Does Clinical Documentation Reflect How Parents and Clinicians Share Decisions About Surgery?

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Angele Kelly, Dalia Mitchell, Anne R. Links, Mary C. Beach, Emily F. Boss, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7632657/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background While use of shared decision-making (SDM) is widely accepted and applied in practice, it is unknown how core elements of SDM are reflected in clinical documentation. This knowledge gap is uniquely pertinent in the setting of surgery in children, where parents serve as proxy decision-makers. Methods We analyzed transcribed audio-recorded outpatient encounters and corresponding medical documentation for pediatric patients undergoing evaluation for elective surgery. Visit transcripts and medical record documentation of the corresponding clinical encounter were coded for two core elements of shared decision-making: parental concerns and preferences. We assessed the frequency, content, and timing of these elements expressed in verbal communication and in clinical documentation. Results Of 109 visits, concerns and preferences were discussed in nearly half of encounters (Concerns n = 46, 42%; Preferences n = 49, 45%). Most verbally-expressed concerns (e.g., “we’re worried about her breathing”; “…she sleeps with me. I'm constantly shaking her. She scares me a lot”) focused on symptoms and were raised throughout the encounter. Preferences (e.g., “I would just rather take them out”; “I’d definitely rather go the conservative route”) centered on treatment decisions and were typically expressed later in the visit, after the physical exam. Of the total unique stated concerns (n = 74) and preferences (n = 62), about half were recorded in the medical record (Concerns n = 34, 46%; Preferences n = 28, 49%). Conclusions These findings show that parent preferences and concerns that are discussed during pediatric surgical encounters are not routinely reflected in clinical documentation. Improving the consistency with which family perspectives are documented may enhance transparency, support communication across the health continuum, and contribute to high quality patient- and family-centered care. shared decision-making patient-physician communication family-centered care pediatric surgery Background Shared Decision-Making (SDM) is a collaborative process where clinicians, patients and families collectively determine a treatment plan based on best available evidence and patient values [ 1 , 2 ]. Engaging the patient and family in decisions promotes higher quality treatment and healthcare delivery, and potentially reduces unwarranted variation in care [ 3 , 4 ]. Shared decision-making prioritizes inclusion of patient and family preferences and concerns to inform decision for treatment [ 5 ]. Shared decision-making has been explored across a variety of medical fields but has unique relevance in the context of pediatric elective surgery, where treatment decisions involve parents as proxies and often clinical equipoise [ 1 , 6 , 7 ]. Despite an established recognition of the importance of shared decision-making, implementation in clinical practice is difficult to measure [ 8 ]. Little is known about how core elements of shared decision-making, especially patient or parent preferences or concerns, are documented by clinicians during pediatric surgical consultations. Understanding how these elements are reflected in clinical documentation may promote safe, patient- and family-centered care and allow for facile measurement of the SDM process and correlation with patient outcomes [ 9 ]. Documentation of shared decision-making is particularly relevant given the recent emphasis on transparency of patient medical records permitting open access to the medical record [ 10 ]. In this study, we examine whether and how core elements of shared decision-making in clinical encounters (parent preferences and concerns) are documented in the medical record. We analyzed transcribed audio-recorded verbal communication occurring during surgical encounters alongside clinical documentation of the encounters to determine the extent to which these elements exist and correspond to one another. Methods Participants Data analyzed in this study is part of a larger investigation of shared decision-making and patient outcomes in pediatric surgical care [ 5 , 11 ]. All procedures were approved by the Johns Hopkins School of Medicine Institutional Review Board (IRB54662) and were performed in accordance with the Declaration of Helsinki. Participants included clinicians and parents/guardians of patients presenting to one of three outpatient surgery clinics at Johns Hopkins Medicine: pediatric otolaryngology, urology, or general surgery. Informed written consent was obtained from all participants, and patients were enrolled over a 3-year period. Clinical encounters were audio-recorded and transcribed verbatim. Parents and clinicians completed demographic questionnaires. Experimental design Mixed-methods analysis was used to examine elements of shared decision-making within verbal encounters and clinical documentation. Qualitative analysis involved coding dialogue between clinicians and parents during the visit (transcribed encounter) according to previously defined SDM themes to indicate presence of each element (parental preferences and concerns) in the transcript. The coded transcript communication was then compared to clinical documentation (electronic health record) to assess if and when it was present. Quantitative analysis involved descriptive statistics of parental preferences and concerns within the two types of communication (verbal and written). Microsoft Excel 2021 and SPSS 29 [ 12 ] were used. Data analysis Both clinical encounter transcripts and corresponding medical documentation were reviewed for two core elements of shared decision-making: expression of parental preferences and parental concerns. These themes were selected prior to analysis based on previous research evaluating central elements of shared decision-making in elective pediatric surgery [ 1 , 5 , 13 ] and based on initial comparative review of transcripts and clinical documentation. We chose to exclusively focus on these elements because in our preliminary analysis, we noted that additional features, such as documentation of treatment alternatives, risks, and benefits, were predominantly included using electronic templates ( "dot phrases", or smart text). Parental preferences were defined as any preference or choice clearly expressed during the encounter. Parental concerns were defined as any instance in which a parent expressed worry, apprehension, or fear during the encounter, typically related to symptoms, risks of surgeries, or similiar. Preferences and concerns were further categorized into topics (symptoms, treatment decision, risks of anesthesia, risks of surgery, surgical plan/logistics, treatment timeline, or other) and timing (occurring early or late in the encounter). “Early” and “late” were defined as occurring prior to or after the physical exam, respectively. Medical documentation of preferences/concerns reported as part of an electronic template was excluded. One coder (AK) independently evaluated all transcripts and clinical documentation to abstract the identified elements. A subset of these transcripts (35%, n = 38) were double-coded by a second researcher (ET) and assessed for interrater agreement [ 14 ]. Full resolution was reached between both coders (AK and ET). The entire research team met routinely to review coding and resolve differences. Results Demographics/participant info Participants included 16 clinicians who engaged in a cumulative 109 clinical visits to evaluate children for elective surgery including tonsillectomy (n = 96; 88%), inguinal or umbilical hernia repair (n = 9, 8%), or circumcision (n = 4, 4%). Nine (56%) clinicians were male and 12 (75%) were White, one was Asian, one was Hispanic, and two were of multiple races/ethnicities. Clinician ages ranged 31–60 (M = 40 +/- 7.45). Parent/guardian participants were mostly female (n = 95, 87%) with ages ranging from 23–66 (M = 35 +/- 7.46). Fifty-three parents were White (48%), forty were Black (37%), one was Hispanic, one Asian, and two were multiples races. There was a balanced distribution across insurance types (private: n = 59, 54%), income status ($20,000-$49,999 n = 28, 26%), and education level (2-year degree or some college n = 33, 30%;) (Table 1). Table 1. Demographics of patients and clinicians. Agreement Final coding represents full consensus between coders (AK and ET). The interrater reliability for the raters was substantial to perfect across all variables [Transcript preferences Kappa = 0.797 (p < 0.001), 95% CI (0.613, 0.981); Transcript concerns Kappa = 0.851 (p < 0.001), 95% CI (0.690, 1.012); Medical record preferences Kappa = 0.918 (p < .0.001), 95% CI (0.761, 1.075); Medical record concerns Kappa = 0.632 (p = 0.004), 95% CI (0.256, 1.008)]. Parental concerns and preferences Parental concerns were expressed in 42% (n = 46) of encounters. There were 74 unique concerns stated across 46 visits. Of the 74 concerns, 34 (46%) had corresponding documentation in the medical record. Of these 34 instances, 33 (97%) matched the verbalized concerns (concordant), and one did not (discordant). In the discordant example, the patient expressed concern about the child falling behind in school because of absences related to illness, and the clinician reported “doing well in school” in the EMR. More than half 54% (n = 40) of visits did not have corresponding data in the medical record. Concern categories were largely related to symptoms (n = 42, 57%), followed by surgery risk (n = 7, 9%) and treatment decisions (n = 6, 8%). A little over half of the concerns occurred were expressed early in the encounter (n = 41, 55%) during the history taking portion. Please see Tables 2 and 3 for further details. Parental preferences were expressed in 45% (n = 49) of encounters. There were 62 unique preferences expressed across these 49 visits. Of the 62 preferences, 28 had corresponding information documented in the medical record (45%); of these 28 instances, all were concordant. Corresponding documentation was absent in more than half of 55% (n = 34) of the visits. The most common preference category was treatment decision (n = 48, 77%), followed by surgical planning/logistics (n = 10, 16%) and timing of treatment (n = 3, 5%). Almost all unique preferences were expressed late in the encounter after physical exam (n = 59, 95%). (Tables 2 and 3). Table 2. Characteristics of