#Assessment and Treatment Units

[noirandchocolate]

RICE Alzheimer's Research Institute

Terry died on 12 March 2015, having given his PCA a run for its money.  Open about his diagnosis, he has helped to unlock the secrecy and stigma that often surrounds dementia.  His legion of fans is undoubtedly grateful that despite the inevitable progression of the PCA he was able to fight his ‘embuggerance’ and continue to produce a number of both well-received and well-reviewed books.  Terry was also a great example to me in emphasizing how important it is that, in caring for people with any type of dementia, we always look for what people with a condition like PCA can still do, rather than what they can’t: by maximizing what is possible, a person can still live well with dementia for a significant time.

–Professor Roy Jones, Director of RICE (taken from “Terry Pratchett: His World”)

I wanted to post something for the Glorious 25th about the Research Institute for the Care of Older People (RICE) in Bath, where Sir Terry Pratchett received treatment for Post-Cortical Atrophy, the type of Alzheimer’s disease that eventually took his life. From the organization’s website:

RICE established one of the first memory clinic services in the UK in 1987 – a service which has since been widely replicated and is now considered standard and best practice by the NHS. In fact, RICE now runs the NHS Memory Clinic in Bath and North East Somerset on behalf of the local clinical commissioning group and local authority through a sub-contract with HCRG Care Group. To date, we’ve assessed, diagnosed, treated and advised 12,000 people with memory problems and their families in our memory clinic. 

Most of RICE’s clinical services and research activities take place in our own purpose built, specialist centre located on the Royal United Hospital site. The building of the RICE Centre was possible as a result of generous donations from major donors, trusts and foundations, and members of the public. RICE moved into the ground and first floor of the centre in 2008. Following the success of the DementiaPlus Appeal and further generous donations from major donors, trusts and foundations and members of the public, RICE converted the attic floor in 2019 to create more office space. This has given us access to much needed additional rooms and offices which will enable us to grow and run more services and activities. We’ve worked hard to ensure that the areas of the centre visited by our patients meets their needs and we regularly receive feedback on how much our patients enjoy their visit to our centre.

RICE not only provides clinical services to patients, but also conducts research into aging and dementia, including performing clinical trials for new drug treatments for memory-related diseases and developing other “techniques for diagnosing, managing, treating and understanding dementia and memory changes in older adults.”

Lady Lyn Pratchett is the patron of the organization, and the website includes a page about how people can donate funds or volunteer at the clinic and participate in fundraising events.

SO, if you’d like to help fund Alzheimer’s research on this Glorious 25th of May–or at any time–in honor of the Man in the Hat, take a look!

[sayruq]

The cost of damage to critical infrastructure in Gaza is estimated at around $18.5 billion according to a new report released today by the World Bank and the United Nations, with financial support of the European Union. That is equivalent to 97% of the combined GDP of the West Bank and Gaza in 2022.

The report finds that damage to structures affects every sector of the economy. Housing accounts for 72% of the costs. Public service infrastructure such as water, health and education account for 19%, and damages to commercial and industrial buildings account for 9%. For several sectors, the rate of damage appears to be leveling off as few assets remain intact. An estimated 26 million tons of debris and rubble have been left in the wake of the destruction, an amount that is estimated to take years to remove. The report also looks at the impact on the people of Gaza. More than half the population of Gaza is on the brink of famine and the entire population is experiencing acute food insecurity and malnutrition. Over a million people are without homes and 75% of the population is displaced. Catastrophic cumulative impacts on physical and mental health have hit women, children, the elderly, and persons with disabilities the hardest, with the youngest children anticipated to be facing life-long consequences to their development. With 84% of health facilities damaged or destroyed, and a lack of electricity and water to operate remaining facilities, the population has minimal access to health care, medicine, or life-saving treatments. The water and sanitation system has nearly collapsed, delivering less than 5% of its previous output, with people dependent on limited water rations for survival. The education system has collapsed, with 100% of children out of school. The report also points to the impact on power networks as well as solar generated systems and the almost total power blackout since the first week of the conflict. With 92% of primary roads destroyed or damaged and the communications infrastructure seriously impaired, the delivery of basic humanitarian aid to people has become very difficult.

[odinsblog]

Game of Thrones stars and other actors read South Africa's case file charging Israel with genocide at the International Court of Justice.

Transcript:

It was already known that repeated exposure to conflict and violence, including witnessing and experiencing housing demolition, combined with Israel'siege of Gaza since 2007, is associated with high levels of psychological distress amongst Palestinians.

Indeed, the United Nations Security Council Resolution 2712 expressed its deep concern that the disruption of access to education has a dramatic impact on children and that conflict has a lifelong effect on their physical and mental health.

This disruption and its dramatic impact on children must be considered in particular and in the context of the number of Palestinian students and educators who have been killed, 4,037 and 209 respectively, and wounded, estimated at 7,259 and the number of Palestinian schools having been damaged or destroyed 352 or 74% of the schools in the whole of Gaza.

Medical professionals assess that the health effects on all Palestinian children, women, men, older people, people with disabilities and people marginalized identities are immense.

An emergency coordinator for Médecins Sans Frontières interviewed on her return from five weeks in Gaza, describes: It's even worse in reality than it looks. The amount of suffering is just something incomparable. It's really unbearable. I'm speechless when I try and think of the future of these children. Generations of children who will be handicapped, who will be traumatized.

The very children in our mental health program are telling us that they would rather die than continue living in Gaza now.

The extreme levels of bombardment and lack of any safe areas are also causing severe mental trauma in the Palestinian population in Gaza.

Even before the latest onslaught, Palestinians in Gaza suffered severe trauma from prior attacks. 80% of Palestinian children experienced higher levels of emotional distress, demonstrating bed wetting, 79% and reactive mutism, 59% and engaging in self harm, 59% and suicidal thoughts, 55%.

Eleven weeks of relentless bombardment, displacement and loss will necessarily have led to a further increase in those figures, particularly for the estimated tens of thousands of Palestinian children who have lost at least one parent and those who are the sole surviving members of their families.

For the families who remain intact or partially intact, quote, “It's about doing everything you can so your child doesn't realize that you've lost control.”

There are reports of Israeli forces using white phosphorus in densely populated areas in Gaza.

As the World Health Organization describes, even small amounts of white phosphorus can cause deep and severe burns, penetrating even through bone and capable of reigniting after initial treatment.

There are no functioning hospitals in the north of Gaza in particular, such that injured persons are reduced to waiting to die, unable to seek surgery or medical treatment beyond first aid, dying slow, agonizing deaths from their injuries or from resultant infections.

Large numbers of Palestinian civilians, including children, have reportedly been arrested, blindfolded, forced to undress and remain outside in cold weather before being forced onto trucks and taken to unknown locations.

Medics and first responders in particular have been repeatedly detained by Israeli forces, with many being detained in communicado at unknown locations.

Videos published by Israeli media on Christmas Day appeared to show hundreds of Palestinians rounded up inside al-Yarmouk football stadium in Gaza City, including children, older people and persons with disabilities, being forced to strip to their underwear in degrading conditions. United Nations Office for the Coordination of Humanitarian affairs, or UN OCHA, reports video footage showing bruises and burns on the bodies of detainees.

Images of mutilated and burned corpses, alongside videos of armed attacks by Israeli soldiers are reportedly circulated in Israel via a Telegram channel called, 72 Virgins Uncensored, billed as exclusive content from the Gaza Strip.

[genderqueerdykes]

Testosterone HRT Overview, Guide & Information for All People Seeking It

Hello, we're a genderqueer person who's been taking testosterone HRT since 2015. I've also worked in a pharmacy and we've seen a lot of the roadblocks that comes with people trying to start HRT. Nobody really explains how difficult it can be, even when you get your prescription. Because testosterone is a controlled substance in many places, it creates hurdles. There can be a lot going on, and some folks become very disheartened if their T isn't covered by insurance. i get that. We wanted to create a relatively easy to digest and succinct post detailing some common hurdles people have to face on the doctor/prescriber and insurance level, as well as after getting their hormones. *please note that a lot of this information is United States centric as that's where i live, i can't give information for a country i've never lived in, unfortunately.*

The estrogen HRT version of this post is here!

Doctors, Insurance & Getting Your Prescription

If your primary care provider is already familiar and comfortable with prescribing HRT, you can go through them, find an informed consent clinic, or seek an endocrinologist or gender affirming care specialist. Planned Parenthood is a good option for many people. If you don't have insurance, check to see if your area offers medicaid or other low income insurance plans, T can get pricey in some areas, especially for topical. if you can't access insurance please look into services like GoodRx that offer coupons and discounted rates for prescriptions.

Here is a list of informed consent clinics in the US for HRT.

Your provider will ask you some questions about your experience with gender, any dysphoria, why you want to seek medical transition, if you'd like to seek surgeries, assess your mental health, and then screen you for potential health problems or roadblocks. Your liver enzymes will be screened, as will your hormone levels, blood pressure, and some other things. Make sure your doctor knows to note that you are a transgender patient so that your blood tests are not discarded because your gender says "F" instead of "M" on the paperwork.

In some areas it is required to seek treatment with a therapist who specializes in transgender care to make sure this avenue is right for you. Not everywhere requires this step.

Make sure you talk to whoever is prescribing the testosterone to you about insurance, and if they are aware that testosterone is a controlled substance. A controlled substance is a substance that has been restricted by your country's government or governing medical organization and has to be monitored carefully. You need what's called a "prior authorization" from your doctor in order to get your insurance to give you your hormones in most states. Talk to your doctor and pharmacy about prior authorizations for your testosterone and syringes if you need them.

Currently, the only forms of testosterone available for masculinizing HRT are testosterone cypionate (injectable), topical gel, and patches. Topical forms are usually applied daily, injections can be done once or twice a week, or even more or less frequently if a person needs it. There is no pill option available for masculinizing HRT currently.

