#tgd review

[after-nine-at-the-oasis]

Hey y'all! So, for just under a year, I've had a review for the Season 6 finale of The Good Doctor sitting in my drafts. There's barely anything, and I've never had the motivation to get around to it, so I'm going to do a really quick one here. I'll try and do a more in depth one with that draft in the future, but the finale season (😭😭💔) premieres in a couple of days, and I want it out before then. I'm super busy and tired so I don't have the energy for the full thing lol, so here's just something to ease my mind.

I'm sad to see Danny go :(. I'm glad he's doing what's best for him and that he's not mad at Jordan (because yeesh I understood him but that hurt me, hurt on all sides lol), but I'll miss him </3. Maybe one day he'll come back :') (although in current context I doubt it buuut you never know). And poor Jordan too 😭.

Also thank goodness Jerome and Jared are okay xD. I mean okay is a relative term here but yk. Anyway, I'm so glad they're okay we went through enough this episode 😭❤️ xD.

AAAHHHHH PARK AND MORGAN ARE BACK TOGETHER!!! WHOOO YAYYY FINALLYYYY!!! They took their sweet time huh xD. Like, the show lol. Still, they're gonna be a family together :'DD I'm so happy. They're adorable, I love them <33.

:OO Andrews is quitting! That's wild tbh. I mean good for him, and Dalisay too, but dang xD. Brave move man, lol. You better hope it works out xD, with her I mean. But nah, I'm happy for them :DD.

Iirc Lim and Glassman were with the patient who couldn't move or was almost brain dead or something like that, and I'm so glad they found a way to help her improve :'). I'm proud of them <3.

I don't remember who was on the case with him but I remember Asher's patient's father (I believe) died and I felt so bad for him 😭. Poor Asher :(. And poor the guy's family! They just kept doing heartbreaking things this episode xdd. Also the little Asher and Jerome moment at the beginning of the episode <33 my lovelies.

AAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH SHAUN AND LEA HAD THEIR BABY :'DDDDD!!! I'M SO HAPPY FOR THEM HOLY CRAP 😭😭❤️❤️❤️🥰🥰😭❤️😍🤩🥳🥳🥳🥳❤️. AND THEY NAMED HIM STEVE AARON AAAAAHHHHHHHH 😭😭😭😭😭💔❤️❤️❤️❤️!!! I'm not okay thank you very much <333. I love them all so much :'))).

Also VOEIAMPFWNIAH GLASSMAN WHY. HOW COULD YOU DO THIS TO ME. I MEAN I KNOW WHY BUT SIRRR 😭😭😭💔💔💔 I DON'T DESERVE THIS!!

Y'all can't/don't believe how much I'm stressin. Again, I do not deserve this xd.

Anyway but him sending the gift was so cute 😭😭😭💔💔❤️❤️❤️. But just aUOAGH he was SO CLOSE TO GOING INNNN-

Once again, I don't deserve this <3.

xD But seriously, even if the hat part made me SAD, I loved the whole storyline <33. And I am so glad Glassman sent a gift xd. They'll make up eventually :')). It would be absolutely WILD if they didn't, and it will be pain until they do, but I'm sure they will lol.

Anyway!! There was a lot of drama between people this season (though there always has to be), and sometimes it was stressful, but I really enjoyed this season. There were so many great moments and I just love all these characters so much <333. And let's not forget the new characters!! Danny and Dani (I still find it absolutely wild that they never addressed that btw lol) were icons, and I was sad to see both of them go but they were really good for their time on <3. They were both super unique and I also loved seeing a disabled character in Dani :D. Her journey helping Lim with her own journey was amazing, and I kind of relate as a disabled person <3. And Danny was also super great, it was nice to see him stick to his reasons and decisions a lot. For a one season character he was really complex and I like that :)). Also his relationship with Jordan was great <333. It was also wild to see Kalu return this season lol!! It took some adjusting (though I enjoyed that time too) but I love having him back :DD. I love all of these guys so much and I can't wait for next season <333.

Sooo yeah!! I absolutely loved this episode, it was so dramatic and so good. I'm so excited for the next season!

This has been my review for. . .

The Good Doctor, Season 6, Episode 22: Love's Labor

I loved it, it was such a culmination of the season. I'm scared of the drama but also so excited for it, and everything else about next season. I'll be back then for my review of. . .

The Good Doctor, Season 7

See you then!!

[the-golden-dragoness]

4.25/5

I I really enjoyed Things We Do in the Dark by Jennifer Hillier.

It’s a thriller-mystery, but at the same time I feel like it focuses on the personal growth of the characters and the characters’ history; it doesn’t sacrifice the story by creating an over complicated mystery.

I really enjoyed the different characters’ viewpoints and how section with a character peeled back the layers of the mystery. I really felt for the characters and I enjoyed that there were also aspects of Toronto’s history woven in. While it has heavy material I think it’s tragic yet heartwarming seeing the main character’s journey.

[crossdreamers]

New study shows that the “regret rate” for gender-affirming surgery is less than 1%.

Three researchers from Johns Hopkins University presents new research in the Journal of the American Medical Association. They conclude that the “regret rate” for gender-affirming surgery is less than one percent:

"This rate of surgical regret among TGD [transgender and gender-diverse ] patients appears to be substantially lower than rates of surgical regret following similar procedures among the broader population, including cisgender individuals. In fact, one systematic review found that the average prevalence of surgical regret was 14.4% among all research studies analyzed, which the authors suggested was relatively low."

In other words: The regret rate for surgery in general (all types) is around 14 percent, which is considered low. That makes the regret rate for trans people having surgery extremely low.

Harry Barbee, Bashar Hassan, and Fan Liang: Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery

See also News Medical: Johns Hopkins researchers find minimal regret after gender affirming surgery

Photo: Shapecharge

[religion-is-a-mental-illness]

By: Jesse Singal

Published: Dec 23, 2023

I’ve written many Singal-Minded posts highlighting deficiencies in both left-of-center journalism and peer-reviewed literature on the use of puberty blockers and hormones as a treatment for gender dysphoria (also known as youth gender medicine). 

