Risk Factors for Mortality in Children with Hypoxemia in Resource- Constrained Settings: A Secondary Analysis of the Global PARITY Study

Risk Factors for Mortality in Children with Hypoxemia in Resource- Constrained Settings: A Secondary Analysis of the Global PARITY Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk Factors for Mortality in Children with Hypoxemia in Resource- Constrained Settings: A Secondary Analysis of the Global PARITY Study Carter Biewen, Shän L Ward, Asya Agulnik, Srinivas Murthy, Qalab Abbas, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7143199/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Hypoxemia, a mortality predictor and hallmark of pediatric acute respiratory distress syndrome (PARDS), is disproportionately common in resource-constrained settings (RCS). The burden of PARDS in RCS is likely substantial considering the high prevalence of known clinical triggers (e.g., sepsis, pneumonia, trauma), but it is challenging to diagnose due to limited diagnostic resources. We aimed to: (1) describe respiratory care resource availability in RCS hospitals and test whether availability was associated with mortality; (2) determine the proportion of children who presented to RCS hospitals with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality. Methods We developed and applied operational definitions for five tiered respiratory care resource bundles. Through a secondary analysis of Global PARITY (Pediatric Acute Critical Illness Point Prevalence Study) data, we performed descriptive statistics, hypothesis testing (i.e. chi-square and Wilcoxon rank-sum tests), and logistic regression analyses. Results Among the entire Global PARITY cohort (n = 7538), 763 (10.1%) were admitted with hypoxemia. Seventy percent (n = 531) were treated at a site with the intermediate or less respiratory care resource bundle available. Mortality was 6.8% (n = 52) and inversely associated with respiratory resource availability. The odds of mortality were higher for patients treated at sites with the intermediate bundle or less compared to those with advanced or expert bundle available (adjusted OR 18, 95% CI 4.1–83). Fifty-six percent (n = 430) had a PARDS trigger, most commonly pneumonia (n = 256), bronchiolitis (n = 116) and sepsis (n = 58). There was no association between the presence of a PARDS trigger and mortality. Ninety-four percent of patients with a PARDS trigger (n = 405/430) had insufficient data available for a PARDS-related diagnosis according to the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines. Conclusions Children with hypoxemia treated at hospitals with respiratory care resource constraints had significantly higher mortality, highlighting the critical role of resource availability for outcomes. Ongoing work to strengthen health systems and support pediatric healthcare providers in identifying PARDS can help clinicians risk stratify children, focus resources, and tailor management to optimize outcomes. Pediatrics Global Health Critical Illness Hypoxemia Resource-Constrained Setting Pediatric Acute Respiratory Distress Syndrome (PARDS) Resource Utilization Figures Figure 1 Figure 2 Figure 3 Background Hypoxemia is common in children; the World Health Organization (WHO) reported a 31% prevalence of hypoxemia among children with WHO-classified pneumonia worldwide 1 , 2 . Hypoxemia is a known risk factor for mortality in certain pediatric disease states such as pneumonia and malaria 3 – 5 . In resource-constrained settings (RCS), where a lack of funds results in limited access to medications, equipment, and supplemental oxygen, less-developed infrastructure, and fewer or less-trained personnel 6 , 7 , hypoxemia is likely underappreciated, and mortality associated with hypoxemia is likely disproportionately high. In a recent survey of 238 hospitals in 60 countries, only 85% of intensive care units (ICUs) in low- and low-middle-income countries reported consistent availability of basic respiratory support (e.g. oxygen, suction, nebulizer) 6 . There is a suggested association between lack of resources and worse outcomes; for example, higher case fatality rates from lower respiratory tract infection (LRTI) have been observed in low- versus middle-income countries 8 . To date, limited pediatric studies in RCS have evaluated the association between respiratory care resource availability and mortality. LRTI is a common cause of hypoxemia in children and the leading cause of under-5 mortality worldwide outside of the neonatal period, with an estimated 700,000 deaths globally in 2022 9 . Pediatric acute respiratory distress syndrome (PARDS), a disorder of acute lung inflammation characterized by hypoxemia, can occur following severe LRTI and other acute triggers such as sepsis, trauma, aspiration, drowning, and shock. PARDS is associated with high mortality that requires specialized care for diagnosis and management 10 – 12 . In children admitted to the pediatric intensive care unit (PICU) with PARDS, mortality is higher in middle-income compared with high-income countries 13 , 14 . Little is known about PARDS in RCS where diagnostic resources may be lacking (e.g. pulse oximetry, chest x-ray, invasive and non-invasive positive pressure ventilation, blood gas analysis) 15 ; however, considering the high prevalence of clinical conditions known to trigger PARDS (e.g., sepsis, pneumonia, trauma), the morbidity and mortality of PARDS in RCS is suspected to be significant. An improved understanding of risk factors associated with poor outcomes in children with hypoxemia, and resources available to care for children with respiratory disease will facilitate further work to identify and optimize the management of children with acute hypoxemia in RCS. We hypothesized that decreased respiratory care resource availability was associated with increased mortality in children with hypoxemia presenting to RCS hospitals. Additionally, given resource constraints preventing accurate diagnosis of PARDS in these settings, we hypothesized that the presence of a PARDS trigger in children with hypoxemia was associated with increased mortality. The objectives of this study were to: (1) describe respiratory care resource availability in participating RCS hospitals and test whether it was associated with mortality among children with hypoxemia; (2) determine the proportion of children presenting to hospitals in RCS with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality. Methods Global PARITY dataset We performed a secondary analysis of the data from Global PARITY (Pediatric Acute Critical Illness Point Prevalence Study) 16 , which was an international, prospective point prevalence study aimed at estimating the burden of pediatric acute critical illness in RCS. The study was conducted during four sampling time points to capture seasonal variation over a 12-month period and enrolled 7538 patients across 46 sites in 19 countries (Fig S1 ). The Global PARITY population included children ages 29 days to 14 years evaluated for acute illness or injury in the emergency department (and subsequently discharged or admitted to the hospital) or directly admitted to an inpatient unit. Admitted children were assessed daily for clinical status and resource utilization over the initial seven days of admission and followed up to hospital day 30 for outcomes. In addition to case report forms for individual patients, participating sites reported hospital-level resource availability using a separate infrastructure and resource survey (Appendix 1). We adhered to a fully descriptive analytical approach, avoiding imputation, extrapolation, or modeling beyond the directly observed data. We followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines (Table S1 ). Participating sites Site-level hospital data included setting type (e.g., rural, urban), funding source (e.g., public, private, mixed), academic center designation (e.g. medical school affiliation), average daily hospital census, presence of a PICU, and pediatric intensivist availability. We summarized site-level data by socio-demographic index (SDI), a composite indicator of country development status that accounts for income, education, and fertility and is strongly correlated with health outcomes 7 . Only the four lowest SDI quintiles were represented (low, low-middle, middle, and high-middle). We also summarized sites by region according to the Global Burden of Disease Report, in which countries were grouped based on geographic proximity, epidemiologic similarity, and cause of death distribution similarity 17 . Respiratory care resources We determined essential respiratory care resources and created operational definitions of tiered resource bundles (categorized as one of five bundles from no bundle through expert ) informed by the literature 17 and in collaboration with a group of international experts developing a pediatric critical care resource evaluation tool for RCS 18 , 19 (Box 1). Box 1. Respiratory care resource bundles. We summarized respiratory care resource availability at each site by analyzing responses to the Global PARITY Hospital Resource Survey, which asked about the availability of all resources included in the bundles. A resource bundle was considered available at a site if at least 80% of the individual resources included in that bundle were reported to be “always” or “often” available on a five-point Likert scale. We reported the highest resource bundle available at each site; all bundles at or below the level reported were also available (e.g., sites with the advanced bundle available also had intermediate and basic bundles available). We summarized resource bundle availability by patient, site, and SDI. Pulse oximetry was defined as either portable or continuous oximetry. Intubation supplies were defined as laryngoscopes and endotracheal tubes. Sedation was defined as any of intravenous opioids, benzodiazepines, propofol, or ketamine. We reported resources utilized by patients during the first seven days of hospitalization as reported on the Global PARITY case report form. This included the highest level of respiratory support utilized by the patient (i.e., invasive mechanical ventilation, continuous positive airway pressure [CPAP], bilevel positive airway pressure [BiPAP], high-flow nasal cannula (HFNC), simple or low flow oxygen, none of these), whether a chest x-ray was obtained, if the patient required continuous sedation longer than four hours, and whether the patient required vasoactive medications (e.g., epinephrine, norepinephrine, dopamine). Patient population In this secondary analysis of Global PARITY data, we included only children with hypoxemia, defined as those having an oxygen saturation < 88% and/or receiving any form of supplemental oxygen within the first 7 days of hospital admission, or experiencing death in the emergency department with an oxygen saturation < 88% or while receiving supplemental oxygen. This oxygenation threshold of < 88% is consistent with the threshold used to define At-risk for PARDS from the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) 10 . We excluded patients with cyanotic heart disease (e.g., tetralogy of Fallot, truncus arteriosus, transposition of the great arteries, total or partial anomalous venous drainage, tricuspid atresia, undifferentiated “cyanotic” heart disease), as we could not determine baseline oxygen saturations. Patient-level data included demographics, comorbidities (e.g., malnutrition), Lambaréné Organ Dysfunction Score (LODS) on admission, PARDS diagnostic criteria (e.g., chest x-ray result, PARDS trigger, highest level of respiratory support, oxygen saturation, mean airway pressure six hours after starting mechanical ventilation, fraction of inspired oxygen six hours after starting mechanical ventilation), and final diagnoses. Malnutrition was considered present if the mid-upper arm circumference was less than 12.5cm, the weight-for-age Z-score was < -2, or comorbid malnutrition was reported on the initial intake form. The LODS, a simple mortality prediction score developed and validated in malaria endemic regions 20 , was used as a marker of severity of illness and calculated on a three-point scale using the presence of prostration (or inability to feed if < 5 months), coma (Blantyre Coma Score < 3, Glasgow Coma Score ≤ 8 or reported unconscious) and deep breathing. The primary outcome was in-hospital mortality. The secondary outcome was hospital length of stay (LOS) among survivors. Patients were categorized into two groups: those with a PARDS trigger, defined as a final diagnosis of pneumonia, bronchiolitis 21 , coronavirus disease of 2019 (COVID-19), sepsis, trauma, aspiration, drowning, or other shock 13 , and those without a reported PARDS trigger (e.g., gastroenteritis, acute malaria, meningitis/encephalitis, status epilepticus, asthma). Patients with pneumonia, bronchiolitis and/or COVID-19 were collectively categorized as LRTI. Patients with sepsis and trauma were analyzed independently. Patients with aspiration, drowning, or other shock were combined to comprise an “other” PARDS trigger group for analysis due to a limited number of patients with these diagnoses. PARDS diagnosis and severity were determined according to criteria from PALICC-2 22 (Table S2). Due to a lack of blood gas data, the saturation/fraction of the inspired oxygen ratio was used to determine oxygenation impairment. Children with a PARDS trigger, as listed above, were then categorized as having PARDS, Possible PARDS, or At-risk for PARDS. PARDS criteria included all of the following: an opacity on chest x-ray, need for positive pressure ventilation, and meeting oxygenation criteria. Airway pressure data were not captured, so we were unable to determine if patients receiving non-invasive positive pressure ventilation met PARDS criteria. In patients with an oxygen saturation > 97%, we were unable to use the oxygenation criteria for PARDS diagnosis as the oxyhemoglobin dissociation curve flattens above 97% 23 . Possible PARDS criteria included need for nasal respiratory support (positive pressure or HFNC) and meeting oxygenation criteria in the absence of chest x-ray results. At-risk for PARDS criteria included an opacity on chest x-ray and need for oxygen supplementation via any interface, without satisfying the criteria for PARDS or Possible PARDS. Minimum acceptable liter flow thresholds for Possible PARDS and At-risk for PARDS diagnosis were established in accordance with PALICC-2 22 . We assumed that patients did not have perinatal lung disease due to the study inclusion criteria (> 28 days), and the fact that all were admitted from home with no documentation of chronic respiratory conditions in the case report forms. Chronic lung disease was considered unlikely in patients without pre-existing pulmonary diagnoses documented in the case report forms at the time of admission. If diagnosed with a PARDS trigger, we assumed that they were within 7 days of the clinical insult having presented to the hospital acutely. Case report forms indicated the presence, location, and interpretation of chest imaging opacification; the case report form did not specify by whom the interpretation was provided (i.e., clinician or radiologist). When interpretation assessing whether opacities were due to atelectasis, cardiac failure, or fluid overload was not available, we assumed that an opacification represented acute pulmonary parenchymal disease. To assess oxygenation, we used the data collected for mean airway pressure, fraction of inspired oxygen, and oxygen saturation documented six hours after starting mechanical ventilation. Statistical analysis: All statistical analyses were performed using STATA 17.0. We performed descriptive statistics to summarize site-, resource- and patient-level data, which are presented as frequencies (percentage), means (standard deviation, SD), or medians (interquartile range, IQR) as appropriate given the underlying data and data distribution. We compared differences between groups (e.g., PARDS trigger vs. no PARDS trigger, survivors vs. non-survivors) using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. A p-value < 0.05 was considered statistically significant. To test whether respiratory care resource bundle availability was associated with mortality, we performed univariate and multivariable logistic regression modeling controlling for confounders – average daily hospital census (> 50 patients), PICU availability, and academic center designation – that were determined a priori based on our hypotheses and directed acyclic graph (Fig S2). For these analyses, we categorized patients into two resource bundle groups based on mortality trends (intermediate or less, and advanced or expert). To test whether the presence of a PARDS trigger was associated with mortality, we performed univariate and multivariable logistic regression modeling controlling for confounders: age (≤ 5 years), presence of malnutrition, LODS (> 0), and site respiratory care resource availability (two groups as above). Confounders were determined a priori based on our hypotheses (Fig S3) and a review of the literature 8 , 20 , 24 , 25 . We reported unadjusted and adjusted odds ratios (OR) with 95% confidence intervals. Results Sites Of the 46 participating Global PARITY sites, most were located in Sub-Saharan Africa (n = 18, 39%) and Latin America/Caribbean (n = 14, 30%). Sites were evenly distributed between the four lowest SDI quintiles: low SDI (n = 10, 22%), low-middle SDI (n = 13, 28%), middle SDI (n = 13, 28%), and high-middle SDI (n = 10, 22%). Eighty-nine percent of sites (n = 41) were in an urban setting and 72% (n = 33) were designated academic centers. Thirty-nine percent of sites (n = 18) had an average daily pediatric census of greater than 50 patients. Sixty-five percent of sites (n = 30) reported a PICU available, and 54% (n = 25) reported a pediatric intensivist available during the weekday in the hospital. Respiratory care resources Three sites (6.5%) did not meet the minimal requirements of the basic respiratory care resource bundle and were categorized as having no bundle available. Eleven (24%) had the basic bundle, 13 (28%) had the intermediate bundle, 16 (35%) had the advanced bundle, and three (6.5%) had the expert bundle available. Of all Global Burden of Disease regions, Sub-Saharan Africa had the highest proportion of sites with less than the intermediate resource bundle available (56%). In general, respiratory care resource availability increased with increasing SDI (Fig S4). In low- and low-middle SDI countries, HFNC and non-invasive positive pressure ventilation were each available at 13 sites (57%) and conventional mechanical ventilation at 14 of 23 sites (60%) (Table S3). Patient characteristics Of the entire Global PARITY cohort, 763 of 7538 patients (10.1%) experienced hypoxemia while hospitalized and were included in this secondary analysis (Fig. 1 ). Characteristics of children with hypoxemia are presented in Table 1 . The median age was 1.9 years (IQR 0.6-5years) and 44% (n = 336) were female. Forty-five percent of patients (n = 343) were treated at a site in a low SDI quintile country. Seventy percent of patients (n = 531) were treated at a site with the intermediate respiratory care resource bundle or less available. Of 430 children with hypoxemia and a PARDS trigger, the most common triggers were pneumonia (n = 256, 60%), bronchiolitis (n = 116, 27%) and sepsis (n = 58, 13%). Compared to children without a PARDS trigger, children with a PARDS trigger were younger, had lower oxygen saturation and higher LODS on admission (Table 1 ). Respiratory resource utilization was similar between those with and without a PARDS trigger (Table S4). Table 1 Characteristics of hypoxemic children with or without a PARDS trigger admitted to resource-constrained hospitals Characteristics Total (n = 763) PARDS trigger (n = 430) No PARDS trigger (n = 333) Missing data n (%) p-value Age (years), median(IQR) 1.9 (0.6-5) 1 (0.4-3) 3 (1.2-7) - < 0.001 Female, n(%) 336 (44) 190 (44) 146 (44) 1 (0.1) 0.5 Weight (kilograms), median (IQR) 10 (6.5–16) 8.4 (5.7–13) 13.3 (8.7–20) 77 (10) < 0.001 SpO2 (%) on admission, median (IQR) 95 (91–98) 94 (89–98) 96 (92–98) 35(4.6) < 0.001 Malnutrition, n (%) 196 (26) 114 (27) 82 (25) - 0.55 LODS, median (IQR) 1 (0–1) 1 (0–1) 0 (0–1) - < 0.001 Global Burden of Disease Region - 0.14 SSA, n (%) 267(35) 156 (36) 111 (33) SA, n (%) 222 (29) 119 (28) 103 (31) LA, n (%) 169 (22) 92 (21) 77 (23) CE, n (%) 22 (2.9) 10 (2.3) 12 (3.6) NA, n (%) 15 (2.0) 13 (3.0) 2 (0.6) SLA, n (%) 68 (8.9) 40 (9.3) 28 (8.4) Socio-demographic Index - 0.08 Low, n(%) 343(45) 202 (47) 141 (42) Low-Middle, n(%) 168 (22) 83 (19) 85 (26) Middle, n(%) 168 (22) 91 (21) 77 (23) High-Middle, n(%) 84 (11) 54 (13) 30 (9.0) P values < 0.05 represent a significant difference in characteristic distribution between groups, calculated with a chi-square test (categorical variables) or Wilcoxon rank-sum test (continuous variables). PARDS pediatric acute respiratory distress syndrome; IQR interquartile range; SpO2 oxygen saturation; LODS Lambaréné Organ Dysfunction Score; CE Central Europe, Eastern Europe, and Central Asia; LA Latin America and Caribbean; SLA Southern Latin America; NA North Africa and Middle East; SA South Asia; SSA Sub-Saharan Africa Of the 430 children with a PARDS trigger, 369 (86%) received HFNC or simple oxygen and 54 (13%) received either invasive (n = 27) or non-invasive (n = 27) mechanical ventilation. Only 25 (5.8%) patients had sufficient data to consider any PARDS-related diagnosis (Fig. 2 ). The most commonly missing data required to make a PARDS diagnosis were fraction of inspired oxygen, mean airway pressure and type of non-invasive interface for children receiving mechanical ventilation (Table S5); these data were more likely to be missing from sites in lower SDI quintile countries (Table S6). Five of 12 patients (42%) with sufficient data for a diagnosis of PARDS met PARDS criteria. Three of eight eligible patients (38%) met criteria for Possible PARDS. Of the remaining 14 patients with sufficient data who did not meet PARDS or Possible PARDS criteria, six patients (43%) met At-risk for PARDS criteria according to PALICC-2 guidelines (Fig S5). Outcomes In-hospital mortality among children with hypoxemia was 6.8% (n = 52/763) compared to 0.8% (n = 16/1907) for patients admitted to the hospital without hypoxemia (p < 0.001). Among children admitted with hypoxemia, those who died were older (median 3.5 years [interquartile range (IQR) 0.5-4] vs. 1.9 years [IQR 0.7–7.5], p = 0.02) and more likely to be malnourished (n = 21 [40%] vs. n = 176 [25%], p = 0.01). Most patients were admitted in a country with low- or low-middle SDI (n = 49, 94%), and the highest mortality was observed in Sub-Saharan Africa (n = 33, 12%) (Table S7). Simple oxygen supplementation was the most common respiratory resource utilized by children with hypoxia in both the survivors and non-survivors (n = 530 [75%] and n = 23 [44%], respectively). (Table S8). Mortality differed by respiratory care resource bundle availability with the highest mortality at the sites with no bundle (n = 10/81 [12%]), the intermediate (n = 21/177 [12%]), and the basic bundles (n = 19/273 [7%]), as compared to the advanced (n = 1/189 [0.5%]) and expert (n = 1/43 [2.3%], p < 0.001) bundles (Fig. 3 ). Patients treated at sites with the intermediate, basic, or no bundles had higher odds of mortality compared to those treated at sites with the advanced or expert bundles (OR 18, 95% CI 4.1–83) when adjusted for average daily hospital census, PICU availability, and academic center designation. The presence of a PARDS trigger was not associated with mortality. Twenty-six patients with a PARDS trigger died (6%). The unadjusted OR for mortality in patients with a PARDS trigger compared to patients without a PARDS trigger was 0.76 (95%CI 0.43–1.3) and the adjusted OR was 0.56 (95% CI 0.30–1.04; adjusted for resource availability, age, malnutrition, and LODS). The median hospital LOS among survivors was 3.25 days (IQR 1-6.6 days). Median hospital LOS among survivors was longer for children with a PARDS trigger compared to those with no PARDS trigger (median 4 days [IQR 1.8-7] vs. 2.6 days [IQR 1-5.8], p < 0.001). Conclusions We found that hypoxemia was common (10%) in children presenting to RCS hospitals, 70% of children with hypoxemia were treated at sites with an intermediate or less respiratory care resource bundle, and mortality was inversely associated with both respiratory care resource availability and SDI. This is consistent with prior studies demonstrating higher mortality with decreasing country development level 8 , 13 , 24 . Only two of 232 (< 1%) hypoxemic patients died when the advanced or expert respiratory care resource bundle was available compared with 50 of 531 (9.4%) patients when the intermediate bundle or less were available. These findings suggest that hospitals with resource constraints care for a high burden of respiratory illness and have higher associated mortality; this highlights the urgent need to optimize resources to ensure all hospitals can provide appropriate respiratory care to children with hypoxemia. Despite consensus recommendations from the WHO for the management of hypoxemia, there exists heterogeneity in the identification and management of hypoxemia due to resource constraints, cost, practice variation, and lack of standardized protocols 2 , 15 , 26 – 28 . Successfully caring for children with hypoxemia relies on timely recognition, sufficient resources, provider training in the management of pediatric respiratory illness, and coordination of a complex healthcare system. Policies and funding should support interventions focused on these areas and be implemented thoughtfully based on local healthcare systems, disease burden, and resource needs 6 , 16 . This secondary analysis also illustrated the significant burden of hypoxemia in RCS, both with respect to prevalence (10%) and associated inpatient mortality (6.8%). This is consistent with hypoxemia prevalence previously reported in a pediatric cohort admitted