. The disease improvements—as measured by a significantly lower annualized rate of acute exacerbations

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My father had purchased "Long Term Infrastructure Bonds" from "India Infrastructure Finance Company Limited" back in 2012 Series-5 . It seems that there was a Rs. 20000 exemption under Section 80CCF back then for these bonds.
The bonds were issued on 26/06/2012 and they matured recently on 31/03/2024 after 12 years. My dad has a certificate from IIFCL, so I'm assuming that these bonds are held in non-demat form.
The bond certificate has "Instructions" on the backside, which says:
7.4 Payment on Maturity, Redemption or Buyback:
The procedure for payment in maturity, redemption and buyback is set out below:
...
7.4.2: Bonds held in physical form:
The company may require the Consolidated Bond Certificate(s), duly discharged by the sole holder or all the joint-holders (signed on the reverse of the Consolidated Bond Certificate(s)) to be surrendered for redemption on Maturity Date and sent by the Bondholders by registered post with acknowledgment due or by the delivery to the Registrar to the Issue or Company or to such persons at such addresses as may be notified by the Company from time to time. Bondholders may be requested to surrender the Consolidated Bond Certificate(s) in the manner stated above, not more than three months and not less than one month prior to the Maturity Date so as to facilitate timely payment.
I have some questions:
Instructions quoted above say that I need to surrender the bond certificate 1-3 months before maturity. But the bond had matured. If I surrender now, would this delay cause any issues?
How should I surrender? Shall I send the certificate by postal mail? Or shall I visit their office (either IIFCL or registrar Karvy) and surrender in-person?
Anything else I need to take care of?
Thanks!

Hi all,
I’m 37 and was diagnosed in the last few years so this is still pretty much new to me
I’m on methylphenidate slow release 40mg a day (20mg x 2)
Now the thing is I feel so chill and for the first 2 hours of the first dose I can focus probably the best I’ve ever focused on
Then soon as that wears off and I’m due the next dose I’m either needing a nap prior to taking it or I take it and I’m so tired it’s pretty much useless
I was on just 20mg prior to this and that dose was too low I felt it did nothing so lowering the dose isn’t the way to go but then I feel upping it more is probably going to conk me out
It’s a shame because it is working but I know that as soon as afternoon comes it’s over
The second dose is supposed to give me a second boost when the first one wears off but that’s just not happening
Prior to this I was on very low dose fast release I think it was 20mg a day in 5mg pills so 10mg at a time. Honestly can’t remember what that was like but maybe I need this dose at fast release not sure
The reason I ask here for opinions is that I’m in the UK and once our meds are set in dosage we get sent back to the GP to prescribe that set dose and basically discharged and then if there’s an issue and we need adjustments we have to be referred back to the adhd psychiatrist
So I don’t know if this is somewhat normal or if I should be looking at telling them this and adjusting it
I’m worried an adjustment is going to be worst and I’ll lose that 2-3 hour focus part altogether
Thanks
(To note it might actually be longer than 2-3 hours but that’s what it feels like to me)

https://www.youtube.com/watch?v=qpSy4p2WYjU&ab_channel=GlassMonarch
Video above. This is a build I played on league start and used to farm Harvest for a good bit before transitioning into something else.
The idea is simple: Plague Bearer makes you pay its mana cost both on incubation and infecting, and there's only a .5s cooldown between the two. If you get it up to above 100 mana, you can trigger Kitava's Thirst every .5 seconds.
To that end, all the supports and inc mana cost of skills are for that purpose. I also went with the mana engine of Replica Covenant + Tawhanuku's + Nexus to make it (somewhat) self sustaining.
Pros:
Very simple to set up, just need a 6 link and Fevered mind, and Kitava's thirst.
The supports for Plague Bearer don't actually matter, they are purely there for the mana multiplier (I also used like, most of the ones that actually work with it)
Theoretically very robust, Automation just triggers every .5 seconds, no questions asked.
Is an autobomber that doesn't do a billion damage to yourself.
Cons:
If you're doing what I'm doing with the Mana sustain, the loop can fail if you run out of mana/ES, but as soon as you get enough the loop will restart. I actually ran with The Burden Of Truth and a hybrid flask for a while to offset this.
50% chance to trigger, which is big but if you're using a duration skill like Tornado or Ball Lightning of Static, this is somewhat offset. Blade Vortex also works.
Limited to 4 link, but the + gem level corrupts on Kitava's Thirst should make up for this somewhat.
It is an autobomber that doesn't self damage, but that makes it cost a TON to sustain.
Other considerations:
Looking back on it, I think Hierophant or some other ascendancy would have been better. I just wanted to play with the double BLoS triggers from triggerbots (35% less damage on it probably also doesn't help).
This CAN work with archmage, though the insane amount of increased mana cost on top of a base 5% might make it unsustainable. Archmage is probably the best way to scale this, OR spellblade with Inquisitor Battlemage double stacking memes.
You don't actually NEED the trio of Replica Covenant/Tawhanuku/Nexus, so if you're fine with chugging a mana flask you can sustain that way and remove the ES cost. Or just index into mana regen heavily.
It's theoretically pretty freeform to do what you want with it, as long as you can sustain mana, so you can do Annihilating light with elemental spells, BV, Tornado of Elemental Turbulence ETC.
I'm just sharing this because I don't think this interaction has been widely known yet, and I think there are better build makers than me here who can take this and run with it. I'm done with the league so I don't have it in me to level a Heiro to see higher potential, but here's hoping Archmage isn't gutted next league I guess.

