PK iIoa,mimetypeapplication/epub+zipPK iIjMETA-INF/container.xml PK iI9OPS/coverpage.htm NICE clinical guideline
NICE clinical guideline
PK iIv<&44OPS/coverpageAdvice.pngPNG  IHDRX p4IDATx=-[~q9p̡߁r~c0BpO4RӁN }|!w'sAD(Ǜnoo4ew񆏏J|JlE)Ɩ<<}ѷKAS g-3S?W2DHo[MIkOWڵ xQјkU2!OY̪%p6"$B)w߾;Xp㈐ADxX`ۉ0Ga#B",Y g6ań!Z )hU6v3')DՌ67DxfpO^l ̾W>EI#B"bn"7A $B"fF+m74BD"$B͌# W†rDH B"T`>"m)JD"$BYXL=#rhە̈ADa}D\h=>DH B"T8pASu VG8wr!B"y5 waQ_g>bYpG%SmF +W7ူNF",׏a"B!p'^٫.›7DH B"$–"yCE!/LL"$B!oP,L12F82DH Ӌ0r|cvaO"$B D)L+>B%DDxqpFʝm_DH B"$~DXk; GD"$B"lSC5aO!ghk^"VOD"$B"ls_ACF^^^ ˗Vc"B"!ݷ6T.|퉐ADH)?bSVyxx\lݧ4 6CD"$B F%Wqʰ]~v`#k(ѩ;,<>>D E**"\sS㐗MEd!_+ %bt)!rjۺDH%"Q{7arDHDX{a] -ADSbF'SSQ } nܞhNM鬜 TCnE!B"^37o>tlUmJ CYe6bb8zDjbjJpJ7D"!D(B BA"D"!D(B BEDH"B B""!EAD("D"$B!B!PDDH"B B""!EAD("D"$B!B!PDDH"B B""!ED("DH B!B"!PDA"BD""$B!ED("DH B!B"!PDA"BD""$B!ED("DH B!B"!!PA B"ED"!B!ϟGH<~9ԩy7?Ƕny݇?8D"$B[ I,8AWW_m|t!zB$Ѷ +nmއh>^QD"^박ADvsfj T;kwʻ7U<A ;8(!_y'b7akгrED"4GfF1J#!T='<FIK#DH BcDH B+˴ڲFAD]NA>@gy!=pEDHD"tr'rUƈA)nNcA'=~j]u231"$BsTY$B!T:ksӧu."$B9r}kX_Dhps|||TAn\'m}SAflhṡ?(TDH “u({_uz!3He&G=y8!OCf-Qv)n>(KDH B.\a0^!B";!_ܙ#]b-_D/Vfh!5dDx77Y%TGOD"|xxM!B"ͬ'yն;$^"$B2ǛCZ///':apmDH 7V-ҡ !M4DHr8+z !#רj2 !ę&gp;Zչ=HD"|isdZ5d͑!B"9*M:EAUV^i{储BD"<}ص*rDH Bu:Z[?iqm"$Bm>??_&A%B" Z\?:ȂDH BY;Y\dA"$BM>ݝт+dA"mT]ׂk*Y$B!'.===]тыWy'B!ʪŝ,A B"tƟ\%-H j!w-.)ru,g!eṴaͫ,*DH fMOOOYz7{ A", rԬVl(ӈ P[0x  *?D"$BYn1㣒C B"K݉-ϟ?{.PX0,9ʂ7H B". ÎGnE) m J B"ڶ_s.O z>DH"B B""!EAD("D"$B!B!PDDH"B B""!EAD("D"$B!B!PDDH"BD""$B!ED("DH B!B"!w '!|<@"B![p_pL B"""!AD(D(DH B!B!B"  !PADx~~C^Y&B!%քAD(D(D"$B!B!B!  !PPAiazmcN!xS9aW8G+}]~hqnF=/_ |}hMLxbb3ʇ4v$*ةV"|#|,fy$ ]^^^b{ m6HD0jnszQ*.÷ۻ6pEDFw\}oz}.oT<ЂBNv_7"$BOqA5[f6>6(Ko"\fYYڍy ^4o.n-4ZuM?7 W\-#=\wZ]n-{.#Z ;{AgmXsGDS0*\ضR7o~]&ѽ ;nwFbm՚cm%kTقq%W S/Z'aT eV 5aa:BQWNeS))35 rZX? <`XpG~8u> k*"$B@SVX6!6OlM'[~ti8D֬l{VaW CDCpk8q0WwSV+gD8ѷGRSǼ]S#ĮV_'B"qE8uv ߻ƶޡహ"tk5"\1 [l5#!*ꔩʽY|V :j9\MD8z̛/Eݪ=5?WyhbܻY|=ӮGlx5"Vwc,"%B"AE8ZQ6z {7Ӹ ; 꾩J.h| a !*ы붓JвYM ZcmE1o!Upzŕ3eL[ӽpfP[nwW]!!*fF䈶"\QްMD1_/#HDSpѶk~Y#onq7f}7FWoDHx"m) F_{K^DHxC"Ztm^6tֈpayn["$BR;PO]Ć->zqp 3BDC/qY}т P,"AbxZh"1-;^|znkT]aKL!",7B}V{WƌVVF"c;tW^1/cҭ mlI?0!!‹[RK%M*)~UMFl.6Q1>1U^EkkdOC8tQFX>+\ maR-?"$BCRL|߰R.M-K57aLÛ#Fe{./(ʂDH8/_- uyg˳MEXM4\?Ǽa?pa"AD7'eT*W%yy\3᳾՘{#avy-yن;Zۅ[&B")E5U^T%Q-*_A[MsCM]!Ŷ59Pm!DH8S@aaFreVͱS 5[vҰF pAF Ѷ!"͋Z\0 w/Ď|жޏw,X0wTv#QQNwi^O5{󃔍uÔV"BD""$B!ED("DH B!B"!PDA"BD""$B!ED"!B!PA B"ED"!B!PA B"ED"!B!PA B"zDAD("D"$B!B!PDDH"B B""!EAD("D"$B!B!PDDH"B B""!EAD("D"$B!B_d@!D@!D@!D@!D@!D@!D@!D@!D B" B" B" B" B" B" B" B" B" B" B" B" B"C B" B" B" B" B" B" B" B" B" B" B" B" B"!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@" B" B" B" B" B" BcoEDDlPDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDQ"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B;/SED$O/8" 䧿FF K`}7Cf#DxM?'°_g#M ¹i<+eOh9<M՗\z₠/(Ê0vmwh:ҩ(+W֧UJՋ0_ꯣE\@ahc`1Ei[07_s@VO.cHD> o9Dl"Ԃ#<1jS<⍿SъKmV p`E{9܉ʗk"$MEX"<M <nv4u}_rmM4:A O]LVn2v?ϓ̤-G,os*NfdI i4$ݽ6`꘤-ny]8۶^ ¼4&C;D,]/Vsz*tĦ.w7,~̋}#.wN'ycXFiwҲi;7£pB2˺o[n4=/zPNT[^7>S],&ńWf8"ι/-2E!"̞+.Kz܍]$e oޝ8Ky+wMnaF_a8E=]sa1cx;D.ݫ"$ E[p`DX>%o'WNbv7]a~͟[ft%"&BZ&?{i㻳~.] -`0^CDv",,8ZTvFzWSˁFx̰\ƖOW?ohc Sz&":iMz~S\W(`c7sVeA5fE}nCyȿJ@ \t>=!WOHkw;fXbC{[d~j߻ۅOjI>07>ޙ]:ݧO'$,4ʋHp@E("B",<0XHD("JDMiSDH""G ȫ,ͳpEvš"\q8yC.Y~e~Zmft6|ͼ*Խg}&rآxFD8k">s|r[Vy'j94u^\he`Go7v` 6\bg;ƿV WKx S,"R.'qLjD-fG[:oS-9LKx=g# braSaw+E8,?CguP\G;]-"P+ a7DX8ÑB/z<_kD8=5=ޅ}wOSUӲeHnee/u]-b}s1+᡻xL抰<2"7|pլ-XDR^3Xg-鲝^7;!cݡz.!5նX5KB|h6hy+{ ^pwFGW#/ϻSGm,oհ;yۺOS4N*7;\r-|gu|IްJc/0n-}zk>#O~wܵn!̻B[p`>"L]꿮ُ)+${1^[D`aw~JyzwnOs_",?hM}wNԮL%U^KЯ_4ZOI΀tȕpސ"vµL}5~۳^n^ݙ[{G [kD;,S_j/VT,cu%u r׈?l4̭4*J-JػY>&yT_< '&tV,_14K:t%6z_>hSSB/vvߪ{拶\*i2pw*kBmM-^a\6<ާ[,~?n]#B0;GFDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDD!"!B"!B"!B"!B"!B"!B]~^4VIENDB`PK iIqnm-m-OPS/coverpageDefault.pngPNG  IHDRX ptEXtSoftwareAdobe ImageReadyqe<-IDATx_]ս/X,.TIU+9j`4El*](j|K?}҄8_>ꋧbEfp[(JL9wJMP9wО5ܣgcds̹w9/b @ A!B @ A!B @ A!B @ A!B @ A!B @ A!B @ @ Agyq&(_S'SA!B @ A!B @ A!BيW^6xzEVMLLl';&''WOn V`箝Xu?sX]l͛777.+x\\lfI(F޸˹Am۶>z`%1Lӟ~֭k~@Gm?\ܖ5kTyq䦚XǏ5UlQFyV,Y1\#dEiځKvI )V1B2+V[R6՗A[oܼy?ڸqcO Nr .I"a,E6ܵspEZo`BO6mu[~ΝǎtUO>XB¸qǍ],\q{vȑj2$Fr&[|V@ Eӛ.8qGREv[n57n,_qԩNj4BxK >~pD'lӦM坰gn _LUӫ# OnEtV7 )],Ty >cm;yjYkFbaCURЍ}wn۶333R! իoæeW@mܸ@iǏV2MMM8Y/RQO.QnW-ku%=1byVc۶mUN:<{5K!g~2* }lz9gh&&&FK F9SD:tCX8vE '!#)9ċ@rNenց>0d?XիWGz#2@JpԩgK^nݺ;v }=Gj'5ʙرc333SS-l> f͚eXa#A2yqfcpp~~Lׯ_ &XNrzC?Ws3!@ C7|AZ<%83S%5kl6 ! ̋3ǏsH(?1!pL/Ϙ1vG a8İ>Glڴ;n/t* X4??ܡnqP>}vvUwe#׭[Y>c y[n۶!f^-tS5j¯(ѳӒ>:̊(]G܃SyqIc &y a\E/*i(wMO|P a%h9~E7] ) g^~a_7ċOi][!g;f-,,tPW;vl7nTn :}c>V1SN[=B{Ǐ~f`3/?v[o1a,;?] &>a8q""ԩS/*rСCsssFЀ 0^cǎj[o1ΩQ/8A.5?w9 z0zSl:Mn:eF⸘g;<7??]