Clinic Review Quotes

While play-acting grim scenarios day in and day out may sound like a good recipe for clinical depression, it’s actually weirdly uplifting. Rehearsing for catastrophe has made me positive that I have the problem-solving skills to deal with tough situations and come out the other side smiling. For me, this has greatly reduced the mental and emotional clutter that unchecked worrying produces, those random thoughts that hijack your brain at three o’clock in the morning. While I very much hoped not to die in space, I didn’t live in fear of it, largely because I’d been made to think through the practicalities: how I’d want my family to get the news, for instance, and which astronaut I should recruit to help my wife cut through the red tape at NASA and the CSA. Before my last space flight (as with each of the earlier ones) I reviewed my will, made sure my financial affairs and taxes were in order, and did all the other things you’d do if you knew you were going to die. But that didn’t make me feel like I had one foot in the grave. It actually put my mind at ease and reduced my anxiety about what my family’s future would look like if something happened to me. Which meant that when the engines lit up at launch, I was able to focus entirely on the task at hand: arriving alive.

I never met Meehl, but he was one of my heroes from the time I read his Clinical vs. Statistical Prediction: A Theoretical Analysis and a Review of the Evidence.

It should come as absolutely no surprise that research has ignored women for so long because the establishment: the journal publishers, the reviewers and the funding agencies has rewarded it. Although the things are changing for the better in the US federal agencies will no longer fund clinical trials involving humans that do not include women... there is still a long way to go [..] Thoughtful, carefully done research on females still takes longer and costs more and is often times harder to interpret than research conducted only on males. So when people's careers depend on their publication rate rather than the need for answers to the questions they are asking, women and the issues they care about most - loose.

The journal articles that Willett’s team wrote to establish the pyramid were not subject to the peer-review process that scientific papers normally undergo; they had only one reviewer, not the usual two to three. This was because the papers were published, along with the entire 1993 Cambridge conference proceedings, in a special supplement of the American Journal of Clinical Nutrition funded by the olive oil industry.

But another type of life review happens to all of us when we die and our consciousness leaves the physical body at the end of each lifetime. This time it is not done with a therapist, but rather with our spiritual guides or other wise beings; it is not a clinical life review but a karmic one. As we are replenished by the beautiful light, our awareness is directed to review the results of our actions while we were on the physical plane. We see the people we have harmed and we feel their emotional reactions, magnified greatly. Similarly, we feel the emotions, again enhanced, of those we have aided and loved. In this manner, we examine all our relationships, and we deeply experience all the anger, hurt, and despair that we have caused—but also all the gratitude, appreciation, love, and hope that we have elicited. This life review is not done in a spirit of punishment or guilt. By truly understanding the result of our behavior, we learn the importance of loving-kindness and compassion. As

A systematic review and meta-analysis published in the Journal of the American Medical Association looked at all the best randomized clinical trials evaluating the effects of omega-3 fats on life span, cardiac death, sudden death, heart attack, and stroke. These included studies not only on fish oil supplements but also studies on the effects of advising people to eat more oily fish. What did they find? Overall, the researchers found no protective benefit for overall mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.12

Dr. Mark Crisplin, a Portland, Oregon, ER doctor, reviewed the original EEG readings of a number of patients claimed by the scientists as being flatlined or “dead” and discovered that this was not at all the case. “What they showed was slowing, attenuation, and other changes, but only a minority of patients had a flat line, and it [dying] took longer than 10 seconds. The curious thing was that even a little blood flow in some patients was enough to keep EEGs normal.” In fact, most cardiac patients were given CPR, which by definition delivers some oxygen to the brain (that’s the whole point of doing it). Crisplin concluded: “By the definitions presented in the Lancet paper, nobody experienced clinical death. No doctor would ever declare a patient in the middle of a code 99 dead, much less brain dead. Having your heart stop for 2 to 10 minutes and being promptly resuscitated doesn’t make you ‘clinically dead.’ It only means your heart isn’t beating and you may not be conscious.”31 Again, since our normal experience is of stimuli coming into the brain from the outside, when one part of the brain abnormally generates these illusions, another part of the brain—quite possibly the left-hemisphere interpreter described by neuroscientist Michael Gazzaniga—interprets them as external events. Hence, the abnormal is interpreted as supernormal or paranormal.

Americans today enjoy a prosperity like no other people in human history. So if money produces pleasure and pleasure produces happiness, we should be the happiest people ever assembled on this planet. The fact is, we are not. How can this be? This is the question New Republic editor Gregg Easterbrook addresses in his provocative book The Progress Paradox: How Life Gets Better While People Feel Worse. Easterbrook reviews the extraordinary progress made since the time of our great-great grandparents: Average life expectancy has increased dramatically; we are far healthier, without the threat of dreaded diseases like polio and smallpox; the typical American adult has twice the purchasing power his or her parents had in 1960, with the quality of life immeasurably improved.[11] We ought to be very happy, Easterbrook concludes. Yet Americans rank number sixteen in a survey of the happiest people in the world. (Nigerians rank number one.)[12] Americans tell pollsters that the country is on the wrong course, that their parents had it better than they do, that people feel incredibly stressed out. More people are popping Prozac and Zoloft pills; the number of people clinically depressed has increased tenfold in the post–World War II era. Remember the paradoxes we talked about earlier? Well, here is another: Life is better, but we feel worse.

Psychoanalysis has suffered the accusation of being “unscientific” from its very beginnings (Schwartz, 1999). In recent years, the Berkeley literary critic Frederick Crews has renewed the assault on the talking cure in verbose, unreadable articles in the New York Review of Books (Crews, 1990), inevitably concluding, because nothing else really persuades, that psychoanalysis fails because it is unscientific. The chorus was joined by philosopher of science, Adolf Grunbaum (1985), who played both ends against the middle: to the philosophers he professed specialist knowledge of psychoanalysis; to the psychoanalysts he professed specialist knowledge of science, particularly physics. Neither was true (Schwartz, 1995a,b, 1996a,b, 2000). The problem that mental health clinicians always face is that we deal with human subjectivity in a culture that is deeply invested in denying the importance of human subjectivity. Freud’s great invention of the analytic hour allows us to explore, with our clients, their inner worlds. Can such a subjective instrument be trusted? Not by very many. It is so dangerously close to women’s intuition. Socalled objectivity is the name of the game in our culture. Nevertheless, 100 years of clinical practice have shown psychoanalysis and psychotherapy not only to be effective, but to yield real understandings of the dynamics of human relationships, particularly the reality of transference–countertransference re-enactments now reformulated by our neuroscientists as right brain to right brain communication (Schore, 1999).

