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## **Meet the editor**

José Antonio Morales-González carried out his undergraduate rotating internship year at the Hospital de Jesus Public Welfare Institution (IAP) (1995), graduating as Surgeon Physician in 1997 from the Faculty of Higher Education (FES)-Iztacala National Autonomous University of Mexico (UNAM). He engaged in Doctoral studies in Biological Sciences (with a specialty in Cellular Biol-

ogy) at the UNAM (1997‒2001). Dr. Morales-Gonzalez has been awarded diverse recognitions: Hospital de Jesus IAP awards (1995 and 1996); Gustavo Baz Prada medal by the UNAM (1997); the Alfonso Caso medal for academic merit by the UNAM (2004); distinguished by the National System of Researchers (SNI) as National Researcher level 1 (2010-2016). He is the author of 45 internationally and nationally published articles. In addition to more than 200 citations to their publications. He is also editor and coordinator of 22 specialized books. Dr. Morales-González is a Full-time Titular Professor-Researcher Escuela Superior de Medicina, IPN

Contents

Authors VII

Preface XI

Chapter 2 Chain of Survival 3

Chapter 3 Initial Steps 7

Chapter 1 Historic Antecedents 1

Chapter 4 Basic Cardiopulmonary Resuscitation in Adults 11

Chapter 8 Basic Cardiopulmonary Resuscitation in Infants 39

Chapter 10 Legal and Ethical Aspects in Cardiopulmonary

Chapter 11 Legal and Ethical Aspects in Cardiopulmonary

Chapter 9 Cardiopulmonary Resuscitation in Pregnant Women 45

Chapter 12 The Importance of the Administration of Drugs Utilized in Advanced Cardiopulmonary Resuscitation 61

Cardiopulmonary Resuscitation Guidelines 23

Chapter 6 Clearing the Airways Due to Foreign Bodies and Liquids 27

Chapter 5 2010 Update of American Heart Association

Chapter 7 Clearing the Airways in Children 35

Resuscitation 49

Resuscitation 55

References 65

## Contents

Authors XI

Preface XIII


References 65

Authors

Evila Gayosso-Islas, M.Sc. Nursing

Cecilia Sánchez-Moreno, M.Sc. Nursing

Reyna Cristina Jiménez Sánchez, M.Sc. Nursing

Ma. Luisa Sánchez- Padilla, M.Sc. Nursing

Isaura Evelia Fuentes-Sánchez, B.Sc. Nursing

(UAEH), Pachuca, Mexico.

UAEH, Pachuca, Mexico.

UAEH, Pachuca, Mexico.

Undergraduate degree in Nursing and Obstetrics, National School of Nursing and Obstetrics (ENEO)-National Autonomous University of Mexico (UNAM). Mexico City, Mexico. Master of Nursing Sciences degree, Faculty of Nursing, Celaya Campus, University of Guanajuato, Mexico. Research Professor, Nursing Academic Area, Institute of Health Sciences (ICSa), Autonomous University of the State of Hidalgo

Undergraduate Degree in Nursing and Obstetrics, ENEO-UNAM, Mexico City, Mexico. Master degree in of Nursing Sciences, Faculty of Nursing, Celaya Campus, University of Guanajuato, Mexico. Research Professor, Nursing Academic Area, ICSa,

Undergraduate degree in Nursing and Obstetrics, ENEO-UNAM, Mexico City, Mexico. Master degree in Nursing Sciences, Faculty of Nursing, Celaya Campus, University of Guanajuato, Mexico. Research Professor, Nursing Academic Area, ICSa,

Undergraduate degree in Nursing and Obstetrics, ENEO-UNAM, Mexico City, Mexico. Master degree in Nursing Sciences, Celaya Campus, University of Guanajuato, Mexico. Master of Science degree in Educative Technology, UAEH, Pachuca, Mexico. Research

Professor, Nursing Academic Area, ICSa, UAEH, Pachuca, Mexico.

Undergraduate degree in Nursing, ICSa, UAEH, Pachuca, Mexico.

## Authors

#### Evila Gayosso-Islas, M.Sc. Nursing

Undergraduate degree in Nursing and Obstetrics, National School of Nursing and Obstetrics (ENEO)-National Autonomous University of Mexico (UNAM). Mexico City, Mexico. Master of Nursing Sciences degree, Faculty of Nursing, Celaya Campus, University of Guanajuato, Mexico. Research Professor, Nursing Academic Area, Institute of Health Sciences (ICSa), Autonomous University of the State of Hidalgo (UAEH), Pachuca, Mexico.

#### Cecilia Sánchez-Moreno, M.Sc. Nursing

Undergraduate Degree in Nursing and Obstetrics, ENEO-UNAM, Mexico City, Mexico. Master degree in of Nursing Sciences, Faculty of Nursing, Celaya Campus, University of Guanajuato, Mexico. Research Professor, Nursing Academic Area, ICSa, UAEH, Pachuca, Mexico.

#### Reyna Cristina Jiménez Sánchez, M.Sc. Nursing

Undergraduate degree in Nursing and Obstetrics, ENEO-UNAM, Mexico City, Mexico. Master degree in Nursing Sciences, Faculty of Nursing, Celaya Campus, University of Guanajuato, Mexico. Research Professor, Nursing Academic Area, ICSa, UAEH, Pachuca, Mexico.

#### Ma. Luisa Sánchez- Padilla, M.Sc. Nursing

Undergraduate degree in Nursing and Obstetrics, ENEO-UNAM, Mexico City, Mexico. Master degree in Nursing Sciences, Celaya Campus, University of Guanajuato, Mexico. Master of Science degree in Educative Technology, UAEH, Pachuca, Mexico. Research Professor, Nursing Academic Area, ICSa, UAEH, Pachuca, Mexico.

#### Isaura Evelia Fuentes-Sánchez, B.Sc. Nursing

Undergraduate degree in Nursing, ICSa, UAEH, Pachuca, Mexico.

#### Cristian Amaury Revoreda-Montes, B.Sc. Nursing

Undergraduate degree in Nursing, ICSa, UAEH, Pachuca, Mexico. Educator in Diabetes with Multidisciplinary Focus, UAEH, Pachuca, Mexico. Consortium of Mexican Universities (CUMex) Scholarship, University of Applied Sciences, Münster, Germany.

Alejandro Chehue-Romero, M.Sc.

Eva María Molina-Trinidad, Ph.D.

Academic Area, ICSa, UAEH, Pachuca, Mexico.

of Pharmacy, ICSa, UAEH, Pachuca, Mexico.

José Antonio Morales-González, Ph.D.

Jorge Gómez-Pedraza, B.Sc. Nursing

of the State of Hidalgo (UAEH), Pachuca, Mexico.

Undergraduate degree in Biology-Pharmacology-Chemistry, Faculty of Higher Studies (FES) Cuautitlán, UNAM, Mexico City, Mexico. Master of Sciences degree (Toxicology), ENCB, IPN, Mexico City, Mexico. Research Professor, Pharmacy

Undergraduate degree in Biology-Pharmacy-Chemistry, Faculty of Higher Studies (FES) Cuautitlán, UNAM, Mexico City, Mexico. Master degree in Pharmacy, Faculty of Chemistry, UNAM, Mexico City, Mexico. Doctoral degree in Chemistry, UNAM, Mexico City, Mexico. Level 1, National Researcher. Research Professor, Academic Area

Undergraduate degree, Surgeon Physician, Faculty of Higher Studies, Iztacala Campus, UNAM, Mexico City, Mexico. Doctoral degree in Biological Sciences, Postgraduate degree in Biological Sciences, UNAM, Mexico City. Level 1 National Researcher.Escuela Superior de Medicina, Instituto Politécnico Nacional, México

Undergraduate degree in Nursing, ICSa, UAEH, Pachuca, Mexico. Research Professor, Nursing Academic Area, Institute of Health Sciences (ICSa), Autonomous University

#### Mirandeli Bautista-Ávila, Ph.D.

Undergraduate degree in Chemistry, UAEH, Pachuca, Mexico. Doctoral degree in Sciences, Complutense University, Madrid, Spain. Level 1 National Researcher. Title B Research Professor, Pharmacy Academic Area, ICSa, UAEH, Pachuca, Mexico.

#### Rocío Belém Mayorga-Ponce, M.Sc. Nursing

Undergraduate and Master degrees, Faculty of Nursing, Meritorious Autonomous University of Puebla (BUAP), Mexico. Research Professor, Nursing Academic Area, ICSa, UAEH, Pachuca, Mexico.

#### Eufrosina Castillo-Arroyo, M.Sc. Nursing

Undergraduate degree in Nursing, Autonomous University of the State of Morelos (UAEM), Cuernavaca, Mexico. Master degree in Nursing Sciences, Autonomous University of the State of Querétaro (UAQ), Mexico. Undergraduate degree in Law, Centro Hidalguense de Estudios Superiores, Pachuca, Mexico. Normative Coordinator of Nursing, Health Services in the State of Hidalgo, Pachuca, Mexico.

#### Tomás Fregoso-Aguilar, Ph.D.

Undergraduate degree in Biology, National School of the Biological Sciences-National Polytechnic Institute (ENCB-IPN), Mexico City, Mexico. Master degree in Physiological Sciences and Doctoral degree in Chemical-Biological Sciences, ENCB - IPN, Mexico City, Mexico. Title C Professor, Department of Physiology, ENCB-Zacatenco Campus, IPN, Mexico City, Mexico.

#### Iván Villanueva-Becerril, Ph.D.

Undergraduate degrees in Biology, IPN, Mexico City, Mexico with a Ph.D. degree in Chemo-Biological Sciences (specialized in Mammalian Physiology) and postdoctoral training in Physiological Regulation of Biological Rhythms. He currently is full-time professor of Human and Comparative Physiology at the National School of Biological Sciences In Mexico City. He is author of 10 original papers and a book chapter on physiological regulation and autonomic control.

#### Alejandro Chehue-Romero, M.Sc.

Cristian Amaury Revoreda-Montes, B.Sc. Nursing

Germany.

Mirandeli Bautista-Ávila, Ph.D.

ICSa, UAEH, Pachuca, Mexico.

Tomás Fregoso-Aguilar, Ph.D.

Iván Villanueva-Becerril, Ph.D.

Rocío Belém Mayorga-Ponce, M.Sc. Nursing

Eufrosina Castillo-Arroyo, M.Sc. Nursing

Zacatenco Campus, IPN, Mexico City, Mexico.

physiological regulation and autonomic control.

Undergraduate degree in Nursing, ICSa, UAEH, Pachuca, Mexico. Educator in Diabetes with Multidisciplinary Focus, UAEH, Pachuca, Mexico. Consortium of Mexican Universities (CUMex) Scholarship, University of Applied Sciences, Münster,

Undergraduate degree in Chemistry, UAEH, Pachuca, Mexico. Doctoral degree in Sciences, Complutense University, Madrid, Spain. Level 1 National Researcher. Title B

Undergraduate and Master degrees, Faculty of Nursing, Meritorious Autonomous University of Puebla (BUAP), Mexico. Research Professor, Nursing Academic Area,

Undergraduate degree in Nursing, Autonomous University of the State of Morelos (UAEM), Cuernavaca, Mexico. Master degree in Nursing Sciences, Autonomous University of the State of Querétaro (UAQ), Mexico. Undergraduate degree in Law, Centro Hidalguense de Estudios Superiores, Pachuca, Mexico. Normative Coordinator

Undergraduate degree in Biology, National School of the Biological Sciences-National Polytechnic Institute (ENCB-IPN), Mexico City, Mexico. Master degree in Physiological Sciences and Doctoral degree in Chemical-Biological Sciences, ENCB - IPN, Mexico City, Mexico. Title C Professor, Department of Physiology, ENCB-

Undergraduate degrees in Biology, IPN, Mexico City, Mexico with a Ph.D. degree in Chemo-Biological Sciences (specialized in Mammalian Physiology) and postdoctoral training in Physiological Regulation of Biological Rhythms. He currently is full-time professor of Human and Comparative Physiology at the National School of Biological Sciences In Mexico City. He is author of 10 original papers and a book chapter on

of Nursing, Health Services in the State of Hidalgo, Pachuca, Mexico.

Research Professor, Pharmacy Academic Area, ICSa, UAEH, Pachuca, Mexico.

Undergraduate degree in Biology-Pharmacology-Chemistry, Faculty of Higher Studies (FES) Cuautitlán, UNAM, Mexico City, Mexico. Master of Sciences degree (Toxicology), ENCB, IPN, Mexico City, Mexico. Research Professor, Pharmacy Academic Area, ICSa, UAEH, Pachuca, Mexico.

#### Eva María Molina-Trinidad, Ph.D.

Undergraduate degree in Biology-Pharmacy-Chemistry, Faculty of Higher Studies (FES) Cuautitlán, UNAM, Mexico City, Mexico. Master degree in Pharmacy, Faculty of Chemistry, UNAM, Mexico City, Mexico. Doctoral degree in Chemistry, UNAM, Mexico City, Mexico. Level 1, National Researcher. Research Professor, Academic Area of Pharmacy, ICSa, UAEH, Pachuca, Mexico.