to hospitals in southwest Nigeria (10.2%) 1 , as well as a pediatric cohort with non-severe pneumonia in low- and middle-income country hospitals (8%) 1,2 . The 6.8% mortality from this study was higher than the reported case fatality rate of children admitted with hypoxemia in southwest Nigeria (3.4–5.6%) 1 and fell between the 28-day mortality of children hospitalized in Uganda or Kenya with pneumonia and hypoxemia (~ 4%) or severe hypoxemia (~ 20%) who received no support, low- or high-flow nasal cannula 29 . We believe that the heterogeneity in site resource availability in this study contributed to the lower observed mortality as compared to previously published estimates in children with severe hypoxemia from single countries. Through this secondary analysis, we gained insight into the applicability of PALICC-2 criteria in RCS, finding that 94% of children with hypoxemia and a PARDS trigger receiving respiratory support had insufficient data available to make a PARDS-related diagnosis. PALICC-2 criteria were designed to be more inclusive of resource-variable settings and were used to inform the Global PARITY data collection form; however, missing data limited the ability to diagnose Possible PARDS and risk-stratify children with hypoxemia in this cohort. Given the challenges associated with identifying PARDS, it would be valuable to further explore the underlying reasons for missing data. Importantly, a diagnosis of PARDS, Possible or At-risk for PARDS was limited by lack of mean airway and positive pressure settings and liter flow data, which were not collected despite being fields on the case report form for those receiving non-invasive ventilation, HFNC, or simple oxygen. Hospitals in lower SDI countries may face greater challenges with clinical data collection, documentation, measurement, and/or electronic data entry, all of which could be influenced by resource availability and systemic factors. This study did not provide funding for research staff, and prior work has demonstrated that human resource shortages contribute to challenges with vital sign measurement and documentation 30 . Furthermore, it is plausible that centers with extreme resource constraints may lack the diagnostic capacity (e.g., chest imaging), clinical infrastructure (e.g., advanced ventilator support), and trained personnel necessary to systematically and efficiently confirm PARDS according to PALICC-2 criteria; this may contribute to under-recognition or misclassification of PARDS in resource-constrained settings. Future research could examine how these systemic limitations influence the epidemiology of PARDS. As PARDS remains an elusive diagnosis in RCS, we hypothesized that the presence of a PARDS trigger would be associated with mortality; however, we did not find this to be the case. This analysis was likely underpowered to detect an association given the overall low number of mortality events. Additionally, PARDS triggers may have been underappreciated; for example, sepsis is also a difficult diagnosis to make accurately in resource-constrained settings. Furthermore, the presence of a PARDS trigger is not a definitive diagnosis of PARDS. Another possible explanation for this lack of association is that other variables (e.g., malnutrition and resource availability) were more influential than lung injury in determining clinical outcomes in RCS. Cornerstones of PARDS management include the identification of hypoxemia, oxygen therapy, followed by lung protective respiratory support including non-invasive and invasive mechanical ventilation; children with “possible PARDS” should ideally be managed as if they have PARDS 10 . Given these proven beneficial management strategies, a crucial step in improving outcomes of children with PARDS in RCS is having the ability to make a timely PARDS diagnosis. Just as critical is the identification of children with Possible PARDS or At-risk for PARDS to facilitate the implementation of strategies to prevent lung disease progression and clinical deterioration. For these reasons, pulse oximetry, organized clinical data collection, and improved documentation should be prioritized in RCS. We acknowledge several limitations related to data availability and the inherent constraints of secondary analyses. While we found an association between mortality and respiratory care resource constraints, we were unable to determine if deaths were directly attributable to respiratory disease or preventable with improved respiratory care resources. However, given that hypoxemia is a strong predictor of mortality and a driver of organ failure 2 , it is reasonable to infer that the burden of mortality and organ dysfunction could have been mitigated with better respiratory support and oxygen delivery. Though we could not account for all confounders in RCS where hospitals are may be hindered by challenges beyond limited respiratory care resources (e.g. other resource infrastructure, sanitation practices, safety protocols, staff training, etc.), our findings demonstrate important resource limitations in areas where hypoxemia is common and hypoxemia-related deaths are high. Additionally, we likely did not capture all patients with hypoxemia. The exclusion of children with reported cyanotic heart disease, many of whom were diagnosed with LRTI or sepsis, may have led to an underestimation of mortality, as we would expect these children to be at higher risk of death from infections. Additionally, we did not capture patients who developed hypoxemia after day seven of hospital admission, after which, daily data were not collected. Late-onset hypoxemia, however, is more likely to represent complications of hospitalization (e.g., hospital-acquired pneumonia and sepsis), though exclusion of these patients may have underestimated the PARDS trigger subgroup and associated mortality. Conversely, there were limitations that likely overestimated the cohort size. Pulse oximetry is not perfectly accurate 31 and we may have included patients with false or brief transient hypoxemia. For example, we included 16 children with documented hypoxemia who survived without receiving respiratory support, potentially leading to an underestimation of mortality. Finally, selection and reporting biases were unavoidable. The site and patient representation varied across RCS globally, and data availability and accuracy were dependent on clinician diagnosis and reporting. Despite these limitations, we believe the study findings are generalizable to pediatric populations in RCS and informative to future work. This study demonstrated that children with hypoxemia in RCS are at increased risk of mortality when respiratory care resources are limited. Additionally, despite the new PALICC-2 criteria, PARDS remains challenging to diagnose in RCS and the presence of a PARDS trigger, as a proxy for PARDS, was not associated with mortality. These findings suggest that mortality may depend more on other factors such as resource availability rather than underlying pathophysiology in RCS. Therefore, ongoing work to strengthen systems and optimize respiratory care resources should be prioritized to reduce inequities. This includes ensuring availability of pulse oximetry to consistently identify children with hypoxemia, oxygen therapy as a minimum basic standard of care, and more advanced infrastructure where feasible. Future initiatives should also focus on global engagement and support of pediatric healthcare providers to promote the implementation of PALICC-2 criteria in RCS to improve diagnosis and management of PARDS. Collectively, these efforts can help clinicians risk-stratify children, allocate available limited resources, and tailor management to optimize clinical outcomes. Abbreviations BiPAP: bilevel positive airway pressure, COVID-19: coronavirus disease of 2019, CPAP: continuous positive airway pressure, HFNC: high-flow nasal cannula, ICU: intensive care unit, IQR: interquartile range, LODS: Lambaréné Organ Dysfunction Score; LOS: length of stay, LRTI: lower respiratory tract infection, PALICC-2: Second Pediatric Acute Lung Injury Consensus Conference, PARDS: pediatric acute respiratory distress syndrome, PARITY: Pediatric Acute Critical Illness Point Prevalence Study, PICU: pediatric intensive care unit, RCS: resource-constrained setting(s), SD: standard deviation, SDI: socio-demographic index, STROBE: Strengthening the Reporting of Observational Studies in Epidemiology, WHO: World Health Organization Declarations Ethics approval and consent to participate: The study was coordinated by the Department of Pediatrics at the University of Maryland and was deemed exempt by the University of Maryland Institutional Review Board (IRB, HP-00086107). It was reviewed and approved by each site prior to data collection. Consent for publication: Not applicable. Availability of data and materials: Study materials, including the template data collection forms, data dictionary, deidentified data used for all analyses, analytic code, and other study-related materials, will be publicly available at https://borealisdata.ca/dataverse/Pedi_SepsisCoLab. Approval from the PALISI Global Health sub-group and a signed data access agreement will be required for publications related to these data. Global PARITY Investigators (all listed Global PARITY Investigator Authors met ICMJE criteria for authorship): Alhassan Abdul-Mumin, Nabisere Allen, Paloma Amarillo, Kokou Amegan-Aho, John Appiah, Pamela Arancibia, Anita Arias, Fehmina Arif, Liliana Arteaga, Jacqueline Asibey, Jonah Attebery, Nataly Ávila Guerrero, Tigist Bacha, Briam Beltran Hernandez, Hippolyte Bwiza Muhire, Juan Calderon-Cardenas, Jhon Camacho-Cruz, Mariana Lucía Cañete, Paula Caporal, Dulamragchaa Chimedbazar, Claudia Curi, Karla Emilia de Sa Rodrigues, Tenywa Emmanuel, Maria Escobar, Sofia Esposto, Arieth Figueroa Vargas, Ericka Fink, Ana Fustiñana, Marina Giulietti, Stephanie Gordon Rivera, Muhammad Irfan Habib, Pascal Havugarurema, David He, Lucia Hernandez Somerson, Nayibe Hincapie Saldarriaga, Shubhada Hooli, Jacob Isabirye, Saifullah Jamro, Juan Jaramillo-Bustamante, Liliana Jurado Salcedo, Halima Kabir, Caleb Karanja, Adama Mamby Keita, Marie-Charlyne Kilba, Niranjan Kissoon, Guillermo Kohn-Loncarica, Kandamaran Krishnamurthy, Jorhk Lasso Noguera, Marianne Majdalani, Isabel Monje Cardona, Emilse Montero Nuñez, Celia Mulgado Aguas, Raya Mussa, Fiona Muttalib, John Nebaza, Katie Nielsen, María Noya, Edna Obodai, Carmen Ocampo, Çağlar Ödek, Tagbo Oguonu, Afua Osew-Gyamfi, Sheila Owusu, Larko Owusu, Mayerly Palencia Bocarejo, Freddy Pantoja Chamorro, Aurora Pedroza, Walugembe Peter, Javier Prego, Amal Rahi, Carmen Ramírez Hernández, Kenneth Remy, Pedro Rino, Adriana Teixeira Rodrigues, Firas Sakaan, Jhuma Sankar, Hendry Sawe, Jesus Serra, Agustin Shaieb, Arianna Shirk, Enkhtur Shonkhuuz, Javier Sierra-Abaunza, Khurram Soomro, Samba Sow, Abner Tagoola, Atnafu Tekleab, Margarita Torres, Pablo Vasquez-Hoyos, Amelie von Saint Andre-von Arnim, Justin Wang, Rafiuk Yakubu, Rita Yeboah, María Zamarbide. Affiliations for the Global PARITY Investigator Authors are provided in the Appendix. Competing interests: JHL has received support from the National Medical Research Council, Singapore (MOH-TA19nov-001) and from the Thrasher Foundation, USA. Dr. Robinder G. Khemani is a paid medical advisor for Nihon Kohden/Orange Med. All other authors declare no competing interests. . Funding: Research effort to create this publication was supported by the National Institute of Allergy and Infectious Diseases (numbers K23AI144029 [TK] and 5U01AI126610 [AB]) of the National Institutes of Health (NIH); the National Cancer Institute (number R37CA276215–01 [AA]) of the NIH; the National Medical Research Council, Singapore (MOH-TA19nov-001 [JHL]); the President’s Global Impact Fund, University of Maryland, Baltimore (AH and AB); and the Thrasher Foundation (JHL and RGK). The views expressed are those of the author(s) and not necessarily those of the funders. Authors’ contributions: C.B., S.L.W., A.A., S.M., A.B., A.H., R.G.K., and T.B.K. conceptualized the study. C.B., S.L.W., A.A., S.M., A.B., A.H., M.O.W., R.G.K., and T.B.K. developed the methodology. C.B., S.L.W., and T.B.K. contributed to software, validation, and formal analysis. A.A., S.M., Q.A., A.B., A.H., J.H.L., E.L.B., C.U., M.O.W., and T.B.K. conducted the investigation. A.B., A.H., R.G.K., and T.B.K. provided resources. C.B., A.B., A.H., M.O.W., and T.B.K. curated the data. C.B. wrote the original draft. C.B., S.L.W., A.A., S.M., Q.A., J.B.M., A.B., A.H., J.H.L., E.L.B., C.U., M.O.W., R.G.K., and T.B.K. reviewed and edited the manuscript. C.B., J.B.M., and T.B.K. prepared the visualizations. S.L.W., R.G.K., and T.B.K. supervised the project. C.B. and T.B.K. administered the project. A.B., A.H., and T.B.K. acquired funding. All authors reviewed the manuscript. Acknowledgements: We thank the Global PARITY Study Collaborators (see Appendix) who made a substantial contribution to at least one of the following areas: the conception or design of the work; or the acquisition, analysis, or interpretation of data; or drafting the work or revising it critically for important intellectual content. We thank Mary Dahmer and Jennifer Muszynski for their thoughtful review of the manuscript draft. Finally, we thank all the patients and families that participated in this study. References Graham H, Bakare AA, Ayede AI, et al. Hypoxaemia in hospitalised children and neonates: A prospective cohort study in Nigerian secondary-level hospitals. EClinicalMedicine . Nov 2019;16:51-63. doi:10.1016/j.eclinm.2019.10.009 Rahman AE, Hossain AT, Nair H, et al. Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health . Mar 2022;10(3):e348-e359. doi:10.1016/S2214-109X(21)00586-6 Subhi R, Adamson M, Campbell H, et al. The prevalence of hypoxaemia among ill children in developing countries: a systematic review. Lancet Infect Dis . Apr 2009;9(4):219-27. doi:10.1016/S1473-3099(09)70071-4 Lazzerini M, Sonego M, Pellegrin MC. Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis. PLoS One . 2015;10(9):e0136166. doi:10.1371/journal.pone.0136166 Orimadegun A, Ogunbosi B, Orimadegun B. Hypoxemia predicts death from severe falciparum malaria among children under 5 years of age in Nigeria: the need for pulse oximetry in case management. Afr Health Sci . Jun 2014;14(2):397-407. doi:10.4314/ahs.v14i2.16 Muttalib F, Gonzalez-Dambrauskas S, Lee JH, et al. Pediatric Emergency and Critical Care Resources and Infrastructure in Resource-Limited Settings: A Multicountry Survey. Crit Care Med . Apr 1 2021;49(4):671-681. doi:10.1097/CCM.0000000000004769 Abbas Q, Holloway A, Caporal P, et al. Global PARITY: Study Design for a Multi-Centered, International Point Prevalence Study to Estimate the Burden of Pediatric Acute Critical Illness in Resource-Limited Settings. Front Pediatr . 2021;9:793326. doi:10.3389/fped.2021.793326 McAllister DA, Liu L, Shi T, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health . Jan 2019;7(1):e47-e57. doi:10.1016/S2214-109X(18)30408-X United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), Levels & Trends in Child Mortality: Report 2023, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation, United Nations Children’s Fund, New York, 2024. Emeriaud G, Lopez-Fernandez YM, Iyer NP, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med . Feb 1 2023;24(2):143-168. doi:10.1097/PCC.0000000000003147 Wong JJ, Jit M, Sultana R, et al. Mortality in Pediatric Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. J Intensive Care Med . Jul 2019;34(7):563-571. doi:10.1177/0885066617705109 Schouten LR, Veltkamp F, Bos AP, et al. Incidence and Mortality of Acute Respiratory Distress Syndrome in Children: A Systematic Review and Meta-Analysis. Crit Care Med . Apr 2016;44(4):819-29. doi:10.1097/CCM.0000000000001388 Khemani RG, Smith L, Lopez-Fernandez YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med . Feb 2019;7(2):115-128. doi:10.1016/S2213-2600(18)30344-8 Gupta S, Sankar J, Lodha R, Kabra SK. Comparison of Prevalence and Outcomes of Pediatric Acute Respiratory Distress Syndrome Using Pediatric Acute Lung Injury Consensus Conference Criteria and Berlin Definition. Front Pediatr . 2018;6:93. doi:10.3389/fped.2018.00093 Morrow BM, Agulnik A, Brunow de Carvalho W, et al. Diagnostic, Management, and Research Considerations for Pediatric Acute Respiratory Distress Syndrome in Resource-Limited Settings: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med . Feb 1 2023;24(12 Suppl 2):S148-S159. doi:10.1097/PCC.0000000000003166 Kortz TB, Holloway A, Agulnik A, et al. Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study. Lancet Glob Health . Feb 2025;13(2):e212-e221. doi:10.1016/S2214-109X(24)00450-9 Diseases GBD, Injuries C. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet . May 18 2024;403(10440):2133-2161. doi:10.1016/S0140-6736(24)00757-8 Schell CO, Khalid K, Wharton-Smith A, et al. Essential Emergency and Critical Care: a consensus among global clinical experts. BMJ Glob Health . Sep 2021;6(9)doi:10.1136/bmjgh-2021-006585 Arias A. Development of a Novel Pediatric Critical Care Resource Evaluation (CRITCARE) Tool for Hospitals in Resource Variable Settings. Poster Abstract. Pediatric Critical Care Medicine . 2024;25(11S):p e40doi:10.1097/01.pcc.0001084868.64857.7e Helbok R, Kendjo E, Issifou S, et al. The Lambarene Organ Dysfunction Score (LODS) is a simple clinical predictor of fatal malaria in African children. J Infect Dis . Dec 15 2009;200(12):1834-41. doi:10.1086/648409 Ghazaly MMH, Abu Faddan NH, Raafat DM, Mohammed NA, Nadel S. Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome. Eur J Pediatr . Apr 2021;180(4):1229-1234. doi:10.1007/s00431-020-03852-9 Yehya N, Smith L, Thomas NJ, et al. Definition, Incidence, and Epidemiology of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med . Feb 1 2023;24(12 Suppl 2):S87-S98. doi:10.1097/PCC.0000000000003161 Lobete C, Medina A, Rey C, Mayordomo-Colunga J, Concha A, Menendez S. Correlation of oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen ratio with Pao2/fraction of inspired oxygen ratio in a heterogeneous sample of critically ill children. J Crit Care . Aug 2013;28(4):538 e1-7. doi:10.1016/j.jcrc.2012.12.006 Tan B, Wong JJ, Sultana R, et al. Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. JAMA Pediatr . Apr 1 2019;173(4):352-362. doi:10.1001/jamapediatrics.2018.4839 Hill K, Zimmerman L, Jamison DT. Mortality risks in children aged 5-14 years in low-income and middle-income countries: a systematic empirical analysis. Lancet Glob Health . Oct 2015;3(10):e609-16. doi:10.1016/S2214-109X(15)00044-3 Cheifetz IM. Pediatric ARDS. Respir Care . Jun 2017;62(6):718-731. doi:10.4187/respcare.05591 Hon KL, Leung KKY, Oberender F, Leung AK. Paediatrics: how to manage acute respiratory distress syndrome. Drugs Context . 2021;10doi:10.7573/dic.2021-1-9 Fernando SM, Ferreyro BL, Urner M, Munshi L, Fan E. Diagnosis and management of acute respiratory distress syndrome. CMAJ . May 25 2021;193(21):E761-E768. doi:10.1503/cmaj.202661 Maitland K, Kiguli S, Olupot-Olupot P, et al. Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia. Intensive Care Med . May 2021;47(5):566-576. doi:10.1007/s00134-021-06385-3 Ogero M, Ayieko P, Makone B, et al. An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care? J Glob Health . Jun 2018;8(1):010409. doi:10.7189/jogh.08.010409 Leon-Valladares D, Barrio-Mateu LA, Cortes-Carmona N, et al. Determining factors of pulse oximetry accuracy: a literature review. Rev Clin Esp (Barc) . May 2024;224(5):314-330. doi:10.1016/j.rceng.2024.04.005 Additional Declarations Competing interest reported. JHL has received support from the National Medical Research Council, Singapore (MOH-TA19nov-001) and from the Thrasher Foundation, USA. Dr. Robinder G. Khemani is a paid medical advisor for Nihon Kohden/Orange Med. All other authors declare no competing interests. Supplementary Files Appendix.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 01 Oct, 2025 Reviews received at journal 16 Sep, 2025 Reviewers agreed at journal 05 Sep, 2025 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 01 Aug, 2025 Reviewers invited by journal 21 Jul, 2025 Editor assigned by journal 17 Jul, 2025 Submission checks completed at journal 17 Jul, 2025 First submitted to journal 16 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7143199","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488615997,"identity":"5fb35700-3c6d-4a13-8c95-c23ba0fe98e7","order_by":0,"name":"Carter 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Francisco","correspondingAuthor":false,"prefix":"","firstName":"Teresa","middleName":"B","lastName":"Kortz","suffix":""}],"badges":[],"createdAt":"2025-07-16 20:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7143199/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7143199/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87666023,"identity":"70f2ad63-5a06-41aa-a5d7-aa76abea3735","added_by":"auto","created_at":"2025-07-27 11:10:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59734,"visible":true,"origin":"","legend":"\u003cp\u003ePatient screening and inclusion\u003c/p\u003e\n\u003cp\u003eAMA = against medical advice, ED = emergency department, PARDS = pediatric acute respiratory distress syndrome.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7143199/v1/72bee82f6bc0dc7384bc9010.jpg"},{"id":87665046,"identity":"021b3615-cd3f-453e-a80e-67376ab1838f","added_by":"auto","created_at":"2025-07-27 11:02:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44570,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart displaying patient eligibility (i.e. sufficient data available) for PARDS-related diagnoses (PARDS, Possible PARDS, At-risk for PARDS)\u003c/p\u003e\n\u003cp\u003ePARDS = pediatric acute respiratory distress syndrome, IMV = invasive mechanical ventilation, NIV = non-invasive ventilation, HFNC = high-flow nasal cannula, O2 = oxygen.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7143199/v1/952290f665eb260c880a7751.jpg"},{"id":87666283,"identity":"9d69f762-b6a9-4ae5-9670-ec46f24895fa","added_by":"auto","created_at":"2025-07-27 11:18:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37220,"visible":true,"origin":"","legend":"\u003cp\u003eMortality by respiratory care resource bundle availability\u003c/p\u003e\n\u003cp\u003e*n represents the total number of patients with hypoxemia treated at sites with each resource bundle available.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7143199/v1/ee20a13b307ab5c99e79d658.jpg"},{"id":87666284,"identity":"a2019656-7765-4253-8531-95bc1da9699c","added_by":"auto","created_at":"2025-07-27 11:18:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":952727,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7143199/v1/f3d14b4b-9edb-4c6c-801b-4817775e035f.pdf"},{"id":87665051,"identity":"768e09e1-0a94-42f3-b7d4-59b324d3f495","added_by":"auto","created_at":"2025-07-27 11:02:15","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1107494,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7143199/v1/efcb6da9302390356d60f024.docx"}],"financialInterests":"Competing interest reported. JHL has received support from the National Medical Research Council, Singapore (MOH-TA19nov-001) and from the Thrasher Foundation, USA. Dr. Robinder G. Khemani is a paid medical advisor for Nihon Kohden/Orange Med. All other authors declare no competing interests.","formattedTitle":"Risk Factors for Mortality in Children with Hypoxemia in Resource- Constrained Settings: A Secondary Analysis of the Global PARITY Study","fulltext":[{"header":"Background","content":"\u003cp\u003eHypoxemia is common in children; the World Health Organization (WHO) reported a 31% prevalence of hypoxemia among children with WHO-classified pneumonia worldwide\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Hypoxemia is a known risk factor for mortality in certain pediatric disease states such as pneumonia and malaria \u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In resource-constrained settings (RCS), where a lack of funds results in limited access to medications, equipment, and supplemental oxygen, less-developed infrastructure, and fewer or less-trained personnel\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, hypoxemia is likely underappreciated, and mortality associated with hypoxemia is likely disproportionately high. In a recent survey of 238 hospitals in 60 countries, only 85% of intensive care units (ICUs) in low- and low-middle-income countries reported consistent availability of basic respiratory support (e.g. oxygen, suction, nebulizer)\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. There is a suggested association between lack of resources and worse outcomes; for example, higher case fatality rates from lower respiratory tract infection (LRTI) have been observed in low- versus middle-income countries\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. To date, limited pediatric studies in RCS have evaluated the association between respiratory care resource availability and mortality.\u003c/p\u003e\u003cp\u003eLRTI is a common cause of hypoxemia in children and the leading cause of under-5 mortality worldwide outside of the neonatal period, with an estimated 700,000 deaths globally in 2022\u003csup\u003e9\u003c/sup\u003e. Pediatric acute respiratory distress syndrome (PARDS), a disorder of acute lung inflammation characterized by hypoxemia, can occur following severe LRTI and other acute triggers such as sepsis, trauma, aspiration, drowning, and shock. PARDS is associated with high mortality that requires specialized care for diagnosis and management\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In children admitted to the pediatric intensive care unit (PICU) with PARDS, mortality is higher in middle-income compared with high-income countries\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Little is known about PARDS in RCS where diagnostic resources may be lacking (e.g. pulse oximetry, chest x-ray, invasive and non-invasive positive pressure ventilation, blood gas analysis)\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e; however, considering the high prevalence of clinical conditions known to trigger PARDS (e.g., sepsis, pneumonia, trauma), the morbidity and mortality of PARDS in RCS is suspected to be significant.