#calling them people who basically use patients as experiments to test if such and such cure works or not

[grison-in-space]

"that ability to just modify your perspective and step into the context someone else is wrestling with and listen, that's such an upsettingly rare skill for knowledge workers and healthcare workers... if you ask people why they're struggling, you can fix it and build a better process!"

You might be interested to know that when I was in pharmacy school, those patient interviewing skills mentioned by you and clockworkcrow in that reblog chain about provider burnout were taught to us as a set of techniques known as "motivational interviewing." It's not really in the scope of the personal vs systemic interventions that that reblog chain is about, but one of the revelational takeaways that I got from learning them was the idea that the healthcare provider cannot assume that their goals for care line up with the patient's; sometimes, the patient really doesn't care about the treatment or its outcomes because they have different goals of care in mind, and eliciting those goals during interviewing (because a lot of the time people are not at all articulate about what they want out of life) is a kind of ongoing step one.

I'm also curious if you or the MDs in this discussion have ever encountered ambulatory care pharmacists practicing the approaches that clockworkcrow talks about? I ask because listening to patients, identifying patient-specific blocks to care, and addressing them was something we were taught to do in pharmacy school (because our program pushed us toward ambulatory care). But since I didn't go into ambcare after graduating, I'm unsure both how much of an impact it has/how widespread such practices actually are, and whether ambcare practitioners actually, on the whole, put their money where the educators' mouths are. Can ambcare clinics actually make a systemic difference?

Oh! I had no idea they taught y'all those skills, but then I don't actually think I've ever had a conversation with a pharmacist about meds beyond a perfunctory question about whether I know what side effects there are. In general I am not used to pharmacists, doctors, or other medical professionals like psychiatrists taking a lot of time to really listen to me. Some of that is probably that all my main health complaints are things that feel normal to me and some is probably that I am a chronic minimizer--like I said in that discussion, it's a coping method.

I have never heard the term "ambulatory care" -- oh, it's outpatient care. Yeah, okay, let's use a specific physical issue: I can't run for more than about two to three without finding myself unable to breathe. This has been a thing for essentially my entire life, and in middle school we did running with heart monitors, so even apart from the physical experience of not being able to breathe and having to stop and take great heaving breaths of air, I was aware that objectively my heart rate was going up very fast no matter how hard I tried.

(We are talking "run until you start getting black spots in your vision, then walk until you can just barely breathe again, and then run, rinse and repeat. Literally the only kid slower than me was excused entirely from running because one leg was an inch shorter than the other.) No one around me seemed to think there was anything unusual about this or that I was anything besides just physically lazy, so I kind of wrote it off until my mid twenties. I mean, I'd been visibly struggling with extended physical exercise my whole life, and no one had called it remarkable yet, but friends were telling me it wasn't normal to experience those kinds of breathing issues, so...

I presented myself with this complaint to a nurse practitioner who basically told me I was just fat and needed to exercise more. I pushed past this and was grudgingly scheduled for an ecg (normal) and a peak flow test (astoundingly poor). There was no explanation presented for the peak flow except that I was out of shape and needed (guess what?) more exercise. Tried a pulmonologist, who confirmed it was not exercise induced asthma (which I had been sort of hoping, because there are fixes for that) and told me I was basically fine.

I more or less gave up until a dentist idly mentioned that my airway was very, very small and told me that micrognathia was something I should look into: my airways might be occluded. So I went to an ENT, who also immediately tried to tell me I was basically fine but did grudgingly agree to scope my airways... and discovered major blockages from my tongue (insufficient room in my jaw, so it gets shoved backwards over the airway), my nasal turbinates (swollen almost completely shut), and I forget what else. It was incredibly exciting to have a reason.

Okay, I say, what do I do with this? Exercise more? But I want to do that, I just can't breathe. I was aware that there is a surgery to artificially extend the jaw; it involves breaking the jaw and encouraging it to heal while maintaining space between the halves. So I brought this up. He was very dubious about this. I asked for a referral anyway and was referred to a plastic surgeon. The surgeon was perplexed by what I wanted to talk about and had clearly expected me to have come in for a cosmetic procedure like a nose job. Eventually I got too exhausted to follow up further; I've been meaning to resume this thing for like six years now.

Generally, my experience of doctors is that they have been trained to be suspicious of patient accounts that don't fit a very specific narrative, and that they are impatient to get on to the next thing unless you are very proactive about your own care. If you don't have a condition in mind that you can point them at without making them decide you're med seeking, they are quick to tell you that you are just making things up in your head. There are a few exceptions but I cannot underscore enough how rare I have found them to be.

And they will all tell you to exercise and lose weight as a first line of response. Not that I'm bitter.

Now, actually working in healthcare, @scientia-rex or @clockworkcrow might have more relevant commentaries than I do. But my experience in this field has not been, to put it mildly, great. Let's not even talk about my history of psychiatric care.

[dorianbrightmusic]

Saw the tag so wanted to send an ask! Do you want to talk/infodump about the history of antipsychotics and how that relates to ASD because that sounds fascinating.

oh my god i got asked to infodump about my most special of interests. thank you so much, most-definitively-a-human, you have made my day.

Disclaimer: I am not a psychiatrist or mental health professional, and I have no experience of either psychosis or taking psychiatric medication, so I can't promise that the facts are 100% perfect, nor that I have an understanding of what these facts mean in day-to-day life. But the least I can do is try to understand, and hope that someone else finds this interesting, or, better yet, useful.

I cannot be bothered tracking down all my sources again, so if anything in this post is interesting to you, please fact-check it, because I can't promise it's going to be right. This is medical information, so, as this is a rambling tumblr post, please take it with a grain of salt.

Skip to the end for the discussion of how autism, schizophrenia, and the antipsychotics are linked. Most of this is just me infodumping about antipsychotics, since I find them so fascinating for some reason.

Trigger warning: This post discusses medical abuse of people with severe mental illness and neurodevelopmental disorders, as well as the side-effects of psychiatric medication. There is also some discussion of self-harm in autism. As such, tread carefully.

A short(-ish) history of antipsychotics

In 1953, a new medication hit the market. Its name was chlorpromazine, and it belonged to a family of chemicals called the phenothiazines. The phenothiazines contained a lot of very, very revolutionary/historically significant meds – some highlights include methylene blue, an antimalarial that happened to be the first ever fully synthetic medication (which, due to its original purpose being 'fabric dye', had the convenient side effect of making your urine go blue); and phenbenzamine, which was not the first antihistamine ever (that honour goes to piperoxan, which is too toxic to use in humans), but was the first that was safe for use in humans. Phenbenzamine was very, very sedating, and from it, we got another compound, fenethazine. From fenethazine, we then got two derivatives: promethazine, and chlorpromazine.

Promethazine is an antihistamine, and like most old antihistamines, it's very sedating. As such, scientists tested whether promethazine worked for sedating people—and, indeed, it worked as a pretty good sedative. Its younger cousin, chlorpromazine, synthesised in 1950, also was very, very sedating. So, someone gave it to a psychiatric patient who was having a manic episode, and then, something cool happened. That is, the manic patient wasn't manic anymore.

Okay—so, chlorpromazine was sedating in a way that meant it could have some potential for previously difficult-to-treat psychiatric syndromes. (From memory, I'm fairly sure that lithium was around at the time, but frustratingly, not all mania responds to lithium. I don't know whether this patient had been trialled on lithium—all I know is that chlorpromazine worked for him.) So, it was trialled on quite a few psychiatric patients with schizophrenia, and they, too, seemed better.

Now, chlorpromazine, being related to promethazine, had a similar side-effect profile to most old antihistamines. That is, it made you eepy beyond belieepy (i'm sorry). This sedation was also accompanied, rather horrifyingly, by apathy, psychomotor retardation (thinking and moving much slower—I once saw someone online liken it to moving 'through molasses'), and emotional quieting. This triad—not moving, not wanting, and not expressing—was known as neurolepsis, and was originally thought to indicate that the drugs were working well. However, this wasn't necessarily true—in part, that's because schizophrenia spectrum disorders have negative, as well as positive, symptoms, and neurolepsis is basically a combination of actively worsened negative symptoms and physical/mental slowing. So, chlorpromazine made the psychosis better, but also induced neurolepsis, as well as several other side-effects (including but not limited to: reversible Parkinson's-like motor symptoms; orthostatic hypotension, which is when your blood pressure plummets when you stand; and anticholinergic effects, which I'm going to get back to later). Chlorpromazine was wonderful because it meant that finally, patients could deal with psychosis in a way that meant they didn't have to be institutionalised, and because it meant that much, much worse treatments (looking at you, insulin shock therapy) could finally be discarded. Chlorpromazine was awful, because, in addition to its awful side-effects, it wasn't always given consensually, and could be used to abuse and harm patients. Such is still an ongoing problem with antipsychotics—while they have revolutionised psychiatry and allowed many people to live much, much better lives, they've also indubitably been used to harm so many people. This is why it's crucial to have informed consent in psychiatry—and while I don't know how to handle this when a person is going through florid psychosis and is probably very, very scared, we ought to do much better than we are at the moment.

