Hall of fame marathon results

Let’s look at 3 scenarios.
1-A player that does not want to spend any money at all to play the game. This player relies on gyms to fund their remote raiding.
2-A dedicated player remote raiding multiple a few times during the week. This player may place some Pokémon in gyms to off set costs of remote raiding but has pretty much decided they’ll spend some money.
3-A hardcore player that remote raids every single day. No issues with spending money to play the game.
Scenario 1 - The frugal player.
Current situation: This player works to get 50 coins a day and for the sake of this scenario we’ll say they are really good at it. So 6 out of 7 days they get 50 coins. That’s 300 coins, and for their hard work at taking gyms (or maybe a single gym they have a daily routine on) they get to purchase 3 remote raid passes (1 bundle) every week. This would likely get them,..2 legendaries weekly, as they are not guaranteed wins and some raids fail. At the end of the month,..they have 8 legendary Pokémon and spent zero dollars on coins.
New situation: This player now cannot buy a 3 raid bundle weekly. But they have 300 coins at the end of each week (basically 1,200 at the end of the month). So they have to make a decision. They could wait two weeks and get a 3 raid bundle, so 6 for the month. Or they could buy a single raid pass as soon as they have enough coin. This would take basically 4 days(200coins, 195 per pass). Either way, they should be able to get 6 raids in the month,..and probably walk away with 4 legendaries. One a week basically,..if they are taking gyms,..6 days a week.
End result…this player gets half of what they used to. But wait! They may get lucky and get a raid pass in their weekly research. I think it’s fair to say they get two in the month,…so now they are up to 6 for the month. So this player has spent no money on coins and lost out on 2 Pokémon from what they are used to getting in the month. Sounds good? Well keep in mind that they have to be physically able to go get those gyms (Sorry anybody out there with limited mobility) and let’s compare it to other player types.
Scenario 2: Current Situation: This player has some income. Doesn’t mind spending a little on the Pokémon habit. Some people smoke, some people do meth, this person plays Pokémon. Right now if they spend $10 bucks a week on coins they could get 4, 3 raid bundles. That’s pretty nice. So after the kids are in bed, after work, after homework, whatever, this person raids a bit. So for their $10 bucks they get to raid 12 times a week. They don’t have to take a gym. If it’s available they will, but it’s not a big deal. 12 raids a week,..that probably gets you 9ish legendaries (if they are only raiding legendaries, which they aren’t but we’ll say they are). At the end of the month they have 36 legendaries in their deck and $40 less in their wallet. However they like the game so not a big deal.
New Situation: So the Pokémon budget of $40 bucks a month got this player 4,800 coins ($10 for 1200 coins weekly). But yikes,…1200 coins used to get them 4 raid bundles for the week. Now they get 2 raid bundles for the week for a chance at 6 Pokémon weekly. We’ll say they walk away with 4 weekly. End of the month they are sitting at 16 legendaries,..+ 2 from research = 18 for the month. Half of what they had previously for the same $40 dollars.
Now this player is looking at other options. They are saying,..”damn I know I end up buying coins weekly,…maybe I should just drop $40 bucks straight up and get 5200 coins.” So now this player drops his $40 bucks and 5200 coins is going to get them 9 bundles for the month (with some change left over to start the next month). So 9 bundles is 27 passes. For $40 bucks. So we used to get 36 legendaries a months,..and now they are getting 27ish. Is that a big hit? I donno,..but it’s a hit.
Scenario 3: The BALLER. Current Situation: This player is dropping serious cash on the game. Let’s keep it kind of light though. They spend 100 bucks and get 14,500 coins. That’s 48 bundles. 144 passes. Basically 4-5 remote raids a day for 30 days. This person is probably walking away with 120 additions to their deck. $200 bucks a month,…240 legendary raids?? A month? 8-10 raids a day every day in a month. Hardcore man.
New situation: 14,500 coins is only going to get you 83ish raid passes now,..2-3 raids per day over 30 days. However now there is a 5 raid cap. So Let’s just keep it simple,…they have enough money to raid as much as they want,..but are capped at 5 a day, which is 150 remote raids in a 30 day month. Which gets them 140 catches? So they add 140,..but need to spend $100+ dollars doing so.
How does all this balance the game? Players that can afford to drop the money still greatly benefit over those who can’t.
If you don’t want to spend money to play it’s now harder for you to even get a legendary and you have LESS access to them.
If you are spending money on coins and passes,..and can afford it,…well you’re going to be rewarded by a min of 20 more legendary Pokémon a month than those poor players.
And if you are a high roller,…well you probably don’t really care because you can afford to pay to play the game.
It all reeks of taking advantage of people and players. They start you with a little taste of things,..get you hooked,…raise the prices,…reel you in.
Keep a close eye on event lengths in the future I have a suspicion that they’ll be just long enough to capitalize on FOMO, “I’m so close to a raid pass,…let me spend $10”.
Rant off. Lol sorry so long.

