Allnationchurch dr frank atlanta

It's Always Sunny In Philadelphia

2010.08.24 06:23 hero0fwar It's Always Sunny In Philadelphia

A sub-reddit for the fans and critics of the show It's Always Sunny In Philadelphia. Discussion of the show, pictures from the show and anything else.
[link]


2023.06.05 07:36 scarlet2248 Wedding Venue in The US: Our Recommendation Part II

Popular wedding venues in the western and central states were featured in Part 1 of US wedding venues. So in part two, we'll focus on wedding venues in the eastern states. Whether it's a luxurious hotel, a rustic barn, or a spacious meadow, all are included. Again, the features of these venues and the approximate prices will be written. Let's explore these beautiful wedding venues!

Wisconsin Wedding Venues

The Paine Art Center and Gardens

This is an art museum located at 1410 Algoma Blvd, Oshkosh. It is an English-style country estate and has nearly four acres of gardens. It has perennial plants and is a great outdoor ceremony venue. Also, there is a historic mansion, charming carriage house, and greenhouse. The venue can accommodate up to 200 people and costs approximately $3000 to $4000 For 100 Guests.

The Lageret

This is a professional event venue located at 515 E Main St, Stoughton. This historic venue offers industrial and rustic charm with exposed brick walls, high ceilings, and wood beams. It has ample space for ceremonies and receptions. The venue offers event coordination, customizable lighting options, a bridal suite, and access to preferred vendors. Accommodations for up to 250 people start at $3,500 for a 12-hour rental.

The Enchanted Barn

Located at 1543 6 1/2 Ave, Hillsdale, this barn has an old-world rustic atmosphere around every corner. Featuring several indoor and outdoor venues, one of the most popular ceremony locations is located in Barn's upper-level Hayloft, featuring old wood timbers. Several wedding package options are available here and can accommodate up to 220 people. Off-season all-inclusive wedding packages are $5,000 plus $21 per person.

Illinois Wedding Venues

Danada House

This is a historic mansion located at 3S501 Naperville Rd, Wheaton. a short drive from Chicago. The mansion is also surrounded by a forest preserve that allows for nature-filled photos. There are seven ceremony locations in total, and the largest Magnolia Garden can accommodate up to 300 guests. Venue rentals start at $3,500.

The Morton Arboretum

This is a public nature garden and outdoor museum located at 4100 IL-53, Lisle. Inside there are not only mature trees and flowers but also a playground for children. Offering beautiful woodland and lakeside views. The large garden has a total of 12 venues to choose from and the largest room can accommodate up to 300 guests. Prices range from $600 to $9,000 depending on the size of the room and the time of year it is held.

Salvage One

Located at 1840 W Hubbard St, Chicago, this is a very unique location that serves as a store besides being a wedding venue. It preserves treasured furniture from the past. This old Chicago warehouse offers an enchanting vintage atmosphere. The ceremony and banquet space can accommodate about 200 people and space rentals start at $4,000.

Kentucky Wedding Venues

The Barn at Cedar Grove

The address is 1000 Brockman Keltner Rd, Greensburg, which has a rustic barn setting with picturesque scenery. Offering outdoor ceremony space, climate-controlled reception space, bridal suite, groom's quarters, and fire pit. The venue in the barn can accommodate up to 230 people. For fewer guests, the average budget for a wedding here is between $6,000 and $9,000.

The Brown Hotel

This 100-year-old hotel is located at 335 W Broadway, Louisville. The hotel has a striking Georgian Revival look and offers elegant ballrooms, luxurious accommodations, and a gorgeous rooftop garden. The hotel also has extensive experience in hosting weddings of different cultures, such as Jewish and Indian weddings. Prices are $18,000 in the off-season and can accommodate up to 300 guests.

Talon Winery & Vineyards

This winery has a large outdoor space at 7086 Tates Creek Rd, Lexington. Offers vineyard and winery backdrop, outdoor ceremony space, and rustic barn. The best part is the wine-tasting and vineyard tours. The venue can accommodate up to 250 guests and prices for ceremonies start at $1500.

Tennessee Wedding Venues

Butterfly Hollow

Located at 28 Bussell Rd, Gordonsville, our vacation accommodations are perfect for small weddings. Surrounded by scenic walking trails, mountains, and woods. This venue specializes in small weddings of 30 people or less, with a focus on an intimate and cozy experience. Wedding packages range from $1795 to $5000.

Dixon Gallery and Gardens

An art gallery on 17 acres of gardens located at 4339 Park Ave, Memphis, offers a romantic and artistic setting for weddings. The gallery offers two indoor reception venues as well as woodlands and gardens, both of which can accommodate up to 200 guests. Prices are approximately $4000 to $5000 For 100 guests.

The Bell Tower

The Bell Tower, located at 400 4th Ave S, Nashville, is almost 140 years old. The ballroom features large windows that provide plenty of natural light, creating a charming and historic setting for weddings. There are two floors beside the lobby. Seated dinners for up to 400 people range from $3,500 to $16,000 depending on time and venue.

Mississippi Wedding Venues

The Cedars

The site at 4145 Old Canton Rd, Jackson is the oldest residential building in Jackson, with a history of 175 years. The courtyard in front of the house with trees such as cedar, oak, and magnolia provides a natural backdrop for weddings. The venue can accommodate up to 300 people and costs $3,500 for a two-day weekend rental.

Dunleith Historic Inn

A National Historic Landmark located at 84 Homochitto St, Natchez, the mansion features Greek Revival columns and original pine floors. The event space has a main floor, courtyard, and South Lawn, which can accommodate up to 700 people. Wedding packages start at $6,500, not including catering.

The Gin at Flora Station

The address is 4819 MS-22, Flora. The refurbished cotton gin blends rustic charm with modern amenities. It offers indoor and outdoor spaces, including a covered gazebo and a patio with an old-fashioned truck bar. Rentals for ceremonies and receptions start at $3,500.

Alabama Wedding Venues

B&A Warehouse

This building, located at 1531 1st Ave S, Birmingham, is historic from the outside. With its industrial-inspired design and high ceilings along with red brick walls. Three indoor venues can accommodate up to 300 guests, and the cost of a ceremony starts at $4,000.

The Sterling Castle

This castle is located at 389 Deseret Dr, Shelby, and has been voted the best wedding venue in Alabama. The fairytale-style castle, elegant ballroom, charming courtyard, and lakeside and drawbridge venues. This beautiful venue can accommodate up to 300 guests and all-inclusive weddings are priced at $10,000+.

Huntsville Museum of Art

This is an art museum located at 300 Church St SW, Huntsville. With unique indoor and outdoor spaces, the museum is a contemporary art gallery. Offering outdoor spaces with a rooftop terrace, and five indoor hospitality venues. The starting venue fee for a wedding reception in high season is $1,500.

Michigan Wedding Venues

Colony Club Detroit

Located at 2310 Park Ave, Detroit, this Georgian-style, historic venue features stunning architecture and gorgeous interiors. The hotel features a grand ballroom decorated with crystal chandeliers and intricate details. The ballroom can accommodate up to 350 guests and is priced between $12,000 and $15,000.

Castle Farms

This historic building, built in 1918, is located at 5052 M-66, Charlevoix. With a total of four site combinations in the summer. It offers several ceremony and reception spaces, including a charming outdoor garden and a majestic stone courtyard. The largest of these, the East Garden and Queen's Courtyard can host up to 300 guests. And the price range is between $6,750 and $9,250.

The Inn at Stonecliffe

This is a Victorian village located at 8593 Cudahy Cir, Mackinac Island. away from the hustle and bustle of the area. With beautiful gardens and breathtaking views of Lake Huron and the Mackinaw Bridge. Accommodates up to 300 people and prices range from $4000 to $10,000.

Ohio Wedding Venues

Franklin Park Conservatory

This is a horticultural and educational institution located at 1777 E Broad St, Columbus. The most popular venue is the indoor garden with an all-glass ceiling. Besides, there is an industrial-style venue and a 200-year-old barn. The venue has plenty of space and can accommodate up to 500 people, with prices ranging from $7,000 to $11,000 for a wedding of 100 guests.

The Columbus Athenaeum

The historic building at 32 N 4th St, Columbus, was built in 1899. With a total of ten venues to choose from, the Grand Ballroom boasts gorgeous details and a stunning atrium. It is decorated with classical Greek art as well as soaring ornate ceilings. It can accommodate up to 230 guests. Prices for receptions start at $3,000.

Gervasi Vineyard

An oversized wine estate located at 1700 55th St NE, Canton. Picturesque vineyard setting and sparkling lake views. The open-air venue can accommodate up to 300 people, while the indoor venue can accommodate up to 120 guests. Full-service event planning, vineyard tours, and wine tastings are available. Prices for receptions will start at $1,450.

Georgia Wedding Venues

Barnsley Resort

This resort is located at 597 Barnsley Gardens Rd NW, Adairsville. With over 3,000 acres of land, it is a historic southern estate. With lush gardens, luxurious cabins, and grounds that can accommodate up to 250 people. Three wedding packages are available: $275 per person, $320 per person, and $350 per person. And a least of 150 people is required.

Summerour Studio

This is a renovated warehouse located at 409 Bishop St NW, Atlanta. The roof is supported by massive bow trusses, which allow for a spacious, open floor plan without columns or supports. Through a wall of windows running the length of the space, there are breathtaking views of Atlantic Station and the downtown skyline. Accommodating up to 425 people, prices start at $4,000.

The Biltmore Ballrooms

The ballroom is located at 817 W Peachtree St NW 208, Atlanta, and was established in 1924. The ballroom features a handcrafted plaster relief ceiling, ornate crystal lighting, and a marble floor. Capacity ranges from 50 to 1,500 people and offers eleven caterers. Rental rates range from $3,500 to $5,000, depending on the day of the week.

Florida Wedding Venues

The Ancient Spanish Monastery

Located at 16711 W Dixie Hwy, North Miami Beach. This monastery was dismantled piece by piece from northern Spain and shipped to the United States, then rebuilt over 19 months. It offers a chapel and gardens for ceremonies. The garden can accommodate up to 300 guests for $6,500 and includes only the cost of the reception.

The Breakers Palm Beach

This is a luxury resort located at 1 S County Rd, Palm Beach. This luxury resort is located in Palm Beach and enjoys magnificent beachfront views, lush gardens, and an exquisite ballroom. It boasts a timeless and elegant ambiance. It can host weddings for a maximum of less than 500 people, and detailed prices need to be communicated with the hotel.

The Ringling Museum

The museum is located at 5401 Bay Shore Rd, Sarasota, with a breathtaking view of Sarasota Bay. This venue offers unique views of art, culture, and the stunning waterfront. It includes many event spaces, including a large courtyard and an elegant ballroom. The largest art gallery courtyard can accommodate up to 125 guests and prices start at $20,000.

New York Wedding Venues

Mohonk Mountain House

Located at 1000 Mountain Rest Rd, New Paltz, this historic resort is surrounded by 40,000 acres of pristine forest. Featuring a majestic Victorian castle with panoramic mountain views. Choose from lakeside, garden, and mountain views for your ceremony. Wedding packages range from $275 to $375 per person.

The Foundry

The address is 42-38 9th Street, Long Island City, with a history dating back to the 19th century. Offering an industrial chic atmosphere, a garden courtyard and conservatory, a stunning main space, plus rustic interiors. Accommodates up to 180 guests, with receptions starting at $14,000.

The Garrison

Estate at 2015 US-9, Garrison, with superb Hudson River views and Catskill Mountain views. The venue offers a modern ballroom, outdoor ceremony space, and golf course. The venue can accommodate up to 200 guests for $12,000.

Pennsylvania Wedding Venues

The Curtis Atrium

The historic building at 699 Walnut St, Philadelphia used to be the Curtis Publishing Company. It is now a building with a mix of residential, office, and retail space. It features a stunning atrium, marble columns, and a stunning rotunda. Space rentals start at $8,000.

The Cork Factory Hotel

This boutique hotel is located at 480 New Holland Ave 3000, Lancaster, a converted historic cork mill with exposed brick walls. Offering industrial charm and modern amenities. The venue has a ballroom, a terrace, and a 2,300-square-foot warehouse. Space is available for up to 200 guests, and wedding packages start at $7,000.

Terrain Gardens at Devon Yard

A stunning garden is located at 138 W Lancaster Ave Suite 130, Devon. The venue is decorated with elements such as reclaimed barn wood floors, raised holiday lights, and skylights to create a unique aesthetic. Of course, there is an essential gardening setting and open-air venue that can accommodate up to 140 guests. Prices for receptions start at $4,525.

West Virginia Wedding Venues

Stonewall Resort

The entire resort is nestled beside a tranquil lake at 940 Resort Drive Roanoke, a place of scenic beauty and rustic charm. Wedding venues are available on the lakeside lawn or in the courtyard, with an indoor grand hall and stone-walled ballroom. Spa services, golf courses, and entertainment can also be experienced with wedding packages ranging from $3,500 to $12,000.

The Greenbrier

A luxury resort located at 101 W Main St, White Sulphur Springs. With stunning architecture, beautiful gardens, and breathtaking mountain views. The indoor venue has a dramatic chandelier and stage. The outdoor grounds feature expansive lawns and rustic cabins. Packages start at $10,000 and vary depending on the number of guests, season, and customization.

Sleepy Hollow Golf Club

The Club at 3780 Sleepy Hollow Dr, Hurricane. It is a private golf club for families. Featuring a scenic golf course, elegant ballroom, outdoor lawn ceremony venue, and picturesque countryside views. Wedding packages start at $3,500.

Virginia Wedding Venues

Maymont

Historic Manor River Park at 1700 Hampton St, Richmond. Inside are gardens, botanical gardens, and native wildlife habitats. The scenic setting includes 100-year-old Italian gardens, European-style manor houses, pavilions, expansive lawns, and the Robbins Nature Center. Prices range from $3,500 to $6,100.

Inn At Willow Grove

This is a rustic accommodation located at 14079 Plantation Way, Orange. It is unusually peaceful and romantic, surrounded by ancient trees and beautiful gardens. One of the gardens, Boxwood, can accommodate up to 175 guests and offers idyllic views. A versatile barn is also available as a hospitality venue, with rates starting at $7,500.

The Tides Inn

Located at 480 King Carter Dr, Irvington, the entire hotel is situated on a beautiful body of water with views of the Chesapeake Bay. It is a waterfront resort. You can also come here to take part in fun activities such as tennis, golf, paddle boarding, biking, and kayaking. Weddings start at $3,100.

North Carolina Wedding Venues

The Bradford

Professional wedding venue located at 523 Pea Ridge Rd, New Hill. It resembles a European town building with charming gardens and rustic barns. It can accommodate up to 250 guests for a ceremony in the gardens. Wedding packages will vary depending on the time of year and are priced at $8,000 on Fridays and $9,800 on Saturdays.

The Merrimon-Wynne House

The mansion located at 500 N Blount St, Raleigh was built in 1876 and has been well maintained and is now a venue for various events. The building has a main floor full of Southern charm. Inside are original floors and mantelshelves, ornate chandeliers, and a wide porch. The outdoor area is also large enough to host ceremonies in the garden and can accommodate up to 250 guests. Prices for receptions start at $5,000.

Fearrington Village

It's an English-style country hotel located at 2000 Fearrington Village Center. Besides the quaint country setting there are dense gardens with water features. The largest venue is the barn, which offers spacious dining and dancing space and can accommodate up to 250 people guests. Prices for ceremonies start at $2500.

South Carolina Wedding Venues

Middleton Place

This National Historic Landmark is located at 4300 Ashley River Rd, Charleston. You can experience daily life on an 18th-century plantation and enjoy 65 acres of unobstructed views and private garden rooms. Also, enjoy the oldest landscaped gardens on the property. There are 7 ceremony venues, ranging from small weddings of 50 to 400 guests. Prices start at $5,000.

William Aiken House

The 1807 mansion is located at 456 King St, Charleston, a restored mansion that showcases Southern charm and architectural elegance. The yard features a magnolia tree that is over two hundred years old and an elegant terrace. It is also rated as one of South Carolina's premier wedding venues. The cost of a ceremony starts at $3,000.

The Cedar Room

Modern industrial event space at 701 E Bay St, Charleston. Featuring exposed brick walls, high ceilings, and large windows overlooking the cityscape. The indoor Cedar Room venue can accommodate up to 500 people for events, and the outdoor yard can seat up to 200. Events on Fridays or Sundays start at $3,500.

Vermont Wedding Venues

Inn at Mountain View Farm

The Inn at 3383 Darling Hill Rd, East Burke, has breathtaking mountaintop views. Enjoy mountain biking, cross-country skiing, and visits to animal farms, among many other activities. Venues can range from beautiful fields to cozy campfires. Weekend wedding packages start at $3,500.

