ࡱ> nZ+ ~%W9"28PNG  IHDR isRGB pHYs.>PLTE (((888000<<<..M>>hMM.MMMXXX@@@PPPHHHJJ|\\TThh>||J|||hhh```xxxppptttkkddqqww}}К\Tٙ采ᐐkdqw}ق ҔTIDATx C࿞Qٔy q& 8?6[hM^?e-)Ϳ\iD$&aTDaTDFEFEFE4ڹH{{ӌNٞG`CF4cJKktx[F{t,ͪ?Jۺeu:|:?{#xy + lޯ)0ڞ>}}Nqlс:Y6p%F[>#Fha_6%/Zc9 }Eqָכ0dtltNkwåcgG1"""¨"¨"¨0*¨0*"0*"0*""""h;%F%NaTtNXQ: buD;%&+i_Q)>&#\Ҍ_Qoe'(&"/u23~~u?|Ժ9ӳl43\QݛlqFKs 2#b5Hx6Q8܍9߉w;;_>ynM,5y~qqĨ,h>1ZK4ۺΣm<Y7KF7ńYDg12Fnu/ݻn܍uɶսhmf#jmm -g E*1ѫz|F_y87&t?{ΨTn|dhny[7;tf`N#w^ڽ;?o}wn붶QwZuFbdnQYNk`O~9.14(8d=FWOG>xߛc/// >4d6qS >è0:>zQ]ǝt=0:АFbK3v.ZfgBv܌Fg=j4FG'`udT$Z8bt!:%[=K1Sy-ǝϿ9]1Ruea`0*o)LFWMÏGLF69F%g9¨$Z` \3LaTK~)Jr` ^3LaTK~)54:x Yg9R[Q^,O3LaTR__o=,9jn42F)|p0QI-g9tF_I2^'3y>}.9C$'3LYwQۺ_>}|){QFm?w0e n~0h:Y/ҺKQGTe4 _tO0hF;L*2QaQFQaTeTFQFeQFQaTeTFQaQFFQaQaTFQaQaTFFeTFQFQaTFeQaTFFQaTFFQaQaQFQј0Q%'E2* 2(JzF"SF%1(n)zOdƨ]}ʨ$ctz!uȄF.Ȩq8* Fm]F%QG3FzmB3(IFeQaTFeQaTFeQaTFeQaTFQFQaTeQFeTFQFeTFeQFFQaQFFQaQFFQaQFFQaTeQFQaQFeQaTFeQaTFeQaTFeQaTnhk aQIh_QrODf2* 2dQIq4FШ%u5G_Q=>ʨ蘮g4]Fe4ɵ0(2*2ʨ0(2ʨ0(2ʨ0((2(( 2*2(2*2ʨ0(2ʨ0(2ʨ0((2((2(( 2( 2*2(2*2(2*2ʨ0(2|b0(Q2(2( 3Z/#gQ}bQ}nyeT_$ftQFE:FGm2ʨHdRXEf5vG{IQheQF4=U>#FMFcQFe{2hׅ'2(2(2(2(2(2(2(2(2(2(2(2(2(7DJJ;'K[2ZQFeQFeQeQ%eQFe FeT FQFUQFeQFbQF`QFeQFeQFe FeT FeQFesd2v FQFUQF+dx[z+(J$b4(dQ%11(@2ʨQFO$,JL[bȌQ\hd2 PF':>ʨ3bQ%]N*>v3hF݌2ʨ2ʨ2 22((*(nFۧ''oţSe494Nƛx&gwd;bD6ryfkmj et .3zmCp( -4ۣx41U5nX+Q]mG^Pk7QbNxbI7j(FG>bNO("b9(>m;Zpjʌ 8Net%f;ݎWHhg_+3oxk*'m(3.ECg*|NT{2zӥ(v蜜GU"IkQFi2ʨ.(b1%nz$F)qK&1ʨXL^2QFŢJI2/iQF5TFeTCm8ʨJLbQ}v F4F`Q ŨeT F`T13?qQ]3'1  \|N1Fbt]8'1  ]b]bѺ]b֊P YWhn3J.S4:'1 в6F1FZY=h FeQ}QCqm&|-D %Vq8/l4FhGP3*Ӣ)xPP2d聆bQF`T1 F(J02ʨ`T1j(F(J0J0ʨ`T1j(FeT FuJ0ʨ`T22( FuJ0ʨ`T2J0( FuJ0ʨbT2J0 FuJ0ʨbQF`T1"Nƨ2ˉUQF52:Q%5Z(JfoeT[6Z~*LFU"1)2d%r͕uc⥙,pqP"e)&2j5.aueF3e4mr2(^Wna7 (IS]C1(2(.QcaQFeoQFeQFeQFeQFeQF-qQFMwl7>cQFS5ue4eq#6eto[21Z+sY*31hm0yKk^-`ꌎKbQFkdle2эN1hawt`ѹvw;Ql(s6z9.eti'`tetݽ2:K~Fg=hۺ)э+7Y.U_133,vwۉhhl~2譮Q^Y~QFour%R;ѺӯQ^Sⷼƈ`tNF1z]V~{'dtU]b#v-ēi~2Zk7ZFܫēgq1z5.]wu3,D](Fo(&S޽^pU^@ FQ{SHh|Z9`ёPDnTF̉,х;hYa 95:5Kh4JS믗2(}ԚeTF_2 PF_E!"qR6[(bJ0F(MhS0EŨXDFEFEFEQFEQFj~ज़~|ᯮ*1CK+UY u %1,_tqI -5@bDy7픘w_ bmݑ;8ΤČ L[_>U_hi kLVbΝv;%f4bի/vJ̹/)b>fhyČ}6RT^"Q}_D}ET)ͪ7Uoṭ4Kr}ŭU/b"雨LQ"o*1߾zoP6D*/QR̰/qqPl6i~M7:yCe՗C?"RyaTDaTDFEFEtG6IENDB`@= T,A>(.X!0Nț# xݙ PUǿQc$c6雸Ԏb1-D1aEhQZ ETTƝNi։֦MN}wyI^=S" DHX>Bd"D{>Iiy䇊)xPay LO*u5 t4b H3_NrX5Wog Ɗ`l&q#%7Ɣ1S2cuw woskufaq\m=1&d;;f˴}\m-{p70O~ku׹ӮUi33g.!:99u;8Q6c5jroF OΪW-QZ HZ*'k`PR 8P*rBjدVjʧ;E Tѷ1[Uǘe#y†倅{ynkUW?57_Yu9\Քw[ݺ:9T1XyG:n;& ~*N5L~ D/I U 2e K&F,0G%I)y`%TRԳZA`+TlWd/y ^5O$Ɠq1L_$ST4Al3-Tv"3 6_Y^3ͅ>nfzM~^j'\ѯ5ZT?.z_yP}6qU^_j&^ua@\6Fⵉm"~o⺅n![%Rۈ6ޅvIS;SR@v]~V J_)<,~2Zogf)OR*M)a%d\/e'e]m3P V;-Y#oKlP62ZY ZC&HetiLetA,IL <3$YSee1*ρYr+`>shdCuaQZX RMUvOb)l {9˞jXgV^Evu^b:,#XJ7 fj`t- 5FbHLKK̽ BhMp 4&Nyyy^#lpn6zހp.:p:ܿkh*ڸF.Kh_h}tM]@[yvՠh Zj1/|_p? ltC.'0c[&htC5W[0WM9@ju_(?:hd29@2Z,/?VY99+9r|G 2c,b8y3&k5ؐ-S*2iNƪ`\fZȌڲRj˳z4^W(<8?ħIv?