é>BE e\LuiMDﭷj 5BLtΖ9|߯3=)D=qCkx񃓓S?5A z\LuF@/N & z0p5 z0(;iG&m7o@BG^?>h˩Q!B @ A!B @ A!B @ A!B @ A!B @ A!B @ A!BB @ A!B @ A!B @ A!B @ A!B @ A!B @ A!B @ @ A!B @ A!B @ A!B @ A/B)S5ך `95 A!B @ A!B @ A!B @ A!B @ A!B @ A!B @ AA!B @ A!B @ A!B @ A!B @ A!B @ A!B @ A!B!B @ A!B @ A!B @ A!B @ A!B @ A!B @ A!BBE A!B @ A!B @ A!B @ A!B @ A!B @ A!B @ AA!B8vϿ*@ A!B @ A!B @ A!B @ A!B @ A!B @ A!B @ !B @ A!B @ A!B @ AlE0?|?/G?<T\7/l~}D8'gdۅuٖ|oXվN~통Ʌ;[dž|7l`Ϗ;psYkWז;9e.w埲u=f/k%UW?*sӛJ`FayvΫz[6SmAm[zIћ|ΫbÛH~-f<Fm[n~ݽ܉n'*ίؓڧ 8HVU>Ow5hAArG^zwH`0]* }ΛlomozeaBe-䁟{y3s[mŸ~/wW[W5c6/xޝơ?. DɽWx. o}<w_S׿L, 37{+LDl*hB1>ˆ^.Z_ឯxχh55d-a}yՏሊbH&?W?Jo><^ߴְт9n4eu&FŧozAm:DQ{8<7ϿMۛVb1_}\N}=J,dxo*TyϮy?KNխᗝo~}q~KFӴiҴxM/;Aғ{= qTd/y=ZաN|juyh/Ĩ>։md]:K2܉dWśm|ruBY- 6xe|bOq-s#og*y& ^؄-fR-hEy-67QhK%v\n[tʋHkMKT5\bD[MQ&QzDZTRꡥ Aߋ7T S}Jԗl~|3 {J[g1*nѐ^W{)}Mϖ47-[AոXT6:_E!wJb =}nr%5R )u#b>][D(VOfkCOO9|omtc fRW.u tziwQ>i[-us?5SW~=KVԭaMe?e}-O?9Rc.e Kczg];.]yphL&G&*mQ-[Ta@S^->h"~ S["6nzA`2[~SGk=]jiqӅ4&+2 V^xЮO-[xSSEtR|gnPD't7 jЊw>4~kb3SŽ[9tv(X 3^w<(9cEv]OnV2 >+M\%tS?/ )YxK{Kӥŧ|proait+O2gv^6Y~HjX*Hy϶:"S5Y2FyqpyimGoQjMǹ)i4įy4`T^Zx]%X_KnqYaBEFrƘZ42f[filAů^nTj%"`l#b`af]Y8g;rDڈлndg@Y5ʓLIHʞ7ejikO47G9|LJ~tp~:G]ތbUij4^I#c}^wMvQػgbF@A8BJN*'z~{(cU辴Ⱥ ]RpN6w yI‡> ,]GϷE ,z uˢUk SkjJ"ڊْű ?5lyA3{eWOVGGA%/8y{ZLkw6{=~/KTZtI$5vuUg_J vGYyUV_g3Ir˼eQXXy4-\S515o4ZTQIEM5]݀ڄ WCǃ,</(?+.ՠ]ݿ/yOQʘ(̺9=rRS)ּibρ߾ͬ(t׼,&ҺًΩDӾ=kDՖ&Wo׻6X*6Zui9vZw,(8M )1=?MI\&wX~J؃58on['.Mk<=6ݗvm׎C9b 棱mHgAl4 +0@ԕ:M;V*~hl\x{ |8V>MyO[:w7]A"Z}?ݒY39sEJo/V\Zvw5O>~prnX`ytpԚi]KiChJ+SUfϗR&}듅uQI[ A8W[[i5O|Mk޸z%ۄƟ|jq-^;Z{G]Q1|pt4zA*wQQvl\~{?nXT>¦X|zӇZG񛡯?m{"֨׿Dqn8mwѥq:Q[,W-׳aH</c6jw*') 5ө*0c4 )<{[ij.j+CfMM.ۦ͸e3o} ;_s/ ;;(>8_:pttg] W H>GR-R\4,gݽtڎ_-MGHCq܏7A7,{*N=g |sxY&Γ|KO6)No~=߱8vÑ *~gD6PMײ4 j xpG~l2mu=pw~Q~J9<p,TX8t=óav!pzFVqRN.=!ɛ(9iR.ugu3_t[ҳtks]A:U?tobLX}݈'ن<纋[JצߝMݱi^zwAvc,.y۾,Ty%Ryx= <~ޗ3ҍ(M%Oy!bNtq\H'-Uvis KDf|HIɧ'vT&-Mņ?by/bA=7?FVV,6x *؛uQ2>B'gv.?uCϋ}Ӛ.\X\,js3uRES4J/ k}/z>ݛʎӸ yjش|-b=Y^2|T͉ק*&6v'F!mI`rߜJ>CU-iwE7nڡQ ŧBF՟: lmXgNtͅ|ˁ7r=`iojG&Q<~DeI_}p5V5sF;y_-b!7^0Kޕhlz<=Rq y]MkҴ-itR޴ߝijվh#5<~.: oMGLѷ'ZU7l= 4(Q|"%ou6/WO=v+q4:;NpU9d=;ng [KYi<ߢ /Ff/t-X٥UH:+>TGӌyZSWnw:͐7m&YA8 #`TޘEՍLmXr_vmL6UZή,}뎚8yrk{}VRUܮFbac:rV;:m7[}xqݯ9KŞ %u+aݩQ^} Sb9j#<ѥǧt}i;:bOF@ ?]xؙFb#/Z #nzAï'Q[hw,\mGs6/v-<Ц3vhIb9p~ݶ7E!cx~$Aa%]ϛhVE.E}} r zaFbaJeaЌ<-*(V*fhͦXY(/>SW~z%DAmKJ=*l]:¦皉n|I MO foi{4ݴ MS9an+Aлj`|k'4:4i`}M{?{x-Vo1Zt];.eXMߦXɒA)R74}drږ.m-q0N?TEoLۤ{[V+:)8cM3i+Jnizz;/S?;yӢgv#}bwwi/Q0Vo (?){TΊ)T̗cȈt}W44WE{%h8TԲLek}cY3!n.|.1?se[w}I]~tEKָ,-<<NK/XV5w>_"U~i9`;,7x#lQEE%8[t$O[ digO~mtqhM3ir-4hT.ՋmO7߼Tg-*閃*Ǐ9R#?(ļgbC]nʎ~CFխ}Ǧn~. bDT,=D3K^eR!`Nmz5Mz9~F<ȩn[lijoMqiWU۞Xn>һq\\%-ߜ8.Sm@;ܢo|!csӤQKN3_wnT[P-:qK{h.p!MTἉQ/JZ5-O&()Ȟ-}L-+KIRr;,/Wn3gOen{qujc?pnI|nZ?җM[g7C_<ƬUޗŹWh^ܜAiN|wjI"&نJ3}/^(yYBya"Mwd2y'6a{X]-gSn o{Y4І*ߣ0R35r ׶!RdO< VƗK_RU+伙9JV_~zc\/&Z?;&@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B !B 8 OOHޮWlQ&BR!BR!BR!BR!BR!BR!BR!BR!BR!BR!BR!BR!B(BBBBBBB_}ww×߼4}B(/~~7߿nwO CCdlŐ'~c0`!BxYsS۷kf_ʧOBv-q<E Up1{ !K%Ϊ߽ސΧ~t$36O!B!>VgIB7lw`n^ EBO´!2D7L= !6Bܽ;g;G% eP!7CG27G0Ӝ&B!,rӧO9#~EP!7 g印K!\ӹ3Y:YB(/. QC BPW,Zϑ9!B «z3qB! N!GmB(B!+&3peW/B! !w]*V:!|ί{'3!B~!_,NK8? !VCx`uBؿ$˗[+BBn2~:!_AxΝ[D!B pZ2WOÓ#B!B!k"G  BgsQ3<BP.Zwsp'BCG9xFN+L0|BBLB5Ru⣗\P/B!n~(!_[B(B!T2DK g BDŽp)$>}UzFP!B(ӿ?c!zl$&!B oEihov B(B!_h~F _~+UB(BݻwwO‘x䕅1q?~B! a yfg7ur;$Q!³0ѿ%BB9&wB[B(tp%B8r8B! ɪc[B! O`B2oݱP!B(?Xx 6<B Ws󃢅8{wv.i>5upյ}5*B!>>8:޽4B! !/?|y1;ϠB! !ϋs{R!BN>PlB! ! a灺g3A#B!Bu۷o#>! !I! !I! !I! !I! !I! !I! !I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!)eB!$B!$B!$B!$B!$B!$B!$B!$B!$B!$B!$B!$B(BH !PI !PI !PI !PI !PI !PyF߾}B2!>/yW߾‡><<_oA-ʄBtˠ D !B(B(B R!B(BH!B !P!B(B!R)B!RBH! !BH!B|!|dWE9&Ex7/3E_{ojnw͙YX@|P߿} WV3~W7qP{wWӧOjٽ311?~87*ӿxx=$S5=z1J#f W´XZR&/@\P]ϰ ob/[7pWTOWGG96g#~1 7> uז:+soP_hf /ehu -ۦlZa`s66lGr[xD ^b !n#sKXD9 "~.7#sUHGbi^NxjӤ~x\e/B]zTqys!{ \mm{bvɮ U|Kذyn+B(8ib,IwCXM=GFJSmO9Y;A6bm3&_ !CE瞕vq[!~ώM yZA;8pHBn7/GnV?۹۰zVמ'Dz" !B,ǑX_ڞ-`B!B!B!B ]v !Po1L(xe}ev22B:a1 ޶pՒtDzM\>BUoM B/+^m ;zxDWm~E*j6La넰}zjyB89MKn1>jCty !n,:`Yڤ[|wAmjKty/^5USvUMQ> !\|dqq˝rZA8CB8u90akOpƃb%f hT|g;ornpp?4W!B=탹 rȊ`,Uvv 7LNu<6s(m.H!۷#Y3['8a'cz?7UhFV&'KWƸL~B!̈́\ˋ޽v:(V,ɁXUoX Q!O4l gM6>ߓY䊑QSunO>չ*~=sۥO⹅1H͵aS.‘Ղhwn>h|1LN;*#B/1s xڶxBJ p1 rn[pJlm1E!B<K:BR/kNL.ӰD0)bƔ_ܦIǺ<ėU~bq;ߤ3UccN)pHMfYU7 =`6h5-P[ B<3S_D ݨB!h[Wy~BqKl8vR$FBqE{Us;oM !O|}DL{qh{7oUL !W:Yf_lr/qcR!BxV~FR!BxnVŤBqoYz R!m?-=-7B#B(ݘ(M@R?$P!$P!$P!$P!$P!$P!$P!$P!$P!$P!$P!$P!$P!$P!B!B!B!B!B!B!B!B!B!B!B!B!BrBBB[&-ʄ!@B!@B!@B!@B!@B!@B!@B!@B !B !B !B !B !B !B !B !B !B !B !B !B !@M !B !B !B !B !B !B !B !B !B !B !B !B !