%PDF-1.7
%
1 0 obj
<>>>
endobj
2 0 obj
<>stream
2017-06-06T15:40:44-04:00
2017-06-06T15:40:46-04:00
2017-06-06T15:40:46-04:00
Adobe InDesign CC 2017 (Windows)
uuid:fc7cf0be-ab15-4036-88fd-c6d3364de54d
xmp.did:4A42F9656056E111960DCE8E95F0DF9D
xmp.id:102826dd-ae9c-0748-90f7-07997dd768b7
proof:pdf
xmp.iid:76b2e8c7-3ac2-f541-ac61-ba2a7419aeaf
xmp.did:2faa42d1-a097-8941-aa78-ce97b5477cb3
xmp.did:4A42F9656056E111960DCE8E95F0DF9D
default
converted
from application/x-indesign to application/pdf
Adobe InDesign CC 2017 (Windows)
/
2017-06-06T15:40:45-04:00
application/pdf
Adobe PDF Library 15.0
False
endstream
endobj
3 0 obj
<>
endobj
5 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
6 0 obj
<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
18 0 obj
<>stream
BT
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
7 0 0 7 60.48 22.6817 Tm
(2 )Tj
/Span<>> BDC
( )Tj
EMC
56.231 0 Td
[(Clinical Briefs in P)18.1 (rimary Care)]TJ
ET
q
0 g
/GS1 gs
0 TL/Fm0 Do
Q
BT
/T1_0 1 Tf
-0.01 Tc 7 0 0 7 40.75 373.76 Tm
(CLINICAL BRIEFS IN PRIMARY CARE)Tj
/T1_1 1 Tf
0 Tc 6 0 0 6 158.4884 373.76 Tm
(\231 )Tj
1.23 0 Td
( )Tj
-0.01 Tc -20.853 -1.167 Td
[(is published monthly by AHC Media, a Relias Learning)-10 ( )]TJ
0 -1.167 TD
[(company. Copyright \251 2017 AHC Media, a Relias Learning)-10 ( )]TJ
0.01 Tw 0 -1.167 TD
[(company.)-10 ( )]TJ
/T1_2 1 Tf
0 Tw 8 0 0 8 40.75 342.76 Tm
(Executive Editor:)Tj
/T1_1 1 Tf
( Leslie Coplin)Tj
/T1_2 1 Tf
0 -1.25 TD
(Physician Editor:)Tj
/T1_1 1 Tf
( Stephen Brunton, MD)Tj
/T1_2 1 Tf
0.01 Tw T*
(Editor:)Tj
/T1_1 1 Tf
0 Tw ( Jonathan Springston)Tj
6 0 0 6 40.75 308.76 Tm
[(This is an educational publication designed to present)-10 ( )]TJ
0 -1.167 TD
[(scientific information and opinion to health professionals,)-10 ( )]TJ
0 -1.167 TD
[(stimulate thought, and further investigation. It does not)-10 ( )]TJ
0 -1.167 TD
[(provide advice regarding medical diagnosis or treatment)-10 ( )]TJ
T*
(for any individual case. It is not intended for the layman.)Tj
0.01 Tc 0 -1.917 TD
(STATEMENT OF FINANCIAL DISCLOSURE)Tj
-0.025 Tc 0 -1.167 TD
[(To reveal any potential bias in this publication, and in)-25 ( )]TJ
-0.001 Tw T*
[(accordance with Accreditation Council for Continuing Medical)-25 ( )]TJ
0 Tw 0 -1.167 TD
[(Education guidelines, Dr. Brunton reports he is a retained)-25 ( )]TJ
0 -1.167 TD