Do NOT become disheartened if you do not see the effects you want to see right away. It can take several years for the full effects of certain aspects of medical transition to show themselves. Stay patient, talk with your provider, talk to other trans people!

Stay patient, Stay positive!

HRT and Administering Testosterone

When you get a prescription, how things go will depend on if you get your doses administered at the clinic, or if you choose to do them at home. If you are not comfortable self administering, ask if they will at the clinic. many places offer this service.

if you choose to administer at home, if you are using injectable T, note that pharmacies may give you the wrong gauges of needles because they don't often give out needles for HRT. You need two different sizes- a thicker, longer needle for drawing from the vial, as testosterone cypionate is thick. You will generally be given large 18g needle for drawing and a small 22 or 23g needle for injecting. Many people have preferences for different gauges so ymmv. Depending on if you are injecting intramuscularly or subcutaneously the gauge of the needle with vary. Sanitize your injection site and your hands, never using the same needle tips twice for any reason. Never use needles that have touched another surface, and get a sharps container.

Make sure you are injecting in different spots every time you inject. you do not want to inject into the same patches of skin every time, as this can cause tissue damage, tissue death (necrosis), and severe scarring after long periods of time of having to heal but being interrupted over and over again. inject into slightly different spots every time to make sure your skin and muscle tissue can heal.

Here is a guide on safely injecting your own testosterone, including steps on how to prepare your skin for the injection, hold the vial while drawing, change needles, and more.

Another guide for hormone injections.

Make sure to check with your provider to see what type of injection you are meant to do, many do intramuscular injections, but many opt for subcutaneous (just below the skin) injections because they are less painful and require less frequent injections.

If you receive topical testosterone like androgel or other alcohol based testosterone gels, make sure you read the informational packet that comes with it to ensure you are administering it in the correct areas- your exact formulation will need to be applied in a certain area, if you do not have the guide or packet that came with it, please read this page to figure out where you need to apply it. if your topical T isn't working you may be applying it in the wrong place.

When applying topical T, make sure you clean the skin before putting it on, and do not shower or go swimming for 2 - 5 hours after application. make sure you cover the skin with some kind of clothing. You want to make sure it doesn't rub off on other people, as other people can absorb it as well by touching you. Do not ever have someone else apply topical testosterone for you, even if they are also trans, as this can mess with their levels in a bad way.

After starting T you may have to adjust your dose over time to achieve desired effects. if so, you will start on a starter dose and then you can move up to higher doses as your body adjusts. This process is called titration.

No matter HOW tempting it is, NEVER TAKE MORE T THAN YOU ARE PRESCRIBED! It is processed through your liver, which can completely wreck it if you take more than it can handle. Slow and steady wins the race with HRT. If you take too much T at once, your body can also aromatize it, meaning your body will convert it and encourage the production of further estradiol, which will provide unwanted effects. Do not increase your dose without your doctor's advice or knowledge, and do not go any faster than advised.

Effects of Testosterone HRT

Growth and thickening of facial and body hair begins 3 - 6 months after treatment starts and the full effect happens within 3 - 5 years.

Menstruation (periods) stop. This occurs around 2 - 6 months within starting treatment, and is one of the most desired effects.

Voice deepens. The vocal cords thicken, which can cause uncomfortable sensations in the throat for a time, such as a scratchy feeling, dryness, tightness, pressure, and a 'sore' throat that isn't sore in an illness related way. This begins 3 - 6 months after treatment starts, and the full effect happens in 1 - 2 years.

Body fat redistribution begins 3 - 6 months after treatment starts and the full effect happens within 3 - 5 years.

Growth or enlargement of Adam's apple.

Clitoris grows larger, and vaginal lining can thin and become drier. Some experience vaginal atrophy and/or painful levels of dryness, while some maintain a healthy level of vaginal fluids without problem. This begins 3 - 12 months after treatment starts, and the full effect is usually seen within 1 - 2 years, though some experience growth over a long period of time if their dose is low.

Change in body odor and increased sweating occurs within 1 - 3 months of starting treatment.

Muscle mass and strength increase, this will begin within 6 - 12 months and the full effect will be seen within 2 - 5 years.

Possible libido increase, though some report no changes or even the inverse.

Potential but not guaranteed balding or receding hairline, which is treatable, and not seen in everyone.

Potential increase in energy in general, some report an almost antidepressant like effect.

Possible increase in red blood cell production leading to high blood pressure, which is treatable via medications and donating red blood cells when appropriate and safe.

There is not really a guide book to masculinizing HRT and medical transition, most of the information there is is passed along between each of us. We will continue to edit this post as we think of more important information.

[itsgreti]

BENEATH THE MASK

pairing. simon "ghost" riley x f!reader

summary. (Y/N), Task Force 141's medic, saw Ghost's face for the first time while patching up his injuries.

warning. descriptions of gunfire, explosions, scenes depicting injuries, medical treatments, and blood (typical cod theme)

word count. 2.3k

a/n: english is my second language, so if you find any mistakes, don't hesitate and text me!

The desert wind howled across the rocky terrain as the Task Force 141 team moved swiftly through the night. (Y/N), their medic, felt the weight of her gear as she kept pace with Captain Price, Soap, Gaz, and the mysterious Ghost. She had been with the elite unit for a few months, but Ghost remained an enigma to her, a silent, masked figure whose presence was always felt but never fully seen.

Their mission that night was simple in concept: infiltrate a heavily guarded compound and extract crucial intel regarding a new shipment of chemical weapons. But as they approached the compound under darkness, their plan quickly unravelled. A patrol they hadn't anticipated stumbled upon them, leading to a chaotic firefight.

Bullets whizzed through the air, accompanied by the sharp cracks of rifles and the distant thunder of explosions. (Y/N) took cover behind a crumbling wall, her mind racing as she assessed the wounded. Soap and Gaz held their ground nearby, providing cover fire as Captain Price barked orders over the radio.

Suddenly, Ghost appeared beside her, his presence as silent as ever. He motioned towards Soap, whose shoulder was grazed by a bullet. Without a word, (Y/N) nodded and hurried to assist.

The firefight continued for what felt like an eternity, but the team managed to eliminate the immediate threat. With the area momentarily secure, they regrouped in a small, dimly lit room within the compound. Captain Price leaned over the map spread out on a makeshift table, his brow furrowed in concentration.

"We need that intel," Price said grimly, his voice low yet commanding. "Ghost, find it. (Y/N), patch up whoever needs it and be ready to move out."

(Y/N) nodded, her focus shifting to Soap and Gaz as she pulled out her medical kit. Soap winced as she began to clean and dress his wound, but Gaz remained alert, scanning their surroundings.

As (Y/N) worked, she stole glances at Ghost, who was hunched over a computer terminal in the corner of the room. His movements were precise and deliberate, his gloved hands flying over the keys as he accessed the encrypted files.

The tension in the room was palpable, broken only by the occasional click of Ghost's keystrokes and the muted sounds of the ongoing battle outside. (Y/N) couldn't help but wonder about the man behind the mask—his past, his motivations. But such thoughts had to wait. Right now, their survival depended on securing the intel and getting out safely.

Just as Ghost seemed to make progress, an explosion rocked the building, sending debris flying and knocking everyone off balance. (Y/N) stumbled, but Ghost was quick to steady her, his gloved hand gripping her arm firmly. For a brief moment, she felt the weight of his presence, his strength beneath the mask.

"Ghost!" Captain Price called out, his voice urgent. "We're running out of time. Can you get that intel or not?"

Ghost nodded, his masked face unreadable. With renewed determination, he returned to the terminal, his fingers moving faster now.

Outside, the gunfire intensified, drawing nearer by the second. Soap and Gaz exchanged worried glances, their weapons at the ready. They knew they couldn't hold out much longer.

"Almost there," Ghost muttered under his breath, his eyes fixed on the screen.

Suddenly, the screen flickered and then displayed a map with a blinking marker. Ghost's gloved hand hovered over the keyboard as he extracted the data onto a portable drive.

"We've got it," Ghost announced, his voice calm yet triumphant.

Captain Price wasted no time. "Good. (Y/N), pack up. We're moving out–"

Before Price could finish his sentence, a barrage of gunfire erupted from outside the room. Bullets tore through the walls, sending chunks of debris flying. (Y/N) ducked instinctively, shielding her head with her arms.

In the chaos, Ghost acted decisively. He grabbed (Y/N)'s arm and pulled her towards him, shielding her with his own body as they sought cover behind a thick concrete pillar. His masked face was just inches from hers, his eyes intense behind the tinted lenses.

"Stay down," Ghost ordered, his voice low yet urgent.

(Y/N) nodded, her heart pounding in her chest. She could feel the heat of his body against hers, his presence a comforting shield amidst the chaos. For the first time, she found herself grateful for his silent strength.

Captain Price and the others returned fire, their shots echoing through the room. The enemy was relentless, their numbers seemingly endless. But Task Force 141 was relentless too, fighting tooth and nail to hold their ground.

As the firefight raged on, (Y/N) couldn't help but steal glances at Ghost. His mask remained firmly in place, betraying nothing of the man beneath. But now, with the adrenaline coursing through her veins, she found herself drawn to him in a way she hadn't before.

"We need to move," Captain Price shouted over the din of gunfire. "Ghost, (Y/N), cover us. Soap, Gaz, with me!"

Without hesitation, Ghost and (Y/N) provided covering fire as Price and the others dashed towards the exit. Bullets whizzed past them, impacting the walls with deadly precision.

"Go!" Ghost called out, his voice barely audible over the cacophony of battle.

(Y/N) nodded and followed Ghost as they made their way towards the exit, their backs pressed against the cold stone walls. The air was thick with smoke and the acrid smell of gunpowder, their lungs burning with each breath.

Just as they reached the exit, a stray grenade sailed through the air and landed at their feet. (Y/N)'s eyes widened in horror as she realized they were trapped. Without thinking, Ghost pushed her behind him and shielded her with his body once more.

