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Stem one to two feet high erectile dysfunction drugs canada discount viagra plus 400 mg overnight delivery, stout, erect, square, white-woolly, branching and bushy. Leaves opposite, broadly oval or rounded, with scalloped edges, wrinkled and rough-hairy above, whitewoolly below, with large veins and short, stout petioles. Flowers nearly white, in dense axillary whorls, the upper lip of the small, tubular corolla notched, the lower one three-lobed and spreading; stamens included; calyx white-woolly, with ten awl-like, recurved teeth, the alternate ones shorter. If the ground is fit for cultivated crops; the necessary tillage promptly destroys the weed. Leaves opposite, ovate or oblong heart-shaped, light green above, downy beneath, deeply scallop-toothed, with slender petioles. Flowers in terminal spikes one to four inches long, subtended by small, narrow bracts corolla pale lilac or white, with pale purple dots, the tube dilated in the throat and the broad middle lobe of the lower lip the stamens ascending finely scalloped under the upper lip, the lower pair the;; calyx downy, five-toothed, percontaining the four nutlets, which are ovoid, slightly flattened, smooth, and shorter sistent,; brown. Like the Plantain, it seems almost domesticated and is a familiar weed about dwellings and in towns. Stems slender, prostrate, and creeping, with many small, ascending branches, very leafy, three to five inches high. Leaves rounded or kidney-shaped, scallop-toothed, green on both sides, with slender In old days, before the hop took for flavoring and clarifying the Flowers in small axillary clusters, pale purple, spotted with deeper purple; corolla about a half -inch long, its upper lip with two lobes, three lobes in the lower lip, the upper pair of stamens nearly twice the length of the lower ones, rising against the upper lip the tube more than twice the length of the fivelobed, hairy calyx. It adapts itself to circumstances, fruiting 353 of the when not more than two inches high or sometimes attaining to more than a foot, the square, grooved stem sometimes erect or ascending, or often prostrate. Leaves long ovate, approaching to lance-shaped, obtuse, entire or with shallow scalloped edges, usually smooth or sometimes sparsely hairy, narrowing to short petioles. Flowers in densely packed terminal and axillary spikes, clustered in threes in the axils of membranaceous, veined, and hairy bracts the blossoms are in various shades of purple, some very deep in color, others so pale as to be nearly white tubular, with; corolla a lengthened upper lip which is arched into a hood, into which the longer of the two pairs of stamens ascend; the lower lip three-lobed and spreading; calyx also two-lipped, closed in fruit, the upper lip truncate or with three short teeth, the lower one two- and pointed. The solution used grasses was somewhat strong of the - about eight per cent - but stronger readily recover from much " doses " of this sward can afford to endure chemical; temporary injury for the sake of relief from such company. Range: Newfoundland to British Columbia and Alaska, southward to North Carolina and Michigan. If nearing maturity when cut the weed should be removed from the ground, as the large, swollen stems contain enough nutriment to ripen the seed. This weed flourishes best in cool weather, dying down in the heat of midsummer but recovering in autumn and maturing a late crop of seeds; autumn seedlings develop fruit very early in the spring, so that the soil is fouled with two abundant sowings each year. Leaves opposite, rounded, deeply scallop-toothed, sparsely hairy, the lower ones with short petioles, the upper ones sessile and clasping. Flowers in small axillary and terminal clusters; calyx hairy, with five erect, awllike teeth: corolla-tube slender, with the upper lip erect, entire, and bearded, dark red, the lower one three-lobed, white, spotted. These seeds are long-lived and tillage should begin early and be continued late, in order to prevent