expression and documentation: frequency, category, and timing of concerns and preferences Table 3 Examples of concerns and preferences expressed in verbal communication and corresponding clinical documentation. Concern or preference Dialogue (from encounter) Corresponding clinical documentation Category Present/Absent Example Concern Symptom "Well, I shake her and that's why we had the sleep study done… because she sleeps with me. I'm constantly shaking her. She scares me a lot.” Present “Witnessed apneas.” Concern Symptom “Well, the reason I'm kind of concerned over the, like, sleep issues is the reports of a bit of lethargy. So they're saying he's not being super focused that instructions are having to be, um, repeated. they are… um, wanting to pursue … testing ...which falls in that ADHD thing, And with, I'm tending to lean more going completely, like neuro-psych eval” Present “Symptoms include fatigue and lethargy during the day as well as snoring and restless sleep. ADD workup being considered” Concern Management decision “I'm a little nervous about doing the sleep study.” Absent NA Concern Anesthesia risk “Um, and I've never wanted him to have surgery again with the anesthesia… 'cause I've just paranoid about he would recover…“ Absent N/A Preference Treatment decision "I checked online for a lot of knowledge already, and uh so I- mm opinion is to do a surgery as soon as possible actually, specifically came to this doctor because they read that the intracapsular procedure is less painful for kids and they would prefer it.” Present “Patient's father would like to proceed with surgery.” Preference Treatment decision “I mean if it's not an issue then um, if it's not broke don't fix it.” Present "Elected observation for now." Preference Treatment decision “I think we should go ahead with the sleep study first…Before we go with the surgery because I think that would be like our last resort” Present “After review of the options, parent elected for sleep study.” Preference Treatment decision “Um, well, if we're gonna try the spray, that's, you know, I prefer that first.” Absent N/A *N/A represents instances where preferences or concerns were discussed in the encounter but were not documented in the electronic medical record. Discussion Use of shared decision-making during clinical encounters has been previously explored through analyses using descriptive or qualitative coding frameworks as well as quantitative communication coding scales [ 5 , 15 , 16 ]. To our knowledge, this is the first study to compare how parent-expressed preferences and concerns during pediatric surgical consultations correspond with clinical documentation. Nearly half of encounters included verbal expressions of concerns or preferences, yet these elements were reflected in less than half of the documentation. Notably, when documentation did occur, it closely aligned with what was said in the encounter. Together these findings suggest that shared decision-making is occurring in real time but is not always documented. Characterizing concerns and preferences is an important step for understanding patient/family values that guide treatment decisions. In the setting of pediatric surgical care, patients and families are faced with choices that require understanding and weighing of operative risks and treatment alternatives. Guidance from surgeons may help families to make informed health care decisions that align with their priorities, improving quality of decisions and reducing parental decisional conflict [ 17 ]. Prior work has explored concerns and preferences as elements of shared decision-making in pediatric surgical care through qualitative analysis using in-depth interviews [ 13 , 18 ], analysis of internet-based parent-reported perspectives [ 19 ], and thematic analysis of visit transcripts [ 5 ]. Our research adds to this literature by incorporating how parent concerns and preferences are documented in the medical record, which has not been explored in this context to date. Documentation carries increasing importance in today’s healthcare landscape. Under the 21st Century Cures Act, families are entitled to full access of their child’s medical records [ 20 ]. Beyond promoting transparency, documentation also serves clinical and legal functions. For example, some insurers require that shared decision-making be documented to authorize treatment, such as for implantable cardioverter defibrillators (ICDs) [ 21 ]. Clinical documentation can also shape downstream care, as the content of medical notes has been shown to impact clinical outcomes [ 22 ]. Although shared decision-making is not regulated for the majority of clinical settings, including pediatric surgical consultations, sparse documentation of parent perspectives may give the false impression that shared decision-making did not occur. Further, as documentation practices evolve, especially with the integration of ambient artificial intelligence scribes, attention to how shared decision-making is captured and measured will be important for standardizing documentation practices. From the family perspective, access to clinical notes improves patient/family knowledge of diagnosis and treatment plans [ 23 ] and fosters trust between patient families and clinicians [ 24 , 25 ]. Documentation can also improve interdisciplinary communication by clarifying what matters most to families, including cultural values, logistical barriers, or fears about treatment [ 9 ]. Our finding that more than half of notes in this study did not reflect verbally-expressed concerns or preferences suggests there may be opportunity to better communicate essential family context to other members of the care team through documentation. This has implications for clarifying how social determinants of health impact care decisions [ 9 ]. Our study has limitations. First, identifying concerns and preferences in verbal communication is inherently subjective, and some instances may have been missed despite careful review. Next, while we excluded templated content within clinical documentation, we recognize that clinicians may sometimes use such phrases intentionally. Additionally, we did not analyze documentation patterns by race, education, or gender, which are important areas for future research given existing disparities in patient-clinician communication [ 26 ]. Because our project aimed to simply identify preferences and concerns, we did not perform analyses to account for clinician clustering. Finally, we did not evaluate whether the patient or clinician initiated the topic of concerns/preferences, which may also implicitly or explicitly influence clinician recall or intent in documentation. Despite these limitations, our findings highlight descrepancies between what is communicated verbally during clinical encounters and what is documented in medical records, revealing opportunities to enhance transparency, continuity, and family-centeredness in pediatric surgical care. Conclusions This study demonstrates that parental concerns and preferences are frequently expressed during pediatric surgical consultations but are not consistently documented in the medical record. Improving documentation of family values and treatment priorities may enhance transparency, support continuity of care, and facilitate communication across providers. Better alignment of physician-patient interpersonal communication and medical documentation may also serve as a measurable indicator of patient- and family-centered care quality in pediatric surgical settings. Abbreviations Shared decision making (SDM), Statistical Package for Social Sciences (SPSS), number (n) Declarations Ethics approval and consent to participate All procedures were approved by the Johns Hopkins School of Medicine Institutional Review Board (IRB54662) and were carried out in accordance with the Declaration of Helsinki. Informed written consent was obtained from all participants. Consent for publication Not applicable Availability of data and materials The dataset supporting the conclusions of this article is not posted publicly in order to respect individual privacy, but is available upon email request to lead author. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Agency for Healthcare Research and Quality (AHRQ K08HS022932), National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI, R01 HL166504-01), and National Institute for Deafness and Communication Disorders (NIDCD, 1R25DC021243-01). This manuscript is the result of funding in whole or in part by the National Institutes of Health (NIH). It is subject to the NIH Public Access Policy. Through acceptance of this federal funding, NIH has been given a right to make this manuscript publicly available in PubMed Central upon the Official Date of Publication, as defined by the NIH. The content reflects the views of the authors alone and does not necessarily represent the official positions of the funding agencies. The funding agreement preserved the authors' independence in designing the study, interpreting the data, writing, and publishing the report. Acknowledgements Not applicable References Boss EF, Mehta N, Nagarajan N, Links A, Benke JR, Berger Z, et al. Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review. Otolaryngol Neck Surg. 2016;154:405–20. https://doi.org/10.1177/0194599815620558. Elwyn G, Durand M-A. Mastering Shared Decision Making: The When, Why and How. 2017. Frosch DL, Moulton BW, Wexler RM, Holmes-Rovner M, Volk RJ, Levin CA. Shared decision making in the United States: policy and implementation activity on multiple fronts. Z Evidenz Fortbild Qual Im Gesundheitswesen. 2011;105:305–12. https://doi.org/10.1016/j.zefq.2011.04.004. Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. 