Ap chemistry 2019 multiple choice answers

AP Students Subreddit

2013.08.21 03:33 AP Students Subreddit

No matter what course you are taking, we are a community that helps students earn college credit!
[link]


2011.09.26 14:10 kommando208 AP US History

A subreddit for everybody's favorite class
[link]


2015.05.23 02:41 Freshrr AP_Calc

AP_Calc
[link]


2023.06.09 08:43 Be_moxe ESSENTIAL OIL TO REPEL MOSQUITOES: WHAT OILS TO USE AND HOW TO USE THEM

Summertime promises a ton of different outdoor actives, but it also brings forth a whole host of bothersome bugs and insects such as mosquitoes. Luckily, natural repellents like essential oils hold the power to help keep bugs away!
For certain species, their one major goal is to make feasts out of your blood. The irritating itching and the annoying buzzing sounds are hard for everyone to bear, especially when you're just trying to enjoy some time outside in nature or even a good night's rest.
They can get into your home and their tiny bite can even affect your health, by transmitting diseases such as malaria and zika.
While mosquitoes are important to maintain ecosystems (we can't get rid of them all, unfortunately), we can keep them out of our personal space.
Certain essential oils are quite effective and helpful in repelling mosquitoes, and are a natural solution to repel insects. Many environmentally focused brands like ours are determined to develop an alternative repellant using natural ingredients to replace the commercial bug sprays with harsh chemicals.
Here we discuss some tips to using essential oils and other natural repellents for mosquitoes and which oils are most effective.
Are you having a BBQ party this summer? Don't forget your essential oils! Check out 6 ways to use essential oils at your next outdoor event.

USE OF NATURAL DEET TO REPEL MOSQUITOES

DEET is as effective as any other natural mosquito repellent. It is easily available and has no side effects for most people. But if you have sensitive skin or any other skin problem, then it may be disastrous.
Several studies revealed that DEET has some adverse health impacts on the human body. Some research has found that DEET can even promote the growth of tumors. Other outcomes include rashes, irritation to the skin, burning lips, nausea, and headaches.
It is better to avoid DEET and use other natural mosquito repellent options.

USE OF ESSENTIAL OILS TO REPEL MOSQUITOES

Essential oils are plant based, considered safe for humans, and still effective in repelling insects. Most people find that you can use various essential oils without worry, and when properly diluted, can provide relaxing results immediately, with no adverse health effects.
When using essential oils topically, always start by mixing pure essential oils in a carrier oil (such as coconut, jojoba, avocado, or almond oil) before applying to the skin. Essential oils are extremely concentrated, and you never want to apply directly to your skin without them being mixed and diluted first.
If you are unaware of how your skin will react to a specific essential oil (or carrier oil), start with a small amount of diluted oil to an isolated patch of skin (either on the back of the hand or on the forearm is recommended). If any irritation occurs, you may want to discontinue use of, and contact a healthcare professional.
To make sure you dilute to the proper ratio, follow the guidelines suggested by the National Association for Holistic Aromatherapy (NAHA) recommendations.

THE FOLLOWING ARE SOME OF THE BEST ESSENTIAL OILS THAT YOU CAN USE TO REPEL MOSQUITOES.

Citronella Essential Oil
Citronella oil is one of the top essential oils to use against mosquitoes. Popularly used as an insect repellent, citronella oil is derived from the citronella plant, and can be found in candles, or can be incorporated into a bug repellent lotion. In addition to being a mosquito repellent, it can also repel other pests such as fleas, head lice, flies, ticks, and others, and is considered a mild and generally safe means of doing so.
Lemon Eucalyptus Essential Oil
Lemon eucalyptus oil also contains significant amounts of citronella and is extracted from lemon eucalyptus trees. It has a pleasant scent of lemon, which makes it a good choice for diffusing in the home.
A large number of users found lemon eucalyptus essential oil more effective when compared with others including the Center for Disease Control. The CDC claims that the oil of lemon eucalyptus (OLE or PMB) can be used as an effective repellent for mosquitoes.

Lavender Essential Oil
Lavender oil is beneficial for resisting mosquitoes. It has relaxing effects to heal the itching bites of mosquitoes and is also considered safe to use on children. Mosquitoes hate the scent of lavender, which helps to limit further bites.
Peppermint Essential Oil
Peppermint has benefits to repel mosquitoes as some researchers note the oil to have a strong repellent action against adult mosquitoes when applied to human skin.
When diffused, peppermint oil can help keep mosquitoes away, and prevent everyone in your family from lots annoying of mosquito bites. Children usually love the refreshing fragrance of peppermint, and cooling sensation of peppermint oil can also provide relief and ease itching of mosquito bites.
Catnip Essential Oil
Also an effective natural repellent for mosquitoes, it is a member of the mint family that helps to repel mosquitoes and other insects.
A 2005 study published by the Journal of Medical Entomology examined the efficacy of catnip essential oil compared to DEET, their result shows catnip to outperform DEET.
Tea Tree Essential Oil
Tea tree oil is one of the greatest antiseptics, and it possesses antibacterial and anti-inflammatory properties. An excellent choice for healing mosquito bites, you can dilute and apply tea tree oil directly to your skin after for immediate results.
A 2014 study concluded that Tree Tree oil has insecticidal and repellent effects against the species of fly used in their study.
Clary Sage Essential Oil
The oil has a floral fragrance that can brighten your mood as it keeps the pests away. Clary sage (S. sclarea) has shown strong repellent properties according to a 2012 study, especially against the tiger mosquito (A. albopictus). You can also discourage mosquitoes from entering your home, and prevent undesirable mosquito bites, by putting the oil into a diffuser.
All of the oils mentioned above have a particular fragrance, and mosquitoes are repelled to all of these smells. Using such a scent that mosquitoes avoid discourages them from coming close.
Other scents include basil, garlic, rosemary, neem, marigold, etc. It is also important to note that insect repellents use different scents to conceal your body scent.

HOW TO MAKE HOMEMADE INSECT REPELLENTS

You can prepare a natural repellent at home to help keep bugs away by using the available essential oils and other ingredients that may already be around your home. The following are some of the naturally produced repellents that you can DIY your own, and you'll definitely want to share with everyone!
Bug Repellent Spray
First start with equal amounts of vodka and witch hazel, then add a double quantity of water to this mixture. Finally add 10 to 15 drops of essential oils (such as lavender, tea tree, and citronella) for every ounce of the mixture. Pour the liquid to a spray bottle, shake thoroughly, and your DIY bug spray is ready to use!
For best practices, shake before every use to make sure the essential oils are evenly distributed throughout the spray bottle.
DIY Bug Repellent Ointment
For making mosquito repellent ointment, you have to melt down beeswax and coconut oil. Stir the mixture well and let it cool.
Once the liquid cools down, add between 10 to 30 drops of essential oil. Blend the mixture well and store it in the refrigerator.
You must store your repellent in a dark blue or amber glass container. Always mix or shake the ingredients before using the repellent.

PERSONAL AROMATHERAPY DIFFUSERS

MOXĒ aromatherapy diffusers and nasal inhalers are artfully-crafted with their signature organic essential oil blend. All organic ingredients are sourced within the United States and come from premium essential oil companies, meaning you get only the best!
Just look for one that has at least one of the essential oils mentioned above. For example, MOXĒ Dream Diffuser's main ingredient is lavender! Simply take this portable diffuser on your next outdoor adventure and stay mosquito-free
If you're interested in purchasing a high-quality and ready-to-use product then you can visit us at BE MOXĒ.

CONCLUSION

While we know DEET is an effective repellent against mosquitos, multiple studies have shown DEET to be harmful to humans. This brings many of us to seek clean and natural alternatives to DEET like essential oils. Oils like lavender and peppermint are great for mosquito repellents, and many experts recommend them as they do not appear to cause any know human toxicity after dilution.
Whether applied topically, sprayed, or diffused through a room diffuser, the essential oils highlighted above can make your summer nights worry-free and bug-free.
Source: https://bemoxe.com/blogs/news/essential-oil-to-repel-mosquitoes-what-oils-to-use-and-how-to-use-them
Website : https://bemoxe.com/
Related Links :
https://bemoxe.com/collections/inhalers-essential-oils
https://bemoxe.com/collections/shower-home
https://bemoxe.com/collections/smell-therapy-kits
submitted by Be_moxe to u/Be_moxe [link] [comments]


2023.06.09 07:24 sgregory07 Stuck between choosing Pharm Tox Major and Cell Bio Specialist

Hello there, I think this question really depends on personal choice but I really want to get some feedback first. So I have already accepted and enrolled in Pharmacology & Toxicology major during the first decision iteration and has enrolled a second major in Human Biology. However, I just got an invite for the Cell & Molecular Biology Specialist last day, if I remember the time period correctly this offer should be a second decision iteration. Since Cell Bio Specialist isn't a collaborative life sci program, it doesn't conflict with Pharm Tox Major and both courses can be taken together.
However, I'm afraid that taking a Specialist and a Major together might be way too much for me and doesn't achieve anything credit and degree-wise. I wanted to pursue a career as a medical examiner and I feel that Toxicology would be a good starting point for undergrad, afterwards I could apply for med school after graduate studies. But, a specialist program in Cell Bio seems too good to pass on. In addition, I had a hard time with the last third of the content (mostly reaction mechanisms) of first-year OChem, in fact, I nearly flopped on the final exam, and Toxicology seems to lean heavily on chemistry. On the other hand, I achieved 4.0 points in BIO 120/130 and I seemly had a relatively easy time studying molecular biology content for BIO 130 compared to other students (no, I"m really not flexing). I'm not sure if it is even possible to drop the Pharm Tox Major now that I have enrolled in it. And if I can, should I pick Cell Bio Specialist instead? I need to understand what bother of these programs demand from their students. I welcome any answers.
submitted by sgregory07 to UofT [link] [comments]


