Baystate medical center pharmacy residency
2008.07.01 22:41 Pharmacy
A subreddit for pharmacists, pharmacy students, techs, and anyone else in the pharmaceutical industry.
2009.10.18 21:53 davedavedavedavedave Nursing for nurses and by nurses for the care of all.
A place to discuss the topics of concern to the nurses of reddit. All are welcome.
2009.12.11 03:20 creator11 /r/MedicalSchool
Welcome to /MedicalSchool: An international community for medical students.
2023.06.09 06:47 EllyJelly543 Can insurance companies see past medications I was prescribed from prior pharmacies?
submitted by EllyJelly543 to healthcaredata [link] [comments]
2023.06.09 06:47 Rainyfriedtofu Attempt at explaining AI by other healthcare providers
Hello fellow Apes,
I am supposed to be playing D4 with my kids but instead I am writing this post for you. It's ok. I'm having fun because I'm actually into talking about this shit. Anyway, I was inspired to write an explanation regarding other companies used of AI based on u/Sandro316
's reply from this post I made earlier https://www.reddit.com/CLOV/comments/144na72/the_reasons_why_big_names_are_linked_with_this/
. I'm posting it here to we can highlight this topic, and the information doesn't get lost in the comments section.
The purpose of this post is to explain in laymen terms what these companies are doing in AI from the perspective of a healthcare administrator. A little bit about my background. I started out in healthcare research and did my fellowship at NIH. I have 13+ years of experience working at director and c level positions in healthcare and social services. I'm also a big computer geek, and I current have my staff working on an AI system so I can train staff faster and equip them with the skills to help clients/consumers/patients navigate the complex healthcare and social service systems that we have in California. With that said, let get started.
As a side note, I will make another post regarding the patents CLOV has which pertain to how its AI's is and will be functioning in the future.
Humana for example is mainly focused on improving the customer experience and streamlining administrative tasks https://www.forbes.com/sites/neiledwards/2020/03/02/why-doesnt-your-healthcare-insurer-use-ai-like-humana-does/?sh=f6faed5608ea
This article is using a lot of big words to explain to you that they trying to build a system that mimic Kaiser and a automated call bot that will hopefully answer all of your questions. Here is a same quote
" Call Center Experience
Humana members call for many reasons: understanding a claim status, inquiring about benefits eligibility, placing orders for new or re-filled prescriptions or appealing a medical coverage decision.
The answers to these questions are stored in different information systems. The company uses artificial intelligence and intelligent automation to help bridge gaps between systems. The aim is a better call experience. "
This is just a small reduction of the current problem regarding claim processing. They are not giving providers a better tool to process claims faster and more accurately. They are just improving their call bot.
The rest of the stuff that was wrote in the article are just Humana trying to copy Kaiser's current system. IF you have Kaiser and appreciate how fast and seamless they make some process such as drug refill, you should get a rough idea of what Humana's AI is trying to achieve.
"United is a little closer to Clover with their optum subsidiary but it is mainly focused on improving patient outcomes by getting them care faster and with the right physician for their case." https://emerj.com/ai-sector-overviews/artificial-intelligence-at-united-health/
- An AI-enhanced virtual assistant platform to collect patient data and offer customized solutions: UnitedHealth Group’s virtual assistance platform uses conversational AI and enhanced agents that reroute calls to sufficient internal resources, collect and classify patient information, and offer services that bring down costs and improve patient service experiences.
This is exactly what you think it is. They are creating an AI to hopefully understand patients and providers communication better so that they can route them to the appropriate people to process the claim. The reason why United is doing this way go back to the comments I made in my previous posts. They are a very old healthcare company that has a lot of money. However, because their system is so old and deeply rooted in their money making process, it is hard for them to build something like CA which can process treatment, make recommendation, and process the claim--"giving providers more time to treat patients instead of doing paperwork." Want to know what happen when a provider fuck up on their claim? They delay your treatment until the claim is approved by the insurance. This is what United System is trying to reduce with AI.
- Developing a centralized data platform to improve patient outcomes: UnitedHealth Group’s resident tech-focused subsidiary, Optum, develops a platform that uses data analytics, NLP, machine and deep learning models to improve patient outcomes by predicting conditions and decreasing the cost of care.
This second part of their AI is exactly what CA is currently doing. While Optum and United are in development of a system that they still have to figure out how to integrate into their legacy system without causing catastrophic errors--CA is being used and has proven to improve healthcare outcomes and reduce cost (MCR). As a side note, if you think integrating, migrating, or switching to a new system is easy, just take a look at the shit show that is redetermination for Medi-caid that is currently going on. So many people are being dropped from Medi-caid and they don't even know it.
As for the rest of the article and the fancy words they used, it's fucking Kaiser. I'm sorry that I get annoyed, but whenever I read an article that used fancy words to trick laymen people, I get mad. I advocate for the people with 9th grade literacy, and this kind of shit are just describing Kaiser's system which is the current king of primary care if you haven't heard about it. Their system is used at the role model at so many meetings, it's not even funny. They have amazing coordinated care because they are the insurance and provider.
Anyway, next article..