Anyone able to advise and see if this is normal , I on the vaginal ring birth control for about 6 months now I have putting it on for 21 days and out for 7 days. I had sexual intercourse with my partner I take out my ring for that and place in within the hour. I have been on time out and in never skipped or nothing. My partner also used condoms and the pull out method. I took out my ring out this weekend and I should expecting my period either today or tomorrow. When I took my ring out it looked like I had a brown discharge but I was thinking since last month I was still bleeding it made it brown. Then today I have got like 2 little watery red dots but you could not see it because it was really small. I did take a plan b last month because I was worried and I think that messed up my period. I did take a pregnancy test they are both negative I am really freaking out.

My daughter has had a fishy/ unusual odor the past couple weeks. She saw pediatrician last week- they prescribed Fluconazole and Nystatin ointment, which we’ve been using for suspected yeast infection. They tested her urine and said no UTI. She has NO discharge, no fever, but has been very unlike herself and not sleeping well (although it could be teething causing this). No improvements after taking those meds, we use fragrance free everything and she’s been using the same type of diapers since newborn. Went back to pediatrician today and they took another urine sample to send out for culturing. The NP seems to think the smell is just a result of her pH balance being thrown off from going to the chlorinated pool at our gym. I’m not buying it… 8 days went by where my daughter didn’t go in a pool and there was absolutely NO improvement in odor. NP also thinks it’s not BV since there’s no discharge. Getting very frustrated and feeling like I should’ve demanded a blood test because this has been an ongoing issue for 3 weeks and the thought my child could be in serious discomfort and just suffering through it, makes me feel horrible. Any ideas as to what to do? Google says it could be a metabolic disorder, diabetes, etc…. Not jumping to conclusions, but just concerned that this isn’t being handled as swiftly as I’d like to get to the bottom of this. It is NOT normal to have this odor and I’m not believing it’s just pH unbalanced due to the potency of the odor. Side note⚠️ my daughter is only with me, her mother 100% of the time, so no possibility of SA.

Hello Everyone, M27 diagnosed with acute diverticulitis 5/15 have been taking Flagyl (500mg), bactrim ds (160mg, & zofran (4mg) for the nausea. it is going to be a week tomorrow and i’m still yet to feel relief from the medication. it’s definitely not as bad as it once was but still dealing with the pain on lower left side without any relief. any suggestions or thoughts on when will i actually start to feel better?? i went to a baseball game and that caused me to eat like trash but ever since then i’ve been on soup,salad, water and smoothie diet. Any tips on how to treat this awful feeling
edit: i am scheduled to return to work today; not a desk job. retail job working in dispensary, will i be okay to return? should i wait the 4-6 weeks before returning to work??

Hi there, I am a 27 year old female and believe I may have symptoms of OC: - inconsistent period (months without) - random / frequent spotting - heavy bleeding when I have my period - fatigue - frequent urination (feeling like I may urinate in my pants) - change in discharge - pelvic pain (cramping without period) - pain between shoulder blades - bloating / nausea / diarrhea (doctors say this is from GERD - which I take medication for and has not helped)
My grandmother had OC in her 30s which has scared me a bit so I have raised these symptoms with my doctor and she has referred me for a pelvic ultrasound, is there anything else I can do / ask for to rule out OC/cysts? Thank you in advance!

