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ccrpsorg · 1 year

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Clinical Research Monitoring: A Guide to Clinical Monitoring

Clinical research monitoring is a vital part of clinical trials and it involves various activities to ensure the safety and accuracy of the data collected. It is important that the clinical trial is conducted in a way that meets regulatory standards, protects human studies participants, and minimizes potential risks to their health and well-being. Clinical trial monitoring can include activities such as auditing study sites, evaluating data for accuracy and completeness, review of protocols and amendments, reviewing case report forms (CRFs), identifying any deviations from the standard operating procedures (SOPs) or protocols, managing corrective action plans (CAPs), following up on safety reports, tracking progress against enrollment goals and much more. Apart from evaluating data quality, clinical research monitoring also ensures compliance with all regulatory standards like GCP (Good Clinical Practices) ICH (International Conference on Harmonization), FDA regulations and local laws. In addition to this ongoing monitoring throughout a study's duration, there may be audits conducted by sponsors or regulatory authorities at any time during or after completion of a clinical trial. All these efforts are dedicated towards ensuring that the results obtained from a clinical trial are accurate, reliable and applicable for use in making medical decisions.

Steps to Clinical Monitoring

1. Establish an Effective Monitoring Plan: Ensure that the plan is comprehensive and contains all applicable elements, such as the types of monitoring activities to be conducted, frequency of monitoring visits, data collection methods, and specific criteria for acceptable performance.

2. Develop Appropriate Documentation: Design protocol-specific monitoring tools and forms to document information from site visits including source documents, data collection instruments, case report forms (CRF). In addition, develop a Monitoring Log or Tracking System which will enable better accountability for study activities.

3. Execute Monitors’ Visits: Depending on the complexity of the trial and regulatory requirements, conduct pre-study qualification visits (PSQV), pre-initiation visits (PIV), initiation visits (IVs), periodic monitoring visits (PMV) and close out visits (COV). During each visit, ensure that good clinical practice is followed at all times by reviewing source documents and data collection instruments. Review patient enrollment logs to ensure accuracy and record any discrepancies in the visit report.

4. Report Findings: Generate detailed yet concise reports per each monitor's visit with clear recommendations for corrective actions if required; provide professional feedback to investigators regarding their performance; identify any areas of noncompliance with protocol requirements or applicable regulations; recommend training or educational sessions when appropriate; track all follow up activities related to corrective actions taken in response to findings from monitors' visits; ensure that essential documentation is complete before closing out a particular study site.

5. Quality Assurance: Validate accuracy of tracking systems used by monitors during their visits; assess risk associated with various deficiencies identified during monitoring process; carry out periodic internal audits/assessments to ensure compliance with established SOPs/guidelines related to clinical research monitoring activities; take preventive measures based on audit/assessment results in order to strengthen internal quality system processes.

Types of Clinical Trial Monitoring

1. Types of Clinical Research Monitoring: Clinical research monitoring is the process to assess the quality and integrity of clinical trial data and ensure compliance with applicable regulatory requirements. It can be done through three primary methods: onsite monitoring, centralized or remote monitoring, and risk-based approaches.

2. Onsite Monitoring: Onsite monitoring is considered the "gold standard" for clinical research monitoring, as it requires the presence of a monitor at a study site during the entire duration of a trial. The monitor will typically review source documentation such as patient records, lab results, and investigational product dispensing logs to assess accuracy and conformance with study protocols and good clinical practices (GCP). The monitor also interviews staff members responsible for conducting the trial to verify that procedures are being followed properly.

3. Centralized or Remote Monitoring in Clinical Trials: Centralized or remote monitoring enables sponsors to conduct clinical research monitoring without needing to send someone onsite to each study location. This is accomplished by using technology such as web portals, video conferencing, and virtual meetings that allow monitors to remotely review data from various sites simultaneously and quickly flag any issues that arise. Additionally, centralized/remote monitoring allows sponsors to be more proactive in identifying potential risks associated with a trial prior to sending monitors onsite for an assessment.

4. Risk-Based Approaches: Risk-based approaches use data analytics tools such as descriptive statistics and predictive algorithms to identify potential trends or outliers in clinical trial data that may represent heightened risk of noncompliance with GCPs or other regulations. By leveraging technology, these approaches can help sponsors identify issues earlier in the course of a trial so they can take corrective action before something goes wrong.

5. Benefits of Clinical Research Monitoring: Utilizing effective clinical research monitoring strategies helps ensure that trials are conducted ethically, safely, correctly according to protocol standards, within timelines agreed upon with regulatory authorities, and within budget constraints set out by sponsors/CROs/investigators/other stakeholders involved in a study’s execution.. Clinical research monitors act as an independent third party who are able to provide objective insight into how studies are being conducted across multiple sites which helps minimize errors due to bias from investigators or other personnel who may have vested interests in outcomes associated with their studies.. In addition, effective clinical research monitoring helps ensure patient safety by providing oversight about how drugs or medical devices used in trials are administered as well as ensuring patient confidentiality is maintained throughout the course of a study.. Lastly, robust clinical research monitoring protocols help reduce costs associated with delays caused by errors made during trials which can add up significantly over time if not avoided through proper oversight methods both pre-study start up until closeout occurs after all enrolled patients have completed their participation in a given trial

Clinical Research Monitoring Guide

1. Understand the Basics of Clinical Research Monitoring: Clinical research monitoring is a key part of the clinical research process, ensuring the safety and accuracy of results. It involves periodically assessing study sites to confirm that data is being collected properly, according to ethical and legal requirements, as per Good Clinical Practice (GCP) guidelines.

2. Know What Types of Studies are Monitored: Clinical research monitoring can be used for a variety of studies, including clinical trials, observational studies, epidemiologic studies, and public health surveys. It is important to know what type of study you are monitoring in order to ensure that the appropriate procedures are followed.

3. Understand How to Monitor a Study Site: The primary goal of clinical research monitoring is to confirm that the protocol and informed consent form have been followed properly at each site. This requires a thorough review of all relevant documents such as case report forms (CRFs), source documentation (e.g., physician notes), internal audit reports (audit trails), and external quality assurance reports. Additionally, it involves evaluating compliance with GCP guidelines during study visits or remote reviews, as well as conducting interviews with staff members to assess how they are handling data collection and reporting processes.

4. Become Familiar With Regulatory Requirements: In addition to GCP guidelines, there may be applicable regulations from local governments or other institutions that must be adhered to when conducting clinical research monitoring activities. Understanding these regulations is essential for ensuring compliance with applicable laws and regulations related to clinical research activities.

5. Develop an Effective Monitoring Plan: An effective monitoring plan should include a detailed timeline for visiting sites, information about any specific areas where focused attention is required (e.g., enrolling/randomizing patients or managing adverse events), and plans for auditing/reviewing data generated by the study site(s). Additionally, it should incorporate measures for controlling risk associated with data collection processes so that issues can be identified early on in the study process before they become problematic later on down the line.

Clinical Research Monitor Job

The job of a Clinical Research Monitor is to ensure that clinical trials are conducted ethically, safely and in compliance with established standards. The primary responsibility of the monitor is to protect the rights, safety and well-being of the human subjects enrolled in the trial. Duties typically include developing protocols for clinical studies; coordinating study start up activities; conducting site visits; monitoring data for timeliness, accuracy and completeness; auditing files for regulatory compliance; managing investigator queries/issues; preparing visit reports; reviewing update protocols related to study operations; resolving issues raised through audit reports or other sources; providing technical guidance to sites regarding protocol implementation or study conduct; and escalating complex issues or potential risks as needed.

