Chaired the Fiscal Policy Committee of the Business Roundtable and served as a director of Catalyst menstruation is triggered by a drop in the levels of buy nolvadex without a prescription. Chair of our Corporate Governance Committee and member of our Audit and Science and Technology Committees innovative women's healthcare boca raton generic 10 mg nolvadex with mastercard. Smith Age: 57 President and Chief Executive Ofcer and Director of Thomson Reuters Corporation pregnancy 41 weeks order nolvadex online, a provider of intelligent information for businesses and professionals menstruation quotes funny best buy for nolvadex, since January 2012 and its Chief Operating Ofcer from September 2011 to December 2011. Member of the International Business Council of the World Economic Forum, the International Advisory Boards of British American Business and the Atlantic Council. Chair of our Compensation Committee and member of our Audit and Science and Technology Committees. Read leads Pfzer, one of the worlds premier innovative biopharmaceutical companies, which brings therapies to patients that signifcantly improve their lives. These include medicines, vaccines and many of the worlds best-known consumer health care products. Prior to being named Chairman of the Board in 2011, and Chief Executive Ofcer in December 2010, he served as Senior Vice President and Group President of the Worldwide Biopharmaceutical Businesses, which he led from 2006 through December 2010. In that role, he oversaw fve global business units–Primary Care, Specialty Care, Oncology, Established Products and Emerging Markets. In 1996, he was appointed President of Pfzers International Pharmaceuticals Group, with responsibility for Latin America and Canada. Group President, Pfzer Innovative Health Albert Bourla is the group president of Pfzer Innovative Health at Pfzer Inc. Pfzer Innovative Health includes six business groups: Consumer Healthcare, Infammation & Immunology, Internal Medicine (neuroscience and pain, and cardiovascular and metabolic), Oncology, Rare Disease and Vaccines. It also includes the Patient and Health Impact group, which is focused on developing solutions for increased patient access, demonstrating the value of our innovations, and ensuring broader business model innovation. Albert has almost 25 years of experience with Pfzer and has held a number of senior global positions across a range of markets and disciplines. Before assuming his current role, Albert was the group president of Pfzers Global Vaccines, Oncology and Consumer Healthcare Business. Previously, he was president and general manager of Pfzers Established Products Business, where he led the development and implementation of strategies and tactics related to Pfzers of-patent portfolio (including legacy brands and generics. He held positions of increasing responsibility across Europe before moving to Pfzer Global Headquarters in New York in 2001 to assume the role of U. In 2004, he became vice president of Business Development and New Products Marketing; supervising Pfzer Animal Health global licensing and acquisition activities, as well as the units R&D portfolio. In 2006, he was appointed area president of Europe, Africa and Middle East and in 2009, he assumed additional responsibilities for Asia and Pacifc. Prior to the merger of Alcatel and Lucent Technologies in 2006, Frank was the chief operating ofcer of Lucent Technologies. In 2001, he was appointed executive vice president and chief fnancial ofcer of Lucent, where he helped lead the company through one of the most challenging periods in the telecom industrys history and returned the company to proftability. In 1999, he was appointed the Group President of Lucents Switching Solutions Business Unit, where he led Lucents multibillion-dollar, global Switching, Access and Application Software businesses. President, Worldwide Research and Development Mikael Dolsten is focused on advancing the companys scientifc leadership in small molecule medicines, biotherapeutics and vaccines. He is a member of the companys Portfolio Strategy and Investment Committee, which governs major pipeline investments and strategic end-to-end R&D priorities. Mikael also has worldwide responsibility for Pfzers groups in safety, regulatory and external R&D innovation, in addition to science-based teams in pharmaceutical sciences, drug safety R&D, and large and small molecule discovery and development. Prior to joining Pfzer in 2009, Mikael was President of Wyeth Research, where he led scientists across the U. In addition, Mikael serves as the chairman of the Translational Advisory Board of the venture capital frm, AppleTree Partners. Mikael is a named inventor on several patents and has published approximately 150 articles in international journals, with particular contributions in areas such as molecular cell biology, immunology and oncology. Chuck joined Pfzers human resources team in 1987, supporting the Pharmaceutical Sales Force. Prior to joining Pfzer, Chuck served for eight years in the United States Air Force as an instructor fghter pilot and fight commander. Chuck is the executive sponsor of the Pfzer Colleague Council, Veterans in Pfzer, which works to maximize the unique role veterans and active military personnel play in driving workplace and marketplace outcomes. Rady has been with Pfzer since 1994 and has served