The grenade exploded with a deafening roar, sending shrapnel flying in all directions. (Y/N) felt the force of the blast against her back, but Ghost absorbed the brunt of it, his body tensing with the impact. She could hear him grunt in pain, but he didn't falter.

"Ghost!" (Y/N) screamed.

"(Y/N)..." Ghost's voice was strained. He was conscious but clearly in pain.

"Ghost is down!" she shouted into her comms, her voice filled with urgency.

There was a brief crackle of static before Price's voice came through, sharp and focused. "Gaz, Soap, fall back to Ghost's position! (Y/N), get to him now!"

As the smoke cleared, (Y/N) peered around Ghost to assess the damage. His mask was scorched and cracked, revealing a glimpse of his face beneath. Blood trickled down his neck from a gash caused by a piece of shrapnel.

"We need to get him out!" she called out, her voice steady despite the adrenaline coursing through her veins.

A few moments later the team managed to get to the position of (Y/N) and Ghost. Soap and Gaz provided cover as Price helped lift Ghost. They moved quickly, bullets whizzing past them, the sounds of battle all around. Outside, the night air was cool against (Y/N)'s skin as they regrouped with the extraction team and jumped into the helicopter that was waiting for them. As everyone was situated, (Y/N) immediately went to work, her focus solely on saving Ghost.

Captain Price and the others scanned the area around the helicopter, holding off the enemy as they flew off. (Y/N) didn't hesitate, knelt beside him. Ignoring his initial resistance, she gently pushed aside his damaged skull mask, and her hands went to his fabric mask that was under the other one.

"I need to see the wound," she said, her voice steady despite the panic rising within her.

Ghost caught her wrist instinctively, his gaze locking with hers. For a moment, neither of them spoke.

"It's alright, I need to patch you up," (Y/N) said softly, her voice barely a whisper.

Ghost hesitated, his grip on her wrist loosening ever so slightly. He gave a barely noticeable nod, allowing her to proceed. (Y/N) peeled back the mask, revealing his face for the first time. His face was a canvas of battle-hardened features, each scar telling a story of survival and sacrifice. A deep, fresh gash ran from his cheek down to his neck, the wound raw and bleeding, but the older scars drew her gaze – the jagged line across his left eyebrow, the faded burn mark along his jawline, and the small, puckered scar near his temple. His skin was pale, almost ghostly, contrasting sharply with the dark stubble that shadowed his jaw. But it was his eyes that caught her attention – dark brown, filled with a mix of determination and vulnerability.

Carefully, (Y/N) cleaned the wound on his neck and applied pressure to staunch the bleeding. Ghost felt a strange mix of emotions. He was not used to being exposed, his face a closely guarded secret. The sensation of her hands, gentle yet firm, was foreign but strangely comforting. Despite the pain, there was a sense of relief, a small crack in the armour he had built around himself.

Even though the severity of the situation, she remained calm, her training guiding her every move. Ghost winced, but he didn't pull away. Instead, he watched her with an intensity that sent a shiver down her spine.

"There," (Y/N) said gently, securing a bandage around his neck. "That should hold for now."

Ghost's eyes met hers, a mixture of pain and gratitude in their depths. "Thanks," he muttered, his voice strained.

"I've got you," she replied firmly. "Just hang on."

As (Y/N) finished, Captain Price stepped over the duo, his expression a mix of concern and relief. "How is he?" he asked, his eyes on Ghost.

(Y/N) looked up, exhaustion evident in her features. "He'll be okay. The wound was serious, but he's stable now."

Price nodded, his respect for (Y/N) clear in his eyes. "Good work. You saved his life."

(Y/N) offered a tired smile. "Just fulfilling my duty."

Price clapped a hand on her shoulder, a rare gesture of affection. The helicopter blades whipped through the night, and (Y/N) stayed beside Ghost, her hands steady as she pressed the bandage on his wound. The field dressings had been held, but the ride was rough, so she kept a close watch to ensure he stayed stable. Despite the dire situation, Ghost’s eyes remained sharp, and focused, a silent testament to his resilience. (Y/N) looked at the others and Ghost knew that she wanted to check on them. He nodded and without another word, he moved (Y/N)’s hand from his gash and pushed her to go to the other injured comrades.

Once she agreed, (Y/N) turned her attention to Soap. She barely took care of his shoulder which took a hit during the firefight, and although he didn’t say anything, she knew he must be in pain.

“Soap,” she called, her voice cutting through the hum of the helicopter. “Let me see your shoulder.”

Soap glanced at her, his usual bravado dimmed by exhaustion. “It’s just a scratch, doc,” he muttered, but he didn’t resist as she moved closer.

(Y/N) carefully peeled back the torn fabric of his sleeve, revealing the graze. The bullet had grazed his shoulder, leaving a raw, bloody scar. She winced at the sight but quickly set to work, cleaning the wound with practised efficiency.

“You need to take it easy,” she said, her tone firm but gentle. “This might not be serious now, but it could get worse if you don’t let it heal.”

Soap grinned, a flicker of his usual humour returning. “Don’t worry about me, lass. I’m tougher than I look.”

(Y/N) smiled back, shaking her head. “Maybe, but even tough guys need to let their medics take care of them.”

As she bandaged his shoulder, Soap’s grin softened into something sincere. “Thanks, doc. We’re lucky to have you.”

She finished securing the bandage and patted his good shoulder. “Just doing my job, Soap. Now sit tight, we’ll be back at base soon.”

She glanced around the helicopter, checking on the rest of the team. Gaz was alert, his eyes scanning the horizon, and Captain Price was deep in thought, already planning their next move. Despite the weariness and the injuries, there was a deep sense of unity among them. They had faced the fire together and come out stronger on the other side.

As the helicopter touched down at the base, the team began to disembark, their movements slow and weary. (Y/N) remained beside Ghost, her presence a steady anchor amidst the chaos. His mask was back in place, hiding his features once more. But now, she knew the man behind the mask – a warrior with a haunted past, driven by a sense of duty and honour. She held his hand gently, ensuring he felt her support. Even through the pain and exhaustion, Ghost’s eyes flickered with a rare vulnerability, acknowledging her silent strength.

As the other medics arrived and began to transfer him onto a stretcher, Ghost’s grip on her hand tightened slightly. “You don’t have to stay,” he muttered, his voice strained but sincere.

(Y/N) smiled softly, squeezing his hand in return. “I want to. You’re my patient and my friend. I’m not leaving you now.”

Ghost’s eyes softened, a flicker of gratitude passing over his features. “Not used to... this kind of care.”

She chuckled lightly, adjusting the blanket around him. “Well, get used to it. You’re stuck with me.”

There was a brief silence as the medics prepared to move him, the sounds of the bustling base fading into the background. Ghost looked at her, his expression serious. “Thanks, (Y/N). For everything.”

(Y/N) leaned closer, her voice gentle but firm. “Just focus on getting better, Ghost. We need you.”

He nodded, a small, almost imperceptible smile tugging at the corners of his mouth behind the fabric mask. “I’ll do my best.”

“You better do,” she said, walking alongside the stretcher as they moved him towards the infirmary.

[mariacallous]

Georgians are in the streets fighting for their democracy. The Georgian Dream party, which is working to align Tbilisi with Moscow’s interests, declared victory in the country’s Oct. 26 election before the votes were even counted. Voters and election observers were harassed by Russian-funded gangs and mobsters; just after the election, protesters holding European Union flags were sprayed with water from high-powered hoses. And the person who has the iron will necessary to lead the charge against Russian-inspired authoritarianism in Georgia? A woman: President Salome Zourabichvili.

This is no accident. Across the world, women have, and are, playing incredible roles as bulwarks against the rise of authoritarianism. Moldovan President Maia Sandu is standing up to a tsunami of Russian disinformation. In Poland, women played a critical role in the effort to oust the right-wing populist Law and Justice (PiS) party. In Hong Kong, women continue to be the practical and normative face of resistance to Chinese authoritarian rule.

These are the freedom fighters of the 21st century. And yet, the U.S. national security community tends to view women’s issues as a domestic concern, frivolous, or irrelevant to “hard” security matters. For example, in 2003, discussions of securing Iraq excluded women, with a top U.S. general stating, “When we get the place secure, then we’ll be able to talk about women’s issues.” More recently, the role of women in the military has been reduced to discussions of diversity, equity, and inclusion, rather than a focus on how women have been vital to solving the United States’ most wicked national security problems—from serving on the front lines in combat to providing essential intelligence analysis. But if the overall aim of U.S. national strategy is to shore up democracy and democratic freedoms, the treatment of women and girls cannot be ignored.

Globally, women’s rights are often eroding in both policy and practice, from the struggles of the Iranian and Afghan women who exist under gender apartheid to the Kenyan women experiencing the harsh backlash of the rise of the manosphere. In tandem, there’s been a sharp rise in reports of online harassment and misogyny worldwide.

National security analysts explore issues and psychologies through any number of prisms, but Women, Peace, and Security (WPS) remains an underutilized one. One of the national security community’s core tasks is discerning signals from noise in the global strategic environment, and regressive ideas on gender and gender equality can be a useful proxy metric for democratic backsliding and authoritarian rise.

The United States’ 2023 Strategy and National Action Plan on Women, Peace and Security provides the backbone for the United States to leverage WPS to counter authoritarianism. It highlights that displays of misogyny online are linked to violent action. The plan also points out that formally incorporating gendered perspectives is essential for maintaining democratic institutions at home and modeling them aboard. This includes recognizing misogyny—online or in policy—as an early indicator of authoritarian rise.

Unfortunately, WPS is often misread as simply including more women in the national security workforce. But it is more than that. It offers a framework for understanding why it is useful to take gendered perspectives into account when assessing how the actions of individuals or groups enhance national security, which is especially important at a time when authoritarian regimes are weaponizing gender in ways that strengthen their grip on power domestically and justify their aggression abroad.

