Diagnosing pulmonary embolism: establishing and consolidating the role of spiral CT

Diagnosing pulmonary embolism: establishing and consolidating the

role of spiral CT

Strijen, M. van

Citation

Strijen, M. van. (2007, March 22). Diagnosing pulmonary embolism: establishing and

consolidating the role of spiral CT. Department of Radiology, Leiden University Medical

Center (LUMC), Faculty of Medicine, Leiden University. Retrieved from

https://hdl.handle.net/1887/11452

Version: Corrected Publisher’s Version

License: Licence agreement concerning inclusion of doctoral thesis in the

Institutional Repository of the University of Leiden

Downloaded from: https://hdl.handle.net/1887/11452

Note: To cite this publication please use the final published version (if applicable).

7KHDSSOLFDWLRQRID

'XWFKFRQVHQVXVGLDJQRVWLF

VWUDWHJ\IRUSXOPRQDU\

HPEROLVPLQFOLQLFDOSUDFWLFH

0-/YDQ6WULMHQ

%DVHGRQ

7KHDSSOLFDWLRQRID'XWFKFRQVHQVXVGLDJQRVWLFVWUDWHJ\IRU

SXOPRQDU\HPEROLVPLQFOLQLFDOSUDFWLFH

3-+DJHQ0-/YDQ6WULMHQ*-.LHIW<3*UDDIVPD0+3ULQV

3(3RVWPXV

1HWK-0HG2FW







6XPPDU\

,Q7KH1HWKHUODQGVWKHµ'XWFKFRQVHQVXVVWUDWHJ\¶ZDV

IRUPXODWHGLQDVDGLDJQRVWLFVWUDWHJ\IRUSDWLHQWV

ZLWKVXVSHFWHGSXOPRQDU\HPEROLVP)RXU\HDUVDIWHU

LWVLQWURGXFWLRQWKHDSSOLFDWLRQRIWKLVVWUDWHJ\ZDV

LQYHVWLJDWHG

$TXHVWLRQQDLUHZDVVHQWWRWKHKRVSLWDOPDQDJHPHQWDQG

WKHGHSDUWPHQWVRILQWHUQDOPHGLFLQHDQGSXOPRQRORJ\RI

DOO'XWFKKRVSLWDOVQ ,QWRWDOTXHVWLRQQDLUHV

ZHUHVHQWRXW7KHUHVSRQVHUDWHVRIWKHLQWHUQLVWVDQG

SXOPRQRORJLVWVZHUHDQGUHVSHFWLYHO\7KH

VSHFLDOLVWVUHSRUWHGWRKDYHIROORZHGWKHFRQVHQVXV

VWUDWHJ\LQRIWKHSDWLHQWVVHHQWKHPRQWKSULRUWRWKH

TXHVWLRQQDLUH

+RZHYHUDQDO\VLVRIRQO\WKHUHSRUWHGODVWSDWLHQWZLWK

WKHVXVSLFLRQRISXOPRQDU\HPEROLVPUHYHDOHGWKDWWKH

FRQVHQVXVVWUDWHJ\ZDVIROORZHGLQRIWKHUHSRUWHG

SDWLHQWV%RWKDQRYHUXVHDQGDQXQGHUXVHRI

WKHGLIIHUHQWGLDJQRVWLFIDFLOLWLHVZHUHGRFXPHQWHG

)XUWKHUPRUHDOPRVWDTXDUWHURIWKHSDWLHQWVZHUHWUHDWHG

ZLWKRXWDQDVFHUWDLQHGGLDJQRVLVZKHUHDVZHUHQRW

WUHDWHGGHVSLWHDQLPSURSHUH[FOXVLRQRIYHQRXVWKURPER

HPEROLVP

&RPSDUHGWRDVXUYH\LQWKHXVHRIWKHµ'XWFK

FRQVHQVXVVWUDWHJ\¶KDVQRWLPSURYHGVXEVWDQWLDOO\,Q

RIWKHSDWLHQWVWKHFRQVHQVXVVWUDWHJ\ZDVVWULFWO\

IROORZHGKRZHYHULQRQO\RIWKHSDWLHQWVDSURSHU

GLDJQRVLVZDVPDGH





,QWURGXFWLRQ

7KHDQQXDOLQFLGHQFHRIFOLQLFDOO\VXVSHFWHGSXOPRQDU\HPEROLVPLQ7KH

1HWKHUODQGVLVSHULQKDELWDQWV^,QDSSUR[LPDWHO\RQHWKLUGRIWKHSDWLHQWV

ZLWKVXVSHFWHGSXOPRQDU\HPEROLVPWKHGLDJQRVLVZLOOEHFRQ¿UPHG^$OWKRXJK

UHFHQWGDWDRQFDVHIDWDOLW\RIXQWUHDWHGSXOPRQDU\HPEROLVPDUHQRWDYDLODEOH

WKLVUDWHKDVEHHQUHSRUWHGWREHFRQVLGHUDEOHDQGWKHUHIRUHWUHDWPHQWLVJHQHUDOO\

FRQVLGHUHGLQGLFDWHG^,QWKHPDMRULW\RIFDVHVWUHDWPHQWZLWKDQWLFRDJXODQWVLV

ZHOOWROHUDWHG6WLOOWKLVWUHDWPHQWLVDVVRFLDWHGZLWKVXEVWDQWLDOFRVWVDVZHOODV

PRUELGLW\DQGHYHQPRUWDOLW\GXHWREOHHGLQJ7KHUHIRUHLWLVPDQGDWRU\WRFRQ¿UP

RUH[FOXGHWKHGLDJQRVLVLQSDWLHQWVZLWKFOLQLFDOVXVSLFLRQRISXOPRQDU\HPEROLVP

ZLWKLQDUHDVRQDEOHSHULRG

)RU7KH1HWKHUODQGVDVWDQGDUGLVHGDSSURDFKKDVEHHQIRUPXODWHGLQDFRQVHQVXV

PHHWLQJLQ^7KLVVWUDWHJ\ZDVEDVHGRQOLWHUDWXUHUHSRUWVDYDLODEOHDWWKDW

WLPHDQGLVNQRZQDVWKHµ'XWFKFRQVHQVXVVWUDWHJ\¶$FFRUGLQJWRWKLVVWUDWHJ\

SXOPRQDU\HPEROLVPLVH[FOXGHGLQSDWLHQWVZLWKDQRUPDOSHUIXVLRQVFLQWLJUDSK\

UHVXOWDQGWKHUHIRUHWUHDWPHQWLVQRWLQGLFDWHG2QWKHRWKHUKDQGDKLJKSUREDELOL

W\OXQJVFLQWLJUDSK\UHVXOWFRQ¿UPVWKHGLDJQRVLVRISXOPRQDU\HPEROLVPDQG