their development and distribution. Habitat: About dwellings and in barnyards; on roadsides; a frequent tenant of vacant city lots. Leaves dark green, thin, finely rough-hairy; usually five-pointed, inches broad; the lower ones rounded, palmately lobed, often three or four higher up they become threelobed and near the top they are often lanceshaped; all with slender petioles. Flowers in crowded axillary whorls, pink, pale purple, or white, the corolla with its curving upper bearded outside, the lower one threelobed and purple-dotted stamens ascending against the upper lip, the lower pair the lip; G wort aca). Range: Newfoundland to the Northwest Territory, southward to New York, Michigan, and in the Illinois Rocky Mountains to New bor- Mexico. Because of its prickly hairiness and unpleasant taste cattle refuse to eat the plant either green or cured in hay. Leaves thick, oblong to lance-shaped, rounded or heartshaped at the base, rough-hairy, coarsely saw-toothed, sessile or with very short petioles. Flowers in terminal interrupted spikes, in whorls of six to ten with small leafy bracts below; calyx bristly-hairy, its awllike teeth more than half as long as the tube of the corolla, which is more than a half-inch in length, the lips pink or pale purple, spotted with deeper purple the upper lip concave Fig 248. Seed-time: August to October, Range: Cape Breton Island to Ontario and Minnesota, southward to Florida and Nebraska. Time of bloom: the oil distilled from this herb is much used in making the "mosquito dopes" which hunters and fishermen and many other persons are obliged to use in localities where mosquitoes are a plague collected in full the plant is also used medicinally and the leaves and flowering tops,; dried, are worth one In taste and odor the plant is very like the true Pennyroyal, which is European. Range: Nova Scotia to Manitoba, southward to West Virginia, and in the Rocky Mountains to Colorado. Not even sheep and if care to eat Calamint, the plant had not such a prefer- ence for partial shade its stoloniferous habit would make it a bad weed. Stems erect, slim, square, hairy, ten to twenty inches tall, usually with a few branches but often simple. Leaves also hairy, variable in shape but mostly a longpointed oval, sometimes toothed, sometimes entire or wavy-edged, the upper ones sessile, the lower ones having short Flowers in dense axillary and petioles. A common weed, of which the most troublesome part is the long, thread-like, leafy, interlacing runners, reaching out in all directions from the parent, sending up new plants and making tangled mats. The plant is used in medicine and brings three or four cents a pound in the drug market. It would be some satisfaction, in clearing out a ditch, to make the weed itself pay for the labor. For this purpose the herb must be pulled entire while in full flower, and dried in the shade. Flowers in dense axillary clusters, pale purple to white, the lobes of the calyx nearly equal, the corolla-tube cylindric to funnel-form, with four flaring lobes, suggesting the reason; why the plant is named Bugleweed perfect stamens two, the posterior pair being rudimentary. Seeds four small nutlets, three-angled, longer than the calyx-lobes, in plain view when mature. Some thousands particularly in of acres in this country, the states of New York, Indiana, and Michigan, are very profitably given to the cultivation of this plant for the distillation of its oil, which is used in flavoring confectionery, in cordials and cosmetics, But beyond the and also medicinally. Leaves dark green, lanceshaped, about half as wide as long, sharply toothed, smooth on both sides except that the veins beneath are slightly hairy, pointed at tip, rounded or narrowed at base to a short petiole. Flowers in terminal spikes, obtuse at tip, densely whorled or sometimes interrupted, purple, rather showy; calyx smooth at base but with nearly equal hairy teeth corolla with upper lip entire and lower lip three-lobed; the four stamens, equal, erect and included; style two-cleft at summit.

