ࡱ> F  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~RdO)jk qPicturesPowerPoint Document(sSummaryInformation(GS n$'G" 3^IPNG  IHDR]75PLTEfc6b4Bf̜d{jF̀fI$I|ryd׬{Rl|D=Υ̼ĝmIٓlZp@ptmU8ᴴjR)Rǹf3f`˙}p9`sLUũss¹væis¦Vy[.[]χsY,Y躺IP]<_Ҽf3qKٌLLikGvOtL՞xpϿyč[}[䶶߯ȹK&KPIbҨۯy@YXoUyyk̙I;lpŞY?qzPxPbKGDHgIFg>U cmPPJCmp0712Hs}IDATx^흍5omU(T -,-ЊHŊ.h-]YPbn>IN2I2d;O{w&3wo޼99ɝY,K>|^ySkk9 `Qi3y[]G"ij%M)Ȫo% '^yMWߣat,-~D]ѪAԂ5{GaMפ2cpgz`Agh↤o, yTD\ڨ4\i [V-Igl ݃»pS-eIwk^2>٢ۣ{tZЋ+nprM7Z'NJwO2]nN`oNm&E߄.#>~w=W_k6. ^l:ӫo03[0at}Y|bk{[FIqK w#J]Ѫv 7gĸ.3v^, mgHwv/4ت+ll| wWnbӌѽwWAfo{tghθI.+Ncf8 7pl9u恽=Ykn H w aOY37L r;lђ3Ԝ..K-xo… ;}%YC9j?cuYqa 5NxΆ} wSJ6|rF85gqt!HKݙ\`-] ۍzΔݔP` l=j B7r6y?ǁ_~e>yB7H n5\Б\wK@P1Wrcݴ{zkgL^11{!Bkg%5ݜҭv'; lKn~Հ$\pŶKvI3'EG~ lҭK c* tI6B,.݁ S_+1s 4u]d@5܀yy0DK6g1Cw0)*kL%lҕt]5i玏Q'* b]tM9]tnZj 5nuܹyy){GAW :Ȕotٔ j;˻rs Q=ܧ;Jd(Yo t׹6,]>py)fr?)\yyuJW5bN-`@6N7`JU>cw 4N7tv5@ǛBݭ_PS|didWf:v  .ѯ` "KO): d݁ip LHd1=_0%)%N)5b]}tfv!#) uԹJMdyyKY/*&]EoXSJtb!yuYWNWDt0WHZMWb=:g,t+/s {k7Q]jcb*t~UrF5]*hjHI+DL+h\/M*c<ΐ.[5 5k*;&LKrk,t' tw3YEhl,nՄ\VMb̓L˥M!J%!z̘٘93PQ;P6]F)"a0Kԝeܼ<]0S8oiSy?TH2n.<֐}\/ SΠ( G1_;(r6wQѪ:[&A:ɦO aĮK843Ӷ=f:_6o|:%i b;]4f Cn!1C/J`GΆX@ '?ZwĻFĊ^W3W㋍1q?L.)@י.pTUvY!Ǣ:l?7'f)-DwF}'Mg1t$}tn!>k± gPmW -XgȰdta} Zl Նj)(lFLLlF~~gskoՂɅt8%[]Ie&̆ϬVm mtJn mղA_=^(c7z֧)Ψ_f>_toO=e3 )>H1~coߣ_GV_B$)S/ݴ?v?/ ?녛X- Lť;7rC-)>4``eN-ל61u;~~Nje39$뾔_80tgnyWѧL(tgntbĮ[w_ncݴW%naМvӲH,y0te1(Ҝ*݂ڝ .H7Հ j7x:qa}rt"(tcaXX $tvTէ;tW_sJw)9[pwb[eV@W]EOJ7ռ<˷j@O *jEOWpAJE2+AUEP@eWpfA,8 ]tٔRM㺳L$ҝA4fZtNr}/XjKw:4 OA]yL)͖XMt۝_u8t#T nE. Y=htO䯳UJg߅ۘ;>MɆs ?fҵ (>~&9T2ti"87Aי7N ԾXTP(]sJ;$+o Nt]Ms*KJNUdaEv4׮QX%lh(w?* BRMv./sg=:`YT_-\Z,wPs&А˷Ub"=X?Uc>{|tlEp@ㄨcN]uuvioĺ z.{%B[<69裛wZ̬ jMWz 1FW|%ԛ/›Әx^DclDt3V-C6HW4uݣ--"Qj45-OTˀ?;$@O8t 7wPO-j hw2]XnНd'S <@<9&h^24 7=LY/OW۟/^ dfyѬF?Éل~ko%~0V1+Хte,^7AHͯ$l!/!y] bR8FJ1*I$Bn';l?UA.w]sP}nM> o0{N0dɌlLyKmr]].l/]dWf_ s]Ž^DGW=4XEU`3]+%@;] J~AtA7V釣v *=ŵ 'P^\~#EXiיpKg:U+ ]ݔiѭ@zz:RO5(jk:3 |J)R3C&.kEvZh]]y3Ҽ6K-R ."Uӯqҗ mPn*m 4|n@'G0< :)!+c]1b /ilb!" (:e@FGJt3 y'w1nDb0v6tbVE7H9'7kcn3LZmIw"$ɋ a#資n+pO>[Y,N]A6cXL e=}57;3&5Ezt:aғ/+rV)hʽv>GtO䯂.iT1;B&Mҝ:^qEЭu!џ_4Nqо,hvwJЭU}wg9hgsMh|5{cAoIENDB`F :ܿo̐19JFIFC   %# , #&')*)-0-(0%()(C   (((((((((((((((((((((((((((((((((((((((((((((((((((" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?ttQEQEs=|Oi-¬Zs[i݆7s!v`::( (gŷ/,A,g2ɍU :jB9=)h((((((((((((((((((o<%=崓Z^iFш% UXIa )k;Fo ٠ o_mlu8 +Ѽa'Ӯt ̲=tF ZžIamHZI79Rp{P VyZ`YbMF6s>:;쓁z*(((((Dqҗ5QO: ( ~)> 6Wlڜ,֫2=V RvUWmY!m{MȞLI&B<!bv$ 8 dE]C:\ u !tǒWc*d>1> %ĚcD۞wU,1p%p0|:n}.k^KK亐K:AG˄,̧ ]mp!F>gn9e5 BQj Qs *e'< ᮝHxm{RB_' 9/׽w v]^M#K,TeI=+¼1+ljiPvsm'Ÿ|Hk/H#ݮ7Io^LJSŞ)nbyX,2 Tu$q;_Ÿ^8t(KxNkX ˴:Pnmf4칠G:[k Z2M7#㗂 v ÄAbPu.i͆hC7)꤫m0^ԼC.J 2Xee?093!$] 2GG3[` lx (PmcZ(Z6m:;XRN#8QEQEQEQEQEQEQEW!b }(ӭm//de)g,('3_-t0n{nɂ% -ӐvHI!UC3Ub1 Z/_L[EszAn*rJHђf`lOk7Iz77 fq܋H8&YK#Vp@x{H)Z_>rHE8ÿ"( @f5#qkm?>Bw9wY9I9DTJLHQԯXKy,䝞C |MkOH[̗6!weCx a+)dw]vj{Pa']P*XmF4 $`m @PEPEPEPEPEPEPEPEPX-ҟ[ޡԱnCE'$Taו]7K$nPLDŽ5$nwbW<94x÷eo}YiZ[IHn╱&! +A=ex|Mn6ھe Y^۠,\q W%. li1tۛ[J൑Csq4q$*y .wJ=[ OodmEPJUag*ƶ~sy4ݤa$;+[卙Fgy7sUnmߌD\.ڙ8YݹMGWiƿu5֡f.wRY$|k7 gC k*u?($p YOg6v. b IRD H-;Pk$4;[\ `W%W`QEQEVJu2 l*T}9# i^qF]*=Q=Mrڣ<K19 )S]P4Q@(((3(?+R5z}Cpוč;Af.u búugCuxm]NcW;U;r7O"--Gkh $T9$4`N6\hVeaeˆ\ HmcЎ&[Fak 3MaI;Us[9|Qi=ŶPUBl;f rn#sGO;s#~ő@ Y:޻ip&y͂BU(.QK ̠VOxz-uKf n5+[w9ՊWlO x*D]1+5cv5T9pHȃo 0 iw^MVV,i DcB[TfQGERf?P@1KEx.-HWȰbG;ϊ[D?d` x%ZwW[9#,3rȎ1^֧݅jM_S{Ivە]и' F ؀{UY~)cҵ+PdLșSnր4Ews<ift}2IexIEP$@o-#SHӝc,v v$*JJZ1W)|ţn%R:#YO -jڍ^jZM/qw~!+g:C6C-\ۜ,p,y a7MHnu6r>ai=;O}֙S>̒.st|JI8 (((Ҁ (=(J(=(Iހ9_T- BД`8tJȹ#TzW-E jq+Ϋ 7nkowYIwPEp(h(=(G|PE@ i=KEr: d,lH$d3˸L\u5sEr[2|L(H:c#IxRF>+9@h 4bn1 ;10p=$$I$Nj("_ 躝ܷ)"#+ ^}+vlMRJn!vPQeyDm#C2ƪRU5-*-sDӦy" &d9IPeC] hı,vcVC$jlv QEQE|="I TT<[y`RO;rzb!W:I(X62:d܎1Qo'm{[I\| s1ӂz]USm:{Hpb!el0+=761 J񝮩cksk;e5FrUJʧ~PF(SN/>;s&8D[0K[LXd^ ;+<ӵ{"u6(u+P#+ [sH#H`S`Ux-X#rF #i r3xt6&Ώ5f` W*21n/*ERl|Ó-m)@Ah( .zp[X4b۶p?s[3xO_!{2 6g&Uڃ>jݒMNPxH#'FFuNLQր-QEQEQEQEQE@0IzZ((i"o8SkO_^G#Bs+$M Bqe<|iѮ-<>|0HIۉq0;Q4(.ܰͤsuw6@SEPEPފ(n`h`FYe`(f'$.Cwia/˔0minUSFr}ih&g 5GteB#b8$2>дY& wOjn*ɸl4tukٕqLu23EPEPEPEPF( 1E7~(j=ϟٷ+LߟuUx|*mRE3ԈVh( ( ( Ϧ~XSkFbmט@ǽlW+՘fX|5MJ%}:"EUUP;uU *[bUڀۧ;7(((Ҋ(x 2<~oAv%-|@ךDG$ƌ.D~q;FF0T{=x|='K&톟`n0BS̍ `PCAO-*:$p_1 ‡ʴ˧ũk$G{Mn/lB|dVTE`dk:~>&Qkk6P9BSqva*ͳW>*/tAlmNڌ<2$XE@pZ2β0;2xJZpj>%# ʼظ 6띉vꏘg͝8~= Х>l$JB2ﴂ6aWfN\E{um;\EeI;*OOndgJ Vˍϻ}&%i(1rgDi{9TY;bxxBhp\Z1ɾDuD.+ʖj>Pw *m(((((((([K|APϧXdc܄H}yu ;}F&ht`C) \ӵ뤨)KgF7ڮzg:|{s;3+O}j\>ky^ $f5W+^|YMCX3`v3rIMuTVV7QЭDoZߏ+M9S}ZgiIl dw(P@ J@H=90=GzVOpx{p}VrHG\TbN >VbJxPwVMmu s̆9"C+*A5aCS= 9yȘαi,Ϭj6v 7bWr  lt厕gmceyv,Qn/¨d~j+Ȼ,\[tՕh[>Ak&vyEͥ%xYsc4h( _IZHc.n"ppU&`1Zq)L^:Vş%2-ze9"fWd\a. 7v\z2q:SGVnXau0+((E4SKԁM.w+ L۹u'$׭8$cS'oPA@Q@g:\QE,2 !!d@efVXEhVswqiVSݐ[ۤm1r#'(OBK濅(Dm3Dg<ǝ֝[̷&iʻ[;8g\⤶ddS͝NT>ߎ{VVm"T๻n%(W`}8lv;VQEQEQEQEQEQEQEQ\>O1,Z[︒8dH~b}7*HZ$ޥ4Ƞ2M"^InNO#ψ(9>&[^jLҬ!L4fe\by@w2$s]Xg<2+dy]\nHX$`FN6=o1ǧ@c[\m:;8Y^jok,e16GV=x@n-`6kI@,T)ߧ#PQ@Q@Q@Q@Q@W7{_Ie<׊}n.`BzHH8RMCį5U+dl7u| Cim6pom,QEHF`Ҧ8_.?ĺ:ז?>\wSVprF_ gv}J՗_^%)6; ^i-3[ܪIywHO8 ԞM BxE;HR(?AM>7!(40o3eIhGan<7J0ʽ>Y=z:|ZΌPujP5ͭnAe ܤ7,#%AH35xR)x15E}3B-nE0#f V>ր:J)4QER9R8Px'CFڣ\ mMchӭC:X& @+$ccsex]5K(t::X%E16"ykv|{-6Nh{+y\Cɍ6ŕźj"Ynt+H-8aF^X۴.&P χZ:(m"KeUӼ)Ib]p᱀yׄ_W{5TmSYKy.cinGV*[$,>^.6jIwRʋfʤ{2%ctZ4( J'$-dF9s~rGAiZ|WZE6#G@! UUTG"P[ oOi6[ۼq=2c;ar|c$|1[id $0QA QHHY:ދM͆n[Ƚƭ+#2d+`2.m{yGc$&Uٕe0ƁxCFP8 +#u̺YIEm 'aw"{pqrG$->kI$Vy.rG#,x[!beY"Y£ 0].n3>05_2KHxF{HY\ich@6hrxZ(:p-!<Gր;fҙiP98wڍ֗rMԣxPnJUNCHT*b5|SnhW6 ?٧m\lyq$2 EFx;px&.X[eiT"13ORĒO$ԽNuMYui°5 $$"p>d`AON@@'=iG+#C&ɡkZ^eWqP'(}oTG^t@I`Yc5vU!FrJ xujQ\M<-o3OUk ώ5iԬg-"<)4JaS9ctnw}[[6:`p1w.ĖwvUI*@8=H]'ր$=izo_NJFݐsRH>wQF}៥58=Ǩǵ.