MXVWL¿HVWUHDWPHQW,QDOORWKHUSDWLHQWVQRQLQYDVLYHWHVWVIRUGHHSYHLQWKURP

ERVLVHJDQXOWUDVRXQGRIWKHOHJVDQGLIQHJDWLYHSXOPRQDU\DQJLRJUDSK\DUH

LQGLFDWHGWRFRQ¿UPRUH[FOXGHWKHGLDJQRVLVRISXOPRQDU\HPEROLVP

,WZDVFDOFXODWHGWKDWWKLVVWUDWHJ\ZRXOGEHPRUHFRVWHIIHFWLYHWKDQWKH

SUHYLRXVO\XVHGQRQVWDQGDUGLVHGGLDJQRVWLFDSSURDFK,WZDVHVWLPDWHGWKDWIRU

WKHVLWXDWLRQLQ7KH1HWKHUODQGVZLWKDSRSXODWLRQRIPLOOLRQVZLWFKLQJWRWKLV

FRQVHQVXVVWUDWHJ\ZRXOGUHVXOWLQDQDQQXDOVDYLQJRIQHDUO\¼PLOOLRQ'À

PLOOLRQZKLFKLVDUHGXFWLRQRIWKHWRWDOFRVWVRIDSSUR[LPDWHO\ ^7KLV

UHGXFWLRQZDVPRVWO\UHODWHGWRDUHGXFWLRQRIXQQHFHVVDU\WUHDWPHQW

8QIRUWXQDWHO\LQLWLDOO\WKLVFRQVHQVXVVWUDWHJ\KDGQRWEHHQZLGHO\DGRSWHGDV

ZDVVKRZQLQDVXUYH\LQ7KH1HWKHUODQGVLQ\HDUDIWHUWKHIRUPXODWLRQ

RIWKHµFRQVHQVXVVWUDWHJ\¶^,PSRUWDQW¿QGLQJVRIWKDWVXUYH\ZHUHWKHXQGHUXVH

RIYHQWLODWLRQVFLQWLJUDSK\DQGSXOPRQDU\DQJLRJUDSK\7KLVZDVDWWULEXWHGWRWKH

UHODWLYHO\ORZDYDLODELOLW\RI.U\SWRQIRUYHQWLODWLRQVFLQWLJUDSK\DQGWKHQRWLRQ

WKDWSXOPRQDU\DQJLRJUDSK\LVDQLQYDVLYHDQGWLPHFRQVXPLQJLQYHVWLJDWLRQ

&RQVHTXHQWO\SXOPRQDU\DQJLRJUDSK\KDGDWWKDWWLPHQRWEHHQLPSOHPHQWHGDV

DURXWLQHLQYHVWLJDWLRQLQPRVWKRVSLWDOV

$QRWKHU¿QGLQJRIWKLVVXUYH\ZDVWKDWVLQFHPRVWSK\VLFLDQVFRQVLGHUSXOPRQDU\

HPEROLVPDSRWHQWLDOO\OHWKDOGLVHDVHRIDOOWKHSDWLHQWVZLWKFOLQLFDOO\VXV

SHFWHGSXOPRQDU\HPEROLVPZHUHWUHDWHGZLWKDQWLFRDJXODQWV ^*LYHQWKHIDFW

WKDWRQO\DSSUR[LPDWHO\RQHWKLUGRIWKHSDWLHQWVZLWKDVXVSLFLRQDFWXDOO\KDYHWKH





GLVHDVHWKLV\LHOGHGDQXQQHFHVVDU\WUHDWPHQWRIDWOHDVWRIWKHSDWLHQWV

7KHDLPRIWKLVVXUYH\ZDVWRUHHYDOXDWHWKHDSSOLFDWLRQRIWKHµFRQVHQVXV

VWUDWHJ\¶LQWKH'XWFKKRVSLWDOV\HDUVDIWHULWVLQWURGXFWLRQLQUHODWLRQWRWKH

GLDJQRVWLFIDFLOLWLHVDYDLODEOHDWWKDWWLPHYHQWLODWLRQSHUIXVLRQVFLQWLJUDSK\

SXOPRQDU\DQJLRJUDSK\DQGXOWUDVRXQG,QDQRWKHUSDUWRIWKHTXHVWLRQQDLUH

WKHDYDLODELOLW\RIWKHGLIIHUHQWIDFLOLWLHVIRUGLDJQRVLQJSXOPRQDU\HPEROLVPZDV

LQYHVWLJDWHG7KHUHVXOWVRIWKLVDYDLODELOLW\VWXG\DUHSXEOLVKHGHOVHZKHUH^

0DWHULDODQGPHWKRGV

7RLQYHVWLJDWHWKHDSSOLFDWLRQRIVHYHUDOGLDJQRVWLFIDFLOLWLHVLQWKHGLDJQRVLVRI

SXOPRQDU\HPEROLVPDTXHVWLRQQDLUHZDVVHQWLQWRDOO'XWFKKRVSLWDOV

7KHTXHVWLRQQDLUHZDVVHQWWRWKHKRVSLWDOPDQDJHPHQWDQGWKHGHSDUWPHQWV

RILQWHUQDOPHGLFLQHDQGSXOPRQRORJ\(DFKGHSDUWPHQWUHFHLYHGWKHVDPH

TXHVWLRQQDLUH$IWHUPRQWKVDUHPLQGHUZDVVHQWWRWKHQRQUHVSRQGLQJ

GHSDUWPHQWV(DFKTXHVWLRQQDLUHZDVQXPEHUHGWRHQDEOHWKHUHFRJQLWLRQRI

KRVSLWDOVDQGGHSDUWPHQWVIRUORJLVWLFSXUSRVHV

4XHVWLRQQDLUH

7KHTXHVWLRQQDLUHFRQWDLQHGVHSDUDWHVHFWLRQVZLWKTXHVWLRQVIRUWKHKRVSLWDO

PDQDJHPHQWDQGWKHPHGLFDOSUDFWLWLRQHUVDWWKHGHSDUWPHQWRILQWHUQDOPHGLFLQH

DQGSXOPRQRORJ\7KHTXHVWLRQZDVDQVZHUHGE\RQHRIWKHVSHFLDOLVWVRIWKHVH

GHSDUWPHQWV

7KHVHFWLRQIRUWKHKRVSLWDOPDQDJHPHQWFRQFHUQHGJHQHUDOKRVSLWDOLQIRUPDWLRQ

LQFOXGLQJWKHQXPEHURIEHGVRIWKHKRVSLWDODQGDYDLODELOLW\RIIDFLOLWLHVIRUWKH

GLDJQRVWLFPDQDJHPHQWRIVXVSHFWHGSXOPRQDU\HPEROLVP

,QWHUQLVWVDQGSXOPRQRORJLVWVZHUHDVNHGDERXWWKHDYDLODELOLW\RIGLDJQRVWLF

PRGDOLWLHVWKHQXPEHURISDWLHQWVZLWKFOLQLFDOO\VXVSHFWHGSXOPRQDU\HPEROLVP

VHHQLQWKHPRQWKSULRUWRDQVZHULQJWKHTXHVWLRQQDLUHDQGWKHGLDJQRVWLFZRUN

XSLQWKHODVWSDWLHQWZLWKFOLQLFDOO\VXVSHFWHGSXOPRQDU\HPEROLVP,QDGGLWLRQ

WKH\ZHUHDVNHGWRLQGLFDWHLQKRZPDQ\SDWLHQWVWKHFRQVHQVXVVWUDWHJ\ZDV

IROORZHG7KHFRPSOHWHTXHVWLRQQDLUHLVSURYLGHGLQWKHDSSHQGL[

$QDO\VLV

'HVFULSWLYHVWDWLVWLFVZHUHFDOFXODWHGXVLQJ6366YHUVLRQ)RUWKLVSXUSRVH

WKHKRVSLWDOVZHUHGLYLGHGLQWR¿YHFDWHJRULHVGHSHQGLQJRQWKHQXPEHURIEHGV

