cce4e51562b6fe7288147fe6c8180ea3 geriatrics_a2019v4p42.pdf 56d42e19efd92ed65504393aa7ffb5a578126056 geriatrics_a2019v4p42.pdf 8a5abd06d5f9c9a59fe2427408cd30891bb409ce34a85a3ef3ada7ddc8aea289 geriatrics_a2019v4p42.pdf Title: Natural History of Swallow Function during the Three-Month Period after Stroke Subject: Oropharyngeal dysphagia is a prevalent complication following stroke (PS-OD), and one that is sometimes spontaneously recovered. This study describes the natural history of PS-OD between admission and three months post-stroke, and the factors associated with its prevalence and development. PS-OD was assessed with the volume-viscosity swallow test (V-VST) in all stroke patients on admission and at the three-month follow-up. We analyzed clinical, demographic, and neuroanatomical factors of 247 older post-stroke patients (National Institute of Health Stroke Scale (NIHSS) = 3.5 3.8), comparing among those with PS-OD the ones with and without spontaneous recovery. PS-OD prevalence on admission was 39.7% (34.0% impaired safety; 30.8%, efficacy) and 41.7% (19.4% impaired safety; 39.3%, efficacy) at three months. Spontaneous swallow recovery occurred in 42.4% of patients with unsafe and in 29.9% with ineffective swallow, associated with younger age and optimal functional status. However, 26% of post-stroke patients developed new signs/symptoms of ineffective swallow related to poor functional, nutritional and health status, and institutionalization. PS-OD prevalence on admission and at the three-month follow-up was very high in the study population. PS-OD is a dynamic condition with some spontaneous recovery in patients with optimal functional status, but also new signs/symptoms can appear due to poor functionality. Regular PS-OD monitoring is needed to identify patients at risk of nutritional and respiratory complications. Keywords: deglutition; deglutition disorders; function recovery; neurophysiology; stroke Author: Viridiana Arreola, Natàlia Vilardell, Omar Ortega, Laia Rofes, Desiree Muriana, Ernest Palomeras, Daniel Álvarez-Berdugo and Pere Clavé Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.17 CreationDate: Tue Jul 9 13:14:57 2019 CEST ModDate: Tue Jul 9 13:14:57 2019 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 925578 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- VPLGKF+URWPalladioL-Ital Type 1 Custom yes yes no 87 0 DOBNQS+URWPalladioL-Bold Type 1 Custom yes yes no 88 0 WAVCBU+Pxbsy Type 1 Builtin yes yes no 89 0 MKXUQA+VnURWPalladioL-Bold Type 1 Custom yes yes no 90 0 FGWECQ+URWPalladioL-Roma Type 1 Custom yes yes no 91 0 OHKNFJ+VnURWPalladioL Type 1 Custom yes yes no 92 0 FATHTC+Rpxr Type 1 Builtin yes yes no 93 0 CXRXDI+Pxsy Type 1 Builtin yes yes no 94 0 UXFKPM+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 99 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 116 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 117 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 118 0 TGMEOR+Rpcxr Type 1 Builtin yes yes no 164 0 BCDEEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 200 0 BCDFEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 201 0 BCDGEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 202 0 BCDHEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 203 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 204 0 BCDEEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 230 0 BCDFEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 231 0 BCDGEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 232 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 233 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 256 0 LGZKLX+Rpxi Type 1 Builtin yes yes no 257 0 RCFYRP+Rpxb Type 1 Builtin yes yes no 265 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2020-01-22 05:43:35 CET RepresentationInformation: geriatrics_a2019v4p42.