[(consultant for Abbott Diabetes, Actavis, AstraZeneca, Becton)-25 ( )]TJ
T*
[(Dickinson, Boehringer Ingelheim, Cempra, Janssen, Lilly,)-25 ( )]TJ
0 -1.167 TD
[(Merck, Novo Nordisk, Sanofi, and Teva; he serves on the)-25 ( )]TJ
0 -1.167 TD
[(speakers bureau of AstraZeneca, Boehringer Ingelheim,)-25 ( )]TJ
T*
[(Janssen, Lilly, Novo Nordisk, and Teva. Dr. Kuritzky \(author\))-25 ( )]TJ
0 -1.167 TD
[(is a retained consultant for and on the speakers bureau of)-25 ( )]TJ
0 -1.167 TD
[(Allergan, Daiichi Sankyo, Lilly, and Lundbeck. Ms. Coplin, Mr.)-25 ( )]TJ
T*
[(Springston, and AHC Media Editorial Group Manager Terrey)-25 ( )]TJ
0 -1.167 TD
[(L. Hatcher report no financial relationships relevant to this)-25 ( )]TJ
0 -1.167 TD
(field of study.)Tj
ET
/CS0 CS 1 SCN
0.25 w 4 M
/GS1 gs
36.125 45.125 165.734 338.51 re
S
/CS0 cs 0.1 scn
43.545 101.88 146.91 68.76 re
f
0.86 0.57 0 0.16 K
0.3 w 10 M
q 1 0 0 1 85.6163 141.0642 cm
0 0 m
80.087 0 l
S
Q
q 1 0 0 1 72.6205 134.0642 cm
0 0 m
42.017 0 l
S
Q
BT
0 0 0 1 k
/GS0 gs
/T1_2 1 Tf
0.05 Tc 8 0 0 8 48.0448 158.9401 Tm
[(SUBSCRIBER INFORMA)92 (TION)]TJ
-0.01 Tc 7 0 0 7 48.0448 148.6641 Tm
(Customer Service: \(800\) 688-2421)Tj
/T1_1 1 Tf
-0.025 Tc 6 0 0 6 48.0448 141.6641 Tm
(Email Address:)Tj
0.86 0.57 0 0.16 k
/GS1 gs
( jspringston@reliaslearning.com)Tj
0 0 0 1 k
/GS0 gs
-0.01 Tc 0.01 Tw T*
(Website: )Tj
0.86 0.57 0 0.16 k
/GS1 gs
4.096 0 Td
(AHCMedia.com)Tj
0 0 0 1 k
/GS0 gs
0 Tw -4.096 -1.917 Td
[(Address Correspondence to: AHC Media, a Relias)-10 ( )]TJ
T*
[(Learning company, 111 Corning Road, Suite 250,)-10 ( )]TJ
T*
[(Cary, NC 27518.)-10 ( )]TJ
ET
q
81.64 94 68.84 -38.25 re
W n
q
/GS1 gs
68.8401276 0 0 38.2499963 81.6398926 55.7500113 cm
/Im0 Do
Q
Q
/CS0 CS 1 SCN
1 w
/GS1 gs
q 1 0 0 1 36 653.6872 cm
0 0 m
165.984 0 l
S
Q
q 1 0 0 1 36 618.5345 cm
0 0 m
165.984 0 l
S
Q
BT
/GS0 gs
/T1_3 1 Tf
9.25 0 0 9.25 36 736.8565 Tm
(data come from relatively small, short-)Tj
0 -1.217 TD
(term trials. Nonetheless, the authors sug)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.217 TD
[(gested that the consistency of the results)-10 ( )]TJ
0 -1.217 TD
[(\(all seven trials found the same positive)-10 ( )]TJ
T*
[(association\) should prompt clinicians to)-10 ( )]TJ
0 -1.217 TD
[(refer PCOS patients for assessment of)-9.9 ( )]TJ
T*
(periodontal health. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 115.2811 669.34 Tm