@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!!B !B !B !B !B !B !O¯'IUIBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I!4HBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !~/տw?eyIpO˻o2?o#o/~5??j~yxqJ ?q#╝qiLRZ$p%ocgGěCovl"|a-HR}pCg҈wl\t3e6W,!$[ a'{sF_^FOls %6s;§ aӷB\Fsµ;WA*'\| &c`i9Hi8F/U U'ts|Fq\iC/ɜVyWmg~1_E9A<ֆ0yOjFDEiu"|sˋ?wC9-I2) ' C`BX,F`YiCZVc'׸a%TJr?-_suK̡{i?/?UW,+!WCB>%>.zG!^67~2>?UC\$ gATnm#&H5ynL灘h r5Bx,x[^9}?fC$,Ѫ_8ZKĐP~'9]͝K#3⬛Ga)!}Bn"*ytnhxG<- aZ]WYT'V9<[G9kN~s">O*Zv휰s&lW.~G½!ڇ#'!I h;O,B!$g¯L;X(BH'CB($B`az歄:7?$)C`C8x\Gx IRk`NrAuj}[ɳe]%'3ig[߄:X!,9v;9f`CsWŊf 冧ʈ j;Xx7ݾSyn}^:M&orG]tsCB({C8~C8w nap>I8#Gm mp§ ]+wTp[hs&VAv .ϲ^!'~>T^t&u~q璕=!LózRvGBX>5byN G#w>9GƹXrӯ NU|-;^!'.}23 ahY%k.夘۳w* kKծx M)oy\ʍf9<9_g˟|Issc!O>=s5#姗;r&̣" ឃ a8>Im5ɽ~?&Q?rޚ<ˣ\5y!TeWK*B?{^O2˾Nrv8sS˚<źO'B PgӶ?MO4Ǹ0 sHmrmC&_G$SI 3gZXy.My!|j!\b:ć bb /,fEwyxM^'@^!93s/ȳM¹ O]$<9MqCsѹ@'.nn}|^M`"JL΍?iIjvͣ67iݪ!_5!H,Z."V9u6._s0}˝?ro^*E{'rԭ- O9mKv`[-Y?G gԄ!\u!B y0\_bpԄ>lңbe>/[՞11vRyY|b*Y丧^('gۖݗ8PKڨF?憧?YQgW`,N.`p YTYtvSfqݴOo2EGM9ֿ)CBH$)$I !IBH$)$I !IBH$)$I !IBH$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIB$$I!$IRIBh$$I!$IRIB$$I!$IRIB$$I!$IRIB$o #$\aIENDB`PK iI//OPS/coverpageGuideline.pngPNG  IHDRX p/IDATx=%[~q}9p̡sk0!L'1F6V{ᶍ 21 L ͒kjUZzj{xgu`~$!B !B !B !B !B !B !B !B !B !B !B !B !B!@B퟼ѿɛ6-̈́BH !BH !BH !BH !BH !BH !BH !BH !BH !BH !BH !BH !P-GH! !I! !I! !I! !I! !I! !I! !_oۂ7߿M! !߽~[.CŻޭ*qvVOab ɇͬ!Bf߿_nOOOoӧF ޖ&0t^sf{mB(1΍4E\޽\?-ڮ]^sB( s0}!4 Bo2OOO_}ՕCKxB(B!|! /½*q!1 Bo5d/cW&(B!b?,<3Ylw?:UFccm7B!R{mxA;?٧0ƧBBBسvEQF/P!B( N aLB! .9!mx@NB(B8ӧOS .;EP!B5!l{<'LB(BRǏ} !PpsBbSv^GB!^%â'ܨ X1{Z !C 괟m4;!MkpB!Ξ9X?{_ZB(:{ 9?O`B! Μk؟="B!B!G=9F8eP!7wS=O?(~B!@vFϼB(ك'0lwKB(B8 kw{@NB(B]v aWv;*B!B!\C8[/B! s]! ӧ$B!B!/jnׯOB! N~ġ!.q BP !ܷ߿B!  :{PS h|P!B({\-7<} !P%K5_Q9u*Jc抋_}*btOclNy*P)B!|N_mś߬;?~+~wnE!bkileiK7CճV ӍB!B!B!B!B!B!B!BPI! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I! !I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B!I!B]fy+ߠB?[ߠBBH! !B!B !B(B !P)BR)B!RBH! !BH!B!B(B !P!B B)B! RB(BH!B !P!B(B! RB(BH!B !P!B(B! RB(BH!B !P!B(B! RB(B(fB!B!B!PP!B!B!BPB!B!B!PP!B!B!BPB!B!B!PP!B!B!BPB(#B(B!B  !P)B(B! BB(B!B  !P)B(B! BB(B!B  !P)B(B! BBKBR)B!R!BH!BBH! !B!B !B(B B)B!R)B!RBH! !BH!B !P!Bx>}B!B_b߾//:#P!B+ǏS|FB!|!|û ?(B!B6>}zE&P!; a`mk3hP!BaTo}h$QB!ܸi(B!B>gn㧿Ֆ3hP!B alo B7b=== Bb=FB(qj !<.e8Bq]Bz0^z"ˎY!BRv"jul&z;w©Md-\S͈%In$eJi,˥ 85"{,*+;B(t_zt1(+S ;aD]>/˭XΞ6턜E2=)+[WVeG,;WezɘL*Bw_,OG=vBNa4wguֳb|\繠1TyIB( Lo7dl ]u&3Chۅү; B!ECXoI_njvkݏd\T#!gphޞ[cs/Bzc ᎓epW՟[4BsovL-6y8k3B(h+W~=7}'KQعyaji!\wq`ME±vyUnC8Xdo4m,YwryCx9뾲] !$mbr!}t~n}sktKsq !,g"ļK2Yz>ۨOv'ȍSoÄB(b[ U-p%xcl}ݴ^t/B(ž\z+Cw!_M(B!B!?Paר\XW!B!;Y ]6Ou;a}m|NB!CX_|xaדؾ9k' CX͸qϖ W_? ۸T'97xQ!Ŋ۹ ⅆp{z7FYu{ 덭],386%eg}o^/" BFa{3-w a}S{)G8v/!*9B(ֻXO=o@.1;>\z9^??(I4G-{.\7C@ޠ6OuHVlaL]xӋ-g !L-K#BGE:Ԩl%WGzۋL asG7sp~cB8.&]=:U3i/DbY?Ghg\1C8==;x~ڳ@}pqzђs]PLww !n ͗X4:u,#rb7 [хT'1>ӾhFϧsGGe6䘍r3S!B\=]y=-!lo)5}񿣋N:;~b3^YOG@scNME='GnjF|%Pq{!;_EX\~!m,m",R^Z^A!BLI"KT.օpų#GpubaϳX1]S˼}`bP !n&e[`:C5'´`htЖύaLE^C7 ']󸛔 BX.cQL85S,S/ak|b4{0"V|fR$JSomܴz`2pш շL;5Q NBq0pXpO=YքP"BX_ aK pp9O B([5Y˨7X&Bq3=~GB!CnO !P ?I!N,]zanjO !PO:kq?t:znL ! akͯKK ! a>B!.wy{LXB!ĝUqt4I!BCI BI BI BI BI BI BI BI BI BI BI BI BI BI BI BI!4B!)B!)B!)B!)B!)B!)B!)B!)B!)B!)B!)B!)B!!B($ByzzƉ?dK3!@B!@B!@B!@B!@B!@B!@B!@B !B !B !B !B !B !B !B !B !B !B !B !B !BB !B !B !B !B !B !B !B !B !B !B !B !B !BB!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B!@B !B !B !B !B !B !?$bB$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IRM$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IBH$)$I !IB??~yOL+Woר?~C?"'{?_j/~xqJ ?#╍qhLRZ$p%_obgGěC2movl-"|0$)k½sCgԈwlݘe6U,!$[ aW[sF_Qx xs`n|n9K s0__߃j4u.!wrc W9:^V_75νm~#Vʿw<Cz;!wwhZcӹLܸ<a~arɃ^4 Cx-du!B(cm!;XxZ+}bԡ!7!LVj@W,`:;ZCD ʫu!CCX!.=XxP!X4u}chۮ>i yj]gji/7+c;y<94yaNS߃3tr ttl)Jz5 4ICXy]8ܶ^<T"}Ж+Xœ)qM< ɘi0y{3˵;Hp?O>i 0ύ<-aZn߻V aKssptn7:WͦzN%ה_=y1FßS`gѽw멗kvBx0/P,aYݏ_wL7o._`ͩ5yyɾWGwO9 ,1$=Tk yyWs/L8;Q~cd zgH_$EO(M\%;N VgrfZbp" W a+B>sߜw  Y.i!,'ZSw-¼BXnpGv-^-imk*ltPyB8uإBsO/03G6fra!y|8B8_A}&?ƿzRYLk y 3q"!~ ats/h;k4-:d[^4ͧ壤O aܐzb{;~b>Z9œ̩ь%C y^1yULN`BX.̞wZWb-.4j&)BxE!cTߑnp{Byۨ!l\WG a=- 3!Q,B;/z풏S=;+OW#ʝKf.CX.CG|(fk4f7w²41auΆpc}1hsƙF_9Q >!xIR{CxrM` !IIh>2m` !IO,LPIB`az歄_ !\tg vq:yA=I },yE.?We=>]f>+Եu&xE =3W.Cyav3}]3<5noYNÓucC8ܬ7Jl`ih|[`=/LEܘgvg<I^3j=_wsnrC`!ʡlgn?Fh`zF7^G؞,yp',qo0/藞gbtzx:;k^U!L/^bԄyfTKCyCسߞ a=A7*`Ҁun¥ O%+C aXy^H"=F9zvY<۶|R<^'XWjfG?ϞCB3l5!<6Z85<t\s|$S6N aeM!v{nbw Ωkqe@<`S2v5LgQGzs,|~}u4N`'RRO/wV|b)Y!̝+rv~{j%/ ˄ƞY=.7̿sh/yB倥,diOlϠKC8:j]ծJgoi f>;b:N:`ѭgŊjqAM-M7}l3,%V0ptcLƞt7E!b=^Ի}Cl.1MF7^C-WpGt1uu6~D:n;4>(m*Njc|L.iA<-4^J,oA9:/NWY߭TKs(%om F=Ѧ=YUQgW`,N.s X ?