#Case Report

[emgoesmed]

5/3/2023

I’m studying before clinic this morning at this cute cafe I found. Then I’ll go to my school’s poster session this afternoon. A solid Thursday schedule ☺️

[solar-nexus-space-station]

Case Report: Nia Veyren

Case Worker: Estella Saaller

Client Name: Nia Veyren

Species: Zyrrhan

Age: 20 Zyrrhan cycles; Approx. 10 Earth Years old.

Client Complaints: Nia reports experiencing a Harmonic Drift, evidenced by an inconsistent bioluminescent glow. Case Worker Observations: Nia is alert and presents well. She is dressed appropriately for this visit. Bioluminescence behaves erratically, showing signs of harmonic drift and resonance destabilization.

Assessment: Nia appears to be suffering from Harmonic Drift and Resonance Destabilization, likely due to being cut off from Zyrrhan resonance for over a year.

Plan: Nia will be placed in my sanctuary among three other Lysari and two other adult Zyrrhans. The caseworker will conduct resonance therapies with Nia for an hour daily to assist in restabilization. The following assessment will be performed one week from today's date.

[indigo6f00ff]

need to share an experience i had 30 minutes ago

(edit: thanks to @walks-the-ages for providing and reminding me to put alt text, sorry it slips my mind alot lol)

[marvelsmostwanted]

Today in 🍂✨October surprises✨🍂

• Secretary of Transportation Pete Buttigieg and Secretary of Labor Julie Su quietly assisted in winning labor rights for dockworkers, ending a strike that could have had catastrophic economic consequences. (10-4-24)

• In Springfield, Ohio, where Haitian migrants have been blamed for the disappearance of local animals with Trump claiming “‘migrants are walking off’ with geese in the town” and “they’re eating the dogs” - a lie also promoted by JD Vance, Ohio’s own sitting Senator, with no evidence - it turns out that the missing geese were actually the victims of a 64-year-old white man who was hunting illegally. (10-3-24)

• A Trump-appointed federal judge blocked Biden’s student loan forgiveness plan again after another judge reinstated it earlier this week. (10-3-24)

• Republicans and crazy Facebook uncles everywhere have spent this week spreading disinformation about the FEMA response to Hurricane Helene, including AI photos of Trump standing in floodwater and wild claims that Biden is sending money to undocumented immigrants. In reality, the Biden-Harris administration has provided substantial emergency assistance and both Biden and Harris have visited the region. Meanwhile, it turns out that Trump was the one who redirected money from disaster relief to send to ICE during his presidency. Shocker. (10-4-24)

• Seriously, though, Trump is not who you want to call in an emergency. Before allowing disaster relief to reach victims of wildfires in California, then-president Trump forced aides to show him an electoral map to see if he had voters there. He evidently intended to withhold the aid if he found out it was going to mostly Democratic voters. This would be a career-ending scandal in any other political era but alas, we are living in this one. (10-3-24)

• Finally, far-right extremist and Oklahoma superintendent of schools Ryan Walters intends to put Bibles in public schools, which is already disturbing, but in a stunning display of corruption, the only ones that meet his specifications are the so-called “Trump Bibles” that include the Constitution and Declaration of Independence. They go for $60 apiece and Trump gets fees from each one. (10-4-24)

No, wait, I’m going to say that one again:

In Oklahoma, taxpayers’ money will be used to put Trump Bibles in public schools. Their money will go directly to Trump. Not a joke!!! Not an exaggeration!!!

…Surely the voters who are still undecided are lying, right?? Right?!

30 days until Election Day.

Go to vote.org for a sample ballot, early voting dates, and more. Seriously, we have to win.

[ikiprian]

Mr. Fenton is a competent teacher. Almost too competent.

If Mr. Daniel Fenton had any more than a BS (with a minor in education), Tim would’ve flagged his profile as a potential Rogue. That’s the way of most charismatic academics, at least in Gotham. (Got a PhD? Instant watchlist.) Instead, he’s Gotham Academy’s newest celebrity, as a young, passionate, out-of-towner substitute while the chemistry teacher’s on maternity leave.