<0084>Tj
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
-0.005 Tc 14 0 0 14 36 639.6872 Tm
[(Combination T)175 (reatment)-4.8 ( )]TJ
0 Tc 9.802 0 Td
( )Tj
-0.005 Tc -9.802 -1.154 Td
(for Hospitalized Influenza)Tj
/TT1 1 Tf
0 Tc 9 0 0 9 36 600.5817 Tm
[(SOURCE: Hung IFN, T)175.2 (o KK)35.8 (W)123.8 (, Chan JFW)124.1 (, et al. )]TJ
/TT2 1 Tf
0 -1.217 TD
(Chest)Tj
/TT1 1 Tf
( 2017;15:1069-1080.)Tj
/TT0 1 Tf
30.3235 0 0 30.3235 36.5182 562.7762 Tm
(W)Tj
/T1_3 1 Tf
-0.01 Tc 9.25 0 0 9.25 64.4508 573.8762 Tm
[(as I the only clinician who was)-10 ( )]TJ
0 -1.2 TD
[(unaware that either clarithromycin)-10 ( )]TJ
-3.076 -1.217 Td
[(or naproxen possess antiviral activity?)-10 ( )]TJ
0 -1.217 TD
[(In their opening discussion of the topic,)-10 ( )]TJ
0 -1.217 TD
[(Hung et al commented, \223In vitro and)-10 ( )]TJ
0 -1.217 TD
(animal studies have shown that ... clar)Tj
0 Tc 16.114 0 Td
(-)Tj
-0.01 Tc -16.114 -1.217 Td
[(ithromycin and naproxen ... both possess)-10 ( )]TJ
0 -1.217 TD
[(antiviral activity)92.1 (. ... In addition, macro)]TJ
0 Tc (-)Tj
-0.01 Tc 0 -1.217 TD
[(lides have effects on the host response to)-10 ( )]TJ
0 -1.217 TD
(in\036uenza virus infection.\224 Who knew?)Tj
0 -2.433 TD
[(In the United States, thousands of people)-10 ( )]TJ
0 -1.217 TD
[(die each year from in\036uenza. The effect)-10 ( )]TJ
0 -1.217 TD
[(of \223traditional\224 antiviral therapy)92 (, most)-9.9 ( )]TJ
T*
[(commonly neuraminidase inhibitors, often)-10 ( )]TJ
0 -1.217 TD
(is limited by the fact that patients are ad)Tj
0 Tc (-)Tj
ET
/GS1 gs
q 1 0 0 1 214.008 464.3906 cm
0 0 m
165.984 0 l
S
Q
q 1 0 0 1 214.008 413.2518 cm
0 0 m
165.984 0 l
S
Q
BT
/GS0 gs
-0.01 Tc 9.25 0 0 9.25 214.008 736.8565 Tm
[(mitted more than 48 hours after symptom)-10 ( )]TJ
0 -1.207 TD
[(onset, rendering neuraminidase inhibitors)-10 ( )]TJ
0 -1.208 TD
(less effective.)Tj
0 -2.415 TD
[(Patients admitted to the hospital \(n = 217\))-10 ( )]TJ
0 -1.208 TD
[(with con\037rmed in\036uenza A \(H3N2\) were)-10 ( )]TJ
0 -1.207 TD
[(randomized to \037ve days of treatment with)-10 ( )]TJ
T*
[(oseltamivir 75 mg twice daily)92 (, plus either)-10 ( )]TJ
0 -1.208 TD
[(clarithromycin 500 mg + naproxen 200)-10 ( )]TJ
T*
[(mg twice daily for the \037rst two days or)-10 ( )]TJ
0.01 Tw 0 -1.207 TD
(placebo.)Tj
0 Tw 0 -2.415 TD
