I like to think I’m an excellent gift giver—but I’ve occasionally detoured into questionable territory. I once wrapped up a 25-inch cardboard cut-out of my smiling face. The recipient—a family member who wished they saw more of me—loved it (despite the strange looks from everyone else). My other greatest hits have been less controversial: Jeni’s ice cream shipped to a friend across the country; punny T-shirts; a rare plant from the Netherlands; dog toys that were ripped open well before their intended reveal. They’re all the result of months of agony. Somewhere around Labor Day every year, I enter elf mode and start spinning my wheels over holiday gifts. How to make a splash without draining the bank account? What to give the person who won’t make a list? Why is this so hard? To my surprise, help comes from an unexpected source: scientific researchers. People actually specialize in the study of gift-giving to shine light on what we get right—and wrong. Lest one think this type of research isn’t as important as other, weightier topics, keep in mind: We all give gifts, and we all stress over it. “It can really have an impact on people’s relationships,” says Julian Givi, who teaches marketing at West Virginia University and has authored numerous studies about gift-giving. “It can bring people closer or drive them apart. It has enormous well-being implications, it’s practiced around the globe, and tons of money goes into it.” (Everyone must look forward to Givi’s gifts, right? “I think it depends who you ask,” he says modestly. “But I definitely try to follow the advice.”) Here are six science-backed tips that can help you up your gift-giving game this year. Embrace the sentimentalA couple years ago, a friend sent me a package on one of my favorite holidays: my birthday. She had stealthily saved a dozen photos from my Instagram account—of me and my dog, and my other dog, and my cat, and my other cat—and had them printed on a big blanket that I still admire every day. I cried. It was one of the most thoughtful gifts I’ve ever received. While most of the stuff we give people eventually disappears into the black hole of forgotten belongings, sentimental gifts often remain cherished for years. But we’re not giving these as frequently as we should—usually because they feel like a risk. When faced with the choice between a sentimental gift or something that directly relates to the recipient’s preferences and tastes, most people choose the latter, according to a 2017 report co-authored by Givi and published in the Journal of Consumer Psychology. However, Givi’s research indicates that recipients actually prefer sentimental gifts that remind them of special events and relationships. Say Givi was shopping for his brother, a Pittsburgh Steelers fan. “I might just go ahead and give him a Steelers jersey,” he says—rather than the more sentimental option he had been considering: an album of special photos. “It’s a superficial type of gift, but I can feel comfortable that it’s going to be at least somewhat well-received.” In reality, he would have been better off going with the photo album, his research suggests. So next time you’re in doubt, remember: It’s hard to go wrong with something sentimental, and recipients really do want these gifts—even more so than whatever ostensibly aligns with their interests. Think beyond the moment of exchangeEveryone wants a “wow” moment—a stunned, ecstatic friend or family member who can’t believe their good fortune at receiving such a cool gift. As a gift-giver, “I want to see your eyes light up and for you to be delighted,” says Robyn LeBoeuf, a gift-giving researcher and professor of marketing at Washington University in St. Louis. But those moments are fleeting, and the recipient will be stuck with the gift well beyond that initial exchange. Research indicates that, rather than striving for a big reaction, we should focus on what will ultimately provide the most utility or long-term enjoyment. “We tend to prioritize desirability or excellence over feasibility or usefulness,” she says. “As givers, we try to optimize and maximize—we’re trying to do the best and the fanciest—but recipients don’t always need or expect that, and might actually be happier with something that fits better into their lives.” For example, LeBoeuf says, recipients don’t necessarily want a gift card to the fanciest restaurant in town—which might be far away or hard to score reservations for. They’d rather go to their favorite restaurant down the street. So take the pressure off finding something that will be super exciting to unwrap, and think two weeks or two months down the road instead. What will still be useful then? (In case you were wondering: A cardboard cut-out doesn’t pass the test, sentimental as it was. Mine is now collecting dust.) Go all in on experiencesYou’ve heard this debate before: things vs. experiences. It turns out that experiential gifts are better at strengthening relationships than material ones, according to research published in 2016 in the Journal of Consumer Research. “What we found was that people who received experiential gifts felt more connected to the gift giver,” says study co-author Cassie Mogilner Holmes, a professor at UCLA’s Anderson School of Management. “And interestingly, it didn’t require the giver to actually experience it—to go to dinner with the person, or to go to the concert with them.” While that’s certainly a bonus, recipients were simply happy to get to experience something fun. “Whether the giver is there or not, the recipient thinks of that person while they’re consuming the experience, which I think is lovely,” Holmes adds. I’ve gifted a rock-climbing class for two; I would be enormously pleased if my friends who are reading this presented me with Taylor Swift tickets. But you can also be creative with what counts as an experience. For example, say you’re giving someone a book. Write a message in it about what you hope they get out of the reading experience. Or perhaps you’ve selected “something as mundane as a mug,” as Holmes puts it. “When you give them the mug, you can write a card saying that when they’re drinking their morning coffee, you want them to relax.” That shows you’re thinking about their morning ritual and the experience of using the gift. Try not to be selfishGivi’s research has found that we often refrain from giving people a gift that we already own ourselves, because we don’t want to devalue the uniqueness of our own possessions. “Say I have a special Josh Allen jersey,” he says, referencing the Buffalo Bills quarterback. “Maybe it’s a throwback jersey. Would I want to give an identical version—or even a better version—to a friend? That’s going to make mine feel not so good anymore.” But it’s also going to deprive the person you’re gifting of something they might love, and c’mon, it’s the holidays. To the extent possible, squash those selfish tendencies. “If you’re really trying to maximize the recipients’ happiness, take yourself out of the picture,” Givi advises. Make things easier on yourselfIf you’ve ever gone shopping for a long list of people, perhaps you’ve felt pressure to make each gift unique. That shouldn’t be a concern. LeBoeuf’s research indicates that in this situation, shoppers focus on differentiating gifts instead of what each person would like the best. As a result, they choose unique gifts over those that would have been liked better. Instead, we should consider what each recipient would choose for themselves, and if that means buying everyone the same thing, so be it. “We want to honor their unique personalities, but maybe that one great gift would have been better for each person,” LeBoeuf says. “Think of everyone in isolation, rather than comparing them to others.” Don’t overdo the personalizationSometimes we’re so eager to prove that we know the person we’re shopping for that we go overboard catering to a specific interest. Let’s say you love cats. “Your friends might start giving you cat things, like cat stationary and cat pens and cat, cat, cat,” you name it, LeBoeuf says. “They’re trying to be really thoughtful and show, ‘Hey, I know who you are.’ But at some point, recipients are like, ‘Enough with the cat stuff already.’” Research that LeBoeuf is currently working on indicates that recipients prefer gifts that are more versatile. For example, even if someone’s favorite color is pink, they might be happier with a nice pen suitable for everyday use, versus a fluorescent pink option. “We try to say, ‘This is going to be the perfect thing for you,’” she says. “But recipients might prefer something a little more flexible and a little more usable.” from https://ift.tt/D5WKjP6 Check out https://takiaisfobia.blogspot.com/
