In March 2016, CPT Assistant published, the additional work of instilling and removing Trypan Blue dye from the anterior segment though an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code.. lhvCuttttttttttttttttttttttttttbC*i)))))mr!#dBO`1p@8 'kh 4 B@h 4 B@h 4 B@h 4 BRgbA&q2$X,E"`X,C BiPZ(-JU^u?j_k_K?f9#$BruN09"s#G8+s-Mh+s$yS\%ur)-B u4TFWgg Cultivation takes place at multiple levels due to the sloping terrain. Persons with developmental disabilities typically report higher quality of life than is perceived by others who are not disabled.37 Awareness of unconscious bias and how it can influence goals of care conversations is paramount.38 Family physicians can help hospital teams distinguish patients who have significant functional limitations but who are relatively healthy from patients who have serious, progressive illnesses. illegal procedure. Copyright 2023, PentaVision Powered by BroadcastMed. Supporters often report that patients with developmental disabilities have a high pain threshold. The Illinois Early Learning Guidelines for Children Birth to Age 3 provide early childhood professionals and policy makers a framework for understanding child development by presenting information on what children know and should do and what development looks like in everyday life. From then, he dedicated his life and his studies to become the best plastic surgeon possible. Mendieta is speaking not a cosmetic one, and he denied that Pinos infection resulted From wrinkles, enlarged pores, cellulite, saggy skin or lack of body curves, Dr. Mendieta can make the best recommendation and treatment option for your condition. National Resource Center for Supported Decision-Making, United Nations Convention on the Rights of Persons with Disabilities Article 12: Equal Recognition Before the Law, Chronic gastroesophageal reflux causing damage to the enamel, Aggression, defiance, withdrawal, meltdowns, Small stools, liquid stools, soiling, rectal digging, urinary retention, Worsening contractures, constipation, decreased mobility, Feeding problems, head banging, agitation, Memory loss, confabulation, unsteady gait, Shortness of breath or cough with or after meals, slight elevation of body temperature, tachycardia, Endocrine or metabolic disorders (especially hypothyroidism and syndrome of inappropriate antidiuretic hormone), Behavior problems, sedation, paradoxical reactions, atypical drug metabolism, Amenorrhea, spontaneous fractures, constipation, pressure sores, Occult fractures or injuries, arthritis, nerve compression, osteoporosis, Irritability; insomnia; decreased participation; change in function; aggression; scratching, banging, or touching the body part that hurts, Seizures, including less common seizure types, Emotional lability, unresponsiveness, fatigue, automatisms, Grabbing genitals, abdominal distention, urinary tract infections, Decreased participation or mobility; easily startled; aggression, Academic-Autistic Spectrum Partnership in Research and Education Healthcare Toolkit: resources for adults on the autism spectrum and their primary care providers; includes a tool for creating a personalized accommodation letter, American Academy for Cerebral Palsy Developmental Medicine: care pathways, fact sheets, systematic reviews, Autistic Self Advocacy Network: resources for accessing home and community-based services and resources on nondiscrimination, transition, communication, and exercising rights, Coalition for Compassionate Care of California: advance care planning for persons with developmental disabilities, Health Care for Adults with Intellectual and Developmental Disabilities: clinical algorithms, Massachusetts Department of Developmental Services: 2017 adult screening recommendations, National Institute of Dental and Craniofacial Research: information about providing dental care for persons with developmental disabilities, University of California, San Francisco, Office of Developmental Primary Care: chart forms, training materials, practice pearls. Why Women Are Removing Their Black Market Butt Enhancement, The Top Cosmetic Procedure Sweeping Hollywood, The Surprising Health Benefits of Abdominoplasty. As always, if you need assistance, Corcoran Consulting Group can help. [CDATA[*/ Care Credit can make it affordable for nearly everyone. 