(There was a dramatic, statistically signi\037)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.207 TD
[(cant effect of the combination therapy on)-9.9 ( )]TJ
0 -1.208 TD
[(mortality)92 (. Of the 10 deaths in the 30-day)-10 ( )]TJ
0 -1.207 TD
[(follow-up, nine were in the neuraminidase)-10 ( )]TJ
T*
[(monotherapy group. Con\037rming that this)-9.9 ( )]TJ
0 -1.208 TD
(is unlikely to be related to the antibacte)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.207 TD
[(rial effects of clarithromycin, the authors)-10 ( )]TJ
T*
[(indicated that < 5% of these patients)-10 ( )]TJ
0 -1.208 TD
[(had con\037rmation of bacterial coinfection)-10 ( )]TJ
T*
[(at presentation. Clinicians may want to)-10 ( )]TJ
0 -1.207 TD
[(consider such a regimen for hospitalized)-10 ( )]TJ
T*
(in\036uenza pneumonia patients. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 336.1346 479.96 Tm
<0084>Tj
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
-0.005 Tc 14 0 0 14 214.008 450.3906 Tm
[(Desmopressin Nasal Spray)-4.8 ( )]TJ
0 -1.148 TD
[(for T)175 (reatment of Nocturia:)-4.9 ( )]TJ
0 -1.148 TD
[(P)17.6 (roceed with Caution)]TJ
/TT1 1 Tf
0 Tc 9 0 0 9 214.008 395.3824 Tm
[(SOURCE: F)54.8 (ralick M, K)17 (esselheim AS. )]TJ
/TT2 1 Tf
(JAMA)Tj
/TT1 1 Tf
( )Tj
0 -1.208 TD
(2017;317:2059-2060.)Tj
/TT0 1 Tf
30.3235 0 0 30.3235 211.787 357.7435 Tm
(N)Tj
/T1_3 1 Tf
-0.01 Tc 9.25 0 0 9.25 235.0704 368.8435 Tm
[(octuria is a symptom than can re\036ect)-10 ( )]TJ
0 -1.2 TD
(a variety of underlying patholo)Tj
0 Tc (-)Tj
-0.01 Tc -2.277 -1.207 Td
[(gies, including heart failure, diabetes, and)-10 ( )]TJ
0 -1.208 TD
[(benign prostatic hyperplasia. Although it)-10 ( )]TJ
0 -1.207 TD
(might be tempting to go directly to phar)Tj
0 Tc 16.879 0 Td
(-)Tj
-0.01 Tc -16.879 -1.208 Td
(macologic treatment, with the recent ap)Tj
0 Tc (-)Tj
-0.01 Tc T*
[(proval of an agent designed to treat such)-10 ( )]TJ
0 -1.208 TD
[(symptoms, caution is in order)111 (. The indica)]TJ
0 Tc (-)Tj
-0.01 Tc 0 -1.207 TD
(tion for the recently approved desmopres)Tj
0 Tc (-)Tj
-0.01 Tc T*
[(sin nasal spray \(Noctiva\) is speci\037ed for)-10 ( )]TJ
0 -1.208 TD
[(\223treatment of nocturia due to nocturnal)-10 ( )]TJ
0 -1.207 TD
[(polyuria in adults who awaken at least)-10 ( )]TJ
0 -1.208 TD
[(two times per night to void.\224 Fralick and)-10 ( )]TJ
0 -1.207 TD
