Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice

Front cover......Page 1
Half title page......Page 2
Evolve page......Page 3
Cardiovascular and Pulmonary Physical Therapy......Page 4
Copyright page......Page 5
Contributors......Page 6
Preface......Page 8
Acknowledgments......Page 10
Table of Contents......Page 12
I Cardiovascular and Pulmonary Function in Health and Disease......Page 14
What Is Health?......Page 15
Lifestyle-Related Conditions......Page 17
Life Cycle and Lifestyle-Related Conditions......Page 18
Addressing the Health Care Priorities  of the Day......Page 19
Our Village......Page 20
Ischemic Heart Disease......Page 21
Smoking-Related Conditions......Page 22
Hypertension and Stroke......Page 23
Obesity......Page 24
Psychological Health......Page 25
Why Physical Therapists Need to Understand and Advocate Optimal Nutrition......Page 26
Why Physical Therapists Need to Understand Exercise in the Context of Population Health......Page 27
Why Physical Therapists Need to Understand Ethnic and Cultural Differences......Page 29
Physical Therapists as Drivers of Change  in Health Behaviors......Page 30
Knowledge into Action......Page 32
Refocusing and Expanding the Clinical Repertoire of Physical Therapists......Page 33
Every Patient Is a Case Study......Page 34
Physical Therapy’s Role: Participation in Population-Wide Health Initiatives......Page 36
Implications of Epidemiology and Health Care Trends for Physical Therapy Professional Education......Page 37
References......Page 38
Key Terms......Page 45
Energy Transfer and Cellular Oxidation......Page 46
Muscle Contraction and Metabolism......Page 48
Oxygen Content of the Blood......Page 50
Oxygen Debt......Page 51
Quality and Quantity of Blood......Page 52
Step Two: Airways......Page 53
Step Six: Myocardial Function......Page 54
Step Nine: Return of Partially Desaturated Blood and CO2 to the Lungs......Page 55
Summary......Page 56
References......Page 57
Sternum......Page 58
Movements of the Thorax......Page 59
Diaphragm......Page 60
Sternocleidomastoid......Page 61
Erector Spinae......Page 62
Internal Intercostals......Page 63
Pharynx......Page 64
Trachea......Page 66
Surface Markings......Page 69
Heart......Page 70
Heart Valves......Page 72
Innervation......Page 74
Systemic Circulation......Page 75
Review Questions......Page 76
References......Page 77
Phases of Systole and Diastole......Page 78
Heart Sounds......Page 79
Transport of Oxygen......Page 80
Perfusion......Page 81
Ventilation and Perfusion Matching......Page 82
Control of Breathing......Page 83
Medullary and Pontine Respiratory  Centers......Page 84
Cough Reflex......Page 85
Mechanical Factors in Breathing......Page 86
Pressure-Volume Relationships......Page 87
Airway Resistance......Page 88
References......Page 89
Key Terms......Page 90
Hypercholesterolemia......Page 91
Angina Pectoris......Page 92
Myocardial Infarction......Page 93
Heart Failure......Page 94
Congestive Heart Failure......Page 95
Chronic Heart Failure......Page 96
Athletic Heart Syndrome......Page 97
Chronic Bronchitis......Page 98
Emphysema......Page 99
Asthma......Page 102
Bronchiectasis......Page 104
Prognosis of Bronchiectasis......Page 105
Diffuse Interstitial Pulmonary Fibrosis......Page 106
Eosinophilic Granuloma......Page 107
Sarcoidosis......Page 108
Tuberculosis......Page 109
Syncope......Page 110
Acknowledgment......Page 111
References......Page 112
Key Terms......Page 116
Cardiovascular Conditions......Page 117
Musculoskeletal Conditions......Page 118
Dysfunction of the Central  Nervous System......Page 119
Gastrointestinal Conditions......Page 121
Renal Conditions......Page 122
Endocrine Conditions......Page 123
Nutritional Disorders......Page 124
References......Page 125
II Cardiovascular and Pulmonary Physical Therapy: Assessment......Page 127
Characteristics of Measurements and Outcomes......Page 128
Interval......Page 129
Validity......Page 130
Selecting Tests and Measures......Page 131
Examination......Page 132
Evaluation and Interpretation of Findings......Page 133
Intervention......Page 134
Guidelines for Content  and Organization......Page 135
References......Page 136
The Interview......Page 138
Prior Treatment......Page 139