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Engaging the patient and family in decisions promotes higher quality treatment and healthcare delivery, and potentially reduces unwarranted variation in care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Shared decision-making prioritizes inclusion of patient and family preferences and concerns to inform decision for treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Shared decision-making has been explored across a variety of medical fields but has unique relevance in the context of pediatric elective surgery, where treatment decisions involve parents as proxies and often clinical equipoise [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite an established recognition of the importance of shared decision-making, implementation in clinical practice is difficult to measure [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLittle is known about how core elements of shared decision-making, especially patient or parent preferences or concerns, are documented by clinicians during pediatric surgical consultations. Understanding how these elements are reflected in clinical documentation may promote safe, patient- and family-centered care and allow for facile measurement of the SDM process and correlation with patient outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Documentation of shared decision-making is particularly relevant given the recent emphasis on transparency of patient medical records permitting open access to the medical record [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, we examine whether and how core elements of shared decision-making in clinical encounters (parent preferences and concerns) are documented in the medical record. We analyzed transcribed audio-recorded verbal communication occurring during surgical encounters alongside clinical documentation of the encounters to determine the extent to which these elements exist and correspond to one another.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eData analyzed in this study is part of a larger investigation of shared decision-making and patient outcomes in pediatric surgical care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. All procedures were approved by the Johns Hopkins School of Medicine Institutional Review Board (IRB54662) and were performed in accordance with the Declaration of Helsinki. Participants included clinicians and parents/guardians of patients presenting to one of three outpatient surgery clinics at Johns Hopkins Medicine: pediatric otolaryngology, urology, or general surgery. Informed written consent was obtained from all participants, and patients were enrolled over a 3-year period. Clinical encounters were audio-recorded and transcribed verbatim. Parents and clinicians completed demographic questionnaires.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExperimental design\u003c/h3\u003e\n\u003cp\u003e Mixed-methods analysis was used to examine elements of shared decision-making within verbal encounters and clinical documentation. Qualitative analysis involved coding dialogue between clinicians and parents during the visit (transcribed encounter) according to previously defined SDM themes to indicate presence of each element (parental preferences and concerns) in the transcript. The coded transcript communication was then compared to clinical documentation (electronic health record) to assess if and when it was present. Quantitative analysis involved descriptive statistics of parental preferences and concerns within the two types of communication (verbal and written). Microsoft Excel 2021 and SPSS 29 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] were used.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eBoth clinical encounter transcripts and corresponding medical documentation were reviewed for two core elements of shared decision-making: expression of parental preferences and parental concerns. These themes were selected prior to analysis based on previous research evaluating central elements of shared decision-making in elective pediatric surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and based on initial comparative review of transcripts and clinical documentation. We chose to exclusively focus on these elements because in our preliminary analysis, we noted that additional features, such as documentation of treatment alternatives, risks, and benefits, were predominantly included using electronic templates ( \"dot phrases\", or smart text).\u003c/p\u003e\u003cp\u003eParental preferences were defined as any preference or choice clearly expressed during the encounter. Parental concerns were defined as any instance in which a parent expressed worry, apprehension, or fear during the encounter, typically related to symptoms, risks of surgeries, or similiar. Preferences and concerns were further categorized into topics (symptoms, treatment decision, risks of anesthesia, risks of surgery, surgical plan/logistics, treatment timeline, or other) and timing (occurring early or late in the encounter). \u0026ldquo;Early\u0026rdquo; and \u0026ldquo;late\u0026rdquo; were defined as occurring prior to or after the physical exam, respectively. Medical documentation of preferences/concerns reported as part of an electronic template was excluded.\u003c/p\u003e\u003cp\u003eOne coder (AK) independently evaluated all transcripts and clinical documentation to abstract the identified elements. A subset of these transcripts (35%, n\u0026thinsp;=\u0026thinsp;38) were double-coded by a second researcher (ET) and assessed for interrater agreement [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Full resolution was reached between both coders (AK and ET). The entire research team met routinely to review coding and resolve differences.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\"\u003e\n \u003ch2\u003eDemographics/participant info\u003c/h2\u003e\n \u003cp\u003eParticipants included 16 clinicians who engaged in a cumulative 109 clinical visits to evaluate children for elective surgery including tonsillectomy (n\u0026thinsp;=\u0026thinsp;96; 88%), inguinal or umbilical hernia repair (n\u0026thinsp;=\u0026thinsp;9, 8%), or circumcision (n\u0026thinsp;=\u0026thinsp;4, 4%). Nine (56%) clinicians were male and 12 (75%) were White, one was Asian, one was Hispanic, and two were of multiple races/ethnicities. Clinician ages ranged 31\u0026ndash;60 (M\u0026thinsp;=\u0026thinsp;40 +/- 7.45).\u003c/p\u003e\n \u003cp\u003eParent/guardian participants were mostly female (n\u0026thinsp;=\u0026thinsp;95, 87%) with ages ranging from 23\u0026ndash;66 (M\u0026thinsp;=\u0026thinsp;35 +/- 7.46). Fifty-three parents were White (48%), forty were Black (37%), one was Hispanic, one Asian, and two were multiples races. There was a balanced distribution across insurance types (private: n\u0026thinsp;=\u0026thinsp;59, 54%), income status ($20,000-$49,999 n\u0026thinsp;=\u0026thinsp;28, 26%), and education level (2-year degree or some college n\u0026thinsp;=\u0026thinsp;33, 30%;) (Table\u0026nbsp;1).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 1.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Demographics of patients and clinicians.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cdiv\u003e\n \u003cdiv align=\"left\"\u003e\u003cimg 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b+17bysLU/B+/dtUt/Rd0giu2oFabxySnQWIpgJ6i5hMBRp85XeNZFVX+c2bN6PkpmJV3EBLXS9+bmtfaivi66mw1N1TN3xtC0sD46rwEQBTA2t8ePWKWj0n3Q8toLUqAr1HnP63UCtL76InbPb1rW8dKmi+xzlAvpXaVvm1Vmx8Z/J1a8Yhz9HKv9cCKuSl2oVDQR3pkxb474P7QO9W2o29M1S+sxgqtnGApuVaDK2YO38N4Pi5oeK5+4/z+PkvuLZ1noEinXc3VIjv+Tmejt8DKK0aBohX53Re/3kucH8Nhnk4xTWF7r2FP5fHy3l/T7of4D50Hgf6DvzqWXUN8XKNvwOeHeo70HnFh9O3Dsvxd+rfjffr33dOPtpGzRfkIcfzl6NvPfWd6zXXCO9BZRz0rnBeTlWudsXjr9/f80b9jsA9KF/tm4v+0v5S5XYpXPoQqQTDKSDf7UM4nBKe4RbKDxW1N2jPFe7zkHnqILOwjgGDyUNGRQDeOY6PPYgUwr5gXA71j9SBlwbqLtTKxxxfPBWodFE5+5qvcwNVMhNbDrpXOlLkEqnqFNwukrbGdwutqHCekI9dPXIJSO15a1BPtNRGp4b6bF/qsymyJ3q4eZg+GUJYTgRICCGEVVzsGEgIIYTTEgESQghhFasFCDNFpqzLhnBJMGNF5iSmZtbIOu4UXK+4emVkTjxzmDtjy+9Jbs61hOstcFQ8U4tjw3WzWoAwXY+V3OeyejaEtZCHWVXNcCAOczGtSpEK921n5b4gLqaSK66WeZ058cwBAbTN7plgZbjuCff06dOtJjl6gpR3g+B49erVGNcSkzjhulglQMi4Ms/RsxwbwiXhFf3jx48ffPjhh5ujd8ztLVAeptZBLO11IGx6jTTMjcyxncT1tZJHSE5V/AiJ1poq4mJtAQIwgiOsEiBkXDIPrZiemWC66OriygltdoSb0/1VWKkDKFQcz+mCh7ANNz5HfuS4Vszk+TkL5OiZe16tzI1nDnMXzVbjejwjZXcKbK31rEGzYPfhw4cpg2G3QXSMDLbUWGQyLL7SvaWbC/wHMhwGwDh+/fr15L4WgrBkWK2opABSAG5hxWs4HjR6yI81P5Nnq4G6HliuJb9ibI8K1lkSzzaWqK8qCIcpY4eU397qZco7jUaVbYz39XpI4QYYMsIiWHXpq2RZ7VhXbbMi1c+RDCsjgfAcu5uz6pb4FGe9hxD2BfmUPKm8Rj6reXlu3mNF+Zp4WmVETnEQ91qIpwdlCwd6Fyq73G+9tlX+w+2wWIC4lVa5asKADKhzyoSC/3MLYEXx7FJ4QtgGFaLyL3lN+dzdnEqTfL5rPPirAne8DNS4p6BsTpWfVvnGqdHGf4fwESC3yyIVFl1V7MoP1925IVO9p8ZifERdeFRPhBEcsyXkGoaM3x3cC2FfMDtJ4waocjy/A/l5rvpU+zDsGo+D+sr3qGnF3WOb+orJBIpnEFzjOX4p0xoXqhMBdtlgKVw4Q0aZDS2XVmuIVkhtEdFaaYGfJ6uWzRwIx7Vzw4ewBtQyvTy2JP8RT4+58bR6ILu0+JcUedIlvKdP+VWvivufesZw/czOTWQUMlPNgBII7kcG93M4FzDeTVZmRJBwzO8UHk8I+0B5T26qYq/+3iDivMfTamyJGs8S1pYBnrN1rT+D0xIg4OV36hnD9XMQY4qomeoccWagzOmuT4VDTbZtnn0IIYTjsNM03hboR7/44ovN0a+wL+8UCB3GTFpzzwXCY8o/hBDC8di7AGGgjTUgCAN3vXnlgh4LnaG66Am0KBFa/iGEEI5P9gMJIYSwir33QEIIIdwGESAhhBBWEQESQghhFREgIYQQVjFbgLTMs+NYt3FoWP/BNN8lcG9L914A0uJaN83SA5Pdx3j+EEI4R2YLEGxbPX/+fNxsh4lbuFcbc85LK/elsP6jLkyscA8SGAi7tTBNuDeduILdIF/U2NvBLYQQrpGdVFiq1P/617+Ov4di2yJE8MWLCLtjg/BiL4gQQrgVdhIganH76nAqUldxuRrJ/Wovwa9x9RH/3XooaSqc1Ef8f/v27YNPPvnkvZ3gpHpzVRPn6LFoZ0TvOegeHVff+fMoHhxpcw+EUbw49c4UxxzVWAghXAQsJJxLNZLYsgqKoTUZRMRIm4wlyjCb4L/CEUZG2YhT14CnQXgdKz5dx383Tsex/LlOVkOJW36ElwE8wilOnOg9j+KRn6cBxOvPgf9a43khhHCOLBYgVIqqaLdZBXVhwP9WeK+03Qm/RpW2O1Xg/K8CRMcSEoKKXtcpfX7Bw8qvh8dTBQhwrHi3vasQQrg0VqmwGGAeKswHX3311T2VjoPKhgF2wThGayOoX375Zfwd7uWeA+J29RVjG6Tr4bYNru8C9zYIgc3Rcr788ssHL168GNVW2QQrhHBtrB4DoeIeegQP/vjHP27OvENjFAwoD72OzdkHYwXKZvyVDz74YPxtjQ38+OOP9wQEQunQA/YO9zb0IFaPW3DvCNk3b97EinAI4erYaRAdC7tUsD5wTYX5+vXr96bBPnr0aNz61nssCBvC0cr3gWz/77A9KL0aVejEpUHqXXoKPXRv9CJE794+/PDDzb/7PH36dJwhNmdacAghXBR/mwn6fILLCXT/OoeeH6djXaNxEA+L0/gA+HnGSxiLIHylxi90nnN+rzVNH0epft9+++3df4/bw3Bv4GlorKWGAZ7Rj0MI4VqIOfcDw/Rh1FfpgYQQro2dVFhhO0weiPAIIVwjESAHgLEZLSR89uzZ5mwIIVwXUWGFEEJYRXogIYQQVhEBEkIIYRURICGEEFZxdAGiwWUciwCZ5urnhFa041g4SLhqadfBzy3uhnBNuEVoz+eUodb5KYirQnmr13sZ9AW0retvnd779+82x6IFE3D0rv1aOV+I7d8ep3NHrQcZRD82JOuL6/jPOV9YCCwO5JwW/GlB4hy4NoRrgPyvxaoO55TPKSeUkVY4p1XOuKaWSZU5wcJZzoHCh/vGYOuCYdVf+r/tnfF+Vcfxjut34hv4uV4dx/me3745iQpreLh7m0TJTpQMKzqsocCm1PBxNme2g5TO5k7hWsD+229/+9vN0a9gqw1zQiCzO7It14Je+lAxvbcuCaOf2LVzSNPP0RqWHTruhXimNAK3Au9yqEffe3/w+eef371rfSfvQTj0TjB5xC6nwHf078R1fAOd45j4WygtmXk6JCcRIFjYxWaW4KXwAb755pvNmXcvyC3xCu+2Obxc/HC+uZNeonfHj9rFC2EHqFiw/9bKt17B4PfkyZN75xxVXFUQUS5UaTnVdh3/fftmxSP/8D71XSPge2BvD0Eu6nekbnTDtRxTz9V6ULD+zHdpPRQnESCysOuZjwzqvYZqiRcI88MPP4wSn48h4UBLCIEBXDN0BUd/wnFMOKwBc0w4N8gYwrnj+bbV6qcSwW9q62cqHIyROr1GGlD50etXJcU9VIjPG31hO1WoCBrUH3/88ebofagb3R8BwTdBm8P3qYLceyqH5GSzsLzHQQVPpU8h0QO3CgPXqHvmXWpaUFPS/euvv75rxSkcJtZDOHdUEfBLhcGeOLVS4DwqJSohNaoqNJg++uijzdE7aPHWRppDL0S0eu3EF1XxPHh/3sNw1Jid6j26+gr0n/qQurMVN9fQED8kJxMgdMeU+ehVkJGp3HlgXmivZbSGY29EFcKhQE3VqhRo2dIapSy1oAw4CBp69DSqcPz3Hg6VFpWShBN+PeEUppGA6NU5rbFfp6qvKsTL9zsFJxMgdMe8xwEUjpcvXz747rvvJrtzS/HeSgiXjvcMHNS0vZ0vKQMOlY43qOjdo7LSeAiVllq5Umf1hFOY5tNPP703flSZmvgAVX3VojWIfwxOJkDInDw0OlbNJqBgIFTYubDXnZtD3dxpaiOqEC4F8i9lo6dHJ4/3dr6kDCxpRCGIfKIL6VbhRHxUjqEPgtt7fy1VIHUd2hfVT05LfVVhIkRrwJx0e42NvTG0Pk4G86aHF7c5egfHnHeYH82t4gahczenGqc4dMz8aXB/8GtqmiGcK+TfXr51P9zQ+Nr4vA/lYirfU65queOc4uZ/hXMqb7eMfwPqGeBb+Hk56rIWXFffP3C+dc22OEn/GPVcrPGGcCMwvoEufR/jfxojaU0BDsuh9zFU+KM6cR/QK2Ec+dBjvREgIdwQDJgzKN5Tg81BlR3q5l1UzeE+