Low Cost Simulator for Cardiopulmonary Resuscitation in Infants: a Proof-of-Concept Study.

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Ailton do Nascimento Targino, Alan Patricio, Adriana Gonçalves de Oliveira, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-16646/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Apr, 2021 Read the published version in Journal of Human Growth and Development → Version 2 posted You are reading this latest preprint version Show more versions Abstract Background: Realistic simulation methodology is used in various learning scenarios, allowing students to participate directly in problematic situations that require immediate professional action. The objective of this proof-of-concept study was to develop a low-cost simulator for cardiopulmonary resuscitation procedures in infants. Findings: The prototype was developed successfully with accessories to simulate cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the Basic Life Support guidelines of the American Heart Association to test the instrument. The prototype was used as a learning object for the teaching-learning process as a low-cost resource. Conclusion: A low-cost prototype was developed, and its application was obtained from the simulation of the training activity in Basic Life Support and from the performance of procedures in the positioning and simulation of cardiopulmonary resuscitation. Critical Care & Emergency Medicine high fidelity simulation training medical education cardiopulmonary resuscitation asphyxia prototype. Figures Figure 1 Figure 2 Figure 3 Introduction The use of realistic simulation methodology has been offered in various learning scenarios in the United States and Europe. This strategy allows students to directly participate in challenging situations that require professional action and, consequently, the students seek solutions to the actual problem [1,2]. Medical Simulation is the modern-day methodology for training healthcare professionals through the use of advanced educational technology. Professional training to help a newborn suffering from cardiac arrest or asphyxiation can reduce the risk of death. In several North American and European countries, several educational institutions are encouraged to develop their own simulators to allow training and knowledge acquisition at an affordable cost [3-10]. Basic Life Support (BLS) training develops specific skills that help to identify cardiorespiratory arrest and contribute to interventions in this sudden event. Studies indicate that educating the population to intervene in cases of cardiopulmonary arrest increases the survival rate of victims 2 to 3 times compared to those who do not receive cardiopulmonary resuscitation [11-13]. The production of low-cost simulators for training enables and encourages teachers and coordinators to actively participate and develop new measures to assess the performance of the use of these resources14. Studies indicate that, compared to traditional lecture teaching, simulation is a more enjoyable learning strategy to provide technical skills [1,15]. Some current physical models have a high commercial value, which limits institutions' access to the equipment. This increases the risk of an institution having simulators in its inventory, but not being able to use them due to the high cost of maintenance. These obstacles are the main motivators for the development of accessible models with low maintenance costs [15-17]. Thus, the objective of this proof-of-concept study was to develop a low-cost simulator for cardiopulmonary resuscitation procedures in infants. Methods In this proof-of-concept study, an experimental prototype for basic life support training was developed and, its performance in cardiopulmonary resuscitation maneuvers in infants was evaluated. The research was approved by the institution's Ethics Committee (number: 1728913). The study population for the simulation consisted of undergraduate nursing students at a Brazilian university. A pre-test was carried out to evaluate the prototype. , Then a class on Basic Life Support in infants was carried out using the prototypes of children's simulators for 30 minutes, followed by renewal of the pre-test. The test was developed by Tavares et al and consists of 16 objective questions with four alternatives each, and only one correct alternative. In addition, students were asked about previous training in Basic Life Support. In the simulation, choking maneuvers and cardiopulmonary resuscitation in infants were demonstrated. The model consists of a child simulator composed of rubber members and a body made of biodegradable ecological fabric (Nonwoven), plastic plates for the chest and scapular region, mesh flaps, 20cm rubber tube coupled to a 10/10 cm air reservoir (Figure 1) The statistical analysis