hello!
so after completing ~19 units of postbacc classes i got my sgpa to be 3.09 (postbacc gpa is 3.3). My cgpa is about 3.28. went to a top 20 undergrad. I have a 501 mcat but am retaking august 2.
for ec’s these are much better with 2,600 clinical hours, ~75 shadowing (MD + DO), 1.2k volunteering, ~3k research (5 pubs, 2 of them are 1st author, peer reviewed for BMJ), leadership roles for 2 years, etc.
i also think my letters of rec should be pretty good as well. i have also been told my ps is strong. for other context, i am a disadvantaged applicant (first gen, low income, was in foster care, both parents deceased, from rural ish area)
i am applying very broadly to about 35-40 schools (all DO). is it realistic for me to expect acceptances during this cycle? thank you guys very much for your help💗good luck to everyone else applying this cycle as well :)

For your daily practice, if you had ~20 min for basic exercises, what would you do to warm up / work on raw technique?
I was thinking to pick a couple from each category and combination:
Scales
Major, minor, harmonic, melodic, broken thirds (a c, b d, c, e, etc)
1 string, 3 octave
1 note per bow, 2, 3, 4, 6, 8, 16
Arpeggios
1 string 1 octave, 3 octave
Major, minor, inv64, inv63, diminished, 57
Double Stops
octaves, alternating finger octaves, thirds, alternating finger thirds, sixths, alternating finger sixths
Bowing
??? what to do here? I know there exist bowings like sautille, staccato and others, but should this be done in conjunction with the exercises above? Scales in upbow staccato? Arpeggios in ricochet?
Etudes
pick some Schradieck

I am looking for values we can get that people would like analyzed.
So far I have the following catagories Faction Date of Entry Mission Armor Type Primary Secondary Grenade Strategem 1 Strategem 2 Strategem 3 Strategem 4 Kills Deaths Accidentals Distance Traveled
Let me know what else we should be looking at? I am also recruiting for people who are willing to do data collection to assist in the research.

Do you know of any operas that feature actual opera composers as characters?
"Mozart and Salieri" (1898) by Rimsky-Korsakov features the two famous composers as characters.
Baroque composer Alessandro Stradella inspired no less than eight (!) operas based on his controversial life:

1. Il cantore di Venezia by Virginio Marchi (1835)
2. Stradella by Louis Niedermeyer (1837)
3. Stradella by César Franck (1841, unfinished)
4. Alessandro Stradella by Friedrich von Flotow (1844)
5. Alessandro Stradella by Adolf Schimon (1846)
6. Stradella il trovatore by Vincenzo Moscuzza (1850)
7. Alessandro Stradella by Giuseppe Sinico (1864)
8. Ti vedo, ti sento, mi perdo by Salvatore Sciarrino (2017)

Any other operas that feature real-life composers as characters?

Antes de mais nada, obrigado pelo tempo que vão tomar em ler o relato!
Eu tenho 33 anos e ela 30. Eu já namorei umas 6 minas e ela teve apenas 1 namorado. Eu estou solteiro desde Novembro do ano passado e ela esta solteira a 3 anos.
Bem, ela era uma pessoa bem presa na vida dela e só teve esse namorado que prendia muito ela. Então quando acabaram ela foi viver a vida dela. Eu a conheci e começamos a conversar por mais ou menos 1 mês e depois a gente saiu, nossa conexão foi bem forte desde as primeiras saídas, o sexo é intenso e forte, a gente tem uma boa interação e conversamos sobre tudo. Já fizemos viagem de casal por duas vezes inclusive. Porem uma coisa que acontece é que as amigas dela são solteiras e vivem chamando ela pra sair, já meus amigos grande parte ta namorando. Então minhas saidas sem ela são mais de boas e as dela pode ser que ela conheça alguem. Daqui a uns dias vai rolar uma festa de São João em minha região e ela vai com as amigas, conversei com ela e disse meio que não tava me sentindo bem se alguém fosse chegar nela lá. Ela disse que esta só saindo comigo e que só fica com 1x de cada vez, porem como não somos namorados, tanto eu como ela pode ficar, mas não quer dizer que vamos ficar com outra pessoa. Quando ela me disse isso, eu meio que fiquei surpreso pois a gente esta se relacionando como um casal já. Depois disso eu puxei outra conversa que foi relacionando a dizer que só tinha interesse nela, pra que ela estivesse ciente disso. Ela respondeu que já tinha ideia disso pelo jeito que a gente se relaciona e com aquela conversa ficou mais claro, porem ela disse para irmos com calma que esta muito bom mas vamos nos conhecendo mais e dando tempo ao tempo. Mesmo tudo estando bem intenso. Depois não conversei mais nada sobre isso. Não consegui interpretar bem isso que ela disse, é como se ela gosta da relação mas quer manter apenas no nível de ficar na minha visão. Eu meio que to curtindo ela porem posso ligar meu modo foda-se e começo a sair com outras como estava antes de a conhecer e fico encaixando ela nas semanas. O que voces acham que eu devo fazer ou qual a impressão desse relato a cima? Obrigado

