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Sex differences in clinical management and outcomes of patients with cardiovascular disease sometimes are due to healthcare inequities (which should https://gbs2015.com/buy-symbicort-online-canada be eliminated) but also might be due to sex-related differences in aetiology and pathophysiology how long does it take for levitra to work. For example, the optimal medical dose how long does it take for levitra to work for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561 women and 615 men with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about 50% of the recommended target dose for both sexes. A lower how long does it take for levitra to work ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF. In patients of both sexes with HFpEF, there was no relationship between medication dose and survival (figure 1).Central figure summarising the design and main findings of this study." data-icon-position data-hide-link-title="0">Figure 1 Central figure summarising the design and main findings of this study.In the accompanying editorial, Hassan and Ahmed 2 comment that.

€˜Sex differences in HF outcomes may be how long does it take for levitra to work further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability. As a result, the administration of sex-neutral medication doses leads to greater drug exposure in female patients, which may subsequently lead to a higher incidence of adverse drug reactions. This raises the possibility how long does it take for levitra to work of sex-based HF treatments to improve clinical outcomes. However, current guidelines adopt a ‘one size fits all’ approach, with an emphasis on target-dosed therapy. In this era of precision medicine, is it time to redefine optimal how long does it take for levitra to work HF therapy based on the sex of the patient?.

€™On the other hand, adverse outcomes in women with infective endocarditis likely are related to bias and healthcare inequities. In a multicentric Spanish cohort of 3541 patients3 diagnosed with endocarditis between 2008 how long does it take for levitra to work and 2018, women underwent surgical intervention less often than men (38.3% vs 50%) despite the increasing recognition that earlier surgical intervention often is beneficial as recommended in current guidelines (figure 2). The lower likelihood of surgery in women how long does it take for levitra to work persisted after propensity matching for age and surgical risk (OR 0.74. 95% CI 0.59 to 0.91. P=0.05).

In addition, women had a higher in-hospital mortality compared with men, even after adjusting for possible confounders (OR 1.41. 95% CI 1.21 to 1.65. P<0.001).Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group." data-icon-position data-hide-link-title="0">Figure 2 Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group.Van Spall, Jaffer and Mamas4 remind us of the many factors to be considered in the decision to recommend surgical intervention in a patient with endocarditis (figure 3).

However, as they conclude. €˜Disparities in referral and receipt of surgical intervention, along with differences in aetiology, microbiology and comorbidities, may be responsible for the higher risk of mortality in women than in men with IE. Ultimately, awareness of these issues should prompt a self-evaluation of biases on the part of clinicians such that objective, timely surgical referrals are made and interventions are offered regardless of demographic group. While the biology is not modifiable, the biases and care disparities are.’Factors associated with infective endocarditis outcomes." data-icon-position data-hide-link-title="0">Figure 3 Factors associated with infective endocarditis outcomes.Another interesting paper in this issue is the study by Sung and colleagues5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC). These findings were based on a cohort of 25 485 Korean men and women with a median interval between CAC measurements of 3 years.

In discussing these seeming paradoxical findings, Gulsin and Moss6 point out that although CAC is a surrogate marker for calcified atherosclerosis and is associated with a higher risk of myocardial infarction, treatment with a statin also accelerates deposition of calcified plaque, similar to the effects of physical activity in the current study. They also remind us that. (1) the severity of CAC at baseline is a key predictor of progression rates, (2) an increase in CAC score is not the same an accelerated rate of total atherosclerotic plaque progression, and (3) the risk of plaque rupture and clinical events is greatest within the necrotic core of noncalcified plaques. Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude.

€˜Sung and colleagues5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals. The coronary artery calcium paradox should not result in paradoxical care for our patients.’The Education in Heart article7 in this issue provides an overview for clinicians to detect and manage mental issues in their patients with cardiovascular disease (CVD). There is a reciprocal relationship between mental disorders and CVD. Patients with mental disorders have a 1.5- to 3.0-fold higher risk of developing CVD and, conversely, the onset of CVD increases the risk of a developing a mental disorder by 2.2-fold.The Cardiology in-Focus topic in this issue is a step-by-step guide to writing a Image Challenge question, authored by our Image Challenge Editor.8 We encourage both cardiology trainees and clinicians to submit Image Challenge questions to Heart, using this basic guide, because this type of question accelerates learning for both the author and the reader (table 1).View this table:Table 1 Key components of an image challenge questionEthics statementsPatient consent for publicationNot applicable.Reducing the risk of plaque rupture events in individuals without a prior myocardial infarction is an imprecise science.

To help clarify whether there is evidence of coronary artery disease and avoid ‘medicalisation’ of otherwise healthy individuals, international guidelines recommend incorporating the measurement of coronary artery calcium alongside risk prediction models.1 Coronary artery calcium serves as a surrogate marker of advanced calcified atherosclerosis and can be calculated from a non-contrast ECG-gated CT scan where a score of 1–99 Agatston units represents subclinical atherosclerosis, and a score of 100 or more Agatston units is considered an appropriate threshold for initiating medical therapy.1 At ≥100 Agatston units, the burden of advanced calcified atherosclerosis justifies statin implementation and this has been validated in a real-world cohort study of 16 996 subjects with a 10-year number needed to treat to prevent one cardiovascular event of 12.2 Many clinicians have advocated the benefits of coronary artery calcium in redefining the cardiovascular risk assessment of healthy individuals, as there is a strong link between high burdens of coronary artery calcium, accelerated progression of calcified plaque and the risk of future myocardial infarction. However, if the burden of calcified plaque is an accurate barometer of cardiovascular risk, one would expect an intervention which reduces an individual’s cardiovascular risk to attenuate progression of calcified plaque. And herein lies the coronary artery calcium paradox. Both invasive and non-invasive imaging studies have consistently demonstrated that high-intensity statin therapy, an established modifier of cardiovascular risk, accelerates the deposition of calcified plaque.3 4 Is this paradoxical response of accelerated calcified plaque progression only observed in response to statin therapy?. Sung and colleagues address whether the progression of coronary artery calcium is associated with different levels of physical activity in healthy individuals.5 In a large cohort derived from two South Korean hospitals, 25 485 subjects underwent serial measurement of coronary artery calcium obtained over a median duration of 3 years and assessment of physical activity using the International Physical Activity Questionnaire Short Form.

Physical activity was graded by the investigators as. Inactive (n=11 920, 47%). Moderately active (n=9683, 38%). Or health-enhancing physically active (n=3882, 15%), equivalent to running 6.5 km/day. Interestingly, the group performing the higher medically recommended levels of physical activity had the highest baseline burden of advanced calcified plaque (coronary artery calcium score ≥100 Agatston units.

Inactive 2.8%, moderately active 3.5%, health-enhancing physically active 5.0%) which may be potentially attributable to an older demographic with higher rates of hypertension, diabetes and statin use. While it is unclear what the rationale was for undertaking health-enhancing physical activity in this cohort, it is likely that some participants with subclinical disease were doing so following medical guidance to improve control of established risk factors. Reassuringly in those with a coronary artery calcium score of zero (a low-risk group from a cardiovascular disease prevention perspective), medically recommended levels of physical activity did not accelerate the rate of coronary artery calcium progression modelled at 5 years (adjusted difference in mean coronary artery calcium score 0.32 Agatston units, 95% CI −0.15 to 0.81). However, in those who already had subclinical or more advanced atherosclerosis, health-enhancing physical activity significantly increased the burden of calcified plaque (adjusted difference in mean coronary artery calcium score 15.02 Agatston units, 95% CI 0.56 to 29.49). Does this really mean that vigorous exercise in those with established coronary artery disease paradoxically accelerates plaque progression?.

This study fuels a wider discussion of some of the key limitations regarding the use of the coronary artery calcium scan to monitor coronary artery disease progression.First, the amount of calcification measured at baseline is a key determinant of the rate of progression. As illustrated in the Heinz Nixdorf Recall study, the trajectory of plaque calcification has a strong relationship with the baseline coronary artery calcium scan.6 In asymptomatic 40 year-olds, a coronary artery calcium score ≥100 Agatston units is considered a high burden of disease and one would expect to observe exponential growth in calcification over 5 years. In contrast, a coronary artery calcium score of zero would rarely change over the same time frame leading some investigators to label this as a ‘warranty period’ conferring coronary vascular stability. These small differences in coronary artery calcium scores at baseline become amplified over a 5-year follow-up period. Hence, the results of the study performed by Sung et al are in keeping with the main observation of the Heinz Nixdorf Recall study.

