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Write up (Non US IMG) - Step 1: 254

I have been a long time lurker and thought I'd give back to this community with a post about my experience and what I wish I'd have done differently. This is going to be a long ride, so buckle up. Skip to end to know my assessment scores. YOG: March 2019. I had thoughts about taking Step 1 in 3rd and 4th year, but didn’t have any proper guidance or a study partner. Made a decision to pursue USMLE journey during internship. Researched a lot about the exam and what resources to use on reddit and online forums. Goal is to keep limited resources and maximize your knowledge. Started prep in mid- April after graduation because I had to get it (internship) out of the way of my prep. Resources used: 1. Dr. Najeeb lectures – this was important for developing my basics 2. Boards and Beyond – Dr. Ryan explains clearly the basics of pathology and physiology. So must watch. 3. Pathoma – Gold for pathology hands down. 4. First Aid – This book has become my SO during prep period. This book has almost all the information. You just have to connect the dots. 5. UsmleWorld – Gold and obligatory Qbank. Annotated some concepts to my FA. Must do 2 passes. 6. Amboss Qbank – For solidifying your knowledge and test taking skills. 7. Goljan audio lectures – Listened to it during dedicated but was sad at the end because I couldn’t hear more of this legend. 8. Linda Costanzo’s Physiology – Beautifully explained physiology. Must read if your basics are shit. 9. Robbins Pathologic Basis of Disease- Read it occasionally because I was in awe with this book. 10. Kaplan Qbank – some really good questions but not really required for Step 1 prep. 11. Usmle Rx Qbank – Great way to drill FA into your brain. 12. ANKI – Realized late that it was even a thing. Only did for anatomy, micro and pharm in dedicated. Didn’t complete the whole thing and couldn’t keep up with my reviews. 13. Sketchy Micro – Absolute necessary for micro but only revised bacteria and viruses. 14. Conrad Fischer’s 100 Ethics cases – Read this one like a novel. 15. GOOGLE- The best one 😉 I had piss poor basics and was an average student academically. So I had start building my fundamentals first and start from scratch. Started prep with neurology (my favorite). Read Kaplan neuroanatomy but didn’t stick. Started watching Dr. Najeeb lectures again along with my notes. My plan was following this for every system: - Watch a Najeeb video (selective systems) if your poor in that topic. - Supplement that with BnB and Pathoma. - Annotate BnB (some topics) and Pathoma to my FA so it’ll be easy to revise. - Did Uworld system wise according to that. - Did Rx to solidify factoids from FA. This strategy was really helpful for my prep. I was getting 80-85% in my Uworld first pass (did it offline). It had 2300 questions then. READ EVERY UWORLD EXPLANATION THOROUGHLY. I cannot stress this enough. Read both the correct explanation and wrong ones and think about why it is wrong and learn the pathophysiology behind it instead of just memorizing. Do this for every question and annotate the topics that are difficult for you to FA. Screenshot some topics like tables, charts, diagrams and pictures for future references. - Read costanzo for physio for selected systems like CVS, Renal, Resp and Endocrine. - Read Robbins and Goljan for some weak topics (Goljan is overkill). The most important things to read in Robbins is Morphology and Pathophysiology so you can become familiarize with the topic. Most of the uworld morphology questions were straight from this book. Did some of the questions from Robbins Rapid Review and they were good. - Did not watch any Kaplan videos as most of the opinions on them were not good. - Read Kaplan lecture notes for molecular and cell biology as these were not stressed in any other resources. - Use GOOGLE as your resource. Search and read articles, Wikipedia if you had any doubts in specific topics and images. Revised every now and then. Didn’t know about anki at this time. May be I’d have done differently if I had started anki by then. Used to go to library from 9am – 9pm. Some days it was 8 hrs and on some days it was 10-11 hours. Took my lunch to library or ordered something because my house was far from my library. Played badminton every evening during this time for 1-2 hours. Really good to just relax and forget everything. Original goal was to write the exam by Feb-March. Took my first baseline assessment NBME 21 (online) - 215. Did it on a shitty day and I couldn’t concentrate much. Was dumbstruck at first and then realized it was very different style of questions from Uworld. Did a bunch of silly mistakes. I was going to set my exam date in April or