Tracking is important you guys!!!
It's easy enough to say nothing works or helps, but memory is short and sometimes we simply may not realise how far we've come.
So this is where we can jot down our thoughts, journey, progress and we feel good about the changes we're making!
Please use the format below, to make things consistent. It'll help you compare your current skin to how things were 3 months ago.

• skin / hair / scalp type
• skin / hair / scalp conditions
• skin / hair / scalp goals
• Current AM/PM routine
• Age range
• Latest products that, you feel, helped you get closer to your goals
• Product fails / Products that set you back
• Techniques you tried and their results Example: 4 layers of toner makes you break out so 3 is the sweet spot; styling your hair while its fully wet vs damp makes your leave in conditioner last longer and you now need less quantity so better results + saving money 💪)
• Specific things that you're tracking (how quickly that one PIH fades if you use X product, how long a tan takes to fade if you're using x routine)
• Notes to your future self

Please make this as detailed as possible! It'll help you analyse and recognise what helps you and you'll be able to curate a more effective routine for yourself.
​
This is NOT the space to ask for recommendations, routine help, off-topic rants & rambles, and critique on your routine. There are other weekly threads that cater solely to those, so please post there.
Other people who post here might have skincare philosophies that differ from you, be using products that in your opinion are sub-par, spending too much in your opinion etc. Unless asked for, please keep your opinions to yourself. This is a judgement free zone.
Please be polite and kind. Rude comments will be removed. And action will be taken against those violate Rule 1.

https://www.reveddit.com/neoliberal/comments/126f0fp/discussion_thread/jeb25d7/
Full comment:
look
you don't just get to change the way you interpret a law because you don't like what the result of the last interpretation was.
an implicit premise of our entire system of laws is that laws have one meaning. this is totally independent of any debate you care to have over textualism or originalism or whatever the fuck else.
i can't stop you from working backwards and saying "I want the second amendment to mean X" and using that to figure out what the interpretation rules are, but you don't get to apply those rules just to the 2nd amendment.
and as an only vaguely related side note "Heller is so new so who even cares" is a moronic argument
if you want judges to change their interpretation in response to actual world outcomes or something then you want the judges to make law. which, in itself, is fine as long as you're fine with how democratically accountable those judges are.
- kznlol

Hi! I did some playtesting and got some feedback, and have made some changes and additions to the Project!
Night Watch(Marquise) Setup: Place a Warrior in each clearing. Activated: Place a warrior in a clearing with enemy pieces and a Watch warrior. Battle in that clearing.
Extinct Eyrie(Eyrie) Setup: Place 6 Warriors in clearing 7. Activated: Reveal the top card of the deck, then move all Eyrie Warriors to a matching adjacent clearing with enemy pieces. Battle in the destination clearing, then put the revealed card back on top of the deck.
Rebellious Revolts(Alliance) Setup: N/A Activated: Remove a Revolt warrior and all warriors in their clearing. Then place a Warrior in an Un-even-numbered clearing with enemy warriors.
Thief(Vagabond 1(there will be another vagabond option later)) Setup: Place the Thief in a clearing with a Ruin. Activated: All players with Faction pieces at the Thief's clearing discard one random card. Place the Thief in a clearing with a ruin. Passive: When a player removes the Thief, that player draws 2 cards and scores on VP(as if it had removed an enemy token).
Wandering Merchant(Company) Setup: N/A Activated: Remove the Merchant from the map. Place the Merchant in a river clearing with at least one building. Then, all players with faction pieces in that clearing may draw one card. Passive: When a player removes the Merchant, they draw 2 cards.
Crazed Cultists(Lizard Cult) Setup: Place a Cultist warrior in clearing 10. Activated: In a clearing with a Cultist Warrior, replace one enemy with a Cultist Warrior. Then place a Cultist warrior in a clearing adjacent to a clearing with a Cultist Warrior, or in Clearing 10 if there are no Cultist Warriors.
Corvid Critnappers(Conspiracy) Setup: roll both attack dice. Place three Corvid warriors in the clearing equal to the combined total of the dice. If the result is 0, re-roll the dice. Activated: Move all Corvid Warriors to an adjacent clearing with the least amount of enemy pieces. Then, move all enemy warriors from with the corvid, ignoring rule. Passive: Corvid ignores rule when moving. Enemy warriors cannot move into or out of a clearing with any Corvid warriors.
Leave some more feedback(i made changes to eyrie and added critnappers. I have not a single idea for the moles so please help me)

