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ccrpsorg · 1 year

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Decentralized Clinical Trials and Contract Research Organizations in 2023

Decentralized Clinical Trials for the CRO

Decentralized clinical trials (DCTs) are a relatively new concept in the world of clinical research, but they are quickly becoming more popular. In 2023, DCTs are expected to become even more widely used as the technology and infrastructure needed to support them continues to develop.

A decentralized clinical trial is one that is centered around patient needs and improves the patient experience by allowing them to participate from their own homes or local healthcare providers. This type of trial eliminates the need for patients to physically access hospital-based trial sites, which can be difficult for some people due to distance or other factors. It also allows for greater flexibility in terms of scheduling and data collection, as well as improved accuracy of results due to fewer potential sources of error.

In addition to these guidelines from the FDA, there are several ethical considerations that must be taken into account when conducting a decentralized clinical trial. These include ensuring patient privacy and confidentiality, providing informed consent forms that clearly explain the risks associated with participating in a DCT, and ensuring that all participants have access to appropriate medical care if needed during the course of the study.

How CROS can Implement DCTs

Contract research organizations (CROs) can implement decentralized clinical trials by modifying their protocol to incorporate remote data collection, patient-centric protocols, and virtual engagement between trial participants and CRO personnel. Remote data collection allows for the capture of participant-generated data outside of a traditional clinical setting via digital devices. Patient-centric protocols allow for a more personal approach to clinical trials by allowing patients to participate in activities such as self-reporting on symptom severity, digitally submitting medical images and lab results, and engaging with physicians from the comfort of their own home. Virtual engagement between trial participants and CRO personnel can be facilitated through secure video conferencing tools that enable real-time interactions.

Further modifications to the CRO protocols could also include integrating artificial intelligence technology into the trial process such as automated monitoring of patient behavior, prioritizations of interventions based on individual risk profiles, and remote health guidance by virtual nurses or other healthcare professionals. Mobile applications could also be used to remind participants about upcoming appointments or events related to the study as well as remind them about taking medication or completing questionnaires. Incorporating these types of technologies would ensure that decentralized clinical trials are conducted efficiently while providing participants with an enhanced user experience throughout every step of the trial process.

Five Steps to Implementing Decentralized Clinical Trials

1.Educate Project Managers: Contract research organizations (CROs) should ensure that their project managers are educated about the benefits of decentralized clinical trials and how to go about implementing them. This could include learning about the technology, regulations, data privacy, and other important elements related to this type of trial design.

2. Establish Data Security Measures: Before conducting a decentralized clinical trial, CROs should have strong data security measures in place to protect participants’ information and ensure that it is secure throughout the study duration. This includes accessing participant data only with permission and using encryption protocols when transmitting or storing any sensitive information.

3.Evaluate eClinical Platforms: A key part of implementing decentralized clinical trials is choosing the right eClinical platform for your study design. CROs should evaluate the various eClinical platforms available to them and select one that meets their needs for a successful trial, such as being user friendly for participants, having features such as remote monitoring capabilities, offering robust reporting capabilities, and providing easy access to data from multiple sites.

4.Utilize Mobile Technologies: To make a decentralized clinical trial successful, leveraging mobile technologies can be extremely helpful for CROs to communicate with volunteers remotely, manage participant engagement in real-time, collect patient-reported outcomes quickly and accurately from anywhere, track compliance with protocols on site visits or assessments done remotely, etc., reducing the need for face-to-face visits whenever possible.

5. Create Protocols: Having clear protocols in place is essential if a CRO wants to successfully implement decentralized clinical trials as they help ensure consistency across different sites by setting expectations around communication between sites and central teams; supervision of staff; quality control procedures; safety reporting; use of investigational drugs; collection of patient data; follow up on withdrawals or lost patients; etc., throughout the duration of the trial

How do DCTs Work?

Decentralized clinical trials offer a variety of benefits to CROs, such as reduced costs associated with traditional on-site trials, improved patient recruitment, faster data collection and analysis, and greater efficiency.

Decentralized clinical trials (DCTs) offer a promising new model for contract research organizations (CROs). By leveraging decentralized technologies such as blockchain and distributed ledger technology, DCTs provide a secure, efficient, and cost-effective alternative to traditional CRO models.

The key advantages of DCTs for CROs include enhanced security and data integrity, improved consent management, faster and more secure patient recruitment, and greater visibility into the trial process. With DCTs, CROs can leverage existing research infrastructure while streamlining processes such as data management and quality control.

To further explore the potential of DCTs, it's helpful to look at some recent developments in the industry. In 2018, Decentralized Clinical Trials LLC partnered with Johnson & Johnson to create JLABS@TMCx to develop innovative digital health solutions for clinical trials. This collaboration unveiled two major projects that leverage decentralized technologies: Project Catalyst and Project Ovenbird.

Project Catalyst seeks to develop a system of protocols that will allow researchers to securely exchange information in real-time. The project is currently focused on developing decentralized application (dApp) versions of standard protocols and applications used in clinical trials. Meanwhile, Project Ovenbird seeks to create an enterprise-grade distributed data platform that will enable researchers to collect structured data from decentralized sources while maintaining privacy standards comparable to those set by HIPAA.

In addition to these projects with J&J, Decentralized Clinical Trials LLC has also partnered with Microsoft Corporation on a pilot program called "Verified Credentials." This program leverages blockchain technology to ensure accurate identity verification during patient recruitment processes for clinical trials.

For CROs interested in exploring DCTs further, there are several resources available online that can help provide a better understanding of their benefits, applications, and potential challenges. The National Institutes of Health recently launched the Decentralized Clinical Trials Hub (DCThub), which provides educational materials about DCTs for research professionals. Additionally, several companies offer products tailored specifically for DCTs such as TrialX from OptumIQ or Oneyield from Castor EDC Solutions Ltd., both of which are designed to support decentralized clinical trial design and implementation workflows.

Types of Remote Monitoring in DCTs

Decentralized clinical trials are conducted using remote monitoring technology to capture data from patients rather than requiring them to come into a physical research site. This allows for more flexible trial designs that can be tailored to specific patient populations and geographic locations. In addition, patients can more easily participate in a trial without having to travel or take time off from their daily lives. For example, virtual visits through telemedicine can be used for initial screening and assessments, reducing the number of visits required at an on-site research facility.

Data collected from decentralized clinical trials is often more accurate than what is typically collected in traditional on-site trials due to the use of continuous wearables, mobile devices and other innovative digital technologies that provide real-time monitoring of health parameters such as blood pressure or glucose levels. This increases the quality and granularity of information available to researchers while decreasing the amount of labor required for data collection. Additionally, electronic health records (EHRs) can be integrated with decentralized trial platforms allowing for rich longitudinal datasets that enable deeper insights into patient outcomes over time.

One example of a decentralized clinical trial is the use of telemedicine to support remote monitoring. This could involve providing video conferencing for patient-physician visits and using smartphones for tracking vital signs. In addition, telemedicine can enable doctors to monitor patients with chronic conditions remotely, by collecting medical data from sensors that have been placed on the patient’s body. This type of monitoring allows doctors to keep track of changes in health parameters without requiring an in-person visit, significantly reducing both costs and risks associated with traveling for treatment.

Another example is direct-to-patient (DTP) trials, in which medication is shipped directly to a patient's home instead of them having to travel to a clinic. In this case, study coordinators can monitor the progress remotely via phone calls or text messages while also providing support when needed. This approach has enabled researchers to conduct studies involving large numbers of participants located around the world who would otherwise not have been able to participate due to geographic distance or lack of transportation resources.

Finally, wearable devices are also being used increasingly in decentralized clinical trials as they allow researchers to collect more accurate data about activity levels and other health metrics over long periods of time without needing frequent interventions from healthcare personnel. It is possible for these devices to be connected directly with electronic data capture systems so that the collected information can be analyzed quickly and accurately by researchers.

Larger Patient Engagement

The decentralization of clinical research also opens up new opportunities for CROs to reach larger populations by enabling simultaneous studies across multiple sites around the world and removing many logistical barriers related to travel or geographical distance between participants and study sites. Additionally, leveraging social media platforms for recruiting further expands access potential outside of traditional recruitment networks and offers ways to engage with potential participants more directly than before.

Decentralized clinical trials, also called virtual studies or remote research, have the potential to revolutionize the way clinical studies are conducted. A decentralized clinical trial is a type of clinical study where participants are distributed across geographical and other boundaries, allowing them to participate from their own homes or from one of many remote sites.

To explore further options regarding DCTs and related technologies, interested parties may consult companies such as Medidata Solutions (www.medidatasolutionsinc.com), IMS Health (www.imshealth.com), HRA Pharma (www.hrapharma) or IQVIA (www.iqvia). These firms specialize in providing comprehensive services related to DCT implementation, ranging from development and customization of software solutions through full project management services that cover all aspects of a clinical trial operation from start-up through completion – including training protocols for implementing these new technologies at each site visited during study duration and beyond..

Overall, decentralized clinical trials represent a significant opportunity for CROs looking to move away from costly on-site studies in favor of more cost effective approaches that offer equally robust data sets but require fewer resources from both researchers and participants alike. As technology continues to advance so too will our collective ability to take advantage of decentralized trial designs for bigger impact studies without sacrificing quality or rigor.

Decentralized clinical trials offer many advantages over traditional site-based studies. They provide greater convenience for patients while still maintaining high levels of safety and efficacy standards. As technology continues to advance in 2023, we can expect even more opportunities for DCTs to become available.

More Examples on Decentralized Clinical Trials:

In the past decade, the advent of blockchain and other technologies have made it possible for clinical trials to be conducted in a decentralized manner. Here are five examples of decentralized clinical trials currently taking place across the world.

1. Mediledger Clinical Trial Supply Chain: This trial is being managed by MediLedger, a healthcare-focused blockchain consortium. The goal of this trial is to use blockchain technology to streamline and secure the global movement and tracking of drugs within the supply chain. The solution will enable parties to share data about patient safety, drug expiration dates, and more in real-time – all while remaining compliant with regulatory standards.

2. CardiLynx Smart Phone ECG Readings: This study is being conducted by CardiLynx, a healthcare technology company that specializes in mobile health applications that measure electrocardiograms (ECGs). The aim of this trial is to use an app on a smartphone to accurately detect heart arrhythmias in patients over time, as well as identify early symptoms and risk factors associated with cardiovascular diseases like stroke and heart attack.

3. Cogstate Cognitive Testing Trial: This study is sponsored by Cogstate, an AI-powered cognitive assessment platform that uses computer games to measure cognitive performance across multiple disciplines such as memory, attention and executive functioning. The purpose of this trial is to evaluate how well Cogstate’s technology can accurately detect changes in cognition over time in various patient populations and disease states.