#### José Antonio Morales-González, Ph.D.

Undergraduate degree, Surgeon Physician, Faculty of Higher Studies, Iztacala Campus, UNAM, Mexico City, Mexico. Doctoral degree in Biological Sciences, Postgraduate degree in Biological Sciences, UNAM, Mexico City. Level 1 National Researcher.Escuela Superior de Medicina, Instituto Politécnico Nacional, México

#### Jorge Gómez-Pedraza, B.Sc. Nursing

Undergraduate degree in Nursing, ICSa, UAEH, Pachuca, Mexico. Research Professor, Nursing Academic Area, Institute of Health Sciences (ICSa), Autonomous University of the State of Hidalgo (UAEH), Pachuca, Mexico.

Preface

The purpose of this publication is to systematize the knowledge necessary to make Cardiopulmonary Resuscitation (CPR) or Cardiorespiratory Resuscitation (CRR) known to nursing health specialists, which translates as a set of temporary and internationally standardized maneuvers assigned to ensure the oxygenation of the vital organs when the blood circulation of an individual stops suddenly, independently of the cause of the Cardiorespiratory arrest (CRA). This knowledge is found correctly delimited in The Basic Cardiopulmonary Resuscitation Manual, which especially emphasizes the step-by-step methodology and techniques to follow for Cardiopulmonary Resuscitation (CPR). This is a basic work that cannot be overlooked by health care specialists, the society, and the public in general, because of the high probability that this situation will present at some moment in life. Thus, it is recommended to be prepared to help some person in an emergency situation. The

In this manual, the chain of survival is considered within the CPR process. The chain of survival includes immediate activation of the Emergency medical system (EMS), early cardiopulmonary resuscitation (CPR), early Defibrillation (DF), and advanced care. This manual makes known the chronological order to follow prior to administering care to the victim with the purpose of establishing safety in the environment, type of patient, origin of the trauma, and the consideration of personnel qualified to respond to an emergency case of this nature. In addition to being a practical form of teaching, the manual makes known basic Cardiopulmonary resuscitation (CPR) in adults and CPR in pediatric patients and what leads to the learning of this technique. It also considers the updated information of American Heart Association (AHA) guidelines and the management of airways blocked by a foreign body. Similarly, in this manual the importance is depicted of the administration of the drugs utilized in CPR. Finally, it is of vital importance to consider the ethical aspects of basic CPR. Given that what is expressed in this work is fundamental for life, it has an intended purpose to and its objective is to make known

Authors

manual is an excellent consultation work for health professionals.

the relevant information concerning the knowledge of CPR.

## Preface

The purpose of this publication is to systematize the knowledge necessary to make Cardiopulmonary Resuscitation (CPR) or Cardiorespiratory Resuscitation (CRR) known to nursing health specialists, which translates as a set of temporary and internationally standardized maneuvers assigned to ensure the oxygenation of the vital organs when the blood circulation of an individual stops suddenly, independently of the cause of the Cardiorespiratory arrest (CRA). This knowledge is found correctly delimited in The Basic Cardiopulmonary Resuscitation Manual, which especially emphasizes the step-by-step methodology and techniques to follow for Cardiopulmonary Resuscitation (CPR). This is a basic work that cannot be overlooked by health care specialists, the society, and the public in general, because of the high probability that this situation will present at some moment in life. Thus, it is recommended to be prepared to help some person in an emergency situation. The manual is an excellent consultation work for health professionals.

In this manual, the chain of survival is considered within the CPR process. The chain of survival includes immediate activation of the Emergency medical system (EMS), early cardiopulmonary resuscitation (CPR), early Defibrillation (DF), and advanced care. This manual makes known the chronological order to follow prior to administering care to the victim with the purpose of establishing safety in the environment, type of patient, origin of the trauma, and the consideration of personnel qualified to respond to an emergency case of this nature. In addition to being a practical form of teaching, the manual makes known basic Cardiopulmonary resuscitation (CPR) in adults and CPR in pediatric patients and what leads to the learning of this technique. It also considers the updated information of American Heart Association (AHA) guidelines and the management of airways blocked by a foreign body. Similarly, in this manual the importance is depicted of the administration of the drugs utilized in CPR. Finally, it is of vital importance to consider the ethical aspects of basic CPR. Given that what is expressed in this work is fundamental for life, it has an intended purpose to and its objective is to make known the relevant information concerning the knowledge of CPR.

Authors

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ȱȱ¢ǰȱȱȱȱȱȱ ȱȱȱȱ ȱȱȱȱ ȱȱȱȱȱȱǰȱ ȱ ȱȱȱȱȱȱȱȱȱ ȱ¢ȱ

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ȱ ȱȱȱȱȱȱ¡ȱȱǻǼȱȱȱ ȱȱȱȱȱȱȱȱǯ

#### **ȱDZȱ¢ȱȱ**

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#### **ȱȱȱ**

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ȱȱȱ¢ȱȱȱDzȱȱȱȱȱǰȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱ¢ǰȱȱȱȱǯ

ȱȱȱȱȱȱȱȱ ȱȱȱȱDzȱȱ ȱ¢ȱǰȱȱȱȱȱȱ¢ȱȱǻǼȱȱȱ

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© 2013, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

## **,QLWLDO6WHSV**

ȱȬ¢ȱǰȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱǯȱȱȱȱȱȱȱ¢ȱȱȱǰȱ ȱȱȱǰȱ¢ȱȱȱȱȱȱȱȱǰȱ ȱȱ¢ȱȱȱȱȱǯ

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**ȱȱǵȱȱȱ ȱȱȱȱȱǵDZ**ȱ¢ȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȧȱ ȱ ȱȱ ¢ȱ ȱ Ȃ ȱ ȱȱȱȱȱȱȱȱ¢ȱǯ

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¢ǰȱȱȱȱȱȱȱȱǰȱȱȱȱ DZȱȱȱȱǵ ȱȱȱȱǵȱȱȱȱǵ

#### **ȱȱȱȱ**

ȱȱȱȱ ȱȱ ȱȂȱȱȱȱ¢ȱȱȱȱȂ ǯȱȱȱȱȱȱȱȱǰȱȱȱȱ ȱȱ ȱȱȱȱȱȱȦȱȱ DZȱȱ¢ȱȱǵȱȱ¢ȱǵȱ ¢ȱȱǵȱȱ¢ȱȱȱȱ¢ȱȱȱǻȱřȬŘǼǯ

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¢ǰȱȱȱȱȱȱȱȱǰȱȱȱȱ DZȱȱȱȱǵ

ȱȱȱȱ ȱȱ ȱȂȱȱȱȱ¢ȱȱȱȱȂ ǯȱȱȱȱȱȱȱȱǰȱȱȱȱ ȱȱ ȱȱȱȱȱȱȦȱȱ DZȱȱ¢ȱȱǵȱȱ¢ȱǵȱ

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© 2013, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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© 2013, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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**ŗǯ**

**Řǯ**

**řǯ**

ǯ

 **¢ȱ**

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ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱȱ ȱ ȱ ȱ ȱ Ȭ ǯ ȱ ȱ ¢ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¡¢ ȱ ȱȱ¢ȱȱǰȱ ȱȱȱȱȱ¢ȱǰȱ ȱ ȱ ȱ ȱ ȱ ¢ ȱ ȱ ȱ ¢ ȱ ȱ ¡¢ȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱȬ ¢ǯȱȱȱȱȱȱȱȱȱȱǯȱȱ ¢ȱȬ ǰȱȱȱȱȱȱ¡¢ȱȱȱ¢ȱȱ ȱȱȱȱǰȱ

**ȱȱȱȱȱȱȱȱ¢ȱȱȱ¢**

¢ȱ ȱ ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱȱȱȱȱȱ¢ǯȱȱȱȱ ¢ȱȱȱ

¢¡ȱȱȱȱȱ¢ȱȱȱȬȱȱ ǯ

**Śǯ** ȱȱȱȱȱȱ¢¡ȱȱȱȱȱȱȱ ȱȱȱ

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#### **¢ȱ**

ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱȱ ȱ ȱ ȱ ȱ Ȭ ǯ ȱ ȱ ¢ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¡¢ ȱ ȱȱ¢ȱȱǰȱ ȱȱȱȱȱ¢ȱǰȱ ȱ ȱ ȱ ȱ ȱ ¢ ȱ ȱ ȱ ¢ ȱ ȱ ¡¢ȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱȬ ¢ǯȱȱȱȱȱȱȱȱȱȱǯȱȱ ¢ȱȬ ǰȱȱȱȱȱȱ¡¢ȱȱȱ¢ȱȱ ȱȱȱȱǰȱ ȱȱȱȱȬ¢ȱǯ

### **ȱȱȱȱȱȱȱȱ¢ȱȱȱ¢**


#### **ȱȱȱȱȱ**

ȱȱȱǰȱȱ¢ȱȱȱ ¢ȱȱȱȱȱȱǰȱ ȱȱȱȱȱȱȱȱǰȱȱȱ ¢ȱȱȱȱ ȱ¡¢ȱȱȱȱȱǯ

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**Řǯ**  ȱǯ

**ȬȬȱȱǻǼ**

ȱȱȱȱȱȱ ȱȱȱǻȱŞȬŘǼǯ

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#### **ȱȱȱ ¢ȱǻǼ**

ȱȱȱ ¢ȱȱȱȱ¢ȱȱȱȱȱȱȱǰ ȱȱȱȱȱȱȱȱȱȱȬ¢ȱǯ

#### *ȱȱȱȱ ¢*

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#### *ȱ*

ȱȱȱǰȱȱȱȱȱȱȱȱȱ DZ

**ŗǯ** ȱȱȱǻȱŞȬŗǼǯ

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**Řǯ**  ȱǯ

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**ȱȱȱ ¢ȱǻǼ**

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ȱȱȱ ¢ȱȱȱȱ¢ȱȱȱȱȱȱȱǰ

ȱȱȱ¢ȱȱȱȱǰȱȱ¢ȱ¢ȱȱȱ ¢ȱȱ¢Dzȱȱȱȱȱȱȱȱ¢ȱȱ¢ȱȱȱǯȱȱȱ

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ȱȱȱȱȱȱȱȱȱȱȬ¢ȱǯ

¡ȱ¢ȱ ȱȱȱ¢ȱȱ¢ȱǯ

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#### **ȱȮȱȱȱǻǼ**

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ȱȱ ¢ȱȱȱȱȱȱȱȱȱȱǰȱȱȱȱ ȱȱȱ£ȱȱȱȱȱǯ

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 ȱȱȱ¢ȱDzȱǰȱȱȱȱȱ¢ȱȱȱȱȱȱ ¢ȱȱȱȱȱ ǯȱȱȱȱȱȱȬ ȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱ Ȭ

 ǰȱȱ¢ȱǰȱȱȱȱȱȱȬȱȱȱȱȱ ¢ȱȱ¢ȱȱȱȱȱȱǯȱȱ¢ǰȱ¢ȱ¢ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ȱȱȱȱȱȱȱ¢ȱȱDzȱ ǰȱȱ ȱȱȱ¡ȱȱȱȱȱȱȱ¢ȱȱ ǰȱȱ ȱȱ¢ȱȱȱȱȱǰȱ ȱȱȱȱ¢ǰȱ

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ȱȱ¢ȱȱȱȱ¢ȱȱȱȱȱȱ¢ ǰȱȱȱȱ DZȱȱȱDzȱȱȱȱȱȱ¡¢ǰ ȱ ȱ ȱ ȱ ¢ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ǯ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ DZȱ ȱ DzȱȱȱȬȱǰȱȱȱȱȱȱȱȱǯ

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ȱȱǰȱ ȱȱȱȱȱȱȱȱǯ

ȱDzȱȱǰȱȱȱȱȱǯ

ȱ ȱȱ ȱȱȱȱȱ ȱȱ

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ȱȱǯ

ȱǰȱȱȱȱȱǯ

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 ȱȱȱ¢ȱDzȱǰȱȱȱȱȱ¢ȱȱȱȱȱȱ ¢ȱȱȱȱȱ ǯȱȱȱȱȱȱȬ ȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱ Ȭ ȱȱǯ

 ǰȱȱ¢ȱǰȱȱȱȱȱȱȬȱȱȱȱȱ ¢ȱȱ¢ȱȱȱȱȱȱǯȱȱ¢ǰȱ¢ȱ¢ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ȱȱȱȱȱȱȱ¢ȱȱDzȱ ǰȱȱ ȱȱȱ¡ȱȱȱȱȱȱȱ¢ȱȱ ǰȱȱ ȱȱ¢ȱȱȱȱȱǰȱ ȱȱȱȱ¢ǰȱ ȱǰȱȱȱȱȱǯ

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ȱȱ¢ȱȱȱȱ¢ȱȱȱȱȱȱ¢ ǰȱȱȱȱ DZȱȱȱDzȱȱȱȱȱȱ¡¢ǰ ȱ ȱ ȱ ȱ ¢ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ǯ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ DZȱ ȱ DzȱȱȱȬȱǰȱȱȱȱȱȱȱȱǯ