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The deriving initial significance of this impact erectile dysfunction treatment vacuum constriction devices discount viagra plus 400 mg visa, (without mitigation measures), is Moderate. Alteration of groundwater flow patterns during excavation and cutting operations the construction works of the Project, carried out at the excavations in alluvial sediments crossed by the Alignment and to a lesser extent in cutting zones, are expected to have an impact on these aquifers by altering groundwater flow patterns. Estimation of the magnitude the major excavation works will take place in hilly areas where groundwater table is well below the surface and any exposures are not likely. In this regard, it is considered that the construction of the bridge over Drini i Bardhe River at chainage km 13+550, will have greater potential of altering groundwater patterns. Where the Alignment approaches Bistrica e Pejл s River at 200m, altering groundwater patterns is also possible, however, the likelihood of occurrence cannot be assessed at present. Alteration may be caused by construction of bridges and viaducts, excavation and cutting. Table 112: Magnitude of the Impact - alteration of groundwater flow patterns during excavation and cutting operations Criteria Characterization of Impact Type of Impact Reversibility Geographic Extent Assessment Thresholds Threshold Descriptions Negative Direct Reversible Local Not desirable Groundwater levels would be intercepted because of excavation and/or cutting operations. Long term if interception zone is not sealed Most of the Alignment where new cuttings are going to be constructed runs over impermeable materials. However, it is not discarded that some isolated bearing water formations could be crossed. See above Unlikely Minor the assessment of significance is based on the magnitude matrix presented above (Table 112) and water resource sensitivity assessment, carried out in previous sections. The deriving initial significance of this impact, (without mitigation measures) is Slight. Operational Phase the groundwater of interest for the analyses are the Alluvial terraces of rivers Drini i Bardhe (crossed at one point only) and the Bistrica e Pejл s River, which runs southern of the Alignment and into which the gullies crossed by the motorway are discharged. Therefore, only the summary of the significance of respective impacts is provided in the next section. Assessment of Impacts and Likely Significance the motorway construction is expected to have shortterm impacts on the air quality and long-term impacts during the operational phase. The main construction activities of the motorway project that may affect air quality are summarized in the table below. Table 113: Construction Activities Potentially Affecting Air Quality Activity Activities - a pollution source Description Movement of construction machinery and vehicles at the construction site Clearance of the top soil and vegetation along the Alignment Blasting, excavations, earthworks and boreholes With regards to the operational phase, the air emissions and their effects on air quality will be due to the traffic flows. The following potential impacts on the air quality have been identified and are subject to assessment for the construction and operational phases of Motorway Project Alignement: Construction phase o Impairment of air quality due to emission of constructionborne air pollutants Operational phase o Impairment of air quality due to emission of air pollutants from traffic along the motorway 6. Dust will mainly be generated from earth movements (blasting, excavation, levelling, dumping), wheels of trucks and machinery moving /travelling along unpaved surfaces, handling and transport of soil, wind erosion from exposed surfaces and crushing plants. An initial step in the construction phase will be the demolition of objects (buildings, Residential Properties, fences, etc. In the case of buildings and Residential Properties, their demolition implies the risk of finding asbestos containing materials that might have been used for their construction. Estimation of the magnitude the estimation of the magnitude for dust emissions depends on the number of mechanization vehicles on the construction site at the same time, number of working hours, meteorological conditions (mainly wind direction, speed, air moisture), and distribution of urban settlements with regards to the source. The software ImmProg2000, which was used to assess the distribution of air pollution from vehicles during operation, can be applicable to construction activities as well. Namely, the same pattern of distribution of pollution will apply as the model considers topographical and climatic characteristics. As a result of the model, the sensitivity of settlements has been identified: out of 13, in 4 settlements the concentration of dust is expected to be high, in 4 will be medium and in 5 will be low. Table 115: Magnitude of the Impact - impairment of air quality due to emission of constructionborne air pollutants Criteria Characterization of Impact Type of Impact Reversibility Geographic Extent Time when the impact occurs Duration Likelihood of appearance Magnitude Assessment Thresholds Threshold Descriptions Not desirable Dust and combustion gases are generated by the Direct/Cumulative construction activities Air contamination stops when construction works are interrupted. Air selfpurification factor is good enough for Reversible reversibility the alteration of air quality is limited to the footprint of the Local project Delayed Short-term Certain Minor the alteration of the air quality occurs as the motorway structures are constructed At each location it will last the time the construction activity takes place. The execution of the construction works generates dust and combustion gases See above Negative the assessment of significance is based on the magnitude matrix presented above (Table 115) and air resource sensitivity assessment, carried out in previous