x 00 UNITED STATES AIR FORCE ARMSTRONG LABORATORY TESTING AND EVALUATION OF THE l-stat BLOOD GAS ANALYZER AL-CF-BR-TR Douglas S.

Transcription

1 AL-CF-BR-TR UNITED STATES AIR FRCE ARMSTRNG LABRATRY TESTING AND EVALUATIN F THE l-stat BLD GAS ANALYZER Duglas S. Twnsend CREW SYSTEMS DIRECTRATE CREW TECHNLGY DIVISIN 2504 Gillingham Drive, Suite 25 Brks Air Frce Base TX May 1998 x 00 Apprved fr public release; distributin is unlimited. RPRCIBD B DTIC QUALITY INSPEUT^

2 NTICES This final technical reprt was submitted by persnnel f the Systems Research Branch, Crew Technlgy Divisin, Air Frce Research Labratry, AFMC, Brks Air Frce Base, Texas, under jb rder This reprt was prepared as an accunt f wrk spnsred by an agency f the United States Gvernment. Neither the United States Gvernment nr any agency theref, nr any f their emplyees, nr any f their cntractrs, subcntractrs, r their emplyees, makes any warranty, expressed r implied, r assumes any legal liability r respnsibility fr the accuracy, cmpleteness, r usefulness f any infrmatin, apparatus, prduct, r prcess disclsed, r represents that its use wuld nt infringe privately wned rights. Reference herein t any specific cmmercial prduct, prcess, r service by trade name, trademark, manufacturer, r therwise, des nt necessarily cnstitute r imply its endrsement, recmmendatin, r favring by the United States Gvernment r any agency, cntractr, r subcntractr theref. The views and pinins f the authrs expressed herein d nt necessarily state r reflect thse f the United States Gvernment r any agency, cntractr, r subcntractr theref. When Gvernment drawings, specificatins, r ther data are used fr any purpse ther than in cnnectin with a definitely Gvernment-related prcurement, the United States Gvernment incurs n respnsibility r any bligatin whatsever. The fact that the Gvernment may have frmulated r in any way supplied the said drawings, specificatins, r ther data, is nt t be regarded by implicatin, r therwise in any manner cnstrued, as licensing the hlder r any ther persn r crpratin; r as cnveying any rights r permissin t manufacture, use r sell any patented inventin that may in any way be related theret. The ffice f Public Affairs has reviewed this reprt, and it is releasable t the Natinal Technical Infrmatin Service, where it will be available t the general public, including freign natinals. This reprt has been reviewed and is apprved fr publicatin. Gvernment agencies and their cntractrs registered with Defense Technical Infrmatin Center (DTIC) shuld direct requests fr cpies t: Defense Technical Infrmatin Center, 8725 Jhn J. Kingman Rd., STE 0944, Ft. Belvir, VA Nn-Gvernment agencies may purchase cpies f this reprt frm: Natinal Technical Infrmatin Services (NTIS), 5285 Prt Ryal Rad, Springfield, VA ,^^^\ "^ V.^LL JAMES C. SYLVESTER, Majr, USAF, NC RGER L. STRK, Clnel, USAF, BSC Chief, Aermedical Research Chief, Crew Technlgy Divisin

