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€˜None of us can you buy ventolin over the counter in france will be safe until everyone is safe. Global access can you buy ventolin over the counter in france to asthma treatments, tests and treatments for everyone who needs them, anywhere, is the only way out’. This statement by Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO and Ursula von der Leyen, President of the European Commission1 has become the rallying call for asthma treatment vaccination. The success of a safe and efficacious asthma treatment depends just not only on production and availability but also crucially on uptake.In countries such as the UK where asthma treatment prioritisation and rollout are proceeding quickly, attitudes to vaccination have rapidly become a priority.2 treatment hesitancy (‘behavioural delay in acceptance or refusal of treatments despite availability of treatment services’)3 is not a single entity can you buy ventolin over the counter in france. Reasons vary and there is a continuum from complete acceptance to refusal can you buy ventolin over the counter in france of all treatments, with treatment hesitancy lying between the two poles.

Factors involved include confidence (trusting or not the treatment or provider), complacency (seeing the need or value of a treatment) and convenience (easy, convenient access to the treatment).3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a treatment’s safety, efficacy and necessity.5Developing strategies to address hesitancy is key.6 The expedited development and relative novelty of the asthma treatments have led to public uncertainty.4 In addition, efforts to explain the mode of action of these treatments involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply. There are genuine knowledge voids (eg, long-term safety data), which in some cases have been filled with misinformation.7 Recent studies have assessed potential acceptance rates specifically for the can you buy ventolin over the counter in france asthma treatment. A UK study of more than 5000 adults using a validated scale found 71.7% were willing to be vaccinated, 16.6% were very unsure and 11.7% were strongly hesitant, with hesitancy relatively evenly spread across the population.8 Willingness to take a treatment was closely bound to recognition of can you buy ventolin over the counter in france the collective importance of this decision as well as beliefs about the likelihood of asthma treatment , the efficacy, speed of development and side effects of the treatment. This implies that public information emphasising social benefits may be especially effective, at least in a majority of a population, and information that encourages mistrust or undermines social cohesion will lower treatment uptake.We also need to consider more focused strategies about treatment hesitancy for particular groups, including those groups who are most at risk of hesitancy and severe course of illness. As mental health clinicians, we assessed the impact of mental health conditions on asthma treatment hesitancy and searched for current guidance in this area using a validated approach.9 We found that there is currently no specific guidance in addressing treatment hesitancy in those with mental health difficulties,10 although can you buy ventolin over the counter in france it is recognised that this is a high-risk group who should be monitored.

People with mental health issues, particularly with can you buy ventolin over the counter in france severe mental illness (SMI), are at particular risk both for with asthma treatment and for more severe complications and higher mortality.11 Historically, the uptake of similar treatments such as the influenza treatment in those with SMI can be as low as 25%,12 and so, similar to other low uptake groups, focused efforts are needed to increase this. Suggestions for change include offering specific discussions from mental health professionals and peer workers, treatment education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake.13Monitoring of vulnerable groups treatment uptake itself presents problems. In the example of the UK, monitoring can you buy ventolin over the counter in france of treatment coverage of most routine immunisation programmes relies on data extracted from primary care systems. To monitor vulnerable groups, the can you buy ventolin over the counter in france data need to be specifically recorded. For example, Public Health England’s national immunisation equity audit in 2019 identified inequalities in uptake by a number of important variables (such as age, geography, ethnicity) but could not assess others including mental illness due to a lack of systematically collected data.14 Inequalities that were assessed by the audit were not only in overall coverage but also in timing of treatments and completion of treatment schedules.

In addition, the extent of a particular inequality varies can you buy ventolin over the counter in france when it intersects with one or more other factors. In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors means that both vulnerability and inequality are likely to be additive.11 However, treatment impact may be greater among the most vulnerable despite lower treatment uptake because the baseline absolute risk is can you buy ventolin over the counter in france so high.15 Therefore, in the context of a asthma treatment programme, even if treatment uptake falls short in some high-risk groups, even small increases in treatment uptake will still have significant health benefits.14Uptake of vaccination is crucial both for the individual and protection of others. It is in everyone’s interests to ensure that groups where a low uptake is predicted have extra care and input. At the moment there is little can you buy ventolin over the counter in france formal guidance on how to support those with mental health issues to access clear and reliable information, and practical and easy access to vaccination for those who are willing. If we are to ensure that ‘everyone is safe’, we need a concerted and global effort16 to guide and focus strategies to support and inform those who are both potentially most hesitant and most vulnerable, including and prioritising those with mental health difficulties..

€˜None of us will be safe until everyone can you buy ventolin over the counter in uk their website is safe. Global access to asthma treatments, tests and treatments for everyone who needs them, anywhere, is the only can you buy ventolin over the counter in uk way out’. This statement by Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO and Ursula von der Leyen, President of the European Commission1 has become the rallying call for asthma treatment vaccination. The success of a safe and efficacious asthma treatment depends just not only on production and availability but also crucially on uptake.In countries such as the UK where asthma treatment prioritisation and can you buy ventolin over the counter in uk rollout are proceeding quickly, attitudes to vaccination have rapidly become a priority.2 treatment hesitancy (‘behavioural delay in acceptance or refusal of treatments despite availability of treatment services’)3 is not a single entity. Reasons vary and there is a continuum from complete acceptance can you buy ventolin over the counter in uk to refusal of all treatments, with treatment hesitancy lying between the two poles.

Factors involved include confidence (trusting or not the treatment or provider), complacency (seeing the need or value of a treatment) and convenience (easy, convenient access to the treatment).3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a treatment’s safety, efficacy and necessity.5Developing strategies to address hesitancy is key.6 The expedited development and relative novelty of the asthma treatments have led to public uncertainty.4 In addition, efforts to explain the mode of action of these treatments involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply. There are genuine knowledge voids (eg, long-term safety data), can you buy ventolin over the counter in uk which in some cases have been filled with misinformation.7 Recent studies have assessed potential acceptance rates specifically for the asthma treatment. A UK study of more than 5000 adults using a validated scale found 71.7% were willing can you buy ventolin over the counter in uk to be vaccinated, 16.6% were very unsure and 11.7% were strongly hesitant, with hesitancy relatively evenly spread across the population.8 Willingness to take a treatment was closely bound to recognition of the collective importance of this decision as well as beliefs about the likelihood of asthma treatment , the efficacy, speed of development and side effects of the treatment. This implies that public information emphasising social benefits may be especially effective, at least in a majority of a population, and information that encourages mistrust or undermines social cohesion will lower treatment uptake.We also need to consider more focused strategies about treatment hesitancy for particular groups, including those groups who are most at risk of hesitancy and severe course of illness. As mental health clinicians, we assessed the impact of mental health can you buy ventolin over the counter in uk conditions on asthma treatment hesitancy and searched for current guidance in this area using a validated approach.9 We found that there is currently no specific guidance in addressing treatment hesitancy in those with mental health difficulties,10 although it is recognised that this is a high-risk group who should be monitored.