DYDLODEOH!DVDQLQGLFDWLRQRIWKHVL]H

RIWKHKRVSLWDODQGWKHQXPEHURILQDQGRXWSDWLHQWVSHU\HDU

)LUVWWKHQXPEHURISDWLHQWVZLWKFOLQLFDOO\VXVSHFWHGSXOPRQDU\HPEROLVP





ZKRZHUHVHHQLQWKHPRQWKSULRUWRWKHTXHVWLRQQDLUHZHUHFRXQWHGDVZHOO

DVWKHSURSRUWLRQRISDWLHQWVLQZKRPWKHSK\VLFLDQKDGLQGLFDWHGWRIROORZWKH

FRQVHQVXVVWUDWHJ\DQGLQZKRPWKHGLDJQRVLVSXOPRQDU\HPEROLVPWKHUHIRUH

FRXOGEHFRQ¿UPHGRUGLVFDUGHG

6HFRQGEDVHGRQGHWDLOHGLQIRUPDWLRQRILQWHUQLVWVDQGSXOPRQRORJLVWVDERXWWKH

GLDJQRVWLFVWUDWHJ\IROORZHGLQWKHODVWSDWLHQWVHHQZLWKVXVSHFWHGSXOPRQDU\

HPEROLVPZHGHWHUPLQHGLQKRZPDQ\FDVHVWKHFXUUHQWFRQVHQVXVVWUDWHJ\ZDV

DFWXDOO\XVHGLQFOLQLFDOSUDFWLFH)RUWKLVSXUSRVHWKHUHVXOWVRIWKHLQWHUQLVWVDQG

SXOPRQRORJLVWVZHUHFRPELQHG

)LQDOO\ZHLQYHVWLJDWHGLQKRZPDQ\SDWLHQWVWKHGHFLVLRQRILQWHUQLVWVDQG

SXOPRQRORJLVWVWRWUHDWRUQRWWRWUHDWZDVEDVHGRQDZLGHO\DFFHSWHGUHIHUHQFH

GLDJQRVLVLHQRUPDOSHUIXVLRQVFLQWLJUDSK\QRUPDOSXOPRQDU\DQJLRJUDSK\

KLJKSUREDELOLW\OXQJVFLQWLJUDSK\SRVLWLYHXOWUDVRXQGRUSRVLWLYHSXOPRQDU\

DQJLRJUDSK\

5HVXOWV

6WXG\SRSXODWLRQ

4XHVWLRQQDLUHVZHUHVHQWWRKRVSLWDOVLQ7KH1HWKHUODQGVKRVSLWDO

PDQDJHPHQWQ LQWHUQDOPHGLFLQHQ SXOPRQRORJ\Q 

7ZRKRVSLWDOVKDGWREHH[FOXGHGIURPDQDO\VLVEHFDXVHRIDUHFHQWPHUJHU

ZLWKDQRWKHUKRVSLWDO7KHUHVSRQVHUDWHRIWKHLQWHUQLVWVZDVQ WKH

UHVSRQVHUDWHRIWKHSXOPRQRORJLVWVZDVQ 7KHUHVSRQVHUDWHVSHU

WDUJHWJURXSLQUHODWLRQWRKRVSLWDOVL]HDUHVKRZQLQWDEOH$QDOPRVWFRPSOHWH

UHVSRQVHRIKRVSLWDOVLQ7KH1HWKHUODQGVZDVDYDLODEOHIRU

JHQHUDOKRVSLWDOLQIRUPDWLRQ

5HSRUWHGSUHYDOHQFHRISXOPRQDU\HPEROLVP

'XULQJWKHPRQWKSULRUWRFRPSOHWLRQRIWKHTXHVWLRQQDLUHWKHUHVSRQGLQJ

LQWHUQLVWVLQGLFDWHGWRKDYHVHHQDWRWDORISDWLHQWVZLWKFOLQLFDOO\VXVSHFWHG

SXOPRQDU\HPEROLVPZKLFKLVDQDYHUDJHRIIRXUSDWLHQWVSHUSK\VLFLDQSHU

PRQWK,QRIWKHFDVHVWKHUHVSRQVLEOHFOLQLFLDQUHSRUWHGWKDWWKH

'XWFKFRQVHQVXVVWUDWHJ\ZDVIROORZHG7KHGLDJQRVLVSXOPRQDU\HPEROLVPZDV

FRQ¿UPHGLQFDVHV7KHSXOPRQRORJLVWVUHSRUWHGWRKDYHVHHQDWRWDO

RISDWLHQWV¿YHSDWLHQWVSHUGRFWRURQDYHUDJHRIZKRPZHUH

UHSRUWHGWREHGLDJQRVHGDFFRUGLQJWRWKHFRQVHQVXVVWUDWHJ\7KHGLDJQRVLV

SXOPRQDU\HPEROLVPZDVFRQ¿UPHGLQSDWLHQWV7KHGLVWULEXWLRQRI

WKHXVHRIWKHGLIIHUHQWGLDJQRVWLFIDFLOLWLHVGXULQJWKHSUHYLRXVPRQWKLVVKRZQ

LQWDEOH





7DEOH1XPEHURIUHVSRQVHVRIWKHYDULRXVGLVFLSOLQHVWRWKHTXHVWLRQQDLUH

1RRIEHGV     ! 7RWDO 5HVSRQVH

UDWH

*HQHUDOKRVSLWDO

LQIRUPDWLRQ       

+RVSLWDO0DQDJHPHQW       

5DGLRORJ\       

1XFOHDU0HGLFLQH       

,QWHUQDOPHGLFLQH       

3XOPRQRORJ\       

7RWDOQXPEHURIKRVSLWDOVLQ7KH1HWKHUODQGVLV7RWDOUHVSRQVHRQWKH¿UVWSDUWRIWKHTXHVWLRQQDLUH

1XPEHUVEHWZHHQSDUHQWKHVHVLQGLFDWHSHUFHQWDJHV

7DEOH7RWDOQXPEHURISDWLHQWVVHHQLQWKHSUHYLRXVPRQWKDQGVWXGLHVSHUIRUPHG

,QWHUQLVW 3XOPRQRORJLVW 1XPEHURISDWLHQWVZLWK

VXVSHFWHG3(  

FRQVHQVXVIROORZHG  

3XOPRQDU\HPEROLVPFRQ¿UPHG  

3HUIXVLRQVFLQWLJUDSK\SHUIRUPHG  

9HQWLODWLRQVFLQWLJUDSK\SHUIRUPHG  

3XOPRQDU\DQJLRJUDSK\

SHUIRUPHG  

(FKR'RSSOHUSHUIRUPHG  

6SLUDO&7VFDQSHUIRUPHG  

1XPEHUVEHWZHHQSDUHQWKHVHVLQGLFDWHSHUFHQWDJHV

&RQ¿UPDWLRQE\JROGVWDQGDUGQRUPDOSHUIXVLRQVFLQWLJUDSK\QRUPDOSXOPRQDU\DQJLRJUDSK\KLJK

SUREDELOLW\OXQJVFLQWLJUDSK\SRVLWLYHXOWUDVRXQGRUSXOPRQDU\DQJLRJUDSK\





'LDJQRVWLFPDQDJHPHQWRIWKHODVWSDWLHQW

,QWRWDOWKHGLDJQRVWLFPDQDJHPHQWRIµODVWSDWLHQWV¶SDWLHQWVVHHQE\

LQWHUQLVWVDQGVHHQE\SXOPRQRORJLVWVZDVDYDLODEOHIRUDQDO\VLV7KHPDQDJH

PHQWRIWKHVHSDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVPZDVVOLJKWO\GLIIHUHQW