Clinical Research Monitor Salary

Salaries for this position tend to vary depending on education level, experience and geographical location but can range from $60,000 per year for entry level positions up to around $90,000 per year for more experienced professionals. In addition to salary many employers also offer benefits such as paid vacation days, health insurance plans and retirement packages.

Resources for Clinical Research Monitoring

1. National Institutes of Health (NIH): Clinical Research Monitoring

This link provides information on NIH's guidelines for monitoring clinical research, which include topics such as the roles and responsibilities of the investigator, data safety monitoring boards, and protocols for reporting unanticipated problems and adverse events.

2. National Institutes of Health (NIH): Guide to Clinical Research Monitoring

This comprehensive guide walks readers through all aspects of clinical research monitoring, including topics such as study design, randomization strategies, regulatory compliance requirements, data management, monitoring plans and reports, quality improvement initiatives, and safety assessments.

3. US Food and Drug Administration (FDA): Guidelines for Clinical Trials Monitoring

This resource from the FDA outlines the importance of effective monitoring in clinical trials and provides an overview of the different roles within a clinical trial as well as details about essential elements for implementation of an effective monitoring strategy such as risk assessments and adverse event tracking.

4. International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH)

ICH has developed standards that provide a set of harmonized technical requirements for clinical trials conducted across countries in the European Union (EU), Japan, and US with an emphasis on quality assurance and safety monitoring during trials.

5. Association of Clinical Research Professionals (ACRP)

ACRP's guidelines provide best practice recommendations for conducting clinical research studies in accordance with applicable regulations and standards to ensure patient safety monitoring during studies as well as data integrity throughout the process from start to finish.

6. Pharmaceutical Research & Manufacturers of America (PhRMA)

The PhRMA guidelines provide an overview of expectations around clinical research activities with respect to ethics, data integrity, safety reporting, resource allocation and more. It defines roles and responsibilities of all those involved in overseeing a clinical trial such as a Clinical Research Monitor or CRA who has primary responsibility for ensuring that the protocol is implemented correctly throughout a study’s duration

Clinical Research Monitoring Review

1. What is the main purpose of clinical research monitoring?

A) To ensure that a research study is conducted in accordance with applicable regulations and ethical standards

B) To ensure that data collected during a research study is accurate and reliable

C) To evaluate the safety of participants enrolled in a research trial

D) To oversee the financial management of a research project

Answer: A) To ensure that a research study is conducted in accordance with applicable regulations and ethical standards. Clinical Research Monitors are responsible for ensuring compliance with Good Clinical Practice guidelines, protecting participant privacy, verifying data accuracy, and evaluating protocol deviations. In addition, they may also be involved in reviewing participant eligibility requirements, conducting site assessments, providing training to investigators and staff on proper study procedures, as well as monitoring progress towards completion of all requirements of the study.

2. What type of individuals typically serve as clinical research monitors?

A) Physicians

B) Nurses

C) Regulatory specialists

D) All of the above

Answer: D) All of the above. Clinical Research Monitors can come from various backgrounds such as medical doctors (MDs), nurses (RNs), pharmacists (RPhs), regulatory specialists (e.g., Regulatory Affairs Professionals or Paralegals), or biostatisticians/data analysts who have experience in clinical trials and understand local regulations related to human subject protection. Each monitor has specific job duties depending on their education and experience, such as assessing compliance with regulatory guidance or analyzing data sets for accuracy, completeness, integrity, or validity.

3. What kind of activities do clinical research monitors need to perform?

A) Protocol reviews or verifications

B) Ensuring appropriate documentation completion

C) Site visits to observe investigator conduct

D )All of the above

Answer: D )All of the above. Clinical Research Monitors need to perform several activities including protocol reviews or verifications; ensuring appropriate documentation completion; site visits to observe investigator conduct; liaising between sponsors and sites; assisting with resolving issues associated with adverse events; reviewing case report forms for completeness, accuracy, consistency and correctness; evaluating subject safety throughout enrollment process;and writing reports detailing their findings at each visit.

4. What is one benefit gained from having an effective Clinical Research Monitor on-site? A) Reduced risk for legal liability stemming from negligence

B) Improved protocol adherence by investigators

C) Increased patient engagement during trial period

D )All of the above

Answer: D) All of the above . An effective Clinical Research Monitor encompasses several benefits such as reduced risk for legal liability stemming from negligence due to thorough oversight and accurate record keeping; improved protocol adherence by investigators through continued communication between sponsor representatives and researchers on-site regarding best practices; increased patient engagement during trial period due to more detailed explanations about potential risks/benefits offered by having monitor on-site ; and improved efficiency when dealing with complex protocols that require multiple levelsof oversight due to familiarity with protocol specifics which decreases time spent troubleshooting errors or unclear instructions..

5. How often should Clinical Research Monitors visit a particular site?

A) Weekly B) Biweekly C) Monthly D) Quarterly

Answer: C) Monthly . It is recommended that Clinical Research Monitors visit sites at least once per month in order to maintain active surveillance over ongoing studies at each location while also providing timely feedback regarding any issues discovered while on-site visits are taking place within a shorter timeframe if needed based upon changes made midstream or other unanticipated circumstances which might require immediate attention by sponsor personnel.

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pwrn51 · 1 year

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Importance of setting up Power Of Attorney

Betsy Wurzel’s guest is Ryan McEniff the CEO of Minute Women Home Care located in Lexington, MA. Ryan McEniff is also Co-Owner of Well Aware Care which is a software fall detector monitoring service that is available nationwide and Ryan is the Host of “The Caregiver’s Toolbox” Podcast which is available wherever you hear your favorite podcasts. Ryan McEniff discusses how he became involved …

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#Alzheimers #Betsy Wurzel #Caregivers #Dementia #Depression #elderly falls #Finding Clinical Trials #Medication Therapy #Power of Attorney #Ryan McEniff #software fall detector monitoring service

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emorphistechno · 1 year

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Have you ever wondered how healthcare workers are no longer limited by manual processes? Technology has been the cause since it removes obstacles that prevent medical personnel from consulting with patients. Healthcare IT solutions are designed to enhance patient outcomes and facilitate the delivery of treatment. Collaboration and communication among the care team members are crucial given the care environment.

Discover the key healthcare settings and technology answering how healthcare IT solutions simplify clinical communication and collaboration software

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cliniexpertsresearch · 2 years

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Clinical Research Services for Local and Global Clinical Trials - Contract Research Organisation (CRO)

CliniExperts Research Services is your one stop expert solution to conducting clinical trials in India, stress-free.

Clinical trials have several phases and must follow strict protocols all throughout, until the very end. Clear objective of the clinical trial, design, methodology, statistical considerations to the organization of the project, etc must be well-designed and equally well-executed. Errors at any step can lead to complications in the application process.

To enable a glitch-free clinical trial, we provide the following services:

Clinical Trial Management

Clinical trials are complex undertakings and effective trial management is crucial. Our experienced project and site managers along with experts in vendor and data management ensure that each phase of the trial is executed meticulously and timely.

Clinical Project Management

Our excellent team promises to deliver the project as per pre-decided timelines with all the components of the project well-aligned. We ensure this by building a strongly structured trial and executing all it just as efficiently.

Clinical Investigation

Clinical investigation refers to studies performed on live subjects. These could be studies concerning diagnosis or treatment of certain diseases or clinical drug development and methodology. We ensure that the investigative trials are carried out smoothly right from patient selection, to sample collection, testing and analysis.