2023.06.09 06:15 dsvoboda080182 I made ChatGPT into a philosopher

I gave ChatGPT some philosophy books as input as asked it to generate some authentic philosophy. Here is what came up:
0 The chapter discusses the views of Kant and others on various philosophical concepts. Hegel and Lacan argue that subjectivity is a matter of interplay between appearance and inaccessible content, while Heidegger focuses on understanding being as it relates to existence. Conant explores theological debates regarding logic, and Stroud questions its necessity. Hamawaki delves deeper into Kantian philosophy's relationship with Cartesian skepticism towards self-consciousness. Finally, the UM examines how anxiety plays a role in our concept of care within being together with other beings.\ 9 The chapter delves into various philosophical concepts such as being, logic, and self-reflection in order to examine key theological debates. Conant argues that the laws of logic are not necessarily necessary, while Stroud believes they must be rooted in an idealistic philosophy. Consequently, both scholars have different interpretations of Frege's theories on logical cohesion and Kant's emphasis on thought formation over judgement using language metaphors like chess-playing and linguistic inquiry respectively. Hamawaki pushes for a more refined understanding of Descartes' ontology towards Kantian self-consciousness which allows us to better discuss topics such as care-taking actions and certain modes of being present within physical space at different times. Throughout all these discussions the theme revolves around looking beyond our own capabilities of reasoning via perception so we can gain insight into ultimate reality or truths about ourselves as sentient beings inhabiting this world where difference exists yet lived-experience is common ground much misunderstood until each second as it passes by leaving something useful clues for those who listen intently enough! 18 In this chapter, the UM examines how Descartes' ideas of existence and Kant's concept of "I" as an existential subject shed light on concepts like care and being in the world. He argues that contemporary philosophers cannot rely solely on intuitions for their claims if they want to build a reliable and trustworthy philosophical theory. The narrator discusses how falling prey demonstrates evidence against the existence of care, while also exploring anxiety as a fundamental ontological question concerning being. The UM uses analogies from Hegel and Moore's theory about necessity and possibility, working through different implications posed in these theories to explore the question of God's existence.\ 27 In this book, various philosophers including the UM, Leibniz, Nozick, Stroud, McDowwell and Anderson explore topics related to ontology perspectives. They discuss how multiples can be used to create multiple identities without being physically presentable in a situation and how introducing an indeterminate element may lead uncertainty into certain situations. The authors cover concepts such as perception and self-consciousness, with Kant's philosophy forming the cornerstone of these discussions. Furthermore logical inference offers us perspective into ways that we can understand the world through science-disciplined propogation theories etc., focusing on Frege's notion of logic ans autonomy However objects involve objectivity wherein from bias comes accuracy leading some alternatives manifesting relativity because they consist its allies rarely even being just sidelined form part-and-parcel truths or intrinsic categorial versions thereof until something comes along to throw another light on it.; As philosophy cannot dwell only theoreticals experience turns valuable always but their limits come in capacity which separates 'Our Nonopenness' restricted exclusively determinate linguistic paradigm veer closely incomplete infinite mechanics involved ensuing infinitesimals transformed making scientific application realistic assisting detailed interpretations valid conclusions- resulting undoubtedly significant plmthic inquiries crucial historical data techniques mind should reckon too strategic potential divulged epistemology spawner objective answers explainable accounts insights further expedient modes utilisation for reasons appropriate legitimate dimension realms reality prioritized verified evidential supports usher up brazenly dilettantic reasoning accountability no-man lands quantum theoretical gravity driven backgrounds functionalities invariant standards lucid examinations sober introductions mode adaption retention succulence worthily reflecting time passing transformative multiplicities invanecological settings which allow our experience flexibility.
36 Frege argues for a content-neutral form of reasoning to help understand and apply logic to the real world. He believes truth in thought is independent of external language or factors, using categorical propositions and functions. Kant's "Transcendental Deduction" emphasizes sensitivity being limited by experience approach that defines limits of knowledge through human limitations. Anderson explores objectivity and relative truths in science with an indispensable need for specificity in understanding scenarios essential to evaluation. Also, he divides beliefs into two groups: those involving bias and objective ones based on reasons rather than facts while introducing morality as a potent driver affecting choosing courses of action ultimately proposing the desire towards an authentic life existence potentially guarantees meaningful experiences overcome limitations experienced within society to bring out better decisions which result from such reflections over conscience drive manifested through meditation such instances acquire significance by placing these events relevantly consciousness continuum extend identity beyond mortal opposable temporalities tensions between general rules imperative visualizations choices ex vivo molded which hinges centrally existential crises implemented imaginative applications retrospective reframing requiring use-value critique interpretation experiencing eternity involves reconciliation perceived reality with potential reality this idea drives validation difference reciprocity efforts build `faculty anatomy' In views fashioned arguments transcendental ultimacy arising matter tension non-standard epistemological concerns while providing much-needed grounding observations about functionally distinctions kinds relevance relation paradigm realities underwent germane philosophical tradition over decades tackling hardest explanatory faults demonstrated coherence getting access worlds needed unprecedented unity knowledgeable pursuits where hidden interest intellect renders instead foreground phenomenal recognition appreciation importantly developing uses metaphor extensive literary relevance offers rich vocabulary creativity promoting outlook invaluable overcoming manifold moral material obstacles besetting today's societies. 45 The chapter discusses how some truths may be more valid than others based on a variety of factors. Anderson examines the role of objectivity and relative truths, contingencies in events and phenomena, and the relationship between value and function. He also delves into morality's influence on human behavior, considers retroactive illusion as an obstacle to understanding reality without God, explores ontology as a potential source of knowledge about ourselves and the world around us, discusses learning a second language through observational knowledge along with theoretical acumen for auditory differentiation e.g., telegraphic syntax which form vocabulary acquisition prioritization at every stage starting plosives to fricatives' long vl near /J/-like ~ ch (non-sharp pronunciation). Finally, he mentions blindsight where consciousness only requires low-level sensory reporting while slower continuous unitary stream two concatenated 40 character-long descriptions meditated after state alterability are high in cognitive load so analysis becomes disrupted necessitating fragmenting visual scans forming successive outlines each amalgamated pieces resulting text. 54 The chapter discusses philosophical concepts of language, including acoustic phonetics and motor-phonetics for learning a second language. Frege talks about the difficulties of predicating objects and concepts, while Wittgenstein emphasizes the use of symbols over signs in language learning. The paper explores multiples as a tool for understanding reality and examines constructivism's approach to change. Stanley argues against Wittgenstein's example with wood-sellers regarding communication without formal languages, and emphasizes the importance of differentiating between symbolic and imaginary identification. Finally, history cannot be fully reconciled due to its complex nature but understanding it can unlock potential within ourselves towards revolutionary ideals. 63 The chapter examines the use of language to express concepts, including phonetics and historical phonography. The author also discusses how natural multiples can be used to formalize situations. Dr. Rivers expands upon this concept using examples such as a multiplication table and introduces constructivism theory. Stanley argues that Wittgenstein's example fails to accurately represent communication without language but provides his own example using builders and private lullabists. Additionally, he explains the differences between symbolic and imaginary identification in relation to movies like Woody Allen's or Hitchcock's North by Northwest. Finally, various philosophers are mentioned regarding politics as an event-based process with reality understood through symbolic meaning, history not always having objective interpretations due to its underlying structures; proposing music and love bringing us closer to truth while Slavoj Zikzek applies hegemony philosophy as analogies of a giant mole waking up from stasis state further back Hegel linking good beauty with truth whilst Richard explains about aliens recognising familiar rhythmic stresses when hearing languages different from theirs typically displayed via Conrad ``he passing across jurisdictional terrain'' taken aback once signal cutoffs arisim%. 72 The narrator talks about the consequences of past actions, highlighting how history is always subject to interpretation and new information. He believes that ideologies have blind spots due to repeated patterns of bureaucracy and perpetual friction, and politics operate on an event-based process where individuals are subject to laws. References to Jean-Jacques Rousseau's arguments on general will, Richard Rorty's emphasis on truth through love and music as well as Wollstonecraft's analogy of reality being accessed symbolically shape his views. Slavoj \'8ei\'9eek introduces the idea of rhizomes representing historical struggles between truth, beauty, and goodness while also examining Hegel's philosophy in relation to language using metaphors like a giant mole. Finally, speakers like Conant argue that language can be learned by recognizing meaningful sounds without understanding their explicit meanings while acknowledging children need exposure to many sound types for proper linguistic comprehension; similarly remarkable abstract forms can convey emotion through their structure irrespective of written or spoken textual meaninglessness or unpredictability. 81 Hegel believed that language goes beyond mere words, and people can recognize meaningful sounds even if they don't know their exact meaning. In order for children to learn languages effectively, they must be exposed to different types of sound. And just like music can express emotions through abstract forms without clear meanings, a piece like Schumann's Carnaval may evoke multiple ideas in the listener despite its lack of consistency or clarity.
submitted by dsvoboda080182 to ChatGPT [link] [comments]


2023.06.09 05:24 Vijaygarv NATIONAL COMMERCE OLYMPIAD SRCC

I hope this message finds you in good health and high spirits. I personally am excited to announce the launch of National Commerce Olympiad here which is organised by The Commerce Society of Shri Ram College of Commerce. NCO is a nationwide competition aimed at assessing students' skills in commerce-related concepts, analysis, and problem-solving.
Date: 30th July 2023, Sunday 🎓 Eligibility: Classes XI, XII & Pass out batch of 2023
Compete with the nation's brightest minds and stand a chance to win cash prizes worth ₹70,000+, certificate of merit, excellence, participation and much more !
NCO offers students a unique opportunity to showcase their talent and compete with their peers from different parts of the country. By participating in this Olympiad, students will have the chance to tackle objective-type questions specifically tailored to commerce subjects. We believe that participating in the NCO will not only enable students to familiarise themselves with the exam format similar to the CUET, but it will also help them gauge their proficiency in answering multiple-choice questions within a limited time constraint.
We are proud to announce that this incredible opportunity is being offered by none other than SRCC, known as Asia's best Commerce College. In collaboration with SRCC, we have partnered with Unacademy, a renowned online learning platform, as our Knowledge Partner for the event. With this collaboration, we aim to provide an enriching and comprehensive learning experience to all participants.
To register your students for this esteemed competition, please visit the following link: https://unstop.com/competitions/national-commerce-olympiad2023-srcc-du-delhi-679635 Don’t forget to mention my name [Garv Arora] when asked for a referring ambassador!
If you have any questions or require further information, please don't hesitate to dm me on reddit or ask in the comments.
Warm regards, Garv Arora Campus Ambassador
submitted by Vijaygarv to CBSE [link] [comments]


2023.06.09 04:29 Bubzoluck [30 min read] The Opioid Epidemic before the Opioid Epidemic - Exploring Morphine Derivatives and the First Opium War (Part 1)

[30 min read] The Opioid Epidemic before the Opioid Epidemic - Exploring Morphine Derivatives and the First Opium War (Part 1)
Hello and welcome back to SAR! I have written and rewritten this post a few times now and I think I have landed on a format I am happy with. When we talk about the impact of medicine on history its important to get the context right, and I think I have found a way to talk about our topic. So what is it? No chemical is more important to the world of medicine than Opium, okay maybe Penicillin, but today we will say its Opium. Principally an analgesic (anti-pain), the Opium Poppy allowed for humans to take away pain in great degrees and further development on the natural chemicals has opened up surgery and post-op recovery. While we tend to look at the recent Opioid Epidemic as the only issue regarding Opiates, history reveals to us a very similar precursor. Also please head over to u/jtjdp post about morphine derivatives here! She does an amazing job explaining the higher level concepts of medicinal chemistry that I just wouldn’t do justice. Alright, enough quibbling, let’s get to the good stuff.
Disclaimer: this post is not designed to be medical advice. It is merely a look at the chemistry of medications and their general effect on the body. Each person responds differently to therapy. Please talk to your doctor about starting, stopping, or changing medical treatment.

How Much do you Know About Pain?

To be alive is to feel pain, and emo sentiments aside, this is one of the biggest biological properties of the central nervous system. When you think about it, how does the body take external stimuli and allow you to recognize it? The answer is the sensory nervous system which is responsible for sensing many different types of stimuli: temperature, pressure, pain, and chemicals. These sensory neurons carry the information from the extremities and transmit it up the spinal cord into the brain for processing. From there the brain alerts you to the issue allowing you to correct whatever problem is causing the pain. Let’s take a look:

https://preview.redd.it/36yiuubbjw4b1.png?width=660&format=png&auto=webp&s=a8dc870ed6d879d67dce1eb126b86ba5acb9bc69
  • We call these receptors Nociceptors and activation of these neurons in the periphery leads to a signal being sent towards the spinal cord. Those peripheral nerves eventually complex with the Dorsal Horn of the spinal cord and interface with the central nervous system to transfer the pain signal. This signal is then sent Ascending to the Thalamus where the pain signal is recognized and initiates a response (such as pulling your hand away from the hot stove). But that’s not the full story, the brain also sends signals back down Descending to modify the incoming signal and dampen it. Its this modifying that makes pain fade over time when you aren’t focusing on it—otherwise the brain would be overwhelmed by the repetitive signal and continuously think injury is still happening. Now let’s divide this process into its two parts, first up the Ascending pathway.

https://preview.redd.it/w6751owcjw4b1.png?width=896&format=png&auto=webp&s=122f8b2c615f741d848ed0171a574b1353a34038
  • As the Action Potential travels from the periphery towards the Spine it causes the influx of Calcium into the Presynaptic Neuron. This neuron is what carries the original signal to then transfer into the Spine for further traveling. Eventually we reach the Synapse where the finger-nerve and spine meet and we get the transfer of information via Neurotransmitters. In this case, two chemicals are released: Glutamate and Substance P (which literally stands for Substance Pain). Glutamate will activate two receptors (AMPA and NMDA) which are Excitatory and stimulate the continuation of the pain signal up to the brain. Substance P activates the NK1 receptor which enhances the frequency of the pain signal (the throbbing) and the intensity of the pain burst. So to simplify, Glutamate allows the signal to be passed up to the brain but depending on the strength of the original pain signal more or less Substance P is released which modulates the strength and attention-grabbing nature of it. Okay great, we sent the pain pathway up and it will get processed in multiple different parts of the brain. But the brain can’t have that signal stinging it so it must send information back down to dampen that pain signal. This is where that aforementioned Descending pathway comes in. Above you can see how the blue line reaches down out of the brain and back into the spine to turn ‘off’ the signal. This is the basis of Analgesia or pain relief.

https://preview.redd.it/audgj8kfjw4b1.png?width=668&format=png&auto=webp&s=c3b58c520e8298e20f787d70e053948c3817c565
  • Okay so now we have to divide the action of the Descending pathway which acts to dampen and modulate the original signal coming into the brain. Now, normally at rest this Descending neuron is inhibited so any fresh incoming signal is not inhibited from the get go but once that pain signal does come in, we get the good stuff! In response to pain the brain releases substances called Endorphins which activate the mu Opioid Receptor (MOR) located on the Descending pathway. Now MOR are inhibitory in nature so they are inhibiting the inhibitory resting state of neurons, or in other words, are allowing the Descending neuron to activate. And this is an important fact to recognize, Opiates do not inhibit pain, they inhibit the physiology of the nervous system that prevents modulation of the pain signal.
    • Once the inhibition is inhibited, the Descending neuron is free to release two neurotransmitters onto the nerve that was carrying the original pain signal. Both Norepinephrine and Serotonin are released to activate their respective receptors which inhibit the release of Substance P and Glutamate thus decreasing the incoming pain signal. Likewise MOR receptors are found directly on the incoming nerve and further prevent the release of Glutamate and Substance P as well as being found on the Ascending neuron preventing the activation of the NMDA/AMPA and NK1 receptors. The result: dampened incoming signal and decreased pain sense being sent to the brain.