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ȱȱȱ ȱ ȱ ȱ ȱȱ ȱ ȱ ȱ ȱ ȱȱ

ȱȱȱ¢ǰȱȱ¡ȱȱȱȱȱǁśŖƖǯȱǰ ȱȱ ȱȱȱȱ ¢ǰȱ ¢ȱ ¢ǰȱ ȱȱ¡¢ȱ¢ ȱȱ¢ǰȱȱ ȱȱȱȱȱ¢ȱȱǯȱ ǰȱȱȱȱȱȱȱȱ ȱȱȱȱ

ȱȱȱ ȱ ȱ¡ȱ ȱȱȱ ȱȱȱȱ ȱ ¢ȱȱȱȱȱȱȱȱȱȱ¢ȱ ȱȱȱȱȱȱȱȱ¢ǯȱȱȱ¢ǰȱȱȱ ȱȱ¢ȱǯȱȱȱ¢ȱȱ ȱȱȱȱǰȱȱ ȱȱȱȱȱ£¢ȱȱȱȱȱǯȱȱŗŖƖȱȱ ȱ ȱ ȱ ȱ ¢ȱ ¢ǰȱ ȱ ȱ ¢ǰȱ ¢ǰȱ ¢ȱǰȱȱȱȱǯȱ¢ȱȱȱȱ¡ ȱ ȱŘśȱȱřŖƖȱ ȱȱȱȱȱȱȱȱȱȱ

ȱ¢ȱȱȱ¢ȱȱȱȱȱȱ¡ȱȱǰ ȱ¢ȱȱȱȱȱȱȱ¢ȱǰȱȱȱȱ¡¢ȱȬ ǰȱ ȱ ȱ ȱ¢ȱȱ ȱ ¢ȱ ȱȱ ȱ ȱȬ ǯȱȱ¢ȱȱȱȬȱ¢ȱȱȱȱȱȱȱ¢ ȱǯȱȱȱȱȱȱȱȱȱ¢ȱ ȱ ȱ ȱ ȱ ȱȱ ȱ ȱ ȱ¢ȱ ȱ ȱ ȱȱ ȱ ¢ǯȱȱȱȱȱ¢ǰȱȱȱ¡¢ȱ

ȱȱȱȱ ȱȱ¢ȱȱȱ¢ȱȱȱȱȱǯȱ ȱȱȱȱȱȱ¡¢ȱȱȱǯȱȱ¡¢ ȱȱȱȱȱȱȱ¡¢ȱȱȱȱȬ

ȱȱ ȱŘŚȱȱǰȱȱǰȱȱȱȱȱȱ ȱȱȱȱȱ ȱȱǰȱȱȱȱ ȱȱ¢ȱȱȱȱǰȱȱ ȱȱȱȱȱȱȱȱȱǯȱ¢ȱ ȱŘŚȱȱǰȱȱ ȱȱȱȱǰȱȱȱȱȱȱȱȱȱȱ¢ȱǯȱ¢ ȱȱȱȱȱȱǻǼȱȱȱ¢ȱȱǻǼǰ ȱȱȱȱǻǼǰȱȱȱȱȱȱǻǼȱȱȱȱ¢

ȱȱ¡¢ȱȱȱ¢ȱȱǯ

ȱȱȱȱȱȱȱǯ

ȱȱȱǯ

ȱ¢ȱǯ

ȱȱȱǯ

ȱȱ ȱǯ

ȱȱ DZ

ǯ

ȱ ¢ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯ ¢ȱȱ ȱǰȱȱȱ ȱȱȱ¢ȱ ȱ ȱ ȱ ¡Dzȱ ǰȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ǯ ¢ȱȱ¢ȱȱȱȱȱȱȱȱȱȱȱ ȱ ¢Dzȱȱ ȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱȱȂȱȱ ȱȱȱǯ

ȱȱȱȱȱ ȱȱȱȱ ȱ ȱȱ ¢ȱ ¡ȱǰȱȱȱȱȱȱȱǯȱȱ ȱŘŖȱȱǰȱ ȱȱȱȱȱȱȱȱȱȱǰȱȱȱ ȱȱ ǯȱȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱǰȱȱ¢ȱȱȱȱ ¢ǯ

ȱȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱ ȱȱȱȱ£ȱȱȱ ȱǯȱȱȱ ¢ȱȱȱȱ ȱȱȱȱǯȱȱȱȱȱȱȱȱȬȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢¢ȱȱȱȱȱȱȱȱȱȱ ȱǯ

#### **¢ȱȬȬȬȱȱȱ**

ǯȱ **¢**ǯȱ ȱ ȱ ȱȱ ȱȱ ¢ǰȱ ȱ ȱ Ȭȱȱ ȱ ȱȱȱȱȱȱȱȦȱǯȱ ¢ȱȱȱȱ ȱȱȱȱȱDzȱȱȱȱȱ¢ȱȱȱȱ ǰȱȱȱȱȱȱȱ¢ȱȱ ȱȱ¢¡ȱȱȬ ¢¡ǰȱ ȱ ȱ ȱȱ ¢ȱ ȱ¡ǯȱ¡¢ȱȱ ȱ¢ȱ ȱ¢¡ȱ ȱ¢Dzȱȱȱȱȱȱ ȱȱǰȱȱȱȱ ȱȱȱȱȱȱȱ£ȱ¢ǯ

ǯȱǯȱȱȱȱȱȱȱȱȱǯȱȱ ȱȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱ ȱǰȱȱȱȱȱȱȱ¢¡ǯ

ǯȱ**¡ȱȱ**ǯȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱ ȱŗśȱȱřŖķǰȱ ȱȱǰȱ ȱȱȱ ȱȱȱȱȱřŖȱȱȱŘȱȱȱśȱ¢ǯȱȱȱȱ ȱȱȱȱȱȱȱȱǻ ȱȱȱȱȱȱȱȱǼȱ ȱȱȱȱȱȱȱȂȱȱǰȱȱȱȱ ¢ȱȱȱȱȱ ȱȱȱȱȱȱȱǯ

ȱȱ¢ȱȱȱȱ¢ȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ řŖǰŖŖŖȱ ǯȱ ȱ ȱ ȱ ȱ ¢ȱȱȱȱȱ ȱȱǰȱȱ¢ȱȱ ȱȱ¢ȱ Dzȱǰȱȱȱȱȱȱȱ¢ȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ǰȱ ȱ ȱ ȱ ȱ ¡ȱ ¢ǰȱ¢ǰȱǰȱȱȱȱȱȱȱ ȱȱǰȱ ȱ ȱȱȱȱ¢ȱȱȱȱȱȱȱȱ

ȱ ¢ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯ ¢ȱȱ ȱǰȱȱȱ ȱȱȱ¢ȱ ȱ ȱ ȱ ¡Dzȱ ǰȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ǯ ¢ȱȱ¢ȱȱȱȱȱȱȱȱȱȱȱ ȱ ¢Dzȱȱ ȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

ȱȱȱȱȱ ȱȱȱȱ ȱ ȱȱ ¢ȱ ¡ȱǰȱȱȱȱȱȱȱǯȱȱ ȱŘŖȱȱǰȱ ȱȱȱȱȱȱȱȱȱȱǰȱȱȱ ȱȱ ǯȱȱȱȱȱȱ¢ȱȱȱȱȱȱ

ȱȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱ ȱȱȱȱ£ȱȱȱ ȱǯȱȱȱ ¢ȱȱȱȱ ȱȱȱȱǯȱȱȱȱȱȱȱȱȬȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ

ǯȱ **¢**ǯȱ ȱ ȱ ȱȱ ȱȱ ¢ǰȱ ȱ ȱ Ȭȱȱ ȱ ȱȱȱȱȱȱȱȦȱǯȱ ¢ȱȱȱȱ ȱȱȱȱȱDzȱȱȱȱȱ¢ȱȱȱȱ ǰȱȱȱȱȱȱȱ¢ȱȱ ȱȱ¢¡ȱȱȬ ¢¡ǰȱ ȱ ȱ ȱȱ ¢ȱ ȱ¡ǯȱ¡¢ȱȱ ȱ¢ȱ ȱ¢¡ȱ ȱ¢Dzȱȱȱȱȱȱ ȱȱǰȱȱȱȱ

ǯȱǯȱȱȱȱȱȱȱȱȱǯȱȱ ȱȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱ

ǯȱ**¡ȱȱ**ǯȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱ ȱŗśȱȱřŖķǰȱ ȱȱǰȱ ȱȱȱ ȱȱȱȱȱřŖȱȱȱŘȱȱȱśȱ¢ǯȱȱȱȱ ȱȱȱȱȱȱȱȱǻ ȱȱȱȱȱȱȱȱǼȱ

ȱȱȱȱȂȱȱ ȱȱȱǯ

¢¢ȱȱȱȱȱȱȱȱȱȱ ȱǯ

ȱȱȱȱȱȱȱ£ȱ¢ǯ

ȱǰȱȱȱȱȱȱȱ¢¡ǯ

ȱǰȱȱ¢ȱȱȱȱ ¢ǯ

**¢ȱȬȬȬȱȱȱ** 

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ǯȱ ǯȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱȱȱȱȱȱȱǰȱȱȱȱȱ ȱȱȱȱȱȱǯȱȱȱȱȱȱȱ ȱȱȱǯ

ȱȱȱ ȱ ȱ ȱ ȱȱ ȱ ȱ ȱ ȱ ȱȱ ǯ

ȱȱȱ¢ǰȱȱ¡ȱȱȱȱȱǁśŖƖǯȱǰ ȱȱ ȱȱȱȱ ¢ǰȱ ¢ȱ ¢ǰȱ ȱȱ¡¢ȱ¢ ȱȱ¢ǰȱȱ ȱȱȱȱȱ¢ȱȱǯȱ ǰȱȱȱȱȱȱȱȱ ȱȱȱȱ ȱ¢ȱǯ

ȱȱȱ ȱ ȱ¡ȱ ȱȱȱ ȱȱȱȱ ȱ ¢ȱȱȱȱȱȱȱȱȱȱ¢ȱ ȱȱȱȱȱȱȱȱ¢ǯȱȱȱ¢ǰȱȱȱ ȱȱ¢ȱǯȱȱȱ¢ȱȱ ȱȱȱȱǰȱȱ ȱȱȱȱȱ£¢ȱȱȱȱȱǯȱȱŗŖƖȱȱ ȱ ȱ ȱ ȱ ¢ȱ ¢ǰȱ ȱ ȱ ¢ǰȱ ¢ǰȱ ¢ȱǰȱȱȱȱǯȱ¢ȱȱȱȱ¡ ȱ ȱŘśȱȱřŖƖȱ ȱȱȱȱȱȱȱȱȱȱ ȱȱȱǯ

ȱ¢ȱȱȱ¢ȱȱȱȱȱȱ¡ȱȱǰ ȱ¢ȱȱȱȱȱȱȱ¢ȱǰȱȱȱȱ¡¢ȱȬ ǰȱ ȱ ȱ ȱ¢ȱȱ ȱ ¢ȱ ȱȱ ȱ ȱȬ ǯȱȱ¢ȱȱȱȬȱ¢ȱȱȱȱȱȱȱ¢ ȱǯȱȱȱȱȱȱȱȱȱ¢ȱ ȱ ȱ ȱ ȱ ȱȱ ȱ ȱ ȱ¢ȱ ȱ ȱ ȱȱ ȱ ¢ǯȱȱȱȱȱ¢ǰȱȱȱ¡¢ȱ ȱȱ¡¢ȱȱȱ¢ȱȱǯ

ȱȱȱȱ ȱȱ¢ȱȱȱ¢ȱȱȱȱȱǯȱ ȱȱȱȱȱȱ¡¢ȱȱȱǯȱȱ¡¢ ȱȱȱȱȱȱȱ¡¢ȱȱȱȱȬ ȱȱ ȱǯ

ȱȱ ȱŘŚȱȱǰȱȱǰȱȱȱȱȱȱ ȱȱȱȱȱ ȱȱǰȱȱȱȱ ȱȱ¢ȱȱȱȱǰȱȱ ȱȱȱȱȱȱȱȱȱǯȱ¢ȱ ȱŘŚȱȱǰȱȱ ȱȱȱȱǰȱȱȱȱȱȱȱȱȱȱ¢ȱǯȱ¢ ȱȱȱȱȱȱǻǼȱȱȱ¢ȱȱǻǼǰ ȱȱȱȱǻǼǰȱȱȱȱȱȱǻǼȱȱȱȱ¢ ȱȱ DZ


#### **ȱȱȱȱ**


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ȱȱȱȱȱȱȱȱȱȱȱȱDzȱǰȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱ

ȱȱȱȱ¢ȱȱȱȱȱȱȱȱȱȱ¢ȱ¢ ȱ ȱȱȱDzȱǰȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȂȱȱȱ

ȱȱȱȱȱȱȱȱȱȱȱȱȱǰȱȱ ȱȱȱȱȱǰȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ǰȱǰȱȱȱȱȱȱȱȱȱȱȱȱ

ȱȱ¢ȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱ ȱȱȱ ȱǯȱȱȱǰȱȱȱȱȱȱȱ ȱ ȱȱǰȱ¢ȱȱȱȱȱȱȱȱȱȱǰȱ ȱȱ