Due to the neurolepsis-inducing side-effect profile, chlorpromazine was deemed a neuroleptic. Most people will use the terms 'neuroleptic' (neurolepsis-inducer) and 'antipsychotic' interchangeably—however, the categories are a venn diagram, not a circle. There are some antipsychotics with only very mild neuroleptic effects (we'll get back to this), and some neuroleptics that aren't antipsychotic—for example, if you've ever the taken over-the-counter antinauseal/migraine relief drug called metoclopramide (Anagraine, Paramax, MigraMax, Metozolv, Reglan, etc), you've taken a neuroleptic. Neuroleptics are dopamine antagonists—that is, they bind to the receptor for dopamine in the brain, which means dopamine can't bind to that receptor, so you can't get the effects of dopamine at that bit. This basically explains neurolepsis as a syndrome, since dopamine is associated with reward pathways and movement; less dopamine in the reward pathways -> emotion blunting, lost motivation; less dopamine in the movement pathway -> i can't fricken' move, can't fricken' move emotionally, Parkinson's-like symptoms (Parkinson's is in part due to a dopamine deficiency in certain movement-related bits of the brain).

The antipsychotics allowed for de-institutionalisation to occur, and also gave rise to the tricyclic antidepressants, as imipramine (the first tricyclic antidepressant) is a chlorpromazine derivative. Fun! Problem was, these older psychiatric drugs tended to have fairly intolerable side-effects. So, the first-generation antipsychotics were by and large very neuroleptic—as such, we needed less neuroleptic antipsychotics for them to be tolerable. This started to happen around the 1990s and onwards, when the second-generation antipsychotics (SGAs)—olanzapine, risperidone, amisulpride, aripiprazole, quetiapine, etc.—started coming out. These SGAs bound to serotonin as well as dopamine receptors, and tended to have fewer motor side-effects than their older counterparts. They came with their own set of extra side-effects, however—some that come to mind are prolactin elevation (sexual side-effects), and appetite increases or decreases (this is not necessarily a bad thing)—but they're generally considered more tolerable, and while they're sedating, they're considered not to induce neurolepsis to the same degree. As such, they're called atypical (where typical means 'cue the neurolepsis and motor symptoms).

The problem with the typical/atypical split, however, is that most atypicals aren't quite as atypical as they're said to be. Every single atypical antipsychotic except for quetiapine and clozapine can still be linked to motor symptoms, and all of 'em can be linked to sedation of some degree. Moreover, one nasty motor side-effect of neuroleptics AND antipsychotics is this thing called tardive dyskinesia—tardive meaning late-onset, dyskinesia meaning unwanted/uncontrolled movements. So, over time, we go from Parkinson's-like symptoms (less movement) to tardive dyskinesia (more, unwanted movements), which is irreversible and sometimes progressive—the only way to deal with it is to switch to another antipsychotic and hope that it doesn't have the same effect, which is great, except if you've otherwise got a nice balance of symptom management and side-effects, that's a horrible curveball. The atypicals are said to cause tardive dyskinesia at much lower rates... except people still get TD on the atypicals. Moreover, most folks who are still taking typical antipsychotics have probably been on them longer than those on the atypicals, since people don't tend to try chlorpromazine first when quetiapine or olanzapine is more likely to do a better job of attenuating psychosis while inducing fewer adverse effects. As such, part of the difference in TD rates may be due to time, since TD develops in the long term. So, most atypicals aren't as atypical as is said.

Moreover, to split more hairs, just as antipsychotics and neuroleptics are a Venn diagram, SGAs and atypicals are also a Venn diagram, rather than a perfect overlap, due to the existence of one pesky compound called clozapine. Clozapine is pesky on several levels. Clozapine is reserved for those who've tried at least two other antipsychotics and found that they didn't fit, and this is because of its side-effects. Clozapine has a small chance of a potentially life-threatening side-effect called agranulocytosis—technically, almost all antipsychotics can cause agranulocytosis, but clozapine is the most likely to do it. If you get regular blood testing, which you will, if you take clozapine, you'll probably be fine. Otherwise, clozapine is the most atypical antipsychotic we have side-effects wise (of course, YMMV for individuals, since the human body doesn't behave according to textbooks), though it still has MANY side-effects, and it's also more likely than the others to be very effective for attenuating psychosis. (I say 'likely' because everyone's brain chemistry is different, so saying 'this drug is better than this drug' just isn't true, because different compounds work differently for different people. Some people will benefit nicely from haloperidol or perphenazine, others from ariprazole, and others will benefit most from taking mood stabilisers, instead of antipsychotics.) Clozapine is also a somewhat old antipsychotic, having been first put onto the market in 1972. But it tends to get lumped in with the SGAs simply because it's so atypical, which leads me back to the point: most atypicals aren't 100% atypical, and drug categorisation in psychiatry is confusing.

One other side-effect that antipsychotics tend to have is that they're usually very anticholinergic. Anticholinergic drugs reduce levels of a neurotransmitter called acetylcholine, which is very important for memory, movement, and so, so much more. However, the reason I mention memory is that most antipsychotics are contraindicated (recommended against) in those with dementia-related psychosis, primarily since depleting memory chemicals is the last thing you wanna do in someone with a major neurocognitive disorder. This is also why we need to be careful prescribing anticholinergics in those over 65. For the record: most severe mental illnesses tend to have some degree of neurodegenerative effect, which is why medication is so, so important, as it prevents that illness-related neurodegeneration: as such, taking an antipsychotic will prevent schizophrenia/bipolar/major depression-related cognitive decline and worsened illness, but may also have some subtle cognitive effects that probably balance out with those of the illness. It's something to monitor over time, but not something to be scared of.

I've harped on a lot about SIDE EFFECTS SIDE EFFECTS SIDE EFFECTS, so this is a reminder—if the name of a certain medication has been brought up here as associated with a side-effect, that doesn't mean the medication is necessarily bad. Antipsychotics have done a lot of good for many people, and so long as they are prescribed consensually, they will continue to be invaluable.

Also: not everyone who takes an antipsychotic has psychosis, and not every with psychosis takes antipsychotics. Medications don't necessarily indicate what illness someone has—they just help with symptoms, and antipsychotics can help with a heckuva lotta symptoms when used well.

Okay, great. How does this relate to autism, aside from that being proof that you, the author, meet criterion B3 for ASD?

We're almost there.

Several early theories of autism conceptualised it as a pervasive, childhood-onset form of schizophrenia ('childhood schizophrenia' and 'autism' have historically been used synonymously at times). Notably, several of the negative symptoms of schizophrenia spectrum disorders can be considered similar to the executive and social symptoms of autism—autism has its own positive set of symptoms, and schizophrenia its own positive symptoms, but there's an overlap between negative symptoms of the two. Autism was originally the name Eugene Bleuler gave to the way schizophrenic patients tended to withdraw into a fantasy world of their own—that is, withdrawing into an inaccessible inner world, rather than reality. While schizophrenic autism isn't nearly as relevant a clinical concept anymore, it's kinda funny how the two diagnoses diverged from that point.

It's also worth noting that schizophrenia spectrum disorders are probably neurodevelopmental, and both schizophrenia-spec disorders and autism feature enlarged ventricles in the brain. But correlation is not causation—this commonality may not mean anything. In schizospec disorders, ventricle enlargement tends to link to greater untreated duration of illness (as a visible sign of neurodegeneration), while in autism, I think it's just there. Not sure on that one, though. Not all people with ASD or schizospec disorders necessarily have enlarged ventricles, either—it's just a thing that seems worth noting.

Further, the predominant theory of how schizophrenia spectrum disorders work is that there is dopamine dysregulation—that is, some bits of the brain are getting too much, causing positive symptoms, and others are not getting enough, causing negative symptoms. Either that, or dopamine metabolism isn't working properly. We largely figured out that dopamine is probably involved in schizospec disorders by working backwards from the mechanism of action of the antipsychotics: that is, neuroleptics suppress dopamine, and dopamine suppression makes psychosis less bad—therefore, dopamine is involved in psychosis. But it's likely more complex than that, in part because not all people with schizospec disorders will respond to antidopaminergic drugs, and in part because SGAs are generally more likely to be effective than first-gen antipsychotics, and SGAs target more than just dopamine. One other theory posits that NMDA, which is a subtype of the neurotransmitter called glutamate, may also be involved. I'm not going to try to explain it here, since I don't know enough about the NMDA theory to be able to coherently string together a sentence about it. But, keep reading.

We don't entirely understand the mechanism behind autism. It probably involves synaptic pruning to some extent. It may also involve having an overactive brain, in part due to lack of pruning meaning that there is no brain highway so much as a network of ratruns that get clogged up very easily, and in part because GABA, the main inhibitory neurotransmitter we have, isn't doing something right. I think it's interesting that NMDA, a form of glutamate, might have links to psychosis, and that autism also probably involves something weird with glutamate, but I also don't know enough to say whether this is just a weird coincidence or if it's actually relevant. Nevertheless, even if it is a coincidence, I do find it funny to note these commonalities considering the historical links between the diagnoses.

It's also notable that autistic people experience psychosis at higher rates than allistic folks—I'm pretty sure schizospec disorder rates are also elevated among autistic folks—and I'm semi-sure autism is also more common in those with schizospec disorders than in those without.

Okay, now to where the meds come in.

Autism can cause varying levels of disability, ranging from those who need relatively little support to those who need full-time care. Often, higher support needs (HSN) autistics tend to have more dramatic self-injurious behaviours, and may struggle more with controlling aggression, with eloping, and other behaviours that are harmful to both themselves and others.

And I'm less-than-comfortable with how modern psychiatry has chosen to deal with this.

The only drug that's approved for treating these behaviours in ASD is risperidone, a second-gen antipsychotic. Some people will find that risperidone works really well for their psychosis—it's an effective drug! —but when it's used in ASD, it's not there to treat psychosis, usually, but to treat aggression, self-injury, and such.