Dyspnea......Page 140
Dyspnea on Exertion......Page 141
Paroxysmal Nocturnal Dyspnea......Page 143
Cough......Page 144
Pulmonary Hypertension......Page 146
Fatigue and Weakness......Page 147
References......Page 148
Key Terms......Page 150
Respiration: Effect of Anatomical and Physiological Dead Space......Page 151
Flow Volume Curve......Page 152
Diagnosis of Restrictive and Obstructive Lung Disease......Page 153
References......Page 155
Key Terms......Page 156
Normal Blood Gas Values......Page 157
Hemoglobin......Page 158
Potential Causes of Error in Arterial Blood Gas Sampling......Page 159
Barometric Pressure Can  Affect Oxygenation......Page 160
Transcutaneous Carbon Dioxide......Page 161
References......Page 162
Key Terms......Page 164
Initial Evaluation......Page 165
Bony Skeleton......Page 166
Heart Size......Page 167
Computed Tomography......Page 168
Positron Emission Tomography Scan......Page 169
References......Page 170
Key Terms......Page 171
Cardiac Action Potential......Page 172
Conduction System......Page 173
Determination of Heart Rate......Page 174
Supraventricular Dysrhythmias......Page 176
Ventricular Dysrhythmias......Page 180
Myocardial Ischemia or Infarction......Page 183
Summary......Page 185
Case Study 2......Page 186
References......Page 187
Rationale for Multisystem Assessment......Page 188
Peripheral Vascular Function......Page 189
Pancreatic Function and Insulin Production......Page 191
Summary......Page 192
References......Page 193
Key Terms......Page 194
Physics of Nuclear Imaging......Page 195
First-Pass and Gated Equilibrium Scans......Page 196
Myocardial Perfusion Imaging......Page 197
Thallium-201......Page 198
Fluorine-18-Fluorodeoxyglucose......Page 199
Gallium Scintigraphy......Page 200
Cardiac Imaging......Page 201
Measurements Derived from Echocardiography......Page 203
Myocardial Contrast Echocardiography......Page 205
Magnetic Resonance Imaging......Page 206
Tests to Evaluate Myocardial Viability......Page 207
References......Page 208
Key Terms......Page 211
Patient/Family Interview......Page 212
Topographic Anatomic Landmarks......Page 213
Jugular Venous Distention......Page 215
Breathing Patterns......Page 216
Technique......Page 217
Breath Sounds......Page 218
Voice Sounds......Page 219
Gallops......Page 220
Palpation......Page 221
Tactile Fremitus......Page 222
Case Study 15-1......Page 223
Case Study 15-2......Page 224
Review Questions......Page 225
References......Page 226
Key Terms......Page 227
Fluid and Electrolyte Balance......Page 228
Chest Tube Drainage and Fluid Collection Systems......Page 230
Blood Gases......Page 231
Hypercapnia......Page 232
Hemodynamic Monitoring......Page 233
Pulmonary Artery Balloon Flotation Catheter......Page 234
Intracranial Pressure Monitoring......Page 236
Neuromuscular Assessment......Page 237
Summary......Page 238
References......Page 239
III Cardiovascular and Pulmonary Physical Therapy: Interventions......Page 241
Key Terms......Page 242
Activity......Page 243
Structure and Function......Page 244
What Is the Problem?......Page 245
Restricted Mobility and Recumbency......Page 246
Practice Patterns......Page 249
Clinical Decision Making......Page 250
What Is the Course of Intervention?......Page 251
Summary......Page 253
References......Page 255
Key Terms......Page 257
Versus......Page 258
Oxygen Transport and Metabolic  Demand of Patients......Page 259
Cellular Energetics in Response to Acute Mobilization and Exercise......Page 260
Effects of Mobilization and Exercise on Oxygen Transport......Page 262
Preventive Effects of Exercise......Page 263
Prescription of Prehabilitation Exercise......Page 264
Physiological Effects of Bed Rest......Page 265
Musculoskeletal Effects......Page 266
Alternatives to the Nonspecific Use  of Bed Rest......Page 267
Physiology of Acute Exercise......Page 268
Musculoskeletal Effects......Page 269
Prescribing Exercise and Mobilization......Page 270
Mobilization Testing for Progression......Page 273
Prescription of a Mobilization Stimulus......Page 274
The Mobilization Session......Page 275
Monitoring in the Mobilization Session......Page 276
Adaptation to an Acute  Mobilization Stimulus......Page 278