<3kS߮ T B" B" B" B" B" B" B" B" B" B" B" B" B@!D@!.?3hʈD(B BA"D"!D(B BA"D"!D(B BA"D"!PAD("D"$B!B!PDDH"B B""z}?T?D B"SFj}Jc`?k{xg%!?dHb+\8ػl~~]&׀!O*_a{£*A/¹ݲ7*!@Njn#5B"$Bᵊpְ"j&ב 0`#B"^;4G0:p///GE26Ty65A-Ɓ#E/-}{VTs1EG!Er0Z&K;i؝OqJJD"|s"liC݂ E!o8Fѓ[?KD"$BY8^1"t_)޲وADH8FUپn:?DHD8E`DH B"-E8vFo%L"$B!ʌ~rіD]vryj!C??ҡF*Ej+8̈A*u]\ &LD"$B"a rI.!!vD8鞯ŊDHDH a]W_% !!6EXXY-Oyyyq!^7}..n}nӽg0!oD|VP^D"Q| zkD"+w߾{yy#&B!"lX-!#;0rwwwANn݃yDHڑ}E[O5!Paب$~"lpVD5ADH?&մqwwwfPi{1$Mr$ ~G!E~psFe&/k_7C BD(=D8klv6T"$B͊02)=D8kl(!C&߻uar !s"ap)QDH B"EXXX@eY-?/!b* &[;gyyxxX;www˂vC 7k.8MeyBN 䚞YBD""$B!ED("DH B!B"!PDA"BD""$B!ED("DH B!B"!PDA"BD"!B!PA B"ED"!B!PA B"ED"!B!PA B"EDHD(B B""B}?oUA7P`⷟?ƉD"ŎCC]C"o*ϳx=!Dx#ӗ_㣪#B!/X $B!.r^Sϟ?|amŇ/_^^(ADH ·PBHb[<S2g'KDH {a___e[m j[&76ߢ!̂WI=҂\HD"4coܽ"}yyyhʈDx,DJ^_ϟ?NtD"@>|aYG>(SHD",%ϚYv+}ȸIXAW9.zY3tt!ZE7w+5.a!B"in26ЉdDH B"$‹ NᲹ*tohD'l5m2>"WM!B!ʅoX<|$"T١ED"^__7 ԷZxJa>q!/?}oQAK4ვx{PaGEqR===ER !P>I2l=}c`AD8n{4>?rXLDH B"ax~70' !PaaVO[|DHDxpADHDHD"$B"$B"$B!!!DHDHDH B"$B"$B"!!!DHDHDH B"$B"$B"!!!ADH""$B!!ߦ<Dx|ÚE:BD"qYGoD۽t!B"H|岗'7PF•a!B"qSK?>> M_nks0DH B) PPDHr"\RDHr&AD(L OOOAD,/U!B!%x[BWD"~1ҧ'}A"om%JE BA"D"$BPDDH"B B""!EAD("D"$B!B!PDDH"B B"" /xxxxzze-< g(D"ĉDJ'i|kSݕGE4"E[ޗA/^ ƒD BQ>>>& /(C*E!D7z)-\<kNJ.5:M BܠcWK"s>|a֤3``W-Y[ܚMzŤ' N7XephZ4:ߙ߲%oi?|A|oRF*}J&0љR+/"rc,8#mBpc=?ݧFčh&;kdE_,,XJ)̝NjxK)NgGc2>Md;SGGtܱw.rye0vZwM&F;(5\3 5eD[amSn*"F*;.wo=h4Uv {Q5"LEDf>S}E]' O;&;"W~ IF{AE8s>(lͱKtiԴl4[Ƭվ>WQN3:,&7gdt*s>xEɬ "`o5WlADdvv-seE8?0;9;?;/7Iݑ"ުu0 ~Ai+Φ̵4mo6y.<\CSF ѷL\jyh9qV;)^s&+Q[&a}wڶagh"EX?&±`A3DXi|;CLj~yiv ŠIIght 5LrDHu2{prH~bN_U(cw:e.%2D"$+aQNʯπ?F{ '5O7;MDw# qYO _+w!"repayj_ݿRyv", D%[.wM/;7ԷADxFvX-^U,;7Gkea*4lk;]+usqRD"$“0Wag]LZyѱ.`0rgX+AD$O2Jǩ<4[Y|Q>y o+djܣN2SR&^wa3fae^Lۖ!EAD("D"$B!B!PDA"BD""$B!ED("DH BYY'2YK !Pj)a9zi3<A B"<婇$!Pފo<~!AD(DHD"$B!B"$B! !PDHBDH B""$B"eDHBDHD""$B"$B!!D(D#B"nt2<'~? 0~{XV}{y<2"06=~ڲѴD϶a{kxA.I䞟F:xA0wVI^^^Vh+ VyDae)qf !/)h7d ,~5pJ[h0zuw)#B |p$,nXipqƩpel]CME OmFnJӗaT8kAEǏnMi_o^K+a TiQ-6ׅa@'v*6摦]PSFqONkLY&" *|G;>^iH/%^bĎT9WJUįN2F)#BܸL'J.vE"lCrl{_Jl֝!8=2"k{i#+e\`<g*Mu.xED"\(5NeW*53+]/(sedxF?VDMXeEcSvp*dǏ;U2!pZ[MLmՉp+XcKK`ur\zxPSFx"pi' .Og'gݮUǟA"vnXar&upH`&shn[vw!w&A(/ {v 'kH)`U7y B"<[-7L][-7*2i#ED"$³pq)W$dpH<"|#B"N @_}Jp1M<)jul"$BfO_GsH;]kyE88S-HDNwh n.+N_ "|q"ADX6sFzؒoa~V}X"E@`#;\9Z͇\HUOq"~Pich98s뙞G8ǫxDH  `i,G.O߰'4xO;ت*N<DHp^ 6d->+Fv&"ܪ'=xuuǞͻմJD"x+Zv JtozpJp҇>^c279~Ǝϝ&6!oǚlC`1o%•V)aWXeUDxc/>GSFxC"9ѠNui%.hd'- vvGlEXis--DH ?28wXpcO&!$YױJk"">_͚{_XUq&!p1؍}R!;z$ ]hK}œ KzVR" ~R'>$w(jʈ7.hga8gۼXo2s D;[*LŶnW:1ҢH *måDX|S\a o!B"N<}EK4kWyKh)Jw х 8&DZɩ%,1 7 S 5lVeE٦)#B s{.jXQ5){{p+ ,^"LGNegDH -ko9h6_$>pza:4$y{WD 3&OxD%{% V4+rj00 ;*wׯ0SYKcɟ_)#BE=Mw|"~MMXs&M"̰rS[+GT*-tÓN,7Rõ͗_X/V7?˯ċ-Qc&╕}YRZ"B3Ro/*:=+7R&Bɓ6Z`ujY~ݙs "47ٵT`虍=E""$8" WFNa|Ys %Z!K0ݟޞÂߝl4vN׃_R<O{sxB&՗Uc>:ܪnqBPQaζáu6FPWlOoUJE?/G\@'ahcsp׾`BV^\&:$B"iC~.oupspW G,Ĩ]Ex\"LVj^\,<wx/"; ArCDKW#¹ & 7eHcWE n(J;ke2v?}ϓI%5˜ߝ:YyyFZo!][JoIwI*aYػxqyٷ^ ¼4&C/wp xYO悵TcUJHӦ\߹`b^1y/r:%W1wZ)-4Dg],<gMszB<5.sec̩CN_\K/6-#GĹekOx\S"9ƖZTXta*[U1~\y`C40k/m%6^v}. R0HI{5_u "]] IVQ=6F?9UHhL@TZyy/߻waS;r1aYN畹?:i5]ant.yYK#y*3?Rv֯Fx5YCzp=_{\ίg!].GA,'aioSzD?<;w`oseJy+SMh 2#b7"\%–a9:dg||eދIC"̞WQ҇>7J^VN0+sl7e/ ׯS1"$E8E3l*LN;L Xb]΢!-w㕋,aCD"]gyDoTj+&Eo{t}ƌ(fwagù EY.yE O ЕwF;=7Zr1",ay?{Z̳w\IgKD%a:y"h^—~&\ -`JNCD~a ",8]B:WcˁFxL\grcϷ]kQQʔNhpZӮ]T5:UDH9tvƲ –Ymt(?#}'A΃rS8􉴦y95c<ؾB'-e)UC9ګ^zgR OcGZi M׊\""D*ʓk* EDnDT6vPDvD8ba8DD("rS"u0=KZDx̢g}BDgp–"l\q<yC.YbaNrC1O>kltygU{ %ik?ވp3κXxq_\m>Ɨm~dvl6-c/N42V*-9-.aD8bU,}SyE羌a2.^nإ/ܲF</\{˧&U$OL+ωpRʾG`%c{1Kx4:_uFyD~qb`7&8 ?v?T Xq)bld;}Y{ey 퓁l3o@Ȼ7=ŢO<w?:ia-FYhMl1ϨJ;T`p_b[9<0?) >#>naI_qx(+~.Zzs:kFʭ;hܵ ̻[!½Db1"\#')VIKb<gykD.t:DPQEj;iY:"7ys[_<8d۾s;x&X͗YS;JJ׶~ ^OUe\{,\| 6ɿ~#dyGO`yp*sk pD8WqUFGZD8Le%K:C+M^9kD8x ftɚ{A>l:"̓\WDf/u*OН.[>>ٹ4XXƣ1.'$/u׼kcOKN)."\v0mK#vnrt.7EʟS9]9_#$ydyj>:";)˓95"Lcw7++X:0*oDX^K-9bpa"okkr}˟9)̓S;9gy캲L.dgϫr*2_k/C]ۗi3kH[ᬋ7 .2D؟H9xMYX_V/<1olGeY^aW_S;/),R?[ .j^һr~J`;X*7S׺9Y[+ݿ9\ߩo9$ZeV%^VV~YT-uR:u|J]9~6VQkeiE-7MZFO" s!/X\arl}qYK'- v.5k%0M _pL}_S-aG5Z2V#%oXY"H(++*Q'hRKݵDaw`:wcn& WTl(l&uűwS>&f̭O~ R%(=}T.a}3}ɽ+m<}" ƿ0`!&hla+M'Z΀aY3禝Jx|/[Wx}sJ;?"!B"!B"!B"!B"!B"!B"!B!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B!BU ""D(""B"""D(""B"""D(""B"""D(""B"""D(""B"""D(""B"""מDϹ'IENDB`PK iIA H6H6OPS/coverpageStandard.pngPNG  IHDRX p6IDATx=e~q8pd  J iHRA'.dce ]62FBa(P %-ktjשϗCO9Z߳| +. B" B" B" B" B" B" B" B" B" B" B" B" B@!D@8?GD^o>(#Bٿބ eD"!B!PA B"ED"!B!PA B"ED"!B!PA B"EDHD(B B""!EAD("D"$B!B!ʇ?Dz'w߾sqDHO>ߎ?oo;\/n}ٖbvVA&5u%ny:sc^qτےADvKJԖuxJÝ OvmID"|%NN.w߾m!85CK./8Z/߱8^T"$BJ pG >==Z!!u87oN(uCc:E-!Ք8=aci9dLSBȚѳk\x}t~"$BKK0gE}!4qq!bӧOCS$B"gYgDخv{qfDH ·[4: /#8v.یDvKFgeD]EAD(+Kˈ=wp'K!P2"\ah"$B!%pD>}piL!_kK\C.q\%!U8q%?