qNVRRdUJD0tBTYbK8RjCPQIkhBuj6uWXghBKtXEY6NkxgUHLFZaCEGKyw9rrlxIBEkIIYRUnm4UVQgjhsokACSGEsIqjCxCtfK1ONvAdzvtCw6Wg6816j3AtkJd7trB6ZaiFLyrkv653SEvn5ZS2Xx+m8fc4py4jjH9HfR//7vjvUi/uk6MLEIZcnj59Ojr+y7Foqb64XeCFM0skhGvhD3/4w+bfr5DPZaYHWgvVHCojmRDiWv6rTHolBV4+SUMzrrAtRzxhGmar8c30Dlk03VosKBA2TI3WADj1IdY5uJaFoKof8Wc69lk0joebOzosjsE5LIapC1+4vV0WKhFfa5FNCJeGFvr5gr66OHDOYkEvT77wkHLiZdL9oF7Lf7+X8D68T18cWI+duvCPY6+e6zEQvn6nY3M2YyDMf54yi0CXTV1BnHfh3K/Xc2l1BUO4BGhptkxVYFTRywxrO4YKpWsSA3z9h6/hoKXsUz/dj/iY9uvX6v+5qFLOEXp3bkqEhX2sz2hR9wPBWvggoDdHv5o78fdNeK47JScTIKisVOnjvOvWAn911QdJfveyydx0DTmPowDVrh1hOI9/Vs6GS4N5/a2Ff739P1rWXVlbUPcDAVRelD/oqVeozFqNu+wHMg11TqW3/qbuB9KzW/bzzz9v/r0zSOv2yk7ByQQIQsArfVpAU+MeVPxalu9G3bDcS1yC+Hz5PoWPzM/5EC4Nesz7WBSGcKj7gQBWYikbtHZ7GgDGPFrbp2Y/kP0gwb10Vb/Cn7IXeBYqLF4EvYtW76GCkMHqqKAV1jNhDUho4u21rkI4V8izvmcH+V7H0Mv3LfPg21aeI6Ra5YTjqr4K80DlVGk1kls9xpawh2pp/NSczRjIthfDDAQKDi2e58+fb86+K0Q9vSIgmAg/Nb4SwjlCw0q9dBz5mJ6CetPo170HQEuUSqvVkp3q3YOuqdf21FdhO7w33/wLbUhLjdgS+KinfJMoBDkC/twE+dkIEMYxoGc9kp7E69ev38vgFCJetHfjfDowaDOXbVMcQ7gk6kA244JM+2yxbT8QyoargkVPfQXZD2Qa3hsb5AECgDqstV8LdRqC33t/nKOxII0Mg+X1+yj8SYXK0Jo5KiTZc46fHyTvOAVOx0xf41fTCJmCKD8c4fHTMf66BhfCJcIUUOV5R/maMtKjNcVX1/WupRzVaxzuxaf2hvfxumnqXfH+W1N8a13nEPfUNz8GMaYYwo3AgHz2AzlP6E0MwuJOPTkH1JKoMKtW5phEgIRwQzCOiCp4F7WHKjt08qesvK4NrfeZY2qfxgBqyam91o9BBEgINwYt1zmVVA+EUKqNw0DPbtt+IIzxHmO3wTlEgIQQQljF2czCCiGEcFlEgIQQQlhFBEgIIYRVHF2AMAAnp9WxzOrw87KYq/NaMHNMuLdtZlVCODUMunrZmYPKnQwpumOAljjrYtywHuoz1WnbaL17rx/lz+9ZwCD6sWHxS2sBDItmWBwTQpgHRVhlprfQ0CE8CwShljWu12K2OXGF7UwtBKzwPWo4vgPX10WI51JXRoUVwoWinrnMgGOAb2p6Lq1g1oBo7YabDwfMbsjUBusLWGcQ8z+7wfcYhMDmqA/fkjUgvjCTXgYGNId6+r11O8RL+FNoZ5yzFiC8QLptQl1uftXNU/dOYXGueqLQ6Lx3I7kepzjVrRec824iYRVPClU4B2RDSZsKYaxP++RUlJe9IvJFgPhTBvwcQsQtX4fDUTeUAqwGIHxU71SVOuGzoZQ5VrYKBIMMLAqs7iKNQZKXAgS8bPyGbt24twj+FAokNeeJW0YXEQCkjwP56wNVYSKBofhTqMK5gCkLlaWpxWW9DaUEVmNb/o/NoF84HHxD7xFSf1EnsV0F9Q6CpO6Jfw4bSnFzR2fuGAh6P79F/lddIPpczvMrevpBv77eQ73Gw+JX0w3hXCB/kl/57YFuvVUmBNd6GRK9shrms208SXWYw7eq35Mw9Rt6PXUKLmoMZHh5Y6+E1tZUq6j2IAjLNWuhJdCy2R/CqSGv0wsZyvJ43JvtMzU20lJfhePR2lCqxSBQNv/Oh4sSIHTPKSgIEqmpWlBY2KAKfwQHumEVsDXw4dhYJ4Rzgoqfxo0qfgSJb0Lk1EaV01NfhePQ21CKb1vruOxIuANqXSFIqjRWBU+hAgYL2S8dHe6ue0qzaQ4zHgQ9GqUTwqlQxaPeOGWg10pFQPQ2lPLZVxUqMMZWwuHQZAgXFpyj7tIgOd+YRoBPglD4XSwr7wx6rGNCknLDSxvPSQcoh74QvV4Nx3mdQ68Iutb9OOd+csTDLzpdneO/X4uOUf9xisvD8D+Ec6CXXyuUJ5Ujh/NT+Zk4w3q83mi9f0E9pDrNUZ3V+g58+1OPT128NV6k8PCS73XlQwjvQw9+yYZSmn146j0nbgHVY0uqY41/nbLeuygVVghhPSxSY+xwjvoVlQmqrQiP44AQYGx3aqzKoTHA/venbjRffA/EZ1elFxLCdqikts3Kyna1p4F3nw2lQgghXD1RYYUQQlhFBEgIIYRVnFyAyKjhEpgd0ltxG8ItwiyeudYWWgO1MiwK6OGXlsnQh7pqbn3Vevf6tjj583sWMAZySriFM7iNEC4arTfYBmHqWhGtufJ1CNvsN4V5aB3HnHfJuo4aju/A9dXeFfES/tSctAfCVEGmrul/CGE59BzmmCKhFTxURO/NVGTG1VBxbY7ekf1A9gOz3QYhsDnqQy8j+4EsBBtVTEUj8/K/Qual28avd+v478d0ydXF8/MUGF2LX9Re4dpQBfLo0aPxt4dUHrUiomz0putmP5Djkf1AFkLG/81vfjP+50W17Nq39v9AIHhY2YghHK0r/AhLwcCwHAWAOdOsEdF+ICFcC1Qgcxb7tfYDoSxss3NF4y7agcNzqfuBnEyAYOhQBty0IKZmVFX4FBC1kvj/9OnT8T9wrfzcqiULccj8vHjCZIFhuDZoTH3++eebo2mokNjy1qEFu20xGuWmpR0I+0ONY6+jZBhTCwrVSPA6UuFP2Sg+mQDBTAIvSN0zqBmV8ZE5+38AhYn4QrgVKEMqH9q9k/+tCqWuPKc80UBT+VNvPWre45P9QBZCBqf1Q9dMDmFRu2O0juTX2/+DuCgAQJcvhFsBoaDyg/oW+N8y712n7qpsyam3HvMlxyf7gSyk1XXmGAlLT0KoNSS/Fuh2UWnN0QOHcKtM7QcyBRVY9gM5LKiiqN9cWHAOoZ79QAokiRte2ObMO4aX9Z6fnxtaR+M57N/7Oc1hx3Gd/v/zP//z3X/CuV+dUx3CpaNy0AP/WuYcyprKmDMVZ9hOq15rkf1AQghnDT367AdyntCbGITFqE6cCz2SU+8HEgESwg3BeCHjJdvUHqhMWKg2ZfY97Jcl75zGAGrJUwv3CJAQbgxarlOVlCa5ZED9+PDusx9ICCGEq+dk60BCCCFcNhEgIYQQVhEBEkIIYRUnEyBMW5MZBbltMPPAFxqGEN6h8jSHuiodGJhV2WIgl+OwO7xr1W++ULBHffeytMGv4/Wnm59hJtcx68iTCBAekjnPTCdkDB+HuZL6onhJehmyrhtCeJ+5FT5ljLUDDmXOzQgxxRdL2V4xheXwTXjX1G9Yy6DOm4J6kdlvmoHFsWycVT799NO7upMZdaonmZmFBd9jNQBOIkCwa4XA8LnoPDgv2V+Y27qXdd0Qwn2oPLKh1PmBpWS9awmF2pMQNJbrhlLUiQiICmF9GjbCxC0tuwA6NEcXIMqQbvteyDQ1D05mp1WEhVBaTQ7StXbdwLuL+lD8cky6+g3hWpBaJBtKnR/1XU/1QFobSvXwBgDflTxQ14Q8e/ZsFEiH5ugChO4VtJbfyyolRt/I1LSKnj9/fk8K1w2iVIAoCF9//fUYlt4NJhvw8x4NfjHLEK6JbCh1WfQsANQNpeZAA5r6rbUoVPWrGg6H4mSD6GtBoCBt9YJkS58PwMukl4GKTKbd6bJDBEe4NuhNZ0Opy4Bv1ethqBHcalRPQSObRjF1XWvMA43Mjz/+uDk6DEcXINrGVi/NkTDY1h2vKC5eJC9UbukHCeGSyIZSl4Hqp56wnruhVA80LnVixLE4ugDRNrZsaVtBWqIn7HXzetTeSAi3AEJBjSX1tPnfKj916q4GaOWkLo79q/3DIPeUBqS1odQS2GSqNTX7GBxdgFDZIzFp7XhLiRYR5xjHEEt6EBQAxj0EXcZWLyeEWyQbSp0GKnbv/bUm8VDP0XBeW1+hGvO6T5DuUm3OYobWx0l4+/YtI+P3XGUQNHd+czaI8nNstFLTCOFaoQxM5XH8KR89hgZYNpTaI636DUed1qK1oZS+ab22d94h/anvvS9ijTeEG4HxjWwodZ7Q+6AXsq/qmEH1Y5h8jwAJ4YZgwHxowW4dZ0SlnA2ljsu+3jmC//vvvz/KeNbFTeMNIayH9mJLX+4wNslYZITHcaG3wHtvTcmdC0KItXbHmgyRHkgIIYRVpAcSQghhFREgIYQQVrFKgGj1Kg59HTMI0L3tE+I71eKYEEII21kkQBAUCA1WrDJ0gmOqGNPP1ixS6sEgHvasQgghnC+LBAhL8tmzw+eFM3MAG1SysrsPmGLIavUQQgjny2wBQq8AQdGy/slSfG1iIlA/Sc0lkyX8cqyejPuBn689Gl2Lc9UWKjSc0iOOEEIIR4BpvHNgmT3BWSK/DZbls9weWGbPknpf2q8l9oTDhILAT9cRRuHA/8vsgu5p7n2FEELYHzvPwsI8Qu0ZbNubQwuUZNodWD2JekwrZN12PgPqxKF0MD3NSktUaVyDW2J4MYQQwu7MFiDajObNmzfjr2DFI4PqWMNFMEiFRIU/CKg7t62CnxpDQZ1F/B5fzE6HEMJpmS1AGCx/+PDh1n12JSjW7M3RG79AeMWsQgghnBeLVFjYaaFn4YPYLegtLN2bg8F5VFNaT8I2mqSFioy9gvnvtvR3sRcTQghhD/xtBQxoc6m7apPewzBYPgiA98LrvwbSfVCccz5wXm3gc+zhSSOEEMLxiDHFEEIIq9h5FlYIIYTbJAIkhBDCKiJAQgghrCICJIQQwioiQEIIIawiAiSEEMIqDi5AWPwnG1a9TafcCu+cBYKEcyu+IVw7sjhdoUyp7PhC2ylqPBy3yh3nFbcvBN62kPiW8bqMRdBz8Pfp1+Na9ZzqVF130u8xrgY5MFoE6AsDHS0IrIsRW2iBoqz2hnDtsKi2VX4oA1pAq4W628oFYQgrOMbVhbha/Kv/hBEqz+F9/P3y3bYtcPbwsC08eaCVD071PY6iwvrggw9Gi7nDi2pKVAwpDi9lczRNbGKFWwPDoa0N1ihX2ocHG3SUIc71oEU8VDb3DJsOdcBYNiuYFlI4paGyi8Vs4pnbwr4V6A3yLvXesBuIZfIere/hFsor9BLZ1K/Wgaf8HkcbA+HF8HLdTDvw0tkWt8LLUjduWxcN/6kuXwjXiFc8qDWePHly75zjlf8carjawJN/ytuv1E3wpt5R63tQF/7pT39q1mMc/+Uvfxn/q65zTvU9jjqILoOJrk/FaCKWfh38kdy0jnD0XHrjJwgajDwSjlaaG3EM4RagMqHimdoS4Ztvvnnw+9//fnO0jipUiI94w6943TZF63tgNFb1GPsp+ZjWjz/+OP7S2CYMAr2OW53iexxVgJABsdT74sWL8ZiX3eqy0YriJYkp9VZr86q5HzGEa4CyggqDstBraFEmtKfPUqjIquYAiE+t4vDgwaNHj+5ZFFc91FIrtr6Heo80qKnHaBQINtCjh6nGNt+jqsdO8T2OKkCAHoIe/Lvvvnvw2Wefjf9b0B1DMPAyW+gD4U8hkut140O4VmicoSKmR99i7dihyljVEoT34RuwuR4NWeotGr40mFv10bbvwTVc21NJffjhh5t/p+XoAkQbU9GqQar2Kns+AFIWgdDrgejaNZtXhXBt0JvvDcKunerJoC1bR4d58K7UkEUAaAJCZe73kNoQ9RT1pTOlmTkWRxcgQFeM7llvd0O6gLycOdvW8pGWbl4VwjVCmer16KmA6iDvNqjkvKXsOnkgPgRMeB8awNRvvQbytu9BHehjJHxX1GPqkdC4rmrFk3yPQVIeFN/0aRAKm7Pv5jPD680cZrmhGz6e93OE5dc3ocK93cyflj9O14dwLZCnPd8LL1s4lYcWlDMvf8LLztAYG88Rj8crV9dpEZ54wzu8ftpG63vwPnV9qx7zurLlf4rvkQ2lQrgRWCdAb30f4xm0hGkBz9EShDbX8D0iQEK4IVCtDK3U96bkLgEV8dB6Hiev9FQ0YR6X/j0iQEK4MerYxlKo9FJt7I9L/h4RICGEEFZxkllYIYQQLp8IkBBCCKs4uABh7jg6upar88oPBXOq1y6kCuHUkH+nyowbHp1jkdXLAuFbcXuacoo7ZalPfWe4bevSWu+Tb9qrH/k2/p1P+T0OLkBYmcnsAOCXIRe5KeNv+4LpbZgWCOESIf+yIE1lhsWCVCCCyonV5/LfNo2TCk32kqigGLz1uLVQDXQeh4E/zfDBeCnxhPvwXfyd4WBqZpR/D8E3qHaunFqfnfJ7nFSF1Vvmv0+YHkfmD+ESwbqqrzjG1hIVhsCe3FxTI7RamTKqCo0GnK9cZirozz//PP7HMqxDmljTBsoU8czp7dwS9Z0hUJ429loR9XsIvjcWNlpwDXnAOeX3OIkA4cV6SweQoHLq8hGO7hlh3Y+WE/9r141jhaumjh3iUDhcCOdKVX/I4qt4+fLlmIe3VR4qb77eANPgtHRJQ+loUZtXavjRU/Fr9b+W41umCgIXupXW9wDqrV4vkvqwZ/7pVN/jqAKEFg6ZvXbByPxSbyFdeYm8CJlnRyLjh1RWi4lj/HipIGHDeaSxCkYL4iAcjhbClLAJ4dRM2UxC/UE+poKfagy19p9AWJD/KZeUid5ahDdv3jRtLBFf9gPpg6CvAkK0vgd1XmtzPYGl5V58cIrvcVQB4kJCUMnzoiVc0MPqxaN64rwkMhKejKwuO36CwqBwU9t68pG4D9LCIWiyp0E4V6gUKBNqDKFi8nyvVi+VP8KgN/DK9a39QFRheWOs0mtJZz+QPrzLKfVV63vQUO6ZNaGRvU3lfxP7gQACQJJUptjVI5BbCwXIC1hFBdDT6rW8Qjg1lBV63uRZ9d6xZt2CSr6a/BatPE4lR6uWMkBjjbirCoSKjmunWr7hfabUV1C/B9+ChrMatvyn4YDgUCNbfmpk8//UnHQQHdRbUAtrLWR8vVBaUz3YiGXKP4Rzg561GjsIkqlB86oWEa2pnlRy2j9E6ixtnSp66qswjbQoPer34P3rG+NoNKCp4dvTy3Q/zuPP/1NzcgHCy6FQ+DjEmjEJdH8UgG0zUvRRd00vhGOiBtJUbxnLrr38j2CpYymUPQbhBeqPqlaZaklnP5A229RX0Poeu3L1+4HgsJnfwsNwzWuzfT8ImHvxDB/nnu184qzh9f/Pf/7z3X+ugaEHcncO17unEE4Ned3zruN5Hke+7kFYykXFywppOcTXukZwT8Qb7jPnvfS+hyAO6rwWnG/lh1N8jxhTDOFGQJ+e/UDOh2v4HhEgIdwQqMGGVupOg+KMVw6t53EsUbPAwjou/XtEgIRwYzCAu8vMQyq9VBv745K/RwRICCGEVZx8FlYIIYTLJAIkhBDCKg4uQGT4UM7NJfTO92C9hq/ZIG5mMhyCQ8Ydwj6h7FCG5i7GrYvYOPZyxYyerI0Ks2AM5NAwN7mXVJ173kPrQOaGd5Zew7oQ0mrNtQ7hnPD1UVPrQEQNp2trGemtNQjBuRgVFitsh0y+OZpPz7jcFMzLHgrQ5iiE84VywfTNOdCjZsqoT/Uc6oBmuSJeVkuvKT/hdjgrAUJXnO60zDZs65ZXlRbXSh2Gww/DY1jc9bgUDkdawtMN4ZpQPl+y3gAhQvkJocfZCBAyeGv/jxcvXmxC3IeWkW/7iMDQddp0BfPHtK5wnKflhVDBvg/HWCBlJSggXD755JMxffxScMI10dp/Yg6UQcpWCC3ORoDQMqJCZ0WlluNPrapsqbQkOFiU0zMPgNBBUNDLkMBCeCCoUFspzaiwwjVBHm/tB7INygMm30NocRQBMrXB075AYLhqqoVUWOplyFFI5BfCNbLLSucQehy1B9KqpPdZcWvfBLrdrSm46l1oE6vKTz/9tPkXwnVB4yqEfXMUAULFTaVebdVTya/Ry7bQwDn4xvPaMEdwHxr3AMZSEGKcQ72lwUZ2dmNTmMyHD9fA2v0nKBtT+3SHG2dosR+NofK+m3eOY6650FoRHHby8dPx06dPR6dj/Ooxazc8/rebue4eL/+B+HWOeITHSVy4EM4ZrVmSUx6vcJ58X/Gy0MrvnA+hR4wphnAj0ONfsv+E1oAwYSWEFhEgIdwQTDAZeiNb14OgDkYVnMH3MMXZTOMNIRwe2os+BtiCcUDWSkV4hG2kBxJCCGEV6YGEEEJYRQRICCGEVcwWIKyH0CpvnNZLhBBC6MOEBNWbdYEzM93k11rsST2L37kyW4BgmFC2qhg2WWLV8xJhAVVMWYcQdoVp09SZ2NdjcbLXKzLHj19r0gJGMOFcDVpGhdWhZwU4hBDWgqDA0vcSDc7jx4/HWXHnyE4CRN0rWuvqhvmLobvGOaQnUlddOXXjpBaTRMafbpzOc6w05BS/0vS0XUr7eZzT2w9EcH+YNeFDE0bPoXh0T3oO7p///Ho44eo/b32EEG6Lzz77bLQijkXwbVCfff755+O0a3ouZwnTeOeC2QSZQ8BUCJfjdA5TIDKHgOkETIwA5/SfXzeZID/CKz7SEfjr2ONXWBwQh5tq4LzMmXBe6ROHzD3481T8noHr/L44Bs7pPhSea3Wf+Ou83pnuK4RwO1APeJ2kOoJzXtcI1TFAveH1z7mwugeCgURWtIJ0d9VwoTZlwkruNnMIvh+Im1rgWh17/MNLv/frex0guYePc2d9l/tT+r39QLZBS0DdSMLrXri34eOP6SkNVvCqxcA16snwbPDmzZvxN4Rwm/zlL395bzzE8ToGBmFylmqsg42BIBB4aKlu5lTSU6B2mrtLIFZHJTwc3QNCYxCed64VtqJJA6ivvvvuu7Er2sP3P0F4IRg9vbm2iEII1wl1Dg1P6rRWg5I6Rg1PHA3fc1RjHXQQnZlbVJgIkmrKfS4aP0Bi88LnQG+E8BUJit5+INtAF6lZEVNCh/jV20DwrTGjHUK4btBYoLlAE1JhbyJvdOLAx3nPgYMJEFrq6p49e/Zs/AUqd6m86BEgVZG0vReD5EVVNqeXID7++OOxl+FxIoiAD+a2gLjHVu+olR49B+6nhbcOEDJPnjwZ/7MPA8+nNHgv55YJQginQdt3O9QPrT1YaED7XkdnwSDZZsGADsHlvv3223vHPpjM4BAD1fzqnAauQec0kMQAEv5+Xni6nOfX48V52rrW48N5+ooHR/wtPM5BGG3O3h8IE5zze+K/U58hhHBbeJ1DfeFQN+mc1xVeZ3l9VP1OSYwpLoSeDKo5h14MOxi2WhMhhHCtHHQM5NpA/ZTtPUMI4R0RIDPQQP6XX3753gwq9JWMcTAGooWFIYRwC0SFFUIIYRXpgYQQQlhFBEgIIYRVRICEEEJYxd4FCAvmtPzenRbyTcGq7SyyC+F93IK020/y8jZ3EgdxiVpemWlYIT0vv359uHEYRD8EWiAIWtTXW7S3T1hwcy6LbELYB1N5mnKlha2UuW1lzMPDtvCErWVX5TmEo6iwMEQ4ZO6mfap9c3ZL/UPYEWyptXYApbc+VOx3ZnfI+z1TO0APZaj875npqRa0K/Q8SMPhXogn09bD0cZAPNPSTaa7TNdYv6AutPxx6jprLQaFpna7pfbi/9BiGs21K3N7XOl6h0uDvC6rrK66gmqk0y1GV3TOBZHWMBF36xrSq1YXxFRa4XY4igAhk9EywiIvBcJ34xp6QaNVSq/c1cJ5+PDhXQbm9/nz5+NCPrab5T/X8qteB8fAtTIrguFEzuNIoxbCEM4d8i4NIyr72uqnPM0BA58Y9nQwOkrcr169Gsuklw3FO2XElPhknTrcKEMGOghuXBDnBgZ7OlTO4ScwQCZ9LefdT6AfdgOFHkc1QIbz+wjh0iCvK3/zS54mn4PGK1RmHPK9wrXQtcLLCeMfrbGSWvbC7XHQHoh6Cbg1hgYxic7GKvDjjz/e634DrbGWLX1BF38oCHf3sPY+QjgXKBOUBaA8UMYoA6ih6LGT31u9Bm2h0INruBZtAQ7TPFL9oj3ARQUcKkcbA1kDu/69fPlyc/QrdLXJ2KiuhlbQ5uz7+N4jIVwLjx492vx7tymRGkcIgN6YxdzKH6GE80YXg+i4lKVQOWsBQqtI4xZeaBAqCI7aIwFaYUIbS7lud856lBDOEcYl2Dagle/VoOqNWTBeMbUzJgPqdYxkG8S3dqfRcCUMLYy9Il2qnOtSofoLP+c63KGL/p6elXMKi59+AV2tH0tPLNcaRwnhXKl53WEMQn7bIN/X6ymbur41xiHwa/lzfcrTbRNrvCHcCIwZMiuxbkmwBsZJ2N4gY4q3TQRICDcEqq6h19BUg80FVdrQmxnVw1PTfMP1EwESwo3BuOIuA+IIoVQbASJAQgghrOKsZ2GFEEI4XyJAQgghrCICJIQQwir2LkCYocEgW3VzF/Dpehlzq7Ao0A3KsQAqJhbCtUMeV1nyhbGwtIy1