Cardiovascular and Pulmonary Effects......Page 279
Metabolic Effects......Page 280
References......Page 281
Pre-exercise Test Evaluation......Page 286
Pre-exercise Screening for Minimizing Cardiovascular Risk During Testing......Page 287
Exercise Testing......Page 288
Contraindications to Exercise Testing......Page 289
Standardization of Exercise Tests and General Procedures......Page 290
Evaluative Submaximal Exercise Tests......Page 293
Maximal Exercise Testing......Page 295
General Testing Considerations......Page 296
Monitoring......Page 297
Time and Frequency......Page 298
Exercise Training to Improve Tasks  or Performance......Page 300
Recovery and Overtraining......Page 301
Monitoring......Page 302
References......Page 303
Key Terms......Page 306
Prescriptive Versus Routine  Body Positioning......Page 307
Physiological Effects of Various Body Positions......Page 308
Upright Positions......Page 309
Supine Position......Page 312
Side-Lying Positions......Page 314
Prone Position......Page 315
Prescription of Therapeutic  Body Positions and Body  Position Changes......Page 316
Monitoring Responses to a Body Position or Position Changes......Page 318
References......Page 319
Key Terms......Page 322
Asthma......Page 323
Treatment with Exercise......Page 324
Contraindications and Precautions for Manual and Mechanical Airway Clearance Techniques......Page 325
Treatment with Postural Drainage......Page 326
Advantages and Disadvantages  of Postural Drainage......Page 327
Percussion......Page 328
Preparation for Percussion......Page 329
Vibration and Shaking......Page 330
Manual Hyperinflation......Page 331
Active Cycle of Breathing Technique......Page 332
Preparation for Active Cycle  of Breathing Technique......Page 333
Autogenic Drainage......Page 334
Treatment with Autogenic Drainage......Page 335
Advantages and Disadvantages  of Autogenic Drainage......Page 336
Positive Expiratory Pressure......Page 337
Preparation for Positive Expiratory Pressure......Page 338
Treatment with Positive Expiratory Pressure......Page 339
High-Frequency Chest Wall Oscillation......Page 340
Treatment with High-Frequency Chest  Wall Oscillation......Page 341
Treatment with Intrapulmonary  Percussive Ventilation......Page 342
Factors Affecting Selection of Airway Clearance Techniques......Page 343
Availability......Page 344
Lifestyle......Page 345
Review Questions......Page 346
References......Page 347
Key Terms......Page 350
Cough Pump......Page 351
Stages of Cough......Page 352
Stage 3: Building-Up of Intrathoracic  and Intraabdominal Pressure......Page 353
Patients with Neuromuscular Weakness  or Paralysis......Page 354
Costophrenic Assist......Page 355
Anterior Chest Compression Assist......Page 356
Counter-Rotation Assist......Page 357
Prone-on-Elbows, Head-Flexion  Self-Assisted Cough......Page 358
Short-Sitting Self-Assisted Cough......Page 359
Hands-Knees, Rocking Self-Assisted Cough......Page 360
CoughAssist Machine......Page 361
References......Page 363
Key Terms......Page 365
Positioning Concerns......Page 366
Inspiration......Page 368
Rolling......Page 369
Facilitating a Controlled Diaphragmatic Breathing Pattern......Page 370
Relationship of the Diaphragm  and Posture......Page 372
Repatterning Technique......Page 373
Procedure for Teaching  Controlled Diaphragmatic Breathing (Scoop Technique)......Page 374
Upper Chest Inhibition......Page 375
Normal Timing......Page 376
Mobilizing the Thorax......Page 378
Pectoralis Facilitation......Page 379
Inhibition of the Diaphragm......Page 380
Serratus Push-Up......Page 381
Reducing Respiratory Rates......Page 382
Butterfly Technique......Page 383
Glossopharyngeal Breathing......Page 384
Enhancing Vocalization Skills......Page 386
Verbal Techniques......Page 387
References......Page 388
Key Terms......Page 390
Cardiac and Pulmonary Rehabilitation: Evidence Base, Efficacy, and Practicalities......Page 391
Patients with Chronic Cardiac Dysfunction: Exercise Responses......Page 393
Individuals with Chronic Cardiac Dysfunction and Failure......Page 394
Individuals after Heart Transplantation......Page 397
Individuals with Hypertension......Page 398
Individuals with Chronic Obstructive  Lung Disease......Page 399