Each case of lackluster journalism or science is different, but the most common theme is omission. Peer-reviewed articles on this subject regularly omit key information about their data (such as this very important federally funded paper in which multiple important variables simply disappear) and fail to explain very basic facts like why dropout rates were so high or why some kids in a sample went on youth gender medicine and others didn’t, while articles and segments produced for popular audiences by both journalists and academics in this space routinely ignore the fact that a number of countries in Europe have found, via systematic evidence reviews, that the evidence base for youth gender medicine is lacking. 

Pediatrics just published a “Perspectives” article on youth gender medicine (an opinion piece, more or less) by Emily Georges, Emily C.B. Brown, and Rachel Silliman Cohen that is one of the worst offenders I’ve come across. Despite clocking in at a brisk two-and-a-half pages, not counting endnotes and a “Ways to Advocate for TGD [transgender and gender diverse youth] Youth” chart that takes up a whole page of its own, the article contains a remarkable amount of misleading information, including a disheartening number of claims that point, via endnote, to resources that don’t come close to supporting them. The fact that Pediatrics would publish this article in its current form — and I’m getting déjà vu typing these sorts of sentences over and over and over — is a really bad sign about the collapse of institutional credibility in this area. 

Now, Georges and her coauthors are clearly concerned with overly draconian reactions to the youth gender medicine controversy, some of which go as far as attempting to remove trans children from their parents’ home. But these are separate questions from whether the evidence base for youth gender medicine is good. It can both be true that all those European countries are correct that the evidence base is shoddy and that banning the treatments outright (which has not been the response in Europe) is the wrong reaction to this medical uncertainty.

Naturally, the authors don’t mention the highest quality evidence in question, which is — say it with me — the European evidence reviews. It is, and again I feel that déjà vu coming on, a shocking omission on the part of doctors writing in perhaps the most important journal of pediatrics in the world.

Let’s get into a few examples of how misleading this paper is, because so many of the specific claims are questionable at best and clearly false at worst. For example, Georges and her colleagues argue that GOP laws seeking to restrict access to youth gender medicine “deny children access to routine health care that has been shown to decrease dramatically high rates of suicide and depression for TGD youth.” There are two footnotes at the end of the sentence.

This sentence contains two claims: one is that TGD youth have “dramatically high rates of suicide and depression.” You see this claim constantly: transgender youth have terrifying rates of completed suicide, and youth gender medicine can protect them from it. I don’t want to reiterate the argument I’ve already made that transgender youth do not, in fact, appear to have a terrifying rate of completed suicide, so click that link and search down to “The article then notes” if you’re curious about that.

As for the claim that youth gender medicine constitutes “routine health care that has been shown to decrease” these symptoms, the first citation points to the WPATH Standards of Care Version 8. This is a big document, and it’s usually a sign of less-than-tight reasoning when an academic makes a strong causal claim and then asks you to pore through a big document to find the justification for that claim. Here and there the WPATH SoC does contain claims about the supposedly salutary effects of blockers and hormones on youth gender medicine, but these claims generally reference papers like Jack Turban and his colleagues’ 2020 analysis of the 2015 United States Transgender Survey — papers that are extremely weak, methodologically speaking (click here and search down for “mental and social health” to read more about Turban’s 2020 study). But the SoC also notes that “Despite the slowly growing body of evidence supporting the effectiveness of early medical intervention, the number of studies is still low, and there are few outcome studies that follow youth into adulthood. Therefore, a systematic review regarding outcomes of treatment in adolescents is not possible.” Methodologists disagree with this — you can still do a systematic review if there aren’t a lot of studies. But either way, if according to the WPATH SoC there aren’t enough studies to do a proper review, how can the WPATH SoC support the claim that youth gender medicine has been “shown to decrease” depression and anxiety?

The second citation points to Jason Rafferty’s policy statement for the American Academy of Pediatrics, which is a very strange document that certainly does not provide evidence that youth gender medicine has been “shown to decrease” depression and anxiety.

A bit later Georges and her coauthors write, “Although some individuals make it seem that GAC [gender-affirming care] is a new, experimental area of medicine, GAC is evidence-based.” Here there is some slippage between youth gender medicine and gender medicine more generally. Whether or not that’s intentional, it’s a serious stretch — arguably a misleading one — to call this area of medicine “evidence-based.” While definitions of that term can vary, we already know what the Europeans found about youth gender medicine, and a systematic review of adult care commissioned by WPATH itself found that, well, let me borrow from myself, writing in UnHerd:

The results, published in the Journal of the Endocrine Society in 2021, revealed that there is almost no high-quality evidence in this field of medicine. After they summarised every study they could find that met certain quality criteria, and applied Cochrane guidelines to evaluate their quality, the authors could find only low-strength evidence to support the idea that hormones improve quality of life, depression, and anxiety for trans people. Low means, here, that the authors “have limited confidence that the estimate of effect lies close to the true effect for this outcome. The body of evidence has major or numerous deficiencies (or both).” Meanwhile, there wasn’t enough evidence to render any verdict on the quality of the evidence supporting the idea that hormones reduce the risk of death by suicide, which is an exceptionally common claim.

Right after that, the authors explain that “When indicated, TGD youth may start gonadotropin-releasing hormone analogs, which have been used in pediatrics since the 1980s. They also may go on to receive gender-affirming hormones or surgical interventions, all of which are supported by a wealth of research on their safety and effectiveness.” First, “used in pediatrics since the 1980s” is exceptionally misleading, because the context there was (generally) precocious puberty, meaning that after the kids ceased blockers their natal puberty (presumably) kicked in, whereas research shows that the vast majority of kids who go on puberty blockers to treat gender dysphoria subsequently proceed to cross-sex hormones. That’s a very different use case, and one for which we have almost no high-quality evidence, so the “decades of use” argument really is a canard. Second, there is no footnote on “wealth of research on their safety and effectiveness,” which makes sense given that there isn’t a wealth of research on their safety and effectiveness in a youth gender medicine context.

