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[International Journal of Emergency Mental Health, 2008, 9\(3\), pp. 171-180].)Tj /TT1 1 Tf 9 0 0 9 119.01 222.99 Tm -0.0055 Tc 0.0028 Tw (Key words: )Tj /TT5 1 Tf 5.1167 0 TD -0.0048 Tc 0.0045 Tw [(T)91.4(e)4.9(rr)41(orism; disaster mental health; psychological first aid; faith community; faith and disaster)108.5(, spiritual)]TJ 3.4667 -1.3333 TD -0.0028 Tw (caregiver; religion and health; public health preparedness.)Tj ET /GS1 gs 66.99 198.765 m 558 198.765 l S BT 9 0 0 9 66.99 180.99 Tm /GS2 gs -0.0587 Tw [(The authors wish to expr)31.8(ess special thanks to: the Mar)-4.9(yland Depar)-4.9(tment of Health and Mental Hygiene, especially )12(Al Romanosky)51.8(, M)]TJ 51.5794 0 TD -0.0038 Tc -0.0589 Tw (D, PhD)Tj -51.5794 -1.22 TD -0.005 Tc 0.0149 Tw (\(Office of Preparedness and Response\) and Frank Monius \(Maryland Hospital Association\), for the generous support of this projec)Tj 52.3303 0 TD (t by a)Tj -52.3303 -1.2233 TD -0.0066 Tc -0.0625 Tw (Special Projects grant from the National Bioterrorism Hospital Preparedness Program of the Health Resources and Services Admini)Tj 51.491 0 TD 0 Tw (stration)Tj -51.491 -1.2233 TD -0.0056 Tc -0.0624 Tw [(\(HRSA\); the members of the Partnership Steering Committee representing the faith-based and academic organizations, Maria Johns)]TJ 51.7031 0 TD (on, MA)Tj -51.7031 -1.22 TD -0.0226 Tw [(\(Hispanic Ministr)-5.5(y)55(,)-5( )8.1(Ar)34.5(chdiocese of Baltimor)34.5(e\), Marshall F)121.2(.)-2( Pr)31.2(entice, M.Div)67.8(, DD \(CURE\), Michael T)84.5(o)7(r)-5.5(r)37(es, MD \(Institute for Mental)]TJ 51.6394 0 TD -0.0053 Tc -0.0228 Tw [( Health)]TJ -51.6394 -1.2233 TD -0.009 Tc -0.0624 Tw [(Ministr)-5.7(y)58.2(,)-0.6( Inc\), and Rober)-5.7(t White, LCSW \(University of Maryland School of Medicine\); Paula J. T)84.3(eague, D.Min., Clinical Pastoral)]TJ 50.0941 0 TD -0.0085 Tc -0.0626 Tw [( Education,)]TJ -50.0941 -1.2233 TD -0.0047 Tc -0.0611 Tw (Johns Hopkins Hospital; and to the dozens of other individual members of the academic/faith community partnership whose time, e)Tj 50.9373 0 TD (ffort, and)Tj -50.9373 -1.22 TD -0.0048 Tc 0.0085 Tw [(ingenuity made this pr)31.9(oject so gratifying; and, finally)48.5(, to the hundr)35.2(eds of faith trainees whose enthusiasm for the pr)35.2(ogram aug)]TJ 49.9821 0 TD 0.0084 Tw (urs well for)Tj -49.9821 -1.2233 TD -0.0045 Tc 0.0479 Tw [(broader application and acceptance. Correspondence concerning this article should be sent to O. Lee McCabe, PhD, Department)]TJ 53.4899 0 TD [( of)]TJ -53.4899 -1.2233 TD -0.0048 Tc -0.0168 Tw [(Mental Health, The Johns Hopkins Bloomber)31.9(g School of Public Health, Hampton House, Room 896, 624 North Br)35.2(oadway)48.5(, Baltimor)31.9(e, MD)]TJ 0 -1.22 TD -0.0051 Tc -0.0092 Tw (21205; email to: lmccabe@jhsph.edu)Tj /F1 1 Tf 14 0 0 14 148.65 689.34 Tm -0.0063 Tc 0.1096 Tw [(The )92.9(T)79.7(o)15.4(wer of Iv)23.7(or)-17(y Meets the House of )71.5(W)67.7(o)3.7(r)8.7(ship:)]TJ -2.2243 -1.1421 TD -0.0039 Tc 0.138 Tw [(Psychological Fir)6.8(s)-1.1(t Aid )97.1(T)80(raining f)13.2(or the F)13.3(aith Comm)15.4(unity)]TJ /TT2 1 Tf 12 0 0 12 141.51 544.65 Tm -0.0197 Tc -0.0604 Tw (Adrian M. Mosley)Tj 10 0 0 10 113.76 531.99 Tm 0.0012 Tc 0.02 Tw [(The Johns Hopkins Health System)]TJ 12 0 0 12 273.15 636.66 Tm -0.007 Tc 0.0188 Tw [(O. Lee McCabe)]TJ 10 0 0 10 165.9 624 Tm 0.0011 Tc -0.0139 Tw (Department of Mental Health and Center for Public Health Preparedness)Tj 3.411 -1.2 TD 0.0009 Tc -0.0214 Tw (The Johns Hopkins Bloomberg School of Public Health)Tj 10.35 -1.2 TD 0.0281 Tc 0 Tw (and)Tj -9.45 -1.2 TD 0.0017 Tc -0.007 Tw (Department of Psychiatry and Behavioral Sciences)Tj 2.214 -1.2 TD 0.0009 Tc 0.017 Tw (The Johns Hopkins School of Medicine)Tj 12 0 0 12 138.75 496.65 Tm -0.0139 Tc -0.0606 Tw [(Geor)11.1(ge S. Everly Jr)48.6(.)]TJ 10 0 0 10 108 483.99 Tm 0.0012 Tc -0.0175 Tw [(Center for Public Health Preparedness)]TJ -3.45 -1.2 TD 0.0009 Tc -0.0214 Tw (The Johns Hopkins Bloomberg School of Public Health)Tj 12 0 0 12 398.01 547.65 Tm -0.0078 Tc -0.0604 Tw (Howard S. Gwon)Tj 10 0 0 10 359.76 534.99 Tm 0.001 Tc -0.0625 Tw (The Office of Emergency Management,)Tj 3.039 -1.2 TD 0.0007 Tc 0.0525 Tw (Johns Hopkins Hospital)Tj 12 0 0 12 390.9 444.66 Tm -0.026 Tc -0.0604 Tw (Michael J. 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Lating)Tj 10 0 0 10 383.25 483.99 Tm 0.0021 Tc -0.0534 Tw (Loyola College in Maryland)Tj ET endstream endobj 39 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 43 0 obj << /Length 9617 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0066 Tc 0 Tw (172 )Tj /TT3 1 Tf 2.0513 0 TD -0.0056 Tc 0.1312 Tw (McCabe Ivory Tower Meets House of Worship)Tj /F1 1 Tf 11 0 0 11 56.01 723.99 Tm -0.0047 Tc 0.0318 Tw [(The Problem: Disaster-Induced Demand for)]TJ 0 -1.0909 TD -0.0048 Tc 0.05 Tw (Behavioral Health Services)Tj /TT2 1 Tf 10 0 0 10 74.01 688.65 Tm -0.0037 Tc 0.0543 Tw (There is increasing recognition that surges in demand)Tj -1.8 -1.401 TD -0.0036 Tc -0.0337 Tw (for medical services in the immediate aftermath of disasters)Tj 0 -1.398 TD 0.0267 Tw (and large-scale public catastrophes can rapidly overwhelm)Tj 0 -1.401 TD -0.0428 Tw [(health care resources. )50.4(An important dimension to this prob-)]TJ T* -0.0066 Tc -0.0622 Tw (lem is the volume of individuals presenting to hospital emer-)Tj 0 -1.398 TD -0.0034 Tc 0.0882 Tw (gency departments and other health care settings who are)Tj 0 -1.401 TD -0.0026 Tc -0.0157 Tw [(more psychologically affected than physically injured. 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Harold Koenig, noted researcher of the)]TJ T* -0.0035 Tc 0.0481 Tw (relationship between faith and health, has offered no fewer)Tj ET endstream endobj 44 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 46 0 obj << /Length 8262 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (173)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0012 Tc 0.125 Tw (than ten reasons that religion and spiritual caregivers can)Tj 0 -1.398 TD -0.0029 Tc 0.0178 Tw (benefit people trying to cope with crises. 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These professionals)]TJ T* -0.0033 Tc 0.1162 Tw (include...faith-based and other community lead-)Tj 0 -1.398 TD 0.0157 Tc 0 Tw (ers. )Tj /TT5 1 Tf 1.875 0 TD 0.1256 Tw [(However)105.8(, these pr)30.8(ofessionals will r)30.8(equir)30.8(e)]TJ -1.875 -1.401 TD -0.0002 Tc 0.1249 Tw [(knowledge and training in order to provide ef-)]TJ T* -0.0064 Tc -0.06 Tw (fective support)Tj /TT2 1 Tf 5.766 0 TD -0.006 Tc -0.0625 Tw ( \(IOM, 2003, p. 15\).)Tj -6.066 -1.998 TD -0.0047 Tc -0.0621 Tw [(Certainly)58.3(,)0( if spiritual caregivers are to become optimally)]TJ -1.8 -1.401 TD -0.0086 Tc (prepared to engage as active partners in disaster mental health)Tj T* -0.0095 Tc -0.0625 Tw (response and to fit formally into local, state, and federal emer-)Tj 0 -1.398 TD -0.0031 Tc 0.0942 Tw (gency response systems, numerous preparatory tasks must)Tj 0 -1.401 TD -0.0033 Tc 0.0493 Tw (be successfully addressed. 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The authors)]TJ 0 -1.401 TD 0.0393 Tc (adapted an earlier form of this crisis-interventionist/)Tj T* -0.0036 Tc -0.04 Tw (gatekeeper model for application to the immediate project.)Tj 1.8 -1.998 TD -0.0083 Tc -0.0625 Tw [(T)71.5(o)-0.1( accomplish a practicable adaptation of the PF)72.7(A)53.9( model)]TJ -1.8 -1.401 TD -0.0034 Tc 0.0268 Tw [(to the faith community)62.6(, there were three fundamental ques-)]TJ T* -0.0039 Tc 0.0525 Tw [(tions to answer)50.1(.)]TJ 1.2 -1.998 TD -0.0036 Tc -0.0413 Tw [()-1453.5(C)0(an an academic health center \(AHC\) and local faith)]TJ 1.8 -1.401 TD 0.0375 Tw (leaders collaborate to develop a training curriculum)Tj T* -0.0031 Tc 0.09 Tw [(for spiritual caregivers that successfully integrates)]TJ 0 -1.398 TD -0.0034 Tc -0.0563 Tw (technical disaster/mental health content \(psychologi-)Tj 0 -1.401 TD -0.0033 Tc 0.1143 Tw (cal first aid principles and practices\) with spiritual)Tj T* -0.0034 Tc 0.1166 Tw (health values and perspectives?)Tj -1.8 -1.998 TD -0.0033 Tc -0.0556 Tw [()-1453.2(If so, can such an integrated curriculum be tailored to)]TJ 1.8 -1.401 TD 0.0417 Tw (fit the spiritual and cultural characteristics, learning)Tj T* -0.0032 Tc 0.0425 Tw (styles, and overall needs of populations in an urban)Tj 0 -1.398 TD -0.0039 Tc -0.0625 Tw [(area comprised of )53.1(African-American and Latino resi-)]TJ 0 -1.401 TD -0.0031 Tc 0.008 Tw (dents predominantly of the Christian faith?)Tj -1.8 -2.001 TD -0.0035 Tc -0.0016 Tw [()-1453.4(Can the training experience measurably enhance the)]TJ 1.8 -1.398 TD -0.0033 Tc -0.007 Tw (participants sense of preparedness and self-efficacy)Tj 0 -1.401 TD -0.0031 Tc -0.0472 Tw (in key competency domains intrinsic to disaster min-)Tj T* -0.0028 Tc -0.0228 Tw [(istry in general, and to PF)72.2(A)59.4( in particular?)]TJ -1.2 -1.998 TD -0.0035 Tc 0.095 Tw (An opportunity for answering these questions was af-)Tj -1.8 -1.401 TD 0.004 Tc 0.125 Tw (forded the authors in the form of a competitive Special)Tj T* -0.0036 Tc 0.048 Tw [(Projects grant from the state of Maryland)53.4(s Bio-T)65.4(errorism)]TJ 0 -1.398 TD 0.0842 Tw (Hospital Preparedness Program funded by the U.S. Health)Tj 0 -1.401 TD -0.0079 Tc -0.062 Tw [(Resources and Services )52.1(Administration \(HRSA; Romanosky)61.1(,)]TJ T* -0.0037 Tc -0.0507 Tw [(2005\). This grant program encouraged applicant institutions)]TJ 0 -1.398 TD -0.0082 Tc -0.0625 Tw (to collaborate with other organizations and community-based)Tj 0 -1.401 TD -0.0035 Tc 0.0344 Tw (preparedness resources in the state, and to develop projects)Tj T* -0.0033 Tc 0.0775 Tw (that were innovative and potentially portable to other geo-)Tj 0 -1.398 TD -0.0038 Tc 0.065 Tw (graphic regions.)Tj /F1 1 Tf 11 0 0 11 321 225.6 Tm -0.0059 Tc 0.0955 Tw (The Program)Tj /TT2 1 Tf 10 0 0 10 339 202.26 Tm -0.0034 Tc -0.035 Tw (The key elements of the program were the following.)Tj /TT5 1 Tf 11 0 0 11 321 168.96 Tm 0.0146 Tc 0.1259 Tw [(Partners and Management S)22.8(t)-0.2(ructur)33.7(es)]TJ /TT2 1 Tf 10 0 0 10 339 149.25 Tm -0.0039 Tc 0.0193 Tw [(The )50.1(AHC partners were )17.1(The Johns Hopkins University)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0443 Tw (School of Medicine [Department of Psychiatry and Behav-)Tj 0 -1.398 TD -0.0037 Tc -0.0423 Tw (ioral Sciences] acting on behalf of the Johns Hopkins Hospi-)Tj 0 -1.401 TD -0.0038 Tc 0.055 Tw (tal, the Johns Hopkins Bloomberg School of Public Health)Tj T* -0.0468 Tw ([the Center for Public Health Preparedness \(CPHP\)], and the)Tj 0 -1.398 TD -0.0035 Tc -0.0107 Tw (University of Maryland School of Medicine [Department of)Tj 0 -1.401 TD -0.0032 Tc 0.0856 Tw [(Psychiatry and Behavioral Sciences]. The FBO partners)]TJ ET endstream endobj 47 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 49 0 obj << /Length 8232 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0066 Tc 0 Tw (174 )Tj /TT3 1 Tf 2.0513 0 TD -0.0056 Tc 0.1312 Tw (McCabe Ivory Tower Meets House of Worship)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0038 Tc -0.0589 Tw [(were the )53.2(Archdiocese of Baltimore - Of)14.2(fice of Hispanic Min-)]TJ 0 -1.398 TD -0.022 Tc -0.0624 Tw [(istry)65(, the Cler)17(gy United for Renewal in East Baltimore \(CURE\),)]TJ 0 -1.401 TD -0.0032 Tc 0.0093 Tw [(and the Institute for Mental Health Ministry)62.8(, Inc.)]TJ 1.8 -2.001 TD -0.0039 Tc -0.039 Tw (Three principal mechanisms for project implementation)Tj -1.8 -1.398 TD -0.051 Tw (were established: a Partnership Steering Committee)Tj /TT5 1 Tf 20.244 0 TD -0.051 Tc 0 Tw ( )Tj /TT2 1 Tf 0.402 0 TD -0.0036 Tc -0.055 Tw (that ini-)Tj -20.646 -1.401 TD -0.0029 Tc -0.0518 Tw [(tially met monthly and subsequently bi-monthly; a Commu-)]TJ T* 0.0052 Tc 0.1248 Tw [(nity )56(Advisory Board, responsible for recruiting cler)14.2(gy to)]TJ 0 -1.398 TD -0.0033 Tc 0.1012 Tw (participate in scheduled training, which met on a monthly)Tj 0 -1.401 TD -0.0041 Tc 0.0009 Tw (schedule; and a Curriculum Development Committee, com-)Tj T* -0.0034 Tc -0.0306 Tw (posed of at least one representative from all partnering orga-)Tj 0 -1.398 TD -0.0233 Tw (nizations, which met on a weekly schedule and designed the)Tj 0 -1.401 TD -0.0038 Tc 0.0872 Tw (content of the Microsoft PowerPoint \(PPT\) slide presenta-)Tj T* -0.0014 Tc 0 Tw (tion.)Tj /TT5 1 Tf 11 0 0 11 54 520.95 Tm 0.0182 Tc 0.125 Tw (Goals and Objectives)Tj /TT2 1 Tf 10 0 0 10 72 501.24 Tm -0.0035 Tc 0.0645 Tw (The long-term goal of the program is to have a public)Tj -1.8 -1.398 TD -0.0031 Tc 0.1108 Tw (health infrastructure in Maryland that formally recognizes)Tj 0 -1.401 TD -0.0034 Tc -0.0407 Tw (specially-trained faith congregations as a vital component of)Tj T* -0.0036 Tc 0.11 Tw [(its continuum of disaster workforce responders. 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The intent was to have a program that would be a)]TJ T* -0.0065 Tc -0.0625 Tw (unique integration of spiritual and disaster mental health con-)Tj 0 -1.398 TD -0.0053 Tc -0.0624 Tw [(tent a jointly-developed, bi-cultural curriculum that could)]TJ 0 -1.401 TD -0.0036 Tc 0.0333 Tw (impart principles of what one of the authors \(JML\) termed,)Tj T* -0.0044 Tc -0.0623 Tw [(therapeutic spirituality)61.6(. Specifically)61.6(,)-0.1( the goal was to create)]TJ 0 -1.398 TD -0.0037 Tc 0.0862 Tw (an overarching model of trauma response that would tran-)Tj 0 -1.401 TD -0.0035 Tc 0.0618 Tw [(scend more secular approaches to crisis intervention. 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Moreover)38.4(, as part of)]TJ T* -0.0038 Tc -0.0193 Tw (the commitment to promote a customized, personalized cur-)Tj 0 -1.398 TD -0.003 Tc 0.0823 Tw [(riculum with which the cler)18(gy could identify)63(, faith leaders)]TJ 0 -1.401 TD -0.0034 Tc -0.0261 Tw (were given an opportunity to incorporate into the PPT slides)Tj T* -0.05 Tw (personally-chosen, disaster-relevant, scriptural passages and)Tj 0 -1.398 TD 0.0017 Tc 0.125 Tw (prayers, as well as their preferred religious images, local)Tj 0 -1.401 TD -0.0035 Tc -0.015 Tw [(church photographs, etc. )17.5(T)73.3(o)0( assure optimal value of the pro-)]TJ T* 0.0825 Tw [(gram for the Latino community)62.4(, Spanish-language transla-)]TJ 0 -1.398 TD 0.0117 Tc 0.125 Tw (tions of the 200-slide PPT program and of the program)Tj 0 -1.401 TD -0.0037 Tc -0.0233 Tw (evaluation forms were created.)Tj /TT5 1 Tf 11 0 0 11 309 283.35 Tm 0.0136 Tc 0.1251 Tw [(Curriculum T)49.1(raining Modules: Or)32.7(ganization and)]TJ 0 -1.1809 TD 0.0291 Tc 0 Tw (Content)Tj /TT2 1 Tf 10 0 0 10 327 250.65 Tm -0.0036 Tc 0.0363 Tw (The broad topics covered in the four training modules,)Tj -1.8 -1.401 TD -0.0033 Tc 0.0533 Tw (listed in the sequence in which they were presented during)Tj 0 -1.398 TD -0.0034 Tc 0.0059 Tw [(the seven-hour training day)59.6(, were as follows:)]TJ 1.2 -2.001 TD -0.0035 Tc 0.0934 Tw [()-1453.4(S)21.7(tress Reactions of Mind, Body & Spirit: a\) )50.8(Acute)]TJ 1.8 -1.401 TD -0.0039 Tc -0.0035 Tw (Stress; b\) Chronic/Cumulative Stress & Burnout; c\))Tj 0 -1.398 TD -0.0401 Tc 0 Tw (PTSD)Tj -1.8 -2.001 TD -0.0033 Tc 0.1249 Tw [()-1453.2(Psychological First )50.6(Aid and Crisis Intervention: a\))]TJ 1.8 -1.401 TD -0.0128 Tc -0.062 Tw (Incident Command System; b\) Individual Psychologi-)Tj 0 -1.398 TD -0.0036 Tc -0.0473 Tw [(cal First )50.6(Aid; c\) Lar)17.4(ge Group Psychological First )53.6(Aid)]TJ 0 -1.401 TD -0.0044 Tc -0.0125 Tw (and Congregational Communications)Tj ET endstream endobj 50 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 52 0 obj << /Length 8336 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (175)Tj /TT2 1 Tf 10 0 0 10 78 722.64 Tm -0.0035 Tc -0.0292 Tw [()-1453.4(Pastoral Care and Disaster Ministry: a\) Fundamental)]TJ 1.8 -1.398 TD -0.0033 Tc -0.0528 Tw [(Aspects of Disaster Ministry; b\) Differentiating Tra-)]TJ 0 -1.401 TD -0.0035 Tc 0.0121 Tw (ditional Pastoral Care and Disaster Pastoral Care; c\))Tj T* -0.004 Tc 0.085 Tw (Responses: Pastoral and Prophetic)Tj -1.8 -1.998 TD 0.028 Tc 0.125 Tw [()-1421.9(Self Care and Practical Resources for Spiritual)]TJ 1.8 -1.401 TD -0.0039 Tc -0.0175 Tw [(Caregivers: a\) Recognizing and Preventing Burnout)]TJ T* -0.0035 Tc -0.0193 Tw (in Oneself; b\) Self-Help Strategies; c\) Disaster Plan-)Tj 0 -1.398 TD -0.0038 Tc -0.0106 Tw [(ning and Resources for Families: )32.3(Y)103.4(ours and )17.3(Theirs.)]TJ -1.2 -2.001 TD -0.0043 Tc 0.0317 Tw [(T)72.5(opics subsumed under Individual PF)70.7(A were: dif)13.7(fer)16.7(-)]TJ -1.8 -1.401 TD 0.0098 Tc 0.125 Tw (entiating between normal and severe signs/symptoms of)Tj 0 -1.398 TD -0.0036 Tc 0.035 Tw (stress; making appropriate triage/referral decisions; provid-)Tj 0 -1.401 TD 0.0236 Tw (ing effective emotional support, spiritual guidance, and cri-)Tj T* 0.0041 Tc 0.125 Tw (sis communication; 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table-top exercises; and participation in role-playing sce-)Tj T* 0.001 Tc 0 Tw (narios.)Tj /TT5 1 Tf 11 0 0 11 66 329.34 Tm 0.0158 Tc 0.1259 Tw [(Educational Materials and Resour)29.4(ces)]TJ /TT2 1 Tf 10 0 0 10 84 309.66 Tm -0.0034 Tc 0.1071 Tw [(T)73.4(o)0( assure participants had tangible materials to retain)]TJ -1.8 -1.401 TD -0.0031 Tc 0.02 Tw [(and share with their parishes, family)62.9(, and friends, a disaster)]TJ T* -0.0038 Tc 0.0986 Tw [()15.9(T)65.2(ool Kit was assembled that incorporated a comprehen-)]TJ 0 -1.398 TD -0.0034 Tc -0.011 Tw (sive collection of practical resources, including:)Tj /TT1 1 Tf 18.936 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.24 0 TD -0.0043 Tc -0.015 Tw (hard copies)Tj -19.176 -1.401 TD -0.0092 Tc -0.0625 Tw (of the PPT slides from the training program; a bibliography of)Tj T* -0.0034 Tc 0.0793 Tw (generic disaster mental health literature references; lists of)Tj 0 -1.398 TD -0.0039 Tc 0.0325 Tw (all-hazards preparedness educational materials, including)Tj 0 -1.401 TD 0.0567 Tw (videos, posters and brochures [that addressed preparedness)Tj T* -0.004 Tc -0.0625 Tw (activities for fires, chemical emergencies, hurricanes, floods,)Tj 0 -1.398 TD -0.0033 Tc -0.0394 Tw (heat waves, winter storms, etc]; protocols for family disaster)Tj 0 -1.401 TD -0.0132 Tc -0.062 Tw (planning, including recommendations for assembling survival)Tj T* -0.0032 Tc 0.0781 Tw (kits, i.e., Go-Packs; copies of journal articles on pastoral)Tj 0 -1.398 TD -0.0033 Tc 0.0993 Tw (crisis intervention; and guidelines on loss-, grief-, and be-)Tj 0 -1.401 TD -0.0038 Tc 0.125 Tw (reavement support.)Tj /TT4 1 Tf 11 0 0 11 321 723.36 Tm 0.1386 Tc 0 Tw ( )Tj /TT5 1 Tf 0.7636 0 TD 0.0054 Tc 0.1256 Tw [(T)57(rainers and T)51.8(raining Sessions)]TJ 10 0 0 10 339 703.65 Tm -0.0039 Tc 0 Tw [(T)57.2(rainers: )]TJ /TT2 1 Tf 3.936 0 TD -0.0033 Tc -0.0016 Tw [(A)58.9( total of eight trainers were used in the two-)]TJ -5.736 -1.401 TD -0.0035 Tc -0.0121 Tw [(person teams, viz., two doctoral-level disaster mental health)]TJ 0 -1.398 TD -0.0037 Tc -0.0018 Tw [(experts and six members of the cler)17.3(g)-8.7(y)59.3(, one of whom was an)]TJ 0 -1.401 TD -0.0033 Tc 0.005 Tw (ordained minister and board-certified psychiatrist.)Tj /TT5 1 Tf 1.8 -2.001 TD 0.085 Tw [(T)57.8(raining sessions - format, venues, etc: )]TJ /TT2 1 Tf 16.65 0 TD -0.0039 Tc [(T)36.9(raining ses-)]TJ -18.45 -1.398 TD -0.004 Tc 0.0872 Tw (sions were conducted using a professional CME/CEU for-)Tj 0 -1.401 TD -0.0273 Tc -0.0623 Tw (mat, i.e., one-day in length [9 a.m. through 4 p.m.] with morning,)Tj T* 0.0227 Tc 0.125 Tw (lunch, and afternoon refreshment breaks. 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Having someone with knowl-)]TJ T* -0.0037 Tc 0.0525 Tw (edge of )Tj /TT5 1 Tf 3.3 0 TD -0.0056 Tc 0 Tw (both)Tj /TT2 1 Tf 1.761 0 TD -0.0033 Tc 0.0535 Tw [( the academic and faith community cultures is)]TJ -5.061 -1.398 TD -0.003 Tc 0.125 Tw (ideal, as that person can support partnership development)Tj 0 -1.401 TD -0.0028 Tc 0.035 Tw [(and strive for a mutually gratifying alliance. 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For example, faculty members acceded to the)]TJ 0 -1.401 TD -0.0036 Tc 0.0061 Tw (preference of faith leaders to have meetings of the Commu-)Tj T* -0.0033 Tc 0.0697 Tw [(nity )50.4(Advisory Board in the evenings; however)38.7(, faith mem-)]TJ 0 -1.398 TD -0.0038 Tc -0.0428 Tw (bers met on Hopkins time when the Partnership Steering and)Tj 0 -1.401 TD -0.004 Tc -0.0267 Tw [(Curriculum Development committees assembled. Other ex-)]TJ T* -0.0039 Tc -0.0464 Tw (amples of between-group osmotic influences of customs and)Tj 0 -1.398 TD -0.0031 Tc 0.0461 Tw (values were seen to occur over time, e.g., faculty members)Tj 0 -1.401 TD -0.0015 Tc 0.125 Tw (honored the wish of the clergy to begin and end all joint)Tj T* -0.003 Tc 0.0527 Tw [(meetings with prayer)36(, as partners prayed for the success of)]TJ 0 -1.398 TD -0.0031 Tc -0.0258 Tw [(the project. Correspondingly)62.9(, faith partners gradually appre-)]TJ 0 -1.401 TD -0.0033 Tc -0.0606 Tw [(ciated the importance of, and accommodated to, the faculty)50.7(s)]TJ T* -0.0034 Tc 0.0064 Tw (sensitivity to the fixed \(seven-month\) timetable for meeting)Tj 0 -1.398 TD -0.0036 Tc 0.0387 Tw (grant deliverables and reporting deadlines.)Tj ET 0.99 w 1000 M /GS1 gs 66.495 730.505 237.01 -304.01 re S endstream endobj 59 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 29 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 63 0 obj << /Length 8919 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0066 Tc 0 Tw (178 )Tj /TT3 1 Tf 2.0513 0 TD -0.0056 Tc 0.1312 Tw (McCabe Ivory Tower Meets House of Worship)Tj /TT5 1 Tf 11 0 0 11 54 723.36 Tm 0.0089 Tc 0.125 Tw [(Cler)30.7(gy Outr)33.4(each and T)49.8(rainee Recr)-4.7(uitment)]TJ /TT2 1 Tf 10 0 0 10 72 703.65 Tm -0.0035 Tc 0.0086 Tw (Although the project originally was designed for mem-)Tj -1.8 -1.401 TD 0.0002 Tc 0.125 Tw (bers of disadvantaged, urban minority populations, mem-)Tj 0 -1.398 TD 0.0115 Tc (bers of other spiritual communities throughout the state)Tj 0 -1.401 TD 0.0025 Tc (learned of, requested, and were granted opportunities for)Tj T* -0.0034 Tc -0.0372 Tw [(training. Such groups included two academically accredited)]TJ 0 -1.398 TD 0.0033 Tc 0.125 Tw (pastoral counseling programs and a professional associa-)Tj 0 -1.401 TD -0.0034 Tc 0.0435 Tw [(tion for parish nurses. Because of the eager response from)]TJ T* -0.004 Tc -0.0621 Tw [(the faith community)68(, little ef)20(fort was required to recruit train-)]TJ 0 -1.398 TD -0.0035 Tc -0.0461 Tw [(ees after the initial program promotion efforts. The numbers)]TJ 0 -1.401 TD -0.0037 Tc 0.0793 Tw (of faith communities responding for training represented a)Tj T* -0.02 Tw (wide spectrum of religious denominations and affiliations.)Tj /TT5 1 Tf 11 0 0 11 54 530.34 Tm 0.0112 Tc 0.125 Tw (Curriculum Customization Issues)Tj /TT2 1 Tf 10 0 0 10 72 510.66 Tm -0.0075 Tc -0.0621 Tw (Because members of the Christian faith were over-repre-)Tj -1.8 -1.401 TD -0.0036 Tc -0.0375 Tw (sented in the targeted geographic area surrounding the Johns)Tj T* -0.0054 Tc -0.0625 Tw (Hopkins Hospital, efforts to embed the disaster mental health)Tj 0 -1.398 TD -0.0032 Tc 0.1145 Tw (content in a spiritual context incorporated the use of only)Tj 0 -1.401 TD -0.0016 Tc 0.125 Tw (Christian scripture and images into the PowerPoint slides)Tj T* -0.0038 Tc -0.0189 Tw [(and )14.3(T)73(ool Kit content. On those occasions when members of)]TJ 0 -1.398 TD -0.0033 Tc 0.0028 Tw (other faiths participated in the training sessions, the level of)Tj 0 -1.401 TD -0.0038 Tc 0.0519 Tw [(satisfaction with the training was compromised despite)]TJ T* -0.0035 Tc -0.001 Tw (considerable effort devoted immediately before mixed-faith)Tj 0 -1.398 TD -0.0033 Tc 0.0019 Tw (training sessions to explain the single-faith emphasis by de-)Tj 0 -1.401 TD 0.0821 Tw [(scribing the original rationale for focusing on Christianity)59.7(.)]TJ T* -0.0038 Tc 0.065 Tw (Thus, prospective designers of similar programs elsewhere)Tj 0 -1.398 TD -0.0003 Tc 0.125 Tw (have three basic options for avoiding such problems: use)Tj 0 -1.401 TD 0.0072 Tc (professional experts to conduct pure \(without spiritual)Tj T* -0.0036 Tc 0.0333 Tw (content\) disaster mental health trainings; create customized)Tj 0 -1.398 TD -0.0029 Tc 0.125 Tw (trainings with faith-/denomination-specific content; or de-)Tj 0 -1.401 TD -0.0074 Tc -0.0625 Tw (velop a chaplaincy model of training an approach that could)Tj T* -0.003 Tc -0.0121 Tw (be experienced as too spiritually diluted, generic, etc.)Tj /TT5 1 Tf 11 0 0 11 54 239.34 Tm 0.0128 Tc 0.1264 Tw [(Car)31.9(egiver )13.4(Appr)29.2(eciation for Mini-Disaster)]TJ 0 -1.1809 TD 0.0183 Tc 0.1273 Tw (Crisis-Management Skills)Tj /TT2 1 Tf 10 0 0 10 72 206.64 Tm -0.0035 Tc 0.0264 Tw (Participants were effusive in their expressions of inter-)Tj -1.8 -1.398 TD -0.0032 Tc 0.0175 Tw (est in and gratitude for the kind of information conveyed in)Tj 0 -1.401 TD -0.003 Tc -0.0539 Tw [(the trainings. Especially appreciated were the efforts to )]TJ /TT5 1 Tf 21.885 0 TD -0.0044 Tc 0 Tw (inte-)Tj -21.885 -1.401 TD (grate )Tj /TT2 1 Tf 2.439 0 TD -0.0035 Tc 0.1 Tw (the technical disaster mental health content with the)Tj -2.439 -1.398 TD -0.0152 Tc -0.0625 Tw [(spiritual. Interestingly)65.8(, despite all trainees being acutely aware)]TJ 0 -1.401 TD -0.0032 Tc 0.0621 Tw [(of terrorist events on )50.7(American soil within recent years, as)]TJ T* -0.0033 Tc 0.0228 Tw (well as major weather events that affected many citizens of)Tj 0 -1.398 TD -0.0071 Tc -0.0621 Tw (our country \(particularly Hurricane Isabel, locally\), most par-)Tj 0 -1.401 TD -0.0035 Tc -0.0513 Tw (ticipants valued the learning experience as much for applica-)Tj 25.5 62.799 TD -0.0344 Tw (tion to their immediate, concrete needs in pastoral ministries)Tj 0 -1.398 TD -0.0038 Tc -0.0619 Tw [(\(or)35.2(, as one trainee of)17.2(fered, for my everyday )]TJ /TT5 1 Tf 17.454 0 TD -0.006 Tc 0 Tw (mini-disasters)Tj /TT2 1 Tf 5.592 0 TD -0.012 Tc (\))Tj -23.046 -1.401 TD -0.0013 Tc 0.125 Tw [(as for its value in true public disaster contexts which, no)]TJ T* -0.0037 Tc 0.016 Tw (doubt, seemed more remote and abstract.)Tj /TT5 1 Tf 11 0 0 11 309 647.34 Tm 0.0047 Tc 0.1251 Tw [(Pr)32(ogram Limitations and Futur)34.7(e Dir)32(ections)]TJ /TT2 1 Tf 10 0 0 10 327 627.66 Tm 0.0017 Tc 0.125 Tw (The open-ended questions in the evaluation form, as)Tj -1.8 -1.401 TD -0.0036 Tc 0.04 Tw (well as direct conversations with participants following the)Tj T* -0.0034 Tc 0.0625 Tw (training sessions, yielded information that disclosed unmet)Tj 0 -1.398 TD -0.0037 Tc 0.0061 Tw (needs and guidelines for future work with the faith commu-)Tj 0 -1.401 TD -0.0034 Tc 0.0411 Tw [(nity)59.6(. )17.6(This input emphasized the wish for: opportunities for)]TJ T* -0.0037 Tc -0.0006 Tw [(more advanced training in PF)71.3(A; specialized training in loss/)]TJ 0 -1.398 TD -0.0044 Tc -0.062 Tw [(grief/bereavement support; guidance in developing concrete,)]TJ 0 -1.401 TD -0.0033 Tc -0.0471 Tw (practical, community disaster plans \(and for community em-)Tj T* -0.0036 Tc 0.0165 Tw (powerment in general\); and clarification of specific respon-)Tj 0 -1.398 TD 0.0125 Tw (dent roles under various disaster and activation/deployment)Tj 0 -1.401 TD 0.0088 Tc 0 Tw (scenarios.)Tj 1.8 -2.001 TD -0.003 Tc 0.125 Tw (In conclusion, the above-described program seems to)Tj -1.8 -1.398 TD -0.0033 Tc 0.0363 Tw (be a practical and eminently portable model for actualizing)Tj 0 -1.401 TD -0.0029 Tc 0.0344 Tw (the latent but typically unrealized potential for disaster ser-)Tj T* -0.0063 Tc -0.0621 Tw (vices inherent in the already established relationship between)Tj 0 -1.398 TD -0.0025 Tc 0.125 Tw (vulnerable urban populations and faith leaders \(and prob-)Tj 0 -1.401 TD -0.0061 Tc -0.0622 Tw (ably rural residents for whom access to disaster mental health)Tj T* -0.0193 Tc -0.0623 Tw [(experts is limited\). By advancing and implementing this model)]TJ 0 -1.398 TD -0.003 Tc 0.0405 Tw (of training on a broader scale, the faith community may be)Tj 0 -1.401 TD -0.0032 Tc -0.05 Tw (able to realize its full potential of being an indigenous, effec-)Tj T* -0.0034 Tc 0.0894 Tw (tive, and durable resource for victims of large-scale disas-)Tj 0 -1.398 TD 0.0618 Tw (ters, with benefits accruing both to individual recipients of)Tj 0 -1.401 TD -0.0032 Tc -0.005 Tw (direct psycho-spiritual services and to leaders of health care)Tj T* -0.0036 Tc -0.058 Tw (facilities who are struggling with the problem of how to cope)Tj 0 -1.398 TD -0.0037 Tc -0.015 Tw (with disaster-driven surges in service demand under various)Tj 0 -1.401 TD -0.0033 Tc 0.114 Tw (hazard circumstances, particularly when front-line clinical)Tj T* -0.0028 Tc -0.0075 Tw (staffing may be significantly reduced.)Tj /F1 1 Tf 11 0 0 11 388.89 225 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 309 207.66 Tm -0.0339 Tc -0.0622 Tw [(Balicer)41.1(, R.D., Omer)38.1(, S.B., Barnett, D.J., & Everly)59.1(, G)122.1(.S., Jr)53.1(. \(2006\).)]TJ 1.2 -1.401 TD -0.0052 Tc -0.0625 Tw (Local public health workers perceptions toward respond-)Tj T* -0.0027 Tc 0.125 Tw (ing to an influenza pandemic. )Tj /TT5 1 Tf 12.654 0 TD -0.003 Tc (International Journal of)Tj -12.654 -1.398 TD -0.0044 Tc 0.0025 Tw (Emergency Mental Health)Tj /TT2 1 Tf 10.461 0 TD 0.001 Tc 0 Tw (, )Tj /TT5 1 Tf 0.498 0 TD 0 Tc (6)Tj /TT2 1 Tf 0.495 0 TD -0.0023 Tc 0.0051 Tw (, 99.)Tj -12.654 -1.8 TD -0.0127 Tc -0.115 Tw [(Bandura, A)55.5( )-53.1(\(1997\). )]TJ /TT5 1 Tf 7.5 0 TD -0.0124 Tc -0.0613 Tw [(Self-efficacy: The exer)32.6(cise of contr)32.6(ol.)]TJ /TT2 1 Tf 14.175 0 TD -0.0161 Tc -0.065 Tw [( New)]TJ -20.475 -1.401 TD -0.0104 Tc -0.0618 Tw [(Y)102.8(ork: )13.8(W)102.5(.)-0.2( H Freeman & Co.)]TJ -1.2 -1.8 TD -0.003 Tc -0.0611 Tw [(Bradfield, C., )18.2(W)76.8(ylie, M.L., Echterling, L.G)117(. \(1989\). )51.2(After the)]TJ 1.2 -1.401 TD -0.0035 Tc 0.0793 Tw [(flood: )14.4(The response of ministers to natural disaster)50.5(. )]TJ /TT5 1 Tf 21.18 0 TD -0.0065 Tc 0 Tw (So-)Tj -21.18 -1.398 TD -0.004 Tc -0.015 Tw (ciological Analysis)Tj /TT2 1 Tf 7.551 0 TD 0 Tc 0 Tw (, )Tj /TT5 1 Tf 0.48 0 TD -0.01 Tc (49)Tj /TT2 1 Tf 0.99 0 TD -0.0038 Tc -0.02 Tw (, 397-407.)Tj ET endstream endobj 64 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 66 0 obj << /Length 12051 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (179)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.014 Tc -0.0622 Tw [(Dougall, )52(A.L., Hayward, M.C., & Baum, )52(A. \(2005\). 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Principles and practical pro-)]TJ 1.2 -1.401 TD -0.0031 Tc 0.01 Tw (cedures for acute psychological first aid training for per-)Tj 0 -1.398 TD -0.0013 Tc 0.125 Tw (sonnel without mental health experience. )Tj /TT5 1 Tf 17.241 0 TD -0.0015 Tc 0 Tw (International)Tj -17.241 -1.401 TD -0.0041 Tc -0.03 Tw (Journal of Emergency Mental Health)Tj /TT2 1 Tf 14.685 0 TD 0.001 Tc 0 Tw (, )Tj /TT5 1 Tf 0.471 0 TD 0 Tc (8)Tj /TT2 1 Tf 0.495 0 TD -0.0036 Tc -0.035 Tw (\(2\), 93-100.)Tj -16.851 -1.8 TD -0.0037 Tc 0.0823 Tw [(Foy)59.3(, D.W)86.3(. \(1992\). )]TJ /TT5 1 Tf 7.68 0 TD -0.0042 Tc 0.0835 Tw [(T)57(r)34(eating post-traumatic str)31.8(ess disor)28.8(der:)]TJ -6.48 -1.401 TD -0.004 Tc -0.01 Tw (Cognitive-behavioral strategies)Tj /TT2 1 Tf 12.561 0 TD -0.0038 Tc -0.0131 Tw [(. New )32.4(Y)103.4(ork: Guilford.)]TJ -13.761 -1.8 TD -0.0157 Tc -0.0622 Tw [(Galea, S., )50.3(Ahern, J., Resnick, H., Kilpatrick, D. Bucuvalas, M.,)]TJ 1.2 -1.398 TD -0.0044 Tc [(Gold, J., )16.9(Vlahov)64.6(, D. \(2002\). Psychological sequelae of the)]TJ 0 -1.401 TD -0.0035 Tc -0.0506 Tw [(September 1)29.5(1)0( terrorist attacks in New )32.6(Y)103.7(ork City)59.5(.)]TJ /TT5 1 Tf 18.915 0 TD -0.0045 Tc -0.0525 Tw [( New En-)]TJ -18.915 -1.401 TD -0.0039 Tc -0.0299 Tw (gland Journal of Medicine, 346)Tj /TT2 1 Tf 12.405 0 TD (\(13\), 982-987.)Tj -13.605 -1.8 TD -0.0032 Tc 0.025 Tw [(Golan, E., )53.8(Arad, M., )50.8(Atsmon, J., Shemer)38.8(, J., & Nehema, H.)]TJ 1.2 -1.398 TD -0.0109 Tc -0.0625 Tw (\(1992\). Medical limitations of gas masks for civilian popu-)Tj 0 -1.401 TD -0.0036 Tc 0.0467 Tw (lations: the 1991 experience.)Tj /TT5 1 Tf 11.535 0 TD -0.0037 Tc 0.0483 Tw [( Military Medicine, 157)]TJ /TT2 1 Tf 9.561 0 TD -0.004 Tc 0 Tw (\(9\),)Tj -21.096 -1.401 TD -0.0232 Tc -0.0625 Tw (444-444. Cited in IOM, 2003)Tj /TT5 1 Tf 10.851 0 TD 0 Tc 0 Tw (.)Tj /TT2 1 Tf -12.051 -1.8 TD -0.0035 Tc 0.0275 Tw (Institute of Medicine \(2003\). )Tj /TT5 1 Tf 11.811 0 TD -0.004 Tc 0.0284 Tw (Preparing for the psychologi-)Tj -10.611 -1.398 TD -0.0037 Tc 0.0479 Tw [(cal consequences of terr)34.5(orism: )17.3(A)22.1( public health strategy)]TJ /TT2 1 Tf 22.251 0 TD 0 Tc 0 Tw (.)Tj -22.251 -1.401 TD -0.0038 Tc -0.0032 Tw [(W)94(ashington, DC: )17.3(The National )50.3(Academy of Sciences.)]TJ -1.2 -1.8 TD -0.0032 Tc -0.0571 Tw (Kawana, N., Ishimatsu, S., Kanda, K. \(2001\). )Tj /TT5 1 Tf 17.901 0 TD -0.0043 Tc -0.06 Tw (Military Medi-)Tj -16.701 -1.401 TD -0.0116 Tc 0 Tw (cine.)Tj /TT2 1 Tf 1.86 0 TD 0 Tc ( )Tj /TT5 1 Tf 0.18 0 TD -0.015 Tc (166)Tj /TT2 1 Tf 1.461 0 TD -0.0121 Tc -0.0625 Tw [(\(12\), 23-26. Cited in IOM, 2003.)]TJ -4.701 -1.8 TD -0.0037 Tc 0.0467 Tw [(Koenig, H.G)116.3(. \(2006\). )]TJ /TT5 1 Tf 8.754 0 TD -0.0035 Tc [(In the wake of disaster: Religious r)32.5(e)2.4(-)]TJ -7.554 -1.398 TD 0.0161 Tc 0.125 Tw [(sponses to terrorism and catastrophe)]TJ /TT2 1 Tf 16.365 0 TD 0.0167 Tc (. Philadelphia:)Tj -16.365 -1.401 TD -0.0041 Tc 0.065 Tw [(T)72.7(empleton Foundation Press.)]TJ -1.2 -1.8 TD -0.0325 Tc -0.0625 Tw [(Larson, D.B., Hohmann, L.G)117.5(., Kessler)36.5(, K.G)117.5(., Meador)36.5(, J.H., Boyd,)]TJ 1.2 -1.401 TD -0.0077 Tc -0.0624 Tw [(J.H., & McSherry)61.3(, E. \(1988\). )13.4(The couch and the cloth: the)]TJ 0 -1.398 TD -0.0034 Tc -0.0533 Tw (need for linkage. )Tj /TT5 1 Tf 6.78 0 TD -0.0042 Tc (Hospital and Community Psychiatry)Tj /TT2 1 Tf 14.286 0 TD -0.001 Tc 0 Tw (, )Tj /TT5 1 Tf 0.444 0 TD -0.01 Tc (39)Tj /TT2 1 Tf -21.51 -1.401 TD -0.0423 Tc (\(10\))Tj /TT5 1 Tf 1.506 0 TD 0 Tc (,)Tj /TT2 1 Tf 0.21 0 TD -0.0414 Tc -0.06 Tw [( 1064-1069.)]TJ -2.916 -1.8 TD -0.0029 Tc -0.0362 Tw [(McCabe, O.L,, Siegel, E.R., Heitt, M.C., & Kaminsky)63.1(, M.J.,)]TJ 1.2 -1.401 TD -0.0032 Tc -0.0427 Tw [(\(2004\). 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Disaster)]TJ 1.2 -1.401 TD -0.0034 Tc 0.0407 Tw (victims speak, Part II: Summary and implications of the)Tj T* -0.0046 Tc -0.06 Tw (health research. )Tj /TT5 1 Tf 6.324 0 TD -0.0063 Tc -0.0587 Tw [(Psychiatr)-6.3(y)56.5(,)-1.3( 65)]TJ /TT2 1 Tf 5.586 0 TD -0.0058 Tc -0.065 Tw (\(3\), 240-260.)Tj -13.11 -1.8 TD -0.0054 Tc -0.0625 Tw (North, C.S., Nixon, S.J., Shariot, S., Mallonee, S., McMillen,)Tj 1.2 -1.398 TD -0.003 Tc -0.0157 Tw (J.C., Spitznagle, E.L., & Smith, E.M. \(1999\). 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314.118 c 440.025 315.119 439.252 315.39 438.479 315.39 c 436.303 315.39 l 436.303 310.658 l 436.939 310.658 l 436.939 312.688 l h 436.939 314.843 m 438.525 314.843 l 438.839 314.843 439.37 314.783 439.37 314.052 c 439.37 313.353 438.879 313.235 438.414 313.235 c 436.939 313.235 l 436.939 314.843 l f* 440.903 310.657 0.636 4.733 re f* 442.162 314.823 m 443.754 314.823 l 443.754 310.657 l 444.39 310.657 l 444.39 314.823 l 445.982 314.823 l 445.982 315.39 l 442.162 315.39 l 442.162 314.823 l f* 446.545 310.657 0.636 4.733 re f* 452.128 313.966 m 452.037 314.757 451.408 315.515 450.195 315.515 c 448.826 315.515 448 314.507 448 313.05 c 448 311.231 449.049 310.532 450.117 310.532 c 450.471 310.532 451.912 310.611 452.174 312.398 c 451.558 312.398 l 451.342 311.297 450.628 311.099 450.215 311.099 c 449.049 311.099 448.655 311.956 448.655 313.07 c 448.655 314.315 449.344 314.948 450.195 314.948 c 450.647 314.948 451.336 314.796 451.513 313.966 c 452.128 313.966 l f* 455.418 312.035 m 455.883 310.657 l 456.578 310.657 l 454.874 315.39 l 454.153 315.39 l 452.384 310.657 l 453.039 310.657 l 453.531 312.035 l 455.418 312.035 l h 453.727 312.602 m 454.481 314.684 l 454.494 314.684 l 455.188 312.602 l 453.727 312.602 l f* 457.659 315.39 m 457.023 315.39 l 457.023 310.658 l 460.044 310.658 l 460.044 311.225 l 457.659 311.225 l 457.659 315.39 l f* 431.219 302.731 0.636 4.733 re f* 436.002 303.642 m 435.989 303.642 l 433.636 307.464 l 432.883 307.464 l 432.883 302.732 l 433.499 302.732 l 433.499 306.555 l 433.512 306.555 l 435.904 302.732 l 436.618 302.732 l 436.618 307.464 l 436.002 307.464 l 436.002 303.642 l f* 441.382 306.041 m 441.29 306.832 440.661 307.589 439.449 307.589 c 438.079 307.589 437.254 306.581 437.254 305.125 c 437.254 303.306 438.302 302.606 439.37 302.606 c 439.724 302.606 441.166 302.685 441.428 304.472 c 440.812 304.472 l 440.596 303.372 439.881 303.174 439.469 303.174 c 438.302 303.174 437.909 304.031 437.909 305.144 c 437.909 306.39 438.597 307.023 439.449 307.023 c 439.901 307.023 440.589 306.871 440.766 306.041 c 441.382 306.041 l f* 442.142 302.731 0.636 4.733 re f* 443.839 302.732 m 445.72 302.732 l 447.266 302.732 447.725 304.103 447.725 305.164 c 447.725 306.528 446.971 307.464 445.746 307.464 c 443.839 307.464 l 443.839 302.732 l h 444.475 306.917 m 445.661 306.917 l 446.526 306.917 447.07 306.318 447.07 305.125 c 447.07 303.932 446.532 303.279 445.707 303.279 c 444.475 303.279 l 444.475 306.917 l f* 451.925 303.299 m 449.088 303.299 l 449.088 304.881 l 451.663 304.881 l 451.663 305.447 l 449.088 305.447 l 449.088 306.897 l 451.879 306.897 l 451.879 307.464 l 448.452 307.464 l 448.452 302.732 l 451.925 302.732 l 451.925 303.299 l f* 455.739 303.642 m 455.726 303.642 l 453.373 307.464 l 452.62 307.464 l 452.62 302.732 l 453.236 302.732 l 453.236 306.555 l 453.249 306.555 l 455.641 302.732 l 456.355 302.732 l 456.355 307.464 l 455.739 307.464 l 455.739 303.642 l f* 456.794 306.897 m 458.386 306.897 l 458.386 302.731 l 459.022 302.731 l 459.022 306.897 l 460.614 306.897 l 460.614 307.464 l 456.794 307.464 l 456.794 306.897 l f* 436.837 298.155 m 436.811 298.675 436.647 299.664 435.003 299.664 c 433.862 299.664 433.384 298.939 433.384 298.201 c 433.384 297.377 434.079 297.16 434.387 297.087 c 435.35 296.863 l 436.123 296.679 436.352 296.52 436.352 296.026 c 436.352 295.347 435.579 295.229 435.121 295.229 c 434.518 295.229 433.823 295.479 433.823 296.336 c 433.227 296.336 l 433.227 295.894 433.305 295.499 433.705 295.136 c 433.915 294.945 434.256 294.681 435.127 294.681 c 435.933 294.681 436.968 294.991 436.968 296.112 c 436.968 296.863 436.51 297.232 435.9 297.377 c 434.557 297.687 l 434.282 297.753 434 297.885 434 298.287 c 434 299.005 434.675 299.117 435.075 299.117 c 435.606 299.117 436.208 298.886 436.241 298.155 c 436.837 298.155 l f* 437.231 298.972 m 438.823 298.972 l 438.823 294.806 l 439.458 294.806 l 439.458 298.972 l 441.051 298.972 l 441.051 299.539 l 437.231 299.539 l 437.231 298.972 l f* 442.23 296.837 m 443.77 296.837 l 444.53 296.837 444.609 296.382 444.609 295.993 c 444.609 295.815 444.629 295.097 444.72 294.807 c 445.5 294.807 l 445.5 294.912 l 445.304 295.024 445.271 295.123 445.264 295.387 c 445.225 296.244 l 445.199 296.903 444.93 297.021 444.661 297.133 c 444.963 297.311 445.317 297.568 445.317 298.267 c 445.317 299.268 444.543 299.539 443.77 299.539 c 441.595 299.539 l 441.595 294.807 l 442.23 294.807 l 442.23 296.837 l h 442.23 298.992 m 443.816 298.992 l 444.131 298.992 444.661 298.932 444.661 298.201 c 444.661 297.502 444.17 297.384 443.705 297.384 c 442.23 297.384 l 442.23 298.992 l f* 449.635 295.374 m 446.798 295.374 l 446.798 296.955 l 449.373 296.955 l 449.373 297.522 l 446.798 297.522 l 446.798 298.972 l 449.589 298.972 l 449.589 299.539 l 446.162 299.539 l 446.162 294.807 l 449.635 294.807 l 449.635 295.374 l f* 453.763 298.155 m 453.737 298.675 453.573 299.664 451.928 299.664 c 450.788 299.664 450.31 298.939 450.31 298.201 c 450.31 297.377 451.005 297.16 451.313 297.087 c 452.276 296.863 l 453.049 296.679 453.278 296.52 453.278 296.026 c 453.278 295.347 452.505 295.229 452.046 295.229 c 451.443 295.229 450.749 295.479 450.749 296.336 c 450.153 296.336 l 450.153 295.894 450.231 295.499 450.631 295.136 c 450.841 294.945 451.182 294.681 452.053 294.681 c 452.859 294.681 453.895 294.991 453.895 296.112 c 453.895 296.863 453.436 297.232 452.826 297.377 c 451.483 297.687 l 451.208 297.753 450.926 297.885 450.926 298.287 c 450.926 299.005 451.601 299.117 452.001 299.117 c 452.531 299.117 453.134 298.886 453.167 298.155 c 453.763 298.155 l f* 457.997 298.155 m 457.97 298.675 457.806 299.664 456.162 299.664 c 455.021 299.664 454.543 298.939 454.543 298.201 c 454.543 297.377 455.238 297.16 455.546 297.087 c 456.509 296.863 l 457.282 296.679 457.511 296.52 457.511 296.026 c 457.511 295.347 456.738 295.229 456.28 295.229 c 455.677 295.229 454.982 295.479 454.982 296.336 c 454.386 296.336 l 454.386 295.894 454.465 295.499 454.864 295.136 c 455.074 294.945 455.415 294.681 456.286 294.681 c 457.092 294.681 458.128 294.991 458.128 296.112 c 458.128 296.863 457.669 297.232 457.06 297.377 c 455.716 297.687 l 455.441 297.753 455.159 297.885 455.159 298.287 c 455.159 299.005 455.834 299.117 456.234 299.117 c 456.765 299.117 457.367 298.886 457.4 298.155 c 457.997 298.155 l f* 426.346 289.03 m 428.653 289.03 l 428.653 289.597 l 426.346 289.597 l 426.346 291.046 l 428.968 291.046 l 428.968 291.613 l 425.711 291.613 l 425.711 286.88 l 426.346 286.88 l 426.346 289.03 l f* 433.214 289.247 m 433.214 288.134 432.598 287.323 431.576 287.323 c 430.553 287.323 429.937 288.134 429.937 289.247 c 429.937 290.361 430.553 291.172 431.576 291.172 c 432.598 291.172 433.214 290.361 433.214 289.247 c h 433.869 289.247 m 433.869 290.269 433.332 291.738 431.576 291.738 c 429.819 291.738 429.282 290.269 429.282 289.247 c 429.282 288.226 429.819 286.755 431.576 286.755 c 433.332 286.755 433.869 288.226 433.869 289.247 c f* 437.552 291.613 m 437.552 288.621 l 437.552 287.593 436.896 287.323 436.313 287.323 c 435.743 287.323 435.121 287.607 435.121 288.635 c 435.121 291.613 l 434.485 291.613 l 434.485 288.457 l 434.485 287.573 435.029 286.755 436.294 286.755 c 437.584 286.755 438.187 287.573 438.187 288.542 c 438.187 291.613 l 437.552 291.613 l f* 442.165 287.791 m 442.152 287.791 l 439.799 291.613 l 439.046 291.613 l 439.046 286.882 l 439.662 286.882 l 439.662 290.704 l 439.675 290.704 l 442.067 286.882 l 442.781 286.882 l 442.781 291.613 l 442.165 291.613 l 442.165 287.791 l f* 443.659 286.882 m 445.54 286.882 l 447.086 286.882 447.545 288.252 447.545 289.313 c 447.545 290.677 446.791 291.613 445.566 291.613 c 443.659 291.613 l 443.659 286.882 l h 444.295 291.066 m 445.481 291.066 l 446.345 291.066 446.889 290.467 446.889 289.273 c 446.889 288.081 446.352 287.429 445.526 287.429 c 444.295 287.429 l 444.295 291.066 l f* 450.572 288.259 m 451.037 286.88 l 451.732 286.88 l 450.028 291.613 l 449.308 291.613 l 447.538 286.88 l 448.194 286.88 l 448.685 288.259 l 450.572 288.259 l h 448.882 288.826 m 449.635 290.908 l 449.648 290.908 l 450.343 288.826 l 448.882 288.826 l f* 450.985 291.046 m 452.577 291.046 l 452.577 286.88 l 453.213 286.88 l 453.213 291.046 l 454.805 291.046 l 454.805 291.613 l 450.985 291.613 l 450.985 291.046 l f* 455.369 286.88 0.636 4.733 re f* 460.722 289.247 m 460.722 288.134 460.106 287.323 459.084 287.323 c 458.062 287.323 457.446 288.134 457.446 289.247 c 457.446 290.361 458.062 291.172 459.084 291.172 c 460.106 291.172 460.722 290.361 460.722 289.247 c h 461.377 289.247 m 461.377 290.269 460.84 291.738 459.084 291.738 c 457.328 291.738 456.791 290.269 456.791 289.247 c 456.791 288.226 457.328 286.755 459.084 286.755 c 460.84 286.755 461.377 288.226 461.377 289.247 c f* 465.093 287.791 m 465.08 287.791 l 462.727 291.613 l 461.974 291.613 l 461.974 286.882 l 462.59 286.882 l 462.59 290.704 l 462.603 290.704 l 464.995 286.882 l 465.709 286.882 l 465.709 291.613 l 465.093 291.613 l 465.093 287.791 l f* q 0.9972 0 0 1.0028 0 0 cm 0.333 w 2.613 M 445.193 354.411 m 448.542 354.411 l 448.541 350.977 l 451.311 352.784 l 452.909 350.182 l 449.943 348.455 l 452.931 346.762 l 451.395 344.096 l 448.52 345.763 l 448.52 342.259 l 445.207 342.259 l 445.205 345.685 l 442.272 343.995 l 440.736 346.779 l 443.637 348.432 l 440.682 350.162 l 442.214 352.748 l 445.193 350.976 l 445.193 354.411 l b* Q 0 0 0 0 k 445.971 353.905 m 445.575 354.608 445.23 353.895 y 445.563 344.887 l 445.69 344.634 445.743 344.911 y 445.971 353.905 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.605 350.037 m 446.378 350.179 446.272 350.301 y 445.695 350.918 445.683 351.391 y 445.667 351.805 445.811 352.043 y 445.928 352.299 446.296 352.434 y 446.513 352.519 446.544 352.496 y 446.833 352.492 446.974 352.259 y 447.443 351.923 446.832 351.933 y 446.542 351.976 446.457 352.039 y 446.097 351.943 446.169 351.411 y 446.241 351.095 446.432 350.75 446.584 350.67 c 446.605 350.037 l b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.831 352.236 m 446.784 352.242 446.734 352.221 446.691 352.243 c 446.671 352.253 446.663 352.278 446.67 352.295 c 446.676 352.308 446.708 352.329 446.729 352.321 c 446.774 352.305 446.784 352.25 446.831 352.236 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.801 345.715 m 446.829 345.881 446.909 346.007 v 446.978 346.116 447.037 346.173 447.151 346.294 c 447.215 346.362 447.305 346.487 447.37 346.565 c 447.592 346.845 447.407 347.146 v 447.321 347.275 447.093 347.475 v 447.097 346.86 l 447.095 346.715 446.704 346.27 y 446.606 346.147 446.557 346.087 446.51 345.736 c 446.472 345.332 446.803 344.902 v 446.783 345.552 l 446.788 345.661 446.801 345.715 v b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 447.161 349.649 m 447.195 349.545 446.654 348.979 y 446.607 348.925 446.552 348.864 446.49 348.795 c 446.151 348.428 446.168 348.123 v 446.186 347.7 446.6 347.301 v 446.651 347.259 446.721 347.184 v 446.703 347.765 l 446.658 347.819 446.607 347.904 446.565 348.033 c 446.52 348.125 446.644 348.32 v 446.861 348.519 447.566 349.354 v 447.77 349.703 447.609 349.932 v 447.453 350.162 447.178 350.343 v 447.161 349.649 l b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 447.025 344.618 m 447.045 344.544 447.035 344.451 446.944 344.347 c 446.747 344.066 l 446.968 344.159 447.073 344.291 v 447.204 344.42 447.173 344.659 v 447.15 344.773 447.037 344.956 v 447.025 344.618 l b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 447.337 257.745 m 447.493 257.791 447.611 257.698 447.767 257.791 c 448.079 257.93 448.352 258.023 448.626 258.255 c 448.821 258.393 448.938 258.625 449.134 258.81 c 449.212 258.857 449.338 258.86 449.368 258.718 c 449.407 258.533 449.524 258.486 449.641 258.44 c 450.227 258.208 450.813 258.348 451.398 258.441 c 452.063 258.533 452.531 259.135 453.156 259.413 c 453.468 259.599 453.704 259.954 454.015 260.016 c 454.249 260.062 454.522 260.062 454.717 260.247 c 454.835 260.34 454.796 260.479 v 455.225 260.526 455.538 260.85 455.811 261.221 c 455.889 261.267 456.006 261.359 456.123 261.313 c 456.084 261.313 l 458.974 264.973 l 458.934 265.066 l 458.895 265.204 458.973 265.344 458.895 265.482 c 450.187 263.118 l 450.148 262.794 449.797 262.377 449.602 262.099 c 449.637 262.149 448.942 262.552 449.006 262.681 c 449.422 263.513 449.318 264.281 448.888 265.022 c 448.81 265.207 448.732 265.277 448.614 265.439 c 448.317 265.85 447.833 266.088 447.326 265.995 c 447.209 265.995 l 446.701 266.087 446.35 265.856 445.979 265.531 c 445.809 265.383 445.51 265.068 445.432 264.883 c 445.002 264.142 445.179 263.239 445.512 262.515 c 445.572 262.384 444.869 262.154 444.905 262.104 c 444.709 262.382 444.358 262.799 444.319 263.123 c 435.61 265.485 l 435.532 265.346 435.61 265.207 435.571 265.068 c 435.532 264.976 l 438.422 261.317 l 438.383 261.317 l 438.5 261.363 438.617 261.27 438.695 261.224 c 438.969 260.853 439.281 260.529 439.711 260.483 c 439.672 260.344 439.789 260.251 y 439.984 260.066 440.258 260.066 440.492 260.02 c 440.802 259.958 441.038 259.603 441.351 259.418 c 441.976 259.14 442.444 258.537 443.108 258.445 c 443.694 258.352 444.28 258.213 444.866 258.445 c 444.983 258.491 445.1 258.537 445.139 258.723 c 445.169 258.865 445.295 258.862 445.373 258.815 c 445.569 258.63 445.686 258.399 445.881 258.259 c 446.154 258.028 446.428 257.935 446.74 257.796 c 446.896 257.704 447.013 257.796 447.17 257.75 c 447.337 257.745 l b* Q 438.968 264.45 m 442.843 263.501 l 442.823 263.501 442.823 263.524 442.804 263.524 c 442.901 263.222 443.018 262.92 443.096 262.595 c 443.204 262.143 443.096 261.643 443.076 261.178 c 442.882 261.271 442.862 261.411 v 442.784 261.736 442.784 261.968 442.706 262.293 c 442.687 262.316 442.57 262.432 442.551 262.479 c 442.422 262.786 442.258 262.827 441.986 262.99 c 441.674 263.153 441.363 263.408 441.071 263.547 c 440.448 263.826 439.786 263.872 439.182 264.174 c 439.163 264.198 439.104 264.221 439.085 264.291 c 439.071 264.34 438.91 264.337 438.968 264.45 c f* 439.922 263.663 m 439.961 263.617 440 263.524 440.039 263.501 c 440.214 263.408 440.389 263.431 440.565 263.431 c 440.526 263.454 440.487 263.501 440.448 263.501 c 440.234 263.501 440.097 263.57 439.922 263.663 c f* 440.506 263.06 m 440.681 263.06 440.837 263.083 441.012 263.06 c 441.032 263.036 441.012 262.99 440.993 262.967 c 440.837 262.92 440.681 262.827 440.526 262.781 c 440.487 262.758 440.428 262.781 y 440.35 262.711 440.149 262.68 440.175 262.758 c 440.214 262.874 440.35 262.944 440.448 263.013 c 440.506 263.06 l f* 440.526 262.27 m 440.584 262.27 440.643 262.247 440.701 262.293 c 440.818 262.386 441.012 262.525 441.149 262.549 c 440.526 262.27 l f* 440.993 261.922 m 441.168 261.922 441.382 261.875 441.519 261.945 c 441.577 261.991 441.655 262.084 441.694 262.2 c 441.441 262.154 441.285 261.991 441.032 261.991 c 440.993 261.922 l f* 442.2 261.759 m 442.161 261.759 442.122 261.782 442.083 261.759 c 441.947 261.666 441.791 261.643 441.694 261.503 c 441.655 261.434 441.655 261.341 441.655 261.271 c 441.694 261.271 441.733 261.248 441.752 261.271 c 441.85 261.457 442.025 261.503 442.122 261.666 c 442.2 261.759 l f* 441.85 260.899 m 441.85 260.876 441.85 260.83 441.85 260.807 c 442.083 260.737 442.239 260.946 442.414 261.109 c 442.551 261.225 442.414 261.318 442.297 261.225 c 442.239 261.178 442.142 261.109 442.064 261.039 c 442.005 260.969 441.908 261.016 441.83 260.946 c 441.85 260.923 441.85 260.899 v f* 442.59 260.714 m 442.687 260.714 442.706 260.83 442.784 260.876 c 442.59 260.714 l f* 443.018 260.69 m 443.018 260.644 443.018 260.621 443.018 260.574 c 443.057 260.574 l 443.057 260.528 443.057 260.458 443.057 260.412 c 443.018 260.69 l f* 435.191 265.22 m 435.307 265.243 435.405 265.196 435.502 265.15 c 435.522 265.15 435.561 265.103 435.599 265.08 c 435.716 265.034 435.833 264.987 435.95 264.941 c 436.32 264.825 436.709 264.848 437.06 264.639 c 437.196 264.569 437.352 264.5 437.488 264.453 c 437.858 264.36 438.189 264.36 438.559 264.291 c 438.617 264.267 438.676 264.198 438.754 264.198 c 438.364 264.221 437.975 264.151 437.566 264.221 c 437.352 264.267 437.138 264.244 436.924 264.314 c 436.865 264.337 436.846 264.407 436.787 264.43 c 436.573 264.5 436.378 264.407 436.184 264.476 c 436.106 264.5 436.008 264.5 435.931 264.546 c 435.658 264.639 435.483 264.894 435.268 265.127 c 435.249 265.15 435.288 265.196 435.249 265.22 c 435.191 265.22 l f* 435.639 264.407 m 435.716 264.314 435.775 264.198 435.892 264.151 c 436.086 264.105 436.262 263.965 436.456 263.919 c 436.69 263.849 436.904 263.803 437.138 263.779 c 437.43 263.733 437.702 263.733 437.994 263.64 c 438.014 263.64 438.074 263.626 438.092 263.617 c 438.54 263.408 439.007 263.501 439.455 263.501 c 439.474 263.64 439.416 263.826 439.279 263.849 c 439.065 263.895 438.871 263.779 438.656 263.756 c 438.384 263.71 438.131 263.71 437.858 263.756 c 437.761 263.779 437.683 263.803 437.605 263.849 c 437.352 263.965 437.099 263.849 436.846 263.965 c 436.748 264.012 436.67 264.035 436.573 264.082 c 436.3 264.151 436.028 264.198 435.775 264.314 c 435.639 264.407 l f* 436.573 263.269 m 437.001 263.245 437.449 263.362 437.878 263.222 c 437.956 263.199 438.014 263.083 438.111 263.06 c 438.267 263.036 438.423 263.083 438.578 263.106 c 438.91 263.176 439.241 263.083 439.571 263.153 c 438.987 262.688 438.228 262.85 437.566 262.897 c 437.41 262.897 437.294 263.036 437.157 263.06 c 437.04 263.06 436.904 263.06 436.787 263.106 c 436.729 263.129 436.69 263.176 436.632 263.199 c 436.573 263.269 l f* 437.702 262.2 m 437.683 262.224 437.722 262.247 437.722 262.27 c 438.072 262.247 438.423 262.363 438.773 262.432 c 439.163 262.502 439.552 262.34 439.941 262.502 c 439.883 262.479 439.823 262.452 439.766 262.432 c 439.085 262.2 438.481 262.247 437.819 262.224 c 437.702 262.2 l f* 438.462 261.55 m 438.676 261.503 438.948 261.55 439.163 261.55 c 439.435 261.596 439.722 261.53 440 261.596 c 440.195 261.643 440.175 261.805 440.409 262.061 c 440.117 262.038 439.98 262.014 439.63 262.038 c 439.408 262.052 439.26 261.898 439.046 261.829 c 438.871 261.782 438.871 261.875 438.734 261.759 c 438.462 261.55 l f* 439.202 260.992 m 439.513 260.969 439.805 260.992 440.117 261.062 c 440.136 261.086 440.175 261.109 440.195 261.132 c 440.311 261.178 440.448 261.132 440.565 261.225 c 440.646 261.289 440.701 261.364 440.798 261.411 c 440.818 261.434 440.857 261.666 440.837 261.666 c 440.759 261.689 440.643 261.55 440.565 261.503 c 440.506 261.503 440.487 261.434 440.428 261.411 c 440.175 261.318 440.156 261.457 439.922 261.295 c 439.786 261.202 439.338 261.225 439.221 261.062 c 439.202 260.992 l f* 440.058 260.482 m 440.273 260.458 440.467 260.551 440.662 260.621 c 440.837 260.69 441.032 260.783 441.188 260.946 c 440.857 261.039 440.565 260.76 440.234 260.667 c 440.195 260.667 440.097 260.598 440.117 260.505 c 440.058 260.482 l f* 440.526 260.203 m 440.565 260.064 440.74 260.087 440.818 260.133 c 440.973 260.249 441.207 260.296 441.246 260.528 c 441.168 260.528 441.11 260.551 441.032 260.505 c 440.973 260.458 440.935 260.412 440.896 260.342 c 440.818 260.226 440.662 260.319 440.584 260.18 c 440.526 260.203 l f* 441.227 259.831 m 441.382 259.831 441.538 259.831 441.694 259.831 c 441.674 260.017 441.733 260.203 441.85 260.342 c 441.85 260.366 441.85 260.412 441.85 260.435 c 441.752 260.482 441.674 260.366 441.597 260.296 c 441.538 260.226 441.538 260.11 441.557 260.017 c 441.46 260.017 441.363 259.971 441.304 259.878 c 441.227 259.831 l f* 442.025 259.715 m 442.2 259.761 442.297 259.947 442.453 260.017 c 442.025 259.715 l f* 442.473 259.738 m 442.59 259.738 442.648 259.924 442.745 260.017 c 442.473 259.738 l f* 442.921 259.715 m 443.062 259.715 443.213 259.645 443.349 259.715 c 443.349 259.785 l 443.252 259.831 443.213 260.017 443.096 259.971 c 443.076 259.971 443.057 259.854 443.018 259.808 c 442.998 259.808 442.979 259.808 442.959 259.808 c 442.921 259.785 442.901 259.715 442.921 259.715 c f* 452.997 264.446 m 449.122 263.496 l 449.142 263.496 449.142 263.519 449.161 263.519 c 449.064 263.217 448.947 262.916 448.87 262.59 c 448.761 262.139 448.87 261.638 448.889 261.174 c 449.084 261.266 449.103 261.406 v 449.181 261.731 449.181 261.963 449.259 262.288 c 449.278 262.312 449.395 262.428 449.415 262.474 c 449.543 262.781 449.707 262.823 449.979 262.985 c 450.291 263.148 450.602 263.404 450.894 263.543 c 451.517 263.822 452.179 263.868 452.783 264.171 c 452.802 264.194 452.861 264.217 452.88 264.287 c 452.894 264.336 453.055 264.333 452.997 264.446 c f* 452.043 263.659 m 452.004 263.613 451.965 263.52 451.926 263.497 c 451.751 263.404 451.576 263.427 451.401 263.427 c 451.44 263.45 451.479 263.497 451.517 263.497 c 451.732 263.497 451.868 263.567 452.043 263.659 c f* 451.459 263.055 m 451.284 263.055 451.128 263.079 450.953 263.055 c 450.933 263.032 450.953 262.986 450.972 262.963 c 451.128 262.916 451.284 262.823 451.44 262.777 c 451.479 262.754 451.537 262.777 y 451.615 262.707 451.816 262.676 451.79 262.754 c 451.751 262.87 451.615 262.939 451.517 263.009 c 451.459 263.055 l f* 451.44 262.266 m 451.381 262.266 451.323 262.242 451.265 262.289 c 451.148 262.382 450.953 262.521 450.817 262.544 c 451.44 262.266 l f* 450.973 261.917 m 450.797 261.917 450.583 261.871 450.447 261.94 c 450.388 261.987 450.31 262.08 450.271 262.196 c 450.525 262.15 450.681 261.987 450.934 261.987 c 450.973 261.917 l f* 449.765 261.754 m 449.804 261.754 449.843 261.778 449.882 261.754 c 450.019 261.662 450.174 261.638 450.271 261.499 c 450.311 261.43 450.311 261.337 450.311 261.267 c 450.272 261.267 450.233 261.244 450.213 261.267 c 450.116 261.453 449.941 261.499 449.843 261.662 c 449.765 261.754 l f* 450.116 260.895 m 450.116 260.872 450.116 260.825 450.116 260.802 c 449.883 260.733 449.727 260.942 449.551 261.104 c 449.415 261.22 449.551 261.313 449.668 261.22 c 449.727 261.174 449.824 261.104 449.902 261.034 c 449.96 260.965 450.058 261.011 450.135 260.942 c 450.116 260.918 450.116 260.895 v f* 449.376 260.709 m 449.279 260.709 449.259 260.825 449.181 260.872 c 449.376 260.709 l f* 448.948 260.686 m 448.948 260.639 448.948 260.616 448.948 260.57 c 448.909 260.57 l 448.909 260.523 448.909 260.454 448.909 260.407 c 448.948 260.686 l f* 456.774 265.217 m 456.657 265.24 456.56 265.193 456.463 265.147 c 456.443 265.147 456.404 265.1 456.365 265.077 c 456.249 265.03 456.132 264.984 456.015 264.938 c 455.645 264.822 455.255 264.845 454.905 264.635 c 454.769 264.566 454.613 264.496 454.477 264.45 c 454.107 264.357 453.776 264.357 453.406 264.287 c 453.347 264.263 453.289 264.194 453.211 264.194 c 453.601 264.217 453.99 264.147 454.399 264.217 c 454.613 264.264 454.827 264.241 455.042 264.31 c 455.1 264.334 455.119 264.403 455.178 264.426 c 455.392 264.496 455.586 264.403 455.781 264.473 c 455.859 264.497 455.957 264.497 456.034 264.543 c 456.307 264.636 456.482 264.891 456.696 265.124 c 456.716 265.147 456.677 265.193 456.716 265.217 c 456.774 265.217 l f* 456.326 264.404 m 456.249 264.311 456.19 264.194 456.073 264.148 c 455.879 264.101 455.703 263.962 455.509 263.916 c 455.275 263.846 455.061 263.8 454.827 263.776 c 454.535 263.73 454.263 263.73 453.971 263.637 c 453.951 263.637 453.891 263.622 453.873 263.613 c 453.426 263.404 452.958 263.497 452.51 263.497 c 452.491 263.636 452.549 263.822 452.686 263.845 c 452.9 263.892 453.095 263.776 453.309 263.753 c 453.581 263.706 453.835 263.706 454.107 263.753 c 454.204 263.776 454.282 263.799 454.36 263.846 c 454.613 263.962 454.866 263.846 455.119 263.962 c 455.217 264.009 455.295 264.032 455.392 264.078 c 455.665 264.148 455.937 264.194 456.19 264.311 c 456.326 264.404 l f* 455.392 263.265 m 454.964 263.242 454.516 263.358 454.088 263.219 c 454.01 263.195 453.951 263.079 453.854 263.056 c 453.698 263.033 453.543 263.079 453.387 263.102 c 453.056 263.172 452.725 263.079 452.394 263.149 c 452.978 262.684 453.737 262.847 454.399 262.894 c 454.555 262.894 454.672 263.033 454.808 263.056 c 454.925 263.056 455.061 263.056 455.178 263.103 c 455.236 263.126 455.275 263.172 455.334 263.196 c 455.392 263.265 l f* 454.263 262.197 m 454.282 262.22 454.244 262.243 454.244 262.267 c 453.893 262.243 453.543 262.359 453.192 262.429 c 452.803 262.498 452.413 262.336 452.024 262.498 c 452.082 262.475 452.143 262.447 452.199 262.429 c 452.881 262.196 453.484 262.243 454.146 262.22 c 454.263 262.197 l f* 453.504 261.546 m 453.29 261.5 453.017 261.546 452.803 261.546 c 452.53 261.592 452.243 261.526 451.966 261.592 c 451.771 261.639 451.79 261.801 451.557 262.057 c 451.849 262.034 451.985 262.01 452.335 262.034 c 452.557 262.049 452.705 261.895 452.92 261.825 c 453.095 261.779 453.095 261.871 453.231 261.755 c 453.504 261.546 l f* 452.764 260.989 m 452.453 260.965 452.16 260.989 451.849 261.058 c 451.829 261.081 451.79 261.104 451.771 261.128 c 451.654 261.174 451.518 261.128 451.401 261.221 c 451.32 261.285 451.265 261.36 451.167 261.406 c 451.148 261.43 451.109 261.662 451.128 261.662 c 451.206 261.685 451.323 261.546 451.401 261.499 c 451.459 261.499 451.479 261.43 451.537 261.407 c 451.79 261.314 451.81 261.453 452.043 261.291 c 452.18 261.198 452.628 261.221 452.745 261.059 c 452.764 260.989 l f* 451.907 260.478 m 451.693 260.454 451.499 260.547 451.304 260.617 c 451.128 260.687 450.934 260.779 450.778 260.942 c 451.109 261.035 451.401 260.756 451.732 260.663 c 451.771 260.663 451.868 260.594 451.849 260.501 c 451.907 260.478 l f* 451.44 260.199 m 451.401 260.059 451.226 260.083 451.148 260.129 c 450.992 260.245 450.759 260.292 450.72 260.524 c 450.798 260.524 450.856 260.547 450.934 260.5 c 450.992 260.454 451.031 260.408 451.07 260.338 c 451.148 260.222 451.304 260.315 451.382 260.176 c 451.44 260.199 l f* 450.739 259.827 m 450.583 259.827 450.428 259.827 450.272 259.827 c 450.291 260.013 450.233 260.199 450.116 260.338 c 450.116 260.361 450.116 260.408 450.116 260.431 c 450.213 260.477 450.291 260.361 450.369 260.292 c 450.428 260.222 450.428 260.106 450.408 260.013 c 450.506 260.013 450.603 259.967 450.661 259.874 c 450.739 259.827 l f* 449.941 259.711 m 449.766 259.757 449.668 259.943 449.513 260.013 c 449.941 259.711 l f* 449.493 259.734 m 449.376 259.734 449.318 259.92 449.221 260.013 c 449.493 259.734 l f* 449.045 259.711 m 448.904 259.711 448.753 259.641 448.617 259.71 c 448.617 259.78 l 448.714 259.827 448.753 260.013 448.87 259.966 c 448.889 259.966 448.909 259.85 448.948 259.804 c 448.968 259.804 448.987 259.804 449.006 259.804 c 449.045 259.78 449.065 259.711 449.045 259.711 c f* 445.404 263.136 m 445.579 263.079 445.768 263.047 445.963 263.047 c 446.921 263.047 447.698 263.797 447.698 264.722 c 447.698 265.647 446.921 266.397 445.963 266.397 c 445.005 266.397 444.229 265.647 444.229 264.722 c 444.229 263.986 444.72 263.361 445.404 263.136 c f* q 0.9972 0 0 1.0028 0 0 cm 1 J 1 j 0.333 w 2.613 M 446.673 262.389 m 446.848 262.331 447.037 262.3 447.234 262.3 c 448.194 262.3 448.973 263.048 448.973 263.97 c 448.973 264.893 448.194 265.641 447.234 265.641 c 446.273 265.641 445.494 264.893 445.494 263.97 c 445.494 263.236 445.987 262.613 446.673 262.389 c S Q q 0.9972 0 0 1.0028 0 0 cm 1 J 1 j 0.166 w 2.613 M 448.59 264.646 m 446.394 262.701 l 446.35 262.684 l 447.228 265.532 l 447.243 265.48 l 448.078 262.631 l 445.945 264.606 l 445.925 264.646 l 448.59 264.646 l S Q 445.47 264.827 m 445.48 264.804 445.518 264.713 445.531 264.693 c 445.57 264.635 445.583 264.637 445.574 264.556 c 445.567 264.497 445.573 264.494 445.615 264.452 c 445.674 264.393 445.671 264.259 445.74 264.201 c 445.769 264.178 445.915 264.358 445.926 264.368 c 446.003 264.44 446.051 264.326 446.206 264.21 c 446.293 264.145 446.3 264.472 446.279 264.618 c 446.275 264.644 446.445 264.804 446.445 264.827 c 446.474 265.071 446.467 264.985 446.32 265.182 c 446.301 265.193 446.136 265.309 446.127 265.333 c 445.99 265.518 445.988 265.446 445.823 265.411 c 445.813 265.411 445.796 265.35 445.802 265.328 c 445.832 265.22 445.633 265.267 445.594 265.244 c 445.526 265.186 445.496 265.174 445.447 265.092 c 445.418 265.023 445.418 264.941 445.408 264.872 c 445.47 264.827 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 1 J 1 j 0.166 w 2.613 M 446.739 264.075 m 446.749 264.052 446.787 263.961 446.8 263.941 c 446.839 263.883 446.853 263.886 446.843 263.804 c 446.836 263.746 446.842 263.743 446.885 263.7 c 446.943 263.642 446.941 263.509 447.009 263.451 c 447.039 263.428 447.186 263.607 447.197 263.617 c 447.274 263.689 447.321 263.576 447.477 263.459 c 447.564 263.395 447.571 263.721 447.55 263.867 c 447.547 263.892 447.717 264.052 447.717 264.075 c 447.746 264.318 447.738 264.232 447.592 264.428 c 447.572 264.44 447.407 264.556 447.397 264.579 c 447.261 264.764 447.259 264.692 447.093 264.657 c 447.083 264.657 447.066 264.596 447.072 264.574 c 447.102 264.466 446.903 264.514 446.864 264.491 c 446.795 264.433 446.765 264.42 446.716 264.339 c 446.687 264.27 446.687 264.189 446.677 264.119 c S Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 0 0 0 0 K 0.333 w 2.613 M 447.344 261.382 m 447.478 261.382 l 447.512 261.345 447.576 261.358 447.629 261.412 c 447.682 261.466 447.733 261.535 447.743 261.57 c 447.861 261.693 448.051 261.641 448.269 261.486 c 448.332 261.404 448.679 261.126 449.111 260.936 c 449.174 260.86 448.904 260.938 448.852 260.957 c 448.936 260.902 448.843 260.857 448.652 260.947 c 448.704 260.859 448.593 260.882 448.463 260.951 c 448.537 260.861 448.413 260.874 448.307 260.943 c 448.351 260.859 448.235 260.864 448.145 260.95 c 448.19 260.871 448.081 260.871 448.001 260.946 c 448.049 260.862 447.895 260.888 447.842 260.951 c 447.885 260.886 447.699 260.922 447.683 260.988 c 447.657 260.898 447.502 260.882 447.466 260.951 c 447.354 260.951 l 447.261 260.858 447.118 260.912 447.102 261.106 c 446.961 260.881 446.757 260.838 446.821 260.959 c 446.709 260.854 446.648 260.89 446.664 260.951 c 446.499 260.809 446.492 260.93 446.508 260.953 c 446.399 260.865 446.306 260.882 446.335 260.941 c 446.234 260.886 446.112 260.876 446.166 260.953 c 446.046 260.883 445.879 260.885 445.95 260.958 c 445.783 260.889 445.6 260.904 445.757 260.969 c 446.23 261.164 446.381 261.35 446.557 261.489 c 446.833 261.709 447.045 261.657 447.093 261.54 c 447.138 261.432 447.286 261.319 447.34 261.375 c 447.344 261.382 l b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 0 0 0 0 K 0.333 w 2.613 M 447.345 258.515 m 447.345 258.483 447.358 258.462 447.401 258.462 c 447.444 258.461 447.457 258.488 447.457 258.517 c 447.482 261.467 l 447.338 261.467 l 447.345 258.515 l b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 0 0 0 0 K 0.333 w 2.613 M 447.401 261.412 m 447.402 261.429 447.461 261.434 447.461 261.415 c 447.439 258.567 l 447.439 258.547 447.429 258.503 447.414 258.503 c 447.403 258.503 447.401 258.543 447.401 258.567 c 447.401 261.412 l b* Q 0 0 0 1 k 446.461 261.954 m 446.426 261.978 446.381 261.971 y 446.437 261.946 446.456 261.925 446.43 261.792 c 446.461 261.954 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.733 261.21 m 447.698 261.234 447.652 261.227 y 447.709 261.202 447.728 261.181 447.702 261.049 c S Q 447.245 262.017 m 447.268 261.999 447.134 261.989 y 447.161 261.967 447.002 261.971 y 447.027 261.942 446.905 261.932 y 446.92 261.909 446.79 261.894 y 446.805 261.873 446.699 261.872 y 446.71 261.85 446.591 261.861 y 446.6 261.833 446.442 261.869 y 447.245 262.017 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.519 261.272 m 448.542 261.255 448.407 261.244 y 448.435 261.223 448.275 261.227 y 448.301 261.198 448.178 261.188 y 448.194 261.165 448.063 261.15 y 448.078 261.129 447.972 261.128 y 447.982 261.106 447.863 261.117 y 447.872 261.089 447.714 261.125 y S Q 447.061 262.173 m 447.06 262.125 446.916 262.165 y 446.913 262.125 446.778 262.15 y 446.787 262.114 446.651 262.119 y 446.661 262.084 446.573 262.093 y 446.6 262.039 446.511 262.015 y 446.532 261.959 446.427 261.968 y 447.061 262.173 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.335 261.428 m 448.333 261.381 448.189 261.42 y 448.186 261.38 448.051 261.406 y 448.06 261.37 447.924 261.374 y 447.933 261.34 447.845 261.349 y 447.872 261.295 447.783 261.271 y 447.804 261.215 447.699 261.224 y S Q 445.818 261.955 m 445.853 261.979 445.898 261.972 y 445.842 261.947 445.823 261.926 445.848 261.794 c 445.818 261.955 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.088 261.211 m 447.123 261.235 447.169 261.228 y 447.112 261.203 447.093 261.182 447.118 261.05 c S Q 445.034 262.02 m 445.011 262.004 445.146 261.992 y 445.118 261.971 445.277 261.974 y 445.252 261.945 445.374 261.935 y 445.358 261.912 445.488 261.896 y 445.474 261.875 445.58 261.874 y 445.569 261.852 445.687 261.862 y 445.679 261.835 445.837 261.87 y 445.034 262.02 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.302 261.276 m 446.279 261.259 446.414 261.248 y 446.386 261.227 446.546 261.23 y 446.52 261.201 446.643 261.191 y 446.627 261.168 446.757 261.152 y 446.742 261.132 446.849 261.131 y 446.838 261.108 446.957 261.119 y 446.948 261.091 447.107 261.126 y S Q 445.219 262.177 m 445.22 262.129 445.364 262.168 y 445.368 262.128 445.502 262.152 y 445.493 262.117 445.629 262.121 y 445.619 262.086 445.707 262.095 y 445.679 262.041 445.768 262.016 y 445.747 261.961 445.852 261.969 y 445.219 262.177 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.488 261.432 m 446.489 261.384 446.633 261.423 y 446.636 261.383 446.771 261.408 y 446.762 261.372 446.898 261.376 y 446.888 261.342 446.977 261.351 y 446.949 261.296 447.038 261.272 y 447.017 261.217 447.122 261.225 y S Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.409 261.454 m 447.311 261.455 447.232 261.517 447.232 261.594 c 447.233 261.671 447.312 261.733 447.41 261.733 c 447.508 261.733 447.587 261.67 447.587 261.593 c 447.586 261.516 447.507 261.454 447.409 261.454 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.393 261.662 m 447.416 261.666 447.401 261.69 447.38 261.69 c 447.318 261.687 447.279 261.639 447.279 261.592 c 447.279 261.568 447.286 261.54 447.301 261.522 c 447.309 261.512 447.332 261.49 447.319 261.495 c 447.276 261.513 447.255 261.554 447.255 261.595 c 447.255 261.662 447.325 261.717 447.411 261.717 c 447.497 261.717 447.566 261.662 447.566 261.594 c 447.566 261.53 447.502 261.476 447.418 261.471 c 447.404 261.47 447.383 261.471 447.376 261.478 c 447.375 261.48 447.404 261.478 447.418 261.48 c 447.483 261.488 447.527 261.53 447.523 261.582 c 447.522 261.595 447.496 261.62 447.499 261.599 c 447.503 261.564 447.461 261.538 447.417 261.537 c 447.382 261.536 447.337 261.565 447.337 261.6 c 447.338 261.634 447.349 261.655 447.393 261.662 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.975 260.629 m 446.948 260.292 447.976 260.631 447.95 260.204 c 447.924 259.795 447.151 260.078 447.176 259.854 c 447.189 259.739 447.855 259.816 447.799 259.549 c 447.747 259.301 447.2 259.423 447.221 259.313 c 447.244 259.191 447.779 259.251 447.679 259.029 c 447.597 258.848 447.182 258.973 447.177 258.776 c 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447.617 259.34 447.587 259.352 447.616 259.358 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.203 258.868 m 447.231 258.958 447.562 258.942 447.571 259.058 c 447.574 259.097 447.554 259.107 447.579 259.112 c 447.602 259.116 447.649 259.103 447.647 259.061 c 447.642 258.934 447.266 258.926 447.203 258.868 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.784 260.795 m 447.939 260.748 447.968 260.651 447.955 260.581 c 447.893 260.245 447.071 260.441 447.051 260.23 c 447.04 260.112 447.25 260.1 447.157 260.083 c 447.044 260.063 446.905 260.141 446.912 260.232 c 446.936 260.56 447.749 260.321 447.862 260.561 c 447.886 260.613 447.881 260.753 447.756 260.748 c 447.663 260.745 447.618 260.755 447.671 260.795 c 447.71 260.824 447.767 260.817 447.784 260.795 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.86 260.583 m 446.91 260.428 447.114 260.462 447.084 260.472 c 447.015 260.496 446.97 260.521 446.94 260.57 c 446.873 260.68 446.926 260.778 447.053 260.755 c 447.145 260.738 447.198 260.756 447.145 260.796 c 447.106 260.826 447.05 260.819 447.032 260.796 c 446.877 260.75 446.83 260.673 446.86 260.583 c b* Q 446.43 261.792 m 446.415 261.716 446.373 261.651 446.286 261.651 c 446.219 261.651 446.204 261.688 y 446.43 261.792 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.702 261.049 m 447.687 260.972 447.644 260.908 447.557 260.908 c 447.49 260.908 447.475 260.944 y S Q 446.877 261.693 m 446.906 261.674 446.861 261.612 446.804 261.646 c 446.625 261.752 446.591 261.861 y 446.495 261.917 446.461 261.954 y 446.877 261.693 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.15 260.95 m 448.18 260.931 448.134 260.869 448.077 260.903 c 447.897 261.008 447.863 261.117 y 447.767 261.173 447.733 261.21 y S Q 446.724 261.7 m 446.768 261.672 446.725 261.61 446.644 261.653 c 446.523 261.717 446.442 261.869 y 446.724 261.7 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.997 260.956 m 448.04 260.929 447.998 260.867 447.916 260.91 c 447.795 260.974 447.714 261.125 y S Q 446.207 262.131 m 446.279 262.052 446.419 262.203 446.461 262.295 c 446.503 262.384 446.678 262.478 447.003 262.223 c 447.15 262.108 447.26 261.945 447.814 261.696 c 447.882 261.665 447.842 261.642 447.749 261.658 c 447.416 261.713 447.134 261.989 y 447.002 262.052 446.916 262.165 y 446.844 262.235 446.781 262.264 y 446.207 262.131 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.478 261.386 m 447.55 261.308 447.69 261.458 447.733 261.55 c 447.775 261.639 447.95 261.733 448.276 261.478 c 448.424 261.363 448.534 261.201 449.09 260.953 c 449.158 260.922 449.118 260.899 449.024 260.914 c 448.691 260.97 448.407 261.244 y 448.276 261.308 448.189 261.42 y 448.117 261.49 448.053 261.519 y S Q 447.577 261.705 m 447.641 261.671 447.603 261.626 447.507 261.648 c 447.245 261.709 447.002 261.971 y 446.892 262.034 446.778 262.15 y 446.664 262.238 446.616 262.244 y 447.577 261.705 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 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447.76 261.408 y S Q 447.033 261.691 m 447.071 261.668 447.027 261.608 446.969 261.635 c 446.836 261.7 446.699 261.872 y 446.579 261.939 446.511 262.015 y 446.475 262.057 446.41 262.059 y 447.033 261.691 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.307 260.948 m 448.344 260.925 448.3 260.865 448.243 260.892 c 448.109 260.956 447.972 261.128 y 447.851 261.195 447.783 261.271 y 447.747 261.313 447.682 261.314 y S Q 445.401 261.695 m 445.371 261.677 445.416 261.615 445.473 261.649 c 445.653 261.754 445.687 261.862 y 445.783 261.918 445.818 261.955 y 445.401 261.695 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.67 260.952 m 446.64 260.934 446.685 260.872 446.742 260.905 c 446.923 261.01 446.957 261.119 y 447.053 261.174 447.088 261.211 y S Q 445.848 261.794 m 445.862 261.717 445.905 261.654 445.991 261.656 c 446.063 261.657 446.083 261.699 y 445.848 261.794 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.118 261.05 m 447.133 260.973 447.175 260.911 447.262 260.913 c 447.334 260.914 447.353 260.956 y S Q 445.554 261.702 m 445.509 261.675 445.552 261.612 445.634 261.655 c 445.755 261.718 445.837 261.87 y 445.554 261.702 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.823 260.959 m 446.779 260.932 446.821 260.869 446.903 260.912 c 447.024 260.975 447.107 261.126 y S Q 446.073 262.131 m 446.001 262.053 445.862 262.204 445.82 262.296 c 445.779 262.386 445.604 262.48 445.278 262.227 c 445.13 262.112 445.019 261.949 444.463 261.702 c 444.396 261.672 444.435 261.649 444.529 261.664 c 444.861 261.718 445.146 261.992 y 445.277 262.056 445.364 262.168 y 445.437 262.238 445.5 262.266 y 446.073 262.131 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.344 261.387 m 447.272 261.308 447.132 261.459 447.09 261.551 c 447.049 261.64 446.874 261.735 446.546 261.482 c 446.398 261.367 446.286 261.205 445.729 260.959 c 445.662 260.929 445.701 260.905 445.795 260.921 c 446.128 260.975 446.414 261.248 y 446.546 261.311 446.633 261.423 y 446.705 261.493 446.769 261.521 y S Q 444.701 261.71 m 444.637 261.677 444.674 261.632 444.77 261.653 c 445.033 261.713 445.277 261.974 y 445.388 262.037 445.502 262.152 y 445.616 262.239 445.665 262.246 y 444.701 261.71 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 445.967 260.967 m 445.903 260.934 445.941 260.888 446.037 260.91 c 446.3 260.97 446.546 261.23 y 446.656 261.293 446.771 261.408 y 446.886 261.494 446.935 261.501 y S Q 444.908 261.7 m 444.854 261.667 444.894 261.625 444.973 261.651 c 445.204 261.728 445.374 261.935 y 445.533 262.027 445.629 262.121 y 445.674 262.184 445.75 262.202 y 444.908 261.7 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.175 260.956 m 446.121 260.923 446.161 260.882 446.241 260.908 c 446.472 260.984 446.643 261.191 y 446.802 261.283 446.898 261.376 y 446.943 261.439 447.019 261.458 y S Q 445.084 261.698 m 445.037 261.669 445.073 261.618 445.138 261.644 c 445.323 261.717 445.488 261.896 y 445.637 261.981 445.707 262.095 y 445.731 262.134 445.792 262.154 y 445.084 261.698 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.351 260.954 m 446.305 260.926 446.34 260.875 446.406 260.901 c 446.591 260.974 446.757 261.152 y 446.906 261.237 446.977 261.351 y 447 261.389 447.062 261.409 y S Q 445.244 261.694 m 445.207 261.672 445.25 261.611 445.308 261.639 c 445.441 261.702 445.58 261.874 y 445.7 261.941 445.768 262.016 y 445.809 262.058 445.87 262.06 y 445.244 261.694 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.513 260.951 m 446.475 260.929 446.519 260.868 446.576 260.896 c 446.71 260.959 446.849 261.131 y 446.97 261.197 447.038 261.272 y 447.079 261.314 447.14 261.315 y S Q 446.565 261.707 m 446.603 261.677 446.555 261.65 446.485 261.673 c 446.417 261.696 446.416 261.746 y 446.565 261.707 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.838 260.964 m 447.876 260.933 447.827 260.907 447.757 260.93 c 447.688 260.953 447.688 261.003 y S Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.556 258.907 m 447.542 258.913 447.501 258.905 447.514 258.901 c 447.556 258.886 447.586 258.882 447.602 258.867 c 447.596 258.886 447.583 258.895 447.556 258.907 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 0 K 0.176 w 2.613 M 447.37 262.21 m 446.316 262.21 445.272 262.086 445.04 261.044 c 444.818 260.046 444.874 260.379 445.262 259.214 c S Q 490.413 310.076 m 490.675 310.237 491.477 311.456 491.509 311.406 c 491.989 310.64 492.645 309.867 494.048 309.867 c 495.449 309.867 496.586 310.556 496.586 311.406 c 496.586 310.556 497.68 309.907 499.081 309.907 c 500.484 309.907 501.183 310.559 501.62 311.446 c 501.637 311.523 l 501.896 311.356 503.149 310.524 503.11 310.479 c 499.169 307.657 507.313 301.772 497.776 298.375 c 497.289 298.236 497.068 297.903 v 496.98 298.064 496.279 298.387 y 485.991 300.644 494.659 307.254 490.413 310.076 c f* q 0.9972 0 0 1.0028 0 0 cm 1 J 1 j 0.333 w 2.613 M 491.81 309.195 m 492.073 309.356 492.877 310.571 492.909 310.521 c 493.39 309.758 494.049 308.986 495.455 308.986 c 496.861 308.986 498.001 309.674 498.001 310.521 c 498.001 310.521 l 498.001 309.674 499.097 309.027 500.503 309.027 c 501.909 309.027 502.611 309.677 503.049 310.561 c 503.066 310.638 l 503.325 310.472 504.582 309.642 504.543 309.597 c 504.543 309.597 l 500.591 306.783 508.758 300.915 499.194 297.527 c 498.705 297.389 498.484 297.056 v 498.484 297.056 l 498.396 297.217 497.693 297.539 y 487.375 299.79 496.069 306.381 491.81 309.195 c S Q 0 0 0 0 k 494.105 300.514 m 495.027 304.263 l 492.69 306.343 l 495.621 306.346 l 496.548 309.799 l 497.62 306.332 l 500.781 306.339 l 498.235 304.096 l 499.341 300.514 l 496.769 302.817 l 494.105 300.514 l f* q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 389.591 306.615 m 389.26 306.547 389.085 306.526 388.879 306.111 c 388.804 305.959 388.727 305.789 388.625 305.651 c 388.218 305.055 388.295 304.343 388.345 303.701 c 388.396 303.609 388.447 303.482 388.447 303.38 c 388.447 303.242 388.589 303.154 388.625 303.012 c 388.701 302.714 388.955 302.599 389.108 302.37 c 389.209 302.278 389.565 302.025 389.565 302.071 c 389.565 302.668 389.387 303.301 389.26 303.793 c 389.082 304.481 389.311 305.147 389.464 305.881 c 389.565 306.156 389.54 306.34 389.591 306.615 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 392.462 299.685 m 392.554 299.39 392.569 299.129 393.037 298.963 c 393.208 298.902 393.4 298.84 393.557 298.755 c 394.236 298.416 395.019 298.518 395.728 298.594 c 395.827 298.644 395.965 298.696 396.078 298.7 c 396.231 298.707 396.322 298.839 396.476 298.878 c 396.803 298.961 396.918 299.195 397.165 299.343 c 397.261 299.439 397.524 299.772 397.473 299.77 c 396.813 299.742 396.122 299.552 395.584 299.415 c 394.83 299.222 394.084 299.397 393.264 299.501 c 392.955 299.58 392.769 299.652 392.462 299.685 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 400.239 302.301 m 400.564 302.389 400.737 302.42 400.913 302.846 c 400.977 303.001 401.042 303.175 401.134 303.319 c 401.498 303.938 401.479 304.657 401.382 305.296 c 401.325 305.384 401.275 305.538 401.268 305.64 c 401.243 305.994 400.966 306.262 401.001 306.156 c 400.904 306.45 400.75 306.384 400.582 306.604 c 400.474 306.69 400.235 306.856 400.239 306.81 c 400.281 306.215 400.344 305.676 400.506 305.192 c 400.732 304.516 400.413 303.783 400.314 303.041 c 400.232 302.76 400.27 302.579 400.239 302.301 c b* Q q 0.9972 0 0 1.0028 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 397.5 309.058 m 397.424 309.357 397.401 309.516 396.941 309.702 c 396.774 309.769 396.586 309.84 396.434 309.932 c 395.773 310.299 394.985 310.231 394.274 310.186 c 394.172 310.14 394.031 310.095 393.918 310.095 c 393.765 310.095 393.668 309.967 393.511 309.935 c 393.18 309.866 393.053 309.637 392.799 309.499 c 392.697 309.407 392.417 309.086 392.468 309.086 c 393.129 309.086 393.83 309.246 394.374 309.36 c 395.137 309.52 395.874 309.313 396.687 309.174 c 396.991 309.082 397.195 309.105 397.5 309.058 c b* 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6834 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 426.84 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (181)Tj /TT3 1 Tf 7 0 0 7 122.49 726.66 Tm -0.0061 Tc 0.0218 Tw [(International Journal of Emergency Mental Health, Vol. 9, No. 3, pp. 181-192 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT4 1 Tf 10 0 0 10 102 392.34 Tm -0.0041 Tc 0 Tw (Abstract: )Tj /TT5 1 Tf 4.086 0 TD -0.0037 Tc 0.0958 Tw [(T)57.5(raditionally)50.3(, faith communities have served important r)32.3(oles in helping survivors cope in the)]TJ -4.086 -1.299 TD 0.0041 Tc 0.1251 Tw [(aftermath of public health disasters. However)106.1(, the pr)31.1(ovision of optimally effective crisis inter)-4.9(vention)]TJ T* -0.0038 Tc 0.0096 Tw (services for persons experiencing acute or prolonged emotional trauma following such incidents requires)Tj 0 -1.302 TD -0.0005 Tc 0.125 Tw [(specialized knowledge, skills, and abilities. Supported by a federally-funded grant, several academic)]TJ 0 -1.299 TD -0.0038 Tc -0.0133 Tw (health centers and faith-based organizations collaborated to develop a training program in Psychological)Tj T* -0.0001 Tc 0.125 Tw [(First )14.9(Aid \(PF)122.9(A\) and disaster ministry for members of the cler)32.9(gy serving urban minorities and Latino)]TJ 0 -1.302 TD -0.0037 Tc 0.0273 Tw [(immigrants in Baltimore, Maryland. This article describes the one-day training curriculum composed of)]TJ 0 -1.299 TD 0.0247 Tc 0.125 Tw (four content modules: Stress Reactions of Mind-Body-Spirit, Psychological First Aid and Crisis)Tj T* -0.0038 Tc -0.0356 Tw [(Intervention, Pastoral Car)32.2(e and Disaster Ministry)53(,)-0.3( and Practical Resour)32.2(ces and Self Car)29.2(e for the Spiritual)]TJ 0 -1.302 TD 0.0051 Tc 0.125 Tw [(Car)35.1(egiver)104.1(. Detailed descriptions of each module ar)32.1(e pr)29.1(ovided, including its purpose; rationale and)]TJ 0 -1.299 TD -0.0037 Tc 0.1004 Tw [(background literature; learning objectives; topics and sub-topics; and educational methods, materials)]TJ T* -0.0036 Tc 0.0211 Tw [(and resources. The strengths, weaknesses, and future applications of the training template are discussed)]TJ 0 -1.302 TD -0.0028 Tc 0.125 Tw (from the vantage points of participants subjective reactions to the training. [International Journal of)Tj 0 -1.299 TD -0.0035 Tc 0.0842 Tw (Emergency Mental Health, 2008, 9\(3\), pp. 181-192].)Tj /TT1 1 Tf 9 0 0 9 125.01 200.01 Tm -0.006 Tc -0.0055 Tw (Key words:)Tj /TT5 1 Tf 4.8533 0 TD -0.005 Tc [( Psychological first aid; disaster ministry; disaster mental health; disaster training curriculum; faith)]TJ 2.8567 -1.3333 TD 0.0089 Tw (community; spiritual caregiver; public health preparedness.)Tj ET /GS1 gs 66.99 171.765 m 558.51 171.765 l S BT /TT2 1 Tf 9 0 0 9 66.99 153.99 Tm /GS2 gs 0.1061 Tw [(The authors are indebted to the Maryland Department of Health and Mental Hygiene, especially )48.4(Al Romanosky)61.8(, MD, PhD \(Of)15.1(fice of)]TJ 0 -1.22 TD -0.0047 Tc 0.0944 Tw [(Preparedness and Response\) and Frank Monius \(Maryland Hospital )48.6(Association\), for the generous support of this project by a Spec)]TJ 53.6231 0 TD 0 Tw (ial)Tj -53.6231 -1.2233 TD 0.0019 Tc 0.1252 Tw (Projects grant from the National Bioterrorism Hospital Preparedness )Tj 28.7911 0 TD 0.0015 Tc 0.1256 Tw [(Program of the Health Resources and Services )51.9(Administration)]TJ -28.7911 -1.2233 TD -0.0056 Tc 0.0319 Tw [(\(HRSA\). Sincere thanks and appreciation are extended to the members of the Curriculum Development Committee and )7.6(W)88.2(orkgroups for)]TJ 0 -1.22 TD -0.0044 Tc 0.0117 Tw [(their creative contributions to the curriculum, especially )48.9(A)91.1(yanna Fews, MBA, Fr Richard Gray)62.3(, Howard S. Gwon, MS, Connie Noll, )]TJ 52.7568 0 TD -0.0041 Tc 0 Tw (MA,)Tj -52.7568 -1.2233 TD -0.0044 Tc 0.048 Tw [(RN-C, Cindy Parker)32.3(, MD, MPH, Marshall F)75.6(.)0.1( Prentice, M.Div)62.3(, DD, and Michael )15.5(T)66.4(orres, MD. Finally)62.3(, gratitude is owed Maria Johnson)]TJ 54.3633 0 TD 0 Tc 0 Tw (,)Tj -54.3633 -1.2233 TD -0.005 Tc -0.0226 Tw [(MA, of the Hispanic Ministry)58.3(, )51.6(Archdiocese of Baltimore, for her lead role in the English-to-Spanish language translation of the)]TJ 49.8019 0 TD -0.0051 Tc [( curriculum.)]TJ -49.8019 -1.22 TD 0.0026 Tc 0.125 Tw (Correspondence concerning this article should be sent to O. Lee McCabe, PhD, Department of Mental Health, The Johns Hopkins)Tj 0 -1.2233 TD -0.0085 Tc -0.0615 Tw [(Bloomber)14.8(g School of Public )]TJ 11.1737 0 TD -0.0077 Tc -0.0625 Tw [(Health, Hampton House, Room 896, 624 North Broadway)59(, Baltimore, MD 21205; email to: )]TJ ET 450 w 558.48 -834 m 486.84 -834 l S BT 9 0 0 9 486.84 66 Tm -0.0095 Tc 0 Tw (lmccabe@jhsph.edu)Tj /F1 1 Tf 14 0 0 14 116.25 688.35 Tm -0.0039 Tc 0.138 Tw [(Psychological Fir)11.1(st Aid )97.1(T)77.8(raining f)17.5(or the F)13.3(aith Comm)15.4(unity:)]TJ 9.1071 -1.1421 TD -0.0015 Tc 0.1375 Tw (A Model Curriculum)Tj /TT2 1 Tf 12 0 0 12 275.64 639.15 Tm -0.007 Tc 0.0188 Tw (O. Lee McCabe)Tj 10 0 0 10 168.39 626.49 Tm 0.0011 Tc -0.0139 Tw (Department of Mental Health and Center for Public Health Preparedness)Tj 3.411 -1.2 TD 0.0009 Tc -0.0214 Tw (The Johns Hopkins Bloomberg School of Public Health)Tj 10.35 -1.2 TD 0.0281 Tc 0 Tw (and)Tj -9.45 -1.2 TD 0.0017 Tc -0.007 Tw (Department of Psychiatry and Behavioral Sciences)Tj 2.214 -1.2 TD 0.0009 Tc 0.017 Tw (The Johns Hopkins School of Medicine)Tj 12 0 0 12 144.9 552.66 Tm -0.0292 Tc -0.0604 Tw (Jeffrey M. Lating)Tj 10 0 0 10 127.26 540 Tm 0.0021 Tc -0.0534 Tw (Loyola College in Maryland)Tj 12 0 0 12 390.66 551.64 Tm -0.0138 Tc -0.0605 Tw [(Geor)8.7(ge S. Everly)56.2(, Jr)48.7(.)]TJ 10 0 0 10 360.99 539.01 Tm 0.0011 Tc -0.0174 Tw [(Center for Public Health Preparedness)]TJ -3.45 -1.2 TD 0.0009 Tc -0.0214 Tw (The Johns Hopkins Bloomberg School of Public Health)Tj 12 0 0 12 140.49 501.66 Tm -0.0197 Tc -0.0604 Tw (Adrian M. Mosley)Tj 10 0 0 10 112.74 489 Tm 0.0012 Tc 0.02 Tw (The Johns Hopkins Health System)Tj 12 0 0 12 405.24 500.64 Tm -0.0164 Tc -0.06 Tw [(Paula J. )9(T)69.4(eague)]TJ 10 0 0 10 370.74 488.01 Tm 0.0013 Tc 0.0199 Tw [(The Johns Hopkins Health System)]TJ 12 0 0 12 142.5 462.66 Tm -0.0219 Tc -0.0604 Tw (Jonathan M. Links)Tj 10 0 0 10 83.25 450 Tm 0.001 Tc -0.03 Tw (Department of Environmental Health Sciences and)Tj 2.475 -1.2 TD 0.0012 Tc -0.0175 Tw [(Center for Public Health Preparedness)]TJ -3.45 -1.2 TD 0.0009 Tc -0.0214 Tw (The Johns Hopkins Bloomberg School of Public Health)Tj 12 0 0 12 389.91 462.66 Tm -0.026 Tc -0.0604 Tw (Michael J. Kaminsky)Tj 10 0 0 10 335.49 450 Tm 0.0017 Tc -0.007 Tw (Department of Psychiatry and Behavioral Sciences)Tj 2.217 -1.2 TD 0.0009 Tc 0.017 Tw (The Johns Hopkins School of Medicine)Tj ET endstream endobj 80 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 82 0 obj << /Length 8935 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.009 Tc 0 Tw (182)Tj /TT3 1 Tf 1.65 0 TD -0.0051 Tc 0.0875 Tw [( McCabe Psychological First Aid Training for the Faith Community)]TJ /TT2 1 Tf 10 0 0 10 72 721.65 Tm -0.0034 Tc -0.0128 Tw (Whether caused by natural forces, accidental events, or)Tj -1.8 -1.401 TD -0.0032 Tc 0.1214 Tw (intentional acts, public health disasters and mass casualty)Tj 0 -1.398 TD -0.003 Tc 0.0311 Tw (incidents can have a profound impact on the physical, psy-)Tj 0 -1.401 TD -0.0034 Tc 0.068 Tw [(chological, and spiritual life of human beings. )17.5(W)55.4(itness the)]TJ T* -0.0355 Tw (effects of the tsunami on the people of Indonesia, Sri Lanka,)Tj 0 -1.398 TD -0.0035 Tc -0.045 Tw [(South India, and Thailand in December of 2004, and of hur-)]TJ 0 -1.401 TD -0.0013 Tc 0.125 Tw (ricane Katrina on the residents of Louisiana, Mississippi,)Tj T* -0.0044 Tc -0.0622 Tw [(and )55.7(Alabama in )55.7(August of 2005. Recall the shock of terrorist)]TJ 0 -1.398 TD -0.0037 Tc 0.0254 Tw [(attacks on the United S)14.3(tates in September)35.3(, 2001, Madrid in)]TJ 0 -1.401 TD -0.0035 Tc 0.0629 Tw [(March, 2004, and London in July)62.5(, 2005. )14.6(Through graphic)]TJ T* 0.0071 Tc 0.125 Tw (images conveyed by daily media-coverage \(Barringer &)Tj 0 -1.398 TD -0.0033 Tc -0.0039 Tw (Fabricant, 2001\) and their impact sustained and spread by a)Tj 0 -1.401 TD 0.0258 Tw [(form of psychological contagion \(Lating, Sherman, Lowry)62.7(,)]TJ T* -0.0031 Tc -0.0323 Tw [(Everly)62.9(, & Per)14.9(gine, 2004\), these events, places, and dates are)]TJ 0 -1.398 TD 0.0425 Tw (enduringly etched in the collective memory of this genera-)Tj 0 -1.401 TD -0.0014 Tc 0 Tw (tion.)Tj 1.8 -2.001 TD -0.0036 Tc -0.0137 Tw (Experience in the United States and other countries has)Tj -1.8 -1.398 TD -0.0031 Tc -0.0025 Tw (shown repeatedly that following such disasters, particularly)Tj 0 -1.401 TD 0.0065 Tc 0.125 Tw (those occasioned by terrorist attacks, there is a surge of)Tj T* -0.0036 Tc 0.0378 Tw (demand for health services and resources to meet the emo-)Tj 0 -1.398 TD -0.0593 Tw [(tional and spiritual needs of victims \(Bowler)38.4(, Murai, & )14.5(T)37.2(r)0.3(ue,)]TJ 0 -1.401 TD -0.0037 Tc 0.0099 Tw [(2001; DeMartino, 2002; Galea, )50.2(Ahern, Resnick, Kilpatrick,)]TJ T* 0.0032 Tc 0.125 Tw (Bucuvalas, et al., 2002; North, Nixon, Shariat, Malonee,)Tj 0 -1.398 TD -0.0034 Tc 0.0956 Tw [(McMillen, et al., 1999; Schlenger)35.6(, Caddell, Ebert, Jordan,)]TJ 0 -1.401 TD 0.0079 Tc 0.125 Tw (Rourke, et al., 2002; Shalev & Solomon, 1996; Ursano,)Tj T* -0.0034 Tc -0.0163 Tw [(Norwood, Fullerton, Holloway)62.6(, & Hall, 2003; )14.7(W)97.4(atts, 1999\).)]TJ 0 -1.398 TD 0.0065 Tc 0.125 Tw (These reports have revealed that \(post-incident\) psycho-)Tj 0 -1.401 TD -0.0031 Tc -0.0143 Tw (logical symptoms are more prevalent than physical injuries,)Tj T* -0.0036 Tc -0.0225 Tw (and that certain populations are more vulnerable than others)Tj 0 -1.398 TD -0.0037 Tc 0.0394 Tw (for the development of both acute and chronic post-trauma)Tj 0 -1.401 TD 0.0832 Tw [(sequelae. )53.2(Among the subgroups observed to be at special)]TJ T* -0.0034 Tc 0.0439 Tw (risk for such difficulties are urban minorities of low socio-)Tj 0 -1.398 TD 0.0027 Tc 0.125 Tw (economic status who possess a disproportionate share of)Tj 0 -1.401 TD -0.0005 Tc (chronic medical problems and severe \(often inadequately)Tj T* -0.0059 Tc -0.0621 Tw (treated\) mental illness and substance abuse conditions \(IOM,)Tj 0 -1.398 TD -0.0022 Tc 0.125 Tw (2003; Lima, Pai, Santacruz, & Lozano, 1991; Pole, Best,)Tj 0 -1.401 TD -0.0232 Tc -0.0614 Tw [(Metzler)36.8(, & Marmar)36.8(, 2005\).)]TJ /F1 1 Tf 11 0 0 11 54 174 Tm -0.0041 Tc 0.0303 Tw (The Role of the Spiritual Caregiver in)Tj 0 -1.0909 TD -0.005 Tc 0.045 Tw [(Comm)14.1(unity T)74.2(rauma)]TJ /TT2 1 Tf 10 0 0 10 72 138.66 Tm -0.0036 Tc 0.0619 Tw (Experience has also shown that people often gather at)Tj -1.8 -1.401 TD 0.05 Tw (houses of worship or seek out spiritual or religious leaders)Tj T* -0.0034 Tc 0.0177 Tw (for psychological support in times of major and more com-)Tj 0 -1.398 TD 0.0008 Tc 0.1246 Tw [(monplace personal crises \(Koenig, 2006; Schuster)36.8(, S)12.8(tein,)]TJ 0 -1.401 TD -0.0032 Tc 0.0412 Tw [(Jaycox, Collins, Marshall, et al., 2001; )17.7(W)94.6(ang, Ber)17.8(glund, &)]TJ 25.5 63.801 TD -0.0089 Tc -0.0618 Tw [(Kessler)36.1(, 2003\). However)36.1(, irrefutable objective data af)18.1(firming)]TJ 0 -1.401 TD -0.0034 Tc -0.0036 Tw (the effectiveness of pastoral crisis interventions are lacking.)Tj T* -0.003 Tc 0.1127 Tw (While one may argue that the popularity of a service is a)Tj 0 -1.398 TD -0.0032 Tc 0.0669 Tw (proxy for its effectiveness, true science cannot advance on)Tj 0 -1.401 TD -0.0036 Tc 0.007 Tw (such premises, and the maxim, )Tj /TT5 1 Tf 12.51 0 TD 0.008 Tw (the plural of anecdote is not)Tj -12.51 -1.401 TD 0 Tw (data, )Tj /TT2 1 Tf 2.25 0 TD -0.0032 Tc -0.015 Tw [(seems especially relevant here. Data do exist suggest-)]TJ -2.25 -1.398 TD -0.0033 Tc -0.0245 Tw (ing that: a\) significant deficiencies exist in the mental health)Tj 0 -1.401 TD -0.0034 Tc -0.05 Tw (expertise of many religious leaders \(Domino, 1990\); b\) there)Tj T* -0.0061 Tc -0.0625 Tw (is considerable variation in their training \(Koenig, 1998\); and)Tj 0 -1.398 TD -0.0034 Tc 0.0727 Tw [(c\) cler)17.6(gy members, themselves, acknowledge the need for)35.6(,)]TJ 0 -1.401 TD -0.0035 Tc -0.035 Tw (and have substantial interest in receiving, additional training)Tj T* -0.0093 Tc -0.0621 Tw [(\()16.6(W)77.7(eaver)35.7(, Flannelly)59.7(, Larson, S)17.7(tapleton, & Koenig, 2002\). Re-)]TJ 0 -1.398 TD 0.002 Tc 0.1248 Tw [(grettably)62(, from the standpoints of both individual profes-)]TJ 0 -1.401 TD -0.0036 Tc -0.0114 Tw (sional growth and broader societal benefit, opportunities for)Tj T* 0.0086 Tw (specialized disaster training of spiritual caregivers and non-)Tj 0 -1.398 TD -0.0034 Tc -0.0175 Tw (mental health audiences, in general, have not been plentiful;)Tj 0 -1.401 TD -0.0033 Tc 0.0561 Tw (indeed, they tend to have been limited to public workforce)Tj T* -0.0036 Tc -0.0222 Tw (members such as fire, police, and EMS personnel.)Tj 1.8 -1.998 TD -0.0032 Tc 0.0587 Tw (An exception to the historical pattern of excluding lay)Tj -1.8 -1.401 TD -0.0036 Tc 0.0557 Tw (citizens and faith professionals from disaster mental health)Tj T* -0.0034 Tc -0.0505 Tw (training was provided in the form of a 2005 federally-funded)Tj 0 -1.398 TD -0.0192 Tw (grant program administered by the Maryland Department of)Tj 0 -1.401 TD -0.0033 Tc 0.1062 Tw [(Mental Hygiene. The Johns Hopkins Department of Psy-)]TJ T* 0.0964 Tw (chiatry and Behavioral Sciences, in partnership with other)Tj 0 -1.398 TD -0.0037 Tc 0.068 Tw (academic institutions and several faith-based organizations)Tj 0 -1.401 TD -0.0038 Tc 0.0908 Tw [(\(FBOs\), developed a program to train urban-based \(Chris-)]TJ T* -0.0078 Tc -0.0622 Tw (tian\) faith leaders in disaster mental health concepts and com-)Tj 0 -1.398 TD -0.0035 Tc 0.0204 Tw [(petencies \(McCabe, Mosley)62.5(, Gwon, Kaminsky)59.5(, 2007\). )17.9(The)]TJ 0 -1.401 TD 0.0673 Tw [(purpose of this article is to describe the unique curriculum)]TJ T* -0.0145 Tc -0.0622 Tw (that was developed for the training of these spiritual caregivers)Tj 0 -1.398 TD -0.0037 Tc 0.0656 Tw (who represented more than 100 separate parishes and con-)Tj 0 -1.401 TD 0.0084 Tc 0 Tw (gregations.)Tj /F1 1 Tf 11 0 0 11 309 243 Tm -0.0045 Tc 0.0443 Tw [(D)10.8(e)9.1(veloping a Special )93.7(T)80.1(raining Curriculum:)]TJ 0 -1.0909 TD -0.0052 Tc 0.0818 Tw (An Academic/Faith)Tj 11 0 2.3381 11 408 231 Tm 0 Tc 0 Tw ( )Tj 11 0 0 11 411.99 231 Tm -0.0048 Tc (Collaboration)Tj /TT2 1 Tf 10 0 0 10 327 207.66 Tm -0.0038 Tc -0.0611 Tw [(W)55(ith input from a Partnership S)17.2(teering Committee and a)]TJ -1.8 -1.401 TD -0.0239 Tc -0.0624 Tw [(Community )51.2(Advisory Board, a Curriculum Development Com-)]TJ T* -0.0038 Tc -0.0307 Tw (mittee composed of representatives from academic and faith)Tj 0 -1.398 TD -0.0041 Tc -0.0625 Tw (cultures designed a one-day training program with four mod-)Tj 0 -1.401 TD -0.0027 Tc 0.125 Tw (ules of 75-minutes each: Stress Reactions of Mind-Body-)Tj T* -0.0175 Tc -0.0621 Tw [(Spirit, Psychological First )51.5(Aid and Crisis Intervention, Pastoral)]TJ 0 -1.398 TD -0.0056 Tc [(Care and Disaster Ministry)63.4(, and Practical Resources and Self)]TJ 0 -1.401 TD -0.0035 Tc 0.1153 Tw [(Care for the Spiritual Caregiver)53.5(. )17.8(The topical content was)]TJ T* 0.0863 Tw (organized in a 200 \()Tj /TT5 1 Tf 8.274 0 TD -0.0046 Tc 0.09 Tw (Microsoft PowerPoint)Tj /TT2 1 Tf 8.922 0 TD -0.0036 Tc 0.0875 Tw (\) slide presenta-)Tj -17.196 -1.398 TD -0.0037 Tc 0.02 Tw [(tion. )53.3(Although mental health disaster information provided)]TJ ET endstream endobj 83 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 85 0 obj << /Length 8633 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 426.84 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (183)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0014 Tc 0.125 Tw (the core content of the curriculum, special effort was de-)Tj 0 -1.398 TD -0.0035 Tc 0.0794 Tw (voted to integrating religious and spiritual content into the)Tj 0 -1.401 TD -0.055 Tw [(training experience. This goal was accomplished in multiple)]TJ T* -0.0034 Tc 0.0806 Tw (ways; for example, photographs of churches and places of)Tj 0 -1.398 TD -0.0039 Tc 0.0486 Tw [(worship, along with quotations from New )14.1(T)72.9(estament scrip-)]TJ 0 -1.401 TD -0.0034 Tc 0.0905 Tw (ture selected on the basis of their relevance to the module)Tj T* -0.0033 Tc 0.0881 Tw [(topic, were incorporated into the slides. )50.7(Additionally)59.7(, and)]TJ 0 -1.398 TD -0.0036 Tc 0.0092 Tw [(perhaps most importantly)62.4(, training sessions were conducted)]TJ 0 -1.401 TD 0.0025 Tc 0 Tw (by )Tj /TT5 1 Tf 1.335 0 TD -0.0043 Tc 0.085 Tw (two-trainer teams)Tj /TT2 1 Tf 7.155 0 TD -0.0037 Tc 0.0843 Tw [( one member an expert in disaster)]TJ -8.49 -1.401 TD -0.0034 Tc -0.005 Tw (mental health \(one of two clinical psychologists with exten-)Tj 0 -1.398 TD -0.0035 Tc -0.0344 Tw (sive, real-world disaster experience\) and the other a member)Tj 0 -1.401 TD -0.0031 Tc 0.0873 Tw [(of the cler)14.9(gy \(one of six ordained ministers or priests\). )50.9(A)]TJ T* -0.0036 Tc 0.0656 Tw (given trainer in these two-person teams would either teach)Tj 0 -1.398 TD -0.0032 Tc -0.0515 Tw (the entirety of a certain content module, or would function in)Tj 0 -1.401 TD -0.0035 Tc 0.0366 Tw (tandem with the other trainer; the latter approach was most)Tj T* -0.0037 Tc 0.0995 Tw [(often used with Module III [see below]. For readers who)]TJ 0 -1.398 TD -0.0036 Tc 0.0863 Tw (might be interested in constructing their own training pro-)Tj 0 -1.401 TD -0.0032 Tc 0.1042 Tw (gram for disaster ministry and pastoral crisis intervention,)Tj T* -0.0036 Tc -0.0061 Tw (the following model is offered as a framework for consider-)Tj 0 -1.398 TD 0.0001 Tc 0 Tw (ation.)Tj /F1 1 Tf 11 0 0 11 66 415.2 Tm -0.0052 Tc 0.1091 Tw (The Curriculum)Tj /TT2 1 Tf 10 0 0 10 84 391.86 Tm -0.0021 Tc 0.125 Tw (The actual training curriculum is described below by)Tj -1.8 -1.401 TD -0.0038 Tc 0.0165 Tw (detailing for each module its intended purpose; background)Tj T* -0.0035 Tc 0.1107 Tw (and rationale for the content selected; learning objectives;)Tj 0 -1.398 TD 0.0069 Tc 0.125 Tw (topics and sub-topics covered; and educational methods,)Tj 0 -1.401 TD -0.0037 Tc -0.0115 Tw (materials and resources used. Each module description ends)Tj T* 0.0367 Tw (with a comment designed to elaborate on an important fea-)Tj 0 -1.398 TD -0.0034 Tc 0.0593 Tw (ture associated with the teaching of that content.)Tj /F1 1 Tf 11 0 0 11 66 275.19 Tm -0.0044 Tc 0.0191 Tw (Module I: Stress Reactions of Mind-Body-)Tj 0 -1.0909 TD 0.007 Tc 0 Tw (Spirit)Tj /TT5 1 Tf 0 -1.5136 TD 0.0354 Tc (Purpose)Tj /TT2 1 Tf 10 0 0 10 84 226.86 Tm -0.0036 Tc 0.075 Tw (The purpose of this module was to raise awareness of)Tj -1.8 -1.401 TD -0.0033 Tc -0.0128 Tw [(the interrelationships among mind, body)62.7(, and spirit, particu-)]TJ T* -0.003 Tc 0.1066 Tw (larly as stress may be manifested in and resolved through)Tj 0 -1.398 TD -0.0037 Tc 0.0825 Tw (those aspects of human nature.)Tj /TT5 1 Tf 11 0 0 11 66 151.56 Tm 0.0232 Tc 0.1252 Tw [(Backgr)36.8(ound and Rationale)]TJ /TT2 1 Tf 10 0 0 10 84 131.85 Tm -0.0034 Tc 0.0138 Tw (This content was chosen because some of the physical,)Tj -1.8 -1.401 TD -0.0166 Tc -0.0621 Tw (emotional, cognitive, behavioral, and spiritual signs and symp-)Tj 0 -1.398 TD -0.0036 Tc -0.0193 Tw (toms of disaster-induced stress reactions, although not with-)Tj 0 -1.401 TD -0.0034 Tc 0.12 Tw (out adaptive functions serving survival, may leave people)Tj T* -0.0033 Tc 0.0071 Tw [(experiencing confusion, feeling uneasy)62.7(, and lacking a sense)]TJ 25.5 64.68 TD -0.0031 Tc 0.0604 Tw [(of control. )50.7(An overview of the basic anatomy and physiol-)]TJ 0 -1.398 TD 0.0015 Tc 0.125 Tw (ogy of the human stress response, using the metaphor of)Tj /TT5 1 Tf 0 -1.401 TD -0.0035 Tc 0.0324 Tw (crisis as toxin)Tj /TT2 1 Tf 5.571 0 TD -0.0034 Tc 0.0336 Tw (, allowed for the introduction of the principle)Tj -5.571 -1.401 TD -0.0038 Tc 0.0671 Tw (that information is empowering, and that knowledge about)Tj 0 -1.398 TD -0.0028 Tc 0.0145 Tw (reactions of the mind and body to crises may actually serve)Tj 0 -1.401 TD -0.0031 Tc 0.0279 Tw (as an antidote in mitigating dysfunctional reactions \(Everly)Tj T* -0.0034 Tc -0.009 Tw [(& Mitchell, 2002\). It was noted that unresolved stress reac-)]TJ 0 -1.398 TD 0.0019 Tw (tions may accumulate and result in sustained disorders such)Tj 0 -1.401 TD -0.0037 Tc 0.0412 Tw (as Posttraumatic Stress Disorder \(PTSD\), which can be ac-)Tj T* -0.0032 Tc 0.0783 Tw (companied by substance use conditions, refractory depres-)Tj 0 -1.398 TD -0.0034 Tc 0.01 Tw (sion and, in some rare occurrences, suicide.)Tj 1.8 -2.001 TD -0.0035 Tc 0.0164 Tw (Stress has been conceptualized and defined from many)Tj -1.8 -1.401 TD -0.0151 Tc -0.0622 Tw (different perspectives derived primarily from the seminal writ-)Tj 0 -1.398 TD -0.0031 Tc 0.0027 Tw (ings of Hans Selye \(1956\). For the purpose of this training,)Tj 0 -1.401 TD -0.0034 Tc -0.0322 Tw (stress was conceptualized as a dynamic process in which the)Tj T* -0.0032 Tc 0.1143 Tw (central nervous system and the peripheral nervous system)Tj 0 -1.398 TD 0.1014 Tw (\(i.e., the autonomic nervous system and its accompanying)Tj 0 -1.401 TD -0.0033 Tc 0.065 Tw (sympathetic and parasympathetic branches\) produce an in-)Tj T* -0.0072 Tc -0.0625 Tw (tegrated cognitive, affective, and physiological response that,)Tj 0 -1.398 TD -0.0031 Tc -0.045 Tw (if excessive enough, may lead to target-organ dysfunction or)Tj 0 -1.401 TD -0.003 Tc 0.1162 Tw [(pathology \(Guyton, 1992\). There are several models that)]TJ T* 0.0003 Tc 0.1249 Tw (describe the hypothesized link between excessive arousal)Tj 0 -1.398 TD -0.0035 Tc 0.0392 Tw [(and manifestation of disease; however)35.5(, Selye)50.5(s master con-)]TJ 0 -1.401 TD 0.0144 Tc 0.125 Tw (cept, termed the general-adaptation-syndrome \(1956\),)Tj T* -0.0035 Tc 0.0078 Tw (which involves stages of alarm, resistance \(adaptation\), and)Tj 0 -1.398 TD -0.003 Tc 0.0133 Tw (exhaustion, is probably the most widely accepted.)Tj 1.8 -2.001 TD -0.0083 Tc -0.0622 Tw (In addition to this foundational anatomic and physiologi-)Tj -1.8 -1.401 TD -0.0034 Tc 0.0023 Tw [(cal overview)62.6(, examples were shared of the growing body of)]TJ 0 -1.398 TD -0.0064 Tc -0.0622 Tw (literature that highlights a correlation between faith, religious)Tj 0 -1.401 TD -0.0033 Tc 0.0772 Tw (practice, and health status \(e.g., Levin, 1994; Strawbridge,)Tj T* -0.011 Tc -0.0622 Tw [(Cohen, Shema, & Kaplan, 1997\). While clear causative infer-)]TJ 0 -1.398 TD -0.0035 Tc 0.0557 Tw (ences between faith and health require additional scientific)Tj 0 -1.401 TD -0.0036 Tw (validation and explication, such findings provide a coherent)Tj T* 0.1107 Tw [(rationale for understanding and ameliorating the stress re-)]TJ 0 -1.398 TD 0.0381 Tw [(sponse. )14.5(The integrative bio-psycho-spiritual model \(T)65.4(orres,)]TJ 0 -1.401 TD -0.0032 Tc 0.06 Tw (2005\), introduced as a theoretically compatible part of this)Tj T* -0.0068 Tc -0.0625 Tw [(training, hypothesizes that \(ideally\) the mind, body)62.2(, and spirit)]TJ 0 -1.398 TD -0.0035 Tc -0.055 Tw (operate in an interacting, integrative manner to produce opti-)Tj 0 -1.401 TD -0.0038 Tc -0.028 Tw (mal functioning within the socio-cultural environment.)Tj 1.8 -2.001 TD -0.0035 Tc -0.0608 Tw (From a pathological stress perspective, critical incidents)Tj -1.8 -1.398 TD -0.0023 Tc -0.0312 Tw (may lead to a )Tj /TT5 1 Tf 5.454 0 TD -0.0041 Tc -0.035 Tw (crisis response)Tj /TT2 1 Tf 5.88 0 TD -0.0035 Tc -0.032 Tw [( \(an acute emotional reaction to)]TJ -11.334 -1.401 TD -0.0044 Tc -0.0625 Tw [(a stimulus or demand; Everly & Mitchell, 1999\) and have the)]TJ T* -0.0036 Tc 0.0244 Tw (potential to overwhelm the coping abilities of an individual)Tj 0 -1.398 TD -0.0068 Tc -0.0625 Tw (or group. The adult lifetime prevalence for exposure to one or)Tj 0 -1.401 TD -0.0075 Tc (more traumatic events or critical incidents has been estimated)Tj T* -0.0033 Tc 0.0444 Tw (to be approximately 90% in an urban community \(Breslau,)Tj ET endstream endobj 86 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 88 0 obj << /Length 8240 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.009 Tc 0 Tw (184)Tj /TT3 1 Tf 1.65 0 TD -0.0051 Tc 0.0875 Tw [( McCabe Psychological First Aid Training for the Faith Community)]TJ /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0037 Tc -0.047 Tw [(Chilcoat, Kessler)35.3(, & Davis, 1999\). )17.4(The estimated prevalence)]TJ 0 -1.398 TD -0.0035 Tc 0.008 Tw (rate of PTSD for the general adult population has been esti-)Tj 0 -1.401 TD -0.0191 Tw [(mated to be approximately 8% \(American Psychiatric )50.7(Asso-)]TJ T* 0.059 Tc 0.1325 Tw [(ciation, 1994\); however)38(, this estimate increases to)]TJ 0 -1.398 TD -0.0064 Tc -0.0625 Tw (approximately 34% in the case of mass disasters \(North et al.,)Tj 0 -1.401 TD -0.0084 Tc -0.0622 Tw [(1999\). Excessive use of legal and illegal chemical substances)]TJ T* -0.0036 Tc 0.1219 Tw (can be concomitant with symptoms of PTSD, and reports)Tj 0 -1.398 TD 0.0673 Tw (indicate that 30% to 80% of patients seeking treatment for)Tj 0 -1.401 TD -0.0038 Tc 0.0312 Tw (PTSD have concurrent diagnoses of substance abuse or de-)Tj T* -0.0064 Tc -0.0622 Tw [(pendency \(Branchey)62.6(, Davis, & Lieber)38.6(, 1984; Keane, Gerardi,)]TJ 0 -1.398 TD -0.0168 Tc -0.0625 Tw [(L)60(yons, & )16.2(W)96(olfe, 1988; Najavits, )19.2(W)90(eiss, & Shaw)64.2(, 1997\). More-)]TJ 0 -1.401 TD -0.0048 Tc -0.0621 Tw [(over)34.2(, there have been anecdotal accounts of suicides of emer)16.2(-)]TJ T* -0.0033 Tc -0.0607 Tw (gency service workers following a natural disaster \(Mitchell,)Tj 0 -1.398 TD -0.0126 Tc -0.0622 Tw [(Schiller)35.4(, Eyler)38.4(, & Everly)62.4(, 1999\) and, in a recent nationally rep-)]TJ 0 -1.401 TD 0.0126 Tc 0.125 Tw (resentative comorbidity survey of anxiety disorders and)Tj T* -0.0029 Tc -0.0401 Tw [(suicidality)63.1(, PTSD was the only disorder significantly associ-)]TJ 0 -1.398 TD -0.0097 Tc -0.0625 Tw (ated with both suicidal ideation and suicidal attempts \(Sareen,)Tj 0 -1.401 TD -0.0066 Tc -0.0623 Tw [(Houlahan, Cox, & )53.6(Asmundson, 2005\).)]TJ /TT5 1 Tf 11 0 0 11 54 451.35 Tm 0.0219 Tc 0.1273 Tw (Learning Objectives)Tj /TT2 1 Tf 10 0 0 10 66 431.64 Tm 0.0071 Tc 0.125 Tw [()-1442.8(T)71.9(o have a greater understanding of the signs and)]TJ 1.8 -1.398 TD -0.0034 Tc 0.095 Tw (symptoms of stress)Tj -1.8 -2.001 TD -0.0091 Tc -0.0625 Tw [()-1459(T)70.7(o become aware of the bio-psycho-spiritual model)]TJ 1.8 -1.401 TD -0.0032 Tc -0.0225 Tw (of analyzing the effects of stress on human function-)Tj 0 -1.398 TD -0.0014 Tc 0 Tw (ing)Tj -1.8 -2.001 TD -0.0033 Tc -0.01 Tw [()-1453.2(T)73.5(o be able to recognize suicidal risk factors)]TJ T* -0.0035 Tc 0.0064 Tw [()-1453.4(T)73.3(o be able to describe posttraumatic stress disorders)]TJ 0 -1.998 TD -0.0144 Tc -0.0625 Tw [()-1464.3(T)71.4(o better comprehend the relationship between trauma)]TJ 1.8 -1.401 TD -0.0036 Tc 0.125 Tw (and certain substance use conditions)Tj /TT5 1 Tf 11 0 0 11 54 262.35 Tm 0.0157 Tc 0.1257 Tw [(Content T)83.9(opics and Sub-T)89.3(opics)]TJ /TT2 1 Tf 10 0 0 10 66 242.64 Tm -0.0037 Tc 0.087 Tw [()-1453.6(Overview of basic stress response patterns)]TJ 0 -1.998 TD 0.0014 Tc 0.125 Tw [()-1448.5(Routine signs and symptoms of stress \(autonomic)]TJ 1.8 -1.401 TD -0.0026 Tc (nervous system reactions\))Tj -1.8 -2.001 TD -0.0035 Tc -0.0164 Tw [()-1453.4(Other common expected reactions to stress \(e.g., an-)]TJ 1.8 -1.398 TD -0.0172 Tc -0.0593 Tw [(ger)39.8(, irritability\))]TJ -1.8 -2.001 TD -0.0031 Tc 0.107 Tw [()-1453(Disruptive latter-stage reactions \(e.g., physical and)]TJ 1.8 -1.401 TD -0.0037 Tc -0.0436 Tw [(mental breakdowns\): Suicide: epidemiology)59.3(, etc; )53.7(Al-)]TJ 0 -1.398 TD 0.0065 Tc 0.125 Tw (cohol/substance use conditions)Tj -1.8 -2.001 TD -0.0122 Tc -0.0625 Tw [()-1462.1(Critical Incident Stress: Definitions of critical incident)]TJ 1.8 -1.401 TD -0.0105 Tc -0.062 Tw (and crisis; Crisis response characteristics; Impairment)Tj 0 -1.398 TD 0.0091 Tc 0 Tw (factors)Tj 23.7 64.398 TD -0.0191 Tc -0.062 Tw [()-1469(Posttraumatic Stress Disorder: Essential elements; Key)]TJ 1.8 -1.398 TD -0.0038 Tc 0.08 Tw (characteristics; & Trauma and substance abuse)Tj -1.8 -2.001 TD -0.0032 Tc -0.02 Tw [()-1453.1(Recognition of how stress and fear may spread \(e.g.,)]TJ 1.8 -1.401 TD -0.0029 Tc 0.125 Tw (psychological contagion\))Tj /TT5 1 Tf 11 0 0 11 309 641.34 Tm 0.0164 Tc [(Educational Methods, Materials and Resour)35.5(ces)]TJ /TT2 1 Tf 10 0 0 10 321 621.66 Tm 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0055 Tc (Methods)Tj /TT2 1 Tf 3.411 0 TD -0.0037 Tc -0.035 Tw (: Lecture using slides; brief Q&A under two)Tj -3.411 -1.401 TD -0.0013 Tc 0.125 Tw [(conditions [see Comment]; personal accounts by)]TJ T* -0.0058 Tc -0.0625 Tw (mental health trainers of experiences providing direct)Tj 0 -1.398 TD -0.0034 Tc 0.0275 Tw (help to disaster survivors of terrorist attacks of 9/11)Tj 0 -1.401 TD -0.0101 Tc -0.0625 Tw [(and Oklahoma City)58.9(.)]TJ -1.8 -2.001 TD 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0042 Tc 0.0281 Tw [(Materials and Resour)28.8(ces )]TJ /TT2 1 Tf 10.206 0 TD -0.004 Tc 0.0286 Tw [([provided in a T)68(ool Kit]:)]TJ -10.206 -1.398 TD -0.0035 Tc 0.1031 Tw (Besides hard copies of the overhead slides for this)Tj 0 -1.401 TD -0.0092 Tc -0.0625 Tw (and all modules, participants were given a binder with)Tj T* -0.0034 Tc -0.0619 Tw [(copies of journal articles and other readings; Internet)]TJ 0 -1.398 TD -0.0036 Tc -0.0343 Tw [(information and web site addresses; and a bibliogra-)]TJ 0 -1.401 TD -0.0031 Tc -0.03 Tw (phy of disaster mental health literature, publications,)Tj T* 0.0044 Tc 0.125 Tw [(and other resources \(e.g., videos, brochures, fact)]TJ 0 -1.398 TD -0.0035 Tc -0.049 Tw (sheets\) related to all-hazards preparedness, response,)Tj 0 -1.401 TD -0.0029 Tc 0.055 Tw [(and recovery)60.1(.)]TJ /TT5 1 Tf -1.2 -2.001 TD -0.0059 Tc 0 Tw (Comment:)Tj /TT2 1 Tf 4.125 0 TD -0.0034 Tc -0.0224 Tw [( )50.2(An ef)14.6(fort was made to begin the training day)]TJ -5.925 -1.398 TD -0.0032 Tc 0.0065 Tw [(by evoking emotion that would create a felt need and affec-)]TJ 0 -1.401 TD 0.0398 Tw [(tive receptivity for the information to follow)62.8(. )18.1(This was ac-)]TJ T* 0.0092 Tc 0.125 Tw [(complished by initially presenting slides of photographs)]TJ 0 -1.398 TD -0.0031 Tc (portraying actual disaster events, following which partici-)Tj 0 -1.401 TD -0.0035 Tc -0.0244 Tw (pants were asked to describe their emotional reactions to the)Tj T* -0.003 Tc -0.055 Tw (events viewed; this exercise routinely elicited reports of dys-)Tj 0 -1.398 TD -0.0034 Tc 0.0927 Tw [(phoric emotions \(sadness, grief, anger)38.6(, etc\). )14.8(The identical)]TJ 0 -1.401 TD -0.0035 Tc 0.0493 Tw (slide images were presented again but with accompanying,)Tj T* -0.018 Tc -0.0621 Tw (overlaid prayers or scriptural references, following which there)Tj 0 -1.398 TD -0.0038 Tc (was the same inquiry about emotional reactions; respondents)Tj 0 -1.401 TD -0.0054 Tc (uniformly indicated that the juxtapositioning of the religious/)Tj T* -0.0034 Tc -0.0531 Tw (spiritual content with the previously disturbing images in the)Tj 0 -1.398 TD -0.0036 Tc 0.019 Tw (overheads had a calming, consoling effect.)Tj 1.8 -2.001 TD 0.002 Tw (The bio-psycho-spiritual model of understanding stress)Tj -1.8 -1.401 TD -0.0031 Tc -0.0114 Tw [(was a ready fit for the faith community)50.9(s acceptance of man)]TJ 0 -1.398 TD -0.003 Tc 0.0206 Tw [(as Mind, Body)60(, and Spirit. )18(This culturally appropriate con-)]TJ 0 -1.401 TD -0.0033 Tc -0.005 Tw (cept enabled participants not only to understand the interac-)Tj T* -0.0086 Tc -0.0621 Tw (tion between the component-dimensions but also to introduce)Tj 0 -1.398 TD -0.0036 Tc 0.0084 Tw (the concept of )Tj /TT5 1 Tf 5.889 0 TD -0.0038 Tc 0.0098 Tw (disaster ministry)Tj /TT2 1 Tf 6.642 0 TD -0.0034 Tc 0.0111 Tw [(. )18.7(The interactive theoretical)]TJ -12.531 -1.401 TD -0.0031 Tc 0.0278 Tw [(approach of how the mind, body)62.9(, and spirit functionally in-)]TJ T* 0.035 Tw (teract helped participants to more readily see their need for)Tj 0 -1.398 TD -0.0136 Tw (psychological first aid and crisis intervention skills training.)Tj ET endstream endobj 89 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 91 0 obj << /Length 8461 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 426.84 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (185)Tj 11 0 0 11 66 723.99 Tm -0.0041 Tc 0.0106 Tw (Module II: Psychological First Aid and Crisis)Tj 0 -1.0909 TD 0.0004 Tc 0 Tw (Intervention)Tj /TT5 1 Tf 0 -1.5136 TD 0.0354 Tc (Purpose)Tj /TT2 1 Tf 10 0 0 10 84 675.66 Tm -0.0036 Tc 0.095 Tw (This content area was meant to increase awareness in)Tj -1.8 -1.401 TD -0.0037 Tc -0.0622 Tw (the faith-based community of the principles of psychological)Tj T* -0.0033 Tc 0.03 Tw [(first aid and crisis intervention and, correspondingly)59.7(, to en-)]TJ 0 -1.398 TD -0.0034 Tc -0.012 Tw (hance participants confidence and perceived self-efficacy)Tj 0 -1.401 TD -0.0037 Tc 0.0936 Tw [(\(Bandura, 1997\) in incorporating PF)71.3(A)58.5( principles into their)]TJ T* -0.0035 Tc -0.0071 Tw (repertoire of pastoral crisis intervention techniques in disas-)Tj 0 -1.398 TD 0.03 Tw (ter contexts.)Tj /TT5 1 Tf 11 0 0 11 66 553.35 Tm 0.0232 Tc 0.1252 Tw [(Backgr)36.8(ound and Rationale)]TJ /TT2 1 Tf 10 0 0 10 84 533.64 Tm -0.0051 Tc -0.0625 Tw (Considering the frequently observed surge in attendance)Tj -1.8 -1.398 TD -0.0036 Tc 0.0683 Tw [(at houses of worship following a disaster)35.4(, it seems reason-)]TJ 0 -1.401 TD 0.0981 Tw (able that members of the spiritual community should pos-)Tj T* 0.0088 Tc 0.125 Tw (sess the essential foundations for helping those who are)Tj 0 -1.398 TD -0.0033 Tc -0.0093 Tw (experiencing emotional difficulty either to cope more effec-)Tj 0 -1.401 TD -0.0032 Tc 0.0648 Tw [(tively)62.8(, or the foundations for knowing when to refer to the)]TJ T* -0.0043 Tc -0.0617 Tw (next level of care.)Tj 1.8 -1.998 TD -0.0036 Tc -0.01 Tw (According to the Institute of Medicine \(2003\),)Tj /TT5 1 Tf 0.3 -2.001 TD -0.0006 Tc 0.125 Tw (In the past decade, there has been a growing)Tj 0 -1.401 TD -0.0037 Tc -0.0262 Tw (movement in the world to develop a concept simi-)Tj 0 -1.398 TD -0.0034 Tc 0.07 Tw (lar to physical first aid for coping with stressful)Tj 0 -1.401 TD 0.0076 Tc 0.125 Tw (and traumatic events in life. 