$@lQ<'fÈ0T=X8G|㈵{x{Ǻ{xk/L_[c\%.PbE2Z|x9+G̻mM]ݯD˿VJ+1zWbu[t'p .rke?G\y:Qw#z1Ph 7S.T1yK܃䨯%2_8Q C\Tnnuyn:m*\yI}zd,Yo%^W}6T9eV*XfVom#<vsTcn{et7NClaa{2&[<}Ϡ<^=}<`_[36': ɬpᲮLxe-w,q%v]y@d6 ns đ9w#s!.p9)(m#,_di#"nW9O Zn igT[S'_ ~_G,A{'_-OxP 2o Niroл&p-nWT5춻qs}v~ oڃ"pZaAwG &{:ofߋy3C1.d]ĴPJzn ~7O-PNG  IHDR4-#sRGB pHYsjPLTE$ @MMM`p|||hhhff  <$ @&Mf`:``M@&XX@@Ls߿s߿IDATx݉zܸr?DrNdj}״hwGk[oVڐ&Oxr,NKkX8ۋ.L7rYO 1exwyo}Xz8vw]zg~yɋ_NMc \à]~weEǗ<<\aOoa{xyJ]ky8g{yx)w[֢詗Z'-,0 }gs/seϧw~n7o{<~twyIko[ԏӮˑl:m:y9o^ zhl/:i \=,Kw聏r]qy<~lg'-qNG罝,WToF48ьn)ڋcye>;c%{./A}ذOpa[x5 E i \fqyzl||ǟ.?I]vfҥ'ۏfl~l/}:T.z/yIZi \f.a#mxltawxIf>#\>m]{xV/zplV֢vep9 a dž1woo;ywyMx:겳0c5oeFs}>/Χqk΢68wN>//Oz8흾ϓ6~@$?'q#o?t_`َw\ϥoS(ͣ/O:m~|][ShAhۿkY=FB~Qԭ^wcJ̛{_qk422wY_/.ӹΘ"˙7.n˸$kN.4vQܑ=qI<ﻍ/ێ%.Kt#~lrԶ/MO{0ej-Y:.IHM&r9G߿%.r>p=wrn ě{o7:rnϭV?O{}I"v%.iFs0.釴Fsi==hn hnR{ܧA pI. A pI. %A \. %A \.i%A$|&bIp9JD .*qI\>Q%Ary޳%Aq< R.. ˜gK}adV |v[p㦈M|vp)\5̇w\ո|xž$qu*,qIT{MWm.K\V\鶧aY| uy>f52p qϡYM%aȥt9~\.\>d;F\Jz4<F\8D.rKti|"MVL%l 虹9]2? e4!'d-D 2@>esmK"=3@>rɔ[¦\iBgukKR(l[ .m  d-/QIL!"2f %˕\F%K\%. \.qI$pK\+?~;oooR6950w&~5~-&TywJD%AlІḁ!_L寠Is6e3ڿGsKx,ax.qIry.qIq9xt .qIv)K\\voK\\z#K\%]-DaˊK\\D?$rx.D r%aqKb \V\x3^6͊K\]6.q)k.G^qYOť9V| ps*ߋm.+p%.We9R%.U4X\@e1[/wmX\ⲠK5]<,uo._qK\&]fť^/nR=421.R4R{ƋKXҦ˰)K5G|8d1 l/.;/HImq&'|F4)3/kŜfMHpyx2%!7v5KwaÛfpsB3bv=.Gr.ɰwRܣA\R;w3u\NHr.3\je.ϊbɥܸ"712Y.z.8ǂt.:x.UK\F%.qi€/[%kXVv.pReZk}Ͽ_܊~z%.Ӻ\Q ĥ=F.>gf{vuQ.#eʣzgXI#sJFe)Dvl܁K]4Rĥ-t%.T'+.qK.pK\s)K\ڕV]I+O0+.q9r{Wt)K\S.pKWᕧٲڞ<.q9ҕׇh{.54x婆ހK9\+OXY(\eK/5Z{^.YKw9\;m?5>zݚ \9.SU׊]v,.5v ]67M1Yq%*/1^>,;xK\sW\\t 󗯸xm]__D>3\g\K\ruu=<.q5Q%.qK\f_G9qK\.]G%.qˈ%.qI,^y/\kU> JG%.qJQspK\QylYĬr&e M2MN]r(ٚFr\or޽ZkWz'r4`:2FT~;gx^M?q}|YT-%\K*eaJr\r)Kzg͕o;.@Zsi5YߨcT,TK9\njݹT۱#.%K\ⲘӎeߥⲺީmǪ> 5.'߈z{vwܧsE\\RǨ1u.퍗 p޹2bp %.qI%qIr\I帤wR9.q99\+΀,;qK\LJ]l˓N\\K\xy_2 #jIy1Sr]TM9=#u\/T.){Jtcwe;K]2:iܥupߥvK}KRߪt}Ւ.e בwoUY65."^PZS9 pb.n#%v$H[rU.۟RS*Sĥ r]zw~.m˺s *һ|e{R*GT9`X˹>.}|wIG*]&YyY.t۟pdT.Uv)cWɓt{N̽y7\uf/k`IX.q9R}~ehHV{ż'fIYrXҥ̹T>5csט _iGL3!c1_:ÛZVzS/Rvu>pS,Lc޷~ ܐw\!/J{g,.]jȈrH NwU>2}c*BrFثƥ>w:}HSv/YvI~1SSwT>ךA92|ÛɈ.圯[@)Ǻ*d ܐч:f]J4sf R~eQ[Αd9٘Jߘ wԐ.sIΓt?9~zRҳKSz٥tcn ޔ[uٜ4so٩gKS*wJ[Lݚ2)7 \. %A$\K\|ѩ7ҥN?HN2=/*/M9ħd)SskS\RHCL`)ר|qʱ5^FbR]g%Lܥ?R.fk~) yʱ{tyy_B-9v1S-f\2کХbMl@ \zs\rˑ\F[SvRm2K|QOoh555ϏʗO<>h&=/)=R\tcl1WzS樻V 'NIs$g WeœS樻F;ؾKo|.=9t'+RrKSfX:]/ӧTt\=~9hRZ|q)jsI. A pI. %A \. %A06IENDB`@= ::ѝ>G\A 60A , x[ pE{w (.*rpِ@"H+(H HD RDaH8: /3=I3nHrpW,3={z'RZ Y֑()n1݉'o#Mw~DDqo0=@%K(\K% m% N}R߮Bc1\z \8q\}+Y(p=ܯ[NWqp nvb{CEwvkql<i7k\}ԇه\^rҔӖ"ȹ+oy)^9YSԳ)s)\)+  Xz  U6Hmn Ϲ^{rޕMyde7a5^rl5mMh+s,{Y ;3s7h'$Gmve\({E+b+nlpaNhN; .'1&Pp=X+a{؃;p\.Y4GCǴ{w]L;iXA;h)%󀹴rOh+ d4P0wM G+Ci=%:XZyt5Z4aQ8|4 `:P|gpm}6OA)<Æðst_֣l? K!|')| F, &gYkĬ+B !xR ϊD"r]BD/!ʗgxPKaa)+]AkWPp:(JRp+Jp28yܼ^W/݋p8] n߀9""16bX91sc4WK0Nal;%\!^!qcG16=zcsÇ1aL cGЀƇІ}^h@wIߺ::oisCCK}b"b1Ahi b%aIJ?,Iz.Q缶-X˞0i?jזB熱I'?l凡xJqQ)B}{ԅ3zro."]A+sORq(~86Ru6F9?kE+~+M6kҎ#5:SE)Z&αۂHDZy'H.mʙ])/4kǽJnZ29cmV\}}r¿ufeArU?e3\{FK2eP(#T)#sErA}C8?4a~MH.j 9fWCkk)Πo5a`z8Qkź&9_748gM8/Ю͡[vq8i'QXtfFČ1#)wڄd9(,>g)KZjڤgUMH KJS5O]AZv>nP٦n))#3&5aUo׽TS*pS\O_ ?'9KꆚaͿZֹUЏ_S!X̿Q+okyx.5h zwE/#i໧ok7y VXSsy ډQ/Optqjo s!Eh?RӍofw"u 5LWw$mc^M|m=4k)x 0+۴T's gjxneQI_-0[̿ (9 x(DrΟĝ{)fML3¤Md]팖i$qiS?7wYaM򨪶T{w̼SaŝTɝL?3uXczmo MtgFjqȘ;9jK[kKU<{WI.S$_KE~P44FcCo59~pT|f~Wj>;0wqBGWq7w2_܉ MXVsXaޫ0W; ;N,eNudbJT'شrְ/e{Uur/kY\f7)%&L{j]?ꘟ*7A.ߋ~RT(}'OGűT_cS.7|hn}8<4 `ϯv"KMuPNG  IHDR.7sRGB pHYs+PLTE 0=;#5. (8FDH@XP`xphǗ˟χÿ߯׷ۧ@{IDATx碣vInJLlEu5Pcx<{9F-Ւs__KP0GU䯡&^_ E1oH.˥G W\hο 70\?1:[w ,pp[i7p+ pS+\u5CpviD )p=oVJXe8gu1:Ё|p*|<7 <~8l!g.wBɇl&:+ypO|L_d%I>;1ćxƥGmȺ"Qv !pknU ? ni'4pE p^npKECTA_+FS.vF_  ߅pɜP?3WM?