compared the proportions of correct answers before and after training, wrong answers before and after training, correct answers followed by wrong answers after the training, and wrong pre-training responses followed by correct ones after training. Two normality tests were applied to distribute correct and erroneous answers in the pre- and post-training questionnaire with the simulator, using the Kolmogorov-Smirnov and Shapiro-Wilk test with a 5% significance. Subsequently, non-parametric tests were used: signal test of related samples and Wilcoxon test, to compare medians of two related samples. In addition, McNemar's binomial probability distribution, suitable for dichotomous nominal variables, was tested. The McNemar test was two-tailed, that is, the p-value takes into account both the modification of responses in one direction and in the opposite direction [18]. Results Development of the prototype The prototype was built successfully. The child represented by the simulator (Figure 2) had a head circumference of 43 cm, head-length measure of 55 cm, and chest diameter of 44 cm. In addition, the simulator had air passages in the oral and nasal region allowing ventilation of the mouth and nose simultaneously (chest expansion) (Figure 1A). The body was filled with fabric scraps, modeled to simulate a child's body (Figures 1B and 1C). Then, the arms and legs were attached to the fabric and the head, and a silicone tube and an air reservoir were added. Thus, the simulator was built at a cost of US$ 15.00 (Figure 1D). The cost of other similar resources found in the market varies between US$ 300 and 500 [19]. In the prototype, it is possible to perform the Heimlich maneuver, (Figure 2A), to maintain good head position for the infant (head tilt - chin lift) to maintain a patent airway (Figure 2B) and check the airways (foreign body aspiration) (Figure 2C and 2D). A 40-minute training session was carried out with the prototype (Figures 3 and 3A). The groups were separated into stations to perform BLS techniques (Figure 3B, 3C and 3D). Thirty nursing students from the first period participated. The prototype proved to be practical in cardiopulmonary resuscitation, facilitating skill training. Table 1 shows the results of the comparisons between the medians of the correct answers, before and after training, and the comparisons between the median of errors, before and after simulator training, for the group of 30 students. Table 1: Errors and correct answers the questionnaire, before (A) and after (D) of the training, for all students (30) using the simulator. A D p* p** Correct MA 6 10 < 0,001 < 0,001 Error ME 10 6 < 0,001 < 0,001 *TSAR: Signal Test for Related Samples; **TW: Wilcoxon Signal Testing of Related Samples Significance, a = 0,05; MA: median answers correct; ME: median answer error. To study the frequency of modification of students' responses after training with the simulator, McNemar's two-tailed test was performed, the results are shown in table 2. Table 2: Frequencies of modified responses in the questionnaire after simulator training for each question for the 30 students Answers (before ® after) Question 0 ® 1 1 ® 0 p- value Q 1 17 0 < 0,001 Q 2 20 0 < 0,001 Q 3 12 0 < 0,001 Q 4 11 0 0,001 Q 5 6 1 0,125 Q 6 4 1 0,375 Q 7 6 1 0,125 Q 8 6 0 0,031 Q 9 7 0 0,016 Q 10 1 0 1,000 Q 11 8 2 0,109 Q 12 7 1 0,070 Q 13 16 1 < 0,001 Q 14 5 1 0,219 Q 15 15 0 < 0,001 Q 16 4 0 0,125 Using the McNemar test, bicauldal, with significance, a = 0.05 1: correct answer and 0: wrong answer Discussion The simulator model that was developed allows easy reproduction, since the materials used in the manufacture are easily accessible. The simulated teaching proposal, based on a prototype made with low-cost material, reached its objective of helping and guiding students on how to proceed in an emergency situation. A variety of models with similar purposes were presented in the contemporary medical literature; the models differ in relation to the level of fidelity when compared to a human body [20,21,22]. Working on low-cost models favors the training of basic skills during undergraduate training in health sciences, a way to partially reduce costs, especially in developing countries [23,24]. According to the BLS course (American Heart Association) [13], an individual, who reaches 84% of correct answers in a similar questionnaire, is considered qualified. Of the 30 participants in this study, only three (10%) achieved performance above 84%. According to students' reports, the use of the simulator helped in the completion of the questionnaire after training (post-test). Researches show that courses that combine simulation with mannequins allow for better knowledge retention compared to a traditional class [25,26]. In general, students commented that the simplicity of the equipment provided the goal