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2006\))]TJ -5.88 -1.401 TD -0.0037 Tc 0.045 Tw (taught in this program has undergone revision since imple-)Tj ET endstream endobj 92 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 94 0 obj << /Length 8170 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.009 Tc 0 Tw (186)Tj /TT3 1 Tf 1.65 0 TD -0.0051 Tc 0.0875 Tw [( McCabe Psychological First Aid Training for the Faith Community)]TJ /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0037 Tc -0.0449 Tw [(mentation of the project. )17.4(The revised PF)71.3(A)58.5( model, developed)]TJ 0 -1.398 TD -0.015 Tc -0.0625 Tw [(by one of the authors \(GSE\) and Cindy L. Parker)36(, MD, MPH at)]TJ 0 -1.401 TD -0.0026 Tc 0.125 Tw (the Johns Hopkins Center for Public Health Preparedness)Tj T* -0.0039 Tc 0.065 Tw (\(CPHP\), is anchored to evidence-informed core competen-)Tj 0 -1.398 TD -0.0183 Tc -0.0622 Tw [(cies \(Parker)38.7(, Barnett , Everly)62.7(, & Links, 2006\). )15(The component-)]TJ 0 -1.401 TD -0.0013 Tc 0.125 Tw (interventions are organized under the acronym RAPID,)Tj T* -0.0036 Tc 0.0002 Tw [(\(Everly)62.4(, 2007\) as follows: Reflective listening; )50.6(Assessment;)]TJ 0 -1.398 TD 0.0086 Tw (Prioritization \(of needs\); Intervention \(to manage stress and)Tj 0 -1.401 TD 0.0233 Tw (instill hope\); and Disposition.)Tj /F1 1 Tf 11 0 0 11 54 578.01 Tm -0.0042 Tc 0.0137 Tw (Module III: Pastoral Care and Disaster)Tj 0 -1.0909 TD -0.0023 Tc 0 Tw (Ministry)Tj /TT5 1 Tf 0 -1.5136 TD 0.0354 Tc (Purpose)Tj /TT2 1 Tf 10 0 0 10 72 529.65 Tm -0.0035 Tc -0.0455 Tw (The purpose of this content area was to provide an over-)Tj -1.8 -1.401 TD -0.0034 Tc 0.063 Tw (view of pastoral care in the context of disasters and public)Tj 0 -1.398 TD -0.0033 Tc 0.0962 Tw (health crises, along with a description of the spiritual/reli-)Tj 0 -1.401 TD -0.0038 Tc 0.04 Tw [(gious dimensions of a disaster)50.2(.)]TJ /TT5 1 Tf 11 0 0 11 54 454.35 Tm 0.0232 Tc 0.1252 Tw [(Backgr)36.8(ound and Rationale)]TJ /TT2 1 Tf 10 0 0 10 72 434.64 Tm -0.0038 Tc 0.045 Tw (Although pastoral counseling services have often been)Tj -1.8 -1.398 TD -0.003 Tc -0.031 Tw (used in the wake of community crises and disasters, they are)Tj 0 -1.401 TD -0.0035 Tc -0.0621 Tw [(not by definition crisis intervention services \(Everly)59.5(, 2000b\).)]TJ T* -0.0033 Tc 0.0533 Tw (Given the value that faith-based resources may have in the)Tj 0 -1.398 TD -0.0031 Tc -0.0225 Tw (aftermath of crises, pastoral care and disaster ministry entail)Tj 0 -1.401 TD -0.0014 Tc 0.125 Tw (the functional integration of pastoral activities with tradi-)Tj T* -0.0222 Tc -0.0624 Tw [(tional crisis intervention services. )52.9(According to Sinclair \(1993\),)]TJ 0 -1.398 TD -0.0031 Tc 0.02 Tw (and contrary to some often held pastoral beliefs, not all cri-)Tj 0 -1.401 TD 0.0289 Tw (ses are viewed from the perspective of spirituality or theol-)Tj T* -0.0033 Tc -0.0027 Tw [(ogy)62.7(. Crises may also manifest themselves in more mundane)]TJ 0 -1.398 TD 0.0047 Tc 0.1249 Tw [(concerns related to personal safety)64.7(, security)61.7(, and welfare)]TJ 0 -1.401 TD -0.0187 Tc -0.062 Tw [(\(Everly & Lating, 2004; Lerner)35.3(, 1980\).)]TJ 1.8 -2.001 TD -0.0031 Tc 0.0077 Tw [(Pastoral care as a discipline is relatively new and )-6.4(it has)]TJ -1.8 -1.398 TD -0.0067 Tc -0.0623 Tw (typically been viewed separately from the field of crisis inter-)Tj 0 -1.401 TD -0.0033 Tc 0.0807 Tw (vention and psychological first aid. 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In addition, pastoral crisis inter-)]TJ 0 -1.398 TD -0.0075 Tc -0.0621 Tw [(ventionists may benefit from theological or divine credibility)61.5(,)]TJ 0 -1.401 TD -0.0029 Tc -0.0521 Tw [(and may tactfully employ)60.1(, where appropriate, scriptural edu-)]TJ T* -0.0033 Tc -0.0617 Tw (cation and reinterpretation \(Brende, 1991\), prayer \(including)Tj 0 -1.398 TD -0.0031 Tc -0.0236 Tw (intercessory prayer\), or forms of confession and forgiveness)Tj 0 -1.401 TD 0.025 Tw [(in a uniquely confidential and privileged exchange \(Everly)59.8(,)]TJ T* -0.0035 Tw [(2000b\). )50.9(As later noted by Everly \(2004\) and emphasized in)]TJ 0 -1.398 TD -0.0021 Tc 0.125 Tw (the training, in order to mitigate iatrogenic risks, pastoral)Tj 0 -1.401 TD -0.0015 Tc (crisis interventionists should be cautious about using cer-)Tj T* 0.0017 Tc (tain tactics. 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The Role of Pastoral Crisis Inter)14.5(-)]TJ T* 0.005 Tw [(vention in Disasters, )17.4(T)70.2(errorism, )17.4(V)64.6(iolence, and Other)]TJ 0 -1.398 TD -0.0064 Tc -0.0619 Tw [(Community Crises, and Everly)62.6(, G)113.6(.)0.7( \(2003\). Pastoral)]TJ 0 -1.401 TD -0.0037 Tc 0.1208 Tw [(Crisis Intervention in Response to )17.3(T)70.1(errorism, and)]TJ T* -0.0038 Tc -0.0449 Tw [(McPherson, K.F)77.2(. \(2004\). Pastoral Crisis Intervention)]TJ 0 -1.398 TD 0.0925 Tw [(with Children: Recognizing and Responding to the)]TJ 0 -1.401 TD -0.0036 Tc -0.0413 Tw (Spiritual Reaction of Children all from the )Tj /TT5 1 Tf 18.444 0 TD -0.0042 Tc 0 Tw (Inter-)Tj ET endstream endobj 95 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 97 0 obj << /Length 9018 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 426.84 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (187)Tj /TT5 1 Tf 10 0 0 10 96 722.64 Tm -0.004 Tc 0.084 Tw (national Journal of Emergency Mental Health)Tj /TT2 1 Tf 18.774 0 TD -0.0047 Tc 0.085 Tw [( [see)]TJ -18.774 -1.398 TD -0.0044 Tc -0.018 Tw (REFERENCES]. Standards of Care for Disasters:)Tj 0 -1.401 TD -0.0069 Tc -0.0625 Tw (Spiritual Care Ministries and Spiritual Care: Bring-)Tj T* -0.0045 Tc -0.0614 Tw [(ing God)52.5(s Peace to Disasters from the )]TJ /TT5 1 Tf 15.204 0 TD -0.0075 Tc -0.0635 Tw [(Chur)28.5(ch W)79.5(orld)]TJ -15.204 -1.398 TD 0.0582 Tc 1.0667 Tw (Service Emergency Response Program)Tj /TT2 1 Tf 0 -1.401 TD -0.0063 Tc 0 Tw [([www)59.7(.churchworldservice.or)11.7(g/resources.html].)]TJ /TT5 1 Tf -1.2 -2.001 TD -0.0053 Tc (Comment: )Tj /TT2 1 Tf 4.464 0 TD -0.0035 Tc 0.0914 Tw (During the teaching of this module, a con-)Tj -6.264 -1.398 TD -0.0313 Tw (certed effort was made to emphasize that disaster ministry)Tj 0 -1.401 TD 0.1222 Tw (was a growing and specialized area of potential focus for)Tj T* -0.0029 Tc 0.0581 Tw (clergy and lay leaders of congregations, with clear distinc-)Tj 0 -1.398 TD -0.0036 Tc 0.0428 Tw (tions needing to be drawn between pastoral care and disas-)Tj 0 -1.401 TD -0.0034 Tc -0.025 Tw (ter pastoral care. More than with other modules, this content)Tj T* -0.003 Tc 0.0272 Tw (was delivered by both the mental health and clergy trainers)Tj 0 -1.398 TD -0.0037 Tc -0.0622 Tw [(in sequential or alternating formats. Greater variation of pre-)]TJ 0 -1.401 TD -0.0032 Tc -0.0586 Tw (sentation styles was observed among the clergy-trainers than)Tj T* -0.0036 Tc 0.0043 Tw (the mental health professionals, with their approaches rang-)Tj 0 -1.398 TD -0.0033 Tc -0.0293 Tw (ing from traditional, one-direction lecture methods to highly)Tj 0 -1.401 TD 0.0614 Tw (interactive exchanges where statements by the faith trainer)Tj T* -0.0035 Tc 0.0675 Tw (were punctuated by validating audience vocalizations such)Tj 0 -1.398 TD -0.0041 Tc -0.0575 Tw [(as Amen, Y)103.1(es, God willing, etc.)]TJ 1.8 -2.001 TD -0.0031 Tc 0.0367 Tw (The variation in the trainers styles indicated a need to)Tj -1.8 -1.401 TD -0.0034 Tc -0.0428 Tw (match the trainer to the theological and religious practices of)Tj 0 -1.398 TD -0.0029 Tc -0.0005 Tw (the participants in such a way that these aspects of diversity)Tj 0 -1.401 TD -0.0036 Tc 0.0479 Tw (were integrated into the proposed interventions for disaster)Tj T* -0.0016 Tc 0.125 Tw [(pastoral care. 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Moreover)38.2(, given the demand-)]TJ 0 -1.401 TD -0.0033 Tc 0.0444 Tw (ing, affect-intensive nature of crisis intervention work, it is)Tj T* -0.0032 Tc 0.0043 Tw (important that the faith community have an appreciation of)Tj 0 -1.398 TD -0.0033 Tc -0.0204 Tw (the need for self care activities to avoid burnout and a corre-)Tj 0 -1.401 TD -0.0036 Tc 0.0057 Tw (sponding diminution in their capabilities of helping others.)Tj 1.8 -2.001 TD -0.003 Tc 0.0064 Tw (A key point offered in the previously-referenced report)Tj -1.8 -1.398 TD -0.0033 Tc -0.0625 Tw [(issued by the Institute of Medicine \(IOM, 2003\) was the con-)]TJ 0 -1.401 TD -0.003 Tc 0.125 Tw (clusion that mental health systems in this country are not)Tj T* -0.0031 Tc -0.0205 Tw [(currently capable of meeting the population)56.9(s)-0.6( needs for psy-)]TJ 0 -1.398 TD -0.0035 Tc 0.065 Tw (chological services resulting from future disasters, particu-)Tj 0 -1.401 TD -0.003 Tc -0.0585 Tw [(larly when provoked by terrorist events. 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The principles)]TJ 0 -1.401 TD 0.0012 Tc 0.125 Tw (behind the above structural and functional considerations)Tj T* -0.0032 Tc -0.0463 Tw [(are relevant for both organizational and family disaster plan-)]TJ 0 -1.398 TD -0.0007 Tc 0 Tw (ning.)Tj 1.8 -2.001 TD -0.0034 Tc -0.0228 Tw (The need for awareness of the potential pitfalls of burn-)Tj -1.8 -1.401 TD -0.0065 Tc -0.0622 Tw (out and for problem-preventive self care are not new insights.)Tj 0 -1.398 TD 0.002 Tc 0.125 Tw (Burnout may be considered the end result of an ongoing)Tj 0 -1.401 TD -0.0036 Tc 0.1084 Tw (process in which highly motivated, committed individuals)Tj T* -0.0032 Tc 0.0669 Tw (experience a dissipation of spirit leading to physical, emo-)Tj 0 -1.398 TD -0.0091 Tc -0.0617 Tw [(tional, and mental exhaustion \(Freudenber)14.9(ger)35.9(, 1980\). )15.3(W)94.8(ould-)]TJ 0 -1.401 TD -0.0034 Tc 0.002 Tw (be helpers, in general, need to be mindful of the importance)Tj T* -0.0035 Tc 0.0313 Tw (of self-care strategies and of the appropriateness of manag-)Tj 0 -1.398 TD -0.0034 Tc 0.041 Tw (ing both external and internal stressors that can have a del-)Tj 0 -1.401 TD -0.013 Tc -0.0622 Tw [(eterious ef)17(fect on personal wellbeing \(W)77(eiss, 2004\). However)35(,)]TJ T* -0.0031 Tc 0.125 Tw (due to the potential effects of vicarious traumatization on)Tj ET endstream endobj 98 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 101 0 obj << /Length 8441 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.009 Tc 0 Tw (188)Tj /TT3 1 Tf 1.65 0 TD -0.0051 Tc 0.0875 Tw [( McCabe Psychological First Aid Training for the Faith Community)]TJ /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0035 Tc -0.0156 Tw (those working with victims of trauma, the need for effective)Tj 0 -1.398 TD -0.0031 Tc 0.0085 Tw (self care may be even more vital \(Bell, Kulkarni, & Dalton,)Tj 0 -1.401 TD -0.0254 Tc -0.0624 Tw [(2003; Figley)58.6(, 2002\).)]TJ /TT5 1 Tf 11 0 0 11 54 661.35 Tm 0.0219 Tc 0.1273 Tw (Learning Objectives)Tj /TT2 1 Tf 10 0 0 10 66 641.64 Tm -0.0036 Tc -0.0172 Tw [()-1453.5(T)73.2(o increase awareness of disaster resources and how)]TJ 1.8 -1.398 TD -0.0034 Tc 0.0328 Tw (to access them in the event of a local catastrophe)Tj -1.8 -2.001 TD -0.0036 Tc -0.0564 Tw [()-1453.5(T)73.2(o assure comprehension of the elements of practical)]TJ 1.8 -1.401 TD -0.0037 Tc 0.031 Tw (disaster plans for families and congregations)Tj -1.8 -1.998 TD -0.0034 Tc 0.0766 Tw [()-1453.3(T)73.4(o appreciate the importance of self-care strategies)]TJ 1.8 -1.401 TD -0.0234 Tw (for the spiritual caregiver)Tj /TT5 1 Tf 11 0 0 11 54 526.35 Tm 0.019 Tc 0.1249 Tw [(T)92.4(opics and Sub-T)89.9(opics)]TJ /TT2 1 Tf 10 0 0 10 66 506.64 Tm -0.0036 Tc 0.0284 Tw [()-1453.5(Community resources in disasters)]TJ 0 -1.998 TD -0.0038 Tc 0.0375 Tw [()-1453.7(Incident command systems)]TJ 0 -2.001 TD -0.0035 Tc -0.0292 Tw [()-1453.4(Examples of local hospital emergency incident com-)]TJ 1.8 -1.401 TD -0.007 Tc -0.0625 Tw (mand structures [)Tj /TT5 1 Tf 6.699 0 TD -0.0067 Tc (particularly relevant for this project)Tj -6.699 -1.398 TD -0.0037 Tc 0.029 Tw (because of the close institution/community relation-)Tj 0 -1.401 TD -0.0035 Tc 0.0343 Tw (ship that the training initiative was meant to recog-)Tj T* -0.0038 Tc 0.0575 Tw (nize and reinforce)Tj /TT2 1 Tf 7.326 0 TD 0 Tc 0 Tw (])Tj -9.126 -1.998 TD -0.0037 Tc -0.045 Tw [()-1453.6(Exercise to generate information on resources within)]TJ 1.8 -1.401 TD -0.0034 Tc -0.0371 Tw (and outside the spiritual community to assist congre-)Tj T* 0.0101 Tc 0 Tw (gation)Tj -1.8 -1.998 TD -0.0039 Tc 0.039 Tw [()-1453.8(Examples and discussion of outside agencies)]TJ 0 -2.001 TD -0.0041 Tc 0.1216 Tw [()-1454(Compassion fatigue and burnout: Signs of burn-)]TJ 1.8 -1.401 TD -0.0037 Tc -0.0507 Tw (out; Elements of pastoral stress management and self)Tj 0 -1.398 TD -0.0049 Tc 0 Tw (care)Tj -1.8 -2.001 TD 0.0589 Tc 0.14 Tw [()-1391(Family disaster plans: Checkpoints; Contact)]TJ 1.8 -1.401 TD -0.0034 Tc 0.0225 Tw (person\(s\); Evacuation & Supply kits.)Tj /TT5 1 Tf 11 0 0 11 54 227.34 Tm 0.0164 Tc 0.125 Tw [(Educational Methods, Materials and Resour)35.5(ces)]TJ /TT2 1 Tf 10 0 0 10 66 207.66 Tm 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0046 Tc (Methods: )Tj /TT2 1 Tf 4.005 0 TD -0.0037 Tc 0.0167 Tw (Lecture using slides; exercise)Tj -5.805 -2.001 TD 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0017 Tc 0.1253 Tw [(Materials and Resour)34.3(ces)]TJ /TT2 1 Tf 10.185 0 TD -0.0012 Tc 0.125 Tw [( [provided in T)64.8(ool Kit]:)]TJ -10.185 -1.401 TD -0.0071 Tc -0.0621 Tw [(Copies of information downloaded from the Internet,)]TJ 0 -1.398 TD -0.0046 Tc 0 Tw (including:)Tj /TT1 1 Tf 4.014 0 TD 0 Tc ( )Tj /TT2 1 Tf 0.285 0 TD -0.0043 Tc 0.0367 Tw [(Preparing )32.2(Y)102.9(our Congregation for Disas)]TJ /TT1 1 Tf 16.071 0 TD 0 Tc 0 Tw (-)Tj -20.37 -1.401 TD (t)Tj /TT2 1 Tf 0.366 0 TD 0.0357 Tc 0.125 Tw (er from the )Tj /TT5 1 Tf 5.979 0 TD 0.0348 Tc (Evangelical Lutheran Church of)Tj -6.345 -1.401 TD 0.0054 Tc 0 Tw (America)Tj /TT2 1 Tf 3.429 0 TD 0.0061 Tc 0.1239 Tw [( [www)60.1(.elca.or)9.1(g/disaster/resources]; Y)93.1(our)]TJ -3.429 -1.398 TD -0.0037 Tc -0.0213 Tw [(Family Disaster Plan from the )53.4(American Red Cross)]TJ 0 -1.401 TD -0.0053 Tc -0.0396 Tw [([www)57.7(.arc.or)15.7(g]; and The )28.1(Y)]TJ 10.626 0 TD -0.0043 Tc -0.0567 Tw [(oungest V)63.9(ictims: )-17(Disas)-4.3(ter)]TJ -10.626 -1.401 TD 0.0012 Tc 0.1249 Tw [(Preparedness to Meet Children)49.2(s Needs)]TJ /TT5 1 Tf 16.77 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.381 0 TD 0.0012 Tc 0.125 Tw (from the)Tj /TT5 1 Tf 8.349 63.3 TD -0.0042 Tc 0.0469 Tw [(American )17(Academy of Pediatrics)]TJ /TT2 1 Tf 13.191 0 TD -0.0049 Tc 0.0473 Tw [( [www)61.1(.aap.or)13.1(g/ter)16.1(-)]TJ -13.191 -1.398 TD -0.0281 Tc 0 Tw (rorism])Tj /TT5 1 Tf -1.2 -2.001 TD -0.0053 Tc (Comment: )Tj /TT2 1 Tf 4.404 0 TD -0.0036 Tc 0.0335 Tw (The authors thought it was important to use)Tj -6.204 -1.401 TD 0.0007 Tc 0.125 Tw (this module to convey to faith community leadership not)Tj 0 -1.398 TD -0.0033 Tc 0.0706 Tw (only the importance of generating lists of resources within)Tj 0 -1.401 TD 0.1083 Tw [(their communities and of having a sense of key organiza-)]TJ T* -0.0035 Tc 0.0122 Tw (tional infrastructures but also to provide an overview of ex-)Tj 0 -1.398 TD -0.0088 Tc -0.0622 Tw (ternal resources in the form of agencies whose missions relate)Tj 0 -1.401 TD -0.0033 Tc 0.0264 Tw [(to disaster preparedness, response, and/or recovery)59.7(, such as)]TJ T* -0.003 Tc 0.1251 Tw [(the )45.1(American Red Cross, Catholic Charities, International)]TJ 0 -1.398 TD -0.0093 Tc -0.0625 Tw (Critical Incident Stress Foundation \(ICISF\), National Organi-)Tj 0 -1.401 TD -0.004 Tc -0.062 Tw [(zation for )17.2(V)61.2(ictim )53.2(Assistance, Salvation )50.2(Army)59(, as well as state)]TJ T* -0.0033 Tc 0.125 Tw (and local government resources and the core functions of)Tj 0 -1.398 TD -0.0034 Tc 0.0925 Tw (the supporting hospital emergency incident command sys-)Tj 0 -1.401 TD -0.0036 Tc 0.0725 Tw [(tem \(HEICS\) of Johns Hopkins Health System and of the)]TJ T* -0.0031 Tc -0.055 Tw (University of Maryland Health System \(UMHS\).)Tj /F1 1 Tf 11 0 0 11 309 468.99 Tm -0.0056 Tc 0.0591 Tw (Summary and Conclusions)Tj /TT2 1 Tf 10 0 0 10 327 445.65 Tm -0.0032 Tc -0.047 Tw (The purpose of this project was to lay the foundation for)Tj -1.8 -1.401 TD -0.0017 Tc 0.125 Tw (strengthening current public health infrastructure and ser-)Tj 0 -1.398 TD -0.0029 Tc -0.0111 Tw (vices in the state of Maryland by establishing a community-)Tj 0 -1.401 TD 0.0035 Tc 0.125 Tw [(academic partnership to develop a disaster mental health)]TJ T* -0.0035 Tc -0.0036 Tw (training program for urban-based faith leaders. The curricu-)Tj 0 -1.398 TD -0.055 Tw (lum was designed to reflect the culture and unique character-)Tj 0 -1.401 TD 0.0454 Tc 0.125 Tw (istics of inner-city clergy along with the vulnerable)Tj T* -0.0036 Tc 0.0377 Tw [(populations with whom they work. )53.3(Among the topics cov-)]TJ 0 -1.398 TD -0.0034 Tc 0.1108 Tw (ered were: stress reactions; principles of crisis- identifica-)Tj 0 -1.401 TD -0.019 Tc -0.0622 Tw (tion, management, and referral; pastoral care; disaster ministry;)Tj T* 0.0063 Tc 0.125 Tw (preparedness, response, and recovery resources; and self)Tj 0 -1.398 TD -0.0032 Tc -0.0225 Tw (care. Participants reported that they viewed the training pro-)Tj 0 -1.401 TD -0.0036 Tc 0.1086 Tw (gram as having successfully expanded their knowledge of)Tj T* 0.0756 Tw (the disaster mental health field, and having enhanced their)Tj 0 -1.398 TD -0.003 Tc 0.0907 Tw (self-confidence in applying psychological first aid in indi-)Tj 0 -1.401 TD -0.004 Tc -0.031 Tw (vidual and congregational communication forums following)Tj T* -0.0123 Tc -0.0625 Tw (major disasters, as well in the context of more limited commu-)Tj 0 -1.398 TD -0.0023 Tc 0.0292 Tw [(nity crises that occur with everyday frequency)60.7(.)]TJ 1.8 -2.001 TD -0.0019 Tc 0.125 Tw (Although the amount of content presented for a one-)Tj -1.8 -1.401 TD -0.0033 Tc -0.0178 Tw [(day training was ambitious, the integrated, collaborative ap-)]TJ 0 -1.398 TD 0.0115 Tc 0.125 Tw (proach to disseminating training information using )Tj /TT5 1 Tf 21.891 0 TD 0.0104 Tc 0 Tw (both)Tj /TT2 1 Tf -21.891 -1.401 TD -0.0032 Tc 0.0333 Tw [(mental health and cler)17.8(gy was especially well-received. )51(Al-)]TJ T* -0.0038 Tc 0.0549 Tw [(though PF)71.2(A)58.4( skill-building exercises were incorporated into)]TJ 0 -1.398 TD 0.001 Tc 0.125 Tw (the curriculum, one can envision how actual competency)Tj 0 -1.401 TD -0.0033 Tc 0.0839 Tw (development in the use of psychological first aid could be)Tj T* -0.0036 Tc 0.0706 Tw (enhanced with a multi-day program and more pointed em-)Tj ET endstream endobj 102 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 104 0 obj << /Length 10712 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 426.84 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (189)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0033 Tc -0.0393 Tw (phasis on facilitated training, practical exercises, and perfor-)Tj 0 -1.398 TD -0.0041 Tc -0.06 Tw (mance feedback.)Tj 1.8 -2.001 TD -0.0034 Tc -0.0228 Tw (Given the potential need for the participation of a wide-)Tj -1.8 -1.401 TD -0.0187 Tw (range of community organizations and agencies in the after-)Tj 0 -1.398 TD -0.0035 Tc -0.0094 Tw [(math of a disaster)35.5(, it would seem that the core mental health)]TJ 0 -1.401 TD -0.0033 Tc 0.105 Tw (disaster content of the curriculum presented here not only)Tj T* -0.0035 Tc -0.0006 Tw [(can be applied to faith communities throughout the country)59.5(,)]TJ 0 -1.398 TD 0.0306 Tw (but also could serve as a foundational template for applica-)Tj 0 -1.401 TD -0.0033 Tc 0.0378 Tw [(tion to other lay communities and special populations. 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Self-Ef)14.8(ficacy: )]TJ /TT5 1 Tf 14.214 0 TD -0.0039 Tc 0.065 Tw [(The exer)29.1(cise of contr)32.1(ol.)]TJ /TT2 1 Tf -13.014 -1.401 TD -0.0095 Tc -0.0622 Tw [(New )29.8(Y)103.7(ork: )14.8(W)103.3(.)-0.3( H Freeman & Co.)]TJ -1.2 -1.8 TD -0.0037 Tc -0.0573 Tw [(Barringer)35.3(, F)77.3(.)-0.4( & Fabrikant, G)116.3(.)-0.3( \(September 12, 2001\). )50.5(As an at-)]TJ 1.2 -1.398 TD -0.0036 Tc -0.054 Tw (tack unfolds, a struggle to provide vivid images to homes.)Tj 0 -1.401 TD -0.0088 Tc -0.0619 Tw [(The New )27(Y)104.4(ork )9(T)38(imes.)]TJ -1.2 -1.8 TD -0.0169 Tc -0.0623 Tw (Bell, H., Kulkarni, S., & Dalton, L. \(2003\). Organizational pre-)Tj 1.2 -1.401 TD -0.0036 Tc -0.0321 Tw (vention of vicarious trauma. )Tj /TT5 1 Tf 11.289 0 TD -0.0034 Tc -0.0334 Tw [(Families in Society)50.6(, 84, )]TJ /TT2 1 Tf 9.396 0 TD -0.006 Tc 0 Tw (463-)Tj -20.685 -1.398 TD -0.0583 Tc (470.)Tj -1.2 -1.8 TD -0.0035 Tc 0.0292 Tw [(Bowler)38.5(, R.M., Murai, K., & )14.8(T)37.3(rue, R.H. \(2001\). Update and)]TJ 1.2 -1.401 TD -0.0033 Tc -0.0423 Tw [(long-term sequelae of the sarin attack in the )18.4(T)70.5(okyo, Japan)]TJ T* -0.0024 Tc 0 Tw [(subway)60.6(. )]TJ /TT5 1 Tf 3.456 0 TD -0.004 Tc -0.0197 Tw [(Chemical Health and Safety)53(, 8)]TJ /TT2 1 Tf 12.003 0 TD -0.0033 Tc -0.025 Tw (\(1\), 53-55.)Tj -16.659 -1.8 TD -0.0138 Tc -0.0622 Tw [(Branchey)61.2(, L., Davis, )22.5(W)105(., & Lieber)34.2(, C. S. \(1984\). )52.5(Alcoholism in)]TJ 1.2 -1.398 TD -0.0085 Tc -0.0614 Tw [(V)62.7(ietnam and Korea veterans: )46.1(A)59.7( long term follow-up. )]TJ /TT5 1 Tf 20.376 0 TD -0.0104 Tc 0 Tw (Alco-)Tj -20.376 -1.401 TD -0.0037 Tc -0.035 Tw (holism: Clinical and Experimental Research, 8, )Tj /TT2 1 Tf 18.951 0 TD -0.0049 Tc 0 Tw (572-577.)Tj -20.151 -1.8 TD -0.0032 Tc 0.0683 Tw (Brende, J.O. \(1991\). )Tj /TT5 1 Tf 8.556 0 TD -0.0044 Tc 0.0684 Tw (Post-traumatic symptoms and trauma)Tj -7.356 -1.401 TD -0.0034 Tc -0.0147 Tw [(r)34.8(ecovery in the Bible.)]TJ /TT2 1 Tf 8.454 0 TD -0.0041 Tc -0.0166 Tw [(Columbus, GA: )14(T)36.7(rauma Recovery)58.9(.)]TJ -9.654 -1.8 TD -0.0299 Tc -0.0622 Tw [(Breslau, N., Chilcoat, H.D., Kessler)39.1(, R.C., & Davis, G)114.1(..C. \(1999\).)]TJ 1.2 -1.398 TD -0.0039 Tc 0.0123 Tw (Previous exposure to trauma and PTSD effects of subse-)Tj 0 -1.401 TD -0.004 Tc -0.0198 Tw [(quent trauma: Results from the Detroit )50.2(Area )14.2(T)36.8(rauma Sur)17(-)]TJ T* -0.0069 Tc -0.0605 Tw [(vey of )18.3(T)33.9(rauma. )]TJ /TT5 1 Tf 6.051 0 TD -0.0079 Tc -0.0619 Tw [(American Journal of Psychiatry)57.9(,)-0.9( 156, )]TJ /TT2 1 Tf 14.649 0 TD -0.011 Tc 0 Tw (902-)Tj -20.7 -1.398 TD -0.0583 Tc (907.)Tj 24.3 64.998 TD -0.0204 Tc -0.0624 Tw [(DeMartino, R. \(2002\). 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Ellicott City: International Criti-)]TJ -3.459 -1.401 TD -0.0038 Tc 0.0684 Tw (cal Incident Stredss Foundation.)Tj -1.2 -1.8 TD -0.0026 Tc 0.0531 Tw [(Figley)60.4(, C. \(2002\). )]TJ /TT5 1 Tf 7.44 0 TD -0.0038 Tc 0.055 Tw [(T)57.3(r)34.4(eating compassion fatigue. )]TJ /TT2 1 Tf 11.91 0 TD -0.0057 Tc 0.0247 Tw [(New Y)101.5(o)-0.7(rk:)]TJ -18.15 -1.401 TD -0.0056 Tc 0 Tw (Brunner-Routledge.)Tj ET endstream endobj 105 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 107 0 obj << /Length 11663 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.009 Tc 0 Tw (190)Tj /TT3 1 Tf 1.65 0 TD -0.0051 Tc 0.0875 Tw [( McCabe Psychological First Aid Training for the Faith Community)]TJ /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0038 Tc -0.0021 Tw [(Freudenber)14.2(ger)38.2(, H.J. \(1980\). )]TJ /TT5 1 Tf 11.196 0 TD -0.004 Tw (Burn-out: The high cost of high)Tj -9.996 -1.398 TD -0.0062 Tc 0 Tw (achievement)Tj /TT2 1 Tf 4.935 0 TD -0.0044 Tc -0.0604 Tw [(. 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New )26.7(Y)100.9(ork: Plenum.)]TJ -8.085 -1.8 TD -0.0083 Tc -0.0618 Tw [(Koenig, H.G)117.7(. \(Ed.\). \(1998\). )]TJ /TT5 1 Tf 10.914 0 TD -0.0097 Tc -0.0625 Tw [(Handbook of r)29.3(eligion and health)]TJ /TT2 1 Tf 12.537 0 TD 0 Tc 0 Tw (.)Tj -22.251 -1.401 TD -0.0042 Tc -0.0512 Tw [(San Diego, CA: )49.8(Academic Press.)]TJ -1.2 -1.8 TD -0.0037 Tc 0.06 Tw [(Koenig, H.G)116.3(. \(1999\). )]TJ /TT5 1 Tf 8.796 0 TD 0.0616 Tw (The healing power of faith Science)Tj -7.596 -1.398 TD -0.0042 Tc 0.003 Tw [(explor)28.8(es medicine)127.8(s last gr)31.8(eat )-6.7(fr)31.8(ontier)103.8(. )]TJ /TT2 1 Tf 15.36 0 TD -0.0054 Tc -0.0226 Tw [(New Y)101.8(ork: )-28.2(Simon)]TJ -15.36 -1.401 TD -0.0047 Tc 0.015 Tw [(& Shuster)49.3(.)]TJ -1.2 -1.8 TD -0.0168 Tc -0.0617 Tw [(Koenig, G)115.2(.)-0.5( \(2006\). )]TJ /TT5 1 Tf 7.221 0 TD -0.0622 Tw [(In the wake of disaster: Religious r)34.2(esponses)]TJ -6.021 -1.401 TD -0.0097 Tc -0.0627 Tw [(to terr)34.5(orism and catastr)29.3(ophe. )]TJ /TT2 1 Tf 11.43 0 TD -0.0103 Tc -0.0624 Tw [(Philadelphia, P)85.7(A)-1.6(: )13.8(T)75.5(empleton)]TJ -11.43 -1.398 TD -0.0011 Tc 0.125 Tw (Foundation Press.)Tj -1.2 -1.8 TD -0.0026 Tc -0.0571 Tw [(Lating, J.M., Sherman, M.F)78.4(., Lowry)63.4(, J.L., Everly)63.4(, G)117.4(.S., Jr)51.4(., &)]TJ 1.2 -1.401 TD 0.0075 Tc 0.1252 Tw [(Peragine, )19.7(T)78.3(.)-2.3(F)76.5(.)-0.7( \(2004\). 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Religion and health: Is there an associa-)Tj 1.2 -1.401 TD -0.0026 Tc -0.0354 Tw (tion, is it valid, and is it causal? )Tj /TT5 1 Tf 12.51 0 TD -0.0039 Tc -0.0367 Tw (Social Science and Medi-)Tj -12.51 -1.401 TD -0.0161 Tc -0.0625 Tw (cine, 38, )Tj /TT2 1 Tf 3.384 0 TD -0.0186 Tc 0 Tw (1475-1482.)Tj -4.584 -1.8 TD -0.019 Tc -0.0625 Tw (Lima, B.R., Pai, S., Santacruz, H., & Lozano, J. \(1991\). Psychi-)Tj 1.2 -1.398 TD -0.0037 Tc -0.0014 Tw (atric disorders among poor victims following a major di-)Tj 0 -1.401 TD -0.0039 Tc -0.0418 Tw [(saster: Armero, )-49.9(Columbia. )]TJ /TT5 1 Tf 10.734 0 TD -0.0041 Tc 0.0098 Tw [(Journal of Nervous and Men-)]TJ -10.734 -1.401 TD -0.0066 Tc -0.0616 Tw (tal Disease, 179, )Tj /TT2 1 Tf 6.675 0 TD -0.0083 Tc 0 Tw (420-427.)Tj -7.875 -1.8 TD -0.0031 Tc 0.0568 Tw [(McCabe, O.L., Mosley)62.9(, )50.8(A, Gwon, H.S., & Kaminsky)62.9(, M.J.)]TJ 1.2 -1.398 TD -0.0034 Tc -0.0606 Tw [(\(2007\). )53.6(A)58.8( disaster spiritual health corps: )14.6(T)37.4(raining the faith)]TJ 0 -1.401 TD -0.0028 Tc 0.125 Tw (community to respond to terrorism and catastrophe. In)Tj T* -0.0022 Tc -0.0224 Tw [(G)126(.S. Everly)60.8(, Jr)51.8(. \(Ed.\) )]TJ /TT5 1 Tf 8.316 0 TD -0.0039 Tc (Pastoral crisis intervention)Tj /TT2 1 Tf 10.794 0 TD -0.0032 Tc -0.025 Tw (. Ellicott)Tj -19.11 -1.398 TD -0.0037 Tc -0.0516 Tw [(City)59.3(, MD: Chevron Publishing Corporation.)]TJ 24.3 64.998 TD -0.0028 Tc -0.0168 Tw [(McCabe, O.L., Siegel, E.R., Everly)60.2(, G)117.2(.S., Jr)51.2(., Heitt, M.C., &)]TJ 1.2 -1.398 TD 0.002 Tc 0.126 Tw [(Kaminsky)62(, M.J. \(2004\). Psychiatry and terrorism: )18(The)]TJ 0 -1.401 TD -0.0036 Tc 0.0761 Tw [(profession)50.4(s role in disaster response planning. )]TJ /TT5 1 Tf 19.254 0 TD -0.0044 Tc 0 Tw (Interna-)Tj -19.254 -1.401 TD -0.0036 Tc 0.0021 Tw (tional Journal of Emergency Mental Health, 6, )Tj /TT2 1 Tf 18.876 0 TD -0.0049 Tc 0 Tw (197-204.)Tj -20.076 -1.8 TD -0.0131 Tc -0.062 Tw [(McPherson, K.F)76.9(. \(2004\). 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Leesbur)17.6(g, )17.6(V)133.8(A)2.8(.)]TJ -1.2 -1.8 TD -0.0075 Tc -0.0623 Tw [(Mitchell, J.T)73.5(., Schiller)37.5(, G)118.5(., Eyler)37.5(, )16.7(V)132.7(.)-0.5( & Everly)64.5(, G)115.5(.S., Jr)52.5(. \(1999\).)]TJ 1.2 -1.401 TD -0.0035 Tc 0.0536 Tw (Community crisis intervention: The Coldenham tragedy)Tj 0 -1.398 TD 0.0087 Tc 0 Tw (revisited. )Tj /TT5 1 Tf 4.17 0 TD 0.0083 Tc 0.125 Tw [(International Journal of Emergency Mental)]TJ -4.17 -1.401 TD -0.0137 Tc -0.0625 Tw (Health, 1, )Tj /TT2 1 Tf 3.951 0 TD -0.0156 Tc 0 Tw (227-236.)Tj -5.151 -1.8 TD -0.0033 Tc 0.0183 Tw [(Najavits, L.M., )17.7(W)94.5(eiss, R.D., & Shaw)62.7(, S.R. \(1997\). )17.7(The link)]TJ 1.2 -1.401 TD -0.0038 Tc 0.0447 Tw (between substance abuse and posttraumatic stress disor-)Tj 0 -1.398 TD -0.0036 Tc 0.0706 Tw [(der in women: )53.2(A)58.6( research review)59.4(. )]TJ /TT5 1 Tf 13.935 0 TD -0.0044 Tc 0.0725 Tw (American Journal on)Tj -13.935 -1.401 TD -0.0069 Tc -0.0625 Tw (Addictions, 6, )Tj /TT2 1 Tf 5.556 0 TD -0.0091 Tc 0 Tw (273-283.)Tj -6.756 -1.8 TD -0.0031 Tc -0.0387 Tw (North, C.S., Nixon, S.J., Shariat, S., Malonee, S., McMillen,)Tj 1.2 -1.401 TD -0.0189 Tc -0.0619 Tw [(J.C., Spitznagel, K.P)107.1(., & Smith, E. \(1999\). Psychiatric disor)17.1(-)]TJ 0 -1.398 TD 0.0003 Tc 0.125 Tw (ders among survivors of the Oklahoma City bombing.)Tj /TT5 1 Tf 0 -1.401 TD -0.0037 Tc 0.025 Tw (Journal of the American Medical Association, 288, )Tj /TT2 1 Tf 20.685 0 TD -0.006 Tc 0 Tw (755-)Tj -20.685 -1.401 TD -0.0583 Tc (762.)Tj -1.2 -1.8 TD -0.0263 Tc -0.0624 Tw [(Parker)33.7(, C.L., Barnett, D.J., Everly)66.7(, G)117.7(.S. 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664.278 m 61.481 664.209 61.307 664.189 61.104 663.779 c 61.031 663.63 60.954 663.463 60.854 663.327 c 60.453 662.738 60.528 662.036 60.578 661.402 c 60.628 661.311 60.678 661.186 60.678 661.085 c 60.678 660.949 60.818 660.862 60.854 660.723 c 60.928 660.429 61.179 660.315 61.33 660.089 c 61.43 659.999 61.781 659.75 61.781 659.794 c 61.781 660.384 61.606 661.008 61.481 661.493 c 61.304 662.172 61.53 662.829 61.68 663.553 c 61.781 663.824 61.756 664.005 61.806 664.278 c b* Q q 1.0111 0 0 0.989 0 0 cm 0.137 0.122 0.125 rg 0.137 0.122 0.125 RG 1 j 0.273 w 2.613 M 64.639 657.441 m 64.729 657.149 64.743 656.893 65.206 656.728 c 65.375 656.669 65.564 656.608 65.719 656.524 c 66.388 656.189 67.161 656.289 67.86 656.365 c 67.958 656.414 68.094 656.465 68.206 656.47 c 68.356 656.475 68.445 656.606 68.598 656.645 c 68.92 656.726 69.034 656.958 69.278 657.104 c 69.373 657.199 69.632 657.527 69.582 657.524 c 68.93 657.497 68.248 657.309 67.718 657.174 c 66.975 656.984 66.238 657.157 65.429 657.259 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115.895 617.588 115.977 617.539 c 116.183 617.344 116.305 617.1 116.511 616.953 c 116.799 616.71 117.087 616.612 117.415 616.466 c 117.58 616.369 117.704 616.466 117.868 616.416 c 118.045 616.411 l b Q 1 g 111.778 615.854 m 115.915 614.868 l 115.894 614.868 115.894 614.892 115.872 614.892 c 115.978 614.579 116.102 614.264 116.185 613.927 c 116.3 613.457 116.185 612.938 116.164 612.456 c 115.956 612.552 115.935 612.697 v 115.852 613.034 115.852 613.276 115.769 613.614 c 115.748 613.637 115.624 613.759 115.603 613.806 c 115.466 614.125 115.291 614.168 115 614.337 c 114.668 614.505 114.335 614.771 114.023 614.916 c 113.358 615.205 112.651 615.254 112.007 615.567 c 111.986 615.591 111.923 615.615 111.903 615.687 c 111.888 615.739 111.716 615.736 111.778 615.854 c f 112.797 615.037 m 112.838 614.988 112.88 614.892 112.921 614.868 c 113.109 614.771 113.295 614.796 113.483 614.796 c 113.441 614.819 113.4 614.868 113.358 614.868 c 113.13 614.868 112.984 614.94 112.797 615.037 c f 113.42 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612.505 c 115.27 612.456 115.167 612.384 115.083 612.311 c 115.021 612.239 114.917 612.287 114.833 612.215 c 114.855 612.191 114.855 612.166 v f 115.645 611.974 m 115.748 611.974 115.769 612.095 115.852 612.142 c f 116.102 611.95 m 116.102 611.902 116.102 611.877 116.102 611.829 c 116.143 611.829 l 116.143 611.781 116.143 611.708 116.143 611.66 c f 107.745 616.652 m 107.871 616.676 107.975 616.628 108.078 616.579 c 108.099 616.579 108.141 616.531 108.182 616.508 c 108.307 616.459 108.432 616.411 108.557 616.363 c 108.951 616.242 109.367 616.266 109.741 616.05 c 109.887 615.977 110.052 615.904 110.198 615.856 c 110.593 615.759 110.947 615.759 111.342 615.687 c 111.404 615.664 111.467 615.591 111.549 615.591 c 111.134 615.615 110.718 615.543 110.282 615.615 c 110.052 615.664 109.824 615.639 109.596 615.712 c 109.533 615.736 109.513 615.808 109.45 615.833 c 109.221 615.904 109.014 615.808 108.806 615.88 c 108.723 615.904 108.619 615.904 108.536 615.953 c 108.245 616.05 108.057 616.314 107.829 616.556 c 107.808 616.579 107.85 616.628 107.808 616.652 c f 108.224 615.808 m 108.307 615.712 108.369 615.591 108.495 615.543 c 108.702 615.494 108.889 615.35 109.097 615.301 c 109.346 615.229 109.575 615.181 109.824 615.156 c 110.136 615.109 110.427 615.109 110.739 615.012 c 110.759 615.012 110.823 614.996 110.843 614.988 c 111.321 614.771 111.82 614.868 112.299 614.868 c 112.318 615.012 112.256 615.205 112.111 615.229 c 111.882 615.278 111.674 615.156 111.446 615.133 c 111.154 615.084 110.885 615.084 110.593 615.133 c 110.49 615.156 110.406 615.181 110.323 615.229 c 110.052 615.35 109.783 615.229 109.513 615.35 c 109.408 615.398 109.326 615.423 109.221 615.47 c 108.931 615.543 108.639 615.591 108.369 615.712 c f 109.221 614.626 m 109.679 614.602 110.157 614.723 110.615 614.579 c 110.697 614.555 110.759 614.434 110.864 614.409 c 111.03 614.386 111.197 614.434 111.362 614.458 c 111.716 614.53 112.069 614.434 112.423 614.505 c 111.799 614.023 110.988 614.193 110.282 614.241 c 110.115 614.241 109.99 614.386 109.845 614.409 c 109.721 614.409 109.575 614.409 109.45 614.458 c 109.388 614.482 109.346 614.53 109.284 614.555 c f 110.427 613.517 m 110.406 613.541 110.448 613.565 110.448 613.59 c 110.822 613.565 111.197 613.686 111.571 613.759 c 111.986 613.831 112.402 613.661 112.818 613.831 c 112.755 613.806 112.691 613.778 112.63 613.759 c 111.903 613.517 111.259 613.565 110.552 613.541 c f 111.238 612.842 m 111.467 612.794 111.757 612.842 111.986 612.842 c 112.277 612.89 112.583 612.821 112.88 612.89 c 113.088 612.938 113.068 613.106 113.317 613.373 c 113.005 613.348 112.859 613.324 112.485 613.348 c 112.248 613.363 112.09 613.204 111.861 613.132 c 111.674 613.083 111.674 613.179 111.529 613.059 c f 112.028 612.263 m 112.361 612.239 112.672 612.263 113.005 612.336 c 113.026 612.36 113.068 612.384 113.088 612.408 c 113.212 612.456 113.358 612.408 113.483 612.505 c 113.569 612.571 113.628 612.65 113.732 612.697 c 113.753 612.721 113.794 612.962 113.774 612.962 c 113.69 612.986 113.566 612.842 113.483 612.794 c 113.42 612.794 113.4 612.721 113.337 612.697 c 113.068 612.601 113.046 612.746 112.797 612.577 c 112.651 612.48 112.174 612.505 112.048 612.336 c f 112.942 611.732 m 113.171 611.708 113.379 611.805 113.587 611.877 c 113.774 611.95 113.982 612.046 114.148 612.215 c 113.794 612.311 113.483 612.022 113.13 611.925 c 113.088 611.925 112.984 611.853 113.005 611.756 c f 113.441 611.443 m 113.483 611.299 113.67 611.323 113.753 611.371 c 113.919 611.492 114.169 611.54 114.21 611.781 c 114.127 611.781 114.064 611.805 113.982 611.756 c 113.919 611.708 113.877 611.66 113.836 611.588 c 113.753 611.467 113.587 611.564 113.503 611.42 c f 114.189 611.057 m 114.356 611.057 114.522 611.057 114.689 611.057 c 114.668 611.251 114.73 611.443 114.855 611.588 c 114.855 611.612 114.855 611.66 114.855 611.685 c 114.751 611.732 114.668 611.612 114.584 611.54 c 114.522 611.467 114.522 611.347 114.543 611.251 c 114.439 611.251 114.335 611.202 114.272 611.106 c f 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615.032 m 125.695 614.984 125.654 614.887 125.612 614.864 c 125.425 614.767 125.238 614.79 125.052 614.79 c 125.093 614.815 125.134 614.864 125.175 614.864 c 125.404 614.864 125.549 614.936 125.736 615.032 c f 125.114 614.405 m 124.926 614.405 124.759 614.43 124.573 614.405 c 124.553 614.381 124.573 614.332 124.594 614.308 c 124.759 614.26 124.926 614.164 125.093 614.116 c 125.134 614.091 125.196 614.116 y 125.279 614.044 125.495 614.011 125.466 614.091 c 125.425 614.212 125.279 614.285 125.175 614.357 c f 125.093 613.586 m 125.031 613.586 124.968 613.561 124.905 613.609 c 124.78 613.706 124.573 613.85 124.428 613.875 c f 124.594 613.223 m 124.406 613.223 124.178 613.175 124.033 613.248 c 123.971 613.295 123.887 613.392 123.846 613.513 c 124.115 613.464 124.283 613.295 124.553 613.295 c f 123.305 613.054 m 123.347 613.054 123.389 613.079 123.43 613.054 c 123.575 612.957 123.742 612.934 123.846 612.79 c 123.887 612.717 123.887 612.621 123.887 612.548 c 123.846 612.548 123.804 612.524 123.783 612.548 c 123.679 612.74 123.492 612.789 123.389 612.957 c f 123.679 612.162 m 123.679 612.139 123.679 612.09 123.679 612.066 c 123.43 611.993 123.264 612.211 123.076 612.379 c 122.931 612.499 123.076 612.596 123.202 612.499 c 123.264 612.452 123.368 612.379 123.451 612.307 c 123.514 612.234 123.617 612.282 123.701 612.211 c 123.679 612.186 123.679 612.162 v f 122.889 611.969 m 122.786 611.969 122.764 612.089 122.682 612.138 c f 122.432 611.945 m 122.432 611.897 122.432 611.872 122.432 611.824 c 122.39 611.824 l 122.39 611.776 122.39 611.703 122.39 611.656 c f 130.787 616.649 m 130.662 616.673 130.559 616.625 130.454 616.577 c 130.434 616.577 130.392 616.528 130.351 616.504 c 130.227 616.456 130.102 616.408 129.977 616.359 c 129.582 616.239 129.165 616.263 128.792 616.046 c 128.646 615.974 128.481 615.901 128.335 615.853 c 127.939 615.756 127.587 615.756 127.192 615.684 c 127.129 615.659 127.068 615.587 126.985 615.587 c 127.4 615.612 127.816 615.539 128.251 615.612 c 128.481 615.66 128.709 615.636 128.938 615.708 c 129 615.732 129.02 615.805 129.082 615.828 c 129.312 615.901 129.52 615.805 129.727 615.877 c 129.81 615.901 129.915 615.901 129.997 615.95 c 130.288 616.046 130.476 616.311 130.704 616.552 c 130.725 616.577 130.684 616.625 130.725 616.649 c f 130.309 615.805 m 130.227 615.709 130.165 615.587 130.04 615.54 c 129.831 615.492 129.644 615.346 129.436 615.298 c 129.188 615.226 128.958 615.178 128.709 615.153 c 128.397 615.104 128.107 615.104 127.794 615.009 c 127.774 615.009 127.71 614.994 127.69 614.984 c 127.212 614.767 126.713 614.864 126.236 614.864 c 126.215 615.008 126.277 615.201 126.423 615.225 c 126.651 615.274 126.859 615.153 127.088 615.129 c 127.379 615.081 127.649 615.081 127.939 615.129 c 128.044 615.153 128.127 615.178 128.211 615.225 c 128.481 615.346 128.751 615.226 129.02 615.346 c 129.125 615.394 129.208 615.418 129.312 615.468 c 129.602 615.54 129.894 615.587 130.165 615.708 c f 129.312 614.623 m 128.854 614.599 128.376 614.719 127.919 614.573 c 127.836 614.55 127.774 614.43 127.669 614.406 c 127.504 614.381 127.337 614.43 127.171 614.454 c 126.818 614.527 126.464 614.43 126.111 614.502 c 126.735 614.019 127.545 614.189 128.251 614.237 c 128.419 614.237 128.543 614.382 128.689 614.406 c 128.813 614.406 128.958 614.406 129.083 614.454 c 129.146 614.478 129.188 614.527 129.25 614.55 c f 128.107 613.513 m 128.127 613.538 128.085 613.562 128.085 613.586 c 127.711 613.562 127.337 613.682 126.963 613.754 c 126.547 613.826 126.132 613.658 125.716 613.826 c 125.779 613.803 125.843 613.775 125.903 613.754 c 126.631 613.513 127.275 613.562 127.982 613.538 c f 127.296 612.838 m 127.068 612.79 126.776 612.838 126.549 612.838 c 126.257 612.886 125.95 612.818 125.654 612.886 c 125.446 612.935 125.466 613.103 125.217 613.368 c 125.529 613.345 125.674 613.32 126.048 613.345 c 126.285 613.359 126.443 613.199 126.673 613.128 c 126.859 613.079 126.859 613.176 127.005 613.055 c f 126.506 612.259 m 126.174 612.235 125.862 612.259 125.529 612.332 c 125.509 612.355 125.466 612.38 125.446 612.404 c 125.322 612.453 125.175 612.404 125.052 612.5 c 124.965 612.568 124.905 612.644 124.802 612.693 c 124.781 612.717 124.74 612.958 124.76 612.958 c 124.843 612.982 124.968 612.838 125.052 612.79 c 125.114 612.79 125.134 612.717 125.196 612.694 c 125.466 612.596 125.488 612.741 125.736 612.573 c 125.883 612.476 126.361 612.5 126.486 612.332 c f 125.592 611.728 m 125.363 611.704 125.155 611.801 124.947 611.873 c 124.76 611.945 124.553 612.041 124.386 612.211 c 124.74 612.307 125.052 612.018 125.404 611.921 c 125.446 611.921 125.55 611.849 125.529 611.753 c f 125.093 611.439 m 125.052 611.295 124.865 611.318 124.781 611.366 c 124.615 611.487 124.365 611.536 124.324 611.777 c 124.406 611.777 124.469 611.801 124.553 611.753 c 124.615 611.704 124.657 611.656 124.698 611.584 c 124.781 611.463 124.947 611.559 125.031 611.415 c f 124.345 611.054 m 124.178 611.054 124.012 611.054 123.846 611.054 c 123.866 611.246 123.804 611.439 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620.403 116.651 620.46 116.806 620.488 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 116.581 620.46 m 116.567 620.376 116.764 620.376 116.933 620.432 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 116.708 620.39 m 116.722 620.333 116.933 620.347 117.06 620.376 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 116.89 620.347 m 116.933 620.235 117.074 620.347 117.102 620.291 c 117.13 620.235 117.299 620.333 117.327 620.067 c 117.355 619.799 117.847 619.827 117.903 619.799 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 116.469 620.46 m 116.103 620.362 115.724 620.137 115.724 620.052 c 115.724 619.968 116.272 620.277 116.398 620.319 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 115.836 620.039 m 115.836 619.968 116.033 620.039 116.511 620.249 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 116.061 620.067 m 116.061 619.996 116.258 619.996 116.736 620.207 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 116.244 619.996 m 116.244 619.925 116.525 619.968 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0.027 w 10 M 117.706 619.701 m 117.706 619.63 117.874 619.645 117.917 619.729 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 118.367 618.524 m 118.436 618.53 118.606 618.618 118.648 618.674 c 118.883 618.987 118.479 619.103 118.296 619.103 c 118.217 619.103 117.963 619.055 117.617 619.097 c 117.273 619.139 117.213 619.236 117.243 619.335 c 117.254 619.37 117.391 619.412 117.42 619.378 c 117.451 619.342 117.509 619.293 117.578 619.307 c 117.647 619.321 117.794 619.35 117.804 619.384 c 117.814 619.42 117.741 619.525 117.692 619.547 c 117.642 619.567 117.418 619.63 117.271 619.559 c 117.215 619.534 116.827 619.293 117.172 619.04 c 117.516 618.787 118.025 618.928 118.198 618.914 c 118.549 618.885 118.613 618.66 118.121 618.604 c 118.184 618.6 118.325 618.572 118.367 618.524 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.027 w 10 M 118.296 619.103 m 118.641 619.146 118.808 619.236 118.778 619.335 c 118.769 619.37 118.631 619.412 118.601 619.378 c 118.572 619.342 118.513 619.293 118.444 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/GS1 gs 50 52 280.5 -19.5 re f endstream endobj 116 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F5 20 0 R /F12 117 0 R /F13 118 0 R /F14 119 0 R /F15 120 0 R /F16 121 0 R /F17 122 0 R /F18 123 0 R /F19 124 0 R /F20 125 0 R /TT3 10 0 R /G1 126 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R /GS3 74 0 R >> /ColorSpace << /Cs9 24 0 R /Cs11 127 0 R /Cs12 128 0 R >> /Properties << /MC1 113 0 R >> >> endobj 129 0 obj << /FunctionType 0 /Domain [0 1] /Range [0 1 0 1 0 1] /BitsPerSample 8 /Size [255] /Length 737 /Filter /FlateDecode >> stream H LЭjsZuٵ\eyWHx(x' }}ߊg5}Cx-ʦbiC:X[[][^YZ^Kscptafx~ NLީўQHHlhokmꁍX^)oVtu&(ko,jo(lk(hURR#min4Ve5Tdrq]Yzm)Քղ*Yre!T$Uey)D_'$" 0+ FgDadn:Kƒ9T*I g%g 2$81@Χh+RSS +!`{ ؔXrb $n(W^KB37eY8&!.܉9 8v.6>6dm֑ᏎYt+d,}a>0jJ5 6 &A&ƁF l@6 C=+ԡhC_gMC!~P N^N<=S%۫Iw$[w;vyb83FBz )1xh8X(;+ٛ޵7~kr ڙܴ5q躍5hmpcpcֿֿdwww{ssRFhBh'5 0 endstream endobj 130 0 obj << /FunctionType 0 /Domain [0 1] /Range [0 1 0 1 0 1] /BitsPerSample 8 /Size [255] /Length 700 /Filter /FlateDecode >> stream H߿|˗ϟ>ʴ7ǰzϞ?<;ܾ{o^zk/]xΝpS'ϞoƴӦ̙:y֔I3'M1}=Sz'tMXPV_Z[RS\]TUPQV_^ZWVR[Z\SRT]\PY_QW[S]UQ^h``fojgbkbclmdmhe`inoafgnjgnbkfbcjlmbdelhilhad`aongfkkcmeeia( */Dr2ʲJ2RҒ RRrb22b"bR’"B‚B|b<"|¼\B<\l|l<,l,\@ B , D F0Du`0  endstream endobj 131 0 obj << /FunctionType 4 /Domain [0 1] /Range [0 1 0 1 0 1 0 1] /Length 20 /Filter /FlateDecode >> stream HN)-PZ.( endstream endobj 127 0 obj [/Separation /PANTONE#20567#20CVU /DeviceRGB 129 0 R] endobj 128 0 obj [/Separation /All /DeviceRGB 130 0 R] endobj 133 0 obj << /Length 5496 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (193)Tj /TT3 1 Tf 7 0 0 7 122.49 726.66 Tm -0.0061 Tc 0.0218 Tw [(International Journal of Emergency Mental Health, Vol. 9, No. 3, pp. 193-200 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT4 1 Tf 10 0 0 10 104.01 363.36 Tm 0.0162 Tc 0 Tw (Abstract: )Tj /TT5 1 Tf 4.32 0 TD 0.017 Tc 0.125 Tw [(V)78.8(ictims of terr)37.2(or attacks, whether or not physically injur)32(ed, sometimes suffer long-term)]TJ -4.32 -1.302 TD 0.0093 Tc (posttraumatic symptoms, although the intensity of symptoms differs among individuals. Often, after)Tj 0 -1.299 TD 0.0073 Tc (discharge from the hospital, additional posttraumatic symptoms and emotional distress are evident,)Tj T* -0.0035 Tc 0.106 Tw [(together with difficulty in readjusting to a normal life. This paper describes an ongoing multi-faceted)]TJ 0 -1.302 TD -0.0038 Tc -0.0103 Tw [(p)6.4(r)32.2(ogram to empower victims and their families and assist them on the journey to r)29.2(ecovery)56.1(.)-0.7( The pr)32.2(ogram is)]TJ 0 -1.299 TD -0.0035 Tc -0.0022 Tw (operated by the social work department in one of the main hospitals in Israel, in alliance with a voluntary)Tj T* -0.0037 Tc 0.035 Tw (non-profit organization in the U.S. One hundred seventeen victims of terror attacks who were previously)Tj 0 -1.302 TD 0.0081 Tc 0.125 Tw (hospitalized in the hospital for immediate care after attack were enrolled in the program, which is)Tj 0 -1.299 TD -0.0035 Tc 0.0563 Tw (structured to offer comprehensive help in order to meet the psychological, material, and social needs of)Tj T* 0.1012 Tw (the participants and their families. Based on needs assessment, the participants are offered individual,)Tj 0 -1.302 TD -0.0037 Tc 0.0037 Tw [(family)53.3(, and gr)29.3(oup therapies and community activities. Differ)32.3(ent elements of the pr)29.3(oject ar)32.3(e described, and)]TJ 0 -1.299 TD 0.0096 Tc 0.125 Tw (the need to further develop intervention models and to evaluate them is highlighted. [International)Tj T* -0.0035 Tc 0.0725 Tw (Journal of Emergency Mental Health, 2008, 9\(3\), pp. 193-200].)Tj /TT1 1 Tf 9 0 0 9 197.76 180.99 Tm -0.0054 Tc 0.0222 Tw (Key words: )Tj /TT5 1 Tf 5.1533 0 TD 0.0032 Tc 0.024 Tw [( victims, terror attaccks, families, empowerment program)]TJ ET /GS1 gs 66.99 148.245 m 303.99 148.245 l S BT 9 0 0 9 66.99 130.5 Tm /GS2 gs -0.0035 Tc 0.125 Tw [(Roni Gagin, MSW)83.2(, Miri Cohen, PhD, Maya Peled-A)49.8(vram, PhD,)]TJ 0 -1.2233 TD -0.0056 Tc -0.0522 Tw [(Y)77.2(ael )-11.4(Unger)14.4(-Arnov)67.7(, )-10.2(BSW)81.1(, )-12.6(Orit ADir)104.4(, )-10.5(MSW)81.1(, )-13.1(and A)55.2(viva )-11.9(T)84.4(essler)107.7(, )-10.2(MA)11.1( )-11.8(all)]TJ 0 -1.22 TD -0.0047 Tc 0.0348 Tw [(serve with the Dept. of Social W)85.3(ork at Ramban Medical Center in)]TJ 0 -1.2233 TD -0.0383 Tw [(Haifa Israel. Correspondence regarding this article may be sent to)]TJ T* -0.005 Tc 0.0306 Tw [(D)6.3(r)105(. Miri Cohen at cohenm@r)31.7(esear)35(ch.haifa.ac.il)]TJ /F1 1 Tf 14 0 0 14 141.51 656.34 Tm -0.0053 Tc 0.1377 Tw [(An Ongoing,)31.1( Multi-F)16.1(aceted Pr)14(ogram f)16.1(or )67.8(Victims of)]TJ 4.0179 -1.1421 TD -0.0018 Tc 0.1374 Tw [(T)62.8(err)17.5(or Attac)15.4(ks and )96.7(Their F)15.4(amilies)]TJ /TT2 1 Tf 10 0 0 10 339 142.14 Tm -0.0013 Tc 0.1252 Tw [(Since September)37.7(, 2000 Israeli society has been con-)]TJ -1.8 -1.398 TD -0.0033 Tc -0.0228 Tw [(fronted with a wave of terror attacks that have acquired the)]TJ 0 -1.401 TD -0.0036 Tc 0.0317 Tw [(title al-Aqsa Intifada. The upsurge of violence has been)]TJ T* -0.003 Tc -0.0218 Tw (the most intensive in the history of the state of Israel. Civil-)Tj 0 -1.398 TD -0.0035 Tc 0.045 Tw (ians have been attacked in public places, including restau-)Tj 0 -1.401 TD 0.002 Tw (rants and buses. Between 2000 and 2005, more than 5,000)Tj 12 0 0 12 414.66 593.64 Tm -0.0293 Tc -0.0625 Tw (Miri Cohen)Tj 10 0 0 10 334.41 581.01 Tm -0.0027 Tc [(Department of Social )18.3(W)95.2(ork, Rambam Medical Center)39.3(,)]TJ -0.867 -1.2 TD 0.0018 Tc -0.0433 Tw [(Haifa, Israel and School of Social )17.7(W)96.6(ork, Faculty of Social)]TJ 2.442 -1.2 TD -0.0201 Tw [(W)96.5(elfare and Health S)16.7(tudies, Haifa University)]TJ 12 0 0 12 160.41 593.64 Tm -0.0432 Tc -0.0625 Tw (Roni Gagin)Tj 10 0 0 10 79.41 581.01 Tm -0.0027 Tc [(Department of Social )18.3(W)95.1(ork, Rambam Medical Center)39.3(,)]TJ 8.208 -1.2 TD -0.0068 Tc -0.06 Tw (Haifa, Israel)Tj 12 0 0 12 399.9 497.64 Tm -0.0271 Tc -0.0628 Tw [(Y)102.6(ael Unger)15.4(-Arnov)]TJ 10 0 0 10 335.4 485.01 Tm -0.0027 Tc -0.0625 Tw [(Department of Social )15.3(W)98.1(ork, Rambam Medical Center)36.3(,)]TJ 8.211 -1.2 TD -0.0068 Tc -0.06 Tw (Haifa, Israel)Tj 12 0 0 12 141.9 497.64 Tm -0.0199 Tc -0.0611 Tw [(Maya Peled-A)62.6(vram)]TJ 10 0 0 10 80.4 485.01 Tm -0.0027 Tc -0.0625 Tw [(Department of Social )15.3(W)98.1(ork, Rambam Medical Center)36.3(,)]TJ 8.211 -1.2 TD -0.0068 Tc -0.06 Tw (Haifa, Israel)Tj 12 0 0 12 410.49 426.66 Tm -0.0299 Tc -0.0751 Tw [(A)79.8(viva T)68.4(essler)]TJ 10 0 0 10 402.24 414 Tm -0.0057 Tc -0.06 Tw (Operation Embrace)Tj 12 0 0 12 165.24 426.66 Tm -0.0259 Tc -0.1091 Tw (Orit Adir)Tj 10 0 0 10 79.41 414 Tm -0.0027 Tc -0.0625 Tw [(Department of Social )18.3(W)95.1(ork, Rambam Medical Center)39.3(,)]TJ 8.208 -1.2 TD -0.0068 Tc -0.06 Tw (Haifa, Israel)Tj ET endstream endobj 134 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 136 0 obj << /Length 9198 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0938 Tw [(194 )]TJ /TT3 1 Tf 2.7563 0 TD -0.0051 Tc 0.0952 Tw (Gagin An Ongoing Multi-Faceted Program for Victims of Terror Attacks and Their Families)Tj /TT2 1 Tf 10 0 0 10 54 721.65 Tm -0.0098 Tc -0.0625 Tw (civilians were injured and more than 670 were killed in terror-)Tj 0 -1.401 TD -0.0035 Tc -0.0042 Tw (ist attacks throughout Israel \(Israel Defense Forces, 2005\).)Tj 1.8 -1.998 TD 0.0015 Tc 0.0288 Tw [(T)72.3(errorism is defined here as violent attacks against ci-)]TJ -1.8 -1.401 TD -0.0066 Tc -0.0625 Tw (vilians in order to achieve political means. This fight is aimed)Tj T* 0.0017 Tc -0.0175 Tw (to strike at public morale by means of atrocities intended to)Tj 0 -1.398 TD 0.0186 Tc 0.125 Tw (cause as many casualties as possible by spreading fear)Tj 0 -1.401 TD 0.0014 Tc -0.0111 Tw (through the entire population. One of the goals of terrorism)Tj T* 0.0015 Tc -0.0275 Tw (is to influence the agenda of the public and political organi-)Tj 0 -1.398 TD 0.0027 Tc 0.125 Tw (zations on the national and international levels \(North &)Tj 0 -1.401 TD -0.0206 Tc -0.06 Tw (Pfefferbaum, 2002\).)Tj 1.8 -2.001 TD 0.0013 Tc 0.0986 Tw [(T)72.1(e)0(rror attacks are man-made disasters, which in con-)]TJ -1.8 -1.398 TD 0.0017 Tc 0.065 Tw (trast to natural disasters are initiated to create destruction,)Tj 0 -1.401 TD -0.0041 Tc -0.0625 Tw (harm, and death \(North & Pfefferbaum, 2002\). Norris, Fried-)Tj T* 0.0015 Tc 0.0743 Tw [(man, )16.5(W)96.3(atson, Byrne, and colleagues \(2002\) reviewed 160)]TJ 0 -1.398 TD 0.0014 Tc -0.0231 Tw (studies on disaster victims, numbering 60,000 people in all.)Tj 0 -1.401 TD 0.0011 Tc -0.0317 Tw (These investigators found that individuals who experienced)Tj T* 0.0015 Tc 0.0225 Tw (mass violence, such as terror attacks, suffered more severe)Tj 0 -1.425 TD 0.05 Tw (psychological reactions than victims of natural disasters.)Tj 1.8 -2.013 TD -0.0037 Tc 0.101 Tw (Common psychological responses to disasters include)Tj -1.8 -1.401 TD 0.111 Tw (depression, posttraumatic stress disorder \(PTSD\), general-)Tj T* -0.0035 Tc -0.0207 Tw [(ized anxiety disorder)38.5(, substance-abuse disorder)35.5(, and somati-)]TJ 0 -1.398 TD -0.0037 Tc -0.0593 Tw (zation disorder \(Austin & Godelski, 1999\). Health problems,)Tj 0 -1.401 TD -0.0034 Tc 0.0325 Tw (loss of resources, and impaired social and employment sta-)Tj T* 0.0288 Tw (tus are also commonly experienced \(Armenian et al., 2000;)Tj 0 -1.398 TD -0.0038 Tc 0.0294 Tw [(Brewin, )50.3(Andrews, & )14.3(V)115.4(alentine, 2000; Norris, 2002; Norris,)]TJ 0 -1.401 TD -0.0032 Tc 0.0033 Tw [(Friedman, )15(W)97.6(atson, Byrne, et al., 2002; Norris, Friedman, &)]TJ T* -0.0033 Tc 0.0614 Tw [(W)94.5(atson, 2002\). More severe exposure, ethnic minority sta-)]TJ 0 -1.398 TD -0.0031 Tc 0.0642 Tw (tus, secondary stressors, prior existing psychological prob-)Tj 0 -1.401 TD 0.059 Tc 0.1608 Tw (lems, and weak psychosocial resources were most)Tj T* -0.0035 Tc -0.0567 Tw (consistently associated with more adverse outcomes \(Norris,)Tj 0 -1.398 TD -0.0072 Tc -0.0617 Tw [(Friedman, & )16.8(W)90.6(atson, 2002\).)]TJ 1.8 -2.001 TD -0.0033 Tc 0.0058 Tw (Psychological reactions to disasters are often described)Tj -1.8 -1.401 TD -0.0032 Tc -0.0215 Tw [(in three phases \(NSW Institute of Psychiatry and Centre for)]TJ 0 -1.398 TD -0.0035 Tc -0.0011 Tw (Mental Health, 2000; Raphael, 1986, 1993\): impact phase,)Tj 0 -1.401 TD -0.0033 Tc 0.0064 Tw (characterized by acute and crisis reactions; immediate post-)Tj T* 0.0079 Tc 0.125 Tw (disaster phase, characterized by different levels of acute)Tj 0 -1.398 TD -0.0033 Tc 0.0359 Tw [(stress responses, confusion, anger)35.7(, depression, and anxiety;)]TJ 0 -1.401 TD -0.0037 Tc 0.1222 Tw (and post-disaster phase, a prolonged period of adjustment)Tj T* -0.0033 Tc -0.0383 Tw (efforts in which individuals try to achieve a new equilibrium)Tj 0 -1.398 TD -0.0035 Tc -0.0588 Tw (\(Raphael, 1986, 1993\). Raphael described this last phase as a)Tj 0 -1.401 TD -0.0153 Tc -0.0621 Tw (disillusionment period, during which formal and informal help)Tj T* -0.0035 Tc 0.0392 Tw (often decreases meaningfully \(Raphael, 1986\). The victims)Tj 0 -1.398 TD -0.0033 Tc 0.0912 Tw (are expected by their surroundings to return to pre-trauma)Tj 0 -1.401 TD -0.0029 Tc -0.0232 Tw (routine life at a time when they are still overwhelmed by the)Tj T* -0.0032 Tc 0.0119 Tw (realities of loss and change, and by bureaucratic constraints)Tj 0 -1.398 TD -0.0222 Tc -0.06 Tw (\(Raphael, 1986\).)Tj 27.3 65.538 TD -0.0035 Tc 0.1207 Tw (Feelings of loneliness and distress often increase sig-)Tj -1.8 -1.398 TD -0.0032 Tc -0.0576 Tw [(nificantly)62.8(, and PTSD symptoms are stabilized during the late)]TJ 0 -1.401 TD -0.0034 Tc 0.0769 Tw (phase \(NSW Institute of Psychiatry and Centre for Mental)Tj T* -0.0091 Tc -0.0614 Tw (Health, 2000; Raphael, 1993\). The theory of )Tj /TT5 1 Tf 17.169 0 TD -0.0101 Tc -0.065 Tw (resource conser-)Tj -17.169 -1.398 TD -0.0049 Tc 0 Tw (vation)Tj /TT2 1 Tf 2.475 0 TD -0.0034 Tc -0.0431 Tw [( \(Hobfoll, 1989\) may be an appropriate framework for)]TJ -2.475 -1.401 TD -0.0033 Tc 0.085 Tw (understanding the psychological, social, and functional ef-)Tj T* -0.0005 Tw (fects of terror attacks on the victims and their families. This)Tj 0 -1.398 TD -0.0031 Tc -0.0595 Tw [(theory postulates that stress in reaction to adverse life events)]TJ 0 -1.401 TD -0.0036 Tc 0.1185 Tw (emerges when the individual experiences actual or threat-)Tj T* 0.0075 Tc 0.1249 Tw (ened depletion of resources. Resources are objects \(e.g.,)Tj 0 -1.398 TD -0.0034 Tc 0.049 Tw (housing\), personal characteristics \(e.g., independence, self-)Tj 0 -1.401 TD 0.0002 Tc 0.125 Tw (esteem\), conditions \(e.g., employment, social status\), and)Tj T* -0.0034 Tc 0.0541 Tw (energies \(e.g., economic resources, information\). These re-)Tj 0 -1.398 TD -0.0035 Tc -0.039 Tw [(sources serve as means to achieve one)50.5(s aims, so their deple-)]TJ 0 -1.401 TD -0.0031 Tc 0.0207 Tw (tion or threat of depletion may cause psychological distress)Tj T* -0.0142 Tc -0.0621 Tw [(\(Silver)36.8(, Holman, McIntosh, Poulin, & Gil-Rivas, 2002\). Inten-)]TJ 0 -1.398 TD -0.0056 Tc (sive use of existing resources, especially in coping with long-)Tj 0 -1.401 TD -0.0112 Tc -0.0625 Tw [(term stressful situations, results in their depletion. Individuals)]TJ T* -0.0132 Tc -0.0622 Tw (with low resources are the most vulnerable to additional losses)Tj 0 -1.398 TD -0.0042 Tc -0.0625 Tw (and experience more adverse outcomes \(Hobfoll, 1989\).)Tj 1.8 -2.001 TD -0.0035 Tc -0.01 Tw (Nevertheless, few victims of terror \(Bleich, Gelkopf, &)Tj -1.8 -1.401 TD -0.0087 Tc -0.0625 Tw (Solomon, 2003\) or sufferers of other trauma \(Jeavons, Green-)Tj 0 -1.398 TD -0.0033 Tc 0.0033 Tw [(wood, & Horne 1998; Bryant & Harvey)59.7(, 1995\) seek profes-)]TJ 0 -1.401 TD -0.0029 Tc 0.0735 Tw (sional help, and even fewer state that they were helped by)Tj T* 0.0084 Tc 0.125 Tw (professional services \(Austin & Godleski, 1999\). Tuval-)Tj 0 -1.398 TD -0.0038 Tc -0.0183 Tw (Mashiach and Shalev \(2005\) suggest that the low number of)Tj 0 -1.401 TD -0.0032 Tc 0.0087 Tw (terror victims seeking help is indicative of low accessibility)Tj T* -0.0095 Tc -0.0623 Tw [(of professional services or of the stigma attached to approach-)]TJ 0 -1.398 TD -0.0036 Tc -0.0115 Tw (ing them. It has been suggested that new modes of interven-)Tj 0 -1.401 TD -0.0034 Tc 0.0993 Tw (tion, better suited to victims needs, should be established)Tj T* -0.0184 Tc -0.0622 Tw [(\(T)32.6(uval-Mashiach & Shalev)62.6(, 2005\). In addition, this help should)]TJ 0 -1.398 TD -0.0052 Tc -0.0625 Tw (be initiated for and offered to victims at locations within their)Tj 0 -1.401 TD -0.0064 Tc (communities \(Austin & Godleski, 1999\). Intervention should)Tj T* -0.001 Tc 0.125 Tw (be flexible, adjusted to the phase following the attack, to)Tj 0 -1.398 TD -0.0031 Tc 0.0906 Tw (individual and family characteristics, to the extent of loss,)Tj 0 -1.401 TD -0.0075 Tc -0.0622 Tw (and to the availability of resources \(Austin & Godleski, 1999;)Tj T* -0.0084 Tc -0.0625 Tw (Hobfoll, 1989; Norris et al., 2002a\). Interventions should also)Tj 0 -1.398 TD -0.0034 Tc 0.0457 Tw [(aim at empowering individuals by reconstructing their per-)]TJ 0 -1.401 TD -0.0097 Tc -0.0621 Tw (sonal and interpersonal resources \(Gutierrez, Parsons, & Cox,)Tj T* -0.0037 Tc -0.0007 Tw [(1998; Hobfoll, 1989\). Norris, Friedman, and )17.3(W)94.1(atson \(2002\))]TJ 0 -1.398 TD 0.0076 Tc 0.125 Tw (stress that a holistic therapeutic approach which encom-)Tj 0 -1.401 TD -0.0033 Tc -0.0595 Tw (passes the individual victim and also the family and the com-)Tj T* -0.0031 Tc 0.0033 Tw (munity should be initiated.)Tj 1.8 -1.998 TD -0.0028 Tc 0.0063 Tw [(In addition to individual therapy)60.2(, family therapy)63.2(, group)]TJ -1.8 -1.401 TD -0.0029 Tc 0.0499 Tw [(therapy)63.1(, and community activities are accordingly required)]TJ T* -0.0036 Tc -0.0178 Tw (\(Austin & Godleski, 1999\). Interventions on the community)Tj ET endstream endobj 137 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 139 0 obj << /Length 8526 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (195)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0033 Tc -0.0078 Tw (and group levels should focus on increasing solidarity and a)Tj 0 -1.398 TD -0.0091 Tc -0.0622 Tw (sense of shared fate, reducing feelings of loneliness and hope-)Tj 0 -1.401 TD 0.0002 Tc 0.125 Tw [(lessness, and fostering mutual work to create alternative)]TJ T* -0.0055 Tc -0.0625 Tw (resources \(Austin & Godleski, 1999; Hobfoll, 1989\). In addi-)Tj 0 -1.398 TD -0.0037 Tc -0.0507 Tw (tion, the group experience makes possible repeated exposure)Tj 0 -1.401 TD -0.0033 Tc 0.0306 Tw (to the traumatic experience, its desensitization, and the for-)Tj T* -0.0037 Tc -0.0418 Tw (mulation of an adjusted narrative \(Foa, Molnal, & Kashman,)Tj 0 -1.398 TD 0.0078 Tc 0.125 Tw (1995\). On the family level, interventions are needed for)Tj 0 -1.401 TD -0.0034 Tc 0.0025 Tw (strengthening the familial system, fostering mutual support,)Tj T* -0.0036 Tc -0.0608 Tw [(and promoting adjustment \(Norris et al., 2002a\).)]TJ 1.8 -1.998 TD 0.125 Tw (This paper describes an empowerment program for)Tj -1.8 -1.401 TD -0.0032 Tc 0.0289 Tw (treating victims of terror attacks through the phases of psy-)Tj T* -0.0037 Tc 0.0344 Tw (chological reaction to them, based on a comprehensive and)Tj 0 -1.398 TD -0.0036 Tc (holistic approach. The program is grounded in the theoreti-)Tj 0 -1.401 TD 0.0672 Tw (cal framework of resource conservation as well as the em-)Tj T* -0.0104 Tc -0.0625 Tw [(powerment approach \(Gutierrez et al., 1998; Hobfoll, 1989\).)]TJ /F1 1 Tf 11 0 0 11 66 474 Tm -0.0053 Tc 0.0681 Tw [(The Empo)8.3(werment Pr)13.8(ogram f)11.1(or )71(Victims of)]TJ 0 -1.0909 TD -0.0049 Tc 0.0523 Tw [(T)60.6(err)14.2(or Attac)14.2(ks and )93.3(Their F)14.2(amilies)]TJ /TT5 1 Tf 0 -1.5136 TD 0.0233 Tc 0.1276 Tw [(P)6(r)31.5(ogram Backgr)31.5(ound)]TJ /TT2 1 Tf 10 0 0 10 84 425.64 Tm -0.0037 Tc 0.1019 Tw (Rambam Medical Center is the largest hospital in the)Tj -1.8 -1.398 TD -0.0035 Tc -0.039 Tw [(north of Israel and serves as the region)50.5(s main trauma center)50.5(.)]TJ 0 -1.401 TD -0.003 Tc 0.0545 Tw (It absorbs many of the severely injured in each mass casu-)Tj T* -0.0072 Tc -0.0622 Tw (alty event. From 2000 to 2005, 369 severely injured individu-)Tj 0 -1.398 TD 0.0221 Tc 0.1249 Tw [(als were treated at Rambam. )16(T)74.9(wenty-six of them were)]TJ 0 -1.401 TD -0.0037 Tc 0.0243 Tw (unidentified injured; 19 were unidentified injured who died)Tj T* -0.0028 Tc 0.034 Tw (on the way to the hospital.)Tj 1.8 -1.998 TD -0.0034 Tc 0.0985 Tw [(Following a mass casualty event, the hospital)50.6(s social)]TJ -1.8 -1.401 TD -0.0037 Tc -0.0375 Tw (work department operates an information center for the pub-)Tj T* -0.0118 Tc -0.0625 Tw [(lic \(Gagin, Cohen, & Peled-A)72.2(vram, 2005\), and provides infor)18.2(-)]TJ 0 -1.398 TD -0.0038 Tc 0.1207 Tw (mation on injured individuals received at Rambam and at)Tj 0 -1.401 TD -0.0051 Tc -0.0622 Tw (other hospitals to the many people who come to look for their)Tj T* -0.0271 Tc -0.0624 Tw [(kin \(Drory)56.9(, Posen, )21(V)65.1(ilner)29.9(, & Ginzbur)14.9(g, 1998; Gagin et al., 2005\).)]TJ 0 -1.398 TD -0.0033 Tc -0.0355 Tw (At the same time, social workers give psychological first aid)Tj 0 -1.401 TD -0.0031 Tc 0.1055 Tw (to people arriving at the hospital in search of their family)Tj T* -0.0037 Tc 0.0314 Tw (members. This includes emotional support, help in answer-)Tj 0 -1.398 TD -0.0035 Tc -0.04 Tw (ing urgent needs, and preparation for seeing the injured fam-)Tj 0 -1.401 TD -0.001 Tc 0.125 Tw (ily member in the operating room, intensive care unit, or)Tj T* -0.0035 Tc 0.0256 Tw [(medical department. Psychological First )50.4(Aid is likewise of-)]TJ 0 -1.398 TD -0.0053 Tc -0.0622 Tw (fered to families of deceased victims \(Gagin et al., 2005\).)Tj /TT5 1 Tf 11 0 0 11 66 120.36 Tm 0.0037 Tc 0.1257 Tw [(The Rationale For The Empowerment Pr)31(ogram)]TJ /TT2 1 Tf 10 0 0 10 84 100.65 Tm 0.0093 Tc 0.125 Tw (The first contact between the social worker and the)Tj -1.8 -1.401 TD -0.0036 Tc 0.03 Tw (wounded person at the hospital is made as soon as possible)Tj 0 -1.398 TD -0.0033 Tc -0.0538 Tw (after his/her admission. It takes place in the emergency room)Tj 25.5 64.998 TD -0.0166 Tc -0.0625 Tw (or in the particular ward after the first medical treatment. Fami-)Tj 0 -1.398 TD -0.003 Tc 0.0032 Tw (lies are also contacted at the very first moment of their tele-)Tj 0 -1.401 TD -0.0031 Tc 0.0496 Tw [(phone call or arrival at the hospital to search for their kin.)]TJ T* -0.0035 Tc 0.1206 Tw (The relations forged in these critical minutes between the)Tj 0 -1.398 TD -0.0065 Tc -0.0625 Tw (social workers and the wounded and their families are of high)Tj 0 -1.401 TD -0.0032 Tc -0.01 Tw [(emotional intensity)62.8(, replete with strong feelings of care and)]TJ T* -0.0033 Tc 0.0857 Tw [(empathy)62.7(. Indeed, the relationship often consolidates into a)]TJ 0 -1.398 TD -0.0032 Tc -0.0294 Tw (very special bond. Our clinical experience indicates that this)Tj 0 -1.401 TD -0.0033 Tc 0.0255 Tw (bond is long remembered by patients and families, and it is)Tj T* -0.003 Tc -0.0481 Tw (only natural for them to stay in touch with the social workers)Tj 0 -1.398 TD 0.0107 Tw (with whom they already are acquainted and trust.)Tj 1.8 -2.001 TD -0.0034 Tc 0.075 Tw (A second rationale for the project arises from the vic-)Tj -1.8 -1.401 TD -0.0036 Tc 0.1017 Tw (tims circumstances after discharge, in the disillusionment)Tj 0 -1.398 TD -0.0033 Tc 0.0443 Tw (phase \(Raphael, 1986\). While hospitalized they are usually)Tj 0 -1.401 TD 0.1125 Tw (surrounded and treated by professional personnel, friends,)Tj T* -0.0029 Tc 0.125 Tw (and others, and they receive support, care, and love. Dis-)Tj 0 -1.398 TD -0.0055 Tc -0.0625 Tw (charge from the hospital is followed by a diminution of atten-)Tj 0 -1.401 TD -0.0039 Tc [(tion and support. )17.1(T)72.9(e)-0.4(rror victims repeatedly say)65.1(,)0.1( One day we)]TJ T* -0.0022 Tc 0.125 Tw (are new headlines and the next day we are forgotten. In)Tj 0 -1.398 TD -0.0036 Tc 0.0619 Tw (addition, on their discharge from the hospital the wounded)Tj 0 -1.401 TD -0.0033 Tc 0.0615 Tw (are commonly expected to resume life as it was before the)Tj T* -0.0031 Tc -0.0544 Tw [(injury)59.9(. Contrary to these expectations, the victims often have)]TJ 0 -1.398 TD -0.0036 Tc -0.0339 Tw (a growing need for emotional and material help and support.)Tj 0 -1.401 TD -0.0033 Tc -0.0394 Tw (The lengthy travail of processing the traumatic experience is)Tj T* 0.0761 Tw (just beginning. Intervention in this phase is critical for pa-)Tj 0 -1.398 TD -0.0034 Tc 0.0728 Tw (tients ability to adjust and return to reasonable life \(NSW)Tj 0 -1.401 TD -0.003 Tc -0.0263 Tw (Institute of Psychiatry and Centre for Mental Health, 2000\).)Tj 1.8 -2.001 TD -0.0033 Tc 0.0322 Tw (Formal services exist that treat the victims of terror at-)Tj -1.8 -1.398 TD 0.001 Tc 0.125 Tw (tacks. The leading organization is the National Insurance)Tj 0 -1.401 TD -0.0031 Tc 0.1078 Tw (Institute. It is responsible for rehabilitation plans, psycho-)Tj T* -0.0572 Tw (logical aid, and answering material needs, in addition to pay-)Tj 0 -1.398 TD 0.0061 Tc 0.125 Tw (ing allowances to the disabled as a result of their injury)Tj 0 -1.401 TD -0.0019 Tc (\(National Insurance Institute of Israel, 2005\). In addition,)Tj T* -0.0017 Tc (therapeutic centers specialize in working with individuals)Tj 0 -1.398 TD -0.0035 Tc 0.0432 Tw [(experiencing traumatic life events. However)35.5(, the many and)]TJ 0 -1.401 TD -0.003 Tc 0.03 Tw (enormously complicated needs in the physical, psychologi-)Tj T* -0.0029 Tc -0.0395 Tw [(cal, social, and material spheres often cannot be fully met by)]TJ 0 -1.398 TD -0.0035 Tc 0.02 Tw (the existing services.)Tj /TT5 1 Tf 11 0 0 11 321 159.36 Tm -0.0005 Tc 0.1267 Tw [(Aims of the pr)29.5(ogram)]TJ /TT2 1 Tf 10 0 0 10 333 139.65 Tm -0.0033 Tc 0.0985 Tw [()-1453.2(T)73.5(o foster an ongoing recovery and healing process)]TJ 1.8 -1.401 TD -0.0035 Tc -0.062 Tw (for the victims and their families.)Tj -1.8 -1.998 TD 0.0568 Tw [()-1453.4(T)73.3(o help adjustment and coping of victims after dis-)]TJ 1.8 -1.401 TD -0.0034 Tc -0.0037 Tw (charge from the hospital, and in restoring their qual-)Tj T* -0.0087 Tc -0.0625 Tw (ity of life.)Tj ET endstream endobj 140 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 142 0 obj << /Length 8698 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0938 Tw [(196 )]TJ /TT3 1 Tf 2.7563 0 TD -0.0051 Tc 0.0952 Tw (Gagin An Ongoing Multi-Faceted Program for Victims of Terror Attacks and Their Families)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0037 Tc 0.1042 Tw [()-1453.6(T)73.1(o help in constructing and strengthening personal)]TJ 1.8 -1.398 TD -0.003 Tc -0.0225 Tw (and family resources.)Tj -1.8 -2.001 TD -0.0051 Tc -0.0625 Tw [()-1455(T)71.7(o create self-help groups that will foster mutual sup-)]TJ 1.8 -1.401 TD -0.0032 Tc -0.015 Tw [(port and a sense of solidarity)59.8(, and that will become a)]TJ 0 -1.398 TD -0.0035 Tc 0.0383 Tw (resource for better coping.)Tj /TT5 1 Tf 11 0 0 11 54 627.36 Tm 0.0097 Tc 0.1254 Tw [(Alliance with the Operation Embrace or)31.5(ganization)]TJ /TT2 1 Tf 10 0 0 10 72 607.65 Tm -0.0037 Tc -0.0072 Tw (The empowerment program is sponsored by the Opera-)Tj -1.8 -1.401 TD -0.0073 Tc -0.0625 Tw (tion Embrace \(OE\) organization. OE is a non-profit organiza-)Tj 0 -1.398 TD -0.0035 Tc 0.0305 Tw (tion in the United States that cooperates with mental health)Tj 0 -1.401 TD -0.0034 Tc 0.0725 Tw (professionals in Israel in assisting injured victims of terror)Tj T* -0.0032 Tc -0.0363 Tw (throughout Israel. OE supports activities initiated by the ser-)Tj 0 -1.398 TD -0.0035 Tc -0.0278 Tw (vices and provides individual help for victims, makes it pos-)Tj 0 -1.401 TD -0.006 Tc -0.0621 Tw (sible for volunteers to maintain correspondence with victims,)Tj T* -0.0036 Tc 0.0733 Tw [(purchases medical equipment and/or therapy)62.4(, and provides)]TJ 0 -1.398 TD -0.0055 Tc -0.0623 Tw (financial aid for needy victims. Its operatives remain with the)Tj 0 -1.401 TD -0.0035 Tc 0.0483 Tw [(injured and their families as needed. )50.5(As its name indicates,)]TJ T* -0.0034 Tc 0.0796 Tw (the goal of OE is to embrace victims of terror and to hold)Tj 0 -1.398 TD -0.0039 Tc 0.1112 Tw (them. While most people and organizations respond in an)Tj 0 -1.401 TD -0.0031 Tc 0.0296 Tw [(emer)17.9(gency)59.9(, OE aims to supply a constant support system.)]TJ /TT5 1 Tf 11 0 0 11 54 406.35 Tm 0.0216 Tc 0 Tw (Participants)Tj /TT2 1 Tf 10 0 0 10 72 386.64 Tm 0.0155 Tc 0.125 Tw (One hundred seventeen victims of terror who were)Tj -1.8 -1.398 TD -0.0031 Tc -0.0431 Tw (physically injured or have PTSD symptoms were enrolled in)Tj 0 -1.401 TD -0.0035 Tc 0.045 Tw [(the project. )17.5(They include Jews and )50.5(Arabs \(Muslims, Chris-)]TJ T* -0.0033 Tc -0.0437 Tw [(tians, and Druze\). Of the 117 participants, 50 were male and)]TJ 0 -1.398 TD -0.0126 Tc -0.0623 Tw [(67 female; mean age was 37 years \(range: 20-58\). The partici-)]TJ 0 -1.401 TD -0.0033 Tc 0.0289 Tw (pants suffered a wide range of physical injuries and trauma)Tj T* -0.0085 Tc -0.0624 Tw [(reactions. )57.3(A)59.7( group of bereaved family members who lost their)]TJ 0 -1.398 TD -0.0031 Tc -0.057 Tw (loved one in a terror attack have recently joined the program.)Tj 1.8 -2.001 TD -0.0034 Tc 0.0636 Tw (Intensity of participation in the program varies among)Tj -1.8 -1.401 TD -0.0031 Tc 0.0067 Tw (the victims, according to their needs, wishes, severity of in-)Tj 0 -1.398 TD -0.0029 Tc -0.0188 Tw [(jury)63.1(, or personal condition and time since injury)60.1(.)]TJ /TT5 1 Tf 11 0 0 11 54 207.36 Tm 0.0055 Tc 0.1255 Tw [(The Empowerment Pr)32.8(ogram)]TJ /TT2 1 Tf 10 0 0 10 72 187.65 Tm -0.004 Tc 0.04 Tw (The program is based on the empowerment model and)Tj -1.8 -1.401 TD -0.0034 Tc 0.0771 Tw (focuses on identifying and using existing strengths includ-)Tj 0 -1.398 TD 0.002 Tc 0.125 Tw (ing the development of coping resources \(Hobfoll, 1985;)Tj 0 -1.401 TD -0.0037 Tc 0.0137 Tw [(Rosenfeld, Lahad, & Cohen, 2001\). )17.3(T)70.1(wo social workers are)]TJ T* -0.0033 Tc -0.0234 Tw (responsible for the program, which is managed by the direc-)Tj 0 -1.398 TD -0.0035 Tc 0.0395 Tw (tor of the social work service. The different components of)Tj 0 -1.401 TD -0.0305 Tw (the program are intended to strengthen or to promote the use)Tj T* -0.0032 Tc -0.0064 Tw (of diverse cognitive, emotional, physical, and coping strate-)Tj 0 -1.398 TD -0.0078 Tc -0.0625 Tw (gies \(Rosenfeld et al., 2001; Lahad, 1997\).)Tj 27.3 64.698 TD -0.0034 Tc 0.09 Tw (As stated, contact and building a bond with the terror)Tj -1.8 -1.398 TD -0.0107 Tc -0.0622 Tw (victims start with admission to the hospital; with family mem-)Tj 0 -1.401 TD -0.0032 Tc 0.0044 Tw (bers this occurs immediately on their arrival at the informa-)Tj T* 0.0295 Tc 0.125 Tw [(tion center)56.5(.)-5.5( )14.5(Throughout the hospitalization, emotional)]TJ 0 -1.398 TD -0.0035 Tc 0.03 Tw (support, crisis intervention, and mediation with community)Tj 0 -1.401 TD 0.0406 Tw (services are offered to the injured and their families. When)Tj T* 0.0825 Tw (the time for discharge approaches, the social worker helps)Tj 0 -1.398 TD -0.003 Tc -0.061 Tw (the injured and the family to prepare emotionally for the sub-)Tj 0 -1.401 TD -0.0035 Tc 0.0075 Tw (sequent psychological sequel, and helps in problem-solving)Tj T* -0.0037 Tc -0.0586 Tw (processes and getting organized at home, providing informa-)Tj 0 -1.398 TD -0.0034 Tc -0.0243 Tw [(tion, and mediating with services in the community)59.6(.)]TJ 1.8 -2.001 TD -0.0033 Tc 0.0907 Tw (After discharge, needs are assessed \(mostly through a)Tj -1.8 -1.401 TD -0.0034 Tc -0.0085 Tw (home visit\) and an intervention plan is tailored for each vic-)Tj 0 -1.398 TD -0.0032 Tc -0.0463 Tw [(tim. Interventions on the individual, family)62.8(, group, and com-)]TJ 0 -1.401 TD -0.0027 Tc 0.0561 Tw (munity levels are offered \(Figure 1\); they are not mutually)Tj T* -0.014 Tc 0 Tw (exclusive.)Tj 1.8 -1.998 TD -0.0034 Tc -0.0071 Tw (The individual intervention may include short- or long-)Tj -1.8 -1.401 TD -0.0005 Tc 0.125 Tw (term psychotherapeutic meetings. In addition, a new pro-)Tj T* -0.0184 Tc -0.0622 Tw (gram, which we call When words end, is offered, applying)Tj 0 -1.398 TD 0.0295 Tc 0.1249 Tw [(complementary therapies such as hydrotherapy)59.5(, dance)]TJ 0 -1.401 TD -0.0032 Tc -0.0052 Tw [(therapy)62.8(, massage therapy)59.8(, )17.6(T)73.6(wina \(Chinese massage\), biblio-)]TJ T* -0.003 Tc 0.0213 Tw [(therapy)63(, and psychodrama. )14.9(These therapies are provided by)]TJ 0 -1.398 TD -0.0102 Tc -0.062 Tw (various complementary therapists, organized and coordinated)Tj 0 -1.401 TD -0.0034 Tc 0.063 Tw [(by the program)50.6(s social worker and sponsored by OE. )17.8(The)]TJ T* -0.0035 Tc 0.0793 Tw (social worker also mediates with and refers participants to)Tj 0 -1.398 TD -0.003 Tc 0.003 Tw (community services, voluntary organizations, and psychiat-)Tj 0 -1.401 TD -0.0037 Tc 0.005 Tw (ric and medical consultations.)Tj 1.8 -2.001 TD -0.003 Tc 0.0317 Tw (Family or spousal therapy is given when there is need,)Tj -1.8 -1.398 TD -0.0036 Tc 0.0788 Tw [(and is used to foster open communication, cohesion, resil-)]TJ 0 -1.401 TD 0.028 Tc 0.125 Tw (ience, and problem-solving abilities within the family)Tj T* -0.0031 Tc -0.0575 Tw [(\(Patterson, 2002\). Group therapy is also part of the program,)]TJ 0 -1.398 TD -0.0034 Tc 0.0489 Tw (offering terror victims a chance to join other individuals in)Tj 0 -1.401 TD -0.0037 Tc 0.0624 Tw [(similar situations. )14.2(T)73.1(wo groups have been conducted so far)50.3(.)]TJ T* -0.0032 Tc 0.0622 Tw [(The first group was for the victims, injured emotionally or)]TJ 0 -1.398 TD -0.0026 Tc -0.051 Tw [(physically)63.4(. )17.4(This group aimed to )]TJ 12.5248 0 TD -0.0036 Tc -0.05 Tw (help in the process of coping)Tj -12.5248 -1.401 TD -0.0033 Tc -0.0478 Tw (in the various spheres of life, promoting adjustment and psy-)Tj T* -0.0022 Tc 0.125 Tw (chological well being. It consisted of ten participants, six)Tj 0 -1.398 TD -0.0037 Tc -0.04 Tw (men and four women, ages 22 to 70, who were six months to)Tj 0 -1.401 TD -0.0032 Tc 0.0956 Tw (three years post event. Eight sessions were held, in which)Tj T* -0.0037 Tc 0.0343 Tw (the themes fluctuated between two sequences. One was the)Tj 0 -1.398 TD -0.0034 Tc 0.0719 Tw (time sequence: before the traumatic event, the event itself,)Tj 0 -1.401 TD 0.125 Tw (and after the traumatic event. The other was the interper-)Tj T* -0.0032 Tc 0.1069 Tw [(sonal sequence: self, couple, family)59.8(, and society)62.8(.)-5.3( )14.8(The ses-)]TJ 0 -1.398 TD 0.023 Tc 0.1249 Tw (sions focused on sharing the traumatic experience and)Tj 0 -1.401 TD -0.0037 Tc 0.0043 Tw (restructuring the trauma, improving present coping with the)Tj T* -0.0032 Tc 0.045 Tw (aftermath of the trauma and injury and the changes in self-)Tj ET endstream endobj 143 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 145 0 obj << /Length 7165 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (197)Tj /TT2 1 Tf 10 0 0 10 66 314.64 Tm -0.0003 Tc 0.125 Tw [(perception and in the meanings attributed to different as-)]TJ 0 -1.398 TD -0.003 Tc 0.083 Tw (pects of private life. By the end of the group intervention,)Tj 0 -1.401 TD -0.0032 Tc 0.0278 Tw (level of distress and posttraumatic symptoms had evidently)Tj T* -0.0035 Tc -0.0314 Tw (decreased. In addition, participants concluded that the group)Tj 0 -1.398 TD -0.0032 Tc 0.0832 Tw (gave them a sense of belonging and the ability to see per-)Tj 0 -1.401 TD -0.0036 Tc 0.015 Tw (sonal benefits and growth that emerged from the trauma, as)Tj T* -0.0034 Tc -0.0372 Tw (well as normalization of their feelings and reactions.)Tj 1.8 -1.998 TD -0.0014 Tc 0.125 Tw (The second group was for victims and their spouses.)Tj -1.8 -1.401 TD -0.0063 Tc -0.0625 Tw (The aims were to improve communication and mutual under-)Tj T* -0.0036 Tc 0.0157 Tw (standing within couples, to ameliorate couples coping, and)Tj 0 -1.398 TD 0.041 Tw (to help with acceptance of the changes on the personal and)Tj 0 -1.401 TD -0.0031 Tc -0.02 Tw (family levels. Eight couples, ages 22 to 45, in each of which)Tj T* -0.0027 Tc -0.0185 Tw (one partner had been physically or emotionally hurt in a ter-)Tj 0 -1.398 TD -0.0031 Tc -0.0328 Tw [(ror attack, participated in the 10 group therapy sessions. The)]TJ 0 -1.401 TD -0.004 Tc -0.0625 Tw (therapy focused on sharing the traumatic experiences of each)Tj T* 0.0075 Tc 0.125 Tw (of the partners, and dealing with the changes in spousal)Tj 0 -1.398 TD -0.0034 Tc -0.0061 Tw [(relationships, intimacy)62.6(, role conflicts, communication prob-)]TJ 25.5 22.8 TD -0.0035 Tc -0.0312 Tw (lems, and acquiring efficient coping skills. The couples con-)Tj 0 -1.401 TD -0.0029 Tc 0.0935 Tw [(cluded that, as a result of the group therapy)60.1(, intimacy and)]TJ T* -0.0037 Tc 0.1142 Tw [(mutual acceptance improved, and the spousal contact was)]TJ 0 -1.398 TD 0.0051 Tc 0.125 Tw (strengthened in the process. They found mutual learning)Tj 0 -1.401 TD -0.0035 Tc 0.0456 Tw (had taken place among the couples, fostering a feeling that)Tj T* -0.0038 Tc -0.0192 Tw (the spousal problems were common to all.)Tj 1.8 -1.998 TD -0.0061 Tc -0.0625 Tw [(The victims and their families create a small community)62.9(.)]TJ -1.8 -1.401 TD -0.0027 Tc -0.0619 Tw [(W)56.1(ithin this community they feel close to each other)36.3(, they can)]TJ T* -0.0033 Tc 0.005 Tw (openly express feelings and thoughts, and can feel accepted)Tj 0 -1.398 TD -0.0035 Tc -0.0568 Tw [(and understood. )50.6(Activities on the community level are aimed)]TJ 0 -1.401 TD -0.035 Tw [(at strengthening this small and unique community)62.4(, and mak-)]TJ T* -0.0037 Tc -0.0127 Tw [(ing it a source of empowerment and support \(Bolton, 1999\).)]TJ 0 -1.398 TD -0.0034 Tc -0.0512 Tw [(However)35.6(, the purpose of the activities is to infuse the partici-)]TJ 0 -1.401 TD -0.003 Tc -0.0033 Tw (pants with strength from the solidarity and familiarity in or-)Tj T* -0.0003 Tc 0.125 Tw (der that they may cope outside the group, not to become)Tj 0 -1.398 TD -0.003 Tc 0.021 Tw [(closed within it. Several activities take place each year)36(, in-)]TJ 0 -1.401 TD -0.0051 Tc -0.0625 Tw (cluding lectures and workshops. For example, in winter 2004)Tj /TT3 1 Tf -8.835 63.834 TD -0.0073 Tc -0.0688 Tw (Figure 1. The Empowerment Program)Tj ET /GS1 gs 312.435 621.39 m 312.435 589.8 l S 0.99 w 129.99 592.305 m 488.79 592.305 l S BT /F21 1 Tf 11 0 0 11 308.925 391.935 Tm /GS2 gs 0 Tc 0 Tw ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj /TT3 1 Tf 10 0 0 10 262.59 693.9 Tm -0.005 Tc -0.06 Tw (Discharge from hospital)Tj ET 1000 M /GS1 gs 236.695 706.905 155.01 -22.01 re S BT 10 0 0 10 266.16 662.01 Tm /GS2 gs -0.0056 Tc 0.0325 Tw (Assessment of needs)Tj ET /GS1 gs 236.495 675.005 155.01 -22.01 re S BT 10 0 0 10 277.65 630 Tm /GS2 gs -0.0078 Tc -0.07 Tw (Intervention plan)Tj ET /GS1 gs 236.395 643.005 155.01 -22.01 re S BT 10 0 0 10 300.9 569.01 Tm /GS2 gs -0.0386 Tc 0 Tw (Group)Tj -0.15 -1.2 TD -0.0265 Tc (sphere)Tj ET /GS1 gs 286.495 582.505 55.01 -35.01 re S BT 10 0 0 10 281.64 525 Tm /GS2 gs -0.005 Tc 0.01 Tw (Victims group)Tj 1.5 -1.2 TD -0.0184 Tc 0 Tw (therapy)Tj ET /GS1 gs 270.495 538.505 84.51 -35.01 re S BT 10 0 0 10 281.49 483 Tm /GS2 gs -0.0159 Tc -0.07 Tw (Couples group)Tj 1.617 -1.2 TD -0.0184 Tc 0 Tw (therapy)Tj ET /GS1 gs 271.495 496.505 84.51 -35.01 re S BT 10 0 0 10 82.65 567.99 Tm /GS2 gs -0.0109 Tc -0.07 Tw (Community Sphere)Tj ET /GS1 gs 66.995 582.505 118.01 -21.01 re S BT 10 0 0 10 456.15 566.49 Tm /GS2 gs (Community Sphere)Tj ET /GS1 gs 440.495 581.005 118.01 -21.01 re S BT 10 0 0 10 99.9 506.01 Tm /GS2 gs -0.0158 Tc 0 Tw (Workshops)Tj ET /GS1 gs 66.995 520.505 118.01 -21.01 re S BT 10 0 0 10 105.51 536.49 Tm /GS2 gs -0.0122 Tc (Lectures)Tj ET /GS1 gs 66.995 551.005 118.01 -21.01 re S BT 10 0 0 10 89.01 477 Tm /GS2 gs -0.0023 Tc 0.14 Tw (Social Activities)Tj ET /GS1 gs 66.995 491.505 118.01 -21.01 re S BT 10 0 0 10 442.26 477 Tm /GS2 gs -0.0127 Tc -0.07 Tw (Complementary therapies)Tj ET /GS1 gs 440.495 491.505 118.01 -21.01 re S BT 10 0 0 10 459 536.49 Tm /GS2 gs -0.007 Tc (Individual therapy)Tj ET /GS1 gs 439.995 551.005 118.01 -21.01 re S BT 10 0 0 10 465.51 506.01 Tm /GS2 gs -0.0052 Tc -0.04 Tw (Family therapy)Tj ET /GS1 gs 440.495 520.505 118.01 -21.01 re S BT 10 0 0 10 453 447.99 Tm /GS2 gs -0.0069 Tc -0.0675 Tw (Mediation & Referral)Tj ET /GS1 gs 439.995 462.505 118.01 -21.01 re S BT 10 0 0 10 251.01 419.16 Tm /GS2 gs -0.0056 Tc -0.03 Tw (Reassessment of needs and)Tj 3.45 -1.2 TD -0.01 Tc 0 Tw (interventions)Tj ET /GS1 gs 235.995 430.505 155.01 -28.51 re S BT 10 0 0 10 274.5 380.01 Tm /GS2 gs -0.0054 Tc -0.05 Tw [(Readjustments of)]TJ 0.264 -1.2 TD -0.009 Tc -0.07 Tw (intervention plan)Tj ET /GS1 gs 235.495 391.505 155.01 -29.51 re S 0.51 w 10 M 312.045 462 m 312.045 439.5 l S 0.99 w 497.505 441 m 497.505 413.79 l 399.99 413.985 m 498 413.985 l 124.995 471 m 124.995 414 l 125.01 414.495 m 229.5 414.495 l S BT /F21 1 Tf 11 0 0 11 309.225 675.345 Tm /GS2 gs 0 Tc 0 Tw ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj 0.015 -2.925 TD ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj 0.015 -5.5159 TD ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj 16.0132 -0.0314 TD ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj -32.5377 0.0014 TD ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj 16.5314 -13.8041 TD ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj 0 -10.9998 10.9998 0 391.3227 417.1849 Tm ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj -0.0002 -10.9998 -10.9998 0.0002 235.7734 417.5848 Tm ()Tj -0.03 0 TD ()Tj 0.03 0.03 TD ()Tj -0.03 0 TD ()Tj 0.015 -0.015 TD ()Tj ET endstream endobj 146 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 150 0 obj << /Length 9102 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0938 Tw [(198 )]TJ /TT3 1 Tf 2.7563 0 TD -0.0051 Tc 0.0952 Tw (Gagin An Ongoing Multi-Faceted Program for Victims of Terror Attacks and Their Families)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.004 Tc 0.06 Tw (a workshop titled Balloons of Hope was conducted; par-)Tj 0 -1.398 TD -0.0034 Tc 0 Tw (ticipants were asked to tell their personal stories and wishes)Tj 0 -1.401 TD 0.0045 Tw (for the future in words, drawings, and other means. Then as)Tj T* -0.0031 Tc 0.0884 Tw (a symbolic act they attached their work to balloons which)Tj 0 -1.398 TD -0.0036 Tc -0.0609 Tw [(were released into the air)50.4(.)-5.6( )53.5(Another recent project is a walking)]TJ 0 -1.401 TD -0.0033 Tc 0.0062 Tw (group for bereaved women, led by a professional guide.)Tj /TT5 1 Tf 11 0 0 11 54 619.35 Tm 0.012 Tc 0.1273 Tw (Case Examples)Tj 10 0 0 10 72 599.64 Tm -0.0035 Tc -0.045 Tw (Case 1: )Tj /TT2 1 Tf 3.42 0 TD -0.0031 Tc -0.0464 Tw [(A., a 40-year)17.9(-old man, married with 3 children,)]TJ -5.22 -1.398 TD -0.0269 Tw (was mildly injured in a terror attack in the North and experi-)Tj 0 -1.401 TD -0.0035 Tc 0.0907 Tw (enced a severe posttraumatic reaction. He suffered serious)Tj T* -0.0034 Tc -0.0005 Tw (sleeping disorders, was afraid to go out, reacted with severe)Tj 0 -1.398 TD -0.0031 Tc -0.0185 Tw (anxiety when his wife or children did so, and restricted their)Tj 0 -1.401 TD -0.0034 Tc 0.0425 Tw [(movement. He was unable to drive, and as a bus driver he)]TJ T* 0.02 Tw [(could not go back to work for a long period. )50.6(A.)53.6(s wife is an)]TJ 0 -1.398 TD -0.024 Tw [(invalid, whom he had cared for before the injury)62.6(.)-7.5( )50.7(A. was ob-)]TJ 0 -1.401 TD -0.0035 Tc 0.0943 Tw (sessed with his situation, experiencing high distress, espe-)Tj T* 0.0072 Tc 0.125 Tw [(cially anxiety and powerful feelings of helplessness. )19.2(W)96(e)]TJ 0 -1.398 TD -0.0035 Tc -0.0036 Tw (started treatment on several levels. Individual sessions were)Tj 0 -1.401 TD -0.004 Tc -0.0625 Tw [(arranged for )50(A. to help him cope with the trauma and with his)]TJ T* -0.0074 Tc (altered life circumstances. Therapy included significant emo-)Tj 0 -1.398 TD 0.0365 Tc 0.125 Tw (tional support, legitimatization of his feelings, and a)Tj 0 -1.401 TD 0.0096 Tc (psychoeducational approach \(i.e., emotional reactions to)Tj T* -0.0032 Tc 0.0927 Tw [(trauma\). The therapy focused on restoring a sense of con-)]TJ 0 -1.398 TD -0.0034 Tc 0.0293 Tw (trol, reducing anxiety and avoidance. Graded exposure was)Tj 0 -1.401 TD -0.0036 Tc 0.07 Tw [(used to encourage )50.4(A. to confront feared thoughts and feel-)]TJ T* -0.0034 Tc -0.0571 Tw [(ing, )-5.5(together with cognitive restructuring of anxiety-evoking)]TJ 0 -1.398 TD 0.1095 Tw (thoughts, such as correlating the act of getting onto a bus)Tj 0 -1.401 TD -0.0035 Tc 0.0362 Tw [(with experiencing an explosion. )53.6(A. and the therapist built a)]TJ T* -0.0031 Tc -0.024 Tw (plan of gradually returning to work, first to office duties and)Tj 0 -1.398 TD -0.0033 Tc 0.0463 Tw (then gradually going back to driving. Strategies of enhanc-)Tj 0 -1.401 TD -0.0006 Tc 0.125 Tw [(ing control in the driving situation were devised, such as)]TJ T* -0.0035 Tc 0.082 Tw (asking to be assigned safe bus lines and checking the bus.)Tj 0 -1.398 TD -0.0088 Tc -0.0625 Tw [(W)95(e)0( received funding for psychological treatment for the other)]TJ 0 -1.401 TD -0.0039 Tc -0.0623 Tw (family members. This focused on the anxiety reactions of the)Tj T* -0.0036 Tc 0.1222 Tw (children, which were evident in deterioration in academic)Tj 0 -1.398 TD -0.0046 Tc -0.0625 Tw (performance and behavioral problems in school and at home.)Tj 0 -1.401 TD -0.0036 Tc (A. participated in the group for victims, and together with his)Tj T* -0.017 Tw (wife joined the group for victims and spouses, in addition to)Tj 0 -1.398 TD -0.0033 Tc -0.0088 Tw (taking part in community activities. In the safe environment)Tj 0 -1.401 TD -0.0035 Tc 0.0294 Tw [(of the couples group, )50.4(A. and his wife succeeded in creating)]TJ T* -0.0033 Tc -0.0088 Tw (an open dialogue, and they acquired better understanding of)Tj 0 -1.398 TD 0.0011 Tc 0.125 Tw [(the each others)70.1( emotional reactions. )49.1(A. was then able to)]TJ 0 -1.401 TD -0.0035 Tc -0.017 Tw (resume caring for his wife and her needs, instead of concen-)Tj T* 0.1168 Tw (trating on his own problems. The feelings of helplessness)Tj 0 -1.398 TD -0.0032 Tc 0.12 Tw (and psychological distress decreased and family function-)Tj 0 -1.401 TD -0.0033 Tc -0.0375 Tw (ing gradually improved. He returned to work.)Tj /TT5 1 Tf 27.3 65.499 TD -0.0047 Tc 0.05 Tw (Case 2:)Tj /TT2 1 Tf 3.105 0 TD -0.0032 Tc 0.0551 Tw [( D.)50.8(s husband was mortally injured in a terror)]TJ -4.905 -1.398 TD -0.0034 Tc -0.0623 Tw (attack at a restaurant and died two weeks later in the hospital.)Tj 0 -1.401 TD -0.003 Tc -0.034 Tw (D. was 45 years old with five children. The youngest daugh-)Tj T* 0.0105 Tw (ter was to be married four days after the terror event. Inten-)Tj 0 -1.398 TD -0.0078 Tc -0.0622 Tw [(sive crisis intervention was conducted with D. and her family)61.2(,)]TJ 0 -1.401 TD -0.0035 Tc 0.0536 Tw (with continuous support throughout the lengthy period fol-)Tj T* 0.0145 Tw (lowing. The intervention with D. focused on grief work, al-)Tj 0 -1.398 TD -0.0134 Tc -0.0622 Tw (lowing outlet and legitimization for feelings of anger and pain.)Tj 0 -1.401 TD -0.0036 Tc 0.122 Tw [(The two-fold problem of being an )50.4(Arab who was hurt by)]TJ T* 0.0884 Tw (Arab terrorists emerged and had to be dealt with, together)Tj 0 -1.398 TD -0.0033 Tc 0.068 Tw (with her rage against the terrorists. D. had to assume roles)Tj 0 -1.401 TD -0.0029 Tc 0.0257 Tw (and responsibilities previously handled entirely by her hus-)Tj T* -0.0036 Tc 0.093 Tw (band. She had to make decisions herself and learn how to)Tj 0 -1.398 TD -0.003 Tc 0.0272 Tw [(manage money)63(, pay bills, etc. )51.2(As part of the )51.2(Arab tradition,)]TJ 0 -1.401 TD -0.0036 Tc -0.0038 Tw [(her married son insisted on shouldering all his father)-39.6()56.4(s)0.3( roles)]TJ T* -0.0161 Tc -0.0623 Tw [(as head of the family)61.9(. Culturally-sensitive work was conducted)]TJ 0 -1.398 TD -0.0034 Tc -0.0145 Tw [(with D. so that she could accept the son)50.6(s help but retain her)]TJ 0 -1.401 TD -0.0038 Tc -0.0277 Tw (independence. She was now strong enough to decide to hold)Tj T* -0.0034 Tc -0.0298 Tw [(her daughter)-39.4()56.6(s)-0.2( wedding before the end of the year of mourn-)]TJ 0 -1.398 TD -0.0033 Tc -0.0159 Tw (ing, which she felt was the right thing to do, considering her)Tj 0 -1.401 TD -0.0034 Tc 0.0009 Tw [(daughter)-39.4()56.6(s)-0.2( mental condition, although it was contrary to the)]TJ T* -0.0035 Tc 0.0275 Tw [(cultural custom. )53.5(Another aspect of the culture-sensitive in-)]TJ 0 -1.398 TD 0.0532 Tw (tervention was helping D. resume a meaningful and enjoy-)Tj 0 -1.401 TD -0.0032 Tc -0.0459 Tw (able life, attending to herself and her needs, in contrast to the)Tj T* -0.0036 Tc 0 Tw (cultural concept of widowhood. D. also received alternative)Tj 0 -1.398 TD -0.0033 Tc 0.0356 Tw (therapy through the project, from which she benefited. The)Tj 0 -1.401 TD -0.0084 Tc -0.0625 Tw [(family was also assisted financially)60.6(, as the wedding expenses,)]TJ T* -0.0028 Tc 0.12 Tw (which had been paid, left the family heavily in debt. The)Tj 0 -1.398 TD -0.0029 Tc -0.0433 Tw (connection with the family still exists, several years after the)Tj 0 -1.401 TD 0.0119 Tc 0 Tw (event.)Tj /F1 1 Tf 11 0 0 11 309 284.01 Tm -0.0019 Tc (Discussion)Tj /TT2 1 Tf 10 0 0 10 327 260.64 Tm -0.0037 Tc 0.0033 Tw (This article describes a continuous and comprehensive,)Tj -1.8 -1.398 TD -0.0035 Tc 0.0464 Tw [(volunteer)38.5(, non-profit program to assist terror victims in the)]TJ 0 -1.401 TD -0.0062 Tc -0.0625 Tw (long and emotionally laborious road back to pre-incident life.)Tj T* -0.0038 Tc 0.0725 Tw (This program is unique in being comprehensive and open-)Tj 0 -1.398 TD -0.0033 Tc 0.12 Tw (ended, functioning throughout the different stages of psy-)Tj 0 -1.401 TD -0.0411 Tw [(chological reactions to trauma as a result of terrorism. )17.6(T)70.5(o)0.9( the)]TJ T* -0.0036 Tc -0.0523 Tw (best of our knowledge, no other such programs are described)Tj 0 -1.398 TD -0.0032 Tc -0.0035 Tw (in the literature or are operated in Israel or other countries.)Tj 1.8 -2.001 TD 0.1244 Tw [(The plan of the program, as outlined at the start, has)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0183 Tw [(evolved through the experience of learning the needs of the)]TJ 0 -1.398 TD -0.0037 Tc 0.0313 Tw (victims and getting acquainted with the problems and chal-)Tj 0 -1.401 TD -0.0031 Tc 0.0555 Tw [(lenges they encounter)53.9(. For example, at the start of the pro-)]TJ T* -0.0034 Tc -0.0029 Tw (gram the plan was to meet the needs of the injured and their)Tj 0 -1.398 TD -0.0035 Tc 0.0272 Tw (families, but of late has been expanded to include bereaved)Tj ET endstream endobj 151 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 153 0 obj << /Length 8853 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (199)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0048 Tc -0.0622 Tw [(individuals as well. )52.3(As a result, the advantage of tailoring the)]TJ 0 -1.398 TD 0.0061 Tc 0.125 Tw (program to the changing needs of the patients has taken)Tj 0 -1.401 TD -0.0034 Tc -0.0493 Tw (place, making the program dynamic and client-centered, and)Tj T* -0.0036 Tc 0.0725 Tw (attuned to patients changing needs during the coping pro-)Tj 0 -1.398 TD 0.0272 Tc 0 Tw (cess.)Tj 1.8 -2.001 TD -0.0037 Tc -0.0286 Tw (The program has several broader applications for work-)Tj -1.8 -1.401 TD -0.0036 Tc 0.0211 Tw (ing with different groups of PTSD patients, such as victims)Tj 0 -1.398 TD -0.0034 Tc 0.038 Tw (of the September 11, 2001 terror attack and veterans of the)Tj 0 -1.401 TD -0.004 Tc -0.0625 Tw (Gulf or Iraq wars. Most important is the realization that treat-)Tj T* -0.0037 Tc 0 Tw (ment of trauma victims can be long-term. Longitudinal pro-)Tj 0 -1.398 TD -0.0036 Tc 0.055 Tw (grams should be designed and tailored to individual needs.)Tj 0 -1.401 TD -0.0037 Tc -0.0513 Tw (Programs should be flexible and subject to change according)Tj T* -0.0036 Tc 0.0211 Tw [(to the passage of time and individual progress. )50.4(Another im-)]TJ 0 -1.398 TD 0.1206 Tw (plication is the advantage of a multi-faceted program that)Tj 0 -1.401 TD 0.0029 Tc 0.125 Tw (offers a variety of services on the individual, group, and)Tj T* -0.0102 Tc -0.0625 Tw (community level. Each level offers different elements of help,)Tj 0 -1.398 TD -0.0034 Tc 0.0638 Tw (while their integration is necessary to encompass the com-)Tj 0 -1.401 TD -0.0031 Tc -0.043 Tw (plexity of PTSD symptoms and effects.)Tj 1.8 -2.001 TD -0.0041 Tc -0.0625 Tw (In the United States, as in Israel, victims of terror attacks)Tj -1.8 -1.398 TD -0.0086 Tc (and war veterans who suffer from PTSD are often from diver-)Tj 0 -1.401 TD 0.0003 Tc 0.125 Tw (gent ethnic or cultural backgrounds. The program can be)Tj T* -0.0033 Tc -0.0256 Tw (sensitively adapted to the different cultural codes and norms)Tj 0 -1.398 TD -0.0037 Tc -0.0175 Tw (of coping with trauma, emotional expression, and the mean-)Tj 0 -1.401 TD -0.0033 Tc 0.0187 Tw (ing ascribed to life situations.)Tj 1.8 -2.001 TD -0.0111 Tc -0.0622 Tw (The model of cooperation between a formal, professional)Tj -1.8 -1.398 TD -0.0036 Tc 0.0714 Tw (organization and a volunteer organization has enriched the)Tj 0 -1.401 TD 0.0069 Tw (project and its participants, and we recommend its adoption)Tj T* 0.0035 Tc 0.1249 Tw [(for use with other groups of PTSD patients. )51.4(A)56.7( voluntary)]TJ 0 -1.398 TD -0.0035 Tc 0.06 Tw (organization may add enthusiasm and warmth, and has the)Tj 0 -1.401 TD -0.0084 Tc -0.0624 Tw [(flexibility to provide solutions to specific problems and needs)]TJ T* -0.0034 Tc -0.0127 Tw (of the terror victims. From the present experience, the assis-)Tj 0 -1.398 TD -0.0033 Tc -0.0394 Tw (tance of the voluntary organization for individuals should be)Tj 0 -1.401 TD -0.0035 Tc 0.1007 Tw (based on needs assessment by mental health professionals)Tj T* -0.0034 Tc 0.0595 Tw (such as psychologists or social workers and should be part)Tj 0 -1.398 TD -0.0035 Tc 0.0105 Tw (of a comprehensive intervention plan. In the case of the OE)Tj 0 -1.401 TD -0.04 Tw (organization, the warmth imparted to victims as well as their)Tj T* -0.0034 Tc 0.019 Tw (sincere concern are a source of support for the social work-)Tj 0 -1.398 TD -0.0032 Tc -0.0425 Tw (ers as well.)Tj 1.8 -2.001 TD -0.0035 Tc -0.0534 Tw (The present program is provided in addition to the exist-)Tj -1.8 -1.401 TD -0.0031 Tc 0.0518 Tw (ing services that treat the victims of terror attacks. It is not)Tj 0 -1.398 TD -0.0054 Tc -0.0623 Tw (intended to compete with the formal help given. It is meant to)Tj 0 -1.401 TD -0.0034 Tc -0.0257 Tw (be complementary to the help received from those organiza-)Tj T* -0.0003 Tc 0.125 Tw (tions. It is conducted in coordination with these services.)Tj 0 -1.398 TD -0.0034 Tc 0.0671 Tw (Coordination between all services is essential. It facilitates)Tj 0 -1.401 TD -0.0037 Tc 0.0381 Tw (the provision of a more comprehensive and cooperative in-)Tj T* -0.0075 Tc -0.0625 Tw (tervention plan from which the participant can find additional)Tj 25.5 65.4 TD -0.0037 Tc -0.0159 Tw [(benefits. )50.3(As one of the victims said, Y)95.3(our program fills the)]TJ 0 -1.398 TD -0.0033 Tc 0.034 Tw (gaps that exist in the services.)Tj 1.8 -2.001 TD -0.0037 Tc 0.0693 Tw (The issue of treatment termination must be addressed.)Tj -1.8 -1.401 TD -0.0039 Tc -0.0125 Tw [(The program is supposed to be open-ended. However)35.1(, ques-)]TJ 0 -1.398 TD -0.0035 Tc -0.0445 Tw (tions arise. How long should terror victims be enrolled in the)Tj 0 -1.401 TD -0.0037 Tc -0.0366 Tw (program? What is the optimal period to prevent the develop-)Tj T* -0.0036 Tc -0.025 Tw (ment of over-dependence? Should an optimal period of time)Tj 0 -1.398 TD -0.0034 Tc -0.0115 Tw (be defined, or should there be a periodic evaluation for each)Tj 0 -1.401 TD 0.06 Tw (patient to define his/her needs and wishes?)Tj 1.8 -2.001 TD -0.0036 Tc 0.0139 Tw [(A limitation of the empowerment program is the diffi-)]TJ -1.8 -1.398 TD -0.0031 Tc 0.0432 Tw (culty in assessing its results due to the long periods of par-)Tj 0 -1.401 TD -0.0027 Tc 0.125 Tw [(ticipants staying in the project with its various elements,)]TJ T* -0.0033 Tc 0.0981 Tw (and the existence of many intervening variables related to)Tj 0 -1.398 TD 0.0025 Tc 0.125 Tw (what happens in participants lives. Nevertheless, we are)Tj 0 -1.401 TD -0.002 Tc (engaged in a longitudinal evaluation of the change in the)Tj T* -0.0036 Tc 0.048 Tw [(participants)71.4( PTSD symptoms \(Foa, 1993\). )17.5(W)94.2(e)0( believe that)]TJ 0 -1.398 TD -0.0037 Tc 0.04 Tw (additional means of evaluation should be developed.)Tj 1.8 -2.001 TD -0.0094 Tc -0.0622 Tw (Cooperation between services around the world that treat)Tj -1.8 -1.401 TD -0.0034 Tc -0.025 Tw (terror and other disasters should be fostered in order to learn)Tj 0 -1.398 TD -0.0037 Tc -0.0061 Tw (from each other and to develop shared knowledge and prac-)Tj 0 -1.401 TD -0.0043 Tc -0.06 Tw (tice models.)Tj /F1 1 Tf 11 0 0 11 400.89 392.01 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 321 374.64 Tm -0.023 Tc -0.0625 Tw [(Armenian, H.K., Morikawa, M., Melkonian, )52(A.K., Hovanesian,)]TJ 1.2 -1.398 TD -0.008 Tc -0.0621 Tw [(A.P)109(., Haroutunian, N., Saigh, P)106(.A., )49.4(Akiskal, K., & )52.4(Akiskal,)]TJ 0 -1.401 TD -0.0035 Tc -0.0527 Tw (H.S. \(2000\). Loss as a determinant of PTSD in a cohort of)Tj T* -0.0037 Tc -0.0567 Tw [(adult survivors of the 1988 earthquake in )53.5(Armenia: Impli-)]TJ 0 -1.398 TD -0.0024 Tc 0.0829 Tw [(cations for policy)63.6(. )]TJ /TT5 1 Tf 7.635 0 TD -0.0039 Tc 0.0833 Tw (Acta Psychiatrica Scandenavia, 102)Tj /TT2 1 Tf 14.616 0 TD 0 Tc 0 Tw (,)Tj -22.251 -1.401 TD -0.0516 Tc (58-64.)Tj -1.2 -1.8 TD -0.0157 Tc -0.0622 Tw (Austin, L.S., & Godleski, L.S. \(1999\). Therapeutic approaches)Tj 1.2 -1.401 TD 0.0075 Tc 0.1247 Tw [(for survivors of disaster)46.5(. )]TJ /TT5 1 Tf 10.68 0 TD 0.1249 Tw [(Psychiatric Clinics of Nort)5.3(h)]TJ -10.68 -1.398 TD -0.0161 Tc 0 Tw (America)Tj /TT2 1 Tf 3.279 0 TD -0.011 Tc (, )Tj /TT5 1 Tf 0.417 0 TD -0.019 Tc (22)Tj /TT2 1 Tf 0.969 0 TD -0.0153 Tc -0.06 Tw (, 897-910.)Tj -5.865 -1.8 TD -0.0035 Tc -0.03 Tw [(Bleich, )50.5(A., Gelkopf, M., & Solomon, Z. \(2003\). Exposure to)]TJ 1.2 -1.401 TD -0.0099 Tc -0.0625 Tw (terrorism, stress-related mental health symptoms, and cop-)Tj T* -0.0035 Tc 0.0142 Tw (ing behaviors among nationally representative sample in)Tj 0 -1.398 TD -0.003 Tc 0 Tw (Israel. )Tj /TT5 1 Tf 2.64 0 TD -0.0044 Tc -0.0625 Tw (Journal of the American Medical Association, 290)Tj /TT2 1 Tf 19.611 0 TD 0 Tc 0 Tw (,)Tj -22.251 -1.401 TD -0.0511 Tc (612-620.)Tj -1.2 -1.8 TD -0.0084 Tc -0.0622 Tw (Bolton, D. \(1999\). The threat to belonging in Enniskillen: Re-)Tj 1.2 -1.401 TD -0.0242 Tc -0.0625 Tw (flections on the Remembrance Day bombing. In: E.S. Zinner)Tj 0 -1.398 TD -0.0035 Tc -0.0215 Tw [(& M.B. )14.2(W)55.3(illiams \(eds.\), )]TJ /TT5 1 Tf 9.765 0 TD -0.0043 Tc -0.0225 Tw (When a community weeps: Case)Tj -9.765 -1.401 TD -0.0064 Tc -0.0617 Tw (studies in group survivorship)Tj /TT2 1 Tf 11.331 0 TD -0.0061 Tc [( \(pp. 191-212\). 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Meta-)]TJ 1.2 -1.398 TD -0.0032 Tc 0.0786 Tw (analysis of risk factors for posttraumatic stress disorder)Tj ET endstream endobj 154 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 156 0 obj << /Length 9565 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0938 Tw [(200 )]TJ /TT3 1 Tf 2.7563 0 TD -0.0051 Tc 0.0952 Tw (Gagin An Ongoing Multi-Faceted Program for Victims of Terror Attacks and Their Families)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0125 Tc -0.0616 Tw (in trauma-exposed adults. )Tj /TT5 1 Tf 10.044 0 TD -0.0131 Tc -0.0625 Tw (Journal of Consulting and Clini-)Tj -10.044 -1.398 TD -0.0042 Tc -0.0398 Tw [(cal Psychology)49.8(, 68)]TJ /TT2 1 Tf 7.38 0 TD -0.0039 Tc -0.045 Tw (, 748766.)Tj -8.58 -1.8 TD -0.0029 Tc -0.0183 Tw [(Bryant, R.A., & Harvey)63.1(, )51.4(A.G)117.1(. \(1995\). 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Reliability and)Tj 1.2 -1.398 TD -0.0033 Tc 0.0783 Tw (validity of brief instrument for assessing post-traumatic)Tj 0 -1.401 TD -0.004 Tc -0.0025 Tw [(stress disorder)53(.)-7.5( )]TJ /TT5 1 Tf 6.135 0 TD -0.0038 Tw [(Journal of T)49.9(raumatic S)31.9(t)2.9(r)31.9(ess, 6)]TJ /TT2 1 Tf 11.946 0 TD -0.0038 Tc -0.005 Tw (, 459-473.)Tj -19.281 -1.8 TD -0.0033 Tc 0.0217 Tw (Foa, E.B., Molnal, C., Kashman, L. \(1995\). Change in rape)Tj 1.2 -1.401 TD 0.0033 Tw (narratives during exposure therapy for PTSD. )Tj /TT5 1 Tf 18.396 0 TD -0.0044 Tc 0.005 Tw (Journal of)Tj -18.396 -1.398 TD -0.0095 Tc -0.0594 Tw [(T)57.7(raumatic S)29.5(t)3.5(r)29.5(ess)]TJ /TT2 1 Tf 6.48 0 TD -0.0087 Tc -0.06 Tw (, 675-690.)Tj -7.68 -1.8 TD -0.0172 Tc -0.0622 Tw [(Gagin, R., Cohen, M., & Peled-A)72.8(vram, M. \(2005\). Family sup-)]TJ 1.2 -1.401 TD -0.0035 Tc 0.0257 Tw (port and victim identification in mass casualties terrorist)Tj T* -0.0037 Tc 0.125 Tw [(attacks: )50.3(An integrative approach: )]TJ /TT5 1 Tf 13.821 0 TD -0.0042 Tc (International Journal)Tj -13.821 -1.398 TD -0.0039 Tc -0.0487 Tw (of Emergency Mental Health, 7)Tj /TT2 1 Tf 12.276 0 TD -0.05 Tw (, 125-132.)Tj -13.476 -1.8 TD -0.0193 Tc -0.0622 Tw (Gutierrez, L.M., Parsons, R.J., & Cox, E.O. \(Eds.\). \(1998\). )Tj /TT5 1 Tf 22.086 0 TD -0.026 Tc 0 Tw (Em-)Tj -20.886 -1.401 TD 0.0331 Tc 0.125 Tw (powerment in social work practice: A sourcebook)Tj /TT2 1 Tf 22.251 0 TD 0 Tc 0 Tw (.)Tj -22.251 -1.401 TD -0.0132 Tc -0.0625 Tw (Belmont, CA: Brooks/Cole.)Tj -1.2 -1.8 TD -0.0036 Tc 0.0505 Tw [(Hobfoll, S.E. \(1989\). Conservation of resources: )50.3(A)58.6( new at-)]TJ 1.2 -1.398 TD 0.08 Tw (tempt at conceptualizing stress. )Tj /TT5 1 Tf 13.011 0 TD -0.0042 Tc (American Psychologist,)Tj -13.011 -1.401 TD -0.034 Tc 0 Tw (44)Tj /TT2 1 Tf 0.945 0 TD -0.027 Tc -0.06 Tw (, 513-524.)Tj -2.145 -1.8 TD 0.0284 Tc 0.125 Tw [(Israel Defense Forces \(2005\). )19.4(T)75.2(error events summary)61.4(.)]TJ 1.2 -1.401 TD 0.4303 Tc 0 Tw [(http://www)61.3(.idf.il/dover/site)]TJ 0 -1.398 TD -0.0041 Tc -0.05 Tw (mainpage.asp?sl=HE&id=22&docid=16703. Retrieved 4)Tj 0 -1.401 TD -0.022 Tc -0.06 Tw (November 2005.)Tj -1.2 -1.8 TD -0.0104 Tc -0.0625 Tw (Jeavons, S., Greenwood, K., & Horne, D. \(1998\). Psychologi-)Tj 1.2 -1.401 TD -0.0072 Tc -0.0614 Tw (cal symptoms in rural road trauma victims. )Tj /TT5 1 Tf 16.704 0 TD -0.0086 Tc -0.065 Tw (The Australian)Tj -16.704 -1.398 TD -0.0038 Tc -0.02 Tw (Journal of Rural Health, 6)Tj /TT2 1 Tf 10.464 0 TD -0.0031 Tc -0.025 Tw (, 52-56.)Tj -11.664 -1.8 TD -0.0076 Tc -0.0622 Tw [(Lahad, M. \(1997\). BASIC PH: The story of coping resources.)]TJ 1.2 -1.401 TD -0.0034 Tc 0.0441 Tw [(In: M. Lahad & )53.4(A. Cohen \(eds.\), )]TJ /TT5 1 Tf 13.509 0 TD -0.0048 Tc 0.0452 Tw [(Community str)28.2(ess pr)31.2(e-)]TJ -13.509 -1.401 TD -0.0091 Tc 0 Tw (vention)Tj /TT2 1 Tf 2.886 0 TD -0.0079 Tc -0.0625 Tw [( \(pp. 117-145\). Kiryat Shmona, Israel: Community)]TJ -2.886 -1.398 TD -0.004 Tc 0.04 Tw [(S)21.2(tress Prevention Center)50(.)]TJ -1.2 -1.8 TD -0.0008 Tc 0.125 Tw (National Insurance Institute of Israel \(2005\). )Tj /TT5 1 Tf 18.789 0 TD -0.0021 Tc (Summary of)Tj -17.589 -1.401 TD -0.0039 Tc 0.066 Tw [(T)57.3(r)34.3(ends and Developments in Social Security)]TJ /TT2 1 Tf 17.826 0 TD 0 Tc 0 Tw (.)Tj -19.026 -1.8 TD -0.0034 Tc -0.045 Tw [(Norris, F)74.6(.H. \(2002\). Psychosocial consequences of disasters.)]TJ /TT5 1 Tf 1.2 -1.401 TD -0.0046 Tc -0.0297 Tw [(PTSD Resear)28.4(ch Quarterly)49.4(, 13)]TJ /TT2 1 Tf 11.766 0 TD -0.0028 Tc -0.035 Tw (, 1-8.)Tj 12.534 59.4 TD -0.0033 Tc 0.0062 Tw [(Norris, F)77.7(.H., Friedman, M.J., & )17.6(W)94.5(atson, P)104.7(.J. \(2002\). 60,000)]TJ 1.2 -1.398 TD -0.0034 Tc -0.0593 Tw (disaster victims speak: Part II. Summary and implications)Tj 0 -1.401 TD -0.0071 Tc -0.0616 Tw (of the disaster mental health research. )Tj /TT5 1 Tf 14.709 0 TD -0.0081 Tc -0.0589 Tw [(Psychiatr)-8.1(y)54.8(,)-1.1( 65)]TJ /TT2 1 Tf 5.562 0 TD -0.0078 Tc -0.065 Tw (, 240-)Tj -20.271 -1.401 TD -0.0583 Tc 0 Tw (260.)Tj -1.2 -1.8 TD -0.0096 Tc -0.0625 Tw [(Norris, F)74.4(.H., Friedman, M.J., )17.4(W)97.2(atson, P)107.4(.J., Byrne, C.M., Diaz,)]TJ 1.2 -1.398 TD -0.0032 Tc -0.0181 Tw [(E., & Kaniasty)59.8(, K. \(2002\). 60,000 disaster victims speak:)]TJ 0 -1.401 TD -0.0175 Tc -0.0623 Tw [(Part I. )54.4(An empirical review of the empirical literature, 1981-)]TJ T* -0.0152 Tc 0 Tw (2001. )Tj /TT5 1 Tf 2.355 0 TD -0.0157 Tc -0.0593 Tw [(Psychiatr)-6.7(y)53.1(,)-0.7( 65)]TJ /TT2 1 Tf 5.454 0 TD -0.0147 Tc -0.06 Tw (, 240-260.)Tj -9.009 -1.8 TD -0.0169 Tc -0.0622 Tw (North, C.S., & Pfefferbaum, B. \(2002\). Research on the mental)Tj 1.2 -1.398 TD -0.004 Tc -0.0625 Tw (health effects of terrorism. )Tj /TT5 1 Tf 10.494 0 TD -0.0046 Tc (Journal of the American Medi-)Tj -10.494 -1.401 TD -0.0039 Tc -0.0375 Tw (cal Association, 288)Tj /TT2 1 Tf 7.989 0 TD -0.0036 Tc -0.04 Tw (, 633-636.)Tj -9.189 -1.8 TD -0.0033 Tc 0.0387 Tw [(NSW Institute of Psychiatry and Centre for Mental Health.)]TJ 1.2 -1.401 TD 0.012 Tc 0 Tw (\(2000\). )Tj /TT5 1 Tf 3.39 0 TD 0.0118 Tc 0.125 Tw (Disaster Mental Health Response Handbook.)Tj /TT2 1 Tf -3.39 -1.398 TD -0.0035 Tc -0.03 Tw (North Sydney: NSW Health.)Tj -1.2 -1.8 TD -0.0032 Tc 0.02 Tw (Patterson, J. \(2002\). Understanding family resilience. )Tj /TT5 1 Tf 21.555 0 TD -0.0053 Tc 0 Tw (Jour-)Tj -20.355 -1.401 TD -0.0039 Tc -0.0099 Tw [(nal of Clinical Psychology)50.1(, 58)]TJ /TT2 1 Tf 11.934 0 TD -0.0036 Tc (, 233-246.)Tj -13.134 -1.8 TD 0.0467 Tw (Raphael, B. \(1986\) )Tj /TT5 1 Tf 7.935 0 TD -0.004 Tc 0.0475 Tw (When disaster strikes: How individuals)Tj -6.735 -1.401 TD 0.045 Tw [(and communities cope with catastr)32(ophe. )]TJ /TT2 1 Tf 16.431 0 TD -0.0049 Tc 0.0164 Tw [(New Y)102.3(ork: )-32(Ba-)]TJ -16.431 -1.398 TD -0.0041 Tc -0.005 Tw (sic Books.)Tj -1.2 -1.8 TD -0.0035 Tc 0.0083 Tw (Raphael, B. \(1993\) )Tj /TT5 1 Tf 7.821 0 TD -0.0042 Tc 0.01 Tw (Disasters management. )Tj /TT2 1 Tf 9.57 0 TD -0.0043 Tc (National Health)Tj -16.191 -1.401 TD 0.0076 Tc 0.125 Tw (and Medical Research Council publication. Canberra:)Tj T* -0.004 Tc -0.035 Tw (Australian Government Publishing Service.)Tj -1.2 -1.8 TD -0.0035 Tc 0.0525 Tw [(Rosenfeld, L., Lahad, M., & Cohen, )50.5(A. \(2001\). Resilience:)]TJ 1.2 -1.398 TD 0.0831 Tw (Implication for evidence practice. In: J. M. Richman &)Tj 0 -1.401 TD 0.0001 Tc 0.125 Tw [(M)11.1(.)11.1(W)90.1(. Fraser \(eds.\), )]TJ /TT5 1 Tf 8.346 0 TD -0.0006 Tc (The context of youth violence )Tj /TT2 1 Tf 12.573 0 TD 0 Tw (\(pp.)Tj -20.919 -1.401 TD -0.0057 Tc -0.0618 Tw [(187-198\). )21.2(W)98.1(estport, Connecticut: Prager)48.3(.)]TJ -1.2 -1.8 TD -0.0188 Tc -0.0621 Tw [(Silver)38.2(, R.C., Holman, E.A., McIntosh, D.N., Poulin, M., & Gil-)]TJ 1.2 -1.398 TD -0.0032 Tc 0.0617 Tw [(Rivas, )15.1(V)134(.)-0.2( \(2002\). Nationwide longitudinal study of psy-)]TJ 0 -1.401 TD -0.0037 Tc 0.1 Tw (chological responses to September 11th. )Tj /TT5 1 Tf 16.74 0 TD -0.0039 Tc (Journal of the)Tj -16.74 -1.401 TD -0.0041 Tc -0.0283 Tw (American Medical Association, 288)Tj /TT2 1 Tf 14.115 0 TD -0.0039 Tc -0.03 Tw (, 1235-1244.)Tj -15.315 -1.8 TD -0.018 Tc -0.0621 Tw [(T)37.8(uval-Mashiach, R. & Shalev)63(, )51(A. \(2005\).Epidemiology of psy-)]TJ 1.2 -1.398 TD -0.0034 Tc 0.0219 Tw (chological reactions of adults to ongoing terror in Israel.)Tj 0 -1.401 TD -0.007 Tc -0.0614 Tw [(In E. Somer and )53(A. Bleich \(Eds.