Tim gets the hype. Fenton seems to genuinely love teaching, and is invested in the welfare of the student body. He hands out bananas during exam week, hosts a “study habits seminar” each month to coach effective learning strategies, and the third time Tim falls asleep in his class, he even pulls Tim aside to ask if he’s doing okay. With all the late work he accepts and the protein bars he sneaks Tim, he’s every teen vigilante’s dream teacher. He could’ve been Tim’s favorite.

In fact, Mr. Fenton was Tim’s favorite. Up until Tim walks into Mr. Fenton’s chemistry classroom for a forgotten textbook, an hour after the final bell.

On the board where tallied scores for today’s review game had been kept, “THE CHEMISTRY BEHIND DR. CRANE’S FEAR GAS: ANXIOGENICS, NERI’S, & YOU,” is now scrawled. A detailed diagram of the human endocrine system projects in front of a small crowd of adoring and attentive students.

Fenton is wrist-deep in the skull cavity of an anatomical model. A short tug, and out pops the brain.

It’s plastic. It’s fake.

Tim identifies the nearest emergency exit.

Fenton turns to the door, and in the dark classroom with the projector illuminating half his face, his eyes almost seem to flash red. “What’s up, Tim?” he asks. His friendly grin is too big for his face. “I didn’t know you wanted to join the Just Science League!”

[OR: Danny’s a science teacher at Tim’s school. Gotham’s a pretty wild place, even for someone who grew up a superhero in a ghost-infested town, so he takes it upon himself to start a club teaching kids how to manage themselves in the event of a crisis. These Gothamites are pretty hardy, but a little extra training never hurt anybody! And he suspects one of his students might be a teen vigilante, like he’d been, back in the day. As a senior super, it's Danny’s duty look out for him! Surely, this is the subtlest and most appropriate way to give the kid pointers.]

[Tim immediately assumes supervillain.]

[forgettable-au]

END OF CHAPTER ONE

FORGETTABLE-AU (Page 65-72)

* Time to put this puzzle together.

[BEGINNING] [PREVIOUS] [CONTINUE]

[ijcimr]

Combined cervical laceration and bladder rupture: a case report of an unusual complication of precipitated labor by Dr Fatemeh Darsareh in International Journal of Clinical Images and Medical Reviews 

Abstract

Cases of bladder rupture have been rarely reported following vaginal childbirth. To the best of our knowledge, however, no cases of combined cervical laceration and bladder rupture have been reported to date. We present the first case of a 31-year-old woman with gestational diabetes who suffered a combined cervical laceration and bladder rupture after childbirth. Precipitated labor caused by oxytocin induction resulted in vaginal and cervical lacerations. The bladder rupture was confirmed by cystography. A team of obstetricians and urologists performed the laparotomy. The patient was kept under observation for two weeks before being discharged with no serious complications.

Keywords: Bladder rupture; Cervical lacerations; Precipitated labor; Childbirth trauma; Case report.

Introduction

Spontaneous bladder rupture following normal vaginal delivery is a surgical postpartum emergency. Previous cesarean section, vacuum/forceps-assisted vaginal deliveries, and distended bladder compressed by engaged head in birth canal are all risk factors for bladder injuries in healthy parturient women 1. Cases of bladder rupture, accompanied by uterine rupture, have been rarely reported following vaginal birth after cesarean section 2. To the best of our knowledge, however, no cases of combined cervical laceration and bladder rupture have been reported to date. We present the first case of spontaneous bladder rupture with cervical laceration after a precipitated vaginal delivery.