in a number of leadership positions, including as associate general counsel for the Specialty Care Business Unit and as head of the global product and regulatory law practice group. Rady graduated from the University of Richmond and Georgetown University Law Center. Doug Lankler Executive Vice President and General Counsel Doug Lankler joined Pfzer in 1999 and currently serves as general counsel. Prior to joining the company, Doug was with the United States Department of Justice as an Assistant U. Doug graduated from the State University of New York at Albany and Cornell Law School. Besides providing science grounded medical information to prescribers and patients, Pfzer Medical is also responsible for the companys ofce of patient afairs, its centers of excellence on pediatric care, clinical trial diversity and healthy aging, its enterprise beneft-risk communications, and its worldwide compassionate access program. Before joining Pfzer in 2009, Freda held senior leadership positions in medical afairs and product development with Vertex, Bristol-Myers Squibb, Pharmacia and Eli Lilly and Company. Prior to joining the biopharmaceutical industry, she served as vice chairperson and associate professor in the Department of Psychiatry at Howard University College of Medicine and was an advisor to the National Institute of Mental Health. She graduated from Johns Hopkins and earned her medical doctorate at Howard University College of Medicine. She launched her medical career as a practicing physician and then focused her academic research on the efects of health care disparities and the impact of mental illness on families and communities. She is a frequent speaker on issues such as improving patient safety and outcomes and reducing stigma and health care disparities. She currently serves on the boards of Tenet Healthcare Corporation, Save the Children, Harvard Medical School and the Patient Centered Outcomes Research Institute. Kirsten was named vice president, supply chain management for all Pfzer global businesses in 2000. She then led the Patented Products Operating Unit (Manufacturing Sites in Europe and Singapore) 2008-2009, and the Primary Care and Oncology Operating Unit (Manufacturing Sites in Europe, Singapore, Canada) 2009-2012. Kirsten was named vice president, Product Portfolio Management for Primary Care, Established Products and Oncology in 2012. Kirsten has chaired Pfzers Environmental Sustainability Council since 2009 and was elected to the Pfzer Foundation Board in 2008. Executive Vice President, Chief Development Ofcer Rod MacKenzie is responsible for the development and advancement of Pfzers pipeline of medicines in several therapeutic areas, including metabolic disease and cardiovascular risks, infammation and immunology, neuroscience, oncology and rare disease. He serves on the Portfolio Strategy and Investment Committee, which focuses on maximizing the return on R&D investment across the Pfzer portfolio. Rod graduated from the University of Glasgow with a 1st Class Honors degree in chemistry and completed his Ph. Olson Executive Vice President, Strategy, Portfolio and Commercial Operations Laurie Olson is responsible for overseeing the shaping of Pfzers longer-term strategy, supporting the execution of Pfzers commercial objectives and providing portfolio advisory functions to guide R&D investment decisions. Laurie is a member of the Portfolio Strategy Investment Committee, which oversees decisions regarding enterprise portfolio investment and advancement. Laurie joined Pfzer in 1987 as an analyst in the companys marketing research organization. In addition to her daily responsibilities, she is the executive sponsor of Pfzers global Lesbian, Gay, Bisexual, and Transgender Colleague Council and serves on the companys worldwide Diversity Leadership Council. She chairs Pfzers Political Action Committee and is vice chair of the Pfzer Foundation. Sally directs Pfzers global communications and its public afairs activities, including high-level relations with the governments of all nations in which the Company has operations or markets products. Sally also heads the frms corporate responsibility group and plays a key role in shaping the companys policy initiatives. Before joining Pfzer in 2007, Sally held roles at Estee Lauder Companies and the American Express Company. Earlier in her career, she spent eight years in government service focused on international trade issues. John Young Group President, Pfzer Essential Health John Young has more than 25 years of experience with Pfzer and has held a number of senior global positions across the organization. Following these experiences, he assumed the role of regional president, Europe, Canada, Australia and New Zealand for the Primary Care Business Unit. He was later appointed president and general manager of the Primary Care Business, where he led both the commercial organization and clinical development of medicines in key disease areas including cardiovascular disease, diabetes and pain.