may and start dedicated but COVID happened and there was a halt in my prep. April – July was quarantine mode. Didn’t do much of a studying except for Amboss. Completed the whole Qbank during this time with 80%. Most of these questions were goods but they were really nitpicking about tiny details that you may miss during studying. My suggestion is to do only 2,3,4 hammer questions. Did every old NBME (1-12). There are no explanations for these anywhere. So just did questions . Some of them are outdated concepts. I was just doing them for practice. More the questions the merrier. There were no test centres in our state so you have to go to other state. But interstate travel was closed at this time. So, there was no motivation to study at all during this period. Started dedicated in early august and set the date in middle of September. DEDICATED – 6 Weeks: TARGET : >255 - My whole plan was to do UW SECOND PASS supplemented with FA. Time gap between first pass and second pass is approx 5 months. UW second pass was about 93%. - I was studying 8-11 hours per day. Some days just taking a break. It is important to take breaks during this time. - Did 2 UW blocks (random and offline) per day in the morning. Each block took 40-50 min to complete. Explanations took about 1-1.5 hrs. so total of 4-5 hours in the morning along with FA. UW has atleast 3000 questions by now. So atleast 600-700 questions were new to me. - From afternoon did content review and referenced Robbins, Goljan and Costanzo for doubts. - From evening used to do anki for Micro, Pharm and Anatomy. - Did Dorian anatomy deck and physeo anatomy deck . Completed within a week. I think these decks covered 90% of the anatomy questions along with FA and UW. Also read CLINICAL ANATOMY MADE RIDICULOUSLY SIMPLE (recommended by fellow SP). Good book to read. Explained some concepts clearly with humor added. - Did Sketchy decks for micro and pharm. 200-300 cards per day. Only did half because couldn’t keep up with my reviews. START ANKI EARLY IN YOUR PREP IF YOU WANT TO. - Started picking up on time with UW explanations and used to complete the whole thing in 3.5-4 hours and was really doing well on assessments so I increased my target to >260. - Read Conrad Fischer’s 100 Ethics cases book. Completed in 2 days. Did UW behavoural sciences after reading this. These two has almost everything you need to know about ethics and psych. - Did UW Biostats questions supplemented with FA. Ethics and biostats were my weak spots in self assessments. So did them both twice in dedicated. - Did 2 new nbmes per week. Did old ones in quarantine. - One important goal in my whole prep was to do more questions and familiarize well with all kinds of styles so you don’t have to panic on exam day. - EXERCISE REGULARLY. Relax your body from time to time. It is the most important this for preparation of an exam of this magnitude. It doesn’t have to an intense workout. I did 20-25 min of workout 4-5 days a week. Do regular walking half hour per day. Listened to Dr.Papi during this time. Do it to get more insights and a big picture of what you studied. I would like to meet this legend one day. - Sleep regulary. Don’t neglect your health. Eat healthy during dedicated. You don’t want to lose time in your prep because of this. - My only advice in dedicated is do more questions and revise what you’ve learned. Did approximately 15000 QUESTIONS. - My aunt has passed away a week before my exam. She was very close to me and it impacted my mental health and I couldn’t study 3-4 days after that. EXAM DAY: Did free 120 a day before the exam at the test centre to familiarize with the process. You can skip the tutorial and 15 min is added to your break time on exam day. - Got to the exam centre a day before and checked the address. Booked a hotel near to the centre 2 weeks before hand. - Ate cereal, 2 eggs and a banana for breakfast. Packed peanut butter and nutella sandwiches, protein bars, bananas, dry fruits and a water bottle. - Slept at 10-10:30 pm before the exam day and woke up at 6 am. This was very important to me to get atleast 7-8 hrs of sleep. Normally I’d sleep for 8-9 hrs in order for my brain to work properly. - Went to test centre at 07:30 am. At first I was really nervous but calmed myself when I sat before the monitor. - 1st block was okay. Some straight forward questions sprinkled with wtf questions. Took a break at the table after that for only 2 min because I still had adrenaline rush from 1st block. - Marked 10 questions for first 2 blocks. 