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Holiday lore has it that you better not pout, you better not cry. But that’s all some of us want to do during the holiday season, when the pressure to be festive is so intense, anyone who doesn’t comply risks being declared a grinch or a Scrooge. There are plenty of reasons one might dislike the holidays, including strained family relationships, chaotic travel logistics, and the pressure to buy lots of gifts (in this economy). All are valid, mental-health experts say. “Just like some people like chocolate and others don’t, some people don’t like the things that are associated with the holidays,” says Dr. Jessica Beachkofsky, a psychiatrist based in Fla. “There might be religious overtones they don’t appreciate. They might not like having to go out and about when it’s cold outside. Some people don’t like the noise—or music—of the holidays, and think it’s gaudy or obnoxious.” If that sounds familiar, it’s important to focus on things that restore you. That includes the year-round stuff--getting enough sleep and exercise, and going easy on the alcohol—as well as activities that really lift you up. This is the time to get that massage, take yourself to the movies, and surround yourself with your favorite things. If you’re dreading decking the halls, here are five ways to better cope this holiday season. Reach out.Maybe you don’t want to have a silent night—and then another and another. There’s so much focus on togetherness during the holidays that those who don’t have a packed calendar might feel isolated and sad. Be open about it. “Don’t be afraid to say to someone, ‘I’m alone. What are your plans? I don’t have any yet,’” says Dr. Sue Varma, a psychiatrist in New York. Many people will respond by extending an invitation; perhaps the only reason they hadn’t done so already was that they didn’t realize you’d be available or interested. You can also seek out new friends and things to do via platforms like Meetup and Nextdoor, Varma recommends. Another way to surround yourself with people is to volunteer, even if it’s not something you plan on doing the rest of the year. Sign up to visit residents at a local nursing home, bake cookies for first-responders, adopt a kitten, or serve food at a homeless shelter. You’ll get to socialize, and whoever you’re helping will be grateful for the company—a win-win from any angle. Set boundaries.Lots of people struggle with the holidays because of strained family relationships. Setting boundaries is key, Varma says: Tell your mom that you’ll join her for Thanksgiving, but only one-on-one and not with her new husband you don’t get along with. Or, if you don’t have the capacity to deal with your uncle’s political opinions, let your family know you’ll see him in a large group setting (not seated right next to you at dinner). Have some lines ready to shut down any unwanted conversations. If someone brings up politics and you don’t want to engage, say, “I’m not here to talk about that, but I would like to talk about this delicious food, or the amazing athletes playing football today,” suggests Marhya Kelsch, a psychotherapist in Calif. If you’re nervous your guests will bring up a thorny personal issue, address it directly, immediately after arriving. You might say, “Todd and I broke up. It’s been really hard. I would appreciate if we could not talk about it, because I really want to enjoy being here with all of you,” Beachkofsky suggests. “It sounds scary, but if you say it one time, and if those people are even a little reasonable, they won’t bring up the thing you’re asking them not to talk about.” Let yourself feel sad.Every year, Beachkofsky hears from people who are overcome with grief at the idea of spending the holidays without someone who’s no longer here. Her best advice? “You need to feel the feels,” she says. “If you’re sad and everyone else is happy, you are entitled to that feeling.” One way to cope, Beachkofsky says, is to let a supportive friend or family member know you’re struggling. Ask if you can call them any time you need an ear. Then, you’ll know you have someone to turn to who won’t simply tell you to be merry and have another cookie. It can also be helpful to find ways of honoring the person—or people—you’re mourning. Did you share a special tradition, like always going to see the Trans-Siberian Orchestra together or making popcorn garland for the tree? “Find a way to incorporate that into the season,” says Steffani Wooley, a licensed professional counselor based in Texas. Or make a special ornament or photo collage that reminds you of your loved one. “You could even set a place at the table to remember them,” she says. Be flexible with travel.Travel can be a logistical nightmare during the busiest time of the year. If you don’t want to fork over the cash for a prime-time plane ticket, or if you’re dreading the crowds and long delays, offer a compromise to your long-distance relatives. “Just say, ‘We’re not celebrating Christmas on December 25—we’re going to do it February 1,’” Varma suggests. Then, you can eliminate a major source of stress—and have something to look forward to throughout the holiday season. Go low-key with gifts.Ongoing inflation is still causing prices for almost everything to spike. If exorbitant costs are stressing you out, take the pressure off. First, tell your family members you need to be more low-key about gifts this year, Varma advises. Those with a big family might draw names and only buy for one person or agree that only the kids will get gifts. And rejigger your perspective on what makes a good gift. As Varma points out, people love to get homemade treats or other inexpensive but thoughtful offerings—“something as simple as homemade pesto,” she says. If you’re gifting someone who you know values time with you, book a yoga class or plan to cook a special meal together. “There are so many ways to be creative that don’t involve a lot of money,” she says. from https://ift.tt/G7iuawM Check out https://takiaisfobia.blogspot.com/ Planning to gather with loved ones over the holidays? Here’s a timely reminder that every member of your family enrolled in health insurance is eligible for eight free rapid at-home COVID-19 tests every month. That goes for whatever insurance you have—whether it’s through Medicare, the Affordable Care Act marketplace, Medicaid, or your employer—because rapid-test reimbursement is still required by the federal government. There are two main ways to purchase these tests. The first is to pick them up at a pharmacy or store that your plan designates as “in-network.” If you’re on Medicare, there’s also a partial list of the pharmacies offering over-the-counter tests here. In many cases, the advantage is that you won’t have to pay for the tests; they’ll be immediately covered. Some pharmacies, including Walgreens and CVS, also