of learning easily. Thus, our study showed that skill training with low fidelity equipment in simulation is a valuable educational approach to learning complex processes. Regarding the cost, the prototype proved to be significantly cheaper compared to the market average. Simulators for the same purpose range from 160 to 290$ [19,26]. In a study by Drummond et al (2016) [25], the authors concluded that knowledge retention was better among students who participated in the simulation than among those who participated in the traditional lecture. The course produced variable results in terms of skills - the transfer of knowledge to practice is a difficulty reported by doctors, and simulation can help in the learning process. This study has some major limitations. We were not able to study the effects of other methods of learning such as within-group learning, computer-assisted learning, and self-study learning. The assessment consisted of a questionnaire and thus, the effects of the model on the ability to correctly perform BLS maneuvers could not be assessed. Conclusion A prototype was developed that obtained its application in the simulation of the training activity in BLS, enabling proper performance of the procedures. Abbreviations BLS - Basic Life Support Q - question Declarations Competing interests The authors declare that they have no competing interests. No funds were received in the support of this study. No editorial or statistical assistance or rights were extended to or claimed by anyone other than the authors. All figures and tables are original work of the authors. Authors’ contributions ANT designed the study and provided primary authorship. ANT and AGO organized data collection efforts. JOE and LCA provided statistical analysis, and provided editorial support services. ANT, RDR, JOE and LCA assisted in initial study design and review of the manuscript. RDR and APS provided data support and manuscript review services. All figures and tables are by APS and JOE. All authors read and approved the final manuscript. ETHICS APPROVAL AND CONSENT TO PARTICIPATE The research was approved by the Ethics Committee of the Integrated Colleges of Patos-PB (number: 1,728,913, in Patos, Paraíba, Brazil, September 15th, 2016 CONSENT FOR PUBLICATION Attachment AVAILABILITY OF DATA AND MATERIAL Please contact author for data requests. FUNDING Not applicable ACKNOWLEDGEMENTS Not applicable References FERREIRA C. Impacto da metodologia de simulação realística, enquanto tecnologia aplicada à educação nos cursos de saúde. Anais do Seminário Tecnologias Aplicadas a Educação e Saúde. 2015; 1(1): 32-40. Page RL. 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Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Nationwide public-access defibrillation in Japan. N Engl J Med. 2010; 367 (11): 994–1004. nejm.org/doi/pdf/10.1056/NEJMoa0906644 Circulation 2005;112;IV-1-IV-5; originally published online Nov 28, 2005; DOI: 10.1161/CIRCULATIONAHA.105.166550 Pugh CM. Low-cost, locally fabricated simulators: The wave of the future. Journal of Surgical Research. 2011; 168(1): 29-30. doi:10.1016/j.jss.2010.07.018 Varga CRR, et al. Relato de experiência: o uso de simulações no processo de ensino-aprendizagem em medicina. Bras. Educ. Med. 2009; 33(2): 291-297. doi:10.1590/s0100-55022009000200018 Mileder LP, et al. Compliance with guidelines recommending the use of simulation for neonatal and infant resuscitation training in Austria. Klinische Pädiatrie, 2014; 226 (01): 24-28. DOI: 10.1055/s-0033-1361106 Pergola AM, Araujo IEM. O leigo e o suporte básico de vida. Rev. da Esc. Enferm. da USP. 2009; 43 (2): 335–342. https://doi.org/10.1590/S0080-62342009000200012 Zangirolami-Raimundo J, Echeimberg JO, Leone C. Research methodology topics: Cross-sectional studies. J. Hum. Growth Dev. 2018; 28(3):356-360. doi:10.7322/jhgd.152198 Silva RR, Lourenção Jr A, Goncharov M, Jatene FB. Low Cost Simulator for Heart Surgery Training. Brazilian J. Cardiovasc. Surg. 2016; 31(6): 449–453. https://doi.org/10.5935/1678-9741.20160089 Denadai R., Saad-Hossne R., Todelo AP, Kirylko, L, Souto LRM. Low-fidelity bench models for basic surgical skills training during undergraduate medical education. Col. Bras. Cir. 2014; 41 (2): 137–145 (2014). Vieira JE, Tamousauskas MRG. Avaliação das resistências de docentes a propostas de renovações em currículos de graduação em medicina. Bras. Educ. Med. 2013; 37(1): 32-38. doi:10.1590/s0100-55022013000100005 Denadai R., Oshiiwa M, Saad-Hossne R. Does bench model fidelity interfere in the acquisition of suture skills by novice medical students? Assoc. Med. Bras. 2012; 58(5): 600-606. doi:10.1590/s0104-42302012000500019 Denadai R, Kirylko L. Teaching basic plastic surgical skills on an alternative synthetic bench model. Aesthetic surgery jornal. 