In Russia, President Vladimir Putin has argued that he is the guardian of traditional Christian values, telling women that they should be back at home raising children, and has been rolling back domestic violence laws at the same time. Days before invading Ukraine in February 2022, Putin said, “Like it or don’t like it, it’s your duty, my beauty,” which was widely interpreted within Russia as a reference to martial rape. Russia’s own army is built on a foundation of hierarchical hazing in which “inferior” men are degraded by their comrades. With that kind of rhetoric from the top, is it any wonder that Russian soldiers’ war crimes have included the rapes of women and children?

But Putin isn’t alone. In Hungary, Prime Minister Viktor Orban has consolidated media outlets to censor women’s voices, in the name of protecting traditional values. He has also used coercive financial practices to push women out of the workforce and positions of political power and into more traditional roles of wife and mother. In Belarus, President Alexander Lukashenko attempted to force the deportation of the most prominent woman opposition leader and imprisoned her after she tore up her passport to prevent it. In China, where women were once told they “hold up half the sky,” President Xi Jinping has worked to undo decades of Chinese Communist Party policy on gender equality. Chinese women are now being encouraged to return home and become mothers, while feminists have been targeted legally and socially.

The WPS agenda provides the U.S. national security community with three opportunities to recognize, understand, and counter early-stage authoritarianism.

First, the United States can do a much better job of supporting women’s groups around the world as a central aspect of its national security strategy. Women’s groups are often a bellwether for authoritarian rise and democratic backsliding—as currently on display in Russia, China, Hungary, Georgia, and Belarus, where women inside and outside their respective regimes have been specifically targeted or attacked.

Women have also found innovative ways to resist the rise of authoritarian norms. In places like Moldova, women have acted as bulwarks against authoritarianism despite vicious disinformation campaigns targeting women leaders. Yet when it comes to formulating and executing strategies on national security, women’s groups are often left in the margins and their concerns dismissed.

Second, gender perspectives are essential to more fulsome intelligence gathering and analysis. The U.S. intelligence community can do a much better job of integrating gender—particularly as it relates to the treatment of the most vulnerable—as an indicator of societal and democratic health. This includes understanding how both masculinities and femininities influence decision-making and how, in turn, lived experiences act as necessary analytical tools. Training collectors and analysts of intelligence to recognize gendered indicators will provide a more robust view of the geopolitical landscape and fill critical holes in national security decision-making.

Finally, the United States must improve the participation of its national security community in WPS and feminist foreign-policy discussions. For too long, the “hard” security sector has distanced itself from more “human” security-focused endeavors and treated women’s rights as something that’s just nice to have.

Yet national security is an essentially human endeavor, and gender is a central component of what it means to be human. This is something that needs to be appreciated to better understand the many dimensions of the conflict—disinformation, online influence campaigns, and lawfare—that authoritarian regimes are waging against the United States and its allies.

[my-autism-adhd-blog]

Hi everyone,

It’s been a while since I posted any articles, so I wanted to share one I found about the similarities and differences between autism and BPD (borderline personality disorder).

According to the article:

Various research has shown an overlap between BPD and autism. A 2024 study from the Brighton and Sussex Medical School in the United Kingdom found that not only is there an overlap in the conditions, but that misdiagnosis of the conditions can have a significant effect on the individual.

The researchers found several key issues that came from a misdiagnosis. These key findings included:

Harmful treatment: Certain treatments for BPD, such as “masking,” were shown to be harmful to individuals with a misdiagnosis. Masking involves hiding certain traits, specifically autistic traits. This was linked to increased suicidal ideation and a feeling of powerlessness. Individuals felt they could not change the BPD diagnosis, even though they thought it was not correct.

Stigma: Individuals who received a misdiagnosis of BPD felt it introduced a certain amount of stigma and diagnostic overshadowing. It led to healthcare professionals neglecting the true underlying issues and imposing treatments that were unhelpful and potentially detrimental.

Diagnostic barriers: Individuals found there were substantial barriers to receiving autism assessments after receiving a BPD diagnosis. This delayed appropriate support.

One of the main findings of this research was that those who did receive a correct diagnosis felt it was “life changing.” It gave them access to proper support, which significantly improved their well-being and mental health.

BPD and autism key similarities

There are several key similarities between BPD and autism, including:

emotional dysregulation, which may involveTrusted Source:

intense mood changes

difficulty managing emotions

impulsivity

social difficulties, which may involve:

fear of abandonment

difficulty with interpersonal relationships

difficulty understanding other’s emotions

communication issues, which may involve:

difficulty understanding social cues

difficulty forming relationships

rigid thinking patterns, which may involve:

black-and-white thinking or viewing situations and people as all “good” or all “bad”

rigid routines, specific interests, and rituals

difficulty accepting and adapting to change

difficulty navigating complex social situations

Learn more about borderline personality disorder.

BPD and autism key differences:

Even though there is an overlap between BPD and autism, they are two separate conditions.

BPD is a personality disorder characterized by impulsive behavior, unstable emotions, and an unstable sense of self. Autism is a neurological and developmental condition that involves repetitive behaviors, challenges in social skills, and nonverbal communication.

I’ll leave the full article below in case anyone wants to read it:

[petrolstationflowers]

Up to your neck in true crime and feel you can really get into why burglars keep stealing your toilet? Then perhaps the Criminal Psychologist career is for you! This was another request from Catrillion and I had to do a fair bit of digging to make sure this one was accurate.

This job is available for YA - Elder, and you can join via the Police Station. Please note you will need University installed as one of the requirements is the Science skill!

No opportunities or books.

If you want to use this, you must have Nraas Careers installed for it to show up!

There are three custom tones to level your skills:

Build a Rapport (Logic) Write Your Report (Writing) Study Previous Cases (Science)

Coworker tones are the same, and skill tones and uniforms appear from level four. The carpool doesn't appear until level three -- you're a poor postgrad, after all!

Levels under here:

Positive Postgraduate - 10 simoleans p/h, 09:00 - 17:00, M-F Description - It’s been a long road to graduation – plenty of sleepless nights watching true crime documentaries and making flash cards for exams, because Watcher forbid you muddle up the Hansford Prison Experiment and the Toto Doll study. You’ve decided you want to jump right in and get an internship, but where to start? Better start cozying up to your professors and making some phone calls! Enthusiasic Intern - 15 simoleans p/h, 09:00 - 18:00, M-F Description - After laying on the praise and asking very nicely, you’ve managed to secure an internship for the year. The pay is nothing special and the hours are long, but you’re learning a lot, working at the local police station, accompanying jail, and the mental health unit over at Sunset Valley General. You’ll be profiling offenders and writing out risk assessments for those living with Unstable personalities, writing recommendations to make the prison nicer and holding therapy sessions. Better hope they’ve got good coffee! Criminal Psychologist In Training - 30 simoleans p/h, 09:00 - 18:00, M-F Description - If you thought you escaped the classroom, think again. Sure, you’re finally getting to put your skills to use, but while you’re still helping out at the precinct, you’re also trying to put together where your skills lie. Would you be best working at HMS Sunset Valley, overseeing prisoner rehabilitation, or in the interview room at the police station working on a report for Sunset Valley Plumbbob Court? Best find a quiet spot in the legal library and do some studying – oh, and your manager wants those reports by the end of the day.

Junior Criminal Psychologist - 40 simoleans p/h, 09:00 - 18:00, M-F

Description - You’re not quite working in the big leagues yet, but you’re getting there. You’ve been assigned to the psychiatric unit, triaging those who have been sent your way and helping out with various studies being conducted around the facility. You are, however, getting to sit in on diagnostic intakes and occasionally are being trusted to write up your own. Hopefully if you format the reports nicely enough, you’ll be allowed to steer the ship yourself.

Clinical Researcher - 70 simoleans p/h, 09:00 - 18:00, M-F

Description - Now you’ve found your feet, you’ve been assigned to work on a clinical research program. Sure, it’s only a contract job, but you’re learning about kleptomania and why certain sims are compelled to steal street lights. Lots of note taking, interviewing people, and staring at graphs until the numbers blur, but when you finally see patterns and correlations, it’ll all be worth it!

Treatment Psychologist - 80 simoleans p/h, 09:00 - 18:00, M-F

Description - The data about street lights proved fruitful, and the local government have decided that the results are valuable enough to be put into practice. Sunset Valley General has set up a specific ward for those suffering from kleptomania, and you’ll be setting up therapeutic workshops and treatment programs to try and cut down on their thievery. It’ll take time, patience, and empathy – luckily, you’ve got those in spades.

Psychologist - 100 simoleans p/h, 09:00 - 15:00, M-F

Description - Out on your own now, with an office and everything! No longer chained to a hospital or a ugly precinct storage room, you’re free to pursue topics that interest you and studies that make your brain light up. It’s back to assessing and evaluating patients, setting up group studies and making recommendations for them to take a long holiday to Barnacle Bay for the sake of their health. The hours are shorter and pay is better – maybe you’re finally at the top?

Senior Psychologist - 120 simoleans p/h, 10:00 - 17:00, M-F

Description - Business is booming, but there’s something missing; counselling snobby sims through their affluenza or prescribing pills for cowards who can’t stop running away from Bonehilda isn’t as fulfilling as it used to be. You’ve been keeping an eye on local job postings and there’s one that’s caught your eye; something about working with the police force to uncover exactly how their minds work. Perhaps it’s time to spruce up your CV…

Investigator in Training - 150 simoleans p/h, 09:00 - 18:00, M-F

Description - You’re back to long hours and endless studying, but this one is paid well and comes with lots of benefits; namely, finally getting to study some of SimNation’s most intriguing criminals up close. You’re not being turned loose quite yet, so for the moment you’ll need to shadow your fellow officers and write up dictated reports on just why you think the Tricou family died and who had the motive to arrange Bella Goth’s disappearance. Keep your nose to the grindstone and soon you’ll be free of hours long recordings and into the interrogation rooms yourself.