**ǯ** ȱ ȱȱȱ ȱȱ ȱȱ¡ȱȱȱȱȱȱȬ ȱȱȱȱȦȱȱȱȱȱȱȱȱ¢ȱǯ

**ǯ** ȱȱȱȱȱȱ¢ȱȱȱȱ ǰȱȱȱȱ

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© 2013, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**ǯ** ȱȱȱȱȱȱȱȂȱȱǯ

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**ǯ** ȱȱȱȱȱȱȱȱǯ

**ȱȱȱǵ**

ȱȱȱȱȱȱȱ¢ȱȱǯ

## **(WKLFDODQG/HJDO\$VSHFWVLQ%DVLF&DUGLRSXOPRQDU\ 5HVXVFLWDWLRQ**

ȱȱȱȱȱȱȱȱȱȱȱȱDzȱǰȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱǯ

ȱȱȱȱ¢ȱȱȱȱȱȱȱȱȱȱ¢ȱ¢ ȱ ȱȱȱDzȱǰȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȂȱȱȱ ȱȱȱȱȱȱȱ¢ȱȱǯ

ȱȱȱȱȱȱȱȱȱȱȱȱȱǰȱȱ ȱȱȱȱȱǰȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ǰȱǰȱȱȱȱȱȱȱȱȱȱȱȱ ǯ

ȱȱ¢ȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱ ȱȱȱ ȱǯȱȱȱǰȱȱȱȱȱȱȱ ȱ ȱȱǰȱ¢ȱȱȱȱȱȱȱȱȱȱǰȱ ȱȱ ȱȱȱȱȱȱȱǯ

#### **ȱȱȱǵ**

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**Śǯ** Ȭȱ¢ȱȱ ȱȱȱśȱȱȬǯ

**řǯ** ȱȱȱȱȱ¡ȱȱǯ

**Śǯ** ȱȱ ȱŘśȱȱřřƖȱȱȬȱȱ¡ȱȱǯ


#### **ȱȱȱȱȱǵ**

**ǯ** ȱȱȱȱȱȱ¢ȱȱȱȱ ǰȱȱȱȱ ȱȱȱǯ

**ǯ** ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱȱǯ

ȱȱ¢ȱȱȱȱ ȱȱ ȱȱȱȃȱȄǰȱȱǰȱȱȱ¢ ȱȱȱǯȱȱȱǰȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱȱǰȱȱȱȱȱ ȱ ȱ ȱȬȱ ȱ¡Ȭ

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ȱȱ¢ȱǰȱȱǰȱǰȱȱȱȱȱǯȱǰȱȱȱȱ ¢ ¢ȱȱ¢ȱȱȱȱȱȱ ȱȱȱ¢ȱǰȱȱȱ ȱȱ

ȱȱȱǰȱȱǰȱǰȱȱȱȱȱȱȱȱ ȱ Ȃȱ ǰȱ ǰȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ǯȱȱȱȱ¡Ȭ¢ȱ¢ȱȱ ȱȱȱȱ ȱȱȱȱȱȱ ȱȱȱȱȱȂȱ ǰȱȦȱȱ ¢ȱȱȱȱȱȱ ȱȱȱȱȱǯȱǰȱ ȱȱȱȱȱȬ ȱȱȱǻȱȱȱȱȱȱȱȱȱȱȱǼǰ ȱȱ¢ȱȱȱȱȱ¢ȱǻȱȱȱȱȱȱǼǯȱȱ ǰȱȱ¡ȱȱȱȱȱȱȱȱȱȱȱ ȱȱ ȱȱȱ ȱǻ ȱȱȱȬȬȱǼǯȱȱȱȱȱȱȱȱȱ¢

ȱȱȱǰȱȱȱȱȱȱȱȱȱ¢ȱ ȱȱȱ ȱ¡¢ȱ¡ȱ ¢ȱȱȱȱȱȱȱ ǰȱȱȱȱ¢ȱȱǻǼȱȱȱȱȱ¢

**Ȋ** ȱ ȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱ¢ǯ

ȱȱ ȱȱȱ¢ȱ¢ȱȱ ȱȱ ȱȱȱȱȱ¢ȱ¢ ȱ ȱ ȱ ȱ Ȧȱ ¢ȱ ȱǯȱ ȱ ȱȱ ǰȱ ȱ

ȱȱȱǰȱȱȱȱȱȱǰȱȱȱȱȱȱȱ ǰȱ¢ȱȱȱȱȱȱǯȱȱȱȱ¢ȱȱȱȱ¢ȱ ȱ

ȱȱȱȱ¢ȱȱȱȱȱȱȱȱ¡¢DZ ȱȱȱȱ ȱ ȱȱǰȱȱ ȱ ȃȱ ȱ ȱȱȱ¢Ȅǰȱȱȱȱȱȱȱȱȱȱȱȱȱ

ȱȱȱȱ ǰȱȱȱȱȱȱȱȱŗŖȱȱ ȱ ȱǰȱȱȱȱȱȱȱȱȱȱǯ

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ȱȱȱȱȱȱȱȱȱȱǯ

**Ȋ** ȱȱȱȱ¢ȱȱ ȱǯ

**Ȋ** ȱȱȱȱǯ

ȱ ȱȱȱȱ ȱȱȱ ȱȱȱȱ¢DZ

**Ȋ** ȱȱ ȱȱȱȱȱȱ¢ȱȱȱȱȱǯ

ȱȱǯȱȱȱȱǰȱȱ ȱȱȱDZ

ȱ¢ǰȱȱȱȱȱȂȱ¢ȱȱȱǯ

ȱȱȱȱȱȱȱȱȱȱȱǯ

¢ȱǯ

#### **ȱȱȱȱ£ǵ**


ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ ȱȱȱǰȱǰȱȱȱȱȱȱǯ ȱȱȱ¡ȱȱȱȱȱȱȱȱȱȱ ȱ ȱȱȱȱ¡ȱȱȱȱ¢ȱȱȱȱ ǯ

ȱȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱȱ ȱȱȱ ȱ ¢ǰȱȱȱȱȱȱȱ ȱȱȱȱȱ ȱǯȱȱȱȱ ȱ¡ȱȱȱǰȱȱǰȱȱȱȱȱȱȱȱǰ ȱǰȱȱȱȱȱȱ¢ȱȱȱȱȱȱȱȱȱȱ¡ǯ

ȱ¡ǰȱȱȱ ȱȱȱȱȱ¢ȱȱǻǼ ȱȱ¢ȱȱ ȱȱȱȱȱȱǰȱȱȱȱ¢ ȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱ ǰȱȱȱȱ¢ȱȱ ȱȱ ȱ ȱȱȱ ȱȱ ȱȱȱȱȱȱǯȱȱȱȱȱȱȱȱȱ ȱȱ ǰȱǰȱȱȱȱȱǯ

#### **ȱȱȱ¢ȱ**

ȱȱȱȱȱȱȱȬȱǯȱ ȱ ȱ ǰȱȦȱȱȱȱȱȱǯȱȱȱȱȱǰȱȱȱ ȱȱȱȱȱȱȱ¢ȱȱȱȱ¢ǰȱ ȱ ȱȱ ǯ

ȱȱ¢ȱȱȱȱ ȱȱ ȱȱȱȃȱȄǰȱȱǰȱȱȱ¢ ȱȱȱǯȱȱȱǰȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱȱǰȱȱȱȱȱ ȱ ȱ ȱȬȱ ȱ¡Ȭ ¢ȱǯ

ȱȱ¢ȱǰȱȱǰȱǰȱȱȱȱȱǯȱǰȱȱȱȱ ¢ ¢ȱȱ¢ȱȱȱȱȱȱ ȱȱȱ¢ȱǰȱȱȱ ȱȱ ȱȱȱȱȱȱȱȱȱǯ

ȱȱȱǰȱȱǰȱǰȱȱȱȱȱȱȱȱ ȱ Ȃȱ ǰȱ ǰȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ǯȱȱȱȱ¡Ȭ¢ȱ¢ȱȱ ȱȱȱȱ ȱȱȱȱȱȱ ȱȱȱȱȱȂȱ ǰȱȦȱȱ ¢ȱȱȱȱȱȱ ȱȱȱȱȱǯȱǰȱ ȱȱȱȱȱȬ ȱȱȱǻȱȱȱȱȱȱȱȱȱȱȱǼǰ ȱȱ¢ȱȱȱȱȱ¢ȱǻȱȱȱȱȱȱǼǯȱȱ ǰȱȱ¡ȱȱȱȱȱȱȱȱȱȱȱ ȱȱ ȱȱȱ ȱǻ ȱȱȱȬȬȱǼǯȱȱȱȱȱȱȱȱȱ¢ ȱȱȱȱȱȱǰȱȱȱȱȱȱȱǯ

ȱȱȱǰȱȱȱȱȱȱȱȱȱ¢ȱ ȱȱȱ ȱ¡¢ȱ¡ȱ ¢ȱȱȱȱȱȱȱ ǰȱȱȱȱ¢ȱȱǻǼȱȱȱȱȱ¢ ȱȱȱȱȱȱȱȱȱȱǯ

ȱ ȱȱȱȱ ȱȱȱ ȱȱȱȱ¢DZ


ȱȱ ȱȱȱ¢ȱ¢ȱȱ ȱȱ ȱȱȱȱȱ¢ȱ¢ ȱ ȱ ȱ ȱ Ȧȱ ¢ȱ ȱǯȱ ȱ ȱȱ ǰȱ ȱ ȱȱǯȱȱȱȱǰȱȱ ȱȱȱDZ

**Ȋ** ȱȱȱȱǯ

**ǯ** ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

**ŗǯ** ȱȱȱȱȱȱȱǁŗŖȱȱȱȱȱȱȱȱȱ

**řǯ** ȱŗŖȱȱȱȱȱȱȱȱȱ ȱ¢ȱȱ

**Śǯ** ȱȱȱȱȱǰȱ ȱȱ¢ȱȱȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ ȱȱȱǰȱǰȱȱȱȱȱȱǯ ȱȱȱ¡ȱȱȱȱȱȱȱȱȱȱ ȱ ȱȱȱȱ¡ȱȱȱȱ¢ȱȱȱȱ

ȱȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱȱ ȱȱȱ ȱ ¢ǰȱȱȱȱȱȱȱ ȱȱȱȱȱ ȱǯȱȱȱȱ ȱ¡ȱȱȱǰȱȱǰȱȱȱȱȱȱȱȱǰ ȱǰȱȱȱȱȱȱ¢ȱȱȱȱȱȱȱȱȱȱ¡ǯ

ȱ¡ǰȱȱȱ ȱȱȱȱȱ¢ȱȱǻǼ ȱȱ¢ȱȱ ȱȱȱȱȱȱǰȱȱȱȱ¢ ȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱ ǰȱȱȱȱ¢ȱȱ ȱȱ ȱ ȱȱȱ ȱȱ ȱȱȱȱȱȱǯȱȱȱȱȱȱȱȱȱ

ȱȱȱȱȱȱȱȬȱǯȱ ȱ ȱ ǰȱȦȱȱȱȱȱȱǯȱȱȱȱȱǰȱȱȱ ȱȱȱȱȱȱȱ¢ȱȱȱȱ¢ǰȱ ȱ ȱȱ

ȱȱǯ

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ȱȱȱȱȱȱǯ

ȱ¢ȱȱȱ¢ȱȱǯ

ȱǯ

ǯ

ǯ

**Řǯ** ȱȱȱȱȱȱȱǯȱ

ȱȱ ǰȱǰȱȱȱȱȱǯ

**ȱȱȱ¢ȱ**

**śǯ** ȱȱȱȱȱȱȱȱȱȱǯ

**Ŝǯ** ȱȱ¢ȱȱȱȱȱȱ¡ȱǯ

**Ȋ** ȱȱȱȱ¢ȱȱ ȱǯ

ȱȱȱǰȱȱȱȱȱȱǰȱȱȱȱȱȱȱ ǰȱ¢ȱȱȱȱȱȱǯȱȱȱȱ¢ȱȱȱȱ¢ȱ ȱ ȱ¢ǰȱȱȱȱȱȂȱ¢ȱȱȱǯ

ȱȱȱȱ¢ȱȱȱȱȱȱȱȱ¡¢DZ ȱȱȱȱ ȱ ȱȱǰȱȱ ȱ ȃȱ ȱ ȱȱȱ¢Ȅǰȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱǯ

ȱȱȱȱ ǰȱȱȱȱȱȱȱȱŗŖȱȱ ȱ ȱǰȱȱȱȱȱȱȱȱȱȱǯ

ȱȱȱȱȱȱȱȱȱ ȱ¢ȱȱ¡¢ȱ ȱȱȱȱȱ ȱȱȱȱǁŗŖȱȱȱȱȱȱ ǯȱȱȱ ȱȱȱȱ¡¢ȱȱȱȱȱǯȱ ȱȱȱ¢ǰȱȱȱ ȱȱȱȱȱǰȱDZ

¢ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱȱ¢ȱȱȱȱȱȱȱȱȱǰȱ¢ǰȱ¢ȱǰ

ȱǰȱ¢ȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱ¢ȱȱȱȱȱȱ

ȱȱ ȱȱ¢ȱȱȱȂȱȱȱǰȱȱȱȱȱ ȱȱȱȱ£ȱǰȱȱ ȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ

ȱȱǰȱȱŘŘŞȱȱȱȱȱȱȱȱ DZȱǰ ǰȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱ ȱ ȱ¡ȱȱ ȱǰȱȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱ

**ŗǯ** ȱ ȱ ȱ ȱ ȱ ¡ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ǰȱȱȱȱŗȱȱȱŘȱ¢ȱ ȱȱȱȱȱȱȱ¡ȱ

**Řǯ** ¢ȱ ȱȱȱȱȱȱȱȱ¢ȱȱ ȱȱȱȱȱ

ȱřŚŖǯȱȱȱȱȱȱȱ¢ȱȱ ȱȱȱȱȱȱȦ ȱȱ ȱȱȱȱȱȱ ȱȱȱ¢ȱ¢ȱȱ ǰȱ ȱ ȱȱŗŖȮŜŖȱ¢ȱ ȱ¢ȱȱ¢ȱȱȱ¢ȱ¢ȱȱ¢ȱ ȱ¢ȱȱȱȱ¢ȱȱ ȱ¢ȱȱȱȱ ȱȱ

ȱȱȱȱȱȱȱ¡ȱȱȱȱ ȱȱȱȱ ȱȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ

ǰȱ ȱȱǰȱ ȱȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ¡ȱǰȱȱȱȱȱ¢ǰȱȱ¢ȱȱȱȱ¢ȱ

ǰȱ ȱȱȱȱȱȱȱȱȱȱǯ

ȱȱȱȱȱ ȱȱȱȱȱǯ

ȱ ȱȱ¡Ȧ¢ȱ ȱȱȱȱȱ

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ǰȱȱȱǰȱȱǰȱȱȱȱȱȱǯ

ȱȱȱǯ

**Řǯ** ¢ȱȱ

**ȱ¢**

ǯ

¢ȱǯ

ȱȱȱȱ ȱ

ȱȱȱȱ¡ǰȱȱȱ ȱDZ

ȱȱȱ¢ȱȱȱȱȱǰȱ

ȱȱȱȱȱȱǯ


ȱȱȱ¢ȱȱȱȱȱȱǰȱ ȱȱ ȱȱȱȱȱȱȱȱȱȱǯ

ȱȱȱȱ¢ȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ¡ȱ ȱ ȱ ǰȱ ȱ ¢ȱ ȱ ȃ ȱȱ ȱ ¢ȱȱ ȱȱ ȱ ȱ ȱ ȱȱ ȱ ¢ȱ ȱ ȱ Ȅǯ

ȱ ȱ ȱ ȱȱ¡ǰȱȱȱŚŜşǰȱȱDZȱȱȱȱȬ ǰȱǰȱȱȱ ȱ ȱȱȱȱȱȱȱȱȱǰȱ ȱȱȱȱ¢ǰȱȱȱȂȱȱȱǰȱ ȱȱȱȱŜ ȱȱśȱ¢ȱȱȱȱȱȱȱśȱȱŗŘŞȱ¢ȱȱȱ¢ȱȱȱ¢ ȱȱȱ£ȱȱȱȱȱȱ¡ȱȱȱȱȱȱȱŘ ¢ǯȱȱȱ ȱȱȱȱȱȱȱȱǰȱȱ ȱ ȱȱDZ ȱ ȱ ȱ ȱ ¡ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ¢ǯȱ ǰȱȱȱȱȱȱȱ¢ǰȱȱȱȱȱȱǰ ȱȱȱ DZ

ȱŗşŗŖǯȱȱȱ ȱ ȱ¢ȱȱȱȱȱȱȱȱȱǰ ȱȱȱȱȱȱǰȱ¡ȱȱȱȱȱȱȱȱ ȱ ȱȱȱȱȱ¡ȱȱȱȱȱȱǯ

ȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȦ ȱȱȱȱǰȱǰȱǰȱȱǰȱ¢ ȱȱȱȱȱȱȱȱǯ

ȱŘŗŖŚǯȱȱȱ ȱ ȱȱȱȱȱȱȱ ȱȱȱȱȱ ȱȱȱȱȱȱȱ ȱȱȱȱǰȱ ȱȱȱȱ ȱȱǯ

ȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱ ȱ ȱ ¢DZ

**ŗǯ** ¢ȱȱȱ

¢ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱȱ¢ȱȱȱȱȱȱȱȱȱǰȱ¢ǰȱ¢ȱǰ ȱȱȱǯ

**Řǯ** ¢ȱȱ

ȱȱȱȱȱȱȱȱȱ ȱ¢ȱȱ¡¢ȱ ȱȱȱȱȱ ȱȱȱȱǁŗŖȱȱȱȱȱȱ ǯȱȱȱ ȱȱȱȱ¡¢ȱȱȱȱȱǯȱ ȱȱȱ¢ǰȱȱȱ ȱȱȱȱȱǰȱDZ

**Ȋ** ȱȱȱ ȱ ȱȱȱ ǻȱ¡ǰȱ ȱǰȱǰ

**Ȋ** ȱ¢ȱȱȱȱ¡ȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ǻȱ ¡ǰȱ ȱ ȱ ȱ ȱ ȱ Ǽǯ ȱȱ¢ȱȱ¡ȱȱȱȦȱȱ ǯȱȱȱ¡ȱȱȱȱȱ ȱȱȱȱȱȱȱǯ

ȱȱȱ¢ȱȱȱȱȱȱǰȱ ȱȱ

ȱȱȱȱ¢ȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ¡ȱ ȱ ȱ ǰȱ ȱ ¢ȱ ȱ ȃ ȱȱ ȱ ¢ȱȱ ȱȱ ȱ ȱ ȱ ȱȱ ȱ ¢ȱ ȱ ȱ

ǰȱǰȱȱȱ ȱ ȱȱȱȱȱȱȱȱȱǰȱ ȱȱȱȱ¢ǰȱȱȱȂȱȱȱǰȱ ȱȱȱȱŜ ȱȱśȱ¢ȱȱȱȱȱȱȱśȱȱŗŘŞȱ¢ȱȱȱ¢ȱȱȱ¢ ȱȱȱ£ȱȱȱȱȱȱ¡ȱȱȱȱȱȱȱŘ ¢ǯȱȱȱ ȱȱȱȱȱȱȱȱǰȱȱ ȱ ȱȱDZ ȱ ȱ ȱ ȱ ¡ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ¢ǯȱ ǰȱȱȱȱȱȱȱ¢ǰȱȱȱȱȱȱǰ

ȱŗşŗŖǯȱȱȱ ȱ ȱ¢ȱȱȱȱȱȱȱȱȱǰ ȱȱȱȱȱȱǰȱ¡ȱȱȱȱȱȱȱȱ ȱ

ȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȦ ȱȱȱȱǰȱǰȱǰȱȱǰȱ¢

ȱŘŗŖŚǯȱȱȱ ȱ ȱȱȱȱȱȱȱ ȱȱȱȱȱ ȱȱȱȱȱȱȱ ȱȱȱȱǰȱ ȱȱȱȱ

ȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱ

ȱȱȱȱȱ¡ȱȱȱȱȱȱǯ

ȱ ȱȱ¡ǰȱȱȱŚŜşǰȱȱDZȱȱȱȱȬ

**Ȋ** ȱȱȱȱȱȬȬȱǯ

ȱȱȱȱȱȱȱȱȱȱǯ

ǰȱȱ¢Ǽǯ

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**ŗǯ** ¢ȱȱȱ

ȱ ȱ ¢DZ

Ȅǯ

ȱ ȱ

ȱǰȱ¢ȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱȱȱȱȱȱǯ

### **ȱ¢**

ȱȱ ȱȱ¢ȱȱȱȂȱȱȱǰȱȱȱȱȱ ȱȱȱȱ£ȱǰȱȱ ȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ǰȱȱȱǰȱȱǰȱȱȱȱȱȱǯ

ȱȱǰȱȱŘŘŞȱȱȱȱȱȱȱȱ DZȱǰ ǰȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱ ȱ ȱ¡ȱȱ ȱǰȱȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱ ȱȱȱȱ ȱ ȱ ȱȱ¡Ȧ¢ȱ ȱȱȱȱȱ ȱȱȱȱ¡ǰȱȱȱ ȱDZ


ȱřŚŖǯȱȱȱȱȱȱȱ¢ȱȱ ȱȱȱȱȱȱȦ ȱȱ ȱȱȱȱȱȱ ȱȱȱ¢ȱ¢ȱȱ ǰȱ ȱ ȱȱŗŖȮŜŖȱ¢ȱ ȱ¢ȱȱ¢ȱȱȱ¢ȱ¢ȱȱ¢ȱ ȱ¢ȱȱȱȱ¢ȱȱ ȱ¢ȱȱȱȱ ȱȱ ǯ

ȱȱȱȱȱȱȱ¡ȱȱȱȱ ȱȱȱȱ ȱȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱȱȱ ȱȱȱȱȱǯ

ǰȱ ȱȱǰȱ ȱȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ¡ȱǰȱȱȱȱȱ¢ǰȱȱ¢ȱȱȱȱ¢ȱ ¢ȱǯ

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ȱȱȱȱǯȱ

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 ¢Ȭȱ ¢ȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ¢ȱȱȱȱȱȱȱȱȱȱȱȱȱ¢ȱǯ ¢ȱȱȱ ȱȱȱȱȱȱȱǰȱ ȱ

ȱȱȱǰȱȱȱȱȱȱȱȱȱ¢ȱȱ

ȱ ȱȱȱȱȱȱȱȱȱȱȱǯ ȱȱȱ¢ȱȱȱȱȱȱǰȱȱ ȱȱ £ȱȱ ȱȱ¢ȱȱȱȱȱȱȱȱȱȱȬ ¢ȱȱǻǼǰȱ ȱ ȱȱȱȱ¢ȱȱ¢ǯȱ ȱ ǰȱ ¢ȱȱ¢ȱȱȱȱǰȱȱȱ ȱȱ

ȱ¢ȱȱ ǻǼǰȱ ȱȱȱ ȱ ȱȱȱȱȬ ȱȱȱ¢ȱȱȱȱ¡Ȭ¢ȱȱ ȱȱȱȱȱ¡ ȱ ǻǼ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ ȱ ȱ ȱ¢ȱȱǰȱȱȱȱȬ¢ȱȱ ȱȱȱ£ ȱ ȱ ȱ ȱ ȱ ¢ ȱ ȱ ¢ ȱ ȱ ȱ ȱǰȱȱǰȱȱȱȱ ȱȱ ȱȱȱ

ȱȱȱȱȱȱȱȱȱȱȱȱ¢ȱ

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## **8VHRI0HFKDQLFDO'HYLFHVLQ&35\$**

 ¢Ȭȱ ¢ȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ¢ȱȱȱȱȱȱȱȱȱȱȱȱȱ¢ȱǯ ¢ȱȱȱ ȱȱȱȱȱȱȱǰȱ ȱ ȱȱȱȱǯȱ ȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱ¢ȱȱȱȱȱǯ

ȱȱȱǰȱȱȱȱȱȱȱȱȱ¢ȱȱ ȱȱȱȱȱȱǯ

ȱ ȱȱȱȱȱȱȱȱȱȱȱǯ ȱȱȱ¢ȱȱȱȱȱȱǰȱȱ ȱȱ £ȱȱ ȱȱ¢ȱȱȱȱȱȱȱȱȱȱȬ ¢ȱȱǻǼǰȱ ȱ ȱȱȱȱ¢ȱȱ¢ǯȱ ȱ ǰȱ ¢ȱȱ¢ȱȱȱȱǰȱȱȱ ȱȱ ǰȱ ȱȱȱ¢ǰȱǰȱǰȱȱ¡ǯ

#### **ȱȱȱȱȱȱȱȱ ¢ȱǵ**

ȱ¢ȱȱ ǻǼǰȱ ȱȱȱ ȱ ȱȱȱȱȬ ȱȱȱ¢ȱȱȱȱ¡Ȭ¢ȱȱ ȱȱȱȱȱ¡ ȱ ǻǼ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ ȱ ȱ ȱ¢ȱȱǰȱȱȱȱȬ¢ȱȱ ȱȱȱ£ ȱ ȱ ȱ ȱ ȱ ¢ ȱ ȱ ¢ ȱ ȱ ȱ ȱǰȱȱǰȱȱȱȱ ȱȱ ȱȱȱ ȱȱǯ