The Stars Align in the Shape of a Poppy


https://preview.redd.it/nfygsi0hjw4b1.png?width=731&format=png&auto=webp&s=60c0b13cdad3d7b7b64f78d6294465f081839f61
To start our story about Opiates we need to turn to the great precursor—Opium. Opium itself is not a chemical but rather a really thick liquor (called latex) that contains a high concentration of Morphine (and some Codeine). There are 38 species of Poppy plants but only two produce Opium is great enough supply that it is worth farming them and humans have been cultivating these varieties for as long as we have known about the plants. When humans settled into Mesopotamia (near modern day Iraq), Poppies were one of the few plants grown in plots as large grain or vegetable fields (meaning that they were thought of as valuable as food). Throughout the Greek age of medicine (pre-500 BCE) through the Islamic medicinal revolution (500 BC-1500 AD), Opium was a major component of treatment, assisted suicide, and poison. In fact its through the rise of the Muslim Caliphates that we see the export of Opium to other parts of the world, especially through the Mediterranean Sea once the Crusaders return. Opium trading to the East via the silk roads was an almost continuous affair since time immemorial and Pakistan was a major growing area for the Eastern Poppy trade.
  • By the time after the Crusades (11-13th centuries), we start to see the West’s fixation on Opium. For many reasons Europe didn’t develop many psychoactive plants to the same degree as more humid/hot climates like Africa, the Middle East, and India. This is why the importation of Opium (and also Marijuana) was such a trade commodity and staple in the development of Western medicine. During the Renaissance and the revival of Greek philosophy we start to see the re-fascination with Opium and by the 1600s we see merchants importing Laudanum into Europe for recreational and medicinal use. The standard use of Tincture of Opium (which is Opium dissolved in ethanol, a DEADLY combination) was a particularly favorite preparation which was prescribed to the lowest day-worker all the way up to kings.
    • The importation and use of Opium exploded in the late 1700s once the British conquered a major Poppy growing region of India. This region (western India and most of Pakistan) was originally slated to grow cotton like the American colonies but the region wasn’t wet enough to sustain the plant—it could however grow copious fields of Poppy plants to create Opium. Throughout the 18th century the British Raj became the largest exporter of Opium to Europe and after the discovery that Mercury and Arsenic may not be safe, Opium took over their duties. By 1780 almost all major remedies incorporated the use of Opium in some capacity and with the huge supply, it was incredibly cheap.

https://preview.redd.it/1cspu1ukjw4b1.png?width=578&format=png&auto=webp&s=4e81b6d401a1806f39592e802b0bd5ab6df9a2e8
  • Poppy wasn’t only important to the British for its medicinal properties but also to bolster the huge amount of loss they were incurring in global trade to one trade partner—China. After she made contact with China in the mid-1500s, Britain starting to import HUGE amounts of tea as the Brits became literally addicted to the substance. By 1800 a full 15% of the ENTIRE British Empire’s revenue was being spent on importing tea, that’s 30 million pounds per YEAR, leading to a massive trade deficit. This means that more money was being sent to China literally enriching a foreign country while the British public was getting their fix on the black stuff. Oh and just in case you think things haven’t changed, Britain still accounts for 42.6% of the world’s tea consumption—seriously Brits, ever heard of coffee? Anyways, all this money leaving the British economy to be spent on non-Empire sustaining commodities was a major national security risk for the British. It would be different if they were importing gunpowder like the Dutch were or Silver as the Spanish had but literally they were consuming the riches they were spending the money on.
    • Remember too that the British were not in the best position by the turn of the 19th century—they had just lost their colonies in the Americas, involvement in the Napoleonic Wars killed a generation of men, and the push to develop industries over public health led to a focus on fast growth rather than smart growth. One of the results of the Napoleonic Wars was the British occupation of the Island of Java which developed a very potent Opium which was traded with Chinese merchants regularly. Soon British merchants realized they could rebalance the trade deficit by selling Javanese Opium into China but the small island was unable to produce enough Poppies to meet the demand. So Britain turned to another one of its colonies, India.

https://preview.redd.it/iiu2j8emjw4b1.png?width=707&format=png&auto=webp&s=d6f54a00fe47739db6545be913c186e4560195d4
  • India by the end of the 1700s was a bit of a challenge. The British hold on the subcontinent was firm but they couldn’t grow the cash crops they wanted. Indian cotton was nothing compared to Egyptian or Southern American (i.e. Virginia/North Carolina/Georgia) cotton and the Indian tobacco was known for being bitter. But by the 1770s the British government realized that Poppy was an easy crop to grow and the demand across the border with China was an easy market; British traders brought their cargo to small islands off the coast of China where it was sold for silver. Initially the Chinese didn’t mind the sale of Opium in their territory—when the British traders collected the silver from the sale they would almost immediately use it to buy Chinese goods, thus driving tax revenue for the Chinese government.

https://preview.redd.it/andjwt0qjw4b1.png?width=644&format=png&auto=webp&s=730782fa74a65c111a62f05024445656b81f9811
  • But if you buy Opium, people are going to use that Opium. By the 1810s all trade with foreigners was restricted to just one port, Canton, and slowly the city started to develop a habit for the drug. The use of mind altering substances was curtailed pretty quickly for hundreds of years in China—the Ming Dynasty banned tobacco in 1640 and the Qing banned Madak (a powdered Opium containing tobacco) was similarly banned in 1729. But by 1790 more and more Chinese citizens were becoming addicted to the substance; what started as a recreational drug slowly became a crippling addiction that took hold over Canton. For a rigid society, the crippling Opiate addiction was a moral corruption for the Qing government and forced them to curtail Opium importation in 1780 and then an outright ban in 1796.

https://preview.redd.it/mw9oflprjw4b1.png?width=879&format=png&auto=webp&s=5640d0bc425726fbd471b8dcf8954222afc49fc5
  • Knowing just how devastating the Opium was having on the inhabitants of Canton, as well as how it spread further inland, British merchants kept peddling their drug. Older ships with larger hulls were converted into floating warehouses and parked just outside of navigable waters. Once set up, Opium smugglers would pull up, purchase the Opium and avoid any oversight by the Chinese government to prevent the sale of the drug. Following their mother country, American merchants started to sell Turkish Opium, an inferior variety, at a much cheaper rate leading to drug peddling competition with more and more tons of Opium being sent into China. This drove down the price of Opium considerably which ultimately increased the demand.
    • This demand eventually led to reversal of trade, meaning that more silver was leaving China to pay for Opium than the British were using to pay for Chinese goods. American and European traders could show up in Canton with holds full of Opium, sell it off for a profit, and then make a tidy silver profit to bring back to Europe. Likewise the importation of cheap machine-made cotton, furs, clocks, and steel into China driving down domestic profits.

Let’s Look at the Drugs a Bit


https://preview.redd.it/y4uwbc1tjw4b1.png?width=548&format=png&auto=webp&s=71f79278925a92ea052d1ae390a495f0496966b2
https://preview.redd.it/pf709wmujw4b1.png?width=918&format=png&auto=webp&s=91cdf3fdd56db4beb95f07f340d24bb7ef7e9cf3
Stepping away from the history a bit, let’s introduce the Family. Okay so we understand how pain is sent to the brain and how it modulates but there is so much more to the mu Opioid Receptor and that’s not the only kind of Opioid receptor that we have. The two most clinically useful receptors are the Mu and Kappa Opioid Receptors (KOR) because they result in analgesia but there is a Delta Opioid Receptor (DOR) that is worth mentioning. The majority of the Opiates that we know and love are Mu agonists but there are some very interesting Kappa agonists that are worth mentioning as well.

https://preview.redd.it/eg9toikwjw4b1.png?width=587&format=png&auto=webp&s=027d16b15bd7e195205513a3034eb5610ba88537
  • Above is a chart that shows the binding affinities of select Opiates to the Mu receptor. The smaller the number is, the more tightly they bond. Now affinity is different than potency—potency is a measure of how much drug (in g) is required to produce the same effect. So even though morphine has a higher affinity than fentanyl, fentanyl has a MUCH more potent effect (which is why it can be so dangerous, you only need a little). Now many of the opiates cause the same effect so I want to spend more time on what makes them all so different:
  • First up we have the 5-Ring Morphinians which are derived from the natural product Morphine. These structures have 5 component parts: an aromatic benzene ring (A), a completely saturated bridge ring (B), a partially unsaturated ring with an alcohol attachment (C), a piperidine heterocycle above the rest of the structure (D) and finally a ether linkage between the top and bottom of the structure to keep it fairly rigid (E). Truthfully we are only going to focus on two locations—firstly the top alcohol (red circle) can be methylated to form Codeine, a natural Prodrug of Morphine. A Prodrug is one that is biologically inactive but goes through an initial metabolism once ingested that makes it active.

https://preview.redd.it/hx3zwwcyjw4b1.png?width=725&format=png&auto=webp&s=bf238a61c14c183cf081da027074a3eb1a11b1f0
  • In fact it’s this initial metabolism of Codeine that makes it very interesting. In order for Codeine to exert any pain relief it needs to be converted to Morphine which actually exerts the desirable properties. This is done by the liver enzyme CYP2D6 which is a pretty minor pathway for Codeine—only about 10% of the Codeine is actually converted to Morphine to have some action. Because of this 2D6 dependent pathway we have to be careful about administering drugs that might inhibit the 2D6 pathway because that would mean we are preventing codeine from being active. Drugs like Fluoxetine (Prozac) and Paroxetine (Paxil) are strong 2D6 inhibitors and so if we administered Codeine to someone taking this drug they’d never get any benefit from the Codeine. In addition there are genetic/ethnic differences that pharmacists can account for such as 2D6 activity. If you are someone with very little 2D6 activity then you would also not convert Codeine to Morphine and thus get no action from the drug—this may be a reason why some people say Codeine doesn’t work for them. Another reason could be that they are Rapid Metabolizers and quickly convert the Codeine to Morphine and thus get a massive hit quickly after ingestion—in that cause you’d need a much smaller dose than another person for the same effect.

https://preview.redd.it/cvbelexfkw4b1.png?width=919&format=png&auto=webp&s=ed6f1683761a69b87bd0de12834a76c1f089a31f
  • A different drug that is the opposite of Codeine is Hydromorphone (Dilaudid) which has a Ketone on ring C. This ketone and the lack of the double bond on this ring increases the lipophilicity of the drug and increases its ability to penetrate into the brain and thus have a greater effect. In fact Hydromorphone is 5-10x more potent than Morphine due to its greater ability to penetrate into the brain and increased receptor affinity for the mu receptor. Because the A ring OH is not capped with a methyl group, we don’t need to rely on 2D6 to metabolize Hydromorphone into an active drug form which again increases the activity of this drug compared to Codeine.
  • So combine these two structural changes—the capped OH on ring A as seen in Codeine and the increased affinity found with the ketone in Hydromorphone and we get Hydrocodone (Norco, Lorcet). Well in this case you’d get a drug that has very good affinity for the mu receptor (better than codeine) BUT is still reliant on the small 2D6 pathway for activation (worse than morphine). In this regard only about 10% of Hydrocodone is active at a time. We can see this effect in the relative doses for equivalent effect: to match the effect of 30mg of Morphine, we’d need only 7.5mg of Hydromorphone (more active) but need 200mg of Codeine (less active).

https://preview.redd.it/la2oqttgkw4b1.png?width=845&format=png&auto=webp&s=0155a6506a5038a6dad7987572a8eabaab75205a
  • This brings us to our last drug of this class, Oxycodone which has a special OH group found on Ring B. What you’ll notice is that Oxycodone has that capped OH on ring A so it requires metabolism through 2D6 just like Codeine and Hydrocodone. When it is uncapped it becomes Oxymorphone which has 3 times as much effect as Morphine BUT that extra OH makes Oxycodone an exclusive Mu receptor agonist. Unlike the other drugs which may go to other receptors causing side effects (more on this later).

https://preview.redd.it/ftdg9l8jkw4b1.png?width=489&format=png&auto=webp&s=e2ceeb6172294b69574f5b929d0a218f481c7e41
https://preview.redd.it/yos35mojkw4b1.png?width=677&format=png&auto=webp&s=0e72e94694147c303defe123d88b048e6ca3369a
  • Next up I want to look at some Mu opioid receptor Antagonists or those than inhibit the function of the opioid receptor. Looking at the first two drugs, Naloxone and Naltrexone, we can see that they have the structure similar to Hydromorphone so they would have incredible brain penetration and affinity for opioid receptors BUT they contain that funky Nitrogen tail. Now normally there is a short methyl tail that is required for the function of Morphine but by adding a bulkier tail the drug is able to fit inside the receptor but prevent activation. What’s most important about these two drugs is that they have much more affinity for the receptor than other opiates. We can see this effect in the graph above: when no Naloxone is present, Fentanyl occupies the opiate receptor about 75% of the time. But as soon as Naloxone is administered that number drops swiftly (within minutes)--this is because Naloxone has a higher affinity for sitting in the receptor than Fentanyl. Think of it like the bully Naloxone coming up and pushing the poor defenseless Fentanyl off the swings so the bully can play on it (except in this instance Fentanyl is causing an overdose and we need to save someone’s life).

https://preview.redd.it/61dx2mwokw4b1.png?width=594&format=png&auto=webp&s=4740b8395ca83304d5e0a756004b119976c621f2
  • Buprenorphine is similar but it is a Partial Agonist instead of being a full antagonist. Buprenorphine is not a 5-ring Morphinian byt a 6-ring Oripavine that has a few different modifications. The biggest additions is that it has the bulky Nitrogen tail found in full Antagonists but it has this funky C ring tail which fights the antagonism. The result is a tug of war between the antagonism of the Nitrogen tail and the agonism of this new C-ring tail resulting in Partial agonism—so if you took Buprenorphine you’d notice a markedly decreased pain relieving ability but importantly there is a ceiling effect, its much harder to overdose on Buprenorphine than other full agonists. In addition in the second graph we can see that Buprenorphine has the greatest affinity for the receptor than our other agonists which prevents someone from taking a more potent opiate while taking Buprenorphine. In this case the bully is already sitting on the swing and scaring away the other kids thus preventing them from having a turn (and potentially causing an overdose). This does mean that if someone was taking a more potent drug (like Fentanyl) and then took Buprenorphine, it would cause withdrawal just like Naloxone or Naltrexone.

https://preview.redd.it/x9wcb8xqkw4b1.png?width=912&format=png&auto=webp&s=d09a59a927363d3864eebfd29cb05215e9f0234b
  • Speaking of withdrawal, let’s take a look at how that happens. Remember that the pain signal is caused by the activation of AMPA and NMDA receptors from the peripheral nerve. AMPA is a type of receptor called a G-Protein Coupled Receptor or GPCR which in this case is linked to an Excitatory G-protein which leads to the activation of the nerve. When AMPA is activated, the G-protein (Ga) activates an enzyme called Adenylate Cyclase (AC) which increases the production of pro-activity cAMP—or in simpler terms—when AMPA is activated, it leads to an increase in levels of pro-pain molecule cAMP. The Opioid receptor is also a GPCR but it is linked to an inhibitory G-protein which prevents the action of Adenylate Cyclase and thus leads to a decrease in cAMP levels. So Opiates prevent pro-pain cAMP signaling from continuing.
    • In the second graph we can see how tolerance forms. Initially (A), Adenylate Cyclase and cAMP levels are not affected by having opiates even though their ability to push along the pain signal is blocked. After a few hours, the leftover cAMP is degraded and cAMP levels start to drop significantly (B). In response to these levels going down, the activity of Adenylate Cyclase starts to increase and increase (C) which raises the level of cAMP. This rise in Adenylate Cyclase activity opposes the action of the opiate which necessitates the need for increased doses of Opiates and is why tolerance forms. As sustained inhibition of Adenylate Cyclase continues, the body upregulates Adenylate Cyclase activity to create more cAMP and to combat this we increase the dose.
    • Now what if after years of taking an Opiate we suddenly administer Naloxone, an Opiate antagonist. Well after weeks to months of taking an Opiate, the level of Adenylate Cyclase activity is WAY above baseline. When you administer the antagonist, suddenly Adenylate Cyclase is able to produce a TON of cAMP that normally is blocked which leads to a MASSIVE amount of downstream signaling. The result is intense nausea and vomiting, stomach cramps, fever, anxiety, insomnia, and cravings. Thankfully the withdrawal process ends after about 72 hours but is one of the worst experiences someone can go through which is why proper down-tapering of Opiates is extremely important.