In April, Dr. Vladimir (Zev) Zelenko, M.D., an upstate New York physician and early HCQ adopter, reproduced Dr. Didier Raoult’s “startling successes” by dramatically reducing expected mortalities among 800 patients Zelenko treated with the HCQ cocktail.29 By late April of 2020, US doctors were widely prescribing HCQ to patients and family members, reporting outstanding results, and taking it themselves prophylactically. In May 2020, Dr. Harvey Risch, M.D., Ph.D. published the most comprehensive study, to date, on HCQ’s efficacy against COVID. Risch is Yale University’s super-eminent Professor of Epidemiology, an illustrious world authority on the analysis of aggregate clinical data. Dr. Risch concluded that evidence is unequivocal for early and safe use of the HCQ cocktail. Dr. Risch published his work—a meta-analysis reviewing five outpatient studies—in affiliation with the Johns Hopkins Bloomberg School of Public Health in the American Journal of Epidemiology, under the urgent title, “Early Outpatient Treatment of Symptomatic, High-Risk COVID-19 Patients that Should be Ramped-Up Immediately as Key to Pandemic Crisis.”30 He further demonstrated, with specificity, how HCQ’s critics—largely funded by Bill Gates and Dr. Tony Fauci31—had misinterpreted, misstated, and misreported negative results by employing faulty protocols, most of which showed HCQ efficacy administered without zinc and Zithromax which were known to be helpful. But their main trick for ensuring the protocols failed was to wait until late in the disease process before administering HCQ—when it is known to be ineffective. Dr. Risch noted that evidence against HCQ used late in the course of the disease is irrelevant. While acknowledging that Dr. Didier Raoult’s powerful French studies favoring HCQ efficacy were not randomized, Risch argued that the results were, nevertheless, so stunning as to far outweigh that deficit: “The first study of HCQ + AZ [ . . . ] showed a 50-fold benefit of HCQ + AZ vs. standard of care . . . This is such an enormous difference that it cannot be ignored despite lack of randomization.”32 Risch has pointed out that the supposed need for randomized placebo-controlled trials is a shibboleth. In 2014 the Cochrane Collaboration proved in a landmark meta-analysis of 10,000 studies, that observational studies of the kind produced by Didier Raoult are equal

Every Day Take Your Daily Doses Black Cumin (Nigella sativa) (¼ tsp) As noted in the Appetite Suppression section, a systematic review and meta-analysis of randomized, controlled weight-loss trials found that about a quarter teaspoon of black cumin powder every day appears to reduce body mass index within a span of a couple of months. Note that black cumin is different from regular cumin, for which the dosing is different. (See below.) Garlic Powder (¼ tsp) Randomized, double-blind, placebo-controlled studies have found that as little as a daily quarter teaspoon of garlic powder can reduce body fat at a cost of perhaps two cents a day. Ground Ginger (1 tsp) or Cayenne Pepper (½ tsp) Randomized controlled trials have found that ¼ teaspoon to 1½ teaspoons a day of ground ginger significantly decreased body weight for just pennies a day. It can be as easy as stirring the ground spice into a cup of hot water. Note: Ginger may work better in the morning than evening. Chai tea is a tasty way to combine the green tea and ginger tweaks into a single beverage. Alternately, for BAT activation, you can add one raw jalapeño pepper or a half teaspoon of red pepper powder (or, presumably, crushed red pepper flakes) into your daily diet. To help beat the heat, you can very thinly slice or finely chop the jalapeño to reduce its bite to little prickles, or mix the red pepper into soup or the whole-food vegetable smoothie I featured in one of my cooking videos on NutritionFacts.org.4985 Nutritional Yeast (2 tsp) Two teaspoons of baker’s, brewer’s, or nutritional yeast contains roughly the amount of beta 1,3/1,6 glucans found in randomized, double-blind, placebo-controlled clinical trials to facilitate weight loss. Cumin (Cuminum cyminum) (½ tsp with lunch and dinner) Overweight women randomized to add a half teaspoon of cumin to their lunches and dinners beat out the control group by four more pounds and an extra inch off their waists. There is also evidence to support the use of the spice saffron, but a pinch a day would cost a dollar, whereas a teaspoon of cumin costs less than ten cents. Green Tea (3 cups) Drink three cups a day between meals (waiting at least an hour after a meal so as to not interfere with iron absorption). During meals, drink water, black coffee, or hibiscus tea mixed 6:1 with lemon verbena, but never exceed three cups of fluid an hour (important given my water preloading advice). Take advantage of the reinforcing effect of caffeine by drinking your green tea along with something healthy you wish you liked more, but don’t consume large amounts of caffeine within six hours of bedtime. Taking your tea without sweetener is best, but if you typically sweeten your tea with honey or sugar, try yacon syrup instead. Stay

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RevSkin Cream Canada With this age being tagged because the age of contamination, it's vital to ascertain that your product selection is sweet which you it delivers lead you to the expected ageless path of youth. Best Wrinkle Cream has got to be natural in its formulation to trigger natural benefits. Right off the bat, you would like a product that has been tested. check out a product's claims to ascertain Wrinkle Cream Reviews if it's produced consistent leads to a testing environment. These clinical trials will help to determine an optimal amount of each ingredient, and prove that it works during a controlled environment. Because otherwise, there's no way of knowing whether a product will live up to its advertised claims or, worse, if it'd even be harmful for your skin!