=3SifAL okIaJg(`{:n%M]FD%UUQpe+Wc~: k5n=R2_`ug aY?̗vc6~1-g`/?f\ @ @ @ @ @ ^iYUPUG|߈ߤy]UmP&}5dMY.瀫=b+GYM%}Uh#rC+kZnmJ3s2x߿ABIGӏu/Ј]_kHjpp;|랧sZg14-p{ZI8{rZ:U-n:Ybg-D]<:pcw){+PRy{n' y肥5]yğTa{;48pՇxGS~sj+z[-u[2?VnY [gd[B:7!| ݰ?|и!kOEֵVk;iyW-4\w pbo>:F2\?;5[M/yΕ&6wN1p=17,*7%R<:.:Tf{I^R'|L5W#a> _^N i>uuBůߞ5Oĵ:%k= PTUe{ۼ.ǃ\?=Ui>ĸYZ'Ңac"*_NJ=ppcx\tִ{>1-+xnLt{PoGW|苳F$ {kCn1%WKFm7>jI} Y YHyJ h3_͎$_;HZK蕞zOD"ɿ ,kTiki#$<ʥ O#6tF312-ܪrZ6[@nF$۱ lp1W3 1f6쭋 ceuJBTZ";XӉep܉QSス VlOZ jFKo٫AsnoH^jwRPcVoe| BN=OǽR"pC饵(۱6J}:*؄[|\''9͋TrbT}a"HH(pw:j)4Yz\;3pn-kuܽh"Ԗ Ѫ/ ET*5pJvlkUޖR*-M#aJyYto#n[٨% 2gu:GЎ)pͣ#TXo,E#eܳm8,c1V"QayOJǁp;V .m}?\Q!9`YTi׵: rcd +p=1ݝ|FM:z31(p>it/"i!6o]YZ,A[aݬ5y͍ɧRkֈJnu>˔O 6\pkpvLeg4.ٔegHp#V ,Hnۡ+[٪u /.>4Na3(Rf+{EBFlipmYN<>u5K g\l];/Gʰ:jHIg:@;ͨ Ҕ18^qx n\V\ꦬ}lCePjxs p#=[j-S{ **qW8\UAb=k{kU*&\kes}yVԛ^79|:{G&q4E>IKmkk+kI=*tӌM+2R ҅pytkeri@!Yu;-:h"`/nmp66MMC%<“ר}v~;}BYh/+xZr>ܖLpBcّza ܭxj7 z)ܰ[ "bK/[%Տ|23_gaܸ10b#Fp̓+Wnm,F?"c[<^iFf;9Zbb[p)by- vlep p+ 8;Ჸ(K[ y;gIXJ[ALpMXkmkGsY3p/O[l;t=d`di?neoER#K}6E]tOD-m*Dne4[m\yf4-Ҥdbu,Xl)l3c>sB⃖6{s݂kvrnW-n*Ay覽xuNW$T5ʮXtt;m=w*5RJcm QO*P91?c;Mp21Mrr~OԷs7\flNpk;۰VcQ }s+ ZڧkqWI|;xX-fqIEXYtV]w9dbh$r\It͟ vwSKGO2t~Z] ֺtpTj+Qk^*!͖@ <]}pG7pLܩz_J)z#/G|:y '4{nMU{Pj{\fO7W6<)ydp/R{oXåCے\w+ΝuA"9Z:! vJ\vtN?DAsdܻtnbX!EFunꕨ&_%~G*Bjn>yPX7 zܻT,յ369 ç}pL=eBp_ 6G]E> 8,t}j.n7NU*?׵ ZKlWYh"}pwA;"ȸ/TZ˓py,E`V; _+S!/6 Z[ݞy.yuN6+G]{gsꆵ3=O_X`9p6S d[$dpn/&VOEdc(}R1/'A Eg:qx3S>` ΃;F&w$R p-.J3\>qp2~<$\w0盨FžU<KfG laYBs՗ǜu~7զ.+cˠ{, S]nW.I k MgOej>mR<Q(elGjȁ?VחSy^(!B@lvk%y䝭1O8P.KH|IT#wyz>UWhj22{nv/sILV{R ph,D;f -vjRδs@e#r;!!̕lm+Β zBX6tlכO\,x",划9 =ӝ2/긳bЃ=;┚ ֟iE ^u0Y"ΒG)}=d̷kʓ7H@ @ @ @ @ @ @ 9lY޼8U m'+c.HifH/xIV=Eyy'M> >9!ꏁ}/խ64c(LLMn$[V# de[Sd*S L$/vGyє|>PIGչze۰0:53Vў˘uwz#MNJƛr{di`df&mR?W\Wm:4?`\hz<5-էUܱᒬِˮ 7"ܜ6hR/[y}&z6hDO6ƽ2 'Ǿ.,~ո@sToe?ԋHιEF-p%[v9͜;j]%V6b4QTKl39J*WF9>)p1]F¨&[Sfp:9(;|z}^X*h\DB|3Q&7+pÐ}8\dhC:QmM *fkdzZܵ$?6\WH f̓p> Gj.IP\G)Diqyp6,wMsq!w wĈpz*o-(\>PX wb'QG"i^?h#TB|\^R Q\Efç}a{b6Xw.k듳\.JmX̃mi^4\}l>7 upщ. >ЧP`; a=Ql{mB6xKGfXІ:tlVȥȕ&vɁc I+'ٻj9(K>"2+$‹wH: HaQ`EYB'SlVmBq|BVwi;jarW[mqcm?a|FiRUGb26+Kۮ(2̽wt$OcCVJ;) ,('xYs@ @ @ @Y$3죵IENDB`@=* GRD\GwEUO`3?8I# x[{l()8K(Hb[6؀1i$E $PB !?hQM*9E ZUfwo/@>vvgv7ή-B61+C4qL"Fߎ&j# ?hh'Nj T@#8=<">{6W}e{K'%=uȴc3r&? msx%)ldMI wEix?j-+W#Ž< t[6!|?YFmCmW}VevVrac-$oToy~Mm/O{tn:!zUWUW{Ѧ\)>g.vqmzbGrSfSxX%mi|g @*! `);s窪fKb/򞷻J578|\q\7(;Hl<,ɰR)EXK3}G[֮@|}h*i5U}]V5z_޶{DI]pI Ds}Y2=ICq~z۰׼\VR-CX*r67_jrz("4bA`b/ԙ18@̷]"/^8t(vo㋼zV㗗UV 80,_lɁTѮ0 zZ ;3~%HH'χ1Ӧ90֜M}u*i=h?}:76xHJ4-sf%T-"cOcS!b?@jck)Q60Hl=6P{F&1ѯ?/{c[1BA_>@${v̹` n7u'p h7W%KUb|_ TRp8A! z*o lD{/i;iFUZAbJE@!ByrKpgSM4$ m_Q~ZNeXh-~<+1Z2DK%j)q[,JM`' evowpԱuU}]zmG`Ar6}>`k5l> ۏQt} Oq~}p}),:9 O45ZV-zΈ[^E-֣z؀ۀ5 v abـ#q=b]#u@PNԂH RΜwNCIpSpv;}?'Gя#ap>.Nna,1c cd/c1v0vo;qN)yӵ2^gϕ8~nf|K'ˀo-$6=K@ˆo4 ay m  T``Em|+o3,9hw.0OhԏE,54d~ӅL@?5hԐIle I$ I<-42Lѐ!!vEC(riH!ԐYԐɊdRC&(2VhSu$34d84$2xBhH41Znh# L2 A,i&)f"5 uNE݅hmMAvlȃ-)eg5 6OY! d \MG4ܙRQs ZdI2,>JB_%+h"z'=M@'ǡǡ!n7bFNIkk*0 _4|\[OLϴ̴|3d\ Tw b:;} .X7D=3o6}\}T͎}ccv 9ίmhj=k*l9=7ub0Ŋ1bJH)yqEJm7G^{`jB_FLg̥{g<0Ep֘u.XgO`Pwd_#9u+b/>'q%"Cq;s>m?s?v5T%ʓQ9ְ). {dޗMdݯbԁha)7lshcuvԁcLX_: 9/Bٯn:kmD=.tGzEKާqURޯN 5Ǭ;v3|[fs2& yof6kmuaUvS.pQ?](Zm,Vd͏. 5}Tx?Dg-_~#81so'P2"l˼@aO_^(bf?