"Oscar is again trying to improve outcomes by routing members to the correct place. Then also improve efficiency." https://www.hioscar.com/deepdive/oscar-strategy
The AI being deploy here is to reduce the amount of fraudulent claims basically medical misuses. I'm actually very knowledgeable about Oscar, and they not investing in AI as much as they should. They are just improving their current system to detect bad claims and speed up the processing time.
In summary, CLOV's current competitors are trying to build AI on top of their current medical billing systems/platforms. Consequently, due to the limitation of those systems/platforms, they are not able to innovate as much as CA. By the end of the day, their system is still heavily reliant on a human being on insurance side to process the claim and another human being on the provider side to file the claim correctly.
This is very different than providing providers with the tools to
1) process claims
2) make recommendation on what claims (treatment) should be used based on the data from previous patients.
The big problem with health insurance companies now a day is they are so out of touch with the amount of time a provider need to invest into their staff to understand each company's process to file claims, reconciliation, out of network referral, and etc so they keep finding ways to make it easier for their staff while introducing a bunch of new rules and procedures that are not helping providers. Providers cannot provide services without authorization. Authorization should not require a fucking manual for every god damn insurance company. Ever wonder why you have to check whether your provider accept your insurance? What you are really checking is whether or not they are vendorized or are on the panel to bill the insurance company. Low payout and complicated procedures for processing claim and vendorization are barriers to care.
The only company that even come close to CLOV is United and they are still in development. CLOV's AI is live with multiple patents. https://www.reddit.com/CLOV/comments/144pi0m/clover_health_54_patents_from_2018_to_2023/
The best analogy I can give here to compare Tesla (pre-big-ass company) to GM during the EV1 era. GM made the first electric car and was much bigger than Tesla. Tesla was testing out it's battery powered roadster. However, Tesla had years to test out building their car, battery, and production line.
While CLOV is working on testing and proving the profitability of its AI, other companies are just in the process of developing them. Some of them aren't working on it at all.
Before I forgot, all of the healthcare company mentioned above are basically trying to reduce their turnaround time for when a claim is submitted for both new and prior authorization.
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to CLOV [link] [comments]
2023.06.09 06:47 PlumpPhoenix Torrhen Hornwood, Lord of the Hornwood
: PlumpPhoenix Discord Name
: plumpphoenix Name and House
: Torrhen Hornwood Age
: 21 Cultural Group
: Northerner (First Men) Religion
: Old Gods Appearance
: Torrhen has short dark brown hair that is at most ear length, and is clean shaven. He is of average height but has a robust build. He is very much a warrior. He is slightly darker than the average Northman, a tan that was obtained over his years as a sellsword in Essos. He has dark gray eyes that are prototypical of a Northman. He dresses simply, wearing furs and leathers with little adornment to them. The only symbol on his clothing is that of his house, that of the bull moose. Even then, the adornment is small in size. Trait
: Strong Skill(s)
: One-Handed Swords (e), Two-Handed Weapons (e), Riding , Vanguard (e), Tactician Talent(s)
: Games (Board/Card), Gardening, Cooking Negative Trait
: N/A Starting Title(s)
: Lord of the Hornwood Starting Location(s)
: White Harbor (changed this on advice of another player) Alternate Characters
Torrhen Hornwood was born the last of four children to Lord Jorah Hornwood and Lady Alys Glover. His elder siblings in order of birth are Beron Hornwood, Alaric Hornwood, and Alarra Hornwood. As the third-born son and the youngest in the family, it was generally expected that he would not inherit into any lands or holdings. In most other families, it would have been likely that Torrhen would have received a lord’s education from a Maester before going off to find his own destiny and life. However, Lord Jorah Hornwood was a man who was a meticulous planner, and assigned every child’s destiny to them shortly after birth. He had dreams of making House Hornwood a house of great repute and renown, and wished each child of his to form a part of a greater whole. Therefore, Beron Hornwood, as the eldest, was specifically trained to be the lord’s heir, to be a master of diplomacy and intrigue, to charm and to impress. Alaric, the lord’s spare, was educated in numbers and administration, so that he would serve as his brother’s steward and principle advisor. Alarra was raised to be the perfect lady, so that she might help to forge a marriage alliance with another noble house. Finally, Torrhen was raised to be a soldier, so that he might server as the master-at-arms and lead his brother’s armies. Although his father had his plans, he could be cruel in crushing his children’s other interests and hobbies.
As such, when it came to skill at arms, although all the sons received some training, it was Torrhen who was deemed the primary focus of the master-at-arms instruction, and worked in a brutal regime, drilling for hours each day every day. He was additionally brought up learning military strategy and tactics, and studying ancient battles from before and after the Conquest. He did learn what would be considered an acceptable education for a noble in numbers and letters from the Maester, but beyond that his father demanded that Torrhen focus on martial skills. This decision did not disappoint Torrhen, as he largely did not really care about nor have any particular talent or gift for numbers and administration.
He was not particularly close with any of his brothers or sister, in part due to an 6 year age gap between the younger two siblings and himself, and also due to a difference in upbringing, as the other three siblings were educated together largely under the care of the Maester, whereas Torrhen was largely educated out in the field. The only member of his family with whom he was close to was his mother, who secretly taught Torrhen how to garden, as such a hobby was considered by Lord Jorah Hornwood to be beneath Torrhen. On his 14th name day, Torrhen was given a fine crafted bastard sword as a gift and has subsequently used that blade in every battle and fight he has been in.
In 195 AC, when Torrhen came of age, Lord Jorah Hornwood announced that Torrhen would depart for Essos at once, where he would take up residency and arms among the Ragged Standard, so that he would further hone his martial skills in genuine live combat. All the necessary arrangements had been made, and Torrhen departed that evening. Whilst overseas fighting in the Disputed Lands, he became familiar with foreign cultures and developed an interest in them. During this time, he became acquainted with various board and card games that were frequently played among sellswords, and was halfway decent at them. He additionally began to learn the basic tenets of cooking, after he grew tired of eating the same gruel that the Ragged Standard called food. This skill came particularly useful during a difficult campaign in the Disputed Lands, where the sellswords of the Ragged Standard were forced to consume rats and insects to survive. However, life was not all perfect in the Hornwood. In 198 AC, Beron Hornwood disappeared without a trace one evening. Servants had opened his chamber door to find the bed neatly made and empty, with no evidence of any struggle. None of the guards had seen him depart and to this day his disappearance remains a mystery. When Lord Jorah sought to recall his second son, Alaric, home from the Free Cities where he was being educated more deeply in numbers, the ship that was carrying Alaric was destroyed in a storm and sank without even seeing White Harbor. In the face of many of his sons dying and his lifelong established plans being torn asunder, Lord Jorah died in a fit of rage.
The news of Lord Jorah and his two elder brother’s deaths only reached Torrhen in 200 AC, when he had returned to Lys after a final campaign in the Disputed Lands. Upon finding out the news, he chartered a ship to White Harbor, where he expects to assume his duties as the Lord of the Hornwood.
Timeline: 179 AC
- Torrhen Hornwood is born the fourth child of Lord Jorah Hornwood and Lady Alys Glover 183 AC
- Torrhen begins learning the basics of gardening from his mother 185 AC
- Torrhen begins his training in arms with the Master-at-Arms of the Hornwood 193 AC
- Torrhen is gifted his bastard sword 195 AC
- Torrhen departs Westeros to join the Ragged Standard and engage in combat in the Disputed Lands 197 AC
- Torrhen distinguishes his skill as a commander and fighter in a difficult campaign while in the Disputed Lands. 200 AC
- After returning from campaign, Torrhen discovers the news about his father and brothers and opts to return to Westeros and the North. 200 AC
- Torrhen arrives in White Harbor. Present Day.
Hornwood Family Tree
NPCs Alarra Hornwood
: (Archetype: Castellan) Alarra is not considered a comely nor homely woman and is tall and strong, taller than Torrhen. She wears her dark brown hair with braids and it flows down to her shoulders. She possesses intelligent dark gray eyes, and has a mind suitable for administration and numbers. She enjoys wearing subtle grays and whites as color in her clothing, and wears slightly more elaborate clothing, such as fine linens and silks. Lady Alys Glover
: (Archetype: Trader) Lady Alys, the mother of Alarra and Torrhen, is still alive. She has black hair that has begun to gray, and has brown eyes that are soft. Despite her age, she still possesses a strength in her posture and eyes. She is a woman of average height and build. She dresses similar to her daughter, but wears more reds and grays in the color of her house. Maester Walder
: (Archetype: Medic) The Maester assigned to serve the Lord of the Hornwood. He is a man of middle age, with a slight receding hairline of gray hair.
submitted by PlumpPhoenix
to ITRPCommunity [link] [comments]
2023.06.09 06:44 ttvomd Brawley Medical Clinic
Are you looking for a medical clinic in Brawley
that you can trust? Look no further than Vo Medical Center. Our team of healthcare professionals is committed to providing you with the best medical care possible. From routine check-ups to specialized treatments, we're here for you every step of the way. Contact us today to schedule an appointment.
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to u/ttvomd [link] [comments]
2023.06.09 06:34 1738firstclass Undergrad -> Med School -> Residency -> Fellowship
To all the med students/residents/fellows/attendings out there, does prestige become more important as move along the process? For example, does prestige of med school matter more for match (more likely to match closer to top of ROL) than prestige of undergrad did for med school admissions? Residency prestige matter more for fellowship match even more than the med school to residency process? Fellowship to job offer? From what I understand it’s hard to quantify but there are trends and the circles get smaller as you progress. Does this differ if we differentiate academics/medical leadership and PP?