ȱȱȱȱȱȱȱȱȱȱȱȱ¢ȱ ǻȬǼǯ

#### **ȱ¢ȱȱǻȬǼ**

ȱȱȱȱȱȱȱȱ ȱȱȱȱȬ ȱȱȱȱȱȱ£ǯȱȱȱȱȱȱ

ǰȱ ȱ ȱ ¢ǰȱ £ȱ ȱ ȱ ¢ǰȱ ȱ ȱ ¢ǯ

 ¢Dzȱ ǰȱȱȱȱȱȱǰȱȱ ȱȱȱȱȱǯȱȱ ȱȱ ȱȱȱ¢ȱȱȱȱȱȱȱȱȱȱ ȱ ȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ¢ǯȱȱ ȱȱ¢ȱDzȱȱȱ¢ȱȱȱȱȱȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ ȱ ȱ ȱ £ǰȱ ȱ ȱȱ ȱȱȱǯȱȱȱȱ£ȱȱȱȱȱ ȱŗŘȮřŜǯȱȱȱ ȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱ¡ȱȱȱDzȱ ǰȱȱȱȱȱȱȱȱȱ ȱȱǰȱȱȱȱȱ ¢ȱ¢ǯȱȱ ȱȱȱȱȱȱ£ȱ¢ȱȱ¢ȱǯȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱ ǰȱȱȱȱȱȱȱȱ£ȱ¢ȱȱȱȱȂȱDz ȱȱȱ ȱȱȱ ȱȱȱȱȱȱȱȱ ǯȱȱȱǰȱȱȱȱȱȱȱ¢¡ǰȱȱȱ ȱȱȱ ȱȱȱ¡ȱȱȱȱȱȱȱȱȱȱȱ ȱȱDzȱȱȱȱȱȱȱ ȱȱǰȱȱȱ¢ ȱ ȱȱȱȱ ȱȱȱȱȱȱȱȱǯȱ ǰȱȱȱȱȱȱǯȱ¢ȱȱȱȱȱȱ ȱȱȱ ȱȱȱ¢¡ǰȱ ȱȱȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ¢ȱ Ȧǯȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱȱ ȱȱȱȱȱȱ ȱȱ¡ȱȱ ȱǯȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ

8VHRI0HFKDQLFDO'HYLFHVLQ&35\$

ȱȱȱȱȱ ȱȱȱȱȱȱȱǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȧȱ ǰȱ ȱ ȱ ȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱȱȱ¢ȱȱȱȱȱȱǰȱȱȱȱȱȱ

ȱȱȱȱȱȱȱȱȱȱȱȱȱǻǼǰ ȱȱȱȱȱȱǻǼȱȱȱǰȱȱȱȱǰȱ ȱȱȱȱ ¢ȱȱȱȱȱȱȱȱȱȱȱȱȱǯ ȱǰȱȱȱ¢ȱ£ȱȱȱȱȱǰȱȱȱȱȱ DzȱȱȬǰȱȱȱȱȱȱȱȱȱȱ ¢ȱǯȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱ¢ȱǯ ȱǰȱȱ ȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱ ¢ȱȱȱȱȱȱ ȱȱȱȱǯȱȱȱ¢ȱ

ȱȱȱȱȱ ȱȱȱȱ¢ȱȱǯ

*ȱȱȱȱȱȱȱǵ*

ȱȱȱǯ

ȱȱȱȱǯ

**Ȋ** ȱ¢¢ȱȱDZ

**ȱ**

ȱȱȱȱȬȱȱȱȱȱȬǰȱȱȱȱȱȱȱ ǰȱȱǻȱȱǼȱȱȱȱȱǰȱȱDZ


#### **ȱȱȱ£ȱȱ ¢ȱȱȱȬǵ**


#### **ȱȱȦ**

ȱǰȱȱȱȬȱȱǰȱȱȱȱȱ ǰȱȱȱȱȱ £ȱȱȱǯȱȱȱȱȱȱȱȱȱ ¢ǯȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱǯȱȱȱ £ȱȱ¡ȱȱȱȱȱȱȱȱȱ¡ȱȱȱȂȱDzȱ ȱȱȱȱǻǰȱǰȱȱǼǰȱȱȱȱ¡ȱȱ ȱȱȱǰ ȱȱȱȦȱǯ

#### **¢Ȧ¢ȱ**

¢ȱȱȱȱȱȱ¢ȱȱȱȱ ¢ȱǰ ȱȱȱȱȱȱǯȱȱȱȱȱȱȱ ȱȱ¢ȱ ȱȱȱȱȱȱȱǯȱȱȱǰȱȱȱŗŞŖķ ȱȱȱ ȱ ǯȱ ȱȱǰȱ ȱ ȱȱ ȱ¢¢ȱȱ £Dzȱ£ȱȱȱȱȱȱǰȱȱȱȱȱȱȱȱ ȱȱȱȱǯȱ£ȱȱ ȱŚȱȱŗŖȱȱȱǯȱȱȱȱ ȱȱȱȱȱȱȱȱ¢ǰȱȱȱȱȱȱ ȱȱȱ  ¢Dzȱ ǰȱȱȱȱȱȱǰȱȱ ȱȱȱȱȱǯȱȱ ȱȱ ȱȱȱ¢ȱȱȱȱȱȱȱȱȱȱ ȱ ȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ¢ǯȱȱ ȱȱ¢ȱDzȱȱȱ¢ȱȱȱȱȱȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ ȱ ȱ ȱ £ǰȱ ȱ ȱȱ ȱȱȱǯȱȱȱȱ£ȱȱȱȱȱ ȱŗŘȮřŜǯȱȱȱ ȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱ¡ȱȱȱDzȱ ǰȱȱȱȱȱȱȱȱȱ ȱȱǰȱȱȱȱȱ ¢ȱ¢ǯȱȱ ȱȱȱȱȱȱ£ȱ¢ȱȱ¢ȱǯȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱ ǰȱȱȱȱȱȱȱȱ£ȱ¢ȱȱȱȱȂȱDz ȱȱȱ ȱȱȱ ȱȱȱȱȱȱȱȱ ǯȱȱȱǰȱȱȱȱȱȱȱ¢¡ǰȱȱȱ ȱȱȱ ȱȱȱ¡ȱȱȱȱȱȱȱȱȱȱȱ ȱȱDzȱȱȱȱȱȱȱ ȱȱǰȱȱȱ¢ ȱ ȱȱȱȱ ȱȱȱȱȱȱȱȱǯȱ ǰȱȱȱȱȱȱǯȱ¢ȱȱȱȱȱȱ ȱȱȱ ȱȱȱ¢¡ǰȱ ȱȱȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ¢ȱ Ȧǯȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱȱ ȱȱȱȱȱȱ ȱȱ¡ȱȱ ȱǯȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱǯ

#### **ȱ**

ǰȱ ȱ ȱ ¢ǰȱ £ȱ ȱ ȱ ¢ǰȱ ȱ ȱ

ȱȱȱȱȬȱȱȱȱȱȬǰȱȱȱȱȱȱȱ

ǰȱȱǻȱȱǼȱȱȱȱȱǰȱȱDZ

**ȱȱȱ£ȱȱ ¢ȱȱȱȬǵ**

**Ȋ** ȬȱȱȱȱȱǻǼȦȱȱȱǻǼǯ

ȱǰȱȱȱȬȱȱǰȱȱȱȱȱ ǰȱȱȱȱȱ £ȱȱȱǯȱȱȱȱȱȱȱȱȱ ¢ǯȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱǯȱȱȱ £ȱȱ¡ȱȱȱȱȱȱȱȱȱ¡ȱȱȱȂȱDzȱ ȱȱȱȱǻǰȱǰȱȱǼǰȱȱȱȱ¡ȱȱ ȱȱȱǰ

¢ȱȱȱȱȱȱ¢ȱȱȱȱ ¢ȱǰ ȱȱȱȱȱȱǯȱȱȱȱȱȱȱ ȱȱ¢ȱ ȱȱȱȱȱȱȱǯȱȱȱǰȱȱȱŗŞŖķ ȱȱȱ ȱ ǯȱ ȱȱǰȱ ȱ ȱȱ ȱ¢¢ȱȱ £Dzȱ£ȱȱȱȱȱȱǰȱȱȱȱȱȱȱȱ ȱȱȱȱǯȱ£ȱȱ ȱŚȱȱŗŖȱȱȱǯȱȱȱȱ ȱȱȱȱȱȱȱȱ¢ǰȱȱȱȱȱȱ ȱȱȱ

**Ȋ** ȱȱȱȱȱȱȱ¢ȱȱ¢ȱǯ **Ȋ** ȱȱȱȱȱȱȱȱȱȱȱǯ

¢ǯ

**Ȋ** ȱǯ

**Ȋ** ȱȱȱǯ

**Ȋ** ǯ

**Ȋ** ȱȱ¢ǯ

%DVLF&DUGLRSXOPRQDU\5HVXVFLWDWLRQ0DQXDO

**Ȋ** £ȱȱȱǯ

**ȱȱȦ**

ȱȱȱȦȱǯ

**¢Ȧ¢ȱ**

**Ȋ** ¢Ȧ¢ȱǯ

**Ȋ** ȱȱȱǯ

ȱȱȱȱȱ ȱȱȱȱȱȱȱǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ Ȧȱ ǰȱ ȱ ȱ ȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱȱ ȱȱȱ¢ȱȱȱȱȱȱǰȱȱȱȱȱȱ ȱȱȱȱȱ ȱȱȱȱ¢ȱȱǯ

ȱȱȱȱȱȱȱȱȱȱȱȱȱǻǼǰ ȱȱȱȱȱȱǻǼȱȱȱǰȱȱȱȱǰȱ ȱȱȱȱ ¢ȱȱȱȱȱȱȱȱȱȱȱȱȱǯ ȱǰȱȱȱ¢ȱ£ȱȱȱȱȱǰȱȱȱȱȱ DzȱȱȬǰȱȱȱȱȱȱȱȱȱȱ ¢ȱǯȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱ¢ȱǯ ȱǰȱȱ ȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱ ¢ȱȱȱȱȱȱ ȱȱȱȱǯȱȱȱ¢ȱ ȱȱȱȱǯ

*ȱȱȱȱȱȱȱǵ*

**Ȋ** ȱ¢¢ȱȱDZ


ȱȱȱȱȱȱ¢ȱȱȱȱ£ȱȱȱȱȱȱ ȱȱȱǯȱȱȱȱȱȱȱȱ ȱȱ¢ȱȱ¢ ¢ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ¡¢ȱ ȱ ǰȱȱȂȱȱȱȱȱ¢ȱ£ȱȱDzȱȱ¢ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱǰȱȱȱȱȱȱȱȱȱȱȱȱȱǯ ȱȱ¢ȱȱȱŚśķȱȱȱȱȱȱ£ǰȱ ȱ¡ȱ ȱȱȱȱȱǰȱ¢ȱ¢ȱȱȱȱȱȱȱǯȱ ȱȱǰȱȱȱȱȱȱȱǰȱȱȱȱȱ ǯȱȱ¢ȱȱȱȱȱŗȱȱŘǯśȱȱ ȱȱDzȱȱ ȱ ȱ¡ȱȱȱȱȱȱȱȱȱȱǰȱ ȱŗşȱȱŘřȱȱȱȱ¢ȱ ǯȱȱ¢ȱȱȱȱ ȱŗŖȮŘŖȱȱȱǰȱȱ ȱȱ ȱǯȱȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¡ȱ ¢ ȱȱȱȱȱȱ¡ǯȱȱȱȱȱȱȱȱȱǰȱȱȱȱ ȱȱ ȱȱȱȱȱȱ¢ȱ¡ǯ

ȱ£ȱȱȱȱȱ¢ȱǯȱȱǰȱȱȱȱǰȱ ȱȱǰ ȱȱȱ¢£ǰȱ ȱ ȱȱȱȱȱȱȱȱȱǰȱ ȱ¢ȱȱȱȱȱȱȱȱȱȱȱ

8VHRI0HFKDQLFDO'HYLFHVLQ&35\$

ȱȱȱȱȱ¢ȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯ ȱ ȱ ȱ ȱ ǰ ȱ ȱ ȱ ȱ ȱȱ£ȱ ȱȱ ȱ ȱ ȱ ȱ ȱȱ ȱ ȱ ǰ ȱ ¡ǰ ȱ ȱ ȱ ȱ ȱ ȱ ǯ ȱ ¢ǰ ȱȱȱ¢ȱȱȱ¢ȱȱȱ ȱȱȱȱǰȱȱ ȱ ȱ ȱ ȱ ȱȱ£ȱȱȱȱ ȱ ȱȂȱȱȱ

**Ȋ** ȱDZȱ ȱȱȱȱȱȱȱȱȱȱ

**Ȋ** ȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱ

**Ȋ** ȱȱȱȱȱȱ¡ǰȱȱȱȱȬȱȱ

**Ȋ** ȱ ȱȱ ȱǰȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ

**Ȋ** ¢ȱȱ¢ȱȱ ȱȱȱȱǰȱȱ ȱǰ ȱȱ ȱȱȱȱȱȱ¢ȱ¢ȱȱȱǻ ȱȱ ¢ȱȱȱȱǼȱȱȱȱȱȱȱȱȱȱȱ ǰȱȱ¢ȱ ȱȱȱǻ Ǽȱ¢ȱȱȱǯ

ȱǯ

£ȱȱȱȂȱ¡ǯ

ȱȱȱȱǯ

 *ȱȱȱȱȱȬȱǵ*

ȱȱǰȱȱ ȱȱDZ

ȱȱ ȱȱ ȱǯ

**Ȋ** ȱȱȱŘȮŚȱȦȱȱȱȱŖǯśȮŗȱȦǯ

ȱȱȱȱȱȬȱ¡ǯ

ȱȱȱȱȱǯ

**Ȋ** ȱȱȱȱȃ¢Ȅȱȱȱȱȱǯ

**Ȋ** ȱ¢ȱȱȱȱȱȱȱȱȱǯ

*ȱȱȱȱȱȱȱȱȬǵ*

**Ȋ** DZȱ¢ȱȱȱȱ¢ȱȱǯ

**Ȋ** DZȱȱ ȱȱȱ ȱȱ£ǯ

ȱȱȱȱ£ȱȱȱȱȱȱȱȱ DZ

#### 

ȱȱȱ¡ȱȱǻǼȱȱȱȱȱȱ£ȱȱȬ ȱȱȱȱȱ ȱ ȱȱȱȱȱȱȱ¢ȱȱ ȱ¢ǰȱȱȱ¢ȱȱǰȱ¢ȱȱȱȬ¢ȱȬ ȱȱ¢ȱȱǯ

ȱǻǼȱȱȱȬȬȱȱȱȱȱȱȱȱǻǼȱ ȱ¢ȱ ȱȱȱǻǼȱȱȱȱǻǼǯȱȱȱȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ȱ ȱ ¢ȱ ǯȱ ȱ ȱ ȱ ȱȱȱȱ¢ȱȱ Ȭȱȱǰȱ ȱȱȱȬ ȱ£ȱȱȱȱȱ¢ȱǯȱȱǰȱȱȱȱǰȱ ȱȱǰ ȱȱȱ¢£ǰȱ ȱ ȱȱȱȱȱȱȱȱȱǰȱ ȱ¢ȱȱȱȱȱȱȱȱȱȱȱ ȱǯ