EHWZHHQWKHWZRVSHFLDOLVWJURXSV)LJXUHVKRZVWRZKDWH[WHQWWKHFRQVHQVXV

VWUDWHJ\ZDVIROORZHGIRUDOOSDWLHQWVVHHQE\LQWHUQLVWVDQGSXOPRQRORJLVWV

FRPELQHG'HWDLOVDUHGHVFULEHGLQWKHIROORZLQJVHFWLRQV

)LJXUH'LDJQRVWLFDOJRULWKP





&RQVHQVXVVWUDWHJ\QRSHUIXVLRQ

,QVHYHQRIWKHSDWLHQWVQRSHUIXVLRQVFLQWLJUDSK\ZDVSHUIRUPHGLQVL[

RIWKHVHSDWLHQWVWKHGLDJQRVLVYHQRXVWKURPERHPEROLVPFRXOGEHFRQ¿UPHG

ZLWKSXOPRQDU\DQJLRJUDSK\RUXOWUDVRXQGRIWKHOHJVDOOWKHVHSDWLHQWVZHUH

WUHDWHG

&RQVHQVXVVWUDWHJ\QRUPDOSHUIXVLRQ

2IWKHSDWLHQWVLQZKRPDSHUIXVLRQVFLQWLJUDSK\ZDVSHUIRUPHGKDGD

QRUPDOSHUIXVLRQVFLQWLJUDP,QRIWKHVHSDWLHQWVWKHFRQVHQVXV

VWUDWHJ\ZDVIROORZHGLHVWRSSHGDQGQRIXUWKHUWHVWVZHUHSHUIRUPHG2IWKH

UHPDLQLQJHLJKWSDWLHQWVVL[KDGDQDGGLWLRQDOYHQWLODWLRQVFLQWLJUDPFRPELQHGLQ

RQHSDWLHQWZLWKDQXOWUDVRXQGRIWKHOHJV,QWZRSDWLHQWVSXOPRQDU\DQJLRJUDSK\

ZDVSHUIRUPHG$OOWKHVHWHVWVKDGQHJDWLYHWHVWUHVXOWV2QHSDWLHQWZLWKD

QRUPDOSHUIXVLRQVFLQWLJUDSK\ZLWKRXWDQ\IXUWKHUGLDJQRVWLFLQYHVWLJDWLRQVZDV

WUHDWHG

&RQVHQVXVVWUDWHJ\VXEVHJPHQWDOSHUIXVLRQGHIHFW

,QRXWRISDWLHQWVZLWKDVXEVHJPHQWDOSHUIXVLRQGHIHFWDQ

XOWUDVRXQGRIWKHOHJVZDVSHUIRUPHGEXWRQO\LQIRXUSDWLHQWVZLWKRXWDYHQWLODWLRQ

VFLQWLJUDSK\,QHLJKWVL[RIWKHVHDOVRKDGDYHQWLODWLRQVFLQWLJUDSK\RIWKH

SDWLHQWVXOWUDVRXQGKDGDSRVLWLYHUHVXOW,QQRQHRIWKHWKUHHSDWLHQWVZLWK

DQHJDWLYHXOWUDVRXQGSXOPRQDU\DQJLRJUDSK\ZDVSHUIRUPHG

2IWKHUHPDLQLQJSDWLHQWVLQZKRPQRXOWUDVRXQGZDVSHUIRUPHGVHYHQKDG

DYHQWLODWLRQVFLQWLJUDSK\,QWZRRIWKHVHVHYHQSDWLHQWVDGGLWLRQDOSXOPRQDU\

DQJLRJUDSK\ZDVSHUIRUPHG,QWKHUHPDLQLQJVL[SDWLHQWVQRIXUWKHULQYHVWLJDWLRQV

ZHUHSHUIRUPHGDQGWKH\ZHUHQRWWUHDWHG2YHUDOOWKHFRQVHQVXVVWUDWHJ\KDG

EHHQIROORZHGH[DFWO\LQRQO\WZRSDWLHQWVZLWKVXEVHJPHQWDOSHUIXVLRQGHIHFWV

&RQVHQVXVVWUDWHJ\VHJPHQWDOSHUIXVLRQGHIHFW

2IWKHSDWLHQWVZLWKDVHJPHQWDOGHIHFWKDGDYHQWLODWLRQVFLQWLJUDSK\

,QSDWLHQWVWKLVVFLQWLJUDSK\ZDVLQWHUSUHWHGDVPLVPDWFKDQGWKHUHIRUHKLJK

SUREDELOLW\VFLQWLJUDSK\,QSDWLHQWVZLWKDKLJKSUREDELOLW\OXQJVFLQWLJUDSK\

DQDGGLWLRQDOXOWUDVRXQGRIWKHOHJVZDVPDGHDQGLQIRXUSDWLHQWVWZRRIWKHVH

DOVRKDGDQXOWUDVRXQGSXOPRQDU\DQJLRJUDSK\ZDVSHUIRUPHG)LIW\RIWKH

SDWLHQWVUHFHLYHGRUDODQWLFRDJXODQWWUHDWPHQW

,QVL[RIWKHSDWLHQWVZLWKDQRQKLJKSUREDELOLW\OXQJVFLQWLJUDPDQXOWUDVRXQG

RIWKHOHJVZDVSHUIRUPHG2QHSDWLHQWUHFHLYHGRUDODQWLFRDJXODQWWUHDWPHQW

GXHWRWKHSRVLWLYHUHVXOWVRIWKHXOWUDVRXQG,QRQHRIWKH¿YHSDWLHQWVZLWKD





QRUPDOXOWUDVRXQGUHVXOWSXOPRQDU\DQJLRJUDSK\ZDVSHUIRUPHGWKHGLDJ

QRVLVSXOPRQDU\HPEROLVPZDVUHMHFWHG,QWKHRWKHUIRXUSDWLHQWVQRIXUWKHU

LQYHVWLJDWLRQVZHUHSHUIRUPHGDQGWKH\ZHUHQRWWUHDWHG

7KHRWKHUKDOIRIWKHSDWLHQWVZLWKDQRQGLDJQRVWLFOXQJVFLQWLJUDSK\XQGHUZHQW

QRIXUWKHUWHVWLQJ7KUHHRIWKHVHVL[SDWLHQWVUHFHLYHGDQWLFRDJXODQWWUHDWPHQW

,QRIWKHSDWLHQWVQRYHQWLODWLRQVWXG\ZDVPDGHSDWLHQWVUHFHLYHG

DQWLFRDJXODQWWUHDWPHQWLQVL[DQXOWUDVRXQGRIWKHOHJVZDVPDGHLQWKUHH

SDWLHQWVSXOPRQDU\DQJLRJUDSK\ZDVSHUIRUPHG

2YHUDOORIWKHSDWLHQWVZLWKDVHJPHQWDOSHUIXVLRQGHIHFWZHUH

PDQDJHGVWULFWO\DFFRUGLQJWRWKHFRQVHQVXVVWUDWHJ\ZLWKDKLJK

SUREDELOLW\OXQJVFLQWLJUDSK\DQGWZRSDWLHQWVZLWKDQRQGLDJQRVWLFOXQJ

VFLQWLJUDSK\

$QWLFRDJXODQWWUHDWPHQW

2IDOOSDWLHQWVUHFHLYHGDQWLFRDJXODQWWUHDWPHQW,Q RIWKHVHSDWLHQWVWKHGLDJQRVLVYHQRXVWKURPERHPEROLVPZDVFRQ¿UPHG

ZLWKDKLJKSUREDELOLW\OXQJVFLQWLJUDSK\DSRVLWLYHXOWUDVRXQGRUSXOPRQDU\