Criminal Investigator - 200 simoleans p/h, 09:00 - 18:00, T,W,U

Description - That work has paid off and you’re finally where you wanted to be – sitting across the table from some of the most dangerous people in SimNation. When Circe Beaker has been hauled in for illegal experimentation and Roderick Synapse has finally been arrested for kidnap, it’s your job to sit down with them and pick apart their alibis. You’ll need to walk the fine line between professional and friendly, keep a cool head when you’re hearing the horrors, and be able to put together everything you’ve learned in a well written report – best get the coffee ready.

Translations: I've included the English Strings in the file; if anyone is talented enough to translate, I would be incredibly grateful, so please let me know in the comments!

With thanks: To MissyHissy's career building tutorial!

[saphronethaleph]

Outpatient Procedure

The door opened, and Janice Olken looked up.

“Chris H?” she asked.

“That’s me,” the man agreed, somewhat nervously. “The receptionist told me to come straight here – is that all right?”

“That’s quite correct,” Janice agreed. “My previous appointment cancelled, and we’ve got a lot to go through… take a seat, please.”

She shuffled away the papers she was working on, official forms, then assessed Chris.

“All right,” she said. “This is the last meeting before you’re committed, but it’s the first meeting with me, so I hope you’ll forgive me that we go through some basics.”

“Not a problem,” Chris replied. “It’s taken so long to get here already, I’m quite patient.”

Janice smiled slightly.

“No doubt,” she said, bringing up the man’s file. “Let’s see… all right, I’ve gone over your chart, but I need to confirm a few things. No heart conditions or history of heart conditions?”

“My paternal grandfather died at fifty-two,” Chris answered. “That was a heart attack. My father’s now sixty-eight. No other history of heart problems in the family.”

Janice nodded, confirming that. Chris himself was thirty-one, which was well before the point that even a hereditary problem of the same scale as his paternal grandfather would manifest.

“That’s what I’ve got here,” she said. “And your referring physician said that that shouldn’t be a significant problem… any known allergies?”

“Hayfever, but I manage it with medication,” Chris replied. “Isn’t this on my chart?”

“Like I say, it’s my first meeting with you,” Janice pointed out, not unkindly. “I need to confirm a few details… any other medication that you take on a regular basis, besides hayfever medication?”

“No,” Chris answered. “And before you ask – I don’t smoke, I drink no more than two units a week, and I get about four hours of exercise per week.”

Janice confirmed those matched what was on the chart, then picked up a clipboard and a sheaf of paper.

“All right, Mr. Hall,” she said. “If you could tell me your reason for seeking treatment? In your own words.”

Chris’s gaze flicked up to the diplomas hanging behind Janice’s desk, then he focused on her again.

“Self-affirmation,” he answered, steadily enough. “That’s why it’s taken so long, right?”

“Affirmative treatment does tend to take longer,” Janice agreed. “It’s an abundance of caution, as I’m sure you’re well aware, but it’s considered to be an elective treatment and – while I have my own thoughts on whether it should be categorized the same way as other elective treatment – it’s probably a good thing that permanent body modification is hedged about with certain safeguards.”

“Do you think they’re all medically necessary?” Chris asked, sounding somewhat bitter. “The amount of time I’ve spent on-”

He shook his head, cutting the statement off.

“Sorry,” he added. “It’s just been… frustrating.”

“I understand your position,” Janice said, evenly. “A lot of the people who I see coming into this office have faced the same thing. Count yourself lucky that you passed the psychiatric evaluation.”

“Yeah, that was…” Chris began, then shook his head. “It was an ordeal.”

Janice nodded, slightly, taking some more notes.

“Now, I’m afraid that because of your reason for treatment I need to go through some legally mandated questions and comments,” she went on. “I appreciate that some of them will sound nonsensical. But they are required and there’s not really any getting around that. Even if you’ve heard – and answered – them before.”

She flicked to the second page on her clipboard. “I am required to ask you if you have undergone a period of non-treatment affirmation.”

“Yes, insofar as that’s possible,” Chris muttered. “I’ve got a suit, if that’s what you mean.”

“That is the usual way,” Janice confirmed, with a slight smile. “I know it’s a shame you probably won’t need it any more, given the investment.”

“No, I intend to keep it,” Chris said. “It’s… helped me, and I kind of like the idea of being able to be in public as myself without people knowing.”

Janice nodded, making a mental tick mark.

“I am also required to point out that the proposed treatment is permanent,” she said. “And to ask you if you have considered alternatives.”

Chris stared.

“Even at this point you have to ask that stupid question?” he asked. “It’s been years since I started this process!”

Janice let the shout die away, then tilted her head slightly.

“It’s a legal requirement,” she stressed slightly. “I have to ask these questions. It’s out of my… hands.”

Chris looked down, stifling a sigh.

“Right, right,” he said. “I get it, it’s just… I know it’s the law, but these are stupid laws. Right?”

“I couldn’t possibly comment,” Janice said. “Your answer?”

“I’ve considered alternatives, yeah,” Chris replied. “I wouldn’t be here, two and a half years into this process, if any of the alternatives worked for me.”

Janice made a precise tick mark on her sheet, then turned over another page.

“I am required to read you the following,” she said, then cleared her throat slightly. “The process of therianization is a process that is poorly understood. It is a process that cannot be reversed. Patients who have undergone therianization gain a strong allergic reaction to certain metals, including cadmium, silver and palladium. These metals are commonly found in jewellery and catalytic converters.”

She glanced up at Chris, noting his reaction to the disclaimer, and kept going. “The process of therianization is also recorded to have a high regret rate, with twenty-seven percent of those who underwent the process for bodily affirmation reasons registering their regret in questionnaires after one year and forty-five percent after two years.”

It went on, and on, for almost a page, until Janice finally reached the end, ticked another checkbox, and put the clipboard down.

Chris looked like he was about to explode, but contained himself, and Janice held up a hand.

“I know,” she said. “Having reached the end of what I am legally required to read, I can tell you that most of the statistics included are not statistics that I consider to be true. They are, however, part of the Therianization Medical Use Act, so I have no choice but to read them for you and to confirm that I have read them for you.”

“Well, you’ve done that,” Chris admitted, with a sigh. “I just… why is it so hard to do this?”

“You saw the protestors, I take it?” Janice said, glancing towards the door and the front of the building beyond. “That’s just one reason why.”

“Right, right,” Chris groaned. “It just feels… completely backwards. Does everyone who comes to you have this much trouble?”

It was a rhetorical question, because they both knew the answer, but Janice provided it anyway.

“No,” she said, simply. “They do not. In any case where the treatment is associated with directly saving a patient’s life, instead of improving their mental health, the consent required is… significantly less stringent. But I’m sure Phyllis went over it with you – it’s the kind of thing she does.”

“You know her?” Chris asked, curious.

“Of course,” Janice replied. “As odd as it may sound, there’s not actually all that many Registered Theiran Practitioners in the country – there’s a reason you were referred to me from all the way over in Oxford. I make it a point to at least meet all the physicians who’ve referred patients to me in the past.”

She checked over the notes she’d taken again. “All right, Mr. Hall. That all seems in order… now, before we go through the requirements of what you’ll need to do before the actual surgical appointment, we should probably make sure you have a good appointment slot as soon as possible. Can you do an evening appointment next Thursday?”

“...next Thursday?” Chris said, sounding astonished. “That soon?”

“That’s the day of the full moon,” Janice replied. “If we get everything out of the way today, then I don’t actually need to be able to speak during your surgical appointment… just to be able to bite you.”

She smiled, and this time it had a lupine cast to it. “Though I’m sure you’ll want to familiarize yourself with what I look like then anyway…”

[elexuscal]

Murderbot Diaries Book Summaries

The release of the 7th book in the Murderbot Diaries series, System Collapse, approaches in November!

I've seen at least one person looking for a summary of past events... So I've made just that! If it's been a while since you read previous books (or you just like hopping into series half-way through), this will get you up to speed!

That said, this absolutely has spoilers, so if that's not your jam, turn away now.

====

Short Story – Compulsory: A recently-rogue Murderbot decides on a whim to rescue a miner who falls into a ventilation shaft. We see its developing love of Sanctuary Moon and what is implied to be the first time it violated its orders to protect someone.

All Systems Red (ASR):

Murderbot is the contractually-obligated security guard on a survey of "surprisingly nice" scientists. Dr. Mensah particularly impresses Murderbot for her level head and kind nature. It turns out their survey is being sabotaged by the cut-throat corporation GreyCris, who don't want them uncovering alien remnants. Murderbot and the scientists go back-and-forth protecting one another. The survey team discover that it's rogue. After some initial tension, they accept it as a team-member. They escape GreyCris, although Murderbot nearly dies in the process. When it wakes up again, the scientists have bought/freed it. In the name of self-actualization, Murderbot runs away.

Artificial Condition (AC): Murderbot sets off to investigate Ganaka Pit, the facility where it supposedly killed a large number of its own clients. On the way, it discovers the spaceship it's travelling on actually dangerously hyper-intelligent. After some initial threats/tension, the two bond over TV. The Asshole Research Transport (ART) helps disguise Murderbot as a human. With ART's help, Murderbot uncovers that the mass death was a tragic accident caused by ComfortUnit malware. Posing as a human, the pair help rescue a trio of researchers and their data from their shitty ex-boss, and set a ComfortUnit free.

Rogue Protocol (RP):

On an impromptu quest to get blackmail on GreyCris for Dr. Mensah's ongoing legal battle, Murderbot investigates an abandoned terraforming facility. It meets a cheerful robot named Miki who immediately declares themselves friends. Miki is helping a human assessment team who become imperiled when they're attacked both by CombatBots and their own double-dealing human security. Murderbot reflectively rescues them, posing as a Definitely Normal SecUnit, although the team's leader clearly sees through that claim. Murderbot manages to collect the intel on GrayCris and protect the humans, but not before Miki performs a heroic sacrifice.