Clinical Performance Evaluation

Performance evaluation of a clinical trial is all about the authenticity and accuracy of the results and the scientific validity of the results. Trial safety must be ensured at each step. Foreseeing, preventing and navigating through possible pitfalls is what ensures a well-executed Clinical performance evaluation.

#Clinical Research Services #clinical trial services #global clinical trials #local clinical trials #clinical trial solutions #Clinical Trial Management Services #Clinical Trial Registry India #Ethics Committee Registration #Contract Research Organisation #CRO #Medical Writing #Medical Monitoring

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dharmveer · 2 years

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Remote Health Monitoring Apps by SISGAIN in California

#Remote patient monitoring is one of the most well-liked and often utilised telemedicine techniques. It allows a doctor to check on a patient #heart disease #or allergies. Patients feel more at ease as a result of the ongoing monitoring. Maintaining open channels of communication between the pati #SISGAIN is a leading remote patient monitoring services provider in California #USA.#Remote patient monitoring #whether done at home or somewhere else than a clinical environment #is common practice. Since remote health monitoring has the potential to significantly improve patients' quality of life when utilised in th #it should come as no surprise that it is growing in popularity.#Leading Features of the Ideal Remote Patient Monitoring System:#Big data analysis at a high level: RPM can be able to recognise #grasp #enhance #and analyse complicated patterns depending on the data sources. In order to address complicated issues #artificial intelligence (AI) and machine learning employ sophisticated research software #cutting-edge algorithms #and rich visualisations (ML). Based on patient-generated health data #RPM dashboards for clinicians provide alert levels from low to high-risk status. The physician dashboard regularly displays information abo #Dependable cyber infrastructure: RPM initiatives are carried out by several parties #and these parties could employ applications and biometric devices to disclose personal information and whereabouts to third parties #endangering cybersecurity and privacy. One of the major components of a perfect RPM should be a robust cybersecurity architecture.#Information from RPM medical devices that is accurate and trustworthy #assisted by AI: By gathering #analysing #processing #and holistically interpreting vital and physiological data from patients #optimum RPM technology enables the system to assess #test #and measure solutions. Because of its exceptional ability to protect sensitive data while minimising or eliminating human error #it inspires confidence.

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p2pchealth · 2 years

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PBS Transforming Healthcare company integrate new technologies for improving the healthcare services reach to patient from provider faster and safer.

For more info:- Healthcare Software in Bahamas

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genderqueerdykes · 1 year

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

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

The estrogen HRT version of this post is here!

Doctors, Insurance & Getting Your Prescription

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

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

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

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

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

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

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

Stay patient, Stay positive!

HRT and Administering Testosterone

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

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

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

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

Another guide for hormone injections.

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

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

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

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

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

Effects of Testosterone HRT

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

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

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

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

Growth or enlargement of Adam's apple.

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

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

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

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

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

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

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

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

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scuderiasundays · 10 months

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a promise is a promise

summary: sliding into a stranger's dm's, nostalgia for your first date, and a promise sealed with a kiss + a little insta au at the end 💙

words: 1,071

a/n: my first time writing for mr. leclerc! thank you for the req, @headinthecloudssblog 🫶🏼 tagging @vamossainz55, @sainzcaleruega, @monzabee, @formulaforza, @thatsdemko, and @diorleclerc because i trust you all deeply. feedback is much appreciated as always. hugs and kisses!

Charles loved Adele and he sure wasn't shy about it. While the other racing drivers were hyping themselves up with rock, EDM, or rap, the Monegasque’s AirPods (which he often lost) were blaring “Someone Like You.” You, yourself, wondered how the powerful yet melancholy ballad could put him in the right headspace to drive at breathtaking speeds of up to 362 km/h.

You were nothing short of euphoric when it was announced that she would be extending her exclusive residency in Las Vegas. It would be a dream come true if you could see her live during the weekend of the Las Vegas Grand Prix. However, a bitter reality crept in when you discovered the final show was scheduled for November 4, a mere two weeks before the two of you would arrive stateside. Charles would be racing at Interlagos, while you would be stuck at a clinical genetics conference in St Andrews.

“I was going to get us tickets to thank you for your service in the Great War!” You huffed as you watched Charles tie the laces of his Puma running shoes, visibly let down by the news. All of your friends thought the racing driver had used his F1 connections to get you those coveted floor seats, but they couldn’t have been more wrong. Your boyfriend had spent 18 hours in a virtual queue on one of his few days off, using multiple of his sim racing monitors to secure tickets to the Eras Tour. Arthur had mocked his older brother about how “whipped” he was, joking that he was relieved someone else’s screen time was as horrific as his own.

With a light kiss on your neck, Charles wrapped his arms around you from behind, his voice filled with affection. "It’s like this, ma chérie. I'm going for a run with Andrea," he whispered. As he headed towards the door, his shoulders slumped and his AirPods in, it became clear today's run would be more of a recovery run, a moment for him to recharge physically but more so emotionally.

Determined to bring Charles closer to his idol, you swiftly grabbed your phone from the kitchen island and opened Adele's Instagram profile. Sliding into someone's DMs had never been your style, let alone that of a Grammy-winning artist, but you figured there was nothing to lose.

"Hi, this is Y/N. I know it's unlikely that you'll ever see this, but I'm taking a leap of faith for my boyfriend Charles, who is undoubtedly your biggest fan. Our first date perfectly encapsulates his essence," you began typing, a wave of nostalgia washing over you. "He took me on the most gorgeous twilight yacht ride, accompanied by a meticulously curated playlist of his favorite songs. Upbeat songs like 'A Sky Full of Stars,' 'Pepas,' and 'Feel So Close' filled the air. But then, out of nowhere, a hauntingly beautiful piano melody began to play."

Pausing for a moment, a reminiscent smile graced your face as the memory came roaring back to life. "'Is this Adele?'" you had asked, a glass of rosé in your hand. Charles looked so at peace compared to the tense expression he sometimes wore during race weekends. He had offered you his blue Ferrari sweatshirt to ward off the evening chill and confirmed that it was indeed Adele. Charles shared that he, unlike most, found comfort in what he deemed “depressive music.”

Since that fateful evening, the British songstress' music had become an integral part of your relationship. It served as the soundtrack to your road trips, where you took turns belting ‘Rolling in the Deep.’ It sparked heated debates about whether Adele’s ‘Daydreamer’ or Sade’s ‘By Your Side’ should be your first dance song. It even led to late nights, downing espresso shots just so you could listen to her latest album the second it dropped.

You reached for your phone once again. "That night ended with Charles’ hand resting on my thigh as he drove me home to 'Make You Feel My Love.’ Your music has been the soundtrack to so many of our most intimate moments, and it would mean the world if you could find some time to perform for him," you typed, pouring your heart into the message. You added, "I know this is a long shot, but I..." before eagerly hitting the "Send" button. With a growing sense of accomplishment, you decided to run to the grocery store to pick up some fresh salmon for dinner.

Unable to keep a secret to save your life, you shared what you’d been up to with Charles. "You DM'd the queen? Je t'aime, ma belle, but I highly doubt she'll reply," he playfully teased, rolling his eyes as he wiped the dish you had just handed him.

"What if she does?" you retorted, a hint of hope in your voice. "You know how I treasure you so much I don’t even trust myself to take you on a hot lap? We’ll do it in Las Vegas if and only if Adele responds." His devilish Leclerc wink accompanied the mischievous remark, leaving you to wonder how this crazy turn of events would unfold.