ң'VAM=>O&=Tdu j7JGYTv֍=cZ((((3֖ ( 6:EڭX..eXLY$5{jz{j+EEq 5"Ĥ4'EAbG1 -zΩT)XT(ѩCoq' X[JvH6cimdtt ԕ},2SX1sY: _hZ o|I"F~A GqK@$!iViK;d*., 8:d`/Yu]3Rl/o1d#ĩ.dItdWBX6Ӻ>k]6i:wDHxxX#sUۀr z[]TgR 1ɠ #kynfѵbrpI wBთ*Vdn>oƺt + eXe%IP) ?0ciMVXigbIi%ݎ.ERj^P EUMWQ,%omlǙqs*d2@$;:jt'umI.0+t$+! Úw.5-lBMaeX2+6XC]`Om %HcWRۣ#FcܬAlFAЯ٬l "F? @),o-Rwap88#"9]F"Ѯs4w#4lFg{Dy7ԼQ+M&b;(nQ,gϖ%v"GR.B(sas5In%&óFBPH$ k|K⸮ &)zѹFDQ ᡮ (L caKE Q@P@斊(0)?PiPB~ERq*((((((|%-EY@Z%ѭCKFiKiZ"Jg# 5ПE䋤vmH㾝GUQWU@Wß5&}7R㌖v=!&fLNZx9*EdT $|_ž,>7iN&ya O2wI #ʱ= %]Lj"^mŪʗ2Ub'.ܐzv8▊+vt_Ggv[1sʠlX5\I'=Zj[+u ͼf,TFf!l6Gz ~#m᭫AuQ'RFt,: .:(+;Ct=_g=zR^y6Ȉ0fF\3 Ïlд_KmO~l.InFL$l,@:Kj?kUܲ4:A dIș 4**CyL!j[]CUUuK ڬ䱸Eku:pTGG44[A.AܳT*?,ih~+nmu ^ mZE+@9]r{Q> CY, =h@ B02vklu G^6A$LaR9P L#hTM-q6vք4:؋kf"?1#|`L }&,}=8Z< ?u~w%UHI&uIi\yo82Aff<_ nWMmԺt+Țn~"MJT P3]~RLy k"5f;.QEQE( ڕ_joioYd8TP2I?J熡k$di_ gD;fS+N/U} P.:;uUP}=㮮04 7m>Dd%Hw/ "T q\i_nX1\%![8'Jo='Tjt4G7E$Nw+r4#A4϶]76:;/#v h l-MuO:T^Mq2mul z=M|>/h-㳷wq@"?iz_5I$+lDTm1 wA@k>,t j[=GBu6V/ FC+M*8q`'̺W|Gisa 8 1tbrd*I}ł'#~EX'RmY1)iTȎ4 |-w> k+kó]3NqL]  !+"D mᴶළqTP0@0*ZhY}=y}_O8^<.ŢPHwutQEQEQEQEQEQEQEQEQEQEQEQEx-j0QX+ -mIdoYU+?kkf2ʫ2G,<-U@Q@Q@V4z!#GpHht@s #|cs6YO4%FӮ-1U.2Oaɫ&m3Z_[s 0*J:RAz_K<`[/QEQEQE (g'=)h ( ( ( ( (9_xw7-^i!s$iq8L1uUx)Jm쵄2 P5EPEPC?`@o&K>YMJ*|%! %U(WR0A:Il.? e:g%1,@-zh$"%flIqiJ:/s郐(((((((uYot+h>wqn%RJB.+p֮O|'s|td `RK8/"XuQEQEQ\][xC$6eqͲBx G7+ ѻEEP5>/`k2B57Hс|ͤIK/-+yeX:Ȍ2pA NN5כÑj~5'ЮOP@Q%,2(|,ؠKc "-"" \ӊCcITF $#cJǕ }(J|xZbno,61ap.u| hw] CYm3O"8ދI*< ܻdU3I?f[ymMWTv]'PʱRTH;*><9jYZK+(e*rlɓ`Ӯ0;1`.#V;ʡ}@]&GBB8\K'.9'45xU9#qH67QLks4@шN5&9#ڦ((((Ҋ((voq[wp %Ebx F8'jڦiXJ&'@+ ժ| Mֆo0so1ؽO1\qꨢ(J]->Aa7A;UGV8dZ>%~:N3&$zHU9}WAܤM$2OmFQ-K42F}As xR/4w~8;]bG=6 9##A+?3N@ c{<`#"sR0: zSvcQEQXmx.܈ly2]%Fy3<ǃ·( QAilqFcuQ@rᥳnM11nı3/1]\Cim5o $F d 5'Y|MGlGf@"IY<,jB m_V@MctٚW}R&~: vl+oi:Ch׶זsbĈ$y؂*s/^yxsGhyy$ 1`6zP7^66vEdc"40K)<TY\/|S8l=ր:)*QErґi*)/Poa3Dr#xV' rD℗[i3xŷ-Dw.&A8E~cfn5x~Hn5ųִditk|ɚe'.A @;*OX>ZN6:mSNݕ7XTUA#?^ҢL}cŷĖFskS((CPJJIΕ;ހ sBO_!fCMgcp g<ڠZxU/U[ c|om;+[?bvn-J;Vԋ) %pϭK.򓹒%sݒ~F 袊(ojZ;=i6pke UsKykW$";`hK`2^Kn+fz,a]mpu ;zCq%]9tI`H`HqAEu=)h.f[cidV 9=+?| r?1? cur,,މ#6"`z6AB}C|EFThsΩJ~"x Y0 ~p<WmcIG c>S1<a8#|D91_X~ WM$8 72¶*8{nХb$~ӅÜgb\ԇ7&^UH-(\6m7w?qMq! o-pw=Z <xoM w9e$Ѷe_"~#$pPn3N,rE(vPcFq=ROxM&7N3 ڄ 'w<ү.${:̆<\cV=hb 13nRf w:R2H~Ac zLz!A,2$m •`C}?kL%ث8݄ 8~=TybFh(6 `۸qf(dJrxy\G_O"6A8gԌ*mm$_ }쑕ntO@Z+̍FXRA 䁞֜|Pm^;g1ӊJǏadm8Mv(ӁO^{I#%MAؠ$>ӚL*x’ 6 cC@ز2[s3}sP9=C HWhTW,%XN*c$sRnwuDrH6q{nyѓAe9!{2`Ӎ.y;2*I1S;,0{\d硠ҰFFGaN"49v9n~OnO~*꺇~..fn#鑊%W%Tq}~nŮ!8]C%Fn )o?|H'njTjRp?>:r3ԓ:<FyλO1 p';3ޥ>r`q>~Ҁ?Cncࣞ޾?xx~k o=)$OxUC;{3X0!T8d)z'+y_r˅ֹ99}+g/Xj^"o, FYB"c(Ue8:T"ذ}qJ"`6scjڄ1M3-O8Fw{3}f(^+Ϫ62g4ʸ#g S\?eqx:؞֐3G8dvgV'$k( Z6Oeٹe9`Z4)n4Qici|##"H,'Y\["09d:ľ:( ( i<cp9z=c=9"Z'`>;FWwzF*z+|Ie, ڃJÒJ ۀ>֢(v 4[1t2s9xՁ(w#qekj nHI rA.H:kbTdp+3%]cX.b74AUz|xvc:uF'"GAHl|8ϩE\-ܖZ8v#AEm;|>m0̤[G*S'[heP@tapyzޮ'ptxG^m ym唞crOY@Q@&]Sn֒g+\ֈrw7v/g9#08cpH'}kڙA9lzR,VBn$@#;ۚfTl!xH\ &dU])bpNNv-\ZPFEfbccT^ZDugf0FWh?S#Ăe$|d=}#u$؍{}q$ond J#o!ĎԜõ1lv"$3>wH?0!yg8uȈ$VbFXpAӯztQ²(F7L䌞NQٶ8zd'>ȬK#n<:2}E7,AbFq#{ ZE_;OL=zrS#`z`ȨTsیހ%1q"I w~]UX!\0۸׶xBA,8=zE*dSPN*:׹"I3 SiXdMrͰ>885?8qOڕK!pI J 2r@=Ϧzv@ d& J@ L)#S(VG+29ϩ8pzMV}LPvTӎplɒO9=lgGsFrdsտf^Vɻ'HS`x=ד݈Ps dR#zW~G BI*Xm$t Hm#=F4ұ\oBGMm^B%n!)*`f'fW?r 3;Vou #˴d!q<"Llq5&Ըڳhug*-jZtS W[ E=eZ\ KmrGtmG,BDP2y<]|N|U $VVWK}5>K ҺK,f+{hY\"F2Y$A etfKM?lRK[p1!Xy࣡%F*ʹ9֯keis[:AD\I@jY2lP׃'To N`E*+H7fI rek)u3gѯBp 8>C_Й+pSr6@Bqadi;[kyM;{1_߼6ȡ++c7li \y'vZt "YA@Cqu3r;Æc> ed DѽXci=qR1ܣi q;H-j%A!a'#Ԟ}fK&g+ouG9wo,2;#$0@1ȦU] ]r7Fcw(Ƿnz(FčRP%pOjk0%FbGPxn@pӨ5,x 0L*=H4" ˂75 s8$><A$O@e ..[cc=19Zk6Vl׷wl"fn% 3 ro]IUcŷ|c{TB 06@^p}x+ꯇNkff:V?0w8(F݀2 x/~X42aQ+ &77@rĒFI&?U,D|{qzDOBy݀]m)sjʹWEPeRv(׋ڡJd6~Ѓq~&q4d_#9Dwp_8a 8^zI*Wd6n ߒufШ 9ӯvݮ0Kc>wZ622 0t Ks7y}3@ !X@8OG~ÿnZʹ`@3ϡY \1$.J gN#u=|t&`0q;ۊ0q*oB9%<₠2 (FYNW~w8 rI=ϩr)T/\6~Cé9E67*w0#$#ߎepr2ss׏T=Iy  *I 9 ebJr8u(T̍Oǃ@r sRN$;V400:W-U |Y*q$ZUq3)pH4#IxU7\Oj];z'"]%`8 㓌~1N兴KX~,('ºIElc_-7=Pԛ&׆xC޵ĩ?T5XK,j+$pg0(vU{G0"..FHy58j]\WiaH./!RMpv1V:R>6𵆞P$A_ˑI< &{4I&;A.\pHk"Ӽ%m}.HcH ky]`(6:_.n-B)3jVLFF 2 0ANBhZ( (!]'?J̍3TJpBt=%?^3yGTbic̱EuXٟNh>@$(Y?1h v&q$݁ 4ͰU`!Q;#׈Qgn>lz(ņvǿy(,Wb@68\ ,ˡ%*={"n$@0㌑w=sPX6ŐBO۰\8rq'\u:Աv4q`?wq{d!@$@w}z{&%UܩymN;>1 N8RM(ު H$:6YS5mPny2DQNms^yzZ,-絅m7:ogpJÝ\=5E&oo4/#ceNA rPx赽V=F;+i[}bIav3>q Ԅ]럗py𽧅~&Vt[i7qoo`,]P0JľӴm-u {`-o>QpcSW7uk E;C72  ʃ:F\ ߴ׎珦s± 9b#`88' ccx|ës=XRF$g$rFxjpx'9<` i 3|I'dB"%ݓ랟AjWU<(p8`?qC@mqTc=[c8^0ikR|QHҹN@[2x秮z6g1j{'#"hG^3w}dln`/ϥzwࡾ3kmٹ' i6q9#=@w  Psy Qޝp~_ji2;X'ޞ mԭPt/%hUЁ*1 49ٰxOZUERXWLjcP 8,,l}nem(oܗʱ;˴uxq:4jPt_&c+Wkoh!qi`svo׋MtDm>3HOJ`xP3w']mmDq9Df"1++v:^j-LZaWd1- ~k؊jfq={. OLcI$D I(H$)\o*᨝TTn%lpG}UEf$$(ǂt M+x#ThFUPBU 89bFO<ڍ=hS )w}*uQ@ ?Y!WX=D,>l?Riږhx:>3ug-1`gh{yO$@MQ@Ayk51Om:U# 2<AZx8NjַZnSZFfA<;&27JҾRZ W6ziEȬ%Fq 2rpYaҕ(?DS/L$gvV,3lsl!H_Py@޻g $HN:+s@d\#=k U W T=20z sh!Q"' b2)m ڌī}Fs;4+C.mͺ y=qL˘7Ts@9?~N9 T*LHPGWPx8'{TFC,h D` F>EbrǕ 1@ (m\IQ| n6<>^qH'#?s@.̈2 ~lZfKFKyP8aNA'cg#鎧:""vqg߯T1ہHcZ9eO$={d#ԏ9P=1򞽻!ޣ* UQp||uNBppq zC+9ߝAWŽAG2w=9ZN \`@{uܟEqڍqgWf_`;nvH\P0I9ni}[;qHTA?h1ONkQuKMOEC,O0#ˍ|qAyFpŀ9R)*02B9ל~V7Xб,IV's^Ӣ|Q>xMGg,7rVb]A76XHِP?,`npq88P'ʹQF0AǦ@>K#'85$`vWߏcˀ]p l<0ߜ# dCF:{fǂux=SV6rUӞ9(VGeRIFX= ǿ4od$}qlw }GNx9);ȏ,䎾F9@ȱc33J.<Nj5c$yb}C>͕s;}Gn{P;ᷟr9rG cZh*>`wX( b'p8ATYeTeXmla; z1(K|=?֜rXێϧ|j$@n*p1z҆.VR2 c:voz2 70x˓G?'Fn@m'#kʢ29FU߳\>E10ߌd|gb,jQ6S?/L 0@^h?NCu p@iM626=/zc\T4 b/mf9gFh\ $kuH1c&c%դi0Ȭ$N`pnE;!;ɑ~3_1jW qoiڵυ_ 4 \-iUAm\=N^7#=Ku 9_@E#/sCySYĭ/[?*ry|ZtxI5ĺ H-$cvSw Cûǩ~/|(Ot駽 yK N>VaP>x_+Gn%nT /!\ YHDOc^ki\Fm>+$V[bm& VՊ劙xQ@W&Vէs־+j^r"y*W$m!pq-4w'_t}?IմjKZD\6R߿nH OB'i,#jNI*p09ae{uivGs ,i g>Gth~:m->2W1a78:^c|='𿇧ԬPsa݄"!A 3p9׊2a$ӎ;n|Og4DOo$PIZ-UB f<=5|1yÞ+MΩ\jh whmp2Lu9@%3Iu?uM2OCq&rym4I` R{W՞7Oo]2-&]VJA6dr10U=&7sVΛi}[Qh<`6I# V!99^gj4PL*UH8nyv'}yݠ=k|ѪoM΂"VBʠ`g׺h/>״'OqoױfC6v+' ?4 _,;;]BCtdhHdŴ>NW:\[kk'{hu{U#TYp08Pa|E?furC7LN8劺~P*~ I_N 7 G\*0.9Ktӵi:ZkWQYf 0sP;Yt{Y,wNɋyP`K'O׊fhoxsOa^RXv%8;8ð!