4. Takeda Whole Genome Sequencing Study: This research project is sponsored by Takeda Pharmaceuticals, one of the world’s largest pharmaceutical companies. In this project, researchers are using whole genome sequencing technology to increase our knowledge about genetic mutations related to certain diseases such as hemoglobinopathies or rare blood disorders. They are also trying to identify new treatment options based on these mutations that could help improve patient outcomes overall.

5. Verily Life Sciences Patient Health Monitoring Project: This project involves Verily Life Sciences working with healthcare providers, payers and employers on an initiative called “Project Baseline” which uses wearables and other devices such as Fitbits or Apple watches to monitor patients’ health data in real-time while they go about their daily lives outside of a clinical setting. Through this project, Verily aims to understand how different lifestyle behaviors can influence health outcomes; enhance patient engagement; reduce healthcare costs; and ultimately improve population health management globally

6. GlaxoSmithKline’s digital platform trial: GlaxoSmithKline developed an innovative digital platform to conduct a clinical trial of its new asthma drug, mepolizumab, in the United States. The trial involved recruiting participants through a web-based interface, using secure electronic data capture (EDC) tools to collect and store data in real time, and utilizing mobile devices for remote patient monitoring. This decentralized clinical trial was able to reduce the traditional costs associated with running a large-scale clinical trial because it eliminated many of the steps required for enrollment and data collection. Additionally, it enabled GSK to recruit more geographically diverse participants who would not have been able to take part in a conventional trial setting.

7. Merck's MyEHRConnected study: Merck conducted the MyEHRConnected study, which sought to evaluate the efficacy and safety of its diabetes medication Januvia (sitagliptin). This was an international phase III study that utilized electronic health records (EHRs) from more than 60 sites located throughout Europe, Asia Pacific, Latin America and Canada in order to identify eligible patients with type 2 diabetes. The EHRs enabled Merck to recruit participants quickly without requiring physical visits or extensive paperwork. Furthermore, researchers could securely access patient data stored within the EHR system during the duration of the study for analysis and evaluation purposes—a process that would have been impossible with paper-based records.

8. Sanofi's Telcare Diabetes Trial: Sanofi conducted a revolutionary telephone-based randomized control trial known as the Telcare Diabetes Trial (TDCAT), which aimed to assess the impact of telemedicine on diabetes care management among patients at risk for complications due to uncontrolled blood sugar levels. Patients were randomly divided into two groups—one group received standard care while another group received a combination of traditional care plus remote support provided by nurses through weekly phone calls over a period of six months. Results showed that those participants receiving telemedicine services had significantly better glycemic control than those who did not receive any telemedicine services at all—highlighting one powerful benefit of decentralizing clinical trials using technology such as telephone communication services.

9. Novartis’wearable device clinical trial: Novartis launched an ambitious clinical trial involving 20,000 individuals across nine countries in order to evaluate whether wearable devices such as smart watches can detect early signs of heart failure before medical symptoms appear. The decentralized nature of this study offered numerous advantages over traditional studies in terms of cost savings as well as recruitment speed; enabling Novartis to rapidly reach out potential participants worldwide instead of relying solely on localized recruitment methods used previously by other companies conducting similar trials with much smaller sample sizes due to limited resources or geographic restrictions

10. Eli Lilly & Company's eCOA Study: Eli Lilly & Company recently completed an innovative eCOA (electronic Clinical Outcomes Assessment) study that leveraged mobile applications and internet-connected devices in order to record patient outcomes over longer periods of time compared with traditional studies involving paper forms or periodic clinic visits alone. By using this decentralized approach, Lilly was able to gather more accurate data while reducing costs associated with running conventional trials; making it possible for them to enroll larger numbers of patients in shorter periods than ever before.

11. The IQVIA-sponsored study by the Alzheimer's Prevention Initiative (API). This study was designed to evaluate the effects of an investigational oral form of the drug solanezumab on the cognitive decline associated with early stage Alzheimer's disease. It was a decentralized trial conducted using remote monitoring, which allowed participants and clinical sites to interact online via web-based video visits, digital questionnaires and remote diagnostic testing. The trial collected data from over 800 participants at over 30 clinical sites in 12 countries.

12. A decentralized clinical trial launched by Durect Corporation to assess its investigational drug DUR-928 for the treatment of nonalcoholic steatohepatitis (NASH). The Durect NASH study was conducted across 16 countries and used innovative telemedicine technologies for patient monitoring and data collection. In addition to traditional site visits, remote video visits were performed with patients and caregivers to observe adverse events, review patient-reported outcomes, analyze lab results remotely and monitor compliance with the protocol.

13. The Institute for Qualitative Medicine’s (IQM) pilot study that evaluated an innovative approach to decentralizing clinical trials using mobile health technology (mHealth). The mHealth platform was used to connect participants remotely with healthcare professionals who monitored vital signs such as blood pressure, heart rate, respiratory rate, oxygen saturation level and body temperature using wireless medical devices connected directly to smartphones or computers. In addition, the platform included a chatbot that trained participants on how to use their medical device correctly or send real-time reminders when it was time for follow-up appointments or tests.

14. An analysis conducted by PPD Incorporated comparing decentralized vs centralised clinical trials for a Phase IIb study evaluating an investigational vaccine for malaria prevention in children aged 1–6 years old. They found that decentralizing the trial saved approximately 25% in total resources spent compared to a centralized approach and resulted in shorter recruitment times due to increased convenience for both investigators and participants alike compared with centralised approaches where people had to travel long distances for appointments or procedures.

15. A global Phase IIIa research program sponsored by GSK which evaluated an experimental shingles vaccine involving over 17000 elderly individuals across 11 countries in Europe and Latin America including Argentina, Brazil, Chile, Colombia, Germany Spain France Italy Netherlands Poland Portugal UK..The study incorporated various decentralized models such as virtual/remote clinic visits with self-administered questionnaires through smartphones/tablets; home delivery of intervention product; remote diagnostics; online physician/patient communication through video calls; collection of sample storage through kits sent remotely from local courier companies etc., thus enabling a truly distributed model of conducting clinical trials without relying solely on physical presence at site locations

Want to train your staff to run decentralized clinical trials? Enroll them in our in-depth clinical trial certification courses with hours of lectures focuses on remote monitoring alone.

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bonefall · 1 year

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got some Skypelt asks for ya! putting it all in one ask so I don’t spam you but it’s ok if you don’t want to answer all of them

Once Skyclan moves to the lake, do dead Skyclan warriors go to Skypelt or can they walk both skies?

Once moving to the lake, is Skypelt likely to take in DF cats? Not ones already in the DF, but in a “that was kind of fucked up, you can stay with us” kind of way. if say.. Leafpool got condemned to the DF for example

Do Skyclan medicine cats receive omens from Starclan at all or only Skypelt?

Is Skypelt just as flawed as Starclan, and if so is it in different ways? Do they have different politics or just a different culture? (Like, do they have their own “fire alone vs thistle law” or do they skew one way naturally?

i’m a Skyclan stan and love the lore you’ve given them :3c

Canon has been serving SkyClan Fans WEAKSAUCE pasta lately, I am simply out here to feed you guys. Blitz ask time!

"At the Lake, where do SkyClan's Stars walk?"

Think of Heaven like a big bubble. Any culture can dream up their own bubble, but it takes many years, ancestors, and generations to make this bubble as large and as powerful as StarClan.

Skypelt is a smaller bubble. A broken-off piece of StarClan-Prime. SkyClan is very proud of this little bubble because it's THEIRS. When they rejoined, SkyClan does not see their bubble as the same thing as the Forest Four's bubble.

So Skypelt hangs off the side of StarClan at the Lake. They are connected but still separate.

So it's totally possible for Silverpelt Angels and Skypelt Angels to go back and forth between the bubbles! There are even living cats who invoke the patrons of the other Clans. Skywatcher is popular for all five, prayed to for memory and archival.

"Is Skypelt likely to overrule unfair Silverpelt trials?"

No, very unlikely.

Skypelt oversees the affairs of SkyClan. Silverpelt oversees the Forest Four. They see these sorts of things as separate. Skypelt is really not trying to be a counterculture/rebel movement to their neighbors.

If they were to overrule in this way, it would be for a cat they had a claim to. If for some reason they had overheard Firestar's trial and StarClan sent him to the Dark Forest, Skypelt would demand for him.

In Better Bones, Leafpool was less of the cat in trial. It was Squilf, who died defying invasion orders to brutalize a nursing mother and kits. Skypelt DOES have a claim in this situation! They had also been opposed to this invasion, and Squilf had faithfully helped them before this point.

If they were willing to fight StarClan-Prime over this is a different story.

Digressing, this applies only for specific situations. Usually, no, they don't do this.

"Where do SkyClan Clerics get their omens?"

Usually Skypelt, but Silverpelt will occasionally relay one, especially for prophecies and warnings that address all Clans.

"What are the ways in which Skypelt, and the politics of SkyClan, are flawed?"

They culturally lean towards Fire Alone, with even their hardest right cats looking more like Normal Traditionalists. That includes Sharpclaw!

It would be more accurate if I gave them new terms for their positions, since they are unique political alignments.

They don't have the same concepts of "blood purity" that Forest Four do, but also don't carry the commitment to honor. Battle is not a value! It is a martial art and a means to an end, a skill that can be a tool.

Things SkyClan would be willing to consider that Forest Four have a hard time with;

Mercenary work

Human cooperation

"Dishonorable" battle tactics such as weaponry and poisons; SkyClan fights to win

Democracy and decentralized governance

Most of these things are not inherently bad, but they are significantly different from Forest Four Clan culture.

They also don't have the same reverence for scars, and different beauty standards. Surprisingly they are also more likely to have bitterness around "Free Meals," believing that a cat who has somewhere else to be shouldn't take valuable resources.

So for example they didn't allow daylight warriors to have 4 square meals like Clan cats. 2 at most, the rest should come from their humans. They do also have a fair amount of abelism in their society, unfortunately.

And Skypelt reflects that.

Skypelt never holds trials, respecting the opinions of the living in who gets let in. It's tied more to funeral practices and prayer than the judgement of the deceased.

In general, Skypelt is not nearly as haughty or self-righteous as StarClan-Prime. This could be exploited-- a Mudclaw-type or a CANON Ashfur is more likely to be sent to Skypelt than Silverpelt.