Progression is almost inevitable following the onset of calcification and the rate of progression appears to be only marginally influenced by the control of traditional risk factors.6Second, an accelerated rate calcified plaque progression does not equate to an accelerated rate of total atherosclerotic plaque progression. In this regard, the Progression of Atherosclerotic Plaque Determined by Computed Tomography Angiography Imaging study (NCT02803411) has provided valuable insight into the temporal changes in plaque composition using contrast-enhanced coronary CT angiography. In a cohort of 1255 patients recruited from seven countries, including South Korea, interval scans performed over a median of 3.4 years demonstrated a small increase in calcified plaque volume per annum in statin-taking compared with statin-naïve patients (progression of calcified plaque volume per annum 1.27±1.54 mm3 vs 0.98±1.27 mm3).4 However, the overall trend was towards slower rates of total plaque progression in those taking statins and this was driven by lower rates of non-calcified plaque accumulation (progression of non-calcified plaque volume per annum 0.49±2.39 mm3 vs 1.06±2.42 mm3).4 These changes are small in line with the chronic nature of atherosclerotic coronary artery disease. More advanced molecular imaging techniques have shown that metabolically active plaques undergo phenotypic transformation from a non-calcified phenotype towards a more calcified plaque.7 It is within necrotic cores of non-calcified plaques, identified on coronary CT angiography as low-attenuation regions, where the propensity of plaques to rupture is greatest.8 As such, the calcification pathways upregulated in non-calcified plaques are thought to be a protective mechanism in response to chronic inflammation. By ‘walling off’ necrotic cores, calcification may indicate a transition towards a more stable metabolic phenotype.Do these findings mean that we should stop using coronary artery calcium scores to assess coronary artery disease?.

Sung and colleagues have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals. The coronary artery calcium paradox should not result in paradoxical care for our patients.Ethics statementsPatient consent for publicationNot required..

Sex differences in clinical management and outcomes of Buy symbicort online canada patients with cardiovascular disease sometimes are due to healthcare inequities (which should be eliminated) but also might be due to sex-related differences buy levitra online from canada in aetiology and pathophysiology. For example, buy levitra online from canada the optimal medical dose for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561 women and 615 men with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about 50% of the recommended target dose for both sexes. A lower ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF buy levitra online from canada.

In patients of both sexes with HFpEF, there was no relationship between medication dose and survival (figure 1).Central figure summarising the design and main findings of this study." data-icon-position data-hide-link-title="0">Figure 1 Central figure summarising the design and main findings of this study.In the accompanying editorial, Hassan and Ahmed 2 comment that. €˜Sex differences in buy levitra online from canada HF outcomes may be further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability. As a result, the administration of sex-neutral medication doses leads to greater drug exposure in female patients, which may subsequently lead to a higher incidence of adverse drug reactions. This raises the buy levitra online from canada possibility of sex-based HF treatments to improve clinical outcomes.

However, current guidelines adopt a ‘one size fits all’ approach, with an emphasis on target-dosed therapy. In this era of precision medicine, is it time to redefine optimal HF therapy based on the sex of the buy levitra online from canada patient?. €™On the other hand, adverse outcomes in women with infective endocarditis likely are related to bias and healthcare inequities. In a multicentric Spanish cohort of 3541 patients3 diagnosed with endocarditis between 2008 and 2018, women underwent surgical intervention less often than men (38.3% vs 50%) despite the increasing recognition that earlier surgical intervention often is beneficial as recommended in current guidelines buy levitra online from canada (figure 2).

The lower likelihood of surgery in women persisted after propensity matching for age and buy levitra online from canada surgical risk (OR 0.74. 95% CI 0.59 to 0.91. P=0.05). In addition, women had a higher in-hospital mortality compared with men, even after adjusting for possible confounders (OR 1.41.

95% CI 1.21 to 1.65. P<0.001).Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group." data-icon-position data-hide-link-title="0">Figure 2 Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group.Van Spall, Jaffer and Mamas4 remind us of the many factors to be considered in the decision to recommend surgical intervention in a patient with endocarditis (figure 3).

However, as they conclude. €˜Disparities in referral and receipt of surgical intervention, along with differences in aetiology, microbiology and comorbidities, may be responsible for the higher risk of mortality in women than in men with IE. Ultimately, awareness of these issues should prompt a self-evaluation of biases on the part of clinicians such that objective, timely surgical referrals are made and interventions are offered regardless of demographic group. While the biology is not modifiable, the biases and care disparities are.’Factors associated with infective endocarditis outcomes." data-icon-position data-hide-link-title="0">Figure 3 Factors associated with infective endocarditis outcomes.Another interesting paper in this issue is the study by Sung and colleagues5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC).

These findings were based on a cohort of 25 485 Korean men and women with a median interval between CAC measurements of 3 years. In discussing these seeming paradoxical findings, Gulsin and Moss6 point out that although CAC is a surrogate marker for calcified atherosclerosis and is associated with a higher risk of myocardial infarction, treatment with a statin also accelerates deposition of calcified plaque, similar to the effects of physical activity in the current study. They also remind us that. (1) the severity of CAC at baseline is a key predictor of progression rates, (2) an increase in CAC score is not the same an accelerated rate of total atherosclerotic plaque progression, and (3) the risk of plaque rupture and clinical events is greatest within the necrotic core of noncalcified plaques.

Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude. €˜Sung and colleagues5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals.

The coronary artery calcium paradox should not result in paradoxical care for our patients.’The Education in Heart article7 in this issue provides an overview for clinicians to detect and manage mental issues in their patients with cardiovascular disease (CVD). There is a reciprocal relationship between mental disorders and CVD. Patients with mental disorders have a 1.5- to 3.0-fold higher risk of developing CVD and, conversely, the onset of CVD increases the risk of a developing a mental disorder by 2.2-fold.The Cardiology in-Focus topic in this issue is a step-by-step guide to writing a Image Challenge question, authored by our Image Challenge Editor.8 We encourage both cardiology trainees and clinicians to submit Image Challenge questions to Heart, using this basic guide, because this type of question accelerates learning for both the author and the reader (table 1).View this table:Table 1 Key components of an image challenge questionEthics statementsPatient consent for publicationNot applicable.Reducing the risk of plaque rupture events in individuals without a prior myocardial infarction is an imprecise science. To help clarify whether there is evidence of coronary artery disease and avoid ‘medicalisation’ of otherwise healthy individuals, international guidelines recommend incorporating the measurement of coronary artery calcium alongside risk prediction models.1 Coronary artery calcium serves as a surrogate marker of advanced calcified atherosclerosis and can be calculated from a non-contrast ECG-gated CT scan where a score of 1–99 Agatston units represents subclinical atherosclerosis, and a score of 100 or more Agatston units is considered an appropriate threshold for initiating medical therapy.1 At ≥100 Agatston units, the burden of advanced calcified atherosclerosis justifies statin implementation and this has been validated in a real-world cohort study of 16 996 subjects with a 10-year number needed to treat to prevent one cardiovascular event of 12.2 Many clinicians have advocated the benefits of coronary artery calcium in redefining the cardiovascular risk assessment of healthy individuals, as there is a strong link between high burdens of coronary artery calcium, accelerated progression of calcified plaque and the risk of future myocardial infarction.

However, if the burden of calcified plaque is an accurate barometer of cardiovascular risk, one would expect an intervention which reduces an individual’s cardiovascular risk to attenuate progression of calcified plaque. And herein lies the coronary artery calcium paradox. Both invasive and non-invasive imaging studies have consistently demonstrated that high-intensity statin therapy, an established modifier of cardiovascular risk, accelerates the deposition of calcified plaque.3 4 Is this paradoxical response of accelerated calcified plaque progression only observed in response to statin therapy?. Sung and colleagues address whether the progression of coronary artery calcium is associated with different levels of physical activity in healthy individuals.5 In a large cohort derived from two South Korean hospitals, 25 485 subjects underwent serial measurement of coronary artery calcium obtained over a median duration of 3 years and assessment of physical activity using the International Physical Activity Questionnaire Short Form.