Exit Strategy (ES):

After discovering Dr. Mensah has been kidnapped by GreyCris, Murderbot rushes to save her. This forces it to re-unite with the other survey members; Pin-Lee, Ratthi, and Gurathin. While unsure of each other, the team manage to rescue their friend. Murderbot attempts a self-destructive last-stand against a CombatSecUnit, only for the humans to save its ass. The team escapes on a company gunship, but not before Murderbot melts its brain fighting off killware. When it rebuilds its systems, it decides to stay with its humans in the Preservation Alliance for a while.

Short Story - Home, Range, Niche, Territory:

Shortly after Exit Strategy, Dr. Mensah reflects on her time in captivity and her new friendship with SecUnit. Apparently she's been avoiding getting treatment for her extensive emotional trauma. She has a panic attack when she's cornered by a journalist, who's scared off by Murderbot.

Fugitive Telemetry (FT): A human is found dead. Murderbot is called in as a consultant on the case, in the hopes of building good will with Preservation Security. Eventually it manages to prove itself, particularly after it succeeds in a daring rescue of kidnapped corporate refugees. One of the refugees realises it's a SecUnit and shoots it. The dead human turns out to have been a liberator of indentured labourers, and the killer was actually the Port Authority robot Balin, who was secretly a disguised CombatBot acting on outside orders. The local bot community intervenes to stop Balin from hurting anyone else.

Network Effect (NE):

Murderbot is providing security for a Preservation Alliance survey which goes south when raiders attack and try to take Dr. Mensah's brother-in-law, Thiago, hostage. It then goes doubly south when, on the way home, the team's ship gets attacked by... ART?

It appears that ART has been deleted and its crew has gone missing, replaced with mysterious grey people. While protecting a team of its humans, including Dr. Mensah's teenage daughter Amena, Murderbot manages to reboot ART. ART kills the grey humans but refuses to let everyone go until and unless they help it retrieve its crew. Everyone reluctantly agrees, but Murderbot is pissed.

Eventually Murderbot and ART make up. Then they create a sort-of-baby in the form of a killware copy of Murderbot who dubs itself Murderbot 2.0. Half of ART's missing crew is found on a local planet's surface, though Murderbot is captured while helping them escape. Murderbot 2.0 manages to rescue the other half from a spaceship with the help of the newly freed SecUnit 3. The local colonists are discovered to have gone a liiiiitttle bit kooky due to infection via an alien fungus. ART threatens to bomb their colony to get Murderbot back. Murderbot gets infected, but Murderbot 2.0 does a self-sacrificial attack to save it and destroy the fungi's primary host. Meanwhile, the humans, ART, and SecUnit 3 work together to rescue Murderbot without any more bloodshed.

Murderbot has a bit of an epiphany that all its various friends do in fact love and care for it. When an understandably pissed and confused Dr. Mensah shows up like a month later, the groups decide on forming a mutual partnership. Murderbot tells Dr. Mensah that it would like to work with ART for a little while.

[hellodarling1357]

Hello! I saw that your requests are open (hopefully it wasn't a post from long ago) and I'd like yo ask if you could write something about what happens to Cassian and reader's relationship when his bond with Nesta snaps. Like reader and him were together for centuries and he has to make a very difficult decision, whether to reject the bond or accelt it. I read Drunk Words, Sober Thoughts and I loved it so I believe you could make a very good multi parts fic to this too. Much love ❤️

The Wrong Ones: Part 1 - Cassian x Reader

Do I have a million WIPs? Yes

Do I have another multi-chapter fic on the go? Also Yes

But I was going through my inbox and remembered this request from weeks ago and got super excited about an idea I had for it, so here we are...

Thank you so so so much @justdreamstars!! Sorry it's taken me this long to get it started

Enjoy 🥰

Word Count: 2.2k

You had first met Cassian on a battlefield during the early months of the war against the fae and the humans. Well, to be more precise, you had first met him in a sweltering healing tent, filled with the scent of blood and rot, on the sidelines of said battlefield.

Being no more than a few months past 26, you had been young, far too young to be forced to witness the horrors of war. But that could be said for the majority of the males you tended to throughout those seven years of hell.

You had felt underprepared when you first received the letter that your skills were required on the front line along with the others in your year. Having just passed the halfway mark of your training, your fear that you weren’t full equipped sent you into a panic induced spiral. You were quick to learn, however, that war didn’t require the precision of healing you were yet to be taught. Instead, it required someone with a strong stomach who new how to stop a body bleeding by whatever means possible.

The first soldier you tended to on your first day had died under your care. The shock of seeing his eyes turn blank and vacant had you momentarily retching up the little food left in your stomach. Your supervisor was quick to send you back to your tent, ordering you to pull yourself together then report back immediately. Although, in hindsight, you knew the soldier wouldn’t have made it through the night, your slow movements as you tried to perfectly stitch the wound together had cost you precious time. It was a mistake you never made again.

*****

“Oh fuck, incoming.” Teresa, one of your closest friends at the camp, yelled out as a mass of soldiers piled in through the entrance, supporting others who were either unconscious or unable to stand.

You slipped into a cool and calculating composure, keeping your mind clear of everything other than the injured males who were being led towards unoccupied beds.

“Right, how many do we have?” You asked, pulling your hair away from your face as you assessed the groans of pain and gruelling wounds. You had quickly moved up in the healing ranks, now being entrusted to oversee the ongoings of the tent whenever the main healers were absent.

“Fifteen. There were more but they have no chance, so we prioritised getting these ones here first.”

You fought down the anger at the commander’s words. They had no right in choosing who lived and died, who they could leave behind. But it wasn’t your place to question him and, as much as you hated to admit it, he was probably right in doing so.

You nodded your thanks before rushing over to the bed with the fewest healers around it.

“Damages?”

One of the healers listed off their observations and what they had done so far in terms of treatment as you looked over the unconscious male in front of you. He was Illyrian. Their unit had only recently been posted so you hadn’t had much experience when it came to healing wings. Luckily, or unlucky depending on how you looked at it, his wings seemed to be in okay shape.

“The swelling on his head seems to be the main source of trauma, it’s already starting to bruise—“

“That would also explain the unconsciousness with no evidence of significant blood loss.” Your fingers gently pressed against his skull. “Alright, if that’s it, Lessa can you look after him? Find me if there’s any changes or if… what the fuck?”

You had just taken a step back when you noticed the small pool of blood that was dripping from the bed. Leaping into action, you ripped away his shirt only to find a worryingly deep, albeit short, wound pressed along his ribs, quick to apply pressure as you barked for someone to bring you supplies.

“Why,” You asked, a sharpness to your tone, “was this not noticed earlier? Why did no one think that there could be injuries underneath his uniform?”

“Sorry,” One of the younger healers stammered, she had only been here for a week. “We… I… I didn’t know how to go about removing his shirt around his wings…”

You let out a sigh before taking in a deep breath as she trailed off as if just realising that now wasn’t the time or place to be concerned with properly undressing a patient.

“It’s fine, okay? You won’t do it again,” You let some softness edge into your voice, thinking back to your first day and the fatal mistakes you had made. “Go and take a break, alright? Grab some food and have a rest, I’ve got it from here.” You dismissed the other two healers, asking them to see if anyone else needed their help.

Easing your hand away from the wound, you quickly cleaned it before stitching and dressing it, reminding yourself to find the young healer when you were done for the day to check in on how she was going. After what was almost a colossal error, you checked over the soldier yourself for any other missed injuries or concerns and, thankfully, found none other than a few small scratches here and there.

The soldier remained unconscious, that being your biggest concern, but there was nothing else you could do for the moment so you moved along to the next patient, assisting where you could for the remainder of the day, but you kept finding yourself back to where the Illyrian soldier lay, checking over him again and again for any signs of change.

Night had finally fallen, and, with it, the fighting had stopped, at least for another day. Yet, as healers filtered out in search for a meal or their bed you remained behind, clearing up the tent, one eye fixed on the Illyrian soldier who was yet to stir.

“Y/N?” Teresa called out from the entrance of the tent. “You coming?”

“No, I want to wait a bit longer, see if he wakes up,” You motioned towards the soldier you sat beside as you prepped medical supplies in the momentary stillness. “We don’t know how he will be when he comes to, so I don’t want to leave him here by himself.”

Teresa knew there would be no arguing with you, instead, she gave you a small smile and promised to bring you some dinner which you gratefully ate half an hour later.

“Y/N?” A small voice called as you finished checking the injuries of one of the soldiers who had been brought in the day before.

“Hi, it’s Grace, right?” You asked the young healer from earlier. She gave you a meek nod, avoiding your gaze as she zeroed in on the soldier who still lay unconscious.

“Is he…?” She trailed off, her face pale as she anxiously twisted her hands together.

“Still no changes,” You knew better than to say he was going to be fine, there was no guarantee of anything anymore. “How are you feeling, Grace?” Your voice was gentle as you led her to one of the chairs pushed against the canvas of the tent, letting her collect herself as you went about making her a cup of tea.

She remained silent until the steaming mug was pressed into her hands, “I’m… I’m hopeless at this. I thought I could do it, my whole life all I’ve wanted to do is help people, but now I just… I can’t even do a basic thing like check over a patient.”

Tears filled her eyes, as she stared down at the floor.

“Grace?” You grasped one of her shaking hands, making her look up at you with a comforting squeeze before saying, “You’re not hopeless. You were thrown into this without the proper training, we all were. But what we all need to do now is the best we can and to learn from our mistakes, because we’re going to make them, regardless of if there’s a war going on or not, okay?”