offer online programs where you can locate tests, enter your insurance information, and then pick them up in person. However, insurance companies sometimes require people to purchase tests themselves and then apply to be reimbursed. However, insurance companies sometimes require people to purchase tests themselves—online, at a pharmacy, or from other retailers—and then apply to be reimbursed. Your plan is required to reimburse you up to $12 per test (or $24 for a box of two). Before buying, you should check your individual insurer’s requirements for reimbursement—and plan to hang on to your receipt. There are some contexts in which insurers are not required to reimburse for testing. For example, they are not legally bound to pay for ongoing tests demanded by an employer as a condition of employment. At this point in the pandemic, at-home rapid COVID-19 tests are indispensable tools. Experts recommend taking them before gathering with other people, especially if they’re at high risk of severe disease (including those over age 65) or are not up-to-date on their vaccines. You should also test whenever you have COVID-19 symptoms, like a fever, sore throat, or runny nose, or after coming into contact with someone who has had COVID-19 in the last five days. from https://ift.tt/EkcVSYR Check out https://takiaisfobia.blogspot.com/ While the world is learning to live with COVID-19, scientists still have many unanswered questions about how the infection affects the body and brain—not just when people are sick, but over the long term as well. In a study presented at the annual meeting of the Radiological Society of North America, researchers report on changes to the brain among people who have recovered from COVID-19. The scientists conducted MRI scans of the brains of 46 people who had had COVID-19 within the past six months, and compared them to the scans of 30 people who had never been infected. They found that most of the people who had recovered from COVID-19 had changes in the circulation of tiny blood vessels in the frontal lobe and brain stem areas, which are involved in higher order cognitive skills such as language expression and voluntary movements. Compared to the control group, this group showed reduced circulation in these microvessels. Exactly how that might translate to daily activities isn’t clear yet; the researchers did not follow up with detailed analyses of cognitive function in the two groups. But Bharat Biswal, professor of biomedical engineering at New Jersey Institute of Technology and a co-investigator of the research, says the team is exploring how these changes might affect other functions. Some of the participants, for example, had high blood pressure or other chronic conditions that might also play a role in how their brains were affected by COVID-19, and the scientists are looking into whether the people with such underlying health conditions showed different levels of brain changes compared to those without these conditions. The study builds on previous work Biswal and his colleagues conducted, which documented structural changes in the brain that distinguished people who had been hospitalized and recovered from COVID-19 from those who had not been infected. That study found changes in the limbic system and hippocampus of the brain, which oversees emotional and behavioral activities, as well as memory. Taken together, says Biswal, the results “provide an initial idea of where to look and what parameters to look at” for scientists studying the effects of Long COVID. He and his team are hoping to track the volunteers in the study for longer to better document how lasting the changes are. “COVID-19 has multi-dimensional effects on the body,” he says, including in the brain. And while the scientists haven’t yet investigated people who have been reinfected, multiple bouts with COVID-19 may also cause cumulative changes on various systems in the body. Biswal says he “worries a little bit” about how reinfections “might show up in the brain and other organs. There are still more studies to be done to understand how COVID-19 affects the brain and body.” from https://ift.tt/3dVu1GD Check out https://takiaisfobia.blogspot.com/ The dreaded scenario has happened: you’ve tested positive for COVID-19 at the worst time, with holiday travel, parties, or family gatherings just days away. Does this mean your plans are doomed? Even nearly three years into the pandemic, the answer is surprisingly complicated. The U.S. Centers for Disease Control and Prevention (CDC) says most people with mild COVID-19 can end isolation five full days after taking a positive test or the beginning of symptoms, as long as they’ve been fever-free for 24 hours and their other symptoms are improving. The CDC considers the day you took your positive test or developed symptoms to be day zero; your five-day isolation period begins the next day. That said, there’s a difference between ending isolation and flying to attend a big holiday gathering. Through day 10, the CDC recommends staying away from people at high risk of severe COVID-19, such as those who are elderly or immunocompromised. If you will be around others, the agency says to wear a high-quality mask, such as an N95 or KN95. You can ditch the mask before day 10 if you test negative on two separate antigen tests taken 48 hours apart, the CDC says. That pair of negative results isn’t guaranteed, even after five days of isolation. In a recent JAMA Network Open study, 80% of people with symptomatic COVID-19 during the first Omicron surge tested positive on rapid tests for longer than five days. In short: you could still test positive, and potentially remain contagious, after an initial five-day isolation. What does that mean for your holiday plans? We asked two experts—Dr. Peter Chin-Hong, a professor of medicine at the University of California, San Francisco, and Dr. Tara Bouton, an assistant professor at the Boston University School of Medicine who has researched COVID-19 isolation periods—to weigh in on several scenarios. If your plans fall within five days of testing positiveStay home, cancel all travel, and connect with loved ones virtually. This advice can be hard to hear, especially around the holidays, but it’s “universally agreed on,” Chin-Hong says. If it’s been longer than five days and you’re still testing positiveIf your symptoms haven’t improved after five days, the CDC says you should remain in isolation. If you feel fine but are still testing positive beyond five days, there’s a chance you’re still contagious. “The clear guidance is that you should not be unmasked around others,” Bouton says. If you have your heart set on attending a holiday gathering, the safest move is to wear a high-quality mask the whole time. That’s especially important if you need to travel by plane, bus, or train to get to the party. If you tested positive 10 or fewer days ago and haven’t received your pair of negative test results, the CDC says not to use public transportation unless you can stay masked the entire time. When deciding whether to travel, Bouton recommends thinking not just of your plans, but of everyone else who will be traveling alongside you. “Would you want your grandmother sitting next to [a person testing positive] on an airplane?” Bouton asks. If it’s been longer than five days and you’re testing negativeUnder CDC guidance, you need a pair of negative antigen test results, received 48 hours apart, to remove your mask around others before day 10. But is it okay to unmask before then if you test negative once? It “depends on the company you keep,” Chin-Hong says. If you’re planning to spend the holidays with people at high risk of severe disease, it’s probably smart to either wait for a second negative test or keep your mask on through day 10. But “if you’re going to hang out with just college friends and you’re negative on day seven, I’d feel fine being normal with them, without wearing a mask,” Chin-Hong says. (It’s still a good idea to inform everyone you plan to see ahead of time and gauge their risk tolerance before you remove your mask.) If you’re testing negative but have lingering symptoms, it’s wise to be extra cautious around vulnerable people, Chin-Hong adds. “If you just have a lingering cough, that’s probably not enough for me not to see grandma,” he says. “I’d wear a mask when I’m in close proximity, but I wouldn’t go crazy.” If you experienced Paxlovid reboundThe antiviral Paxlovid can drastically reduce high-risk individuals’ chances of dying or becoming hospitalized if they catch COVID-19. But some people who take the drug experience what’s known as “Paxlovid rebound“: they test negative, then test positive again shortly thereafter. It is possible to be contagious during your rebound phase, Bouton says—so if it happens to you, you should be “thinking about extending your isolation period.” If it’s been more than 10 days and you’re still testing positiveIt’s fairly uncommon that someone who is not immunocompromised would test positive on an at-home test for longer than 10 days, but it does happen. (This scenario is more common with PCR tests, which can detect even tiny fragments of the virus.) “I usually tell people, ‘Don’t even bother to test after day 10,’” Chin-Hong says. Unless you’re immunocompromised, you’re likely not contagious at this point, even if your tests are coming back positive, Bouton agrees. from https://ift.tt/kpe9aoW Check out https://takiaisfobia.blogspot.com/ As successful as the COVID-19 vaccines have been in curbing the pandemic, their benefits haven’t been enjoyed equally by people around the globe. Throughout the pandemic—and even now—vaccine development and distribution has been undeniably lopsided, skewed in favor of developed countries with the resources to create, test, manufacture, and distribute shots when the need arises. In the third year of pandemic, while nearly 70% of people worldwide have received at least one COVID-19 vaccine dose, in low-income countries, only 24% have. In its latest report on the global vaccine market, which includes an assessment of vaccines against COVID-19 and a variety of infectious diseases, the World Health Organization (WHO) calls upon both governments and companies to reshape the vaccine market to equalize these discrepancies. Pulling from the lessons learned from the global COVID-19 response, the report urges governments to invest more aggressively in the development and manufacturing of vaccines against infectious diseases—even in the absence of an existing public-health threat—focusing specifically on pursuing innovative technologies that could streamline and reduce the cost of shots. The idea is to build a more local network of scientists and manufacturers who can create and distribute a new vaccine during a crisis. But governments can’t accomplish that alone. Companies should create new pathways for sharing intellectual property and opening doors that are currently closed by proprietary priorities, the report says. It asks companies to concentrate on developing vaccines for WHO’s priority diseases, targeting pathogens (such as coronaviruses) that are likely to cause outbreaks but may not be in line with business objectives, if these diseases only affect a relatively small percentage of the world’s population and don’t represent a major market. That’s a big ask, says Dr. Robert Murphy, executive director of the Havey institute for Global Health at Northwestern University’s Feinberg School of Medicine. “Big pharma is not going to do this,” he says. “There has to be more technology transfer.” Murphy points to efforts by vaccine maker AstraZeneca, which developed a COVID-19 vaccine based on research from Oxford University, and took steps to share its technology with countries who were willing to capitalize on that knowledge. The company worked with a Brazilian research institute to allow scientists in that country to produce the vaccine for its citizens. WHO has also designated that institute as a hub for making mRNA vaccines in Latin America. Read More: Why Masks Still Matter There are signs that the pharmaceutical industry is taking steps to follow WHO’s recommendations. Two of the largest COVID-19 vaccine makers for the developed world, Moderna and Pfizer-BioNTech (both of whom produce mRNA-based vaccines), have plans to manufacture the vaccines in Africa to more efficiently address vaccination needs on the continent. Pfizer-BioNTech announced a partnership in 2021 with a South African biopharmaceutical company, the Biovac Institute, to make and distribute COVID-19 vaccines in Africa, and Moderna said earlier this year that it would build a manufacturing facility in Kenya. Moderna has also pledged to not enforce its patent on its vaccine in certain low- and middle-income countries during the pandemic. But it remains to be seen how committed they are to these steps. It won’t be until at least 2023 when locally sourced vaccines from either company will be available on the African continent, and public-health groups Oxfam and Doctors Without Borders have criticized the vaccine makers for not doing more to fulfill the pandemic needs of the developing world. Toward a ‘global vacine strategy’Governments, too, are making progress. India and China have also built capacity for developing and manufacturing vaccines, and, despite early growing pains, are establishing an infrastructure for producing vaccines for their populations. But making effective and safe vaccines remains a challenge for nascent industries. While China produced its own vaccines against COVID-19—which the WHO recommended, making it the most widely administered COVID-19 vaccine around the world--studies showed that the original 51% and 79% efficacy in protecting people against COVID-19 waned more quickly than protection from the mRNA shots, mainly because the vaccines made in China generated lower levels of virus-fighting antibodies. Read More: The Virus Hunters Trying to Prevent the Next Pandemic “We have to not only produce vaccines, but produce vaccines that are validated and that work,” says Dr. Ian Lipkin, professor of epidemiology and director of the center for infection and immunity at Columbia Mailman School of Public Health. That could require more intentional coordination around another important part of the vaccine-making process: testing and validating their effectiveness. COVID-19 revealed how disjointed the regulatory system is around the world. While billions of doses of COVID-19 vaccines have been distributed and administered, a relatively low efficacy could promote new mutations and new variants that can escape the protection provided by vaccines. Lipkin would like to see a system that does not rely solely on different countries testing and validating vaccines, but rather a global one for evaluating these quickly and consistently. “There are so many advantages to adopting a global vaccine strategy. We will reduce mortality and morbidity in the developing world, reduce social and economic damage due to disruption of travel and trade, and expedite the validation of vaccines through international trials,” he says. Establishing some type of global FDA to run the trials and evaluate the results would streamline the process of bringing new vaccines to market. Going forward, to ensure that vaccines are distributed more equitably, the WHO recommends prioritizing innovation around vaccine storage and delivery in favor of the least burdensome methods—unlike the ultra-cold temperatures required for the mRNA COVID-19 vaccines. Those conditions made it challenging to administer the vaccines in many parts of the world with minimal health infrastructure. And for those around the world who are needle-averse, having other modes of delivery, such as nasal, inhalable, or oral vaccines, is also a must. “We can come up with vaccines that cost pennies to deliver and that people are more likely to accept,” says Lipkin. “The more we get away from needing needles, syringes, and experts in vaccination, that would be enormously helpful.” The state of global vaccination groupsWhile 15 billion doses of COVID-19 vaccines were distributed globally, the vast majority of these went to people in the developed world, with only 12% trickling through COVAX: a pandemic-era program created by the WHO, GAVI the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and UNICEF to pool resources and purchasing power to obtain and distribute vaccines to low- and middle-income nations. One problem is that only a couple of vaccine manufacturers make 80% of the world’s supply of COVID-19 vaccines. Most companies that manufacture any type of vaccine are based in Europe, Indonesia, Japan, or the U.S.