\). )]TJ /TT5 1 Tf 13.029 0 TD -0.0073 Tc -0.0634 Tw [(Mental health in terr)36.9(o)5.9(r)-43.3()130.7(s)]TJ -13.029 -1.401 TD -0.0242 Tc -0.0616 Tw (shadow: The Israeli experience)Tj /TT2 1 Tf 11.676 0 TD -0.024 Tc -0.0618 Tw [( \(pp. 29-54\). )18.2(T)70.8(el )54.2(A)77.2(viv: Ramot)]TJ -11.676 -1.398 TD -0.0226 Tc 0 Tw (\(Hebrew\).)Tj /TT5 1 Tf 7.35 -3.63 TD -0.004 Tc 0.0925 Tw (Manuscript received March 27, 2007)Tj 2.1 -1.752 TD -0.0038 Tc 0.0762 Tw (Revision received May 22, 2007)Tj 3.525 -1.749 TD 0.0917 Tw (Accepted July 26, 2007)Tj ET endstream endobj 157 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 159 0 obj << /Length 5492 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (201)Tj /TT3 1 Tf 7 0 0 7 122.49 726.66 Tm -0.0061 Tc 0.0218 Tw [(International Journal of Emergency Mental Health, Vol. 9, No. 3, pp. 201-214 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT4 1 Tf 10 0 0 10 104.01 326.34 Tm -0.0042 Tc 0 Tw (Abstract: )Tj /TT5 1 Tf 4.02 0 TD -0.0037 Tc 0.0304 Tw [(Considerable literatur)32.3(e exists on surveillance for medical effects of r)29.3(esponses to a disaster)107.3(, but)]TJ -4.02 -1.299 TD -0.0035 Tc -0.0444 Tw (there is a dearth of information on conducting surveillance of behavioral health effects for first responders.)Tj T* 0.0864 Tw [(This article reviews the literature and rationale behind behavioral health surveillance in the context of)]TJ 0 -1.302 TD 0 Tc 0.125 Tw (medical surveillance of first responders, examines special populations and ethical issues, discusses a)Tj 0 -1.299 TD -0.0036 Tc 0.0081 Tw [(model curr)34.6(ently used by the U.S. military)56.2(,)0.1( discusses unr)32.4(esolved issues, and concludes with some practical)]TJ T* 0.0733 Tw [(suggestions. [International Journal of Emergency Mental Health, 2008, 9\(3\), pp. 201-214].)]TJ /TT1 1 Tf 9 0 0 9 156.51 218.01 Tm -0.0054 Tc 0.0139 Tw (Key words: )Tj /TT5 1 Tf 5.1367 0 TD -0.0048 Tc 0.0166 Tw (disasters, first responders, behavioral health, medical surveillance, surveillance)Tj ET /GS1 gs 67.5 187.245 m 300.51 187.245 l S BT 9 0 0 9 67.5 169.5 Tm /GS2 gs 0.0059 Tc 0.1253 Tw [(Correspondence regarding this article should be sen to: Jan)]TJ 0 -1.2233 TD -0.0044 Tc 0.0615 Tw [(Shuber)-4.4(t, MA, L.C.S.W)82.3(., Office of Emer)35.6(gency Management, U.S.)]TJ 0 -1.22 TD -0.0107 Tc -0.0616 Tw [(Envir)36(onmental Pr)32.6(otection )13.1(Agency)46(, 1200 Pennsylvania )9.7(A)56.8(venue, NW)82.6(,)]TJ 0 -1.2233 TD -0.0042 Tc 0.125 Tw [(W)95.5(ashington, DC 20460, Mail Code 5104A. \(202\) 564-2527. E-)]TJ T* -0.005 Tc 0.0546 Tw [(Mail: shuber)-5(t.jan@epa.gov)68.3(. The views expr)35(essed in this ar)-5(ticle)]TJ 0 -1.22 TD -0.0069 Tc -0.0624 Tw (are the views of the authors and do not necessarily reflect the views)Tj 0 -1.2233 TD 0.0065 Tc 0.1256 Tw [(of the U.S. Envir)36.5(onmental Pr)33.2(otection )7.1(Agency)49.8(, the Uniformed)]TJ T* -0.0046 Tc 0.0031 Tw (Services University of the Health Sciences, the Department of the)Tj 0 -1.22 TD -0.0051 Tc 0.0652 Tw [(Army)48.2(, the Depar)-5.1(tment of Defense, the Mar)-5.1(yland Depar)-5.1(tment of)]TJ 0 -1.2233 TD -0.0046 Tc -0.0178 Tw [(Health and Mental Hygiene, or any other federal or state agency)52.1(.)]TJ /F1 1 Tf 14 0 0 14 157.65 656.34 Tm -0.0055 Tc 0.1256 Tw (A Missing Element in Disaster Mental Health:)Tj -1.7957 -1.1421 TD 0.0016 Tc 0.1379 Tw (Behavioral Health Surveillance for First Responders)Tj /TT2 1 Tf 10 0 0 10 339 176.64 Tm -0.0034 Tc 0.1125 Tw (Most of the literature related to worker protection in)Tj -1.8 -1.398 TD -0.0033 Tc -0.0105 Tw (disasters has focused on the physical health of the respond-)Tj 0 -1.401 TD -0.0055 Tc 0 Tw (ers)Tj /TT5 1 Tf 1.155 0 TD -0.0005 Tc -0.0025 Tw (. )Tj /TT2 1 Tf 0.744 0 TD -0.0031 Tc (Whether they are local firefighters, federal emergency)Tj -1.899 -1.401 TD 0.0056 Tc 0.125 Tw (responders, or construction workers, disaster responders)Tj 0 -1.398 TD -0.0029 Tc 0.063 Tw (often are exposed to a variety of physical hazards such as)Tj 0 -1.401 TD -0.0034 Tc -0.05 Tw (toxic chemicals, fires, explosions, biological or radiological)Tj T* -0.0036 Tc 0.0721 Tw [(contamination, and collapsing buildings. )14.4(T)73.2(o)0( protect these)]TJ 0 -1.398 TD -0.0037 Tc 0.073 Tw (workers, organizations take various approaches, including)Tj 12 0 0 12 138.9 464.64 Tm -0.0356 Tc -0.06 Tw [(Mary Beth )14.8(W)43.2(illiams)]TJ 10 0 0 10 146.01 452.01 Tm 0.0015 Tc -0.0685 Tw [( T)36.3(rauma )-18.5(Recovery)61.5(,)]TJ -2.661 -1.2 TD 0.0008 Tc 0 Tw (Education & Counseling Center)Tj 12 0 0 12 158.91 593.64 Tm -0.0194 Tc -0.0625 Tw (Jan Shubert)Tj 10 0 0 10 107.91 581.01 Tm 0.0013 Tc -0.0534 Tw [(U.S. Environmental Protection )52.2(Agency)]TJ 12 0 0 12 138.66 539.64 Tm -0.0138 Tc -0.0605 Tw [(Geor)8.7(ge S. Everly)56.2(, Jr)48.7(.)]TJ 10 0 0 10 73.41 527.01 Tm 0.0009 Tc -0.025 Tw (The Johns Hopkins Bloomberg School of Public Health,)Tj 3.408 -1.2 TD 0.0012 Tc -0.0125 Tw (Center for Public Health Preparedness;)Tj -2.433 -1.2 TD 0.0141 Tw (The Johns Hopkins University School of Medicine)Tj 12 0 0 12 406.26 538.65 Tm -0.0212 Tc -0.0625 Tw (Nancy Fiedler)Tj 10 0 0 10 336.51 525.99 Tm 0.0021 Tc -0.0271 Tw [(University of Medicine & Dentistry of New Jersey)65.1(,)]TJ 1.464 -1.2 TD 0.001 Tc 0.0366 Tw [( Robert )15.9(W)95.8(ood Johnson School of Medicine)]TJ 12 0 0 12 356.76 593.64 Tm -0.0196 Tc -0.0615 Tw (Col. Elspeth Cameron Ritchie, USA)Tj 10 0 0 10 326.76 581.01 Tm 0.0016 Tc -0.0113 Tw [(Psychiatry Consultant to the US )52.7(Army Sur)13.6(geon General)]TJ 12 0 0 12 395.4 464.64 Tm -0.032 Tc -0.0604 Tw (Clifford S. Mitchell)Tj 10 0 0 10 332.01 452.01 Tm 0.0016 Tc -0.0075 Tw (Maryland Department of Health and Mental Hygiene)Tj 12 0 0 12 272.64 403.65 Tm -0.0303 Tc -0.0604 Tw (Alan M. Langlieb)Tj 10 0 0 10 209.64 389.64 Tm 0.0013 Tc 0.0141 Tw (The Johns Hopkins University School of Medicine)Tj -0.864 -1.398 TD 0.0009 Tc -0.0214 Tw (The Johns Hopkins Bloomberg School of Public Health)Tj ET endstream endobj 160 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 162 0 obj << /Length 8945 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0052 Tc 0.1021 Tw [(202 )]TJ /TT3 1 Tf 2.7825 0 TD 0.1044 Tw (Shubert Behavioral Health Surveillance for First Responders)Tj /TT2 1 Tf 10 0 0 10 54 721.65 Tm -0.0084 Tc -0.0625 Tw (the use of engineering controls and personal protective equip-)Tj 0 -1.401 TD -0.0036 Tc 0.0135 Tw (ment \(PPE\) during the response and the use of medical sur-)Tj 0 -1.398 TD -0.0064 Tc -0.0625 Tw [(veillance after the response \(Hogan & Burstein, 2002\). In the)]TJ 0 -1.401 TD -0.0036 Tc 0.0893 Tw (wake of recent natural and human-made disasters, such as)Tj T* -0.0041 Tc 0.015 Tw [(the bombing of the )49.9(Alfred P)103.9(.)0( Murrah Building in Oklahoma)]TJ 0 -1.398 TD -0.0033 Tc 0.0106 Tw [(City in 1995, the attacks on the )17.8(W)94.5(orld )14.8(T)37.5(rade Center and the)]TJ 0 -1.401 TD -0.007 Tc -0.0625 Tw (Pentagon in 2001, and the twin hurricanes Katrina and Rita in)Tj T* -0.0037 Tc 0.065 Tw (2005, the need to broaden the term protection to include)Tj 0 -1.398 TD -0.0035 Tc 0.0222 Tw (the psychological protection of responders has become evi-)Tj 0 -1.401 TD 0.0133 Tc 0 Tw (dent.)Tj 1.8 -2.001 TD -0.0037 Tc 0.05 Tw (This article examines existing methods used to protect)Tj -1.8 -1.398 TD -0.0035 Tc 0.0275 Tw [(responders, recent research findings on the effects of emer-)]TJ 0 -1.401 TD -0.0016 Tc 0.125 Tw [(gency response work and stressful experiences on behav-)]TJ T* 0.0101 Tc (ioral and physical health, the importance of considering)Tj 0 -1.398 TD -0.0028 Tc -0.0266 Tw [(diversity and ethical issues, and the model currently used by)]TJ 0 -1.401 TD -0.0033 Tc 0.0607 Tw (U.S. military organizations to respond to behavioral health)Tj T* -0.0037 Tc 0.1095 Tw [(issues. )17.3(W)94.1(e)0.3( conclude with some thoughts on how behav-)]TJ 0 -1.398 TD -0.0056 Tc -0.0625 Tw (ioral health protection could be integrated into existing medi-)Tj 0 -1.401 TD -0.0035 Tc 0.1127 Tw [(cal monitoring and surveillance programs. Our goal is to)]TJ T* 0.0078 Tc 0.125 Tw (stimulate discussion regarding appropriate psychological)Tj 0 -1.398 TD -0.0036 Tc 0.1143 Tw [(protection interventions. Because recognition of the need)]TJ 0 -1.401 TD 0.0312 Tw (for such interventions must precede application of an inter-)Tj T* 0.0081 Tc 0.125 Tw (vention, we propose the integration of behavioral health)Tj 0 -1.398 TD -0.0081 Tc -0.0625 Tw (monitoring into existing medical monitoring and surveillance)Tj 0 -1.401 TD -0.0034 Tc 0.1037 Tw [(programs for emer)17.6(gency responders. )17.6(W)94.4(e)0.1( also raise issues)]TJ T* -0.0035 Tc 0.0596 Tw [(that must be resolved as we address this serious gap in the)]TJ 0 -1.398 TD -0.0034 Tc 0.07 Tw (protection of emergency responders.)Tj /F1 1 Tf 11 0 0 11 54 318.99 Tm -0.0062 Tc 0.0864 Tw [( Background)]TJ /TT2 1 Tf 10 0 0 10 72 295.65 Tm -0.003 Tc -0.0383 Tw (First responders are at risk of both physical and psycho-)Tj -1.8 -1.401 TD -0.0037 Tc 0.0164 Tw (logical health problems during and after disasters \(Feldman)Tj 0 -1.398 TD -0.0189 Tc -0.0624 Tw [(et al., 2004; Liao et al., 2002; Fullerton, Ursano & )17.2(W)93.9(ang, 2004;)]TJ 0 -1.401 TD -0.0035 Tc -0.0511 Tw [(Berrios-T)65.5(orres et al., 2001\).)]TJ 5.8 0 0 5.8 162.45 257.01 Tm 0 Tc 0 Tw ( )Tj 10 0 0 10 163.59 253.65 Tm -0.0037 Tc -0.052 Tw [( )14.3(These include acute injuries and)]TJ -10.959 -1.401 TD -0.0033 Tc 0.0212 Tw (illness, and chronic health effects.)Tj 1.8 -1.998 TD -0.0036 Tc 0.0872 Tw (One of the most important public health tools used to)Tj -1.8 -1.401 TD -0.0088 Tc -0.0625 Tw [(prevent such adverse ef)18.2(fects is surveillance. Generally)60.2(, medi-)]TJ T* -0.0034 Tc -0.0611 Tw (cal surveillance is used to detect potential health effects from)Tj 0 -1.398 TD -0.0031 Tc 0.0806 Tw (exposures before the onset of clinical effects, thereby pro-)Tj 0 -1.401 TD -0.0029 Tc 0.0239 Tw [(viding an opportunity for early intervention. In the context)]TJ T* -0.001 Tc 0.125 Tw (of occupational health, medical surveillance has been de-)Tj 0 -1.398 TD -0.0034 Tc 0.1085 Tw (scribed as having four components: the systematic collec-)Tj 0 -1.401 TD -0.0074 Tc -0.0625 Tw (tion of data on occupational exposures, injuries, and diseases;)Tj T* 0.0029 Tc 0.125 Tw (the analysis of these data; dissemination of these data to)Tj 0 -1.398 TD -0.0037 Tc 0.0086 Tw [(appropriate parties; and interventions to improve outcomes)]TJ 0 -1.401 TD -0.0031 Tc 0.0091 Tw [(\(Markowitz, 1998\). Medical surveillance typically consists)]TJ 25.5 64.299 TD -0.0095 Tc -0.0619 Tw (of standardized questionnaires, physical examinations, physi-)Tj 0 -1.398 TD -0.0028 Tc 0.0283 Tw [(cal testing \(particularly cardio-pulmonary)63.2(, auditory)63.2(, and vi-)]TJ 0 -1.401 TD -0.0026 Tc -0.0606 Tw (sual\), and laboratory tests \(especially of systems at risk, such)Tj T* -0.0031 Tc 0.1111 Tw [(as liver function tests and the hematopoietic system\). )50.9(A)10.1(n)]TJ 0 -1.398 TD 0.0036 Tc 0.1249 Tw [(important component of surveillance is an assessment of)]TJ 0 -1.401 TD -0.0036 Tc -0.0275 Tw (exposure to a hazard, allowing interventions even before the)Tj T* -0.0211 Tc -0.0625 Tw [(onset of biological or clinical ef)14.9(fect \(Halperin & Frazier)32.9(, 1985\).)]TJ 1.8 -1.998 TD -0.0036 Tc 0.0194 Tw (Medical surveillance has been shown to be effective in)Tj -1.8 -1.401 TD -0.0032 Tc 0.0717 Tw (the prevention of injury and illness related to exposures in)Tj T* -0.0033 Tc 0.0777 Tw [(many industrial settings \(Hulshof)17.7(f, )17.5(V)112.9(erbeek, van Dijk, van)]TJ 0 -1.398 TD -0.011 Tc -0.0623 Tw [(der )13.2(W)92.8(eide, & Braam, 1999\). )16.2(There have been fewer examples)]TJ 0 -1.401 TD -0.0031 Tc -0.0435 Tw [(of surveillance in disasters, but there are some. Probably the)]TJ T* -0.0039 Tc 0.0242 Tw (most comprehensive surveillance of responders involved in)Tj 0 -1.398 TD -0.0035 Tc -0.0237 Tw (a civilian disaster is the surveillance program for responders)Tj 0 -1.401 TD 0.1028 Tw [(to the )17.5(W)94.3(orld )17.5(T)37.3(rade Center attacks. )14.5(That surveillance pro-)]TJ T* -0.0037 Tc -0.0528 Tw (gram has followed approximately 40,000 workers over more)Tj 0 -1.398 TD -0.0033 Tc 0.0344 Tw (than 2.5 years, and has documented both acute and chronic)Tj 0 -1.401 TD -0.0065 Tc -0.0622 Tw [(health effects among responders \(Herbert et al., 2006\). There)]TJ T* -0.0073 Tc -0.0625 Tw (are also parallels in military medicine suggesting that surveil-)Tj 0 -1.398 TD -0.0028 Tc 0.0561 Tw (lance may well play an important role in preventing injury)Tj 0 -1.401 TD -0.0031 Tc -0.019 Tw [(and illness associated with disasters \(May et al., 2004\). The)]TJ T* -0.0038 Tc -0.0304 Tw [(CDC)50.2(s strategic plan for bioterrorism includes detection and)]TJ 0 -1.398 TD -0.0034 Tc 0.068 Tw (surveillance as one of its five areas of focus \(CDC, 2000\).)Tj 0 -1.401 TD -0.0033 Tc 0.001 Tw (There is now discussion of how surveillance can play a role)Tj T* -0.0367 Tw (in the context of large-scale disasters that might require acti-)Tj 0 -1.398 TD -0.0034 Tc -0.045 Tw [(vation of the National Response Plan \(Mitchell et al., 2007\).)]TJ /F1 1 Tf 11 0 0 11 309 333.99 Tm -0.0042 Tc 0.0341 Tw (Behavorial Health Surveillance in First)Tj 0 -1.0909 TD -0.005 Tc 0.0284 Tw (Responders: Review of the Evidence)Tj /TT2 1 Tf 10 0 0 10 327 298.65 Tm -0.0039 Tc -0.0621 Tw [(T)72.9(o)-0.3( date there has been relatively little or)20.1(ganized ef)14.1(fort to)]TJ -1.8 -1.401 TD -0.0036 Tc 0.0007 Tw (monitor behavioral effects of exposure to disaster response-)Tj 0 -1.398 TD 0.0205 Tc 0.125 Tw (related risks and hazards upon first responders \(North,)Tj 0 -1.401 TD -0.0038 Tc 0.0484 Tw [(Pfef)17.2(ferbaum, & )14.5(T)37(ucker)35.2(, 2002\). Disaster responders can be)]TJ T* -0.0035 Tc -0.034 Tw [(subjected to numerous potentially traumatizing experiences:)]TJ 0 -1.398 TD -0.0033 Tc -0.01 Tw (fear of the unknown and the increased anxiety that are com-)Tj 0 -1.401 TD -0.02 Tw [(mon in high-risk situations; the actual physical dangers that)]TJ T* -0.0032 Tc -0.0194 Tw (require workers to be constantly vigilant; the sights, sounds,)Tj 0 -1.398 TD -0.0034 Tc -0.0584 Tw [(and odors associated with fatalities and injuries, which often)]TJ 0 -1.401 TD 0.0061 Tw (foster unrealistic feelings of guilt over not having been able)Tj T* -0.0032 Tc 0.0482 Tw [(to do more or save more; grief over the loss of fellow re-)]TJ 0 -1.398 TD -0.0015 Tc 0.125 Tw (sponders; and fears associated with possible exposures to)Tj 0 -1.401 TD -0.0037 Tc 0.095 Tw (harmful substances during the response and potential seri-)Tj T* -0.0034 Tc 0.0785 Tw [(ous health ef)17.6(fects. )51(A)58.8( review of the literature suggests that)]TJ 0 -1.398 TD 0.111 Tw [(those who respond in the wake of disasters may develop)]TJ 0 -1.401 TD 0.075 Tw (adverse psychological and behavioral reactions.)Tj ET endstream endobj 163 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 165 0 obj << /Length 9084 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (203)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0036 Tc -0.0443 Tw (The potential for trauma reactions and for posttraumatic)Tj -1.8 -1.398 TD 0.0042 Tc 0.125 Tw (symptoms in disaster responders has received significant)Tj 0 -1.401 TD -0.0031 Tc -0.0625 Tw [(attention in recent years. In the proceedings from the confer-)]TJ T* -0.0038 Tc -0.0367 Tw [(ence, Protecting Emergency Responders: Lessons Learned)]TJ 0 -1.398 TD -0.0037 Tc 0.1172 Tw [(from )14.4(T)73.1(errorist )53.4(Attacks, conducted by the RAND Science)]TJ 0 -1.401 TD -0.0034 Tc -0.0299 Tw [(and )17.7(T)70.4(echnology Policy Institute in December 2001 \(Jackson)]TJ T* -0.0031 Tc -0.0025 Tw (et al., 2002\), stress was considered one of the many hazards)Tj 0 -1.398 TD -0.0034 Tc 0.09 Tw (faced by the thousands of responders to the September 11)Tj 0 -1.401 TD -0.0033 Tc -0.0335 Tw [(terrorist attacks. The condition of the victims of the terrorist)]TJ T* -0.0031 Tc 0.125 Tw (attacks contributed to the stress levels of the construction)Tj 0 -1.398 TD -0.0042 Tc -0.0622 Tw [(and trades workers. )55.9(As one member of the )19.9(T)36.6(rades Panel said,)]TJ 0 -1.401 TD -0.0035 Tc -0.017 Tw [(Many of these workers had never seen a dead person not)]TJ T* -0.0034 Tc 0.0625 Tw (in an automobile accident, not even in a funeral home \(p.)Tj 0 -1.398 TD -0.0032 Tc -0.0195 Tw [(16\). Panelists reported that more than 100 cases of psycho-)]TJ 0 -1.401 TD -0.0083 Tc -0.0622 Tw [(logical stress were treated in the first two months of the )18.8(W)95.5(orld)]TJ T* -0.0088 Tc (Trade Center response, a number believed to be much smaller)Tj 0 -1.398 TD -0.0033 Tc -0.0477 Tw [(than the number of those actually experiencing distress. The)]TJ 0 -1.401 TD -0.0037 Tc -0.0169 Tw (panel also acknowledged the need for conducting studies on)Tj T* -0.0033 Tc 0.065 Tw (psychological risks for responders.)Tj 1.8 -1.998 TD -0.0035 Tc -0.0425 Tw (Trauma reactions are not limited to responders at terror-)Tj -1.8 -1.401 TD 0.0004 Tc 0.125 Tw [(ist events. Those responding to natural disasters such as)]TJ T* 0.0007 Tc (the recent hurricanes that devastated the U.S. Gulf Coast)Tj 0 -1.398 TD -0.0033 Tc 0.0595 Tw [(saw destruction on a scale that caused potentially harmful)]TJ 0 -1.401 TD -0.0034 Tc 0.0807 Tw [(behavioral health effects in many responders. Responders)]TJ T* -0.0035 Tc -0.0058 Tw (to these hurricanes included traditional emergency respond-)Tj 0 -1.398 TD -0.0031 Tc -0.0117 Tw (ers, such as fire, police, and other local emergency response)Tj 0 -1.401 TD -0.0034 Tc 0.0911 Tw (personnel, as well as state and federal responders, such as)Tj T* -0.0032 Tc -0.061 Tw [(the U.S. Coast Guard, the U.S. )53.8(Army Corps of Engineers, the)]TJ 0 -1.398 TD -0.0039 Tc 0.0409 Tw [(Federal Emer)17.1(gency Management )53(Administration, the Envi-)]TJ 0 -1.401 TD -0.0035 Tc 0.0735 Tw [(ronmental Protection )50.4(Agency)62.5(, the Red Cross, and medical,)]TJ T* -0.0033 Tc 0.0236 Tw (psychological, and mortuary teams from the Department of)Tj 0 -1.398 TD -0.0026 Tc 0.125 Tw [(Health and Human Services. Less traditional responders,)]TJ 0 -1.401 TD -0.0035 Tc 0.0855 Tw (such as those in the construction and trades industries and)Tj T* 0.1208 Tw [(the transportation sector)38.4(, also were involved. )14.6(There were)]TJ 0 -1.398 TD -0.0029 Tc 0.125 Tw (ample experiences to cause responders unpleasant memo-)Tj 0 -1.401 TD -0.0033 Tc 0.0389 Tw (ries, at best, and more significant trauma reactions, such as)Tj T* -0.0035 Tc 0.072 Tw (sleepless nights and flashbacks, at worst.)Tj 1.8 -1.998 TD -0.0037 Tc 0.1091 Tw (The importance of behavioral health surveillance was)Tj -1.8 -1.401 TD 0.0029 Tc 0.125 Tw (raised in a study conducted for the National Institute for)Tj T* -0.0034 Tc 0 Tw (Occupational Safety and Health by the RAND Corporation,)Tj 0 -1.398 TD 0.001 Tc 0.125 Tw (on ways to improve protection of emergency responders.)Tj 0 -1.401 TD -0.0068 Tc -0.0625 Tw (The study report, Protecting Emergency Responders: Safety)Tj T* -0.004 Tc -0.0391 Tw [(Management in Disaster and )17.1(T)69.8(errorism Response \(Jackson,)]TJ 0 -1.398 TD -0.0116 Tc -0.0623 Tw [(Baker)36.4(, Ridgely)57.4(, Bartin, & Linn, 2003\), recommended the con-)]TJ 0 -1.401 TD 0.0009 Tc 0.125 Tw (sideration of critical incident stress in response planning.)Tj T* -0.0087 Tc -0.0622 Tw (Furthermore, it emphasized the importance of providing criti-)Tj 0 -1.398 TD 0.009 Tc 0.125 Tw (cal incident stress assistance to nontraditional responder)Tj 25.5 65.598 TD -0.0035 Tc -0.0067 Tw (groups, such as construction and trades workers, and also to)Tj 0 -1.398 TD 0.0049 Tc 0.125 Tw [(the families of responders. Study participants suggested)]TJ 0 -1.401 TD -0.0035 Tc 0.0428 Tw (that it would be important to consider responder stress lev-)Tj T* -0.0034 Tc -0.0335 Tw (els before, during, and after deployment because responding)Tj 0 -1.398 TD -0.0032 Tc 0.0019 Tw (to a disaster would likely exacerbate pre-existing stress lev-)Tj 0 -1.401 TD -0.003 Tc 0.015 Tw (els and potentially result in an increase in unhealthy coping)Tj T* 0.0061 Tc 0.125 Tw (strategies such as alcohol consumption; that is, a person)Tj 0 -1.398 TD -0.0038 Tc -0.0375 Tw (who experienced a previous personal disaster might be more)Tj 0 -1.401 TD -0.0035 Tc -0.0261 Tw (likely to be traumatized than would someone who had never)Tj T* -0.0037 Tc 0.055 Tw (had that exposure.)Tj 1.8 -1.998 TD -0.0058 Tc -0.0625 Tw (Disaster research is difficult to perform, especially in the)Tj -1.8 -1.401 TD -0.0023 Tc 0.125 Tw (wake of mass violence and terrorism. Nevertheless, in an)Tj T* -0.0043 Tc -0.0623 Tw [(attempt to project the mental health needs should such events)]TJ 0 -1.398 TD -0.0058 Tc [(recur)33.2(, a review of relevant research seems warranted. In Sep-)]TJ 0 -1.401 TD -0.0074 Tc -0.0625 Tw (tember 2004, the Centers for Disease Control \(CDC\) released)Tj T* -0.0036 Tc 0.0145 Tw [(information derived from a study of 1,138 WTC rescue/re-)]TJ 0 -1.398 TD 0.1146 Tw [(covery workers conducted between July 2002 and )50.8(August)]TJ 0 -1.401 TD -0.0178 Tc -0.0623 Tw [(2004. Each worker had worked an average of 966 hours \(range)]TJ T* -0.0065 Tc -0.0625 Tw [(of 24-4,080\). During the first six months of the study)59.5(, 51% of)]TJ 0 -1.398 TD -0.0034 Tc 0.074 Tw (the workers met criteria indicating the need for a more in-)Tj 0 -1.401 TD -0.006 Tc -0.0622 Tw [(depth clinical mental health evaluation on at least one screen-)]TJ T* -0.0163 Tc -0.0624 Tw [(ing instrument. )49.8(Approximately 6% of the participants reported)]TJ 0 -1.398 TD 0.007 Tc 0.125 Tw [(symptoms of depression, panic, and generalized anxiety)61(.)]TJ 0 -1.401 TD -0.0035 Tc -0.0325 Tw (Nearly 10% reported alcohol use issues; 15% reported prob-)Tj T* -0.012 Tc -0.0623 Tw (lems with social life, 14% with work, and 13% with home life.)Tj 0 -1.398 TD 0.0005 Tc 0.125 Tw (Approximately 20% of the participants met the symptom)Tj 0 -1.401 TD -0.0055 Tc -0.0625 Tw [(threshold for posttraumatic stress disorder \(PTSD\). Only 3%)]TJ T* -0.0034 Tc 0.1008 Tw (reported obtaining mental health services before the study)Tj 0 -1.398 TD -0.0033 Tc 0.0378 Tw [(began. The study also pointed out the unusual heterogene-)]TJ 0 -1.401 TD -0.0036 Tc -0.0344 Tw (ity of the WTC responder population, with its large numbers)Tj T* -0.0031 Tc -0.0461 Tw (of construction and trade workers a heterogeneity that may)Tj 0 -1.398 TD -0.0037 Tc 0.0107 Tw (become more common if large scale terrorist incidents con-)Tj 0 -1.401 TD -0.0094 Tc -0.0625 Tw (tinue to occur \(CDC, 2004\).)Tj 1.8 -2.001 TD -0.0079 Tc [(Castellano \(2005\) reported on a unique law enforcement)]TJ -1.8 -1.398 TD -0.0028 Tc 0.0325 Tw (telephone hotline and referral system run by the University)Tj 0 -1.401 TD -0.0033 Tc -0.006 Tw [(of Medicine and Dentistry of New Jersey \(UMDNJ\) Uni-)]TJ T* -0.0031 Tc 0.0707 Tw [(versity Behavioral Healthcare \(UBHC\). Staffed by retired)]TJ 0 -1.398 TD -0.0033 Tc -0.0624 Tw [(peer volunteers and clinical experts in police psychology)62.7(, the)]TJ 0 -1.401 TD -0.0075 Tc -0.0625 Tw (system received approximately 1700 calls during its first year)Tj T* -0.003 Tc -0.06 Tw [(of operation, prior to 9/11/01. The year after 9/11, more than)]TJ 0 -1.398 TD -0.0099 Tc -0.0623 Tw [(4,500 calls were received. This can be interpreted as a signifi-)]TJ 0 -1.401 TD -0.0032 Tc 0.005 Tw (cantly increased need resulting from the events of 9/11.)Tj 1.8 -2.001 TD -0.0036 Tc 0.0793 Tw (In an assessment of emergency workers conducted 34)Tj -1.8 -1.398 TD -0.0033 Tc 0.0531 Tw [(months after the Oklahoma City terrorist attack, North and)]TJ 0 -1.401 TD -0.011 Tc -0.062 Tw (colleagues \(North, Tivis, McMillan, Pfefferbaum, Spitznagel,)Tj T* -0.0035 Tc -0.0222 Tw (Cox, et al., 2002\) used the Diagnostic Interview Schedule to)Tj ET endstream endobj 166 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 168 0 obj << /Length 8315 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0052 Tc 0.1021 Tw [(204 )]TJ /TT3 1 Tf 2.7825 0 TD 0.1044 Tw (Shubert Behavioral Health Surveillance for First Responders)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm 0.0043 Tc 0.1248 Tw [(assess, retrospectively)58.3(, probable PTSD subsequent to the)]TJ 0 -1.398 TD -0.0038 Tc -0.0293 Tw (Oklahoma City bombing. The prevalence of probable PTSD)Tj 0 -1.401 TD -0.0016 Tc 0.125 Tw [(was found to be 13% in male responders compared to a)]TJ T* -0.0118 Tc -0.0625 Tw (prevalence of 23% found in a sample of male primary victims.)Tj 0 -1.398 TD -0.0037 Tc -0.0492 Tw (About 16% of firefighters received professional intervention)Tj 0 -1.401 TD -0.0173 Tc -0.0621 Tw (for mental health issues \(North, Tivis, McMillan, Pfefferbaum,)Tj T* -0.0121 Tc -0.0625 Tw (Cox, Spitznagel, et al., 2002\), while only about 5% of teachers)Tj 0 -1.398 TD -0.0035 Tc -0.0494 Tw (\(Pfefferbaum et al., 2004\) and about 5% of children received)Tj 0 -1.401 TD -0.0085 Tc -0.0625 Tw (counseling \(Pfefferbaum et al., 2003\).)Tj 1.8 -2.001 TD -0.0112 Tc (Fullerton and colleagues \(2004\) compared disaster work-)Tj -1.8 -1.398 TD -0.0061 Tc -0.0622 Tw (ers exposed to an airport disaster to unexposed disaster work-)Tj 0 -1.401 TD -0.0036 Tc -0.0007 Tw [(ers who were matched on socioeconomic status, geography)59.4(,)]TJ T* -0.0034 Tc 0.0518 Tw [(and urban or rural location. The two groups were alike on)]TJ 0 -1.398 TD -0.0036 Tc 0.0325 Tw [(previous exposure to disaster work. The rate of PTSD was)]TJ 0 -1.401 TD -0.0037 Tc -0.036 Tw (13% among the exposed group at 13 months after the airport)Tj T* -0.0035 Tc 0.0276 Tw [(disaster)50.5(. )50.9(After adjustment for level of previous disaster ex-)]TJ 0 -1.398 TD 0.0736 Tw (posure, the odds of PTSD were 6.34 \(95% CI 1.7 - 23.61\))Tj 0 -1.401 TD -0.0055 Tc -0.0625 Tw [(comparing the exposed to unexposed disaster workers. Early)]TJ T* 0.0029 Tc 0.125 Tw [(dissociative symptoms, acute stress disorder)38.9(, and depres-)]TJ 0 -1.398 TD -0.0037 Tc -0.0525 Tw (sion were also predictive of later PTSD at 13 months; among)Tj 0 -1.401 TD 0.0515 Tw [(the exposed disaster workers, assisting survivors was asso-)]TJ T* -0.009 Tc -0.0623 Tw (ciated with greater \(2.98: 95% CI 1.04 - 8.51\) odds of PTSD.)Tj 1.8 -1.998 TD -0.003 Tc 0.0215 Tw (In the fall of 1996 \(4.5 years after the Iraqi withdrawal)Tj -1.8 -1.401 TD -0.0035 Tc -0.0293 Tw (from Kuwait\) a random survey of 2,387 Kuwaiti firefighters)Tj T* -0.025 Tw (was conducted in an effort to assess the prevalence of PTSD)Tj 0 -1.398 TD -0.0034 Tc -0.0535 Tw [(\(Al-Naser & Everly)59.6(, 1999\). Using the Impact of Event Scale)]TJ 0 -1.401 TD -0.0036 Tc 0.1235 Tw [(to assess probable posttraumatic stress disorder)35.4(, 18.5% of)]TJ T* 0.0055 Tc 0.125 Tw (the 108 male respondents endorsed symptoms consistent)Tj 0 -1.398 TD -0.0181 Tc -0.06 Tw (with PTSD.)Tj 1.8 -2.001 TD -0.0036 Tc 0.0436 Tw (At the very minimum, surveillance programs might be)Tj -1.8 -1.401 TD -0.0031 Tc -0.0523 Tw (initiated to help identify those who may prosper from mental)Tj 0 -1.398 TD -0.004 Tc 0.1059 Tw [(health services. )17.1(The National )14.1(V)133.2(olunteer Or)14(ganizations )53.1(Ac-)]TJ 0 -1.401 TD -0.0057 Tc -0.0622 Tw (tive in Disaster \(NVOAD\) recently released their recommen-)Tj T* -0.0031 Tc 0.0508 Tw (dations for early psychological intervention, which include)Tj 0 -1.398 TD -0.0035 Tc 0.1172 Tw [(screening, assessment, and triage \(Olson, 2005\). Further-)]TJ 0 -1.401 TD -0.0032 Tc 0.0314 Tw (more, some form of early psychological intervention might)Tj T* -0.0036 Tc 0.0863 Tw (then be considered using surveillance data as an empirical)Tj 0 -1.398 TD 0.002 Tc 0.125 Tw (guide, rather than working from the spurious assumption)Tj 0 -1.401 TD -0.0031 Tc 0.0907 Tw (that everyone exposed to a disaster requires psychological)Tj T* -0.0068 Tc -0.0625 Tw [(support. Indeed, )50.2(Arendt and Elklit \(2001\) conclude that while)]TJ 0 -1.398 TD -0.006 Tc (there is little evidence that crisis interventions prevent PTSD,)Tj 0 -1.401 TD -0.003 Tc 0.125 Tw (there may be value in using such intervention to mitigate)Tj T* -0.0035 Tc 0.068 Tw (untoward reactions in emergency response personnel.)Tj 27.3 60.6 TD -0.0144 Tc -0.0627 Tw [(Similarly)60.6(, Deahl and colleagues \(2000\), Solomon, Shklar)33.6(,)]TJ -1.8 -1.398 TD -0.0104 Tc -0.0622 Tw (and Mikulincer \(2005\), and Solomon and Benbenishty \(1986\))Tj 0 -1.401 TD -0.0035 Tc -0.014 Tw (offer data that support the notion that those exposed to mass)Tj T* 0 Tc 0.125 Tw (disaster-like venues \(in these cases, warfare\) may benefit)Tj 0 -1.398 TD 0.0026 Tc (from some form of acute psychological intervention \(see)Tj 0 -1.401 TD -0.0027 Tc 0.0036 Tw (Everly & Mitchell, 2008, for a review\). It seems likely that)Tj T* -0.0034 Tc 0.1187 Tw (some form of psychological assistance should be in place)Tj 0 -1.398 TD -0.0033 Tc -0.0017 Tw (after surveillance and used on an as-needed basis \(Everly &)Tj 0 -1.401 TD 0.0095 Tw (Flynn, 2005\). In the past decade, there has been a growing)Tj T* -0.0048 Tc -0.0624 Tw [(movement in the world to develop a concept similar to physi-)]TJ 0 -1.398 TD -0.0034 Tc -0.014 Tw (cal first aid for coping with stressful and traumatic events in)Tj 0 -1.401 TD -0.0031 Tc -0.0459 Tw (life. This strategy has been known by a number of names but)Tj T* -0.0117 Tc -0.0622 Tw [(is most commonly referred to as psychological first aid \(PF)75.3(A\).)]TJ 0 -1.398 TD -0.0048 Tc -0.0627 Tw [(Essentially)64.2(, PF)70.2(A)63.4( provides individuals with skills they can use)]TJ 0 -1.401 TD -0.0037 Tc -0.0041 Tw (in responding to psychological consequences of [disasters])Tj T* -0.0052 Tc -0.0625 Tw (\(Institute of Medicine, 2003, p.4\).)Tj /F1 1 Tf 11 0 0 11 309 480 Tm -0.0046 Tc 0.0468 Tw [(P)10.7(h)11.8(ysical Health Eff)6.3(ects of Emotional )94(T)80(rauma)]TJ /TT2 1 Tf 10 0 0 10 327 456.66 Tm -0.0031 Tc -0.0123 Tw (It has long been recognized that there are physical risks)Tj -1.8 -1.401 TD -0.0038 Tc 0.0479 Tw (involved in responding to natural and human-caused disas-)Tj T* -0.0035 Tc 0.0789 Tw [(ters. )50.5(As the preceding review indicates, there is mounting)]TJ 0 -1.398 TD 0.0007 Tw (evidence regarding the potential risks to disaster responders)Tj 0 -1.401 TD -0.0028 Tc 0.0745 Tw (of psychological injury such as the broad range of anxiety)Tj T* -0.0035 Tc 0.0657 Tw [(disorders, including PTSD and depression. More recently)59.5(,)]TJ 0 -1.398 TD 0.0002 Tc 0.1252 Tw [(however)39.2(, the possible connections between psychological)]TJ 0 -1.401 TD -0.015 Tc -0.0625 Tw (and physical health also are being examined, particularly those)Tj T* -0.0051 Tc [(relating to PTSD)-5.1(.)]TJ 1.8 -1.998 TD -0.0035 Tc -0.0015 Tw [(Numerous studies \(e.g., Beckham et al., 1998; Schnurr)35.5(,)]TJ -1.8 -1.401 TD -0.0234 Tc -0.0625 Tw (Spiro, & Paris, 2000; Ouimette et al., 2004; Kimerling, Clum, &)Tj T* -0.0093 Tc -0.0621 Tw [(W)94.5(olfe, 2000\) have explored the relationship between combat-)]TJ 0 -1.398 TD -0.0038 Tc (related PTSD, general trauma exposure, and health problems)Tj 0 -1.401 TD -0.0034 Tc 0.0269 Tw [(in both the veteran and civilian populations. )53.5(All found that)]TJ T* -0.0033 Tc -0.032 Tw (the presence and severity of PTSD were related to the extent)Tj 0 -1.398 TD -0.0029 Tc -0.0122 Tw (of physical health problems, particularly arterial, lower gas-)Tj 0 -1.401 TD 0.0007 Tc 0.125 Tw (trointestinal, dermatologic, and musculoskeletal problems)Tj T* 0.0178 Tc 0.1252 Tw [(\(Schnurr)38.8(, Spiro, & Paris, 2000\). In addition, Miranda,)]TJ 0 -1.398 TD -0.0035 Tc -0.0336 Tw (Meyerson, Marx, and Tucker \(2002\) suggest that depression)Tj 0 -1.401 TD -0.0034 Tc 0.0907 Tw (accompanying PTSD may account for the relationship be-)Tj T* -0.0033 Tc -0.0243 Tw (tween the severity of PTSD and somatic symptoms, particu-)Tj 0 -1.398 TD -0.0029 Tc -0.0625 Tw (larly chronic pain.)Tj 1.8 -2.001 TD -0.0037 Tc 0.1129 Tw (Research also has been conducted on the relationship)Tj -1.8 -1.401 TD -0.0036 Tc -0.0494 Tw [(between trauma and specific health problems. For example,)]TJ 0 -1.398 TD -0.0034 Tc 0.0087 Tw (Norman and colleagues \(2006\) found that different types of)Tj ET endstream endobj 169 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 171 0 obj << /Length 8701 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (205)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0094 Tc -0.0622 Tw (trauma predicted different types of illness in men and women.)Tj 0 -1.398 TD -0.0038 Tc 0.0725 Tw (Men exposed to trauma showed an increased likelihood of)Tj 0 -1.401 TD -0.0021 Tc 0.125 Tw (developing arthritis and diabetes, while women showed a)Tj T* -0.0036 Tc -0.0543 Tw (greater likelihood of developing digestive disorders and can-)Tj 0 -1.398 TD -0.0224 Tc 0 Tw [(cer)52.6(.)]TJ 1.8 -2.001 TD -0.0141 Tc -0.0625 Tw (In addition to research on the relationship between PTSD,)Tj -1.8 -1.401 TD -0.0032 Tc 0.1079 Tw (trauma, and physical illness, researchers are exploring the)Tj 0 -1.398 TD 0.0563 Tw [(effects of stressful experiences on physical health. Maddi,)]TJ 0 -1.401 TD -0.0035 Tc 0.055 Tw (Bartone, and Puccetti \(1987\) found a clear relationship be-)Tj T* -0.0029 Tc 0.0968 Tw [(tween stressful life events and physical illness. Similarly)60.1(,)]TJ 0 -1.398 TD -0.0034 Tc 0.0256 Tw (OLeary \(1990\), in an overview of empirical evidence con-)Tj 0 -1.401 TD -0.004 Tc 0.0371 Tw (necting emotions and immune functions, noted that Those)Tj T* -0.0034 Tc 0.1175 Tw [(stressors most likely to generate HP)86.6(A)58.8( [hypothalamic-pitu-)]TJ 0 -1.398 TD -0.0031 Tc 0.046 Tw (itary-adrenocortical system] activation and cortisol release,)Tj 0 -1.401 TD 0.1132 Tw [(namely)62.8(, chronic stress, depression, and social deprivation,)]TJ T* -0.0033 Tc 0.0508 Tw (seem to be consistently immunologically suppressive, con-)Tj 0 -1.398 TD -0.009 Tc -0.0625 Tw [(sonant with cortisol effects on immunity \(p. 377\). In another)]TJ 0 -1.401 TD -0.0034 Tc 0.0061 Tw (review of research on the relationship of stress to infectious)Tj T* -0.0038 Tc -0.0249 Tw [(disease, Cohen and )17.3(W)55(illiamson \(1991\) found consistent evi-)]TJ 0 -1.398 TD -0.0031 Tc 0.1064 Tw (dence of both increased upper respiratory infection symp-)Tj 0 -1.401 TD -0.0166 Tc -0.0625 Tw (toms and increased health care use by individuals experiencing)Tj T* -0.0028 Tc -0.0365 Tw [(stress. They also indicated that stress may result in reactiva-)]TJ 0 -1.398 TD -0.0031 Tc 0.0584 Tw [(tion of herpes viruses. In 1993, Cohen, )17.8(T)70.7(yrrell, and Smith)]TJ 0 -1.401 TD -0.0033 Tc 0.0431 Tw (concluded that their prospective study of 420 people inten-)Tj T* -0.0006 Tc 0.125 Tw (tionally exposed to upper respiratory viruses showed that)Tj 0 -1.398 TD -0.0036 Tc 0.0509 Tw [(psychological stress is associated with increased suscepti-)]TJ 0 -1.401 TD -0.003 Tc 0.0833 Tw (bility to biologically verified infections disease processes)Tj T* -0.0258 Tc -0.06 Tw (\(p. 139\).)Tj 1.8 -1.998 TD -0.0083 Tc -0.0625 Tw (Segerstrom and Miller \(2004\) conducted a meta-analysis)Tj -1.8 -1.401 TD -0.0105 Tc (of more than 300 empirical studies examining the relationship)Tj T* -0.003 Tc -0.0331 Tw [(between psychological stress and the immune system. They)]TJ 0 -1.398 TD -0.0005 Tc 0.125 Tw (concluded that stressors that trigger the fight-or-flight re-)Tj 0 -1.401 TD -0.0035 Tc -0.0014 Tw (sponse elicit potentially helpful responses from the immune)Tj T* -0.003 Tc 0.0349 Tw [(system. )17.9(They also noted, however)36(, that the more chronic a)]TJ 0 -1.398 TD -0.0035 Tc -0.055 Tw (stressor became, the greater was the potential for detrimental)Tj 0 -1.401 TD -0.0033 Tc -0.0062 Tw (effects on the immune system.)Tj 1.8 -2.001 TD -0.0037 Tc 0.0736 Tw (Additional studies have been conducted on the effects)Tj -1.8 -1.398 TD -0.0032 Tc 0.0335 Tw [(of psychological stress on the healing of wounds. In 1995,)]TJ 0 -1.401 TD -0.004 Tc 0.095 Tw (Kiecolt-Glaser and colleagues)Tj /TT5 1 Tf 12.129 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.345 0 TD -0.0039 Tc 0.095 Tw (studied the speed of wound)Tj -12.474 -1.401 TD -0.004 Tc 0.1059 Tw [(healing among 34 spouses caring for )50.2(Alzheimer)-40()53(s)0( patients)]TJ 0 -1.398 TD -0.0035 Tc -0.006 Tw [(and 33 controls. The caregivers wounds healed at a slower)]TJ 0 -1.401 TD -0.0031 Tc -0.024 Tw (rate than did those of the controls. They concluded that their)Tj T* -0.0035 Tc 0.0123 Tw (results could have health implications in the area of healing)Tj 0 -1.398 TD -0.0032 Tc 0.0577 Tw [(from sur)14.8(gery)62.8(. Most recently)62.8(, the ef)17.8(fects on wound healing)]TJ 0 -1.401 TD 0.0688 Tw (caused by stress from hostile marriages were examined by)Tj 25.5 63.399 TD 0.0136 Tc 0.125 Tw [(Kiecolt-Glaser and colleagues \(2005\). They found that)]TJ 0 -1.398 TD -0.0036 Tc 0.0294 Tw (wounds of couples having high hostility healed much more)Tj 0 -1.401 TD -0.003 Tc 0.0087 Tw [(slowly than did those of couples with low hostility)60(.)]TJ 1.8 -2.001 TD -0.0037 Tc 0.0814 Tw (Although considerable research remains to be done in)Tj -1.8 -1.398 TD -0.0007 Tc 0.125 Tw (this area, there are significant indications of the potential)Tj 0 -1.401 TD 0.0035 Tc (effects of PTSD, trauma, and stress, both acute and pro-)Tj T* -0.0049 Tc -0.0625 Tw (longed, on the mental and physical well-being of individuals.)Tj 0 -1.398 TD -0.0037 Tc 0.0986 Tw (From a preventive perspective, this would warrant serious)Tj 0 -1.401 TD -0.0036 Tc 0.1029 Tw [(consideration of the potential benefits from incorporating)]TJ T* -0.0057 Tc -0.062 Tw (psychological surveillance into existing medical surveillance)Tj 0 -1.398 TD -0.0039 Tc 0.0575 Tw (programs for responders.)Tj /F1 1 Tf 11 0 0 11 321 543.99 Tm -0.0046 Tc 0.0561 Tw [(P)43.3(opulation Diver)9(sity Considerations in)]TJ 0 -1.0909 TD -0.0026 Tc 0 Tw (Surveillance)Tj /TT2 1 Tf 10 0 0 10 339 508.65 Tm -0.0031 Tc -0.0462 Tw (The United States has always been an ethnically diverse)Tj -1.8 -1.401 TD -0.003 Tc 0.0394 Tw [(country)60(, but never more so than today)63(. Both traditional re-)]TJ 0 -1.398 TD 0.0024 Tc 0.125 Tw (sponders and nontraditional responders \(i.e., construction)Tj 0 -1.401 TD 0.0037 Tc [(trades workers\) reflect this increasing diversity)63.7(, although)]TJ T* -0.0032 Tc -0.053 Tw [(detailed statistical breakdowns are difficult to find. In 2004,)]TJ 0 -1.398 TD -0.0036 Tc 0.0587 Tw [(the National Fire Protection )50.4(Association reported a total of)]TJ 0 -1.401 TD -0.0288 Tc -0.0623 Tw [(268,800 firefighters. Of these, 15,000 \(5.2%\) were women \(con-)]TJ T* -0.0031 Tc 0.0395 Tw (sidered because they represent a minority in terms of num-)Tj 0 -1.398 TD -0.0034 Tc 0.0533 Tw [(bers\), 23,000 were Black \(7.9%\), and 24,000 \(8.3%\) were)]TJ 0 -1.401 TD 0.0001 Tc 0.1249 Tw [(Hispanic. )48(According to the U.S. Department of Justice)51.1(s)]TJ T* -0.0034 Tc 0.0272 Tw (Bureau of Justice Statistics \(2006\), in 2003 local police de-)Tj 0 -1.398 TD -0.0151 Tc -0.0621 Tw (partments had 580,749 full-time employees, 451,737 of whom)Tj 0 -1.401 TD -0.0037 Tc 0.0687 Tw (were sworn personnel; 23.6% of these were minorities \(no)Tj T* -0.0033 Tc 0.0439 Tw [(further breakdown was provided\). For the same year sher-)]TJ 0 -1.398 TD -0.0244 Tc -0.0625 Tw (iffs offices had 330,274 full-time employees, of whom 174,251)Tj 0 -1.401 TD -0.0082 Tc -0.0622 Tw [(were sworn personnel; 18.8% of these were minorities. Simi-)]TJ T* -0.0033 Tc -0.0211 Tw [(lar information is available for the construction industry)59.7(, the)]TJ 0 -1.398 TD -0.0034 Tc -0.0187 Tw [(group that generally contributes the greatest number of non-)]TJ 0 -1.401 TD -0.0035 Tc -0.0128 Tw [(traditional responders. In 2000, 17 % of construction work-)]TJ T* -0.0311 Tw (ers were Hispanic, 10% were racial minorities, and 9% were)Tj 0 -1.398 TD -0.0039 Tc -0.0556 Tw [(women \(Center to Protect )17.3(W)93.9(orkers)71.1( Rights, 2002\).)]TJ 1.8 -2.001 TD -0.0034 Tc 0.0357 Tw (All of these figures leave many questions unanswered,)Tj -1.8 -1.401 TD -0.0033 Tc 0.005 Tw (such as, the definition of minorities, in what category mi-)Tj 0 -1.398 TD -0.0035 Tc -0.0348 Tw [(nority women are accounted for)35.5(, and the number of dif)17.5(ferent)]TJ 0 -1.401 TD 0.0268 Tw (ethnic groups and cultures covered by the term Hispanic.)Tj T* -0.0033 Tc -0.0075 Tw [(They do, however)35.7(, indicate the challenge involved in devel-)]TJ 0 -1.398 TD -0.0017 Tc 0.125 Tw (oping a culturally sensitive psychological surveillance in-)Tj 0 -1.401 TD -0.0057 Tc -0.0625 Tw [(strument and interventions. For example, Perilla, Norris, and)]TJ T* -0.0035 Tc 0.0638 Tw (Lavizzo \(2002\) found that the minority groups involved in)Tj 0 -1.398 TD -0.0034 Tc -0.0444 Tw [(their post Hurricane )50.6(Andrew study tended to be more fatalis-)]TJ ET endstream endobj 172 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 174 0 obj << /Length 8564 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0052 Tc 0.1021 Tw [(206 )]TJ /TT3 1 Tf 2.7825 0 TD 0.1044 Tw (Shubert Behavioral Health Surveillance for First Responders)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0089 Tc -0.0625 Tw (tic in their attribution of blame for their experiences, a charac-)Tj 0 -1.398 TD -0.0035 Tc 0.1137 Tw (teristic found to contribute to poorer outcomes in post-di-)Tj 0 -1.401 TD -0.0046 Tc -0.0625 Tw [(saster adjustment. Combined with a greater tendency toward)]TJ T* -0.0126 Tc [(familism, or more collective behavior)38.4(, which makes individu-)]TJ 0 -1.398 TD 0.0244 Tc 0.125 Tw (als reluctant to seek or accept assistance from outside)Tj 0 -1.401 TD -0.0034 Tc 0.026 Tw (sources, these characteristics complicate psychological sur-)Tj T* 0.0015 Tc 0.125 Tw (veillance and successful implementation of interventions.)Tj 0 -1.398 TD -0.0038 Tc -0.0621 Tw (This challenge was recognized by Jayasinghe and colleagues)Tj 0 -1.401 TD -0.003 Tc 0.115 Tw (\(2005\) in their study of utility workers who had been de-)Tj T* 0.0205 Tw [(ployed to the )15(W)97.8(orld )18(T)37.8(rade Center disaster site. )15(They found)]TJ 0 -1.398 TD -0.0101 Tc -0.0625 Tw (that racial/ethnic minority workers were less likely than non-)Tj 0 -1.401 TD -0.0033 Tc 0.0829 Tw (Hispanic white workers to attend psychotherapy that was)Tj T* -0.0088 Tc 0 Tw (offered.)Tj 1.8 -1.998 TD -0.0033 Tc -0.0197 Tw [(Clearly)62.7(, there is no such thing as a universal response)]TJ -1.8 -1.401 TD 0.0002 Tc 0.125 Tw [(to trauma exposure. Individuals perceive and respond to)]TJ T* -0.0031 Tc -0.0471 Tw (traumatic experiences through many layers of filters, includ-)Tj 0 -1.398 TD -0.006 Tc -0.0624 Tw [(ing age, gender)39(, religion, extent of previous trauma exposure,)]TJ 0 -1.401 TD -0.0035 Tc 0.115 Tw [(and ethnic and cultural background. )50.5(As noted in )]TJ /TT5 1 Tf 20.895 0 TD -0.0055 Tc 0 Tw (Mental)Tj -20.895 -1.401 TD 0.0041 Tc 0.125 Tw [(Health: Culture, Race, and Ethnicity: A Supplement to)]TJ 0 -1.398 TD 0 Tc [(Mental Health: A Report of the Surgeon General )]TJ /TT2 1 Tf 21.21 0 TD 0.0007 Tc [( \(U.S.)]TJ -21.21 -1.401 TD 0.0266 Tc (Department of Health and Human Services, 2001\), an)Tj T* -0.0009 Tc 0.1252 Tw [(individual)50.1(s culture and social background strongly influ-)]TJ 0 -1.398 TD -0.0029 Tc 0.055 Tw (ence the availability and accessibility of mental health ser-)Tj 0 -1.401 TD -0.0033 Tc 0.0291 Tw (vices as well as whether or not he or she will recognize the)Tj T* -0.003 Tc 0.0574 Tw [(need for such services and actually seek them out. )53.9(As ef-)]TJ 0 -1.398 TD -0.0036 Tc -0.0428 Tw (forts are made to develop methods for recognizing and inter-)Tj 0 -1.401 TD -0.0034 Tc -0.0607 Tw (vening in negative psychological effects of trauma exposure,)Tj T* -0.0033 Tc 0.0343 Tw (all of these factors need to be considered.)Tj /F1 1 Tf 11 0 0 11 54 306 Tm -0.0045 Tc 0.0341 Tw (Surveillance: Ethical Considerations)Tj /TT2 1 Tf 10 0 0 10 72 282.66 Tm -0.0048 Tc -0.0622 Tw [(T)72(o)0( be ethical in any context or situation means maintain-)]TJ -1.8 -1.401 TD -0.0033 Tc -0.0135 Tw (ing a certain moral stance as to what is good or evil in terms)Tj T* -0.0036 Tc 0.0661 Tw [(of one)53.4(s treatment of oneself and others. )14.4(This definition of)]TJ 0 -1.398 TD -0.0033 Tc -0.0583 Tw (ethical behavior is a goal for practitioners and researchers, as)Tj 0 -1.401 TD -0.0091 Tc -0.0623 Tw (well as for organizational managers, in their pursuit of knowl-)Tj T* -0.0035 Tc 0 Tw (edge gained through research, observation, investigation, or)Tj 0 -1.398 TD -0.0034 Tc 0.0481 Tw [(surveillance. Ethical principles are designed to protect hu-)]TJ 0 -1.401 TD -0.003 Tc -0.0275 Tw (man subjects by prioritizing their rights of voluntary partici-)Tj T* 0.0337 Tc 0.125 Tw (pation and informed consent while doing no harm or)Tj 0 -1.398 TD -0.0305 Tc -0.0619 Tw [(minimizing harm \(W)35.5(illiams, 2005\).)]TJ 1.8 -2.001 TD -0.0094 Tc -0.0625 Tw (Organizations have the ethical duty to protect their work-)Tj -1.8 -1.401 TD -0.0037 Tc -0.0137 Tw (ers from harm, while maximizing those workers abilities to)Tj 0 -1.398 TD -0.0038 Tc -0.0306 Tw [(perform ef)14.2(fectively \(W)77.2(orld Health Or)17.2(ganization, 2002\). For)]TJ 0 -1.401 TD -0.0034 Tc 0.0075 Tw (those responding to potentially hazardous incidents, protec-)Tj T* 0.0064 Tc 0.125 Tw (tion should not necessarily end when the response ends.)Tj 25.5 64.2 TD -0.0073 Tc -0.0625 Tw (For this reason, incorporating psychological surveillance into)Tj 0 -1.398 TD -0.0035 Tc 0.1225 Tw (medical surveillance or monitoring programs that identify)Tj 0 -1.401 TD -0.0032 Tc 0.015 Tw (potentially damaging physical and posttraumatic symptoms)Tj T* -0.003 Tc -0.039 Tw (is an ethical duty that must be undertaken by those organiza-)Tj 0 -1.398 TD -0.0001 Tc 0.125 Tw [(tions. Pre-deployment monitoring of physical health and)]TJ 0 -1.401 TD -0.0035 Tc -0.0306 Tw (levels of stress and/or exposure to previous critical incidents)Tj T* -0.003 Tc -0.0461 Tw (can develop baseline data by which later physical and stress-)Tj 0 -1.398 TD -0.0035 Tc 0.0695 Tw [(based symptoms can be measured. However)35.5(, there can be)]TJ 0 -1.401 TD -0.0038 Tc 0.0518 Tw [(ethical concerns about how and what to communicate with)]TJ T* -0.003 Tc -0.013 Tw (workers in this context, particularly if it is not clear whether)Tj 0 -1.398 TD -0.0036 Tc -0.0275 Tw (the knowledge of exposure will affect the outcome \(Schulte,)Tj 0 -1.401 TD -0.0516 Tc 0 Tw (1986\).)Tj 1.8 -2.001 TD -0.0037 Tc 0.0813 Tw [(Development of this monitoring process is not free of)]TJ -1.8 -1.398 TD -0.0047 Tc -0.0625 Tw [(ethical issues and considerations. In fact, post-disaster medi-)]TJ 0 -1.401 TD -0.0034 Tc -0.0517 Tw (cal and psychological surveillance for participating respond-)Tj T* -0.0035 Tc -0.0138 Tw (ers is fraught with potential ethical questions and dilemmas.)Tj 1.2 -1.998 TD -0.0079 Tc -0.0622 Tw [()-1457.8(What is the objective of the surveillance: to minimize)]TJ 1.8 -1.401 TD -0.0028 Tc 0.024 Tw (future risks; to identify present risks?)Tj -1.8 -2.001 TD -0.0035 Tc 0.0894 Tw [()-1453.4(How justified is a potential intrusion into the post-)]TJ 1.8 -1.398 TD -0.0033 Tc 0.0816 Tw (response lives of participants?)Tj -1.8 -2.001 TD -0.0057 Tc -0.0625 Tw [()-1455.6(W)59.1(ill surveillance actually help create and/or maintain)]TJ 1.8 -1.401 TD -0.0033 Tc -0.0258 Tw (future healthy response work environments, or is the)Tj 0 -1.398 TD -0.003 Tc 0.0857 Tw (data gathering only a way to enhance research and)Tj 0 -1.401 TD 0 Tw (establish the gatherers credibility and expertise?)Tj -1.8 -2.001 TD -0.0032 Tc -0.0439 Tw [()-1453.1(Who has access to data, particularly if sharing of that)]TJ 1.8 -1.398 TD -0.0055 Tc -0.0625 Tw (data could be harmful to those from whom it has been)Tj 0 -1.401 TD 0.0111 Tc 0 Tw (gathered?)Tj -1.8 -2.001 TD -0.0033 Tc -0.0278 Tw [()-1453.2(Does the surveillance in and of itself violate the trust)]TJ 1.8 -1.398 TD 0.12 Tw (of employees of the organization or volunteers re-)Tj 0 -1.401 TD -0.0034 Tc -0.025 Tw (sponding to a disaster \(Marx, 1998\)?)Tj -1.2 -2.001 TD 0.0024 Tc 0.125 Tw (Inclusion of sensitive, probing questions designed to)Tj -1.8 -1.398 TD 0.0035 Tc (assess psychological health also leads to many questions)Tj 0 -1.401 TD -0.0036 Tc -0.0278 Tw [(and concerns. How detailed and intrusive need questions be)]TJ T* -0.0034 Tc 0.0896 Tw [(to gather the most helpful data? )50.7(Are there objective mea-)]TJ 0 -1.398 TD -0.0032 Tc 0.0536 Tw [(sures upon which to base criteria? Is the measure of long-)]TJ 0 -1.401 TD 0.0228 Tc 0.125 Tw (term effect in the psychological arena based solely on)Tj T* -0.0034 Tc 0.07 Tw (questions relating to acute stress, or are questions on post-)Tj 0 -1.398 TD 0.0004 Tc 0.125 Tw (traumatic stress, coping skills, and other potential mental)Tj 0 -1.401 TD -0.0027 Tc 0.063 Tw (health issues \(e.g. depression, anxiety\) necessary?)Tj 1.8 -2.001 TD -0.0034 Tc 0.0312 Tw (Responses to any measures of surveillance must be re-)Tj -1.8 -1.398 TD -0.0035 Tc -0.0393 Tw (spected as confidential, within ethical limits and boundaries.)Tj 0 -1.401 TD 0.1137 Tw (Responses of persons identified with acute stress or long-)Tj T* -0.0142 Tw [(term posttraumatic stress, however)35.4(, also need to be coded in)]TJ 0 -1.398 TD -0.0033 Tc 0.0961 Tw (such a way that the responders can be offered appropriate)Tj ET endstream endobj 175 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 177 0 obj << /Length 8877 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (207)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0064 Tc -0.0622 Tw (crisis management or intervention without fear of stigmatiza-)Tj 0 -1.398 TD -0.002 Tc 0.125 Tw [(tion or potential job loss. It is also important to develop)]TJ 0 -1.401 TD -0.0035 Tc -0.0123 Tw (guidelines as to who receives surveillance data and for what)Tj T* 0.0212 Tc 0 Tw (purposes.)Tj 1.8 -1.998 TD 0.0044 Tc 0.125 Tw [(How should all of these issues be addressed? First,)]TJ -1.8 -1.401 TD -0.0037 Tc -0.0309 Tw (workers should be educated regarding surveillance practices)Tj T* -0.0029 Tc -0.0466 Tw (at the time of hiring, not just before deployment, particularly)Tj 0 -1.398 TD -0.0036 Tc -0.0622 Tw (if their employer automatically mandates surveillance if they)Tj 0 -1.401 TD -0.0034 Tc 0.0518 Tw (have been exposed to a hazard in the course of a response.)Tj T* -0.0035 Tc 0.0706 Tw (An informative handout that covers both medical and psy-)Tj 0 -1.398 TD 0.0741 Tw (chological aspects of surveillance and highlights purposes,)Tj 0 -1.401 TD -0.0032 Tc 0.045 Tw (uses, confidentiality constraints, and interventions is a use-)Tj T* 0.0682 Tw [(ful first step. )53.7(Acknowledgement of the rights to privacy of)]TJ 0 -1.398 TD -0.0039 Tc -0.0336 Tw [(information under HIP)86.1(A)9.4(A)53.1( also could be included. )14.4(The pam-)]TJ 0 -1.401 TD 0.0104 Tc 0.125 Tw (phlet also could educate potential participants about the)Tj T* -0.0032 Tc -0.0261 Tw (objectives of surveillance and justify the use of specific pro-)Tj 0 -1.398 TD -0.0034 Tc 0.0394 Tw [(tocols and plans of action. )14.6(W)97.4(orkers are entitled to informa-)]TJ 0 -1.401 TD -0.0036 Tc 0.0428 Tw (tion about the objectives of surveillance and must be given)Tj T* 0.0306 Tw (the rationale for the choice of specific methods of informa-)Tj 0 -1.398 TD 0.0338 Tw (tion collection and data distribution.)Tj 1.8 -2.001 TD -0.0075 Tc -0.0625 Tw (Second, models of surveillance across multiple incidents)Tj -1.8 -1.401 TD -0.0034 Tc 0.1095 Tw [(need to be consistent and standardized. It is important to)]TJ 0 -1.398 TD -0.0035 Tc 0.1062 Tw (develop consensus as to when to use these measures \(i.e.,)Tj 0 -1.401 TD 0.0325 Tw (what constitutes a critical enough incident to indicate the)Tj T* -0.0034 Tc 0.0419 Tw [(use of surveillance and at what point to use it\). Measuring)]TJ 0 -1.398 TD -0.0032 Tc 0.1046 Tw (effects at an acute stage of a disaster is not sufficient and)Tj 0 -1.401 TD -0.0417 Tw [(often is impractical. Symptoms of behavioral distress at that)]TJ T* -0.0029 Tc -0.0488 Tw [(point are often transitory)63.1(. )15.7(T)37.9(rue, chronic symptoms generally)]TJ 0 -1.398 TD -0.0031 Tc -0.0044 Tw (are visible 30 days post event \(crisis\). If individuals are de-)Tj 0 -1.401 TD -0.0389 Tw [(ployed only for short periods of time, however)35.9(, how can sur)17.9(-)]TJ T* -0.0034 Tc 0.0643 Tw [(veillance/monitoring occur and at what locations? 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Under ideal conditions, the Incident)]TJ T* -0.0029 Tc 0.0837 Tw (Command System falls in place quickly and everyone, in-)Tj 25.5 65.4 TD -0.0035 Tc -0.0224 Tw [(cluding volunteers, is identified and accounted for)50.5(. )17.9(The eth-)]TJ 0 -1.398 TD -0.0032 Tc 0.125 Tw (ics surrounding this potential requirement raise questions.)Tj 0 -1.401 TD -0.0037 Tc 0.1161 Tw [(Who becomes the gatekeeper of the responder list? 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These considerations,)Tj 0 -1.398 TD -0.0078 Tc -0.0623 Tw (and potentially many more, need to be considered when look-)Tj 0 -1.401 TD -0.0034 Tc -0.0588 Tw [(ing at the ethical components of surveillance \(Iatrona, 2003\).)]TJ T* 0.002 Tc 0.125 Tw (If surveillance is used, the command structure governing)Tj 0 -1.398 TD -0.0034 Tc 0.0725 Tw (responses needs to recognize that ethical practices are part)Tj 0 -1.401 TD -0.0035 Tc 0.085 Tw (of the process.)Tj /F1 1 Tf 11 0 0 11 321 188.01 Tm -0.0042 Tc 0.0125 Tw (Lessons from the Military Model)Tj /TT2 1 Tf 10 0 0 10 339 164.64 Tm -0.0031 Tc -0.0166 Tw [(Although there are few)59.9(, if any)62.9(, models of psychological)]TJ -1.8 -1.398 TD -0.0033 Tc 0.0943 Tw [(or behavioral health surveillance in the civilian sector)38.7(, the)]TJ 0 -1.401 TD -0.0495 Tw [(military sector does have such a model. The model includes)]TJ T* -0.0034 Tc -0.0209 Tw (a wide range of surveillance tools in the form of anonymous)Tj 0 -1.398 TD 0.0075 Tw [(surveys and clinical encounters, including in-theater mental)]TJ 0 -1.401 TD 0.0002 Tc 0.125 Tw (health assessments; anonymous surveys after troops have)Tj T* -0.0034 Tc 0.084 Tw (returned from deployment; post-deployment health assess-)Tj 0 -1.398 TD -0.0035 Tc 0.0536 Tw (ments and clinical encounters upon re-deployment; the up-)Tj ET endstream endobj 178 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 181 0 obj << /Length 8635 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0052 Tc 0.1021 Tw [(208 )]TJ /TT3 1 Tf 2.7825 0 TD 0.1044 Tw (Shubert Behavioral Health Surveillance for First Responders)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0036 Tc 0.092 Tw (coming initiative, the Post-Deployment Health Re-Assess-)Tj 0 -1.398 TD -0.0023 Tc 0.125 Tw (ment \(PDHRA\); and evaluations of an installation after a)Tj 0 -1.401 TD -0.0096 Tc -0.0622 Tw [(suicide cluster \(known as )-7.6()11.2(EPICON or epidemiological con-)]TJ T* 0.0023 Tc 0 Tw (sultation\).)Tj 1.8 -1.998 TD -0.0033 Tc 0.0211 Tw [( In 1996, the )50.7(Assistant Secretary of Defense for Health)]TJ -1.8 -1.401 TD -0.0036 Tc -0.0122 Tw (Affairs called for the development of the Joint Medical Sur-)Tj T* -0.0194 Tc -0.0625 Tw (veillance Program for U.S. Forces to provide appropriate medi-)Tj 0 -1.398 TD 0.0593 Tc 0.1487 Tw (cal services to U.S. troops deployed to Bosnia on)Tj 0 -1.401 TD -0.0034 Tc 0.0899 Tw [(peace-keeping operations. )50.5(A)58.8( psychological screening pro-)]TJ T* -0.0035 Tc -0.0458 Tw [(gram was part of that ef)17.5(fort \(W)35.5(right et al., 2002\). Reports on)]TJ 0 -1.398 TD -0.0096 Tc -0.0625 Tw [(two military mental health studies were released in 2002. The)]TJ 0 -1.401 TD -0.0036 Tc -0.0055 Tw (first \(Hoge et al., 2002\) found that mental disorders appear)Tj T* -0.0122 Tw (to represent the most important source of medical and occu-)Tj 0 -1.398 TD -0.003 Tc 0.0067 Tw (pational morbidity among active-duty U.S. military person-)Tj 0 -1.401 TD -0.0032 Tc 0.0442 Tw [(nel \(p. 1576\). In the second study)59.8(, )18(W)55.6(right and colleagues)]TJ T* -0.0035 Tc 0.0767 Tw (\(2002\) examined military health surveillance programs for)Tj 0 -1.398 TD -0.0054 Tc -0.062 Tw (peace-keeping operations, focusing on psychological screen-)Tj 0 -1.401 TD -0.0032 Tc 0.0476 Tw [(ing conducted by the U.S. )50.9(Army in Europe. )17.9(These authors)]TJ T* 0 Tc 0.1248 Tw [(suggested that the )56.8(Army)54(s program could be viewed as a)]TJ 0 -1.398 TD -0.0039 Tc 0.015 Tw (comprehensive program for assessing troops mental health)Tj 0 -1.401 TD -0.002 Tc 0.125 Tw [(across the three phases of the deployment cycle: pre-de-)]TJ T* -0.007 Tc -0.0617 Tw (ployment, deployment/re-deployment, and post-deployment.)Tj 0 -1.398 TD -0.0036 Tc 0.0169 Tw (They concluded: In addition to demonstrating the need for)Tj 0 -1.401 TD -0.003 Tc 0.0167 Tw (psychological screening for military personnel deployed on)Tj T* -0.0038 Tc 0.073 Tw (peacekeeping operations, the successful implementation of)Tj 0 -1.398 TD -0.0036 Tc 0.04 Tw (the program demonstrated that large-scale screening is fea-)Tj 0 -1.401 TD -0.0116 Tc -0.0625 Tw (sible \(p. 860\).)Tj 1.8 -2.001 TD -0.0031 Tc 0.0756 Tw (A third study \(Hoge et al., 2004\), assessed the mental)Tj -1.8 -1.398 TD -0.0033 Tc 0.09 Tw (health of members of the military who had participated in)Tj 0 -1.401 TD -0.0031 Tc -0.0411 Tw [(operations in )53.9(Afghanistan and Iraq after they returned. )14.9(They)]TJ T* -0.0037 Tc -0.0111 Tw [(concluded that there was a significant risk of mental health)]TJ 0 -1.398 TD -0.0036 Tc -0.0306 Tw (problems and that the subjects reported important barriers to)Tj 0 -1.401 TD -0.0033 Tc -0.0016 Tw (receiving mental health services, particularly the perception)Tj T* -0.0034 Tc -0.0175 Tw (of stigma among those most in need of care \(p. 13\).)Tj 1.8 -1.998 TD -0.0137 Tc -0.0621 Tw (There have now been four comprehensive in-theater \(Iraq)Tj -1.8 -1.401 TD -0.0043 Tc 0.1252 Tw [(and )52.9(Afghanistan\) mental health assessment team \(MHA)106.7(T\))]TJ T* 0.0005 Tc 0.125 Tw [(evaluations performed. The first two of these have been)]TJ 0 -1.398 TD 0.0589 Tc 0.4414 Tw (published and are available on the web under)Tj 0 -1.401 TD -0.005 Tc -0.0622 Tw [(w)8.8(w)8.8(w)58(.Armymedicine.mil. )15.9(The studies were done by a combi-)]TJ T* -0.0032 Tc -0.0164 Tw (nation of anonymous surveys, focus groups, and interviews.)Tj 0 -1.398 TD -0.003 Tc 0.0273 Tw (The information creates a very helpful tapestry to guide re-)Tj 0 -1.401 TD -0.0006 Tc 0.125 Tw (sources and interventions.)Tj 1.8 -2.001 TD -0.0033 Tc -0.0093 Tw [(The )50.8(Army also uses clinical surveillance. Since the be-)]TJ -1.8 -1.398 TD -0.0034 Tc 0.0049 Tw [(ginning of the deployments to )50.5(Afghanistan and Iraq, return-)]TJ 0 -1.401 TD 0.0113 Tc 0.125 Tw (ing soldiers and other service members have received a)Tj 25.5 63.999 TD -0.0036 Tc 0.0992 Tw (post-deployment health assessment, using a standard form)Tj 0 -1.398 TD 0.0657 Tw (\(DD2796\) and a face-to-face interview with a clinical pro-)Tj 0 -1.401 TD 0.0467 Tw [(vider)50.4(. )50.9(Approximately 4% of soldiers have received further)]TJ T* 0.001 Tc 0 Tw (evaluation.)Tj 1.8 -1.998 TD -0.0096 Tc -0.0625 Tw (The military recognizes that many soldiers will not admit)Tj -1.8 -1.401 TD -0.0028 Tc 0.0039 Tw (to symptoms when they return, either because they are anx-)Tj T* -0.0031 Tc 0.0545 Tw (ious to return home or because symptoms have not yet de-)Tj 0 -1.398 TD 0.12 Tw [(veloped. Because of this, the military has developed and)]TJ 0 -1.401 TD -0.0036 Tc 0.0308 Tw (implemented a post-deployment health reassessment that is)Tj T* 0.0069 Tw (administered three to six months after soldiers return home.)Tj 0 -1.398 TD -0.0014 Tw (This extensive questionnaire asks about exposures to physi-)Tj 0 -1.401 TD -0.0029 Tc 0.0493 Tw (cal and psychological toxins and physical or psychological)Tj T* -0.0031 Tc -0.0372 Tw (symptoms. It is followed up by a face-to-face interview with)Tj 0 -1.398 TD -0.0624 Tw [(a primary provider)50.8(. It is critical to have follow-up evaluation)]TJ 0 -1.401 TD -0.0033 Tc 0.0655 Tw (and treatment options in place for any soldiers who screen)Tj T* -0.0034 Tc 0.0108 Tw [(positive. )50.7(All of the Services use this tool.)]TJ 1.8 -1.998 TD -0.0032 Tc 0.0157 Tw [(The )53.9(Army has now completed five analyses of suicidal)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0945 Tw [(and other high-risk behavior on an installation basis. The)]TJ T* -0.0022 Tc 0.125 Tw (first of these was at Ft. Bragg after the highly publicized)Tj 0 -1.398 TD -0.0013 Tc (apparent cluster of homicides and two suicide-homicides.)Tj 0 -1.401 TD -0.0129 Tc -0.062 Tw [(Similar to the MHA)107.1(T)21.9( assessment, these Epidemiological Con-)]TJ T* -0.0034 Tc 0.0837 Tw [(sultation )14.7(T)73.4(eams use a combination of anonymous surveys,)]TJ 0 -1.398 TD -0.0032 Tc 0.01 Tw [(focus groups, and interviews with key leaders. The records)]TJ 0 -1.401 TD -0.0036 Tc -0.0475 Tw (of index cases \(e.g., completed suicides\) also are reviewed)Tj T* -0.0069 Tc -0.0625 Tw [(in detail. Findings from these visits have led to recommenda-)]TJ 0 -1.398 TD -0.0034 Tc 0.0067 Tw [(tions on which the )50.5(Army has acted. )14.5(The U.S. )53.5(Air Force also)]TJ 0 -1.401 TD -0.0035 Tc -0.0005 Tw (has developed a number of mental health related tools. The)Tj T* -0.0047 Tc -0.0617 Tw [(Leader)-40.7()52.3(s)-0.4( Guide for Managing Personnel in Distress \(2007\))]TJ 0 -1.398 TD -0.0034 Tc -0.0531 Tw (provides military leaders with numerous check lists for iden-)Tj 0 -1.401 TD -0.0029 Tc -0.0335 Tw [(tifying a variety of mental health issues and includes check-)]TJ T* -0.0074 Tc -0.0621 Tw (lists to help identify pre-deployment, during deployment, and)Tj 0 -1.398 TD 0.0333 Tc 0.125 Tw (post-deployment stressors that can lead to behavioral)Tj 0 -1.401 TD -0.0036 Tc 0.0125 Tw [(changes and/or mental health difficulties.)]TJ /F1 1 Tf 11 0 0 11 309 230.01 Tm -0.0045 Tc 0.0651 Tw (Options for Civilian Responders)Tj /TT2 1 Tf 10 0 0 10 327 206.64 Tm -0.0035 Tc -0.0287 Tw (If one accepts the notion that mental health surveillance)Tj -1.8 -1.398 TD -0.0339 Tw (should be conducted for the benefit of disaster workers, who)Tj 0 -1.401 TD -0.0037 Tc 0.1107 Tw (should deliver these services and how should surveillance)Tj T* -0.0034 Tc 0.0988 Tw [(activities be conducted? It seems reasonable that medical)]TJ 0 -1.398 TD -0.0035 Tc 0.0787 Tw (and nursing personnel, as well as mental health personnel,)Tj 0 -1.401 TD 0.0012 Tc 0.125 Tw [(could be used to conduct mental health surveillance, and)]TJ T* -0.0034 Tc 0.04 Tw (specially trained disaster response personnel could conduct)Tj 0 -1.398 TD -0.039 Tw [(surveillance in the field. In determining how to conduct sur-)]TJ 0 -1.401 TD -0.0035 Tc -0.0275 Tw (veillance activities, it is important to remember that workers)Tj T* -0.0033 Tc 0.0412 Tw [(can begin a response while carrying the effects of previous)]TJ ET endstream endobj 182 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 184 0 obj << /Length 9503 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (209)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0032 Tc 0.0228 Tw (responses; they also can exhibit effects from the current re-)Tj 0 -1.398 TD -0.0034 Tc 0.1094 Tw [(sponse both during and after the response. Thus, surveil-)]TJ 0 -1.401 TD -0.0036 Tc -0.0622 Tw (lance should take place during a similar timeframe.)Tj /TT5 1 Tf 11 0 0 11 66 661.35 Tm 0.0184 Tc 0 Tw [(Pr)32(e-Deployment)]TJ /TT1 1 Tf 10 0 0 10 84 641.64 Tm 0 Tc ( )Tj /TT2 1 Tf 0.201 0 TD -0.0034 Tc -0.0515 Tw (Pre-deployment activities might consist of a basic men-)Tj -2.001 -1.398 TD -0.0031 Tc 0.0065 Tw (tal status screen as well as a screening for psychiatric histo-)Tj 0 -1.401 TD 0.0227 Tc 0.125 Tw (ries that could suggest a significant vulnerability once)Tj T* -0.0031 Tc 0.0166 Tw [(deployed to the field. Generally)59.9(, responders who must use)]TJ 0 -1.398 TD -0.0036 Tc 0.0587 Tw (personal protective equipment on a regular basis must par-)Tj 0 -1.401 TD -0.045 Tw [(ticipate in medical monitoring programs. For these workers,)]TJ T* -0.012 Tc -0.0623 Tw [(it would be relatively easy to incorporate mental status screen-)]TJ 0 -1.398 TD -0.0077 Tc -0.0625 Tw [(ing into their medical monitoring programs. These decisions,)]TJ 0 -1.401 TD -0.0032 Tc 0.0734 Tw [(however)38.8(, must be guided not only by relevant empiricism,)]TJ T* 0.125 Tw (but also by concerns for the personal, organizational, and)Tj 0 -1.398 TD -0.0036 Tc -0.035 Tw (legal ramifications of excluding someone from field service.)Tj 0 -1.401 TD 0.057 Tw (For these reasons, establishing an )Tj /TT5 1 Tf 13.83 0 TD -0.0043 Tc 0.06 Tw (a priori)Tj /TT2 1 Tf 3.114 0 TD -0.0034 Tc 0.0584 Tw [( list of exclusion)]TJ -16.944 -1.401 TD -0.0036 Tc -0.0237 Tw (factors that applies to all situations and workforces becomes)Tj 0 -1.398 TD -0.019 Tc 0 Tw (difficult.)Tj /TT5 1 Tf 11 0 0 11 66 426.36 Tm 0.018 Tc 0.1273 Tw (During Deployment)Tj /TT2 1 Tf 10 0 0 10 84 406.65 Tm -0.0036 Tc 0.0775 Tw (In this phase)Tj /TT1 1 Tf 5.166 0 TD 0 Tc 0 Tw (,)Tj /TT2 1 Tf 0.249 0 TD -0.0036 Tc 0.0775 Tw [( the surveillance needs to be approached)]TJ -7.215 -1.401 TD -0.0034 Tc 0.1133 Tw (carefully to avoid disrupting responders concentration on)Tj 0 -1.398 TD 0.0775 Tw [(response activities. )17.6(T)73.4(o)0( conduct psychological surveillance)]TJ 0 -1.401 TD 0.0175 Tc 0.125 Tw (as unobtrusively as possible, managers and supervisors)Tj T* -0.0035 Tc 0.0167 Tw (could be educated about symptoms of stress and the impor-)Tj 0 -1.398 TD 0.001 Tc 0.125 Tw [(tance of taking care of their people. They also could be)]TJ 0 -1.401 TD -0.0034 Tc -0.0557 Tw (taught to watch for trembling, a thousand-yard-stare, diffi-)Tj T* -0.0183 Tc -0.0625 Tw [(culty communicating, crying, irritability)62.7(, startle response, rapid)]TJ 0 -1.398 TD -0.0046 Tc [(and inappropriate speech, and indif)16.4(ference to danger)55.4(. Know-)]TJ 0 -1.401 TD -0.0033 Tc 0.0777 Tw [(ing what to look for could allow supervisors to informally)]TJ T* -0.0034 Tc -0.0205 Tw (assess the status of their teams or crews during the course of)Tj 0 -1.398 TD -0.0067 Tc -0.0617 Tw [(the workday)62.3(. )20.8(This could be particularly ef)20.3(fective with groups)]TJ 0 -1.401 TD -0.0034 Tc -0.005 Tw (that work together regularly and who know each other well.)Tj T* -0.0036 Tc -0.03 Tw [(W)94.2(orker experiences, such as witnessing others being injured)]TJ 0 -1.398 TD -0.0034 Tc -0.0475 Tw (or killed, finding human remains, or feeling at risk of serious)Tj 0 -1.401 TD -0.0023 Tc -0.005 Tw (injury or death, )Tj /TT1 1 Tf 6.336 0 TD -0.0075 Tc 0 Tw (can)Tj /TT2 1 Tf 1.485 0 TD -0.0037 Tc -0.006 Tw [( trigger emotional responses in workers.)]TJ -7.821 -1.401 TD -0.0035 Tc 0.088 Tw (The operative word here is )Tj /TT1 1 Tf 11.316 0 TD -0.0075 Tc 0 Tw (can)Tj /TT2 1 Tf 1.485 0 TD -0.0036 Tc 0.0888 Tw (, because each worker will)Tj -12.801 -1.398 TD -0.0032 Tc -0.0304 Tw [(react and respond dif)17.8(ferently to such situations. )50.9(At the least,)]TJ 0 -1.401 TD 0.0046 Tc 0.1253 Tw [(however)34.6(, such experiences can serve to alert supervisors)]TJ T* -0.0035 Tc 0.0075 Tw [(about workers who might be vulnerable. In addition, since)]TJ 0 -1.398 TD -0.0033 Tc -0.0586 Tw (under the Incident Comand System the overall responsibility)Tj 0 -1.401 TD -0.0032 Tc 0.0839 Tw (for ensuring the health and safety of responders rests with)Tj T* -0.0036 Tc -0.0011 Tw [(the Safety Of)17.4(ficer)35.4(, a reminder about stress management and)]TJ 0 -1.398 TD -0.0039 Tc -0.062 Tw [(stress symptoms can be included in the Safety Of)17.1(ficer)-39.9()53.1(s)-2( daily)]TJ 0 -1.401 TD -0.0025 Tc 0.125 Tw [(Health and Safety Briefing. This briefing is presented to)]TJ 25.5 65.199 TD -0.0031 Tc 0.0582 Tw (responders each morning before they deploy into the field.)Tj 0 -1.398 TD -0.0033 Tc -0.0077 Tw (This would appear to be particularly appropriate as one fed-)Tj 0 -1.401 TD -0.0028 Tc -0.0431 Tw (eral agency already has given the Safety Officer responsibil-)Tj T* 0.0077 Tc 0.125 Tw (ity for evaluating the need for and requesting assistance)Tj 0 -1.398 TD -0.0101 Tc -0.0619 Tw [(from the agency)52.9(s Critical Incident S)13.9(tress Management )20.1(T)72.7(eam.)]TJ /TT5 1 Tf 11 0 0 11 321 633.36 Tm 0.0203 Tc 0 Tw (Post-Deployment)Tj /TT2 1 Tf 10 0 0 10 339 613.65 Tm -0.0025 Tc 0.125 Tw (Numerous studies document that first responders and)Tj -1.8 -1.401 TD -0.003 Tc -0.05 Tw (workers involved in cleanup and recovery are at risk for psy-)Tj 0 -1.398 TD 0.0211 Tc 0.125 Tw [(chiatric sequelae following disasters \(Neria, Gross, &)]TJ 0 -1.401 TD -0.0043 Tc -0.0622 Tw [(Marshall, 2006\). Some emergency response technicians, po-)]TJ T* -0.0032 Tc -0.0111 Tw (lice, and firefighters may be more resilient than workers not)Tj 0 -1.398 TD -0.0027 Tc 0.1025 Tw (typically involved in emergency situations \(e.g., construc-)Tj 0 -1.401 TD -0.003 Tc 0.0474 Tw [(tion workers\). )53.9(Also, many disasters involve lay volunteers)]TJ T* -0.0097 Tc -0.0622 Tw (who may have minimal training and little preparation for their)Tj 0 -1.398 TD 0.0032 Tc 0.1248 Tw [(reactions to the disaster scene. )18(T)71(o)0.8( screen ef)12.2(fectively for)]TJ 0 -1.401 TD -0.0005 Tc 0.125 Tw (psychiatric symptoms during and after the emergency re-)Tj T* -0.0019 Tc (sponse requires instruments that are brief, easily incorpo-)Tj 0 -1.398 TD -0.0032 Tc 0.0568 Tw (rated into a field clinic, and acceptable to a broad range of)Tj 0 -1.401 TD -0.004 Tc 0 Tw (individuals.)Tj 1.8 -2.001 TD -0.0033 Tc -0.0071 Tw (Psychiatric screening in medical settings and for epide-)Tj -1.8 -1.398 TD -0.0035 Tc 0.0221 Tw (miologic surveys has shown significant progress during the)Tj 0 -1.401 TD -0.004 Tc 0.0537 Tw [(past decade. Since WWII, questionnaires such as the SCL-)]TJ T* -0.0038 Tc 0.035 Tw (90 \(Derogatis, 1983\))Tj /TT1 1 Tf 8.301 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.285 0 TD -0.0039 Tc 0.0363 Tw (and the General Health Questionnaire)Tj -8.586 -1.398 TD -0.004 Tc 0.0387 Tw [(\(GHQ; Goldber)17(g & )14(W)54.8(illiams, 1988\) have been used exten-)]TJ 0 -1.401 TD -0.0027 Tc 0.065 Tw [(sively to assess psychological distress in many studies. In)]TJ T* -0.0036 Tc 0.0008 Tw (contrast, structured clinical interviews have been developed)Tj 0 -1.398 TD -0.0027 Tc 0.0561 Tw (for use by lay interviewers as aides in identifying standard)Tj 0 -1.401 TD -0.0032 Tc 0.092 Tw (psychiatric disorders according to the )Tj /TT5 1 Tf 15.585 0 TD -0.0041 Tc 0.095 Tw (Diagnostic and Sta-)Tj -15.585 -1.401 TD -0.0038 Tc -0.032 Tw (tistical Manual of Mental Disorders IV)Tj /TT2 1 Tf 15.336 0 TD -0.0033 Tc -0.035 Tw [( \(American Psychiat-)]TJ -15.336 -1.398 TD 0.0013 Tw [(ric )53.7(Association, 1994\) criteria. )50.7(Although the sensitivity and)]TJ 0 -1.401 TD -0.003 Tc 0.0043 Tw (specificity of the psychiatric diagnostic interviews are quite)Tj T* -0.0054 Tc -0.0625 Tw (good, they are time consuming and require extensive training)Tj 0 -1.398 TD -0.0033 Tc 0.0093 Tw [(to administer correctly)62.7(. Furthermore, there is some sugges-)]TJ 0 -1.401 TD -0.0035 Tc 0.0183 Tw (tion that when diagnostic interviews are used in the general)Tj T* -0.0033 Tc 0.1219 Tw [(population, cases identified from the community are less)]TJ 0 -1.398 TD -0.0187 Tw (severe than cases in treatment \(Kessler et al., 2001\).)Tj 1.8 -2.001 TD -0.0028 Tc 0.0269 Tw [(Ideally)63.2(, instruments that reflect general severity of dis-)]TJ -1.8 -1.401 TD -0.003 Tc 0.125 Tw (tress as well as diagnosis would be optimal for screening)Tj 0 -1.398 TD -0.0036 Tc 0.0517 Tw [(workers and the general volunteer population. Such an in-)]TJ 0 -1.401 TD -0.0055 Tc -0.0622 Tw (strument was developed and used in the U.S. National Health)Tj T* -0.0034 Tc (Interview Survey where it was important to fit within signifi-)Tj 0 -1.398 TD -0.0035 Tc 0.0068 Tw [(cant time constraints. Kessler and colleagues \(2002\) devel-)]TJ 0 -1.401 TD 0.0591 Tc 0.1361 Tw (oped the six- \(K6\) or ten- \(K10\) question self- or)Tj T* -0.0038 Tc -0.015 Tw (interviewer-administered screening scales, which show sen-)Tj 0 -1.398 TD -0.0026 Tc -0.047 Tw (sitivity in the 90 to 99)Tj 5.8 0 0 5.8 406.11 72.99 Tm -0.002 Tc 0 Tw (th)Tj 10 0 0 10 410.61 69.66 Tm -0.0034 Tc -0.0475 Tw [( percentile and consistent psychomet-)]TJ ET endstream endobj 185 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 187 0 obj << /Length 9234 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0052 Tc 0.1021 Tw [(210 )]TJ /TT3 1 Tf 2.7825 0 TD 0.1044 Tw (Shubert Behavioral Health Surveillance for First Responders)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0096 Tc -0.0622 Tw [(ric properties across different demographic sub-samples. The)]TJ 0 -1.398 TD 0.0045 Tc 0.125 Tw (authors have developed weighted scoring methods based)Tj 0 -1.401 TD 0.0041 Tc 0.1252 Tw [(on the )13.3(W)92.9(orld Health Or)22.1(ganization \(WHO\) )13.3(W)92.9(orld Mental)]TJ T* -0.0035 Tc -0.0111 Tw (Health Surveys \(Kessler & Usten, 2000\) and with data from)Tj 0 -1.398 TD 0.0119 Tc 0.125 Tw (the WHO Composite International Diagnostic Interview)Tj 0 -1.401 TD -0.0083 Tc -0.0625 Tw (\(CIDI; WHO, 1997\); rules for prediction of clinical outcomes)Tj T* -0.0035 Tc 0.0075 Tw (are available for these instruments.)Tj 1.8 -1.998 TD -0.0043 Tc -0.0624 Tw [(Post-deployment surveillance might come in two forms:)]TJ -1.8 -1.401 TD -0.0033 Tc -0.0132 Tw (in the field post mission, but prior to release to return home;)Tj T* -0.0035 Tc 0.1219 Tw (and follow-up, conducted two to four weeks post deploy-)Tj 0 -1.398 TD -0.0034 Tc 0.0439 Tw (ment. The follow-up may be conducted via telephone or in)Tj 0 -1.401 TD -0.0032 Tc 0.0073 Tw (person , as well as more formal structured psychiatric inter-)Tj T* 0.0094 Tw [(views. )53.9(As noted previously)62.9(, the military has developed and)]TJ 0 -1.398 TD -0.0035 Tc 0.0379 Tw (implemented approaches that may be adaptable for civilian)Tj 0 -1.401 TD 0.0143 Tc 0 Tw (responders.)Tj 1.8 -2.001 TD -0.0032 Tc 0.0611 Tw (The notion that exposure to a disaster is the necessary)Tj -1.8 -1.398 TD 0.0024 Tc 0.125 Tw (and sufficient condition for the development of posttrau-)Tj 0 -1.401 TD -0.007 Tc -0.0625 Tw (matic morbidity is obviously false; nevertheless, there will be)Tj T* -0.0038 Tc -0.055 Tw (those who do develop untoward reactions, even among those)Tj 0 -1.398 TD -0.0035 Tc 0.0191 Tw (who are trained disaster responders. Surveillance initiatives)Tj 0 -1.401 TD -0.0089 Tc -0.0623 Tw (may be a way to reduce posttraumatic morbidity and/or facili-)Tj T* -0.0034 Tc 0.0283 Tw (tate access to appropriate mental health care.)Tj 1.8 -1.998 TD -0.0033 Tc 0.045 Tw (At the same time, it is important to consider the reluc-)Tj -1.8 -1.401 TD -0.0072 Tc -0.0622 Tw [(tance of emergency response personnel to seek mental health)]TJ T* -0.0035 Tc 0.1031 Tw [(treatment. For this reason crisis assessment and interven-)]TJ 0 -1.398 TD -0.003 Tc -0.0034 Tw (tion may provide their only access to mental health services)Tj 0 -1.401 TD -0.0109 Tc -0.0621 Tw (\(North, Tivis, McMillan, Pfefferbaum, Cox, Spitznagel, et al.,)Tj T* -0.0082 Tc -0.0625 Tw (2002; North, Tivis, McMillan, Pfefferbaum, Spitznagel, Cox,)Tj 0 -1.398 TD -0.0072 Tc -0.0623 Tw [(et al., 2002\). Whereas ~ 85% of military sampled who served)]TJ 0 -1.401 TD -0.0036 Tc 0.065 Tw (in Iraq/Afghanistan recognized problems, only ~44% were)Tj T* -0.0034 Tc -0.0586 Tw [(willing to seek assistance \(Hoge et al., 2004\). Less than 50%)]TJ 0 -1.398 TD -0.0036 Tc -0.0581 Tw (of civilian disaster workers who screened positive for mental)Tj 0 -1.401 TD -0.0034 Tc 0.0457 Tw (health concerns were willing to seek treatment \(Jayasinghe)Tj T* -0.003 Tc -0.0477 Tw [(et al., 2005\). Thus, it may be that providing surveillance and)]TJ 0 -1.398 TD -0.0035 Tc -0.0183 Tw (acute follow-up intervention services in the wake of a disas-)Tj 0 -1.401 TD -0.003 Tc 0.0707 Tw [(ter)36(, specifically for those who respond in rescue, recovery)60(,)]TJ T* -0.0035 Tc 0.0966 Tw (relief, and/or material removal and construction functions,)Tj 0 -1.398 TD -0.0037 Tc 0.02 Tw (could serve as a bridge to more formal mental health ser-)Tj 0 -1.401 TD 0.0041 Tc 0 Tw (vices.)Tj /F1 1 Tf 11 0 0 11 54 140.01 Tm 0.0011 Tc (Conclusion)Tj /TT2 1 Tf 10 0 0 10 72 116.64 Tm -0.0037 Tc 0.0125 Tw (In addition to the growing documentation of the poten-)Tj -1.8 -1.398 TD -0.0033 Tc -0.0564 Tw (tial for negative psychological effects from disaster response)Tj 0 -1.401 TD -0.0035 Tc 0.1108 Tw (work, researchers also recognize the potential relationship)Tj 25.5 63.399 TD 0.0046 Tc 0.125 Tw (between these negative effects and physical health prob-)Tj 0 -1.398 TD -0.0033 Tc 0.0317 Tw [(lems. Because of the complexity of the factors influencing)]TJ 0 -1.401 TD -0.0037 Tc -0.035 Tw (individual responses to trauma, the mechanisms that eventu-)Tj T* -0.0034 Tc -0.0233 Tw [(ally can be implemented to monitor these responses should,)]TJ 0 -1.398 TD -0.003 Tc 0.1006 Tw [(of necessity)63(, be capable of recognizing the potentially nu-)]TJ 0 -1.401 TD -0.0005 Tc 0.125 Tw (merous ways negative responses may present in different)Tj T* -0.004 Tc 0 Tw (individuals.)Tj 1.8 -1.998 TD -0.0035 Tc 0.0883 Tw (Military organizations have made enormous strides in)Tj -1.8 -1.401 TD -0.0033 Tc 0.0363 Tw [(confronting many of these issues. 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Last, a protocol must be developed to address the)]TJ T* -0.0033 Tc 0.0009 Tw (ethical dilemmas posed by confidentiality requirements and)Tj 0 -1.398 TD -0.0124 Tc -0.0625 Tw [(treatment needs. )50.6(Although the civilian population will present)]TJ 0 -1.401 TD -0.0031 Tc 0.0072 Tw (quite a different challenge than the military population, it is)Tj T* -0.0038 Tc 0.0322 Tw (imperative that the medical and mental health communities)Tj 0 -1.398 TD -0.0036 Tc 0.0794 Tw (provide civilian disaster responders with the same level of)Tj 0 -1.401 TD -0.0034 Tc 0.0693 Tw (psychological protection and assistance it has provided for)Tj T* -0.0028 Tc 0.0125 Tw (their physical health.)Tj /F1 1 Tf 11 0 0 11 388.89 348 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 309 330.66 Tm -0.0155 Tc -0.062 Tw [(Al-Naser)41.5(, F)74.5(., & Everly)65.5(, G)113.5(.S., Jr)56.5(. \(1999\). Prevalence of posttrau-)]TJ 1.2 -1.401 TD -0.0077 Tc -0.0622 Tw (matic stress disorder among Kuwaiti firefighters. )Tj /TT5 1 Tf 19.284 0 TD -0.0087 Tc 0 Tw (Interna-)Tj -19.284 -1.401 TD -0.0039 Tc 0.008 Tw (tional Journal of Emergency Mental Health)Tj /TT2 1 Tf 17.406 0 TD 0 Tc 0 Tw (, )Tj /TT5 1 Tf 0.51 0 TD -0.006 Tc (1,)Tj /TT2 1 Tf 0.744 0 TD -0.004 Tc 0.01 Tw [( 99-101.)]TJ -19.86 -1.8 TD -0.0034 Tc 0.0479 Tw [(American Psychiatric )53.5(Association. \(1994\). )]TJ /TT5 1 Tf 17.571 0 TD -0.0046 Tc 0.05 Tw (Diagnostic and)Tj -16.371 -1.398 TD -0.004 Tc -0.0335 Tw [(statistical manual of mental disor)32(ders)]TJ /TT2 1 Tf 14.856 0 TD -0.0045 Tc -0.03 Tw [( \(4)]TJ 5.8 0 0 5.8 480 273.99 Tm -0.002 Tc 0 Tw (th)Tj 10 0 0 10 484.5 270.66 Tm -0.0033 Tc -0.0335 Tw [( ed.\). )16.2(W)97.5(ashing-)]TJ -16.35 -1.401 TD -0.0043 Tc -0.0358 Tw [(ton, DC: )50.6(Author)49.7(.)]TJ -1.2 -1.8 TD -0.0133 Tc -0.0625 Tw [(Arendt, M. & Elklit, )49.7(A. \(2001\). 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Health status, somatiza-)]TJ T* -0.0055 Tc -0.0624 Tw [(tion, and severity of posttraumatic stress dissorder in )18.6(V)65.7(iet-)]TJ 0 -1.398 TD -0.0038 Tc 0.0483 Tw [(nam combat veterans with posttraumatic stress disorder)50.2(.)]TJ /TT5 1 Tf 0 -1.401 TD -0.0418 Tw [(American Journal of Psychiatry)56(.)-0.8( 155)]TJ /TT2 1 Tf 14.655 0 TD -0.045 Tw (, 1565-1569.)Tj -15.855 -1.8 TD -0.0032 Tc 0.0538 Tw [(Berrios-T)65.8(orres, S.I., Greenko, J.A., Phillips M, Miller J.R.,)]TJ 1.2 -1.401 TD -0.0035 Tc -0.021 Tw [(T)37.3(readwell )14.7(T)79.3(,)-0.4( Ikeda R.M. \(2003\). )14.7(W)97.3(o)1.2(rld )17.7(T)37.3(r)-0.1(ade Center res-)]TJ 0 -1.398 TD -0.0172 Tc -0.0625 Tw [(cue worker injury and illness surveillance, New )27.8(Y)105(ork, 2001.)]TJ /TT5 1 Tf 0 -1.401 TD -0.0039 Tc -0.043 Tw [(American Journal of Preventive Medicine)]TJ /TT2 1 Tf 16.656 0 TD 0.001 Tc 0 Tw (, )Tj /TT5 1 Tf 0.453 0 TD -0.01 Tc (25)Tj /TT2 1 Tf 0.99 0 TD -0.0033 Tc -0.045 Tw [( \(2\): 79-87.)]TJ ET endstream endobj 188 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 190 0 obj << /Length 11661 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (211)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.01 Tc -0.0625 Tw [(Castellano, C. \(2005\). 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The role of operational stress training and psycho-)Tj 0 -1.401 TD -0.0035 Tc 0.12 Tw (logical debriefing. )Tj /TT5 1 Tf 7.755 0 TD -0.0039 Tc 0.1225 Tw (British Journal of Medical Psychol-)Tj -7.755 -1.401 TD -0.0169 Tc 0 Tw (ogy)Tj /TT2 1 Tf 1.401 0 TD -0.011 Tc (, )Tj /TT5 1 Tf 0.414 0 TD -0.025 Tc (73)Tj /TT2 1 Tf 0.966 0 TD -0.0149 Tc -0.06 Tw (, 77-85.)Tj -3.981 -1.8 TD -0.0033 Tc 0.0533 Tw (Derogatis, L.R. \(1983\). )Tj /TT5 1 Tf 9.666 0 TD -0.0041 Tc 0.055 Tw [(SCL-90-R Administration, scoring)]TJ -8.466 -1.398 TD 0.034 Tw [(and pr)28.9(ocedur)31.9(es manual-II. )]TJ /TT2 1 Tf 11.214 0 TD -0.0049 Tc 0.03 Tw [(T)68.9(owson, MD:)]TJ /TT5 1 Tf 5.52 0 TD 0.035 Tc 0 Tw ( )Tj /TT2 1 Tf 0.57 0 TD -0.0028 Tc 0.035 Tw (Clinical Psy-)Tj -17.304 -1.401 TD -0.0043 Tc -0.06 Tw (chometric Research.)Tj -1.2 -1.8 TD -0.0092 Tc -0.0622 Tw [(Everly)65.8(, G)116.8(.)0.2(S., Jr)50.8(. & Flynn, B.W)92.8(. \(2005\). 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Baltimore: Johns)Tj -11.07 -1.401 TD -0.014 Tw (Hopkins Center for Public Health Preparedness.)Tj -1.2 -1.8 TD -0.0175 Tc -0.0618 Tw [(Everly)63.5(, G)117.5(.S., Jr)51.5(. & Mitchell, J.T)72.5(. \(2008\). )]TJ /TT5 1 Tf 15.009 0 TD -0.0184 Tc -0.0625 Tw [(Integrative crisis inter)14.6(-)]TJ -13.809 -1.398 TD -0.0038 Tc 0.1063 Tw [(vention and disaster mental health.)]TJ /TT2 1 Tf 14.379 0 TD -0.0028 Tc 0.1075 Tw [( Ellicott City)63.2(, MD:)]TJ -14.379 -1.401 TD 0 Tw (Chevron.)Tj -1.2 -1.8 TD -0.0032 Tc -0.005 Tw [(Feldman, D.M., Baron, S.L., Bernard, B.P)107.8(., Lushniak, B.D.,)]TJ 1.2 -1.401 TD -0.0028 Tc 0.0255 Tw [(Banauch, G)117.2(., )51.1(Arcentales, N., Kelly)63.2(, K.J., & Prezant, D.J.)]TJ 0 -1.398 TD -0.0032 Tc 0.07 Tw (\(2004\). Symptoms, respirator use, and pulmonary func-)Tj 0 -1.401 TD -0.0036 Tc -0.0515 Tw [(tion changes among New )29.3(Y)103.6(ork City fire-fighters respond-)]TJ T* -0.0159 Tc -0.0622 Tw [(ing to the )17(W)99.9(orld )17(T)39.9(rade Center disaster)56.1(. )]TJ /TT5 1 Tf 14.586 0 TD -0.0166 Tc -0.0625 Tw (Chest, 125, )Tj /TT2 1 Tf 4.458 0 TD -0.019 Tc 0 Tw [(1256-64)-7(.)]TJ -20.244 -1.8 TD -0.0103 Tc -0.0624 Tw [(Fullerton, C.S., Ursano, R.J., & )19.8(W)99.5(ang, L. \(2004\). )52.8(Acute stress)]TJ 1.2 -1.398 TD -0.0036 Tc 0.0459 Tw [(disorder)38.4(, posttraumatic stress disorder and depression in)]TJ 0 -1.401 TD -0.0325 Tw (disaster or rescue workers. )Tj /TT5 1 Tf 10.689 0 TD -0.004 Tc -0.035 Tw (American Journal of Psychia-)Tj -10.689 -1.401 TD -0.028 Tc 0 Tw [(tr)-13(y)]TJ /TT2 1 Tf 1.044 0 TD -0.014 Tc (, )Tj /TT5 1 Tf 0.405 0 TD -0.0255 Tc (161)Tj /TT2 1 Tf 1.431 0 TD -0.023 Tc -0.06 Tw (, 1370-1376.)Tj -4.08 -1.8 TD -0.0035 Tc 0.0171 Tw [(Goldber)17.5(g, R.J. & )18.2(W)55.3(illiams, P)104.5(.)-0.9( \(1988\). )]TJ /TT5 1 Tf 15.54 0 TD -0.0037 Tc 0.0175 Tw [(A)22.1( user)-36.7()128.3(s)-0.4( guide to the)]TJ -14.34 -1.398 TD -0.0131 Tc -0.0625 Tw [(General Health Questionnnair)31.9(e)]TJ /TT2 1 Tf 12.186 0 TD -0.0133 Tc [(.)-5.3( )-5.3( )16.7(W)54.5(indsor: NFER-Nelson.)]TJ 12.114 64.998 TD -0.0177 Tc -0.062 Tw [(Halperin )18.5(W)101.2(.E., Frazier )15.5(T)80.1(.M. \(1985\) Surveillance for the ef)15.3(fects)]TJ 1.2 -1.398 TD -0.0036 Tc -0.0362 Tw (of workplace exposure. )Tj /TT5 1 Tf 9.63 0 TD -0.004 Tc -0.0375 Tw (Annual Review of Public Health)Tj /TT2 1 Tf 12.621 0 TD 0 Tc 0 Tw (,)Tj /TT5 1 Tf -22.251 -1.401 TD (6)Tj /TT2 1 Tf 0.471 0 TD -0.0327 Tc -0.06 Tw (, 419-432.)Tj -1.671 -1.8 TD -0.0173 Tc -0.0624 Tw [(Herbert, R., Moline, J., Skloot, G)117.7(., Metzger)39.7(, K., Baron, S., Luft,)]TJ 1.2 -1.401 TD -0.0034 Tc -0.0206 Tw [(B., et al. \(2006\) )14.9(The )17.9(W)94.4(orld )17.9(T)37.4(rade Center disaster and the)]TJ 0 -1.398 TD -0.0587 Tw (health of workers: five-year assessment of a unique medi-)Tj 0 -1.401 TD 0.0575 Tw (cal screening program. )Tj /TT5 1 Tf 9.786 0 TD -0.0043 Tc (Environmental Health Perspec-)Tj -9.786 -1.401 TD -0.0194 Tc 0 Tw (tives)Tj /TT2 1 Tf 1.74 0 TD -0.014 Tc (, )Tj /TT5 1 Tf 0.405 0 TD -0.095 Tc [(11)-70(4)]TJ /TT2 1 Tf 1.365 0 TD -0.0199 Tc -0.06 Tw (\(12\), 1853-1858.)Tj -4.71 -1.8 TD -0.0035 Tc -0.0005 Tw [(Hoge, C.W)86.5(., Castro, C., Messer)35.5(, S.C., McGurk, D., Cotting,)]TJ 1.2 -1.398 TD -0.0031 Tc 0.025 Tw [(D.I., & Koffman, R.L. \(2004\). Combat duty in Iraq and)]TJ 0 -1.401 TD -0.0036 Tc -0.0378 Tw [(Afghanistan, mental health problems and barriers to care.)]TJ /TT5 1 Tf T* -0.0042 Tc 0.0212 Tw (New England Journal of Medicine)Tj /TT2 1 Tf 13.734 0 TD -0.001 Tc 0 Tw (, )Tj /TT5 1 Tf 0.522 0 TD -0.0075 Tc (351)Tj /TT2 1 Tf 1.485 0 TD -0.0034 Tc 0.025 Tw (, 13-22.)Tj -16.941 -1.8 TD -0.0623 Tw [(Hoge, C.W)86.6(., Lesikar)38.6(, S.E., Guevara, R., Lange, J., Brundage,)]TJ 1.2 -1.398 TD -0.0109 Tc [(J.F)79.1(., Engel, C.C., Jr)49.1(., et al. \(2002\). Mental disorders among)]TJ 0 -1.401 TD -0.0034 Tc 0.092 Tw [(U.S. military personnel in the 1990s: )50.7(Association with)]TJ T* -0.0028 Tc -0.0389 Tw (high levels of health care utilization and early military at-)Tj 0 -1.398 TD -0.0029 Tc 0 Tw (trition. )Tj /TT5 1 Tf 2.976 0 TD -0.0039 Tc 0.0603 Tw [(American Journal of Psychiatry)53(.)-0.9( 159)]TJ /TT2 1 Tf 15.165 0 TD 0.06 Tw [(\(9\): 1576-)]TJ -18.141 -1.401 TD -0.0563 Tc 0 Tw (1583.)Tj -1.2 -1.8 TD -0.003 Tc -0.05 Tw (Hogan, D.E., Burstein, J.L. \(eds\) \(2002\). )Tj /TT5 1 Tf 16.326 0 TD -0.0043 Tc -0.055 Tw (Disaster medicine)Tj /TT2 1 Tf 7.125 0 TD 0 Tc 0 Tw (.)Tj -22.251 -1.401 TD -0.0135 Tc -0.0782 Tw [(Philadelphia: W)54.3(illiams )-16.6(& W)57.3(ilkins.)]TJ -1.2 -1.8 TD -0.0031 Tc 0.0312 Tw [(Hulshof, C.T)71.9(., )18(V)113.1(erbeek, J.H., van Dijk, F)77.9(.J., van der )15(W)94.7(eide,)]TJ 1.2 -1.398 TD -0.003 Tc 0.125 Tw [(W)106.8(.E., Braam, I.T)72(. 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Check )]TJ 9.9815 0 TD 0.0023 Tc (or PO )Tj 2.7951 0 TD -0.006 Tc 0 Tw [(#)-172.7(___________)]TJ -29 -1.5533 TD 0.0028 Tc 0.0268 Tw [(Credit Card: )]TJ /F26 1 Tf 6.4 0 TD 0 Tc 0 Tw ()Tj /F24 1 Tf 0.75 0 TD 0.0017 Tc 0.0078 Tw [( )-13.8( )-20(MasterCard)-441.6( )]TJ /F26 1 Tf 7.7 0 TD 0 Tc 0 Tw ()Tj /F24 1 Tf 0.75 0 TD 0.0011 Tc -0.0011 Tw [( )-12.5(Visa)]TJ /F26 1 Tf 6.0667 0 TD 0 Tc 0 Tw ()Tj /F24 1 Tf 0.75 0 TD 0.0025 Tc 0.0742 Tw [( Discover)]TJ /F26 1 Tf 6.5233 0 TD 0 Tc 0 Tw ()Tj /F24 1 Tf 0.75 0 TD -0.0032 Tc 0.0032 Tw ( AMEX)Tj -29.69 -1.5567 TD -0.0006 Tc -0.0024 Tw ( Card )Tj 3.1815 0 TD 0.0014 Tc (Number:)Tj 3.7418 0 TD -0.0057 Tc (_____________________________________)Tj 18.9667 0 TD 0.0015 Tc 0.0778 Tw (Exp. Date)Tj 4.27 0 TD -0.0063 Tc (__________)Tj -30.16 -1.5567 TD 0 Tc 0.0178 Tw [( )]TJ 1.0712 0 TD 0.0023 Tc 0.0155 Tw (Cardholder Name:)Tj 7.8288 0 TD -0.0059 Tc 0 Tw [(______________________)-479.2(S)-16.2(i)]TJ 12.1165 0 TD 0.0103 Tc (gnature)Tj 3.7068 0 TD -0.0058 Tc (_____________________)Tj -24.7233 -1.5533 TD 0.0026 Tc 0.03 Tw [( I authorize)5.3( )5.6(A)62.6(T)12.6(SS to charge my car)9.3(d for the amount shown abo)15.9(ve)8.6(.)]TJ 0 -1.3333 TD 0.0034 Tc 0.0333 Tw [(R)15.1(eturn this application with fee to: )]TJ /F22 1 Tf 14.3833 0 TD 0.0023 Tc 0.0348 Tw [(A)86(T)11(SS, P)169(.O. Box 246, Phillips, ME 04966 USA)]TJ /F24 1 Tf -14.3833 -1.2233 TD 0.003 Tc 0.0061 Tw (If paying by credit card, this form may be faxed to: )Tj /F22 1 Tf 20.1233 0 TD 0.0031 Tc 0.0111 Tw [( 207-639-2434)]TJ ET 1000 M /GS1 gs 54.495 671.505 109.16 -12.81 re B* BT /TT9 1 Tf 8 0 0 8 55.44 662.76 Tm /Cs9 cs 0 scn -0.0175 Tc -0.0688 Tw [( MEMBERSHIP BENEFITS)]TJ ET 0 0 0 1 k 54.495 155.105 106.91 -12.81 re B* BT 8 0 0 8 61.26 145.65 Tm /Cs9 cs 0 scn 0.0009 Tc -0.0242 Tw [(METHOD OF P)68.4(A)93.1(YMENT)]TJ ET 0 0 0 1 k 54.495 411.905 121.86 -12.81 re B* BT 8 0 0 8 54 402.6 Tm /Cs9 cs 0 scn 0.0008 Tc 0.046 Tw [( MEMBERSHIP )39.6(APPLICA)68.3(TION)]TJ ET endstream endobj 200 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F22 201 0 R /F23 202 0 R /F24 203 0 R /F25 204 0 R /F26 205 0 R /TT3 10 0 R /TT9 206 0 R >> /XObject << /Fm6 207 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> /ColorSpace << /Cs9 24 0 R >> >> endobj 208 0 obj << /FunctionType 4 /Domain [0 1] /Range [0 1 0 1 0 1 0 1] /Length 20 /Filter /FlateDecode >> stream HN)-PZ.( endstream endobj 210 0 obj << /Length 5694 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (215)Tj /TT3 1 Tf 7 0 0 7 123.66 726.66 Tm -0.0061 Tc 0.0201 Tw (International Journal of Emergency Mental Health, Vol. 9, No. 3, pp. 215-224 2008 Chevron Publishing ISSN 1522-4821)Tj /TT4 1 Tf 10 0 0 10 104.01 484.35 Tm -0.0042 Tc 0 Tw (Abstract: )Tj /TT5 1 Tf 3.99 0 TD -0.0036 Tc -0.0017 Tw (Little is known about the impact of Critical Incidents \(CIs\) on the lives of ambulance personnel.)Tj -3.99 -1.299 TD -0.0038 Tc 0.0107 Tw (One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous)Tj 0 -1.302 TD -0.0036 Tc 0.0626 Tw (12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes)Tj 0 -1.299 TD 0.0107 Tw [(toward support services; and explore barriers to service use. The results showed that incidents involving)]TJ T* 0.001 Tc 0.125 Tw [(children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide)]TJ 0 -1.302 TD -0.0036 Tc 0.0825 Tw (range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality)Tj 0 -1.299 TD 0.0003 Tc 0.125 Tw [(and feelings of alienation. Key themes included: low support service uptake due to fears relating to)]TJ T* -0.0038 Tc -0.002 Tw (confidentiality and machismo; a perceived lack of concern and support from management; and a need for)Tj 0 -1.302 TD 0.125 Tw [(professional counselling and stress awareness training. Emergency Medical Controllers \(EMCs\) also)]TJ 0 -1.299 TD -0.0035 Tc 0.1126 Tw (reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a)Tj T* 0.0199 Tc 0.125 Tw (significant impact on health and well-being; this has important implications for recognizing and)Tj 0 -1.302 TD -0.0037 Tc 0.0896 Tw (appropriately addressing the health and training needs of ambulance personnel, including the effective)Tj 0 -1.299 TD -0.0038 Tc 0.0375 Tw (management of Critical Incident Stress. [International Journal of Emergency Mental Health, 2008, 9\(3\),)Tj T* 0.0023 Tc 0.125 Tw (pp. 215-224].)Tj /TT1 1 Tf 9 0 0 9 120.39 276.99 Tm -0.0054 Tc -0.0111 Tw (Key words: )Tj /TT5 1 Tf 5.09 0 TD -0.0052 Tc -0.0135 Tw [(Critical Incident S)28.1(t)5.1(r)34.8(ess, Emer)34.8(gency Medical T)81.5(echnicians, Emer)34.8(g)0.3(ency Medical Contr)34.8(ollers, qualitative)]TJ 10.45 -1.3333 TD -0.005 Tc 0.0778 Tw (research, dispatchers.)Tj ET /GS1 gs 66 136.755 m 303 136.755 l S BT 9 0 0 9 66 119.01 Tm /GS2 gs 0.0938 Tw (Correspondence regarding this article should be sent to: Sharon)Tj 0 -1.2233 TD 0.0175 Tc 0.1253 Tw [(Gallagher)104.2(, Principal Resear)37.5(cher)104.2(, Depar)-5.8(tment of Psychology)50.8(,)]TJ T* -0.0207 Tc -0.0625 Tw (National Univiversity of Ireland at Maynooth, Maynooth, Co. Kildare,)Tj 0 -1.22 TD 0.0053 Tc 0.1255 Tw [(Ir)35.3(eland. T)82(el: +353 87 9369378. Fax: +353 1 7084767. Email:)]TJ 0 -1.2233 TD -0.0025 Tc 0 Tw (sharon.gallagher@nuim.ie)Tj /F1 1 Tf 14 0 0 14 231.51 630.36 Tm -0.0056 Tc 0.1018 Tw [(Living in Critical )95.7(Times:)]TJ -10.7679 -1.1443 TD -0.0023 Tc 0.1377 Tw [(The Impact of Critical Incidents on Fr)17(ontline Amb)14.9(ulance P)23.4(e)4.1(r)6.3(sonnel:)]TJ 10.2857 -1.1421 TD 0.0033 Tc [(A Qualitative P)24.7(e)1.2(r)11.9(spective)]TJ 11 0 0 11 66.99 225 Tm 0 Tw (Background)Tj /TT2 1 Tf 10 0 0 10 84.99 201.66 Tm 0.0029 Tc 0.1253 Tw [(Emer)11.9(gency Medical )15.2(T)67.7(echnicians \(EMT)62.9(s\) and Emer)17.9(-)]TJ -1.8 -1.401 TD -0.0037 Tc -0.06 Tw (gency Medical Controllers \(EMCs; known as )Tj /TT5 1 Tf 17.877 0 TD -0.0042 Tc 0 Tw (dispatchers )Tj /TT2 1 Tf 4.755 0 TD -0.0068 Tc (in)Tj -22.632 -1.401 TD -0.0067 Tc -0.0625 Tw (the United States\) are often exposed to high levels of Critical)Tj 0 -1.398 TD -0.0034 Tc 0.0428 Tw (Incident Stress \(CIS\), which refers to stress arising from a)Tj 0 -1.401 TD -0.007 Tc -0.0622 Tw (disturbing incident \(i.e., a Critical Incident\) that overwhelms)Tj 12 0 0 12 395.91 550.65 Tm -0.0329 Tc -0.0625 Tw (Sinad McGilloway)Tj 10 0 0 10 386.49 537.99 Tm 0.0019 Tc 0.0175 Tw (Department of Psychology)Tj -5.1 -1.2 TD -0.0129 Tw [( National University of Ireland at Maynooth, Ireland)]TJ 12 0 0 12 146.49 550.65 Tm -0.0309 Tc -0.0625 Tw (Sharon Gallagher)Tj 10 0 0 10 108.99 537.99 Tm -0.0032 Tc [( Pre-Hospital Emergency Care Council)]TJ 4.875 -1.2 TD 0.0015 Tc -0.025 Tw [( Naas, Ireland)]TJ 16.326 -30.333 TD -0.0036 Tc 0.0121 Tw [(an individual)53.4(s usual coping abilities \(Alexander and Klein,)]TJ 0 -1.401 TD -0.0038 Tc -0.0036 Tw (2001\). Previous research has shown that ambulance person-)Tj T* -0.0074 Tc -0.0625 Tw (nel are highly vulnerable to the effects of CIS, with up to 20%)Tj 0 -1.398 TD -0.0034 Tc -0.0592 Tw (reporting symptoms of trauma \(Ravenscroft, 1994; Clohessy)Tj 0 -1.401 TD -0.0515 Tw [(and Ehlers, 1999; )14.8(W)97.4(ard et al., 2006\))]TJ /TT1 1 Tf 13.986 0 TD 0 Tc 0 Tw (.)Tj /TT2 1 Tf 0.249 0 TD -0.0037 Tc -0.053 Tw [( )-5.7( )17.3(These, and other health)]TJ -14.235 -1.401 TD -0.0034 Tc 0.0088 Tw (problems described in a recent systematic review \(Sterud et)Tj 0 -1.398 TD -0.0033 Tc 0.0288 Tw (al., 2006\) include physical and mental health \(and somatic\))Tj 0 -1.401 TD -0.0055 Tc -0.0621 Tw [(problems, and higher standardized mortality rates. However)33.5(,)]TJ T* -0.0035 Tc -0.0525 Tw (there is a marked absence of qualitative data and no informa-)Tj 0 -1.398 TD -0.05 Tw [(tion is provided on EMCs. Sterud and colleagues highlight a)]TJ ET endstream endobj 211 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 213 0 obj << /Length 9010 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0875 Tw [(216 )]TJ /TT3 1 Tf 2.7375 0 TD -0.0053 Tc 0.0881 Tw (Gallagher & McGilloway The Impact of Critical Incidents on Frontline Ambulance Personnel)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0031 Tc 0.0505 Tw (need for a psychological perspective in this area as well as)Tj 0 -1.398 TD -0.0036 Tc 0.0164 Tw (more qualitative studies into the subjective experiences and)Tj 0 -1.401 TD -0.0037 Tc -0.0375 Tw (views of ambulance personnel on the effects of work-related)Tj T* 0.0255 Tc 0 Tw (stress.)Tj 1.8 -1.998 TD -0.0033 Tc 0.0355 Tw [(V)112.9(ery little is known about the impact of CIS on ambu-)]TJ -1.8 -1.401 TD -0.0368 Tw [(lance personnel working in Ireland. )50.9(At the time of this study)62.7(,)]TJ T* -0.0034 Tc 0.07 Tw (the Irish health service comprised 8 health boards, each of)Tj 0 -1.398 TD -0.004 Tc -0.0028 Tw [(which had its own ambulance service and Chief )53.3(Ambulance)]TJ 0 -1.401 TD -0.0033 Tc -0.0364 Tw [(O)7.9(f)14.7(ficer)53.7(.)-4.8( )14.8(The current study was carried out in one of Ireland)50.7(s)]TJ T* -0.0042 Tc -0.0623 Tw (largest services, serving a population of 1.6 million within an)Tj 0 -1.398 TD -0.0036 Tc 0.0449 Tw [(average radius of 622 square miles. EMT)65.4(s within the Irish)]TJ 0 -1.401 TD -0.0032 Tc 0.0238 Tw (ambulance service typically work in pairs, while EMCs are)Tj T* -0.0043 Tc -0.0625 Tw (responsible for organizing, reporting, and communicating on)Tj 0 -1.398 TD -0.0037 Tc 0.1221 Tw (ambulance services. The local management of the service)Tj 0 -1.401 TD -0.0041 Tc -0.062 Tw [(remains the duty of )56.1(Ambulance of)19.9(ficers \(usually one in every)]TJ T* -0.0033 Tc -0.0114 Tw (station\) who provide day-to-day middle management to sta-)Tj 0 -1.398 TD -0.0036 Tc 0.0037 Tw (tions throughout the service region under the governance of)Tj 0 -1.401 TD -0.0039 Tc 0.0256 Tw [(a Chief )50.1(Ambulance Of)17.1(ficer)50.1(. )53.1(A)58.3( Critical Incident S)17.1(tress Man-)]TJ T* -0.0046 Tc -0.0622 Tw (agement program, initiated in 1998, involved the distribution)Tj 0 -1.398 TD -0.0042 Tc -0.0625 Tw (of a number of CIS leaflets and posters to all stations with the)Tj 0 -1.401 TD -0.0083 Tc [(aim of raising awareness of CIS. )51.7(A)53.9( Peer Support program was)]TJ T* -0.0088 Tc -0.06 Tw (also initiated whereby)Tj /TT1 1 Tf 8.52 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.18 0 TD (a)Tj /TT1 1 Tf 0.435 0 TD ( )Tj /TT2 1 Tf 0.186 0 TD -0.0103 Tc -0.062 Tw [(Peer Support )13.7(W)93.5(orker \(PSW\) is drawn)]TJ -9.321 -1.398 TD -0.0038 Tc 0.0671 Tw [(from the ranks of one)50.2(s colleagues under the ICISF Model)]TJ 0 -1.401 TD -0.0081 Tc -0.0625 Tw (\(previously known as the Mitchell Model\) of CISM \(Mitchell)Tj T* -0.0064 Tc -0.0623 Tw [(& Everly)59.6(, 2001\). )14.8(The PSW)53.6(s role includes assessing the need)]TJ 0 -1.398 TD -0.0034 Tc -0.01 Tw (for defusing; initiating contact with at risk staff; providing)Tj 0 -1.401 TD -0.0036 Tc -0.0306 Tw (short-term peer counselling; and liasing with other peer sup-)Tj T* -0.0038 Tc 0.09 Tw (port providers.)Tj 1.8 -1.998 TD -0.0032 Tc 0.1069 Tw (The current study forms part of a larger investigation)Tj -1.8 -1.401 TD -0.0049 Tc -0.0623 Tw (into the nature and extent of CIS in a large ambulance service)Tj T* -0.0032 Tc 0.0145 Tw (in Ireland. The first stage of the study involved a documen-)Tj 0 -1.398 TD -0.0275 Tw (tary analysis of current CIS policies and procedures; one-to-)Tj 0 -1.401 TD -0.0033 Tc 0.1042 Tw (one interviews with key service providers \()Tj /TT5 1 Tf 17.76 0 TD -0.006 Tc 0 Tw (n )Tj /TT2 1 Tf 0.849 0 TD -0.0033 Tc 0.105 Tw (= 12\); and a)Tj -18.609 -1.401 TD -0.0032 Tc -0.03 Tw (cross-sectional postal survey \()Tj /TT5 1 Tf 11.895 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0033 Tc -0.0309 Tw [( = 180\). The principal aim of)]TJ -12.39 -1.398 TD -0.0031 Tc 0.0255 Tw (this second stage of the study was to ascertain, using quali-)Tj 0 -1.401 TD -0.0405 Tw (tative methods, the impact of CIs on frontline staff by allow-)Tj T* -0.0033 Tc 0.0985 Tw [(ing them to tell their own stories. These participants also)]TJ 0 -1.398 TD -0.004 Tc -0.0625 Tw (completed a number of self-report measures of overall health)Tj 0 -1.401 TD -0.0032 Tc 0.0875 Tw (and well-being, but only the qualitative data are presented)Tj T* -0.0033 Tc -0.0115 Tw [(here. The specific objectives were to ascertain the nature of)]TJ 0 -1.398 TD -0.0115 Tc -0.0625 Tw [(CIs experienced by EMT)69.5(s and EMCs; to explore the impact of)]TJ 0 -1.401 TD -0.0029 Tc 0.0394 Tw (these on their day-to-day lives; and to assess their attitudes)Tj T* -0.0036 Tc -0.0307 Tw (toward current support services being provided for Irish am-)Tj 0 -1.398 TD 0.0793 Tw (bulance service staff who have experienced difficulties re-)Tj 0 -1.401 TD -0.055 Tw (lated to CIS.)Tj /F1 1 Tf 11 0 0 11 399.39 723.99 Tm 0.0189 Tc 0 Tw (METHODS)Tj -8.2173 -1.4536 TD 0.0003 Tc (Participants)Tj /TT2 1 Tf 10 0 0 10 327 684.66 Tm -0.0033 Tc 0.041 Tw (The results of the Stage One survey showed that 98 of)Tj -1.8 -1.401 TD -0.0075 Tc -0.0622 Tw (112 respondents \(87%\) had experienced one or more CIs dur-)Tj T* -0.0034 Tc 0.0313 Tw [(ing their career)38.6(, approximately two-thirds of whom \(64/98\))]TJ 0 -1.398 TD -0.0081 Tc -0.0619 Tw [(had experienced a CI during the previous year)51.9(. )16.2(T)74.7(wenty-seven)]TJ 0 -1.401 TD -0.0049 Tc -0.0625 Tw [(members \(42%, 27/64\) of this last group \(21 EMT)67.1(s, 6 EMCs\))]TJ T* -0.0036 Tc 0.033 Tw (volunteered to participate in one-to-one interviews.)Tj /F1 1 Tf 11 0 0 11 309 582 Tm -0.0064 Tc 0 Tw (Measures)Tj /TT2 1 Tf 10 0 0 10 327 558.66 Tm -0.0016 Tc 0.125 Tw (An interview schedule was devised on the basis of a)Tj -1.8 -1.401 TD -0.0035 Tc -0.0339 Tw (review of the literature coupled with the Stage One findings.)Tj T* 0.0588 Tw (Questions covered a range of topics including job satisfac-)Tj 0 -1.398 TD -0.0032 Tc -0.0595 Tw (tion; ratings of CI-induced stress; the impact of CI\(s\) on day-)Tj 0 -1.401 TD 0.019 Tc 0.125 Tw (to-day living; support from management; and views of)Tj T* -0.0038 Tc 0.12 Tw [(support services/procedures. Some closed questions were)]TJ 0 -1.398 TD -0.0036 Tc 0.1108 Tw (included to elicit background information and to facilitate)Tj 0 -1.401 TD 0.001 Tc 0.125 Tw (comparisons across participants. The responses to the re-)Tj T* -0.0038 Tc 0.0333 Tw (maining questions were transcribed verbatim and subjected)Tj 0 -1.398 TD -0.0148 Tc -0.0625 Tw (to a thematic analysis \(see Hayes, 2000\) to identify key themes)Tj 0 -1.401 TD -0.0111 Tc (and sub-themes related to interviewees personal experiences.)Tj T* -0.0034 Tc -0.01 Tw [(A random sample of transcripts was read and coded by both)]TJ 0 -1.398 TD -0.0029 Tc -0.0038 Tw [(authors in order in ensure good reliability and validity)60.1(.)]TJ /F1 1 Tf 11 0 0 11 401.64 357.99 Tm 0.0198 Tc 0 Tw [(RESUL)82.5(TS)]TJ /TT2 1 Tf 10 0 0 10 327 334.65 Tm -0.0147 Tc -0.0622 Tw (Participants were all male \(mean age: 42, range 31-60, )Tj /TT5 1 Tf 20.706 0 TD -0.0282 Tc 0 Tw (SD)Tj /TT2 1 Tf -22.506 -1.401 TD -0.0092 Tc -0.0625 Tw (= 8\) and more than half \(15/27\) had more than 16 years expe-)Tj 0 -1.398 TD -0.0032 Tc -0.0419 Tw (rience; the remainder had between 1 and 5 years \(6/27\) or 11)Tj 0 -1.401 TD -0.0033 Tc 0.0413 Tw [(and 15 years \(6/27\) of experience respectively)62.7(.)-8( )17.7(The themes)]TJ T* -0.0034 Tc 0.1243 Tw (and sub-themes identified from the analysis are described)Tj 0 -1.398 TD -0.017 Tc 0 Tw [(below)58(.)]TJ /TT5 1 Tf 11 0 0 11 309 231.36 Tm 0.0028 Tc 0.1253 Tw [(Theme 1: The natur)35.5(e of the Critical Incident\(s\))]TJ 10 0 0 10 327 211.65 Tm -0.0038 Tc 0.0546 Tw [()6.4(T)86.2(aken befor)32.2(e their time)104.2( - pr)32.2(ematur)29.2(e deaths: )]TJ /TT2 1 Tf 18.984 0 TD 0 Tw (Partici-)Tj -20.784 -1.401 TD -0.0031 Tc 0.1168 Tw (pants recounted with great clarity and poignancy some of)Tj 0 -1.398 TD -0.0034 Tc 0.0531 Tw (the most distressing incidents to which they were exposed,)Tj 0 -1.401 TD 0.0293 Tw (most of which revolved around the death/injury of children)Tj T* -0.0014 Tc 0.1251 Tw [(\()6.4(T)64.6(able 1\). )19.7(These included Cot [)]TJ /TT5 1 Tf 13.419 0 TD -0.0043 Tc 0 Tw (Crib)Tj /TT2 1 Tf 1.827 0 TD -0.0012 Tc 0.1243 Tw [(] Deaths, emer)19.8(gency)]TJ -15.246 -1.398 TD -0.0033 Tc -0.055 Tw (childbirth, neonatal resuscitation, and other injuries or fatali-)Tj 0 -1.401 TD -0.0027 Tc 0.1249 Tw [(ties to children. )18.2(T)74.1(wenty interviewees reported the last of)]TJ T* -0.0032 Tc -0.0362 Tw (these to be particularly stressful, while 11 participants found)Tj 0 -1.398 TD -0.0033 Tc 0.0875 Tw (Cot Deaths to be particularly harrowing, not least because)Tj 0 -1.401 TD -0.0039 Tc -0.0614 Tw (they also had to deal with traumatized parents)Tj /TT5 1 Tf 17.751 0 TD 0.001 Tc 0 Tw (. )Tj /TT2 1 Tf 0.438 0 TD -0.0062 Tc -0.065 Tw (Another EMT)Tj ET endstream endobj 214 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 216 0 obj << /Length 10308 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (217)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0036 Tc 0.0795 Tw (spoke at length about an incident during which he was re-)Tj 0 -1.398 TD -0.004 Tc -0.0625 Tw [(quired to carry out a lengthy resuscitation of a newborn baby)59(.)]TJ 0 -1.401 TD -0.0037 Tc 0.1135 Tw [(He recalled the mother)-36.7()53.3(s)0( trauma and afterwards described)]TJ T* -0.0091 Tc 0 Tw (how)Tj /TT5 1 Tf 1.704 0 TD 0 Tc ( )Tj /TT2 1 Tf 0.201 0 TD -0.0078 Tc (he)Tj /TT5 1 Tf 0.936 0 TD 0 Tc ( )Tj /TT2 1 Tf 0.198 0 TD -0.0036 Tc -0.0507 Tw (was having nightmares about it. Every time I saw)Tj -3.039 -1.398 TD -0.0029 Tc -0.0225 Tw [(a baby)60.1(, I was getting shivers down my spine.)]TJ /TT5 1 Tf 18.069 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.231 0 TD -0.0046 Tc -0.025 Tw (All six EMCs)Tj -18.3 -1.401 TD -0.0035 Tc 0.0183 Tw (also reported high levels of stress when taking calls involv-)Tj T* -0.0039 Tc -0.0625 Tw (ing children and in providing reassurance to traumatized par-)Tj 0 -1.398 TD -0.0031 Tc -0.025 Tw [(ents. Many of the interviewees also spoke about identifying)]TJ 0 -1.401 TD 0.1208 Tw (with the victim either as a parent or as an individual at a)Tj T* -0.0033 Tc -0.0562 Tw [(similar stage of his/her life.)]TJ 1.8 -1.998 TD -0.0035 Tc -0.0356 Tw (Eight of the participants reported suicide incidents to be)Tj -1.8 -1.401 TD -0.0034 Tc -0.025 Tw (the most traumatic due in large part to overriding feelings of)Tj T* 0.0002 Tc 0.125 Tw (helplessness, and the trauma and tragedy for the families)Tj 0 -1.398 TD -0.021 Tc -0.0624 Tw [(involved. For example, one 38-year-old EMT described a death)]TJ 0 -1.401 TD -0.0033 Tc -0.0265 Tw (by suicide on a train track and his overwhelming distress for)Tj T* -0.0032 Tc 0.0593 Tw [(the family)59.8(. He also reported that he had experienced a dis-)]TJ 0 -1.398 TD -0.0034 Tc -0.0306 Tw (turbing flashback to that incident after returning to the scene)Tj 0 -1.401 TD -0.003 Tc -0.0273 Tw [(recently)60(. Like many of his counterparts, he reported consid-)]TJ T* -0.0032 Tc 0.0167 Tw [(erable distress in dealing with the body)59.8(.)]TJ /TT5 1 Tf 1.8 -1.998 TD -0.0001 Tc 0.125 Tw (Serious and grotesque mutilation: )Tj /TT2 1 Tf 14.385 0 TD 0.0002 Tc (Ireland has a high)Tj -16.185 -1.401 TD -0.0057 Tc -0.062 Tw [(\(per capita\) number of Road )18.5(T)35.1(raf)15.3(fic )48.5(Accidents \(R)57.3(T)80.1(As\) - espe-)]TJ T* -0.0031 Tc 0.0215 Tw (cially among young males - and it is perhaps not surprising)Tj 0 -1.398 TD -0.0034 Tc 0.041 Tw (that 17 of the interviewees found road and rail accidents to)Tj 0 -1.401 TD -0.0033 Tc -0.0257 Tw (be extremely distressing. Other CIs included cardiac arrests,)Tj T* -0.0031 Tc -0.0536 Tw (fire fatalities, murders, physical abuse, and accidents involv-)Tj 0 -1.398 TD -0.0034 Tc 0.0105 Tw [(ing the ambulance. )50.6(A)58.8( selection of illustrative quotes is pro-)]TJ 0 -1.401 TD -0.0036 Tc 0.002 Tw [(vided in )14.4(T)73.2(ables 1 through 6.)]TJ /TT3 1 Tf 10.089 -3.765 TD -0.0055 Tc -0.05 Tw (Table 1.)Tj /F1 1 Tf -4.425 -1.2 TD -0.0683 Tw (Nature of Critical Incidents)Tj /F8 1 Tf 10 0 2.1256 10 78 264.99 Tm -0.0047 Tc 0.008 Tw (I can honestly say they )Tj /TT3 1 Tf 10 0 0 10 185.1 264.99 Tm -0.005 Tc 0.0075 Tw ([Cot deaths] )Tj /F8 1 Tf 10 0 2.1256 10 241.35 264.99 Tm -0.0055 Tc 0.01 Tw (are the)Tj -16.0799 -1.2 TD -0.0052 Tc 0 Tw [(w)11.8(o)0.1(rst )]TJ /TT3 1 Tf 10 0 0 10 104.04 252.99 Tm -0.0048 Tc -0.03 Tw ([interviewee gets upset])Tj /F8 1 Tf 10 0 2.1256 10 207.39 252.99 Tm -0.005 Tc -0.0305 Tw [(...there)43(s nothing)]TJ -12.6839 -1.2 TD -0.0048 Tc -0.0494 Tw (worse than carrying a dead infant. 