ȱȱȱȱȱ¢ȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯ ȱ ȱ ȱ ȱ ǰ ȱ ȱ ȱ ȱ ȱȱ£ȱ ȱȱ ȱ ȱ ȱ ȱ ȱȱ ȱ ȱ ǰ ȱ ¡ǰ ȱ ȱ ȱ ȱ ȱ ȱ ǯ ȱ ¢ǰ ȱȱȱ¢ȱȱȱ¢ȱȱȱ ȱȱȱȱǰȱȱ ȱ ȱ ȱ ȱ ȱȱ£ȱȱȱȱ ȱ ȱȂȱȱȱ £ȱȱȱȂȱ¡ǯ

#### *ȱȱȱȱȱȱȱȱȬǵ*

ȱȱȱȱ£ȱȱȱȱȱȱȱȱ DZ


#### *ȱȱȱȱȱȬȱǵ*

**Ȥ** ¢ȱȱ ȱȱȱǯ

**Ȥ** ȱȱȱȱȱǯ

ȱȱ ȱȱȱȱȱȱ¢ȱ¡ǯ

**Ȋ** ¡ȱȱȱȱȱ ȱȱȱǯ

ȱȱȱȱȱȱ¢ȱȱȱȱ£ȱȱȱȱȱȱ ȱȱȱǯȱȱȱȱȱȱȱȱ ȱȱ¢ȱȱ¢ ¢ȱ ȱ ȱ ȱ ¢ȱ ȱ ǯȱ ȱ ȱ ȱ ȱ ¡¢ȱ ȱ ǰȱȱȂȱȱȱȱȱ¢ȱ£ȱȱDzȱȱ¢ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¢ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱȱȱǰȱȱȱȱȱȱȱȱȱȱȱȱȱǯ ȱȱ¢ȱȱȱŚśķȱȱȱȱȱȱ£ǰȱ ȱ¡ȱ ȱȱȱȱȱǰȱ¢ȱ¢ȱȱȱȱȱȱȱǯȱ ȱȱǰȱȱȱȱȱȱȱǰȱȱȱȱȱ ǯȱȱ¢ȱȱȱȱȱŗȱȱŘǯśȱȱ ȱȱDzȱȱ ȱ ȱ¡ȱȱȱȱȱȱȱȱȱȱǰȱ ȱŗşȱȱŘřȱȱȱȱ¢ȱ ǯȱȱ¢ȱȱȱȱ ȱŗŖȮŘŖȱȱȱǰȱȱ ȱȱ ȱǯȱȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ¡ȱ ¢ ȱȱȱȱȱȱ¡ǯȱȱȱȱȱȱȱȱȱǰȱȱȱȱ

ȱȱȱ¡ȱȱǻǼȱȱȱȱȱȱ£ȱȱȬ ȱȱȱȱȱ ȱ ȱȱȱȱȱȱȱ¢ȱȱ ȱ¢ǰȱȱȱ¢ȱȱǰȱ¢ȱȱȱȬ¢ȱȬ

ȱǻǼȱȱȱȬȬȱȱȱȱȱȱȱȱǻǼȱ ȱ¢ȱ ȱȱȱǻǼȱȱȱȱǻǼǯȱȱȱȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ȱ ȱ ¢ȱ ǯȱ ȱ ȱ ȱ ȱȱȱȱ¢ȱȱ Ȭȱȱǰȱ ȱȱȱȬ

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**Ȋ** ǯ

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ȱȱ¢ȱȱǯ

**Ȋ** ȱǯ

**Ȋ** DZȱȱȱ¡ǯ

ȱȱǰȱȱ ȱȱDZ


ȱȱȱȱȱȱȱȱ¢ȱȱ ȱȱ¢¢ȱȱȱ ȱȱǯȱȱǰȱȱȱȱȱȱȱ¢ȱȱȱ ȱȱȱȱ ȱȱȱȱǯ

**Chapter 12**

**The Importance of**

**the Administration of**

**Drugs Utilized in CPR-A**

Advances in the clinical sciences are under constant change. Pharmacological therapeutics orders the information necessary to know at what exact moment the utilization is necessary of treatments and drug use, of the activities directly involving the personnel who constantly

Cardiorespiratory arrest (CRA) is the most critical emergency that has presented in the history of mankind in the extra- and intra-hospitalary ambit because when it is not identified in timely fashion, it has fatal consequences. Thus, it is important for persons, found or not in the health ambit, to be prepared and to know what to do immediately and how to act in the face of this

Basic cardiopulmonary resuscitation (CPR-B) should be given immediately after identifying CRA. It is important to remember that the time between the arrest and the resuscitation, as well as the time that it takes to reestablish the cardiac rhythm that allows reestablishing organic

In the hospital areas, health professionals form an important part of the multidisciplinary team; those confronting emergency situations require technical, scientific, and ethical knowledge. In the majority of times, the therapeutic success of Advanced cardiopulmonary resuscitation (CPR-A) rests upon on the speed with which the drugs are administered by one of the team members, although more often that not this responsibility falls to the nursing professionals. Those in charge of this task should follow the therapeutic indications in urgent and in emergency situations. Thus, possessing broad and scientific preparation is of vital importance

The circumstances of action are diverse in the hospital ambit; one of these is the emergency care of a patient with CRA, in that the event merits offering an immediate and professional response that permits them to resolve the event that presents in the most ideal manner, by means of an accurate participation and one accompanied by scientific knowledge, due to that the activities involved in drug administration and their direct contact with the sick individual, the importance should be considered of possessing the know-how and having at hand the action, doses, and administration routes, as well as the adverse effects that each drug has in relation to the event requiring its utilization (this revolves around taking the actions the actions that should be borne in mind with respect to normativity in the administration of the drugs).

reproduction in any medium, provided the original work is properly cited.

© 2013 ; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and

© 2013, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

have the responsibility of administering drugs and observing their effects.

emergency. Therefore, the lives of many persons could be saved.

perfusion, is transcendental for the final prognosis.

in this respect.

ȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱ ǰȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱǯȱȱȱǰȱȱȱȱȱȱȱȱȱ ǻǼȱȱȱȱȱȱ£ȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱ ȱȱȱǯ

ȱȱȱǰȱȬȱȱ ȱȱȱȱȱȱ£ȱ ȱȱȱȱȱȱ¢ȱȱȱȱ¢ȱȱ¢ȱ ȱ¢¡ǰȱ¢ȱȬ¡ȱ¢ǯȱǰȱȱȱ ȱȱȱ DZ


ȱȱȱȱȱ DZȱ¢ȱȱȱ ȱȱǯȱȱȱǰȱȱȱȱȱȱȱȱ ȱȱ¢ȱǰȱ¢ȱȱȱȂȱ¢ȱDzȱȱȱǰ ȱ¢ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱ¢ȱDzȱȱȱȱȱȱȱǰȱȱȱ ȱȱȱȱȱȱ ȱ¢ȱȱȱȱǯ

ȱȱ ȱȱȱȱȱȱǻǼȱȱȱȱȱȱȱȱ ȱ ȱ Dzȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱ ȱ ȱ ȱȱȱǯȱȱȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱǰȱǰȱȱȱȱȱ¢ǰȱȱȱȱ ȱȱȱǰȱȱȱǰȱȱȱȱȱ¢ǯ

ȱ ȱ ȱ ǰȱȱȱȱ ȱ ȱ ȱ ȱ ȱ¢ȱ ǰȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ǰȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ȱ ǯȱȱ ȱ ¢ȱ ȱȱ ȱ ȱȱȱǰȱ ȱ ȱ ȱ ȱ ȱȱ ȱȱȱǯ

#### **Chapter 12**

## **The Importance of the Administration of Drugs Utilized in CPR-A**

ȱȱȱȱȱȱȱȱ¢ȱȱ ȱȱ¢¢ȱȱȱ ȱȱǯȱȱǰȱȱȱȱȱȱȱ¢ȱȱȱ

ȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱ ǰȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱǯȱȱȱǰȱȱȱȱȱȱȱȱȱ ǻǼȱȱȱȱȱȱ£ȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱ¢ȱȱȱȱȱ

ȱȱȱǰȱȬȱȱ ȱȱȱȱȱȱ£ȱ ȱȱȱȱȱȱ¢ȱȱȱȱ¢ȱȱ¢ȱ ȱ¢¡ǰȱ¢ȱȬ¡ȱ¢ǯȱǰȱȱȱ ȱȱȱ DZ

**Ȋ** ȱȱȱȂȱ¢ȱȱȱȱȱȱȱȱȱȱǯ

**Ȋ** ȱȱȱȱȱȱ¢ǰȱ ȱ£ȱȱȱȱȱǯ

ȱȱȱȱȱ DZȱ¢ȱȱȱ ȱȱǯȱȱȱǰȱȱȱȱȱȱȱȱ ȱȱ¢ȱǰȱ¢ȱȱȱȂȱ¢ȱDzȱȱȱǰ ȱ¢ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱ¢ȱDzȱȱȱȱȱȱȱǰȱȱȱ ȱȱȱȱȱȱ ȱ¢ȱȱȱȱǯ

ȱȱ ȱȱȱȱȱȱǻǼȱȱȱȱȱȱȱȱ ȱ ȱ Dzȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱ ǯȱ ȱ ȱ ȱȱȱǯȱȱȱȱȱȱȱȱȱȱȱ ȱ ȱ ȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ȱ ȱ ȱ ȱ ȱǰȱǰȱȱȱȱȱ¢ǰȱȱȱȱ ȱȱȱǰȱȱȱǰȱȱȱȱȱ¢ǯ

ȱ ȱ ȱ ǰȱȱȱȱ ȱ ȱ ȱ ȱ ȱ¢ȱ ǰȱ ȱ ȱ ȱ ǰȱ ȱ ȱ ǰȱ ȱ ȱ ¢ȱ ȱ ȱ ¢ȱ ǯȱȱ ȱ ¢ȱ ȱȱ ȱ ȱȱȱǰȱ ȱ ȱ ȱ ȱ ȱȱ

ȱȱȱȱ ȱȱȱȱǯ

ȱȱȱǯ

%DVLF&DUGLRSXOPRQDU\5HVXVFLWDWLRQ0DQXDO

ȱȱȱǯ

Advances in the clinical sciences are under constant change. Pharmacological therapeutics orders the information necessary to know at what exact moment the utilization is necessary of treatments and drug use, of the activities directly involving the personnel who constantly have the responsibility of administering drugs and observing their effects.

Cardiorespiratory arrest (CRA) is the most critical emergency that has presented in the history of mankind in the extra- and intra-hospitalary ambit because when it is not identified in timely fashion, it has fatal consequences. Thus, it is important for persons, found or not in the health ambit, to be prepared and to know what to do immediately and how to act in the face of this emergency. Therefore, the lives of many persons could be saved.

Basic cardiopulmonary resuscitation (CPR-B) should be given immediately after identifying CRA. It is important to remember that the time between the arrest and the resuscitation, as well as the time that it takes to reestablish the cardiac rhythm that allows reestablishing organic perfusion, is transcendental for the final prognosis.

In the hospital areas, health professionals form an important part of the multidisciplinary team; those confronting emergency situations require technical, scientific, and ethical knowledge. In the majority of times, the therapeutic success of Advanced cardiopulmonary resuscitation (CPR-A) rests upon on the speed with which the drugs are administered by one of the team members, although more often that not this responsibility falls to the nursing professionals. Those in charge of this task should follow the therapeutic indications in urgent and in emergency situations. Thus, possessing broad and scientific preparation is of vital importance in this respect.

The circumstances of action are diverse in the hospital ambit; one of these is the emergency care of a patient with CRA, in that the event merits offering an immediate and professional response that permits them to resolve the event that presents in the most ideal manner, by means of an accurate participation and one accompanied by scientific knowledge, due to that the activities involved in drug administration and their direct contact with the sick individual, the importance should be considered of possessing the know-how and having at hand the action, doses, and administration routes, as well as the adverse effects that each drug has in relation to the event requiring its utilization (this revolves around taking the actions the actions that should be borne in mind with respect to normativity in the administration of the drugs).