3rd block was relatively easy as I only marked 5-6. Last block was also relatively easy. - 4th, 5th, 6th blocks were relatively difficult and had like 10 wtf questions per every block. I marked 14-15 per block. Some of these were questions you’ve never seen before. I had to search pubmed for some of these answers. - Breaks: after 2 blocks – 10 min. Ate a protein bar and dry fruits during these breaks. After 3rd block – 10 min. After 4th block – 20 min. Lunch. After 5th block – 10 min. After 6th block – 10 min. - Came out exhausted and didn’t even know how I’ve done. I was praying to get atleast 230 after that. - 50% of the exam was straightforward and is not trying to trick you like UW or AMBOSS. - In other 50% half of them were difficult and you have to narrow It down to two options. While other half are just wtf questions and don’t even know what they were trying to ask here. So eliminating the options plays a key role here as well as test taking skills. - I guessed 40-50% of my exam AND IT IS OK. - I had a pic attached to the question for every 3-4 questions. It may be a graph, table, histology, gross specimen, imaging etc., Histo pictures were really of poor quality. I couldn’t see what the hell was going on in some of them. - I had 1-2 biostats for every block and only one of them were asking to calculate in the whole exam. All others were interpretations, bias, study types and most of these started with ‘an investigator’. - Micro, Pharm and Anatomy were not numerous and UW+FA+Sketchy was enough for that. I had 4-5 ques about US MARINE CORPS related to micro. - My form heavy on molecular biology which were mostly asked as experimental questions. ASSESSMENTS: I have an attention span of a 3 year old and I’m easily distractable. So it was a hectic task for me to sit through these assessments. - NBME 21 – 215 (210 days out) – 40- 50 mistakes - NBME 15 – 242 (207 days out) - 35 mistakes. - NBME 13 – 250 (200 days out) - 22 mistakes. - AMBOSS SA – 251 (198 days out) – 25 mistakes. - NBME 16 – 261 (191 days out) – 11 mistakes. - NBME 20 – 257 (41 days out) offline – 19 mistakes. - NBME 19 – 242 (36 days out) – 16 mistakes. This has a shitty curve and will demotivate you. - NBME 22 – 259 (32 days out) offline - 18 mistakes. - NBME 23 – 261 (30 days out) offline – 16 mistakes. Did good on these two because it had 10-15 repeats from old forms. - NBME 17 – 269 (16 days out) – 5 mistakes. Easiest one out there and I think I peaked here. - NBME 24 – 257 (11 days out) offline – 18 mistakes. Other NBMEs were easier than this. - UWSA 1 – 271 (9 days out) - 18 mistakes. Don’t get your hopes up by this one. - NBME 18 – 250 (7 days out) – 19 mistakes. Did a bunch of silly mistakes but was fair and not fucked up like other ones. I think the Curve is getting worse on this one. - UWSA 2 – 264 (4 days out) – 16 mistakes. Was not an easy one for sure. More biochem and genetics oriented. - FREE 120 – 88% - (2 days out) – 14 mistakes. Most of the questions were straight forward. Got 3-4 concepts in the main thing directly from here. - By now you know I am stressing more on the number of mistakes because those were more important to improvise than your scores. Read every explanation for your incorrect and think why you got it wrong. - Step 1 predictor from reddit – 258 with 11 SD (95%CI). - FINAL STEP 1 (17-09-2020) SCORE – 254. Was a bit bummed by that as I was hoping atleast 260. I was pretty calm during the whole exam except before lunch where I was really tired and hypoglycemic. But nonetheless it is a good score for programs I’m interested in (Psych and Path) and I’m satisfied. Hoping to get up my score in CK. LAST WORDS OF WISDOM: - Don’t overwhelm yourself with many resources. Pick the ones which will stick for you through the whole prep time. Even if you read one concept you should know everything about it. It is better than reading everything and retaining only a small part of it. - GET YOUR BASICS RIGHT. This is the most important thing for step 1. Don’t try to memorize everything. My exam was more focused on basic concepts and understanding than memorization of weird and random factoids. - Active reading is >>>> Passive reading. - DON’T COMPARE YOURSELF WITH OTHERS. Whatever it maybe, assessments or preparation. Everyone has their own way of learning things. So do what’s best for you. - TIME IS ESSENCE. Don’t procrastinate. You’ll be in a better place than you’re in now if you do well. Think about the quote when you are demotivated – ‘THIS TOO SHALL PASS’. - UFAPS is still gold standard for step 1. So be perfect in these things. - Read FA thoroughly. You never know what they’re going to ask on the exam. - REVISE REVISE REVISE (anki or FA). - EAT HEALTHY AND EXERCISE REGULARLY AND SLEEP WELL DURING DEDICATED. - The exam is doable. So don’t get panicked and calm your nerves on the last week before. So, that was my experience of tackling this beast. GOODBYE. Take care good people.
submitted by Dr_NajeebRyan to step1