Thing is, the use of risperidone for this purpose is basically an attempt to sedate the autistic child into not doing these things. I'm a low support needs (LSN) autistic who's never taken psychiatric medication, so it's not really my place to judge this as a tactic. I understand that things that some of us initially flinch at, such as putting HSN autistic children on leashes, is the right thing to do if the child is likely to elope, and I understand that if a child is going to hurt themself badly, they need help. But on the other hand, I have reservations since antipsychotics have been used unethically through history, and continue to be used unethically in certain situations. In some cases, antipsychotics may be helpful for autistic children, and I don't know enough to comment, but it's also profoundly uncomfortable to contemplate the fact that certain medications that are infamous for having horrible side-effects are being used on people who may not be able to provide informed consent. It's an ethical conundrum, since if it is the best way to prevent harm, then it's important that we don't flinch on instinct, but I also really, really hope that the HSN autistic people's needs and comfort are being taken into consideration in these circumstances, since both historically and today, HSN autistic people have been treated as subhuman in so, so many circumstances.

[tailoroffates]

Safety Signals For The Anxious, And Why They Help.

Hey-hi! I am TailorOfFates and I’m back again to chat about yet another aspect of anxiety! Safety Signals… Many people have asked me about the face mask I wear. No, it’s not to protect me from covid, it’s filled with holes you sillies. Though, this question actually brings us to the topic of todays rant. See, the previously ignorant version of me used to call them safety items, but after doing my research and checking around I’ve learned that they’re actually called “Safety Signals.” This can be anything from playing a favored song or playlist, a comforting item, or even just a friendly face.

Safety signals are things that help us to feel comfortable while we are outside of our comfort zone, making it easier to cope with unfamiliar or even chaotic environments. This was officially named when researchers of both Weill Cornell Medicine and Yale University conducted a test where they taught a group of people (and mice) to associate safety with colored shapes and simple tones. They then exposed the group to a threatening object and of course, the people undergoing the test had the expected response, they got anxious, however, when shown the same threatening item with the addition of the associated safety signals the threat perceived by the group was significantly reduced.

Now, as I mentioned earlier “safety signals” can be produced by anything that brings the person in question comfort. Fun fact, you ever notice how children have issues outgrowing safety blankets and favored toys? Well, that’s because they are technically safety signals and they allow them to face new experiences with a calmer mindset. You hear that? Anxious people are basically just big children. Please be patient with us, we’re trying! So I’m going to assign those of you who are anxious a little homework. I know, I know, homework sucks, but I bet you it’ll help! The assignment is to study yourself so you can learn what your safety signals are, and once you figure them out, test them in areas that usually induce anxiety. Remember to take your baby steps. Try not to overstimulate yourself and day by day you may be able to use these safety signals to reduce your overall anxiety. They work pretty well for me. I personally have 6 safety signals. My vape, my phone & headphones (this includes the music I listen to and I consider it all as one item), my housecoat or a similar style of comfortable and soft coat, my water bottle, and my backpack (which I usually use to store things I think I might need when traveling away from my home). These items serve to help me feel more comfortable when I exit my comfort zone and by discovering your own safety signals you may be able to ease your anxieties in your own way.

That’s all I have for you today, but for those of you who have your own safety signals, I’d love to hear about them and how they help you. Stay safe out there, and remember, anxiety isn’t something you need to struggle through alone, so let’s do our best to help each other turn anxiety attacks into anxiety hacks! Bye-bye <3

[moonfurthetemmie]

OKAY so

- currently, the disease has no official name, not even in-universe. Zuli and Mercury are pretty much the only people in memory who have come into contact with it and survived uninfected. Everyone who was infected refers to it as some variation of ‘The Colony’s Gift’.

- The stranger’s not any other character from JMV. Just an OC made for the story. They are essentially Patient 0, though many non-intelligent creatures had been infected before them, and were almost definitely their first encounter with the disease.

- The disease can infect pretty much anything, though it kills all non-sentient life.

- The stranger’s age is undecided, but given the disease was able to almost entirely take over Jade and Obsidian’s bodies to the point of turning their own cells into fungal cells, it’s possible that the stranger is Old As Fuck and has been kept alive by the Colony constantly replacing the cells in their body in a very weird and parasitic form of regeneration.

- The Stranger officially lives with what I’ve been calling ‘The main body’ of the Colony. This thing has grown so big, it can house multiple humans inside it. Which it does. Some monsters, too, probably. But it really wants to spread everywhere, so it has people leave sometimes to try and infect others.

- The longer you’re infected, the less of your own personality remains. A few things may stay, but eventually you’re just part of the hive mind that is The Colony. The Stranger has very little of who they used to be left, if any.

- Aside from changes due to Trauma, most of the JMV manor residents have retained their personalities entirely. They weren’t infected all that long, compared to all the people who live with the main body.

- The manor residents remained on a closed network because of their isolation from the main body, and the infected there. Had the stranger stayed longer, they all would already know where the main body was and would likely have gone there to ‘connect’ with everyone else.

For whatever reason, though, the stranger left not too long after Koroit showed signs of infection. This was definitely not what the Colony wanted. Hopefully this is a good thing and won’t come back to haunt us later

- While symptomatic and part of the system, everything Jade experienced—Thoughts, physical sensations, sounds, smells, tastes—were essentially broadcast to the others at all times. Obsidian’s experiences should have been, too, but he completely mentally shut down. Since he wasn’t sensing anything, no one else did, either.

- Now that they’re network is closed off even from the Colony, and their symptoms are significantly less severe, Jade is learning how to cut everyone off from everything he senses, and only let them know what he wants them to know.

Obsidian seems to be more with-it now, but he’s already blocking them out from his thoughts. Maybe he wasn’t as shut-down as they had thought this whole time…?

But Jade’s doing good; without the Colony insisting it know everything he does, he’s getting to a point where he can use the network just like the others do, and keep some shit to HIMSELF for fucks sake

- the others are also learning how to keep some things out of the network, though they’re having an easier time of it.

- Obsidian and Jade are still contagious. Their bodies are almost entirely fungus now, and trying to completely ‘cure’ them will kill them. Mercury suspects this, but still has to do some tests to be sure. Maybe he can find a way to make them not be contagious without hurting them too much, though?

- Everyone has scars from this ordeal.

- The Colony may seem incomprehensible, and even the ones who were infected get a headache from trying to remember what it was like being under its influence, but it still has tel very basic desires: Survive, and Reproduce.

It’s almost impossible for it to not know Obsidian’s reputation, and it was likely hoping it could use the manor as a secondary ‘body’; another ‘base of operations’. Everyone inside (that it knew about) could travel between universes, which would make it extremely easy to spread; it wouldn’t have to even make them change what they were doing all that much. Dead bodies can still spread the disease just fine. Obsidian in particular would be very helpful, if the infection could spread to his tentacles.

Unfortunately for it, Obsidian and Jade were not able to be absorbed into the hive mind, and were significantly less useful as a result.

- Obsidian’s tentacles are full of spores though. That part did work.

- obsidian and Jade are also highly flammable now so. they’re not allowed near the camp fire.

Actually all the infected from the manor are pretty afraid of fire now. Instinctively. Even before Zuli suggested they torch the manor and saw how easily the mushrooms burned.

- There is a chance—albeit a small one—that once Mercury finds people who actually know how to help, that Obsidian will pull his head out of space and try to help. But that will depend on just how much the Colony scares him, and whether or not he cares enough to do anything about it.

It’s much more likely that he’ll just watch and occasionally tell them their ideas are stupid, until Peridot gets a nice containment cell to keep him in. At which point he probably gets to help by letting the pathologists take tissue samples from him

- tbh he and Jade might be a good source of material for vaccines against the disease. They’re contagious still, but the fungal cells that make up their bodies may be inert enough to be used to immunize others.

Maybe. But I don’t know if you can make a vaccine for a fungal disease. I know they’re really really difficult to treat compared to viral and bacterial diseases. Also this bitch is sentient

- There is hypothetically an alternate ending where Mercury and Zuli notice far too late that they’ve been infected. This is not a good ending

- Also, hypothetically, if two infected people were to have a child, that child would just be part mushroom. With little to no hope of being ‘cured’ or even just disconnected from the Colony without dying.

Given how large the main body is and how long it’s been around, there’s probably a number of such children. Some are even adults now.

These very important people to the Colony, especially after losing our beloveds in the manor. It knew they were more ‘connected’ to it somehow, but it never thought anyone could be cured of it. It really hopes these little shits can’t be cured.

- While it is aware of people’s perception of it as a disease, it sees absolutely nothing wrong with trying to spread. It’s not like it’s killing anyone anyways. And look! They’re all sooo happy staying with it <33

- a seemingly small symptom is that the infected do not ponder the oddness of The Colony. Specifically how it speaks to them and what they perceive from its senses. They also don’t have trouble ‘understanding’ what they’re perceiving; it tells them what it wants them to know/do and that understand that, so they don’t need to understand the rest.

Once you do start trying to understand it in its entirety, though, it can do a lot more than just give you a headache.

The Colony perceives its surroundings in a way entirely unlike humans. Trying to understand it could drive you insane. Imagine trying to explain sight to a creature with no eyes. Imagine suddenly having that electrosense shit some other animals have and trying to understand what the fuck you’re sensing. It’s gonna fuck you up, man.

Some monsters may not experience the eldritch madness. Depends on what their default senses are and how close they are to the sense of a fungal disease that can still produce fruiting bodies.

[hiiragi7]

Frustrated about how inaccessible and inaccurate so much info about CAH is.

Annoyed with how many people call CAH a condition which only affects females, when it isn't.