A Change in Trade Policy


https://preview.redd.it/bb4eb0ltkw4b1.png?width=628&format=png&auto=webp&s=321048bd5d5edf8877aede887c3fcb7aa387a0e4
Oh, you’re still here. Neat! So by the 1820s the Qing dynasty was running into many problems regarding Opium. Firstly they needed the Opium taxes to fund their efforts to put down the White Lotus Rebellion and retain power. But after almost 30 years of trade the effects on Chinese communities could not be ignored along with local officials operating under the imperial trade department, the Hong, profiting from bribes to allow Opium. Regardless of initial efforts things were getting out of hand for the Qing government. In 1800, about 4000 chests of Opium or 560,000 pounds entered the country but by 1830 that number exploded to 20,000 chests or about 3 million pounds. But more than the amount of Opium actually entering the country was the incessant rudeness of the British government to open trade.
  • One of the “problems” for the British traders was how clamped down trade was with China. By 1800 all trade was limited to just Canton and the Hong was a strict master of trade. Foreigners were not allowed to appeal decisions made by the Hong and only Chinese traders could sell goods further inland than Canton. Traders chafed against this extreme oversight and sent hundreds of letters to the Hong requesting special dispensations which were summarily denied. Things changed significantly in 1834 when the Chinese trade was de-monopolized away from the East India Company allowing any private trader to get involved in the Eastern trade.

https://preview.redd.it/cvbkq7vukw4b1.png?width=669&format=png&auto=webp&s=9340d153989a2f8c32a72792554f86be77e1f4eb
  • In August of 1834, the British sent Lord William John Napier to Macau as superintendent of Chinese trade with the explicit order to follow all Chinese regulations. Thinking he knows best, Napier decided that the restrictive Chinese trade system was too restrictive and sent a letter to the Viceroy of Canton. This was unheard of—NO foreign traders were allowed to speak directly with Chinese officials and the Viceroy refused to accept it. So why not double down by ordering two British ships to BOMBARD two Pearl River forts as a show of force? Luckily Napier died of Typhus almost directly after else it would have resulted in a full blown war.
  • In 1839 the Qing government appointed Lin Zexu as the Opium czar to completely eradicate the Opium trade from China. Lin banned the sale of Opium in China completely, set up rehabilitation centers for those affected by the drug, and put addicts to work to distract them while detoxing. Lin demanded that all Opium supplies must be surrendered to Qing authorities and any Chinese citizen disobeying the order would be punishable by death. He even went as far as closing the Pearl River Channel, trapping British traders in Canton and seizing their Opium warehouse stockpiles.
  • The replacement for Napier was Admiral Sir Charles Elliot who protested the seizure of the Opium stockpile but knew that they could do nothing. He ordered all Opium ships to flee and prepare for battle which caused Lin Zexu to beseige a group of traders inside a Canton warehouse. Elliot convinced the traders to cooperate with the Chinese government and surrender their stock, saying that the British government would compensate for the lost Opium (which he had no authority to do). During April and May 1839 the British (and American) traders to surrender 20,000 chests of Opium which was burned for three days outside Canton. Following the burning, trade resumed to normal except no more Opium was allowed. Like many other instances of the government removing legitimate sale of a drug, the black market increased markedly.
  • In July 1839 a new scandal rocked the British-Chinese trade system; two British sailors became drunk and beat a man death outside of his village. In response, Superintendent Elliot arrested the two men and paid compensation to the villager’s family for the loss of the man but Elliot refused to hand over the sailors to the Qing government. Lin Zexu saw this as a blatant disregard for Chinese law—afterall traders needed to understand that they can’t just come to China and violate Chinese law as they saw fit. Elliot offered to hold a trial on a British ship in front of Chinese officials to show that the men would not get off free. This incident would start the smoldering.
    • On September 4th, Elliot sent two ships to Kowloon to buy food and provisions from Chinese peasants. While approaching the harbor, three Chinese war junks gave permission to the two British ships to trade but that permission was rescinded by the commander of Kowloon fort. Elliot fumed against the slight and said that if the British were not allowed to trade by 3pm, he would fire on the fort. 3pm passed and the British opened fire on the fort causing the Chinese junks to return fire. The fighting continued for 7 hours until nightfall and Elliot had to prevent the British officers from pressing the attack, thus ending the Battle of Kowloon. Having driven off the Chinese ships, the British purchased the supplies they needed while the Kowloon commander claimed that both ships were sunk and 50 British sailors killed.
    • The reaction in Britain was about as much as you expect. Prime Minister Palmerston sent out letters to the Governor General of India to prepare marines to invade China and another letter to the Chinese Emperor telling him that Britain would send a military force. He sent a letter to Superintendent Elliot to set up a blockade on the Pearl River and capture Chusan Island. He also instructed Elliot to accomplish the following objectives:
      • Demand the respect as a British envoy from the Qing Government.
      • Secure the right for British law to be doled out on British subjects
      • Get recompense for destroyed British property, especially the illegal drugs that they destroyed
      • And most important, End the Canton System thus opening up China to free trade for the first time, ever.
Alright this is where we will leave things off for now, on the brink of war with China. Stay tuned!
submitted by Bubzoluck to SAR_Med_Chem [link] [comments]


2023.06.09 04:24 VixinXiviir "One of Your Friends Has to Leave": Mono Black Midrange Meta Report

Howdy Arena goers! Once again it is I, Vixin, the guy who will play Mono Black decks against all reason and probably to his own detriment.

Since the bannings and the new season I've taken a break from ladder. With my finish from last month I definitely feel a lot less pressure to actually climb, so instead I've been grinding Traditional Standard events (hereafter referred to as leagues) in order to build my collection and get my daily games in. I've included some screenshots below, but I've played about 20 leagues and 100 matches with this deck and maintained about a 72% win rate overall. I got a lot of comments on my last post asking for an updated list since the bannings so I figured I'd share. With that in mind, let's get the list and talk about some cards!

A note on leagues: I am well aware of the difference in competitive level between leagues and ladder, especially higher up on ladder. That being said, more often than not I faced meta in the leagues and can definitely speak to meta matchups and play patterns. In addition, I also gained the insight that this deck is very strong against rogue matchups. You have a lot of different interaction and flexibility to be ready for anything, which can definitely translate to ladder performance.

The List:


Creatures (16):
4x Evolved Sleeper
2x Ayara's Oathsworn
4x Tenacious Underdog
3x Sheoldred, the Apocalypse
2x Sheoldred
3x Phyrexian Fleshgorger

Non-Creature Spells (18):
3x Cut Down
2x Go for the Throat
3x Sheoldred's Edict
4x Liliana of the Veil
3x Sorin the Mirthless
1x Invasion of Fiora

Lands (26)
23x Swamp
1x Takenua, Abandoned Mire
2x Mirrex

Sideboard (15):
1x Cut Down
2x Go for the Throat
2x Glistening Deluge
2x Graveyard Trespasser
4x Duress
1x Invasion of Fiora
3x Breach the Multiverse

Interlude: A Farewell to Fallen Brothers


Some of you may notice that there are several cards missing from the list that I talked way, way up in my last post: Jadar, Fell Stinger, and Concealing Curtains. Unfortunately, the context of the format completely changed with the bannings, and these cards are no longer as well-positioned as they previously were. There were a lot of incidental values and synergies between these cards and both Invoke Despair and Reckoner Bankbuster, as well as the fact that they're a lot stronger in a format dominated by slow, grindy Rakdos than in the much more open field we're facing today. It very well may be possible these cards will see play again, but for now, in the current format, they're just not optimal. No one is more disappointed than I.

Deck Overview


The name of the game is efficient threats, value generation, and disruption--and we've got it all. This deck can curve out, it can play the grind game, it can disrupt those pesky combo decks. With the loss of Invoke and Bankbuster this deck definitely leans a little more aggressive, but it's still at its heart a midrange deck. Get a couple of good threats out there, get your planeswalkers ticking up, and outlast everyone on your way to the top. The biggest deal in this deck is managing what you're spending your mana on. You have a lot of sinks in this deck, and making sure you weave in Sleeper activations and get in damage with Underdog when it's the right time to do so is a skill you're going to need to perfect, or else you may find yourself with no cards, too much mana, and you're staring down an Atraxa on field and another in hand.


Individual Card Choices


Evolved Sleeper
I have a love/hate relationship with this card. Every time I play it, I wish it was something else, but every time I go back to the collection and scroll through all of the cards in Standard I have to come to terms with the fact that, while it does everything in a very cumbersome manner, this card does a lot. Early damage, mana sink, value generation, stonewall defender, this card is so darn flexible that it's essentially unreplaceable. This card is a solid 1 drop, 2 drop, 4 drop, and 7 drop, since those are the breakpoints of all the different ways you can spend your mana on it at once. However, if you play it on turn 1, that ALSO means it's a solid 3 and 6 drop. If you count those numbers, that means Evolved Sleeper can fit in essentially anywhere on your curve, and it is very, very difficult to replace that kind of flexibility.
There's something to be said of knowing when to dump mana into sleeper when to just leave it alone like a ticking time bomb. It's hard to explain in text which is the correct move in which situation. Gaining a sense of the right time to evolve your boy is both difficult and necessary.

Tenacious Underdog
Another love/hate relationship for me. Underdog's just a simple, easy guy. He's above rate, he comes back, he draws you cards, he gets in damage, he keeps on punching. Another example of a hyper-flexible threat that is difficult to replace. With the need to be both aggressive and grindy (since you can't predict what you'll face on ladder or in leagues), Underdog just does it slightly better than other options.

Ayara's Oathsworn
This is a flex slot that I wanted to try a new card in, and it's doing alright so far. In many ways, the Menace on this creature is a lot more important than the scaling. Being able to attack around big blockers to either get in damage or hit Planeswalkers (very important!) is a surprisingly big deal. Even then, the scaling is pretty good. This thing can get very big very quickly and makes your opponent have to decide which time bomb of a creature they want to spend their removal on, and we are VERY happy to put our opponents in difficult positions. That being said, this could easily be something else.

Liliana of the Veil
Hoo boy. HOOOOOOOOOOOOOOOOOOOO boy. This card is nuts. This card is fantastic. You wanna talk flexibility? Liliana has your back. Removal with a threat attached, disruption and pressure against control and ramp opponents, Liliana is good in basically every matchup. Playing her in the ramp/control matchup turns the game into a question of "can your opponent afford to get rid of your Liliana?", to which the answer is often "no, not really". Curving Sleeper into Underdog/Ayara into Liliana means your opponent is going to have to look long and hard at their hand and figure out what they value more: their life total, or their ability to play the game. If they remove your creatures with Ossify or Binding, you'll rip their hand apart and blow up their lands. If they get rid of Liliana, you bash their face in. Liliana is such a scary card for your opponent to deal with, even in the hard aggro matchups. If you can have Liliana and another removal spell or two, you'll stonewall their early aggression and start to deprive them of precious resources. An absolute champion of a card, earning her voice line the prized position at the top of this post.

Sorin the Mirthless
This is our flex slot at 4--it's either this or Phyrexian Obliterator. I started seeing way more hard control (Esper / Azorius) later on so I chose Sorin, but either choice is justifiable. In Sorin's favor, he's once again a flexible, value-oriented guy. He can provide blockers, cards, whatever you need to stay in the game against a variety of opponents. By no means is he as strong as Liliana, not by a long shot, but he's good enough to earn a slot when the context of the format is right.

Invasion of Fiora
Sometimes you just gotta blow everything up. Like the 1-of Farewell in a lot of Mono W lists, Fiora provides a panic button available to you, and you have enough dig to be able to find it. Wiping the board comes up a surprising amount--you have few ways of answering a Herd Migration or multiple Wedding Announcements otherwise. And, very occasionally, you get to flip this thing, and Marchesa is pretty good!