People with mental health issues, particularly with severe mental illness (SMI), are at particular risk both for can you buy ventolin over the counter in uk with asthma treatment and for more severe complications and higher mortality.11 Historically, the uptake of similar treatments such as the influenza treatment buy ventolin online in those with SMI can be as low as 25%,12 and so, similar to other low uptake groups, focused efforts are needed to increase this. Suggestions for change include offering specific discussions from mental health professionals and peer workers, treatment education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake.13Monitoring of vulnerable groups treatment uptake itself presents problems. In the example of can you buy ventolin over the counter in uk the UK, monitoring of treatment coverage of most routine immunisation programmes relies on data extracted from primary care systems. To monitor can you buy ventolin over the counter in uk vulnerable groups, the data need to be specifically recorded. For example, Public Health England’s national immunisation equity audit in 2019 identified inequalities in uptake by a number of important variables (such as age, geography, ethnicity) but could not assess others including mental illness due to a lack of systematically collected data.14 Inequalities that were assessed by the audit were not only in overall coverage but also in timing of treatments and completion of treatment schedules.

In addition, the extent of a particular inequality varies when it intersects with one or more other factors can you buy ventolin over the counter in uk. In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors means that both vulnerability and inequality are likely to be additive.11 However, treatment impact may be greater among the most vulnerable despite lower treatment uptake because the baseline absolute risk is so high.15 Therefore, in the context of a asthma treatment programme, even if treatment uptake falls short in can you buy ventolin over the counter in uk some high-risk groups, even small increases in treatment uptake will still have significant health benefits.14Uptake of vaccination is crucial both for the individual and protection of others. It is in everyone’s interests to ensure that groups where a low uptake is predicted have extra care and input. At the moment there is little formal guidance on how to support those with mental health issues to access clear and reliable information, and practical and easy access to vaccination for those who can you buy ventolin over the counter in uk are willing. If we are to ensure that ‘everyone is safe’, we need a concerted and global effort16 to guide and focus strategies to support and inform those who are both potentially most hesitant and most vulnerable, including and prioritising those with mental health difficulties..

What may interact with Ventolin?

  • anti-infectives like chloroquine and pentamidine
  • caffeine
  • cisapride
  • diuretics
  • medicines for colds
  • medicines for depression or for emotional or psychotic conditions
  • medicines for weight loss including some herbal products
  • methadone
  • some antibiotics like clarithromycin, erythromycin, levofloxacin, and linezolid
  • some heart medicines
  • steroid hormones like dexamethasone, cortisone, hydrocortisone
  • theophylline
  • thyroid hormones

This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

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€‹15 full-time Where can i buy viagra over the counter equivalent specialist counsellors will be deployed across rural NSW to help prevent suicide, with the free ventolin coupon first two counsellors starting in the Eurobodalla and Snowy Mountains regions.NSW Mental Health Minister Bronnie Taylor said the relatively high rates of suicide in rural areas are devastating families and communities, and the $6.75 million investment will add another layer of help.“Many factors can contribute to suicide, from domestic violence, to relationship issues or unemployment, to stress and hardship,” Mrs Taylor said. €œThese specialist mental health counsellors are there on the ground to support people thinking of suicide or impacted by suicide, and I encourage communities across the state to lean on them for support.”Director Mental Health Drug and Alcohol for Southern NSW Local Health District Damien Eggleton said he wants more people to ask for help when they need it. €œOur rural communities have proven beyond a doubt they’re resilient and fearless when faced with free ventolin coupon adversity, whether that be geographic isolation, searing drought or the impact of the current ventolin – but they don’t need to go it alone,” Mr Eggleton said. €œThe support provided by these counsellors will complement the peer work and drought support provided by our Farm Gate Counsellors and Drought Counsellors.”Rural counsellor Samara Byrne said she wants young people to know there are people you can turn to when feeling overwhelmed with life or feeling like a burden on others. €œWe are here for you and here to listen if you are feeling distressed, anxious or a burden free ventolin coupon to loved ones.

The service is easily accessible through the Mental Health Line. Just ask for the Rural Counsellor.”“Having moved from Sydney in 2016 to our beautiful farm in SNSW, I am so pleased to be able to do what I am most passionate about, supporting people’s wellbeing in Rural Australia and building on the natural local community resilience”.Minister Taylor urges people in the bush free ventolin coupon to get help by contacting these rural counsellors. €œSupport is available, all you need to do is pick up the phone and make an appointment by calling the NSW Mental Health Line on 1800 011 511.”The 15 rural counselling positions are part of the Towards Zero Suicides. A $87 million investment over three free ventolin coupon years in new suicide prevention initiatives. A NSW Premier’s Priority, this is a whole-of-government commitment to transforming the way we identify and support anyone impacted by suicide.If you, or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately in a life-threatening situation by calling 000 or seek support though one of these services:Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511Minister for Mental Health Bronnie Taylor and Minister for Police and Emergency Services David Elliott today announced the expansion of the Police Ambulance and Clinical Early Response (PACER) pilot program.“This ground breaking collaboration embeds mental health experts with first responders to support them to appropriately recognise, assess, and respond to mental health emergencies live at the scene,” Mrs Taylor said.

€œThe pilot program has had incredible results free ventolin coupon with significant reductions in emergency department presentations, police and ambulance time on scene. €œThis approach has enormous potential to change lives, with the community getting more appropriate care at the time when they need it most.” Mr Elliott welcomed the support for the police officers who are deeply committed to serving and protecting the people of NSW “During the pilot program, police time-on-scene was reduced by an average of 45 minutes, not only supporting first responders to appropriately recognise and respond to psychiatric incidents in the community, but also freeing up officers to serve thecommunity in other areas,” Mr Elliott said. €œThe presence and availability of a PACER clinician in a police station increases the knowledge and understanding of mental health issues amongst officers This initiative is crucial, now more than ever, following the devastating ‘Black Summer’ bushfires and the asthma treatment ventolin, which have affected us all.” NSW Police Force Deputy Commissioner, Malcolm Lanyon APM, said the PACER model has been a success at the trial site free ventolin coupon in St George Police Area Command. €œDuring the trial we saw a significant reduction in time taken for police to respond to these matters. It translated to a better outcome for both our officers and the individuals in need of assistance,” Mr Lanyon said free ventolin coupon.

The PACER program will expand to Campbelltown, Nepean, Northern Beaches, Sutherland Shire, Blacktown, Eastern Beaches, Kuring-gai, Metro Combined consisting of Kings Cross/Surry Hills/City of Sydney, South Sydney and Bankstown Police Area Commands with recruitment underway for the specialist mental health clinicians from July 2020. This investment free ventolin coupon is part of the $73 million suite of mental health measures recently announced by the NSW Government. This includes 216 new mental health staff, additional funding for the NSW Mental Health Line, extra support for Telehealth, funding for extra therapeutic programs to aid recovery in mental health units and a $6 million investment in Lifeline to expand their invaluable service..

€‹15 full-time equivalent specialist counsellors will be deployed across rural NSW to help prevent suicide, with the first two counsellors starting in the Eurobodalla and Snowy Mountains regions.NSW Mental Health Minister Bronnie Taylor said the relatively high rates of suicide in rural areas are devastating families and communities, can you buy ventolin over the counter in uk and the $6.75 million investment will add another layer of help.“Many factors can contribute to suicide, from domestic violence, to relationship issues or unemployment, to stress and hardship,” Mrs Taylor said. €œThese specialist mental health counsellors are there on the ground to support people thinking of suicide or impacted by suicide, and I encourage communities across the state to lean on them for support.”Director Mental Health Drug and Alcohol for Southern NSW Local Health District Damien Eggleton said he wants more people to ask for help when they need it. €œOur rural communities have proven beyond a doubt they’re resilient and fearless when faced with adversity, whether that be geographic isolation, searing drought or the impact can you buy ventolin over the counter in uk of the current ventolin – but they don’t need to go it alone,” Mr Eggleton said.