Teaching academic writing to Bachelor of Science in Nursing (BSN) students is crucial early in their academic journey and should continue throughout their program. Here's a breakdown: Foundation Level (First Year): Introducing basic academic writing skills at the onset helps students develop a strong foundation. This includes understanding essay structure, proper citation methods (APA, MLA), and critical reading and writing skills NURS FPX 4010 Assessment 2. Core Nursing Courses: As students progress into core nursing courses, integrating academic writing into these subjects is beneficial. Assignments related to evidence-based practice, research papers, case studies, and reflective writing can aid in linking theoretical knowledge to practical application through writing.NURS FPX 4010 Assessment 3 Clinical Practice Integration: Incorporating writing assignments that reflect on clinical experiences or patient interactions helps students articulate their observations, reflections, and professional development, enhancing their communication skills.online class help services Advanced Nursing Courses: In advanced years, focus on more complex academic writing, such as scholarly articles, thesis or capstone projects, and literature reviews. This phase aligns with deeper research and specialization within nursing fields. Continuous Improvement: Encourage ongoing improvement by providing resources, workshops, and feedback on writing. Additionally, revisiting and reinforcing academic writing skills periodically ensures students maintain and enhance these crucial abilities.nursfpx.com By introducing and reinforcing academic writing skills across various stages of the BSN program, students develop proficiency in communicating their ideas effectively, a skill essential for their future practice, research endeavors, and professional growth.

Even the results of clinical trials, which are usually randomized experiments and therefore the gold standard of medical research, should be viewed with some skepticism. In 2011, the Wall Street Journal ran a front-page story on what it described as one of the “dirty little secrets” of medical research: “Most results, including those that appear in top-flight peer-reviewed journals, can’t be reproduced.”7

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what’s most curious in clinical trials with psilocybin is that participants who have the most mystical experiences, as defined by the Mystical Experience Questionnaire (MEQ), a peer reviewed psychological scale,52 also seem to benefit the most from psychedelic therapy, no matter if the study is for addiction53 or end-of-life anxiety.54 But why?

Blumenfeld, H. (2010). Neuroanatomy through clinical cases (2nd ed.). Sunderland, MA: Sinauer Associates.

Donders, J., & Hunter, S. (Eds.). (2018). Neuropsychological conditions across the lifespan. Cambridge, UK: Cambridge University Press.

Heilman K. M., & Valenstein, E. (Eds.). (2012). Clinical neuropsychology (5th ed.). New York, NY: Oxford University Press.

Kolb, B., & Whishaw, I. Q. (2015). Fundamentals of human neuropsychology (7th ed.). New York, NY: Worth Publishers.

Morgan, J. E., & Ricker, J. H. (Eds.). (2018). Textbook of clinical neuropsychology (2nd ed.). New York, NY: Taylor and Francis.

Schoenberg, M. R., & Scott, J. G. (Eds). (2011). The little black book of neuropsychology: A syndrome-based approach. New York, NY: Springer.

Strauss, E., Sherman, E., & Spreen, O. (in press). A compendium of neuropsychological tests: Administration, norms, and commentary (4th ed.). New York, NY: Oxford University Press.

McPherson, S., & Koltai, D. (2018). A practical guide to geriatric neuropsychology. New York, NY: Oxford University Press.

Baron, I. S. (2018). Neuropsychological evaluation of the child (2nd ed.). New York, NY: Oxford University Press.

Beauchamp, M. H., Ris, M. D., Taylor, H. G., Peterson, R. L., & Yeates, K. O. (Eds.) (in press). Pediatric neuropsychology: Research, theory, and practice (3rd ed.). New York, NY: Guilford Press.

This is how we know that Anthony Fauci was well aware of remdesivir’s toxicity when he orchestrated its approval for COVID patients. NIAID sponsored that project. Dr. Fauci had another NIAID-incubated drug, ZMapp, in the same clinical trial, testing efficacy against Ebola alongside two experimental monoclonal antibody drugs. Researchers planned to administer all four drugs to Ebola patients across Africa over a period of four to eight months.10,11 However, six months into the Ebola study, the trial’s Safety Review Board suddenly pulled both remdesivir and ZMapp from the trial.12 Remdesivir, it turned out, was hideously dangerous. Within 28 days, subjects taking remdesivir had lethal side effects including multiple organ failure, acute kidney failure, septic shock, and hypotension, and 54 percent of the remdesivir group died—the highest mortality rate among the four experimental drugs.13 Anthony Fauci’s drug, ZMapp, ran up the second-highest body count at 44 percent. NIAID was the primary funder of this study, and its researchers published the bad news about remdesivir in the New England Journal of Medicine in December 2019.

According to a memo that Keller himself wrote to the Brown Institutional Review Board on January 30, 1995, this patient (number 70) ingested eighty-two Tylenol pills in an apparent overdose attempt on January 19. Patient 70 was admitted to a hospital and terminated from the study shortly afterward, according to Keller’s memo to Brown IRB. Yet this teenage girl was not included in the group reported to have experienced serious adverse events while in the study. Instead, in another memo that Keller had written to the Brown IRB in 1995, she was described as having been terminated from the study for being “noncompliant.” In an even more mysterious turn, patient 70 was described in GlaxoSmithKline’s final report of the study as being a twelve-year-old boy. This boy was enrolled in the clinical trial a month after the teenage girl identified in Keller’s memos as patient 70 overdosed on Tylenol and withdrew from the study. The boy with the same patient number was removed from the study on March 22, 1995, after developing tachycardia (rapid heartbeat) while taking the tricyclic antidepressant known as imipramine, according to the company’s final report. There was no mention in the company’s posted final report or the 2001 journal paper that the original patient 70 was a young girl who had ingested eighty-two Tylenol pills in a clear bid to kill herself.

GOOD ENERGY BIOMARKERS AND MOVEMENT When you’re striving to be part of the 6.8 percent of metabolically healthy Americans, regular movement will help you get there. Research shows that exercise improves all five of the following basic biomarkers of metabolism: Glucose Levels Above 100 mg/dL: Twelve-week exercise programs of either high-intensity running (40 minutes per week) or low-intensity running (150 minutes per week) both brought participants’ blood sugar from the prediabetic range (100 mg/dL or greater) to the nondiabetic range (<100 mg/dL). HDL Cholesterol Less Than 40 mg/dL: A 2019 review of the literature showed that exercise increased HDL cholesterol, “with exercise volume, rather than intensity, having a greater influence.” Meanwhile, “raising HDL levels pharmacologically has not shown convincing clinical benefits.” Triglycerides Above 150 mg/dL: Numerous studies have demonstrated that physical activity effectively lowers triglyceride levels. In a 2019 study, an eight-week moderate aerobic exercise program significantly reduced triglyceride levels in participants. Furthermore, even a single session of intense aerobic exercise has been found to decrease triglyceride levels the following day. This positive effect could be due to the increased activity of hepatic lipase in the liver, an enzyme that facilitates the absorption of triglyceride from the bloodstream. Blood Pressure of 130/85 mmHg or Higher: Research has shown the effects of exercise among populations with high blood pressure were similar to the effects of commonly used medications. A Waistline of More Than 35 Inches for Women and 40 Inches for Men: Not surprisingly, regular exercise can help decrease obesity by increasing energy expenditure and promoting weight loss. Research shows a clear inverse relationship between the amount of movement people do each week and the size of their waistline: more movement, smaller waist circumference. What’s more, lower activity (fewer than 5,100 steps per day) yields a 2.5 times higher risk of central obesity than higher activity (more than 8,985 steps per day).