Later, the authors write that youth gender medicine “decreases many negative health outcomes, including rates of depression, and improves well-being for children and adolescents.” The footnote points to this letter Texas Governor Greg Abbott wrote to another state official attempting to institute a policy of investigating instances of youth gender medicine performed in that state. This is clearly an error on the part of the authors, who definitely didn’t mean to cite this here. Next sentence: “GAC has not been shown to lead to short- or long-term negative health effects, and in fact, the benefits of GAC have been shown to far outweigh the risks.” Another strong claim, and this time the footnote points back to the SoC 8. I do not believe that document contains any language stating, conclusively, that all gender medicine is this safe and has such a lopsided benefit:risk ratio, but I could potentially be wrong. Either way, again, if someone makes a strong claim and then asks you to find the evidence for it in a haystack of a document, you should be skeptical.

A bit later on, the authors argue that youth gender medicine is not “medical child abuse,” as some conservatives have argued. I agree: for myriad reasons, that’s a really extreme claim, and the sort of overheated language that doesn’t really help get this conversation back on track. 

But again, the specifics of the authors’ argument are quite strange and ill-founded:

GAC is not MCA. Although caregivers are vital supports in a child’s gender journey, the provision of gender-affirming medical and surgical care necessitates an alignment of the child’s goals with the evidence-based treatment plan determined most appropriate by the medical team. As a testament to GAC being patient driven, studies have found that the vast majority of youth who initiated medication intervention continue these treatments when followed in adulthood.

Setting aside how odd it is to see “child’s goals” used so breezily in this context, let’s once again check the footnote. It points to this study out of the Netherlands, which indeed showed a high continuation rate. But under that protocol — and this is very well-known to anyone who studies this issue — youth seeking blockers or hormones could be excluded for a wide variety of reasons, including mental health comorbidities, insufficiently severe symptoms, unsupportive parents, and so on. It’s really not “patient driven.” This is a misdemeanor compared to some of the misleading statements and miscitations in this paper, but it’s another sign of sloppiness and what might be genuine unfamiliarity with the contours of this debate on the part of the authors.

A bit later on the authors repeat that “The benefits of GAC, most notably on mental health,

self-esteem, and development, outweigh the risks in the majority of circumstances.” No footnote at all this time, although I guess, to be fair, we’ve already been told to read the 260-page SoC to find out where this claim is supported. Then an even stronger claim: “GAC is, for many, lifesaving.” No citation. This is the top journal Pediatrics! How can such a claim be allowed with no evidence?

This next part tips over from sloppy into genuine medical misinformation:

Research highlights how transgender youth disproportionately experience negative mental health outcomes, including anxiety, depression, and suicidality.12 However, when children are supported in their gender identities and have access to GAC, they have better mental health outcomes.12,13 Some studies demonstrate that appropriate GAC, in the context of caregiver support, entirely mitigates the increased risk of depression and suicidal ideation for TGD youth.12

Footnote 12 points to “Baseline Physiologic and Psychosocial Characteristics of Transgender Youth Seeking Care for Gender Dysphoria,” a paper published by Joanna Olson (now Olson-Kennedy) and her colleagues in 2015. As the title suggests, it simply captures the baseline characteristics of kids who showed up to their clinic. Therefore, it definitionally can’t tell us that “when children are supported in their gender identities and have access to GAC, they have better mental health outcomes,” and it definitely can’t tell us that “appropriate GAC, in the context of caregiver support, entirely mitigates the increased risk of depression and suicidal ideation for TGD youth.” The authors have severe problems getting their citations straight throughout the paper, but this is a particularly galling instance because this miscitation communicates such a strong claim about adolescent suicide.

Footnote 13 points to Diana Tordoff and her colleagues’ 2022 study of outcomes at the Seattle Children’s Hospital gender clinic, which readers of this newsletter might remember because I wrote about it twice.

Tordoff and her colleagues at the clinic and the University of Washington–Seattle (Seattle Children’s is the teaching hospital of the UW School of Medicine’s pediatrics department) watched as a group of kids at their clinic were given blockers and/or hormones and showed no meaningful mental health improvement over the course of a year. Then, by torturing various statistics so severely it’s a miracle they weren’t dragged to The Hague, they published a study basically claiming the opposite. It was one of the more noteworthy examples of genuinely pernicious medical misinformation being published by youth gender medicine clinicians in recent years — a complete breakdown of the important barrier between researcher and activist. You can read my posts for more details, but the fact that a doctor at Seattle Children’s Hospital, Emily Georges, would lead-author a Pediatrics Perspectives piece that treats this research as solid evidence represents a serious mortgaging of trust on her and the institution’s part. It’s 2023. She must be aware of the critiques of this study and how little evidence it provides for the efficacy of youth gender medicine. 

This is not going to be an exhausting look at every claim in this piece. But I’ll leave you with one last example of how sloppy it all is:

Denying GAC not only represents medical neglect, but it is also state-sanctioned emotional abuse. In addition to the basic physical needs all people require for survival, humans have vital psychological needs. The degree to which these needs are met during childhood impact a child’s identity, capacities, and behaviors into adulthood.14 Emotional abuse involves actions, either as a repeated pattern or an extreme single incident, that thwart a child’s basic psychological needs.14 This form of abuse can be especially damaging because it undermines a child’s self-worth and psychological development.14 Policies that prohibit or limit a caregiver or physician’s ability to provide necessary GAC force caregivers and providers to perpetuate psychological distress.

The footnote points to a study that does not mention the word child or its variants, and which has nothing to do with the matter under discussion. The authors didn’t even give their paper a rudimentary proofreading to ensure the footnotes were correct before publishing it.

Of course, it isn’t just their fault. It would be quite easy for Pediatrics not to publish a Perspective this wildly off-base and disconnected from the real-world debate over youth gender medicine. It would be similarly easy for Pediatrics to insist on the rudimentary proofreading of citations. Pediatrics chose not to take these steps. This is a pattern.