She offered you a small, watery smile, “You don’t though. Make mistakes that is. You’re only three years older than me and you’re already one of the most respected healers here.”

Taking a sip from your own mug, you gave Grace a small smile of your own. “I make mistakes every day, we all do. But the longer you’re here, the faster you get at correcting them. All it is is practice. Besides, my first day here? My very first patient? He died on my watch, and it was because of a stupid mistake, alright? So it happens to everyone, don’t beat yourself up over today.”

“Really? But… What did you do?” Your stomach coiled at the memory, the guilt never truly leaving. But her wide eyes had you pushing that down.

“I was trying to impress my supervisor by showing off the perfect stitch. He died from blood loss that could have easily been avoided if I had acted faster and not let my ego get in the way.”

“Oh.”

“We all make mistakes; we just need to learn from them. Now it’s late, so go get some rest.” She bid you goodnight, leaving you in the silence of the tent.

You walked back over to the Illyrian soldier, pulling aside the bandages to check over the wound to his ribs.

“I’m not too sure if I want you looking over them. Doesn’t sound like you have much luck with stitches.” You jumped at the deep rasp of the male’s voice, assuming that he had still been unconscious by how still his body was.

You tore your eyes up to his face and found the most stunning shade of hazel staring back at you.

“You… you’re awake.” All your training and bed manner seemed to fly out the window as his lips pulled into a teasing smile. He adjusted slightly, the pain that took over his features had you jumping into action.

“You’re okay. Where does it hurt?” Your fingers gently prodded at the bruising around his temple, noting the swelling had already started to go down. You brushed back his hair to get a better look at the injury as you waited for him to answer.

“No where when you do that,” You quizzically looked at him, wondering if there had been some sort of brain damage from the evident blow he had received, but he continued talking, “Honestly, the feel of your fingers running through my hair might just be worth the throbbing against my ribs.”

You ignored his quip, focusing on the, very limited, information he gave you.

His ribs. Fine. At least you knew what was causing him the most pain.

Moving so you were by his ribs again, you gently pressed around the area of the wound, watching his face for any sort of reaction.

“Does it feel like something could be lodged in there? Or is it just the wound itself?”

“It’s fine, just hurt a little bit when I moved,” His nonchalant act didn’t fool you as you prodded again, causing a flicker of discomfort to flash across his face. “Okay, yep, right there. Fuck that’s painful.”

You gave him an apologetic smile as you assessed the wound further.

“Sorry. You may have some bruised ribs; I don’t think they’re broken though. I’m going to dress the wound then wrap everything up to keep it in place, alright? I’ll let you get some sleep and then I’ll check in on you again in the morning.”

The Illyrian soldier grimaced but made not fuss like you had experienced with some of the other soldiers. Just as you were finishing wrapping the bandages he asked, “What’s your name?”

“I’m Y/N,” You offered another tight, apologetic smile as you pulled on the bandages to ensure they were tightly secured before tying them off, his slight hiss of pain was the only sign he gave that it had hurt.

“Sorry.” You repeated.

“Don’t worry about it,” You cautiously watched as he adjusted himself into a more comfortable position. Shutting his eyes for a moment as the pain settled before opening them to stare right at.

“It’s nice to meet you, Y/N,” A charming smile spread across his features as his hazel eyes remained fixed on you, causing your heart to falter in your chest.

“I’m Cassian.”

*****

Let me know what you think!

And, as always, my inbox is open for requests so please send them my way 🥰

[noirandchocolate]

RICE Alzheimer's Research Institute

Terry died on 12 March 2015, having given his PCA a run for its money.  Open about his diagnosis, he has helped to unlock the secrecy and stigma that often surrounds dementia.  His legion of fans is undoubtedly grateful that despite the inevitable progression of the PCA he was able to fight his ‘embuggerance’ and continue to produce a number of both well-received and well-reviewed books.  Terry was also a great example to me in emphasizing how important it is that, in caring for people with any type of dementia, we always look for what people with a condition like PCA can still do, rather than what they can’t: by maximizing what is possible, a person can still live well with dementia for a significant time.

--Professor Roy Jones, Director of RICE (taken from “Terry Pratchett: His World”)

I wanted to post something for the Glorious 25th about the Research Institute for the Care of Older People (RICE) in Bath, where Sir Terry Pratchett received treatment for Post-Cortical Atrophy, the type of Alzheimer's disease that eventually took his life. From the organization's website:

RICE established one of the first memory clinic services in the UK in 1987 – a service which has since been widely replicated and is now considered standard and best practice by the NHS. In fact, RICE now runs the NHS Memory Clinic in Bath and North East Somerset on behalf of the local clinical commissioning group and local authority through a sub-contract with HCRG Care Group. To date, we’ve assessed, diagnosed, treated and advised 12,000 people with memory problems and their families in our memory clinic. 

Most of RICE’s clinical services and research activities take place in our own purpose built, specialist centre located on the Royal United Hospital site. The building of the RICE Centre was possible as a result of generous donations from major donors, trusts and foundations, and members of the public. RICE moved into the ground and first floor of the centre in 2008. Following the success of the DementiaPlus Appeal and further generous donations from major donors, trusts and foundations and members of the public, RICE converted the attic floor in 2019 to create more office space. This has given us access to much needed additional rooms and offices which will enable us to grow and run more services and activities. We’ve worked hard to ensure that the areas of the centre visited by our patients meets their needs and we regularly receive feedback on how much our patients enjoy their visit to our centre.

RICE not only provides clinical services to patients, but also conducts research into aging and dementia, including performing clinical trials for new drug treatments for memory-related diseases and developing other "techniques for diagnosing, managing, treating and understanding dementia and memory changes in older adults."

Lady Lyn Pratchett is the patron of the organization, and the website includes a page about how people can donate funds or volunteer at the clinic and participate in fundraising events.

SO, if you'd like to help fund Alzheimer's research on this Glorious 25th of May--or at any time--in honor of the Man in the Hat, take a look!

[cassiiia]

AP Psychology notes + Resources and stuff

notes + flashcards that I used 2 study (not all my resources, found online)

Notes

Summary of every unit (16 pages)

A longer summary of every unit (53 pages)

Knowt AP Psych Guide

Doc for Notes

Unit 1 Notes - Intro to Psychology

Unit 2 Notes - Biological Psychology

Consciousness/Drugs Notes

Unit 3 Notes - Sensation/Perception

Unit 4 Notes - Learning

Unit 5 Notes - Cognitive

Intelligence Notes

Unit 6 - Developmental Psychology

Unit 7 - Motivation/Emotion/Stress

Personality Notes

Unit 8 - Disorders

Clinical Treatment Notes

Unit 9 - Social Psychology Notes

Flashcards

Quizlets

Important People

Domains of Psychology

Terms

Experiments

Knowt

AP Psychology Ultimate Guide

AMSCO AP Psych Chapters

Ch. 1 - Intro to Psychology

Ch. 2 - Research Methods

Ch. 3 - Statistics

Ch. 4 - Understanding the Brain: Its Structures and Functions

Ch. 5 - Neurons, Neural Communication, and Behavioral Genetics

Ch. 7 - Perception

Ch. 13 - Motivation

Ch. 15 - Infancy and Childhood

Ch. 16 - Adolescence and Adulthood

Ch. 17 - Personality Theories, Approaches, and Assessment

Ch. 20 + 21 - Abnormal Behavior

Ch. 22 + 23 - Treatment of Abnormal Behavior

Ch. 24 + 25 - Social Psychology

Websites

Fiveable Study Guides for each unit

Youtube - Tim Steadman

Youtube - The School of Ireland

Youtube - Crash Course Playlist - Psychology Playlist

Youtube - Mandy Rice

Youtube - College Board - AP Psychology Playlist

Youtube - Social Science Simplified

AP Psychology Reddit

Other Tumblr blogs with more resources!

@ap-psych-ology

@nuroscience

[itsawritblr]

The Courage to Follow the Evidence on Transgender Care.

(WOW, the New York Times -- which a couple years ago had an ad about a qu**r girl who wished for a world in which J.K. Rowling wasn't the author of Harry Potter -- has published yet another opinion piece about trans, this one about the Cass Review. Personally, I think he's too lenient, but at least he's bringing attention to the review to Americans. )

(For those who can't read the NYT page, here's the text.)

Opinion, David Brooks, April 18, 2024.

Hilary Cass is the kind of hero the world needs today. She has entered one of the most toxic debates in our culture: how the medical community should respond to the growing numbers of young people who seek gender transition through medical treatments, including puberty blockers and hormone therapies. This month, after more than three years of research, Cass, a pediatrician, produced a report, commissioned by the National Health Service in England, that is remarkable for its empathy for people on all sides of this issue, for its humility in the face of complex social trends we don’t understand and for its intellectual integrity as we try to figure out which treatments actually work to serve those patients who are in distress. With incredible courage, she shows that careful scholarship can cut through debates that have been marked by vituperation and intimidation and possibly reset them on more rational grounds.

Cass, a past president of Britain’s Royal College of Pediatrics and Child Health, is clear about the mission of her report: “This review is not about defining what it means to be trans, nor is it about undermining the validity of trans identities, challenging the right of people to express themselves or rolling back on people’s rights to health care. It is about what the health care approach should be, and how best to help the growing number of children and young people who are looking for support from the N.H.S. in relation to their gender identity.”

This issue begins with a mystery. For reasons that are not clear, the number of adolescents who have sought to medically change their sex has been skyrocketing in recent years, though the overall number remains very small. For reasons that are also not clear, adolescents who were assigned female at birth are driving this trend, whereas before the late 2000s, it was mostly adolescents who were assigned male at birth who sought these treatments.

Doctors and researchers have proposed various theories to try to explain these trends. One is that greater social acceptance of trans people has enabled people to seek these therapies. Another is that teenagers are being influenced by the popularity of searching and experimenting around identity. A third is that the rise of teen mental health issues may be contributing to gender dysphoria. In her report, Cass is skeptical of broad generalizations in the absence of clear evidence; these are individual children and adolescents who take their own routes to who they are.