3 REPRT DCUMENTATIN PAGE Frm Apprved MB N Public reprting burden fr this cllectin f infrmatin is e»tim»ted t average 1 hur per respnse, including the time fr reviewing instructins, searching existing data surces, gathering and maintaining the data needed, and cmpleting and reviewing the cllectin f infrmatin. Send cmments regarding this burden estimate r any ther aspect f this cllectin f infrmatin, including suggestins fr reducing this burden, t Washingtn Headquarters Services, Directrate fr Infrmatin peratins and Reprts, 1216 Jeffersn Davis Highway, Suite 1204, Arlingtn, VA , and t the ffice f Management and Budget, Paperwrk Reductin Prject ( ), Washingtn, DC AGENCY USE NLY (Leave blank) 2. REPRT DATE 3. REPRT TYPE AND DATES CVERED 4. TITLE AND SUBTITLE MAY 98 Final, July FUNDING NUMBERS Testing and Evaluatin f the i-stat Bld Gas Analyzer 6. AUTHR(S) Duglas S.Twnsend 7. PERFRMING RGANIZATIN NAME(S) AND ADDRESS(ES) PE: 62202F PR: 7184 TA: 56 WU: PERFRMING RGANIZATIN REPRT NUMBER Systems Research Branch 2504 Gillingham Dr. STE 25 Brks AFB TX SPNSRING/MNITRING AGENCY NAME(S) AND ADDRESS(ES) Air Frce Research Labratry (AFMC) Human Effectiveness Directrate Flight Stress Prtectin Divisin 2504 Gillingham Dr. STE 25 Brks AFB TX SUPPLEMENTARY NTES 10. SPNSRING/MNITRING AGENCY REPRT NUMBER AL-CF-BR-TR a. DISTRIBUTIN AVAILABILITY STATEMENT 12b. DISTRIBUTIN CDE Apprved fr public release; distributin unlimited. 13. ABSTRACT (Maximum 200 wrds) The i-stat, Inc., Bld Gas Analyzer is a prtable hand-held unit designed t analyze and prvide data n human bld, e.g., chemistries and bld gases. The unit use cartridges and a very small amunt f bld t analyze varius parameters in the bld depending upn the cartridge being used. The unit runs n tw 9v lithium batteries and weighs unces, and is 2.52 in. W. X 8.26 in. L. X 2.05 in. D. 14. SUBJECT TERMS i-stat aircraft istat apprved istat airwrthy 17. SECURITY CLASSIFICATIN F REPRT UNCLASSIFIED medical equipment aermedical bld gas 18. SECURITY CLASSIFICATIN F THIS PAGE UNCLASSIFIED li analyzer bld gas analyzer bld 19. SECURITY CLASSIFICATIN F ABSTRACT UNCLASSIFIED 15. NUMBER F PAGES PRICE CDE 20. LIMITATIN F ABSTRACT UL Standard Frm 298 (Rev. 2-89) (EG) Prescribed by ANSI Std Designed using Perfrm Pr, WHS/DIR, ct 84

4 TABLE F CNTENTS BACKGRUND ; 1 DESCRIPTIN 1 PRCEDURES 2 INITIAL INSPECTIN AND TEST PREPARATIN 3 TEST SETUP 3 PERFRMANCE CHECK 4 VIBRATIN 5 ELECTRMAGNETIC CMPATIBILITY 7 THERMAL/HUMIDITY ENVIRNMENTAL CNDITINS 7 HYPBARIC CNDITINS 9 AIRBRNE PERFRMANCE 9 EVALUATIN RESULTS 10 INITIAL INSPECTIN 10 VIBRATIN 10 ELECTRMAGNETIC CMPATIBILITY.. 10 THERMAL/HUMIDITY ENVIRNMENTAL CNDITINS 10 HYPBARIC CNDITINS 11 AIRBRNE PERFRMANCE 11 SUMMARY 11 REFERENCES 12 APPENDIX 13 LIST F FIGURES Figure 1. i-stat Bld Gas Analyzer 2 Figure 2. Test Setup 3 Figure 3. Vibratin Table Munting 4 Figure 4. Aermedical Research Vibratin Curves 6 in

5 ACKNWLEDGMENTS I wuld like t thank thse wh helped and prvided advice during the evaluatin f the i-stat Bld Gas Analyzer System. I wuld particularly like t thank: Lt. Cl. Jacqueline Hale Mr. Edward W. Hade MSgt. Butch Blake TSgt. Allen Jnes IV

6 TESTING AND EVALUATIN F THE i-stat BLD GAS ANALYZER BACKGRUND Representatives f Wilfrd Hall USAF Medical Center requested Aermedical Research t evaluate and certify the i-stat Bld Gas Analyzer fr use n bard USAF aermedical evacuatin aircraft. The i-stat Bld Gas Analyzer system cnsists f the bld gas analyzer, an electrnic simulatr, an infrared data transfer system, cartridges that perfrm different types f analysis (see page 15), and an infrared printer. The i-stat bld gas analyzer and fö 6+, EC 8+, 6+, and EG 7+ cartridges were the nly parts tested during this prcedure. DESCRIPTIN The i-stat unit uses cartridges and a very small amunt f bld t analyze varius parameters in the bld depending upn the cartridge being used. The unit runs n tw 9v lithium batteries. The unit has a sleep mde that is initiated autmatically t save the batteries. The unit has a liquid crystal display, a numeric keypad with additinal keys fr clear(clr), enter(ent), print(prt), *, display(dis), and arrw up and arrw dwn. The fllwing infrmatin defines the general specificatins f the i-stat Bld Gas Analyzer. Size: Width 6.41 cm (2.52 in), Length cm (8.26 in), Depth 5.21 cm (2.05 in). Weight: 520 grams (18.34 unces).