Metro Pillar – 211, 22, NDV Towers, First Floor, Kanakapura Rd, above Dry Fruit Shop, Raghuvanahalli, Bengaluru, Karnataka 560062 Contact Us +91 8618292628 Is Elite Orthocare Robotic Knee Replacement Better Than Conventional Surgery? Elite Orthocare's Robotic Total Knee Replacement, led by Dr. Abhinandan Punit, offers superior accuracy in implant positioning, resulting in better patient outcomes, reduced pain, faster recovery, and overall improved results. Robotic knee replacement at Elite Orthocare is among the most innovative technologies in orthopedic surgery. With thousands of robotic knee replacements performed worldwide, this advanced technology continues to set new standards in joint replacement. But you might ask: Does robotic knee replacement surgery in Bangalore really offer significant advantages over conventional surgery? Over 250 peer-reviewed studies highlight the enhanced clinical outcomes and patient benefits of robotic knee replacements compared to traditional manual methods. Here are the major differences between manual knee replacement and Elite Orthocare’s robotic knee replacement: Stage Manual Total Knee Replacement Elite Orthocare’s Robotic Knee Replacement Pre-surgery - Simple X-ray planning - CT scan-based planning for improved precision Surgery - Positioning with traditional tools - Robotic-assisted precise alignment - Larger incision needed - Smaller incision, less tissue damage - Standard ligament release - Minimal ligament release, reducing pain Post-Surgery Benefits of Elite Orthocare’s Robotic Knee Replacement: • Less pain • Faster recovery • Quicker return to mobility • Enhanced overall outcomes Understanding the Benefits of Elite Orthocare’s Robotic Knee Replacement: Accuracy: The robotic system used at Elite Orthocare ensures precise implant positioning and knee alignment. Studies show that robotic-assisted knee replacements are far more accurate than manual methods, ensuring better long-term results. For instance, one study revealed that robotic procedures were 47% more accurate in tibial component alignment and 36% more accurate in femoral component rotation compared to manual surgery. Outcomes: Patients undergoing robotic knee replacement with Dr. Abhinandan Punit report better functional outcomes, less post-operative pain, and higher satisfaction rates. Clinical studies show patients experience faster improvements in mobility and higher overall satisfaction compared to manual knee replacements. Why Choose Dr. Abhinandan Punit at Elite Orthocare? Dr. Abhinandan Punit, founder of Elite Orthocare, is an expert in robotic knee replacement surgery. With a wealth of experience and a dedication to providing top-notch care, Dr. Punit ensures the best outcomes for all his patients. If you're considering robotic knee replacement surgery in Bangalore or want to explore its benefits, book a consultation with Dr. Abhinandan Punit at Elite Orthocare today!

Illumina’s soup-to-nuts strategy—of providing fundamental sequencing technologies as well as services that mine genomic insights—appears to be a winner as genomic information begins to touch the practice of medicine and enter everyday life. Illumina already has an iPad app that lets you review your genome if it has been analyzed. “One of the biggest challenges now is increasing the clinical knowledge of what the genome means,” Flatley says. “It’s one thing to say, ‘Here’s the genetic variation.’ It’s another to say, ‘Here’s what the variation means.’” Demand for that understanding will only increase as millions of people get sequenced. “We want to be at the apex of that effort,” he says.

Exercise as Medicine More than 1000 trials have examined the relationship between exercise and depression, and most have demonstrated an inverse relationship between them.13,14 Physical activity may also prevent the initial onset of depression.15,16 Regularly performed exercise is as effective an antidepressant as psychotherapy or pharmaceutical approaches.13,17–21 Well-designed studies also support that exercise combined with pharmacologic treatment is superior to either alone, but exercise appears to be superior in maintaining therapeutic benefit and preventing recurrence of depression.22–26 Evidence provides some support for the use of exercise. A recent Cochrane review (updated from 2009) included 32 studies (n=1858) involving exercise for the treatment of researcher-defined depression. From these studies, 28 randomized controlled trials (RCTs) (n=1101) were included in a meta-analysis revealing a moderate to large effect in favor of exercise over standard treatment or control. However, only four trials (n=326) with adequate allocation concealment, blinding, and ITT analysis were found, resulting in a more modest effect size in favor of exercise. Pooled data from seven trials (n=373) with long-term follow-up data also found a small clinical effect in favor of exercise.28 The additional benefits that may be attained by patients who exercise, including increased self-esteem, increased level of fitness, and reduced risk of relapse, make exercise an ideal intervention for patients suffering from depression. Both aerobic and anaerobic activities are effective.19,23,33,34 Regardless of the type of exercise, the total energy expenditure appears more important than the number of times a week a person exercises, and high-energy exercises are superior to low-energy exercises.

While some mainstream medical professionals continue to insist that NCGS doesn’t exist, scientists have validated it as a distinct clinical condition. In one major study, researchers reviewed the charts of 276 patients with irritable bowel syndrome (IBS) who had been diagnosed with NCGS using a double-blind, placebo-controlled wheat challenge (patients were put on a gluten-free diet and then given capsules containing either wheat or an inert substance). As a whole, the NCGS group had a higher frequency of anemia, weight loss, self-reported wheat intolerance, and a history of childhood food allergies than those in the IBS without NCGS group. The authors concluded that their data “confirm the existence of non-celiac wheat sensitivity as a distinct clinical condition.