© 2013 ; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013, licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In the previous chapters, we have explained that related with basic CPR. In this chapter, some aspects will be approached that are related with the use of drugs in the second phase of CPR-A. According to the classification of Peter Safar, for CPAR-A to be viable, the first phase of CPR-B? must have been carried out effectively by trained persons.

*The endotracheal route* is utilized for drug administration when, due to the seriousness of the patient's state, it is not possible to install either of the previous two if the patient has already been intubated. Although it is important to remember that doses vary in relation to those administered by venous route, it is noteworthy that this route is only utilized in cases that

The Importance of the Administration of Drugs Utilized in CPR-A 63

There are other routes for drug administration during CPR that are less frequently employed less frequently in current practice during CPR; this is due to the side effects and the compli‐ cations with which their utilization is consequently accompanied. These other routes comprise

The venous routes are essential during CPR-A maneuvers. Thus, the maintenance and

With respect to the drugs, these should be localized in the first drawer of the RC; the order of these can be subject to change, according to the structure of the RC and to the hospital routine

On the other hand, it is important to consider that the drugs utilized in CPR-A should be localized in a specific place, such as the **Red Cart (RC)**, which is a necessary piece of equipment that is required mainly in the emergency room, but that is also highly important in other areas of the hospital. This cart should have the equipment, drugs, and specialized materials for resolving health problems meriting urgent attention. The RC is utilized in urgent situations

With respect to the drugs, these should be localized in the first drawer of the RC; the order of these can be subject to change, according to the structure of the RC and to the hospital routine. It is important to remember that the first drawer of the RC has 265 compartments and that each drug is ordered and accommodated in the previously mentioned order, observing the

As noted previously, the rapidity with which each and every CPR maneuver is carried out in all of its phases will transfer into the success obtained in these situations that comprise a true

and when life is at risk, whether due to a sudden disease manifestation or to trauma.

involve strictly emergency scenarios.

(Table 10-1).

the intra-osseous and the intra-cardiac routes.

permeability of these are very important, as is their functionality.

importance of the first three, which are utilized in CPR.

**Drug Amounts**

emergency in patient care.

**1. Adrenaline 2. Atrophin**

**4. Aminofilin 5. Potassium chloride 6. Dexamethazone 7. Diazepam**

**3. Sodium bicarbonate**

**8. Diphenylhydantoin (DPH) 9. Diphenydramine**

In CPR-A, a trained person should guide the actions and is directly responsible for verifying the following:


In CPR-A, the installation and maintenance of a permeable and functional airway is something fundamental that will coadjuvate in having the best possibilities of survival, and this is related with the speed with which it is carried out, in addition to maintaining the airway, strength‐ ening the circulation, Defibrillation (DF), drug administration, and obtaining a venous route for the perfusion of these. There are various ways of installing a venous route, which depends on the general conditions in which the patient is found. In the case of CPR, there are the following:


Each of these has its own specifications and here are the following:

*The peripheral venous route* should preferentially be installed at the level of, or above the level of, the diaphragm; it is recommended that this be in the antecubital vein, which is safer and faster to obtain. In addition to having the advantage of being able to be catheterized, it is not necessary to delay the CPR maneuvers. When a person with this skill is available, a long catheter can be inserted into this vein. When the drug is administered by peripheral route in a patient with CRA, this drug takes somewhat longer to enter the central circulation, which is much delayed; thus, it is recommended that a drug always be administered in diluted form so that its arrival in the bloodstream will be faster. In addition, it is recommended that the limb in which the venous route is installed be raised so that the drug can reach it more rapidly.

*The central venous route* possesses the great advantage of the *rapidity* with which the drugs reach the central circulation and are distributed to the vital organs. But the disadvantage is that only personnel with the knowledge and the skill can install it in the least possible amount of time. The venous accesses are in the internal jugular vein and in the subclavial vein. The choice of one or the other depends on the practice of the person who is to carry this out.

*The endotracheal route* is utilized for drug administration when, due to the seriousness of the patient's state, it is not possible to install either of the previous two if the patient has already been intubated. Although it is important to remember that doses vary in relation to those administered by venous route, it is noteworthy that this route is only utilized in cases that involve strictly emergency scenarios.

In the previous chapters, we have explained that related with basic CPR. In this chapter, some aspects will be approached that are related with the use of drugs in the second phase of CPR-A. According to the classification of Peter Safar, for CPAR-A to be viable, the first phase of

In CPR-A, a trained person should guide the actions and is directly responsible for verifying

In CPR-A, the installation and maintenance of a permeable and functional airway is something fundamental that will coadjuvate in having the best possibilities of survival, and this is related with the speed with which it is carried out, in addition to maintaining the airway, strength‐ ening the circulation, Defibrillation (DF), drug administration, and obtaining a venous route for the perfusion of these. There are various ways of installing a venous route, which depends on the general conditions in which the patient is found. In the case of CPR, there are the

*The peripheral venous route* should preferentially be installed at the level of, or above the level of, the diaphragm; it is recommended that this be in the antecubital vein, which is safer and faster to obtain. In addition to having the advantage of being able to be catheterized, it is not necessary to delay the CPR maneuvers. When a person with this skill is available, a long catheter can be inserted into this vein. When the drug is administered by peripheral route in a patient with CRA, this drug takes somewhat longer to enter the central circulation, which is much delayed; thus, it is recommended that a drug always be administered in diluted form so that its arrival in the bloodstream will be faster. In addition, it is recommended that the limb in which the venous route is installed be raised so that the drug can reach it more rapidly.

*The central venous route* possesses the great advantage of the *rapidity* with which the drugs reach the central circulation and are distributed to the vital organs. But the disadvantage is that only personnel with the knowledge and the skill can install it in the least possible amount of time. The venous accesses are in the internal jugular vein and in the subclavial vein. The choice of

one or the other depends on the practice of the person who is to carry this out.

**•** That there is an installation and maintenance of a permeable and functional airway.

**•** That the decision is made concerning the moment at which CPR is finalized.

Each of these has its own specifications and here are the following:

CPR-B? must have been carried out effectively by trained persons.

the following:

following:

**•** Peripheral venous route.

**•** Central venous route.

**•** Endotracheal route.

**•** That the CPR-B has been correct.

62 Basic Cardiopulmonary Resuscitation Manual

**•** That the pharmacological is correct.

**•** That Defibrillation is carried out.

**•** That endotracheal intubation is performed.

There are other routes for drug administration during CPR that are less frequently employed less frequently in current practice during CPR; this is due to the side effects and the compli‐ cations with which their utilization is consequently accompanied. These other routes comprise the intra-osseous and the intra-cardiac routes.

The venous routes are essential during CPR-A maneuvers. Thus, the maintenance and permeability of these are very important, as is their functionality.

With respect to the drugs, these should be localized in the first drawer of the RC; the order of these can be subject to change, according to the structure of the RC and to the hospital routine (Table 10-1).

On the other hand, it is important to consider that the drugs utilized in CPR-A should be localized in a specific place, such as the **Red Cart (RC)**, which is a necessary piece of equipment that is required mainly in the emergency room, but that is also highly important in other areas of the hospital. This cart should have the equipment, drugs, and specialized materials for resolving health problems meriting urgent attention. The RC is utilized in urgent situations and when life is at risk, whether due to a sudden disease manifestation or to trauma.

With respect to the drugs, these should be localized in the first drawer of the RC; the order of these can be subject to change, according to the structure of the RC and to the hospital routine.

It is important to remember that the first drawer of the RC has 265 compartments and that each drug is ordered and accommodated in the previously mentioned order, observing the importance of the first three, which are utilized in CPR.

As noted previously, the rapidity with which each and every CPR maneuver is carried out in all of its phases will transfer into the success obtained in these situations that comprise a true emergency in patient care.



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enseñanza.

S.A. de C.V.

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**Table 10-1.** Drugs included in the **Red Cart (RC)**

## References

**Drug Amounts**

**10. Diazoxide 11. Digoxin 12. Dobutamine 13. Dopamine 14. Flunitrazepam 15. Furosemide 16. Calcium gluconate 17. Glucose at 50% 18. Hydrocortisone 19. Isoproterenol 20. Methylprednisolone 21. Sodium nitroprussiate 22. Magnesium sulfate 23. Verapamil**

64 Basic Cardiopulmonary Resuscitation Manual

**24. Simple xylocaine at 1% 25. Simple xylocaine at 2% 26. Xylocaine at 10% in spray**

**Table 10-1.** Drugs included in the **Red Cart (RC)**

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American Heart Association. 2010 CPR and ECC Guidelines.www.heart.org/ cpr

Brunner Sholtis, L. (1998). Enfermeria Medico Quirurgica (Vol. 2). Interamericana.

Chapleau, W. (2007). Primer Interviniente en Emergencias: Marcando la Diferencia. Madrid, España: Elsevier España, S.A.

Cisneros, F.J. Rivas. (2006) paro cardíaco y embarazo, vol. 29.

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Comision inter institucional de enfermería. (2011). Codigo de etica para enfermeras y enfermeros de méxico. D.F., México: Subsecretaria de inovación y calidad.

Davis, A., & Tschundin, V. (2009). Etica en enfermeria, conceptos fundamentales en su enseñanza.

DeCherney, A., Nathan, L., Goodwin, M., & Laufer, N. (2007). Diagnostico y tratamiento gineco obstétrico (9 ed.). (I. d. Monteón Batalla, Trad.) D.F., México: Manual Moderno S.A. de C.V.

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Whitty JE. Maternal Cardiac arrest in pregnancy. Clin Obstet Gynecol 2002;45:377-92

www.slideshare.net/.../reanimacin-cardio-pulmonar-en-embarazo consultado en diciembre 2012

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Lemone, P. (2009). Enfermeria medico quirurgica, pensamiento critico en la atención del paciente (4 ed.). Pearson Prentice Hall.

Morales Gonzales, J. A. (2011). Etica, bioetica y conocimiento del hombre. D.F., México.

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Johnson MD, Luppi CJ, Over DC Cardiopulmonary resuscitation. In Gambling DR Douglas MJ, editors. Obstetric Anesthesia and uncommon disorders. Philadelphia: WB

Kerr Mg The mechanical effects of the gravid uterus in late pregnancy.J Obstet

Ortega Deballón, I. M, "Ética y responsabilidad legal del personal sanitario en las urgencias, emergencias y catástrofes". En formación continuada de Urgencias y

Ortega Deballón. I. M, "Aspectos éticos-legales en las emergencias Extrahospitalarias".

Peralta Rodríguez Narciso Manual de Soporte Básico Avanzado 4ª Edición editorial

Poole JH, Long J Maternal mortality-a review of current treds. Crit Care Nurs Clin

Rodríguez Palomares Consuelo. Farmacología para enfermeras Mc Graw Hill

Rovira Gil, E; López González, A; García Fernández, C. "Ética y reanimación cardiopulmonar: visión actualizada. Artículo de la revista de enfermería 1999; Número

Whitty JE. Maternal Cardiac arrest in pregnancy. Clin Obstet Gynecol 2002;45:377-92

www.slideshare.net/.../reanimacin-cardio-pulmonar-en-embarazo consultado en

Lemone, P. (2009). Enfermeria medico quirurgica, pensamiento critico en la atención

Morales Gonzales, J. A. (2011). Etica, bioetica y conocimiento del hombre. D.F., México.

Artículo de la revista Metas de Enfermería 2002, Numero 48, paginas 26-30.

Saunders:1998.p51-74

Elsevier Mason 2007

9: Pagina 39-42.

diciembre 2012

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del paciente (4 ed.). Pearson Prentice Hall.

North Am 2004;16:227-30

Interamericana editores S.A.de C.V, 2007

Gynaecol Br Commw 1965; 72513-29

Ley General de Salud. México 2012.

Morris S, Stacey M. Resuscitation in pregnancy. BMJ 2003; 327.

emergencias sanitarias. Ed Formación Alcalá. Jaén.2002.

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T., D. Cuidados de la enfermera reanimación. Taray-Masson.

*Edited by Jose A. Morales Gonzalez*

The purpose of this publication is to systematize the knowledge necessary to make Cardiopulmonary Resuscitation (CPR) or Cardiorespiratory Resuscitation (CRR) known to nursing health specialists, which translates as a set of temporary and internationally standardized maneuvers assigned to ensure the oxygenation of the vital organs when the blood circulation of an individual stops suddenly, independently of the cause of the Cardiorespiratory arrest (CRA). This knowledge is found correctly delimited in The Basic Cardiopulmonary Resuscitation Manual, which especially emphasizes the step-by-step methodology and techniques to follow for Cardiopulmonary Resuscitation (CPR). This is a basic work that cannot be overlooked by health care specialists, the society, and the public in general, because of the high probability that this situation will present at some moment in life. Thus, it is recommended to be prepared to help some person in an emergency situation. The manual is an excellent consultation work for health professionals.

Given that what is expressed in this work is fundamental for life, and its objective is to make known the relevant information concerning the knowledge of CPR.

Basic Cardiopulmonary Resuscitation Manual

Basic Cardiopulmonary

Resuscitation Manual

*Edited by Jose A. Morales Gonzalez*

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