So I am someone who has often spent at least some part of their birthday crying; since I was a child and possibly even before I began menstruating? However I do recall it more vividly by the ages of 12/13. Anyway. Today I am 23, its my birthday, my period is somewhere between here and there (like 1-3 days away I hope), and this week has been the most drawn out, exhausting, emotionally challenging week. I feel like this every month and have often resonated with other posts in this group. But I am writing this today because I cancelled all of my birthday plans with friends; because I was so exhausted from the previous month/weekend full of overtime work weeks, too much socializing, and not enough rest.
Despite my exhaustion and having a few days off, Ive spent this entire week staying up too late, eating without rhyme/rhythm, still not sleeping enough, and now I am spending my birthday evening crying. Inside and too exhausted to move. I am also stuck in a loop in my head about all the disappointment I have experienced surrounding my birthday the last few years, and I know that it is all enhanced because of my hormones. To echo what everyone says: WHYYYYY DOES IT HAVE TO BE SO HARD. SO INTENSE, SO CONVINCING THAT ALL I CAN BE TODAY IS SORRY FOR MYSELF ? Why can't I just be present? Why is my body stuck in the past and so overwhelmed even when I am not doing anything else?
I know that ahead of me lies so much joy and excitement and newness; a part of me is celebrating all the change to come- yet I feel so much grief and sadness and resentment today. Just one of those days where I think anything I do or try to do wont be enough to satisfy me. And coincidentally the day I was born. I want to hide but I want someone to help me out of the hole I'm digging. But I don't have the energy to ask for help. I'll be talking to a friend soon and I hope I'll be honest with her instead of pretending everything is okay today. I just find it unfortunate that the one day I am conditioned to look forward to all year comes and I am in such despair that all I want is for the day to end. Lol. Stay strong fellow PMDD fighters <3