- 滦wME>$@"AB̋|gs-l.G\d~`s Z7`Mrs_gxjH~.x/XkVDU}"k,\ʲ(RHf +-ž*ɦm q8ԟ.4 q<ƞ /]]O,qH$hQk']RZr~Pq1?7=WQcXKoUm ʻ<s־r8''_PQ3 q۟9 `g_ _{ ;x$<{E ڣh(`&3Na8AR_ d `zI>1`c?}:9{|ݩ 2Tyky;?S֯3ŵ[QO)ɚEHKfJNdJ֒9,'9 rɿƴ(+񆗢jv~jP ue`Uvr$$ݭfiz#%֠i[wՍ8.|PB.=epVWqm jH(p->"ӦYңT_8EPǗ _tjyk9j'yqZjm4 3p;Iin!TQP w%'(ȥ=H܁szZ(9_ ;^6@ jZ+cY-S-yi͔2>pM@5r21NO?~cFNP/8sא85wk2xȆ7<4ZI G}  tg .v2z~zL>vvn3;==̞5ß_ T2GAO~ LJW2bq<4 m1F̠0uNGXy#9<|a^W~19^u_?N'' 7\v=(X,ܑJRʣ;˞񞼏}N Iϕ+uS6P !BѲ9>6xƲx &oIq`;1 O G<)aׂG*pRN yǹ|;; jz]S-lwĂx !F T|kxO%͛_Ml-Z&ա(nظmuAJ Pf#}Ƭ't,`u'ƭ^?i:xkNjܭTgv; s¹Mw"NK-jKHeYDd}CnTd;^߲acҘ~ ?Z/3ʠxHҀ<x/E}=+Qˉ wXvc*Fr@=6K./x^8"[hጋsZ#̥Yg`Y(Tf% ٧vCo#'=:8oNjm3WҮ-tKw{WPċ$|1ۇ8vkx{O43F}3úchl.F.U$עP2~9ӽ+~ʤ'eġ_>>rֵMG\Ԯ]^kwml\H,9+җXA&Ӄ$c?eGO2O883ɧitcyfYAKn׌lyOR|;>{y\3!{IZCB]ؓ'Wfl413?ZOeɺΒ~^sFh5$ &d326:|)[ֵB[Y".i-Vi9DO$ z~˓|hpp1Oj`2e@ӧ1 nZ6#RsG/q} tk:V7Oj hJ `N0{2{~ܾ7U?ߏ$RL7HҔd2o:ֿhnv- Xi1G-h2}=0>N־_r)xXG߯5'21}/o;O1׎xH.U݂ ϨN9_TG1h>&ռ|{zzLmQr?axRHn^_ZG2xMn@G^ Ԯ<빙O Y&3m9`.;A'eeai 's!.F~'5WEG|+,L(%`'HL cCT֗12u4EF/y(HSzx\mUx<؎;"!ǵtC`˃q:qX"sncaQ?3/k7ڬbϝ$/ I*e'h($_]Usme{kdy.nۋhQ"('tQEQER-F;Iq;Ig!"@U]v>l)0bX{I~Mxtzsק zg+d(/Ivۨҝנ4z0_)S\VVv1ȖpEI+5 ݋3u$IĚfy[iK,2o,jI$gk2|-M$4 Hmb2y/\yd#޸Y~kQ[ao 'BXs:Aq:H 3;?>sij:-ݽLC+9F #,"CՕmUm!ck[i3g-uG)oĺ>\-]]i{@o6c.O9Hx1ӛrCww&>mo,5^ݫ~Ex؎PB\(((_?. Ok fhv#ed]w+oxrR{4Rfʏvl;g>Rg;F:J(i`Ao+E-ZW袀 ( (3-Rxz201zPH ԴQ@bHq@; :c>3\xWb!|EFQeRNbihw& nh^&Eu8 2 ) 0xH@ހg''KI}h(E3oNzXN)q֚dh(8n*1灊/-{!qHq**]qTՅc8GUp i0t`82( s@ dl>>Su3H_IW HI<}=)ĝ4 }; 9,=iY}(4WU;(`rHґۑz@DmW jTVDPxNݸ>CSC: J1LGSʂAq,>׮ms,g$hcxukM.&J9"((((jKȭ^xTi#C0^˒:n 9J} ;*]'旜 뜚P1H'8?҃I>ԚB>R:HIG#  8F 5- KkDR dwo b8K86iK˖acWYcuZxʕ AAA`ׄfG=Va}Q(3> p gAm[Ps&ë_ s$!pntav)"XWh~jcW?}FRѮn/%MOQV{4Q"Sݍ r ~_7Յ>Fz)@9>H AF5s{cPCl۽(Qit ^>*09>FI>4N;i\d+V>6.8~4)րi(1ڀI斎w4 }==)9M#9<7Пߐ9?ŏ QEQX ֯8.Vw 6>ON}ڀ6m=Z,3i7q J]vUI8u򈭼[cv:w# &|DɫIY)iVJf#.,5S,j<˨Ჶ kF%p%NVrXv5tXit^Y.U9qRy<`~ KR5+m5qp}xhˆs9mm 𶍬gѲ߿#vqg>XdP i^rpi IzgKMiT`@ \L#V~ MBT-. [١xD<`A83 A 00>T| ksw+pD*G@ 34^k]QXݣB 9Y>_T* T V9''?OBu{3) [d Ehu lYAxQ$jdpUWm$~mć?g譐tKlQWH8!my*z?:ΞUtXkzvaKu_"EnQ6vU H|yv=:{SdRu7 gT@J)HO('ӚZ(kJ! c gS\1"o\j׮KИ\ V;{$@<7QW78' i&A$hUhm[Xxt]&FKH b910`6'-u|A{DO7UZLUioB{kFrz]Oe[^Wб`ވѼVG%ElcYAi#ⶹ,ΝTvAo|uͻφ%afMWQd?-f%Tn1ޤڎe E'lw U$/WGgYHbV[˙a$?y<.d`h\rǯ{ ӽ7q=y1ҟ֍4 O^ (~2E)U';F~Ѵ=!=GnI_GV17ev*:ŀ;cwSrǠMr+δKot%o`RU5Tl%JWrD#(v)gHɸ==ҜQ6@$9rRI<OnH@ (@zJ)(N)\3ڗץր=qM>OFʀI FOCJqǪQEhω" gqJ+ K+M?}:( t*~!.몮WMV<@;8"{~tx nUD \Ȇ+ILc9=:raq\td`A:Ϊ\멠;`zsX0A𞹬 6$+gV~5x$,vH#ݏ65Iy1Hޙ+Gak1,-_2s{ԔPrJ@收'-s?gv ╆G\Rib 3\G?\s_ZjMaYQ ԯr 0|ҹ;sk|FNyZ+].h^ :H lֶZ}QYq (_`0`'<3OAdIwbx?JHۑwNP#Z:R {(< >I5?@..Q`c gJǃ4T|BdJ~z}id𝴁}OF;Z1NC'qzʭ=V/xad{&n,.F&{[S%G \>_xN('>0(V%OƟH@ZZ((>1b}X~!nU( |f_OW]\;\Og?ug[S1p -sHu4p:Zngv ~+ZOMP1YdDc9?PxdA<֧+'=R2WI(7@ySYdG|p3=rαs-h.U| "<{HPկn,|<|hhnus. RU#i,h!!^J%-`AնM*m:$24}[JԬ[̵;_Q?i f"2Dx oxe!r~Mmk:Up%Gh|!QHTͫw>4CUecƑ[,Wy]$: ln\I#}+p:~o.Ei8AR]尧kH;` QEQE OjSҐRuw`ZCl)>_((WM>t*~!??}uU\k->k!I଻T#[UHa);XF |x/xOz2V4 yvTB޹\xs%โă(Oko~;n J>/?˨6T72+M$ ]U!#r&\x3y>z)i, ߃?UW/sI + n>=q YgPO~E4LΟE {8!uci_09aRQ@d?<^[5{ˋH #WS- ">UcvUE/ş%2-z.-FX@"0VSz|9Adz%:d?n4rͼA0;d1z-Ul֛pŸc*Ѹpx(2zҎQ@ *r9qPzTu=Clen#,e뻈l+{X#i%Gbx {bsj#Nsf%զ[M6BSȷ67xySτ'p!i:;k-GXĐGmg5 !K+HE#ۤ"7HV_6+g-4_e_b򶍛`1XCe)!VvUҞVMXT]wg` {3@ۡx6XFBL\;W'm_<(WEP\ƨ~!z?k'Ol?V^?ºzu/*~.(((:ƌ0TPIbpcM'4F6]CUjw{& 9jdFD\V-evkm>{ o]\{iV̭/B?@(1F)PJ)#I'*;kF$.8G ` =5X17r{iVX MWMln*A YYH*2 )s#jV1S&VEFf0Tf dPkϼS=jMCk~vDM̒XX#FBɺV^3o \ʓYoo~CBLwi7UGċ[y4-jy&GePӭekճkx$dIte +?;9R7"or-͓nݻ8ظhxA{thBz[xnڹ'@x#i[ZCbX٫G]˹=@Pʍ&{eY[|<m̻p:U 1URD^WڙMb|;M}͏@쫖[]S\@V-r HH|WI HRB s3"=5g@UQ@Q@Q@%c׼9ŨZKhUdBp EXuDu (ndj3Z|/h;IA3e&B{p:PS\IuK :)u^Plu*U8*y'sSƋ8Ip{@1|#cqq 6Iᭉ+.>Ea2PWfxЮ$UҴyJA5`1nH *$:QN۸t|ppAs(+F3?f? ?\w {M;HeB20 Py7ZuV|1CJȧg7#vqLEQEQEQEr<-Q[<}]I>f%O.lcR>}LCt{/:=}w{PHysm\XۊQJ,;P 0I3S4mK>ٞP#Pu\ʼn2|Ocv%#Ѵݏf 91(ϥ.y#FyրQ3)CRA Xʏ,wf?SրX+[xn̑nLº=O=zs\Zlj7%R n0]4>`&:`.;,L|qHbRO-wg=<(4k ?%QaC :YQ%?g; g3={+'4>݌DNaX `x/|h4 fk]sv6#bg$1&=NXXVV6Qg˷b2I8U OsK0((WDh{؎bMQ4~t>.9'Һ)I՜!Vegm #(:uy&%񵽠ӗP{KV\شkqVT<9E&P8*6RMԼAY“n W.Y ?tDaBAw>k:>l,SGBA#C g_xBZZ[DNծ  .Xm:O hP첾fM\GX,X$k05ူa ~PjUI9um?j6%D?U@*!ԴH4۩]pMב\hd *C F9O>#8zB⺪4izUijY@8VFl%@bcuuU7F?j?7YPUEP:QEQEW-j1\c $YXHcBx)+**e+#0aw"A@XEP8Ė4FC|mw0 <_ G*~(ί_ϭ E-"Q-dr0z94ρ>!灣i7JISË41h G<Ĕ);IS>4j]^ikZ$sIRc1H\#\c@ Y߁?k淖Vљ!yD^$,J0bWG 5Ĉۍ̊|""Ez3uqHXPցM+V'kǒEV"`.Fs8r=kK}}6lPt$P8d5KYSMI <>Efr@i KC.릹X.bh%RG"WR0A \ք)@V`҈qD%}Wmj]z:^qǫiriSd $E0S+ǂWi=l|B5IQbsts@0:u*{7 oZvm>1ϗ&v;WqT~[ilw{e8n$8'87ڵ= TF1A [XF1@bK>_Xk4Oj}hXu#ak\cZQ@yr\֓z꫘s%ꭉ# 7q MZ((k!]wOoծCL]vK\3ȑjQ/%-NI'؀d#<㩠((((((sm7,yitldQ>I c2:(gQEi OUw66Ѡ'xxf'`<t-GN^Ku1kBET0 Z(Z%&I༎,~@֑#ݧ''@Qy{9@Nz(!T1}pz@ ֖C`Ҕ@4x4.J@NzP`6FЇ 1i̾SJr0pOҀ# vpzRmÌjB['"`~tӨ&q\:&@7pN4@## hG#Hsq֚w֞FT}h*zTNE/؋[y.(!K6sj~`kL. _]R 2W#9Ƞ < c}xcOXcZݶfi8Ǚ#ϛ7}nW5CĚp99\вb"Tc)H ?JǼ'N! ݫex1~Inv|Rh7 AHTE#=p:b=֐`y >JUPc("&)C5p3QttooSQhQ@Q@Q@Q@ vڥҜOR`cҀ4`1N})å Bq@`g҃!03sր ‚pG P@&st4R !980yrJR`0yK"pzR9ڔh  c$GzӊAր4d8sNq▀ (pNx!uSr3Al2A絫Y|sx%k8o/S.61wOMEFɹ$0ya.lII>+Ӷk.W$$D[,ORkAusUt6 Ct1+ZXZk9#P1*|'NIB#%l˻:.9J| I#cZ159m$ b% )H9@'s^L[UV?xVw{hpy@L,Bžx#679cqF$~\DnlN=DK`wLw'i =$UdL svXfR{Ss20x8%;zTB7 qAnrpxN{8 hnDD*1Ԯr`֩E>4\~:Bdz՝=(@x;})@j@q@{s@ҐBG=7 /HW#=I@?*6?(wz(Q@Q@Q@s>$F {%$ }( &`V2SvӂpzjEYԵ+x"%D02P:ߘrP`pŀP+EֺQ,GGs+:6Q&P<'&H1]> YivvP{lhJYpbp2tὢXkGL|̶cSaD8bU1l[O.-[Pݷy{Hsp&Mݤ+ v,.