ygvX1niFLGGr3KW8BbF3AcK0PsblMasgW1hMG8SWzpwMzvTAHjI/7TCnPSYWwjVDvv/666/HsoTDfImgUscqg+bC9ISAQBDUfXlkLbsF4WnMEb/WfHAvnA/hKCos5pwjUOZsKMXc8h4IC4RSCLdEb0MpKn4aT1oY+PnnnzdtxwmEDY25unaDBYGUzwrhKW91sSD3QjyuCQi3ydHGQJRpXcUFtK74XzPjL7/8cheOMD2qSquq0EK4ZMjPvQ2lsMrrtqio2GmAtdS/CBuoggitQGs1ucoctrdIu6qtFI/iDbfJUQSIushkdgQJrRfR61VoIyi655irbhWKlkpLK2S5lv/buvQhnDvkZfJ03VDqp59+2vy7D42vSmtDKcrl7373u83RfX744Yexd4OBRqVfy1I2lAoHFSBqObHbGV3knqnpFlJ3IWAQBG/evBmPnSp8ECiko94OBcD1xSFcGsrL/FKRk6fXtPppgLG9gYPqSuqvCuUPf/U0KGdVPUZ8c9TS4Xo5qAAh05HpcbsYXZs76wNdsQpcCNeIbyj1m9/8ZvytfPDBB5t/v1InmtDY8k2j+F97OE4VPiHA0cZAdoHM/+GHH26O+qRFFG4B7Y3Dr+d3eib01luNqNoIo+ehxh1OsybV0EPdjBrLyfTdUDmJAFELSeMadI1pAfk0X6msaCmRcevgXwttIKUBQJgzdTiES4Dy4htK1YFsVE70UFps21Cqwowuxi1VRhkLwTnZUCrQ+tgrQwXOhPQ7N7RsNj734bzCsFmNh/M4/PzQQrp3TT2G19lAKlwRnseH3sXm7H3k39r0SVAOetcD5Yy0HN+wqvoB16R83TaxxhvCjcD4RjaUCvskAiSEG4IBc6bRz1EJ90CtxVgL6uJMWrltIkBCuDEYU6yzspaAEEq1ESACJIQQwiouYhpvCCGE8yMCJIQQwipWC5BqxPCUMCMEvWyFwT6ttMXpfhVe7thrRUhvbZo8Q8++V++b9N5DCOHwsC6tV/Yos/JrLdTs1W1nA2Mga2BOOZezZuOU+JqRHq057sA1x57Hrnn9U3P2e3AN17aeRXP2fd1MhW9GuBDC8VHZr+WXOqxVpkFl/lzL7aoeiOaAw3fffTf+ngqmETIt8VLAuOOQKTZHy8AY5SAgNkf3qYYlQwjnB2UUm2PUoXOhzLOJ1zmySoBgwpkKi4oQ0woVqWjUPfOumdQs3q0DddUUVte6qgc/XbNWBbQNT0MfmbQ45p5AYeSve+e5/L50HufvQLTeD0x1eSuexlKIm3vQ89W0OFbcbh6m91xSlbnKjOs8PH6iqtZCuHY+++yzsd7EQvk2KDuYlGHxJ6aezpJNT2QRdKsA9Q9RuBpL3TScumX8pwvmphEUB2oVhcPfzS0QRuHwk3qmpqvjHlyndKtzFZareHSv8icO3SdUP6j34c/i1/NMhPP3o7jqO+C/4gePR+o7vQf+e9iKP5/uAcc5xaX7wF/p8Kt7qs9IevJTfPLXdbonfvU9QdcB590vhGuD8qCy6uWCcyprjpcHypTK7jmxuAciqQisZh1exD01llQ0OO3FQRiQmmV4cXd7g7Ra5i24VmYTWuaqt0G6w/Pecw6t5OFD3pl54Jf7nLthDi153ofi5T0Rn1rXtCC8t1bfz88//zz+p6vqBvE45lpvuYsXL16Mz6XVwPyfi9RhXMOz1hXFGNKjtQTcpxae8T64d0E8PKfeH+hXJsD13TwNhdf7Ib1YUg63Anmdci2tRoXy7ub6KXPnqMZaLEB4CLpfKvhUAi011qHghUsg7RMq8BrvXDMNVKLaPEsqLCyVUkG7wJpjN4iK2vdemBKWLaGyDxRv6/lrxp77jip63/5+dlkdHcIlQbmh8Ua90dosj0a56hQ1sM5RjbVIgFB5YBbaC/3r16+7LeR9Ij06qIW7T9hvhHjrc/Q27XHIDLwLrudD0/tACKypEOmR1X0YoFdR97Y13QWlxTuv4NdqMCztFep9h3Cr0LOnkcmW3RXKtdezOKBuOScWCRBUJlJrCNQ2vAT8dqVWKlTGOHodUp1I7bNvpI7zQXDS1vNScaqy1kekJ4bA0eAzYaTe0d4k3kX1uHswYEa6qrxpibjKyKlhqdgR5nPS2QbfVDPtgOfgWVFfkobeAb+E7Qm4HjLm5/e6j/sO4ZJoaSUoU6296umx1D1ZTs4g2WYxVK7jQE69ZKjc7s7jhoe8+4/fULncHf/rv/7r3X/O+7VcB54O/jjQ4C3Ow3z77bf3zjtDBX7nhyNN8LhwSgP8vAaUwa/Rfcvfn1lpQE2H46n3o0GyXnytsLoXhfXwovUe/DrS83eq56rfQpC2zvs71zlcDVOfG+p9neMgYQj7wMsSZcFRvQBeLlUOwctT9TslMaYYQghhFavWgYQQQggRICGEEFYRARJCCGEVESAhhBBWEQESQghhFScXIJn7H0IIl8nJBAiLZbREXyvMhfxwLQEjK7Fz7GitjYfwujaEU+JWkat1ABZ4ys8XrU7h+V3X4ipeDj3dOeUu3AYnESCsaGb5PktQnj59Oq7YVqbED1Me+HFeK9EF/1n1jD8rpbUKvAV+r169GsPC3HgoONwHfq9fv06BCSeDfMrqY/Li8+fP76wfgCp15VNsJ5F3p0AYyGgleZ5rcY8fP76Xz72M4jxd7OG1BE64QYbMcTRYAc2KS1ZVagWzViXrt66wJLyvruaWWcEs6rEgHl8lXY+n4iGc30c9DuFY1HxHXtSK/epHGVI5akE58mv8P3nfywDx+Irpesy1Xi7DbXLwHgitJHWDaUlhy0o2r7y1JPPuspEk3DItcQ0F6J7dJVpOLWuWP/7444NPP/10c/QuXtKkFTUVD/6E8/sgHuIL4djU8uC9hOo3ZfhTvRW/xv9XW2b0Uh49erQ5ejDaZnIjmrpW8Ybb5GACRHpb1EODoBqdMh2/dMfpIqtb3AOz6BgNBO2ZUSFMpWel9pdffpmMB/8Wh7B6G8JSsPCsPWsq5FHt1VPBGCmWtHtQDmlESZDQiKpU69LEN3e/nHCdHESAqLeB0OjtgUFPhPEJLLtO6VNfvnzZLTAh3BL02H2zMQcBgPNehYOf9+YrWNNeaumV+LIJ2G1zEAGC4KDnsW3wGcHw9OnTseXTEiLMhPJWD6qvFq2C0evOs2/FVDy9fS3m7AsSwiFhcklvOwMEwNSGZVN706CGQkXlwgcVbyWTSULlYCosMjOtEwQDbkpXqozvYZh9Um3ik8E1jiHowbD3RgX9rbeOiFvjHlPx4E84v5eqDw7h2FB5a5ywQkOrp7oSvcqfMkBjr/by67gfwmtKBRZuk4MOolMZa/yDTIogQTDQFfcBdFXWagHJT5kaf4Whx6I92InL9baO4tJ1pO/d/6l4CCfdru7FW2chHBPGE70xRH4Vamh52fGGkaDyb40VIii856K4EUioj4H4fHM1QXw+USXcIEPlfhKYFkjyckOPoHkeN/QIRj8xVPbN8xzXc4qDeCu9eMDvI4RToTzoTtNplX/dca4F0249n3Ncr8X51F7fxMjPC9JqnQ+3w8k3lKL73euar4EWmFRRIYRfoSfDjMZ9TEqhZ0+vfmrcJVw/V7UjIXpeutT7FEghXBOokYdew04qWVRaQ29mHEdMQ+22yZa2IdwYNLSmZmVtAyGUaiNABEgIIYRVHHQWVgghhOvloAIEXalPObx0WibhQwjhVjmYAEFwMNCGiem6iAk/LTBsCRjZ0eotfnIUT6ty53r8iK+yJA0EIWG1d4nWllSI09e3gD9r9avonnB1Lj/PJ7+a/pI0wuXh+aJ+e47lh5uD5/k51yrvqRzNKTPhNjiIACFTswiJWRoYTWT/AGU+FQCGXpgNUvcwoDLUAkSmCeq6Fvj19vsg07MgED8WUbmAWZIGMLOLe2XxIdcwFbJW8DwDq9kdzmHBlGt4FxiPrBWA4P64T8LyTAhfoefCj/vwvRmWpBEuD759bz8Q4FhlAP9teRlBoEWJhOU63OPH9/cDEYQnPcJoym72Awl3DBlj77DQiUVGLA7Uoict5KsLjzjvi/y4Ja4T9VgQT10YpWPC+6PV47lpgK7lV/fJM3l4+ZE+i69EXWhVn9Xx+wOPi/+eHvHqvS5JI1wetbx4vvC8CZxXGWhR84r/r3GB57MK1+IfbpuD9EAwSkhr3Pfp6O334UYKaTkPBeDe3PIhky7e74PwXCeIj3iJf0kaoHAYqxMYtPPr8WutPalTJTE54SYpRO3NAM+G/SHguRx6KtqbYW4a4TKp5cV7CcrXypvkF3rULdQr9fj8v+dnkFaAfEZvo/ZOdG16u7fNQQSIrOyiTtm2j4bvYbCv/T5a4YH4l6QhhtbWOP6Bq1DQpgzZ9dJr0RIkordPCSxJI1w2NBh8JTmNBY3N0XjorTJfuh8Iwoi0pD6jEeMqYiC+7Ady2xxsEJ0W+dD9HTN3b9CNTIurraxzg/tTL4CCqlYX905B690/vQiEqEBItd6FWpI+TkPc6p1RsLWpFiA8VdDnphEuHxordT8Q5R2Y2s+D/LRkPxAEE70Z5W3KsowriuwHEg4mQADrnWQ8aFVqdQ+Dfe330SsoxD+VBoUMASHnLS4KKr0qnoeBS4QI1nzV+sMhZKjMJQgQohRu+TNhwAWBQ0HU5lo4/sv6Ke+IuOVHmur1LEkjXDY0Vup+IJQr8g69BOgNok+tPCcvu0XfFlPCJ9ww40jIgRgqvbsBZ5LiVzDQWwcIoYarx4Jrh4pzc3S4QXRHg9NDj6A5uEj6PojuED/XzYE4WvEDz9kbJF+SRrgsPK8L8sJUPnfIF6282csz5DHPZ1xbw20btA/Xz0F6ILTcfXCNAeoho92pXfDv7WEwZNqd9/sgPNdpIJCeDvGKuWkA9+WqJaB3sGSDKe4DVdMcy6Wk1WppAvfKc7YG7JekES4LehWuKiIfgHbPVD5XOWvBeEVrnK/mGcVND5eersol6q2qIiM+rg83zEaQ7B1aK0QvJ+p5HOcchamtm1ZYxeGtJcH1rWugl0YLWlpKB9dqyQFxuZ/SaN0b5/BTz2cqbj1Hq1cylUa4fJQv3Hk+qHlT+anS6rH7dXKcFx53L+95+HB7HEyAAJm5p4pZy77jW8K+K2neT08YhbBvqPD3ld8QHMQXbpuLssbLIPEgQJrqnUsDVRVqianBzRD2DWVoqPwnB8y3gVpr6M2MEzt6qt9wG8Scewg3BjO3dmm4IIRSbQSIAAkhhLCKg64DCSGEcL1EgIQQQljFQQUIg22aV34N1PUgIYRwyxxMgCA4mKnR2lAKqIxlfqOaX+CY83NsOimOVuXO9a34YUkaCELCymyJL5L055Bzocl/ndeCrx4eV8Xj0eIuQbzy83sL1wN5Yyqv8t17+aNS4+G4VX4Eec/955SZcBscRICQmXsbSgEZHFtWjN/j6kpYpgZyfttmT/i9OvGGUqyo55wcYWQ3iIp97mZPhCVOwpKWF1K9T8WDYBZcQ7xKv244FC4f8ieNlx7kbb47eYM8MDW1FgHjq9o55roe5CUagU42lAp3DBlu77DYj0VGQ8a8W/jni/CmFgNyS1wn6rFgIVNdWatjwvuj1eO5aYCu5VfPwP1z3LrG06krdbne34PDvXtYP64LwPyY+Px91uNwHfC9Pb+L3vkWNT+KqXzJNS1/4sEv3DYH6YHQAu9tKAW0pmnB1JY/Le2hMNxrQQ2ZtLnZ0zlsKOVxAL2IoaBtjpZtKMW9++Iuno1nBN7lxx9/PP4HelTYywLic7tcpKHNpsL1Q++TnjblCdfr4er8kgWE9NRbdteg2qILt8lBBMi2DaWo9AbhNVaw3hW+xA2lHCp1KnBnzmZPvc2ieMaeOkrnETyVrG6/DbzypjxR5nqm/LdtKFVR/qqNJCcbSoWDDaLTcnn+vL2hlDIlFR2Z3scuzhH1bmCqlcez+o5w9CIQogIhlQHIsC/oodJ7lmmfZ8+ejfm0lT8RCEv29GBcZZvJIOJr9ajD7XAwAQLbNpQCzEZL5XJpG0o5VX0Fczd7klnuCs/YawHqPPFXIqRuk6newpJeKXnbNzdT7zv5KlQOKkAErRSNT7RQ19rHMUTV/wv0/t76IdNrbIPwXCeIj3iJfyoNrkUVINdqgXGOVp/GJ0RLfQUUXOIiTa5r7VlNuhqjET62UcdoELhKy8dKgPtYoqoIlwv5w/O5aDVIllT+lBEvBzSMcFGNhspBBAgtd68MqfzqwLWgRe4VNRn1EjeUquorh/ugop/a7Il7lz5Z961n5B0xdRLUOlRa9OC0VzX3yn1oK9xw3ZA/KFfqKfNL3m7lZRoVU+N8ayA+n8gSbpChhXEQhkp5nNIqJ5j+5+eHlvnG51d07VA4NmfewTn8HMUzFJzNmV/h+tY10EujBVMllQ7Op9QCx630lUbLj3P4+fPrHK7C1Fz51Xfm99eaphkuG88XuIrOT+Vl8kXLX2UE1yonQPqtPEz45Lfb5mACBKjo9r0mYd/xLaFViHaB91OFUQiHggp/X/kNwdETOOF2yIZSJwK1GOMc0SuHY0IZGir/O/XoGlCVDj2XcVyvp/oNt0H2AwnhxmBAfZeGC0Io1UaACJAQQgirOMo03hBCCNfHQQUIulJNMbwG6nTeEEK4ZQ4mQBAcDLS19gNhLYNWueIqGFnk/JzFT4qjVblzPX4tc+1L0kAQEpY1Fvz6GhfB+ZawZE0Hfq3r/D1o7UcP4lZY7seZSkP3jrsmYX5rkL9bedXzxdzvW+PhuNc4opzU8jOnzIQbgTGQfaM555rGW6f8kaymE+LvfhxruixhpqYK+rRErvEpvn7sccKSNIBn4Rl0jZ4N+OV5cJ4+yE/wX9eBHyuNFnqfUOPclobH6+8rXA58N76r8oDguyrP8Z8w275vzR8c47x8CNLDr5YPpRXCQXIBmZpMR0ZVBlcGVYWnTEyG94LhflCPhVeq4MdKQ9TjuWmAruVXz8Az1fA8bxUghPdzfsyvF9p67NSK34+n0iCMF/56HC6HWk6APO/w7Xt5CPj29RqYuo681MozxJO8FA6iwsIwIeY23H6T9hVg3vhQEO7218B2E2ZIAPULfj63fMikzb06zmE/kG24PSvwvTrcnhVU216ObHUJzFLM2Q+k2sWqNsLCZVPXcvQMjIJUm7us/3AUT1WZhtviIAJkzn4gGk+gwpNdp0vfD6SCQKto/n1rHn4rfB3vEDo/lca2a8N1QZnANlqLpfuBzIH4sh/IbXOwQfRt+4HQC4Avvvhi/D1n1LsBhF5aXeHcoFGA6/Uw8Ottc7AW4uv1msNtcNBpvL39QPhPxvvbOPzwbqYHXPJ+IC0kJB29h9ZMllb4nqpM56fS2HZtuB5QsU5Ze47JnHAIDipABMJC4xNUvPxXJYaf9PJq6RNOVP2/qGMGxKuxjVPsB9Jiaq8OH8eAOqbj1DGaufuB+HgI1LGhcB0wBbenuhKtBksIu3IQAULL3VvoVFyq3LXZjdY9yE/Qyr/E/UBaTO3Vwa+PqbBeplcJrN0PhDCElbBEXdjbMztcJuRfGgoqD+R5bxwJGhXZDyTsnaGlfRCGSnmc/irnMCXR/YYewcbnHbp2ECybM+/gHH6O4hiEwubMr3B96xropdGi3i/HjvvV+/Br6xRKjuXncTJ1sobXOVx9X1NpEFZ+xBEuD/KUviFO1DKGa+V1IF+08rrKSOtaj791Lf41v4Xb4mACBKi89l1pnbISbAmpQ5IKP+wTKvza+FkLgqMnrMLtkP1AzhDUEqi0LujThAuBMjRU/ncqrzWgIht6JPfGMsNtEnPuIdwYDKhnP5CwDyJAQgghrOIo03hDCCFcHxEgIYQQVnFyAdLbhyCEEMJ5czIBok2QWPjGb4UFc5z3BYliajMoZjDhh2stqHKm4kGwKZ7KkjRC2BXlU1wtDzrvblue9Pzu17Vwfy3Mzar2cAeD6MdGi9uAtRUc+0KlqYVxrI3QegzC+Vx0XyzlabSYisePPU5YkkYIu0I+VRngP/mNfAetNR3b8qNf73me/57PgfQU1uF+ku8D7D0XqFJtZTxBxldmVSXeWqRHPCo8osZdC4QXqnrsTMXDvXm6frwkjRB2peZ/8qLyWy1jnG+VI0Fe9fj8P3HVMoEA6cG1xBdum72rsFhYNMQ72sih29sa48Ai7pBR77rEoA2npqD7PhSge4uXhkx8Z2hQRhFFNVgopuKh+8+9+UIrN1g4N40Q9kFd8Ofqo7qID3tpPXtqUn15fP6/xkV4FrO66srRtVWlFm6Lg42BsFAJQYKhN+lQpZsl8w2tm3HDqSVjCFObQfXiaZ2fiocNqVqwWc+SNEI4BJQrGdKs0LipAkds21CKPEwjSoIEo6eU36GnMZbTVkOQ+LKh1G1z8EF0MjsZUb0StWYwRzJ0ucdMj3AJIUxD2ZHF6Qp+T83idAUBMbWhFBarfXM3CRIEEmWXyS61oZQNpcJRZmGRuRESZDZvPfGfTE/LZ44QmdoMqnbBRev8VDwyN19hA6slaYSwb1CV9uzATamvYMp0CWooNwnfgnIqVXEI4qACRNMPyfi0YnoVrXZS26ZPJYMzPuEtIR+T8PEQ8I2XnKl4uEfGR/xeEHza/2NuGiHsE8Y+psYJp9RX0Jt6SxlgL52eWszxsb8QYO8ChAyJ0MDRJUZw1IxPj0SqLFBlPVUABC2h3mZQUxsvVabiQU0g3a7uU/e2JI0Q9gENMVcVkV+dbeor6G0ohVrZt8KtcYPKZ20AZkOpQAV/EoYMP04blPPpg0wRdL86TXao7MfzTGmsaK48zuPUNc5UPH5/lV4aIewb5TN3dXot+din5LbA3/N5LWNyisfzP/G3mJNuuG5Obo2X2R1zpvDugyU9nRCuDXoy9KD30WOmLKH68t5LuD1uxpw7hQeS4cMtg2p56DXs1IhCTc04IeOIvXHNcBtkP5AQbgwG1LOhVNgHESAhhBBWcZR1ICGEEK6PCJAQQgirOLgA8b0z3GlG1Fqm9kgI4dbQ+qs5tBYVMhtSa0AoTy3bVyFUDi5AML3AbA3glyEXFj198sknqyt+MjoLoxTXKQy6UWBbi64EfoQJ4RjMrfARMtV+FeUQW1eCGVqY7tHMxRB6nESF9ezZs/FXJtKXgvkQwRqSY60jcTA+NwWmsEM4BmpQbQOBwBTeOvWW9RyPHz/eHL2Dhh9xTjWSQjiJAKkZmIxNRpVKCtwkis4B/zEfor0K1Mr3sDqHiQe667TOOO/mU0BpeFo1DNfLTz0m7pcWm+7BUVzAXHm1DLlW8fTsEoHCkYa3KvUMfr2/M92bjsNtoLwuW209lD/q+g/yVW9tFEIkDaEwCdN4Dw3mPkhKZj9kJgEzCD2TIW52gTA4gQkFN+fAseLmvEwsKN7ejoHyV9pc6+nyX9fySziZbqj34NTn1b0IrvV0HPzAr1F8gv9+X/5uuCelG64fffuaxyqEq/mVa5SPevmZ8woTQuWoPRBa5LSOab0PmXJsDaF+GjLpuMGUoLU0VIJ3rWnC9/YdoAVGj0Rx02KSZVLS4HzPdANp+K/vl6B70LX8cp9rxlu4ZijAm6N3ajfiVquwQs+C+x++z3hMj03/gWcS3Jfrr9n4KquDbwPyyZQJd4dyUvcDmWOFl7yUHTdDj6MKECpNKkLcVMZlx0AqSYXF9VbOagdBD4vbFd2Ds7ZipvAyKCmm4kG4SDXmKixA4HBeAk8gfKlM8I9p+dvh5cuX42QU8gS/wP9Ww6SWH1S1NLQIj5NaOAPnYQknGQPZhvZMn4M2gJIueF/oHmq8LgjmgsDwgX/R2ryKsAhA0qZnoTEZCjktRvyqYPvss8/GyoRJCdtalOF6QCiowfT69evxHP/rOAfUcTfyia7FSQsQW3FhCWcpQFQA6iByCypcKtQ5YZfAPdR4qdCprGGqF1H9UDPQwpMw4JcC24pDLUD8pPYiPPfSK9yEpYJoCakQoLcfyDZoQKVXG7oMrY+DwsAcycjVATkG9+Tng3hDC7x5nZ8bKtXxHPh54tGgYg3n+DXE3wrvYYhTeHjutcLgI378Qi/+ir8vXQs6p+v59XfpA6Lh9lB+74H/VL4jr3n5E1NxhhBjilcCPaVTrIcJlwO92yX7gTCuBr192EM4SxVWCGH/oAL9wx/+0J3956A2ZVwtwiNMEQFywVDINYsmvY8wBxQO9EKmQMCw7/8ue4aE2yAqrBBCCKtIDySEEMIqIkBCCCGsYrYAcaOC1Wl9Q4VZHMdc2cpMpH2sAQkhhH3hY5W1PqSOlF/LyKqsT5wrswUIA2rPnz8fF8AxbCL3+vXr5gIlXtqhLXlWYcFAcgaTQwjnhFb9U3+yoFjTo0H7JeHXmrQg23u9Rvqp2VmFxYrt1lQ/Xhov5VCwQtaNCIYQwrlDnUjDes5UakGjnVlx58hOAoSXUCWjuly126VzVPwKU7tsCqNw4PHhOMY93NiD4pwkOt1Dl+5+bSst/KWa8+tCCOEQYAoJE0UyfjkFdStmkJh2Tc/lHFksQNyCZ30JVPqco0tGl81VWJwT9FpevXq1OXoHFTnqMK5D4mrHPwwIEpbzvHiOuZ6wwHl6QKiz/CUjHLgX/HHELyGiX/wxE0/8h1a3hRACoGanAbxtfBgz+tR1shxwjmqsxQLEx0BUiQsqfbpoMhI4V4VFZQ+8LGDFrMYy+K8XOGUJl/Dcm5jag0O6Ru6fe8XybgghHAsarnU8xKEx7vUdddk5qrF2UmG5dASpnZbC3hvqFfTAf0kvoX6AluXbEEI4BdRHGg958+bN5uyvfPfdd6OftD2M956jGmvnQfQKO+IthR5A7+WgmuIFIrGXDMrzgebuwRFCCMcG1TtaE+yTVahHpemRg3NTY+1FgKDLo8XPYA+SUiopKnAEA0JAPQDtIEh3DJUS10p15d05TdElPqmanG2CYMkeHCGEcApae/xQV7X2YKEB/cUXX2yOzoRBss1Ce1C0HHt6CP7r/FBh39vTwv347/sTDMLkzg+nvS38Gt2D4tQxYTincLqWX53ztPxZPAwuhBD2jdc5gyDYnH3H0EC+O+f1HedFrafc75TEmGIIIYRV7H0MJIQQwm0QARJCCGEVESAhhBBWEQESQghhFREgIYQQVhEBEkIIYRV7FyAsKNTye9w2g2GHhAU520yk7IKetWfCZUn6hNOix32y7R7XsiReFpYSNhwOveM536SVJymnXMsCXuLSQt4Qpti7AGGlN0tLWPXNysnWSstDooxPIWiZCNgnDzcm5XtgJ6y1SUyFwuvWivfJtntcy9x4qczmmK4O6yHPuxXsKWsLCAnMAgk1BFRuMTqKZQjsyJ2y8Rcug6tSYSE0VDgoBK+Kyfh9s69KHyF7qIr+UIJpbrxUTJiiCYeBXit5fpvgAARCNQv06aefjuVE1q8Fdpp+//vfZ5+cMMlJBYi6zThX39DF1jmdVxeda1rda8KpFVbj63XvdQ7nBUXqJN3fnO684vF0idNbcX4fcjXuOWm23g9wjeJtFXz5+TWg87iq/uh9oznouh9//HFz5h1q9co5np4c4Umb59Yz6l70LnC8X8Hz6/yc73ep0Mt+8uRJ8x04Oi+7c8A7QoBgX4lrPa8CQiT75IRJhpbLQcA2VbX54uCHfRfArotuhXM6j/0Y/Zf9Kw9bISzXCI4Jq2v9nvjF7gwoHBCG/zjSUnqDYBr9Hc4pLBCn0qppg+IEzit94L7lv+0ZceDvp/c8U/cIShPw41jPSjjOge5J6Sne1nuB+u2UPvg34p51335vSo/49d/TB67TvXNe8XLO3y3XKdw1ofeib8Qz+7t18FM4wbsmPO9Y39PfLxCmngtBtGupPeCVTwsyrioFOQqEVwTOtvigXluPKUResQgVRME1KjRTFWX1q+l5hdgKKz+Ym2ZNQ3CuVUm20tX1rbg45r5b98C76z2PU5/N36/+u9M91O/jz9S61xoPjvshjnp+W965RDx/gb5JKx8Qjnfo1LD+fUX9JiE4J1NhDZl91McO93DntEGVqyUEOlptsLJPlQRxHWOQF73zUDjvNo/561//ulVn3aL3fnifS/c64R6Iy9GxzO77PU7tCOkQbw82DxsEwb3vrokGmOD3Ad6pZ5KqjTAeF/eL31C53juPOubamcpPcyZzzP2+IYijCxBV/lQiVCYtGFSm0FPhSi9L4eAcFQZ7hCzVx1e4ngoYu/sIsmOArhmdNem+fPnyvYHLubTeD++ztbPZFB999FFzIy/Oq+KuOvW5Qq9XYbF5GN+wBQ0IF45Di7mbns5L0Dn4rdnY7NJ49OhR8/u1hG5tKAD5p45Pzf2+IcBRBQjCQxulMHjn02yp0Kms+JVw8M1TXJAMXerxf2XJ3uZsaEUr1bfkPTRsuKUW8ZwWYYve+9FgqND7nELPLqFOy50KifO8ZyoY7lkg9OglbOOzzz4bhYQG8lVJUYlpENd7kfpPeH9H275NvT+u5xnIY76xGed0L9cE75KGg56NX8pGSwgwo6r2DHl3PkjO/2fPnm2O3qH3GUKToaDulaHiuKd7rg5/MVQAd+f5D9Kf1/Doe2vYFgqD3lb/0Z379fiRjvvrv6ftYXB+7+B+Nb6aHng6cuigl6TZez/g5/WOdIyr9whc72Fqen7PXA/1mhaelu5L1OsVr18jx7W8Ix3rvoXfn94z+PvHXTN6xvpuHN5hy9/fk76Dc+3vLuxGNpQ6IvQKaquaVuMt6Ofn0Ho/nPv444+jWtkD9OLpdWzr2Qn1bJI/Q4+rWkh4zqCmqSoEKkf02OGdqqRlOeCHH36I8NgTjJ3xjrepNoG8icoywiNMkR7IEfFZU4C+eu1A+jVCi7cuXHv79m0EyJ5hLGpqDA4B8+WXXx7dDFG4PCJAQgghrCIqrBBCCKuIAAkhhLCKvQsQBkO1EAyn9RvoVf285v7r/ByISzND9g33MGdwcSlz413yHsJtQb4nb/TyEgPe+FH25lAXFXLs63IEZU3pkoZoLUoMt8neBQgDngyrPH58fz8QFj1puIWV3xo89vNTkMFbq273waEKxNx4KfjZMyO0oBJngShlhPJEPnFBgX9r9loPhIGbi+GYiQoVBMb3338/pou/z95iES7XhXAxKiwEDkLpEKxdFb6NufEidI9lTiVcFkzz1up9ptQ+LCZrONcSAC3oyZDPfFYbAoLZgBWEhCwbEJ4w33zzzXjM/RCPtAvhdjm5AKGl4y31qgLD1YxKb6R13lG3n/hd7eXd8la3nXvBz68BncdVNYLSwnlXfw66bh97ZkgNpmfUM/Tuj/86P/Uuw+mQ8BBre8vKszW+HrXxgzkT77konpZKLdwOBxUgsp7rziHz1e63dkhTy4heh89HJ04yM60uVFrenRfEi+0f4qAlJagw1S2nBYW9JL8e9QCFhPRZRCUotMyL5zr8CKeCQ8WrtIiT55krRIhXz8p9ObwHzuN4DxJ2EgpKD9QCdTUY/rROCS/7Uro/4Ll5N0qDCmOp8AvHh+80dyW5Q++BfLqEnrFTQXzqlYQbZag8DgI2jLCzUyHJoSLbHL2/z4P78+t+Nc4al+Bc69G4nvRa1HR1fSsu4hkq9TubTvwKzuMvPF6H+/BwrTTd6T0QP05wXvG37hX/Ghfh3AaSnMcbzg/yTKtMtfJhZSrv1zwFHBOnIF3Pr1DLbrg9zm4MZMi4d+ocWkBruux0r4lHvR71Mmi9LbHYC9q/wpEO+dz3zAD8B4FxLy7eD+bOeUd+PqvizxvMuqw1LVJVUtsgL5AHVYbo+bvl4xDg7AQI5qSl+kLdstacAgWASpFKEnUQIIzqWMM2tH9FVZUhKM59zwygEmipIrj/lvovnCd8810E/JqGGPmTMkReHHofq1Rn4bo5OwHiun/cGqjQNVbg+xugs3VbS4TbpvenwqYS9gF3xk7Y84KKm4LlLbNz2zOD9+njTDwvz63NiPz5W5MKwulhnM17ncozSyDvT/V6e5A/yEOthhzxqXEWbpShEtorQ6V4p1PHSW9a9froWNGh1nD8ejgc4QivY/SxQ6V+d6wxAMGxx+P+Hg9xgMfl94QTfq6mV68Xfg3vpVKfn19R36PirfeH49oa3vF3wX9R42rdYzgt/n3kfBykfsOaNwXnld8dz7ueN5RnKC89CNNLL9wGexcgu6KK0mkNHN4qrffDuVT+YRtU+K38swYEhwuccJuclQqLrjkDhQ7qFvboDu+m3tZpz5A9M8IcUEORf+qY3VLIh0wZz6SLcHbm3BkDGFrTm6N3+16vHUi/RhCyPo4DvK8IkDAXytjSWVkOkzfOrNoIJyL7gYQQQljF2c3CCiGEcBlEgIQQQlhFBEgIIYRVHEyAsABJq6UZ+NUCtkuD+/f7rschHBoWeKos1bxXy9kcfFU6/3V9xeP2dP36cNscRIBouimzgzRG35p+eu7UgpKCE44NQgHr05SjVxtL0IJKnSnc+FHWmJ23rXGDMNCqdq1w53pM/rhJf5Vh/HCkK9M32VAqiIMIEDa8efjw4d3UUgzAkfkvjTrVcZepjyGsAZM3Mlfz8ccfj+VKYItNazEoa/hNGdZEQLx+/euGUlyr/wgpnwr+4sWLcQdEgYD57rvvxv+Y2iEeFzjhNjmIACGj0yJy20oUAtl4AlpK6h57y55WDuf0i5P6S8dqCUEvnorHh3NcRTBXDSAoRLqW+xTe/ZdT3HPvOQSv1Mmnvr+N+5G3njx5cu+co56Jl0EPS2/DFwbSM8FemkDA+J41ikfxhhtl6J4eBEwmED2umk/ADIInjUkE2enRNfKX3SuZTeDX7fPoOsCvZ/aE+AahNv7nGoUjLsWHP+E8Do7d3o8fE07P5s+keFrpwdx7DgGUt3C1LIH8vFxU8GvlM87peuVX4NjzPel6vgWunUozXD8HEyCCTKcMKrzSBlW4ZNha+daM69fip7jlJGgcwrXOA9d4QaFQeHrV34/92eTww/FfeEGbe88hVFTZe0UvlOfIXy3IYz0/wH8q33Ot+0PrXLgtDj6NV3sKgFRaqJN846Vet3sbmJMeMv4Yv1zP7HQrDanCXG+8xO7WUJCbmzXhhoJ1171n8yY979x7DqHCWCL5ijHGCnluaKS8Z0tObBu/Q31FflaZIJ1K1K2hchABQsXp4wEwtJ7uMieVed0DHKYGAFtQ2c8Z2Cac76cgJFRqgZxbUChkvX2j2UOdmSuMc/Dc2klu7j2H0IK82dtVk0aKN8ycbXlaZUG/7PPhm68hmJbuqR6un4P1QBiUk8AANlpSBmTDJd/MiF9a5a1ewhQarPeBbx+4FwrnQk3haLX5FGMGKedu3dnbrInnJp5WD2PuPYdQIW/R+PCBcIdpvMzaarFtQynyI2VBUEYps0B+1iZqTjaUClRwe0fjAOhHSQKnMQDhYwGEEzqHq2GkA8YpPul+5Vxv60yFQ/+r86QhPPxQ6b93DH4t/4WHldM1c+85BM9fXk7AywNO+asFeaxe79fW8gle/lp5lHtL3r1tYo33QNAbqdvN0sqTKiuEY8OUc3rX+9jbnN4QatqM3902Bx9Ev0VaC6wQHj31QgjHgMoelasmd6wFlVY2lAqQHsgBoIA9LLNYmESQ3kc4BxhQ32UiBxNDUm0EiAAJIYSwiqiwQgghrCICJIQQwir2LkDQ/8tQYHW+9mEtxLNmEHDtdaBn2nW9BrpnX4sSwhzcYGcrD5Mv5T/HQq4vKtR1uIqnSxkQ2xYlhtth7wKExYAMqzx+/HgcOOY/jsVzLHTaRYiszbi7Zng9U2+V7xwojLyDEJZAefniiy/G/Ed58n05gP/kS5WzbdNqEQa+H4iuo7x6OUEoebq+YDD7gQRxNBUWlTAZsWXCZC5rZ47sw3QIhW2JnawKBbvOzAphG5hU18rzli0s9uiYO7uPPPza9gNBQIhqC+vZs2d36XIPLlw4TzzEF26bo46B0ANxezq0rtRFri0a92upjsjQ+NUeja7BeUut0osfFQHn5K/4EQC+AMv9p1RbUi+0wsjP0wHdgztdz3MrbRVq1GIKVwu1zuOm3kc4T6rZEq/IAXMjre9ekerL4/P/1YyQH7P4sK750LVr1cLhShi6qAfBTTDIVbMHnJP5BcwsDD2U8T8mFLgeuMbDKS6OqzlprlE44lIc4Om3/DDlwLWKX/fSQ9fXuBz3k1kIfnWsNJSuP6PuletlZoL/+Pkzc42nj5/S4HzvfYTLxL896PtynrzRgzw0ladrPgLlWc+PDvG1TKCE2+GgAsQzrARBrxLz8PxXJVjxzKw4gQKgzO5O8F/XeSULKijgcU7h8fUgjAo41Modf3f46Tl0Hef8ndV7553VeKowdBcuF777lBCYEhJTZQq4tpef8WvlHeKrAi3cFkdTYdHlHTL3aIXXu72oVeiCc14wZtEzWd3jl19+GX+HZ7rnWgyV6734l6YFQ+G5M9femlm1TV3EMxKH3ysqMlQHQ2G/03P39jIR7DUyFPB78aBuWPI+wmWASfWp8Q4s6PbGGKfGASmPbFlb1WVC6quoq0LlqGMgdRAafS6zO6jYqDQF530vgjloL5E5ev6h1fRe/JxbApU9940QqKbrHVXkFZ6xZ16bwU3iRDih456yOcQMnFbaS95HOH/IL1P5QPT27KhjJ4L8gVHEbQYWKR9L9+sJ18/RBAgZlUqRjEhLh9YMPYFWy4hCwIC7IOy29RO00onbB6tbA9fw5MmTMX5Vrt988814bgkatKTgtYSPehLaW4S0eF4Zs9Mz6h78GblGPYZtM8iYIeN7qwDPveR9hPOGvOYbovmEC4d80+uh9PYDoQHnU39bcZO3EEC1J5z9QAKV1F7p6d5xQ4W2CfUOjt2PX+lwpXf16zw8+lf9xwk/p7j8HPcHHj//od77FOiUFW5KL60w3DuO+xatZwR/Tjn0056mx1PfhZ4R/PzUfYbzxL9f/Y4ar5Pz714hrOexeq2cxkE8D5LvWnBe4cNtEmOKZwgtvqpSoGUYa75hF+jJZD+QsE8iQM4M1EyMa7iwQKAw0N8b5AxhLoyrDb2GnfISatehhzKqZKcmeITrJwLkDKGQO8yymjOAGsIcGM/YNrY2Bfkz1UaACJAQQgirOOo03hBCCNdDBEgIIYRVRICEEEJYxUEFCFP9GHCTYzYRTovndoU4SeOY9BZx7QMGN/Wu9vWOmLp5yHvmPuferxakhWXwDZUvan7nncpv7nf2b6BrcS1IG+fkGwZxMAFCxsZWFFMGGafHYcuHldg98x5L2FcmptDtq7LeBabvMq+e98QKdvZ52AfM0z/k+hGmc86Bio9vH5ZB/uxtKMU7pUzhx5RaLBtsa1AhKOZsKAUcu406kQ2lwh1D5tk7WtHtq6UF51rn10Aau66EJY6pFbwOae3r3ius/D1U3IdE33rOO+T5fDV02E7N355P6jvHb+o71JXj/r/3HVn13lqJzrWt8+G2OEgPRK3n1opXzvl5Wjm0smjRqAXEr7rV1X6TuvPeXdf1Cqsw9IJAahY5qdH4D7Sida2rBGrXHQOMunf8SFdpeVjiwuk51GJUWFy9t6Hg3hlQ9PNyghYmx8Tl74b/nCdeP889KC3oPZ/i9XS9Nev37tdtw+Ortph6zwieB9yf+8fPnxc8vN+38gbO38ulUBf88ZzCF/HxnNhz6y3s0zvx+Pz/0gWButbfdbhBNoJkr9AymdPSJBy34GFpXallQysHf7WKsB0lu1W0jPBTK8r9wFtqnJf9IH6VXm118eutKo8DFAfxcZ2nz3/8dV8eLxCvrtdzedw1LX8n/mz13QDpyL+G9XT49Xj5Txi9B5z8icPT0nmF1XPr2J/V8bDEUdMXft/+n3smDtAz4/xdEVZp+DNyTvGA38ul4u9M6J34s1bwU/5rwffT93a4pnUe8JtKM1w/RxUgyuie2QnnlYHjlZP+OxyrQiA+z8y9eL2C8fjBK385xUk6Hh/P6AXSC1q9l5oO4O8F0++XtOp96J5rutCKX3i89Vqlw3X6L/x5KoTTe59Kmzj8Pfi7X/KMHr/HIWo8Ck/a9Xx9d5cEz967f71PfesK77TnB7wrfVNnKh+0vkW4LQ6iwqI7PBTgUUXhDOmNg3VDptxqmoMu+ZA5N0f9fTWWgOplaiC3tzkTYPJ9yghd3evE0b27mgB7Vz1+/vnn8dn9PmR6gvthsNRVMsTLO+WaqsJxiMPvc+n+DlJ/zYX32WPqGTH4p42RlId6Khb5k988LsLjx3vx85dskHJqQylUSuRdwrSYMl1CfpnaUCqEHgcRIM+ePRt/X7x4Mf4ugcysSopKoVKF0hykB2c2y9Bq2px9n97mTDBV4cPUzoGqqGvF3guP4cTWswPXUBHi/9VXX92NAVCxcJ4Kk5k6LdCftyqY3n0I3gnvTzN+ltB7n1PPiKCmwiNNhMzQMt74vI/uvdXAwG9KiF0SfLttjS7yaC+f+tiJw/eZs6FUCC0O1gOhIqOCWzpwSUufllRtadE6ojJRfKqMNa3RK3/8qJy0eRO7+iE4agurVpy9zZmIA7+Kbx9KGmwp2oJ06HlpcymYCq/79Hen/xrAJk7eE/Dc8p9qYZM+30TvjskOimMKwnH/Sw068nz+PhFAfBeeYeoZ+WWqqHoN21rG9d3SYOCd0Kr25+UcfpcG72vOhlL0TD/77LPN0X122VCqRzaUChTQgzFUFvf0z3KcB3SrOif9rOvGB4Fx959rPD5dK71t9eNaxTkIszs/xckvKB5+gWsUFke8QyU7+jmE17U40gBPq17nz6N78/vG6T7q+dazeFi/F4X19PSeetfrHM7fAWGqv+L99ttv751vUdPTe4c5zyjHu6x5w/Fn9fde47o0/N7leCaoz8b77MG783fm79Kd8gl4nqrvG/D38OH2iDXeldAqpFV3yTr1c4UeS1Wp0DLOu94N8mw2lAr75GAr0UNYAxUTY1WVaxnLOCVU9lLr7gKqQFTHS1Wa4fpID2QF6OjRrcPz58/TMt4z/n5Fsun+YEB9albWNpjckO8RYLYA0cyoEEIIAdIDCSGEsIqMgYQQQljBgwf/H62tiuv5xdbbAAAAAElFTkSuQmCC\"\u003e\u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003eAgreement\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003cp\u003eFinal coding represents full consensus between coders (AK and ET). The interrater reliability for the raters was substantial to perfect across all variables [Transcript preferences Kappa\u0026thinsp;=\u0026thinsp;0.797 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 95% CI (0.613, 0.981); Transcript concerns Kappa\u0026thinsp;=\u0026thinsp;0.851 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 95% CI (0.690, 1.012); Medical record preferences Kappa\u0026thinsp;=\u0026thinsp;0.918 (p\u0026thinsp;\u0026lt;\u0026thinsp;.0.001), 95% CI (0.761, 1.075); Medical record concerns Kappa\u0026thinsp;=\u0026thinsp;0.632 (p\u0026thinsp;=\u0026thinsp;0.004), 95% CI (0.256, 1.008)].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eParental concerns and preferences\u003c/h3\u003e\n\u003cp\u003eParental concerns were expressed in 42% (n\u0026thinsp;=\u0026thinsp;46) of encounters. There were 74 unique concerns stated across 46 visits. Of the 74 concerns, 34 (46%) had corresponding documentation in the medical record. Of these 34 instances, 33 (97%) matched the verbalized concerns (concordant), and one did not (discordant). In the discordant example, the patient expressed concern about the child falling behind in school because of absences related to illness, and the clinician reported \u0026ldquo;doing well in school\u0026rdquo; in the EMR. More than half 54% (n\u0026thinsp;=\u0026thinsp;40) of visits did not have corresponding data in the medical record. Concern categories were largely related to symptoms (n\u0026thinsp;=\u0026thinsp;42, 57%), followed by surgery risk (n\u0026thinsp;=\u0026thinsp;7, 9%) and treatment decisions (n\u0026thinsp;=\u0026thinsp;6, 8%). A little over half of the concerns occurred were expressed early in the encounter (n\u0026thinsp;=\u0026thinsp;41, 55%) during the history taking portion. Please see Tables\u0026nbsp;2 and 3 for further details.