Hildene - The Lincoln Family Home

The building at 1005 Hildene Rd, Manchester is full of meaning. The Lincolns built Hildene as a summer home at the turn of the 20th century. Here you can look out over the Taconic Mountains to the west and the Green Mountains to the east. The outdoor venue can accommodate up to 200 people and wedding reception prices start at $8,000.
📷
(Hildene - The Lincoln Family Home)

The Henry House

The historic house at 1338 Murphy Rd, North Bennington, built in 1769, is one of the oldest surviving houses in Vermont. Overlooks the authentic red-covered Henry Bridge. The site offers several vendors for you to consider. The large trees outside the house make for the best wedding photos. The venue needs to be contacted for a specific quote.

Massachusetts Wedding Venues

The Crane Estate

This is a Tudor Revival mansion located at 290 Argilla Rd, Ipswich. It was the summer home of Mr. and Mrs. Richard Taylor Crane, Jr. with winding salt marshes, miles of barrier beaches, and a beautiful hilltop mansion. And of course the rolling lawns and gardens. There are three sites to choose from in all, with the beachfront site accommodating 200 to 500 people. Weekend weddings are priced at $6500.

Red Lion Inn

The Inn at 30 Main St, Stockbridge has a 250-year history. The entire Inn combines traditional New England hospitality with the amenities of a modern hotel. The largest Hitchcock room capacity is capacity 30-175 people. Venue rentals start at $4,000.

Liberty Hotel

A sophisticated hotel located at 215 Charles St, Boston. Located in the heart of downtown, just steps from shopping, dining, Boston Parks, and more. The hotel offers a private secret garden that can accommodate up to 200 people outdoors and an indoor 3000-square-foot ballroom. Wedding venue rates start at $26,000 for up to 100 guests.

Connecticut Wedding Venues

The Lace Factory

This historic factory is located at 161 River St, Deep River, and offers a charming and rustic atmosphere for a wedding venue. It has wood floors, high ceilings, and large windows overlooking the river. The Lace Factory offers event planning services, on-site catering, and a variety of rental options for weddings of all sizes. The Factory can accommodate up to 225 people and prices start at $5,000.

Eolia Mansion at Harkness State

The address is 275 Great Neck Rd, Waterford. Nestled on the shoreline of Waterford, Connecticut, this elegant mansion offers breathtaking views of Long Island Sound. It has manicured gardens, a stone terrace, and a beautiful ballroom. The price of $5,100 includes exclusive use of the mansion's first floor and south courtyard tent for 5 hours.

The Society Room of Hartford

This event venue is located at 31 Pratt St, Hartford, and the historic venue boasts magnificent architecture. It includes a marble staircase, beautifully frescoed ceilings, and crystal chandeliers. It provides a luxurious and timeless setting for weddings. The venue can accommodate up to 300 guests and prices start at 15,000.

New Hampshire Wedding Venues

Wentworth By The Sea Country Club

Country Club at 60 Wentworth Rd, Rye. This private club is near the shore and enjoys magnificent waterfront views and a romantic atmosphere. The hotel has manicured grounds and a historic clubhouse. It can accommodate up to 250 guests in this setting. Three options are available: lawn, clubhouse, and tent weddings. Reception prices start at $30,000.

The Preserve at Chocorua

This venue, located at 88 Philbrick Neighborhood Rd, Tamworth, is a rustic and secluded wedding venue nestled in the White Mountains. It offers scenic views, a charming barn, and plenty of outdoor space for the ceremony. Outdoor activities such as sleigh rides and hiking are also available. Approximate prices will start at $1000.

Bishop Farm

The Farmhouse, located at 33 Bishop Cutoff, Lisbon, is a historic and beautifully landscaped site in the White Mountains. It offers a restored 1876 farmhouse, a barn, and lush greenery. There is also a romantic bistro with a terrace to relax in. Accommodating up to 200 guests, prices start at $15,000.

Rhode Island Wedding Venues

The Chanler at Cliff Walk

A luxury hotel located at 117 Memorial Blvd, Newport. The Chanler offers luxurious accommodations and a grand mansion setting with stunning views of the Atlantic Ocean and access to their world-class restaurant. Specializing in weddings for up to 120 guests with access to their world-class restaurant. Site rentals start at $10,000.

Blithewold Mansion, Gardens & Arboretum

Historic mansion on 33 acres located at 101 Ferry Rd, Bristol with breathtaking views of Narragansett Bay. Large tents are available in the outdoor area, followed by sunset views. Accommodating up to 225 guests, weekend wedding rates start at $12,995.

The Dorrance

Situated in the heart of Providence, The Dorrance is a restored bank building with a sophisticated atmosphere and elegant decor. The most special feature is the long, luxurious bar, which can accommodate up to 200 guests throughout the venue. Venue rentals start at $7,500.

New Jersey Wedding Venues

The Ashford Estate

Located at 637 Province Line Rd, Allentown, this elegant property is nestled in a picturesque setting. Surrounded by hundreds of acres of beautifully preserved farmland, it features sparkling fountains, waterfalls, garden pavilions, expansive views, and of course, luxurious private suites. The wedding venue can accommodate up to 300 guests. Starting at $10,000.

Mallard Island Yacht Club

A club surrounded by water at 1450 NJ-72, Manahawkin. six more venues to choose from in the luxurious private island mansion. The center plaza boasts grand arches and ornate ceilings reminiscent of old-world glamour. The ballroom can accommodate up to 250 people, and prices for receptions start at $20,000.

Liberty House Restaurant & Events

This waterfront event venue is located at 76 Audrey Zapp Dr, Jersey City. It features unparalleled views of the New York City skyline, Ellis Island, the Statue of Liberty, and the Liberty Landing Pier. The Grand Ballroom features a marble floor and floor-to-ceiling windows. The venue can accommodate up to 300 people and venue rental fees start at $8,000.

Delaware Wedding Venues

The Queen Wilmington

This dazzling venue is located at 500 N Market St, Wilmington is downtown. It is a historic music venue that offers a unique and eclectic atmosphere. The venue features a grand ballroom with a stage, state-of-the-art sound system, and elegant décor. The venue can accommodate up to 200 guests and wedding reception prices start from $3,000.

The Cordrey Center

The address is 30366 Cordrey Rd, Millsboro, and its restored barn and surrounding gardens provide a rustic and charming setting. The venue offers a range of services, including in-house catering, bar service, and event coordination. It has indoor and outdoor options and can accommodate up to 200 guests. Venue rental rates start at $3,500.

The Waterfall Catering and Special Events

With an address at 3416 Philadelphia Pike, Claymont, The Waterfall has a modern venue. Centered around a stunning indoor waterfall. The spacious ballroom features contemporary décor and customizable LED lighting systems. The venue can accommodate up to 500 guests. Prices for venue rentals start at $6,000.

Maryland Wedding Venues

Belvedere Hotel

Located at 1 East Chase Street and built-in 1902 as a historic landmark in Baltimore, The Belvedere showcases stunning architecture and classic charm. It offers a variety of event spaces, including a rooftop ballroom with panoramic views of the city. Inside, the décor is more vintage and ornate. Accommodating up to 500 guests, venue rentals start at $8,000.

Evergreen Museum & Library

This grand Gilded Age mansion is located at 4545 N Charles St, Baltimore. It is full of history with a house museum and research library. With beautiful gardens, this venue offers a mix of elegance and history. It's architectural details and scenic surroundings provide a unique backdrop. As well as a tour of the museum's collection. Accommodates up to 200 guests and starts at $6,000.

Chesapeake Bay Beach Club

Located at 500 Marina Club Rd, Stevensville, this venue offers stunning waterfront views and an elegant ballroom. It also has an oceanfront ceremony venue and luxurious accommodations. There are four ballrooms in total, three indoor and one outdoor. Accommodations for up to 300 guests start at $10,000.

District of Columbia Wedding Venues

Larz Anderson House

Located at 2118 Massachusetts Ave NW, Washington, the Anderson House, established in 1905, is a stunning Beaux-Arts mansion that offers a romantic and intimate setting for weddings. The venue features beautiful gardens, a grand staircase, and gorgeous rooms decorated with historic artwork. It can accommodate up to 200 guests and has access to the house's magnificent library. Prices start from $8,000.

The Hay-Adams

Located at 800 16th St NW, Washington, across from the White House, the hotel offers magnificent views of the iconic landmark. This venue has many event spaces, including a rooftop terrace from which the White House can be used as a photo backdrop. Wedding venues can accommodate up to 250 guests and prices start at $15,000.

National Museum of Women in the Arts

Located at 1250 New York Ave NW, Washington, this unique venue celebrates women artists and offers a distinctive setting for weddings. With its stunning architecture and world-class art collection, it provides an exquisite atmosphere for your special day. The venue offers a variety of event spaces, including an assembly hall and mezzanine level, and can accommodate up to 400 guests. However, the museum is temporarily closed for renovations.

Maine Wedding Venues

Hidden Pond

The resort's address is 354 Goose Rocks Rd, Kennebunkport, and is nestled in a secluded wooded area. Featuring elegant indoor and outdoor spaces. Surrounded by 60 acres of birch and balsam fir, it features two outdoor pools and a three-room treetop spa. It ensures an unforgettable wedding experience. Prices start from US$10,000.

Hardy Farm

The farm is located at 254 W Fryeburg Rd, Fryeburg. This rustic and chic site features a restored 18th-century farmhouse and a spacious barn with panoramic mountain views. Of course, there are also seasonal gardens and a woodland church. The most special feature is the provision of a cable car to reach the top of the mountain, which is also a popular backdrop for photos. It can accommodate up to 250 guests and prices start from $6,500.

Portland Regency Hotel & Spa

The address is 20 Milk St, Portland, and is centrally located, offering a blend of classic elegance and modern amenities. With many event spaces, on-site catering, and a spa, it can accommodate intimate and large weddings. Accommodations range from 10 to 220 guests, with rates starting at $3,500.

Conclusion

"When you realize you want to spend the rest of your life with somebody, you want the rest of your life to start as soon as possible." When Harry Met Sally
Finally, we've rounded up our recommendations for wedding venues in each of the remaining states. Choosing the perfect wedding venue is an important step in creating your dream wedding. It sets the tone for the entire celebration and provides the backdrop for your special day. No matter what style of wedding venue you prefer, there is a venue above that perfectly suits your style and preferences.
Last but not least, don't forget to check out Quictent's wedding tent. we offer quality wedding tents for your outdoor wedding, containing various types and sizes.
submitted by scarlet2248 to u/scarlet2248 [link] [comments]


2023.06.05 05:37 BlazerYanko Potential New Tenant Insisted on Paying 6 Months Up Front

Searched the sub and only found the opposite situation (being asked by landlord to pay many months up from). This happened almost a year ago and I shut down contact with the because it didn't smell right. Curious whether it was a scam attempt or not. Long story because I think the details adding up are important.
Partner and I were moving out of our owned house and wanted to rent it out, so first time looking for tenants. Listed on Facebook and Zillow. One person, jerry contacted me via phone. Basically he said that he lives in Atlanta (we are about 1,000 miles away in the US midwest) and that he is looking for a place for his mother, who lives in our town. He sounded 30s to 40s. Okay. The weirdness detector first went off because he elaborated that he is a very successful owner of Mutiple businesses in that he has multiple millions of dollars. This is why he wanted to get a place for his mom. Okay...maybe true but I would expect someone like that would look to buy rather than rent, and our house was like a typical midwest starter house. Probably on the nicer end of that class of house, but not millionaire renting a house for mom from across the country. And in particular the neighborhood is right on the edge of a rougher part of town. This is not a tucked away subdivision, it's an old part of town, a loud street. Still, fine, maybe. He says in that initial phone call that he wants to set a time for mom to come tour it, and also that he will be looking to pay 6 months of front. I was already feeling off about it so I did say we probably wouldn't be interested in that. He ignored that. We set up a time for mom. We were going to be there cleaning anyway. Robbery scam crossed my mind but we had already moved out and the house was empty and I made sure to mention that offhand in the call.

So mom does show and is the age expected. However she's also with a man that age, which wasn't mentioned. Fair enough maybe. Women are unfortunately not safe by themselves. But it's the many small things adding up the suspicion. They were also in an awful beater car. Idk, you're going to rent mom a house but you have her car-less and being around by this type of guy? This guy was also just very odd as they toured the house. Comically gravelly voice. Him and mom moved fast. It's far less than what you would expect from someone trying to pick out a place to live. Barely asked any questions and didn't seem interested in any of the facts I told them. So maybe she just could tell right away it wasn't for her? Nah, at the end they both definitely yet unenthusiastically said it was perfect for her. She would be contacting her son to set up the payment and sign the lease. I mention I'll still need her to fill out the little free background check thing on the Zillow listing since she'll be living there.

Maybe a day later i get an email from supposedly Jerry's secretary or assistant or something. Says they want to sign and again pay 6 months up front. I say in the email that both mom as tenant and Jerry as the person signing the lease need to do the background check thing. Again, very easy. There might have been a couple emails after of him/her saying something like he is paying 6 months up front, that's more valuable that a credit score check anyway. He absolutely refused to do the background check or have his mom do it. Or that might have been something he said on the call. Because soon enough he called me, not quite angry, but close, saying stuff to the tune of that. Reiterating that he is a multi millionaire and very successful. Here's where he got very angry and was yelling at me on the phone.

I essentially told him it's my first time doing this, we're just trying to be smart and we aren't anywhere near desperate to get the lease signed right now, plus we have other tour requests. I said from my perspective and in my experience (I work in a finance related field), a person or company would nearly always rather pay later than now, assuming no interest on paying later. It's cash flow. I know there are plenty of examples of the opposite, but I said this and some of the other things adding up are why it smells off (and that he is getting very mad). He said it's just convenient to pay and then not think about it, because such small amounts of money to him are rounding errors and not worth his time to think about every month. I did mention we could set up an auto-pay. He rambled loudly for an impressive amount of time, I wish i remember everything he said. But it was truly not believable at this point and was pretty funny - He kept just talking about how successful he was but the specific things he said sounded like things that someone very not successful (or a 12 year old) would think a very successful person would say. Hopefully this makes sense and you would be sketched out too. I think at this point I shut it down.

I couldn't quite figure out what scam this could be but I just didn't like it and we had other good prospects and no time crunch. Similar-ish things I found online weren't quite this situation. Most assumed scouting for burglary. Closest hits had that upfront payment not going through. Then either 1 they live there a few months free before we notice and evict or 2 something about they would change their mind, ask for a refund, we send the refund, but in reality what they initially sent bounces so they just got wired money form me worth 6 months rent. But we wouldn't have let them move in before the payment cleared nor would we have sent a refund if they signed a lease. Super curious.
So tl;dr someone cross country with a story that didn't smell right about his wealth and success wanted to rent our house for his mom. He refused to do the Zillow background check or have his mom do it, and he insisted on paying 6 months up front. He got very angry on the phone when I pushed back on those points and explained I believe politely why those points made me uncomfortable. Was this a scam and if so what was it?
submitted by BlazerYanko to Scams [link] [comments]


2023.06.05 05:16 screwedup120806 Falling down a spiral really quick warning trigger for some (suicidal thoughts)

I made my husband take all the knives n lock them up in the gun cabinets. I don’t trust myself right now. I also made him lock up all my meds so I can’t OD. I have such awful things going on in my life right now. I just don’t want to b here anymore. Contacting my dr isn’t gonna help bc he can’t make my life situations go away. No meds or therapy can make my life better right now. It’s just a waiting game to see what happens long term. The situations r complicated and long n don’t really want to put all of my business out there bc frankly I can’t deal w any criticism right now bc I’m so on edge as it is. Ugh I just want to die so badly. Going to the hospital isn’t gonna help either. I’ve been there 2 times and it’s a waste of time plus if I go it makes me look even more unstable and could possibly make my life situations even worse if people find out. I’m currently off work bc I lost my job n in getting clean from weed so I can find another job which means I’m at home all by myself. I have no friends to hang out w and no family now. I just want to die
submitted by screwedup120806 to bipolar2 [link] [comments]


2023.06.05 03:14 transthrwaway2019 VFS Surgical Experience Vocal Fold Shortening and Retrodisplacement of the Anterior Commissure (VFSRAC) at Yeson Voice Center (May 2023)

Hey folks, me again back to detail my experiences at Yeson.
For a summary of my decision to get VFS, I had always been curious about VFS and some of the promises it made, but it was never a priority for me as my voice has always been assumed as cis. Frankly I've received a lot of compliments about my voice and in the past had people accuse me of lying about being trans on the basis of my voice. None the less, I was still curious. My voice was always decidedly in the lower register of the female ranges, and I wanted it to be more average.
In recent years I noticed the pitch of my voice come down a bit and it became increasingly difficult for me to even reach the prior speaking pitches/it required a lot more concentrated effort. At a certain point the absolute higher range became inaccessible. As I approached the higher range I noticed an air leaking sound in my voice, picture opening a bottle of seltzer water very slightly. Additionally I had developed a vocal tremor. My voice also tended toward vocal fry a lot so I started needing to control my speaking differently to avoid every word turning into a fry sound. I needed to speak very punchy with a lot of air pressure to compensate for these things. These were all things I had observed that led me to deciding I would seek VFS and see what was up and if any of this could be corrected.
It could be a complication of numerous intubations, or even a tracheal shave procedure, but I never collected enough data to say conclusively if A led to B. It could also be that because my vocal training was self directed I was doing it "wrong" and slightly straining every time I spoke for almost 15 years, and it just has this kind of end result. Regardless of the why, I know the what.
Now, into the actual details.