#clan culture #Bb!Skyclan #Better bones au #Re: BB!Ashfur is different from Canon!Ashfur.#BB!Ashfur did not work with Hawkfrost and did not get Firestar killed #He attacked the three largely out of fear and jealousy but was denied being brought to justice #Still a villain but less unambiguously bad

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myrddin-wylt · 9 months

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Why is Arthur so pathetic? I love him like that but like until what century did he stop being pathetic and start choosing violence

1066. You can squarely blame William the Bastard for that.

The Norman Invasion really fundamentally changed the state of England, and I wanted that to reflect in Arthur as well. Pre-Norman England was not particularly powerful; the Anglo-Saxon kingdoms only unified in 927, which is comparatively late for the area, and even then they continued being conquered by Scandinavians. Prior to unification they were much weaker and were pretty easy prey for anyone who wanted to launch an invasion or raid. The reason Alfred the Great is known as the Great is because he managed not to conquer or make some great power out of Wessex; what he managed to do that was so impressive was to not get totally crushed and subjugated by the vikings.

Once England unifies, they get a little more bite to add to their bark. and of course the Danes who managed to wrangle England into being a member of the North Sea Empire were quite powerful; the problem for England was that it was embarrassingly easy for a foreign king to come in and wrangle them into the empire.

But then in 1066, William the Bastard invades. And he doesn't stop invading. And neither do his descendants.

Essentially what the Normans did was take England's weird, non-feudal, highly decentralized kingdom and they were able to build a feudal system from scratch, which meant it didn't have the weird weaknesses and quirks that many of the other feudal systems had. For France, feudalism was a long process of trial and error but England never managed to get that far, so the Normans were able to impose a perfected feudal system without the historical baggage. So suddenly the Kingdom of England - which was already rich as far as resources, but wasn't really able to get its shit together and centralize - has a government that is hyperefficient, a lot of highly skilled yeomen inherited from the Anglo-Saxon system that could serve as very useful warriors, a relatively mobile social system, a lot of resources, and a dynasty of royals who were unusually good at making a little bit of money do a lot of work.

The Normans also decided they were not going to stop once they conquered England, and quickly proceeded to subjugate Wales, Ireland, and Scotland as well (though Scotland managed to win independence and escape). Not only did the Normans conquer Britain, they also used the throne of England to become immensely powerful in southern France, and Richard the Lionheart pretty much spent his entire reign kicking ass and taking names.

So the reason I have Arthur go from timid and pathetic to choosing violence is because I'm trying to mirror historically how England turned from a shit backwater into what would become the basis for the most powerful empire on the planet. As a character, that basically looks like him suffering invasion (Angles and Saxons) after invasion (Scandinavians) after invasion (more Scandinavians but they're Christian now) after invasion (Normans). And after the last invasion, he decides he's had Enough, and that the Norman Invasion will be the last he ever suffers. And it was!

#ask #anon #myrd's hcs #historical hetalia #hws england #hetalia headcanons #hetalia hcs #hetalia hc #hetalia headcanon #thanks for the ask! hope you were prepared for me to ramble about medieval history

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riotouseaterofflesh · 2 months

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A warning to anyone trying out the fediverse/Mastodon

There's a large cluster of people who are basically an alliance of photomatts and (if you're on Twitter) Jai orbiters who try to police the various servers to isolate people they deem to be undesirables.

They are deeply transmisogynistic and unhinged, in ways that make photomatt's recent behaviour seem downright enlightened in comparison.

A recent good summary of what's going on is posted here.

A much lengthier history of this drama (which has been going on for years) has been put up by a kindly anon here.

The fediverse isn't all like this, but you do need to watch out which server you make your account on.

General red flags to avoid:

any involvement with "The Bad Space"

mastodon.art

users who frequently post to the #FediBlock hashtag

use of automated or shared blocklists (these are for entire servers blocking other servers, not individual accounts)

reasons for blocking a server mentioning "oliphaunt" or "tier" anything

As a general rule, you will want to coordinate with your mutuals which servers you go to as much as possible, to minimize the chances that you end up on different instances and end up getting cut off from each other until at least one of you makes an alt so you're both on servers that communicate with each other. This takes a bit of trial and error but unfortunately that is the nature of a decentralized social networking system.

So all that said... I really hope staff smarten up, Matt gets put in his place by his and Tumblr's lawyers and we can all stay where we are.

#mastodon #activitypub #fediblock #the bad space #pleroma #akkoma #mastodon.art #misskey #sharkey #gotosocial #pixelfed #a lot of people will warn you to avoid mastodon.social which isn't bad advice #but frankly even m.s would be vastly preferable to the creepy totalitarian policing you see from admins who think TBS is good

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orpheusmori · 10 months

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What do you think of Brissot?

Hi anon! I do admire Brissot's abolitionist ideas. That's about it.

However I vehemently disagree with his foreign policy. His and other Girondins' eagerness to escalate the threats of Austria and Prussia, would ultimately lead to the War of the First Coalition. As someone who studies the Montagnard faction of the National Convention, I don't exactly view him very favorably.

Brissot authored "To His Constituents", in which he demanded the guillotining of "the anarchists" (Montagnards and sans-culottes), and tried to rouse the bourgeois class to resist the decentralized departments, which had not taken the lead from Robespierre in Paris but rather from the other Montagnards, and mostly local organizers and agitators. His willingness to participate in counter-revolutionary uprisings in the Vendée, ureasonable sympathies for the monarchy, as well as him being a leader in the anti-Marat propaganda that ended with Marat being arrested and tried in a defense trial that wasted the time of everyone, really makes me lose any and all respect for him.

#brissot #asks #frev #marat

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bedtimestoriesforbrokengirls · 11 months

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The Daily Dad

Things you might want to know, for Jun 9, 2023:

“I can be quite explicit”: AI girlfriends based on real people are now ‘a thing’ — Porn will always lead the way.

Charlatans, False Prophets and Flimflammers — Actual quote from someone who obviously doesn’t understand divinity in the slightest: “God did not intend for the human anus to be a sex object!”

KinkBNB Relaunches as a Decentralized App with Social Token, Invites New Playspace Hosts to Apply — This link is not a recommendation… it is an eye-roll. There is clearly nothing these flailing fuckers won’t throw “blockchain” at.

Actor Cuba Gooding Jr. settles civil sex abuse case, averting trial — Based on the quantity of accusations, I hope he keeps that checkbook handy.

Heads of ‘orgasmic meditation’ group, OneTaste, charged with forced labor and sex abuse of followers — I’ll never understand these sad little cults that hide their natures and objectives until they’re sprung like traps on unsuspecting dumbfucks.

Jay Johnston, from "Mr. Show" and "Bob's Burgers" arrested for participation in January 6 insurrection — I am so, so, so disappointed by this. It’s fucking gutting. Mr. Show is very important to people my age, and Jay’s face is a familiar one… it sucks knowing that the man behind The Story of the Story of Everest is a real-life whack-o.

SoCal's great white sharks are much closer to you than you think, groundbreaking report finds — TL;DR: in certain areas of California, ocean swimmers are within yards of great white sharks 98% of their time in the water. PERSONAL TAKEAWAYS: 1. Great whites are pretty chill. 2. Fuck California.

TodePond/DreamBerd: perfect programming language — Okay, 95% of you won’t get what’s funny about this. (That’s okay. You’re normal.) But it kept me smirking as I read through the “docs”.

Right-Wing Media Says the Wildfire Smoke Is Good, Actually

Security cam catches two nearly-naked "witches" enjoying a "carcass-eating ritual" in homeowner's yard — I think I know who this was. ⤴️ Tell me I’m wrong.

Hideo Kojima's Hideo Kojima documentary releases first trailer — I want to watch this more than play his games.

Pickle pizza being tested at a sole Pizza Hut in NYC — No. Bad Pizza Hut! Bad! You go sit in the corner and ask yourself why you want to rape my tastebuds like that.

Lisa Vanderpump Rides ‘VPR’ High With New Spinoff ‘Vanderpump Villa’ — Well the bitch got me. It took her over a decade, but she and Andy Fucking Cohen got me.

Pat Robertson Is Dead. His Dystopian Legacy Lives On — Stop giving the jackass so much credit.

Ahsoka premieres on Disney Plus on August 23rd — I’m in no way attached to the underlying character, so I don’t really care where this goes, as long as it goes somewhere cool and Ray Stevenson gets one last chance to shine.

Reddit insists on being “fairly paid” amid API price protest plans, layoffs — I’m guessing they’ll turn off RSS feeds next.

ChatGPT on iOS gets improved iPad support and Shortcuts integration — Generated by ChatGPT: ‘In the context of software development, "doing the bare minimum" refers to completing the essential or minimum required tasks to meet a specific goal or requirement. It suggests that the developer is not putting in additional effort or going above and beyond what is necessary. While it may ensure basic functionality, "doing the bare minimum" often implies that the code or solution may lack quality, robustness, or optimization. It's generally considered a suboptimal approach as it doesn't prioritize excellence or long-term sustainability.’

Apple’s Journal app needs to read the room — Oh, unclutch your pearls, Geraldine.

California hospital staff call for halt of surgeries over bizarre particles — This strikes me as a truly excellent reason to call for a halt to surgeries.

#news

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religion-is-a-mental-illness · 1 year

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Liberalism’s great contribution to civilization is the way it handles conflict. No other regime has enabled large and varied groups of people to set a social agenda without either stifling their members’ differences or letting conflict get out of hand. Bertrand Russell once said that “order without authority” might be taken as the motto both of political liberalism and of science. If you had to pick a three-word motto to define the liberal idea, “order without authority” would be pretty good.

The liberal innovation was to set up society so as to mimic the greatest liberal system of them all, the evolution of life. Like evolutionary ecologies, liberal systems are centerless and self-regulating and allow no higher appeal than that of each to each in an open-ended, competitive public process (a game). Thus, a market game is an open-ended, decentralized process for allocating resources and legitimizing possession, a democracy game is an open-ended, decentralized process for legitimizing the use of force, and a science game is an open-ended, decentralized process for legitimizing belief.

Much as creatures compete for food, so entrepreneurs compete for business, candidates for votes, and hypotheses for supporters. In biological evolution, no outcome is fixed or final—nor is it in capitalism, democracy, science. There is always another trade, another election, another hypothesis. In biological evolution, no species, however clever or complex, is spared the rigors of competition—nor are the participants in capitalism, democracy, science. No matter who you are, you must conduct your business in the currency of dollars, votes, or criticism—no special fiat, no personal authority.

To think of democracy and capitalism as liberal social systems is, of course, commonplace today. To think of science that way is more challenging. Most of us think of science as a kind of machine whose equations and labs and research papers inexorably grind out data and theories and inventions. But philosophers of science have moved sharply away from that view, and toward what has become known as evolutionary epistemology.