Individuals with Primary  Pulmonary Hypertension......Page 400
Definition, Purpose, Goals, and Outcomes......Page 401
Assessment......Page 404
Goals: Long Term......Page 405
Phases......Page 406
Risk Reduction......Page 407
Monitoring......Page 409
Exercise Training......Page 410
Physical Activity and Exercise:  Special Considerations......Page 412
Exercise Training......Page 413
Review Questions......Page 414
References......Page 415
Key Terms......Page 422
Individuals with  Musculoskeletal Conditions......Page 423
Stroke......Page 424
Spinal Cord Injury......Page 425
Down Syndrome......Page 426
Individuals with Renal Conditions......Page 427
Individuals with Cancer......Page 428
Summary......Page 429
References......Page 430
Respiratory Muscle Strength Testing......Page 432
Respiratory Muscle Endurance Testing......Page 433
Inspiratory Muscle Training......Page 434
Respiratory Muscle Training  in Health......Page 435
Asthma......Page 436
Neurological and Neuromuscular Disease......Page 437
Weaning Failure......Page 438
References......Page 439
What Are Complementary Therapies?......Page 444
Herbal Approaches......Page 445
Mind/Body Link......Page 446
The Problem of Scientific Evidence......Page 447
Tai Chi......Page 448
Manual Therapies/Body Work Therapies......Page 449
Energy Work Interventions......Page 450
Hypertension......Page 452
Cardiovascular Conditions......Page 454
Coronary Artery Disease......Page 455
Congestive Heart Failure......Page 458
Patients in the Coronary Care Unit......Page 459
Asthma......Page 461
Chronic Obstructive Pulmonary Diseases......Page 463
Lung Cancer......Page 464
References......Page 465
Defining Patient Education......Page 470
Learning Theory: Concepts Pertinent  to Cardiopulmonary Patient Education......Page 471
Tools......Page 472
Health Literacy......Page 473
Formulation and Prioritization of Goals......Page 474
Advantages and Disadvantages......Page 476
Determination of Effectiveness......Page 477
Communication......Page 478
Interprofessional Considerations and Resources......Page 479
References......Page 480
Bibliography......Page 481
IV Cardiovascular and Pulmonary Physical Therapy: Acute Conditions......Page 482
Key Terms......Page 483
Principles of Physical Therapy Management......Page 484
Principles of Physical Therapy Management......Page 485
Principles of Physical Therapy Management......Page 486
Pathophysiology and Medical Management......Page 487
Principles of Physical Therapy Management......Page 488
Principles Of Physical Therapy Management......Page 489
Bacterial Pneumonia......Page 490
Principles of Physical  Therapy Management......Page 491
Pathophysiology and Medical Management......Page 492
Pathophysiology and Medical Management......Page 494
Principles of Physical Therapy Management......Page 495
Principles of Physical Therapy Management......Page 496
Pathophysiology and Medical Management......Page 497
Pathophysiology and Medical Management......Page 498
References......Page 499
Key Terms......Page 501
Surgery and Its Cardiovascular  and Pulmonary Consequences......Page 502
Anesthesia and Supplemental Oxygen......Page 503
Pharmacological Considerations......Page 504
Preoperative Assessment And Preparation For Surgery......Page 505
Goals......Page 507
Rationale......Page 509
Thoracic Surgery......Page 510
Cardiovascular Surgery......Page 511
Review Questions......Page 512
References......Page 513
V Cardiovascular and Pulmonary Physical Therapy: Chronic Conditions......Page 514
Key Terms......Page 515
Principles of Physical Therapy Management......Page 516
Pathophysiology and Medical Management......Page 517
Principles of Physical Therapy Management......Page 518
Principles of Physical Therapy Management......Page 519
Pathophysiology and Medical Management......Page 520
Principles of Physical Therapy Management......Page 521
Principles of Physical Therapy Management......Page 522
Pathophysiology and Medical Management......Page 523
Principles of Physical Therapy Management......Page 524
Pathophysiology and Medical Management......Page 525
Principles of Physical Therapy Management......Page 526
Pathophysiology and Medical Management......Page 527
Principles of Physical Therapy Management......Page 528