While some mainstream medical professionals continue to insist that NCGS doesn’t exist, scientists have validated it as a distinct clinical condition. In one major study, researchers reviewed the charts of 276 patients with irritable bowel syndrome (IBS) who had been diagnosed with NCGS using a double-blind, placebo-controlled wheat challenge (patients were put on a gluten-free diet and then given capsules containing either wheat or an inert substance). As a whole, the NCGS group had a higher frequency of anemia, weight loss, self-reported wheat intolerance, and a history of childhood food allergies than those in the IBS without NCGS group. The authors concluded that their data “confirm the existence of non-celiac

Hyperbaric oxygen therapy is controversial. In theory, at 2.5 atmospheres, it reduces the half-life of carboxyhaemoglobin to 20 minutes and increases the amount of dissolved oxygen by a factor of 10. The logistical difficulties of transporting sick patients to hyperbaric chambers and managing them therein should not be underestimated and recent systematic reviews have shown no improvement in clinical outcomes.

In 2002, a Cochrane Collaboration review of the evidence concluded that low-fat diets induced no more weight loss than calorie-restricted diets, and in both cases the weight loss achieved “was so small as to be clinically insignificant.” A similar analysis was published in 2001 by the U.S. Department of Agriculture. In this case, the authors identified twenty-eight relevant trials of low-fat diets, of which at least twenty were also calorie-restricted. The overweight subjects consumed, on average, less than seventeen hundred calories a day for an average weight loss of not quite nine pounds over six months.

FDA classifies devices according to the risk they pose to consumers. Premarket review is required for moderate- and high-risk devices. There are two paths that manufacturers can use to bring such devices to market. One path consists of conducting clinical studies, submitting a premarket approval (PMA) application and requires evidence providing reasonable assurance that the device is safe and effective. The other path involves submitting a 510(k) notification demonstrating that the device is substantially equivalent to a device already on the market (a predicate device) that does not require a PMA. The 510(k) process results in FDA clearance and tends to be much less expensive and less time-consuming than seeking FDA approval via PMA.

Clip This Article on Location 1397 | Added on Monday, September 1, 2014 4:10:39 PM REVIEW & OUTLOOK An $8.3 Billion Rebuke to the FDA Roche buys a drug approved in Europe but not in America. 359 words Amid this summer's M&A fever, Roche's agreement Monday to buy the San Francisco biotech InterMune deserves special notice. The tie-up is an $8.3 billion guided missile into the fortified bunker that is the Food and Drug Administration. InterMune has never turned a profit in 16 years of existence and other than its clinical expertise the company holds a single asset: an idea for treating a lethal lung disorder called idiopathic pulmonary fibrosis with no known cause, cure or approved therapy—at least in the U.S. An InterMune drug called pirfenidone that slows the progression of irreversible lung scarring is on the market in Europe, Japan, Canada and even China. Bloomberg News But the FDA refused to approve pirfenidone in 2010, despite the 40,000 Americans who are killed annually by lung fibrosis and a positive recommendation from its outside scientific advisory committee. The agency brass claimed the evidence was statistically unsatisfactory, when one clinical trial was inconclusive but another showed strong benefits such as improved lung function. The results of the third trial the FDA ordered were reported earlier this year and confirmed that pirfenidone is even more of a treatment advance than it seemed in 2010, and may prolong life. The agency is expected, finally, to approve the medicine in November. Roche is paying a 38% premium over Friday's closing share price, and 63% over trading before the news of InterMune's corporate suitors broke a few weeks ago. The deal is a big vote of confidence in pirfenidone, not least because a rival lung fibrosis drug is awaiting U.S. approval. Then again, maybe that drug's maker, the German pharmaceutical consortium Boehringer Ingelheim, will have the same FDA experience as InterMune. The Roche deal is a tacit reprimand to the FDA's unscientific and uncompassionate—and wrong—2010 defenestration. Amid medical ambiguity about effectiveness, the humane option is to allow a drug to come to patients and follow on with more research, in particular for a drug with few side effects. Pulmonary fibrosis is a protracted death sentence of three to five years. The FDA denied tens of thousands of dying people better and possibly longer lives in the time they had left. ==========

In 1996, the U.S. Preventive Services Task Force, the independent panel of experts that reviews screening tests, recommended against routine fetal monitoring.5 But according to their current Web site, fetal monitoring has become such an ingrained fixture of medical care that, frankly, the task force seems to have simply given up on trying to dissuade doctors from using it: Despite the lack of evidence on its positive impact on health outcomes and the 1996 USPSTF recommendation against its routine use, intrapartum electronic fetal monitoring in pregnancy has become common practice in the U.S. Based on currently available evidence, the USPSTF believes there would be limited potential impact on clinical practice in updating the 1996 recommendation. The

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Prescribing a drug results from clinical judgment based on a thorough assessment of the patient and the patient’s environment, the determination of medical and nursing diagnoses, a review of potential alternative therapies, and specific knowledge about the drug chosen and the disease process it is designed to treat. In general, the best therapy is the least invasive, least expensive, and least likely to cause adverse reactions. Frequently, the choice is to have nonpharmacological and pharmacological therapies working together.

new onset AF or pulmonary HTN defined as a PA systolic pressure >50 mmHg at rest or >60 mmHg with exercise should also be considered for surgical intervention. Lastly, if severe chronic MR is due to a

further investigated to rule out the possibility of AS, HCM, pulmonic stenosis, and ASD.