Common CAH variations may still show signs in male patients (but are usually deemed "socially acceptable"), and there are CAH variations such as 3bHSD2D where *both sexes may have ambiguous genitals at birth*.

Sick especially of medical resources doing this shit because apparently all they know is what they read off of google about 21-OHD and stopped there. This is just one example of all the shitty misinfo about CAH and other intersex variations online and why it took so long to know basic shit about our body. Even our doctors did not know basic information on CAH and it was pure luck we got moved to an endocrinologist who knew there was more types of CAH than just 21-OHD and tested for them.

Want to know another fun fact? One I did not myself know until very recently despite having diagnosed CAH? Classic CAH is not synonymous with ambiguous genitals at all. In fact, with the type of CAH I have, most female infants are born with mild or no virilization at all and almost all have very low prader scale scores.

And yet ambiguous genitals as a classic CAH symptom are made out to be like it's the biggest sign of classic vs nonclassic CAH even by doctors. Nobody reads the actual fucking literature on this shit.

We've been under the assumption for years that we could not have classic CAH because our genital ambiguity grew over childhood and puberty rather than being born with super obviously ambiguous genitals and that it would've been obvious at birth if it were classic and we would've been diagnosed as an infant. It turns out with the type of CAH we were diagnosed with our experience is actually extremely fucking textbook for classic-type!!

We also assumed that we would've been caught by our country's mandatory CAH screenings as an infant if it were classic - Nope, our CAH variant in the way it presents in us does not cause elevated 17-OHP levels and the infant screenings only test for 21-OHD. It's why as an adult we were missed the first time by CAH screening as well until we ended up with previously mentioned endo who tested for CAH variations that aren't necessarily related to 17-OHP.

I am. So so tired of how nobody seems to know shit about anything intersex-related. I just want to know basic information about my own body like anybody else. I just want my friends to be able to understand themselves without going through this slow, horrible, agonizing process of constantly wondering if you're making it all up in your head or why the doctors are so fucked up or why your body looks and functions the way it does and having no answers.

This information should be so much more easily accessible and spread than it is.

[vacantgodling]

some random shit about nad cuz i’m thinking about those losers

nyseah takes a low dosage of e so she looks more like a masculine woman and this is on purpose.

she does like feeling pretty every now and again but she’s a tshirt and sweatpants kind of gyal

she voice trained solely just to be able to do a customer service voice that she uses with patients but on her own she rarely uses it because she likes her voice—she just knows what people expect of her

she’s been out for like 10 years

she stops smoking bc it’s bad around the kids (leila, luna, axel & trinity) and makes don stop smoking bc it makes her want some LMAO

“stop testing my fucking resolve macbride” “…. yes’m”

don and leonine are uncles but in extremely different ways (mid life crisis drinks too much uncle with a pessimistic worldview vs rich flamboyant uncle who buys y’all a house in the country i’m not joking)

leonine wears a locket after roxanne’s death with her picture in it

nyseah cries when axel calls her mom for the first time (basically she was expecting it from the other 3 but she didn’t think axel would ever see her like that and it made her emo). he then started crying because he felt like he could finally be a kid. it’s sweet :)

alona is more like an older sister to the kids than anything. but she also views nyseah like an older sister and looks up to her a lot

don is also alona’s older brother. he doesn’t know how this occurred but he’s begrudgingly endeared

my favorite thing about this found family they all made is the fact that don was so ready to be a brooding “i work alone” type but alona was all 🥺 and nyseah was more 😒 and so he ended up getting dragged into love. sorry bruv this isn’t ur usual noir! ya got dragged into the family!! there’s no escape!!!

tbh i’m still trying to figure out what i want to happen with 12 cuz idk if he makes it safely into the found family 🤔🥲 same thing with the other experiments that didn’t get out.

i ALSO don’t know if i want to have nyseah ever MEET 17 again after what he did to her or if it just happened and what started as her chasing him down for fucking her over becomes her just finding her family and leaving the fucked city and her closure is having people to care about vs like *actual* catharsis from beating his ass

i definitely think they’re blowing up the company building

maybe 12 can sacrifice himself to save them all lmao. mayhaps. i’m still thinking of yknow. the actual plot pff

i also think nyssie is stuck with her powers forever so she just only has use of the one eye

maybe i’ll do more thoughts later

[con-clavi-con-jae]

Would you mind talking about THAT PLAY?

I would like to know a bit more.

ALRIGHT THEN! I HAVE ANOTHER POST ON MY DRAFTS ABT MY CHARACTER BUT ALSO I'm gonna talk a bit abt the plot.

Basically it's a retelling of Jekyll and Hyde.

Doctor Jekyll needed a test subject for one of his experiments, and ends up finding a mental patient named Nancy Noonan, who's the main suspect of murder that Hyde committed.

He knows that she's innocent, obviously, so he makes his lawyer Jane Utterson find some way to keep the girl and use her as a test subject (Jane is also my second favorite character btw I love her she's cool). Nancy also has weird abilities that let her see the future and read minds, so she gets taken away to a circus by a weird nurse that like. We don't liek her.

So there's a whole thing, the wife of the man that was murdered doesn't want the girl to be back and she's so pissed that these people are trying to get her back (she's also Jekyll's not so secret lover and she's another one of my favs and I made her dress btw she's so cool and she's played by one of my besties) but she agrees in the end bc science. And like his housekeeper, Mrs Poole, she also fucking hates Nancy bc of course, she's the suspect of a murder and she doesn't want her boss to be associated with that? Which is a very reasonable concern? (Poole was right all along, I'd fight for her)

Also my character. He's the best, and I read the book he's even better there. So, Rick gets contacted by Jane (the lawyer, who's also his cousin and whatnot) to do a whole investigation on Nancy and the nurse to get them back and all that shit. Which he kinda does? But the nurse hates him already so it's not like he can do much. But he does.

There's also this girl called Elizabeth (she's also just a character our director invented but she's played by one of my besties too) who just. Shows up? And she says she's the daughter of one of Jekyll's old friends, which is why he sort of takes pity on her when she says her dad was murdered and allows her to stay (spoiler alert but none of you're gonna see it so it's fine, she's truly not the daughter of that dude, and she killed him and the real Elizabeth) so she stays and no one likes her but she doesn't care.

So, they go to the circus and kinda try to kidnap Nancy back, but she reads Jekyll's mind and they both go insane. (Also holy shit the dude that plays Jekyll/Hyde is the coolest actor in the world and I sang a duet with him????) Which leads to him switching for the most part but not like. Forever.

Act two, bitches!

So there's a whole thing, also one of the characters is literally Mary Shelly (yes, *that one*, the one who's literally one of the most interesting humans to exist? That Mary Shelly), and she's writing everything that happens for a book. So "Elizabeth" goes to her and is all like "ayo Mary, if you could write a version of what happened at the circus where none of the whole going insane and switching thing happens and I save him, that'd be sick. Please?" So Mary's very confused? But Elizabeth convinces her by saying that she js wants to marry him or whatever, so Mary accepts... for some reason. I mean, she literally just wants to write something and she keeps being removed from situations where things could be written, I don't blame her.

Anyhow, while Elizabeth is trying to convince Jekyll that the thing at the circus never happened and that he's fine or whatever, Lady Danvers (the wife of the dude that was murdered) is paying Rick to investigate the whole case. To which obviously, Rick accepts bc he's a detective and that's also literally his best friend who just went insane with no explanation.

So Elizabeth convinces him and all, and then she's just like "ayo Hyde, it'd be fucking awesome if you could just like. Stay like that. That's a cool plan, so just do it." There's a whole thing with those two, like it's *very heavily* implied that they knew about each other's plan for a while.

So, Elizabeth just fires fucking everyone except for Mary and tries to make her whole weird ass plan happen, but Rick and Jane, as well as the weird nurse, find out about her. "Elizabeth's" real name is Gretchen and she worked for the real Elizabeth's family before she killed them all. Rick takes her to jail, Jekyll is fucking not normal again but almost, and then the ending is fucking weird (lovingly, ofc, I love that ending)

This is my really bad summary of that play. I could talk about it in detail, there's a lot I didn't say, but yk. Summaries r hard.

[whump-on-a-string]

I like to draw my OCs personally, but sometimes trying to fit them into the limitations of a picrew is fun so here's some blorbos.

This is Remus. A doctor/scientist of sorts. He frequently hires body snatchers to study anatomy and such. He treats humans fine if not a bit rough but gets a little too gung-ho with his instruments when he has any non-human beings on his table though. A bit obsessed with wanting to dissect and test stuff on werewolves, vampires, and the like. He has found success in hiring a bounty hunter to bring him fresh meat for his various experiments. He wants to understand these strange creatures and try to use their abilities for his own benefit (and that of his patients of course, but he is a bit selfish first and foremost). Basically he's kind of racist against anything that's not a human/elf and sees animals, supernatural creatures, etc. As "less than human" and therefore free game to do whatever he wants to them to sate his endless curiosity. He has very little empathy for others so he struggles to put himself in other's shoes.

Hunter. Who was unwillingly turned into a werewolf. He just tells people to call him Hunter because his occupation is all that matters in any interactions with his clients. He thinks it's cool (and kinda funny). A bounty hunter of sorts, primarily dealing with inhuman creatures, especially werewolves which he has a hatred for, and wants to destroy as many as he can so no one else gets turned like he did. Frequently works for Remus because the pay is good and usually he's only dragging "unsavory" victims to the doctors office for various "treatment" and studies. Assumes most inhuman creatures are generally dangerous to humans and innocent people that should be purged.