{_q/?;3:` p1@g,p^̳nF{ƶk3 eH~A|̈́H2/\w UؼXrB:'¶Ww՞wEuo5xSQs >\s/Wa˿jm%DD"Ż>_{A(QFmC(Ra6|} qqjK]AGc/F78DQ/з&#s[٢c9:- qZ߆K{k"׉_ĜzU_?Xd\(ebDwi͒$jKw#׿5y~k;%;Ko[)kܑy&bYCHOr;ѹ'U[yuj^ {@\:,t7Ar Gkbkp(qsn% B@+`\QmK 4<?j) e5`EŠ MMĐ" J11AM4Csۥ$nNf9g|s)I=zZ3-~6@K`% ޕ%pr BDfId?AZH\wj†2or"O>T>l)uޔD(ͳ7㐚.XFaT|dN|*/綔GS0Lݔ[YǪUGv/WɬzPN!]y1%3no1X]7Q.3-g'izxu|]\v28q6+8mVzy pȖח2U.EznҭHo`# pz\c껩}qztjGZ d9L[RlIr,_3צ\֠^. nu?jک}ىnu :kJ&}ىivM7:8{i'h'K [7: ӀO< v $ rϝKJ77 {o2瞳BPJg+kNVEAX ]bxQ.[Z[ιYGBީ̼O]g >i *DÉǑ@:t2ncof3﹟DGz.6lG؝ #0`/܆d2.°bء-1qxZJ?pz>YJ?@Tz'+[eNkgч&Xk^1G\Z6+`z~>!ϖt S 9>c&#i7w+GX /.6=Bb(O˞7G0]cEeG~TKB龃fCyaQUySLۼ ,x`u+ҫ0kE"yҒ:ckacī 0Æ7_/}ybMl+}`zdsvya|Ƶ}06:6Yi<:;P2ZXKz}ǐِx^ %jkb1y]L[>$a|.!}mb{E3tP<:pcu:or-6c/)ڊ;2 ]+?b&E4!}%FCn`sZ؊8BژVk]kz6lZbU7WT"wy`E>YtƷ*<#е6:lgl :˵wwl(r;C'7:_ ~p,X ۔ft xc:¾yx^X^Xp.'xwt ix 8q ߉"UN堟s.Yd']9[IH4^U ͻmùms>#D9g$8&_IysrKYvS?Od+@=^T 0c40}K_7x0xZoU?wvm4 ([ aKۥh`J ȣ(Lj&Ldi|ԨDE?`z̹ۙYʒݜ;sw={QX) "MSg-em13Xw2t6`MA 6P܎z~Ds6Lfy؆ΧҖӖfv:i3M[mdzI 6(\.u)SQ(s es^jx>d^ɸE;1Osl,Iw׷XG2M}Bcږn34NkW/qÍS83s_^_+u!]ù1^T./]( Pc3*LF~<WgXm -9٦6E5!EtڀW6e:u{:e|!q4cӽ d#+_6BjS@q^Cm'` 02\4> \H 80vV5ifQg)\Ş7u9m1K<ɵ3r930=K, K<> %ON5E=}pvM,yIOxȇ^e6G"x}s~Mϵ oo,TYUnsUK:"? wrc&漴GGjj#s6.읞?%tѾ{넽Gw3aVcET%]b_@ۍÆ=j]= s L?4a+]I. & mT.9L1}\XNG)xq0=aأUB;rg-c7TsIL_10h݄oʡ81}_*!RZbzO պ m=G`;^D9aC6>_k%|Z;>;\> "=c.lLwazWb'8\*'3l0'%m9ysoiZ7) >dC?81<".3s͕_'Ű& ʒ <:*Wv>$W$F+4G<Ƈ..+ȕ8 CArΥ',~$ŵ C)& JWƅC"{*jI9$1 -+N従u;{K ZxK\Tuߒ EmT.>x*Ee~g..|^{ g|(SLqѷ ~[Uƻ=-!!RzMN={~k9? ʼާ깎%yS_б@= X\ %0DJ,$ xݙ PUǿQj$ !F,N絶L"Sq(kQPc"Ӥ5qj\pO%n5%n{3Z8i&mjvڡs߹ `uz?{9w]LT"_I#v" "JwLn ErDJQ\{ni0t SIJt1k 7}%Kv{$5Wxj'"“$i|h3z /(%J}8ӮGL;ƌmx45t.ʬ>NN XǍVR)`R}όw刋X\3cBeI:Sz:;j,æu4oYr/;a8=xO;hG5Gcrs plepˍTȷ_3kO͒u0[9@TRoN5Wv"@͓mj lU^PN0sCA`~2Pv`KH,#.afnYja ioCsjU]r]s֫;]zL|[v=#.QzJx<:^-]AJ T2Ud>t0NɪL,!\)K@ `)VYz,UٲTCdʑ5=WlRÈp;jM~G۱[#:L"+`knxflΝkOQ̓upm[0ȧ:5ɧ`/A.g쿴ښc "b&1|Xbb61.!֋Yeb,JrR ;l{W`ZKߓ>X'n4l3; &j3,O'A"qQ DJR\*d\jpTӲY*IpD6apF >XV:Yb@deLU2EޑI )e8R 0OD`dJdK+oJ,4BUfDɋR$2W P(ݥ@yA^L0L l`I݌)M2>` aClƇROG>|O$kU k>OJbQILxuO1"U"QD.D Bϫkoj\Z,2>zȹ.n.n\-ܫpN8Z Wl5ܽ +p ܾ /Kp"ܿH TQ  yjB Yj 5TI-URSS'Z5[jcj$jy=FfPYciԷ}_Ck?C(q"z1 bZaP֋Lt 4"hEgt"hEGZ+ІxF/VDC+n[+8Њ֊}A+rdIP+AǬV2Z҉Vhe['kF+lИW+ј̘I&0x0bc4FcsGp|O-se|0lZȢgkL%d P>,g(]=; Uvb?l& c[CܗUCFt+Kc:gt{۞wX+2ZGiǣ0>7c~>++jc6Ihc٭.k*td1܉R8jo8K\reu&u}*SǏȳv}Vg;9g7~OdgC#4̥meJ hsZd Oc̖k+ 2U [IM؉%Mx|5Ak2DJ}}cOZ_ hY^׺M}ۚ`k^uc@tP Chart Excel.Chart.808Microsoft Office Excel Chart?Q Chart Excel.Chart.808Microsoft Office Excel Chart`/ 0DTimes New Roman,v0,0$DArialNew Roman,v0,0$@ .  @n?" dd@  @@``  8fcZ jj8) !" %! '&&hb$Z+ ~%W9"28"$T,A>(.X! b$~7O- !"$::ѝ>G\A A$$$b$8<4 `ϯv"KMu O"$GRD\GwEUO`2  m$"$<_W& Ry"$^T 0c4׀$"$ X\ %  0AA@S}33@m g4tdtdD0*ppp<4BdBdph0 <4!d!dph0 g4ddD0.p pʚ;ȍ7ʚ;<4ddddpkd0\{9___PPT10 62___PPT9/ 0? %O =j!3OVERALL CATHETERIZATION LABORATORY NORMAL ANGIOGRAPHY RATE DOES NOT INCREASE WITH EMERGENCY ROOM ACTIVATION OF PRIMARY CORONARY INTERVENTION (PCI) FOR STEMI "Timothy J. Boyek M.D., Cindy Brockway, RN, Alain Efstratiou, M.D., Mian A. Jan, M.D., Joseph Lewis, M.D., Verdi J. DiSesa, M.D. The Cardiovascular Center at the Chester County Hospital, West Chester, PA&KP ! ,S4 BackgroundPrior multivariate analyses have demonstrated that ER physician activation of the PCI/Reperfusion