Long term therapy in asymptomatic patients with hypertension and any degree of regurgitation I C 4 menstruation moon phases cheap nolvadex 10 mg with amex. Poststenotic tion or systolic dysfunction menstrual zits order nolvadex 20mg overnight delivery, the timing of surgical intervention dilation may involve the proximal aorta in aortic stenosis women's health center rochester ny order nolvadex mastercard. A measurement of greater than 40 mm is a measure of the severity when (or before) the degree of aortic root dilation is at ascending aorta because a diameter of 40 mm may be observed least 50 mm (141-145 women's health center of houston cheapest nolvadex. In Marfans syndrome, surgery is rec at the sinus of Valsalva in a normal sized adult. An ascending ommended when the root diameter reaches 45 to 50 mm aortic aneurysm of greater than 55 mm must dictate the timing because of the risk of acute dissection or aneurysm rupture of surgery regardless of the severity of aortic stenosis. There is sufficient evidence to recommend bioprostheses, porcine or pericardial, for patients at least 65 years of age. The Surgical treatment options evidence pertains to both first and second generation hetero Annuloaortic ectasia is usually managed with aortic root graft stented bioprostheses (190-205. The actual freedom reconstruction using either a mechanical valve conduit, allo (cumulative incidence) from structural valve deterioration at graft (homograft) aortic root or stentless porcine aortic root, 15 years is 87% for 61 to 70 years of age and 96% for greater inclusive of coronary artery/aortic wall button reanastomoses than 70 years of age; the actuarial freedom is 76% and 82%, (156. The freedom from structural valve the pathological aorta can be replaced with a valve-sparing deterioration does not warrant bioprosthesis use in patients operation using a nontailored or tailored tubular synthetic below 60 to 65 years of age (209,210. The mechanical prostheses currently marketed are free the valve-sparing operation with a nontailored graft is a from structural failure (211-213. The linearized rates of re-implantation procedure that corrects annuloaortic ectasia major thromboembolism and hemorrhage in patients less (as in Marfans syndrome) and dilation of the sinotubular junc than 65 years of age are both approximately 1. The literature provides a variation of results dependent dilated sinuses and the dilated sinotubular junction without on follow-up methodology, adequacy of follow-up, and exclu annular disease (168-170. The remodelling operation incor sion or inclusion of events up to 30 days (186,212,214-220. When only the sinotubular junction is dilated and patients on chronic renal dialysis is unresolved. The publications since 1998 have overwhelmingly rec the valve-sparing operations are currently indicated for ommended bioprostheses (222-225. It was considered that aneurysms of the ascending aorta and root (greater than 50 to patients on chronic dialysis do not generally survive long 60 mm) and the tricuspid valve without gross structural defect, enough to experience structural valve deterioration. The absence of severe cusp prolapse or asymmetry, with or without two-year survival was only 39% for both bioprostheses and valve insufficiency. These valve-sparing procedures are usually mechanical prostheses, which is poor for both prosthesis performed with a trileaflet aortic valve. Mechanical prostheses have been shown to have preliminary experience with bicupsid valve morphology a sixfold higher incidence of late bleeding or stroke (222. Allografts are recommended for aortic valve disease as a sub Poststenotic aortic dilation can be managed conservatively coronary implantation or aortic root replacement (227-232. Additional allograft the choice of prosthesis is a decision made by the surgeon experience has demonstrated a 10-year freedom from structural and the patient (174-178. The most recently reported experi the risks and advantages of the prostheses (179-189. The report has recommended allografts in or bioprosthetic valve are reported by the Veterans Affairs ran patients over 20 years of age because the freedom from reopera domized trial (183. The homovital allografts, in con ical valve, even though structural valve deterioration was vir tradistinction to the cryopreserved allografts, demonstrates a tually absent with the mechanical valve. The major deterrent to occurred at a much higher rate in those aged less than 65 years. The allograft aortic root replacement pro the Edinburgh randomized trial reported in 2003 results to vides the opportunity for less likelihood of distortion in cases of 20 years (184. The prosthesis type did not influence survival, asymmetry and bicuspid disease, and makes size matching less thromboembolism or endocarditis. The con Age range (years) Prosthesis type traindications to the use of autografts must be respected to avoid structural failure. The contradictions are connective 20 to 40 Pulmonary autograft (no contraindication, ie, annuloaortic tissue disorders (ie, Marfans syndrome), immunological dis ectasia) orders, and bicuspid or fenestrated pulmonary valves. Pulmonary autograft (to 55 years if good candidate) the autograft is safe and reproducible in overall hemody Allograft namic and durability performance in properly selected young 65 and Stented heterograft porcine or pericardial (specifically adults (232,247-255. There have been two documented con older if large annulus) cerns with the autograft procedure. There is an incidence of Stentless heterograft subcoronary implantation late pulmonary allograft stenosis attributed to younger donor Allograft or stentless porcine root (specifically if small annulus age, shorter