Terrible PMDD since I was, oh, 16. Ketamine therapy with Sirolimus has finally got it under some semblance of control. Hooray for me, right?
Wrong. Last week my pap results came back, was quickly given a colposcopy, still waiting for results but the post-procedure notes make it crystal clear I'm staring down the barrel of cancer, or just short of it, and a likely hysterectomy (oh how I hate that word! Always with the hysteria root words!)
I've been avoiding the "scoop me out like a cantaloupe" option for years, to skip having to deal with HRT. But with these findings, plus my husband being baby-proof, it's looking like all my efforts and hard won "victory" has gone for fucking nothing, and I'm bereft. Terrified. Angry.
Fuck being born with a set of female reproductive bits, man.

Immigration lawyers help people emigrate from one country to another for work, travel, school, or other reasons. They concentrate on offering legal services in all spheres of the immigration and nationality act, to the extent that is permitted by law. Immigration experts are frequently used by people who want to apply for permanent residence. But there are differences in the services that immigration representatives offer. Although you may be seeking to find an "immigration consultant near me," a consultant who has expertise in immigration can typically help you from anywhere in the world! Let us assist you in determining what to look for as you seek to choose the best immigration expert available. This indicates that the immigration consultant is subject to regulation and is required to abide by a set of guidelines that serve to protect a client or consumer.
Immigration consultants in Bangalore for Canada offer the following services:

• providing assessments of their client's chances of getting a visa. For any reason, no immigration representative should ever guarantee that you will obtain a visa; this is especially true if they charge you money or claim to have a connection with the immigration office.)
• providing customers with assistance with all facets of immigration, including family sponsorship, refugee claims, appeals, temporary residency, work permits, and student immigration.
• assisting customers in preparing for meetings with various types of visa officials.
• helping clients prepare their immigration applications and supporting documentation or copy-editing them to ensure they are accurate and error-free.

What factors are most crucial to take into account while obtaining expert immigration advice?

• counseling with transparency
• According to the rules and laws of the relevant countries, they must offer clear and in-depth information.
• The world's most reputable and trustworthy company
• Knowledge and Certification
• possess several years of successful visa filing experience, are certified, and have connections to numerous authorities
• For PR, Immigration, Employment Opportunities, Visits, Education, and Travel Visa as well as other nations, like Australia, Canada, Germany, Hong Kong, Quebec, New Zealand, and many more, Visa Immigration offers specialized advice and expertise. Australia Immigration PR is one of the most popular demands by a large population.
• Cost-effectiveness
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• We make sure that all of our customers are happy. That is a result of the outstanding assistance we provide in all desired foreign "Facilities." Look at what others are saying; it's not only what we say!

Want to feel confident again in your favorite dress? Ever feel like no matter how hard you train, your booty just doesn't seem to show results? The Electrical Hip Muscle Stimulator solves this problem for you instantly!
https://zafyn.com/collections/new-products/products/electrical-hip-muscle-stimulator
​
https://reddit.com/link/127cdi7/video/hu6xu6ejol261/player
This allows you to train your booty and lower bodyeffectively from the comfort of your own home. It uses electrical muscle stimulation to promote muscle movement, scientifically proven to tighten your musclesto help achieve that perfect figure.