|lj_@ןSیDZE3u!!Dسu!! E8;c!w!!S{YHDHD"N<E>1Lqn3"$B5pvmuʾ'Znۄz"gJ' !P)}Yx#S!PQr`YW}!PQrlYyg7HD"$B٧_Y}]DD"$B"|cED8:\YW`ʚDH B"${?|DSP>??Fu4fj)!p7o^D=²v[ ?FcqD"V"Z9i1BZbc DH}:YCz`žtAD(D:vZ{B"[ DM80AD(Xb+m_ DHRg+[jqT!sQnooWy DHWTZ]:ãq?|auu6, B!EV.N^ǓDH,&sΪ)!-%z%Up{ADlRAD"4_[puیAD+t!8yeq2C B"|[Y: <: "`/z׳!B!D7&EDH-š:LBD"$BˊΫ⊇ ΰD=ADh}Wf(P]y [x^O"L\2LDHE_w0Q"都8W0 !ˊ&J B"M&[D"$B+n2LwDH0LADH~~D}D"$BY6R0Q!B"^aG1LA ݞy=6BZg03/N Byˠ#eޖWn 5f0Qkj!ee"5lkc\tb(PϝX*©z[T Wa7UDˈp͆&V 6P.'IOOO̲q)!r"\Zo|_ %B!D+Z/Cr&9=GD"$&OM2LtG"$B!Y:ElҲehl n?"$Ba{ɖ˪j'W0΁9n?"$B ioҌmn&qOD"|CeP{IV{kw6Nd: ! gU?W/D1L;`0uTP$B"^C:4˵Ճ\W] !!#P)\ǎwvyAok }mн,?ֽGD"OZ_1E=6~t3kjw)DH —Ol`E+X6q<Dx=պ?3N`X29BD"vQ"$B[oݥsnSs^,.JD"|kU)\NIGՈAo}}|~zߢvZ!j;6QxY/j5Dh_ 1Yb!U S&b !Pf>h^uљ!U ,̊ͤU}n A"$BG'; woLt4Lts#DH “>iimn3X5ՈAAS!B":+> YpY"BD"Ҥs*),∥MDx -K=JOA ³ DkkFQ"l"f҃_.zDug9A,\T܃p%r*V^pcDHxNŊHOH/͔ B!l˭C B"[eyUoDxUͤ|5!-V _|S!B"^yB3GL؅{=D"$BDKt ( "_DH'&|FC(PN͎Kc7rB B"CuZM²G B"'ŏ?| G9&xWDHDxlGOB BA"D"!D(B B"$B"!EAD("D"$B!B!PDDH"B B""!EAD("D"$B!B!PDDH"B B"WO>7}sADHr{{;{WXm QLDH BwN[oزKD"""$B!D(R{OD"$By["!AD(DHD"$W߽|Pr}W,w}i#mny8x}yq.Ul>_Z'q}^q۳D")Dː(jgh庲C n ύFuE^ \"'k.D''ah sT<z?GK2(#B iTn>߼-IDXV j-S"$BRT=QʺWaTUzQQe[|׵p8}=DH M#$ˋ }Y_Qw?QeQ*A]a*y= //ª"T",[z{we%2>O BaW>.,ª럛1J-<AkRV 8Z&/,-c嬾zCGgM!w(2e}aJޖYwga;?@[D"y||\>Q.wN&c!pM*Ŋ50_jB}uJӜPާNך5AD"aJaOMO(¨2SY!D8sp!N.ª>T1kDR#—A VA?\+^YX1kD'[/N]9:-WۥEXV0kDCw >Q+ '/<s=+/!pTkolѥ;U~K+*zq8WD"\p5yzz:iݕ{jGdxcjWQG>.{[פS|`hhi* eD"DT5W25UvW{a(|V_8T'nġt;E8+۳߱!QG"MX=~]f[k{rf+UUuNj"lLbcY%B!p?7JFb6[v"\j,)v ga DH 5¨g477]Y ga>).NCD;A ™"JqExaS#$B"^:QR >5VQ_G^wgPnA +3v{Ĩ"CN5j}-c9A =q"O5P%yEX֓fGƖק1prY ]'H BHq.[j^C\a8bjUʲYxxc+_ z=!Dlծ.2:^f-߳'ª9ኝ픥mHqFэ"kD"QveU#=\sݢiGy.:PDXU`僉$N@xcKl$-J-ݱ]{A Ÿ-}]bZ" I[?ZG5蹆bE{ 5 ".+8՞nB}g-=t4CNI_k{pD"M_?]9B'uEz.n +_C7ٖS*׹$r;?R.z?D"!B!PA B"ED"!B!PADH"D"$B!B!PDDH"B B""!EAD("D"$B!B!_?x?W!D@!D@!D@!D@!D@!D@!D@!D@"t D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@" B" B" B" B" B" B" B" B" B" B" B" B" B@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D@!D B" B" B" B" B" B" B oɿy!B!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B"!B!BWADDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDDEDDPDD#__?oO1~]+W,ͯ=ӻ?{]8_|&^oc{?"^8KOKDpA%_/ҳqHfwJvgG oF/W׃n!"B½3;j9ލ ٔc_D("DǜY?=FٗJ f|҇ߎK0O|}" T_DA8wr G9zsrG..c?"<W3N+8}C;/DNgA^GIٙYE-:܋1F?Ҳ8³pFZ1Ͷ+=_KfPFTZYn!ƕ/[Q8yYZ!FהCn'?el7+6|._ƒ?-jhkR}ȇDxuJ_2KGɦHU.F~.-^PKTJuO%Q86*׭ӎbKcK7ƯݕݟS"o*vwa^K.ャS*`7?˘U@/v0vv$gCͿ*kSm$yTG|E?/o{sj@wJ^7S2WwBeQC/ǔ s7<\L#~kj{pB8  8~x5Y[z=wxr_˼g!C: #\,'aioSzD{χS`os\%F|Q^ϲw6ejXψMTK~/bBDYxc.^PBanڇWh|iH|6.˝#ol3^mX)_3|?f%jhv玮E9B1j<"眛Ï/`܄n> # =B$"l^˯乡b"\~y[.)u-ϲV:<{X!5'_H\'EߚˋZNX#5~fW7/&²FY&Tym5% 6Z#$B"|N ;{TkO"g6z{6g;DXW0 ]=Ývn^-!X!'IE_KmE:W^\7j4Muٖs՗0o|.%}1dž Rlaso2N3J8vh+q/7#B"s)Ϩ{ox=",Ԑ\bxN耣nK.p^䞻q,:k蚯pe"8z0ؕ0 ;0|_*lXbe;}X{Ƿ?@ȧ7=Ţl-~w?k#|fK|5Hob}FU:`'DEwx㑄Oqxf` k۝"?#Ǿʷ4nѿUwz(a~M"l\aOU=~˯-":ƹĽnJqS h8O$ׇ2ćuuMzZfv`mָK7{M2[nEG~qSp}2"\q*r\C]YW|{TbKhVb٠O*UZpx:tO#/4D8hö#G5iJ)󹔕vc?񼯲IOZLYFa*Z{s5"˿YtZySQ"YxF\#gSJb[շFGy_p\\uҡTv*Y* |,/m2e_C]=gʗYCw_LBFն}vKe\{MY$6ZhO$-3w_ ?LUzC;Ԕ+‹p&3j &pʊ.Ή%͐>FW6k-{Cf^oJSO˦15swOT7R {>5|jNԩ %uvM}ٵ$OAec@:eYe{yp*\DX{Ui(}ٳ\/+=].WW {nsY"T_j/+~+?,kR:uvB}Jݸsp;/QyjE-&N=ѓ"]h?jDX /-T#ʋol:hwu ޛV/˧vWtfTvC ϔGӕts}Ţ87- 7;A_X:n.KT5YKE8zj@Nl"V6>!/X`m}ۿ!/T]w)5= >T6-4eD^jG=Ef썖"~3p/aDMye[qԁd=}Kmt˽S]tcFw6" qEƎRfVWx8n{장"ijBedr sO^fYiؖ8PKmT߾hS>F+q;* \,%`:KFiSW򡶯s`X^YҸߪet ݡF+a?K ""D(""B"""D(""B"""D(""B"""D(""B"""D(""B"""D(""B"""=2o,IENDB`PK iIڱf f OPS/style.css* { text-decoration: none; } .content-item { margin-bottom: 0.5em; margin-left: 0.5em; } h1, h2, h3, h4, h5, h6 { margin-bottom: 0.5em; text-align: left; } h1 { font-weight: normal; margin-top: 0em; } #top-branding { margin: 0 0 1em 0; background-color: #ffffff; } .relations { margin-bottom: 3em; } #document-heading-container { margin-bottom: 4em; } h1.programme-name { margin-top: 0 0 0.5em 0; background-color: #777678; font-size: 1.5em; } h1.programme-name span { margin-left: 0.3em; } #document-information { margin-top: 1em; } div#document-information p { line-height: 0.9em; } .boilerplate { font-size: 0.60em; } #acceditations { margin-top: 1.5em; padding: 0; margin: 0; float: left; } #acceditations div { padding-bottom: 2em; margin: 0; width: 300px; min-height: 100px; float: left; text-align: center; margin-right: 2em; } #acceditations div img { max-width:100%; height:auto; float: left; } #document-url { font-size: 0.85em; } p.copyright { margin-top: 2em; } div.logo { float: right; margin: 0 0 .3em 1em; } div.his-logo, div.information-standard-logo { text-align: right; margin: .3em 0 .3em 1em; clear: both; } div.p, p, ul, ol { line-height: 