duration of cryopreservation and smaller homo or calcified root) graft size (256. The other concern is late dilation of the auto Mechanical prosthesis graft involving the root, sinuses of Valsalva and sinotubular junction (257. Dilation of the sinotubular junction, and not the sinuses, causes aortic regurgitation (258-259. The dilation has been attributed to accompanying pulmonary wall pathology in bicuspid aortic valve morphology and other congenital the optimization of hemodynamic performance of valvular anomalies. The most frequent cause of high postoperative gradients is autograft root replacement but unrelated to bicuspid aortic when the effective prosthetic valve area is less than that of the valve disease (260. This is commonly known as patient no correlation between bicuspid aortic valves, degenerative prosthesis mismatch, even in the presence of a normally func changes of the pulmonary artery and autograft root aneurysm. The autograft is contraindicated if the aor When selecting a prosthesis for a given patient, surgeons tic annulus is greater than 30 mm. The stentless design may increase long term freedom from structural valve degener Special surgical considerations ation and potentially improve survival (261. There is reserved for the young person, it should not be used in the evidence of significant residual gradients with valve sizes 19 young patient with rheumatic heart disease when there is and 21 with the majority of stented bioprostheses and mechan mitral involvement. The sewing cuff configurations of small aortic the young patient with bicuspid aortic morphology and annu mechanical prostheses and external mounted pericardial bio loaortic ectasia. Aortic root replacement may not be recom prostheses have been designed to address these issues. The mended because the autograft may not tolerate systemic stentless bioprostheses also address this issue (262-272. Patients with a mechanical prosthetic valve already in place in a different position than the valve to be replaced I B 3. Adopted and modified from American College of Cardiology and American Heart Association Guidelines (29. If an aortic root replacement or repair is fied arch, as well as a calcified intervalvular fibrous body. Aortic annuloplasty of the large annulus with the with a reconstructive procedure if the root is dilated to 40 mm to remodelling procedure may have the same durability as the 45 mm. Supracoronary replacement of the aorta is needed if the reimplantation, modelling aortic reconstruction and coronary root is normal. The small aortic root can be managed by either stentless the patient with mild or moderate aortic stenosis undergo bioprosthesis, supra-annular noncoronary sinus implantation ing coronary artery bypass requires exploration of the valve. If (advantage: one size) of stented bioprosthesis, or patch the leaflets are calcified and fibrotic, they can be replaced with enlargement of the noncoronary sinus and anterior leaflet of a stented or stentless bioprosthesis because the aortic root is the mitral valve (advantage: possibly two sizes. Rate of New observations on the etiology of aortic valve disease: progression of severity of valvular aortic stenosis. Usefulness of Progression of aortic stenosis in adults: New appraisal using Doppler dobutamine echocardiography in distinguishing severe from echocardiography. Am J Cardiol asymptomatic valvular aortic stenosis: Clinical, echocardiographic, 1995;75:191-4. The natural history echocardiography in patients with aortic stenosis and left ventricular and rate of progression of aortic stenosis. Three-year outcome after Rate of change in aortic valve area during a cardiac cycle can predict balloon aortic valvuloplasty: Insights into prognosis of valvular aortic the rate of hemodynamic progression of aortic stenosis. Related predictors of findings to clinical outcome and agreement with hemodynamic outcome in severe, asymptomatic aortic stenosis. The role of intraoperative history of adults with asymptomatic, hemodynamically significant echocardiography in valve surgery. Ross operation for severity, disease progression, and the role of echocardiography in bicuspid aortic valve disease in adults: Is it a valid surgical option J Heart formula and continuity equation valve areas on transvalvular volume Valve Dis 1993;2:114-8.
The evidence of this survey is that there are encouraging steps being taken towards this goal breast cancer sayings purchase 10mg nolvadex otc. This is welcome menstruation 6 weeks after giving birth purchase generic nolvadex on line, but the development is fragile in many situations and needs to be nurtured to full development menopause hot flashes cheap nolvadex 20 mg mastercard. A National Commission on Genetics and Health menopause 42 years old cost of nolvadex, appointed in 2005, conducted countrywide studies on the situation of genetic services and submitted a proposal to the Ministry for their improvement. The proposal asked that the number of positions of clinical geneticists in public hospitals be increased and that the laboratory equipment for cytogenetics and molecular genetics in several hospitals countrywide be modernized and expanded. The Commission conducted a survey of genetic services and proposed the organization of a network of genetic services to maximize their efficiency, avoid duplication of services, and channel referrals