€œThe support provided by these counsellors will complement the peer work and drought support provided by our Farm Gate Counsellors and Drought Counsellors.”Rural counsellor Samara Byrne said she wants young people to know there are people you can turn to when feeling overwhelmed with life or feeling like a burden on others. €œWe are here for you and here to listen can you buy ventolin over the counter in uk if you are feeling distressed, anxious or a burden to loved ones. The service is easily accessible through the Mental Health Line.

Just ask for the Rural Counsellor.”“Having moved from Sydney in 2016 to our beautiful farm in SNSW, can you buy ventolin over the counter in uk I am so pleased to be able to do what I am most passionate about, supporting people’s wellbeing in Rural Australia and building on the natural local community resilience”.Minister Taylor urges people in the bush to get help by contacting these rural counsellors. €œSupport is available, all you need to do is pick up the phone and make an appointment by calling the NSW Mental Health Line on 1800 011 511.”The 15 rural counselling positions are part of the Towards Zero Suicides. A $87 million investment over three years in can you buy ventolin over the counter in uk new suicide prevention initiatives.

A NSW Premier’s Priority, this is a whole-of-government commitment to transforming the way we identify and support anyone impacted by suicide.If you, or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately in a life-threatening situation by calling 000 or seek support though one of these services:Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511Minister for Mental Health Bronnie Taylor and Minister for Police and Emergency Services David Elliott today announced the expansion of the Police Ambulance and Clinical Early Response (PACER) pilot program.“This ground breaking collaboration embeds mental health experts with first responders to support them to appropriately recognise, assess, and respond to mental health emergencies live at the scene,” Mrs Taylor said. €œThe pilot program has had incredible results with significant reductions in emergency department presentations, police and can you buy ventolin over the counter in uk ambulance time on scene. €œThis approach has enormous potential to change lives, with the community getting more appropriate care at the time when they need it most.” Mr Elliott welcomed the support for the police officers who are deeply committed to serving and protecting the people of NSW “During the pilot program, police time-on-scene was reduced by an average of 45 minutes, not only supporting first responders to appropriately recognise and respond to psychiatric incidents in the community, but also freeing up officers to serve thecommunity in other areas,” Mr Elliott said.

€œThe presence and availability of a PACER clinician in a police station increases the knowledge and understanding of mental health issues amongst officers This initiative is crucial, now more than ever, following the devastating ‘Black Summer’ can you buy ventolin over the counter in uk bushfires and the asthma treatment ventolin, which have affected us all.” NSW Police Force Deputy Commissioner, Malcolm Lanyon APM, said the PACER model has been a success at the trial site in St George Police Area Command. €œDuring the trial we saw a significant reduction in time taken for police to respond to these matters. It translated can you buy ventolin over the counter in uk to a better outcome for both our officers and the individuals in need of assistance,” Mr Lanyon said.

The PACER program will expand to Campbelltown, Nepean, Northern Beaches, Sutherland Shire, Blacktown, Eastern Beaches, Kuring-gai, Metro Combined consisting of Kings Cross/Surry Hills/City of Sydney, South Sydney and Bankstown Police Area Commands with recruitment underway for the specialist mental health clinicians from July 2020. This investment can you buy ventolin over the counter in uk is part of the $73 million suite of mental health measures recently announced by the NSW Government. This includes 216 new mental health staff, additional funding for the NSW Mental Health Line, extra support for Telehealth, funding for extra therapeutic programs to aid recovery in mental health units and a $6 million investment in Lifeline to expand their invaluable service..

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In low-and-middle-income countries http://kollman.com/generic-seroquel-online-for-sale/ (LMICs), there remain critical gaps in the how many puffs of ventolin is equivalent to nebuliser quality of surgical care. Comparatively high rates of surgical adverse events occur and are likely highly preventable.1–3 There has been substantial focus on improving access to how many puffs of ventolin is equivalent to nebuliser health services, including surgical care in LMICs, yet quality oversight and improvement practices remain limited in these settings.4 Over the past decade, surgical volume has doubled in the most resource-poor settings. Between 2004 and 2012, the annual number of operations jumped from 234 million to 313 million, with the biggest growth occurring in countries with the lowest amount of healthcare spending.5 6 This signals a profound shift. Whereas prior efforts were focused on s and maternal health, non-communicable diseases such as cancers and trauma are an increasing priority for LMIC health systems how many puffs of ventolin is equivalent to nebuliser.

With the rapid growth in surgical delivery, the quality and safety of care are critically important. Poor outcomes and high morbidity breed mistrust, scepticism and fear among local populations, and thus hinder the mission of health systems to provide timely and essential services, especially risky ones like surgery.In how many puffs of ventolin is equivalent to nebuliser this issue of the Journal, two articles shed some light on the challenges and opportunities for improving and maintaining high-quality surgical and anaesthetic services in LMICs. The first explores variation in the determinants of surgical quality across 10 hospitals in Tanzania that participated in the Safe Surgery 2020 (SS2020) programme.7 The investigators identified significant differences between what they termed high-performing and low-performing institutions. These included the perception and application of the SS2020 surgical quality how many puffs of ventolin is equivalent to nebuliser improvement interventions meant to boost adherence to safety practices, enhance teamwork and communication, and improve completeness of documentation in patient records.

These practices were aimed at reducing how many puffs of ventolin is equivalent to nebuliser postsurgical s in hospitals implementing the intervention. The programme worked to change organisational culture, build capacity to deliver evidence-based practices in safe surgery and anaesthesia, and facilitate the sustainability of the first and second phases through in-person and virtual mentorship.The authors noted that the high-performing sites had a strong prior culture of teamwork, with references to surgery as a team effort, collective problem-solving and support of co-workers, as well as a flattened hierarchy with open communication. These facilities used the Surgical Safety Checklist (SSC) as a tool to strengthen how many puffs of ventolin is equivalent to nebuliser teamwork and communication. Lower performing sites gave more emphasis to individual learning than organisational learning, thought of the SSC as a means to improve outcomes rather than encourage teamwork, considered SS2020 as a programme for surgeons rather than for all members of the perioperative team and expressed higher levels of reluctance to engage in open communication because of hierarchy.The second article describes surgical service monitoring and quality control systems at district hospitals Malawi, Tanzania and Zambia.8 The authors investigated surgical surveillance at a facility level and the types of quality processes and controls in place to assess service capacity, volume, outcomes and adherence to standards.

After evaluating 75 district hospitals, the how many puffs of ventolin is equivalent to nebuliser authors noted a number of major challenges, including that data registry and recording formats were not standardised. In fact, over half of hospitals surveyed had two or more systems in place. Hospitals also lacked accountability how many puffs of ventolin is equivalent to nebuliser mechanisms. Of the 75 hospitals, only 43 created mortality reports for review, 11 conducted surgical audits of any kind and 22 used the SSC routinely despite numerous how many puffs of ventolin is equivalent to nebuliser studies confirming its benefit to patient safety in these environments.Each study has its own limitations.

In the article by Alidina et al, the grading used to classify high and low performers was subjectively set by the study team, the sample size of facilities was relatively small, and interviewee responses were potentially affected by recall and social desirability biases. Furthermore, high-performer hospitals were overwhelmingly from smaller-sized facilities, indicating a strong how many puffs of ventolin is equivalent to nebuliser clustering effect. In the article by Clarke et al, self-reported information also introduces a potential for bias, there was limited interviewing of hospital administration and other stakeholders outside of perioperative providers, and the focus on district hospitals might miss more robust practices in urban and teaching hospitals.Although there have been proposals for standardised surgical and anaesthesia metrics to track service delivery and quality, there is not a firm consensus on minimum standards or an organising body to incentivise monitoring.9–12 Yet proper data collection using standardised and comparable metrics is essential for service planning, as the routine and appropriate monitoring of such information is critical for implementation of quality surgical services. As these two articles make clear, how many puffs of ventolin is equivalent to nebuliser such processes are still rudimentary in many LMIC environments.