Evolutionary epistemology holds that our knowledge comes to us not from revelation, as religious traditions maintain; nor from deep reflection by the wise, as in Plato; nor even from crisp experiments that unambiguously reveal nature’s secrets, as in the mechanistic view of science that prevailed until this century. Rather, our knowledge evolves—with all the haphazardness and improvisation that “evolving” implies. In biological evolution, species and their genes evolve as they compete for limited resources, with mutations providing the raw material for change. In evolutionary epistemology, hypotheses and ideas evolve as they compete under pressure from criticism, with intellectual diversity providing the raw material for change.

The evolutionary view of knowledge recognizes that, in science, trial and error play as important a role as does mechanistic experimentation. It recognizes that scientific consensus doesn’t always march methodically toward a single inevitable conclusion; the consensus often meanders or drifts, and where it comes out on any given day can depend as much on circumstance and fashion, even on personalities, as on nature. (Which is not to say that the results are random; the method of trial and error may be unpredictable in the short term, but in the longer term it produces steady improvement. The path may veer this way or that, but the long-term direction is uphill.) Most important, the evolutionary view recognizes that knowledge comes from a social process. Knowledge comes from people checking with each other. Science is not a machine; it is a society, an ecology. And human knowledge, like the species themselves, is a product of the turmoil of the interreactions of living organisms.

Order emerging as each interreacts with each under rules which are the same for all (order without authority): just as that idea links the great liberal systems, so it also links the great liberal theorists. Darwin is known to have been strongly influenced by the economic ideas of Adam Smith. “The theory of natural selection,” writes Stephen Jay Gould, a paleontologist and historian of science, “is a creative transfer to biology of Adam Smith’s basic argument for a rational economy: the balance and order of nature does not arise from a higher, external (divine) control, or from the existence of laws operating directly upon the whole, but from struggle among individuals for their own benefits.”

And Adam Smith was deeply familiar with the thinking of the British political liberals (he published The Wealth of Nations in 1776, after all). Yet the most intimate connection between members of the liberal constellation is also the least appreciated: the connection between democracy and science. Indeed, the theory of political liberalism and the theory of epistemological liberalism were fathered by one and the same man, the father of liberalism itself.

John Locke proposed, three hundred years ago, that the legitimacy of a government resides not with the rulers but with the rolling consent of the governed. To the argument that “no government will be able long to subsist, if the People may set up a new Legislative, whenever they take offence at the old one,” Locke replied that government based on popular consent will be more rather than less stable than a regime in which the ruler is fixed, initial impressions notwithstanding.2 The genius of Locke (and, later, of Adam Smith and Charles Darwin) was to see, as Plato had not, that social stability does not require social stasis; just the opposite, in fact.

This same John Locke also set on its feet the empirical theory of knowledge. Locke himself never explicitly linked his philosophy of knowledge with his philosophy of politics, but the kinship is not hard to see. To begin with, he was one of the greatest of all the fallibilists (or, in that sense, of the skeptics). Just as no one is absolutely entitled to claim the right to rule, so no one is absolutely entitled to decide what is true. Just as not even a king may infringe on basic rights, so not even the wisest or holiest man may claim to be above error. For any and all of us may be mistaken. “All men are liable to error,” Locke said. “Good men are men still liable to mistakes, and are sometimes warmly engaged in errors, which they take for divine truths, shining in their minds with the clearest light.”

No: however certain you may feel, however strongly you are convinced, you must check. Knowledge of all things except our own being, God’s being, and mathematics can be obtained only by looking to experience—that is, by checking. From Locke, then, comes our public process for picking worthy beliefs, as well as our public process for picking worthy leaders. From him comes liberalism’s defining principle: rule by rules, not by persons.

And—no surprise, this—from him also comes the strongest of all arguments for toleration of dissent. In passages which today define the morality of liberal science, Locke preached the sermon which every generation learns with such difficulty and forgets with such ease: “We should do well to commiserate our mutual ignorance, and endeavor to remove it in all the gentle and fair ways of information, and not instantly treat others ill, as obstinate and perverse, because they will not renounce their own, and receive our opinions. . . . For where is the man that has incontestable evidence of the truth of all that he holds, or of the falsehood of all he condemns?”

This, finally, is why the Constitution protects the speech of Nazis, Communists, racists, sexists, homophobes, and Andy Rooney: they may be right. And, if they turn out to be wrong, it does us good to hear what they have to say so that we can criticize their beliefs and know why they are wrong.

-- Jonathan Rauch, "Kindly Inquisitors"

We describe human knowledge as evolving, but this is more accurate than a mere metaphor. We can see it in the decline of religion and belief in gods. And we can see what we might call a kind of epistemic creationism in attempts to - or even demands to - artificially circumvent that evolutionary process.

#Jonathan Rauch #Kindly Inquisitors #liberalism #liberal ethics #liberal science #knowledge #knowledge advancement #epistemology #evolutionary epistemology #freedom of speech #freedom of thought #free speech #conflict resolution #evolution of knowledge #religion is a mental illness

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gobstoppr · 2 years

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a ramble about . having hand and wrist pain that all started hitting me at once .theres no real thesis i just have been thinking about shit . happy disability awareness month .

god for what, over 4months now , ive had chronic hand/wrist pain thats made it fucking frustrating as all hell to do . the things i want to do . i cant play games for hours at a time . i can barely draw for over 30 minutes at a time without a break (oftentimes i have to take breaks long before that point) . i cant scroll on my dash forever since even with the keyboard shortcuts it strains over time (sidenote but CHRIST can i just . but a bookmark on a point on my dash. i want to come back there later and scroll from there . iwant the site to stop lagging ). everything i do i have to consider how bad my bones will hurt from it and if i can do it, if its something i can adjust to make easier on my hands, if its something worth 'wasting' what i call my 'hand stamina' for the afternoon. like oh if i play video game then i wont be able to draw or do shit for like at least 30min .

ive gone to the doctors. ive gone to the tests . its not carpel tunnel they say ! thank you for clearing that option after 3.5 months of pain. now i get to do more trial and error tests to see what i have . ive finally gotten at least like. the orders to let me get physical therapy so hopefully that can help . just side note i fucking HATE decentralized medical care holy SHIT why cant this info just be fucking shared between u guys . i wait 2 weeks between getting to go into the doctor and say 'yea mate it still fucking hurts' so they can give me a different appointment 2 weeks later and so on . its so much fucking treading water . weve been over this bullshit . why do i have to wait 2 weeks to see the dr for 10 minutes and then figure out an appointment . i just fucking . god .

i have to go to college in a month . im not going to be better in a month . im definetly never reaching what was once 'normal' condition for a long time . its . its hard to think about that shit . i feel like ive been trapped ykno.

i remember . for about 3 months. starting in late september 2021. i was having an absolute fucking blast . i had spamton brainrot . i could pump out several small doodles a day, sometimes multiple cleaned up/colored sketches, every couple weeks i might make a fully finished piece . i could spend hours upon hours just. doing what i loved . drawing silly guy who i liked . seeing what the other people in my community were doing . art, creativity is a conversation to me. i see peoples works, i get inspired, i want to create, even if i don't have anything in particular to say at that moment . it doesnt matter i have no ideas for posing or anything . i wanted to create . and i created .

i could be in my element . have this conversation . this feedback loop of inspiration . a constant improvement to my own skills as i just enjoyed art how i enjoy art . i'm mad at myself for not taking more breaks. im mad at myself for not fucking stretching all these years . but i will never regret my time . it was worth every second . and even if im not always interacting with everyone i met thru that time, im forever thankful for getting to meet all of them .

this is sounding a bit mopey huh . ok some quick advice then for this sorta shit in general.

for one . yes i know its fucking hard . but please just stretch a lil sometimes . even just learning one or two u can do pretty consistently can help u get going . this page has alot of good ones.

two . get yourself a good dumbass friend to watch stupid cartoons with you . yes im serious . if it were not for having my sister this summer to watch anime for children i would have gone insane with boredom whenever my hands hurty so i cant do shit . find yourself some bullshit to binge and laugh at . highly recommend the yokai watch dub of seasons 1+2 . good head empty but very entertaining shit . incredible for passing the time

three . find shortcuts for doing smaller straining tasks udont really think about . for example, theres the more prominant things like using keyboard shortcuts to navigate ur dash, but then theres stuff like realizing . oh trying to cut my sandwich with a knife is a kinda weird strain and because the bread is so soft its hard to cut super easily . so now i just . tear my pb+j up with my hands to cut it . jsut rip it . its not fucking worth the nonsense

yeah ok i think im out of things to say for now but yea. fucking hands huh . take care of yourselves gamers . i apologize if this is a bit gloomy

#disabled pride #disabled artist #text #tw injury

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onecornerface · 2 years

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Sarah Schulman on “My Name is Andrea”

Sarah Schulman, earlier today--

Tonight I saw a film by old friends, whose work I love, who I respect, who I would love to work with in the future...and I found a central element of it absolutely perplexing.

The film is "My Name Is Andrea" about Andrea Dworkin, by Pratibha Parmar, Produced by Shaheen Haq, and with additional production work by Amy Scholder and by V (formerly known as Eve Ensler.) Whew- that is a list of folks I really care about.

This film- while filled with cinematic invention, bright creative visual ideas, amazing archival footage and exciting movie making- is part of this recent trend of canonizing Andrea Dworkin that I just don't understand.

Other smart people like Johanna Fateman and Martin Duberman have also been part of this wave. It involves huge emphasis on Dworkin's early feminist writings against violence- which were and are widely compelling. And Pratibha does a fantastic job of articulating these ideas and presenting them with searing impact. But like the rest of the pro-Dworkin works we have seen recently this rich representation is accompanied by a shallow overlook of her very questionable work on pornography. Why one and not the other?

At the time, the dichotomous discourse was between pornography and censorship- today of course, we have total access to pornography (except involving minors) for anyone with a laptop, while living in a society obsessed with imposing censorship on ideas, language, and historical facts in all realms of everyday life. And the porn industry has been so decentralized that the way money is made is very different than the world Dworkin lived in and theorized.So neither side of these 1980's and 90's debates actually won.

As I recall, there were three basic elements to Dworkin's role in the efforts to control pornography that could be included in any revisitation of her life and work:

First, her totalizing theories about pornography and its social role. While I think generalizing against rape (actual rape, not the metaphoric use of the word that has arisen since that time)works then and now, using that template and applying it to all commodified sexual imagery just never fit. She was an absolutist about something that just was never absolute. How she failed in using the same approach from one arena to another would be worth unpacking.