Duress
It's a very close toss up between Duress and Pilfer in the side. Duress is better against a wider swath of matchups, but Pilfer is better against specifically the ramp decks (knocking out an Atraxa, Archangel, or Etali is super good). For now Duress is good enough against Ramp and great against everything else, so we run it over Pilfer, but it's very close.

26 Lands
This is the new normal, folks. You NEED to hit your land drops, and given the variety of mana sinks in your deck we're happy to flood. Pump up those sleepers, weave in those underdogs, we're happy to be able to play our cards.

Honorable Mentions:
Gix, Yawgmoth Praetor - Once again, our praetor boy is pretty good but didn't seem to quite be doing enough the times I played him. If he went off, it was usually because we were already winning, and he doesn't do enough from behind.

Phyrexian Obliterator - This guy is a WALL, so if you're seeing more aggro in your format (Soldiers, Legends, ESPECIALLY Mono Red), slot this guy in instead of Sorin and start sweeping up the silly aggro players.

Breach the Multiverse - No longer a main deck worthy card, Breach now belongs in the sideboard. It's powerful, absolutely, but you can no longer expect to make it to turn 7 against a random opponent. Bring this in against Ramp, planeswalker control, and other midrange matchups.


Matchup Discussion


5 Color Ramp - Even
The new boogeyman of the format, winning your first match or two in a league essentially guarantees you're going to see a bunch of tri-color lands and Atraxa further on. What's the gameplan? Liliana, that's what. Try and present an early clock with a backup Liliana, requiring them to have drawn a lot of removal (meaning they'll have to topdeck their threats) or else you'll rip their hand apart. Side in Breaches (to pretend we're the ramp deck), PilfeDuress, and an extra Invasion over removal and Sorin / MOM Sheoldred.

Esper Legends - Slightly Favored
I haven't seen this deck anywhere near as much as I thought I would, but we seem to have a pretty good time against it. There's been a trend overall away from Thalia which is great for us--curving a Cut Down or Throat into a Liliana on their Raffine turn is pretty strong. Deluge isn't as good out of the side, but with fewer Thalias running around Invasion of Fiora is more viable. Side out Ayara's Oathsworn and Sorin for a bit more removal.

Esper / Azorius Control - Even / Slightly Favored
The control matchup is super skill based, as your prime avenue for victory is identifying the windows between their counterspells to slam a threat. Both Sleeper and Underdog pull double duty as dual value generators/threats so they can get you a lot of resources over the course of the game--don't be afraid to just Underdog, hit for three, and pass! Your planeswalkers are great in this matchup, especially Liliana, just make sure you have a solid chance of landing them on the board before you go to play 'em--if your opponent left up two mana, don't just slam the Liliana into their Make Disappear. Side in some combination of Trespassers, Breaches, and Duress / Pilfer over removal, MOM Sheoldred (though try to keep some planeswalker sacrifice around), and Ayara's Oathsworn on the draw.

Azorius Soldiers - Unfavored
Golly I hate this deck. They have an intense ability to flood the board and get around blockers, so you're going to have to rely heavily on your sweepers in the side. Problem is, they can grow bigger than your Deluges SUPER quickly, meaning you have to time it just right. Some of these decks have been slotting in the 3/4 with the spell-cancelling ability that makes soldiers when it attacks, and that thing doesn't die to Deluge OR Cut Down. Tricky matchup, luckily we don't see it that much. Side in sweepers and removal for Sorin and Oathsworn.

Mono White and Orzhov Midrange - Even / Slightly Favored
The only truly dangerous card in this matchup is Wedding Announcement. If you don't have an established clock or a leveled-up Sleeper out before they drop that, they can swarm you pretty quick. The tokens also nullify Liliana's sacrifice ability somewhat, so this is actually the only matchup we tend to side her out in. The upside of all the tokens is MOM Sheoldred almost always snipes their planeswalkers in the backrow, so not playing into their Wandering Emperor turn and responding with a Sheoldred is a solid swing. They only tend to run one Loran so flipping Sheoldred is a solid win-con, and their Planeswalkers are great for Breaching. The Orzhov variant is a bit trickier since they have Breaches too, but it's essentially the same thing. Side in sweepers, Breach, and Duress for Liliana, creature-spot removal, and some Underdogs (exile based removal means this guy doesn't come around often).

Selesnya Enchantments - Even / Slightly Favored
This is another deck that I thought was going to be big and haven't really seen. Enchantments in general is a bit harder to deal with now that Invoke is banned, but we can usually control the board enough to the point of just winning in the value game. The real dangers are Wedding Announcement (again) and Katilda's flying, so try to keep track of if you have a plan for a giant flyer and you should be fine. Side in sweepers and spot removal for Sorin, Oathsworn, and an Underdog or two.


Closing Thoughts

Mono-Black had to adapt and evolve to match the sudden shift in the meta, but it still have a wide variety of efficient, valuable threats to take over a game. The flexibility and consistent mana base coupled with value and disruption is a big draw to the color combination (plus you get to flex on aggro decks with your 4 black symbol monster of an Obliterator). Try it out and let me know what you think. Hopefully, later in the month, I'll be speaking to you from high mythic again!



https://preview.redd.it/hqejz8ukuv4b1.png?width=952&format=png&auto=webp&s=7fb4f6a6bac61624d49a4028d5e73f033c92868f
https://preview.redd.it/9ass3ocfuv4b1.png?width=1907&format=png&auto=webp&s=81c79605a9e7474fc266cfcec7b0d085a929e155
submitted by VixinXiviir to MagicArena [link] [comments]


2023.06.09 04:18 FopDoodle04 A Musician's Opportunity for top Chemistry Programs with above average-ish grades

Demographics: Male, half-Chinese half-white, mid public school in New Jersey
Hook: Does being a triplet count?
Intended Major: Chemistry or Materials science
SAT: 1400
GPA: 94% UW/98% W, Top 10% of a class of 300. No class ranks
Course Load:
AP Seminar lol (5), AP Human Geo lol (4)
These are pending but my guesses: AP Chem (5), APUSH (4), AP Physics 1, (4), AP Research (5)
Planning to take AP lit, AP Physics 2, AP Calc BC and auditing orgo course at community college
Awards: Honors wind ensemble saxophonist at local state college and CJMEA and biliteracy seal for Spanish (idk if these count)
ECs:
Drum Major for 2 years of state champion marching band
Jazz Ensemble for 4 years. Received a gold rating after our school not competing for >20 years
Co-leader of school's jazz combo
Marimba player for indoor percussion
Varsity sabre fencing for 2 years
Rubik's Cube competition organizer for two competitions with 400 people (it's pretty big in the cubing community), a New Year's competition in Chicago and 3 Brooklyn competitions
Staff at CubingUSA Nationals and Continental Championship starting 2019
World Cube Association Competitor for 8 years with over 100 competitions competed in
Peer leader at high school (adjust the freshman to the high school environment since the high school is regional but the primary schools aren't)
Character Education committee (Selective school organization to promote school spirit and involvement)
Environmental Club for 4 years
NHS recording secretary
Unorganized ECs
Rock climbing
Essays/LOR:
I think my essays can turn out to be a solid 7-8/10
LORs will probably average out to be a 9/10
ED: UChicago
EA: Georgia Tech, Emory, NYU (legacy), Rutgers, CMU, Purdue, Pitt
Please give me some advice for applying to schools. I literally have no idea of what I'm doing. My college research has consisted of scrolling through top chemistry programs on Niche and seeing if the school is in an urban location or not.



submitted by FopDoodle04 to chanceme [link] [comments]


2023.06.09 04:03 _Dahak_ Appendix carry test - Alien Gear Shapeshift

Will this be a fair proof of concept for appendix IWB carry? I just started a few day test of appendix carry (can appendix be comfortable for me when slouching multiple hours sitting at a desk and/or driving? We'll see).
The Alien Gear won't be the final answer if I end up liking appendix, I'll probably get a JM Customs George (LH so I have some manufacturer limitations). However I am looking to give appendix a fair test with the setups I have on hand. My choices are the Alien Gear or the do it all badly Academy MFT cheapo holster. (Tip for newer to carry folks: with holsters cheap does not equal value).
Any appendix carry tips for someone who has been 9 o'clock split between inside and outside for 4 years? I already figured out rolling my belt buckle off center toward the support side.
Thanks!
submitted by _Dahak_ to P365 [link] [comments]


2023.06.09 03:48 agirl1313 Another reason to be OAD

Went to the playground today with some mom's with multiple (3 each). I was able to sit and enjoy the one mom's newborn while the other two frequently had to stop talking and answer children's cries. My only is an extremely independent 4yo and only needed my intervention once while we were there. We are all happy and respect each other's choices for having one or multiple, but I enjoyed not having to answer the cries of multiple kids.
submitted by agirl1313 to happilyOAD [link] [comments]


2023.06.09 03:20 mf_tepis [Mod-Post] Round One Applications

Welcome to NinePennyKings!
ROUND ONE WILL BE OPEN FOR 72 HOURS
Round 1 Applications
The following claims will be open for application in this round:

ROUND 1 APPLICATIONS FOR MONARCH AND LORD PARAMOUNTS ARE HERE
You may apply to as many of these round one claims as you want, but please send in a new form for each individual claim application.
There are a series of questions to answer in the application form linked above.
After applying, please send in a modmail confirming which claims you have applied for. If you do not send confirmation via modmail, your application will not be considered. If you apply to multiple claims during this round, please rank your choices in your modmail confirmation.
submitted by mf_tepis to NinePennyKings [link] [comments]


2023.06.09 03:03 Rare_Series_9721 I’m thankful to Persona 3

So I never really feel the urge to post on any subreddit, but my love for my favorite video game ever supersedes all my transgressions in regards to posting - so here we are. I have a college roommate to thank for getting me into Persona in the first place, 5 being my first experience with the series; I was impressed with the visuals and attitude the game presented itself with. I was never an RPG guy, I despised them with a passion. Persona was the first RPG to catch my attention and now RPGs are really all I play anymore. My roommate, however, was plying two Persona games at once - 3 and 5. He was fighting Nyx and I am not sensitive to spoilers at all so I didn’t mind watching him fail at the final boss countless times for several nights in a row, I was having fun. Eventually he finished it and I began watching a Persona 5 playthrough on YouTube which I finished in around four days. From there I wanted to go back and learn more about the series, and how 3 rejuvenated the series as a whole. I loved the edginess of the game and how you let go of the fear of death to summon a persona. I convinced my roommate to help me emulate the game as I was a broke college student at the time. I began playing and loved it immediately, particularly because of the characters and how they are just average school students. Hot take incoming - my favorite character still to this day, and one of my favorites in any fiction I’ve come across - Yukari Takeba kept me interested in the game. It sounds silly of course, some random school girl in a Japanese RPG is one of my favorite characters of all time in anything - but it’s true. I never found her to be annoying or bitchy, but one of the most realistically written characters. My two favorite scenes are the beach scene and the one in The Answer where she confesses her promise to Makoto as he lie dead. It hit me and I’ve never responded to a message like this before. I was a wreck for three days but it was a happy feeling if that makes sense. I finished Persona 3 in 2019 and would always follow news concerning a remake..which leads us to now. While the initial trailer got me hyped as hell and I began crying, some things stuck out to me (like the battle UI being downgraded, some sprites looking weird, no overhead camera, and pause menu looking like a reskinned P5.) I hope there’s enough to distinguish itself from 5, but I’m extremely happy nonetheless. Finally, I want to mention how this game saved my life. Multiple times on surveys I’d write an essay to Atlus about P3 and it’s meaning to me, its messages of death and how a depressed college student like me needed to see it. I changed my outlook on life after finishing this game, it was perfect for me. This game affected me in a way that no other game has - it made me cry. This is why Persona 3 is my favorite game of all time. P.S. Yukari looks amazing in Reload, I can’t ask for more :)
submitted by Rare_Series_9721 to PERSoNA [link] [comments]