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I just had to walk away)]TJ -9.7199 -1.2 TD -0.0052 Tc 0.0072 Tw [(otherwise I)45.8(d ha)12.8(v)26.8(e)1( cra)6.8(c)15.8(k)17.8(ed up o)9.8(v)26.8(er it.)93.8()]TJ /TT3 1 Tf 10 0 0 10 333 633 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 336.3 633 Tm -0.0053 Tc -0.0432 Tw [(There w)6.7(ere two f)24.7(ellas b)15.7(u)4.7(r)-32.3(ned to death in a car)45.7(.)]TJ -0.0749 -1.2 TD -0.0055 Tc -0.002 Tw [(That w)9.5(as last y)12.5(ear sometime)12.5(.)56.5( )45.7(The)12.5(y w)6.5(ere in their)]TJ 0.2551 -1.2 TD -0.0052 Tc -0.0019 Tw [(mid-tw)6.8(enties)9.8(.)56.8( It w)9.8(as the undignified w)6.8(a)31.8(y)98.8(,)-0.1( the con-)]TJ 0.2551 -1.2 TD -0.0056 Tc 0.0007 Tw [(dition of the bo)24.4(ys)9.4(, y)12.4(ou kno)9.4(w)62.4(.)56.4( )48.1(That w)9.4(as near)-20.6(ly a)]TJ 0.2551 -1.2 TD -0.0045 Tc 0.0106 Tw (year ago but it sticks out in your mind.)Tj /TT3 1 Tf 10 0 0 10 499.95 585 Tm 0 Tc 0 Tw ()Tj -16.695 -2.4 TD -0.0043 Tc -0.0025 Tw ([It was] )Tj /F8 1 Tf 10 0 2.1256 10 370.35 561 Tm -0.0054 Tc -0.0055 Tw [(something lik)12.6(e y)15.6(ou would see in )54.1(Night-)]TJ -3.4799 -1.2 TD -0.0057 Tc -0.0141 Tw [(mare on Elm Street.)93.3()66.3( )48.2(There w)9.3(as that much b)15.3(lood)]TJ 0.2551 -1.2 TD -0.0053 Tc -0.0051 Tw [(all o)9.7(v)23.7(er the w)9.7(alls)9.7(.)56.7( )48.6(The w)6.7(oman w)6.7(as killed that)]TJ 0.2551 -1.2 TD -0.0047 Tc 0.02 Tw (stuck in my mind alright)Tj /TT3 1 Tf 10 0 0 10 437.19 525 Tm -0.0048 Tc 0 Tw (.)Tj -10.419 -2.4 TD -0.0038 Tc (...)Tj /F8 1 Tf 10 0 2.1256 10 344.55 501 Tm -0.0049 Tc -0.0022 Tw (that knocked the wind out of me )Tj /TT3 1 Tf 10 0 0 10 486.84 501 Tm -0.0025 Tw ([15 year old)Tj -15.384 -1.2 TD -0.0045 Tc 0.015 Tw (fatality in RTA])Tj /F8 1 Tf 10 0 2.1256 10 397.65 489 Tm -0.0047 Tc 0.0151 Tw [(...afterw)10.3(ards that night, par)-46.7(ticu-)]TJ -6.2099 -1.2 TD 0.0041 Tw [(lar)-19.7(ly when y)16.3(ou)43.3(re lying in bed, it just flashes bac)16.3(k)]TJ 0.2551 -1.2 TD -0.005 Tc -0.0033 Tw (to you because I might have been looking at my)Tj 0.2551 -1.2 TD -0.0047 Tc -0.0287 Tw (own son lying there on the stretcher with blood)Tj 0.2551 -1.2 TD -0.0027 Tw (everywhere...that one had an effect. It took a lot)Tj 0.2551 -1.2 TD -0.0054 Tc 0.0175 Tw [(out of me)9.6(.)98.6()]TJ /TT3 1 Tf 10 0 0 10 333 405 Tm -0.0038 Tc 0 Tw (...)Tj /F8 1 Tf 10 0 2.1256 10 344.55 405 Tm -0.0046 Tc -0.0072 Tw (a young child was murdered. I lost a lot of)Tj -0.8999 -1.2 TD -0.0044 Tc -0.0024 Tw [(sleep after it and I still remember the f)25.6(ather)46.6(s)]TJ 0.2551 -1.2 TD -0.0048 Tc -0.0222 Tw (words on the phone...I hated coming to work for a)Tj 0.2551 -1.2 TD -0.0058 Tc 0.042 Tw [(while)9.2(.)59.2( It shak)15.2(es y)12.2(ou.)93.2()]TJ /TT5 1 Tf 11 0 0 11 321 320.34 Tm 0.0014 Tc 0.1253 Tw (Theme 2: The Impact of the Critical Incident\(s\))Tj 10 0 0 10 339 300.66 Tm -0.0036 Tc 0.0657 Tw [(S)37.4(t)3.4(r)29.4(ess and coping - the psychological impact: )]TJ /TT2 1 Tf 19.065 0 TD -0.004 Tc 0.015 Tw [( A)58.2( )-55(sec-)]TJ -20.865 -1.401 TD -0.0033 Tc 0.0044 Tw (ond key theme explored during the interviews related to the)Tj T* -0.0036 Tc 0.1207 Tw (perceived negative impact of a CI\(s\) on the interviewees)Tj 0 -1.398 TD -0.016 Tc -0.0625 Tw [(lives. Eighty percent of the CIs were rated as extremely stress-)]TJ 0 -1.401 TD -0.0032 Tc 0.0742 Tw [(ful)71.8( with symptoms lasting up to 8 months. )17.9(T)73.6(wo key sub-)]TJ T* 0.0593 Tc 0.1471 Tw (themes were explored here, relating mainly to the)Tj 0 -1.398 TD -0.0033 Tc 0.0336 Tw (psychological/emotional impact of the CI\(s\), but also relat-)Tj 0 -1.401 TD -0.0028 Tc 0.071 Tw (ing to effects on physical health and overall quality of life)Tj T* -0.0036 Tc -0.0599 Tw [(\(see T)70.2(able )-17.8(2\).)]TJ 1.8 -1.998 TD 0.0014 Tc 0.1117 Tw (The most common psychological effects reported in-)Tj -1.8 -1.401 TD 0.0015 Tc 0.1133 Tw (cluded angry outbursts, sleep problems, recurring dreams)Tj T* 0.0013 Tc -0.0564 Tw (and nightmares, an increase in alcohol consumption, feeling)Tj 0 -1.398 TD 0.002 Tc -0.03 Tw (alienated from other people, and an inability to relax. Many)Tj 0 -1.401 TD 0.0014 Tc 0.0542 Tw [(also described feelings of despondency)61.4(, intrusive thoughts)]TJ T* 0.0015 Tc -0.0395 Tw (of the incidents, and flashbacks, while some others said that)Tj 0 -1.398 TD 0.0017 Tc 0.0525 Tw (they had become irrational, and over-protective due to the)Tj 0 -1.401 TD 0.0045 Tw (high levels of stress they encountered in the course of their)Tj ET 0.99 w 1000 M /GS1 gs 66.495 326.505 236.01 -255.01 re 322.995 730.005 236.01 -375.51 re S endstream endobj 217 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 29 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 220 0 obj << /Length 9741 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0875 Tw [(218 )]TJ /TT3 1 Tf 2.7375 0 TD -0.0053 Tc 0.0881 Tw (Gallagher & McGilloway The Impact of Critical Incidents on Frontline Ambulance Personnel)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm 0.0018 Tc -0.0075 Tw [(work \(T)67.8(able 2\). )13.8(The delayed psychological impact of many)]TJ 0 -1.398 TD 0.0016 Tc 0.0377 Tw [(of these incidents was also commonly reported. Four par-)]TJ 0 -1.401 TD 0.0035 Tc 0.125 Tw (ticipants also reported having taken long-term sick leave)Tj T* 0.002 Tc 0.1193 Tw (during the previous year due to job-related stress, saying)Tj 0 -1.398 TD 0.0022 Tc 0.0322 Tw [(that they felt continuously tired, fatigued, and/or moody)62.2(.)]TJ 1.8 -2.001 TD 0.0013 Tc 0.0922 Tw (Interviewees also alluded to the cumulative nature of)Tj -1.8 -1.401 TD 0.0015 Tc 0.0139 Tw (CIS, which appeared, in some cases, to be compounded by)Tj 0 -1.398 TD -0.0009 Tc -0.0621 Tw (interpersonal conflicts at work and personal problems which)Tj 0 -1.401 TD 0.0012 Tc -0.0312 Tw (left them unable to cope. Furthermore, the common percep-)Tj T* -0.0035 Tw (tion that EMCs are not exposed to stress was not supported)Tj 0 -1.398 TD 0.0017 Tc -0.044 Tw [(by the, albeit smaller)34.7(, number of EMCs included here, all of)]TJ 0 -1.401 TD -0.0006 Tc -0.0622 Tw (whom referred to the stress they had experienced when deal-)Tj T* 0.0016 Tc 0.0373 Tw [(ing with CIs. Only five interviewees reported no negative)]TJ 0 -1.398 TD 0.0014 Tc 0.0789 Tw (effects on their mental health and an examination of their)Tj 0 -1.401 TD -0.0034 Tc -0.0625 Tw (responses revealed a recurring, underlying machismo, which)Tj T* -0.0027 Tc -0.0623 Tw (set them apart from the remainder of the group. Only three of)Tj 0 -1.398 TD 0.0012 Tc 0.0079 Tw (the interviewees sought help from a professional counselor)Tj 0 -1.401 TD 0.0022 Tc 0.0775 Tw (or a psychologist.)Tj /TT3 1 Tf 10.239 -4.026 TD -0.0055 Tc -0.05 Tw (Table 2.)Tj /F1 1 Tf -4.239 -1.2 TD -0.0048 Tc -0.0333 Tw (Impact of Critical Incident)Tj -4.8 -2.598 TD -0.0064 Tc -0.0674 Tw (Stress and Coping:)Tj /TT3 1 Tf 0 -1.137 TD 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 69.3 389.04 Tm -0.0045 Tc -0.0194 Tw (I had sleep problems, I couldnt eat- lost weight.)Tj -0.0966 -1.098 TD -0.0047 Tc -0.0072 Tw (I smoked more. - I wouldnt go to bed...I was)Tj 0.234 -1.101 TD -0.0117 Tw [(w)18.4(alking the house all night...I)43.4(d go to bed in the)]TJ 0.234 -1.101 TD -0.0307 Tc -0.025 Tw (middle of the day forgetting thingspure and utter)Tj 0.2474 -1.164 TD 0.0117 Tc 0 Tw [(stress)11.7(...)98.7()]TJ 0.5388 -2.535 TD -0.0047 Tc -0.0175 Tw (I was very nervous and agitated for weeks after)Tj 0.234 -1.101 TD -0.0045 Tc 0.01 Tw (this...I woke up several times in a lather of sweat)Tj 0.2474 -1.164 TD -0.0051 Tc 0.0159 Tw [(thinking that I or m)9.9(y)-1.8( f)24.9(amily would be shot.)93.9()]TJ /TT3 1 Tf 10 0 0 10 66 273.06 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 69.3 273.06 Tm -0.0049 Tc -0.0393 Tw (I nearly had a complete breakdown that night)Tj -0.096 -1.101 TD -0.0045 Tc 0.01 Tw (when I got home...I drank a full bottle of Jack)Tj 0.2474 -1.164 TD -0.005 Tc 0.005 Tw (Daniels [)Tj /TT3 1 Tf 10 0 0 10 104.55 250.41 Tm -0.0063 Tc 0 Tw (whiskey)Tj /F8 1 Tf 10 0 2.1256 10 139.74 250.41 Tm -0.0045 Tc 0.0062 Tw (]...I couldnt take any more)Tj /TT3 1 Tf 10 0 0 10 256.05 250.41 Tm -0.013 Tc 0 Tw ()Tj -19.005 -2.337 TD 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 69.3 227.04 Tm -0.005 Tc -0.002 Tw [(Bef)25(ore I came into this job)34(, I w)10(anted to help)]TJ -0.0966 -1.098 TD -0.0048 Tc -0.0289 Tw (people and save lives and I probably did on nu-)Tj 0.234 -1.101 TD -0.0022 Tw (merous occasions but it doesnt matter any more,)Tj 0.2474 -1.164 TD -0.0044 Tc 0.0383 Tw [(it just doesnt matter)46.6(...)94.6()]TJ 0.4967 -2.337 TD -0.012 Tw [()5.5(Y)136.5(ou become irrational I think really)94.5(, slightly irra)5.5(-)]TJ 0.2334 -1.098 TD -0.0017 Tw (tional and over protective, the way I drive with my)Tj 0.234 -1.101 TD -0.0048 Tc 0.0076 Tw [(wif)25.2(e and kids in the car)43.2(.)57.2( If the kids go out on the)]TJ 0.234 -1.101 TD -0.0051 Tc -0.0261 Tw [(bik)15.9(e without a helmet y)12.9(ou)45.9(re r)-20.1(unning the streets)]TJ 0.2334 -1.098 TD -0.0044 Tc 0.015 Tw (trying to find them...They cant climb walls or)Tj 0.234 -1.101 TD -0.0046 Tc 0.0085 Tw (trees, they cant go out on the roads...Every)Tj 0.234 -1.101 TD -0.0183 Tw (headache is a brain tumour all that kind of thing)Tj 0.2474 -1.164 TD -0.0064 Tc -0.015 Tw [(y)19.6(ou kno)8.6(w)58.6(.)97.6()]TJ /F1 1 Tf 10 0 0 10 321 719.49 Tm -0.0047 Tc -0.0292 Tw (Physical Health and overall quality of life:)Tj /TT3 1 Tf 0 -1.2 TD 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 324.3 707.49 Tm -0.0049 Tc -0.0142 Tw [(Since I joined this job)34.1(, I de)25.1(v)24.1(eloped diabetes)10.1(.)]TJ -0.0749 -1.2 TD -0.0077 Tw [(Because of the nature of the job)34.1(, I w)10.1(asnt eating)]TJ 0.2551 -1.2 TD -0.0053 Tc -0.0538 Tw [(proper)-20.3(ly)93.7(.)56.7( I had no proper lunch breaks theref)24.7(ore)]TJ 0.2551 -1.2 TD -0.0054 Tc -0.0289 Tw [(the diabetes got worse and that)42.6(s ho)9.6(w I ended up)]TJ 0.2551 -1.2 TD -0.0289 Tc 0.008 Tw (being out sick for 14 weeks)Tj /TT3 1 Tf 10 0 0 10 444.21 659.49 Tm -0.0048 Tc 0 Tw (..)Tj -12.321 -2.4 TD -0.0038 Tc (...)Tj /F8 1 Tf 10 0 2.1256 10 332.55 635.49 Tm -0.0046 Tc (if I have a bad day in work and I arrive home, I)Tj -0.8999 -1.2 TD -0.0051 Tc -0.0327 Tw [(w)11.9(ouldnt be the w)6.9(elcoming husband.)51.9( I)45.9(d be lik)12.9(e)]TJ 0.2551 -1.2 TD -0.0047 Tc 0.0013 Tw (thunder some days..I dont want to talk to any-)Tj 0.2551 -1.2 TD -0.0045 Tc -0.0071 Tw (one.. I just want to be left alone)Tj /TT3 1 Tf 10 0 0 10 457.44 599.49 Tm -0.0048 Tc 0 Tw (.)Tj -13.644 -2.4 TD 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 324.3 575.49 Tm -0.0048 Tc -0.0359 Tw [(Y)143.2(ou cant relie)25.2(v)24.2(e)0.1( the adrenaline that)46.2(s b)13.2(uilding up)]TJ -0.0749 -1.2 TD 0.0067 Tw [(on the job)34.1(...it)43.1(s going to mak)16.1(e y)16.1(ou ill)]TJ /TT3 1 Tf 10 0 0 10 476.94 563.49 Tm 0 Tw (.)Tj /F1 1 Tf -15.594 -2.4 TD -0.0099 Tc -0.07 Tw (Machismo attitude)Tj /TT3 1 Tf 0 -1.2 TD 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 324.3 527.49 Tm -0.0047 Tc -0.0133 Tw [(Y)143.3(o)1(u lear)-31.7(n to deal with it, y)16.3(ou lear)-31.7(n to accept it.)]TJ -0.0749 -1.2 TD -0.005 Tc -0.0008 Tw [(It)46(s a job that y)13(ou either w)10(a)-0.1(nt to do or y)13(ou dont)]TJ 0.2551 -1.2 TD -0.0047 Tc 0.0365 Tw [(w)18.3(ant to do)34.3(...It)46.3(s lik)13.3(e a v)22.3(ocation...y)13.3(ou cant just go)]TJ 0.2551 -1.2 TD -0.0085 Tw (in and just go through your day as if nothing is)Tj 0.2551 -1.2 TD -0.0044 Tc 0.0137 Tw [(wrong...That)46.6(s not the type of job it is)10.6(.)99.6()]TJ /TT3 1 Tf 10 0 0 10 321 455.49 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 324.3 455.49 Tm -0.007 Tc (It)Tj /TT3 1 Tf 10 0 0 10 329.79 455.49 Tm -0.005 Tc 0.014 Tw [( [working as an EMT] )]TJ /F8 1 Tf 10 0 2.1256 10 426.21 455.49 Tm -0.0052 Tc 0.015 Tw (has not affected my)Tj -10.2659 -1.2 TD -0.0047 Tc -0.0067 Tw (health...It makes you more confident going into)Tj 0.2551 -1.2 TD -0.0467 Tw [(situations dealing with people)10.3(.)99.3()]TJ /TT3 1 Tf 10 0 0 10 321 407.49 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 324.3 407.49 Tm -0.0045 Tc 0.035 Tw (If it does affect them )Tj /TT3 1 Tf 10 0 0 10 417.9 407.49 Tm -0.0053 Tc ([other EMTs])Tj /F8 1 Tf 10 0 2.1256 10 474.9 407.49 Tm 0.04 Tw (, they)Tj -15.1349 -1.2 TD -0.0046 Tc -0.035 Tw [(shouldnt be in the job)37.4(.)]TJ /TT3 1 Tf 10 0 0 10 418.2 395.49 Tm 0 Tc 0 Tw ()Tj /TT5 1 Tf -9.12 -3.933 TD -0.0034 Tc 0.0644 Tw [(Physical health and overall quality of life: )]TJ /TT1 1 Tf 17.805 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.315 0 TD -0.0049 Tc 0.065 Tw (The most)Tj -19.92 -1.401 TD -0.0116 Tc -0.0625 Tw (commonly reported effects of CIS on physical health included)Tj T* -0.0032 Tc 0.0311 Tw (weight gain, back problems, and lack of appetite. Many re-)Tj 0 -1.398 TD -0.0035 Tc 0.0061 Tw (spondents reported that it was difficult for them to maintain)Tj 0 -1.401 TD -0.0029 Tc 0.125 Tw (or improve their general levels of fitness because of shift)Tj T* -0.0033 Tc 0.1067 Tw (work and the lack of on-site exercise facilities. Others re-)Tj 0 -1.398 TD -0.0035 Tc 0.0519 Tw (ported smoking-related illnesses due to an increase in their)Tj 0 -1.401 TD -0.0042 Tc 0.025 Tw (smoking habits.)Tj 1.8 -2.001 TD -0.0032 Tc 0.11 Tw [(A sub-theme emerged, related to the effect on family)]TJ -1.8 -1.398 TD -0.0131 Tc -0.0622 Tw (relationships. Over half of the interviewees \(14/27\) mentioned)Tj 0 -1.401 TD 0.0007 Tc 0.125 Tw (that their personal relationships and their home lives had)Tj T* -0.0038 Tc -0.0625 Tw [(been negatively af)17.2(fected due to work-related stress \(T)65.2(able 2\).)]TJ 0 -1.398 TD -0.0116 Tc -0.0622 Tw (Some reported having angry outbursts at home after a stress-)Tj 0 -1.401 TD -0.003 Tc 0.0262 Tw [(ful day)63(, or not being able to talk to their partners about dis-)]TJ T* -0.0036 Tc 0.0578 Tw [(tressing incidents. The long working hours and shift work)]TJ 0 -1.398 TD -0.0031 Tc -0.0465 Tw [(also reduced the amount of time they spent with their family)59.9(.)]TJ /TT5 1 Tf 11 0 0 11 309 106.86 Tm 0.0106 Tc 0.1253 Tw [(Theme 3: Or)35.1(ganizational hassles)]TJ /TT2 1 Tf 10 0 0 10 327 87.15 Tm -0.0034 Tc 0.1019 Tw (A third theme related to the participants attitudes to-)Tj -1.8 -1.401 TD -0.0078 Tc -0.0625 Tw [(ward and views of the general management of the ambulance)]TJ ET 0.99 w 1000 M /GS1 gs 55.495 452.005 238.01 -392.51 re 310.495 731.505 236.01 -351.01 re S endstream endobj 221 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 29 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 223 0 obj << /Length 9938 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (219)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0034 Tc 0.1121 Tw (service. These were predominantly negative in nature and)Tj 0 -1.398 TD -0.0039 Tc 0.0525 Tw (revolved around several emergent sub-themes.)Tj /TT5 1 Tf 1.8 -2.001 TD -0.0036 Tc 0.0134 Tw (Interpersonal conflict: )Tj /TT1 1 Tf 9.48 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.264 0 TD -0.0037 Tc 0.015 Tw [(T)70.1(en respondents alluded to the)]TJ -11.544 -1.401 TD -0.0034 Tc 0.0363 Tw [(amount and nature of interpersonal conflict and bullying in)]TJ 0 -1.398 TD -0.0015 Tc 0.125 Tw (individual stations which appeared to add significantly to)Tj 0 -1.401 TD -0.0124 Tc -0.0625 Tw [(their overall stress levels \(T)68.6(able 3\). For example, one 53-year)17.6(-)]TJ T* -0.0042 Tc -0.0623 Tw (old EMT found that he had more difficulty in coping with the)Tj 0 -1.398 TD -0.0034 Tc -0.0329 Tw (stress he encountered in the station than )Tj /TT5 1 Tf 16.149 0 TD -0.0041 Tc -0.035 Tw (on the road)Tj /TT2 1 Tf 4.5 0 TD -0.0034 Tc (. Other)Tj -20.649 -1.401 TD -0.0032 Tc 0.0694 Tw [(E)6.7(M)6.7(T)68.8(s spoke of how they did not mind )]TJ /TT5 1 Tf 16.086 0 TD -0.0038 Tc 0.07 Tw (doing the job)Tj /TT2 1 Tf 6.03 0 TD -0.0046 Tc [( but)]TJ -22.116 -1.401 TD -0.0034 Tc -0.0525 Tw (referred to )Tj /TT5 1 Tf 4.629 0 TD -0.0036 Tc (issues in the base and their colleagues)Tj /TT2 1 Tf 15.267 0 TD -0.0037 Tc [( that were)]TJ -19.896 -1.398 TD -0.0036 Tc 0.0687 Tw (a major source of concern, such as unprofessional conduct)Tj 0 -1.401 TD -0.0027 Tc 0.125 Tw [(which was not appropriately managed. )51.3(All but one of the)]TJ T* -0.0037 Tc -0.0237 Tw [(EMCs \(5/6\) also indicated that EMT)65.3(s regularly abused them)]TJ 0 -1.398 TD -0.0035 Tc -0.006 Tw (on the radio when receiving calls.)Tj /TT3 1 Tf 10.239 -5.265 TD -0.0055 Tc -0.05 Tw (Table 3.)Tj /F1 1 Tf -3.6 -1.2 TD -0.01 Tc -0.0699 Tw (Organizational Hassles)Tj -5.439 -3.201 TD -0.0113 Tc -0.07 Tw (Interpersonal Conflict:)Tj /TT3 1 Tf 0 -1.2 TD -0.0038 Tc 0 Tw (...)Tj /F8 1 Tf 10 0 2.1256 10 89.55 426 Tm -0.006 Tc (they )Tj /TT3 1 Tf 10 0 0 10 111.09 426 Tm -0.0051 Tc 0.015 Tw ([fellow EMTs])Tj /F8 1 Tf 10 0 2.1256 10 170.64 426 Tm -0.0046 Tc 0.0125 Tw [( actually took the rubber)]TJ -9.0089 -1.2 TD 0.005 Tw (protection off the ear pieces of my stethoscope)Tj 0.2551 -1.2 TD -0.0048 Tc -0.0017 Tw (and glued the tops of medication bottles that I)Tj 0.2551 -1.2 TD -0.0054 Tc -0.0413 Tw (had in my equipment bag)Tj /TT3 1 Tf 10 0 0 10 187.44 390 Tm -0.0048 Tc 0 Tw (.)Tj -10.944 -2.4 TD -0.0038 Tc (...)Tj /F8 1 Tf 10 0 2.1256 10 89.55 366 Tm -0.007 Tc (she )Tj /TT3 1 Tf 10 0 0 10 108.39 366 Tm -0.005 Tc 0.02 Tw ([fellow EMT])Tj /F8 1 Tf 10 0 2.1256 10 163.05 366 Tm -0.0051 Tc 0.018 Tw [( star)-47.1(ted screaming at me to)]TJ -8.2499 -1.2 TD -0.0185 Tc 0.0025 Tw (go back to the station... I knew we couldntshe)Tj 0.2551 -1.2 TD -0.0048 Tc 0.0063 Tw [(star)-43.8(ted screaming at me again, so loud lik)16.2(e it)]TJ 0.2551 -1.2 TD -0.0294 Tw (was unbearable... I had to get out of the ambu-)Tj 0.2551 -1.2 TD 0.0348 Tw [(lance)10.2(.)57.2( I couldnt stic)13.2(k it an)13.2(y longer)43.2(.)60.2( I f)25.2(elt v)19.2(e)5.2(r)-34.8(y)]TJ 0.2551 -1.2 TD -0.0047 Tc 0.0125 Tw (stressed after that)Tj /TT3 1 Tf 10 0 0 10 157.44 306 Tm -0.0048 Tc 0 Tw (.)Tj -7.944 -2.4 TD 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 81.3 282 Tm -0.0052 Tc -0.0079 Tw (EMTs have messed me over the airways too)Tj -0.0749 -1.2 TD -0.0057 Tc 0.0115 Tw [(man)9.3(y times)9.3(...the)12.3(y question e)27.3(v)23.3(er)-35.7(ything I do)33.3(.)]TJ 0.2551 -1.2 TD -0.0055 Tc 0.0017 Tw [(The)12.5(y)45.5(re shouting bac)12.5(k at y)15.5(ou o)9.5(v)26.5(er the airw)9.5(a)31.5(ys -)]TJ 0.2551 -1.2 TD -0.0057 Tc 0.0093 Tw [(the)12.3(y tr)-32.7(y and put y)15.3(o)1.1(u do)6.3(w)34.9(n)34.9( )]TJ 11.5293 0 TD -0.0406 Tc 0.009 Tw [(all the timeit)10.4(s)-35.3( )-35.3(a)-35.3( )]TJ 7.5245 0 TD -0.0053 Tc 0 Tw (case)Tj -18.7988 -1.2 TD -0.0054 Tc 0.0475 Tw (of us )Tj /TT3 1 Tf 10 0 0 10 103.14 234 Tm -0.0064 Tc 0 Tw ([EMCs])Tj /F8 1 Tf 10 0 2.1256 10 135.6 234 Tm -0.0057 Tc 0.05 Tw [( and them )]TJ /TT3 1 Tf 10 0 0 10 183.84 234 Tm -0.0063 Tc 0 Tw ([EMTs])Tj /F8 1 Tf 10 0 2.1256 10 215.19 234 Tm -0.0045 Tc [(...)94.5()]TJ /TT3 1 Tf 10 0 0 10 78 201.99 Tm 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 81.3 201.99 Tm -0.0047 Tc (All they)Tj /TT3 1 Tf 10 0 0 10 113.76 201.99 Tm -0.005 Tc 0.0044 Tw ( [EMCs] )Tj /F8 1 Tf 10 0 2.1256 10 151.8 201.99 Tm -0.0047 Tc (want to do at the end of their)Tj -7.1249 -1.2 TD -0.0044 Tc 0.0255 Tw (shift is to make sure that theyve left a clean)Tj 0.2551 -1.2 TD -0.0048 Tc -0.0118 Tw (screen and they dont care who pays for it)Tj /TT3 1 Tf 10 0 0 10 260.19 177.99 Tm 0 Tw (.)Tj /F1 1 Tf -18.219 -3.6 TD -0.0062 Tc -0.0687 Tw (Lack of concern from Management:)Tj /TT3 1 Tf 0 -1.2 TD 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 81.3 129.99 Tm -0.0057 Tc -0.0564 Tw [(Y)142.3(ou)42.3(re only a number)45.3(.)56.3( )92.9(Y)139.3(ou)45.3(re counted in pounds)9.3(,)]TJ -0.0749 -1.2 TD -0.0046 Tc -0.005 Tw (shillings and pence...they [)Tj /TT3 1 Tf 10 0 0 10 194.46 117.99 Tm -0.0085 Tc 0 Tw (mgt)Tj /F8 1 Tf 10 0 2.1256 10 210.96 117.99 Tm -0.0055 Tc -0.005 Tw (] never come and)Tj -13.0409 -1.2 TD -0.0283 Tw (ask how you are)Tj /TT3 1 Tf 10 0 0 10 149.19 105.99 Tm -0.0048 Tc 0 Tw (.)Tj /F8 1 Tf 10 0 2.1256 10 333 714 Tm -0.0456 Tw (We are heroes to the public when we arrive on)Tj 0.2551 -1.2 TD -0.0054 Tc -0.0165 Tw [(scene b)15.6(ut we are only tools to management.)93.6()]TJ /TT3 1 Tf 10 0 0 10 333 678 Tm -0.0038 Tc 0 Tw (...)Tj /F8 1 Tf 10 0 2.1256 10 344.55 678 Tm -0.0049 Tc 0.0286 Tw [(if the)16.1(y think y)13.1(ou)46.1(re suff)25.1(e)5.1(r)-19.9(ing from stress)10.1(, then)]TJ -0.8999 -1.2 TD 0.0014 Tw [(the)13(y think y)16(ou shouldnt be doing the job)34(.)60( If y)16(o)6(u)]TJ 0.2551 -1.2 TD -0.0045 Tc -0.0025 Tw (cant handle it, get out!)Tj /TT3 1 Tf 10 0 0 10 432.45 654 Tm 0 Tc 0 Tw ()Tj /TT5 1 Tf -9.345 -4.335 TD -0.0041 Tc 0.081 Tw (Lack of concern/support from management: )Tj /TT1 1 Tf 18.099 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.33 0 TD -0.0041 Tc 0.085 Tw (The per-)Tj -20.229 -1.401 TD -0.0033 Tc -0.0488 Tw (ception of an absence of climate of care on the part of man-)Tj 0 -1.398 TD -0.0034 Tc 0.0695 Tw (agement \(i.e., at Officer level and above\) was a prominent)Tj 0 -1.401 TD -0.0031 Tc -0.0231 Tw [(theme - reported by all but four of the participants \(T)65.9(able 3\).)]TJ T* -0.008 Tc -0.0625 Tw (For example, more than three-quarters of the participants \(21/)Tj 0 -1.398 TD -0.0031 Tc 0.0355 Tw (27\) alluded to the lack of recovery time allowed after a CI,)Tj 0 -1.401 TD -0.0033 Tc -0.0556 Tw (while difficulties for non-rostered staff were also noted \(e.g.,)Tj T* -0.003 Tc 0.0937 Tw [(varying travel times to stations\) and most importantly)63(, the)]TJ 0 -1.398 TD -0.0054 Tc -0.0622 Tw (failure on the part of management to acknowledge the impact)Tj 0 -1.401 TD -0.0041 Tc (of Critical Incidents. Some participants felt that management)Tj T* -0.0031 Tc 0.0365 Tw (only paid lip service to the Peer Support service and that,)Tj 0 -1.398 TD -0.006 Tc -0.0626 Tw [(realistically)60(, it was not a priority for them perhaps because, as)]TJ 0 -1.401 TD -0.0035 Tc 0.0332 Tw [(a number of EMT)65.5(s suggested, they had no personal experi-)]TJ T* -0.0042 Tc -0.0625 Tw (ence of CIS.)Tj 1.8 -1.998 TD 0.02 Tw [(Other EMT)64.9(s also expressed concerns about responding)]TJ -1.8 -1.401 TD -0.0027 Tc 0.1141 Tw (to further calls after exposure to a CI. They felt that they)Tj T* -0.0043 Tc -0.0623 Tw (might be unable to give the next patient their full attention, or)Tj 0 -1.398 TD 0.003 Tc 0.125 Tw (be so distracted that they would be unable to adequately)Tj 0 -1.401 TD -0.0028 Tc -0.055 Tw [(carry out their life saving skills. Clearly)60.2(, this could have seri-)]TJ T* -0.0036 Tc 0.1012 Tw [(ous consequences. In general, the EMT)68.4(s felt that manage-)]TJ 0 -1.398 TD 0.0183 Tw (ment were too distant to appreciate the nature of on-the-job)Tj 0 -1.401 TD 0.0255 Tc 0 Tw (stress.)Tj /TT5 1 Tf 1.8 -2.001 TD -0.0036 Tc -0.035 Tw [(T)57.5(r)0.1(aining: )]TJ /TT1 1 Tf 4.17 0 TD -0.036 Tc 0 Tw ( )Tj /TT2 1 Tf 0.429 0 TD -0.0037 Tc -0.035 Tw (Almost two-thirds \(17/26\) indicated that the)Tj -6.399 -1.398 TD -0.0033 Tc 0.067 Tw (training they had received to help them deal with CIS was)Tj 0 -1.401 TD -0.0035 Tc -0.0622 Tw [(not at all adequate, while only 9 considered it to be reason-)]TJ T* -0.0033 Tc 0.0808 Tw (ably adequate. Fifteen participants suggested that training)Tj 0 -1.398 TD -0.0038 Tc -0.0026 Tw (and education on stress in general should be an integral part)Tj 0 -1.401 TD -0.0034 Tc 0.0944 Tw [(of their basic training. The major training needs included)]TJ T* -0.0037 Tc 0.0158 Tw [(communication skills, coping skills, learning how to detach)]TJ 0 -1.398 TD -0.0036 Tc 0.0394 Tw [(from a CI or to manage one)53.4(s emotions, facilitating discus-)]TJ 0 -1.401 TD 0.0032 Tc 0.125 Tw (sions concerning CIs, preparatory CI training, improving)Tj T* 0.009 Tc (awareness of support available, and education regarding)Tj 0 -1.398 TD -0.0034 Tc 0.0025 Tw (signs and symptoms of CIS.)Tj 1.8 -2.001 TD -0.0035 Tc 0.0028 Tw (Other participants felt that additional training would be)Tj -1.8 -1.401 TD -0.0307 Tw (beneficial for new recruits who have no previous experience)Tj 0 -1.398 TD -0.0097 Tc -0.0622 Tw (in emergency work. The general view of the interviewees was)Tj 0 -1.401 TD -0.0035 Tc 0.1187 Tw (summed up well by one EMT who stated, )Tj /TT5 1 Tf 17.79 0 TD -0.0043 Tc 0.1199 Tw [(The more in-)]TJ ET 0.99 w 1000 M /GS1 gs 65.495 502.005 237.01 -412.01 re 322.495 729.505 236.01 -95.01 re S endstream endobj 224 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 29 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 226 0 obj << /Length 8907 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0875 Tw [(220 )]TJ /TT3 1 Tf 2.7375 0 TD -0.0053 Tc 0.0881 Tw (Gallagher & McGilloway The Impact of Critical Incidents on Frontline Ambulance Personnel)Tj /TT5 1 Tf 10 0 0 10 54 722.64 Tm -0.0039 Tc -0.0276 Tw [(formed you ar)29.1(e r)32.1(egar)29.1(ding str)32.1(ess issues, the better)107.1(. )]TJ /TT2 1 Tf 20.454 0 TD -0.0051 Tc 0 Tw (Another)Tj -20.454 -1.398 TD -0.0035 Tc -0.0122 Tw (suggested that the amount of training received is not benefi-)Tj 0 -1.401 TD -0.0031 Tc 0.0411 Tw (cial unless staff are given appropriate recovery time after a)Tj T* -0.0035 Tc 0.0575 Tw (CI. Others highlighted a need for management \(i.e., ambu-)Tj 0 -1.398 TD -0.0031 Tc 0.0105 Tw (lance or station officers\) to be properly trained to recognize)Tj 0 -1.401 TD -0.0036 Tc -0.0621 Tw [(signs of stress and, more importantly)59.4(, to be able to take ef)17.4(fec-)]TJ T* -0.0212 Tw (tive and appropriate action \(e.g., to allow some down-time)Tj 0 -1.398 TD -0.0034 Tc 0.015 Tw [(or advise/refer to a professional counsellor; see )17.6(T)73.4(able 4\).)]TJ /TT3 1 Tf 10.239 -3.267 TD -0.0055 Tc -0.05 Tw (Table 4.)Tj /F1 1 Tf -0.15 -1.2 TD -0.0057 Tc 0 Tw [(T)80.3(raining)]TJ /TT3 1 Tf -8.889 -3.198 TD 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 69.3 548.01 Tm -0.0053 Tc -0.026 Tw [(Y)142.7(ou are not giv)18.7(en an)12.7(y training whatsoe)24.7(v)23.7(er to deal)]TJ -0.0749 -1.2 TD -0.0044 Tc -0.0011 Tw (with stress involved. It would help to cope with it)Tj 0.2551 -1.2 TD -0.0041 Tc -0.015 Tw (a bit better - )Tj /TT3 1 Tf 10 0 0 10 120.96 524.01 Tm -0.0057 Tc 0 Tw ([you])Tj /F8 1 Tf 10 0 2.1256 10 142.41 524.01 Tm -0.0054 Tc -0.015 Tw [( could go home and detach)]TJ -7.3859 -1.2 TD -0.0049 Tc 0.0148 Tw [(from it or tak)13.1(e y)16.1(our mind a)13.1(w)18.1(a)32.1(y)-0.6( from it.)94.1()]TJ /TT3 1 Tf 10 0 0 10 66 488.01 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 69.3 488.01 Tm -0.0042 Tc -0.0034 Tw (I think each individual buries it, )Tj /TT3 1 Tf 10 0 0 10 206.61 488.01 Tm -0.005 Tc -0.005 Tw ([CIS and their)Tj -14.061 -1.2 TD -0.0051 Tc 0 Tw (feelings])Tj /F8 1 Tf 10 0 2.1256 10 102.84 476.01 Tm -0.0048 Tc -0.0267 Tw [(. Everyone could benefit from more)]TJ -3.4289 -1.2 TD -0.0046 Tc -0.025 Tw (education and training as regards CIS. I think that)Tj 0.2551 -1.2 TD -0.0045 Tc -0.005 Tw (would be a major benefit, just to have it out in the)Tj 0.2551 -1.2 TD -0.0056 Tc -0.0109 Tw [(open to mak)15.4(e sure that e)24.4(v)23.4(er)-35.6(y)17.4(one kno)9.4(ws it)45.4(s there)9.4(.)]TJ 0.2551 -1.2 TD -0.0642 Tc 0.0015 Tw [(E)-52.2(v)-40.2(e)-54.2(r)-94.2(y)-38.2(one has itw)-55.2(e)-57.2()-13.2(r)-59.8(e)-59.8( )]TJ 9.7352 0 TD -0.0046 Tc [(still thinking we dont suff)25.4(e)5.4(r)]TJ -9.4801 -1.2 TD -0.0053 Tc 0.0049 Tw [(mental prob)12.7(lems)12.7(, that)42.7(s a big dra)22.7(wbac)12.7(k I think.)96.7()]TJ /TT3 1 Tf 10 0 0 10 66 392.01 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 69.3 392.01 Tm -0.0044 Tc 0.0275 Tw (Its still a very taboo subject among the staff,)Tj -0.0749 -1.2 TD -0.0048 Tc 0.0146 Tw [(e)32.2(v)24.2(en if y)16.2(ou only mention the word )55.4(stress, it im-)]TJ 0.2551 -1.2 TD -0.0045 Tc 0.007 Tw (plies that you are not able to cope...A lot of the)Tj 0.2551 -1.2 TD 0.0091 Tw [(staff the)16.5(y)43.5(re just not au f)28.5(ait with it or dealing with)]TJ 0.2551 -1.2 TD -0.0039 Tc -0.0033 Tw (it. If they )Tj /TT3 1 Tf 10 0 0 10 106.05 344.01 Tm -0.0062 Tc 0 Tw ([management])Tj /F8 1 Tf 10 0 2.1256 10 169.29 344.01 Tm -0.0049 Tc -0.0038 Tw ( could go a step better)Tj -10.0739 -1.2 TD -0.0046 Tc -0.0122 Tw (and let people know that the service is there for)Tj 0.2551 -1.2 TD -0.006 Tc -0.0275 Tw (them and )Tj /TT3 1 Tf 10 0 0 10 109.44 320.01 Tm -0.0049 Tc 0 Tw ([that])Tj /F8 1 Tf 10 0 2.1256 10 131.46 320.01 Tm -0.03 Tw [( the)16.2(y)43.2(re not jeopardising their posi-)]TJ -6.2909 -1.2 TD -0.0051 Tc 0.0026 Tw [(tion b)15.9(y)-0.3( seeking out these things)9.9(.)59.9( )44.5(That)42.9(s the main)]TJ 0.2551 -1.2 TD -0.0054 Tc 0.0176 Tw [(concer)-29.4(n among staff)24.6(...)93.6()]TJ /TT5 1 Tf 11 0 0 11 54 241.56 Tm 0.0095 Tc 0.1248 Tw [(Theme 4: The per)34(ceived effectiveness of Peer)]TJ 0 -1.1836 TD 0.0403 Tc 0 Tw (Support)Tj /TT2 1 Tf 10 0 0 10 72 208.86 Tm -0.0043 Tc -0.0621 Tw (Issues regarding the Peer Support Service related princi-)Tj -1.8 -1.401 TD -0.0026 Tc -0.005 Tw (pally to barriers to using the service, fears of discovery by)Tj T* -0.0071 Tc -0.0621 Tw [(management and issues related to machismo \(T)64.9(able 5\). )17.3(While)]TJ 0 -1.398 TD -0.0049 Tc -0.0625 Tw (all of the participants were aware of the Peer Support service,)Tj 0 -1.401 TD -0.0034 Tc 0.0225 Tw (almost two-thirds \(17/27\) reported that they had never seen)Tj T* -0.0036 Tc 0.0734 Tw (or read the CIS information leaflets or posters which form)Tj 0 -1.398 TD -0.0032 Tc -0.0595 Tw (part of the service. Only two of the interviewees had used the)Tj 0 -1.401 TD -0.0018 Tw (service and felt that it had been beneficial as they were sub-)Tj T* -0.0028 Tc 0.125 Tw [(sequently referred to counselling. Most of the comments)]TJ 25.5 62.58 TD -0.0013 Tc (suggest a general perception that PSWs are not appropri-)Tj 0 -1.398 TD -0.0047 Tc -0.0622 Tw (ately qualified to undertake such a role, while concerns about)Tj 0 -1.401 TD [(confidentiality were also highlighted. Many felt that the sup-)]TJ T* -0.0033 Tc -0.0374 Tw [(port service was a service in name only)62.7(,)68.7( while others stated)]TJ 0 -1.398 TD -0.0032 Tc 0.064 Tw (that it should be more widely advertised. There was also a)Tj 0 -1.401 TD -0.0033 Tc 0.0671 Tw (commonly held view that only mental health professionals)Tj T* -0.0036 Tc -0.0504 Tw (should manage CIS and that staff should have access to a 24-)Tj 0 -1.398 TD -0.0039 Tc 0.0472 Tw [(hour helpline. )50.1(A)58.3( number of EMT)65.1(s indicated that managers)]TJ 0 -1.401 TD -0.0034 Tc -0.0323 Tw (should be more closely involved with the service and should)Tj T* -0.0088 Tc -0.0625 Tw [(promote it more actively in order to overcome barriers of fear)36.2(,)]TJ 0 -1.398 TD -0.0038 Tc -0.005 Tw (trust, and machismo.)Tj /TT3 1 Tf 10.389 -4.467 TD -0.0055 Tc -0.05 Tw (Table 5.)Tj /F1 1 Tf -3.189 -1.2 TD -0.055 Tw (Peer Support Service)Tj /F8 1 Tf 10 0 2.1256 10 324 494.01 Tm -0.0047 Tc 0.0131 Tw [(I think that for EMTs it seems to be a good)]TJ 0.2551 -1.2 TD -0.0052 Tc 0.0107 Tw [(ser)-35.2(vice)9.8(, b)15.8(u)-0.3(t f)24.8(or EMCs it)45.8(s not, and needs to be)]TJ 0.2551 -1.2 TD -0.005 Tc -0.0687 Tw (improved. Resources are restricted which)Tj 0.2551 -1.2 TD -0.0046 Tc -0.005 Tw (causes extra stressors for everyone, - flared)Tj 0.2551 -1.2 TD -0.0031 Tw (tempers, its not good for the service and has)Tj 0.2551 -1.2 TD -0.0126 Tc 0 Tw [(repercussions)8.4(.)100.4(\(EMC\))]TJ 0.5101 -2.4 TD -0.0052 Tc -0.0228 Tw (No EMT feels the need to approach PSW due to)Tj 0.2551 -1.2 TD -0.0048 Tc -0.012 Tw (it being a sign of weakness)Tj 0.5101 -2.4 TD -0.0055 Tc -0.0153 Tw [(Not comf)24.5(or)-47.5(tab)15.5(le with people selected f)21.5(or the)]TJ 0.2551 -1.2 TD -0.0049 Tc 0.0202 Tw [(role)10.1(, f)25.1(eel the)16.1(y are as stressed as I am.)97.1()]TJ 0.5101 -2.4 TD -0.0044 Tc -0.0272 Tw (Not qualified to give help or advice, confidential-)Tj 0.2551 -1.2 TD -0.0046 Tc -0.0095 Tw (ity also a big issue would not dream of confiding)Tj 0.2551 -1.2 TD -0.0056 Tc -0.0197 Tw [(in an)9.4(y)17.4(one at wor)-20.6(k)-0.8( - need prof)24.4(essionals)9.4(.)98.4()]TJ 0.5101 -2.4 TD -0.0048 Tc -0.0117 Tw (Our PSW lacks experience within the service)Tj 0.2551 -1.2 TD -0.0051 Tc 0.029 Tw [(and sho)9.9(w signs of stress himself)21.9(.)98.9()]TJ 0.5101 -2.4 TD -0.0049 Tc -0.0357 Tw (Our PSW would not keep any information confi-)Tj 0.2551 -1.2 TD -0.0106 Tc 0 Tw [(dential.)94.4()]TJ 0.5101 -2.4 TD -0.0049 Tc -0.0182 Tw [(There)46.1(s nothing worse if w)7.1(e)-0.5( get a bad call, be it)]TJ 0.2551 -1.2 TD -0.0146 Tw [(a R)25(T)120(A or a cardiac arrest, and we finish up the)]TJ 0.2551 -1.2 TD -0.01 Tw [(call at the hospital, pac)16.2(k up our gear)43.2(, clean up)]TJ 0.2551 -1.2 TD -0.0054 Tc -0.0491 Tw [(the amb)15.6(ulance and we get another call.)54.6( )37.5(W)32.6(e)1.6()45.6(r)4.6(e)]TJ 0.2551 -1.2 TD -0.0045 Tc 0.01 Tw (taking all the hassle and stress with us to the)Tj 0.2551 -1.2 TD 0.0085 Tw (next call. It might only be as simple as a drunk)Tj 0.2551 -1.2 TD -0.005 Tc -0.0293 Tw (or something and you might take out your anger)Tj 0.2551 -1.2 TD -0.0048 Tw [(on them and not meaning to do it.)55( But it)46(s some-)]TJ 0.2551 -1.2 TD -0.0361 Tw (thing that we need to be aware of and deal)Tj 0.2551 -1.2 TD 0.0007 Tc 0 Tw [(with...)96.7()]TJ ET 0.99 w 1000 M /GS1 gs 54.495 610.505 237.01 -331.01 re 309.495 555.505 237.01 -462.01 re S endstream endobj 227 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 29 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 229 0 obj << /Length 9363 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (221)Tj /TT5 1 Tf 11 0 0 11 66 723.36 Tm 0.0027 Tc 0.125 Tw [(Theme 5: EMCs - the for)30(gotten few?)]TJ /TT2 1 Tf 10 0 0 10 84 703.65 Tm -0.0037 Tc -0.0364 Tw (Potential sources of stress for EMCs were multi-faceted)Tj -1.8 -1.401 TD -0.0035 Tc -0.0305 Tw (and a source of considerable concern for all six interviewees)Tj 0 -1.398 TD -0.0037 Tc (who felt that neither Peer Support staff nor management had)Tj 0 -1.401 TD -0.0088 Tc -0.0623 Tw [(any concern for their well-being \(T)66.2(able 6\). S)15.2(tress in Control)]TJ T* -0.0031 Tc 0.0027 Tw (appeared to be a daily occurrence as EMCs were constantly)Tj 0 -1.398 TD -0.0103 Tc -0.0622 Tw [(dealing with traumatic callers)73.7( \(in contrast to EMT)67.7(s who may)]TJ 0 -1.401 TD -0.0027 Tc 0.0425 Tw (not necessarily experience this on a daily basis\), especially)Tj T* -0.0192 Tc -0.0625 Tw (calls involving violence or children. While the EMCs acknowl-)Tj 0 -1.398 TD 0.0025 Tc 0.125 Tw (edged that they do not deal physically with trauma, they)Tj 0 -1.401 TD -0.0033 Tc 0.07 Tw [(reported that they)62.7(,)0.2( nonetheless, experience stress when en-)]TJ T* 0.0049 Tc 0.125 Tw [(gaging with distressed callers. Interviewees alluded fre-)]TJ 0 -1.398 TD -0.0032 Tc -0.0187 Tw (quently to repetitive calls from patients and/or their families)Tj 0 -1.401 TD 0.0672 Tw (as they become increasingly traumatized while waiting for)Tj T* -0.0035 Tc 0.0265 Tw [(the ambulance. Dealing with abuse, animosity)62.5(, and trauma-)]TJ 0 -1.398 TD -0.0163 Tc -0.0625 Tw (tized callers was also commonly reported; four EMCs reported)Tj 0 -1.401 TD -0.0034 Tc 0.1139 Tw [(that they had been threatened on several occasions \(T)65.6(able)]TJ T* -0.054 Tc 0 Tw (6\).)Tj 1.8 -1.998 TD -0.0033 Tc -0.0306 Tw (Other potential sources of stress may arise from dealing)Tj -1.8 -1.401 TD -0.0097 Tc -0.0624 Tw [(directly with EMT)65.3(s on the radio as well as members of the fire)]TJ T* -0.0035 Tc 0.0326 Tw [(and police service, GPs, hospital staf)17.5(f, and undertakers. )53.6(All)]TJ 0 -1.398 TD -0.0461 Tw (of the EMCs reported that their training was inadequate. The)Tj 0 -1.401 TD -0.0033 Tc 0.0505 Tw (solitary role of an EMC was also highlighted as being par-)Tj T* -0.0431 Tw (ticularly problematic. In the two Control stations included in)Tj 0 -1.398 TD -0.003 Tc 0.0294 Tw [(this study)63(, there is one EMC on duty at night and on week-)]TJ 0 -1.401 TD -0.0035 Tc -0.028 Tw (end shifts. The EMCs indicated that these are often the busi-)Tj T* 0.0107 Tc 0.125 Tw (est shifts and that this solitary role can be stressful and)Tj 0 -1.398 TD -0.0028 Tc -0.0035 Tw (isolating, particularly if they deal with a bad call and have)Tj 0 -1.401 TD -0.004 Tc -0.02 Tw (no immediate support.)Tj /TT3 1 Tf 10.239 -4.146 TD -0.0055 Tc -0.05 Tw (Table 6.)Tj /F1 1 Tf -2.775 -1.2 TD -0.0177 Tc -0.07 Tw (EMCs \(Dispatchers\))Tj /TT3 1 Tf -6.264 -3.198 TD 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 81.3 234.21 Tm -0.0045 Tc -0.0055 Tw [(We get stress in Control from all sides -the)]TJ -0.0749 -1.2 TD -0.0055 Tc 0 Tw (Gardai )Tj /TT3 1 Tf 10 0 0 10 110.61 222.21 Tm -0.0042 Tc 0.015 Tw ([Irish police force], )Tj /F8 1 Tf 10 0 2.1256 10 194.1 222.21 Tm -0.0048 Tc 0.0167 Tw (fire services, EMTs on)Tj -11.3549 -1.2 TD -0.0355 Tw [(the radio and then trying to calm people down on)]TJ 0.2551 -1.2 TD -0.0331 Tc 0.0286 Tw [(the phone...it can be v)-9.1(e)-23.1(r)-63.1(y)-28.7( )]TJ 11.8768 0 TD -0.0044 Tc [(difficult to cope)10.6(...)94.6()]TJ /TT3 1 Tf 10 0 0 10 78 174.21 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 81.3 174.21 Tm -0.005 Tc -0.034 Tw (We are helpless at the end of a phone and we)Tj -0.0749 -1.2 TD -0.027 Tw (worry constantly about the outcome. Psychologi-)Tj 0.2551 -1.2 TD -0.0053 Tc 0.0087 Tw [(cally)93.7(, it)45.7(s tor)-47.3(ture)9.7(...we dont kno)9.7(w ho)9.7(w the patient)]TJ 0.2551 -1.2 TD -0.0044 Tc -0.0024 Tw (is after an incident - we cant follow up every call)Tj 0.2551 -1.2 TD -0.0049 Tc 0.0036 Tw [(- there are just too man)10.1(y)99.1(...b)16.1(ut when I get home)10.1(, I)]TJ 0.2551 -1.2 TD 0.0185 Tw [(star)-43.8(t to wonder about the callers)10.2(...its not health)25.2(y)102.2(,)]TJ 0.2551 -1.2 TD 0 Tw (we dont get closure like the EMTs)Tj /TT3 1 Tf 10 0 0 10 228.69 102.21 Tm (.)Tj 10.431 60.978 TD 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 336.3 711.99 Tm -0.0047 Tc -0.0338 Tw (We definitely need more training in how to calm)Tj -0.0749 -1.2 TD -0.005 Tc -0.055 Tw (people down on the phone, and how to deliver)Tj 0.2551 -1.2 TD -0.0048 Tc -0.0286 Tw (instructions over the phone to people on the)Tj 0.2551 -1.2 TD -0.0051 Tc -0.0239 Tw [(scene)9.9(.)56.9( )39(W)35.9(e)-0.6( could also benefit from training on ho)9.9(w)]TJ 0.2551 -1.2 TD -0.0057 Tw [(to calm ourselv)18.8(es do)9.8(wn after an ab)15.8(usiv)18.8(e caller)45.8(.)98.8()]TJ /TT3 1 Tf 10 0 0 10 333 639.99 Tm 0 Tc 0 Tw ()Tj /F8 1 Tf 10 0 2.1256 10 336.3 639.99 Tm -0.005 Tc -0.0064 Tw [(The animosity from EMTs and from the public)]TJ -0.0749 -1.2 TD -0.0046 Tc -0.0078 Tw (happens on a daily basis...Control is a pivotal)Tj 0.2551 -1.2 TD -0.0045 Tc -0.015 Tw (point...you get embroiled with all the services.)Tj 0.2551 -1.2 TD -0.0051 Tc 0.0017 Tw [(Y)142.9(ou can get v)18.9(e)4.9(r)-38.1(y)0.5( fr)-20.1(ustrated if the EMTs are out)]TJ 0.2551 -1.2 TD -0.0046 Tc -0.0269 Tw [(on the road screaming for a fire brigade...so you)]TJ 0.2551 -1.2 TD 0.004 Tw (can get it from every angle and get it very quick)Tj 0.2551 -1.2 TD -0.0045 Tc -0.0035 Tw (and then it can stop all of a sudden...we are left)Tj 0.2551 -1.2 TD -0.018 Tc -0.0458 Tw (wondering...hangingbut we still have to deal with)Tj 0.2551 -1.2 TD -0.0047 Tc 0.02 Tw (the next call)Tj /TT3 1 Tf 10 0 0 10 386.19 543.99 Tm -0.0048 Tc 0 Tw (.)Tj -5.319 -2.4 TD 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 336.3 519.99 Tm -0.0059 Tc -0.0225 Tw [(T)119.1(oda)24.1(y w)6.1(e)0.3( w)6.1(ere )54.1(out the door)63.1( )]TJ /TT3 1 Tf 10 0 0 10 461.76 519.99 Tm -0.0051 Tc -0.02 Tw ([very busy])Tj /F8 1 Tf 10 0 2.1256 10 509.4 519.99 Tm -0.025 Tw [( with)]TJ -17.3849 -1.2 TD -0.0045 Tc -0.03 Tw (calls...We had hospitals ringing looking for routine)Tj 0.2551 -1.2 TD -0.0048 Tc -0.0117 Tw (transfers and we had to say to them we couldnt)Tj 0.2551 -1.2 TD -0.0044 Tc 0.0025 Tw (do it...this builds up in you...pressure, pressure)Tj 0.2551 -1.2 TD 0.017 Tw [(all the time. I think sometimes that some of the)]TJ 0.2551 -1.2 TD -0.0047 Tc 0.0039 Tw (lads might blow a gasket if they dont get some)Tj 0.2551 -1.2 TD -0.0191 Tc -0.0079 Tw (release or relief...Some of the lads can cope)Tj 0.2551 -1.2 TD -0.0051 Tc -0.0155 Tw [(with it, b)15.9(ut y)15.9(ou need release and suppor)-47.1(t from)]TJ 0.2551 -1.2 TD -0.0183 Tc 0 Tw [(management.)92.7()]TJ /TT3 1 Tf 10 0 0 10 333 399.99 Tm 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 336.3 399.99 Tm -0.005 Tc -0.0325 Tw (In here )Tj /TT3 1 Tf 10 0 0 10 369.21 399.99 Tm -0.0041 Tc -0.03 Tw ([in Control])Tj /F8 1 Tf 10 0 2.1256 10 421.14 399.99 Tm -0.0053 Tc -0.0333 Tw [( )4.4(y)12.7(ou)45.7(re )54.7(in a tunnel.)54.7( )86.4(Y)139.7(ou can)]TJ -8.5589 -1.2 TD -0.005 Tc -0.0161 Tw [(hear what)46(s going on, b)16(ut y)16(ou cant see or touch)]TJ 0.2551 -1.2 TD 0.013 Tc 0 Tw [(it.)97()]TJ /TT3 1 Tf 10 0 0 10 333 351.99 Tm 0 Tc ()Tj /F8 1 Tf 10 0 2.1256 10 336.3 351.99 Tm -0.005 Tc 0.0032 Tw (Sometimes it can take a few hours to come)Tj -0.0749 -1.2 TD -0.0044 Tc 0.0184 Tw (back to yourself after a stressful caller)Tj /TT3 1 Tf 10 0 0 10 500.19 339.99 Tm -0.0048 Tc 0 Tw (.)Tj /F1 1 Tf 11 0 0 11 404.25 287.01 Tm 0.0207 Tc (DISCUSSION)Tj /TT2 1 Tf 10 0 0 10 339 263.64 Tm -0.0044 Tc -0.0622 Tw (This study qualitatively explored the impact of exposure)Tj -1.8 -1.398 TD -0.0055 Tc -0.0625 Tw (to one or more Critical Incidents on the health and well-being)Tj 0 -1.401 TD -0.0038 Tc 0.007 Tw [(of EMT)68.2(s and EMCs. )14.2(T)73(o)-0.4( date, there is no published research)]TJ T* -0.0033 Tc -0.0082 Tw (in Ireland in this area, while little is known within the wider)Tj 0 -1.398 TD -0.0032 Tc 0.0623 Tw (literature about peer support in emergency care, or the im-)Tj 0 -1.401 TD -0.0039 Tc -0.0625 Tw [(pact of CIS on EMCs. The lack of qualitative research in this)]TJ T* -0.0034 Tc 0.0465 Tw (area has also prevented a full exploration of the nature and)Tj 0 -1.398 TD -0.0036 Tc -0.0017 Tw (experience of stress in frontline ambulance personnel.)Tj 1.8 -2.001 TD 0.0056 Tw [(The findings indicate that some CIs are more traumatic)]TJ -1.8 -1.401 TD -0.0032 Tc 0.0294 Tw [(than others and may)62.8(, therefore, have a more significant im-)]TJ 0 -1.398 TD -0.0035 Tc 0.02 Tw (pact on mental health. CIs involving children, suicides, and)Tj 0 -1.401 TD -0.0034 Tc -0.003 Tw [(R)63.6(T)82.4(As appeared to be most distressing, a pattern also seen in)]TJ T* -0.008 Tc -0.0619 Tw [(previous work \(e.g. )16.3(V)111.2(an der Ploeg & Kleber)37(, 2003; )52.3(Alexander)]TJ 0 -1.398 TD -0.0033 Tc 0.0199 Tw [(& Klein, 2001\). )53.6(Additionally)59.7(, the findings support those of)]TJ ET 0.99 w 1000 M /GS1 gs 66.495 301.505 238.01 -215.01 re 321.495 732.505 236.01 -409.01 re S endstream endobj 230 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 29 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 232 0 obj << /Length 9125 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0875 Tw [(222 )]TJ /TT3 1 Tf 2.7375 0 TD -0.0053 Tc 0.0881 Tw (Gallagher & McGilloway The Impact of Critical Incidents on Frontline Ambulance Personnel)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0034 Tc 0.1007 Tw (earlier studies which have highlighted the serious psycho-)Tj 0 -1.398 TD -0.0033 Tc -0.0222 Tw (logical impact of dealing with injured or dead children \(e.g.,)Tj 0 -1.401 TD -0.0034 Tc -0.0575 Tw [(James, 1988; Dyregrov & Mitchell, 1992\). Incidents involv-)]TJ T* -0.0032 Tc 0.0011 Tw (ing suicides were also described as very traumatic, not least)Tj 0 -1.398 TD -0.0038 Tc 0.1107 Tw (because of the overwhelming sense of helplessness which)Tj 0 -1.401 TD -0.0033 Tc 0.0117 Tw [(was compounded by the distress of family members. Simi-)]TJ T* -0.0028 Tc 0.0298 Tw [(larly)63.2(, Bryant and Harvey \(1996\) reported strong feelings of)]TJ 0 -1.398 TD -0.0034 Tc 0.0862 Tw (helplessness in helpers and rescuers after a traumatic inci-)Tj 0 -1.401 TD -0.0031 Tc -0.0396 Tw (dent. The rating of most of the CIs as extremely stressful is)Tj T* -0.0033 Tc -0.0187 Tw (supported by the results of the standardized self-report mea-)Tj 0 -1.398 TD -0.0032 Tc 0.0811 Tw [(sures, which were administered at the same time. Briefly)59.8(,)]TJ 0 -1.401 TD 0.0015 Tc 0.125 Tw (these showed poor physical and mental health \(including)Tj T* -0.0037 Tc -0.0622 Tw (high levels of PTSD symptoms\) and moderate levels of emo-)Tj 0 -1.398 TD -0.0036 Tc -0.018 Tw (tional exhaustion and depersonalization. Many interviewees)Tj 0 -1.401 TD -0.0052 Tc -0.0622 Tw (also described the cumulative effect of several CIs which had)Tj T* -0.0033 Tc 0.0961 Tw (occurred over a relatively short period and which had im-)Tj 0 -1.398 TD -0.0031 Tc 0.015 Tw (pacted negatively on their overall health.)Tj 1.8 -2.001 TD -0.0055 Tc -0.0625 Tw (The need for more recovery \(down\) time after a CI was)Tj -1.8 -1.401 TD -0.0033 Tc 0.1086 Tw [(identified by three quarters of participants; )53.7(Alexander and)]TJ 0 -1.398 TD -0.0034 Tc 0.063 Tw (Klein \(2001\) suggest that the nature of the incident and its)Tj 0 -1.401 TD -0.0028 Tc 0.0837 Tw [(impact may be related to recovery time availability)60.2(.)-2( )18.6(This,)]TJ T* -0.0035 Tc 0.0394 Tw (coupled with the other findings, highlights the need to pro-)Tj 0 -1.398 TD -0.0076 Tc -0.0625 Tw (vide more support for EMT/Cs in the aftermath of these kinds)Tj 0 -1.401 TD -0.0035 Tc 0.0611 Tw (of incidents as well as appropriate training to help manage)Tj T* 0.0905 Tw [(CIS. However)35.4(, this raises questions about the appropriate)]TJ 0 -1.398 TD -0.0033 Tc 0.0775 Tw (use of available resources and the capacity and/or willing-)Tj 0 -1.401 TD -0.0034 Tc 0.0981 Tw (ness of senior managers to respond sensitively and appro-)Tj T* -0.0009 Tc 0.125 Tw [(priately to the needs of frontline staff. The absence of a)]TJ 0 -1.398 TD -0.0034 Tc -0.047 Tw (climate of care at managerial level was a prominent and re-)Tj 0 -1.401 TD -0.0033 Tc 0.1165 Tw (curring theme in this study and has been highlighted as a)Tj T* -0.0039 Tc 0.09 Tw (significant stressor among ambulance personnel elsewhere)Tj 0 -1.398 TD -0.0116 Tc -0.0627 Tw [(\(e.g., )54.2(Alexander & Klein, 2001; Mahony)57.4(, 2001\).)]TJ 1.8 -2.001 TD -0.0034 Tc -0.015 Tw (Mitchell and Everly \(2001)Tj /TT1 1 Tf 10.455 0 TD 0 Tc 0 Tw (\))Tj /TT2 1 Tf 0.33 0 TD -0.0035 Tc -0.015 Tw [( describe a resistance within)]TJ -12.585 -1.401 TD -0.0032 Tc 0 Tw (the emergency services to acknowledge the presence of any)Tj 0 -1.398 TD -0.0034 Tc 0.0593 Tw (psychological problems among staff which may hinder the)Tj 0 -1.401 TD -0.0038 Tc 0.04 Tw [(ef)17.2(fective identification and management of CIS. However)35.2(,)]TJ T* -0.0036 Tc -0.0043 Tw [(Alexander and Klein \(2001\) suggest that displacement may)59.4(,)]TJ 0 -1.398 TD -0.005 Tc -0.0622 Tw (in part, account for this, whereby some staff may not admit to)Tj 0 -1.401 TD -0.0032 Tc -0.0017 Tw (or be able to tolerate their own emotional vulnerability with)Tj T* -0.0029 Tc 0.0172 Tw (the result that they may blame the system instead. There-)Tj 0 -1.398 TD -0.0077 Tc -0.0625 Tw (fore, the role of middle management also ought to be clarified)Tj 0 -1.401 TD -0.0037 Tc 0.0243 Tw (in relation to the acknowledgement and prevention or man-)Tj T* -0.0034 Tc -0.02 Tw (agement of CIS and to other work-related stressors that may)Tj 0 -1.398 TD -0.0035 Tc -0.0333 Tw (exacerbate Critical Incident-related stress.)Tj 1.8 -2.001 TD 0.0055 Tc 0.125 Tw (The concept of Critical Incident Stress Management)Tj -1.8 -1.401 TD -0.0039 Tc -0.015 Tw (\(CISM\) and Peer Support has received considerable support)Tj 25.5 64.8 TD -0.0035 Tc 0.0238 Tw (since the 1980s, with the work of Mitchell \(Mitchell, 1983;)Tj 0 -1.398 TD -0.022 Tc -0.0615 Tw (1988\) and Dunning \(1988\) in the US, but)Tj /TT1 1 Tf 15.21 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.171 0 TD -0.0226 Tc -0.065 Tw (participants expressed)Tj -15.381 -1.401 TD -0.0036 Tc 0.0422 Tw (a largely negative view toward using the PSWs attached to)Tj T* -0.0033 Tc 0.055 Tw [(the current service. Barriers to service utilization included)]TJ 0 -1.398 TD -0.0035 Tc -0.0428 Tw (their perceived lack of training, concerns about confidential-)Tj 0 -1.401 TD -0.0034 Tc 0.0975 Tw [(i)-5.1(t)-5.1(y)59.6(, feelings of embarrassment, peer pressure, and the per)17.6(-)]TJ T* -0.0038 Tc -0.055 Tw (ceived negative views of management. Some of these appear)Tj 0 -1.398 TD -0.0043 Tc -0.0622 Tw (to stem from the machismo attitude that prevails within this)Tj 0 -1.401 TD -0.0048 Tc -0.0625 Tw (male-dominated occupational group. The results suggest that)Tj T* -0.0037 Tc 0.0125 Tw (confidence-building measures may need to be implemented)Tj 0 -1.398 TD -0.0034 Tc -0.0255 Tw (in order to promote a greater awareness of the service and to)Tj 0 -1.401 TD 0.0039 Tc 0.125 Tw (improve uptake. Many interviewees believed that mental)Tj T* -0.0036 Tc 0.0321 Tw (health professionals or qualified counsellors should be rou-)Tj 0 -1.398 TD -0.003 Tc -0.0573 Tw (tinely available to all staff with the support, in some cases, of)Tj 0 -1.401 TD -0.0079 Tc -0.0623 Tw [(a 24-hour helpline to accommodate shift-working. )52.3(According)]TJ T* -0.0032 Tc -0.002 Tw (to Mitchell and Everly \(2001\), the use of mental health pro-)Tj 0 -1.398 TD -0.0034 Tc -0.0564 Tw (fessionals in combination with specially trained peer support)Tj 0 -1.401 TD -0.0038 Tc -0.0386 Tw (personnel are encouraged when dealing with high-risk occu-)Tj T* -0.0034 Tc 0.0118 Tw [(pations such as ambulance personnel. They further empha-)]TJ 0 -1.398 TD -0.0003 Tc 0.125 Tw (size that the application of CISD by inadequately trained)Tj 0 -1.401 TD -0.0032 Tc 0.0175 Tw (staff may cause the process to fail; hence the importance of)Tj T* -0.0036 Tc 0.0238 Tw [(providing appropriate training for the PSWs in this study)59.4(.)]TJ 1.8 -1.998 TD -0.0365 Tw (Little research has examined the impact of work-related)Tj -1.8 -1.401 TD -0.0037 Tc 0.0427 Tw [(or CI stress on EMCs. While our findings should be inter-)]TJ T* -0.0604 Tw (preted with caution in view of the small number of EMC par-)Tj 0 -1.398 TD -0.0117 Tc -0.0622 Tw (ticipants, four key issues were identified relating to this group,)Tj 0 -1.401 TD -0.0047 Tc (including the lack of support from management and the PSW)Tj T* -0.0032 Tc 0.1 Tw (service; the lack of appropriate training \(e.g., to deal with)Tj 0 -1.398 TD -0.018 Tw (traumatised callers\); insufficient resources, particularly dur-)Tj 0 -1.401 TD -0.003 Tc 0.005 Tw (ing busy periods; and the solitary nature of night and week-)Tj T* -0.0029 Tc -0.0301 Tw [(end duty)63.1(. )54(All of these factors would only serve to exacerbate)]TJ 0 -1.398 TD -0.0072 Tc -0.0624 Tw [(pre-existing difficulties related to CIS and especially the feel-)]TJ 0 -1.401 TD -0.0035 Tc 0.1068 Tw (ings of helplessness which constitute an inevitable part of)Tj T* -0.0037 Tc -0.0325 Tw (the job of an EMC.)Tj /F1 1 Tf 11 0 0 11 309 222 Tm -0.0001 Tc 0 Tw (Conclusions)Tj /TT2 1 Tf 10 0 0 10 327 198.66 Tm -0.0036 Tc -0.0219 Tw (The findings from both stages of this research converge)Tj -1.8 -1.401 TD -0.0032 Tc 0.0019 Tw (to highlight the significant and potentially serious effects of)Tj T* -0.0036 Tc -0.0154 Tw (exposure to one or more CIs on the health and well-being of)Tj 0 -1.398 TD -0.0034 Tc -0.0188 Tw (those working at the frontline of emergency ambulance care)Tj 0 -1.401 TD -0.0035 Tc 0.11 Tw (in Ireland. The results raise important questions about the)Tj T* -0.0083 Tw (appropriateness and effectiveness of support services, stress)Tj 0 -1.398 TD -0.0038 Tc -0.0154 Tw [(awareness training for EMT)65.2(s and EMCs, and the role of and)]TJ 0 -1.401 TD 0.0825 Tw [(support from middle management. Our findings also sug-)]TJ T* -0.0034 Tc -0.05 Tw (gest, in line with recommendations by Sterud and colleagues)Tj 0 -1.398 TD -0.0035 Tc -0.0217 Tw (\(2006\), that more attention should be focused on the general)Tj ET endstream endobj 233 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 235 0 obj << /Length 9980 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (223)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0033 Tc 0.0505 Tw (job and time pressures faced by ambulance staff as well as)Tj 0 -1.398 TD -0.0107 Tc -0.0625 Tw (their emotional demands, particularly in view of research sug-)Tj 0 -1.401 TD -0.0035 Tc 0.095 Tw (gesting that stress-related problems of emergency workers)Tj T* 0.0246 Tc 0.125 Tw (may lead to career disruption and long-term disability)Tj 0 -1.398 TD -0.0107 Tc -0.0624 Tw [(\(Bennett et al., 2004; )19.4(V)117.5(an der Ploeg et al., 2003; Marmar et al.,)]TJ 0 -1.401 TD -0.003 Tc 0.0033 Tw [(1999\). Importantly)63(, the ambulance service in this study has)]TJ T* -0.0038 Tc 0.0671 Tw (implemented some support for its personnel, which should)Tj 0 -1.398 TD -0.0036 Tc 0.0013 Tw [(be recognized and valued. However)35.4(, the results suggest that)]TJ 0 -1.401 TD 0.0037 Tw (there is considerable scope for further development and im-)Tj T* 0.0375 Tw [(provement of existing support services. In conclusion, this)]TJ 0 -1.398 TD -0.0033 Tc 0.0777 Tw [(study highlights a number of important lessons for the ap-)]TJ 0 -1.401 TD -0.0038 Tc -0.0581 Tw [(propriate and effective management of CIS in the ambulance)]TJ T* -0.003 Tc 0.0544 Tw (service and by extension, perhaps, to other emergency ser-)Tj 0 -1.398 TD 0.0041 Tc 0 Tw (vices.)Tj /TT5 1 Tf 1.8 -2.001 TD -0.0048 Tc (Acknowledgements:)Tj /TT2 1 Tf 7.92 0 TD -0.0035 Tc -0.0207 Tw [( The authors would like to thank all)]TJ -9.72 -1.401 TD 0.0047 Tc 0.125 Tw (those who participated in the study and the Pre-Hospital)Tj 0 -1.398 TD -0.0035 Tc -0.0108 Tw (Emergency Care Council for sponsoring the research.)Tj /F1 1 Tf 11 0 0 11 145.89 459.99 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 66 442.65 Tm -0.0037 Tc 0.0241 Tw [(Alexander)35.3(, D.A. & Klein, S., \(2001\). )53.8(Ambulance personnel)]TJ 1.2 -1.401 TD -0.0033 Tc 0.0157 Tw (and critical incidents: impact of accident and emergency)Tj 0 -1.398 TD -0.0036 Tc 0.015 Tw (work on mental health and emotional well being. )Tj /TT5 1 Tf 19.806 0 TD -0.0048 Tc 0 Tw (British)Tj -19.806 -1.401 TD -0.0038 Tc -0.0183 Tw [(Journal of Psychiatry)53(,)-0.3( 178,)]TJ /TT2 1 Tf 10.71 0 TD -0.02 Tw [( 76-81.)]TJ -11.91 -1.8 TD -0.0031 Tc -0.024 Tw [(Bennett, P)104.9(., )17.9(W)55.7(illiams, )32.9(Y)134.1(., Page, N., Hood K., & )14.9(W)94.7(oolard, M.)]TJ 1.2 -1.401 TD -0.0148 Tc -0.0625 Tw (\(2004\). Levels of mental health problems among UK emer-)Tj 0 -1.398 TD 0.0014 Tc 0.1249 Tw (gency ambulance workers.)Tj /TT5 1 Tf 10.974 0 TD 0.0007 Tc 0.125 Tw [( Emergency Medicine Jour-)]TJ -10.974 -1.401 TD -0.0143 Tc 0 Tw (nal,)Tj /TT2 1 Tf 1.476 0 TD 0 Tc ( )Tj /TT5 1 Tf 0.18 0 TD -0.0145 Tc (21,)Tj /TT2 1 Tf 1.209 0 TD -0.0141 Tc -0.06 Tw [( 235-236.)]TJ -4.065 -1.8 TD -0.0072 Tc -0.0622 Tw [(Bryant, R.A. & Harvey)61.8(,)-10.7( )56.1(A.G)118.8(. \(1996\). Post-traumatic stress re-)]TJ 1.2 -1.401 TD -0.0033 Tc 0.123 Tw (actions in volunteer fire fighters. )Tj /TT5 1 Tf 13.83 0 TD -0.0044 Tc 0.1254 Tw [(Journal of T)52.6(raumatic)]TJ -13.83 -1.398 TD -0.012 Tc -0.06 Tw (Stress, 9,)Tj /TT2 1 Tf 3.459 0 TD -0.0137 Tc [( 51-62.)]TJ -4.659 -1.8 TD -0.0033 Tc -0.0624 Tw [(Clohessy)62.7(, S. & Ehlers, )50.8(A. \(1999\). PTSD symptoms, response)]TJ 1.2 -1.401 TD -0.0038 Tc 0.0886 Tw (to intrusive memories and coping in ambulance service)Tj T* 0 Tw (workers. )Tj /TT5 1 Tf 3.66 0 TD -0.0349 Tw [(British Journal of Clinical Psychology)50.2(, 38)]TJ /TT2 1 Tf 16.56 0 TD -0.0036 Tc -0.035 Tw (, 251-)Tj -20.22 -1.398 TD -0.0583 Tc 0 Tw (265.)Tj -1.2 -1.8 TD -0.0034 Tc 0.0984 Tw (Dunning, C. \(1988\). Intervention strategies for emergency)Tj 1.2 -1.401 TD -0.0029 Tc 0.0808 Tw [(workers. In L)51.1(ystad, M \(Ed.\), )]TJ /TT5 1 Tf 11.964 0 TD -0.0041 Tc 0.0832 Tw [(Mental health r)28.9(esponse to)]TJ -11.964 -1.401 TD -0.0069 Tc -0.0604 Tw [(mass emer)35.1(gencies.)]TJ /TT2 1 Tf 7.29 0 TD -0.0072 Tc -0.0623 Tw [( New )25.2(Y)106(ork: Brunner/Mazel.)]TJ -8.49 -1.8 TD -0.0034 Tc -0.0514 Tw [(Dyregrov)62.6(, )50.5(A. & Mitchell, J.T)71.6(. \(1992\). )17.5(W)94.4(ork with traumatised)]TJ 1.2 -1.398 TD 0.0043 Tc 0.125 Tw (children - psychological effects and coping strategies.)Tj /TT5 1 Tf 0 -1.401 TD -0.0038 Tc -0.01 Tw [(Journal of T)53.2(raumatic S)32.2(t)3.2(r)29.2(ess, 5,)]TJ /TT2 1 Tf 12.171 0 TD [( 5-17.)]TJ -13.371 -1.8 TD -0.0025 Tc -0.0383 Tw (Hayes, N. \(2000\). )Tj /TT5 1 Tf 7.23 0 TD -0.0041 Tc -0.04 Tw (Doing psychological research: Gathering)Tj -6.03 -1.401 TD 0.05 Tw (and analyzing data.)Tj /TT2 1 Tf 7.944 0 TD -0.0037 Tc [( Buckingham, UK: Open University)]TJ -7.944 -1.398 TD 0.0077 Tc 0 Tw (Press.)Tj 24.3 62.598 TD -0.0038 Tc -0.0483 Tw [(James, )53.7(A. \(1988\). Perceptions of stress in British )50.6(Ambulance)]TJ 1.2 -1.398 TD -0.004 Tc 0 Tw (Personnel. )Tj /TT5 1 Tf 4.344 0 TD -0.0059 Tc -0.0589 Tw [(W)92.1(o)-1.2(rk S)33.1(t)1.1(r)27.1(ess)]TJ /TT2 1 Tf 4.536 0 TD 0.001 Tc 0 Tw (, )Tj /TT5 1 Tf 0.441 0 TD -0.006 Tc (2,)Tj /TT2 1 Tf 0.744 0 TD -0.0047 Tc -0.0601 Tw [( 319-326.)]TJ -11.265 -1.8 TD -0.0042 Tc -0.0624 Tw [(Mahony)58.8(, K.L. \(2001\). Management and the creation of occu-)]TJ 1.2 -1.401 TD -0.0039 Tc 0.0396 Tw [(pational stressors in an )50.3(Australian and a UK )53.3(Ambulance)]TJ T* -0.0048 Tc 0 Tw (Service)Tj /TT5 1 Tf 2.97 0 TD 0 Tc (.)Tj /TT2 1 Tf 0.249 0 TD ( )Tj /TT5 1 Tf 0.216 0 TD -0.0042 Tc -0.04 Tw [(Australian Health Review)70.8(,)]TJ /TT2 1 Tf 10.329 0 TD 0 Tc 0 Tw ( )Tj /TT5 1 Tf 0.21 0 TD -0.0055 Tc (24,)Tj /TT2 1 Tf 1.242 0 TD -0.0042 Tc -0.0401 Tw [( 135-144.)]TJ -16.416 -1.8 TD -0.0032 Tc -0.0133 Tw [(Marmar)35.8(, C.R., )18.3(W)94.6(eiss, D.S., Metzler)35.8(, )18.2(T)79.6(.J., Ronfeldt, H.M., &)]TJ 1.2 -1.398 TD -0.0034 Tc 0.05 Tw (Foreman, C. \(1996\). Stress response of Emergency Ser-)Tj 0 -1.401 TD -0.0037 Tc -0.0057 Tw (vices personnel to Loma Prieta earthquake Interstate 880)Tj T* -0.0047 Tc -0.0625 Tw (Freeway Collapse and Control Traumatic Incidents. )Tj /TT5 1 Tf 20.361 0 TD -0.0068 Tc 0 Tw (Jour-)Tj -20.361 -1.398 TD -0.0042 Tc -0.0299 Tw [(nal of T)49.8(raumatic S)31.8(t)2.8(r)28.8(ess,)]TJ /TT2 1 Tf 9.309 0 TD 0 Tc 0 Tw ( )Tj /TT5 1 Tf 0.222 0 TD -0.006 Tc (9,)Tj /TT2 1 Tf 0.744 0 TD -0.0038 Tc -0.035 Tw [( 63-85.)]TJ -11.475 -1.8 TD -0.0064 Tc -0.0624 Tw [(Mitchell, J.T)68.6(. \(1988\). 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Critical)]TJ 1.2 -1.401 TD -0.0036 Tc 0.109 Tw [(incident exposure in South )50.2(African emer)17.4(gency services)]TJ T* 0.0007 Tc 0.125 Tw (personnel: prevalence and associated mental health is-)Tj 0 -1.398 TD -0.0032 Tc 0 Tw (sues. )Tj /TT5 1 Tf 2.211 0 TD -0.0043 Tc 0.0075 Tw (Emergency Medicine Journal)Tj /TT2 1 Tf 11.733 0 TD 0 Tc 0 Tw (,)Tj /TT5 1 Tf 0.252 0 TD -0.0025 Tc 0.0075 Tw [( 23, )]TJ /TT2 1 Tf 1.755 0 TD -0.0049 Tc 0 Tw (226-231.)Tj /TT5 1 Tf -2.601 -6.03 TD -0.0038 Tc 0.0767 Tw (Received June 7, 2007)Tj -0.975 -1.752 TD 0.0899 Tw [(Accepted August 9, 2007)]TJ ET endstream endobj 236 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 237 0 obj << /Length 747 >> stream ChevronJournalAd_CSPfP.pdf endstream endobj 240 0 obj << /Length 415107 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.0875 Tw [(224 )]TJ /TT3 1 Tf 2.7375 0 TD -0.0053 Tc 0.0881 Tw (Gallagher & McGilloway The Impact of Critical Incidents on Frontline Ambulance Personnel)Tj /TT10 1 Tf 10 0 0 10 311.16 279.51 Tm 0.0482 Tc 0.275 Tw (Catalog #DVDSPP)Tj -0.03 0 TD (Catalog #DVDSPP)Tj 0.03 0.03 TD (Catalog #DVDSPP)Tj -0.03 0 TD (Catalog #DVDSPP)Tj 0.015 -0.015 TD (Catalog #DVDSPP)Tj 0.015 -1.116 TD 0.0576 Tc 0 Tw (\(DVD\))Tj -0.03 0 TD (\(DVD\))Tj 0.03 0.03 TD (\(DVD\))Tj -0.03 0 TD (\(DVD\))Tj 0.015 -0.015 TD (\(DVD\))Tj /F11 1 Tf 11 0 0 11 311.01 251.64 Tm -0.1336 Tc ($40.00)Tj /TT3 1 Tf 14 0 0 14 311.01 234.36 Tm -0.0042 Tc 0.1381 Tw (CISM Strategic Planning for)Tj 0 -1.1443 TD 0.0145 Tc 0 Tw (Practitioners)Tj /F27 1 Tf 10 0 0 10 311.01 198.99 Tm -0.0035 Tc 0.0833 Tw (Provides an overview of the steps and elements for CISM)Tj 0 -1.2 TD -0.0034 Tc -0.0338 Tw [(Strategic Planning offers detailed information about the)]TJ T* -0.0027 Tc 0.095 Tw (strategic planning process and includes three interactive)Tj T* -0.0033 Tc -0.015 Tw (exercises to review and apply strategic planning principles.)Tj /TT10 1 Tf -2.835 46.05 TD 0.0486 Tc 0.335 Tw (Catalog #MIT5)Tj -0.03 0 TD (Catalog #MIT5)Tj 0.03 0.03 TD (Catalog #MIT5)Tj -0.03 0 TD (Catalog #MIT5)Tj 0.015 -0.015 TD (Catalog #MIT5)Tj 0.015 -1.113 TD 0.048 Tc 0.23 Tw (Paperback 186pp \(2007\))Tj -0.03 0 TD (Paperback 186pp \(2007\))Tj 0.03 0.03 TD (Paperback 186pp \(2007\))Tj -0.03 0 TD (Paperback 186pp \(2007\))Tj 0.015 -0.015 TD (Paperback 186pp \(2007\))Tj 0.015 -1.116 TD 0.0471 Tc 0.865 Tw (ISBN 1)Tj -0.03 0 TD (ISBN 1)Tj 0.03 0.03 TD (ISBN 1)Tj -0.03 0 TD (ISBN 1)Tj 0.015 -0.015 TD (ISBN 1)Tj 3.705 -0.015 TD 0.0481 Tc 0 Tw (3:9)Tj -0.03 0 TD (3:9)Tj 0.03 0.03 TD (3:9)Tj -0.03 0 TD (3:9)Tj 0.015 -0.015 TD (3:9)Tj 1.374 -0.015 TD 0.0473 Tc (78-1-88358)Tj -0.03 0 TD (78-1-88358)Tj 0.03 0.03 TD (78-1-88358)Tj -0.03 0 TD (78-1-88358)Tj 0.015 -0.015 TD (78-1-88358)Tj 5.109 -0.015 TD 0.0465 Tc (1-2)Tj -0.03 0 TD (1-2)Tj 0.03 0.03 TD (1-2)Tj -0.03 0 TD (1-2)Tj 0.015 -0.015 TD (1-2)Tj 1.44 -0.015 TD (4-4)Tj -0.03 0 TD (4-4)Tj 0.03 0.03 TD (4-4)Tj -0.03 0 TD (4-4)Tj 0.015 -0.015 TD (4-4)Tj /F11 1 Tf 11 0 0 11 282.51 584.64 Tm 0.0164 Tc ($30.00)Tj /TT3 1 Tf 14 0 0 14 282.51 568.65 Tm 0.0016 Tc 0.1375 Tw (Group Crisis Support)Tj 0 -1.0007 TD -0.0051 Tc 0.0875 Tw (Why it works)Tj 0 -1.0929 TD 0.0921 Tw (When & How to provide it)Tj /F28 1 Tf 12 0 0 12 282.51 525.36 Tm -0.0033 Tc -0.0514 Tw (Jeffrey T. Mitchell, PhD)Tj /F29 1 Tf 10 0 0 10 282.51 513 Tm -0.0035 Tc -0.0533 Tw (Group Crisis Support )Tj /F27 1 Tf 6.879 0 TD -0.0478 Tw (is a straightforward, practical guidebook for anyone providing)Tj -6.879 -1.2 TD -0.0034 Tc -0.02 Tw [(either crucial information or crisis support services to distressed groups. More than)]TJ T* 0.028 Tw (a hundred years of sound crisis intervention theory and positive-outcome research)Tj T* -0.0036 Tc 0.0143 Tw (back up the guidelines in the book. )Tj /F29 1 Tf 11.559 0 TD 0.0175 Tw (Group Crisis Support)Tj /F27 1 Tf 6.855 0 TD 0.015 Tw [( provides valuable infor)71.5(-)]TJ -18.414 -1.2 TD 0.0019 Tc 0.095 Tw (mation for those recently trained as well as the more experienced peer support)Tj T* -0.0033 Tc 0.02 Tw [(personnel and crisis intervention professionals. 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Mitchell)]TJ ET q 70.55 654.3 194.45 -297.3 re W n /Fm10 Do Q BT 14 0 0 14 140.4 101.01 Tm /GS2 gs -0.0009 Tc 0.1127 Tw (Order by phone, Monday-Friday, 9-5 EST, \(410\) 740-0065)Tj 10.0971 -1.0714 TD -0.0051 Tc 0.0262 Tw [( or )]TJ -8.7321 -1.0714 TD 0.0045 Tc 0.1125 Tw (Order online 24/7 at www.chevronpublishing.com)Tj ET 0.99 w 1000 M /GS1 gs 103.495 307.705 186.21 -161.71 re S /EmbeddedDocument /MC2 BDC q /RelativeColorimetric ri 0 0 0 0.2 k /GS3 gs 160.976 289.299 127.694 -58.433 re f 0 0 0 0.8 k 104.33 163.751 184.34 -17.11 re f 0 0 0 1 k 104.33 230.866 56.646 -67.115 re f 0 0 0 0.8 k 104.33 307.181 56.646 -17.881 re f 0 0 0 0.4 k 119.376 222.383 m 119.517 222.383 119.639 222.333 119.74 222.233 c 119.842 222.133 119.892 222.014 119.892 221.875 c 119.892 221.729 119.844 221.608 119.747 221.51 c 119.651 221.411 119.53 221.363 119.385 221.363 c 119.249 221.363 119.129 221.413 119.025 221.514 c 118.921 221.615 118.869 221.736 118.869 221.875 c 118.869 222.008 118.921 222.126 119.023 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219.557 150.018 219.175 150.018 218.668 c 150.018 216.178 l 149.148 216.178 l 149.148 218.88 l 149.148 219.199 149.071 219.456 148.915 219.651 c 148.758 219.846 148.552 219.943 148.296 219.943 c 148.108 219.943 147.93 219.894 147.762 219.796 c 147.595 219.698 147.41 219.535 147.209 219.307 c 147.209 216.178 l 146.339 216.178 l 146.339 222.805 l f 151.563 218.806 m 153.75 218.806 l 153.728 219.151 153.626 219.417 153.444 219.604 c 153.26 219.791 153.015 219.885 152.706 219.885 c 152.398 219.885 152.145 219.791 151.948 219.604 c 151.752 219.417 151.623 219.151 151.563 218.806 c h 154.608 218.29 m 151.54 218.29 l 151.562 217.87 151.702 217.537 151.96 217.289 c 152.218 217.041 152.552 216.918 152.96 216.918 c 153.53 216.918 154.056 217.093 154.537 217.445 c 154.537 216.601 l 154.271 216.424 154.007 216.298 153.746 216.222 c 153.484 216.146 153.176 216.108 152.825 216.108 c 152.343 216.108 151.953 216.208 151.655 216.408 c 151.357 216.607 151.118 216.876 150.939 217.213 c 150.759 217.551 150.67 217.943 150.67 218.386 c 150.67 219.052 150.858 219.593 151.236 220.01 c 151.612 220.426 152.102 220.635 152.703 220.635 c 153.283 220.635 153.745 220.432 154.09 220.027 c 154.435 219.622 154.608 219.079 154.608 218.399 c 154.608 218.29 l f 155.573 222.805 0.87 -6.627 re f 157.514 222.805 0.87 -6.627 re f 0 0 0 0.8 k 143.126 275.364 m 142.889 275.25 142.326 275.109 141.613 275.109 c 139.564 275.109 138.509 276.39 138.509 278.084 c 138.509 280.102 139.951 281.216 141.745 281.216 c 142.44 281.216 142.968 281.075 143.205 280.953 c 142.924 279.9 l 142.66 280.014 142.282 280.119 141.798 280.119 c 140.743 280.119 139.916 279.479 139.916 278.154 c 139.916 276.969 140.62 276.224 141.807 276.224 c 142.22 276.224 142.66 276.303 142.932 276.417 c 143.126 275.364 l f 144.023 281.119 1.337 -5.913 re f 146.564 276.575 m 146.916 276.39 147.479 276.206 148.05 276.206 c 148.666 276.206 148.991 276.461 148.991 276.855 c 148.991 277.215 148.71 277.434 147.997 277.68 c 147.012 278.031 146.362 278.575 146.362 279.444 c 146.362 280.453 147.215 281.216 148.604 281.216 c 149.281 281.216 149.765 281.084 150.117 280.918 c 149.818 279.847 l 149.589 279.961 149.158 280.128 148.587 280.128 c 148.006 280.128 147.725 279.856 147.725 279.558 c 147.725 279.18 148.05 279.014 148.824 278.715 c 149.87 278.329 150.354 277.785 150.354 276.943 c 150.354 275.952 149.598 275.109 147.971 275.109 c 147.294 275.109 146.626 275.294 146.291 275.478 c 146.564 276.575 l f 156.281 277.47 m 156.255 278.18 156.228 279.031 156.228 279.9 c 156.211 279.9 l 156.017 279.145 155.771 278.303 155.542 277.61 c 154.821 275.302 l 153.775 275.302 l 153.142 277.584 l 152.948 278.285 152.755 279.119 152.605 279.9 c 152.588 279.9 l 152.561 279.101 152.526 278.189 152.491 277.452 c 152.377 275.206 l 151.137 275.206 l 151.515 281.119 l 153.3 281.119 l 153.88 279.137 l 154.074 278.461 154.25 277.724 154.382 277.031 c 154.417 277.031 l 154.575 277.715 154.777 278.487 154.979 279.154 c 155.604 281.119 l 157.363 281.119 l 157.679 275.206 l 156.378 275.206 l 156.281 277.47 l f 123.402 267.801 m 123.754 267.617 124.317 267.432 124.888 267.432 c 125.504 267.432 125.829 267.687 125.829 268.082 c 125.829 268.441 125.548 268.661 124.836 268.906 c 123.851 269.257 123.2 269.801 123.2 270.67 c 123.2 271.679 124.053 272.442 125.442 272.442 c 126.119 272.442 126.603 272.311 126.955 272.144 c 126.656 271.074 l 126.427 271.188 125.996 271.354 125.425 271.354 c 124.844 271.354 124.563 271.082 124.563 270.784 c 124.563 270.407 124.888 270.24 125.662 269.942 c 126.709 269.556 127.192 269.012 127.192 268.169 c 127.192 267.178 126.436 266.336 124.809 266.336 c 124.132 266.336 123.464 266.52 123.13 266.704 c 123.402 267.801 l f 129.514 271.889 m 129.514 270.723 l 130.472 270.723 l 130.472 269.74 l 129.514 269.74 l 129.514 268.178 l 129.514 267.661 129.646 267.424 130.041 267.424 c 130.226 267.424 130.314 267.432 130.437 267.459 c 130.446 266.45 l 130.279 266.388 129.953 266.336 129.584 266.336 c 129.153 266.336 128.793 266.485 128.573 266.704 c 128.327 266.959 128.203 267.371 128.203 267.976 c 128.203 269.74 l 127.632 269.74 l 127.632 270.723 l 128.203 270.723 l 128.203 271.53 l 129.514 271.889 l f 131.255 269.31 m 131.255 269.942 131.246 270.354 131.22 270.723 c 132.363 270.723 l 132.416 269.924 l 132.451 269.924 l 132.671 270.556 133.189 270.819 133.611 270.819 c 133.735 270.819 133.796 270.81 133.893 270.793 c 133.893 269.538 l 133.779 269.556 133.673 269.573 133.524 269.573 c 133.031 269.573 132.697 269.319 132.609 268.898 c 132.591 268.81 132.583 268.713 132.583 268.599 c 132.583 266.432 l 131.246 266.432 l 131.255 269.31 l f 136.777 268.459 m 136.074 268.459 135.529 268.292 135.529 267.783 c 135.529 267.441 135.757 267.274 136.056 267.274 c 136.381 267.274 136.663 267.494 136.751 267.766 c 136.768 267.836 136.777 267.915 136.777 267.994 c 136.777 268.459 l h 138.07 267.468 m 138.07 267.064 138.088 266.669 138.14 266.432 c 136.936 266.432 l 136.856 266.862 l 136.83 266.862 l 136.549 266.52 136.109 266.336 135.599 266.336 c 134.728 266.336 134.21 266.967 134.21 267.652 c 134.21 268.766 135.212 269.292 136.733 269.292 c 136.733 269.345 l 136.733 269.573 136.61 269.898 135.951 269.898 c 135.511 269.898 135.045 269.749 134.763 269.582 c 134.517 270.433 l 134.816 270.6 135.405 270.819 136.188 270.819 c 137.621 270.819 138.07 269.977 138.07 268.968 c 138.07 267.468 l f 140.558 271.889 m 140.558 270.723 l 141.517 270.723 l 141.517 269.74 l 140.558 269.74 l 140.558 268.178 l 140.558 267.661 140.69 267.424 141.086 267.424 c 141.271 267.424 141.359 267.432 141.482 267.459 c 141.491 266.45 l 141.324 266.388 140.998 266.336 140.629 266.336 c 140.198 266.336 139.837 266.485 139.618 266.704 c 139.371 266.959 139.248 267.371 139.248 267.976 c 139.248 269.74 l 138.677 269.74 l 138.677 270.723 l 139.248 270.723 l 139.248 271.53 l 140.558 271.889 l f 144.85 269.073 m 144.85 269.389 144.709 269.942 144.102 269.942 c 143.531 269.942 143.302 269.424 143.267 269.073 c 144.85 269.073 l h 143.276 268.161 m 143.32 267.599 143.865 267.336 144.489 267.336 c 144.947 267.336 145.316 267.397 145.676 267.52 c 145.852 266.617 l 145.413 266.432 144.876 266.344 144.296 266.344 c 142.836 266.344 142.001 267.187 142.001 268.538 c 142.001 269.626 142.687 270.828 144.173 270.828 c 145.562 270.828 146.09 269.749 146.09 268.687 c 146.09 268.459 146.063 268.257 146.046 268.152 c 143.276 268.161 l f 149.625 268.977 m 149.625 269.056 149.616 269.143 149.598 269.222 c 149.502 269.573 149.247 269.81 148.877 269.81 c 148.385 269.81 147.998 269.372 147.998 268.591 c 147.998 267.95 148.314 267.45 148.868 267.45 c 149.22 267.45 149.493 267.678 149.581 267.985 c 149.616 268.091 149.625 268.231 149.625 268.345 c 149.625 268.977 l h 150.961 267.055 m 150.961 266.231 150.794 265.555 150.302 265.125 c 149.836 264.721 149.194 264.599 148.561 264.599 c 147.989 264.599 147.4 264.713 147.013 264.923 c 147.277 265.941 l 147.549 265.783 148.016 265.616 148.526 265.616 c 149.159 265.616 149.642 265.95 149.642 266.748 c 149.642 267.02 l 149.625 267.02 l 149.37 266.669 148.956 266.467 148.464 266.467 c 147.4 266.467 146.644 267.327 146.644 268.555 c 146.644 269.942 147.532 270.819 148.596 270.819 c 149.185 270.819 149.554 270.565 149.774 270.214 c 149.792 270.214 l 149.836 270.723 l 150.996 270.723 l 150.979 270.442 150.961 270.082 150.961 269.442 c 150.961 267.055 l f 152.034 270.723 1.337 -4.29 re 152.694 271.284 m 152.245 271.284 151.955 271.6 151.955 271.995 c 151.955 272.398 152.254 272.706 152.711 272.706 c 153.168 272.706 153.45 272.398 153.459 271.995 c 153.459 271.6 153.168 271.284 152.702 271.284 c 152.694 271.284 l f 157.671 266.538 m 157.433 266.424 156.985 266.336 156.475 266.336 c 155.085 266.336 154.197 267.187 154.197 268.538 c 154.197 269.793 155.059 270.819 156.659 270.819 c 157.011 270.819 157.398 270.758 157.679 270.652 c 157.468 269.661 l 157.31 269.731 157.073 269.793 156.721 269.793 c 156.017 269.793 155.56 269.292 155.569 268.591 c 155.569 267.801 156.097 267.38 156.747 267.38 c 157.064 267.38 157.31 267.432 157.512 267.52 c 157.671 266.538 l f 124.862 260.808 m 124.976 260.782 125.117 260.773 125.31 260.773 c 126.022 260.773 126.462 261.133 126.462 261.73 c 126.462 262.274 126.093 262.598 125.416 262.598 c 125.143 262.598 124.958 262.581 124.862 262.554 c 124.862 260.808 l h 123.534 263.493 m 123.947 263.563 124.528 263.616 125.345 263.616 c 126.172 263.616 126.77 263.458 127.166 263.133 c 127.544 262.844 127.79 262.353 127.79 261.773 c 127.79 261.186 127.605 260.694 127.254 260.37 c 126.796 259.949 126.11 259.747 125.319 259.747 c 125.143 259.747 124.985 259.755 124.862 259.782 c 124.862 257.659 l 123.534 257.659 l 123.534 263.493 l f 128.581 263.888 1.337 -6.229 re f 133.277 259.685 m 132.574 259.685 132.028 259.519 132.028 259.01 c 132.028 258.668 132.257 258.501 132.556 258.501 c 132.881 258.501 133.163 258.72 133.251 258.992 c 133.268 259.062 133.277 259.141 133.277 259.22 c 133.277 259.685 l h 134.57 258.694 m 134.57 258.29 134.587 257.895 134.64 257.659 c 133.435 257.659 l 133.356 258.089 l 133.33 258.089 l 133.048 257.746 132.609 257.562 132.099 257.562 c 131.228 257.562 130.709 258.194 130.709 258.878 c 130.709 259.992 131.712 260.519 133.233 260.519 c 133.233 260.572 l 133.233 260.8 133.11 261.124 132.45 261.124 c 132.011 261.124 131.545 260.975 131.263 260.808 c 131.017 261.659 l 131.316 261.826 131.905 262.046 132.688 262.046 c 134.121 262.046 134.57 261.203 134.57 260.194 c 134.57 258.694 l f 135.634 260.58 m 135.634 261.116 135.616 261.563 135.599 261.949 c 136.759 261.949 l 136.821 261.352 l 136.847 261.352 l 137.023 261.633 137.454 262.046 138.175 262.046 c 139.054 262.046 139.714 261.458 139.714 260.194 c 139.714 257.659 l 138.377 257.659 l 138.377 260.036 l 138.377 260.589 138.184 260.966 137.7 260.966 c 137.331 260.966 137.111 260.712 137.014 260.466 c 136.979 260.379 136.97 260.256 136.97 260.133 c 136.97 257.659 l 135.634 257.659 l 135.634 260.58 l f 140.787 260.58 m 140.787 261.116 140.769 261.563 140.752 261.949 c 141.912 261.949 l 141.974 261.352 l 142 261.352 l 142.176 261.633 142.607 262.046 143.328 262.046 c 144.207 262.046 144.867 261.458 144.867 260.194 c 144.867 257.659 l 143.53 257.659 l 143.53 260.036 l 143.53 260.589 143.337 260.966 142.853 260.966 c 142.484 260.966 142.264 260.712 142.167 260.466 c 142.132 260.379 142.123 260.256 142.123 260.133 c 142.123 257.659 l 140.787 257.659 l 140.787 260.58 l f 145.94 261.949 1.337 -4.29 re 146.599 262.51 m 146.151 262.51 145.861 262.826 145.861 263.221 c 145.861 263.625 146.16 263.932 146.617 263.932 c 147.074 263.932 147.356 263.625 147.364 263.221 c 147.364 262.826 147.074 262.51 146.608 262.51 c 146.599 262.51 l f 148.349 260.58 m 148.349 261.116 148.332 261.563 148.314 261.949 c 149.475 261.949 l 149.536 261.352 l 149.563 261.352 l 149.739 261.633 150.169 262.046 150.891 262.046 c 151.77 262.046 152.429 261.458 152.429 260.194 c 152.429 257.659 l 151.093 257.659 l 151.093 260.036 l 151.093 260.589 150.899 260.966 150.416 260.966 c 150.046 260.966 149.827 260.712 149.73 260.466 c 149.694 260.379 149.686 260.256 149.686 260.133 c 149.686 257.659 l 148.349 257.659 l 148.349 260.58 l f 156.237 260.203 m 156.237 260.282 156.228 260.37 156.211 260.449 c 156.114 260.8 155.859 261.036 155.489 261.036 c 154.997 261.036 154.61 260.598 154.61 259.817 c 154.61 259.176 154.927 258.676 155.481 258.676 c 155.832 258.676 156.105 258.905 156.193 259.212 c 156.228 259.317 156.237 259.457 156.237 259.571 c 156.237 260.203 l h 157.574 258.281 m 157.574 257.457 157.407 256.781 156.914 256.351 c 156.448 255.948 155.806 255.825 155.173 255.825 c 154.601 255.825 154.012 255.939 153.625 256.15 c 153.889 257.167 l 154.162 257.009 154.628 256.843 155.138 256.843 c 155.771 256.843 156.255 257.176 156.255 257.975 c 156.255 258.246 l 156.237 258.246 l 155.982 257.895 155.569 257.694 155.076 257.694 c 154.012 257.694 153.256 258.554 153.256 259.782 c 153.256 261.168 154.144 262.046 155.208 262.046 c 155.797 262.046 156.167 261.791 156.386 261.44 c 156.404 261.44 l 156.448 261.949 l 157.609 261.949 l 157.591 261.668 157.574 261.309 157.574 260.668 c 157.574 258.281 l f 147.408 248.885 m 147.408 252.193 l 146.837 252.193 l 146.837 253.175 l 147.408 253.175 l 147.408 253.342 l 147.408 253.86 147.567 254.43 147.945 254.781 c 148.288 255.097 148.745 255.211 149.141 255.211 c 149.431 255.211 149.66 255.167 149.844 255.123 c 149.792 254.097 l 149.677 254.132 149.536 254.158 149.361 254.158 c 148.921 254.158 148.736 253.816 148.736 253.395 c 148.736 253.175 l 149.598 253.175 l 149.598 252.193 l 148.745 252.193 l 148.745 248.885 l 147.408 248.885 l f 152.183 249.745 m 152.711 249.745 153.036 250.263 153.036 251.035 c 153.036 251.666 152.79 252.316 152.183 252.316 c 151.55 252.316 151.304 251.666 151.304 251.026 c 151.304 250.298 151.612 249.745 152.175 249.745 c 152.183 249.745 l h 152.157 248.789 m 150.899 248.789 149.932 249.613 149.932 251 c 149.932 252.386 150.847 253.272 152.236 253.272 c 153.546 253.272 154.426 252.368 154.426 251.07 c 154.426 249.508 153.309 248.789 152.166 248.789 c 152.157 248.789 l f 155.261 251.763 m 155.261 252.394 155.252 252.807 155.226 253.175 c 156.369 253.175 l 156.422 252.377 l 156.457 252.377 l 156.677 253.009 157.196 253.272 157.618 253.272 c 157.741 253.272 157.802 253.263 157.899 253.246 c 157.899 251.991 l 157.785 252.008 157.679 252.026 157.53 252.026 c 157.037 252.026 156.703 251.772 156.615 251.35 c 156.598 251.263 156.589 251.166 156.589 251.052 c 156.589 248.885 l 155.252 248.885 l 155.261 251.763 l f 109.676 243.261 m 109.79 243.235 109.931 243.226 110.124 243.226 c 110.836 243.226 111.276 243.586 111.276 244.182 c 111.276 244.726 110.907 245.051 110.23 245.051 c 109.957 245.051 109.772 245.033 109.676 245.007 c 109.676 243.261 l h 108.348 245.946 m 108.761 246.016 109.341 246.069 110.159 246.069 c 110.986 246.069 111.584 245.911 111.98 245.586 c 112.358 245.297 112.604 244.805 112.604 244.226 c 112.604 243.638 112.419 243.147 112.068 242.822 c 111.61 242.401 110.924 242.199 110.133 242.199 c 109.957 242.199 109.799 242.208 109.676 242.234 c 109.676 240.111 l 108.348 240.111 l 108.348 245.946 l f 113.343 242.989 m 113.343 243.621 113.334 244.033 113.308 244.402 c 114.451 244.402 l 114.503 243.603 l 114.539 243.603 l 114.758 244.235 115.277 244.498 115.699 244.498 c 115.823 244.498 115.884 244.489 115.981 244.472 c 115.981 243.217 l 115.866 243.235 115.761 243.252 115.611 243.252 c 115.119 243.252 114.785 242.998 114.697 242.577 c 114.679 242.489 114.671 242.392 114.671 242.278 c 114.671 240.111 l 113.334 240.111 l 113.343 242.989 l f 118.865 242.138 m 118.162 242.138 117.616 241.971 117.616 241.462 c 117.616 241.12 117.845 240.954 118.144 240.954 c 118.469 240.954 118.751 241.173 118.839 241.445 c 118.856 241.515 118.865 241.594 118.865 241.673 c 118.865 242.138 l h 120.158 241.147 m 120.158 240.743 120.175 240.348 120.228 240.111 c 119.023 240.111 l 118.944 240.541 l 118.918 240.541 l 118.636 240.199 118.197 240.015 117.687 240.015 c 116.816 240.015 116.297 240.647 116.297 241.331 c 116.297 242.445 117.3 242.971 118.821 242.971 c 118.821 243.024 l 118.821 243.252 118.698 243.577 118.038 243.577 c 117.599 243.577 117.133 243.428 116.851 243.261 c 116.605 244.112 l 116.904 244.279 117.493 244.498 118.276 244.498 c 119.709 244.498 120.158 243.656 120.158 242.647 c 120.158 241.147 l f 124.449 240.217 m 124.212 240.103 123.763 240.015 123.253 240.015 c 121.864 240.015 120.976 240.866 120.976 242.217 c 120.976 243.472 121.837 244.498 123.438 244.498 c 123.789 244.498 124.177 244.437 124.458 244.331 c 124.247 243.34 l 124.089 243.41 123.851 243.472 123.499 243.472 c 122.796 243.472 122.339 242.971 122.347 242.27 c 122.347 241.48 122.875 241.059 123.526 241.059 c 123.842 241.059 124.089 241.111 124.291 241.199 c 124.449 240.217 l f 126.823 245.568 m 126.823 244.402 l 127.782 244.402 l 127.782 243.419 l 126.823 243.419 l 126.823 241.857 l 126.823 241.34 126.955 241.103 127.351 241.103 c 127.535 241.103 127.623 241.111 127.746 241.138 c 127.755 240.129 l 127.588 240.067 127.263 240.015 126.893 240.015 c 126.463 240.015 126.102 240.164 125.882 240.383 c 125.636 240.638 125.513 241.05 125.513 241.655 c 125.513 243.419 l 124.941 243.419 l 124.941 244.402 l 125.513 244.402 l 125.513 245.209 l 126.823 245.568 l f 128.555 244.402 1.337 -4.29 re 129.215 244.963 m 128.766 244.963 128.476 245.279 128.476 245.674 c 128.476 246.077 128.775 246.385 129.233 246.385 c 129.69 246.385 129.971 246.077 129.98 245.674 c 129.98 245.279 129.69 244.963 129.224 244.963 c 129.215 244.963 l f 132.46 245.568 m 132.46 244.402 l 133.418 244.402 l 133.418 243.419 l 132.46 243.419 l 132.46 241.857 l 132.46 241.34 132.592 241.103 132.987 241.103 c 133.172 241.103 133.26 241.111 133.383 241.138 c 133.392 240.129 l 133.225 240.067 132.899 240.015 132.53 240.015 c 132.099 240.015 131.739 240.164 131.519 240.383 c 131.272 240.638 131.149 241.05 131.149 241.655 c 131.149 243.419 l 130.578 243.419 l 130.578 244.402 l 131.149 244.402 l 131.149 245.209 l 132.46 245.568 l f 134.192 244.402 1.337 -4.29 re 134.851 244.963 m 134.403 244.963 134.113 245.279 134.113 245.674 c 134.113 246.077 134.412 246.385 134.869 246.385 c 135.326 246.385 135.608 246.077 135.616 245.674 c 135.616 245.279 135.326 244.963 134.86 244.963 c 134.851 244.963 l f 138.606 240.971 m 139.134 240.971 139.459 241.489 139.459 242.261 c 139.459 242.893 139.213 243.542 138.606 243.542 c 137.973 243.542 137.727 242.893 137.727 242.252 c 137.727 241.524 138.035 240.971 138.597 240.971 c 138.606 240.971 l h 138.58 240.015 m 137.322 240.015 136.355 240.84 136.355 242.226 c 136.355 243.612 137.27 244.498 138.659 244.498 c 139.969 244.498 140.849 243.594 140.849 242.296 c 140.849 240.734 139.732 240.015 138.589 240.015 c 138.58 240.015 l f 141.675 243.033 m 141.675 243.568 141.658 244.016 141.64 244.402 c 142.801 244.402 l 142.862 243.805 l 142.889 243.805 l 143.065 244.086 143.495 244.498 144.217 244.498 c 145.096 244.498 145.755 243.91 145.755 242.647 c 145.755 240.111 l 144.419 240.111 l 144.419 242.489 l 144.419 243.042 144.225 243.419 143.742 243.419 c 143.372 243.419 143.153 243.164 143.056 242.919 c 143.021 242.831 143.012 242.708 143.012 242.585 c 143.012 240.111 l 141.675 240.111 l 141.675 243.033 l f 149.431 242.752 m 149.431 243.068 149.29 243.621 148.684 243.621 c 148.112 243.621 147.883 243.103 147.848 242.752 c 149.431 242.752 l h 147.857 241.84 m 147.901 241.278 148.446 241.015 149.07 241.015 c 149.528 241.015 149.897 241.076 150.258 241.199 c 150.434 240.296 l 149.994 240.111 149.457 240.023 148.877 240.023 c 147.417 240.023 146.582 240.866 146.582 242.217 c 146.582 243.305 147.268 244.507 148.754 244.507 c 150.143 244.507 150.671 243.428 150.671 242.366 c 150.671 242.138 150.645 241.936 150.627 241.831 c 147.857 241.84 l f 151.48 242.989 m 151.48 243.621 151.471 244.033 151.445 244.402 c 152.588 244.402 l 152.641 243.603 l 152.676 243.603 l 152.896 244.235 153.415 244.498 153.837 244.498 c 153.96 244.498 154.021 244.489 154.118 244.472 c 154.118 243.217 l 154.004 243.235 153.898 243.252 153.749 243.252 c 153.256 243.252 152.922 242.998 152.834 242.577 c 152.817 242.489 152.808 242.392 152.808 242.278 c 152.808 240.111 l 151.471 240.111 l 151.48 242.989 l f 154.804 241.269 m 155.05 241.12 155.56 240.954 155.956 240.954 c 156.36 240.954 156.527 241.085 156.527 241.304 c 156.527 241.533 156.396 241.638 155.903 241.805 c 155.006 242.094 154.663 242.585 154.672 243.086 c 154.672 243.893 155.358 244.498 156.422 244.498 c 156.923 244.498 157.363 244.375 157.627 244.244 c 157.398 243.331 l 157.204 243.428 156.826 243.568 156.466 243.568 c 156.14 243.568 155.956 243.437 155.956 243.226 c 155.956 243.015 156.123 242.91 156.651 242.726 c 157.468 242.454 157.803 242.033 157.811 241.41 c 157.811 240.603 157.187 240.015 155.956 240.015 c 155.393 240.015 154.892 240.146 154.566 240.322 c 154.804 241.269 l f 0 0 0 1 k 167.786 276.794 m 167.545 277.616 l 167.481 277.846 167.412 278.139 167.354 278.363 c 167.337 278.363 l 167.285 278.133 167.222 277.84 167.164 277.616 c 166.928 276.794 l 167.786 276.794 l h 166.801 276.139 m 166.531 275.144 l 165.62 275.144 l 166.807 279.018 l 167.953 279.018 l 169.163 275.144 l 168.218 275.144 l 167.919 276.139 l 166.801 276.139 l f 170.54 275.144 m 170.897 277.041 l 170.966 277.398 171.012 277.702 171.047 277.955 c 171.778 277.955 l 171.727 277.49 l 171.738 277.49 l 172.003 277.852 172.354 278.018 172.723 278.018 c 173.184 278.018 173.449 277.737 173.449 277.248 c 173.449 277.122 173.426 276.915 173.403 276.777 c 173.092 275.144 l 172.262 275.144 l 172.556 276.702 l 172.573 276.8 172.585 276.909 172.585 277.012 c 172.585 277.214 172.516 277.352 172.303 277.352 c 172.032 277.352 171.721 277.012 171.6 276.392 c 171.369 275.144 l 170.54 275.144 l f 175.713 277.179 m 175.713 277.317 175.598 277.415 175.407 277.415 c 175.022 277.415 174.802 277.093 174.745 276.834 c 175.39 276.828 175.713 276.915 175.713 277.173 c 175.713 277.179 l h 176.139 275.305 m 175.811 275.139 175.402 275.081 175.091 275.081 c 174.284 275.081 173.869 275.535 173.869 276.271 c 173.869 277.127 174.492 278.018 175.511 278.018 c 176.081 278.018 176.49 277.696 176.49 277.173 c 176.49 276.461 175.793 276.202 174.664 276.231 c 174.664 276.15 174.693 276.024 174.751 275.943 c 174.86 275.8 175.05 275.725 175.292 275.725 c 175.598 275.725 175.857 275.794 176.081 275.903 c 176.139 275.305 l f 177.689 277.955 m 177.694 276.76 l 177.7 276.443 177.689 276.179 177.671 275.869 c 177.683 275.869 l 177.781 276.168 177.908 276.449 178.023 276.731 c 178.582 277.955 l 179.255 277.955 l 179.325 276.771 l 179.342 276.438 179.354 276.168 179.336 275.869 c 179.354 275.869 l 179.445 276.179 179.544 276.455 179.659 276.782 c 180.143 277.955 l 180.978 277.955 l 179.607 275.144 l 178.829 275.144 l 178.749 276.122 l 178.725 276.415 178.725 276.685 178.725 277.018 c 178.708 277.018 l 178.559 276.622 178.495 276.415 178.374 276.162 c 177.896 275.144 l 177.118 275.144 l 176.853 277.955 l 177.689 277.955 l f 183.259 275.805 m 183.334 275.788 183.46 275.788 183.564 275.788 c 184.365 275.782 184.889 276.219 184.889 277.145 c 184.889 277.978 184.417 278.375 183.656 278.375 c 183.466 278.375 183.334 278.357 183.259 278.34 c 183.259 275.805 l h 182.383 278.961 m 182.706 279.018 183.126 279.047 183.564 279.047 c 184.307 279.047 184.791 278.926 185.16 278.645 c 185.563 278.346 185.816 277.863 185.816 277.173 c 185.816 276.432 185.546 275.92 185.177 275.604 c 184.768 275.265 184.14 275.104 183.38 275.104 c 182.925 275.104 182.596 275.133 182.383 275.162 c 182.383 278.961 l f 187.228 275.144 m 185.984 279.018 l 186.946 279.018 l 187.418 277.38 l 187.55 276.915 187.672 276.478 187.764 275.995 c 187.781 275.995 l 187.879 276.461 188 276.92 188.132 277.363 c 188.628 279.018 l 189.561 279.018 l 188.253 275.144 l 187.228 275.144 l f 190.851 275.805 m 190.926 275.788 191.053 275.788 191.156 275.788 c 191.957 275.782 192.481 276.219 192.481 277.145 c 192.481 277.978 192.009 278.375 191.249 278.375 c 191.059 278.375 190.926 278.357 190.851 278.34 c 190.851 275.805 l h 189.976 278.961 m 190.298 279.018 190.719 279.047 191.156 279.047 c 191.9 279.047 192.383 278.926 192.752 278.645 c 193.155 278.346 193.409 277.863 193.409 277.173 c 193.409 276.432 193.138 275.92 192.769 275.604 c 192.36 275.265 191.732 275.104 190.972 275.104 c 190.517 275.104 190.189 275.133 189.976 275.162 c 189.976 278.961 l f 195.223 275.144 m 195.223 277.311 l 194.849 277.311 l 194.849 277.955 l 195.223 277.955 l 195.223 278.064 l 195.223 278.403 195.327 278.777 195.575 279.007 c 195.799 279.214 196.099 279.288 196.358 279.288 c 196.549 279.288 196.698 279.26 196.819 279.231 c 196.785 278.558 l 196.71 278.582 196.618 278.599 196.502 278.599 c 196.214 278.599 196.093 278.375 196.093 278.099 c 196.093 277.955 l 196.658 277.955 l 196.658 277.311 l 196.099 277.311 l 196.099 275.144 l 195.223 275.144 l f 197.09 277.03 m 197.09 277.444 197.084 277.714 197.067 277.955 c 197.816 277.955 l 197.85 277.432 l 197.873 277.432 l 198.017 277.846 198.357 278.018 198.634 278.018 c 198.715 278.018 198.755 278.012 198.818 278.001 c 198.818 277.179 l 198.743 277.191 198.674 277.202 198.576 277.202 c 198.253 277.202 198.035 277.035 197.977 276.76 c 197.965 276.702 197.96 276.639 197.96 276.564 c 197.96 275.144 l 197.084 275.144 l 197.09 277.03 l f 200.546 275.708 m 200.892 275.708 201.105 276.047 201.105 276.553 c 201.105 276.966 200.944 277.392 200.546 277.392 c 200.132 277.392 199.97 276.966 199.97 276.547 c 199.97 276.07 200.172 275.708 200.54 275.708 c 200.546 275.708 l h 200.529 275.081 m 199.705 275.081 199.072 275.622 199.072 276.53 c 199.072 277.438 199.67 278.018 200.58 278.018 c 201.439 278.018 202.015 277.426 202.015 276.576 c 202.015 275.552 201.284 275.081 200.535 275.081 c 200.529 275.081 l f 202.557 277.058 m 202.557 277.409 202.545 277.702 202.534 277.955 c 203.277 277.955 l 203.311 277.57 l 203.329 277.57 l 203.449 277.754 203.703 278.018 204.181 278.018 c 204.55 278.018 204.832 277.829 204.953 277.535 c 204.965 277.535 l 205.074 277.685 205.195 277.8 205.333 277.88 c 205.489 277.966 205.662 278.018 205.869 278.018 c 206.41 278.018 206.82 277.639 206.82 276.8 c 206.82 275.144 l 205.967 275.144 l 205.967 276.668 l 205.967 277.076 205.835 277.311 205.552 277.311 c 205.345 277.311 205.207 277.173 205.143 277.007 c 205.126 276.944 205.115 276.857 205.115 276.788 c 205.115 275.144 l 204.262 275.144 l 204.262 276.719 l 204.262 277.07 204.135 277.311 203.853 277.311 c 203.628 277.311 203.496 277.139 203.444 277.001 c 203.415 276.932 203.409 276.852 203.409 276.777 c 203.409 275.144 l 202.557 275.144 l 202.557 277.058 l f 209.579 275.805 m 209.654 275.788 209.78 275.788 209.884 275.788 c 210.685 275.782 211.209 276.219 211.209 277.145 c 211.209 277.978 210.737 278.375 209.976 278.375 c 209.786 278.375 209.654 278.357 209.579 278.34 c 209.579 275.805 l h 208.703 278.961 m 209.026 279.018 209.446 279.047 209.884 279.047 c 210.627 279.047 211.111 278.926 211.48 278.645 c 211.883 278.346 212.137 277.863 212.137 277.173 c 212.137 276.432 211.866 275.92 211.497 275.604 c 211.088 275.265 210.46 275.104 209.7 275.104 c 209.245 275.104 208.916 275.133 208.703 275.162 c 208.703 278.961 l f 212.701 277.03 m 212.701 277.444 212.695 277.714 212.678 277.955 c 213.427 277.955 l 213.461 277.432 l 213.484 277.432 l 213.628 277.846 213.968 278.018 214.245 278.018 c 214.326 278.018 214.366 278.012 214.429 278.001 c 214.429 277.179 l 214.354 277.191 214.285 277.202 214.187 277.202 c 213.864 277.202 213.646 277.035 213.588 276.76 c 213.576 276.702 213.571 276.639 213.571 276.564 c 213.571 275.144 l 212.695 275.144 l 212.701 277.03 l f 214.954 275.081 m 214.66 275.081 214.447 275.305 214.447 275.61 c 214.447 275.926 214.66 276.144 214.965 276.144 c 215.265 276.144 215.472 275.932 215.478 275.61 c 215.478 275.305 215.27 275.081 214.959 275.081 c 214.954 275.081 l f 217.621 279.018 m 218.496 279.018 l 218.496 276.57 l 218.496 275.466 217.966 275.081 217.12 275.081 c 216.912 275.081 216.647 275.116 216.475 275.173 c 216.572 275.88 l 216.693 275.84 216.849 275.811 217.022 275.811 c 217.39 275.811 217.621 275.978 217.621 276.576 c 217.621 279.018 l f 220.893 276.874 m 220.893 277.081 220.8 277.444 220.403 277.444 c 220.028 277.444 219.879 277.104 219.856 276.874 c 220.893 276.874 l h 219.861 276.277 m 219.89 275.909 220.248 275.736 220.656 275.736 c 220.956 275.736 221.198 275.777 221.434 275.857 c 221.55 275.265 l 221.261 275.144 220.91 275.087 220.529 275.087 c 219.573 275.087 219.026 275.639 219.026 276.524 c 219.026 277.237 219.476 278.024 220.449 278.024 c 221.359 278.024 221.705 277.317 221.705 276.622 c 221.705 276.472 221.688 276.34 221.676 276.271 c 219.861 276.277 l f 222.333 275.144 m 222.333 277.311 l 221.958 277.311 l 221.958 277.955 l 222.333 277.955 l 222.333 278.064 l 222.333 278.403 222.437 278.777 222.684 279.007 c 222.908 279.214 223.208 279.288 223.467 279.288 c 223.658 279.288 223.807 279.26 223.929 279.231 c 223.894 278.558 l 223.819 278.582 223.727 278.599 223.612 278.599 c 223.324 278.599 223.202 278.375 223.202 278.099 c 223.202 277.955 l 223.767 277.955 l 223.767 277.311 l 223.208 277.311 l 223.208 275.144 l 222.333 275.144 l f 224.297 275.144 m 224.297 277.311 l 223.922 277.311 l 223.922 277.955 l 224.297 277.955 l 224.297 278.064 l 224.297 278.403 224.401 278.777 224.648 279.007 c 224.873 279.214 225.172 279.288 225.432 279.288 c 225.622 279.288 225.772 279.26 225.893 279.231 c 225.858 278.558 l 225.783 278.582 225.691 278.599 225.576 278.599 c 225.287 278.599 225.167 278.375 225.167 278.099 c 225.167 277.955 l 225.731 277.955 l 225.731 277.311 l 225.172 277.311 l 225.172 275.144 l 224.297 275.144 l f 230.634 276.627 m 230.617 277.093 230.599 277.65 230.599 278.219 c 230.587 278.219 l 230.461 277.725 230.3 277.173 230.15 276.719 c 229.677 275.208 l 228.992 275.208 l 228.577 276.702 l 228.45 277.162 228.324 277.708 228.226 278.219 c 228.214 278.219 l 228.197 277.696 228.174 277.099 228.151 276.616 c 228.076 275.144 l 227.264 275.144 l 227.511 279.018 l 228.681 279.018 l 229.061 277.719 l 229.188 277.277 229.303 276.794 229.389 276.34 c 229.412 276.34 l 229.516 276.788 229.649 277.294 229.781 277.731 c 230.191 279.018 l 231.342 279.018 l 231.55 275.144 l 230.697 275.144 l 230.634 276.627 l f 232.229 277.955 0.876 -2.811 re 232.661 278.323 m 232.368 278.323 232.178 278.53 232.178 278.788 c 232.178 279.053 232.373 279.254 232.673 279.254 c 232.973 279.254 233.157 279.053 233.163 278.788 c 233.163 278.53 232.973 278.323 232.667 278.323 c 232.661 278.323 l f 234.787 278.719 m 234.787 277.955 l 235.415 277.955 l 235.415 277.311 l 234.787 277.311 l 234.787 276.288 l 234.787 275.949 234.874 275.794 235.133 275.794 c 235.254 275.794 235.311 275.8 235.392 275.817 c 235.398 275.156 l 235.288 275.116 235.075 275.081 234.833 275.081 c 234.551 275.081 234.315 275.179 234.171 275.323 c 234.009 275.489 233.928 275.759 233.928 276.156 c 233.928 277.311 l 233.554 277.311 l 233.554 277.955 l 233.928 277.955 l 233.928 278.484 l 234.787 278.719 l f 238.007 275.213 m 237.851 275.139 237.558 275.081 237.224 275.081 c 236.314 275.081 235.732 275.639 235.732 276.524 c 235.732 277.346 236.296 278.018 237.344 278.018 c 237.575 278.018 237.829 277.978 238.013 277.909 c 237.874 277.26 l 237.771 277.306 237.616 277.346 237.385 277.346 c 236.924 277.346 236.624 277.018 236.631 276.558 c 236.631 276.041 236.976 275.765 237.403 275.765 c 237.609 275.765 237.771 275.8 237.903 275.857 c 238.007 275.213 l f 238.491 279.225 m 239.366 279.225 l 239.366 277.616 l 239.378 277.616 l 239.47 277.742 239.585 277.84 239.724 277.909 c 239.857 277.978 240.018 278.018 240.179 278.018 c 240.738 278.018 241.164 277.633 241.164 276.782 c 241.164 275.144 l 240.288 275.144 l 240.288 276.69 l 240.288 277.058 240.162 277.311 239.833 277.311 c 239.603 277.311 239.459 277.162 239.395 277.001 c 239.372 276.949 239.366 276.874 239.366 276.811 c 239.366 275.144 l 238.491 275.144 l 238.491 279.225 l f 243.572 276.874 m 243.572 277.081 243.479 277.444 243.083 277.444 c 242.707 277.444 242.558 277.104 242.535 276.874 c 243.572 276.874 l h 242.541 276.277 m 242.569 275.909 242.927 275.736 243.336 275.736 c 243.635 275.736 243.877 275.777 244.113 275.857 c 244.229 275.265 l 243.941 275.144 243.589 275.087 243.209 275.087 c 242.252 275.087 241.706 275.639 241.706 276.524 c 241.706 277.237 242.155 278.024 243.128 278.024 c 244.038 278.024 244.384 277.317 244.384 276.622 c 244.384 276.472 244.367 276.34 244.355 276.271 c 242.541 276.277 l f 244.908 279.225 0.876 -4.081 re f 246.487 279.225 0.876 -4.081 re f 171.226 269.112 m 170.988 269.112 170.793 269.303 170.793 269.548 c 170.789 269.788 170.988 269.983 171.23 269.983 c 171.471 269.983 171.667 269.793 171.667 269.548 c 171.667 269.307 171.471 269.112 171.23 269.112 c 171.226 269.112 l f 173.881 269.535 m 173.961 269.514 174.065 269.506 174.181 269.506 c 174.622 269.506 174.884 269.722 174.884 270.1 c 174.884 270.473 174.622 270.652 174.222 270.652 c 174.065 270.652 173.944 270.635 173.881 270.623 c 173.881 269.535 l h 173.52 270.88 m 173.694 270.913 173.923 270.938 174.214 270.938 c 174.572 270.938 174.834 270.855 175.001 270.706 c 175.154 270.573 175.25 270.37 175.25 270.121 c 175.25 269.867 175.175 269.668 175.03 269.523 c 174.838 269.319 174.526 269.216 174.173 269.216 c 174.065 269.216 173.965 269.22 173.881 269.24 c 173.881 268.12 l 173.52 268.12 l 173.52 270.88 l f 175.654 269.502 m 175.654 269.739 175.65 269.942 175.637 270.129 c 175.958 270.129 l 175.974 269.734 l 175.987 269.734 l 176.078 270.004 176.303 270.174 176.548 270.174 c 176.586 270.174 176.615 270.17 176.648 270.162 c 176.648 269.822 l 176.607 269.826 176.569 269.83 176.519 269.83 c 176.261 269.83 176.078 269.635 176.028 269.365 c 176.02 269.311 176.016 269.253 176.016 269.191 c 176.016 268.12 l 175.65 268.12 l 175.654 269.502 l f 177.817 268.348 m 178.167 268.348 178.429 268.676 178.429 269.133 c 178.429 269.473 178.258 269.901 177.826 269.901 c 177.397 269.901 177.21 269.502 177.21 269.12 c 177.21 268.68 177.459 268.348 177.813 268.348 c 177.817 268.348 l h 177.805 268.074 m 177.264 268.074 176.84 268.473 176.84 269.108 c 176.84 269.78 177.285 270.174 177.838 270.174 c 178.416 270.174 178.807 269.755 178.807 269.145 c 178.807 268.398 178.287 268.074 177.809 268.074 c 177.805 268.074 l f 179.373 270.129 m 179.768 269.004 l 179.835 268.817 179.889 268.651 179.931 268.485 c 179.943 268.485 l 179.989 268.651 180.047 268.817 180.114 269.004 c 180.505 270.129 l 180.888 270.129 l 180.097 268.12 l 179.747 268.12 l 178.982 270.129 l 179.373 270.129 l f 181.233 270.129 0.366 -2.009 re 181.408 270.498 m 181.27 270.498 181.179 270.606 181.179 270.735 c 181.179 270.863 181.274 270.967 181.416 270.967 c 181.557 270.967 181.649 270.863 181.649 270.735 c 181.649 270.606 181.557 270.498 181.412 270.498 c 181.408 270.498 l f 183.579 269.311 m 183.579 269.361 183.575 269.419 183.563 269.469 c 183.508 269.697 183.309 269.888 183.034 269.888 c 182.656 269.888 182.431 269.556 182.431 269.116 c 182.431 268.705 182.635 268.369 183.026 268.369 c 183.272 268.369 183.496 268.535 183.563 268.805 c 183.575 268.854 183.579 268.904 183.579 268.962 c 183.579 269.311 l h 183.945 271.067 m 183.945 268.639 l 183.945 268.46 183.949 268.257 183.962 268.12 c 183.633 268.12 l 183.617 268.468 l 183.608 268.468 l 183.496 268.244 183.255 268.074 182.926 268.074 c 182.439 268.074 182.061 268.485 182.061 269.095 c 182.057 269.768 182.477 270.174 182.964 270.174 c 183.276 270.174 183.484 270.029 183.571 269.871 c 183.579 269.871 l 183.579 271.067 l 183.945 271.067 l f 185.83 269.323 m 185.834 269.552 185.734 269.917 185.327 269.917 c 184.952 269.917 184.794 269.577 184.765 269.323 c 185.83 269.323 l h 184.761 269.062 m 184.769 268.568 185.081 268.365 185.447 268.365 c 185.71 268.365 185.872 268.41 186.005 268.464 c 186.072 268.207 l 185.942 268.149 185.718 268.078 185.397 268.078 c 184.782 268.078 184.407 268.489 184.407 269.091 c 184.407 269.701 184.769 270.179 185.356 270.179 c 186.013 270.179 186.184 269.602 186.184 269.232 c 186.184 269.157 186.18 269.099 186.171 269.058 c 184.761 269.062 l f 186.587 268.489 m 186.699 268.423 186.891 268.348 187.074 268.348 c 187.336 268.348 187.461 268.477 187.461 268.647 c 187.461 268.821 187.357 268.917 187.091 269.016 c 186.724 269.149 186.554 269.344 186.554 269.585 c 186.554 269.909 186.82 270.174 187.249 270.174 c 187.453 270.174 187.631 270.121 187.74 270.05 c 187.652 269.788 l 187.573 269.834 187.428 269.905 187.24 269.905 c 187.024 269.905 186.908 269.78 186.908 269.631 c 186.908 269.461 187.024 269.386 187.286 269.286 c 187.631 269.157 187.815 268.983 187.815 268.68 c 187.815 268.323 187.536 268.074 187.066 268.074 c 186.845 268.074 186.641 268.132 186.5 268.215 c 186.587 268.489 l f 190.228 269.145 m 189.828 269.153 189.375 269.083 189.375 268.693 c 189.375 268.452 189.533 268.344 189.716 268.344 c 189.982 268.344 190.153 268.51 190.211 268.68 c 190.224 268.717 190.228 268.759 190.228 268.796 c 190.228 269.145 l h 190.585 268.601 m 190.585 268.427 190.594 268.257 190.615 268.12 c 190.286 268.12 l 190.253 268.373 l 190.24 268.373 l 190.132 268.215 189.912 268.074 189.624 268.074 c 189.217 268.074 189.009 268.36 189.009 268.651 c 189.009 269.137 189.441 269.402 190.219 269.398 c 190.219 269.44 l 190.219 269.606 190.174 269.909 189.762 269.905 c 189.57 269.905 189.375 269.851 189.233 269.755 c 189.15 270 l 189.317 270.104 189.562 270.174 189.816 270.174 c 190.436 270.174 190.585 269.755 190.585 269.352 c 190.585 268.601 l f 191.172 269.585 m 191.172 269.797 191.168 269.963 191.156 270.129 c 191.48 270.129 l 191.501 269.801 l 191.509 269.801 l 191.609 269.988 191.842 270.174 192.175 270.174 c 192.453 270.174 192.886 270.008 192.886 269.319 c 192.886 268.12 l 192.52 268.12 l 192.52 269.278 l 192.52 269.602 192.399 269.876 192.054 269.876 c 191.817 269.876 191.63 269.705 191.563 269.502 c 191.546 269.456 191.538 269.39 191.538 269.332 c 191.538 268.12 l 191.172 268.12 l 191.172 269.585 l f 195.195 268.348 m 195.544 268.348 195.807 268.676 195.807 269.133 c 195.807 269.473 195.636 269.901 195.203 269.901 c 194.775 269.901 194.588 269.502 194.588 269.12 c 194.588 268.68 194.837 268.348 195.191 268.348 c 195.195 268.348 l h 195.183 268.074 m 194.642 268.074 194.217 268.473 194.217 269.108 c 194.217 269.78 194.662 270.174 195.216 270.174 c 195.794 270.174 196.185 269.755 196.185 269.145 c 196.185 268.398 195.665 268.074 195.187 268.074 c 195.183 268.074 l f 196.751 270.129 m 197.146 269.004 l 197.213 268.817 197.267 268.651 197.309 268.485 c 197.321 268.485 l 197.367 268.651 197.425 268.817 197.492 269.004 c 197.883 270.129 l 198.266 270.129 l 197.475 268.12 l 197.126 268.12 l 196.36 270.129 l 196.751 270.129 l f 199.842 269.323 m 199.847 269.552 199.747 269.917 199.339 269.917 c 198.965 269.917 198.806 269.577 198.777 269.323 c 199.842 269.323 l h 198.773 269.062 m 198.781 268.568 199.093 268.365 199.46 268.365 c 199.722 268.365 199.884 268.41 200.017 268.464 c 200.083 268.207 l 199.955 268.149 199.73 268.078 199.41 268.078 c 198.794 268.078 198.42 268.489 198.42 269.091 c 198.42 269.701 198.781 270.179 199.368 270.179 c 200.025 270.179 200.196 269.602 200.196 269.232 c 200.196 269.157 200.192 269.099 200.184 269.058 c 198.773 269.062 l f 200.654 269.502 m 200.654 269.739 200.65 269.942 200.637 270.129 c 200.957 270.129 l 200.974 269.734 l 200.987 269.734 l 201.078 270.004 201.303 270.174 201.548 270.174 c 201.586 270.174 201.615 270.17 201.648 270.162 c 201.648 269.822 l 201.607 269.826 201.569 269.83 201.519 269.83 c 201.261 269.83 201.078 269.635 201.028 269.365 c 201.02 269.311 201.015 269.253 201.015 269.191 c 201.015 268.12 l 200.65 268.12 l 200.654 269.502 l f 202.255 270.129 m 202.651 269.004 l 202.717 268.817 202.771 268.651 202.813 268.485 c 202.825 268.485 l 202.871 268.651 202.929 268.817 202.996 269.004 c 203.387 270.129 l 203.77 270.129 l 202.979 268.12 l 202.629 268.12 l 201.864 270.129 l 202.255 270.129 l f 204.115 270.129 0.366 -2.009 re 204.29 270.498 m 204.153 270.498 204.061 270.606 204.061 270.735 c 204.061 270.863 204.156 270.967 204.298 270.967 c 204.44 270.967 204.531 270.863 204.531 270.735 c 204.531 270.606 204.44 270.498 204.294 270.498 c 204.29 270.498 l f 206.366 269.323 m 206.37 269.552 206.27 269.917 205.862 269.917 c 205.488 269.917 205.33 269.577 205.301 269.323 c 206.366 269.323 l h 205.297 269.062 m 205.305 268.568 205.617 268.365 205.983 268.365 c 206.245 268.365 206.407 268.41 206.54 268.464 c 206.607 268.207 l 206.478 268.149 206.254 268.078 205.933 268.078 c 205.317 268.078 204.943 268.489 204.943 269.091 c 204.943 269.701 205.305 270.179 205.892 270.179 c 206.549 270.179 206.719 269.602 206.719 269.232 c 206.719 269.157 206.715 269.099 206.707 269.058 c 205.297 269.062 l f 207.319 270.129 m 207.589 269.112 l 207.643 268.888 207.697 268.676 207.734 268.468 c 207.747 268.468 l 207.792 268.672 207.859 268.888 207.926 269.108 c 208.254 270.129 l 208.563 270.129 l 208.874 269.124 l 208.949 268.888 209.008 268.672 209.053 268.468 c 209.066 268.468 l 209.099 268.672 209.153 268.884 209.219 269.12 c 209.507 270.129 l 209.869 270.129 l 209.219 268.12 l 208.887 268.12 l 208.579 269.079 l 208.508 269.307 208.45 269.506 208.4 269.743 c 208.392 269.743 l 208.342 269.502 208.279 269.29 208.209 269.074 c 207.884 268.12 l 207.551 268.12 l 206.944 270.129 l 207.319 270.129 l f 211.949 268.348 m 212.299 268.348 212.56 268.676 212.56 269.133 c 212.56 269.473 212.39 269.901 211.957 269.901 c 211.529 269.901 211.342 269.502 211.342 269.12 c 211.342 268.68 211.591 268.348 211.945 268.348 c 211.949 268.348 l h 211.937 268.074 m 211.396 268.074 210.972 268.473 210.972 269.108 c 210.972 269.78 211.417 270.174 211.97 270.174 c 212.548 270.174 212.939 269.755 212.939 269.145 c 212.939 268.398 212.419 268.074 211.941 268.074 c 211.937 268.074 l f 213.434 268.12 m 213.434 269.851 l 213.156 269.851 l 213.156 270.129 l 213.434 270.129 l 213.434 270.224 l 213.434 270.507 213.501 270.764 213.671 270.926 c 213.809 271.059 213.992 271.113 214.158 271.113 c 214.291 271.113 214.399 271.084 214.47 271.054 c 214.424 270.772 l 214.366 270.797 214.296 270.818 214.188 270.818 c 213.879 270.818 213.796 270.544 213.796 270.237 c 213.796 270.129 l 214.283 270.129 l 214.283 269.851 l 213.801 269.851 l 213.801 268.12 l 213.434 268.12 l f 215.939 270.61 m 215.939 270.129 l 216.463 270.129 l 216.463 269.851 l 215.939 269.851 l 215.939 268.767 l 215.939 268.518 216.01 268.377 216.213 268.377 c 216.313 268.377 216.372 268.385 216.425 268.402 c 216.442 268.124 l 216.372 268.099 216.259 268.074 216.118 268.074 c 215.947 268.074 215.81 268.132 215.723 268.228 c 215.623 268.34 215.581 268.518 215.581 268.755 c 215.581 269.851 l 215.269 269.851 l 215.269 270.129 l 215.581 270.129 l 215.581 270.498 l 215.939 270.61 l f 216.875 271.067 m 217.241 271.067 l 217.241 269.813 l 217.249 269.813 l 217.307 269.917 217.399 270.013 217.511 270.071 c 217.62 270.137 217.749 270.174 217.886 270.174 c 218.156 270.174 218.589 270.008 218.589 269.315 c 218.589 268.12 l 218.223 268.12 l 218.223 269.274 l 218.223 269.602 218.102 269.871 217.757 269.871 c 217.52 269.871 217.337 269.705 217.266 269.506 c 217.245 269.456 217.241 269.402 217.241 269.332 c 217.241 268.12 l 216.875 268.12 l 216.875 271.067 l f 220.461 269.323 m 220.465 269.552 220.365 269.917 219.958 269.917 c 219.583 269.917 219.425 269.577 219.396 269.323 c 220.461 269.323 l h 219.392 269.062 m 219.4 268.568 219.712 268.365 220.078 268.365 c 220.341 268.365 220.503 268.41 220.636 268.464 c 220.703 268.207 l 220.573 268.149 220.349 268.078 220.028 268.078 c 219.412 268.078 219.038 268.489 219.038 269.091 c 219.038 269.701 219.4 270.179 219.987 270.179 c 220.644 270.179 220.814 269.602 220.814 269.232 c 220.814 269.157 220.811 269.099 220.802 269.058 c 219.392 269.062 l f 222.1 268.489 m 222.213 268.423 222.404 268.348 222.587 268.348 c 222.849 268.348 222.974 268.477 222.974 268.647 c 222.974 268.821 222.87 268.917 222.604 269.016 c 222.238 269.149 222.067 269.344 222.067 269.585 c 222.067 269.909 222.333 270.174 222.762 270.174 c 222.966 270.174 223.145 270.121 223.253 270.05 c 223.165 269.788 l 223.087 269.834 222.941 269.905 222.753 269.905 c 222.537 269.905 222.421 269.78 222.421 269.631 c 222.421 269.461 222.537 269.386 222.799 269.286 c 223.145 269.157 223.328 268.983 223.328 268.68 c 223.328 268.323 223.049 268.074 222.579 268.074 c 222.358 268.074 222.155 268.132 222.013 268.215 c 222.1 268.489 l f 224.239 270.61 m 224.239 270.129 l 224.763 270.129 l 224.763 269.851 l 224.239 269.851 l 224.239 268.767 l 224.239 268.518 224.309 268.377 224.513 268.377 c 224.613 268.377 224.671 268.385 224.726 268.402 c 224.742 268.124 l 224.671 268.099 224.559 268.074 224.417 268.074 c 224.247 268.074 224.11 268.132 224.022 268.228 c 223.922 268.34 223.881 268.518 223.881 268.755 c 223.881 269.851 l 223.569 269.851 l 223.569 270.129 l 223.881 270.129 l 223.881 270.498 l 224.239 270.61 l f 226.428 269.323 m 226.431 269.552 226.331 269.917 225.924 269.917 c 225.549 269.917 225.391 269.577 225.362 269.323 c 226.428 269.323 l h 225.358 269.062 m 225.366 268.568 225.678 268.365 226.044 268.365 c 226.307 268.365 226.469 268.41 226.602 268.464 c 226.669 268.207 l 226.539 268.149 226.315 268.078 225.994 268.078 c 225.379 268.078 225.004 268.489 225.004 269.091 c 225.004 269.701 225.366 270.179 225.953 270.179 c 226.61 270.179 226.781 269.602 226.781 269.232 c 226.781 269.157 226.777 269.099 226.768 269.058 c 225.358 269.062 l f 227.6 268.937 m 227.6 268.888 227.605 268.834 227.617 268.788 c 227.68 268.535 227.904 268.36 228.162 268.36 c 228.549 268.36 228.773 268.676 228.773 269.137 c 228.773 269.539 228.566 269.884 228.179 269.884 c 227.929 269.884 227.692 269.71 227.621 269.436 c 227.613 269.386 227.6 269.332 227.6 269.286 c 227.6 268.937 l h 227.235 269.473 m 227.235 269.73 227.23 269.938 227.218 270.129 c 227.546 270.129 l 227.567 269.784 l 227.575 269.784 l 227.721 270.033 227.962 270.174 228.287 270.174 c 228.778 270.174 229.144 269.763 229.144 269.153 c 229.144 268.431 228.699 268.074 228.228 268.074 c 227.958 268.074 227.73 268.19 227.609 268.39 c 227.6 268.39 l 227.6 267.298 l 227.235 267.298 l 227.235 269.473 l f 229.552 268.489 m 229.664 268.423 229.855 268.348 230.039 268.348 c 230.301 268.348 230.426 268.477 230.426 268.647 c 230.426 268.821 230.321 268.917 230.055 269.016 c 229.689 269.149 229.519 269.344 229.519 269.585 c 229.519 269.909 229.784 270.174 230.213 270.174 c 230.417 270.174 230.596 270.121 230.704 270.05 c 230.617 269.788 l 230.537 269.834 230.392 269.905 230.205 269.905 c 229.989 269.905 229.872 269.78 229.872 269.631 c 229.872 269.461 229.989 269.386 230.251 269.286 c 230.596 269.157 230.779 268.983 230.779 268.68 c 230.779 268.323 230.5 268.074 230.03 268.074 c 229.809 268.074 229.605 268.132 229.464 268.215 c 229.552 268.489 l f 233.192 269.145 m 232.793 269.153 232.339 269.083 232.339 268.693 c 232.339 268.452 232.497 268.344 232.68 268.344 c 232.946 268.344 233.117 268.51 233.175 268.68 c 233.188 268.717 233.192 268.759 233.192 268.796 c 233.192 269.145 l h 233.55 268.601 m 233.55 268.427 233.558 268.257 233.579 268.12 c 233.25 268.12 l 233.217 268.373 l 233.205 268.373 l 233.096 268.215 232.876 268.074 232.589 268.074 c 232.181 268.074 231.973 268.36 231.973 268.651 c 231.973 269.137 232.406 269.402 233.184 269.398 c 233.184 269.44 l 233.184 269.606 233.138 269.909 232.726 269.905 c 232.535 269.905 232.339 269.851 232.198 269.755 c 232.114 270 l 232.281 270.104 232.526 270.174 232.78 270.174 c 233.4 270.174 233.55 269.755 233.55 269.352 c 233.55 268.601 l f 234.137 269.585 m 234.137 269.797 234.132 269.963 234.12 270.129 c 234.444 270.129 l 234.465 269.801 l 234.473 269.801 l 234.573 269.988 234.806 270.174 235.139 270.174 c 235.418 270.174 235.85 270.008 235.85 269.319 c 235.85 268.12 l 235.484 268.12 l 235.484 269.278 l 235.484 269.602 235.364 269.876 235.019 269.876 c 234.781 269.876 234.594 269.705 234.527 269.502 c 234.511 269.456 234.502 269.39 234.502 269.332 c 234.502 268.12 l 234.137 268.12 l 234.137 269.585 l f 237.818 269.311 m 237.818 269.361 237.814 269.419 237.801 269.469 c 237.748 269.697 237.548 269.888 237.273 269.888 c 236.894 269.888 236.67 269.556 236.67 269.116 c 236.67 268.705 236.874 268.369 237.265 268.369 c 237.511 268.369 237.735 268.535 237.801 268.805 c 237.814 268.854 237.818 268.904 237.818 268.962 c 237.818 269.311 l h 238.185 271.067 m 238.185 268.639 l 238.185 268.46 238.188 268.257 238.201 268.12 c 237.873 268.12 l 237.856 268.468 l 237.848 268.468 l 237.735 268.244 237.494 268.074 237.165 268.074 c 236.678 268.074 236.3 268.485 236.3 269.095 c 236.296 269.768 236.716 270.174 237.203 270.174 c 237.514 270.174 237.723 270.029 237.81 269.871 c 237.818 269.871 l 237.818 271.067 l 238.185 271.067 l f 240.951 269.323 m 240.955 269.552 240.855 269.917 240.448 269.917 c 240.073 269.917 239.915 269.577 239.886 269.323 c 240.951 269.323 l h 239.882 269.062 m 239.89 268.568 240.202 268.365 240.569 268.365 c 240.83 268.365 240.993 268.41 241.126 268.464 c 241.192 268.207 l 241.064 268.149 240.839 268.078 240.519 268.078 c 239.903 268.078 239.528 268.489 239.528 269.091 c 239.528 269.701 239.89 270.179 240.477 270.179 c 241.134 270.179 241.305 269.602 241.305 269.232 c 241.305 269.157 241.3 269.099 241.292 269.058 c 239.882 269.062 l f 241.758 271.067 0.366 -2.947 re f 244.009 269.323 m 244.013 269.552 243.913 269.917 243.506 269.917 c 243.131 269.917 242.973 269.577 242.944 269.323 c 244.009 269.323 l h 242.939 269.062 m 242.948 268.568 243.26 268.365 243.626 268.365 c 243.888 268.365 244.051 268.41 244.184 268.464 c 244.25 268.207 l 244.121 268.149 243.896 268.078 243.576 268.078 c 242.961 268.078 242.586 268.489 242.586 269.091 c 242.586 269.701 242.948 270.179 243.534 270.179 c 244.192 270.179 244.363 269.602 244.363 269.232 c 244.363 269.157 244.358 269.099 244.35 269.058 c 242.939 269.062 l f 244.816 269.585 m 244.816 269.797 244.808 269.963 244.8 270.129 c 245.12 270.129 l 245.137 269.805 l 245.149 269.805 l 245.261 269.996 245.448 270.174 245.785 270.174 c 246.056 270.174 246.263 270.008 246.351 269.772 c 246.36 269.772 l 246.422 269.888 246.505 269.971 246.589 270.033 c 246.709 270.125 246.838 270.174 247.029 270.174 c 247.3 270.174 247.695 270 247.695 269.303 c 247.695 268.12 l 247.337 268.12 l 247.337 269.257 l 247.337 269.647 247.192 269.876 246.9 269.876 c 246.688 269.876 246.53 269.722 246.464 269.548 c 246.447 269.494 246.434 269.427 246.434 269.365 c 246.434 268.12 l 246.077 268.12 l 246.077 269.323 l 246.077 269.647 245.935 269.876 245.657 269.876 c 245.432 269.876 245.261 269.693 245.203 269.51 c 245.182 269.456 245.174 269.394 245.174 269.332 c 245.174 268.12 l 244.816 268.12 l 244.816 269.585 l f 249.563 269.323 m 249.567 269.552 249.467 269.917 249.059 269.917 c 248.685 269.917 248.527 269.577 248.498 269.323 c 249.563 269.323 l h 248.494 269.062 m 248.502 268.568 248.814 268.365 249.18 268.365 c 249.443 268.365 249.604 268.41 249.738 268.464 c 249.805 268.207 l 249.675 268.149 249.451 268.078 249.13 268.078 c 248.514 268.078 248.14 268.489 248.14 269.091 c 248.14 269.701 248.502 270.179 249.089 270.179 c 249.746 270.179 249.916 269.602 249.916 269.232 c 249.916 269.157 249.913 269.099 249.904 269.058 c 248.494 269.062 l f 250.37 269.585 m 250.37 269.797 250.366 269.963 250.354 270.129 c 250.678 270.129 l 250.699 269.801 l 250.707 269.801 l 250.807 269.988 251.04 270.174 251.373 270.174 c 251.652 270.174 252.084 270.008 252.084 269.319 c 252.084 268.12 l 251.718 268.12 l 251.718 269.278 l 251.718 269.602 251.598 269.876 251.252 269.876 c 251.015 269.876 250.828 269.705 250.761 269.502 c 250.745 269.456 250.736 269.39 250.736 269.332 c 250.736 268.12 l 250.37 268.12 l 250.37 269.585 l f 253.104 270.61 m 253.104 270.129 l 253.627 270.129 l 253.627 269.851 l 253.104 269.851 l 253.104 268.767 l 253.104 268.518 253.174 268.377 253.378 268.377 c 253.478 268.377 253.536 268.385 253.59 268.402 c 253.607 268.124 l 253.536 268.099 253.424 268.074 253.282 268.074 c 253.112 268.074 252.974 268.132 252.887 268.228 c 252.787 268.34 252.745 268.518 252.745 268.755 c 252.745 269.851 l 252.434 269.851 l 252.434 270.129 l 252.745 270.129 l 252.745 270.498 l 253.104 270.61 l f 253.99 268.489 m 254.102 268.423 254.294 268.348 254.477 268.348 c 254.739 268.348 254.864 268.477 254.864 268.647 c 254.864 268.821 254.759 268.917 254.493 269.016 c 254.127 269.149 253.957 269.344 253.957 269.585 c 253.957 269.909 254.222 270.174 254.651 270.174 c 254.855 270.174 255.034 270.121 255.142 270.05 c 255.055 269.788 l 254.976 269.834 254.83 269.905 254.643 269.905 c 254.427 269.905 254.31 269.78 254.31 269.631 c 254.31 269.461 254.427 269.386 254.689 269.286 c 255.034 269.157 255.217 268.983 255.217 268.68 c 255.217 268.323 254.938 268.074 254.468 268.074 c 254.247 268.074 254.044 268.132 253.902 268.215 c 253.99 268.489 l f 256.602 268.12 m 256.602 269.851 l 256.323 269.851 l 256.323 270.129 l 256.602 270.129 l 256.602 270.224 l 256.602 270.507 256.669 270.764 256.84 270.926 c 256.977 271.059 257.16 271.113 257.327 271.113 c 257.46 271.113 257.568 271.084 257.638 271.054 c 257.593 270.772 l 257.534 270.797 257.463 270.818 257.355 270.818 c 257.048 270.818 256.964 270.544 256.964 270.237 c 256.964 270.129 l 257.451 270.129 l 257.451 269.851 l 256.968 269.851 l 256.968 268.12 l 256.602 268.12 l f 258.566 268.348 m 258.915 268.348 259.178 268.676 259.178 269.133 c 259.178 269.473 259.007 269.901 258.575 269.901 c 258.146 269.901 257.959 269.502 257.959 269.12 c 257.959 268.68 258.209 268.348 258.562 268.348 c 258.566 268.348 l h 258.554 268.074 m 258.013 268.074 257.588 268.473 257.588 269.108 c 257.588 269.78 258.034 270.174 258.587 270.174 c 259.166 270.174 259.556 269.755 259.556 269.145 c 259.556 268.398 259.036 268.074 258.558 268.074 c 258.554 268.074 l f 260.022 269.502 m 260.022 269.739 260.018 269.942 260.006 270.129 c 260.326 270.129 l 260.343 269.734 l 260.355 269.734 l 260.447 270.004 260.671 270.174 260.917 270.174 c 260.954 270.174 260.983 270.17 261.017 270.162 c 261.017 269.822 l 260.975 269.826 260.938 269.83 260.888 269.83 c 260.63 269.83 260.447 269.635 260.397 269.365 c 260.389 269.311 260.384 269.253 260.384 269.191 c 260.384 268.12 l 260.018 268.12 l 260.022 269.502 l f 175.475 263.098 m 175.346 263.031 175.075 262.965 174.734 262.965 c 173.944 262.965 173.353 263.463 173.353 264.385 c 173.353 265.265 173.948 265.854 174.817 265.854 c 175.163 265.854 175.388 265.779 175.483 265.73 c 175.392 265.435 l 175.258 265.501 175.063 265.551 174.83 265.551 c 174.173 265.551 173.736 265.132 173.736 264.397 c 173.736 263.708 174.131 263.272 174.809 263.272 c 175.034 263.272 175.258 263.318 175.404 263.389 c 175.475 263.098 l f 175.928 265.809 0.366 -2.798 re f 176.881 263.451 m 177.043 263.347 177.276 263.268 177.526 263.268 c 177.896 263.268 178.113 263.459 178.113 263.745 c 178.113 264.003 177.963 264.156 177.584 264.298 c 177.126 264.464 176.843 264.704 176.843 265.095 c 176.843 265.53 177.206 265.854 177.75 265.854 c 178.033 265.854 178.246 265.788 178.366 265.717 c 178.266 265.423 l 178.179 265.477 177.992 265.555 177.738 265.555 c 177.355 265.555 177.21 265.327 177.21 265.136 c 177.21 264.875 177.38 264.746 177.767 264.596 c 178.241 264.41 178.479 264.186 178.479 263.775 c 178.479 263.343 178.162 262.965 177.501 262.965 c 177.23 262.965 176.935 263.048 176.785 263.148 c 176.881 263.451 l f 181.341 264.24 m 181.32 264.63 181.295 265.103 181.295 265.447 c 181.287 265.447 l 181.187 265.124 181.075 264.771 180.933 264.385 c 180.438 263.027 l 180.164 263.027 l 179.706 264.36 l 179.573 264.758 179.465 265.115 179.385 265.447 c 179.377 265.447 l 179.369 265.099 179.348 264.634 179.323 264.21 c 179.248 263.011 l 178.903 263.011 l 179.099 265.809 l 179.56 265.809 l 180.039 264.455 l 180.155 264.111 180.247 263.804 180.322 263.513 c 180.33 263.513 l 180.405 263.795 180.505 264.102 180.63 264.455 c 181.129 265.809 l 181.591 265.809 l 181.765 263.011 l 181.408 263.011 l 181.341 264.24 l f 183.159 263.451 m 183.321 263.347 183.554 263.268 183.804 263.268 c 184.174 263.268 184.391 263.459 184.391 263.745 c 184.391 264.003 184.241 264.156 183.862 264.298 c 183.405 264.464 183.122 264.704 183.122 265.095 c 183.122 265.53 183.484 265.854 184.028 265.854 c 184.312 265.854 184.524 265.788 184.645 265.717 c 184.544 265.423 l 184.457 265.477 184.27 265.555 184.016 265.555 c 183.633 265.555 183.488 265.327 183.488 265.136 c 183.488 264.875 183.658 264.746 184.045 264.596 c 184.519 264.41 184.757 264.186 184.757 263.775 c 184.757 263.343 184.44 262.965 183.779 262.965 c 183.508 262.965 183.213 263.048 183.063 263.148 c 183.159 263.451 l f 185.668 265.501 m 185.668 265.02 l 186.192 265.02 l 186.192 264.742 l 185.668 264.742 l 185.668 263.658 l 185.668 263.409 185.738 263.268 185.942 263.268 c 186.042 263.268 186.1 263.276 186.154 263.293 c 186.171 263.015 l 186.1 262.99 185.988 262.965 185.846 262.965 c 185.676 262.965 185.539 263.023 185.451 263.119 c 185.351 263.231 185.31 263.409 185.31 263.646 c 185.31 264.742 l 184.998 264.742 l 184.998 265.02 l 185.31 265.02 l 185.31 265.389 l 185.668 265.501 l f 186.608 264.393 m 186.608 264.63 186.604 264.833 186.592 265.02 c 186.912 265.02 l 186.928 264.626 l 186.941 264.626 l 187.033 264.895 187.257 265.066 187.503 265.066 c 187.54 265.066 187.569 265.061 187.603 265.053 c 187.603 264.713 l 187.561 264.717 187.524 264.721 187.474 264.721 c 187.216 264.721 187.033 264.526 186.983 264.256 c 186.974 264.202 186.97 264.144 186.97 264.082 c 186.97 263.011 l 186.604 263.011 l 186.608 264.393 l f 189 264.036 m 188.601 264.044 188.147 263.974 188.147 263.584 c 188.147 263.343 188.306 263.235 188.489 263.235 c 188.755 263.235 188.926 263.401 188.984 263.571 c 188.996 263.609 189 263.65 189 263.687 c 189 264.036 l h 189.358 263.492 m 189.358 263.318 189.367 263.148 189.387 263.011 c 189.059 263.011 l 189.025 263.264 l 189.013 263.264 l 188.905 263.106 188.684 262.965 188.397 262.965 c 187.99 262.965 187.781 263.252 187.781 263.542 c 187.781 264.028 188.214 264.293 188.992 264.289 c 188.992 264.331 l 188.992 264.497 188.946 264.8 188.534 264.796 c 188.343 264.796 188.147 264.742 188.006 264.646 c 187.923 264.891 l 188.089 264.995 188.335 265.066 188.588 265.066 c 189.208 265.066 189.358 264.646 189.358 264.244 c 189.358 263.492 l f 190.369 265.501 m 190.369 265.02 l 190.893 265.02 l 190.893 264.742 l 190.369 264.742 l 190.369 263.658 l 190.369 263.409 190.44 263.268 190.644 263.268 c 190.744 263.268 190.802 263.276 190.856 263.293 c 190.873 263.015 l 190.802 262.99 190.69 262.965 190.548 262.965 c 190.377 262.965 190.24 263.023 190.153 263.119 c 190.053 263.231 190.011 263.409 190.011 263.646 c 190.011 264.742 l 189.699 264.742 l 189.699 265.02 l 190.011 265.02 l 190.011 265.389 l 190.369 265.501 l f 192.558 264.215 m 192.562 264.443 192.462 264.808 192.054 264.808 c 191.68 264.808 191.521 264.468 191.492 264.215 c 192.558 264.215 l h 191.488 263.953 m 191.496 263.459 191.808 263.256 192.175 263.256 c 192.437 263.256 192.599 263.301 192.732 263.355 c 192.799 263.098 l 192.67 263.04 192.445 262.969 192.125 262.969 c 191.509 262.969 191.135 263.38 191.135 263.982 c 191.135 264.592 191.496 265.07 192.083 265.07 c 192.74 265.07 192.911 264.493 192.911 264.123 c 192.911 264.049 192.907 263.99 192.898 263.949 c 191.488 263.953 l f 194.721 264.231 m 194.721 264.289 194.717 264.343 194.7 264.393 c 194.633 264.609 194.459 264.783 194.188 264.783 c 193.839 264.783 193.589 264.489 193.589 264.02 c 193.589 263.629 193.793 263.297 194.184 263.297 c 194.413 263.297 194.617 263.438 194.692 263.675 c 194.712 263.733 194.721 263.804 194.721 263.87 c 194.721 264.231 l h 195.087 263.305 m 195.087 262.841 194.991 262.563 194.8 262.384 c 194.6 262.206 194.317 262.143 194.063 262.143 c 193.822 262.143 193.556 262.201 193.394 262.309 c 193.485 262.592 l 193.618 262.504 193.826 262.43 194.076 262.43 c 194.45 262.43 194.725 262.625 194.725 263.135 c 194.725 263.355 l 194.717 263.355 l 194.608 263.169 194.388 263.019 194.076 263.019 c 193.577 263.019 193.219 263.443 193.219 264.003 c 193.219 264.684 193.664 265.066 194.13 265.066 c 194.479 265.066 194.667 264.887 194.758 264.721 c 194.767 264.721 l 194.779 265.02 l 195.103 265.02 l 195.091 264.879 195.087 264.717 195.087 264.472 c 195.087 263.305 l f 195.69 265.02 0.366 -2.009 re 195.865 265.389 m 195.728 265.389 195.636 265.497 195.636 265.626 c 195.636 265.755 195.732 265.858 195.873 265.858 c 196.015 265.858 196.106 265.755 196.106 265.626 c 196.106 265.497 196.015 265.389 195.869 265.389 c 195.865 265.389 l f 198.099 263.081 m 198.003 263.036 197.791 262.965 197.521 262.965 c 196.913 262.965 196.518 263.376 196.518 263.995 c 196.518 264.613 196.943 265.066 197.6 265.066 c 197.816 265.066 198.008 265.012 198.108 264.958 c 198.025 264.68 l 197.937 264.725 197.799 264.775 197.6 264.775 c 197.138 264.775 196.889 264.43 196.889 264.011 c 196.889 263.546 197.188 263.26 197.588 263.26 c 197.796 263.26 197.933 263.31 198.037 263.355 c 198.099 263.081 l f 199.784 264.426 m 199.863 264.406 199.967 264.397 200.083 264.397 c 200.524 264.397 200.787 264.613 200.787 264.991 c 200.787 265.364 200.524 265.543 200.125 265.543 c 199.967 265.543 199.847 265.526 199.784 265.514 c 199.784 264.426 l h 199.422 265.771 m 199.597 265.804 199.825 265.829 200.117 265.829 c 200.475 265.829 200.737 265.746 200.903 265.597 c 201.057 265.464 201.152 265.261 201.152 265.012 c 201.152 264.758 201.078 264.559 200.932 264.414 c 200.741 264.21 200.429 264.107 200.075 264.107 c 199.967 264.107 199.867 264.111 199.784 264.131 c 199.784 263.011 l 199.422 263.011 l 199.422 265.771 l f 201.602 265.958 0.366 -2.947 re f 203.636 264.036 m 203.237 264.044 202.784 263.974 202.784 263.584 c 202.784 263.343 202.942 263.235 203.125 263.235 c 203.391 263.235 203.562 263.401 203.62 263.571 c 203.633 263.609 203.636 263.65 203.636 263.687 c 203.636 264.036 l h 203.995 263.492 m 203.995 263.318 204.003 263.148 204.023 263.011 c 203.695 263.011 l 203.661 263.264 l 203.649 263.264 l 203.541 263.106 203.321 262.965 203.033 262.965 c 202.626 262.965 202.418 263.252 202.418 263.542 c 202.418 264.028 202.85 264.293 203.628 264.289 c 203.628 264.331 l 203.628 264.497 203.583 264.8 203.171 264.796 c 202.979 264.796 202.784 264.742 202.643 264.646 c 202.559 264.891 l 202.726 264.995 202.971 265.066 203.224 265.066 c 203.845 265.066 203.995 264.646 203.995 264.244 c 203.995 263.492 l f 204.581 264.476 m 204.581 264.688 204.576 264.854 204.565 265.02 c 204.889 265.02 l 204.91 264.692 l 204.918 264.692 l 205.018 264.879 205.251 265.066 205.583 265.066 c 205.862 265.066 206.295 264.899 206.295 264.21 c 206.295 263.011 l 205.929 263.011 l 205.929 264.169 l 205.929 264.493 205.809 264.767 205.463 264.767 c 205.226 264.767 205.038 264.596 204.972 264.393 c 204.955 264.347 204.947 264.281 204.947 264.223 c 204.947 263.011 l 204.581 263.011 l 204.581 264.476 l f 206.89 264.476 m 206.89 264.688 206.885 264.854 206.874 265.02 c 207.198 265.02 l 207.219 264.692 l 207.227 264.692 l 207.327 264.879 207.56 265.066 207.892 265.066 c 208.171 265.066 208.604 264.899 208.604 264.21 c 208.604 263.011 l 208.238 263.011 l 208.238 264.169 l 208.238 264.493 208.117 264.767 207.772 264.767 c 207.535 