sections. Operational Phase With regards to the operational phase, there is a concern about air pollution by emissions of transportation activities (traffic). The sensitive receptors of interest are residential properties which are located within a ± 100m buffer from either side of the Alignment. However, the identification of sensitive receptors and the width of the buffer between the motorway Alignment and the residential properties will have to be updated during the Preliminary Design stage. Measurements of air quality within the Project area will have to be carried out along with air quality modelling. The current Alignment (at the Conceptual Design stage), avoids densely populated areas for the most of its length. The traffic from the existing N9 road will be diverted to the new motorway which will imply a decrease of air pollution in the densely populated areas crossed by the existing road. The 271 cumulative effect in this regards is positive due to the split of the traffic and dispersion of the pollution from vehicles running along two parralel Alignments over wider area. Sensitivity of receptors is as follows: 4 settlements are highly sensitive, 4 are assigned by medium sensitivity and 5 by low sensitivity. The impacts on air quality are very similar to those described for the Construction Phase and thus the applied methodology is the same. However, sensitive receptors (residential properties) are located at limited sections only (please see table 52 above). Estimation of the magnitude the traffic flows will grow in 2020 and 2030 and the pollution will increase; however, the technologically advanced vehicles will penetrate the market in Kosovo* and the pollution from mobile sources will stabilise. Considering also the sensitivity of receptors, which are for the most length of the Alignment located at a distance of 70-100 meters from it, the magnitude of the impact on air quality is considered to be minor. Table 116: Magnitude of the Impact - impairment of air quality due to emission of air pollutants from traffic along the motorway Criteria Characterization of Impact Type of Impact Reversibility Geographic Extent Time when the impact occurs Duration Likelihood of appearance Magnitude Assessment Thresholds Threshold Descriptions Negative Direct Reversible Local Immediate Longterm Certain Minor Not desirable Air emissions are generated by diesel combustion engines If contamination is slight, return to natural conditions through selfpurification may be possible.

The majority of small-scale fermentations in developing countries are still spontaneous processes: a range of micro-organisms present at the start of the process compete ­ and those that are best adapted to the food substrate and the conditions in which they are maintained eventually come to dominate erectile dysfunction pain medication 400 mg viagra plus for sale. In many cases, material from a previous successful batch is used to facilitate the initiation of a new process. This practice, known as "backslopping", shortens the initial phase of the fermentation process and reduces the risk of fermentation failure. However, as demand for traditional fermented products grows and manufacturing has to be scaled up, it tends to be necessary to introduce the use of starter cultures (isolated cultures that can be produced on a large scale). This often reduces the uniqueness of the original product and leads to the loss of the characteristics that originally made it popular. Although the country-reporting guidelines did not include any questions specifically related to the use of micro-organisms in food processing, a number of country reports mention the significance of this role. The report from Ethiopia, for example, notes that micro-organisms play pivotal roles in the preparation of traditional foods, such as injera, kocho, bulla and cheese, and local drinks such as tella, tej, borde, cheka and areke, that are sources of livelihood and income for millions of rural and urban Ethiopians. Mali mentions traditional fermented products such as soumbala82 and local beers and cheeses, and notes the potential use of genetically modified micro-organisms to add value 81 82 Injera is a sour fermented bread made from tef, sorghum or other grains; kocho and bulla are produced from the abyssinian banana (Ensete ventricosum); tella and borde are drinks brewed from grains; cheka is brewed from grains and vegetables; tej is a honey wine; areke is a distilled beverage (bacha, Mehari and ashenafi, 1998; battcock and azam-ali, 1998; berza and Wolde, 2014; Haard et al. Soumbala is a condiment traditionally produced from the seeds of the african locust bean tree (Parkia biglobosa) (lamien, Sidibe and bayala, 1996). Spain refers to a growing interest in the use of micro-organisms in the design of new "functional foods" for sections of the population that have special nutritional requirements, for example for the elderly and those suffering from coeliac disease, noting the potential benefits both of probiotics and of using micro-organisms to synthesize vitamins or to increase the bio-availability of minerals in food products. The country reports include few priorities specifically related to the use of food-processing micro-organisms. The latter paper identifies a number of challenges to the sustainable management of foodprocessing micro-organisms. With regard to drivers of change, it notes that: traditional food-processing practices and indigenous knowledge are in decline worldwide; agricultural practices are changing and urbanization is affecting dietary preferences; and product availability is being influenced by the effects of climate change on production and post-harvest storage. With regard to the current state of use and development, the paper notes that: there are food safety concerns about some traditional foods; and 83 the development of single-strain inoculations has tended to result in a lack of attention to the potential of mixed cultures and their contributions to the attributes of traditional products. With