Gibbs (2003) and others (e.g., Straus, Richardson, Glaziou, & Haynes, 2005) have provided detailed suggestions in this regard. Some general principles for clinicians are as follows. Evidence from multiple studies is always preferred to results of a single study. Systematic reviews of research are preferable to traditional narrative reviews. Thus, clinicians should look for systematic reviews, mindful of the fact that these reviews vary in quality. The Cochrane and Campbell Collaborations are good sources of high-quality systematic reviews. Clinicians can and should assess potential sources of bias in any review. The characteristics of systematic reviews described in this chapter can be used as a yardstick that clinicians can use to judge how well specific reviews measure up. The QUOROM statement (Moher et al., 1999) provides guidance about what to look for in reports on systematic reviews, as does a recent report by Shea et al. (2007). When relevant reviews are not available, out of date, or potentially biased, clinicians can identify individual studies and assess the credibility of those studies, using one of many tools developed for this purpose (e.g., Gibbs, 2003). It would be ideal if clinicians were able to rely on others to produce valid research syntheses. Above all, clinicians should remember that critical thinking is crucial to understanding and using evidence. Authorities, expert opinion, and lists of ESTs provide insufficient evidence for sound clinical practice. Further, clinicians must determine how credible evidence relates to the particular needs, values, preferences, circumstances, and ultimately, the responses of their clients. Clinicians and researchers also need to have an effect on policy so that EBP is not interpreted in a way that unfairly restricts treatments. Policymakers and others can be educated about the nature of EBP. EBP is a process aimed at informing the choices that clinicians make. It should inform and enhance practice, “increasing, not dictating, choice” (Dickersin, Straus, & Bero, 2007, p. s10). EBP supports choices among alternative treatments that have similar effects. It supports the choice of a less effective alternative, when an effective treatment is not acceptable to a client. Policymakers and others can be educated about the nature of evidence and methods of research synthesis. Empirical evidence is tentative, and it evolves over time as new information is added to the knowledge base. At present, there is insufficient evidence about the effectiveness of most psychological and psychosocial treatments (including some so-called empirically supported treatments). Policymakers need to understand that most lists of effective treatments are not based on rigorous systematic reviews; thus, they are not necessarily based on sound evidence. It makes little sense to base policy decisions on lists of preferred treatments because this limits consumer choice. Lists of selected or preferred treatments should not restrict the use of other potentially effective treatments. Policies that restrict treatments that have been shown to be harmful or ineffective, however, are of benefit. Lists of harmful or wasteful treatments could be compiled to discourage their use.

The changes that occur during the prodromal phase have been broadly characterised by Hafner and colleagues (Hafner et al., 1995), though other more intensive studies are reviewed and summarised in Yung et al. (1996). These and other studies (Jones et al., 1993) showed that although diagnostic specificity and ultimately potentially effective treatment comes with the later onset of positive psychotic symptoms, most of the disabling consequences of the underlying disorder emerge and manifest well prior to this phase. In particular, deficits in social functioning occur predominantly during the prodromal phase and prior to treatment. Hafner et al. (1995) demonstrated clearly that the main factor determining social outcome two years after first admission for schizophrenia is acquired social status during the prodromal phase of the disorder. The importance of this phase was previously poorly appreciated because no conceptual

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Eighteen months into the COVIDcrisis, many people suddenly realized that Dr. Anthony Fauci, longstanding director of the National Institutes of Allergy and Infectious Diseases (NIAID), was not the benign, selfless, fatherly protector of public health that corporate media had made him out to be. I had known for decades of his failure to follow the clinical research standards that should apply to scientists. I had lived through the consequences of his aggressive moves to gather power and money at the expense of other scientists and federal agencies. My decades of professional experience in dealing with the NIAID in the context of grant and contract peer review, combined with Jill’s PhD research project concerning the NIH peer review system, had left me with little respect for Dr. Fauci’s professional integrity.

Between 1877 and 1900, Freud published six extensive monographs, forty articles, and an enormous number of reviews. In books such as On Aphasia (1891), the collaborative Clinical Study on the Unilateral Cerebral Paralyses of Children (1891), and Infantile Cerebral Paralysis (1897)

Beaudart, C., et al. (2017), Nutrition and physical activity in the prevention and treatment of sarcopenia: Systematic review, Osteoporosis International 28:1817–33; Lozano-Montoya, I. (2017), Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: A systematic overview—the SENATOR Project ONTOP Series, Clinical Interventions in Aging 12:721–40. 55. Fiatarone, M. A., et al. (1990), High-intensity strength training in nonagenarians: Effects on skeletal muscle, Journal of the American Medical Association 263:3029–34. 56. Donges, C. E., and Duffield, R. (2012), Effects of resistance or aerobic exercise training on total and regional body composition in sedentary overweight middle-aged adults, Applied Physiology, Nutrition, and Metabolism 37:499–509; Mann, S., Beedie, C., and Jimenez, A. (2014), Differential effects of aerobic exercise, resistance training, and combined exercise modalities on cholesterol and the lipid profile: Review, synthesis, and recommendations, Sports Medicine 44:211–21. 57. Phillips, S. M., et al. (1997), Mixed muscle protein synthesis and breakdown after resistance exercise in humans, American Journal of Physiology 273:E99–E107; McBride, J. M. (2016), Biomechanics of resistance exercise, in Haff and Triplett, Essentials of Strength Training and Conditioning, 19–42.

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British Medical Journal Clinical Evidence completed a review of 3,000 medical practices. Those researchers found that 35 percent of medical practices are effective (or likely to be effective); 15 percent are harmful, unlikely to be beneficial, or a tradeoff between benefits and harms; and 50 percent are of unknown effectiveness.

Based on this review of the emotion socialization literature, I put forth the normative male alexithymia hypothesis (Levant, 1992; Levant & Williams, 2009), which stated that boys reared to conform to the masculinity norm1 of restrictive emotionality will likely become at least mildly alexithymic. Alexithymia is a clinical term that refers to an individual’s difficulty identifying and describing their emotional experiences. As previously noted, the term literally means “without words for emotions.

For Levi, the fault lay in part with Améry’s intransigence, his elevation of bitterness to an ethical imperative (for his part, Améry disparaged Levi as “the forgiver”). Favoring Levi’s suppositions is the vast clinical literature on the benefits of positive illusions and the deleterious psychological effects of “depressive realism.

The Most Widely Known Path If you're like most people, you believe landing an interview is limited to these three steps: 1.) Applying online, 2.) HR reviewing your application, and 3.) If your application is selected, the hiring manager reviewing it. You believe this because almost everything you’ve read comes from current or former HR folks. This process has significant flaws. Because the Internet made applying for positions easy, HR was drowning in applications. As a result, the HR Elimination system was born. That’s not its official name, but the name fits. The official name is Applicant Tracking System or ATS. ATS systems reject, on average, 75% of all applicants. Sometimes the rejection rate can be as high as 90%. J. P. Medved, content director at Capterra, a firm that helps companies find the right software for their business, said, Reducing the number of candidates might seem good if we're weeding out irrelevant resumes...In reality, many of these rejected candidates were knocked out of the running for bad reasons. An automated system, like an ATS, will sometimes reject people for very minor reasons, like incorrect resume formatting. Bersin & Associates, an Oakland-based firm specializing in talent management, tested an ATS system. They created the perfect resume for an ideal candidate for a clinical scientist position. Matching the resume to the job description from a leading manufacturer, they submitted the resume to an applicant tracking system. The ATS lost one of the candidate's work experiences. It also failed to read several educational degrees. As a result, the perfect resume for a clinical scientist position earned a score of 43, because the applicant tracking system misread it. Similarly, a Vice-President of Human Resources decided to test his company's ATS system. He applied for a job at his own company and received an automated rejection letter from the ATS.