DQJLRJUDSK\WDEOH

,QRIWKHUHPDLQLQJSDWLHQWVQRWUHFHLYLQJDQWLFRDJXODQWWUHDWPHQWWKH

GLDJQRVLVSXOPRQDU\HPEROLVPRUGHHSYHLQWKURPERVLVZDVH[FOXGHGEDVHGRQ

DQRUPDOOXQJVFLQWLJUDSK\RUSXOPRQDU\DQJLRJUDSK\ZLWKQRUPDOSHUIXVLRQ

VL[ZLWKQRUPDODQJLRJUDSK\7KHGHFLVLRQWRWUHDWRUQRWZDVEDVHGVWULFWO\RQ

WKHFRQVHQVXVVWUDWHJ\LHZLWKRXWDQ\DGGLWLRQDOLQYHVWLJDWLRQLQRQO\RIWKH

SDWLHQWV2IWKHVHSDWLHQWVKDGDQRUPDOOXQJVFLQWLJUDSK\UHVXOW

DKLJKSUREDELOLW\OXQJVFLQWLJUDSK\WKUHHSDWLHQWVDSRVLWLYHXOWUDVRXQGUHVXOW

DQGRQHSDWLHQWDQHJDWLYHDQJLRJUDSK\

'LVFXVVLRQ

3XOPRQDU\HPEROLVPLVVWLOODGLDJQRVWLFFKDOOHQJH7KLVVXUYH\VKRZVWKDW

\HDUVDIWHUWKHLQWURGXFWLRQRIWKH'XWFKFRQVHQVXVVWUDWHJ\WKHH[WHQWWRZKLFK

LWLVDSSOLHGWRSDWLHQWVZLWKFOLQLFDOO\VXVSHFWHGSXOPRQDU\HPEROLVPKDVQRW

LPSURYHGVXEVWDQWLDOO\FRPSDUHGWRDVXUYH\DPRQJ'XWFKPHGLFDOVSHFLDOLVWV

LQ^7KHUHVXOWVRIWKLVVXUYH\VKRZHGERWKDQRYHUXVHDQGDQXQGHUXVHRI

VHYHUDOGLDJQRVWLFLQYHVWLJDWLRQV)XUWKHUPRUHWUHDWPHQWGHFLVLRQVZHUHEDVHG

RQLQFRPSOHWHGLDJQRVLVLQDSSUR[LPDWHO\RQHWKLUGRISDWLHQWV

2YHUXVHRILQYHVWLJDWLRQV

$OWKRXJKLWLVZLGHO\DFFHSWHGWKDWDQRUPDOSHUIXVLRQVFLQWLJUDSK\UXOHVRXWWKH





GLDJQRVLVRISXOPRQDU\HPEROLVPDQGQHHGVQRIXUWKHULQYHVWLJDWLRQLQDOPRVW

RIWKHFDVHVDQDGGLWLRQDOYHQWLODWLRQVWXG\ZDVSHUIRUPHG$VLPLODURYHUXVH

RIYHQWLODWLRQVFLQWLJUDSK\ZDVVHHQLQWKHJURXSRISDWLHQWVZLWKDVXEVHJPHQWDO

SHUIXVLRQGHIHFWRIWKHSDWLHQWV3DUWRIWKLVRYHUXVHFDQEHH[SODLQHGE\

ORJLVWLFUHTXLUHPHQWVRIQXFOHDUPHGLFLQHGHSDUWPHQWVVLPXOWDQHRXVDFTXLVLWLRQ

RIDSHUIXVLRQDQGYHQWLODWLRQVFLQWLJUDSK\WDEOH,QDGGLWLRQDQXQQHFHVVDU\

XOWUDVRXQGZDVSHUIRUPHGLQRIWKHSDWLHQWVZLWKDKLJKSUREDELOLW\YHQWLODWLRQ

SHUIXVLRQVFLQWLJUDSK\

8QGHUXVHRILQYHVWLJDWLRQV

,QWKHJURXSRISDWLHQWVZLWKDVHJPHQWDOSHUIXVLRQGHIHFWDQLQGLFDWHGYHQWLODWLRQ

VFLQWLJUDSK\ZDVQRWSHUIRUPHGLQRIWKHSDWLHQWV7KHPRVWSUREDEOH

H[SODQDWLRQLVWKHOLPLWHGDYDLODELOLW\RI.U\SWRQJDVIRUYHQWLODWLRQVFLQWLJUDSK\

7DEOH'LDJQRVWLFVFKHPHIRUDOOSDWLHQWV

3HUIXVLRQ

VFLQWLJUDSK\

UHVXOW

3HUIXVLRQ

VFLQWLJUDSK\

SHUIRUPHG

9HQWLODWLRQ

VFLQWLJUDSK\

SHUIRUPHG

86'97WHVWV

SHUIRUPHG

3$SHUIRUPHG



2$&WUHDWPHQW



1RSHUIXVLRQ

VFLQWLJUDSK\     

1RUPDO

SHUIXVLRQ     

6XEVHJ

PHQWDO     

6HJPHQWDO

GHIHFW     

1R

YHQWLODWLRQ

VFLQWLJUDSK\

 

7RWDOQXPEHU

RISDWLHQWV     

1XPEHUVEHWZHHQSDUHQWKHVHVLQGLFDWHSHUFHQWDJHV

86XOWUDVRQRJUDSK\

'97GHHSYHLQWKURPERVLV 3$SXOPRQDU\DQJLRJUDSK\

2$&RUDODQWLFRDJXODQWWUHDWPHQW





5HOLDQFHRQDQRUPDOFKHVWUDGLRJUDSK\LQFRPELQDWLRQZLWKDQRUPDOSK\VLFDO

H[DPLQDWLRQLQVWHDGRIYHQWLODWLRQVFLQWLJUDSK\PLJKWEHDQRWKHUH[SODQDWLRQ

8QGHUXVHRIXOWUDVRXQGQRWGRQHLQRIWKHSDWLHQWVZLWKDQRQKLJKOXQJ

VFLQWLJUDSK\DQGSXOPRQDU\DQJLRJUDSK\QRWGRQHLQRIWKHSDWLHQWV

ZLWKDQRQKLJKOXQJVFLQWLJUDSK\EXWZLWKRXWDSRVLWLYHXOWUDVRXQGZHUHRWKHU

IUHTXHQWO\REVHUYHGGHYLDWLRQVIURPWKHFRQVHQVXVVWUDWHJ\)HDUIRUSXOPRQDU\

DQJLRJUDSK\DQGLWVFRPSOLFDWLRQVRYHULQWHUSUHWDWLRQRIDQRQKLJKSUREDELOLW\

OXQJVFLQWLJUDSK\LQFRPELQDWLRQZLWKDKLJKFRQ¿GHQFHLQDQWLFRDJXODQWWUHDWPHQW

PLJKWEHH[SODQDWLRQVIRUWKHVHREVHUYDWLRQV

7UHDWPHQWGHFLVLRQV

$OPRVWDTXDUWHURIWKHSDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVPZHUH

WUHDWHGZLWKRXWDQDVFHUWDLQHGGLDJQRVLVWDEOH0RVWRIWKHVHSDWLHQWVQ  KDGDVHJPHQWDOSHUIXVLRQGHIHFWZLWKRXWDYHQWLODWLRQVFLQWLJUDSK\+RZHYHU