The challenges to improving them include a lack of properly developed registries, inappropriate formatting, technological barriers for centralised data recording and storage, absence of data interpretation and feedback, and gaps in planning mechanisms.13 These challenges are overwhelmingly due to lack of dedicated leadership in the oversight of surgical service provision and fundamental gaps in basic service management, without any proper linkage of data capture to future planning or improvement interventions. Without adequate and complete data, how many puffs of ventolin is equivalent to nebuliser assessments of patient outcomes and safety process gap identification at the institutional level is impossible. Furthermore, strong management is critical for ensuring adherence to standards and clear standard operating procedures. While leadership training is the focus of much discussion, as it was in the article by Alidina, little has been done to elevate and promote how many puffs of ventolin is equivalent to nebuliser management skills that are essential for efficient service provision.

Work in Ghana, for example, has demonstrated that good management how many puffs of ventolin is equivalent to nebuliser practices can avoid depletion of critical supplies14. Yet even when service delivery increases, facility readiness and the practices that must accompany increased volume do not necessarily follow.15 16There are a number of solutions to these challenges. Hospital leaders need to emphasise quality as central to the how many puffs of ventolin is equivalent to nebuliser hospital mission. Lessons from high-performing hospitals have demonstrated that a focus on quality by hospital leadership can raise the standards of care delivery, although under specific conditions that promote quality through accountability and transparency and with evidence from relatively small numbers of hospitals.13 Such efforts require a standardised approach to data collection and robust assessments of processes, such as compliance with critical standards of care (eg, prevention standards such as hand hygiene and antimicrobial stewardship).

When implemented in a rigorous way in surgery, high-quality data and strong process adherence have tremendous beneficial effects.17 18Improvements in quality and safety also require infrastructure and a management team that sets targets for performance, benchmarks quality standards, allocates resources and assigns people with skill sets matched to clinical service needs to drive improvements.19 20 Good management practices have been correlated with improved outcomes and better compliance with known standards of care.21Unfortunately, studies from LMICs show substantial variability in the way in which quality of care is measured.22 Furthermore, there is a fundamental lack of appropriate guidelines and management protocols, and those that do exist are not easily implemented how many puffs of ventolin is equivalent to nebuliser. Our experience indicates that integrating a proper monitoring and evaluation programme into institutional efforts to improve perioperative processes have powerful positive effects on outcomes.18 We have done this in our work through the use of process mapping, an exercise that takes a quality improvement team through the pathway of a care routine or a standard operating procedure in order to gain a complete understanding of the barriers to appropriate compliance.23 This type of process was developed for industry but has been applied in healthcare as a means of improving compliance by aligning tasks with specific process goals. The work requires data-driven, quality-controlled surgical services structured in a manner that allow changes to be how many puffs of ventolin is equivalent to nebuliser made to the care routine and associated processes. Assessing baseline data, understanding barriers to quality services and care, seeking local solutions, addressing knowledge gaps, standardising monitoring and rewarding improvements must all be integrated to how many puffs of ventolin is equivalent to nebuliser achieve such change.

Appropriate surgical monitoring and evaluation tools can help measure quantitative and qualitative improvements to surgical care in LMICs.24Like politics, all quality improvement is local, so a deep understanding of local context and circumstances is essential. As surgical and anaesthetic services how many puffs of ventolin is equivalent to nebuliser continue to expand, hospital-based surgical programmes will need to engage more concertedly in research and quality improvement initiatives in order to decrease adverse outcomes and raise the quality and safety of surgical services in LMICs. As the authors of both articles note, however, these improvement mechanisms are not without substantial challenges, many will not be effective, and all require a more coordinated approach and a strengthening of management practices to ensure the quality and safety of care.Ethics statementsPatient consent for publicationNot required.In this issue we are presented with two novel and important studies in English primary care addressing the epidemiology of patient safety. The first study, by Reeves and colleagues, retrospectively reviewed 2057 randomly selected consultations in 21 general practices to identify missed diagnostic opportunities, in order to estimate their incidence, origins and potential harms.1 They conclude how many puffs of ventolin is equivalent to nebuliser that diagnostic errors occur in up to 4% of consultations, are multifactorial, and that 40% of them have the potential to result in moderate or severe patient harm.

The second study recruited 12 randomly selected general practices and reviewed the case notes of an ‘enhanced’ sample of 14 407 patients with significant health problems.2 In this second study, Avery and colleagues were interested in actual harms that could be considered avoidable, in order to estimate their incidence and to quantify and classify the context from which they arose. They identified 74 cases of avoidable significant harm, a rate of 36/100 000 patient years, with diagnosis problems accounting for the majority (61%).Although how many puffs of ventolin is equivalent to nebuliser the field of patient safety research goes back to the 1980s, much of it was initially focused on specialist care and hospital settings, where rates of adverse events as high as 10% were reported.3 4 In contrast, studies in primary care found that rates of adverse events were much lower, but the potential for harm, notably from prescribing errors, was significant.5 This led to developments such as PINCER, a pharmacist-led intervention to reduce clinically important medication errors that has since been widely adopted in England,6 and in the USA to a focus on preventing ‘Never Events’ or serious, preventable medical errors.7 More recently, the importance of diagnostic error in patient safety has come to the fore, with a landmark report from the US Institute of Medicine (IoM)8 and recognition that this aspect of patient safety is distinct from errors in the management of patients with a diagnosis and that it represents a global concern.9 10 The latter has been driven by early diagnosis being a policy focus in many high-income countries, particularly in relation to cancer, with misdiagnosis one of the most common reasons for malpractice claims11 and evidence that early cancer diagnosis leads to better outcomes.Diagnostic error was defined in the IoM report Improving Diagnosis in Healthcare as the ‘failure to make an accurate and timely explanation of the patient’s health problem, or to communicate that explanation to the patient’.8 The concept of ‘missed diagnostic opportunities’, proposed by Singh and colleagues and applied in the study by Reeves and colleagues, is one that works well for primary care, since it takes account of the evolving course of a patient’s presenting problem, sometimes over multiple consultations.12Preventable or avoidable harm is by definition attributable to medical error, although many errors do not lead to harm. Harm can also be a broad concept, ranging from transient anxiety through to death. Avery and colleagues have been particularly diligent in their definitions of avoidability and significant harm, deriving the latter from that provided by WHO,13 which in turn lies between the definitions of moderate and severe harm described by England’s National Patient Safety Agency and by Panesar and colleagues.14By drawing our attention to the extent to which errors and avoidable harms occur, these two studies also prompt us to consider ways in which we might take action to how many puffs of ventolin is equivalent to nebuliser improve diagnostic safety in primary care.