247 Step Score - The details of how I got there. Pick my brain

I just want to give back to the reddit community. I can’t tell you how many of these posts I’ve read over the past while, and they have all been very helpful to me. I hope my anecdotal experience can help you guys out. I’ll try to emphasize unique aspects of my prep and not overemphasize stuff that everyone already knows.
When I came to med school a couple of years ago, I literally had never even heard of First Aid, and I didn’t even know what step 1 was. Thankfully, before M1 started I became friends with a guy who had done his homework scouring reddit/SDN, and I went all in since day 1. So I definitely owe him and indirectly the reddit/SDN community. If there was one thing i’d want you to take away from this post, it’s go all in ASAP. If you don’t know what I mean, I’m saying only use step prep materials to study.
My goal score was >250. I wanted it SO bad. I’ll admit I was a little bummed I didn’t’ reach my goal, but I’m still happy with my score and I should be competitive for most specialties.

Real deal: 247
Nbme 13: 225 (6 weeks out, right before dedicated)
Nbme 15: 238 (4 weeks outs)
Nbme 16: 242 (2.5 weeks out)
Uwsa 1: 251 (2 weeks out)
Nbme 19: 220 (1.5 weeks out)
Nbme 17: 250 (1 week out)
Nbme 18: 246 (5 days out)
Uwsa 2: 243 (3 days out)
Free 120: 85% (2 days out)
UW first pass: 77%
Rx first pass: 81%

US MD student. Mid-tier med school. I scored a little above average on my in-house exams, but I definitely feel super average in terms of intellect when comparing myself to my classmates. I also definitely felt like I had to work very hard in order to understand the med school material and keep up with my really smart class. So if you feel inadequate or like you are surrounded by people way smarter than you, then this post should provide you some hope.
I’m not sure about specialty really yet. I’m honestly all over the board still, really undecided. Lifestyle and location are really important to me, I know that much.