My daughter has had a fishy/ unusual odor the past few weeks. She saw pediatrician last week- they prescribed Fluconazole and Nystatin ointment, which we’ve been using for suspected yeast infection. They tested her urine and said no UTI. She has NO discharge, no fever, but has been very unlike herself and not sleeping well (although it could be teething causing this). No improvements after taking those meds, we use fragrance free everything and she’s been using the same type of diapers since newborn. Went back to pediatrician today and they took another urine sample to send out for culturing. The NP seems to think the smell is just a result of her pH balance being thrown off from going to the chlorinated pool at our gym. I’m not buying it… 8 days went by where my daughter didn’t go in a pool and there was absolutely NO improvement in odor. NP also thinks it’s not BV since there’s no discharge. Getting very frustrated and feeling like I should’ve demanded a blood test of vaginal swab because this has been an ongoing issue for 3 weeks and the thought my child could be in serious discomfort and just suffering through it, makes me feel horrible. Any ideas as to what this could be? Google says it could be a metabolic disorder, diabetes, etc…. Not jumping to conclusions, but just concerned that this isn’t being handled as swiftly as I’d like to get to the bottom of this. It is NOT normal to have this odor and I’m not believing it’s just pH unbalanced due to the potency of the odor. Side note⚠️ my child is only with me, her mother 100% of the time, so no chance of SA

Howdy all. I'm almost 2 years into my first "real" (post-military) FM job. I'm full-time (36 patient contact hours) inpatient/outpatient, no OB. I'm closing on a thousand patients in my panel. I've got an average blend for rural midwestern.
I've just figured out how to discharge patients from my panel (only working on aggressive/abusive patients at the moment). I just saw an establish care request from a patient I'm not thrilled about seeing (to another doc: "No, marijuana isn't making me anxious, my anxiety is making me anxious! It's YOUR job to fix it!").
This sets me wondering about how best to say no. I'm deploying in a couple of months. Do I just close my panel now? ("Dr. Scapholunate isn't taking any new patients) Or do I specifically block patients based off gestalt?
What're y'all's thoughts on this?

I am a 33 year old female who’s 99 lbs. I can’t gain weight. I have itchy skin, my bowels hurt and I have tinnitus in my ears, headaches, discomfort and loose stools mostly. I am on no current medication but I did abruptly stop Lunesta almost 9 days ago abruptly after being on it for 2 months. The day after that I was given flagyl for BV and I got toxicity from it. I’ve had blood tests galore as well as imaging done. I have some labs that are definitely off and the doctor said they’re fine but I don’t feel like they are fine. The nearest city is SF and it takes months to get an apt. I currently am waiting on a back appointment with ucsf as well as endocrinology and neurology appointments that I can’t be seen for till next year. I hope someone can maybe check my labs out. I strongly feel like there is something wrong and the doctors are missing it.

I just wanted to share my story here! I was diagnosed with three uterine fibroids earlier this year, and scheduled my hysterectomy (laparoscopic) for June 20th. My doctor put me on megestrol acetate to help control my bleeding leading up to the surgery, as it was an anemia diagnosis that put me on this path in the first place. I found this subreddit and joined with the intent of using it to help me prepare for the surgery when the date got closer.
At first all was well, but two weeks after starting the megestrol, I started bleeding *constantly*. Some days were manageable, and some days had flooding so bad I just sat on the toilet for hours. Eventually my doctor doubled my megestrol dosage, but it didn't seem to make much difference.
On April 28th, I had terribly bad constipation and just general abdominal pain. I tried to treat with gas-x and plenty of fluids, but by the evening I started passing golf-ball sized blood clots and made the call to go to the ER. My husband drove, and as we got there I ended up passing a *softball* sized clot in the parking lot.
(It turns out you get admitted to the ER pretty quickly when you show up covered in your own blood.)
I spent about two days in the hospital as they tried to figure out what was wrong. A CT scan showed far more than the three fibroids we'd known about, and an MRI eventually confirmed that they'd detached and started deteriorating. Suddenly my surgery was moved up to May 1st, and as it turned out, my uterus was now too large to be done as simply as originally planned (equivalent of a 6mo pregnancy). I was in surgery for 4.5 hours, with five little incisions above my stomach and one 5cm incision below my belly.
They kept me two more nights in the hospital, as they wanted to do a full course of IV antibiotics due to the nastiness they pulled out of me. Moving and walking was like the game QWOP - learning to move each of my limbs individually, without engaging my core muscles. I was able to void on my own within 24 hours (because I'm stubborn and desperately wanted to be home again) and discharged on May 3rd.
I spent the first two weeks post-op laid up either in bed or my armchair downstairs, taking little walks as I felt able to. It was such a relief when I was finally able to sit down or stand up without risking searing pain! They gave me oxycodone, but it didn't seem to do much more for me than the ibuprofen/tylenol combo I was prescribed, so it's mainly sat untouched. As of this week I'm sitting upright at my desk and finally able to get back to work (at home, thankfully), but I can tell it's going to be a long while yet until I'm at 100% mobility.
One thing I've struggled to find help with was how to manage my lower incision as an obese person with an apron belly. The incision is perfectly in the fold of my stomach, and I can't quite tell if that's helped me or made things worse. If anything, keeping it clean is a struggle, and having my husband to help has been an absolute godsend. But I think it's managed to keep some pressure against a spot that benefits from having some weight against it (especially since the hospital-supplied belly band was too small, sigh).
At any rate, I'm so thankful for this resource, and I hope my story can help somebody else in their own journey. <3 Wishing all of us the best!