66991 Extracapsular cataract re-moval with insertion of intraocular lens prosthesis (1-stage procedure), manual Management of intraoperative complications, such as vitreous loss, iris prolapse, and dropped nucleus or IOL, does not qualify the case as complex. Use of Dye. https://www.americanbar.org/content/dam/aba/administrative/law_aging/2017_SDM_%20Resolution_Final.authcheckdam.pdf, https://www.aclu.org/other/faqs-about-supported-decision-making, http://autisticadvocacy.org/2014/07/asan-unveils-toolkit-for-advocates-on-health-care-and-the-transition-to-adulthood/, http://odpc.ucsf.edu/supported-health-care-decision-making, http://odpc.ucsf.edu/sites/odpc.ucsf.edu/files/pdf_docs/FINAL%20Trans%20Guide%2011.18.16%20ALL_0.pdf, https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-12-equal-recognition-before-the-law.html. 0000055080 00000 n Speaking to the supporter: Who makes her medical decisions? 0000105838 00000 n Medical professionals, such as doctors, pharmacists, and nurses, must maintain Pino slipped into coma and doctors amputated her hands and feet hoping to save her life, but she died in August. The American Society for Aesthetic Plastic Surgery, 2310 S. Dixie Hwy He is very smart, caring, and kind. 669X2 - Routine cataract surgery with IOL and implantation of The presence of trauma, or weak or abnormal lens support structures caused by numerous conditions (e.g., uveitis) and disease states (e.g., glaucoma, pseudoexfoliation syndrome, Marfan syndrome) require additional surgical involvement, and utilization of additional techniques and surgical devices. 0000006790 00000 n The other issues with these fillers are that there are currently no standards or monitoring system as to the quality of the product being made and many of these fillers are not as pure. V?#:Ft1cDw,i4g3Ls9i444444W`e0p,p0:`tv[,~*DDX,0+0+h4@shP3 Instead of transferring decision making to a power of attorney or having a judge or hospital protocol assign a proxy decision maker, patients choose one or more supporters they trust, select the type of support they want, and receive help to make decisions or to communicate. Specifically, goniotomy (CPT code 65820) should not be coded in addition to other angle surgeries, stent insertions or Schlemm canal implants or if the incision into the trabecular meshwork is minimal or simply incidental to another procedure. Because this treatment will not change your blindness or improve your intellectual disability, I recommend hospice. <> (Exact numbers are hard to track; Dr. Mendieta estimates the death toll to be closer to 16, with four occurring in the past year alone.) ?[ c`:1iF Z` +F The small incision may self-seal or require 1-2 sutures, decreasing likelihood of suture-induced astigmatism. 0000106332 00000 n 0000009794 00000 n A breach of this duty, such And in August 2013, Miami radio DJ Betty Pino died after undergoing a butt-injection removal performed by Mendieta. In all instances, it is wise to have complete and precise chart documentation preoperatively and include documentation in the operative note itself. document.write(['horizonoliveoil','gmail.com'].join('@'))/*]]>*/ , [emailprotected] 0030-28410-26084, 0030-6972236082. I receive multiple phone calls a day regarding butt enhancement surgery via fat grafting, which proves its growing demand. A South Florida doctor fighting the states effort to revoke his license on grounds of repeated medical malpractice is the surgeon whose patient died either lack government approval or are banned outright. My Highlight Liposculpting and Lipo Fat Transfer signature technique delicately recontours the abdomen, waist, hips, and then reshapes and lifts the buttocks using a 3-D approach. This Extra Virgin Organic Olive Oil is officially certified as organic by the Bio Hellas Institute. Capsular support rings to allow the placement of an intraocular lens may be required in the presence of weak or absent support structures. Ameloblasts must also be present for dentinogenesis to continue.. A message is sent from the newly differentiated I need a little more information. If the rate exceeds 10%, it would do well to consider an internal or external audit. Is lazy eye preventable? endstream endobj 1305 0 obj <. 0000106008 00000 n 1327 0 obj <>/Filter/FlateDecode/ID[<1968E1843686274CA0C93DD31C73456A>]/Index[1304 45]/Info 1303 0 R/Length 105/Prev 134828/Root 1305 0 R/Size 1349/Type/XRef/W[1 2 1]>>stream hQkGo =3;nH( %2A5bAB#:jWl1K,Xa~y3p~Y?}!z@5a/}igg>v;/ngpyz;_fw>nKa{uYlns=O?Ov_>Otx?n=xe(p%BGxFf,EhHs9i4G#Hs9hN4' hbbd``b`!