Some activists and medical practitioners on the left have come to see the surge in requests for medical transitioning as a piece of the new civil rights issue of our time — offering recognition to people of all gender identities. Transition through medical interventions was embraced by providers in the United States and Europe after a pair of small Dutch studies showed that such treatment improved patients’ well-being. But a 2022 Reuters investigation found that some American clinics were quite aggressive with treatment: None of the 18 U.S. clinics that Reuters looked at performed long assessments on their patients, and some prescribed puberty blockers on the first visit.

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Unfortunately, some researchers who questioned the Dutch approach were viciously attacked. This year, Sallie Baxendale, a professor of clinical neuropsychology at the University College London, published a review of studies looking at the impact of puberty blockers on brain development and concluded that “critical questions” about the therapy remain unanswered. She was immediately attacked. She recently told The Guardian, “I’ve been accused of being an anti-trans activist, and that now comes up on Google and is never going to go away.”

As Cass writes in her report, “The toxicity of the debate is exceptional.” She continues, “There are few other areas of health care where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behavior.”

Cass focused on Britain, but her description of the intellectual and political climate is just as applicable to the U.S., where brutality on the left has been matched by brutality on the right, with crude legislation that doesn’t acknowledge the well-being of the young people in question. In 24 states Republicans have passed laws banning these therapies, sometimes threatening doctors with prison time if they prescribe the treatment they think is best for their patients.

The battle lines on this issue are an extreme case, but they are not unfamiliar. On issue after issue, zealous minorities bully and intimidate the reasonable majority. Often, those who see nuance decide it’s best to just keep their heads down. The rage-filled minority rules.

Cass showed enormous courage in walking into this maelstrom. She did it in the face of practitioners who refused to cooperate and thus denied her information that could have helped inform her report. As an editorial in The BMJ puts it, “Despite encouragement from N.H.S. England,” the “necessary cooperation” was not forthcoming. “Professionals withholding data from a national inquiry seems hard to imagine, but it is what happened.”

Cass’s report does not contain even a hint of rancor, just a generous open-mindedness and empathy for all involved. Time and again in her report, she returns to the young people and the parents directly involved, on all sides of the issue. She clearly spent a lot of time meeting with them. She writes, “One of the great pleasures of the review has been getting to meet and talk to so many interesting people.”

The report’s greatest strength is its epistemic humility. Cass is continually asking, “What do we really know?” She is carefully examining the various studies — which are high quality, which are not. She is down in the academic weeds.

She notes that the quality of the research in this field is poor. The current treatments are “built on shaky foundations,” she writes in The BMJ. Practitioners have raced ahead with therapies when we don’t know what the effects will be. As Cass tells The BMJ, “I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood.”

She writes in her report, “The option to provide masculinizing/feminizing hormones from age 16 is available, but the review would recommend extreme caution.” She does not issue a blanket, one-size-fits-all recommendation, but her core conclusion is this: “For most young people, a medical pathway will not be the best way to manage their gender-related distress.” She realizes that this conclusion will not please many of the young people she has come to know, but this is where the evidence has taken her.

You can agree or disagree with this or that part of the report, and maybe the evidence will look different in 10 years, but I ask you to examine the integrity with which Cass did her work in such a treacherous environment.

In 1877 a British philosopher and mathematician named William Kingdon Clifford published an essay called “The Ethics of Belief.” In it he argued that if a shipowner ignored evidence that his craft had problems and sent the ship to sea having convinced himself it was safe, then of course we would blame him if the ship went down and all aboard were lost. To have a belief is to bear responsibility, and one thus has a moral responsibility to dig arduously into the evidence, avoid ideological thinking and take into account self-serving biases. “It is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence,” Clifford wrote. A belief, he continued, is a public possession. If too many people believe things without evidence, “the danger to society is not merely that it should believe wrong things, though that is great enough; but that it should become credulous, and lose the habit of testing things and inquiring into them; for then it must sink back into savagery.”

Since the Trump years, this habit of not consulting the evidence has become the underlying crisis in so many realms. People segregate into intellectually cohesive teams, which are always dumber than intellectually diverse teams. Issues are settled by intimidation, not evidence. Our natural human tendency is to be too confident in our knowledge, too quick to ignore contrary evidence. But these days it has become acceptable to luxuriate in those epistemic shortcomings, not to struggle against them. See, for example, the modern Republican Party.

Recently it’s been encouraging to see cases in which the evidence has won out. Many universities have acknowledged that the SAT is a better predictor of college success than high school grades and have reinstated it. Some corporations have come to understand that while diversity, equity and inclusion are essential goals, the current programs often empirically fail to serve those goals and need to be reformed. I’m hoping that Hilary Cass is modeling a kind of behavior that will be replicated across academia, in the other professions and across the body politic more generally and thus save us from spiraling into an epistemological doom loop.

[covid-safer-hotties]

Also preserved in our archive (Daily updates!)

There've been a lot of studies showing vitamin D deficiency in people with mild to severe covid cases. A new meta-analysis probes into the possible connections and effects of vitamin D during acute covid infections.

By Dr. Liji Thomas, MD

New study suggests vitamin D supplementation may lower ICU and intubation rates in COVID-19 patients, with greater benefits seen in older and severe cases.

The impact of vitamin D on the progression of COVID-19 remains uncertain. A recent meta-analysis in Nutrients reviewed studies on vitamin D supplementation in COVID-19 patients to assess its effectiveness in reducing disease severity across various health metrics.

Why is vitamin D important? Vitamin D is essential for bone health, but its influence extends far beyond, as its receptor is present in all nucleated human cells. This receptor regulates nearly 4% of human genes, impacting many physiological processes, including cancer development, muscle function, cardiovascular health, glucose balance, and immune response to infections and autoimmune reactions.

With the onset of the SARS-CoV-2 pandemic, there was significant interest in whether vitamin D could reduce the severity or spread of COVID-19. Vitamin D plays a role in immunity by lowering the release of pro-inflammatory cytokines, boosting antimicrobial peptides, supporting epithelial barriers, and modulating T-cell activity—mechanisms that may help prevent the severe hyperinflammation associated with critical COVID-19 cases and high mortality.

This study investigates the protective effects of vitamin D supplementation during COVID-19, used alongside standard treatments like glucocorticoids, anticoagulants, and antivirals, as recommended in current care guidelines.

About the study The researchers included 21 randomized controlled trials (RCTs) and eight analytical studies in the meta-analysis. Of these, mortality rates were examined in 19 RCTs and seven analytical studies, intensive care unit (ICU) admissions in 14 and five, respectively, intubation rates in nine and three, respectively, and the length of hospital stay (LOS) only in RCTs.

Vitamin D dosage varied considerably between studies, both in intervention and control groups.

Vitamin D and ICU admissions In the randomized controlled trials (RCTs), vitamin D supplementation demonstrated a stronger protective effect at higher doses compared to lower doses. Specifically, higher doses were associated with a 63% reduction in ICU admission rates compared to lower doses.

ICU admissions decreased by 57% among patients aged 65 or older and by 44% among those under 65. Patients with severe disease did not show a significant response to vitamin D, while those with non-severe disease experienced 33% fewer ICU admissions.

Intubation rates Intubation rates fell by 50% in RCTs. The lack of effect in analytical studies may have been because they were carried out only in non-severe older COVID-19 patients and were limited in number.

The tendency towards significance strengthens the hypothesis of the benefit of vitamin D in reducing the need for intubation during COVID-19.

Mortality rates Mortality rates showed significant differences in the vitamin D supplementation group but only in analytical studies, with a fall of 55%. This might indicate a tendency to bias in analytical studies.

Despite the overall lack of significance, age-stratified analysis of the RCTs showed a 42% reduction in mortality in older patients but not those <65 years. The authors suggested that the overall analysis might have failed to reveal these more granular effects.

Another interesting effect was that vitamin D supplementation had a more marked mortality-reducing impact in the early months of the pandemic, up to May 2020, than later on.

Finally, the most ill patients had a 50% mortality reduction benefit, but not the less severely ill patients. Thus, mortality analyses in the RCTs present a complex picture, with significant protective effects observable in some subgroups but not in the overall analysis.

LOS Among non-severe COVID-19 patients, vitamin D supplementation was associated with a -0.95-day difference in hospital length of stay. Potential benefits could exist in other groups, but this awaits validation from future research.

The variations between studies should be interpreted as accounting for the forms of vitamin D in use, such as calcifediol or cholecalciferol.

The latter is faster-acting than the former, which may make a difference in acute severe COVID-19, especially as evidence indicates that active vitamin D is used up in the acute response to the infection.

However, broad differences were noted across the studies, including baseline vitamin D levels, dosages, and duration of symptoms before vitamin D supplementation. Still, the findings agree with some previous analyses, with a more nuanced conclusion.

Conclusions The findings do indicate that vitamin D supplementation could be of benefit in COVID-19 treatment, reducing ICU admissions, mortality, and intubation requirements. All studies showed fewer ICU admissions in the intervention group.

“The differing effects based on age, disease severity, and possibly baseline vitamin D status highlight the need for a nuanced approach to vitamin D supplementation in COVID-19 management.”

The greatest effect seems to be in reducing ICU admissions. Still, with differences in the evidence across various patient subgroups and for different outcomes, there is a need for larger trials with a better design that adjusts for baseline vitamin D levels and uses standardized dosages and regimens, as well as compensating for patient characteristics.

Journal reference: Sartini, M., Puente, F. D., Carbone, A., et al. (2024). The Effect of Vitamin D Supplementation Post COVID-19 Infection and Related Outcomes: A Systematic Review and Meta-Analysis. Nutrients. doi: doi.org/10.3390/nu16223794. www.mdpi.com/2072-6643/16/22/3794.