2013; 33: 458-461. Denadai Rafael, Souto Luís Ricardo Martinhão. Organic bench model to complement the teaching and learning on basic surgical skills. Acta Cir. Bras. [Internet]. 2012 Jan [cited 2020 Apr 28] ; 27( 1 ): 88-94. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502012000100015&lng=en. https://doi.org/10.1590/S0102-86502012000100015 . Drummond D, Arnaud C, Thouvenin G. et al. An innovative pedagogic course combining video and simulation to teach medical students about pediatric cardiopulmonary arrest: a prospective controlled study. Eur J Pediatr . 2016; 175: 767–774. https://doi.org/10.1007/s00431-016-2702-1 Wang C, Chen L, Mu D, Xin M, Luan J. A Low-Cost Simulator for Training in Endoscopic-Assisted Transaxillary Dual-Plane Breast Augmentation. Plast. Surg. 2017; 79: 525–528. Vieira LJES, Carneiro RCMM, Frota MA, Gomes ALA, Ximenes LB. Ações e possibilidades de prevenção de acidentes com crianças em creches de Fortaleza, Ceará. Saude Colet. 2009; 14: 1687-1697. doi:10.1590/S1413-81232009000500010 Supplementary Files TCLE18982.docx Cite Share Download PDF Status: Published Journal Publication published 28 Apr, 2021 Read the published version in Journal of Human Growth and Development → Version 2 posted You are reading this latest preprint version Show more versions 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. 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This strategy allows students to directly participate in challenging situations that require professional action and, consequently, the students seek solutions to the actual problem [1,2].\u003c/p\u003e\n\u003cp\u003eMedical Simulation\u0026nbsp;is the modern-day methodology for training healthcare professionals through the use of advanced educational technology. Professional training to help a newborn suffering from cardiac arrest or asphyxiation can reduce the risk of death. In several North American and European countries, several educational institutions are encouraged to develop their own simulators to allow training and knowledge acquisition at an affordable cost [3-10].\u003c/p\u003e\n\u003cp\u003eBasic Life Support (BLS) training develops specific skills that help to identify cardiorespiratory arrest and contribute to interventions in this sudden event. Studies indicate that educating the population to intervene in cases of cardiopulmonary arrest increases the survival rate of victims 2 to 3 times compared to those who do not receive cardiopulmonary resuscitation [11-13].\u003c/p\u003e\n\u003cp\u003eThe production of low-cost simulators for training enables and encourages teachers and coordinators to actively participate and develop new measures to assess the performance of the use of these resources14. Studies indicate that, compared to traditional lecture teaching, simulation is a more enjoyable learning strategy to provide technical skills [1,15].\u003c/p\u003e\n\u003cp\u003eSome current physical models have a high commercial value, which limits institutions' access to the equipment. This increases the risk of an institution having simulators in its inventory, but not being able to use them due to the high cost of maintenance. These obstacles are the main motivators for the development of accessible models with low maintenance costs [15-17].\u003c/p\u003e\n\u003cp\u003eThus, the objective of this proof-of-concept study was to develop a low-cost simulator for cardiopulmonary resuscitation procedures in infants.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this proof-of-concept study, an experimental prototype for basic life support training was developed and, its performance in cardiopulmonary resuscitation maneuvers in infants was evaluated. The research was approved by the institution's Ethics Committee (number: 1728913).\u003c/p\u003e\n\u003cp\u003eThe study population for the simulation consisted of undergraduate nursing students at a Brazilian university. A pre-test was carried out to evaluate the prototype. , Then a class on Basic Life Support in infants was carried out using the prototypes of children's simulators for 30 minutes, followed by renewal of the pre-test. The test was developed by Tavares et al and consists of 16 objective questions with four alternatives each, and only one correct alternative. In addition, students were asked about previous training in Basic Life Support.\u003c/p\u003e\n\u003cp\u003eIn the simulation, choking maneuvers and cardiopulmonary resuscitation in infants were demonstrated.