My school’s curriculum ended up being pretty conducive to step prep. Lectures were not mandatory which is huge. We had anatomy first all together, then the rest of the curriculum basically went in the order of first aid – we did all of principles (eg, biochem, genetics, micro, etc.) followed by each system. I definitely acknowledge that some of you don’t have curricula that line up so well with First Aid like mine did. I literally did not attend 1 day of class at my school.
I used anki starting day 1 in anatomy using a pre-made deck that was passed down from an upperclassman at my school. It was super detailed and thorough (>13,000 cards). I did not stay up with reviews during anatomy after each exam. Each time we had an exam, I abandoned those cards and went on to the next ones. This was pure naivety. I wish I stayed up on anatomy reviews for the entirety of M1/M2 through dedicated. My actual step exam had a lot of hard anatomy that was probably covered back in the day at my school.
MY DECK - Once anatomy ended, I completely switched over to First Aid. My friend and I made our own deck; we will probably upload it if there is enough interest. I don’t want to spend too much time on this post talking about our deck, but I should at least mention some things about it. He and I were extremely particular. Part of the reason why we didn’t want to do zanki, Bros, Lightyear etc. was because each of those decks, although very useful and thorough, did not have 100% of first aid covered. So we decided to make our own. I can assure you that this deck has every word of First Aid 2018 covered, every single important fact of UW not covered in First Aid 2018, and then some other misc. additions from Rx qbank, Kaplan, Firecracker, etc. But it has literally 100% of First Aid covered, trust us haha. The disclaimer about our deck is that it is Front/Back cards. This will scare many people away. We wanted Front/Back because in anatomy, we quickly found that clozed cards were too easy to get right based off of other cues. Like for instance we literally would get cards right because we’d recognize the position of the cloze within the sentence – basically we could see the format of the card and get it right without even reading the sentence. That scared us. Plus, with the pre-made clozed decks, we didn’t like putting our trust in someone else choosing the right word/words to cloze. Many of the clozed cards in Zanki for instance only have 1 word clozed, and I personally would have clozed additional or different words for instance. Obviously we know Zanki and Bros and all those decks have been proven to work and I know they do, but we just personally felt better about making our own. At the end of the day, you have to memorize First Aid one way or another so you just needa do what works for you to get it down. But I will tell you Front/Back was really hard, but it forces you to really know your stuff. The deck is super organized and clean, and every card has a first Aid jpeg (not a screenshot). Again, we’ll upload it if people are interested in a good front/back deck.
MY SCHEDULE – I am an early riser and I go to bed early, I kinda always have been. I get up very early, go the gym, walk my dog, shower and get ready, and normally I aimed to be at my desk to start cards between 7-8. Mind you, I do cards during my 30 minutes of cardio and throughout my workout between sets. I literally did cards all day every day. Every free second in the day I was doing cards. In terms of social life, no I didn’t have much of one but that personally didn’t bother me. If I wanted to go out more I could have, but I just wanted to put my head down and crank this out. I hung out with friends and would do stuff on the weekends, but mainly only during M1; M2 I basically didn’t’ do anything but study up until my test. For me, staying in shape and my dog are priority. Those things take a few hours every day for me – so yes I did leave some time for me, you just may prioritize other stuff. You definitely need something tho because burnout is real. I also love playing Halo online, so I tried to play a few games before bed as often as possible, even during dedicated.
The way I learned the material was through Rx videos, but mainly through straight memorization of First Aid. So our deck is formatted in the order of FA, pretty much perfectly, and the Rx videos cover every single section of First Aid. So I would watch the relevant Rx video, then unlock the relevant Anki cards. I normally aimed for 50-100 new cards a day (that is roughly 150-250+ clozed cards). I typically didn’t do new cards on the weekends. Ill probably get flack for the “straight memorization,” but honestly, up front I’d watch videos and try and understand the concepts the best that I could, and then I would memorize. And then over time after I repeated cards over and over and I kept learning more, stuff just starts to tie together and make sense. And if some concepts just never made sense even after weeks of reviews, then I’d be sure to talk to friends and watch other videos like from BnB or something to really make sure I knew what was going on. But by in large, straight memorization of FA turned into understanding overtime. But I had to stay ahead of my curriculum for this to work out.
I stayed ahead of my curriculum the entire time. One scary thing is that every in-house exam I just had to hope that my school’s exam was representative of step prep material, since I didn’t use my school at all. Early M1 it was really scary and going into tests blind gave me tons of anxiety. But I consistently did fine, so over time it got less and less stressful. I think my lowest exam score was 78%, and all others were 80s and 90s. Also, I have a group of friends here that did this with me since day 1. Honestly I would not have been able to abandon my curriculum and use only First Aid if I didn’t have my friends doing it with me. So that was a big deal, just knowing that you’ve got friends who are equally worried about failing in house exams, even though none of us ever came close (well one of us did one time haha).
I started Rx qbank right away. As soon as I’d finish a section or system, I’d do the Rx questions relevant to that section prior to my school’s in house exam to prepare. I started UW as soon as our curriculum started the systems. For instance when my school was doing GI, I had already finished GI a few weeks prior and was doing new cards for the next system. But every day I’d do Rx and UW questions for GI. So I always was doing Qbank questions that correlated with the system my curriculum was currently teaching, since I was way ahead of the curriculum in First Aid for my personal study. I also did Kaplan, but I only finished like 60-70% of it, I didn’t prioritize it. For all qbanks prior to dedicated, I did tutor mode and it was subject specific.
I did not use sketchy, pathoma, or BnB. I know people are going to be like WHAT. I will probably get roasted for this but honestly, you do not need them. I’ve watched videos from all three, and they are awesome resources. I know they work, and I know they are very good and can be very helpful. But that does not make them necessary. You have to know First Aid. That needs to be your number 1 priority. You need to know ALL of First Aid, and well. There is basically nothing unique in Pathoma. You can probably find a handful of sentences in Pathoma that you can’t find in First Aid. I understand the Pathoma/BnB videos help a lot of people, but at the end of the day, you need to know First Aid, so if Pathoma or BnB or whatever other resource helps you get there, then great, but for me it didn’t so I just learned it my own way. Sketchy is the same way. Everyone at my school was so shocked to hear I don’t use sketchy. I just felt like I didn’t want to memorize all these sketches on top of what they meant. I felt like I could just memorize the First Aid pages without having the additional worry of remembering what all those sketchy symbols meant. Plus, First Aid is more thorough for micro anyway. My point of this paragraph is to emphasize the importance of First Aid. If you know that book like the back of your hand, you will be in very good shape. If you are using Bnb, Pathoma, sketchy, etc. as primary resources, makes sure you go back to First Aid and fill in the gaps, because there is more in First Aid that you have to know. Many people get caught up using like 50 resources. Knowing a couple of resources extremely well is much more worthwhile than knowing 10 decently. Again, I know all the resources I mentioned are excellent, worthwhile, and that they work. I’m just saying you don’t have to use them to do well. Pick what works best for you. For me, if you know First Aid and UW very well, you will be in very good shape to do well.
I finished UW and Rx prior to dedicated, and like I said probably 60% of Kaplan. People always say how many “passes of First Aid” they did, and honestly I have no idea how to quantify how many “passes” of First Aid I did because I started FA right away and stayed up on my reviews. I’m pretty sure I saw some of those sections like 100 times haha.
You guys it was such a grind. It was so hard to keep it up for so long. Having friends doing it with me was huge because it was just exhausting in every way. If you don’t have a friend studying like this at your school with you, you’ve got us here on reddit haha. Also, life happens you guys. I had a pretty sucky life event happen like right in the middle of school, and I’m proof you still can get an OK score despite that.