One is to identify errors as soon as, how many puffs of ventolin is equivalent to nebuliser or right after, they are made, which then provides an opportunity to forestall any ensuing harm or reduce its severity. Safety-netting is a well-established if ill-defined consultation technique where the patient is advised on the anticipated course of events and the action(s) to take if these do not follow within a specified timeframe.15 It is specifically advocated in English national guidance on management and referral of suspected cancer.16 A more systematic and technical approach is the use of e-triggers, signals of a likely error or adverse event, generated by the systematic mining of electronic patient data. These can prompt clinicians to the correct actions or can generate reminders when the correct actions are not performed in a timely way.17 Singh and others have also proposed the SaferDx e-Trigger Tool Framework for the future development of tools that monitor diagnostic errors and how many puffs of ventolin is equivalent to nebuliser intervene for specific patients when needed.17Another way to take action to improve diagnostic safety is to use retrospective clinical record review to identify the circumstances and types of events that might threaten patient safety during the diagnostic process, in order to address these circumstances in the future. Examples include a Danish study that found ‘quality deviations’ in 30% of the 5711 patients presenting with symptoms subsequently found to be due to cancer,18 and an English national audit of 14 259 patients with cancer where GPs reported avoidable delays in 24% of the sample.19 ‘Quality deviations’ and other avoidable delays can potentially be prevented, but only with a strong professional culture that values identifying them in the first place.

A culture of identifying and reflecting on safety incidents how many puffs of ventolin is equivalent to nebuliser is well established in many countries where strong primary care systems pertain. In the UK, significant event audit is widely practised and is part of the Royal College of General Practitioners’ patient safety toolkit. Changes in clinical practice or quality of care are often reported although not easily verified.20 However, qualitative analysis of multiple significant event audits has been used to how many puffs of ventolin is equivalent to nebuliser identify opportunities for quality improvement in the diagnostic process for lung cancer.21 On the other hand, reporting of patient safety incidents to a central body, such as the National Reporting and Learning System in England has not been widely adopted in primary care, in contrast to secondary care, which accounts for more than 99% of patient safety incident reports. Incident reporting has also not generally been as successful as it could be in the USA, despite strong models of its importance for improvement in other fields, such as how many puffs of ventolin is equivalent to nebuliser aviation.22These various approaches to identifying errors and harms that occur in primary care can all inform the design of safer systems and/or safer diagnosticians, to reduce the risk of error in the first place.

By learning about which processes lead to errors, one can try to improve those processes and prevent errors occurring. In this way, e-triggers, for example, could provide the information needed for a healthcare system to identify targets for diagnostic safety, as suggested in the SaferDx how many puffs of ventolin is equivalent to nebuliser framework. For example, if triggers identified frequent failures in a particular healthcare system in the follow-up on abnormal test results, a system re-design could be put in place to prevent these. Alternatively, one might provide clinicians how many puffs of ventolin is equivalent to nebuliser with tools that enhance their diagnostic capabilities.

These could include better access to diagnostic tests or the provision of electronic clinical decision support systems. A recent systematic review confirmed that these have the capacity to improve diagnostic decision making for cancer in primary care.23 The two studies in this issue of the journal clearly describe the problems how many puffs of ventolin is equivalent to nebuliser. Action is now needed to address them in a concerted and systematic way.Ethics statementsPatient consent for publicationNot required..

In low-and-middle-income http://kollman.com/generic-seroquel-online-for-sale/ countries (LMICs), there remain critical gaps in the can you buy ventolin over the counter in uk quality of surgical care. Comparatively high rates of surgical adverse events can you buy ventolin over the counter in uk occur and are likely highly preventable.1–3 There has been substantial focus on improving access to health services, including surgical care in LMICs, yet quality oversight and improvement practices remain limited in these settings.4 Over the past decade, surgical volume has doubled in the most resource-poor settings. Between 2004 and 2012, the annual number of operations jumped from 234 million to 313 million, with the biggest growth occurring in countries with the lowest amount of healthcare spending.5 6 This signals a profound shift. Whereas prior efforts were focused on s and maternal can you buy ventolin over the counter in uk health, non-communicable diseases such as cancers and trauma are an increasing priority for LMIC health systems. With the rapid growth in surgical delivery, the quality and safety of care are critically important.

Poor outcomes and high morbidity breed mistrust, scepticism and fear among can you buy ventolin over the counter in uk local populations, and thus hinder the mission of health systems to provide timely and essential services, especially risky ones like surgery.In this issue of the Journal, two articles shed some light on the challenges and opportunities for improving and maintaining high-quality surgical and anaesthetic services in LMICs. The first explores variation in the determinants of surgical quality across 10 hospitals in Tanzania that participated in the Safe Surgery 2020 (SS2020) programme.7 The investigators identified significant differences between what they termed high-performing and low-performing institutions. These included the perception and application of the SS2020 surgical quality improvement interventions meant to boost adherence can you buy ventolin over the counter in uk to safety practices, enhance teamwork and communication, and improve completeness of documentation in patient records. These practices were aimed at can you buy ventolin over the counter in uk reducing postsurgical s in hospitals implementing the intervention. The programme worked to change organisational culture, build capacity to deliver evidence-based practices in safe surgery and anaesthesia, and facilitate the sustainability of the first and second phases through in-person and virtual mentorship.The authors noted that the high-performing sites had a strong prior culture of teamwork, with references to surgery as a team effort, collective problem-solving and support of co-workers, as well as a flattened hierarchy with open communication.

These facilities used the Surgical Safety Checklist can you buy ventolin over the counter in uk (SSC) as a tool to strengthen teamwork and communication. Lower performing sites gave more emphasis to individual learning than organisational learning, thought of the SSC as a means to improve outcomes rather than encourage teamwork, considered SS2020 as a programme for surgeons rather than for all members of the perioperative team and expressed higher levels of reluctance to engage in open communication because of hierarchy.The second article describes surgical service monitoring and quality control systems at district hospitals Malawi, Tanzania and Zambia.8 The authors investigated surgical surveillance at a facility level and the types of quality processes and controls in place to assess service capacity, volume, outcomes and adherence to standards. After evaluating 75 district hospitals, the authors noted a number of major challenges, including that data registry and can you buy ventolin over the counter in uk recording formats were not standardised. In fact, over half of hospitals surveyed had two or more systems in place. Hospitals also lacked can you buy ventolin over the counter in uk accountability mechanisms.

Of the 75 hospitals, only 43 created mortality reports for review, 11 conducted surgical audits of any kind and 22 used the can you buy ventolin over the counter in uk SSC routinely despite numerous studies confirming its benefit to patient safety in these environments.Each study has its own limitations. In the article by Alidina et al, the grading used to classify high and low performers was subjectively set by the study team, the sample size of facilities was relatively small, and interviewee responses were potentially affected by recall and social desirability biases. Furthermore, high-performer hospitals were overwhelmingly from smaller-sized facilities, indicating a can you buy ventolin over the counter in uk strong clustering effect. In the article by Clarke et al, self-reported information also introduces a potential for bias, there was limited interviewing of hospital administration and other stakeholders outside of perioperative providers, and the focus on district hospitals might miss more robust practices in urban and teaching hospitals.Although there have been proposals for standardised surgical and anaesthesia metrics to track service delivery and quality, there is not a firm consensus on minimum standards or an organising body to incentivise monitoring.9–12 Yet proper data collection using standardised and comparable metrics is essential for service planning, as the routine and appropriate monitoring of such information is critical for implementation of quality surgical services. As these two articles make clear, such processes are still rudimentary can you buy ventolin over the counter in uk in many LMIC environments.