+m>+[WThbcvm`Gdʬ ݮNp}Zm_TقSKkS3m0cAU!3Pkc$ PXF = ֝@ !q3ր~POn@xsF9SҀbdJH<s=X1?JyluPXc#'͆RܑHX=iҀgޔdy>$t)X;z@;'L)d sN (r3E8(RB3z01KE!JQ֛L:tvv@sh2( 0: Smd⌾Bzt@M5 I 1;PykcP uHA#t'(0NZlFܶpʸbc? pr FRZ۪$,C Cn۵G88=é$bA\Cp ߚ)RT?M2;(s$i \]ͅ|`cN Fß@:ZNJIM.HB9ZF̷ٕn%|Ӓ63l"_}sn$`mF|zB9i )*1u'h==i*Aƀ9Ҁ9-@z Q'XL%u.Xn*7/=jJ;(+;TҖf1\o*B6`u34h(|9s=˫F)%dRl9 *( ( ( ( ( ( .EK8d20lt +rH\e@3Aj$ծ˔pG"F +\J?7G25vѴ..IdI;ٴ١Ihg,@KS/QHJHEs2khڬnG.TV,#$ 1]=|߈]%|75֙{wJXgrYt |uØ:u׌*TE`3JIP@P.o;J:%oVH<`44ȅ$WH1T5G-5)/RMojLO9{x\F3AV՟Kh,a+{hb("F0TpjMn> )$=4NCrMX3gռ3{ob.lB e?HH2*z&n6Ca:\P(M=E:@ ގ~Td{~T( ( 6m:',-Y5(.X.T]\I:1Árz( 'gVbե&eF$ $n+)EaUojU6w:lֱ8եYdʘ!c@>yc&D(Ի I$Zrĺޓ{y&5c %NArx54ewSf]aB"Ep@8iu_ cUmkK2 u@\+lt,_-u 'h:š.WM˅k@A9EPEPEPEPXxŴJ{VR(gD3'-raiaF#[Z8ds,E# QEa^0HRy:u#׷^[;;7RͧFhZvnEPX8tòp-Ӧi'˂I±9d$q`?xԨenXD"n~kZ[nllx^V @.ʇc>UˍGu譬飸MV(PȽnu$+(Zsij.n!.sgk;%DFHnlVH:tmRi"RHEPaCΡJn,mnA) 0Dq*EQEQEQEQEQEW-Uİ[iu'ռ˹#Q =MyKiᏵ^h:w7Z0% ̓P͝s'$Ҫ컿){)VX' O@OOi/ OOh>TYخ\aup >]%i<~~EuUQw隬nٶ"쨗+pYu<,ȍڶ<'*z犫 FZk6 n-(,%dV ((EQEQEQEO}-j)a? (DasՋw$VmLZ\vg ۭ. A01`KrZOm몠WǁM jO@!Px[BAqێQ@sI>'Jhq|7?ꩭilp r<BoWRxm/vph((((-lj|As$<`Hr÷JݮwsjcV=@eifnIbr5jt =690m-a%o)F[#'+<$2YXYO*)"YO/a[x$ 1yJ!($F<5tHfմS[0a ClY MEgh I 9` $ eee,thg;N|yoixwg\+sMԬ-lfY.Kє@h((+xújT6ڰEtuP>6F}jo<kЅQcs Q@Q@Q@Q@Q@H!VpCqm>,SF$F $bWfq$eԂ>g,NN_6/E? i?qQfmJK ObP+5 a^+sC^ms͛#+mt}VXNrqU`x EPEj*}ٝJFeHlQvY|*M.kn"z><ڊ;V <ޓ '5(ԯ4oCMm/iiQq9!{65.- -7y rQM!`ﷸ)ʓFG8## G[DP]OFk`gEPEPEPEP3(1ڼgwlcF1֪z\%ּ;[M!S#t/i,B "/1EtHXJhkle\ZL I#`AN U]c}._fj/Mmq2w0P:Ȁ"0C!_º2H^Ȏ9%UG- 1 H 5Q@ v]^M,#E,xOJ/5UJ,73ULϑHZMEln [@wdKw>2vDn^G:fw7J}.A$IڊWQO"Iqs{8_^]Hdm#',"E.Urk3x#qHO}@EQ@Q@Q@Q@Q@Ze.d?ڱ(8 - /k/RմwMBkB";4x_VMZNM z7k p#8 J[Y&[]Pv) 7:5b=>kNLJFA8]Jɪx4goog ȖѡI2KblOxQ{ COddX㉈:᳒b<}rWU L'_H䒝umopXkkBcLHb8Mo;߮nWXchoL!`M"v\b%TW+~|[֮kf+$`ڲ>㓸;>(rXE$rĬeWd06*^YN 3ֵk{^&&L]UN_ ݧOBҵ{X-ѕ_r.2sۮ>KV}Jz֣2I`HO͓szQ@Q@Q@Q@Q@ X9]eaGmE|Y-Xn'c ;P4{rKi/`1-ȇ)#4OGZa 3b Xn&tY"'# VA#xwmCľ𝝬76ϸ \MnX/mL4NSY׿n,u?_I,h.|3m1!#(X + dXX9Q^7R2=A|K|-,<]=F;fU* i ř>m4[xF),QG\Vv[/F 4)b.dShKJ@ )0|WMw=}IƐE.WhV/+/,ܼ.,=C+U*@ \k+mvn# OIե%$&X#)`gеc[U Ae.2,H] Dc+5uQEx?o <,MnV$nA&XM+^!ZM r J$\m Jw2?W0 ax :-^tKkúF)8VSkLx7Wus$c- Ɂ-F؃#ڸ_?5a5{MbHPWq8$He}F{}:}inA,\_92X!FV 8 Uůjg-oT}TOEPEPEPEPEP\0i+\T>Xv tii=lzQj30&IeQQc<$p:( ~ȹya[N7W+E jq( ͠OZ1+i3݄=>?Tcм9i->+Dr0Yc@VGĀxilT4\F; 8(c3]MQEQEQEPh(( kKgo& !YXVR  k\w^%夆w1ޤ( ll`1)b8 j2&{ ɫ7dmqI8Uu(цBD9EA2gg$l=F9ܙEy9hLg.k4&du tncVS$̠gle }hK4[M]i&?MLMyD.G%%JFkD.*W[鑗=-fb02o4Qk8#P*aO(5k./lY "섐r9RA*̛Yb@b_xJ#-ɻRIR1I+7/,g,nC 8qd}f%{X&{ef&/ۀHNYwe%ޛ.USa&0ٷ1\,N6 QEQEQEie#xTGoqaey'-{[}ykH]?cgBtP.9n#\ O(+xg]4Z^!9MPUEP\ρ;]gRX5{Řn$3A)VKhtʈYUQI,nn]wrTI)v?tTQEQEQEQEQEq>en 0FILezć#=hS_qF@l2P+':G&5wmǟq$q|͹gZ(>>ņ8q?G.'l5g((((((g>w4>x< Ow۟wyM8KQ|G(t3O%owyKݤdFYٌ/J\@uwUW%gҒ=彌H>6 4l<ۈo9h8*U0O֥ciraRNiG43JvĨT?o*amiz}^M)1NE p+ H"ٯnѦK{#n%f|VgeQ@Q@]xRe5)4v{y4%(`T{Ցo]мwKVoʗ^7yd"R4멤P_m-(\ LV !O\h;<O.i-yV#ZΪ;Uē#6mAݴ+w5$R!Da ,ّI zcmi}f[K^ Wz2 2 5lt;{ta1ImqF ̏,S4Gw%Ł Q@Q@Q@Q@CumkMJE FU@#MEQER=>=VRH{q Vɸ2 gY@9ź((?_#ִ=CKHྷGJSDZ (((((((((((((R4-Q@Q@Q@(((((;Gz(((((((((((((٠FEoRɑچYYNJFIFLEAD Technologies Inc. V1.01    &-'/.,'+*18G<15C5*+>U?CJLPQP0]!.j^KErZvb+F_=-@1s@h @J}(D8V2mbrw3PdGJLH.$:h!s=6T`$M Q4-\"<`_O?2P@tb PXB--: Zr#;Q}(-ŹUX2 JEJ+F%Wc(T-Q`rKDJLɲAHRCI@ %()40DdkcӰIC"ÖV^~#'+LҌʖP!GJ1@(q@ P@e!hbP@ (Xay2O@ҹYE"c6YҐ2H#Gz˸y. <קz}#'Kezv3ucB}) 4&EC(mBb ( ֘ ZpP٤|oAJh0"דb3J g?=C@m]6$Tj~E?AoVF̀"f\Ĥ*QS@EuF\jYbAԚZ@(P@@ =e=3ҝp54Bkb 9R9[TǓ 8C Ԙ]B&GN}o֑rDSD.LQtz:h&O wD9(+P@b`bB@@ZCE6 e--FӵJ5fmSf6ʊahu@C,sPjtl=)=rYOJ"sO#K#n晝] 1ޥs.W'LWQ1@SP@!4j f)F1TL ;:;J.'o.?0h#X.KYHe*}ԝ1' Ф6.^ӧ)&p 4fѻ ' :uj[>z^A%c6D0(28Pp@ @Ff+seju@#I|=MQI8=* 9sM%.ꖄ36~8BتmdQI+>gdbjV+-f 0c(4P@ L9A@ÚCCPRlP6UAB4ЬZ"M'RjhI ,:cN0̻H?t/yi !U4gkG  qI&m F6bʚ9* A@PXP((Vf%e#b[nT3X+"]m\zP#vߵFX̷FM Pʊ:)Q3R/c>UwO(܈f%I43J+b58=Yw ޚBKn"L"`IEԚ ;4ff @ 81L@\cE)LS!҈ l1ٚ:i>@?w ,.53;zjhRᩐ;feCxU[&xr?ffWGZSb ʦ!€,1$h2B&;mnֱ½#@7[XWyڽOJhe%1psw&ƬUH-BC g/wgͫ{R*1$9WIhicJ רƈ!L Iz"Ua֤29"Ġf=O4dʃ4nÚ%H$eNEKV7">8<Ĕ1E S1;M*Khb'l-+PP|:"\Mgpba߱SDo2wi9;f_zGDu<U.s0QVcj*d@ (@>Fn;FKl?\ResЛ flcʆK¨2r?ؽg((urv4 /C5Ge %Sygk\'@{P"y 3^iRvå"n1I!n hZ ( U@ɠEpϥZ0-"dtdm28*3qn*lti1I"`pi4owP~F/FtIrTu'&6ڤE_(704^Th%xiZ3-oJFg1<\J'85*" SqH2*Eu-5*_!IGS3mR?JE`B\ZϽmzqRR" 01LKS>ݙ_PvHޓgR>bvXsH F#ޙ%iW$L (@fIFIOu 2ґYY*" ((E<գ R2Qfeaހ!؂N= iRz1ajŻW(##ট#ሤV$T 'R^$¿? iMJi/Ʊfqيǟha&rUg8P@TH(h< f8w4cҴ;5tsMC:"BL:@۲3Jż;$9 dV#D6rq*ăsOr餽kef3u&j͢c cH>킐b,X "vJ`R:})8w9JSReŔe皓$$bP@PץcsM+l ֬q@O Bv5j,cT8V^%h/`V.ZDKr=I8moO:~ѯz~iYU)PP@YV4f Iڞmv6qFӒu6Hnsv@RFfq2T2gncv0g7sv/n)7bw<(|s㄃EM˰BY1tFE 'H=*fK +p69I]uv8QЊb*N˚g]&JyL2bD/ ֥"w4C((( K7y#ǿJƥX*ۭ #h)VII5?1 rz|Բorr:Vmms$ф?/VDׯ sOf^&C2gOĴ= Ö́qzVR:!5+4 CRMh@?-̜yw;SZ1I]uYP@dZ𭟙xnrT⎶4isRj[H(' Vr VB嘖&v2FQ:`F`{.n`WCIDUzޠ!Ρg4mhfCrgǯPj1hÞ-A8?J]$t?"ʍ3b&l$N=)ɹF2=J(94e7\v7C((J(P.^3Ƅc)9nC 〣lġ".IPY5y*G#z:CFC&O eEڠz VLЊ&RqM;8_QފBj6h:ZDfjisRpi$gk6nֳzݎs-U6xLs?&^r=) vkC)P@"FL1X-Ypn8Aґv-`%Cf*.3sZDGӳ9#)Nhe%1w$ecO=n8@& qPb< Cflҕ=@Z3.$GCTI Ԑ< d|I$ߵ1.9P:TF29ˉAדRt"6JEGP0 zɢךhE)#gf )xi1#̊ϥ"hZ[~ʓFͪn023HiЂO]=[M3ɭi+J@v) z 0 ՜GWe `3K@͌tXp>nJ,mRe#5Vc +21)t>oُiu0TXpGjI90Rڭ=Y#\Q֝է7P!*ۦdjYvzcKܐv4BHdu!ʬţ6d|8w%Iz̨U#$hR)ۃH ǭ!؍OZE!0( %^ƍcZ9tp 1`ЌDXzT#^(PJu,%Z[RngW<"Jæ^qIM=īzfr;8-0z3C[.쫵Y=AKP͢+d**RE3ͯks,؏[N&A@;{[)EMl^x!sh f#& ch uZ9urО#@ :RYjcpk9ZTOY8oOCMnL#-nv[ԦX6)2`l$zqLRv;4ܝGғ&'h,jMKI⡛D}IK_h\:LEٙUW[P[j4G(M1X̜NĜδX\U"cZ'O𕝨%)E ͕֜uSVItGz*kx Ŷw5= eaұ6A@€lWO8W׋@OZ#&b]&@=2Z1obM=1%RDx4"cŕel{ԖH%"* P )9z`sTsβ2 I':M6shW>: H2U:xcP?p>`:kreG4:-J% ׽j4m:QXdg&DmFNTzb">&;h#(e %tydlu!J3J̡ҨGFF1Yr@*JHlm9M aj?+ޕfl6h9#P=q%7z`ɵAQَ{Squ tzQ c4 KxfP֑OcۇJl (JbekqۭZ0w}ٙs uNf qCFEcy*rqLDA9=LWRjI&XLHY=:SF37}@~N-$o#PK-C6@8ω%l4dG_qFSzyZ9_u;b1E'^ S#UMhzd}&$usPh>QY+Ai]4&fXQZAc8#0=;fRBJ>CB ڊeڬɍ!V9nH64- |Gi;Ton#F@\ΜtUuwi~ Tx?қzؔlѦf-OmЅJj!P1 cdPɃM%trzΓh%V{ I4M,=REHͼ#&iXc#(RZ CI$`kpDkxvrs[u;`a&A:^ 9sDVrZ =)#qfʓ'qTA{뚢Yw0f$[I)@U@hv;tǼkLjMHGG3zL7JM܉A,oCNQ7vw:"Ps)1|iˏ܂=n&F1)1y,oHr3kd]Qh@Y4ѪcXmd1ey j*ݦTzb2.erZ1n#ۑL`1ʟ#|=jY I>hRҁr9e {{Re؊8i$[8MY5zR)_dbWTgh+ۑC$D6n^]́Cl߃Vt ص&V&4qTrvrGLg {=ycԋm*y2/Ta4rE7K`gjtw*=-J}D /sEWP #tP U&KFHF{S!j]#SDɈ Lc>)CeyNx=ћ'\JRJ^P؂|HbVU&ia_iQiri8XN L9o4k>A,MۜM/xpwf[PDSV[hPXEQSQsOgʂ$LNH2̭) { Srn:4)6TU*MdN7bኴCcTb$$Ɠ3.)AInFlR謥X)&6WEY>heyUS2KR":iKwd 9?1jfK~2ڕՄCkʥhB:V%i7둜w!