Summer before M2
I did research. It took a ton of time. But I still stayed up on my reviews of course and managed to finish a couple of systems as well.

I had 6 weeks of dedicated. During dedicated, I systematically reviewed every system using different videos and reading First Aid. I stopped doing my reviews from First Aid, but continued doing the cards that I had been making from Qbanks as well as all the cards I made during dedicated.
I still woke up first thing in the morning, went to the gym and did cards there, and walked my dog. At 8 am I’d do 2-3 random, timed UW blocks. I still read all of the explanations and wrong answers, but faster than I did prior to dedicated. Obviously I spent more time reading explanations if I felt shaky/weak on a particular concept. I typically finished between 12-3 pm. I’d usually take a break for an hour and take my dog to the park. Then the rest of the day til 9 or so I’d be reading First Aid and watching videos. I also would sometimes do random Rx and Kaplan blocks during that time if I felt like I was zoning out with videos and reading. I typically watched the Office in bed for an hour or 2 before I slept and I’d flip through cards. I did nbmes/UW forms throughout as you see in my scores section.
Once I finished my second UW pass, I went through and did all of my incorrects, then all of my marked. I marked like 10 per block usually. I marked the ones that I knew I wanted to see one more time.
I burned out hard af in dedicated… probably about 4 weeks in. My first 3 weeks were super productive – I reviewed all of First Aid one time and I was like cranking super hard and I was super efficient. But then the last 2.5 weeks I just slowly deteriorated and my productivity steadily declined. It got really hard for me. I started playing a lot of Halo and a ton of basketball. I actually watched pathoma during those last couple of weeks because it made me accountable to sit down and do something productive. The closer my date got, the more unproductive I became, it sucked.
6 weeks was too long for me that’s for sure. I ran out of gas at the end hard.

The Test:
I posted about this right after I took it: https://www.reddit.com/step1/comments/an1ode/just_took_step_last_week_key_takeaways_from_my/?st=jsg9kab4&sh=c01eeb31

But yeah I got my email at like 10:40 ET, could see my score report 11 am ET on the dot.

- I wish I took my test earlier. 6 weeks was too long for me and I burned out. I was too superstitious to move my date up; I just wish I originally scheduled it earlier
- Firecracker has EVERYTHING. I would have done Firecracker from day 1. In the ideal world, I would have put firecracker into anki and used it. Firecracker literally has EVERYTHING
- Stay up on your reviews, and do them honestly. You will be very happy once dedicated hits
- Go all in ASAP. Trust the process
- Don’t overload your resources. Focus on learning and memorizing all of First Aid, using whatever resources you need to get that done
- Start UW early
- Be consistent and just go as hard as you can. It’ll be over before you know it

What an intense last couple of years. It’s impossible for our friends and family to really understand what step 1 is and what is required of us. It’s nice to have a community here that gets it. Please ask any questions you have, I’m more than happy to help in any way that I can. Best of luck to all of you, and thanks for the support!
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