submitted by 1738firstclass
to medicalschool [link] [comments]
2023.06.09 06:16 Deep_Ear3799 Wondering if this is an unusual hospital experience
Last July, I started taking Mounjaro for weight loss shortly after it was FDA approved. Even at the lowest dose, I got super sick. In early Sept, I got so sick I was vomiting uncontrollably. I ended up going to the ER at a level 1 trauma center here in Chicago and ended up having to wait forever, unsurprisingly, while writhing in pain. After 8 hours, I was finally given a bed, and the docs tried several different antiemetic meds via IV. I could not keep food or drink down. Eventually they admitted me to the hospital overnigjt for observation. I slept fitfully, kept throwing up for about 10 more hours, and had one final spectacular barf then felt fine. I had CT scans, EKG, the works. (I had chest pain, I think from vomiting so much) before I got discharged, 9 doctors come in to give me a final report out about all the tests they ran and their conclusion that it was probably the Mounjaro. The head of internal medicine at this hospital led the meeting. I was just kind of tickled and a little worried that so many docs and the head of internal medicine at a major urban hospital came in to talk to a patient who was just throwing up a lot. Was I a medical mystery or is this standard practice?
submitted by Deep_Ear3799
to AskDocs [link] [comments]
2023.06.09 06:06 UltravioletDingo Total cost of medical training in the US (as a function of the cost of healthcare)
I'm not a medical student, but I was just discussing the cost of healthcare in the US with a friend, and I was trying to make the point that the ridiculous cost of higher education in the US is another inflation point in the cost of healthcare. I threw out a number: $500k to be trained as a doctor, which I initially thought might be an exaggeration.
But the more I thought about it, the less exaggerated it seemed. The average cost of medical school tuition for 4 years in the US is around $220k, and that's for in-state students. I don't even want to think about the cost for out-of-state and/or private school students. Also, I imagine that you can't really work even part time while in medical school unless you have a job that allows you to study. So you also have to factor in cost of living.
Then there's obviously the undergrad years and the internship and residency years. So that's what, at least 12 years? I know you make some money while an intern and a resident, but it's tiny in relation to the hours, stress and expertise/ education required.
As for undergrad, I imagine that a lot of would-be MDs get academic scholarships and/or can shave time off from the 4 years of undergrad by taking AP classes in high school.
Obviously, the total costs can vary wildly due to the aforementioned variables but the point is, the education/ training is so expensive that physicians in the US have the burden of making that all back. They inherently have to make more money, as opposed to places like the UK where the costs are significantly lower.
I don't think you can discount the cost of higher education/ training when talking about the cost of healthcare in the US, but I've never heard a single person bring it up.
What do you think? Am I way off? Am I overblowing this?
submitted by UltravioletDingo
to medicalschool [link] [comments]
2023.06.09 06:01 Yokhan77 It's not the fighting that strikes you, but the cruelty for the sake of cruelty - The 24-year-old Syrian artist Ahmed Shamsaldin has been residing in the city of Dnipro since 2019, dedicating his time to both volunteering at a medical facility and expressing himself through painting.
2023.06.09 06:00 commander_kawaii What WFH industry should I try to break into?
I'm on mobile, so apologies for any weird formatting.
I had a WFH job for about 9 months in 2021, but quickly burned out on the repetitive call center script. I had to stay at my desk, ready for a phone call to connect at any moment for the whole shift. Every day felt exactly the same and the work wasn't stimulating at all, so it felt like shutting my brain off for 40 hours a week. I have ADHD as well, so an 8 hour shift of this felt like 12 hours. It kicked me into a depressive episode for a while and I struggled to stay at jobs for many months until I found my current job, which I've had for over a year, doing customer service at a casino. The fast pace of the casino work makes time fly and the constantly changing set of tasks before me is great for my ADHD. I can troubleshoot the problem and fix it in under 5 minutes, 20 at most. I don't want to stay there forever because the interpersonal drama with the staff is obnoxious and the job is giving me a lot of knee and back pain from tons and tons of walking. The pay is great for a three day, part time schedule. I make about 50k, mostly tips from customers.
I would love to find a WFH job that is stimulating enough to keep me engaged, while providing that flexibility we all crave from WFH. My real passion is learning permaculture design and turning that into a career down the road, but I need stable income in the meantime that will allow me time to learn and practice permaculture on the side.
I'm working on treatment for my ADHD, possibly including medication soon. I have an English degree (graduated in 2020,) but have only worked customer service jobs. Serving, bartending, call center, and now this casino job. I'd be willing to get some kind of certification, though I struggle with math and tech stuff. I'm pretty creative and relatively good with people. I do not want another call center job after my previous experience. I wouldn't mind being on the phone sometimes, but 100% of the job being phone work is a no-go for me now. Does anyone have suggestions for some industries that would fit my situation? This sub has a lot of useful advice and I'd appreciate anyone's input.
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to WFH [link] [comments]
2023.06.09 05:55 adog1214 🚨 Sublet Opportunity for UT Austin West Campus 2023-2024!
🚨 Sublet Opportunity for 2023-2024! Step into luxury at "The Mark", a brand-new 6x6 construction in West Campus, only a 10-min walk to UT Austin. This unique SMART housing contract is available for a fantastic $1035/mo for the upcoming school year.
Every bedroom features a private bathroom. Enjoy top-tier student living with amenities: a rooftop pool, a state-of-the-art two-story fitness center, cozy study lounges, and a fun game room.