264.767 207.347 264.596 207.281 264.393 c 207.264 264.347 207.256 264.281 207.256 264.223 c 207.256 263.011 l 206.89 263.011 l 206.89 264.476 l f 209.199 265.02 0.366 -2.009 re 209.374 265.389 m 209.236 265.389 209.145 265.497 209.145 265.626 c 209.145 265.755 209.241 265.858 209.382 265.858 c 209.523 265.858 209.615 265.755 209.615 265.626 c 209.615 265.497 209.523 265.389 209.378 265.389 c 209.374 265.389 l f 210.173 264.476 m 210.173 264.688 210.168 264.854 210.156 265.02 c 210.48 265.02 l 210.501 264.692 l 210.51 264.692 l 210.61 264.879 210.842 265.066 211.175 265.066 c 211.454 265.066 211.887 264.899 211.887 264.21 c 211.887 263.011 l 211.52 263.011 l 211.52 264.169 l 211.52 264.493 211.4 264.767 211.055 264.767 c 210.817 264.767 210.63 264.596 210.563 264.393 c 210.547 264.347 210.538 264.281 210.538 264.223 c 210.538 263.011 l 210.173 263.011 l 210.173 264.476 l f 213.837 264.231 m 213.837 264.289 213.834 264.343 213.817 264.393 c 213.751 264.609 213.576 264.783 213.306 264.783 c 212.956 264.783 212.706 264.489 212.706 264.02 c 212.706 263.629 212.91 263.297 213.301 263.297 c 213.53 263.297 213.734 263.438 213.809 263.675 c 213.829 263.733 213.837 263.804 213.837 263.87 c 213.837 264.231 l h 214.204 263.305 m 214.204 262.841 214.108 262.563 213.917 262.384 c 213.717 262.206 213.434 262.143 213.181 262.143 c 212.939 262.143 212.673 262.201 212.51 262.309 c 212.602 262.592 l 212.736 262.504 212.943 262.43 213.193 262.43 c 213.567 262.43 213.842 262.625 213.842 263.135 c 213.842 263.355 l 213.834 263.355 l 213.726 263.169 213.505 263.019 213.193 263.019 c 212.694 263.019 212.336 263.443 212.336 264.003 c 212.336 264.684 212.781 265.066 213.247 265.066 c 213.596 265.066 213.784 264.887 213.875 264.721 c 213.884 264.721 l 213.896 265.02 l 214.221 265.02 l 214.208 264.879 214.204 264.717 214.204 264.472 c 214.204 263.305 l f 171.226 256.978 m 170.988 256.978 170.793 257.169 170.793 257.414 c 170.789 257.655 170.988 257.85 171.23 257.85 c 171.471 257.85 171.667 257.659 171.667 257.414 c 171.667 257.173 171.471 256.978 171.23 256.978 c 171.226 256.978 l f 174.63 256.235 m 175.204 256.235 175.529 256.762 175.529 257.397 c 175.529 257.954 175.238 258.535 174.634 258.535 c 174.031 258.535 173.732 257.974 173.732 257.368 c 173.732 256.779 174.056 256.235 174.626 256.235 c 174.63 256.235 l h 174.614 255.94 m 173.869 255.94 173.353 256.513 173.353 257.36 c 173.353 258.248 173.902 258.829 174.651 258.829 c 175.421 258.829 175.916 258.244 175.916 257.414 c 175.916 256.455 175.329 255.94 174.618 255.94 c 174.614 255.94 l f 176.473 255.986 m 176.473 257.717 l 176.195 257.717 l 176.195 257.995 l 176.473 257.995 l 176.473 258.091 l 176.473 258.373 176.54 258.63 176.711 258.792 c 176.848 258.925 177.031 258.979 177.197 258.979 c 177.331 258.979 177.439 258.95 177.509 258.921 c 177.464 258.639 l 177.405 258.663 177.335 258.684 177.227 258.684 c 176.919 258.684 176.835 258.41 176.835 258.103 c 176.835 257.995 l 177.322 257.995 l 177.322 257.717 l 176.84 257.717 l 176.84 255.986 l 176.473 255.986 l f 177.688 255.986 m 177.688 257.717 l 177.409 257.717 l 177.409 257.995 l 177.688 257.995 l 177.688 258.091 l 177.688 258.373 177.755 258.63 177.925 258.792 c 178.063 258.925 178.246 258.979 178.412 258.979 c 178.545 258.979 178.654 258.95 178.724 258.921 c 178.679 258.639 l 178.62 258.663 178.549 258.684 178.441 258.684 c 178.133 258.684 178.05 258.41 178.05 258.103 c 178.05 257.995 l 178.537 257.995 l 178.537 257.717 l 178.054 257.717 l 178.054 255.986 l 177.688 255.986 l f 180.097 257.19 m 180.101 257.418 180.001 257.783 179.594 257.783 c 179.219 257.783 179.061 257.443 179.032 257.19 c 180.097 257.19 l h 179.028 256.928 m 179.036 256.434 179.348 256.231 179.714 256.231 c 179.976 256.231 180.139 256.277 180.272 256.331 c 180.338 256.073 l 180.209 256.015 179.985 255.945 179.664 255.945 c 179.049 255.945 178.674 256.356 178.674 256.957 c 178.674 257.568 179.036 258.045 179.623 258.045 c 180.28 258.045 180.451 257.468 180.451 257.098 c 180.451 257.024 180.447 256.966 180.438 256.924 c 179.028 256.928 l f 180.908 257.368 m 180.908 257.605 180.904 257.808 180.892 257.995 c 181.212 257.995 l 181.229 257.601 l 181.241 257.601 l 181.333 257.871 181.557 258.041 181.803 258.041 c 181.84 258.041 181.869 258.037 181.903 258.028 c 181.903 257.688 l 181.861 257.692 181.824 257.696 181.774 257.696 c 181.516 257.696 181.333 257.501 181.283 257.231 c 181.274 257.177 181.27 257.119 181.27 257.057 c 181.27 255.986 l 180.904 255.986 l 180.908 257.368 l f 182.215 256.356 m 182.327 256.289 182.518 256.214 182.701 256.214 c 182.963 256.214 183.088 256.343 183.088 256.513 c 183.088 256.688 182.984 256.783 182.718 256.883 c 182.352 257.016 182.181 257.211 182.181 257.451 c 182.181 257.775 182.447 258.041 182.876 258.041 c 183.08 258.041 183.259 257.987 183.367 257.916 c 183.28 257.655 l 183.201 257.7 183.055 257.771 182.868 257.771 c 182.651 257.771 182.535 257.646 182.535 257.497 c 182.535 257.327 182.651 257.252 182.913 257.152 c 183.259 257.024 183.442 256.849 183.442 256.546 c 183.442 256.19 183.163 255.94 182.693 255.94 c 182.472 255.94 182.269 255.999 182.127 256.081 c 182.215 256.356 l f 186.167 257.177 m 186.167 257.227 186.163 257.285 186.15 257.335 c 186.096 257.563 185.897 257.754 185.622 257.754 c 185.243 257.754 185.019 257.422 185.019 256.982 c 185.019 256.571 185.223 256.235 185.614 256.235 c 185.859 256.235 186.084 256.401 186.15 256.671 c 186.163 256.721 186.167 256.771 186.167 256.829 c 186.167 257.177 l h 186.533 258.933 m 186.533 256.505 l 186.533 256.326 186.537 256.123 186.55 255.986 c 186.221 255.986 l 186.205 256.335 l 186.196 256.335 l 186.084 256.111 185.842 255.94 185.514 255.94 c 185.027 255.94 184.649 256.351 184.649 256.962 c 184.645 257.634 185.065 258.041 185.551 258.041 c 185.863 258.041 186.072 257.895 186.159 257.738 c 186.167 257.738 l 186.167 258.933 l 186.533 258.933 l f 188.418 257.19 m 188.422 257.418 188.322 257.783 187.915 257.783 c 187.54 257.783 187.382 257.443 187.353 257.19 c 188.418 257.19 l h 187.349 256.928 m 187.357 256.434 187.669 256.231 188.035 256.231 c 188.297 256.231 188.46 256.277 188.593 256.331 c 188.659 256.073 l 188.53 256.015 188.306 255.945 187.985 255.945 c 187.369 255.945 186.995 256.356 186.995 256.957 c 186.995 257.568 187.357 258.045 187.944 258.045 c 188.601 258.045 188.771 257.468 188.771 257.098 c 188.771 257.024 188.767 256.966 188.759 256.924 c 187.349 256.928 l f 189.666 258.477 m 189.666 257.995 l 190.19 257.995 l 190.19 257.717 l 189.666 257.717 l 189.666 256.634 l 189.666 256.385 189.737 256.243 189.94 256.243 c 190.04 256.243 190.099 256.252 190.153 256.268 c 190.169 255.99 l 190.099 255.965 189.986 255.94 189.845 255.94 c 189.674 255.94 189.537 255.999 189.45 256.094 c 189.35 256.206 189.308 256.385 189.308 256.621 c 189.308 257.717 l 188.996 257.717 l 188.996 257.995 l 189.308 257.995 l 189.308 258.365 l 189.666 258.477 l f 191.663 257.011 m 191.263 257.02 190.81 256.949 190.81 256.559 c 190.81 256.318 190.968 256.21 191.151 256.21 c 191.417 256.21 191.588 256.376 191.646 256.546 c 191.659 256.584 191.663 256.625 191.663 256.663 c 191.663 257.011 l h 192.021 256.467 m 192.021 256.293 192.029 256.123 192.05 255.986 c 191.721 255.986 l 191.688 256.239 l 191.675 256.239 l 191.567 256.081 191.347 255.94 191.06 255.94 c 190.652 255.94 190.444 256.227 190.444 256.517 c 190.444 257.003 190.876 257.269 191.655 257.265 c 191.655 257.306 l 191.655 257.472 191.609 257.775 191.197 257.771 c 191.005 257.771 190.81 257.717 190.669 257.622 c 190.585 257.866 l 190.752 257.97 190.997 258.041 191.251 258.041 c 191.871 258.041 192.021 257.622 192.021 257.219 c 192.021 256.467 l f 192.607 257.995 0.366 -2.009 re 192.782 258.365 m 192.645 258.365 192.553 258.473 192.553 258.601 c 192.553 258.73 192.649 258.834 192.79 258.834 c 192.932 258.834 193.023 258.73 193.023 258.601 c 193.023 258.473 192.932 258.365 192.786 258.365 c 192.782 258.365 l f 193.581 258.933 0.366 -2.947 re f 195.832 257.19 m 195.836 257.418 195.736 257.783 195.328 257.783 c 194.954 257.783 194.796 257.443 194.767 257.19 c 195.832 257.19 l h 194.762 256.928 m 194.771 256.434 195.082 256.231 195.449 256.231 c 195.711 256.231 195.873 256.277 196.006 256.331 c 196.073 256.073 l 195.944 256.015 195.719 255.945 195.399 255.945 c 194.783 255.945 194.409 256.356 194.409 256.957 c 194.409 257.568 194.771 258.045 195.357 258.045 c 196.014 258.045 196.185 257.468 196.185 257.098 c 196.185 257.024 196.181 256.966 196.173 256.924 c 194.762 256.928 l f 198.011 257.177 m 198.011 257.227 198.007 257.285 197.995 257.335 c 197.941 257.563 197.741 257.754 197.466 257.754 c 197.088 257.754 196.863 257.422 196.863 256.982 c 196.863 256.571 197.067 256.235 197.458 256.235 c 197.704 256.235 197.928 256.401 197.995 256.671 c 198.007 256.721 198.011 256.771 198.011 256.829 c 198.011 257.177 l h 198.378 258.933 m 198.378 256.505 l 198.378 256.326 198.381 256.123 198.394 255.986 c 198.066 255.986 l 198.049 256.335 l 198.041 256.335 l 197.928 256.111 197.687 255.94 197.358 255.94 c 196.871 255.94 196.493 256.351 196.493 256.962 c 196.489 257.634 196.909 258.041 197.396 258.041 c 197.708 258.041 197.916 257.895 198.003 257.738 c 198.011 257.738 l 198.011 258.933 l 198.378 258.933 l f 199.867 257.995 0.366 -2.009 re 200.042 258.365 m 199.905 258.365 199.813 258.473 199.813 258.601 c 199.813 258.73 199.908 258.834 200.05 258.834 c 200.192 258.834 200.283 258.73 200.283 258.601 c 200.283 258.473 200.192 258.365 200.046 258.365 c 200.042 258.365 l f 200.84 257.451 m 200.84 257.663 200.836 257.829 200.824 257.995 c 201.149 257.995 l 201.169 257.667 l 201.177 257.667 l 201.277 257.854 201.511 258.041 201.843 258.041 c 202.122 258.041 202.554 257.875 202.554 257.186 c 202.554 255.986 l 202.189 255.986 l 202.189 257.144 l 202.189 257.468 202.068 257.742 201.722 257.742 c 201.486 257.742 201.298 257.572 201.232 257.368 c 201.215 257.323 201.207 257.256 201.207 257.198 c 201.207 255.986 l 200.84 255.986 l 200.84 257.451 l f 203.183 255.986 m 203.183 257.717 l 202.904 257.717 l 202.904 257.995 l 203.183 257.995 l 203.183 258.091 l 203.183 258.373 203.249 258.63 203.42 258.792 c 203.557 258.925 203.74 258.979 203.907 258.979 c 204.04 258.979 204.148 258.95 204.219 258.921 c 204.173 258.639 l 204.115 258.663 204.044 258.684 203.936 258.684 c 203.628 258.684 203.544 258.41 203.544 258.103 c 203.544 257.995 l 204.031 257.995 l 204.031 257.717 l 203.549 257.717 l 203.549 255.986 l 203.183 255.986 l f 205.147 256.214 m 205.496 256.214 205.758 256.542 205.758 256.999 c 205.758 257.339 205.588 257.767 205.155 257.767 c 204.727 257.767 204.54 257.368 204.54 256.986 c 204.54 256.546 204.789 256.214 205.143 256.214 c 205.147 256.214 l h 205.134 255.94 m 204.593 255.94 204.169 256.339 204.169 256.974 c 204.169 257.646 204.614 258.041 205.168 258.041 c 205.746 258.041 206.137 257.622 206.137 257.011 c 206.137 256.264 205.617 255.94 205.138 255.94 c 205.134 255.94 l f 206.603 257.368 m 206.603 257.605 206.599 257.808 206.586 257.995 c 206.907 257.995 l 206.923 257.601 l 206.936 257.601 l 207.027 257.871 207.252 258.041 207.497 258.041 c 207.535 258.041 207.564 258.037 207.597 258.028 c 207.597 257.688 l 207.556 257.692 207.518 257.696 207.468 257.696 c 207.211 257.696 207.027 257.501 206.977 257.231 c 206.969 257.177 206.965 257.119 206.965 257.057 c 206.965 255.986 l 206.599 255.986 l 206.603 257.368 l f 207.976 257.451 m 207.976 257.663 207.967 257.829 207.959 257.995 c 208.279 257.995 l 208.296 257.671 l 208.309 257.671 l 208.421 257.862 208.608 258.041 208.945 258.041 c 209.216 258.041 209.423 257.875 209.511 257.638 c 209.52 257.638 l 209.581 257.754 209.665 257.837 209.748 257.9 c 209.869 257.991 209.998 258.041 210.189 258.041 c 210.46 258.041 210.855 257.866 210.855 257.169 c 210.855 255.986 l 210.497 255.986 l 210.497 257.123 l 210.497 257.514 210.352 257.742 210.06 257.742 c 209.848 257.742 209.69 257.588 209.623 257.414 c 209.606 257.36 209.594 257.294 209.594 257.231 c 209.594 255.986 l 209.236 255.986 l 209.236 257.19 l 209.236 257.514 209.095 257.742 208.816 257.742 c 208.591 257.742 208.421 257.559 208.363 257.377 c 208.342 257.323 208.334 257.26 208.334 257.198 c 208.334 255.986 l 207.976 255.986 l 207.976 257.451 l f 212.506 257.011 m 212.107 257.02 211.654 256.949 211.654 256.559 c 211.654 256.318 211.812 256.21 211.995 256.21 c 212.261 256.21 212.432 256.376 212.49 256.546 c 212.502 256.584 212.506 256.625 212.506 256.663 c 212.506 257.011 l h 212.864 256.467 m 212.864 256.293 212.872 256.123 212.893 255.986 c 212.565 255.986 l 212.531 256.239 l 212.519 256.239 l 212.41 256.081 212.19 255.94 211.903 255.94 c 211.495 255.94 211.287 256.227 211.287 256.517 c 211.287 257.003 211.72 257.269 212.498 257.265 c 212.498 257.306 l 212.498 257.472 212.452 257.775 212.04 257.771 c 211.849 257.771 211.654 257.717 211.512 257.622 c 211.429 257.866 l 211.595 257.97 211.84 258.041 212.094 258.041 c 212.714 258.041 212.864 257.622 212.864 257.219 c 212.864 256.467 l f 213.875 258.477 m 213.875 257.995 l 214.399 257.995 l 214.399 257.717 l 213.875 257.717 l 213.875 256.634 l 213.875 256.385 213.946 256.243 214.149 256.243 c 214.249 256.243 214.308 256.252 214.362 256.268 c 214.379 255.99 l 214.308 255.965 214.196 255.94 214.054 255.94 c 213.883 255.94 213.746 255.999 213.659 256.094 c 213.559 256.206 213.517 256.385 213.517 256.621 c 213.517 257.717 l 213.206 257.717 l 213.206 257.995 l 213.517 257.995 l 213.517 258.365 l 213.875 258.477 l f 214.811 257.995 0.366 -2.009 re 214.986 258.365 m 214.849 258.365 214.758 258.473 214.758 258.601 c 214.758 258.73 214.853 258.834 214.994 258.834 c 215.136 258.834 215.228 258.73 215.228 258.601 c 215.228 258.473 215.136 258.365 214.99 258.365 c 214.986 258.365 l f 216.617 256.214 m 216.967 256.214 217.228 256.542 217.228 256.999 c 217.228 257.339 217.058 257.767 216.625 257.767 c 216.197 257.767 216.01 257.368 216.01 256.986 c 216.01 256.546 216.259 256.214 216.613 256.214 c 216.617 256.214 l h 216.605 255.94 m 216.064 255.94 215.64 256.339 215.64 256.974 c 215.64 257.646 216.085 258.041 216.638 258.041 c 217.216 258.041 217.607 257.622 217.607 257.011 c 217.607 256.264 217.087 255.94 216.609 255.94 c 216.605 255.94 l f 218.069 257.451 m 218.069 257.663 218.065 257.829 218.052 257.995 c 218.377 257.995 l 218.397 257.667 l 218.406 257.667 l 218.506 257.854 218.739 258.041 219.072 258.041 c 219.351 258.041 219.783 257.875 219.783 257.186 c 219.783 255.986 l 219.417 255.986 l 219.417 257.144 l 219.417 257.468 219.296 257.742 218.951 257.742 c 218.714 257.742 218.527 257.572 218.46 257.368 c 218.444 257.323 218.435 257.256 218.435 257.198 c 218.435 255.986 l 218.069 255.986 l 218.069 257.451 l f 222.321 257.011 m 221.921 257.02 221.468 256.949 221.468 256.559 c 221.468 256.318 221.626 256.21 221.809 256.21 c 222.075 256.21 222.246 256.376 222.304 256.546 c 222.317 256.584 222.321 256.625 222.321 256.663 c 222.321 257.011 l h 222.678 256.467 m 222.678 256.293 222.687 256.123 222.708 255.986 c 222.379 255.986 l 222.346 256.239 l 222.333 256.239 l 222.225 256.081 222.005 255.94 221.718 255.94 c 221.31 255.94 221.102 256.227 221.102 256.517 c 221.102 257.003 221.535 257.269 222.313 257.265 c 222.313 257.306 l 222.313 257.472 222.267 257.775 221.855 257.771 c 221.663 257.771 221.468 257.717 221.326 257.622 c 221.243 257.866 l 221.41 257.97 221.655 258.041 221.909 258.041 c 222.529 258.041 222.678 257.622 222.678 257.219 c 222.678 256.467 l f 223.631 256.791 m 223.631 256.746 223.635 256.7 223.644 256.658 c 223.714 256.405 223.931 256.231 224.193 256.231 c 224.58 256.231 224.804 256.542 224.804 257.003 c 224.804 257.41 224.597 257.754 224.206 257.754 c 223.956 257.754 223.723 257.58 223.652 257.306 c 223.64 257.26 223.631 257.211 223.631 257.152 c 223.631 256.791 l h 223.265 258.933 m 223.631 258.933 l 223.631 257.675 l 223.64 257.675 l 223.769 257.9 224.002 258.041 224.326 258.041 c 224.826 258.041 225.175 257.626 225.175 257.02 c 225.175 256.297 224.717 255.94 224.268 255.94 c 223.977 255.94 223.748 256.052 223.594 256.318 c 223.585 256.318 l 223.565 255.986 l 223.249 255.986 l 223.261 256.123 223.265 256.326 223.265 256.505 c 223.265 258.933 l f 226.469 256.214 m 226.818 256.214 227.08 256.542 227.08 256.999 c 227.08 257.339 226.91 257.767 226.477 257.767 c 226.049 257.767 225.861 257.368 225.861 256.986 c 225.861 256.546 226.111 256.214 226.464 256.214 c 226.469 256.214 l h 226.456 255.94 m 225.916 255.94 225.491 256.339 225.491 256.974 c 225.491 257.646 225.936 258.041 226.489 258.041 c 227.068 258.041 227.459 257.622 227.459 257.011 c 227.459 256.264 226.939 255.94 226.461 255.94 c 226.456 255.94 l f 229.605 256.534 m 229.605 256.326 229.61 256.144 229.622 255.986 c 229.298 255.986 l 229.277 256.314 l 229.269 256.314 l 229.177 256.152 228.961 255.94 228.603 255.94 c 228.287 255.94 227.908 256.119 227.908 256.82 c 227.908 257.995 l 228.274 257.995 l 228.274 256.887 l 228.274 256.505 228.395 256.243 228.723 256.243 c 228.969 256.243 229.14 256.414 229.206 256.58 c 229.227 256.629 229.24 256.696 229.24 256.766 c 229.24 257.995 l 229.605 257.995 l 229.605 256.534 l f 230.654 258.477 m 230.654 257.995 l 231.178 257.995 l 231.178 257.717 l 230.654 257.717 l 230.654 256.634 l 230.654 256.385 230.725 256.243 230.929 256.243 c 231.029 256.243 231.087 256.252 231.141 256.268 c 231.158 255.99 l 231.087 255.965 230.974 255.94 230.833 255.94 c 230.662 255.94 230.525 255.999 230.438 256.094 c 230.338 256.206 230.296 256.385 230.296 256.621 c 230.296 257.717 l 229.984 257.717 l 229.984 257.995 l 230.296 257.995 l 230.296 258.365 l 230.654 258.477 l f 232.913 258.477 m 232.913 257.995 l 233.437 257.995 l 233.437 257.717 l 232.913 257.717 l 232.913 256.634 l 232.913 256.385 232.984 256.243 233.188 256.243 c 233.288 256.243 233.346 256.252 233.4 256.268 c 233.416 255.99 l 233.346 255.965 233.233 255.94 233.092 255.94 c 232.921 255.94 232.784 255.999 232.697 256.094 c 232.597 256.206 232.555 256.385 232.555 256.621 c 232.555 257.717 l 232.243 257.717 l 232.243 257.995 l 232.555 257.995 l 232.555 258.365 l 232.913 258.477 l f 233.849 258.933 m 234.215 258.933 l 234.215 257.68 l 234.223 257.68 l 234.282 257.783 234.373 257.879 234.485 257.937 c 234.594 258.003 234.723 258.041 234.86 258.041 c 235.13 258.041 235.563 257.875 235.563 257.182 c 235.563 255.986 l 235.197 255.986 l 235.197 257.14 l 235.197 257.468 235.077 257.738 234.731 257.738 c 234.494 257.738 234.311 257.572 234.24 257.372 c 234.22 257.323 234.215 257.269 234.215 257.198 c 234.215 255.986 l 233.849 255.986 l 233.849 258.933 l f 237.436 257.19 m 237.439 257.418 237.339 257.783 236.932 257.783 c 236.557 257.783 236.399 257.443 236.371 257.19 c 237.436 257.19 l h 236.366 256.928 m 236.374 256.434 236.686 256.231 237.052 256.231 c 237.315 256.231 237.477 256.277 237.61 256.331 c 237.677 256.073 l 237.548 256.015 237.323 255.945 237.003 255.945 c 236.387 255.945 236.012 256.356 236.012 256.957 c 236.012 257.568 236.374 258.045 236.961 258.045 c 237.618 258.045 237.789 257.468 237.789 257.098 c 237.789 257.024 237.785 256.966 237.776 256.924 c 236.366 256.928 l f 239.075 256.356 m 239.186 256.289 239.378 256.214 239.562 256.214 c 239.823 256.214 239.948 256.343 239.948 256.513 c 239.948 256.688 239.844 256.783 239.578 256.883 c 239.211 257.016 239.041 257.211 239.041 257.451 c 239.041 257.775 239.307 258.041 239.736 258.041 c 239.94 258.041 240.118 257.987 240.227 257.916 c 240.14 257.655 l 240.06 257.7 239.915 257.771 239.728 257.771 c 239.512 257.771 239.395 257.646 239.395 257.497 c 239.395 257.327 239.512 257.252 239.773 257.152 c 240.118 257.024 240.302 256.849 240.302 256.546 c 240.302 256.19 240.023 255.94 239.553 255.94 c 239.332 255.94 239.128 255.999 238.987 256.081 c 239.075 256.356 l f 241.213 258.477 m 241.213 257.995 l 241.737 257.995 l 241.737 257.717 l 241.213 257.717 l 241.213 256.634 l 241.213 256.385 241.284 256.243 241.487 256.243 c 241.587 256.243 241.646 256.252 241.7 256.268 c 241.717 255.99 l 241.646 255.965 241.534 255.94 241.392 255.94 c 241.221 255.94 241.084 255.999 240.997 256.094 c 240.897 256.206 240.855 256.385 240.855 256.621 c 240.855 257.717 l 240.543 257.717 l 240.543 257.995 l 240.855 257.995 l 240.855 258.365 l 241.213 258.477 l f 242.153 257.368 m 242.153 257.605 242.149 257.808 242.137 257.995 c 242.457 257.995 l 242.474 257.601 l 242.486 257.601 l 242.577 257.871 242.802 258.041 243.048 258.041 c 243.085 258.041 243.114 258.037 243.148 258.028 c 243.148 257.688 l 243.106 257.692 243.069 257.696 243.019 257.696 c 242.761 257.696 242.577 257.501 242.527 257.231 c 242.519 257.177 242.515 257.119 242.515 257.057 c 242.515 255.986 l 242.149 255.986 l 242.153 257.368 l f 244.545 257.011 m 244.146 257.02 243.693 256.949 243.693 256.559 c 243.693 256.318 243.851 256.21 244.034 256.21 c 244.3 256.21 244.471 256.376 244.529 256.546 c 244.541 256.584 244.545 256.625 244.545 256.663 c 244.545 257.011 l h 244.903 256.467 m 244.903 256.293 244.911 256.123 244.932 255.986 c 244.604 255.986 l 244.57 256.239 l 244.558 256.239 l 244.45 256.081 244.23 255.94 243.942 255.94 c 243.534 255.94 243.326 256.227 243.326 256.517 c 243.326 257.003 243.759 257.269 244.537 257.265 c 244.537 257.306 l 244.537 257.472 244.491 257.775 244.08 257.771 c 243.888 257.771 243.693 257.717 243.551 257.622 c 243.468 257.866 l 243.634 257.97 243.879 258.041 244.133 258.041 c 244.753 258.041 244.903 257.622 244.903 257.219 c 244.903 256.467 l f 245.914 258.477 m 245.914 257.995 l 246.439 257.995 l 246.439 257.717 l 245.914 257.717 l 245.914 256.634 l 245.914 256.385 245.985 256.243 246.188 256.243 c 246.288 256.243 246.347 256.252 246.401 256.268 c 246.418 255.99 l 246.347 255.965 246.235 255.94 246.093 255.94 c 245.922 255.94 245.785 255.999 245.698 256.094 c 245.598 256.206 245.557 256.385 245.557 256.621 c 245.557 257.717 l 245.245 257.717 l 245.245 257.995 l 245.557 257.995 l 245.557 258.365 l 245.914 258.477 l f 248.103 257.19 m 248.107 257.418 248.007 257.783 247.599 257.783 c 247.225 257.783 247.067 257.443 247.038 257.19 c 248.103 257.19 l h 247.034 256.928 m 247.042 256.434 247.354 256.231 247.72 256.231 c 247.982 256.231 248.144 256.277 248.277 256.331 c 248.344 256.073 l 248.215 256.015 247.991 255.945 247.67 255.945 c 247.054 255.945 246.68 256.356 246.68 256.957 c 246.68 257.568 247.042 258.045 247.629 258.045 c 248.286 258.045 248.456 257.468 248.456 257.098 c 248.456 257.024 248.452 256.966 248.444 256.924 c 247.034 256.928 l f 250.266 257.206 m 250.266 257.265 250.262 257.318 250.245 257.368 c 250.179 257.584 250.004 257.758 249.734 257.758 c 249.384 257.758 249.134 257.464 249.134 256.995 c 249.134 256.605 249.338 256.272 249.73 256.272 c 249.958 256.272 250.162 256.414 250.237 256.65 c 250.258 256.708 250.266 256.779 250.266 256.845 c 250.266 257.206 l h 250.632 256.281 m 250.632 255.816 250.536 255.538 250.345 255.359 c 250.145 255.181 249.863 255.119 249.609 255.119 c 249.368 255.119 249.101 255.177 248.939 255.285 c 249.031 255.567 l 249.164 255.48 249.371 255.405 249.621 255.405 c 249.996 255.405 250.27 255.6 250.27 256.111 c 250.27 256.331 l 250.262 256.331 l 250.154 256.144 249.933 255.994 249.621 255.994 c 249.122 255.994 248.764 256.418 248.764 256.978 c 248.764 257.659 249.209 258.041 249.675 258.041 c 250.025 258.041 250.212 257.862 250.303 257.696 c 250.312 257.696 l 250.325 257.995 l 250.649 257.995 l 250.636 257.854 250.632 257.692 250.632 257.447 c 250.632 256.281 l f 251.235 257.995 0.366 -2.009 re 251.41 258.365 m 251.273 258.365 251.182 258.473 251.182 258.601 c 251.182 258.73 251.277 258.834 251.418 258.834 c 251.56 258.834 251.652 258.73 251.652 258.601 c 251.652 258.473 251.56 258.365 251.414 258.365 c 251.41 258.365 l f 253.644 256.057 m 253.549 256.011 253.336 255.94 253.066 255.94 c 252.459 255.94 252.064 256.351 252.064 256.97 c 252.064 257.588 252.488 258.041 253.145 258.041 c 253.361 258.041 253.553 257.987 253.652 257.933 c 253.569 257.655 l 253.482 257.7 253.345 257.75 253.145 257.75 c 252.683 257.75 252.434 257.406 252.434 256.986 c 252.434 256.521 252.733 256.235 253.132 256.235 c 253.341 256.235 253.478 256.285 253.582 256.331 c 253.644 256.057 l f 255.321 256.804 m 255.321 256.754 255.325 256.7 255.338 256.654 c 255.4 256.401 255.625 256.227 255.883 256.227 c 256.27 256.227 256.494 256.542 256.494 257.003 c 256.494 257.406 256.286 257.75 255.9 257.75 c 255.65 257.75 255.413 257.576 255.342 257.302 c 255.333 257.252 255.321 257.198 255.321 257.152 c 255.321 256.804 l h 254.955 257.339 m 254.955 257.597 254.951 257.804 254.938 257.995 c 255.267 257.995 l 255.288 257.651 l 255.296 257.651 l 255.441 257.9 255.683 258.041 256.008 258.041 c 256.498 258.041 256.865 257.63 256.865 257.02 c 256.865 256.297 256.42 255.94 255.949 255.94 c 255.679 255.94 255.45 256.057 255.329 256.256 c 255.321 256.256 l 255.321 255.164 l 254.955 255.164 l 254.955 257.339 l f 257.322 258.933 0.366 -2.947 re f 259.356 257.011 m 258.957 257.02 258.504 256.949 258.504 256.559 c 258.504 256.318 258.662 256.21 258.845 256.21 c 259.111 256.21 259.282 256.376 259.34 256.546 c 259.352 256.584 259.356 256.625 259.356 256.663 c 259.356 257.011 l h 259.714 256.467 m 259.714 256.293 259.722 256.123 259.743 255.986 c 259.415 255.986 l 259.381 256.239 l 259.369 256.239 l 259.261 256.081 259.04 255.94 258.753 255.94 c 258.345 255.94 258.137 256.227 258.137 256.517 c 258.137 257.003 258.57 257.269 259.348 257.265 c 259.348 257.306 l 259.348 257.472 259.302 257.775 258.891 257.771 c 258.699 257.771 258.504 257.717 258.362 257.622 c 258.279 257.866 l 258.445 257.97 258.69 258.041 258.944 258.041 c 259.564 258.041 259.714 257.622 259.714 257.219 c 259.714 256.467 l f 260.301 257.451 m 260.301 257.663 260.296 257.829 260.284 257.995 c 260.609 257.995 l 260.629 257.667 l 260.638 257.667 l 260.738 257.854 260.971 258.041 261.303 258.041 c 261.582 258.041 262.015 257.875 262.015 257.186 c 262.015 255.986 l 261.649 255.986 l 261.649 257.144 l 261.649 257.468 261.528 257.742 261.183 257.742 c 260.946 257.742 260.758 257.572 260.692 257.368 c 260.675 257.323 260.667 257.256 260.667 257.198 c 260.667 255.986 l 260.301 255.986 l 260.301 257.451 l f 262.61 257.451 m 262.61 257.663 262.606 257.829 262.593 257.995 c 262.918 257.995 l 262.938 257.667 l 262.947 257.667 l 263.047 257.854 263.28 258.041 263.613 258.041 c 263.892 258.041 264.324 257.875 264.324 257.186 c 264.324 255.986 l 263.958 255.986 l 263.958 257.144 l 263.958 257.468 263.837 257.742 263.492 257.742 c 263.255 257.742 263.068 257.572 263.001 257.368 c 262.985 257.323 262.976 257.256 262.976 257.198 c 262.976 255.986 l 262.61 255.986 l 262.61 257.451 l f 264.919 257.995 0.366 -2.009 re 265.094 258.365 m 264.957 258.365 264.865 258.473 264.865 258.601 c 264.865 258.73 264.961 258.834 265.102 258.834 c 265.244 258.834 265.335 258.73 265.335 258.601 c 265.335 258.473 265.244 258.365 265.098 258.365 c 265.094 258.365 l f 265.893 257.451 m 265.893 257.663 265.888 257.829 265.876 257.995 c 266.201 257.995 l 266.221 257.667 l 266.229 257.667 l 266.329 257.854 266.563 258.041 266.895 258.041 c 267.174 258.041 267.606 257.875 267.606 257.186 c 267.606 255.986 l 267.241 255.986 l 267.241 257.144 l 267.241 257.468 267.12 257.742 266.774 257.742 c 266.538 257.742 266.35 257.572 266.284 257.368 c 266.267 257.323 266.259 257.256 266.259 257.198 c 266.259 255.986 l 265.893 255.986 l 265.893 257.451 l f 269.558 257.206 m 269.558 257.265 269.554 257.318 269.537 257.368 c 269.47 257.584 269.296 257.758 269.025 257.758 c 268.676 257.758 268.427 257.464 268.427 256.995 c 268.427 256.605 268.63 256.272 269.021 256.272 c 269.25 256.272 269.454 256.414 269.529 256.65 c 269.55 256.708 269.558 256.779 269.558 256.845 c 269.558 257.206 l h 269.924 256.281 m 269.924 255.816 269.829 255.538 269.637 255.359 c 269.437 255.181 269.154 255.119 268.9 255.119 c 268.659 255.119 268.393 255.177 268.231 255.285 c 268.322 255.567 l 268.455 255.48 268.663 255.405 268.913 255.405 c 269.287 255.405 269.562 255.6 269.562 256.111 c 269.562 256.331 l 269.554 256.331 l 269.445 256.144 269.225 255.994 268.913 255.994 c 268.414 255.994 268.056 256.418 268.056 256.978 c 268.056 257.659 268.501 258.041 268.967 258.041 c 269.317 258.041 269.504 257.862 269.595 257.696 c 269.604 257.696 l 269.616 257.995 l 269.94 257.995 l 269.928 257.854 269.924 257.692 269.924 257.447 c 269.924 256.281 l f 271.775 256.804 m 271.775 256.754 271.779 256.7 271.792 256.654 c 271.854 256.401 272.079 256.227 272.337 256.227 c 272.724 256.227 272.948 256.542 272.948 257.003 c 272.948 257.406 272.741 257.75 272.354 257.75 c 272.104 257.75 271.867 257.576 271.796 257.302 c 271.788 257.252 271.775 257.198 271.775 257.152 c 271.775 256.804 l h 271.409 257.339 m 271.409 257.597 271.405 257.804 271.392 257.995 c 271.721 257.995 l 271.742 257.651 l 271.75 257.651 l 271.896 257.9 272.137 258.041 272.462 258.041 c 272.953 258.041 273.319 257.63 273.319 257.02 c 273.319 256.297 272.874 255.94 272.403 255.94 c 272.133 255.94 271.904 256.057 271.784 256.256 c 271.775 256.256 l 271.775 255.164 l 271.409 255.164 l 271.409 257.339 l f 273.78 257.368 m 273.78 257.605 273.776 257.808 273.764 257.995 c 274.084 257.995 l 274.101 257.601 l 274.113 257.601 l 274.205 257.871 274.43 258.041 274.675 258.041 c 274.712 258.041 274.742 258.037 274.775 258.028 c 274.775 257.688 l 274.733 257.692 274.696 257.696 274.646 257.696 c 274.388 257.696 274.205 257.501 274.155 257.231 c 274.147 257.177 274.142 257.119 274.142 257.057 c 274.142 255.986 l 273.776 255.986 l 273.78 257.368 l f 275.944 256.214 m 276.293 256.214 276.556 256.542 276.556 256.999 c 276.556 257.339 276.385 257.767 275.952 257.767 c 275.524 257.767 275.337 257.368 275.337 256.986 c 275.337 256.546 275.586 256.214 275.94 256.214 c 275.944 256.214 l h 275.931 255.94 m 275.39 255.94 274.966 256.339 274.966 256.974 c 274.966 257.646 275.411 258.041 275.965 258.041 c 276.543 258.041 276.934 257.622 276.934 257.011 c 276.934 256.264 276.414 255.94 275.935 255.94 c 275.931 255.94 l f 278.835 256.057 m 278.74 256.011 278.528 255.94 278.257 255.94 c 277.649 255.94 277.254 256.351 277.254 256.97 c 277.254 257.588 277.679 258.041 278.336 258.041 c 278.553 258.041 278.744 257.987 278.844 257.933 c 278.761 257.655 l 278.673 257.7 278.536 257.75 278.336 257.75 c 277.874 257.75 277.625 257.406 277.625 256.986 c 277.625 256.521 277.924 256.235 278.324 256.235 c 278.532 256.235 278.669 256.285 278.773 256.331 c 278.835 256.057 l f 280.517 257.19 m 280.52 257.418 280.42 257.783 280.013 257.783 c 279.638 257.783 279.48 257.443 279.451 257.19 c 280.517 257.19 l h 279.447 256.928 m 279.455 256.434 279.767 256.231 280.133 256.231 c 280.396 256.231 280.558 256.277 280.691 256.331 c 280.758 256.073 l 280.628 256.015 280.404 255.945 280.083 255.945 c 279.468 255.945 279.093 256.356 279.093 256.957 c 279.093 257.568 279.455 258.045 280.042 258.045 c 280.699 258.045 280.87 257.468 280.87 257.098 c 280.87 257.024 280.866 256.966 280.857 256.924 c 279.447 256.928 l f 281.274 256.356 m 281.385 256.289 281.577 256.214 281.76 256.214 c 282.022 256.214 282.147 256.343 282.147 256.513 c 282.147 256.688 282.043 256.783 281.777 256.883 c 281.41 257.016 281.24 257.211 281.24 257.451 c 281.24 257.775 281.506 258.041 281.935 258.041 c 282.139 258.041 282.317 257.987 282.426 257.916 c 282.339 257.655 l 282.259 257.7 282.114 257.771 281.927 257.771 c 281.71 257.771 281.594 257.646 281.594 257.497 c 281.594 257.327 281.71 257.252 281.972 257.152 c 282.317 257.024 282.501 256.849 282.501 256.546 c 282.501 256.19 282.222 255.94 281.752 255.94 c 281.531 255.94 281.327 255.999 281.186 256.081 c 281.274 256.356 l f 282.921 256.356 m 283.033 256.289 283.224 256.214 283.408 256.214 c 283.669 256.214 283.794 256.343 283.794 256.513 c 283.794 256.688 283.691 256.783 283.424 256.883 c 283.058 257.016 282.887 257.211 282.887 257.451 c 282.887 257.775 283.154 258.041 283.583 258.041 c 283.786 258.041 283.965 257.987 284.073 257.916 c 283.986 257.655 l 283.907 257.7 283.761 257.771 283.574 257.771 c 283.358 257.771 283.241 257.646 283.241 257.497 c 283.241 257.327 283.358 257.252 283.619 257.152 c 283.965 257.024 284.148 256.849 284.148 256.546 c 284.148 256.19 283.869 255.94 283.399 255.94 c 283.179 255.94 282.975 255.999 282.833 256.081 c 282.921 256.356 l f 171.226 249.953 m 170.988 249.953 170.793 250.144 170.793 250.389 c 170.789 250.63 170.988 250.825 171.23 250.825 c 171.471 250.825 171.667 250.634 171.667 250.389 c 171.667 250.148 171.471 249.953 171.23 249.953 c 171.226 249.953 l f 173.515 251.759 0.366 -2.798 re f 174.502 250.427 m 174.502 250.638 174.497 250.804 174.485 250.97 c 174.809 250.97 l 174.83 250.642 l 174.838 250.642 l 174.938 250.829 175.171 251.016 175.504 251.016 c 175.783 251.016 176.215 250.85 176.215 250.161 c 176.215 248.961 l 175.849 248.961 l 175.849 250.119 l 175.849 250.443 175.729 250.717 175.383 250.717 c 175.146 250.717 174.959 250.547 174.893 250.344 c 174.876 250.298 174.868 250.231 174.868 250.173 c 174.868 248.961 l 174.502 248.961 l 174.502 250.427 l f 178.246 249.032 m 178.15 248.986 177.938 248.916 177.667 248.916 c 177.06 248.916 176.665 249.327 176.665 249.945 c 176.665 250.564 177.089 251.016 177.747 251.016 c 177.963 251.016 178.154 250.962 178.254 250.908 c 178.171 250.63 l 178.083 250.676 177.946 250.725 177.747 250.725 c 177.285 250.725 177.035 250.381 177.035 249.962 c 177.035 249.497 177.335 249.21 177.734 249.21 c 177.942 249.21 178.079 249.26 178.183 249.306 c 178.246 249.032 l f 178.674 251.908 0.366 -2.947 re f 181.333 249.509 m 181.333 249.302 181.337 249.119 181.349 248.961 c 181.025 248.961 l 181.004 249.289 l 180.996 249.289 l 180.904 249.127 180.688 248.916 180.33 248.916 c 180.014 248.916 179.635 249.094 179.635 249.796 c 179.635 250.97 l 180.001 250.97 l 180.001 249.862 l 180.001 249.48 180.122 249.219 180.451 249.219 c 180.696 249.219 180.867 249.389 180.933 249.555 c 180.954 249.605 180.967 249.671 180.967 249.742 c 180.967 250.97 l 181.333 250.97 l 181.333 249.509 l f 183.313 250.153 m 183.313 250.202 183.309 250.26 183.296 250.31 c 183.242 250.539 183.042 250.73 182.768 250.73 c 182.389 250.73 182.165 250.398 182.165 249.958 c 182.165 249.547 182.369 249.21 182.76 249.21 c 183.005 249.21 183.23 249.376 183.296 249.646 c 183.309 249.696 183.313 249.746 183.313 249.804 c 183.313 250.153 l h 183.679 251.908 m 183.679 249.48 l 183.679 249.302 183.683 249.098 183.696 248.961 c 183.367 248.961 l 183.351 249.31 l 183.342 249.31 l 183.23 249.086 182.988 248.916 182.66 248.916 c 182.173 248.916 181.794 249.327 181.794 249.937 c 181.79 250.609 182.21 251.016 182.697 251.016 c 183.009 251.016 183.217 250.871 183.305 250.713 c 183.313 250.713 l 183.313 251.908 l 183.679 251.908 l f 185.564 250.165 m 185.568 250.393 185.468 250.759 185.06 250.759 c 184.686 250.759 184.528 250.418 184.499 250.165 c 185.564 250.165 l h 184.494 249.904 m 184.503 249.41 184.815 249.206 185.181 249.206 c 185.443 249.206 185.606 249.252 185.739 249.306 c 185.805 249.048 l 185.676 248.99 185.451 248.92 185.131 248.92 c 184.515 248.92 184.141 249.331 184.141 249.933 c 184.141 250.543 184.503 251.02 185.09 251.02 c 185.747 251.02 185.917 250.443 185.917 250.074 c 185.917 249.999 185.913 249.941 185.905 249.899 c 184.494 249.904 l f 186.321 249.331 m 186.433 249.264 186.625 249.19 186.808 249.19 c 187.07 249.19 187.195 249.318 187.195 249.488 c 187.195 249.663 187.091 249.758 186.824 249.858 c 186.458 249.991 186.288 250.186 186.288 250.427 c 186.288 250.75 186.554 251.016 186.983 251.016 c 187.186 251.016 187.365 250.962 187.473 250.891 c 187.386 250.63 l 187.307 250.676 187.161 250.746 186.974 250.746 c 186.758 250.746 186.641 250.622 186.641 250.472 c 186.641 250.302 186.758 250.227 187.02 250.128 c 187.365 249.999 187.548 249.825 187.548 249.522 c 187.548 249.165 187.269 248.916 186.799 248.916 c 186.579 248.916 186.375 248.974 186.233 249.057 c 186.321 249.331 l f 189.342 251.452 m 189.342 250.97 l 189.866 250.97 l 189.866 250.692 l 189.342 250.692 l 189.342 249.609 l 189.342 249.36 189.412 249.219 189.616 249.219 c 189.716 249.219 189.774 249.227 189.828 249.243 c 189.845 248.965 l 189.774 248.941 189.662 248.916 189.52 248.916 c 189.35 248.916 189.212 248.974 189.125 249.069 c 189.025 249.181 188.984 249.36 188.984 249.596 c 188.984 250.692 l 188.672 250.692 l 188.672 250.97 l 188.984 250.97 l 188.984 251.34 l 189.342 251.452 l f 190.278 251.908 m 190.644 251.908 l 190.644 250.655 l 190.652 250.655 l 190.71 250.759 190.802 250.854 190.914 250.912 c 191.022 250.979 191.151 251.016 191.289 251.016 c 191.559 251.016 191.992 250.85 191.992 250.157 c 191.992 248.961 l 191.626 248.961 l 191.626 250.115 l 191.626 250.443 191.505 250.713 191.16 250.713 c 190.922 250.713 190.739 250.547 190.669 250.348 c 190.648 250.298 190.644 250.244 190.644 250.173 c 190.644 248.961 l 190.278 248.961 l 190.278 251.908 l f 192.591 250.344 m 192.591 250.58 192.587 250.784 192.574 250.97 c 192.894 250.97 l 192.911 250.576 l 192.924 250.576 l 193.015 250.846 193.24 251.016 193.485 251.016 c 193.523 251.016 193.552 251.012 193.585 251.004 c 193.585 250.663 l 193.544 250.667 193.506 250.671 193.456 250.671 c 193.198 250.671 193.015 250.476 192.965 250.207 c 192.957 250.153 192.953 250.094 192.953 250.032 c 192.953 248.961 l 192.587 248.961 l 192.591 250.344 l f 195.199 250.165 m 195.203 250.393 195.103 250.759 194.696 250.759 c 194.321 250.759 194.163 250.418 194.134 250.165 c 195.199 250.165 l h 194.13 249.904 m 194.138 249.41 194.45 249.206 194.817 249.206 c 195.079 249.206 195.241 249.252 195.374 249.306 c 195.441 249.048 l 195.312 248.99 195.087 248.92 194.767 248.92 c 194.151 248.92 193.776 249.331 193.776 249.933 c 193.776 250.543 194.138 251.02 194.725 251.02 c 195.382 251.02 195.553 250.443 195.553 250.074 c 195.553 249.999 195.549 249.941 195.54 249.899 c 194.13 249.904 l f 197.284 250.165 m 197.288 250.393 197.188 250.759 196.78 250.759 c 196.406 250.759 196.248 250.418 196.219 250.165 c 197.284 250.165 l h 196.214 249.904 m 196.223 249.41 196.535 249.206 196.901 249.206 c 197.163 249.206 197.325 249.252 197.458 249.306 c 197.525 249.048 l 197.396 248.99 197.171 248.92 196.851 248.92 c 196.235 248.92 195.861 249.331 195.861 249.933 c 195.861 250.543 196.223 251.02 196.809 251.02 c 197.466 251.02 197.637 250.443 197.637 250.074 c 197.637 249.999 197.633 249.941 197.624 249.899 c 196.214 249.904 l f 198.973 250.97 0.366 -2.009 re 199.148 251.34 m 199.01 251.34 198.919 251.448 198.919 251.576 c 198.919 251.705 199.015 251.809 199.156 251.809 c 199.297 251.809 199.389 251.705 199.389 251.576 c 199.389 251.448 199.297 251.34 199.152 251.34 c 199.148 251.34 l f 199.946 250.427 m 199.946 250.638 199.942 250.804 199.93 250.97 c 200.254 250.97 l 200.275 250.642 l 200.283 250.642 l 200.383 250.829 200.616 251.016 200.949 251.016 c 201.227 251.016 201.66 250.85 201.66 250.161 c 201.66 248.961 l 201.294 248.961 l 201.294 250.119 l 201.294 250.443 201.174 250.717 200.828 250.717 c 200.591 250.717 200.404 250.547 200.337 250.344 c 200.32 250.298 200.312 250.231 200.312 250.173 c 200.312 248.961 l 199.946 248.961 l 199.946 250.427 l f 202.679 251.452 m 202.679 250.97 l 203.204 250.97 l 203.204 250.692 l 202.679 250.692 l 202.679 249.609 l 202.679 249.36 202.75 249.219 202.954 249.219 c 203.054 249.219 203.112 249.227 203.166 249.243 c 203.183 248.965 l 203.112 248.941 203 248.916 202.858 248.916 c 202.688 248.916 202.551 248.974 202.463 249.069 c 202.363 249.181 202.322 249.36 202.322 249.596 c 202.322 250.692 l 202.01 250.692 l 202.01 250.97 l 202.322 250.97 l 202.322 251.34 l 202.679 251.452 l f 204.868 250.165 m 204.872 250.393 204.772 250.759 204.365 250.759 c 203.99 250.759 203.832 250.418 203.803 250.165 c 204.868 250.165 l h 203.799 249.904 m 203.807 249.41 204.119 249.206 204.485 249.206 c 204.748 249.206 204.91 249.252 205.043 249.306 c 205.11 249.048 l 204.98 248.99 204.756 248.92 204.435 248.92 c 203.82 248.92 203.445 249.331 203.445 249.933 c 203.445 250.543 203.807 251.02 204.394 251.02 c 205.051 251.02 205.222 250.443 205.222 250.074 c 205.222 249.999 205.218 249.941 205.209 249.899 c 203.799 249.904 l f 205.679 250.344 m 205.679 250.58 205.675 250.784 205.663 250.97 c 205.983 250.97 l 206 250.576 l 206.012 250.576 l 206.104 250.846 206.329 251.016 206.574 251.016 c 206.611 251.016 206.64 251.012 206.674 251.004 c 206.674 250.663 l 206.632 250.667 206.595 250.671 206.545 250.671 c 206.287 250.671 206.104 250.476 206.054 250.207 c 206.045 250.153 206.041 250.094 206.041 250.032 c 206.041 248.961 l 205.675 248.961 l 205.679 250.344 l f 208.071 249.987 m 207.672 249.995 207.219 249.924 207.219 249.534 c 207.219 249.293 207.377 249.185 207.56 249.185 c 207.826 249.185 207.997 249.352 208.055 249.522 c 208.068 249.559 208.071 249.601 208.071 249.638 c 208.071 249.987 l h 208.429 249.443 m 208.429 249.268 208.438 249.098 208.458 248.961 c 208.13 248.961 l 208.096 249.214 l 208.084 249.214 l 207.976 249.057 207.756 248.916 207.468 248.916 c 207.061 248.916 206.852 249.202 206.852 249.493 c 206.852 249.978 207.285 250.244 208.063 250.24 c 208.063 250.281 l 208.063 250.447 208.017 250.75 207.606 250.746 c 207.414 250.746 207.219 250.692 207.077 250.597 c 206.994 250.842 l 207.161 250.945 207.406 251.016 207.659 251.016 c 208.279 251.016 208.429 250.597 208.429 250.194 c 208.429 249.443 l f 210.451 249.032 m 210.355 248.986 210.143 248.916 209.873 248.916 c 209.265 248.916 208.87 249.327 208.87 249.945 c 208.87 250.564 209.294 251.016 209.952 251.016 c 210.168 251.016 210.36 250.962 210.46 250.908 c 210.376 250.63 l 210.289 250.676 210.151 250.725 209.952 250.725 c 209.49 250.725 209.241 250.381 209.241 249.962 c 209.241 249.497 209.54 249.21 209.94 249.21 c 210.148 249.21 210.285 249.26 210.389 249.306 c 210.451 249.032 l f 211.375 251.452 m 211.375 250.97 l 211.899 250.97 l 211.899 250.692 l 211.375 250.692 l 211.375 249.609 l 211.375 249.36 211.445 249.219 211.649 249.219 c 211.749 249.219 211.807 249.227 211.862 249.243 c 211.879 248.965 l 211.807 248.941 211.695 248.916 211.553 248.916 c 211.383 248.916 211.246 248.974 211.158 249.069 c 211.058 249.181 211.017 249.36 211.017 249.596 c 211.017 250.692 l 210.705 250.692 l 210.705 250.97 l 211.017 250.97 l 211.017 251.34 l 211.375 251.452 l f 212.311 250.97 0.366 -2.009 re 212.485 251.34 m 212.349 251.34 212.257 251.448 212.257 251.576 c 212.257 251.705 212.352 251.809 212.494 251.809 c 212.635 251.809 212.727 251.705 212.727 251.576 c 212.727 251.448 212.635 251.34 212.49 251.34 c 212.485 251.34 l f 213.426 250.97 m 213.821 249.845 l 213.888 249.659 213.942 249.493 213.983 249.327 c 213.996 249.327 l 214.042 249.493 214.1 249.659 214.166 249.845 c 214.558 250.97 l 214.94 250.97 l 214.15 248.961 l 213.8 248.961 l 213.035 250.97 l 213.426 250.97 l f 216.517 250.165 m 216.522 250.393 216.422 250.759 216.014 250.759 c 215.64 250.759 215.481 250.418 215.452 250.165 c 216.517 250.165 l h 215.448 249.904 m 215.456 249.41 215.768 249.206 216.135 249.206 c 216.397 249.206 216.559 249.252 216.692 249.306 c 216.758 249.048 l 216.63 248.99 216.405 248.92 216.085 248.92 c 215.469 248.92 215.095 249.331 215.095 249.933 c 215.095 250.543 215.456 251.02 216.043 251.02 c 216.7 251.02 216.871 250.443 216.871 250.074 c 216.871 249.999 216.867 249.941 216.858 249.899 c 215.448 249.904 l f 219.484 250.165 m 219.487 250.393 219.387 250.759 218.98 250.759 c 218.605 250.759 218.447 250.418 218.419 250.165 c 219.484 250.165 l h 218.414 249.904 m 218.422 249.41 218.734 249.206 219.101 249.206 c 219.363 249.206 219.525 249.252 219.658 249.306 c 219.725 249.048 l 219.596 248.99 219.371 248.92 219.051 248.92 c 218.435 248.92 218.06 249.331 218.06 249.933 c 218.06 250.543 218.422 251.02 219.009 251.02 c 219.666 251.02 219.837 250.443 219.837 250.074 c 219.837 249.999 219.833 249.941 219.824 249.899 c 218.414 249.904 l f 220.449 250.97 m 220.736 250.543 l 220.811 250.427 220.873 250.327 220.94 250.215 c 220.952 250.215 l 221.018 250.331 221.085 250.435 221.156 250.543 c 221.435 250.97 l 221.834 250.97 l 221.148 249.999 l 221.851 248.961 l 221.435 248.961 l 221.139 249.414 l 221.06 249.53 220.993 249.642 220.923 249.762 c 220.915 249.762 l 220.848 249.642 220.777 249.534 220.703 249.414 c 220.411 248.961 l 220.008 248.961 l 220.723 249.987 l 220.041 250.97 l 220.449 250.97 l f 223.419 250.165 m 223.424 250.393 223.324 250.759 222.916 250.759 c 222.542 250.759 222.383 250.418 222.354 250.165 c 223.419 250.165 l h 222.35 249.904 m 222.358 249.41 222.67 249.206 223.037 249.206 c 223.299 249.206 223.461 249.252 223.594 249.306 c 223.66 249.048 l 223.532 248.99 223.307 248.92 222.987 248.92 c 222.371 248.92 221.996 249.331 221.996 249.933 c 221.996 250.543 222.358 251.02 222.945 251.02 c 223.602 251.02 223.773 250.443 223.773 250.074 c 223.773 249.999 223.769 249.941 223.76 249.899 c 222.35 249.904 l f 224.23 250.344 m 224.23 250.58 224.226 250.784 224.214 250.97 c 224.534 250.97 l 224.551 250.576 l 224.563 250.576 l 224.655 250.846 224.879 251.016 225.125 251.016 c 225.162 251.016 225.191 251.012 225.225 251.004 c 225.225 250.663 l 225.183 250.667 225.146 250.671 225.096 250.671 c 224.838 250.671 224.655 250.476 224.605 250.207 c 224.597 250.153 224.592 250.094 224.592 250.032 c 224.592 248.961 l 224.226 248.961 l 224.23 250.344 l f 226.997 249.032 m 226.901 248.986 226.689 248.916 226.419 248.916 c 225.811 248.916 225.416 249.327 225.416 249.945 c 225.416 250.564 225.841 251.016 226.498 251.016 c 226.714 251.016 226.906 250.962 227.005 250.908 c 226.922 250.63 l 226.835 250.676 226.698 250.725 226.498 250.725 c 226.036 250.725 225.786 250.381 225.786 249.962 c 225.786 249.497 226.086 249.21 226.485 249.21 c 226.693 249.21 226.831 249.26 226.935 249.306 c 226.997 249.032 l f 227.426 250.97 0.366 -2.009 re 227.6 251.34 m 227.463 251.34 227.371 251.448 227.371 251.576 c 227.371 251.705 227.467 251.809 227.608 251.809 c 227.75 251.809 227.841 251.705 227.841 251.576 c 227.841 251.448 227.75 251.34 227.605 251.34 c 227.6 251.34 l f 228.349 249.331 m 228.462 249.264 228.653 249.19 228.836 249.19 c 229.098 249.19 229.223 249.318 229.223 249.488 c 229.223 249.663 229.119 249.758 228.853 249.858 c 228.487 249.991 228.316 250.186 228.316 250.427 c 228.316 250.75 228.582 251.016 229.011 251.016 c 229.215 251.016 229.394 250.962 229.502 250.891 c 229.414 250.63 l 229.335 250.676 229.19 250.746 229.002 250.746 c 228.786 250.746 228.67 250.622 228.67 250.472 c 228.67 250.302 228.786 250.227 229.048 250.128 c 229.394 249.999 229.577 249.825 229.577 249.522 c 229.577 249.165 229.298 248.916 228.828 248.916 c 228.607 248.916 228.403 248.974 228.262 249.057 c 228.349 249.331 l f 231.324 250.165 m 231.328 250.393 231.228 250.759 230.821 250.759 c 230.446 250.759 230.288 250.418 230.259 250.165 c 231.324 250.165 l h 230.255 249.904 m 230.263 249.41 230.575 249.206 230.941 249.206 c 231.204 249.206 231.366 249.252 231.499 249.306 c 231.566 249.048 l 231.436 248.99 231.212 248.92 230.891 248.92 c 230.276 248.92 229.901 249.331 229.901 249.933 c 229.901 250.543 230.263 251.02 230.85 251.02 c 231.507 251.02 231.678 250.443 231.678 250.074 c 231.678 249.999 231.674 249.941 231.665 249.899 c 230.255 249.904 l f 232.081 249.331 m 232.193 249.264 232.385 249.19 232.568 249.19 c 232.83 249.19 232.955 249.318 232.955 249.488 c 232.955 249.663 232.851 249.758 232.585 249.858 c 232.218 249.991 232.048 250.186 232.048 250.427 c 232.048 250.75 232.314 251.016 232.743 251.016 c 232.946 251.016 233.125 250.962 233.233 250.891 c 233.146 250.63 l 233.067 250.676 232.921 250.746 232.735 250.746 c 232.518 250.746 232.401 250.622 232.401 250.472 c 232.401 250.302 232.518 250.227 232.78 250.128 c 233.125 249.999 233.308 249.825 233.308 249.522 c 233.308 249.165 233.03 248.916 232.56 248.916 c 232.339 248.916 232.135 248.974 231.994 249.057 c 232.081 249.331 l f 235.102 251.452 m 235.102 250.97 l 235.625 250.97 l 235.625 250.692 l 235.102 250.692 l 235.102 249.609 l 235.102 249.36 235.172 249.219 235.376 249.219 c 235.476 249.219 235.534 249.227 235.588 249.243 c 235.605 248.965 l 235.534 248.941 235.422 248.916 235.28 248.916 c 235.11 248.916 234.972 248.974 234.885 249.069 c 234.785 249.181 234.743 249.36 234.743 249.596 c 234.743 250.692 l 234.432 250.692 l 234.432 250.97 l 234.743 250.97 l 234.743 251.34 l 235.102 251.452 l f 236.845 249.19 m 237.194 249.19 237.456 249.518 237.456 249.974 c 237.456 250.314 237.286 250.742 236.853 250.742 c 236.425 250.742 236.237 250.344 236.237 249.962 c 236.237 249.522 236.487 249.19 236.841 249.19 c 236.845 249.19 l h 236.832 248.916 m 236.292 248.916 235.867 249.314 235.867 249.949 c 235.867 250.622 236.312 251.016 236.866 251.016 c 237.444 251.016 237.835 250.597 237.835 249.987 c 237.835 249.239 237.315 248.916 236.837 248.916 c 236.832 248.916 l f 239.183 250.344 m 239.183 250.58 239.179 250.784 239.166 250.97 c 239.487 250.97 l 239.503 250.576 l 239.516 250.576 l 239.607 250.846 239.832 251.016 240.077 251.016 c 240.115 251.016 240.144 251.012 240.177 251.004 c 240.177 250.663 l 240.136 250.667 240.098 250.671 240.048 250.671 c 239.79 250.671 239.607 250.476 239.557 250.207 c 239.549 250.153 239.545 250.094 239.545 250.032 c 239.545 248.961 l 239.179 248.961 l 239.183 250.344 l f 241.792 250.165 m 241.796 250.393 241.696 250.759 241.288 250.759 c 240.914 250.759 240.755 250.418 240.727 250.165 c 241.792 250.165 l h 240.722 249.904 m 240.73 249.41 241.042 249.206 241.409 249.206 c 241.671 249.206 241.833 249.252 241.966 249.306 c 242.033 249.048 l 241.904 248.99 241.679 248.92 241.359 248.92 c 240.743 248.92 240.368 249.331 240.368 249.933 c 240.368 250.543 240.73 251.02 241.317 251.02 c 241.974 251.02 242.145 250.443 242.145 250.074 c 242.145 249.999 242.141 249.941 242.132 249.899 c 240.722 249.904 l f 242.732 250.97 m 243.127 249.845 l 243.194 249.659 243.248 249.493 243.289 249.327 c 243.302 249.327 l 243.348 249.493 243.406 249.659 243.473 249.845 c 243.863 250.97 l 244.246 250.97 l 243.456 248.961 l 243.106 248.961 l 242.341 250.97 l 242.732 250.97 l f 244.591 250.97 0.366 -2.009 re 244.766 251.34 m 244.629 251.34 244.538 251.448 244.538 251.576 c 244.538 251.705 244.633 251.809 244.775 251.809 c 244.916 251.809 245.008 251.705 245.008 251.576 c 245.008 251.448 244.916 251.34 244.77 251.34 c 244.766 251.34 l f 246.842 250.165 m 246.846 250.393 246.746 250.759 246.339 250.759 c 245.964 250.759 245.806 250.418 245.777 250.165 c 246.842 250.165 l h 245.773 249.904 m 245.781 249.41 246.093 249.206 246.459 249.206 c 246.722 249.206 246.884 249.252 247.017 249.306 c 247.084 249.048 l 246.954 248.99 246.73 248.92 246.409 248.92 c 245.793 248.92 245.419 249.331 245.419 249.933 c 245.419 250.543 245.781 251.02 246.368 251.02 c 247.025 251.02 247.195 250.443 247.195 250.074 c 247.195 249.999 247.192 249.941 247.183 249.899 c 245.773 249.904 l f 247.795 250.97 m 248.066 249.953 l 248.119 249.729 248.174 249.518 248.211 249.31 c 248.224 249.31 l 248.269 249.513 248.336 249.729 248.402 249.949 c 248.731 250.97 l 249.039 250.97 l 249.351 249.966 l 249.426 249.729 249.484 249.513 249.53 249.31 c 249.543 249.31 l 249.576 249.513 249.629 249.725 249.696 249.962 c 249.983 250.97 l 250.345 250.97 l 249.696 248.961 l 249.363 248.961 l 249.056 249.92 l 248.985 250.148 248.927 250.348 248.877 250.584 c 248.868 250.584 l 248.818 250.344 248.756 250.132 248.685 249.916 c 248.361 248.961 l 248.028 248.961 l 247.421 250.97 l 247.795 250.97 l f 174.568 244.878 m 174.168 244.886 173.715 244.815 173.715 244.425 c 173.715 244.184 173.873 244.077 174.056 244.077 c 174.322 244.077 174.493 244.243 174.551 244.413 c 174.564 244.45 174.568 244.492 174.568 244.529 c 174.568 244.878 l h 174.926 244.334 m 174.926 244.16 174.934 243.989 174.955 243.852 c 174.626 243.852 l 174.593 244.106 l 174.58 244.106 l 174.472 243.948 174.252 243.807 173.965 243.807 c 173.557 243.807 173.349 244.093 173.349 244.384 c 173.349 244.869 173.781 245.135 174.56 245.131 c 174.56 245.172 l 174.56 245.338 174.514 245.641 174.102 245.637 c 173.911 245.637 173.715 245.583 173.574 245.488 c 173.49 245.733 l 173.657 245.837 173.902 245.907 174.156 245.907 c 174.776 245.907 174.926 245.488 174.926 245.085 c 174.926 244.334 l f 175.512 245.318 m 175.512 245.529 175.508 245.695 175.496 245.861 c 175.82 245.861 l 175.841 245.534 l 175.849 245.534 l 175.949 245.72 176.182 245.907 176.515 245.907 c 176.794 245.907 177.226 245.741 177.226 245.052 c 177.226 243.852 l 176.86 243.852 l 176.86 245.01 l 176.86 245.334 176.74 245.608 176.394 245.608 c 176.157 245.608 175.97 245.438 175.903 245.235 c 175.887 245.189 175.878 245.123 175.878 245.064 c 175.878 243.852 l 175.512 243.852 l 175.512 245.318 l f 179.194 245.044 m 179.194 245.094 179.19 245.152 179.177 245.201 c 179.123 245.43 178.924 245.621 178.649 245.621 c 178.27 245.621 178.046 245.289 178.046 244.849 c 178.046 244.438 178.25 244.101 178.641 244.101 c 178.886 244.101 179.111 244.267 179.177 244.537 c 179.19 244.587 179.194 244.637 179.194 244.695 c 179.194 245.044 l h 179.56 246.8 m 179.56 244.371 l 179.56 244.193 179.565 243.989 179.577 243.852 c 179.248 243.852 l 179.232 244.201 l 179.223 244.201 l 179.111 243.977 178.869 243.807 178.541 243.807 c 178.054 243.807 177.676 244.218 177.676 244.828 c 177.672 245.5 178.092 245.907 178.579 245.907 c 178.89 245.907 179.099 245.762 179.186 245.604 c 179.194 245.604 l 179.194 246.8 l 179.56 246.8 l f 182.11 244.878 m 181.711 244.886 181.258 244.815 181.258 244.425 c 181.258 244.184 181.416 244.077 181.599 244.077 c 181.865 244.077 182.036 244.243 182.094 244.413 c 182.106 244.45 182.11 244.492 182.11 244.529 c 182.11 244.878 l h 182.468 244.334 m 182.468 244.16 182.477 243.989 182.497 243.852 c 182.169 243.852 l 182.135 244.106 l 182.123 244.106 l 182.015 243.948 181.794 243.807 181.507 243.807 c 181.1 243.807 180.892 244.093 180.892 244.384 c 180.892 244.869 181.324 245.135 182.102 245.131 c 182.102 245.172 l 182.102 245.338 182.056 245.641 181.644 245.637 c 181.453 245.637 181.258 245.583 181.116 245.488 c 181.033 245.733 l 181.199 245.837 181.445 245.907 181.699 245.907 c 182.319 245.907 182.468 245.488 182.468 245.085 c 182.468 244.334 l f 183.421 244.67 m 183.421 244.62 183.426 244.566 183.438 244.521 c 183.5 244.267 183.725 244.093 183.983 244.093 c 184.37 244.093 184.594 244.409 184.594 244.869 c 184.594 245.272 184.387 245.617 184 245.617 c 183.75 245.617 183.513 245.442 183.442 245.168 c 183.434 245.118 183.421 245.064 183.421 245.019 c 183.421 244.67 l h 183.055 245.206 m 183.055 245.463 183.051 245.67 183.039 245.861 c 183.367 245.861 l 183.388 245.517 l 183.396 245.517 l 183.542 245.766 183.783 245.907 184.108 245.907 c 184.599 245.907 184.965 245.496 184.965 244.886 c 184.965 244.164 184.52 243.807 184.049 243.807 c 183.779 243.807 183.55 243.923 183.43 244.122 c 183.421 244.122 l 183.421 243.03 l 183.055 243.03 l 183.055 245.206 l f 185.788 244.67 m 185.788 244.62 185.793 244.566 185.805 244.521 c 185.867 244.267 186.092 244.093 186.35 244.093 c 186.737 244.093 186.962 244.409 186.962 244.869 c 186.962 245.272 186.754 245.617 186.367 245.617 c 186.117 245.617 185.88 245.442 185.809 245.168 c 185.801 245.118 185.788 245.064 185.788 245.019 c 185.788 244.67 l h 185.422 245.206 m 185.422 245.463 185.418 245.67 185.406 245.861 c 185.734 245.861 l 185.755 245.517 l 185.763 245.517 l 185.909 245.766 186.15 245.907 186.475 245.907 c 186.966 245.907 187.332 245.496 187.332 244.886 c 187.332 244.164 186.887 243.807 186.417 243.807 c 186.146 243.807 185.917 243.923 185.797 244.122 c 185.788 244.122 l 185.788 243.03 l 185.422 243.03 l 185.422 245.206 l f 187.79 246.8 0.366 -2.947 re f 188.896 245.861 m 189.333 244.674 l 189.383 244.541 189.433 244.384 189.466 244.263 c 189.474 244.263 l 189.512 244.384 189.553 244.537 189.603 244.683 c 190.003 245.861 l 190.39 245.861 l 189.841 244.429 l 189.578 243.74 189.399 243.387 189.15 243.167 c 188.967 243.014 188.792 242.952 188.701 242.935 c 188.609 243.242 l 188.701 243.267 188.821 243.325 188.929 243.421 c 189.029 243.5 189.15 243.641 189.237 243.827 c 189.254 243.865 189.267 243.89 189.267 243.915 c 189.267 243.935 189.258 243.964 189.237 244.006 c 188.497 245.861 l 188.896 245.861 l f 191.555 244.222 m 191.667 244.155 191.858 244.081 192.042 244.081 c 192.303 244.081 192.428 244.209 192.428 244.38 c 192.428 244.554 192.324 244.649 192.058 244.749 c 191.692 244.882 191.521 245.077 191.521 245.318 c 191.521 245.641 191.788 245.907 192.216 245.907 c 192.42 245.907 192.599 245.853 192.707 245.783 c 192.62 245.521 l 192.541 245.567 192.395 245.637 192.208 245.637 c 191.992 245.637 191.875 245.513 191.875 245.363 c 191.875 245.193 191.992 245.118 192.253 245.019 c 192.599 244.89 192.782 244.716 192.782 244.413 c 192.782 244.056 192.503 243.807 192.033 243.807 c 191.812 243.807 191.609 243.865 191.467 243.948 c 191.555 244.222 l f 193.693 246.343 m 193.693 245.861 l 194.217 245.861 l 194.217 245.583 l 193.693 245.583 l 193.693 244.5 l 193.693 244.251 193.764 244.11 193.968 244.11 c 194.068 244.11 194.126 244.118 194.18 244.135 c 194.197 243.857 l 194.126 243.832 194.014 243.807 193.872 243.807 c 193.701 243.807 193.564 243.865 193.477 243.96 c 193.377 244.072 193.335 244.251 193.335 244.488 c 193.335 245.583 l 193.024 245.583 l 193.024 245.861 l 193.335 245.861 l 193.335 246.231 l 193.693 246.343 l f 194.633 245.235 m 194.633 245.471 194.629 245.675 194.617 245.861 c 194.937 245.861 l 194.954 245.467 l 194.966 245.467 l 195.058 245.737 195.283 245.907 195.528 245.907 c 195.565 245.907 195.594 245.903 195.628 245.895 c 195.628 245.554 l 195.586 245.558 195.549 245.563 195.499 245.563 c 195.241 245.563 195.058 245.368 195.008 245.098 c 195 245.044 194.995 244.986 194.995 244.923 c 194.995 243.852 l 194.629 243.852 l 194.633 245.235 l f 197.026 244.878 m 196.626 244.886 196.173 244.815 196.173 244.425 c 196.173 244.184 196.331 244.077 196.514 244.077 c 196.78 244.077 196.951 244.243 197.009 244.413 c 197.021 244.45 197.026 244.492 197.026 244.529 c 197.026 244.878 l h 197.383 244.334 m 197.383 244.16 197.392 243.989 197.413 243.852 c 197.084 243.852 l 197.051 244.106 l 197.038 244.106 l 196.93 243.948 196.71 243.807 196.422 243.807 c 196.015 243.807 195.807 244.093 195.807 244.384 c 195.807 244.869 196.239 245.135 197.018 245.131 c 197.018 245.172 l 197.018 245.338 196.971 245.641 196.56 245.637 c 196.368 245.637 196.173 245.583 196.031 245.488 c 195.948 245.733 l 196.114 245.837 196.36 245.907 196.614 245.907 c 197.234 245.907 197.383 245.488 197.383 245.085 c 197.383 244.334 l f 198.395 246.343 m 198.395 245.861 l 198.918 245.861 l 198.918 245.583 l 198.395 245.583 l 198.395 244.5 l 198.395 244.251 198.465 244.11 198.669 244.11 c 198.769 244.11 198.827 244.118 198.881 244.135 c 198.898 243.857 l 198.827 243.832 198.715 243.807 198.573 243.807 c 198.403 243.807 198.265 243.865 198.178 243.96 c 198.078 244.072 198.036 244.251 198.036 244.488 c 198.036 245.583 l 197.725 245.583 l 197.725 245.861 l 198.036 245.861 l 198.036 246.231 l 198.395 246.343 l f 200.583 245.056 m 200.587 245.284 200.487 245.65 200.079 245.65 c 199.705 245.65 199.547 245.309 199.518 245.056 c 200.583 245.056 l h 199.513 244.795 m 199.522 244.301 199.833 244.097 200.2 244.097 c 200.462 244.097 200.624 244.143 200.757 244.197 c 200.824 243.94 l 200.695 243.881 200.47 243.811 200.15 243.811 c 199.534 243.811 199.16 244.222 199.16 244.824 c 199.16 245.434 199.522 245.911 200.109 245.911 c 200.765 245.911 200.936 245.334 200.936 244.965 c 200.936 244.89 200.932 244.832 200.924 244.79 c 199.513 244.795 l f 202.746 245.073 m 202.746 245.131 202.742 245.185 202.726 245.235 c 202.659 245.45 202.484 245.625 202.214 245.625 c 201.864 245.625 201.615 245.33 201.615 244.861 c 201.615 244.471 201.819 244.139 202.209 244.139 c 202.438 244.139 202.643 244.28 202.717 244.517 c 202.738 244.575 202.746 244.645 202.746 244.712 c 202.746 245.073 l h 203.113 244.147 m 203.113 243.682 203.017 243.404 202.825 243.226 c 202.626 243.047 202.342 242.985 202.089 242.985 c 201.847 242.985 201.581 243.043 201.419 243.151 c 201.511 243.433 l 201.644 243.346 201.852 243.271 202.101 243.271 c 202.476 243.271 202.751 243.466 202.751 243.977 c 202.751 244.197 l 202.742 244.197 l 202.634 244.01 202.414 243.861 202.101 243.861 c 201.602 243.861 201.244 244.284 201.244 244.844 c 201.244 245.525 201.689 245.907 202.156 245.907 c 202.505 245.907 202.692 245.729 202.784 245.563 c 202.792 245.563 l 202.804 245.861 l 203.129 245.861 l 203.116 245.72 203.113 245.558 203.113 245.314 c 203.113 244.147 l f 203.716 245.861 0.366 -2.009 re 203.89 246.231 m 203.753 246.231 203.661 246.339 203.661 246.467 c 203.661 246.596 203.757 246.7 203.898 246.7 c 204.04 246.7 204.131 246.596 204.131 246.467 c 204.131 246.339 204.04 246.231 203.895 246.231 c 203.89 246.231 l f 206.124 243.923 m 206.029 243.877 205.817 243.807 205.546 243.807 c 204.938 243.807 204.543 244.218 204.543 244.836 c 204.543 245.455 204.968 245.907 205.625 245.907 c 205.842 245.907 206.033 245.853 206.133 245.799 c 206.05 245.521 l 205.962 245.567 205.825 245.617 205.625 245.617 c 205.163 245.617 204.914 245.272 204.914 244.853 c 204.914 244.388 205.213 244.101 205.613 244.101 c 205.821 244.101 205.958 244.151 206.062 244.197 c 206.124 243.923 l f 207.801 244.67 m 207.801 244.62 207.806 244.566 207.817 244.521 c 207.88 244.267 208.105 244.093 208.363 244.093 c 208.749 244.093 208.974 244.409 208.974 244.869 c 208.974 245.272 208.766 245.617 208.379 245.617 c 208.13 245.617 207.892 245.442 207.822 245.168 c 207.814 245.118 207.801 245.064 207.801 245.019 c 207.801 244.67 l h 207.435 245.206 m 207.435 245.463 207.431 245.67 207.419 245.861 c 207.747 245.861 l 207.768 245.517 l 207.776 245.517 l 207.922 245.766 208.163 245.907 208.488 245.907 c 208.979 245.907 209.345 245.496 209.345 244.886 c 209.345 244.164 208.899 243.807 208.429 243.807 c 208.159 243.807 207.93 243.923 207.809 244.122 c 207.801 244.122 l 207.801 243.03 l 207.435 243.03 l 207.435 245.206 l f 209.802 246.8 0.366 -2.947 re f 211.837 244.878 m 211.437 244.886 210.983 244.815 210.983 244.425 c 210.983 244.184 211.142 244.077 211.325 244.077 c 211.591 244.077 211.762 244.243 211.82 244.413 c 211.832 244.45 211.837 244.492 211.837 244.529 c 211.837 244.878 l h 212.194 244.334 m 212.194 244.16 212.203 243.989 212.224 243.852 c 211.895 243.852 l 211.862 244.106 l 211.849 244.106 l 211.741 243.948 211.52 243.807 211.233 243.807 c 210.826 243.807 210.618 244.093 210.618 244.384 c 210.618 244.869 211.05 245.135 211.829 245.131 c 211.829 245.172 l 211.829 245.338 211.782 245.641 211.37 245.637 c 211.179 245.637 210.983 245.583 210.842 245.488 c 210.759 245.733 l 210.925 245.837 211.171 245.907 211.425 245.907 c 212.045 245.907 212.194 245.488 212.194 245.085 c 212.194 244.334 l f 212.781 245.318 m 212.781 245.529 212.777 245.695 212.764 245.861 c 213.089 245.861 l 213.109 245.534 l 213.118 245.534 l 213.218 245.72 213.451 245.907 213.784 245.907 c 214.063 245.907 214.495 245.741 214.495 245.052 c 214.495 243.852 l 214.129 243.852 l 214.129 245.01 l 214.129 245.334 214.008 245.608 213.663 245.608 c 213.426 245.608 213.239 245.438 213.172 245.235 c 213.156 245.189 213.147 245.123 213.147 245.064 c 213.147 243.852 l 212.781 243.852 l 212.781 245.318 l f 215.09 245.318 m 215.09 245.529 215.086 245.695 215.073 245.861 c 215.398 245.861 l 215.418 245.534 l 215.427 245.534 l 215.527 245.72 215.76 245.907 216.093 245.907 c 216.372 245.907 216.804 245.741 216.804 245.052 c 216.804 243.852 l 216.438 243.852 l 216.438 245.01 l 216.438 245.334 216.317 245.608 215.972 245.608 c 215.735 245.608 215.548 245.438 215.481 245.235 c 215.465 245.189 215.456 245.123 215.456 245.064 c 215.456 243.852 l 215.09 243.852 l 215.09 245.318 l f 217.399 245.861 0.366 -2.009 re 217.574 246.231 m 217.437 246.231 217.345 246.339 217.345 246.467 c 217.345 246.596 217.44 246.7 217.582 246.7 c 217.724 246.7 217.815 246.596 217.815 246.467 c 217.815 246.339 217.724 246.231 217.578 246.231 c 217.574 246.231 l f 218.372 245.318 m 218.372 245.529 218.368 245.695 218.356 245.861 c 218.681 245.861 l 218.701 245.534 l 218.709 245.534 l 218.809 245.72 219.042 245.907 219.375 245.907 c 219.654 245.907 220.086 245.741 220.086 245.052 c 220.086 243.852 l 219.721 243.852 l 219.721 245.01 l 219.721 245.334 219.6 245.608 219.254 245.608 c 219.017 245.608 218.83 245.438 218.764 245.235 c 218.747 245.189 218.739 245.123 218.739 245.064 c 218.739 243.852 l 218.372 243.852 l 218.372 245.318 l f 222.038 245.073 m 222.038 245.131 222.033 245.185 222.017 245.235 c 221.95 245.45 221.776 245.625 221.505 245.625 c 221.156 245.625 220.906 245.33 220.906 244.861 c 220.906 244.471 221.11 244.139 221.501 244.139 c 221.73 244.139 221.934 244.28 222.008 244.517 c 222.03 244.575 222.038 244.645 222.038 244.712 c 222.038 245.073 l h 222.404 244.147 m 222.404 243.682 222.308 243.404 222.117 243.226 c 221.917 243.047 221.634 242.985 221.38 242.985 c 221.139 242.985 220.873 243.043 220.711 243.151 c 220.802 243.433 l 220.935 243.346 221.143 243.271 221.393 243.271 c 221.767 243.271 222.042 243.466 222.042 243.977 c 222.042 244.197 l 222.033 244.197 l 221.925 244.01 221.705 243.861 221.393 243.861 c 220.894 243.861 220.536 244.284 220.536 244.844 c 220.536 245.525 220.981 245.907 221.447 245.907 c 221.796 245.907 221.983 245.729 222.075 245.563 c 222.083 245.563 l 222.096 245.861 l 222.42 245.861 l 222.408 245.72 222.404 245.558 222.404 245.314 c 222.404 244.147 l f 224.255 244.67 m 224.255 244.62 224.26 244.566 224.272 244.521 c 224.334 244.267 224.559 244.093 224.817 244.093 c 225.204 244.093 225.429 244.409 225.429 244.869 c 225.429 245.272 225.221 245.617 224.834 245.617 c 224.584 245.617 224.347 245.442 224.276 245.168 c 224.268 245.118 224.255 245.064 224.255 245.019 c 224.255 244.67 l h 223.889 245.206 m 223.889 245.463 223.885 245.67 223.873 245.861 c 224.201 245.861 l 224.222 245.517 l 224.23 245.517 l 224.376 245.766 224.617 245.907 224.942 245.907 c 225.433 245.907 225.799 245.496 225.799 244.886 c 225.799 244.164 225.354 243.807 224.884 243.807 c 224.613 243.807 224.384 243.923 224.264 244.122 c 224.255 244.122 l 224.255 243.03 l 223.889 243.03 l 223.889 245.206 l f 226.261 245.235 m 226.261 245.471 226.256 245.675 226.244 245.861 c 226.564 245.861 l 226.581 245.467 l 226.593 245.467 l 226.685 245.737 226.91 245.907 227.155 245.907 c 227.193 245.907 227.221 245.903 227.255 245.895 c 227.255 245.554 l 227.213 245.558 227.176 245.563 227.126 245.563 c 226.868 245.563 226.685 245.368 226.635 245.098 c 226.627 245.044 226.623 244.986 226.623 244.923 c 226.623 243.852 l 226.256 243.852 l 226.261 245.235 l f 227.633 245.861 0.366 -2.009 re 227.808 246.231 m 227.671 246.231 227.58 246.339 227.58 246.467 c 227.58 246.596 227.675 246.7 227.817 246.7 c 227.958 246.7 228.05 246.596 228.05 246.467 c 228.05 246.339 227.958 246.231 227.812 246.231 c 227.808 246.231 l f 228.607 245.318 m 228.607 245.529 228.603 245.695 228.59 245.861 c 228.915 245.861 l 228.935 245.534 l 228.944 245.534 l 229.044 245.72 229.277 245.907 229.61 245.907 c 229.889 245.907 230.321 245.741 230.321 245.052 c 230.321 243.852 l 229.955 243.852 l 229.955 245.01 l 229.955 245.334 229.834 245.608 229.489 245.608 c 229.252 245.608 229.065 245.438 228.998 245.235 c 228.982 245.189 228.973 245.123 228.973 245.064 c 228.973 243.852 l 228.607 243.852 l 228.607 245.318 l f 232.351 243.923 m 232.256 243.877 232.043 243.807 231.773 243.807 c 231.166 243.807 230.771 244.218 230.771 244.836 c 230.771 245.455 231.195 245.907 231.852 245.907 c 232.068 245.907 232.26 245.853 232.359 245.799 c 232.276 245.521 l 232.189 245.567 232.052 245.617 231.852 245.617 c 231.39 245.617 231.141 245.272 231.141 244.853 c 231.141 244.388 231.44 244.101 231.839 244.101 c 232.048 244.101 232.185 244.151 232.289 244.197 c 232.351 243.923 l f 232.78 245.861 0.366 -2.009 re 232.955 246.231 m 232.818 246.231 232.726 246.339 232.726 246.467 c 232.726 246.596 232.821 246.7 232.963 246.7 c 233.105 246.7 233.196 246.596 233.196 246.467 c 233.196 246.339 233.105 246.231 232.959 246.231 c 232.955 246.231 l f 234.12 244.67 m 234.12 244.62 234.124 244.566 234.136 244.521 c 234.198 244.267 234.423 244.093 234.681 244.093 c 235.068 244.093 235.293 244.409 235.293 244.869 c 235.293 245.272 235.085 245.617 234.698 245.617 c 234.448 245.617 234.211 245.442 234.14 245.168 c 234.132 245.118 234.12 245.064 234.12 245.019 c 234.12 244.67 l h 233.753 245.206 m 233.753 245.463 233.749 245.67 233.737 245.861 c 234.065 245.861 l 234.087 245.517 l 234.095 245.517 l 234.24 245.766 234.482 245.907 234.806 245.907 c 235.297 245.907 235.663 245.496 235.663 244.886 c 235.663 244.164 235.218 243.807 234.748 243.807 c 234.477 243.807 234.248 243.923 234.128 244.122 c 234.12 244.122 l 234.12 243.03 l 233.753 243.03 l 233.753 245.206 l f 236.121 246.8 0.366 -2.947 re f 238.371 245.056 m 238.376 245.284 238.276 245.65 237.868 245.65 c 237.494 245.65 237.336 245.309 237.306 245.056 c 238.371 245.056 l h 237.302 244.795 m 237.311 244.301 237.623 244.097 237.989 244.097 c 238.251 244.097 238.413 244.143 238.546 244.197 c 238.613 243.94 l 238.484 243.881 238.259 243.811 237.939 243.811 c 237.323 243.811 236.949 244.222 236.949 244.824 c 236.949 245.434 237.311 245.911 237.897 245.911 c 238.555 245.911 238.725 245.334 238.725 244.965 c 238.725 244.89 238.721 244.832 238.713 244.79 c 237.302 244.795 l f 239.128 244.222 m 239.241 244.155 239.432 244.081 239.615 244.081 c 239.877 244.081 240.002 244.209 240.002 244.38 c 240.002 244.554 239.898 244.649 239.632 244.749 c 239.266 244.882 239.095 245.077 239.095 245.318 c 239.095 245.641 239.362 245.907 239.79 245.907 c 239.994 245.907 240.173 245.853 240.281 245.783 c 240.193 245.521 l 240.115 245.567 239.969 245.637 239.782 245.637 c 239.565 245.637 239.449 245.513 239.449 245.363 c 239.449 245.193 239.565 245.118 239.827 245.019 c 240.173 244.89 240.356 244.716 240.356 244.413 c 240.356 244.056 240.077 243.807 239.607 243.807 c 239.387 243.807 239.183 243.865 239.041 243.948 c 239.128 244.222 l f 0 0 0 0 k 114.453 158.641 m 113.666 158.641 l 113.666 158.924 l 115.582 158.924 l 115.582 158.641 l 114.791 158.641 l 114.791 156.342 l 114.453 156.342 l 114.453 158.641 l f 115.832 159.062 m 116.17 159.062 l 116.17 157.905 l 116.177 157.905 l 116.231 158.001 116.316 158.089 116.419 158.142 c 116.519 158.204 116.638 158.238 116.765 158.238 c 117.015 158.238 117.414 158.085 117.414 157.445 c 117.414 156.342 l 117.076 156.342 l 117.076 157.407 l 117.076 157.709 116.965 157.959 116.646 157.959 c 116.427 157.959 116.258 157.805 116.193 157.621 c 116.173 157.575 116.17 157.526 116.17 157.46 c 116.17 156.342 l 115.832 156.342 l 115.832 159.062 l f 117.963 158.196 0.338 -1.854 re 118.124 158.537 m 117.998 158.537 117.913 158.637 117.913 158.756 c 117.913 158.874 118.002 158.97 118.132 158.97 c 118.263 158.97 118.347 158.874 118.347 158.756 c 118.347 158.637 118.263 158.537 118.128 158.537 c 118.124 158.537 l f 118.815 156.683 m 118.919 156.621 119.096 156.552 119.265 156.552 c 119.507 156.552 119.622 156.671 119.622 156.828 c 119.622 156.989 119.526 157.077 119.28 157.169 c 118.942 157.292 118.785 157.472 118.785 157.694 c 118.785 157.993 119.031 158.238 119.426 158.238 c 119.614 158.238 119.78 158.188 119.879 158.123 c 119.799 157.882 l 119.726 157.924 119.591 157.989 119.419 157.989 c 119.219 157.989 119.111 157.874 119.111 157.736 c 119.111 157.579 119.219 157.51 119.461 157.418 c 119.78 157.299 119.948 157.139 119.948 156.859 c 119.948 156.529 119.691 156.299 119.257 156.299 c 119.054 156.299 118.865 156.353 118.735 156.43 c 118.815 156.683 l f 121.197 158.196 0.338 -1.854 re 121.358 158.537 m 121.231 158.537 121.147 158.637 121.147 158.756 c 121.147 158.874 121.235 158.97 121.365 158.97 c 121.496 158.97 121.581 158.874 121.581 158.756 c 121.581 158.637 121.496 158.537 121.362 158.537 c 121.358 158.537 l f 122.095 157.694 m 122.095 157.889 122.091 158.043 122.08 158.196 c 122.379 158.196 l 122.399 157.893 l 122.406 157.893 l 122.499 158.066 122.714 158.238 123.021 158.238 c 123.278 158.238 123.677 158.085 123.677 157.449 c 123.677 156.342 l 123.34 156.342 l 123.34 157.41 l 123.34 157.709 123.228 157.962 122.909 157.962 c 122.69 157.962 122.518 157.805 122.456 157.618 c 122.441 157.575 122.433 157.514 122.433 157.46 c 122.433 156.342 l 122.095 156.342 l 122.095 157.694 l f 124.618 158.641 m 124.618 158.196 l 125.102 158.196 l 125.102 157.939 l 124.618 157.939 l 124.618 156.939 l 124.618 156.709 124.684 156.579 124.872 156.579 c 124.964 156.579 125.018 156.587 125.068 156.602 c 125.083 156.345 l 125.018 156.323 124.914 156.299 124.783 156.299 c 124.626 156.299 124.499 156.353 124.419 156.441 c 124.326 156.545 124.288 156.709 124.288 156.928 c 124.288 157.939 l 124 157.939 l 124 158.196 l 124.288 158.196 l 124.288 158.537 l 124.618 158.641 l f 126.638 157.453 m 126.642 157.663 126.55 158.001 126.174 158.001 c 125.828 158.001 125.682 157.686 125.655 157.453 c 126.638 157.453 l h 125.651 157.211 m 125.659 156.755 125.947 156.568 126.285 156.568 c 126.527 156.568 126.677 156.61 126.8 156.66 c 126.861 156.422 l 126.742 156.368 126.535 156.303 126.239 156.303 c 125.671 156.303 125.325 156.683 125.325 157.238 c 125.325 157.801 125.659 158.242 126.201 158.242 c 126.807 158.242 126.965 157.709 126.965 157.368 c 126.965 157.299 126.961 157.246 126.953 157.207 c 125.651 157.211 l f 127.387 157.618 m 127.387 157.836 127.383 158.024 127.372 158.196 c 127.668 158.196 l 127.683 157.832 l 127.695 157.832 l 127.779 158.081 127.986 158.238 128.213 158.238 c 128.248 158.238 128.274 158.234 128.305 158.227 c 128.305 157.912 l 128.267 157.916 128.232 157.92 128.186 157.92 c 127.948 157.92 127.779 157.74 127.733 157.491 c 127.725 157.441 127.721 157.388 127.721 157.33 c 127.721 156.342 l 127.383 156.342 l 127.387 157.618 l f 129.596 157.288 m 129.227 157.296 128.808 157.231 128.808 156.87 c 128.808 156.648 128.954 156.549 129.123 156.549 c 129.369 156.549 129.527 156.702 129.58 156.859 c 129.592 156.893 129.596 156.932 129.596 156.966 c 129.596 157.288 l h 129.926 156.786 m 129.926 156.625 129.934 156.468 129.953 156.342 c 129.649 156.342 l 129.619 156.575 l 129.607 156.575 l 129.507 156.43 129.304 156.299 129.039 156.299 c 128.662 156.299 128.47 156.564 128.47 156.832 c 128.47 157.28 128.87 157.526 129.588 157.522 c 129.588 157.56 l 129.588 157.713 129.546 157.993 129.165 157.989 c 128.989 157.989 128.808 157.939 128.678 157.851 c 128.601 158.077 l 128.755 158.173 128.981 158.238 129.215 158.238 c 129.788 158.238 129.926 157.851 129.926 157.48 c 129.926 156.786 l f 131.792 156.407 m 131.704 156.365 131.508 156.299 131.258 156.299 c 130.698 156.299 130.333 156.679 130.333 157.25 c 130.333 157.821 130.725 158.238 131.331 158.238 c 131.531 158.238 131.708 158.188 131.8 158.139 c 131.723 157.882 l 131.642 157.924 131.516 157.97 131.331 157.97 c 130.905 157.97 130.675 157.652 130.675 157.265 c 130.675 156.836 130.951 156.571 131.32 156.571 c 131.512 156.571 131.639 156.617 131.735 156.66 c 131.792 156.407 l f 132.645 158.641 m 132.645 158.196 l 133.129 158.196 l 133.129 157.939 l 132.645 157.939 l 132.645 156.939 l 132.645 156.709 132.71 156.579 132.898 156.579 c 132.99 156.579 133.044 156.587 133.094 156.602 c 133.109 156.345 l 133.044 156.323 132.94 156.299 132.81 156.299 c 132.652 156.299 132.526 156.353 132.445 156.441 c 132.353 156.545 132.314 156.709 132.314 156.928 c 132.314 157.939 l 132.026 157.939 l 132.026 158.196 l 132.314 158.196 l 132.314 158.537 l 132.645 158.641 l f 133.509 158.196 0.338 -1.854 re 133.67 158.537 m 133.543 158.537 133.459 158.637 133.459 158.756 c 133.459 158.874 133.547 158.97 133.678 158.97 c 133.808 158.97 133.893 158.874 133.893 158.756 c 133.893 158.637 133.808 158.537 133.674 158.537 c 133.67 158.537 l f 134.538 158.196 m 134.903 157.158 l 134.964 156.985 135.014 156.832 135.053 156.679 c 135.064 156.679 l 135.106 156.832 135.16 156.985 135.221 157.158 c 135.582 158.196 l 135.936 158.196 l 135.206 156.342 l 134.884 156.342 l 134.177 158.196 l 134.538 158.196 l f 137.391 157.453 m 137.395 157.663 137.303 158.001 136.927 158.001 c 136.581 158.001 136.435 157.686 136.408 157.453 c 137.391 157.453 l h 136.404 157.211 m 136.412 156.755 136.7 156.568 137.038 156.568 c 137.28 156.568 137.43 156.61 137.553 156.66 c 137.614 156.422 l 137.495 156.368 137.288 156.303 136.992 156.303 c 136.424 156.303 136.078 156.683 136.078 157.238 c 136.078 157.801 136.412 158.242 136.954 158.242 c 137.56 158.242 137.718 157.709 137.718 157.368 c 137.718 157.299 137.714 157.246 137.706 157.207 c 136.404 157.211 l f 139.296 156.602 m 139.381 156.587 139.504 156.587 139.634 156.587 c 140.348 156.583 140.736 156.985 140.736 157.683 c 140.74 158.299 140.395 158.679 139.688 158.679 c 139.515 158.679 139.384 158.664 139.296 158.644 c 139.296 156.602 l h 138.958 158.89 m 139.166 158.92 139.408 158.943 139.672 158.943 c 140.152 158.943 140.494 158.836 140.721 158.625 c 140.955 158.415 141.09 158.112 141.09 157.694 c 141.09 157.273 140.955 156.928 140.717 156.69 c 140.471 156.449 140.072 156.318 139.569 156.318 c 139.327 156.318 139.131 156.326 138.958 156.349 c 138.958 158.89 l f 142.103 156.342 m 141.255 158.924 l 141.62 158.924 l 142.023 157.652 l 142.13 157.303 142.226 156.985 142.299 156.686 c 142.307 156.686 l 142.38 156.985 142.484 157.311 142.603 157.648 c 143.041 158.924 l 143.398 158.924 l 142.472 156.342 l 142.103 156.342 l f 144.012 156.602 m 144.097 156.587 144.219 156.587 144.35 156.587 c 145.064 156.583 145.452 156.985 145.452 157.683 c 145.456 158.299 145.111 158.679 144.404 158.679 c 144.231 158.679 144.1 158.664 144.012 158.644 c 144.012 156.602 l h 143.674 158.89 m 143.881 158.92 144.124 158.943 144.388 158.943 c 144.868 158.943 145.21 158.836 145.437 158.625 c 145.671 158.415 145.806 158.112 145.806 157.694 c 145.806 157.273 145.671 156.928 145.433 156.69 c 145.187 156.449 144.788 156.318 144.285 156.318 c 144.043 156.318 143.847 156.326 143.674 156.349 c 143.674 158.89 l f 147.038 158.196 0.338 -1.854 re 147.2 158.537 m 147.073 158.537 146.988 158.637 146.988 158.756 c 146.988 158.874 147.077 158.97 147.207 158.97 c 147.338 158.97 147.422 158.874 147.422 158.756 c 147.422 158.637 147.338 158.537 147.203 158.537 c 147.2 158.537 l f 147.891 156.683 m 147.995 156.621 148.171 156.552 148.34 156.552 c 148.582 156.552 148.697 156.671 148.697 156.828 c 148.697 156.989 148.601 157.077 148.356 157.169 c 148.018 157.292 147.86 157.472 147.86 157.694 c 147.86 157.993 148.106 158.238 148.502 158.238 c 148.69 158.238 148.855 158.188 148.955 158.123 c 148.874 157.882 l 148.801 157.924 148.667 157.989 148.494 157.989 c 148.294 157.989 148.187 157.874 148.187 157.736 c 148.187 157.579 148.294 157.51 148.536 157.418 c 148.855 157.299 149.024 157.139 149.024 156.859 c 149.024 156.529 148.766 156.299 148.332 156.299 c 148.129 156.299 147.941 156.353 147.81 156.43 c 147.891 156.683 l f 151.251 157.288 m 150.883 157.296 150.464 157.231 150.464 156.87 c 150.464 156.648 150.61 156.549 150.779 156.549 c 151.025 156.549 151.182 156.702 151.236 156.859 c 151.247 156.893 151.251 156.932 151.251 156.966 c 151.251 157.288 l h 151.582 156.786 m 151.582 156.625 151.589 156.468 151.608 156.342 c 151.305 156.342 l 151.274 156.575 l 151.263 156.575 l 151.163 156.43 150.959 156.299 150.694 156.299 c 150.318 156.299 150.126 156.564 150.126 156.832 c 150.126 157.28 150.525 157.526 151.244 157.522 c 151.244 157.56 l 151.244 157.713 151.201 157.993 150.821 157.989 c 150.644 157.989 150.464 157.939 150.333 157.851 c 150.257 158.077 l 150.41 158.173 150.637 158.238 150.871 158.238 c 151.443 158.238 151.582 157.851 151.582 157.48 c 151.582 156.786 l f 152.204 158.196 m 152.568 157.158 l 152.63 156.985 152.68 156.832 152.718 156.679 c 152.73 156.679 l 152.772 156.832 152.826 156.985 152.887 157.158 c 153.248 158.196 l 153.601 158.196 l 152.872 156.342 l 152.549 156.342 l 151.842 158.196 l 152.204 158.196 l f 154.846 157.288 m 154.477 157.296 154.059 157.231 154.059 156.87 c 154.059 156.648 154.204 156.549 154.373 156.549 c 154.619 156.549 154.777 156.702 154.83 156.859 c 154.842 156.893 154.846 156.932 154.846 156.966 c 154.846 157.288 l h 155.176 156.786 m 155.176 156.625 155.184 156.468 155.203 156.342 c 154.9 156.342 l 154.869 156.575 l 154.857 156.575 l 154.758 156.43 154.554 156.299 154.289 156.299 c 153.913 156.299 153.721 156.564 153.721 156.832 c 153.721 157.28 154.12 157.526 154.838 157.522 c 154.838 157.56 l 154.838 157.713 154.796 157.993 154.416 157.989 c 154.239 157.989 154.059 157.939 153.928 157.851 c 153.851 158.077 l 154.005 158.173 154.231 158.238 154.466 158.238 c 155.038 158.238 155.176 157.851 155.176 157.48 c 155.176 156.786 l f 155.718 158.196 0.338 -1.854 re 155.879 158.537 m 155.752 158.537 155.668 158.637 155.668 158.756 c 155.668 158.874 155.756 158.97 155.887 158.97 c 156.017 158.97 156.102 158.874 156.102 158.756 c 156.102 158.637 156.017 158.537 155.883 158.537 c 155.879 158.537 l f 156.616 159.062 0.338 -2.721 re f 158.494 157.288 m 158.126 157.296 157.707 157.231 157.707 156.87 c 157.707 156.648 157.853 156.549 158.022 156.549 c 158.268 156.549 158.425 156.702 158.479 156.859 c 158.49 156.893 158.494 156.932 158.494 156.966 c 158.494 157.288 l h 158.825 156.786 m 158.825 156.625 158.832 156.468 158.851 156.342 c 158.548 156.342 l 158.517 156.575 l 158.506 156.575 l 158.406 156.43 158.202 156.299 157.937 156.299 c 157.561 156.299 157.369 156.564 157.369 156.832 c 157.369 157.28 157.768 157.526 158.487 157.522 c 158.487 157.56 l 158.487 157.713 158.444 157.993 158.064 157.989 c 157.887 157.989 157.707 157.939 157.576 157.851 c 157.5 158.077 l 157.653 158.173 157.88 158.238 158.114 158.238 c 158.686 158.238 158.825 157.851 158.825 157.48 c 158.825 156.786 l f 159.704 157.085 m 159.704 157.043 159.708 157.001 159.715 156.962 c 159.781 156.729 159.98 156.568 160.222 156.568 c 160.579 156.568 160.787 156.855 160.787 157.28 c 160.787 157.656 160.595 157.974 160.234 157.974 c 160.003 157.974 159.788 157.813 159.723 157.56 c 159.711 157.518 159.704 157.472 159.704 157.418 c 159.704 157.085 l h 159.366 159.062 m 159.704 159.062 l 159.704 157.901 l 159.711 157.901 l 159.831 158.108 160.046 158.238 160.345 158.238 c 160.806 158.238 161.129 157.855 161.129 157.296 c 161.129 156.629 160.706 156.299 160.291 156.299 c 160.023 156.299 159.811 156.403 159.669 156.648 c 159.661 156.648 l 159.642 156.342 l 159.35 156.342 l 159.362 156.468 159.366 156.656 159.366 156.82 c 159.366 159.062 l f 161.551 159.062 0.338 -2.721 re f 163.629 157.453 m 163.632 157.663 163.54 158.001 163.164 158.001 c 162.818 158.001 162.672 157.686 162.645 157.453 c 163.629 157.453 l h 162.642 157.211 m 162.649 156.755 162.937 156.568 163.275 156.568 c 163.517 156.568 163.667 156.61 163.79 156.66 c 163.851 156.422 l 163.732 156.368 163.525 156.303 163.229 156.303 c 162.661 156.303 162.315 156.683 162.315 157.238 c 162.315 157.801 162.649 158.242 163.191 158.242 c 163.798 158.242 163.955 157.709 163.955 157.368 c 163.955 157.299 163.951 157.246 163.944 157.207 c 162.642 157.211 l f 165.219 156.342 m 165.219 157.939 l 164.961 157.939 l 164.961 158.196 l 165.219 158.196 l 165.219 158.284 l 165.219 158.545 165.28 158.782 165.438 158.932 c 165.564 159.054 165.733 159.104 165.887 159.104 c 166.01 159.104 166.11 159.077 166.175 159.051 c 166.133 158.79 l 166.079 158.813 166.014 158.832 165.914 158.832 c 165.629 158.832 165.553 158.579 165.553 158.296 c 165.553 158.196 l 166.002 158.196 l 166.002 157.939 l 165.556 157.939 l 165.556 156.342 l 165.219 156.342 l f 166.313 157.618 m 166.313 157.836 166.309 158.024 166.298 158.196 c 166.593 158.196 l 166.609 157.832 l 166.62 157.832 l 166.705 158.081 166.912 158.238 167.139 158.238 c 167.173 158.238 167.2 158.234 167.231 158.227 c 167.231 157.912 l 167.193 157.916 167.158 157.92 167.112 157.92 c 166.874 157.92 166.705 157.74 166.659 157.491 c 166.651 157.441 166.647 157.388 166.647 157.33 c 166.647 156.342 l 166.309 156.342 l 166.313 157.618 l f 168.31 156.552 m 168.633 156.552 168.875 156.855 168.875 157.276 c 168.875 157.591 168.717 157.985 168.318 157.985 c 167.922 157.985 167.749 157.618 167.749 157.265 c 167.749 156.859 167.98 156.552 168.306 156.552 c 168.31 156.552 l h 168.299 156.299 m 167.799 156.299 167.407 156.667 167.407 157.254 c 167.407 157.874 167.818 158.238 168.329 158.238 c 168.863 158.238 169.224 157.851 169.224 157.288 c 169.224 156.598 168.744 156.299 168.302 156.299 c 168.299 156.299 l f 169.65 157.694 m 169.65 157.889 169.643 158.043 169.635 158.196 c 169.931 158.196 l 169.946 157.897 l 169.958 157.897 l 170.061 158.073 170.234 158.238 170.545 158.238 c 170.795 158.238 170.987 158.085 171.068 157.867 c 171.075 157.867 l 171.133 157.974 171.21 158.05 171.286 158.108 c 171.398 158.192 171.517 158.238 171.694 158.238 c 171.943 158.238 172.308 158.077 172.308 157.434 c 172.308 156.342 l 171.978 156.342 l 171.978 157.391 l 171.978 157.752 171.843 157.962 171.574 157.962 c 171.379 157.962 171.233 157.821 171.171 157.66 c 171.156 157.61 171.144 157.549 171.144 157.491 c 171.144 156.342 l 170.814 156.342 l 170.814 157.453 l 170.814 157.752 170.683 157.962 170.426 157.962 c 170.219 157.962 170.061 157.794 170.008 157.625 c 169.988 157.575 169.981 157.518 169.981 157.46 c 169.981 156.342 l 169.65 156.342 l 169.65 157.694 l f 175.484 156.422 m 175.365 156.361 175.115 156.299 174.8 156.299 c 174.071 156.299 173.525 156.759 173.525 157.61 c 173.525 158.422 174.074 158.966 174.877 158.966 c 175.196 158.966 175.403 158.897 175.492 158.851 c 175.407 158.579 l 175.284 158.641 175.104 158.686 174.889 158.686 c 174.282 158.686 173.879 158.299 173.879 157.621 c 173.879 156.985 174.243 156.583 174.869 156.583 c 175.077 156.583 175.284 156.625 175.419 156.69 c 175.484 156.422 l f 175.883 159.062 m 176.221 159.062 l 176.221 157.905 l 176.229 157.905 l 176.283 158.001 176.367 158.089 176.471 158.142 c 176.571 158.204 176.69 158.238 176.816 158.238 c 177.066 158.238 177.465 158.085 177.465 157.445 c 177.465 156.342 l 177.128 156.342 l 177.128 157.407 l 177.128 157.709 177.016 157.959 176.697 157.959 c 176.478 157.959 176.31 157.805 176.244 157.621 c 176.225 157.575 176.221 157.526 176.221 157.46 c 176.221 156.342 l 175.883 156.342 l 175.883 159.062 l f 179.194 157.453 m 179.197 157.663 179.105 158.001 178.729 158.001 c 178.383 158.001 178.237 157.686 178.211 157.453 c 179.194 157.453 l h 178.207 157.211 m 178.214 156.755 178.502 156.568 178.84 156.568 c 179.082 156.568 179.232 156.61 179.355 156.66 c 179.416 156.422 l 179.298 156.368 179.09 156.303 178.794 156.303 c 178.226 156.303 177.88 156.683 177.88 157.238 c 177.88 157.801 178.214 158.242 178.756 158.242 c 179.363 158.242 179.52 157.709 179.52 157.368 c 179.52 157.299 179.516 157.246 179.509 157.207 c 178.207 157.211 l f 180.062 158.196 m 180.426 157.158 l 180.488 156.985 180.538 156.832 180.576 156.679 c 180.588 156.679 l 180.63 156.832 180.684 156.985 180.745 157.158 c 181.106 158.196 l 181.459 158.196 l 180.73 156.342 l 180.407 156.342 l 179.701 158.196 l 180.062 158.196 l f 181.782 157.618 m 181.782 157.836 181.778 158.024 181.767 158.196 c 182.063 158.196 l 182.078 157.832 l 182.089 157.832 l 182.174 158.081 182.381 158.238 182.608 158.238 c 182.642 158.238 182.669 158.234 182.7 158.227 c 182.7 157.912 l 182.662 157.916 182.627 157.92 182.581 157.92 c 182.343 157.92 182.174 157.74 182.128 157.491 c 182.12 157.441 182.116 157.388 182.116 157.33 c 182.116 156.342 l 181.778 156.342 l 181.782 157.618 l f 183.779 156.552 m 184.102 156.552 184.344 156.855 184.344 157.276 c 184.344 157.591 184.186 157.985 183.787 157.985 c 183.391 157.985 183.218 157.618 183.218 157.265 c 183.218 156.859 183.449 156.552 183.775 156.552 c 183.779 156.552 l h 183.768 156.299 m 183.268 156.299 182.877 156.667 182.877 157.254 c 182.877 157.874 183.288 158.238 183.798 158.238 c 184.332 158.238 184.693 157.851 184.693 157.288 c 184.693 156.598 184.213 156.299 183.771 156.299 c 183.768 156.299 l f 185.119 157.694 m 185.119 157.889 185.115 158.043 185.104 158.196 c 185.404 158.196 l 185.423 157.893 l 185.431 157.893 l 185.523 158.066 185.738 158.238 186.045 158.238 c 186.302 158.238 186.702 158.085 186.702 157.449 c 186.702 156.342 l 186.364 156.342 l 186.364 157.41 l 186.364 157.709 186.252 157.962 185.934 157.962 c 185.715 157.962 185.542 157.805 185.48 157.618 c 185.465 157.575 185.457 157.514 185.457 157.46 c 185.457 156.342 l 185.119 156.342 l 185.119 157.694 l f 188.411 157.648 m 188.483 157.629 188.579 157.621 188.687 157.621 c 189.094 157.621 189.336 157.821 189.336 158.169 c 189.336 158.514 189.094 158.679 188.725 158.679 c 188.579 158.679 188.468 158.664 188.411 158.652 c 188.411 157.648 l h 188.076 158.89 m 188.238 158.92 188.449 158.943 188.718 158.943 c 189.048 158.943 189.29 158.867 189.444 158.729 c 189.586 158.606 189.674 158.418 189.674 158.188 c 189.674 157.955 189.605 157.771 189.47 157.637 c 189.294 157.449 189.006 157.353 188.679 157.353 c 188.579 157.353 188.487 157.357 188.411 157.376 c 188.411 156.342 l 188.076 156.342 l 188.076 158.89 l f 191.606 156.847 m 191.606 156.656 191.609 156.487 191.621 156.342 c 191.322 156.342 l 191.302 156.644 l 191.295 156.644 l 191.21 156.495 191.011 156.299 190.68 156.299 c 190.388 156.299 190.039 156.464 190.039 157.112 c 190.039 158.196 l 190.377 158.196 l 190.377 157.173 l 190.377 156.82 190.488 156.579 190.792 156.579 c 191.018 156.579 191.176 156.736 191.237 156.889 c 191.256 156.936 191.268 156.997 191.268 157.062 c 191.268 158.196 l 191.606 158.196 l 191.606 156.847 l f 192.504 157.085 m 192.504 157.043 192.508 157.001 192.516 156.962 c 192.581 156.729 192.781 156.568 193.023 156.568 c 193.38 156.568 193.587 156.855 193.587 157.28 c 193.587 157.656 193.395 157.974 193.034 157.974 c 192.804 157.974 192.589 157.813 192.524 157.56 c 192.512 157.518 192.504 157.472 192.504 157.418 c 192.504 157.085 l h 192.166 159.062 m 192.504 159.062 l 192.504 157.901 l 192.512 157.901 l 192.631 158.108 192.846 158.238 193.146 158.238 c 193.607 158.238 193.929 157.855 193.929 157.296 c 193.929 156.629 193.507 156.299 193.092 156.299 c 192.823 156.299 192.612 156.403 192.47 156.648 c 192.462 156.648 l 192.443 156.342 l 192.151 156.342 l 192.163 156.468 192.166 156.656 192.166 156.82 c 192.166 159.062 l f 194.352 159.062 0.338 -2.721 re f 195.25 158.196 0.338 -1.854 re 195.411 158.537 m 195.285 158.537 195.2 158.637 195.2 158.756 c 195.2 158.874 195.289 158.97 195.419 158.97 c 195.55 158.97 195.634 158.874 195.634 158.756 c 195.634 158.637 195.55 158.537 195.415 158.537 c 195.411 158.537 l f 196.103 156.683 m 196.206 156.621 196.383 156.552 196.552 156.552 c 196.794 156.552 196.909 156.671 196.909 156.828 c 196.909 156.989 196.813 157.077 196.567 157.169 c 196.229 157.292 196.072 157.472 196.072 157.694 c 196.072 157.993 196.318 158.238 196.713 158.238 c 196.901 158.238 197.067 158.188 197.166 158.123 c 197.086 157.882 l 197.013 157.924 196.878 157.989 196.706 157.989 c 196.506 157.989 196.398 157.874 196.398 157.736 c 196.398 157.579 196.506 157.51 196.748 157.418 c 197.067 157.299 197.236 157.139 197.236 156.859 c 197.236 156.529 196.978 156.299 196.544 156.299 c 196.341 156.299 196.152 156.353 196.022 156.43 c 196.103 156.683 l f 197.669 159.062 m 198.007 159.062 l 198.007 157.905 l 198.015 157.905 l 198.069 158.001 198.153 158.089 198.257 158.142 c 198.357 158.204 198.476 158.238 198.603 158.238 c 198.852 158.238 199.252 158.085 199.252 157.445 c 199.252 156.342 l 198.914 156.342 l 198.914 157.407 l 198.914 157.709 198.802 157.959 198.484 157.959 c 198.265 157.959 198.096 157.805 198.03 157.621 c 198.011 157.575 198.007 157.526 198.007 157.46 c 198.007 156.342 l 197.669 156.342 l 197.669 159.062 l f 199.801 158.196 0.338 -1.854 re 199.962 158.537 m 199.836 158.537 199.751 158.637 199.751 158.756 c 199.751 158.874 199.839 158.97 199.97 158.97 c 200.1 158.97 200.185 158.874 200.185 158.756 c 200.185 158.637 200.1 158.537 199.966 158.537 c 199.962 158.537 l f 200.7 157.694 m 200.7 157.889 200.696 158.043 200.684 158.196 c 200.984 158.196 l 201.003 157.893 l 201.01 157.893 l 201.103 158.066 201.318 158.238 201.625 158.238 c 201.882 158.238 202.282 158.085 202.282 157.449 c 202.282 156.342 l 201.944 156.342 l 201.944 157.41 l 201.944 157.709 201.832 157.962 201.514 157.962 c 201.295 157.962 201.122 157.805 201.06 157.618 c 201.045 157.575 201.037 157.514 201.037 157.46 c 201.037 156.342 l 200.7 156.342 l 200.7 157.694 l f 204.083 157.468 m 204.083 157.522 204.079 157.571 204.064 157.618 c 204.002 157.817 203.841 157.978 203.591 157.978 c 203.269 157.978 203.039 157.706 203.039 157.273 c 203.039 156.912 203.227 156.606 203.588 156.606 c 203.799 156.606 203.987 156.736 204.056 156.955 c 204.075 157.008 204.083 157.073 204.083 157.135 c 204.083 157.468 l h 204.421 156.613 m 204.421 156.184 204.333 155.928 204.156 155.763 c 203.972 155.598 203.71 155.541 203.476 155.541 c 203.254 155.541 203.008 155.594 202.858 155.694 c 202.942 155.955 l 203.065 155.874 203.257 155.805 203.488 155.805 c 203.833 155.805 204.087 155.985 204.087 156.457 c 204.087 156.66 l 204.079 156.66 l 203.979 156.487 203.776 156.349 203.488 156.349 c 203.027 156.349 202.697 156.74 202.697 157.257 c 202.697 157.886 203.108 158.238 203.538 158.238 c 203.86 158.238 204.033 158.073 204.118 157.92 c 204.125 157.92 l 204.137 158.196 l 204.436 158.196 l 204.425 158.066 204.421 157.916 204.421 157.69 c 204.421 156.613 l f 206.771 157.288 m 206.403 157.296 205.984 157.231 205.984 156.87 c 205.984 156.648 206.13 156.549 206.299 156.549 c 206.545 156.549 206.702 156.702 206.756 156.859 c 206.767 156.893 206.771 156.932 206.771 156.966 c 206.771 157.288 l h 207.101 156.786 m 207.101 156.625 207.109 156.468 207.128 156.342 c 206.825 156.342 l 206.794 156.575 l 206.783 156.575 l 206.683 156.43 206.48 156.299 206.214 156.299 c 205.838 156.299 205.646 156.564 205.646 156.832 c 205.646 157.28 206.045 157.526 206.764 157.522 c 206.764 157.56 l 206.764 157.713 206.721 157.993 206.341 157.989 c 206.164 157.989 205.984 157.939 205.854 157.851 c 205.777 158.077 l 205.93 158.173 206.157 158.238 206.391 158.238 c 206.963 158.238 207.101 157.851 207.101 157.48 c 207.101 156.786 l f 208.035 158.641 m 208.035 158.196 l 208.519 158.196 l 208.519 157.939 l 208.035 157.939 l 208.035 156.939 l 208.035 156.709 208.1 156.579 208.288 156.579 c 208.38 156.579 208.434 156.587 208.484 156.602 c 208.499 156.345 l 208.434 156.323 208.331 156.299 208.2 156.299 c 208.042 156.299 207.916 156.353 207.835 156.441 c 207.743 156.545 207.705 156.709 207.705 156.928 c 207.705 157.939 l 207.416 157.939 l 207.416 158.196 l 207.705 158.196 l 207.705 158.537 l 208.035 158.641 l f 210.12 158.641 m 210.12 158.196 l 210.604 158.196 l 210.604 157.939 l 210.12 157.939 l 210.12 156.939 l 210.12 156.709 210.185 156.579 210.374 156.579 c 210.466 156.579 210.52 156.587 210.569 156.602 c 210.585 156.345 l 210.52 156.323 210.416 156.299 210.285 156.299 c 210.128 156.299 210.001 156.353 209.921 156.441 c 209.828 156.545 209.79 156.709 209.79 156.928 c 209.79 157.939 l 209.502 157.939 l 209.502 158.196 l 209.79 158.196 l 209.79 158.537 l 210.12 158.641 l f 210.984 159.062 m 211.322 159.062 l 211.322 157.905 l 211.33 157.905 l 211.383 158.001 211.468 158.089 211.572 158.142 c 211.672 158.204 211.791 158.238 211.917 158.238 c 212.167 158.238 212.566 158.085 212.566 157.445 c 212.566 156.342 l 212.228 156.342 l 212.228 157.407 l 212.228 157.709 212.117 157.959 211.798 157.959 c 211.579 157.959 211.41 157.805 211.345 157.621 c 211.326 157.575 211.322 157.526 211.322 157.46 c 211.322 156.342 l 210.984 156.342 l 210.984 159.062 l f 214.294 157.453 m 214.298 157.663 214.206 158.001 213.83 158.001 c 213.484 158.001 213.338 157.686 213.311 157.453 c 214.294 157.453 l h 213.307 157.211 m 213.315 156.755 213.603 156.568 213.941 156.568 c 214.183 156.568 214.333 156.61 214.456 156.66 c 214.517 156.422 l 214.398 156.368 214.191 156.303 213.895 156.303 c 213.327 156.303 212.981 156.683 212.981 157.238 c 212.981 157.801 213.315 158.242 213.857 158.242 c 214.464 158.242 214.621 157.709 214.621 157.368 c 214.621 157.299 214.617 157.246 214.609 157.207 c 213.307 157.211 l f 216.191 157.096 m 216.191 157.05 216.196 157.001 216.207 156.958 c 216.265 156.725 216.472 156.564 216.71 156.564 c 217.067 156.564 217.275 156.855 217.275 157.28 c 217.275 157.652 217.083 157.97 216.725 157.97 c 216.495 157.97 216.276 157.809 216.211 157.556 c 216.203 157.51 216.191 157.46 216.191 157.418 c 216.191 157.096 l h 215.854 157.591 m 215.854 157.828 215.85 158.02 215.838 158.196 c 216.142 158.196 l 216.161 157.878 l 216.169 157.878 l 216.303 158.108 216.526 158.238 216.825 158.238 c 217.278 158.238 217.616 157.859 217.616 157.296 c 217.616 156.629 217.205 156.299 216.772 156.299 c 216.522 156.299 216.311 156.407 216.199 156.591 c 216.191 156.591 l 216.191 155.583 l 215.854 155.583 l 215.854 157.591 l f 218.043 157.618 m 218.043 157.836 218.039 158.024 218.027 158.196 c 218.323 158.196 l 218.339 157.832 l 218.35 157.832 l 218.435 158.081 218.642 158.238 218.868 158.238 c 218.903 158.238 218.93 158.234 218.961 158.227 c 218.961 157.912 l 218.922 157.916 218.888 157.92 218.841 157.92 c 218.603 157.92 218.435 157.74 218.388 157.491 c 218.381 157.441 218.377 157.388 218.377 157.33 c 218.377 156.342 l 218.039 156.342 l 218.043 157.618 l f 219.31 158.196 0.338 -1.854 re 219.471 158.537 m 219.345 158.537 219.26 158.637 219.26 158.756 c 219.26 158.874 219.348 158.97 219.479 158.97 c 219.609 158.97 219.694 158.874 219.694 158.756 c 219.694 158.637 219.609 158.537 219.475 158.537 c 219.471 158.537 l f 221.533 156.407 m 221.445 156.365 221.249 156.299 221 156.299 c 220.439 156.299 220.074 156.679 220.074 157.25 c 220.074 157.821 220.466 158.238 221.073 158.238 c 221.272 158.238 221.449 158.188 221.541 158.139 c 221.464 157.882 l 221.384 157.924 221.257 157.97 221.073 157.97 c 220.646 157.97 220.416 157.652 220.416 157.265 c 220.416 156.836 220.692 156.571 221.061 156.571 c 221.253 156.571 221.38 156.617 221.476 156.66 c 221.533 156.407 l f 223.085 157.453 m 223.089 157.663 222.997 158.001 222.62 158.001 c 222.275 158.001 222.129 157.686 222.102 157.453 c 223.085 157.453 l h 222.098 157.211 m 222.106 156.755 222.394 156.568 222.732 156.568 c 222.973 156.568 223.123 156.61 223.246 156.66 c 223.308 156.422 l 223.189 156.368 222.981 156.303 222.685 156.303 c 222.117 156.303 221.771 156.683 221.771 157.238 c 221.771 157.801 222.106 158.242 222.647 158.242 c 223.254 158.242 223.411 157.709 223.411 157.368 c 223.411 157.299 223.408 157.246 223.4 157.207 c 222.098 157.211 l f 225.413 156.552 m 225.735 156.552 225.977 156.855 225.977 157.276 c 225.977 157.591 225.819 157.985 225.42 157.985 c 225.025 157.985 224.852 157.618 224.852 157.265 c 224.852 156.859 225.082 156.552 225.408 156.552 c 225.413 156.552 l h 225.401 156.299 m 224.901 156.299 224.51 156.667 224.51 157.254 c 224.51 157.874 224.921 158.238 225.432 158.238 c 225.965 158.238 226.326 157.851 226.326 157.288 c 226.326 156.598 225.846 156.299 225.405 156.299 c 225.401 156.299 l f 226.783 156.342 m 226.783 157.939 l 226.526 157.939 l 226.526 158.196 l 226.783 158.196 l 226.783 158.284 l 226.783 158.545 226.845 158.782 227.002 158.932 c 227.129 159.054 227.298 159.104 227.451 159.104 c 227.575 159.104 227.674 159.077 227.74 159.051 c 227.697 158.79 l 227.644 158.813 227.578 158.832 227.478 158.832 c 227.194 158.832 227.117 158.579 227.117 158.296 c 227.117 158.196 l 227.567 158.196 l 227.567 157.939 l 227.121 157.939 l 227.121 156.342 l 226.783 156.342 l f 229.245 156.012 m 229.245 156.399 l 229.022 156.403 228.796 156.472 228.661 156.568 c 228.753 156.824 l 228.888 156.732 229.088 156.66 229.299 156.66 c 229.575 156.66 229.76 156.817 229.76 157.035 c 229.76 157.246 229.61 157.376 229.326 157.491 c 228.934 157.644 228.692 157.825 228.692 158.158 c 228.692 158.476 228.918 158.717 229.268 158.775 c 229.268 159.158 l 229.51 159.158 l 229.51 158.786 l 229.74 158.778 229.898 158.717 230.009 158.652 c 229.913 158.399 l 229.833 158.445 229.675 158.533 229.43 158.533 c 229.134 158.533 229.022 158.357 229.022 158.2 c 229.022 158.004 229.164 157.905 229.499 157.763 c 229.894 157.602 230.094 157.407 230.094 157.066 c 230.094 156.759 229.883 156.476 229.487 156.41 c 229.487 156.012 l 229.245 156.012 l f 231.595 157.28 m 231.595 158.115 l 231.595 158.246 231.599 158.376 231.607 158.507 c 231.595 158.507 l 231.518 158.361 231.457 158.254 231.388 158.135 c 230.777 157.288 l 230.777 157.28 l 231.595 157.28 l h 231.595 156.342 m 231.595 157.02 l 230.435 157.02 l 230.435 157.238 l 231.549 158.832 l 231.914 158.832 l 231.914 157.28 l 232.263 157.28 l 232.263 157.02 l 231.914 157.02 l 231.914 156.342 l 231.595 156.342 l f 233.331 156.56 m 233.673 156.56 233.838 156.962 233.838 157.598 c 233.838 158.212 233.684 158.614 233.331 158.614 c 233.024 158.614 232.824 158.223 232.824 157.598 c 232.816 156.951 233.016 156.56 233.327 156.56 c 233.331 156.56 l h 233.316 156.299 m 232.828 156.299 232.494 156.755 232.486 157.579 c 232.486 158.418 232.851 158.874 233.358 158.874 c 233.88 158.874 234.184 158.407 234.184 157.614 c 234.184 156.767 233.865 156.299 233.32 156.299 c 233.316 156.299 l f 235.75 157.096 m 235.75 157.05 235.754 157.001 235.766 156.958 c 235.823 156.725 236.031 156.564 236.269 156.564 c 236.626 156.564 236.833 156.855 236.833 157.28 c 236.833 157.652 236.641 157.97 236.284 157.97 c 236.054 157.97 235.835 157.809 235.77 157.556 c 235.762 157.51 235.75 157.46 235.75 157.418 c 235.75 157.096 l h 235.412 157.591 m 235.412 157.828 235.409 158.02 235.397 158.196 c 235.7 158.196 l 235.72 157.878 l 235.727 157.878 l 235.862 158.108 236.084 158.238 236.384 158.238 c 236.837 158.238 237.175 157.859 237.175 157.296 c 237.175 156.629 236.764 156.299 236.33 156.299 c 236.081 156.299 235.869 156.407 235.758 156.591 c 235.75 156.591 l 235.75 155.583 l 235.412 155.583 l 235.412 157.591 l f 237.598 159.062 0.338 -2.721 re f 240.052 156.847 m 240.052 156.656 240.055 156.487 240.067 156.342 c 239.767 156.342 l 239.748 156.644 l 239.74 156.644 l 239.656 156.495 239.456 156.299 239.126 156.299 c 238.834 156.299 238.485 156.464 238.485 157.112 c 238.485 158.196 l 238.823 158.196 l 238.823 157.173 l 238.823 156.82 238.934 156.579 239.237 156.579 c 239.464 156.579 239.621 156.736 239.683 156.889 c 239.702 156.936 239.713 156.997 239.713 157.062 c 239.713 158.196 l 240.052 158.196 l 240.052 156.847 l f 240.566 156.683 m 240.67 156.621 240.847 156.552 241.015 156.552 c 241.257 156.552 241.373 156.671 241.373 156.828 c 241.373 156.989 241.277 157.077 241.031 157.169 c 240.693 157.292 240.535 157.472 240.535 157.694 c 240.535 157.993 240.781 158.238 241.177 158.238 c 241.365 158.238 241.53 158.188 241.63 158.123 c 241.549 157.882 l 241.476 157.924 241.342 157.989 241.169 157.989 c 240.969 157.989 240.862 157.874 240.862 157.736 c 240.862 157.579 240.969 157.51 241.211 157.418 c 241.53 157.299 241.699 157.139 241.699 156.859 c 241.699 156.529 241.442 156.299 241.008 156.299 c 240.804 156.299 240.616 156.353 240.486 156.43 c 240.566 156.683 l f 242.901 156.683 m 243.005 156.621 243.182 156.552 243.35 156.552 c 243.592 156.552 243.708 156.671 243.708 156.828 c 243.708 156.989 243.612 157.077 243.366 157.169 c 243.028 157.292 242.87 157.472 242.87 157.694 c 242.87 157.993 243.116 158.238 243.512 158.238 c 243.7 158.238 243.865 158.188 243.965 158.123 c 243.884 157.882 l 243.811 157.924 243.677 157.989 243.504 157.989 c 243.304 157.989 243.197 157.874 243.197 157.736 c 243.197 157.579 243.304 157.51 243.546 157.418 c 243.865 157.299 244.034 157.139 244.034 156.859 c 244.034 156.529 243.777 156.299 243.343 156.299 c 243.139 156.299 242.951 156.353 242.821 156.43 c 242.901 156.683 l f 244.468 159.062 m 244.806 159.062 l 244.806 157.905 l 244.814 157.905 l 244.867 158.001 244.952 158.089 245.056 158.142 c 245.156 158.204 245.275 158.238 245.401 158.238 c 245.651 158.238 246.05 158.085 246.05 157.445 c 246.05 156.342 l 245.712 156.342 l 245.712 157.407 l 245.712 157.709 245.601 157.959 245.282 157.959 c 245.063 157.959 244.894 157.805 244.829 157.621 c 244.81 157.575 244.806 157.526 244.806 157.46 c 244.806 156.342 l 244.468 156.342 l 244.468 159.062 l f 246.599 158.196 0.338 -1.854 re 246.761 158.537 m 246.634 158.537 246.549 158.637 246.549 158.756 c 246.549 158.874 246.638 158.97 246.769 158.97 c 246.899 158.97 246.984 158.874 246.984 158.756 c 246.984 158.637 246.899 158.537 246.764 158.537 c 246.761 158.537 l f 247.836 157.096 m 247.836 157.05 247.84 157.001 247.851 156.958 c 247.909 156.725 248.116 156.564 248.354 156.564 c 248.712 156.564 248.919 156.855 248.919 157.28 c 248.919 157.652 248.727 157.97 248.37 157.97 c 248.139 157.97 247.921 157.809 247.855 157.556 c 247.847 157.51 247.836 157.46 247.836 157.418 c 247.836 157.096 l h 247.498 157.591 m 247.498 157.828 247.494 158.02 247.483 158.196 c 247.786 158.196 l 247.805 157.878 l 247.813 157.878 l 247.947 158.108 248.17 158.238 248.47 158.238 c 248.923 158.238 249.261 157.859 249.261 157.296 c 249.261 156.629 248.85 156.299 248.416 156.299 c 248.166 156.299 247.955 156.407 247.844 156.591 c 247.836 156.591 l 247.836 155.583 l 247.498 155.583 l 247.498 157.591 l f 250.021 157.096 m 250.021 157.05 250.025 157.001 250.036 156.958 c 250.094 156.725 250.301 156.564 250.539 156.564 c 250.896 156.564 251.104 156.855 251.104 157.28 c 251.104 157.652 250.912 157.97 250.555 157.97 c 250.324 157.97 250.105 157.809 250.04 157.556 c 250.032 157.51 250.021 157.46 250.021 157.418 c 250.021 157.096 l h 249.683 157.591 m 249.683 157.828 249.679 158.02 249.668 158.196 c 249.971 158.196 l 249.99 157.878 l 249.998 157.878 l 250.132 158.108 250.355 158.238 250.655 158.238 c 251.108 158.238 251.446 157.859 251.446 157.296 c 251.446 156.629 251.035 156.299 250.601 156.299 c 250.351 156.299 250.14 156.407 250.029 156.591 c 250.021 156.591 l 250.021 155.583 l 249.683 155.583 l 249.683 157.591 l f 251.868 158.196 0.338 -1.854 re 252.029 158.537 m 251.903 158.537 251.818 158.637 251.818 158.756 c 251.818 158.874 251.907 158.97 252.037 158.97 c 252.168 158.97 252.252 158.874 252.252 158.756 c 252.252 158.637 252.168 158.537 252.033 158.537 c 252.029 158.537 l f 252.767 157.694 m 252.767 157.889 252.763 158.043 252.752 158.196 c 253.051 158.196 l 253.07 157.893 l 253.078 157.893 l 253.17 158.066 253.385 158.238 253.692 158.238 c 253.95 158.238 254.349 158.085 254.349 157.449 c 254.349 156.342 l 254.011 156.342 l 254.011 157.41 l 254.011 157.709 253.9 157.962 253.581 157.962 c 253.362 157.962 253.19 157.805 253.128 157.618 c 253.113 157.575 253.105 157.514 253.105 157.46 c 253.105 156.342 l 252.767 156.342 l 252.767 157.694 l f 256.15 157.468 m 256.15 157.522 256.146 157.571 256.131 157.618 c 256.07 157.817 255.908 157.978 255.659 157.978 c 255.336 157.978 255.106 157.706 255.106 157.273 c 255.106 156.912 255.294 156.606 255.655 156.606 c 255.866 156.606 256.054 156.736 256.123 156.955 c 256.142 157.008 256.15 157.073 256.15 157.135 c 256.15 157.468 l h 256.488 156.613 m 256.488 156.184 256.4 155.928 256.223 155.763 c 256.039 155.598 255.778 155.541 255.543 155.541 c 255.321 155.541 255.075 155.594 254.925 155.694 c 255.009 155.955 l 255.133 155.874 255.324 155.805 255.555 155.805 c 255.9 155.805 256.154 155.985 256.154 156.457 c 256.154 156.66 l 256.146 156.66 l 256.046 156.487 255.843 156.349 255.555 156.349 c 255.094 156.349 254.764 156.74 254.764 157.257 c 254.764 157.886 255.175 158.238 255.605 158.238 c 255.927 158.238 256.1 158.073 256.185 157.92 c 256.192 157.92 l 256.204 158.196 l 256.503 158.196 l 256.492 158.066 256.488 157.916 256.488 157.69 c 256.488 156.613 l f 258.838 157.288 m 258.47 157.296 258.051 157.231 258.051 156.87 c 258.051 156.648 258.197 156.549 258.366 156.549 c 258.612 156.549 258.769 156.702 258.823 156.859 c 258.835 156.893 258.838 156.932 258.838 156.966 c 258.838 157.288 l h 259.169 156.786 m 259.169 156.625 259.176 156.468 259.196 156.342 c 258.892 156.342 l 258.861 156.575 l 258.85 156.575 l 258.75 156.43 258.547 156.299 258.282 156.299 c 257.905 156.299 257.713 156.564 257.713 156.832 c 257.713 157.28 258.113 157.526 258.831 157.522 c 258.831 157.56 l 258.831 157.713 258.789 157.993 258.408 157.989 c 258.232 157.989 258.051 157.939 257.921 157.851 c 257.844 158.077 l 257.997 158.173 258.224 158.238 258.458 158.238 c 259.031 158.238 259.169 157.851 259.169 157.48 c 259.169 156.786 l f 259.71 157.694 m 259.71 157.889 259.707 158.043 259.695 158.196 c 259.994 158.196 l 260.014 157.893 l 260.021 157.893 l 260.113 158.066 260.328 158.238 260.636 158.238 c 260.893 158.238 261.293 158.085 261.293 157.449 c 261.293 156.342 l 260.954 156.342 l 260.954 157.41 l 260.954 157.709 260.843 157.962 260.524 157.962 c 260.306 157.962 260.133 157.805 260.071 157.618 c 260.056 157.575 260.048 157.514 260.048 157.46 c 260.048 156.342 l 259.71 156.342 l 259.71 157.694 l f 263.109 157.441 m 263.109 157.487 263.105 157.541 263.094 157.587 c 263.044 157.797 262.859 157.974 262.606 157.974 c 262.256 157.974 262.049 157.667 262.049 157.261 c 262.049 156.882 262.237 156.571 262.598 156.571 c 262.825 156.571 263.032 156.725 263.094 156.974 c 263.105 157.02 263.109 157.066 263.109 157.119 c 263.109 157.441 l h 263.447 159.062 m 263.447 156.82 l 263.447 156.656 263.451 156.468 263.463 156.342 c 263.159 156.342 l 263.144 156.663 l 263.136 156.663 l 263.032 156.457 262.81 156.299 262.506 156.299 c 262.057 156.299 261.707 156.679 261.707 157.242 c 261.704 157.863 262.091 158.238 262.541 158.238 c 262.829 158.238 263.021 158.104 263.102 157.959 c 263.109 157.959 l 263.109 159.062 l 263.447 159.062 l f 264.822 159.062 m 265.16 159.062 l 265.16 157.905 l 265.167 157.905 l 265.221 158.001 265.306 158.089 265.409 158.142 c 265.509 158.204 265.628 158.238 265.755 158.238 c 266.005 158.238 266.404 158.085 266.404 157.445 c 266.404 156.342 l 266.066 156.342 l 266.066 157.407 l 266.066 157.709 265.955 157.959 265.636 157.959 c 265.417 157.959 265.248 157.805 265.183 157.621 c 265.164 157.575 265.16 157.526 265.16 157.46 c 265.16 156.342 l 264.822 156.342 l 264.822 159.062 l f 267.932 157.288 m 267.564 157.296 267.145 157.231 267.145 156.87 c 267.145 156.648 267.291 156.549 267.46 156.549 c 267.706 156.549 267.863 156.702 267.917 156.859 c 267.929 156.893 267.932 156.932 267.932 156.966 c 267.932 157.288 l h 268.263 156.786 m 268.263 156.625 268.271 156.468 268.29 156.342 c 267.986 156.342 l 267.956 156.575 l 267.944 156.575 l 267.844 156.43 267.641 156.299 267.376 156.299 c 266.999 156.299 266.807 156.564 266.807 156.832 c 266.807 157.28 267.207 157.526 267.925 157.522 c 267.925 157.56 l 267.925 157.713 267.883 157.993 267.502 157.989 c 267.326 157.989 267.145 157.939 267.015 157.851 c 266.938 158.077 l 267.091 158.173 267.318 158.238 267.552 158.238 c 268.125 158.238 268.263 157.851 268.263 157.48 c 268.263 156.786 l f 268.804 157.694 m 268.804 157.889 268.8 158.043 268.789 158.196 c 269.088 158.196 l 269.108 157.893 l 269.115 157.893 l 269.207 158.066 269.422 158.238 269.729 158.238 c 269.987 158.238 270.386 158.085 270.386 157.449 c 270.386 156.342 l 270.048 156.342 l 270.048 157.41 l 270.048 157.709 269.937 157.962 269.618 157.962 c 269.399 157.962 269.227 157.805 269.165 157.618 c 269.15 157.575 269.142 157.514 269.142 157.46 c 269.142 156.342 l 268.804 156.342 l 268.804 157.694 l f 272.203 157.441 m 272.203 157.487 272.199 157.541 272.188 157.587 c 272.138 157.797 271.953 157.974 271.7 157.974 c 271.35 157.974 271.143 157.667 271.143 157.261 c 271.143 156.882 271.331 156.571 271.692 156.571 c 271.919 156.571 272.126 156.725 272.188 156.974 c 272.199 157.02 272.203 157.066 272.203 157.119 c 272.203 157.441 l h 272.541 159.062 m 272.541 156.82 l 272.541 156.656 272.545 156.468 272.556 156.342 c 272.253 156.342 l 272.238 156.663 l 272.23 156.663 l 272.126 156.457 271.903 156.299 271.6 156.299 c 271.151 156.299 270.801 156.679 270.801 157.242 c 270.797 157.863 271.185 158.238 271.634 158.238 c 271.923 158.238 272.114 158.104 272.195 157.959 c 272.203 157.959 l 272.203 159.062 l 272.541 159.062 l f 273.102 159.062 0.338 -2.721 re f 274 158.196 0.338 -1.854 re 274.162 158.537 m 274.035 158.537 273.95 158.637 273.95 158.756 c 273.95 158.874 274.039 158.97 274.169 158.97 c 274.3 158.97 274.384 158.874 274.384 158.756 c 274.384 158.637 274.3 158.537 274.165 158.537 c 274.162 158.537 l f 274.899 157.694 m 274.899 157.889 274.895 158.043 274.883 158.196 c 275.183 158.196 l 275.202 157.893 l 275.21 157.893 l 275.302 158.066 275.517 158.238 275.824 158.238 c 276.082 158.238 276.481 158.085 276.481 157.449 c 276.481 156.342 l 276.143 156.342 l 276.143 157.41 l 276.143 157.709 276.032 157.962 275.713 157.962 c 275.494 157.962 275.321 157.805 275.26 157.618 c 275.244 157.575 275.237 157.514 275.237 157.46 c 275.237 156.342 l 274.899 156.342 l 274.899 157.694 l f 278.282 157.468 m 278.282 157.522 278.279 157.571 278.263 157.618 c 278.202 157.817 278.04 157.978 277.791 157.978 c 277.468 157.978 277.238 157.706 277.238 157.273 c 277.238 156.912 277.426 156.606 277.787 156.606 c 277.998 156.606 278.186 156.736 278.255 156.955 c 278.274 157.008 278.282 157.073 278.282 157.135 c 278.282 157.468 l h 278.62 156.613 m 278.62 156.184 278.532 155.928 278.355 155.763 c 278.171 155.598 277.91 155.541 277.675 155.541 c 277.453 155.541 277.207 155.594 277.057 155.694 c 277.142 155.955 l 277.265 155.874 277.457 155.805 277.687 155.805 c 278.033 155.805 278.286 155.985 278.286 156.457 c 278.286 156.66 l 278.279 156.66 l 278.179 156.487 277.975 156.349 277.687 156.349 c 277.226 156.349 276.896 156.74 276.896 157.257 c 276.896 157.886 277.307 158.238 277.737 158.238 c 278.059 158.238 278.232 158.073 278.317 157.92 c 278.324 157.92 l 278.336 158.196 l 278.635 158.196 l 278.624 158.066 278.62 157.916 278.62 157.69 c 278.62 156.613 l f 279.242 156.299 m 279.112 156.299 279.02 156.403 279.02 156.541 c 279.02 156.679 279.115 156.782 279.25 156.782 c 279.384 156.782 279.476 156.683 279.476 156.541 c 279.476 156.403 279.384 156.299 279.246 156.299 c 279.242 156.299 l f 146.253 151.824 m 146.134 151.762 145.884 151.701 145.569 151.701 c 144.84 151.701 144.294 152.161 144.294 153.012 c 144.294 153.824 144.843 154.368 145.646 154.368 c 145.965 154.368 146.172 154.299 146.261 154.253 c 146.176 153.981 l 146.053 154.042 145.873 154.088 145.658 154.088 c 145.051 154.088 144.648 153.701 144.648 153.023 c 144.648 152.387 145.012 151.985 145.638 151.985 c 145.846 151.985 146.053 152.027 146.188 152.092 c 146.253 151.824 l f 147.382 151.954 m 147.705 151.954 147.947 152.257 147.947 152.678 c 147.947 152.993 147.789 153.387 147.39 153.387 c 146.994 153.387 146.821 153.019 146.821 