\u003c/p\u003e\u003cp\u003eAn improved understanding of risk factors associated with poor outcomes in children with hypoxemia, and resources available to care for children with respiratory disease will facilitate further work to identify and optimize the management of children with acute hypoxemia in RCS. We hypothesized that decreased respiratory care resource availability was associated with increased mortality in children with hypoxemia presenting to RCS hospitals. Additionally, given resource constraints preventing accurate diagnosis of PARDS in these settings, we hypothesized that the presence of a PARDS trigger in children with hypoxemia was associated with increased mortality. The objectives of this study were to: (1) describe respiratory care resource availability in participating RCS hospitals and test whether it was associated with mortality among children with hypoxemia; (2) determine the proportion of children presenting to hospitals in RCS with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eGlobal PARITY dataset\u003c/span\u003e\u003c/p\u003e\u003cp\u003eWe performed a secondary analysis of the data from Global PARITY (Pediatric Acute Critical Illness Point Prevalence Study)\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, which was an international, prospective point prevalence study aimed at estimating the burden of pediatric acute critical illness in RCS. The study was conducted during four sampling time points to capture seasonal variation over a 12-month period and enrolled 7538 patients across 46 sites in 19 countries (Fig \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). The Global PARITY population included children ages 29 days to 14 years evaluated for acute illness or injury in the emergency department (and subsequently discharged or admitted to the hospital) or directly admitted to an inpatient unit. Admitted children were assessed daily for clinical status and resource utilization over the initial seven days of admission and followed up to hospital day 30 for outcomes. In addition to case report forms for individual patients, participating sites reported hospital-level resource availability using a separate infrastructure and resource survey (Appendix 1). We adhered to a fully descriptive analytical approach, avoiding imputation, extrapolation, or modeling beyond the directly observed data. We followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eParticipating sites\u003c/span\u003e\u003c/p\u003e\u003cp\u003eSite-level hospital data included setting type (e.g., rural, urban), funding source (e.g., public, private, mixed), academic center designation (e.g. medical school affiliation), average daily hospital census, presence of a PICU, and pediatric intensivist availability. We summarized site-level data by socio-demographic index (SDI), a composite indicator of country development status that accounts for income, education, and fertility and is strongly correlated with health outcomes\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Only the four lowest SDI quintiles were represented (low, low-middle, middle, and high-middle). We also summarized sites by region according to the Global Burden of Disease Report, in which countries were grouped based on geographic proximity, epidemiologic similarity, and cause of death distribution similarity\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRespiratory care resources\u003c/span\u003e\u003c/p\u003e\u003cp\u003eWe determined essential respiratory care resources and created operational definitions of tiered resource bundles (categorized as one of five bundles from no bundle through expert\u003cem\u003e)\u003c/em\u003e informed by the literature\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and in collaboration with a group of international experts developing a pediatric critical care resource evaluation tool for RCS\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e (Box 1).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBox 1. Respiratory care resource bundles.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cimg 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LqlTqUqV/sz9uVELAfws64kAGelEJQFzp2+B2wLu/jSCYNvSAyxv8kELlqTZpB2xnlo8QLA1avCHC2xPXdsSEUrX0x08VR7ZuXo+LNkZWPn2M6h/8+MwBYXD6XKkL3dZF+kLBNvL6nlhVAcFbLekF2P8+jSkucDWRLBtGyj3cAE2fX8uvtuVJa4zpS/Kr7TntdL//jsQuO8rbcHiG1D6Vn7GZ/mbdBI8lV2sQHbpSwKq3H3eVRjLqQ47CGdT3fmA7XXtA/F/nRWwXbI3R3xBTwVbysPLJa+cQrvoojRsnqoLvj+eBg1u7x4i2+/frUqT+09VmTtwzd0mDu6nyphl+Zi14v+b6Q7AcgUmur/nrouXSStBb7SEuneK3GOVe+IQi597MmE/0roCT04RrDK+nGgnP1YCVU6vgZI+ynY6AQbn3d83FANb+uNgWjGenRWP/GI32Cp1CPTSS11PlbdS91OfffLkx3v4jMFt/NG+nhde+zsRhRbHaeXnnjyVCfT0785/WlXBYEtA6NumHkbf1EVcCOgHarU58PX8rXh3+npYbGf2g+R35f0XlzqN3Pv5o5fjmm6NsGEfwXY+0rILwftOvUTvGlp5T17AMvCIqhS9yft+onyNxACcrGjZ7tZr4edlQlZekdT9RD/SQKs9M5xI/U+xerL80/kW0+J40nxxhvvYTuX9cfUTDd8TI169vReu7dkER1JzcNW4GcitLWALoH5okIBt+yYNRM13vvEZpi5aVQK2lGlc/QgUFFmQmZOLdk0aYs3O/SiyKH65JeOFCyR5vyK/k0FC6RfKwN8oKhQ2uwOHk9JOeifZPejTe6ZL0eOJcpWxTQl0OzFuOcV9wsNkRHp2rlib2Su1Wq28p+w3Pl5mPH/79Qjw8cK9b30huxX8vEqviw22XjoNno4zYV6KFQmFTtxW3yj+txQlfW7nJ9sEwE4CByfwRmsPzEm2Ykmq7STrFccJwlxTHyUAzKzVIM3ixP48O44WKqhRFmsX77kmQo/BkbRS0GJrw8f7LbC66KGdvw73xyouFJuybeLHysAiuuT6GpT68yKg59oU6KCPMAO4WEd2gkIbBNr5GV0szDoNLgvTi3sDrdGRHlo089YK/McX2rEjxwkLV9+legi/y/rV89CiHoPxjr88hwvsKHJAwJYeHqXBlouHh9xgm2TFbwnW/0ASy2njq5O6Zlic2JFrR1LheWz11kCLLd04Lon2xNhOwYrFNr0Yr61LQ1qhTeTUPMCEp9sHib/tkVwr3t2UgR2ZJ1v37E4nfAw6cVuI9tKLNXdPpgX7cqwnTRYsL9RDj44hZkR56cVv9mCOFbsyi5FjVfx2Oc4wUj3K24ARzfywNb0I0w/knVQOnxfuqRf/4HreBplM0wrtWJ1ciKP5lWiRr4CR6nzA9tr2gbjVBbaLd+dg0rIUASRl4uS75IS/px4jegSLVXDp3lw0DjWjRYSHLBC2Hi3AgbTiEuATCDZqcUOHIFzdxh+Ldufi21WpMsgX890tycCgQZNQE1pHecLDoEFanh0b4/ORnMtt6RO7TQGeetzXOxTHsi34e3s2ujb0FgvwjiQlop7144TRJsoDfeJ8MH19JjyNWrSv7wVaM49mWrAhPh8pOVbJTsC6t4v2hIdRJ5ZUPjOPwFl6HHBy0gJaRHpKOwnVfP7GIwUC16culNhm1pMuBgwMy8q3Y1dyIf6vS5BYbAm2Y2YdRW4xx1cNzAaNtPuaNgESpFfaFYFlsT0Ng0zi++xp1CExy4KdxwqRXXRisc/d1/5N/TCsc5D8/eXZCaI3grIboijzYG8DOsV4Sb3Yzp3HCrAnpVjkdlYjVEWDrdOJZ27sgvBAb+yKT8eYm7uKxLcfScMDHy3AkRRuF5/8Esj04HAiyM8DbWNDEB3kg7ScQizfdhTj7+qDKzvHYqMbbHMKERnoDb6/BAI3+GflF8s7HB3iK1HyFrtdgORYeh6KrHaB1Rb1g9C2YQg8TAbZwl+3Nwn8ngI+kOAjfufG3k3RrF4gPpi1Hj4eRvRsGYVQf0/sS8zEki3xUl5pIHYbX6KCvHBJu/oS7EYkOZqWh0Wbj4hV1X0/72U/axsbiq7NImA26hGfmoN/tycgKT3/P7IhbEUEeqFNbCiigrwlA8Kuoxl4/NqOYrGNT8vFoOem1yqwrRcSiG/GjJRAMl53jZ+EXxauLAFbk1GPUf83GHuPJuGHecslawK7lNlkhL+3pwKFGo3cT4hMysgu8cu12Gzip0trb15BEYL8vDGoRwfcdnkv/DBvGb74YyEaRYcjNiJEvkP/3V2HE+VdOxVWqcum9SJweZc28Pf2QkpGNhZv3I7d8cegIbTSuGJ3iI4fv+kqWeB89ts/GNKrA9Kz8/DPhu3ILyyCj4cZI4dehgevvxwrtu7F/W9PljYUWU6e+ypg6ihfEVUBtk/GmQRQF6bYBEbvamhEjKciTPo8csucPrcnVg3ASy09JCCKVt3SF793bZQBjby0WJpqR7rFiTb+WnEZoHsDQTn/VPPaGUR0VYQeQyONAocH8x34K4nBYxrU99SgV7ABeo2SxWFGghXZrgmwiY8Ww2MMiDLrBDhXZdjx7WGLAO710Xr0CjKI2wUnYPoS08/VUwe099eDsNzKV4eNmTbJ8tA3VA+zDgLnnBRWpdvwy1Ersq0nUneFmrQYEqlHt0A9EgodiC90IMSklWj95r5KHSYdZPCYYrGN8dDiocYmBLkstrNKuSLQGjkgVI9LQ/VYlWGTrA/dg/QINWnwa4IFK9LKGalZQ8G2f7QnnnOBLeF1mit4jJDKwLIGvkZsTC0WS+32DE4mJzoQB/ouoWYMa+KHvdkWgdVLo70Q4qHD5zuyMH1/TonFpWWQCSNbBeJYvg37sorRJtiMDiFmLDpagLc3pYtFsm+EB66M8UGLIBM0TqfU5btd2bC5VtZMAdYvyhN3tgjA9rRi7MgoRvcID7QOMiGzyI73t2RgVVJh+QaBi3h3ecGWsqbFlnBE+dDH9vN/U8TKSsiI8jeiU4w3+sf5SHT/vB058PPUoW2Up1gvfMw6sTZ+syIV83ZlA06NgOCIHiFoGmaWVS9BMCPPhqxCO95ZcAy5xQ5x6fm/LsHo0cgbKw7kISXXhitb+MHTpMVXK1Kx6mCebNO3jPTA0LYBaF/PE6sO5ct40bWhl9Tv6RlHkHg8ewOtlSynR6w3cors2JJQiAaBRgGc6ACTQG5qrhUfL05BiwgzOtb3Qk6RA3GhJnne2kP5+GhxMvKKlPeRE5WvWY87egSjZYQnFu7OFuvcoNYBAo5fLk/BloSCkiU9jSd9G/tiWJcgmPQa7DpWJONslL8BTOlFGTLrwXO/HRWZXtnKH30a+6BhsEnqO3FxClbszy2xEET4GnFt+wBEBxixKb4AzcLNaFfPEwdSizFh7jEk51hFByP7hArkE9apg8RsC7ILHfh+dRr2pRTJs9jW4d2CkZRjxcoDeQL0hNyFu3Pw/Zo0WWic0TBRwWDradLjh1FXY+q/u/HX2gP46+UbEB5I2HDi2a+X4qfFu6DnaqLUxd+v6NgAT1zfCUE+Hli1M1EyeAT6mAXm6of6CoSO/Gg+0nOLMPmxK9CrZRR0Oq2Aw+b9qXj951WyqHppeE80CPWTfr5mzzE8+cUS+Hkace+VbRDi74nVu46he/MoXNKunkDno58tRH6hFf7eZvRswb/XF9eHVbuOYdP+FNzSr5kADQGXqbWWbU/Ak18sQmpWgfydcMPUW1d3bYTHhnbA5oOp2LA3Gf3a1kf3ZhFidX5k4kIs2HhYyUqk10m2CD7/91X7xQJ924AWMOp1eOWnlVi0JV7eCQ5VbMPQno3x0DUdYDbqsG5PMhxOB2JC/RDoY5LMCPuPZWHIS7NqjysCgKggf3z17P3o1rKJ9JKR73yFXxethEGnl/21BuEheO+R4Zi2aBW++GORACNBsE+7Fvhq9H3w8TQL1FI/E2fMxQtfTUObxjF49e6b0Dq2PpIzsvDprPmyiBl3x/Xw9/GUvjNn9WbodBr0adNcvs8f+vxO/nMR3vzxd2TkKMFp1LmH0YDbB/bFqFsH4/fl67B572Fc17cL2jaOwRvf/4bJfy6E3e5Eq9h6uGtQX9xyaQ/8sWIjPE1GDOreTsq6763J2BN/DB88ejv6tG0mFtq07FwcSU7DgcRkvPT1DBxJSS+TUbFSpp+qAVszlqdbBTr5wtD6OKyeUWCUMEaLF10S5hFKJXoLeLaZGVuyFVcF9xZstIdGLL6NvXX47nAxFqcqW7a0Cj/QyIgmPjr8nWQVQC1LUPlV4XoMjVLAlq4BO3IUH9oAgxahZuaI1WBbtk18a5lOi7zMzwmuI2NNEsC1It2O745YJG0OLclxPjrc1cAoVli3KwAhc3CkAZ0D9JJ3ls9an2HH8gwbsixO9ArWCWAXOpz4/ogFq9KVdoUYNbilnlGAeHO2HVMOWwR6WfZtMQZ0CuDLc2aw/TPJKhkd3FbsK8IMuDJcj2XpNvwUbxU5sw33NzKKtXnyIQvWZZbDp7mGgm2/aE+Mc4Etg8a2HLdesQ8GmHSSESHUU49dmRb8E5+HFUmFyCxWAINuAlfFeGNYnC8Wxudj4vYs6TsPtQnE1Q28xRr70ppUJOQri4znOgfDz6iT4LTEAiuCzXqMaO6PGB8DxqxKkWc29DEKTF/fyEcsJwK2u7PF8uip1+LGxr64poE35hzJw7e7spBvdaJ5gBHjOocg1EOHn/fm4Mc9OQJN1fEqP9hqJHjsxo6BYsk4CWyZ6i7KA8M6B6N5hIc0l5bSf3blYO2hPPn9tq7B6NnYB7lFNjz082HJqtAw2IgO9b1wfYdA+Ji0WH0wH+uP0Cpqx5qD+bJ9fkunQFzV2h+zNmXhp7XpYulqEeEJBlvZHA68NS9JYHRk3zABMQJjWp4NhzOKxQJJuHljDiHZjkua+gic0yKZW2TH71uysGBntsBvkxAzRvQMEYhMy7dhye4csfoyp2yzcA88PiAc/p46fLEsBb9vzpK6BRz3vb6zRyh6NPLC18vT8OfWTLGC9mzkgycui8CxLAvenH8MSdmKBXhAcz/c3i1IFtefLknB6oPcASBUeuLhS8Lh76ErAVv2MwI/Myb0a+or9Z24JBnL9yvypJX2rl4hCPU2YNzvR6W9XFg8c3mEQDgXEKwnXTP6NPFB/2Z+aBZmFovwH1uzUGR1YGtCAbIK7GLBfqBfmMjtnflJSMm1IMjLIH/j4mDmxkyB2zN25QoEW0Lm4O6Ncf9VbfHM5CXYfCAVY4d1w8ir2goQLN+RgBHv/g2La0HlXmAM7d4Yo27qCkLx018sweKt8QIaA9rH4K27+wpUrtuThJEfK1kRaD19+obOYrGkHy7/vnx7goCgr6cR40f0xapdifh5yS6EB3hhwog+Aj+PT1qEfYlZ6No0HBMfvkzKISz/teYA6oX6YsTlrXFr/+bwMOmRll2AfzYdkTKOZeRjYKeGeHRoR/h7mTD+19WY9NdmscqT0R8e0gHD+jXH9OV78M70dSgstolFdvyI3mjTMASf/bUZE35dAy+THs/c1AVDuzfBxD83YdLszSi22sR14517+sn7cfd7cwVWzQYdbr2kBUbd1AWp2YV4+YeVWLzliCwQruzcEM/f2kNSfwnY1pLgMfYHjringu3yrbvFOqvXasUq2yQ6Ag0jQvD8l1Px1ezFJa4eXCB1bxWH1++9Ga0a1pNUYE9P/BE/LliOIF9vPH/n9bBYbfhg6l84lp4NH08P3NCvKybcP0wWSVv2H8GcVZuQlJGFBuGhGNi1LeLqhYvl9MNpf+O9X/+S/xN46dtLqF2wditGvvcVCossaBNbH9NefRy+Xh4Y/dlPWLB+G8bdfi1u7N8NXmaTlEsAjgwOkN0B3pOQmiFAPHxgb2nXwg3bMW3xKmTmFmDZll3ILajCLCBVAbZPxZmxMsOKv5OUCZ+DbISHFjdHG9DGT7E6un1ueQ+39h9vYsLBAofAofjCAbg6Qo9rIo0CkaO2FiLfrvzb1dnqAAAgAElEQVSdLNwrSId7Y01iwf1wX7Hknj2X/+GgcD2udYHtthwHJh8olroZdRB/YFqGozy0AqKsBy3Obkh8pLFJcsWWBltultY/fv9jTUwSAKdYoq1SP/rVPtzYiOY+OoHkifuLUWBXXg6C/phmJnFV+C3RIkF1hOgrwvS4PsoI+hwzK8PePEdJXuAWPlqMaqakRPrioAVLT2OxdYMtsSzCpMHopmZ46YF/Um3Yn++ElmmADBoMDNeLhZcBdMwMcZo4ndMzUw0FW4Lk8wRbDcQC+t7mDAkeo0W7PvN5xvmhXbAJBTYnZh/OxY97sgUowzz1GNMxWPT09sZ07My0SBnDm/lheJwfkgtteHVdGnZkWMRf9sPeoTKB8fvrUoqQbbELOHcN88TvB3MFbLn92tDXiHd6hko+W/r0frs7G8V2h9zHDA2EmMeXJSOl0FZygEnnUA809jdidVIB9udUX3eE8oIt5XVLpyBc3yFAwHbxnhxMosXW1Sk5FnQ/bgl94tJw+Xz6pgxMXZ8Bi1j6nLi8hb+AI10Pnpoej11JBfKS0XXhrRvqI8Rbjx/WpGPahowSJ/1uDb3wyCXhAoVztmVhb2qxvFdMi3VNaz9E+hsxc1MmJi+jhdUDD/YLQ4MgE3YnF+G9f5LEAkvX8oNpRRIwy+/e1TMEQ9oGCHgT4vgZ+wotpvf0CsWAZr4Ce4TFIxnFskVpZqDtwEiB8CV7c/H2vGOi7yta+OPOnsFS3+kbMyW4SxbgXnrc1DFInv/Fvyn4bUsmGoeYpC10b1h3KB8T5iYqVlBa4LQajBoYiS4NvLA/rRhjZ8WLKwABpFtDbzx/dZQCtktTsHxfrrSDiwxahuduzxLLq8OpQWywCc9dFYkgLz1mbMzED6vp66fkgX7kkggBe8L0y7MTXdvVTngbdXhuUCRaRXli7eF8CQqkexbdcJi7mBZwWtDHzIpHQhbTQZ1myKkgsBX3H70Wkx69HAHeJkz+ewuy8i1oGROMx67tKKDGlFT3fjAPS7ceFast28dDHL596kpxQfhj9X48PHFBiZWcFrWfRl+NLk3DT/axdTpxafsYvHFnHwT5mPHxHxvx4W8bxOIeHeSN10f0xis/rsS+hEwBQML2t/O344u/t8gWdGy4Hz5+8FI0jQ7Ei98vx1dzt4mlztfThMmPDUTnuDCs2JGAUV8tFTcB9sMmUYGY+NCliIsOwM+Ld8n3Copt6NUiSiA5M7cID3yyQNwv+A6x7rQqd4wLw9z1h7B5f4rU4/37+ksGgx8W7sTOI8q94YFeGD6gBaKCffDJHxvx5tQ1aNcoFG/f0w9xUQH4c/V+PD15ieSq5ZsQ6GvGu/f0EyA+lJyDa16oXT62p4LtB1PnCPDJ5QSiQgJx7+AB+PqvxfhmzpISFwEuhjj2923fXKyz7RrHIDE9C699N1O2+wN9vfHJjPnIzGNOZY4vDgR4e2HLt2+KC8M7P/+JF7+eJgsWg16Pgd3a4oNHbkewnw827zuMB979SuC3ab1IfD3mfrRsEIUvZy/Gv1u4C6GD2WjA6P8bjOiwIPyxfAMe/+g7qdvXz96HPm2bY9uBeMnwYDYZ4GU2Y8eho5Kv19/LA1PGPSj3fDj9b4z69Efo9Xqx3FfpVRVg+3ScGStKga1bABEmLW6NMaKF7wmfW+a5nZFgwz2xBqQVA7MSLDJZcLv+nlgjOhz3fU0qcmDMtqIS31GCY3MfLZ5uahIBf3PYIhDqyjB2RnmXBtuNmXZMPFBckl+XauoTohfLMi2x6cVOvLO3WNwBCJqPNjbJQQmlwZaDX31PrXxGsCUM88ftc3tPQyO6B+oltdikgy6/TSckz+/YZmb5dw79YhOt0mbCc1s/ncD6c9sKUcjTsFx+meEmDV5udUrwmOv5D7tcEdxgS0juHawHn8+DJwjBqRan+OsS5ujzy63YdAvzBtvg2gE9dz+tBWDL4LE3XMFjMhY5gQ7BZrzePVTcQzKLHXh9fZoc1uBv1qF9sBl7syyIz1N8ioI99LivZYD47aYU2PD6+nRsyygW/+Xx3cPEZSDf6hCfWkI0/WLXJheV5MZl36A/71s9Q+Gt12Lq/lzJncsTyEa2DsRNjXzEokwLb/GpwSanBFCeW2EX/47zAVum+rrODbZ0RVh2IniM8moaasbLQ6IF7qasScOfW7JKrHw9Gvng/t6hYvV8/vcErD+SJ8BFf9MJ19dHiJcCttM3ZpQIY3jXYNlqJwDO3pYlbggsmxDqbdIKBCVkWvDntiyE+egFqltFemLZvlzZiperVBApJ6wbOwTijh4h4uv71rxj4lfLsZ8gR6vyVW38kZFvE5BLzlF2svjZQ/3CxHJKH9dX/koUH8d7eodiQFMf2d6fuTED+RanWH7oB8z68cQsWkWX789Bvzg/PNQ/TE4X+251Gn5dpwCJErCmZEW4oiV9bIswZuZR5DHdl1M5HINgW9oVgbBNFw/2813ss8V2kUWvRt64t3eoPHvW5ixMWUXgdcrYS6juT7A9lIdXZycq8zujqINM+PDmGGknXRDonsEB3KjXgAF2Zld6pDnbs8V/tzLBlvpp3SAY08cNkW1xQh8vyoc5aelnyOvPtQfw8Cf/lPgf0ir76UOXylb8W9PW4sPf1kuKMF7FViV47KousSeBLdtO14EPRw5A71ZR2HYoTVwKCJUjr2qP6BBvvPHzapHfwI6xSM8rFLcCBlhRr4M6x+K5Yd0EKN/4dTU++3OTLJY1Gi3evbefWILnbTiE0V8tRXZ+sSxS6DP86cOXol1sKGYu34vnvl2G/GKrZCegK8HKnYliEU7JovvKiUvZJlf8M8cN64Y7Lm8lFthfl+5GYkauALC32SCWZpNRh91HMzF16R4M698Mz97UFV7HTxebwDrO3lwCcPzbK8N7YmiPJuKzfNXztcvHNpKuCKPvE+srL/rY/vzPihIfW/q+Pn/HddifkIzP/1jo8pE+2Qd2QMeWeOeh28RtITuvAPPWbsXYz39BcmbWSSDMgK7NX09AWKAfXp8yS9wIqBO3se2TJ0bg1st6Iis3Hw++9zVmLF2D6/p2xaSn7ha3ko+n/42jqZnSf+hmwOAvk9GI+OQ0/LhghbgWfPHMPfi/y3oK7N41YRKKLVYJGHJjK7/z3dgH0LttM3w0bS5GT/oJer2u6lwQ3N23qsB2TabiR1s6XZaY8s1ayRcb6wooowsBYTDEpJz+NS1BAUOf40dAPhJnRGMvnfiZvrD9ZLCN89ZKkBp9EvkcBme5xsozzubclr/OZbHdkGnDxAMnsiLwSyzz7oYmqQsNRkwHxq16BpA9HmcS6+upYNvQUwuCJd0VTgVbuij0DNJjdYYNnx5wnUrjBPyMGoxpakKwSYu5SVbMSLTKtjTdMRp6aXHseKTYizuKUFwKbOkX+1JLs7hLlPjY0vrren6wUYMSsHUAQ6IMuD7KINbnT/ZZxO1CMjyUkg4nk3MtBk4SZk0EWyfQJ8ITL3RWLLalsyK4Ftki0+8vj5IgQW7Vfro9C7P25whM8HcCSD0vA3pFeopbAC25dC9ILrDhtXW05BbLZN4nylOgN9isE0DhRV/HJYkF+GBThoBqabD1Oh408uu+HHy/OwfFDgfGdwtDlzAz9mVb8NSKFLhTM118PD3/J54X2HYOwnXtA2RQX7grG5OXpco2Pi/Ki9v5rxJstcAPa9NlK1wiiQF0b+gt7gIBnjq89GcC1hw6O9hykGcgGAOqmF3h5dlHsS2xUPEddEWls6PQb5X3Bnvp8diAcLSN9sTK/XkYP/fYf47IJDjd0CEQd7rAlpbX+FJg+7+uwRLEpoDtUfFRdVtUWfdLm/tKUNgrfyUI+D16SbjknqVf8DMzjuBoFscH18GcMqsp28y0ODPjAa3F/D99kxkIJiDkCj67q1eouFzsTS3Cc+48tsd99ugbO+6qKDmRjK4IbBtnK/Z3Ah+D3lpHeoq1PNBbj0bBJqnbrE2ZcqBDCdgOCBf/Z/okv/pXooxj/Iy+yROuqy/6+25VKn5dnwGnwz3+KIFVfL/4npzR+FNBFlvWZ+wt3WTL/o535ggQSlAWID6rz97STay2OfkWDBv/J7YfThP/WG63MzUY4e+1n1fhizlbBHLdYPvRyEtwXa+4Ez62rgMaGBTEIK837+6LgiIb3py2BtP+3YMvHr0cn/y5CSu2J0jb6eNKUKHbQbdmkRjaoxG8zEYJDqNbwSs/rcLkOZuVyHcN8OZdfXFDrzj8s/GwWGwz84qkbvz+Z49chvaNwsQ3dszXS8VV5ufRV6N94zAB54cn/iOpzU69qAeC/et3KJkMDqfk4IGPF2DDviTXO6Fkx5BIeY0WRoMWD1zdTlwfaNl+ccoKfLNgW0kAGl0lXvxfT9zYO65W5bF1yy2cYDvqPvRorYDtyLe/xHdz/xWQlMWSVoN+7VrI//9Zvx0Gg062+nMLTmTMYH+8tlcnfPzECPG53XEoAY99+B1W79xbErTK8Y2uDesnv47okEC8/v1veGPKrJIsCPSvHXZpD3zxzL3i1vDQe9/ghwXLce81/cWSy7419Nm3sXDDDrH4y9DmImL2J+qO/fSjx+7EnYP64q+VmzBi/CTJ3lD6Kg22dHl4dtLPJW09/1miAr55scHW+3ggwTNNzdicbcPUo9b/5IHlQMfTv26LMYq/p9vnNs8OCdyadlSBTQ9OQI2MYsFMKnZizNbCkyy29NflcwhmPxyxYG7yyRB9OtEJ2DJ4TMt0X3Z8sv9EHlvqvKWPDnc3NIollRkc3t9XjB05DqnLE3Em8RFekWHHd4cVH1t+h+nMHow1yRa/++Qv94rqzgZGsZyuy1RSiwlUloCtGcGmExZbfkaLLV01mI2BFltmf3CnGyPYvtCCrgWaE64IZwBbyo9BY8NjGMAC/BSvyOdUiHXXs8zdrDaCLS3oZh2+viRCXAOo13c2ZWBhQr5M0hFeelwd440+kV7Ykl4kINo70hO3uVwRmGGBLgqEXx68EOahR+dQsxznG+6pEwjm5P3mhnTMFWuiBg18DXi7h+KK8POeHPywJwfW42eQj+sSgn6RnsizOjBqRTJ2ZZ38/ogVTsvzyqunfy370fmALXPYDm0XIIP6P7uz8eUpYEuoen1oPXDuoD8s/WLd6dAIXiP7KGD7wh9Hsf5wvkAAXRAIVoGeegGxmZsySrbP7+gegmva+IvLxzcr08QdobRES/+f2++PXRKOtvU8Zbt9wt/H/uPfTH3c1DFQUovR1/TtBcdwJP2/Ftv0PJuk3ErNVSy27BfuPLNisZ2dKIA6sm8o+sb5ir/qBwuTxP+1tJuV+71lf+jdxEdcJWixpfXz06XJCjQKOAIE26tb+2N/ajHG/qak+6LsaLF94eoocY/4ZEkyVh9QwNak18pnV7byg69ZJxbglDybWK2DvfWKX+zqdIEdAjR9hOlru/JgHl77K0H6N2GrSahZXEHYRmax+GRxcslixT3enC792kljUQWALdsaHewj1tUFmw7jnWlrT1jFADSJ9Me79/YXf1NO9B/M2oBP/tgEi9WOyzs2kC1+BmB9OXcrnp+yHKZSYPve/Zfgpt5xWL8vGSM/nC/ZEmSIl1O4THKAQ1xUIOZvOIQ5aw/gqq6N8NDEf5S0YkyVdjyIbFCXRvi//s3kJKvPZm8Un9nxI/qgef0gvPzjSnGboP8mL0L2zX2aSWDZM18uQUbuf8F21sq9GPvNMnkGA9l49G9yVgEe/XShBL6dmt5LguWOQ88Lt/UQH17C8qs/rRLLb+nLnXqK/ZZWYPrXMmXa1/O2yf3utFIMJCPY3tSnaa1zRaA8wgP8MXn0vejVpqmI54F3vsK3fy89CfboRsCLcRD0k6XbwTu/zJZMB0pAnx7X9OyIEYP6okFECCKDArBy21488uG32H0kUbHKusB29WevyD3jv/8dr02ZWQK29IO9rGMrzHrjKSSmZWLkO19i3potGHZZT0x8YoQ8462f/sDL38yAjsFqLmUq/uyKBZlw/MEjw3HX1Zdg3totkpOXRwaXvugi8f24B9GjVRzen/o3xnz+c8nirszcUBk3XmywZaDTmGZmsRDSReB0FkHKNsKs+Nxye59wSwBjRoSpLrDlqzzElXeWW+VjtheWZA/gVnvPIKbnMsnfPtpXjL30sT2LAPnMq8MNGBrF7AeQ4Cz65rpi12QyoI/rzfWU4LK9efzcIqeQcdv+8SZmtPTVigWX6bboI8zu2zlAhzsaGMWnltkUZicp/o+sy5nAlhA8tpkJQSatuCLwtDDWY2ikQY7O5eDBvzHDgfsACQaWvdzyBNguTrVJvUpbbPnsma7gsWiz4pPrrWe6MIekL6NbhXtSJCAze0OmxWUJKkvnq4FgS8Nf/yhX8JgG2JpeLK4GzGNLYXDw6RHhiZe6hEg/PJRjlc8P5VoFPO9q7o/L63shtcCOx5cnI7XQhntbBOCWJr7iA0tXBFpsGYj2YOsAfLkzC0n5NngbtXKa2fWxPlL+L3tz8PmOTLGC0Nr7ds8weBvoj5uDH/dmi2X3ulhf3NfSX3wjVyYV4N3NmUhnDjnX1T7EA4EmHVYkFcj91fEqL9gS2G6lawDB1mWx/WJZqkAdLzazUYgZrw+JPi3Y0lf0gb6h4nrAI2OZOkvA1ktxRSDY0hVh6oZ0KY/wTB/Phy8Jk+3wrYmFmLQ0WXxjxW8UGnFrYBlZBTYJFHODLQPPxv+dKBksSnuYEWzpJ3xbt2AcdPnYHk5X0o+VdkUQsJ0Zj9S8E2BL/1tC5JrD+XhjTqJAIaGbVl5aSLmN/+XyNCTlKBMO+w99bemzSUhlOi7CJTMYHMu24tU5ieJ2QPsRIfPu3qFSHoF71Mx4FLhO3OtU3wsvDY6WjBEfL0qWzAxsVNcG3rindwhCfAx4d34S5u/MlmAzWne5eJjpCrajRZOQ9MSAcIHrVQfzxfotiy9oJFvFS4OjBHAz8+34YnkKlu7JlVywvMeo0yLUVy9uIGdcqFUQ2A7p1hhP3dAZI977G3uOZpyU+9Ns0EvGg+GXthA4YWaCJz9fhKOpueIO8OvYwYgJ9cX+xCyx9tJvlO1mYNUH9w3Azf2aiivCfR/OkywC7rRLlM9tA1ripdt6ILfAImm1Pp+zRbIxEFTZ5ss7xOC1O3pLQNiTny/GX+sOoGW9YEx8+FI0ivDHaz+twpfztorOef8bI/rg5j5NsXjzETxdCmxD/BSLbYfGYZixfA/GfbtcXBvuvKIVxg3rIf2QYD3mm2UCru73gKnC6of4YNqy3RI09s69/eQ5TBv24g/LcShJyfjC9vIZfFfpztCjRRTeuqevZIXYejANT3y+CLuPZkh/4yKA2R9u6dsMR1PzcMXYqcjnyWPnCoA5ZTCrTkfqlq5aWIAfvhx9XwnY3vvWZEyZu1QWJu6Liym73YGGkaH45tn7sX7PQcl+UFRsEZeFmy7phi7NG0v2A6YNe+HO6xHq74tFG3fgofe+RnyK4k5kMhqwfOJLaBIdfgJSXYscBpo9ccsgvHL3zVi1fa/42O47moTWDevhm7EPSGDZoeQ03Dv+c6zYvqckh7e3p4f47DL9F9OL0bp719X9MX/dVgx/baLk3y09thFsfxj3ELq3aiJBagx4Mxp0Sp7bqpyALhbYclLgXERr50stzJJOixZPZWV6+lyzhNth9Qxo6auTSYV+sr8cPXEKDgO5CI3c7v8x3iLBaHw/CCAM2OL3FqZaMf2o9awBUARhkxa4tZ4RfUP0Usa+fIcAcY7VKVvR9Nm9MdqAcLNWfHq/PGTFnjzlsAh+/+4GyndTip1iseX3YzyZp9YgVmXeR9icn2JDapFD8uMyL26PID125tgxfrcy0XGiJtg+38yEQJNWSRHmStHF1GZ006DfboFdyRyxNtMO5mLtFKjDDS4on55gxcJUG/KsTgl6oysED2hghoifjzKFmQLWt9Q34pIQnmkNJBc7MS/ZiqMFTgQZFR9cAi9BWHL5luWqYWAr7Hc8YOymRr64p6W/vIj7spmrNh27j0eWczHSNMCEO5r7oVWgCdlMG7UzC3Pj82VLNtJLj1e6hkguWfrYPrU8Rayy/xfnh54RHnIE77JjBQK2y48VYmLfcKxKLsRXO7LE6srB/NYmvrg1zk+CzJYfK5CFSpy/Ce/1DpVTz+hf+8OebJkQGWj2TPsg8dMlcG9KLcYfh/KQXmRDrJ8R18X6YNaBXMw5nCeLqup4lQdsOYkSSJk2qnsjH2kO004xaIuR9OIKYncKvL0+pJ6A3vQNGfhxXbqSYs0VBEUfU5ZDaNx0tEAsYXRReuvGGEm7xYA0Bo8xMwEtunwfHh8Qgc4NlEM59qUUY/bWLMlfy/RcBN/VB3Px2+YshPsZ8NRlEWgZ4YHNRwsF3ugm4XY1kRyjNof4197SOQgE2jfnJcm/fA4NYiN6hGJQaz9k5tsELpnNgNkP2B9Z98ua+4mP7Qt/JEi7wn31GHVFBJqEeUiQHF0l/t6RJdZVgmKXhl6YvSVLAr7o93pLl2CxytKCyvRc9Cemj3CYrwHDuzNlmIdA7+t/J0igVkGxQyzCzw6MEPcIWoUJtoTw/3ULlmwSrNuEuUnYFJ+Hy5r7Y0i7AAHbrYkF2JtcjL+2Zsp3Gbg3uG0ADh8PoHx/wTH4eOiRlGWR1F98BttH3+XsAjvm7czGxiP5chJcj1gfBHnr5dkE/or2sZX5yGZHRKA3Xr6tp2zvX/3CDHFDYK5QPo9WMVrtaQV9/tZuYmXl5/SnZeovWj0fG9oRDw9pL/6vTGn1/qz1OJCULRkN6EvaqkEwdsVnSLow5nAtYp5gl9U60McD3z49EK0bhMixu7dO+BMWDuauELQJd/WVLfvsgmI8NmkR1u46hmH9m2PEFa2l/LnrDolvLgO0didkiN/utT2aSLovBrIxvZjD7pSALVpnCbZTl+7G2G+XiQ8wfWO/efJKdGwSJm1ZsztJAtVSswvEQs2MCQwI+2b+Nrn3qycGolOTcLmX7gvfzN8uINs0OkB8e2cu34efFu+At4dR3Ddo4WXfZxqwyXO24FByNppEBcgion2jUKTnFGLY+Nk4kpJz1sMvTjeOVTew5ULFarOhaf0IfDv2xAEN43/4HR9N+1v6GtOdMe0X3Qt4SMOz/xsiKbxe+mY6Pv/9H8k2MGJQP8lLO27yVKzZtV+Cuu4bcimeGXaNuCzM/Hctnvrke/F/9TAaseTj59E8Jgr/rN8mFlUeosCXk0f2/vjCQ4gKDsTzk6diyrxlsuPA8phH94HrLhfL6v6EFHw1e5HAdWigH27o2wVHktMxfspvSM/NxXdjHxTQ5oliQ8e8g6z8AphKQbq3pxmfPnkXrunRAYs2bMeYz39BVHAANu07LHWssutigC0H42CzBpeF6iXnKn1VeR3Kd+JIoV0AjZkPTiV8fo+HFjDPLbMLMJDp53jFFcF9L31Ob4o2ItikgOPRQqcElHUM0MkhC9MTbGK1PdNFCO4XokfXQB0iPXQCfTIpwoljRU7x6+WhDJFmjRyCsCtHyczAwx/c/sEEJObjvS/WiBCjFpbj0Er4TS5S2ndFqEHgmPUgiDJnbLcgneSipQWb0cArMmwCsPTFZbqvPsEGgU/60y5Os2FJik0mQcL6TdEGkSM/p9wI38xB28JXB63GKX6zzJiwIcuOLgF6tPFTTkViwBvTrC1Ps8v3Agwa3FhPcedgABxlyrbQ4rQx245f461SVplXXjUIbNlOAiKhsjHzeTLS2WWhZTYDWlu9dDpxNaBsjubZ8PPebKxJOZHCxM+oxSNtAtElzEMmQh5/S2ssYXNwQx85iKHA5sBHWzOwOqkIL3YJFkDmIRAL4vMl0OzKGC/JjfvRZlqKFH/fflFeaBNsEuvhkTwbliYWYPahXAk6axFoxIjmAYjzV1xmRGeA5DH+7UAeft6XXa2P4C0r2BJqezX2xdC2/ohgW12gV2x1ID3fhpUH8jFjY7qkxKJ/KnPF8n3kZ7+syxBYZRquy5v7o1WUh8iWUPfHlkwBQZbvzo/LdyOr0IZ1h/Px7co0CYoSS+yAcMnRKpDqGhcYsMWUY7TyBnrpcHOnIIng5xY9IZjP4Nb6Oi4uGAtw3IJOf93+zXwQ7GVQQPRYoWQUYF7aq9sEoHtDL7GAsk48YIIBa9sSCiWgjEDKLX9aqJftz8OMDRlIzbOicYgZD/cPQ71AowCr23pNv+C/tmWJryvLY59m6q3buoUIkNOVgfVMybVKvl4unhoEmwTGCduL9+TK/b0a+aB+oFEWzbuSCiUwju3u39QXdNVgai8CML9DK3hGgV2yOxh0wKoDefh0qZJrmJZfBrvRZYOpz5i/9usVqUjMtkrf5eEbPJmMFlyBV44/DqdYkBkkyPy6pzvBTxp8nhZbAisth/df1U4OMGgY7ieHIOw6koklW+Pxw8IdcvhBdLA3HhzcAR0bh4p1Vgm604i1c9uhVLw5dS2Ss/Lx0OAOuL5nEwmWou8qDyJISM+Hn5cRzesFIrfQisPJ2fjotw0Cee5cuISh+wa1xRPXdZI0XF/P2ypWYeqMCzZC7LhhXeVvBEj6t67fk4SU7AI8cHV7BPiYxO2ArhH929YTCzABlNA6b/1hvPLjCgR4m3FLv+a4tmdjyeJAV4YpC3dg2r+7kVdgRZvYEIy+uYuk+GIgINtHiyLL+O6fbfhw1kbxJ2ZfYk7f9+7tL1kPCP9UIBePDLj7ZeluvD9jvcAZZ1tCO4PcLm1XXyx41Onh5Bxk5ReJf3BshD8Kiqxi0WXGBwawleeqTmBL14BLO7bCNb06okm9CDSrH1Fi9WcqrYNJKWLp5GU2GBDo542IIH/JXpCekyf+s1v2HcYjNwzELQO6I7+oWKy1n836BwTHJ2++Cv+7opdAKXXBk8xe+nq6pO9a+MFYtGkUg+z8Avy7eRfW7z4ALw8TBnXrIM94f9lBWzYAACAASURBVOocTJw5T1KFuXcLwgJ8Me726zG4V0cpU/Lbis5tYhUeN/kXcUN45PqBco+3hwfsDruUT7/gaYtXSyovvq98J4YP7IPR/xusHPSQmS2Q/eq3s+SY4Cq7LhbY+ho1ApwcuxgkQyhj1DdTHK3JsIE+tKfN6OJKf0Wf0H15dqzM4MpHEZdrHBTLGjMp0MJLCGFg16F8uxzby5SjZ8s8wcmQfqsERboPsD4MyiI8c75gwnVuxhfYgLRiBzKsThnsTy2TVeJhCDxy11OvQUqRE9ty7LKdL5kbip04mG9Hjg0IMioHSNDSyxeegMLtJB7jG2hQThRzBxIxSwFBk/7FbpCm9ZUHQ3jpFJ/PQwUOcRnoHawTGE8oYtS94t/Le3kP4YeuCezE27LtAuy8CNysC5/JbA/5NuBAvkOs0aUXEGXqoDUKbJ2I9TWifYhZ9M4I+CK7Q3TCvum2uDEbASE3Kd8uAVynTrIE3zaBJnFLyLI4BFIJtz5GrUAsLbO0/hI8mQ+XME1LL1OE8TPCMDMs0ALPvtsykNkwdOJKwP5t0CuHe6xLKZSIdV5+Ji3aBJnFZYFWtKxiO7alW7AnW8msUeaFSJmUWrE3lRVsObkyKCzM1ygpp5g7lrKnVdbfQ4/MQju2HM1Ho1Azov2NsFJx9AE97oOanGsVQOShAbyXgEVYIIzRGkpQY++n7Hi6FqGSFkSenEXw5HvP53ub9BIUFhNklNRbDKTamVyEvclFciwut/cbBZvl/aJlimBAX1Zak3cmFYjePA1aybHLesuhEtBIztvdyYXS55qHK/l3aYHn9jutl0zfRWBkgBXryL5DeCU870gskHpwTGLKMgI9D1pwH+dLaD+YfuJ4TvdilUBLlwHWmXLkAmDHsUL5G6GTAJnqyrfcNEx5LuGKO5tsF+u+5mCe1J2nnfFQB8IO67knuUjGMaYUY1l7UgolX7CSeQHy90YhJnE52JlUJO4N7p1ntouQThn5eWhRbHWKdZcHTOQwnd3ZtqjPF2ype70OfVpHSx25/c7ffb0YxGORQwqY3ivYzwNdm0WKNTG/kDuFToE0T6MBZpNy6ABTajG4qk3DUMRF+UtO0cT0PKzZdQw9W0Uh2NdDcuImpucip8AiMnVf/B9PIrusfQzmbTiIpMz8krfXfSpZr1bRaBDqK/Jliq3NB1OkDzHFGGGbzyEod4oLl7awHzIgiRZkuhcE+nqgY2PmM7XB5rDLQQ2E73+3Jkgb5dhkHzO6NI2QFGLsY2m5hSID1rv0iVXso8HeZvRoGSWWVy4OaN3dsDcFWw+nwmbjoSnK6ENQ4mKBVuJGEXQjggD/xv3J6Nw0HL4eJmw9lCZtJhiXNy6guoEtXQaaN4iG1WZFQWGxyJsWUiqFiwD2C/YxWmwNBr1yiIJWi/yiIsxft00+69qisfiw2p0OWK12LNm0E14eZvRsHSf3Ek6NBgMKiouxctseFNtsmP/uGHSIa4gpc/+VQx86NWskQWU8yGH97oPYuPdQiXthSb/j2GY2o1ebZmjTqJ7Ac05+ITbtO4TlW/cIWMeEh6Bz01gJFiPwsn7MnZtbWIRlW3aXgC3LZEYFHkjRKDIMB5JSsHbHfgHt0n2nYmeRMpR2McBWOrorddKpE29Z050Rujitu3ZqSlrmnsQ5iRD8OA5yjjtn4IGrBPfAXwZRnRWQlbdZAV6WKVDo2vLnRwJMpYijdNJx91Dn/vxsn7lhvvQ97ufwM7fHpdx3iqHa/au7ju7qiJ+US3astzsdWVlkctI9NQhslcFX6VOlQbBEJqX6h/TZM9Bi6X7tvq+0jvh/93f5PN7PfkoQ4WTlXkC55Xgm19hT53fp7zwvHko54v9ZnYnWLU+dDqkbliJt7kx0uG0CHPYz59x1y+u/OznKy+UOnDxx3rlL8i5LgsjSHepb6gV1y0l5993n2CvluS/3+yP60iqfUc4ss+S+UpHE7v6kDAKKJePERHJiPHLFZihluKzAJ93n0qMC1yfqU/I9V6DAyfVTFqyEptP1g9JjpDtbhHIuvFJPWt3kPXCNXYrcTn62Yp1x7+oocfDuGfPE3xWgYdnu5rvHV/dYJM9wVah0vdzBcoQn7mCVfm/OOA6dJ9i6y1Ng6kSqJWmVkxkv3HBGHZwYIU4eA7gAOhG1ochQWYy6ZUt4EQtmSZ85/Qvqtpidrp1u4JNgPMnGoZzsxX4rmSfkSFZ3wOgJpSluLsx3euL4YrdFXHl3Tu6fLIu7Iop7j7IQPJ2l3N1/CM68V9liP/29yjtR+vnKcxmFTwhWPMHOkvXiLBNQdQJbVpMBYe55syQZ1qmTifS2/+4eu+UsR9+6ZiMl+FJJ3cWy5e8lk7oiM6bVmvPWaHRp3khOGHvy4yni28ry2O94nXG3wzX2EZi5MOJix263S9o4txtOSX1c7ZB3m9kvTjPRSL9wjbXl9ZcuN2eU5QsXC2zLUpcLvccNFBdajvr985RADQPb82yl+rULkEBZLbYX8Aj1q3VFAhcItnVFTLWxndUNbC+2jAmRXDj9Mf5pSS3GU8zoe0sYVS9llZ5/7BCGNAnCtF9/KRGJxnnCDFLyRxL9m+PHY6FHHGIGXAe71XWogCpJVQKUgAq2aj84hwRUsFW7SIVJQAXbChNlTStIBVu6CWnxxxtPoVfbZvh2zhI89tGUkrRqNU2fFV5fFWwrXKR1t0AVbOuu7svYchVsyygo9bZzS0AF23PLqJbeUdfBlkfbNgwPwQ/PP4zYyFD8vmw9npr4AzJy8iTwq85fKtjW+S5QcQJQwbbiZFlLS1LBtpYqtiqapYJtVUi9WjyzLoMtMxlc26czruzaFrGRYcqJgDY7Nu49jKkLV2HZtt1n9a2tFgqs7EqoYFvZEq5D5atgW4eUfX5NVcH2/OSmfus0ElDBts52i7oMtgwqC/L1kgwJbuss/W15CERWXgEycv97NHKd6ygq2NY5lVdeg1WwrTzZ1pKSVbCtJYqsDs1QwbY6aKFK6lCXwbZKBF7THqqCbU3TWDWurwq21Vg51aNqKthWDz3UilqoYFsr1Hg+jVDB9nykVoe+o4JtHVJ2ZTdVBdvKlnCNL18F2xqvwurTABVsq48uLnJNVLC9yAKvaY9Twbamaawa11cF22qsnOpRNRVsq4ceakUtVLCtFWo8n0aoYHs+UqtD31HBtg4pu7KbqoJtZUu4xpevgm2NV2H1aYAKttVHFxe5JirYXmSB17THqWBb0zRWjeurgm01Vk71qJoKttVDD7WiFirY1go1nk8jVLA9H6nVoe+oYFuHlF3ZTVXBtrIlXOPLV8G2xquw+jRABdvqo4uLXBMVbC+ywGva41SwrWkaq8b1VcG2GiunelRNBdvqoYdaUQsVbGuFGs+nESrYno/U6tB3VLCtQ8qu7KaqYFvZEq7x5atgW+NVWH0aoIJt9dHFRa6JCrYXWeA17XEq2NY0jVXj+qpgW42VUz2qpoJt9dBDraiFCra1Qo3n0wgVbM9HanXoO+UG2wkTsNirOWIuGwq71V6HJKU29VwS0GiA4uwMrJjwJGKGPQ1jcDjgcJzra+rndUgCGq0OqesXI2XOdHS84x04bdY61Hq1qRUpASecWPvtKGjD2sAUGA04nRVZvFpWdZWARgOn3Yojf70KjxbdoPf2U3VfXXVVVfXSaJGXeBBDGgdg2q+/lNRC43T+d5SwWq146aWXMHNfJgJbtIfDZquqaqvPrZYS0MBWmI/9c6cioPPlMKgDTrXUUpVWSqtF7uFdyNu6HvV73gSnXV0cV6k+avLDNcDh5dPg9ImGzjOgJrdErXt5JeC0I3vbbGgjGkJr9ASgLmrKK8Jafb9GA1tGCq7r2QbTpk49O9haLBaMGjUKifFH0KxpHBwOtTPV6s5xHo0rLCzEgoWLcEn/fvD29sJp1kfnUar6ldoiAY1GiwP7D2D7zp0YPPgqOFSLfm1R7UVvh91ux4KFi9GhXTuEhoWpVruLroEqeqAGsNls+P77HzBkyBAEBQap80wVqaK6Plaj0WDf/n2w2R34+eefzw62HEjGjx+Pdu3a4aqrrqqubVLrVYUSyMjIwNNPPy39JCQkpAproj66ukpg/vz5mDp1Kj7//PPqWkW1XjVAAgUFBRg3bhxuv/12tGnTpgbUWK1iRUmARrbLLrsMX3/9NWJjYyuqWLWcWiSBJUuWYPLkyZgyZUrZwLZ169YYPHhwLRKB2pSKkkB6ejqeeuopvP7664iIiKioYtVyapEE5s6dK2DLQUe9VAmcrwTy8/Px3HPP4Y477kDbtm3Ptxj1ezVQAtwZvOKKK/DVV1+hcePGNbAFapUrWwILFy6UhY8KtpUt6TpQvgq2dUDJF9hEFWwvUIDq10UCKtjW3Y6ggm3d1X1ZW66CbVklpd53TgmoYHtOEdX5Gy4m2NJ9Ki8vD8XFxdBqtaDvlZeXF8xmc4XqgVujf87+E8lJybj++usRGhp6QeUnJiYiMzMTzZs3l3qr138lcLHBln6d2dnZYJ/i/z08PBAQoAStFRUVST9jTAH15evrC51Oh507dyI6Ohp+fn5nVCG/Q13/+++/cm/Hjh3LrG4+d9WqVVi8eLFsyd94441Sr9p+qWBb2zV84e1TwfbCZaiW4JKACrZqVziXBC4m2Obk5GDdunWYMWMG6Nv70EMPYdCgQWjYsGGFAiOhZsKECVi5ciU+++yzC94e5Rbrxo0bpUxPT0Z9q9epErjYYMv4gW+//VZ+brvtNlx77bUl/p1HjhwR9xp+duedd2L48OEwmUwSbM17u3XrdkYFMtvQvHnzpG/y/vvvv79MyiZgs09zzE1JSZGfZ555pgS2y1RIDb1JBdsaqriLWG0VbC+isGv7o1Swre0avvD2nQtsOdEzWwLBoKIuRsZy0p89ezYYI1CWi5Y01sVgMIil91yXG0RfeeUVNGnS5Fy3/+dzWt/YZj6LFjwGR0VGRpbp2eV+WC34wrnAlvqjJZ36qyir96qVK/HMqGfwwQcfon379