This fresh, never-lived-in space is waiting for its first resident. Sounds like a deal you don't want to miss for next year, right? Interested? DM for more info. #UTAustin #Sublet #TheMarkAustin 🎓💫
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2023.06.09 05:55 pampam3456 [ONLINE COURSE] Michael Singer – Living From a Place of Surrender
| || | LINK DOWNLOAD: https://healingcourse.net/michael-singer-living-from-a-place-of-surrende submitted by pampam3456 to u/pampam3456 [link] [comments]
The teachings in this course are meant to set you firmly on the path of spiritual surrender, in order to liberate your inner energy and live in harmony with the flow of life. Here are some of the profound benefits: Freedom from struggle
Let go of chronic anxiety and stress through the art and practice of personal surrender Clarity and calm
Shift from a noisy mind to a beautiful mind that works for you instead of against you Spontaneous joy
Experience the natural effulgence of well-being that arises when you decide to open your heart and never close it again Harmony in relationship
Transform the way you interact with others by discovering who we are in our most essential nature Energetic renewal
Clear negative emotions and inner blockages to return to your true power Creative inspiration
Open to the wisdom that life itself is waiting to share with you
About Michael A. Singer
Michael A. Singer has been a spiritual teacher for more than four decades and has written two books: the #1 New York Times bestseller The Untethered Soul and the New York Times bestseller The Surrender Experiment. He is also the creator of a leading-edge software package that transformed the medical practice management industry, and founding CEO of a billion-dollar public company whose achievements are archived in the Smithsonian Institution.
While working on his doctorate in economics in 1971, Michael experienced a deep inner awakening and went into seclusion, focusing on yoga and meditation. In 1975, he founded the yoga and meditation center known as Temple of the Universe, where people have come together to practice and study ever since. In addition to his work as a spiritual teacher, Michael has made major contributions in the areas of business, education, health care, and environmental protection. https://preview.redd.it/1ti7e07w0x4b1.png?width=510&format=png&auto=webp&s=0efbb2b11f998bc07fce407837f446dcc27e1177
2023.06.09 05:44 spitfirez28 Chiesel for days
2023.06.09 05:31 Quick_Problem9687 "Minecraft Mastery: Test Your Knowledge with 30 Trivia Questions!"
Sure! Here are 30 questions about Minecraft:
- What is the primary objective of Minecraft?
- What are the different game modes available in Minecraft?
- What is the name of the main character in Minecraft?
- How do you gather resources in the game?
- What is the purpose of crafting tables in Minecraft?
- Name three hostile mobs in Minecraft.
- What is the maximum level of enchantment in Minecraft?
- How do you create a Nether portal?
- What is the purpose of Redstone in Minecraft?
- What is the name of the dimension where the Ender Dragon resides?
- Name three types of biomes in Minecraft.
- How do you tame a wolf in Minecraft?
- What is the rarest ore in the game?
- How do you brew a potion in Minecraft?
- Name three types of trees found in Minecraft.
- What happens when you defeat the Ender Dragon?
- How do you create a map in Minecraft?
- What are the different types of villagers you can encounter?
- How do you create an iron golem in Minecraft?
- What is the name of the boss mob found in ocean monuments?
- Name three decorative blocks in Minecraft.
- How do you create an enchanting table?
- What are the different modes of transportation in Minecraft?
- How do you make a bed in Minecraft?
- What is the purpose of a beacon in Minecraft?
- Name three types of food you can find or create in Minecraft.
- How do you make a cake in Minecraft?
- What is the maximum height limit in the game?
- How do you create a shield in Minecraft?
- Name three different types of armor available in the game.
Feel free to answer as many questions as you like! Certainly! Here are the answers to the 30 Minecraft questions:
- The primary objective of Minecraft is to survive and thrive in an open-world environment by gathering resources, exploring, crafting, and building.
- The different game modes available in Minecraft are Survival, Creative, Adventure, Spectator, and Hardcore.
- The main character in Minecraft is simply known as "Steve" or "Alex," depending on the chosen skin.
- Resources in Minecraft can be gathered by mining blocks, chopping down trees, killing animals, and exploring underground caves.
- Crafting tables in Minecraft are used to craft more advanced items and tools by combining different resources.
- Three hostile mobs in Minecraft are zombies, skeletons, and creepers.
- The maximum level of enchantment in Minecraft is level 30.
- To create a Nether portal, you need obsidian blocks arranged in a rectangular shape of at least 4 blocks tall and 5 blocks wide, then light it with a flint and steel.
- Redstone in Minecraft is a mineral-like material that can transmit power and be used for creating complex redstone contraptions and mechanisms.
- The dimension where the Ender Dragon resides is called "The End."
- Three types of biomes in Minecraft are forest, desert, and ocean.
- To tame a wolf in Minecraft, you can give it bones until it becomes friendly and its collar turns red.
- The rarest ore in the game is the "emerald ore."
- To brew a potion in Minecraft, you need a brewing stand, water bottles, and various ingredients such as Nether wart, blaze powder, and different types of herbs.
- Three types of trees found in Minecraft are oak, spruce, and birch.
- When you defeat the Ender Dragon, you trigger an end cinematic and gain access to the End cities and the ability to collect dragon egg as a trophy.
