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A startingly high number

Neurological: Numbness or tingling in the extremities (paresthesias), difficulty walking, balance problems, muscle weakness, vision problems, cognitive disorders (difficulty concentrating, memory loss), mood changes (depression, irritability)

The commenter noted implementing multiple methodological changes simultaneously may obscure the impact of individual updates, compound penalties that do not reflect actual quality performance, and undermine transparency by limiting public understanding and visibility

I have heard of members using out of date ampoules, but not as out of date as yours