Elliot (I decided just now to call them Elliott) originally an elf, who's life ended tragically at the hands of a hungry vampire . They are now a recently turned vampire that is incapable of turning others. Generally androgynous but very tall and exceptionally strong despite their slim appearance due to their vampirism. They're indifferent to pronouns, feeling as though it doesn't matter now. While stronger than humans, they are weak for a vampire as they have struggled to adapt to feeding on blood. They prefer to eat the food they did when they were alive, even if the tastes and nutrients are muted to them now. They're a little desperate, but generally try not to harm or kill whoever they feed from as they're still struggling to learn how to live as a vampire. Elliot never had many friends before their death and is a bit of an airhead, but recently discovered they have a sort of vampire charm/persuasion ability and has been using their new power to try and invite guests to their home as company. It's probably not a good idea. They're a bit of an idiot.

[naamahdarling]

A lot of this overlaps with trauma because most of us have medical trauma. Learn that. Learn about trauma, learn about what patients experience, understand that it isn't rare. At all. Even a little.

Ask if there is anyone you need to use different pronouns with, especially if someone came with us but is in the waiting room.

Make sure you assure the patient that you will take it seriously if staff makes them uncomfortable.

We fear retaliation if we speak up or complain. That may factor into a patient's behavior. We may hide discomfort, not call out shit behavior, or pretend something was no big deal while screaming internally.

We will hear you when you think we can't. Or the people we are with will. Mind how you talk to colleagues about us. Even if you and/or your conversational partner roll your eyes about trans stuff, keep it to yourself on the job.

Believe your patients when they say they have experienced medical discrimination or mistreatment. Even if it sounds so outlandish or so frequent it makes you think twice.

You do not know your coworkers as anything but coworkers. If a patient tells you a coworker was rude or creepy or whatever, believe them. We aren't on the same footing as you, and we see bad shit you will never see.

You ALL need to know how to deal compassionately with a panic attack.

You need to understand that there is NO procedure, not one, that "isn't a big deal" and that our discomfort has to be not tolerated or humored, but taken really seriously. The norm must be trauma informed care. Especially with queer patients.

If there is any way around it, do not coerce ("I can't give you this HBC until you have an intrusive exam.") because once you touch that patient who doesn't want to be touched but has "consented" because the alternative is no care, that will affect them like an assault. That is such a hard and ugly truth for you. I am so fucking sorry, especially if you are only just being confronted with it. But you need to sit with it and understand that your intent to harm or not absolutely matters, but often it doesn't help the patient to know you don't intend harm. Being forced to do it by an uncaring system is fucking traumatic.

If there is no alternative to a test/procedure being required for another thing, and the patient is upset by that test or whatever, try to think of ways to build trust over time, and discuss what other care can be given. Maybe you can offer something less invasive that isn't AS good but is better than nothing. Don't let a patient be stonewalled without alternatives, don't let them feel ganged up on, unheard. DO NOT get impatient. A good question is "what would help you become comfortable enough to do this?" We may not know right then because we are probably super super upset, so if you feel you aren't making progress you can always say "Well, think about it and we can revisit it another time."

With a new patient who has indicated anxiety and is showing fear or seems fine but says they are fearful, see if you can do the basic history or a get to know you in a room that is NOT the exam room. Make sure they know nothing has to happen today and they will not be touched if they don't want to be. Even something as simple as taking blood pressure LAST if you can. Being medicalized immediately is upsetting for patients with a history of medical trauma. Things being done to us as a matter of routine can be intensely upsetting, frustrating, and depersonalizing.

Some people are just assholes who don't think you are qualified or important to their care and will want to talk to a "real doctor" or whatever. But some of us can only say or discuss things once per appointment. They can either tell you, or the doctor. Not both. Don't be offended by this. Seriously, it's just really hard sometimes to have to lay out something horrible, and then do it again ten minutes later with no aftercare or airlock time.

Don't take history and basic stuff from an unclothed patient under ordinary outpatient general care. Dooooooooo nooooooot. It is so gross. If you wouldn't want to be at the DMV in whatever state they are in, don't expect them to be tolerant of it.

I don't want my body pathologized or overly medicalized. There is nothing wrong with me being trans. Do not ask queerness-related questions unrelated to your area of practice. If I come to you with a skin problem, you simply are not entitled to ask about my genitals UNLESS those are the body parts involved or the condition may also appear on the genitals. Explain WHY you are asking what may seem like intrusive questions.

If you need info on our sexual history, and must take a thorough one like Planned Parenthood, use clear language and explain why you need to know a thing. Asking whether their partner has a penis or a vagina is going to get you results more useful to you than asking if their partner is a man or woman.

I know there are people who get SO MAD when you so much as imply that they or their partner might be cheating, and I'm so sorry about that. Some of us get uncomfortable because we are afraid we are about to be either tested for something unknowingly without consent, or be pressured into something, or are going to be asked to do something triggering.

We can in fact usually recognize a yeast infection, UTI, or hemorrhoid if we have had those before. If you don't HAVE to do an exam to rule out something dangerous, don't. Consider informed consent and treating with the usual to see if the issue resolves before requiring an exam.

It is not a myth that hysterectomy patients who have had their cervixes removed don't lose vaginal depth. That thang got folded over like a stapled paper bag. I lost over an inch.

Take a patient nauseated with anxiety seriously and make sure they have something nice and big nearby they can use if they have to, and tell them it's okay and not embarrassing.

Trans patients are gonna bitch if they have to constantly ask to get names/pronouns fixed in your system. Acknowledge the shittiness of the programs and the people who designed them. As long as YOU are getting it right, commiserating in a professional way, and acknowledging how frustrating it is, helps.

If there are possibly intrusive or unrelated questions you are prompted to ask, let them know you care about the answers because you care about them, but they can opt out if they want to. Thinking specifically of the short psych screening I have to deal with at my GP even though he doesn't manage my psych meds. I do not want to discuss that with anyone but my psych because I don't feel safe doing it. Patients may lie during these to get you off their back. That doesn't make them unreliable, it makes them human.

And the most important. Genuinely. You have a chance nobody else does, not even the patient. You have the chance to treat a patient with respect and make them feel safe and heard. Which, great, everyone should get that. But for us? For us it actually is healing to be treated well, and every time it happens a little of the bad treatment becomes less painful. Having good providers has done more for my (genuine, not exaggerated) phobia than therapy. I'm serious. It is just that simple. What a lovely chance you have, every time you see one of us, to make a difference. What a wonderful thing to heal trauma with something as simple as "what name do you go by, and what are your pronouns, do you need someone in the room with you?" And genuinely caring about the answer. I WISH I could do something that important every day.

Understand that your position is, whether you are the kindest and most loving nurse in the world, a position of gatekeeping. There are things that your patients may hide or lie about because they know that anyone in your position can make things go very wrong, and they will seize any means of control they can to offset that, and controlling what information someone has is a potent way of maintaining agency. You need to understand that there is always a reason for a wary patient. And trying to dig that reason out of them if they don't want to give it is only going to make it worse. (And no, it's not always drugs.)

(And on that subject, no, you cannot always tell by looking or speaking to someone briefly how much pain they are in, or if they're faking. When I hear a medical professional claim to be able to do that, it sounds as ridiculous as a cishet guy claiming to have accurate gaydar.)

hey, since you're answering asks, could i ask a favor of you and your followers?

I'm giving a presentation to a couple hundred nurses in a few months about trans healthcare, basically telling them how not to be a transphobic piece of shit, but i don't have a lot of ideas. if any of your followers have anything they'd like to say in my position, could they chime in? they can also send me asks if they want!

thank you so much if you decide to publish this ❤️‍🔥

For sure, I'll post it! That's such an amazing thing you're doing!

Hopefully, you get some good responses. And good luck when the time comes! I know you'll do fantastic.

[itsnazib]

Some Important Characteristics Of A Good Psychologist

What is a Psychologist?

The dictionary meaning of the word psychologist corresponds to the word "psychologist". Let's express this definition more clearly. People who study human and animal behavior, try to correct behaviors that are not considered normal, get their knowledge from scientific research and use it to solve the problems people experience  are called psychologists.

Psychologists are people who graduated from the psychology departments of the faculties of science and literature of universities. Apart from this, people who graduated from a four-year department of any university, who also have a master's degree in some areas of psychology or who have received some paid training and call themselves therapists are not considered psychologists.

Why A Good Psychologist?

There are mental problems that affect human life at least as much as biological diseases.   There are many people who want to receive therapy support and seek out experts due to these mental problems. There are many reasons why people want to research and find the best, especially in psychotherapy. 

The most important of these is the ineffective therapy experiences they or their acquaintances have had before.  Being a good psychologist is not an easy job. Because this profession can be stressful and overwhelming for the person who does it.

It is very difficult to listen to other people's problems and deal with those problems. It is tiring to help patients manage their emotions seriously and correctly. However, there is a more important issue than these, and that is that a good psychologist must first have solved their own personal problems and gone through a psychotherapy process. 

Among psychology experts, especially those who have dedicated themselves to psychological therapy, the first people who should attend therapy sessions are themselves. According to psychoanalytic theory, unconscious processes have a great effect on people's career choices. In other words, it is assumed that many people who want to become psychologists unconsciously turn to this profession "in order to solve their own internal problems." 

When we look at it from this perspective, people working in the field of psychology, like everyone else, may experience mental problems in their own inner worlds. The success of a psychotherapist is related to how many of these problems they have solved and the struggle they have given in solving the problems. 