- To create a map in Minecraft, you need a compass and paper. The compass is placed in the center of the crafting table surrounded by paper.
- The different types of villagers you can encounter include farmers, librarians, blacksmiths, butchers, and clerics, among others.
- To create an iron golem in Minecraft, you need four blocks of iron arranged in a "T" shape and place a pumpkin or jack o' lantern on top as the head.
- The boss mob found in ocean monuments is called the "Elder Guardian."
- Three decorative blocks in Minecraft are paintings, flower pots, and carpets.
- To create an enchanting table, you need obsidian blocks, a book, and diamonds. The setup includes placing the obsidian blocks in a U-shape and the book in the center.
- The different modes of transportation in Minecraft include walking, running, swimming, riding horses or boats, using minecarts, and flying with Elytra.
- To make a bed in Minecraft, you need three blocks of wool and three wooden planks. The wool is arranged in a horizontal line at the top, and the wooden planks are placed below each wool block.
- The purpose of a beacon in Minecraft is to provide a buff to nearby players, granting special abilities such as increased speed, strength, and regeneration.
- Three types of food you can find or create in Minecraft are steak, bread, and pumpkin pie.
- To make a cake in Minecraft, you need three buckets of milk, two sugar, one egg, and three wheat. The ingredients are arranged in a specific pattern on the crafting table.
- The maximum height limit in Minecraft is 256 blocks from bedrock to the sky limit.
- To create a shield in Minecraft,
try this minecraft hacks
submitted by Quick_Problem9687
to TKASYLUM [link] [comments]
2023.06.09 05:13 CompetitiveBass3644 Free meds
So in April I completed my intake and approval for sema with md exam. Two weeks later they sent an email I was removed from the program. So I questioned why, and they told me it was because they didn’t participate with Pennsylvania. Got my $50 deposit dr fee returned and then a few days later had to call for my $279 I paid. Both were refunded, I have the email that states it was cancelled. Everything was fine.
Today I receive a package from fed ex, with a script and syringes from Hallandale Pharmacy. Dated 6-1 for the RX and 6/9 for the attached invoice. I haven’t been billed yet but I’m expecting it to happen here soon, as I can’t imagine they had an error on their end and sent our free medication.
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to semaglutidecompounds [link] [comments]
2023.06.09 05:11 Difficult-Zombie-547 Ran out of meds and dont know what to expect
Long story short i live in a very remote area and my prescriptions need to be flown to me. The pharmacy recently screwed up and forgot to send them on the plane last week, so now I am going to be without my medications for probably 3-5 days starting tomorrow. I am very nervous about what may happen and am wondering if anyone else has ever ran out, forgot them on a trip or quit cold turkey and what your experience was like. Did your psychosis come back right away? Did you have any other symptoms? Im super anxious. I am on 30mg abilify, 200mg lamotrigine and 300xl wellbutrin. Any input helps thanks
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to Psychosis [link] [comments]
2023.06.09 05:06 Brittanyj104 I am afraid to know what is happening at my government funded housing site
The apartment site is not a good place and it houses the mental Ill and drug abusers. However, it’s for treatment. many lies on lies. The apartments themselves are decent looking and they fill them with decent furniture to keep ppl unsuspecting of what goes on. Furniture of stores like Ashley’s furniture and Kloss, but it’s to reel those in. Crazy to say but it s their thing.they treat people nice in their face but their has been at-least 5 deaths in 5 years. Every year someone dies. I am afraid to know the rest but I have to move and I don’t have any strength, but marking up the courage. The streets is a better option and that’s sad. This place is government funded but it’s not used for treatment, they want the people crazy and on medication to control them. The people are not fighting to avoid going back to jail and trying to keep little freedom. Their freedom is going to cheap stores everyday. No money for better places like Walmart or it’s on a budget. A sit down fast food joint is even extra. I could puke. The workers are so miserable they won’t ever show it, they think I’m crazy for asking for things like therapy or for them to do their job. Why should I expect it. They paint a better picture then what it is. Is this what the government want for the people? I was told Its not going to be like a mansion or luxury like am use to. I am not sane to them for wanting more.They play mind games and when one lady start to figure it out she left and later came back to visit and died soon as she crossed the street to leave. Ugh. Why am I not on the streets? I was stalked heavily by a evil guy who wanted me dead and more. People are lied to about my living place and when I ran to the hospital for help they were told by my stalker that I am a brat and need to be on meds and thrown back to the place. I went to three hospitals. I couldn’t get a job due to that bastard.