`bX Although it has been around since the 1960s it never really gained popularity, and many surgeons just simply ignored this part of the body. Just like any patient, those with developmental disabilities should have access to a full range of life-sustaining, curative, and end-of-life services. An IOL must be inserted to use this code even though pediatric cataract extraction is more difficult that adult cataract extraction. You can start at any time. They can provide ancillary information, translate or interpret unclear speech or nonverbal communication, and break down concepts in a way the patient can understand. If you need time to think about it, we can record the information in plain language to review with your supporter at home. These fillers being used are not approved in the United States. I'm glad to hear that expediting the repair of your electric wheelchair enabled you to return to church and work. 0000017239 00000 n Persons with developmental disabilities who have been taught to comply, especially those who need assistance with activities of daily living, may not have been encouraged or taught to set personal boundaries or to recognize or communicate when they are being mistreated or abused. from the procedure. When establishing care, it is critical to get a detailed history of baseline traits and characteristics in the areas of cognition and communication; neuromuscular function; sensory function such as vision, hearing, and sensory processing; seizure threshold; mental health; and behavior. http://www.aacpdm.org/publications/care-pathways, http://coalitionccc.org/tools-resources/people-with-developmental-disabilities/, http://www.mass.gov/eohhs/docs/dmr/reports/health-screening-wallchart.pdf, https://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/, Persons with developmental disabilities can and do have sex, marry, and have children.30,31 They have a full range of sexual orientations. the surgery. rgNOQ 8::ps43b|*e`p1q5e|eaUdec-d]pcOozO3nqf! Can you tell me what brings him in today? Two months later, the medical examiner issued Doctors had to amputate her hands and her feet on August 6, and she died Pino reportedly had difficulty finding A month later, Pino was admitted to Doctors Hospital in Miami with flu-like symptoms, where she was diagnosed with sepsis. Member of The American Society of Plastic Surgeons & 6 reviews of 4 Beauty Aesthetic Institute "Dr. Mendieta did my Brazilian Butt Lift and I am OBSESSED with my results! She underwent surgery on June 14, 2013 to remove silicone that Board Certified Plastic & Reconstructive Surgeon. Pediatric anatomy contributes to the complexity of cataract surgery. <> %PDF-1.6 % Ensuring timely care may require more frequent office visits and adjustments to office protocols.29 Table 4 includes toolkits to help physicians optimize care for patients with developmental disabilities. The Center for Medicare and Medicaid Services (CMS) has increased efforts to contain compliance infringements regarding coding and billing of Current Procedural Terminology (CPT) code 66982the complex cataract code. endstream endobj startxref %%EOF Systematically comparing current with past function is essential to recognizing treatable medical problems and rehabilitation potential. Dr. Kimberly Henry, a board-certified plastic surgeon who performs BBLs in the San Francisco area, explains: You do not want to want to inject fat into the gluteus maximus muscle layer, near blood vessels. Communication may include speech, sign language, writing, letter boards, voice output devices, pictures, facial expressions, gestures, vocalizations, and behavior. Developmental disabilities are attributable to a cognitive impairment, physical impairment, or both. However, in the neurodiversity model, the individual's most effective means of communication would be accepted because his or her potential for producing clear, fluent speech might be limited, slow, and effortful. For years now, external auditors have been engaged by CMS to audit complex cataract surgery claims. 0000001116 00000 n Persons with developmental disabilities often have atypical behavior in response to pain. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 15 0 R 23 0 R 25 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Dr. Mendieta is a member of the American Society of Plastic Surgeons (ASPS), American Society For Aesthetic Plastic Surgery (ASAPS) and is a diplomate of the American Board of Plastic Surgery (ABPS). How would you like to spend your day? Can you tell me what happened the last time he was in the emergency department? The basis for this overutilization is a basic misunderstanding of the differences between complex and complications. This article reviews the definition, requirements, and chart documentation necessary to code a case as complex. place outside of hospitals or clinics, and may involve procedures that We have made tremendous advancements, but the most important was learning how to decrease the complication. And I hope you found this helpful. Are you in any pain or discomfort? Most adults with developmental disabilities have had genetic, diagnostic, cognitive, speech, occupational, physical, educational, vocational, or developmental assessments. I forgot to turn off my turtle's filter so act like you don't hear that . PjtqW?zGc~Z_hS_\pIz6W| N7. 0000106820 00000 n eTable A includes resources for more information about supported decision making. The following is the 2020 CPT description of code 66982: Extracapsular cataract removal with insertion of intraocular lens prosthesis ([sic] 1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage. Our mission is to encourage the beauty and self-confidence our patients desire. *, I am proud to promote safety first! These audits are commonly known as Supplemental Medical Review Contractor (SMRC) audits. h;G_2Mw#=UZ=#hxzyd7-\74 \'R ~)+ @e|V^gc9Z`]=mRy,9OFQ!s4Lz$;\NfIvg W3Bzwa'Nz)`R,Bod;tr|2.r`[P4+nz6~UL fe3%","# %2"]!Q3j$s/R=T_zQ+g9w b2-nk7:_s|rZh@N>%U&Vcz%^Gq5!4y^%B}^``j) |]z!td"zuEQqB WebFor example, we used CPT code 66982, which is the code for cataract surgery during the amblyogenic developmental stage, whereas Stager and coworkers used CPT code 66940, which is the code for a routine cataract surgery. In the medical model, someone with dysarthria might be referred for speech therapy to improve articulation because people primarily communicate through speech. Speaking directly to the patient: I see you're hitting your head. Because waiting is difficult for you, we scheduled your next visit for the first appointment of the day so that you can be seen right away. 0000105257 00000 n It would do well for cataract surgeons to perform a review of their percentage by dividing the number of complex procedures (# of 66982) performed (the numerator) by the total of all cataract extractions performed (# of 66982 + 66984). 0  3 0 obj Developmental disabilities are attributable to a cognitive impairment, physical impairment, or both. MAC policies generally do not include manual or viscoelastic pupillary stretching. 0000002957 00000 n 0000002534 00000 n Supported decision making is a paradigm, support practice, and emerging legal structure that focuses on assisting patients with communicating their wants and needs as an alternative to guardianship or power of attorney. According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), core physicians (plastic surgeons, dermatologists, and facial plastic surgeons) performed 18,487 of these procedures in 2015 compared to 7382 in 2011.1 For the purposes of tabulation of procedural statistics, the number of cases performed by nonplastic surgeons is included in estimates provided by ASAPS (h *, Board Certified Plastic Surgeon The cause of Hernandez's death was respiratory arrest associated with anesthesia given her during To get information about financing click here. Some persons with developmental disabilities have had extensive educational and therapeutic interventions focused on improving their compliance with the expectations of authority figures such as parents and teachers. Contents 1Disease Entity 1.1Disease 1.2Etiology 1.3Risk Factors 1.4General Pathology the following day. In the medical model, persons with short stature might receive growth hormone, whereas in the social or neurodiversity model, they may be referred to vocational training to pursue a career that interests them and for which they can perform the essential functions with or without accommodations. Physicians can support full inclusion and access to medical care for patients with disabilities by ensuring that their practices comply with guidelines for physical access. Another form of glaucoma is acute angle-closure glaucoma (AACG), which occurs as a dramatic, violent attack with closure of the entire angle. According to the Miami New Times, he has faced as a misdiagnosis, surgical error, or medication error, may entitle a His specialties include Internal Medicine, Plastic Surgery. endstream endobj 2368 0 obj <>stream OK to use. Whereas the CPT definition and CPT Insiders elucidations enumerate conditions for coding a case as qualifying as complex, other qualifying usages for the complex code may vary with each MACs LCD. Led by Chief Medical Editor Lisa K. Feulner, MD, PhD, Ophthalmology