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2020-01-21 12:08:41 CET Size: 925578 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 0 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: ぉのぴひはつふっぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸲ Item: Title: きちぴづひどちぬぜ〴ぜ〰ちのつぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮ㄩ‾㸊⡜㌷㙜㌷㝜〰こぴふつべぜ〴ぜ〰いづびどでのぜ〴ぜ〰ちのつぜ〴ぜ〰ぐはばふぬちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㈩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぃはぬぬづっぴづつぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰ぃぬどのどっちぬぜ〴ぜ〰ぁびびづびびねづのぴぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぁのちぬべびどびぜ〴ぜ〰ちのつぜ〴ぜ〰こぴちぴどびぴどっちぬぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Children: Item: Title: こぴふつべぜ〴ぜ〰いづびどでのぜ〴ぜ〰ちのつぜ〴ぜ〰ぐはばふぬちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㈩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぃはぬぬづっぴづつぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰ぃぬどのどっちぬぜ〴ぜ〰ぁびびづびびねづのぴぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぁのちぬべびどびぜ〴ぜ〰ちのつぜ〴ぜ〰こぴちぴどびぴどっちぬぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: いちぴちぜ〴ぜ〰ぃはぬぬづっぴづつぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㌩‾㸊⡜㌷㙜㌷㝜〰ぃぬどのどっちぬぜ〴ぜ〰ぁびびづびびねづのぴぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぁのちぬべびどびぜ〴ぜ〰ちのつぜ〴ぜ〰こぴちぴどびぴどっちぬぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: ぃぬどのどっちぬぜ〴ぜ〰ぁびびづびびねづのぴぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㈮㐩‾㸊⡜㌷㙜㌷㝜〰いちぴちぜ〴ぜ〰ぁのちぬべびどびぜ〴ぜ〰ちのつぜ〴ぜ〰こぴちぴどびぴどっちぬぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: いちぴちぜ〴ぜ〰ぁのちぬべびどびぜ〴ぜ〰ちのつぜ〴ぜ〰こぴちぴどびぴどっちぬぜ〴ぜ〰きづぴとはつびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸳ Item: Title: げづびふぬぴびぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮ㄩ‾㸊⡜㌷㙜㌷㝜〰こぴふつべぜ〴ぜ〰ぐはばふぬちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㈩‾㸊⡜㌷㙜㌷㝜〰ぐひづぶちぬづのっづぜ〴ぜ〰はてぜ〴ぜ〰くい〺ぜ〴ぜ〰ぁつねどびびどはのぜ〴ぜ〰ちのつぜ〴ぜ〰ぴとづぜ〴ぜ〰〳〭きはのぴとぜ〴ぜ〰うはぬぬはぷ〭さばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぉねばちどひづつぜ〴ぜ〰こちてづぴべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㐩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぅててどっちっべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㔩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰しはひびづのどのでぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷどのでぜ〴ぜ〰うふのっぴどはのぜ〴ぜ〰いふひどのでぜ〴ぜ〰うはぬぬはぷぜ〴ぜ〰ふばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Children: Item: Title: こぴふつべぜ〴ぜ〰ぐはばふぬちぴどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㈩‾㸊⡜㌷㙜㌷㝜〰ぐひづぶちぬづのっづぜ〴ぜ〰はてぜ〴ぜ〰くい〺ぜ〴ぜ〰ぁつねどびびどはのぜ〴ぜ〰ちのつぜ〴ぜ〰ぴとづぜ〴ぜ〰〳〭きはのぴとぜ〴ぜ〰うはぬぬはぷ〭さばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぉねばちどひづつぜ〴ぜ〰こちてづぴべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㐩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぅててどっちっべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㔩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰しはひびづのどのでぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷどのでぜ〴ぜ〰うふのっぴどはのぜ〴ぜ〰いふひどのでぜ〴ぜ〰うはぬぬはぷぜ〴ぜ〰ふばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: ぐひづぶちぬづのっづぜ〴ぜ〰はてぜ〴ぜ〰くい〺ぜ〴ぜ〰ぁつねどびびどはのぜ〴ぜ〰ちのつぜ〴ぜ〰ぴとづぜ〴ぜ〰〳〭きはのぴとぜ〴ぜ〰うはぬぬはぷ〭さばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㌩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぉねばちどひづつぜ〴ぜ〰こちてづぴべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㐩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぅててどっちっべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㔩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰しはひびづのどのでぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷどのでぜ〴ぜ〰うふのっぴどはのぜ〴ぜ〰いふひどのでぜ〴ぜ〰うはぬぬはぷぜ〴ぜ〰ふばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぉねばちどひづつぜ〴ぜ〰こちてづぴべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㐩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぅててどっちっべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㔩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰しはひびづのどのでぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷどのでぜ〴ぜ〰うふのっぴどはのぜ〴ぜ〰いふひどのでぜ〴ぜ〰うはぬぬはぷぜ〴ぜ〰ふばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰げづっはぶづひべぜ〴ぜ〰はてぜ〴ぜ〰ぅててどっちっべぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷぜ〴〩਼㰠⽓ 