Physical activity was graded by the investigators as. Inactive (n=11 920, 47%). Moderately active (n=9683, 38%). Or health-enhancing physically active (n=3882, 15%), equivalent to running 6.5 km/day.

Interestingly, the group performing the higher medically recommended levels of physical activity had the highest baseline burden of advanced calcified plaque (coronary artery calcium score ≥100 Agatston units. Inactive 2.8%, moderately active 3.5%, health-enhancing physically active 5.0%) which may be potentially attributable to an older demographic with higher rates of hypertension, diabetes and statin use. While it is unclear what the rationale was for undertaking health-enhancing physical activity in this cohort, it is likely that some participants with subclinical disease were doing so following medical guidance to improve control of established risk factors. Reassuringly in those with a coronary artery calcium score of zero (a low-risk group from a cardiovascular disease prevention perspective), medically recommended levels of physical activity did not accelerate the rate of coronary artery calcium progression modelled at 5 years (adjusted difference in mean coronary artery calcium score 0.32 Agatston units, 95% CI −0.15 to 0.81).

However, in those who already had subclinical or more advanced atherosclerosis, health-enhancing physical activity significantly increased the burden of calcified plaque (adjusted difference in mean coronary artery calcium score 15.02 Agatston units, 95% CI 0.56 to 29.49). Does this really mean that vigorous exercise in those with established coronary artery disease paradoxically accelerates plaque progression?. This study fuels a wider discussion of some of the key limitations regarding the use of the coronary artery calcium scan to monitor coronary artery disease progression.First, the amount of calcification measured at baseline is a key determinant of the rate of progression. As illustrated in the Heinz Nixdorf Recall study, the trajectory of plaque calcification has a strong relationship with the baseline coronary artery calcium scan.6 In asymptomatic 40 year-olds, a coronary artery calcium score ≥100 Agatston units is considered a high burden of disease and one would expect to observe exponential growth in calcification over 5 years.

In contrast, a coronary artery calcium score of zero would rarely change over the same time frame leading some investigators to label this as a ‘warranty period’ conferring coronary vascular stability. These small differences in coronary artery calcium scores at baseline become amplified over a 5-year follow-up period. Hence, the results of the study performed by Sung et al are in keeping with the main observation of the Heinz Nixdorf Recall study. Progression is almost inevitable following the onset of calcification and the rate of progression appears to be only marginally influenced by the control of traditional risk factors.6Second, an accelerated rate calcified plaque progression does not equate to an accelerated rate of total atherosclerotic plaque progression.

In this regard, the Progression of Atherosclerotic Plaque Determined by Computed Tomography Angiography Imaging study (NCT02803411) has provided valuable insight into the temporal changes in plaque composition using contrast-enhanced coronary CT angiography. In a cohort of 1255 patients recruited from seven countries, including South Korea, interval scans performed over a median of 3.4 years demonstrated a small increase in calcified plaque volume per annum in statin-taking compared with statin-naïve patients (progression of calcified plaque volume per annum 1.27±1.54 mm3 vs 0.98±1.27 mm3).4 However, the overall trend was towards slower rates of total plaque progression in those taking statins and this was driven by lower rates of non-calcified plaque accumulation (progression of non-calcified plaque volume per annum 0.49±2.39 mm3 vs 1.06±2.42 mm3).4 These changes are small in line with the chronic nature of atherosclerotic coronary artery disease. More advanced molecular imaging techniques have shown that metabolically active plaques undergo phenotypic transformation from a non-calcified phenotype towards a more calcified plaque.7 It is within necrotic cores of non-calcified plaques, identified on coronary CT angiography as low-attenuation regions, where the propensity of plaques to rupture is greatest.8 As such, the calcification pathways upregulated in non-calcified plaques are thought to be a protective mechanism in response to chronic inflammation. By ‘walling off’ necrotic cores, calcification may indicate a transition towards a more stable metabolic phenotype.Do these findings mean that we should stop using coronary artery calcium scores to assess coronary artery disease?.

Sung and colleagues have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals. The coronary artery calcium paradox should not result in paradoxical care for our patients.Ethics statementsPatient consent for publicationNot required..

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Latest Cancer News Buy lasix for horses By Cara how to order levitra online Murez HealthDay ReporterTHURSDAY, Jan. 7, 2021 (HealthDay News)If you're a Black man, your risk of getting prostate cancer is 75% higher than it is for a white man, and it's more than twice as deadly.Now, research is helping to bring genetic risks for people of various racial how to order levitra online and ethnic groups into focus. In doing so, dozens more risk factors that could better help pinpoint the odds of developing prostate cancer have been uncovered. And that could potentially lead to better screening protocols and earlier detection for men of all races, experts said."The potential utility of this is that it can be used to define men who are at elevated risk of developing prostate cancer," said lead author Christopher Haiman, professor of preventive medicine at Keck School of Medicine at the University of Southern California (USC) in Los Angeles."This is knowledge that men could find out, I hate to say it, but at birth," he added.More likely, men would get this information later in life, Haiman said, but clinicians could use it to determine when blood tests to screen for prostate cancer should begin and how often screening should occur.Researchers from the USC Center for Genetic Epidemiology in Los Angeles and the Institute of Cancer Research in London led the study.They noted that past prostate cancer studies included an overrepresentation of white men, making it more difficult to understand and address variations in risk by race.The new study brought together data from genomic prostate cancer studies around the world, including in the United States, Ghana, Japan, Sweden and the United Kingdom.The study — described as the most diverse genetic analysis for prostate cancer ever — included men of African, Asian, Hispanic how to order levitra online and European ancestry.The researchers compared genomic data from more than 107,000 men with prostate cancer to a control group of 127,000 men without prostate cancer.Using a model for assessing risk based on an interplay of genetic risk factors, the investigators found that men of African ancestry inherit twice the prostate cancer risk on average as men of European ancestry. Men of Asian ancestry inherit about three-quarters the risk of white men.That is evidence that genetics play some role in the differences in frequency of prostate cancer among various racial groups, the study how to order levitra online authors said.Though genes appear to be responsible for the greater risk in men of African descent, there is no evidence that genes make the disease more aggressive, Haiman said.

Yet Black men are more likely to have an aggressive form of the disease and to die of prostate cancer, he added."We have yet to find that the genetic markers that we're identifying in the genome are more likely to predict a man's risk of developing aggressive disease," Haiman said. "I think there's substantial evidence, strong support, for it's actually being due to other factors, such as access to care, access to treatment, access to earlier how to order levitra online screening. I think how to order levitra online those factors probably are having a much greater impact."The study identified 86 previously unknown genetic variations that increase prostate cancer risk. Known variations now number 269.The long-term goal is to develop a risk score that can be used to gauge a man's prostate cancer risk so the disease can be identified early when it's more treatable. Haiman said there's still room for improvement to increase risk prediction, especially for men of African ancestry.The findings were published how to order levitra online Jan.

4 in the journal Nature Genetics. The next how to order levitra online phase of research is to integrate the new information into a larger-scale clinical study, Haiman said.Prostate cancer affects a gland below a man's bladder that produces fluid for semen, according to the U.S. National Cancer how to order levitra online Institute. Like all cancers, it happens when cells grow out of control.Dr. William Cance, chief medical and scientific officer for the American Cancer Society, welcomed the findings."It's good to get additional risk factor how to order levitra online data for prostate cancer.

We need to get a better refinement of who has a severely higher risk and focus our screening efforts there," he how to order levitra online said. "That's one good thing. It's a step forward in risk stratification."The findings also highlight key disparities, Cance said."We know there's disparity in prostate cancer and outcomes," he said, noting that African-Americans face both genetic risks as well as disparities in cancer care.He said it's exciting to see genetic data and other tests, including those that could eventually be used for blood-based cancer diagnosis."That's where the exciting part of the evolution in early detection is going to be, in that realization how to order levitra online that there are differences we can hopefully predict," Cance said. "And then as we evolve the blood tests for cancer, we want to pull the diagnosis earlier, earlier and earlier until we can prevent it."More information IMAGES Prostate Illustrion Browse through our medical image collection to see illustrations of human anatomy and physiology See Images The U.S. National Cancer how to order levitra online Institute has more about prostate cancer.SOURCES.