1.3; text-align: left; } ul ul, ol ul, ul ol, ol ol { margin-top: 0.4em; text-align: left; } a { color: #000000; text-decoration: underline; font-weight: bold; } small, sub, sup { font-size: .7em!important; } sub { vertical-align: sub; line-height: 1em; } sup { vertical-align: super; line-height: 1em; } sup a { font-size: .9em!important; text-decoration:none; } strong { font-weight: bold; } em { font-style: italic; } .spanmeasure { font-weight: bold; } p.numbered-paragraph { text-indent: 0em; } span.paragraph-number { font-weight: bold; } .indented { text-indent: 1em; } .strikethrough { text-decoration: line-through; } .nomargin { margin: 0; } p, div.p { text-indent: 0em; line-height: 1.5em; margin: 0 0 0.5em 0; text-align: left; } .listitem { text-indent: 0em; line-height:1.5em; margin: 0 0 0.5em 0; text-align: left; } .listitem ul { /* margin-top: 0.5em; */ } a.footnote[href]::after { content: normal; } div.mediaobject table { border:0; } div.mediaobject table td { border: 0; } div.mediaobject img { } div.callout { margin-bottom: 1.5em; } div.callout p.heading1 { font-size: 1.75em; font-weight: bold; } div.callout p.heading2 { font-size: 1.5em; } div.callout p.heading3 { font-size: 1.17em; } div.callout p.heading4 { font-size: 1.17em; font-style: italic; } div.callout1 { background-color: #f3f2f2; border:1px solid #d7d6d6; padding: 10px 20px; } div.callout p, div.callout p.heading1, div.callout p.heading2, div.callout p.heading3, div.callout p.heading4 { margin-bottom: 15px; color: #000000; } div.callout2 p, div.callout2 p.heading1, div.callout2 p.heading2, div.callout2 p.heading3, div.callout2 p.heading4, div.callout2 li.listitem { color: #a09f9f; } PK iIO $$OPS/images/advice.pngPNG  IHDR+im3PLTE???ߟ___OOOooo///؀IDATx^r8`Z@#IRΤRAOjmxz.d yv5Y^q^6o /FZU%2a楎`~RĥE|Dg. !{e a٢oP Rۡ %,kjvk^;}A*:r|hj@|FAWo JpXfSK#LA6|'y| }: :LС Gt3࿹VcYpXܐcC7S=I7|!UO`M?O@uнHZ稃3̖aM3G8`W9 218,nAwCfHL-"u1J>\-Њ o<;_`k CD`^m4Q>"/:"JH i^8ʮ<B488:dp$@z=c:c-iCFG78S# pOk7Ӟ|hyAB{A9٠V_,lA`v%VPr[$ (:.t[<ԉY)8ą> NX`>ԁP9g($VQF4 @<.;h0*n :y鱠Z`2ӘD͛58%{upW?]mF3uA\57'NLRu,JBmƬ}8#߹oyiIVGsTPC|:0tqP!l(Vgd49R4:I"'YҧǂA]>x>۟[9 8Oam+qc;0.qY%0cAw`52hG8LswmP1U/N͕=VnP2ʲ°{fCDpQg^7*rd˛yx,ٺSR1a%"a6m/b""l*/eAHxvACMõÿpA^;zEFQlNqQ/?f)IENDB`PK iIkEOPS/images/guidance.pngPNG  IHDR-3PLTE???___oooOOO///2IDATx^k `fkۨ٦'O"Vn >9VC%?M0 f;&U6\#'TĊ=BK1""3YD*Z4?$eQ7uc `!hh$ $ؚs}d_8Y+4k<H_%d$г o/'lj rˉTKFBŇtRՠZOI᩺IbA @ݤ$ eyDw"ITG e+2MuE]$Ya D%N8H:H$LzHpR1mؾDw&v, G[*ƻHZDM|HK"$y2 $1BNrx`}'$ fA1e$YX"7MFc>T P :zeR&;ILq[vBPU"/+/;Hp$JQwE&j8C(I}ORt%"NqB/}oPezzqH!т""ir t+6vH4-kgHZOf9rq cmL_Khif$C qywe]t$X~.gu|X m|azc' {'b1_(`h}]?>3^"!iS" 2%!IQ!)AOmz5@RJ R?>&ئȹc @bգL%/H'ɲM =B$ $:H:L$^w$2N7$}&USoA9:މy; dKB"O /[V~$1Jj)A>~/OC$}Ʒ# ]D׸cx%yb-㢮Mw#Ӽ!R)*"tVJRu(Q$!8~CBEH;nkDmIENDB`PK iIƩ99OPS/images/guideline.pngPNG  IHDR-h 3PLTE???___///oooOOO IDATx^ks: `K_R d}1/OC#3j*)u`t4rT@ʓX+蹥/EìebYh~9RZ%ъI8O:E;^j|NOJᴅץRR D'cQY:E{_,Q╅Zba\kNX m)9,p]w0RNJJfQv'lihYX7T,Jj8qkQ|Ex6B$JEtfp5A{ZQ)S!Iq_kM1SOf ]#") BXRG2Y8ܡ-+CDom6RS)fSIn%Xx”eil*ߵ/-*t("EhAR o2BƅE#-.f+;Bq ^~Z=]5Zr.|XFT-Jщ^R7𳨫0O"!Z͓;=ʂFHw)Z,!a +;jnZ8ۧgqZΔ:RΒ/ZTQWE6 zA?> ]OSE 1f ±GBkrż-(ʻI8f ՂVJ7Y,f'Vu;W-gIiSE tomPI-uB=Zc%vo{(EdZ^'lմY g,΂Fvg`qqĂǾNzJ[ ku۬Z8JvZ^aa*-Rd a,H,򎅡x!Vԃ5vt6Yd]-;h61~ _ҳ|B$B (TpzU[͊da(M%mRe! .,7qu y? Oq)VQ'!G9-d,'aA/s8g!LaIk 'xB1  G%f eOʴťƢDq0}Ђ[pr9 EztWv$j# -vݕ>a!q KSaw<"v9kE䈈2:ĀIdBn/Z,`v ,aΞ( yv p/,anq4SϱnB/XhG5>"U[f--fݓ~nm'a~#*zn\ܲ WI ""JFc-(4 ᾝ[ƑDT_f(p63v.IENDB`PK iI-OPS/images/ifp.pngPNG  IHDRR3axIDATxq<A$DB$\    p%DB$\ 7K6_[hefΞy#a ÂY/"m'1q#lf5I%d?co]*4=hQur,`*r]hknp2nHn 2٦ٺب`7~>f2+Y:V3ٲJlW3RW^ =%OIUHI\'UiU鈩x>MZvOIMM+YU*j%/iV A&YK?,$KdA U$ZH,6׫w<3QSR>Te9OSU'E?73L;FБ"x IY"phgiIX13!Hh>G2Co',AEOc0du} Aw3[~J=#LPɊIe)&4 ɠNDΤ#O ٯ/~4҃>AcY?Jܲr_IӒ4RYIA'#I׿u\yyҊExk@)OԒVoIߥoHGR-Y0TNMS-l*otAR^$eM,G^Rf̍?ZylA&&i>UG|ϑ!{F13a.ZhV}#iX<_p]9W~(ctޥKJ6ixš{i^|'>ζI{@mR%{=F|ҁ\OH;*W5ime+֚ܔk ))[H]{Lw};/$ns~daR3̹ 1i\[a^&]_ϼ@Zq 5t [Ǘr)kF>)+tH)JJ)wŨO?\g{wl5%%%%~QmIENDB`PK iI/OPS/images/standard.pngPNG  IHDR,f7IDATxq* H$DH@0$̻'vJIZͻw~HZof[RIt7yֻpoqw$2Fj1EFJke u['u@{qWgŗ nRp#mhAF-nDlsI,41RkL=La;~zM6*QԓwJlwI56+)h%E8BIzi K̼l2?$M]+yM(Ah\;h@^>$Hv+g΀aן2l]K#ކ]|{xXK@Q0+׆tۓdQ?,JjaZ 5u",'}:Wۡ#dBQq,}ohYĕ4?~&5jIj#uM*]=!'GHsfW-in, 5(߫9 ~(v{$hhh!ҁGkJOHC{nv@XT7IAQ軺aP  JS_hxMyBJ'y 5,Iwzv^^rjH۽Ց(~iնصuTv9=H#u}Ҷ?0@=ȜH(i0odx@SҰr_V[aRfi=y&)6&9}yThTǃĐ~x1>kMTjhg+Q$wcv$RÄLKwWʇTËZ䯆wD#}RMDD35; :IENDB`PK iI$fH6T6TOPS/coverpage.pngPNG  IHDRX psRGBgAMA a pHYsodSIDATx^O%I7_A;-NK}go0YhiZd.ȀJ+tT. 2h%"F1BH+hD@G* "sѯkenݞ sss3wg!kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !7/_)"W|!.A0:!%CF D<apG A!C"]08atBģK Axt !.A0:!