\u003c/p\u003e\n\u003cp\u003eParental preferences were expressed in 45% (n\u0026thinsp;=\u0026thinsp;49) of encounters. There were 62 unique preferences expressed across these 49 visits. Of the 62 preferences, 28 had corresponding information documented in the medical record (45%); of these 28 instances, all were concordant. Corresponding documentation was absent in more than half of 55% (n\u0026thinsp;=\u0026thinsp;34) of the visits. The most common preference category was treatment decision (n\u0026thinsp;=\u0026thinsp;48, 77%), followed by surgical planning/logistics (n\u0026thinsp;=\u0026thinsp;10, 16%) and timing of treatment (n\u0026thinsp;=\u0026thinsp;3, 5%). Almost all unique preferences were expressed late in the encounter after physical exam (n\u0026thinsp;=\u0026thinsp;59, 95%). (Tables 2 and 3).\u003c/p\u003e\n\u003cdiv\u003e\n \u003cdiv align=\"left\"\u003e\u003cstrong\u003e\u003cem\u003eTable 2.\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Characteristics of expression and documentation:\u0026nbsp;\u003c/em\u003e\u003cem\u003efrequency, category, and timing of concerns and preferences\u003c/em\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eExamples of concerns and preferences expressed in verbal communication and corresponding clinical documentation.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eConcern or preference\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDialogue (from encounter)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCorresponding clinical documentation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePresent/Absent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eExample\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSymptom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026quot;Well, I shake her and that\u0026apos;s why we had the sleep study done\u0026hellip; because she sleeps with me. I\u0026apos;m constantly shaking her. She scares me a lot.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;Witnessed apneas.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSymptom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;Well, the reason I\u0026apos;m kind of concerned over the, like, sleep issues is the reports of a bit of lethargy. So they\u0026apos;re saying he\u0026apos;s not being super focused that instructions are having to be, um, repeated. they are\u0026hellip; um, wanting to pursue \u0026hellip; testing ...which falls in that ADHD thing, And with, I\u0026apos;m tending to lean more going completely, like neuro-psych eval\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;Symptoms include fatigue and lethargy during the day as well as snoring and restless sleep. ADD workup being considered\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManagement decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;I\u0026apos;m a little nervous about doing the sleep study.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnesthesia risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;Um, and I\u0026apos;ve never wanted him to have surgery again with the anesthesia\u0026hellip; \u0026apos;cause I\u0026apos;ve just paranoid about he would recover\u0026hellip;\u0026ldquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026quot;I checked online for a lot of knowledge already, and uh so I- mm opinion is to do a surgery as soon as possible actually, specifically came to this doctor because they read that the intracapsular procedure is less painful for kids and they would prefer it.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;Patient\u0026apos;s father would like to proceed with surgery.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;I mean if it\u0026apos;s not an issue then um, if it\u0026apos;s not broke don\u0026apos;t fix it.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026quot;Elected observation for now.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;I think we should go ahead with the sleep study first\u0026hellip;Before we go with the surgery because I think that would be like our last resort\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;After review of the options, parent elected for sleep study.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;Um, well, if we\u0026apos;re gonna try the spray, that\u0026apos;s, you know, I prefer that first.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*N/A represents instances where preferences or concerns were discussed in the encounter but were not documented in the electronic medical record.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUse of shared decision-making during clinical encounters has been previously explored through analyses using descriptive or qualitative coding frameworks as well as quantitative communication coding scales [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. To our knowledge, this is the first study to compare how parent-expressed preferences and concerns during pediatric surgical consultations correspond with clinical documentation. Nearly half of encounters included verbal expressions of concerns or preferences, yet these elements were reflected in less than half of the documentation. Notably, when documentation did occur, it closely aligned with what was said in the encounter. Together these findings suggest that shared decision-making is occurring in real time but is not always documented.\u003c/p\u003e\u003cp\u003eCharacterizing concerns and preferences is an important step for understanding patient/family values that guide treatment decisions. In the setting of pediatric surgical care, patients and families are faced with choices that require understanding and weighing of operative risks and treatment alternatives. Guidance from surgeons may help families to make informed health care decisions that align with their priorities, improving quality of decisions and reducing parental decisional conflict [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Prior work has explored concerns and preferences as elements of shared decision-making in pediatric surgical care through qualitative analysis using in-depth interviews [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], analysis of internet-based parent-reported perspectives [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and thematic analysis of visit transcripts [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Our research adds to this literature by incorporating how parent concerns and preferences are documented in the medical record, which has not been explored in this context to date.\u003c/p\u003e\u003cp\u003eDocumentation carries increasing importance in today\u0026rsquo;s healthcare landscape. Under the 21st Century Cures Act, families are entitled to full access of their child\u0026rsquo;s medical records [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Beyond promoting transparency, documentation also serves clinical and legal functions. For example, some insurers require that shared decision-making be documented to authorize treatment, such as for implantable cardioverter defibrillators (ICDs) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Clinical documentation can also shape downstream care, as the content of medical notes has been shown to impact clinical outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although shared decision-making is not regulated for the majority of clinical settings, including pediatric surgical consultations, sparse documentation of parent perspectives may give the false impression that shared decision-making did not occur. Further, as documentation practices evolve, especially with the integration of ambient artificial intelligence scribes, attention to how shared decision-making is captured and measured will be important for standardizing documentation practices.\u003c/p\u003e\u003cp\u003eFrom the family perspective, access to clinical notes improves patient/family knowledge of diagnosis and treatment plans [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and fosters trust between patient families and clinicians [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Documentation can also improve interdisciplinary communication by clarifying what matters most to families, including cultural values, logistical barriers, or fears about treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our finding that more than half of notes in this study did not reflect verbally-expressed concerns or preferences suggests there may be opportunity to better communicate essential family context to other members of the care team through documentation. This has implications for clarifying how social determinants of health impact care decisions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study has limitations. First, identifying concerns and preferences in verbal communication is inherently subjective, and some instances may have been missed despite careful review. Next, while we excluded templated content within clinical documentation, we recognize that clinicians may sometimes use such phrases intentionally. Additionally, we did not analyze documentation patterns by race, education, or gender, which are important areas for future research given existing disparities in patient-clinician communication [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Because our project aimed to simply identify preferences and concerns, we did not perform analyses to account for clinician clustering. Finally, we did not evaluate whether the patient or clinician initiated the topic of concerns/preferences, which may also implicitly or explicitly influence clinician recall or intent in documentation. Despite these limitations, our findings highlight descrepancies between what is communicated verbally during clinical encounters and what is documented in medical records, revealing opportunities to enhance transparency, continuity, and family-centeredness in pediatric surgical care.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates that parental concerns and preferences are frequently expressed during pediatric surgical consultations but are not consistently documented in the medical record. Improving documentation of family values and treatment priorities may enhance transparency, support continuity of care, and facilitate communication across providers. Better alignment of physician-patient interpersonal communication and medical documentation may also serve as a measurable indicator of patient- and family-centered care quality in pediatric surgical settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eShared decision making (SDM), Statistical Package for Social Sciences (SPSS), number (n)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were approved by the Johns Hopkins School of Medicine Institutional Review Board (IRB54662) and were carried out in accordance with the Declaration of Helsinki. Informed written consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset supporting the conclusions of this article is not posted publicly in order to respect individual privacy, but is available upon email request to lead author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Agency for Healthcare Research and Quality (AHRQ K08HS022932), National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI, R01 HL166504-01), and National Institute for Deafness and Communication Disorders (NIDCD, 1R25DC021243-01).