DOPRVWDWKLUGRIWKHVHSDWLHQWVQ KDGVXEVHJPHQWDOGHIHFWVWKDWFDUU\RQO\

DOLNHOLKRRGRISXOPRQDU\HPEROLVP,QFRQWUDVWRXWRIWKHSDWLHQWV

ZHUHQRWWUHDWHGDOWKRXJKYHQRXVWKURPERHPEROLVPZDVQRWSURSHUO\

H[FOXGHG6LQFHWKHTXHVWLRQQDLUHSHUWDLQHGWRXVHRIGLDJQRVLVDQGQRWWRFOLQLFDO

IROORZXSWKHFOLQLFDOFRQVHTXHQFHVRIWKLVUHPDLQXQNQRZQ7KHVSHFLDOLVWV

UHSRUWHGWRKDYHIROORZHGWKH'XWFKFRQVHQVXVVWUDWHJ\LQDSSUR[LPDWHO\

RIWKHSDWLHQWVVHHQWKHPRQWKEHIRUHFRPSOHWLRQRIWKHTXHVWLRQQDLUH7KH

DQDO\VLVRISHUIRUPHGLQYHVWLJDWLRQVDQGWUHDWPHQWLQWKHODVWSDWLHQWVKRZHG

WKDWLQRIWKHSDWLHQWVWKHGLDJQRVLVRISXOPRQDU\HPEROLVPZDV

SURSHUO\GRFXPHQWHGRUH[FOXGHG+RZHYHUWKHFRQVHQVXVVWUDWHJ\ZDVVWULFWO\

7DEOH2UDODQWLFRDJXODQWWUHDWPHQWUHODWLYHWR¿QDOGLDJQRVLVJROGVWDQGDUGLQSDWLHQWV

:LWKJROGVWDQGDUG

LQYHVWLJDWLRQ

:LWKRXWJROG

VWDQGDUG

LQYHVWLJDWLRQV

7RWDOSDWLHQWV

2$&WUHDWPHQW

MXVWL¿HGQRW

MXVWL¿HG^

  

1R2$&WUHDWPHQW

MXVWL¿HGQRW

MXVWL¿HG^

  

*ROGVWDQGDUGLQYHVWLJDWLRQVQRUPDOSHUIXVLRQRUSXOPRQDU\DQJLRJUDSK\KLJKSUREDELOLW\OXQJ 

VFLQWLJUDSK\SRVLWLYHXOWUDVRXQGRUSXOPRQDU\DQJLRJUDSK\

QRWMXVWL¿HGQRWEDVHGRQJROGVWDQGDUGLQYHVWLJDWLRQV

2$&RUDODQWLFRDJXODQWWUHDWPHQW





IROORZHGLQRQO\RIWKHSDWLHQWV,QWKHRWKHUSDWLHQWVDGGLWLRQDO

LQYHVWLJDWLRQVZHUHSHUIRUPHG

,QDQDWWHPSWWRLPSURYHSK\VLFLDQ¶VGHFLVLRQPDNLQJDQGTXDOLW\RIFDUHDQGWR

GHFUHDVHFRVWVDQGUHGXFHYDULDWLRQJXLGHOLQHVVXFKDVWKH'XWFKFRQVHQVXV

VWUDWHJ\KDYHEHHQIRUPXODWHG7RDFKLHYHWKHGHVLUHGRXWFRPHVJXLGHOLQH

UHFRPPHQGDWLRQVPXVWEHLPSOHPHQWHGLQFOLQLFDOSUDFWLFH+RZHYHUV\VWHPDWLF

UHYLHZVRIOLWHUDWXUHKDYHGRFXPHQWHGWKHFRPPRQVHQVHREVHUYDWLRQWKDW

JXLGHOLQHVGRQRWDOZD\VJXLGHSUDFWLFH5DWHVRIDGKHUHQFHZLWKJXLGHOLQHV

YDU\IURPWRDOPRVWGHSHQGLQJRQWKHJXLGHOLQHDQGWKHGH¿QLWLRQ

RIDGKHUHQFH^&RPSDUHGWRWKLVOLWHUDWXUHREVHUYDWLRQVWKHDGKHUHQFHLQRXU

VWXG\YDULHGIURPWRLQGLIIHUHQWKRVSLWDOV([SODQDWLRQVIRUQRWIROORZLQJ

WKHFRQVHQVXVVWUDWHJ\FRXOGEHORJLVWLFVDQGWKHGLIIHUHQWORFDOVLWXDWLRQV

+RZHYHUFOLQLFLDQVPD\DOVRQRWDSSHDUWRIROORZWKHSXEOLVKHGFRQVHQVXV

VWUDWHJ\LQSDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVPLIWKLVLVSRVVLEOH,WLV

XQFOHDUZKHWKHUWKLVUHÀHFWVGLI¿FXOWLHVLQDSSO\LQJWKLVVWUDWHJ\LQWKHFOLQLFDO

VHWWLQJDQLQIRUPHGGLVDJUHHPHQWZLWKWKHGLIIHUHQWLQYHVWLJDWLRQVRULQVXI¿FLHQW

NQRZOHGJHDERXWWKHGLDJQRVWLFSHUIRUPDQFHRIWKHDYDLODEOHWHFKQLTXHV

,QDQGDVLPLODUVXUYH\ZDVSHUIRUPHGLQ7KH1HWKHUODQGV ^ 7KHVHVWXGLHVERWKLQYHVWLJDWHGWKHGLDJQRVWLFPDQDJHPHQWE\WKHJURXSRI

SXOPRQRORJLVWVDQGLQWHUQLVWVZKHUHDVZHDOVRLQYHVWLJDWHGWKHGLDJQRVWLF

PDQDJHPHQWSHUKRVSLWDO7KHGLIIHUHQWVWXG\GHVLJQVH[SODLQWKHGLIIHUHQFHEH

WZHHQWKHQXPEHURISDWLHQWV7KHVWXG\SHUIRUPHGE\.XLMHUHWDOGLGQRWUHSRUW

WKHH[DFWFRPELQDWLRQRIGLDJQRVWLFWHVWVQHYHUWKHOHVVLQDSSUR[LPDWHO\

RIWKHSDWLHQWVQRJROGVWDQGDUGGLDJQRVLVZDVDFKLHYHGFRPSDUHGWR

LQRXUVWXG\)XUWKHUPRUHWKHQXPEHURISDWLHQWVZLWKVXVSHFWHG

SXOPRQDU\HPEROLVPZKRZHUHWUHDWHGZLWKDQWLFRDJXODQWVLVUHGXFHG

&RQVLGHULQJWKDWRQO\DSSUR[LPDWHO\RIWKH

SDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVPKDYHWKHGLVHDVHDFRQVLGHUDEOH