Travel to Korea

The flying was uneventful. I have airline status and bought nice seats, spent some time in the airline lounges yada yada. I arrived, there were taxis waiting, I got one, and it took me to my hotel. I stayed at the Entra Hotel which is maybe half a block away from the clinic. It does require one street crossing, the walk was less than 5 minutes door to door. I stayed in one of the "superior king" rooms with the nice views and a fancy bathtub that looks out the window.
The hotel is nice, the hot breakfast is not vegan friendly unfortunately, but the buffet had options and was nice and easy. The staff are nice and have likely dealt with a few Yeson clients and were quick to assist me reading messages off my phone. There's a supermarket maybe 3 blocks away, called SSG. Definitely stop there, buy some extra water and some snacks for yourself all that good stuff. They give you 2 bottles of water per day at the hotel, and will provide more on request.

Pre-Op Consult

For the consult they had the clinic staff responsible for arranging transportation for the clients pick me up, take me to a nearby hospital, he arranged everything I just had to follow him, get a chest X-ray, then he drove me to the clinic. This too maybe half an hour total, way more efficient than US hospitals or urgent care centers.
At the clinic I had to fill out some paperwork that detailed my feelings about my voice. There is a general form about vocal disability and then a trans specific form to fill out. Some forms and charts may have your sex listed as "T." This is better than misgendering, though I'd prefer if it said "F" I'm not about to wage a war against medical practice in Korea to get them to change this. It might even be legally required for all I know. Regardless I still wrote F everywhere it asked, and they didn't care.
At the clinic you'll meet with the international patient care coordinator who will help you out a bunch throughout this process. She'll bring you to a room where they have you do a standard vocal exam. You have to read some stuff in a lower voice and a higher voice. I'll admit I was anxious during all this so I think I limited both ends of my range as my voice gets tight when I'm anxious. I wasn't anxious from worry, I think just from being recorded and wanting to do the best I could or something. Not really sure.
Anyway you do some tests, they stick a camera down your throat and observe your vocal folds. Then they take you downstairs, draw some blood, do an EKG. All standard stuff, and the coordinator is with you the whole time to assist you so you don't need to be worried about not speaking Korean.
Then you meet with Dr. Kim, he'll have you do some more exercises, he'll stick a camera up your nose this time, and then will answer any questions you have while discussing what he sees. This is where things got interesting for me because there was a physical reality behind each of my observed symptoms. My vocal folds are asymmetric, I sort of twist my whole vocal instrument when I speak to accommodate for this, my vocal folds do not actually touch when I speak leading to some of those other issues, I speak with 3-5 times the air pressure of a normal person, and consume about 8x as much oxygen speaking as well as a result.
Dr. Kim theorized this all might be the result of just how I've used my voice over the years, but had a few other potential theories including potential injury at some point and so on. Regardless he assured me that his approach would actually address my concerns if I was diligent about following the care rules. And I will be, I always am.
This process took maybe 2 hours in total, but we did a lot so there's not a lot of doing nothing. It goes by quickly.

Surgery Day

Surgery day is easy. Walk 5 minutes, get myself prepared for surgery, lay on the bed. I chatted with the care coordinator for a bit, the nurses put your hair up and put a hair bonnet on, you meet with the doctor, the anesthesiologist, and sign some papers then you walk to the OR and get put under and that's that. It's all super standard stuff like every other surgery I've had. Easy peasy.
You wake up and will probably have a sore throat (3-4 discomfort for me) and some discomfort swallowing (3-6 depending on if it was a good or bad one). Especially if you typically swallow "hard." I found it more comfortable if I had my chin at 80-110 degrees angle with my neck. Might vary person to person. You are advised to practice circular breathing in through nose out through mouth, so do that. You might get a little phlegm, I didn't at this stage, but make sure not to cough or speak. You'll get nurse visits at noon, two, and four. At four you'll meet with the doctor before you get discharged, and he'll do the camera nose thing again and repeat the care instructions.
They usually bring people ice cream I guess, but I'm vegan and so they brought me some insanely good pumpkin soup that I need to try to recreate. This will come around noon with that nurse checkup. Just try to sleep as much as you can honestly, but you can get up and play on your phone or something if you prefer.

Follow-Up

The follow up was two days later in the late afternoon. They do the camera nose thing again, take some pictures, go over the care instructions again, answer any questions you have in written form, do not speak. You get a copy of the pictures, and a copy of all the exam and test results, you get some pills you might have to take depending on the 3 month follow up audio results, you get a USB device with some of the recordings they took and some follow up videos and all that. I really think these videos are super neat, and I get to see the patterns I habituated, where I really narrow the area I'm speaking from and all that. Cool stuff.
In my case there was some raw and slightly bloody looking area near the former anterior commisure, but not on the folds themselves., this may have been due to coughing in my sleep. I had worried I coughed and spoke in my sleep the night before as I dreamed vividly about it and woke up immediately after, but I wasn't sure. I raised this with the doctor, he says botox will help prevent this from happening. I think it may have also been due to just how bad it hurt to swallow a few times, but regardless he said it was nothing to be worried about and that overalll it looks fine and should heal if I stick to the care plan. There will be some sloughing looking skin above the stitching, it'll look weird, but it's fine and part of wound healing so don't be worried there. If you've had other surgeries, you know what this is so you'll not be scared.
You'll meet with a speech pathologist who covers the follow up training you have to do starting at 2 months to connect your brain with the new action of your modified vocal folds. I'm told this training is essential to get the full benefit of the surgery, so make sure you do it. The exercises are very simple and will take you maybe 15 minutes, 3-5 times a day as advised. Do one in the morning, one before bed, and fit in the others anywhere else.
Then I met with the doctor again, he injected botox into the muscles around my vocal folds to help correct the tremor and also to help prevent potential damage to the surgical site thru coughing or all that. They come in through the front of the neck so be prepared. For some reason the second one scared me a little, so be prepared for more than one jab. I did notice less static discomfort overall after this, but you know botox does block up the nerves so it might just be that I can't feel the pain.
They use much less botox than say you'd get in your forehead, so it should wear off somewhat quicker and not lead to any long term muscle atrophy, though there may be in the short term after 2 months of not using so be prepared for a tired voice when you start training again.
You'll be advised not to tip your head back with a mouth full of liquid to avoid aspirating any water while the botox is in effect, so just do that. Essentially your vocal folds will be paralyzed wide open, so it would be easy to aspirate water and you don't want the resulting coughing fit.

Trip Home

Largely uneventful. I made sure to let the flight attendants know I couldn't respond verbally and just kept my requests simple. Like writing "water please" before they got the beverage cart to me so I could just hold it up. They were all sympathetic, likely because I'm not old and look overall healthy so they felt bad for me and wanted to help.
I'm home now, drinking my usual 4-5L of water per day, crying that I can't have coffee, chocolate, or spicy food for 2 months. Making sure not to speak or talk and just waiting to see if this was worth the 9k lol (I'm sure it will be)
Anyway, not too much to note, it was very uneventful, the area being operated on is like 1.5cm big so there's nothing major to discuss with you all like some of my prior surgeries. But yeah here it is! Feel free to ask any questions. I'll follow up later once I can speak to let you know what's going on.
Currently I feel no pain, occasionally very slight discomfort when swallowing, haven't had to cough, had to stop myself when I was about to speak a couple times. I noticed how much I occasionally mouth words to myself when I think them, so trying to make sure not to do this as well.
My throat feels maybe slightly heavy? I think I was subconsciously keeping my larynx elevated for the last 15 years, and so with botox weakening the muscles they get extremely fatigued when I try to do this without thinking lol.
If I get a lot of phlegm build up and feel like I have to cough, I bend over and let it kinda grossly slide up more toward my mouth, and then it's easier to clear via swallowing.
Prior Yeson related post: https://www.reddit.com/Transgender_Surgeries/comments/10vj6kyeson_first_contact_thru_booking_current_price/
submitted by transthrwaway2019 to Transgender_Surgeries [link] [comments]


2023.06.05 03:04 nipplesaurus I had one rule: "No dating co-workers". Then I saw Lindsay...

Hi all. Just discovered this sub tonight, hopefully you can offer some words of support, advice, and maybe encouragement.

tl;dr: I'm shy. Haven't dated much. Had some romance with co-workers years ago but said never again. Saw a cute beautiful girl at work, she is also really shy. I said hi, don't know how to go further, due to working apart and not having much opportunity to get to know her. She blushes when we run into each other and I think she looks at me when she thinks I'm not looking

I have changed names for anonymity.
A bit about me: Male in my late thirties. Painfully shy with girls all my life. Had a high school girlfriend for two months, and a more serious, three-year relationship in my late twenties.
(Here comes a long backstory. Skip to *** if you want to skip most of it)
I went through a phase of trying (mostly very unsuccessfully) to date co-workers in my early to mid-20s. It alway ended terribly, as I worked with these girls closely twice a day, it led to some very awkward situations that I finally decided ten years ago to just cut out altogether and never try dating co-workers again. Shortly after taking the vow, I met a new co-worker (we had the same job) and we very quickly fell for each other but I turned her down because of the vow I made. I don't regret it though, other than feeling a bit bad for rejecting her, because I met my first serious girlfriend very soon after.
My ex and I dated for three years and were very much in love. She genuinely wanted to marry me, but I just couldn't get myself there with her. Frankly, as much as I did love her, I also resented her because of her controlling and insecure ways. Not going to go into too much detail there, but I was a film student and she essentially wouldn't let me watch movies because she was afraid I would see naked ladies, which she was very insecure about. Add on top of all of that, I was growing increasingly depressed due to the stress of work, feeling lost in life, and the way she treated me.
Anyway, we mutually decided to break up but we still saw each other, had sex, etc. She went away for an internship on the other side of the country and we kept in touch. I expected us to get back together when she returned in the fall but she didn't call, text, anything. Then I found out she had gotten pregnant just before she left for back home and that, combined with my preexisting and growing depression, sent me into a nervous breakdown.
I finally recovered enough to move on but the hurt remained and honestly, I still loved her very much. I decided very firmly that I never wanted to get back together, even after my ex started calling me again in 2020, but I still couldn't fully get over her. Call me wimp, whatever.
Then last year, I met four new girls (not all at once) and tried my hand at dating again, but each effort went down in flames. Still, it was good to try to get back out there. But still, I couldn't get over my ex. I would have episodes of pure sadness, remembering the love. I couldn't even look at the pictures of her or us in order to delete them. They just lived on my phone.
***
Then last year, I was working in a great [but unfortunately temporary] job that I loved, and rarely had to come into the office. But one of the rare occasions I did, and I saw this super cute girl, Lindsay, had started working there. She was working in another department, and in a job that had a high turnover rate so she probably wouldn't be there for long. And to top it all off, I noticed that she bore a striking resemblance to Shirley, a woman I had worked with for twenty years and have always liked (as a person) and got along great with. Turns out Lindsay is Shirley's daughter.
I returned to the office and my permanent job this past January and Lindsay sits just on the other side of the cubicle. She is in a junior position in another department, and I am much more senior, but I have absolutely no authority or influence over her, so anyone reading this who is concerned about that need not be.
I told myself, "Yeah, she's cute but I don't date co-workers. Nope. Never again"
But then I noticed that Lindsay is not just super cute, but absolutely gorgeous. Like stunning. I can't take my eyes off her. She is quiet and shy like me, and a snappy dresser. I resisted and resisted, telling myself no, but I can't resist anymore and decided that I have to break my one rule. I would never forgive myself if I let her go.
An interesting thing happened too: falling for Lindsay has given me the emotional break from my ex that even all four of those girls last year couldn't. Finally, two months ago, I was ready to delete all of the old pictures of my ex and I. And it wasn't that hard. I was finally ready to fully move on.
On April 11, I got a really bad haircut during my lunch break. Really bad. But despite that and the total blow to my self-confidence it gave me, I ran into Lindsay at the end of the day and introduced myself. I was not the lively person I wanted to be (because of the haircut) but Lindsay blushed and smiled when I said hello, then left me with a "have a good night"
The next day, I waved hello. A week or so later, I was passing by her and began smiling ear-to-ear completely involuntarily. She blushed.
Since then, I have been falling harder and harder and I swear she is getting more beautiful every day. I steal glances whenever I can, and I'm 99.99% sure I have caught her doing the same to me.
Three weeks ago, I was standing at my car and she came up behind me and said bye, but kept walking.
I also did what I told myself not to - I found her TikTok and Instagram. I'm old fashioned and want to learn about a girl by actually knowing and talking to her. But I got weak and looked at her profiles. Turns out she is super single (at least as of last month) and looking. But she is also super shy, turns down dates, and doesn't talk to anyone. We're two peas in a pod, as the saying goes. The Instagram I found is her old one; she started a new, private one a couple months ago. Should I follow her? Is that weird? It's weird, isn't it?
So why don't I just ask her out, you say? Well, that's difficult. I am only in the office Monday and Friday. She's part-time, I'm full. On Mondays, we finish work at the same, on Fridays, she leaves an hour earlier than I. Plus she is in the different department, surrounded by prying eyes, so it would be awkward for both of us if I walked up to her desk to chat. And she never leaves her desk except to use the washroom or chat with her co-worker friend at lunch. So I only have Monday to catch her going out the door. And timing that is difficult. Sometimes she stops to chat with her co-workers, other times she leaves soon after me but has her earbuds in so when I am at my car and she walks by, her back is to me and she can't hear me. Plus, what am I going to yell, "Hey you!"? We don't even really know each other.
I'm old, time is getting on for me, and for all I know, the world could end next week. She's looking, I'm looking, so why don't I just go for it? I'm afraid. But mostly, I feel like I have no idea what to do. Like seriously, I feel completely lost and a little helpless. I met those other girls, but those conversations/connections happened more organically. I didn't have to pursue, really. With Lindsay, I have to make a move. A move at work. With people looking. Or if not that, I have literally thirty seconds once a week to try to nab her. But I can't get her out of my head and I can't let this chance, however slim it may be, slip away because I was scared.
As I mentioned, I have known Lindsay's mom for twenty years. I could ask her if Lindsay is single. Shirley has always liked me, and she's very nice. Is that a good idea?

Sorry for writing a novel. Any help would be appreciated. Thanks.
submitted by nipplesaurus to Crushes [link] [comments]


2023.06.05 01:26 theyoungriddler Help with my school list? Low stat af (<3) and mediocre MCAT

before immediately stating "do not apply", would really really appreciate if people could look at my stats/experiences and give me advice. thank you!
Demographics:
ORM, 25F, and resident of Georgia.
Stats:
cGPA: 2.75 (includes smp)
sGPA: 2.65 (includes smp)
SMP at RWJMS: 3.38 gpa
Dunno if this is useful info but:
last 90 credits cGPA/sGPA: 3.1/3.1
last 60 credits cGPA/sGPA: 3.3/3.2
MCAT 2x: 506 (126/124/125/131) & 509 (128/124/126/131)
**I lost a parent during college and that fucked up 2 years of classes for me which is why even with the smp my gpa doesn't really budge. i do have an upward trend. i graduated college with a 2.62 lol.
Extracurriculars/Clinical Experience:
25 hours - Shadowing
400 hours - Medical Assistant (ongoing)
800 hours - Leadership in Sorority & Student Government
1000 hours - Established a program that provides free menstrual products to students on undergraduate campus (still involved)
250 hours - RWJMS Research Intern (1 abstract publication & conference presentation)
480 hours - Physical Therapy Aide
100 hours - Background Acting for Film/TV Productions
5000 hours - Jobs: front desk at a dorm and a restaurant delivery driver
125 hours - Volunteering
MD schools
Albany Medical College
Chicago Medical School at Rosalind Franklin University of Medicine & Science
Creighton University School of Medicine
Drexel University College of Medicine
Eastern Virginia Medical School
Frank H Netter MD School of Medicine at Quinnipiac University
Geisinger Commonwealth School of Medicine
George Washington University School of Medicine and Health Sciences
Hackensack Meridian
Howard University College of Medicine
Loyola University Chicago Stritch School of Medicine
Medical College of Wisconsin
Meharry Medical College
Mercer School of Medicine
Morehouse School of Medicine
Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine
Pennsylvania State University College of Medicine
Robert Larner, M.D. College of Medicine at the University of Vermont
St. Louis University School of Medicine
Tulane University School of Medicine
University of California, Los Angeles David Geffen School of Medicine
University of Colorado School of Medicine
USF Health Morsani College of Medicine
Virginia Tech Carilion School of Medicine
Wake Forest University School of Medicine
Wayne State university School of medicine
West Virginia University School of Medicine
DO schools
A.T. Still University SOM - Arizona
Alabama COM
Midwestern University - Arizona COM
Arkansas COM
Campbell University Jerry M. Wallace SOM
Midwestern University - Chicago COM
Edward Via COM - Auburn
Edward Via COM - Carolinas
Edward Via COM - Louisiana
Idaho COM
Kansas City University COM - Joplin Campus
Kansas City University COM - Kansas City
Lake Erie COM
Lincoln Memorial University DeBusk COM
Michigan State University COM
New York Institute of Technology COM
Philadelphia COM - Georgia Campus
Philadelphia COM - South Georgia
Philadelphia COM
Rowan University SOM
Western University of HS COM of the Pacific - Oregon
William Carey University COM
University of Pikeville Kentucky COM
submitted by theyoungriddler to premed [link] [comments]


2023.06.05 01:16 yesAThrowawayName I [34M] disinvited my mother [58F] from my wedding for continuing to ask to take my stepfather [60?M], should I apologize for that?