process can result in a significant impact on overall reperfusion times. One national survey reported a reduction in time to reperfusion of 8.3 6.1 min (p=.010) if the ER physician activated the catheterization laboratory rather than the cardiologist (Bradley-2004) As a result of these findings current GAP-D2B Alliance strategy recommends ER physician activate the cath lab as a primary initiative for implementing a STEMI PCI process.C5 Background4Interventional cardiologists may be reluctant to advocate this approach due to concerns for laboratory overutilization with resultant effect on normal angiography rate for STEMI events. If ER attendings (as opposed to Cardiologists) initiate a primary PCI process some would suggest a higher incidence of patients will be found to have normal coronary anatomy. (i.e.  False Alarms ) Prior database reports described normal angiogram percentages in the 10-20% range for STEMI events for all cases presenting to a primary PCI site but have not addressed the possible impact on overall laboratory normal angiography events for STEMI procedures if ER activation occurs. Z,gJ 6 BackgroundzWe initiated such a protocol for activation of primary angioplasty by ER Attending ( Code PCI ) in a community hospital setting with PCI capability per current ACC/AHA guidelines in January 2005 Hospital Characteristics include: (Non profit) Community hospital in suburban Philadelphia Total Beds=220 Total Critical Care Beds=20 Participant in ACC/NCDR since inception of PCI program in 2001 24/7 staffed ER with 9 Board Certified ED physicians(7Study ObjectiveWe hypothesized the following: that ER Attending activation would increase the frequency of normal angiograms as reported by our institution to the ACC/NCDR registry. We were concerned that ER activation would increase utilization of the catheterization lab due to false positive activations. that despite an expected increase in normal angiography rate for STEMI events we predicted a decrease in D2B times.({{8 MethodsData elements regarding door to reperfusion times (as defined by ACC/NCDR) were collected prospectively from January 2005 until December 2005 (Control observation population). In January 2006 a protocol directing ER Attending physicians to initiate the  Code PCI process call began and similar elements were collected until March 2007.QP9 MethodsTraining Process included: Frequent ER physician didactic sessions with instruction to equate their prior fibrinolytic therapy experience with  Code PCI process (ie- if you would give lytics& call a code PCI) ACC/NCDR Definition of normal angiography per current data element described as  when all coronary branches had <50% stenosis ACC/NCDR Definition of Reperfusion time per current data element described as  date and time of intracoronary treatment device deployment (flow is re-established) Door to reperfusion times and frequency of normal angiograms were compared before and after implementation of this process.