\u003c/p\u003e\n\u003cp\u003eThe model consists of a child simulator composed of rubber members and a body made of biodegradable ecological fabric (Nonwoven), plastic plates for the chest and scapular region, mesh flaps, 20cm rubber tube coupled to a 10/10 cm air reservoir (Figure 1)\u003c/p\u003e\n\u003cp\u003eThe statistical analysis compared the proportions of correct answers before and after training, wrong answers before and after training, correct answers followed by \u0026nbsp;wrong answers after the training, and wrong pre-training responses followed by correct ones after training. Two normality tests were applied to distribute correct and erroneous answers in the pre- and post-training questionnaire with the simulator, using the Kolmogorov-Smirnov and Shapiro-Wilk test with a 5% significance. Subsequently, non-parametric tests were used: signal test of related samples and Wilcoxon test, to compare medians of two related samples. In addition, McNemar's binomial probability distribution, suitable for dichotomous nominal variables, was tested. The McNemar test was two-tailed, that is, the p-value takes into account both the modification of responses in one direction and in the opposite direction [18].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDevelopment of the prototype\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prototype was built successfully. The child represented by the simulator (Figure 2) had a head circumference of 43 cm, head-length measure of 55 cm, and chest diameter of 44 cm. In addition, the simulator had air passages in the oral and nasal region allowing ventilation of the mouth and nose simultaneously (chest expansion) (Figure 1A).\u003c/p\u003e\n\u003cp\u003eThe body was filled with fabric scraps, modeled to simulate a child's body (Figures 1B and 1C). Then, the arms and legs were attached to the fabric and the head, and a silicone tube and an air reservoir were added. Thus, the simulator was built at a cost of US$ 15.00 (Figure 1D). The cost of other similar resources found in the market varies between US$ 300 and 500 [19].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the prototype, it is possible to perform the Heimlich maneuver, (Figure 2A), to maintain good head position for the infant (head tilt - chin lift) to maintain a patent airway (Figure 2B) and check the airways (foreign body aspiration) (Figure 2C and 2D).\u003c/p\u003e\n\u003cp\u003eA 40-minute training session was carried out with the prototype (Figures 3 and 3A). The groups were separated into stations to perform BLS techniques (Figure 3B, 3C and 3D).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThirty nursing students from the first period participated. The prototype proved to be practical in cardiopulmonary resuscitation, facilitating skill training. Table 1 shows the results of the comparisons between the medians of the correct answers, before and after training, and the comparisons between the median of errors, before and after simulator training, for the group of 30 students.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style='box-sizing: border-box; border-collapse: collapse; color: rgb(33, 37, 41); font-family: \"Source Sans Pro\", sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-style: initial; text-decoration-color: initial;'\u003e\n \u003ctbody style=\"box-sizing: border-box;\"\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd colspan=\"6\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"100%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px;\"\u003eTable 1:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e Errors and correct answers the questionnaire, before (A) and after (D) of the training, for all students (30) using the simulator.\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"14.612676056338028%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"18.661971830985916%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003eA\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"18.661971830985916%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003eD\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"24.823943661971832%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003e\u0026nbsp;p*\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"23.239436619718308%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003ep**\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"14.612676056338028%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eCorrect\u003csup style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; top: -0.5em;\"\u003eMA\u0026nbsp;\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"18.661971830985916%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"18.661971830985916%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e10\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.464788732394368%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"20.598591549295776%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"14.612676056338028%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eError\u0026nbsp;\u003csup style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; top: -0.5em;\"\u003eME\u003c/sup\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"18.661971830985916%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e10\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"18.661971830985916%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.464788732394368%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"20.598591549295776%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd colspan=\"6\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"100%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px;\"\u003e*TSAR: Signal Test for Related Samples; **TW: Wilcoxon Signal Testing of Related Samples Significance, a = 0,05; MA: median answers correct; ME: median answer error.