idJkfq/55578MEHH6Bnz57Sh48dOyagea7FCe8dOHCgRPk/+OCDZdLOgQMHJOL70UcflV0I7koYjcY60V9UsC1TF6nTN9V5sOXK1z0o6PV66QwcFPnycFDkj3qVTQIq2JZNTnX5rrOBLSfrSZMm4ejRoxIUxMjnirh++fUXjHpmlIBty5Yty1Qkt51Xr16N/v37l2kM2Lp1K95880288MIL5bbYEsBo8bvllltkC5sXxx+Civv3MlW6Dt10NrClq8CXX34JRkYTMpk5wdvb+4Kls2L5cjz19NP46KOP/uMysGHDBtx7770lYMuHcW7hD/V4ruuaa66RgChabstyff/999i2bRveeOONk2CWc1dZFmJleUZ1vUcF2+qqmbLVi32Ui7nKHNuqBdhyYOckcvjwYbGScJXbokULNGrUqNIaT+EePHgQv/zyC/7880+JrH3++edl9fvTTz/hjz/+QG5uLi655BKJvj3bqp8D6W+//QYfHx8MGDCg0upctm5TdXddDLB1Lzq2b98Obg/y5eBWcFhYmKT9oXWktg/sVafhC3/ymcCWFkq+f++9954Mes2aNZN3Ki4u7oIf+uuvv0oaOoJtq1atpDxaRdeuXYuoqCjxb+TYc+WVV6J79+7Sf7744gusWLECDzzwgIxHHAs4obKP0Y+R4xXfe9aPZRAyCLbMCsL6swy6PHBM4NjBfktgX7ZsmZQjOTiDgmS8Y+ozukswTR79M1mX33//Ha+99pr4Z/K73Gpmn+czuRDv1asX/P395TNuha9Zs0bGTLaRMEVIrs2pkM4GtnPmzBGXE16UH10EKO8LvZYvX44nnngCH3/88WnB9r777hPo7dGjB1JTU8UtpW/fvujTp488Ojk5GXv37pW+xHoxdSb7CS31zDR05cCBuOL4D11amC6Rc8/poJh95vHHH5dnPPzww9LPwsPDsWnTJiQkJMh3169fj1tvvVWC7Ng3rRYLwsLDxdLsNtZw3NyzZw/S0tKkL4WEhCIrK0P698GDh2T+5c/u3bul7wYGBkr/Z53cc3ZWZiZMZrO0ke1ISkoCIb9Dhw6YNWuWtJnpQTt16iRtZf9lefyhLzkXmnzntmzZIr9zAcLvHjp0SN4DZtehnEr7xVcm2HIcovWddeF7xPqwvU6+01qtzDXckeE4os4z5XujOFbt27dP3osGDRpI362sq1qALTsQB2cOQO+//768EOw4fJEqahvpVAFyAOAkwxeLAickMViDkMu/cYLhxMYXmvkSzwW206ZNk0mMW0qVuRKprI5QEeVWNtiynxBGuPCgJY164iBMX0pO7AzWYPBOly5dKqI5ahmVIIEzgW1WVhYee+wxfPfdd/I+1qtXDwTSs/knlrV6tIY++eSTJa4InJQJ0Hxnhw0bhpiYGJlYCRRuuBwzZoxsJRMOCK8ci5jGjlu/Xbt2lb729ttvC7jQIkh4oLsDAYqLrM1bNmP/vv3iM0mrIcvneEIwIDQTbFgHLq7pW7l//36x1hEw3EBA2OXEygCh76ZMwe3Dh0vZhAJuQ1NeHHMIOZTf3XfdDZ1eh5kzZwrI8DtnC1wqq/yq431nA1vKl9ZTXoS4Tz75RNwELvQi2I4cORIEWAKigyfnaTQy3tNiT+DljgNBjf2c1vsXX3xR5gQuTOimwP8T1tjPCHmENvbBu+++Gw1iGqBnr55yL/XLvseF1akAxbGOgM05iQFjXOQQKgkKDEAj2BJY+Tt9zDt37ozgoCBMnzFD+t91110n/YWAwcUP68D5kHWiYYY+wmPHjpVy6OdN8OW7yDYxTR/7HBdx0VFR6NipE2jJ3rptm5xMyvl76dKl4mvM+yizHTt2yPc5VrNdnFOHDh0qPsKUG+dXtpHvCq3W/JcLT8qLwM8xwL2bSh1WJthy0UBZfPzxR5gxYyYmTpyoLBCdPMQZIgPqm3Wsq/P8+b5H7gU6xysaA956663zLeqc36sQsKV/GFdYHEQ58J4vjHJ7ZfTo0TJw03JaWRcFTIf9w4cOYfjtt5esBmmF4YvHCcd9lXVrp6z3laVNXKnWr1+/xq0Izwa2/IyrdwILB7zzuTZu2oSxY8bINvUNN9xwUj/jYEfL14IFC2Qb8kIj08+nfup3zi2BM4EtJ3kC3csvvyz95H//+59MeAS9C70IegRSLlo5sXPy4k4NxxtCD61S7J8EU064tPZ98803YpWlBY4WG07uo0eNxh133oHevXvL5EqLKi0PnMQ5QRMMCDJNmzaVCHqCMBfMHE8IBFw4E2zYPwnbbC+BhHX4559/BLQ5wdNa++mnn8o9HFcIPrQmuy0c/BvBg88g3HLM5NjLSZiWLbe/5w8//CB1qY3X2cCWLi0EQloOCXVcgFD2F3oR0tiPCJWUKxfa1BfnO1qiCHuEW4It50T6y3Kcou64+0C4o46oq+nTp8sCh/DGPsR+R1imXjn3MYCQkzNB+dS5kDsC7Ht8T9g29iEuwvjucNHGzwiCnMvi4+MFDllXWnS5S8A6sc9t3rxZ/uV4zD7FdvF940KLvuK0XrrnQi7KCLmTv5iMbduVRRyfTbg7Gh+PefPn49VXXxXjFMtlH2e9OZfxXWb/53vHnRPugHKxx7qyDQRo9tsPP/xQoJ6LStaXgHzppZf+x9/+bGDLfkEjGReEnGvO9/rs08/w4UcfgtZ/LnzdF6GXdeZi4FycwzbwHaUcKjJm4HzbVF2+xwUfd504XlbWdcFgywlp9KhRmDlrlnQkTgRlDdA4tVGcaJ599lmxhpT2ieILxo7BZ7FTnzrZ8XN+xhe0LNsD7HCcuNjpaCVxb/dwsuME4z4ViQMIX1Jaj0/1tT0VZDkxcouJQOru8Pw+X+bSnZp/YxvY2bmtwc9Kl52Tm4sxzz4rA2RNu84Ettyeuv+++7Bl61axcHFwL29aGg5YHGy5HUtL1ul8nzmg0RrBgZzb2hdyUb82ux06rfa0A5h8brPJwF5a3xysOUjzxaXuK8K370LaUd2+ezYfW8IAJ2j+S6tWRUDt/7N3J/B2VdX9wDezLVhRsNj+QRGwqCSAUJBqA4kVaA20DGEwDEJIAAVCmFQGkTCPYSZYRRwACWoYhZShIaCCDIIKCGGylXmoigOooH+/G9bzcH3Dve/dc98dzv583ue9d+85++yz19pr/daw1/b+gKJ1HsDWZ9Y1IMJrYJMWDxYgLRJgx7vi3jylFD9eE/alcIFYoWYyR34jbw4PF48sRQ9cAMqadCbKmqwJGRDeVh5agDuALYMM2MFLV199dQY8gC1Fb0xAEcAU7aorr0ynzJqVx8nzRqa4RwPsgGHgIlIv2o0PRjqewYCttQl88PrhIUZuM7xrUlboJ2CzNlebYcMrPGvWrMwf5ABDhAefoUSvoBPZB8hddNFF2fsH3NI/wvWuDU+zEl6+o09FC2ob3uVM8jzyxjujPxkMHOtzt912yzwzefLk/D3dg5fNBcDoO/1ovserdBKAi4/JLzytiW4CucaEr/zvHaJfOhVgJ5vnz5+f9RddzCAURWOoAdnAsfnrb4OlaJzryG78TIYCkLVtIGBL/xojg8664j2WzjGc5h29O5kR6xlNzS+eqkd/WbuAMcMmHC3GjncZGEWsgjYDAeXBnGZ0kPtq7/UcMq14UNLTzzydXnrxpdcB9f7mJnRbrY7FD/rMkfTFFk2LpD9vqvWdMdSuM31pxXdFX3PZ1sBWWGTDcePSb3/3u/wCLFoMNZxmobAEhS6kAkReGkADEFlMcodYe2GVEv5PPP5E+t+f/m8OGRIu8swoLmEaigdzUjzjx4/PoRYAiKeDcqI0hHJY4Lwt373lu2nyRyfnvCXXUT7QPyLzvlx2+WXpqSefyqFvz+Mt0bjXAXq/EVEIiMdniSWXTC/84hdZyHgnCurH9/84vWu1d2UrniJnwfDkYBrhHJY2JStvyudleq+HQ6eB7hkI2OIH8xKNt7zRjUFoIVyHXpRLf41Q5h0g8AEF84iX5E/jHx4yC8qc8gbwsmyyySZZyAMIBC8lwEBzrXkXKuaho4xCSer/8ssuS2/4q7/KAljI0PcEOpoDExFy23WXXdIuu+46pHXfTDq0c19DVUUoY+xoGR7bMLrJB0o2h1RXXDEbuQFsec8oNmu8CGyt9SlTpmT5Q3bwyFLQSjrxhgHJZFWchgSgUtT6Aj6kWfD+AMkAgB8AJMK3PLaUA/kFGJAVZALeBYrwajT8isd49oyRUgeCNDwrx7ZXgW0ZPKRPwJa3ES1qPcDoT/egZXgjAVtGEnnDWKPI8YZUFjSTwhLVFTbbbLMMbCNlArBlEAGr/aWT4LUAtkBcAFtgCnDAVwwuzyMvw7ACoIAhz3KNtC77EtyP56R1Abb4GLA85ZRT8nTaiGcs+A1f4TWyNSo+6FejL6UY4PsMbJ9/Pk36U21ngB6gkxIEQAdgLQIf64IO5lG2Hs1JMQUh6DoQsOX0cI950fTDgzxUVYr++MXcM1y9T6xn3lp6naFCN5D1sWbpAHm5DBg5wgwVGIWeMde88gAu49X4rXN/83KTJa67//77M06gj6I6ChkiL9uzYBJYYfnll0933Alf3JbevOyy6YnHH0//sPrq+d3hFLIArwGgDA4RHHLriM8ekSZuNrFPVwHXnieKZTzoA+vgIf3Qh/S090Enhjq5ac8B2WQdkJ3wlXvxC3noHnQTMXFPvFfIL+8ACJOfZbURe2xZql6EhWyh8GoY+HBaAFt9mjxCnTIBADEZgIFpp0+fnpUSZuGJoSAQ06QDriaN5Qvk8N4RKsbFMwNgmWiTyuqiADCusetTrhwFB4QKPTmSTRiG9U8Jyg0RYkI0kycsjgkJD+DY5hEeZwsZM7HU9GEMm202Me2xx565D1a1tA0LSD8YGOgi8KJeIsYDnuvZVTuc+W72PQMBW+9ozixg4JDi5tVopFncAIQ5Da9G7f0WFgDDSibkGA3oTYh6PuFhPv2Ptrwd+Ard0B3d8LL8KeBmu+22y/cQWvLqhDUJFzQWUsN/eFNf+EkIj1Cg/DwHTQkvkQC0rNqrOWqtOlKXUKdEeHDCYAQqCF2KgvC3ptHK4Qozj5yZZcy2226bvVEMMB6gAAXkgk1tFA95Q17oD2/IaSRjrGsbZQh6QJZskJepP0DZ9+TBvHnz8jonk6yPOXMuSV//+iVZgfgOgKA8yCEghvzRvwiAdeZvueRkHH4DBMgOssJawbM8Ywr+N8Nb2W68O1S5r2aPFxgE2PDR5879XFpr7T8f4xsHJdBF+ImXkJFNTwFXgA1PPQOLs4K3FyCgB9Cb3FIVAQAmp4AKgAD90ZTMLHq8IoyL5/AnAEN3ANURWXAP/sNbZCI+cI0f+i5AOuANqAHPgIqoJ/ApyuH5kRpBzpFnPLa8sBwAogJ+06OicuQhh4I1Tv/hVTLYdXjY++Lbt6/09rTHnnv0pfjQgxwD5hjfWyfmobak2lDAduHCB9I222yb04K0KL82nANZzJt1BcuglQbIwxbm0zujA8PA2jb31hmvM1CLXgA8R1zOn1555SyL6I7l3rJcxiUv/PKFDDxhHeuVXHA/naR/vAZAM5CsaTSgAxmu+IIhwglDNtBZcpHJGjoLYOWwg4eAVnO57/R909g1x2aHn/eAm/AQ44XzB23lP0dKCh2KbnQu/fWJj388LbnUUlk30uV4h4zUvDPeE+32bPzPONOX54jG+18jR713WwNbA+Q9wPQmmSeU8h9OAwAsKt7VsDaAFJYPy4lQ0AgKE2lBAjk+p4woGQvapGI+IRDXWcwnnnRSWvZNb8q5V6xLC49ywmihuAgC78ETollgvueJwyys2AijhLuekjQHGM1zACnjBcoxYQ5fPPdcWnSxxTKYw3iAVIB/jIwRWD3SGFiArFZAq9PaQMDW5xa+dwIc0KBRYWPBEVTm0MLorxEc5hL/8KCgDWPHI3kgSAAAIABJREFU4vJcApZFaaEDoGiQdyP/279lSxzPAQZCdPgNQAEYeNkoNYtfjtmCmxZkAU2hESqMOgoMbxDkAFOcPAQA824Md010Gg8MNd5WAlveJ3xA2TJmeT6BB3RGXwYJQAGoWoeAB1pbtxQ1Ic0IAgp44XljAA5glJHDE0KB8YzhA16qsWPGphVXWjGv//AsuZ7CFnEik8gOgp6HhZKgqE484cQ0fvxGabnll89KjMLBy7wl+MzYgFwgIDxS+BYfU0gUDSObDGYokyfejfxzX7e1VgNb0R26gR4ADMy9eSX7gVaf33H7HWn996+fAYUIE15BP9fTJWQgPsJjgCR5z1smD5WMAKDoMc4Qxhg+kPoiylD0XPqcrsJzaIwXedfwNLClQgHZ5R7XMeLwoKoZZFtUGrEu6DYAVB/4xrjIS/3wJtKVABO5SAaSod7J2qH33Uuf+YxsBWIAS3xOH1tXgJ/+8To5jl9zDuyKK6VVVl0lbTR+fPY8aq43T0BbnOxWy7sDeWx9PnfuN9Nll71aoch7DDcVx7sBmPRxyO6oTMJwiRQzWEP+MIAHXIoKx3qDXThx6HNeVjzLmfLkE0+mU087NfMOGpg/6Q7mCR/BD9Y4QEym4Cct0ttgHkCVbolmvdNn+AZfkWH4CLjGB+QUAxwt8ZTGAw0niYJy8NGF8A7AqpE7eMBz6VzjwyNo433oOs4c1+NpMsgckZl4Dp/RmcA/A4ws1hhLmvcsq43YY2tgwBsAACDWm+fa3wuxEAPYBlPLc5Oe4LsAtvIoKSOMJJ8sPCAWE+uG5YdgIYByPscJJ6Tl3vKWDCwtVkDUmBEmgK1+WKo8Str3brstHfQasCXUEIclh3GKzfMQ22/APkC2hRWWduTBAHXeI3JAEZvXBWOy6oB7lhrrsNPaYJvHLGqMjz8aBbXmgQCxcHlVzVV/+UjAiEUm5GEOtQihEC4Ele/QhFAJIKpfO+IJZw39LHTCgcXNE0NpsFoJE/xEYETuU2wgAV7kTjKAAFvgBA8I4UWeVqfRtNnjbSWwjSN10Qut8AyFRNDH8agUNp7EnwS5ayh3v6UekRUUFQ8KLwcwoZFPBH6UBPKdPvCCfvQrBBphUN/FRhJeGGuF3PEsz/B/HEzht/FaJ67Vp2cB6j43fmPymzKP41yNUZ8MduPi+YvjXZtNx9Hur9XA1pyia+Q0Bk+gBxr4CVmPbngOTwStGDpC+PpAc7zF2CKPyCz00or8qe/goaLHNmjuMzSOAxp8rnmmz3znMzxrPJw+xl3cE4B3fOc5dJtrySy8hF/JbPfoy7WuC33JQ6d/15KN+NY8mSPXx7rCu8bq+Z7tGd5/maWXScu+ednXpQqQ4UAzEDxQpGGwzWPexToxByPJ0RdNoS8A05DdaOT9vK/nxCZotBXdA/bCw44OsIToC10UHmlAlSOEzjFG/cAw9M/zzz2fHnr4oaw/GEJwDzBZzDM2P7zkjFgGdTQ4wuccdsB1GLn6igZ7iPL4Tot9Amhq/Ly73jvK03lfes5YgHdz4X0YHniCgcWzHpsz0Th0IRqhA6BODzJ4RLk1wBZt5XGX1ZoCbJs1OJ5SwIFnL/KKTCqwC9hGIjTv2MYf3jhN2mZSXkwYijeEpwxheWR4TlkgLFrChNub1cpqCY+thYt5isAW8cJjy+qwMe76G27I3pnIHy7W5LNQ9cfi9ts1ns1iZ/VRgAQUJkFM4SnjBbQ0HkUMyroHmD2bldRNHttm8Qd6oB+BoyxMEdyae+CTYBH+D8OIBcnTRth+66qr0rGvbfgxJt4BoUO0IHwjl4gH7agjj0zjNtww/erXv06bbrJJtqrREY8BxOHhtZBDgVEMFjFLFK0tfLwL2FYe21e5oJXAtll8V/XTfjPQamA7khmg5OkEnjJezGixEZZMG+0qLmQb0BWVNurZHDWSOenvXjIcQAOaIq+1v+vKLPcVzwPwyPri5rH4jvNCWF1ExZilKjIkhPTpEGAPpoh8YwCOzqeDzLFcXGCX8atM2pfOP78v3QAApI+8o4g0LMDwCWcMPcVjK51FmmYYPO4DYnmYAfHdpEGusELWlUVgy9MbedxRucVnIlnwEscgh2AAX2Ohy/wG1OGjyPuGcTiBeHnDEIlca2Cf8w5gBnD9zUmkSfHAX36X1doC2AJ93OLCJrEbWPiF5UsRYgJhQWEbViLCCklzoQMtckBYkyZdQn7UiOQqZxEjDG+aMB3gzFLifZUrRODYYAacACyYESDFqPKQWCO8qBabMAKP4T57752WXmaZbHkJU8aOUkwGKAsjsHqDYSJdATjiIdYXZveM737nu2mf6ftkS0lfCGJhGIf3AMY75fSzsuvYmmc0RkvKQJjJAiEEzDnjhrVKebCEgcxL585NEzfbLIf5LCQCB43wAovVXL91+bemQw87NM83izjCMzaBxO78CAXyshAM8sV4ddEST7JyAVvf41deeeBXCMeiFgIcjqe6rIU/Wv1WwHa0Zr67nttJwJZc5GChc3jfyBLOlttuvz09/dRT+bvR3iBMB8sZB5zIx1aPB8i67rprs9zeeONNsodzoFYmsAU+eZTpYyBU2gSQTbcDbeF5F9IHPKVywBmxgZQnlmdUChAvLE8nXcVpxTN6ztlnpyefeio7PHi5YY5nn3kmfWKvvbJu05+osr0enHEcavAOw4dugiGMT4QYxqDX8JdcWCkLcnXhGnqNc4fOc69nq0zkkAn0xYP0o/55euEMmINDzf/uZXhxEvHwek6kIsAuHDVwFe8tDAbA2n/w61/9Kq262mr5MxFw7y/dQv42p5N54Eyit6XzoXM9lawalV5tAWyBSp5L4Xdg0aSxfAANzMHzBdT6jLUkPQFTAI48uhFiYRWZXBMO6GAUVhEmxBQsB3l2FgbQ+rvf/z6t/tpmIp/Z+YlJ43AIFol+CCNeWuETaQoYB7BxnTEJJXCzIxCAgwmcK6623xKLL57GjB2bQSuhgXEJEUyIqLyGcrS8izCBa+TfeSfPtfu2ArZ/Zmvg1nzJS8MfeUewfKAXX8x5PoAoTy7Qik8eevDBtPb73pfzv26cPz/99LHH8tyHdxYYDUDuKQQXKxcvMniEBj0DMAWa0QJ4ZRkTgvgNkKYIWPF4A6/4nNCQb2Zc+K4bcx0bFTgVsG10xqrr+5uBTgK25D19Q5dQ7JGu5x3kvQ4G4lpB/ShrOefiOVl37jZ1t5afWkfvAkHyV2OD52gAWziA7LdPAxah4+EKQJC8J9/pnqjYQObTCVIjXU/HvPktb8k52HANL+eSSyyR1lxrrezYuOP229NLf9LxwLIfjjJ6Qg4yMCl0T1fpjy6iZ8wNvYZX6C0g1fg4A+EEfKRv8waDAKzSOYwZfqCL9C1aTH8C4caG7p4VKZ6wB68q3UnveT5+lSvrnWEVGMr/+pXvbz6i8sFKK66Y1l1vvbTWmmtmvSd9k651HbkPF/E0w3rmknMy9rw0m8/bAth6KYs/Sn/4bYGF+z1e2meRi+SzSAOI3DjEjfC0PhBPA24jb00f/g6Xue8jlycKbkfuZIwnromwM0bCzKwOzyuOPXJp3Rs5Wa7DZPHcyPcLK7D4fvGMqH/bSTuay/bYFpk/ytb4bW5ra/lF+kdxboMHzHHMK0HCWo3Ql9QFVirDhaXLg0CAWJhybYFWjRDwHdCbj1x8Ld0keKeWV4Ofm72AO62/Cth2GsXac7ydBGzNILkgP5NcJwvIrNoa5qM108YGsOQ84bRI+ps3vZpT3spGNqNp6MrBnl2mx9ZcFHPyjSNyR4OOoT9C5hf/D1wR8l5f8EFUNipiCjornocf/EQ92IgQ+h/Q9H/gjZibyOOGRYqVk4p4pIhdDjzggLTiSitlPVbUm7V6lW7zvT7DqVbbZ1HfxvkCPosxuh/+MW59GKvm75ijoh5uNq+1DbBt9otV/bV+BloJbEf6dhaq8cqPklsUBpFQEk+tlJZohI/0B5YnS71qw5+BCtgOf+6qO/88A50GbCvaNW8GygS2zRtl+/X0qU9+Mq3wtrf11dpvvxE2b0QVsG3eXPZ8T50EbDG+MJKQUfFEJ0cpPvHE42nKbrv1hQyFYYRogNoI2/Q8sYc5ARWwHebEVbe9bgYqYNu7DFEB28ZozzEjrUBurfQ9m85qTz5rrMf2v7oCtu1Po44ZYScBW3lNcqLkABWPvbUJUfUF4RL5S8KFwkE2m432zuWOYYRBBtorwLaY+tQNdGu3d+hGYFvLMwMdl9putGj1eCpg29iM4ys5rzZxSQWg89SX7aQ0x8beOOVN+IoA2MAWbZE/FhNBXvtU6Fb5C9UKhG6rVs1A7Qx0ErDF4pHrXPsekR/tcykKco3K2LnZixzUC8BWNQw7jG0YVJVF8XwHLNixrBRh1UY+A90AbG06tiFHqSUbkylhm4iVMsQ/NhapcT5Y6auRz2Tn9VAB28ZpJt81clvptG6v0FMB28Z5pLpjgBnoJGBbEXF0ZqAXgK2qHZM/+tG0y6675rqQvCXKDCrQb1Ni1UY+A90AbFX0cSqTEpBAhzJRNqfiFfVTlXtSl71Y+3bkM9f5PVTAtvNpWPYbVMC27Bnuof4rYNt5xLbjlke6eGRnmW/RC8DW/CnGD6SoJ1m15s9ANwDb4qwAtgr8+63Gqd+OjlcYfyhgqwasUoK9ElWqgG3z11O39VgB226j6Ci+T5nANrJjBhLexTBLlNxq1lTo22kxcnFHckxjs8bTrH6Ep4Q8hcttJmhFGw1gix8o/zhytpY/+uMXmy0o0DjtsHZu1CSVVjBQbWJVNdSlDmCrFreycsXC91HapzbXTbkdzy4ef9oK2nTSM0YT2Mp9xTP91Re3ppQ26o8vyJFi6Sj0V17Q2mNcKlzv+wC2/7755mnmkUf2Adv+0qc8Sy6hU7BqjVPPk0Lo89ojec2f+qwDycpmy9Bm8la3AltOBnX68Y76sb1iqDSTN6KvCtiWMas92meZwNaGLodjEMi8GEpvFZuiz4phEw7OvHYqXbOS4z3XQQ5AitNmuqUJkTvEROFuRb9b0VoNbNUglt9KSch1dYqOAvmKigOmTn1yhLKDYIAAR0M6zMXxlA52sWnQd+756Ec/mguKX3755fkUnb332js9+9yz+RjQsWuOTZO2ntRXbN9zFF136pA5duS2VASHdeBhfQA2gJBDXRQ8B0QcKoIuP//Zz9Jiiy+eAUscD90K+nTKM0YD2OILpxsCtE5/kqcoHzaOTZdb7efxxx5Piy+xeFI6EN/5TFUVB/64z0lSDhxSL/vGBQvSIQcfnA0op0e53olSeMFeliNnzkzrv//9uQYuniHnHCqkagv+YZg6dlU6A3A8bty4DFjnzZuXZaH+PJPcApZ85iAE1V3UrpU2wwgDBJ579rm00fiN8kEA1ocTFY3BIQXtBLK6Fdjik4MPPjjLJGkprYqidcqab2ScFbBtZLaqawedgTKBLUGvPBelQAkAK7VeRmW5gAhCoZktAI+jBoGbbmjeyak2vJjKmEUd37LfrZXAltdp5hFH5BNvdv7YxzJvOOXJUclXXH5F+spXv5KPzARw7/nRj9K+M2bkY08pccd0AwJBb8d942/HbPK+OvYS6NQXr5swspCxI7j153QfwFg/F198cT5a2WlAvLaHHnpoBrI2kwEqABCvG6Air5LHTgWOCy+8MJ/E5KSfqr1+BloNbBkgaOgEyW222SYPxnGiQKPyScCuo7jRfcwaY9KM/WZk48fmMJ5Yhg3jEXi1QYwswUvXX3ddOv2MMzKPOtKWMQ7YWp9SERxfilfwzLbbbpsNLAX2HTHvHhvOHPWO/3xncze+cTSqY1eBbyBXqScyEw/K4VXm0AmfwBMeffSRRzL/Oz7e53j8yiuuTNP3nd52AKtbga1IDSOFTI5jb6t1P7wZqIDt8OataXfZGUtAFU8OaVrnTeoIQBCK55kYzLM3ELB1/0MPPZQBALDACzacBrhSFgQ00AAEmLtoPAyO8SserjCc5/R3j93JAOD222/fb5dDpUo0axzN6sdRiI5utiPbkYutaq0Ett6Jwp//p6OO995rr+wl482y1pw455x2/CS9hDcXoBANcOwjkOJc9jCSeOsYVYAmb6x5O+OMM3K6gcbT6h5ARGoHfgF63W/Hu+Mjr7nmmpwSAZgASQC0NeM47j333DOnugBJQC0+AzCWXmaZfCx31UYX2F533XUZeIrchMzhWecpDcDLO4+/0G7VVVdNr/zhD2nf6dPT2mutlQ486KD8AtIYNICSUYP/gFYyUdUhABkfSjHYcsstc+QA4CHX/E0Oy9/GZ3gK74i48CRrjoPdeeed04UXXJBWf21dcwroy5iMV+RJuFsEITyxgPvUqVPTpEmTMqC+9tprc3TCYTXt1roV2OINhrF24IEHtp1B0W58MNh42gbYslBZibxxrHGLkXeDJ8liFkIBqoSgWbVx1CkFTTFZgBF6dj9lglHUIdWPv1nXAAjh43/XaO6P8hcEhQUtTEP48PBY/J4DOBkPIRS5cvrUj88ppPjc+IwbmOPBoaRqQ+OU2syZM7MgMwbvR+kSMp5ljARdEbzVElNOjmsIKsCPciTAzJcwk3kVSiqW9zC2xx57LM+FMbP0Ndeq7epeVqO5NgfGecaZZ6ZJW2+dx2Ks/YWmBgK2ytbYHS7kq34eQDGc89G9nzOyjXe//fbLIEPoBj01NAKceMKiEYLuM15h4JgHtPGu5huAibAPepobz/Cu8bk+hYhqga05BHqMS+j5pd++lH7/u9/neY1jKc0rJYZHjVG/xoHOeIenTj/CgzE+9+Ad/GScnrHyyivnXfXhXfVuxvvb3/02vXGZN/bNg3fHv0KfaI0fFOYuNjuyhb6AtFalIXh+q4EtOn/5y1/OtYmtW3xoffP+85LypJkbc2UdAgxCsTNmzMh8wTOroRXPG5CB9yj/008/ve+IZbwPxEpl2G677bLnTr1I96Oj1Bg73Xnwzj333DR37twsm/AlegafoQuDgyG48cYbZ69wN+V1N0s5ttpjC3QyXvBMpIbIswYqyQSefTzGW0omM27ICyCSkeOntvUHbPEE3rNut95668yP+JA8IM8ZYKIKDDbGPX7C09Jl8JL1dcghh2Qjqlh3G6C9//77MzD3NwfDYYcd1jck8ocHmTzCxzy70iza0eFSNrA113AATzk9LN+e7rAOyROygm4kV4stcAq5D3OgB0OW/Kb/8QVZ72962v9kg77hHs/lfScP0FRNdfK/qLvdz3hhfNNTnhVHv4eeI+fiHn1IY/E8/KPhp6LONwbrKbBSs1L4mrXWh9NPWwBbBA1FM3HixBxmMfnHHXdcXrgLFy7MhEQYv50UxYK2yDHb1y66KJ162mlZ8WM6x59a9AhF2AAUvG3uueiii/ICBgYJKqHIadOm5ZqTvmdB88wI43gOD4pFjtE9i9LxOSVH+QjzGBOAQflReJiNxWt8lKYcTSEoDB0Ns8l1IjApL+DMvRiO4hPywtRys/QhXFQMFxNEwBRr/0MTJqQ//PGP2TAQghLKJBh5g41j/Pjx2auAYQEe82MxLbnkEmnhwgfz840ZDeQkqpvo3YzXuxm7sDWlTSAS5o0AW/ebR8aKMcgVQ+dGG9qaD+MwHiFcYUHGgQZcEOzCfBqhwtOB1j6Xf+Y7fCS/DeD3+/DPfCZ7Nygqng9za97MC77wroCtfDOgpdgIPh44QoZX5KeP/TT94O4fZO9gGCznzJ6dQ93m0vMoJuFI+XF/vfRfp5VWXCmPCf8IN1Kc+J4BgKc1dAWq8Iu1gX+uuvLKzJNLv3GZHDZEUzxjftzr/x/cfXf62xVWyGMpNgJ0nXXWybzRytZKYIvfCG1Gn7VoTZvPAALWn8+sL0ph//32S8cce2z2YO+/3/5Zbuy9z955eihTa54SwQN4IdIPfM9gMccADEAK2MqdJUueefqZNH7C+Aw2KCXyxjzgh2hkoGf4rVnbQt2AEVDcTjmOreSXgZ7VamBL3tAbynMFYGSwk4WfPvjg9M8f/GAGQIAgg5EMxi9C+3iOrKptcrP1SYZHKgI5rE9rnSwg26xTeod8A5j3mzEjHXX00dmQZgiJFAC2GvnIWCX3ipEx4JsBS7/pn4EsOlFsxm1N4GHASFWPdmxlAltOHWlH6MzzTYdai+jKSIVFyGp6goyNOXL4QeCTe++9N+sWMp7xSzfQ5773s/baa2dv+wP3P5B++KMfZlrTCVLryGX3kyHue/LJJ7OutG+EbLCPhA6hj6QtMD7Qny6h5xwR7146QL8MGeOnMzhH8Ie+8Cc8AdtwONH53g0f+r7TwW1bAFsEwAAA3Q477pB22nGnDIL8cMkLwQB8QCRPByIec8wxGWAiIED2rtVWS29Zbrm8KFnKQIkGDGEMSoiip5T0wztmgQAj7pFcj7mAaspsi//YIls5FKIQDXDK2+jEKgINUDYGOU2YlPWl5iBrW3hSHhOPIrAKQLPwioW2Mam+LJ4bbrihr1wLkCSnDhDUACeMxrom6IoNEPM+71793enkU07OC8N9wLuFRkHPnz8/h+aBdv0KdVgwhBvlIJdH/+aI0ON5ALItXPcCUqw+ffB8mcOBPHwDeWzNnTlmbQJe+jaXjTa0MJfArL4IYfNCQPMyAO0AqTnBU47H5RmevMPkLBAinOc9vXsYTubNOwstEwpCyJSS/igWi9y8hDeuOO4QNubJ/QQayx1dKSS/Dz344PTU089k78tKb18pewQJJ8aS/gErnhIKjgBkxBBa8ucYBXgIcOJpAbSBJooMPVxH0eJdSk7uHBqhs1AjgYz2kRdo7DwI0jg8u9XewFYCW7SxJgl/INU8UBR4kRGI961XPHLzzTenr15wQTru2GMz2Cd3XnrxpXTCiSdko4/QN9/kirWMT4SeI+2FN5YHzroiqxhQAClgS6EAudYkWgv34l80okgY3xSPdUUW8NQxyj3PGq6A7V9KilYDWzIQv9AX5DrekjsNnJJBQAXdgbfIEwaJdYrfgFoAll4AIqxl3nzr1ee+BzSlOtA5eOjF3/wmbbvddln34Qv6hswAvOiIww8/POd04y36SWoNOYWv9AOY0gUMIsAG33LikLt4kv4jj9wTDhMyyLswBMmVdt28VCawFSUld8laeoLsJc/Ri3FgzqxNc27eyFiygcwGSslToMrfnBP6sBEPnTk7yBlyA3bAS/Q7PmHs+h/t6B28RnZfcsklWa8A2wwk99Hv6ESmGIPUPDIMjcmwb998czaK8V5EfMhBNCeDYCG8y/FDB9IN5JDUGs9xbzumoDSCF9oC2Bowy4gy4U0hyDVMYfGzLnizCBdgF5Ak9DEMQCrfDSFYHwjppYrhe0yDSeSxYUDKVXqABQKwsH4QF4NiMiDBMzwLAwMCmKdY3gUTYEL3AhYv/ubFDJbGjB2TFR8hR9kBjBSrsEWt10VoyHOBFAKNkNQfKx9Aigbw8KASTMUyMhYh4PSRiRPTjq+F3+fMuTideuppWUECkeaMZ8gCAWy9r3uEWSKUDQh5nwULFmRr3zi9C8HGIrUAKFvjGiw/diBgi3aMFgvdXBD+w9msBNgS4JFq4N0IED9oQQjJp9x+u+2yArj5ppvSGmPGZMXAo3nr927NgonXjGD48Ic/nI0gFjSPO4DBC8Jjy5PnN9BsHgi1rbba6i+MCzT6zne+nWbNOjW/Y6RYMJ4AFzxs3J7HUx3VHPTF+0LImW+8xpPuGrRyj7EKKwLC6AHkClnhZ/zIAwiA8/ASVNZK7MQ2RxQskM9THccGR8gR+MLrrW6tBLbezTwBnIwV/E6x42E8SYbwYFA41jsDzG/GgTXHiwu4og0POUMFAKV48DH+ofD0K0IC8JhnBiHaCEfqj1yxxskpP9bTsccck557/vlskP/zuHHZuMSzX/7SlzL4ffs73pH7dP9AJcVaTbt2el6rga1357xglAMYjJ7Hn3g8Gzj4iSwmM8hc/6MlMGq9SV9gVImAiXjhLzTlpOEkwTcAEaOcnmJYccgw4jlveP7IAnzKsMVfkToDEEunwSuuA3aAWikR9JJ+w0tIzpHBnkumkQsMaTKFDPIOgBp+jxScdqJ5jKVMYOsZd999V5o2bffsDDE35gONOJYi5563Fk3JDKDxhuuvT0fMnJllAd70G2+QA+hFPwHEjz7yaJo6bWrW5TCLvhka9CysQZ7Lqd9v//0zjcgKOsK1nBHkFZ2A5vQ5uQSsojteA3rvveeedNrpp2e84jkMFo42vCXyx+ABYHl3Xc9QYuAYs0bOdbrMaRtgy5Kl/E2yxayxSnkXKfzahljAm53OrB4MQfAgGkYqloM68IAD0zPPPpO9M5jISyMcQmJWYJg3jhcHaOA9pgAtdIoNgCIMiu55TMHaYd3U5toYq/FhuCuvuio9+8wzGSwDk8VGqAWwBTQAS5Y+j7Q8wGgnnnBiWnDTgjwPxfcyPhsJLDq/NVY9oEdIErLekdcHKKVoASpjIdSiWVwAGAHI8xggKL6XngDYAlwE80BtsKoIA9VUbERw4gU0L24OAzLQ4fLLLkv7TJ+ehQfgTiiYH8qB5eodvB8Fwajh5RfKv/e++zIYBHwICTTQB6Hlt+/0xSAwd0XPZ4wdLwCdgG3Qh6GAf3lczIt+8FAcqUoQ4TtjDYOHp4BiYbAxptzLcmeYUJSeoX88DJx7HmONwiRcfcdTyGhgNOkHrwNgwuT411xIS0HnyE1uhAYjvbbVwDZAKdoyAIp1ZPEHJcTwQWPeLr/NH1nEU8uofvlPx4m/Yaml+jxY+iIv0AYdNbziPspFP2gaGwrj6Ga/o39ABF8AIcWcdfeSHcaNPv3VSh0pDbrh/tEAtuaNQQRsAAlkdtGrGbRzHVAZ6xotrWffM3zxlc+ijnHUtw26hKEb/IQHyDn845m8xb984YUcoXRtPJdBFHnb+pQa4Vq6zufujxq88azgR/+8m3weAAAgAElEQVS7lnFMRjHg2rWVDWwZwmQzPRyOHCBVpAXI1EQL6VgOBZEv8p58LzbzTQbTJZwcaMBY1gd5HcAWWGa0kOvkMprE5jG0tY+E3Gas3PX976cjjzoqe3FjbGjNEyztCqagJ2EYfMOo4tUnqzz/nnvvzX9f8NWvZqzAUHNtqyN3ZfNW2wBbBGeJFIEtogiJyG9ijWoWK2LHZhohZ141oJEXhcLhiWGJahYyy5kXGDjjpQLyADSM4HpKjOcXMObRBVbjeRiQtQWkBtiMQsq8y4BOFGH3eRRWl2aAWYFi1pIwVK0VfN+99+XFcuf378zCTsgDeAJoLCTN4pj80clpxZVWzBZbUdERRDysrHjWnsaCZM0BEPo0P4QUUGqOeChZoeY2EsyBPoDOYhEyKc61ayhgc4cOg21kK7Pcl3ezYAkTNCo2QANgnfvNuWnTf900vwelgLl5eNHJAkZDQgjoAxZdY668v8XNeqW4cimec85Jv/7NbzJvuc5naIU+tY2nF3Al7GJ+PNt8uZ/HjnDijQ1gS3ABWoQMmqKTEJGx4D/rAR/gHd57fMVgoTAJXYpd/pR352Wm4IQmKT5W+V8vvXT6+7/7u+wptK482734AJ1GyyPTamA7XAGKnuhi7mqjC+Ze2BANed2r1voZGC1g2/o3bd0TX3jhFzk9auzYNVt2YMtw3q4VwJajiMwM8Mg5IGoXepaTiSwDbP3NocbJFlVSRAA5EuhV0TuynS6VPkj28vjCIPQ7YMubTq4Dtpr+AFzyPfLsjUlUl06hr0RaNTpRZIpuMwb6iK4gv2AhOkVqBWB7349/nA7+1KfT+V86P91+x+3589nnzM57kugQeMXvogNgODQa7XvaAtgCaDxrPEmAGg8k7xOiAiU8YpjBZ4AtkMHFTuHzPFLwPKzAK2bEcEKJPDGsEh5cABXQwyTCvAAt4QjgeZ7nAJa+Nw5gkceEZ0VY12+KzPN5l3eTdztnTgYfW2y5ZfYyA8oWAA/u8ccdl9Zbf/0cSsT4xue7YsPkNqHImxFW8Dz5UK7HpIAPprVxwPvKkYnGSgPuzQUgCpxjSAzP88dS5MkDcoQ5eQK9s3QN3kfj8j+Qw6NrfBaT5wOOwtjAlvC+xRfhWX0CyP3tli0T2Jp/YRj0JQiMr7j45K3xrqEh+ue6k4cdlmksrAN0up9hY94IHYLEPBEAaKPfcRtumD74gQ9krzYvCetaHjW+BO7dU5tjTNgAvTzHPL94hHUNBLPKjZmgQQPGEetYdACd0QDI5iVAN4ad1AMeZWDdOzHYjJlhwytDGOnTZg879IFp4MuP99LXOcoIHXZY9i55d4LVnPAceIfBPO9lCqVOALbk0WcP/2x6+ZWX8/ouGpPWAsXKEEYrNB5OWk2Zc9wLfVfAtrlU5lWkZ+mxdt88VCawpfPoBNFduALgC7xAF3JQaGQxAGmTmQinSC+56zevPCwgsgj42tvBgUJO86yKnrnfPNMx7qEX6HApjPAKPU7/A8Z0tuvpXHjA3wxvjjP6wOYxsp2ThE4xjsBRADScQZdIW6FXPCcizXBS6EXfGw9H4EAnLjaX68rrrS2ALWZCcJYF8GlS5XkALiaaJw1gQXw5q4iJGDxhAA4G4LWKVAHhFECHhQIQAbzhneTSx2xAJPAqpMsy0rdQtTFgVNYQ4AzEYFJA5f+e/7/0zlXembbcaqv05mWXzd5gihoo54njZQX68mkzt9+ewYtwke9YcrU5thQoxuXd9SyLyLthTIvJszEs8B7lOYIV3MvzaAelBnzp37y4Rx4YxjcXxs8okA8oLOV5FpvrhVJ9rpkbixpwB7YAKosUiGZ18iJ6Tlxfy5ZlAltj431Fn2XftGz6x/X+se+dYxzytAkB4NX8AH6EdQB3aQzmBagjyM2J+QZG0ZJAQTOgH/h0PaMBOMR/aEDwFw0Mz2YMMLx4V92HnxkqnmVM8toIYzwHtAK75t48Cx3hN95+43SPiATvsncNvpJjjS/chx/QmPHjWdaLPvwmlHgZWPBLLrFEroMqf8s6MRc8MsD6aJXxaXdgi9cZKjwdi6SU1zp+CHALUOETMsRaB2xFRCpwW56S6q/nCtg2d745gMhYjpKIKjX3Cc3rrUxgS9bT55wTZDl9R0b/7//8T5aZ663/fnHUHAmDNziEIlUMyKW3yYPIrxYpxKuiZVkff+972Umx+BJLZLwgjZK8YTDTqzy98qdfTWP6Y1psscWz/KGHYSH6TVoLeU+P6ZNM9xxeX3qHfOKAslnd9RyEdItr/U+X0XucVTy0vLyi1e61B6D2VM/mUa51PbUFsK3ndQEVyqMIDoERP8U6b0XgR0k1K0ctqjRg5v4AatSjLL6LsRk3gD1Y6+9cbvf5Mf4ySv14ZuT+1Y4NsBrOvJUJbGP+8YB5MSf97dqtd+yR4+Y9RwpKCD4WPms7wkP18LRrjIPx1R8PD9YHgEgohbeW8CKQCV9jiR3SfsfGAAYiAw4wLoOn6nnndge21oS5RBMNj1ECMV94j/JzHdoxPv2M1nzWM+fdeE0FbJtLVbyMpzuhzFOZwHYksxoyoRanNNJn5FuTJ2RQvQ6I/jBEI8+FVdq1CkYj7xHXdgywHc7LVfe0dgbKBLatfZPGnsabymML2BZrFTfWS/1XA1bSJmxOK27y4EXwI62m1jDh4eWN5s0dzY0C7Q5s66dCdeVozkAFbEdz9kf32e0KbEd3VqqnF2egArYVPzRtBnoR2LKwhYHkZqtSIFVhpB7goQjCuraBQOqB/G8eQxvrlJbhjY20lKH6GY3vK2A7GrPefc+sgG330bTeN6qAbb0z1bvXVcC2d2nf9DfvRWArL03+MS+q3CQ1KFuReC8NQW4VBS8XXc6V5H+5WGUD65EwzmgCW0YIpSgvWciVQTCclJuRvH8z7vUOQpRlho2lXMjps+eh0TSZZrzjUH10M7BluEqpMvfoIN8TDRrdqR7pVnilm1JlKmA71Oqovq+AbcUDTZuBXgS2TZu8HulotICtzaR2Mctbs9kUMLI5z6ZNZdLKBInNJK38XxUu7NCOsnzN7D/6spnXBkQHfEQJozKeM9w+uxnY2rQqX17FE5ubVTVRb131nkaaDUGiOGgYB8c0cn+7XlsB23alTPuMqwK27UOLjh9JBWw7noSlv8BoAFs7j5VNUx1CeTXAlteW8LMjWa3a2kNJSp+IYT6AUlc2Tnk6O53Laip2KG+obJDa1+3WuhnYqmSjco26pXbQ+40OjZ4UaIe+NCk73fF8t7QK2HYLJct7jwrYlje3PddzBWx7juQNv/BgwFboFGARhlWJoBleVOF0h6hIEwEIi6kHNtTdd++9+djloSqXNPyiTboh5gTwbmU4mWdYvWSgSK3tdmvdBGzxoZSD/lINvKdDAZRmckrhYE0Kg4iEFIZW8kqreaMCtq2e8c57XkcCW6Ut4gQytUFHmlPYjP7UIeXlUDNWCSaHNAx3XJSZenYWMGEVJb98TuHX1rStl+14qXgA1GEtQ5GPFrBVl88cNTvcRtnw9ulf9YFGc9zqpctwrotQuvq0fjqlDQRso6azU/7wKO+Uyg+1h2E0+p4OvVDAXN3iOI1woD7iiF1jsdass+I6kddsTVtHeN335h4Qt/7jkAx8gj768FmsV2vaZ4BHeIjjOkAEr8mHBMKV3iGXFj7wQD6W21xEiTtyxjPkVGvGHUeu+p93LmSPsUYe9tNPPZVUx6xd/8ZOnnrXuBewVZfZQRS9DmzNrxz6OOIW7dA8SsLhUXOHBpG/HbVg0VAaDD6hG8w1naWeuOZ6NdLpC7XYyTFyX6UV9VE924Eq6BDANujlWs9hAHoO76zjmOX54zH3SrdxlHrILn0HkHa/cQQIxt+a7/WDF4x7uHqs0bVa7/UVsK13pl5/HX4lY9C0HfPmh/dW/d/VkcDWgpX/BXCwZkeq/Cgy/REChEijAMZ4HLSgGL8i+mqFUkTD3ZhC2CmmDwQQcHE+tf6984477th3vG8jzEAhOh2LJ4YgbXYbDWALKDgdCqg1581sBKgjis2ZAuYOV2iX5mxy48ILvDmd4qEZCNgCBULf8gkpaWXTHP8rfWC4zTr6xCc+nr797e/klAPKfqBG6MsrBRrwEhD429/9Lof8gQeg5Ctf+UoGpA6+uP+BB7LxGScNXXXVVblwuiN25b7a2OdH0XQ5vEAHwEC2KMCOZsAQUOPZwKZ8St85scipRDYmnnD88emOO+/MzwF43e8UIaeeybMFQG1eNC4gRfhZv9IHvL9x4RWg3imEDqExxgBJjAihb/34Tj4mQOV/JxkBVL2eimAuKEr8gbbmD+19xmhBK7LPPKMjujloBVCVUuCwD8aBetcO1AEsnG7JeNGH06zMs3xvh35YI/SJutN0CJ3kYCLGHmByO3r96lf5eXjAc9BWSg0w6tAd68YBPnjDKVXGo3KK3N1wAOA1BrvDkPCBcSoF6Jn6wz9KBxpXO7UK2A6PGmTD2WefneULPuvm1pHAluKjRCgKdTlHGrIcaX+UJuWzzaRJ2ZLXH6t8uGDD/TwEjj91EpjapFE4nvInaJ1y0iigp7QBZSeSNHpvPYtgNICtcTmBjjJv9HCEod4JaCb8ndhCqTllpl0aBedoRKfXOOp3uLzW6vcZCNjyFh386U+ns885J/M6w4uxORKl+vzzz6Vdd52SD7Lw3MEMTSfyAJnTp0/PMsX6owR4u4BK9zMIHUfNmGAM+x4QsMnH6XInnnhiPh4b+GGAOj0OgAUSgAaeY94vx1kCF45hBlABX+vad47xBH4YVMZ94gknpAcWLkxHH310XrN4EtAEVoAl6RUA6aGHHZqWWnKp9Myzz6Z9p0/Pm42AG89cbNFF08mnnJLBr/eYPXt2BrPxjoCZ0/DOOOOMfJoRZwHZakxOUOp1YBuRG7SSmgEYMEbIZjLHiU2cD3jD3+S1Of7GN76RHGnKQBM5AC6d3ojHHPEOkDq1kEHOiGAEAcruY+DZRAb8yrFFayBWrewxa6yR/nG99TL/+R6dyF5HonOqSL1x0hWexB+OYEVfYJrB6Hu85mRGxhq+dqrjSSedlPbcc898mh4+c5/3kZ8+Uh3bTDlTAdvhzaY17XhdEeVO2VMwvDdN2WA8//zz87qLtsgfXz3P7XXN4j7++ONzjczRCE31d7JGhPoMVChNyE2ppXpCJ0P118iEOm/5HW9/e9p9jz3qvm2ok0IAZGHZK664IiuhaMAMYtnhXXu0a38Pr31O8WSTugdb54WtArZD0W6wuR3olLeBBLd3Ygg4Y7tRYDsUjeuc1r7Liv3xcKpl6zhgiqjTga2X5IGylhwkAbjxHo7kvRhy06ZOTQ89/HA2TAY7xYdXzHri/Q/5cemll6bPf/7zWfkDEDxigB7vGnl4wQUXZC8cwADoAAB2rgM4oisiQI7tVmsYYHSfMfH2MXwdlclbh4beVbOLHYgFtLWzzjwr/eieH2WApOEBHkNAyv277757Bt5ATzTnzBPqeBawAWB5eTVACjDPYevnn0//PX9+5h9zA3AzEAE47wMwkfW8he3WWp1jS26aSxE5PMJz7lhyhgsD7NRTT836kdxmkABfQLDrfc6g0HwHGKM344ODhidW9CVSZRyJCuhKn8F3No6hEd7Sj6POeX3POuusrPcAWnTDS4AtIEyeiQCgKeAqWoGODCyGusY4RmOGlQNm8C1+iuoLgDPvs4Ng6j0BqxV8UgHb+maZjEI/xpIUxpAffg9HrjZbn9X3FsO7qq2ALU+kfCSLn4Bg4QqtyPfhlWNp8ISwIoVVEE1BeqkAvC2EAO+DRY+YFIiFj8C8HUJ5FrywC0/c//v7v09PPPlk9gopjaJv/bmW4NQ/pUApDZS/aczCeqxvCsx1hIjQpVCOsRGKvECRr6dvShwIJ9i8Jwu72Ly/sj7OpJeW4B0oS2BGDhWrH3N6hnEDOkKmPEzeMfJpATN92UFtHISl0BOwpvnM/ebcu+iDdT8cxi8b2KIF2qEr+hLiFhtlbR4DOAD9wqloj3fQBA3Rk8eEUgpPIDrcd+996d//ffP01NNPZ3rJXYwcOe/kOUAChWC+ABaK39/oFkKjSD/WsVCg7wliSsSYeUyMyzg06Q1xvz69x/PPPZfH+M5VVsk8bU3gJ/TBw7xE6DVz5swMbiIkjc4UUDFvbnhioby7hqqKEEcnN+t4R6AC6BAStjZqWxx7veWWW+az2oHXaIQjpT7n4ovTMm98Y/4OWOHBtB7JHN5YIFzOGqBrrQIpgDTAas3jS2BjypQpr3s8OQAU8/DGjnehY2tcyFgDUnlweepivQK2gAjeESoGbKRMRBPNMW59SUXA9+ZBs1Y8C3jC4/jUGiAPXa9PHkS8KMcWsDX+dmutBrbeP2jN+MKfZCy5zxDhnfdTy7f4wDr1nWYN4wVRFkCS7KU/0CfSbvAdml577bV9HlteVkAYXQBW8oMsp+sAWusevch5fEYH4BvAVl/kCrryHtOfGnnqXcgl3ll8YSz4SwNsjQ8vlbEnY7g81Qpgi7/I7Mipt1b80D3x+fLLLZ9+//Lv82c8oCJC9IXfZA1a0VdkA5lNRwcewSd0Az0bx7rrN47rphN8T7/R++afrOJxhS84GCPq6jnopG/3RRTbtSJAMI2UEzwhPYrugzk0POy5nhNHu0eOP32CzzybHvUusAEd1iz5PFweGOq+tgG2JnfOnDmZmJiJt4SFyeMhJA/IqqcoPGOhCgOZeEKFwLG4gTXWp9OfLHiCGkMBCXfeeWfaYIMN8iJmcWMmgOXmm25Kp8yalUM/hLwFjgEoYL8pGAQPK704oZQbgQVk8uYRCELDQAiPS5xC5dkYYfvtt8/MSWDwwmI4gKnW4+IZrqOQhaxY5haPMelbuJN1z/sTIVZMHCV6AGbhMM8Fxi6//PIM+M0rTwBvDiHqGcZPGZsbyg4De95g+YgDMVWZwNa7EsoECAFzzdVXZ0H9hz/+MXuv1hw7Nh1/wgk5RUNImMK3WIFLoMa16ImPhHl5KswhXqLUXW/+KHm8QeBTAEVgSyDwdOE39xImQAOPSm1qB75BJ/lu+A9/897gDzwOrMqjA6aE//AymhFOQCulZoyECKDzLx/6l/TMs8/k+4SXCXdeOOCJ18h7ew/eFp/VE7UYSjiU8f1QwLbZzxSm56EEDKQMFNMRCPU7Cfo11sjr3nomTwhyAFuOo7UDVJpPMiaqBPjenAMPoijoz3t78CGHpK232iobrWihzwj9kjFhMFnP+BHoITsi5xXdfRYeWzJAvwFs8TQQi1/RmewBPAMY+x7Q/u4tt6RL587Nax3PWxMBzjyL3LHGAV9GPY8goM4oAprNjbXBaAqg02zajKS/0QC2nmnN4QXyk0yViiKCZq1eecUVaf33vz+/lvVpTVvzgCHZqukD8JSGgi/QBj2kiqzzvvfla+g4PIUXPCtKfdGH5DX5AxjTkcASOuFrEQMyyvUBbKWX8NiSQZ4nCkgvaeQXMEwm8SIbh7XCI6yJEriGLOwljy2Zb60CgwCgOVhw04K08047Z5DqhElRpZNPOjk99vhjeS1tNnFiWnKppdKZZ56Z81cZL9Y4nfXu97w7bbThRunLX/pyWmvttfpy6+EPThfrGV9ccfkVae33rZ311vU3XJ/22H2P9MILv0hHHXV01kWujxJuaMUwwmd4iy6nYwDXGTNmZNwj0gRrWMP0CJnF+KaX6HtrXIQID8EJjC7pKUDzhAkTslNt7ty5GafQu3Qj/IGf2z1Hty2ALQGAkXgTKHGgFONQMBYkzyXmkQOEEVhDFI7rTTLiUgaEDW8KJWPRB5AAWL/1rW9lYlACR3z2s+npZ57Ji1z/mFc4CRgBYF3LStp///2zp5gnFgPw+hUbBrQIMDElIzfNZ7w/hAxvB8FkYQAjcZ13ZUlhMAzLQgqFF/1jVNb2F7/4xZwv4n9WN2abd8016T8///ls3RGChC2G1x+mpiiFzTCi9zE/gCHhJARG2AFmAJ9xmQeeB6AJQDaPw7HIygS2FhSPGaFLKeAPvIBHvOOvfvnLdPoZZ2TBT3EIIRPg3ptCAEjcjx7AAkBibv1NgZhX3wGqgKbFPWvWrHw/LwgQik4HHnBA+pcPfzhHD+QrSxUBimrTFIwPkKKA8CS+4JUBWtGJoJBLh9eEB807EMLI0bcxUJwMO/TAz4QPOuMZ/aA7AeSayPfjqe7PgzwSENHMe1sNbAlzfE7Am09KBHgjxM19eOHQHT/EwQc8FRS7+SUzGD3W9CYbb5x2nTIlr0ffk0HAMBlis5m/be4BdiLKw2sHLFpz+rceyR30xJMMcrwCaFKE+MO6FjmgnCgjOZthrOAn/CF9gsyysdHYpFKQefj2gAMPTO99z3vyeLyLNU/G4GOGIONOOkSkT3AI8A7zIAHJvD6AvPGSGcMxdJvJN7V9jQawtYbJYiCWTsIb5ovcRA8eLQDxbSuskCOBDE7GKp2G1+gtfGaNu5dxgo/oi5123CmNnzA+A1K6hlyypv1PrwCl6K4vXnU86RrgCT3xNTCsP9dr5BO605HoS+cwnIFX9NS/tcE4YoDRT5MnT84Al9yjf0Sn8FArTlOsl1/K9Njm3Pmzzkq33HprxiSwBHzCuUZWSA366WM/zXNlTZP7wC6ahM4GGK1r4+Q0kjtt3X39kkvShRddlHUrncXpwtHEC4p2yyy9TNp4k437nEsMlLXWXDNNnTYtH9nO+MQPHE/WOUeg/vGWdey51qz1i7/s/aGbYALYB+/RGWQN3eh96CT87D3ISuk1ZBe+gbHoRfeI8sIfIkzkwWiko9bLH65rC2BLyViMFLhJrwVVLBLCOjwKCABQIGqEhTCG+3lFAVmg1GLmbQh3PyalUD537rmZcQGJUBYICuAQHEBtgE3EJRh8F+772gn2TN5kz7xm3ry0+9Sp6cYFC/oqD0RYz7ONE9Al1Fh3kRJQ22csEoqN8oxmsWDSD2+8cfrkQQelZZZeOr31b/82hz4JOmMFUm0cIGwpM8wufQEYUqAekKVkeYEsXlZaM1qZwNYcAhKMGwqDp8EGI7Tl7Xj0kUcyeAEoAV+WZlR+oDjQxzxoaArEABEMgOuvuz7NvXRu3xTgLYuZRw4IIrQIJoLBfPF+4VG8w1NSWxZKR5QdIUBRsHgJR+OjiNCIgOL9BSYA20hXMGYglzAiQPzwuBAwvM6UGN5kZTPm8JTrCcpmb55rBk/U9tFqYFtcNyI4UaaLp4yxBCwQ8ugBvPKUMjrML2EfAt/65w1Bb/xEAVIoABbvB6+XRllYr+hebAwp0ReyDv8CKiIq1i3a8+yjH1CDd8gaRhFZhm/wPx7GR+iN/4Ab8sPzyEJA2niAHCCX4hSuZgAz1KSt6N+7kwtAq/dyv3lwPy+1vwEa87Hsm96UPjJxYja22qmNBrD1/gCf9Upf1dZEtpaBCcYl2Us2AY/mm2cXMOFswEdAsvl3LSUM9Kyz7rrZs0aG/fKFF14tGbnYYtmjTtaIAPDeM2bwkGsZPYx2jhXf+Z9jCLDxHBE41wEi9CaZg+8jKoFvOTzwMn5hFBsnWWdc7vFcurRdWpnA1toD7DlDgMloMIG5YhACeff86Edphx13zHgFkIw9GgxSeop+ATTRjj7GGzfOn58uveyyzBccL2QhuS7SZs3RLSHD8Ra8gk84auAFekRzDyMFZsFbrmEE4z26BchlxP/k0UfTIYcemkE2Tz7c4W86hMwzRmMwXvwZxpDvObzIPnjIPbzFZCKdZhztvmG5LYAtwIWJLGRhldqwBy8cC8KiBTQC2LKGTXps7KBgAAFCj1VMwEcifXFRUjCxY7QIbCkBYTzPoHSEMTEY0ICJaj220SclBlQDtgQZAAKMB2illD550CfTUm9YKjMepYFxhgK23hn4JgyjUaiE2NgxY9I5s2fnhcObHZsZWIBy9iwqnhqLAJCzMCjkLbfaKu+0BmyBZmBYWkQzQk1lAls0J9DQxYIknFmjrOGTTj45/c9PfpItWV4K78kbKpSkWYR4AxjWAFfzam70hbboFi28GIQH0AoUoCfhZr4A4qFqxxKQjBjhIh5VgATfRV4bQQiM6M9zeFAIOEAHKKE8KSz3AzcWqs/wJr7BB4AtTwqFBqh4v9pc7XZRRjGO0QK28Xx0sDbIjP5qOeIz8z2SqiFo099mRH1rZaSJUG7eC2AZTn58u/HJUOMZLWBrXAPR13dlbs4dak7q/R6f4JFmyPx6n9nM68oEtsL5PNqMjmL5SHoWnqAzgHyeb97OAIt0TXjvOSWAQ7I48msZDRwi06ZOS+9Y+R35bwZDlIHTN6OSrig2YBKW0V9s6uNwoQvoLY0BClAzTI0vsI/PVZo57DOf6RfYigLRa1IrImJMf9pACI/BCPAQjOX96C7AlhFeAds6OJqyMcmUt7yV1d61WganmId3ipUp9APYsigJD2DNJiGTTokAxMALIMCqxnS8JxHuB571x/MAzAAVfocCYrHGZhHWqvGwyrnfERnwYfn2VzIIsAWwgErhKBYvUBObLvQBWEr+9x2PizAGIMYS6q8RnkJBmI5H1XsDyEAsUGw+hKS9J0Y0Lu/KWhPiZPXzPDEWMLtyLoAghgSmWGMseuFMoQhjo3CBKwuy0Vq+3qFMYGtRAXA8HASyBQfAM2TMAWMB4PPerF+h+8gDIqTkshaBLU8t6xvAZT3jB/3iRXQBTEUD8I25Mn++M1+8JehpjuJwiCiWH7R0P36IsBAPvPG98MsX0mGHHpb5jncQLfA1fo8UEYID7+EfljdL3DsQOvjc+AAvwJZA5Mk76uij0luXf7WWbzsfnznawLYOcVRd0gEzMJrAtgOmp6uHWCawpWPJZBv06AU6Ad6gi+GQyLenD0Ty4JCIztG3DEzyOXQr7y5ZTefPuXhOdoiMXXNsvi5S/uCSSVtPSsstv1wGvFJWYuO7v3nWvP4AACAASURBVOkcOp4u0EJvwSw8tqKYIkCwDR3HmQcEwyJ0EDAKE9CR9Ac8AyvBFd7V99LtjEkEhwf3lFNOTmpjhcfW9xEl5LGlj9rZgG4Ljy1iyR00iTxxQmaYibucFSIFQRiRJWRSWZzCc6wowBaRZs06Jd177319ih5IA370KxTAsyUc73O5mI8+/HDad8aM7P0Emmafc05a+OCDGZBiVKFoVhKQgDmAVwxRDMkBK8JCwhE+B3aMWWiPNQV0YGrhP/lscnWFhjAmUI1ZhYxq8zOBWhaYxbTgxhvTlN12y3MCZLHCWHXeBfGMTT/654GV3/WZww/PuVPGBuj7myeHl8p7GQerTvgB6AWQMKp3ZbkJxQzndLMyga15A+blI7GYAXy8wIiRA6ZZoASKVAsAX9oFWsiLfe8aa+R3J6h87zo8xJIG7AksxsOTTzyRnn0tHGWh21zje/cySni3pQYwSIDsqAtZ68HFr3bHo5scNkLl2D8ZHkLRNhgRNAQI61tEgJCMmqZ4EthFb3QifPAe+hC4BFeUmQLeAXDzQSjGDnw5ku3YKmDbjlTpvDFVwLbzaNasEZcJbI0RqAROOdXoc2lEnBBkMTB37uzZ6Tcvvpixh+/IX7qeXgBE7//xj3PUcPbnPpfGv+aBJcNFhKUVcEjBC+S5/ugZzosZ6lwvtlh2ksErHCiwCLDKewpfiOyddvppad418/IYOVfoOg4e6UuwEh0Hx8BOvvMs+oUO5RV2rVQZzhUOOxhJmoXvYQp4irMEnhBNNGZYKDseTz45R6L13646Bg3bBtgaDGElvUA4AHhBKEDghV/84tVjA1PKYAzw87kGsAF17gVSAEkTz4PpMwwDcOkPoyKez8NTi7lYaT7DYPoD6iRn+w6QEtIHprnji2FE1+svQjue6R59Wxw8bBgXY0XNWeP2XRyZycqr3eyjX3NgATvlCIBeZNFFM8MCnpGDbNy80p7HovKeFgLQJJzq+bzPvLaY0Fj1zfMIiEW4lYHAejNOC2i4x+2VCWyN27yhsXlhDET5Fe+66CKLpMWXWKLvGNM4EtV8v/Lyy5l30BX9zANaERI8uzypLFXX+ixoha6eqenP88wN2kiJwIvG0d/GGs8wz+7DE/rKPIvH3vCGTHPz5Xv01PfDjzySXvz1b9IaY9bI17Py8R/wDtDiTWkRhJm+/OAvtCwelel57bbZJ5RaBWybpd57u58K2PYu/csGtjGzNo4//9zzWb6uutqqWc/yWnKEaeQs3Ww85DV8Qe7CJ5/69KfT4Z/5TN/Rya4DJkWZ6Q26W2SUM49XlxyPqgT+5ozTF28u/eaHjqC36KTYN0SPiFLqD3jlDBFF5HSh6zgKpdAB3PADPaoBvfqif2AEugYWgbn0SXfRc95FE5Gk07yrBnO1q45pO2Dbu0u1O968TGBb1gyxSqUANGsDXVnj7JZ+K2DbLZQc3feogO3ozv9oPr1VwHa47yg6x5PLCwqAAqU8nxxuwCdACYDakCwCK+Ibm7eG+8zqvtfPQFt5bCvidPYMdCKwVdpE7rHQftXKn4EK2JY/x73whArY9gKV+3/HdgW2vLa8pzZ7C+VHVR7gVeUkZfkilZHnVDocD67NajYFV615M1AB2+bNZc/31GnAVphGGTleW5vIpKtUlnO5bFwB23Lnt1d6r4Btr1D6L9+zXYGtFAAbuG0KA1Zjo3mU7JMaYP+ElDjpDKou2Sgs/N/OG7E6kdMqYNuJVGvTMXcasLVrlDVN4MglshGrnSsKtCnZGxpWtwFbnhd5arw18q+bXcprpCXConyZ/Oz+SpA1RLw2urjVwBad4ydAyFC0LvJGo+XjYi+E33Ij6wU+ciPl5PstJ3OoMfZHUrLQ8xq9133uqXesw2WndgW23t/cyz3t74AjFYeihjA90261oYdLj3a8rwK27UiVDh1TpwHbDp3mjh52twFbykp1C2V35Go389Q3G06kygA2Kpk02gAAmyNV2FBRpN2PwWzk/VoNbOVM2lAs1GwjjoL3Nv0wGAZqNtvIrXQS3dcuvriR18ubeVRVkZNp09Fgzyl2bMOwKjE2t8rhrD3RcqhB4BlRLNErO/3rbTYt2zFv97xKMWW2dgW2Zb5z1XdjM1AB28bmq7p6kBmogG3FHkPNQLcBWwALsFUWzqEgjQKJweaLB0jtTCFNZeMabe5XZUYZOQXda8sKNtpfO13famBrd7qyiQ7hUX5x+z8dTY7Wg3nBefGV83OiFDo20uyQl/vPY2vnfL2VauyOl8vpHs+MY53rfbb7lae00cnO+nqbzVDqqqqf2ugz631GXFcB20ZnrPeur4Bt79G8tDeugG1pU9s1HXcbsEUYpeJ4uYCYdktlUaqQt1fN5l4CtkoVyWHkPeRhbUZ4XPknB6c4IMdBN/U0hfzVqVbDtJEG0KqtzXOrHnu9wNYznNSp5rva1soyjbQpB+nUzf4OJxpp38O5vwK2w5m13rqnbYCtsFvU+sS4LGFKQm5SGblhnkfwOXGKZaoQs/wXoSYJ3s0QhL3FSuWePGYu49hQgpaHgNIiuAfLBXOPk98oePV9o/aezxWmdoStz4TdijtTfc9LIwTYSH6c+2wicFShjWhqIOJjdYYbafjTBgNjaheF0sj4B7q21cBWjqk8ahs0zKn/hfbxDO8UGqNTMdSLhrydvpcrZ/5DHrjf9/rSh+8BCaF+xc/Ry/dkVpEv3ZfrUau3vPjiff2ReZ4TNSs9Sx9RuB3v4ncyKdaAvmIcnhPy0ZgjzzFy/AAjwNZxzr0CbKWFOI5a+oDd6dIBmpGGAdhOmzo17TN9epo0aVIfi1unATzVGEU/9ERDwNbhLoBt0K0/3kA336M/vsFDIgHkVgDbyLuVP+t5Rb0Y+byeSakrITVQKgJvtxY1UdUvJeOC5/CbdWETlJxRBxAA594peNqOfic/Fo8XlqqhBrjDBbQin/q/yPcjkSUVsB3J7PXGvW0BbIVdnNTlFCyCwUlPFq9To3gBHRPaKDAYinz6F6bTt1NCWLhObgJ0nDJSAduhZvAvvy/TY0uAOmyDQBUmI3h5ypy17YSWgZoNYk6EMTYhwTh8gdJDf8WpGThOdykqfoW4Tz/99HxKjOOG6+EHYzQ+P56nX+FLx+rGcb71ziowBiw5ermRkGC9/Y/Wda0EtpSyU/4uueSSPI9K61C+To0DTOQhBq14XJXnQcO4TgF1NSnxhVPu5BGSU66Ry+gHXeVSyi90CiAedTqdI5zlRgIgDB2CFq85YMQJQk4XYkjPPmd2WmTRVw9xcR+6y1N0yl0cgYlnHZsJBANKjG8gWag5jl8G5pw06H6HeRiPouqArR3agC3DrlvaYKkIjkJ1GqMG/Hn3+H8k72/eHW+6t+PRt9kmAzfzfdRRR6YPfvCfMwjEU+jqlMF11l03g0s5r+jB2MVvQDYdB1iSY2jqHrW0Nxw3Lk3aZpv8HWArh/vwww/PgBI45om2qx4f0Vv6Yvx8++ab8yE+wCf9ddlll2VdVkyNAX4BZXrOYUPmxjOLu/mVPaQTlafaZZddchRCWgMZipc5gPC4fHInb/Equ8545QSLDMg9Jnfnzp2bx+16vE+ekd0jbRWwHekMdv/9bQFsTTOvhePfCGXHyWoUhuNDLSglmepNoK+XbJQDJSJUxSKVJ0eBEECN7git95ndfN1gwDZ2FA93Xgn02bNn5yNjeRIoFUqDMpk4ceKg04qfHGlI4fEmMGocVyyc6GQvIJbHoriTFXihBJzy5USZeholZ7MOEIVXGWwUmGccfPDBg3ZR3HENRBPenu/EOGPoltZKYGsOzz333Axs/KZUAT3HTAMLgAEZQDE7h9056sDLAfsfkPb8+J5ZLgAH+AzvyVMlkwBY9CInbO5Bd0qeZ44R4n/0dg8QrQRQPgZ7woT0yYMOymFdgPiuu+9O0/fZJ3sV8QzA4qhtAPWKK67IHntHVwIrjoEGZL0LngK2XSdy4bRAx0mTlQALQ8yx2ACtU4f83UvAlsErB/ZnP/95NmTPO++8LDdG2gLY7rX33mm7bbfNvCMfFe3w06abbpr1Bl4QqSFjpAPQa/JlyQFAFZ/ZFOh/Xn6N8Uv/XHP11enIo47Kear4h3GDtgxk/0uFIA84gYBJx3WHUYafyS3gEiBloBVTEXxn/ckTdjws48546T7vYp4AbHzkiHW/yU6g1lGt9LBnArWu9RybJfGcvoF+n3EG7DZlSnrPe9+b351ekH/LAdGMjWUVsB0pJ3f//W0DbIENCgOwtfg04MU5xUIjrNVG8ozqIZ3FzDoFdmbOnJk9gMcff3wOLQ4XgNXz3G69ZiBgCwR88xvfSN+/6668uaCR3bYxVxQChU5pRxhQfUAG0VDFrXlmKRbeBbSm7NEb2B1qsw8erJcX8C0gpG/eEPxFsFOuQwFbIMa4AKUw4OL4w3q8xZ3CU60EtuYEsAA0CDrygyEEFDpnHRDRhFrNf1bYXzgvffs7385ggrLmJfUDaPD6BSBAE7zhN6XNuw9MABI+p8QZzePHj888sckmm+RnAxUAjfCyZxqbjWFR9YBHmIdPipTGu2ZdAc08YtJn8G2kPMRR07x+wBvPGJlpnfAYk52ALe+fnfzd0gbz2JILl19+eZ5DR5MCaYyGkTZzCbwBstttt102bng7ySMGSaQ7oI9nixYwfgBHANi6ZkQDsQCqk6luv/32bHCJDjCcGFF0EGMakEVPvAjA+sy9+BK4+6s3vCE9+dRTmTfwTaRZ0V+iAp4dEap4d0DZ+Mkj3leN0WPjozWieUfOA9c5bADPM6oY/ngb2MVj+FqKj2YupH/gUfPPkPP9BhtskL8nC8nEZsiyCtiOlJO7//62AraEvFAOEGuhACSR3yPHTLgNU/N4WGSEfCgdgsGiE4bhNfnRD3+YQ4Xv32CD/H8sKP3ypLFMgRoLXMiOxe25AWzjetcKWxMm73jHO7IXp16g0/3s8/o3HAjYAjO8o5QRTwZPU6MhKfcKiSldlHcmT5mS6VcUlIQnmhsHDyxPgt+ex2sG2BL0xiM0yDuP9nintsXuYPxCMepbjp3xU3D46x/XWy+DJF4M18nlowDwlLw14+OZC2DrGmPjfaHkhOxc53NKTf+8h56h2d0sBE5hClnyNgJYFAa+pxjxYygWIUk/5gpApsyHU4+yTL5tNbBFDzSg5APYAjuA7YQJE/KrAgYABG/TkTOPTI/+5NFMj2Ije4AKKUv4odiACuAgcmx95xqAEt+jL+ApzAu4kEc8sQHO5Cq6VgOA8Dlvm8ZTKz3LZ8YZaQ/4ptjwA8NcCBhIAbYAEryKp3isuymlpdVVEcy1uQRIAT6GgyaSZK7xThgOjBx0FopnWJEzjB/NuNFFqF8aFd6gXwBxMkH6EiAMxKIZvqQDrfXNNtssO3+Kbc6cOTkSBcxGw2uMGp+FfIjvjNd3cnCly2gANA+wMWtkqzXiPaUDBrCNXH/9A7/kUADnIrBlsImA0OV4u9mtArbNntHu669tgC3gwDJl5fJmAJ6AZoADObbyiixK3jeLEhAASAEYgp9ApwgoIIAm8iiFfcaOHZsBLWHDagYWeAGFcQgZiobS5SGJVAhCxoK3yC1qC5rCYs1W7S9nYCBga06FszRAS5iVkG60ARe8We7n9SJ49SMcxhsmr0xoFtjkafAZpY4PeBIAW0IR8OQp4XVBSyG8Wk/CPffck70eW26xRd4scuWVV+bQIr4jzHlX5UQajzxH/zPMhCvlRwpBG5uwI/AMXBmT58qnlPeJB+2wxsd77bVXBl4UgtD04489lmafe272BAIkeB5A55Xj+WDA4Un8TnkBQvjT/eaJAeA+ynaLLbYoZQNmo/RzfauBrTlhCAG45hf95bfiBV4ljYcdIAROAAX8AaQyPBixgCX+8DnaoymjITbheMaZZ56ZZUVED8gJgAC99Il27pN7ufxb35r/JvPIHfyKTzXg1HjQV8O35BXDDM/IEwfKyUP343ehaZ/j98mTJ+fn4j3gg4zz2/sKEXdLGw1ga20DfeRCAFt514wX9I8cZvQBaOkjYBEN582bl6cevdBapJBhhS/wGvkIRDJm6UFOFF52ehCv0InWOBBK9nG00Gd0Im+uVAHyJDaPKfHGmKtNowpgS+6QWxreuPhrF6f/nv+qx/ZjH/tY3qwoQmFMwDx+5EwCYP3tGmuqaFiLSgDx0qesMc8wDusO2DW2oaJr9fBnBWzrmaXevqatgC0hTyAQ7jxmwjyUBVDBIyJ0AlhY5LFhyMLRLCjKHPigAAh+XgzhEblChInPCRjeOoAZELNAKTBWsu+AMJPi+UCvRcSyplwAXsohvCu9zTr1A1uWO+UKwDESCHJgbziN55Ky4FEDPvVLKdgURLkAlaoQAJq+xx9yHvEHRcEbypMh7Ox/QCU8rjGeyHGlkN62wgrpE3vtlXNnKSw8KrxMQXmu98FfQIY8cGDXJok4LYhnRIQBCOfRpfwoFEqP4gFYGWEAqkZJASrGDMxQogw3/MljiyfNHe8fY47S4xUxFs8BkDUAhzFH6fKOt0uUoZXA1prFa0FrXmw8scPkydlYYQALm6IperrO3JtrPEvGmGufUdo+Q1upA2jiXnPrc8YzfmGUiCQBA3JcefP8llso3cB4eOHwJd4DYoED/+NbMgxfymHEq2SVseEFHj1jA+rklYtQuUcxfWkVwCz5iE/xFIALlLsHf7imW46MbjWwFQniobROzT1nCMPRZjAg1VyTPa+8/HJOFfnebbdlfmLMAqPus05FVKSoWJ+MH0d528AFBOJNxvk222yTZQSd5z3RjjEbud0MMsY8A9kaJ/cYzPQSftWPyOP5X/xi+udx4/pSm+g01+kPr+BHso7OtC7JJ3JL+pS14nnuIWP9SDsQMaIf8a3neidjIX+liul78803z/nCxm+uyCU8jDetm5G2CtiOdAa7//62Ara8r4SHn2gsPYuHhQzQCsnE7wAClLbFSchYlLyyUU+St8o9FqYwooUFbGgUA+BAcQG0woAUCQALVFN4hBVF5toos9JutSrbhU0H8tjyLvB+m1MKnseh0VyrYnkj7ytXjPKX14juaOcHD1Hqnsm7wICR0gIQAgw8GPLfAMqoksBbByijL4DKy8bYAYZ55oBFQBlwoYAoE6CGcOdZoai8D88csMrzRxHpD895X4CV94XHQkiTkQV06BPYoIi8I/4FYIAjgITXhFcZsLZYXS8M7XvvSqkC155jLMHbPEv43kapdmqtBLY8mOaaDJH7SunjG3xozfOqU9xAi+Z//IEueAQARTv0dj96Air4DY/xhgOn+vQMf1P+POY8peQE4Evp4zE8pd35/e+ndddZJ/eBr/CqdQEg8Aoy3oBdvKdvz/W9/HDAiIdYSgLjHQABgMksvBu8aSe657nXPcai6kNtCkM78UYjY2k1sMUz+AGdgT98ArChj02e1iynB5mDn8gH/OY3uYhGeAlt0Rj/4Q0eVF5RegloxF+uRWv96s99eIthy2urT7zneXhEnwCrvtCYPsS/G224YVpjzJi+coH4g9zAm+ST+11rvNZKpPjhX59bD2STMeFT/GYdmAf852/zgI+NzbrxDsagf2MVLfM++JJ8asYG8ArYNrJSevPatgK2gML1112fbrn1lj5qWNhCLDwfco1sPHJdbECKUAdASpgDEIBt7AYVZnYtr5o0BmE/4CGALSDAY+d+HlseGSkQBIC+AericZbG0ygo6xXWKrPcF2FKiTByon4jryaDBSgFXnn3eQlqN0wwlIT0eU4I3thMJjfNtbwJlAtgCehQOBQLYAtsAI/hQQVseV0pFzmPlEER2Io48JgFsMVfFAi+pDxsMtEnHuLdBV79L6WBMikCW58Btna98+TwNAPkwHEtsBUelKLBUyhS4V2FNGvnYrR5sZXAdrTftXp+eTPQamBb3ptUPTc6AxWwbXTGeu/6tgG2lD4PKQUu7yjyJiXVywGKAuM8qPJ/eKKAEB5XOT08rsKzwCjvFmDCEyKsI5cJOAFkfMdzxyPie0CFVcoTZhPIaaeemv7r2mvzd0CHPCIhpSgTJa+J5VqB279cLGUCW14DfMA44d1gYPBSyC1DnzBqGCFSR3gGjMfGMB42XtQAtmgKNNqcwcPW3wEg+JEXlYGEd3j+AFn8wkNKseKPALZAqTAz4KZfeWX4E6DlXQF+hfp4foT4hK55NEQfjMGzPFM4Ty6b64zRs3ls5d5F1Q4eEEB75hEz0+577J5TdLyTFA2gHJgNL2O7ibQK2LYbRTpzPBWw7Uy6NWPUFbBtxix2dx9tAWyFy3iceN6ELoATXi7CS1hEbg6vFTAZwEFyOu+dEBwPVeRwynPknbWJhlcL4JWLJMdR+IdnVr/y0gAAIWH3A8S333FHmn/DDWn6vvvmMiXCh67nKZRP9c6VV07/9IEPdNXu4mayd5nAVljumKOPzh7XjcaPz8DWZ3gA0CTs5K3afCgEiH+EaRkkeAQIBoqFyRg3vPLy5OSy9Zfv63r5jryj8rCVoQOief/lxwnNMZCU2MFbDDHAlRdWPjd+Ea7jvQVE5VlKlRCyi+L7IgRAuKiA8RiX/F0hwP/5yU/SZZdfnvM88SI+lTvHI4t3gVypD/jcJjg5fPjUWjFHnil8jcfbyQirgG0zV1zv9lUB296lfQVse5f29b55WwBbIWD5QULCcRylPCaeNDlExQL18oQi94jSxuSAKQBC2PF6uZdy97/8I4rd/5GPxBvmmZS/73nWeHDjeEs5Q673fHlDwLXnusbn7bIRp14it+q6MoEtDzoesSEoaIx+PKrhcUU/4E4uK08t/kBn4/Ib/dHWTmb05FXlre/vyFyg1LPwjvxEfIY/pa3gA3/jDfzqWT43PkYabzGgi69+8fOfpz+mlHN9/e/Z/jYW6RV+u19qA0OMt9Z76d/7GKO8SOMxZnzufu+Iv33vPXmsbUSJI6jlVRqTagyAcru0Cti2CyU6exwVsO1s+o1k9BWwHcns9ca9bQFse2Oqu/8tywS23T97w39DIPfkU05JM/bdt6/8DoAtegHo8ui2izFWAdvh07m6888zUAHb3uWGCtj2Lu3rffMK2NY7U9V1Q85ABWyHnKJSLlBaRxqDyg88xRpvstQH+efSE9olHaECtqWwQM91WgHbniN53wtXwLZ3aV/vm1fAtt6Zqq4bcgYqYDvkFJVyARBr45p84iipI3VB+oWNZ+1U4qkCtqWwQM91WgHbniN5BWx7l+QNv3kFbBuesuqGgWagArajxxvyjtXYlHIg51h+rTSEOAZz9Eb2+id3K7CVay0nW36/DYVypG0UZGjIo26kAW1yruNo5Ubu7ZVrOwnYyo2XWx/7Noo0iiO25eer4CPHvmqDz0Dlsa04ZKgZqIDtUDNUfV/3DFTAtu6p6tkLuxXYArWO3FXjWBUNfztRSpm5OGq1XqIr/ab2srrMjYLiep/R6dd1ErBVbtBpXKqzKBVZbMr2OT1QDWrgtp2iK+3KIxWwbVfKtM+4KmDbPrTo+JFUwLbjSVj6C3QTsJXqIXfZD6+cOtqqVqhtrBycesUOyVCacLDG2+snNvipmQzkKGPXX43l0onUAQ/oJGCr9rnT4tRT768CCyNG2T8nglWGzNDMVwHboeeo16+ogG2vc0AT379sYEv5a63YCKWespxVpbWq1rwZ6BZgC8gCr0q1KRmnFQGq0m08ccqtDQVs77///uypU287mvJ2gG4reL151G1dT50EbM1K0QiqnSXH3/7Hf/xHTl0plrZs3Wx21pMqYNtZ9BqN0VbAdjRmvUufWSawFbJzYIKTtZw6V2aT33jMMcfkgxfUrC2rUXZqMl955ZX5YIZGQ9ZljavMflsFbIFMeY1+AhyiJR5VT1jjWQUeFy5cmHNa1UT2GS+pnGU8p4axE+LkKn/gAx/oM3Tc4yRDeZEqT8iHdWIimqpCoUbxpz71qey1BWwBVUBYDW08HIeCGA/w68jwddZZJ1e1UDfb8ck77bRTX2iaN0+6g7G7d4UVVugjk/E5jOSBBx7Iz8BHtSHvMmk6Gn2PBrBFQ3RFB+AKDRgjxmId4xE1rKNWNr5zjd/nzJ6ddtxhh8wrYQQxftShfvDBB9MWW2yRPbbyszU52j7HT04mrPKt/8xlFbAdjRXXWc+sgG1n0autR1smsKWwDzjggHyimFO2ymyOcRYO3n///ct8TA5fC0P+67/+a5o7d26aOHFiqc9rh85bBWwBAjzjWGIe0ZkzZ2bg6IRDx3PPmDEjA07zDkwCD4Cp44mdZnfEEUfkHFlgFphUUu1DH/pQPvrY/7vvvns+zc7Jb06zc4Kd472dgMggAoDk2QK2a621Vj7u2CEagO1NCxakef/1XxlUn3baaZmf0R5vjxs3Lh/VbBOa48WFpuXa3nX33enfN988HyjjFLqp06alf9pgg3xinWOYhbK9s9PpHD/tc0dPd2trNbA1t8rnoeFGG22Ugac5Rjd8pGb0eV84Lx140IGZT9AdXziF0HdOwEQbRo00Eyda+h6wRWdHYgPHgK3DVfCtUw7xCJ7FS1HKr1tpWu97VcC23pnq3esqYNu7tG/6m5cJbIFAx9NS7EBHWY3C+sQnPpEOO+ywDDTKbjyLgA8wIxzZ7a1VwDbmUZh3yq67pquvuSatssoq2Tt755135kMrrr766nw0sc1egAsvqdPefLfffvtlIHHmmWfmdAMbgA4//PB0yimnZHByyy23ZH488sgjMyh2H7DCQzdt2rQMYHlsARJgBbA+9dRT87CAYd7e9ddfPxtQnnfuuedmPgBkHAvteHFHRN91113pkEMOSZd8/evp7//u7/L9xi1397zzzssbkgBjXn+l3Sh9RzQDRWUbZqPJq60GtowkxhDZw0CybgFbdGTsqH5x7LHH5ojAHnvskfOtHYeN9jyxjCWGk9Sm6dOnZ0OEwBSTbgAAIABJREFUt18/+pC2wlMP6KLtEosvkbbbfrv085/9LJ19zjlp0003zSC5ainzuPn44he/mNdi1aoZqJ2BCthWPNG0GSgT2DpJi6cNsP3sZz877DFTJIPlLc6fPz8BX1IRYuNOHOHbXyme3//u92mJJZeoezy8fZ4fZbgAdpuEKMwK2NY9jXVfSAnuNmVKWmXVVTMw5SF/z3vek/NiAVHAY8stt8ypAnGEMU/al770pez5BGTxgbSEQw89NAPVsWPHZqDrO2AGqHEvECwMHcAWWAlPG6DruTx+DKcvfOEL2RsMzKA7JQ3YajyDQDBg6xnAuDrFwbfKun1owoS0+x57pA/80z+lXXbdNXuE5ekC6HvttVcuLQV0d2trNbBleKhcwPsqZUV75OFH0vR9p2cvPR5CY3NuTTM2In2AXBwzZky68cYbM8g97rjjcl9RAQHg3WyzzXLqAdoCxvhGWgx5Qf5Emky30rOR96qAbSOz1ZvXVsC2N+leyluXDWxnz56dnnrqqRwGvu+++/IOdGHAUBDAifCxnEN/81xFLqNjZ3m/fC4UKPwvH85mjQCZlAiFpDSPfoEEyuo///M/s+Li6bOpjGeMIuLhEybk2dt3330zWAKchRVdy/sid5JSouyAoYUPLEwLH1yY1l133QxojGeDDTbIHmKevMcffzyHOeV2UmzdVtey1R5bjC70f+BBByX8AyQwJNDDnPOwSnER+i82QBO/AJhoEMAWWJXDisdOP/307K1DJzm6gC1enDp1auYbnlYABagBYHlagWBh6vDY2jC09dZbvw7Yfutb30pnnHFG9twysPCE/PJocjztsOdpFvbedddds+cZzwSwxXOiAN3aWg1sGRiMXsA2NpQ++sijaa+998p04HUHuHjOefKBXZ9r8rzXHLtmWnDTgvSDH/wgnXP22TmCQD5ot912W/bgki3kFM+s58nVrtpfzkAFbCuuGGoGKmA71AxV39c9A2UDWzVBgUmAVchW7iFQ+rWvfS3/5ukCWikZYcN3vetd+bfv9p8xI/3bRz6SNho/PnvZ5NHykO25554ZWGq8aRQTz5z+AUye1M997nM5b9J1PC48xrxyH/nIRzI4psB23HHHHEI0JsDDd/oRjpw8eXIOOZ991lnZm/byK69kj52+KTdAi6cH2AWGPBdQ9rx2O2ChbmYY4MLRALaGwoiQUrD33ntnjyuDAgDhCZVnGxUJHnv88fS2FVbInzOS5MDy2AKmgLCNXmussUYGtpEfG8AWfzK2AE05tuHhfec735l23nnnzDNA7oTxE9JFX7soh7QBWxuHvvrVr+ZxaQCwsQG282+8MR17zDE57B075hlINlDitaWWXDJ9bJdd+oCt+4W6AVse6m5trQa2vOYf3/Pj2Tj6h9VfTVECSBkPJ510Us5ndo3SXvgFv5FLH/zgB5NTAN/7nvemW269JUecyKcLL7ggrbf++n8Gtptvnh586KHMl75neJFFsZlMaoMNglWrUhEqHhh6BipgO/QcVVfUOQNlAlveVB4xiiNybHnRAAbeU16O888/P2211VY57woY5eniYXPkrOt44YAMwADoKG7gkOowZ86cHD7kzY2wLy/KxhtvnHjR5MnxyAKgngPoaFIkeG6POvLIvPsZ8AWMeV14c20qeuihh3LOJe8cLxtACwQt8icgI9fyU5/+dAbiQLH/Q6HVOfUdc9loAVsbdABYHtaodGFXOloxVtAE7Vd6+9vTGu99b/bSA52+d70wMp4CWvEb3kJPnja5u1IQeGH1gddsWGO8ALNSG9Dd9W/6mzel004/LYNaVQ/wI8NHVQweOuAVr8md5S3Gy/gaP8mb5RnmvcWLIgs8tfJ3rQkbz/C6MeMvn4lYdGPJsFYDW4Dzm9/8ZvrlC79MEz40IaeeXHXllWnV1VbL8gHIlV7A6AZAeeV5X23sM1YyAD3RWJrLpZdemiNP6CvlhRHCkGHkihQwwORuA8YiBmSCn6pVwLbigaFnoAK2Q89RdUWdM9AKYEtJhCcKyLRBRloC0AL0ClMBLHax86YCtu7ZYYcdsmLhMRNSBFJ42CIPzk5kHhZgARCJBvTYBQ1oADAaRQbc8KpqFJLn8+D94ZVXskdW6SVAmReOkgJI5ExSfkCKPDrhZKFjO/GBFuMHnADnbm2jBWzlLjKE0L+Y3iG1BSjhSfuH1VfPaQY27PC+ATNSB972trflHe3oIwyNpsAiAMIbB4BogAxvnfrHws/4zvXAq/QU6Q7uFVUwFiBH+gAQ7IfXmLHje4YWUOpe7Yc//GHmFc01NjZKq8BnngXI8iQDtgC58TGU9FkB2+asJrKFgRp58owZwBStGMu+573nLSeTfvvSS+nNb3lL9r6iFbopw2b923yIXxhNf/PGv0l3/+DuTD/8h0/k2+oT7aRFtWIja3NmqfxeqlSE8ue4059QAdtOp2Abjb9sYCvvMNID4rUP2H//9L8//WkGkcAIgCkfFhAFEHhOKCDe2qefejqN23Bc3kAETAKscdqT0LL8N160orcUSAZApEAACtomm2ySPXUAq8aTA7QCy4Awj8z222+fQ4nC39IYKDfAiEd23rx5eZw2pABOcnalIAAoQBZPb7fWrRwtYItOg20cBBqDF9poSb1uKIA2oNPu42zF/LXaY1t8p5dfeTktusiiI6ZDkR/RtvaUuVYeSNMKmjXrGRWwbdZMdm8/FbDtXtq2/M3KBrY8rjxUQKoGRMon5JW141ztR+E6aQJyISmKyLHNaQgrvzOtt/56ecd47dGVs2bNymFA4dxiU1vS58pGRWkZu9kBV8/WgFrglsfW84Si3WNc71599bTTzjtnj40NZfIpeQzl9gK88nx58dS5FA7njebNs0klNpe0nJAlPnA0gW2Jr1V13eIZGE1g2+JXrR5XMwMVsK1YYqgZqIDtUDNUfV/3DJQNbIX8w9vKoylcJ9SqHqRQspxZY5AjK0R89beuTtt/dPu8sUOuG9ALAAsVRvkcoWIbfeTvyoGM41G9tPC1XDibdORI6ldI2LXvWm21tMeee2aQyvMqpC3dQaqBDV/qLAKot3z3u2mHHXfMOZFSH6QZeAbPs/QDObw2nflbrqUNS/rnEfbMOKmobiK0+YUVsG1zAnXI8Cpg2yGEKmGYFbAtYVK7rMsK2HYZQUfzdcoEtkLFgKYwLMEGGMpZA3B5ZoXtgFs/PLLya+WwAZHSAOw6B2Bt5pIjB4jywMpplTogZYAXtpiPKDxIgWr6l6Lg2cYS/7veNcYlN873xqmMFIArdzf+NjaA23XyMIFinlzjcb/+5esZr/6lUNSWoRpN+jbj2RWwbcYsVn1UwLZ3eaACtr1L+3rfvAK29c5Udd2QM1AmsB3y4QNcACQK78uTdewpMAmw8qbyxsrHBWzVG+3WvNbhzl0Z91XAtoxZ7b0+K2DbezSPN66Abe/Svt43r4BtvTNVXTfkDLQjsOURVVNW7qv81mg2itmprh5oFFwf8gWrC0Y8AxWwHfEUVh2klKMkyu0p8xcntlUT0xszUAHb3qDzSN6yArYjmb3q3tfNQDsCWwO04UzRe/UlpSloNp7Z4BUnk1WkbM0MdBuwHeqI5sFm1b1+pKGMpJ/WUK6xp5T9PhWwbYwe3XR1BWy7iZrlvEsFbMuZ157stV2BLWJQhPJbIxeWl7a2vE5PEq3FL91KYCsXWgk1dJeSIodZ3VC/faccnLqvkc/MyFED1rXqjQ7W5EWrVSqPW4pLoxUsHPCgxJwx2AApPcaGQ7nhndy8h02d5kb1EDWAy2itBrboJUc/Sq2pVb3M0kvnzZ21FVaa+b74zIZVtZJteK1adUBDxQNDz0AFbIeeo+qKOmegnYFtna9QXVbyDLQS2AbIOv2009L9DzyQy6+pX2zToe8cuqCEnI2IqmZE5Qr1hp3eNVhzj2NvVelQmq2R/GwbCh3/bHOgaMLDDz2c7rn3nlx72ebGTm6AmOOqzfWFF17Yd1x1s9+p1cDWYRyqsqCR6ifALOUpAoR34jS7Zr8nmbrP3nvnCizqbletArYVDww9AxWwHXqOqivqnIEK2NY5UT18WSuBbUyzwy9uvfXWXIptmWWW6Zt9FSgOOOCA7LVVNUOLihQqWgzVnB4FGCvjFikuQ93DU+wIXKXcnDKlOZTD0bsLFix4Xbm5ofpq1+/NoXdzLLFNm2W0VgNb7+DYbLWrHcSibN/dd9+dc3wnTZqUS/aV1RgL+LEbT5AbzpxVqQjDmbXeuqcCtr1F71LfthXAVtjY8bQ8bsK/xeNRm/ly+hd2rJRJM2c1pYGALbryZDrhTXjescVyoptxytb+++2X7rjzzgxsi3WK8VEA24suuii/KLrbcFgbXu7vFCipBA724LmtF9hKi1CjWG1kKQj/n737gLerKPf/P/eKXgGlKEWahKrSCb0moUPoJXRIKKEECAktVOm9htAJhBaakNBzKX96r6L03kEUBL0oyr3+7/v5uXI3x5y++555vc7rnLP3WrNmnnnWWp/5zjMzks0/bNjxwAMPfKt8ldh5ClgXPq2u3bl/HC91FsIDPPr27ZsuuuiimoAtEDQx1ARR29SCa+p4bxOwHTZsWLIDovATYS52HwSdRceo9BpT2s2u7e5x2pj6r8PV3rOGnxbLC8r/a6A71VSd3hs6GLZqtpShn7apvTho9uMX5bj3emvzKZ2fwbYSVm2uPDPYNld71rQ2lQZb29Ha0MCD3lqxAMRLy/7s5UxePpdddlnq379/mnfeecuZdcvn1R7YalM7tx1//PHxorcL29ixY2PL4d6mvffeOxlKvvXWW78Fjn/7+m+xWsYXX34Rw+b8yQPxww8/TEOHDo3LfvPN39MLL7wYYOF7axKLdQR3QhmEOZxy6qkxGVEcJhi3CciUoIBf2X3OhiI24RCfaS3l3/zmN7ELXaHYAgufSewi7tbMf6BSxPUKWRB3aWc86yMDdnmJ+X3//fejjIssssi3YnZ9J/RB2IS4Tfer0Ax5q4/yiTEWIyscw9B3AUQASR2BufjjJZZYIn399dexjfUbr7+evvcf/5EGDBgwea1nYR3ab6WVVupt803x/I4UW1C75ZZbRkwsGwHs1VdfvdflALZ77rlngK0dCrXRoYcemtZff/3omEhg9vXXX492kHR45ptvvrCvttM2gJh9bNFtQ5Z77703lN/XX3s9/eGzP6R55pknFG+gK5+rr746NpcRs+wZKIxF2+hYaWff6Qx6NrKL/4VGaOPzzjsv6u4+WnDBBQOg33jjjfAZ+Ru10J7FyjDuPfl7rvJVfqxTwPf5qzh0bc53+Jdnb7U7/xlse+3KTZ9BBtumb+LqVbCSYOsFL3aPSrv88svHRghUNg9sMW/lTF5OAMsatxSfnMpngfbA1ouW+gUwJS/ma6+9tiyKH3gFtZaHmnHGGQM+gAZQ9OIHb64LTMWGTjP11OmCCy+M45wH6rbffvsAWT7nBQ8ErKphK2TLyU077bTppZdeCiik4E5JIVNHayZbV9kud0BU5wloAFuKrYlt5557bthAuALIvfSSS9JMM8+cdtttt/Tkk08moA6k7FRntQ++6ppLL710XP+UU06JY/xfKLJA1XA5FXOrLbdMP5lttgBpoOVcgAT+wZctnn0G0IcPHx6hGiNHjoy/ldXPgQceGPGmQMgEsaOPPjqgb6ONNop7s5Zgy36UVQmY6UQoW28TZd2GLp43YO+Rhx9OK628cnxWgKH2ue+++2JpQeDvmUWhB7jUfcsLAmLraLOpslF7lfe7U303vfDiCxE2w2cHDRqUhLv47rhjj039+vePsBdbeO+0007hC+ysQ+E6dka0Njcf4usXX3xxhE1oE89Juxvq2IgL58+UZnUCsMJj3A/CR5Rnl112ic917HXmdDr5Phi/66674tojRozoVmx5b+1fnJ/BtlyWbN58Mtg2b9tWvWYdgW1vh1Xfe++9UEp23nnnyTPWvWApFUC3t8lDHewU6kOllyvqbXkb9fz2wJb9vYgBH1WKCuYFWxo60NM6gzxqG7AwcaxYYgs0+szubsVQsu2RKV3giDrp5b31NtukddZeOwAPUO6www6hilHmbOwx+qzRadHFFg11zbUAuqHqKSUqIn+ltgEG/kZhBLbKCCb22Xvv9NjjjwcsS4AbAIMOECMe9+/ffBPAS/0T4ymkAkABVeACoEqTjuFpp50WUGrraSAGckx8Ai3KAk7XWmutACDw5OVw4oknRoiIz6677rqAeXYBbccee2zALsVvj913T3PMOWcAFfCgOBr1oDJWInWk2KrX6qutlj748MMoG8WTwtzbpH20v5htHWy2Yx/21446D2zItq7LHyZNmhQdFADKVmzPNtpUB0lbsSN7U1PdB6ecfHI68aSTIobXDoXUXLsiDhw4MKAS9LoO5Z8PKw/lnUotH50xHSjKqo4X31Ae7ehY0M1XJCNf2223XfgV3wXl4oj323+/NHjHwXGMzottyeVNqaYwA3WKbS1SBttaWL2xrpnBtrHaq65L2x7YAgIP66efeSZekB6g3V0eyfCwB7qXAriliBXrf/rtAU9hAyn+9+IFMFSJIiawiM/1HSWLsuE7ebsRPPB95nzArIxASJI3OCji5trG7Bmqk5e8PXidJ6+cvm2BjiaPgRWQBwgsfTUl1bMn9qR0vvnmm6FqlbYbn6E88tsCbClcgIKSC+DAC8jedNNN43/Knx/gSk2juOlwUTwBOTBXdn5uSBfsGOKngoJhvgYOxBIbopbUWZ7UM9f1HTuVJkPDlDeQQkEGrkAXaLqfPvvDZ2nsJWOjTPI1BF+a+D51l59TjIUysInyHnPMMaEev/P22+kHP/xh1EMYAegBRvzYKhEUWoDt/qOoqwsFHKyz04D+/dOogw9Of/nqq7hPr7jyyrJ0OqfU5p1NHqOeG+Zndz+dxQV3xa+ArU4L1ZTd1Vl4BnW7WCpOaAK10zXBrusWzxnH67gIDRDqwobansJudKJ4Jn780Udp/gUWiFUY+Jn8wDNABu3KwO/AqlACnRXtDZaNPADaK6+8Mo494YQT0gEHHBAjT/xaGbSpGGiJX1DywTDFnpJMIQbsxcYXjuEnnotH/PKX6cknnghfrtXzLYNtV7y1tY/JYNva7V/W2rcHtpeNGxfL1YA+qoSXdneVHBBiwo1hV7FiXuwmGBVrO3poe5H5jBLifw9qD39xfpQQw7Ae/oaEDSsDFvFs8hRbSImTN+j1sqJkiGXz8jBM7AEv3rGI3TMz2ovL/14oXi4gnuLnpVUAeFmN3OCZ1WJVBArn+++9n2648YZvgS1/9NKnehaTx4Ct9gMvgBSc3nP33Wnb7bYL0DOMzC/4nSFjgHHWWWdNBluKmNAEChjI9BLmP0XcZCnYFvHb4AZMOF486MSJE0MVKxK/A1KuS00DTEceeWTEPYJ2quDll12WTj7llPBz6l2h9pbmAV5As2FnSngp2JYqjHxXvCZFGhgBGnVwT1E/XZeyTR0Ge6DJ6hCLLb54OnjUqKgzKGJT4RCVSJ2BbSWuqa46EToyninaS2dbWAAlFxSCTp0U6mpp0lnQNp5RlGwdcD72zDPPBGiya9FmniEL/eIX6brrrw8A9Ryh2Op4g1VloLKL55a0BzXd+Ua2PNsuueSS6AB5tgmvcSzfBbYUYv4k8XGdOyMI1OOiDscdd1yozEXy7OQ3FHnPvFru9pbBthLe3Vx5ZrBtrvasaW3aA1uwUEyu8FDkdO0N1XZUAS+zO++8M16iYgmpYtQGMEq18LKnbsjbsJthv9lnmz2N3G9kvISuvOKKtP0OO0RMIHigsiy33HIxAYQaa6jQZyBaeb0QDM1eMnZsrIPqJUZVkbcXvmO8eLyYvKxAkmtT9gwVAirDhdWeXFFTJ+jk4rUAW+oYZW3ihInp+1N/f3IJzS7fd/jwUIhvuOGG+ByoggcdGy9Q0AgQtKvhekBo8pU2BbYgp1Sx5TMgpD3//vjjjwM8QWYRv12sigByQInwB+UohnoBB99yHxVAwf+pt/ISi3nOmDHp99Y83Wfv1HfJvv+iUBaKLfvzTfUw8Ux5gY7OIKgGX4a+hS18+MGH6aijjwoFFxS5DhgWGypUg40oszqT4k6XX2GFdMD++we0Gbq+8cYbyxICMCWXqgXYFiEj2kHHHFCynbhW6iobeh5RTIGnuFbt7TidKHakeGs7sMo+Og9gE4h6jhkR8my67tprI87biJMOtzhesOxcYSv8Qwy0RF3XYeGHlFrLx+l4aF/Kq+cbX/Pc0q46MWBccgwQ99w0p0AH33PN860UbPmF66qTYyu18UZXnl0ZbLtipdY+JoNta7d/WWvfHth+8cUf05AhO0V8mIe0h35X1gltr3BUBg92Q3he7GK/PLSpCfI31OtF4iE+3Q+nS3vtvVc8rKnFFAwv3tKYXy8nqh0QLibbyMfkHOBLiaWIGGIukuFcyor85LXeuuulCy+6cLKKIvaS8uVl0J0llcraIHWYWTXBFvw8/NBDAW8g1tC9IVS+BzYAibhe7ehl7aXtf6q+dgUDFDgzv7U9cPG3MBN5CxsQy2iImHIKEkAKNQyctg0HcJ3xV12Vjj7mmFB1t9t2uzT9DNMH1ICZYsIieFEOw8+uA4J1kpS9SDpiFDSJLxqdoBy7J6a0SgglTsiBST/uBWCl/CCNugx+TjrppABYsZp82j2mXsoBqoC0EQvqrf8dB5ABkY4jAOfvykzx06Hwv2XNyt25qzbY6sRQVYWsAHmdXLHSJtvpvAI/fuZ5QbWn7vpeSALf0qEftueeacfBg8M+/veMoeD6foMNNohOghAo4SuU+b9/8/fojGkXHRpKLRtrM/bXblYP0VHhP3xVuvTSS+M7eQDbv339dVp8iSUmd7JBL9/mn0YkALIRMP7JnynJa66xRlpjzTUjf+EmEmhWL3nWciORDLZ1+GCvsyJlsK2zBmnk4nQ0eQxomoTggdgT0HO+H+uLekl6kVA8KCQetmAX2FIiwK4Xv5e8IWMvV8N4gANwtl2KidJLZQXCBXCbNUyFMnlDyIGhOr+L5OUi5hCkUy8odF4YhcoGFEyw8LLpSX0b2Q86Kns1wZYPUMz4BhjTDiCL6s5/hBYUsZfFIvgUsyI2WzwuoNHGxTqjVDftyo/4ouMlfu16Xrr//T//k2aYfvp/WTtVOZwvFesw80WQXayZDJqVCWQIW9AJ44OlG0s4XxmFwLgXfK/8VGnxtVOCSPV37WJ9ZqqzkJxiQwoTngAVe8lP3YA6cPUdVRvws0mxfJVj5alDoMxvv/NOmnmmmeIayqCM6tObTmx7vlRtsFVPbVs8e9jHjzp67vkO9LOVtqD6szloLI5jL23KpkV8NbD13AKTfIg/yYOvsqNnpt+Fv8hbcpzrCT9wbZ0hHWm+qd34uHbk48ITfO6HnzneMdres8v1fF7cE+rkh+/xu+IeEaKjDmKEyxGz3NNnXAbbnlqudc7LYNs6bV3xmlZyuS+Kk6HadddddzIweJgLH6AySCCXyiouFixQqKgSVCdKmpcTVbaYGe9l4QHtPC91YFtAKLAV00hFMSRHBXHtIplMo77UXi8kMXfAtthNiooGqg3zZbD9P9erJtj21uGplzo01C8T2QowNQwvPrZY67a318nnd98C1Qbb7pewa2dQ2nWChRMA0XpOVHkgLF68limDbS2t3xjXzmDbGO3UEKWsJNiauCLOkAJqvUZqiFneYsJAa6HQGsozrGZiiwld1CQzesWyGbIzfGpoFRSDX+outcRDW8wgRYYqtflmm6Whu+0WSi+oFWdpqBHEyovKSwk2W526JnYO2AJcZfGyMoSnbG0n8jREY1aokI0CthSrCTfemJ559tkYWi5WUwBUo0efnZZdZpm0+hq9X/S/QmZu+mybBWxNyvKM8IwpdqKrt8azwoTnn+easBtKbi1TBttaWr8xrp3BtjHaqSFKWUmwNWxqgpahOzN8Ka0g04SWIgYMcAo/oMzuussu6dNPf5/eefediC0TdyieTFyh4TxhCWINxU0aXjO0bHhWTBno9SA3XFiEIwAyqjEV1jAjODZBBkh7KZn0Y9hxxx13jNAI8cRgyP8U33LHGDaEQ0yhkI0Ctoou7lrbGo5dZOGF03e/972YGGSCIT/JbVo7L2wGsDVKJGZXbLTOuJjr+ReYv3ZGncKVhTwYyfI8cy/w/VqnDLa1boH6v34G2/pvo4YpYSXBtjCCODDXoRqIVWsLF51tBEGllUcRq1vk6wHupwgbmNIGDRQLUFysbVvaMG2Pzxs8TNltGwls1YCvFPGI4hZ1ftrGuzbMDdpEBW0GsPU84VtCXDxXhCJYeaPeEpCUarVubVt7ZLCtNw+pv/JksK2/NmnYElUDbBvWOLngYYFGA9vcbPVpgWYA2/q0bP2XKoNt/bdRrUuYwbbWLdBE189g20SNWaGqZLCtkGFbLNsMti3W4CXVzWDbum3f1ZpnsO2qpfJxnVogg22nJmr5AzLYtrwLlMUAGWzLYsaGzCSDbUM2W1ULncG2quZu7otlsG3u9i1H7VodbK2gYXtm8bqlG36Uw7atlEetwVY8vgmmVgywHJy1YGuVrHVrwqoVWVoh/juDba08rXGum8G2cdqq7kuawbbum6jmBWx1sC3WXrZKh+XhcuqZBWoNtpYbtGOcXQ+ta7zAAgv0rCJlOMvGHHZCs3pBrdeYLUN1Os0ig22nJmr5AzLYtrwLlM8AGWzLZ8tmzanVwdZqGQceeGCs7AGMcuqZBWoBtsWudKU7cdk62EYwCy64YM8qUoazQLYdzew81tEub3yv2JSmkZeqy2BbBqdp8iwy2DZ5A1ezehlsq2ntxrxWq4OtVrPRhy1qM9j23IdrAbZvvvlmdEisgS29+OKLsfOgzVoqDba2E7eFbnup2Aa37Xbhpcd/8sknsQa38tfL0l098YD0IZRaAAAgAElEQVQMtj2xWmudk8G2tdq7orWtJNi+8cYbsTmDtR/XX3/9WE+0NFkP0pa71AsbOPhp7yH/2GOPpZNPPjnysXVud/ay/+yzz2KjCMN/Xmg2ibBxw8SJEyMvGzjk1L4Fqg22XvjvvfdeAiU20wBEYiKFAmhLcZK+o3atuuqqsY6xzUAmTZoUw7p2tnv1lVfSEksumdZaa62IjQUZTzzxROxcx3dsu8sPNtpoo1hf2Va8fot5/OijjyJ/i/HL3y50ow4+OP3+d79LF48dG+vk8h8hCl988UVaYfnl09x9+uTNHzq5iaoNtjbroM5a/9rOhzZ20aY+GzFiRKxDqx1t6tK3b99of74HJm0cUyilNnXxjPD5LbfckhZZZJEAZJu7AE55gE/XW3311WPzGc8W981RRx0V/uq6Cy+8cGwQw1/5ji2+beMtH3k4Tjy3NbeLzUQuvvji2EjG7ov8/ec//3lD+lkG2/yG6cwCGWw7s1D+vssWqCTYAgQvghNPPDG2rz3++ONj3/IieRE8+eST6ZFHHkm77rprvHjaG26z09jIkSPTUkstlfbZZ59uga2JGsDWjkG29DVpxIvk5ptvTttss02aeeaZu2yvVjyw2mCrszPm7DFpi0FbxG51N954Y7zo11hjjYiP7NOnT9KmZ5xxRuxKN+8886SzRo9O48aNS8OGDQu4BSZXXnllOv3001O/fv3SvffeG+EESy+9dFp33XUDcH2/3HLLxTnOVU/+AVaffuqptPc++8T/8847byi2/PWCCy6IiWQghC8CGJN/gFIjK2rV8Otqg60tvffbb79oP8C5+OKLB7jabnmdtddJs/5k1tiVTqdZaAJgBa+eE87pM0+fmOD197/9PTrA2v66665LW221VWz/rROks8XXwCkfsgGNLcRd46GHHkqnnnpqdMaeffbZ6Ez5nP/deeedkY/nny3EbdFrZ0S+5DN/exbaXRHs+l+ZbCfekcJbjXbsyTUy2PbEaq11Tgbb1mrvita2I7ClMnjQ2w+d6tWTBCDBBTjZZJNN0tFHH/2t2cgUOfBgG9vOEvWD+rL33nt3C2zla3/3PffcM0Ab2DZL7FpnNivH99UEW8C67/Dhabrpp4+tlr3E+SjA5Uv3/n/3pqG7DY2X/qabbhrgAnq1q44TKKFqUdvAAIV/l112SR988EH4GOVryJAhkd/VV18dKq8JYbZuBsqg1TV1pFZcccXkYQukDzjggABeZQI4FMBFF100/Bo0UwEpwDm1b4Fqgy2YApJU0p133jna3IoIPtOeyy+/fLTpoYceGuDLX/jBTRMnpk033Sx9Z6rvhPqv3LbPpcrqXB922GGh5FP+habYfnvllVdO11xzTbr11lvDP3Saxo4dm+67774IR7BlOHimvupk+wwM33PPPQHHOtjK6dlG8bW1t/JeeOGFAdE6VsVnjehjGWwbsdWqW+YMttW1d1NfrT2wBZwetlQGcOAB3hO4FW5g2A6IbLfddvFiKFW3XAc4+a5tKoYCi8+9GIAtha07oQjOf/a559Jew4ZNBlufeWlRWACJoewpbfdbWqa25TEkDcSUqZic0ozOUk2w5S9DBg9O22y7bQBpaWJvSUgJYDj77LMjPGXNNdcM6KD6X3755QGiEp8CHLvvvnv8v8MOO0RoQuFrFHsK8JgxY8IHAQklDdgabXAuaAUe1F4dvXPOOSeg2XAyNe+aq69Jf//m7wG8U9q2uRn9oad1qjbYCnE66KCDoqMzdOjQKPYLL7yQTjrppAgBmH/++UO51yGyQgK/oLDyM8+p0vhYPmGy1x577BHnUusl4QyON8rA9zwPhA+AXL+NRhXJ82aDDTaIDpXRKSDL3xZbbLFQaYcPHx5+J3/PXqERwFZYDvhu5BGBDLY9vWta57wMtq3T1hWvaXtgCxoM+ReJskAZ624CIR76G2+8cShiHtTAlmoGTl3/LsNyW28dWYvHBdNi0AzL/f1vf0v9+vcPuKDYekACGfG7HvTLLrtsmmOOOQJ0xPOCF4rs/fffn55//vkIgTBk6G9DhGAGgFx//fUxdHjmmWfGUKAX2RprrpHmmH2OeLnIn0rj2AcffDDKCWb8UHdce8L/xui+8frraZZZZokhaXBDxWu2VE2wpaBR14AG4ChCU8ADlV07G/rli0DAEK4QBf7Cpyi2xfJJho9XWWWVyVBDsXVeMTpA5S0FW9DKz0EMwF5twIDwoznnmisddOCB6S9//WsaPXp0xP3q6CkjWHv66adjJCKDbceeXwuw1SGhjBZgq5MtNOqIw49I8y/wf2ArDGHQoEHxPPC8sgzXrLPOGhUCyDquRq922223gEwhLJKRAPc+X+AXRgA844CtjtKjjz462Yf5Ld+m2HpGmbx29913B+ACbCB7ww03hA/rxIvfFWoDqDPYNttTNdenrQUy2GafKJsF2gPbq666Kl4GHriUTHADIrubgC1Q3WKLLWLYz4vj2muvjQe1FwmFQ97izYALkDC8O3jw4LiUY71gwDAlQx7g1TI+wIRS5yUAbtdbb710wgknxBCyyUKUOsONlDzxdkAI2ALmu+66K87zkvHS8rlYTC8XoROu46XiZjN8qfwUu/FXXZVW7dcvYjWBP8VG2dXDRCSQ3GypmmDLByhf2gCAUMYAgw4NGDCMLKREG2rXPXbfI2208UYBoqABFJiko4MEdLW/Dg04ociZhEZ1c50JEyYESFBshTnIlwJsKFjsJZ/zPegxFAyuKXpCF0wuE35w6aWXBtg6VlmbWbnvrV/XAmy1mxh6zzKdpKLdhBOIuXVPm8QFIt3H4m3FtYqDNVJVTEw0sZUfAlvf6zB5VvAdcMun+K3zQXERtwtczSsQiiA0QVn4oecuP6XY6oh5zm277bbRqdJ50nkXT0v1FUbF7ynIfDPH2PbWE/P59WiBDLb12CoNWqb2wPaLL/6Yxow5J17aHrI77bRTh0vXtFd9w2gUT0NrkusBlmJij1