>ZZZbj -b : Results1Total Patient Case Mix/Demographics Gender/Race .02EResults2Total Patient Case Mix/Demographics Risk Factors .13; Results1Total Cases: Normal/STEMI n=15 pre vs n=10 post22% =Results >Results ?'Limitations of this Observational StudyNStudy size (n=95 vs 131, Normal n=15 pre vs n=10 post) Predominately Caucasian population Predominately Male population Unable to control for prior ER attending experience with lytic therapy which is not a universal learned experience prompting activation process Decrease in reperfusion times did not reach statistical significance (MO>@ Conclusions#There was no change in institutional normal angiography events in STEMI patients despite an actual increase in volume of primary angioplasty procedures recorded. (Total Cases n=95 pre vs n=131 post, Normal Angiography n=15 pre vs n=10 post p=0.941) We demonstrated a definite trend towards reduction in door to reperfusion times utilizing ER attending physician activation process (85.7m vs 77.2m) ER Attending activation is a simple process to implement allowing direct collaboration with the ED department and Interventional Cardiology Section.>) ` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@ ?" dd@   @ ` n?" dd@   @@``PR    @ ` ` p>>   >6;b(   [ BKCHDEF :;<$=5@FFhNYet:Tm*I]r`M<)o`PB4{%n` RC3$vuPj(_:!A`~*(D=]Tum"?[w%-4:@C/GOImJJIHF B+=I9h3,%0J[nK1+CZqcC$|Y'7/6<ADG`H;HGDA<8_0;( jI( ~fMp5S8jI)n]N@4](: hN4@`@`@  \ n BKCFDEFbbK3~oaR|Cs3l$d^XRMJFAx>U>1? CINX^dql`tP|?0!"3C|Trdjvb[TNIEA=<;;";);/:5:::@:F_FX%RMJGF{FXG6JMSY`hnrN|0 {l _T)G9;I0Z&k} $8K_t,@Sex",7CO!\/j>xLZgt1G^hs| {xsK"   ~V/,(&%""#&)-03567753/-mV>'pU9uY="iO8  !0ASydfwTD3$ 6Me~+D]|+FF( oQ!3)2;FP\ilwQ6l)U?=W'n2QvqgYK?3*=!` 9] 3Wy(1=JS^'i@uWo " 7K3@`@@F     BCDEF++!z$r)j/d8]DVSOdIz@1(((a(N>6z0d)S"D8/ )$!X\@`E  ^8   BzCDEXFbVVAA2"  !/<KZk|  ")09!A$J*_/u122zzffufYLA80)#vlaUG:-&.8DRaqHH@` D ^   B!CDEF }k[MA6-*'$",8!C$N(Y.b5j?rIyUbr  * ylbXNE=4,&}q e YK=0! ")1;uEjO`YUeKrB~:2+$ 0CVj~  !),0<8I@WIcRp]|gr}&2?KWcoz~th^RF 9,!!+6AKT]fov}o\H3* }ukaWK?2$RMHC>94/**@`@`V  c@   BCDE\Ff{g^S(A0ujaXQJC>:7410n-R-?-,/159?FOXbn|{nbVKA8/%6Sq &P{ 7c !A`"|+4=GR^jw(7DQ[dlsy}"8Met{wrle]UJ@4(' 19AP_oO]hqzu^H2zdC#sXr>c$S A/xgWgIH<)0$ xS+` 9$0<IjWLg.x q$_>OX@s3' #Cd| 4H!]'q-5<DM@`   BCDEF8Whw !)05|;r?gC\FQIFK;L/MMKHD?80&weSD6*  %A]{L"saXQJD?:6%2-/6,>*G(Z%p$%(*.38@HQ]ivkt|j@vdTF8+ 1CWn  !!(+.47<>DFLOSXZaalgvmrvz~*?S}fwyneYM@2"ppKK~xwsnlfd]\TTLKDB=86,/!)"  yeTD3$ $0d=dLL@`@`V`   B8CoDE F*HH[>>teV!H,<71C'O^l{  !.88ggkZRLGC@>=<z=t>m?gBaE[ITMNRB^7l-{# 3NJhJhooJ[J[>@`tVh  8BCDElFx}K ~vmg a[W"S*P2N:LCKLJVJ`JjKsM}OSW[agnw/Y !Oy)4>HQY`glqwzx}o~e[PF=}4{+y#tql g`ZRJ?5*Y'ee%%qeYOE<4-(x#j[K<, "&+18AIS]htvh^SI?7.' 4K bz0I `x")19BLW"b0l>xLWbmw *9MbtxmcWL>1# # @`@`y   B>CrDE0F<LLM>M>rrMQMQAAM  (08AJT_is|{sjc\VQLHE|CsBiA_BTCJEAH8L0Q(V \cjs {@`@`     BCDEFU%{pe\RK D>8%4.08-B*L(X'c%o$z%'(*-048>DKR\ep{ "(%,U./.,5(e" %/8@GMRW\_bdezfofcfXeLdBb8_.\%WRM G@8/%e5% =Si}$,4=GQ^i v)6BMWajqx}#5H\o}xqjaW/M>BL6[)gt }iS=%|eN8" t~gp[bLT>I/>3*!  o\H5#  !*3>ITbvpi~^QG=4,$ "8 Ne|@`@` Vk   BCsDEDFN-H-ss -e-e->-ssi--$(@`s V   BCDEF8Whw !)05{;r?gC]FQIFK;L0MMKHD?80&weSD6*  &@]{L"saXQJD?:6&2./6,>*G([%p$%(*.38@HQ]ivkt|j@veTF8, 1CWn  !!)+/46<>DFLOSXZbalgvmrvz~+?S}gwyneYM@2"ppKK~xwrnlfe]]TTLKDB=86-/!)"  yfTD4% $0e=eLL@`@`B V    BtCDEF.9KDxOYcnu { *2:AGLQUY]`bce$f<eTcj_YRJ@5/)!  