\u003c/p\u003e\n\u003cp\u003eThis manuscript is the result of funding in whole or in part by the National Institutes of Health (NIH). It is subject to the NIH Public Access Policy. Through acceptance of this federal funding, NIH has been given a right to make this manuscript publicly available in PubMed Central upon the Official Date of Publication, as defined by the NIH.\u003c/p\u003e\n\u003cp\u003eThe content reflects the views of the authors alone and does not necessarily represent the official positions of the funding agencies. The funding agreement preserved the authors' independence in designing the study, interpreting the data, writing, and publishing the report.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoss EF, Mehta N, Nagarajan N, Links A, Benke JR, Berger Z, et al. Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review. Otolaryngol Neck Surg. 2016;154:405\u0026ndash;20. https://doi.org/10.1177/0194599815620558.\u003c/li\u003e\n\u003cli\u003eElwyn G, Durand M-A. Mastering Shared Decision Making: The When, Why and How. 2017.\u003c/li\u003e\n\u003cli\u003eFrosch DL, Moulton BW, Wexler RM, Holmes-Rovner M, Volk RJ, Levin CA. Shared decision making in the United States: policy and implementation activity on multiple fronts. Z Evidenz Fortbild Qual Im Gesundheitswesen. 2011;105:305\u0026ndash;12. https://doi.org/10.1016/j.zefq.2011.04.004.\u003c/li\u003e\n\u003cli\u003eOshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368:6\u0026ndash;8. https://doi.org/10.1056/NEJMp1209500.\u003c/li\u003e\n\u003cli\u003eCallon W, Beach MC, Links AR, Wasserman C, Boss EF. An expanded framework to define and measure shared decision-making in dialogue: A \u0026lsquo;top-down\u0026rsquo; and \u0026lsquo;bottom-up\u0026rsquo; approach. Patient Educ Couns. 2018;101:1368\u0026ndash;77. https://doi.org/10.1016/j.pec.2018.03.014.\u003c/li\u003e\n\u003cli\u003eCarlisle EM, Klipowicz CJ, Shinkunas LA, Scherer AM, Kaldjian LC. Discrepancies in decision making preferences between parents and surgeons in pediatric surgery. BMC Med Inform Decis Mak. 2021;21:42. https://doi.org/10.1186/s12911-021-01414-z.\u003c/li\u003e\n\u003cli\u003eCarlisle EM, Shinkunas LA, Ruba E, Klipowicz CJ, Lieberman MT, Hoffman RM, et al. A valued voice: A qualitative analysis of parental decision-making preferences in emergent paediatric surgery. Health Expect Int J Public Particip Health Care Health Policy. 2023;26:531\u0026ndash;41. https://doi.org/10.1111/hex.13686.\u003c/li\u003e\n\u003cli\u003eIkeda AK, Hong P, Ishman SL, Joe SA, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 7: Introduction to Shared Decision Making. 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Otolaryngol Neck Surg. 2021;165:282\u0026ndash;9. https://doi.org/10.1177/0194599820982639.\u003c/li\u003e\n\u003cli\u003eSPSS Statistics.\u003c/li\u003e\n\u003cli\u003eBoss EF, Links AR, Saxton R, Cheng TL, Beach MC. Parent Experience of Care and Decision Making for Children Who Snore. JAMA Otolaryngol Neck Surg. 2017;143:218. https://doi.org/10.1001/jamaoto.2016.2400.\u003c/li\u003e\n\u003cli\u003eMcHugh ML. Interrater reliability: the kappa statistic. Biochem Medica. 2012;22:276\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eEvong Y, Chorney J, Ungar G, Hong P. Perceptions and observations of shared decision making during pediatric otolaryngology surgical consultations. J Otolaryngol - Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale. 2019;48:28. https://doi.org/10.1186/s40463-019-0351-x.\u003c/li\u003e\n\u003cli\u003eNicolai J, Moshagen M, Eich W, Bieber C. The OPTION scale for the assessment of shared decision making (SDM): methodological issues. 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JAMA Otolaryngol-- Head Neck Surg. 2019;145:45\u0026ndash;52. https://doi.org/10.1001/jamaoto.2018.2917.\u003c/li\u003e\n\u003cli\u003est Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program; Final Rule. 2020.\u003c/li\u003e\n\u003cli\u003eDecision Memo for Implantable Cardioverter Defibrillators (CAG-00157R4). Centers for Medicare \u0026amp; Medicaid Services; 2018.\u003c/li\u003e\n\u003cli\u003eGoddu A, O\u0026rsquo;Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, et al. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J Gen Intern Med. 2018;33:685\u0026ndash;91. https://doi.org/10.1007/s11606-017-4289-2.\u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;Costa SN, Kuhn IL, Fritz Z. A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences. BMC Med Ethics. 2020;21:18. https://doi.org/10.1186/s12910-020-0459-6.\u003c/li\u003e\n\u003cli\u003eCrucefix AL, Fleming APL, Lebus CS, Slowther A-M, Fritz Z. Sharing a written medical summary with patients on the post-admission ward round: A qualitative study of clinician and patient experience. J Eval Clin Pract. 2021;27:1235\u0026ndash;42. https://doi.org/10.1111/jep.13574.\u003c/li\u003e\n\u003cli\u003eKelly MM, Hoonakker PLT, Nacht CL, Smith CA, Dean SM, Sklansky DJ, et al. Parent Perspectives on Sharing Pediatric Hospitalization Clinical Notes. Pediatrics. 2023;151:e2022057756. https://doi.org/10.1542/peds.2022-057756.\u003c/li\u003e\n\u003cli\u003eHarris VC, Links AR, Walsh J, Schoo DP, Lee AH, Tunkel DE, et al. A Systematic Review of Race/Ethnicity and Parental Treatment Decision-Making. Clin Pediatr (Phila). 2018;57:1453\u0026ndash;64. https://doi.org/10.1177/0009922818788307.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-informatics-and-decision-making","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"midm","sideBox":"Learn more about [BMC Medical Informatics and Decision Making](http://bmcmedinformdecismak.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/midm/default.aspx","title":"BMC Medical Informatics and Decision Making","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"shared decision-making, patient-physician communication, family-centered care, pediatric surgery","lastPublishedDoi":"10.21203/rs.3.rs-7632657/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7632657/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWhile use of shared decision-making (SDM) is widely accepted and applied in practice, it is unknown how core elements of SDM are reflected in clinical documentation. This knowledge gap is uniquely pertinent in the setting of surgery in children, where parents serve as proxy decision-makers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe analyzed transcribed audio-recorded outpatient encounters and corresponding medical documentation for pediatric patients undergoing evaluation for elective surgery. Visit transcripts and medical record documentation of the corresponding clinical encounter were coded for two core elements of shared decision-making: parental concerns and preferences. We assessed the frequency, content, and timing of these elements expressed in verbal communication and in clinical documentation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 109 visits, concerns and preferences were discussed in nearly half of encounters (Concerns n\u0026thinsp;=\u0026thinsp;46, 42%; Preferences n\u0026thinsp;=\u0026thinsp;49, 45%). Most verbally-expressed concerns (e.g., \u0026ldquo;we\u0026rsquo;re worried about her breathing\u0026rdquo;; \u0026ldquo;\u0026hellip;she sleeps with me. I'm constantly shaking her. She scares me a lot\u0026rdquo;) focused on symptoms and were raised throughout the encounter. Preferences (e.g., \u0026ldquo;I would just rather take them out\u0026rdquo;; \u0026ldquo;I\u0026rsquo;d definitely rather go the conservative route\u0026rdquo;) centered on treatment decisions and were typically expressed later in the visit, after the physical exam. Of the total unique stated concerns (n\u0026thinsp;=\u0026thinsp;74) and preferences (n\u0026thinsp;=\u0026thinsp;62), about half were recorded in the medical record (Concerns n\u0026thinsp;=\u0026thinsp;34, 46%; Preferences n\u0026thinsp;=\u0026thinsp;28, 49%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings show that parent preferences and concerns that are discussed during pediatric surgical encounters are not routinely reflected in clinical documentation. Improving the consistency with which family perspectives are documented may enhance transparency, support communication across the health continuum, and contribute to high quality patient- and family-centered care.\u003c/p\u003e","manuscriptTitle":"Does Clinical Documentation Reflect How Parents and Clinicians Share Decisions About Surgery?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 10:55:59","doi":"10.21203/rs.3.rs-7632657/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-04T05:20:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T14:45:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201938494872179563513798959062094046899","date":"2026-01-12T21:05:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-16T21:02:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T18:31:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336729062774489706058952905025106514750","date":"2025-09-25T16:46:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94776860801028474221546195346673888325","date":"2025-09-25T14:08:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-23T14:52:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-20T14:20:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-20T14:18:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Informatics and Decision Making","date":"2025-09-16T16:31:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-informatics-and-decision-making","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"midm","sideBox":"Learn more about [BMC Medical Informatics and Decision Making](http://bmcmedinformdecismak.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/midm/default.aspx","title":"BMC Medical Informatics and Decision Making","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ae98cd2b-99f9-492f-861d-f35ff5060a97","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T03:10:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-06 10:55:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7632657","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7632657","identity":"rs-7632657","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}