Weeks passed, and with each passing day, the likelihood of a reply dwindled. Charles was away in Qatar when the doorbell unexpectedly rang. A courier stood before you, holding a grand bouquet of white roses along with a message card. Assuming it was from him, your hands trembled as you read the sign-off on the ivory white card. There it was, unmistakably etched in the most elegant script. Five letters. Adele.

You snatched the card eagerly and read it over countless times, overcome with disbelief. It turned out that Adele's devoted fan base had made her very much aware of Charles' fanboying. She expressed her delight and confirmed that she would be more than happy to sing a few songs for you over dinner so long as she could score some “cool mom points” and bring her son Angelo to the race.

Your hands trembled with sheer excitement as you shared the spectacular news with Charles. He blamed his nonexistent allergies as tears welled up in his eyes, but you saw right through his lies.

"So, you'll be taking me on that hot lap, Leclerc?" you grinned, blissed out seeing him so happy. "Bah oui, une promesse est une promesse," he replied, sealing his vow with a well-earned kiss.

﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏﹏

liked by charles_leclerc, arthur_leclerc, and 61,616 others

yourusername: weekends with adele (and charles) 🎰🍸❤️

fan1: “it’s true that, after a bad day, if you listen to that, you cry. you don’t feel any better. but i like it. i like the mood of depressive music.” - chuck leclerc

charles_leclerc: i have the best girlfriend in the world! tu est simplement la meilleure ❤️

adele: she’s one of a kind! thank you for letting me bear witness to your love x

yourusername: you, sir, are the love of my life. thanks for tolerating my impulsivity!

fan2: i need a charles and adele collab and i need it NOW 😤

joris_trouche: he’ll never shut up about this

charles_leclerc: prepare to be sick of me! wait, you and @andferrari007 already are 🫣

scuderiaferrari: c² music challenge but adele songs only?

carlossainz55: why play when i don’t even stand a chance 🤨

#charles leclerc imagine #charles leclerc x reader #charles leclerc x y/n #charles leclerc x you #charles leclerc edit #charles leclerc #f1 x you #charles leclerc fluff #f1 imagine #f1 x reader #f1 fic #f1 instagram au #charles leclerc one shot #charles leclerc instagram edit #charles leclerc blurb #charles leclerc au #charles leclerc drabble

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going-to-ikea-for-the-fries · 17 days

Note

Ayo can we get a hot ass "keep my wife's name out your goddamn mouth" Kathy x John

Kathy does routine physical exams obviously and in the showers Price overhears some locker room talking about his wife, how they'd like those hands to go further, like how she bosses them around etc.

Cue him rounding the corner to give them a solid punch and "Don't you dare utter my wife's name again"

Up to you if she rewards him ☺️

yes you fucking can!!!!

That's My Wife!

pairing: F!OC: Kathleen "Brass" Moore x John Price words: 1.5K~ cw: jealousy, protectiveness, arguments, violence, injuries (mentioned), misogyny, sexually-charged comments, "locker room talk", smutless smut.

The worst time of the year for the army medical staff at Tidworth is September. Oh, how the nurses and doctors hate the month of September during which, for two weeks straight, they see nothing but soldier after soldier for health checks and physical exams to confirm that they’re fit for service.

It’s, unfortunately, repetitive, mind-numbing and time-consuming. It’s also, unfortunately, a whole hands on deck situation. So, everyone who’s not actively doing something else, gets called in to help process the soldiers.

That’s how Kathleen ends up, every year, in the clinic, helping physicians assess the soldiers. Her jobs tend to be easy. More of the same that she tends to already do: measuring heights and weights, calculating their BMI and body fat percentages, using the stethoscope to listen to their heartbeat and breathing, manning the blood pressure gauge…

And, of course, the most interesting stuff. Conducting stress tests and having to strap all sorts of machines and sensors to the soldiers and monitor how they perform as they run on a treadmill, as well as doing physical checks on old injuries, scars…

In short, she spends a long time in front of shirtless men… and even longer touching their chests, arms, backs, and sometimes their legs, to check for injuries, which often ends with her crouching or kneeling at their feet.

And, of course, the stupid soldiers can’t keep their mouths shut. More often than not they make a few remarks about taking her out later, about coming to see her more often, of being lucky they get her for their checks…

It’s a nightmare. Kathleen hates it. In fact, she wishes she wasn’t tasked with that every year… But the choice is her or risking one of the pretty new interns having to do it, girls who haven’t yet developed the thick skin she has, and would likely giggle and get flustered at the lads behaviour… instead of calling them out on it or just downright ignoring them.

September, as it turns out, is also a nightmare for John. But he only figured that out today.

After his Bravo team finished training for the morning, John allowed them to hit the showers and he stayed behind to finish some work and talk with Soap.

As they enter the locker room, the rest of Bravo team is already in the communal showers, talking loudly amidst themselves and laughing, their voices echoing amidst the spraying of the showers over them.

John pops open his locker and starts shedding his workout kit, tossing it into his bag on the shelf. Soap isn’t far from him, a few lockers up, in the adjacent wall, his locker door having his name ‘MACTAVISH’ inside the clear plastic name tag holder, with a post-it naming him ‘F.N.G’ scotch taped below it.

John doesn’t need to pay much attention to know they’re talking about women, especially, the nurses from the nearby Tidworth base. All of them had gone through their check-ups in the last couple of days and, as is typical, they couldn’t keep their traps shut about the pretty women with soft hands doting all over them.

“Oh, mine bent over and pushed those tits of hers right up to my knee.” One of them said.

“Lucky bastard. I got a bloke.” Another replied.

Oh, how many times John had told them to be quiet and keep those sorts of talks to themselves when they were at the barracks, and not in public… But did those knobheads listen? No, never.

John grabbed his towel and 2-in-1 shampoo and bodywash and headed into the showers, taking up one of the vacant spots and drawing the curtain after hanging the curtain just outside his stall.

“I swear she was giving me the look… Definitely wants a piece of me.”

“No bird would want a piece of yer ugly mug.”

The lads continued talking as he let the water run over his body and began quickly lathering himself up with his 2-in-1, washing his hair and face aggressively before running his head under the falling shower water.

“I’m not devout, but this new batch’a nurses they got this year makes me a believer.”

“That’s right, brother.”

One-by-one they started vacating their stalls, still chatting loudly about their check-ups and the young women that treated them, lounging about the locker room and making each other laugh.

“But that arse of hers… I just know she’d bounce so well on my cock-”

“Oh that’s nothing. You didn’t see her last year before they changed the colour of the scrubs… That blue colour just… mmmmm…”

John finishes his shower not long after, wrapping his grey towel around his hip and tying it up to stay still. Then, he collects his 2-in-1 bottle from its perch atop the metal piping of the shower and starts making his way back.

That’s when he hears it:

“It’s no wonder the Captain’s peacockin’ himself around like that… I mean have you seen the size of her tits?”

John’s blood runs cold. They wouldn’t fucking dare. They wouldn’t talk about Kathleen.

No.

Not they.

Him.

Sergeant Ellis Evans.

One he’s always had problems reining in.

“Captain’s lucky is all I’ll say… Body like hers… Hell, even I’d forgive that bloody attitude of hers.”

The others laughed as Evans continued.

“I mean, I’m sure Kathleen’s mouth’s good for more than just talking… Gotta be good on her knees.. They call her ‘Brass’ for a reason, right? Bet she leaves ‘em with a nice polish and shine once she’s done.”