sh^TKB:{2d*5ydQ@0"|i T>&  %-y5n>dGZQP\Gg?s70)" %7IZk| ##/;;;I IkZRKE@;730|-t+k)b(O%9$&%(+06<ENXdp|}xuromkkjlqx $0:CLT?eov~#4DR]g#n:rRtmt}rpmie`ZSLD:1')3<EMU^ekqv{p_N;)|xysfnUhCa1Y!RIA.@` V\   XBCDEFgPgA33'jWOHB=841.*'%$y%o'f(\*S-I1?56:-@$FMU _hs~ !8Ng7Ndy&08$>.E8JBNNRYUeXpY~Z\ZZXVTQNIE@:4-$&- 39?DIOSWZ]_{cXe44J_s|xsnhaZSK!A-88/B%KT]dkqv{r]I5"}wqiaWMB6)qe YNC:1)"}iR =%|e N8" $,4>IT`l~{pbTI>3*!( < Si (D"b-6g@`v V   BCpDEFffV V (3=HQX_ezjhmVoBp&o lkheb^ZVPKE=6/'{v qmifc`^\[}[%% % .&9+E/S1a3q32/-+($    qU 5 %%11V@` \   B>CDE,F6 e>e>ePeP%%e@`    BCDEF8Whw !)05};s?hC^FSIHK<L0M MKHD?80&weSD6* 'B^}L"saXQJ D?:6&2./6,@*H([%p$%(*.38@HQ]ivkt|kAweVG9,! 1CWn  #!)+047<?DHLPSYZbalgwmrvz~+AT}gw{neYM@2"ppKKzwtnlfe]^TVLMDC=86./")"  zfVF5% $0e=eLL@`@` V  B9CoDE F*HHZ>>teV!H,<71C'P]m|  !.99ggkZRLGC@>=<z=t>n?gBaEZITMNRC^7l-{" 3NJhJhooJZJZ>@`V   B*CDELFV U"vkaxXqPjIbB[=S8K4B09-0+'(&%$$&(,/4:z@lH`QTZIf=r2( 3Nj7^6Sp %0/>9KFWQc^mkvz} %0:EPYb~kxsp}h_UK?3%h5**xq^K8%~eN6  |o_P?.sdWJ=2v(Z?! ^< (c2G=-JWds~n]O B 66+N e~ (<Pcv  %2 ? @`O  0  BCDEFO, qh`WO IC=8'4/08,A)I'R%\$e$v%',29BMZizOOt_I4 yrj`zWmMaCU8J,@ 7.& ziVD1   )3=HTbwoj}^RH>5+# !8 Me{% <Rh}")3<EP[g s(5ALVaipw}!4GZn~~ytoibY'Q2H>>I4S(]fpxnZE00CU~h{ywsojc]WPIB: 1($- 3:?EIMQTVXYZZsZhY\WQUGR<N2I(D>7 /&s]G0ztt@`@`    BCpDEFllsfXL+A96G,W"fw  !6 @IS\e#m)u0}7>FOXcmxKKppK K x lbXPJEA?==>AwEgL_PXTPYH`Af;l4s.{(#  *;KYKYppKZKZ??@` >   `BC9DEFaajj  ")19BKWbo{kUKk "&*-l3U6>9&9963-*'#}yvqmkjoj@`M  0  BCDEFO, qh`WO IC= 8'4/08,@)J'S%\$f$u%',29BMZizOOt_I4 yriazXmNaCU8J,@ 7.& {iWD2!  )3=HTbvoj}^SH=4,$ !8 Me{% <Rh}"*2;FP[g s(5ALVaipw}!3GZn~~ytoibY'Q3H>>J4T(]gownZE00CUhzywsnid^WQJA9 1) $- 3:?EIMQTVXYZZsZgY\WRUGR<N2I)D>7 /&s]G0ztt@`@` >   B8CpDE F*HH[??ufV"I,=72C'O^l{  !.88hhlZSMHDA?==z=t>m@gBaE[ITMNRB_7l-|# 4OKgKgppK[K[?@`V  @  BWCDEXFd<<d<ee{0{`{{WW{A{ {{e/0@`@`<5}   pB CDEF##>wgwg C : 2/,)'!*>Y ||  ||Y>* ww>>wHL@`6 ! pB CDEF##=wgwg B : 2.+)& *>Y ||  ||Y>* ww==wHL@`6p " @BQCDEtF~^^www"w" ^ ^ QQ / /wQwQww^<@@`&6f # B"CDEFEEw"w" }}Z?+ ^ ^}hh^^wwwwusqmhbZQG: ""@`u6 $ BCDEFqq aD90'! }ul"e+_5Y@TOP^LoIGFEFGIK&O7SFXU^`djksty}}xrkbXL@#}wgXJu>k1^&QA1   vdT&D17>*J Xgw   @`5 p % @BQCDEtF~__www"w" _ _ QQ 0 0wQwQww_<@@`* 6j  & B!CDEFEEw!w! }}Z?+ ] ]}hh]]wwwwusqmhbZQG: !!@`z 6  ' BCDEF$<)I-V3`8i>pDwJ|RZbku~{wrlf_XQH@7-$ {hUA90(! zncWK A8/&#,6@ KXdq E=60*%  z q i aYRJC>"8'4-03,9*@(G'O&V'^(d)k,p/v3z8>L_u'3?JV`iry}naTE7){uNP@` 5  ( pB CDEF##=whwh D : 30-*'"*>Y ||  ||Y>* ww==wHL@` 63  ) B!CDEFEEw!w! }}Z?+ ^ ^}hh^^wwwwusqmhbZQG: !!@`A 6w 8 * BGCDETF`UU^ "'-3:AIPW^hr|~^^ w^w^`GGw,w | r"h"^"U MC;3+ $  " "ww@`@` 6  + BCDEFqq aD90'! ~vm"f+_5Z@UOP^MoJHFFFGIL&O7TFXU^`ejlsuy~}xrkbXL@#}xgYKu=k1^'QA1 vdT'D17=*K Ygx   @` 5+  , pBBCDEFEEFHKoN]QNV@[4a*i"px "*4@N]o&7GUakszxpzisak[aVUQGN7K&HFEE  0@&P0^<jIuV~cs~uj^P%@-05: ?ABA?:5w-e%UE7+ scVI <+07&EUe w@`@`? 5}  - B3CDE<FFOO ^ ^'^3`>bIdRhZlaqgvm{rvz}}{vrmgaZRJ@7-# 33  #/:F OYaipv}xj_T}KwBp:h3`.W)M&A$5"("" @` 6 @ . BECDE\Ff655wdwdw$w$ k EE  604@` 6  / pB CDEF##=wgwg B : 2/,)'!*>Y ||  ||Y>* ww==wHL@` 6P 8 0 BBCDEXFb d  BB  wwTTww! .0@`X 6 p 1 @BQCDEtF~^^www"w" ^ ^ QQ / /wQwQww^<@@` 6  2 pBBCDEFFFGIKoN]RNW@\4b*h"qy "*4@N]o&7GUakszyqzhsbk\aWURGN7K&IGFF 0@&P1^=jIuV~ds~uj^P%@.04: ?BBB?:4w.e%UE7+ sdVI =+17&EUew@`@` 5T  3 BCDEF$<)I.V3`9i?pEwK|SZblv{wrlf_XQH@7-$ |hUC:0(! zncWK A8/&$,6A LXes E=60*%  { s i aYRKE?":'4-03-9*@(G'O&V'^(d*k,p/v4z9?M_v'3?JV`iryoaTF8){uNP@`f 5  4 B*CDE@FLPP^  &,3:AKS\fr}^^ w^w^!