Not only are the people drugged but they lose their support system to death. Over 5 people lost someone close to them and more. People were stalked after leaving. Lots of witchcraft. Their told they are helping the workers I would say but truth is the workers hate them too. More they cover up but I can not
Their trying to make the place worse and want to start putting their anger off on certain individuals. It’s more uneasy at night now days, more like a weird darkness that you can’t sleep. You start to wish for the day. come to realize the worse hasn’t came. I am not sticking around. Not to mention the witchcraft, stalking, and poverty mind set. It’s so many lies that it’s a better place that people are trying to send a mental retarded man back to live and have no clue what is happening. They let him do his thing but won’t put a hand to truly help him. If his apartment is messy, no cares. If he hasn’t bathed, it’s life. They forced him to get a shot without him understanding what it was or if he truly got it. He is 49 years old and needs help. those who try doing better for themselves the residents /staff resent.But won’t realize that if they did better with their life they would see they are lied to. Staff are they to sit down and get a check
submitted by Brittanyj104
to MentalHealthPH [link] [comments]
2023.06.09 04:53 pollyprissypants89 Pharmacy databases
Do medications prescribed to compounding pharmacies show up in the pharmacy databases? I currently have a prescription for MJ from my primary care doctor and insurance has been covering it. Unfortunately there is a shortage due to people stockpiling medication. If I choose to go through a telehealth provider and a compounding pharmacy to bridge the gap, will that prescription show up in the pharmacy database that my PCP can see?
submitted by pollyprissypants89
to Tirzepatide [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)
| || | submitted by Bubzoluck to SAR_Med_Chem [link] [comments]
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:
- 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.
- 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.
- 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
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.
- 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.
- 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.
- 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.
- 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
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.
- 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.
- 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.
- 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).
- 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).
- 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).
- 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.
- 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
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.
- 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!
2023.06.09 04:27 some_url Rambling
I received an acceptance and am emotionally preparing myself to begin medical school by the end of this summer, and to be honest, I’ve been hemming and hawing about my motivations for pursuing medicine, especially with apprehension towards my perception of American medicine as an industry and workforce, examining labor conditions of residents, work cultures I’ve been exposed to and the worldviews of coworkers, and the state of American healthcare in regards to physician workloads, expectations and salaries, as well as how patients may be treated as a result of how our healthcare system often functions.
I was a neuroscience major for my undergrad, and went to a school with an excellent pain research program. Of the prominent professors I was aware of, I had an immense respect for their emphasis on chronic pain and migraine research, and loved learning how neuroscience can be applied to the ailments of everyday life, from idle pains and phenomena to chronic and acute health conditions.
Following graduation, I took a gap year, and during this gap year I took time to work in the hospital and personal time for introspection. I decided on medicine halfway through my undergrad, I really liked the application of research on the ground, versus physiological, psychological, or pharmacological research. Anyways, I met amazing coworkers and worked with kind people, but I also met some less than kind people, and I feel like i’ve seen challenging circumstances in the industry of healthcare and medicine. I think it’s puzzling to think about how money interacts with healthcare, the economic restraints on staffing, and just kindness in healthcare. I still occasionally have trouble moving on from stressful incidents, I don’t know how to switch gears when someone declines and yet there is still work to be done, the economic conditions of medicine sometimes just feel strange to me.
Talk of resident working conditions sometimes just make me think that the healthcare system doesn’t value the health of their workforce whatsoever. Not enough space to allow residents to remain healthy, and not enough time for some of these appointments to properly provide care for patients. And there are sometimes moments where patients neglect their health anyways. Sometimes there are moments where families value the quantity of life over its quality for those with terminal illness.
During this time off, I guess i’ve been thinking a lot about my cynicism. Medicine isn’t going to stop death, heck even if I am able to care well for my patients, there will be a day that everyone declines and passes and returns to the earth, and I am not able to make that transition happen for everyone without unfulfilled desires and regrets. I didn’t even know how to respond to someone once when they asked if they will be able to recover from their son dying, or when someone else questioned whether they could recover from the trauma of someone jumping off a bridge in front of their truck. I guess I’ve just had questions at times about the nature of my role in medicine, and the place of a physician.
Anyway, this is the answer that I have right now: I want to practice medicine to provide windows for myself and others to appreciate the value of human life, and have the time to find fulfillment and satisfaction in existence. I want to learn skills to work in the profession and use the profession as a means of my own appreciation of the beauty of life in the face of its ceaseless facets and circumstances. I want to earn a reasonable about of money where I need not think about money, and be able to understand what is important in my own life to help provide guidance if someone needs it. I don’t want to be in a position where I advise someone to prepare for death or debility if I myself could not prepare for those circumstances. I wish to expand the window to experience good life for others when I can. I don’t want to preach, but I want to be able to know the info or resources when asked. I want to be empowered to practice through an appreciation of biology, but also proper reverence of human life and appreciation of the phenomenological experience we are thrust into, and that I am able to maintain that appreciation throughout future education and practice.
Emotionally, this year has been a wild ride, I don’t feel quite prepared for everything yet, it’s gonna be even wilder when things start. I’m looking forward to seeing how life changes moving forward. Anyways, i’m not sure if this will fall into the void, but I hope this isn’t a poorly placed post, and if you were listening, I appreciate your time and would love to hear other’s thoughts, motivations, doubts and hopes as y’all also move through medicine. Even if my journey has begun I certainly feel light on wisdom for certain hahaha.
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2023.06.09 04:14 Awkward-Patience7860 No. I will NOT Break the Law Just Because You're Stupid
Just a little rant here:
I work in an optometrist office. There is this dumbass patient that keeps coming in, after over half a year, to say they want us to just, sell them contacts that we did not fit her into... Over half a year ago. It's closer to their next exam then it is to when they were actually fit into the contacts and "they can't see out of them"... Sounds like you need to be seen again to me.