Highlights:

​

• Electronic muscle stimulation: stimulate the hip and gluteal muscles and help to tone, tighten and firm your hips and buttocks to achieve the body that you’ve always wanted
• Exercise anytime: provide endless possibilities in training your booty like in front of the TV, when doing the dishes, or even when cooking
• U-shaped design: ergonomic pads cover targeted regions in the buttocks to stimulate nerves where they are most concentrated
• Cost-effective: save time and money on expensive gym subscriptions and allow you the convenience of getting amazing results without tiring workouts

​
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• You only need to train for 15-20 minutes/day to get that noticeable improvement in just 4 weeks
• Easy to use push-button operation with 6 modes and 10 intensity levels
• With a push of a button, you can adjust the intensity of the stimulation and go about with your daily activities
• 100% skin-friendly and pain-free

Specifications:

​

• Material: PU
• Power Source: 2 x AAA batteries (not included)
• Certificate: CE/EMC, ROHS-certified
• Color: Black & Orange
• Size: Approximately 260mm x 188mm x 12.8mm

Package Includes:

​

• 1 x Electrical Hip Muscle Stimulator with Reuseable Gel Pads
• 1 Set of Reusable Gel Pad Replacement

https://zafyn.com/collections/new-products/products/electrical-hip-muscle-stimulator

North America
Nickel powder prices in the third quarter showcased a mixed trend in the US market amid the rising fears of recessions. According to market participants, LME three-month nickel prices were under pressure, and trading activity was relatively stable. According to manufacturers, the demand outlook for September was flat; they were still seeing consumer orders for nickel during the final month of Q3 2022. However, the market was highly volatile at the time, with people unwilling to commit beyond October. Although sources had predicted periodic steel production cuts for some time, reports of closures and rumors of further suspensions had yet to shake nickel markets. There has been a reduction due to a few mills taking time off, but this is due to electricity prices rather than demand. Traders say it is difficult to predict where nickel prices and premiums will go in this market. As a ripple effect, the Nickel powder prices for Ex-San Diego settled at USD 22754/MT.
Asia Pacific
In the Chinese market, Nickel powder prices witnessed a mixed trend during the third quarter of 2022 amidst rising interest rates and the firm US dollar index. Nonferrous metal prices are under pressure in July due to the Fed's tight monetary policy. Additionally, the plants had previously stockpiled high-priced nickel ore inventories; thus, they reduced production to reduce losses. On the other hand, the macro situation significantly impacted nickel prices, and the fundamentals were poor, so nickel prices will remain volatile. Due to weak demand and rising inventory, nickel prices received insufficient fundamental support in August. Despite a slight rebound in spot premiums, spot trading has significantly improved. Ore prices are unlikely to fall as the rainy season approaches, and the Stainless-steel Prices resumes production in September. As a result of the strong demand from the downstream steel seasonal demand, Ex Shanghai nickel powder prices settled at USD 787/MT.
Europe
In the European market, Nickel Powder prices witnessed a mixed price trend in the third quarter of 2022 amidst soaring energy costs. According to market participants, nickel powder prices fell in the second half of the year despite expected seasonality. Because of high raw material prices and economic uncertainties, global demand for nickel from the stainless-steel sector remained weak and slow in the third quarter. The latter include historically high energy and sea freight prices. While soaring energy costs forced temporary production cuts at several steel mills across Europe, including those in the stainless sector, speculation about further cuts spread among nickel market participants. As a result, downstream demand for nickel powder remained relatively stable. At the moment, the market is extremely volatile. As a result, Ex Hamburg's nickel powder costs were settled at USD 22245/MT.
ChemAnalyst tackles the primary difficulty areas of the worldwide chemical, petroleum, pharmaceutical, and petrochemical industries, empowering decision-makers to make informed decisions. It examines and analyses geopolitical risks, environmental concerns, raw material availability, supply chain functioning, and technological disruption. It focuses on market volatility and guarantees that clients manage obstacles and hazards effectively and efficiently. ChemAnalyst's primary expertise has been data timeliness and accuracy, benefiting both local and global industries by tuning in to real-time data points to execute multibillion-dollar projects internationally.

my love can only be described as two powerful magnets on opposite ends of the earth. as life continues, the attraction between us grows but to the point in a magnet where attraction are at its peak. as soon as we set sight on each other, the magnets attract and travel faster than the speed of sound and collide, shattering both magnets as a result. our love was so strong we couldn’t handle it in our young, powerful but fragile bodies. but soon i hope to grow into a weaker magnet even though we would attract much slower, at the end of the day, i would be with you intact.