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTo study the frequency of modification of students' responses after training with the simulator, McNemar's two-tailed test was performed, the results are shown in table 2.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style='box-sizing: border-box; border-collapse: collapse; color: rgb(33, 37, 41); font-family: \"Source Sans Pro\", sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration-style: initial; text-decoration-color: initial;'\u003e\n \u003ctbody style=\"box-sizing: border-box;\"\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd colspan=\"5\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"100%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cstrong style=\"box-sizing: border-box; font-weight: bolder;\"\u003e\u003cspan style=\"font-family: Helvetica; font-size: 12px; color: rgb(0, 0, 0);\"\u003eTable 2:\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e Frequencies of modified responses in the questionnaire after simulator training for each question for the 30 students\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"44.89051094890511%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eAnswers (before\u0026nbsp;\u0026reg;\u0026nbsp;after)\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQuestion\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u0026nbsp;\u0026reg;\u0026nbsp;1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u0026nbsp;\u0026reg;\u0026nbsp;0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003ep- value\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e1\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e17\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e2\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e20\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e3\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e12\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; 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font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e5\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,125\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e6\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,375\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e7\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,125\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e8\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,031\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e9\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,016\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e10\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1,000\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e11\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e8\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e2\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,109\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e12\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,070\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e13\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e16\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e14\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e5\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,219\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e15\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e15\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026lt; 0,001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"27.554744525547445%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eQ\u003csub style=\"box-sizing: border-box; position: relative; font-size: 11.25px; line-height: 0; vertical-align: baseline; bottom: -0.25em;\"\u003e16\u003c/sub\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"22.445255474452555%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" valign=\"top\" width=\"25.912408759124087%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e0,125\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"box-sizing: border-box;\"\u003e\n \u003ctd colspan=\"4\" style=\"box-sizing: border-box;\" valign=\"top\" width=\"98.35766423357664%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u003cspan