—so many countries in Africa, for example, where nearly 17% of the world’s population lives, depend on getting 90% of their vaccines from outside the continent. To date, these African nations have received only 3% of all available COVID-19 vaccine doses. To address the existing gap, COVAX began soliciting donations as the pandemic unfolded in 2020 from developed nations to fund pooled purchasing of vaccine doses, at significantly lower cost, for the developing world. While 180 countries have joined COVAX, either as donors or recipients, the WHO report found that a lack of coordination of supply and demand left many doses out of reach for countries that needed them. Public-health experts say the impact of COVAX is mixed so far. While it represented a step in the right direction in terms of creating more purchasing power for certain countries, it faced challenges in executing on its mission, as developed nations continued to receive priority when it came to vaccine doses. Read More: MRNA’s Next Chapter Has Nothing to Do With COVID-19 Vaccines “The impact was way more modest than [health experts] had anticipated, because they were such a new structure,” says Murphy. “COVAX was made for this pandemic, and they had to start basically from scratch to negotiate with more than 100 different countries. But the work was still important. While there was a learning curve, now all the players are in place, and hopefully the system is geared up so everything can happen more quickly and more money will continue to support the program.” To sustain that momentum, the report concludes, a better balance is required between national interests and global ones, especially in a world that is increasingly connected. Even if a new virus such as SARS-CoV-2 is controlled with impressive vaccination campaigns in one part of the world, continued pockets of infections in any region can seed new outbreaks and provide fertile ground for mutant strains that can evade those vaccines. “If we had been much more efficient and faster to deliver vaccines globally, we might have deprived the virus of the opportunity to evolve as rapidly as it has,” says Lipkin. As the virus continues to mutate, the inequitable vaccine market only widens the gap between those who are able to benefit from these innovations and those who aren’t. The next step in bridging this divide requires a more significant shift in how governments and companies perceive health threats. The WHO calls for heightened diplomacy between countries that would set binding obligations to distribute vaccines more equitably, especially during a crisis when supplies are scarce. That would require a change in culture at the political level, so leaders see investment in manufacturing as an insurance policy against future health threats, rather than a cost with little return. “We need to…strike a much better balance between serving national interests and global public health objectives,” the report concludes. Already, some efforts to train scientists locally to learn about the latest vaccine-making techniques are starting to build a base of experts who can quickly adapt to producing new vaccines, even if the basic technology is provided from abroad. “It’s not just about building factories around the world,” says Murphy. “Those factories are highly regulated and sophisticated, so you’ve got to have a cadre of scientists who can put that together. Why can’t low-income countries also get into the game? They can do it.” Tapping into that potential may be the quickest way to protect against another pandemic in which an emerging virus maintains the upper hand. from https://ift.tt/JX3Z6eG Check out https://takiaisfobia.blogspot.com/ If only the turkey on your Thanksgiving table could talk. That bird would like a word about how “exhausting” it is. The idea that turkey makes us tired has been passed around holiday celebrations for a long time—and it’s not the only myth shared year after year. Is canned pumpkin really less nutritious than fresh? Is dousing the cranberries in sugar an absolute must? Here, we debunk these and other myths about Thanksgiving food—so you can serve up the facts at this year’s feast. Myth: Turkey makes you tired.Truth: Turkey meat contains L-tryptophan, which is an essential amino acid that helps produce serotonin—often described as the “feel-good” hormone—and melatonin, which promotes sleep. “But you’d have to eat a lot of turkey—actually about 4 pounds of it—by yourself, in one sitting, for it to make you sleepy,” says Roxana Ehsani, a registered dietitian nutritionist based in Miami. So why do we get drowsy after inhaling a big holiday feast? “Likely because you’re consuming high amounts of carbohydrate-rich foods—like stuffing or mashed potatoes, rolls, cornbread, all the desserts, maybe even a few alcoholic beverages,” Ehsani says. “All those things will cause a rise in blood sugar and then a crash, which will lead to fatigue.” Research indicates that high-carb, high-fat meals—hello, Thanksgiving dinner—lead to sleepiness that usually hits the hardest about 60 to 90 minutes after eating. If you’re hoping to remain energetic for that flag-football game, opt for small portions, take breaks and then get seconds if you’re still hungry after 20 minutes, and stop eating after you’re full. Turkey, vindicated. Myth: Canned pumpkin is less nutritious than fresh.Truth: Canned foods tend to get a bad rap. But both fresh pumpkin and canned pumpkin are full of nutrients—including potassium, vitamin A, and iron—and suitable for your pumpkin pie. “One should feel totally OK about having canned pumpkin,” says Keri Gans, a registered dietitian nutritionist based in New York City. “A lot of times, vegetables are canned at peak ripeness,” when they have the most vitamins and nutrients they’ll ever have. Research indicates that in addition to being nutritious, canned vegetables are cost-effective and often have a conveniently long shelf-life. But don’t just grab the first can of pumpkin you see: It’s important to check out the labels first, Gans says. Look for a brand that’s 100% pure pumpkin and doesn’t contain any other ingredients, such as added sugars. Myth: Cranberries require a ton of added sugar to taste good.Truth: Cranberries are a Thanksgiving staple—and because they’re tart, they’re usually made with copious amounts of sugar in dishes like cobblers or cranberry sauce. But here’s some sweet news: They don’t have to be sugar minefields. “A lot of people don’t know this, but you can eat them raw, without sugar,” Ehsani says. Yes, they’ll taste bitter, but consider the health benefits: Cranberries are full of nutrients like potassium, vitamin C, vitamin A, vitamin K, and magnesium. Still, there’s