Throwaway because my cousin knows my regular account.
My fiancée [29F] and I are getting married soon and my mother has been getting more and more irritating by bringing up my stepfather, who is not invited. My biological father was verbally and physically abusive, and when my mother left him when I was about 8 she began dating and married my stepfather. My stepfather does seem to love my mother and vaguely like my brothers, but he hates me. He was often very verbally abusive to me (and on a handful of occasions, he was physically abusive).
He was never a positive figure in my life, and since moving out I have never spoken to him and avoid visiting my mother due to him (and because, frankly, I resent her inaction). As such, he was not invited to our wedding, and my fiancée and I have made it very clear to my mother that she is not allowed to bring him to the wedding or any of our events.
However, since receiving the invitation, she has not once refrained from mentioning him when we've spoken (and she's insisted upon talking to me more often than normal). Usually, she doesn't mention him unless some major event happened, but now she will talk about him endlessly between asking me how wedding planning is going. She has also asked over the phone if she could take him to the wedding on three separate occasions, and has asked if he could attend the rehearsal dinner on two separate occasions.
Two days ago, my fiancée and I were invited to a family dinner to celebrate my nephew's high school and my niece's kindergarten graduation, where my mother and stepfather (in addition to my brothers, their children & wives, my cousin & her wife, my grandma, and my aunt & uncle) were present. Once the kids were sent to bed the conversation turned towards our wedding. My mother decided to express to everyone that she was terribly upset that my stepfather was not invited, and given that he was quiet now he should be invited because it is apparently not completely impossible for him to shut up.
I was not happy about her bringing this up in front of everyone (or at all). I snapped at her, told her that I had been clear that I didn't want to hear it and wasn't going to change my mind, and told her that because she couldn't respect my wishes, she was no longer invited to my wedding. She started crying and my stepfather started swearing at me. She then told me that it was cruel to not let her go because I'm her son and she's done x, y, and z for me. I then told her that she didn't seem too concerned with all that when my stepfather was denigrating me and telling me I wasn't worth anything as a person while I was still a child, but this didn't stop her from whining.
My fiancée and I left after that. Aside from my fiancée (who very clearly supports me and has been an absolute angel this and every other time my mother's insistences have upset me) and grandma (who thinks I could have been less acerbic), every family member has said that I was being a dick.
Should I apologize for the way I spoke to her in front of other people? Should I reinstate her invitation? How can I work through some of this animosity?
Tl;dr - My mother wouldn't stop talking about how she wanted to bring my verbally abusive stepfather to my wedding, so I disinvited her. Should I apologize or "take back" any of what I said?
submitted by yesAThrowawayName to relationships [link] [comments]


2023.06.05 00:49 forgetablepassenger The End of an era... kinda (Reading the Archie comics Pt5)

The End of an era... kinda (Reading the Archie comics Pt5)
I did it... After weeks of pain staking issues, bad writing, and poor execution... it's over. I'm only going to be talking very key moments in this series because talking about each issue would be boring as hell, and it sounds like a lot of work.
The Gag era: I don't really mind this era of comics. It's wasn't meant to be taken seriously, so why should? Slowly, it got more serious, but it was still mostly comedic. The later half is this run is where things kinda got crazy (a sign of things to come...). The writers during this era were none other Michael Gallagher, ken Taylor, Karl bollers, and, of course, the infamous Ken Penders. The rest of the issues would slowly BUT SURELY rot my brain into a soupy mush (image it like oatmeal, but instead of nutritious breakfast, it's brain matter).
The Knuckles comics: Never in my life have I read such atrocious story-telling until these issues. I've always heard the knuckles' comics bad, so I came into reading thinking "OK, I know these are gonna bad but that can't be THAT bad" and OOOOOOOHHHH BOY THEIR WORSE THAN I THOUGHT! The way Penders write his stories is horrible. I've never seen so much word vomit in ONE ISSUE, and don't get me started on how he does flashbacks and exposition. The characters are written poorly, when he draws an issue it's bad to look at, and the plot (if you even want to call it that) is fucking convoluted and messy that it physically brings me pain. I couldn't go on and on about Pender, then it'll turn into a "penders sucks," post, and I don't want that.
The Slap: sigh frankly, this was stupid and an overexaggeration (ik it's not a real word shush). This really horned in how much I don't really like romance in the Sonic series. Don't get me wrong, it can be cute sometimes, but I'd rather it not in it in the first place.
The last 9 issues: By this time, Karl bollers had to quit archie (at least he ended on a high note. I actually liked that arc and have the echidnas no less.) Meaning that Ken took over the rest of the issues before he inevitably quit. These were... very hard to get through... because WE'RE BACK TO ROMANTIC BULLSHIT!! ( bollers did these romantic stories throughout some of his own stuff, and yes, I didn't like them either, but penders were worse at these) God, I just wanted cool Sonic stories, but Penders was like, "Hey, you wanna see anti-sonic get with bunnie and have implied that might have had sex" (technically rape which makes this scene worse. I want to cry.)
I'm SOOOOOOOOOOO glad I'm done with this part of the series. I want to start reading what some people call (even some of you) have called "peak" sonic. I'll have to see for myself. TL;DR: I hate reading this part of the series, but I'm onto something better.
submitted by forgetablepassenger to MoonPissing [link] [comments]


2023.06.04 23:41 Danthedude1 Ultimate ERB Poll results

Hey again, it's me, the guy who did that big poll 2 weeks back. I finally stopped procrastinating and compiled the results here (I meant to post this like a week ago, when the responses slowed down).
Anyway, thanks for the support on this! I got 90 responses, and the poll did much better than I thought it would. Here's the results:
(Below, the text in bold are the results, and the normal text are my comments. All percentages are calculated without the "Haven't watched" responses included, while the haven't watched percentages themselves are calculated with all votes counted. Remember that every question was required, so all questions had 90-91 votes). Hopefully my explanation isn't too terrible. If a percentage has a tilde (~) in front of it, the percent was rounded up to the nearest tenth.

John Lennon vs. Bill O'Reilly
Darth Vader vs. Adolf Hitler
Only one person said they didn't watch it. I checked the responses and the person who said that responded HW for 50% of the battles, so that's why. Not calling them out or anything, just thought you might be wondering
Abe Lincoln vs. Chuck Norris
Sarah Palin vs. Lady Gaga
Hulk Hogan and Macho Man vs. Kim Jong-Il
Justin Bieber vs. Beethoven:
With a percentage of 97.6%, Beethoven has the biggest slam dunk out of every battle on this list.
Albert Einstein vs. Stephen Hawking
Genghis Khan vs. Easter Bunny
Napoleon vs. Napoleon
Okay so at this point someone decided to submit a vote, so the results above are off by one vote. I'm not wasting my time changing it.
Billy Mays vs. Ben Franklin
Gandalf vs. Dumbledore
I believe this is the least watched battle. Apparently, more than 1/4 of this subreddit has not watched this battle
Dr. Seuss vs. Shakespeare
I'm assuming that Thing 1 and 2 drag down the team a lot.
Mr. T vs. Mr. Rogers
Christopher Columbus vs. Captain Kirk
NicePeter vs. EpicLLOYD
Hitler vs. Vader 2
Master Chief vs. Leonidas
Mario Bros vs. Wright Bros
Michael Jackson vs. Elvis Presley
Cleopatra vs. Marilyn Monroe
Steve Jobs vs. Bill Gates
This is the most balanced 1v1+1 battle. Kind of surprised that HAL got so many votes, I initially believed that people didn't like that part of the battle.
Frank Sinatra vs. Freddie Mercury
Barack Obama vs. Mitt Romney
This is the only battle in which everyone stated they had watched it. Makes sense, it is ERB's most viewed video
Doc Brown vs. Doctor Who
Bruce Lee vs. Clint Eastwood
Batman vs. Sherlock Holmes
I bet Robin would've done better if he were a standalone option.
Moses vs. Santa Claus
Adam vs. Eve
Gandhi vs. Martin Luther King Jr
Nikola Tesla vs. Thomas Edison
Babe Ruth vs. Lance Armstrong
Mozart vs. Skrillex
Rasputin vs. Stalin
This one. Actually suprised to see Lenin so high, I've never really seen anyone talk about his verse.
Hitler vs. Vader 3
With the trilogy complete, Darth Vader wins best of three 2-1.
Blackbeard vs. Al Capone
Miley Cyrus vs. Joan of Arc
Bob Ross vs. Pablo Picasso
Michael Jordan vs. Muhammed Ali
Donald Trump vs. Ebeneezer Scrooge
This one is weird. Meta-battles cause problems for polls because, well, do you need a winner for a story? I considered leaving this one out, and I also considered all the ghosts being put on one team, but I really just see these results as "Who had the best verse?", over who won the battle.
Rick Grimes vs. Walter White
Goku vs. Superman
Stephen King vs. Edgar Allen Poe
Sir Isaac Newton vs. Bill Nye
George Washington vs. William Wallace
Artists vs. TMNT
Ghostbusters vs. Mythbusters
Romeo and Juliet vs. Bonnie and Clyde
Zeus vs. Thor
Jack the Ripper vs. Hannibal Lecter
Oprah Winfrey vs. Ellen DeGeneres
Steven Spielberg vs. Alfred Hitchcock
Lewis and Clark vs. Bill and Ted
David Copperfield vs. Harry Houdini
I'm not sure, but I'm pretty sure this is the most balanced battle. Nvm, there's a closer one.
Terminator vs. Robocop
Alright, we're moving onto East vs. West Philosophers. In the poll, I split it into two categories: teams and individual.
Eastern Philosophers vs. Western Philosophers (Team)
Eastern Philosophers vs. Western Philosophers (Solo)
So yeah, the Western Philosophers barely scrape the win both times. Also, an attentive reader will notice that the first part has 4 "Haven't watched" votes, while the other one has 5. Someone did the poll wrong.
Shaka Zulu vs. Julius Caesar
Jim Henson vs. Stan Lee
You might have noticed the weird haven't watched thing. It turns out, I accidentally left that question unrequired, so someone skipped the question, leaving it with only 90 responses. Due to the fact someone skipped, I assume they haven't watched.
Deadpool vs. Boba Fett
J. R. R. Tolkien vs. George R. R. Martin
Gordon Ramsey vs. Julia Child
Frederick Douglass vs. Thomas Jefferson
James Bond vs. Austin Powers
Bruce Banner vs. Bruce Jenner
Alexander the Great vs. Ivan the Terrible
Well, let's talk about Pompey. At the start, Pompey was leading the poll, however people seemed to vote normally after that. I have my reasons for including him (aka it was funny), though you might disagree and that's totally fine. I would probably upset more people if I excluded him in any case.
Donald Trump vs. Hillary Clinton
Ash Ketchum vs. Charles Darwin
Wonder Woman vs. Stevie Wonder
Tony Hawk vs. Wayne Gretsky
Theodore Roosevelt vs. Winston Churchill
Nice Peter vs. EpicLLOYD 2
This means that EpicLLOYD has won both times.
Elon Musk vs. Mark Zuckerberg
Freddy Krueger vs. Wolverine
Guy Fawkes vs. Che Guevara
Ronald McDonald vs. The Burger King
- Haven't watched: 6 votes (6.6%)
George Carlin vs. Richard Pryor
Once again, I included Bill Cosby for the same reason as Pompey. Cosby did better than 2 people, but none of them did very well anyway. This battle was mostly in contention between Rivers and Williams
Jacques Cousteau vs. Steve Irwin
Mother Teresa vs. Sigmund Freud
Vlad the Impaler vs. Count Dracula
The Joker vs. Pennywise
Thanos vs. J. Robert Oppenheimer
Donald Trump vs. Joe Biden
With that, all 3 election battles had the "winner" be the actual winner of the election. Curious.
Harry Potter vs. Luke Skywalker
Ragnar Lodbrok vs. Richard the Lionheart
Jeff Bezos vs. Mansa Musa
John Wick vs. John Rambo vs. John McClane
Lara Croft vs. Indiana Jones
And that's it. If you made it down here, congrats, you just absorbed a bunch of useless info. Thank you for taking the time to read. I might do something like this again in the future, with opinions on things other than the winners of the battles (things like best battle, season, rapper). But not for a while, considering how long it took to compile this data. Anyways, that's my time, gotta set myself free.
submitted by Danthedude1 to ERB [link] [comments]


2023.06.04 20:06 mightbeathrowaway70 Can I do something to make sure someone does not become a therapist?

okay this might be a long post but I would like to know if I could do something about this girl I know. To be frank this girl is obsessive and a pathological liar. I outted her back in high school only to her, her brother and my close friend at the time knew because they were the ones who helped me figure out that she lied about her dad having cancer for at that point 2 years. I would like to make it clear, it was about once a week give or take that she was crying over her "dying father". I tell her that shes lying and all she did was not talk to me and that was that. A few years go by and we are all in college and her best friend (we spoke semi often after high school) spoke to me how she was upset because it was like she became a different person and how they had not have been talking as much. I said "well you know she is a bad person right?" and explained to her how she lied about her father. The girl calls the liar about this and at first she doesnt admit it but eventually caves in and says that she lied and chalked it up to other issues she had. They stop talking and now my friend gets prank calls, text messages and other petty garbage. I get a few prank calls but my friend is getting most of the problems (i would like to mention the girl who lied denies that she never prank called us, which is a lie). We bring parents involved and shes lying the whole way through and is shaking and red in the face, kept cutting me and my friend off while explaining our points. Reguardless, its over, nothing changes and no one besides the old best friend and her boyfriend knows about her dad not ever having cancer. Come a few months later prank calls AGAIN. stupid and dumb yes but at this point i have not spoken to this girl neither has my friend or any one for that matter and she decides to start with the prank calls again and for a few weeks this goes on for. she made the mistake of calling me in which i record the whole thing and call my boyfriend. so i text her best friend that she lied about her dad having cancer and that she is crazy. she then texts me saying how she never prank called me and yada yada, and is super angry i told her friend. she then keeps texting me saying how this is over and we should be grown ups blah blah. she sends me 19 text messages where i respond to zero and says how she is going to get a harassment charge against me and my friend, she said that my friend should watch her back (WTF? THIS GIRL DIDNT DO ANYTHING????) regardless the prank calls stopped and I am back at square one. why is this all important? this nut job wants to become a child therapist. this obsessive nut job should not be near anyone. she manipluated everyone around her, does childish stuff like prank call, and makes you feel like ur the crazy one when shes the manipluator. she goes to therapy herself and obviously hasnt gotten far but i need to know is therre somehting i could do to make sure she doesnt become a therapist??
TL;DR: manipulative, pathological liar, obsessive-nutcase wants to become a child therapist when she should not
submitted by mightbeathrowaway70 to askatherapist [link] [comments]


2023.06.04 20:04 Weary_Flower_6921 I hate the Braves. Trade me your Mets and Ohtani cards and get these out of my house.