[sebscore]

Do you have any requests/ works of little leclerc with just her brothers? Im missing the younger fics without ollie😭

I MISS THEM TOO !!! 🥺🥺 I was thinking about this a few days ago and it’s the same with the old tgd fics! like I miss being able to write these small drabbles, cause I make everything so long now 😭😭

but I have a wip of a little leclerc comfort fic that’s charles centered, but I’m not very happy with it at the moment, but I’ll review it 🫣💜

[gender-affirmingcare]

Impact of Gender-Affirming Care Bans on Transgender and Gender Diverse Youth: Parental Figures’ Perspective

Abreu, Roberto L., Jules P. Sostre, Kirsten A. Gonzalez, Gabriel M. Lockett, Em Matsuno, Della V. Mosley. 2022. “Impact of Gender-Affirming Care Bans on Transgender and Gender Diverse Youth: Parental Figures’ Perspective.” Journal of Family Psychology 36(5):643–52.

Critical Review # 1

"Impact of Gender-Affirming Care Bans on Transgender and Gender Diverse Youth: Parental Figures’ Perspective" is a study that explains the experiences of TGD (transgender and gender diverse) youth and what it is like to be a parental figure during these times. The article begins by explaining how TGD youth face an unprecedented number of systemic barriers that affect their physical and mental health, and many of these barriers come from legislators/policymakers making laws, bans, and bills that prevent the youth from getting the care they need (Abreu et al., 2022). The article mentions how there are many trans prejudices, where trans women and girls of color find themselves most affected, "because of the intersection of racism, cisgenderism, and sexism. Facing intersectional discrimination results in transgender women and girls of color experiencing higher rates of negative health outcomes and exposure to higher rates of violence, with transgender women of color making up 73% of transgender murders in 2020. Additionally, transgender youth experience disproportionately high numbers of homelessness when compared to their cisgender counterparts," (Abreu et al., 2022).

In the United States, many red states have enacted bills to ban gender-affirming care for TGD youth. For example, in Arkansas, the "Save Adolescents From Experimentation (SAFE) Act" was passed in 2021, prohibiting gender-affirming treatments for minors, including hormone therapy and puberty blockers. Texas proposed Senate Bill 1311 in 2021, seeking to classify gender-affirming care for transgender youth as child abuse, potentially subjecting parents and healthcare providers to criminal penalties. Similarly, Tennessee introduced House Bill 578 and Senate Bill 657 in 2021, aiming to restrict access to gender-affirming treatments for minors. With that, the authors of this article conducted a study to gain insight into parental figures who have TGD children from February 27th to March 20th, 2020. "The aim of this study is to explore parental figures’ perspectives on how bans on gender-affirming care impact their TGD child," (Abreu et al., 2022). The study included 134 parental figures who participated in an online free-response survey, and participants’ ages ranged from 28 to 68, residing in 37 states. The participants’ race/ethnicity ranged from White, Hispanic, Asian American/Pacific Islander, and multiracial. Participants reported their child’s current age between 5-10 years old, 11-15 years old, 16-20 years old, and 21 and older. While participating in the study, parental figures were asked open-ended questions, such as, “What are your reactions to these bills/laws being imposed and/or passed?” and “What would you like for legislators to know in response to these proposed bills/laws?” (Abreu et al., 2022). What researchers found were five themes among the youth that are a result of these antitransgender laws on TGD youth. These include depression and suicidal ideation/risk of suicide, anxiety, increased gender dysphoria, decreased safety and increased stigma, and lack of access to medical care. Some participants gave their advice to legislators/lawmakers regarding these antitransgender laws. "Thirty-seven parental figures advised that TGD youth healthcare should not be controlled by the government or politics but instead by medical professionals, parents, and TGD youth themselves," (Abreu et al., 2022). 

This study relates to the research topic of gender-affirming care because the parental perspectives on these antitransgender bans highlight the dire consequences of legislative bans on gender-affirming care for transgender and gender diverse (TGD) youth. It elucidates how such bans exacerbate mental health issues, increase gender dysphoria, compromise safety, and impede access to vital medical treatments. The parental figures' advocacy underscores the crucial role of healthcare decisions being guided by medical professionals, parents, and the TGD individuals themselves rather than political agendas. Ultimately, this study underscores the critical importance of gender-affirming care in supporting the well-being and rights of TGD youth.

[andrewsoc438]

Terminology

LGBT: Abbreviation for Lesbian, Gay, Bisexual, and Transgender. An umbrella term used to refer to the community as a whole.

Queer:  An umbrella term for people who are not heterosexual or are not cisgender. Originally meaning 'strange' or 'peculiar', queer came to be used pejoratively against those with same-sex desires or relationships in the late 19th century.

Surrogacy: An arrangement, often supported by a legal agreement, whereby a woman agrees to delivery/labor on behalf of another couple or person, who will become the child's parent after birth.

Assisted Reproductive Technology: Any fertility-related treatments in which eggs or embryos are manipulated. Procedures where only sperm are manipulated, such as intrauterine inseminations, are not considered under this definition.

Marginalized: To relegate to an unimportant or powerless position within a society or group.

Disenfranchised: Deprived of some right, privilege, or immunity.

Intersectionality: The interconnected nature of social categorizations such as race, class, and gender as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.

Iterative Coding Process: A process where the design of a product or application is improved by repeated review and testing.

Heteronormative: The concept that heterosexuality is the preferred or normal mode of sexual orientation. It assumes the gender binary and that sexual and marital relations are most fitting between people of the opposite sex.

Dysphoric: very unhappy, uneasy, or dissatisfied: marked or characterized by dysphoria.

Gestation: The carrying of young in the uterus.

TGD: Transgender and Gender Diverse

Testosterone: A steroid hormone that stimulates the development of male secondary sexual characteristics, produced mainly in the testes, but also in the ovaries and adrenal cortex. Can also be used for gender-affirming care.