Management provides all the tools ophthalmologists need to succeed, bringing them the latest practice management pearls, clinical advancements and medical economics they need to help their practices grow. The elucidation of pathways and intermediates is crucial for the understand It is said to have been liquid injections that caused problems for Magnano, however, reports are not yet providing definitive details regarding the substance used for her butt augmentation surgery. Doctors had to amputate her hands and her feet on August 6, and she died the following day. I can't imagine how hard it must be to be wheelchair-bound. For example, they may not grimace, cry, or clutch the part of the body that hurts. b`#wIg/v^Y{8*_{o|5xqj{R:a:P4S`9/>t^G}, hX!P! Family physicians are important advocates for their patients to access a full range of life-sustaining, curative, palliative care, and hospice services. Pharmacological assistance with pupillary dilation/maintenance is not one of the criteria for a case qualifying for being coded as complex (e.g., use of epi-Shugarcaine or Omidria [Omeros]). You can access our new mobile application, Corcoran 24/7, via the links below. However, the term supporter can encourage person-centered thinking that respects the patient's autonomy, even if the patient requires assistance to communicate or make decisions.12 Supporters are helpful in a variety of ways. Because pain is an internal sensation, communication difficulties can complicate the assessment. WebNCI's Dictionary of Cancer Terms provides easy-to-understand definitions for words and phrases related to cancer and medicine. 0000004352 00000 n Let me go over all of the treatment options with you. out aggressively against silicone injections, saying that the injections Miami, FL 33133 a doctor to perform the removal procedure. The region boasts 300 days of sunshine annually, and its altitude ensures only small changes in temperate throughout the year (mild winters and cool summers). People with disabilities have a right to maximize their potential, and so do parents. The CPT definition for 66982 states: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, fOZi20%2\)\gXh(=^jUK2{2lT,2x4,U?hnUMA(ce?wXf;Pwp Le;Pf l>2t{3&mMOQGNaTTM2q1y3Xs|,r ,oXL5:fV +?$iL.Dl@H]. 1304 0 obj <> endobj Horizon elite organic olive oil is produced in the Cretan village of Kalamafka in the southern foothills of the Diktian mountain range, located 12km north of Ierapetra and 24km west of Agios Nikolaos. Review diet for adequate fiber and fluid intake, and check for medications that may contribute to constipation, Evaluate wheelchair seating to ensure the patient's nose, umbilicus, and knees are facing the same direction, which may help with bowel motility and a strong Valsalva maneuver, Prescribe exercise; even passive knee to chest range of motion can improve bowel motility, Teach supporters to position themselves behind the patient when providing oral care, with the patient's head held back and to the side to protect the airway, Consider prescribing bite blocks to prop open the mouth, Consider recommending adaptive toothbrushes; water pic and suction; xylitol gum or spray; antimicrobial agents, such as chlorhexidine (Peridex); and clearing food and rinsing the mouth with water after meals, Assess the patient's diet for sugar and acidic foods to reduce caries and erosion of enamel, Customize seating for wheelchair users to reduce pressure points and provide support, Assess for occult fractures, which can easily be missed in patients with communication difficulties, Instruct supporters to lift from the patient's core rather than extremities to prevent fragility fractures, Prescribe exercise for maintaining strength and range of motion, Consider prescribing calcium and vitamin D supplements for the prevention of osteoporosis, especially if there are risk factors such as wheelchair use, nutritional problems, use of medications that inhibit absorption, or limited exposure to sunlight, Consider recommending a wheelchair for longer outings if gait is abnormal to preserve joints, Treat gastroesophageal reflux, which may present as cough (as well as erosion of tooth enamel), Recommend upright positioning to reduce aspiration risk, For patients with dysphagia, consider ordering a swallow study to optimize food texture and feeding procedure to prevent aspiration, Consider prescribing a nebulizer for inhaled medication in patients who cannot use metered dose inhalers correctly, Assess for occult spinal cord and peripheral nerve compression, which can easily be missed in persons with communication and baseline functional limitations, Assess for treatable medical conditions that can be misdiagnosed as dementia, Prescribe exercise to maintain strength and range of motion, especially during hospitalizations and illnesses, Prescribe rehabilitation for any loss of function from deconditioning, especially after hospitalization, Consider ordering a pressure-reducing mattress, Train patients and supporters on protocols to maintain good hygiene, For patients who pick at skin, evaluate boredom or anxiety and explore possible replacement behaviors. 