I hate the Braves. Trade me your Mets and Ohtani cards and get these out of my house. submitted by Weary_Flower_6921 to baseballcards [link] [comments]


2023.06.04 18:28 1234ideclareworldwar (Low Effort Sunday) I don't how understand how a good portion of the Succession fanbase could have watched 4 seasons of this show and still be left surprised by the ending

Major spoilers for HBOs "Succession", obviously. Also if you have any interest in this show, like any at all, please don't read this rant, it will definitely ruin part of the experience for you. Also, this should be fairly obvious based on the overwhelmingly positive reception its received both my critics and audiences, this is a really good fucking show, with some of the best acting, dialogue and music (holy shit the music) I've ever seen on television. It is a family drama following 3 children battling for control of their aging fathers media conglomerate (with the crown jewel being the equivalent of fox news), with the central question the series posses being who will succeed the fathefounder, and everyone involved happens to be a raging narcissist.
That being said Succession seems to have suffered a fate most IPs do when they become popular; fan discourse surrounding it devolves into unfunny memes, tribalistic stan wars, and a complete misunderstanding the story and characters and the themes they are communicating, with the succession subreddit sorta being a perfect storm for all of this nonsense. I'm really not trying to sound pretentious here or flex my flawless media literacy it whatever, but I seriously don't understand how one can watch 4 seasons of this show and think a Roy kid was gonna win the company in the end.
None of the three main kids, who the story is largely told from the perspective of, are component, or in the words of their father, "serious" people and the show makes this obvious. Kendall, the eldest boy (sorry Connor you're irrelevant), has worked at the company and at the beginning of the series is seemingly positioned as the obvious choice to succeed his father, but he suffers from addiction issues and lacks the sense of business initiative or ruthlessness his father wants. The second boy, Roman, who was the biggest victim of the fathers abusive tendencies, is basically a manchild, prone to emotional outbursts, a sexual deviant, and basically needs to be ordered around, making him the most loyal to the father but also his least favourite, and is never really taken seriously as a legitimate successor by anyone.
Finally there is Shiv, the daughter, and oh boy where to even start here. The discourse surrounding this character could frankly get a rant of its own, but the jist of it is Shiv laughs at the common trope in modern media of the women always being the smartest in the room. While she is seemingly more articulate and book smart than her brothers, she is comically entitled, inexperienced and power hungry, but completely overestimates her own intelligence time after time that more or less leads to her taking L after L after L, humiliation after humiliation and you can't even feel bad because the character is given almost no redeeming qualities. Despite having no experience at the company or in the business world, she feels entitled to be CEO of one of Americas largest corporations and even rejects her fathers proposal of a 3-5 year fast track working in the company to prepare her for the role. She decries misogyny and the corporations enabling of reactionary right wing politics, but intimidates sexual assault victims, tries to get another women fired for being sexually harassed by her brother (Roman), and immediately U-turns on her opposition to a pseudo-fascist president the moment she realizes it could help her gain power in the company. She marries Tom, a man she considers weak and servile for the purpose of controlling him, cheating on him, proposing an open relationship the night after they get married, yet still ends up getting fucked over by him multiple times. She has no values, fails at everything, is cruel, smug and condescending to everyone around her (and the actress absolutely nails it!), so no, this absolutely is not another Skylar White situation, lol.
Oh and guess who does end up being CEO in the end? Tom, though admittedly he is more or less a puppet/pain sponge to the Swedish Techbro who ends up buying out the company. Thats the thing cool thing about succession, the concepts of "winning and losing" are hysterically warped. The kids "lose" while gaining a billion dollar cashout, because they were so comically rich to begin with money didn't even matter. There's even fourth kid who doesn't involve himself in the company at all who pretty much just lives a life of leisure and luxury off the money he was born into without bothering with work at all. The company mattered to them because it meant succeeding their father, symbolic of his favouritism, which they all desperately wanted. The Dad (Logan) however, a raging abusive narcissist himself, probably the morally most despicable character in the series even, was always disappointed with his children, jealous of them even for the comfortable upbringing he provided them with compared to one of hardship and suffering he experienced, and thus encouraged them to backstab and compete with each other in hopes they'd finally become someone he was proud of. Logan dies early into season 4, simply succumbing to his age and fragility on a plane, and even catches an L from beyond the grave as his kids end up losing ATN (fox news equivalent) to the swedish tech bro (which was not part of the original acquisition detail Logan had agreed to) and thus the propaganda arm of the American right is effectively controlled by a foreigner.
The series ends with the three kids making one final play to stop the company being sold to the tech bro in the shareholder board meeting, of which they are all members of. Shiv was originally working with the Tech Bro under the faulty assumption that he would make her the puppet CEO, but like everyone else he doesn't take her seriously and plays her like a fiddle. When she finds out about this the night before the acquisition is to be voted on, she defects to her brothers side and they all agree to make Kendall CEO. During the shareholder meeting however, Shiv becomes the tie breaking vote and gets cold feet, triggered by Kendall already acting like a arrogant, unprofessional frat guy, resulting in an absolutely hysterical sequence where the siblings argue and even fight like literal children in front of the entire company and ends with Shiv signing over the control of the company to the TechBro and Tom being named as the new CEO. Roman seems to have the "happiest" ending of the three, seemingly finally gaining clarity to how pointless this all was. Shiv (who is pregnant with Toms child), returns to his side in a nasty role reversal of the power dynamics of their relationship, with the implication being she'll end up a housewife/mother, a seemingly brutal fate to a women of her ambition. Kendall gets easily the most crushing blow, estranged from his family, betrayed by his siblings, his only company being a security guard who watches him to ensure he doesn't commit suicide. Some people loved this ending, some people hated it, but a concerning amount of people either didn't seem to coming or "doesn't think it makes sense". I really question if these people were watching the same show for the past 5 years because this was a predictable, heavily forshadowed conclusion.
Succession is heavily inspired by Shakespeares King Lear, a story in which 3 children fight (and eventually die) for control of their aging fathers kingdom. There are multiple cases of direct dialogue references to quotes from this play in the show, but even if you missed this, the entire show constantly and repeatedly hammers home the fact that the 3 main characters are incompetent nepobabies, with their flaws being explicitly spelled out numerous times, often by their own father or even each other. Yet a good portion of the audience seemed to think or hope that this story was going to end with one of siblings (usually Kendall or Roman, most people didn't seem to take Shiv seriously) finally becoming the "killer" their father wanted and taking over the company, and of course this people were really mad when this didn't happen. There were numerous instances throughout the show of characters making dumb mistakes which the audience then interpreted as moments of triumph, like when Roman ends up getting ATN included as part of the tech bros acquisition of the company. Hell the night before the acquisition vote the kids are fucking around acting like children as if they have already won, just further demonstrating how immature and unserious they are. Really a lot of discourse surrounding the show devolved into "who is worse" or "who deserves it more" kinda like a game of thrones (with the question of "who wins the throne" also not being the point of the book series at least, the dumb hack writers decided to go in that direction in the end), with endless discourse arguing whether Shiv was a worse person than Kendall or not, or if Roman secretly was a business bro god who was gonna rise from his fathers shadow or whatever, and little discussion of the actual themes of the show regarding the impacts of generational wealth and the cycle of abuse. I originally started using reddit as a way to find communities revolving around media I had consumed and how other people had interpreted this content, but it seems that this sorta discourse is increasingly polluted by toxic stan culture, shitty memes, and people looking to use media as an excuse to argue about culture war shit.
Tl:Dr: The succession fanbase are not serious people
submitted by 1234ideclareworldwar to CharacterRant [link] [comments]


2023.06.04 17:54 Scooby_Myers 28m Heyy! Night owl here looking for a chill, wholesale soul (: [Chat]

Hey there, A few things about me : Midwest home and grown!
Musically influenced. I like outdoors & camping( a introverts dream)
I'd also like to mention, that im a introvert that finds himself in his own company a lot .I like to consider myself friendly. Warm , compassionate, Laid back, well mannered.
As most people want to be treated as such . I'm more of a home body, So that's where reddit comes into play. I keep a small circle, it's been easier for me that way. Its something I take a lot if pride in doing.
I'd really enjoy a deep , consistent connection as well out of this.
I like to read & write when I'm not being a nerd or something Big on horror stories & and movies, but not all that im into . Music-related wide range there too, but metal /rock/rap/ alternative and yes( the softer stuff too) Not all metal heads are desensitized!
I'd say supernatural/ crime fiction/ mystery as well as horror books I mentioned a second ago. Audiobooks have gotten more popular with Mr lately. Creative writing is another hobby.( mostly mystery-suspense- a horror element to blend too.
Podcasts: I like listening to scare you to sleep on spotify. And Dr. No sleep.
Love to cook and try new things/ recipes even though they don't always turn out good 😋 I can kinda bake . I'm kinda basic and simple but home-style is my jam!
Interests /goals/ motivation
*playing guitar, learning drums, and well as sampling / producing music.( all goals)
*but guitar is my main interest for sure. I've recently gotten back into practicing.
*Snowboarding, getting a motorcycle ( goals/ interest)
More tattoos ( I have a little guy on my shoulder!: this is a want definitely)
I'm looking for a friendly yet rambunctious spirit to vibe with (: age range id say," mid 20's and lower 30's preferred. Ill reply to all but I'd prefer to have a girl bestie im gonna be frank with that.
I'm finally at a better place in my life
Although not looking for anything too specific but im pretty much open if we end up clicking & chatting on a regular basis. I have a few platforms to chat on if we click too also. I'm open to voice calls as well, I feel like that's important in connections.
Cause let's face it, This new Reddit chat is buggy as hell sometimes..
Please feel free to reach out , im looking to hear from you & hopefully you have a good day P.S thanks for talking the time and reading this! (:
submitted by Scooby_Myers to MeetPeople [link] [comments]


2023.06.04 17:51 Scooby_Myers 28m Helloo just a Drifter looking for a chill, warm bestie (:

Hey there, A few things about me : Midwest home and grown!
Musically influenced. I like outdoors & camping( a introverts dream)
I'd also like to mention, that im a introvert that finds himself in his own company a lot .I like to consider myself friendly. Warm , compassionate, Laid back, well mannered.
As most people want to be treated as such . I'm more of a home body, So that's where reddit comes into play. I keep a small circle, it's been easier for me that way. Its something I take a lot if pride in doing.
I'd really enjoy a deep , consistent connection as well out of this.
I like to read & write when I'm not being a nerd or something Big on horror stories & and movies, but not all that im into . Music-related wide range there too, but metal /rock/rap/ alternative and yes( the softer stuff too) Not all metal heads are desensitized!
I'd say supernatural/ crime fiction/ mystery as well as horror books I mentioned a second ago. Audiobooks have gotten more popular with Mr lately. Creative writing is another hobby.( mostly mystery-suspense- a horror element to blend too.
Podcasts: I like listening to scare you to sleep on spotify. And Dr. No sleep.
Love to cook and try new things/ recipes even though they don't always turn out good 😋 I can kinda bake . I'm kinda basic and simple but home-style is my jam!
Interests /goals/ motivation
*playing guitar, learning drums, and well as sampling / producing music.( all goals)
*but guitar is my main interest for sure. I've recently gotten back into practicing.
*Snowboarding, getting a motorcycle ( goals/ interest)
More tattoos ( I have a little guy on my shoulder!: this is a want definitely)
I'm looking for a friendly yet rambunctious spirit to vibe with (: age range id say," mid 20's and lower 30's preferred. Ill reply to all but I'd prefer to have a girl bestie im gonna be frank with that.
I'm finally at a better place in my life
Although not looking for anything too specific but im pretty much open if we end up clicking & chatting on a regular basis. I have a few platforms to chat on if we click too also. I'm open to voice calls as well, I feel like that's important in connections.
Cause let's face it, This new Reddit chat is buggy as hell sometimes..
Please feel free to reach out , im looking to hear from you & hopefully you have a good day P.S thanks for talking the time and reading this! (:
submitted by Scooby_Myers to MakeNewFriendsHere [link] [comments]


2023.06.04 17:49 Scooby_Myers 28[M4F] - Midwest US - Hey Night owl here! looking for a Chill, Wholesome soul (:

Hey there, A few things about me : Midwest home and grown!
Musically influenced. I like outdoors & camping( a introverts dream)
I'd also like to mention, that im a introvert that finds himself in his own company a lot .I like to consider myself friendly. Warm , compassionate, Laid back, well mannered.
As most people want to be treated as such . I'm more of a home body, So that's where reddit comes into play. I keep a small circle, it's been easier for me that way. Its something I take a lot if pride in doing.
I'd really enjoy a deep , consistent connection as well out of this.
I like to read & write when I'm not being a nerd or something Big on horror stories & and movies, but not all that im into . Music-related wide range there too, but metal /rock/rap/ alternative and yes( the softer stuff too) Not all metal heads are desensitized!
I'd say supernatural/ crime fiction/ mystery as well as horror books I mentioned a second ago. Audiobooks have gotten more popular with Mr lately. Creative writing is another hobby.( mostly mystery-suspense- a horror element to blend too.
Podcasts: I like listening to scare you to sleep on spotify. And Dr. No sleep.
Love to cook and try new things/ recipes even though they don't always turn out good 😋 I can kinda bake . I'm kinda basic and simple but home-style is my jam!
Interests /goals/ motivation
*playing guitar, learning drums, and well as sampling / producing music.( all goals)
*but guitar is my main interest for sure. I've recently gotten back into practicing.
*Snowboarding, getting a motorcycle ( goals/ interest)
More tattoos ( I have a little guy on my shoulder!: this is a want definitely)
I'm looking for a friendly yet rambunctious spirit to vibe with (: age range id say," mid 20's and lower 30's preferred. Ill reply to all but I'd prefer to have a girl bestie im gonna be frank with that.
I'm finally at a better place in my life
Although not looking for anything too specific but im pretty much open if we end up clicking & chatting on a regular basis. I have a few platforms to chat on if we click too also. I'm open to voice calls as well, I feel like that's important in connections.
Cause let's face it, This new Reddit chat is buggy as hell sometimes..
Please feel free to reach out , im looking to hear from you & hopefully you have a good day P.S thanks for talking the time and reading this! (:
submitted by Scooby_Myers to r4r [link] [comments]


2023.06.04 17:14 bigfatsac Best TV’s Frank death 💀

The one where Dr. F wrings him through the cartooner still is a little upsetting, but I think my favorite is when frank gets deep fried. How about you?
submitted by bigfatsac to MST3K [link] [comments]


2023.06.04 16:28 Alternative-Coat6972 How can we (25f) (24m) stop fighting about the same thing?

I need an outsiders perspective, because we both feel like we're going crazy. We've been dating for two years and moved in together at the beginning of the year.
My boyfriend, Josh (fake name), is a wonderful man. He's very hardworking and funny and overall just lovely to be around. He's my best friend in the entire world, and I love spending time with him. The issue therein lies with his friends. And let me make myself very clear: I like his friends. I do! I think they're also very funny and hardworking people. But I also think they're a little immature.
Josh spends a LOT of time with his friends. Probably more than he spends with me. This has always really bothered me, but Josh has gotten better with the balance. We plan nights just for us and I go out with his friends a lot (we'd go out with mine too, but all my friends are scattered around the state so we barely see each other). We recently argued about him spending too much time with his friends and not making me a priority, and Josh admitted that he sometimes feels FOMO when he's not with his friends. That hurt, because it made me feel like he didn't want to spend time with me when he was with me. As if he was just thinking about his friends when he was with me.
Josh's friends also believe that he's whipped, and they never fail to bring it up. If Josh and I are dong something together, they'll make fun of him. They refer to the girlfriends of the group as being "a ball and chain". Josh does NOT believe this and normally just laughs it off. I talked to him about this and he assured me that it was just a joke. I told him that I did not find it very funny, and he told me that his friends don't actually think this way. It's just a "guy's joke". I told him that none of my female friends found the joke to be particularly funny, as it's a little immature and, quite frankly, misogynistic. And in case you were wondering... no, very few of his friends are in a relationship.
We've talked about this many many many times, and we seem to be at an impasse. I'm not asking him to drop his friends, but I am telling him that it hurts my feelings that his friends think of me this way. I know I'm probably just being a bit sensitive and overreacting a bit, as I have my own insecurities. I never really think that people want to spend time with me, and I think this particular thing just strikes a chord within me. I would NEVER ask my boyfriend to drop his friends, but he thinks he might have to choose one day. I told him that if I ever make him choose, he should break up with me right away. I don't want to isolate him- I think I just need reassurance that, yes, he does want to spend time with me. He doesn't want to be with his friends at all times and he's not just doing things I want to do because he's "whipped".
How do we come to a conclusion? I think we're both wrong in this situation tbh- me being a little oversensitive/harping on the same issue, and him sometimes prioritizing his friends.
tl;dr: My boyfriend's friends are a little immature, and he sometimes prioritizes them. This has led to many many arguments.
submitted by Alternative-Coat6972 to relationship_advice [link] [comments]