The challenges to improving them include a lack of properly developed registries, inappropriate formatting, technological barriers for centralised data recording and storage, absence of data interpretation and feedback, and gaps in planning mechanisms.13 These challenges are overwhelmingly due to lack of dedicated leadership in the oversight of surgical service provision and fundamental gaps in basic service management, without any proper linkage of data capture to future planning or improvement interventions. Without adequate and complete data, assessments of patient outcomes and safety process gap identification at can you buy ventolin over the counter in uk the institutional level is impossible. Furthermore, strong management is critical for ensuring adherence to standards and clear standard operating procedures. While leadership training is the focus of much discussion, as it was in the article by Alidina, little has been done to elevate and promote management skills that are can you buy ventolin over the counter in uk essential for efficient service provision. Work in Ghana, for example, has can you buy ventolin over the counter in uk demonstrated that good management practices can avoid depletion of critical supplies14.

Yet even when service delivery increases, facility readiness and the practices that must accompany increased volume do not necessarily follow.15 16There are a number of solutions to these challenges. Hospital leaders need to emphasise quality as central can you buy ventolin over the counter in uk to the hospital mission. Lessons from high-performing hospitals have demonstrated that a focus on quality by hospital leadership can raise the standards of care delivery, although under specific conditions that promote quality through accountability and transparency and with evidence from relatively small numbers of hospitals.13 Such efforts require a standardised approach to data collection and robust assessments of processes, such as compliance with critical standards of care (eg, prevention standards such as hand hygiene and antimicrobial stewardship). When implemented in a rigorous way in surgery, high-quality data and strong process adherence have tremendous beneficial effects.17 18Improvements in quality and safety also require infrastructure and a management team that sets targets for performance, benchmarks quality standards, allocates resources and assigns people with skill sets matched to clinical service needs to drive improvements.19 20 Good management practices have been correlated with improved outcomes and better compliance with known standards of care.21Unfortunately, studies from LMICs show substantial variability in the way in which quality of care is measured.22 Furthermore, there is a fundamental lack of can you buy ventolin over the counter in uk appropriate guidelines and management protocols, and those that do exist are not easily implemented. Our experience indicates that integrating a proper monitoring and evaluation programme into institutional efforts to improve perioperative processes have powerful positive effects on outcomes.18 We have done this in our work through the use of process mapping, an exercise that takes a quality improvement team through the pathway of a care routine or a standard operating procedure in order to gain a complete understanding of the barriers to appropriate compliance.23 This type of process was developed for industry but has been applied in healthcare as a means of improving compliance by aligning tasks with specific process goals.

The work requires data-driven, quality-controlled surgical services structured in a manner that allow changes to be made to the care routine and associated processes can you buy ventolin over the counter in uk. Assessing baseline data, understanding barriers to quality services and care, seeking local solutions, addressing knowledge gaps, standardising monitoring and rewarding improvements must all be can you buy ventolin over the counter in uk integrated to achieve such change. Appropriate surgical monitoring and evaluation tools can help measure quantitative and qualitative improvements to surgical care in LMICs.24Like politics, all quality improvement is local, so a deep understanding of local context and circumstances is essential. As surgical and anaesthetic services continue to expand, hospital-based surgical can you buy ventolin over the counter in uk programmes will need to engage more concertedly in research and quality improvement initiatives in order to decrease adverse outcomes and raise the quality and safety of surgical services in LMICs. As the authors of both articles note, however, these improvement mechanisms are not without substantial challenges, many will not be effective, and all require a more coordinated approach and a strengthening of management practices to ensure the quality and safety of care.Ethics statementsPatient consent for publicationNot required.In this issue we are presented with two novel and important studies in English primary care addressing the epidemiology of patient safety.

The first study, by Reeves and colleagues, retrospectively reviewed 2057 randomly selected consultations in 21 general practices to identify missed diagnostic opportunities, in order to estimate their incidence, origins and potential can you buy ventolin over the counter in uk harms.1 They conclude that diagnostic errors occur in up to 4% of consultations, are multifactorial, and that 40% of them have the potential to result in moderate or severe patient harm. The second study recruited 12 randomly selected general practices and reviewed the case notes of an ‘enhanced’ sample of 14 407 patients with significant health problems.2 In this second study, Avery and colleagues were interested in actual harms that could be considered avoidable, in order to estimate their incidence and to quantify and classify the context from which they arose. They identified 74 cases of avoidable significant harm, a rate of 36/100 000 patient years, with diagnosis problems accounting for the majority (61%).Although the field of patient safety research goes back to the 1980s, much of it was initially focused on specialist care and hospital settings, where rates of adverse events as high as 10% were reported.3 4 In contrast, studies in primary care found that rates of adverse events were much lower, but the potential for harm, notably from prescribing errors, was significant.5 This led to developments such as PINCER, a pharmacist-led intervention to reduce clinically important medication errors that has since been widely adopted in England,6 and in the USA to a focus on preventing ‘Never Events’ or serious, preventable medical errors.7 More recently, the importance of diagnostic error in patient safety has come to the fore, with a landmark report from the US Institute of Medicine (IoM)8 and recognition that this aspect of patient safety is distinct from errors in the management of patients with a diagnosis and that it represents a global concern.9 10 The latter has been driven by early diagnosis being a policy focus in many high-income countries, particularly in relation to cancer, with misdiagnosis one of the most common reasons for malpractice claims11 and evidence that early cancer diagnosis leads to better outcomes.Diagnostic error was defined in the IoM report Improving Diagnosis in Healthcare as the ‘failure to make an accurate and timely explanation of the patient’s health problem, or to communicate that explanation to the patient’.8 The concept of ‘missed diagnostic opportunities’, proposed by Singh and colleagues and applied in the study by Reeves and colleagues, is one can you buy ventolin over the counter in uk that works well for primary care, since it takes account of the evolving course of a patient’s presenting problem, sometimes over multiple consultations.12Preventable or avoidable harm is by definition attributable to medical error, although many errors do not lead to harm. Harm can also be a broad concept, ranging from transient anxiety through to death. Avery and colleagues have been particularly diligent in their definitions of avoidability and significant harm, deriving the latter from that provided by WHO,13 which in turn lies between the definitions of moderate and severe harm described by England’s National Patient Safety Agency and by Panesar and colleagues.14By drawing our attention can you buy ventolin over the counter in uk to the extent to which errors and avoidable harms occur, these two studies also prompt us to consider ways in which we might take action to improve diagnostic safety in primary care.

One is to identify errors can you buy ventolin over the counter in uk as soon as, or right after, they are made, which then provides an opportunity to forestall any ensuing harm or reduce its severity. Safety-netting is a well-established if ill-defined consultation technique where the patient is advised on the anticipated course of events and the action(s) to take if these do not follow within a specified timeframe.15 It is specifically advocated in English national guidance on management and referral of suspected cancer.16 A more systematic and technical approach is the use of e-triggers, signals of a likely error or adverse event, generated by the systematic mining of electronic patient data. These can prompt clinicians to the correct actions or can generate reminders when the correct actions are not performed in a timely can you buy ventolin over the counter in uk way.17 Singh and others have also proposed the SaferDx e-Trigger Tool Framework for the future development of tools that monitor diagnostic errors and intervene for specific patients when needed.17Another way to take action to improve diagnostic safety is to use retrospective clinical record review to identify the circumstances and types of events that might threaten patient safety during the diagnostic process, in order to address these circumstances in the future. Examples include a Danish study that found ‘quality deviations’ in 30% of the 5711 patients presenting with symptoms subsequently found to be due to cancer,18 and an English national audit of 14 259 patients with cancer where GPs reported avoidable delays in 24% of the sample.19 ‘Quality deviations’ and other avoidable delays can potentially be prevented, but only with a strong professional culture that values identifying them in the first place. A culture of identifying and reflecting on safety incidents is well established in many countries where strong can you buy ventolin over the counter in uk primary care systems pertain.