%'|)q*f)['Q%G!=4,%  " "ww@`@` 6  5 BCDE4F> w"w" ^ ^ww @` 6 6 pB CDEF##=whwh C : 30-*'"*>Y ||  ||Y>* ww==wHL@`6F@ 7 BXCDEXFd<<d<ff{0{a{{XX{A{!{{f/0@`@`F5h 8 8BCDEpFz^wwwwvtrnjc\RG8w!w! ^ ^w:<@`6 Y BRCjDEF--R osuuutrqocXLB90( uf XJ:,dF(  !(09BLWalwxk`UKB8/' -<K\k{-< JZhv%,4>GQ[eq|  )2;DMV!]3cGh[mnpNs-t spnkhea\WrQbJTDF=75*-%}xregQ]<T'LD=60+'$q!YA* #&l*U/>5'<BJOV]dnv|nbUH<1' (7GWgx#4GXj|,:IVd#r.~:FS`n|   '(.021609/=-A*C'E$F DBA><o:K6)20/-+&!       waK5y`H/qYC,ygW&G56E'Vg x)=Sh}~|{zy+y@zV{k} 1CVgx*9 IY'j4CQ^jt~ #>Wr/Kf7Pwgne[RI@7.$ R];s# mR5(2<EMUf[G`(d gijjikgLd,` \VNF>q4S*5rX?{&dL4ow_ZQ<D7-#h F%`? &0;hFJR-_o~nU<$ 5OhugZ:NWAu7-% + Ji&E c #+5@+HARU\jfp{.@R \`@`` 0e  ^ 6\  P   T Click to edit Master title style! ! _ 0l_     RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S ` 0e  P    >* a 0  `0    @* b 0  P    @*B  s *޽h ? 33 ,Blank Presentation.pot0 0( 1;1   N,y pTpT )    n*  R))RR||  Nh;y pTpT  p) {  p*  R))RR||d  c $ ?q  { 4  Ny pTpT  Sw {  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S   TxOy pTpT  4  y  n*  R))RR||   Ty pTpT   p4 y  p*  R))RR||H  0:l ? ̙3380___PPT10. 0\" p((    Nv pTpT )  v  \* R))RR||  Nv pTpT  o) v  ^* R))RR||  Tؑv pTpT  3  v  \* R))RR||  Tدv pTpT   o3 v  ^* R))RR||H  0:l ? 3380___PPT10.|~  P4r(  4x 4 c $ ^P   x 4 c $ _ `   : 4 3 A LH 4 0޽h ? 33___PPT10i. c+D=' = @B +  `8x(  8~ 8 s *Ƞ ^   x 8 c $ _    : 8 3 A @H 8 0޽h ? 33___PPT10i.PjV+D=' = @B +  p<x(  <~ < s *t ^   x < c $H _= `   : < 3 AP @ H < 0޽h ? 33___PPT10i.PjV+D=' = @B +  @x(  @~ @ s * ^`0   x @ c $p _`    : @ 3 A @ H @ 0޽h ? 33___PPT10i.PjV+D=' = @B +  Dx(  D~ D s *H ^   x D c $ _    : D 3 AP @ H D 0޽h ? 33___PPT10i.PjV+D=' = @B +  Hx(  H~ H s *ͣ ^0 P   x H c $ͣ _    : H 3 AP @ H H 0޽h ? 33___PPT10i.PjV+D=' = @B +  Lx(  L~ L s *ӣ ^`0   x L c $֣ _`#   : L 3 A PH L 0޽h ? 33___PPT10i.PjV+D=' = @B +-  D<(P(  P~ P s *Lߣ ^p @   ~ P s *0 _`   : P 3 A` ` %P c $A <?  : < &P0  `A =? ?_ 3 =   'P0  `A >? ?_  $ >  ~ (P BA ?? ?  ?H P 0޽h ? 33___PPT10i.PjV+D=' = @B +  P t(  t~ t s * ^ `   ~ t s * _   n t c $A +? "`5  + t BA ,? ?"`  ,:  t 3 A0H t 0޽h ? 33___PPT10i.PjV+D=' = @B +  Tx(  T~ T s *, ^ 0 p   x T c $- _   : T 3 A 0zH T 0޽h ? 33___PPT10i.PjV+D=' = @B +i<  ;x;K_;(  \~ \ s *09 ^0 @   : p _ #"B6 fp( z_ BC ? r @ @` y_ BL ?Y r  @ @` x_ BT ?x rY  @ @` w_ B] ? rx  @ @` v_ Blf ?>r  @ @` u_ B8o ?r> @ @` t_ Bţ ? ,r @ @` s_ B, r a1.(#  @` o_ Bۣ ?,>r Cardiomyopathy, #  @` n_ B<{ ? , @ @` m_ B{ ?Y , @ @` l_ B{ ?x Y , @ @` k_ Bh{ ? x , @ @` j_ B{ ?>  , a1.(#  @` i_ B{ ? >, `MI, #  @` h_ B:{ ?   @ @` g_ B;{ ?Y  @ @` f_ BL{ ?x Y  @ @` e_ BT{ ? x  @ @` d_ Bx{ ?>   a1.(#  @` c_ B.{ ? >  eSyncope, #  @` b_ B{ ? Z   @ @` a_ B$ { ?Y Z  @ @` `_ BtY{ ?x Z Y  @ @` __ B{ ? Z x  @ @` ^_ B^{ ?>Z   a1.(#  @` ]_ Bh{ ?Z >  bRBBB, #  @` \_ B0r{ ?  Z  a3.(#  @` Z_ B{ ?x  Z  h Chest Pain,   #  @` Y_ B{ ?  x Z  @ @` X_ B{ ?>  Z  a1.(#  @` W_ B{ ? >Z   Cholecystitis,  #   @` V_ B{ ?   a2.(#  @` T_ B{ ?x    lGI Dysfunction, #  @` S_ B̒{ ? x   @