Case Presentation

A 31-year-old, G2P1L0D1, woman with gestational diabetes, was admitted to our maternity ward at 38 weeks of pregnancy for elective induction of labor to terminate her pregnancy.  She had a history of preterm birth and was a known case of minor thalassemia. The induction of labor began at 5:00 a.m. with oxytocin, and contractions began approximately two hours later. Table 1 depicts the progress of labor. During her labor, the patient urinated once. Finally, at 10:40 a.m., she gave birth to a baby boy weighing 3700 grams with an Apgar score of 7/9.  Excessive vaginal bleeding was observed following placental expulsion. The examination revealed an extensive laceration in the vagina and cervix that was repaired by the obstetrician and midwife. The patient was catheterized and was being closely monitored. A urologist was consulted due to the oliguria and hematuria (100 cc output with gross hematuria within 5 hours of childbirth). Cystography, as recommended by the urologist, revealed the bladder rupture. The patient was prepared for a laparotomy immediately. The laparotomy was performed by a team of obstetricians and urologists. Several hematomas were discovered in the uterine body and the broad ligament that the team decided not to manipulate because it did not grow during the surgery. A bladder rupture was found at the dome of bladder that was repaired in two layers. One pack cell unit and two FFP units were transfused. A peritoneal drain was placed posterior to the bladder and the skin incision was closed in layers. The patient was observed for two weeks. The result of the ultrasound revealed the shrinking of the hematoma. The blood and renal tests were normal. The catheter was removed after 2 weeks and the patient was discharged.

Table 1: The progress of labor

Discussion

Precipitate labor is defined as the expulsion of the fetus within three hours of the start of contractions. Few studies have found that precipitated labor is harmful to both the mother and the newborn. Precipitated labor, which is most commonly associated with placental abruption and induction of labor, is a significant risk factor for maternal complications 3. Maternal morbidities reported included extensive birth canal lacerations, uterine rupture, placenta retention, the need for revision of uterine cavity, post-partum hemorrhage, and blood transfusions 3,4. The lower urinary tract's anatomic proximity to the reproductive tract predisposes it to iatrogenic injury during obstetric procedures. The bladder and lower ureter are two of the most commonly involved organs. Because the dome of the bladder is the weakest area, most bladder ruptures occur through the peritoneal cavity 5. In our case, in addition to deep vaginal tears and extensive cervical laceration, bladder rupture occurred, but the diagnosis was delayed by a few hours. Given the nonspecific clinical features of bladder rupture, the diagnosis should be approached with caution. Oliguria and gross hematuria after a traumatic childbirth increase the likelihood of bladder rupture. In such cases, a cystogram is thought to be the best method for early detection.

In our case the patient had induced labour with oxytocin. The use of oxytocin to induce labour can result in tachy-systole and thus shorter deliveries. So in our case we believe that the power of uterine contractions and quick descent of passenger (3700 grams fetus) were the main risk factors of precipitated labour and the complications accompanied with it. A distended bladder during labor, particularly in our case, where the fetus descended quickly, could also be a factor in bladder rupture. Although the patient urinated normally during labor, it was critical to ensure that the bladder was empty, especially during the active phase of labor, to avoid bladder damage.

CONCLUSIONS

Bladder and cervical rupture should be considered, after precipitated vaginal delivery. When there is gross hematuria, a urinary catheter should be inserted to monitor the hematuria and urine output. If the hematuria persists and other associated symptoms appear, cystography is a useful tool for determining the severity of the bladder injury and determining the cause.

Funding

This study received no specific funding from public, commercial, or not-for-profit funding agencies.

Conflict of Interest

Authors had no conflicts of interest to declare.

Patient consent

Obtained.

For more details: https://ijcimr.org/editorial-board/ 

[jack-abbot]

SAMIRA MOHAN & EMERY WALSH in The Pitt 1x13 — "7:00 PM" // 1x14 — "8:00 PM"

[wishfulsketching]

Mind yo own business, Harvey!

(are those open-plan cells really the best idea?)

[carriesthewind]

"Reviewers told the report’s authors that AI summaries often missed emphasis, nuance and context; included incorrect information or missed relevant information; and sometimes focused on auxiliary points or introduced irrelevant information. Three of the five reviewers said they guessed that they were reviewing AI content.

The reviewers’ overall feedback was that they felt AI summaries may be counterproductive and create further work because of the need to fact-check and refer to original submissions which communicated the message better and more concisely."