[(Kesselheim reinforced the FDA labeling,)-9.9 ( )]TJ
0 -1.208 TD
[(indicating that the use of desmopressin)-10 ( )]TJ
0 -1.207 TD
[(should be preceded by elimination of)-9.9 ( )]TJ
T*
(underlying serious pathology \(e.g., blad)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.208 TD
[(der cancer)111 (, pituitary pathology\) as well as)-10 ( )]TJ
0 -1.207 TD
[(con\037rmation of polyuria with a 24-hour)-10 ( )]TJ
0 -1.208 TD
(urine collection.)Tj
0 -2.415 TD
[(Adverse effects of desmopressin include)-10 ( )]TJ
0 -1.208 TD
[(hyponatremia, which can be severe.)-9.9 ( )]TJ
0 -1.207 TD
[(Although clinical trial data demonstrated)-10 ( )]TJ
T*
(severe hyponatremia \()Tj
/C2_1 1 Tf
0 Tc <0064>Tj
/T1_3 1 Tf
-0.01 Tc 9.828 0 Td
[( 125 mmol/L\),)-10 ( )]TJ
-9.828 -1.208 Td
(only rare \(0.7% of desmopressin recipi)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.208 TD
(ents vs. 0.3% of placebo subjects\), moder)Tj
0 Tc 17.482 0 Td
(-)Tj
-0.01 Tc -17.482 -1.207 Td
[(ate hyponatremia \(126-129 mmol/L\) is)-9.9 ( )]TJ
0 -1.207 TD
[(substantially more common \(2.2% of)-10 ( )]TJ
0 -1.208 TD
[(desmopressin subjects vs. no placebo)-10 ( )]TJ
ET
/GS1 gs
q 1 0 0 1 392.016 578.0077 cm
0 0 m
165.984 0 l
S
Q
q 1 0 0 1 392.016 542.2271 cm
0 0 m
165.984 0 l
S
Q
BT
/GS0 gs
9.25 0 0 9.25 392.016 736.8565 Tm
[(subjects\). Finally)92 (, the mean change in)-10 ( )]TJ
0 -1.284 TD
[(nocturia episodes decreased from about)-10 ( )]TJ
0 -1.284 TD
[(3.3 episodes per night to about 1.9/night)-10 ( )]TJ
0 -1.284 TD
[(with desmopressin treatment, which many)-10 ( )]TJ
T*
(of us might consider only a modest symp)Tj
0 Tc (-)Tj
-0.01 Tc T*
(tomatic improvement.)Tj
0 -2.569 TD
(Because desmopressin can result in seri)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.284 TD
[(ous adverse events, it is important that)-10 ( )]TJ
T*
[(clinicians become fully familiar with FDA)-10 ( )]TJ
0 -1.284 TD
(labeling of the new product and be con\037)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.284 TD
[(dent that no underlying serious pathology)-10 ( )]TJ
T*
(is present before prescribing. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 508.814 594.2884 Tm
<0084>Tj
0 0 0 1 k
/GS0 gs
/TT0 1 Tf
-0.005 Tc 14 0 0 14 392.016 564.0077 Tm
[(Efficacy of Cephalexin)-5 ( )]TJ
0 Tc 8.998 0 Td
( )Tj
-0.005 Tc -8.998 -1.199 Td