In many countries around the world, institutions and organizations that provide training in the field of psychoanalytic therapy require that the experts they train also go through a psychotherapy process. 

The psychotherapist receiving psychotherapy also helps them become aware of their own pathologies and solve them. It also allows them to experience the techniques they will apply to their patients firsthand. This helps them to be more objective when providing psychologist services.

What Are The Characteristics of a Good Psychologist?

How to Become a Psychologist?

Although many university diplomas include the phrase "psychology graduate", anyone who graduates from this department is called a psychologist. Some universities do not offer psychotherapy training in undergraduate departments such as psychology and psychological counseling. 

During undergraduate education, students are taught basic psychology information, how to apply psychological tests, superficial information about psychological theories, and simple therapy techniques. As a result, a newly graduated psychologist does not have the psychotherapy knowledge and experience to help an adult.

So what are the characteristics of a good psychologist? We can evaluate the qualities that psychologists should have in three groups. These consist of professional knowledge, psychological counseling skills, and the personality traits of the psychological counselor.

If you want to get help from psychologists who are experts in their fields,  you can make an appointment at Reliant Family Psychiatry clinic in Mansfield and Grand Prairie TX immediately.

Based on what we have explained so far,  let's list some important characteristics of a good psychologist .

Good Communication

A good psychologist needs to be fully specialized in communication types and social skills. The most basic quality to be successful in this profession is to know how to interact with people. For example, it is good to know how to ask questions during a session or to find out what triggers a disorder.

Good Listener

Creating a comfortable environment at the office is halfway there. In a friendly environment, people will be able to talk to the psychiatrist honestly. Being a good listener means always being open and engaged with the other person. It also means showing interest in what they are saying. 

A good psychiatrist should not interrupt the other person and allow them to speak freely. Giving patients enough space in silence between conversations also has an informative effect. He/she should observe how the patient behaves during these quiet moments. Each of these behaviors, such as hand gestures, facial expressions, and facial expressions, tells something.

Empathy

It is very important for a psychologist to put himself in the shoes of his patients. In order to understand the concerns and needs of the client, it is necessary to have mental strategies and to be aware of the details of his situation. Reaching the level of understanding the other person helps to handle his situation.

Security

This item has many similarities to open-mindedness. Security is the psychologist being confident in himself and his abilities. If you do not appear confident, it will be difficult to convey this sense of trust to the other person. This means that you explain the steps to be followed in a clear, concise and confident manner to the patient. Being unclear and giving mixed messages are things that harm patients.

Introspection

A good psychologist is very important to be introspective and very open-minded. This means looking at yourself, analyzing and understanding yourself. When you know yourself, you can manage your mood.

Choosing the right psychologist helps the treatment process to be completed in a shorter time. You can get immediate support from the experienced staff of Reliant Family Psychiatry in Mansfield and Grand Prairie TX.

Being Accessible

This feature has a place between comfort and understanding. It is important for the patient to feel comfortable with the psychologist. In this way, patients can tell their own situations, problems and deepest secrets. It makes them accessible when their patients feel understood. It makes it easy and natural for them to talk about their problems.

Good Analytical Ability

A good psychologist should know how to interpret what the patient is saying. Since you cannot stop talking, you should be able to extract important parts of the conversation. You should know how to choose the important ones and leave the unimportant ones. 

This feature allows them to apply better meditation techniques. It is also a necessary task to make a treatment plan and evaluate the treatment process.

[ketamineineurope]

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Ketamine is a polarizing therapeutic option with a long history of use at parties, festivals, and hospitals before reaching its current spot in the American marketplace. Buy ketamine in The Netherlands, Europe.

If you’re considering ketamine, there are four basic ways to go about obtaining it:

Spravato Prescription — An FDA-approved ketamine nasal spray psychiatrists prescribe for treatment-resistant depression.

Ketamine Clinics — On-site clinics providing off-label ketamine for patients suffering from a variety of conditions/symptoms along with therapeutic oversight. Buy ketamine online in Sweden, Europe.

Telehealth Providers — Mail-order ketamine providers with limited (often no) resources for people using their ketamine. Ketamine powder for sale in Spain, Europe.

Clandestine Markets — Ketamine sold illegally on the streets in the illicit market. Order ketamine online in Greece, Europe.

The “right” option will depend on a variety of factors, and each has merit along with potential downsides. We’ll break each of them down below but, as a word of warning: Buy ketamine online in Norway, Europe.

Ketamine on the illicit market is frequently contaminated with other, more dangerous drugs, and you should always test your ketamine before taking it.

KETAMINE THERAPY IN EUROPE.

The only FDA-approved use of ketamine for mental health involves a proprietary formulation by Johnson & Johnson called Spravato for treatment-resistant depression. Order ketamine online in Austria, Europe.

Outside of this, clinics may be more or less lenient on dispensing ketamine off-label — depending on the route you take and each individual clinic’s beliefs. Ketamine for sale in Ireland, Europe.

In-person clinics may require proof of other treatment attempts failing (though they rarely do), whereas telehealth companies “screen” your need for ketamine with a 10-question survey and a 15-minute phone call.

1. How to Get Spravato In Europe

A Spravato prescription requires a diagnosis from a professional for treatment-resistant depression. If you have this diagnosis, you should be able to request Spravato from your doctor. Buy esketamine nasal spray in Europe.

While FDA-approved, insurance will still unlikely cover Spravato prescriptions — though more likely than off-label infusions. 

The frequency of their use (often up to two times per week) and the proprietary drug they use makes this one of the most expensive options.

2. How To Get Ketamine At An IV Ketamine Clinic In Europe

To get a prescription for ketamine at a specialized clinic, all you have to do is schedule an appointment. Most clinics are very lenient about who they dispense ketamine to. Depression, post-traumatic stress disorder, chronic pain, and anxiety are common reasons doctors administer ketamine in a clinic. Buy ketamine online in Romania, Europe.

Ketamine clinics offer varying levels of care and psychotherapy alongside intravenous ketamine infusions, making them more useful for people concerned about taking ketamine without professional support. However, they’re also quite expensive, and ketamine’s requirement can be financially insurmountable. Order ketamine online in Iceland, Europe.

Treatment is more effective if you have a psychologist or other mental health professional to openly discuss your ketamine experiences with. In many cases, telehealth ketamine treatment alongside regular therapy is cheaper than ketamine clinics, provided you have someone you trust present during doses (a trip sitter). Buy ketamine in Finland, Europe.

Occasionally, insurance providers may also cover ketamine therapy (though this is rare), making it a viable option financially.

3. How To Get A Ketamine Prescription Online In Europe

Many have expressed alarm at the ease with which telehealth companies send people ketamine. All you have to do is sign up to one of the online ketamine therapy companies on this list, fill out an intake survey, pay the fee (usually starts around $250–400 per month), schedule an appointment with a doctor, and get ready to receive your ketamine lozenges in the mail.

These companies make getting access to ketamine therapy super straightforward and are much cheaper than in-person clinics.

The problem is that the level of care is notoriously poor, and most of these companies are set up to have you using ketamine for months or years. Ketamine therapy should not look like this, so be careful when signing up.

Additionally, companies in this space rarely mention the potential for harm — and it’s not just “bad trips,” frequent ketamine use can be toxic to the urinary tract and bladder [1]. Buy ketamine in Hungary, Europe.

Furthermore, companies often uplift ketamine’s rapid-acting efficacy (which is quite remarkable) over the reality that relief usually goes away quickly as well. One study found ketamine’s reliable antidepressant effect was underscored by an average time of 18 days before depression survey scores dropped again [2]. 

Ketamine clinics answer this with repeated and frequent dosing, increasing the potential for urinary and bladder concerns. 

This doesn’t mean responsible, educated, and prepared users shouldn’t use ketamine telehealth providers — there are way more harmful ways to get ketamine out there. However, if you’re going with a telehealth provider, you have to be prepared to handle your education, preparation, and integration.

They may have some tools to assist you, but the marketing surrounding ketamine on these websites has made them terrible educational resources. One study found “At-home, sublingual ketamine telehealth is a safe and effective treatment” using surveys from people who utilized MindBloom, but, notably, one person had to drop out after dose five from urinary concerns [3].

4. How To Buy Ketamine Without A Prescription

Ketamine is widely available on the black market — we aren’t going to provide specific sources, but it’s relatively easy to find from local dealers or illicit online marketplaces. 

Outside of clinical use — even off-label clinics — ketamine is illegal. 

Criminal punishments aside, contamination in ketamine is rampant, and buying it from unknown sources can be extremely dangerous.

If you decide to purchase ketamine from a clandestine source, always make sure you test it before using it — even if you trust the person who gave it to you. Periodically, the market for ketamine dries up following a major bust or new tightening of prohibition, and contamination becomes even more predominant.

Never take a friend’s word a drug is safe — know for sure using a ketamine drug test kit before you take it.

What’s the Best Way To Get Ketamine In Europe?

There’s no “best” way to get ketamine because it depends on how you intend to use it and how much you want to spend. 

Ketamine clinics are probably the most effective route for getting high-dose medical ketamine — but they’re expensive. These clinics often charge upwards of $400 per session.

Online ketamine therapy is a cheaper option and is by far the most convenient — but it’s also pretty expensive at around $200 per dose. There are more affordable companies selling ketamine microdoses, but we recommend avoiding these altogether — there’s no evidence this ultra-low dose ketamine offers any real benefits.

Spravato — the ketamine nasal spray, is another good option, but it’s way overpriced compared to an IV clinic — which offers substantially better care. This option is only good if you have insurance coverage. 