2023.06.04 14:34 Dirtclodkoolaid AMA RESOLUTION 235

AMA RESOLUTION 235
AMA RESOLUTION 235 November 2018 INAPPROPRIATE USE OF CDC Guidelines FOR PRESCRIBING OPIOIDS (Entire Document)
“Resolution 235 asks that our AMA applaud the CDC for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths; and be it further, that no entity should use MME thresholds as anything more than guidance and that MME thresholds should not be used to completely prohibit the prescribing of, or the filling of prescriptions for, medications used in oncology care, palliative medicine care, and addiction medicine care: and be it further, that our AMA communicate with the nation’s largest pharmacy chains and pharmacy benefit managers to recommend that they cease and desist with writing threatening letters to physicians and cease and desist with presenting policies, procedures and directives to retail pharmacists that include a blanket proscription against filling prescriptions for opioids that exceed certain numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care; and be it further, that AMA Policy opposing the legislating of numerical limits on medication dosage, duration of therapy, numbers of pills/tablets, etc., be reaffirmed; and be it further, that physicians should not be subject to professional discipline or loss of board certification or loss of clinical privileges simply for prescribing opioids at a quantitative level that exceeds the MME thresholds found in the CDC Guidelines; and be it further, that our AMA encourage the Federation of State Medical Boards and its member boards, medical specialty societies, and other entities to develop improved guidance on management of pain and management of potential withdrawal syndromes and other aspects of patient care for “legacy patients” who may have been treated for extended periods of time with high-dose opioid therapy for chronic non-malignant pain.
RESOLVED, that our American Medical Association (AMA) applaud the Centers for Disease Control and Prevention (CDC) for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths
RESOLVED, that our AMA actively continue to communicate and engage with the nation’s largest pharmacy chains, pharmacy benefit managers, National Association of Insurance Commissioners, Federation of State Medical Boards, and National Association of Boards of Pharmacy in opposition to communications being sent to physicians that include a blanket proscription against filing prescriptions for opioids that exceed numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care.
RESOLVED, that our AMA affirms that some patients with acute or chronic pain can benefit from taking opioid pain medications at doses greater than generally recommended in the CDC Guideline for Prescribing Opioids for Chronic Pain and that such care may be medically necessary and appropriate, and be it further
RESOLVED, that our AMA advocate against misapplication of the CDC Guideline for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit patients’ medical access to opioid analgesia, and be it further
RESOLVED, that our AMA advocate that no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guideline for Prescribing Opioids.””
Pain Management Best Practices Inter-Agency Task Force - Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations Official Health and Human Services Department Released December 2018
“The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force (Task Force), whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The Task Force consists of 29 experts who have significant experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health.”
In addition to identifying approximately 60 gaps in clinical best practices and the current treatment of pain in the United States, HHS PMTF provided recommendations for each of these major areas of concern. In alignment with their original charter, the PMTF will submit these recommendations to Congress to become our ‘National Pain Policy’. The 60+ gaps and inconsistencies with their recommendations will serve to fill gaps in pain treatment at both the state and federal level; and the overwhelming consensus was that the treatment of pain should be multimodal and completely individualized based on the individual patient. The heart of each recommendation in each section was a resounding call for individualization for each patient, in regards to both non-pharmacological and pharmacological modalities; including individualizations in both opioid and non-opioid pharmacological treatments.
While each of the gap+recommendation sections of what is poised to become our national pain policy is extremely important, one that stands out the most (in regards to opioid prescribing) is the Stigma section. Contained in this section is one of the core statements that shows our Health and Human Services agency - the one that should have always been looked to and followed - knew the true depth of the relationship (or lack of) between the overdose crisis and compassionate prescribing to patients with painful conditions:
“The national crisis of illicit drug use, with overdose deaths, is confused with appropriate therapy for patients who are being treated for pain. This confusion has created a stigma that contributes to raise barriers to proper access to care.”
The recommendation that follows - “Identify strategies to reduce stigma in opioid use so that it is never a barrier to patients receiving appropriate treatment, with all cautions and considerations for the management of their chronic pain conditions” - illustrates an acknowledgment by the top health agency of the federal government that the current national narrative conflating and confusing compassionate treatment of pain with illicit drug use, addiction, and overdose death is incorrect and only serving to harm patients.
Since March of 2016 when the CDC Guidelines were released, advocates, patients, clinicians, stakeholders, and others, have began pointing out limitations and unintended consequences as they emerged. In order to address the unintended consequences emerging from the CDC Guidelines, this task force was also charged with review of these guidelines; from expert selection, evidence selection, creation, and continuing to current misapplication in order to provide recommendations to begin to remedy these issues.
“A commentary by Busse et al. identified several limitations to the CDC guideline related to expert selection, evidence inclusion criteria, method of evidence quality grading, support of recommendations with low-quality evidence, and instances of vague recommendations. In addition, the CDC used the criterion of a lack of clinical trials with a duration of one year or longer as lack of evidence for the clinical effectiveness of opioids, whereas Tayeb et al. found that that was true for all common medication and behavioral therapy studies.
Interpretation of the guideline, in addition to some gaps in the guideline, have led to unintended consequences, some of which are the result of misapplication or misinterpretation of the CDC guideline.
However, at least 28 states have enacted legislation related to opioid prescription limits, and many states and organizations have implemented the guideline without recognizing that the intended audience was PCPs; have used legislation for what should be medical decision making by healthcare professionals; and have applied them to all physicians, dentists, NPs, and PAs, including pain specialists.441–444 Some stakeholders have interpreted the guideline as intended to broadly reduce the amount of opioids prescribed for treating pain; some experts have noted that the guideline emphasizes the risk of opioids while minimizing the benefit of this medication class when properly managed.”
“The CDC guideline was not intended to be model legislation for state legislators to enact”
“In essence, clinicians should be able to use their clinical judgment to determine opioid duration for their patients”
https://www.hhs.gov/ash/advisory-committees/pain/reports/2018-12-draft-report-on-updates-gaps-inconsistencies-recommendations/index.html
HHS Review of 2016 CDC Guidelines for responsible opioid prescribing
The Pain Management Task Force addressed 8 areas that are in need of update or expansion with recommendations to begin remediation for each problem area:
Lack of high-quality data exists for duration of effectiveness of opioids for chronic pain; this has been interpreted as a lack of benefit Conduct studies Focus on patient variability and response for effectiveness of opioids; use real-world applicable trials
Absence of criteria for identifying patients for whom opioids make up significant part of their pain treatment Conduct clinical trials and/or reviews to identify sub-populations of patients where long-term opioid treatment is appropriate
Wide variation in factors that affect optimal dose of opioids Consider patient variables for opioid therapy: Respiratory compromise Patient metabolic variables Differences in opioid medications/plasma concentrations Preform comprehensive initial assessment it’s understanding of need for comprehensive reevaluations to adjust dose Give careful considerations to patients on opioid pain regimen with additional risk factors for OUD
Specific guidelines for opioid tapering and escalation need to be further clarified A thorough assessment of risk-benefit ratio should occur whenever tapering or escalation of dose This should include collaboration with patient whenever possible Develop taper or dose escalation guidelines for sub-populations that include consideration of their comorbidities When benefit outweighs the risk, consider maintaining therapy for stable patients on long term opioid therapy
Causes of worsening pain are not often recognized or considered. Non-tolerance related factors: surgery, flares, increased physical demands, or emotional distress Avoid increase in dose for stable patient (2+ month stable dose) until patient is re-evaluated for underlying cause of elevated pain or possible OUD risk Considerations to avoid dose escalation include: Opioid rotation Non-opioid medication Interventional strategies Cognitive behavior strategies Complementary and integrative health approaches Physical therapy
In patients with chronic pain AND anxiety or spasticity, benzodiazepine co-prescribed with opioids still have clinical value; although the risk of overdose is well established When clinically indicated, co-prescription should be managed by specialist who have knowledge, training, and experience with co-prescribing. When co-prescribed for anxiety or SUD collaboration with mental health should be considered Develop clinical practice guidelines focused on tapering for co-prescription of benzodiazepines and opioids
The risk-benefit balance varies for individual patients. Doses >90MME may be favorable for some where doses <90MME may be for other patients due to individual patient factors. Variability in effectiveness and safety between high and low doses of opioids are not clearly defined. Clinicians should use caution with higher doses in general Using carefully monitored trial with frequent monitoring with each dose adjustment and regular risk reassessment, physicians should individualize doses, using lowest effective opioid dose that balances benefit, risk, and adverse reactions Many factors influence benefits and risk, therefore, guidance of dose should not be applied as strict limits. Use established and measurable goals: Functionality ADL Quality of Life
Duration of pain following acute and severely painful event is widely variable Appropriate duration is best considered within guidelines, but is ultimately determined by treating clinician. CDC recommendation for duration should be emphasized as guidance only with individualized patient care as the goal Develop acute pain management guidelines for common surgical procedures and traumas To address variability and provide easy solution, consideration should be given to partial refill system
Human Rights Watch December 2018 (Excerpt from 109 page report)
“If harms to chronic pain patients are an unintended consequence of policies to reduce inappropriate prescribing, the government should seek to immediately minimize and measure the negative impacts of these policies. Any response should avoid further stigmatizing chronic pain patients, who are increasingly associated with — and sometimes blamed for — the overdose crisis and characterized as “drug seekers,” rather than people with serious health problems that require treatment.
Top government officials, including the President, have said the country should aim for drastic cutbacks in prescribing. State legislatures encourage restrictions on prescribing through new legislation or regulations. The Drug Enforcement Administration (DEA) has investigated medical practitioners accused of overprescribing or fraudulent practice. State health agencies and insurance companies routinely warn physicians who prescribe more opioids than their peers and encourage them to reduce prescribing. Private insurance companies have imposed additional requirements for covering opioids, some state Medicaid programs have mandated tapering to lower doses for patients, and pharmacy chains are actively trying to reduce the volumes of opioids they dispense.
The medical community at large recognized that certain key steps were necessary to tackle the overdose crisis: identifying and cracking down on “pill mills” and reducing the use of opioids for less severe pain, particularly for children and adolescents. However, the urgency to tackle the overdose crisis has put pressure on physicians in other potentially negative ways: our interviews with dozens of physicians found that the atmosphere around prescribing for chronic pain had become so fraught that physicians felt they must avoid opioid analgesics even in cases when it contradicted their view of what would provide the best care for their patients. In some cases, this desire to cut back on opioid prescribing translated to doctors tapering patients off their medications without patient consent, while in others it meant that physicians would no longer accept patients who had a history of needing high-dose opioids.
The consequences to patients, according to Human Rights Watch research, have been catastrophic.”
[https://www.hrw.org/report/2018/12/18/not-allowed-be-compassionate/chronic-pain-overdose-crisis-and-unintended-harms-us](
Opioid Prescribing Workgroup December 2018
This is material from the Board of Scientific Counselors in regards to their December 12, 2018 meeting that culminated the works of a project titled the “Opioid Prescribing Estimates Project.” This project is a descriptive study that is examining opioid prescribing patterns at a population level. Pain management is a very individualized process that belongs with the patient and provider. The Workgroup reviewed work done by CDC and provided additional recommendations.
SUMMARY There were several recurrent themes throughout the sessions.
Repeated concern was voiced from many Workgroup members that the CDC may not be able to prevent conclusions from this research (i.e. the benchmarks, developed from limited data) from being used by states or payors or clinical care systems to constrain clinical care or as pay-for- performance standards – i.e. interpreted as “guidelines”. This issue was raised by several members on each of the four calls, raising the possibility that providers or clinical systems could thus be incentivized against caring for patients requiring above average amounts of opioid medication.
Risk for misuse of the analysis. Several members expressed concerns that this analysis could be interpreted as guidance by regulators, health plans, or clinical care systems. Even though the CDC does not plan to issue this as a guideline, but instead as research, payors and clinical care systems searching for ways to reign in opioid prescribing may utilize CDC “benchmarks” to establish pay-for-performance or other means to limit opioid prescribing. Such uses of this work could have the unintended effect of incentivizing providers against caring for patients reliant upon opioids.
…It was also noted that, in order to obtain sufficient granularity to establish the need for, dosage, and duration of opioid therapy, it would be necessary to have much more extensive electronic medical record data. In addition, pain and functional outcomes are absent from the dataset, but were felt to be important when considering risk and benefit of opioids.
...Tapering: Concerns about benchmarks and the implications for tapering were voiced. If tapering occurs, guidance was felt to be needed regarding how, when, in whom tapering should occur. This issue was felt to be particularly challenging for patients on chronic opioids (i.e. “legacy” patients). In addition, the importance of measuring risk and benefit of tapering was noted. Not all high-dose patient populations benefit from tapering.
Post-Surgical Pain
General comments. Workgroup members noted that most patients prescribed opioids do not experience adverse events, including use disorder. Many suggested that further discussion of opioids with patients prior to surgery was important, with an emphasis on expectations and duration of treatment. A member suggested that take-back programs would be more effective than prescribing restrictions.
Procedure-related care. Members noted that patient factors may drive opioid need more than characteristics of a procedure.
Patient-level factors. Members noted that opioid-experienced patients should be considered differently from opioid-inexperienced patients, due to tolerance.
Chronic Pain
It was noted that anything coming out of the CDC might be considered as guidelines and that this misinterpretation can be difficult to counter. There was extensive discussion of the 50 and 90 MME levels included in the CDC Guidelines. It was recommended that the CDC look into the adverse effects of opioid tapering and discontinuation, such as illicit opioid use, acute care utilization, dropping out of care, and suicide. It was also noted that there are major gaps in guidelines for legacy patients, patients with multiple diagnoses, pediatric and geriatric patients, and patients transitioning to lower doses.
There were concerns that insufficient clinical data will be available from the dataset to appropriately consider the individual-level factors that weigh into determination of opioid therapy. The data would also fail to account for the shared decision-making process involved in opioid prescribing for chronic pain conditions, which may be dependent on primary care providers as well as ancillary care providers (e.g. physical therapists, psychologists, etc).
Patient-level factors. Members repeatedly noted that opioid-experienced patients should be considered differently from opioid-experienced patients, due to tolerance.
Members noted that the current CDC guidelines have been used by states, insurance companies, and some clinical care systems in ways that were not intended by the CDC, resulting in cases of and the perception of patient abandonment. One option raised in this context was to exclude patients on high doses of opioids, as those individuals would be qualitatively different from others. A variant of this concern was about management of “legacy” patients who are inherited on high doses of opioids. Members voiced concerns that results of this work has caused harm to patients currently reliant upon opioids prescribed by their providers.
Acute Non-Surgical Pain
Patient-level factors. Members felt that opioid naïve versus experienced patients might again be considered separately, as opioid requirements among those experienced could vary widely.
...Guidelines were also noted to be often based on consensus, which may be incorrect.
Cancer-Related and Palliative Care Pain
It was noted that the CDC guidelines have been misinterpreted to create a limit to the dose of opioids that can be provided to people at all stages of cancer and its treatment. It was also noted that the cancer field is rapidly evolving, with immunotherapy, CAR-T, and other novel treatments that affect response rates and limit our ability to rely upon historical data in establishing opioid prescribing benchmarks.
Concern that data would not be able to identify all of the conditions responsible for pain in a patient with a history of cancer (e.g. people who survive cancer but with severe residual pain). Further, it was noted that certain complications of cancer and cancer treatment may require the least restrictive long-term therapy with opioids.
The definition of palliative care was also complicated and it was suggested that this include patients with life-limiting conditions.
Overall, it was felt that in patients who may not have long to live, and/or for whom returning to work is not a possibility, higher doses of opioids may be warranted.
https://www.cdc.gov/injury/pdfs/bsc/NCIPC_BSC_OpioidPrescribingEstimatesWorkgroupReport_December-12_2018-508.pdf
CDC Scientists Anonymous ‘Spider Letter’ to CDC
Carmen S. Villar, MSW Chief of Staff Office of the Director MS D­14 Centers for Disease Control and Prevention (CDC) 1600 Clifton Road Atlanta, Georgia 30329­-4027
August 29, 2016
Dear Ms. Villar:
We are a group of scientists at CDC that are very concerned about the current state of ethics at our agency. It appears that our mission is being influenced and shaped by outside parties and rogue interests. It seems that our mission and Congressional intent for our agency is being circumvented by some of our leaders. What concerns us most, is that it is becoming the norm and not the rare exception. Some senior management officials at CDC are clearly aware and even condone these behaviors. Others see it and turn the other way. Some staff are intimidated and pressed to do things they know are not right. We have representatives from across the agency that witness this unacceptable behavior. It occurs at all levels and in all of our respective units. These questionable and unethical practices threaten to undermine our credibility and reputation as a trusted leader in public health. We would like to see high ethical standards and thoughtful, responsible management restored at CDC. We are asking that you do your part to help clean up this house!
It is puzzling to read about transgressions in national media outlets like USA Today, The Huffington Post and The Hill. It is equally puzzling that nothing has changed here at CDC as a result. It’s business as usual. The litany of issues detailed over the summer are of particular concern:
Recently, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has been implicated in a “cover up” of inaccurate screening data for the Wise Woman (WW) Program. There was a coordinated effort by that Center to “bury” the fact that screening numbers for the WW program were misrepresented in documents sent to Congress; screening numbers for 2014 and 2015 did not meet expectations despite a multi­million dollar investment; and definitions were changed and data “cooked” to make the results look better than they were. Data were clearly manipulated in irregular ways. An “internal review” that involved staff across CDC occurred and its findings were essentially suppressed so media and/or Congressional staff would not become aware of the problems. Now that both the media and Congresswoman DeLauro are aware of these issues, CDC staff have gone out of their way to delay FOIAs and obstruct any inquiry. Shouldn’t NCCDPHP come clean and stop playing games? Would the ethical thing be to answer the questions fully and honestly. The public should know the true results of what they paid for, shouldn’t they?
Another troubling issue at the NCCDPHP are the adventures of Drs. Barbara Bowman and Michael Pratt (also detailed in national media outlets). Both seemed to have irregular (if not questionable) relationships with Coca­Cola and ILSI representatives. Neither of these relationships were necessary (or appropriate) to uphold our mission. Neither organization added any value to the good work and science already underway at CDC. In fact, these ties have now called into question and undermined CDC’s work. A cloud has been cast over the ethical and excellent work of scientists due to this wanton behavior. Was cultivating these relationships worth dragging CDC through the mud? Did Drs. Bowman and Pratt have permission to pursue these relationships from their supervisor Dr. Ursula Bauer? Did they seek and receive approval of these outside activities? CDC has a process by which such things should be vetted and reported in an ethics review, tracking and approval system (EPATS). Furthermore, did they disclose these conflicts of interest on their yearly OGE 450 filing. Is there an approved HHS 520, HHS 521 or “Request for Official Duty Activities Involving an Outside Organization” approved by Dr. Bauer or her Deputy Director Ms. Dana Shelton? An August 28, 2016 item in The Hill details these issues and others related to Dr. Pratt.
It appears to us that something very strange is going on with Dr. Pratt. He is an active duty Commissioned Corps Officer in the USPHS, yet he was “assigned to” Emory University for a quite some time. How and under what authority was this done? Did Emory University pay his salary under the terms of an IPA? Did he seek and receive an outside activity approval through EPATS and work at Emory on Annual Leave? Formal supervisor endorsement and approval (from Dr. Bauer or Ms. Shelton) is required whether done as an official duty or outside activity.
If deemed official, did he file a “Request for Official Duty Activities Involving an Outside Organization” in EPATS? Apparently Dr. Pratt’s position at Emory University has ended and he has accepted another position at the University of California ­ San Diego? Again, how is this possible while he is still an active duty USPHS Officer. Did he retire and leave government service? Is UCSD paying for his time via an IPA? Does he have an outside activity approval to do this? Will this be done during duty hours? It is rumored that Dr. Pratt will occupy this position while on Annual Leave? Really? Will Dr. Pratt be spending time in Atlanta when not on Annual Leave? Will he make an appearance at NCCDPHP (where he hasn’t been seen for months). Most staff do not enjoy such unique positions supported and approved by a Center Director (Dr. Bauer). Dr. Pratt has scored a sweet deal (not available to most other scientists at CDC). Concerns about these two positions and others were recently described in The Huffington Post and The Hill. His behavior and that of management surrounding this is very troubling.
Finally, most of the scientists at CDC operate with the utmost integrity and ethics. However, this “climate of disregard” puts many of us in difficult positions. We are often directed to do things we know are not right. For example, Congress has made it very clear that domestic funding for NCCDPHP (and other CIOs) should be used for domestic work and that the bulk of NCCDPHP funding should be allocated to program (not research). If this is the case, why then is NCCDPHP taking domestic staff resources away from domestic priorities to work on global health issues? Why in FY17 is NCCDPHP diverting money away from program priorities that directly benefit the public to support an expensive research FOA that may not yield anything that benefits the public? These actions do not serve the public well. Why is nothing being done to address these problems? Why has the CDC OD turned a blind eye to these things. The lack of respect for science and scientists that support CDC’s legacy is astonishing.
Please do the right thing. Please be an agent of change.
Respectfully,
CDC Spider (CDC Scientists Preserving Integrity, Diligence and Ethics in Research)
https://usrtk.org/wp-content/uploads/2016/10/CDC_SPIDER_Letter-1.pdf
January 13, 2016
Thomas Frieden, MD, MPH Director Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30329-4027
Re: Docket No. CDC-2015-0112; Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain
Dear Dr. Frieden:
There is no question that there is an opioid misuse epidemic and that efforts need to be made to control it. The Centers for Disease Control and Prevention (CDC) is applauded for its steps to undertake this lofty effort. However, based on the American Academy of Family Physicians’ (AAFP’s) review of the guideline, it is apparent that the presented recommendations are not graded at a level consistent with currently available evidence. The AAFP certainly wants to promote safe and appropriate prescribing of opioids; however, we recommend that the CDC still adhere to the rigorous standards for reliable and trustworthy guidelines set forth by the Institute of Medicine (IOM). The AAFP believes that giving a strong recommendation derived from generalizations based on consensus expert opinion does not adhere to evidence-based standards for developing clinical guideline recommendations.
The AAFP’s specific concerns with the CDC’s methodology, evidence base, and recommendations are outlined below.
Methodology and Evidence Base
All of the recommendations are based on low or very low quality evidence, yet all but one are Category A (or strong) recommendations. The guideline states that in the GRADE methodology "a particular quality of evidence does not necessarily imply a particular strength of recommendation." While this is true, it applies when benefits significantly outweigh harms (or vice versa). When there is insufficient evidence to determine the benefits and harms of a recommendation, that determination should not be made.
When evaluating the benefits of opioids, the evidence review only included studies with outcomes of at least one year. However, studies with shorter intervals were allowed for analysis of the benefits of nonopioid treatments. The guideline states that no evidence shows long-term benefit of opioid use (because there are few studies), yet the guideline reports "extensive evidence" of potential harms, even though these studies were of low quality. The accompanying text also states "extensive evidence" of the benefits of non-opioid treatments, yet this evidence was from shorter term studies, was part of the contextual review rather than the clinical systematic review, and did not compare non- opioid treatments to opioids.
The patient voice and preferences were not explicitly included in the guideline. This raises concerns about the patient-centeredness of the guideline.
https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/risk/LT-CDC-OpioidGuideline011516.pdf The Myth of Morphine Equivalent Daily Dosage Medscape Neuro Perspective
For far too many years, pain researchers and clinicians have relied on the concept of the morphine equivalent daily dosage (MEDD), or some variant of it, as a means of comparing the "relative corresponding quantity" of the numerous opioid molecules that are important tools in the treatment of chronic pain.
...And, most unfortunately, opioid prescribing guideline committees have relied on this concept as a means of placing (usually arbitrary) limits on the levels of opioids that a physician or other clinician should be allowed to prescribe. Although these guidelines typically bill themselves as "voluntary," their chilling effect on prescribers and adaptation into state laws[2] makes calling them "voluntary" disingenuous.
Although some scientists and clinicians have been questioning the conceptual validity of MEDD for several years, a recent study[3] has indicated that the concept is unequivocally flawed—thereby invalidating its use empirically and as a tool in prescribing guideline development.
The authors used survey data from pharmacists, physicians, nurse practitioners, and physician assistants to estimate daily morphine equivalents and found great inconsistency in their conversions of hydrocodone, fentanyl transdermal patches, methadone, oxycodone, and hydromorphone—illustrating the potential for dramatic underdosing or, in other cases, fatal overdosing.
Patients with chronic pain (particularly that of noncancer origin) who are reliant on opioid analgesia are already sufficiently stigmatized and marginalized[7] to allow this type of practice to continue to be the norm.
Although the use of MEDD in research and, to a greater extent, in practice, is probably due to unawareness of its inaccuracy, we posit that the use of MEDD by recent opioid guideline committees (eg, the Washington State Opioid Guideline Committee[8] and the Centers for Disease Control and Prevention Guideline Committee[9]) in the drafting of their guidelines is based more heavily on disregarding available evidence rather than ignorance. Furthermore, their misconduct in doing so has been more pernicious than the use of MEDD by researchers and individual clinicians, because these guidelines widely affect society as a whole as well as individual patients with persistent pain syndromes. We opine that these committees are strongly dominated by the antiopioid community, whose agenda is to essentially restrict opioid access—irrespective of the lack of data indicating that opioids cannot be a useful tool in the comprehensive treatment of carefully selected and closely monitored patients with chronic pain.
Above 100% extracted from: Medscape Journal Brief https://www.medscape.com/viewarticle/863477_2
Actual Study https://www.dovepress.com/the-medd-myth-the-impact-of-pseudoscience-on-pain-research-and-prescri-peer-reviewed-article-JPR
Are Non-Opioid Medications Superior in Treatment of Pain than Opioid Pain Medicine? Ice Cream Flavor Analogy...
In the Oxford University Press, a November 2018 scientific white paper[5] was released that examined the quality of one of the primary studies that have been used to justify the urgent call to drastically reduce opioid pain medication prescribing while claiming that patients are not being harmed in the process.
The study is commonly referred to as ‘the Krebs study’. “The authors concluded that treatment with opioids was not superior to treatment with non opioid medications for improving pain-related function over 12 months.”
Here is an excerpt from the first paragraph of the design section (usually behind a paywall) from the Krebs study that gives the first hint of the bias that led to them to ‘prove’ that opioids were not effective for chronic pain:
“The study was intended to assess long-term outcomes of opioids compared with non opioid medications for chronic pain. The patient selection, though, specifically excluded patients on long-term opioid therapy.” 
Here is an analogy given in the Oxford Journal white paper to illustrate how the study design was compromised:
If I want to do a randomized control study about ice cream flavor preferences (choices being: vanilla, chocolate, or no preference), the results could be manipulated as follows based on these scenarios:
Scenario A: If a study was done that included only current ice-cream consumers, the outcome would certainly be vanilla or chocolate, because of course they have tried it and know which they like.
Scenario B: If a study was done that included all consumers of all food, then it can change the outcome. If the majority of study participants do not even eat ice-cream, than the result would certainly be ‘no preference’. If the majority do eat ice-cream it would likely be ‘chocolate’. Although this study is wider based, it still does not reflect real world findings.
Scenario C: In an even more extreme example, if this same study is conducted excluding anyone who has ever ate ice-cream at all, then the conclusion will again be ‘no preference’ and the entire study/original question becomes so ludicrous that there is no useful information to be extracted from this study and one would logically question why this type of study would even be conducted (although we know the answer to that)
Scenario C above is how the study that has been used to shift the attitudes towards the treatment of pain in our nation's medical community was designed. “One has to look deep into the study to find that they began with 9403 possible patients and excluded 3836 of them just because they had opioids in their EMR. In the JAMA article, they do not state these obvious biases and instead begin the explanation of participants stating they started with 4485 patients and excluded 224 who were opioid or benzo users.” That is the tip of the iceberg to how it is extremely misleading. The Oxford white paper goes into further detail of the studies “many flaws and biases (including the narrow focus on conditions that are historically known to respond poorly to opioid medication management of pain)”, but the study design and participant selection criteria is enough to discredit this entire body of work. Based on study design alone, regardless of what happened next, the result would be that opioids are no more effective than NSAIDs and other non-opioid alternatives.
The DEA Is Fostering a Bounty Hunter Culture in its Drug Diversion Investigators[8]
A Good Man Speaks Truth to Power January 2019
Because I write and speak widely on public health issues and the so-called “opioid crisis”, people frequently send me references to others’ work. One of the more startling articles I’ve seen lately was published November 20, 2018 in Pharmacy Times. It is titled “Should We Believe Patients With Pain?”[9]. The unlikely author is Commander John Burke, “a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association.”
The last paragraph of Commander Burke’s article is worth repeating here.
“Let’s get back to dealing with each person claiming to be in legitimate pain and believe them until we have solid evidence that they are scamming the system. If they are, then let’s pursue them through vigorous prosecution, but let’s not punish the majority of people receiving opioids who are legitimate patients with pain.”
This seems a remarkable insight from anyone in law enforcement — especially from one who has expressed this view in both Pain News Network, and Dr Lynn Webster’s video “The Painful Truth”. Recognizing Commander Burke’s unique perspective, I followed up by phone to ask several related questions. He has granted permission to publish my paraphrases of his answers here.
“Are there any available source documents which establish widely accepted standards for what comprises “over-prescription?” as viewed by diversion investigators?” Burke’s answer was a resounding “NO”. Each State and Federal Agency that investigates doctors for potentially illegal or inappropriate opioid prescribing is pretty much making up their own standards as they go. Some make reference to the 2016 CDC Guidelines, but others do not.
  1. “Thousands of individual doctors have left pain management practice in recent years due to fears they may be investigated, sanctioned, and lose their licenses if they continue to treat patients with opioid pain relievers.. Are DEA and State authorities really pursuing the worst “bad actors”, or is something else going on?
Burke’s answer: “Regulatory policy varies greatly between jurisdictions. But a hidden factor may be contributing significantly to the aggressiveness of Federal investigators. Federal Agencies may grant financial bonuses to their in-house diversion investigators, based on the volume of fines collected from doctors, nurse practitioners, PAs and others whom they investigate.