style=\"font-family: Helvetica;\"\u003eUsing the McNemar test, bicauldal, with significance,\u0026nbsp;a\u0026nbsp;= 0.05\u003cbr style=\"box-sizing: border-box;\"\u003e\u0026nbsp;1: correct answer and 0: wrong answer\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"box-sizing: border-box;\" width=\"1.6423357664233578%\"\u003e\n \u003cp style='box-sizing: border-box; color: rgb(97, 97, 97); font-family: \"Source Sans Pro\", sans-serif; font-size: 15px; line-height: 24px; letter-spacing: 0.5px; font-weight: 400; margin-bottom: 1rem; margin-top: 0px;'\u003e\u003cspan style=\"font-family: Helvetica; font-size: 12px; color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe simulator model that was developed allows easy reproduction, since the materials used in the manufacture are easily accessible. The simulated teaching proposal, based on a prototype made with low-cost material, reached its objective of helping and guiding students on how to proceed in an emergency situation.\u003c/p\u003e\n\u003cp\u003eA variety of models with similar purposes were presented in the contemporary medical literature; the models differ in relation to the level of fidelity when compared to a human body [20,21,22]. Working on low-cost models favors the training of basic skills during undergraduate training in health sciences, a way to partially reduce costs, especially in developing countries [23,24].\u003c/p\u003e\n\u003cp\u003eAccording to the BLS course (American Heart Association) [13], an individual, who reaches 84% of correct answers in a similar questionnaire, is considered qualified. Of the 30 participants in this study, only three (10%) achieved performance above 84%. According to students' reports, the use of the simulator helped in the completion of the questionnaire after training (post-test). Researches show that courses that combine simulation with mannequins allow for better knowledge retention compared to a traditional class [25,26].\u003c/p\u003e\n\u003cp\u003eIn general, students commented that the simplicity of the equipment provided the goal of learning easily. \u0026nbsp;Thus, our study showed that skill training with low fidelity equipment in simulation is a valuable educational approach to learning complex processes. Regarding the cost, the prototype proved to be significantly cheaper compared to the market average. Simulators for the same purpose range from 160 to 290$ [19,26]. In a study by Drummond et al (2016) [25], the authors concluded that knowledge retention was better among students who participated in the simulation than among those who participated in the traditional lecture. The course produced variable results in terms of skills - the transfer of knowledge to practice is a difficulty reported by doctors, and simulation can help in the learning process.\u003c/p\u003e\n\u003cp\u003eThis study has some major limitations. We were not able to study the effects of other methods of learning such as within-group learning, computer-assisted learning, and self-study learning. The assessment consisted of a questionnaire and thus, the effects of the model on the ability to correctly perform BLS maneuvers could not be assessed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA prototype was developed that obtained its application in the simulation of the training activity in BLS, enabling proper performance of the procedures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBLS - Basic Life Support\u003c/p\u003e\n\u003cp\u003eQ - question\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. No funds were received in the support of this study. No editorial or statistical assistance or rights were extended to or claimed by anyone other than the authors. All figures and tables are original work of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eANT designed the study and provided primary authorship. ANT and AGO organized data collection efforts. JOE and LCA provided statistical analysis, and provided editorial support services. ANT, RDR, JOE and LCA assisted in initial study design and review of the manuscript. RDR and APS provided data support and manuscript review services. All figures and tables are by APS and JOE. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Ethics Committee of the Integrated Colleges of Patos-PB (number: 1,728,913, in Patos, Para\u0026iacute;ba, Brazil, September 15th, 2016\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAttachment\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePlease contact author for data requests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFERREIRA C. 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Surg. 2016; 31(6): 449\u0026ndash;453. https://doi.org/10.5935/1678-9741.20160089\u003c/li\u003e\n\u003cli\u003eDenadai R., Saad-Hossne R., Todelo AP, Kirylko, L, Souto LRM. Low-fidelity bench models for basic surgical skills training during undergraduate medical education. \u003cem\u003e Col. Bras. Cir.