What was the new research he was referencing? A research document that claimed to show benefit to masking based on reviewing a collection of studies, which somehow ignored all of the randomized controlled trials showing no effect from masking. These kinds of glaring omissions have been a continuous problem among scientists desperate to justify the implementation of masks despite the gold standard of evidence indicating they would be effectively useless. One randomized controlled trial did occur during 2020, conducted by researchers in Denmark. Those researchers’ objective was clearly stated: “To assess whether recommending surgical mask use outside the home reduces wearers’ risk for SARS-CoV-2 infection in a setting where masks were uncommon and not among recommended public health measures.”25 Given all of the pre-COVID scientific research, it should come as no surprise that the results showed no benefit to mask wearing to protect against infection with COVID-19. The Denmark researchers’ summary clearly identifies the lack of any significant impact: “The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers.” Thousands of Danes were enrolled in this trial, the most comprehensive effort by any scientific researchers to study the potential effect of mask wearing by the general public. Participants were provided high-quality surgical masks, not the cloth face coverings recommended by many public health agencies. In the best approximation of a gold-standard clinical trial that researchers could design, the results showed absolutely no statistically significant benefit. The findings, surprisingly, received no major media attention, nor did they generate questions for the expert community that now universally embrace masking.

In a review of the published literature on the role of empathy on patient satisfaction, adherence to treatment, and patient outcomes, researchers at Radboud University Nijmegen Medical Center in the Netherlands stated that ‘empathy in the patient-physician communication in general practice is of unquestionable importance.’20 They reported that empathy lowers anxiety and distress levels in patients and that it delivers significantly better clinical outcomes.

his triumph. “No director of an NIH institute had ever contacted the press like that,” says Nussbaum.84 Traditionally, the NIH director himself made major announcements, but Dr. Fauci was apparently unwilling to share the glory with his nominal boss, NIH Director James Wyngaarden, or with HHS Secretary Otis Bowen. In making his proclamation, Dr. Fauci employed the gimmick that he watched Robert Gallo pioneer during his premature announcement of Gallo’s study linking HIV to AIDS. That announcement had shattered another tradition: Historically, agencies didn’t announce the results of clinical trials until the data were peer-reviewed and published so that journalists—and the scientific community—could read the study and reach their own conclusion about what the science said. Gallo had trailblazed the technique of “science by press release” four years earlier, when he

Birdsall, T. C. (1998). 5-Hydroxytryptophan: A clinically-effective serotonin precursor. Alternative Medical Review, 3(4), 271–280.

clinical picture

this salt/hypertension hypothesis has resolutely resisted confirmation in clinical trials. For those not hopelessly wedded to the hypothesis, it has become increasingly difficult to believe that consuming too much salt is why we become hypertensive and why our blood pressure rises inexorably with age. Systematic reviews of the evidence from these trials invariably conclude that reducing our average salt intake by half, for instance, which is difficult to accomplish in the real world, will decrease blood pressure by 4 to 5 mm Hg mercury, on average, in those with hypertension, and perhaps 2 mm Hg in those without (known as normotensives). But even stage 1 hypertension, the less severe form of the condition, is defined by having a blood pressure elevated by at least 20 mm Hg over what’s considered healthy. Stage 2 is defined as blood pressure elevated by at least 40 mm Hg over healthy levels. Hence, the fact that halving our salt consumption will result in a decrease of only 4 to 5 mm Hg suggests that the salt we eat is not the primary dietary driver of this disorder.

Several studies have demonstrated an association between alexithymia and insecure attachments (e.g., Taylor et al., 2014; Troisi et al., 2001); and there is evidence that alexithymia or the difficulty identifying feelings facet are associated with retrospectively reported experiences of adverse experiences during childhood, especially emotional neglect (e.g., Goldsmith & Freyd, 2005; Paivio & McCulloch, 2004). Research studies exploring the relationships among trauma, attachment, and alexithymia are reviewed by Schimmenti and Caretti in Chapter 8.

There’s actually lots of ways to “infect” a rat with depression, though some are more efficient than others. A frequently cited 1992 paper2 reviewing the best methods concludes that you don’t actually want to traumatize or terrify your rats, like Selye accidentally did. The closest approximation of the depression that plagues modern humans can be achieved by bombarding lab rats with mild but chronic, random, and inescapable stress. You don’t have to terrify them—just remove predictability and control from their lives, and they’ll eventually lose interest in pleasurable things. When they do, you’re ready to test whether your experimental antidepressant will get them interested again. “Losing interest in pleasure” so perfectly described my own gray years that it was kind of surreal to read it in the sterile, clinical context of a scientific paper about rats. I found the characterization of the best stressors as “mild” to be oddly affecting, too—I put off going to a doctor much longer than I should have because I didn’t think I’d really “earned” the right to have PTSD or depression, a feeling that’s apparently very common. I wasn’t a soldier or a refugee—nothing that bad had happened to me. But trauma isn’t the best method of creating a model of depression. All you have to do is remove control and predictability—the exact things low-wage workers have been forced to sacrifice in the name of corporate efficiency and flexibility. Is it any surprise that it feels like the country’s losing its collective mind? It would be more surprising if we weren’t.

The personalities may have quite a complex and subjectively compelling inner world, in which they have alliances, relationships and civil wars among themselves.

The review by Swanson and colleagues (Swanson et al. 2000) confirmed the likely role of the 7-repeat allele of this gene in making the postsynaptic receptor subsensitive, thus possibly reducing the efficiency of neural circuits for behavior inhibition. Comings et al. (1999) report findings related to impulsive, compulsive, addictive behaviors that indicate a greater complexity than does a sole focus on the 7- versus non-7 alleles of the DRD4 gene. In view of recent findings, which have linked disorganized attachment in infancy to clinical conditions in middle childhood, it may be particularly important that in this study 71% of the infants classified as disorganized were found to have at least one 7-repeat allele, in contrast with only 29% of the nondisorganized group. Thus infants classified as disorganized were more than four times more likely to be carrying this allele.