"No law enforcement agency at any level should be rewarded with monetary gain and/or promotion due to their work efforts or successes. This practice has always worried me with Federal investigators and is unheard of at the local or state levels of enforcement.”

Commander Burke’s revelation hit me like a thunder-clap. It would explain many of the complaints I have heard from doctors who have been “investigated” or prosecuted. It’s a well known principle that when we subsidize a behavior, we get more of it. Financial rewards to investigators must inevitably foster a “bounty hunter” mentality in some. It seems at least plausible that such bonuses might lead DEA regulators to focus on “low hanging fruit” among doctors who may not be able to defend themselves without being ruined financially. The practice is at the very least unethical. Arguably it can be corrupting.
I also inquired concerning a third issue:
  1. I read complaints from doctors that they have been pursued on trumped-up grounds, coerced and denied appropriate legal defense by confiscation of their assets – which are then added to Agency funds for further actions against other doctors. Investigations are also commonly announced prominently, even before indictments are obtained – a step that seems calculated to destroy the doctor’s practice, regardless of legal outcomes. Some reports indicate that DEA or State authorities have threatened employees with prosecution if they do not confirm improper practices by the doctor. Do you believe such practices are common?”

Burke’s answer: “I hear the same reports you do – and the irony is that such tactics are unnecessary. Lacking an accepted standard for over-prescribing, the gross volume of a doctor’s prescriptions or the dose levels prescribed to their patients can be poor indicators of professional misbehavior. Investigators should instead be looking into the totality of the case, which can include patient reports of poor doctor oversight, overdose-related hospital admissions, and patterns of overdose related deaths that may be linked to a “cocktail” of illicit prescribing. Especially important can be information gleaned from confidential informants – with independent verification – prior patients, and pharmacy information.”