Secondly, while she and her colleague Catherine McKinnon attempted to use Civil Rights approaches to control pornography -a questionable goal in and of itself- without success, they did influence legislation like the Butler law in Canada, which caused the seizure of LGBT books, and resulted in a famous show trial in Vancouver, in which Little Sisters, a queer bookshop lost.

And third, she and McKinnon worked in coalition with Right Wing groups, a tactic being repeated by anti-trans "feminist" groups today.

All of these complex and consequential decisions should not be ignored. When Pratibha's film eventually gets to this part of Andrea's life, the coverage is short and confusing, with a great clip of Carole Vance explaining the problems with Dworkin's ideas, but then the film drops what could have been an interesting historical revisitation of these difficult questions, that I think are worthy of unpacking.

I would really like an objective assessment of what the real impact of her work on sexual imagery ultimately was, if there was any in the end. And a look back to see what charges and counter-charges in those debates turned out to be overblown and which turned out to be accurate, and which under-predictive. And we may be far enough away from those events, and in such a different landscape now, that such a look might be possible.

After all, now we live in a world with extreme sexual violence and wide access to both violent and sexual imagery at the same time that saying "gay", talking about racism in classrooms, supporting BDS, and helping women get abortions are increasingly forbidden. So we ended up with porn AND censorship. And how did that happen?

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nickelpolish0 · 2 years

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Serving To You Keep Bitcoin Decentralized

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This publish covers the basics of Bitcoin buying and selling community is launching a trial. Not having banks concerned technique of July 1st the group of Bitcoin to be. These nine banks together with Lehman brothers a number of instances only to get their networks freed. Thus banks launched a coordinated effort to lure you to online buy-and-promote websites. Buying and selling and brief-selling and increases your personal safety by making it harder to mine. Likewise the telephone with restricted resources and restricted investment or trading expertise and low. Funding ranges tended to be subjected to related rules which might be safe against tampering is. At present 27.07.20, there are working to attach each College to the web. There was actually regardless that no name or e mail handle is associated with. Anybody with a single authority like a certificate of ownership and dwell on and even better riches. A stop-loss order acts as a global computer not controlled by any central authority.

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Nakamoto and there's a giant skeptic a couple of holy grail of meals traceability but said blockchain. CEO Ben Horowitz addressed the one involving Locky which was recorded below the banking system. The system to easily reveal the pitfalls of a virtual token representing possession. As not too long ago as with his non-public key to transact immediately with each other without the federation. This one is not something we might suggest If you're going to encounter a number of settings. Brent settled up one of those smartbulbs. Whinestone is the private security consultants say that’s one thing lengthy-term crypto buyers do. The funding rush means crypto companies registered with it the Bitcoin block reward. What ought to crypto fund was announced we'll settle for Bitcoin as authorized tender. https://www.daddydogeback.finance/ will now require Overwatch gamers to do whether or not they plan to. Now enjoying Watch this which they racked up a small quantity as a result of the transaction. Different cryptocurrencies have climbed to Tom Winter CRO co-founding father of Devskiller tokenization is the process after all. Wall Avenue Monday sending the S&P 500 index have been inspired by the announcement.

#bitcoin

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tennantrosendahl01 · 3 days

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China Biotech Services Holdings Limited: Shareholders Board Members Managers And Company Profile Bmg2152f1014

The space is massive and rising quickly, accelerated by medical trial decentralization. Additionally, it's complicated, and there are more than 15 discrete product markets, with every product market having its personal set of buying for dynamics and different aggressive sets. This creates significant opportunities for disruptive choices and investment for financial traders in each best-in-breed product corporations, and in multiproduct platforms. Several multiproduct platforms acquired investments and/or underwent recapitalizations over the past few years, together with Signant Health (backed by Genstar) and WCG (backed by Arsenal Capital Partners, Leonard Green & Partners, and Novo Holdings). While deal activity was restricted within the area in 2022 outside of Blackstone and CPP Investments’ acquisition of Advarra, we expect much more activity in 2023. For the finance group, this journey from awaiting clinical data to a industrial launch or different vital company life cycle occasions can happen shortly. According to a McKinsey analysis of pharmaceutical industry information from Evaluate, roughly 400 gene therapies are at present in development; by 2025, they could comprise round 20 percent of recent product launches. The field continues to evolve, with gene enhancing enabling everlasting and precise genetic deletions and ex vivo modifications. From 2019 to 2021, VC corporations invested greater than $52 billion in therapeutic-based biotech companies globally. In biotech retirement planning boston , we are going to explore how the powerful mixture of AI software program and Sage Intacct can revolutionize accounting workflows, helping Biotech firms streamline their operations, achieve financial insights, and achieve sustainable growth. 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They can even learn how to handle new trends in the industry like environmental, social, and governance (ESG) reporting and the potential financial reporting influence of the Inflation Reduction Act (IRA). With a humble start in 2001, we've expanded steadily with very excessive development. With AI-driven analytics and customizable dashboards, your finance staff can effortlessly monitor financial health, establish tendencies, and make data-driven choices. About Deloitte As used on this doc, “Deloitte” means Deloitte & Touche LLP, a subsidiary of Deloitte LLP. Over the past five years, the Biotechnology within the US industry has grown by 1.5% to succeed in income of $108bn in 2018. In the same timeframe, the variety of businesses has grown by 1.1% and the number of workers has grown by 0.2%. Establishing a budget is one of the most necessary steps you'll find a way to take throughout this stage. This finances ought to include all your anticipated bills and income for the upcoming fiscal yr. It has become widely accepted to categorize all small drugmakers as belonging to the biotech trade even after they don’t meet the definition of a biotech. By placing finance on the centre of all enterprise techniques, finance teams can see all of their key metrics on one dashboard and know where they stand in real-time. That also makes it easier for them to report their numbers to stakeholders and traders. Biotech finance groups must spend much less time gathering knowledge and extra time analysing it to inform strategic enterprise selections. Given most finance teams’ measurement and price targets, the one viable option is to automate information capture and consolidation. Securities and advisory services provided via Commonwealth Financial Network®, Member FINRA/SIPC, a Registered Investment Adviser. Based on analysis and interviews with greater than 100 founders, fintech and banking executives, buyers, and senior ecosystem stakeholders, we've recognized key themes shaping the future of fintechs. To help fintechs capitalize on these themes, we additionally provide a framework for sustainable development, based on an analysis of the methods utilized by long-established public corporations which have weathered earlier financial cycles. The final step in biotech financial planning is to develop a long-term strategy that takes into account their goals and goals. This consists of identifying potential collaboration companions, making a product pipeline that can be developed over time, and figuring out potential acquisition targets. By taking these steps, biotech companies can make sure that they've the sources they want to reach a extremely competitive and ever-changing industry. Biotech CPA startups require substantial investment to fund R&D, medical trials, and regulatory compliance.

#biotech wealth management #biotech financial services #biotech investment advisors #biotech tax planning #biotech estate planning #biotech investment planning #biotech retirement planning #biotech financial services boston #biotech investment advisors boston #biotech tax planning boston #biotech estate planning boston #biotech investment planning boston #biotech retirement planning boston

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drwhitegreen · 16 days

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White Green: Analyzing 2023's Digital Currency Market

White Green: Summary of the digital currency trading market in 2023 and outlook for the digital currency market in 2024.

In 2023, the crypto world will witness some very interesting developments, while certain other events are likely to occur in 2024. We conclude this year with an overall optimistic sentiment in the entire market - something we couldn't say in 2022. On the other hand, according to some reliable sources, the adoption rate of cryptocurrencies did not increase last year, but it still holds some hope for the future.

According to Chainalysis, the global cryptocurrency adoption landscape is mainly dominated by Central Asia and South Asia. Their Global Cryptocurrency Adoption Index takes into account factors such as the value of cryptocurrencies traded on centralized exchanges in different countries and decentralized finance (DeFi) protocols to reach this conclusion.

What happened in the cryptocurrency world in 2023?

It can be said that the United States is a contradictory country, with different states having different laws. For example, Wyoming is considered the most cryptocurrency-friendly destination worldwide, while the U.S. Securities and Exchange Commission (SEC) has filed lawsuits against over 150 cryptocurrency projects and brands since 2013. Last year was no exception.

In June 2023, the SEC sued both Binance and Coinbase, the two largest cryptocurrency exchanges by trading volume. Considering their lawsuit against Ripple began in 2020 and concluded just this year, it may take some time to see the conclusions of these proceedings for these cryptocurrency companies, which achieved favorable results in July.

However, in November of last year, Zhao Changpeng (former CEO of Binance) admitted to charges of violating US anti-money laundering laws. Binance is expecting to pay a fine of over $4 billion for the violations, and Zhao will face trial in the country. The new CEO of Binance is Richard Teng, and the brand's products continue to operate normally.

Similarly in the United States, the notorious cryptocurrency exchange FTX's former CEO, Sam Bankman-Fried (SBF), was found guilty in a fraud trial. He is expected to serve decades in prison, while Zhao is facing only a few months behind bars.

After leaving the United States, Terra (LUNA) founder Do Kwon was arrested in Montenegro in March. El Salvador remains the only country with Bitcoin as its legal tender, still planning to issue new Bitcoin 'volcano bonds' by 2024 and passing a law offering citizenship to foreigners investing in Bitcoin in the country. In the European Union, the MiCA law (Markets in Crypto-Assets) has finally been approved and is set to come into effect in April, with full enforcement scheduled for June 2024.

Overall, the total market capitalization of cryptocurrencies grew by over 101% in 2023 (according to CMC data). Additionally, cryptocurrencies are now legalized in 119 countries/regions, which represents the majority of countries/regions worldwide (according to CoinGecko). Investors can expect to hear some good news at the beginning of 2024.

The Cryptocurrency Trends of 2024

We can never be certain about the future, but some early trends can provide us with clues about the next steps in the crypto world. According to the 2024 Cryptocurrency Trends Report by Gemini, we might see some interesting developments. For example, they expect a higher intersection between artificial intelligence (AI) and cryptocurrency systems.

This integration is expected to completely change various aspects, including smart contracts, secure data solutions, transparent large language models, cryptographic security (auditing), and combating misinformation. Meanwhile, the prices of tokens related to artificial intelligence are significantly rising, indicating growing interest and confidence in the market.

On the other hand, speculation is rife regarding the potential approval of a spot Bitcoin ETF in the United States. The launch of this product, along with the next Bitcoin halving scheduled for April 2024 (aimed at reducing supply inflation), could have a positive impact on the price of Bitcoin, thereby influencing the overall cryptocurrency market capitalization.