Principles of Physical Therapy Management......Page 529
Pathophysiology and Medical Management......Page 530
Pathophysiology and Medical Management......Page 531
Principles of Physical Therapy Management......Page 532
References......Page 533
Key Terms......Page 535
Primary Interventions......Page 536
Patient Monitoring......Page 537
Pathophysiology and Medical Management......Page 538
Patient Monitoring......Page 539
Pathophysiology and Medical Management......Page 540
Ventilatory Strategies......Page 541
Exercise......Page 542
Goals of Long-Term Management......Page 543
Ventilatory Strategies......Page 544
Goals of Long-Term Management......Page 545
Exercise......Page 546
Patient Monitoring......Page 547
Pathophysiology and Medical Management......Page 548
Patient Monitoring......Page 549
Exercise......Page 550
Pathophysiology and Medical Management......Page 551
Pathophysiology and  Medical Management......Page 552
Pathophysiology and Medical Management......Page 553
References......Page 554
VI Cardiovascular and Pulmonary Physical Therapy: Intensive Care......Page 556
Key Terms......Page 557
Goals and General Basis  of Management......Page 558
Restricted Mobility and Recumbency......Page 559
Maximizing Function......Page 560
Prophylaxis......Page 561
Monitoring......Page 562
Pharmacological Agents......Page 563
Breathing and Coughing Maneuvers......Page 564
Bagging or Manual Hyperinflation......Page 565
Special Noninvasive Intensive Care Unit Priorities and Considerations......Page 566
The Patient as a Person......Page 567
Principles of Physical Therapy Management......Page 568
References......Page 569
Pathophysiology and  Medical Management......Page 571
Pathophysiology and Medical Management......Page 572
Mobilization: Special Considerations......Page 574
Body Positioning: Special Considerations......Page 577
Pathophysiology and  Medical Management......Page 578
Principles of Physical  Therapy Management......Page 579
Principles of Physical  Therapy Management......Page 580
Principles of Physical  Therapy Management......Page 581
References......Page 583
Pathophysiology and  Medical Management......Page 585
Principles of Physical  Therapy Management......Page 586
Principles of Physical  Therapy Management......Page 587
Pathophysiology and  Medical Management......Page 588
Multiple Fractures......Page 589
Pathophysiology and  Medical Management......Page 590
Principles of Physical  Therapy Management......Page 591
Principles of Physical  Therapy Management......Page 592
Pathophysiology and  Medical Management......Page 593
Principles of Physical  Therapy Management......Page 594
References......Page 595
Key Terms......Page 597
Pulmonary Dysfunction......Page 598
Myocardial Dysfunction......Page 599
Hypoxemia......Page 600
Pulmonary Embolism and Deep  Vein Thrombosis......Page 601
Acute Lung Injury and Acute Respiratory Distress Syndrome......Page 602
Principles of Physical Therapy Management......Page 604
Shock......Page 605
Sepsis and Multiorgan System Failure......Page 606
Principles of Physical Therapy Management......Page 607
References......Page 608
VII Cardiovascular and Pulmonary Physical Therapy: Special Cases......Page 612
Key Terms......Page 613
Newborn Respiration......Page 614
Cardiac Diagnoses......Page 615
Pulmonary Diagnoses......Page 616
Bronchopulmonary Dysplasia......Page 617
Asthma......Page 618
Cystic Fibrosis......Page 619
Cerebral Palsy......Page 620
Down Syndrome......Page 621
Miscellaneous Conditions......Page 622
Positional Rotation......Page 623
Postural Drainage......Page 625
Chest Percussion and Vibration......Page 626
CPT for Children......Page 629
Pediatric Pulmonary Rehabilitation......Page 630
Therapeutic Handling to Maximize Trunk and Ventilatory Function......Page 631
Summary......Page 632
References......Page 633
Key Terms......Page 638
Cardiac Mechanics......Page 639
Vascular and Autonomic Changes with Aging......Page 640
Structure and Function......Page 641
Responses to Exercise......Page 642
Exercise Training......Page 643
References......Page 644
Key Terms......Page 646
Effects of Gravity on Normal and Abnormal Chest Wall Development......Page 647