That did it.

John rounded the corner into the locker room and, abruptly, the room fell into silence, breaths hitching and the temperature dropping into an uncomfortable ice.

But John didn’t stop walking at the doorway… In fact, he beelined right for Evans.

“Captain, I-” Evans immediately tried backtracking. “We were just joking, we were just-”

“Keep my wife’s name out your bloody mouth.” John grits at him through clenched teeth before he throws a right cross to Evans’ face.

It’s just past 7P.M. when Kathleen comes in through the front door. John has made dinner for them and little Charlotte is already asleep in her crib by the time she does.

She sets her bag down in the entrance, takes off her shoes, and pads over to the kitchen in search of John.

“Hi…” She greets him softly as she approaches the table, causing him to swivel on his chair to greet her, wrapping his arms around her waist.

She presses a kiss to his mouth, which he returns. “Hi, Da’lin’.” He murmurs to her once they separate.

“Is she down?” She asks in a soft tone as she looks at him.

“Mhm… Full belly and empty diaper.” He tells her, which makes her smile softly, seeming relieved.

Kathleen feels exhausted, as usual, still not used to the work-life balance that comes from having a 4-month-old baby who doesn’t like to sleep + and a physically demanding job that runs on a 12-hour-shift schedule.

John swivels back to his previous position, nursing a glass of whiskey with his left hand, the right one resting on the table, the knuckles covered by a blue gel ice pack.

“So that’s what happened...” Kathleen muses as she glances at his iced hand, before backing away to grab herself a plate of food from the cupboard.

“What is?” John murmurs as he glances at her, watching her serve herself of some frozen lasagna and salad.

“One of your lads ended up in my emergency room after some ‘roughhousing gone wrong in the locker room’... I was musing about what he did all afternoon.” She quips as she pads over to the table again again.

“Hm.” John mutters quietly, seemingly a mix of embarassed and annoyed at that fact.

“So what did he do?” She asks as she takes a seat on his lap, perched on his lap, as she pops a cherry tomato in her mouth.

“Talked about you.” John murmurs, wrapping his free arm around her waist. “Only I get to say debauching things about My Wife.” He grumbles as he looks up into her eyes.

Kathleen rolls her eyes at him and shakes her head, but she can’t help the smirk that takes over her rudy lips as he calls her ‘his wife’. “My, Mr. Price, defending my honour, huh?” She jokes as she pops a bit of lettuce in her mouth.

“Defending my honour… and yours by proxy. Just an unforeseen consequence of it.” He tells her, trying to act nonchalant about the fact he broke a man’s nose, eyesocket and three of his ribs, for demeaning his wife.

“Right… Of course… How stupid of me…” Kathleen teases as she leans toward him, pressing a soft kiss to his lips, which makes his blue eyes close, a smile taking over his features.

“As opposed to… what exactly? There isn’t much up there other than thoughts of my cock, da’lin’.” John remarks, causing her to roll her eyes, annoyed, and flick his head away from her by pushing his cheek, annoyed.

“I can very well just stop thinking about it all together… And I’m sure you wouldn’t want that when I was just about to reward you for defending me…” Kathleen teases as she pops another cherry tomato in her mouth, eyes locked on John and the way his pupils dilated, his cock already stirring awake in his joggers against her ass in her green scrubs.

#ikea writes 💚#tw violence #tw misogyny #tw injury #cod x reader #cod fanfic #masterlist #call of duty #cod fandom #cod oc #oc: kathleen “brass” price #price x kathleen #john price x oc

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momkat · 6 months

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If you are in the USA today, go VOTE!!!

So many people only vote in presidential elections when it is the smaller more local elections that have so much control over your lives!!! The president is not a king and can effect NOTHING if they have a hostile congress!! Congresspeople come from smaller local government offices! VOTE! VOTE! VOTE!

If you don't show up to vote against, then you are voting for. A mediocre candidate who votes FOR you in office most of the time is still better than a hostile candidate who will vote against you while in office. If you can't vote for, then at least vote against!

Vote LOCAL!

School Board – Your local School Board is responsible for:

Content of your sex education including gay sex & safety, and all the sexual variants that real people have.

whether gay marriage can be talked about in school

whether a child gets called their chosen name vs their dead name in class.

all policies about trans kids, including anti-bullying policies

whether or not your school has to tell parents that you are identifying as queer. (If a kid is not telling their parents that they are some form of alt/queer/non-b THERE IS A REASON FOR IT. Schools telling these parents can result in abuse, shaming, being kicked out of the house, being 'beaten straight' etc.)

Access to gender affirming care in the clinic or counselor's office

Book bans – school book bans are often used as a step/justification for book bans at the local library.

The content of your history class. Whitewashing slavery. Whitewashing Nazi Germany. Whitewashing colonialism.

And much, much more. In addition, School Boards are often a stepping stone to larger offices. The progression is: School Board, City/County board, State office, National office. If you want state and national officials to support you, you have to grow them at the LOCAL LEVEL!!!

City/County Government:

How much money schools get. (And therefore can effect/dictate policies.)

How much money cops get. (And therefore can effect/dictate policies.)

How much money public services (firemen, local health services, libraries etc) get.

Local government regulations & laws (i.e. being arrested for 'indecency' because you are in drag.)

And again, don't forget that these are the 'feeder' offices that lead to government offices. These people go on to state offices!!

Your STATE Legislature is responsible for:

All abortion policies. Since Roe v. Wade has been tossed there is no federal prevention against any abortion policies.

All sexual health policies. From birth control to sex changes. Their laws can range from sensible to inhumane.

All CIVIL RIGHTS policies that are not explicitly guarded and monitored by the federal government are left up to the states. Take a look at Louisiana, Florida, Mississippi, Arizona, etc. if you want examples.

And, of course, they can dictate policies to smaller municipalities (see City/County).

The most likely State office that leads to the presidency is Governor or a state. If you want better presidents, you need better governors!

Gerrymandering:

“But...but, but... I am gerrymandered so it doesn't make a difference if I vote!!” It DOES! If you are in a gerrymandered district and the crazy left wing crusader wins with a landslide because you DID NOT VOTE, then their party will keep putting in crazy right wing crusaders! If the vote is closer, EVEN IF YOU LOSE, their party is more likely to put in a more centrist candidate because they don't want to risk losing the seat. In addition, voting records are used to determine 1) the NEXT time areas are redistricted and 2) To show severe gerrymandering to courts to OVERTURN gerrymandered districts and force a redistricting. Right now there are people who are wining court case after court case to force redistricting of gerrymandered states and they are using voting data to do so!!! VOTE!!!

Please re-post this. Please blaze this. Please pass it on. PLEASE VOTE!

#VOTE #Please Vote #If you don't vote you get crazy left crusaders

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earthstellar · 2 years

Photo

It’s 3 AM on a Monday Morning: Let’s Talk About Pharma

I cannot emphasise enough how Pharma was possessed/resurrected by literal space gods and the very first thing he did, leading up to the panels above, was to monitor his ex-not-boyfriend via security cameras-- presumably at least in part to ascertain if Ratchet had a new boyfriend or not-- solely in order to overpower the space god possessing his frame so that he could enact “revenge” and kill the shit out of his ex-not-boyfriend’s new boyfriend immediately.

The very first thing Possessed Pharma actually does is have Drift shot as close to the spark as possible via targeted and clustered minion open fire.