Christopher Haiman, ScD, professor, preventive medicine, Keck School of Medicine, University of Southern California, and director, U.S how to order levitra online. Center for Genetic Epidemiology, USC Norris Comprehensive Cancer Center, Los Angeles. William Cance, how to order levitra online MD, chief medical and scientific officer, American Cancer Society. Nature Genetics, how to order levitra online Jan. 4, 2021Copyright © 2020 HealthDay.

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Latest Cancer buy levitra online from canada News By Cara Murez HealthDay ReporterTHURSDAY, http://marthamukaiwa.com/buy-lasix-for-horses/ Jan. 7, 2021 (HealthDay News)If you're a Black man, your risk of getting prostate cancer is 75% higher than it is for a white man, and buy levitra online from canada it's more than twice as deadly.Now, research is helping to bring genetic risks for people of various racial and ethnic groups into focus. In doing so, dozens more risk factors that could better help pinpoint the odds of developing prostate cancer have been uncovered. And that could potentially lead to better screening protocols and earlier detection for men of all races, experts said."The potential utility of this is that it can be used to define men who are at elevated risk of developing prostate cancer," said lead author Christopher Haiman, professor of preventive medicine at Keck School of Medicine at the University of Southern California (USC) in Los Angeles."This is knowledge that men could find out, I hate to say it, but at birth," he added.More likely, men would get this information later in life, Haiman said, but clinicians could use it to determine when blood tests to screen for prostate cancer should begin and how often screening should occur.Researchers from the USC Center for Genetic Epidemiology in Los Angeles and the Institute of Cancer Research in London led the study.They noted that past prostate cancer studies included an overrepresentation of white men, making it more difficult to understand and address variations in risk by race.The new study brought together data from genomic prostate cancer studies around the world, including in the United States, Ghana, Japan, Sweden and the United Kingdom.The study — described as the most buy levitra online from canada diverse genetic analysis for prostate cancer ever — included men of African, Asian, Hispanic and European ancestry.The researchers compared genomic data from more than 107,000 men with prostate cancer to a control group of 127,000 men without prostate cancer.Using a model for assessing risk based on an interplay of genetic risk factors, the investigators found that men of African ancestry inherit twice the prostate cancer risk on average as men of European ancestry. Men of Asian ancestry inherit about three-quarters the risk of white men.That is evidence that genetics play some role in the differences in frequency of prostate cancer among various racial groups, the study authors said.Though genes appear buy levitra online from canada to be responsible for the greater risk in men of African descent, there is no evidence that genes make the disease more aggressive, Haiman said.

Yet Black men are more likely to have an aggressive form of the disease and to die of prostate cancer, he added."We have yet to find that the genetic markers that we're identifying in the genome are more likely to predict a man's risk of developing aggressive disease," Haiman said. "I think there's substantial evidence, strong support, for it's actually being due to other factors, such buy levitra online from canada as access to care, access to treatment, access to earlier screening. I think those factors buy levitra online from canada probably are having a much greater impact."The study identified 86 previously unknown genetic variations that increase prostate cancer risk. Known variations now number 269.The long-term goal is to develop a risk score that can be used to gauge a man's prostate cancer risk so the disease can be identified early when it's more treatable. Haiman said there's still room for improvement to increase risk prediction, especially for men buy levitra online from canada of African ancestry.The findings were published Jan.

4 in the journal Nature Genetics. The next phase of research is to integrate the buy levitra online from canada new information into a larger-scale clinical study, Haiman said.Prostate cancer affects a gland below a man's bladder that produces fluid for semen, according to the U.S. National Cancer Institute buy levitra online from canada. Like all cancers, it happens when cells grow out of control.Dr. William Cance, chief medical and scientific officer for the American Cancer Society, welcomed the findings."It's good to get additional risk factor data buy levitra online from canada for prostate cancer.

We need buy levitra online from canada to get a better refinement of who has a severely higher risk and focus our screening efforts there," he said. "That's one good thing. It's a step forward in risk stratification."The findings also highlight key disparities, Cance said."We know there's disparity in prostate cancer and outcomes," he said, noting that African-Americans face both genetic risks as well as disparities in cancer care.He said it's exciting to see genetic data and other tests, including those that could eventually be used for buy levitra online from canada blood-based cancer diagnosis."That's where the exciting part of the evolution in early detection is going to be, in that realization that there are differences we can hopefully predict," Cance said. "And then as we evolve the blood tests for cancer, we want to pull the diagnosis earlier, earlier and earlier until we can prevent it."More information IMAGES Prostate Illustrion Browse through our medical image collection to see illustrations of human anatomy and physiology See Images The U.S. National Cancer Institute has more about buy levitra online from canada prostate cancer.SOURCES.

Christopher Haiman, buy levitra online from canada ScD, professor, preventive medicine, Keck School of Medicine, University of Southern California, and director, U.S. Center for Genetic Epidemiology, USC Norris Comprehensive Cancer Center, Los Angeles. William Cance, MD, chief medical and scientific officer, American Cancer buy levitra online from canada Society. Nature Genetics, buy levitra online from canada Jan. 4, 2021Copyright © 2020 HealthDay.

All rights buy levitra online from canada reserved. From Cancer Resources Featured Centers Health Solutions From Our Sponsors.

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Start Preamble levitra kaufen 10mg http://drtumbarello.com/buy-propecia-online-without-prescription/ Centers for Medicare &. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule. This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule levitra kaufen 10mg. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021.

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In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for donations of cybersecurity technology and related levitra kaufen 10mg services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations.

This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule levitra kaufen 10mg. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances. In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously levitra kaufen 10mg established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020.

However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of the final levitra kaufen 10mg rule until August 31, 2021. Start Signature Dated. August 24, 2020. Wilma M.

Robinson, Deputy Executive Secretary to levitra kaufen 10mg the Department, Department of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18867 Filed 8-26-20. 8:45 am]BILLING levitra kaufen 10mg CODE 4120-01-PToday, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced over $117 million in quality improvement awards to 1,318 health centers across all U.S.

States, territories and the District of Columbia. HRSA-funded health centers will use these funds to further strengthen quality improvement activities and expand quality primary health levitra kaufen 10mg care service delivery.“These quality improvement awards support health centers across the country in delivering care to nearly 30 million people, providing a convenient source of quality care that has grown even more important during the erectile dysfunction treatment levitra,” said HHS Secretary Alex Azar. €œThese awards help ensure that all patients who visit a HRSA-funded health center continue to receive the highest quality of care, including access to erectile dysfunction treatment testing and treatment.”Health centers deliver comprehensive care to people who are low-income, uninsured or face other obstacles to getting health care. On top of the safety-net that they provide, health centers have been on the front lines preventing and responding to the erectile dysfunction treatment public health emergency, including providing over 3 million erectile dysfunction treatment tests. Health centers continue to provide essential services for our nation’s most vulnerable and medically underserved populations, including those who often do not have access to care, before, during and after the erectile dysfunction treatment levitra.HRSA’s quality improvement awards recognize the highest performing health centers nationwide as well as those health centers that have made significant quality improvements from the previous year.Health centers are recognized for levitra kaufen 10mg achievements in various areas.

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Start Preamble buy levitra online from canada Centers http://drtumbarello.com/buy-propecia-online-without-prescription/ for Medicare &. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule. This notice announces an extension of the timeline for publication buy levitra online from canada of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021.

Start Further Info Lisa O. Wilson, (410) 786-8852 buy levitra online from canada. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients over Paperwork initiative and the Department buy levitra online from canada of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care.

In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for donations of cybersecurity technology and buy levitra online from canada related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations.

This notice buy levitra online from canada announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances. In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted buy levitra online from canada publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020.

However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of the final rule buy levitra online from canada until August 31, 2021. Start Signature Dated. August 24, 2020. Wilma M.

Robinson, Deputy Executive Secretary to the Department, buy levitra online from canada Department of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE buy levitra online from canada 4120-01-PToday, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced over $117 million in quality improvement awards to 1,318 health centers across all U.S.