Hello Fellow Apes,
Now that meme week is over, we can get back to our regular programing. Recently, there was a publication on yahoo news regarding CVS and Humana downsizing their Medicare advantage program.
https://finance.yahoo.com/news/humana-cvs-downsizing-medicare-advantage-143026371.html
This was published on June 6th, 2024. This isn't really news because Moocao talked about it in DD on CVS and Humana based on their Q1 earning last month.
https://www.reddit.com/Healthcare_Anon/comments/1cjpur9/cvs_q1_2024_earnings_analysis_earnings_call10q/
https://www.reddit.com/Healthcare_Anon/comments/1ce2ps8/humana_q1_2024_earnings_analysis_part_1_earnings/
Before we get too excited, let's clarify some points. Contrary to what the author of the Yahoo article suggests, insurers do not have unlimited freedom to indiscriminately cut benefits to boost their profit margins. That's not how the system operates. Regulatory controls, particularly the Total Beneficiary Cost metric used by CMS, play a crucial role. This metric is essential for evaluating any changes insurers make to benefits from year to year. Now, let's delve deeper to better understand the specifics of how this works.
The term "Total Beneficiary Cost" (TBC) in the context of health insurance typically refers to the complete cost of care for insured individuals that the insurance company is responsible for covering, considering both the insurance provider's payments and the patient's own contributions (like deductibles and copayments). The concept of TBC can impact health insurance companies in various ways, especially in scenarios involving high-cost treatments or chronic care, which can make it less financially attractive for insurance companies to operate in certain markets or offer certain types of plans. Higher total beneficiary costs increase the financial risk for insurance companies, especially if these costs weren't anticipated in their pricing models. This could lead to losses, making some markets or segments less attractive. If certain insurers face disproportionately high beneficiary costs, they might consider withdrawing from specific markets or reducing the scope of their offerings. However, regulatory environments and commitments to existing customers often hamper such decisions, forcing companies to seek other ways to manage costs, like tightening network agreements or reducing benefits. We will dig more on this later in the post. Therefore, accurately predicting TBC is crucial for setting premiums that are competitive yet sufficient to cover costs. Misjudgment can lead to financial strain, requiring companies to either increase future premiums, which can affect market competitiveness, or absorb losses.
The thing that we want to focus on is the Regulatory Constraints. In many regions, health insurance companies are subject to regulatory requirements that might limit their ability to adjust premiums quickly or exit markets. High TBC can make it difficult to maintain profitability under these constraints. Regulatory constraints play a crucial role in the health insurance industry, particularly in how they limit the ability of insurers to quickly downsize operations or exit markets.
In many countries, especially in the U.S. under the Affordable Care Act (ACA), there are specific regulations that govern how and when a health insurance company can exit a particular market. These rules often require insurers to provide notice well in advance (sometimes up to a year) before discontinuing a plan. This is intended to protect consumers by ensuring they have adequate time to find alternative coverage and to prevent market destabilization. Insurers are typically required to submit their premium rates for review by state or federal regulators to ensure they are based on accurate cost projections and are not excessively high or discriminatory. This process can limit the ability of insurers to rapidly adjust premiums in response to unforeseen cost increases, such as a sudden rise in total beneficiary costs.
Regulatory bodies often have stipulations regarding the adequacy of provider networks that insurance companies must maintain. These requirements ensure that beneficiaries have reasonable access to healthcare services without undue travel or waiting times. Adjusting these networks by downsizing can be complex and must comply with these regulatory standards. Some regulations require insurers to renew policies unless specific justifiable reasons are cited, such as non-payment of premiums or fraud. This limits the ability of insurers to drop coverage for individuals or groups simply based on the cost of claims.
Regulators require insurance companies to maintain certain levels of capital to ensure they can meet their obligations to policyholders. Decisions about exiting a market or downsizing operations can be influenced by these financial requirements, as they dictate the need to manage financial resources prudently. This is a very big regulatory requirement that if you understand it well, you can predict how a company will react. Nevertheless, these regulations are designed to ensure the stability of the health insurance market and to protect consumers from abrupt changes in their health insurance coverage. They can, however, limit the flexibility of insurance companies to rapidly adapt to changing market conditions or to manage high costs associated with high total beneficiary costs effectively in which I really don’t give a fuck about because I’m a pro-consumer kind of guy.
All of the stuff above were just preamble the meat of the post. Medicare Advantage, also known as Medicare Part C, is a program in the United States where private health insurers offer plans that provide Medicare benefits. These plans are closely regulated by the Centers for Medicare & Medicaid Services (CMS). If a Medicare Advantage plan decides to exit a market or discontinue a plan, it must follow strict guidelines about notifying both CMS and its members. Typically, this involves providing notice before the annual enrollment period begins, allowing members time to find new coverage. If CVS or Humana were planning to exit, they would have announced it last year, otherwise they would have to wait for another year if they announce it soon.
Market exit restrictions are critical regulations that control how Medicare Advantage plans can discontinue their services in a particular area or withdraw from the market entirely. These rules are designed to protect beneficiaries from sudden losses of coverage and to ensure stability in the Medicare Advantage market. Medicare Advantage plans are required to notify CMS and their enrollees if they decide not to renew their contract for the following year. This notice must be given at least 90 days before the start of the annual enrollment period, which begins on October 15. This timing ensures that enrollees have ample opportunity to understand their options and choose a new plan during the enrollment period.
Plans must provide reasons for their decision not to renew their contracts. While financial reasons can be a factor, CMS also evaluates whether the plan followed all contractual and regulatory obligations, aiming to identify any patterns of non-compliance or poor performance that could affect beneficiary health outcomes. The rules stipulate that plans must clearly communicate their decision to leave the market to all affected beneficiaries. This communication should include information about the timeline for the plan's departure and instructions on how to enroll in a new plan. Additionally, it often includes resources or contact information for assistance, such as help from local SHIP (State Health Insurance Assistance Program) offices. Plans that exit a market must also ensure a smooth transition for their enrollees to other available plans. This includes providing information about other Medicare Advantage plans or returning to Original Medicare. Special attention is given to ensuring that ongoing treatments are not interrupted. In some cases, CMS may facilitate special enrollment periods outside of the normal enrollment window for affected beneficiaries to ensure continuous coverage.
CMS closely monitors the process of plan withdrawal from the market to ensure that plans comply with all regulatory requirements and that beneficiaries' interests are protected. This oversight includes reviewing the plans' communication strategies and transitional arrangements. A plan’s decision to exit a market can impact its Star Ratings, as these ratings reflect both beneficiary satisfaction and the quality of care. Exiting plans might see a dip in ratings due to disruptions or dissatisfaction among enrollees, which can impact the company’s reputation and its performance in other markets. These exit restrictions are part of a broader regulatory framework that seeks to balance the operational flexibility of insurance providers with the need to protect Medicare beneficiaries and ensure the stability of the health insurance market. This framework helps mitigate potential negative impacts on enrollees and ensures that changes in the availability of Medicare Advantage plans do not adversely affect the health care coverage of older adults and other eligible individuals. Therefore, it is not as simple as the article is trying to tell you. Additionally, this is why you heard from Andrew Toy from Clover health that these companies will spend the next 2-3 years to fix their financial situation because it will impact other markets that they are profiting from.
We can assume the writer of the article has some insider knowledge regarding the situation, and we can start figuring some stuff out. Let first look at the initial decision and notification to CMS, Plans typically decide whether to renew their contracts and must notify CMS of their intent not to renew by the first Monday in June.