[(Monotherapy for Cellulitis)-5 ( )]TJ
/TT1 1 Tf
0 Tc 9 0 0 9 392.016 523.6464 Tm
(SOURCE: Moran GJ, Krishnadasan A, Mower )Tj
0 -1.287 TD
(WR, et al. )Tj
/TT2 1 Tf
(JAMA)Tj
/TT1 1 Tf
( 2017;317:2088-2096.)Tj
/TT0 1 Tf
30.3235 0 0 30.3235 391.8087 484.585 Tm
(T)Tj
/T1_3 1 Tf
-0.01 Tc 9.25 0 0 9.25 410.0875 495.685 Tm
(he past decade has seen methicillin-)Tj
0.01 Tw 0 -1.2 TD
(resistant )Tj
/T1_4 1 Tf
0 Tc 0 Tw 3.789 0 Td
(S)Tj
-0.01 Tc 0.01 Tw 0.49 0 Td
(taphylococcus)Tj
0 Tw ( aureus)Tj
/T1_3 1 Tf
0 Tc 9.034 0 Td
( )Tj
-0.01 Tc -15.267 -1.284 Td
[(\(MRSA\) maintain suf\037cient prevalence)-10 ( )]TJ
0 -1.284 TD
[(in cases of acute cutaneous abscesses that)-10 ( )]TJ
T*
(treatment oriented to that pathogen, typi)Tj
0 Tc (-)Tj
-0.01 Tc T*
(cally t)Tj
0.01 Tw (rimethoprim)Tj
0 Tw [(-sulfamethoxazole or)-10 ( )]TJ
0 -1.284 TD
(doxycycline, has become routine adjunc)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.284 TD
[(tive treatment to incision and drainage.)-10 ( )]TJ
T*
[(The pathogen responsible for cellulitis)-10 ( )]TJ
T*
[(without abscess often has been assumed)-10 ( )]TJ
0 -1.284 TD
[(to involve MRSA frequently)92 (, leading to)-9.9 ( )]TJ
0 -1.284 TD
[(similar treatment regimens. Although)-10 ( )]TJ
0 -1.284 TD
[(nailing down with certainty the etiologic)-10 ( )]TJ
0 -1.284 TD
(agent of cellulitis presents greater dif)Tj
0 Tc (-)Tj
-0.01 Tc T*
(\037culty than an abscess, the currently pre)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.284 TD
[(dominant cellulitis pathogen is believed)-10 ( )]TJ
0 -1.284 TD
[(to be beta-hemolytic strep. In typical)-10 ( )]TJ
T*
[(clinical settings, the pathogen usually is)-10 ( )]TJ
T*
[(not identi\037ed prior to treatment initiation.)-10 ( )]TJ
0 -1.284 TD
[(If MRSA is not a major player in simple)-10 ( )]TJ
0 -1.284 TD
[(cellulitis \(without abscess\), might agents)-10 ( )]TJ
T*
(to address MRSA be omitted safely?)Tj
0 -2.569 TD
[(A randomized, clinical trial of cellulitis)-10 ( )]TJ
0 -1.284 TD
[(patients \(n = 500\) without evidence of)-10 ( )]TJ
T*
(abscess compared cephalexin + trime)Tj
0 Tc (-)Tj
-0.01 Tc 0 -1.284 TD
[(thoprim-sulfamethoxazole to cephalexin)-10 ( )]TJ
0 -1.284 TD
[(monotherapy)92 (. The primary outcome was)-10 ( )]TJ
0 -1.284 TD
(clinical cure.)Tj
0 -2.569 TD
[(There was no statistically signi\037cant)-10 ( )]TJ
0 -1.284 TD