States, territories and the District of Columbia. HRSA-funded health centers will use these funds to further strengthen quality improvement activities and expand quality primary health care service delivery.“These quality improvement awards support health centers across the country in delivering care to nearly 30 million people, providing a convenient source of quality care buy levitra online from canada that has grown even more important during the erectile dysfunction treatment levitra,” said HHS Secretary Alex Azar. €œThese awards help ensure that all patients who visit a HRSA-funded health center continue to receive the highest quality of care, including access to erectile dysfunction treatment testing and treatment.”Health centers deliver comprehensive care to people who are low-income, uninsured or face other obstacles to getting health care. On top of the safety-net that they provide, health centers have been on the front lines preventing and responding to the erectile dysfunction treatment public health emergency, including providing over 3 million erectile dysfunction treatment tests. Health centers continue to provide essential services for our nation’s most vulnerable and medically underserved buy levitra online from canada populations, including those who often do not have access to care, before, during and after the erectile dysfunction treatment levitra.HRSA’s quality improvement awards recognize the highest performing health centers nationwide as well as those health centers that have made significant quality improvements from the previous year.Health centers are recognized for achievements in various areas.

Improving cost-efficient care delivery. Increasing quality of care. Reducing health buy levitra online from canada disparities. Increasing both the number of patients served. Increasing patients’ ability to access comprehensive services.

Advancing the use of buy levitra online from canada health information technology. And Achieving patient-centered medical home recognition.“Nearly all HRSA-funded health centers have demonstrated improvement in their clinical quality measures reflecting HRSA’s strong commitment to providing high value health care,” said HRSA Administrator Tom Engels. €œHealth centers serve approximately 1 in 11 people nationally. These awards will support health centers as they continue to be a primary medical home for communities around the country. Today, nearly 1,400 health centers operate nearly 13,000 service delivery sites nationwide.”For a list of today’s award recipients, visit.

Https://bphc.hrsa.gov/programopportunities/fundingopportunities/qualityimprovement/index.html To locate a HRSA-funded health center, visit. Https://findahealthcenter.hrsa.gov/..

!]


How long does it take for levitra to work

Apr 292013
 

From Reveal: A Sacred Manual for Getting Spiritually Naked, by Meggan Watterson:

“The world of magic and of love that I secretly believed in was all around me, a part of me and a part of what it is to be human. As terrifying as it was to believe … I knew the time had come to surrender to the truth that I have the power to conjure what my soul longs for most.”

I really liked this book — a lot.

As a woman, I always enjoy learning about and applying ideas related to the Divine Feminine. It’s a rich and fascinating area.

I had the impression that’s what this book was about. As I eagerly cracked it open, I saw that it was.

And it’s also so much more.

Lift the veil that shrouds your strangeness. Dare to see how powerful you are.

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As a master theologian and scholar of the Divine Feminine, Meggan is able to share way more about this rich subject than I could possibly get into right here. I very much enjoyed the breadth of information she shared about all the various “incarnations” of the Divine Feminine.

I found it very interesting, and although she made her points about it, she did it in such a way that it often left me wanting even more.

Fortunately she cites various books and provides lots of references that we can follow up on for further reading.

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What I didn’t expect is that Meggan’s journey would be so expertly interwoven into that information. Not only the stories of her pilgrimages (which were really interesting) but also her own inner journeys as she discovered the Divinity within herself.

I really loved this aspect of the book and was able to identify. It’s really fun to be able to connect my experiences with the symbology and actuality of what the famous icons of the Divine Feminine represent.

It keeps the reading interesting and even though you’re learning a lot about the Divine Feminine as it’s existed throughout the ages, you’re always relating it to now and what it means to you in your life.

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And yet, Meggan takes it even another step farther.

The book is laid out in a way that we are peeled like an onion. Or rather, that “the veils” are lifted in succession. The subtitle is, after all: A Sacred Manual for Getting Spiritually Naked.

And it really is about embracing and honoring ourselves as women, and as spirit. As the Divine, and the Feminine.

The true human can remember the Divine within and use that consciousness to help create reality through the infinite grace and power of the “I Am.”

The 7 veils she helps remove are related to:

  • Our stories
  • Our bodies
  • Our soul-voice
  • Our worth
  • Our inner mystic
  • Our soul-work
  • Our spiritual community

In several of these chapters, I found myself highlighting almost everything!

I especially liked the soul-voice and soul-work chapters. They are both so rich in ideas and inspiration that we can apply meaningfully in these areas of our lives.

Meggan is masterful at making a genuine connection with your heart, so you really “get”, at a deep level, what she’s saying. She also includes beautiful transcendent poetry which, like her words, can reach out from the page and touch you.

We all have encounters with the sacred. We just have to cultivate the eye that can perceive them. We have to see what’s already here, interwoven with what we claim is human and mundane. We have to take inventory of the magic that conspires to love us in and through our ordinary lives.

So really, what you’ve got here, is:

  • This wonderfully rich source of interesting and relevant information
  • Meggan’s fascinating stories that go along with it and illuminate the principles
  • Compelling examples and ideas you can actually use to more fully enjoy your own spiritual journey and take it as deep as you dare.

It’s time to stop investing in the limits we’ve identified with and start believing in the impossible, the ineffable, that lives in and through us all the time. It’s time to come out of the spiritual closet. We need to let our own mystery breathe. It’s time to unlock the chains we have placed on the most magical aspect of our being and let our inner mystic go for a walk around the neighborhood in broad daylight.

This book, like the author, is a true celebration of the feminine … Divine or otherwise.

I highly recommend it.

(All quotes from  Reveal: A Sacred Manual for Getting Spiritually Naked, by Meggan Watterson.)

Disclaimer: I received this book for free from Hay House Publishing for review purposes, yet you can rest assured that this review reflects my honest evaluation.

Have you read this book? I’d love for you to leave a comment and let us know how it was for you! Or do you have any questions about it? Ask away!

Patti

How long does it take for levitra to work

Apr 052013
 

Frozen Shoulder - Healed!Welcome to the 2nd article in my new series about the Open State.

(Click here for the first article which introduces the series and covers why the heck you should even care about the Open State.)

★   ★   ★

I want to start with something kind of fun and amazing!

I’m going to show with an example why you want to care about this.

It involves a complete healing of my frozen shoulder.

I’m also including the audio from a private session I did on myself.

So you’ll not only see the usefulness of the Open State, but also open your mind to what’s possible, a super-helpful frame of mind to be in to really make use of the Open State.

If you haven’t been reading along up until now, you might enjoy perusing my last set of articles about the value and importance of an open mind.

It really is a prerequisite for making use of the Open State — at least when it comes to facilitating magic and miracles! (And who wouldn’t want to do that?)

If you can’t believe in *magical* possibilities, you’re not as likely to manifest them.
Open to the Possibilities and Emerge!

Can you let go of what you think you know and open your mind wide to all the possibilities?
Let Magic Be Your New Normal

This is about the dance between and open mind and the Open State, and how they both enhance each other.
Dance Your Way to an Expanded Reality

And here are some of my favorite books that can help immensely.
10 Books to Blow Your Mind Wide Open

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Actually … no.

Note I don’t say that “I” healed my shoulder. I simply accessed “The Field” (by entering the Open State) and let it do the rest.

Here’s the background.

Awhile back, I’d developed what’s known as a “frozen shoulder”, although I didn’t think about it that way. (Richard Bartlett says when we hook into a diagnosis, it’s like a curse. Think about it. You sort of set it in stone as your reality.)

I could barely lift it to be parallel to the ground, and for awhile, not even that. This was as good as it got, even after numerous intensive treatments by professionals. They had essentially given up on any significant improvement without expensive, ongoing physical therapy or surgery.

So that sets the stage, in a nutshell.

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Since I’ve already written about my healing process as it occurred, I’m listing the articles that contain the details.

Together these articles reveal the key to how it finally healed 100% using the Open State. (Search each one for “shoulder” to see what was going on at the time.)

They also have useful information and exercises you can apply right now.

This first might be outside your comfort zone about what our bodies even are, but it’s one of my very favorite posts. Even I still refer to it from time to time. 😉 Open your mind to the idea that our bodies may not be a “solid” thing. It has lots of great quotes by Deepak Chopra.
Your Magical Mind, Magical Body

Here’s a holistic view of what was going on with my shoulder. I took advantage of some amazing signs, synchronicities, and even a channeled message. They all played a part in some powerful guidance that helped get me on a healing track.
Does Your Guidance Have to Scream to Get Your Attention?