hF4CT2EYwAU0P7Xizg1MQLShiF5PDDD4+VFYpQBHlb5FzsrpeCvKi6YEYSf7nwQgunwUMGh5pL3bvpppvi5fDVX/6SBq67bsArRQ6Q+AH0t9122+ShZUsDeQGBehCr/GKODWOCYnUDYaCrWaGmmmCr3XQSAKNOjpngZq0bwmVfnRvtQXnVTv/15/9Km2+xefgpNZcPONbQLiidbbbZAiTEKYJebUexFU5gIpCOF98ENhQ2ip6OkeHhs846Kzo0QlXETgJb8EPRo8TpyFgxASALW9DhauS1Riv9CKs22Or8UlDFzfIZHVedVP+DWm1rYtZFF10Uqx7wA51o5wBN/mYERviK73WGH7j//lhtw/PID+XeJLENN9wwnk1AlP95dum8ezaIjQXQBAKjR8QCwKsD7zkn//Hjx8dxfJ2fAWfPKSNNgNiIFR/jpxlsK+2pOf9aWCCDbS2s3qTX7GjymBdDEVfa04cpoOCwXvpF8mAXP0nJ9eCnZgBTvylfti0FuqUJMFBZvGAKsPWipMhQRCgaANzwdaEsg94lllgiQAbYmjACQrww/uurr9L6AwcG2IrBk7ygwLNhZS8WKqAYPSqNkIYiFfACjMRgAvVmnjhUbbBlZ75HpaW0UmcpZ1RW/7O//wv/LL7zv+8Aib9L/y8mCxbfu0YRs8u3i3N85m+fFX8X5ZGH7/zWyaHYOa4Yqm7Wjk25Hn3VBtui3bSVtil8pq1f+F9yDP/QvtoejOpUF+1a6lPa3Y/nY+kz0nk+F+JC3afcFsnnRf5t/VMeOvZ+dJKL523h8/JQ/p4+h8vVhj3NJ8fY9tRyrXNeBtvWaeuK17SSy30pvGE6YETxLU1eGuBWbCSQFRZA5TAsKJZNjK+XihcAEPY3BQRAAlZQQc0FttQ7IEw1odKCUnkJFaByFGALfr1w5OElu+EGG6Tzzj8/Yt3E1BqKpv4qq++VHbRSUQCuuFovyQK2xOlScQxfU2OaNdUCbJvVlq1cr1qAba3sbbTA6JPJY55VrZ4y2La6B3Re/wy2ndsoH9FFC1QSbD3MqLKW86LYioOllhZJHCPYpFKIcZXMNKeagk3xkGCyWLBcbBvopdjKhwprqI6iapaxvMCuIUfDgiarGXIEtpQT6qxhPQqvBfmFJoBS51pmhxpssglVxIuJAmy3KfnIk/rrO8OChsivuPzy9PAjjwT0mqBCaWnGlMG2GVu1+nVqJbA1ecxmMEaB8gYwKUZfCBhCN4Rx5ZQt0NYCGWyzT5TNApUEW2uBikUUC2vlAPFqJmEUQ/nUWIDpmGJJJmqoyRJi0CQwaVKOSRcAi3orrpEia/kxAAxMAaeJIWa1U09NvLC0j+E7QG2pHQvsA13Qa4F9s43NSKaoiOf0NzgV4ykMgQIMrJXPC0rsrxg38ZfsZk1KL2ug62Gtjs2YMtg2Y6tWv06tAraeNSaSeW5Ya9mkVs+gVk4ZbFu59btW9wy2XbNTPqoLFqgk2BZ7oRfFALRtJ9e0t1866PVdEZcmD/+X/p5SfkX8XBHL1gUTTM6ztGzFtYvrFdcurln8X1q3rl6r0Y7LYNtoLVaf5W0VsC3iuT2LivjtVp9UmMG2Pu/JeipVBtt6ao0GL0slwbbBTZOL/08LZLDNrlAOC7QK2JbDVs2WRwbbZmvR8tcng235bdqyOWawbdmm73LFM9h22VT5wA4skMG2dd0jg23rtn1Xa57BtquWysd1aoEMtp2aqOUPyGDb8i5QFgPUM9gKH6hEuIB8S5cTK4shGzCTDLYN2GhVLnIG2yobvJkvl8G2mVu3PHWrJtha9cLkQStlmABo0mBpskqFzRgAg5Ux7ApmUl+5k6XebOZhW+XSlTzKfZ22+VlOzhJyxWL+lb5eNfOvJthaF9bEVNvY2oTBrl0mnZp8Ou+888bOgT6zw6CNEuw8Z/3qcicTVC37ZQUYywO26rbLGWzL7VnNl18G2+Zr05rVKINtzUzfMBeuJthaucL1LO1mRQxLrQGRQk0DKYDlnHPOiW1MbcZhx6ZyJztU2cXO9e1eVq0EAM4999xYYWP77bev1mWrcp1qgy2Y5Eu2qLUeNZi1XrVdD+1Ap33Z20YKVj2xokq5k9VbLP1lG2a711mRpRVTBttWbPXu1TmDbffslY/uwAIZbLN7dGaBjsDWMKu1gyms1ge2vFpvkzxtvGH942WXWSYddfTRsaRbaQIrQ4YMqYhaW1zH0nPf/e53e1udbp9PbQTyjbrLVHsV7gxs+dCnn34aCrnd5sqRbHk9cuTIAEvLBkp2DLReteW4dFoo87ZwnjhxYjku+S952KSBGmzb3GZd67ozw2Ww7cxC+fsMttkHymaBaoKth5sXtiHArsazgZyPPvoodgsr18uup8ZTFltmttpOQu2B7T/+53/So489FoqXEALbIttNrrf2EWZgM41ZZ501nXTSSWmllVZKxx133LeUWRttrL/++nFMaSriGdtCId+zJrH2A6zWQO7MB6l7YN0QtgTM/A3AAHw5IF5ZhB9QnYvyWEeZct2nT58uu2qtILzLBfyn/WyLPXjw4FhPujR98cc/psMOPzzCTKwVrWNTDqW8AFv+RLHlHxdccEG66qqr0m23356mn266ANpx48ZNEWxLlw+cUl2L7XQ7sgOwPfbYYwNsO9qhsNimuTs25Suep7XogHWnnBlsu2Ot1jw2g21rtntFal1JsLWBgYXKbZtraNVGBjZREOdmp68VV1yxwzoZxvMCsr2u4Vkxl7VMNo2YMHFCOuTgQ1pqwfX2wPbLL79MBxxwQLrooosi5nXuueeOHdsKZaynbSWvc885N22zzTbpzrvujG2S7S5nR7oiXXvttWm55ZabDH9g05Cvc8VNAgjng+w//vGP6fjjj4/tksU5Pvvss6l///4JZH3nO9/5l2KCFcPGzrn66qsjFOLJJ59Mt912W4RHABSxvs7/+c9/HnXW+eLja621VnwHZkCw3ZYA8IQJE2JDDwv22/jDdW0Coh42MlFu11N2v0Gd3foMm7MzwN5qq61iJz8xyDp5tpF2L02aNCnqwAagsV5VwY4UW/W0QyCQBGrg0/+9TXYytFW2rbqXXHLJ2IGQQmvXQaArAdvLLrss2kjSFgDbsT+cbrr06e9+F7sQFjDO5rfcckuEMXhGaV++VWp3MbuFD2hTPqOtpwS2OlDKqXPz/vvvhw9RreXHZmKAAbrr2ybc9YySeCayF3+zzXg97+iVwba3ntz852ewbf42rloNKwm2Hrpe5ibgDBo0KLa89ZAfM2ZMPJS9zDzEO0pAeOjQoQERYKSWycvqxRdfTKuuumpFhsArNTO7tzZrD2y1JbC1TSYYnG+++eIFLu61t+nMM8+MGFNwaBj5mGOOia2LbafsMy97u9gBS+rmiBEj0jrrrJO22GKLeNmfddZZ6dVXXklHHnVUxONeeOGFscUp9ffdd98NEPAZ8GybvIQNVwPpBx54IMByp512inzFZeqg+f6OO+5Id955Z3TclFV4hDL86U9/iglDwDQmg919V9pm622iU3fSiSfGcfPMO2/ECK+yyipp4MCB6awzz0q77b5bgBKQt0sfn2d7qrXOnc/AMDADyBRedtpoo41i1zzbUoOkQw89tOajG1Nq/47AFljuuuuuk9V0bcbmvU3gUj46AfPMM0/sRuiZZMdC/mRr7Ak3TkiXXX5ZAK421q5sbJQAYBZbfw8fPjz17ds3bC5GV/vyez4Pgk877bQYFdABErOrk0FJ1d7A9L777vuXiYhAVn46LTpNV48fH5C94M9+Fp/pUOnQg9yVV1458qZoux+MSvAV7b7AAgv0ukPZW1t3dH4G20patznyzmDbHO1YF7VoD2xBFoizHa6XANWqJ4masMEGG6SNN944JgRJQIFaS0EBRR0NozkfAFB4aw22hZrT2RB2T+xEVQSKVM96S+2BrZc68AOR2mnzzTePrZHLMZkLzO28885ppplmii2OwQEVT2wkYDDRB6iAPWAB/HxWXJtf6zRR5nwG9sAHpRNs6mytumq/tPfee4X6xScLtZDyCk6BBMixMgOA93IWi6n9X3nllQi9MKIA6MVxglLlECf6xBNPhN+DGXZaffXV43464ogjYlh64YUXDrByf6kPqAEvYAUgUV8da7KcOlMXqdbAVdgHuKE+axvhH8ruc7babLPNInSn3lJHYMt/1Pf555+P5wLb6ED0NlFCqZxAefnll49QFJMP+ak20MEGi1dccUWArU4Sn+nfr18aPGRIXN6z0OQzKr7OkbCGk08+ebJCqg1Brpjvfv36RYcIpOu0SHxAjC3Ftu0qH/xE2eTLn4Gs+4m/Snyaf7Cd/ECwzpNyG01QNyMXFH3hNfWaMtjWa8vUT7ky2NZPWzR8SdoDW6qGhz91ywtASEHbh3JXKu8l7wVPVSrA1kvY0J4HMXUCKFiyyRAbwPDy8R1lzvnK4QEObEGCJXQM/YIeL78i1tG56uP/tpON2pbVixTgeGkBGcOfYALQFNv4+sywo2PMZgaehoENCYIQIOGBbXiRkkbdsSe8z6g88qGkUXGK5AWlTvI03Kye6uRFBboojkXMnJe8Y8RP+oxdJPVzTS9h+bBTJZa8Ksrc0eQxZTOUzk5sXg6odV3D8eCg8DnAZoUCL3PDykIMtL2whwKIqLilsbX8Zd11100DBgxIe+21V7r//vujLZTZMDf1TYfJA9UQv3YAhNrAcc4HPYDDNahrOmISwNxuu+0iDMOSY9oK6IJsZeVTOoPa2w+AAam/+tWvApKozXyG/1PzwJx6aWdgC5JdU/sKsbj44otj+Pvll1+O9tbZBGB8AUgV94AQB39XovPVlfu9o2M6mzzGPu5L95qfctThkYcfjjY+a/To6KhInj+UTqqsCWTUVR0U/qNdPWs8czy3igRKnaMDc/9996VzzztvcjgS39dR0inlV1T9U045Je59SdtrI20NQEuT1Td04nRe+MS9996bbpo4MR162GFxT3seGRFwj7m+zp0Om+ece0EYCl8zGpZDEXrrofn8Wlogg20trd9k124PbKlKxYvVC8YL2fBndxP4ElMIZD3wJTGOVAbwAjq8BMSo+fGdiRwS9YuaRrE1DGgY2YOc8mUI0XDwEYcfnpZaeukAcGraL37xiwAQ4EdBaftyBIdi6bwsqGTCC4CmlwZw9ZIBpRQTL5ZiCJgqdughh6Q333orFBYQ7WXiepJzvKT232//9Pdv/h6Knhcmm8kbwLoO8Jnpxz9O//OPfwScgzfgKNyCTYCaF6oXGrtQZ0DNeuutF5AHggyt+t+L8qmnnooYQueVAwSm1L7VXO6ruD6Fi0JZOjmMzQECwBPaQiGmZHrZU9woYwXg6VwYwgU1VF1gCxpAIbClgi219FJp5IiRAbRFp4ENjSAALGDL3wCLe6EAUWUUViD8ANgCErBEYdbhMalNW4J8SrxOi84QfxMCoW5UXveeNuU7IJl/bbTxxun000+PMhaqnQ6Ue4M9wLxQD/U49phj02OPPxZ+0AjLSHUGtt19tnTl+EcfeSTCV84866wIIZJ0GjwbwKL25U86DxRwtna8zo3whSJpE+1IMRXCQlXV4ZGc43hK+WqrrRbwa0JlEZNLheU/nmttJzvyPaEEfNO9zq+Uk89KYFtHnn/wZ2Fc/NJzUcfeteUtFAEc12vKim29tkz9lCuDbf20RcOXpD2wBX8ACuxRBMQSLrbYYt2urxc7UAOlhuuAmbyoC17cgI864qVPKZHEVIJWxymfF3oRdyi2zAMePBTqFVWTYiImzXAjYFR2k3qKF4R8wYclpLzEwBA4oNqC+LfffjuuC5BdC5CCbgu8ux7Ivf2229K1110XgK7cJieBGi8ULyxKnJg+ihuV2zCiFxFYprD5HjQJy/ByLSY0yR+oUfy8IEGW87wIlQW0UoL/Lf1bOvjgUemgUaPiM2UDW150U5oE1e3GaueEaoKtFz3Fk2+AUvXWTgW02zjBMDXfKOINtTffAZZCXLSzYWUbHbC9jlARi6hDRGHTkdBGQgyKVQ+K6msbyp3YV6oesNXmOkE6T9RcnRidEoADNAG1BzPwFhtLVaMegyZqH/gALYawwa02v/iii9KGG20UsOpznym/v6XSWFmhGCCa3xaTLqnE6rHGGmuET1F7gQ71tx5Bt9pgq3PIB8Rfu0eBp3tL+IxngPuRqk6tnThhQrp03LhQ7PmODiNANYrC5zwjdNA9E7Q5GwsvkQpf9LkOibCCQhXWuZGXNqX2g+HSe1UHWGfX81CogevrlPN35fecM9IFYnVu+IRRCGERSy+1VFpo4YXjb/Wq53WPM9iW62ncvPlksG3etq16zdoDWw8iSpB4NAoCdawn8OTh7IVAvfBy8XK3+47hWy9+EAFggBqAlcADKAUVRSgCAKHOeQlQVsAEYAbEjz/xRNpxhx3iO0PUQgooblQzUF4kQAMwQCoAKYatxV4CEaqJchieVNb1Bg5Mu+y88+Th8Oeeey5UGy8aLyhDwRRbQCWBGC8Z8O266gpyHOd4Lx5wb8KTeoN+yh3Y8gKjIoFbCayBXOoeFUiiWHrBsh0Fh7rtJSiPSqZqgq06AgHQyk46JiACtBWJXanZVFhwKumQUGxBKKgA/CAEKAAPbQoI+bJjqWSghV+XbgAhL0oetd054EX7sIGygQshF8IahC+AUb7Dp31POTYhrRgWfvKJJ9I1/1zBgQ94eLuujth/TpqUvvzTn+JYvqmDom5gTB3cN2wgAVaqIb8soFUnQJ3dK+zDF3UgndOTe7WSPiTvaoOtiWLuaR1gIQCeQYARfPIrdnefiaPWadHWKyy/fEr/9m9xXrE2s2N0fow6OR/oit11j7Oz7/ko1VTS4eQHji1GdLQpP/HMKg1NUja+7FnED/mG9uVXOsueNdrTs89zyggY33n7rbfSr59/PmKtdc7VrRzLo1XKBzLYVsqyzZNvBtvmacua16SjVRGKNT+9NHu6WLwXtoc5+DKE1zZ5eRhK90IuANHQO0A0DFdMHrOuJVAFD4b2Jv7vdqevvPxygJ9jnCu8AMi0NyQPsgGyslDwijp5AXoxASBw4cVnVjt4AamFQvbMM8+EqisEwRqjlEMvR2EKrkkNBmQUG0PMXpbAlvLjZeWFRCUCV6Vl9MKnDsoHsBYgA4QphcUyZ2CHku0FR4mkfsurt+vGduaE1QRbPqedQFsxmUtHpK3/ecGDgNIJM3zpL1/9Jf37d/494IFd5OHF77d4Vce7hvwlCnrbyYu+c45UbJRQhCoUMaw6JsX3xf0hf/7u/yIkoqiPayiv75WlCImgTjtPHZXXdV3fZ/Io2rZYxqytf8vLPQEcwHVb9bmztq3m99UGW7Z0L/Md9ivai00L8G/b1sUa2z5XXu3nM/5U6oPa3/c+K3yt9J7WHmKGKbbaXjv7mw+UHgeKhUP4TBgL3/c8UnYqr/+VXdsWoxn+9pk81U+bK0OlQpHK4SMZbMthxebOI4Ntc7dvVWtXyeW+VARsAFvDrRbVb5s8mCmahpyLGDFD9NRREEepEmNLYQWRYNFvLwtw50VvCI9yYahW7KTkhU8RLV1b0rUM8VPFxMoVLzeTMACoIUrlAIxAlCIKdpXH5/43FExFoQwqr7IYkvZSAeNeUsDW0KGyUogNhVJdDBlTbUA6wFIeoKMcYmaFZAhvkCjV/jahqJj04nNDl4YjXRNcFxNUKuk01QTbStYj511bC1QbbGtb286v7hlFrTXq4P73DAGs7KTTrHNdj6tbdF6zfz0ig21PrNZa52Swba32rmhtKwm2FAZL4ZgpbFhN7GmxAkFppcTzUl7FC1I1DPOJHzQLHvSBWt8JPzDsCub8fdedd6WZZ5k5wFZ8m3VxDRUbqqeEmIxRDA8W1zMRw+Qvw46GI4EzIBa3ZqkemzCYxSw8ApSDbvGx1FSfF9txAnXfGT40sU0SQgp7A9IAACAASURBVPHYo4/GjGbxyEAZfMvLi0sIheFkCrBrsb0hROUVhgHCKc8UGOUaOWJE2nPYsCgr+xXDqMBW/UB2uVYh6MjJMthW9BZsmcwz2H67qYGt0CKhLVaNoQx7ZurU68DqvDZLymDbLC1ZuXpksK2cbVsu50qCLTA0cUecLiib+6dzp0UXW/RfdkYyrGcI30Q1Ma5gVuwZOFQ+8ZIAzne/++ST9Nbbb8dQv89M3qJ+eklQTItdzqicFM0pDc+BRst2Gf415Ae2KaquT631EF6yb9807TTTRBzlX//ylzTf/PPH0KJj5pt33jT1NNPEy8fLCJzKx25FVFihDpaSArbiNb24wKxhTXGbjgOvPlN+Q87yAvSUYbCsQ/DxRx+lGWacMdRhsXrFUKj4UHWo1osvg23LPRYqUuEMtv9qVvG6njHCCywX6Hnl+UPF7Wj73Yo0UAUzzWBbQeM2SdYZbJukIeuhGpUEW8NqxV7roAzY+d1evK5juxLLW8T+lk7CYEvX8x0w7ko+xXaY1Z5oU8T9tb1uZ/vSF/5iYgsgbrt0UKX8KYNtpSzbWvlmsJ1ye3sOCUnyzNLJ1VGv9jOp0p6YwbbSFm78/DPYNn4b1k0NKgm2dVPJJikI8KXkUsDNvO9ox7ZyVjmDbTmt2bp5ZbBt3bbPYNu6bd/Vmmew7aql8nGdWiCDbacmqpsDxBebnCYEwWS5as2CzmBbNy7Q0AXJYNvQzderwmew7ZX5WuLkDLYt0czVqWQG2+rYuRxXscqCHYfE31VzX/hmAVuKt1CV9pZHE8oiTIQSXq1OQzn8olHyaAaw5R/i7MW/Fku6dcf+xTJ21Rpt6U7ZKnlsBttKWrc58s5g2xztWBe1yGBbF81Q14VoFrC9864700svvhQbYZis0zbpOFx++eWxMsWcc85Z123SiIVrdLA1QdSShXalsw52dzdE0HGyUYMNHKxRbfJqq6QMtq3S0j2vZwbbntsun9nGAhlss0t0ZoFmAVsbbIAKu7xNaZk0K01YncO6y1bdyKm8Fmh0sAWmdnqzXKD1Z+0k153kfCuiiJO3FGHbya/dyavRjs1g22gtVv3yZrCtvs2b9ooZbJu2actWsVqALQiodDgABc5s9I52qyuHEatRl3KUs9J5NDrYso9lAm3uYuOV7oJtYd9W9IcMtpW+uxo//wy2jd+GdVODDLZ10xR1W5Bqgq2Xvi2ShQWYIFe6pWjbJZDEOhbb5VoDtHT7WVvu2mpWLLJ1isU0Ot6ayHaLo9h6kNrhzeYZ1DPxkxRdawkXUF1sw1usL6qRrF3sfC9reSqXneamtMSc7+10Z51k+fuxrao8JHG/7777bgxrq6u4zWK3KXUQE2zNY8PWxQYd7ln52tDDdYvPKc7WjrZrnhhQW64W2/cqo3OkYgtYf8tLYh/nspXlpxzrXGUp1yYgtQBbMa2f/eEP6et/rlddGl9tsxZ+w85sJfykNDzAuWyqXSn4bGjzBGBrR0DH8zFJvuxa2Fg+2tJGKvxEm7iWGHnXtda1413D+tiff/ZZmmbaadNPfvKTplvqi30y2Nbt471uCpbBtm6aovELksG28duw0jWoJtgCgeOOOy6Ga7fccsv0wgsvBBguscQSseVwAX33339/bGphFzpwaqH7rbfeOsDsySefTI899lhAgvADWxPb9MJWx+DqqKOOijjJkSNHxjGrrrpq/FDjrDphZzdAY6c4ELzpppsG+N1+++0BQEIZwKmwBZuAuIeUy+elCSDaHW7SHZPSFoO2CMh56aWXApxtEw2MbMpxzTXXpM022yx2z1NPWzZ7yNsSGhA5z3bM4NdQuLoCXnUDWIDJttAg/Euw//e/x059r776amxaYtjb5ibsYg1ku/HZ6er9999PF118cZqnT5/4DpSdeOKJkW+xlioQs7QcgO5tqjbYAvOnnnoqNnt57tln05xzzRW7AAJVIQGjR49O/VZdNX38ySfxP98RYqAtdUBuueWWgE7L6w0cODCtueaa31Js2f3iiy5Kv//DH6L9+CKfcQ6fs0GLzsqf//Sn9Kc//zkdcsghsXU3yKP4Ftt2s/10P/xhuvW222KXxWpsk93btuzu+Rlsu2ux1js+g23rtXnFapzBtmKmbZqMqwm2YFAMo0lcF198cYDns88+m4YNG5a22GKLdPLJJweEHHjggXHM7LPPHkAHFMCoLYuBsV3dwAhIM1EMzF1xxRWxs5xtjqmc++yzT2yrvMMOO4TCCWBOOfmU2OZ0wZ8tGBBELQV7YOiee+4Jhc0Wx8DUVs7+BpDKc8kll8RueUUCVnfeeWeU54ADDgi4BOzKKt/LLrssrgVK991337TkkkvG5wDQ9sy2mVa3Cy+8MFRUYA56QRQQv+mmm2KHO2Vin6uuuirKaXc7ZVNHxzuW7ajb5557bsCW8tge2jVWGzAgbbX11gFcngdAWqfCNdm7f//+MdmpK5uedOT01QZbHZVx48algw46KHYAHDBgQHSU1IO9gKfv2Qrkb7zxxlHfDTfcMHwQ6GtXnRM7KJ533nnfUmx1arSvrbyPP/746KiAVHbmV+zO5xx38003p2223SZ8hE+yO8Xdb+rtVlttFdt5U4aXXnrppnl2FBXJYNt0TVr2CmWwLbtJWzfDDLat2/ZdrXk1wVaZKJjW7AVeRUgAAAGIVFJwwG8vuuiiyVV4++23J4PE888/H5C35557htJphzbDyI888kiAzDHHHBOf+R6IUoIlcEOtBTOWVHviiSfSCSecENBCRZswYUJAkNABIEotpeQCRaoxcGobdwlizj57dDrhhBMD0iUPcDAtP8PRw4cPDyC3NTOYBDvKS2kFg7//9NM03fTTpdVWWz1AGEhbyxgAgSPKLvAUMqAuYBfMix+mENpeepNNNonQArP6qbDKD5pHjBiRFllkkbAF+FAWqjG7+N+xtnP2f293w6o22LKvkI/VVlst1P1+/fpF58UW11YnYBsKPeVV0kkBmNRWfkKBB5o6INqRv+lkUdZ1MgCr0QQjAOy+/PLLh8/obPGvzTffPEIU2FZbaRPwSkXnZ1RwnTcq70477RQdCOdVOra8q/d9OY/LYFtOazZnXhlsm7Nda1KrDLY1MXtDXbTaYHvttdcG1PopYAqQgMHzzz8/VEfD+YCzSCBuwQUXDOgAmKAGvADP/fffP8DsoYceCgWtAFvD9VRSUAImAKuh4AJsKXaUTWBIfTOkDTZB92mnnRahCZ1NPCtACJQrsyTOV3iDcoAj16MQzj333AGplGTXs+xYKeQAUYov+3gJUAhBsBAFIQ46BBRDgAVc2Q5AATpqJGUXnIkLBbDyMzwOqHfccce4NrATorHWWmuVHbCqDbbCNaj4fEfdtDflld2otewu3KBYAUMniLLtOJ0ANgWuwkUAfgG2Z599dqju2k5HxAgAxd95Qh/YX3ytOHH+BnbFi1OOjRjonGkX1/X8LTZecU0dKR2JZksZbJutRctfnwy25bdpy+aYwbZlm77LFa822FKwKFnAsQBbyppJO0Bh7MUXp+d+/esAuSIBCkqb8ATAQJUzpG4YH1BSOMXdUnLBoHhK4Ag4CsUWNBZgu9BCCwUIOh4gA9pC/ZXPoEGD0qmnnhq/JRAFGCmopclkI6EMYjeVSQK7wNMQNrW3FGwBwKGHHJpefuXlUPKEJkgmOJmQBLQAsLIC0MGDBwd4u756P/7441HnUaNGxRA3VVkIhHI6BpCDLmEWBdhSbK3tCzy33XbbgH3nF5ObdBqowY2m2LLtGWecEfb5yayzpmWXWy699tpr0REAq+xHPS3Adu2110lbbLF52mWXXSLchR11AMQlg2OdKm2nY8VPfvrTn0bbCEcQOqIDBXDZHUhrIyEwfIDPsb2QCDCtQyHGVmcJaANnKrBJhvyh2VTbDLZdfty27IEZbFu26ctf8Qy25bdps+VYbbCdOHFixLD6LQTgow8/TGeeeVYaPGRwWmGFFdInH3+cRowcGQqu4VtQACooZQBtzJgxabnllos4WxBhOJqKSxkTlwoywQe4FG9psX3QZzUGwAFCXAdcACFQTMkzpOwzMZTAT2ysc6nBv/3tb0PlBImlCRABZyosOKYCX3nFFWmhhReOWE7xsPI45dRT02KLLhqT0sATSKdAg28TmcClcAKgZojcdYD1iiusmOaYc450liWofvnLlP7xj3TJpZcGoAJ68aHAy8Q6dgLp7KGe4N61hV1QGw2VU7rBsLV8XYe6DODAYU922iq1RbUV2zvuuCMdfcwxMUnsmaefDkhlD+EkRZw2f6CQmhSo/Uyq40vsYZUISrvztaOwDYBGMQeh4mj5j2eoUAJ+QIk18c4EMv6pvXR2KLF77bVXxGlrA/lSfEefdVaaf4EFYmKaTpkRBp2VZksZbJutRctfnwy25bdpy+aYwbZlm77LFa822IJRcFVMngIYVEQrFBSJguk4cAaYxCYacjecK+SAqgqKKY0gl9JpGNjQMZV2pZVWCmgFpxQ8n4nNFSvrPCsBFIplMUkLiBQJCIv1Ncwsdhb4GtJvmwBvMeFLWQGqOFzHKjcl2goN4Ef9ADWVFkgVk8YAugljgGnSHXeEEjjb7LNHbKiQBXWiZFOYZ59tttRnnnkCfCmshuLHjx8f8CUP1zRE7jqWNqMmqicVGPz7W5kMl4sPtRSaz8uxhXO1wVZoCShdUHuutVZ0avgHgNWhYEc2F4MLdMXRUlxNOhSTyw7sC3x1in4800xpmqmnDptSYh1XbLKgs6QjoUNSJJPNqOJ8UycFtIqxBXnLLrts5C3uW/iIzsN3p5oqrb3OOu1u+dzlG7YOD8xgW4eNUmdFymBbZw3SyMXJYNvIrVedslcbbEGV2ekedB0Nf4MGL0wA1lZNBDBUOApoMZvf8VLpMK/jpNJj2g4DU0zl3/Zz+fnOue2pmWI6Abo4TPA4pdTegv0+pw6rX+m1gT6ILcIUijx9rj5TWne2o2tMadgbLPu8dN3X3npbtcFWeUvb3N9+2mvrtjbSeSnalV3Zw0/b47SFsBmgWixHV1y7WGdZx6B0beRSmzuGvZt5i90Mtr29e5r//Ay2zd/GVathBtuqmbphL1RtsHU9E6s86MoJVrVoADGU1GdD0dbSbeVUC7CttL3Br9EAKjiVP6cpWyCDbfaMziyQwbYzC+Xvu2yBDLZdNlXLHlhtsDXsa2KPiVDFElmNanxrqZqoRbE1/N/KqdnAllJrhQThHFbPEKucUwbb7AM9s0AG257ZLZ81BQtksM1u0ZkFqgW2xXJWN998cyhgFE4xnm3Xhu2svPXyPZAzAQ7ciqGl6IkVbtXUbGDLX8VY+23lCTG0OWWwzT7QMwtksO2Z3fJZGWyzD/TAAtUC26JoRVyk/xt92aNmqksPXOdbpzQb2PbWHq10fg5FaKXW7lldM9j2zG75rAy22Qd6YIFqg20PiphPaQALZLBtgEaqUBEz2FbIsE2UbQbbJmrMWlclhyLUugXq//oZbOu/jRqhhBlsG6GVKlPGDLaVsWsz5ZrBtplas8Z1yWBb4wZogMvXEmwtg+SlaKKOZZr8WObKMmB2lvKd9VwbffWEBnCDXhexlmDLfyz/5rckxMUatDaraPRwlyk1jHtDKscSYpY6s5OaNZ7tljbTTDN12xcy2HbbZC13QgbblmvyylU4g23lbNssOdcKbF966aXYhcsaoCZfARObClgc345j1113XWy6YAtSW5HmVN8WqBXY2lDBRghgz2Yckh3VgJodw2yg0EwJiF500UWxxrLdznqbrLNrtzQbjbCXHfu6mzLYdtdirXd8BtvWa/OK1TiDbcVM2zQZ1wJs7cZk7dctt9wydhSz8L0NCCwBZnvUvfbeO7axPfbYY+O4Ke361TQN0CQVqQXYfvzxx+n0008PpdHucDPPPHMotLZP9rnP+FczJRMW3T9+23Wvt0k+X375ZdyLduw7/PDDu51lBttum6zlTshg23JNXrkKZ7CtnG2bJeeOwJY6RP364osvYhvX9nbg6o4tPvroo9j2dP311w9wLd19zIL4FDgqm9/UWj/lAlvqlHsCAJWjLt2pd7Mf2xnY2m7YVra2lwWivU3CDs4444x0//33p3PPPTfNNddc38rStsxST4bWe1u2zs439M9etuntSZrSLns9yaf0nEGDBqXFFlssHXbYYd3OKoNtt03WcidksG25Jq9chTPYVs62zZJze2ALMoUDHHTQQaGA7bjjjumUU0751rai3bWBF/JZZ50Vu3VZ+L6jNWw/+OCDgNr9998/tqsVqjDddNPF9Yu4ScOx1CZlFZ8rHhew+t9QNJgS6mCI2rUfeOCB9MILL6RNN9004hNtyVvkBXoBfLFtrXVL5S3fGWaYYYog7DrW5LXRhGPFAoM2scPy8r3/wfvnn38eZRBDLPYT3PhffZSx0VNHYMtGwMmav8suu2y64IILer3hwe8//TStvvrqafCQIbFJRkcdFXZmb20LiL/33e+mGWacMUzuu88++ywB4dlnnz3+9pm/Hc/3jSbobPE/9XzooYdS3759Y23bwseE0/Al/zvG1sd+/A38+IBjfH/OOeek+eabL6222mqTY4F9zsdd23lF/Cw/9rnOmLLJQ1lt52wdaN/pBBY+rn7K4Xx5+d71Jfny+aLeysZH+e3gwYNjHWYhCd1NGWy7a7HWOz6Dbeu1ecVqnMG2YqZtmozbA1tgNnz48HTZZZdFXalLv/rVr9Lyyy/f47p7eQ8dOjQA56mnngrAay8BW/F+IBQoiscFhXvuuWeac845ExCl1gHGWWaZJbY+Bcorr7xyuuOOO9Lbb78dat1vfvObtN9++wWcHHLIIQE46667bpp//vkjlrdYeN+9cu2110Y4xK677hr1vfrqqyNPAAFASxOoFpt49fir04YbbZhuv/32iA/ebrvtom6AwQL/SyyxRFpjjTXS+PHjky14d9ttt9SnT590yy23pA8//DA6DD1V7nrcEBU4sSOwvfjii8OmEgClsBb/97Qo4mr5xvnnn5823njjdrMBemK12d6og3K+8NvfpuVXWCF8WRvYOc5xwhYA4zPPPJMGDhwY8Ell1o5A0QgDqLUT2aGHHho+paOkU6Ms66yzToxwnHfeeaF+brPNNumNN96IjTzee++9dOaZZ8ZW0vzRsYsuumiEE+iQ3XjjjeEHAJgv6wgAax1B9wnQdu5WW20Vx0qXX355lMc9DPIlZXWfDBs2LMqi7qBYXsqw0UYbBRz7HCC7Nvg96qij0tZbbx0d2e6mDLbdtVjrHZ/BtvXavGI1zmBbMdM2Tcbtga2X1YknnhgvfWC5zDLLpGuuuSZ2DOtp4o8mqACBO++8s8PdnIDtkCFD0rbbbhsACmANPW+yySZpww03DGBQPn97OYs7BC9HHHFEbNkLUpwPom2HWkACuFYGL/ciJlN9fG/ymvOpcQBVnrbKLT2uqDubXHXVVem0006LSTwAFoAABsoeSACv9913XwARQFJePz/72c/Sww8/lP76169DtaMKN3rqCGy91AAVgKJ86izZqa03acKECdHxMZFKaEt76fnnn48RAj9AUjvzPe3Mn6nx++yzTyipJ598cgDs9ddfH7Hdt956a8AtxVn5jWDo4IjdPe644wKUwa3P1UnHj+/ovOhsHX/88QHMl1xySRozZkwA82uvvZZ23333UJmXXnrp8N2xY8em1159LW23/Xah9FO0gTXfAJrKpvw6SwAX7ILScePGRSdK0gEDxMccc0yor8DYCAs/dS+4n3UCdthhh1BtlYcvyu/999+POgFxwN7dlMG2uxZrveMz2LZem1esxhlsK2bapsm4oxhb8bBXXHFFqJ+UVrGuvVk+icq629Ch6blf/zo99thjHSq2XraULUOjoNHL89RTTw3I3GWXXQIknjbRbK+9ApABy39873tp9jnmCJAQK+g4yhWFl8J64YUXBjjId0rD/4ZurdYADEAF+DF8K2/Kr3MdA4ZADbiWF0AAzyAHDPsOPCgHBVi5wauwCiC+wQYbpIkTJ6Q11lizLEs21YMzdgS24O62224LJX3AgAFRf8tx9Sb9+rnn0rrrrRewxqZTStqNOjxp0qToZBS+C7B1WHbZeec0fN99o52tqqDjJPFNZQSh2lq7KveoUaPiPPHh1P0ilMa5Rgo233zzmHxlVAHYHnnkkZEftd5kNhDqmQwuAeuqq64aijEQHr7P8NRnnj6TwyVc14iDsAX3n7IV5dfZBOxXXnllHM+3QC+/XXDBBcPP2Bfwg3+rivBbx+p0CfGhKFOei6QjZsTh6KOP7nazZLDttsla7oQMti3X5JWrcAbbytm2WXLubFWEck9U8aIGnV7y1LC2icJkONaMdy9/YFsoY2effXYoZhRXapj4R1BZxA3Ky8vbjzAFQ8KgxDXFIPof1LQHts4H32CIGksZM1wtP/9T7gCyvID+u+++G3CgLL/4xS+iKgDDcPajjz4aqprhX+ofJfDSSy+N2F/hB/JaccUVm0KtVe/OJo85hi/1pmNU6iviTddcc81QGYXMtI2x1WbKpO2BqnCAIlFADd0DP0PwAFRbUTElnRHhDa+++mq0G3BzrJEAAEtNFaZS6r/CVZZaaqlQTPfYY48IKygmYgkZGHP22emJJ58MnwWg/HqVVVaJUQKgS/kHzaWJL/FFnTxqcpH4vI4Wn5SMgAiz4VujR48OIOan4pmBPz8rEgjfeKON07bbbRv3UZGMUIhlp0R3N2Ww7a7FWu/4DLat1+YVq3EG24qZtmky7gxsy11RCpX4SrDq5U6ZKpIX9IP/GzO4wvLLB0wAWz+GkP3vpQ0qhScYigYDhluLZY/4Oyh+7dVX0zLLLhsKq2uIZ6TAgRywQ9Eq4ntLQQtUAwYKsNjJu++6Kx1y6KERj1uAmd/FORTbESNGRBmEFwA3MY/UPJ8bejbsDXYoeBRmw8wURhN12s7kL7etq5lfV8C2nOWhAgtD0IGhuBYdi+IalHOdGj4FWKmbxWoMQlaEQoj9BcfOB5wgsADbDTbcML3z9tuhfOrsUGx1YgqwFS9bgKhO2Pbbbx9+JV/HsYdjnOv6N9xwQ3r44YcjpAbIUnYtrwXQ3Q/81nGglK8rjxUklEmIAcW3SDpSRhaMpuiouS/cx+wBtsWjg2yx3a5BtRV6435wvI6W+9CoRzFJTewuHwb63U0ZbLtrsdY7PoNt67V5xWqcwbZipm2ajKsNtuAPEBqe9bKlKoFVYQ+GiylNYBQgUo8Ag5eulzIAoYSN2Hff9G///u/xErberZe3PIAAdcp5QgNWXmmldMekSaG2GY4VU3nTTTfFkLFYYSEOhdInf7GS4HPobrulGWeYIcIYhD5Qw7z0SxPVTwwmSDCUDCQWWmihUNYohMAWHN92661p0802C3UMaKkb+KAaly511ugOVW2wZS8TASmxFE1+xK5AEtSCNh0KQ+6gVvvqUGgDPgAgtQko1SYA89TTTks/mnHGAEbnXj1+fFp5lVWis0NlpbSDUr8p+fxSZ8gKH/IThwuE77333ojbpewKDeCjN9x4Y7ri8ssjnIe//GTWWSOUgl9S/sXcUkx10oQL+K3TJ4zF9yP32y8tMP/8UX5+bySAmquup59xejpg/wMiLyqz6wlXuPnmmwOI3Rf808gGMFdmqrLPBvTvn2b83xUd5Okecp4OV3eU9Qy2jX73Vr78GWwrb+OWuUIG25Zp6h5XtNpgWxTUyxCQmCQGEv0vnhWIUDfFNxo2BQoUU0oTIAaiAAYUAxuzwA3rOw80OB4ICAfwchY3aBUCEEm9AwKGqR1fuiuV64MCYDTHnHOmH0w7bVzP/2Iplak0gQNKmnJZLgmMiOVVJ3AMaIAK6DFBiOosgSz1aTvs3OMGrJMTawG2qm64nrpZtAXw8xn7Az1to7NkyB/EUuoBHHjjE56R1EsdLoouH7SagDz8rQ2dB3z5lrY0YqDjstA/46p//KMfxZJvRUeFmgwu5cvPJEty8UPn83nqrc4Vpdl1XMPEQ9cFzY4VWiCPWIJu2mnTLDPPHHWRl+PANP9zH4Bgx/nf3zpZjlFvYTFiysX0KqeYXB1Jn7tHdAKVV7kp0zpz3UkZbLtjrdY8NoNta7Z7RWqdwbYiZm2qTGsFtk1lxC5WBnQZJgZcAKeZUq3Atto2BLibbbZZKPW9Wfqu2uWu5PUy2FbSus2Rdwbb5mjHuqhFBtu6aIa6LkQG2+o0T6EqggDhEh2t4VudEpX3Kq0CttTRzTfbLB1+xBFNt11vTz0ig21PLdc652WwbZ22rnhNM9hW3MQNf4EMttVpQissCFOwBJlh8u7EMFanhL27SiuAraF98bYme4nXHTxkcJpzjjmbZmWLnnpABtueWq51zstg2zptXfGaZrCtuIkb/gIZbKvThGIaxXEWMY7VuWr1rtIKYCuUxPqxOija8qdz/zT1XbJvU00C7InHZLDtidVa65wMtq3V3hWtbQbbipq3KTLPYNsUzVjzSrQC2NbcyHVagAy2ddowdVSsDLZ11BiNXpQMto3egpUvfwbbytu4Fa6QwbYVWnnKdcxg27pt39WaZ7DtqqXycZ1aIINtpyZq+QMy2La8C5TFABlsy2LGhswkg21DNltVC53Btqrmbu6LZbBt7vYtR+1qBbbW7bSNqbVkrcdZrclU4iRjXdBppvkX83lBv/LKK+ntt9+OheyVK6euWSCDbdfs1JujrM9sNY3S9Zd7k1+5zs1gWy5LNm8+GWybt22rXrMMtlU3ecNdsNpgyycn3DghfX/q78ei8XfffXcsUj98+PCK286EH7tKPfDAA7GdattkKacLL7wwdi674447YlmunLpmgQy2XbNTT46yGoMtec8+++y05557pq233rpqHcGulDeDbVes1NrHZLBt7fYva+0z2JbVnE2ZWTXBllJ63nnnhVpqi1IqxNT5RgAAIABJREFUrW1nr7rqqnT88cdPtq8dkCq13awdqqwp297i+nZ6WmONNQJ8M9h23eVrAbY6KlK11P6uW6P8R9pxbOjQoal///6xrW891TmDbfnbu9lyzGDbbC1aw/pksK2h8Rvk0h2BrV2W7rnnngDBtdZaK7an7U2yPe1ew4alPvPMkw455JDICsRaPsnWpRJ16uGHHkr9+vfvzaU6PBcQtQcGtjFdffXVQ7nNO0t1vQlqAbb80rbLtlhuhsQv/djydkrpwAMPjO1vM9g2Q2u3Vh0y2LZWe1e0thlsK2repsi8PbD929dfpzHnnJOOPfbYRJERc3r55Zen2WabrVf1HjNmTDrqyCPT0N12S3vttde/5OcBOG7cuDR69OiAzx/84Aeh3r733nsJaP/whz8MCPYZFevxxx9PiyyySPriiy/i+Lnmmit+O/6rr74KcJ533nkj7EESPztx4sQIfSiF288//zwBb2mdddZJF1xwQVp22WWj7i+//HKyDq2NFeaZZ56Kqcm9MmyNT6422GrXsWPHBgRuvPHGaeqpp07TTjtt+IS20m4gkT/4vOhEGSHgw19//XWi3vv+pz/9adL+Tz/9dJphhhnSEkssMXlnOPmJB1c//jLnnHNOzk+efOyTTz5JX/3lL2nmmWZKs8wyy+SWcN4HH3wQ/sof+el3v/vdKN8bb7yR+vTpk+aYY47IV4fqlltuSWuuuWb4l1hwefH/Iu2///5pscUWS5tsskl65513IgbcushCaJSfLdR1qqmmivh1vx1Tmkcl3CQrtpWwanPlmcG2udqzprXJYFtT8zfExdsDWy/KYcOGpauvvjrqAQauueaatOqqq/aqXgDhl7/8ZcS6goR99903rb/++mnGGWcM0BgxYkSA5LbbbhsQue666yYPRUDqpf7cc88FiHi5T7jxxjTussvSoEGD0vnnnx+hA4ceemi6evz49J2ppkqLL754Elrw0EMPpT322CP96Ec/SgcddFDkJc5WUs/rr78+/SP9I80008zpt7/5TeQFfhdaaKF0wfnnp5lnmSUg4bFHH0v77b9fAElO37ZAtcH2/vvuS8P22iugcckllwwgpGby0emmmy5GF1599dVo6+222y46N7feems644wzItSE0msylu932mmnAGHAed9998X/O++8c8Ch/HSmfvazn6VXXn45vf3OO5EflRiMXnvtteEP008/fdwrQBMcu8YJJ5yQZpxhxvT5Hz9PDz74YJowYUL685//HOXy27131FFHhZ/tvffe6eGHH468Pbefeuqp9OMf/zgdcMABaYUVVghoHTlyZJQFrNoo4rXXXksHjxoVZTto1KiAevmp/+mnnx7lcA9XerJZBtv8NOjMAhlsO7NQ/r7LFshg22VTteyB7YEtxUg8LMWWGkrFBHxgtLeJWmZyltjaJ554Im2wwQYxYYvq5poggBpH3XrppZfSwaMOTocdflgoT88++2yER5x66qnp9ttvT7aqBcdiDyld9957byhf1OVCqTLpxvXEzXrAXnbZZemuu+4KmKEMqys1zIzzRx55JKD6uuuuCzVt1KhRAc6rrbZaQDIVDSDnVFuw1SE57LDDQkUXr63tQCjgO/zww6OjRE3lJ449+eSTYztcITBbbbVV2nzzzUOh19HhN6eddlrkwe/4hvbnQ1PKj0J6yimnhK/ddNNN0VEDoVR+Iwibbrpp+A7I5NOg899SilED+Qol0Dnjtzpfyu8+OPjgg9PRRx8dijHwFXdO9T3zzDPjvgOpFFnnuZ77EZgfc8wx0eHzW5n5KB8fMGDA5BCfSvprBttKWrc58s5g2xztWBe1yGBbF81Q14XoKMaWInX//feHgkSp/fnPf96rSSulMYQmkn380Ufp+l/9KqBWTKsh5YsuuijAFaRIwPPXv/51vPANP4MRyhQFznAuGPBCp+ZSDSmz1DSwUSQK8EYbbRSzyp0PhsHL66+/HoqYn2KimHAHYRcgZZlllgnQMSPd9XbZZZf4rFIT2+raUTopXLUVWz6g00GtNKlKu2p7Pgr8dIokyjtApJbyPx21IUOGpOWWWy78iarKF4844og4/rbbbgtf1ObyFT4gvyLu9eabbw5gtZqHkQDHyx9Ijx8/PkDYqAFllWrqHuKLABdg6xwZ/XjrrbcCuim7FGK+LIYWMBcxw08++WSAuPyXXnrpUGxBbxFjO2nSpABr38sfIO+4444RG65zaLSjsEMlfSuDbSWt2xx5Z7Btjnasi1pksK2LZqjrQnS2KoKXvtTehJbuVI7SJdxg0UUXnfzCBSiGXw0jgwsqlDABkCABES94L/C2iZpLnTvyyCMDQL788su06667BuSCiyIZ+h04cGCAhiTOV71ByH777ZdOPPHEtNRSS8V31OmVVloplONVVlklgMmQL9gRpgC0F15kke5UuyWOrQXYAkFLxQFQowAAUTvus88+EToiAVE+4rfPdIKAoY4M3z7ppJMCeIvJjJR9nZpf/epXafvttw8ALo3HBrJUXi9qvsKXXFfoA/+iwAqtkfjK7z75JB1+xBGTY7xNlOTbwgvAM18F2u4LHSzK8vzzzx/n81tlN5qgQ8VX+/btGyMKEh9WHp0+YQeUXXbYcMMN4zcIrkbKYFsNKzf2NTLYNnb71VXpM9jWVXPUZWE6A9tyFtqEF6qp+EVKm0kzgGi33XYL2Fh77bUDKu78z/9M14l7/cc/IoQAuAAIqxWAEyqYcAATcwAJsAUI8gPGYhWBKBWLKif20f/iIQ0Vg1ZqlxhKMb3gyG9DxRTbfv36RTmotEAErABwyhjoBcn1tNxSOduop3nVAmyBIAjcfffdo50Nv1Ph+QTQE2LC3yj2RgK0JfUUSOq0WIFDm+q06QhpU3G4fOXGG29Ml1xySSirlGH5gUWw6hrnnHNOjGQAYD4DPMW+ivel6CuPkQGhBK5piTuKLUUWVAttAcxAXHnE97oPKMjy4PtGS4CregovALZgFXArs1CcO26/PR1z7LFRvmeeeSbK5z7acssty9IZ7Yo/ZLDtipVa+5gMtq3d/mWtfQbbspqzKTOrJthanoli5kVIdTJcS3UFjf4X42iI18vfS3/22WeP2EKAQXETImCiDqgFBgB27MVj0xaDtogXvnhLeYNSE88A6e8+/TRe/uutt15A0JVXXhnXoNSZtAMeKF3yo/oCCkO+VmwQowhcQMscs8+enn3uuVDaCkWtKR2ih5WqNtgCR50Yarr4b20v/hSQil/VtlRQar8wFCEKhufPPffctNqAAWmLQYMCJs8688xkNVz+ZoWEcZdemm6/444IN+Br2t8ENSMK8jOpiyIqP6MIQhwshedY/jzzzDMHhAotENNtFIFv8y0jFqCbH/PN6669Nv35v/4rru0cSq9wF+ALyoXgCCtQF51CIwvuByDseKuHqB/gdYz765dH/DKtsuoqaZtttulhS3b/tAy23bdZq52RwbbVWryC9c1gW0HjNknW1QRbQ79UVksfgVnxfyZ4gZJiOS4Tfn7729+m//7mm/TTueeOWeaOpUZRxmaZddZQWL//H/8RahpYoMyalS52UZ7FjPdiTVBqlu8c+/5776W//HMpJSDjGEO+Zsg7zvUABaimKoMfQ86gG0yYYV6OsIwmcZ/J1ag22Lowxd0WyIBWXCqw5CNUUr5GOdUJApvUWIottV9bAlHQ6TPHam+KKzWWD/pbnqX5GS0QSys/PmDiFoWUX7kOwKPqGn0QmiCeln9ZpcBkMuV58cUXI7xF58jx7gVQ6m8xsjpVzlUm9eFz8gCtyqoeQNt3yuo8sMtv/U1xBtHukWqlDLbVsnTjXieDbeO2Xd2VPINt3TVJ3RWommBbWnkv7gI8pzSsP6VNFDraWGFKhnUNeXclbKB0FyvnlcJrOeOM684BylSgWoCtorfnE91p+85MUEx6LPUl+QtxAcBUVf5CRbZcmHAXIQXdScBViI6YcmpuT5IOnZUfQC0Ar1bKYFstSzfudTLYNm7b1V3JM9jWXZPUXYFqBbZ1Z4hcoF5ZoFZg26tC9+JkKr5JasIATIYEvWJ2H3vssRhd8F13EiWZ0itUxwoI3UnAm5pr1AFwiwOv5qhCBtvutFZrHpvBtjXbvSK1zmBbEbM2VaYZbJuqOWtWmVYDWxBrHWa/TQATUiOEQWytiYzd2ebXeWK9xdAKRxAT3J21koXqFEuMWRVEWEI1Uwbbalq7Ma+VwbYx260uS53Bti6bpa4KlcG2rpqjYQvTamCroQCpGGwhCOJ2xeACXPGv3VFMgaFYYTG/zrcah3jvriaKrXhb54LaroTedDXvrhyXwbYrVmrtYzLYtnb7l7X2GWzLas6mzCyDbVM2a9Ur1YpgW3Uj1+kFM9jWacPUUbEy2NZRYzR6UTLYNnoLVr78GWwrb+NWuEIG21Zo5SnXMYNt67Z9V2uewbarlsrHdWqBDLadmqjlDwC21uq0gH1O2QI9tUAG255arvHPy2Db+G1Y6RpksK20hVso/wy2LdTYPaxqLcDWDkwm2YgpFJdoVnl3licSU2jb3UceeSQWtXd+d5IZ7S+88ELs8GQN3Jx6b4EMtr23YaPmkMG2UVuueuXOYFs9Wzf9lTLYNn0T97qC1QZbOyjZ+tSSRCbZXHHFFbGpwumnn96tugDbgw8+OJZVGjRoULcmzNitaaeddordzOxQllPvLZDBtvc2bNQcMtg2astVr9wZbKtn66a/Ugbbpm/iXlewM7C1lJC1Mc367m0ye9ySRhaQ33TTTSO7Tz75JLYetVxRd5LF6EeNGpVWXXXVTsHWdSU7P0mWaKLaUom7M3u9O+VrtWMz2LZai/9ffTPYtm7bd7XmGWy7aql8XKcWyGDbqYla/oD2wLZY9N0WnRaPX2eddWK9zgIOe2I4W4lSWG1/e+CBB6Yf//jHAc12Xeru2pvCGIDtaqutljbffPMOi/P4E0+kGaafPrbILRKwnWaaaUIt7koCxwUEFzumdeW8Vjkmg22rtPS/1jODbeu2fVdrnsG2q5bKx3VqgQy2nZqo5Q9oD2y9rE477bR0yimnxHqdK6ywQrr00ku7tfB8W+MCwuuvvz6gdpVVVkm77LJLbEdaqgY75qmnngqYBpILLbRQmmuuuSLU4Ouvv54cmwuOhS8A7s022yxUWHGzTz/9dJp+uunSRhtvHBAu9GH48OFpzTXXTMsss0yEHgDpsWPHpv333z/NMcccUcxf//rX6bPPPkvgW9wvJbiAXra47bbb0oILLhjbpVq7dMCAAVGHnP6fBTLYtq4nZLBt3bbvas0z2HbVUvm4Ti2QwbZTE7X8Ae2BrQlee+65Z7rmmmvCRrPNNlv8Dfh6k4Q2jB8/Ph122GEBo9tss0065JBDJqu3N910U3rzzTdje9G33norgHKvvfaKSV5WbqCygmEPyrPPPjvAG9jee++9cTxV9oADDgg1F8zKTz223nrrtPjii6flllsu3X777en8889PDz74YECzej366KNx3ve+972I+33vvfcibAKwHX744emOO+5IO++8c1p44YXTQw89lO6+++44D3jnlMG2lX0gg20rt37X6p7Btmt2ykd1wQIZbLtgpBY/pD2wBaDjxo2LvevFs4JEMNidrT47Mu1LL72UzjzzzDRhwoS04oorxrUow6MOGpXWXmftNNNMMwVc3nPPPWnkyJHp7bffDpgFm9Ra6uoee+yRNt1ss7TO2muH+nvsscem+eefP+22225p9tlnT0cffXTA8yKLLJIuueSSuI7kvqBA33nnnaECb7jhhrHkWbG6gvpSgocOHZo23njjKKeQjFtuuSVCJqjKffv2DdtYlSGnDLat7AMZbFu59btW9wy2XbNTPqoLFshg2wUjtfghHU0eA3iW1BIWsPrqq4dq25skThUwCz0QWvDnP/85FFWhCaeeemqac84505gxYwJITewCkN/5939P080wQ9ppyJC09NJLR1iBc5XNhDPqLfh89dVXo3xCD5y/7LLLpiOOOCL99a9/DWA1Qa1fv35RfKEI/fv3DzVYaAFApdhON910k6tn1QTq8Mknn5yeeOKJdOSRR0ZZQbUkFEG88CabbNIbkzTNuTkUoWmastsVyWDbbZO13AkZbFuuyStX4Qy2lbNts+Tc2aoI5awnfxTLaqmvIq5WTOu2224bgCoG9ojDj0jnnX9erJxQmizpBWyFCxRgK5xBaIEwA0A7adKkWJt29OjRaaFf/CIdethhyUt3scUWC8W2iIm1EgMwFZLw3HPPRaxtxOb+E1pdd8stt4z42+OPPz7gF0RTbIv1dp0PskF1TlmxbWUfyGDbyq3ftbpnsO2anfJRXbBABtsuGKnFD6km2IqBpaaKeQWxktUJdtxxx4i5NcwvjnXmmWcO5ZaC+tprrwXI3nXXXRHnet5550VcrFURDjrooLTGGmuEagoyQe0GG2wQ8blCDUAw1VdcLLDtP2BAXPPzzz6bHKdrghiIlde6664b3wt72GqrrSK0Qf5ian3v+oWqK1Rh2LBhcb2cMti2sg9ksG3l1u9a3TPYds1O+aguWCCDbReM1OKHVBNs+aNh/2eeeSbgVhwtNRSQrrfeetESvjNZrIhjtRLB9ttvH3BrkplJbZRXS4Vdd911EUs7YsSItO+++6ZZZ5014PThhx9OTz71VBo5YkQaOHBgxOg6b9111kl9+vRJzz73XLrgggsiBAIUC0248MIL09prrZ2+//3vp1tuvSXUYZPS3n333TiWWmtCWgG6J510UpTDtYuVFVrZlXIoQuu2fgbb1m37rtY8g21XLZWP69QCGWw7NVHLH1BNsGVscbUff/zx5OW8ZpllljT33HN/a6MEoEmptRKCVQ6mnXbaaCcq7SuvvBLHAtrf//73sQ4u+PU3eJWXlQ3E3Pp7hhlmiGv6XxiByW/+lywHBpCptiajuS6Adg5Ilry03Ueu4zjnO1assHKAczDc6imDbet6QAbb1m37rtY8g21XLZWP69QCGWw7NVHLH1BtsG15gzepATLYNmnDdqFaGWy7YKQWPySDbYs7QDmrn8G2nNZszrwy2DZnu1a7Vhlsq23x+rleBtv6aYt6LUkG23ptmQYsVwbbBmy0Khc5g22VDd6kl8tg26QN24VqZbDtgpFa/JAMti3uAOWsfgbbclqzOfPKYNuc7VrtWmWwrbbF6+d6GWzrpy3qtSQZbOu1ZRqwXBlsG7DRqlzkDLZVNniTXi6DbZM2bBeqlcG2C0Zq8UMy2La4A5Sz+hlsy2nN5swrg21ztmu1a5XBttoWr5/rZbCtn7ao15JksK3XlmnAcmWwbcBGq3KRawm21qq1vFYjpUYsczXsm8G2Glauz2tksK3PdqmnUmWwrafWaPCyZLBt8AasQvGrBbaA8NNPP431ZK1Ha/taa9H6sb2utWXt+PXRRx+lH/zgB7GlrvVk6ylZ59aWwHY1U8ac/s8CGWxb1xsy2LZu23e15hlsu2qpfFynFshg26mJWv6AaoPtrbfemo477ri0+WabpWF77RUbIRRg+9hjj6Urrrgibb311rHlbb2Brc0hrr766tgZzcYMOWWwzT7w/zYxWXvttWPb6vnnnz+bJFvgXyyQwTY7RdkskMG2bKZs2oyqBbaFAam1m266aSie48ePT9NMM81k2z799NPpqaeeStttt93k3cZqaXgqsx87jEnffPNN+utf/xplLj6rZfnq6dpZsa2n1qhuWTLYVtfejXi1DLaN2Gp1WuYMtnXaMHVUrPbAFtC9/vrraezYsemDDz5IO+ywQ1pttdViG9repokTJ6a99947XXvttWnFFVeM7P77v/873XXXXRGiQK0Ve2vbWuWwlW1pLK7PQSa4tH1u8Z1j5WP7W585rzQ5x/c+bwumxXc+9728bOtrq96ll1568mdCJmzx6/siuZbz5C35n52UQ75SaR18/re//S3yoFY3AyRnsO3tXdG452ewbdy2q1bJM9hWy9ItcJ0Mti3QyL2sYntgC1SOOuqodOaZZwZgLr744umaa65JP//5z3t5xRSq53rrrRcA+8tf/jLgjpJ79913p+WWWy7NMcccAdMvvPhi+uD992N4c+WVVw5g/PDDD9MzzzyT/vubb9Ifv/girbnmmhGnq4wvvPBC+uqrrwIq//jHP6Y+ffqk+eabL0011VTJvfD888+nd999N80yyywxdAooweVvf/vb9PHHH0cM8Oeffx5lo8qecfrp6a9ff53WWWed9NOf/jSxCZX54IMPjuNffPHFKPsiiywSIRXUZtdX3nnnnTficf0PeKebbrqwoXIKufj6668jnthnSy65ZMPDbQbbXt8WDZtBBtuGbbqqFTyDbdVM3fwXymDb/G3c2xq2B7ZffPFFGjFiRLr00kvjEnPOOWe64YYb0rLLLtvbS8b548aNi59zzz03LbTQQgGcwHT11VdPn3zySRp7ySVprbXWSi+/9FLE7ikn1fPss8+O2NtVV1klPfDggwGFffv2Tffcc0+6//770xZbbJFmnHHG9Oabb6YJEyakHXfcMc0999zpnHPOCTiWt2uK5Z1rrrnSgw8+GHXcddddQ0WlJgNbQAxgfzTjjGm9gQMDVF9++eV0xhlnhNIMUEE/9fXAAw9MM888c5QRGCv3s88+G8Dsb/mefvrpafjw4QG04PiQQw4J8HX++uuvH8pzI6cMto3cer0rewbb3tmvFc7OYNsKrVylOmawrZKhG/gy7YEt4Lr99tvTPvvsk9555510wAEHpCOPPDJ9//vfL0tt33vvvQhvEE87ePDgdP9996WZZ5klLbroouniiy9Of/rTnwIE33jjjbTGGmsEKIrLPeKII9JvfvObdMoppwR8FiEAgHbDDTdMu+yySyi7XrYmqflbuAPwPemkk0Il3WabbeJ8yqqQCIrrqFGj4liABqCprKeeempMEtt5553jM5PHXB/cUpUnTZoUUDxmzJiAaUos9dh3m2yySZR7wQUXDDWamrvBBhsE2I4cOTIdf/zxad111w1bUn0bbdmztk6QwbYst0VDZpLBtiGbraqFzmBbVXM398Uy2DZ3+5ajdh1NHgO3hudBi6F4Q/rlSgAPaIpjPe200wKit9122wBI1wOsVFxACqippT/60Y8CdA8//PBQQ8GjFQqopyuusGK64MILIsRAEmIAkO+444503nnnRSgAqH3ggQcCWKnFPtt9990DXF27NAmXUD5K7NChQ6PuwNa1qa8UbPkNGzYsDRkyJJTmRx99NC211FIB1eJyhVYAW9Ba/Kj36NGjQ7WlAh922GFpiSWWyGBbLsfK+VTdAhlsq27yhrtgBtuGa7L6LXAG2/ptm3opWbVXRSittzCAQw4+OA3acsuIrS3CHAzdC3vwWxgBVVeYgrhXSq7fDz30ULrwwgtDBR04cGBae6210/4H7J+23HLLuATYpaxaNxc4P/zwwwHKCy+8cIQYgEtwuscee0ScKyW2SMXktBNOOCH95Cc/mQy24NpxBdhSdUEzWAaoYHiZZZaJCWdgVajCZpttNjmWV74mn0099dShggNvUEC9NWmukVNWbBu59XpX9gy2vbNfK5ydwbYVWrlKdcxgWyVDN/Blagm2/JPiCggvv/zy9MMf/jAs+fjjj8cat5deckmszEBRve2229Jss82WHrj//ph0Nu9880WsK1V5q622SuMuHZfefe/diAsWFkDZpbgKTxCyIIYWQIJl4QfHHHNM5KP+Qgkc63+xuSZ8UV5PPvnkgFIhEaDUBhJiYx0vTyqs44U29OvXL+BWHayEsO+++waMC+UQB/z2W2+lGX/0o1B5gcBGG20Uk+DE9ApNoEY3cspg28it17uyZ7Dtnf1a4ewMtq3QylWqYwbbKhm6gS9TS7AVLmDDAyApNrZI4mnB59prrZX6DxgQS45RaUEldVS8av9+/dJ/ffVVWmWVVUJ5BVZiXq2G4H8rFiy+2GJp5VVWCaV2zz33DGUW6IJJgCnEQYgF1fXmm2+O1RIcI/ZXrCxV2MQ1qrHdxqi/wg2EGQBloQzqILTBqgjOKxLVlmIsD0AOZKnL8rjgggsi7teEMaEK1N1yLKNWSzfMYFtL69f22hlsa2v/Rrh6BttGaKUGKWMG2wZpqBoWs5Zgq9piTiUTqEoTZbVYixY8+t8x/naO2F8w2XY1gT99+af01V++iu86yk8epRPhALHQAmpv6bqy1GTxtUV8seu3neglL5+3nVjnM6ETzi3diMLnwNp6uI0eglDYOINtDW/iGl86g22NG6ABLp/BtgEaqVGKmMG2UVqqduWsNdjWrub5yuW0QAbbclqzsfLKYNtY7VWL0mawrYXVm/SaGWybtGHLWK0MtmU0ZgtnlcG2dRs/g23rtn1Xa57BtquW+v/bO3schWEgCnsLSnoOQEvOQMkNoKOEC1Cm4CZI/ByChpYWLkADLRISPatnCRTtsiQbOZGc+SJR4Uzsb0b2I0jzGJdLAGGbi8j8AISt+RIIAgBhGwRjlEEQtlGmrdZJI2xrxd3shyFsm53fEKtD2IagSAyErd0aQNjazX3RlSNsi5JiXC4BhG0uIvMDELbmSyAIAIRtEIxRBkHYRpm2WieNsK0Vd7MfhrBtdn5DrA5hG4IiMRC2dmsAYWs390VXjrAtSopxuQQQtrmIzA9A2JovgSAAELZBMEYZBGEbZdpqnfS/hK0sH3u9nm/8rd6IXBDIErher242mznVifp6UiPUR5aA+rFut1tvXyvTAOqD+ihLQCYbaZq68XjskiQpG4b7IiSgPs6DwcBbRHe7XfaRCHNY5ZR1zux2O7dYLNxyuXw96uvx5sSRxeN8Pvf2jXLCUXNxLgg8CaiY1Bx+vV674XDoG88jXKiPLAEZERwOB7ff791kMvH2tFwQKENA589ms3H9ft+7ubHXlKEY5z0yT9HLk+l06jqdDrmPM42XxrcpAAAArUlEQVSVzVrnzPF4dKfTya1Wq8/CVoJW/unn89m72rCRVJaXaANLqMjaU+5GckWiRqJNZSUT148f/YV8v995o18JYVtBtde02+1fLnK2KNhbrc6Vy+XiLamf7oD2KLDivwjonLndbv5Hz2g0+ixs9a3e2r6zeAQxBJ4EJG5VWD9tQCEEARHQ/qFP1kYWMhAoQ4C9pgy1ZtyjN/baQzhnmpHP0KvQ3qD6aLVar9Df+4TxhW4U8OcAAAAASUVORK5CYII=\" width=\"694\" height=\"313\"\u003e\u003c/p\u003e\u003cp\u003eWe