no need to snack on raw cranberries like they’re peanuts. Instead, use them as garnishes, tossing them into salads or dropping them into cocktails. That can add a delicious, savory twist to your meal, Ehsani says. You can also simply cut back on the amount of sugar you use in your cranberry sauce, and it’ll still taste great. Myth: Dark turkey meat is worse for you than breast meat.Truth: There’s some truth to the idea that white meat is healthier, Gans says: It contains less saturated fat and calories than dark meat. However, the differences are negligible. According to the U.S. Department of Agriculture, 3 ounces of roasted turkey dark meat contain 175 calories, 2.49 grams of saturated fat, and 114 mg of cholesterol. Roasted light meat, meanwhile, has 150 calories, 1.36 grams of saturated fat, and 75.6 mg of cholesterol. Dark meat actually tops white meat when it comes to several nutrients: A 3-ounce serving contains a little more iron, zinc, and selenium. So nutritionally, it’s pretty much a wash. “If you prefer the dark meat over the white meat, go for it,” Gans says. “Let’s be honest—the dark meat has more flavor.” Myth: Post-meal is the best time to take a Thanksgiving nap.Truth: The couch develops an almost magnetic pull after you’ve satiated yourself with mashed potatoes, doughy pies, and butter-soaked rolls. But it’s actually “the worst time” to take a nap, Gans says. Lying down could lead to digestive issues like heartburn and acid reflux—which you can better avoid by staying upright for 45 to 60 minutes after eating. Plus, there are benefits to being active post-meal. According to research published earlier this year, a short walk—even just 2 to 5 minutes will do—can lower blood sugar levels after a meal. “If you’re able to move a little, that’s definitely preferred,” Ehsani says. “Get up, maybe clean the dishes, put some food away, and get a little active,” perhaps whisking a dining companion outside for a lap around the block. from https://ift.tt/nrZpl7P Check out https://takiaisfobia.blogspot.com/ On Saturday, June 29, 2019, a group of over 200 queer and trans folks were gathered in New York City, celebrating the city’s big World Pride weekend. They had all come to a party called NYC Inferno known for sexual activity. At around midnight, they were gathered in the front of the venue, rapt as an artist led them in an interactive performance. Within moments, everyone was singing the refrain: “We’ve got to keep each other alive, because no one else is gonna do it.” With this care-based ethos in mind, NYC Inferno, and all other queer sex-based venues in NYC, quickly shut down in July 2022, when Monkeypox (MPV) cases climbed in the United States. The horror of MPV was almost unfathomable to many, including the queer community: excruciating pain, terrible sores, and a treatment that few doctors could prescribe. When NYC Inferno relaunched on Sept.17, 2022, attendees were able to first make a stop at a white van parked near the venue, a mobile clinic offering Jynneos—the MPV vaccine. Jynneos, safe and effective, requires two doses for full immunity. As executive leadership at NYC Health + Hospitals, a community organizer and queer scientist, and the creator and host of NYC Inferno, we are part of a team that provided free, subcutaneous Jynneos vaccine doses on site at commercial sex venues in NYC. Over this summer, MPV vaccination was severely limited by supply as cases rapidly rose. In New York, the Health Department partnered with community organizations and set up mass vaccination sites, even as demand remained consistently higher than supply through the fall. The success in lowering the MPV epidemiological curve, and the continued low and declining case counts even as sexual behaviors are returning to normal, highlight the power of bringing sexual healthcare directly to impacted communities and the places where they congregate. Read More: How the Monkeypox Virus Does—and Doesn’t—Spread People who participate in group sex tend to have a high number of sexual partners. Providing preventative care to this group can help prevent infectious disease—from HIV and STIs to MPV—not only in people who attend sex parties, but all the other people in their sexual networks. By getting vaccinated to help prevent MPV, this community has shown that queer pleasure and community care can go hand-in-hand. After initially closing on July 14, 2022, spaces where queer people meet for sex in NYC reopened on Sept. 3. Community members wanted to ensure people could safely be vaccinated on site. NYC Health + Hospitals—in collaboration with the sexual health team at NYC’s Department of Health and Mental Hygiene, community experts, event hosts and participants—worked rapidly to meet this need. To date, NYC has administered over 3,000 doses of the MPV vaccine at nearly 60 mobile sites across the city—from queer health clinics and community pride centers to sex parties and raves. Our model of collaboration at NYC Inferno and other sex parties prompted a rapid uptake of vaccines at safe, accessible sites. On Sept. 17 in Brooklyn, after NYC Inferno reopened, and NYC allowed access to second Jynneos doses on site, 60% of those attending the party received an MPV vaccine dose at a mobile unit. At GBU, a weekly sex party for queer men, mobile vaccine delivery was proving to be efficient, but we needed to adjust our model to meet community need. When the party re-opened on Sept. 3 and only first Jynneos doses were available, only 13 vaccinations were administered. When we spoke to the event attendees, most reported having received one vaccination already—and because of NYC’s vaccine criteria, they were not eligible to receive a second dose. It was clear that demand for second doses was high. It was also clear participants recognized the risk they faced and wanted full protection. The community advocated for and successfully persuaded NYC health officials to allow a second subcutaneous Jynneos dose to be administered at commercial sex venues. The next week at GBU, healthcare workers administered 82 vaccinations, mostly second doses, to 40% of those in attendance. The following week, healthcare workers provided another 57 doses, reaching 43% of attendees that night. NYC Inferno had the highest vaccine uptake of any MPV mobile vaccine event in the city, with 90 shots given in one night. To address the racial disparities in MPV vaccine access and cases, we partnered with hosts of nightlife events for queer people of color, like Papi Juice and Trappy Hour, providing dozens of doses on site. The NYC Health Department also provided outreach teams on site to educate community members about both MPV and the vaccine. NYC Health + Hospitals’ mobile fleet clearly met a need—73% of the doses administered by mobile units at high risk events like sex parties were second doses. Low-risk events promoted broad uptake of first doses, and high-risk events proved essential to providing high immunity for those at most risk of MPV infection. Both increasing first doses in the queer community at large, and ensuring full protection of those with the most sexual partners, has helped keep daily MPV cases in N.Y. in single digits through the fall. Research on MPV shows that preventing infection in the most-connected people in a sexual network is essential to protecting the community at large. While our work cannot directly determine the Jynneos vaccine’s efficacy, which is currently not known, high vaccine uptake in NYC among those most at risk, including second doses, has resulted in ongoing low transmission of MPV, even as sex parties resume. Read More: TIME 100 Next: Joe Osmundson On Nov. 5, one of us staffed a GBU party and asked if people needed an MPV dose as they streamed in. 20 minutes after walking someone down to the mobile