In this post I only mention it along with other things I’ve used Emergence for. I’m including it because you can see where the Open State fits into the entire Emergence process which is nicely summarized. (Pay attention to the section ”The Field” which is where I talk about “the state” which is what I now call the Open State. Toward the end is a link to a popular post that guides you into the Open State.
Activate Magic and Miracles With Me!

Here’s one where I use the “Magic Mirror” tool (suggested by my channeling guide) with much success — in fact my shoulder completed its healing as a result of this work, I’m sure of it. This post also tells exactly how you can do this too.
Heal Your Paired Body Part :: The Magic Mirror Tool

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And now … I’m sharing an audio with you of one of my private sessions with myself so you can get a feel for what transpires.

It was one of just a few sessions with my shoulder.

At that point, I could only lift my left arm about 45-90 degrees (so at best just parallel to the floor).

I was guided to stand in front of the mirror and do a session on “that person in the mirror” (oui, c’est moi!) as if for someone else.

You’ll hear me mention a two-point which is a Matrix Energetics technique.

I also have what I call “healing burps”. These started when I learned to channel and are indications that things are being processed and are shifting/healing.

Also, at one point (maybe two) you’ll hear me get suddenly emotional. That’s not uncommon and again, just shows that things are moving.

Patti does an Emergence session on her shoulder (Audio – 16 min.)
Listen below, or click here if you’re reading this in email.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

In the audio, I refer to two books. Just FYI,

• When I talk about giving to the universe vs. taking — and using the mirror as part of an exercise for that — I’m referring to something I learned from The Presence Process by Michael Brown. It’s an excellent book that walks you through a powerful process.

• And then, I mention a book that my eyes fall upon during the session. It’s Byron Katie’s A Thousand Names for Joy, and one of my all-time favorites.

So … I hope the combination of reviewing the story of my healed – yes, healed! – shoulder along with listening to the session itself has opened your eyes to:

1. What’s possible, and

2. How the Open State (which is the foundation for Holographic Emergence™) is super useful!

Until next time … Namasté,

Patti

Any questions? Comments? Were all those posts a bit too much for you? Let me know! And if you liked this post, your sharing it on Twitter or Facebook is much appreciated! (Buttons below.)


Want a perfect summary of what Emergence is all aboutplus a session I did just for subscribers? You’ll receive the Emergence Primer + Tune-Up Session as a thank-you gift (it’s an instant download) when you subscribe to my free newsletter.


How long does it take for levitra to work

Feb 242013
 

In Western society, the rational mind rules.

We’re encouraged to develop and honor it above all else, even to the exclusion of all else.

It’s too bad.

Being purely rational — even predominantly rational — limits us more than we know.

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In my last post, I talked about the importance of having an open mind. And what I mean by this is not just being open to new, rational ideas.

It’s about opening your whole self, your larger “mind”, to the idea that you may not know it all; you may never know it all!

And it’s helpful to open to the possibility that there is more than we can ever know or understand.

What happens then is you allow some other parts of you to operate along with (or sometimes instead of) your rational mind.

It’s a more holistic, aware, intuitive, and in short, expanded way of being. (And so fun!)

This is an especially important foundation to build on if you want to be able to take advantage of the Open State that is critical to Emergence, allowing the magic that is you to unfold into your life.

As I’ve said before, if you believe there’s no such thing as magic, you’re not as likely to experience it.

Entering the Open State is easiest if you can expand your mind, or let go of your thoughts altogether (especially your thoughts of disbelief).

But in the meantime, you don’t have to be perfect.

Just make a start.

Open the door just a little.

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The Open State and an open mind work together (or play together).

It’s like a dance, where each interacts with and enlivens the other.

Expanding and strengthening each is an iterative process.

I know this to be true as I am doing the dance, and have been for a long time!

If you’re willing to do this, you’ll find that rather than build new beliefs, your mind will be fluid and open to whatever shows up in the moment.

Your perceptions will be spontaneous and dynamic. (Much more about what this means and how you can do it too in the upcoming Open State series.)

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During our last Activation, we did a quick and easy process together.

Afterward, I got a question that made the idea of this dance quite apparent.

It was about the questioner’s thoughts, and her beliefs — that rational mind, again! — and how they help or hurt the process.

How long does it take for levitra to work

I wanted to share the question and answer with you.

After the call, a few more ideas came to me and I’ve added those also. (So those of you on the call and with the recording have not heard all of this yet.)

(For some context it might help you to first listen to the Opening + Emergence audio found in my post Open to the Possibilities and Emerge!)

Beliefs Question and Answers (Audio – 10 min.)
Listen below, or right-click here to download.

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Enjoy!

Note: In my answer, I recommend a book called The Field by Lynne McTaggart. It’s a great way to help open your mind, and is a fun read, besides. You can always find it and other books I recommend in my store.

I’ll be recommending more books that are specifically on this topic shortly.

In the meantime, if you want to know more about Emergence, sign up for my newsletter. As a free gift you’ll get the Emergence Primer plus a Tune-Up Session audio that you can use over and over.

Or check out the posts listed in my side-bar for an ordered introduction to this new and exciting way of being and manifesting.

Thanks for reading!

Until next time,

Patti

How long does it take for levitra to work

Feb 162013
 

Magic is the New NormalWOW, I sure enjoyed our recent January Activation!

It went well, and it was enlightening for me to interact with those of you who participated (thank you)!

I got a great question during the Q & A that made something I’d been considering even more apparent.

It’s the importance of developing an open mind.

It’s the very first step, even before learning about the Open State and how to be in it.

We need to get out of our own way so that we can take advantage of what the Open State offers.

(If you were on the call, you heard me announce a February blog series about the Open State, but this made me realize I first want/need to write awhile about an open mind. So here we go!)

Can you let go of what you think you know and open your mind wide to all the possibilities?

How long does it take for levitra to work

I’ve been developing my magical thinking all my life, really. I didn’t think about it that way at the time, but that’s what I was doing. It’s perfectly natural to me.

It’s so natural, that I’m coming to the conclusion that magic is the new normal: Many of my friends live that way, as do many of you.

If the idea of an open mind sounds or feels foreign to you, know that you can develop one deliberately.

How long does it take for levitra to work

And it’s not so much about learning something new. It’s more about UN-learning what you think you know.

UN-learning all your limiting beliefs.

How long does it take for levitra to work

And it’s not about believing in magic and miracles.

It’s not about believing in anything!

It’s about letting go of beliefs and being willing to open to the possibilities!

Then you’ll be not only more able, but also more motivated to embrace the Open State which is an expanded way of perceiving and experiencing (and the state from which you can easily facilitate magic and miracles).

How long does it take for levitra to work

In many ways, an open mind is the primary foundation of Emergence. But to be more accurate, it’s more of a non-foundation, since unlike most foundations, it’s an undefined element.

Rather than being “solid”, it’s malleable and always changeable.

That’s the beauty, the magic, and the fun of it.

In the world where magic is the new normal, you get to make it up as you go. (Stick with me and you’ll “get” what this means. ;-))

How long does it take for levitra to work

So a truly open mind allows for a new mindset where your perspective remains fluid.

It enables you to open to the possibilities:

• Of the process

No rules!

• Of the results

No limits!

• Of reality

It may not be what you think it is — in fact, it’s probably not!

Your open mind will be much more open to possibilities than is the (old ;-)) norm.

So, are you open to becoming more open?

If so, keep an eye on this space.

In upcoming posts I’ll be presenting some new models to play with that will help you open your mind even more than it already is.

And if you want to know more about Emergence, sign up for my newsletter and as a free gift you’ll get the Emergence Primer plus a Tune-Up Session audio you can use over and over.

Thanks for reading! Until next time,

Patti

How long does it take for levitra to work

Feb 082013
 

Hello, magical creatures!

Here’s a short, easy-to-listen-to audio that sets the stage for several of my upcoming articles.

It’s an excerpt from our most recent live Activation (a group Holographic Emergence™ session).

In essence, it’s about opening to the possibilities of your reality:

If you can’t believe in *magical* possibilities, you’re not as likely to see or manifest them

• A brief, in-a-nutshell explanation of what I call “Emergence” and why

Listening will give you a better idea of what this blog is about, too.