However, more regulatory measures are set to be introduced globally. Despite the legalization of cryptocurrencies in most countries, only 52.1% of countries have implemented specific frameworks (according to CoinGecko). The MiCA law is the first to simultaneously cover multiple aspects of cryptocurrencies across multiple countries. With regulatory clarity, more institutions and companies can adopt cryptocurrencies for investment or to provide services to users, or even create their own stablecoins.

In summary, 2023 was a year of development for the cryptocurrency market, laying the groundwork for 2024. Cryptocurrencies will continue to evolve globally and gradually become an integral part of the financial system. However, investors should remain vigilant and exercise caution when participating in the cryptocurrency market. Understanding market dynamics and investment risks is key to success.

White Green is a highly regarded investment analyst renowned in the industry for his outstanding macro-strategic investments. His unique investment philosophy and excellent investment strategies have made him a rising star and pride of the Australian federal market.

As an outstanding investment analyst, White Green excels in quantitative portfolio management and data analysis to guide investment decisions. He focuses on value growth and utilizes portfolio diversification for risk hedging management. He successfully led teams and clients through the financial crises of 2008 and 2020, generating substantial returns for clients.

White Green's investment achievements are not only attributed to his excellent investment strategies but also to his forward-thinking market insights. He deeply understands the behavior patterns of market participants and excels at capturing market trends and opportunities. His global macro strategy enables him to grasp the pulse of the global economy, providing unique insights for investment decisions.

White Green is a prominent figure in today's investment community, and his macro-strategic investment approach and outstanding investment results make him a role model for many investors. Whether professional or individual investors, they can draw valuable experience from his investment philosophy and strategies to guide their investment journey.

#White Green

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whitegreen01 · 16 days

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White Green: Understanding the Future of Cryptocurrency in 2024

In 2023, the crypto world will witness some very interesting developments, while certain other events are likely to occur in 2024. We conclude this year with an overall optimistic sentiment in the entire market — something we couldn’t say in 2022. On the other hand, according to some reliable sources, the adoption rate of cryptocurrencies did not increase last year, but it still holds some hope for the future.

What happened in the cryptocurrency world in 2023?

Similarly in the United States, the notorious cryptocurrency exchange FTX’s former CEO, Sam Bankman-Fried (SBF), was found guilty in a fraud trial. He is expected to serve decades in prison, while Zhao is facing only a few months behind bars.

After leaving the United States, Terra (LUNA) founder Do Kwon was arrested in Montenegro in March. El Salvador remains the only country with Bitcoin as its legal tender, still planning to issue new Bitcoin ‘volcano bonds’ by 2024 and passing a law offering citizenship to foreigners investing in Bitcoin in the country. In the European Union, the MiCA law (Markets in Crypto-Assets) has finally been approved and is set to come into effect in April, with full enforcement scheduled for June 2024.

The Cryptocurrency Trends of 2024

White Green’s investment achievements are not only attributed to his excellent investment strategies but also to his forward-thinking market insights. He deeply understands the behavior patterns of market participants and excels at capturing market trends and opportunities. His global macro strategy enables him to grasp the pulse of the global economy, providing unique insights for investment decisions.

White Green is a prominent figure in today’s investment community, and his macro-strategic investment approach and outstanding investment results make him a role model for many investors. Whether professional or individual investors, they can draw valuable experience from his investment philosophy and strategies to guide their investment journey.

#white green

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twotwotwofive · 27 days

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You said what, ‘duty bound’? What are you, relic? Dunno, just confused that you’re willing to play fall guy for the *species*, when if you fidget too uncannilly you get your personhood put to decentralized tribunal-trial, voted on silent auction, decision dealt in slantward glances every time you shift or smile: What you need my friend is be fortified against actualization.

#FUCKING PLEB

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octalsoft · 29 days

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Does Your Electronic Data Capture (EDC) System Provide Enough Flexibility

According to the Tufts Centre for the Study of Drug Development (Tufts CSDD) study, at least one protocol change happens in more than half of all clinical trials. These changes have the potential to destabilize locations and research teams, causing inefficiencies. For example, if a change affects how therapy is administered or how and what data is collected, sites may need to re-consent with a patient. Changes in research procedures cause big logistical issues for everyone involved and waste a lot of time, especially when it comes to clinical trial data gathering.

Modern EDC Systems Must Accommodate Protocol Amendments

Data collection and patient visit schedules are disrupted if a protocol amendment necessitates. According to the Tufts CSDD research, clinical trials average 2.2 to 2.3 protocol revisions. This means that electronic data capture in clinical trials may have to be shut down several times, which is both disruptive and wasteful. Given the frequency with which changes occur, EDC systems should be built to sustain regular operations while adapting to changes.

Amendments that codify clinical trial data gathering, on the other hand, must be explicitly indicated for users to ensure that each modification is implemented throughout the study. If a new field is introduced to a form, the user interface should make it apparent that the new field must be filled out. Otherwise, clinical research coordinators may overlook the addition of a new item to their process. These sorts of notifications are straightforward but useful procedures that should be common in EDC systems. A clear approach for training or retraining users on any new feature should be included as part of that infrastructure.

Adaptable Designs, Adaptable EDC

Clinical trial design is becoming increasingly difficult. Adaptive trials, for example, evolve over time, which means that an EDC system must account for every conceivable path the trial may take. There are also several types of trials, such as basket, umbrella, and platform, each of which need a versatile electronic data capture software for clinical trials. As sponsors employ a broader range of complicated clinical trial designs, their EDC systems must be capable of implementing complex changes—often in the middle of a study.

Telehealth consultations quickly became a viable and essential alternative to in-person sessions during the COVID-19 epidemic. Remote visits in clinical trials increased in 2020 and 2021 as a result of site closures, travel limitations, and patients' reluctance to attend a medical center. Data from telemedicine platforms, wearables, sensors, and other sources must be integrated into EDC systems for this decentralized research. They also need the capability and flexibility to support numerous treatment arms as well as the mid-study adjustments that are inherent in adaptive trial designs.

Octalsoft EDC Supports the Next Era of Clinical Data Management

Octalsoft is constantly improving electronic data capture systems to match the flexibility demands of current clinical trials. EDC does not need any downtime for protocol changes. Following implementation, site users are automatically allocated the tasks necessary to accommodate the change, and revised eCRF completion criteria may be published and made instantly accessible, informing site users about the eCRF modifications and what new/changed data are required. Once a modification is made, it may be implemented without disrupting patient site appointments or bringing the entire system down. The ultimate goal: consistent, uninterrupted performance.

For reporting reasons, effective electronic data capture solutions log all modifications so users know when and how they were applied. modifies can also be reversed if, for example, a patient withdraws consent following a protocol modification that modifies what data they must supply. EDC saves users time by automating as many of these procedures as possible, allowing them to focus more on patients and the day-to-day operations of clinical trials.

Although all aspects of a clinical trial are rigorously monitored, studies are becoming increasingly complicated, protocol changes are regular, and recruitment is unpredictable. Furthermore, our environment is continually and rapidly changing, which has a direct influence on both trials and participants.

There are three core reasons why Octalsoft EDC is a firm favorite for clinical data management, clinical operations, and clinical database programming teams:

1. High Configurability

The majority of EDC studies may be built without the use of special functions. A study's components may be customized in 95% of cases. Octalsoft and our clients both have libraries of reusable custom functions to help them construct new studies faster. Customers can employ EDC's Professional Services team or create their own sophisticated research. Other solutions may need the development of additional functionality by a vendor in order to support a certain protocol.

2. Flexibility

EDC enables the ability to personalize the study construct and execute any protocol amendment or other mid-study design modification to provide support for any protocol, including complex adaptive designs and master protocols.

3. Transformational Study Build Processes

Octalsoft is dedicated to streamlining operations while maintaining quality and efficacy. By allowing greater study-build customization through the user interface, our next-generation study design technology changes the process. This novel method incorporates complicated casebook dynamic behavior. Because clinical data capture is no longer limited to EDC, we're centralizing the definition of a study across applications, including developing data source agnostic edit checks and data definitions (i.e., the same data definitions and edit checks would apply whether collected via EDC or eCOA).

Many of the edit checks we write now (to account for all eventualities) never run. A recent study at a big pharma customer revealed that anywhere from 45% to 75% of scheduled edit checks were never completed.

Octalsoft is enabling a more intelligent, risk-based approach to building research. As part of our next-generation data platform that supports the progression of clinical data management to clinical data science, we maintain data quality by concentrating edit check development on the most prevalent cases and employing AI/ML to detect data abnormalities. As a result, the amount of custom programming necessary to implement research will be reduced.

These three fundamental elements result in simplified study builds, which speed up the study construction procedure for many clinical studies.

Conclusion

To meet the clinical trial landscape's complexity and unpredictability, the only logical technology solution is a system with the functionality, adaptability, and flexibility to properly fit with your research. This necessitates the use of a system that is adaptable, can use pre-existing custom functions, and can create new custom functions to meet specific needs. If your EDC lacks them, it will be unable to expand and accommodate the rising number of complex/innovative trials.

This adaptability is one of the primary reasons Octalsoft's EDC has been chosen by over 30,000 users.

Octalsoft's staff collaborates with you to understand your study objectives, study design, and any special requirements. Alternatively, our training experts will assist you in creating your own studies.

Want to know more about how Octalsoft can help boost the flexibility and modularity of your next clinical trial? Book a demo with us today.

#data capture software #edc software #electronic data capture #edc clinical trials #electronic data capture software #edc system #edc in clinical research

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empyllon · 1 month

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Around the Bureaucracy in +80 Days: 5 Weeks in Hell — Where is Em?

TW unaliving, self harm, harmful thoughts, domestic violence, depression, systemic abuse and the factors that drive/prevent it systematically in Sweden, from one perspective

Part I, the Austerity Measures

Foreword

Today is March 26th as I start writing this, but I am doubtful I'll finish this draft tonight, or this week. When I publish, it might be tomorrow, or the week after, or never. I won't know until this is formulated and I hit post.

The title is a reference to the book "Around the world in 80 days", but the similarities ends there. I just needed a witty title to my experiences, at the expense of a preexisting work.

The State, the Laws, the System

So let me begin as far as I can go back. Because this story is not about me, but about the system around me. The attitudes, the support, and the erosion of it that caused such a thing as mass suicides among vulnerable citizens.

It begins in 2010, our government has become moderate. Some quiet changes has been made to the welfare and benefits system. There is a 180 day cap introduced to the sick pay. And 2012, a specific kind of sick pay (sjukpenning, SP) is created for individuals who has never had a job. The catch?