RYHUWUHDWPHQWVWLOOH[LVWV,QWKH¿UVWWZRVWXGLHVDOPRVWRIWKHSDWLHQWVZLWKD

QRUPDOSHUIXVLRQVFLQWLJUDSK\UHFHLYHGDQWLFRDJXODQWWUHDWPHQWLQRXUVWXG\WKLV

ZDV)URPWKHVXEJURXSRISDWLHQWVZLWKDQDEQRUPDOSHUIXVLRQVFLQWLJUDSK\

PRUHWKDQUHFHLYHGWUHDWPHQW2YHUWUHDWPHQWRFFXUVPRVWIUHTXHQWO\LQWKH

SDWLHQWVZLWKVXEVHJPHQWDOSHUIXVLRQGHIHFWV

7KHGLDJQRVWLFPDQDJHPHQWRISDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVPKDV

LPSURYHGQHYHUWKHOHVVWUHDWPHQWZLWKDQWLFRDJXODQWVZLWKRXWDQDVFHUWDLQHG

GLDJQRVLVRIDOPRVWDTXDUWHURIWKHSDWLHQWVUHPDLQVDSUREOHP7KHUHDVRQV





IRUXQGHUXVHRIGLDJQRVLVDQGRYHUWUHDWPHQWDUHSUREDEO\WKHVDPHDVLQWKH

SDVWWKHIHDUIRUFRPSOLFDWLRQVRISXOPRQDU\DQJLRJUDSK\DQGWKHZHOODFFHSWHG

DQWLFRDJXODQWWUHDWPHQW

7KH¿HOGRIGLDJQRVLVRISXOPRQDU\HPEROLVPKDVSURJUHVVHGUDSLGO\GXULQJWKH

SDVW\HDUV6RPHFKDQJHVLQWKHGLDJQRVWLFDSSURDFKVKRXOGEHPHQWLRQHG)LUVW

WKH'GLPHUEORRGWHVWKDVEHHQLQWURGXFHGDVDVFUHHQLQJWHVWIRUSXOPRQDU\

HPEROLVP$OWKRXJKLWLVVXJJHVWHGWKDWDQRUPDO'GLPHUPD\VDIHO\H[FOXGH

SXOPRQDU\HPEROLVPWKLVLVQRW\HWYDOLGDWHGLQODUJHFOLQLFDORXWFRPHVWXGLHV

2QO\3HUULHUHWDOXVHGWKH'GLPHUDVWKH¿UVWVWHSLQDFOLQLFDOPDQDJHPHQW

VWXG\LQRXWSDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVP ^6HFRQGWKH

XVHRIYHQWLODWLRQVFLQWLJUDSK\KDVWREHGLVFXVVHG+RZHYHULQWKHWDVNIRUFH

UHSRUWRIWKH(XURSHDQ6RFLHW\RI&DUGLRORJ\RQSXOPRQDU\HPEROLVPYHQWLODWLRQ

VFLQWLJUDSK\LVVWLOOUHFRPPHQGHG ^7KHLUVXJJHVWLRQLVWKDWWKHUHVXOWVRIWKH

3,6$3('VWXG\LQZKLFKSHUIXVLRQVFLQWLJUDSK\DQGFKHVW;UD\ZHUHXVHG

VKRXOGEHFRQ¿UPHGLQDPDQDJHPHQWVWXG\)LQDOO\WKHUHLVDQLQFUHDVHG

LQWHUHVWLQWKH6&7VFDQIRUGLDJQRVLQJSXOPRQDU\HPEROLVPLQWKHODVWIHZ\HDUV

+RZHYHUWKHUROHRIWKH6&7VFDQLQWKHGLDJQRVWLFZRUNXSRISDWLHQWVZLWK

VXVSHFWHGSXOPRQDU\HPEROLVPLVVWLOOLQWKHLQYHVWLJDWLRQDOVWDJH

4XHVWLRQQDLUHVGRKDYHWKHLUOLPLWDWLRQVVXFKDVWKHOLPLWHGQXPEHURITXHVWLRQV

DQGWKHDVVXPSWLRQWKDWWKHDQVZHUVUHÀHFWUHDOLW\DQGWKDWWKHDQVZHUVDUH

UHÀHFWLQJWKHPDQDJHPHQWRIDOOSDWLHQWVDQGRIDOOVSHFLDOLVWVRIWKHGHSDUWPHQW

2XUTXHVWLRQQDLUHZDVDQVZHUHGE\RQHRIWKHPHPEHUVRIHDFKGHSDUWPHQW:H

DVVXPHGWKDWWKHDQVZHUUHÀHFWVWKHPDQDJHPHQWSHUKRVSLWDO

,QDQRWKHUSDUWRIWKHTXHVWLRQQDLUHWKHDYDLODELOLW\RIWKHGLIIHUHQWIDFLOLWLHVIRU

GLDJQRVLQJSXOPRQDU\HPEROLVPZDVLQYHVWLJDWHG'HVSLWHWKHOLPLWHGDFFHSWDQFH

LQFOLQLFDOSUDFWLFHIDFLOLWLHVIRUSXOPRQDU\DQJLRJUDSK\ZHUHDYDLODEOHLQRI

WKHKRVSLWDOV)DFLOLWLHVIRUWKHµ'XWFKFRQVHQVXVVWUDWHJ\¶ZHUHDYDLODEOHLQWZR

WKLUGVRIWKHKRVSLWDOVZKHUHDV6&7VFDQIDFLOLWLHVZHUHOHVVZLGHVSUHDGERWKDW

WKHWLPHRIWKHTXHVWLRQQDLUHDVZHOODIWHUFRPSOHWLRQRIWKHLQYHVWPHQWSODQV^

,QWKHVHFRQGµFRQVHQVXVPHHWLQJYHQRXVWKURPERHPEROLVP¶RI'HFHPEHU

6&7ZDVDGGHGDWDQHTXDOSRVLWLRQDVYHQWLODWLRQVFLQWLJUDSK\$FFRUGLQJWRWKLV

FRQVHQVXVSXOPRQDU\DQJLRJUDSK\UHPDLQVWKHJROGVWDQGDUGIRUWKHGLDJQRVLV

RISXOPRQDU\HPEROLVP$GGLWLRQRI6&7LQWKLVVWHSLQWKHSURWRFROZLOOQRWUHVROYH

WKHSUREOHPRIWKHUHVWULFWHGDFFHSWDQFHRISXOPRQDU\DQJLRJUDSK\DQGWKHUHIRUH

LVQRWOLNHO\WROHDGWRDPDMRUUHGXFWLRQRIRYHUWUHDWPHQW

$Q\QHZIRUPXODWHGVWUDWHJ\IRUWKHGLDJQRVLVRISXOPRQDU\HPEROLVPVKRXOG





FRQVLGHUWKHDYDLODELOLW\RIGLDJQRVWLFIDFLOLWLHVDVZHOODVWKHDFFHSWDQFHRIWKH

VWUDWHJ\E\WKHSK\VLFLDQVLQYROYHGLQWKHGLDJQRVLVRISDWLHQWVZLWKFOLQLFDOO\

VXVSHFWHGSXOPRQDU\HPEROLVPWRUHGXFHRYHUWUHDWPHQWZLWKDOOLWVDVVRFLDWHG