Opening + Emergence (Audio – 10 min.)
Listen below, or right-click here to download.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

I hope you enjoyed that! (Let me know!)

And if you want a bit more on Emergence, sign up for my newsletter and as a free gift you’ll get the Emergence Primer plus a Tune-Up Session audio you can use over and over.

Thanks for reading! Until next time,

Patti

How long does it take for levitra to work

Nov 022012
 

Life as a Doorway to the Field“Death is not the opposite of life. Life has no opposite. The opposite of death is birth. Life is eternal.”

~ Eckhart Tolle, Stillness Speaks

I LOVE this quote. It’s crossed my mind often since first reading it.

And it’s come to mind most recently after losing our sweet lab, Ollie, especially because I had a lot of synchronicities that made me aware — at a deep level — of the same thing.

How long does it take for levitra to work

It started just a few days after his death.

I was in the back yard and as I looked up I saw 2 mourning doves walking around the bush from his grave. Now, I never see mourning doves back there, even rarely see them at all around here. And that they should come right from his grave while I was there … Well, let’s just say I noticed.

Shortly after that, I was walking over to visit his grave and out hopped a bunny from behind it. It came right over to me, within about 3′, and stopped right at the grave. Again, I took notice.

Even funnier, the next morning I got up and there was the bunny lying in the backyard, all stretched out, right where Ollie used to lay all stretched out!

This was odd enough but this happened several days in a row.

This was getting a little strange, even for me!

Over the next week or two, the quote just kept coming back to mind.

And it seemed that everywhere I went, there was Life.

There were lizards, snakes, birds (ravens, baby flycatchers that hatched and flew the coop, and another mourning dove that flew right in front of me), a big moth that sat right on the post near me on the front porch while I worked, and of course, bunnies galore — to name a few.

How long does it take for levitra to work

All of this made me sooo aware that Life goes on.

And I don’t mean “life goes on” like your life situation has to continue.

I mean Life just goes on! There is no end to it.

And I did revel in the fact that Ollie was still around. I felt him, not only as his presence, but as Life itself!

I recently did a book review of Dying To Be Me by Anita Moorjani about her near-death experience (NDE). But did you know I had my own NDE? I did … Not as involved as Anita’s, but enough for me to get a taste of what happens when we die. And I can tell you, Life goes on! It’s amazing.

How long does it take for levitra to work

So you may wonder what this has to do with Emergence.

Well, experiencing the Life that you are — even your life force (which is a little bit of an abstraction of it but still a good stepping stone) — is a doorway to the state of consciousness you enter when you “do” Emergence.

It’s your conscious connection to a powerful field of magic and miracles.

In some ways, the state is impossible to speak of, but there are a lot of pointers that can help lead you to it.

This is one of them. (Note: For some instruction on experiencing your life force and using it to strengthen your immune system or even heal, see remedy #16 in Kiss Your Cold Goodbye Fast With These 20 Natural and Vibrational Remedies.)

And once you’re adept at entering the state … at being … and being life consciously, with awareness — the rest is a piece of cake. 😉

The truth is: you don’t have a life, you are life, the One Life, the one consciousness that pervades the entire universe and takes temporary form to experience itself as a stone or a blade of grass, as an animal, a person, a star or a galaxy.

Can you sense deep within that you already know that? Can you sense that you already are That?

~ Eckhart Tolle, Stillness Speaks

Thanks for reading, and here’s to you — as Life emerging!

Patti

 

 

As usual, I’d love to hear what you have to share about this topic, or any questions you might have. Just use the comment box! Thank you!


How long does it take for levitra to work

Then sign up for my newsletter to qualify and be notified of our next free group Emergence session (aka “Activation”).

Of course, you can always get your own private Emergence session too. ;-) For more information, see my Holographic Emergence Sessions™ page.

How long does it take for levitra to work

Apr 042012
 

Don’t you love a bargain?

I do too.

And I love activations, magical thinking, books, and all types of meditation.

They all have the potential to open you to new worlds, just like cracking the egg does for a little hatch-ling.

And oooo, combinations of all of the above are worth getting excited about!

Here are some valuable bargains that have come to my attention lately that I want to share with you.

(And they’re almost upon us so read this now!)

How long does it take for levitra to work

If you didn’t see my tweets or Facebook postings and haven’t already registered, hop on over to Jo Dunning’s site and sign up for her “Activations of Awakening”.

It’s imminent! Tonight (Weds. ) at 6p PDT.

You write down your intentions for the session ahead of time, and then show up.

It’s different than what I did in my recent Spring Activation, and you can read all about Jo’s on her site.

I did it in Jan. ’11 and it was powerful! I swear, all kinds of things related to my intentions were suddenly on the move. So much so that it was a bit overwhelming for awhile.

Oh, and did I say it’s FREE? Yes!

And speaking of free, check out her brand new Wish Project while you’re there.

Thank you, Jo! 🙂

How long does it take for levitra to work

I live in the high desert and over the years here have deeply connected with the ravens and all that Raven implies. S/he is magical, a messenger, and helps bring the subconscious into the light of awareness.

I recently had a friend pass away who was known far and wide as Raven. A gifted poet and otherwise remarkable man who was loved by many. So sad for us left behind without his bright light.

And then what flies into my life unexpectedly but a book about Raven. It’s beautifully written by my sweet and wise friend Christopher Foster of The Happy Seeker. I’m enjoying it little morsel by little morsel and can say that the love with which it obviously was written is almost palpable.

In Christopher’s words:

I’ve written four or five books over the years but am most proud of an animal fable entitled The Raven Who Spoke with God.

It’s a story about integrity and the unconquerable spirit in us all, and I mailed out the first copies on the morning of 9/11. The book was translated into 11 foreign-language editions but then it reached the end of its natural life, or so I thought.

Recently, however, my book has been published in Kindle format.

Oh, and did I say it’s FREE too?

Well, that is if you jump on it this Easter weekend, from this Friday thru Sunday, you can download a free Kindle edition. (And if you don’t have a Kindle it’s a snap to install the free software from Amazon so you can read Kindle books on your PC or Mac.)

You can get it here. And please help spread the word!

And of course it will still be available after this weekend, and well worth the little bit Christopher is asking for it.

Thank you, Christopher! 🙂

How long does it take for levitra to work

And finally, someone I know is getting close to releasing an awesome meditation product.

[Update: This meditation product has launched! You can find out more about it here.]

It’s aimed at the busy individual (know anyone like that?) who wants to reawaken to their natural inner balance, their calm connection to spirit, and their body’s natural state of health. It helps awaken intuitive guidance, dreams and aspirations, and it enhances productivity and success.

I was lucky to be one of the reviewers and my gosh! I can’t say enough good things about it.

I was hugely impressed.

It consists of:

  • 1 instruction manual (how to use the system)
  • 3 beautiful (and beautifully written) books
  • 1 workbook, and
  • 20 guided meditations

I’m not normally much of a guided meditation gal, but I have to say, I absolutely loved them! Every day I looked so forward to my guided meditation time.

It seemed to me that it’s almost like 3 offerings in one, although tightly integrated so each supports the others.

It’s like a class on silent meditation, another on using guided meditations, and yet another with step-by-step instruction/exercises for creating your own guided meditations to visualize what it is you want to create in your life.

ON top of that, there are four bonuses included … and they’re BIG bonuses!

And then I found out the asking price. What?! I thought I must have read it wrong.

Surely the price was supposed to have a zero behind it or maybe in the middle.

But no.

Talk about value. It’s worth it for the versatile set of guided meditations alone.

I’m delighted to have an interview with the creator about it that I’ll post here for you once the product’s available.

[Update: It’s available! You can find the interview here.]

You’ll hear all about the (amazing!) bonuses and you’ll get a link to a special free download so you can try out a part of the system.

Note that the system is not available quite yet! But in the interview post I’ll include all the details about how to get your hot little hands on it once it’s available. (And just so you know, if I’m smart I’ll be an affiliate by then, because it’s a truly remarkable system and I highly recommend it.)

Thank you, Mystery Person! 🙂

That’s it for now. Signing off. Happy Easter, and namasté.

If you take advantage of any of these bargains, please let us know what you thought of them in the comments!

How long does it take for levitra to work

Mar 212012
 

This Friday I’m holding my first group Holographic Emergence Session, in the form of a Spring Activation teleconference.