in a regionalized 253 manner. Acting on such recommendations, in 2010 the National MoH started some actions to improve the capacity of the existing genetic units in the public system. In the period 2009-2011, 182,070 live neonates (28% of the total annual number of births of the country) were examined in 107 hospitals, finding 3,234 neonates with major 254 structural defects (1. This will lead to the availability of better actionable data for informed policy decision making to improve services. Service providers initiatives the National Pediatric Hospital Garrahan has taken a leadership role in conducting training in clinical genetics for primary care health personnel in several underserved areas of the country. Diseno y organizacion de una Red Nacional de Genetica Medica (Design and organization of a national network of medical genetics. Currently, a commission is elaborating a policy for rare disorders which may include a policy for genetic disorders (expected to be implemented in 2013. Brazil has made significant investments to fund research in medical genetics and genomics. Government initiatives that already exist need to be consolidated In addition to formalizing and carrying out the organization of a network in clinical genetics in Brazil, other actions need to be implemented for the system not only to properly function, but also to be gradually expanded and adapted to the country s growing needs. Government initiatives that already exist need to be consolidated, and non-governmental programmes may eventually be added and enrich the system. As examples of optimization and integration, informing city officials about the importance of the correct completion of "Field 34" of the “Liveborn Declaration (“Field 34 addresses congenital anomalies present at birth) needs to be 256 encouraged. Supporting parent and patient organizations the importance of patient-parent organizations should be reinforced; besides offering support and comfort to their members, such associations have as objectives the dissemination of information among lay people and to physicians. These non governmental associations can play a fundamental role of introducing new topics on the political agenda. China: Drivers: Policies to improve capacity and access to services 256 Former “Field 34has been now divided in two different field in the liveborn declaration. The economic situation and quality of life of the population have improved dramatically in the past 20 years. Since the founding of the Republic in 1949, the central government has given a great deal of attention to maternal and child health. As a consequence, during the last two decades, China made substantial progress in reducing maternal, infant and under-five mortality. Barriers: Nevertheless, national figures for maternal, infant health indicators mask large disparities, which exist between urban and rural populations, and across different regions of China. There is limited access to medical genetic services and maternal and infant death rates are highest among the rural poor and migrant population, and in those regions with least access to antenatal and intrapartum care, such as the western provinces. Future outlook: the governmental awareness in health service is moving towards coverage for the whole population as well as to the development of state of the art molecular diagnostic centers. It is widely believed that in the short future, the imbalance of health service between urban and rural areas will be improved, and more molecular tests will be available for the public. Parent and patient organizations have put pressure on the government to pay attention to the burden of congenital and genetic disorders like autism, haemophilia and thalassemia. Recently the government has launched an ambitious programme to screen for congenital disorders such as blindness, deafness, cleft lip and palate, autism, cognitive decline and others, starting in about 20 districts and 258 then spreading this programme to all districts in India. Barriers: the sheer size of the country and its vast population, living predominantly in the rural areas, has hindered the provision of genetic services to many people. The cost of genetic testing services, the lack of medical geneticists and genetic counsellors is also a barrier. The mindset of the government administrators (priority given to infectious disorders, limited understanding of the burden of congenital and genetic disorders and of the scope of available interventions for care and prevention) is not yet attuned to providing genetic services and therefore administrators still lack political will and commitment to these services. Oman: Drivers: the main drivers for the development of medical genetic services are (i) the increasing recognition by policy-makers of community needs for genetic services and (ii) the increasing availability of new genetic information evolving from the advancement of the science of genetics and better understanding of genetic predisposition to adult-onset disorders. Policies to improve capacity and access to services the MoH Health of the Sultanate of Oman has recognized the need for genetic services and genetic technologies as means for controlling genetic diseases in the Sultanate and aims at ensuring high standard medical care in the era of rapidly expanding genetic science and biotechnology. In 2005, the MoH