Just prior to these panels, Pharma watches the security cameras for at least a brief period of time and immediately singles out Ratchet (and whoever appears to be closest to Ratchet) to ensure that his initial shots upon entering the deck are guaranteed as possible to destroy Ratchet’s new boyfriend and ONLY Ratchet’s new boyfriend (most of the other minion shots go wide/miss most of the others/don’t give as much damage to other bots present).

There is no indication that Possessed Pharma would have given that much of a shit about any of what was going on, had it not been for Pharma’s deep seated obsession with Ratchet immediately kicking in the second he realised Ratchet was actually on board.

It completely derails whatever the original plan might have been to address the loss of the God Gun. He 100% pivots towards getting the fuck down there with two new core objectives: 1) Obtain Ratchet and 2) Destroy Bot Most Likely to Be Ratchet’s Boyfriend

Essentially: Pharma is so petty and so invested in Ratchet that it overpowers the influence of a literal god on his spark, processor, and frame-- Total possession, totally overridden by his instinctual petty needs.

(There is quite possibly also a further motive in the form of wanting to just generally isolate Ratchet the way Pharma felt isolated; Aiming at Ratchet’s closest friends and colleagues has a lot of intent behind it...

We see most medic characters tend to be social or actively at their best and most comfortable when with other people. First Aid is even part of a gestalt. We know Pharma did reasonably well in the past, right up until being stationed as a sole medical lead in an isolated location.

There’s nothing in canon that explicitly states that medic type bots might do better in groups, but it does make sense for the nature of the work, and we tend to see medic characters that have fairly social personalities or tendencies. So this is just my conjecture, but I have a whole too-long-post planned about Cybertronian class/caste and social behaviours in the works anyway...!)

I know that we all already know all of this, but I feel like the sheer level of both pettiness and genuine obsession is core to what makes Pharma an effective and frightening villain.

We’ve all seen a million “unhinged doctor” type enemies in all kinds of media before, but Pharma is somewhat unique among them in terms of how he got to this point, and how his obsession realistically developed.

He knows what-- and who--he wants.

Death can’t stop him.

God can’t stop him.

It creates a far more effective unsettling vibe to Pharma overall; He’s not just dangerous due to medical knowledge and skills, but we know that he’s going to inevitably make unpredictable mistakes because his sheer obsessive focus on his points of interest have potential to fuck up his higher reasoning.

It’s not just Ratchet he’s obsessed with, either.

Pharma at Delphi: Loneliness Under Duress and the DJD

He was obsessed enough with running his clinic effectively enough under difficult conditions to provide care to an isolated and vulnerable population, at the very least to the degree that it’s hinted that he had such a focus on keeping the doors open and continuing to service those in need that when the DJD initially approached him. (Keeping in mind, of course, that a visit from the DJD is very much in the overwhelming majority of cases a brutal and horrific death for all on site.)

We can assume that in engaging with Tarn, even though Tarn approached him first and specifically sought him out, that Pharma did his best to negotiate not just a reasonable “way out” of death for himself-- But for his patients and staff as well. The end deal was X number of t-cogs at X intervals, and you leave me, my staff, and the rest of my patients alone.

It’s an unwinnable situation: Any deal with the DJD in such a situation essentially boils down to “Commit atrocities, or we will commit worse ones”.

He clearly felt the need to continue his deal with Tarn despite the spark-crushing, processor-warping level of moral injury it caused him to do, so out of an effort to continue providing medical services as needed-- For those who wouldn’t be effectively harvested for their t-cogs, at least.

He viewed it, most likely, as a sacrifice of few so that the many could still receive treatment.

His mindset on this may have been warped by his service as a medic during the war, although we have very little to no canonical information on what Pharma was really up to during the war for the most part, so it’s hard to say-- We do know that he worked with the New Institute, so who knows.

But obviously, in the past, Pharma was well-adjusted; Even when working at the New Institute, which is when the panel below takes place.

He was intensely devoted to his patients, took pride in his job. He was a good doctor, as far as we ever see him working in the past, and we do get to see a few glimpses of him administering what appears to be compassionate care.

It’s unclear at what point various traumas from war etc. may have started to derail him, thus priming him as an ideal victim for Tarn to manipulate, and that’s something that needs to be remembered:

Pharma is a victim of the DJD.

He’s not a bad guy for evil’s sake; He set out to do good, or as good as possible given the circumstances that gradually developed. He wanted to make the best of an impossible situation for the sake of those he might still be able to save.

It’s suggested that Pharma created the rust plague as a way to justify the closing of the Delphi site-- Which in and of itself suggests a serious level of desperation; It may have been during the creation of the rust plague that Pharma genuinely suffered a mental break of some kind. It’s a sign that he saw no way out, the situation was becoming unbearable/untenable, and he realised that Delphi needed to close somehow before it purely became a harvesting factory for Tarn’s t-cog demands.

It’s a sign that he felt so isolated, even from his own staff, that he did not feel able to reach out for assistance.

Left as the sole authority under such severe pressure, with all the typical pressure that comes with being in charge of the wellbeing and care of others also bearing down on him in a remote location with supply concerns etc., it’s very easy to see why Pharma eventually folded-- It was inevitable.

He was under duress for an indeterminate amount of time, with very little outside assistance if any, with a limited number of staff who he evidently did not feel he could reach out to-- Either because of medical hierarchy nonsense (which is unfortunately a very real issue in actual real life medical systems) or out of a desire to prevent his other staff members, most of whom are junior medics, from potentially getting looped into the deal with Tarn and the DJD themselves.

Pharma is uniquely effective as what would otherwise be a very stereotypical “mad doctor” type villain, because he is genuinely unwell, and we can understand fairly clearly how that happened-- Even with a lack of much background elaboration on Pharma’s past, and without having all the details of the lead up to where we pick up the Delphi situation.

Pharma had a mental breakdown under sustained duress which spiralled into far more unhinged actions, but those actions--while not excusable--are at least understandable.

Because what do you do when you’re all alone, you have vulnerable patients at risk, you only have junior medical staff who are part of a terrifyingly small number of available/still alive medics post-war (which must also be taken into consideration when potentially sharing information with them which could place them at greater risk themselves), and the DJD-- a group of people that will kill everyone in the vicinity regardless of anything if their demands are not met-- is knocking on your door?

It’s likely Pharma fixated on Ratchet because not only is Ratchet an exemplary medic, but because Ratchet seems to be one of the few colleagues Pharma was ever particularly close with in the past.

In isolation, particularly in prolonged periods of isolation (famously, a few case studies exist involving prisoners held in solitary confinement for at least 12 continuous months, although I won’t link those reports here as they may be genuinely disturbing for some people), it is known that there is often a tendency for people at an intermediate stage of cognitive degradation caused by extreme isolation to mentally fixate on family members, close friends, colleagues, or any person or people they can more easily bring to mind-- People that they have formative or significant memories about, for example.

(Part of this is simply because it is easier to imagine these better-remembered people in greater detail, which helps provide a slightly greater degree of mental stimulation while in total isolation. Among other reasons, but anyway!)

Ratchet fits that description for Pharma.

A more mild version of this has also been reported to some degree by several adventurers/explorers, such as those who go on long term expeditions to isolated areas such as high elevation mountain caps--- An apt comparison, given the icy and isolated location Delphi is located in.

Many explorers who survive gruelling expeditions mention fixating on a photograph of a loved one, or imagining what advice their friends would give them if they were present, or even talking out loud to their friends as if they were there-- Which is also useful for regulating breathing at high altitudes, so this serves multiple physical and mental purposes, for what it’s worth!