Compare these results to my poll of the general Reddit population here
View Poll

Revive Adserver provides a range of targeting options to help publishers deliver relevant ads to their audience. Here are some targeting strategies that can be implemented in Revive Adserver:
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Behavioral targeting: This involves targeting ads based on the user's browsing behavior, such as the pages they have visited or the keywords they have searched for. Revive Adserver includes features for tracking user behavior and targeting ads based on that behavior.
Contextual targeting: This involves targeting ads based on the content of the page the user is currently viewing. Revive Adserver includes features for analyzing page content and targeting ads based on keywords, topics, or categories.
Retargeting: This involves targeting ads to users who have previously interacted with your website or shown interest in your products or services. Revive Adserver includes features for tracking user behavior and retargeting ads to those users based on their previous actions.
Demographic targeting: This involves targeting ads based on the user's demographic profile, such as age, gender, or income level. Revive Adserver includes features for collecting and analyzing user demographic data, which can be used to target ads more effectively.
By implementing these targeting strategies in Revive Adserver, publishers can deliver more relevant ads to their audience, which can help improve ad performance and increase revenue. It's important to test and optimize targeting strategies over time to ensure that they are delivering the desired results.
You can find a list of official Revive Adserver plugins on ReviveAdserverMod.com which helps to improve targeting options to help publishers deliver relevant ads to their audience

Glucans from mushrooms are polysaccharides that contain sugar chains, sometimes of only one kind (glucose), sometimes having several monosaccharide units, and they have two (α and β) anomeric forms (isomers). Their molecular weights range from 104 to 105 Da, and rarely 106 Da. X-ray diffraction studies were the first to determine the triple helix configuration of some glucans. It seems that the existence and integrity of the triple helix structure are criteria for their biological effects.
Different glucans can be isolated from different mushroom species, and several glucan fractions can be obtained. The biosynthesis of glucans takes place in the cytoplasm, the processes of initiation and then chain extension take place with the help of the glucan synthase enzyme complex (EC 2.4.1.34), and the sugar units are provided by sugar donor UDPG molecules. The two methods used today for glucan determination are the enzymatic and Congo red methods. True comparisons can only be made using the same method. Congo red dye reacts with the tertiary triple helix structure, and the resulting glucan content better reflects the biological value of glucan molecules.
The biological effect of β-glucan molecules is proportional to the integrity of the tertiary structure. The glucan contents of the stipe exceed the values of the caps. The glucan levels of individual fungal taxa (including varieties) differ quantitatively and qualitatively.
This review presents in more detail the glucans of lentinan (from Lentinula edodes), pleuran (from Pleurotus ostreatus), grifolan (from Grifola frondose), schizophyllan (from Schizophyllum commune), and krestin (from Trametes versicolor), along with their main biological effects.
Full: https://www.mdpi.com/2304-8158/12/5/1009

Hello! Would really appreciate if you saw results on 50mg to share your experience with it. If you could talk about the type of acne you get as well as how long it took to see results that would be really helpful. Im reluctant in upping my dose but everyone seems to get results on 100mg so I wanted to hear from some people who saw success with 50mg, hopefully y’all exist on here :’) also im using tretinoin, which I have been for three years I don’t know if that helps. As for my type of acne I rarely breakout except for once around my ovulation and before my period. But when I do breakout they’re inflamed (hormonal), besides those times my skin is clear. I don’t get normal whiteheads or blackheads because of the tretinoin. I usually have 3 cysts a month.

hi everyone, my mom passed away unexpectedly in february of this year after battling with multiple chronic illnesses, chrons being one. she had a very severe case— she gained over 100 lbs in a year due to chrons (instead of losing weight) and was recommended for a colectomy, which she never went through with. she also had a rare occurrence where she had ulcerative colitis as well. the chrons took a very big toll on her health and she had an ostomy bag for about 2-3 years before she passed. about a month after her passing, i had to go through her phone to arrange her finances. i saw on google that she had looked up why her ostomy bag output was bright green a day before she died. there were no real results after her search, and unfortunately the county coroner’s office did not perform an autopsy so we do not know her cause of death. she was supposed to go to the hospital the next day when specialists would have been there but she didn’t make it until then. does anyone know why her output would be such an abnormal color? i’m not saying it was the sole reason as to how she passed, she was also constantly fainting and throwing up the week before her passing. i just wanted to post in this community to see if anyone has experienced that kind of abnormal colored output/would know what would cause that to happen. thank you all!