In the UK, significant event audit is widely practised and is part of the Royal College of General Practitioners’ patient safety toolkit. Changes in clinical practice or quality of care are often reported although not easily verified.20 However, qualitative analysis of multiple significant event audits has been used to can you buy ventolin over the counter in uk identify opportunities for quality improvement in the diagnostic process for lung cancer.21 On the other hand, reporting of patient safety incidents to a central body, such as the National Reporting and Learning System in England has not been widely adopted in primary care, in contrast to secondary care, which accounts for more than 99% of patient safety incident reports. Incident reporting has also not generally been as successful as it could be in the USA, despite strong models of its importance for improvement in other fields, such as aviation.22These various approaches to identifying errors and can you buy ventolin over the counter in uk harms that occur in primary care can all inform the design of safer systems and/or safer diagnosticians, to reduce the risk of error in the first place. By learning about which processes lead to errors, one can try to improve those processes and prevent errors occurring. In this way, e-triggers, for example, could provide can you buy ventolin over the counter in uk the information needed for a healthcare system to identify targets for diagnostic safety, as suggested in the SaferDx framework.

For example, if triggers identified frequent failures in a particular healthcare system in the follow-up on abnormal test results, a system re-design could be put in place to prevent these. Alternatively, one might can you buy ventolin over the counter in uk provide clinicians with tools that enhance their diagnostic capabilities. These could include better access to diagnostic tests or the provision of electronic clinical decision support systems. A recent systematic review confirmed that these have the capacity to improve diagnostic decision making for cancer in primary care.23 The two studies in this can you buy ventolin over the counter in uk issue of the journal clearly describe the problems. Action is now needed to address them in a concerted and systematic way.Ethics statementsPatient consent for publicationNot required..

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Medicaid Services, where can you buy ventolin over the counter Health advice and Human Services (HHS). Notice. The Centers for Medicare &. Medicaid Services (CMS) is where can you buy ventolin over the counter announcing an opportunity for the public to comment on CMS' intention to collect information from the public.

Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments must be received by October where can you buy ventolin over the counter 19, 2021. When commenting, please reference the document identifier or OMB control number.

To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1. Electronically. You may send your comments electronically to http://www.regulations.gov.

Follow the instructions for “Comment or Submission” or “More Search Options” to find the information collection document(s) that are accepting comments. 2. By regular mail. You may mail written comments to the following address.

CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention. Document Identifier/OMB Control Number. __, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following.

1. Access CMS' website address at website address at https://www.cms.gov/​Regulations-and-Guidance/​Legislation/​PaperworkReductionActof1995/​PRA-Listing.html. Start Further Info William N. Parham at (410) 786-4669.

End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES). CMS-10280 Home Health Change of Care Notice CMS-1557 Survey Report Form for Clinical Laboratory Improvement Amendments (CLIA) and Supporting Regulations CMS-3070G-I ICF/IID Survey Report Form and Supporting Regulations Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor.

The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Information Collection 1. Type of Information Collection Request. Extension of a currently approved collection. Title of the Information Collection.

Home Health Change of Care Notice. Use. The purpose of the Home Health Change of Care Notice (HHCCN) is to notify original Medicare beneficiaries receiving home health care benefits of plan of care changes. Home health agencies (HHAs) are required to provide written notice to Original Medicare beneficiaries under various circumstances involving the reduction or termination of items and/or services consistent with Home Health Agencies Conditions of Participation (COPs).

The home health COP requirements are set forth in § 1891[42 U.S.C. 1395bbb] of the Social Security Act (the Act). The implementing regulations under 42 CFR 484.10(c) specify that Medicare patients receiving HHA services have rights. The patient has the right to be informed, in advance about the care to be furnished, and of any changes in the care to be furnished.

The HHA must advise the patient in advance of the disciplines that will furnish care, and the frequency of visits proposed to be furnished. The HHA must advise the patient in advance of any change in the plan of care before the change is made.” Notification is required for covered and non-covered services listed in the plan of care (POC). The beneficiary will use the information provided to decide whether or not to pursue alternative options to continue receiving the care noted on the HHCCN. Form Number.

CMS-10280 (OMB control number. 0938-1196). Frequency. Yearly.

Affected Public. Private Sector (Business or other for-profits, Not-for-Profit Institutions). Number of Respondents. 11,157.

Total Annual Responses. 12,385,108. Total Annual Hours. 824,848.

(For policy questions regarding this collection contact Jennifer McCormick at 410-786-2852.) 2. Type of Information Collection Request. Extension of a currently approved collection. Title of Information Collection.

Survey Report Form for Clinical Laboratory Improvement Amendments (CLIA) and Supporting Regulations. Use. The form is used to report surveyor findings during a CLIA survey. For each type of survey conducted (i.e., initial certification, recertification, validation, complaint, addition/deletion of specialty/subspecialty, transfusion fatality investigation, or revisit inspections) the Survey Report Form incorporates the requirements specified in the CLIA regulations.

Form Number. CMS-1557 (OMB control number. 0938-0544). Frequency.

Biennially. Affected Public. Private sector (Business or other for-profit and Not-for-profit institutions, State, Local or Tribal Governments and Federal Government). Number of Respondents.

15,975. Total Start Printed Page 46855Annual Responses. 7,988. Total Annual Hours.

3,994. (For policy questions regarding this collection contact Kathleen Todd at 410-786-3385). 3. Type of Information Collection Request.

Revision of a currently approved collection. Title of Information Collection. ICF/IID Survey Report Form and Supporting Regulations. Use.

The information collected with forms 3070G, CMS-3070H and CMS-3070I is used by the surveyors from the State Survey Agencies (SAs) to determine the level of compliance with the ICF/IID Conditions of Participation (CoPs) necessary to participate in the Medicare/Medicaid program and to report any non-compliance with the ICF/IID CoPs to the Federal government. These forms summarize the survey team characteristics, facility characteristics, client population, and the special needs of clients. These forms are used in conjunction with the CMS regulation text and additional surveyor aids such as the CMS interpretive guidelines and probes. The CMS-3070G-I forms serves as coding worksheets, designed to facilitate data entry and retrieval into the Automated Survey Processing Environment Suite (ASPEN) in the State and at the CMS regional offices.

Form Number. CMS-3070G-I (OMB control number. 0938-0062). Frequency.

Reporting—Yearly. Affected Public. Business or other for-profits and Not-for-profit institutions. Number of Respondents.

5,758. Total Annual Responses. 5,758. Total Annual Hours.

17,274. (For policy questions regarding this collection contact Caroline Gallaher at 410-786-8705.) Start Signature Dated. August 17, 2021. William N.

Parham, III Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. End Signature End Supplemental Information [FR Doc. 2021-17908 Filed 8-19-21. 8:45 am]BILLING CODE 4120-01-PStart Preamble Centers for Medicare &.

Medicaid Services, Health and Human Services (HHS). Notice. The Centers for Medicare &. Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public.

Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our Start Printed Page 42842burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments must be received by October 4, 2021. When commenting, please reference the document identifier or OMB control number.

To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1. Electronically. You may send your comments electronically to http://www.regulations.gov.

Follow the instructions for “Comment or Submission” or “More Search Options” to find the information collection document(s) that are accepting comments. 2. By regular mail. You may mail written comments to the following address.

CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention. Document Identifier/OMB Control Number. __, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following.

1. Access CMS' website address at website address at https://www.cms.gov/​Regulations-and-Guidance/​Legislation/​PaperworkReductionActof1995/​PRA-Listing.html. Start Further Info William N. Parham at (410) 786-4669.