This is almost five months before the start of the new coverage year, and it was this Monday.

Afterward, Plans that are exiting must notify their beneficiaries at least 90 days before the start of the Annual Election Period (AEP), which begins on October 15. This means that notifications must be sent out by mid-July. Then we have the AEP. This period runs from October 15 to December 7. During this time, affected beneficiaries have the opportunity to choose a new Medicare Advantage plan or switch back to Original Medicare for coverage that will start on January 1 of the following year. This is also during the time where CMS start going for these company’s kneecaps such as star rating.
While the formal transition in terms of enrollment happens during the AEP, the actual transition in terms of healthcare coverage takes effect on January 1 of the new year. During this period, beneficiaries may start to engage with their new Medicare Advantage plan or Original Medicare providers. After the transition, CMS and other regulatory bodies continue to monitor the situation to ensure that the exit was handled properly and that there are no ongoing issues affecting former members of the discontinued plan.
As you can tell, it is not a simple process for CVS and Humana to just cut lost an focus on margins. Insurers don't have free reign to slash benefits willy-nilly to improve their margins. "They're hamstrung by the total beneficiary cost" and the regulations that come with it. This is what happen to companies that became dependent on the FFS rate always being at the rate that would profit them.

What do you think the top 5 beat drops The Weeknd has? I think it goes
1: Alone Again 2: The Hills 3: After Hours 4: Acquainted 5: The Morning
Honorable mentions Double Fantasy Try Me