No formal legal prosecution should ever proceed from the testimony of only one witness — even one as well informed as Commander John Burke. But it seems to me that it is high time for the US Senate Judiciary Committee to invite the testimony of others in open public hearings, concerning the practice of possible bounty hunting among Federal investigators.
C50 Patient, Civil Rights Attorney, Maine Department of Health, and Maine Legislature Collaborative Enacted Definition of Palliative Care
One suggestion that our organization would like to make is altering the definition of “palliative care” in such a manner that it can include high-impact or intractable patients; those who are not dying this year, but our lives have been shattered and/or shortened by our diseases and for whom Quality of Life should be the focus. Many of our conditions may not SIGNIFICANTLY shorten my life, therefore I could legitimately be facing 30-40 years of severe pain with little relief; that is no way to live and therefore the concern is a rapidly increasing suicide rate.
This is a definition that one of our coalition members with a civil rights attorney and the Maine Department of Health agreed upon and legislators enacted into statues in Maine. This was in response to a 100mme restriction. This attorney had prepared a lawsuit based on the Americans with Disability Act that the Department of Health in Maine agreed was valid; litigation was never the goal, it was always patient-centered care.
A. "Palliative care" means patient-centered and family-focused medical care that optimizes quality of life by anticipating, preventing and treating suffering caused by a medical illness or a physical injury or condition that substantially affects a patient's quality of life, including, but not limited to, addressing physical, emotional, social and spiritual needs; facilitating patient autonomy and choice of care; providing access to information; discussing the patient's goals for treatment and treatment options, including, when appropriate, hospice care; and managing pain and symptoms comprehensively. Palliative care does not always include a requirement for hospice care or attention to spiritual needs. B. "Serious illness" means a medical illness or physical injury or condition that substantially affects quality of life for more than a short period of time. "Serious illness" includes, but is not limited to, Alzheimer's disease and related dementias, lung disease, cancer, heart, renal or liver failure and chronic, unremitting or intractable pain such as neuropathic pain.
Here is the link to the most recent update, including these definitions within the entire statute: https://legislature.maine.gov/statutes/22/title22sec1726.html?fbclid=IwAR0dhlwEh56VgZI9HYczdjdyYoJGpMdA9TuuJLlQrO3AsSljIZZG0RICFZc
January 23, 2019
Dear Pharmacists,
The Board of Pharmacy has had an influx of communication concerning patients not able to get controlled substance prescriptions filled for various reasons, even when signs of forgery or fraudulence were not presented. As a result of the increased “refusals to fill,” the board is issuing the following guidance and reminders regarding the practice of pharmacy and dispensing of controlled substances:
  1. Pharmacists must use reasonable knowledge, skill, and professional judgment when evaluating whether to fill a prescription. Extreme caution should be used when deciding not to fill a prescription. A patient who suddenly discontinues a chronic medication may experience negative health consequences;
  2. Part of being a licensed healthcare professional is that you put the patient first. This means that if a pharmacist has any concern regarding a prescription, they should attempt to have a professional conversation with the practitioner to resolve those concerns and not simply refuse the prescription. Being a healthcare professional also means that you use your medication expertise during that dialogue in offering advice on potential alternatives, changes in the prescription strength, directions etc. Simply refusing to fill a prescription without trying to resolve the concern may call into question the knowledge, skill or judgment of the pharmacist and may be deemed unprofessional conduct;
  3. Controlled substance prescriptions are not a “bartering” mechanism. In other words, a pharmacist should not tell a patient that they have refused to fill a prescription and then explain that if they go to a pain specialist to get the same prescription then they will reconsider filling it. Again, this may call into question the knowledge, skill or judgment of the pharmacist;
  4. Yes, there is an opioid crisis. However, this should in no way alter our professional approach to treatment of patients in end-of-life or palliative care situations. Again, the fundamentals of using our professional judgment, skill and knowledge of treatments plays an integral role in who we are as professionals. Refusing to fill prescriptions for these patients without a solid medical reason may call into question whether the pharmacist is informed of current professional practice in the treatment of these medical cases.
  5. If a prescription is refused, there should be sound professional reasons for doing so. Each patient is a unique medical case and should be treated independently as such. Making blanket decisions regarding dispensing of controlled substances may call into question the motivation of the pharmacist and how they are using their knowledge, skill or judgment to best serve the public.
As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation. These laws are:
AS 08.80.261 DISCIPLINARY ACTIONS
(a)The board may deny a license to an applicant or, after a hearing, impose a disciplinary sanction authorized under AS 08.01.075 on a person licensed under this chapter when the board finds that the applicant or licensee, as applicable, …
(7) is incapable of engaging in the practice of pharmacy with reasonable skill, competence, and safety for the public because of
(A) professional incompetence; (B) failure to keep informed of or use current professional theories or practices; or (E) other factors determined by the board;
(14) engaged in unprofessional conduct, as defined in regulations of the board.
12 AAC 52.920 DISCIPLINARY GUIDELINES
(a) In addition to acts specified in AS 08.80 or elsewhere in this chapter, each of the following constitutes engaging in unprofessional conduct and is a basis for the imposition of disciplinary sanctions under AS 08.01.075; …
(15) failing to use reasonable knowledge, skills, or judgment in the practice of pharmacy;
(b) The board will, in its discretion, revoke a license if the licensee …
(4) intentionally or negligently engages in conduct that results in a significant risk to the health or safety of a patient or injury to a patient; (5) is professionally incompetent if the incompetence results in a significant risk of injury to a patient.
(c) The board will, in its discretion, suspend a license for up to two years followed by probation of not less than two years if the licensee ...
(2) is professionally incompetent if the incompetence results in the public health, safety, or welfare being placed at risk.
We all acknowledge that Alaska is in the midst of an opioid crisis. While there are published guidelines and literature to assist all healthcare professionals in up to date approaches and recommendations for medical treatments per diagnosis, do not confuse guidelines with law; they are not the same thing.
Pharmacists have an obligation and responsibility under Title 21 Code of Federal Regulations 1306.04(a), and a pharmacist may use professional judgment to refuse filling a prescription. However, how an individual pharmacist approaches that particular situation is unique and can be complex. The Board of Pharmacy does not recommend refusing prescriptions without first trying to resolve your concerns with the prescribing practitioner as the primary member of the healthcare team. Patients may also serve as a basic source of information to understand some aspects of their treatment; do not rule them out in your dialogue.
If in doubt, we always recommend partnering with the prescribing practitioner. We are all licensed healthcare professionals and have a duty to use our knowledge, skill, and judgment to improve patient outcomes and keep them safe.
Professionally,
Richard Holt, BS Pharm, PharmD, MBA Chair, Alaska Board of Pharmacy
https://www.commerce.alaska.gov/web/portals/5/pub/pha_ControlledSubstanceDispensing_2019.01.pdf
FDA in Brief: FDA finalizes new policy to encourage widespread innovation and development of new buprenorphine treatments for opioid use disorder
February 6, 2018
Media Inquiries Michael Felberbaum 240-402-9548
“The opioid crisis has had a tragic impact on individuals, families, and communities throughout the country. We’re in urgent need of new and better treatment options for opioid use disorder. The guidance we’re finalizing today is one of the many steps we’re taking to help advance the development of new treatments for opioid use disorder, and promote novel formulations or delivery mechanisms of existing drugs to better tailor available medicines to individuals’ needs,” said FDA Commissioner Scott Gottlieb, M.D. “Our goal is to advance the development of new and better ways of treating opioid use disorder to help more Americans access successful treatments. Unfortunately, far too few people who are addicted to opioids are offered an adequate chance for treatment that uses medications. In part, this is because private insurance coverage for treatment with medications is often inadequate. Even among those who can access some sort of treatment, it’s often prohibitively difficult to access FDA-approved addiction medications. While states are adopting better coverage owing to new legislation and resources, among public insurance plans there are still a number of states that are not covering all three FDA-approved addiction medications. To support more widespread adoption of medication-assisted treatment, the FDA will also continue to take steps to address the unfortunate stigma that’s sometimes associated with use of these products. It’s part of the FDA’s public health mandate to promote appropriate use of therapies.
Misunderstanding around these products, even among some in the medical and addiction fields, enables stigma to attach to their use. These views can serve to keep patients who are seeking treatment from reaching their goal. That stigma reflects a perspective some have that a patient is still suffering from addiction even when they’re in full recovery, just because they require medication to treat their illness. This owes to a key misunderstanding of the difference between a physical dependence and an addiction. Because of the biology of the human body, everyone who uses a meaningful dose of opioids for a modest length of time develops a physical dependence. This means that there are withdrawal symptoms after the use stops.
A physical dependence to an opioid drug is very different than being addicted to such a medication. Addiction requires the continued use of opioids despite harmful consequences on someone’s life. Addiction involves a psychological preoccupation to obtain and use opioids above and beyond a physical dependence.
But someone who is physically dependent on opioids as a result of the treatment of pain but who is not craving the drugs is not addicted.
The same principle applies to replacement therapy used to treat opioid addiction. Someone who requires long-term treatment for opioid addiction with medications, including those that are partial or complete opioid agonists and can create a physical dependence, isn’t addicted to those medications. With the right treatments coupled to psychosocial support, recovery from opioid addiction is possible. The FDA remains committed to using all of our tools and authorities to help those currently addicted to opioids, while taking steps to prevent new cases of addiction.”
Above is the full statement, find full statement with options for study requests: https://www.fda.gov/NewsEvents/Newsroom/FDAInBrief/ucm630847.htm
Maryland’s co-prescribing new laws/ amendments regarding benzos and opioids
Chapter 215 AN ACT concerning Health Care Providers – Opioid and Benzodiazepine Prescriptions – Discussion of Information Benefits and Risks
FOR the purpose of requiring that certain patients be advised of the benefits and risks associated with the prescription of certain opioids, and benzodiazepines under certain circumstances, providing that a violation of this Act is grounds for disciplinary action by a certain health occupations board; and generally relating to advice regarding benefits and risks associated with opioids and benzodiazepines that are controlled dangerous substances.
Section 1–223 Article – Health Occupations Section 4–315(a)(35), 8–316(a)(36), 14–404(a)(43), and 16–311(a)(8) SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, That the Laws of Maryland read as follows: Article – Health Occupations (a) In this section, “controlled dangerous substance” has the meaning stated in § 5–101 of the Criminal Law Article.
Ch. 215 2018 LAWS OF MARYLAND (B) On treatment for pain, a health care provider, based on the clinical judgment of the health care provider, shall prescribe: (1) The lowest effective dose of an opioid; and (2)A quantity that is no greater than the quantity needed for the expected duration of pain severe enough to require an opioid that is a controlled dangerous substance unless the opioid is prescribed to treat: (a.) A substance–related disorder; (b.) Pain associated with a cancer diagnosis; (c.) Pain experienced while the patient is receiving end–of–life, hospice, or palliative care services; or (d.) Chronic pain
(C.) The dosage, quantity, and duration of an opioid prescribed under [subsection (b)] of this [section] shall be based on an evidence–based clinical guideline for prescribing controlled dangerous substances that is appropriate for: (1.) The health care service delivery setting for the patient; (2.) The type of health care services required by the patient; (3.) and The age and health status of the patient.
(D) (1) WHEN A PATIENT IS PRESCRIBED AN OPIOID UNDER SUBSECTION (B) OF THIS SECTION, THE PATIENT SHALL BE ADVISED OF THE BENEFITS AND RISKS ASSOCIATED WITH THE OPIOID.
 (2) WHEN A PATIENT IS CO–PRESCRIBED A BENZODIAZEPINE WITH AN OPIOID THAT IS PRESCRIBED UNDER SUBSECTION (B) OF THIS SECTION, THE PATIENT SHALL BE ADVISED OF THE BENEFITS AND RISKS ASSOCIATED WITH THE BENZODIAZEPINE AND THE CO–PRESCRIPTION OF THE BENZODIAZEPINE. 
(E) A violation of [subsection (b) OR (D) of] this section is grounds for disciplinary action by the health occupations board that regulates the health care provider who commits the violation.
4-315 (a) Subject to the hearing provisions of § 4–318 of this subtitle, the Board may deny a general license to practice dentistry, a limited license to practice dentistry, or a teacher’s license to practice dentistry to any applicant, reprimand any licensed dentist, place any licensed dentist on probation, or suspend or revoke the license of any licensed dentist, if the applicant or licensee: (35) Fails to comply with § 1–223 of this article.
8–316. (a) Subject to the hearing provisions of § 8–317 of this subtitle, the Board may deny a license or grant a license, including a license subject to a reprimand, probation, or suspension, to any applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke the license of a licensee if the applicant or licensee: (36) Fails to comply with § 1–223 of this article.
14–404. (a) Subject to the hearing provisions of § 14–405 of this subtitle, a disciplinary panel, on the affirmative vote of a majority of the quorum of the disciplinary panel, may reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the licensee: (43) Fails to comply with § 1–223 of this article.
16–311. (a) Subject to the hearing provisions of § 16–313 of this subtitle, the Board, on the affirmative vote of a majority of its members then serving, may deny a license or a limited license to any applicant, reprimand any licensee or holder of a limited license, impose an administrative monetary penalty not exceeding $50,000 on any licensee or holder of a limited license, place any licensee or holder of a limited license on probation, or suspend or revoke a license or a limited license if the applicant, licensee, or holder:
(8) Prescribes or distributes a controlled dangerous substance to any other person in violation of the law, including in violation of § 1–223 of this article;
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect October 1, 2018.
Approved by the Governor, April 24, 2018.
https://legiscan.com/MD/text/HB653/id/1788719/Maryland-2018-HB653-Chaptered.pdf
submitted by Dirtclodkoolaid to ChronicPain [link] [comments]


2023.06.04 14:32 LveeD Week 22: Street Food - Corn Dogs (fail)

Week 22: Street Food - Corn Dogs (fail) submitted by LveeD to 52weeksofcooking [link] [comments]


2023.06.04 14:22 GrayBest Braves day FT/FS. Captions

Braves day FT/FS. Captions submitted by GrayBest to baseballcards [link] [comments]


2023.06.04 13:48 traderdj I want to hear people’s experiences on the No Shave FUE (aka shaveless, long hair or celebrity hair FUE transplant)

Amount of grafts, price, results, satisfaction. All is appreciated! I’m in late 20s. Been on oral finasteride and minoxidil for years. I’m a NW3 so obviously light recession with very slight diffuse thinning. My hair has stopped in it’s tracks for 5 years and I’m stable for a transplant around 1500 grafts in the hairline area. I want to do a longer hair shaveless fue since my line of work will be too exhausting to explain to literally hundreds of people until it’s no longer noticeable. Appreciate any info! Looking into Dr. Danyo from Atlanta who specializes In this procedure.
submitted by traderdj to HairTransplants [link] [comments]


2023.06.04 06:46 RhiaKyrie Clerk with no OIC/PM - Carry mail? Make Schedule? Crisis? Many questions, and a useless union rep.

Hey all, another question- a few really. Buckle up, this one is gonna be big.
So, to clarify some prior posts, I work in a level 18 office in SoCal (not clarifying further for plausible deniability anonymity reasons). Four routes, three PTF clerks (FTF position in arbritration), and a LOT of problems. Those being, we only have two RCA's, one is on medical and fighting labor to even get treatment while the other is 6-days acting regular on an overburdened (~49hweek K route + DACA-5 every week) route.
So, a good few things: I was an RCA before, and thus have the training to run routes. I've done so for our Auxi before, and have not been appropriately paid for the mileage- but am not sure if it's viable for eTravel as it's personal vehicle delivery. At this point, I'm wondering if I'm even allowed to deliver routes, not just express- I've not gotten a straight answer when asking more directly.
My Postmaster is currently out on medical, he had a massive surgery and has been out for a good few months as is. We had an OIC come from, way away, and was doing genuinely fantastic work and fixing things that were long standing issues. Unfortunately, HIS home office practically imploded for something only a month in, his MPOO pulled him back to his district, to my knowledge. As a result- it's just us clerks, and the occasional nearby postmaster coming in for reports we don't have access too. We're doing CSAW, DCV, DMS, things that I'm fairly sure we're good to do, but some other ones- Scheduling, even giving instructions (instructing to pass instruction to carriers or other employees), feels like it's way sketch.
Yesterday we had a full route vacant due to callout- I called eight neighboring offices near and far, but with Saturday being a popular K-Day, there's jack squat available to come and cover. I'm there at like 2:30 AM on another postmaster's suggestion due to having a heavy and unexpected late UPS/Amazon drop yesterday afternoon, and it's enough it'll impact carrier time if trying to do my normal arrival times. (Note: All other clerks are otherwise indisposed on saturdays, I fly a solo ship and was told there MAY be relief later in the day if a nearby clerk in a single HWY route office gets done.) So, crap's hitting the fan, there's a whole route just fusterclucked, another one with a fairly fresh RCA that's gonna get in past 1800 as is. Eventually, I pull a big trigger- I contact District on another Postmaster's reccomendation (unsure why they didn't do it themselves, since I'm a PTF clerk...). I've never seen both my personal phone and hotline blow up so fast. Every postmaster nearby I had contacted is wondering what is going on- mind you most of them were told the details of my MIA route risking full failure to deliver- and others from farther offices immediately offering help later in the afternoon if I'm willing to case the mail (which, at this point to avoid being in a HUGE hot seat I am willing to do.) I'm already catching huge professional but passive flak from my Boss, but he's on medical, frankly should be resting- as well as the fact that he's not even hooked to the office in terms of accountability right now. The long-gone OIC is. I have postmasters telling me I made the right gut call- it was either being on the radar for requesting Aid on a level over what I usually have to (but with my hands otherwise tied), or get in trouble in one of three ways: Go into major OT (14 hr+ knowing my time on that route) and leave a lot of mail undelivered in PO Box, and fail integrity for all the PO box parcels and see if the RCA can help and get us both less overtime with the same PO box issues, or say 'not my problem' and end up on a big red flag list for failure to deliver- with me being the one that made the call to just not deal with it. Rock, meet hard place, meet blast explosives. It's already causing major friction with coworkers who hate being on anyone's radar, let alone district level management- fair enough.
How much of this am I realistically even supposed to be doing? I'm not getting paid OIC/EAS17-18 rates (technically no supervisor position here) rates, I have access to some head clerk tools and such, but by no means any supervisor, timekeeping or leave input, any of that. I just make the schedule, cover a vacant route with other RCA's as I can, and dangit if I don't do it WELL too, this being the first major issue, though one I was dreading to come inevitably given staffing issues.
What doesn't help either is that our steward is very much barely doing anything, and the actual rep is radio silent on myself and other clerks, same for the Rural rep. Glad I didn't join either of those, thank god.
Guess my questions are really: How much of this should I not be touching with a 0.5 mile delivery range pole? What calls am I on the hook for, given that I've only been verbally told what things to do, and that I'm a kinda, a standing scheduler? Was my call way too overboard, or was making sure it got done while doing a proper CYA with the call/communication a good call? Any other input would be, greatly appreciated. I just find myself anxious as hell about what's going on above my head, while still performing these duties.
Semi-related: I've also been informed though, that if I want to be put at a nearby city office to train back end OIC/Sup, I may well be offered it considering what I've been doing came to light in a big way today. Yay? Thank y'all for reading, and thanks ahead for any input. Ask any questions, I'll answer to the best of my ability.
Edit for TL;DR: Doing a LOT of things that I have no clue if I should be/if its above my pay grade, had a major incedent or so it seems, and seeking reflection and advice.
submitted by RhiaKyrie to USPS [link] [comments]