/#oLbf=~pG?Ι,?x^ƙ3МqZ`dީ".;r}ꃥl,\=4'n߻9^l 1֐\h"~b1SrN Nxi(S^ lAxSQ `Rv!ׯ]+N$@=(bH;TI]BvgI*^jRcEƢ0 HrZ0{Xi/Y ☘R4KϼZ$`ٟquz֧bI,6{ڀ!8HbF,}ҳЂx6vct'JCÃޕLd˞HPĉ{T"^Sd`d%aV̧P&-߇ٔuW!Ŝl"36sӠ (atW@WW=L(hļpT̛=?2($SLu2ϵTfGPc^rF*֦C%0@#]>2ւ:Þ4HoT簢UY%?98'zcZ 7 -wʍ[ΚFfn6F i'dc]oqֵ9;$5ԱPj!/P +(r5.x?ZF ;n?*v+)1!$t)w6K:EU LgN»,~K"ҋNt ycNbZ& \і1vZBOȩѡjH+:0j,W24uơԓ%3A3xWhOmޕ;Ծ_j {:QCVCNR흽ŻG *SeN1^#FPQg7"0qhz[4:3D7s)1fN S "A`2֐zRGBh*;2j҄ocROݳy42NLA P~:͚$aj>l5w3hƛDPGUobB w)۸b2H\3 `pF ^"Ij3 z8xG>³jvEEqKs.R*ipS"銗H҇ \c{΋1'ӡJZ#G!zZ"siij'LrFw@bLX̷JJ4SIwhLDï E+[ƀLIdsr( uIz7 >ʷȷ1r.T#d 6ejT: TܽjvS3lsoΨ6% H>#(Ǘ; ^ 6muG47ty-ؠuZX*g,'MbfȎXC"d@*ac\G4 UT(o4-.2Q)Ӌs!~ζcw$ iمH ΟhlzqUc+#wpzg?*UNC~tv &1@\QNO#.j7 XƁ݇$|_K͆1V3./ԁ]3Nr*̊d @ ZZQ(4*ҰDɷV2ZtߺiTJST٣YpA@ڼAiYR=284Iw' ҁ Lq̗A1ւb&FRFpҙ:*`8ғ*,,eʀ*/Ph֓-XyqBy;>JZ#Nj a@qzPҘ€ ZyɽG?Q@2J=();# 2Y~adqt8P@ŠPP1vu~֧M'Pj5SDΟhdSw4&H8X:?Q&siD36?8@lIQ~ C()(h3hв)Ta-7D:aŝucjSI:T2H:T!hPguTf?ZHC(R@Ťҁ \^ 0ЉA8PQZ-(P6L\\L5,[Ȧ*x p ;sPo'*C0fqn"C4\*0'q@46ij PPi<2m9U& 9Qѝ֗p%ǥE7 9桚EC78mh"U??ֵ%g5@ @ @ ր a@ŦFF(VhpxL* @(A-@@ (Wۨy?eE~T۞[&s1Hf}0zdy--#vHڋbϡ fAIHzL"T ()hг1aUs .e~,,0z3T_SfΈiy[>!?[c2Z`P(i (  Z`#.u/A@ @€Q@:5h?JLm5515 bYjW{<FfTEʵE6A} NP1 CEwq@ `"&~hNh-DZDE-! ; (Z% Cց@ Z )(jd4Ob3hotPqA|2⽸;Ӹ(P@- (w 1@ 'Dvr(+II -ajCHa4yP(E bP P0 (!h52lHE4K@ @ @ @ϵ(4awbXpjrZhRUq&K;f10H t4r?t ma,&R-@!ja; J@@( ({P0@( PP ( )P@B,8b Mbd~hx*2lsց4 bqPtvMf Ha@ @  @P!1@1@9a@%"(;!PB (d43@hۨ XpjdؑZ gM#.@ɨ: R ( P0a@ JPLZ @ (%P@(4 ZدRjb J(P@ (h !bP @ @@1h(P@(h(P1)P]ؠV9,!Zb(ZC 1@t ;PP@@ %Q@ (iQ@ (( ()P@-0 (!3@M@ Ha@P@%P@bP  Q@ŠLZ(&( (( (aHz(P@@!@P@  (3@ @ ( \1Eb!E4&8P&-tbf ( J( \ӚBh1( ( ( (a@ @/J-LPP1( p@P@ @h&h <f4( ( (@@p@★ (@4P@(8&@P0hbf (P恉@ (  (P@P!!0!PPP@Ĥ@ Lf%(G :P P04 (A@f@ @ @(P !sJ) J( ( f 8`(h (BP0&@@-f ( 4)J(%P44&hf 1( u@-P@vP@P@'j(P@C-@z %P@A@€@a@ @٠F+4d DzU:=JFIFddDuckyAdobed   #%'%#//33//@@@@@@@@@@@@@@@&&0##0+.'''.+550055@@?@@@@@@@@@@@@6"!1AQaq"24BR#3br$SӤe!1AQqa"2CBRr#bc ?ŢeDDŽҩ0lٵwwank09C(GIJv=Bt6"]tB@Ε6;$v.Hv2tXqYbJwq'Μ(PNnz`eG7'mVHioC5FP08Ұ#Rr_շ@_ӧQǛK.[]Фp &nGR~zl/ ݠ²*A{1PQEa rN_joB$WBF[}/f&KgN`Bw1mZU*@04( V† DbU#iSOBWNBJ<ơQ5W&$f8XB1PkaZ=td.^ta% 8JBWHݰ*8 f;Iʿ諧7L0Uo5ƥo|'t 0`8~{Lh_sCZA9Jl\ aNgan޹ӴLC.%JDExXUʅ[n1 \59NT@YZhIT$vmZBj3[+e$vJOָ@Gd.-XMnPLy6hkqX#p6Vm`qY=0m䎂PrܲC)-Kjsm^X:S{G/lAR'1gWRbUN*9Љ;iƪjhy˽F],Xs \`te`DQkJr9 1}h+)XyIi +E6vk|4?1' ~34zK2cX I T.M&f5 q1g0BLdG6YF3T SNB Xrf}l3j#2mk-N&';0r=]jEu2[v*~fF[[qD~ۋe؆N}]8xȶN\u BsWL &riGu|Nf/M1賂&ۨnȸ[eu4U &]^֍Ek N4x0(1"@'[RCYp܍pk-jWc"<75*r{aG8q+B!P "D%"1׼fNN3?J?ogR hL5%ɂUlDDM !W8g"bu1jbda(  qG$}rX#P%)}ܽm6}l^]h+NTf$vx _zbƴ$!=NaPs@ZUPvSmK(~՜?;z_nkݗU+y u ҷN_}􁺓[׻AUAZʫweOowTCenr5\oPҀi2q3y\]|,mԬn-=lěu4X߱sJtѝۡaRĦ!> 3 <~)d?8 Y2K+l;C6Mm?=nklva-^=GC$.)=NB7q2:҂,'D6N3Jo9`|%505[&VQk@Gl+1D (ePVAqĆ1SvD)35cUh *0psg-R lAEs{Fn' bBV\j48ryw ڒxc*arnZPP)L onmne#<{}Y}' |#rn*=SId>kEFn6FW$}o;^fS*u}Q ykܶZ*4b:I_w_]VQh>1tc^DMfߥ{&n=eeO:gSTGV\4=B&A7p4;5H<!cSQ}¿+ia="{!gbLf| BLH^tuːrjH%;lm j)3sJ#s ^pʍ{8EyyPLRרn줣׸OdWcγ89kP59Gf2LG}k^-OrcM<Єg/~OqWdn߬5jOB;]x+TY2EPG}}/L9Tݼ`nx{YU 19F.At֜m0!]M܆CSNU&۔ټ.)B-e2_ig4R*~{uE]:orRxfYqǰBpcC%ydl\Ki-FdQ Yl*0:H5mņpMkWU4(U`y6mSW8  X`P$ndd23Ȁ P /EAʬxSy6Zbj( C^h"WBf:}K l 6GGB< r(p1kwάT2\`&UZ$IRPmI>1ZNVeUZ<{v).˺b dn# xGBwfԪYE#I.|wp-bXZf^>nt& tUƈC֏OaЙ<PNq[:S L~P[kumTXݛU]XQw͹r4,LRA>2VZ&lF,tܹtQ*-04SHCV t~UikCͽvSNʂq(S\](AV8𜹄J$v3}˸. ;e< Β^{ &UR[PraSN.Bs]jޗD*gFm<φO߆ ^EqE!MSc/lJ|}oS|ɍ ]]Wnd 8v˟9ON%/31USPtMI|AUEܕ)]~,bdBcse.[#$sjӜvqX0i9K6NsemܵV>q]@ Tl!͸$KjЗ}qSEsnQO1A9ߙ"(%Vl lm iZՀC{sm"*;1u(M]bkZ!Hm_+%hCW\1|1 [ Y==1w*G^(~)OQ<Ӟ[x({DcY~؝v~V;Z6 igGYf;T_x3!p)$s yS6?NQ*weu}\5c'E8ֲ=Սh9g '*P/$hb8LC=/'Lt\$(wQ3(iP/Yh@Rp?S]N3)zp{'ʃUAlHG4e "f hxF,J҆ [jjORke<%z9b;5"q7]:{1 -TCmmM [8]EHſU8fN0u`U„xOHaXapgS7ȸu8`;0~Yqt634f$ Tl'pf-I뤥f.4dP[V?d-C5j p &3uƬm,x.|S3C46)Avp])<\wͣ rUT.ܷ'cIŒ<[O ;]3j{Qݱ{ `{0r̾ʻH|d̅߇p'TQE0!MSc/lJ|}o9E#9mJVOwt*(c5#XpB`Pc8d2iƺfm)^ezGENWŽKwO@N(M+6?`ޡsM(h§mY"{%\U29Nm?4Ȏ`Ҝ{ 辰c%F ;,Β;RKrˊP>Jd6۶DcUN]FڹPuq ǜ0ctS5XPBE[x-/UaeG [f@8NQT=t`.UO"کqJp<պ Pc(aNeAkBuOZ kroZOz`RSVh(<5 Kkgr@E<+3χtTF+Eonl"<1Ď22Űy~iW:-jlSi[N*xQYyE3ԷUG9'BCO"`Bҧ{|_(;2:}7_TR<7:W@54(jVF;ƵK 2|̀"Yv̷\{FVYdyebg4Hݭr Z4<_{1 ?Q3 rТg+FR焽t_1&r' ,) Jg~;3DJ>yeʵa.߲zVd YJda[Z>ja#}2C`ʐ\g]. zۉp Rɡj9um@M8gGRʅ6@Н8)[}+PMWvN~[>'gzC@A;p)),(AIj vnٹMAj@2>Kph8W^O ˶zsji 1SU>%V:͑Ppe(G3ښ0o6@p"XE}'யl1F"3epqo_t #u%)J-%|On4S)QIspۿm *rou;]*ꕦτ]G WKu\s(^0H#914Lu$Rɚ3E(VK̢Ww.[d{ADzBځ]E ;G8 CKR}7ʵ_n#TRTJ4ݜ}?-s'92!* 51[5S6ަ!\k&HP t.m}BpU`cxRA5phpi1_[ k3T5N$CMX.q5`} ABGg*>+G{]'FZrm#^ Pj4+շf @TS@!QH4$WObs4]Qn6⦕@0`ʱTlh%6U9֝ٓ.ۋpiG`3S`0vf:Ho gann_QS0BG`&}7l-ۻԚ԰4Fum8J¦P uP\,9.45Dٯ#RƑڿAvbBع C-8TxX)7;;mյU Ý>J]홙ƣ5VxrjB:Y86Vp_Z͹n]AǙqɗj!oEsV?\c_6}[TO!V"i1?Ұ*`M5١;iwBx%24aiEg9Īur?C?7kGO:=Ӓ$?1aZUThc#$I_K`ڹSQU*:oIYʃw(@$ &j*Ĩ2,>䓕4KRPF9YYratTPt@t1iƲ&播}khz´!0T^}[ͮ!$AQl%u[|Yj\Hb1BxTAqO@~pR<67m ejUBZ`sjciv|Zo}i+\GԹ5MFc,i2Z_XK(yY0ҤD'Fm?2\RUOx ŃlyW\MQQ-pV-r0%f2k0:tc,r݇vt(#*gw,3d=J-6q`ߨ6kmVս ႑ǖzڮTr큺Q]ۊ:qD5i$a[iƜJ&Kjɂ0匵B丙/Zx8 EݹV;"6Rye' >&-8Gpȸ (F,M~(e&tXd|f¸Qx T*]<{$P67wȦD@s;&[*32K51u^ڋKdY{+=`g/ܝF՝NUˋ!