But given the way Pharma monologues to Ratchet towards the end of the Delphi rust plague incident, it very much gives me the vibe that Pharma had likely been fixating on Ratchet for some time prior to Ratchet’s arrival at Delphi, and it may even be indicative that Pharma is at a point of mental stress where he may have been monologuing to an imagined Ratchet prior to where we step into the Delphi situation.

Which is just my conjecture, as nothing suggests this in-canon, but it wouldn’t surprise me at all if this had been the case to at least some degree. Pharma’s ranting to Ratchet is very effectively unsettling and disturbing, especially with the in-universe context that Pharma in the past had been a very calm and effective medic.

Stress and isolation and prolonged duress do things to people. Oftentimes, bad things. What happened with Pharma is overwhelmingly sad, and that lends greater weight to how frightening his behaviour is later on.

This is someone who was unable, for whatever reasons, to get any help dealing with a nightmarish ultimatum under difficult circumstances while in relative isolation, with a lot of responsibility and professional stress bearing down on them throughout. It’s a realistic setup for a brutal downfall.

Pharma undoubtedly had a connection to Ratchet going back a long way, both personally to some degree as well as professionally, but whatever else may have been going on with him between then and the end of the war, it seems the DJD and Tarn specifically may have ultimately been what pushed his tendencies for high independence and self-motivation towards fuel for obsessive behaviours.

It seems to me as though, to some degree, his obsession with Ratchet may have initially manifested as an attempt to cope and stay on top of things-- At least for a while. Ratchet was a good colleague, a friend, a great example of the type of CMO to aspire to be.

But the DJD leaves no survivors. Pharma is not an exception; It just took him that much longer to die, and he suffered-- particularly mentally-- the entire time.

Which doesn’t justify anything he did. But we can understand why he went on to do those things.

And upon being resurrected as a frame-puppet for a space god, that fixation-- Ratchet as a sole point of focus, warped from being a coping method under isolation and duress to being a genuine full-blown obsession-- continues to drive him through what is, really, a horrendous situation there, too.

It lets us know that the bots possessed by these gods are conscious, to some degree, in their own processors. They are aware to some degree, but their frames are moving beyond their control, their processors are muddled with the thoughts of a cosmic entity.

That has potential to be terrifying-- And Pharma is powering through, once again, fixating, raging against impossible circumstances, inevitably failing.

Pharma is, fundamentally, a doctor who fell prey to manipulation under threat of death and suffered severe mental health challenges as a result, and owing to ultimately being unable to cope, committed atrocities, acts of abuse of power, and violence while developing obsessive fixations with periodic episodes of acute manic behaviour.

Things only spiralled out from there; Again, not excusing Pharma’s actions, especially as he does seem to have a reasonable degree of clarity/lucidity while in the process of setting up and/or actively committing several heinous acts even when they are bookended by what might be considered manic episodes (I really wish we had more canonical information on how Cybertronian processors function), but we can absolutely understand how he got to this point.

And it’s rare to see a realistic and understandable “mad doctor” type character, so I appreciate Pharma as being a great example of how to do “mad doctor” correctly.

Also, it’s hard to make such a character be in any way funny, but even though Drift getting shot is not funny, we can still make the connection that Pharma truly is interested in Ratchet to the degree that in his mind, Ratchet’s periphery-- friends, colleagues, boyfriend-- are targets for him as well. Which is frightening. And also sort of easy fuel for fandom, which is helpful to offset the horror.

It gives us an “out” from the potentially depressing background of Pharma, in that we can acknowledge the realistically serious and disturbing nature of his obsession with Ratchet, and the upsetting nature of his downfall, while also being able to say “lol so gay for Ratchet” and do normal gay fandom shit, which makes some of the extreme violence slightly more bearable for us as audience members/readers. (I love gay Pharma memes; I also cried at the end of the Delphi arc, at least twice. All things in good balance, lmao)

JRO really nailed it with Pharma; This is a character that has been extremely well-written and well presented, especially considering the fairly limited amount that has actually been written for the character! We really only have the Delphi Arc and the somewhat brief later on shenanigans towards the end of Lost Light for any direct content involving Pharma, but we can still piece together this much from that comparatively little. 10/10 Nicely done.

tl;dr it’s fun to talk about how Pharma is so gay for Ratchet that he overpowered a god in order to shoot Ratchet’s new boyfriend, because yes, but also, holy shit I have feelings about Pharma

if you read all this, thank you so much! <3

it genuinely is 3 AM on a Monday morning at the moment, now almost 4 AM LOL, so I have not edited this at all lmao, and I apologise for any errors etc. that there might be. <3

[Source: Lost Light Issue #22, MTMTE Issue #17]

#long post #maccadam #maccadams #pharma #tf pharma #idw pharma #idw 1 #mtmte #lost light #transformers #idw transformers #tf ratchet #idw ratchet #dratchet #medbay posting #analysis post #tf analysis

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regina-bithyniae · 3 months

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I have these lumps on my fingers like my left pinky:

Between hand joint and knuckle. Another on my right index ringer. It get a bit painful in cold weather, and is firm but not bone hard.

Girlfriend said I need to see a doctor but I don't get any paid sick leave or vacation in my job and I'm too busy with second job outside of work hours so that's not happening when clinic wait times are three hours.

But ChatGPT says it's just a ganglion cyst, which is worth monitoring but is noncancerous, probably won't spread, and doctors probably won't care about anyways. So that's a few hours saved!

I think this is a microcosm for the future: increasingly dysfunctional and useless public services and institutions but technological workarounds possible if you think about it a little.

#econposting

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tomorrowusa · 3 months

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Trump White House staffers were apparently big pill poppers. And we're not talking about generic ibuprofen or Vitamin C.

The White House has its own pharmacy. It's run by the military because the president happens to be commander-in-chief of the armed forces. But during the Trump administration things went awry – as you might expect.

For years, the White House Medical Unit, run by the White House Military Office, provided the full scope of pharmaceutical services to senior officials and staff—it stored, inventoried, prescribed, dispensed, and disposed of prescription medications, including opioids and sleep medications. However, it was not staffed by a licensed pharmacist or pharmacy support staff, nor was it credentialed by any outside agency. The operations of this pseudo-pharmacy went as well as one might expect, according to the DoD OIG's alarming investigation report. The investigation was prompted by complaints in May 2018 alleging that an unnamed "senior military medical officer" was engaged in "improper medical practices." [ ... ] Provigil is a drug that treats excessive tiredness and is typically used for patients with narcolepsy, sleep apnea, and other sleep disorders. Brand-name Provigil is 55 times more expensive than the generic equivalent. Between 2017 and 2019, the White House pharmacy spent an estimated $98,000 for Provigil. In that same timeframe, it also spent an estimated $46,500 for Ambien, a prescription sedative, which is 174 times more expensive than the generic equivalent. Even further, the White House Medical Unit spent an additional $100,000 above generic drug cost by having Walter Reed National Military Medical Center fill brand-name prescriptions.

While they were plotting to repeal Obamacare for millions of Americans, Trump staffers were getting brand name stimulants and sedatives cheap and sticking US taxpayers with the bill.

They were handing out baggies of drugs to staffers going on trips overseas.