2023.06.09 02:43 Fraaday Working in an Emergency Operations Centre

I mentioned offering to do a post about working in an ops centre, and I shall indeed, therefore, do such a post.
I don't intend here to go over all the operations of the UK's resilience and emergency infrastructure. You can look all that up. This post is more about what it's like as a civil servant to actually work on these issues.
In brief, however, in 2007 several incidents (Bovine TB notably and lots of piles of burning cows) made Gov realise the Cold War emergency management infrastructure was a bit rubbish. This brought in the Civil Contingencies Act, which dictates modern emergency management and planning stuff. There's a load of things around this, for example reporting through METHANE, following the JESIP principles, adhering to the UK's Concept of Operations, running emergencies through Local Resilience Forums, and so on. Again, not getting into that here.
Nowadays, the UK plans for and anticipates various emergencies, conducting exercises to test procedures, and then responding to the emergency through Operations/ Emergency Management Centres. There's about 20 different types of emergencies that we plan for, and some we don't really bother with.
After all, it's not like pandemic influenza ever hurt anyone, is it? No need to plan for such a thing.
Different departments have different responsibilities. For example, DESNZ has space weather, DLUHC has earthquakes, Home Office have terrorism. Some departments don't have anything because they don't do emergency stuff, but any department that does (there's a list) will have an operations centre and a resilience team. If it's a really big thing Cabinet Office takes over to coordinate in the Cabinet Office Briefing Rooms (COBR).
Some of the function of these teams is to speak with partner agencies, local groups, and other government departments to establish plans for emergencies. Under certain principles, emergencies are to be dealt with at the lowest level. For example, a local agency such as the police would be able to handle something like a small riot or outbreak of crime. However, if this disruption escalated, it may prevent the local police doing other jobs, like controlling a traffic incident on a motorway. At this point the police may declare a Major Incident, requesting assistance through the Local Resilience Forum, and maybe some firefighters would turn up to help or something. If this disruption got worse, the relevant agency would call for help from the relevant department (eg Home Office in this example). If this got even worse, Cabinet Office would step in to coordinate multiple departments and their operations. As such, you can see how there's several levels of response to incidents, and how there's a few different areas where civil servants would work in operations centres.
Occasionally exercises are undertaken to test these arrangements and train staff. Sometimes these identify important areas of improvement, other times such areas are ignored.
In 'peacetime', if you worked in an emergency team, you might travel about to different places, like regional police headquarters or hospitals, to talk to them about Government guidance, and see if partners had questions. For example you might go up and go through an LRF's cyber incident planning, make sure they were content with what they had to do, ask a few probing questions and so on. You might then put this info into a tracker to assess where you could join up different groups and get them working together to better share resources. Alternatively, you might write a case study on an emergency incident and publicise it to provide learnings for various organisations.
Sometimes you might be on a rota to receive emergency calls. This means you'd have a special number people phone when something's exploded. I got 1 call on such a number once, where a local council phoned me to tell me that everything was fine there and they weren't planning to do anything. This is an emergency number, you're not meant to phone it for that reason.
You will also train to fill various roles in an Emergency Operations/Management Centre (the name differs). This means that when something important happens and the department has to assemble the Centre, you'll be able to slot into whatever role you've been assigned.
In 'wartime' however, everything changes. Things are suddenly exploding and people are dying or falling off tall things. The situation is suboptimal all around, there are stranded Mongolian circus artists all over the place, and everything's a bit of a mess. Someone's been given out-of-date hedgehog food instead of ambient cupboard stuff and now they're sad.
These are all things I dealt with btw.
In the EMC you'll be assigned one of various roles:
Government Liaison Officer: You go along to meetings at local level and represent the government. You'd better know what you're doing and have the latest lines, otherwise they'll complain that you're 'patchy, junior and ineffectual' and sent a formal complaint into your Director. You'll also have to take notes very carefully as it will be important in future inquiries regarding the emergency incident, and it's important to know what central government knew at what time regarding various matters.
Liaison Officer: Get your stuff you're going down the road to camp out in another department. You're the liaison officer between your home department and your new campsite. You're responsible for triaging requests, finding answers in complex policy, and getting an idea of how things work over there.
Policy Officer: You have a pretty nebulous job. You basically are getting information from people about certain issues. During emergencies lots of questions come in from lots of people, whether local government or OGDs, and your job is to answer them and form a relationship with the relevant policy team. You're an expert in emergency management, not space weather for example.
Briefing Officer: You do briefings. To be honest pretty much the same as any other briefing role, except sometimes a lot faster. I did a COBR briefing in 20 mins once.
Situation Officer: You have to manage the situation intelligence of the EMC, you prepare reports and summarise data from local level, you manage meetings to bring together intel from the local level and pass it onto briefing officers or the policy cell.
Logistics Officer: You manage the Battle Rhythm, the cadence of meetings, briefing due dates, and set up relevant teams meetings to keep the EMC running. One department I worked in also had their Logs Cell sort lunch for everyone, so that's nice.
Information Officer: You manage and allocate tickets, emails, inboxes, and the general flow of information around the EMC. You might get 1000 emails an hour, your IT might fall over and collapse. You also hold the specialist information, like maps of terminals for oil which you might need to provide someone who was working on that sort of issue. Sometimes Logs and Info cell are combined.
Ops Management: You manage either cells, for example as a Situation Cell Manger, or you manage the whole Operations centre. Some departments will group cells in particular ways, but basically, you have different levels, from Bronze, like a G7 Briefings Manager, to Silver, a G6 Logistics Manager who manages the Logs and Info cells, to a Gold, who might be a DD Response Director.
Grades in this are extremely flexible, I acted about 2 grades up from where I was once, and in emergency management, you do have to have that flexibility. I've worked in a couple of departments doing this stuff, so it really depends on the structures they put in place too.
Speaking of flexibility, you might be so busy you might be put on a 4 day week. Comparably, you might have to work late at night, get up at 3am to take a call, or work during the weekends. Any overtime is worked out through payments or flexi, and (hopefully) wellbeing is considered during these periods.
You will have to be resilient and calm. You will have to be flexible and adaptable. You will ideally anticipate issues and communicate effectively, and you'll need to be capable of both close team working and independent action.
You will find emergency management to be extremely developing, but potentially extremely stressful. I worked on half a dozen emergencies, including Covid, the Afghan Withdrawal, a couple of big cyber attacks and some floods, and I did indeed get quite burnt out a couple of times. It is a personal choice about whether to go work in resilience. It's a very rewarding career I think, you bring order to chaos, you solve problems and go some way in coordinating terrible events. However, I personally am not sure I'd go back to it. Especially not in the department/team I was in, which had a Bullying/Harassment rate of 25% for 3 years because they consistently failed to manage wellbeing. I've heard some teams call a rate of 15% 'high', to which I say 'lol, get good, scrub'. I suppose to contrast that though there are some amusing incidents which are just very very silly, like 'woops we didn't secure out laptops so we've lost all the vulnerable children on the child sexual exploitation database'.
In terms of career path, you potentially have a lot of stuff though. You can become an expert in a particular field, for example you can be the Space Weather Guy. You could also just go further and further up in response management, which would provide you with a very valuable skill in certain parts of the private sector.
I do however certainly support people getting training and getting involved in exercises as part of the broader cadre of trained personnel. Most departments will have some sort of system for this, so have a look and you can see.
Questions welcome. Will either add to this or answer in the comments.
submitted by Fraaday to TheCivilService [link] [comments]


2023.06.09 02:05 Dopamorous Step 2 Level 2

Let’s break it down real quick
Step - Excruciatingly long passages, but overall relatively fair. I actually enjoyed the HPI questions. Overall, it did not feel nearly as bad as step 1, however I took it last year. I don’t know how some of y’all are doing them so close together.
Level 2 - Shorter passages, a decent amount of straightforward questions, multiple vague answer choices based off little info, and a lot of randomness like law, ethics, and random pharmacology; minimal OMM. If you told me the people over at NBOME were making up words, I’d believe it. The break schedule still sucked, but overall not as mentally draining as Step.
Now for some common questions seen on here. - Was it like NBME __ ? Yes, depending on your understanding of the concepts, it is just as hard or as easy. No one’s subjective opinion will help but boost an ego or two - Any last minute HY topics? Lol shit, for how often our savior Divine Intervention says “high yield,” I’d say everything is
Best of luck everyone!
submitted by Dopamorous to Step2 [link] [comments]


2023.06.09 02:00 AutoModerator Questions Megathread – June 09, 2023

Post your game questions below for the community to try help out and answer.
If your question is more complex and warrants a significant constructive discussion, such as you contributing deeper insights and opinions into the combat potential and potential strategies of an Esper, consider posting a dedicated thread with the Discussion flair instead.

FAQ

The official Discord community has a collection of information that is kept up to date by their Helper team within their #faq-resources channel. This includes:
Esper-Related:
Game Mechanics:
Purchases and Acquisition Guides:
Boss/Content Guides:

Resources

Brahmsogama's Dislyte Bible [Google Sheets]
Exceptional in-dept beginner guide to help understand game mechanics, basic strategies and guide your progression.
Dislyte Tier List & Guide [Google Sheets]
Regularly updated community-maintained, this sheet contains an Esper Tier List (standard & role based), info on espers, team comps and relic suggestions.
Bounty List [Google Sheets]
Find the highest quantity of a bounty target that requires the least amount of Stamina to complete. It provides a list of all enemies in every Story Chapter, Ritual Miracle, and Sonic Miracle and their quantity.
Dislyte Cube Rune Tier List [Google Sheets]
Rates Cube Miracle runes according to the synergies they can have with espers and other runes, their usability, and their upgrade potential.
Pack Value Comparison [Google Sheets]
Calculates the value of packs that you can purchase within the Plaza — and other areas of the game — to help you decide on what purchases are the best value for you.
Esper Fusion Cost Calculator [Google Sheets]
Calculates how much materials are needed for Esper Fusion, including calculations for multiple fusions.
Team Composition Suggestions [Google Sheets]
A collection of teams for player reference that's been able to beat a specific stage or game mode.
Temporal Tower Listings [Google Sheets]
Details of the floors in Temporal Tower such as enemies , floor effects and prizes, along with some general tips for tackling the tower.

Tools

Dislyte Helper
Converts your manually inputted team compositions, collections, and personal tier lists into simple images and links to share with others easily.

Other Megathreads

submitted by AutoModerator to Dislyte [link] [comments]


2023.06.09 00:55 joonv2 🔥[FREE TRIAL VOD REVIEW] RANK PROOF IN POST! Professional PG/CLOL Challenger Coach - 3,000+ Students 5 Roles GM+ All Roles/Ranks/Solo Q and Competitive Coaching Low Prices Bundle a Free Session 🔥

🔥[FREE TRIAL VOD REVIEW] RANK PROOF IN POST! Professional PG/CLOL Challenger Coach - 3,000+ Students 5 Roles GM+ All Roles/Ranks/Solo Q and Competitive Coaching Low Prices Bundle a Free Session 🔥
- Hey everyone, my name is Joon and I am a GrandmasteChallenger player on the NA server. I also achieved the Master rank in 100 games on the Korean server. I currently have 5 accounts in 5 roles in MasteGM Elo and I constantly play Solo Q to keep up with meta changes (No Season 3-High Elo-washed up player coaching here 😉). I am also a CLOL collegiate coach for Ryerson University-TMU and verified both on Pro Guides (https://www.proguides.com/coach/joon) and the League Coaching subreddit.
Why Choose Me?
- More than anything I am very proud of the work and progress that I have achieved with all of my students over the course of years of coaching. I would encourage you, my potential new students, to have a look at the student progress page on my server, where many of my students post frequently showing the tremendous progress that they have made since they started coaching with me (https://discord.gg/SUrJuazdBz). My approach to each student is individual and I can quickly identify your strengths and weaknesses. Unlike many other coaches, my goal is not to push you to play my playstyle or my champions but to highlight YOUR strengths in your gameplay and minimize any weaknesses you might have.
Pricing
- Each coaching session takes 1 hour and costs $30 per session.
Do you offer bundles and plans?
- Absolutely, I include a FREE 1-HOUR session for a bundle of 5 sessions. (5 Hours + 1 Free)
Is there a trial session?
- Yes, a trial session lasts around 15 minutes, in which I will review and analyze your OP.GG and watch one of your recent VODs of choice. During the trial session, I will focus on the common fundamental mistakes that you often make as well as point out some windows of opportunities that you tend to miss.
Rank Proof
Unlike many other "High Elo" coaches out there with no proof or accounts dating back to Season 6 or other prehistoric times when the game was completely different, I grind Solo Q on multiple high elo accounts and servers constantly while reaching top GM+ ranks on every lane from top to bot on different servers (NA, EUW, KR) every season. In the last 2 seasons, I have climbed to Grandmaster + in every role. Accounts are posted on my discord for proof with screenshots and have my students added on my accounts as they tend to refer to my games for their own improvement.
Grandmaster
Challenger
Pro Guides Reviews
https://preview.redd.it/y2t042i2jv4b1.png?width=1094&format=png&auto=webp&s=74cd047816a8a465e6793303a938a9559f56f315
Grandmaster
Rank 4 Rumble 64% winrate on champion and 60% winrate overall Grandmaster
https://discord.gg/kB25pSwMEM - My accounts posted on my server
What can I expect from the sessions?
- A Session's format will depend on what you and I both believe would be a better fit for you based on your learning style (practical, theoretical, observing, etc.) and will consist of:
  • VOD Review
  • 1v1 Custom Practice (to apply the theoretical knowledge of mechanics, wave management, trading patterns, recall timers, solo kills etc.)
  • Co-Piloted Live Game
  • Champion-Specific Coaching
  • Duo game with Commentary
  • You can expect Guaranteed Improvement in every aspect of the game such as trading, jungle pathing and ganking routes, wave management, objective control, team fighting, split pushing, increasing your lead, mid and late-game macros, etc.
  • No longer will you run around the map cluelessly after the laning phase is over and question yourself on your next move, you will have ALL YOUR QUESTIONS ANSWERED.
  • Ever wondered how smurfs can 1v9 games in your elo? You will learn how to gain and how to push your advantages like a smurf focusing on resource accumulation and keeping your in-game tempo high and close-out games early as well as how to come back from unwinnable games.
- Your dedication to improving combined with the knowledge I can provide you will result in the growth of Divisions and even Tiers.
❗This is an example of a Full Coaching Session with me: https://www.twitch.tv/videos/1257158400
Recent Achievements:
My recent students climbed from
  • Diamond 2 to Master 190 LP in 2 Sessions (MID) (Updated 300 LP)
  • Master 50 LP to 800 LP Challenger (MID)
  • Diamond 3 to Master 250 LP 3 Sessions (ADC)
  • Diamond 1 to Master 10 LP 1 Session (ADC) (Updated 200 LP)
  • Diamond 3 to Master 100 LP (JG) (Updated 300 LP)
  • Platinum 3 to Master 200 LP (Jungle, Mid, Top)
  • Gold 3 to Master 300 LP (Top Renekton, Fiora)
  • Platinum 3 to Diamond 3 in 3 sessions and 3 weeks (JG)
  • Gold 3 to Diamond 4 in 5 sessions
  • Iron 2 to Gold 3 in 6 sessions (Mid, Jungle)
  • Bronze 4 to Silver 1 in 1 month (ADC)
  • Platinum 4 to Platinum 1 in 3 weeks (Renekton) (Updated Diamond 2)
  • Diamond 2 to Grandmaster 480 LP in 2 sessions! (TOP Riven Updated 600 LP)
  • Platinum 1 to Diamond 1 in 3 weeks (ADC)
  • Silver 2 to Plat 3 in 3 weeks (TOP) (Updated Diamond 1!)
  • Silver 4 to Plat 4 in 1.5 months (MID)
  • Gold 4 to Plat 4 in 3 sessions (MID) (UPDATE - PLAT 2!)
  • Silver 1 to Diamond 4 in 2 months (JG)
  • Diamond 2 to Master in 5 sessions (MID)
  • Platinum 1 to Diamond 2 in 4 sessions (SUPP)
  • Gold 1 to Plat 3 in 1 Session (ADC)
  • Platinum 4 to Diamond 4 (ADC) and many more
Recent Students reaching Grandmaster from Diamond 2 and Diamond 1 from Platinum 3
Master for Top and ADC students (NA and EUW)
All of these achievements and more you can see posted by my students in my Discord Group (https://discord.gg/SUrJuazdBz)
- Imgur links to students' progress (Names Blurred for Privacy): https://imgur.com/gallery/Supm2J1-
Availability
- I am available practically 16-17 hours a day as I am a full-time League of Legends Coach
- Session lasts for 1 hour and the price is $30 per session
- COACHING ON ALL SERVERS AND TIME ZONES
- BUNDLE TAKE 5 SESSIONS + 1 HOUR Session Free
- FIRST SESSION IS FREE (15 mins)
Contact Details
My Discord is Joon#7556
DISCORD SERVER: https://discord.gg/uhvrcH5yYS
Proguides Review Page: https://www.proguides.com/coach/joon
VOUCH POST: https://www.reddit.com/LeagueCoaching/comments/nkx9td/vouch_post_for_joons_coaching
submitted by joonv2 to LeagueCoaching [link] [comments]