7 Figure 1. i-stat Bld Gas Analyzer PRCEDURES Test methds and perfrmance criteria were derived frm military standards (1-3, 8 & 9), natinally recgnized perfrmance guidelines (4 & 7), and manufacturer's literature (5). The Aermedical Research Prcedures Guide describes additinal safety and human interface issues t be cnsidered during equipment testing (6). A test setup and perfrmance check were develped specifically fr this prduct t verify prper functining f the equipment under varius test cnditins. Unless therwise nted all testing is cnducted and mnitred by Aermedical Research persnnel assigned t the Systems Research Branch (CFTS), Crew Technlgy Divisin, Armstrng Labratry, Brks AFB, TX. The device was subjected t varius labratry and in-flight tests t bserve and evaluate its perfrmance under anticipated peratinal cnditins. 1. Initial Inspectin

8 2. Vibratin 3. Electrmagnetic interference (EMI) 4. Thermal/Humidity Envirnmental Cnditins, encmpassing: a. Ht peratin b. Cld peratin c. Humidity peratin d. Ht Strage e. Cld Strage 5. Hypbaric Cnditins a. Cabin Pressure/Altitude b. Rapid Decmpressin t Ambient Pressure 6. Airbrne Perfrmance INITIAL INSPECTIN AND TEST PREPARATIN a. The i-stat Bld Gas Analyzer was inspected fr quality f wrkmanship, prductin techniques, and pssible damage incurred during shipment. b. The i-stat Bld Gas Analyzer was checked t ensure it met basic requirements fr gd human factrs design as utlined in Mil STD 1472 (3). c. A test setup and perfrmance check were develped t evaluate the i-stat Bld Gas Analyzer peratin in accrdance with manufacturer/custmer specificatins thrughut the varius testing cnditins. TEST SETUP The i-stat Bld Gas Analyzer was first tested with the electrnic simulatr. After this test was cmplete the unit was tested using EC 8+ and 6+ cartridges (see page 15) with level 1 and level 3 cntrls prvided by i-stat fr testing f the unit. The cntrls are used t test prper peratin f the unit. A list f test values is prvide by the cmpany t be cmpared with the readings frm the unit t check fr prper peratin.

9 istat A A * 0 CLR ENT PRT DIS Figure 2. Test Setup PERFRMANCE CHECK A cartridge was filled using ne f the level cntrls. The cartridge was inserted int the unit and when the values were displayed they were cmpared t the values listed n the infrmatin prvided with the level cntrls.

10 VIBRATIN Vibratin testing is critical t determine "the resistance f equipment t vibratinal stresses expected in its shipment and applicatin envirnments" (2). Testing was cnducted n a Unhltz-Dickey Crpratin Vibratin Test System, amplifier mdel SA30 and shaker mdel R16W. This testing invlved a set f peratinal tests perfrmed alng each f the i-stat Bld Gas Analyzer's three axes - X, Y, and Z, with the unit munted n the NAT litter segment. (Figure 3). The unit was subjected t vibratin curves with reduced levels that are derived frm Mil STD 81E, Categry 10, Figures and (Figure 4). Figure 3. Vibratin Table Munting

11 03 s a M Helicpter j^*r Prpeller Aircraft <n m -c c! 1 N^ m Frequency Hz Sinusidal Vibratin Test Curve 500 M CM * J045 Jet Aircraft v> c 03 Q 9 J Grms Minimum Cmpsite G -' 03. J CJ Frequency Hz Randm Vibratin Test Curve Figure 4. Aermedical Research Vibratin Curves