{mf܏^d6Zy`OtOJUTg|Q^zUsg)0oB skJGX37q#;/roPC)B ~DpG#(UIv98ƩUljSe"򚄸QkYS}/m+1VS21NֲUY18BG(   |http://www.acponline.org/journals/news/dec04/pain/clinical.htmb/ 0DArialngs@k@k PIn@0  Questions0What do you think is the main cause of his pain?WHO Analgesic LadderOriginally proposed for tx of cancer pain Step-Up: Start low and escalate meds for pain control 3 Steps Non-opioids: Acetaminophen, NSAIDs, ASA Weak opioids: Tramadol, Codeine, Dextropropoxyphene Strong opioids: Morphine&ixixS   WHO Analgesic Ladder!DEA Rx=How many days does a patient have to fill a DEA prescription? AntidepressantsTricyclic antidepressants Amitriptyline Tx of neuropathic pain Helpful for chronic musculoskeletal pain such as fibromyalgia, low back pain:ffH  8  AnticonvulsantsCarbamazepine (Tegretol) Phenytoin (Dilantin) Gabapentin (Neurontin) Pregabalin (Lyrica) Tx of neuropathic pain Tx of fibromyalgia       Non-pharmacologicPhysical Therapy (PT)/Exercise Exercise has been shown to reduce pain and improve function in pt with OA of the knee Massage Effective in low back pain Acupuncture Some evidence for improvement in OA kneevV )V )  Non-pharmacologic~Transcutaneous electrical nerve stimulation (TENS) Evidence doesn t clearly support Cognitive behavioral therapy (CBT) Psychosocial and occupational interventions educational programs Surgery:3!l3!l  TENS Case 2)65 yo F with h/o DM type II presents for routine follow-up. At last visit her HbA1C was 9.5 and she started using insulin. Today pt reports that she has had worsening burning sensation in her feet with occasional tingling. On exam pt has decreased sensation in a glove and stocking distribution.%  Questions0What is the most likely cause of the pt s pain? What type of pain is this? What are some other medical conditions that cause a similar pain syndrome?P0K0g0hNeuropathic Pain Features of neuropathic pain Pain is experienced in parts of the body that otherwise appear normal Chronic, severe, resistant to OTC pain meds Aggravated by allodynia (touch-evoked pain)&,  Neuropathic Pain Syndromes RDiabetic neuropathy Cervical or lumbar radiculopathy DJD Compression and entrapment syndromes Spinal cord injury Cancer-related Trigeminal neuralgia Post-herpetic neuralgia HIV-related neuropathy Complex regional pain syndrome type II Stroke Surgery-related thoracotomies, mastectomies, amputation*Z*,'   1How would you tx our pt with diabetic neuropathy?"Antidepressants_Tricyclic antidepressants Serotonin and norepinephrine re-uptake blockade SSRIs not effective6  AnticonvulsantsCarbamazepine (Tegretol) First-line therapy for trigeminal neuralgia Oxcarbazepine (Trileptal) Gabapentin (Neurontin) Pregabalin (Lyrica) Not effective: Valproic acid (Depakote), Lamotrigine (Lamictal), Topiramate (Topamax):,, .       OpioidrControversial role some state that neuropathic pain does not respond but increasing evidence for efficacy Tramadol (Ultram) Weak opioid RCT support use of Tramadol for neuropathic pain&}=}=t# = Topical AgentspLidocaine patch 5% Post-herpetic neuralgia Capsaicin Ingredient from hot peppers Some pt with pain exacerbationd ; ; h Other DrugsyMexiletine (Mexitil) Clonidine Medical marijuana Combination Morphine and Gabapentin Gabapentin and Venlafaxine (Effexor)&====~  ,   Case 368 yo M is hospitalized with recent dx of lung CA. In the hospital he has been receiving 50 mg morphine/24 hours via IV infusion. He is ready to be discharged and his pain meds need to be converted to pills., QuestionsWould you give him morphine ER or morphine IR? How much morphine would you give him? How much morphine does he receive in 24 hours? Questions]Would you give him 50 mg/day of morphine PO? Would you give him 150 mg/day of morphine PO?<-/-/-0 Questions,What dose of Morphine ER PO would you give? &,,Opioid Adverse Outcomes"Opioid Tolerance repeated use causes need to increase dose to maintain analgesia Opioid-Induced Abnormal Pain Sensitivity Hyperalgesia Allodynia&{{HL#  Opioid Side Effects`Short-term use Respiratory depression Sedation Nausea Euphoria or dysphoria Constipation Itching&RRB Opioid Side EffectsWith chronic use, most side effects subside Except constipation Endocrine effects Suppresses adrenal axis Decrease cortisol Suppresses gonadal axis Decrease LH, FSH, testosterone/estrogen Immune suppression,o,  *)  ,v D"ACP Clinical Cases`From December ACP Observer 2004 http://www.acponline.org/journals/news/dec04/pain/clinical.htm Ԁ!_  BibliographyBallantyne, J. Opioid Analgesia: Perspectives on Right Use and Utility. Pain Physician, 2007; 10: 479-491. Ballantyne, J and Mao J. Opioid Therapy for Chronic Pain. N Engl J Med, 2003; 349 (20): 1943-1953. Bergman, Stefan. Management of musculoskeletal pain. Best Practice & Research Clinical Rheumatology, 2007; 21 (1): 153-166. Gilron, I et al. Neuropathic pain: a practical guide for the clinician. CMAJ, 2006; 175 (3): 265-275.vPKQ   T.d  ~ X  L  BibliographyHallenbeck, James. Palliative Care Perspectives (http://www.mywhatever.com/cifwriter/library/70/4932.html) Raja, S and Haythornthwaite, J. Combination Therapy for Neuropathic Pain Which Drugs, Which Combination, Which Patients? N Engl J Med, 2005; 352(13): 1373-1375.(Z H n 9#  ` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴` 33>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> f(    6  `}  T Click to edit Master title style! !  0  `  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  0 ^ `  >*  0@ ^   @*  0p ^ `  @*H  0޽h ? 3380___PPT10.P~ Default Design0 `X0(  r  S u2>  r  S 02 `    b  C :A"head%20for%20webP Z  C 2Achronic-pain$H  0޽h ? 3380___PPT10.lj$ 0 @ $(   r  S p `}   r  S  `  H  0޽h ? 3380___PPT10.k$ 0 P$(  r  S L `}   r  S . `  H  0޽h ? 3380___PPT10.ϳ 0 `4(  r  S  `}     S @ `<$D <     0P0 ,$D , w;-Osteoarthritis -Musculoskeletal pain. Prevalence is ~35%. < 2;  0N ]  a How would you treat his pain?& ! 2   0 0 ,$D , l0-Medications -Physical Therapy -Other modalities 1 20H  0޽h ? 33  ___PPT10 .._+_D ' @= @B D ' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*+p+0+ ++0+ +$ 0 p$(        !"#$%&'()*+,-./0123456789:;<=>?@ABCDEHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnoprsr  S p `}   r  S O `  H  0޽h ? 3380___PPT10.pd 0 d(  r  S PT `}     rA*WHO_Analgesic_ladder`Y H  0޽h ? 3380___PPT10.wc 0 ?7(  r  S b `}   r  S d `    0h 0 g,$D , G -Seven days 2   0pn0 P  m5 How many refills can you put on a DEA prescription?6! 26   0`s ,$D , W%-None. A new prescription is needed.& 2&H  0޽h ? 33  ___PPT10 +]D ' @= @B D ' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*+p+0+ ++0+ + 0 $$(  $r $ S ;  `}   r $ S p<  `  H $ 0޽h ? 33___PPT10u.!+D=' ̰= @B + 0 ($(  (r ( S `  `}   r ( S Й  `  H ( 0޽h ? 33___PPT10u.p+D=' ̰= @B +$ 0 ,$(  ,r , S "!  `}   r , S $!  `  H , 0޽h ? 3380___PPT10.0 h$$ 0 0$(  0r 0 S  j!  `}   r 0 S k!  `  H 0 0޽h ? 3380___PPT10.O¤D 0 4D(  4r 4 S !  `}    4 RA TENS0+ H 4 0޽h ? 3380___PPT10.@WL,$ 0 @$(  @r @ S p!  `}   r @ S !  `  H @ 0޽h ? 3380___PPT10.{?  0 DJ(  Dr D S *"  `}    D S +"  `<$D <   D 00"  0g,$D , ^Diabetic peripheral neuropathy$  H D 0޽h ? 33-%___PPT10..$Z+D' @= @B DD' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*D%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*DD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*D+8+0+D +$ 0 H$(  Hr H S U"  `}   r H S W"  `  H H 0޽h ? 3380___PPT10.j7q! 0  LP(  Lr L S "  `}    L S "  `<$D <  H L 0޽h ? 33YQ___PPT101.0E'6+XD' @= @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L%(D' =-m6Bbox(in)*<3<*LDS' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L9%(D' =-m6Bbox(in)*<3<*L9D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L9^%(D' =-m6Bbox(in)*<3<*L9^D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L^q%(D' =-m6Bbox(in)*<3<*L^qD' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*Lq%(D' =-m6Bbox(in)*<3<*LqD' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L%(D' =-m6Bbox(in)*<3<*LD' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L%(D' =-m6Bbox(in)*<3<*LD1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L%(D' =-m6Bbox(in)*<3<*LD' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L%(D' =-m6Bbox(in)*<3<*LD' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L%(D' =-m6Bbox(in)*<3<*LD' =%(D' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*L*%(D' =-m6Bbox(in)*<3<*L*+  0  0P(  Pr P S  `}    P S p, `<$D <  L P 0PP@V,$D ,  DM management glycemic control Not much evidence for efficacy of non-pharmacologic modalities Medications Antidepressants Anticonvulsants\!! 2O    ! O  xH P 0޽h ? 33-%___PPT10..`"+CD' @= @B DD' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*P%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*PD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*P+8+0+P + 0 @T$(  Tr T S ؍ `}   r T S ٍ `  H T 0޽h ? 33___PPT10u.`+D=' ̰= @B + 0 PX$(  Xr X S 1 `}   r X S 03 `  H X 0޽h ? 33___PPT10u.R+D=' ̰= @B + 0 `\$(  \r \ S  `}   r \ S @ `  H \ 0޽h ? 33___PPT10u.uA+D=' ̰= @B +$ 0 p`$(  `r ` S t9 `}   r ` S u9 `  H ` 0޽h ? 3380___PPT10.PL7 0 d$(  dr d S P9 `}   r d S 9 `  H d 0޽h ? 33___PPT10u.U0+D=' ̰= @B +$ 0 h$(  hr h S  `}   r h S p `  H h 0޽h ? 3380___PPT10.p9 0 ll(  lr l S H `}    l S I `<$D <  3 l 0PN ,$D , A-Morphine ER (MS Contin). Dosed Q12 hours instead of Q3-4 hours. B 2A+ l 0U  ,$D , E50 mg$  H l 0޽h ? 33  ___PPT10 ..q?+CYdD ' @= @B D ' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*l%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*lD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*lD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*l%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*lD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*l+p+0+l ++0+l + 0 p'(  pr p S ` `}    p S Ќ `<$@ <  A p 00p0 ,$D , qNo. 1 mg of morphine IV is NOT equivalent to 1 mg of morphine PO. The ratio for oral to parental morphine is 3:1 r 2q p 0pZ P,$D , No. With conversion of opioids there is a risk for side effects from dosing too high. Decrease 24 hour dose by 20-25% until see how pt responds."  tH p 0޽h ? 33  ___PPT10 ..f+D ' @= @B D ' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*p%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*pD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*pD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*p%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*pD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*p+p+0+p ++0+p +  0 JBt(  tr t S @ `}    t S  `<$D <   t 0` P ,$D , D50 mg morphine IV/24 hours 3:1 ratio 150 mg morphine PO/24 hours Decrease dose by 20% 120 mg morphine PO/24 hours Dosing Q12 hours Morphine ER 60 mg po Q12H.l%0 .H t 0޽h ? 33-%___PPT10..%+~D' @= @B DD' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<*tD' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<*t+8+0+t +$ 0 x$(  xr x S Z `}   r x S p[ `  H x 0޽h ? 3380___PPT10.@|$ 0 $(  r  S 0 `}   r  S  `  H  0޽h ? 3380___PPT10._$ 0 |$(  |r | S p+9 `}   r | S `ߊ `  H | 0޽h ? 3380___PPT10.V 0  $(  r  S p$  `}   r  S $  `  H  0޽h ? 33$ 0 <$(  <r < S @ `}   r < S  `  H < 0޽h ? 3380___PPT10.`K$ 0 $(  r  S : `}   r  S 8 `  H  0޽h ? 3380___PPT10.dxp^RЀ3ÿ lHbP  @AL G@;b `B&VOHGKsMO_asvxz}TNJl /}#dK#DocumentSummaryInformation8HCurrent UserV Oh+'0S hp   $' Chronic PainawHilary SuzawawBalanceAnoop Agrawal User39Microsoft PowerPoint@PWf@|1 @ۨ GRPICTR HH HH  l8|͙͙͙͙͙͙͙͙͙͙͙͙͙͙͙́́́́́́́́́́́́́́́*) +-/01344658899:<=<>?=?<<;962XY\adgiklmopprqttuuvxyxz{y{xxwurnghknortvwxz{{}|}y**))+,-1134567899:;;<==>>??@BABAA?<;8Y\adfhimmopqrstuuvuvwwxyyz{ ||z|z{yxwthjnorstxxz{|}~ **)*,/02246679:<<=> ?@ACCDCDCDDBA= ]`dfhklnnprrsuvxyz {z{||{{|{||{zy knpqsvwyy{}}~ *)*,.11345789:<:<==<879=??