Influence of Multisystem Interactions on Motor Performance: Relationship Between Respiratory and Postural Control......Page 650
Structurally Weak, Yet Functionally Strong......Page 651
Positive Pressure Support Instead of More Skeletal Support......Page 652
Vocal Folds and Vocal Apparatus......Page 653
Soda Can Model Summary......Page 654
Paradoxical Breathing......Page 655
Asymmetrical Breathing......Page 656
Case History......Page 657
Impairment Categories......Page 658
Priorities of Interventions......Page 660
Quality of Life......Page 661
Application......Page 662
References......Page 664
Organ Donation......Page 667
Psychological and Social Considerations......Page 668
Surgical and Medical Considerations......Page 669
Lung Transplant and End-Stage  Pulmonary Disease......Page 670
Surgical Implications......Page 671
Lung Transplant Acute Management......Page 672
Rejection......Page 673
Exercise and the Heart Transplant Patient......Page 674
Cardiac and Respiratory Physiology in Lung Transplant......Page 675
Community- or Home-Based Rehabilitation......Page 676
Corticosteroids......Page 677
Bronchiolitis Obliterans......Page 678
References......Page 679
Key Terms......Page 681
Chronic Conditions and Self-Management......Page 682
Long-Term Care Facilities and Nursing Homes......Page 683
Monitoring Cardiovascular and Pulmonary Status in the Long-Term Care Facility......Page 684
Physical Therapy in Home......Page 685
Monitoring Cardiovascular and Pulmonary Status at Home......Page 686
Special Monitoring Considerations for Patients on Oxygen......Page 687
Home Oxygen......Page 688
Support for People in the Home  or Community......Page 690
Summary......Page 691
References......Page 692
VIII Related Aspects of Cardiovascular and Pulmonary Physical Therapy......Page 693
Supine Position......Page 694
Upright Postures......Page 695
Lifting and Moving Dependent Patients......Page 697
Moving Dependent Patients......Page 699
Review Questions......Page 701
References......Page 702
Oxygen Therapy......Page 703
Nasal Cannulas......Page 704
Transtracheal Oxygen Catheter......Page 705
Venturi Mask......Page 706
Portable Oxygen......Page 707
Incentive Spirometry......Page 708
Aerosol Therapy......Page 709
Mechanical Ventilation......Page 710
Invasive Versus Noninvasive  Mechanical Ventilation......Page 711
Alarm Management and Precautions......Page 712
Weaning from Mechanical Ventilation......Page 713
References......Page 714
Complications of Tracheostomy......Page 716
Postoperative Physiological Complications......Page 717
Polyvinyl Chloride (Plastic)  Disposable Tubes......Page 718
Other Airway Devices......Page 719
Suctioning......Page 720
Suction Procedure......Page 721
Sterile Suctioning......Page 722
Extubation/Decannulation......Page 723
References......Page 724
Key Terms......Page 725
Autonomic Pharmacology......Page 726
Phenylephrine and Metaraminol......Page 727
Propranolol......Page 728
Parasympathetic Neurotransmission......Page 729
Anticholinesterase Drugs......Page 730
Atropine......Page 731
Functional Reflex......Page 732
Epinephrine......Page 733
Corticosteroids......Page 734
Drug Inhalation Devices......Page 735
References......Page 736
Appendix A Elements of International Standards for a Cardiac Rehabilitation Program......Page 737
Bibliography......Page 740
Appendix B Elements of International Standards for a Pulmonary Rehabilitation Program......Page 741
Bibliography......Page 744
Appendix C Exercise Testing and Prescription Considerations  for People with Primary Cardiovascular, Pulmonary, and Endocrine Conditions......Page 745
Bibliography......Page 759
Appendix D Exercise Testing and Prescription Considerations  for People with Nonprimary Heart, Lung, and Endocrine Conditions......Page 761
Bibliography......Page 776
Psychotherapies, Hypnosis......Page 777
Feldenkrais Method......Page 778
Reiki......Page 779
Bibliography......Page 780
Glossary......Page 781
A......Page 789
B......Page 794
C......Page 795
D......Page 800
E......Page 801
F......Page 804
H......Page 805
I......Page 807
L......Page 808
M......Page 809
N......Page 812
O......Page 813
P......Page 815
R......Page 822
S......Page 824
T......Page 827
V......Page 831
Z......Page 832