Estrogen: A group of steroid hormones that promote the development and maintenance of female characteristics of the body. Such hormones are also produced artificially for use in oral contraceptives or to treat menopausal and menstrual disorders. Can also be used for gender-affirming care.Medical Transition: A part of a transition in which a transgender person undergoes medical treatments so that their sex characteristics better match their gender identity.

[efrost]

Global Dravet Syndrome Treatment Market Is Likely to Experience a Tremendous Growth in Near Future

Latest added Dravet Syndrome Treatment Market research study by AMA Research offers detailed outlook and elaborates market review till 2027. The market Study is segmented by key regions that are accelerating the marketization. At present, the market players are strategizing and overcoming challenges of current scenario; some of the key players in the study are Biocodex (United Kingdom)

Epygenix Therapeutics, Inc. (United States)

 GW Pharmaceuticals Plc. (United Kingdom)

Ovid Therapeutics (United States)

 Takeda Pharmaceutical Company Ltd (Japan)

 OPKO Health Inc. (United States)

 Zogenix, Inc. (United States)

 PTC Therapeutics, Inc. (United States)

Biscayne Neurotherapeutics, Inc. (Supernus Pharmaceuticals) (United States)

Pfizer Inc. (United States)

Dravet syndrome is a rare disease and a severe form of epilepsy that is a part of the group of diseases known as SCN1A-related seizure disorders. It occurs due to a mutation in the SCN1A gene, which is required for the proper function of brain cells. The condition appears during the first year of life as febrile seizures. As the condition progresses, other types of seizures typically occur, including myoclonus and status epilepticus. The mortality rate of DS is high, with 15% of patients dying by adolescence and 20% by early adulthood. Moreover, there is no cure for Dravet syndrome but most treatments aim to reduce seizures. But there are anti-epileptic medications available i.e. first line anti-seizure medications, Second line anti-epileptic medications and third line anti-epileptic medications treatments for DS. Seizures in DS is difficult to manage but can be reduced by anticonvulsant medications such as Clobozam, Stiriptenol, valproate etc. As the disorder varies from individual to individual, treatment protocols may vary. A diet high in fats and low in carbohydrate may be beneficial known as Ketogenic diet.

Influencing Trend: Strong Drug Pipeline for the Treatment

Increased Use of New Generation Drugs

Challenges: Poor Healthcare System in Low and Middle-Income Countries

Opportunities: Highly Focused Innovation in Product Technologies

Advancement in Biomedical Sciences

Market Growth Drivers: Rising Number of Treatment Strategies

Increasing Research and Development Activities

Rising Prevalence of Rare Disease

The Global Dravet Syndrome Treatment segments and Market Data Break Down by Application (Hospital Pharmacy, Retail Pharmacy, E- Commerce, Others), Drug Type (First-generation Drug (FGD), Second-generation Drug (SGD), Third-generation Drug (TGD)), Treatment Type (Anticonvulsant, Benzodiazepines, Vagal nerve stimulation, Others)

Presented By

AMA Research & Media LLP

[dreameratbest]

There are several things regarding The Good Doctor this week

Concerning Morgan

What the fuck was with her hair

I'm glad I didn't have to look at it or her bitchy ass for very long

Lea can fuck off

She's slowly turning into Morgan here and it's gotta stop

At first I was neutral because her and Shaun both fucked up, but now it's ridiculous

She's acting like she's the only one who was hurt by this

Shaun has feelings too, and she seriously can't expect him to just be fine with her suddenly coming back after she suddenly left

Of course things aren't going to go back to normal

He tried to make it right and he tried to be nice to her, but she's all "he gave me nothing, this is his fault" seriously acting like he didn't let her stay in his apartment, eat his food, and take up his space and time

And he finally asked and explained that while he didn't care what happened (why would he, he feels like she abandoned and left him for Hershey, Hershey's probably the one thing he doesn't want to talk about), he cared about her feelings.

SHE MADE A BIG ASS DEAL ABOUT HIM NOT ASKING OR CARING AND THEN WHEN HE DOES SHE CHANGES THE TOPIC

Honestly Lea, not everything is about you, and could you please stop being selfish for one fucking minute, it's getting ridiculous and I'm tired of your bullshit

Sorry, I just really needed to rant about that, let's move on: Glassman

Maddie please stop, you're hurting him and he doesn't deserve this

The whole suicide reveal hit me hard

I'm siding with Glassman on this though, like he's such a good guy, I'm sure he did reach out to her and I believe him when he says that she pushed him away

I also think what she did was selfish and cruel. Suicide is never the answer, and does no one any good.

Okay, and then the mom

I can see why people are pissed. "She abandoned her son." She didn't abandon her son, guys, seriously. Yeah, she could've done a bit better, but his health isn't the only factor here- she was clearly stressed and overwhelmed having to take care of him by herself (to the father, I say "fuck you"), putting him in a care facility alleviates some of the stress from her and allows her to focus on her life and wellbeing and not just solely her son's. You guys are acting like she doesn't care about him at all, which is clearly not the case. Anyone with eyes and a brain can see she does, and if she didn't care about him, she would've bailed on him like his dad did.

And it's not like they'd never see each other again, she could literally visit him whenever she wanted and take him out and go do stuff with him whenever she wanted. She did not abandon him, please just stop.

And then, Melendez

Again, everyone's pissed because of how he's behaved in the past and then the producers just throwing in that scene with his sister to make up for it, and while I agree that scene was forced and didn't seem fitting, I think Melendez can change.

Like Shaun in the episode "She," when he had a transgender patient and at first didn't understand it and came across as transphobic, he learned and he became accepting of it at the end of the episode. People are capable of change, and I really believe Melendez is too.

Although, I do agree, this seemed way too forced, and yeah, while it was sweet and touching, I think if they really want to make him a better person and give him a redemption arc, the producers need to take it slower and make it more realistic.