12 ELECTRMAGNETIC CMPATIBILITY Electrmagnetic cmpatibility testing is a primary cncern n USAF aermedical evacuatin aircraft. Ensuring the safety f everyne n bard is the driving factr in assessing the effects f electrmagnetic emissins emitted by medical devices n aircraft navigatin and cmmunicatin equipment. Medical devices may als be susceptible t EMI fields generated by the aircraft equipment r ther medical devices. The i-stat Bld Gas Analyzer was evaluated fr cmpliance with Mil STD 461D (1). WL/AASW Wright Pattersn AFB perfrmed the evaluatin in their electrmagnetic cmpatibility facility. ASC/ENAI, Wright-Pattersn AFB, evaluated the electrmagnetic emissins data and determined the airwrthiness f the medical device. Specific tests cnducted were as fllws: a. Radiated Emissins (RE-102), "Radiated Emissins, Electric Field, 10 khz t 18 GHz.": Fr Air Frce aircraft applicatins, radiated emissins were tested in a narrwer range f frequencies frm 2 MHz -1 GHz. This test measured the amunt f EMI emitted by the system under test during its peratin. b. Radiated Susceptibility (RS-103), "Radiated Susceptibility, Electric Field, 10 khz t 40 GHz.": Fr Air Frce aircraft applicatins, radiated susceptibility was tested in a narrwer frequency range frm 30 MHz GHz at the fllwing field strength levels: 20 V/M belw 1 GHz and 60 V/M abve 1 GHz (field strength values frm Table IV, categry Aircraft Internal, f 461D). This test measured the resistance f the system under test t set levels f EMI generated by antennas bth internal and external t the aircraft. THERMAL/HUMIDITY ENVIRNMENTAL CNDITINS Extreme temperature and humidity testing is critical t determine if aermedical equipment can be stred and perated during severe envirnmental cnditins "withut experiencing physical damage r deteriratin in perfrmance" (2). Extreme envirnmental cnditins can have detrimental effects n medical equipment including, but nt limited t: changes in material characteristics and size, pssible verheating, changes in electrnic cmpnent characteristics, and electrnic r mechanical failures due t rapid water r frst frmatin. Testing was cnducted in the Armstrng Labratry research chambers perated and mnitred by chamber peratins persnnel assigned t the Systems Research Branch (CFTS) f the Crew Technlgy Divisin at Armstrng Labratry, Brks AFB, Tx. The i-stat Bld Gas Analyzer was placed in the center f the envirnmental chamber. The manufacturer states in their literature that the unit will perate in a temperature range f C. This range may change slightly with each sftware update. A decisin was made t mdify the nrmal thermal and humidity test since the

13 manufacturer states in the literature that the unit will nt functin utside f its nrmal perating range. a. Humidity: 94 +/- 4% RH, /- 2 C (85 +/- 3.6 F) fr 4 hurs The chamber was set t the nted RH and temperature and the unit (at rm temperature) was placed inside the chamber. After ten minutes the unit displayed "analyzer errr cde 92". The unit was remved frm the chamber and required 22 minutes at rm temperature befre it wuld recver and functin prperly. The chamber was reset t 65% RH and 23 C and the unit was placed int the chamber. The unit perated ne hur withut any prblems. The humidity level was increased t 70% and the unit perated fr 45 minutes with n prblems. The humidity was increased t 75% and after 45 minutes the unit displayed "Fail see manual". The unit was remved frm the chamber and after five minutes at rm temperature the unit functined nrmally. b. Ht peratin: 49 +/- 2 C (120 +/- 3.6 F) fr 2 hurs The chamber was set t the nted cnditins and the unit (at rm temp) was placed inside the chamber. After ten minutes the unit displayed 33.8 C and an errr message. The unit was pulled frm the chamber and allwed t cl dwn at rm temperature. When the temperature value displayed by the unit reached 29.5 C the unit began t functin nrmally. c. Cld peratin: 0 +/- 2 C (32 +/- 7.2 F) fr 2 hurs The chamber was started at 16 C. The unit was at rm temperature when placed in the chamber. The unit required 2.5 hurs t cl t 16 C at the 16 C chamber temperature. The chamber temperature was lwered t 0 C and when the unit displayed a temperature f 15.8 C the unit display indicated "ready t use" but when a cartridge was inserted a message f "temperature ut f range" was displayed. d. Ht Strage: 60 +/-2 C (140 +/-3.6 F) fr 6 hurs The unit was tested at the nted temperature and time. A pre test was dne and the values were crrect fr the level cntrl used. The unit tk ne hur t return t its peratinal range after being remved frm the chamber. A pst test was dne and all values were crrect except fr GLU which displayed "***". e. Cld Strage: -40 +/- 2 C (-40 +/- 3.6 F) fr 6 hurs The unit was tested at the nted temperature and time. A pre test was dne and the values were crrect fr the level cntrl used. The unit tk ne hur t return t its peratinal range after being remved frm the chamber. The unit displayed a lw battery message initially but then cleared itself. A pst test was run and the values were crrect fr the level cntrl used.