summarized respiratory care resource availability at each site by analyzing responses to the Global PARITY Hospital Resource Survey, which asked about the availability of all resources included in the bundles. A resource bundle was considered available at a site if at least 80% of the individual resources included in that bundle were reported to be “always” or “often” available on a five-point Likert scale. We reported the highest resource bundle available at each site; all bundles at or below the level reported were also available (e.g., sites with the advanced bundle available also had intermediate and basic bundles available). We summarized resource bundle availability by patient, site, and SDI. Pulse oximetry was defined as either portable or continuous oximetry. Intubation supplies were defined as laryngoscopes and endotracheal tubes. Sedation was defined as any of intravenous opioids, benzodiazepines, propofol, or ketamine.\u003c/p\u003e\u003cp\u003eWe reported resources utilized by patients during the first seven days of hospitalization as reported on the Global PARITY case report form. This included the highest level of respiratory support utilized by the patient (i.e., invasive mechanical ventilation, continuous positive airway pressure [CPAP], bilevel positive airway pressure [BiPAP], high-flow nasal cannula (HFNC), simple or low flow oxygen, none of these), whether a chest x-ray was obtained, if the patient required continuous sedation longer than four hours, and whether the patient required vasoactive medications (e.g., epinephrine, norepinephrine, dopamine).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePatient population\u003c/span\u003e\u003c/p\u003e\u003cp\u003eIn this secondary analysis of Global PARITY data, we included only children with hypoxemia, defined as those having an oxygen saturation \u0026lt; 88% and/or receiving any form of supplemental oxygen within the first 7 days of hospital admission, or experiencing death in the emergency department with an oxygen saturation \u0026lt; 88% or while receiving supplemental oxygen. This oxygenation threshold of \u0026lt; 88% is consistent with the threshold used to define At-risk for PARDS from the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2)\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. We excluded patients with cyanotic heart disease (e.g., tetralogy of Fallot, truncus arteriosus, transposition of the great arteries, total or partial anomalous venous drainage, tricuspid atresia, undifferentiated “cyanotic” heart disease), as we could not determine baseline oxygen saturations.\u003c/p\u003e\u003cp\u003ePatient-level data included demographics, comorbidities (e.g., malnutrition), Lambaréné Organ Dysfunction Score (LODS) on admission, PARDS diagnostic criteria (e.g., chest x-ray result, PARDS trigger, highest level of respiratory support, oxygen saturation, mean airway pressure six hours after starting mechanical ventilation, fraction of inspired oxygen six hours after starting mechanical ventilation), and final diagnoses. Malnutrition was considered present if the mid-upper arm circumference was less than 12.5cm, the weight-for-age Z-score was \u0026lt; -2, or comorbid malnutrition was reported on the initial intake form. The LODS, a simple mortality prediction score developed and validated in malaria endemic regions\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, was used as a marker of severity of illness and calculated on a three-point scale using the presence of prostration (or inability to feed if \u0026lt; 5 months), coma (Blantyre Coma Score \u0026lt; 3, Glasgow Coma Score ≤ 8 or reported unconscious) and deep breathing. The primary outcome was in-hospital mortality. The secondary outcome was hospital length of stay (LOS) among survivors.\u003c/p\u003e\u003cp\u003ePatients were categorized into two groups: those with a PARDS trigger, defined as a final diagnosis of pneumonia, bronchiolitis\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, coronavirus disease of 2019 (COVID-19), sepsis, trauma, aspiration, drowning, or other shock\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, and those without a reported PARDS trigger (e.g., gastroenteritis, acute malaria, meningitis/encephalitis, status epilepticus, asthma). Patients with pneumonia, bronchiolitis and/or COVID-19 were collectively categorized as LRTI. Patients with sepsis and trauma were analyzed independently. Patients with aspiration, drowning, or other shock were combined to comprise an “other” PARDS trigger group for analysis due to a limited number of patients with these diagnoses.\u003c/p\u003e\u003cp\u003ePARDS diagnosis and severity were determined according to criteria from PALICC-2\u003csup\u003e22\u003c/sup\u003e (Table S2). Due to a lack of blood gas data, the saturation/fraction of the inspired oxygen ratio was used to determine oxygenation impairment. Children with a PARDS trigger, as listed above, were then categorized as having PARDS, Possible PARDS, or At-risk for PARDS. PARDS criteria included all of the following: an opacity on chest x-ray, need for positive pressure ventilation, and meeting oxygenation criteria. Airway pressure data were not captured, so we were unable to determine if patients receiving non-invasive positive pressure ventilation met PARDS criteria. In patients with an oxygen saturation \u0026gt; 97%, we were unable to use the oxygenation criteria for PARDS diagnosis as the oxyhemoglobin dissociation curve flattens above 97%\u003csup\u003e23\u003c/sup\u003e. Possible PARDS criteria included need for nasal respiratory support (positive pressure or HFNC) and meeting oxygenation criteria in the absence of chest x-ray results. At-risk for PARDS criteria included an opacity on chest x-ray and need for oxygen supplementation via any interface, without satisfying the criteria for PARDS or Possible PARDS. Minimum acceptable liter flow thresholds for Possible PARDS and At-risk for PARDS diagnosis were established in accordance with PALICC-2\u003csup\u003e22\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWe assumed that patients did not have perinatal lung disease due to the study inclusion criteria (\u0026gt; 28 days), and the fact that all were admitted from home with no documentation of chronic respiratory conditions in the case report forms. Chronic lung disease was considered unlikely in patients without pre-existing pulmonary diagnoses documented in the case report forms at the time of admission. If diagnosed with a PARDS trigger, we assumed that they were within 7 days of the clinical insult having presented to the hospital acutely. Case report forms indicated the presence, location, and interpretation of chest imaging opacification; the case report form did not specify by whom the interpretation was provided (i.e., clinician or radiologist). When interpretation assessing whether opacities were due to atelectasis, cardiac failure, or fluid overload was not available, we assumed that an opacification represented acute pulmonary parenchymal disease. To assess oxygenation, we used the data collected for mean airway pressure, fraction of inspired oxygen, and oxygen saturation documented six hours after starting mechanical ventilation.\u003c/p\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using STATA 17.0. We performed descriptive statistics to summarize site-, resource- and patient-level data, which are presented as frequencies (percentage), means (standard deviation, SD), or medians (interquartile range, IQR) as appropriate given the underlying data and data distribution.\u003c/p\u003e\u003cp\u003eWe compared differences between groups (e.g., PARDS trigger vs. no PARDS trigger, survivors vs. non-survivors) using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003eTo test whether respiratory care resource bundle availability was associated with mortality, we performed univariate and multivariable logistic regression modeling controlling for confounders – average daily hospital census (\u0026gt; 50 patients), PICU availability, and academic center designation – that were determined \u003cem\u003ea priori\u003c/em\u003e based on our hypotheses and directed acyclic graph (Fig S2). For these analyses, we categorized patients into two resource bundle groups based on mortality trends (intermediate or less, and advanced or expert).\u003c/p\u003e\u003cp\u003eTo test whether the presence of a PARDS trigger was associated with mortality, we performed univariate and multivariable logistic regression modeling controlling for confounders: age (≤ 5 years), presence of malnutrition, LODS (\u0026gt; 0), and site respiratory care resource availability (two groups as above). Confounders were determined \u003cem\u003ea priori\u003c/em\u003e based on our hypotheses (Fig S3) and a review of the literature\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. We reported unadjusted and adjusted odds ratios (OR) with 95% confidence intervals.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSites\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eOf the 46 participating Global PARITY sites, most were located in Sub-Saharan Africa (n\u0026thinsp;=\u0026thinsp;18, 39%) and Latin America/Caribbean (n\u0026thinsp;=\u0026thinsp;14, 30%). Sites were evenly distributed between the four lowest SDI quintiles: low SDI (n\u0026thinsp;=\u0026thinsp;10, 22%), low-middle SDI (n\u0026thinsp;=\u0026thinsp;13, 28%), middle SDI (n\u0026thinsp;=\u0026thinsp;13, 28%), and high-middle SDI (n\u0026thinsp;=\u0026thinsp;10, 22%). Eighty-nine percent of sites (n\u0026thinsp;=\u0026thinsp;41) were in an urban setting and 72% (n\u0026thinsp;=\u0026thinsp;33) were designated academic centers. Thirty-nine percent of sites (n\u0026thinsp;=\u0026thinsp;18) had an average daily pediatric census of greater than 50 patients. Sixty-five percent of sites (n\u0026thinsp;=\u0026thinsp;30) reported a PICU available, and 54% (n\u0026thinsp;=\u0026thinsp;25) reported a pediatric intensivist available during the weekday in the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRespiratory care resources\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThree sites (6.5%) did not meet the minimal requirements of the basic respiratory care resource bundle and were categorized as having no bundle available. Eleven (24%) had the basic bundle, 13 (28%) had the intermediate bundle, 16 (35%) had the advanced bundle, and three (6.5%) had the expert bundle available. Of all Global Burden of Disease regions, Sub-Saharan Africa had the highest proportion of sites with less than the intermediate resource bundle available (56%). In general, respiratory care resource availability increased with increasing SDI (Fig S4). In low- and low-middle SDI countries, HFNC and non-invasive positive pressure ventilation were each available at 13 sites (57%) and conventional mechanical ventilation at 14 of 23 sites (60%) (Table S3).\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePatient characteristics\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eOf the entire Global PARITY cohort, 763 of 7538 patients (10.1%) experienced hypoxemia while hospitalized and were included in this secondary analysis (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Characteristics of children with hypoxemia are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age was 1.9 years (IQR 0.6-5years) and 44% (n\u0026thinsp;=\u0026thinsp;336) were female. Forty-five percent of patients (n\u0026thinsp;=\u0026thinsp;343) were treated at a site in a low SDI quintile country. Seventy percent of patients (n\u0026thinsp;=\u0026thinsp;531) were treated at a site with the intermediate respiratory care resource bundle or less available. Of 430 children with hypoxemia and a PARDS trigger, the most common triggers were pneumonia (n\u0026thinsp;=\u0026thinsp;256, 60%), bronchiolitis (n\u0026thinsp;=\u0026thinsp;116, 27%) and sepsis (n\u0026thinsp;=\u0026thinsp;58, 13%). Compared to children without a PARDS trigger, children with a PARDS trigger were younger, had lower oxygen saturation and higher LODS on admission (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Respiratory resource utilization was similar between those with and without a PARDS trigger (Table S4).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of hypoxemic children with or without a PARDS trigger admitted to resource-constrained hospitals\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;763)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePARDS trigger\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;430)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo PARDS trigger\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;333)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMissing data\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years), median(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9 (0.6-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.4-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.2-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e336 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight (kilograms), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (6.5\u0026ndash;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.4 (5.7\u0026ndash;13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.3 (8.7\u0026ndash;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpO2 (%) on admission, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95 (91\u0026ndash;98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94 (89\u0026ndash;98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96 (92\u0026ndash;98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMalnutrition, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e196 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLODS, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eGlobal Burden of Disease Region\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSSA, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e267(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSA, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLA, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCE, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSLA, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSocio-demographic Index\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e343(45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e202 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow-Middle, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh-Middle, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eP values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 represent a significant difference in characteristic distribution between groups, calculated with a chi-square test (categorical variables) or Wilcoxon rank-sum test (continuous variables). PARDS pediatric acute respiratory distress syndrome; IQR interquartile range; SpO2 oxygen saturation; LODS Lambar\u0026eacute;n\u0026eacute; Organ Dysfunction Score; CE Central Europe, Eastern Europe, and Central Asia; LA Latin America and Caribbean; SLA Southern Latin America; NA North Africa and Middle East; SA South Asia; SSA Sub-Saharan Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOf the 430 children with a PARDS trigger, 369 (86%) received HFNC or simple oxygen and 54 (13%) received either invasive (n\u0026thinsp;=\u0026thinsp;27) or non-invasive (n\u0026thinsp;=\u0026thinsp;27) mechanical ventilation. Only 25 (5.8%) patients had sufficient data to consider any PARDS-related diagnosis (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The most commonly missing data required to make a PARDS diagnosis were fraction of inspired oxygen, mean airway pressure and type of non-invasive interface for children receiving mechanical ventilation (Table S5); these data were more likely to be missing from sites in lower SDI quintile countries (Table S6).\u003c/p\u003e\n\u003cp\u003eFive of 12 patients (42%) with sufficient data for a diagnosis of PARDS met PARDS criteria. Three of eight eligible patients (38%) met criteria for Possible PARDS. Of the remaining 14 patients with sufficient data who did not meet PARDS or Possible PARDS criteria, six patients (43%) met At-risk for PARDS criteria according to PALICC-2 guidelines (Fig S5).\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eOutcomes\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eIn-hospital mortality among children with hypoxemia was 6.8% (n\u0026thinsp;=\u0026thinsp;52/763) compared to 0.8% (n\u0026thinsp;=\u0026thinsp;16/1907) for patients admitted to the hospital without hypoxemia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among children admitted with hypoxemia, those who died were older (median 3.5 years [interquartile range (IQR) 0.5-4] vs. 1.9 years [IQR 0.7\u0026ndash;7.5], p\u0026thinsp;=\u0026thinsp;0.02) and more likely to be malnourished (n\u0026thinsp;=\u0026thinsp;21 [40%] vs. n\u0026thinsp;=\u0026thinsp;176 [25%], p\u0026thinsp;=\u0026thinsp;0.01). Most patients were admitted in a country with low- or low-middle SDI (n\u0026thinsp;=\u0026thinsp;49, 94%), and the highest mortality was observed in Sub-Saharan Africa (n\u0026thinsp;=\u0026thinsp;33, 12%) (Table S7). Simple oxygen supplementation was the most common respiratory resource utilized by children with hypoxia in both the survivors and non-survivors (n\u0026thinsp;=\u0026thinsp;530 [75%] and n\u0026thinsp;=\u0026thinsp;23 [44%], respectively). (Table S8).\u003c/p\u003e\n\u003cp\u003eMortality differed by respiratory care resource bundle availability with the highest mortality at the sites with no bundle (n\u0026thinsp;=\u0026thinsp;10/81 [12%]), the intermediate (n\u0026thinsp;=\u0026thinsp;21/177 [12%]), and the basic bundles (n\u0026thinsp;=\u0026thinsp;19/273 [7%]), as compared to the advanced (n\u0026thinsp;=\u0026thinsp;1/189 [0.5%]) and expert (n\u0026thinsp;=\u0026thinsp;1/43 [2.3%], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) bundles (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Patients treated at sites with the intermediate, basic, or no bundles had higher odds of mortality compared to those treated at sites with the advanced or expert bundles (OR 18, 95% CI 4.1\u0026ndash;83) when adjusted for average daily hospital census, PICU availability, and academic center designation.\u003c/p\u003e\n\u003cp\u003eThe presence of a PARDS trigger was not associated with mortality. Twenty-six patients with a PARDS trigger died (6%). The unadjusted OR for mortality in patients with a PARDS trigger compared to patients without a PARDS trigger was 0.76 (95%CI 0.43\u0026ndash;1.3) and the adjusted OR was 0.56 (95% CI 0.30\u0026ndash;1.04; adjusted for resource availability, age, malnutrition, and LODS).\u003c/p\u003e\n\u003cp\u003eThe median hospital LOS among survivors was 3.25 days (IQR 1-6.6 days). Median hospital LOS among survivors was longer for children with a PARDS trigger compared to those with no PARDS trigger (median 4 days [IQR 1.8-7] vs. 2.6 days [IQR 1-5.8], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe found that hypoxemia was common (10%) in children presenting to RCS hospitals, 70% of children with hypoxemia were treated at sites with an intermediate or less respiratory care resource bundle, and mortality was inversely associated with both respiratory care resource availability and SDI. This is consistent with prior studies demonstrating higher mortality with decreasing country development level\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Only two of 232 (\u0026lt;\u0026thinsp;1%) hypoxemic patients died when the advanced or expert respiratory care resource bundle was available compared with 50 of 531 (9.4%) patients when the intermediate bundle or less were available. These findings suggest that hospitals with resource constraints care for a high burden of respiratory illness and have higher associated mortality; this highlights the urgent need to optimize resources to ensure all hospitals can provide appropriate respiratory care to children with hypoxemia. Despite consensus recommendations from the WHO for the management of hypoxemia, there exists heterogeneity in the identification and management of hypoxemia due to resource constraints, cost, practice variation, and lack of standardized protocols\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Successfully caring for children with hypoxemia relies on timely recognition, sufficient resources, provider training in the management of pediatric respiratory illness, and coordination of a complex healthcare system. Policies and funding should support interventions focused on these areas and be implemented thoughtfully based on local healthcare systems, disease burden, and resource needs\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis secondary analysis also illustrated the significant burden of hypoxemia in RCS, both with respect to prevalence (10%) and associated inpatient mortality (6.8%). This is consistent with hypoxemia prevalence previously reported in a pediatric cohort admitted to hospitals in southwest Nigeria (10.2%)\u003csup\u003e1\u003c/sup\u003e, as well as a pediatric cohort with non-severe pneumonia in low- and middle-income country hospitals (8%)\u003csup\u003e1,2\u003c/sup\u003e. The 6.8% mortality from this study was higher than the reported case fatality rate of children admitted with hypoxemia in southwest Nigeria (3.4\u0026ndash;5.6%)\u003csup\u003e1\u003c/sup\u003e and fell between the 28-day mortality of children hospitalized in Uganda or Kenya with pneumonia and hypoxemia (~\u0026thinsp;4%) or severe hypoxemia (~\u0026thinsp;20%) who received no support, low- or high-flow nasal cannula\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. We believe that the heterogeneity in site resource availability in this study contributed to the lower observed mortality as compared to previously published estimates in children with severe hypoxemia from single countries.