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Migraine, like my patient Sarah had, also correlates closely to poor metabolic health. In the ENT otology clinic, we often saw this condition and had limited success in treating it. Sufferers of this debilitating neurological disease—about 12 percent of people in the United States—tend to have higher insulin levels and insulin resistance. A comprehensive review of fifty-six research articles identified links between migraine and poor metabolic health, pointing out that “migraine sufferers tend to have impaired insulin sensitivity.” The review supports the “neuro-energetic” theory of migraine. Additionally, evidence suggests that micronutrient deficiencies in key mitochondrial cofactors may also be a contributing factor of migraine. Research has suggested that migraines could be treated by restoring levels of vitamins B and D, magnesium, CoQ10, alpha lipoic acid, and L-carnitine. Vitamin B12, for instance, is involved in the electron transport chain responsible for the final steps of ATP generation in the mitochondria, and studies have indicated that high doses of B12 can help prevent migraine. These micronutrients usually have fewer side effects than other drugs used to treat migraines, making them a promising option for relief, which can be obtained through a diet rich in these micronutrients, or supplementation. Having high markers of oxidative stress, a key Bad Energy feature, is associated with a significantly higher risk of migraine in women, with some studies suggesting that migraine attacks are a symptomatic response to increased levels of oxidative stress. Less painful and more common tension-type headaches are also linked to high variability (excess peaks and crashes) in blood sugar. Hearing Loss The same story of metabolic ignorance in the ENT department unfolded for auditory problems and hearing loss, one of the most common issues presented to our ENT clinic. We’d typically tell our patients that their auditory decline was inevitable, due to aging and loud concerts in their youth, and we would suggest interventions like hearing aids. Yet insulin resistance is a little-known link to hearing problems. If you have insulin resistance, you are more likely to lose hearing as you age because of poor energy production in the delicate hearing cells and blockage of the small blood vessels that supply the inner ear. One study showed that insulin resistance is associated with age-related hearing loss, even when controlling for weight and age. The likely mechanism for this is that the auditory system requires high energy utilization for its complex signal processing. In the case of insulin resistance, glucose metabolism is disturbed, leading to decreased energy generation. The impact of Bad Energy on hearing is not subtle: A study showed that the prevalence of high-frequency hearing impairment among subjects with elevated fasting glucose levels was 42 percent compared to 24 percent in those with normal fasting glucose. Moreover, insulin resistance is associated with high-frequency mild hearing impairment in the male population under seventy years of age, even before the onset of diabetes. These papers suggest that assessing early metabolic function and levels of insulin resistance is essential in the ENT clinic and counseling individuals on the potential warning signs is paramount.

As I sat alone that morning, I felt my heart beating, and I started thinking about who was beating my heart. I realized in one instant that I had distanced myself from this innate intelligence. I closed my eyes and put all of my attention on it. I started to admit who I’d been, what I’d been hiding, and how unhappy I was. I began to surrender some aspects of myself to a greater mind. I then reminded myself of who I no longer wanted to be. I decided how I no longer wanted to live based on that same personality. Next, I observed my unconscious behaviors, thoughts, and feelings that reinforced my old self and reviewed them until they became familiar to me. Then I thought about who I did want to be as a new personality … until I became it. Suddenly I began to feel different—joyful. This had nothing to do with all of those things outside of me; it was part of an identity that was independent of any of that external stuff. I knew that I was on to something. I had an immediate reaction after that first meditation on the couch, and it caught my attention, because I didn’t get up as the same person who had sat down. I stood up and I felt so aware and so alive. It was like I was seeing so many things for the first time. Some mask was removed from me, and I wanted more of that. So I retreated from my life for about six months. I kept up my clinical practice to some degree, but I canceled all my lectures. My friends thought I was losing my mind (I was), because What the BLEEP was at its height, and they reminded me about how much money I could have been making. But I said I would never walk onstage again until I was no longer living an ideal for the world, but one for myself. I didn’t want to lecture again until I was the living example of everything that I was talking about. I needed to take time for my meditations and to make true change in my life, and I wanted to have joy from within me and not from outside of me. And I wanted that to come across when I lectured.

Faith: It Does a Body Good A cheerful heart is good medicine, but a downcast spirit dries up the bones. —PROVERBS 17:22 We’re all trying to be healthier these days. It’s not an easy task, given our hectic schedules. But I know I feel better when I get to the gym at least a few times a week and steer clear of salty, fatty foods. I also feel better physically, not just emotionally, when I stay close to God and active in my faith. That’s not mere coincidence. There is an actual growing amount of evidence showing that faith is good for us on the spiritual and physical level. For example, one study of liver transplant patients conducted a few years ago found that those who were actively “seeking God” were more likely to survive.25 The researchers interviewed transplant patients and, after two years, found that the patients who had a strong religious connection were three times more likely to survive compared to those with no faith. Similar studies, according to this particular report, have also been done on heart patients, HIV patients, and those on kidney dialysis. Other studies have found that losing faith was bad for a person’s health. A comprehensive report entitled “Health Benefits of Christian Faith” reviewed over 1,200 studies and 400 reviews drawing connections between health and faith. According to this report, published in 2011, faith has a number of positive health benefits including “coping with illness, faster recovery, as well as protection from future illnesses.”26 But why is there such a strong connection from a medical sense? This report indicates that those who believe in God have a deep sense that it is not all about them. The report notes that the mental health benefits for believers include: “well-being, happiness and life satisfaction; hope and optimism; purpose and meaning in life; higher self-esteem; better adaptation to bereavement; greater social support and less loneliness; lower rates of depression and faster recovery from depression; lower rates of suicide and fewer positive attitudes towards suicide; less anxiety; less psychosis and fewer psychotic tendencies; lower rates of alcohol and drug abuse; less delinquency and criminal activity; greater marital stability and satisfaction.”27 It’s also impressive to see certain key beliefs of Christianity such as forgiveness and helping others have a positive impact on a number of different ailments. According to the Mayo Clinic, forgiveness is the gift you give yourself.28 And volunteering has been shown to lower stress levels as well. The more you give to God and to others, the more benefits you get in return. Sounds like a pretty good deal to me. Pray softly… Lord, I am so grateful for all the many gifts you have given me, including my health. Help me to take good care of myself—body, mind, and spirit—so I can continue to give back in your name.

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