[(difference in the primary outcomes for)-9.9 ( )]TJ
0 -1.284 TD
[(the two groups, with a higher than 80%)-10 ( )]TJ
0 -1.284 TD
[(success rate in both treatment arms. In the)-10 ( )]TJ
T*
[(absence of evidence of purulent infection,)-10 ( )]TJ
T*
[(these data support the use of cephalexin)-10 ( )]TJ
0 -1.284 TD
[(treatment \(500 mg four times daily for)-10 ( )]TJ
0 -1.284 TD
[(seven days\) as a simpler)111 (, less expensive)-10 ( )]TJ
T*
(antimicrobial regimen. )Tj
/CS0 cs 1 scn
/GS1 gs
/C2_0 1 Tf
0 Tc 10 0 0 10 485.3752 44.9999 Tm
<0084>Tj
ET
endstream
endobj
19 0 obj
<>
endobj
26 0 obj
<>>>/Subtype/Form>>stream
0 0 0 1 K
3 w 4 M 0 j 0 J
/GS0 gs
q 1 0 0 1 18 754.5 cm
0 0 m
558 0 l
S
Q
endstream
endobj
27 0 obj
<>stream
How,~ FQm
-lUEhʣm
J(q mLR>TThEU5Mm'FiZPllCٙٝǾL~gs̹(iEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?QQDEOT?Q=xK<ۛљu
5+VR%26FdvqycOi[hBYe\o %e̹, V/Pq'ņB/si-lٌ[.]8⏝+L#7̛Ӌ?$s\OmfO۴kJu
,3eEϏt$/!i*L~cqMb9G&?e?+IyQ{zƔo]Rz(\W^Dy*3~i`ĸYWo٩B+(a`ָ-`Ju_ݾRƙk][|y'[lͺi㧍\,Kۓ"D#0Qhd}=`ExZlm KC}}-7tհ
NlgY]]]c?JcCn\*wYwLI]kbc$/]oUpT`Z4>?NAHOK4[RY.rOV5
ߘ~/jOKYk/
N.4x/ ks)`նGad?7U{!Dna}&C{3ꔜ86&~4r0>>𗗗;WK*f';;
0.@}{% @C_5sm8?>>6>֖btbs>hƺ6NhUgȵa&Zw8ũS-?{{i}[i 0kpW1~K|aTJR0j.W➦ ج*2Gm+%}2bjj#~DVR7d"G(-~72q,h-AMJ _ 7$x0˷G
w^Hz
=h1?2MdŔw"SSbѹlj
B2w>6v2
aaH~уƟ[78Gna
ۤ0Js;rrkReeq='|~M^PϓQ4l%:UEw hl(/\AԔ
S_V*~thA`eH)|Ξ)ߌ/WړLt0Ib7S_7`w{{{&P.طvT`̶trsZr%%I<ĥb4Q#eՂEwe^o5EW"HofL@ec0|ewX3'Ebc\'t̿Z!rX#DSoP7շ!4lzr0MLgÆ{fK]$߃73GF/e\x,n":0Ws!Tp
L}PzyꐦZ3#MM!
IC?q=?yrRsi<ݟ%xnZĿ@NP"2I|kmV\>''p5NƟjFmiO]G2 TT(v E`agVe= hh=u%HQ؈.*,jg;3xT ~NĂAW{4bG*Du_C:@aFީ3+B݄iͪp-|
2(J0gJ(S,Ma}@S:%~=k7l< ,:R#M,+_u/
֗ޟyy;b`qQ+EIX2d(I~7*g{!Ze7qC0tݪ5웨2^(?H AagP]֯ohg=Z+MU2ɹᾘ,K={8ϯzFtj(U5) !Ѡ|* (U
8'Uj34"W0υv[nATVvu#Ud9S,&~T
vv_[8р/~*K
~5anٯW+=~mOiö×[GEO!o
~Ӱws
_@?N/s!UF=GpR6ajƽ,,G" $hs?G}:.CXϖoҹ}At/8EDPdm%FZdtMPitڷfZdq0"*QQ
=r=/U7t9{{E6ww}}֢H%GN#^1Rd0km
1tSd>m(IB7VuX%OOnR~.Ϻlr_/HSO- ԺzF"O@-&DZ1'o=}E|j}WqOB_a`[z(P+ro/r68C\gu lzX'I;$W12LnjyǓsOu?e2dKIoǞ~d] RVAϺ2]$y^@Iؘ,c:_Lom$7Wlo.2M?QI^$rǟ3|[
[G,|2۟KlAvHO(~jc%AK7yi2%igZIV(חmI]9WYI$,lɽ=ɵ!U]؏P>r
OzZ'ѻ!MqȤ+GI}nhZM. b_}
$DMe^G;^gδ26dk5 yr;Ώnb
VuX7ل^Jl~WvO!V4˪2RL
/}"dƟ.ԧVt2M5UjJn&.{3/ūyxmڊEPeu>N:[7A
7554z먎_|&6G>L?ZD};~&ף,|ȲzM]xze5;#4p@6Y}2XgarDOWjG9'?t5t"gcԹBnq XF:5@Px/{25~#2ü;2h} /]ۻ4WJu{G#bhnV?^[
uVf^H)㇇at621Ift7N'U6KjLq`՞?tɾٺ;vhiL}l
Q _vqUR"p_dqTL
P8c{x٤(窎271%LeHː E;کe3 LRkG!n0glJtNkmHCQi
{$%{W{vٛT_yw