Objective
To investigate protective effect of Cordyceps sinensis (CS) through autophagy-associated adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) signaling pathway in acute kidney injury (AKI)-induced acute lung injury (ALI).
Methods
Forty-eight male Sprague-Dawley rats were divided into 4 groups according to a random number table, including the normal saline (NS)-treated sham group (sham group), NS-treated ischemia reperfusion injury (IRI) group (IRI group), and low- (5 g/kg·d) and high-dose (10 g/kg·d) CS-treated IRI groups (CS1 and CS2 groups), 12 rats in each group. Nephrectomy of the right kidney was performed on the IRI rat model that was subjected to 60 min of left renal pedicle occlusion followed by 12, 24, 48, and 72 h of reperfusion. The protein expressions of light chain 3 II/light chain 3 I (LC3-II/LC3-I), uncoordinated-51-like kinase 1 (ULK1), P62, AMPK and mTOR were measured by Western blot and immunohistochemistry, respectively.
Results
The renal IRI induced pulmonary injury following AKI, resulting in significant increases in W/D ratio of lung, and the levels of Scr, BUN, inflammatory cytokines, MDA and MPO (P<0.01); all of these were reduced in the CS groups (P<0.05 or P<0.01). Compared with the IRI groups, the expression levels of P62 and mTOR were significantly lower (P<0.05 or P<0.01), while those of LC3-II/LC3-I, ULK1, and AMPK were significantly higher in the CS2 group (P<0.05 or P<0.01).
Full: https://link.springer.com/article/10.1007/s11655-023-3593-4

Hericium erinaceus is a kind of large fungus with rich nutrition and its polysaccharides exhibit various biological activities. In recent years, widespread interest has been focused on maintaining or improving intestinal health through the consumption of edible fungi. Studies have shown that hypoimmunity can damage the intestinal barrier, which in turn seriously affects human health.
The aim of this work was to investigate the ameliorative effects of Hericium erinaceus polysaccharides (HEPs) on intestinal barrier damage in cyclophosphamide (CTX)-induced immunocompromised mice. The results showed that the HEP effectively increased the levels of total antioxidant capacity (T-AOC), glutathione peroxidase (GSH-PX), and total superoxide dismutase (T-SOD), and decreased malondialdehyde (MDA) content in the liver tissues of mice.
In addition, the HEP restored the immune organ index, increased the serum levels of IL-2 and IgA, augmented the mRNA expression levels of intestinal Muc2, Reg3γ, occludin and ZO-1, and reduced intestinal permeability in mice. It was further confirmed by an immunofluorescence assay that the HEP enhanced the expression level of intestinal tight junction proteins to protect the intestinal mucosal barrier.
These results suggested that the HEP could reduce intestinal permeability and enhance intestinal immune functions by increasing antioxidant capacity, tight junction proteins and immune-related factors in CTX-induced mice. In conclusion, the HEP effectively ameliorated CTX-induced intestinal barrier damage in immunocompromised mice, which provides a new application direction for the HEP as a natural immunopotentiator with antioxidant function.
Full: https://pubs.rsc.org/en/content/articlelanding/2023/fo/d2fo03769f/unauth

So apparently only around half of people with British and Irish results were given more detail in the latest update. I wasn't one of them.
I've also seen americans on here with very mixed results get given several groups, but despite being 95% British & Irish, I get nothing! I have phased results with my mum who got 'Wales'.
Why is this?