regard to institutional, policy and legal matters, it notes that: local producers of fermented products are often ignored or marginalized by government agencies and financial institutions; and legal frameworks related to intellectual property rights, food safety and claims about the health-promoting properties of particular products need to be strengthened. Research and development There is a need to facilitate and encourage in-depth study of traditional food-fermentation processes ­ improving the characterization of microbial populations, identifying strains and species that play key roles in conferring quality attributes to products and selecting appropriate strains for use in the development of starter cultures. Another priority is to use knowledge of the preservation mechanisms associated with food fermentation to further the development and application of "natural" processing methods that can serve as alternatives to chemical and thermal preservation. Studies are also needed on the functional properties of traditional fermented foods to identify possible health-promoting (probiotic) effects. Further research on the efficacy of nutraceuticals based on microbes is also required. In view of climate change, there is a need to develop mathematical models that can predict the behaviour of microbial communities under changing conditions. Starter cultures for small-scale producers the country-reporting guidelines did not invite countries to list priorities in this field. Introducing starter cultures for small-scale food fermentations is another priority area. Use of starter cultures accelerates metabolic activities and means that fermentation can be better controlled. For example, in many regions, basic laboratory equipment and biobank facilities for preserving and storing microbial cultures are often lacking. Industrial bioreactor design needs to be improved, as does diagnostic equipment for monitoring starter-culture performance. Promoting small-scale starter-culture processing in rural areas is likely to require the use of "lowtech" procedures and the provision of support for local networking between the providers of starter cultures and small-scale processors. Key tasks include the development and implementation of simple but effective methods for preserving and maintaining traditional starter cultures without refrigeration and the further development and standardization of traditional methods so as to increase their ability to withstand climatic fluctuations. Coordination and information exchange Although a degree of progress has been made in establishing mechanisms for coordination and information-exchange among stakeholders, further work is needed at both national and international (regional and global) levels. For example, efforts to improve the quality and safety of food produced via traditional "low-tech" processes would benefit from the creation of multistakeholder fora at local and national levels. Such bodies would need to address a wide range of tasks, including the following: promoting the exchange of general, scientific and technical information; facilitating access to specialized technical information on food-processing biotechnology, including by promoting knowledge transfer between the public and private sectors; organizing training and educational activities; giving guidance to small-scale processors and addressing their concerns; facilitating unbureaucratic, low-cost access to microbial strains suitable for use in smallscale operations from culture collections; enabling communication and exchange between local and central governments and small-scale producers; providing guidance and support to governments on the application of food-processing biotechnologies and on their role and importance in food safety and food security; providing technical advice and facilitating access to science parks and other infrastructure; and supporting the dissemination of scientific and technical information generated by collaborative research projects. Many of these tasks have international dimensions and hence the work of country-level stakeholder bodies needs to be coordinated at regional and global levels. There is a need, for example, to develop a comprehensive global database in which information on the nutritional and health-related properties of fermented foods can be collected and organized. For example, strains cited in the scientific literature should, whenever possible, be secured for future use. Policies are also in place to ensure that voucher specimens underpinning microbial taxonomy are preserved and made available for the long term. However, the accessibility of key strains still needs to be improved (Stackebrandt et al. Common policies are needed to address regulatory issues such as the control of access to dangerous organisms and access and benefit-sharing under the Nagoya Protocol. Training and education Training and education for small-scale producers, both on practical techniques and on product marketing, are another priority. Trainers need to be trained to address the specific needs and concerns of this group. In addition to providing training per se, trainers can potentially also serve as a vital link between the formal and informal sectors, contribute to the work of national and international stakeholder bodies and support efforts to promote traditional fermented foods. Micro-organisms used in biofertilizers come from a range of different taxa, ranging from bacteria to yeasts and filamentous fungi. They perform a variety of different functions, including nitrogen fixation, production of phytohormones and plant growth regulators, solubilization of phosphorus and other elements, production of siderophores (substances that facilitate the uptake of iron from the soil) and the formation of mycorrhizae (symbiotic associations between fungi and plants that, inter alia, facilitate the uptake of nutrients by the plants). These then have to be multiplied and packed in carrier materials that allow them to be stored and distributed effectively.