End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES). CMS-10148 HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form CMS-10784 The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor.

The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Frequency Where to get cialis can you buy ventolin over the counter in uk. Biennially. Affected Public. Private sector (Business or other for-profit and can you buy ventolin over the counter in uk Not-for-profit institutions, State, Local or Tribal Governments and Federal Government).

Number of Respondents. 15,975. Total Start Printed Page 46855Annual Responses can you buy ventolin over the counter in uk. 7,988.

Total Annual Hours. 3,994. (For policy questions regarding this collection contact Kathleen Todd at 410-786-3385). 3.

Type of Information Collection Request. Revision of a currently approved collection. Title of Information Collection. ICF/IID Survey Report Form and Supporting Regulations.

Use. The information collected with forms 3070G, CMS-3070H and CMS-3070I is used by the surveyors from the State Survey Agencies (SAs) to determine the level of compliance with the ICF/IID Conditions of Participation (CoPs) necessary to participate in the Medicare/Medicaid program and to report any non-compliance with the ICF/IID CoPs to the Federal government. These forms summarize the survey team characteristics, facility characteristics, client population, and the special needs of clients. These forms are used in conjunction with the CMS regulation text and additional surveyor aids such as the CMS interpretive guidelines and probes.

The CMS-3070G-I forms serves as coding worksheets, designed to facilitate data entry and retrieval into the Automated Survey Processing Environment Suite (ASPEN) in the State and at the CMS regional offices. Form Number. CMS-3070G-I (OMB control number. 0938-0062).

Frequency. Reporting—Yearly. Affected Public. Business or other for-profits and Not-for-profit institutions.

Number of Respondents. 5,758. Total Annual Responses. 5,758.

Total Annual Hours. 17,274. (For policy questions regarding this collection contact Caroline Gallaher at 410-786-8705.) Start Signature Dated. August 17, 2021.

William N. Parham, III Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. End Signature End Supplemental Information [FR Doc. 2021-17908 Filed 8-19-21.

8:45 am]BILLING CODE 4120-01-PStart Preamble Centers for Medicare &. Medicaid Services, Health and Human Services (HHS). Notice. The Centers for Medicare &.

Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our Start Printed Page 42842burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments must be received by October 4, 2021.

When commenting, please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1. Electronically.

You may send your comments electronically to http://www.regulations.gov. Follow the instructions for “Comment or Submission” or “More Search Options” to find the information collection document(s) that are accepting comments. 2. By regular mail.

You may mail written comments to the following address. CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention. Document Identifier/OMB Control Number. __, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following. 1. Access CMS' website address at website address at https://www.cms.gov/​Regulations-and-Guidance/​Legislation/​PaperworkReductionActof1995/​PRA-Listing.html. Start Further Info William N.

Parham at (410) 786-4669. End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES). CMS-10148 HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form CMS-10784 The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment Under the PRA (44 U.S.C.

3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval.

To comply with this requirement, CMS is publishing this notice. Information Collection 1. Type of Information Collection Request. Extension of a currently approved collection.

Title of Information Collection. HIPAA Administrative Simplification (Non-Privacy/Security) Complaint Form. Use. The Secretary of Health and Human Services (HHS), hereafter known as “The Secretary,” codified 45 CFR parts 160 and 164 Administrative Simplification provisions that apply to the enforcement of the Health Insurance Portability and Accountability Act of 1996 Public Law 104-191 (HIPAA).

The provisions address rules relating to the investigation of non-compliance of the HIPAA Administrative Simplification code sets, unique identifiers, operating rules, and transactions. 45 CFR 160.306, Complaints to the Secretary, provides for investigations of covered entities by the Secretary. Further, it outlines the procedures and requirements for filing a complaint against a covered entity. Anyone can file a complaint if he or she suspects a potential violation.

Persons believing that a covered entity is not utilizing the adopted Administrative Simplification provisions of HIPAA are voluntarily requested to file a complaint with CMS via the Administrative Simplification Enforcement and Testing Tool (ASETT) online system, by mail, or by sending an email to the HIPAA mailbox at hipaacomplaint@cms.hhs.gov. Information provided on the standard form will be used during the investigation process to validate non-compliance of HIPAA Administrative Simplification provisions. This standard form collects identifying and contact information of the complainant, as well as the identifying and contact information of the filed against entity (FAE). This information enables CMS to respond to the complainant and gather more information if necessary, and to contact the FAE to discuss the complaint and CMS' findings.

Form Number. CMS-10148 (OMB control number. 0938-0948). Frequency.

Occasionally. Affected Public. Private sector, Business or Not-for-profit institutions, State, Local, or Tribal Governments, Federal Government, Not-for-profits institutions. Number of Respondents.

21. Total Annual Responses. 21. Total Annual Hours.

12. (For policy questions regarding this collection contact Kevin Stewart at 410-786-6149). 2. Type of Information Collection Request.

New collection (Request for a new OMB control). Title of Information Collection. The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment. Use.

The reporting of quality data by HHAs is mandated by Section 1895(b)(3)(B)(v)(II) of the Social Security Act (“the Act”). This statute requires that “each home health agency shall submit to the Secretary such data that the Secretary determines are appropriate for the measurement of health care quality. Such data shall be submitted in a form and manner, and at a time, specified by the Secretary for purposes of this clause.” HHCAHPS data are mandated in the Medicare regulations at 42 CFR 484.250(a), which requires HHAs to submit HHCAHPS data to meet the quality reporting requirements of section 1895(b)(3)(B)(v) of the Act. This collection of information is necessary to be able to test updates to the HHCAHPS survey and administration protocols.

CMS proposes to conduct a mode experiment with the main goal of testing the effects of a web-based mode on response rates and scores as an addition to the three currently approved modes (OMB Control Number. 0938-1370). The addition of a web mode will give HHAs an alternative or an addition to the use of mail and telephone modes. CMS is also interested in testing a revised, shorter version of the HHCAHPS survey, based on feedback from patients and stakeholders.

The data collected from the HHCAHPS Survey mode experiment will be used for the following purposes. Test the shortened survey instrument, including several new items. Compare survey responses across the four proposed modes to determine if adjustments are needed to ensure that data collection mode does not influence results. And Determine if and by how much patient characteristics affect the patients' rating of the care they receive Start Printed Page 42843and adjust results based on those factors.

The mode experiment is designed to examine the effects of the shortened survey on response rates and scores and to provide precise adjustment estimates for survey items and composites on the shortened survey instrument. Information from this mode experiment will help CMS determine whether an additional mode of administration (i.e., Web data collection) should be included and a shortened survey instrument should be used in the current national implementation of the HHCAHPS Survey. Form Number. CMS-10784 (OMB control number.

0938-New). Frequency. Annually. Affected Public.

Individuals or Households. Number of Respondents. 6,280. Total Annual Responses.

6,280. Total Annual Hours. 1,049. (For policy questions regarding this collection contact Lori E.

Teichman at 410-786-6684). Start Signature Dated. August 2, 2021. William N.

Parham, III, Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. End Signature End Supplemental Information [FR Doc. 2021-16755 Filed 8-4-21. 8:45 am]BILLING CODE 4120-01-P.

!]


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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

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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.


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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.

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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.

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.

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

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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?

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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.

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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.

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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).

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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. ;-))

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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

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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

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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.

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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.

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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.

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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!


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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.

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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!)

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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! 🙂

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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! 🙂

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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!

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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.

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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.

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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.

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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.)

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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.

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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.

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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.

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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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