Direct CDC Article link: Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021
Summary
What is already known about this topic?
Prescriptions for stimulants, primarily used to treat attention-deficit/hyperactivity disorder (ADHD), were increasing for adults before the COVID-19 pandemic. Policies enacted during the pandemic expanded access to prescription stimulants via telehealth.
What is added by this report?
The percentage of adolescent and adult females and adult males receiving prescription stimulant fills increased during 2016–2021, particularly during 2020–2021.
What are the implications for public health practice?
Growing recognition of ADHD in adults and increases in prescription stimulant fills raise questions about current adult ADHD care. Development of clinical recommendations for diagnosing and managing adult ADHD could help guide safe and appropriate stimulant prescribing. Evaluation of policies enacted during the pandemic could identify benefits and harms of those policies.
Prescription stimulant use, primarily for the treatment of attention-deficit/hyperactivity disorder (ADHD), has increased among adults in the United States during recent decades, while remaining stable or declining among children and adolescents (1,2). MarketScan commercial claims data were analyzed to describe trends in prescription stimulant fills before and during the COVID-19 pandemic (2016–2021) by calculating annual percentages of enrollees aged 5–64 years in employer-sponsored health plans who had one or more prescription stimulant fills overall and by sex and age group. Overall, the percentage of enrollees with one or more prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021. The percentages of females aged 15–44 years and males aged 25–44 years with prescription stimulant fills increased by more than 10% during 2020–2021. Future evaluation could determine if policy and health system reimbursement changes enacted during the pandemic contributed to the increase in stimulant prescriptions. Stimulants can offer substantial benefits for persons with ADHD, but also pose potential harms, including adverse effects, medication interactions, diversion and misuse, and overdoses. Well-established clinical guidelines exist for ADHD care, but only for children and adolescents* (3); clinical practice guidelines for adult ADHD could help adults also receive accurate diagnoses and appropriate treatment.
CDC analyzed claims data from the Merative MarketScan Commercial Database, a national convenience sample of deidentified health care claims from enrollees in employer-sponsored insurance plans. CDC accessed 2016–2021 MarketScan data using Treatment Pathways 4.0, an online analytic platform that includes plans with complete data on prescription drug fills, to calculate the annual percentages of persons continuously enrolled throughout the calendar year with one or more prescription stimulant† fills. All prescription stimulants were included in the analyses, regardless of whether the enrollee had any claims with an ADHD diagnosis code present. Percentages and annual percent change (APC) were calculated for enrollees aged 5–64 years overall and by sex and age group; primary results were calculated by 5-year age groups, but some results were summarized by wider age groups to describe broader patterns. Among persons with one or more prescription stimulant fills during the calendar year, the mean number of prescription stimulant fills during that year and the percentage of persons who met a case definition for receipt of care for ADHD§ were calculated. Statistical testing was not performed because the size of the MarketScan database often results in significant p-values that are not clinically meaningful. All point estimates are presented, and changes >10% are highlighted. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶
Across all years, the percentages of male and female enrollees with one or more prescription stimulant fills were highest among those aged 5–19 and 15–24 years, respectively. Overall, the percentage of enrollees with prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021, with percentages and APC varying by sex and age (Table) (Figure 1) (Figure 2). During 2016–2020, percentages remained stable or decreased among females aged ≤24 years (average APC range = −1.8% to 0.1%) and increased modestly among those aged 25–64 years (average APC range = 2.3% to 6.6%). However, during 2020–2021, the percentage of females with one or more prescription stimulant fills increased substantially among most age groups, with the largest changes among those aged 15–44 and 50–54 years (APC range = 14.3% to 19.2%).
During 2016–2020, the pattern among males was similar to that among comparably aged females: the percentage with prescription stimulant fills decreased slightly among those aged ≤24 years (average APC range = –3.8% to –1.7%) and remained stable or increased modestly among those aged ≥25 years (average APC range = 0% to 6.5%). During 2020–2021, the percentage of males with prescription fills decreased among those aged ≤19 years and increased substantially among those aged 25–44 years and 50–54 years (APC range = 11.1% to 14.7%).
Among persons with one or more prescription stimulant fills, the annual mean number of fills ranged from 7.4 to 7.6 (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/125800). Most persons aged 5–19 years (≥75%) and adults aged 20–64 years (53%–77%) with one or more prescription stimulant fills met the case definition for receipt of ADHD care in the preceding or current calendar year; these percentages were relatively stable during the study period (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/125800).

Aims of the study This study aimed to investigate the protective effects of GLP on high-fatdiet-induced hyperlipidemia and exploring its underlying mechanism.
Materials and methods The GLP was successfully obtained from G. lucidum mycelium. The mice were conducted with high-fatdiet to establish the hyperlipidemia model. Biochemical determination, histological analysis, immunofluorescence, western blot and real-time qPCR were used to assess the alterations in high-fatdiet-treated mice after the GLP intervention.
Results It was found that GLP administration significantly decreased body weight gain and the excessive lipid levels, and partly alleviated tissue injury. Oxidative stress and inflammations were efficiently ameliorated after the treatment of GLP by activing Nrf2-Keap1 and inhibiting NF-κB signal pathways. GLP promoted cholesterol reverse transport by LXRα-ABCA1/ABCG1 signaling, increased the expressions of CYP7A1 and CYP27A1 responsible for bile acids production, accompanied by inhibition of intestinal FXR-FGF15 levels
Conclusion Taken together, our results suggested that GLP showed potential lipid-lowering effects and its possible mechanism was involved in improving oxidative stress and inflammation response, modulating bile acids synthesis and lipid regulatory factors, and promoting reverse cholesterol transport, thereby suggesting that GLP may possibly used as a dietary supplement or medication for the adjuvant therapy for hyperlipidemia.
Full: https://www.sciencedirect.com/science/article/abs/pii/S0378874123001897