I, legally, cannot sell her the contacts they wans because they do not have a valid prescription for them. It would be like going to a pharmacy and demanding they give you a new kind of medication that "you've had before" but you do not have prescribed by your doctor.
But no, they're going to swear at me and rant and rave because "I'm on my last pair of contacts" and "I can't see out of the trials that you guys have me."
Maybe you should have tried the new contacts within your trialing period and figured it out before coming and bitching to me about it. I can set up a new contact lens fit for you to see the doctor, you can buy the contacts we prescribed to you, or you can wear glasses. Those are your options.
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2023.06.09 04:11 tylogotya Esco a dickhead🤦🏾♂️😂
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This nigga was hopping pharmacy counters wit stun guns for drink and jammers 😂😂 this Nigga gon throw a bag with pill bottles, gloves & mask inna water and a nigga saw him throw the bag wit pills and the gloves he used to bag the stores wit and told the feds , dumbass nigga left all his DNA inna open🤦🏾♂️ submitted by tylogotya to TheCapitalLink [link] [comments]
2023.06.09 04:11 moshpitrocker RISEUP Program Launches to Help Temporarily Repair Metal Roofs
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Joint Information Center - JIC Recovery Release No. 41 June 9, 2023, 11:50 a.m. (ChST) JRR0609#41
RISEUP Program Launches to Help Temporarily Repair Metal Roofs
The U.S. Department of Defense, U.S. Army Corps of Engineers, in coordination with the Office of the Governor, Guam Homeland Security/Office of Civil Defense, the Federal Emergency Management Agency (FEMA) and the Mayor’s Council of Guam, have launched the Roofing Installation Support Emergency Utilization Program (RISEUP) to help temporarily repair metal roofs damaged by Typhoon Mawar. Guam residents who have damaged metal roofs can enroll for the program through their Mayor’s office. There are three steps to sign up: 1. Guam resident contacts their Mayor’s office to apply. 2. Resident’s roof damage is assessed for eligibility. 3. If eligible, a temporary metal roof is installed.
The timeline for how fast temporary roofs can be installed will be largely based on the number of requests and size of the area impacted.
Guam residents do not need to register with FEMA to qualify for this program and participation will not affect other forms of federal disaster assistance, such as those provided by FEMA. Emergency roof repair assistance is limited to pre-disaster owner-occupied residences. Repairs to commercial properties, including rental units are ineligible.
Additional Eligibility Criteria: Dwellings must have disaster-caused roof damage that impacts habitability. Dwellings must be otherwise structurally sound. Only dwellings that can be safely occupied after the roof repairs have been completed are eligible. Dwellings that are affected by disaster-caused utility outages are not disqualified based on utility outages alone. Approximately 50% of roof substructure (rafters/trusses) must remain, as determined by USACE. The damaged roof must cover indoor living space completely enclosed by walls. Living space includes facilities for cooking, eating, sleeping and sanitation. Outdoor kitchens with a damaged roof covering will qualify to the extent that it covers the dwelling’s only means of cooking and storing food. Garages, carports, porches, etc. do not qualify. Repairs will only be performed on dwellings with pre-disaster metal roofs. Roofs composed of materials such as concrete, slate, asbestos or clay tile, or other material are not covered under this program. Homes unable to be assessed are not eligible. Accessibility is the responsibility of the resident and GovGuam. To get started visit your Mayor’s office: AGANA HEIGHTS Paul M. McDonald, Mayor [email protected]
ASAN-MAINA Frankie A. Salas, Mayor [email protected]
BARRIGADA June U. Blas, Mayor [email protected]
CHALAN PAGO-ORDOT Jessy C. Gogue, Mayor [email protected]
DEDEDO Melissa B. Savares, Mayor [email protected]
HÅGAT Kevin J. T. Susuico, Mayor [email protected]
HAGÅTÑA John A. Cruz, Mayor [email protected]
HUMÅTAK Johnny A. Quinata, Mayor [email protected]
INALÅHAN Anthony P. Chargualaf, Mayor [email protected]
MALESSO’ Ernest T. Chargualaf, Mayor [email protected]
MANGILAO Allan R.G. Ungacta, Mayor [email protected]
MONGMONG-TOTO-MAITE Rudy A. Paco, Mayor [email protected]
PITI Jesse L.G. Alig, Mayor [email protected]
SANTA RITA-SUMAI Dale E. Alvarez, Mayor [email protected]
SINAJANA Robert RDC Hofmann, Mayor [email protected]
TALO’FO’FO Vicente S. Taitague, Mayor [email protected]
TAMUNING Louise C. Rivera, Mayor [email protected]
YIGO Anthony P. Sanchez, Mayor [email protected]
YONA Bill A. Quenga, Mayor [email protected]
Visit the following links for the latest information: Governor’s Facebook: https://www.facebook.com/govlouguam
GHS/OCD Website: https://ghs.guam.gov/
GHS/OCD Facebook: https://www.facebook.com/GHSOCD/
For more information, contact the Joint Information Center at (671) 478-0208/09/10.