of the Sultanate of Oman published its 7th Five-Year Plan for 260 Health Development (2006-2010) which included a national strategic plan on genetic diseases in order to reduce the infant and under-five morbidity and mortality to the lowest international rates. Among the strategies implemented to achieve these objectives, a National Genetic Centre to provide clinical and laboratory diagnostic services was established to provide care services and to support community prevention programmes, conducting training activities and research in the field of genetic health. The construction of the National Genetic Centre has been completed in December 2012. Extensive training of Omani nationals is underway to prepare for functions of the National Genetic Centre. Barriers: Lack of Omani specialists trained in genetic counselling and bioinformatics. Limited availability of genetic testing services for late-onset disorders and rare disorders. Due to the scarcity of skilled experts current services are ill-prepared to take advantage of the new genetics/genomics technologies and to use new genetic/genomic knowledge in clinical patient pathways. The Philippines: Drivers: Policies to improve capacity and access to services the Philippines is one of the most active countries in Southeast Asia in regard to genetic services development. Barriers: Being a developing middle-income country, the Philippines is faced with the challenge of providing healthcare for all Filipinos. Although one of the most active countries in southeast Asia with regard to genetics, the country still has a shortage of geneticists and genetic counsellors. Difficulties exist for continued research and integration of healthcare services into the public health system. The main barriers to accessing genetic services in the Philippines are: (i) financial, since most families cannot afford out-of-pocket expenses for the expensive genetic testing and treatment; (ii) geographical, being an archipelago of 7,107 islands; (iii) lack of awareness among different stakeholders, i. There are four academic departments of human genetics in four of the major universities situated in three provinces which have already set up clinical services, compatible with any in developed countries, as well as laboratory services, which have the expertise to offer genetic testing services to the country and to the rest of Africa. They have also developed a research capacity so that local genetic disorders can be investigated on many different levels. However, the aging of laboratory equipment and lack of financial support for the introduction of new technology are making it difficult for these capable scientists to keep up to date with new developments in the field. At this meeting there were international experts, as well as those from Africa, networking and sharing their expertise, knowledge, insights and needs, which will both benefit and stimulate the field of human genetics on the African continent in future. At this stage there is some hope that the investment by international and local agencies in, for example, the 139 261 Southern African Human Genome project and the Human Heredity and Health in 262 Africa (H3Africa) programme, may raise the profile of medical genetic services and contribute to their upgrading. However, the proportion of the global burden of disease borne by South Africa with a population of only 49 million is disproportionately high. The total disability adjusted life years for high burden diseases in South Africa is almost equivalent to that of Bangladesh, which has a 263 population three times as large and living in much worse poverty. Since medical genetics services are, presently, being developed and delivered against this background, it is not surprising that the recommendations in the Policy Guidelines for 266 the Management and Prevention of Genetic Disorders have not been met. Declining political commitment to invest in the provision of clinical genetic services the commitment to provide clinical genetic services in South Africa has declined over the last few years. Until this issue is resolved or another solution found, clinical genetics services will not improve and are at risk of deterioration. Laboratory genetic services are also at risk from increasing demand for tests in the face of reducing staff availability. Policy Guidelines for the management and prevention of Genetic Disorders, Birth Defects and Disabilities. Lack of employment opportunities for qualified professionals leading to brain drain and understaffed services this has become a major problem in the last two years. Two medical geneticists have recently qualified and at least another four will qualify in the next two years. No posts are available for them and are unlikely to become available in the foreseeable future. Medical genetic laboratory service units and staffing is also being reduced resulting in decreasing opportunities for medical genetic diagnostic scientists and technologists. Inequity of access leading to inaccessibility of genetic services for the poorer population the reducing available clinical genetic services are largely available in three centres, Cape Town, Johannesburg and Bloemfontein. Geographic (distance) and expense therefore act a serious barriers to most of the public accessing genetic services.
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