14 HYPBARIC CNDITINS Testing was cnducted in the Armstrng Labratry research chambers perated and mnitred by chamber peratin persnnel assigned t the Systems Research Branch (CFTS) f the Crew Technlgy Divisin at Armstrng Labratry, Brks AFB, Tx. a. Cabin Pressure/Altitude: Altitude testing is critical fr aermedical evacuatin equipment due t the ptential effects f barmetric pressure changes n the equipment. A majrity f the aircraft, which are characterized as pprtune aircraft available fr use in aermedical evacuatin, pressurize their cabin atmsphere t barmetric pressures equivalent t 8,000-10,000 feet abve sea level. The differences in pressures can be critical t the effective peratin f sme medical equipment. Altitude testing cnsisted f perating the i-stat Bld Gas Analyzer while ascending frm grund level t 10,000 ft (maintaining altitude fr ne hur) and then descending back t grund at rates f 5,000 ft/min, while stpping at 2,000 ft increments t allw fr perfrmance checks. b. Rapid Decmpressin Testing: Rapid decmpressins are caused by the lss f aircraft cabin pressurizatin and subsequent pressure equalizatin with ambient atmspheric pressure. It is imprtant t determine hw medical equipment will functin during and after such a decmpressin t ensure that it will nt endanger a patient, the aircraft persnnel, r the aircraft itself. The i-stat Bld Gas Analyzer perated inside the rapid decmpressin test chamber as the chamber was pressurized t an equivalent altitude f 8,000 ft (2,430 meters). Then, the chamber altitude was brught t 45,000 ft (13,716 meters) ver a perid f 60 secnds, held at 45,000 ft fr a few minutes, and then returned t grund level at a rate f 10,000-12,000 ft/min. This sequence was repeated fr the seven secnd and ne secnd perid. AIRBRNE PERFRMANCE Airbrne perfrmance evaluatins are a cst-effective and invaluable means f validating a piece f equipment's clinical and peratinal suitability under actual perating cnditins. By carefully evaluating medical equipment in the actual peratinal envirnment, Aermedical Research ensures that all pertinent patient care issues are adequately addressed by the test prtcls. Ensuring safe and reliable peratin f this medical device is the primary gal f the in-flight evaluatin and frms the basis fr subsequent recmmendatins t the users. This phase f testing was cnducted by an aircraft-qualified aermedical research technician n bard a C-9 aermedical evacuatin missin. The i-stat Bld Gas Analyzer was carried by the Aermedical Research technician and tested using the cntrl fluid. Human factrs characteristics, securing methds, and equipment setup times and lcatin were als evaluated.

15 EVALUATIN RESULTS INITIAL INSPECTIN Initial inspectin revealed n manufacturing defects. The unit perfrmed t the manufacturer's specificatin. Since the unit has an all plastic case n electrical safety tests were dne. VIBRATIN During initial vibratin testing the ica reading appeared t be inaccurate. In later testing this did nt seem t reccur. ELECTRMAGNETIC CMPATIBILITY The i-stat Bld Gas Analyzer met all limits fr emissins and susceptibility testing. ASC/ENAI Wright-Pattersn AFB certified that the emissins frm the unit were within limits and the system was acceptable fr use during all phases f flight n all Air Frce aircraft THERMAL/HUMIDITY ENVIRNMENTAL CNDITINS The nrmal testing parameters were changed due t the cmpany literature cncerning the unit perating range. The cmpany stated clearly in their literature and manuals that the unit wuld nly perate ver a temperature range f 20 F. The nrmal thermal/humidity tests were mdified t test whether the unit wuld stp functining at the temperature/humidity specified by the cmpany. The unit perfrmed exactly as the cmpany said it wuld ver the temperature/humidity range Special attentin shuld be given t the Thermal/Humidity parameters and the results encuntered. The test parameters and the results are in the Prcedures sectin, subsectin Thermal/Humidity. The i-stat Bld Gas Analyzer perated satisfactrily during all five phases f testing. 10

16 HYPBARIC CNDITINS 1. Cabin pressure/altitude: N prblems were nted. 2. Rapid Decmpressin: The cartridges used leaked cntrl fluid int the unit causing a malfunctin during the sixty secnd perid test. Test f the cartridges alne shwed that there was uncntrlled fluid flw in the cartridges and rupturing f the cartridge membrane. The cartridges will nt survive a rapid decmpressin. Testing cntinued using the backup i-stat and the simulatr. N prblems were nted with the unit. After several days f drying ut, the riginal unit began t functin again. AIRBRNE PERFRMANCE The in-flight evaluatin f the i-stat Bld Gas Analyzer was perfrmed n a C-9 aermedical evacuatin missin. There were n prblems nted. SUMMARY Aermedical Research fund the i-stat Bld Gas Analyzer t be cnditinally acceptable fr use n all U.S. Air Frce aermedical evacuatin aircraft during all phases f flight. The requirement that the perating temperature be within a very narrw range will present sme prblems but many hspitals have fund ways t vercme this limitatin, such as string the unit in Igl ice chest r placing the i-stat inside f the flight suits wrn by medical persnnel. The perating range limitatin is a restrictin fund n all bld gas analyzers evaluated by this rganizatin. The failure f the filled cartridge t survive rapid decmpressin is nt cnsidered serius. The i- STAT and empty cartridges will survive rapid cmpressin. 11