152.667 c 146.821 152.261 147.052 151.954 147.378 151.954 c 147.382 151.954 l h 147.371 151.701 m 146.871 151.701 146.48 152.069 146.48 152.655 c 146.48 153.276 146.891 153.64 147.401 153.64 c 147.935 153.64 148.296 153.253 148.296 152.69 c 148.296 152 147.816 151.701 147.374 151.701 c 147.371 151.701 l f 148.722 153.096 m 148.722 153.291 148.715 153.445 148.707 153.598 c 149.003 153.598 l 149.018 153.299 l 149.03 153.299 l 149.133 153.475 149.306 153.64 149.617 153.64 c 149.867 153.64 150.059 153.487 150.14 153.269 c 150.147 153.269 l 150.205 153.376 150.282 153.452 150.358 153.51 c 150.47 153.594 150.589 153.64 150.766 153.64 c 151.015 153.64 151.38 153.479 151.38 152.835 c 151.38 151.743 l 151.05 151.743 l 151.05 152.793 l 151.05 153.153 150.915 153.364 150.646 153.364 c 150.45 153.364 150.305 153.222 150.243 153.061 c 150.228 153.012 150.216 152.95 150.216 152.893 c 150.216 151.743 l 149.886 151.743 l 149.886 152.855 l 149.886 153.153 149.755 153.364 149.498 153.364 c 149.291 153.364 149.133 153.196 149.08 153.027 c 149.06 152.977 149.053 152.92 149.053 152.862 c 149.053 151.743 l 148.722 151.743 l 148.722 153.096 l f 152.263 152.498 m 152.263 152.452 152.267 152.403 152.279 152.36 c 152.336 152.127 152.544 151.966 152.782 151.966 c 153.139 151.966 153.346 152.257 153.346 152.682 c 153.346 153.054 153.154 153.372 152.797 153.372 c 152.566 153.372 152.348 153.211 152.282 152.958 c 152.275 152.912 152.263 152.862 152.263 152.82 c 152.263 152.498 l h 151.925 152.993 m 151.925 153.23 151.921 153.422 151.91 153.598 c 152.213 153.598 l 152.232 153.28 l 152.24 153.28 l 152.374 153.51 152.597 153.64 152.897 153.64 c 153.35 153.64 153.688 153.261 153.688 152.698 c 153.688 152.031 153.277 151.701 152.843 151.701 c 152.593 151.701 152.382 151.809 152.271 151.993 c 152.263 151.993 l 152.263 150.985 l 151.925 150.985 l 151.925 152.993 l f 154.11 154.464 0.338 -2.721 re f 156.188 152.855 m 156.192 153.065 156.1 153.403 155.723 153.403 c 155.378 153.403 155.232 153.088 155.205 152.855 c 156.188 152.855 l h 155.201 152.613 m 155.209 152.157 155.497 151.969 155.835 151.969 c 156.077 151.969 156.226 152.012 156.349 152.061 c 156.411 151.824 l 156.292 151.77 156.084 151.705 155.789 151.705 c 155.22 151.705 154.875 152.085 154.875 152.64 c 154.875 153.203 155.209 153.644 155.75 153.644 c 156.357 153.644 156.514 153.111 156.514 152.77 c 156.514 152.701 156.511 152.648 156.503 152.609 c 155.201 152.613 l f 157.34 154.042 m 157.34 153.598 l 157.824 153.598 l 157.824 153.341 l 157.34 153.341 l 157.34 152.341 l 157.34 152.111 157.405 151.981 157.593 151.981 c 157.686 151.981 157.739 151.988 157.789 152.004 c 157.805 151.747 l 157.739 151.724 157.636 151.701 157.505 151.701 c 157.348 151.701 157.221 151.755 157.14 151.843 c 157.048 151.946 157.01 152.111 157.01 152.33 c 157.01 153.341 l 156.722 153.341 l 156.722 153.598 l 157.01 153.598 l 157.01 153.939 l 157.34 154.042 l f 159.36 152.855 m 159.364 153.065 159.272 153.403 158.895 153.403 c 158.55 153.403 158.404 153.088 158.377 152.855 c 159.36 152.855 l h 158.373 152.613 m 158.381 152.157 158.669 151.969 159.007 151.969 c 159.249 151.969 159.399 152.012 159.521 152.061 c 159.583 151.824 l 159.464 151.77 159.256 151.705 158.961 151.705 c 158.392 151.705 158.047 152.085 158.047 152.64 c 158.047 153.203 158.381 153.644 158.922 153.644 c 159.529 153.644 159.687 153.111 159.687 152.77 c 159.687 152.701 159.683 152.648 159.675 152.609 c 158.373 152.613 l f 161.326 154.042 m 161.326 153.598 l 161.81 153.598 l 161.81 153.341 l 161.326 153.341 l 161.326 152.341 l 161.326 152.111 161.392 151.981 161.58 151.981 c 161.672 151.981 161.726 151.988 161.776 152.004 c 161.791 151.747 l 161.726 151.724 161.622 151.701 161.492 151.701 c 161.334 151.701 161.207 151.755 161.127 151.843 c 161.034 151.946 160.996 152.111 160.996 152.33 c 160.996 153.341 l 160.708 153.341 l 160.708 153.598 l 160.996 153.598 l 160.996 153.939 l 161.326 154.042 l f 162.19 154.464 m 162.528 154.464 l 162.528 153.307 l 162.536 153.307 l 162.59 153.403 162.674 153.491 162.778 153.544 c 162.878 153.606 162.997 153.64 163.124 153.64 c 163.373 153.64 163.773 153.487 163.773 152.847 c 163.773 151.743 l 163.435 151.743 l 163.435 152.809 l 163.435 153.111 163.323 153.361 163.005 153.361 c 162.786 153.361 162.617 153.207 162.551 153.023 c 162.532 152.977 162.528 152.927 162.528 152.862 c 162.528 151.743 l 162.19 151.743 l 162.19 154.464 l f 165.501 152.855 m 165.505 153.065 165.413 153.403 165.036 153.403 c 164.69 153.403 164.545 153.088 164.518 152.855 c 165.501 152.855 l h 164.514 152.613 m 164.522 152.157 164.81 151.969 165.148 151.969 c 165.389 151.969 165.539 152.012 165.662 152.061 c 165.724 151.824 l 165.604 151.77 165.397 151.705 165.101 151.705 c 164.533 151.705 164.187 152.085 164.187 152.64 c 164.187 153.203 164.522 153.644 165.063 153.644 c 165.67 153.644 165.827 153.111 165.827 152.77 c 165.827 152.701 165.823 152.648 165.816 152.609 c 164.514 152.613 l f 167.828 151.954 m 168.151 151.954 168.393 152.257 168.393 152.678 c 168.393 152.993 168.235 153.387 167.836 153.387 c 167.44 153.387 167.267 153.019 167.267 152.667 c 167.267 152.261 167.498 151.954 167.824 151.954 c 167.828 151.954 l h 167.817 151.701 m 167.317 151.701 166.926 152.069 166.926 152.655 c 166.926 153.276 167.337 153.64 167.847 153.64 c 168.381 153.64 168.742 153.253 168.742 152.69 c 168.742 152 168.262 151.701 167.82 151.701 c 167.817 151.701 l f 169.172 153.019 m 169.172 153.238 169.168 153.425 169.157 153.598 c 169.453 153.598 l 169.468 153.234 l 169.479 153.234 l 169.564 153.483 169.771 153.64 169.998 153.64 c 170.032 153.64 170.059 153.636 170.09 153.629 c 170.09 153.314 l 170.052 153.318 170.017 153.322 169.971 153.322 c 169.733 153.322 169.564 153.142 169.518 152.893 c 169.51 152.843 169.506 152.79 169.506 152.732 c 169.506 151.743 l 169.168 151.743 l 169.172 153.019 l f 171.668 152.843 m 171.668 152.889 171.665 152.943 171.653 152.989 c 171.603 153.199 171.419 153.376 171.165 153.376 c 170.816 153.376 170.608 153.069 170.608 152.663 c 170.608 152.284 170.797 151.973 171.158 151.973 c 171.384 151.973 171.592 152.127 171.653 152.376 c 171.665 152.422 171.668 152.467 171.668 152.521 c 171.668 152.843 l h 172.006 154.464 m 172.006 152.222 l 172.006 152.058 172.01 151.87 172.022 151.743 c 171.718 151.743 l 171.703 152.065 l 171.695 152.065 l 171.592 151.858 171.369 151.701 171.066 151.701 c 170.616 151.701 170.267 152.08 170.267 152.644 c 170.263 153.264 170.651 153.64 171.1 153.64 c 171.388 153.64 171.58 153.506 171.661 153.361 c 171.668 153.361 l 171.668 154.464 l 172.006 154.464 l f 173.746 152.855 m 173.75 153.065 173.658 153.403 173.281 153.403 c 172.936 153.403 172.79 153.088 172.763 152.855 c 173.746 152.855 l h 172.759 152.613 m 172.767 152.157 173.055 151.969 173.393 151.969 c 173.635 151.969 173.785 152.012 173.907 152.061 c 173.969 151.824 l 173.85 151.77 173.642 151.705 173.347 151.705 c 172.778 151.705 172.433 152.085 172.433 152.64 c 172.433 153.203 172.767 153.644 173.308 153.644 c 173.915 153.644 174.073 153.111 174.073 152.77 c 174.073 152.701 174.069 152.648 174.061 152.609 c 172.759 152.613 l f 174.495 153.019 m 174.495 153.238 174.491 153.425 174.479 153.598 c 174.775 153.598 l 174.791 153.234 l 174.802 153.234 l 174.887 153.483 175.094 153.64 175.321 153.64 c 175.355 153.64 175.382 153.636 175.413 153.629 c 175.413 153.314 l 175.374 153.318 175.34 153.322 175.294 153.322 c 175.056 153.322 174.887 153.142 174.84 152.893 c 174.833 152.843 174.829 152.79 174.829 152.732 c 174.829 151.743 l 174.491 151.743 l 174.495 153.019 l f 176.592 151.743 m 176.592 153.341 l 176.334 153.341 l 176.334 153.598 l 176.592 153.598 l 176.592 153.686 l 176.592 153.947 176.653 154.184 176.811 154.334 c 176.937 154.456 177.106 154.506 177.26 154.506 c 177.383 154.506 177.483 154.479 177.548 154.452 c 177.506 154.192 l 177.452 154.215 177.387 154.234 177.287 154.234 c 177.003 154.234 176.926 153.981 176.926 153.698 c 176.926 153.598 l 177.375 153.598 l 177.375 153.341 l 176.93 153.341 l 176.93 151.743 l 176.592 151.743 l f 178.404 151.954 m 178.727 151.954 178.969 152.257 178.969 152.678 c 178.969 152.993 178.812 153.387 178.412 153.387 c 178.017 153.387 177.844 153.019 177.844 152.667 c 177.844 152.261 178.074 151.954 178.401 151.954 c 178.404 151.954 l h 178.393 151.701 m 177.894 151.701 177.502 152.069 177.502 152.655 c 177.502 153.276 177.913 153.64 178.424 153.64 c 178.957 153.64 179.318 153.253 179.318 152.69 c 179.318 152 178.838 151.701 178.397 151.701 c 178.393 151.701 l f 179.749 153.019 m 179.749 153.238 179.745 153.425 179.733 153.598 c 180.029 153.598 l 180.044 153.234 l 180.056 153.234 l 180.14 153.483 180.348 153.64 180.574 153.64 c 180.609 153.64 180.636 153.636 180.666 153.629 c 180.666 153.314 l 180.628 153.318 180.593 153.322 180.547 153.322 c 180.309 153.322 180.14 153.142 180.094 152.893 c 180.087 152.843 180.083 152.79 180.083 152.732 c 180.083 151.743 l 179.745 151.743 l 179.749 153.019 l f 181.016 153.096 m 181.016 153.291 181.008 153.445 181.001 153.598 c 181.296 153.598 l 181.311 153.299 l 181.323 153.299 l 181.427 153.475 181.6 153.64 181.911 153.64 c 182.16 153.64 182.352 153.487 182.433 153.269 c 182.441 153.269 l 182.498 153.376 182.575 153.452 182.652 153.51 c 182.763 153.594 182.882 153.64 183.059 153.64 c 183.309 153.64 183.673 153.479 183.673 152.835 c 183.673 151.743 l 183.343 151.743 l 183.343 152.793 l 183.343 153.153 183.209 153.364 182.94 153.364 c 182.744 153.364 182.598 153.222 182.537 153.061 c 182.521 153.012 182.51 152.95 182.51 152.893 c 182.51 151.743 l 182.18 151.743 l 182.18 152.855 l 182.18 153.153 182.049 153.364 181.792 153.364 c 181.584 153.364 181.427 153.196 181.373 153.027 c 181.354 152.977 181.346 152.92 181.346 152.862 c 181.346 151.743 l 181.016 151.743 l 181.016 153.096 l f 185.371 152.487 m 185.371 152.445 185.375 152.403 185.382 152.364 c 185.448 152.13 185.647 151.969 185.889 151.969 c 186.246 151.969 186.454 152.257 186.454 152.682 c 186.454 153.058 186.262 153.376 185.901 153.376 c 185.67 153.376 185.455 153.215 185.39 152.962 c 185.378 152.92 185.371 152.874 185.371 152.82 c 185.371 152.487 l h 185.033 154.464 m 185.371 154.464 l 185.371 153.303 l 185.378 153.303 l 185.498 153.51 185.713 153.64 186.012 153.64 c 186.473 153.64 186.796 153.257 186.796 152.698 c 186.796 152.031 186.373 151.701 185.958 151.701 c 185.69 151.701 185.478 151.805 185.336 152.05 c 185.328 152.05 l 185.309 151.743 l 185.018 151.743 l 185.029 151.87 185.033 152.058 185.033 152.222 c 185.033 154.464 l f 188.401 152.855 m 188.405 153.065 188.313 153.403 187.936 153.403 c 187.59 153.403 187.444 153.088 187.418 152.855 c 188.401 152.855 l h 187.414 152.613 m 187.422 152.157 187.71 151.969 188.048 151.969 c 188.289 151.969 188.439 152.012 188.562 152.061 c 188.624 151.824 l 188.504 151.77 188.297 151.705 188.001 151.705 c 187.433 151.705 187.087 152.085 187.087 152.64 c 187.087 153.203 187.422 153.644 187.963 153.644 c 188.57 153.644 188.727 153.111 188.727 152.77 c 188.727 152.701 188.723 152.648 188.716 152.609 c 187.414 152.613 l f 189.146 154.464 0.338 -2.721 re f 190.813 151.954 m 191.135 151.954 191.377 152.257 191.377 152.678 c 191.377 152.993 191.22 153.387 190.82 153.387 c 190.425 153.387 190.252 153.019 190.252 152.667 c 190.252 152.261 190.482 151.954 190.809 151.954 c 190.813 151.954 l h 190.801 151.701 m 190.302 151.701 189.91 152.069 189.91 152.655 c 189.91 153.276 190.321 153.64 190.832 153.64 c 191.366 153.64 191.727 153.253 191.727 152.69 c 191.727 152 191.247 151.701 190.805 151.701 c 190.801 151.701 l f 192.26 153.598 m 192.51 152.659 l 192.56 152.452 192.61 152.257 192.645 152.065 c 192.656 152.065 l 192.698 152.253 192.76 152.452 192.821 152.655 c 193.125 153.598 l 193.409 153.598 l 193.697 152.671 l 193.766 152.452 193.82 152.253 193.862 152.065 c 193.873 152.065 l 193.904 152.253 193.954 152.448 194.016 152.667 c 194.281 153.598 l 194.615 153.598 l 194.016 151.743 l 193.708 151.743 l 193.424 152.629 l 193.359 152.839 193.305 153.023 193.259 153.242 c 193.251 153.242 l 193.205 153.019 193.148 152.824 193.082 152.625 c 192.783 151.743 l 192.475 151.743 l 191.915 153.598 l 192.26 153.598 l f 196.535 151.954 m 196.858 151.954 197.099 152.257 197.099 152.678 c 197.099 152.993 196.942 153.387 196.542 153.387 c 196.147 153.387 195.974 153.019 195.974 152.667 c 195.974 152.261 196.205 151.954 196.531 151.954 c 196.535 151.954 l h 196.523 151.701 m 196.024 151.701 195.632 152.069 195.632 152.655 c 195.632 153.276 196.043 153.64 196.554 153.64 c 197.088 153.64 197.449 153.253 197.449 152.69 c 197.449 152 196.969 151.701 196.527 151.701 c 196.523 151.701 l f 197.879 153.019 m 197.879 153.238 197.875 153.425 197.864 153.598 c 198.159 153.598 l 198.175 153.234 l 198.186 153.234 l 198.271 153.483 198.478 153.64 198.705 153.64 c 198.739 153.64 198.766 153.636 198.797 153.629 c 198.797 153.314 l 198.758 153.318 198.724 153.322 198.678 153.322 c 198.44 153.322 198.271 153.142 198.225 152.893 c 198.217 152.843 198.213 152.79 198.213 152.732 c 198.213 151.743 l 197.875 151.743 l 197.879 153.019 l f 201.27 151.809 m 201.182 151.766 200.986 151.701 200.736 151.701 c 200.175 151.701 199.811 152.08 199.811 152.651 c 199.811 153.222 200.202 153.64 200.809 153.64 c 201.009 153.64 201.185 153.59 201.278 153.54 c 201.201 153.284 l 201.12 153.326 200.994 153.372 200.809 153.372 c 200.383 153.372 200.153 153.054 200.153 152.667 c 200.153 152.238 200.429 151.973 200.798 151.973 c 200.99 151.973 201.116 152.019 201.212 152.061 c 201.27 151.809 l f 202.411 151.954 m 202.733 151.954 202.975 152.257 202.975 152.678 c 202.975 152.993 202.818 153.387 202.418 153.387 c 202.023 153.387 201.85 153.019 201.85 152.667 c 201.85 152.261 202.08 151.954 202.407 151.954 c 202.411 151.954 l h 202.399 151.701 m 201.9 151.701 201.508 152.069 201.508 152.655 c 201.508 153.276 201.919 153.64 202.43 153.64 c 202.964 153.64 203.324 153.253 203.324 152.69 c 203.324 152 202.844 151.701 202.403 151.701 c 202.399 151.701 l f 203.751 153.096 m 203.751 153.291 203.747 153.445 203.735 153.598 c 204.035 153.598 l 204.054 153.295 l 204.062 153.295 l 204.154 153.468 204.369 153.64 204.676 153.64 c 204.934 153.64 205.333 153.487 205.333 152.851 c 205.333 151.743 l 204.995 151.743 l 204.995 152.812 l 204.995 153.111 204.884 153.364 204.565 153.364 c 204.346 153.364 204.173 153.207 204.112 153.019 c 204.096 152.977 204.089 152.916 204.089 152.862 c 204.089 151.743 l 203.751 151.743 l 203.751 153.096 l f 206.274 154.042 m 206.274 153.598 l 206.758 153.598 l 206.758 153.341 l 206.274 153.341 l 206.274 152.341 l 206.274 152.111 206.339 151.981 206.528 151.981 c 206.62 151.981 206.674 151.988 206.723 152.004 c 206.739 151.747 l 206.674 151.724 206.57 151.701 206.439 151.701 c 206.282 151.701 206.155 151.755 206.074 151.843 c 205.982 151.946 205.944 152.111 205.944 152.33 c 205.944 153.341 l 205.656 153.341 l 205.656 153.598 l 205.944 153.598 l 205.944 153.939 l 206.274 154.042 l f 208.117 152.69 m 207.749 152.698 207.33 152.632 207.33 152.272 c 207.33 152.05 207.476 151.95 207.645 151.95 c 207.891 151.95 208.048 152.104 208.102 152.261 c 208.113 152.295 208.117 152.333 208.117 152.368 c 208.117 152.69 l h 208.448 152.188 m 208.448 152.027 208.455 151.87 208.474 151.743 c 208.171 151.743 l 208.14 151.977 l 208.129 151.977 l 208.029 151.832 207.826 151.701 207.561 151.701 c 207.184 151.701 206.992 151.966 206.992 152.234 c 206.992 152.682 207.391 152.927 208.11 152.924 c 208.11 152.962 l 208.11 153.115 208.068 153.395 207.687 153.391 c 207.511 153.391 207.33 153.341 207.2 153.253 c 207.123 153.479 l 207.276 153.575 207.503 153.64 207.737 153.64 c 208.309 153.64 208.448 153.253 208.448 152.882 c 208.448 152.188 l f 210.314 151.809 m 210.226 151.766 210.03 151.701 209.78 151.701 c 209.219 151.701 208.855 152.08 208.855 152.651 c 208.855 153.222 209.246 153.64 209.853 153.64 c 210.053 153.64 210.23 153.59 210.322 153.54 c 210.245 153.284 l 210.164 153.326 210.038 153.372 209.853 153.372 c 209.427 153.372 209.197 153.054 209.197 152.667 c 209.197 152.238 209.473 151.973 209.842 151.973 c 210.034 151.973 210.161 152.019 210.256 152.061 c 210.314 151.809 l f 211.167 154.042 m 211.167 153.598 l 211.65 153.598 l 211.65 153.341 l 211.167 153.341 l 211.167 152.341 l 211.167 152.111 211.232 151.981 211.42 151.981 c 211.512 151.981 211.566 151.988 211.616 152.004 c 211.631 151.747 l 211.566 151.724 211.462 151.701 211.332 151.701 c 211.174 151.701 211.048 151.755 210.967 151.843 c 210.875 151.946 210.836 152.111 210.836 152.33 c 210.836 153.341 l 210.548 153.341 l 210.548 153.598 l 210.836 153.598 l 210.836 153.939 l 211.167 154.042 l f 214.661 151.824 m 214.542 151.762 214.293 151.701 213.978 151.701 c 213.248 151.701 212.702 152.161 212.702 153.012 c 212.702 153.824 213.252 154.368 214.054 154.368 c 214.373 154.368 214.58 154.299 214.669 154.253 c 214.584 153.981 l 214.461 154.042 214.281 154.088 214.066 154.088 c 213.459 154.088 213.056 153.701 213.056 153.023 c 213.056 152.387 213.421 151.985 214.047 151.985 c 214.254 151.985 214.461 152.027 214.596 152.092 c 214.661 151.824 l f 215.061 154.464 m 215.399 154.464 l 215.399 153.307 l 215.406 153.307 l 215.46 153.403 215.545 153.491 215.648 153.544 c 215.748 153.606 215.867 153.64 215.994 153.64 c 216.244 153.64 216.643 153.487 216.643 152.847 c 216.643 151.743 l 216.305 151.743 l 216.305 152.809 l 216.305 153.111 216.194 153.361 215.875 153.361 c 215.656 153.361 215.487 153.207 215.422 153.023 c 215.403 152.977 215.399 152.927 215.399 152.862 c 215.399 151.743 l 215.061 151.743 l 215.061 154.464 l f 218.371 152.855 m 218.375 153.065 218.283 153.403 217.906 153.403 c 217.561 153.403 217.415 153.088 217.388 152.855 c 218.371 152.855 l h 217.384 152.613 m 217.392 152.157 217.68 151.969 218.018 151.969 c 218.26 151.969 218.409 152.012 218.532 152.061 c 218.594 151.824 l 218.475 151.77 218.267 151.705 217.972 151.705 c 217.403 151.705 217.058 152.085 217.058 152.64 c 217.058 153.203 217.392 153.644 217.933 153.644 c 218.54 153.644 218.697 153.111 218.697 152.77 c 218.697 152.701 218.694 152.648 218.686 152.609 c 217.384 152.613 l f 219.239 153.598 m 219.604 152.559 l 219.665 152.387 219.715 152.234 219.753 152.08 c 219.765 152.08 l 219.807 152.234 219.861 152.387 219.923 152.559 c 220.284 153.598 l 220.637 153.598 l 219.907 151.743 l 219.585 151.743 l 218.878 153.598 l 219.239 153.598 l f 220.959 153.019 m 220.959 153.238 220.955 153.425 220.944 153.598 c 221.24 153.598 l 221.255 153.234 l 221.266 153.234 l 221.351 153.483 221.558 153.64 221.785 153.64 c 221.82 153.64 221.846 153.636 221.877 153.629 c 221.877 153.314 l 221.839 153.318 221.804 153.322 221.758 153.322 c 221.52 153.322 221.351 153.142 221.305 152.893 c 221.297 152.843 221.293 152.79 221.293 152.732 c 221.293 151.743 l 220.955 151.743 l 220.959 153.019 l f 222.957 151.954 m 223.279 151.954 223.521 152.257 223.521 152.678 c 223.521 152.993 223.364 153.387 222.964 153.387 c 222.569 153.387 222.396 153.019 222.396 152.667 c 222.396 152.261 222.626 151.954 222.953 151.954 c 222.957 151.954 l h 222.945 151.701 m 222.446 151.701 222.054 152.069 222.054 152.655 c 222.054 153.276 222.465 153.64 222.976 153.64 c 223.509 153.64 223.87 153.253 223.87 152.69 c 223.87 152 223.39 151.701 222.949 151.701 c 222.945 151.701 l f 224.297 153.096 m 224.297 153.291 224.293 153.445 224.281 153.598 c 224.581 153.598 l 224.6 153.295 l 224.608 153.295 l 224.7 153.468 224.915 153.64 225.222 153.64 c 225.48 153.64 225.879 153.487 225.879 152.851 c 225.879 151.743 l 225.541 151.743 l 225.541 152.812 l 225.541 153.111 225.43 153.364 225.111 153.364 c 224.892 153.364 224.719 153.207 224.658 153.019 c 224.642 152.977 224.635 152.916 224.635 152.862 c 224.635 151.743 l 224.297 151.743 l 224.297 153.096 l f 227.588 153.05 m 227.661 153.031 227.757 153.023 227.865 153.023 c 228.272 153.023 228.513 153.222 228.513 153.571 c 228.513 153.916 228.272 154.081 227.903 154.081 c 227.757 154.081 227.646 154.066 227.588 154.054 c 227.588 153.05 l h 227.254 154.292 m 227.415 154.322 227.626 154.345 227.895 154.345 c 228.226 154.345 228.468 154.269 228.621 154.13 c 228.763 154.008 228.852 153.82 228.852 153.59 c 228.852 153.356 228.783 153.172 228.648 153.038 c 228.471 152.851 228.183 152.755 227.857 152.755 c 227.757 152.755 227.665 152.759 227.588 152.778 c 227.588 151.743 l 227.254 151.743 l 227.254 154.292 l f 230.783 152.249 m 230.783 152.058 230.787 151.889 230.798 151.743 c 230.499 151.743 l 230.48 152.046 l 230.472 152.046 l 230.387 151.897 230.188 151.701 229.857 151.701 c 229.565 151.701 229.216 151.866 229.216 152.514 c 229.216 153.598 l 229.554 153.598 l 229.554 152.575 l 229.554 152.222 229.665 151.981 229.969 151.981 c 230.195 151.981 230.353 152.138 230.414 152.291 c 230.433 152.337 230.445 152.399 230.445 152.464 c 230.445 153.598 l 230.783 153.598 l 230.783 152.249 l f 231.682 152.487 m 231.682 152.445 231.686 152.403 231.693 152.364 c 231.758 152.13 231.958 151.969 232.2 151.969 c 232.557 151.969 232.765 152.257 232.765 152.682 c 232.765 153.058 232.573 153.376 232.212 153.376 c 231.981 153.376 231.766 153.215 231.701 152.962 c 231.689 152.92 231.682 152.874 231.682 152.82 c 231.682 152.487 l h 231.344 154.464 m 231.682 154.464 l 231.682 153.303 l 231.689 153.303 l 231.809 153.51 232.024 153.64 232.323 153.64 c 232.784 153.64 233.106 153.257 233.106 152.698 c 233.106 152.031 232.684 151.701 232.269 151.701 c 232 151.701 231.789 151.805 231.647 152.05 c 231.639 152.05 l 231.62 151.743 l 231.328 151.743 l 231.34 151.87 231.344 152.058 231.344 152.222 c 231.344 154.464 l f 233.529 154.464 0.338 -2.721 re f 234.428 153.598 0.338 -1.854 re 234.589 153.939 m 234.462 153.939 234.378 154.039 234.378 154.158 c 234.378 154.276 234.466 154.372 234.597 154.372 c 234.727 154.372 234.812 154.276 234.812 154.158 c 234.812 154.039 234.727 153.939 234.593 153.939 c 234.589 153.939 l f 235.28 152.085 m 235.384 152.023 235.56 151.954 235.729 151.954 c 235.971 151.954 236.086 152.073 236.086 152.23 c 236.086 152.391 235.991 152.479 235.745 152.571 c 235.407 152.693 235.249 152.874 235.249 153.096 c 235.249 153.395 235.495 153.64 235.891 153.64 c 236.079 153.64 236.244 153.59 236.344 153.525 c 236.263 153.284 l 236.19 153.326 236.056 153.391 235.883 153.391 c 235.683 153.391 235.576 153.276 235.576 153.138 c 235.576 152.981 235.683 152.912 235.925 152.82 c 236.244 152.701 236.413 152.54 236.413 152.261 c 236.413 151.931 236.156 151.701 235.722 151.701 c 235.518 151.701 235.33 151.755 235.199 151.832 c 235.28 152.085 l f 236.847 154.464 m 237.185 154.464 l 237.185 153.307 l 237.193 153.307 l 237.246 153.403 237.331 153.491 237.434 153.544 c 237.534 153.606 237.654 153.64 237.78 153.64 c 238.03 153.64 238.429 153.487 238.429 152.847 c 238.429 151.743 l 238.091 151.743 l 238.091 152.809 l 238.091 153.111 237.98 153.361 237.661 153.361 c 237.442 153.361 237.273 153.207 237.208 153.023 c 237.189 152.977 237.185 152.927 237.185 152.862 c 237.185 151.743 l 236.847 151.743 l 236.847 154.464 l f 238.978 153.598 0.338 -1.854 re 239.14 153.939 m 239.013 153.939 238.928 154.039 238.928 154.158 c 238.928 154.276 239.017 154.372 239.147 154.372 c 239.278 154.372 239.362 154.276 239.362 154.158 c 239.362 154.039 239.278 153.939 239.143 153.939 c 239.14 153.939 l f 239.877 153.096 m 239.877 153.291 239.873 153.445 239.862 153.598 c 240.161 153.598 l 240.18 153.295 l 240.188 153.295 l 240.28 153.468 240.495 153.64 240.802 153.64 c 241.06 153.64 241.459 153.487 241.459 152.851 c 241.459 151.743 l 241.121 151.743 l 241.121 152.812 l 241.121 153.111 241.01 153.364 240.691 153.364 c 240.472 153.364 240.299 153.207 240.238 153.019 c 240.223 152.977 240.215 152.916 240.215 152.862 c 240.215 151.743 l 239.877 151.743 l 239.877 153.096 l f 243.26 152.87 m 243.26 152.924 243.257 152.973 243.241 153.019 c 243.18 153.219 243.018 153.38 242.769 153.38 c 242.446 153.38 242.216 153.108 242.216 152.674 c 242.216 152.314 242.404 152.008 242.765 152.008 c 242.976 152.008 243.164 152.138 243.233 152.356 c 243.253 152.41 243.26 152.475 243.26 152.537 c 243.26 152.87 l h 243.598 152.015 m 243.598 151.586 243.51 151.33 243.333 151.165 c 243.149 151 242.888 150.943 242.653 150.943 c 242.431 150.943 242.185 150.996 242.035 151.096 c 242.12 151.356 l 242.243 151.276 242.435 151.207 242.665 151.207 c 243.011 151.207 243.264 151.387 243.264 151.858 c 243.264 152.061 l 243.257 152.061 l 243.157 151.889 242.953 151.751 242.665 151.751 c 242.204 151.751 241.874 152.142 241.874 152.659 c 241.874 153.288 242.285 153.64 242.715 153.64 c 243.038 153.64 243.21 153.475 243.295 153.322 c 243.303 153.322 l 243.314 153.598 l 243.614 153.598 l 243.602 153.468 243.598 153.318 243.598 153.092 c 243.598 152.015 l f 245.948 152.69 m 245.58 152.698 245.161 152.632 245.161 152.272 c 245.161 152.05 245.307 151.95 245.476 151.95 c 245.722 151.95 245.879 152.104 245.933 152.261 c 245.945 152.295 245.948 152.333 245.948 152.368 c 245.948 152.69 l h 246.279 152.188 m 246.279 152.027 246.287 151.87 246.306 151.743 c 246.003 151.743 l 245.972 151.977 l 245.96 151.977 l 245.86 151.832 245.657 151.701 245.392 151.701 c 245.015 151.701 244.823 151.966 244.823 152.234 c 244.823 152.682 245.223 152.927 245.941 152.924 c 245.941 152.962 l 245.941 153.115 245.899 153.395 245.518 153.391 c 245.342 153.391 245.161 153.341 245.031 153.253 c 244.954 153.479 l 245.107 153.575 245.334 153.64 245.568 153.64 c 246.141 153.64 246.279 153.253 246.279 152.882 c 246.279 152.188 l f 247.212 154.042 m 247.212 153.598 l 247.696 153.598 l 247.696 153.341 l 247.212 153.341 l 247.212 152.341 l 247.212 152.111 247.277 151.981 247.466 151.981 c 247.558 151.981 247.612 151.988 247.661 152.004 c 247.677 151.747 l 247.612 151.724 247.508 151.701 247.377 151.701 c 247.22 151.701 247.093 151.755 247.013 151.843 c 246.92 151.946 246.882 152.111 246.882 152.33 c 246.882 153.341 l 246.594 153.341 l 246.594 153.598 l 246.882 153.598 l 246.882 153.939 l 247.212 154.042 l f 248.222 153.054 m 248.092 153.054 247.999 153.157 247.999 153.291 c 247.999 153.433 248.095 153.533 248.226 153.533 c 248.364 153.533 248.452 153.433 248.452 153.291 c 248.452 153.157 248.364 153.054 248.226 153.054 c 248.222 153.054 l h 248.218 151.701 m 248.088 151.701 247.996 151.805 247.996 151.939 c 247.996 152.08 248.092 152.18 248.222 152.18 c 248.36 152.18 248.449 152.08 248.449 151.939 c 248.449 151.805 248.36 151.701 248.222 151.701 c 248.218 151.701 l f 0 0 0 1 k 166.528 217.762 m 165.772 217.762 l 165.826 218.038 l 167.661 218.038 l 167.608 217.762 l 166.847 217.762 l 166.409 215.455 l 166.091 215.455 l 166.528 217.762 l f 167.439 215.455 m 167.957 218.176 l 168.276 218.176 l 168.046 216.984 l 168.053 216.984 l 168.211 217.21 168.437 217.352 168.718 217.352 c 168.929 217.352 169.178 217.225 169.178 216.854 c 169.178 216.758 169.167 216.635 169.148 216.544 c 168.94 215.455 l 168.622 215.455 l 168.829 216.528 l 168.84 216.593 168.852 216.681 168.852 216.785 c 168.852 216.953 168.771 217.087 168.564 217.087 c 168.318 217.087 168.007 216.8 167.93 216.386 c 167.758 215.455 l 167.439 215.455 l f 170.085 217.651 m 169.973 217.651 169.896 217.739 169.896 217.858 c 169.9 217.984 169.996 218.084 170.115 218.084 c 170.234 218.084 170.315 217.996 170.315 217.877 c 170.311 217.743 170.215 217.651 170.089 217.651 c 170.085 217.651 l h 169.489 215.455 m 169.843 217.31 l 170.162 217.31 l 169.808 215.455 l 169.489 215.455 l f 170.388 215.773 m 170.473 215.72 170.634 215.658 170.788 215.658 c 171.003 215.658 171.141 215.796 171.141 215.961 c 171.141 216.107 171.076 216.199 170.88 216.306 c 170.665 216.425 170.546 216.586 170.546 216.777 c 170.546 217.103 170.826 217.352 171.221 217.352 c 171.387 217.352 171.536 217.306 171.606 217.26 c 171.517 217.019 l 171.452 217.057 171.337 217.103 171.199 217.103 c 171.003 217.103 170.864 216.98 170.864 216.823 c 170.864 216.689 170.953 216.605 171.122 216.513 c 171.329 216.394 171.467 216.233 171.467 216.022 c 171.467 215.632 171.152 215.413 170.757 215.413 c 170.557 215.417 170.38 215.474 170.296 215.54 c 170.388 215.773 l f 173.771 216.869 m 173.771 217.019 173.656 217.103 173.487 217.103 c 173.184 217.103 172.957 216.808 172.88 216.517 c 173.38 216.509 173.771 216.578 173.771 216.865 c 173.771 216.869 l h 173.84 215.559 m 173.702 215.482 173.476 215.413 173.226 215.413 c 172.734 215.413 172.519 215.75 172.519 216.16 c 172.519 216.72 172.934 217.352 173.533 217.352 c 173.887 217.352 174.079 217.141 174.079 216.873 c 174.079 216.386 173.53 216.26 172.842 216.271 c 172.827 216.191 172.838 216.019 172.88 215.919 c 172.953 215.75 173.103 215.67 173.295 215.67 c 173.514 215.67 173.679 215.735 173.794 215.796 c 173.84 215.559 l f 174.712 217.31 m 174.893 216.907 l 174.946 216.785 174.981 216.693 175.016 216.609 c 175.027 216.609 l 175.1 216.708 175.142 216.773 175.231 216.888 c 175.572 217.31 l 175.941 217.31 l 175.158 216.406 l 175.596 215.455 l 175.25 215.455 l 175.062 215.873 l 175 216.011 174.973 216.084 174.931 216.206 c 174.92 216.206 l 174.866 216.114 174.808 216.03 174.727 215.919 c 174.351 215.455 l 173.983 215.455 l 174.797 216.409 l 174.367 217.31 l 174.712 217.31 l f 177.139 215.528 m 177.043 215.478 176.851 215.413 176.602 215.413 c 176.122 215.413 175.887 215.735 175.887 216.13 c 175.887 216.766 176.356 217.352 177.024 217.352 c 177.197 217.352 177.354 217.302 177.412 217.268 c 177.32 217.019 l 177.247 217.053 177.143 217.087 177.005 217.087 c 176.521 217.087 176.218 216.612 176.218 216.172 c 176.218 215.869 176.375 215.674 176.678 215.674 c 176.871 215.674 177.013 215.731 177.109 215.777 c 177.139 215.528 l f 178.084 217.651 m 177.973 217.651 177.896 217.739 177.896 217.858 c 177.9 217.984 177.996 218.084 178.115 218.084 c 178.234 218.084 178.315 217.996 178.315 217.877 c 178.311 217.743 178.215 217.651 178.088 217.651 c 178.084 217.651 l h 177.489 215.455 m 177.842 217.31 l 178.161 217.31 l 177.808 215.455 l 177.489 215.455 l f 179.19 217.754 m 179.106 217.31 l 179.551 217.31 l 179.501 217.061 l 179.056 217.061 l 178.887 216.156 l 178.864 216.053 178.848 215.957 178.848 215.861 c 178.848 215.75 178.902 215.681 179.025 215.681 c 179.082 215.681 179.132 215.685 179.175 215.697 c 179.159 215.448 l 179.102 215.425 179.006 215.413 178.914 215.413 c 178.633 215.413 178.522 215.582 178.522 215.773 c 178.522 215.881 178.537 215.988 178.564 216.122 c 178.745 217.061 l 178.48 217.061 l 178.526 217.31 l 178.791 217.31 l 178.856 217.651 l 179.19 217.754 l f 180.165 217.651 m 180.054 217.651 179.977 217.739 179.977 217.858 c 179.981 217.984 180.077 218.084 180.196 218.084 c 180.315 218.084 180.396 217.996 180.396 217.877 c 180.392 217.743 180.296 217.651 180.169 217.651 c 180.165 217.651 l h 179.57 215.455 m 179.924 217.31 l 180.242 217.31 l 179.889 215.455 l 179.57 215.455 l f 180.454 215.455 m 180.699 216.77 l 180.742 216.976 180.768 217.157 180.788 217.31 c 181.076 217.31 l 181.026 216.946 l 181.033 216.946 l 181.202 217.206 181.452 217.352 181.725 217.352 c 181.944 217.352 182.193 217.225 182.193 216.839 c 182.193 216.754 182.178 216.635 182.159 216.54 c 181.951 215.455 l 181.636 215.455 l 181.84 216.528 l 181.851 216.597 181.863 216.685 181.863 216.766 c 181.863 216.95 181.79 217.087 181.571 217.087 c 181.344 217.087 181.022 216.816 180.937 216.356 c 180.768 215.455 l 180.454 215.455 l f 183.948 217.034 m 183.887 217.065 183.772 217.099 183.641 217.099 c 183.176 217.099 182.854 216.612 182.854 216.153 c 182.85 215.946 182.927 215.708 183.211 215.708 c 183.484 215.708 183.76 216.053 183.829 216.417 c 183.948 217.034 l h 182.52 215.034 m 182.631 214.961 182.819 214.911 183.011 214.911 c 183.326 214.911 183.572 215.068 183.679 215.57 c 183.741 215.85 l 183.733 215.85 l 183.568 215.586 183.341 215.455 183.088 215.455 c 182.712 215.455 182.52 215.769 182.52 216.099 c 182.52 216.731 182.98 217.352 183.699 217.352 c 183.914 217.352 184.152 217.291 184.298 217.222 c 184.01 215.689 l 183.937 215.294 183.829 215.026 183.637 214.857 c 183.449 214.7 183.199 214.654 182.988 214.654 c 182.761 214.654 182.546 214.708 182.431 214.785 c 182.52 215.034 l f 185.215 215.455 m 185.461 216.77 l 185.503 216.976 185.53 217.157 185.55 217.31 c 185.838 217.31 l 185.788 216.946 l 185.795 216.946 l 185.964 217.206 186.214 217.352 186.487 217.352 c 186.705 217.352 186.955 217.225 186.955 216.839 c 186.955 216.754 186.94 216.635 186.921 216.54 c 186.713 215.455 l 186.398 215.455 l 186.602 216.528 l 186.613 216.597 186.625 216.685 186.625 216.766 c 186.625 216.95 186.552 217.087 186.333 217.087 c 186.106 217.087 185.784 216.816 185.699 216.356 c 185.53 215.455 l 185.215 215.455 l f 188.534 216.869 m 188.534 217.019 188.418 217.103 188.249 217.103 c 187.946 217.103 187.72 216.808 187.643 216.517 c 188.142 216.509 188.534 216.578 188.534 216.865 c 188.534 216.869 l h 188.603 215.559 m 188.464 215.482 188.238 215.413 187.988 215.413 c 187.497 215.413 187.282 215.75 187.282 216.16 c 187.282 216.72 187.696 217.352 188.296 217.352 c 188.649 217.352 188.841 217.141 188.841 216.873 c 188.841 216.386 188.292 216.26 187.604 216.271 c 187.589 216.191 187.6 216.019 187.643 215.919 c 187.716 215.75 187.865 215.67 188.057 215.67 c 188.276 215.67 188.441 215.735 188.557 215.796 c 188.603 215.559 l f 189.455 217.31 m 189.52 216.268 l 189.536 216.038 189.532 215.919 189.528 215.769 c 189.54 215.769 l 189.582 215.888 189.651 216.049 189.743 216.233 c 190.292 217.31 l 190.573 217.31 l 190.688 216.252 l 190.707 216.049 190.719 215.892 190.719 215.769 c 190.726 215.769 l 190.776 215.919 190.826 216.061 190.903 216.241 c 191.406 217.31 l 191.729 217.31 l 190.811 215.455 l 190.515 215.455 l 190.392 216.463 l 190.373 216.635 190.365 216.792 190.365 216.957 c 190.358 216.957 l 190.281 216.777 190.227 216.639 190.143 216.474 c 189.609 215.455 l 189.313 215.455 l 189.14 217.31 l 189.455 217.31 l f 193.215 215.666 m 193.591 215.666 193.875 216.149 193.875 216.582 c 193.875 216.796 193.776 217.099 193.442 217.099 c 193.042 217.099 192.777 216.612 192.777 216.187 c 192.777 215.884 192.946 215.666 193.211 215.666 c 193.215 215.666 l h 193.177 215.413 m 192.712 215.413 192.451 215.758 192.451 216.176 c 192.451 216.789 192.877 217.352 193.48 217.352 c 193.983 217.352 194.21 216.973 194.21 216.582 c 194.21 216.007 193.803 215.413 193.18 215.413 c 193.177 215.413 l f 194.478 215.455 m 194.782 217.061 l 194.536 217.061 l 194.582 217.31 l 194.832 217.31 l 194.847 217.409 l 194.893 217.666 194.985 217.904 195.15 218.053 c 195.27 218.16 195.431 218.218 195.592 218.218 c 195.723 218.218 195.803 218.195 195.849 218.168 c 195.78 217.915 l 195.73 217.938 195.665 217.95 195.592 217.95 c 195.339 217.95 195.216 217.704 195.162 217.398 c 195.147 217.31 l 195.561 217.31 l 195.511 217.061 l 195.1 217.061 l 194.797 215.455 l 194.478 215.455 l f 195.565 215.455 m 195.869 217.061 l 195.623 217.061 l 195.669 217.31 l 195.919 217.31 l 195.934 217.409 l 195.98 217.666 196.072 217.904 196.237 218.053 c 196.356 218.16 196.518 218.218 196.679 218.218 c 196.81 218.218 196.89 218.195 196.936 218.168 c 196.867 217.915 l 196.817 217.938 196.752 217.95 196.679 217.95 c 196.425 217.95 196.303 217.704 196.249 217.398 c 196.233 217.31 l 196.648 217.31 l 196.598 217.061 l 196.187 217.061 l 195.884 215.455 l 195.565 215.455 l f 197.873 216.869 m 197.873 217.019 197.758 217.103 197.589 217.103 c 197.286 217.103 197.059 216.808 196.982 216.517 c 197.481 216.509 197.873 216.578 197.873 216.865 c 197.873 216.869 l h 197.942 215.559 m 197.804 215.482 197.578 215.413 197.328 215.413 c 196.836 215.413 196.621 215.75 196.621 216.16 c 196.621 216.72 197.036 217.352 197.635 217.352 c 197.988 217.352 198.18 217.141 198.18 216.873 c 198.18 216.386 197.631 216.26 196.944 216.271 c 196.928 216.191 196.94 216.019 196.982 215.919 c 197.055 215.75 197.205 215.67 197.397 215.67 c 197.616 215.67 197.781 215.735 197.896 215.796 c 197.942 215.559 l f 198.342 215.455 m 198.568 216.651 l 198.615 216.892 198.641 217.137 198.661 217.31 c 198.941 217.31 l 198.929 217.179 198.914 217.053 198.891 216.907 c 198.902 216.907 l 199.025 217.16 199.221 217.352 199.471 217.352 c 199.502 217.352 199.536 217.348 199.563 217.344 c 199.502 217.03 l 199.478 217.034 199.448 217.038 199.413 217.038 c 199.141 217.038 198.895 216.704 198.814 216.275 c 198.661 215.455 l 198.342 215.455 l f 200.154 217.651 m 200.043 217.651 199.966 217.739 199.966 217.858 c 199.97 217.984 200.066 218.084 200.185 218.084 c 200.304 218.084 200.385 217.996 200.385 217.877 c 200.381 217.743 200.285 217.651 200.158 217.651 c 200.154 217.651 l h 199.559 215.455 m 199.912 217.31 l 200.231 217.31 l 199.878 215.455 l 199.559 215.455 l f 200.442 215.455 m 200.688 216.77 l 200.73 216.976 200.757 217.157 200.777 217.31 c 201.065 217.31 l 201.015 216.946 l 201.022 216.946 l 201.191 217.206 201.441 217.352 201.714 217.352 c 201.932 217.352 202.182 217.225 202.182 216.839 c 202.182 216.754 202.167 216.635 202.147 216.54 c 201.94 215.455 l 201.625 215.455 l 201.829 216.528 l 201.84 216.597 201.852 216.685 201.852 216.766 c 201.852 216.95 201.779 217.087 201.56 217.087 c 201.333 217.087 201.011 216.816 200.926 216.356 c 200.757 215.455 l 200.442 215.455 l f 203.937 217.034 m 203.876 217.065 203.76 217.099 203.63 217.099 c 203.165 217.099 202.843 216.612 202.843 216.153 c 202.839 215.946 202.916 215.708 203.2 215.708 c 203.473 215.708 203.749 216.053 203.818 216.417 c 203.937 217.034 l h 202.508 215.034 m 202.62 214.961 202.808 214.911 203 214.911 c 203.315 214.911 203.561 215.068 203.668 215.57 c 203.73 215.85 l 203.722 215.85 l 203.557 215.586 203.33 215.455 203.077 215.455 c 202.701 215.455 202.508 215.769 202.508 216.099 c 202.508 216.731 202.969 217.352 203.688 217.352 c 203.903 217.352 204.141 217.291 204.286 217.222 c 203.999 215.689 l 203.926 215.294 203.818 215.026 203.626 214.857 c 203.438 214.7 203.188 214.654 202.977 214.654 c 202.75 214.654 202.535 214.708 202.42 214.785 c 202.508 215.034 l f 205.247 215.455 m 205.55 217.061 l 205.304 217.061 l 205.35 217.31 l 205.6 217.31 l 205.615 217.409 l 205.662 217.666 205.753 217.904 205.919 218.053 c 206.038 218.16 206.199 218.218 206.36 218.218 c 206.491 218.218 206.572 218.195 206.618 218.168 c 206.549 217.915 l 206.499 217.938 206.434 217.95 206.36 217.95 c 206.107 217.95 205.984 217.704 205.93 217.398 c 205.915 217.31 l 206.33 217.31 l 206.28 217.061 l 205.869 217.061 l 205.565 215.455 l 205.247 215.455 l f 206.287 215.455 m 206.514 216.651 l 206.56 216.892 206.587 217.137 206.606 217.31 c 206.886 217.31 l 206.875 217.179 206.86 217.053 206.836 216.907 c 206.848 216.907 l 206.971 217.16 207.167 217.352 207.416 217.352 c 207.447 217.352 207.482 217.348 207.509 217.344 c 207.447 217.03 l 207.424 217.034 207.393 217.038 207.359 217.038 c 207.086 217.038 206.84 216.704 206.76 216.275 c 206.606 215.455 l 206.287 215.455 l f 208.277 215.666 m 208.653 215.666 208.937 216.149 208.937 216.582 c 208.937 216.796 208.838 217.099 208.503 217.099 c 208.104 217.099 207.839 216.612 207.839 216.187 c 207.839 215.884 208.008 215.666 208.273 215.666 c 208.277 215.666 l h 208.238 215.413 m 207.774 215.413 207.512 215.758 207.512 216.176 c 207.512 216.789 207.939 217.352 208.542 217.352 c 209.045 217.352 209.271 216.973 209.271 216.582 c 209.271 216.007 208.864 215.413 208.242 215.413 c 208.238 215.413 l f 209.494 215.455 m 209.744 216.77 l 209.782 216.976 209.809 217.157 209.828 217.31 c 210.108 217.31 l 210.059 216.961 l 210.07 216.961 l 210.243 217.222 210.477 217.352 210.723 217.352 c 211.007 217.352 211.142 217.172 211.157 216.938 c 211.322 217.206 211.56 217.348 211.837 217.352 c 212.052 217.352 212.29 217.214 212.29 216.865 c 212.29 216.781 212.279 216.655 212.259 216.551 c 212.052 215.455 l 211.741 215.455 l 211.94 216.524 l 211.956 216.593 211.967 216.689 211.967 216.766 c 211.967 216.961 211.894 217.087 211.687 217.087 c 211.457 217.087 211.18 216.819 211.103 216.406 c 210.927 215.455 l 210.619 215.455 l 210.827 216.544 l 210.842 216.628 210.85 216.697 210.85 216.77 c 210.85 216.927 210.807 217.087 210.573 217.087 c 210.339 217.087 210.051 216.781 209.978 216.386 c 209.805 215.455 l 209.494 215.455 l f 215.097 215.536 m 214.951 215.471 214.717 215.413 214.425 215.413 c 213.772 215.413 213.377 215.827 213.377 216.486 c 213.377 216.973 213.572 217.436 213.926 217.731 c 214.195 217.957 214.525 218.076 214.905 218.076 c 215.19 218.076 215.397 218.003 215.466 217.954 c 215.362 217.697 l 215.266 217.754 215.082 217.804 214.851 217.804 c 214.583 217.804 214.31 217.701 214.11 217.513 c 213.868 217.287 213.715 216.923 213.715 216.528 c 213.715 216.068 213.926 215.685 214.502 215.685 c 214.698 215.685 214.913 215.723 215.055 215.796 c 215.097 215.536 l f 215.424 215.455 m 215.942 218.176 l 216.261 218.176 l 216.03 216.984 l 216.038 216.984 l 216.196 217.21 216.422 217.352 216.702 217.352 c 216.914 217.352 217.163 217.225 217.163 216.854 c 217.163 216.758 217.152 216.635 217.133 216.544 c 216.925 215.455 l 216.607 215.455 l 216.814 216.528 l 216.825 216.593 216.837 216.681 216.837 216.785 c 216.837 216.953 216.756 217.087 216.549 217.087 c 216.303 217.087 215.992 216.8 215.915 216.386 c 215.742 215.455 l 215.424 215.455 l f 218.746 216.869 m 218.746 217.019 218.631 217.103 218.461 217.103 c 218.158 217.103 217.932 216.808 217.855 216.517 c 218.354 216.509 218.746 216.578 218.746 216.865 c 218.746 216.869 l h 218.815 215.559 m 218.676 215.482 218.45 215.413 218.2 215.413 c 217.709 215.413 217.494 215.75 217.494 216.16 c 217.494 216.72 217.909 217.352 218.507 217.352 c 218.861 217.352 219.053 217.141 219.053 216.873 c 219.053 216.386 218.504 216.26 217.816 216.271 c 217.801 216.191 217.812 216.019 217.855 215.919 c 217.928 215.75 218.077 215.67 218.269 215.67 c 218.488 215.67 218.654 215.735 218.769 215.796 c 218.815 215.559 l f 219.632 217.31 m 219.794 216.252 l 219.821 216.041 219.848 215.896 219.852 215.796 c 219.863 215.796 l 219.905 215.896 219.955 216.019 220.063 216.229 c 220.628 217.31 l 220.977 217.31 l 219.944 215.455 l 219.632 215.455 l 219.31 217.31 l 219.632 217.31 l f 220.965 215.455 m 221.192 216.651 l 221.238 216.892 221.265 217.137 221.284 217.31 c 221.564 217.31 l 221.553 217.179 221.537 217.053 221.514 216.907 c 221.526 216.907 l 221.649 217.16 221.845 217.352 222.094 217.352 c 222.125 217.352 222.16 217.348 222.187 217.344 c 222.125 217.03 l 222.102 217.034 222.071 217.038 222.036 217.038 c 221.764 217.038 221.518 216.704 221.438 216.275 c 221.284 215.455 l 220.965 215.455 l f 222.955 215.666 m 223.331 215.666 223.615 216.149 223.615 216.582 c 223.615 216.796 223.515 217.099 223.181 217.099 c 222.782 217.099 222.517 216.612 222.517 216.187 c 222.517 215.884 222.686 215.666 222.951 215.666 c 222.955 215.666 l h 222.916 215.413 m 222.452 215.413 222.19 215.758 222.19 216.176 c 222.19 216.789 222.617 217.352 223.22 217.352 c 223.723 217.352 223.949 216.973 223.949 216.582 c 223.949 216.007 223.542 215.413 222.92 215.413 c 222.916 215.413 l f 224.176 215.455 m 224.422 216.77 l 224.464 216.976 224.491 217.157 224.51 217.31 c 224.798 217.31 l 224.748 216.946 l 224.756 216.946 l 224.925 217.206 225.174 217.352 225.447 217.352 c 225.666 217.352 225.916 217.225 225.916 216.839 c 225.916 216.754 225.9 216.635 225.881 216.54 c 225.673 215.455 l 225.359 215.455 l 225.562 216.528 l 225.574 216.597 225.585 216.685 225.585 216.766 c 225.585 216.95 225.512 217.087 225.293 217.087 c 225.067 217.087 224.744 216.816 224.66 216.356 c 224.491 215.455 l 224.176 215.455 l f 227.494 216.758 m 227.586 216.739 227.659 216.735 227.751 216.735 c 228.189 216.735 228.481 217.003 228.481 217.367 c 228.481 217.674 228.262 217.796 227.966 217.796 c 227.84 217.796 227.743 217.785 227.686 217.77 c 227.494 216.758 l h 227.421 218 m 227.567 218.03 227.77 218.053 227.982 218.053 c 228.231 218.053 228.469 217.992 228.615 217.854 c 228.738 217.743 228.803 217.593 228.803 217.39 c 228.803 217.103 228.661 216.858 228.492 216.72 c 228.293 216.551 228.001 216.471 227.709 216.471 c 227.609 216.471 227.525 216.478 227.444 216.49 c 227.248 215.455 l 226.933 215.455 l 227.421 218 l f 230.635 217.31 m 230.382 215.995 l 230.343 215.789 230.316 215.609 230.301 215.455 c 230.013 215.455 l 230.063 215.804 l 230.055 215.804 l 229.886 215.563 229.645 215.413 229.399 215.413 c 229.161 215.413 228.907 215.528 228.907 215.949 c 228.907 216.038 228.919 216.141 228.942 216.264 c 229.145 217.31 l 229.46 217.31 l 229.264 216.275 l 229.245 216.172 229.234 216.084 229.234 216.003 c 229.234 215.812 229.31 215.681 229.529 215.681 c 229.764 215.681 230.059 215.953 230.136 216.36 c 230.316 217.31 l 230.635 217.31 l f 231.257 216.172 m 231.242 216.107 231.23 216.034 231.234 215.934 c 231.234 215.758 231.338 215.662 231.534 215.662 c 232.014 215.662 232.306 216.233 232.306 216.647 c 232.306 216.877 232.206 217.087 231.953 217.087 c 231.676 217.087 231.392 216.804 231.3 216.367 c 231.257 216.172 l h 231.661 218.176 m 231.415 216.973 l 231.423 216.973 l 231.588 217.222 231.826 217.352 232.075 217.352 c 232.482 217.352 232.636 217.015 232.636 216.685 c 232.636 216.114 232.225 215.413 231.48 215.413 c 231.154 215.413 230.908 215.547 230.908 215.888 c 230.908 215.98 230.923 216.091 230.942 216.179 c 231.342 218.176 l 231.661 218.176 l f 232.863 215.455 m 233.381 218.176 l 233.7 218.176 l 233.181 215.455 l 232.863 215.455 l f 234.333 217.651 m 234.222 217.651 234.145 217.739 234.145 217.858 c 234.149 217.984 234.245 218.084 234.364 218.084 c 234.483 218.084 234.564 217.996 234.564 217.877 c 234.56 217.743 234.464 217.651 234.337 217.651 c 234.333 217.651 l h 233.738 215.455 m 234.092 217.31 l 234.41 217.31 l 234.057 215.455 l 233.738 215.455 l f 234.637 215.773 m 234.721 215.72 234.883 215.658 235.036 215.658 c 235.251 215.658 235.389 215.796 235.389 215.961 c 235.389 216.107 235.324 216.199 235.128 216.306 c 234.913 216.425 234.794 216.586 234.794 216.777 c 234.794 217.103 235.074 217.352 235.47 217.352 c 235.635 217.352 235.785 217.306 235.854 217.26 c 235.766 217.019 l 235.7 217.057 235.585 217.103 235.447 217.103 c 235.251 217.103 235.113 216.98 235.113 216.823 c 235.113 216.689 235.201 216.605 235.37 216.513 c 235.578 216.394 235.716 216.233 235.716 216.022 c 235.716 215.632 235.401 215.413 235.005 215.413 c 234.806 215.417 234.629 215.474 234.545 215.54 c 234.637 215.773 l f 236.05 215.455 m 236.568 218.176 l 236.887 218.176 l 236.657 216.984 l 236.664 216.984 l 236.822 217.21 237.048 217.352 237.329 217.352 c 237.54 217.352 237.79 217.225 237.79 216.854 c 237.79 216.758 237.778 216.635 237.759 216.544 c 237.552 215.455 l 237.233 215.455 l 237.44 216.528 l 237.452 216.593 237.463 216.681 237.463 216.785 c 237.463 216.953 237.383 217.087 237.175 217.087 c 236.929 217.087 236.618 216.8 236.542 216.386 c 236.369 215.455 l 236.05 215.455 l f 238.696 217.651 m 238.585 217.651 238.508 217.739 238.508 217.858 c 238.512 217.984 238.608 218.084 238.727 218.084 c 238.846 218.084 238.926 217.996 238.926 217.877 c 238.923 217.743 238.826 217.651 238.7 217.651 c 238.696 217.651 l h 238.101 215.455 m 238.454 217.31 l 238.773 217.31 l 238.42 215.455 l 238.101 215.455 l f 238.984 215.455 m 239.23 216.77 l 239.272 216.976 239.299 217.157 239.318 217.31 c 239.606 217.31 l 239.556 216.946 l 239.564 216.946 l 239.733 217.206 239.983 217.352 240.255 217.352 c 240.474 217.352 240.724 217.225 240.724 216.839 c 240.724 216.754 240.709 216.635 240.689 216.54 c 240.482 215.455 l 240.167 215.455 l 240.37 216.528 l 240.382 216.597 240.393 216.685 240.393 216.766 c 240.393 216.95 240.321 217.087 240.102 217.087 c 239.875 217.087 239.552 216.816 239.468 216.356 c 239.299 215.455 l 238.984 215.455 l f 242.479 217.034 m 242.417 217.065 242.302 217.099 242.172 217.099 c 241.707 217.099 241.385 216.612 241.385 216.153 c 241.38 215.946 241.457 215.708 241.741 215.708 c 242.014 215.708 242.291 216.053 242.36 216.417 c 242.479 217.034 l h 241.05 215.034 m 241.162 214.961 241.35 214.911 241.542 214.911 c 241.857 214.911 242.102 215.068 242.21 215.57 c 242.271 215.85 l 242.264 215.85 l 242.099 215.586 241.872 215.455 241.619 215.455 c 241.242 215.455 241.05 215.769 241.05 216.099 c 241.05 216.731 241.511 217.352 242.229 217.352 c 242.444 217.352 242.682 217.291 242.828 217.222 c 242.54 215.689 l 242.467 215.294 242.36 215.026 242.168 214.857 c 241.98 214.7 241.73 214.654 241.519 214.654 c 241.292 214.654 241.077 214.708 240.962 214.785 c 241.05 215.034 l f 245.182 217.072 m 245.137 217.087 245.071 217.099 244.964 217.099 c 244.484 217.099 244.088 216.601 244.088 216.084 c 244.088 215.877 244.161 215.674 244.403 215.674 c 244.672 215.674 244.986 216.019 245.075 216.513 c 245.182 217.072 l h 244.979 215.455 m 244.979 215.566 244.998 215.743 245.021 215.934 c 245.013 215.934 l 244.81 215.547 244.553 215.413 244.291 215.413 c 243.961 215.413 243.758 215.674 243.758 216.026 c 243.758 216.674 244.234 217.352 245.04 217.352 c 245.217 217.352 245.413 217.321 245.54 217.283 c 245.352 216.314 l 245.29 215.992 245.267 215.662 245.275 215.455 c 244.979 215.455 l f 245.751 215.455 m 245.997 216.77 l 246.039 216.976 246.066 217.157 246.085 217.31 c 246.373 217.31 l 246.323 216.946 l 246.331 216.946 l 246.5 217.206 246.749 217.352 247.022 217.352 c 247.241 217.352 247.491 217.225 247.491 216.839 c 247.491 216.754 247.475 216.635 247.456 216.54 c 247.249 215.455 l 246.934 215.455 l 247.137 216.528 l 247.149 216.597 247.16 216.685 247.16 216.766 c 247.16 216.95 247.087 217.087 246.868 217.087 c 246.642 217.087 246.319 216.816 246.235 216.356 c 246.066 215.455 l 245.751 215.455 l f 249.238 217.019 m 249.176 217.065 249.069 217.099 248.934 217.099 c 248.489 217.099 248.143 216.624 248.143 216.13 c 248.143 215.907 248.22 215.674 248.493 215.674 c 248.739 215.674 249.034 215.953 249.115 216.371 c 249.238 217.019 l h 249.775 218.176 m 249.365 216.041 l 249.33 215.85 249.299 215.635 249.288 215.455 c 248.996 215.455 l 249.046 215.823 l 249.038 215.823 l 248.869 215.559 248.635 215.413 248.366 215.413 c 248.009 215.413 247.813 215.708 247.813 216.087 c 247.813 216.747 248.305 217.352 248.961 217.352 c 249.08 217.352 249.211 217.325 249.292 217.287 c 249.457 218.176 l 249.775 218.176 l f 252.014 216.67 m 251.073 216.67 l 250.897 215.727 l 251.957 215.727 l 251.903 215.455 l 250.524 215.455 l 251.016 218.038 l 252.337 218.038 l 252.283 217.766 l 251.285 217.766 l 251.127 216.938 l 252.068 216.938 l 252.014 216.67 l f 252.318 215.455 m 252.836 218.176 l 253.155 218.176 l 252.636 215.455 l 252.318 215.455 l f 254.464 216.869 m 254.464 217.019 254.349 217.103 254.18 217.103 c 253.877 217.103 253.65 216.808 253.574 216.517 c 254.073 216.509 254.464 216.578 254.464 216.865 c 254.464 216.869 l h 254.534 215.559 m 254.395 215.482 254.169 215.413 253.919 215.413 c 253.428 215.413 253.212 215.75 253.212 216.16 c 253.212 216.72 253.627 217.352 254.227 217.352 c 254.58 217.352 254.772 217.141 254.772 216.873 c 254.772 216.386 254.222 216.26 253.535 216.271 c 253.52 216.191 253.531 216.019 253.574 215.919 c 253.646 215.75 253.796 215.67 253.988 215.67 c 254.207 215.67 254.372 215.735 254.488 215.796 c 254.534 215.559 l f 256.373 217.072 m 256.327 217.087 256.262 217.099 256.154 217.099 c 255.674 217.099 255.279 216.601 255.279 216.084 c 255.279 215.877 255.351 215.674 255.594 215.674 c 255.862 215.674 256.177 216.019 256.266 216.513 c 256.373 217.072 l h 256.17 215.455 m 256.17 215.566 256.189 215.743 256.212 215.934 c 256.204 215.934 l 256 215.547 255.743 215.413 255.482 215.413 c 255.152 215.413 254.948 215.674 254.948 216.026 c 254.948 216.674 255.424 217.352 256.231 217.352 c 256.408 217.352 256.603 217.321 256.73 217.283 c 256.542 216.314 l 256.481 215.992 256.457 215.662 256.465 215.455 c 256.17 215.455 l f 256.938 215.455 m 257.164 216.651 l 257.211 216.892 257.237 217.137 257.257 217.31 c 257.537 217.31 l 257.525 217.179 257.51 217.053 257.487 216.907 c 257.498 216.907 l 257.621 217.16 257.817 217.352 258.067 217.352 c 258.098 217.352 258.132 217.348 258.159 217.344 c 258.098 217.03 l 258.074 217.034 258.044 217.038 258.009 217.038 c 257.737 217.038 257.491 216.704 257.41 216.275 c 257.257 215.455 l 256.938 215.455 l f 258.163 215.455 m 258.409 216.77 l 258.451 216.976 258.478 217.157 258.497 217.31 c 258.785 217.31 l 258.735 216.946 l 258.743 216.946 l 258.912 217.206 259.161 217.352 259.434 217.352 c 259.653 217.352 259.902 217.225 259.902 216.839 c 259.902 216.754 259.887 216.635 259.868 216.54 c 259.661 215.455 l 259.346 215.455 l 259.549 216.528 l 259.561 216.597 259.572 216.685 259.572 216.766 c 259.572 216.95 259.499 217.087 259.28 217.087 c 259.054 217.087 258.731 216.816 258.647 216.356 c 258.478 215.455 l 258.163 215.455 l f 261.212 217.624 m 261.204 217.624 l 260.778 217.409 l 260.743 217.662 l 261.308 217.946 l 261.581 217.946 l 261.104 215.455 l 260.797 215.455 l 261.212 217.624 l f 263.37 216.758 m 263.463 216.739 263.535 216.735 263.628 216.735 c 264.065 216.735 264.357 217.003 264.357 217.367 c 264.357 217.674 264.139 217.796 263.843 217.796 c 263.716 217.796 263.62 217.785 263.562 217.77 c 263.37 216.758 l h 263.298 218 m 263.443 218.03 263.647 218.053 263.858 218.053 c 264.108 218.053 264.346 217.992 264.492 217.854 c 264.615 217.743 264.68 217.593 264.68 217.39 c 264.68 217.103 264.538 216.858 264.369 216.72 c 264.169 216.551 263.877 216.471 263.585 216.471 c 263.486 216.471 263.401 216.478 263.32 216.49 c 263.125 215.455 l 262.81 215.455 l 263.298 218 l f 264.703 215.455 m 264.93 216.651 l 264.976 216.892 265.003 217.137 265.022 217.31 c 265.302 217.31 l 265.291 217.179 265.275 217.053 265.252 216.907 c 265.264 216.907 l 265.387 217.16 265.582 217.352 265.832 217.352 c 265.863 217.352 265.897 217.348 265.924 217.344 c 265.863 217.03 l 265.84 217.034 265.809 217.038 265.774 217.038 c 265.502 217.038 265.256 216.704 265.176 216.275 c 265.022 215.455 l 264.703 215.455 l f 266.692 215.666 m 267.069 215.666 267.353 216.149 267.353 216.582 c 267.353 216.796 267.253 217.099 266.919 217.099 c 266.519 217.099 266.254 216.612 266.254 216.187 c 266.254 215.884 266.423 215.666 266.689 215.666 c 266.692 215.666 l h 266.654 215.413 m 266.189 215.413 265.928 215.758 265.928 216.176 c 265.928 216.789 266.354 217.352 266.957 217.352 c 267.46 217.352 267.687 216.973 267.687 216.582 c 267.687 216.007 267.28 215.413 266.658 215.413 c 266.654 215.413 l f 269.361 217.019 m 269.3 217.065 269.192 217.099 269.058 217.099 c 268.612 217.099 268.267 216.624 268.267 216.13 c 268.267 215.907 268.344 215.674 268.616 215.674 c 268.862 215.674 269.158 215.953 269.238 216.371 c 269.361 217.019 l h 269.899 218.176 m 269.488 216.041 l 269.454 215.85 269.423 215.635 269.411 215.455 c 269.119 215.455 l 269.169 215.823 l 269.162 215.823 l 268.993 215.559 268.758 215.413 268.49 215.413 c 268.132 215.413 267.936 215.708 267.936 216.087 c 267.936 216.747 268.428 217.352 269.085 217.352 c 269.204 217.352 269.334 217.325 269.415 217.287 c 269.58 218.176 l 269.899 218.176 l f 271.754 217.31 m 271.5 215.995 l 271.462 215.789 271.435 215.609 271.42 215.455 c 271.132 215.455 l 271.182 215.804 l 271.174 215.804 l 271.005 215.563 270.763 215.413 270.517 215.413 c 270.279 215.413 270.026 215.528 270.026 215.949 c 270.026 216.038 270.037 216.141 270.06 216.264 c 270.264 217.31 l 270.579 217.31 l 270.383 216.275 l 270.364 216.172 270.352 216.084 270.352 216.003 c 270.352 215.812 270.429 215.681 270.648 215.681 c 270.882 215.681 271.178 215.953 271.255 216.36 c 271.435 217.31 l 271.754 217.31 l f 273.232 215.528 m 273.136 215.478 272.944 215.413 272.694 215.413 c 272.214 215.413 271.98 215.735 271.98 216.13 c 271.98 216.766 272.449 217.352 273.117 217.352 c 273.29 217.352 273.447 217.302 273.505 217.268 c 273.413 217.019 l 273.34 217.053 273.236 217.087 273.098 217.087 c 272.614 217.087 272.311 216.612 272.311 216.172 c 272.311 215.869 272.468 215.674 272.771 215.674 c 272.964 215.674 273.105 215.731 273.201 215.777 c 273.232 215.528 l f 274.427 217.754 m 274.342 217.31 l 274.788 217.31 l 274.738 217.061 l 274.292 217.061 l 274.123 216.156 l 274.1 216.053 274.085 215.957 274.085 215.861 c 274.085 215.75 274.138 215.681 274.261 215.681 c 274.319 215.681 274.369 215.685 274.411 215.697 c 274.396 215.448 l 274.338 215.425 274.242 215.413 274.15 215.413 c 273.87 215.413 273.758 215.582 273.758 215.773 c 273.758 215.881 273.774 215.988 273.801 216.122 c 273.981 217.061 l 273.716 217.061 l 273.762 217.31 l 274.027 217.31 l 274.092 217.651 l 274.427 217.754 l f 275.402 217.651 m 275.29 217.651 275.214 217.739 275.214 217.858 c 275.218 217.984 275.314 218.084 275.433 218.084 c 275.552 218.084 275.632 217.996 275.632 217.877 c 275.629 217.743 275.532 217.651 275.406 217.651 c 275.402 217.651 l h 274.807 215.455 m 275.16 217.31 l 275.479 217.31 l 275.125 215.455 l 274.807 215.455 l f 276.473 215.666 m 276.85 215.666 277.134 216.149 277.134 216.582 c 277.134 216.796 277.034 217.099 276.7 217.099 c 276.301 217.099 276.035 216.612 276.035 216.187 c 276.035 215.884 276.205 215.666 276.47 215.666 c 276.473 215.666 l h 276.435 215.413 m 275.97 215.413 275.709 215.758 275.709 216.176 c 275.709 216.789 276.135 217.352 276.738 217.352 c 277.242 217.352 277.468 216.973 277.468 216.582 c 277.468 216.007 277.061 215.413 276.439 215.413 c 276.435 215.413 l f 277.694 215.455 m 277.94 216.77 l 277.983 216.976 278.009 217.157 278.029 217.31 c 278.317 217.31 l 278.267 216.946 l 278.274 216.946 l 278.444 217.206 278.693 217.352 278.966 217.352 c 279.185 217.352 279.434 217.225 279.434 216.839 c 279.434 216.754 279.419 216.635 279.4 216.54 c 279.192 215.455 l 278.877 215.455 l 279.081 216.528 l 279.092 216.597 279.104 216.685 279.104 216.766 c 279.104 216.95 279.031 217.087 278.812 217.087 c 278.585 217.087 278.263 216.816 278.179 216.356 c 278.009 215.455 l 277.694 215.455 l f 279.761 215.773 m 279.845 215.72 280.007 215.658 280.16 215.658 c 280.375 215.658 280.513 215.796 280.513 215.961 c 280.513 216.107 280.448 216.199 280.252 216.306 c 280.037 216.425 279.918 216.586 279.918 216.777 c 279.918 217.103 280.198 217.352 280.594 217.352 c 280.759 217.352 280.909 217.306 280.978 217.26 c 280.89 217.019 l 280.824 217.057 280.709 217.103 280.571 217.103 c 280.375 217.103 280.237 216.98 280.237 216.823 c 280.237 216.689 280.325 216.605 280.494 216.513 c 280.702 216.394 280.84 216.233 280.84 216.022 c 280.84 215.632 280.525 215.413 280.129 215.413 c 279.93 215.417 279.753 215.474 279.669 215.54 c 279.761 215.773 l f 281.32 215.413 m 281.193 215.413 281.109 215.513 281.109 215.639 c 281.109 215.781 281.209 215.896 281.351 215.896 c 281.481 215.896 281.566 215.796 281.566 215.666 c 281.566 215.524 281.466 215.413 281.324 215.413 c 281.32 215.413 l f 167.039 211.926 m 166.936 212.673 l 166.924 212.808 166.905 212.999 166.893 213.149 c 166.882 213.149 l 166.813 212.995 166.747 212.834 166.671 212.677 c 166.287 211.926 l 167.039 211.926 l h 166.167 211.673 m 165.757 210.857 l 165.422 210.857 l 166.759 213.44 l 167.135 213.44 l 167.492 210.857 l 167.166 210.857 l 167.062 211.673 l 166.167 211.673 l f 167.823 210.857 m 168.068 212.172 l 168.111 212.378 168.138 212.559 168.157 212.712 c 168.445 212.712 l 168.395 212.348 l 168.403 212.348 l 168.572 212.608 168.821 212.754 169.094 212.754 c 169.313 212.754 169.562 212.627 169.562 212.241 c 169.562 212.156 169.547 212.037 169.528 211.942 c 169.32 210.857 l 169.005 210.857 l 169.209 211.93 l 169.22 211.999 169.232 212.087 169.232 212.168 c 169.232 212.352 169.159 212.49 168.94 212.49 c 168.714 212.49 168.391 212.218 168.306 211.758 c 168.138 210.857 l 167.823 210.857 l f 171.84 212.271 m 171.84 212.421 171.725 212.505 171.555 212.505 c 171.252 212.505 171.026 212.21 170.949 211.919 c 171.448 211.911 171.84 211.98 171.84 212.267 c 171.84 212.271 l h 171.909 210.961 m 171.77 210.884 171.544 210.815 171.294 210.815 c 170.803 210.815 170.588 211.152 170.588 211.562 c 170.588 212.122 171.002 212.754 171.602 212.754 c 171.955 212.754 172.147 212.543 172.147 212.275 c 172.147 211.788 171.598 211.662 170.91 211.673 c 170.895 211.593 170.906 211.421 170.949 211.321 c 171.022 211.152 171.171 211.072 171.363 211.072 c 171.582 211.072 171.747 211.137 171.863 211.198 c 171.909 210.961 l f 172.781 212.712 m 172.961 212.309 l 173.015 212.187 173.049 212.095 173.084 212.011 c 173.095 212.011 l 173.168 212.11 173.211 212.175 173.299 212.29 c 173.641 212.712 l 174.009 212.712 l 173.226 211.808 l 173.664 210.857 l 173.318 210.857 l 173.13 211.275 l 173.069 211.413 173.042 211.486 172.999 211.608 c 172.988 211.608 l 172.934 211.516 172.877 211.432 172.796 211.321 c 172.42 210.857 l 172.051 210.857 l 172.865 211.811 l 172.435 212.712 l 172.781 212.712 l f 175.208 210.93 m 175.112 210.88 174.92 210.815 174.67 210.815 c 174.19 210.815 173.956 211.137 173.956 211.532 c 173.956 212.168 174.424 212.754 175.093 212.754 c 175.265 212.754 175.423 212.704 175.48 212.67 c 175.388 212.421 l 175.315 212.455 175.212 212.49 175.073 212.49 c 174.59 212.49 174.286 212.014 174.286 211.574 c 174.286 211.271 174.444 211.076 174.747 211.076 c 174.939 211.076 175.081 211.133 175.177 211.179 c 175.208 210.93 l f 176.79 212.271 m 176.79 212.421 176.675 212.505 176.506 212.505 c 176.202 212.505 175.976 212.21 175.899 211.919 c 176.398 211.911 176.79 211.98 176.79 212.267 c 176.79 212.271 l h 176.859 210.961 m 176.721 210.884 176.494 210.815 176.245 210.815 c 175.753 210.815 175.538 211.152 175.538 211.562 c 175.538 212.122 175.953 212.754 176.552 212.754 c 176.905 212.754 177.097 212.543 177.097 212.275 c 177.097 211.788 176.548 211.662 175.86 211.673 c 175.845 211.593 175.857 211.421 175.899 211.321 c 175.972 211.152 176.122 211.072 176.314 211.072 c 176.533 211.072 176.698 211.137 176.813 211.198 c 176.859 210.961 l f 177.262 210.857 m 177.781 213.578 l 178.099 213.578 l 177.581 210.857 l 177.262 210.857 l f 178.142 210.857 m 178.66 213.578 l 178.979 213.578 l 178.461 210.857 l 178.142 210.857 l f 180.288 212.271 m 180.288 212.421 180.173 212.505 180.004 212.505 c 179.701 212.505 179.474 212.21 179.397 211.919 c 179.897 211.911 180.288 211.98 180.288 212.267 c 180.288 212.271 l h 180.357 210.961 m 180.219 210.884 179.993 210.815 179.743 210.815 c 179.251 210.815 179.036 211.152 179.036 211.562 c 179.036 212.122 179.451 212.754 180.05 212.754 c 180.404 212.754 180.596 212.543 180.596 212.275 c 180.596 211.788 180.046 211.662 179.359 211.673 c 179.344 211.593 179.355 211.421 179.397 211.321 c 179.47 211.152 179.62 211.072 179.812 211.072 c 180.031 211.072 180.196 211.137 180.311 211.198 c 180.357 210.961 l f 180.761 210.857 m 181.007 212.172 l 181.049 212.378 181.076 212.559 181.095 212.712 c 181.383 212.712 l 181.333 212.348 l 181.341 212.348 l 181.51 212.608 181.759 212.754 182.032 212.754 c 182.251 212.754 182.501 212.627 182.501 212.241 c 182.501 212.156 182.485 212.037 182.466 211.942 c 182.258 210.857 l 181.944 210.857 l 182.147 211.93 l 182.159 211.999 182.17 212.087 182.17 212.168 c 182.17 212.352 182.097 212.49 181.878 212.49 c 181.652 212.49 181.329 212.218 181.245 211.758 c 181.076 210.857 l 180.761 210.857 l f 183.629 213.156 m 183.545 212.712 l 183.991 212.712 l 183.941 212.463 l 183.495 212.463 l 183.326 211.558 l 183.303 211.455 183.288 211.359 183.288 211.263 c 183.288 211.152 183.341 211.083 183.464 211.083 c 183.522 211.083 183.572 211.087 183.614 211.099 c 183.599 210.85 l 183.541 210.827 183.445 210.815 183.353 210.815 c 183.073 210.815 182.961 210.984 182.961 211.175 c 182.961 211.283 182.977 211.39 183.004 211.524 c 183.184 212.463 l 182.919 212.463 l 182.965 212.712 l 183.23 212.712 l 183.295 213.053 l 183.629 213.156 l f 184.709 210.857 m 184.935 212.053 l 184.981 212.294 185.008 212.539 185.027 212.712 c 185.308 212.712 l 185.296 212.581 185.281 212.455 185.258 212.309 c 185.269 212.309 l 185.392 212.562 185.588 212.754 185.838 212.754 c 185.868 212.754 185.903 212.75 185.93 212.746 c 185.868 212.432 l 185.845 212.436 185.815 212.44 185.78 212.44 c 185.507 212.44 185.262 212.106 185.181 211.677 c 185.027 210.857 l 184.709 210.857 l f 187.182 212.271 m 187.182 212.421 187.067 212.505 186.898 212.505 c 186.594 212.505 186.368 212.21 186.291 211.919 c 186.79 211.911 187.182 211.98 187.182 212.267 c 187.182 212.271 l h 187.251 210.961 m 187.113 210.884 186.886 210.815 186.636 210.815 c 186.145 210.815 185.93 211.152 185.93 211.562 c 185.93 212.122 186.345 212.754 186.944 212.754 c 187.297 212.754 187.489 212.543 187.489 212.275 c 187.489 211.788 186.94 211.662 186.252 211.673 c 186.237 211.593 186.249 211.421 186.291 211.321 c 186.364 211.152 186.514 211.072 186.705 211.072 c 186.924 211.072 187.09 211.137 187.205 211.198 c 187.251 210.961 l f 187.67 211.175 m 187.754 211.122 187.915 211.06 188.069 211.06 c 188.284 211.06 188.422 211.198 188.422 211.363 c 188.422 211.509 188.357 211.601 188.161 211.708 c 187.946 211.827 187.827 211.988 187.827 212.179 c 187.827 212.505 188.107 212.754 188.503 212.754 c 188.668 212.754 188.818 212.708 188.887 212.662 c 188.799 212.421 l 188.733 212.459 188.618 212.505 188.48 212.505 c 188.284 212.505 188.146 212.382 188.146 212.225 c 188.146 212.091 188.234 212.007 188.403 211.915 c 188.61 211.796 188.749 211.635 188.749 211.424 c 188.749 211.034 188.434 210.815 188.038 210.815 c 187.838 210.819 187.662 210.876 187.577 210.942 c 187.67 211.175 l f 189.87 211.068 m 190.246 211.068 190.53 211.551 190.53 211.984 c 190.53 212.198 190.431 212.501 190.096 212.501 c 189.697 212.501 189.432 212.014 189.432 211.589 c 189.432 211.286 189.601 211.068 189.866 211.068 c 189.87 211.068 l h 189.831 210.815 m 189.367 210.815 189.106 211.16 189.106 211.578 c 189.106 212.191 189.532 212.754 190.135 212.754 c 190.638 212.754 190.865 212.375 190.865 211.984 c 190.865 211.409 190.457 210.815 189.835 210.815 c 189.831 210.815 l f 192.904 212.712 m 192.651 211.397 l 192.612 211.191 192.585 211.011 192.57 210.857 c 192.282 210.857 l 192.332 211.206 l 192.324 211.206 l 192.155 210.965 191.913 210.815 191.667 210.815 c 191.429 210.815 191.176 210.93 191.176 211.352 c 191.176 211.44 191.187 211.543 191.21 211.666 c 191.414 212.712 l 191.729 212.712 l 191.533 211.677 l 191.514 211.574 191.502 211.486 191.502 211.405 c 191.502 211.214 191.579 211.083 191.798 211.083 c 192.032 211.083 192.328 211.355 192.405 211.762 c 192.585 212.712 l 192.904 212.712 l f 193.107 210.857 m 193.334 212.053 l 193.38 212.294 193.407 212.539 193.426 212.712 c 193.707 212.712 l 193.695 212.581 193.68 212.455 193.657 212.309 c 193.668 212.309 l 193.791 212.562 193.987 212.754 194.237 212.754 c 194.267 212.754 194.302 212.75 194.329 212.746 c 194.267 212.432 l 194.244 212.436 194.214 212.44 194.179 212.44 c 193.906 212.44 193.66 212.106 193.58 211.677 c 193.426 210.857 l 193.107 210.857 l f 195.581 210.93 m 195.485 210.88 195.293 210.815 195.043 210.815 c 194.563 210.815 194.329 211.137 194.329 211.532 c 194.329 212.168 194.797 212.754 195.465 212.754 c 195.638 212.754 195.796 212.704 195.853 212.67 c 195.761 212.421 l 195.688 212.455 195.584 212.49 195.446 212.49 c 194.962 212.49 194.659 212.014 194.659 211.574 c 194.659 211.271 194.816 211.076 195.12 211.076 c 195.312 211.076 195.454 211.133 195.55 211.179 c 195.581 210.93 l f 197.163 212.271 m 197.163 212.421 197.048 212.505 196.879 212.505 c 196.575 212.505 196.349 212.21 196.272 211.919 c 196.771 211.911 197.163 211.98 197.163 212.267 c 197.163 212.271 l h 197.232 210.961 m 197.094 210.884 196.867 210.815 196.618 210.815 c 196.126 210.815 195.911 211.152 195.911 211.562 c 195.911 212.122 196.326 212.754 196.925 212.754 c 197.278 212.754 197.47 212.543 197.47 212.275 c 197.47 211.788 196.921 211.662 196.233 211.673 c 196.218 211.593 196.23 211.421 196.272 211.321 c 196.345 211.152 196.495 211.072 196.687 211.072 c 196.906 211.072 197.071 211.137 197.186 211.198 c 197.232 210.961 l f 199.152 213.156 m 199.068 212.712 l 199.513 212.712 l 199.463 212.463 l 199.018 212.463 l 198.849 211.558 l 198.826 211.455 198.81 211.359 198.81 211.263 c 198.81 211.152 198.864 211.083 198.987 211.083 c 199.045 211.083 199.095 211.087 199.137 211.099 c 199.122 210.85 l 199.064 210.827 198.968 210.815 198.876 210.815 c 198.595 210.815 198.484 210.984 198.484 211.175 c 198.484 211.283 198.499 211.39 198.526 211.524 c 198.706 212.463 l 198.441 212.463 l 198.488 212.712 l 198.753 212.712 l 198.818 213.053 l 199.152 213.156 l f 199.532 210.857 m 200.051 213.578 l 200.369 213.578 l 200.139 212.386 l 200.147 212.386 l 200.304 212.612 200.531 212.754 200.811 212.754 c 201.022 212.754 201.272 212.627 201.272 212.256 c 201.272 212.16 201.26 212.037 201.241 211.946 c 201.034 210.857 l 200.715 210.857 l 200.922 211.93 l 200.934 211.995 200.945 212.083 200.945 212.187 c 200.945 212.355 200.865 212.49 200.657 212.49 c 200.412 212.49 200.1 212.202 200.024 211.788 c 199.851 210.857 l 199.532 210.857 l f 203.023 212.474 m 202.977 212.49 202.912 212.501 202.804 212.501 c 202.324 212.501 201.929 212.003 201.929 211.486 c 201.929 211.279 202.002 211.076 202.244 211.076 c 202.513 211.076 202.828 211.421 202.916 211.915 c 203.023 212.474 l h 202.82 210.857 m 202.82 210.968 202.839 211.145 202.862 211.336 c 202.854 211.336 l 202.651 210.949 202.393 210.815 202.132 210.815 c 201.802 210.815 201.598 211.076 201.598 211.428 c 201.598 212.076 202.075 212.754 202.881 212.754 c 203.058 212.754 203.254 212.723 203.38 212.685 c 203.192 211.716 l 203.131 211.394 203.108 211.064 203.115 210.857 c 202.82 210.857 l f 204.41 213.156 m 204.325 212.712 l 204.771 212.712 l 204.721 212.463 l 204.275 212.463 l 204.106 211.558 l 204.083 211.455 204.068 211.359 204.068 211.263 c 204.068 211.152 204.121 211.083 204.245 211.083 c 204.302 211.083 204.352 211.087 204.394 211.099 c 204.379 210.85 l 204.321 210.827 204.225 210.815 204.133 210.815 c 203.853 210.815 203.741 210.984 203.741 211.175 c 203.741 211.283 203.756 211.39 203.784 211.524 c 203.964 212.463 l 203.699 212.463 l 203.745 212.712 l 204.01 212.712 l 204.075 213.053 l 204.41 213.156 l f 206.084 213.053 m 205.973 213.053 205.896 213.141 205.896 213.26 c 205.9 213.386 205.995 213.486 206.115 213.486 c 206.234 213.486 206.314 213.398 206.314 213.279 c 206.31 213.145 206.214 213.053 206.088 213.053 c 206.084 213.053 l h 205.488 210.857 m 205.842 212.712 l 206.161 212.712 l 205.807 210.857 l 205.488 210.857 l f 206.387 211.175 m 206.472 211.122 206.633 211.06 206.787 211.06 c 207.002 211.06 207.14 211.198 207.14 211.363 c 207.14 211.509 207.075 211.601 206.879 211.708 c 206.664 211.827 206.545 211.988 206.545 212.179 c 206.545 212.505 206.825 212.754 207.221 212.754 c 207.386 212.754 207.536 212.708 207.605 212.662 c 207.516 212.421 l 207.451 212.459 207.336 212.505 207.197 212.505 c 207.002 212.505 206.863 212.382 206.863 212.225 c 206.863 212.091 206.952 212.007 207.121 211.915 c 207.328 211.796 207.466 211.635 207.466 211.424 c 207.466 211.034 207.151 210.815 206.756 210.815 c 206.556 210.819 206.379 210.876 206.295 210.942 c 206.387 211.175 l f 208.914 212.712 m 209.075 211.654 l 209.102 211.443 209.129 211.298 209.133 211.198 c 209.144 211.198 l 209.187 211.298 209.237 211.421 209.344 211.631 c 209.909 212.712 l 210.258 212.712 l 209.225 210.857 l 208.914 210.857 l 208.591 212.712 l 208.914 212.712 l f 211.468 212.271 m 211.468 212.421 211.353 212.505 211.184 212.505 c 210.88 212.505 210.654 212.21 210.577 211.919 c 211.076 211.911 211.468 211.98 211.468 212.267 c 211.468 212.271 l h 211.537 210.961 m 211.399 210.884 211.172 210.815 210.923 210.815 c 210.431 210.815 210.216 211.152 210.216 211.562 c 210.216 212.122 210.631 212.754 211.23 212.754 c 211.583 212.754 211.775 212.543 211.775 212.275 c 211.775 211.788 211.226 211.662 210.538 211.673 c 210.523 211.593 210.535 211.421 210.577 211.321 c 210.65 211.152 210.8 211.072 210.992 211.072 c 211.211 211.072 211.376 211.137 211.491 211.198 c 211.537 210.961 l f 211.937 210.857 m 212.163 212.053 l 212.209 212.294 212.236 212.539 212.255 212.712 c 212.535 212.712 l 212.524 212.581 212.509 212.455 212.486 212.309 c 212.497 212.309 l 212.62 212.562 212.816 212.754 213.066 212.754 c 213.096 212.754 213.131 212.75 213.158 212.746 c 213.096 212.432 l 213.073 212.436 213.042 212.44 213.008 212.44 c 212.736 212.44 212.49 212.106 212.409 211.677 c 212.255 210.857 l 211.937 210.857 l f 213.661 212.712 m 213.845 211.716 l 213.888 211.501 213.911 211.363 213.93 211.225 c 213.938 211.225 l 213.987 211.344 214.041 211.474 214.137 211.681 c 214.613 212.712 l 214.951 212.712 l 214.252 211.302 l 214.053 210.899 213.864 210.574 213.611 210.325 c 213.404 210.118 213.177 210.03 213.073 210.007 c 212.992 210.279 l 213.073 210.309 213.207 210.359 213.334 210.459 c 213.461 210.554 213.596 210.704 213.695 210.888 c 213.711 210.915 213.711 210.938 213.703 210.972 c 213.331 212.712 l 213.661 212.712 l f 217.463 212.712 m 217.209 211.397 l 217.171 211.191 217.144 211.011 217.128 210.857 c 216.84 210.857 l 216.89 211.206 l 216.883 211.206 l 216.714 210.965 216.472 210.815 216.226 210.815 c 215.988 210.815 215.735 210.93 215.735 211.352 c 215.735 211.44 215.746 211.543 215.769 211.666 c 215.973 212.712 l 216.287 212.712 l 216.091 211.677 l 216.072 211.574 216.061 211.486 216.061 211.405 c 216.061 211.214 216.138 211.083 216.357 211.083 c 216.591 211.083 216.887 211.355 216.963 211.762 c 217.144 212.712 l 217.463 212.712 l f 217.685 211.175 m 217.77 211.122 217.931 211.06 218.085 211.06 c 218.3 211.06 218.438 211.198 218.438 211.363 c 218.438 211.509 218.373 211.601 218.177 211.708 c 217.962 211.827 217.843 211.988 217.843 212.179 c 217.843 212.505 218.123 212.754 218.519 212.754 c 218.684 212.754 218.834 212.708 218.903 212.662 c 218.814 212.421 l 218.749 212.459 218.634 212.505 218.496 212.505 c 218.3 212.505 218.162 212.382 218.162 212.225 c 218.162 212.091 218.25 212.007 218.419 211.915 c 218.626 211.796 218.765 211.635 218.765 211.424 c 218.765 211.034 218.45 210.815 218.054 210.815 c 217.854 210.819 217.678 210.876 217.593 210.942 c 217.685 211.175 l f 220.37 212.271 m 220.37 212.421 220.255 212.505 220.086 212.505 c 219.783 212.505 219.556 212.21 219.479 211.919 c 219.978 211.911 220.37 211.98 220.37 212.267 c 220.37 212.271 l h 220.439 210.961 m 220.301 210.884 220.074 210.815 219.824 210.815 c 219.333 210.815 219.118 211.152 219.118 211.562 c 219.118 212.122 219.532 212.754 220.132 212.754 c 220.485 212.754 220.677 212.543 220.677 212.275 c 220.677 211.788 220.128 211.662 219.441 211.673 c 219.425 211.593 219.437 211.421 219.479 211.321 c 219.552 211.152 219.702 211.072 219.894 211.072 c 220.113 211.072 220.278 211.137 220.393 211.198 c 220.439 210.961 l f 220.885 210.857 m 221.188 212.463 l 220.942 212.463 l 220.988 212.712 l 221.238 212.712 l 221.253 212.811 l 221.299 213.068 221.391 213.306 221.556 213.455 c 221.676 213.562 221.837 213.62 221.998 213.62 c 222.129 213.62 222.209 213.597 222.255 213.57 c 222.186 213.317 l 222.137 213.34 222.071 213.352 221.998 213.352 c 221.745 213.352 221.622 213.106 221.568 212.8 c 221.553 212.712 l 221.967 212.712 l 221.917 212.463 l 221.506 212.463 l 221.203 210.857 l 220.885 210.857 l f 223.742 212.712 m 223.488 211.397 l 223.45 211.191 223.423 211.011 223.408 210.857 c 223.119 210.857 l 223.169 211.206 l 223.162 211.206 l 222.993 210.965 222.751 210.815 222.505 210.815 c 222.267 210.815 222.013 210.93 222.013 211.352 c 222.013 211.44 222.025 211.543 222.048 211.666 c 222.252 212.712 l 222.567 212.712 l 222.371 211.677 l 222.352 211.574 222.34 211.486 222.34 211.405 c 222.34 211.214 222.417 211.083 222.636 211.083 c 222.87 211.083 223.165 211.355 223.242 211.762 c 223.423 212.712 l 223.742 212.712 l f 223.949 210.857 m 224.467 213.578 l 224.786 213.578 l 224.268 210.857 l 223.949 210.857 l f 226.964 212.474 m 226.918 212.49 226.852 212.501 226.745 212.501 c 226.264 212.501 225.869 212.003 225.869 211.486 c 225.869 211.279 225.942 211.076 226.184 211.076 c 226.453 211.076 226.768 211.421 226.856 211.915 c 226.964 212.474 l h 226.76 210.857 m 226.76 210.968 226.78 211.145 226.802 211.336 c 226.795 211.336 l 226.591 210.949 226.334 210.815 226.073 210.815 c 225.743 210.815 225.539 211.076 225.539 211.428 c 225.539 212.076 226.015 212.754 226.821 212.754 c 226.998 212.754 227.194 212.723 227.321 212.685 c 227.133 211.716 l 227.071 211.394 227.048 211.064 227.056 210.857 c 226.76 210.857 l f 227.547 211.175 m 227.632 211.122 227.793 211.06 227.947 211.06 c 228.162 211.06 228.3 211.198 228.3 211.363 c 228.3 211.509 228.235 211.601 228.039 211.708 c 227.824 211.827 227.705 211.988 227.705 212.179 c 227.705 212.505 227.985 212.754 228.381 212.754 c 228.546 212.754 228.695 212.708 228.765 212.662 c 228.676 212.421 l 228.611 212.459 228.496 212.505 228.358 212.505 c 228.162 212.505 228.023 212.382 228.023 212.225 c 228.023 212.091 228.112 212.007 228.281 211.915 c 228.488 211.796 228.627 211.635 228.627 211.424 c 228.627 211.034 228.312 210.815 227.916 210.815 c 227.716 210.819 227.54 210.876 227.455 210.942 c 227.547 211.175 l f 229.398 212.168 m 229.275 212.168 229.191 212.267 229.191 212.39 c 229.191 212.532 229.291 212.647 229.429 212.647 c 229.56 212.647 229.644 212.551 229.644 212.421 c 229.644 212.279 229.544 212.168 229.402 212.168 c 229.398 212.168 l h 229.137 210.815 m 229.014 210.815 228.93 210.915 228.93 211.037 c 228.93 211.179 229.03 211.294 229.168 211.294 c 229.299 211.294 229.383 211.198 229.383 211.068 c 229.383 210.926 229.283 210.815 229.141 210.815 c 229.137 210.815 l f 171.181 206.026 m 170.962 206.026 170.781 206.202 170.781 206.428 c 170.777 206.65 170.962 206.83 171.184 206.83 c 171.407 206.83 171.588 206.654 171.588 206.428 c 171.588 206.206 171.407 206.026 171.184 206.026 c 171.181 206.026 l f 174.762 206.183 m 174.505 206.926 l 174.451 207.094 174.413 207.248 174.374 207.397 c 174.363 207.397 l 174.328 207.248 174.286 207.087 174.236 206.93 c 173.983 206.183 l 174.762 206.183 l h 173.914 205.922 m 173.645 205.11 l 173.299 205.11 l 174.179 207.692 l 174.582 207.692 l 175.465 205.11 l 175.108 205.11 l 174.831 205.922 l 173.914 205.922 l f 176.986 205.865 m 176.986 205.819 176.99 205.769 177.001 205.727 c 177.059 205.493 177.266 205.332 177.504 205.332 c 177.861 205.332 178.069 205.623 178.069 206.048 c 178.069 206.42 177.877 206.738 177.52 206.738 c 177.289 206.738 177.07 206.577 177.005 206.324 c 176.997 206.278 176.986 206.229 176.986 206.186 c 176.986 205.865 l h 176.648 206.359 m 176.648 206.597 176.644 206.788 176.633 206.964 c 176.936 206.964 l 176.955 206.646 l 176.963 206.646 l 177.097 206.876 177.32 207.006 177.62 207.006 c 178.073 207.006 178.411 206.627 178.411 206.064 c 178.411 205.397 178 205.068 177.566 205.068 c 177.316 205.068 177.105 205.175 176.993 205.359 c 176.986 205.359 l 176.986 204.351 l 176.648 204.351 l 176.648 206.359 l f 178.837 206.386 m 178.837 206.604 178.833 206.792 178.822 206.964 c 179.117 206.964 l 179.133 206.6 l 179.144 206.6 l 179.229 206.849 179.436 207.006 179.663 207.006 c 179.697 207.006 179.724 207.003 179.755 206.995 c 179.755 206.681 l 179.716 206.685 179.682 206.688 179.636 206.688 c 179.398 206.688 179.229 206.508 179.182 206.259 c 179.175 206.209 179.171 206.156 179.171 206.098 c 179.171 205.11 l 178.833 205.11 l 178.837 206.386 l f 181.245 206.221 m 181.249 206.432 181.157 206.769 180.78 206.769 c 180.434 206.769 180.289 206.455 180.262 206.221 c 181.245 206.221 l h 180.258 205.98 m 180.266 205.524 180.554 205.336 180.892 205.336 c 181.133 205.336 181.283 205.378 181.406 205.428 c 181.468 205.19 l 181.349 205.137 181.141 205.071 180.845 205.071 c 180.277 205.071 179.931 205.451 179.931 206.006 c 179.931 206.57 180.266 207.01 180.807 207.01 c 181.414 207.01 181.571 206.478 181.571 206.137 c 181.571 206.068 181.567 206.014 181.56 205.976 c 180.258 205.98 l f 182.113 206.964 m 182.478 205.926 l 182.539 205.753 182.589 205.6 182.627 205.447 c 182.639 205.447 l 182.681 205.6 182.735 205.753 182.796 205.926 c 183.157 206.964 l 183.511 206.964 l 182.781 205.11 l 182.458 205.11 l 181.752 206.964 l 182.113 206.964 l f 183.829 206.964 0.338 -1.855 re 183.991 207.305 m 183.864 207.305 183.78 207.405 183.78 207.524 c 183.78 207.643 183.868 207.738 183.998 207.738 c 184.129 207.738 184.214 207.643 184.214 207.524 c 184.214 207.405 184.129 207.305 183.995 207.305 c 183.991 207.305 l f 185.907 206.221 m 185.911 206.432 185.819 206.769 185.442 206.769 c 185.097 206.769 184.951 206.455 184.924 206.221 c 185.907 206.221 l h 184.92 205.98 m 184.928 205.524 185.216 205.336 185.554 205.336 c 185.796 205.336 185.945 205.378 186.068 205.428 c 186.13 205.19 l 186.011 205.137 185.803 205.071 185.508 205.071 c 184.939 205.071 184.594 205.451 184.594 206.006 c 184.594 206.57 184.928 207.01 185.469 207.01 c 186.076 207.01 186.233 206.478 186.233 206.137 c 186.233 206.068 186.23 206.014 186.222 205.976 c 184.92 205.98 l f 186.786 206.964 m 187.036 206.026 l 187.086 205.819 187.136 205.623 187.171 205.432 c 187.182 205.432 l 187.224 205.619 187.286 205.819 187.347 206.022 c 187.651 206.964 l 187.935 206.964 l 188.223 206.037 l 188.292 205.819 188.346 205.619 188.388 205.432 c 188.399 205.432 l 188.43 205.619 188.48 205.815 188.542 206.033 c 188.807 206.964 l 189.141 206.964 l 188.542 205.11 l 188.234 205.11 l 187.95 205.995 l 187.885 206.206 187.831 206.389 187.785 206.608 c 187.777 206.608 l 187.731 206.386 187.674 206.19 187.608 205.991 c 187.309 205.11 l 187.001 205.11 l 186.441 206.964 l 186.786 206.964 l f 190.631 205.853 m 190.631 205.811 190.634 205.769 190.642 205.73 c 190.707 205.497 190.907 205.336 191.149 205.336 c 191.506 205.336 191.714 205.623 191.714 206.048 c 191.714 206.424 191.521 206.742 191.161 206.742 c 190.93 206.742 190.715 206.581 190.65 206.328 c 190.638 206.286 190.631 206.24 190.631 206.186 c 190.631 205.853 l h 190.293 207.83 m 190.631 207.83 l 190.631 206.669 l 190.638 206.669 l 190.757 206.876 190.972 207.006 191.272 207.006 c 191.733 207.006 192.055 206.623 192.055 206.064 c 192.055 205.397 191.633 205.068 191.218 205.068 c 190.949 205.068 190.738 205.171 190.596 205.416 c 190.588 205.416 l 190.569 205.11 l 190.277 205.11 l 190.289 205.236 190.293 205.424 190.293 205.589 c 190.293 207.83 l f 193.661 206.221 m 193.664 206.432 193.572 206.769 193.196 206.769 c 192.85 206.769 192.704 206.455 192.677 206.221 c 193.661 206.221 l h 192.674 205.98 m 192.681 205.524 192.969 205.336 193.307 205.336 c 193.549 205.336 193.699 205.378 193.822 205.428 c 193.883 205.19 l 193.764 205.137 193.557 205.071 193.261 205.071 c 192.693 205.071 192.347 205.451 192.347 206.006 c 192.347 206.57 192.681 207.01 193.223 207.01 c 193.83 207.01 193.987 206.478 193.987 206.137 c 193.987 206.068 193.983 206.014 193.975 205.976 c 192.674 205.98 l f 194.436 205.11 m 194.436 206.708 l 194.179 206.708 l 194.179 206.964 l 194.436 206.964 l 194.436 207.052 l 194.436 207.313 194.498 207.551 194.655 207.7 c 194.782 207.823 194.951 207.872 195.105 207.872 c 195.228 207.872 195.327 207.846 195.393 207.819 c 195.35 207.558 l 195.297 207.581 195.231 207.6 195.132 207.6 c 194.847 207.6 194.771 207.347 194.771 207.064 c 194.771 206.964 l 195.22 206.964 l 195.22 206.708 l 194.774 206.708 l 194.774 205.11 l 194.436 205.11 l f 196.249 205.321 m 196.572 205.321 196.814 205.623 196.814 206.045 c 196.814 206.359 196.656 206.754 196.257 206.754 c 195.861 206.754 195.688 206.386 195.688 206.033 c 195.688 205.627 195.919 205.321 196.245 205.321 c 196.249 205.321 l h 196.238 205.068 m 195.738 205.068 195.347 205.435 195.347 206.022 c 195.347 206.642 195.758 207.006 196.268 207.006 c 196.802 207.006 197.163 206.619 197.163 206.056 c 197.163 205.367 196.683 205.068 196.241 205.068 c 196.238 205.068 l f 197.593 206.386 m 197.593 206.604 197.589 206.792 197.578 206.964 c 197.874 206.964 l 197.889 206.6 l 197.9 206.6 l 197.985 206.849 198.192 207.006 198.419 207.006 c 198.453 207.006 198.48 207.003 198.511 206.995 c 198.511 206.681 l 198.473 206.685 198.438 206.688 198.392 206.688 c 198.154 206.688 197.985 206.508 197.939 206.259 c 197.931 206.209 197.927 206.156 197.927 206.098 c 197.927 205.11 l 197.589 205.11 l 197.593 206.386 l f 200.001 206.221 m 200.005 206.432 199.913 206.769 199.537 206.769 c 199.191 206.769 199.045 206.455 199.018 206.221 c 200.001 206.221 l h 199.014 205.98 m 199.022 205.524 199.31 205.336 199.648 205.336 c 199.89 205.336 200.04 205.378 200.162 205.428 c 200.224 205.19 l 200.105 205.137 199.897 205.071 199.602 205.071 c 199.033 205.071 198.688 205.451 198.688 206.006 c 198.688 206.57 199.022 207.01 199.563 207.01 c 200.17 207.01 200.328 206.478 200.328 206.137 c 200.328 206.068 200.324 206.014 200.316 205.976 c 199.014 205.98 l f 202.539 206.056 m 202.171 206.064 201.752 205.999 201.752 205.639 c 201.752 205.416 201.898 205.317 202.067 205.317 c 202.313 205.317 202.471 205.47 202.524 205.627 c 202.536 205.661 202.539 205.7 202.539 205.734 c 202.539 206.056 l h 202.87 205.554 m 202.87 205.393 202.878 205.236 202.897 205.11 c 202.593 205.11 l 202.563 205.343 l 202.551 205.343 l 202.451 205.198 202.247 205.068 201.982 205.068 c 201.606 205.068 201.414 205.332 201.414 205.6 c 201.414 206.048 201.814 206.294 202.532 206.29 c 202.532 206.328 l 202.532 206.481 202.489 206.761 202.109 206.757 c 201.933 206.757 201.752 206.708 201.622 206.619 c 201.545 206.845 l 201.699 206.941 201.925 207.006 202.159 207.006 c 202.732 207.006 202.87 206.619 202.87 206.248 c 202.87 205.554 l f 203.803 207.409 m 203.803 206.964 l 204.287 206.964 l 204.287 206.708 l 203.803 206.708 l 203.803 205.708 l 203.803 205.478 203.868 205.347 204.056 205.347 c 204.149 205.347 204.202 205.355 204.252 205.37 c 204.268 205.114 l 204.202 205.091 204.099 205.068 203.968 205.068 c 203.811 205.068 203.684 205.121 203.603 205.209 c 203.511 205.313 203.473 205.478 203.473 205.696 c 203.473 206.708 l 203.184 206.708 l 203.184 206.964 l 203.473 206.964 l 203.473 207.305 l 203.803 207.409 l f 205.074 207.409 m 205.074 206.964 l 205.558 206.964 l 205.558 206.708 l 205.074 206.708 l 205.074 205.708 l 205.074 205.478 205.14 205.347 205.328 205.347 c 205.42 205.347 205.473 205.355 205.523 205.37 c 205.539 205.114 l 205.473 205.091 205.37 205.068 205.239 205.068 c 205.082 205.068 204.955 205.121 204.875 205.209 c 204.782 205.313 204.744 205.478 204.744 205.696 c 204.744 206.708 l 204.456 206.708 l 204.456 206.964 l 204.744 206.964 l 204.744 207.305 l 205.074 207.409 l f 207.094 206.221 m 207.098 206.432 207.006 206.769 206.63 206.769 c 206.284 206.769 206.138 206.455 206.111 206.221 c 207.094 206.221 l h 206.107 205.98 m 206.115 205.524 206.403 205.336 206.741 205.336 c 206.983 205.336 207.133 205.378 207.256 205.428 c 207.317 205.19 l 207.198 205.137 206.991 205.071 206.695 205.071 c 206.127 205.071 205.781 205.451 205.781 206.006 c 205.781 206.57 206.115 207.01 206.656 207.01 c 207.263 207.01 207.421 206.478 207.421 206.137 c 207.421 206.068 207.417 206.014 207.409 205.976 c 206.107 205.98 l f 207.839 206.462 m 207.839 206.658 207.835 206.811 207.824 206.964 c 208.123 206.964 l 208.143 206.662 l 208.15 206.662 l 208.243 206.834 208.458 207.006 208.765 207.006 c 209.022 207.006 209.421 206.853 209.421 206.217 c 209.421 205.11 l 209.084 205.11 l 209.084 206.179 l 209.084 206.478 208.972 206.731 208.653 206.731 c 208.434 206.731 208.262 206.573 208.2 206.386 c 208.185 206.344 208.177 206.282 208.177 206.229 c 208.177 205.11 l 207.839 205.11 l 207.839 206.462 l f 211.238 206.209 m 211.238 206.255 211.234 206.309 211.223 206.355 c 211.173 206.566 210.988 206.742 210.735 206.742 c 210.385 206.742 210.178 206.435 210.178 206.029 c 210.178 205.65 210.366 205.34 210.727 205.34 c 210.954 205.34 211.161 205.493 211.223 205.742 c 211.234 205.788 211.238 205.834 211.238 205.888 c 211.238 206.209 l h 211.576 207.83 m 211.576 205.589 l 211.576 205.424 211.58 205.236 211.591 205.11 c 211.288 205.11 l 211.273 205.432 l 211.265 205.432 l 211.161 205.225 210.938 205.068 210.635 205.068 c 210.186 205.068 209.836 205.447 209.836 206.01 c 209.832 206.631 210.22 207.006 210.67 207.006 c 210.958 207.006 211.15 206.872 211.23 206.727 c 211.238 206.727 l 211.238 207.83 l 211.576 207.83 l f 212.137 206.964 0.338 -1.855 re 212.298 207.305 m 212.171 207.305 212.087 207.405 212.087 207.524 c 212.087 207.643 212.175 207.738 212.305 207.738 c 212.436 207.738 212.521 207.643 212.521 207.524 c 212.521 207.405 212.436 207.305 212.302 207.305 c 212.298 207.305 l f 213.035 206.462 m 213.035 206.658 213.031 206.811 213.02 206.964 c 213.319 206.964 l 213.339 206.662 l 213.346 206.662 l 213.439 206.834 213.654 207.006 213.961 207.006 c 214.218 207.006 214.618 206.853 214.618 206.217 c 214.618 205.11 l 214.279 205.11 l 214.279 206.179 l 214.279 206.478 214.168 206.731 213.849 206.731 c 213.631 206.731 213.457 206.573 213.396 206.386 c 213.381 206.344 213.373 206.282 213.373 206.229 c 213.373 205.11 l 213.035 205.11 l 213.035 206.462 l f 216.419 206.236 m 216.419 206.29 216.415 206.34 216.4 206.386 c 216.338 206.585 216.177 206.746 215.927 206.746 c 215.605 206.746 215.374 206.474 215.374 206.041 c 215.374 205.681 215.562 205.374 215.923 205.374 c 216.135 205.374 216.323 205.504 216.392 205.723 c 216.411 205.776 216.419 205.842 216.419 205.903 c 216.419 206.236 l h 216.757 205.382 m 216.757 204.953 216.668 204.696 216.492 204.531 c 216.307 204.366 216.046 204.309 215.812 204.309 c 215.589 204.309 215.343 204.363 215.194 204.462 c 215.278 204.723 l 215.401 204.642 215.593 204.573 215.823 204.573 c 216.169 204.573 216.422 204.753 216.422 205.225 c 216.422 205.428 l 216.415 205.428 l 216.315 205.255 216.111 205.117 215.823 205.117 c 215.363 205.117 215.032 205.508 215.032 206.026 c 215.032 206.654 215.443 207.006 215.873 207.006 c 216.196 207.006 216.369 206.842 216.453 206.688 c 216.461 206.688 l 216.472 206.964 l 216.772 206.964 l 216.76 206.834 216.757 206.685 216.757 206.459 c 216.757 205.382 l f 218.535 207.409 m 218.535 206.964 l 219.019 206.964 l 219.019 206.708 l 218.535 206.708 l 218.535 205.708 l 218.535 205.478 218.6 205.347 218.788 205.347 c 218.88 205.347 218.934 205.355 218.984 205.37 c 218.999 205.114 l 218.934 205.091 218.83 205.068 218.7 205.068 c 218.542 205.068 218.415 205.121 218.335 205.209 c 218.243 205.313 218.204 205.478 218.204 205.696 c 218.204 206.708 l 217.916 206.708 l 217.916 206.964 l 218.204 206.964 l 218.204 207.305 l 218.535 207.409 l f 219.399 207.83 m 219.737 207.83 l 219.737 206.673 l 219.744 206.673 l 219.798 206.769 219.883 206.857 219.986 206.911 c 220.086 206.972 220.205 207.006 220.332 207.006 c 220.582 207.006 220.981 206.853 220.981 206.213 c 220.981 205.11 l 220.643 205.11 l 220.643 206.175 l 220.643 206.478 220.532 206.727 220.213 206.727 c 219.994 206.727 219.825 206.573 219.76 206.389 c 219.741 206.344 219.737 206.294 219.737 206.229 c 219.737 205.11 l 219.399 205.11 l 219.399 207.83 l f 222.709 206.221 m 222.713 206.432 222.621 206.769 222.244 206.769 c 221.899 206.769 221.753 206.455 221.726 206.221 c 222.709 206.221 l h 221.722 205.98 m 221.73 205.524 222.018 205.336 222.356 205.336 c 222.598 205.336 222.748 205.378 222.87 205.428 c 222.932 205.19 l 222.813 205.137 222.605 205.071 222.31 205.071 c 221.741 205.071 221.396 205.451 221.396 206.006 c 221.396 206.57 221.73 207.01 222.271 207.01 c 222.878 207.01 223.035 206.478 223.035 206.137 c 223.035 206.068 223.032 206.014 223.024 205.976 c 221.722 205.98 l f 224.676 207.409 m 224.676 206.964 l 225.159 206.964 l 225.159 206.708 l 224.676 206.708 l 224.676 205.708 l 224.676 205.478 224.741 205.347 224.929 205.347 c 225.021 205.347 225.075 205.355 225.125 205.37 c 225.14 205.114 l 225.075 205.091 224.971 205.068 224.841 205.068 c 224.683 205.068 224.556 205.121 224.476 205.209 c 224.384 205.313 224.345 205.478 224.345 205.696 c 224.345 206.708 l 224.057 206.708 l 224.057 206.964 l 224.345 206.964 l 224.345 207.305 l 224.676 207.409 l f 225.689 206.964 m 225.939 206.026 l 225.989 205.819 226.039 205.623 226.073 205.432 c 226.085 205.432 l 226.127 205.619 226.188 205.819 226.25 206.022 c 226.553 206.964 l 226.837 206.964 l 227.125 206.037 l 227.195 205.819 227.248 205.619 227.291 205.432 c 227.302 205.432 l 227.333 205.619 227.383 205.815 227.444 206.033 c 227.709 206.964 l 228.043 206.964 l 227.444 205.11 l 227.137 205.11 l 226.853 205.995 l 226.788 206.206 226.734 206.389 226.688 206.608 c 226.68 206.608 l 226.634 206.386 226.576 206.19 226.511 205.991 c 226.211 205.11 l 225.904 205.11 l 225.343 206.964 l 225.689 206.964 l f 229.115 205.321 m 229.437 205.321 229.679 205.623 229.679 206.045 c 229.679 206.359 229.522 206.754 229.123 206.754 c 228.727 206.754 228.554 206.386 228.554 206.033 c 228.554 205.627 228.785 205.321 229.111 205.321 c 229.115 205.321 l h 229.103 205.068 m 228.604 205.068 228.212 205.435 228.212 206.022 c 228.212 206.642 228.623 207.006 229.134 207.006 c 229.668 207.006 230.029 206.619 230.029 206.056 c 230.029 205.367 229.549 205.068 229.107 205.068 c 229.103 205.068 l f 230.29 206.267 0.949 -0.245 re f 232.901 206.209 m 232.901 206.255 232.898 206.309 232.886 206.355 c 232.836 206.566 232.652 206.742 232.398 206.742 c 232.049 206.742 231.842 206.435 231.842 206.029 c 231.842 205.65 232.03 205.34 232.391 205.34 c 232.617 205.34 232.825 205.493 232.886 205.742 c 232.898 205.788 232.901 205.834 232.901 205.888 c 232.901 206.209 l h 233.239 207.83 m 233.239 205.589 l 233.239 205.424 233.243 205.236 233.255 205.11 c 232.951 205.11 l 232.936 205.432 l 232.928 205.432 l 232.825 205.225 232.602 205.068 232.299 205.068 c 231.849 205.068 231.5 205.447 231.5 206.01 c 231.496 206.631 231.884 207.006 232.333 207.006 c 232.621 207.006 232.813 206.872 232.894 206.727 c 232.901 206.727 l 232.901 207.83 l 233.239 207.83 l f 234.779 206.056 m 234.411 206.064 233.992 205.999 233.992 205.639 c 233.992 205.416 234.138 205.317 234.307 205.317 c 234.553 205.317 234.71 205.47 234.764 205.627 c 234.775 205.661 234.779 205.7 234.779 205.734 c 234.779 206.056 l h 235.109 205.554 m 235.109 205.393 235.117 205.236 235.136 205.11 c 234.833 205.11 l 234.802 205.343 l 234.791 205.343 l 234.691 205.198 234.488 205.068 234.223 205.068 c 233.846 205.068 233.654 205.332 233.654 205.6 c 233.654 206.048 234.053 206.294 234.772 206.29 c 234.772 206.328 l 234.772 206.481 234.729 206.761 234.349 206.757 c 234.173 206.757 233.992 206.708 233.862 206.619 c 233.785 206.845 l 233.938 206.941 234.165 207.006 234.399 207.006 c 234.971 207.006 235.109 206.619 235.109 206.248 c 235.109 205.554 l f 235.732 206.964 m 236.135 205.868 l 236.181 205.746 236.227 205.6 236.258 205.489 c 236.266 205.489 l 236.3 205.6 236.339 205.742 236.385 205.876 c 236.753 206.964 l 237.111 206.964 l 236.604 205.642 l 236.361 205.006 236.196 204.681 235.966 204.478 c 235.797 204.336 235.636 204.278 235.551 204.263 c 235.467 204.546 l 235.551 204.57 235.663 204.623 235.763 204.711 c 235.855 204.784 235.966 204.914 236.047 205.087 c 236.062 205.121 236.074 205.144 236.074 205.167 c 236.074 205.186 236.066 205.213 236.047 205.251 c 235.363 206.964 l 235.732 206.964 l f 173.453 201.046 m 173.603 200.95 173.818 200.877 174.048 200.877 c 174.39 200.877 174.59 201.053 174.59 201.318 c 174.59 201.555 174.451 201.697 174.102 201.827 c 173.679 201.981 173.418 202.203 173.418 202.563 c 173.418 202.965 173.752 203.264 174.255 203.264 c 174.517 203.264 174.712 203.203 174.824 203.138 c 174.732 202.866 l 174.651 202.915 174.478 202.988 174.244 202.988 c 173.891 202.988 173.756 202.778 173.756 202.601 c 173.756 202.36 173.914 202.241 174.271 202.103 c 174.709 201.931 174.928 201.724 174.928 201.344 c 174.928 200.946 174.636 200.597 174.025 200.597 c 173.775 200.597 173.503 200.674 173.364 200.766 c 173.453 201.046 l f 175.768 202.939 m 175.768 202.494 l 176.252 202.494 l 176.252 202.237 l 175.768 202.237 l 175.768 201.237 l 175.768 201.007 175.834 200.877 176.022 200.877 c 176.114 200.877 176.168 200.885 176.218 200.9 c 176.233 200.643 l 176.168 200.62 176.064 200.597 175.934 200.597 c 175.776 200.597 175.649 200.651 175.569 200.739 c 175.476 200.843 175.438 201.007 175.438 201.226 c 175.438 202.237 l 175.15 202.237 l 175.15 202.494 l 175.438 202.494 l 175.438 202.835 l 175.768 202.939 l f 176.636 201.915 m 176.636 202.134 176.633 202.322 176.621 202.494 c 176.917 202.494 l 176.932 202.13 l 176.944 202.13 l 177.028 202.379 177.235 202.536 177.462 202.536 c 177.497 202.536 177.524 202.532 177.554 202.525 c 177.554 202.21 l 177.516 202.214 177.481 202.218 177.435 202.218 c 177.197 202.218 177.028 202.038 176.982 201.789 c 176.974 201.739 176.971 201.685 176.971 201.628 c 176.971 200.639 l 176.633 200.639 l 176.636 201.915 l f 178.845 201.586 m 178.476 201.593 178.057 201.528 178.057 201.168 c 178.057 200.946 178.203 200.846 178.372 200.846 c 178.618 200.846 178.776 201 178.829 201.157 c 178.841 201.191 178.845 201.23 178.845 201.264 c 178.845 201.586 l h 179.175 201.084 m 179.175 200.923 179.183 200.766 179.202 200.639 c 178.898 200.639 l 178.868 200.873 l 178.856 200.873 l 178.756 200.728 178.553 200.597 178.288 200.597 c 177.911 200.597 177.719 200.862 177.719 201.13 c 177.719 201.578 178.119 201.823 178.837 201.82 c 178.837 201.858 l 178.837 202.011 178.795 202.291 178.414 202.287 c 178.238 202.287 178.057 202.237 177.927 202.149 c 177.85 202.375 l 178.004 202.471 178.23 202.536 178.464 202.536 c 179.037 202.536 179.175 202.149 179.175 201.777 c 179.175 201.084 l f 180.108 202.939 m 180.108 202.494 l 180.592 202.494 l 180.592 202.237 l 180.108 202.237 l 180.108 201.237 l 180.108 201.007 180.173 200.877 180.362 200.877 c 180.454 200.877 180.507 200.885 180.557 200.9 c 180.573 200.643 l 180.507 200.62 180.404 200.597 180.273 200.597 c 180.116 200.597 179.989 200.651 179.908 200.739 c 179.816 200.843 179.778 201.007 179.778 201.226 c 179.778 202.237 l 179.49 202.237 l 179.49 202.494 l 179.778 202.494 l 179.778 202.835 l 180.108 202.939 l f 182.128 201.751 m 182.132 201.961 182.04 202.299 181.663 202.299 c 181.318 202.299 181.172 201.984 181.145 201.751 c 182.128 201.751 l h 181.141 201.509 m 181.149 201.053 181.437 200.866 181.775 200.866 c 182.017 200.866 182.167 200.908 182.289 200.958 c 182.351 200.72 l 182.232 200.666 182.024 200.601 181.729 200.601 c 181.16 200.601 180.815 200.98 180.815 201.536 c 180.815 202.099 181.149 202.54 181.69 202.54 c 182.297 202.54 182.455 202.007 182.455 201.666 c 182.455 201.597 182.451 201.544 182.443 201.505 c 181.141 201.509 l f 184.125 201.766 m 184.125 201.82 184.121 201.869 184.106 201.915 c 184.045 202.115 183.883 202.276 183.634 202.276 c 183.311 202.276 183.081 202.004 183.081 201.571 c 183.081 201.21 183.269 200.904 183.63 200.904 c 183.841 200.904 184.029 201.034 184.098 201.252 c 184.118 201.306 184.125 201.371 184.125 201.433 c 184.125 201.766 l h 184.463 200.911 m 184.463 200.482 184.375 200.226 184.198 200.061 c 184.014 199.896 183.753 199.839 183.518 199.839 c 183.296 199.839 183.05 199.892 182.9 199.992 c 182.985 200.252 l 183.107 200.172 183.299 200.103 183.53 200.103 c 183.876 200.103 184.129 200.283 184.129 200.754 c 184.129 200.958 l 184.121 200.958 l 184.021 200.785 183.818 200.647 183.53 200.647 c 183.069 200.647 182.739 201.038 182.739 201.555 c 182.739 202.184 183.15 202.536 183.58 202.536 c 183.902 202.536 184.075 202.371 184.16 202.218 c 184.167 202.218 l 184.179 202.494 l 184.479 202.494 l 184.467 202.364 184.463 202.214 184.463 201.988 c 184.463 200.911 l f 185.02 202.494 0.338 -1.855 re 185.181 202.835 m 185.054 202.835 184.97 202.935 184.97 203.053 c 184.97 203.172 185.058 203.268 185.189 203.268 c 185.319 203.268 185.404 203.172 185.404 203.053 c 185.404 202.935 185.319 202.835 185.185 202.835 c 185.181 202.835 l f 187.244 200.705 m 187.155 200.662 186.959 200.597 186.71 200.597 c 186.149 200.597 185.784 200.977 185.784 201.548 c 185.784 202.118 186.176 202.536 186.783 202.536 c 186.982 202.536 187.159 202.486 187.251 202.436 c 187.174 202.18 l 187.094 202.222 186.967 202.268 186.783 202.268 c 186.356 202.268 186.126 201.95 186.126 201.563 c 186.126 201.134 186.402 200.869 186.771 200.869 c 186.963 200.869 187.09 200.915 187.186 200.958 c 187.244 200.705 l f 188.799 201.946 m 188.872 201.927 188.968 201.919 189.075 201.919 c 189.482 201.919 189.724 202.118 189.724 202.467 c 189.724 202.812 189.482 202.977 189.114 202.977 c 188.968 202.977 188.857 202.961 188.799 202.95 c 188.799 201.946 l h 188.465 203.188 m 188.626 203.218 188.837 203.241 189.106 203.241 c 189.436 203.241 189.678 203.165 189.832 203.027 c 189.974 202.904 190.062 202.716 190.062 202.486 c 190.062 202.253 189.993 202.069 189.859 201.935 c 189.682 201.747 189.394 201.651 189.068 201.651 c 188.968 201.651 188.876 201.655 188.799 201.674 c 188.799 200.639 l 188.465 200.639 l 188.465 203.188 l f 190.477 203.36 0.338 -2.721 re f 192.355 201.586 m 191.986 201.593 191.568 201.528 191.568 201.168 c 191.568 200.946 191.714 200.846 191.883 200.846 c 192.128 200.846 192.286 201 192.34 201.157 c 192.351 201.191 192.355 201.23 192.355 201.264 c 192.355 201.586 l h 192.685 201.084 m 192.685 200.923 192.693 200.766 192.712 200.639 c 192.409 200.639 l 192.378 200.873 l 192.367 200.873 l 192.267 200.728 192.063 200.597 191.798 200.597 c 191.422 200.597 191.23 200.862 191.23 201.13 c 191.23 201.578 191.629 201.823 192.347 201.82 c 192.347 201.858 l 192.347 202.011 192.305 202.291 191.925 202.287 c 191.748 202.287 191.568 202.237 191.437 202.149 c 191.36 202.375 l 191.514 202.471 191.741 202.536 191.975 202.536 c 192.547 202.536 192.685 202.149 192.685 201.777 c 192.685 201.084 l f 193.227 201.992 m 193.227 202.187 193.223 202.341 193.212 202.494 c 193.511 202.494 l 193.53 202.191 l 193.538 202.191 l 193.63 202.364 193.845 202.536 194.152 202.536 c 194.41 202.536 194.809 202.383 194.809 201.747 c 194.809 200.639 l 194.471 200.639 l 194.471 201.709 l 194.471 202.007 194.36 202.26 194.041 202.26 c 193.822 202.26 193.649 202.103 193.588 201.915 c 193.572 201.873 193.565 201.812 193.565 201.758 c 193.565 200.639 l 193.227 200.639 l 193.227 201.992 l f 195.358 201.992 m 195.358 202.187 195.354 202.341 195.343 202.494 c 195.642 202.494 l 195.662 202.191 l 195.669 202.191 l 195.761 202.364 195.977 202.536 196.284 202.536 c 196.541 202.536 196.94 202.383 196.94 201.747 c 196.94 200.639 l 196.603 200.639 l 196.603 201.709 l 196.603 202.007 196.491 202.26 196.172 202.26 c 195.953 202.26 195.781 202.103 195.719 201.915 c 195.704 201.873 195.696 201.812 195.696 201.758 c 195.696 200.639 l 195.358 200.639 l 195.358 201.992 l f 197.489 202.494 0.338 -1.855 re 197.651 202.835 m 197.524 202.835 197.44 202.935 197.44 203.053 c 197.44 203.172 197.528 203.268 197.659 203.268 c 197.789 203.268 197.874 203.172 197.874 203.053 c 197.874 202.935 197.789 202.835 197.655 202.835 c 197.651 202.835 l f 198.388 201.992 m 198.388 202.187 198.384 202.341 198.373 202.494 c 198.672 202.494 l 198.691 202.191 l 198.699 202.191 l 198.791 202.364 199.007 202.536 199.314 202.536 c 199.571 202.536 199.97 202.383 199.97 201.747 c 199.97 200.639 l 199.633 200.639 l 199.633 201.709 l 199.633 202.007 199.521 202.26 199.202 202.26 c 198.983 202.26 198.811 202.103 198.749 201.915 c 198.734 201.873 198.726 201.812 198.726 201.758 c 198.726 200.639 l 198.388 200.639 l 198.388 201.992 l f 201.772 201.766 m 201.772 201.82 201.768 201.869 201.752 201.915 c 201.691 202.115 201.53 202.276 201.28 202.276 c 200.957 202.276 200.727 202.004 200.727 201.571 c 200.727 201.21 200.915 200.904 201.276 200.904 c 201.487 200.904 201.676 201.034 201.745 201.252 c 201.764 201.306 201.772 201.371 201.772 201.433 c 201.772 201.766 l h 202.11 200.911 m 202.11 200.482 202.021 200.226 201.845 200.061 c 201.66 199.896 201.399 199.839 201.165 199.839 c 200.942 199.839 200.696 199.892 200.547 199.992 c 200.631 200.252 l 200.754 200.172 200.946 200.103 201.176 200.103 c 201.522 200.103 201.776 200.283 201.776 200.754 c 201.776 200.958 l 201.768 200.958 l 201.668 200.785 201.464 200.647 201.176 200.647 c 200.715 200.647 200.385 201.038 200.385 201.555 c 200.385 202.184 200.796 202.536 201.226 202.536 c 201.549 202.536 201.722 202.371 201.806 202.218 c 201.814 202.218 l 201.826 202.494 l 202.125 202.494 l 202.113 202.364 202.11 202.214 202.11 201.988 c 202.11 200.911 l f 203.511 200.639 m 203.511 202.237 l 203.254 202.237 l 203.254 202.494 l 203.511 202.494 l 203.511 202.582 l 203.511 202.843 203.573 203.08 203.73 203.23 c 203.857 203.352 204.026 203.402 204.18 203.402 c 204.302 203.402 204.402 203.375 204.467 203.348 c 204.425 203.088 l 204.371 203.111 204.306 203.13 204.206 203.13 c 203.922 203.13 203.845 202.877 203.845 202.594 c 203.845 202.494 l 204.295 202.494 l 204.295 202.237 l 203.849 202.237 l 203.849 200.639 l 203.511 200.639 l f 205.324 200.85 m 205.647 200.85 205.889 201.153 205.889 201.574 c 205.889 201.889 205.731 202.283 205.332 202.283 c 204.936 202.283 204.763 201.915 204.763 201.563 c 204.763 201.157 204.994 200.85 205.32 200.85 c 205.324 200.85 l h 205.313 200.597 m 204.813 200.597 204.421 200.965 204.421 201.551 c 204.421 202.172 204.832 202.536 205.343 202.536 c 205.877 202.536 206.238 202.149 206.238 201.586 c 206.238 200.896 205.758 200.597 205.316 200.597 c 205.313 200.597 l f 206.668 201.915 m 206.668 202.134 206.664 202.322 206.653 202.494 c 206.949 202.494 l 206.964 202.13 l 206.975 202.13 l 207.06 202.379 207.267 202.536 207.494 202.536 c 207.528 202.536 207.555 202.532 207.586 202.525 c 207.586 202.21 l 207.547 202.214 207.513 202.218 207.467 202.218 c 207.229 202.218 207.06 202.038 207.014 201.789 c 207.006 201.739 207.002 201.685 207.002 201.628 c 207.002 200.639 l 206.664 200.639 l 206.668 201.915 l f 210.551 200.72 m 210.432 200.659 210.182 200.597 209.867 200.597 c 209.138 200.597 208.592 201.057 208.592 201.908 c 208.592 202.72 209.141 203.264 209.944 203.264 c 210.263 203.264 210.47 203.195 210.558 203.149 c 210.474 202.877 l 210.351 202.939 210.171 202.984 209.955 202.984 c 209.349 202.984 208.945 202.597 208.945 201.919 c 208.945 201.283 209.31 200.881 209.936 200.881 c 210.144 200.881 210.351 200.923 210.485 200.988 c 210.551 200.72 l f 210.969 203.222 0.338 -2.583 re f 211.849 201.046 m 211.999 200.95 212.214 200.877 212.444 200.877 c 212.786 200.877 212.986 201.053 212.986 201.318 c 212.986 201.555 212.847 201.697 212.498 201.827 c 212.075 201.981 211.814 202.203 211.814 202.563 c 211.814 202.965 212.148 203.264 212.651 203.264 c 212.912 203.264 213.108 203.203 213.22 203.138 c 213.127 202.866 l 213.047 202.915 212.874 202.988 212.64 202.988 c 212.286 202.988 212.152 202.778 212.152 202.601 c 212.152 202.36 212.31 202.241 212.667 202.103 c 213.104 201.931 213.323 201.724 213.323 201.344 c 213.323 200.946 213.031 200.597 212.421 200.597 c 212.171 200.597 211.899 200.674 211.76 200.766 c 211.849 201.046 l f 215.966 201.774 m 215.946 202.134 215.923 202.571 215.923 202.889 c 215.916 202.889 l 215.823 202.59 215.72 202.264 215.589 201.908 c 215.132 200.655 l 214.879 200.655 l 214.456 201.885 l 214.333 202.253 214.233 202.582 214.161 202.889 c 214.153 202.889 l 214.145 202.567 214.126 202.138 214.103 201.747 c 214.034 200.639 l 213.715 200.639 l 213.896 203.222 l 214.322 203.222 l 214.764 201.973 l 214.871 201.655 214.955 201.371 215.025 201.103 c 215.032 201.103 l 215.101 201.364 215.194 201.647 215.309 201.973 c 215.77 203.222 l 216.196 203.222 l 216.357 200.639 l 216.027 200.639 l 215.966 201.774 l f 218.999 200.705 m 218.911 200.662 218.715 200.597 218.465 200.597 c 217.905 200.597 217.54 200.977 217.54 201.548 c 217.54 202.118 217.932 202.536 218.539 202.536 c 218.738 202.536 218.915 202.486 219.007 202.436 c 218.93 202.18 l 218.85 202.222 218.723 202.268 218.539 202.268 c 218.112 202.268 217.882 201.95 217.882 201.563 c 217.882 201.134 218.159 200.869 218.527 200.869 c 218.719 200.869 218.846 200.915 218.942 200.958 c 218.999 200.705 l f 220.14 200.85 m 220.463 200.85 220.704 201.153 220.704 201.574 c 220.704 201.889 220.547 202.283 220.148 202.283 c 219.752 202.283 219.579 201.915 219.579 201.563 c 219.579 201.157 219.81 200.85 220.136 200.85 c 220.14 200.85 l h 220.128 200.597 m 219.629 200.597 219.237 200.965 219.237 201.551 c 219.237 202.172 219.648 202.536 220.159 202.536 c 220.693 202.536 221.054 202.149 221.054 201.586 c 221.054 200.896 220.574 200.597 220.132 200.597 c 220.128 200.597 l f 223.035 201.145 m 223.035 200.954 223.039 200.785 223.051 200.639 c 222.752 200.639 l 222.732 200.942 l 222.725 200.942 l 222.64 200.793 222.44 200.597 222.11 200.597 c 221.818 200.597 221.469 200.762 221.469 201.41 c 221.469 202.494 l 221.806 202.494 l 221.806 201.471 l 221.806 201.118 221.918 200.877 222.222 200.877 c 222.448 200.877 222.605 201.034 222.667 201.187 c 222.686 201.233 222.698 201.295 222.698 201.36 c 222.698 202.494 l 223.035 202.494 l 223.035 201.145 l f 223.6 201.915 m 223.6 202.134 223.596 202.322 223.585 202.494 c 223.88 202.494 l 223.896 202.13 l 223.907 202.13 l 223.992 202.379 224.199 202.536 224.426 202.536 c 224.461 202.536 224.487 202.532 224.518 202.525 c 224.518 202.21 l 224.48 202.214 224.445 202.218 224.399 202.218 c 224.161 202.218 223.992 202.038 223.946 201.789 c 223.938 201.739 223.934 201.685 223.934 201.628 c 223.934 200.639 l 223.596 200.639 l 223.6 201.915 l f 224.806 200.98 m 224.91 200.919 225.086 200.85 225.256 200.85 c 225.497 200.85 225.613 200.969 225.613 201.126 c 225.613 201.287 225.517 201.375 225.271 201.467 c 224.933 201.59 224.776 201.77 224.776 201.992 c 224.776 202.291 225.021 202.536 225.417 202.536 c 225.605 202.536 225.77 202.486 225.87 202.421 c 225.789 202.18 l 225.716 202.222 225.582 202.287 225.409 202.287 c 225.209 202.287 225.102 202.172 225.102 202.034 c 225.102 201.877 225.209 201.808 225.451 201.716 c 225.77 201.597 225.939 201.436 225.939 201.157 c 225.939 200.827 225.682 200.597 225.247 200.597 c 225.044 200.597 224.856 200.651 224.726 200.728 c 224.806 200.98 l f 227.552 201.751 m 227.556 201.961 227.464 202.299 227.087 202.299 c 226.741 202.299 226.596 201.984 226.569 201.751 c 227.552 201.751 l h 226.565 201.509 m 226.573 201.053 226.861 200.866 227.199 200.866 c 227.441 200.866 227.59 200.908 227.713 200.958 c 227.775 200.72 l 227.656 200.666 227.448 200.601 227.153 200.601 c 226.584 200.601 226.239 200.98 226.239 201.536 c 226.239 202.099 226.573 202.54 227.114 202.54 c 227.721 202.54 227.878 202.007 227.878 201.666 c 227.878 201.597 227.875 201.544 227.867 201.505 c 226.565 201.509 l f 229.879 200.85 m 230.202 200.85 230.444 201.153 230.444 201.574 c 230.444 201.889 230.286 202.283 229.887 202.283 c 229.491 202.283 229.319 201.915 229.319 201.563 c 229.319 201.157 229.549 200.85 229.875 200.85 c 229.879 200.85 l h 229.868 200.597 m 229.368 200.597 228.977 200.965 228.977 201.551 c 228.977 202.172 229.388 202.536 229.898 202.536 c 230.432 202.536 230.793 202.149 230.793 201.586 c 230.793 200.896 230.313 200.597 229.871 200.597 c 229.868 200.597 l f 231.25 200.639 m 231.25 202.237 l 230.993 202.237 l 230.993 202.494 l 231.25 202.494 l 231.25 202.582 l 231.25 202.843 231.312 203.08 231.469 203.23 c 231.596 203.352 231.765 203.402 231.918 203.402 c 232.041 203.402 232.141 203.375 232.206 203.348 c 232.164 203.088 l 232.11 203.111 232.045 203.13 231.945 203.13 c 231.661 203.13 231.584 202.877 231.584 202.594 c 231.584 202.494 l 232.034 202.494 l 232.034 202.237 l 231.588 202.237 l 231.588 200.639 l 231.25 200.639 l f 232.371 200.639 m 232.371 202.237 l 232.114 202.237 l 232.114 202.494 l 232.371 202.494 l 232.371 202.582 l 232.371 202.843 232.433 203.08 232.59 203.23 c 232.717 203.352 232.886 203.402 233.04 203.402 c 233.163 203.402 233.262 203.375 233.328 203.348 c 233.286 203.088 l 233.232 203.111 233.166 203.13 233.066 203.13 c 232.782 203.13 232.705 202.877 232.705 202.594 c 232.705 202.494 l 233.155 202.494 l 233.155 202.237 l 232.71 202.237 l 232.71 200.639 l 232.371 200.639 l f 234.595 201.751 m 234.599 201.961 234.507 202.299 234.131 202.299 c 233.785 202.299 233.639 201.984 233.612 201.751 c 234.595 201.751 l h 233.608 201.509 m 233.616 201.053 233.904 200.866 234.242 200.866 c 234.484 200.866 234.633 200.908 234.757 200.958 c 234.818 200.72 l 234.699 200.666 234.492 200.601 234.196 200.601 c 233.627 200.601 233.282 200.98 233.282 201.536 c 233.282 202.099 233.616 202.54 234.158 202.54 c 234.764 202.54 234.922 202.007 234.922 201.666 c 234.922 201.597 234.918 201.544 234.91 201.505 c 233.608 201.509 l f 235.344 201.915 m 235.344 202.134 235.34 202.322 235.329 202.494 c 235.624 202.494 l 235.64 202.13 l 235.651 202.13 l 235.736 202.379 235.943 202.536 236.17 202.536 c 236.204 202.536 236.231 202.532 236.262 202.525 c 236.262 202.21 l 236.223 202.214 236.189 202.218 236.143 202.218 c 235.905 202.218 235.736 202.038 235.69 201.789 c 235.682 201.739 235.678 201.685 235.678 201.628 c 235.678 200.639 l 235.34 200.639 l 235.344 201.915 l f 237.752 201.751 m 237.756 201.961 237.664 202.299 237.287 202.299 c 236.942 202.299 236.796 201.984 236.769 201.751 c 237.752 201.751 l h 236.765 201.509 m 236.772 201.053 237.061 200.866 237.398 200.866 c 237.64 200.866 237.79 200.908 237.913 200.958 c 237.974 200.72 l 237.855 200.666 237.648 200.601 237.353 200.601 c 236.784 200.601 236.438 200.98 236.438 201.536 c 236.438 202.099 236.772 202.54 237.314 202.54 c 237.921 202.54 238.078 202.007 238.078 201.666 c 238.078 201.597 238.074 201.544 238.067 201.505 c 236.765 201.509 l f 239.764 201.739 m 239.764 201.785 239.761 201.839 239.749 201.885 c 239.699 202.096 239.515 202.272 239.261 202.272 c 238.912 202.272 238.705 201.965 238.705 201.559 c 238.705 201.18 238.893 200.869 239.254 200.869 c 239.48 200.869 239.687 201.023 239.749 201.272 c 239.761 201.318 239.764 201.364 239.764 201.417 c 239.764 201.739 l h 240.102 203.36 m 240.102 201.118 l 240.102 200.954 240.106 200.766 240.118 200.639 c 239.814 200.639 l 239.799 200.961 l 239.791 200.961 l 239.687 200.754 239.465 200.597 239.161 200.597 c 238.712 200.597 238.363 200.977 238.363 201.54 c 238.359 202.161 238.747 202.536 239.196 202.536 c 239.484 202.536 239.676 202.402 239.757 202.256 c 239.764 202.256 l 239.764 203.36 l 240.102 203.36 l f 241.884 202.939 m 241.884 202.494 l 242.368 202.494 l 242.368 202.237 l 241.884 202.237 l 241.884 201.237 l 241.884 201.007 241.949 200.877 242.138 200.877 c 242.23 200.877 242.284 200.885 242.333 200.9 c 242.349 200.643 l 242.284 200.62 242.18 200.597 242.049 200.597 c 241.892 200.597 241.765 200.651 241.685 200.739 c 241.592 200.843 241.554 201.007 241.554 201.226 c 241.554 202.237 l 241.266 202.237 l 241.266 202.494 l 241.554 202.494 l 241.554 202.835 l 241.884 202.939 l f 242.748 203.36 m 243.086 203.36 l 243.086 202.203 l 243.094 202.203 l 243.148 202.299 243.232 202.387 243.336 202.44 c 243.436 202.502 243.555 202.536 243.681 202.536 c 243.931 202.536 244.33 202.383 244.33 201.743 c 244.33 200.639 l 243.992 200.639 l 243.992 201.705 l 243.992 202.007 243.881 202.256 243.562 202.256 c 243.343 202.256 243.174 202.103 243.109 201.919 c 243.09 201.873 243.086 201.823 