66991 The social model focuses on improving participation in society with accommodations such as adaptive equipment or improvements to the social and physical environment. 0000011371 00000 n Persons with developmental disabilities have high rates of psychiatric problems.34 The Diagnostic and Statistical Manual for Intellectual Disability (DSM-ID-2) can assist physicians in making psychiatric diagnoses in persons with intellectual disabilities who may have atypical signs and symptoms.35 Generally, with accurate diagnosis, psychiatric conditions in patients with developmental disabilities can be managed effectively with the same range of medical, behavioral, and therapeutic modalities used to treat these conditions in the general population.36. 0000015450 00000 n The olive groves of the Nikolarakis family are found throughout the region of Kalamafka. The distinction between the medical, neurodiversity, and social models has important implications for medical care. Pediatric (or other) cases cannot be coded with CPT code 66982 when an IOL is not inserted. In fact, in CPT Assistant, an AMA publication, in March of 2016 it is stated: the additional work of instilling and removing Trypan Blue dye from the anterior segment though an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code. So the use of dye in and of itself does not constitute sufficient extra work or intensity to qualify the case as being coded complex, nor does it require significant extra time. It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other wayin short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.. 0000002822 00000 n hb```b``* @Q kLL}? Supported decision making affords persons with disabilities the same opportunity. Webon patients in the amblyogenic development stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more $856 $3245 New Technology APC1563 $4251 66991 Extracapsular cataract removal with insertion of At a minimum, patients should be included in discussions about decisions that impact them. 2367 0 obj <>stream Gathering information directly from patients, as much as possible, is important because only they can report on their internal thoughts and symptoms. Speaking directly to the patient: Can you show me how you say yes? The information on this website is for general information purposes only. Accurate and thorough record keeping is critical because patients and supporters may not be able to provide a detailed medical history. Nothing on this site should be taken as legal advice for any individual month later. These patients may be particularly vulnerable. You should not go to just any doctor who offers, and claims, to specialize in gluteal augmentation. "The Stage 29 producer responded that the procedure would only be free of charge if Jenelle Butler went with Dr. Mendieta. Silicone injections are illegal in the United States, but still happen Learn More. Author disclosure: No relevant financial affiliations. This technique involves the removal of the entire lens and surrounding capsule. The Miami Herald reports Lattia Baumeister of Rock Island, Illinois, died Thursday while undergoing an unidentified procedure at Seduction by Jardon's Medical Center in Doral.. please update to most recent version. We offer one on one virtual consultations with Dr. Mendieta. The anterior capsule tears with great difficulty and the cortex is difficult to remove from the eye because of intrinsic adhesion of the lens material. Enter your email and we will send you the password. Dr. Constantino Mendieta, who has built a niche practice focused on buttocks. xrJ-xqR\2i-y$IftRH`3 CECykVn-.X-?xv6w[5PmjFm>07uY*7sU+7w]vyS9^*rUxeS6W#yva0zy6Uy5[T\UrUwA; 1\@j>?^w]g?L{2biFdR^NR+|s3Xw"n7Tm9`ga*7wniO7j:e%qM7C9uU7Swf,r^qQdz)b"Q?yyiOF,[vQeD`eS%+#U}udeqrM\?T_qaQ~WMt9q1-li]-g6#~)Sh,24-I,L:Y&30m?=A@FsgLK`]O:wnA4/\j~jT4Yts
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