䝯呯 䐠⡳畢獥捴楯渮㌮㔩‾㸊⡜㌷㙜㌷㝜〰うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰しはひびづのどのでぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷどのでぜ〴ぜ〰うふのっぴどはのぜ〴ぜ〰いふひどのでぜ〴ぜ〰うはぬぬはぷぜ〴ぜ〰ふばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: うちっぴはひびぜ〴ぜ〰ぁびびはっどちぴづつぜ〴ぜ〰ぷどぴとぜ〴ぜ〰ぴとづぜ〴ぜ〰しはひびづのどのでぜ〴ぜ〰はてぜ〴ぜ〰こぷちぬぬはぷどのでぜ〴ぜ〰うふのっぴどはのぜ〴ぜ〰いふひどのでぜ〴ぜ〰うはぬぬはぷぜ〴ぜ〰ふばぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: いどびっふびびどはのぜ〴〩਼㰠⽓ 䝯呯 䐠⡳散瑩潮⸴ Item: Title: げづてづひづのっづび Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: LGZKLX+Rpxi FontSubset: true FirstChar: 14 LastChar: 14 FontDescriptor: FontName: LGZKLX+Rpxi Flags: Symbolic FontBBox: -162, -280, 856, 733 FontFile: true Font: BaseFont: TGMEOR+Rpcxr FontSubset: true FirstChar: 169 LastChar: 174 FontDescriptor: FontName: TGMEOR+Rpcxr Flags: Symbolic FontBBox: -212, -286, 1344, 973 FontFile: true Font: BaseFont: VPLGKF+URWPalladioL-Ital FontSubset: true FirstChar: 45 LastChar: 121 FontDescriptor: FontName: VPLGKF+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: DOBNQS+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: DOBNQS+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: WAVCBU+Pxbsy FontSubset: true FirstChar: 6 LastChar: 121 FontDescriptor: FontName: WAVCBU+Pxbsy Flags: Symbolic FontBBox: 5, -978, 1382, 913 FontFile: true Font: BaseFont: RCFYRP+Rpxb FontSubset: true FirstChar: 14 LastChar: 14 FontDescriptor: FontName: RCFYRP+Rpxb Flags: Symbolic FontBBox: -57, -266, 932, 729 FontFile: true Font: BaseFont: MKXUQA+VnURWPalladioL-Bold FontSubset: true FirstChar: 129 LastChar: 178 FontDescriptor: FontName: MKXUQA+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: FGWECQ+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 246 FontDescriptor: FontName: FGWECQ+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: OHKNFJ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: OHKNFJ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: FATHTC+Rpxr FontSubset: true FirstChar: 11 LastChar: 61 FontDescriptor: FontName: FATHTC+Rpxr Flags: Symbolic FontBBox: -40, -283, 904, 728 FontFile: true Font: BaseFont: CXRXDI+Pxsy FontSubset: true FirstChar: 1 LastChar: 121 FontDescriptor: FontName: CXRXDI+Pxsy Flags: Symbolic FontBBox: -21, -994, 1292, 912 FontFile: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 75, 757, 210, 793 Annotation: Subtype: Link Rect: 474, 757, 519, 793 Annotation: Subtype: Link Rect: 341, 661, 352, 675 Annotation: Subtype: Link Rect: 283, 648, 294, 662 Annotation: Subtype: Link Rect: 389, 648, 400, 662 Annotation: Subtype: Link Rect: 466, 521, 518, 540 Annotation: Subtype: Link Rect: 508, 172, 515, 181 ActionDest: 309 Annotation: Subtype: Link Rect: 180, 131, 187, 140 ActionDest: 309 Annotation: Subtype: Link Rect: 404, 104, 411, 113 ActionDest: 320 Annotation: Subtype: Link Rect: 123, 77, 130, 86 ActionDest: 309 Annotation: Subtype: Link Rect: 162, 38, 253, 50 Annotation: Subtype: Link Rect: 398, 38, 519, 50 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 404, 729, 411, 738 ActionDest: 320 Annotation: Subtype: Link Rect: 228, 702, 235, 711 ActionDest: 320 Annotation: Subtype: Link Rect: 238, 702, 245, 711 ActionDest: 320 