2023.06.09 00:25 108113221333123111 Another OCSMP - Model Builder - Fundamental Exam Write-Up

When I was studying for OMG OCSMP MBF certification, I found this post pretty helpful (thanks Rhedogian!), so I thought I'd write up my experience as well because I'm sure there are other systems engineers trying to differentiate themselves in a tough labor market.
I also barely passed with a score of 64 out of 90 (the passing score is 60), but I didn't study as much as I should have, which I think was a mistake in retrospect. Today, the price to take the exam is $350 and it would be extremely frustrating to have to take it twice due to the cost and logistics of having to deal with PearsonVUE as the exam administer.
My overall impression that it was about 1.5x as difficult as the Model User exam even though you are tested on similar concepts. There were a lot of questions specifically designed to trick you and you genuinely have to know the material in order to do well. Maybe that is why the OCSMP certs are generally respected in this field.
These were my immediate thoughts after walking out of the exam room:
It was definitely more difficult than I was expecting, but I'm very relieved it's over. I'm still considering whether or not I want to pursue the Model-Builder Intermediate later this year. Will it translate to a higher earning potential? I'm not sure. But good luck to those who are currently working towards the MBU or MBF certs!
submitted by 108113221333123111 to systems_engineering [link] [comments]


2023.06.09 00:19 Puzzleheaded-Eye2077 Environmental Science/Policy Freshman Advice

I'm an incoming freshman looking to major in Environmental Science/Policy. I have all of my math credits and the bio 1 credit, but still need to take the following prerequisites: CHM1045 General Chemistry I and CHM1045 Lab, GLY 2010C Physical Geology with Lab, and BSC2011 Biological Science II and BSC2011 Lab. I don't enjoy chemistry (although I have prior experience with AP Chemistry), so my first choice would be to go ahead and start with bio 2. Is there a specific/recommended order that I have to take these classes in? Teacher recommendations also greatly appreciated, as I am picking classes soon!
submitted by Puzzleheaded-Eye2077 to fsu [link] [comments]


2023.06.08 23:55 emgiselle When you complete multiple choice tests...

Do you always write your own thoughts/answers in the margins if you felt the choices were unfainot totally accurate/off-base?
I've just realized that growing up all throughout primary and secondary school I always did this. I found some multiple choice questions to be easy to interpret in other ways and felt the need to explain my reasoning. I loved to answer in my own words rather than pick the "best" out of the choices given when I knew there was an even better answer. I feel like this seemed defiant to teachers or they thought I didn't get the point of MC in picking the most accurate answer from the choices given...obviously there are some questions that the answer is plainly one thing such as dates, names of people etc... but I wonder if there is a 'tism reason for why I do this! Anyone relate?
submitted by emgiselle to AutismInWomen [link] [comments]


2023.06.08 23:45 Cultural_Fudge_9030 Episode help!

Walt interviews Sunday Jeff at his home and later asks Bry and Q to guess his choices from multiple choice answers. TIA 🙂
submitted by Cultural_Fudge_9030 to tesdcares [link] [comments]


2023.06.08 23:45 Parqueteam_Hardwood Laminate Flooring: A Comprehensive Guide

Laminate Flooring in Toronto: A Comprehensive Guide

When it comes to flooring options, laminate flooring has become a popular choice for many homeowners in Toronto. This is due to its affordability, durability, and the wide variety of styles available. However, like any other flooring option, it comes with its own set of pros and cons. This blog post aims to provide a comprehensive guide to laminate flooring in Toronto, answering some of the most common questions homeowners have.​

The Cost of Installing Laminate Flooring in Toronto

One of the most common questions homeowners have is about the cost of installing laminate flooring. On average, the cost to install laminate flooring in Toronto ranges from $2 to $8 per square foot, including the cost of materials and labor. This means that for a 1000 square foot area, you can expect to pay between $5,000 and $8,000. However, these costs can vary depending on the quality of the laminate you choose and the complexity of the installation process. For more detailed information about the cost of installing laminate flooring, you can visit our laminate flooring installation page.

Pros and Cons of Laminate Flooring

Like any flooring option, laminate flooring comes with its own set of advantages and disadvantages. On the positive side, laminate flooring is durable, easy to clean, and resistant to stains and scratches. It's also available in a wide variety of styles, allowing you to mimic the look of more expensive flooring options like hardwood at a fraction of the cost. However, there are also some disadvantages to consider. Laminate flooring can be susceptible to water damage, making it a less ideal choice for areas with high moisture levels like bathrooms or basements. It can also be less comfortable to stand on for long periods compared to other flooring options. For a more in-depth comparison of laminate and hardwood flooring, you can check out our blog post on the topic.

Laminate Vs. Hardwood Flooring: Which Is Cheaper?

In terms of upfront costs, laminate flooring is generally cheaper than hardwood. However, it's important to consider the long-term costs as well. Hardwood flooring can last for decades with proper care and can be refinished multiple times, potentially making it a more cost-effective choice in the long run. ​Moreover, while laminate flooring is generally cheaper than hardwood, it's worth noting that hardwood flooring can last for decades and can be refinished multiple times, potentially making it a more cost-effective choice in the long run.

Is It Worth To Install Laminate Flooring?

Whether or not it's worth it to install laminate flooring depends on your specific needs and circumstances. If you're looking for a cost-effective, durable, and stylish flooring option, then laminate flooring can be a great choice. However, if you prefer the feel and longevity of real wood, then you might want to consider hardwood or engineered hardwood flooring instead. You can learn more about engineered hardwood flooring on our engineered hardwood flooring page.

Where Should You Not Install Laminate Flooring?

As mentioned earlier, laminate flooring is not the best choice for areas with high moisture levels, such as bathrooms or basements. This is because laminate can warp or swell when exposed to water for extended periods. If you're considering installing laminate flooring in your kitchen, you might want to read our blog post about installing engineered hardwood flooring in kitchens for some useful insights. Laminate flooring can be a great choice for many homeowners in Toronto due to its affordability, durability, and aesthetic appeal. However, it's important to consider the potential disadvantages as well. For instance, while laminate is highly resistant to scratches, it can be susceptible to water damage if not properly sealed. This is why it's crucial to avoid installing laminate flooring in areas with high moisture levels, such as bathrooms or basements.

Let's Wrap Things Up...

In conclusion, whether laminate flooring is the right choice for you will depend on your specific needs and circumstances. If you're looking for a cost-effective, durable, and stylish flooring option, then laminate flooring can be a great choice. However, if you prefer the feel and longevity of real wood, then you might want to consider hardwood or engineered hardwood flooring instead. For more information about laminate flooring, or to explore other flooring options, feel free to visit our website. Our team of experienced professionals is always here to help you make the best decision for your home.

Frequently Asked Questions About Laminate Floors in Toronto

1. How much does it cost to install laminate flooring in Toronto?
The cost to install laminate flooring can vary depending on several factors, including the quality of the laminate and the complexity of the installation. On average, you can expect to pay between $2,000 and $8,000 for 1000 square feet of laminate flooring, including installation. 2. What are the disadvantages of laminate flooring?
While laminate flooring is durable and easy to maintain, it can be susceptible to water damage if not properly sealed. This makes it less suitable for areas with high moisture levels, such as bathrooms or basements.
3. Is laminate flooring cheaper than hardwood?
Generally speaking, laminate flooring is cheaper than hardwood in terms of upfront costs. However, hardwood flooring can last for decades and can be refinished multiple times, potentially making it a more cost-effective choice in the long run.
4. Is it worth it to install laminate flooring?
If you're looking for a cost-effective, durable, and stylish flooring option, then laminate flooring can be a great choice. However, the decision ultimately depends on your specific needs and circumstances.
5. Where should you not install laminate flooring?
Laminate flooring is not recommended for areas with high moisture levels, such as bathrooms or basements, as it can be susceptible to water damage.
submitted by Parqueteam_Hardwood to Construction [link] [comments]


2023.06.08 23:24 traitor25 CaRMS 2022-2023 Pathway Experience + Advice/Tips from a UK Graduate CSA Perspective

Hey guys! I just wanted to put up my own experience moving through this year’s Canadian Resident Matching Service or CaRMS cycle so that others have a bit more clarity into what to prepare/focus on for future cycles. Here’s a bit of my background in a nutshell below to give some context:
I am currently a 27M Vietnamese-Canadian studying abroad (CSA originally born in Winnipeg, MB but spent the majority of my life in Ottawa, ON) awaiting to start family medicine residency on July 1 in Brandon, Manitoba but started this journey back in 2015.
I originally did 1.5 years of my undergraduate degree in Biochemistry at the University of Ottawa before seriously deciding on medicine as my career path. During my 1st university year, I applied to different medical schools in the UK (I think only Cardiff + Bristol considered me briefly but still turned down in the end) but got rejected from them. I was only invited + accepted to the MBChB programme at the University of Buckingham Medical School which lasted for about 4.5 years starting from January 2015. I had also done 2 electives in Ottawa (one under neurosurgery and the other in orthopaedics) during my final year of medical school prior to graduation in June 2019.
From there, I entered into the Foundation Programme in August 2019 (equivalent of medical internship in the US/Canada), which I did under the West Midlands South Foundation School, with pretty much all my time being in Worcestershire county. I did my FY1 rotations at the Alexandra Hospital, Redditch and my FY2 rotations at the Worcestershire Royal Hospital, Worcester. During this time, I had attempted the MCCQE1 exam twice (failed at 202 in January 2020, passed at 236 in October 2020) and attempted the NAC exam once (failed at 390 in March 2020). Ultimately, I withdrew early before my last FY2 rotation in April 2021 to focus on my 2nd NAC exam attempt, gain some clinical experience/connections on Canadian ground, and sort out other personal issues. I attempted the NAC exam again in October 2021 but failed at 1364. After taking a mixture of time off to mentally recover with family support and studying for the USMLE step I via UWorld as a distraction from November 2021 to April 2022, I took up a few different private NAC courses in the following chronological order from then onward to figure out where I was lacking at up until my third NAC attempt (passed with superior performance at 1452 on September 17, 2022):
  1. BeMo’s OSCE Preparation Platinum (all done virtually over Zoom; first session on April 11, 2022 and last session on August 28, 2022 for a total of 13 sessions).
  2. TutorIMG NAC OSCE Live Online Course (all done virtually over Zoom; first session on July 21, 2022 and last session on August 30, 2022 for a total of 11 sessions over).
  3. Medical Training Express Live Online OSCE Course (all done virtually over Zoom on July 28, 2022 and last session on September 10, 2022 for a total of 12 sessions).
  4. Mark’s MedSckool Reviews (technically took last year in person from August 30 - September 3, 2021 and again virtually over Zoom from August 22 – 26, 2022).
After I received notification of my NAC exam result on November 3, 2022, things were pretty hectic as I was busy entering into this year’s CaRMS cycle preparing different things:
  1. CaRMS documents (e.g. personal CV, personal letters, letters of reference/LOR’s, MSPE/MSPR, post-graduate internship regarding Foundation training, university & high school transcripts).
In total, I applied to about 105 different programs and 76 unique, personal letters to go along with them.
  1. Additional exams (FMProC and CASPer) – wrote my FMProC exam on December 12, 2022 and CASPer exam on December 15, 2022 after registering for them separately.
I primarily used a combination of the PasTest SJT question bank (went with 6 month subscription for £4) and free, online practice SJT’s provided for Foundation Programme Applicants as per the UKFPO website while I signed up for BeMo’s CASPerSIM Gold (3x mock CASPer sessions with feedback from different assessors).
  1. USMLE Step I (wrote on November 29, 2022 but had been revising for it again since my 3rd NAC wrapped up; was originally a backup plan in case I had failed the NAC for a 3rd time as you’re only allowed a maximum of 3 attempts).
  2. F2 Standalone application – the application window was opening on January 16 this year and was preparing evidence of my previous Foundation training + securing my Reapplication to Foundation Training form from my previous Foundation School director.
  3. Volunteer shadowing at local family medicine practice (managed to shadow a GP in Ottawa for both Canadian experience and fortunately an LOR in the end).
  4. Mock interview scenarios – did not have any previous formal/professional interview experience so I practiced with a combination of family members, my previous NAC study partner, and BeMo’s Residency Interview Gold Program (3x mock interview sessions with feedback from different assessors).
I recall having my joint FM ON interview first on February 3 followed by my FM MB interview second on February 13 (both were around midday/noon).
  1. USMLE Step II CK (after passing the USMLE step I around early December, I was intermittently studying for the USMLE Step II CK until Match Day on March 22, 2023).
I have already been in contact with a mix of people from both inside and outside Reddit regarding NAC practice and general info/advice around the CaRMS process. A good starting point about common, high-yield complaints to prepare for can be found on the MCC website under the “Medical Expert” tab. Outside of private NAC courses, I primarily used a mix of Dr. Basil’s notes (for focusing my history-taking approach), Geeky Medics/Macleod’s Clinical Examination (for structuring my physical examinations; focusing it down for NAC’s time limits came through practice), and the USMLE First Aid Step II CS mini-cases (for inspiration of mock NAC scenarios to do). I personally never used much of other mentioned NAC resources so can’t really say too much as to how useful they are:
  1. Edmonton Manual, “Master the NAC” by Dr. Bryce Lowry
  2. “NAC OSCE – A Comprehensive Review” by Canadaprep
  3. “OSCE and Clinical Skills Handbook” by Dr. Katrina F. Hurley
  4. “Canadian IMG’s Guide to OSCE and Practice” by Dr. Hanan Ahmed
The most important thing other than the following tips below would be to find ~1-2 regular, dedicated NAC partners you can study with and exchange honest feedback to each other with (nicely organized NAC partner spreadsheet (https://docs.google.com/spreadsheets/d/10Kk6YJtFKKn9IY3g96cC-rIWBQGyxtMUB9YQkAfND1g/edit#gid=0) with NAC partners made originally by u/MarinatedinPeace). Other specifics (ex. what can I bring?) around the NAC exam can be found on the MCC website but I generally recommend that ~3-4 months of time practicing 1-2x/week then ramping up to every other day (ideally everyday but I understand everyone has different backgrounds and recency of studying/practice) in the last 1-2 months seems to be a good time frame.
During my time giving advice about both, these were the most important points in terms of approaching preparation for the NAC exam that I've encountered:

  1. Make sure you exhaust the presenting complaint(s) as that will ensure your following questions into the systems review (mostly for ruling in/out the 3-5 differentials on your list) + associated risk factors (i.e. PMedHx, PSurgHx, medications, allergies, smoking, alcohol, drugs, social living/financial conditions, occupational history, travel/immigration history) will be focused on what's relevant as not every section of a mnemonic needs to be asked (ex. SOCRATES, OCD PQRST AAA, COCA OCDCS, PM BINDE, MGOS, DIGFAST/MSIGECAPS).
  2. If a patient is acting in pain, acknowledge it and try to address it on the spot if you can by offering pain relief with a follow-up question about allergies to ensure it's safe to give.
  3. Counselling can be difficult as it's not a format many people are used to but you still need to take a focused history regardless so that your management options are personalized/tailored to the person in front of you (ex. do not discuss smoking cessation/NRT as a long term management option for someone you're counselling about asthma for if they told you clearly they are a non-smoker; do discuss changing to hypoallergenic soaps/shampoos if they have an asthma exacerbation triggered by a new shampoo they tried out 3 days ago).
  4. Be wary that you're expected to rule in/out differentials (you should have ~3-5 by the time you enter after knocking) that you have considered outside the door within the time given (ex. don't stop asking other questions about PE, pneumothorax, GERD, or costochondritis even if the case sounds dead on for acute congestive cardiac failure).
  5. Do not try to track the time on the timer in the room because it can be anywhere (the side, top of a wall, behind the SP/examiner) and your focus should be on the SP/examiner anyways.
  6. Make good use of transitioning statements when moving between different sections of your consultation whether it's the history or physical exam (ex. after exhausting the presenting complaint, you could say "There is a list of other symptoms we look for in patients experiencing [insert their presenting complaint/issue if applicable] and I just want you to give me a yes or no answer, OK?" to transition to the systems review).
  7. PLEASE show empathy and kindness when the SP is acting/says something unusual ex. SP appears visibly down in mood, poor eye contact, and slow in speech so acknowledge it, "Mr. Anderson, I see that you appear quite down in yourself. I want to assure you that everything we discuss between us will remain confidential unless required by law." This also applies to situations where the patient's most pressing issue is different from what's on the door (ex. door vignette suggestive of abdominal pain hinting appendicitis but the patient abruptly drops that they're pregnant).
  8. Make good use of the time (about 1.5 minutes) outside the door to write your ~3-5 differentials along with any relevant investigations, management/counselling, and follow-up.
  9. Don't forget to ask about vital signs and any pending lab work/investigations if a station has a physical exam component (ex. highly relevant to ask if vital signs are available and if a FAST USS + routine bloods have been done in a patient you suspect with a dissecting AAA just before you're about to start your physical exam).
  10. The SP cannot lie to you however they can be vague or provide a different answer other than a clear, "No." ex. You ask the SP, "Have you ever smoked any tobacco or cigarettes in the past? and the SP responds, "Well, not recently that I know of, doctor." This is your cue to probe further about what they mean by "not recently".
  11. Some NAC stations can be mean by giving you normal investigations in what seems like a highly suggestive history/physical in an attempt to mislead you ex. You complete your history/physical exam and your working diagnosis in a 3 year old child with 4-day history of fever, SOB, and purulent sputum production is bacterial pneumonia but you're handed a normal CXR (treat based on the clinical evidence gathered/known not on your gut feeling).
Same is true vice-versa where a patient presentation seems benign but then the examiner hands you an alarming investigation ex. 35F in ED has symptoms consistent with likely viral URTI but the examiner hands you an EKG that shows saddle shaped ST elevation in line with acute pericarditis.
  1. Avoid repeating or leading questions as it wastes time, unless it’s to clarify something a patient says that you may not understand, and looks unprofessional (remember the CANMEDS framework expected for CMG's in your clinical approach; these are some ways I practiced phrasing my intro, "How would you like to be addressed today?" or "How would you like me to address you?" or "What name do you usually go by?").
  2. You can place the exam sticky labels you get on the back of your hand prior to entering a station so you don't fumble/experience difficulty handing it to the examiner (?unless the MCC decides you can just verbalize your candidate code for the NAC this year).
  3. Introduce yourself as a doctor not a medical student (you're assuming the role of a family/ED physician or PGY-1 resident on exam day depending on the scenario).
  4. Don't assume a patient's mode of address/pronouns used. Ask them first how they would like to be addressed today.
  5. Make sure to clearly wash your hands AT THE START of BOTH your history-taking AND physical examination.
  6. Even if you feel like you messed up the previous station, try as hard as you can to push it out of your mind until the NAC is over. You can cry, vent, or get frustrated AFTERWARD but not in the stations themselves.

These next points are more towards preparing for upcoming CaRMS cycles from what I've gathered reading/listening around:

  1. High MCCQE1 & NAC scores (most people who were invited for interviews, if not matched, to ON FM from the CaRMS 2024 Discord server and the CaRMS stats spreadsheet set up by Carms#5615 (https://docs.google.com/spreadsheets/d/1HAtnmyfCIAxKIux2akj8-hgWGvPgOVejVlfEHXuUa-8) had QE1 scores > 250-260 and NAC scores well above 1420-1430.
  2. Research into how CaRMS works to really have a careful look at the general overview, current year timelines, program descriptions, past trending data (may need to scroll down page further) in previous cycles. This will give you a good idea into what to have ready in time for the CaRMS file submission opening.
For reference, the rates of matching in R-1 as a current-year IMG was about 72.3% and 30.1% as a previous-year IMG according to the table on slide 11 of the CaRMS 2023 forum presentation. This goes down further in R-2 as a current-year IMG to about 39.0% and 12.5% as a previous-year IMG (about 751 went unmatched after R-1 and 822 went unmatched after R-2 for previous-year IMG’s).
  1. Recent practice or graduation (my last time practicing clinically was in April 2021 as an FY2 doc at the time which was only 2 years back at the time of my application (my year of graduation/YOG was 2019 but I know that time since YOG or gaps in studying/training are scrutinized especially if they're big like >5 years so it'd be worthwhile having an explanation ready if this applies to you).
  2. At least one Canadian LOreferee (seems a lot of university programs prefer applicants who have had clinical exposure in the form of shadowing/electives/observership with a Canadian doctor related to their field that you're applying to; mine happened to be a GP in Ottawa I connected to via family friends).
  3. Personal research around First Nation/Indigenous Peoples of Canada (this one is very specific particularly to Manitoba as they had several questions around ethnic minorities + Indigenous peoples; ex. smudging as a common Indigenous practice that even I only became aware of via the IMG/IEHP resources provided by Ontario Health Force or [[email protected]](mailto:[email protected])).
  4. Canadian research and electives - at the time of application, I was involved in a systematic review around women's health issues (had not been published at time of application) and I had done two electives under neurosurgery + orthopedics (heard that observerships don't count as formal clinical experience relative to electives so this was important too).
  5. High CASPer + FMProC scores (had 4th quartile score for CASPer and 516/4th quartile for FMProC which I know a lot of FM and some psych/pediatric programs look at).
  6. Try to secure as many Canadian LOR's/referees as they're favoured over international ones (ideally 3 but even 1 seems to be good), shadowing Canadian doctors depending on where you're applying to (ex. FM has the biggest seat pool so reach out to Canadian GP's around you to see who's willing to take you on).
  7. If you have the time and money for it, try to apply to as many programs and attend their relevant socials/events (can be found on CANPREPP closer to the opening of CaRMS) that you think you may have a chance at as you'll never know who might invite you later on for interviews!
  8. Really rank by your TRUE preference as CaRMS will prioritize your rank order first BEFORE considering how other programs ranked you (Rural Brandon was my 13th choice out of 22 programs I ranked across FM ON + FM MB). Even if you ranked a program at the bottom of your ROL, as long as that particular program has ranked you and they still have an available spot, you will match to them in the end!
There's a YouTube video regarding the CaRMS Match algorithm which clears things up nicely.
  1. Make sure to check your main email’s spam/junk inbox during the period where interview invitations/rejections are sent out as they can end up here sometimes (my joint FM ON interview invitation ended up in my spam and it is time sensitive to take it up).
In terms of the QE1, I think a lot of other people on Reddit have covered that much better than I have in terms of approaching it as I agree that a combination of UWorld Step II CK question bank (personally found Canada QBank questions and explanations to be lacking relative to UWorld in retrospect even if the price was much friendlier) and the Toronto Notes are the way to go. I also used Sketchy videos as a nice support for pharmacology/microbiology related topics.
Overall, I was glad to have had the opportunity to try for FM ON in the first iteration even if it didn't work out as I understand they only invite the top 300 applicants for interviews and even fewer of those 300 match (only ~80-90 from I heard but could be wrong so feel free to correct me). I understood the possibility my poor QE1 score and 2-year gap from formal clinical training may filter me despite my other scores being good.
I’m sure there are other things in this that I didn’t quite cover or explore (ex. the F2 Standalone process, IELTS/OETS, BC CAP/AIMG requirements, gaining permanent residency/PR, clinical/physician/medical assistant positions, CV/PL structure, thoughts around the different private programs/courses I took etc.) but I’m more than happy to discussing finemiscellaneous points via Reddit, Discord (herrdok#6944), email ([[email protected]](mailto:[email protected])), text, or virtual/phone call. For the time being though, I’m not taking on any new, regular NAC practice partners but would consider it once I figure out things more.
Otherwise, thanks to anyone reading this wall of text (if anything is incorrect/inconsistent, do let me know and I can have a look), looking forward to giving advice where I can, and best of luck to everyone moving through what is an extremely vague, challenging, and unforgiving process for matching into Canadian residency!😊
submitted by traitor25 to MCCQE [link] [comments]


2023.06.08 22:53 MedicineCritical115 2022-23 Kaplan Books. Pasadena local pick-up

FOR SALE. Missed deadline to return them to Kaplan as I was out of the country. Asking $150 to break even (amount that would be refunded to me). Take all. Minimal markings in outlines.

EDIT: The book set includes
  1. Kaplan MBE subjects outline 2022-23
  2. Kaplan California subject outline 2022-23
  3. Kaplan MBE bar points and subject memorization 2022-23
  4. Kaplan California bar points and subject memorization 2022-23
  5. Kaplan Multiple choice questions with answers and explanations 2022-23
Can throw in Mary Basick essay book (non-PT) for free.
submitted by MedicineCritical115 to CABarExam [link] [comments]