243.086 201.758 c 243.086 200.639 l 242.748 200.639 l 242.748 203.36 l f 244.883 201.915 m 244.883 202.134 244.88 202.322 244.868 202.494 c 245.164 202.494 l 245.179 202.13 l 245.191 202.13 l 245.275 202.379 245.482 202.536 245.709 202.536 c 245.744 202.536 245.771 202.532 245.801 202.525 c 245.801 202.21 l 245.763 202.214 245.728 202.218 245.682 202.218 c 245.444 202.218 245.275 202.038 245.229 201.789 c 245.222 201.739 245.217 201.685 245.217 201.628 c 245.217 200.639 l 244.88 200.639 l 244.883 201.915 l f 246.88 200.85 m 247.203 200.85 247.445 201.153 247.445 201.574 c 247.445 201.889 247.287 202.283 246.888 202.283 c 246.493 202.283 246.32 201.915 246.32 201.563 c 246.32 201.157 246.55 200.85 246.876 200.85 c 246.88 200.85 l h 246.869 200.597 m 246.369 200.597 245.978 200.965 245.978 201.551 c 245.978 202.172 246.389 202.536 246.9 202.536 c 247.433 202.536 247.794 202.149 247.794 201.586 c 247.794 200.896 247.314 200.597 246.873 200.597 c 246.869 200.597 l f 249.776 201.145 m 249.776 200.954 249.78 200.785 249.791 200.639 c 249.492 200.639 l 249.473 200.942 l 249.465 200.942 l 249.38 200.793 249.181 200.597 248.85 200.597 c 248.558 200.597 248.209 200.762 248.209 201.41 c 248.209 202.494 l 248.547 202.494 l 248.547 201.471 l 248.547 201.118 248.658 200.877 248.962 200.877 c 249.189 200.877 249.346 201.034 249.407 201.187 c 249.426 201.233 249.438 201.295 249.438 201.36 c 249.438 202.494 l 249.776 202.494 l 249.776 201.145 l f 251.589 201.766 m 251.589 201.82 251.585 201.869 251.57 201.915 c 251.508 202.115 251.347 202.276 251.097 202.276 c 250.775 202.276 250.544 202.004 250.544 201.571 c 250.544 201.21 250.732 200.904 251.093 200.904 c 251.305 200.904 251.493 201.034 251.562 201.252 c 251.581 201.306 251.589 201.371 251.589 201.433 c 251.589 201.766 l h 251.927 200.911 m 251.927 200.482 251.838 200.226 251.662 200.061 c 251.478 199.896 251.216 199.839 250.982 199.839 c 250.759 199.839 250.513 199.892 250.364 199.992 c 250.448 200.252 l 250.571 200.172 250.763 200.103 250.993 200.103 c 251.339 200.103 251.592 200.283 251.592 200.754 c 251.592 200.958 l 251.585 200.958 l 251.485 200.785 251.282 200.647 250.993 200.647 c 250.533 200.647 250.202 201.038 250.202 201.555 c 250.202 202.184 250.613 202.536 251.043 202.536 c 251.366 202.536 251.539 202.371 251.623 202.218 c 251.631 202.218 l 251.643 202.494 l 251.942 202.494 l 251.931 202.364 251.927 202.214 251.927 201.988 c 251.927 200.911 l f 252.484 203.36 m 252.821 203.36 l 252.821 202.203 l 252.829 202.203 l 252.883 202.299 252.967 202.387 253.071 202.44 c 253.171 202.502 253.29 202.536 253.417 202.536 c 253.666 202.536 254.066 202.383 254.066 201.743 c 254.066 200.639 l 253.728 200.639 l 253.728 201.705 l 253.728 202.007 253.616 202.256 253.298 202.256 c 253.079 202.256 252.91 202.103 252.845 201.919 c 252.825 201.873 252.821 201.823 252.821 201.758 c 252.821 200.639 l 252.484 200.639 l 252.484 203.36 l f 173.891 198.468 m 173.891 198.024 l 174.374 198.024 l 174.374 197.767 l 173.891 197.767 l 173.891 196.767 l 173.891 196.537 173.956 196.407 174.144 196.407 c 174.236 196.407 174.29 196.414 174.34 196.43 c 174.355 196.173 l 174.29 196.15 174.186 196.127 174.056 196.127 c 173.898 196.127 173.771 196.181 173.691 196.269 c 173.599 196.372 173.56 196.537 173.56 196.755 c 173.56 197.767 l 173.272 197.767 l 173.272 198.024 l 173.56 198.024 l 173.56 198.365 l 173.891 198.468 l f 174.755 198.89 m 175.093 198.89 l 175.093 197.732 l 175.1 197.732 l 175.154 197.828 175.238 197.916 175.342 197.97 c 175.442 198.031 175.561 198.066 175.688 198.066 c 175.937 198.066 176.337 197.913 176.337 197.273 c 176.337 196.169 l 175.999 196.169 l 175.999 197.234 l 175.999 197.537 175.887 197.786 175.569 197.786 c 175.35 197.786 175.181 197.633 175.116 197.449 c 175.096 197.403 175.093 197.353 175.093 197.288 c 175.093 196.169 l 174.755 196.169 l 174.755 198.89 l f 178.065 197.28 m 178.069 197.491 177.977 197.828 177.6 197.828 c 177.255 197.828 177.109 197.514 177.082 197.28 c 178.065 197.28 l h 177.078 197.039 m 177.086 196.583 177.374 196.395 177.712 196.395 c 177.954 196.395 178.103 196.437 178.226 196.487 c 178.288 196.25 l 178.169 196.196 177.961 196.131 177.666 196.131 c 177.097 196.131 176.752 196.51 176.752 197.066 c 176.752 197.629 177.086 198.07 177.627 198.07 c 178.234 198.07 178.391 197.537 178.391 197.196 c 178.391 197.127 178.388 197.073 178.38 197.035 c 177.078 197.039 l f 179.632 198.752 0.338 -2.583 re f 180.542 197.522 m 180.542 197.717 180.538 197.87 180.527 198.024 c 180.826 198.024 l 180.845 197.721 l 180.853 197.721 l 180.945 197.893 181.16 198.066 181.468 198.066 c 181.725 198.066 182.124 197.913 182.124 197.277 c 182.124 196.169 l 181.786 196.169 l 181.786 197.238 l 181.786 197.537 181.675 197.79 181.356 197.79 c 181.137 197.79 180.964 197.633 180.903 197.445 c 180.888 197.403 180.88 197.342 180.88 197.288 c 180.88 196.169 l 180.542 196.169 l 180.542 197.522 l f 183.065 198.468 m 183.065 198.024 l 183.549 198.024 l 183.549 197.767 l 183.065 197.767 l 183.065 196.767 l 183.065 196.537 183.13 196.407 183.319 196.407 c 183.411 196.407 183.465 196.414 183.515 196.43 c 183.53 196.173 l 183.465 196.15 183.361 196.127 183.23 196.127 c 183.073 196.127 182.946 196.181 182.865 196.269 c 182.773 196.372 182.735 196.537 182.735 196.755 c 182.735 197.767 l 182.447 197.767 l 182.447 198.024 l 182.735 198.024 l 182.735 198.365 l 183.065 198.468 l f 185.085 197.28 m 185.089 197.491 184.997 197.828 184.62 197.828 c 184.275 197.828 184.129 197.514 184.102 197.28 c 185.085 197.28 l h 184.098 197.039 m 184.106 196.583 184.394 196.395 184.732 196.395 c 184.974 196.395 185.124 196.437 185.246 196.487 c 185.308 196.25 l 185.189 196.196 184.981 196.131 184.686 196.131 c 184.117 196.131 183.772 196.51 183.772 197.066 c 183.772 197.629 184.106 198.07 184.647 198.07 c 185.254 198.07 185.412 197.537 185.412 197.196 c 185.412 197.127 185.408 197.073 185.4 197.035 c 184.098 197.039 l f 185.834 197.445 m 185.834 197.664 185.83 197.851 185.819 198.024 c 186.114 198.024 l 186.13 197.66 l 186.141 197.66 l 186.226 197.909 186.433 198.066 186.66 198.066 c 186.694 198.066 186.721 198.062 186.752 198.054 c 186.752 197.74 l 186.713 197.744 186.679 197.748 186.633 197.748 c 186.395 197.748 186.226 197.568 186.18 197.319 c 186.172 197.269 186.168 197.215 186.168 197.158 c 186.168 196.169 l 185.83 196.169 l 185.834 197.445 l f 187.101 197.522 m 187.101 197.717 187.097 197.87 187.086 198.024 c 187.386 198.024 l 187.405 197.721 l 187.412 197.721 l 187.505 197.893 187.72 198.066 188.027 198.066 c 188.284 198.066 188.684 197.913 188.684 197.277 c 188.684 196.169 l 188.346 196.169 l 188.346 197.238 l 188.346 197.537 188.234 197.79 187.915 197.79 c 187.697 197.79 187.524 197.633 187.462 197.445 c 187.447 197.403 187.439 197.342 187.439 197.288 c 187.439 196.169 l 187.101 196.169 l 187.101 197.522 l f 190.212 197.116 m 189.843 197.123 189.425 197.058 189.425 196.698 c 189.425 196.476 189.571 196.376 189.74 196.376 c 189.985 196.376 190.143 196.529 190.197 196.686 c 190.208 196.721 190.212 196.759 190.212 196.794 c 190.212 197.116 l h 190.542 196.614 m 190.542 196.453 190.55 196.296 190.569 196.169 c 190.266 196.169 l 190.235 196.403 l 190.224 196.403 l 190.124 196.257 189.92 196.127 189.655 196.127 c 189.279 196.127 189.087 196.391 189.087 196.66 c 189.087 197.108 189.486 197.353 190.204 197.349 c 190.204 197.388 l 190.204 197.541 190.162 197.821 189.782 197.817 c 189.605 197.817 189.425 197.767 189.294 197.679 c 189.217 197.905 l 189.371 198.001 189.598 198.066 189.832 198.066 c 190.404 198.066 190.542 197.679 190.542 197.307 c 190.542 196.614 l f 191.476 198.468 m 191.476 198.024 l 191.96 198.024 l 191.96 197.767 l 191.476 197.767 l 191.476 196.767 l 191.476 196.537 191.541 196.407 191.729 196.407 c 191.821 196.407 191.875 196.414 191.925 196.43 c 191.94 196.173 l 191.875 196.15 191.771 196.127 191.641 196.127 c 191.483 196.127 191.356 196.181 191.276 196.269 c 191.184 196.372 191.145 196.537 191.145 196.755 c 191.145 197.767 l 190.857 197.767 l 190.857 198.024 l 191.145 198.024 l 191.145 198.365 l 191.476 198.468 l f 192.34 198.024 0.338 -1.855 re 192.501 198.365 m 192.374 198.365 192.29 198.464 192.29 198.583 c 192.29 198.702 192.378 198.798 192.508 198.798 c 192.639 198.798 192.724 198.702 192.724 198.583 c 192.724 198.464 192.639 198.365 192.505 198.365 c 192.501 198.365 l f 194.006 196.38 m 194.329 196.38 194.571 196.683 194.571 197.104 c 194.571 197.418 194.413 197.813 194.014 197.813 c 193.618 197.813 193.446 197.445 193.446 197.093 c 193.446 196.686 193.676 196.38 194.003 196.38 c 194.006 196.38 l h 193.995 196.127 m 193.496 196.127 193.104 196.495 193.104 197.081 c 193.104 197.702 193.515 198.066 194.026 198.066 c 194.559 198.066 194.92 197.679 194.92 197.116 c 194.92 196.426 194.44 196.127 193.999 196.127 c 193.995 196.127 l f 195.347 197.522 m 195.347 197.717 195.343 197.87 195.331 198.024 c 195.631 198.024 l 195.65 197.721 l 195.658 197.721 l 195.75 197.893 195.965 198.066 196.272 198.066 c 196.529 198.066 196.929 197.913 196.929 197.277 c 196.929 196.169 l 196.591 196.169 l 196.591 197.238 l 196.591 197.537 196.48 197.79 196.161 197.79 c 195.942 197.79 195.769 197.633 195.708 197.445 c 195.692 197.403 195.685 197.342 195.685 197.288 c 195.685 196.169 l 195.347 196.169 l 195.347 197.522 l f 198.457 197.116 m 198.089 197.123 197.67 197.058 197.67 196.698 c 197.67 196.476 197.816 196.376 197.985 196.376 c 198.231 196.376 198.388 196.529 198.442 196.686 c 198.453 196.721 198.457 196.759 198.457 196.794 c 198.457 197.116 l h 198.788 196.614 m 198.788 196.453 198.795 196.296 198.815 196.169 c 198.511 196.169 l 198.48 196.403 l 198.469 196.403 l 198.369 196.257 198.165 196.127 197.9 196.127 c 197.524 196.127 197.332 196.391 197.332 196.66 c 197.332 197.108 197.731 197.353 198.45 197.349 c 198.45 197.388 l 198.45 197.541 198.407 197.821 198.027 197.817 c 197.85 197.817 197.67 197.767 197.539 197.679 c 197.463 197.905 l 197.616 198.001 197.843 198.066 198.077 198.066 c 198.649 198.066 198.788 197.679 198.788 197.307 c 198.788 196.614 l f 199.329 198.89 0.338 -2.721 re f 202.858 196.25 m 202.739 196.188 202.489 196.127 202.175 196.127 c 201.445 196.127 200.9 196.587 200.9 197.437 c 200.9 198.25 201.449 198.794 202.252 198.794 c 202.57 198.794 202.778 198.725 202.866 198.679 c 202.781 198.407 l 202.659 198.468 202.478 198.514 202.263 198.514 c 201.656 198.514 201.253 198.127 201.253 197.449 c 201.253 196.813 201.618 196.41 202.244 196.41 c 202.451 196.41 202.659 196.453 202.793 196.518 c 202.858 196.25 l f 203.269 197.445 m 203.269 197.664 203.265 197.851 203.254 198.024 c 203.549 198.024 l 203.565 197.66 l 203.576 197.66 l 203.661 197.909 203.868 198.066 204.095 198.066 c 204.13 198.066 204.156 198.062 204.187 198.054 c 204.187 197.74 l 204.149 197.744 204.114 197.748 204.068 197.748 c 203.83 197.748 203.661 197.568 203.615 197.319 c 203.607 197.269 203.603 197.215 203.603 197.158 c 203.603 196.169 l 203.265 196.169 l 203.269 197.445 l f 204.536 198.024 0.338 -1.855 re 204.698 198.365 m 204.571 198.365 204.486 198.464 204.486 198.583 c 204.486 198.702 204.575 198.798 204.705 198.798 c 204.836 198.798 204.921 198.702 204.921 198.583 c 204.921 198.464 204.836 198.365 204.702 198.365 c 204.698 198.365 l f 205.842 198.468 m 205.842 198.024 l 206.326 198.024 l 206.326 197.767 l 205.842 197.767 l 205.842 196.767 l 205.842 196.537 205.908 196.407 206.096 196.407 c 206.188 196.407 206.242 196.414 206.292 196.43 c 206.307 196.173 l 206.242 196.15 206.138 196.127 206.007 196.127 c 205.85 196.127 205.723 196.181 205.643 196.269 c 205.55 196.372 205.512 196.537 205.512 196.755 c 205.512 197.767 l 205.224 197.767 l 205.224 198.024 l 205.512 198.024 l 205.512 198.365 l 205.842 198.468 l f 206.706 198.024 0.338 -1.855 re 206.867 198.365 m 206.741 198.365 206.656 198.464 206.656 198.583 c 206.656 198.702 206.745 198.798 206.875 198.798 c 207.006 198.798 207.091 198.702 207.091 198.583 c 207.091 198.464 207.006 198.365 206.871 198.365 c 206.867 198.365 l f 208.93 196.234 m 208.842 196.192 208.646 196.127 208.396 196.127 c 207.836 196.127 207.471 196.506 207.471 197.077 c 207.471 197.648 207.862 198.066 208.469 198.066 c 208.669 198.066 208.845 198.016 208.938 197.966 c 208.861 197.71 l 208.78 197.752 208.653 197.798 208.469 197.798 c 208.043 197.798 207.812 197.48 207.812 197.093 c 207.812 196.663 208.089 196.399 208.458 196.399 c 208.649 196.399 208.776 196.445 208.872 196.487 c 208.93 196.234 l f 210.308 197.116 m 209.94 197.123 209.521 197.058 209.521 196.698 c 209.521 196.476 209.667 196.376 209.836 196.376 c 210.082 196.376 210.24 196.529 210.293 196.686 c 210.305 196.721 210.308 196.759 210.308 196.794 c 210.308 197.116 l h 210.639 196.614 m 210.639 196.453 210.647 196.296 210.666 196.169 c 210.362 196.169 l 210.331 196.403 l 210.32 196.403 l 210.22 196.257 210.016 196.127 209.751 196.127 c 209.375 196.127 209.183 196.391 209.183 196.66 c 209.183 197.108 209.583 197.353 210.301 197.349 c 210.301 197.388 l 210.301 197.541 210.258 197.821 209.878 197.817 c 209.702 197.817 209.521 197.767 209.391 197.679 c 209.314 197.905 l 209.468 198.001 209.694 198.066 209.928 198.066 c 210.501 198.066 210.639 197.679 210.639 197.307 c 210.639 196.614 l f 211.18 198.89 0.338 -2.721 re f 212.901 198.752 0.338 -2.583 re f 213.811 197.522 m 213.811 197.717 213.807 197.87 213.796 198.024 c 214.095 198.024 l 214.114 197.721 l 214.122 197.721 l 214.214 197.893 214.429 198.066 214.736 198.066 c 214.994 198.066 215.393 197.913 215.393 197.277 c 215.393 196.169 l 215.055 196.169 l 215.055 197.238 l 215.055 197.537 214.944 197.79 214.625 197.79 c 214.406 197.79 214.233 197.633 214.172 197.445 c 214.157 197.403 214.149 197.342 214.149 197.288 c 214.149 196.169 l 213.811 196.169 l 213.811 197.522 l f 217.267 196.234 m 217.179 196.192 216.983 196.127 216.733 196.127 c 216.173 196.127 215.808 196.506 215.808 197.077 c 215.808 197.648 216.2 198.066 216.807 198.066 c 217.006 198.066 217.183 198.016 217.275 197.966 c 217.198 197.71 l 217.118 197.752 216.991 197.798 216.807 197.798 c 216.38 197.798 216.15 197.48 216.15 197.093 c 216.15 196.663 216.427 196.399 216.795 196.399 c 216.987 196.399 217.114 196.445 217.21 196.487 c 217.267 196.234 l f 217.663 198.024 0.338 -1.855 re 217.824 198.365 m 217.697 198.365 217.613 198.464 217.613 198.583 c 217.613 198.702 217.701 198.798 217.832 198.798 c 217.962 198.798 218.047 198.702 218.047 198.583 c 218.047 198.464 217.962 198.365 217.828 198.365 c 217.824 198.365 l f 219.829 197.269 m 219.829 197.315 219.825 197.368 219.813 197.414 c 219.763 197.625 219.579 197.801 219.326 197.801 c 218.976 197.801 218.769 197.495 218.769 197.089 c 218.769 196.709 218.957 196.399 219.318 196.399 c 219.545 196.399 219.752 196.552 219.813 196.801 c 219.825 196.847 219.829 196.893 219.829 196.947 c 219.829 197.269 l h 220.167 198.89 m 220.167 196.648 l 220.167 196.483 220.171 196.296 220.182 196.169 c 219.879 196.169 l 219.863 196.491 l 219.856 196.491 l 219.752 196.284 219.529 196.127 219.226 196.127 c 218.776 196.127 218.427 196.506 218.427 197.07 c 218.423 197.69 218.811 198.066 219.261 198.066 c 219.548 198.066 219.741 197.932 219.821 197.786 c 219.829 197.786 l 219.829 198.89 l 220.167 198.89 l f 221.906 197.28 m 221.91 197.491 221.818 197.828 221.442 197.828 c 221.096 197.828 220.95 197.514 220.923 197.28 c 221.906 197.28 l h 220.919 197.039 m 220.927 196.583 221.215 196.395 221.553 196.395 c 221.795 196.395 221.945 196.437 222.068 196.487 c 222.129 196.25 l 222.01 196.196 221.803 196.131 221.507 196.131 c 220.939 196.131 220.593 196.51 220.593 197.066 c 220.593 197.629 220.927 198.07 221.469 198.07 c 222.075 198.07 222.233 197.537 222.233 197.196 c 222.233 197.127 222.229 197.073 222.222 197.035 c 220.919 197.039 l f 222.652 197.522 m 222.652 197.717 222.647 197.87 222.636 198.024 c 222.936 198.024 l 222.955 197.721 l 222.963 197.721 l 223.055 197.893 223.27 198.066 223.577 198.066 c 223.834 198.066 224.234 197.913 224.234 197.277 c 224.234 196.169 l 223.896 196.169 l 223.896 197.238 l 223.896 197.537 223.784 197.79 223.465 197.79 c 223.247 197.79 223.074 197.633 223.012 197.445 c 222.997 197.403 222.989 197.342 222.989 197.288 c 222.989 196.169 l 222.652 196.169 l 222.652 197.522 l f 225.174 198.468 m 225.174 198.024 l 225.658 198.024 l 225.658 197.767 l 225.174 197.767 l 225.174 196.767 l 225.174 196.537 225.24 196.407 225.428 196.407 c 225.52 196.407 225.574 196.414 225.624 196.43 c 225.639 196.173 l 225.574 196.15 225.47 196.127 225.34 196.127 c 225.182 196.127 225.056 196.181 224.975 196.269 c 224.882 196.372 224.844 196.537 224.844 196.755 c 224.844 197.767 l 224.556 197.767 l 224.556 198.024 l 224.844 198.024 l 224.844 198.365 l 225.174 198.468 l f 226.822 196.575 m 226.972 196.48 227.187 196.407 227.417 196.407 c 227.759 196.407 227.959 196.583 227.959 196.847 c 227.959 197.085 227.821 197.227 227.471 197.357 c 227.049 197.51 226.788 197.732 226.788 198.093 c 226.788 198.495 227.121 198.794 227.625 198.794 c 227.886 198.794 228.082 198.732 228.193 198.667 c 228.101 198.395 l 228.02 198.445 227.847 198.518 227.613 198.518 c 227.26 198.518 227.125 198.307 227.125 198.131 c 227.125 197.89 227.283 197.771 227.64 197.633 c 228.078 197.46 228.297 197.254 228.297 196.874 c 228.297 196.476 228.005 196.127 227.394 196.127 c 227.145 196.127 226.872 196.204 226.734 196.296 c 226.822 196.575 l f 229.138 198.468 m 229.138 198.024 l 229.622 198.024 l 229.622 197.767 l 229.138 197.767 l 229.138 196.767 l 229.138 196.537 229.203 196.407 229.391 196.407 c 229.483 196.407 229.537 196.414 229.587 196.43 c 229.602 196.173 l 229.537 196.15 229.434 196.127 229.303 196.127 c 229.145 196.127 229.019 196.181 228.938 196.269 c 228.846 196.372 228.808 196.537 228.808 196.755 c 228.808 197.767 l 228.519 197.767 l 228.519 198.024 l 228.808 198.024 l 228.808 198.365 l 229.138 198.468 l f 230.006 197.445 m 230.006 197.664 230.002 197.851 229.99 198.024 c 230.286 198.024 l 230.302 197.66 l 230.313 197.66 l 230.398 197.909 230.605 198.066 230.832 198.066 c 230.866 198.066 230.893 198.062 230.924 198.054 c 230.924 197.74 l 230.885 197.744 230.851 197.748 230.805 197.748 c 230.566 197.748 230.398 197.568 230.351 197.319 c 230.344 197.269 230.34 197.215 230.34 197.158 c 230.34 196.169 l 230.002 196.169 l 230.006 197.445 l f 232.414 197.28 m 232.418 197.491 232.325 197.828 231.949 197.828 c 231.603 197.828 231.458 197.514 231.431 197.28 c 232.414 197.28 l h 231.427 197.039 m 231.434 196.583 231.723 196.395 232.06 196.395 c 232.302 196.395 232.452 196.437 232.575 196.487 c 232.636 196.25 l 232.517 196.196 232.31 196.131 232.014 196.131 c 231.446 196.131 231.1 196.51 231.1 197.066 c 231.1 197.629 231.434 198.07 231.976 198.07 c 232.583 198.07 232.74 197.537 232.74 197.196 c 232.74 197.127 232.736 197.073 232.729 197.035 c 231.427 197.039 l f 233.113 196.51 m 233.216 196.449 233.393 196.38 233.562 196.38 c 233.804 196.38 233.919 196.499 233.919 196.656 c 233.919 196.817 233.823 196.905 233.577 196.997 c 233.239 197.119 233.082 197.299 233.082 197.522 c 233.082 197.821 233.328 198.066 233.723 198.066 c 233.911 198.066 234.077 198.016 234.176 197.951 c 234.096 197.71 l 234.023 197.752 233.888 197.817 233.716 197.817 c 233.516 197.817 233.408 197.702 233.408 197.564 c 233.408 197.407 233.516 197.338 233.758 197.246 c 234.077 197.127 234.246 196.966 234.246 196.686 c 234.246 196.357 233.988 196.127 233.554 196.127 c 233.351 196.127 233.162 196.181 233.032 196.257 c 233.113 196.51 l f 234.633 196.51 m 234.737 196.449 234.914 196.38 235.083 196.38 c 235.325 196.38 235.44 196.499 235.44 196.656 c 235.44 196.817 235.344 196.905 235.098 196.997 c 234.76 197.119 234.603 197.299 234.603 197.522 c 234.603 197.821 234.849 198.066 235.244 198.066 c 235.432 198.066 235.597 198.016 235.697 197.951 c 235.616 197.71 l 235.544 197.752 235.409 197.817 235.236 197.817 c 235.037 197.817 234.929 197.702 234.929 197.564 c 234.929 197.407 235.037 197.338 235.279 197.246 c 235.597 197.127 235.766 196.966 235.766 196.686 c 235.766 196.357 235.509 196.127 235.075 196.127 c 234.871 196.127 234.683 196.181 234.553 196.257 c 234.633 196.51 l f 237.022 198.752 m 238.416 198.752 l 238.416 198.472 l 237.36 198.472 l 237.36 197.614 l 238.335 197.614 l 238.335 197.338 l 237.36 197.338 l 237.36 196.169 l 237.022 196.169 l 237.022 198.752 l f 239.538 196.38 m 239.86 196.38 240.102 196.683 240.102 197.104 c 240.102 197.418 239.945 197.813 239.545 197.813 c 239.15 197.813 238.977 197.445 238.977 197.093 c 238.977 196.686 239.207 196.38 239.534 196.38 c 239.538 196.38 l h 239.526 196.127 m 239.027 196.127 238.635 196.495 238.635 197.081 c 238.635 197.702 239.046 198.066 239.557 198.066 c 240.091 198.066 240.452 197.679 240.452 197.116 c 240.452 196.426 239.972 196.127 239.53 196.127 c 239.526 196.127 l f 242.433 196.675 m 242.433 196.483 242.437 196.315 242.449 196.169 c 242.149 196.169 l 242.13 196.472 l 242.122 196.472 l 242.038 196.322 241.838 196.127 241.508 196.127 c 241.216 196.127 240.866 196.292 240.866 196.939 c 240.866 198.024 l 241.204 198.024 l 241.204 197.001 l 241.204 196.648 241.316 196.407 241.619 196.407 c 241.846 196.407 242.003 196.564 242.065 196.717 c 242.084 196.763 242.095 196.824 242.095 196.889 c 242.095 198.024 l 242.433 198.024 l 242.433 196.675 l f 242.994 197.522 m 242.994 197.717 242.99 197.87 242.978 198.024 c 243.278 198.024 l 243.297 197.721 l 243.305 197.721 l 243.397 197.893 243.612 198.066 243.919 198.066 c 244.177 198.066 244.576 197.913 244.576 197.277 c 244.576 196.169 l 244.238 196.169 l 244.238 197.238 l 244.238 197.537 244.127 197.79 243.808 197.79 c 243.589 197.79 243.416 197.633 243.355 197.445 c 243.339 197.403 243.332 197.342 243.332 197.288 c 243.332 196.169 l 242.994 196.169 l 242.994 197.522 l f 246.393 197.269 m 246.393 197.315 246.389 197.368 246.377 197.414 c 246.327 197.625 246.143 197.801 245.889 197.801 c 245.54 197.801 245.333 197.495 245.333 197.089 c 245.333 196.709 245.521 196.399 245.882 196.399 c 246.108 196.399 246.316 196.552 246.377 196.801 c 246.389 196.847 246.393 196.893 246.393 196.947 c 246.393 197.269 l h 246.73 198.89 m 246.73 196.648 l 246.73 196.483 246.734 196.296 246.746 196.169 c 246.443 196.169 l 246.427 196.491 l 246.419 196.491 l 246.316 196.284 246.093 196.127 245.79 196.127 c 245.34 196.127 244.991 196.506 244.991 197.07 c 244.987 197.69 245.375 198.066 245.824 198.066 c 246.112 198.066 246.304 197.932 246.385 197.786 c 246.393 197.786 l 246.393 198.89 l 246.73 198.89 l f 248.271 197.116 m 247.902 197.123 247.483 197.058 247.483 196.698 c 247.483 196.476 247.629 196.376 247.798 196.376 c 248.044 196.376 248.202 196.529 248.255 196.686 c 248.267 196.721 248.271 196.759 248.271 196.794 c 248.271 197.116 l h 248.601 196.614 m 248.601 196.453 248.609 196.296 248.628 196.169 c 248.325 196.169 l 248.294 196.403 l 248.282 196.403 l 248.182 196.257 247.979 196.127 247.714 196.127 c 247.337 196.127 247.145 196.391 247.145 196.66 c 247.145 197.108 247.545 197.353 248.263 197.349 c 248.263 197.388 l 248.263 197.541 248.221 197.821 247.841 197.817 c 247.664 197.817 247.483 197.767 247.353 197.679 c 247.276 197.905 l 247.43 198.001 247.656 198.066 247.891 198.066 c 248.463 198.066 248.601 197.679 248.601 197.307 c 248.601 196.614 l f 249.534 198.468 m 249.534 198.024 l 250.018 198.024 l 250.018 197.767 l 249.534 197.767 l 249.534 196.767 l 249.534 196.537 249.599 196.407 249.788 196.407 c 249.88 196.407 249.934 196.414 249.983 196.43 c 249.999 196.173 l 249.934 196.15 249.83 196.127 249.699 196.127 c 249.542 196.127 249.415 196.181 249.334 196.269 c 249.242 196.372 249.204 196.537 249.204 196.755 c 249.204 197.767 l 248.916 197.767 l 248.916 198.024 l 249.204 198.024 l 249.204 198.365 l 249.534 198.468 l f 250.398 198.024 0.338 -1.855 re 250.559 198.365 m 250.433 198.365 250.348 198.464 250.348 198.583 c 250.348 198.702 250.436 198.798 250.567 198.798 c 250.698 198.798 250.782 198.702 250.782 198.583 c 250.782 198.464 250.698 198.365 250.563 198.365 c 250.559 198.365 l f 252.065 196.38 m 252.388 196.38 252.63 196.683 252.63 197.104 c 252.63 197.418 252.472 197.813 252.073 197.813 c 251.677 197.813 251.504 197.445 251.504 197.093 c 251.504 196.686 251.735 196.38 252.061 196.38 c 252.065 196.38 l h 252.053 196.127 m 251.554 196.127 251.162 196.495 251.162 197.081 c 251.162 197.702 251.573 198.066 252.084 198.066 c 252.618 198.066 252.979 197.679 252.979 197.116 c 252.979 196.426 252.499 196.127 252.057 196.127 c 252.053 196.127 l f 253.405 197.522 m 253.405 197.717 253.401 197.87 253.39 198.024 c 253.689 198.024 l 253.709 197.721 l 253.716 197.721 l 253.808 197.893 254.023 198.066 254.331 198.066 c 254.588 198.066 254.988 197.913 254.988 197.277 c 254.988 196.169 l 254.649 196.169 l 254.649 197.238 l 254.649 197.537 254.538 197.79 254.219 197.79 c 254.001 197.79 253.828 197.633 253.766 197.445 c 253.751 197.403 253.743 197.342 253.743 197.288 c 253.743 196.169 l 253.405 196.169 l 253.405 197.522 l f 171.181 191.337 m 170.962 191.337 170.781 191.514 170.781 191.74 c 170.777 191.962 170.962 192.142 171.184 192.142 c 171.407 192.142 171.588 191.966 171.588 191.74 c 171.588 191.518 171.407 191.337 171.184 191.337 c 171.181 191.337 l f 174.762 191.494 m 174.505 192.238 l 174.451 192.406 174.413 192.56 174.374 192.709 c 174.363 192.709 l 174.328 192.56 174.286 192.399 174.236 192.242 c 173.983 191.494 l 174.762 191.494 l h 173.914 191.234 m 173.645 190.422 l 173.299 190.422 l 174.179 193.004 l 174.582 193.004 l 175.465 190.422 l 175.108 190.422 l 174.831 191.234 l 173.914 191.234 l f 176.652 191.698 m 176.652 191.916 176.648 192.104 176.636 192.276 c 176.932 192.276 l 176.947 191.912 l 176.959 191.912 l 177.043 192.161 177.251 192.318 177.477 192.318 c 177.512 192.318 177.539 192.315 177.57 192.307 c 177.57 191.993 l 177.531 191.996 177.497 192 177.45 192 c 177.212 192 177.043 191.82 176.997 191.571 c 176.99 191.521 176.986 191.468 176.986 191.41 c 176.986 190.422 l 176.648 190.422 l 176.652 191.698 l f 179.06 191.533 m 179.063 191.744 178.971 192.081 178.595 192.081 c 178.249 192.081 178.103 191.767 178.076 191.533 c 179.06 191.533 l h 178.073 191.291 m 178.08 190.835 178.368 190.648 178.706 190.648 c 178.948 190.648 179.098 190.69 179.221 190.74 c 179.282 190.502 l 179.163 190.448 178.956 190.383 178.66 190.383 c 178.092 190.383 177.746 190.763 177.746 191.318 c 177.746 191.882 178.08 192.322 178.622 192.322 c 179.229 192.322 179.386 191.79 179.386 191.448 c 179.386 191.38 179.382 191.326 179.375 191.288 c 178.073 191.291 l f 179.928 192.276 m 180.292 191.238 l 180.354 191.065 180.404 190.912 180.442 190.759 c 180.454 190.759 l 180.496 190.912 180.55 191.065 180.611 191.238 c 180.972 192.276 l 181.326 192.276 l 180.596 190.422 l 180.273 190.422 l 179.567 192.276 l 179.928 192.276 l f 181.644 192.276 0.338 -1.855 re 181.805 192.617 m 181.679 192.617 181.594 192.717 181.594 192.836 c 181.594 192.954 181.683 193.05 181.813 193.05 c 181.944 193.05 182.028 192.954 182.028 192.836 c 182.028 192.717 181.944 192.617 181.809 192.617 c 181.805 192.617 l f 183.722 191.533 m 183.726 191.744 183.634 192.081 183.257 192.081 c 182.911 192.081 182.766 191.767 182.739 191.533 c 183.722 191.533 l h 182.735 191.291 m 182.743 190.835 183.031 190.648 183.369 190.648 c 183.61 190.648 183.76 190.69 183.883 190.74 c 183.945 190.502 l 183.826 190.448 183.618 190.383 183.322 190.383 c 182.754 190.383 182.408 190.763 182.408 191.318 c 182.408 191.882 182.743 192.322 183.284 192.322 c 183.891 192.322 184.048 191.79 184.048 191.448 c 184.048 191.38 184.044 191.326 184.037 191.288 c 182.735 191.291 l f 184.601 192.276 m 184.851 191.337 l 184.901 191.131 184.951 190.935 184.985 190.743 c 184.997 190.743 l 185.039 190.931 185.1 191.131 185.162 191.334 c 185.465 192.276 l 185.749 192.276 l 186.038 191.349 l 186.107 191.131 186.16 190.931 186.203 190.743 c 186.214 190.743 l 186.245 190.931 186.295 191.127 186.356 191.345 c 186.621 192.276 l 186.955 192.276 l 186.356 190.422 l 186.049 190.422 l 185.765 191.307 l 185.7 191.518 185.646 191.701 185.6 191.92 c 185.592 191.92 l 185.546 191.698 185.488 191.502 185.423 191.303 c 185.124 190.422 l 184.816 190.422 l 184.256 192.276 l 184.601 192.276 l f 188.876 190.632 m 189.198 190.632 189.44 190.935 189.44 191.357 c 189.44 191.671 189.283 192.065 188.883 192.065 c 188.488 192.065 188.315 191.698 188.315 191.345 c 188.315 190.939 188.545 190.632 188.872 190.632 c 188.876 190.632 l h 188.864 190.38 m 188.365 190.38 187.973 190.747 187.973 191.334 c 187.973 191.954 188.384 192.318 188.895 192.318 c 189.429 192.318 189.79 191.931 189.79 191.368 c 189.79 190.678 189.31 190.38 188.868 190.38 c 188.864 190.38 l f 190.247 190.422 m 190.247 192.019 l 189.989 192.019 l 189.989 192.276 l 190.247 192.276 l 190.247 192.364 l 190.247 192.625 190.308 192.862 190.466 193.012 c 190.592 193.134 190.761 193.184 190.915 193.184 c 191.038 193.184 191.138 193.157 191.203 193.131 c 191.161 192.87 l 191.107 192.893 191.042 192.912 190.942 192.912 c 190.657 192.912 190.581 192.659 190.581 192.376 c 190.581 192.276 l 191.03 192.276 l 191.03 192.019 l 190.585 192.019 l 190.585 190.422 l 190.247 190.422 l f 192.558 192.721 m 192.558 192.276 l 193.042 192.276 l 193.042 192.019 l 192.558 192.019 l 192.558 191.019 l 192.558 190.789 192.624 190.659 192.812 190.659 c 192.904 190.659 192.958 190.667 193.008 190.682 c 193.023 190.426 l 192.958 190.402 192.854 190.38 192.724 190.38 c 192.566 190.38 192.439 190.433 192.359 190.521 c 192.267 190.625 192.228 190.789 192.228 191.008 c 192.228 192.019 l 191.94 192.019 l 191.94 192.276 l 192.228 192.276 l 192.228 192.617 l 192.558 192.721 l f 193.422 193.142 m 193.76 193.142 l 193.76 191.985 l 193.768 191.985 l 193.822 192.081 193.906 192.169 194.01 192.223 c 194.11 192.284 194.229 192.318 194.356 192.318 c 194.605 192.318 195.005 192.165 195.005 191.525 c 195.005 190.422 l 194.667 190.422 l 194.667 191.487 l 194.667 191.79 194.555 192.039 194.237 192.039 c 194.018 192.039 193.849 191.885 193.783 191.701 c 193.764 191.656 193.76 191.606 193.76 191.54 c 193.76 190.422 l 193.422 190.422 l 193.422 193.142 l f 196.733 191.533 m 196.737 191.744 196.645 192.081 196.268 192.081 c 195.923 192.081 195.777 191.767 195.75 191.533 c 196.733 191.533 l h 195.746 191.291 m 195.754 190.835 196.042 190.648 196.38 190.648 c 196.622 190.648 196.771 190.69 196.894 190.74 c 196.956 190.502 l 196.837 190.448 196.629 190.383 196.334 190.383 c 195.765 190.383 195.42 190.763 195.42 191.318 c 195.42 191.882 195.754 192.322 196.295 192.322 c 196.902 192.322 197.059 191.79 197.059 191.448 c 197.059 191.38 197.056 191.326 197.048 191.288 c 195.746 191.291 l f 198.292 191.774 m 198.292 191.97 198.285 192.123 198.277 192.276 c 198.572 192.276 l 198.588 191.977 l 198.599 191.977 l 198.703 192.153 198.876 192.318 199.187 192.318 c 199.437 192.318 199.628 192.165 199.709 191.947 c 199.717 191.947 l 199.774 192.054 199.851 192.131 199.928 192.188 c 200.039 192.272 200.159 192.318 200.335 192.318 c 200.585 192.318 200.95 192.157 200.95 191.514 c 200.95 190.422 l 200.619 190.422 l 200.619 191.472 l 200.619 191.832 200.485 192.042 200.216 192.042 c 200.02 192.042 199.874 191.901 199.813 191.74 c 199.798 191.69 199.786 191.629 199.786 191.571 c 199.786 190.422 l 199.456 190.422 l 199.456 191.533 l 199.456 191.832 199.325 192.042 199.068 192.042 c 198.86 192.042 198.703 191.874 198.649 191.705 c 198.63 191.656 198.622 191.598 198.622 191.54 c 198.622 190.422 l 198.292 190.422 l 198.292 191.774 l f 202.474 191.368 m 202.106 191.376 201.687 191.311 201.687 190.95 c 201.687 190.728 201.833 190.629 202.002 190.629 c 202.248 190.629 202.405 190.782 202.459 190.939 c 202.471 190.973 202.474 191.012 202.474 191.046 c 202.474 191.368 l h 202.805 190.866 m 202.805 190.705 202.813 190.548 202.832 190.422 c 202.528 190.422 l 202.498 190.655 l 202.486 190.655 l 202.386 190.51 202.182 190.38 201.917 190.38 c 201.541 190.38 201.349 190.644 201.349 190.912 c 201.349 191.36 201.749 191.606 202.467 191.602 c 202.467 191.64 l 202.467 191.793 202.424 192.073 202.044 192.069 c 201.867 192.069 201.687 192.019 201.556 191.931 c 201.48 192.157 l 201.633 192.253 201.86 192.318 202.094 192.318 c 202.666 192.318 202.805 191.931 202.805 191.56 c 202.805 190.866 l f 203.346 192.276 0.338 -1.855 re 203.507 192.617 m 203.381 192.617 203.296 192.717 203.296 192.836 c 203.296 192.954 203.384 193.05 203.515 193.05 c 203.646 193.05 203.73 192.954 203.73 192.836 c 203.73 192.717 203.646 192.617 203.511 192.617 c 203.507 192.617 l f 204.245 191.774 m 204.245 191.97 204.241 192.123 204.23 192.276 c 204.529 192.276 l 204.548 191.973 l 204.556 191.973 l 204.648 192.146 204.863 192.318 205.17 192.318 c 205.428 192.318 205.827 192.165 205.827 191.529 c 205.827 190.422 l 205.489 190.422 l 205.489 191.491 l 205.489 191.79 205.378 192.042 205.059 192.042 c 204.84 192.042 204.667 191.885 204.606 191.698 c 204.59 191.656 204.583 191.594 204.583 191.54 c 204.583 190.422 l 204.245 190.422 l 204.245 191.774 l f 207.597 192.721 m 207.597 192.276 l 208.081 192.276 l 208.081 192.019 l 207.597 192.019 l 207.597 191.019 l 207.597 190.789 207.662 190.659 207.851 190.659 c 207.943 190.659 207.997 190.667 208.047 190.682 c 208.062 190.426 l 207.997 190.402 207.893 190.38 207.762 190.38 c 207.605 190.38 207.478 190.433 207.397 190.521 c 207.306 190.625 207.267 190.789 207.267 191.008 c 207.267 192.019 l 206.979 192.019 l 206.979 192.276 l 207.267 192.276 l 207.267 192.617 l 207.597 192.721 l f 209.617 191.533 m 209.621 191.744 209.529 192.081 209.153 192.081 c 208.807 192.081 208.661 191.767 208.634 191.533 c 209.617 191.533 l h 208.63 191.291 m 208.638 190.835 208.926 190.648 209.264 190.648 c 209.506 190.648 209.656 190.69 209.779 190.74 c 209.84 190.502 l 209.721 190.448 209.514 190.383 209.218 190.383 c 208.649 190.383 208.304 190.763 208.304 191.318 c 208.304 191.882 208.638 192.322 209.179 192.322 c 209.786 192.322 209.944 191.79 209.944 191.448 c 209.944 191.38 209.94 191.326 209.932 191.288 c 208.63 191.291 l f 211.342 191.368 m 210.973 191.376 210.555 191.311 210.555 190.95 c 210.555 190.728 210.7 190.629 210.869 190.629 c 211.115 190.629 211.273 190.782 211.327 190.939 c 211.338 190.973 211.342 191.012 211.342 191.046 c 211.342 191.368 l h 211.672 190.866 m 211.672 190.705 211.68 190.548 211.699 190.422 c 211.395 190.422 l 211.365 190.655 l 211.353 190.655 l 211.253 190.51 211.05 190.38 210.785 190.38 c 210.408 190.38 210.216 190.644 210.216 190.912 c 210.216 191.36 210.616 191.606 211.334 191.602 c 211.334 191.64 l 211.334 191.793 211.292 192.073 210.912 192.069 c 210.735 192.069 210.555 192.019 210.424 191.931 c 210.347 192.157 l 210.501 192.253 210.727 192.318 210.962 192.318 c 211.534 192.318 211.672 191.931 211.672 191.56 c 211.672 190.866 l f 213.538 190.487 m 213.45 190.445 213.254 190.38 213.005 190.38 c 212.444 190.38 212.079 190.759 212.079 191.33 c 212.079 191.901 212.471 192.318 213.077 192.318 c 213.277 192.318 213.454 192.269 213.546 192.219 c 213.469 191.962 l 213.389 192.004 213.262 192.05 213.077 192.05 c 212.651 192.05 212.421 191.732 212.421 191.345 c 212.421 190.916 212.697 190.652 213.066 190.652 c 213.258 190.652 213.385 190.698 213.481 190.74 c 213.538 190.487 l f 213.934 193.142 m 214.272 193.142 l 214.272 191.985 l 214.279 191.985 l 214.333 192.081 214.418 192.169 214.521 192.223 c 214.621 192.284 214.74 192.318 214.867 192.318 c 215.117 192.318 215.516 192.165 215.516 191.525 c 215.516 190.422 l 215.178 190.422 l 215.178 191.487 l 215.178 191.79 215.067 192.039 214.748 192.039 c 214.529 192.039 214.36 191.885 214.295 191.701 c 214.276 191.656 214.272 191.606 214.272 191.54 c 214.272 190.422 l 213.934 190.422 l 213.934 193.142 l f 216.065 192.276 0.338 -1.855 re 216.227 192.617 m 216.1 192.617 216.016 192.717 216.016 192.836 c 216.016 192.954 216.104 193.05 216.234 193.05 c 216.365 193.05 216.45 192.954 216.45 192.836 c 216.45 192.717 216.365 192.617 216.231 192.617 c 216.227 192.617 l f 216.964 191.774 m 216.964 191.97 216.96 192.123 216.948 192.276 c 217.248 192.276 l 217.267 191.973 l 217.275 191.973 l 217.367 192.146 217.582 192.318 217.889 192.318 c 218.147 192.318 218.546 192.165 218.546 191.529 c 218.546 190.422 l 218.208 190.422 l 218.208 191.491 l 218.208 191.79 218.097 192.042 217.778 192.042 c 217.559 192.042 217.386 191.885 217.325 191.698 c 217.31 191.656 217.302 191.594 217.302 191.54 c 217.302 190.422 l 216.964 190.422 l 216.964 191.774 l f 220.348 191.548 m 220.348 191.602 220.344 191.652 220.328 191.698 c 220.267 191.897 220.106 192.058 219.856 192.058 c 219.533 192.058 219.303 191.786 219.303 191.353 c 219.303 190.993 219.491 190.686 219.852 190.686 c 220.063 190.686 220.251 190.816 220.321 191.035 c 220.34 191.088 220.348 191.153 220.348 191.215 c 220.348 191.548 l h 220.685 190.694 m 220.685 190.264 220.597 190.008 220.42 189.843 c 220.236 189.678 219.975 189.621 219.741 189.621 c 219.518 189.621 219.272 189.674 219.122 189.774 c 219.207 190.035 l 219.33 189.954 219.522 189.885 219.752 189.885 c 220.098 189.885 220.351 190.065 220.351 190.537 c 220.351 190.74 l 220.344 190.74 l 220.244 190.567 220.04 190.429 219.752 190.429 c 219.291 190.429 218.961 190.82 218.961 191.337 c 218.961 191.966 219.372 192.318 219.802 192.318 c 220.124 192.318 220.298 192.153 220.382 192 c 220.389 192 l 220.401 192.276 l 220.701 192.276 l 220.689 192.146 220.685 191.996 220.685 191.77 c 220.685 190.694 l f 222.394 191.177 m 222.394 191.131 222.398 191.081 222.41 191.039 c 222.467 190.805 222.675 190.644 222.913 190.644 c 223.27 190.644 223.477 190.935 223.477 191.36 c 223.477 191.732 223.285 192.05 222.928 192.05 c 222.698 192.05 222.478 191.889 222.413 191.636 c 222.406 191.59 222.394 191.54 222.394 191.498 c 222.394 191.177 l h 222.056 191.671 m 222.056 191.908 222.052 192.1 222.041 192.276 c 222.344 192.276 l 222.363 191.958 l 222.371 191.958 l 222.505 192.188 222.728 192.318 223.028 192.318 c 223.481 192.318 223.819 191.939 223.819 191.376 c 223.819 190.709 223.408 190.38 222.974 190.38 c 222.724 190.38 222.513 190.487 222.402 190.671 c 222.394 190.671 l 222.394 189.663 l 222.056 189.663 l 222.056 191.671 l f 225.013 190.632 m 225.336 190.632 225.578 190.935 225.578 191.357 c 225.578 191.671 225.42 192.065 225.021 192.065 c 224.626 192.065 224.452 191.698 224.452 191.345 c 224.452 190.939 224.683 190.632 225.009 190.632 c 225.013 190.632 l h 225.002 190.38 m 224.502 190.38 224.111 190.747 224.111 191.334 c 224.111 191.954 224.522 192.318 225.032 192.318 c 225.566 192.318 225.927 191.931 225.927 191.368 c 225.927 190.678 225.447 190.38 225.006 190.38 c 225.002 190.38 l f 226.354 192.276 0.338 -1.855 re 226.515 192.617 m 226.388 192.617 226.304 192.717 226.304 192.836 c 226.304 192.954 226.392 193.05 226.523 193.05 c 226.653 193.05 226.738 192.954 226.738 192.836 c 226.738 192.717 226.653 192.617 226.519 192.617 c 226.515 192.617 l f 227.252 191.774 m 227.252 191.97 227.248 192.123 227.237 192.276 c 227.536 192.276 l 227.556 191.973 l 227.563 191.973 l 227.656 192.146 227.871 192.318 228.178 192.318 c 228.435 192.318 228.834 192.165 228.834 191.529 c 228.834 190.422 l 228.497 190.422 l 228.497 191.491 l 228.497 191.79 228.385 192.042 228.067 192.042 c 227.847 192.042 227.675 191.885 227.613 191.698 c 227.598 191.656 227.59 191.594 227.59 191.54 c 227.59 190.422 l 227.252 190.422 l 227.252 191.774 l f 229.775 192.721 m 229.775 192.276 l 230.259 192.276 l 230.259 192.019 l 229.775 192.019 l 229.775 191.019 l 229.775 190.789 229.84 190.659 230.029 190.659 c 230.121 190.659 230.175 190.667 230.225 190.682 c 230.24 190.426 l 230.175 190.402 230.071 190.38 229.94 190.38 c 229.783 190.38 229.656 190.433 229.576 190.521 c 229.484 190.625 229.445 190.789 229.445 191.008 c 229.445 192.019 l 229.157 192.019 l 229.157 192.276 l 229.445 192.276 l 229.445 192.617 l 229.775 192.721 l f 230.593 190.763 m 230.697 190.701 230.874 190.632 231.042 190.632 c 231.284 190.632 231.4 190.751 231.4 190.908 c 231.4 191.069 231.304 191.157 231.058 191.249 c 230.72 191.372 230.562 191.552 230.562 191.774 c 230.562 192.073 230.808 192.318 231.204 192.318 c 231.392 192.318 231.557 192.269 231.657 192.203 c 231.576 191.962 l 231.503 192.004 231.369 192.069 231.196 192.069 c 230.997 192.069 230.889 191.954 230.889 191.816 c 230.889 191.659 230.997 191.59 231.238 191.498 c 231.557 191.38 231.726 191.219 231.726 190.939 c 231.726 190.609 231.469 190.38 231.035 190.38 c 230.831 190.38 230.643 190.433 230.513 190.51 c 230.593 190.763 l f 233.005 190.422 m 233.005 192.019 l 232.748 192.019 l 232.748 192.276 l 233.005 192.276 l 233.005 192.364 l 233.005 192.625 233.066 192.862 233.224 193.012 c 233.351 193.134 233.52 193.184 233.673 193.184 c 233.796 193.184 233.896 193.157 233.961 193.131 c 233.919 192.87 l 233.865 192.893 233.8 192.912 233.7 192.912 c 233.416 192.912 233.339 192.659 233.339 192.376 c 233.339 192.276 l 233.788 192.276 l 233.788 192.019 l 233.343 192.019 l 233.343 190.422 l 233.005 190.422 l f 234.099 191.698 m 234.099 191.916 234.096 192.104 234.084 192.276 c 234.38 192.276 l 234.395 191.912 l 234.407 191.912 l 234.491 192.161 234.698 192.318 234.925 192.318 c 234.96 192.318 234.987 192.315 235.017 192.307 c 235.017 191.993 l 234.979 191.996 234.944 192 234.898 192 c 234.66 192 234.491 191.82 234.445 191.571 c 234.438 191.521 234.433 191.468 234.433 191.41 c 234.433 190.422 l 234.096 190.422 l 234.099 191.698 l f 236.097 190.632 m 236.419 190.632 236.661 190.935 236.661 191.357 c 236.661 191.671 236.504 192.065 236.104 192.065 c 235.709 192.065 235.536 191.698 235.536 191.345 c 235.536 190.939 235.766 190.632 236.093 190.632 c 236.097 190.632 l h 236.085 190.38 m 235.586 190.38 235.194 190.747 235.194 191.334 c 235.194 191.954 235.605 192.318 236.116 192.318 c 236.65 192.318 237.011 191.931 237.011 191.368 c 237.011 190.678 236.531 190.38 236.089 190.38 c 236.085 190.38 l f 237.437 191.774 m 237.437 191.97 237.429 192.123 237.422 192.276 c 237.717 192.276 l 237.733 191.977 l 237.744 191.977 l 237.848 192.153 238.021 192.318 238.332 192.318 c 238.581 192.318 238.773 192.165 238.854 191.947 c 238.862 191.947 l 238.919 192.054 238.996 192.131 239.073 192.188 c 239.184 192.272 239.303 192.318 239.48 192.318 c 239.73 192.318 240.094 192.157 240.094 191.514 c 240.094 190.422 l 239.764 190.422 l 239.764 191.472 l 239.764 191.832 239.63 192.042 239.361 192.042 c 239.165 192.042 239.019 191.901 238.958 191.74 c 238.942 191.69 238.931 191.629 238.931 191.571 c 238.931 190.422 l 238.6 190.422 l 238.6 191.533 l 238.6 191.832 238.47 192.042 238.213 192.042 c 238.005 192.042 237.848 191.874 237.794 191.705 c 237.775 191.656 237.767 191.598 237.767 191.54 c 237.767 190.422 l 237.437 190.422 l 237.437 191.774 l f 241.861 192.721 m 241.861 192.276 l 242.345 192.276 l 242.345 192.019 l 241.861 192.019 l 241.861 191.019 l 241.861 190.789 241.926 190.659 242.115 190.659 c 242.206 190.659 242.261 190.667 242.31 190.682 c 242.326 190.426 l 242.261 190.402 242.157 190.38 242.026 190.38 c 241.869 190.38 241.742 190.433 241.661 190.521 c 241.569 190.625 241.531 190.789 241.531 191.008 c 241.531 192.019 l 241.243 192.019 l 241.243 192.276 l 241.531 192.276 l 241.531 192.617 l 241.861 192.721 l f 242.725 193.142 m 243.063 193.142 l 243.063 191.985 l 243.071 191.985 l 243.124 192.081 243.209 192.169 243.313 192.223 c 243.413 192.284 243.532 192.318 243.658 192.318 c 243.908 192.318 244.307 192.165 244.307 191.525 c 244.307 190.422 l 243.969 190.422 l 243.969 191.487 l 243.969 191.79 243.858 192.039 243.539 192.039 c 243.32 192.039 243.151 191.885 243.086 191.701 c 243.067 191.656 243.063 191.606 243.063 191.54 c 243.063 190.422 l 242.725 190.422 l 242.725 193.142 l f 246.035 191.533 m 246.039 191.744 245.947 192.081 245.571 192.081 c 245.225 192.081 245.079 191.767 245.052 191.533 c 246.035 191.533 l h 245.048 191.291 m 245.056 190.835 245.344 190.648 245.682 190.648 c 245.924 190.648 246.074 190.69 246.197 190.74 c 246.258 190.502 l 246.139 190.448 245.932 190.383 245.636 190.383 c 245.068 190.383 244.722 190.763 244.722 191.318 c 244.722 191.882 245.056 192.322 245.598 192.322 c 246.204 192.322 246.362 191.79 246.362 191.448 c 246.362 191.38 246.358 191.326 246.35 191.288 c 245.048 191.291 l f 248.002 192.721 m 248.002 192.276 l 248.486 192.276 l 248.486 192.019 l 248.002 192.019 l 248.002 191.019 l 248.002 190.789 248.067 190.659 248.255 190.659 c 248.347 190.659 248.401 190.667 248.451 190.682 c 248.466 190.426 l 248.401 190.402 248.297 190.38 248.167 190.38 c 248.009 190.38 247.883 190.433 247.802 190.521 c 247.71 190.625 247.671 190.789 247.671 191.008 c 247.671 192.019 l 247.383 192.019 l 247.383 192.276 l 247.671 192.276 l 247.671 192.617 l 248.002 192.721 l f 249.015 192.276 m 249.265 191.337 l 249.315 191.131 249.365 190.935 249.399 190.743 c 249.411 190.743 l 249.453 190.931 249.515 191.131 249.576 191.334 c 249.88 192.276 l 250.164 192.276 l 250.452 191.349 l 250.521 191.131 250.575 190.931 250.617 190.743 c 250.628 190.743 l 250.659 190.931 250.709 191.127 250.771 191.345 c 251.036 192.276 l 251.37 192.276 l 250.771 190.422 l 250.463 190.422 l 250.179 191.307 l 250.114 191.518 250.06 191.701 250.014 191.92 c 250.006 191.92 l 249.96 191.698 249.903 191.502 249.837 191.303 c 249.538 190.422 l 249.23 190.422 l 248.67 192.276 l 249.015 192.276 l f 252.441 190.632 m 252.764 190.632 253.006 190.935 253.006 191.357 c 253.006 191.671 252.848 192.065 252.449 192.065 c 252.053 192.065 251.881 191.698 251.881 191.345 c 251.881 190.939 252.111 190.632 252.437 190.632 c 252.441 190.632 l h 252.43 190.38 m 251.93 190.38 251.539 190.747 251.539 191.334 c 251.539 191.954 251.95 192.318 252.46 192.318 c 252.994 192.318 253.355 191.931 253.355 191.368 c 253.355 190.678 252.875 190.38 252.434 190.38 c 252.43 190.38 l f 253.616 191.579 0.949 -0.245 re f 256.228 191.521 m 256.228 191.567 256.224 191.621 256.212 191.667 c 256.162 191.878 255.978 192.054 255.725 192.054 c 255.375 192.054 255.168 191.747 255.168 191.341 c 255.168 190.962 255.356 190.652 255.717 190.652 c 255.944 190.652 256.151 190.805 256.212 191.054 c 256.224 191.1 256.228 191.146 256.228 191.199 c 256.228 191.521 l h 256.566 193.142 m 256.566 190.901 l 256.566 190.736 256.57 190.548 256.581 190.422 c 256.278 190.422 l 256.262 190.743 l 256.255 190.743 l 256.151 190.537 255.928 190.38 255.625 190.38 c 255.175 190.38 254.826 190.759 254.826 191.322 c 254.822 191.943 255.21 192.318 255.659 192.318 c 255.947 192.318 256.139 192.184 256.22 192.039 c 256.228 192.039 l 256.228 193.142 l 256.566 193.142 l f 258.106 191.368 m 257.737 191.376 257.318 191.311 257.318 190.95 c 257.318 190.728 257.464 190.629 257.633 190.629 c 257.879 190.629 258.037 190.782 258.09 190.939 c 258.102 190.973 258.106 191.012 258.106 191.046 c 258.106 191.368 l h 258.436 190.866 m 258.436 190.705 258.444 190.548 258.463 190.422 c 258.16 190.422 l 258.129 190.655 l 258.117 190.655 l 258.018 190.51 257.814 190.38 257.549 190.38 c 257.172 190.38 256.981 190.644 256.981 190.912 c 256.981 191.36 257.38 191.606 258.098 191.602 c 258.098 191.64 l 258.098 191.793 258.056 192.073 257.676 192.069 c 257.499 192.069 257.318 192.019 257.188 191.931 c 257.111 192.157 l 257.265 192.253 257.491 192.318 257.726 192.318 c 258.298 192.318 258.436 191.931 258.436 191.56 c 258.436 190.866 l f 259.058 192.276 m 259.461 191.18 l 259.507 191.058 259.553 190.912 259.584 190.801 c 259.592 190.801 l 259.626 190.912 259.665 191.054 259.711 191.188 c 260.08 192.276 l 260.437 192.276 l 259.93 190.954 l 259.688 190.318 259.523 189.992 259.292 189.789 c 259.123 189.648 258.962 189.59 258.878 189.575 c 258.793 189.858 l 258.878 189.881 258.989 189.935 259.089 190.023 c 259.181 190.096 259.292 190.226 259.373 190.399 c 259.388 190.433 259.4 190.456 259.4 190.479 c 259.4 190.498 259.392 190.525 259.373 190.563 c 258.69 192.276 l 259.058 192.276 l f 262.883 190.487 m 262.795 190.445 262.599 190.38 262.349 190.38 c 261.789 190.38 261.424 190.759 261.424 191.33 c 261.424 191.901 261.815 192.318 262.422 192.318 c 262.622 192.318 262.799 192.269 262.891 192.219 c 262.814 191.962 l 262.733 192.004 262.607 192.05 262.422 192.05 c 261.996 192.05 261.766 191.732 261.766 191.345 c 261.766 190.916 262.042 190.652 262.411 190.652 c 262.603 190.652 262.73 190.698 262.826 190.74 c 262.883 190.487 l f 264.024 190.632 m 264.346 190.632 264.588 190.935 264.588 191.357 c 264.588 191.671 264.431 192.065 264.031 192.065 c 263.636 192.065 263.463 191.698 263.463 191.345 c 263.463 190.939 263.694 190.632 264.02 190.632 c 264.024 190.632 l h 264.012 190.38 m 263.513 190.38 263.121 190.747 263.121 191.334 c 263.121 191.954 263.532 192.318 264.043 192.318 c 264.577 192.318 264.938 191.931 264.938 191.368 c 264.938 190.678 264.458 190.38 264.016 190.38 c 264.012 190.38 l f 266.919 190.927 m 266.919 190.736 266.923 190.567 266.935 190.422 c 266.635 190.422 l 266.616 190.724 l 266.608 190.724 l 266.524 190.575 266.324 190.38 265.994 190.38 c 265.702 190.38 265.352 190.544 265.352 191.192 c 265.352 192.276 l 265.691 192.276 l 265.691 191.253 l 265.691 190.901 265.802 190.659 266.105 190.659 c 266.332 190.659 266.489 190.816 266.551 190.969 c 266.57 191.015 266.581 191.077 266.581 191.142 c 266.581 192.276 l 266.919 192.276 l 266.919 190.927 l f 267.484 191.698 m 267.484 191.916 267.48 192.104 267.469 192.276 c 267.764 192.276 l 267.78 191.912 l 267.791 191.912 l 267.876 192.161 268.083 192.318 268.31 192.318 c 268.344 192.318 268.371 192.315 268.402 192.307 c 268.402 191.993 l 268.363 191.996 268.329 192 268.283 192 c 268.045 192 267.876 191.82 267.83 191.571 c 267.822 191.521 267.818 191.468 267.818 191.41 c 267.818 190.422 l 267.48 190.422 l 267.484 191.698 l f 268.69 190.763 m 268.793 190.701 268.97 190.632 269.139 190.632 c 269.381 190.632 269.496 190.751 269.496 190.908 c 269.496 191.069 269.4 191.157 269.154 191.249 c 268.817 191.372 268.659 191.552 268.659 191.774 c 268.659 192.073 268.905 192.318 269.3 192.318 c 269.488 192.318 269.654 192.269 269.754 192.203 c 269.673 191.962 l 269.6 192.004 269.466 192.069 269.293 192.069 c 269.093 192.069 268.986 191.954 268.986 191.816 c 268.986 191.659 269.093 191.59 269.335 191.498 c 269.654 191.38 269.823 191.219 269.823 190.939 c 269.823 190.609 269.565 190.38 269.132 190.38 c 268.928 190.38 268.74 190.433 268.609 190.51 c 268.69 190.763 l f 271.436 191.533 m 271.44 191.744 271.347 192.081 270.971 192.081 c 270.626 192.081 270.48 191.767 270.453 191.533 c 271.436 191.533 l h 270.449 191.291 m 270.456 190.835 270.745 190.648 271.082 190.648 c 271.324 190.648 271.474 190.69 271.597 190.74 c 271.658 190.502 l 271.539 190.448 271.332 190.383 271.036 190.383 c 270.468 190.383 270.122 190.763 270.122 191.318 c 270.122 191.882 270.456 192.322 270.998 192.322 c 271.605 192.322 271.762 191.79 271.762 191.448 c 271.762 191.38 271.758 191.326 271.751 191.288 c 270.449 191.291 l f 171.181 185.59 m 170.962 185.59 170.781 185.766 170.781 185.992 c 170.777 186.215 170.962 186.394 171.184 186.394 c 171.407 186.394 171.588 186.218 171.588 185.992 c 171.588 185.77 171.407 185.59 171.184 185.59 c 171.181 185.59 l f 174.762 185.747 m 174.505 186.49 l 174.451 186.659 174.413 186.812 174.374 186.962 c 174.363 186.962 l 174.328 186.812 174.286 186.651 174.236 186.494 c 173.983 185.747 l 174.762 185.747 l h 173.914 185.486 m 173.645 184.674 l 173.299 184.674 l 174.179 187.257 l 174.582 187.257 l 175.465 184.674 l 175.108 184.674 l 174.831 185.486 l 173.914 185.486 l f 176.986 185.429 m 176.986 185.383 176.99 185.333 177.001 185.291 c 177.059 185.057 177.266 184.896 177.504 184.896 c 177.861 184.896 178.069 185.188 178.069 185.613 c 178.069 185.985 177.877 186.302 177.52 186.302 c 177.289 186.302 177.07 186.142 177.005 185.889 c 176.997 185.843 176.986 185.793 176.986 185.751 c 176.986 185.429 l h 176.648 185.923 m 176.648 186.161 176.644 186.352 176.633 186.529 c 176.936 186.529 l 176.955 186.211 l 176.963 186.211 l 177.097 186.441 177.32 186.571 177.62 186.571 c 178.073 186.571 178.411 186.191 178.411 185.628 c 178.411 184.962 178 184.632 177.566 184.632 c 177.316 184.632 177.105 184.739 176.993 184.923 c 176.986 184.923 l 176.986 183.915 l 176.648 183.915 l 176.648 185.923 l f 180.016 185.785 m 180.02 185.996 179.928 186.333 179.551 186.333 c 179.205 186.333 179.06 186.019 179.033 185.785 c 180.016 185.785 l h 179.029 185.544 m 179.037 185.088 179.325 184.9 179.663 184.9 c 179.904 184.9 180.054 184.942 180.177 184.992 c 180.239 184.755 l 180.119 184.701 179.912 184.636 179.616 184.636 c 179.048 184.636 178.702 185.015 178.702 185.571 c 178.702 186.134 179.037 186.575 179.578 186.575 c 180.185 186.575 180.342 186.042 180.342 185.701 c 180.342 185.632 180.338 185.578 180.331 185.54 c 179.029 185.544 l f 180.765 185.95 m 180.765 186.168 180.761 186.356 180.749 186.529 c 181.045 186.529 l 181.061 186.165 l 181.072 186.165 l 181.156 186.414 181.364 186.571 181.591 186.571 c 181.625 186.571 181.652 186.567 181.683 186.559 c 181.683 186.245 l 181.644 186.249 181.61 186.253 181.564 186.253 c 181.326 186.253 181.156 186.073 181.11 185.823 c 181.103 185.774 181.099 185.72 181.099 185.663 c 181.099 184.674 l 180.761 184.674 l 180.765 185.95 l f 181.971 185.015 m 182.074 184.954 182.251 184.885 182.42 184.885 c 182.662 184.885 182.777 185.004 182.777 185.161 c 182.777 185.322 182.681 185.41 182.435 185.502 c 182.097 185.624 181.94 185.804 181.94 186.027 c 181.94 186.326 182.186 186.571 182.581 186.571 c 182.769 186.571 182.935 186.521 183.034 186.456 c 182.954 186.215 l 182.881 186.257 182.746 186.322 182.574 186.322 c 182.374 186.322 182.266 186.207 182.266 186.069 c 182.266 185.912 182.374 185.843 182.616 185.751 c 182.935 185.632 183.104 185.471 183.104 185.191 c 183.104 184.862 182.846 184.632 182.412 184.632 c 182.209 184.632 182.021 184.686 181.89 184.762 c 181.971 185.015 l f 184.306 184.885 m 184.628 184.885 184.87 185.188 184.87 185.609 c 184.87 185.923 184.713 186.318 184.313 186.318 c 183.918 186.318 183.745 185.95 183.745 185.597 c 183.745 185.191 183.975 184.885 184.302 184.885 c 184.306 184.885 l h 184.294 184.632 m 183.795 184.632 183.403 185 183.403 185.586 c 183.403 186.207 183.814 186.571 184.325 186.571 c 184.859 186.571 185.22 186.184 185.22 185.62 c 185.22 184.931 184.74 184.632 184.298 184.632 c 184.294 184.632 l f 185.646 186.027 m 185.646 186.222 185.642 186.375 185.631 186.529 c 185.93 186.529 l 185.949 186.226 l 185.957 186.226 l 186.049 186.398 186.264 186.571 186.571 186.571 c 186.829 186.571 187.228 186.417 187.228 185.781 c 187.228 184.674 l 186.89 184.674 l 186.89 185.743 l 186.89 186.042 186.779 186.295 186.46 186.295 c 186.241 186.295 186.068 186.138 186.007 185.95 c 185.992 185.908 185.984 185.847 185.984 185.793 c 185.984 184.674 l 185.646 184.674 l 185.646 186.027 l f 188.757 185.62 m 188.388 185.628 187.969 185.563 187.969 185.203 c 187.969 184.981 188.115 184.881 188.284 184.881 c 188.53 184.881 188.687 185.034 188.741 185.191 c 188.753 185.226 188.757 185.264 188.757 185.299 c 188.757 185.62 l h 189.087 185.118 m 189.087 184.958 189.095 184.801 189.114 184.674 c 188.81 184.674 l 188.779 184.908 l 188.768 184.908 l 188.668 184.762 188.465 184.632 188.2 184.632 c 187.823 184.632 187.631 184.896 187.631 185.165 c 187.631 185.613 188.031 185.858 188.749 185.854 c 188.749 185.893 l 188.749 186.046 188.706 186.326 188.326 186.322 c 188.15 186.322 187.969 186.272 187.839 186.184 c 187.762 186.41 l 187.915 186.506 188.142 186.571 188.376 186.571 c 188.949 186.571 189.087 186.184 189.087 185.812 c 189.087 185.118 l f 189.628 187.395 0.338 -2.721 re f 191.679 185.429 m 191.679 185.383 191.683 185.333 191.694 185.291 c 191.752 185.057 191.959 184.896 192.197 184.896 c 192.555 184.896 192.762 185.188 192.762 185.613 c 192.762 185.985 192.57 186.302 192.213 186.302 c 191.982 186.302 191.763 186.142 191.698 185.889 c 191.69 185.843 191.679 185.793 191.679 185.751 c 191.679 185.429 l h 191.341 185.923 m 191.341 186.161 191.337 186.352 191.326 186.529 c 191.629 186.529 l 191.648 186.211 l 191.656 186.211 l 191.79 186.441 192.013 186.571 192.313 186.571 c 192.766 186.571 193.104 186.191 193.104 185.628 c 193.104 184.962 192.693 184.632 192.259 184.632 c 192.009 184.632 191.798 184.739 191.687 184.923 c 191.679 184.923 l 191.679 183.915 l 191.341 183.915 l 191.341 185.923 l f 193.53 185.95 m 193.53 186.168 193.526 186.356 193.515 186.529 c 193.81 186.529 l 193.826 186.165 l 193.837 186.165 l 193.922 186.414 194.129 186.571 194.356 186.571 c 194.39 186.571 194.417 186.567 194.448 186.559 c 194.448 186.245 l 194.41 186.249 194.375 186.253 194.329 186.253 c 194.091 186.253 193.922 186.073 193.876 185.823 c 193.868 185.774 193.864 185.72 193.864 185.663 c 193.864 184.674 l 193.526 184.674 l 193.53 185.95 l f 194.797 186.529 0.338 -1.854 re 194.959 186.87 m 194.832 186.87 194.747 186.969 194.747 187.088 c 194.747 187.207 194.836 187.303 194.966 187.303 c 195.097 187.303 195.181 187.207 195.181 187.088 c 195.181 186.969 195.097 186.87 194.962 186.87 c 194.959 186.87 l f 195.696 186.027 m 195.696 186.222 195.688 186.375 195.681 186.529 c 195.976 186.529 l 195.992 186.23 l 196.003 186.23 l 196.107 186.406 196.28 186.571 196.591 186.571 c 196.841 186.571 197.033 186.417 197.113 186.199 c 197.121 186.199 l 197.178 186.306 197.255 186.383 197.332 186.441 c 197.443 186.525 197.563 186.571 197.739 186.571 c 197.989 186.571 198.354 186.41 198.354 185.766 c 198.354 184.674 l 198.023 184.674 l 198.023 185.724 l 198.023 186.084 197.889 186.295 197.62 186.295 c 197.424 186.295 197.278 186.153 197.217 185.992 c 197.201 185.942 197.19 185.881 197.19 185.823 c 197.19 184.674 l 196.86 184.674 l 196.86 185.785 l 196.86 186.084 196.729 186.295 196.472 186.295 c 196.264 186.295 196.107 186.126 196.053 185.958 c 196.034 185.908 196.026 185.85 196.026 185.793 c 196.026 184.674 l 195.696 184.674 l 195.696 186.027 l f 200.078 185.785 m 200.082 185.996 199.99 186.333 199.613 186.333 c 199.267 186.333 199.122 186.019 199.095 185.785 c 200.078 185.785 l h 199.091 185.544 m 199.098 185.088 199.387 184.9 199.725 184.9 c 199.967 184.9 200.116 184.942 200.239 184.992 c 200.3 184.755 l 200.182 184.701 199.974 184.636 199.678 184.636 c 199.11 184.636 198.765 185.015 198.765 185.571 c 198.765 186.134 199.098 186.575 199.64 186.575 c 200.247 186.575 200.404 186.042 200.404 185.701 c 200.404 185.632 200.4 185.578 200.393 185.54 c 199.091 185.544 l f 200.827 185.95 m 200.827 186.168 200.823 186.356 200.811 186.529 c 201.107 186.529 l 201.122 186.165 l 201.134 186.165 l 201.219 186.414 201.426 186.571 201.652 186.571 c 201.687 186.571 201.714 186.567 201.745 186.559 c 201.745 186.245 l 201.706 186.249 201.672 186.253 201.626 186.253 c 201.387 186.253 201.219 186.073 201.172 185.823 c 201.165 185.774 201.161 185.72 201.161 185.663 c 201.161 184.674 l 200.823 184.674 l 200.827 185.95 l f 203.661 184.885 m 203.984 184.885 204.226 185.188 204.226 185.609 c 204.226 185.923 204.068 186.318 203.669 186.318 c 203.273 186.318 203.1 185.95 203.1 185.597 c 203.1 185.191 203.331 184.885 203.657 184.885 c 203.661 184.885 l h 203.65 184.632 m 203.15 184.632 202.758 185 202.758 185.586 c 202.758 186.207 203.169 186.571 203.68 186.571 c 204.214 186.571 204.575 186.184 204.575 185.62 c 204.575 184.931 204.095 184.632 203.653 184.632 c 203.65 184.632 l f 205.001 186.027 m 205.001 186.222 204.997 186.375 204.986 186.529 c 205.285 186.529 l 205.305 186.226 l 205.312 186.226 l 205.405 186.398 205.62 186.571 205.927 186.571 c 206.184 186.571 206.584 186.417 206.584 185.781 c 206.584 184.674 l 206.245 184.674 l 206.245 185.743 l 206.245 186.042 206.134 186.295 205.815 186.295 c 205.597 186.295 205.423 186.138 205.362 185.95 c 205.347 185.908 205.339 185.847 205.339 185.793 c 205.339 184.674 l 205.001 184.674 l 205.001 186.027 l f 209.763 184.755 m 209.644 184.693 209.395 184.632 209.079 184.632 c 208.35 184.632 207.805 185.092 207.805 185.942 c 207.805 186.755 208.354 187.299 209.156 187.299 c 209.475 187.299 209.683 187.23 209.771 187.184 c 209.686 186.912 l 209.564 186.973 209.383 187.019 209.168 187.019 c 208.561 187.019 208.158 186.632 208.158 185.954 c 208.158 185.318 208.523 184.915 209.149 184.915 c 209.356 184.915 209.564 184.958 209.698 185.023 c 209.763 184.755 l f 210.182 187.257 0.338 -2.583 re f 211.061 185.08 m 211.211 184.984 211.426 184.912 211.657 184.912 c 211.999 184.912 212.198 185.088 212.198 185.352 c 212.198 185.59 212.06 185.732 211.71 185.862 c 211.288 186.015 211.027 186.238 211.027 186.598 c 211.027 187 211.361 187.299 211.864 187.299 c 212.125 187.299 212.321 187.238 212.432 187.172 c 212.34 186.9 l 212.26 186.95 212.087 187.023 211.852 187.023 c 211.499 187.023 211.365 186.812 211.365 186.636 c 211.365 186.394 211.522 186.276 211.879 186.138 c 212.317 185.965 212.536 185.759 212.536 185.379 c 212.536 184.981 212.244 184.632 211.633 184.632 c 211.384 184.632 211.111 184.709 210.973 184.801 c 211.061 185.08 l f 215.178 185.808 m 215.159 186.168 215.136 186.605 215.136 186.923 c 215.128 186.923 l 215.036 186.625 214.933 186.299 214.802 185.942 c 214.345 184.689 l 214.091 184.689 l 213.669 185.92 l 213.546 186.287 213.446 186.617 213.373 186.923 c 213.366 186.923 l 213.358 186.601 213.339 186.172 213.316 185.781 c 213.246 184.674 l 212.928 184.674 l 213.108 187.257 l 213.534 187.257 l 213.976 186.007 l 214.084 185.689 214.168 185.406 214.238 185.138 c 214.245 185.138 l 214.314 185.398 214.406 185.682 214.522 186.007 c 214.983 187.257 l 215.409 187.257 l 215.57 184.674 l 215.24 184.674 l 215.178 185.808 l f 216.856 185.08 m 217.006 184.984 217.221 184.912 217.452 184.912 c 217.794 184.912 217.993 185.088 217.993 185.352 c 217.993 185.59 217.855 185.732 217.505 185.862 c 217.083 186.015 216.822 186.238 216.822 186.598 c 216.822 187 217.156 187.299 217.659 187.299 c 217.92 187.299 218.116 187.238 218.227 187.172 c 218.135 186.9 l 218.055 186.95 217.882 187.023 217.647 187.023 c 217.294 187.023 217.16 186.812 217.16 186.636 c 217.16 186.394 217.317 186.276 217.674 186.138 c 218.112 185.965 218.331 185.759 218.331 185.379 c 218.331 184.981 218.039 184.632 217.428 184.632 c 217.179 184.632 216.906 184.709 216.768 184.801 c 216.856 185.08 l f 219.172 186.973 m 219.172 186.529 l 219.656 186.529 l 219.656 186.272 l 219.172 186.272 l 219.172 185.272 l 219.172 185.042 219.237 184.912 219.426 184.912 c 219.518 184.912 219.572 184.919 219.622 184.935 c 219.637 184.678 l 219.572 184.655 219.468 184.632 219.337 184.632 c 219.18 184.632 219.053 184.686 218.972 184.774 c 218.88 184.877 218.842 185.042 218.842 185.26 c 218.842 186.272 l 218.554 186.272 l 218.554 186.529 l 218.842 186.529 l 218.842 186.87 l 219.172 186.973 l f 220.04 185.95 m 220.04 186.168 220.036 186.356 220.024 186.529 c 220.32 186.529 l 220.336 186.165 l 220.347 186.165 l 220.432 186.414 220.639 186.571 220.866 186.571 c 220.9 186.571 220.927 186.567 220.958 186.559 c 220.958 186.245 l 220.919 186.249 220.885 186.253 220.839 186.253 c 220.601 186.253 220.432 186.073 220.386 185.823 c 220.378 185.774 220.374 185.72 220.374 185.663 c 220.374 184.674 l 220.036 184.674 l 220.04 185.95 l f 222.248 185.62 m 221.88 185.628 221.461 185.563 221.461 185.203 c 221.461 184.981 221.607 184.881 221.776 184.881 c 222.021 184.881 222.179 185.034 222.233 185.191 c 222.244 185.226 222.248 185.264 222.248 185.299 c 222.248 185.62 l h 222.578 185.118 m 222.578 184.958 222.586 184.801 222.605 184.674 c 222.302 184.674 l 222.271 184.908 l 222.26 184.908 l 222.16 184.762 221.956 184.632 221.691 184.632 c 221.315 184.632 221.123 184.896 221.123 185.165 c 221.123 185.613 221.522 185.858 222.241 185.854 c 222.241 185.893 l 222.241 186.046 222.198 186.326 221.818 186.322 c 221.641 186.322 221.461 186.272 221.33 186.184 c 221.254 186.41 l 221.407 186.506 221.634 186.571 221.868 186.571 c 222.44 186.571 222.578 186.184 222.578 185.812 c 222.578 185.118 l f 223.512 186.973 m 223.512 186.529 l 223.996 186.529 l 223.996 186.272 l 223.512 186.272 l 223.512 185.272 l 223.512 185.042 223.577 184.912 223.765 184.912 c 223.857 184.912 223.911 184.919 223.961 184.935 c 223.977 184.678 l 223.911 184.655 223.808 184.632 223.677 184.632 c 223.519 184.632 223.393 184.686 223.312 184.774 c 223.22 184.877 223.182 185.042 223.182 185.26 c 223.182 186.272 l 222.893 186.272 l 222.893 186.529 l 223.182 186.529 l 223.182 186.87 l 223.512 186.973 l f 225.532 185.785 m 225.536 185.996 225.444 186.333 225.067 186.333 c 224.721 186.333 224.576 186.019 224.549 185.785 c 225.532 185.785 l h 224.545 185.544 m 224.552 185.088 224.841 184.9 225.179 184.9 c 225.421 184.9 225.57 184.942 225.693 184.992 c 225.754 184.755 l 225.636 184.701 225.428 184.636 225.132 184.636 c 224.564 184.636 224.219 185.015 224.219 185.571 c 224.219 186.134 224.552 186.575 225.094 186.575 c 225.701 186.575 225.858 186.042 225.858 185.701 c 225.858 185.632 225.854 185.578 225.847 185.54 c 224.545 185.544 l f 227.529 185.801 m 227.529 185.854 227.525 185.904 227.51 185.95 c 227.448 186.149 227.287 186.31 227.037 186.31 c 226.715 186.31 226.484 186.038 226.484 185.605 c 226.484 185.245 226.672 184.939 227.033 184.939 c 227.245 184.939 227.433 185.069 227.502 185.287 c 227.521 185.341 227.529 185.406 227.529 185.467 c 227.529 185.801 l h 227.867 184.946 m 227.867 184.517 227.778 184.26 227.602 184.095 c 227.417 183.931 227.156 183.873 226.922 183.873 c 226.699 183.873 226.454 183.927 226.304 184.026 c 226.388 184.287 l 226.511 184.207 226.703 184.138 226.934 184.138 c 227.279 184.138 227.533 184.318 227.533 184.789 c 227.533 184.992 l 227.525 184.992 l 227.425 184.82 227.221 184.682 226.934 184.682 c 226.473 184.682 226.143 185.073 226.143 185.59 c 226.143 186.218 226.553 186.571 226.983 186.571 c 227.306 186.571 227.479 186.406 227.563 186.253 c 227.571 186.253 l 227.583 186.529 l 227.882 186.529 l 227.871 186.398 227.867 186.249 227.867 186.023 c 227.867 184.946 l f 228.423 186.529 0.338 -1.854 re 228.585 186.87 m 228.458 186.87 228.374 186.969 228.374 187.088 c 228.374 187.207 228.462 187.303 228.593 187.303 c 228.723 187.303 228.808 187.207 228.808 187.088 c 228.808 186.969 228.723 186.87 228.589 186.87 c 228.585 186.87 l f 230.647 184.739 m 230.559 184.697 230.363 184.632 230.113 184.632 c 229.552 184.632 229.188 185.011 229.188 185.582 c 229.188 186.153 229.579 186.571 230.186 186.571 c 230.386 186.571 230.562 186.521 230.655 186.471 c 230.578 186.215 l 230.497 186.257 230.371 186.302 230.186 186.302 c 229.76 186.302 229.529 185.985 229.529 185.597 c 229.529 185.168 229.806 184.904 230.175 184.904 c 230.366 184.904 230.493 184.95 230.589 184.992 c 230.647 184.739 l f 232.202 185.981 m 232.275 185.962 232.371 185.954 232.479 185.954 c 232.886 185.954 233.128 186.153 233.128 186.502 c 233.128 186.847 232.886 187.012 232.517 187.012 c 232.371 187.012 232.26 186.996 232.202 186.985 c 232.202 185.981 l h 231.868 187.222 m 232.029 187.253 232.241 187.276 232.51 187.276 c 232.84 187.276 233.082 187.199 233.235 187.061 c 233.377 186.939 233.466 186.751 233.466 186.521 c 233.466 186.287 233.397 186.103 233.262 185.969 c 233.086 185.781 232.798 185.686 232.471 185.686 c 232.371 185.686 232.279 185.689 232.202 185.709 c 232.202 184.674 l 231.868 184.674 l 231.868 187.222 l f 233.881 187.395 0.338 -2.721 re f 235.759 185.62 m 235.39 185.628 234.971 185.563 234.971 185.203 c 234.971 184.981 235.117 184.881 235.286 184.881 c 235.532 184.881 235.69 185.034 235.743 185.191 c 235.755 185.226 235.759 185.264 235.759 185.299 c 235.759 185.62 l h 236.089 185.118 m 236.089 184.958 236.097 184.801 236.116 184.674 c 235.813 184.674 l 235.782 184.908 l 235.77 184.908 l 235.67 184.762 235.467 184.632 235.202 184.632 c 234.825 184.632 234.633 184.896 234.633 185.165 c 234.633 185.613 235.033 185.858 235.751 185.854 c 235.751 185.893 l 235.751 186.046 235.709 186.326 235.329 186.322 c 235.152 186.322 234.971 186.272 234.841 186.184 c 234.764 186.41 l 234.918 186.506 235.144 186.571 235.379 186.571 c 235.951 186.571 236.089 186.184 236.089 185.812 c 236.089 185.118 l f 236.631 186.027 m 236.631 186.222 236.627 186.375 236.615 186.529 c 236.915 186.529 l 236.934 186.226 l 236.942 186.226 l 237.034 186.398 237.249 186.571 237.556 186.571 c 237.814 186.571 238.213 186.417 238.213 185.781 c 238.213 184.674 l 237.875 184.674 l 237.875 185.743 l 237.875 186.042 237.764 186.295 237.445 186.295 c 237.226 186.295 237.053 186.138 236.992 185.95 c 236.976 185.908 236.968 185.847 236.968 185.793 c 236.968 184.674 l 236.631 184.674 l 236.631 186.027 l f 238.762 186.027 m 238.762 186.222 238.758 186.375 238.746 186.529 c 239.046 186.529 l 239.065 186.226 l 239.073 186.226 l 239.165 186.398 239.38 186.571 239.687 186.571 c 239.945 186.571 240.344 186.417 240.344 185.781 c 240.344 184.674 l 240.006 184.674 l 240.006 185.743 l 240.006 186.042 239.895 186.295 239.576 186.295 c 239.357 186.295 239.184 186.138 239.123 185.95 c 239.107 185.908 239.1 185.847 239.1 185.793 c 239.1 184.674 l 238.762 184.674 l 238.762 186.027 l f 240.893 186.529 0.338 -1.854 re 241.055 186.87 m 240.928 186.87 240.843 186.969 240.843 187.088 c 240.843 187.207 240.932 187.303 241.062 187.303 c 241.193 187.303 241.277 187.207 241.277 187.088 c 241.277 186.969 241.193 186.87 241.058 186.87 c 241.055 186.87 l f 241.792 186.027 m 241.792 186.222 241.788 186.375 241.776 186.529 c 242.076 186.529 l 242.095 186.226 l 242.103 186.226 l 242.195 186.398 242.41 186.571 242.717 186.571 c 242.975 186.571 243.374 186.417 243.374 185.781 c 243.374 184.674 l 243.036 184.674 l 243.036 185.743 l 243.036 186.042 242.925 186.295 242.606 186.295 c 242.387 186.295 242.214 186.138 242.153 185.95 c 242.137 185.908 242.13 185.847 242.13 185.793 c 242.13 184.674 l 241.792 184.674 l 241.792 186.027 l f 245.175 185.801 m 245.175 185.854 245.172 185.904 245.156 185.95 c 245.095 186.149 244.933 186.31 244.684 186.31 c 244.361 186.31 244.131 186.038 244.131 185.605 c 244.131 185.245 244.319 184.939 244.68 184.939 c 244.891 184.939 245.079 185.069 245.148 185.287 c 245.167 185.341 245.175 185.406 245.175 185.467 c 245.175 185.801 l h 245.513 184.946 m 245.513 184.517 245.425 184.26 245.248 184.095 c 245.064 183.931 244.803 183.873 244.568 183.873 c 244.346 183.873 244.1 183.927 243.95 184.026 c 244.035 184.287 l 244.158 184.207 244.35 184.138 244.58 184.138 c 244.926 184.138 245.179 184.318 245.179 184.789 c 245.179 184.992 l 245.172 184.992 l 245.071 184.82 244.868 184.682 244.58 184.682 c 244.119 184.682 243.789 185.073 243.789 185.59 c 243.789 186.218 244.2 186.571 244.63 186.571 c 244.952 186.571 245.125 186.406 245.21 186.253 c 245.217 186.253 l 245.229 186.529 l 245.528 186.529 l 245.517 186.398 245.513 186.249 245.513 186.023 c 245.513 184.946 l f 171.181 179.842 m 170.962 179.842 170.781 180.019 170.781 180.245 c 170.777 180.467 170.962 180.647 171.184 180.647 c 171.407 180.647 171.588 180.471 171.588 180.245 c 171.588 180.022 171.407 179.842 171.184 179.842 c 171.181 179.842 l f 174.762 180 m 174.505 180.743 l 174.451 180.911 174.413 181.065 174.374 181.214 c 174.363 181.214 l 174.328 181.065 174.286 180.904 174.236 180.747 c 173.983 180 l 174.762 180 l h 173.914 179.739 m 173.645 178.927 l 173.299 178.927 l 174.179 181.509 l 174.582 181.509 l 175.465 178.927 l 175.108 178.927 l 174.831 179.739 l 173.914 179.739 l f 177.055 181.226 m 177.055 180.781 l 177.539 180.781 l 177.539 180.524 l 177.055 180.524 l 177.055 179.524 l 177.055 179.295 177.12 179.164 177.308 179.164 c 177.401 179.164 177.454 179.172 177.504 179.187 c 177.52 178.93 l 177.454 178.908 177.351 178.884 177.22 178.884 c 177.063 178.884 176.936 178.938 176.855 179.026 c 176.763 179.13 176.725 179.295 176.725 179.513 c 176.725 180.524 l 176.437 180.524 l 176.437 180.781 l 176.725 180.781 l 176.725 181.122 l 177.055 181.226 l f 177.923 180.203 m 177.923 180.421 177.919 180.609 177.908 180.781 c 178.203 180.781 l 178.219 180.417 l 178.23 180.417 l 178.315 180.666 178.522 180.823 178.749 180.823 c 178.783 180.823 178.81 180.819 178.841 180.812 c 178.841 180.498 l 178.802 180.501 178.768 180.505 178.722 180.505 c 178.484 180.505 178.315 180.325 178.268 180.076 c 178.261 180.026 178.257 179.973 178.257 179.915 c 178.257 178.927 l 177.919 178.927 l 177.923 180.203 l f 180.131 179.873 m 179.763 179.881 179.344 179.816 179.344 179.455 c 179.344 179.233 179.49 179.134 179.659 179.134 c 179.905 179.134 180.062 179.287 180.116 179.444 c 180.127 179.478 180.131 179.517 180.131 179.551 c 180.131 179.873 l h 180.462 179.371 m 180.462 179.21 180.469 179.053 180.488 178.927 c 180.185 178.927 l 180.154 179.16 l 180.143 179.16 l 180.043 179.015 179.839 178.884 179.574 178.884 c 179.198 178.884 179.006 179.149 179.006 179.417 c 179.006 179.865 179.405 180.111 180.124 180.107 c 180.124 180.145 l 180.124 180.298 180.081 180.578 179.701 180.574 c 179.524 180.574 179.344 180.524 179.213 180.436 c 179.137 180.662 l 179.29 180.758 179.517 180.823 179.751 180.823 c 180.323 180.823 180.462 180.436 180.462 180.065 c 180.462 179.371 l f 181.003 180.781 0.338 -1.854 re 181.164 181.122 m 181.037 181.122 180.953 181.222 180.953 181.341 c 180.953 181.459 181.041 181.555 181.172 181.555 c 181.302 181.555 181.387 181.459 181.387 181.341 c 181.387 181.222 181.302 181.122 181.168 181.122 c 181.164 181.122 l f 181.902 180.279 m 181.902 180.474 181.898 180.628 181.886 180.781 c 182.186 180.781 l 182.205 180.479 l 182.213 180.479 l 182.305 180.651 182.52 180.823 182.827 180.823 c 183.084 180.823 183.484 180.67 183.484 180.034 c 183.484 178.927 l 183.146 178.927 l 183.146 179.995 l 183.146 180.295 183.034 180.547 182.716 180.547 c 182.497 180.547 182.324 180.39 182.263 180.203 c 182.247 180.16 182.24 180.099 182.24 180.045 c 182.24 178.927 l 181.902 178.927 l 181.902 180.279 l f 184.033 180.781 0.338 -1.854 re 184.194 181.122 m 184.068 181.122 183.983 181.222 183.983 181.341 c 183.983 181.459 184.071 181.555 184.202 181.555 c 184.333 181.555 184.417 181.459 184.417 181.341 c 184.417 181.222 184.333 181.122 184.198 181.122 c 184.194 181.122 l f 184.932 180.279 m 184.932 180.474 184.928 180.628 184.916 180.781 c 185.216 180.781 l 185.235 180.479 l 185.243 180.479 l 185.335 180.651 185.55 180.823 185.857 180.823 c 186.115 180.823 186.514 180.67 186.514 180.034 c 186.514 178.927 l 186.176 178.927 l 186.176 179.995 l 186.176 180.295 186.064 180.547 185.746 180.547 c 185.527 180.547 185.354 180.39 185.293 180.203 c 185.277 180.16 185.27 180.099 185.27 180.045 c 185.27 178.927 l 184.932 178.927 l 184.932 180.279 l f 188.315 180.053 m 188.315 180.107 188.311 180.156 188.296 180.203 c 188.234 180.402 188.073 180.563 187.823 180.563 c 187.501 180.563 187.27 180.291 187.27 179.858 c 187.27 179.498 187.459 179.191 187.82 179.191 c 188.031 179.191 188.219 179.321 188.288 179.54 c 188.307 179.593 188.315 179.658 188.315 179.72 c 188.315 180.053 l h 188.653 179.198 m 188.653 178.769 188.565 178.513 188.388 178.348 c 188.204 178.183 187.943 178.126 187.708 178.126 c 187.485 178.126 187.24 178.179 187.09 178.279 c 187.174 178.54 l 187.297 178.459 187.489 178.39 187.72 178.39 c 188.065 178.39 188.319 178.57 188.319 179.042 c 188.319 179.245 l 188.311 179.245 l 188.211 179.072 188.008 178.934 187.72 178.934 c 187.259 178.934 186.929 179.325 186.929 179.842 c 186.929 180.471 187.34 180.823 187.77 180.823 c 188.092 180.823 188.265 180.658 188.35 180.505 c 188.357 180.505 l 188.369 180.781 l 188.668 180.781 l 188.657 180.651 188.653 180.501 188.653 180.275 c 188.653 179.198 l f 190.362 179.681 m 190.362 179.635 190.366 179.586 190.377 179.543 c 190.435 179.31 190.642 179.149 190.88 179.149 c 191.237 179.149 191.445 179.44 191.445 179.865 c 191.445 180.237 191.253 180.555 190.896 180.555 c 190.665 180.555 190.446 180.394 190.381 180.141 c 190.373 180.095 190.362 180.045 190.362 180.003 c 190.362 179.681 l h 190.024 180.176 m 190.024 180.413 190.02 180.605 190.009 180.781 c 190.312 180.781 l 190.331 180.463 l 190.339 180.463 l 190.473 180.693 190.696 180.823 190.995 180.823 c 191.449 180.823 191.787 180.444 191.787 179.881 c 191.787 179.214 191.376 178.884 190.942 178.884 c 190.692 178.884 190.481 178.992 190.369 179.176 c 190.362 179.176 l 190.362 178.168 l 190.024 178.168 l 190.024 180.176 l f 192.213 180.203 m 192.213 180.421 192.209 180.609 192.197 180.781 c 192.493 180.781 l 192.509 180.417 l 192.52 180.417 l 192.605 180.666 192.812 180.823 193.039 180.823 c 193.073 180.823 193.1 180.819 193.131 180.812 c 193.131 180.498 l 193.092 180.501 193.058 180.505 193.012 180.505 c 192.774 180.505 192.605 180.325 192.558 180.076 c 192.551 180.026 192.547 179.973 192.547 179.915 c 192.547 178.927 l 192.209 178.927 l 192.213 180.203 l f 194.21 179.137 m 194.533 179.137 194.774 179.44 194.774 179.861 c 194.774 180.176 194.617 180.571 194.218 180.571 c 193.822 180.571 193.649 180.203 193.649 179.85 c 193.649 179.444 193.88 179.137 194.206 179.137 c 194.21 179.137 l h 194.198 178.884 m 193.699 178.884 193.307 179.252 193.307 179.839 c 193.307 180.459 193.718 180.823 194.229 180.823 c 194.763 180.823 195.124 180.436 195.124 179.873 c 195.124 179.183 194.644 178.884 194.202 178.884 c 194.198 178.884 l f 196.806 180.053 m 196.806 180.107 196.802 180.156 196.787 180.203 c 196.725 180.402 196.564 180.563 196.314 180.563 c 195.992 180.563 195.761 180.291 195.761 179.858 c 195.761 179.498 195.949 179.191 196.311 179.191 c 196.522 179.191 196.71 179.321 196.779 179.54 c 196.798 179.593 196.806 179.658 196.806 179.72 c 196.806 180.053 l h 197.144 179.198 m 197.144 178.769 197.056 178.513 196.879 178.348 c 196.695 178.183 196.433 178.126 196.199 178.126 c 195.976 178.126 195.731 178.179 195.581 178.279 c 195.665 178.54 l 195.788 178.459 195.98 178.39 196.211 178.39 c 196.556 178.39 196.81 178.57 196.81 179.042 c 196.81 179.245 l 196.802 179.245 l 196.702 179.072 196.499 178.934 196.211 178.934 c 195.75 178.934 195.42 179.325 195.42 179.842 c 195.42 180.471 195.831 180.823 196.261 180.823 c 196.583 180.823 196.756 180.658 196.841 180.505 c 196.848 180.505 l 196.86 180.781 l 197.159 180.781 l 197.148 180.651 197.144 180.501 197.144 180.275 c 197.144 179.198 l f 197.704 180.203 m 197.704 180.421 197.701 180.609 197.689 180.781 c 197.985 180.781 l 198 180.417 l 198.012 180.417 l 198.096 180.666 198.304 180.823 198.53 180.823 c 198.565 180.823 198.592 180.819 198.622 180.812 c 198.622 180.498 l 198.584 180.501 198.55 180.505 198.503 180.505 c 198.265 180.505 198.096 180.325 198.05 180.076 c 198.043 180.026 198.039 179.973 198.039 179.915 c 198.039 178.927 l 197.701 178.927 l 197.704 180.203 l f 199.913 179.873 m 199.544 179.881 199.126 179.816 199.126 179.455 c 199.126 179.233 199.272 179.134 199.44 179.134 c 199.686 179.134 199.844 179.287 199.898 179.444 c 199.909 179.478 199.913 179.517 199.913 179.551 c 199.913 179.873 l h 200.243 179.371 m 200.243 179.21 200.251 179.053 200.27 178.927 c 199.967 178.927 l 199.936 179.16 l 199.924 179.16 l 199.825 179.015 199.621 178.884 199.356 178.884 c 198.98 178.884 198.788 179.149 198.788 179.417 c 198.788 179.865 199.187 180.111 199.905 180.107 c 199.905 180.145 l 199.905 180.298 199.863 180.578 199.483 180.574 c 199.306 180.574 199.126 180.524 198.995 180.436 c 198.918 180.662 l 199.072 180.758 199.298 180.823 199.533 180.823 c 200.105 180.823 200.243 180.436 200.243 180.065 c 200.243 179.371 l f 200.785 180.279 m 200.785 180.474 200.777 180.628 200.769 180.781 c 201.065 180.781 l 201.08 180.482 l 201.092 180.482 l 201.195 180.658 201.368 180.823 201.679 180.823 c 201.929 180.823 202.121 180.67 202.202 180.452 c 202.209 180.452 l 202.267 180.559 202.344 180.635 202.421 180.693 c 202.532 180.777 202.651 180.823 202.828 180.823 c 203.077 180.823 203.442 180.662 203.442 180.019 c 203.442 178.927 l 203.112 178.927 l 203.112 179.976 l 203.112 180.337 202.978 180.547 202.709 180.547 c 202.513 180.547 202.367 180.406 202.305 180.245 c 202.29 180.195 202.278 180.134 202.278 180.076 c 202.278 178.927 l 201.948 178.927 l 201.948 180.038 l 201.948 180.337 201.817 180.547 201.56 180.547 c 201.353 180.547 201.195 180.379 201.142 180.21 c 201.122 180.16 201.115 180.103 201.115 180.045 c 201.115 178.927 l 200.785 178.927 l 200.785 180.279 l f 204.832 178.927 m 204.832 180.524 l 204.575 180.524 l 204.575 180.781 l 204.832 180.781 l 204.832 180.869 l 204.832 181.13 204.894 181.368 205.051 181.517 c 205.178 181.639 205.347 181.689 205.5 181.689 c 205.623 181.689 205.723 181.663 205.788 181.636 c 205.746 181.375 l 205.693 181.398 205.627 181.417 205.527 181.417 c 205.243 181.417 205.167 181.164 205.167 180.881 c 205.167 180.781 l 205.616 180.781 l 205.616 180.524 l 205.17 180.524 l 205.17 178.927 l 204.832 178.927 l f 206.645 179.137 m 206.968 179.137 207.21 179.44 207.21 179.861 c 207.21 180.176 207.052 180.571 206.653 180.571 c 206.257 180.571 206.084 180.203 206.084 179.85 c 206.084 179.444 206.315 179.137 206.641 179.137 c 206.645 179.137 l h 206.634 178.884 m 206.134 178.884 205.743 179.252 205.743 179.839 c 205.743 180.459 206.154 180.823 206.664 180.823 c 207.198 180.823 207.559 180.436 207.559 179.873 c 207.559 179.183 207.079 178.884 206.637 178.884 c 206.634 178.884 l f 207.989 180.203 m 207.989 180.421 207.985 180.609 207.974 180.781 c 208.269 180.781 l 208.285 180.417 l 208.296 180.417 l 208.381 180.666 208.588 180.823 208.815 180.823 c 208.849 180.823 208.876 180.819 208.907 180.812 c 208.907 180.498 l 208.869 180.501 208.834 180.505 208.788 180.505 c 208.55 180.505 208.381 180.325 208.335 180.076 c 208.327 180.026 208.323 179.973 208.323 179.915 c 208.323 178.927 l 207.985 178.927 l 207.989 180.203 l f 211.872 179.007 m 211.753 178.946 211.503 178.884 211.188 178.884 c 210.458 178.884 209.913 179.344 209.913 180.195 c 209.913 181.007 210.462 181.551 211.265 181.551 c 211.583 181.551 211.791 181.482 211.879 181.436 c 211.795 181.164 l 211.672 181.226 211.492 181.271 211.277 181.271 c 210.67 181.271 210.266 180.885 210.266 180.206 c 210.266 179.57 210.631 179.168 211.257 179.168 c 211.465 179.168 211.672 179.21 211.807 179.275 c 211.872 179.007 l f 212.29 181.509 0.338 -2.583 re f 213.17 179.333 m 213.319 179.237 213.534 179.164 213.765 179.164 c 214.107 179.164 214.306 179.34 214.306 179.605 c 214.306 179.842 214.168 179.984 213.819 180.114 c 213.396 180.268 213.135 180.49 213.135 180.85 c 213.135 181.252 213.469 181.551 213.973 181.551 c 214.233 181.551 214.429 181.49 214.541 181.425 c 214.448 181.153 l 214.368 181.203 214.195 181.276 213.961 181.276 c 213.607 181.276 213.473 181.065 213.473 180.889 c 213.473 180.647 213.631 180.528 213.988 180.39 c 214.426 180.218 214.644 180.011 214.644 179.632 c 214.644 179.233 214.353 178.884 213.742 178.884 c 213.492 178.884 213.22 178.961 213.081 179.053 c 213.17 179.333 l f 217.287 180.061 m 217.267 180.421 217.244 180.858 217.244 181.176 c 217.237 181.176 l 217.145 180.877 217.041 180.551 216.91 180.195 c 216.453 178.942 l 216.2 178.942 l 215.777 180.172 l 215.655 180.54 215.555 180.869 215.481 181.176 c 215.474 181.176 l 215.466 180.854 215.447 180.425 215.424 180.034 c 215.355 178.927 l 215.036 178.927 l 215.216 181.509 l 215.643 181.509 l 216.085 180.26 l 216.192 179.942 216.277 179.658 216.346 179.39 c 216.353 179.39 l 216.422 179.651 216.515 179.934 216.63 180.26 c 217.091 181.509 l 217.517 181.509 l 217.679 178.927 l 217.348 178.927 l 217.287 180.061 l f 219.402 181.226 m 219.402 180.781 l 219.887 180.781 l 219.887 180.524 l 219.402 180.524 l 219.402 179.524 l 219.402 179.295 219.468 179.164 219.656 179.164 c 219.748 179.164 219.802 179.172 219.852 179.187 c 219.868 178.93 l 219.802 178.908 219.698 178.884 219.568 178.884 c 219.41 178.884 219.284 178.938 219.203 179.026 c 219.111 179.13 219.072 179.295 219.072 179.513 c 219.072 180.524 l 218.784 180.524 l 218.784 180.781 l 219.072 180.781 l 219.072 181.122 l 219.402 181.226 l f 221.423 180.038 m 221.426 180.248 221.335 180.586 220.958 180.586 c 220.612 180.586 220.466 180.271 220.439 180.038 c 221.423 180.038 l h 220.436 179.796 m 220.443 179.34 220.731 179.153 221.07 179.153 c 221.311 179.153 221.461 179.195 221.584 179.245 c 221.645 179.007 l 221.526 178.953 221.319 178.888 221.023 178.888 c 220.455 178.888 220.109 179.268 220.109 179.823 c 220.109 180.387 220.443 180.827 220.985 180.827 c 221.591 180.827 221.749 180.295 221.749 179.953 c 221.749 179.884 221.745 179.831 221.738 179.792 c 220.436 179.796 l f 223.147 179.873 m 222.778 179.881 222.36 179.816 222.36 179.455 c 222.36 179.233 222.506 179.134 222.675 179.134 c 222.92 179.134 223.078 179.287 223.132 179.444 c 223.143 179.478 223.147 179.517 223.147 179.551 c 223.147 179.873 l h 223.477 179.371 m 223.477 179.21 223.485 179.053 223.504 178.927 c 223.201 178.927 l 223.17 179.16 l 223.159 179.16 l 223.059 179.015 222.855 178.884 222.59 178.884 c 222.214 178.884 222.021 179.149 222.021 179.417 c 222.021 179.865 222.421 180.111 223.139 180.107 c 223.139 180.145 l 223.139 180.298 223.097 180.578 222.717 180.574 c 222.54 180.574 222.36 180.524 222.229 180.436 c 222.152 180.662 l 222.306 180.758 222.533 180.823 222.767 180.823 c 223.339 180.823 223.477 180.436 223.477 180.065 c 223.477 179.371 l f 224.019 180.279 m 224.019 180.474 224.011 180.628 224.004 180.781 c 224.299 180.781 l 224.314 180.482 l 224.326 180.482 l 224.43 180.658 224.602 180.823 224.914 180.823 c 225.163 180.823 225.355 180.67 225.436 180.452 c 225.444 180.452 l 225.501 180.559 225.578 180.635 225.655 180.693 c 225.766 180.777 225.885 180.823 226.062 180.823 c 226.311 180.823 226.676 180.662 226.676 180.019 c 226.676 178.927 l 226.346 178.927 l 226.346 179.976 l 226.346 180.337 226.212 180.547 225.943 180.547 c 225.747 180.547 225.601 180.406 225.539 180.245 c 225.524 180.195 225.513 180.134 225.513 180.076 c 225.513 178.927 l 225.182 178.927 l 225.182 180.038 l 225.182 180.337 225.052 180.547 224.794 180.547 c 224.587 180.547 224.43 180.379 224.376 180.21 c 224.357 180.16 224.349 180.103 224.349 180.045 c 224.349 178.927 l 224.019 178.927 l 224.019 180.279 l f 227.175 179.268 m 227.279 179.206 227.456 179.137 227.625 179.137 c 227.867 179.137 227.982 179.256 227.982 179.413 c 227.982 179.574 227.886 179.662 227.64 179.754 c 227.302 179.877 227.145 180.057 227.145 180.279 c 227.145 180.578 227.391 180.823 227.786 180.823 c 227.974 180.823 228.14 180.773 228.239 180.708 c 228.159 180.467 l 228.086 180.509 227.952 180.574 227.778 180.574 c 227.579 180.574 227.471 180.459 227.471 180.321 c 227.471 180.164 227.579 180.095 227.821 180.003 c 228.14 179.884 228.308 179.724 228.308 179.444 c 228.308 179.114 228.051 178.884 227.617 178.884 c 227.414 178.884 227.225 178.938 227.095 179.015 c 227.175 179.268 l f 257.354 171.746 29.456 -0.217 re f 257.491 172.021 m 257.527 172.14 l 257.746 172.14 257.778 172.166 257.842 172.366 c 258.261 173.704 l 258.324 173.904 258.306 173.93 258.088 173.93 c 258.126 174.048 l 259.604 174.048 l 259.553 173.587 l 259.39 173.587 l 259.408 173.89 259.379 173.905 259.215 173.905 c 258.825 173.905 l 258.729 173.905 258.713 173.886 258.679 173.777 c 258.481 173.145 l 258.823 173.145 l 258.953 173.145 258.991 173.179 259.067 173.421 c 259.224 173.421 l 259.003 172.715 l 258.846 172.715 l 258.929 172.979 258.911 173.001 258.78 173.001 c 258.436 173.001 l 258.212 172.287 l 258.177 172.177 258.198 172.165 258.258 172.165 c 258.744 172.165 l 258.913 172.165 258.957 172.188 259.133 172.5 c 259.296 172.5 l 259.046 172.021 l 257.491 172.021 l f 261.56 172.305 m 261.501 172.134 261.514 172.115 261.632 172.115 c 261.6 172.021 l 260.962 172.021 l 260.994 172.115 l 261.106 172.115 261.132 172.136 261.186 172.296 c 261.377 172.858 l 261.409 172.951 261.431 173.032 261.425 173.09 c 261.422 173.144 261.395 173.177 261.33 173.177 c 261.238 173.177 261.131 173.109 261.003 172.981 c 260.773 172.305 l 260.713 172.129 260.724 172.115 260.839 172.115 c 260.807 172.021 l 260.176 172.021 l 260.208 172.115 l 260.327 172.115 260.344 172.132 260.4 172.296 c 260.589 172.853 l 260.628 172.967 260.647 173.046 260.638 173.105 c 260.63 173.145 260.601 173.177 260.544 173.177 c 260.468 173.177 260.358 173.108 260.215 172.977 c 259.987 172.307 l 259.928 172.133 259.937 172.115 260.053 172.115 c 260.022 172.021 l 259.351 172.021 l 259.382 172.115 l 259.538 172.115 259.558 172.136 259.62 172.316 c 259.824 172.916 l 259.883 173.09 259.874 173.112 259.721 173.112 c 259.751 173.199 l 259.896 173.217 260.089 173.254 260.268 173.319 c 260.306 173.298 l 260.259 173.125 l 260.263 173.125 l 260.393 173.224 260.561 173.319 260.739 173.319 c 260.841 173.319 260.912 173.297 260.956 173.258 c 260.996 173.224 261.019 173.177 261.022 173.117 c 261.035 173.117 l 261.155 173.212 261.327 173.319 261.526 173.319 c 261.638 173.319 261.725 173.289 261.769 173.22 c 261.813 173.153 261.813 173.051 261.76 172.895 c 261.56 172.305 l f 262.406 172.278 m 262.43 172.186 262.495 172.121 262.58 172.121 c 262.643 172.121 262.717 172.151 262.793 172.238 c 262.865 172.321 262.937 172.457 263.011 172.674 c 263.073 172.858 263.093 172.985 263.077 173.067 c 263.061 173.145 263.017 173.18 262.95 173.18 c 262.847 173.18 262.74 173.092 262.652 173.003 c 262.406 172.278 l h 262.195 171.658 m 262.137 171.487 262.144 171.466 262.284 171.466 c 262.252 171.372 l 261.563 171.372 l 261.595 171.466 l 261.746 171.466 261.767 171.489 261.825 171.659 c 262.252 172.916 l 262.311 173.088 262.309 173.112 262.154 173.112 c 262.184 173.199 l 262.319 173.214 262.52 173.256 262.699 173.319 c 262.731 173.297 l 262.692 173.148 l 262.697 173.148 l 262.821 173.258 262.948 173.319 263.112 173.319 c 263.244 173.319 263.353 173.278 263.413 173.172 c 263.472 173.07 263.483 172.909 263.401 172.666 c 263.326 172.444 263.218 172.269 263.078 172.153 c 262.952 172.048 262.804 171.99 262.632 171.99 c 262.479 171.99 262.397 172.046 262.356 172.117 c 262.351 172.117 l 262.195 171.658 l f 264.502 172.652 m 264.422 172.416 264.34 172.264 264.255 172.181 c 264.199 172.125 264.137 172.096 264.075 172.096 c 264.013 172.096 263.969 172.125 263.953 172.181 c 263.926 172.265 263.946 172.416 264.026 172.652 c 264.108 172.891 264.189 173.04 264.27 173.125 c 264.332 173.186 264.391 173.212 264.452 173.212 c 264.455 173.212 l 264.518 173.212 264.56 173.186 264.58 173.125 c 264.602 173.04 264.583 172.891 264.502 172.652 c h 264.9 173.168 m 264.825 173.266 264.691 173.319 264.491 173.319 c 264.293 173.319 264.134 173.268 263.998 173.177 c 263.838 173.065 263.714 172.889 263.637 172.661 c 263.546 172.393 263.556 172.214 263.657 172.108 c 263.735 172.028 263.86 171.989 264.034 171.989 c 264.038 171.989 l 264.226 171.989 264.395 172.033 264.54 172.129 c 264.686 172.231 264.808 172.398 264.898 172.661 c 264.973 172.885 264.975 173.057 264.9 173.168 c f 266.413 171.988 m 266.191 171.988 l 266.213 172.892 l 266.208 172.892 l 265.604 171.988 l 265.376 171.988 l 265.344 173.017 l 265.337 173.182 265.319 173.193 265.237 173.193 c 265.269 173.287 l 265.87 173.287 l 265.838 173.193 l 265.721 173.193 265.698 173.168 265.699 173.041 c 265.698 172.354 l 265.707 172.354 l 266.199 173.105 l 266.195 173.152 l 266.191 173.187 266.17 173.193 266.085 173.193 c 266.118 173.287 l 266.704 173.287 l 266.673 173.193 l 266.561 173.193 266.532 173.172 266.53 173.057 c 266.51 172.354 l 266.519 172.354 l 267 173.088 l 267.052 173.166 267.046 173.193 266.935 173.193 c 266.967 173.287 l 267.351 173.287 l 267.32 173.193 l 267.25 173.193 267.216 173.171 267.143 173.064 c 266.413 171.988 l f 267.913 173.127 m 267.965 173.186 268.013 173.212 268.049 173.212 c 268.094 173.212 268.111 173.181 268.118 173.133 c 268.127 173.053 268.093 172.913 268.046 172.776 c 267.732 172.776 l 267.789 172.946 267.854 173.06 267.913 173.127 c h 268.387 172.67 m 268.453 172.865 268.463 173.046 268.41 173.163 c 268.357 173.268 268.264 173.319 268.091 173.319 c 267.941 173.319 267.795 173.271 267.668 173.185 c 267.514 173.072 267.381 172.9 267.312 172.697 c 267.226 172.444 267.227 172.273 267.285 172.16 c 267.36 172.032 267.498 171.989 267.67 171.989 c 267.812 171.989 267.926 172.029 268.021 172.09 c 268.113 172.15 268.187 172.226 268.249 172.304 c 268.141 172.343 l 268.096 172.273 268.042 172.223 267.987 172.183 c 267.917 172.134 267.841 172.11 267.778 172.11 c 267.711 172.11 267.648 172.157 267.628 172.245 c 267.608 172.347 267.633 172.486 267.695 172.67 c 268.387 172.67 l f 269.273 173.117 m 269.435 173.257 269.545 173.319 269.68 173.319 c 269.747 173.319 269.796 173.296 269.83 173.259 c 269.863 173.221 269.874 173.168 269.853 173.105 c 269.825 173.023 269.759 172.969 269.674 172.969 c 269.612 172.969 269.569 172.996 269.566 173.067 c 269.564 173.146 269.555 173.169 269.514 173.169 c 269.455 173.169 269.367 173.1 269.225 172.967 c 269.003 172.314 l 268.945 172.143 268.955 172.115 269.126 172.115 c 269.094 172.021 l 268.366 172.021 l 268.399 172.115 l 268.55 172.115 268.571 172.132 268.633 172.316 c 268.842 172.927 l 268.898 173.094 268.888 173.111 268.737 173.111 c 268.767 173.198 l 268.913 173.215 269.102 173.252 269.283 173.319 c 269.32 173.298 l 269.269 173.117 l 269.273 173.117 l f 270.615 172.776 m 270.662 172.913 270.696 173.053 270.687 173.133 c 270.679 173.181 270.662 173.212 270.618 173.212 c 270.582 173.212 270.534 173.186 270.482 173.127 c 270.423 173.06 270.358 172.946 270.3 172.776 c 270.615 172.776 l h 270.264 172.67 m 270.201 172.486 270.177 172.347 270.197 172.245 c 270.217 172.157 270.279 172.11 270.347 172.11 c 270.41 172.11 270.486 172.134 270.557 172.183 c 270.611 172.223 270.665 172.273 270.71 172.343 c 270.818 172.304 l 270.755 172.226 270.682 172.15 270.589 172.09 c 270.495 172.029 270.381 171.989 270.238 171.989 c 270.066 171.989 269.929 172.032 269.854 172.16 c 269.796 172.273 269.795 172.444 269.881 172.697 c 269.95 172.9 270.083 173.072 270.237 173.185 c 270.363 173.271 270.509 173.319 270.66 173.319 c 270.833 173.319 270.926 173.268 270.979 173.163 c 271.031 173.046 271.022 172.865 270.955 172.67 c 270.264 172.67 l f 272.245 173.038 m 272.221 173.115 272.162 173.197 272.054 173.197 c 271.979 173.197 271.884 173.165 271.8 173.082 c 271.72 172.999 271.64 172.862 271.568 172.651 c 271.51 172.48 271.495 172.349 271.519 172.253 c 271.538 172.169 271.593 172.117 271.681 172.117 c 271.798 172.117 271.91 172.201 271.988 172.283 c 272.245 173.038 l h 272.425 173.57 m 272.481 173.734 272.481 173.762 272.312 173.762 c 272.342 173.85 l 272.519 173.865 272.703 173.904 272.888 173.97 c 272.925 173.951 l 272.36 172.288 l 272.304 172.126 272.317 172.111 272.449 172.111 c 272.421 172.027 l 272.354 172.027 272.272 172.026 272.193 172.021 c 272.107 172.016 272.025 172.008 271.937 171.989 c 271.913 172.005 l 271.949 172.137 l 271.944 172.137 l 271.858 172.066 271.72 171.99 271.538 171.99 c 271.366 171.99 271.243 172.048 271.178 172.158 c 271.106 172.276 271.11 172.452 271.184 172.673 c 271.246 172.853 271.352 173.016 271.495 173.133 c 271.634 173.249 271.809 173.32 272.018 173.32 c 272.177 173.32 272.254 173.257 272.296 173.202 c 272.3 173.202 l 272.425 173.57 l f 275.026 172.021 m 273.499 172.021 l 273.536 172.14 l 273.753 172.14 273.785 172.166 273.848 172.368 c 274.267 173.704 l 274.329 173.903 274.312 173.93 274.098 173.93 c 274.135 174.048 l 275.013 174.048 l 274.976 173.93 l 274.748 173.93 274.726 173.907 274.66 173.698 c 274.22 172.293 l 274.184 172.177 274.202 172.165 274.277 172.165 c 274.717 172.165 l 274.895 172.165 274.938 172.192 275.123 172.526 c 275.288 172.526 l 275.026 172.021 l f 276.289 172.776 m 276.336 172.913 276.37 173.053 276.361 173.133 c 276.354 173.181 276.337 173.212 276.292 173.212 c 276.256 173.212 276.208 173.186 276.156 173.127 c 276.098 173.06 276.033 172.946 275.975 172.776 c 276.289 172.776 l h 275.938 172.67 m 275.876 172.486 275.851 172.347 275.871 172.245 c 275.891 172.157 275.954 172.11 276.021 172.11 c 276.084 172.11 276.161 172.134 276.231 172.183 c 276.285 172.223 276.339 172.273 276.384 172.343 c 276.492 172.304 l 276.43 172.226 276.357 172.15 276.264 172.09 c 276.169 172.029 276.055 171.989 275.912 171.989 c 275.741 171.989 275.603 172.032 275.529 172.16 c 275.469 172.273 275.469 172.444 275.555 172.697 c 275.624 172.9 275.757 173.072 275.91 173.185 c 276.038 173.271 276.184 173.319 276.334 173.319 c 276.507 173.319 276.601 173.268 276.653 173.163 c 276.706 173.046 276.696 172.865 276.63 172.67 c 275.938 172.67 l f 277.73 172.73 m 277.606 172.7 277.478 172.662 277.373 172.605 c 277.265 172.549 277.18 172.481 277.142 172.37 c 277.119 172.301 277.119 172.244 277.142 172.205 c 277.164 172.167 277.21 172.144 277.281 172.144 c 277.397 172.144 277.496 172.207 277.568 172.255 c 277.73 172.73 l h 277.952 172.294 m 277.907 172.162 277.924 172.116 277.985 172.116 c 278.013 172.116 278.043 172.124 278.073 172.136 c 278.064 172.045 l 277.982 172.02 277.899 172.005 277.777 172.005 c 277.621 172.005 277.561 172.048 277.551 172.141 c 277.539 172.141 l 277.418 172.061 277.278 171.989 277.049 171.989 c 276.947 171.989 276.848 172.017 276.786 172.074 c 276.726 172.129 276.701 172.212 276.738 172.322 c 276.783 172.455 276.881 172.557 277.05 172.635 c 277.179 172.698 277.35 172.751 277.561 172.791 c 277.765 172.833 l 277.805 172.952 l 277.83 173.024 277.842 173.089 277.826 173.136 c 277.807 173.186 277.759 173.212 277.671 173.212 c 277.591 173.212 277.535 173.191 277.478 173.155 c 277.429 173.124 277.387 173.08 277.343 173.02 c 277.298 172.962 277.246 172.928 277.149 172.928 c 277.052 172.928 277.028 172.98 277.049 173.04 c 277.075 173.118 277.172 173.198 277.3 173.249 c 277.399 173.287 277.527 173.319 277.733 173.319 c 277.984 173.319 278.091 173.279 278.149 173.194 c 278.204 173.12 278.197 173.017 278.154 172.891 c 277.952 172.294 l f 279.126 173.117 m 279.287 173.257 279.398 173.319 279.533 173.319 c 279.599 173.319 279.649 173.296 279.682 173.259 c 279.716 173.221 279.727 173.168 279.706 173.105 c 279.678 173.023 279.611 172.969 279.526 172.969 c 279.464 172.969 279.421 172.996 279.419 173.067 c 279.417 173.146 279.407 173.169 279.367 173.169 c 279.307 173.169 279.219 173.1 279.077 172.967 c 278.856 172.314 l 278.798 172.143 278.807 172.115 278.979 172.115 c 278.946 172.021 l 278.219 172.021 l 278.251 172.115 l 278.403 172.115 278.423 172.132 278.486 172.316 c 278.694 172.927 l 278.751 173.094 278.74 173.111 278.59 173.111 c 278.619 173.198 l 278.766 173.215 278.954 173.252 279.135 173.319 c 279.172 173.298 l 279.122 173.117 l 279.126 173.117 l f 280.997 172.31 m 280.943 172.149 280.946 172.115 281.072 172.115 c 281.041 172.021 l 280.395 172.021 l 280.427 172.115 l 280.551 172.115 280.568 172.134 280.63 172.316 c 280.833 172.912 l 280.863 173.003 280.881 173.084 280.85 173.132 c 280.831 173.161 280.797 173.177 280.737 173.177 c 280.641 173.177 280.503 173.089 280.362 172.957 c 280.143 172.314 l 280.081 172.132 280.08 172.115 280.2 172.115 c 280.167 172.021 l 279.501 172.021 l 279.532 172.115 l 279.691 172.115 279.712 172.137 279.773 172.316 c 279.977 172.916 l 280.036 173.09 280.025 173.112 279.871 173.112 c 279.901 173.199 l 280.05 173.217 280.241 173.254 280.418 173.319 c 280.459 173.298 l 280.407 173.108 l 280.412 173.108 l 280.57 173.237 280.743 173.319 280.922 173.319 c 281.054 173.319 281.146 173.291 281.195 173.232 c 281.249 173.169 281.256 173.07 281.204 172.92 c 280.997 172.31 l f 282.258 173.856 m 282.374 173.856 282.443 173.775 282.402 173.655 c 282.361 173.534 282.237 173.453 282.118 173.453 c 282 173.453 281.931 173.534 281.971 173.655 c 282.013 173.775 282.136 173.856 282.255 173.856 c 282.258 173.856 l h 281.932 172.314 m 281.873 172.139 281.881 172.115 282.061 172.115 c 282.03 172.021 l 281.252 172.021 l 281.284 172.115 l 281.479 172.115 281.503 172.139 281.562 172.316 c 281.769 172.921 l 281.829 173.099 281.822 173.11 281.623 173.112 c 281.653 173.199 l 281.84 173.212 282.023 173.25 282.231 173.319 c 282.267 173.3 l 281.932 172.314 l f 283.735 172.31 m 283.68 172.149 283.683 172.115 283.81 172.115 c 283.778 172.021 l 283.132 172.021 l 283.164 172.115 l 283.288 172.115 283.305 172.134 283.367 172.316 c 283.569 172.912 l 283.6 173.003 283.618 173.084 283.588 173.132 c 283.568 173.161 283.534 173.177 283.474 173.177 c 283.378 173.177 283.241 173.089 283.098 172.957 c 282.881 172.314 l 282.818 172.132 282.818 172.115 282.937 172.115 c 282.905 172.021 l 282.238 172.021 l 282.27 172.115 l 282.428 172.115 282.45 172.137 282.511 172.316 c 282.714 172.916 l 282.774 173.09 282.762 173.112 282.609 173.112 c 282.639 173.199 l 282.787 173.217 282.978 173.254 283.155 173.319 c 283.196 173.298 l 283.144 173.108 l 283.149 173.108 l 283.307 173.237 283.48 173.319 283.66 173.319 c 283.791 173.319 283.884 173.291 283.933 173.232 c 283.987 173.169 283.994 173.07 283.942 172.92 c 283.735 172.31 l f 284.688 172.489 m 284.796 172.489 284.892 172.622 284.972 172.855 c 285.03 173.028 285.059 173.212 284.926 173.212 c 284.802 173.212 284.697 173.026 284.639 172.854 c 284.562 172.629 284.574 172.489 284.685 172.489 c 284.688 172.489 l h 284.293 171.948 m 284.176 171.87 284.109 171.786 284.081 171.701 c 284.03 171.554 284.104 171.45 284.309 171.45 c 284.502 171.45 284.707 171.549 284.769 171.728 c 284.802 171.829 284.782 171.948 284.533 171.948 c 284.293 171.948 l h 284.682 172.183 m 285.059 172.183 285.145 172.008 285.073 171.798 c 284.978 171.516 284.634 171.343 284.26 171.343 c 283.912 171.343 283.72 171.445 283.794 171.662 c 283.848 171.821 284.015 171.925 284.179 171.985 c 284.096 172.013 284.022 172.086 284.058 172.195 c 284.102 172.322 284.225 172.398 284.365 172.465 c 284.268 172.543 284.237 172.684 284.294 172.853 c 284.397 173.153 284.658 173.319 284.958 173.319 c 285.103 173.319 285.2 173.282 285.25 173.241 c 285.568 173.287 l 285.516 173.134 l 285.305 173.155 l 285.356 173.073 285.356 172.975 285.315 172.855 c 285.202 172.523 284.93 172.382 284.658 172.382 c 284.578 172.382 284.505 172.396 284.449 172.424 c 284.376 172.381 284.332 172.341 284.314 172.288 c 284.291 172.222 284.337 172.183 284.436 172.183 c 284.682 172.183 l f 257.734 170.824 m 257.391 170.824 l 257.391 170.923 l 258.228 170.923 l 258.228 170.824 l 257.882 170.824 l 257.882 170.02 l 257.734 170.02 l 257.734 170.824 l f 258.535 170.466 m 258.535 170.542 258.533 170.608 258.528 170.668 c 258.657 170.668 l 258.664 170.541 l 258.669 170.541 l 258.705 170.628 258.796 170.683 258.895 170.683 c 258.91 170.683 258.922 170.682 258.935 170.679 c 258.935 170.569 l 258.919 170.571 258.904 170.571 258.883 170.571 c 258.78 170.571 258.705 170.509 258.685 170.422 c 258.682 170.405 258.68 170.385 258.68 170.365 c 258.68 170.02 l 258.533 170.02 l 258.535 170.466 l f 259.759 170.351 m 259.598 170.354 259.415 170.331 259.415 170.205 c 259.415 170.127 259.479 170.092 259.553 170.092 c 259.66 170.092 259.728 170.146 259.752 170.201 c 259.757 170.213 259.759 170.227 259.759 170.239 c 259.759 170.351 l h 259.903 170.175 m 259.903 170.119 259.907 170.064 259.915 170.02 c 259.782 170.02 l 259.769 170.102 l 259.764 170.102 l 259.721 170.051 259.632 170.005 259.516 170.005 c 259.351 170.005 259.267 170.098 259.267 170.191 c 259.267 170.348 259.442 170.434 259.756 170.432 c 259.756 170.446 l 259.756 170.5 259.737 170.597 259.571 170.596 c 259.494 170.596 259.415 170.578 259.358 170.548 c 259.325 170.626 l 259.391 170.66 259.49 170.683 259.593 170.683 c 259.843 170.683 259.903 170.548 259.903 170.418 c 259.903 170.175 l f 260.4 170.668 0.148 -0.648 re 260.47 170.787 m 260.415 170.787 260.378 170.822 260.378 170.864 c 260.378 170.905 260.416 170.939 260.473 170.939 c 260.531 170.939 260.567 170.905 260.567 170.864 c 260.567 170.822 260.531 170.787 260.471 170.787 c 260.47 170.787 l f 261.052 170.493 m 261.052 170.561 261.05 170.615 261.046 170.668 c 261.176 170.668 l 261.184 170.562 l 261.188 170.562 l 261.228 170.622 261.322 170.683 261.456 170.683 c 261.568 170.683 261.743 170.63 261.743 170.407 c 261.743 170.02 l 261.595 170.02 l 261.595 170.394 l 261.595 170.498 261.547 170.586 261.407 170.586 c 261.312 170.586 261.237 170.531 261.209 170.466 c 261.203 170.452 261.2 170.43 261.2 170.411 c 261.2 170.02 l 261.052 170.02 l 261.052 170.493 l f 262.243 170.668 0.147 -0.648 re 262.313 170.787 m 262.258 170.787 262.221 170.822 262.221 170.864 c 262.221 170.905 262.26 170.939 262.317 170.939 c 262.373 170.939 262.41 170.905 262.41 170.864 c 262.41 170.822 262.373 170.787 262.315 170.787 c 262.313 170.787 l f 262.895 170.493 m 262.895 170.561 262.893 170.615 262.888 170.668 c 263.019 170.668 l 263.027 170.562 l 263.031 170.562 l 263.072 170.622 263.165 170.683 263.299 170.683 c 263.412 170.683 263.586 170.63 263.586 170.407 c 263.586 170.02 l 263.438 170.02 l 263.438 170.394 l 263.438 170.498 263.39 170.586 263.251 170.586 c 263.155 170.586 263.079 170.531 263.053 170.466 c 263.046 170.452 263.043 170.43 263.043 170.411 c 263.043 170.02 l 262.895 170.02 l 262.895 170.493 l f 264.632 170.414 m 264.632 170.432 264.631 170.45 264.624 170.466 c 264.597 170.536 264.527 170.592 264.418 170.592 c 264.277 170.592 264.176 170.496 264.176 170.346 c 264.176 170.22 264.259 170.113 264.416 170.113 c 264.509 170.113 264.591 170.158 264.621 170.235 c 264.629 170.253 264.632 170.276 264.632 170.297 c 264.632 170.414 l h 264.78 170.115 m 264.78 169.965 264.742 169.876 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0 R /GS2 13 0 R /GS3 74 0 R >> /Properties << /MC2 238 0 R >> >> endobj 250 0 obj << /Length 5600 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (225)Tj /TT3 1 Tf 7 0 0 7 122.49 726.66 Tm -0.0061 Tc 0.0218 Tw [(International Journal of Emergency Mental Health, Vol. 9, No. 3, pp. 225-230 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT4 1 Tf 10 0 0 10 104.01 485.34 Tm 0.0069 Tc 0 Tw (Abstract: )Tj /TT5 1 Tf 4.23 0 TD 0.0082 Tc 0.125 Tw (Conversations with school and crisis personnel following large scale emergencies in and)Tj -4.23 -1.299 TD -0.0037 Tc 0.0309 Tw [(a)6.5(r)32.3(ound schools, such as shootings, wildfir)29.3(es, and the attack on the W)86.3(orld T)50.3(rade Center on September 1)74.3(1)2.3(,)]TJ T* 0.0272 Tw [(2001, indicated a need for pre-incident training in managing student behavior during 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This)]TJ 0 -1.302 TD 0.0117 Tc 0.125 Tw [(article outlines a training program of this kind and offers suggestions regarding both content and)]TJ 0 -1.299 TD -0.0035 Tc 0.0317 Tw [(process of this training. The suggestions follow discussion of the unique context and needs of the school)]TJ T* 0.0885 Tw (setting. [International Journal of Emergency Mental Health, 2008, 9\(3\), pp. 225-230].)Tj /TT1 1 Tf 9 0 0 9 117 387.99 Tm -0.0062 Tc 0 Tw (Key words:)Tj /TT5 1 Tf 4.86 0 TD -0.0049 Tc -0.0009 Tw ( School crisis; critical incident training; school personnel; pupil support services; emergency behavior;)Tj 1.2233 -1.3333 TD -0.0313 Tw (emergency mental health; mental health critical care; crisis intervention)Tj ET /GS1 gs 68.01 178.755 m 300.99 178.755 l S BT 9 0 0 9 68.01 161.01 Tm /GS2 gs 0.058 Tw [(Editor)-41.6()128.1(s)-0.6( Note: )12(An invited paper for the International Journal of)]TJ 0 -1.2233 TD 0.016 Tc 0.1254 Tw [(Emergency Mental Health. Kendall Johnson, Ph.D. teaches)]TJ T* -0.0146 Tc -0.0622 Tw (orthopedically handicapped and seriously health-impaired children)Tj 0 -1.22 TD -0.0197 Tc -0.0626 Tw [(at Danbury School in Claremont, California. He is a family therapist)]TJ 0 -1.2233 TD -0.002 Tc 0.1253 Tw (in private practice in Claremont, and lectures and consults on)Tj T* 0.0233 Tc [(trauma, crisis intervention, and self care. Correspondence)]TJ 0 -1.22 TD -0.0097 Tc -0.0623 Tw (regarding this article may be addressed to Kendall Johnson, Ph.D.,)Tj 0 -1.2233 TD 0.0124 Tc 0.125 Tw [(Danbury School, 1725 Lynoak Drive, Claremont, California.)]TJ T* -0.005 Tc 0.0389 Tw [(Email: kjohnson@chsmail.claremont.edu.)]TJ /F1 1 Tf 14 0 0 14 95.01 629.34 Tm -0.0062 Tc 0.133 Tw [(Calming the Campus:)34.5( )94.1(T)79.8(raining School Staff and Crisis )94.6(T)60.5(eams to)]TJ 3.885 -1.1421 TD 0.0063 Tc 0.1375 Tw [(Manage Student Behavior During Emergencies)]TJ /TT2 1 Tf 10 0 0 10 86.01 321.66 Tm 0.0161 Tc 0.125 Tw (Unfolding violence on campus, prolonged isolated)Tj -1.8 -1.401 TD -0.0031 Tc (lockdowns inside classrooms, sudden disasters impacting)Tj T* -0.0036 Tc -0.0081 Tw (the campus or adjacent communitythese are just some of)Tj 0 -1.398 TD 0.0003 Tc 0.125 Tw (the many incidents that can introduce sudden chaos into)Tj 0 -1.401 TD -0.0036 Tc 0.0734 Tw [(the school campus. Site personnel and school crisis team)]TJ T* -0.0122 Tw (members need tools to assist in regaining calm and control.)Tj 0 -1.398 TD 0.1011 Tw (The purposes of this discussion are to describe a training)Tj 0 -1.401 TD -0.0023 Tc 0.125 Tw (approach for teaching these skills and to illustrate its di-)Tj T* -0.0037 Tc 0.06 Tw (verse application.)Tj 12 0 0 12 276.51 566.64 Tm -0.0272 Tc -0.0625 Tw (Kendall Johnson)Tj 10 0 0 10 237.9 554.01 Tm -0.0006 Tc (Claremont Unified School District and)Tj -1.014 -1.2 TD -0.0001 Tc -0.0616 Tw (Independent Practice, Claremont California)Tj /F1 1 Tf 11 0 0 11 321 324 Tm 0.0033 Tc 0 Tw (Background)Tj /TT2 1 Tf 10 0 0 10 339 300.66 Tm -0.0037 Tc 0.04 Tw (During 1992 and 1993 this author trained school crisis)Tj -1.8 -1.401 TD -0.0035 Tc -0.0294 Tw [(response teams in the New )32.6(Y)103.7(ork City Schools under the aus-)]TJ T* -0.0037 Tc 0.046 Tw [(pices of the Chancellor)-36.7()53.3(s)1.4( Of)17.3(fice. )14.2(These teams consisted of)]TJ 0 -1.398 TD -0.0035 Tc -0.0616 Tw (school counselors, school psychologists, school social work-)Tj 0 -1.401 TD -0.0033 Tc 0.065 Tw [(ers, nurses, and teachers. The teams were trained to assist)]TJ T* 0.0289 Tw (students and staff in dealing with the psychological and or-)Tj 0 -1.398 TD -0.0037 Tc 0.0871 Tw (ganizational aftermath of events that could overwhelm the)Tj 0 -1.401 TD -0.0033 Tc 0.0096 Tw [(students)71.7( and school)53.7(s capacities to cope. Such events typi-)]TJ T* -0.0031 Tc 0.0366 Tw (cally include violence, sudden loss, or destruction.)Tj 1.8 -1.998 TD -0.0035 Tc 0.069 Tw [(In the immediate aftermath of the attack on the )14.6(W)97.3(o)1.5(rld)]TJ -1.8 -1.401 TD -0.0038 Tc -0.045 Tw (Trade Center on September 11, 2001, these teams responded)Tj T* -0.0034 Tc 0.0225 Tw (to a school and community crisis of hitherto unprecedented)Tj 0 -1.398 TD -0.0091 Tc -0.0622 Tw [(magnitude. The skills, strategies, and experience of the teams)]TJ 0 -1.401 TD -0.0037 Tc 0.0975 Tw [(were tested under unforeseen circumstances. While all of)]TJ T* -0.0042 Tc -0.0621 Tw [(the school districts in New )31.9(Y)103(ork were gravely af)16.8(fected, Com-)]TJ 0 -1.398 TD -0.0029 Tc 0.0923 Tw [(munity School District 2 lay at the epicenter)51.1(. )18.4(The district)]TJ 0 -1.401 TD -0.0038 Tc 0.0313 Tw [(boundaries began in mid-Central Park and included all K-8)]TJ ET endstream endobj 251 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 253 0 obj << /Length 7666 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.1 Tw [(226 )]TJ /TT3 1 Tf 2.775 0 TD -0.0057 Tc (Johnson Managing Student Behavior During Emergencies)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0032 Tc 0.0343 Tw [(and some specialty high schools southward to Battery Park)]TJ 0 -1.398 TD 0.0003 Tc 0.1251 Tw [(\(i.e., the area including and surrounding the )15.4(W)98.1(orld )18.4(T)38.1(rade)]TJ 0 -1.401 TD -0.0033 Tc 0.0744 Tw [(Center\). )50.7(All schools within the district were seriously im-)]TJ T* -0.0038 Tc 0.0614 Tw (pactedsome more than othersby the sights and sounds)Tj 0 -1.398 TD -0.0034 Tc 0.0795 Tw (of the attack; the loss of parents who worked in the Trade)Tj 0 -1.401 TD -0.0032 Tc -0.005 Tw (Center; the financial and psychological effect on their fami-)Tj T* -0.0034 Tc 0.0257 Tw (lies; and by the prolonged disruption to the communities.)Tj 1.8 -1.998 TD -0.0031 Tc 0.125 Tw (As part of their support duties to Community School)Tj -1.8 -1.401 TD -0.0079 Tc -0.0622 Tw [(District 2, the author)37.1(, in conjunction with Dr)52.1(. Joanne )16.1(T)74.9(ortorici)]TJ T* -0.0111 Tc -0.0625 Tw (Luna of California State University at Long Beach, conducted)Tj 0 -1.398 TD -0.0033 Tc -0.0325 Tw (an informal after-action study to determine the usefulness of)Tj 0 -1.401 TD -0.0023 Tc 0.125 Tw (the various components of the team trainings provided in)Tj T* -0.0033 Tc 0.1025 Tw (1992 - 1993. The purpose of this query was formative: to)Tj 0 -1.398 TD -0.0035 Tc -0.0033 Tw [(assess the team)53.5(s needs for further training. Group and indi-)]TJ 0 -1.401 TD -0.004 Tc -0.0214 Tw [(vidual conversations held with team members in November)35(,)]TJ T* -0.0035 Tc 0.0278 Tw (2001 revealed several things regarding their training needs.)Tj 0 -1.398 TD -0.0008 Tc 0.125 Tw (The team reported that for the most part the training had)Tj 0 -1.401 TD -0.0087 Tc -0.0624 Tw [(served them well. Specifically)60.3(, it was the micro-skills of indi-)]TJ T* -0.0036 Tc -0.0169 Tw (vidual consultation and group interaction that were the most)Tj 0 -1.398 TD -0.0038 Tc 0.1237 Tw [(useful, combined with an overview of the team)50.2(s purpose)]TJ 0 -1.401 TD -0.0046 Tc -0.0625 Tw [(and intent. In particular)34.4(, the simulation exercises in the train-)]TJ T* -0.0035 Tc 0.0669 Tw [(ing were deemed to have been the most helpful. It was re-)]TJ 0 -1.398 TD 0.0122 Tw (ported that what their team needed most were techniques to)Tj 0 -1.401 TD 0.0862 Tw (stabilize students and adults while the incident was occur-)Tj T* -0.0034 Tc -0.0259 Tw (ring, during moments of loss of control in class time, or dur-)Tj 0 -1.398 TD 0.0136 Tw (ing consultation in the aftermath of the incident.)Tj 1.8 -2.001 TD 0.011 Tc 0.125 Tw [(T)72.8(echniques to stabilize students and their behaviors)]TJ -1.8 -1.401 TD -0.0033 Tc -0.0485 Tw (during times of severe crises were expressed to the author by)Tj 0 -1.398 TD -0.0038 Tc -0.0385 Tw (crisis team members and other professionals following other)Tj 0 -1.401 TD 0.0106 Tc 0.125 Tw (large, chaotic incidents, such as the school shootings in)Tj T* -0.0035 Tc -0.0436 Tw (Littleton, Colorado and Santee and Granite Hills, California,)Tj 0 -1.398 TD 0.0864 Tw [(the wildland fires in )32.4(Y)103.6(ellowstone and Southern California,)]TJ 0 -1.401 TD -0.0037 Tc -0.0193 Tw [(and the San Francisco and Northridge earthquakes. Further)35.3(,)]TJ T* -0.055 Tw (a widespread fear exists among both school and law enforce-)Tj 0 -1.398 TD -0.0031 Tc -0.0193 Tw (ment professionals that schools may be specifically targeted)Tj 0 -1.401 TD 0.039 Tw [(in the future by terrorists, foreign or domestic. From these)]TJ T* -0.0035 Tc 0.125 Tw (discussions it became apparent that a training supplement)Tj 0 -1.398 TD -0.0037 Tc 0.0138 Tw (for crisis team members and school personnel, dealing with)Tj 0 -1.401 TD -0.0006 Tc 0.125 Tw (the management of individual and group behavior during)Tj T* -0.0037 Tc 0.0277 Tw [(emer)17.3(gency)59.3(, was needed.)]TJ /F1 1 Tf 11 0 0 11 54 132 Tm -0.0055 Tc 0.0848 Tw [(A School-Friendl)8.1(y Appr)13.6(oach to )95(T)79.1(raining)]TJ /TT2 1 Tf 10 0 0 10 72 108.66 Tm -0.0036 Tc 0.0157 Tw (Some training programs exist along these lines, but are)Tj -1.8 -1.401 TD -0.0033 Tc 0.0057 Tw (generally geared toward law enforcement, mental health, or)Tj 25.5 62.799 TD -0.0037 Tc 0.0375 Tw (trauma-specific organizations. Schools present a unique set)Tj 0 -1.398 TD -0.0033 Tc 0.0989 Tw [(of response needs. The majority of school incidents have)]TJ 0 -1.401 TD -0.0029 Tc 0.0668 Tw (the capacity to spin quickly out of control and must be re-)Tj T* -0.0031 Tc 0.0894 Tw (solved by site personnel before police or other emergency)Tj 0 -1.398 TD -0.0035 Tc 0.0517 Tw (agencies have time to arrive. Large numbers of children of)Tj 0 -1.401 TD -0.0619 Tw [(differing developmental levels must be considered. Thus the)]TJ T* -0.0038 Tc 0.1029 Tw (training must involve simple on-scene assessment of indi-)Tj 0 -1.398 TD -0.0037 Tc 0.0164 Tw (vidual and group behavior and intervention approaches that)Tj 0 -1.401 TD -0.0033 Tc 0.0778 Tw (are easy and natural to perform for professionals and non-)Tj T* -0.0034 Tc 0.0562 Tw [(professionals alike. Further)35.6(, the strategies must be generic)]TJ 0 -1.398 TD -0.0032 Tc 0.0167 Tw (and applicable to a wide variety of situations and contexts.)Tj /F1 1 Tf 11 0 0 11 309 549.99 Tm -0.0053 Tc -0.0002 Tw [(The T)79.3(raining)]TJ /TT2 1 Tf 10 0 0 10 327 526.65 Tm 0.0012 Tc 0.125 Tw (Training can take place on several topics: awareness)Tj -1.8 -1.401 TD -0.0139 Tc -0.0625 Tw (raising \(approximately 2 hours recommended\); basic concepts)Tj 0 -1.398 TD -0.0032 Tc -0.0444 Tw (and strategies \(1/2 day\); basic concepts and basic skill build-)Tj 0 -1.401 TD -0.0034 Tc 0.0929 Tw (ing simulation exercises \(full day\); and extended concepts)Tj T* -0.0036 Tc 0.0793 Tw [(and expanded skill building with practice in responding to)]TJ 0 -1.398 TD -0.0033 Tc -0.0049 Tw (contingencies \(2 days\). The full training should address the)Tj 0 -1.401 TD -0.0038 Tc 0.0833 Tw (following subjects and sequence.)Tj 1.2 -2.001 TD -0.0035 Tc 0.0442 Tw [()-1453.4(The nature and characteristics of school crisis)]TJ 0 -1.998 TD 0.0017 Tc 0.125 Tw [()-1448.2(The immediate response of students and adults to)]TJ 1.8 -1.401 TD -0.0022 Tc 0 Tw (crisis)Tj -1.8 -2.001 TD 0.0096 Tc 0.125 Tw [()-1440.3(Simple rapid assessment techniques to determine)]TJ 1.8 -1.398 TD 0.0122 Tc 0 Tw (approach)Tj -1.8 -2.001 TD -0.0036 Tc -0.0267 Tw [()-1453.5(Facilitative vs. Stabilizing approaches)]TJ T* -0.0037 Tc 0.005 Tw [()-1453.6(Dealing with over-reactive and agitated behavior)]TJ 0 -1.998 TD -0.0038 Tc -0.003 Tw [()-1453.7(Dealing with under-reactive and fading behavior)]TJ 0 -2.001 TD 0.002 Tw [()-1453.7(T)73(echniques for dealing with small groups)]TJ T* -0.0037 Tc 0.0239 Tw [()-1453.6(T)73.1(echniques for dealing with lar)17.3(ge groups)]TJ 0 -1.998 TD -0.0035 Tc 0.09 Tw [()-1453.4(Considerations for dealing with key special groups)]TJ 1.8 -1.401 TD 0.125 Tw (and circumstances)Tj -1.8 -2.001 TD -0.0042 Tc -0.0625 Tw [()-1454.1(Self-care during emergency)]TJ 0.6 -1.998 TD -0.0034 Tc 0.0478 Tw (Several key concepts should include the unique nature)Tj -1.8 -1.401 TD 0.0944 Tw (of school crises, the purpose of emergency behavior man-)Tj T* -0.0036 Tc 0.115 Tw (agement, a rapid assessment technique, differentiating be-)Tj 0 -1.398 TD -0.0042 Tw (tween facilitative vs. stabilizing approaches, and techniques)Tj 0 -1.401 TD -0.0037 Tc 0 Tw (for dealing with groups.)Tj ET endstream endobj 254 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 256 0 obj << /Length 8231 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (227)Tj /TT5 1 Tf 11 0 0 11 66 723.36 Tm 0.0383 Tc (Schools)Tj /TT2 1 Tf 10 0 0 10 84 703.65 Tm -0.0035 Tc -0.0322 Tw [(The school presents a unique setting for crises. 