\u003c/p\u003e\u003cp\u003eThrough this secondary analysis, we gained insight into the applicability of PALICC-2 criteria in RCS, finding that 94% of children with hypoxemia and a PARDS trigger receiving respiratory support had insufficient data available to make a PARDS-related diagnosis. PALICC-2 criteria were designed to be more inclusive of resource-variable settings and were used to inform the Global PARITY data collection form; however, missing data limited the ability to diagnose Possible PARDS and risk-stratify children with hypoxemia in this cohort. Given the challenges associated with identifying PARDS, it would be valuable to further explore the underlying reasons for missing data. Importantly, a diagnosis of PARDS, Possible or At-risk for PARDS was limited by lack of mean airway and positive pressure settings and liter flow data, which were not collected despite being fields on the case report form for those receiving non-invasive ventilation, HFNC, or simple oxygen. Hospitals in lower SDI countries may face greater challenges with clinical data collection, documentation, measurement, and/or electronic data entry, all of which could be influenced by resource availability and systemic factors. This study did not provide funding for research staff, and prior work has demonstrated that human resource shortages contribute to challenges with vital sign measurement and documentation\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Furthermore, it is plausible that centers with extreme resource constraints may lack the diagnostic capacity (e.g., chest imaging), clinical infrastructure (e.g., advanced ventilator support), and trained personnel necessary to systematically and efficiently confirm PARDS according to PALICC-2 criteria; this may contribute to under-recognition or misclassification of PARDS in resource-constrained settings. Future research could examine how these systemic limitations influence the epidemiology of PARDS.\u003c/p\u003e\u003cp\u003eAs PARDS remains an elusive diagnosis in RCS, we hypothesized that the presence of a PARDS trigger would be associated with mortality; however, we did not find this to be the case. This analysis was likely underpowered to detect an association given the overall low number of mortality events. Additionally, PARDS triggers may have been underappreciated; for example, sepsis is also a difficult diagnosis to make accurately in resource-constrained settings. Furthermore, the presence of a PARDS trigger is not a definitive diagnosis of PARDS. Another possible explanation for this lack of association is that other variables (e.g., malnutrition and resource availability) were more influential than lung injury in determining clinical outcomes in RCS. Cornerstones of PARDS management include the identification of hypoxemia, oxygen therapy, followed by lung protective respiratory support including non-invasive and invasive mechanical ventilation; children with \u0026ldquo;possible PARDS\u0026rdquo; should ideally be managed as if they have PARDS\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Given these proven beneficial management strategies, a crucial step in improving outcomes of children with PARDS in RCS is having the ability to make a timely PARDS diagnosis. Just as critical is the identification of children with Possible PARDS or At-risk for PARDS to facilitate the implementation of strategies to prevent lung disease progression and clinical deterioration. For these reasons, pulse oximetry, organized clinical data collection, and improved documentation should be prioritized in RCS.\u003c/p\u003e\u003cp\u003eWe acknowledge several limitations related to data availability and the inherent constraints of secondary analyses. While we found an association between mortality and respiratory care resource constraints, we were unable to determine if deaths were directly attributable to respiratory disease or preventable with improved respiratory care resources. However, given that hypoxemia is a strong predictor of mortality and a driver of organ failure\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, it is reasonable to infer that the burden of mortality and organ dysfunction could have been mitigated with better respiratory support and oxygen delivery. Though we could not account for all confounders in RCS where hospitals are may be hindered by challenges beyond limited respiratory care resources (e.g. other resource infrastructure, sanitation practices, safety protocols, staff training, etc.), our findings demonstrate important resource limitations in areas where hypoxemia is common and hypoxemia-related deaths are high. Additionally, we likely did not capture all patients with hypoxemia. The exclusion of children with reported cyanotic heart disease, many of whom were diagnosed with LRTI or sepsis, may have led to an underestimation of mortality, as we would expect these children to be at higher risk of death from infections. Additionally, we did not capture patients who developed hypoxemia after day seven of hospital admission, after which, daily data were not collected. Late-onset hypoxemia, however, is more likely to represent complications of hospitalization (e.g., hospital-acquired pneumonia and sepsis), though exclusion of these patients may have underestimated the PARDS trigger subgroup and associated mortality. Conversely, there were limitations that likely overestimated the cohort size. Pulse oximetry is not perfectly accurate\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and we may have included patients with false or brief transient hypoxemia. For example, we included 16 children with documented hypoxemia who survived without receiving respiratory support, potentially leading to an underestimation of mortality. Finally, selection and reporting biases were unavoidable. The site and patient representation varied across RCS globally, and data availability and accuracy were dependent on clinician diagnosis and reporting. Despite these limitations, we believe the study findings are generalizable to pediatric populations in RCS and informative to future work.\u003c/p\u003e\u003cp\u003eThis study demonstrated that children with hypoxemia in RCS are at increased risk of mortality when respiratory care resources are limited. Additionally, despite the new PALICC-2 criteria, PARDS remains challenging to diagnose in RCS and the presence of a PARDS trigger, as a proxy for PARDS, was not associated with mortality. These findings suggest that mortality may depend more on other factors such as resource availability rather than underlying pathophysiology in RCS. Therefore, ongoing work to strengthen systems and optimize respiratory care resources should be prioritized to reduce inequities. This includes ensuring availability of pulse oximetry to consistently identify children with hypoxemia, oxygen therapy as a minimum basic standard of care, and more advanced infrastructure where feasible. Future initiatives should also focus on global engagement and support of pediatric healthcare providers to promote the implementation of PALICC-2 criteria in RCS to improve diagnosis and management of PARDS. Collectively, these efforts can help clinicians risk-stratify children, allocate available limited resources, and tailor management to optimize clinical outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBiPAP: bilevel positive airway pressure, COVID-19: coronavirus disease of 2019, CPAP: continuous positive airway pressure, HFNC: high-flow nasal cannula, ICU: intensive care unit, IQR: interquartile range, LODS: Lambar\u0026eacute;n\u0026eacute; Organ Dysfunction Score; LOS: length of stay, LRTI: lower respiratory tract infection, PALICC-2: Second Pediatric Acute Lung Injury Consensus Conference, PARDS: pediatric acute respiratory distress syndrome, PARITY: Pediatric Acute Critical Illness Point Prevalence Study, PICU: pediatric intensive care unit, RCS: resource-constrained setting(s), SD: standard deviation, SDI: socio-demographic index, STROBE: Strengthening the Reporting of Observational Studies in Epidemiology, WHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study was coordinated by the Department of Pediatrics at the University of Maryland and was deemed exempt by the University of Maryland Institutional Review Board (IRB, HP-00086107). It was reviewed and approved by each site prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Study materials, including the template data collection forms, data dictionary, deidentified data used for all analyses, analytic code, and other study-related materials, will be publicly available at https://borealisdata.ca/dataverse/Pedi_SepsisCoLab. Approval from the PALISI Global Health sub-group and a signed data access agreement will be required for publications related to these data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGlobal PARITY Investigators\u0026nbsp;\u003c/strong\u003e(all listed Global PARITY Investigator Authors met ICMJE criteria for authorship): Alhassan Abdul-Mumin, Nabisere Allen, Paloma Amarillo, Kokou Amegan-Aho, John Appiah, Pamela Arancibia, Anita Arias, Fehmina Arif, Liliana Arteaga, Jacqueline Asibey, Jonah Attebery, Nataly Ávila Guerrero, Tigist Bacha, Briam Beltran Hernandez, Hippolyte Bwiza Muhire, Juan Calderon-Cardenas, Jhon Camacho-Cruz, Mariana Lucía Cañete, Paula Caporal, Dulamragchaa Chimedbazar, Claudia Curi, Karla Emilia de Sa Rodrigues, Tenywa Emmanuel, Maria Escobar, Sofia Esposto, Arieth Figueroa Vargas, Ericka Fink, Ana Fustiñana, Marina Giulietti, Stephanie Gordon Rivera, Muhammad Irfan Habib, Pascal Havugarurema, David He, Lucia Hernandez Somerson, Nayibe Hincapie Saldarriaga, Shubhada Hooli, Jacob Isabirye, Saifullah Jamro, Juan Jaramillo-Bustamante, Liliana Jurado Salcedo, Halima Kabir, Caleb Karanja, Adama Mamby Keita, Marie-Charlyne Kilba, Niranjan Kissoon, Guillermo Kohn-Loncarica, Kandamaran Krishnamurthy, Jorhk Lasso Noguera, Marianne Majdalani, Isabel Monje Cardona, Emilse Montero Nuñez, Celia Mulgado Aguas, Raya Mussa, Fiona Muttalib, John Nebaza, Katie Nielsen, María Noya, Edna Obodai, Carmen Ocampo, Çağlar Ödek, Tagbo Oguonu, Afua Osew-Gyamfi, Sheila Owusu, Larko Owusu, Mayerly Palencia Bocarejo, Freddy Pantoja Chamorro, Aurora Pedroza, Walugembe Peter, Javier Prego, Amal Rahi, Carmen Ramírez Hernández, Kenneth Remy, Pedro Rino, Adriana Teixeira Rodrigues, Firas Sakaan, Jhuma Sankar, Hendry Sawe, Jesus Serra, Agustin Shaieb, Arianna Shirk, Enkhtur Shonkhuuz, Javier Sierra-Abaunza, Khurram Soomro, Samba Sow, Abner Tagoola, Atnafu Tekleab, Margarita Torres, Pablo Vasquez-Hoyos, Amelie von Saint Andre-von Arnim, Justin Wang, Rafiuk Yakubu, Rita Yeboah, María Zamarbide. Affiliations for the Global PARITY Investigator Authors are provided in the Appendix.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e JHL has received support from the National Medical Research Council, Singapore (MOH-TA19nov-001) and from the Thrasher Foundation, USA. Dr. Robinder G. Khemani is a paid medical advisor for Nihon Kohden/Orange Med. All other authors declare no competing interests. .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Research effort to create this publication was supported by the National Institute of Allergy and Infectious Diseases (numbers K23AI144029 [TK] and 5U01AI126610 [AB]) of the National Institutes of Health (NIH); the National Cancer Institute (number R37CA276215–01 [AA]) of the NIH; the National Medical Research Council, Singapore (MOH-TA19nov-001 [JHL]); the President’s Global Impact Fund, University of Maryland, Baltimore (AH and AB); and the Thrasher Foundation (JHL and RGK). The views expressed are those of the author(s) and not necessarily those of the funders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u003c/strong\u003e C.B., S.L.W., A.A., S.M., A.B., A.H., R.G.K., and T.B.K. conceptualized the study. C.B., S.L.W., A.A., S.M., A.B., A.H., M.O.W., R.G.K., and T.B.K. developed the methodology. C.B., S.L.W., and T.B.K. contributed to software, validation, and formal analysis. A.A., S.M., Q.A., A.B., A.H., J.H.L., E.L.B., C.U., M.O.W., and T.B.K. conducted the investigation. A.B., A.H., R.G.K., and T.B.K. provided resources. C.B., A.B., A.H., M.O.W., and T.B.K. curated the data. C.B. wrote the original draft. C.B., S.L.W., A.A., S.M., Q.A., J.B.M., A.B., A.H., J.H.L., E.L.B., C.U., M.O.W., R.G.K., and T.B.K. reviewed and edited the manuscript. C.B., J.B.M., and T.B.K. prepared the visualizations. S.L.W., R.G.K., and T.B.K. supervised the project. C.B. and T.B.K. administered the project. A.B., A.H., and T.B.K. acquired funding. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We thank the Global PARITY Study Collaborators (see Appendix) who made a substantial contribution to at least one of the following areas: the conception or design of the work; or the acquisition, analysis, or interpretation of data; or drafting the work or revising it critically for important intellectual content. We thank Mary Dahmer and Jennifer Muszynski for their thoughtful review of the manuscript draft. Finally, we thank all the patients and families that participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGraham H, Bakare AA, Ayede AI, et al. Hypoxaemia in hospitalised children and neonates: A prospective cohort study in Nigerian secondary-level hospitals. \u003cem\u003eEClinicalMedicine\u003c/em\u003e. Nov 2019;16:51-63. doi:10.1016/j.eclinm.2019.10.009\u003c/li\u003e\n\u003cli\u003eRahman AE, Hossain AT, Nair H, et al. Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: a systematic review and meta-analysis. \u003cem\u003eLancet Glob Health\u003c/em\u003e. Mar 2022;10(3):e348-e359. doi:10.1016/S2214-109X(21)00586-6\u003c/li\u003e\n\u003cli\u003eSubhi R, Adamson M, Campbell H, et al. The prevalence of hypoxaemia among ill children in developing countries: a systematic review. \u003cem\u003eLancet Infect Dis\u003c/em\u003e. Apr 2009;9(4):219-27. doi:10.1016/S1473-3099(09)70071-4\u003c/li\u003e\n\u003cli\u003eLazzerini M, Sonego M, Pellegrin MC. Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis. \u003cem\u003ePLoS One\u003c/em\u003e. 2015;10(9):e0136166. doi:10.1371/journal.pone.0136166\u003c/li\u003e\n\u003cli\u003eOrimadegun A, Ogunbosi B, Orimadegun B. Hypoxemia predicts death from severe falciparum malaria among children under 5 years of age in Nigeria: the need for pulse oximetry in case management. \u003cem\u003eAfr Health Sci\u003c/em\u003e. Jun 2014;14(2):397-407. doi:10.4314/ahs.v14i2.16\u003c/li\u003e\n\u003cli\u003eMuttalib F, Gonzalez-Dambrauskas S, Lee JH, et al. Pediatric Emergency and Critical Care Resources and Infrastructure in Resource-Limited Settings: A Multicountry Survey. \u003cem\u003eCrit Care Med\u003c/em\u003e. Apr 1 2021;49(4):671-681. doi:10.1097/CCM.0000000000004769\u003c/li\u003e\n\u003cli\u003eAbbas Q, Holloway A, Caporal P, et al. Global PARITY: Study Design for a Multi-Centered, International Point Prevalence Study to Estimate the Burden of Pediatric Acute Critical Illness in Resource-Limited Settings. \u003cem\u003eFront Pediatr\u003c/em\u003e. 2021;9:793326. doi:10.3389/fped.2021.793326\u003c/li\u003e\n\u003cli\u003eMcAllister DA, Liu L, Shi T, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. \u003cem\u003eLancet Glob Health\u003c/em\u003e. Jan 2019;7(1):e47-e57. doi:10.1016/S2214-109X(18)30408-X\u003c/li\u003e\n\u003cli\u003eUnited Nations Inter-agency Group for Child Mortality Estimation (UN IGME), Levels \u0026amp; Trends in Child Mortality: Report 2023, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation, United Nations Children\u0026rsquo;s Fund, New York, 2024. \u003c/li\u003e\n\u003cli\u003eEmeriaud G, Lopez-Fernandez YM, Iyer NP, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). \u003cem\u003ePediatr Crit Care Med\u003c/em\u003e. Feb 1 2023;24(2):143-168. doi:10.1097/PCC.0000000000003147\u003c/li\u003e\n\u003cli\u003eWong JJ, Jit M, Sultana R, et al. Mortality in Pediatric Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. \u003cem\u003eJ Intensive Care Med\u003c/em\u003e. Jul 2019;34(7):563-571. doi:10.1177/0885066617705109\u003c/li\u003e\n\u003cli\u003eSchouten LR, Veltkamp F, Bos AP, et al. Incidence and Mortality of Acute Respiratory Distress Syndrome in Children: A Systematic Review and Meta-Analysis. \u003cem\u003eCrit Care Med\u003c/em\u003e. Apr 2016;44(4):819-29. doi:10.1097/CCM.0000000000001388\u003c/li\u003e\n\u003cli\u003eKhemani RG, Smith L, Lopez-Fernandez YM, et al. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. \u003cem\u003eLancet Respir Med\u003c/em\u003e. Feb 2019;7(2):115-128. doi:10.1016/S2213-2600(18)30344-8\u003c/li\u003e\n\u003cli\u003eGupta S, Sankar J, Lodha R, Kabra SK. Comparison of Prevalence and Outcomes of Pediatric Acute Respiratory Distress Syndrome Using Pediatric Acute Lung Injury Consensus Conference Criteria and Berlin Definition. \u003cem\u003eFront Pediatr\u003c/em\u003e. 2018;6:93. doi:10.3389/fped.2018.00093\u003c/li\u003e\n\u003cli\u003eMorrow BM, Agulnik A, Brunow de Carvalho W, et al. Diagnostic, Management, and Research Considerations for Pediatric Acute Respiratory Distress Syndrome in Resource-Limited Settings: From the Second Pediatric Acute Lung Injury Consensus Conference. \u003cem\u003ePediatr Crit Care Med\u003c/em\u003e. Feb 1 2023;24(12 Suppl 2):S148-S159. doi:10.1097/PCC.0000000000003166\u003c/li\u003e\n\u003cli\u003eKortz TB, Holloway A, Agulnik A, et al. Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study. \u003cem\u003eLancet Glob Health\u003c/em\u003e. Feb 2025;13(2):e212-e221. doi:10.1016/S2214-109X(24)00450-9\u003c/li\u003e\n\u003cli\u003eDiseases GBD, Injuries C. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. \u003cem\u003eLancet\u003c/em\u003e. May 18 2024;403(10440):2133-2161. doi:10.1016/S0140-6736(24)00757-8\u003c/li\u003e\n\u003cli\u003eSchell CO, Khalid K, Wharton-Smith A, et al. Essential Emergency and Critical Care: a consensus among global clinical experts. \u003cem\u003eBMJ Glob Health\u003c/em\u003e. Sep 2021;6(9)doi:10.1136/bmjgh-2021-006585\u003c/li\u003e\n\u003cli\u003eArias A. Development of a Novel Pediatric Critical Care Resource Evaluation (CRITCARE) Tool for Hospitals in Resource Variable Settings. Poster Abstract. \u003cem\u003ePediatric Critical Care Medicine\u003c/em\u003e. 2024;25(11S):p e40doi:10.1097/01.pcc.0001084868.64857.7e\u003c/li\u003e\n\u003cli\u003eHelbok R, Kendjo E, Issifou S, et al. The Lambarene Organ Dysfunction Score (LODS) is a simple clinical predictor of fatal malaria in African children. \u003cem\u003eJ Infect Dis\u003c/em\u003e. Dec 15 2009;200(12):1834-41. doi:10.1086/648409\u003c/li\u003e\n\u003cli\u003eGhazaly MMH, Abu Faddan NH, Raafat DM, Mohammed NA, Nadel S. Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome. \u003cem\u003eEur J Pediatr\u003c/em\u003e. Apr 2021;180(4):1229-1234. doi:10.1007/s00431-020-03852-9\u003c/li\u003e\n\u003cli\u003eYehya N, Smith L, Thomas NJ, et al. Definition, Incidence, and Epidemiology of Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference. \u003cem\u003ePediatr Crit Care Med\u003c/em\u003e. Feb 1 2023;24(12 Suppl 2):S87-S98. doi:10.1097/PCC.0000000000003161\u003c/li\u003e\n\u003cli\u003eLobete C, Medina A, Rey C, Mayordomo-Colunga J, Concha A, Menendez S. Correlation of oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen ratio with Pao2/fraction of inspired oxygen ratio in a heterogeneous sample of critically ill children. \u003cem\u003eJ Crit Care\u003c/em\u003e. Aug 2013;28(4):538 e1-7. doi:10.1016/j.jcrc.2012.12.006\u003c/li\u003e\n\u003cli\u003eTan B, Wong JJ, Sultana R, et al. Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis. \u003cem\u003eJAMA Pediatr\u003c/em\u003e. Apr 1 2019;173(4):352-362. doi:10.1001/jamapediatrics.2018.4839\u003c/li\u003e\n\u003cli\u003eHill K, Zimmerman L, Jamison DT. Mortality risks in children aged 5-14 years in low-income and middle-income countries: a systematic empirical analysis. \u003cem\u003eLancet Glob Health\u003c/em\u003e. Oct 2015;3(10):e609-16. doi:10.1016/S2214-109X(15)00044-3\u003c/li\u003e\n\u003cli\u003eCheifetz IM. Pediatric ARDS. \u003cem\u003eRespir Care\u003c/em\u003e. Jun 2017;62(6):718-731. doi:10.4187/respcare.05591\u003c/li\u003e\n\u003cli\u003eHon KL, Leung KKY, Oberender F, Leung AK. Paediatrics: how to manage acute respiratory distress syndrome. \u003cem\u003eDrugs Context\u003c/em\u003e. 2021;10doi:10.7573/dic.2021-1-9\u003c/li\u003e\n\u003cli\u003eFernando SM, Ferreyro BL, Urner M, Munshi L, Fan E. Diagnosis and management of acute respiratory distress syndrome. \u003cem\u003eCMAJ\u003c/em\u003e. May 25 2021;193(21):E761-E768. doi:10.1503/cmaj.202661\u003c/li\u003e\n\u003cli\u003eMaitland K, Kiguli S, Olupot-Olupot P, et al. Randomised controlled trial of oxygen therapy and high-flow nasal therapy in African children with pneumonia. \u003cem\u003eIntensive Care Med\u003c/em\u003e. May 2021;47(5):566-576. doi:10.1007/s00134-021-06385-3\u003c/li\u003e\n\u003cli\u003eOgero M, Ayieko P, Makone B, et al. An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care? \u003cem\u003eJ Glob Health\u003c/em\u003e. Jun 2018;8(1):010409. doi:10.7189/jogh.08.010409\u003c/li\u003e\n\u003cli\u003eLeon-Valladares D, Barrio-Mateu LA, Cortes-Carmona N, et al. Determining factors of pulse oximetry accuracy: a literature review. \u003cem\u003eRev Clin Esp (Barc)\u003c/em\u003e. May 2024;224(5):314-330. doi:10.1016/j.rceng.2024.04.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-global-and-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Global and Public Health](https://bmcglobalpublichealth.biomedcentral.com/)","snPcode":"44263","submissionUrl":"https://submission.springernature.com/new-submission/44263/3","title":"BMC Global and Public Health","twitterHandle":"@BMC_GPH","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatrics, Global Health, Critical Illness, Hypoxemia, Resource-Constrained Setting, Pediatric Acute Respiratory Distress Syndrome (PARDS), Resource Utilization","lastPublishedDoi":"10.21203/rs.3.rs-7143199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7143199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHypoxemia, a mortality predictor and hallmark of pediatric acute respiratory distress syndrome (PARDS), is disproportionately common in resource-constrained settings (RCS). The burden of PARDS in RCS is likely substantial considering the high prevalence of known clinical triggers (e.g., sepsis, pneumonia, trauma), but it is challenging to diagnose due to limited diagnostic resources. We aimed to: (1) describe respiratory care resource availability in RCS hospitals and test whether availability was associated with mortality; (2) determine the proportion of children who presented to RCS hospitals with hypoxemia and their associated outcomes; and (3) test whether, in children with hypoxemia, having a PARDS trigger was associated with mortality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe developed and applied operational definitions for five tiered respiratory care resource bundles. Through a secondary analysis of Global PARITY (Pediatric Acute Critical Illness Point Prevalence Study) data, we performed descriptive statistics, hypothesis testing (i.e. chi-square and Wilcoxon rank-sum tests), and logistic regression analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the entire Global PARITY cohort (n\u0026thinsp;=\u0026thinsp;7538), 763 (10.1%) were admitted with hypoxemia. Seventy percent (n\u0026thinsp;=\u0026thinsp;531) were treated at a site with the intermediate or less respiratory care resource bundle available. Mortality was 6.8% (n\u0026thinsp;=\u0026thinsp;52) and inversely associated with respiratory resource availability. The odds of mortality were higher for patients treated at sites with the intermediate bundle or less compared to those with advanced or expert bundle available (adjusted OR 18, 95% CI 4.1\u0026ndash;83). Fifty-six percent (n\u0026thinsp;=\u0026thinsp;430) had a PARDS trigger, most commonly pneumonia (n\u0026thinsp;=\u0026thinsp;256), bronchiolitis (n\u0026thinsp;=\u0026thinsp;116) and sepsis (n\u0026thinsp;=\u0026thinsp;58). There was no association between the presence of a PARDS trigger and mortality. Ninety-four percent of patients with a PARDS trigger (n\u0026thinsp;=\u0026thinsp;405/430) had insufficient data available for a PARDS-related diagnosis according to the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eChildren with hypoxemia treated at hospitals with respiratory care resource constraints had significantly higher mortality, highlighting the critical role of resource availability for outcomes. Ongoing work to strengthen health systems and support pediatric healthcare providers in identifying PARDS can help clinicians risk stratify children, focus resources, and tailor management to optimize outcomes.\u003c/p\u003e","manuscriptTitle":"Risk Factors for Mortality in Children with Hypoxemia in Resource- Constrained Settings: A Secondary Analysis of the Global PARITY Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-27 11:02:11","doi":"10.21203/rs.3.rs-7143199/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-01T15:56:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-16T23:57:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142266707533693765644858073501342090320","date":"2025-09-06T02:09:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T03:12:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210052025605427264283107377332879550581","date":"2025-08-01T12:43:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-21T13:45:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-17T05:55:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-17T05:49:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Global and Public Health","date":"2025-07-16T20:29:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-global-and-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Global and Public Health](https://bmcglobalpublichealth.biomedcentral.com/)","snPcode":"44263","submissionUrl":"https://submission.springernature.com/new-submission/44263/3","title":"BMC Global and Public Health","twitterHandle":"@BMC_GPH","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9dd05116-cf08-4c90-b4f2-979c6a105f83","owner":[],"postedDate":"July 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T18:53:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-27 11:02:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7143199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7143199","identity":"rs-7143199","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}