All in all, this episode was a complete mess. It was all over the place and didn't seem to have a core focus. I notice the other episodes weren't just focused around the doctors, but the patients as well, and while this did have patient interaction, it seemed more focused on the doctors. The audience didn't even see a surgery happen, and we didn't get to see any of the doctors really get hands on work experience like they usually do. I don't know about anyone else, but I didn't really like that, and I'm not going to lie, this weeks episode was a bit of a disappointment.

[thegetdownandout]

Genuinely considering spending All of my fun budget on this jacket

[after-nine-at-the-oasis]

Hey guys! I will be liveblogging 9-1-1: Lone Star tonight :). Well, actually, it'll probably be in a little bit, this afternoon. I'm excited to finally be watching it!

See you tonight!

[the-golden-dragoness]

4.25/5

The Paris Apartment by Lucy Foley is not my usual taste but I quite enjoyed this one. It was a good introduction to the mystery genre but it wasn’t mind-bending.

Jess is the main character who goes to crash at her brother’s apartment in Paris, but he’s gone when she gets there. No one in the apartment seems to want to help.

Jess is a good character but is also a good person. I’m not always in the mood to read about bad people solving mysteries but Jess seems so nice :) I was half expecting the characters to seem a bit flat because of the book being a mystery, but I liked how the characters were fleshed out a lot. Even though it only happens in the span of three or four days, the backstory interactions between characters made them quite interesting. There’s no point where you know who is dangerous or not.

It suited my needs well because I wanted a good summer read and I got it

[crossdreamers]

The World Professional Association for Transgender Health Attacks the Republican Anti-transgender Policies

The World Professional Association for Transgender Health has released a letter from WPATH President, Dr. Marci Bowers, addressing the attacks on gender affirming care throughout the United States. Read it. This is important!

Here’s the letter:

//Dear Colleagues,

In the United States, 2023 has been a difficult year thus far for trans rights, to say the least. Although anti-trans sentiment has simmered for years, the exponential rise in TGD [Transgender and gender diverse] identification among adolescents has triggered unprecedented attacks against all things trans. 

American anti-trans legislation

More than 400 anti-transgender bills, particularly in conservative states, see anti-trans messaging as a winning political posture for some. Eleven (11) states alone have already banned or restricted gender affirming care for gender diverse adolescents. 

Last week, Missouri became the first state to attempt gender enforcement on adult populations when attorney general, Andrew Bailey, issued an 'emergency declaration' that added draconian new hurdles for adult trans care to its adolescent ban. 

It is already probable that gender affirming care will be a wedge issue in the 2024 US election cycle.

Cherry-picking arguments

Globally, many of the arguments used here in the US to ban transgender care have been cherry-picked or use narrowly excerpted language for restrictions that have been implemented in gender services policies in Sweden and the UK---'lack of evidence', 'experimental' and 'focus on mental health'. They also ignore European countries where access to trans care has recently expanded (Spain, Portugal, and France). 

And unlike Swedish and British restrictions---which do not end treatment but rather, make research participation compulsory in order to answer remaining questions---conservative US policy makers have no interest in research on TGD medical therapy; they only care about shutting it down. 

Rather than safeguard young people by outlawing automatic weapons and high capacity munitions, conservatives feel that banning trans care and removing LGBTQ-themed books will better protect society.

Anguish and despair

Caught in the middle are TGD individuals, providers, and families, who are now in anguish here in US-affected states. WPATH membership continues to receive stories of growing despair, clinics closing, families moving or seeking healthcare out of state [see link]. Suicidality and desperation are again, needlessly in play.

Telemedicine and the emergence of sanctuary US states (California, Minnesota, and Colorado) that have chosen to defend access to trans care, provide some hope. But real progress on the road back will be difficult until the flow of anti-trans legislation slows and then stops. If there is one reductionist word that WPATH does not deserve, it is advocacy--all scientific organizations participate in some form of advocacy.

Scientific and biological arguments

Photo of Dr., Eli Coleman, American sexologist. He is the director of the Program in Human Sexuality at the University of Minnesota, and a professor in the Department of Family Medicine and Community Health. (Photo from RO)

That said, the scientific and biological arguments can all be won and should continue to be argued. In a recent interview, Dr. Eli Coleman responded 

"WPATH followed a rigorous, multi-year process and was based on the best available scientific evidence and weighing all risks and benefits to arrive at the recommendations in our Standards of Care 8 guidelines. Our multi-step methodology is clearly set forth in the guidelines themselves. 

“When you compare the process we followed, the SOC8 has by far the more robust methodology than any other trans health related guidelines. We had 119 experts from around the world involved, developed PICO questions which formed the basis of systematic reviews, used a consensus-based approach (Delphi) involving all committee members to arrive at our conclusions and then graded the strength of our recommendations. 

“We had an extensive period of public comment on a draft of the SOC8 and this input was checked against the available evidence resulting in the final version of the SOC8. The rationale for our recommendations is clearly explicated in the SOC8 referencing the extant research. WPATH stands behind our process and conclusions."

The recent New York Times opinion piece, "What Decades of Providing Trans Care Have Taught Me", was my take on the situation and can be read here.

Make the suffering visible

The first step on the road back, in my opinion, will be to allow the public to hear the anguish and the stories of those in pain as a direct result of anti-trans legislation, difficult as this will be to watch---and to pin this pain upon those legislators and policy makers who have inflicted the agony. 

In my interview with CBS Evening News to be aired any day, I called it 'legislative cruelty'. The moment we are in reminds me of San Francisco's Harvey Milk and his plea to gay persons to come out. We need to be heard-trans persons, allies, parents, families, politicians, clergy---those who have been hurt and those who know us.

Intersectionality

The second step on the road back will be to unite disparate causes in our fight against a common foe. An attack on trans care is an attack on women. It is an attack on black people, brown people, and Asian people. It is an attack on Jewish, Muslim, Hindi, Sikh, and trut Christian communities. It is an attack on diversity and all of the ideals that diversity holds. It is an attack on us all. 

A majority of Americans favor access to adolescent trans care (see link to NPR-Marist poll) but the support is regional and it is thin. We need to better explain what adolescent TGD care looks like, why it is effective and indicated and who these patients really are. 