%CF D<apG A!C"]08atBģK Axt !.A0:!%CF D<aph~?ϵGJ08at&}(EgY3i?F[Jz͛7F(Ʋ_}T@Uˡfc)A0:aJq#e5ק5G( 7| 1 65>߂q2bVRK Aؤ&qS4<ӴڈB S¬Lu1i l A\«{Ϟmr6܆Az{ݹapM^߼y2.AIסjaeI Ad\Z> J嫬ra6ȌapMV5ч$PjƲapMV5o8߼y7vCN:WL.* ;=[IyGp,A0:aS]⛅ ¶ ůB}t,) A 7 o/K(7yO K08at&PfA63l K08at&[P7[so,_|JLaD{I Adkwe7 E ½$CF lrAM>qzzH%A0:a˂PS6Ag)%3p/ !,oڍYx ,4Xl1w|W6 !,Ͽx^BMêngWZJ} !,ʡ?i=L7==EVxav5!C6YB(WAx\GAapM^ B9G$ ! B\B%jdVx^!C6Y݃PdWIa!C6YF Q{v+ <ֳ5!C6:u܈q h+YUn*1d,.& * Aɦ |oot4+Fp/ !l B6 `[$ A U0etß% AA(˟Xm­AapM. B%Mflmo,{I A 2 By3;޽/|K^!C68/< v*6BլO}WYz !,P*BR"H%(7B紲O/A0:a+PQInAgS-|t ,%CF lreʏwfbV$ AA(/ҕPnUWG ½$CF lr 7 R12ƿM%A0:a[a«|wK=P!C6YxU) 5Oޜ=yV؝kW *8VݡJyF Ȩld>5$A0:a!B%Jfe2'iR+ߘS ʘܝV+=H Axt !.A0:!%CF D<apG A!C"]08atBģK Axt !.A0:!%CF D<apG A!C"]08atBģK Axt !.A0:!%CF D<apG A!C"]08atBģK Axt !.A0:!%CF D<apG A!C"]08atBģK Axt !.A0:!%CF D<apG A!C"]08atBģK Ai$Ȼw}]$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7!H Ai$AD08atM#q@ !CnB ApwH0apFA$CF 4 "A0:8 a !w7x?oI "A0:ؔg|/^\e$H Ai$CGV}*a !w7Fϳ]7oR- H Ai$V7|>20apFb^ʪ-ʰ  !Cn/fuָ4a !w7"޼y3\L5!H Ai$э]V^J6B ApwH7YmZ!nTmX᝹`So\Bg9vJlH5lap =kj+϶ p m\!'$A*A$A0:Ԕ<UCYF74m: pۏOVP͂0+ceix˶!s -+dexٍB}Tf1w+cu l7#_T-m< +A0: B{kOĕl"+0pod]59q$S6+ap\5ٜ(iQ$_Ě=#Y7ˉ^m[aeےfUWG ѹjfo,e7(OyY(oue9:? +f? nYvSNUH. J:|1X!C6 T08at2>4=FyzDnY&R %V-ɶ;N/ D 5Z(@%KL08atk^Qtk-]fW&A8pu4NMdņf/;Q+9 NǺW;8N㫐#Y,K εPo c;s8.@-c$VL6rZgDVxnIV.bqP{FYXӫ1_ϛ/] A0:7B7&,M*{xqzYB:brVA8Z6HFV>s|$+5fa/ sθx0-: }t-J. ANLBfV͹\Ӗ&AMCRaKqf-)[6JNiuM. m*{bw}wi} hMki:Z+/f9_|T0Ҷgv_~N~ꅭ1N/|cu_믿۴tAxΪMZ_}Zn}(kzy銢g=˚q3}fs5^A[y~mb>Pm @oA(5}שWFC?ڟ/\m6nH*JLzV3aOWg=J~f[z/\g <TRCF_aVVsS/6wӬkAxzŸ|oߦn&.RpAW떯]Oӆ,g sĺwٸM5A`i <]jjC6BE&n kꊁ; &V~nYofc;ɗ AxB?I-^VV}&z~g϶zr1jf*ԈtO}HCc!6"Yjөp|3*3k}TPbe0VT~^25VEtTF<깨:|Wc6  <0֎A9͌v5?G,_Úk>M~A*)Q7 }!9ѝٲLZsYe74CËt~˪3t\Pco ɂP}٭LZBճ8 :o֥qT07U@ڷ#tx[#,!8qAXKu˞W%^l\_I(زj _ȽW5H=8k.{Zz[_;bJu?nt'UXp]'c] :0 < o=O1ivzuDm7ͪ*;~[k_u![򃝚˞lOo_>k:ZW)/?gdA e)XN8f]wbRg7ׂCQYU :&yg4Ayy[Vjj/ZX^lk}aSk]K}, 15㷯߽S%ߚ7rdYZ?:qw vTV <p/0+Nk.%k׸mjч! NAxBM6]/nq ukkɓ[a&8 [_׿307TqP˗/߾}57_zRYp|3y~S[iY0n|o]ꆾpw!ep4u5`?ULJ <=a닢F딺?`6'O*_V,~MႸ-|a>!@AG@k,2sEuJ+ϳ&uZ湿o1#n OAx BY_l5hA;<׋2F -6\ū}T%M t_MYeOct'4owYސSꥴ _ֿ=h!ps,TfXL*]oZ Ax BPhM֟ lQ z/ݱ5nr@¾g ԌԦ/c}nܳF-M u[P׿Y%H AxNO>}B'6tѦM3Eӫj4J^YUs6 qP97DR[ԝڸn+Am6x]ke=Na!@ L\ -4h lz=Z5U.29 :.5};f~:kg.<+_VWivցBpٵ_s l:~k͚ j++ hyg_n|g \F5i~/Z񻖿Z|-!AHOg ]nUY; `KДOrv<`Z Ax4f䃟,V{n~Ⱦ Mt&5 khf矤̕1r+.VDQXpw?BCp >2#:+}"߿o۶Aش Z;MoUn7eT7 +ip?Woo-iOM f5M VBp%p?'b۷e5nM^t-ZfdSjO[Wno6 <z"َTyv'22Tϲ{S)?eߵ|TW Y%^m=&)Tտ"UB3@G_35>Վ:ӕ6a;ImmM uiK4}x/! A M˜TqJ*믿Vz-{!tlS~O+Y WG͚/0% [:ɓ/o^(z{Py t lz'Tb}6?6QZp{KO[ÕM3@n?V([pڐB=K|r/e.H\]W^ֿhAWp;x3@n&^ 'pV,18UKg_3Ap[458.P[%?e_p޾}UxBps4% KV@O~S/ Ax%4n9曋ܳ_MnM[A,ͳ+I/, x7n>{],D < rkxtn+}Ys= w^q>_V޿ɓl~O֠5Q: 6g %Y>fR_q@Ս6"<_?= oϷ~kRT)jCaSrItܮ|gWizp }~࣒ZW(5a=f˗/Cu"dP/ݔjV)* `3yutwwgUyVj=skl+=yDK>DuK s©aojw !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kB !kBKDDn%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%C'˯w/ ++?{0?'+X?WZEm=mRڿlsa ?}nzUZU%.nBγ>uהcJr+,SQym!0͝hrљT!*ĭTt5]3Kwm+!"cUoͼq^*_]bSTm-A&3^e{(m< BV4r*?~9ۜy ̶XOԚ+2[n :mw/6mNvZY;'._y L{$^?d=Re5jxzrjw}94cǗF-դck](ԇ2[n WV~=/6χ8\d7zvN.\kO;B]re, ,COM'U*϶tZ=E B|XNv!k^o~W{  ,ţOMUSP^i5 6݇8\lS7Zɕ'vhR;[=x o+? ԟWt̐E5k>J8y}ƒz Mo+? T5P6(P5i{EMQ&|Ew̖ܵ=eh?r f3iյ mE{K}{U \X fkTؖK/i?wY6?bj _oXM7SVҶ+mDc{[bnQ5`e-45Lcj5 jsXz Z?>wst"[NfV;$fM&͵)ƶӍͤÒ g!6[?6nS=Ͱ6MV`F'#U~¸.6gT ' -iшq7؈Xz}LFhs'\* >.&lc/vx 2 gcm\Dϐ2>ԫ-6C ڄh[ԄesΰTf%}T؞6 rA5W0 mVSV7|a^XgӮo խ-1ۊ6[Wz *`WRlURӍ-؁mӿX_KlSj? z!Y =ǀ:͗fKxx{BG|Vդ:R Iu@\D]]f4itHa\8|޼NVoGzo4ç|( -Abè0r Mҧq}{^9lk0hK`{8L=5n.o FO.֯B.tde|q), Foa~xgچ5 [3{үo_ QދlG<{%cr\҇wa$sf~o4| Y'[)1\>GZׇc^U3_cx5cK€#uEt&b?y ϟL? *i،Mlnq^ B)6!%PrkvM3}6?. BLV..MA(P:Ǖ^/}X}K26ֵ\ZRxL[mINІlsFUf묷B{axdN"vXЏl±#u`etfW~ΫjC*:OL뾘$ܛg/Ze7B\mB%cٓ [k;6q zṽ<>ކfVC|Sk?lRZ^P?S-{ 0y-* O/sz]Ѭ61lکڢ͒ wV&E;n?] {Or)R`S7$6۶^?BɎak[U S޵lk`| BbWb%hY~&61,VRٙh_^mc\1-j,싎m;}=j0td^wۗ9p͎d1&=2 =/|ǽOYKzf?޼,2<|ȺQ{M-W BY2!>֏+㯆՚f\oc}˖g|29惥O9M~x/׊%-0kBߢG6j*Rb A6z%^B/9|Xo1s yZkȼU\[mg}j-Ծhg}_7C+S~h/|sZmy' 5XHooT˽܈ ݖu/Ǐhuߐ*>";\}D[>=5mTA(50iFPӏ+sp*F̮O9|vz VN9oya ܧbSϳs&{ޟ,)ux_Qntj| WQZ֥ڴ={K$0?޲ >"=N~L?j=j֞.;OMV"{X>&w|/r8sqT5C#Chr2Qgx57O9Ӭ?l}fG2-q/7pcf6]4]Wy6ħyXu<}fkX_?$6{MNRhH~9AjvJZLZG^y6Ǐ$K̖6Z9ܵ] PB sG^~7ǎ6ps97?~\̂ڗf~0(N'M_PUVƗ\pްg-Q|M]봹+a{|,\ s蚜sف% {L"Z2XRM'#3{ʵ + Ǐ@> gbͮ Zy' BYiWb%+W? GeW6]vPccq{5lrٹn]+_#g_a{.MZՙ-w}ođ~Q/Kl}Ha_\.Ēn ӳÅs`}кaζUvEA(DՐGC~a{=jnG}WH;/rVa;U15'=6b\خ_vi\l23[\O[!A/ߗ u]%l6kX]o `jiZl[eZO_A㗭GC mj M2f6g+pڄ-bڰܷ}AvMB9Gly.V2xs)(Tj4uEa:.~ә<4Y+fh轰vVC]0kB=ÅCBLÚ-wڸ=ó@pmZqeM2T֒xgzz^*/_޻yY@fZ4^y\5R('lɰa^FdRmn;dԞviώAeu/-+ $k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDDZ DDĮ%k BDD IENDB`PK iI[^^OPS/chapter1.htm 1 Guidance