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For these questions erectile dysfunction causes relationship problems generic 400mg viagra plus with visa, higher quality Class 2 evidence was available, and the Class 3 evidence was not used to inform the recommendations. Response to intracranial hypertension treatment as a predictor of death in patients with severe traumatic brain injury. Relationship of "dose" of intracranial hypertension to outcome in severe traumatic brain injury. Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Technical considerations in decompressive craniectomy in the treatment of traumatic brain injury. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury. Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion. Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury. A prospective study of early versus late craniectomy after traumatic brain injury. Cerebral blood flow and metabolism following decompressive craniectomy for control of increased intracranial pressure. Evidence supports the administration of hypothermia as standard of care for neuroprotection after cardiac arrest from acute coronary syndromes. In addition to suggested neuroprotective effects, hypothermia is well known for its ability to reduce intracranial pressure. However, hypothermia bears risks, including coagulopathy and immunosuppression, and profound hypothermia bears the additional risk of cardiac dysrhythmia and death. For this 4th Edition we re-examined the underlying assumptions of our prior work in light of the current standards for meta-analysis and decided not to repeat the metaanalysis because the hypothermia interventions in the higher-quality studies (Class 2 or better) differed across the studies in clinically important ways. The quality of the body of evidence for the comparison of hypothermia with normothermia is low because the findings were inconsistent, with some studies reporting benefits and others reporting no difference between treatment and control groups. For the questions addressing length of cooling8 and head-only versus systemic cooling,9 the evidence was insufficient. In both cases, the evidence consisted of single studies which, although rated Class 2, had limitations that minimized confidence in the findings. For the comparison of hypothermia to normothermia, one Class 1 and three Class 2 studies were conducted in the United States,7,11,12,14 two in China,13,15 and one in Japan. However, the studies conducted in China and Japan reported benefits from hypothermia, while three out of the four U. Another difference is that two studies were conducted at multiple sites7,12 with comparatively large sample sizes while the others were limited to a single site and fewer patients (sample sizes ranged from 26 to 87). Details Related to Assessment for Meta-Analysis Since the publication of the 3rd Edition there has been a proliferation of meta-analyses in the neurosurgery literature as well as in the medical literature in general. While meta-analyses are useful for combining small but similar studies in order to increase precision, issues have been raised about when meta-analysis is appropriate and about the level of rigor required to establish confidence in the findings. These issues have complicated the interpretation of the results of the studies for this topic. We re-evaluated the included studies in the 3rd Edition meta-analysis and found that they varied in terms of the target temperature, the length of time hypothermia was maintained, and the rate of rewarming. These differences were used for subgroup analyses in the 3rd Edition but with the caveat that sample sizes were small. However, if these treatment differences are clinically important, combining the studies in order to determine an overall impact is not appropriate. One new Class 1 study,7 two new Class 2 studies,8, 9 and six Class 2 studies10-15 from the 3rd Edition were included as primary evidence for this topic (Table 2-2). Class 1 and 2 Studies the evidence from Class 1 and 2 studies of prophylactic hypothermia is summarized in Table 2-2; results from studies included in the 3rd Edition are replicated in the table for continuity and new references are noted. Japan 39 Reference Study Topic Clifton, 199311 Comparing effect of hypothermia (2 days, 32-33є C) vs. Trend toward poor outcomes for patients hypothermic on arrival and randomized to normothermia. Fewer poor outcomes when patients with surgically evacuated hematomas are treated with hypothermia. The studies that compare hypothermia to normothermia represent a body of literature with conflicting results. The authors reported non-significant trends toward better outcomes and no significant differences in most complications in the hypothermia patients. Authors suggested that hypothermia was not induced quickly enough to produce a benefit in normothermic patients, and that rewarming patients who arrived hypothermic was detrimental. Follow-up was completed for enrolled patients, and exploratory subgroup analyses revealed that in patients with surgically removed hematomas the hypothermia group had better outcomes, while in patients with diffuse brain injuries there was no significant difference in outcomes. These findings suggest a potential underlying reason for the null finding, but would need to be tested in studies designed to determine if there is a difference in outcome for different types of patients before it could be used to inform evidence-based recommendations.

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