Anti-trans legislation needs to be fought with every voice, every thought, every inclination by all who know it. We need to make anti-trans legislation a losing political issue.

A need for sex education

Already lost in this debate is the deplorable state of health and sex education throughout the Southern US. Furthering this ignorance, books are now banned, especially and specifically those with LGBTQI themes. It is of little surprise to many that persistent rates of new HIV infection, incest, and STDs remain highest where sex education is lowest, most in states where anti-trans legislation has been proposed.

What is a woman?

And finally, 'What is a Woman?', the title to a trite and condescending 2022 American movie produced by conservative Matt Walsh, whose edits left out any answer to the question, as though the answer was obvious. 

What was cut from the piece was reality; that nature lacks a definitive answer to the question. Because there is no biological measure----not chromosomes, not hormones, not anatomy nor any of the six other biological markers of sex---a woman is what society sees based upon the gender identity the individual projects. No measure in biology gets it right every time. For every rule, there is an exception. 

Sex and gender are complicated and diverse---but let us explain the phenomena, not allow the issues to be put back in the societal closet. 

Ultimately, what terrifies conservatives most is that gender diversity is a force of nature that can no longer be contained by religious conscription or enforcement of a gender binary.

Killarney, Ireland and EPATH [The European Professional Association for Transgender Health] will again surely exceed expectations as we meet April 26-28, 2023.

Until we all dance once more.

Marci L Bowers, MD//

Dated April 21, 2023

Subsection headlines added by Transgender World.

Source: Erin Reed and WPATH.

Marci Bowers, M.D. of Burlingame, California, is acknowledged as a pioneer in the field of Gender Affirmation Surgery and is the first woman worldwide to hold a personal transgender history while performing transgender surgery. (Source: MarciBowers.com Photo: Drew Bird.)

Top photo: Tero Vesalainen

[sunflowerofchaos]

Dear Melendaire community,

It has been a while since we were all posting about the ridiculous finale. Now it's season 4 and it's safe to say that it's getting worse!

Not only have they killed him off in the most idiotic, forced and rushed way, they also went and thought "oh you know what let's humiliate this character and actor once more and bring him as AS A BLOODY GHOST!"

THE AUDACITY

LIKE THIS IS A BIG F*CK YOU TO ALL OF US

They really said you want him??? Alright here you go have him as a ghost where he says that he is not important and that you should move on.. And then that's it moveeee on and pretend he was never there! And in the meantime have some forced Shaun and Lea phone s*x, you're welcome! Also Idk who is behaving more like a baby Shaun or Glassman... Point is the show is sh*t without:

And now look at the writers suffering from their own doing...

They are getting bad reviews and people complaining [and not only because of Neil's death but also because of how bad the quality is]

They are losing viewers [they lost 3 million viewers between the finale and premiere]

People suspect season 4 is their downfall and last season

Last words,those two deserved the world! They deserved to have idiotic happiness and little kids♥️♥️

I- I really just want tgd writers to suffer for what they did to them..

[vendelbo06thorsen]

Using biocidal items is controlled in the EU.chemicalThis is to check if the degree of threat positioned to health and wellness and also setting by the energetic material from the second source is comparable to the first evaluated energetic substance.Disinfectants safeguard your skin and the surfaces in your house from germs, yeasts, fungis as well as viruses.Alternatively, the substance can remain in the water phase in the STP as well as subsequently wind up in the water area such as surface water etc

. Consumer products: Several customer products consist of biocides, e.Like all living points, microorganisms need food, water and the proper atmosphere to live as well as grow.Biofilms begin as specific bacteria that drift in the water and also when left neglected will certainly move to a location where they affix themselves to a surface area as well as begin multiplying.The typical solution for this issue is routine alternation of 2, or extra, non oxidising biocides in a closed system or open cooling system.The modern-day meaning of a biocide is a formulation including one or more active substances that will certainly-- in really small dosages-- repel, regulate or destroy unsafe microorganisms. There may be circumstances, however, when specialist judgment may show its use (for example, when immune-compromised people exist). Nevertheless, oxidizing biocides position the threat of equipment corrosion as well as unwanted responses with various other hydraulic fracturing chemicals. * [Selective pressure: chemical, physical, or organic factors or restraints which select well-adapted germs or induce the expression of particular biological devices involved in the bacterial feedback to exterior stresses.However, production volumes of many of these substances are considered to be a number of orders of magnitude greater than those of antibiotics., N-bromosuccinimide, NBS) and chlorine-based (e. Fungicides, chemicals or herbicides are all instances of different kinds of biocide.Almost all of the biocidal active materials have a loved one high toxicity, Although the meaning of biocides is rather rigorous, today throughout the Covid duration little difference is made at the nonprofessional degree for disinfectants which contain high does of alcohols and also authorized biocides.The first indicator of microbial contamination is mucous-like buildups on fuel-filters as well as boosted demands for fuel-filter replacement.The transforming industry landscape presents significant difficulties to oil and also gas organisations, which include differing guidelines, changing regulation and also staying within spending plan. This map will certainly assist EPA recognize the level of the evidence as well as educate choice making on EPAs toxicology endpoints for threat assessments, reviewing threat mitigation, and also the need for extra data.They are similar to plant protection items (frequently referred to as chemicals). The term "biocide" can represent a wide range of products and makes use of including disinfectants, preservatives, antiseptics, herbicides, fungicides, and insecticides.These substances are stable while solids and might be utilized in powdered, granular, or tablet form.Biocides can be contributed to various other products (generally fluids) to shield them versus organic problem and also development. Because of biocide chemical , mold growth might repeat if the underlying dampness issue is not resolved.Approved uses, make use of constraints as well as guidelines for secure use can be located from the product packaging as well as the recap of product characteristics.In the authorisation decision of a biocidal item, the product is authorized only for controlling particular organisms in areas where the item can be utilized effectively and safely.The use of two solutions needs exact mixing as well as injection systems for both solutions to make certain that dose degrees are controlled.The Bromgard product array stands for one of the most approximately date cooling water therapy products that combine the latest scale, corrosion and also fouling control innovation with the biocidal power of bromine for applications in the largest possible series of cooling down water systems. Once ESDs appear they are introduced in the European Union System for the Evaluation of Substances (EUSES), an IT tool sustaining the implementation of the threat evaluation concepts embeded in the Technical Advice File for the Threat Evaluation of Biocides (TGD). chemicalThe last priority (and also the very least efficient) are specific control actions: personal safety equipment, such as gloves, masks, overalls, etc. The item ought to be made use of constantly to prevent improvement of this growth.Some daily-use household and medical care anti-bacterials as insecticides, acaricides, rodenticides, preservatives as well as bug sprays are included in that list.One of the primary benefits of using chlorine dioxide is that, unlike most various other biocides, it is able to ruin biofilmThe EU Law on Biocides (BPR, Policy (EU) 528/2012) worries the positioning on the marketplace and use biocidal items, which are used to protect humans, animals, products or short articles versus hazardous microorganisms, like insects or microorganisms, by the activity of the active compounds contained in the biocidal item. Numerous principles are offered for predicting the impact of a mix on the basis of known toxicities and also concentrations of the single components.The listing also consists of the last dates that products with these active compounds can be put on the market.Humans may be subjected to biocidal products in various methods both domestic and also job-related settings.Alternatively, the compound can stay in the water stage in the STP and also ultimately end up in the water area such as surface area water etc.Last yet not the very least, various other fundamental components are the directions of use, the risk monitoring steps and also the risk communication, which is under responsibility of the EU member states. Non-oxidising biocides consist of: quaternary ammonium substances, Bronopol, Gluteraldehyde.Chlorine, dbnpa and also thps dioxide does not generally respond with various other water treatment chemicals or with nitrogen substances consisting of ammonia and normally taking place natural products such as natural acids.As a result, customers have actually been exposed to biocidal items in cured posts that have not been evaluated by the qualified authorities.