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Response Levels)Tj ET endstream endobj 257 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 260 0 obj << /Length 7910 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.1 Tw [(228 )]TJ /TT3 1 Tf 2.775 0 TD -0.0057 Tc (Johnson Managing Student Behavior During Emergencies)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0033 Tc -0.005 Tw (students who are less functional, the intervener may need to)Tj 0 -1.398 TD -0.0035 Tc -0.0381 Tw [(help focus the student)53.5(s attention, use simple, more directive)]TJ 0 -1.401 TD -0.0034 Tc 0.0257 Tw (language, determine their capacity for decision making and)Tj T* -0.0033 Tc 0.1123 Tw [(self-care, and provide external structure as necessary)62.7(. )14.9(The)]TJ 0 -1.398 TD 0.0299 Tw [(goal, then, with less functional students is to provide direc-)]TJ 0 -1.401 TD 0.0761 Tw [(tion and stabilization. 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If our)]TJ 0 -1.398 TD -0.0035 Tc -0.0033 Tw (children are to be protected we must be more proactive.)Tj /F1 1 Tf 11 0 0 11 400.89 438 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 321 420.66 Tm -0.0032 Tc -0.058 Tw [(Johnson, K. \(2006\). )]TJ /TT5 1 Tf 8.31 0 TD -0.004 Tc [(After the S)32(torm: Healing after T)50(rauma,)]TJ -7.11 -1.401 TD -0.0038 Tc -0.0132 Tw [(T)57.4(ragedy and T)86.2(e)4.2(rr)34.4(o)6.4(r)104.2(.)]TJ /TT2 1 Tf 7.86 0 TD -0.0134 Tw [( )51.1(Alameda, CA: Hunter House, Inc.)]TJ -9.06 -3.6 TD -0.0034 Tc 0.0816 Tw (Johnson, K. \(2004\). )Tj /TT5 1 Tf 8.346 0 TD -0.0041 Tc 0.082 Tw [( Classroom Crisis: Quick and Proven)]TJ -7.146 -1.401 TD 0.0124 Tc 0.1249 Tw [(S)38.4(trategies for S)27.4(tabilizing Y)87.4(our S)33.4(tudents and Y)84.4(ourself.)]TJ /TT2 1 Tf 0 -1.398 TD -0.0038 Tc -0.0425 Tw (Alameda, CA: Hunter House, Inc.)Tj /TT5 1 Tf 6.3 -6.03 TD -0.004 Tc 0.0938 Tw (Manuscript received September 5, 2007)Tj 5.25 -1.752 TD 0.0717 Tw (Revised September 6, 2007)Tj -0.6 -1.749 TD 0.0883 Tw (Accepted September 7, 2007)Tj ET endstream endobj 264 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 266 0 obj << /Length 8566 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0054 Tc 0.1 Tw [(230 )]TJ /TT3 1 Tf 2.775 0 TD -0.0057 Tc (Johnson Managing Student Behavior During Emergencies)Tj ET /Cs9 cs 0 scn /GS1 gs 43 68 507 -35 re f BT /TT2 1 Tf 11 0 0 11 60.75 671.04 Tm 0 0 0 1 k /GS2 gs 0.0166 Tc 0 Tw [(1)16.6(.)-256.1(The )]TJ /TT5 1 Tf 3.0191 0 TD 0.0175 Tc 0.1261 Tw [(International Journal of Emer)31.1(gency Men-)]TJ -1.9964 -1.1809 TD -0.0001 Tc 0.1136 Tw (tal Health)Tj /TT2 1 Tf 4.1455 0 TD -0.021 Tc 0.1182 Tw [( )-26.4(provides a peer-reviewed forum for re-)]TJ -4.1455 -1.1809 TD -0.0203 Tc 0.0193 Tw (searchers, scholars, practitioners, and administrators)Tj 0 -1.1836 TD 0.0066 Tw [(to report, disseminate, )]TJ 8.6918 0 TD -0.0001 Tc 0.0091 Tw (and discuss information rel-)Tj -8.6918 -1.1809 TD 0.0003 Tc 0.1157 Tw [(evant to the goal of improving practice and re-)]TJ T* -0.004 Tc -0.0624 Tw (search within the field of emergency mental health.)Tj 0 -1.1836 TD -0.008 Tc (Editorials, special articles or invited papers may not)Tj 0 -1.1809 TD 0.0046 Tc 0.1273 Tw (be peer-reviewed.)Tj -1.0227 -1.5464 TD -0.0011 Tc 0 Tw [(2.)-273.8(The )]TJ /TT5 1 Tf 2.8827 0 TD -0.0012 Tc (Journal)Tj /TT2 1 Tf 3.1091 0 TD 0.0002 Tc 0.0591 Tw [( publishes manuscripts on topics rel-)]TJ -4.9691 -1.1809 TD -0.0002 Tc 0.0705 Tw (evant to emergency mental health including psy-)Tj T* -0.0001 Tc 0.0227 Tw [(chological trauma, disaster psychology)59.9(, traumatic)]TJ 0 -1.1836 TD 0.0009 Tc -0.0154 Tw (stress, crisis intervention, rescue services, Critical)Tj 0 -1.1809 TD -0.0003 Tc 0.0372 Tw [(Incident S)13.3(tress Management \(CISM\), war)35.2(, terror)13.3(-)]TJ T* -0.0008 Tc 0.0237 Tw (ism, emergency medicine and surgery emergency)Tj 0 -1.1836 TD -0.0002 Tc -0.05 Tw [(nursing, burnout and compassion fatigue, occupa-)]TJ 0 -1.1809 TD 0.0004 Tc 0.0887 Tw (tional stress and crisis, employee assistance pro-)Tj T* -0.0038 Tc -0.0621 Tw (grams, suicidology and violence.)Tj -1.0227 -1.5464 TD 0.0212 Tc 0 Tw [(3)21.2(.)-251.5(The )]TJ /TT5 1 Tf 3.0355 0 TD 0.0215 Tc (Journal)Tj /TT2 1 Tf 3.27 0 TD 0.023 Tc 0.1261 Tw [( publishes manuscripts which fall)]TJ -5.2827 -1.1809 TD 0.0198 Tc -0.0621 Tw (into eight major categories:)Tj 0.99 -1.3636 TD 0.02 Tc 0.0432 Tw ( original research)Tj 0 -1.1836 TD 0.0189 Tc 0.05 Tw ( book reviews)Tj 0 -1.1809 TD 0.0198 Tc 0.1113 Tw ( case studies)Tj T* 0.0193 Tc 0.0318 Tw ( empirical reviews)Tj 0 -1.1836 TD 0.0186 Tc 0.1273 Tw ( commentaries)Tj 0 -1.1809 TD 0.0199 Tc 0.0568 Tw ( theoretical reviews)Tj T* 0.0197 Tc -0.0136 Tw ( continuing education updates/reviews)Tj 0 -1.1836 TD 0.0183 Tc 0.0068 Tw ( program development)Tj -2.0127 -1.5436 TD -0.0031 Tc 0 Tw [(4.)-275.8(The )]TJ /TT5 1 Tf 2.8773 0 TD -0.0039 Tc (Journal)Tj /TT2 1 Tf 3.0873 0 TD -0.0031 Tc 0.0655 Tw [( will not consider manuscripts which)]TJ -4.9418 -1.1836 TD -0.0027 Tc 0.0818 Tw (are under concurrent review for publication else-)Tj 0 -1.1809 TD -0.0032 Tc -0.0401 Tw (where, or manuscripts which have been previously)Tj T* -0.0205 Tc 0 Tw (published.)Tj -1.0227 -1.5464 TD 0.0025 Tc 0.1255 Tw [(5.)-270.2(For purposes of author-editor communication, )-5.6(a)]TJ 1.0227 -1.1809 TD -0.0036 Tc 0.054 Tw [(phone number)37.3(, fax number)37.3(, e-mail address, and a)]TJ 0 -1.1836 TD -0.003 Tc 0.0435 Tw (postal address should be included with the manu-)Tj 0 -1.1809 TD -0.0028 Tc 0.0982 Tw (script. 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Participants who reported moderate distress by)]TJ 0 -1.401 TD -0.0035 Tc 0.0672 Tw (one or more re-experiencing symptoms, three or more)Tj T* -0.0033 Tc 0.0964 Tw (avoidance symptoms, and two or more arousal symp-)Tj 0 -1.398 TD -0.0008 Tc 0.125 Tw (toms over the past month were identified as meeting)Tj 0 -1.401 TD -0.0067 Tc -0.0622 Tw [(symptoms criteria for PTSD. 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When asked to name their worst event, 59% of)]TJ 0 -1.398 TD -0.0036 Tc 0.05 Tw (the sample reported that receiving their HIV diagnosis)Tj 0 -1.401 TD -0.0048 Tc -0.0625 Tw (was their hardest or worst event; the remaining 41%)Tj T* 0.0038 Tc 0.125 Tw (of the sample named another event such as physical)Tj 0 -1.398 TD -0.0031 Tc 0.0238 Tw [(attacks or other serious injury)59.9(.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0122 Tc -0.0622 Tw (The majority of the participants \(57%\) reported traumatic)Tj 0 -1.398 TD -0.0036 Tc 0.0656 Tw (stress symptoms consistent with PTSD or PTSS in re-)Tj 0 -1.401 TD 0.0627 Tw (sponse to at least one traumatic stressor among the 15)Tj T* -0.0031 Tc 0.1042 Tw [(potentially traumatic events surveyed. )53.8(An average of)]TJ 0 -1.398 TD -0.0025 Tc 0.1251 Tw [(each participant)48.5(s most severe traumatic stress symp-)]TJ 0 -1.401 TD -0.0036 Tc 0.095 Tw (toms was calculated and revealed a moderate level of)Tj 25.5 64.839 TD -0.014 Tc -0.06 Tw (symptoms \()Tj /TT5 1 Tf 4.5 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.816 0 TD -0.0132 Tc -0.0617 Tw [( = 36.87, )]TJ /TT5 1 Tf 3.498 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.191 0 TD -0.0141 Tc -0.0625 Tw [( = 14.29\).)]TJ /F21 1 Tf -11.805 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0975 Tw (20% of the participants reported symptoms consistent)Tj 0 -1.401 TD -0.0037 Tc 0.1083 Tw (with PTSS in response to the HIV diagnosis, with an)Tj 0 -1.398 TD -0.0252 Tc -0.0621 Tw (additional 13.3% meeting full symptoms criteria for PTSD.)Tj 0 -1.401 TD -0.0036 Tc 0.0134 Tw (Thus, overall, 33% of the sample showed a notable de-)Tj T* -0.0534 Tw (gree of posttraumatic stress in response to the HIV diag-)Tj 0 -1.398 TD 0.1243 Tw [(nosis. 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No significant differences existed between)]TJ T* -0.0037 Tc -0.0308 Tw (extent of HIV diagnosis-related symptoms as compared)Tj 0 -1.398 TD -0.0033 Tc -0.0407 Tw (to other trauma-related symptoms in each symptom cat-)Tj 0 -1.401 TD 0.0291 Tw [(egory)62.7(, although there was a trend toward re-experienc-)]TJ T* -0.001 Tc 0.125 Tw (ing symptoms being more severe for other-related as)Tj 0 -1.398 TD -0.0094 Tc -0.0613 Tw [(opposed to HIV)86.6(-related trauma \()]TJ /TT5 1 Tf 12.435 0 TD 0 Tc 0 Tw (t)Tj /TT2 1 Tf 0.27 0 TD -0.0084 Tc -0.0634 Tw (\(25\) = -1.780, )Tj /TT5 1 Tf 5.499 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.0085 Tc -0.0625 Tw [( = 0.09\).)]TJ /F21 1 Tf -20.496 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0472 Tw (Of the participants who met PTSD criteria, all but one)Tj 0 -1.398 TD -0.0178 Tc -0.0622 Tw [(met criteria for functional impairment as well. There were)]TJ 0 -1.401 TD -0.0001 Tc 0.125 Tw (no significant differences found between the average)Tj T* -0.0032 Tc -0.0481 Tw (number of stressors experienced, for both types of stres-)Tj 0 -1.398 TD -0.0067 Tc -0.0622 Tw [(sors combined, or for HIV)86.3(-related traumatic stress alone.)]TJ /TT1 1 Tf 11 0 0 11 309 306.24 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /F21 1 Tf 10 0 0 10 309 290.25 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD 0.002 Tc 0.125 Tw (Individuals in the study reported having experienced)Tj 0 -1.401 TD -0.0032 Tc -0.0375 Tw (high levels of potentially traumatic events in addition to)Tj 0 -1.398 TD -0.0037 Tc -0.0154 Tw [(receiving a diagnosis of HIV)128.3(. )14.5(Though receiving a diag-)]TJ 0 -1.401 TD -0.0034 Tc -0.0275 Tw (nosis of HIV was almost universally traumatic, 20% re-)Tj T* -0.0103 Tc -0.062 Tw (ported diagnosis-related PTSS while approximately 13%)Tj 0 -1.398 TD -0.0035 Tc -0.0565 Tw (of the sample met criteria for PTSD related to HIV diag-)Tj 0 -1.401 TD 0.0188 Tc 0 Tw (nosis.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0083 Tc -0.0621 Tw (Other life stressors were more frequently associated with)Tj 0 -1.401 TD -0.0125 Tc (both PTSD and PTSS with 23.3% of the sample reporting)Tj T* -0.004 Tc -0.0566 Tw [(PTSD and an additional 23.3% reporting PTSS.)]TJ -1.8 -1.599 TD -0.0036 Tc 0.075 Tw [()-1470.6(Reactions to receiving a diagnosis of HIV were as in-)]TJ 1.8 -1.401 TD -0.003 Tc 0.0206 Tw (tense as reactions to other life stressors, with relatively)Tj 0 -1.398 TD -0.0041 Tc -0.062 Tw (high levels of re-experiencing, hyperarousal, avoidance,)Tj 0 -1.401 TD -0.0063 Tc -0.0625 Tw (and functional impairment.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD 0.0012 Tc 0.125 Tw [(The numbers of traumatic events experienced by the)]TJ 0 -1.401 TD -0.0123 Tc -0.0625 Tw (participants are increased relative to community samples.)Tj ET endstream endobj 277 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 279 0 obj << /Length 8612 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (233)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0034 Tc 0.0243 Tw (The high rate of posttraumatic stress symptoms related)Tj 0 -1.398 TD -0.0036 Tc -0.0228 Tw (to HIV diagnosis and other events is consistent with the)Tj 0 -1.401 TD -0.0105 Tc -0.0625 Tw (adult HIV literature.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0049 Tc -0.0622 Tw (One limitation of the present study is the relatively small)Tj 0 -1.401 TD -0.0092 Tc [(number of participants, especially females. Females rep-)]TJ T* -0.0036 Tc 0.0028 Tw (resent the fastest growing population of individuals be-)Tj 0 -1.398 TD -0.0098 Tc -0.0622 Tw [(ing diagnosed with HIV)125.2(, and women with HIV)20.2( have been)]TJ 0 -1.401 TD -0.0032 Tc 0.0978 Tw (found to present with high rates of trauma history in-)Tj T* 0.0044 Tc 0.125 Tw (cluding sexual abuse and violence, thus, including a)Tj 0 -1.398 TD -0.0033 Tc 0.0489 Tw (greater number of females in the study would have al-)Tj 0 -1.401 TD -0.0032 Tc -0.0611 Tw (lowed for more detailed analysis of the effects of trauma)Tj T* -0.0037 Tc -0.0035 Tw [(on adolescent and young adult women with HIV)125.3(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0489 Tw (An additional limitation of the current study was the use)Tj 0 -1.401 TD -0.0036 Tc 0.0186 Tw (of a questionnaire format to assess posttraumatic stress)Tj 0 -1.398 TD -0.0086 Tc -0.0624 Tw [(reactions instead of a structured clinical interview)60.4(. Other)]TJ 0 -1.401 TD 0.0115 Tc 0.125 Tw (limitations include the cross-sectional design of the)Tj T* -0.0029 Tc 0.035 Tw (study and the lack of information on illness severity at)Tj 0 -1.398 TD -0.0035 Tc 0.0605 Tw [(the time o the interview)59.5(, and the sequence of stressors)]TJ 0 -1.401 TD -0.0097 Tc -0.0625 Tw (reported, especially in relation to receiving the HIV diag-)Tj T* 0.0188 Tc 0 Tw (nosis.)Tj /TT1 1 Tf 11 0 0 11 66 422.25 Tm 0.0255 Tc [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /F21 1 Tf 10 0 0 10 66 406.26 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc -0.0167 Tw (Care providers need to be aware of the traumatic nature)Tj 0 -1.401 TD -0.0039 Tc 0.105 Tw (of receiving a diagnosis of HIV/AIDS among adoles-)Tj T* -0.0026 Tc 0.0605 Tw [(cents and young adults. This may be particularly true)]TJ 0 -1.398 TD -0.0068 Tc -0.0621 Tw (among the youth who have already experienced multiple)Tj 0 -1.401 TD -0.0058 Tc 0 Tw (traumas.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0009 Tw (The symptoms associated with posttraumatic stress, re-)Tj 0 -1.401 TD -0.003 Tc 0.069 Tw (experiencing, hyperarousal, and avoidance, may inter-)Tj T* -0.0035 Tc -0.039 Tw (fere with adherence to medical care.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0192 Tw (Having counseling resources available or making refer-)Tj 0 -1.401 TD -0.0036 Tc 0.0332 Tw (ral to mental health professionals is an important com-)Tj 0 -1.398 TD -0.0038 Tc 0.0083 Tw (ponent of providing comprehensive care to adolescents)Tj 0 -1.401 TD -0.0034 Tc -0.0125 Tw [(and young adults with HIV)125.6(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0067 Tc -0.0625 Tw (Future research needs to examine the prevalence of post-)Tj 0 -1.401 TD -0.0002 Tc 0.125 Tw (traumatic stress among adolescents and young adults)Tj T* -0.0134 Tc -0.0625 Tw (with HIV/AIDS through larger scale studies, and it would)Tj 0 -1.398 TD -0.0031 Tc 0.03 Tw (be helpful to expand the study to include the effects of)Tj 0 -1.401 TD -0.0035 Tc 0.0929 Tw (posttraumatic stress on adherence to medical care, in-)Tj T* -0.0029 Tc -0.0113 Tw [(cluding highly active antiretroviral therapy)60.1(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0185 Tw [(Finally)62.7(, the development of ef)17.7(fective clinic-based inter)14.7(-)]TJ 0 -1.401 TD -0.0037 Tc 0.0244 Tw (ventions to reduce PTSS in youth with HIV/AIDS will)Tj 0 -1.398 TD -0.0035 Tc 0.0264 Tw (facilitate their over-all competence in living with HIV/)Tj 0 -1.401 TD -0.0271 Tc 0 Tw (AIDS.)Tj ET 3.99 w /GS1 gs 321 728.985 m 558 728.985 l S BT /TT1 1 Tf 11 0 0 11 321 710.01 Tm /GS2 gs 0.0212 Tc 0.1252 Tw [(Denson, )18.4(T)74.6(.)2.4( F)83.9(., Marshall, G)113.9(.)-0.6( N., Schell, )13(T)77.3(.)-0.5( L., &)]TJ 0 -1.1836 TD -0.0029 Tc 0.0381 Tw [(Jaycox, L. H. \(2007\). Predictors of Posttraumatic)]TJ 0 -1.1809 TD -0.004 Tc 0.0261 Tw [(Distr)12.4(ess 1 )31.6(Y)115.4(ear)12.4( )51.2(After)12.4( Exposur)12.4(e)-0.3( to Community )15.2(V)41.8(io-)]TJ T* 0.0014 Tc 0.1248 Tw [(lence: )14.8(The Impor)-9.5(tance of )53(Acute Symptom Sever)34.1(-)]TJ 0 -1.1836 TD -0.0017 Tc 0.0385 Tw [(ity)52.8(. )]TJ /TT4 1 Tf 1.8736 0 TD -0.0035 Tc 0.0382 Tw [(Journal of Consulting and Clinical Psychology)34.7(,)]TJ ET 0.99 w /GS1 gs 321 636.495 m 558 636.495 l S BT 11 0 0 11 321 645 Tm /GS2 gs 0.0173 Tc 0 Tw (75)Tj /TT1 1 Tf 1.05 0 TD 0.027 Tc 0.1272 Tw (\(5\), 683-692.)Tj -1.05 -2.9782 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.4( )46.5(A)10(R)27.5(TICLE)]TJ /F21 1 Tf 10 0 0 10 321 596.25 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0112 Tc -0.0625 Tw (Original Empirical Investigation)Tj /TT1 1 Tf 11 0 0 11 321 564.24 Tm 0.0066 Tc 0.126 Tw [(OBJECTIVE/PURPOSE OF)31.1( )14.4(THE )47.8(A)13.7(R)28.4(TICLE)]TJ /F21 1 Tf 10 0 0 10 321 548.25 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.014 Tw [(T)73.2(o)0( replicate cross-sectional findings demonstrating that)]TJ 0 -1.401 TD -0.014 Tc -0.0621 Tw (exemplars of broadly defined risk factors assessed shortly)Tj 0 -1.398 TD 0.0126 Tc 0.125 Tw (after trauma exposure predict PTSD severity at 12-)Tj 0 -1.401 TD -0.0042 Tc 0.105 Tw (months post-trauma.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0522 Tw [(T)73.5(o)0( determine whether widely recognized risk factors re-)]TJ 0 -1.401 TD -0.0065 Tc -0.0625 Tw (main significant predictors of 12-month PTSD symptom)Tj T* -0.0032 Tc -0.0621 Tw (severity after adjusting for initial levels of posttraumatic)Tj 0 -1.398 TD 0.0156 Tc 0 Tw (distress.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc -0.0082 Tw [(T)73.4(o)0( evaluate the extent to which long-term symptoms of)]TJ 0 -1.398 TD -0.0033 Tc 0.0608 Tw (posttraumatic distress are explained by acute posttrau-)Tj 0 -1.401 TD -0.0032 Tc 0.0343 Tw (matic stress above and beyond the risk factors studied.)Tj /TT1 1 Tf 11 0 0 11 321 372.24 Tm 0.0344 Tc 0 Tw (METHODS)Tj 0 -1.4536 TD 0.0026 Tc (Participants)Tj /F21 1 Tf 10 0 0 10 321 340.26 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc 0.0611 Tw (Medical patients seen at a Level I trauma facility who)Tj 0 -1.401 TD -0.0171 Tw (sustained an injury related to community violence were)Tj T* -0.0033 Tc -0.0485 Tw [(eligible to participate. 413 of the 423 \(98%\) eligible pa-)]TJ 0 -1.398 TD -0.0032 Tc -0.0271 Tw [(tients agreed to participate. The majority of participants)]TJ 0 -1.401 TD -0.0125 Tc -0.0621 Tw (sustained injuries from gunshots \(57%\) while the remain-)Tj T* -0.0032 Tc -0.0389 Tw (der had received injuries from blunt \(e.g., closed fists or)Tj 0 -1.398 TD 0.0291 Tw (bats\) or other penetrating objects \(e.g., knives\).)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0195 Tc -0.0622 Tw (Participants were predominately young \(mean age = 25.10)Tj 0 -1.398 TD -0.0008 Tc 0 Tw (years, )Tj /TT5 1 Tf 2.565 0 TD -0.0132 Tc (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0036 Tc -0.0433 Tw [( = 6.03\) male \(94%\) adults and 78% were His-)]TJ -3.774 -1.401 TD -0.0233 Tc -0.0625 Tw (panic: 47% were born in the United States, 38% in Mexico,)Tj T* -0.0253 Tc -0.0624 Tw [(and 15% in Central )49.8(America. 41% were high school gradu-)]TJ 0 -1.398 TD 0.0176 Tc 0 Tw (ates.)Tj /TT1 1 Tf 11 0 0 11 321 152.25 Tm 0.0233 Tc (Materials)Tj /F21 1 Tf 10 0 0 10 321 136.26 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD 0.0014 Tc 0.125 Tw [(Demographic variables assessed include gender)34.4(, age,)]TJ 0 -1.401 TD -0.0034 Tc -0.0014 Tw [(ethnicity)62.6(, income, and educational attainment)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.004 Tc 0.0975 Tw (Pretraumatic psychological factors)Tj /TT2 1 Tf 14.226 0 TD -0.0035 Tc 0.0983 Tw [( were assessed, in-)]TJ -14.226 -1.401 TD -0.0625 Tw (cluding prior exposure to traumatic events and life stres-)Tj T* 0.0472 Tc 0.125 Tw (sors, pretraumatic psychological symptoms, and)Tj ET endstream endobj 280 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 282 0 obj << /Length 9291 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.007 Tc 0 Tw (234 )Tj /TT3 1 Tf 2.0625 0 TD -0.004 Tc 0.1375 Tw ( Selected Annotated Journal Resources)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0035 Tc -0.0625 Tw [(personality variables. Lifetime community violence ex-)]TJ 0 -1.398 TD -0.0038 Tc 0.0744 Tw (posure was measured with the 18 items modeled after)Tj 0 -1.401 TD -0.0034 Tc 0.0257 Tw [(the Survey of Children)50.6(s Exposure to Community )17.6(V)64.8(io-)]TJ T* -0.0271 Tc -0.0624 Tw [(lence \(SCECV)74.9(; Richters & Saltzman, 1990\). Other lifetime)]TJ 0 -1.398 TD -0.0038 Tc 0.1207 Tw (trauma exposure was assessed with 8 items assessing)Tj 0 -1.401 TD -0.0116 Tc -0.0616 Tw (non-community-violence-related traumatic events which)Tj T* -0.0037 Tc -0.0044 Tw (were summed to create an index of trauma exposure. 9)Tj 0 -1.398 TD -0.0212 Tc -0.0625 Tw (items were drawn from the Life Experiences Survey \(LES;)Tj 0 -1.401 TD -0.0036 Tc -0.0056 Tw (Sarason, Johnson, & Siegel, 1978\) were included to as-)Tj T* -0.0031 Tc -0.025 Tw (sess the number of life stressors during the past year \()Tj /TT5 1 Tf 21.075 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf -21.075 -1.398 TD -0.0029 Tc -0.01 Tw (= 2.08, )Tj /TT5 1 Tf 3.024 0 TD -0.0066 Tc 0 Tw (SD )Tj /TT2 1 Tf 1.452 0 TD -0.0031 Tc -0.0122 Tw [(= 1.68\). Recent history of major depression)]TJ -4.476 -1.401 TD -0.0034 Tc 0.0221 Tw (and dysthymia was assessed with 3 dichotomous items)Tj T* -0.0022 Tc -0.06 Tw (\(i.e., have you had 2 years or more in your life when you)Tj 0 -1.398 TD -0.0025 Tc 0.079 Tw (felt depressed or sad most days, even if you felt okay)Tj 0 -1.401 TD 0.0021 Tc 0.125 Tw (sometimes?\) developed by Rost, Burnam, and Smith)Tj T* -0.0485 Tc 0 Tw (\(1993\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0563 Tw (Trait optimism was assessed with the 6-item Life Orien-)Tj 0 -1.401 TD -0.0103 Tc -0.0623 Tw [(tation )19.9(T)72.5(estRevised \(Scheier)34.7(, Carver)37.7(, & Bridges, 1994\).)]TJ 0 -1.398 TD -0.0037 Tc 0.1088 Tw (Trait neuroticism was assessed with 5 items from the)Tj 0 -1.401 TD 0.0875 Tw (NEO Five-Factor Inventory \(Costa & McCrae, 1989\).)Tj T* -0.0036 Tc -0.0081 Tw (This was an abbreviated version of the original 12-item)Tj 0 -1.398 TD -0.0225 Tw [(scale. In responding, participants were asked to answer)]TJ 0 -1.401 TD -0.003 Tc 0.002 Tw (with respect to what they were generally like as a per-)Tj T* -0.0034 Tc 0.0516 Tw (son before the attack.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0038 Tc 0.1088 Tw (Characteristics of the traumatic event)Tj /TT2 1 Tf 15.459 0 TD -0.0032 Tc [( such as the se-)]TJ -15.459 -1.401 TD -0.0029 Tc -0.0317 Tw [(verity of the injury)63.1(, mechanism of assault, and length of)]TJ 0 -1.398 TD -0.0032 Tc 0.0436 Tw [(the hospitalization were all obtained. Objective injury)]TJ 0 -1.401 TD -0.0028 Tc 0.0435 Tw (severity was obtained using the Injury Severity Scores)Tj T* -0.0042 Tc 0.0729 Tw [(\(ISS; )50.2(Association for the )53.2(Advancement of )50.2(Automotive)]TJ 0 -1.398 TD -0.0095 Tc -0.0623 Tw [(Medicine, 1990\). The mechanism of injury was coded as)]TJ 0 -1.401 TD -0.0037 Tc -0.0119 Tw [(gunshot versus all other mechanisms. The mean length)]TJ T* -0.0031 Tc 0.025 Tw (of hospitalization was 6.96 days \()Tj /TT5 1 Tf 13.464 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.212 0 TD -0.0031 Tc 0.026 Tw [( = 8.06\). The ISS)]TJ -14.676 -1.398 TD -0.0035 Tc 0.0814 Tw (and length of hospitalization variables were log trans-)Tj 0 -1.401 TD -0.0032 Tc 0.0855 Tw (formed to meet the assumptions of linearity in the re-)Tj T* 0.0012 Tc 0.125 Tw (gression analysis.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0037 Tc 0.0525 Tw (Reactions to the traumatic event)Tj /TT2 1 Tf 13.035 0 TD -0.0034 Tc 0.0549 Tw [(. Peritraumatic disso-)]TJ -13.035 -1.401 TD 0.0081 Tc 0.125 Tw (ciation was assessed with a modified version of the)Tj 0 -1.398 TD -0.001 Tc (Peritraumatic Dissociative Experiences Questionnaire)Tj 0 -1.401 TD -0.0039 Tc 0.0051 Tw [(\(PDEQ; Marmar)38.1(, )14.2(W)93.9(eiss, & Metzler)38.1(, 1997\). Self-blame)]TJ T* -0.0034 Tc -0.0342 Tw [(was assessed using items developed by Downey)59.6(, Silver)35.6(,)]TJ 0 -1.398 TD -0.0038 Tc 0.0744 Tw [(and )17.2(W)94(ortman \(1990\) and assessed the extent to which)]TJ 0 -1.401 TD -0.0117 Tc -0.0622 Tw (participants blamed themselves for the attack \(e.g., How)Tj T* -0.003 Tc 0.0015 Tw (much do you blame yourself for what happened?\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT5 1 Tf 1.8 0 TD -0.0044 Tc -0.02 Tw (PTSD symptom severity)Tj /TT2 1 Tf 9.426 0 TD -0.0038 Tc -0.021 Tw [( was assessed using the 17-item)]TJ -9.426 -1.401 TD -0.0175 Tc -0.062 Tw [(PTSD Checklist \(PCL; )15.6(W)98.3(eathers, Litz, Herman, Huska, &)]TJ 0 -1.398 TD -0.0034 Tc 0.1081 Tw [(Keane, 1993\). Participants rated the degree to which)]TJ 0 -1.401 TD -0.0029 Tc -0.0461 Tw (they were bothered by each symptom on a scale ranging)Tj 25.5 65.199 TD -0.0345 Tw [(from 1 \(not at all\) to 5 \(extremely\). Symptoms were as-)]TJ 0 -1.398 TD -0.0034 Tc 0.067 Tw (sessed with respect to the attack.)Tj /TT1 1 Tf 11 0 0 11 309 678.24 Tm 0.0242 Tc 0 Tw (Procedure)Tj /F21 1 Tf 10 0 0 10 309 662.25 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0125 Tc -0.062 Tw (Participants completed face-to-face interviews in English)Tj 0 -1.401 TD -0.0034 Tc 0.0489 Tw (\(72%\) or Spanish \(28%\) in the hospital within days of)Tj 0 -1.398 TD 0.0557 Tw (the injury; median interval from admission to baseline)Tj 0 -1.401 TD -0.0019 Tc 0.1249 Tw [(interview was 5 days. Subsequently)61.1(, face-to-face in-)]TJ T* -0.0031 Tc 0.125 Tw (home interviews were conducted at 3 and 12 months)Tj 0 -1.398 TD -0.0088 Tc -0.0617 Tw [(following the initial interview)60.2(.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0271 Tw (Of the 413 participants initially interviewed, 304 \(74%\))Tj 0 -1.398 TD -0.0039 Tc -0.0468 Tw [(completed the 12-month follow-up interview)62.1(. For those)]TJ 0 -1.401 TD -0.0356 Tw (who did not complete the 12-month follow-up and were)Tj T* -0.0144 Tc -0.0625 Tw (missing PTSD symptom severity outcome data, estimates)Tj 0 -1.398 TD -0.0038 Tc -0.001 Tw (were determined based on 3-month data.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0177 Tc -0.0621 Tw (Participants were given $25 for each interview completed.)Tj /TT1 1 Tf 11 0 0 11 309 473.85 Tm 0.0154 Tc 0 Tw [(RESUL)83.6(TS)]TJ /F21 1 Tf 10 0 0 10 309 457.86 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0714 Tw (A substantial portion of the sample reported clinically)Tj 0 -1.401 TD 0 Tc 0.125 Tw (significant psychological distress at each assessment.)Tj T* -0.0036 Tc -0.0045 Tw (Based on a screening of the PCL responses, 25% of the)Tj 0 -1.398 TD -0.0046 Tc -0.0625 Tw (participants met screening criteria for PTSD at the 5-day)Tj 0 -1.401 TD -0.0037 Tc 0.0535 Tw (assessment, whereas 20% met criteria at the 12-month)Tj T* -0.0036 Tc -0.0324 Tw [(follow-up. )50.5(Although there was a significant decrease in)]TJ 0 -1.398 TD -0.0029 Tc -0.0539 Tw (symptom severity over time, the effect size was small \()Tj /TT5 1 Tf 21.405 0 TD 0 Tc 0 Tw (d)Tj /TT2 1 Tf -21.405 -1.401 TD -0.003 Tc 0.0343 Tw (= -.31\), suggesting that while symptom levels may de-)Tj T* -0.0024 Tc -0.0469 Tw (cline somewhat, they stay relatively constant in the year)Tj 0 -1.398 TD -0.0036 Tc -0.0375 Tw (following the attack.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0089 Tc -0.0625 Tw (Recent history of depression, lifetime violence exposure,)Tj 0 -1.398 TD -0.0031 Tc -0.0009 Tw [(neuroticism, optimism, injury severity)59.9(, length of hospi-)]TJ 0 -1.401 TD -0.0034 Tc -0.046 Tw (talization, peritraumatic dissociation, self-blame, and 5-)Tj T* -0.0199 Tc -0.0625 Tw (day PTSD severity were all associated with PTSD severity)Tj 0 -1.398 TD -0.0042 Tc -0.0622 Tw [(at follow-up. )49.8(As would be expected, the strongest corre-)]TJ 0 -1.401 TD -0.0068 Tc (lation existed between 5-day and 12-month PTSD sever-)Tj T* -0.0133 Tc 0 Tw [(ity)64.7(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.0562 Tw (There was a small but significant percentage of variance)Tj 0 -1.401 TD -0.0032 Tc -0.0586 Tw (\(4%\) in 12-month PTSD symptom severity predicted by)Tj 0 -1.398 TD -0.0036 Tc 0.0715 Tw (demographics such that being younger and being His-)Tj 0 -1.401 TD -0.0014 Tc 0.125 Tw (panic was associated with decreased PTSD symptom)Tj T* 0.0029 Tc 0 Tw [(severity)62.9(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc -0.0283 Tw (Controlling for demographic and the other pretraumatic)Tj 0 -1.401 TD -0.0028 Tc 0.0378 Tw (factors, only a recent history of depression prior to the)Tj 0 -1.398 TD -0.0037 Tc -0.0375 Tw (traumatic event has significant unique associations with)Tj 0 -1.401 TD -0.006 Tc -0.0616 Tw [(12-month PTSD symptom severity)57(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0071 Tw (Characteristics of the traumatic event only predicted an)Tj 0 -1.401 TD -0.0036 Tc -0.0375 Tw (additional 2% of the variance in 12-month PTSD symp-)Tj ET endstream endobj 283 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 285 0 obj << /Length 8744 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (235)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0022 Tc 0.02 Tw [(tom severity; specifically)63.8(, injury severity was uniquely)]TJ 0 -1.398 TD -0.0062 Tc -0.0621 Tw [(related to 12-month PTSD symptom severity)62.8(, while con-)]TJ 0 -1.401 TD -0.0036 Tc -0.029 Tw (trolling for demographic and pretraumatic factors.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc 0.0607 Tw (An additional 4% of the variance was explained when)Tj 0 -1.401 TD -0.0034 Tc 0.1158 Tw (adding psychological reaction variables to the model;)Tj T* -0.0037 Tc 0.038 Tw (Peritraumatic dissociation and self-blame were signifi-)Tj 0 -1.398 TD -0.0034 Tc -0.0275 Tw [(cant predictors of 12-month PTSD symptom severity)59.6(.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc 0.0975 Tw (Five-day posttraumatic distress was the strongest pre-)Tj 0 -1.398 TD -0.0001 Tw [(dictor of 12-month PTSD symptom severity)59.6(. )54.1(After this)]TJ 0 -1.401 TD -0.032 Tw (predictor was entered into the model, none of the 6 con-)Tj T* -0.0036 Tc -0.005 Tw (structs that had been significant predictors of 12-month)Tj 0 -1.398 TD -0.0104 Tc -0.0621 Tw [(PTSD symptom severity remained significant. The addi-)]TJ 0 -1.401 TD -0.0027 Tc 0.0825 Tw (tion of 5-day symptom severity resulted in the largest)Tj T* -0.0141 Tc -0.0625 Tw (improvement in the predictive ability of the model \(11%\),)Tj 0 -1.398 TD -0.0102 Tc (and this single coefficient is approximately 4 times larger)Tj 0 -1.401 TD -0.0027 Tc 0.0332 Tw (than any other predictor and is nearly as large as all of)Tj T* -0.0033 Tc -0.0193 Tw [(the other predictors combined. These regression analy-)]TJ 0 -1.398 TD -0.0035 Tc 0.095 Tw (ses were replicated using logistic regression and a di-)Tj 0 -1.401 TD -0.0041 Tc -0.0263 Tw (chotomous index of probable PTSD.)Tj /TT1 1 Tf 11 0 0 11 66 434.64 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /F21 1 Tf 10 0 0 10 66 418.65 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.079 Tw (The regression analysis revealed demographic charac-)Tj 0 -1.401 TD -0.0032 Tc -0.0625 Tw (teristics \(i.e., age, Hispanic ethnicity\), pretraumatic psy-)Tj 0 -1.398 TD 0.0008 Tc 0.125 Tw (chological factors \(i.e., recent history of depression\),)Tj 0 -1.401 TD -0.0033 Tc -0.0039 Tw (characteristics of the traumatic event \(i.e., injury sever-)Tj T* -0.0031 Tc 0.0042 Tw (ity\), and reactions to the traumatic event \(peritraumatic)Tj 0 -1.398 TD -0.0036 Tc 0.073 Tw (dissociation, self-blame\) all predicted PTSD symptom)Tj 0 -1.401 TD -0.0032 Tc -0.0469 Tw [(severity at 12 months. )18.1(T)73.6(ogether)35.8(, these categories of risk)]TJ T* -0.0135 Tc -0.0622 Tw (factors accounted for 14% of the variance in PTSD symp-)Tj 0 -1.398 TD -0.0031 Tc 0.0103 Tw [(tom severity)62.9(. )18.2(This is consistent with prior research.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0212 Tw [(However)35.7(, 5-day PTSD symptom severity remained the)]TJ 0 -1.398 TD -0.0034 Tc 0.0635 Tw (only significant predictor of 12-month PTSD after ad-)Tj 0 -1.401 TD -0.0033 Tc 0.0105 Tw (justing for the four classes of apparent risk factors, and)Tj T* -0.009 Tc -0.0625 Tw (it predicted nearly as much variability in PTSD symptom)Tj 0 -1.398 TD -0.0031 Tc 0.0107 Tw (severity as all of the other predictors combined.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0047 Tc -0.0621 Tw [(Symptoms of distress in the days immediately following)]TJ 0 -1.398 TD -0.0035 Tc 0.0636 Tw (the trauma were good predictors of long-term psycho-)Tj 0 -1.401 TD -0.0026 Tc 0.125 Tw [(logical problems. High levels of acute posttraumatic)]TJ T* -0.0035 Tc -0.0345 Tw (distress should be seen as a marker for risk of long-term)Tj 0 -1.398 TD -0.0034 Tc 0.0499 Tw (psychological problems.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc 0.0322 Tw (Only acute posttraumatic distress appeared to meet the)Tj 0 -1.398 TD 0.0411 Tw (criteria for being designated as a risk factor for PTSD,)Tj 0 -1.401 TD -0.0036 Tc 0.0258 Tw [(based on demonstrations that it precedes )]TJ /TT5 1 Tf 16.449 0 TD -0.0075 Tc 0 Tw (and)Tj /TT2 1 Tf 1.485 0 TD -0.0033 Tc 0.0275 Tw [( is associ-)]TJ -17.934 -1.401 TD -0.0045 Tc -0.0625 Tw (ated with PTSD.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0031 Tc -0.0256 Tw (Limitations of the study include the homogeneity of the)Tj 0 -1.401 TD -0.003 Tc 0.095 Tw (sample \(i.e., young, male, Hispanic\), retrospective re-)Tj 25.5 64.8 TD -0.0033 Tc 0.1121 Tw (ports on several of the measures, participant attrition,)Tj 0 -1.398 TD -0.0038 Tc -0.0329 Tw (and possible omission of important predictors of PTSD.)Tj /TT1 1 Tf 11 0 0 11 321 678.24 Tm 0.0255 Tc 0 Tw [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /F21 1 Tf 10 0 0 10 321 662.25 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0028 Tc 0.0285 Tw (The study was the first to explicitly address the role of)Tj 0 -1.401 TD 0.0042 Tc 0.125 Tw (acute symptoms while systematically adjusting for a)Tj 0 -1.398 TD -0.0032 Tc -0.0125 Tw (broad range of theoretically important risk factors.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0031 Tc 0.062 Tw (Long-term psychopathology might be significantly in-)Tj 0 -1.398 TD -0.0064 Tc -0.0625 Tw (fluenced by survivors extreme initial reactions to a trau-)Tj 0 -1.401 TD -0.0038 Tc -0.045 Tw (matic event.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc 0.0107 Tw [(This finding raises questions about the nature of symp-)]TJ 0 -1.401 TD -0.0036 Tc 0.0431 Tw (toms of distress that, when occurring in the immediate)Tj T* -0.0033 Tc 0.0514 Tw (days following trauma exposure, are often regarded as)Tj 0 -1.398 TD -0.0044 Tc 0.06 Tw (normal and nonpathognomonic.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0086 Tc -0.0625 Tw (High levels of distress during the immediate aftermath of)Tj 0 -1.398 TD -0.0033 Tc 0.0863 Tw (trauma may be an important target for intervention or)Tj 0 -1.401 TD -0.0017 Tc 0.125 Tw (prevention: most respondents who developed chronic)Tj T* -0.0036 Tc 0.0381 Tw (PTSD symptoms in this sample had established an un-)Tj 0 -1.398 TD -0.0029 Tc 0.0256 Tw (healthy pattern of distress within days of the trauma.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.0625 Tw (The finding that self-blame did not directly contribute to)Tj 0 -1.398 TD -0.0086 Tc -0.0621 Tw (PTSD may be inappropriately regarded as indicating that)Tj 0 -1.401 TD 0.0072 Tc 0.125 Tw (self-blame is not an important contributor to PTSD.)Tj T* -0.0033 Tc 0.0237 Tw [(However)35.7(, self-blame may operate by influencing acute)]TJ 0 -1.398 TD -0.0032 Tc 0.0821 Tw (symptoms of distress, which, in turn, affect long-term)Tj 0 -1.401 TD 0.0012 Tc 0 Tw (adjustment.)Tj ET 3.99 w /GS1 gs 321 349.605 m 558 349.605 l S BT /TT1 1 Tf 11 0 0 11 321 330.6 Tm /GS2 gs -0.002 Tc 0.125 Tw [(Salciglu, E., Basoglu, M., & Livanou, M. \(2007\).)]TJ 0 -1.1809 TD 0.0272 Tc 0.1253 Tw (The Effects of Live Exposure on Symptoms of)Tj 0 -1.1836 TD 0.0156 Tc 0.125 Tw [(Posttraumatic S)42.9(t)-3.9(r)15.6(ess Disorder: )12.9(The Role of Re-)]TJ 0 -1.1809 TD 0.0379 Tc [(duced Behavioral )51.5(A)78.2(voidance in Impr)16.1(ovement.)]TJ ET 0.99 w /GS1 gs 321 270.105 m 558 270.105 l S BT /TT4 1 Tf 11 0 0 11 321 278.61 Tm /GS2 gs 0.0098 Tc 0.1251 Tw [(Behaviour Research and Therapy)34.3(, 45)]TJ /TT1 1 Tf 16.2191 0 TD 0.0106 Tc 0.1272 Tw (, 2268-2279.)Tj -16.2191 -2.9782 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.4( )46.5(A)10(R)27.5(TICLE)]TJ /F21 1 Tf 10 0 0 10 321 229.86 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0112 Tc -0.0625 Tw (Original Empirical Investigation)Tj /TT1 1 Tf 11 0 0 11 321 197.85 Tm 0.0066 Tc 0.126 Tw [(OBJECTIVE/PURPOSE OF)31.1( )14.4(THE )47.8(A)13.7(R)28.4(TICLE)]TJ /F21 1 Tf 10 0 0 10 321 181.86 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0344 Tw [(T)73.3(o)-0.1( explore the ef)14.5(fects of exposure on the PTSD symp-)]TJ 0 -1.401 TD -0.004 Tc -0.0108 Tw [(tom of avoidance and how this impacts improvement.)]TJ /TT1 1 Tf 11 0 0 11 321 135.84 Tm 0.0344 Tc 0 Tw (METHODS)Tj 0 -1.4536 TD 0.0026 Tc (Participants)Tj /F21 1 Tf 10 0 0 10 321 103.86 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0052 Tc -0.0625 Tw (Participants were recruited from two permanent housing)Tj 0 -1.401 TD -0.012 Tc -0.0622 Tw (sites that were built by the Turkish government for home-)Tj T* -0.0038 Tc 0.0343 Tw (less survivors following the 1999 earthquake and from)Tj ET endstream endobj 286 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R 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One hundred and eighty)]TJ 0 -1.401 TD -0.0038 Tc -0.0467 Tw (survivors who presented with posttraumatic stress prob-)Tj T* -0.0036 Tc -0.0045 Tw (lems according to the TSSC and were available for fur-)Tj 0 -1.398 TD -0.0029 Tc -0.0488 Tw [(ther interview were assessed for eligibility for the study)60.1(.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD 0.0042 Tc 0.125 Tw (Inclusion criteria were PTSD diagnosis according to)Tj 0 -1.398 TD -0.0041 Tc -0.0238 Tw [(DSM-IV)13.9( criteria, )]TJ 7.007 0 TD -0.0027 Tc -0.0259 Tw [(literacy)63.3(, age 16-65 years, and absence)]TJ -7.007 -1.401 TD -0.0037 Tc 0.0458 Tw (of alcohol or drug dependence, severe depression with)Tj T* -0.0032 Tc 0.116 Tw (suicidal intent, psychotic illness, predominating grief,)Tj 0 -1.398 TD -0.0035 Tc -0.0371 Tw (use of benzodiazepines, use of antidepressants, and pre-)Tj 0 -1.401 TD -0.0037 Tc -0.0467 Tw (vious CBT for earthquake-related traumatic stress prob-)Tj T* -0.0284 Tc 0 Tw (lems.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0041 Tc -0.0622 Tw (Fifty-nine survivors fulfilled these criteria and were ran-)Tj 0 -1.401 TD -0.0185 Tc -0.062 Tw (domized into either the SSBT \()Tj /TT5 1 Tf 11.61 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.48 0 TD -0.0188 Tc -0.0625 Tw [( = 31\) or waiting list \(WL\))]TJ -12.09 -1.398 TD -0.0038 Tc -0.02 Tw (control conditions \()Tj /TT5 1 Tf 7.719 0 TD -0.004 Tc 0 Tw (n )Tj /TT2 1 Tf 0.726 0 TD -0.0034 Tc -0.025 Tw (= 28\).)Tj /F21 1 Tf -10.245 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.003 Tc -0.018 Tw (Mean age was 36.3 years \()Tj /TT5 1 Tf 10.5 0 TD -0.0061 Tc 0 Tw (SD )Tj /TT2 1 Tf 1.44 0 TD -0.0036 Tc -0.0187 Tw [(= 11.5\); 50 \(85.5%\) were)]TJ -11.94 -1.398 TD -0.0189 Tc -0.0622 Tw [(women and 48 \(81%\) married. )14.1(T)72.9(welve \(20%\) of survivors)]TJ 0 -1.401 TD -0.0034 Tc 0.0279 Tw (were trapped under rubble, 23 \(39%\) suffered physical)Tj T* -0.0032 Tc -0.0217 Tw [(injury and 11 \(19%\) participated in rescue work. Three)]TJ 0 -1.398 TD -0.0109 Tc -0.0622 Tw (\(5%\) survivors lost a first-degree relative, 19 \(32%\) lost a)Tj 0 -1.401 TD -0.0035 Tc 0.0156 Tw (second-degree relative, and 58% lost a friend or neigh-)Tj T* -0.011 Tc 0 Tw [(bor)49(.)]TJ /TT1 1 Tf 11 0 0 11 54 360.66 Tm 0.0233 Tc (Materials)Tj /F21 1 Tf 10 0 0 10 54 344.64 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc -0.0019 Tw (The standardized Turkish version \(Aker et al., 1999\) of)Tj 0 -1.398 TD -0.0128 Tc -0.0625 Tw (the Clinician-Administered PTSD Scale \(CAPS; Blake et)Tj 0 -1.401 TD -0.0035 Tc -0.0144 Tw (al., 1996\) was used for assessment of PTSD symptoms.)Tj T* -0.0033 Tc -0.06 Tw (The CAPS assesses severity of a particular PTSD symp-)Tj 0 -1.398 TD -0.0031 Tc -0.0219 Tw [(tom on two dimensions: frequency and intensity)62.9(. )51.2(A)59.1( fre-)]TJ 0 -1.401 TD -0.0028 Tc -0.0118 Tw (quency rating of 1 or higher and an intensity rating of 2)Tj T* -0.0034 Tc 0.0195 Tw (or higher is considered present \(Blake et al., 1999\) and)Tj 0 -1.398 TD -0.0035 Tc 0.04 Tw (this scoring approach was adopted to determine symp-)Tj 0 -1.401 TD -0.0033 Tc 0.0436 Tw [(tom presence or absence in the current study)59.7(.)]TJ /TT1 1 Tf 11 0 0 11 54 202.26 Tm 0.0242 Tc 0 Tw (Procedure)Tj /F21 1 Tf 10 0 0 10 54 186.24 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.0359 Tw (Participants in the treatment condition received single-)Tj 0 -1.398 TD -0.0065 Tc -0.0622 Tw (session behavioral treatment \(SSBT\) within 1 week after)Tj 0 -1.401 TD -0.0051 Tc -0.0623 Tw (baseline assessment and were followed up at 6-, 12-, and)Tj T* -0.004 Tc -0.0471 Tw [(24-week post-treatment. Survivors in the WL condition)]TJ 0 -1.398 TD -0.0031 Tc 0.0589 Tw [(were re-assessed at 6 weeks after trial entry)62.9(, given the)]TJ 0 -1.401 TD -0.0035 Tc -0.0572 Tw (same treatment, and followed up at 6-, 12-, and 24-week)Tj T* 0.0035 Tc 0 Tw (post-treatment.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0055 Tc -0.0625 Tw [(T)35.3(reatment involved a shorter version of CBT)72.5(, which was)]TJ 0 -1.401 TD -0.0033 Tc 0.1185 Tw (modified by a\) limiting cognitive interventions to the)Tj 25.5 65.04 TD 0.0135 Tw [(explanation of the treatment rationale only)62.7(, b\) focusing)]TJ 0 -1.398 TD -0.0035 Tc -0.0322 Tw (on reduction of fear and avoidance, and c\) shifting from)Tj 0 -1.401 TD 0.0064 Tc 0.125 Tw (habituation to anxiogenic stimuli to enhancement of)Tj T* -0.0035 Tc 0.063 Tw (sense of control over traumatic stressors.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc -0.0081 Tw (The first step in treatment \(10 min\) involved identifica-)Tj 0 -1.401 TD -0.0033 Tc -0.0299 Tw [(tion of the presenting problem \(i.e., fear of earthquakes,)]TJ 0 -1.398 TD -0.0037 Tc -0.045 Tw (behavioral avoidance of earthquake reminders, re-expe-)Tj 0 -1.401 TD -0.0031 Tc 0.02 Tw (riencing, and hyperarousal\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.035 Tw (The second step \(30 min\) consisted of an explanation of)Tj 0 -1.401 TD 0.0028 Tw (the treatment rationale and focused on increasing sense)Tj T* 0.0129 Tc 0.125 Tw (of control over earthquake-related fears, distressing)Tj 0 -1.398 TD -0.0037 Tc 0.0308 Tw (trauma reminders, and associated emotional and/or be-)Tj 0 -1.401 TD -0.0036 Tc -0.005 Tw (havioral responses rather than habituation to trauma re-)Tj T* -0.0138 Tc 0 Tw (minders.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.0493 Tw (The third step \(20 min\) involved treatment target setting)Tj 0 -1.401 TD -0.0044 Tc -0.0625 Tw (and self-exposure instructions, and targets involved four)Tj 0 -1.398 TD 0.0027 Tc 0.125 Tw (of the most functionally disabling problems, such as)Tj 0 -1.401 TD -0.0033 Tc -0.0078 Tw (avoidance of safe buildings, staying home alone, sleep-)Tj T* -0.0034 Tc 0.0475 Tw [(ing in the dark, etc. Once agreement was achieved on)]TJ 0 -1.398 TD -0.0035 Tc 0.0022 Tw (the targets, self-0exposure instructions were given. No)Tj 0 -1.401 TD -0.0033 Tc -0.0386 Tw (fear hierarchy was established and the participants were)Tj T* -0.0032 Tc 0.0122 Tw [(advised to work on any treatment target of their choos-)]TJ 0 -1.398 TD -0.0033 Tc 0.0514 Tw [(ing. No systematic cognitive restructuring was under-)]TJ 0 -1.401 TD -0.0037 Tc 0.0025 Tw (taken during treatment.)Tj /TT1 1 Tf 11 0 0 11 309 364.26 Tm 0.0154 Tc 0 Tw [(RESUL)83.6(TS)]TJ /F21 1 Tf 10 0 0 10 309 348.24 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0113 Tc -0.0621 Tw (The most common symptoms reported \(endorse rate over)Tj 0 -1.398 TD -0.0038 Tc -0.0333 Tw (80%\) were behavioral avoidance, distress upon remind-)Tj 0 -1.401 TD -0.0029 Tc 0.0541 Tw [(ers, cognitive avoidance, irritability)63.1(, memory and con-)]TJ T* -0.0064 Tw [(centration dif)15.1(ficulty)63.1(, hypervigilance, and startle.)]TJ -1.8 -1.599 TD -0.0037 Tc -0.0286 Tw [()-1470.7(The between-groups differences at week 6 were signifi-)]TJ 1.8 -1.401 TD -0.0032 Tc 0.0112 Tw [(cant on all outcome measures. Greater illness severity)59.8(,)]TJ 0 -1.398 TD 0.0028 Tc 0.125 Tw (higher education, and past trauma predicted less im-)Tj 0 -1.401 TD -0.0029 Tc 0 Tw (provement.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc -0.0191 Tw [(There was no significant between-groups differences in)]TJ 0 -1.401 TD -0.003 Tc 0.065 Tw (symptom severity scores or symptom prevalence rates)Tj T* -0.0035 Tc 0.04 Tw (at baseline.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0039 Tc 0.071 Tw (Significant between-groups differences were found on)Tj 0 -1.401 TD -0.0034 Tc 0.0009 Tw (only behavioral avoidance, with trends towards signifi-)Tj 0 -1.398 TD -0.0036 Tc -0.02 Tw (cance on distress upon reminders, nightmares, intrusive)Tj 0 -1.401 TD 0.0063 Tc 0.125 Tw (thoughts, cognitive avoidance, hypervigilance, sense)Tj T* -0.0035 Tc -0.0083 Tw (of foreshortened future, and memory and concentration)Tj 0 -1.398 TD -0.0124 Tc -0.0622 Tw [(dif)11.6(ficulty)62.6(. )17.5(Thus, behavioral avoidance was the first symp-)]TJ 0 -1.401 TD -0.0037 Tc 0.025 Tw (tom to respond to self-exposure.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.005 Tc -0.0625 Tw (Effect sizes on behavioral avoidance and hypervigilance)Tj 0 -1.401 TD -0.0034 Tc -0.0256 Tw (were large, despite the fact that the between-groups dif-)Tj ET endstream endobj 289 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 291 0 obj << /Length 9170 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (237)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0031 Tc -0.01 Tw (ferences failed to reach significance on the latter symp-)Tj 0 -1.398 TD -0.0034 Tc -0.0069 Tw [(tom. Medium effect sizes were noted on psychological)]TJ 0 -1.401 TD -0.0035 Tc 0.012 Tw (and physiological distress upon reminders, nightmares,)Tj T* -0.0037 Tc 0.045 Tw (cognitive avoidance, emotional numbing, memory and)Tj 0 -1.398 TD -0.0033 Tc 0.0728 Tw [(concentration dif)17.7(ficulty)62.7(, sense of foreshortened future,)]TJ 0 -1.401 TD -0.0039 Tc -0.05 Tw (and intrusive memories.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc 0.0817 Tw (Although change in behavioral avoidance was signifi-)Tj 0 -1.401 TD -0.0035 Tc -0.035 Tw (cant, improvement was partial \(32% reduction in symp-)Tj T* 0.0151 Tc 0.125 Tw (tom severity\), reflecting the slow pace of exposure)Tj 0 -1.398 TD -0.0031 Tc 0.1066 Tw (conducted by the participants.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0173 Tc -0.0622 Tw [(T)74.5(otal CAPS scores reduced by 35% in the treatment group)]TJ 0 -1.398 TD -0.0035 Tc 0.0536 Tw (\(10% in the control group\), reflecting partial improve-)Tj 0 -1.401 TD -0.0051 Tc -0.0616 Tw (ment at week 6.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc -0.0375 Tw (Some improvement was noted in some symptoms in the)Tj 0 -1.401 TD 0.0038 Tc 0.125 Tw (control group, which could be attributed to therapist)Tj T* -0.0033 Tc 0.0783 Tw (contact, detailed assessment, and possibly other none-)Tj 0 -1.398 TD -0.0044 Tc -0.0625 Tw (specific factors \(Basoglu, Salcioglu et al., 2005\).)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc -0.0461 Tw [(Treatment effect sizes were large for all symptoms. Re-)]TJ 0 -1.398 TD -0.0051 Tc -0.0625 Tw (covery rates \(symptom absent\) ranged from 60% to 89%)Tj 0 -1.401 TD -0.0024 Tc 0.0261 Tw [(for the majority of the symptoms. Similarly)60.6(, clinically)]TJ T* -0.0036 Tc -0.0433 Tw (significant change \(2 )Tj /TT5 1 Tf 8.43 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0032 Tc -0.045 Tw [( change from baseline in symp-)]TJ -9.639 -1.398 TD 0.0533 Tw (tom severity\) ranged from 60% to 100% for 14 symp-)Tj 0 -1.401 TD -0.0114 Tc -0.0623 Tw [(toms. Overall, PTSD symptoms improved by 605, with a)]TJ T* -0.0057 Tc -0.0625 Tw (large effect size of 1.8.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0161 Tc -0.0621 Tw (Compared to those who recovered from behavioral avoid-)Tj 0 -1.401 TD -0.0031 Tc -0.0294 Tw (ance, those who still had the symptom were more likely)Tj 0 -1.398 TD -0.0037 Tc 0.09 Tw (to have intrusive memories, nightmares, distress upon)Tj 0 -1.401 TD -0.0113 Tc -0.0621 Tw [(reminders, physiological reactivity)63.7(, avoidance of trauma-)]TJ T* -0.003 Tc 0.0133 Tw (related thoughts, los of interest, hypervigilance, startle,)Tj 0 -1.398 TD -0.0013 Tc 0.1248 Tw [(insomnia, memory and concentration dif)13.7(ficulty)58.7(, emo-)]TJ 0 -1.401 TD -0.0038 Tc -0.0607 Tw [(tional numbing, and detachment. Compared to avoidant)]TJ T* 0.0285 Tc 0.125 Tw (participants, those who recovered from avoidance)Tj 0 -1.398 TD -0.0038 Tc 0.0606 Tw [(showed twice as much reduction in total CAPS scores)]TJ 0 -1.401 TD -0.0033 Tc -0.0088 Tw [(\(respectively)62.7(, mean 36% \()]TJ /TT5 1 Tf 10.329 0 TD -0.0066 Tc 0 Tw (SD )Tj /TT2 1 Tf 1.452 0 TD -0.0034 Tc -0.008 Tw [( = 35\) vs 72% \()]TJ /TT5 1 Tf 6.114 0 TD -0.0066 Tc 0 Tw (SD )Tj /TT2 1 Tf 1.449 0 TD -0.0028 Tc -0.01 Tw (= 20, )Tj /TT5 1 Tf 2.28 0 TD 0 Tc 0 Tw (t)Tj /TT2 1 Tf -21.624 -1.401 TD -0.0226 Tc -0.0616 Tw (\(19.5\) = 3.88, )Tj /TT5 1 Tf 5.211 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.474 0 TD -0.0227 Tc -0.0625 Tw [( < .001\).)]TJ /TT1 1 Tf 11 0 0 11 66 204.66 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /F21 1 Tf 10 0 0 10 66 188.64 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0367 Tw (Given the chronic nature of PTSD in the study partici-)Tj 0 -1.398 TD -0.0038 Tc 0.0445 Tw [(pants and less than 10% reduction in PTSD during the)]TJ 0 -1.401 TD -0.0159 Tc -0.0625 Tw (waiting period, improvement in behavioral avoidance and)Tj T* -0.0035 Tc 0.01 Tw (other PTSD symptoms can be attributed to treatment.)Tj -1.8 -1.599 TD -0.0033 Tc -0.0122 Tw [()-1470.3(A)0( relatively short control period of 6 weeks might have)]TJ 1.8 -1.401 TD -0.0064 Tc -0.0625 Tw [(underestimated the treatment effects. Because treatment)]TJ 0 -1.398 TD -0.0048 Tc (did not involve the usual monitoring of behavior therapy)Tj 0 -1.401 TD -0.0034 Tc 0.075 Tw (\(e.g., verbal praise, encouragement, setting new expo-)Tj T* 0.1034 Tw (sure tasks, etc.\), the participants conducted self-expo-)Tj 25.5 64.8 TD 0.002 Tc 0.125 Tw (sure at their own pace, which slowed and protracted)Tj 0 -1.398 TD -0.0165 Tc 0 Tw (improvement.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.1039 Tw (The fact that avoidance was the first symptom to im-)Tj 0 -1.398 TD -0.0375 Tw (prove suggests that the treatment effects on other symp-)Tj 0 -1.401 TD -0.0038 Tc 0.015 Tw (toms were mediated through reduction in avoidance.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.024 Tw (A symptom constellation consisting of re-experiencing)Tj 0 -1.401 TD 0.0534 Tc 0.125 Tw (symptoms, cognitive and behavioral avoidance,)Tj T* -0.009 Tc -0.0625 Tw (hypervigilance, and startle is characteristic of earthquake)Tj 0 -1.398 TD -0.0063 Tc -0.0622 Tw (trauma and reflects conditioned fears caused by repeated)Tj 0 -1.401 TD -0.0035 Tc -0.0271 Tw [(exposures to earthquakes. Improvement in these symp-)]TJ T* -0.003 Tc 0.0646 Tw (toms is thus likely to be a direct result of reduction in)Tj 0 -1.398 TD -0.0037 Tc 0.0325 Tw (fear and avoidance.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0145 Tc -0.0625 Tw (The generalization of treatment effects to all PTSD symp-)Tj 0 -1.398 TD -0.0032 Tc 0.0483 Tw (toms, as well as depression, might be explained by in-)Tj 0 -1.401 TD -0.0055 Tc -0.0625 Tw (creased sense of control over fear and distress associated)Tj T* -0.0037 Tc -0.0475 Tw (with the trauma.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc 0.0242 Tw (Improvement in cognitive symptoms is consistent with)Tj 0 -1.401 TD -0.0063 Tc -0.0622 Tw (findings of other studies reporting cognitive change with)Tj 0 -1.398 TD -0.0038 Tc 0.0693 Tw [(exposure treatment. Emotional numbing is thought to)]TJ 0 -1.401 TD 0.104 Tw (be associated with opioid-induced analgesia produced)Tj T* -0.0035 Tc 0.0884 Tw (by cues associated with uncontrollable stress \(Mineka)Tj 0 -1.398 TD -0.0033 Tc -0.0243 Tw (& Zinbarg, 2006\), and analgesia produced by initial ex-)Tj 0 -1.401 TD -0.0034 Tc 0.0862 Tw (posure to the trauma might be sustained by continued)Tj T* -0.0033 Tc 0.0313 Tw (exposure to fear and distress triggered by reminders of)Tj 0 -1.398 TD -0.0035 Tc -0.0117 Tw (the trauma \(e.g., conditioned emotional responses; Foa,)Tj 0 -1.401 TD -0.0038 Tc -0.0336 Tw [(Zinbarg, & Rothbaum, 1992\). Thus exposure treatment)]TJ T* 0.0334 Tw (might improve numbing by reducing and/or enhancing)Tj 0 -1.398 TD -0.0035 Tc 0.0744 Tw (sense of control over fear and distress associated with)Tj 0 -1.401 TD -0.0039 Tc 0.015 Tw (trauma cues.)Tj /TT1 1 Tf 11 0 0 11 321 290.64 Tm 0.0255 Tc 0 Tw [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /F21 1 Tf 10 0 0 10 321 274.65 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD 0.0034 Tc 0.125 Tw (The suggestion that PTSD can be effectively treated)Tj 0 -1.401 TD -0.0103 Tc -0.0621 Tw (with an intervention focusing solely on behavioral avoid-)Tj 0 -1.398 TD -0.0035 Tc 0.0056 Tw (ance raises questions about the need for other interven-)Tj 0 -1.401 TD -0.0038 Tc 0.003 Tw (tions often used in CBT programs.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0086 Tc -0.0625 Tw (Evidence that live exposure is more effective than imagi-)Tj 0 -1.401 TD -0.0093 Tc (nal exposure may be explained by the fact that the former)Tj T* -0.0011 Tc 0.125 Tw (involves exposure to both past trauma memories and)Tj 0 -1.398 TD -0.0034 Tc 0.005 Tw (cues that signal future threat, and thus, provides oppor-)Tj 0 -1.401 TD -0.0031 Tc 0.0681 Tw (tunities to gain control over both types of stressors.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc -0.005 Tw (Few treatment studies have measured effects on behav-)Tj 0 -1.401 TD -0.0168 Tc -0.0622 Tw (ioral avoidance, and it is hard to determine whether imagi-)Tj T* 0.0275 Tc 0.125 Tw [(nal exposure reduces avoidance )]TJ /TT5 1 Tf 14.301 0 TD 0.0273 Tc 0 Tw (before)Tj /TT2 1 Tf 2.718 0 TD 0.03 Tc 0.125 Tw [( any actual)]TJ -17.019 -1.398 TD -0.0036 Tc -0.0322 Tw [(exposure occurs. In one of few studies examining these)]TJ 0 -1.401 TD -0.0014 Tw (issues, imaginal exposure was not effective in reducing)Tj T* -0.0586 Tw (avoidance, a finding which might explain why improve-)Tj ET endstream endobj 292 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 295 0 obj << /Length 9513 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.007 Tc 0 Tw (238 )Tj /TT3 1 Tf 2.0625 0 TD -0.004 Tc 0.1375 Tw ( Selected Annotated Journal Resources)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0035 Tc -0.055 Tw (ment did not generalize to other symptoms such as emo-)Tj 0 -1.398 TD -0.0038 Tc -0.015 Tw (tional numbing and guilt.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.1 Tw (Findings of the current study suggest that a treatment)Tj 0 -1.398 TD -0.0036 Tc 0.0264 Tw (focus on reducing behavioral avoidance is sufficient in)Tj 0 -1.401 TD -0.0054 Tc -0.0625 Tw (achieving marked generalized improvement in all PTSD)Tj T* -0.0034 Tc 0.1143 Tw [(symptoms and depression. Replication of these find-)]TJ 0 -1.398 TD -0.0045 Tc -0.0625 Tw (ings might lead to the development of a briefer and more)Tj 0 -1.401 TD -0.0037 Tc -0.0434 Tw (cost-effective treatment for PTSD.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0428 Tw (In other cases where PTSD is not characterized by be-)Tj 0 -1.401 TD -0.0036 Tc -0.0407 Tw (havioral avoidance, treatment could focus on trauma re-)Tj T* 0.0019 Tc 0.125 Tw (minders that trigger distress or other re-experiencing)Tj 0 -1.398 TD -0.0015 Tc 0 Tw (symptoms.)Tj ET 3.99 w /GS1 gs 54 539.985 m 291 539.985 l S BT /TT1 1 Tf 11 0 0 11 54 521.01 Tm /GS2 gs 0.0059 Tc 0.1253 Tw [(Craig, D.C., & Sprang, G)115(.)-1.3( \(2007\). )14.1(T)78.3(rauma expo-)]TJ 0 -1.1836 TD 0.0061 Tc 0.125 Tw (sure and child abuse potential: Investigating the)Tj 0 -1.1809 TD 0.0084 Tc 0.1258 Tw (cycle of violence. )Tj /TT4 1 Tf 7.9282 0 TD 0.0075 Tc (American Journal of Orthopsy-)Tj ET 0.99 w /GS1 gs 54 473.505 m 291 473.505 l S BT 11 0 0 11 54 482.01 Tm /GS2 gs 0.0149 Tc 0.1272 Tw [(chiatry)34(, 77)]TJ /TT1 1 Tf 4.65 0 TD 0.0155 Tc (, 296-305.)Tj -4.65 -2.9782 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.5( )46.5(A)10(R)27.5(TICLE)]TJ /F21 1 Tf 10 0 0 10 54 433.26 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc 0.0413 Tw (Original empirical investigation: Passive observational)Tj 0 -1.401 TD 0.0107 Tc 0 Tw (design.)Tj /TT1 1 Tf 11 0 0 11 54 387.24 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /F21 1 Tf 10 0 0 10 54 371.25 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc -0.015 Tw (This study investigated the relation between trauma ex-)Tj 0 -1.401 TD -0.0035 Tc -0.0425 Tw (posure experienced at different ages and the potential as)Tj 0 -1.398 TD -0.0034 Tc 0.051 Tw (an adult to perpetuate child abuse.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.085 Tw (In addition, the researchers examined the influence of)Tj 0 -1.398 TD -0.0067 Tc -0.0619 Tw [(gender)38.3(, prevalence of trauma experiences \(e.g., the num-)]TJ 0 -1.401 TD -0.0012 Tc 0.125 Tw (ber of traumatic events experiences\), and the type of)Tj T* -0.0031 Tc -0.0009 Tw (trauma experienced \(e.g., physical abuse, sexual abuse,)Tj 0 -1.398 TD -0.0033 Tc 0.0517 Tw (etc.\) on abuse potential.)Tj /TT1 1 Tf 11 0 0 11 54 239.25 Tm 0.0265 Tc 0 Tw (PROCEDURE)Tj 0 -1.4536 TD 0.0198 Tc (Subjects)Tj /F21 1 Tf 10 0 0 10 54 207.24 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc 0.0043 Tw (1,680 caregivers receiving services at the University of)Tj 0 -1.398 TD 0.0013 Tc 0.1247 Tw [(Kentucky)49.3(s Comprehensive )52(Assessment and )16(T)39.1(raining)]TJ 0 -1.401 TD -0.0189 Tc -0.0625 Tw (Services project, a multidisciplinary outpatient clinic serv-)Tj T* -0.0126 Tc (ing maltreating families.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0116 Tc -0.062 Tw (Number of lifetime traumas experienced \()Tj /TT5 1 Tf 16.026 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.813 0 TD -0.0107 Tc -0.0625 Tw [( = 4.84\).)]TJ -18.639 -1.599 TD -0.0034 Tc 0.1 Tw [()-1470.4(T)73.4(ype of trauma included childhood sexual abuse \()]TJ /TT5 1 Tf 22.29 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD 0.101 Tc ( =)Tj -20.985 -1.401 TD -0.0036 Tc 0.0175 Tw (244\), motor vehicle accidents \()Tj /TT5 1 Tf 12.375 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0033 Tc 0.0174 Tw [( = 131\), sexual harass-)]TJ -12.87 -1.401 TD -0.0045 Tc -0.04 Tw (ment \()Tj /TT5 1 Tf 2.52 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0031 Tc -0.043 Tw [( = 1\) and torture \()]TJ /TT5 1 Tf 6.819 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0022 Tc -0.045 Tw [( = 1\).)]TJ /TT1 1 Tf 11 0 0 11 309 722.64 Tm 0.0069 Tc 0.1113 Tw [(P)6.1(r)12.4(edictor)15.1( V)93.6(ariables)]TJ /F21 1 Tf 10 0 0 10 309 706.65 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.125 Tw [(Using the criteria in the DSM-IV)86.5(-TR for exposure to)]TJ 0 -1.401 TD -0.0002 Tc (trauma, participants answered either yes or no to the)Tj 0 -1.398 TD -0.0037 Tc -0.0066 Tw (following, I have been exposed to a traumatic event in)Tj 0 -1.401 TD -0.0036 Tc 0.1088 Tw (which both of the following were present: \(a\) experi-)Tj T* 0.1081 Tw (enced, witnessed, or was confronted with an event or)Tj 0 -1.398 TD -0.0034 Tc 0.0468 Tw (events that involved actual or threatened death or seri-)Tj 0 -1.401 TD -0.0024 Tc -0.005 Tw [(ous injury)60.6(, or a threat to the physical integrity of self or)]TJ T* -0.0035 Tc 0.0143 Tw (others, and \(b\) response involved intense fear helpless-)Tj 0 -1.398 TD 0.0225 Tw [(ness, or horror)35.4(,)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0045 Tc -0.0622 Tw (Individuals who answered no were then categorized into)Tj 0 -1.398 TD -0.0039 Tc 0.0638 Tw (a no-trauma exposure group \()Tj /TT5 1 Tf 11.979 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0034 Tc 0.065 Tw [( = 294\). Those who re-)]TJ -12.474 -1.401 TD -0.0071 Tw (sponded yes were classified as the experiencing trauma)Tj T* -0.006 Tc -0.06 Tw (group \()Tj /TT5 1 Tf 2.82 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0053 Tc -0.0625 Tw [( = 446\).)]TJ /F21 1 Tf -5.115 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0199 Tw [(Additionally)59.5(, participants were categorized into groups)]TJ 0 -1.401 TD -0.0031 Tc -0.0104 Tw (based on the time in their life in which they had experi-)Tj 0 -1.398 TD -0.0037 Tc -0.005 Tw (enced trauma. Those who had experienced trauma at or)Tj 0 -1.401 TD -0.0028 Tc 0.0834 Tw (before the age of 17 years \()Tj /TT5 1 Tf 11.364 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0033 Tc 0.084 Tw [( = 93\) were classified as)]TJ -11.859 -1.401 TD -0.0035 Tc -0.0542 Tw (child-only trauma group, those who experienced trauma)Tj 0 -1.398 TD -0.0031 Tc -0.051 Tw (at age 18 or older \()Tj /TT5 1 Tf 7.266 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0031 Tc -0.0516 Tw [( = 154\) were classified as adult-only)]TJ -7.761 -1.401 TD -0.0052 Tc -0.0621 Tw (trauma group, and those who experienced trauma during)Tj T* -0.0036 Tc 0.1129 Tw (both times were classified into the child-adult trauma)Tj 0 -1.398 TD -0.0085 Tc -0.06 Tw (group \()Tj /TT5 1 Tf 2.799 0 TD -0.009 Tc 0 Tw (n )Tj /TT2 1 Tf 0.675 0 TD -0.0092 Tc (=199\).)Tj /TT1 1 Tf 11 0 0 11 309 376.65 Tm 0.0117 Tc 0.1128 Tw [(Outcome V)93(ariables)]TJ 0 -1.4536 TD 0.003 Tc 0.1251 Tw [(Child )46.7(Abuse Potential Inventor)-5.2(y \(CAPI\))]TJ /F21 1 Tf 10 0 0 10 309 344.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD 0.0026 Tc 0.125 Tw (The CAPI is a self-report measure that contains 160)Tj 0 -1.398 TD 0 Tc (forced-choice questions.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc 0.0432 Tw [(Seventy-seven of the items load on the )50.7(Abuse scale.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0039 Tc 0.0651 Tw [(The )14.2(T)72.9(otal )50.2(Abuse score derived measures the degree in)]TJ 0 -1.401 TD -0.0036 Tc -0.0299 Tw [(which the respondent)50.4(s answers, and his or her interper)17.4(-)]TJ 0 -1.398 TD -0.0128 Tc -0.0625 Tw (sonal profile, are indicative of individuals who are known)Tj 0 -1.401 TD -0.003 Tc 0.033 Tw (to be physical abusers of children.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0006 Tc 0.1249 Tw [(The total score is referred to as an individual)47.4(s child)]TJ 0 -1.401 TD -0.0035 Tc 0.0693 Tw (abuse potential, with higher scores categorizing an in-)Tj T* -0.0032 Tc 0.032 Tw (creased risk for physical abuse perpetration.)Tj /TT1 1 Tf 11 0 0 11 309 180.66 Tm 0.0154 Tc 0 Tw [(RESUL)83.6(TS)]TJ /F21 1 Tf 10 0 0 10 309 164.64 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc 0.0744 Tw (Individuals who experienced trauma as a child and an)Tj 0 -1.398 TD -0.0036 Tc -0.0227 Tw (adult had a higher number of total trauma exposures \()Tj /TT5 1 Tf 21.075 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf -21.075 -1.401 TD -0.007 Tc -0.06 Tw (= 6.49, )Tj /TT5 1 Tf 2.895 0 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.206 0 TD -0.0069 Tc -0.0628 Tw [( = 3.60\) compared to the child-only \()]TJ /TT5 1 Tf 14.088 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.822 0 TD -0.0071 Tc -0.0625 Tw [( = 4.41,)]TJ /TT5 1 Tf -19.011 -1.401 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.003 Tc -0.0433 Tw [( = 3.57\) and adult-only trauma \()]TJ /TT5 1 Tf 12.462 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.0025 Tc -0.045 Tw [( = 3.77, )]TJ /TT5 1 Tf 3.159 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.003 Tc -0.045 Tw [( = 2.42\))]TJ -18.864 -1.398 TD 0.0171 Tc 0 Tw (groups.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0163 Tc -0.0623 Tw (There was a significant difference in the total CAPI scores)Tj 0 -1.398 TD -0.0037 Tc -0.0356 Tw (between the groups that experienced trauma and the no-)Tj ET endstream endobj 296 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 298 0 obj << /Length 10200 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (239)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.004 Tc 0.0575 Tw (trauma group \()Tj /TT5 1 Tf 6.006 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0037 Tc 0.0602 Tw [( < .0005\); however)35.3(, no dif)17.3(ference was)]TJ -6.501 -1.398 TD 0.0131 Tc 0.125 Tw (found in between group comparisons of the trauma)Tj 0 -1.401 TD -0.0036 Tc 0.0567 Tw (groups based on the specific time in which the trauma)Tj T* -0.005 Tc -0.06 Tw (was experienced.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0625 Tw (A significant differences was found for gender and child)Tj 0 -1.401 TD 0.105 Tw (abuse potential \()Tj /TT5 1 Tf 6.759 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0036 Tc 0.1075 Tw [( = .005\). Higher mean CAPI scores)]TJ -7.254 -1.398 TD -0.0039 Tc -0.0038 Tw (were found for women \()Tj /TT5 1 Tf 9.621 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.003 Tc -0.003 Tw ( = 10.64, )Tj /TT5 1 Tf 3.78 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0034 Tc -0.0047 Tw ( = 3.27\) than for)Tj -15.435 -1.401 TD -0.0174 Tc -0.06 Tw (men \()Tj /TT5 1 Tf 2.16 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.81 0 TD -0.0161 Tc -0.0617 Tw [( = 9.27, )]TJ /TT5 1 Tf 2.985 0 TD -0.0282 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.185 0 TD -0.0171 Tc -0.0625 Tw [( = 3.27\).)]TJ /F21 1 Tf -8.94 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0066 Tc -0.0622 Tw (Those who had not experienced trauma had significantly)Tj 0 -1.401 TD -0.0216 Tc -0.06 Tw (lower \()Tj /TT5 1 Tf 2.655 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.474 0 TD -0.0212 Tc -0.0617 Tw [( < .0005\) mean CAPI scores \()]TJ /TT5 1 Tf 10.965 0 TD -0.022 Tc 0 Tw (M )Tj /TT2 1 Tf 0.975 0 TD -0.02 Tc -0.0625 Tw (= 8.69, )Tj /TT5 1 Tf 2.781 0 TD -0.0312 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.176 0 TD -0.0211 Tc -0.0625 Tw [( = 3.28\))]TJ -19.026 -1.401 TD -0.0087 Tc -0.0614 Tw (than those in the child-only trauma group \()Tj /TT5 1 Tf 16.335 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.819 0 TD -0.0083 Tc -0.0634 Tw [( = 11.47, )]TJ /TT5 1 Tf 3.546 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf -20.7 -1.398 TD -0.0076 Tc -0.0625 Tw (= 3.65\), those in the adult-only trauma group \()Tj /TT5 1 Tf 17.706 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.819 0 TD -0.008 Tc -0.0625 Tw [( = 10.65,)]TJ /TT5 1 Tf -18.525 -1.401 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.206 0 TD -0.0077 Tc -0.0625 Tw [( = 3.99\), and the child-adult trauma group \()]TJ /TT5 1 Tf 16.5 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.819 0 TD -0.008 Tc -0.0625 Tw [( = 11.41,)]TJ /TT5 1 Tf -18.525 -1.401 TD -0.0312 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.176 0 TD -0.0216 Tc -0.0625 Tw [( = 4.06\).)]TJ /F21 1 Tf -2.976 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.061 Tw (Hierarchical regression results indicated significant pre-)Tj 0 -1.401 TD -0.0242 Tw (dictors of adult caregivers child-abuse potential. These)Tj 0 -1.398 TD -0.0179 Tc -0.062 Tw (predictors included experiencing: childhood sexual abuse,)Tj 0 -1.401 TD -0.0013 Tc 0.125 Tw (childhood physical abuse, adult physical abuse, adult)Tj T* -0.0037 Tc 0.0138 Tw (sexual abuse, and domestic violence.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.0093 Tw (Although not reaching significance, the authors noted a)Tj 0 -1.401 TD 0.0812 Tw (trend towards child abuse potential for those who had)Tj 0 -1.398 TD -0.0375 Tw (experienced a motor vehicle accident.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.02 Tw (Exposure to disasters and the death of loved ones were)Tj 0 -1.398 TD -0.0043 Tc -0.0622 Tw (not significant predictors of child abuse potential among)Tj 0 -1.401 TD -0.0036 Tc 0.05 Tw (adult caregivers.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.004 Tc 0.045 Tw (Those who experienced trauma during childhood were)Tj 0 -1.401 TD -0.0055 Tc -0.03 Tw (53% \()Tj /TT5 1 Tf 2.364 0 TD -0.006 Tc 0 Tw (p )Tj /TT2 1 Tf 0.717 0 TD -0.0027 Tc -0.0305 Tw (= .007\) more likely to be in a clinically elevated)Tj -3.081 -1.401 TD -0.0039 Tc 0.085 Tw (group \(CAPI scores of )Tj ET 500 w 184.95 -667.36 m 179.34 -667.36 l S BT 10 0 0 10 179.34 332.64 Tm -0.0037 Tc 0.087 Tw (> 215\) than those who experi-)Tj -9.534 -1.398 TD -0.0035 Tc 0.0187 Tw (enced trauma as an adult.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.0665 Tw [(W)94.2(omen had a 2.1 times higher chance \()]TJ /TT5 1 Tf 16.125 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0032 Tc 0.0666 Tw [( = .007\) than)]TJ -16.62 -1.398 TD -0.0033 Tc -0.01 Tw (men to be categorized into the clinically elevated CAPI)Tj 0 -1.401 TD 0.0084 Tc 0 Tw (group.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0074 Tc -0.0625 Tw (Individuals who experienced trauma as a child were 2.26)Tj 0 -1.401 TD -0.0186 Tc (times more likely to be in the clinical elevated CAPI group)Tj T* -0.0037 Tc -0.0171 Tw (than those who had not experienced trauma \()Tj /TT5 1 Tf 17.691 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0029 Tc -0.0175 Tw [( = .029\).)]TJ /F21 1 Tf -19.986 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.009 Tc -0.0622 Tw (Those who had experienced trauma as an adult were 3.03)Tj 0 -1.401 TD -0.003 Tc 0.0289 Tw (times more likely to be in the clinically elevated CAPI)Tj 0 -1.398 TD -0.0037 Tc 0.025 Tw (group than those who had not experienced trauma \()Tj /TT5 1 Tf 20.571 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD 0.02 Tc ( =)Tj -21.066 -1.401 TD -0.0466 Tc (.001\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0039 Tc -0.0241 Tw (Furthermore, those who had experienced trauma during)Tj 0 -1.401 TD -0.0032 Tc -0.061 Tw (both timeframes were 4.23 times more likely to be in the)Tj T* -0.0035 Tc 0.0175 Tw (clinically elevated CAPI group than those who had not)Tj 0 -1.398 TD -0.0095 Tc -0.06 Tw (experienced trauma.)Tj /TT1 1 Tf 11 0 0 11 321 722.64 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /F21 1 Tf 10 0 0 10 321 706.65 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0075 Tc -0.0622 Tw [(Results indicated that those who had experienced trauma)]TJ 0 -1.401 TD -0.0029 Tc -0.0155 Tw (during any period in their life were more likely to show)Tj 0 -1.398 TD -0.0036 Tc -0.0256 Tw (elevations on their CAPI scores, which the authors con-)Tj 0 -1.401 TD -0.0034 Tc 0.0165 Tw (tend increases their risk for child abuse perpetration.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0095 Tc -0.0622 Tw (The most significant factors that predicted a risk for child)Tj 0 -1.401 TD -0.0036 Tc 0.1041 Tw (abuse potential were experiencing child abuse, sexual)Tj T* 0.05 Tw (abuse, and adult sexual abuse.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc -0.014 Tw (Being a woman was also found to be related to a higher)Tj 0 -1.401 TD -0.0033 Tc 0.0048 Tw (risk of child abuse perpetration.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0062 Tc -0.0625 Tw (Although not significant, there was a trend towards child)Tj 0 -1.401 TD -0.0039 Tc 0.0186 Tw (abuse potential among those who had experienced mo-)Tj 0 -1.398 TD -0.0032 Tc 0.0278 Tw (tor vehicle accidents. This may indicate that additional)Tj 0 -1.401 TD -0.0037 Tc 0.0482 Tw [(factors such as the overall turmoil in an individuals)]TJ T* -0.012 Tc -0.0625 Tw (life after experiencing a trauma, which may include prob-)Tj 0 -1.398 TD -0.0035 Tc 0.0473 Tw (lems with alcohol and drug abuse, also factor into risk)Tj 0 -1.401 TD 0.0001 Tc 0 Tw (potential.)Tj /TT1 1 Tf 11 0 0 11 321 458.64 Tm 0.0255 Tc [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /F21 1 Tf 10 0 0 10 321 442.65 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0714 Tw (Results of this study could influence intervention pro-)Tj 0 -1.401 TD -0.0037 Tc -0.0105 Tw (grams for those who had experienced trauma to end the)Tj 0 -1.398 TD -0.0033 Tc 0 Tw (cycle of violence which begins with being a victim and)Tj 0 -1.401 TD -0.025 Tw [(may result in becoming a perpetrator)50.7(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.0095 Tw (These findings could be used to come up with a profile)Tj 0 -1.401 TD -0.0037 Tc -0.0364 Tw (for those who have experienced trauma and characteris-)Tj T* -0.0031 Tc 0.0186 Tw (tics that may lead to child abuse perpetration.)Tj ET 3.99 w /GS1 gs 321 333.615 m 558 333.615 l S BT /TT1 1 Tf 11 0 0 11 321 314.61 Tm /GS2 gs 0.035 Tc 0.125 Tw [(Pole, N., Neylan, )15.6(T)80.2(.C., Otte, C., Metzler)86.8(, )12.9(T)77.4(.J.,)]TJ 0 -1.1836 TD 0.0447 Tc [(Best, S.R., Henn-Haase, C., & Marmar)91.1(, C.R.)]TJ 0 -1.1809 TD 0.023 Tc 0.1249 Tw [(\(2007\). )50.2(Associations between childhood trauma)]TJ T* 0.0171 Tc 0.1257 Tw [(and emotion-modulated psychophysiological re-)]TJ 0 -1.1836 TD 0.0008 Tc 0.125 Tw [(sponses to startling sounds: )49.9(A)57.5( study of police ca-)]TJ 0 -1.1809 TD 0.0148 Tc 0 Tw (dets. )Tj /TT4 1 Tf 2.4355 0 TD 0.014 Tc 0.1268 Tw [(Journal of )31(Abnormal Psychology)35.8(, 1)52.2(16,)]TJ /TT1 1 Tf 16.8409 0 TD 0.0147 Tc 0.1273 Tw [( 352-)]TJ ET 0.99 w /GS1 gs 321 228.105 m 558 228.105 l S BT 11 0 0 11 321 236.61 Tm /GS2 gs 0.053 Tc 0 Tw (361.)Tj 0 -2.9782 TD -0.008 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-1.401 TD -0.0034 Tc 0.0293 Tw (to asses participants exposure to trauma and if present,)Tj 0 -1.398 TD -0.0071 Tc -0.0625 Tw (the age at which they experienced the traumatic event\(s\).)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0112 Tc -0.0622 Tw (On this checklist, Childhood Trauma \(CT\) group \()Tj /TT5 1 Tf 19.194 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.492 0 TD -0.0116 Tc -0.0625 Tw [( = 25\))]TJ -19.686 -1.398 TD -0.0033 Tc 0.1107 Tw (indicated that they had experienced a traumatic event)Tj 0 -1.401 TD -0.003 Tc 0.0961 Tw (before the age of 14 years during which they thought)Tj T* -0.0223 Tw (that they could be killed or seriously harmed, and felt)Tj 0 -1.398 TD -0.0035 Tc 0.0359 Tw [(emotions such as helplessness, horror)38.5(, or fear)50.5(.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0074 Tc -0.0625 Tw (The No Childhood Trauma \(NCT\) group \()Tj /TT5 1 Tf 16.296 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.489 0 TD -0.0067 Tc -0.0625 Tw [( = 65\) did not)]TJ -16.785 -1.398 TD -0.0133 Tc (indicate experiencing such events. Individuals who stated)Tj 0 -1.401 TD -0.0034 Tc 0.0725 Tw (that they witnessed such an event happening to some-)Tj T* 0.0102 Tc 0.125 Tw (one else and did not indicate the feelings described)Tj 0 -1.398 TD -0.0036 Tc 0.0088 Tw (above could also be classified in the NCT group.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0084 Tc -0.06 Tw (Using the )Tj /TT5 1 Tf 3.909 0 TD -0.0087 Tc -0.063 Tw (Structured Clinical Interview for DSM-IV Axis)Tj -3.909 -1.398 TD -0.0013 Tc 0.1249 Tw (I Disorders)Tj /TT2 1 Tf 4.701 0 TD 0 Tc 0.125 Tw (, the researchers verified that none of the)Tj -4.701 -1.401 TD -0.0031 Tc -0.0381 Tw [(cadets currently met criteria for an )53.9(Axis I disorder)50.9(.)]TJ /TT1 1 Tf 11 0 0 11 54 398.64 Tm 0.0048 Tc 0.1143 Tw [(Contr)15.7(ol V)97(ariables)]TJ /F21 1 Tf 10 0 0 10 54 382.65 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.003 Tc 0.071 Tw [(In order to control for issues of social desirability)60(, the)]TJ 0 -1.401 TD -0.0036 Tc 0.115 Tw (participants were administered the )Tj /TT5 1 Tf 14.331 0 TD -0.004 Tc (Social Desirability)Tj -14.331 -1.398 TD -0.0074 Tc 0 Tw (Scale)Tj /TT2 1 Tf 2.13 0 TD -0.0062 Tc -0.0622 Tw [( \(Reynolds, 1982\). This scale contains 13 true/false)]TJ -2.13 -1.401 TD -0.0034 Tc 0.0557 Tw [(questions that measure an individual)50.6(s tendency to an-)]TJ T* -0.0035 Tc 0.0468 Tw (swer self report-items in an attempt to obtain approval)Tj 0 -1.398 TD 0.0171 Tw (from others and avoid being viewed as controversial.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0125 Tw (The researchers measured the participants trait anxiety)Tj 0 -1.398 TD -0.0031 Tc -0.035 Tw (by administering the )Tj /TT5 1 Tf 8.304 0 TD -0.004 Tc -0.0349 Tw [(S)34(tate T)53(rait )14.1(Anxiety Inventory)55.8(,)-0.4( T)50(rait)]TJ -8.304 -1.401 TD -0.0087 Tc -0.06 Tw [(Form Y)66.3(-)5.3(2)]TJ /TT2 1 Tf 3.669 0 TD -0.007 Tc -0.0622 Tw [(.)-10.1( )16.9(This measure consists of 20-items of enduring)]TJ -3.669 -1.401 TD -0.0091 Tc -0.0624 Tw [(anxiety symptoms. Respondents indicate how they gen-)]TJ 0 -1.398 TD -0.0032 Tc 0.1138 Tw (erally feel using a 4-point Likert scale ranging form)Tj 0 -1.401 TD -0.025 Tw (scores of 1 \(almost never\) to 4 \(almost always\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0234 Tw [(T)73.1(o)-0.1( measure the participants positive and negative af)14.3(fect)]TJ 0 -1.401 TD -0.0033 Tc -0.0412 Tw (during the past month, they were administered the )Tj /TT5 1 Tf 19.809 0 TD -0.005 Tc 0 Tw (Posi-)Tj -19.809 -1.401 TD 0.0008 Tc 0.1251 Tw [(tive and Negative )15.9(Affect Schedule)]TJ /TT2 1 Tf 13.956 0 TD 0.0015 Tc 0.125 Tw [( )6.9(\()6.9(W)79.5(atson, Clark, &)]TJ -13.956 -1.398 TD -0.0036 Tc 0.0306 Tw [(T)73.2(ellegen, 1988\). )17.3(This measure asks respondents to rate)]TJ 0 -1.401 TD -0.0032 Tc -0.0404 Tw (how often they felt 20 feelings in the past month using a)Tj T* -0.003 Tc -0.0261 Tw [(5-point Likert scale ranging from 1 \(very slightly or not)]TJ 0 -1.398 TD -0.0092 Tc -0.0625 Tw (at all\) to 5 \(extremely\). Sum scores for affects falling into)Tj 0 -1.401 TD -0.0035 Tc 0.0416 Tw (negative and positive affect categories were obtained.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0581 Tw (In order to investigate whether there were current symp-)Tj 0 -1.401 TD -0.0032 Tc 0.1016 Tw (toms of general psychiatric distress, participants were)Tj 25.5 63.999 TD -0.0038 Tc 0.025 Tw (administered the )Tj /TT5 1 Tf 6.876 0 TD -0.0042 Tc 0.0275 Tw (Symptom Checklist 90-Revised)Tj /TT2 1 Tf 12.27 0 TD -0.0052 Tc 0.03 Tw [( \(SCL-)]TJ -19.146 -1.398 TD -0.0038 Tc -0.0528 Tw (90-R\). On this measure, respondents indicate how much)Tj 0 -1.401 TD -0.0035 Tc 0.0561 Tw (they have been distressed during the past week on a)Tj T* -0.0031 Tc 0.0611 Tw (5-point Likert-type scale with anchors of 0 \(not at all\))Tj 0 -1.398 TD -0.021 Tc -0.0622 Tw (and 4 \(extremely\). The global severity index or mean score)Tj 0 -1.401 TD -0.0034 Tc 0.125 Tw (was used to measure participants general psychiatric)Tj T* 0.0362 Tw (distress over the last week.)Tj /TT1 1 Tf 11 0 0 11 309 608.25 Tm 0.0069 Tc 0.1113 Tw [(P)6.1(r)12.4(edictor)15.1( V)93.6(ariables)]TJ /F21 1 Tf 10 0 0 10 309 592.26 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0671 Tw (Using a Lablinc V Modular System, participants were)Tj 0 -1.401 TD 0.02 Tc 0.125 Tw (presented with 10 sounds, binaurally though head-)Tj T* -0.0038 Tc -0.0057 Tw (phones, that were 106-dB\(A\), 40-ms white noise bursts)Tj 0 -1.398 TD -0.0032 Tc 0.0519 Tw (within 0-ms rise and fall times separated by intertribal)Tj 0 -1.401 TD -0.0034 Tc -0.0093 Tw (intervals of between 30 s and 50 s.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.011 Tc -0.0625 Tw (Care was taken to allow for 2 minute initial resting period)Tj 0 -1.401 TD 0.0089 Tc 0.125 Tw (to gather baseline psychophysiological measures. In)Tj T* -0.0033 Tc 0.1219 Tw [(addition, the first 5 sounds were not used in order to)]TJ 0 -1.398 TD -0.0035 Tc 0.095 Tw (obtain a stable response.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0186 Tw (Participants were exposed to three different threat con-)Tj 0 -1.398 TD -0.0038 Tc 0.0428 Tw [(ditions: low)59.2(, medium, and high that were administered)]TJ 0 -1.401 TD -0.0034 Tc 0.0411 Tw (less than l minute apart. The order of threat conditions)Tj T* 0.0034 Tc 0.125 Tw (was counterbalanced. Each condition lasted approxi-)Tj 0 -1.398 TD -0.007 Tc -0.0625 Tw (mately 4 minutes.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.0814 Tw (During the low threat condition participants were told)Tj 0 -1.398 TD -0.0034 Tc 0.0714 Tw (that they would receive shocks during another portion)Tj 0 -1.401 TD -0.0085 Tc -0.0625 Tw (of the study that would require them to wear a Coulbourn)Tj T* 0.0089 Tc 0.125 Tw [(Instruments E13-22 )17.9(T)34.7(ranscutaneous )53.9(A)83.1(versive Finger)]TJ 0 -1.398 TD -0.0032 Tc 0.0859 Tw [(S)22(timulator)53.8(. )15.1(They were told they could not be shocked)]TJ 0 -1.401 TD 0.02 Tw (unless they were wearing this device.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc 0.0817 Tw (The medium threat condition consisted of participants)Tj 0 -1.401 TD -0.0061 Tc -0.0623 Tw [(wearing the finger stimulator)50.9(. However)32.9(, in the low threat)]TJ T* -0.0034 Tc -0.0427 Tw (condition they looked at a computer monitor that had an)Tj 0 -1.398 TD -0.007 Tc -0.0622 Tw (X, in the medium threat condition the words No Shock)Tj 0 -1.401 TD 0.0052 Tc 0 Tw (appeared.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0881 Tw (In the high threat condition the participants also wore)Tj 0 -1.401 TD -0.0038 Tc 0.0264 Tw (the finger stimulator but the computer monitor showed)Tj T* -0.0514 Tw (the words, Shock Coming, and participants received a)Tj 0 -1.398 TD -0.0037 Tc -0.0022 Tw (2.5-mA shock which the authors describe as annoying)Tj 0 -1.401 TD -0.0036 Tc 0.0375 Tw (but not painful.)Tj /TT1 1 Tf 11 0 0 11 309 145.86 Tm 0.0117 Tc 0.1128 Tw [(Outcome V)93(ariables)]TJ 0 -1.4564 TD 0.0255 Tc 0.1273 Tw (Psychometric Measures)Tj /F21 1 Tf 10 0 0 10 309 113.85 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0275 Tw (Participants were administered the )Tj /TT5 1 Tf 13.815 0 TD -0.0046 Tc -0.03 Tw (Emotional Response)Tj -13.815 -1.401 TD -0.0051 Tc 0 Tw (Scale)Tj /TT2 1 Tf 2.145 0 TD -0.0032 Tc 0.1087 Tw [( after receiving all three of the threat conditions)]TJ -2.145 -1.398 TD 0.008 Tw (and were asked to indicate how they felt during the ex-)Tj ET endstream endobj 302 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 304 0 obj << /Length 9451 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (241)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm 0.0106 Tc 0.125 Tw (periment. This scale consists of 7 negative emotion)Tj 0 -1.398 TD -0.0032 Tc 0.1182 Tw [(words such as anxiety)62.8(, danger)35.8(, fear)35.8(, anger)38.8(, stress, an-)]TJ 0 -1.401 TD 0.125 Tw (noyance, and helplessness. It also contains 5 positive)Tj T* -0.0034 Tc 0.0443 Tw [(emotion words such as safety)59.6(, pleasure, calm, content-)]TJ 0 -1.398 TD -0.0036 Tc -0.0569 Tw (ment, and amusement. Participants rated each word on a)Tj 0 -1.401 TD -0.0031 Tc 0.0611 Tw (5-point Likert-type scale with anchors of 1 \(not at all\))Tj T* -0.025 Tw (and 5 \(quite a bit\).)Tj /TT1 1 Tf 11 0 0 11 66 608.25 Tm 0.0267 Tc 0.125 Tw (Physiological Response Measures)Tj /F21 1 Tf 10 0 0 10 66 592.26 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0029 Tc -0.037 Tw (Three physiological behaviors typically associated with)Tj 0 -1.401 TD -0.0032 Tc -0.034 Tw (startle responses were measured: eye-blink electromyo-)Tj T* -0.0156 Tc -0.0625 Tw (gram \(EMG\), skin conductance \(SC\), and heart rate \(HR\).)Tj 0 -1.398 TD -0.0032 Tc 0.125 Tw (These were measured during the resting baseline and)Tj 0 -1.401 TD -0.0033 Tc 0.0641 Tw (after the presentation of each startle response.)Tj /TT1 1 Tf 11 0 0 11 66 504.24 Tm 0.0154 Tc 0 Tw [(RESUL)83.6(TS)]TJ /F21 1 Tf 10 0 0 10 66 488.25 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc -0.0367 Tw (The results did not show any differences among the two)Tj 0 -1.401 TD -0.0533 Tw (groups in reporting bias that is indicative of social desir-)Tj 0 -1.398 TD -0.0025 Tc 0.0455 Tw [(ability)60.5(, trait anxiety)63.5(, or current general psychiatric dis-)]TJ 0 -1.401 TD -0.0031 Tc 0.0308 Tw (tress \(as measured by the control variables\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0038 Tc -0.0562 Tw (The CT group reported fewer positive emotions than the)Tj 0 -1.401 TD -0.0055 Tc -0.0625 Tw (NCT group. This was evident for positive emotions such)Tj T* -0.004 Tc 0.0225 Tw (as contentment \()Tj /TT5 1 Tf 6.594 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.003 Tc 0.0225 Tw [( < .001\), calm \()]TJ /TT5 1 Tf 6.222 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.003 Tc 0.0237 Tw [( < .001\), pleasure \()]TJ /TT5 1 Tf 7.599 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf -21.405 -1.398 TD -0.0037 Tc -0.0625 Tw (<.001\), and reported safety \()Tj /TT5 1 Tf 11.04 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.004 Tc -0.0625 Tw [( = .005\).)]TJ /F21 1 Tf -13.335 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0469 Tw (There were no significant findings for the influence of)Tj 0 -1.398 TD -0.0032 Tc 0.1137 Tw (type of threat condition on the experience of positive)Tj 0 -1.401 TD -0.0041 Tc -0.0009 Tw (emotions among the CT and NCT groups.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD 0.0012 Tc 0.125 Tw (The CT group also reported more negative emotions)Tj 0 -1.401 TD -0.0036 Tc -0.0622 Tw (than the NCT group. This was specifically true for nega-)Tj T* -0.0031 Tc 0.093 Tw (tive emotions such as anxiety \()Tj /TT5 1 Tf 12.729 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.003 Tc 0.0938 Tw [( = .002\), danger \()]TJ /TT5 1 Tf 7.275 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD 0.092 Tc ( <)Tj -20.994 -1.398 TD -0.0029 Tc 0.005 Tw (.001\), fear \()Tj /TT5 1 Tf 4.695 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0024 Tc 0.0047 Tw ( = .001\), stress \()Tj /TT5 1 Tf 6.426 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0023 Tc 0.0048 Tw ( < .001\), annoyance \()Tj /TT5 1 Tf 8.475 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD 0.005 Tc ( =)Tj -21.081 -1.401 TD -0.0035 Tc -0.0467 Tw (.002\), and helplessness \()Tj /TT5 1 Tf 9.579 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0026 Tc -0.05 Tw [( < .001\).)]TJ /F21 1 Tf -11.874 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0108 Tc -0.0622 Tw (When examining the difference in negative emotions and)Tj 0 -1.401 TD -0.0036 Tc 0.0637 Tw (threat conditions, the CT group showed an increase in)Tj T* -0.0071 Tc -0.0625 Tw (negative emotions from the conditions of low to medium)Tj 0 -1.398 TD -0.0091 Tc -0.06 Tw (threat \()Tj /TT5 1 Tf 2.73 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.489 0 TD -0.0093 Tc -0.0625 Tw [( = .005\) and from medium threat to high threat \()]TJ /TT5 1 Tf 18.186 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf -21.405 -1.401 TD -0.0033 Tc 0.0363 Tw (< .001\), whereas the NCT group results only indicated)Tj T* -0.0205 Tc -0.0625 Tw (increases in negative emotions from medium to high threat)Tj 0 -1.398 TD -0.004 Tc -0.055 Tw (conditions \()Tj /TT5 1 Tf 4.65 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0027 Tc -0.06 Tw [( < .001\).)]TJ /F21 1 Tf -6.945 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0611 Tw (The CT group had a larger eyeblink response than the)Tj 0 -1.398 TD -0.0053 Tc -0.06 Tw (NCT group.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.092 Tw (The CT group also had a larger SC response than the)Tj 0 -1.398 TD -0.0053 Tc -0.06 Tw (NCT group.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc 0.0057 Tw (There were no significant findings for the HR response)Tj 0 -1.398 TD -0.004 Tc 0.0466 Tw (among the two groups.)Tj /TT1 1 Tf 11 0 0 11 321 722.64 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /F21 1 Tf 10 0 0 10 321 706.65 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc 0.0243 Tw (The findings indicate that for adult police academy ca-)Tj 0 -1.401 TD -0.0033 Tc -0.0499 Tw [(dets who are currently free of )50.8(Axis I diagnoses, but have)]TJ 0 -1.398 TD -0.0032 Tc -0.0094 Tw [(a history of childhood trauma, there was a difference in)]TJ 0 -1.401 TD -0.0033 Tc 0.04 Tw (their physiological and emotional response to the pair-)Tj T* -0.001 Tc 0.125 Tw (ing of startling sounds and the threat of shock, com-)Tj 0 -1.398 TD 0.019 Tc (pared to those who had not experienced childhood)Tj 0 -1.401 TD -0.0169 Tc 0 Tw (trauma.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD 0.0078 Tc 0.125 Tw (Specifically the cadets who had experienced trauma)Tj 0 -1.401 TD -0.0034 Tc 0.0516 Tw (showed elevations in physiological measures of startle)Tj T* -0.0033 Tc 0.0174 Tw [(response such as an increase in eyeblink responses and)]TJ 0 -1.398 TD 0.0005 Tc 0.125 Tw (skin conductance response.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc 0.0412 Tw (As the level of threat increased, the cadets that experi-)Tj 0 -1.398 TD -0.0035 Tc 0.1029 Tw (enced childhood trauma also indicated they had more)Tj 0 -1.401 TD -0.0407 Tw (negative emotions, and less positive emotions than their)Tj T* 0.0111 Tc 0 Tw (counterparts.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc 0.1088 Tw (The authors contend that because the cadets who had)Tj 0 -1.401 TD -0.06 Tw (experienced childhood trauma were more reactive to the)Tj 0 -1.398 TD -0.0033 Tc -0.0275 Tw (medium threat condition than their peers, this may indi-)Tj 0 -1.401 TD -0.0036 Tc 0.0744 Tw (cate that those who have experienced trauma place an)Tj T* -0.0037 Tc 0.0193 Tw (emphasis on danger cues when faced with situations in)Tj 0 -1.398 TD -0.0033 Tc 0.0729 Tw (which both dangerous and safety cues are present.)Tj /TT1 1 Tf 11 0 0 11 321 388.65 Tm 0.0255 Tc 0 Tw [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /F21 1 Tf 10 0 0 10 321 372.66 Tm 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0033 Tc -0.0367 Tw (The authors state that their findings may allow for some)Tj 0 -1.401 TD -0.0038 Tc -0.0266 Tw (prediction of PTSD factors.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc 0.0431 Tw (In addition, the results appear to provide evidence that)Tj 0 -1.401 TD 0.0089 Tc 0.125 Tw [(the physiological response, and potentially a child)53.9(s)]TJ T* 0.005 Tc (developing nervous system, is altered for those who)Tj 0 -1.398 TD -0.0039 Tc -0.0366 Tw (experience trauma during childhood.)Tj ET 3.99 w /GS1 gs 321 277.605 m 558 277.605 l S BT /TT1 1 Tf 11 0 0 11 321 258.6 Tm /GS2 gs 0.059 Tc 0.2173 Tw [(Meiser)37.2(-S)42.6(tedman, R., Smith, P)86.3(.)-5.8(,)-5.9( )37.8(Y)93.9(ule, )13.3(W)99(.)-2.1( &)]TJ 0 -1.1809 TD 0.0043 Tc 0.108 Tw [(Dalgleish, T)74(.)-1.5( )-18.5(\(2007\). The T)76.7(rauma )-15.5(Memory )-17.1(Qual-)]TJ 0 -1.1836 TD 0.0072 Tc 0.125 Tw (ity Questionnaire: Preliminary development and)Tj 0 -1.1809 TD -0.0033 Tc -0.0065 Tw (validation of a measure of trauma memory charac-)Tj T* -0.0029 Tc 0.0762 Tw [(teristics for)16.2( childr)13.5(en and adolescents. )]TJ /TT4 1 Tf 16.3445 0 TD -0.0038 Tc 0.079 Tw [(Memory)31.7(, 15,)]TJ ET 0.99 w /GS1 gs 321 185.115 m 558 185.115 l S BT /TT1 1 Tf 11 0 0 11 321 193.59 Tm /GS2 gs 0.0433 Tc 0 Tw (271-279.)Tj 0 -2.9755 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.4( )46.5(A)10(R)27.5(TICLE)]TJ /F21 1 Tf 10 0 0 10 321 144.84 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc -0.0425 Tw (Original empirical investigation: Survey construction.)Tj /TT1 1 Tf 11 0 0 11 321 112.86 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /F21 1 Tf 10 0 0 10 321 96.84 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD 0.0017 Tc 0.125 Tw (The purpose of this article is to validate the Trauma)Tj 0 -1.398 TD -0.0035 Tc -0.0242 Tw [(Memory Quality Questionnaire \(TMQQ\) a measure de-)]TJ ET endstream endobj 305 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 307 0 obj << /Length 8671 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.007 Tc 0 Tw (242 )Tj /TT3 1 Tf 2.0625 0 TD -0.004 Tc 0.1375 Tw ( Selected Annotated Journal Resources)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0031 Tc 0.0483 Tw (scribed by the authors to use in identifying which as-)Tj 0 -1.398 TD -0.0063 Tc -0.062 Tw [(pects of a child)53.7(s [traumatic] memories merit therapeutic)]TJ 0 -1.401 TD -0.0007 Tc 0.125 Tw (attention. The researchers employed two samples to)Tj T* -0.0018 Tc (test their survey and they also examine the question-)Tj 0 -1.398 TD -0.0033 Tc 0.0103 Tw [(naires)71.7( criterion and construct validity)59.7(.)]TJ /TT1 1 Tf 11 0 0 11 54 634.65 Tm 0.0265 Tc 0 Tw (PROCEDURE)Tj 0 -1.4536 TD 0.0198 Tc (Subjects)Tj 0 -1.4564 TD -0.0031 Tc 0.1273 Tw (Sample 1)Tj /F21 1 Tf 10 0 0 10 54 586.65 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0019 Tc 0.125 Tw (254 children and adolescents who were enrolled in a)Tj 0 -1.401 TD -0.0033 Tc 0.055 Tw (secondary school in England.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.1129 Tw (Participants were asked to recall the most frightening)Tj 0 -1.401 TD -0.016 Tc -0.0625 Tw [(event they had experienced recently)59(. Some of these events)]TJ 0 -1.398 TD -0.0034 Tc -0.0109 Tw (included: road traffic accidents, bereavement, illness or)Tj 0 -1.401 TD -0.0118 Tc -0.0622 Tw (injury of a family member or close friend, bullying, being)Tj T* -0.0031 Tc 0 Tw [(attacked or followed by a stranger)50.9(.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.013 Tc -0.0622 Tw (The sample consisted of 146 females \(57.5%\) with an age)Tj 0 -1.401 TD -0.0081 Tc -0.0612 Tw (range of 11-18 years \()Tj /TT5 1 Tf 8.409 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.822 0 TD -0.008 Tc -0.0633 Tw [( = 14.5, )]TJ /TT5 1 Tf 3.054 0 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.2 0 TD -0.0081 Tc -0.0625 Tw [( = 2.2\).)]TJ /TT1 1 Tf 11 0 0 11 54 438.66 Tm -0.0031 Tc 0.1273 Tw (Sample 2)Tj /F21 1 Tf 10 0 0 10 54 422.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0039 Tc -0.0492 Tw [(106 children and adolescents who had attended an )50.3(Acci-)]TJ 0 -1.398 TD -0.0037 Tc -0.0464 Tw (dent and Emergency Department in London following a)Tj 0 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TD 0.0052 Tc 0.1255 Tw (Revised Impact of Event Scale \(RIES-C\))Tj /F21 1 Tf 10 0 0 10 54 240.66 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.0095 Tw (The RIES-C is a shortened form of the adult version of)Tj 0 -1.401 TD 0.0283 Tw (the scale and measures posttraumatic stress symptoms.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc 0.0135 Tw (The scale consists of 13 items that load on three symp-)Tj 0 -1.401 TD 0.059 Tc 0.3913 Tw (tom factors, re-experiencing, avoidance, and)Tj T* 0.005 Tc 0 Tw (hyperarousal.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0036 Tc 0.0744 Tw (Children respond to the questions indicating 0 \(Not at)Tj 0 -1.401 TD -0.0142 Tc -0.0622 Tw (all\), 1 \(Rarely\), 3 \(Sometimes\), or 5 \(Often\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0333 Tw (Children completed this scale during every assessment)Tj 0 -1.401 TD -0.0045 Tc 0 Tw (visit.)Tj /TT1 1 Tf 11 0 0 11 309 722.64 Tm 0.0074 Tc 0.1254 Tw (Anxiety Disorders Interview Schedule for DSM-)Tj 0 -1.2709 TD -0.0028 Tc [(I)9.4(V)81.7(: Child and Par)10.8(ent )13.5(V)97.5(ersions \(ADIS-C\))]TJ /F21 1 Tf 10 0 0 10 309 692.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0039 Tc -0.0623 Tw [(The )50.3(ADIS-C is a structured clinical interview)62.1(. )17.3(This mea-)]TJ 0 -1.398 TD -0.0037 Tc 0.0935 Tw [(sure was administered at 2-4 weeks in cases of )50.5(Acute)]TJ 0 -1.401 TD -0.0172 Tc -0.0625 Tw (Stress Disorder \(ASD\) and at 6 months for cases of PTSD.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc 0.1019 Tw (This measure is used to assess whether children meet)Tj 0 -1.401 TD -0.0103 Tc -0.0625 Tw [(criteria for DSM-IV)88.7(-TR anxiety disorders.)]TJ /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc 0.125 Tw (The authors note that they added questions regarding)Tj 0 -1.401 TD -0.0037 Tc 0.0114 Tw [(dissociation to the )50.3(ADIS-C to aid in diagnosis.)]TJ /TT1 1 Tf 11 0 0 11 309 572.64 Tm 0.0015 Tc 0.1255 Tw [(T)76.7(rauma Memory Quality Questionnair)17.9(e)]TJ /F21 1 Tf 10 0 0 10 309 556.65 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.004 Tc -0.0625 Tw (This measure is the authors self-designed questionnaire)Tj 0 -1.401 TD -0.0036 Tc -0.0261 Tw (which consists of 14 items, which the authors note have)Tj 0 -1.398 TD -0.0029 Tc -0.018 Tw [(a high degree of face validity)60.1(.)]TJ /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0031 Tc 0.0211 Tw (Respondents indicate if they 1 \(Disagree a lot\), 2 \(Dis-)Tj 0 -1.398 TD -0.0029 Tc -0.0368 Tw (agree a bit\), 3 \(Agree a bit\), or 4 \(Agree a lot\).)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0425 Tw (This questionnaire was administered at the 2-4 week as-)Tj 0 -1.398 TD -0.0027 Tc 0.125 Tw (sessment period.)Tj /F21 1 Tf -1.8 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0039 Tc 0.0141 Tw (When completing the questionnaire, children are asked)Tj 0 -1.398 TD 0.0176 Tc 0.125 Tw (to consider their memories of pertinent frightening)Tj 0 -1.401 TD 0.0201 Tc 0 Tw (events.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0225 Tw (According to the researchers, the items are designed to)Tj 0 -1.401 TD -0.0028 Tc -0.0206 Tw (stress the visual quality \(i.e, my memories of the fright-)Tj T* -0.0031 Tc 0.0483 Tw (ening event are mostly pictures or images.\), as well as)Tj 0 -1.398 TD -0.0488 Tw (the non-visual sensory qualities \(i.e., when I think about)Tj 0 -1.401 TD -0.0035 Tc -0.0472 Tw (the frightening event I can sometimes smell things that I)Tj T* -0.0037 Tc 0.0225 Tw (smelt when the frightening event was happening.\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0032 Tc 0.095 Tw (The researchers indicate that they attempted to gather)Tj 0 -1.401 TD -0.0148 Tc -0.0622 Tw (information on the quality of the memory \(i.e., my memo-)Tj 0 -1.398 TD -0.003 Tc -0.0461 Tw (ries of the frightening event are very clear and detailed\),)Tj 0 -1.401 TD -0.0032 Tc -0.003 Tw (not the frequency of the memories.)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.1086 Tw (Furthermore, the researchers asked the children if the)Tj 0 -1.401 TD -0.0037 Tc 0.1129 Tw (memories of the traumatic event where different than)Tj T* -0.0038 Tc -0.0444 Tw (normal memories \(i.e., when I think about the fright-)Tj 0 -1.398 TD -0.0032 Tc 0.0734 Tw (ening event it is just like thinking about anything else)Tj 0 -1.401 TD 0.0134 Tc 0.125 Tw (that has happened to me, note this item is reverse)Tj T* 0.0046 Tc 0 Tw (scored\).)Tj /F21 1 Tf -1.8 -1.599 TD 0 Tc ()Tj /TT2 1 Tf 1.8 0 TD -0.0037 Tc -0.0563 Tw (An additional item attempted to measure how scared the)Tj 0 -1.401 TD -0.0035 Tc 0.1119 Tw (children were during the event. The authors note that)Tj 0 -1.398 TD -0.0034 Tc -0.0044 Tw (responses to this question utilized a Likert scale but the)Tj 0 -1.401 TD -0.003 Tc -0.0019 Tw (point system varied slightly for each sample. In sample)Tj T* -0.0034 Tc 0.1081 Tw (1, participants responded using a 0-10 scale, while in)Tj 0 -1.398 TD 0.0259 Tw (sample 2 the scale was the same as the one utilized for)Tj 0 -1.401 TD -0.0155 Tw (the other questions with anchors of 1 \(Disagree a lot\), 2)Tj T* -0.0031 Tc -0.0354 Tw (\(Disagree a bit\), 3 \(Agree a bit\), and 4 \(Agree a lot\).)Tj ET endstream endobj 308 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F21 147 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT5 41 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 310 0 obj << /Length 3563 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.74 42.6 Tm 0 0 0 1 k /GS2 gs -0.005 Tc 0.0316 Tw [(IJEMH Vol. 9, No. 3 2008 )]TJ /F1 1 Tf 14.7563 0 TD -0.009 Tc 0 Tw (243)Tj /TT1 1 Tf 11 0 0 11 66 722.64 Tm 0.0154 Tc [(RESUL)83.6(TS)]TJ 0 -1.4536 TD 0.006 Tc 0.125 Tw (Item Reduction and Internal Consistency)Tj /F21 1 Tf 10 0 0 10 66 690.66 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0034 Tc 0.0907 Tw (Following an item analysis, three items were dropped)Tj 0 -1.401 TD -0.0087 Tc -0.0625 Tw (from the measure due to weak-item total correlations and)Tj T* -0.0033 Tc 0.0787 Tw [(poor additions to internal consistency)59.7(.)]TJ /TT1 1 Tf 11 0 0 11 66 630.66 Tm -0.0031 Tc 0.0931 Tw [(Criterion V)97.3(alidity)]TJ /F21 1 Tf 10 0 0 10 66 614.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0223 Tc -0.0625 Tw [(Children who met criteria for )46.7(ASD had significantly higher)]TJ 0 -1.398 TD -0.0131 Tc [(scores on the )16.9(TMQQ than those without )52.9(ASD \()]TJ /TT5 1 Tf 17.754 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.486 0 TD -0.0124 Tc -0.0625 Tw [( < .0001\).)]TJ /F21 1 Tf -20.04 -1.602 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.1029 Tw (Children who met criteria for PTSD had significantly)Tj 0 -1.398 TD -0.004 Tc 0.0675 Tw (higher scores on the TMQQ than those without PTSD)Tj 0 -1.401 TD 0 Tc 0 Tw (\()Tj /TT5 1 Tf 0.321 0 TD (p)Tj /TT2 1 Tf 0.48 0 TD -0.0176 Tc -0.0625 Tw [( < .05\).)]TJ /TT1 1 Tf 11 0 0 11 66 524.64 Tm -0.0009 Tc 0.1145 Tw [(Construct V)94(alidity)]TJ /F21 1 Tf 10 0 0 10 66 508.65 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0041 Tc -0.0407 Tw (Correlations between the TMQQ and the RIES-C, show)Tj 0 -1.401 TD -0.0033 Tc 0.0489 Tw (support for construct validity of the TMQQ in that the)Tj 0 -1.398 TD -0.0039 Tc -0.0625 Tw (measure is related to the symptom presentation of PTSD)Tj 0 -1.401 TD -0.0036 Tc -0.0367 Tw (following contemporary cognitive models.)Tj /F21 1 Tf 23.7 25.599 TD 0 Tc 0 Tw ()Tj /TT2 1 Tf 1.8 0 TD -0.0035 Tc 0.0714 Tw (Additional data analysis indicate that the TMQQ does)Tj 0 -1.398 TD -0.0032 Tc 0.0441 Tw (not simply measure symptoms of re-experiencing, like)Tj 0 -1.401 TD -0.0036 Tc 0.0285 Tw (the RIES-C, but can be used to show unique pattern of)Tj T* -0.0075 Tc -0.06 Tw (PTSD symptoms.)Tj /TT1 1 Tf 11 0 0 11 321 650.25 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /F21 1 Tf 10 0 0 10 321 634.26 Tm 0 Tc 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No company or institution checks can be accepted for)Tj T* -0.025 Tw (individual subscriptions.)Tj 0 -2.001 TD -0.0177 Tw (A limited number of back issues are also available for $15.00 each. 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Rule number one is that young men die.)]TJ T* -0.0037 Tc 0.0733 Tw (Rule number two is that doctors cant change rule number)Tj 0 -1.398 TD -0.004 Tc -0.0622 Tw [(one. )17.1(T)72.8(o)-0.4( this dialogue, the author)35(, Dr)53(. Kraft adds, W)74(ar dam-)]TJ 0 -1.401 TD -0.0029 Tc -0.0414 Tw [(ages doctors, too. They are damaged by rule number two \(p.)]TJ T* -0.0407 Tc 0 Tw (133-4\).)Tj 1.8 -1.998 TD -0.0107 Tc -0.0622 Tw (Former Lieutenant Commander Heidi Kraft, a U.S. Navy)Tj -1.8 -1.401 TD -0.0031 Tc 0.0789 Tw [(clinical psychologist, deployed to Iraq in 2004 with )54.1(Alpha)]TJ T* -0.0127 Tc -0.0619 Tw [(Sur)14.3(gical Company)62.3(, First Medical Battalion, First Marine Fleet)]TJ 0 -1.398 TD -0.0022 Tc 0.125 Tw (Service Support Group, leaving behind her Marine Corps)Tj 0 -1.401 TD -0.0119 Tc -0.0622 Tw [(husband with their fifteen-month-old twins. 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She writes, I decided one of the things I should)]TJ 0 -1.398 TD -0.0034 Tc 0.012 Tw (compose for my own closure and healing was a list: Things)Tj 0 -1.401 TD -0.0032 Tc 0.1251 Tw [(That )17.9(W)94.6(ere Good about Iraq and being Deployed with the)]TJ T* -0.0039 Tc -0.006 Tw [(Marines, and )14.4(Things )17.3(That )17.4(W)93.9(ere Not Good \(p. 221\).)]TJ 1.8 -1.998 TD -0.0035 Tc -0.0111 Tw (Under the Good, for example, she lists Sunset over the)Tj -1.8 -1.401 TD -0.006 Tc -0.0622 Tw [(desert,)72( )9.5()9.2(W)78(alking, every day)60(, and having literally every single)]TJ T* 0.0041 Tc 0.125 Tw (person who passed by say Ooh-rah, Maam, and My)Tj 0 -1.398 TD -0.0073 Tc -0.0622 Tw [(friendsMy patientsMy comrades. 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That dying)Tj 0 -1.401 TD -0.0079 Tc -0.0621 Tw (Marine was Corporal Jason Dunham, who was posthumously)Tj 25.5 45.801 TD 0.0031 Tc 0.1251 Tw [(awarded )18.2(The Congressional Medal of Honor)33.1(, the highest)]TJ 0 -1.401 TD -0.0031 Tc -0.0163 Tw (award for valor in action against an enemy force.)Tj 1.8 -2.001 TD -0.0038 Tc 0.0568 Tw (Corporal Dunham, who threw himself on a grenade to)Tj -1.8 -1.398 TD -0.0035 Tc -0.028 Tw (save two of his Marines, was triaged as expectant \(the medi-)Tj 0 -1.401 TD -0.003 Tc 0.0999 Tw [(cal term for casualties who are too critically injured to be)]TJ T* -0.0034 Tc 0.004 Tw [(saved\) when he arrived at the hospital. Dr)50.6(. Kraft was asked)]TJ 0 -1.398 TD 0.0445 Tw (to hold his hand as those in attendance waited for his heart)Tj 0 -1.401 TD -0.0073 Tc -0.0622 Tw [(and breathing to finally still. However)37.7(, he suddenly squeezed)]TJ T* -0.0034 Tc 0.0595 Tw [(D)7.8(r)50.6(. 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Kraft states she had the)]TJ T* -0.0037 Tc 0.0545 Tw (honor of attending the ceremony at the White House when)Tj 0 -1.398 TD -0.0039 Tc 0.0038 Tw [(President Bush awarded the Medal to Jason)50.1(s parents \(Read)]TJ 0 -1.401 TD 0.0127 Tc 0.1248 Tw [(the full-text citation at www)63.7(.history)63.7(.army)60.7(.mil/html/moh/)]TJ T* -0.0246 Tc 0 Tw (iraq.html\).)Tj 1.8 -1.998 TD -0.0032 Tc -0.0128 Tw (Amidst the loss, trauma, and terror of a combat deploy-)Tj -1.8 -1.401 TD -0.0255 Tw [(ment, how does one stay sane? One of the engaging charac-)]TJ T* 0.0007 Tc 0.1249 Tw [(teristics of this book is Dr)54.7(. Kraft frankly sharing tales of)]TJ 0 -1.398 TD -0.0033 Tc 0.039 Tw [(managing her stress. Some are humorous. Many are tech-)]TJ 0 -1.401 TD -0.0153 Tc -0.0625 Tw [(niques that we as Critical Incident Stress Management \(CISM\))]TJ T* -0.0035 Tc 0.0429 Tw (practitioners often recommend, such as exercise, sleep, hu-)Tj 0 -1.398 TD -0.0183 Tw [(mor)38.4(, and talking to others.)]TJ 1.8 -2.001 TD -0.0034 Tc -0.0481 Tw (For example, she and colleagues made an early decision)Tj -1.8 -1.401 TD -0.0031 Tc 0.0054 Tw (to watch the entire series of The Sopranos, timing it so they)Tj 0 -1.398 TD 0.0314 Tw [(watched the last episode on their last night in country)62.9(. She)]TJ 0 -1.401 TD -0.0029 Tc -0.042 Tw (details acts of kindness, such as the petty officer who quietly)Tj ET endstream endobj 323 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT4 40 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 325 0 obj << /Length 6423 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0052 Tc 0.0771 Tw [(246 )]TJ /TT3 1 Tf 2.7075 0 TD -0.006 Tc 0.0791 Tw (Clark Media Reviews)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0038 Tc 0.0366 Tw (cleaned a blood soaked Humvee so the Marines who trans-)Tj 0 -1.398 TD -0.0032 Tc -0.0078 Tw (ported their fatally-injured colleague in it would not have to)Tj 0 -1.401 TD 0 Tc 0.125 Tw (clean the vehicle themselves, explaining Theyre all our)Tj T* -0.0035 Tc -0.0357 Tw [(Marines, maam. It)53.5(s just what we do.)]TJ 1.8 -1.998 TD -0.0229 Tc -0.0622 Tw (Numerous examples of CISM principles pervade the book.)Tj -1.8 -1.401 TD -0.0036 Tc 0.0283 Tw (Several interventions/CISDs are referenced, including a se-)Tj T* -0.0034 Tc 0.1137 Tw (ries of interventions with Seabees after their unit suffered)Tj 0 -1.398 TD 0.0622 Tw [(multiple casualties in a two-day period. )50.6(Another was with)]TJ 0 -1.401 TD -0.003 Tc 0.02 Tw [(Marines in Mortuary )51(A)8.2(f)18(fairs, whose daily task is to recover)]TJ T* -0.0034 Tc 0.0025 Tw (bodies, inventory personal effects, and complete paperwork)Tj 0 -1.398 TD -0.0039 Tc -0.0559 Tw [(on the deceased. Later)35.1(, an impromptu Post )50.2(Action S)17.1(taf)14.1(f Sup-)]TJ 0 -1.401 TD -0.0032 Tc 0.035 Tw (port session with a visiting psychiatrist provided a brief re-)Tj T* 0.0108 Tw (spite for the weary mental health professionals.)Tj 1.8 -1.998 TD -0.0039 Tc -0.0477 Tw [(At one point, Dr)50.1(. 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Rather)38.8(, simple actions such as lis-)]TJ T* -0.0036 Tc 0.0395 Tw (tening when someone wants to talk, cleaning a vehicle like)Tj 0 -1.398 TD -0.0091 Tc -0.0622 Tw (the petty officer described above, or helping a colleague clean)Tj 0 -1.401 TD -0.0034 Tc 0.0327 Tw [(a patient)50.6(s blood of)17.6(f her boots are the right things to do.)]TJ 1.8 -2.001 TD -0.005 Tc -0.0621 Tw [(Like many returning military veterans \(Clark, 2006\), Dr)49(.)]TJ -1.8 -1.398 TD -0.0036 Tc 0.1238 Tw [(Kraft struggled after returning home. 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Rule Number )14.8(T)70.5(wo of)17.7(fers)]TJ -1.8 -1.401 TD -0.0008 Tc 0.125 Tw (outstanding insight into the daily challenges, heartbreaks,)Tj T* -0.0033 Tc -0.0185 Tw (and occasional joys of living and working in a combat zone.)Tj 0 -1.398 TD -0.0091 Tc -0.0625 Tw [(From her multiple perspectives of Navy of)14.9(ficer)35.9(, mental health)]TJ 0 -1.401 TD -0.0035 Tc 0.0533 Tw [(professional, colleague, friend, mother)38.5(, wife, and daughter)35.5(,)]TJ T* -0.0033 Tc -0.0182 Tw [(she shares from her heart. Her clinical cases cover the diag-)]TJ 0 -1.398 TD -0.01 Tw (nostic spectrum, from anxiety to schizophrenia to suicide.)Tj 1.8 -2.001 TD -0.0035 Tc 0.0193 Tw (She even assisted five senior enlisted personnel to stop)Tj -1.8 -1.401 TD -0.0069 Tc -0.0623 Tw [(smoking. One day in the chow line, one of the five called out,)]TJ 0 -1.398 TD -0.0035 Tc -0.0622 Tw [(Hey)62.5(, Doc what do you call a Marine in a combat zone who)]TJ 0 -1.401 TD -0.0034 Tc 0.0725 Tw (smokes two packs a day and is worried about getting lung)Tj T* -0.0033 Tc -0.0613 Tw (cancer someday?An optimist \(p. 172\).)Tj 1.8 -1.998 TD -0.0114 Tc -0.0625 Tw (Heidi Squier Kraft received her Ph.D. in clinical psychol-)Tj -1.8 -1.401 TD -0.0081 Tc [(ogy from the UC San Diego School of Medicine in 1996. She)]TJ T* -0.0033 Tc 0.0505 Tw (joined the Navy during her internship and served as both a)Tj 0 -1.398 TD -0.0029 Tc 0.0606 Tw [(flight and clinical psychologist. Having left active duty in)]TJ 0 -1.401 TD -0.0038 Tc -0.0624 Tw [(2005, Dr)53.2(. Kraft serves as the deputy coordinator for the Navy)]TJ T* -0.05 Tw [(Combat Stress Control Program. She is donating 10% of her)]TJ 0 -1.398 TD -0.0034 Tc 0.0867 Tw (royalties to the Injured Marine Semper Fi Fund. For more)Tj 0 -1.401 TD -0.009 Tc -0.0615 Tw [(information, please visit RuleNumberT)69(wo.com.)]TJ /TT5 1 Tf 1.8 -2.001 TD -0.0039 Tc -0.0304 Tw [(Clark, D.W)86.1(. \(2006\). 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