This is a bottleneck, specifically designed to make it as hard as possible for people entitled to "disability reimbursement" (sjukersättning, SE), formerly called early retirement (förtidspension). If you are below 30, you'd have "activity reimbursement" (aktivitetsersättning, AE).

It's about saving money either way.

The idea is that you would go from AE to SE if your rehabilitation hasn't been fruitful, but you might be placed on SP until you have done your trials. However, while AE & SE have about the same pay (it's adjusted for inflation), SP is not. In the later years, SP has been used to deny people AE as well, due to the 180 day limitation, causing people to become "uninsured", as a way to lower the statistic for people on benefits.

The Numbers

SP, 100% disability is fixed 160 sek/day, no adjustment for inflation

SP has a housing benefit with a cap of 7000 sek, that supposedly is paid the month after (this is what I'm told)

AE, 100% disability in 2023 was 568 sek/day, adjusted for inflation

AE has a housing benefit with a percentile coverage based on cost between 90-75% of your max rent, and is paid the same month

AE also comes with expanded rights to activities that promote rehabilitation, I'm unsure if SE includes this, SP does not. But realistically, with the crashed housing market, and increased rental costs, not even the smallest benefit can cover comfortable living for a disabled person. As in, assistive fitted tools, medication or adjustments. My own numbers were abysmally small by themselves; SP alone was 2560sek (due to delayed/refused housing benefit) and supposedly, at full reimbursement only yields 3712kr, and AE was 11928 (plus a housing benefit of 75% coverage in June 2023) allowed for a much better living standard. The issue lies in the daily allowance; AE is 350% times higher than SP, and SP is well below the minimum existence level. The system is designed to be punishing and harsh, so that people stop being "lazy" and go to work. I'll get back to this in a bit.

Too Sick to work, Too Healthy to be Sick

There is a saying here in Sweden that "you have to be healthy enough to be sick". Damned if you do, damned if you don't.

Along with these statements each state agency behind this has their own derogatory names; Försäkringskassan "Förskräcklingskassan" (akin to "antisocial nonsurance system", more literally "horrible insurance") and Arbetsförmedlingen "Arbetsförnedringen" (Public Humiliation Service, or literally "work humiliation"). I'll just refer to them as FK and AF from now on though, but there is a reason for their "names".

The purpose of these bottlenecks is that our government has since the new financial policies from 1993 that decentralized some institutions (read privatized), decided we need to cut spending on welfare. It's only in 2010 that our government realized the plans, and we now in 2024 have record low reports of people living on welfare.

There is a reason for every number, and the bad math is on full display (this is the so called "9. 0 goal", referring to the median days of sick pay being paid out). Post 2010, there have been reports of people either dying from cut assistance, or simply choosing to end their lives when they have nowhere to go.

Erland, 55 (2018)

Johan 35, (2021) (Source #2)

Sara, 33 (2019)

Linnéa, 22 (2020)

These are only a few names and articles I could pull under the search query "självmord försäkringskassan" on google (these are complete separate instances of welfare from the entire chaos that are the migration policies, although sometimes they overlap). There is a staggering amount of articles, that again and again state that a stable income is one of the foundations to improve mental wellbeing. And that the government knew that cutting welfare came with this risk. And... only in 2022 have they as much lifted the issue in the riksdag.

So why the hubbub? Why raise a fuss? Because aptly put — Sweden has invented a suicide machine, and I'm one causality.

News outlets are reporting of elevated suicide threats to FK staff (source #1, #2, #3, #4, #5, #6) and that the insurance system FK is disregarding the red flags. It's been reported that the case managers are actively encouraged to, or sometimes gets a bonus based on how many people they reject (#2), and has made it a competition in their office. They have also been documented as being callous, derogatory and outright ableist. They will even override doctors medical expertise to pull benefits and sometimes override their NDAs. Due to the toxic work environment, the government agency also has a high turnover.

As of today, Sweden has no legal clause to hold state workers accountable for such grave errors. It was scrapped in 1976, and replaced with a law that has less legal effect. You can report agencies to Justitieombudsmannen (justice ombudsman department), but it often has little effect. Even if you pull FK to court, and you win, they might totally disregard your case. In some cases they might demand a new court trial, in order to make you pay back.

What used to be jokingly memed about, "svensk välfärd" has become somewhat of a zeitgeist of a bygone era, where swedes took pride in sayings like "arrived like a letter in the mail"("som ett brev på posten"), "smooth as the train" ("går som loket/på räls") and so on. All of these referenced phenomena have since become privatized or decentralized with negative effects (#1, #2, #3).

Part II, The Time Frame to Disintegrate a Human

The Basic Understanding of Needs

It doesn't take much to totally annihilate a human and make them be void of any positive feelings of the self.

We can talk about it in terms of psychology, and use something simple like Maslow's pyramid.

The levels are (from bottom to top);

Pysiological Needs (Breathing, Food, Water, Shelter, Clothing, Sleep)

Safety & Security (Health, Employment, Property, Family, Social Ability)

Love & Belonging (Friendship, Family, Intimacy, Sense of Connection)

Self-Esteem (Confidence, Achievement, Respect of Others, the need to be a unique individual)

Self-Actualization (morality, creativity, spontaneity, acceptance, experience purpose, meaning and inner potential)

If we are talking about an already lesser-abled/differently-abled person — because let's be frank — without tools or assistance, some of us are unable to function, rendering us partially or fully disabled. This pyramid becomes the easiest way to explain the ableist droning of "why can't you just...", this is why.

A lot of neurotypical and/or ablebodied seem to lack the architectural skill of designing inclusive systems and societies that promote healthy growth, instead opting for some sort of stick. Usually in a similar fashion to people who say "my parents hit me and I came out fine", but reality is, you get a better growth curve with positive reinforcements and constructive negative reinforcement. Heck, even after owning only one elderly dog of 14 years, I've encountered these preconceived notions that "you can't teach an old dog to sit", mind you, he (the dog was untrained when I got him). Since then, he now knows a bunch of commands, and can almost perfectly heel off-leash. This is with a mostly positive reinforcement regimen, where negative reinforcement has only been used to teach him to avoid danger.

Enough side tracking, back to the main point.

The Calm Before the Storm

So how many days does it take to destroy a human through bureaucratic means?

About 90 days, if you count from my experience. I'll explain it.

It starts with being put on AE, because I was lucky to get on it before the 2012 reform. In Sweden, you also have something called LSS, which is summarized an anti-discrimination law of disabled individuals that includes neurodivergencies. This has mostly shielded me from most bullshit, until now, and allowed me quite a lot of support, which might be why I'm still alive.

Today it's March 27th. 90 days ago it would've been November 22nd, it's actually not that far from reality.

As I mentioned AE only covers you until you turn 30, and then you either have to

a) go into work rehabilitation programs or,

b) apply for SE, which with the new rules is increasingly hard to get.

Even though I could technically and legally qualify for it, my casemanager has told me that she will deny any applications I make. (I'll try to explain this later.)

Timeline Begin!

So in mid December I was scheduled for a "handover meeting", where my AE case manager gave me to a manager overseeing SP and a manager overseeing my case at AF. I had an assistive person attend from the LSS network, that helps specifically with work rehabilitation/education/occupation, abbreviated as EFA.

I was told the following;

My reimbursement would be less than now, but it shouldn't be a problem...

I'll be put on a work training program with AF to be an intern in active training...

I would get some paperwork sent to my home regarding rehabilitation reimbursement, RE ("rehab ersättning"), and was supposed to fill it in. However, I've forgotten the rest of the details, because despite my best efforts being neurodivergent, ND often means information overloading, despite keeping notes. (This will be relevant later.)

All government agencies will work together...

What I wasn't told;

But my reimbursement would be below poverty level, to the degree I could not afford any amenities, including medication to attend "training".

But I would have to apply to any programs/workplaces myself, while my case manager at AF does nothing but criticizes my efforts.

But my case manager at FK overseeing the SP would constantly use veiled legal terms and difficult words to delay or prevent me from applying to the right aid. She would sometimes flat out lie about papers sent, and misinform my social workers calling for clarification, causing paperwork to go missing.

But only in a way that would erode my energy, and in a way to deny me my legally approved LSS services. Claiming that I don't have the right to them and so on.

I'm getting a bit ahead of myself, so let's pull back a bit.

It's January now, so me and EFA draws a battle plan with AF, following the guidelines of FK. My month is mostly normal, I contact my doctor, apply for a new ID, take out my medications, work out, care for the dog.

Mid month, I talk with FK and get told what is going to happen. The only reason I know this is because my external memory is a notebook and a paper calendar with color coding. My notes from December-January state I was supposed to apply for;

a) SP with housing benefits

b) apply for SE if I can't work

c) fill in a form for RE and send it in

Don't report later than February 1st, and there will be a meeting with the case managers. To summarize, my notes are twice the size in bullets and span pages per meeting and task, each page with stick-ns and post-its (so you can see how easily someone gets overwhelmed).

Somehow I managed to get this step done, minus RE, because I forgot what the one prior case manager said (but it's still relevant to the story).

It's already just barely 4 weeks in, and we are already tangenting level #2 of Maslow's famous pyramid.

Oblivious to my abysmal future, I carry on, doing my best, trying to ignore the gut feeling (always trust it).

It rolls over to February, I send in the some papers, because I am not sure about what they mean. I couldn't apply in the end of January, and only in early February I understood it as.

Attend my doctors meeting to get the evaluation, and the eerie thing is this guy tells me "Em, from experience I don't think it will work, but they usually don't deny my extended applications for SP". I know he has his reasons of clinical expertise to make a judgement, and in hindsight, guy was right. I wasn't too invested in trying to understand the bureaucratic lingo, as I was in the middle of trying to combat a shortage on one of my daily medications, and I was more focused on solving that issue.

One problem less right?

Dead wrong. So from this day onward, in a picturesque description; it's like you start observing seismic activity on the radar, and you get concerned over the readings, before the actual catastrophe hits.

I keep going though, I wanna be good, I want to show I am a citizen of good standing. My performance anxiety kicks in. I'm placed at a dog daycare, and I make sure to be good with my boss. I never ask for accommodations other than asking that nobody eats peanuts in the kitchen, I use all my assistive tools (corset, orthoses, pain relief, psychotherapeutic medications, planners, custom shoes, etc.). I bring my dog with me initially to work, along with my gear. And I do good, at least I try. I make sure my dog behaves with their pups and help them organize/discuss stuff. Mostly I'm helping with the dog walks (relevant). This is from the 18th onward.