\u003c/em\u003e 2014; 41 (2): 137\u0026ndash;145 (2014).\u003c/li\u003e\n\u003cli\u003eVieira JE, Tamousauskas MRG. Avalia\u0026ccedil;\u0026atilde;o das resist\u0026ecirc;ncias de docentes a propostas de renova\u0026ccedil;\u0026otilde;es em curr\u0026iacute;culos de gradua\u0026ccedil;\u0026atilde;o em medicina. \u003cem\u003e Bras. Educ. Med.\u003c/em\u003e 2013; 37(1): 32-38. doi:10.1590/s0100-55022013000100005\u003c/li\u003e\n\u003cli\u003eDenadai R., Oshiiwa M, Saad-Hossne R. Does bench model fidelity interfere in the acquisition of suture skills by novice medical students? \u003cem\u003e Assoc. Med. 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Available from: http://www.scielo.br/scielo.php?script=sci_arttext\u0026amp;pid=S0102-86502012000100015\u0026amp;lng=en.\u0026nbsp;\u0026nbsp;\u003ca href=\"https://doi.org/10.1590/S0102-86502012000100015\"\u003ehttps://doi.org/10.1590/S0102-86502012000100015\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eDrummond D, Arnaud C, Thouvenin G.\u0026nbsp;\u003cem\u003eet al.\u003c/em\u003eAn innovative pedagogic course combining video and simulation to teach medical students about pediatric cardiopulmonary arrest: a prospective controlled study.\u0026nbsp;\u003cem\u003eEur J Pediatr\u003c/em\u003e. 2016; 175:\u0026nbsp;767\u0026ndash;774. https://doi.org/10.1007/s00431-016-2702-1\u0026nbsp;\u003c/li\u003e\n\u003cli\u003eWang C, Chen L, Mu D, Xin M, Luan J. A Low-Cost Simulator for Training in Endoscopic-Assisted Transaxillary Dual-Plane Breast Augmentation. \u003cem\u003e Plast. Surg.\u003c/em\u003e 2017; 79: 525\u0026ndash;528.\u003c/li\u003e\n\u003cli\u003eVieira LJES, Carneiro RCMM, Frota MA, Gomes ALA, Ximenes LB. A\u0026ccedil;\u0026otilde;es e possibilidades de preven\u0026ccedil;\u0026atilde;o de acidentes com crian\u0026ccedil;as em creches de Fortaleza, Cear\u0026aacute;. \u003cem\u003e Saude Colet.\u003c/em\u003e 2009; 14: 1687-1697. doi:10.1590/S1413-81232009000500010\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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"high fidelity simulation training, medical education, cardiopulmonary resuscitation, asphyxia, prototype.","lastPublishedDoi":"10.21203/rs.3.rs-16646/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-16646/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eRealistic simulation methodology is used in various learning scenarios, allowing students to participate directly in problematic situations that require immediate professional action. The objective of this proof-of-concept study was to develop a low-cost simulator for cardiopulmonary resuscitation procedures in infants.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFindings: \u003c/strong\u003eThe prototype was developed successfully with accessories to simulate cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the Basic Life Support guidelines of the American Heart Association to test the instrument. The prototype was used as a learning object for the teaching-learning process as a low-cost resource.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e A low-cost prototype was developed, and its application was obtained from the simulation of the training activity in Basic Life Support and from the performance of procedures in the positioning and simulation of cardiopulmonary resuscitation.\u003c/p\u003e","manuscriptTitle":"Low Cost Simulator for Cardiopulmonary Resuscitation in Infants: a Proof-of-Concept Study.","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2020-05-20 10:23:49","doi":"10.21203/rs.3.rs-16646/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-03-10 21:08:50","doi":"10.21203/rs.3.rs-16646/v1","editorialEvents":[{"type":"communityComments","content":5}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"351cfb40-eada-49cc-87eb-045281294bce","owner":[],"postedDate":"May 20th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":103673,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2021-05-21T17:37:12+00:00","versionOfRecord":{"articleIdentity":"rs-16646","link":"https://doi.org/10.36311/jhgd.v31.11339","journal":{"identity":"journal-of-human-growth-and-development","isVorOnly":true,"title":"Journal of Human Growth and Development"},"publishedOn":"2021-04-28 13:00:00","publishedOnDateReadable":"April 28th, 2021"},"versionCreatedAt":"2020-05-20 10:23:49","video":"","vorDoi":"10.36311/jhgd.v31.11339","vorDoiUrl":"https://doi.org/10.36311/jhgd.v31.11339","workflowStages":[]},"version":"v2","identity":"rs-16646","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-16646","identity":"rs-16646","version":["v2"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}