van, a freshly vaccinated man returned to the party, a wide smile on his face. “Thank you so much for helping to keep our community safe,” he said Healthcare, when it’s so seamlessly integrated into your life, can be a joyful thing. Based on our experience with MPV vaccines, and with parties like GBU and NYC Inferno, queer people want to protect themselves. Queer people want to enjoy parties and have sex with as little risk of disease as possible. Mobile healthcare units meet community needs by bringing people into care that they need and are actually excited about. While NYC Health + Hospitals’ mobile units administered only MPV vaccines at commercial sex venues, we envision a sexual healthcare pop-up model that could provide resources for HIV prevention routine vaccination for COVID-19, influenza, and even prevent bacterial sexually transmitted infections. Sex parties attract people with many sexual connections. Providing care directly at these locations is an opportunity to lower the frustratingly high rates of infectious and sexually-transmitted diseases and HIV in NYC. from https://ift.tt/YuRNvVm Check out https://takiaisfobia.blogspot.com/ Although Mac Howard has spent the last 16 years without a bladder-cancer recurrence, he never feels truly free. The 58-year-old Indiana resident still studies his urine for any traces of blood, and every time he marks another anniversary of his diagnosis, there’s a twist of fear in his stomach. “It’s always in the back of my mind,” he says. “At times, the anxiety has been crippling, and I know my wife and three kids have been affected by that. The recurrence rate for bladder cancer is fairly high, and going as long as I have doesn’t feel like a success—it’s more like suspense. Is this going to be the month it comes back?” [time-brightcove not-tgx=”true”] More than 81,000 new cases of bladder cancer will be diagnosed in 2022, according to the American Cancer Society, and the five-year recurrence rate is 50% to 70%. According to a 2020 survey of nearly 600 people living with bladder cancer conducted by the online patient community Health Union, 18% of respondents were diagnosed with depression and 16% with anxiety. About 60% said they experience anxiety about their cancer returning, and 23% have searched the terms “mental health and bladder cancer” online. Only about 38% reported feeling emotionally supported through their cancer process. “Bladder cancer can be highly stressful because you’re often dealing with changes in body function and sometimes body image, as well as possible sexual health changes,” says Dr. Shawn Dason, a urologic surgeon with The Ohio State University Comprehensive Cancer Center. “There can also be shifts in sleep quality or a need for smoking cessation since bladder cancer is strongly linked to smoking, and it can all feel overwhelming.” Fortunately, there are some strategies that can be useful, no matter where you might be on your cancer path. Focus on what you can controlDealing with a bladder-cancer diagnosis is tough enough—but it’s common for patients to have even more going on, like a secondary cancer, which can lead to feelings of helplessness. In the Health Union survey, 30% of respondents had been diagnosed with another cancer either before or after their bladder-cancer diagnosis. And 87% reported other health conditions like high cholesterol, hypertension, and arthritis. Having a secondary cancer, in particular, can make it feel like bad news is always just around the corner, says New Jersey resident Rebecca Capizzi, 52, who was diagnosed with bladder cancer in October 2020, but had ovarian, thyroid, and breast cancer before that. “It’s hard not to be in a fight-or-flight response all the time, especially when I have tests coming up,” she says. “I have dread in the pit of my stomach just thinking: What’s next? I’ve already been through so much with surgeries and chemo, but it still feels like this will never end for me.” That’s why Capizzi has focused on finding what helps her feel a stronger sense of control over her body and mind: exercise, especially walking. Even when she’s in active treatment and can only do minimal physical activity, she takes short walks because it boosts her mental health so much. “Staying active is a huge stress reliever for me,” Capizzi says. “When everything feels like it’s too much, I know that I can move my body, and that makes a difference.” It’s important to understand how destabilizing a cancer diagnosis can be, adds Naomi Torres-Mackie, a clinical psychologist at Lenox Hill Hospital in New York, New York. There can often be a conflation of “sick” with “weak,” she says, and bladder-cancer treatments might heighten that feeling. Incorporating more exercise might be a way to build an emotional sense of strength as well as the physical resilience needed for treatment, Torres-Mackie says. Read More: Why Pelvic Floor Rehabilitation Is Key For Bladder Cancer Patients Accept help from othersEven when friends and family are eager to provide assistance, accepting help can be difficult because it may feel like a loss of autonomy, says Dr. Shanthi Gowrinathan, a psychiatrist specializing in psycho-oncology at Saint John’s Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif. “With bladder cancer, especially if you have changes to your bodily function, it can come with difficulty navigating social situations,” she says. “There’s social stigma, shame, awkwardness, and embarrassment. Because of that, people tend to withdraw and become more isolated. Unfortunately, that can make you feel more demoralized.” Allowing others to lend a hand can counteract those feelings of isolation—as well as the idea that you have to do everything yourself, says Capizzi. It was challenging for her to accept the many offers from her family, friends, and colleagues to provide support, such as bringing food and walking her dogs. “Most people want to be helpful, and they love when you take them up on their offer because they want to be useful,” she says. “You learn quickly who you can lean on. But it’s up to you to do the leaning.” Consider talking with a therapistAlthough being open with friends and family can help relieve the pressure that comes with bladder cancer diagnosis, treatment, and anxiety over recurrence, talking with a trained therapist may give you more freedom to express all the anger, fear, frustration, and sadness that may be layering inside you, Howard says. “My top advice to anyone with bladder cancer is to get a therapist,” he says. “Family means well, and they have the best intentions when they’re willing to listen, but it’s difficult to unload all of this on your loved ones. For me, I needed a safe space where I could cry and rant and just let go. Also, a therapist doesn’t just listen. They help you work through what’s happening, and they can help you create a plan that gives you a path forward.” Specific mental-health treatments have been proven to be effective for cancer patients, adds Torres-Mackie, such as cognitive behavioral therapy (CBT). A 2019 study in the journal Urologic Oncology found that CBT and other mental-health interventions done both pre- and post-treatment for bladder cancer played an important role in health outcomes. The researchers noted that depression and anxiety can raise postsurgical complication rates and affect long-term survival rates. That means therapy isn’t just about helping you feel better emotionally right now—it could have a profound effect on your physical health for years to come. Connect with other patientsWhen Atlanta resident Brittany Tellekamp, 32, was first diagnosed with cancer, there was debate among her doctors about what type it might be. At the time, she was 28—and the average age for bladder-cancer diagnosis is 73. About 90% of those diagnosed with