The staffer told OIG investigators that ahead of overseas trips, the staff would prepare packets of controlled medications to be handed out to White House staff. "And those would typically be Ambien or Provigil and typically both, right. So we would normally make these packets of Ambien and Provigil, and a lot of times they’d be in like five tablets in a zip‑lock bag. And so traditionally, too, we would hand these out. ... But a lot of times the senior staff would come by or their staff representatives... would come by the residence clinic to pick it up. And it was very much a, 'hey, I’m here to pick this up for Ms. X.' And the expectation was we just go ahead and pass it out."

Trump wanted to send the US military into Mexico to go after drug kingpins. But he was running his own out of control drug dispensing operation financed by tax money.

The Department of Defense Inspector General's report detailed how Schedule II drugs were poorly inventoried and monitored. (emphasis added)

The Code of Federal Regulations requires that registered pharmacies maintain inventories and records of Schedule II controlled substances separately from all other pharmacy records.16 In our site visit to the EEOB Clinic, we concluded that the clinic maintained the controlled substance inventory records in a binder on hand‑written paper logs, stored in the EEOB clinic’s medication dispensing area. The inventory records showed that White House Medical Unit stocked four different types of Schedule II opioid pain medications (fentanyl, hydrocodone, morphine, and oxycodone), as well as medications from Schedules III through V, such as stimulants and sedatives. However, White House Medical Unit kept the records for its Schedule II medications in the EEOB’s inventory binder together with records for all other controlled medications and not maintained separately as required by the CFR.

So the Trump White House pharmacy also included opioids which were not properly kept track of. The Trump drug mill was a microcosm for his administration as a whole.

#donald trump #trump white house #trump staffers #white house pharmacy #pill pushers #ambien #provigil #baggies of drugs #opioids #schedule ii drugs #department of defense inspector general #sloppy inventory #poor management #trump administration #election 2024

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pronoun-fucker · 2 years

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“The NHS is shutting down its gender identity clinic for children after a damning review found that it failed vulnerable under-18s.

The gender identity service at Tavistock & Portman NHS Foundation Trust has been ordered to close by spring 2023.

It will be replaced by regional centres at existing children’s hospitals offering more “holistic care” with “strong links to mental health services”.

Tavistock’s Gender Identity Development Service (GIDS) clinic has been accused of rushing children into life-altering treatment on puberty blockers.

The paediatrician Dr Hilary Cass, who is leading a review of the service, has today issued a series of recommendations for a radical overhaul of how the NHS treats young people who are questioning their gender identity.

She found that the Tavistock clinic was “not a safe or viable long-term option” and that other mental health issues were “overshadowed” when gender was raised by children referred to the clinic.

Cass, former president of the Royal College of Paediatrics and Child Health, said the current model of a sole provider for gender services should be scrapped as it failed to meet the holistic needs of distressed and vulnerable teenagers.

She said Tavistock should be replaced by regional centres with an “appropriate multi-professional workforce to enable them to provide an integrated model of care that manages the holistic needs of this population”.

Amid concerns that the clinic fails to take into account wider health problems before putting children on puberty blockers, Cass added: “Staff should maintain a broad clinical perspective in order to embed the care of children and young people with gender uncertainty within a broader child and adolescent health context.”

NHS England, which commissioned Cass to review the service in September 2020, say they will implement her recommendations in full and decommission the Tavistock clinic.

They have announced they will launch two new clinics for children with gender dysphoria by spring 2023, which will bring together multiple doctors from a broad range of specialities.

The first, in London, will be based at Great Ormond Street Hospital and receive specialist mental health support from the South London and Maudsley NHS Foundation Trust.

The second, in the northwest, will be led by a partnership between Alder Hey Children’s NHS Foundation Trust and the Royal Manchester Children’s Hospital.

Cass said these clinics must have “established academic and education functions” to monitor evidence on children who are put on hormone therapy. The Tavistock clinic failed to collect sufficient data on the impact of puberty blockers in under-16s.

She said there was currently “insufficient evidence” for her to make any firm recommendations around their routine use.

Cass told the NHS to “enrol young people being considered for hormone treatment into a formal research protocol with adequate follow up into adulthood, with a more immediate focus on the questions regarding puberty blockers”.

The NHS said it would launch clinical trials in partnership with the National Institute for Health and Care Research to follow children on puberty blockers into adulthood.

A spokesman said: “This will ensure that there is greater transparency for children and their parents/carers around the uncertain clinical benefits and longer-term health impacts surrounding their use.”

The clinic has been overwhelmed by a sudden increase in referrals, particularly among young girls and children on the autism spectrum. Last year it received more than 5,000 referrals, compared to 250 a decade ago.

Cass’s final report will be published next year. Her interim review published in March found that services had developed without clear rules and that there was a “clinician lottery”, with widely varying approaches to treatment.

She found there was “a lack of agreement, and in many instances a lack of open discussion” about whether unhappiness with gender in adolescence was permanent or temporary. However, last year the Court of Appeal overturned a controversial ruling made by the High Court that children under 16 were unlikely to be able to give informed consent to receiving puberty blockers.

The case was brought against the Tavistock and Portman trust by Keira Bell, 24, who began taking puberty blockers when she was 16 to transition to male before later “detransitioning”.”

Link | Archived Link

#radical feminism #radfem #gender critical #transgender #trans activism

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ukrfeminism · 2 years

Text

The NHS is shutting down its gender identity clinic for children after a review found that it failed vulnerable under-18s.

The gender identity service at Tavistock & Portman NHS Foundation Trust has been ordered to close by next spring.

It will be replaced by regional centres at existing children’s hospitals offering more “holistic care” with “strong links to mental health services”.

Tavistock’s Gender Identity Development Service (GIDS) clinic has been accused of rushing children into life-altering treatment on puberty blockers.

The paediatrician Dr Hilary Cass, who is leading a review of the service, issued a series of recommendations today for a radical overhaul of how the NHS treats young people who are questioning their gender identity.

Cass, former president of the Royal College of Paediatrics and Child Health, said the existing model of a sole provider for gender services should be scrapped as it failed to meet the holistic needs of distressed and vulnerable teenagers.

NHS England, which commissioned Cass to review the service in September 2020, says it will implement her recommendations in full and decommission the Tavistock clinic.

It has announced the launch of two clinics for children with gender dysphoria by next spring, which will bring together multiple doctors from a broad range of specialities.

The first, in London, will be based at Great Ormond Street Hospital and receive specialist mental health support from the South London and Maudsley NHS Foundation Trust.

The second, in the northwest, will be led by a partnership between Alder Hey Children’s NHS Foundation Trust in Liverpool and the Royal Manchester Children’s Hospital.

She said there was “insufficient evidence” for her to make any firm recommendations around their routine use.

Cass told the NHS to “enrol young people being considered for hormone treatment into a formal research protocol with adequate follow-up into adulthood, with a more immediate focus on the questions regarding puberty blockers”.

The NHS said it would launch clinical trials in partnership with the National Institute for Health and Care Research to follow children on puberty blockers into adulthood. “This will ensure that there is greater transparency for children and their parents/carers around the uncertain clinical benefits and longer-term health impacts surrounding their use,” a spokesman said.

She found there was “a lack of agreement, and in many instances a lack of open discussion” about whether unhappiness with gender in adolescence was permanent or temporary. However, last year the Court of Appeal overturned a ruling made by the High Court that children under 16 were unlikely to be able to give informed consent to receiving puberty blockers.

The case was brought against the Tavistock and Portman trust by Keira Bell, 24, who began taking puberty blockers when she was 16 to transition to male before later “detransitioning”.

226 notes · View notes