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To the Editor :

As an academic pulmonologist who cares for women with lymphangioleiomyomatosis (LAM) and directs a LAM Clinic, I find it provocative to propose, as McCormack and colleagues ( 1 ) have, that LAM should be called a “low grade, destructive, metastasizing neoplasm.” The idea that LAM is a neoplasm, however, is not new and has surfaced in the literature for more than two decades. Yet I am faced with a level of uneasiness and confusion with the current declaration of LAM as a cancer. The authors express their own confusion through a series of questions that conclude by suggesting that the conventional labels, “benign” or “malignant,” be accompanied by the descriptive modifiers of a neoplasm. Does this make LAM a “cancer” or not if it is a destructive and metastasizing process? Does the statement, “LAM cells have growth-promoting DNA mutations, evidence of clonal origins, invasive and metastatic potential, and metabolic profiles” make LAM “entirely consistent with a neoplastic process”? Does the fact that LAM results in “remote tissue destruction, progressive respiratory failure and death or need for lung transplantation” further support LAM as a neoplastic process? I would propose that the jury is undecided. My decision is based on the fact that to date, LAM does not fulfill all eight hallmarks of cancer as described by Hanahan and Weinberg ( nike free tr 5 print mensa
):

So, what is LAM? The answers remain unknown to this question posed in Finlay’s editorial in 2008 about LAM ( 3 ): “What is it, where does it come from, and why does it grow?” Is cancer just anything that grows without control, invades locally and remotely, and causes tissue destruction? This is the National Cancer Institute definition of cancer, and in this regard, LAM almost fits the definition. Inappropriate proliferation and invasion controlled by hormones, particularly estrogens, is certainly a characteristic of LAM ( 4 ) ( Figure 1 ). There remains a gray zone between uncontrolled proliferations and diseases like LAM, which only serves to underscore our current ignorance.

Figure 1. Is lymphangioleiomyomatosis (LAM) benign or malignant? The diagram shows the diverse features of LAM that could be argued to support one designation over the other. The only common feature between them is inappropriate proliferation and invasion. LOH = loss of heterozygosity; mTOR = mammalian target of rapamycin; TSC = tuberous sclerosis complex.

According to the English American Dictionary, to “affirm” is to state that something is true. When applied to the spiritual life, an affirmation is a statement of truth which one aspires to absorb into his life. (1)

Affirmations are dynamic and practical — not wishful thinking. One reason they work is because they are based on higher truths, which, perhaps, we have yet to realize on a conscious level. (2) “The greatest mistake people make,” Swami Kriyananda wrote, “is to belittle their own power to change themselves.” (3) According to Remez Sasson, a self-improvement writer, the repetition and corresponding mental images formed when saying affirmations help them to change the subconscious mind. (4)

Ideally, affirmations should be repeated in a quiet space with concentration. This repetition allows one to change habit patterns and attitudes over which one normally has little control. (1) When one realizes that a recurring tendency has been negatively impacting their life, this is an especially good time to use affirmations. (5)

Instructions for Practice

As taught by Paramhansa Yogananda , an affirmation should be repeated with ever-deeper attention: first loudly, then in a normal speaking voice, then in a whisper, and then silently, carrying its meaning down into the subconscious.

Finally, it should be said in such a way as to draw one into the superconscious. This can be done by repeating it while concentrating at the point between the eyebrows, the seat of divine consciousness in the body. (1)

Examples of Affirmations from Affirmations for Self-Healing by Swami Kriyananda

Affirmation for Success: “I leave behind me both my failures and accomplishments. What I do today will create a new and better future, filled with inner joy.”

Affirmation for love: “I will love others as extensions of my own Self, and of the love I feel from God.” (6)

How to Repeat an Affirmation for Greatest Effect

Jesus Christ said “Pray believing,” and the same is true of doing an affirmation. Negative thoughts, disbelief, and doubt all cripple the ability of an affirmation to bring about a desired change. In How to Be a Success, Yogananda wrote,

Shooting with your camera’s flash can sometimes produce undesirable results—harsh shadows, washed-out color, lack of details, and many of the other negative markers typically found in an overexposed photo. This kind of lighting can look both unnatural and unflattering, which is why photographers who are just starting out are advised to avoid using the flash when shooting certain subjects or scenes.

But what if there’s little to no available light to help you capture the scene you want to shoot? Does that mean you have no choice but to skip taking the photo altogether? Of course not. With a good camera that effectively handles low-light or night photography , you can simply adjust some of your camera settings (i.e., slower shutter speed, larger aperture, higher ISO, and more) to compensate for the lack of lighting. However, if you still need more light, using the built-in camera flash is still better than using nothing at all.

If you often find yourself shooting low-light scenes, it’s best to invest in an external flash unit so that you can easily take control of any low-light situation and take amazing pictures. Using an external flash can be highly effective in giving you the results you want, especially if you have the right portable light modifier to make the flash less harsh and unforgiving—like a flash diffuser, for instance.

What is a Flash Diffuser?

A flash diffuser is a simple light modifier that attaches to the upper part of an external flash unit. It’s used to soften or spread the harsh, concentrated light that bursts out of the flash, creating a more even and flattering light on the subject. It also helps remove heavy shadows created by the harshness of the strong lighting.

One of the most basic types of light diffusers is the rectangular, snap-on dome box made of white, semi-transparent plastic, which creates a diffused “bare bulb” effect. But flash diffusers come in various shapes and sizes, and each one gives you varying levels of diffusion. The larger the diffuser, the softer the light will be.

When it comes to manipulating the light from your hot shoe camera flash, there are a lot of options to choose from—knowing which one to use is a matter of what you’re photographing and the result you’re hoping to achieve. Some photographers even opt for DIY flash diffusers made from regular everyday items that can produce similar results, such as white coffee filters or small plastic food containers.

Project Team

Mike Brownsell - Chair of steering group and PAR lead

Contact Details

[email protected] Clatterbridge General Hospital, Wirral, CH63 4JY
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