Fascinating (the full report is linked in the article). I've seen this kind of summarization being touted as a potential use of LLMs that's given a lot more credibility than more generative prompts. But a major theme of the assessors was that the LLM summaries missed nuance and context that made them effectively useless as summaries. (ex: “The summary does not highlight [FIRM]’s central point…”)

The report emphasizes that better prompting can produce better results, and that new models are likely to improve the capabilities, but I must admit serious skepticism. To put it bluntly, I've seen enough law students try to summarize court rulings to say with confidence that in order to reliably summarize something, you must understand it. A clever reader who is good at pattern recognition can often put together a good-enough summary without really understanding the case, just by skimming the case and grabbing and repeating the bits that look important. And this will work...a lot of the time. Until it really, really doesn't. And those cases where the skim-and-grab method won't work aren't obvious from the outside. And I just don't see a path forward right now for the LLMs to do anything other than skim-and-grab.

Moreover, something that isn't even mentioned in the test is the absence of possibility of follow up. If a human has summarized a document for me and I don't understand something, I can go to the human and say, "hey, what's up with this?" It may be faster and easier than reading the original doc myself, or they can point me to the place in the doc that lead them to a conclusion, or I can even expand my understanding by seeing an interpretation that isn't intuitive to me. I can't do that with an LLM. And again, I can't really see a path forward no matter how advanced the programing is, because the LLM can't actually think.

[currentlyjaywalking]

So you can use the Historama to see anything any where any time?

JL Member: It was so embarrassing, Cap. I had to wipe all the security footage after just to make sure it wouldn’t end up in some compilation online. You promise you won’t tell anyone, right?

Marvel: Oh yeah, of course. Secret is safe with me.

Later:

[hoofpeet]

Our ex landlord owes us 3 times the security deposit we paid him lmaooooo get FUCKED💥💥💥💥💥💥💥💥💥💥💥💥💥

[astralzeraphias]

“he was mentally ill. this monster was a- was a sick fantasy. a product of his dementia.”

“…i saw it too. does that make me disturbed? demented? does… that make me sick too?”

[phierecycled]

i just read an article and apparently jonathan kaplan (who played jason in the falsettos obc and was 11 at the time), watched his voice teacher who helped him through the show's auditions decline and eventually die from aids related illness during the show's previews.

in this same article michael rupert mentioned how there would be patients who came and saw the show and would go to the stage door just to be near the performers and tell them how much the story meant to them.

one day, heather macrae (charlotte) attended the funeral of her friend paul jabra and immediately after went straight to the theatre to perform in the evening show.

stephen bogardus recalls leaving the theatre and walking through the audience (about 15 minutes after the show had finished) and people would still be there holding each other.

[lightgamble]

DAREDEVIL | 1.01

Our practice is relatively young, Miss Page, and we are aggressively pursing new clientele.

[thebroccolination]

THE EX-MORNING WILL HAVE "A LOT OF LOVE SCENES," ALL DESIGNED BY KRISTSINGTO

[Thank you again, @ysphcpb, both for your translation and your help locating a video source that allows subs! And also for your gifs and your general presence. <3]

[full unsubbed interview on youtube]

Transcript:

Ex-Morning director Lit explains that he gave Krist and Singto the freedom to design and modify their own love scenes, which flowed well without him having to give them any direction.

Krist: I mean, we're all grown up now, right? Honestly, I find it enjoyable when we discuss what we'll do in a love scene. Also, we might feel bored with the same old things we've done before, so we might want to put in some new things. So we had a blast designing [the love scenes].

Singto: There's so many. I mean, there are a lot of love scenes. [laughs]

Krist: I'm worried that there might be too many, and the fans might not like that~ [teasing]

Singto: But the two of us still do the same thing. Even during our SOTUS days, we would design love scenes and other scenes, reasonably. This time, both of us also design our own scenes, reasonably. So please stay tuned, and try to figure out which scenes Kit designed and which I designed.

Krist: It's gonna be something new that no one has never seen before, when it comes to love scenes between me and P'Sing. [turns to Lit] Right, P'Lit?

Lit: Right, right.

Krist: There hasn't been any of that before now.

Lit: Let's just say, they really redesigned [the scenes].

Krist: Please look forward to that. [laughs]

Lit: I also secretly screamed (t/n: in a shipper way) while watching the monitor. So many. I have to say, there really are a lot of love scenes.

Krist & Singto: Many. Many scenes.