[bonita-floare]

Hi long time no see❤

Negent l iim ym bgd dursamjaa mungukj uldeej bgagynh uurt mn yu ymr stgegdel toruulsn bolon toruulj bgag l huwaaltsy. Muu nuuhaar sain ilchil chgshg. Zgr l ireeduid bi hrd iim hrhn jijkn ymn drs az jargal mdreed hunguhun huuruud c blsn depressed bdlasa salj bje gj bdh bh. Tgj bdj bwl on sartai n comm bichrei ireeduin Tuya :^

So, gntsra tglj gunigt awtd, 1 vs sq ugsa yaj bardy tgl tiireel hed hng pubgda orsonq shu. Togloochq bur hylaigaachq hrn tr hrndoo uur zuiles feeling awc bsn. Ter n kino. Emma., 17 again, bohemian rhapsody, geh 3n kinog uzsn ble xD. Awh ym ih bsn oilgj mderc, az jargal bayr gunigiig mdrsn zuils c ih blaa shu. Bas sodoo ah, jawhaa 2-iig animed oruulchihsn. Hamtdaa tokyo revengersiig uzej bga. Kino unher stgeld niitssn gmr gy kino gwl 17 again, emma 2 bn 2langas n uur2 feeling awsn. Ghde movie review gd hrhn bichleg editleed uuruu yriad ng tmrhu video hiiy gd beldd bga ghde hun blgnd uurynh n hooloi trash bdg shd hahah ahin dahin bicheel yaj yrihaa mdq c ymu asuuda grc bga.( like, hund yrihda zgr yriad bsn eswl bichihed uyngaluulaal gy2 bicheed bsn yma blhro yrih daraallaa martah yrian dunda gatsah gh met) za tgd ingj feeling awaal bjisn zgr l ng orood gants tglchy gd orool gntsra huduuruul gantsham bot altsn bsn cn mna kuromi match revision blu ywuultsn tghr n ywjgf gyls garaal tgsn cn agent47, kuromi 2 tgl ireedui orj ireel bid 4 tglsy. Zgr huntei tglhr uhsnde tiiltrq kuromigyn yriag snsd naashn uulhny gj bdsr bgal taarsn. Bas anime uzkeel delgets sharelj bhd kuromigyn utsyg uzsn UwU. Tgel neeh hrhn section bsn mny hamgyn hairtai 3n hun gl(eej n, nz ohin n🥺, tgd duu n bsn) bas uuryh n zurgyg harsn neeh hrhn zurg bsn. Tgl dnda nz ohinyh n zurag(pubg pro n nz ohin n, discord pro n nz ohinyh n zurag, home/lock geeel aimr hrhn) bas chatnda orsn neeh hrhn hairtaishu edr gd orhitson chat mat how cute🥺🙆‍♀️ iim huurhun huuhedtei uchirdag ter ohin aztai gj bdjiisn ghde say bdsn cn bas l iim sngolt hiij ergtei huuhdyg i gj durluulsn ter ohin c bs egel bish sngdsn.(neeh huurhun) ania2 ingeel bdgy mna kuromi😘.

Za tgl gants bot alchaal bi cn lagyn bishu edr gl hahh mna hed c nmg huurguul. Tgsn cn kuro cn 15+ kill edrtei c bh shg ahhha. Tgl bi bs hun edrtei taarhra nuugdyshd end hun aaa gel mna 2(agent, kuro) 2 guigeel irjagan mna ray egch haanen gejisna nmg hrd neeh hrhn modny ard suuchij geel za 🤣 yhu tgl huurhuntuul chiruulel ywq bol mani cn dia orh hudshde tru ss orj cdaq ene ss crown ormr l bnshd.

Uur twndo bi turj bga. Tursn oppai jijgerc bnle xD jin ih buugaq c galbir zasraad irj bnle. Hoid nogoon talbai dr alhaj uuland garaad bs deglem barij bga blhr ur nuluu saitai bga.

2021.07.17(ern 7n saryn adal ywdal ghimuda)

Tursun udryn tuhai dra n tusta oruulna