17 REFERENCES 1. Mil-STD 461D T Electrmagnetic Emissin and Susceptibility Requirements fr the Cntrl f Electrmagnetic Interference. 2. Mil-STD 81E. Envirnmental Test Methds and Engineering Guidelines. 3. Mil-STD 1472, Human Engineering Design Criteria fr Military Systems. 4. Emergency Care Research Institute (ECRI). 5. i-stat Bld Gas Analyzer, peratr's Manuals. 6. Aermedical Research Prcedures Guide. Internal perating Instructin, Systems Research Branch, Armstrng Labratry. 7. Natinal Fire Prtectin Agency (NFPA) 99, Health Care Facilities Cde. 8. AFI 41-2Q3 T Electrical Shck Hazards. 9. AFI Equipment Management in Hspitals. 12

18 APPENDIX MANUFACTURER'S SPECIFICATINS F THE i-stat BLD GAS ANALYZER SPECIFICATINS General Size Weight Pwer Envirnmental CALIBRATIN MEMRY/CLCK BACKUP PWER: Width 6.41 cm (2.52 in), Length cm (8.26 in), Depth 5.21 cm (2.05 in) 520 grams (18.34 unces) Tw 9v lithium batteries Temperature (perating) C (64-86 F) perating temperature range may change with sftware updates. (Transprt) C ( F) Relative Humidity 0-65% (minimum) nncndensing Factry (electrnic, mechanical, thermal, pressure) Internal lithium battery DISPLAYS. INDICATRS. & KEYS Display CLR DIS ENT PRT up/dwn arrws Dt matrix supertwist liquid crystal Clear entry Recall display after blanking Enter inputs utput data t Infra-red link Select areas f display t activate Keys 0-9 numeric keys, * 13

19 EXPECTED VALUES Test(Measured) Units Reprtable Ranae Reference Ranae Sdium/Na mml/l Ptassium/K mml/l Chlride/CI mml/l ph (arterial) PC0 2 mmhg (arterial) P0 2 mmhg (arterial) Inized Calcium/iCa mml/l Urea Nitrgen/BUN mg/dl Urea mml/l Glucse/GLU mg/dl Glucse/GLU mml/l Hematcrit/Hct %PCV Test (Calculated) Units Reprtable Ranae Reference Ranae Hemglbin/Hb g/dl TC0 2 mml/l HC0 3 mml/l BEecf mml/l N/A (-2) - (+3) Anin Gap mml/l -10) + (+99) sqa % N/A CMMUNICATINS LINK infrared light-emitting dide. BATTERY Type Indicatr 9v Lithium (2), user replaceable. L BATT indicatin n display. 14

20 c 8 E.l + 3 C.8 c ^5 w c ^ ÜSE c n. x c ja ) E X c r Ü in c Ü c Äip Q.Ü 13 c D. -2 C C c S " x c ;=: c 5 r t CM g>8 c d c 2 Li ; "i e c + LU + T3 2 w C C C 3 C Q. E. -g C r E X 2 C <D la a> E X C C m n s: ü Z *. ti C 3-2 r 55 E F C g>g t C T- r C T- r ü 03 <.3 55 x JS c a. UJ a.. * c a). c -2 - P. «= - * C.» r -pö n» C C r> 'S ü 'S Q 00 f- c Cd * c r C CM * c la T E X CM C " ' CN C CN * + Ü LU " C s 7K a. -tiis-ix t ^ C + t 3 -a.2 w = T =5 52 j is "E c Hi- C Ü a. C C C T <D _ D.-fe2 Z c 5? = 5 * r CM c r LTD x-8 Q. a. c X 1*8 x {8 C c S3 c Ü c n C Ü CQ r- X & ö * if * 10 'T m -2 CQ X P. UJ F C - c x UJ - E < * r- c c r Ü 0)8 C c CM C CM 0)0 T C L Em?! X t a c > a 4-1 J2 3 Ü C 15