Annotation: Subtype: Link Rect: 204, 648, 211, 657 ActionDest: 320 Annotation: Subtype: Link Rect: 249, 621, 256, 630 ActionDest: 309 Annotation: Subtype: Link Rect: 114, 567, 121, 576 ActionDest: 309 Annotation: Subtype: Link Rect: 121, 567, 128, 576 ActionDest: 320 Annotation: Subtype: Link Rect: 129, 567, 141, 576 ActionDest: 320 Annotation: Subtype: Link Rect: 132, 540, 139, 549 ActionDest: 309 Annotation: Subtype: Link Rect: 311, 486, 323, 495 ActionDest: 320 Annotation: Subtype: Link Rect: 109, 405, 121, 414 ActionDest: 320 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 165, 655, 177, 665 ActionDest: 320 Annotation: Subtype: Link Rect: 446, 628, 458, 638 ActionDest: 320 Annotation: Subtype: Link Rect: 142, 601, 154, 611 ActionDest: 320 Annotation: Subtype: Link Rect: 398, 574, 410, 584 ActionDest: 320 Annotation: Subtype: Link Rect: 300, 534, 312, 543 ActionDest: 320 Annotation: Subtype: Link Rect: 264, 480, 276, 489 ActionDest: 320 Annotation: Subtype: Link Rect: 438, 370, 449, 379 ActionDest: 320 Annotation: Subtype: Link Rect: 450, 369, 462, 379 ActionDest: 320 Annotation: Subtype: Link Rect: 232, 302, 244, 311 ActionDest: 320 Annotation: Subtype: Link Rect: 430, 248, 442, 257 ActionDest: 320 Annotation: Subtype: Link Rect: 393, 167, 405, 176 ActionDest: 320 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 508, 552, 515, 564 ActionDest: 185 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 303, 360, 310, 372 ActionDest: 193 Annotation: Subtype: Link Rect: 403, 306, 410, 318 ActionDest: 193 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 149, 89, 156, 100 ActionDest: 253 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 428, 128, 435, 140 ActionDest: 262 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 418, 88, 424, 100 ActionDest: 268 Page: Sequence: 9 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 432, 594, 444, 603 ActionDest: 320 Annotation: Subtype: Link Rect: 447, 594, 459, 603 ActionDest: 320 Annotation: Subtype: Link Rect: 128, 567, 140, 576 ActionDest: 320 Annotation: Subtype: Link Rect: 140, 567, 152, 576 ActionDest: 320 Annotation: Subtype: Link Rect: 136, 540, 148, 549 ActionDest: 320 Annotation: Subtype: Link Rect: 387, 459, 399, 468 ActionDest: 320 Annotation: Subtype: Link Rect: 399, 459, 411, 468 ActionDest: 330 Annotation: Subtype: Link Rect: 412, 459, 424, 468 ActionDest: 330 Annotation: Subtype: Link Rect: 269, 391, 281, 400 ActionDest: 330 Annotation: Subtype: Link Rect: 282, 391, 294, 400 ActionDest: 330 Annotation: Subtype: Link Rect: 254, 364, 266, 373 ActionDest: 330 Annotation: Subtype: Link Rect: 266, 364, 278, 373 ActionDest: 330 Annotation: Subtype: Link Rect: 281, 364, 293, 373 ActionDest: 330 Annotation: Subtype: Link Rect: 503, 161, 515, 171 ActionDest: 330 Annotation: Subtype: Link Rect: 111, 80, 123, 90 ActionDest: 330 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 442, 742, 454, 752 ActionDest: 330 Annotation: Subtype: Link Rect: 375, 661, 387, 671 ActionDest: 330 Annotation: Subtype: Link Rect: 210, 607, 222, 617 ActionDest: 330 Annotation: Subtype: Link Rect: 301, 594, 313, 603 ActionDest: 330 Annotation: Subtype: Link Rect: 140, 526, 152, 535 ActionDest: 320 Annotation: Subtype: Link Rect: 257, 391, 269, 400 ActionDest: 330 Annotation: Subtype: Link Rect: 300, 364, 312, 373 ActionDest: 330 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 424, 572, 462, 583 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 76, 286, 166, 317 Annotation: Subtype: Link Rect: 234, 280, 407, 291 Checksum: 8f664ac4 Type: CRC32 Checksum: cce4e51562b6fe7288147fe6c8180ea3 Type: MD5 Checksum: 56d42e19efd92ed65504393aa7ffb5a578126056 Type: SHA-1