I was experiencing recurring yeast infections after sexual activity with my partner Feb-April. This happened all 3 times we were intimate. I treated all 3 of these with Canesten. This helped the first 2 times, but the third time the yeast infection was persistent. I stopped seeing him.
April 27 I got a UTI that added to the complications. Started drinking lots of water and this eventually cleared up.
I saw my doc May 7th - tested for STDs, BV, UTI, yeast. Everything came out negative. At this point I only had the white discharge and itching but all other symptoms cleared up.
I got my period. May 8-11. After sexual activity May 10, I had UTI symptoms again.

• frequency peeing/urge to pee
• cloudy urine
• lower abdominal pain/pelvic cramping
• fatigue
• back pain

Started drinking lots of water which mostly cleared everything up. Had basically non-existent back pain on May 17. Thought I was better so I had an alcoholic drink. immediately brought back the UTI symptoms.
It's now May 21. All my UTI symptoms have cleared except my lower back pain and I now have occasional pain under my ribs on the right side. I had this on the left side but it cleared up. And I have a dull achy pain in my right side back under my shoulder blade and below leading to my back. It's worse at night. I can't get an appt with my doctor until Friday and even then it's a phone appointment so I'm panicking because I read about kidney infections.
tldr; upper and lower back pain after UTI and I am panicking. Can't see my dr. until friday and even then it's a phone appt. Should I be worried

The title is the TL/DR
We are riders. We know the dangers that come with riding. We accept this and still choose to ride. But this one hits close to home. Here's the situation with my brother:
So this year I've been riding almost everyday its not raining, commuting to work on it. 15 miles/day. Really getting into it. Been riding for 3 years but this year something clicked haha. (07 shadow 750 btw)
Anyways, my brother was recently discharged from the military due to a training accident that required back and knee surgery (fell off 3 story buiding) and he moved back to our home town. Hes 15 minutes away from me now. Hes doing better now but still experience periodic sharp pains and cramps. I mean its bad enough for the military to release him. He wears a back brace a lot of the time. Anyways. He approcahed me and said he wants to start riding! As his younger brother, I'm excited to hear this and hope to go on rides together ofc.
He's been talking to me, talking to other riders, doing his research on types of bikes and what he'd like to get.
Then last night he sent me a list of the bikes he's thinking of getting for his first bike (new or used, depending on the bike).
Well, here's the list (He's around 6 foot 1, 220 lbs , 26yo btw):
Triumph Daytona 660 or 675 Kawasaki Ninja 650 Gsxr 600 or 750
I was honestly surprised by the list?
They are amazing bikes btw! Look like so much fun! Just, besides the normal debate of if a 600cc plus sports bikes are good for beginners (debatable). I am concerned about his injuries, and ongoing back and knee issues. Sports bikes ofc demand a pretty aggressive riding posture. I mean sometimes he can't pick anything, (or even his kids) up for days because of the pain.
On top of that, Hes....a bit reckless at times. He's a car guy like me, but he's one of those to go to take overs and drift in the middle of the road type shit. Instagram and tik tok content type of guy lol.
Concerned he may be doing a highway run or trying to drop knee on a corner when he gets a sharp pain that takes his breathe away (which are unpredictable and has happened while driving before even), and BOOM...
I talked to him about other riding styles, types of bikes, smaller CC bikes as well, he does not care at all. Thinks all other motorcycle types are ugly or "not cool" (ouch? lol), and that he does not want to get a lower CC bike because "they're too f*cking slow, I'll have to upgrade next year".
I hate that misconception btw. I mean how would he know what's enough for him, he's never even ridding a bike yet! Everyone is different. Sure for some 600 is not enough, for others its plenty. And it's not about the ccs. Just a factor ofc. Oh, and annoying to hear from a nonrideaspiring rider. Love him to death but his mindset concerns me.
He also wants to finance if possible. And does not want to take the msf or any training. Said me or someone else can teach him or he'll learn by himself....
Am I crazy to think he's being irresponsible about it? Has a Wife, kids, pets back home , as many of us do.
I already know most people will say "it's his life. Let him do what he wants" or that I sound like a hater. But It's my brothers life here. Youre not here in person to see how bad the iniury still affects him. Its been 6 months. Ofc I care.
I want him to ride. With or without me. We all know how fun and fulfilling it is. And I truly believe he will enjoy it.
What do you guys think? Should he atleast have conversation with his doctor?