Some generalizations on when each option might be best are available below:Form of Ketamine TherapyWhen to ConsiderWhen to AvoidSpravatoBest for extreme cases of treatment-resistant depression under the supervision and recommendation of a mental health professionalIf you’re uncomfortable with psychedelics, unwilling to spend large amounts of money/don’t have insurance to cover it, or if you’re concerned about the health effects of frequent ketamine useOff-Label ClinicsWhen you’re interested in ketamine and want some support before, during, and after your experience with the drug — particularly beneficial for complex mental health concerns where dark thoughts may arise during treatmentWhile this is often a nice middle ground between telehealth sources and pricy Spravato prescriptions, it’s still important to research your clinic before you begin treatment as some are better than others.Telehealth Ketamine ClinicsA great option for people familiar with ketamine, comfortable with using it with very little oversight, and willing to put in the work of preparing for and integrating the experience by themselvesIt’s never wise to undergo a psychedelic experience without therapeutic oversight if you have a mental health condition.Illicit Ketamine SourcesYou have a reliable source, a way to test and ensure its purity, and someone you trust who is willing to be sober and sit with you while you take it.If you have any other route to receive ketamine, fear legal retribution, or don’t have a reliable source you trust, it’s best not to seek out ketamine on the clandestine market.

This list is a broad-stroke overview, but the right option comes down to each person and the guidance of their mental health professional. No drug is good or bad, ketamine included — but it has potentially harmful properties and can cause a lot of harm when people use it poorly. 

[aihs]

Which College is Best For MPT in Bangalore?

Physiotherapy is an important healthcare profession that teaches people how to stay healthy. It teaches them to use drug-free methods to prevent injuries and help them maintain their physical fitness.

Students who want to join the Mpt Colleges in Bangalore must meet the basic eligibility criteria set by their colleges. They must also take the university or college’s entrance exam. Those who made it through the test will be called for counselling or an interview.

Career opportunities after masters:

Master of Physiotherapy (MPT) is one of the most popular postgraduate degrees in medical science. This two-year program focuses on therapeutic approaches to treatment. The degree is available in several specialisations. The most popular options include ortho, neuro, and cardio. Moreover, the degree has numerous job opportunities all over the world. The degree also has tie-ups with strategic health centres and hospitals.

The admission process for MPT is similar to that of other graduate programs. Students must apply online and submit all required documents and payment receipts. They then take a college or university-based entrance exam. Then, they must attend counselling. During counselling, they must confirm their choice of specialisation. Specialisations include sports, musculoskeletal physiotherapy, neurology, orthopaedics, geriatrics, and disability rehabilitation.

A career in physiotherapy is an exciting choice for those who want to work with people. Physiotherapists can work with patients in many different ways, including promoting a healthy lifestyle. They can also help patients recover from injuries and manage their pain without drugs.

They can work in areas of:

The MPT (Master of Physiotherapy) course is a two-year postgraduate degree program in medical science. The course teaches you how to heal patients through physical treatment and rehabilitation. It is ideal for candidates who want to work in the field of medicine without specialising in human disease or surgical treatment. It also offers a wide variety of career opportunities in hospitals, fitness centres, sports teams, and educational or research institutions.

Mpt colleges in bangalore offer various areas of specialisation such as Musculoskeletal disorders and sports physiotherapy, Cardiorespiratory disorder and intensive care, Neurological and psychosomatic disorders, and community-based rehabilitation. These courses provide in-depth knowledge of the subject and equip students with the skills to assess, diagnose, plan, execute, and document physiotherapy.

One of the top MPT colleges in Bangalore is the “Acharya Institute of Health Sciences”. This college is a reputed healthcare university, which is affiliated with Rajiv Gandhi University of Health Science. It has an excellent teaching staff, which focuses on student-centered learning and provides an environment of excellence for the students. The college has state-of-the-art infrastructure and facilities to help students excel in their academics. Besides this, the college encourages students to learn and grow through practice and experience. The school has a high pass rate in all examinations and the faculty is dedicated to achieving their goals and helping students reach their potential.

They can work as:

The Acharya Institute of Health Sciences offers several MPT programs and is one of the top private colleges in India. Its faculty is composed of highly-qualified professionals who are committed to providing students with a quality education. Its curriculum is also diverse and broad, which allows students to acquire precise advanced knowledge.

MPTs have a wide range of career opportunities and are responsible for providing patients with a variety of services. They may work in hospitals, private businesses, or educational institutions. They can also be self-employed and offer their services through a consulting business. MPTs can earn up to 6 lakh rupees per year.

To qualify for an MPT, you must have a bachelor’s degree in physiotherapy and complete six months of internship. You can get admission to a college through an entrance exam or on merit. MPTs can work as physiotherapists, acupuncturists, and osteopaths. They can also help their clients stay healthy and avoid injuries by advising them on a proper diet and exercise. They can even teach them how to use exercise to relieve pain and manage stress. These jobs require extensive knowledge of the human body and can be very rewarding. MPT graduates are often paid well for their expertise and are in demand.

[refinewellnessclinic]

Enjoy the Medical Weight Loss of Refine Wellness Clinic

Enjoy the Medical Weight Loss of Refine Wellness Clinic

If you’re struggling to lose weight, enjoy the medical weight loss of Refine Wellness Clinic. They provide personalized, affordable healthcare that’s accessible 24/7. From basic episodic visits to full-on primary care, they are here for you every step of the way.

Call or book online today! Get started on your path to a healthier, happier you.

Customized

Enjoy the medical weight loss of Refine Wellness Clinic and experience a whole new you. The experts at Refine Wellness Clinic in Stillwater, Minnesota will customize a personalized medical plan to meet your specific goals and needs, which includes custom diet plans, lifestyle coaching, exercise classes, and more. They also offer a full range of non-invasive treatments to help you look and feel your best, including Botox, acupuncture, and infusion therapy.

In addition to their impressive list of services, Refine Wellness also conserves energy by using a programmable thermostat, computers that sleep when not in use, smart power strips, and lighting that's dimmed or turned off when sunlight is available. In fact, they're the only med spa in the state to boast a 5 star Google review rating. Check out their profile to see how they're rated for customer satisfaction, quality of service, and other awards they've won over the years. If you're interested in learning more about their medical weight loss and other offerings, give them a call today.

Safe

Refine Wellness Clinic is a modern medical and holistic wellness office in Stillwater, Minnesota. They specialize in medical weight loss, botox and infusion therapy, as well as helping men and women improve their hormone health to reach their aesthetic goals.

The medical weight loss team starts by getting to know each patient and their goals, including diet and exercise habits. They also review a person's medications and talk about whether they're a good fit for medical weight loss.

They offer both surgical and nonsurgical options. The surgical treatments make the stomach smaller or change the path of the intestines to help patients lose weight. They're safe and effective for people who meet certain criteria, and they can reduce your risk of other health conditions. In addition, they can help you keep the weight off and improve your health for a long time to come. Ultimately, they can help you live healthier and happier. And they're all at a fraction of the cost of a traditional medical practice.

Long-Term

Rather than one quick fix, you'll have ongoing access to your dedicated medical weight loss concierge to help you achieve and maintain a healthy weight for life. With the help of the ProHealth team, you'll enjoy one-on-one sessions with a nurse practitioner as well as a personalized diet and exercise program to get your metabolism ticking. A savvy nutritionist and chef will show you how to plan and prepare meals that meet your unique nutritional needs and dietary restrictions while minimizing calorie consumption and negative side effects such as mood swings, sleepiness and digestive woes. You'll also have the chance to test your mettle with monthly one-on-one sessions to monitor your progress and help you celebrate your victories.

Affordable

Enjoy the medical weight loss of Refine Wellness Clinic, a holistic wellness and medical aesthetics clinic in Stillwater, Minnesota. They specialize in medical weight loss, botox, and infusion therapy to help men and women improve their hormone health and reach their aesthetic goals.

The medical weight loss program includes a medical exam and consultation, lab testing, meal supplements, prescription medications as needed, nutrition education, support from your nurse practitioner and more to help you achieve your health goals. Your personalized weight loss plan incorporates doctor-suggested dietary changes, physical activity and behavior change coaching to make long-term weight loss possible for you.

To learn more about this program, schedule a free consultation. You’ll meet with a nurse practitioner, who will also serve as your wellness coach, to set and achieve weight loss goals. Then, you’ll work with a dietitian and a behavioral health specialist to develop a customized plan that suits your tastes, lifestyle, budget and health goals.

Refine Wellness

Address : 275 3rd Street South, Suite 101-A Stillwater, Minnesota 55082

Phone : (651) 309-4300

Email : hello@refinewellnessclinic.com

Website : https://refinewellnessclinic.com/

[libramonthlyhoroscope1]

Happy mod

The Happiness Project and The How of Happiness, and happiness programs like Happify and Tal-Ben Shahar’s Wholebeing Institute.

Happy mod

Here at the Greater Good Science Center, we offer an online course on “The Science of Happiness” and boast a collection of research-based happiness practices on our new website, Greater Good in Action.

But all of these books and classes raise the question: Why bother? Many of us might prefer to focus on boosting our productivity and success rather than our positive emotions. Or perhaps we’ve tried to get happier but always seem to get leveled by setbacks. Why keep trying?

Recently, a critical mass of research has provided what might be the most basic and irrefutable argument in favor of happiness: Happiness and good health go hand-in-hand. Indeed, scientific studies have been finding that happiness can make our hearts healthier, our immune systems stronger, and our lives longer.