the condition are over age 55. In addition to being younger than most patients, Tellekamp didn’t have any of the top risk factors associated with bladder cancer, such as smoking or regular exposure to chemicals like paint or solvents. When doctors finally settled on a diagnosis, the news was worse than she feared: metastatic, stage IV bladder cancer. One doctor told Tellekamp’s husband and mother that it was doubtful she’d make it to her next birthday, which was three months away. Thanks to immunotherapy, she sailed past that birthday and a couple more since then, but she feels like she’s in “extra innings” now. The confusion, terror, and dramatic news in those first few months—paired with frustrating insurance issues—led Tellekamp to start a blog, even though she didn’t think anyone would read it. “It felt like screaming into the void,” she recalls. “But it was very cathartic from the start. Also, I thought maybe there would be a chance I’d find other young people with bladder cancer, which tends not to be the case in support groups.” Not only did she find those connections, but she extended her outreach onto social media and began contributing to a group chat of people with metastatic cancer. “When you know you’re not going to ring that bell signaling the end of your cancer treatment, you can feel really alone,” Tellekamp says. “Community becomes hugely important.” Deepening those friendships provides her with a sense of control, she adds, because she feels like a patient advocate, helping others through feelings and situations that have been challenging for her, too. Read More: The Latest Breakthroughs That Could Help Bladder Cancer Patients Grieve your lossTellekamp’s mother, who had thyroid cancer a few years ago, has been a major source of support through treatment. One piece of wisdom she shared that’s been particularly meaningful is, “Let yourself grieve for who you won’t be again.” That means that even if you go into remission or are declared cancer-free, you’ll never again be the person who existed before cancer. That realization can feel like a gut punch, Tellekamp says. There can also be tension around the desire to stay positive and cheery whenever possible. But Tellekamp believes that if you don’t acknowledge your identity has shifted, those feelings get lodged inside of you, instead of being released. It’s important not to live in the darkness of profound loss for the former version of yourself you had to leave behind. “Sometimes, I set a timer for 15 minutes for grief, and then I cry and scream,” she says. “When the timer goes off, I get up and go fold the laundry. You can’t stop living and live in your grief, but you also can’t pretend it’s not there. You have to respect the grieving process and find ways to let it out.” Take actionWhen considering the effects of bladder cancer, the term “silver lining” may seem incongruous. But Howard notes that even anxiety over potential recurrence can be a benefit, depending on what you do with that energy. “One thing cancer did for me was sharpen the understanding that if there’s something I want to do, I better get to it,” he says. That led to a stint as a part-time prison chaplain, as well as getting tattoos that he’d hesitated over previously, worried about what people might think. He also takes more time to simply be present and mindful, and to soak in feelings of gratefulness for how far he’s come. “If I could go back in time, I wouldn’t change anything, even getting cancer,” he says. “It’s made me who I am, and I’ve had 58 amazing years. I don’t know how many I have left, but I’m going to be here, fully, for all of them.” from https://ift.tt/mbNy5sE Check out https://takiaisfobia.blogspot.com/ America’s third pandemic Thanksgiving may feel like the most normal holiday gathering in a while. AAA expects travel over the long weekend to reach 98% pre-pandemic levels, with an estimated 54.6 million people driving and flying to see loved ones. In fact, 2022 is on track to be the third busiest Thanksgiving since AAA started tracking these travel numbers in 2000. At the beginning of the pandemic, celebrating Thanksgiving meant either virtual or very small in-person gatherings. Now that COVID-19 vaccines and medications are available, it makes it easier to see more family, “which is a beautiful thing,” says Dr. Juanita Mora, an allergy and immunology specialist at the Chicago Allergy Center and a national spokesperson for the American Lung Association. But that doesn’t mean you shouldn’t do your best to keep everyone safe this year—particularly since this Thanksgiving comes amid a new set of Omicron subvariants, a heavy flu season, and high RSV infection rates among children and older adults. Mora tells TIME how she’s approaching this holiday season. “I’m trying to follow exactly what I’m telling patients,” she explains. “Our precautions should revolve around the most vulnerable person that’s going to be at our Thanksgiving table: so that grandparent who’s having chemotherapy, that parent with diabetes, or a child who has asthma, or that brand-new baby.” For Mora’s family, their precautions “revolve around my dad who’s 76. He’s pretty healthy, but we want to make sure to keep him healthy.” The first step is to make sure everyone is up-to-date with their shots. “I’m the type of doctor that’s very proactive with her family,” says Mora, which means she makes sure “everyone’s flu vaccinated and has COVID-19 updated boosters, including the kids.” Read More: Cold Weather Can Be Dangerous for the Human Body. This Winter Worries Experts Mora’s sister and her children will be visiting from California, and will have gotten their shots before traveling. She’s asking that all her family members wear a mask while traveling: “Mask on the plane, mask at the airport, mask at the train station, mask on the train as well, because all of that is going to be key in keeping our family members safe.” Donald Milton, professor of environmental and occupational health at the University of Maryland, is also hosting family this year who are traveling, and they are taking a similar approach. “We consistently use N95s when in public places with possible close contact and/or low indoor air quality,” he says. On top of this, “we will use HEPA filters and DIY Corsi-Rosenthal boxes to reduce risk of transmitting COVID and flu,” he says, adding that “everyone, including the 8-month old grandchild, has been vaccinated and boosted multiple times when eligible.” Those gathering for Mora’s Thanksgiving will also be doing a “mini quarantine” in the week leading up to Thanksgiving dinner, she says; this means trying to limit the amount of people that they’re in contact with. “So no big events. Trying not to go to bars, not going to restaurants, shopping at the grocery store when there’s not going to be a lot of people,” Mora explains. “I’m a 7 A.M. grocery shopping kind of girl.” Then, on the day prior to gathering, everyone will take a COVID-19 rapid test, says Mora. The same goes for Milton’s family: “We will ask everyone to test on two consecutive days, including the morning of the gathering or prior to arrival and stay away if they have either a positive test or symptoms,” he says. It’s also worth taking a few additional precautions once the holiday is over. Mora recommends wearing a mask for a week afterwards if it was a big family reunion or family festivity, “just to make sure” that nobody unwittingly spreads viruses. Also, consider doing a rapid test five days after the gathering or if people start feeling sick. Taking all these precautions to minimize the risk of infection will be key, she says, to getting through—and enjoying—the holidays. from https://ift.tt/8LQxDAg Check out https://takiaisfobia.blogspot.com/ |
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