>??ACDEFB acfhjmmopqstuvyyxtqorwy{z|z{|{||}~}{ noqsuxxz{|~}|~"))+-0124668::C62;3-+))*,08C8JKDDFGGH"degilmnprstvv{g`uh\UNORXfs}j~{|~"oprtwxy{}}uoukeaacgsw(*,.1245989445)++) **+)(+40=MEGGHIdfhjmnpquttmijBFPK IHIMUfWo~ oqsuxy{|zwwRWa^[[XVUZ_fsd~(+-014678@?1+)+)(++))()+*) ()3IKHIIJMK%dgilmprstxwiWE2>JKHHFDEGIIE8EN`$ortwx{}~ufTCLX[USRPQTUZSFU[o+,.14477FaI8'*+))*) *)*)'((5_OKMLMMghjmopst}rHCNMMGCBA DIKJ>29C\$rsux{{~~WR\[XSPPNNOPTZYKAFPg+-02577A]6(30*)(())( )*)()*'=dQLMN#gilnqssxmKYhYOIB??@@??EJRTB3:Ai#rtwy|~~zXiuh`VOMMNNMMQZcaRDHMv+/1368=uN4GE20')*++('()/;/))%TwPNOOPgkmortvcs~j`M@=>>?@DN`nY8>Ervxz}p~wo[NLM Q^o{gGLP-03579pc3T[:92()+( **-EB8'),[bPiloqstelq_=<>? @AQz{h7DRtwz|~Šn|~mKJLM NPasHSc&/1357JEJ\*+3+())*))(())*()),26'(-itNPQ&kmoqsǮwrYXhC1:==?@>>??>88KRd\>=7.3\괋yz}̏Yx^LCDDFPm}mGKiﻒ4482y/WkY>-)**)4H`B')GȫRYYZZpptp̪\}Ův]C3238Eil8M~Ɋ{{{յiζlQBCDGSwxG[Β468C͕ECxj]E/**)*^}z_yŹmQEBCF\yOm4@D鷚uS?0+*)()*2t5&Br[^]*pyxDwhPB5223:IeLKu*{R˲t\OECCDGWt[\*3rߜ<$ˡwK9.*+*(*)((6~D&-X^_*ntFȧqaUM=3667Di^H^*{ʀTѰ~obYKCFFEPwjVk×GׁV6hްM3,)*)()(9K%0\__*|j֯l`OJA9:85CnfD]ߏwܸym]VMGHGEO|rSl♛Ͱd/U뻅Q4,*)())'=J&+s\_ִdv߲maOA;65BpceUR~[uzCZ*]@ڴkFNsc`g̈́Qh*ُJ?Xx̱ZO3()64lltt:a†q޻pHNyyJm*t:#CZQ7('9Jp:TlIr츢%ǤrPfӮi;O=()4`૔hHߩam*ru{ivq?:dҼuӓƒ*~vʛ~LGqĜٞ̃*:<=>ABBI}}wA/H<)),X^X[__`]JR]g!uwzyxyz̹Ƿyhr?9[㒎z!u~MIi朗*9:=@CDFHFc鿶z3+@7),*GSWZ\]]_S+.A`*vwxy{|~}hbznA8PԉX`y*voyNH^ٔhn*993())7SVWX[\^`L++=*uvxyz|}~ו_]vjB6Ek]asŒ*ߢmkuMEUylo*9:<=ADDEIO߸N)+90))++coSTUXZ[\]_@),W_~'{0x uvxzz{|}V[sfB5?YzdfIttnha*ʏfjrMDMhor.AAf.*9:;=ADDEIJ֦s7*+1.))*(E`STTWXVXZ^W7-Nxg{{~{7'{uvwyy||}ͣmV^la?6:Kzsj Ińttzzɛ*װ{flxnKEHX񜗖~u pAOyͿW98;=?CDEHGċK,,--*(),sVSSTTUUWY\]O9nn~'=77Cn~C0CC''~~qC~~C0Cƙutwyz{|}嶀[V_fV=67@^ ttz%t̬I%?4%nz̛̄Rz4tn̎%?nz!jfmrfKEFOk痘\OApfypAAfyyN 79:=?BDDGFЫg.++,+*()**'IQRRTXYZ[\S~~uxRxC7~~~xx{WR~ux7jn'x~xxƙsuvy{|}јcWW]^N:44:F~݊z4z¨zɉztn%tzZhz!~ۦpeejk]HDEIVOOf.yOOf..ȱOpט׫AOf.O69:;?@DDGD<(-+))**))-zLQQSTSTVVYZ[^~{NW{CR{Ix{~Nq[0''x{Ixƙ*ruvw{{|||qX]ZXTE7336=[ԇ%tn̾tttnz%̳nttt*}gligcUGDDFKf؎OA.AAA͑\.AҫyAAAM!58::=@CDDCxK++-,*)'(**'(&DKQQRST[\c7{xIR{Wu{~'g_''x{Wuƙ!qtvvy|{||{ĀT]e[WP@42369Cv̅Itn%̻tn4tn%Űz%ZRttn4|Јbkrjd]MCDDEFPώf A.AOA͑A AAOS*689;=??@CAfc++..,+,))+*'')(nJPQQRSSQSSUYZ$Nxj{WR=I{{Wu{cc~W'x{Wuƙ*rtuwy{z{{yUQce^TI<543578M„%Itn%̛tn4tnIaz%4atn4*}`apsldXJEEDDFG[ɏ%pAAAOAͱA AAOJ469:;=>??G_3),--* (')*(&'&4JPPQSSUVVI_~'[WW~'Wu~'~~ =7'{~'Wuƙ pruvwyz|z~_J[``ZOB:863688:aʾ? tt%%̨tt4tt̉%4 I%tt4!{}jZjonh^QHFEDEFFJmÎ AAAOAyyO .AAAO 4699;==?BU<)--+,+))(&&''&&)&LzMPPQSTTWpruuwyy{ziIb`[TNH@98878?}º{}vYnmic\UMGFGM458::<=?P?(-/+)*+)('&'*()*)ReNPQRSSTpqtvvxyxtRbjSMHB@>98 :;AQ{|anva[UPNKGF GHIP^2469:;JFxA5lnpruvwx|efdTE?<;:8 78;=<<;8:9:9978;;=?@??@BDHMWYQ+ROLKJJIHIHIGFIIMMNMMNQT[egaּǹ )*))()()((+*)'),)())(()()*)(+ŰZ$%OM:%!#J߹=<;;:;:8878;<=?@@??>@BGKI+ܽtLKJJIIHIHGFEFGHIJMNNMLLNPVXV+ʽŸ)()*())())((*'&(&*)( )()((+))*())++Ļq#(+"%l߸>=;<<;;97864589;<>? @?@??><<==?@B+Ȟ]NezLKIJJIIHFDEFHIKMNMNMJJKKMNP+z*)**)( *'&'('(()()**)()+*)(*˧ 4),b޶GDB?=<;;9787558:;=@A@@?>=>?@ԗ|=VN)[SQPMKJIIHF EEFHILNONNMKLMMNݼ\rŵl7g*)(()**((& '&**)()*))*)(*)()*+q ;F\ܴGE@>=<:98 787;>??+ؤ(>F%k#)8 KKIHIIHIHGF EFFJLPQPPOMOPM+Ž߼BEO+/3 7ø *))((+(('%&'( '&&')*)()*((**)*)((*)((+к`("@cᯟ 98678878778788753358=?ACB@>>=>?@??>=+Ԧ&1f_t.! IGFFGHFGFEFEDDEGJMNPONMLKLMNMLK"ݾ>@|sӑ>0 +)*(()(&&(()**)(**)*)(*)*))*)*(*+)+ȳf! +jᰠ 5346767887764456775423359=?@@?=<<=<=;;:9+ݠ(>C{EDDFEDEF DCDDEHKMNNMLJJKJIIH+$1Hۥ_$v))*)*)*'(**)*)(**(**)(*) (()())*(*+*+ŧo  +䱢 22334345643544233236<= <<;;<;<:87753+ۨ'7?"T CCDDEDEEFEDECDDCDFJKLKKJJIIJIJIGFGFD+-0Dի_+R"'(()*)**))*)*'()()++)'(**)ՙ+˻M    Bޱ/0223223232358;<;99774332+˾tYW J@BCCDCCDCDDGIJIFFDC+חwĞl  Ḱ֙+ʲsI  G!ȼI  e̿!վȶc _+εxp_    v+U %̿%Ǯn'} +ռŪdD   p +ǿY_ ;̿ %Ѿȳv} ; +ɭf;$   t+¹vT4)̿%Ѷě#cH,w+Ͼ_   +W%G 6Nwy̼ ˸β϶u.b*GOnu͙+̹nF ! ![+u&+X;jm̲+ŷöҺ92y[el͙+ɬuA L+ĺ~B}[Rlm̳"ŴȰˤ^!vel!аwpH  9+ĻzKbQAIoó+ɲխŘf#"~pbSjm+ϵiVV? !    >+{B- FWjV;Uś+μŘ_?Ccv\'Sr+°k`hY+-    N+l0 `jiV@>x́+ѽϡżF$Uo|];x{+Ѷso}Z      l+ėtt8 l}hVC={~́+ɷխKez`!,%{hM<@y̽ ýٽZ`>+xuV(>r +ʨ}r}ijl%    ; +Dz`)! /hD: K̾ +ƻԄD/9oR-Iv +ƤU0\yc_Y5 *C %ƺ +ӻ`"  ~  +m~{ ,HZc\E P@ - +ˆ:9aL{ZF09̾ +۠MDuݲdwbGF+vvĿl 'RRGHVW9-+ƙ@́+АNPkD-;Y[hZ]dLv+8Q !   $ɻ+оz@2:@16H@D@YnuzSW<;}́+|ɧhQYS56KGOTqnxWCt+ :v #  7ͼ+MO^Ǖ`<#&0!4`R3.>eW?&;x́+_amċ`6;A$!;n]:?Uk`;Aq+ 9\    Pп+[NKŸJ  #20Dc$Eŕ+gfgl  ':6(Np0!Ej+,#*   qо!oE>zˠ  !^ZCḱ+t``Ÿۡ4)-*  (ba@`+ 0!/ ! Ʒ+A.kѓg_VUfs9 5QAMń+YTضءzw{Z(K`LDf+.)     (+l0#`К>DvxtZEVF \́+nJJ}׺`_}pk&$0*% Q+ $5   S+R˴t$#-*   Hź++7Ap̔04:D>(,#  N{+!&vW+   @+NƼV b́+(5eήi    f+!rlR!   V+EļRA  "Ev́+&XսdL  "1*!@m¾+qe_O='  m$4ýx<  +:_~xý)JοR ($>Vjlhrʾ+ vngy~SG: 6~+ %ʿG-(.A2'EOSQń!;Ү[>"3>U@1]kpiafϽ+ qsO+,1%2IEHLMMNR]  ƹf3>RjZ3RhUI#;Vnv́)1кTUfhAnqY .Ssw+d+  & Rb+"ħ}xYU^z*'-5?IYx́+1ĸĥxmz4!.59IRUZ`hu+^  0 ! !# &!  h+¯x9A1#-/>Zṕ+)ʠM\M+/347JOYkv+~}yH 7!! !# G+Ǿ~q*a\@-  %)2Hfẃ+ ʭJhP=+)8A@GVop(b}ubJ#  '%  ?(ƾ{xxoi{)CX^I=BC1 %EŚ(Fnuhe^G30LQ+DDEExrdSKJKMPLGKOPJMQ^X_WWNQMGJKLJQNPMDvD(HĿ}[u~ojx́D(Lktlt~ć 5͙͙͙͙͙͙͙͙͙͙͙͙͙͙́́́́́́́́́́́́́́́ ՜.+,D՜.+,H    $ 'On-screen ShowBaylor College of Medicinesj  #Arial WingdingsDefault Design Chronic Pain ObjectivesCase 1 QuestionsWHO Analgesic LadderWHO Analgesic LadderDEA RxAntidepressantsAnticonvulsantsNon-pharmacologicNon-pharmacologicTENSCase 2 QuestionsNeuropathic PainNeuropathic Pain SyndromesPowerPoint PresentationAntidepressantsAnticonvulsantsOpioidTopical Agents Other DrugsCase 3 Questions Questions QuestionsOpioid Adverse OutcomesOpioid Side EffectsOpioid Side EffectsACP Clinical Cases Bibliography Bibliography  Fonts UsedDesign Template Slide Titles  8@ _PID_HLINKS'A?http://www.acponline.org/journals/news/dec04/pain/clinical.htm*_O"BAnoop Agrawal UserAnoop Agrawal User