ULVNVDQGFRVWV$SRWHQWLDOQRQLQYDVLYHDQGUHDGLO\DYDLODEOHLQYHVWLJDWLRQ

FRXOGEHVHULDOFRPSUHVVLRQXOWUDVRXQG5HFHQWVWXGLHVZLWKVHULDOFRPSUHVVLRQ

XOWUDVRXQGVKRZHGWKDWLWLVVDIHWRZLWKKROGWUHDWPHQWIURPSDWLHQWVZLWKFOLQLFDOO\

VXVSHFWHGYHQRXVWKURPERHPEROLVPZLWKDVHULDOQRUPDOUHVXOWRQFRPSUHVVLRQ

XOWUDVRXQG^,QWHUPVRIDYDLODELOLW\DQGDFFHSWDQFHWKLVQHZIRUPRIXOWUDVRXQG

FRXOGEHFRPHDQDOWHUQDWLYHIRUWKHOHVVDFFHSWHGSXOPRQDU\DQJLRJUDSK\)XUWKHU

SURVSHFWLYHYDOLGDWLRQLVQHHGHGWRDUULYHDWDQRSWLPDOO\DYDLODEOHDQGDFFHSWHG

GLDJQRVWLFDOJRULWKPIRUSDWLHQWVZLWKFOLQLFDOO\VXVSHFWHGSXOPRQDU\HPEROLVP





5HIHUHQFHV

YDQ%HHN(-%XOOHU+59DQ5R\HQ($YDQ(YHUGLQJHQ--WHQ&DWH-: 

'LDJQRVWLFPDQDJHPHQWLQVXVSLFLRQRISXOPRQDU\HPEROLVPUHVXOWVRIDVXUYH\DPRQJ'XWFK

LQWHUQLVWVDQGSXOPRQRORJLVWV

1HG7LMGVFKU*HQHHVNG±LQ'XWFK

7KH3,23(',QYHVWLJDWRUV 

9DOXHRIWKHYHQWLODWLRQSHUIXVLRQVFDQLQDFXWHSXOPRQDU\HPEROLVP5HVXOWVRIWKH

SURVSHFWLYHLQYHVWLJDWLRQRISXOPRQDU\HPEROLVPGLDJQRVLV3,23('

-$P0HG$VVRFWKURPERHPEROLVP±

+XOO5'+LUVK-&DUWHU&-5DVNRE*(*LOO*--D\50HWDO 

'LDJQRVWLFYDOXHRIYHQWLODWLRQSHUIXVLRQOXQJVFDQQLQJLQSDWLHQWVZLWKVXVSHFWHGSXOPRQDU\

HPEROLVP

&KHVW±

%DUULWW':-RUGDQ6& 

$QWLFRDJXODQWGUXJVLQWKHWUHDWPHQWRISXOPRQDU\HPEROLVP$FRQWUROOHGWULDO

/DQFHW±

%ULHW(YDQ%HHN(-2XGNHUN0 

&RQVHQVXVGLDJQRVLVSXOPRQDU\HPEROLVP

1HG7LMGVFKU*HQHHVNG±VHHFRPPHQWV>5HYLHZLQ'XWFK@

0LFKHO%&6HHUGHQ5-YDQ%HHN(-%XOOHU+55XWWHQ)) 

&RVWVRIGLDJQRVLVDQGWUHDWPHQWIRUSXOPRQDU\HPEROLVPORZHUGXHWRDSSOLFDWLRQRI

FRQVHQVXVVWUDWHJ\

1HG7LMGVFKU*HQHHVNG±>VHHFRPPHQWVLQ'XWFK@

.XLMHU307XUNVWUD)YDQ%HHN(-WHQ&DWH-:%XOOHU+5 

$VXUYH\RIWKHGLDJQRVWLFDQGWKHUDSHXWLFPDQDJHPHQWRISDWLHQWVZLWKVXVSHFWHGSXOPRQDU\

HPEROLVPLQWKH1HWKHUODQGV

1HWK-0HG±

'DYLV'$7KRPVRQ0$2[PDQ$'+D\QHV5% 

&KDQJLQJSK\VLFLDQSHUIRUPDQFH$V\VWHPDWLFUHYLHZRIWKHHIIHFWRIFRQWLQXLQJPHGLFDO

HGXFDWLRQVWUDWHJLHV

-$P0HG$VVRF±

*ULOOL5/RPDV- 

(YDOXDWLQJWKHPHVVDJHWKHUHODWLRQVKLSEHWZHHQDGKHUHQFHUDWHDQGWKHVXEMHFWRIDSUDFWLFH

JXLGHOLQH

0HG&DUH

*ULPVKDZ-05XVVHOO,7 

(IIHFWRIFOLQLFDOJXLGHOLQHVRQPHGLFDOSUDFWLFHDV\VWHPDWLFUHYLHZRIULJRURXVHYDOXDWLRQV

/DQFHW±

/RPDV-$QGHUVRQ*3LHUH'RPQLFN.9D\GD((QNLQ0+DQQDK: 

'RSUDFWLFHJXLGHOLQHVJXLGHSUDFWLFH"7KHHIIHFWRIDFRQVHQVXVVWDWHPHQWRQWKHSUDFWLFHRI

SK\VLFLDQV

(QJO-0HG±

:RUUDOO*&KDXON3)UHDNH' 

7KHHIIHFWVRIFOLQLFDOSUDFWLFHJXLGHOLQHVRQSDWLHQWVRXWFRPHVLQSULPDU\FDUHDV\VWHPDWLF

UHYLHZ

&DQ0HG$VVRF-±

3HUULHU$'HVPDUDLV60LURQ0-GH0RHUORRVH3/HSDJH56ORVPDQ' 

1RQLQYDVLYHGLDJQRVLVRISXOPRQDU\YHQRXVWKURPERHPEROLVPLQRXWSDWLHQWLQFOXGLQJFOLQLFDO

SUREDELOLW\'GLPHUDQGXOWUDVRQRJUDSK\

/DQFHW±

*XLGHOLQHVRQGLDJQRVLVDQGPDQDJHPHQWDFXWHSXOPRQDU\HPEROLVP7DVN)RUFHRQ

3XOPRQDU\(PEROLVP(XURSHDQ6RFLHW\RI&DUGLRORJ\

(XU+HDUW-±





+DJHQ3-YDQ6WULMHQ0-/.LHIW*-3ULQV0+3RVWPXV3( 

$YDLODELOLW\RIGLDJQRVWLFIDFLOLWLHVIRUSDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVP

1HWK-0HG±

&RJR$/HQVLQJ$:.RRSPDQ003LRYHOOD)6LUDJXVD6:HOOV36HWDO

&RPSUHVVLRQXOWUDVRQRJUDSK\IRUGLDJQRVWLFPDQDJHPHQWRISDWLHQWVZLWKFOLQLFDOO\VXVSHFWHG

GHHSYHLQWKURPERVLVSURVSHFWLYHFRKRUWVWXG\

%U0HG-±VHHFRPPHQWV

:HOOV36*LQVEHUJ-6$QGHUVRQ'5.HDURQ&*HQW07XUSLH$*HWDO 

8VHRIDFOLQLFDOPRGHOIRUVDIHPDQDJHPHQWRISDWLHQWVZLWKVXVSHFWHGSXOPRQDU\HPEROLVP

$QQ,QWHUQ0HG±