Several of the studies cited below suggest that happiness causes better health; others suggest only that the two are correlated—perhaps good health causes happiness but not the other way around. Happiness and health may indeed be a virtuous circle, but researchers are still trying to untangle their relationship. In the meantime, if you need some extra motivation to get happier, check out these six ways that happiness has been linked to good health. 

1. Happiness protects your heart

Love and happiness may not actually originate in the heart, but they are good for it. For example, a 2005 paper found that happiness predicts lower heart rate and blood pressure. In the study, participants rated their happiness over 30 times in one day and then again three years later. The initially happiest participants had a lower heart rate on follow-up (about six beats slower per minute), and the happiest participants during the follow-up had better blood pressure.

Research has also uncovered a link between happiness and another measure of heart health: heart rate variability, which refers to the time interval between heartbeats and is associated with risk for various diseases. In a 2008 study, researchers monitored 76 patients suspected to have coronary artery disease. Was happiness linked to healthier hearts even among people who might have heart problems? It seemed so: The participants who rated themselves as happiest on the day their hearts were tested had a healthier pattern of heart rate variability on that day. 

Over time, these effects can add up to serious differences in heart health. In a 2010 study, researchers invited nearly 2,000 Canadians into the lab to talk about their anger and stress at work. Observers rated them on a scale of one to five for the extent to which they expressed positive emotions like joy, happiness, excitement, enthusiasm, and contentment. Ten years later, the researchers checked in with the participants to see how they were doing—and it turned out that the happier ones were less likely to have developed coronary heart disease. In fact, for each one-point increase in positive emotions they had expressed, their heart disease risk was 22 percent lower.

2. Happiness strengthens your immune system

Do you know a grumpy person who always seems to be getting sick? That may be no coincidence: Research is now finding a link between happiness and a stronger immune system.

In a 2003 experiment, 350 adults volunteered to get exposed to the common cold (don’t worry, they were well-compensated). Before exposure, researchers called them six times in two weeks and asked how much they had experienced nine positive emotions—such as feeling energetic, pleased, and calm—that day. After five days in quarantine, the participants with the most positive emotions were less likely to have developed a cold.

Some of the same researchers wanted to investigate why happier people might be less susceptible to sickness, so in a 2006 study they gave 81 graduate students the hepatitis B vaccine. After receiving the first two doses, participants rated themselves on those same nine positive emotions. The ones who were high in positive emotion were nearly twice as likely to have a high antibody response to the vaccine—a sign of a robust immune system. Instead of merely affecting symptoms, happiness seemed to be literally working on a cellular level.

A much earlier experiment found that immune system activity in the same individual goes up and down depending on their happiness. For two months, 30 male dental students took pills containing a harmless blood protein from rabbits, which causes an immune response in humans. They also rated whether they had experienced various positive moods that day. On days when they were happier, participants had a better immune response, as measured by the presence of an antibody in their saliva that defends against foreign substances.

3. Happiness combats stress

Stress is not only upsetting on a psychological level but also triggers biological changes in our hormones and blood pressure. Happiness seems to temper these effects, or at least help us recover more quickly. 

In the study mentioned above, where participants rated their happiness more than 30 times in a day, researchers also found associations between happiness and stress. The happiest participants had 23 percent lower levels of the stress hormone cortisol than the least happy, and another indicator of stress—the level of a blood-clotting protein that increases after stress—was 12 times lower.

Happiness also seems to carry benefits even when stress is inevitable. In a 2009 study, some diabolically cruel researchers decided to stress out psychology students and see how they reacted. The students were led to a soundproof chamber, where they first answered questions indicating whether they generally felt 10 feelings like enthusiasm or pride. Then came their worst nightmare: They had to answer an exceedingly difficult statistics question while being videotaped, and they were told that their professor would evaluate their response. Throughout the process, their heart was measured with an electrocardiogram (EKG) machine and a blood pressure monitor. In the wake of such stress, the hearts of the happiest students recovered most quickly.

4. Happy people have fewer aches and pains

Want to learn specific, research-tested steps you can take toward happiness? Check out our new site, Greater Good in Action.

Unhappiness can be painful—literally.

A 2001 study asked participants to rate their recent experience of positive emotions, then (five weeks later) how much they had experienced negative symptoms like muscle strain, dizziness, and heartburn since the study began. People who reported the highest levels of positive emotion at the beginning actually became healthier over the course of the study, and ended up healthier than their unhappy counterparts. The fact that their health improved over five weeks (and the health of the unhappiest participants declined) suggests that the results aren’t merely evidence of people in a good mood giving rosier ratings of their health than people in a bad mood.

A 2005 study suggests that positive emotion also mitigates pain in the context of disease. Women with arthritis and chronic pain rated themselves weekly on positive emotions like interest, enthusiasm, and inspiration for about three months. Over the course of the study, those with higher ratings overall were less likely to experience increases in pain.

5. Happiness combats disease and disability

Happiness is associated with improvements in more severe, long-term conditions as well, not just shorter-term aches and pains.

In a 2008 study of nearly 10,000 Australians, participants who reported being happy and satisfied with life most or all of the time were about 1.5 times less likely to have long-term health conditions (like chronic pain and serious vision problems) two years later. Another study in the same year found that women with breast cancer recalled being less happy and optimistic before their diagnosis than women without breast cancer, suggesting that happiness and optimism may be protective against the disease.

As adults become elderly, another condition that often afflicts them is frailty, which is characterized by impaired strength, endurance, and balance and puts them at risk of disability and death. In a 2004 study, over 1,550 Mexican Americans ages 65 and older rated how much self-esteem, hope, happiness, and enjoyment they felt over the past week. After seven years, the participants with more positive emotion ratings were less likely to be frail. Some of the same researchers also found that happier elderly people (by the same measure of positive emotion) were less likely to have a stroke in the subsequent six years; this was particularly true for men.

[sahani55rishav]

Cloud Arrangements and Its Purposes in Current Registering

Cloud plans, generally called dispersed registering or cloud organizations, pass IT resources on demand on over the Internet. Cloud expert associations such Amazon Web Organizations, Microsoft Purplish blue and Google Cloud Arrangements can pass everything from applications on to server ranches on a remuneration for-use reason to their allies. With cloud courses of action, IT resources can increment or down quickly to fulfill business needs. Cloud plans engage quick permission to versatile and negligible cost IT resources without colossal straightforward interests in hardware or monotonous foundation and upkeep. Associations can course of action the very type and size of figuring resources they need to actually control another drive or work their IT divisions even more.

Who is using circulated figuring?

Relationship of every single sort, size, and industry are including the cloud for a wide variety of direction cases, for instance, data support, disaster recovery, email, virtual workspaces, programming improvement and testing, gigantic data examination, and client defying web applications. For example, clinical associations are including the cloud to encourage more tweaked treatments for patients. Money related organizations associations are using the cloud to control progressing blackmail disclosure and expectation. Moreover, PC game makers are using the cloud to pass electronic games on to countless players all around the planet. It is a common obligation among you and your cloud specialist organization. You execute a cloud security procedure to safeguard your information, stick to administrative compliance,business cloud benefits and safeguard your clients’ protection. Which thusly shields you from the reputational, monetary, and legitimate implications of information breaks and information misfortune.

Check: cloud migration companies

Cloud security is a basic prerequisite for all associations. Particularly with the most recent examination from (ISC)2 revealing 93% of associations are modestly or very worried about cloud security, and one out of four associations affirming a cloud security episode in the beyond a year.

Understanding Distributed computing: Distributed computing is the on-request conveyance of registering administrations over the web to offer quicker development, adaptable assets, and economies of scale. Administrations incorporate servers, stockpiling, information bases, systems administration, programming, and investigation. Distributed computing furnishes organizations with speed, efficiency, business cloud services, execution, and security, cloud movement organizations. Cloud-based capacity makes it conceivable to save documents to a distant data set and recover them on request. As the cloud administration the executives keeps on developing, various voices with alternate points of view arise. Current and potential cloud adopters search for specialists, sellers, and locals to instruct and frame contemplations on the benefits and inconveniences of the innovation.

What provoked interest for cloud specialists?

As people contributed most of their energy inside, working from a good ways, virtual joint exertion developments saw a rising interest. As a quick result, OTT stages like Netflix and Amazon Prime saw an incomprehensible piece of endorsers during the time with the takeoff of people moving from inclining toward the ordinary television interface model. Online Foodservice aggregators like Swiggy and Zomato too used disseminated figuring for their expected advantage in giving end-clients steady data right from perfect sanitization of their food-transport associate to ensuring a sans contact food movement experience following the remarkable pandemic. This brought into the picture the versatility of conveyed processing to for all intents and purposes all endeavors and that it doesn’t restrict just to redesigning standard IT directing firms’ cloud service management. Second satisfaction and progressing association subsequently transformed into the norm for associations to sack dedicated clients and it became possible through commonsense undertakings — disseminated figuring. Learning the various uses of conveyed figuring past the traditional game plan, adventures across endeavors in India started embracing it in their middle capacity which has hence provoked a pushing interest for capacity gifted in dispersed registering. NASSCOM in its last year’s report named ‘Cloud Capacities: Controlling India’s Electronic DNA’ referred to the necessity for associations to move essential obligations to the cloud and modernize legacy on-premise IT establishment, especially post the pandemic, has been accelerating improvement in cloud gathering. The report furthermore referred to that India at this point positions third with a presented restriction of 608,000 (FY2021) secure cloud computing across all verticals incl. Development; and that the interest for cloud capacities far balances the continuous reserve and there is a need to focus in on upskilling across accomplices.