And boy, do I keep wanting to control it!

I’m so trained. We all are. Trained to take charge, “make” it happen, be responsible. I want so badly for it to be beneficial for all the attendees that I keep feeling like I have to force it somehow. No unknowns. Not even “happy accidents”. I notice myself starting to worry that I need to be better prepared. That it ought to be structured.

But this new (cutting edge, truly) way of operating challenges all those old habits.

And it can be downright unnerving.

How long does it take for levitra to work

The power of consciousness technology (such as Matrix Energetics, on which my Holographic Emergence sessions are based) is that you don’t need to “do” anything.

In fact, doing can be counterproductive.

In order to achieve success, first give up the idea that you are “the Doer.” Instead of constantly doing from the mere human or conscious level, become the “Open Door.”

– Dr. Richard Bartlett (founder of Matrix Energetics), The Physics of Miracles

Rather than “do” something, the main (and maybe only) skill involved is being able to access the state in which “it is done”. And even in this paradoxical statement, the word “done” is more an adjective than a verb.

The other main skill for some of us (as already mentioned) is to let go of being a control freak! Aach! Pant pant pant.

So how do I manage to step into this new way of operating? Or rather, NOT operating? This state of being, and allowing?

♦ I can only remind myself that a lot of people for whom I’ve done individual Holographic Emergence Sessions where I’ve let go of control have noticed positive results.

♦ I also remind myself that when this idea came to me just a few weeks ago, it already had a life of its own.

I was compelled and propelled to just do it.

It was kind of odd, actually.

It was as though I knew the doubts existed but I wasn’t able or inclined to even look at them. I often think it’s smart to examine doubts to see if they’re valid, but almost always I decide that they are — and then they are crippling.

And so, this time, I simply allowed myself to be moved.

Can it be that there is something, some force, some something (I know not what) that actually knows better than me?

Well, let’s hope so.

How long does it take for levitra to work

So, I’m letting this be a lesson to me to live as that door instead of just be that door when I do Holographic Emergence Sessions (or LOL when I absolutely have to let go and surrender because I have no other choice).

That means I won’t just be the door during the Activation session, but am also being a door that opens for this and possibly future Activation sessions to enter my life as they will.

The trust required to be an open door also opens you to receive inner guidance easily. I’m noticing that certain inspirations are appearing to me about the sessions. Things that may or may not be a part of it. That’s all fine and is a part of the process. It’s “showing up” on its own — through the open door.

I’m choosing it this time. To not do. To trust.

Because I’ve learned that that’s how magic happens.

Want to join us for the Spring Activation? There’s still time! You can find the registration link here. (And it’s free!)

And a big thanks to those of you who’ve already registered. We’ve already got a group of wonderful people; I’m so excited!

How about you? How do you know if it’s time to DO or time to be a DOOR … or don’t you? Have you seen the door lead to magical results? Would love to hear your thoughts.

How long does it take for levitra to work

Aug 252011
 

Don’t you just love it when a chronic physical issue just goes away?

Me too.

So today I want to share a little *magic* with you that can increase the chances of that happening in your life. Auto-magically.

I hurt my shoulder a few months ago. My chiropractor says it’s my rotator cuff, and that I need to baby it so it can heal. So I’ve been doing that … But I don’t see much improvement. If anything, I keep re-injuring it.

The other day, I decided it’s time I work a little magic with it. That can mean a lot of things to me (as you may know), but in this case I mean that I’m going to practice some Holographic Emergence with it. (And I just finished an astonishing session. Very fun.)

How long does it take for levitra to work

I have every confidence doing this will make a big difference.

Years back I developed bothersome TMJ (Temporomandibular Joint disorder; quite the mouthful). It was painful and had become chronic. After I’d had it for years it was recommended to me that I have surgery. Yikes. No way. I decided to get to work.

I used a combination of Matrix Energetics and Reiki on myself. Amazingly, I didn’t even have to do too many sessions (I did regular Reiki for awhile, maybe about 10 treatments, and about 3 or 4 Matrix sessions, all over about a 4 month period) before I simply forgot about it and later realized that the TMJ was gone. Completely gone! This was a few years ago and it’s never returned.

And so, it’s foolish of me not to do a similar thing with my shoulder.

How long does it take for levitra to work

But here’s the cool thing. The morning I decided to do this–and to perhaps blog about the process–I was walking Ollie (our sweet old lab) and decided to listen to some Deepak Chopra on my MP3 player.

OMG! Talk about synchronicity! Everything he said was such an affirmation of what I’ve experienced ever since beginning my practice of Matrix Energetics. And to me it said “Do it!” It also said to share it.

It’s one thing to be familiar with the ideas, but when you live them, that’s when the real magic happens.

How long does it take for levitra to work

How long does it take for levitra to work

So, without further ado, I want to share some of Deepak’s statements with you. They’re from his 5 CD audio set “Magical Mind, Magical Body“, and I’m only 1/2 hr. into it but I can already recommend it. (And I love that he sounds so excited as he talks about these things. It makes for an involved listening experience.)

• Health is not just the absence of a disease, it’s a joyfulness that should be inside us all the time. It’s a state of positive well-being, which is not only physical but emotional and ultimately even psychological and spiritual.

[Note: You can use that simple idea with great effect. Every time you feel frumpy, repeat the idea to yourself that you are well and express well-being and you’ll feel an instant shift.]

The body is not a frozen sculpture, it’s a river of energy and information. … You can not step into the same flesh and bones twice.

• You replace 98% of all the items of your body in less than one year.

• There is a deeper reality to the body and that deeper reality is what we want to see because from that deeper reality comes both the mind and the body. Both come from that deeper level of existence.

• A physicist would say: “Our atoms are particles that are moving at lightening speeds around huge empty spaces, they emerge from something which is just a field of pure potentiality, just a field of pure energy, and from that field these particles emerge. They’re fluctuations of energy and information. They emerge from a void. They rebound, collide, and then disintegrate into the void.”

• We have a thinking body. And you can’t imprison the mind in the brain. That’s an old notion, that the mind is confined to the brain. The mind is in every cell of our body.

You can’t even confine the mind to your physical body because it extends beyond your physical body into the whole universe. We are part of a thinking conscious universe that is basically a non-local field of information. We can call the universe a non-local field of information and energy with which this local expression (which we call the physical body) is exchanging energy and information.

• It’s estimated that the average person thinks about 60,000 thoughts a day … and 95% of the thoughts you have today are the ones that you had yesterday. So you keep creating the same patterns that give rise to the same physical expression of the body. If you go to a deeper level, witness the whole process, become conscious of it, then you’d realize that in fact there are choices here.

What we do is we take that chaos of energy soup, we ingest it through our 5 senses, and then we convert that into a physical reality in our own awareness, in our own consciousness. And we do it unconsciously most of the time that results in certain interpretations that are part of a cultural indoctrination.

There’s one part of you that doesn’t change. If you find that part of you that doesn’t change then you’ll be able to cause transformations in that part of you that does change.

[Note: Deepak uses the word “you” but then goes on to complicate it. You can discover that part of you that doesn’t change easily and simply. Just visit  John Sherman’s website and take advantage of what he so generously offers.]

• Now if I said the mind is omniscient it would sound sort of mystical. That it knows everything, it’s omnipotent, it’s omnipresent, it would sound almost like I’m talking in mystical terms. But in fact, in scientific terms, that’s an accurate statement.

Now once we recognize that — even to have the insight — is to begin to cause transformations in your body. A person’s body is nothing but an expression of all the ideas they have about it.

• If there’s a fluctuation that changes at deeper levels of energy and information then it causes, spontaneously without having to do anything, you don’t have to brainwash yourself about this. You just have to have the insight. And the insight itself causes the changes.

How long does it take for levitra to work

So, these are some of the ideas I use — that have become a part of me — as I work with my shoulder. Or more accurately, this pattern of light and information that I perceive as a shoulder. 😉

Like Deepak says, recognizing this reality helps create a transformation all by itself. It’s what gives us a lot more power than we think we have otherwise.

And therein lies your magic.

So this is the world I get to play in every day.

Want to join me? Or have you already?

(Need some extra magic in your life? Consider booking a Holographic Emergence session.)

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