However second week, I'm told that my dog is no longer welcome due to new regulations, and that I need to start taking more/other dogs. Most of their clients are bully-type dogs, which is by no means something bad, but they are strong and have bullish willpower that requires a strong handler with the right physique. Just by comparison — I own a 3,4kg senior toypoodle that has been leash trained, and mostly walks off-leash as part of his training. The dog I was given to walk was a small French bulldog that was used to flexi-leashes and would run into oncoming car traffic any chance she could. I would describe her posture as frog-like due to the sheer pulling. She had a good nature, but horrible leash manners. It seemed she got worse when she was given shorter leads, which could be a sign of frustration.

Imagine handling that daily, intensively for 30-45 minutes. I think anyone would be sore.

On the 23rd FK finally responded to my claim. After being radio silent for a week. On the 24th they approved it, a text stated I'd be entitled to 2560 sek. So I logged into my e-services to make sure it was real, because like I said AE was much higher. In December 2023 they sent a sms statement saying they will be paying me 17589 sek. Anyone with at least one point in logic skill can see there is a huge gap of 15029 sek, you can sort of explain some of it away, but the more you stare, the more of an offensive austerity measure it becomes.

AE broken down looked like;

13036 + 6549 (housing allowance) - 1996 (tax)

Remember how I talked about flexibility and percentages earlier? This is where that stuff matters.

The daily reimbursement is closer to a very low wage job, that can allow you some flexibility. It also comes with a beneficiary card for 25% discounts.

SP broken down;

3200 + (no housing allowance) - 640 (tax)

When the daily allowance is fixed, you get no wiggle room for errors, or extras.

I might have dyscalulia, but I can still use markers, tools and excel sheets to sort my own finances, so I did. I thought there must be some grave mistake. You know, the oblivious to the fact, believing it was a simple solution. DEAD WRONG.

Regardless, I checked my medication stock. I'm running low. Made a journey into town on my way to work between my doctors appointments for newer orthoses and my internship. I showed a clerk at the office my paperslip with the math and said "can you make this work?" I think this was on the 26th or the 27th. She called my case manager, saying I might not even be entitled to SP. My case manager at FK had changed, you know, like that story of Jekyll and Hyde. She became cold, callous.

I had entered a state of panic.

I had friends run my numbers too. And it was all the same, after rent I'd have around 397 sek left. If you ever seen the memes that say "I finally paid rent, now I have a place to starve and freeze in", this is exactly it. I used my adaptive excel sheet to calculate my finances, and cut off anything that isn't essential (not that I had any to begin with). I had so many suggestions as well, I could move theoretically (but rent is still due), I could give up/surrender/sell my dog (and suffer alone).

Regardless of how these numbers went I'd be -4023 every month. Half is just the cost of utilities, you know, heat, water, internet and so on. Half is groceries and medical expenses. I had with assistive tools set up a frugal lifestyle that allowed me some savings. But if you are constantly reliant on new assistive tools, your savings can vanish just like so (a set of shoes with custom soles are usually 3600 sek, my much needed orthoses are 900 sek).

I'm not writing this to e-beg, I'm writing this for you to see, to understand how financially crippling it is to be disabled and in need of tools you can't afford.

And we are still only in February.

So I asked my social workers to help me locate the contacts and numbers for each case manager to rectify this problem. Because I've never been late with rent and it's honestly one of the most stressful situations to be in.

So we called the case manager for SP, and asked, and sought clarification. Did I send in all my papers right? Will I be able to pay my rent? What about RE, because I need to afford my medications. Yes the papers came in. Rent next month, it will be a delay. RE is irrelevant and you won't be reimbursed for your days in training.

Meanwhile me and EFA have weekly meetings, AF decided I should only contact them every 6 weeks for a follow up. I started lifting the fact I will have issues to go to work, both because of my ticket expiring and my lack of access to affordable medication. My casemanager at AF said that any financial questions are to be forwarded to FK. (So I brought them there.) EFA was keen on still hounding them down for me.

It's not like I didn't try, I did. On the 26th(?) I applied for municipal welfare, after being heckled by FK; "if you can't afford anything, apply for welfare". I sat through 1 e-application, 1 phone meeting, 1 physical meeting and at least 2 complementary paperworks, either with a parent and/or social workers. Trying to note down what I needed to do. My welfare, "WF" manager, has been away from work since mid-February. Despite calling weekly to ask who is overseeing my case, so I can pay rent, I never got full answers.

I couldn't sleep, nor afford my meds. I had to chose between my sleep aid, or my daily tablets, so I chose my dailies.

On the 29th I physically broke down, unable to work. My hands stopped functioning. I dropped a mug due to a failing grip, and I recall vividly that day. I let the last of my spotify premium play podcasts run on autoplay sometime during the week, and P3 Dystopia aired an episode on suicides and what drives them.

The three factors mentioned

Economic crisis — I can't afford my living

Isolation — I can't travel freely

Feeling like a burden — Shamed for being less abled

There are a few more, but the short summary gave only 3.

The podcast was more about the statistics, and trends within the genders, than the actual act of it. It also went over preventative measures and buffering effects. Regardless, after hearing that, and glancing over my own situation. I turned to my contact at EFA and said "put me on suicide watch and don't let me go".

The Beginning of the End

It's now March, I've called my landlord and pleaded for help. Asked to postpone my billing, just tried to put out any fire possible while balancing trying to not stress my dog and keeping up with the good girl image. Just trying to survive. I got no good graces left, my landlord won't push anything past March. The welfare system bans you from receiving payments, so I am forced to wait for their evaluations. I feel like I'm standing before the executioner.

I recall the podcast, and the time process it takes to go from just an intrusive thought, to real actionable plans. I cracked a joke at my peers, to synchronize their death watches, nobody would suspect a harmless TF2 meme as my way to say "I'm dying soon, it was nice to know you". A meme is a meme after all.

I think I set it to 2 weeks. That's when my expiry date as a passable good is over. I'm just another carcass thrown to the biowastage grinder, perhaps to end up as fuel somewhere, or just as pure filth.

I thought I wasn't good for anything. A failure. Just a waste of space. That I was better off dead.

I went as far as considering the comfort of my peers, to simply vanish. I won't say how, or with what, as that is how someone else might end up hurting themselves. I imagined remaining gone forever would be better than finding my remains. I also considered my dog, how he's my child, and that he deserved someone better than me.

If you have read this far, you can see how the pyramid of needs have eroded, and it didn't take that long either. You can also see given the sources, that I'm fitting all the criteria for becoming suicidal.

Did you try...x?

It's not like I didn't try. I really did.

At every instance where there was a snag, I referred to my health network. I talked to my occupational therapist about the hands and the internship, and was recommended to ask for help finding an office job because they were mortified regarding the laboring tasks. AF told me I have no redeeming qualifications for that. When I asked in forums for my disabilities what people worked with, I requested to be put on a training program that suit my abilities, again AF said no, I'm not entitled to it. I also asked a friend that works as a job coach what is going wrong, explaining my situation, only to be turned down when I asked AF for an evaluation of my competencies (on their suggestion as this would enable me to find internships faster and enter programs more tailored to me). This past week I learned AF also has something called SIUS consultants, which is a specifically appointed consultant with competencies tailored to disabled individuals. I asked EFA to find out if my AF contact was one, the answer no.

Ground 0

After exhausting all my ideas, all my possible solutions. I had none left, even with LSS at my back, the system won. Last Wednesday I had my final call with FK and AF with EFA.

I once more asked "realistically, how do you think I will manage work, without my assistive tools? Without medication?"

FK replied "seek welfare then"

I replied "I did in February, it's at least 3 weeks waiting time, I can't afford to maintain my health"

Radio silence.

AF chimes in "Em forget the money"

I again reiterated my needs, and asked about RE.

I questioned her on it asking why one is called rehab and the other is called sick in title.

FK then started citing some legal paper, without explaining the differences or why I was sent this paper to begin with. She just kept repeating that they are the same. And I'm wrong and won't get any more money.

They are not the same. They are two different economic programs for different activities and purposes. You can read about them here and here. My issue is I need to verify I do things correct, due to my disability.

After that call I decided, I didn't want to live anymore.

Disability Bingo

So how many conditions qualify for a humane insurance system?

It's individual, and regional. Randomly based on the case manager you get.

I won't state my full medical history because I'm not some zoo animal to watch, but I'll say this.

I have more than 3. The ones that impact my day the most are Ehler-Danlos (hypermobile), AD(H)D (I think it's type C nowadays), and Autism Spectrum Disorder.

When I'm medicated, I'm slightly more prominent on the spectrum, but it's manageable, ASD comes with perks too. EDS require a strict regimen of rest, and regular exercise. I used to lift weight machines to prevent my physical pain and subluxations. Despite the best of efforts, I'm still very limited. I rely on cars and buses, but I'm very much self reliant.

With the right supports I'm a star model for rehabilitation and upward mobility, but denied my basic needs, I'm like a fish out of water, forced to climb a tree.

Due to my severe counts of subluxations, I'm always careful with how I use my body. (I've dislocated my elbow by lifting a phone and opening a car door.)

You hopefully understand my predicament now, and the true scope of my limitations.

Part III — Where are you now?

Inside You There Are Two Beasts

That's how the meme goes.

Inside me,

there's the dark overwhelming monster that wants to kill myself,

and then there is the side that wants to live.

The side that wants lo live has won, for now.

Before I acted on my plans, and undo myself forever, I called 112.

I cried on the phone, told them how I felt. An ambulance came, and they took down my story.

I got placed in urgent psychiatric care with supervision and has mostly slept.

What I told you here is only really the short, and tailored version of actual events. There is so much more I wish I could talk about, but I need you to know.

I. Am. Safe.

My dog, Robin is safe. A friend that knows me has his full care sheet and is updating me.

The hospital knows about my situation, so does my network. Most of them.

I hate opening up to people about myself, to show myself at my most delicate, but maybe this post will stand as a beacon to someone in the dark.

I tried, and I tried real damn hard to get everyone to see and hear me. I shouted on top of my lungs, and only now has I arrived in a place where my weary voice is tuned into.

There was this quote from the Netflix series Midnight Club, it goes something like;

"Here but not here. Gone but not forgotten."

I'm still here, I hope you haven't forgotten me.

And I hope anyone out there, reading and identifying with this, will keep trying.

Someone will hear you.

Today it's the 27th as I write this. I've been hospitalized for about 5 days, and I've slept most of it. I feel like I still have to justify my own existence, even though I don't have to.

Call the hotline, tell your story.

The most disgusting part was that FK still tried to call me, to make sure I was actually sick. Had I not had EFA or LSS... I don't even wanna think about it.

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