1 Guidance

1.1 Current evidence on the safety and efficacy of complete cytoreduction for pseudomyxoma peritonei does not appear adequate for this procedure to be used in the NHS outside centres funded by the National Specialist Commissioning Advisory Group (NSCAG).

1.2 Clinicians wishing to undertake complete cytoreduction for pseudomyxoma peritonei should take the following action.

  • Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. Use of the Institute's information for the public is recommended.
  • Audit and review clinical outcomes of all patients having complete cytoreduction for pseudomyxoma peritonei.

1.3 Publication of safety and efficacy outcomes will be useful in reducing the current uncertainty. The Institute may review the procedure upon publication of further evidence.

1.4 These recommendations apply only to the use of this technique to treat pseudomyxoma peritonei. The Institute will consider complete cytoreduction for peritoneal carcinomatosis separately.

PK iI 0m¦OPS/chapter2.htm 2 The procedure

2 The procedure

2.1 Indications

2.1.1 Pseudomyxoma peritonei is a rare, borderline malignant, slowly progressing tumour. It arises from the appendix or bowel and spreads throughout the peritoneal cavity, producing a large amount of mucus. Most patients will develop symptoms due to the bulk of the tumour. Most patients will eventually die of this condition, but they often survive for several years.

2.1.2 Standard treatment for pseudomyxoma peritonei is surgical debulking, in which the surgeon attempts to remove as much tumour as possible. Chemotherapy is also used. Recurrence is common, and therefore repeated debulking operations may be needed.

2.1.3 Patients with pseudomyxoma peritonei may be treated by 'watchful waiting', using surgery only when unacceptable symptoms or life-threatening complications, such as intestinal obstruction, arise.

2.2 Outline of the procedure

2.2.1 The Sugarbaker technique combines complete surgical tumour removal (complete cytoreduction) with intraoperative heated chemotherapy, and is followed by postoperative intraperitoneal chemotherapy. The operation takes around 10 hours and includes:

  • removal of the right hemicolon, spleen, gallbladder, greater omentum and lesser omentum
  • stripping of the peritoneum from the pelvis and diaphragm
  • stripping of the tumour from the surface of the liver
  • removal of the uterus and ovaries in women
  • removal of the rectum in some cases.

2.3 Efficacy

2.3.1 No controlled studies were found. The studies were of poor quality. One study of 385 patients showed 5-year survival to be 86% for those with less malignant pathology (adenomucinosis) and 50% for those with more malignant pathology (mucinous adenocarcinoma). However, not all patients in this study were followed up for 5 years, and it is not clear how survival was calculated. Another study showed overall 5-year survival to be around 74% in 98 out of 321 patients who underwent repeat cytoreductive surgery. For more details, refer to the Sources of evidence section.

2.3.2 The Specialist Advisors commented that there is international controversy about the effectiveness of this procedure, given the slow natural history of pseudomyxoma peritonei. One Advisor noted that uncertainty about efficacy emanates from the difficulty in accurately diagnosing pseudomyxoma peritonei preoperatively.

2.4 Safety

2.4.1 In a study of 46 patients the main complications included: prolonged gastric paresis (almost all patients); neutropenia (49%); re-operation for postoperative complications (24%); stomach or bowel perforation (22%); enteric fistula (13%); and peripheral pressure neuropathy (11%). Most studies, however, were of poor quality with regard to safety outcomes. For more details, refer to the Sources of evidence section.

2.4.2 The Specialist Advisors listed the potential complications as: death; major blood loss; respiratory infection; peritonitis; bowel perforation; obstruction; adhesions; wound dehiscence; and wound infection. One Advisor commented that such prolonged surgery increased the risk of morbidity and mortality.

2.5 Other comments

2.5.1 It was noted that the procedure has a considerable risk of serious side effects, and that efficacy is not clearly established.

2.5.2 The procedure needs to be evaluated in comparison with less radical surgery.

Andrew Dillon
Chief Executive
April 2004

PK iI:]]OPS/chapter3.htm 3 Further information

3 Further information

Sources of evidence

The evidence considered by the Interventional Procedures Advisory Committee is described in the following document.

'Interventional procedure overview of complete cytoreduction (Sugarbaker technique) in patients with pseudomyxoma peritonei', October 2002.

Information for patients

NICE has produced information on this procedure for patients and carers. It explains the nature of the procedure and the guidance issued by NICE, and has been written with patient consent in mind.

PK iID))OPS/chapter4.htm 4 Changes since publication

4 Changes since publication

As part of NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. This guidance therefore remains current.

28 January 2012: minor maintenance.

PK iIҩ**OPS/chapter5.htm 5 About this guidance

5 About this guidance

NICE interventional procedure guidance makes recommendations on the safety and efficacy of the procedure. It does not cover whether or not the NHS should fund a procedure. Funding decisions are taken by local NHS bodies after considering the clinical effectiveness of the procedure and whether it represents value for money for the NHS. It is for healthcare professionals and people using the NHS in England, Wales, Scotland and Northern Ireland, and is endorsed by Healthcare Improvement Scotland for implementation by NHSScotland.

This guidance was developed using the NICE interventional procedure guidance process.

We have produced a summary of this guidance for patients and carers. Information about the evidence it is based on is also available.

Your responsibility

This guidance represents the views of NICE and was arrived at after careful consideration of the available evidence. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of healthcare professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.

Copyright

© National Institute for Health and Clinical Excellence 2004. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.

Contact NICE

National Institute for Health and Clinical Excellence
Level 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT

www.nice.org.uk
nice@nice.org.uk
0845 033 7780

Endorsing organisation

This guidance has been endorsed by Healthcare Improvement Scotland.

PK iI: : OPS/content.opf Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) NICE Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) en NICE None PK iI>QQ OPS/toc.ncx Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) Contents 1 Guidance 2 The procedure 3 Further information 4 Changes since publication 5 About this guidance PK iI5Z/OPS/titlepage.htm Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique) (IPG56)

Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique)

Interventional procedures guidance

Published: 28 April 2004

nice.org.uk/guidance/ipg56

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

PK iIIddOPS/contents.htm Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique)

Contents

PK3 iIoa,mimetypePK3 iIj:META-INF/container.xmlPK3 iI9oOPS/coverpage.htmPK3 iIv<&44cOPS/coverpageAdvice.pngPK3 iIqnm-m-i8OPS/coverpageDefault.pngPK3 iIŞ?0?0 fOPS/coverpageGuidance.pngPK3 iI//OPS/coverpageGuideline.pngPK3 iIn66(OPS/coverpageInformationForThePublic.pngPK3 iIA H6H6OPS/coverpageStandard.pngPK3 iIڱf f R4OPS/style.cssPK3 iIO $$AOPS/images/advice.pngPK3 iIkE:IOPS/images/guidance.pngPK3 iIƩ99POPS/images/guideline.pngPK3 iI-VOPS/images/ifp.pngPK3 iI/]OPS/images/standard.pngPK3 iI$fH6T6TeOPS/coverpage.pngPK3 iI[^^OPS/chapter1.htmPK3 iI 0m¦OPS/chapter2.htmPK3 iI:]]~OPS/chapter3.htmPK3 iID)) OPS/chapter4.htmPK3 iIҩ**`OPS/chapter5.htmPK3 iI: : OPS/content.opfPK3 iI>QQ OPS/toc.ncxPK3 iI5Z/OPS/titlepage.htmPK3 iIIdd[ OPS/contents.htmPKf