University of Groningen Albuminuria: more than a renal risk marker? van den Belt, Sophie Mariëlle

Albuminuria: more than a renal risk marker?

van den Belt, Sophie Mariëlle

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Publication date: 2018

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van den Belt, S. M. (2018). Albuminuria: more than a renal risk marker? About the prevalence, measurement, and treatment of albuminuria in children. Rijksuniversiteit Groningen.

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518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

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Comparison of urine collection methods for

albuminuria assessment in young children

Authors ^ŽƉŚŝĞD͘ǀĂŶĚĞŶĞůƚ1_{͕sĂůĞŶƟŶĂ'ƌĂĐĐŚŝ}2_{͕ŝĐŬĚĞĞĞƵǁ}1_, ,ŝĚĚŽ:͘>ĂŵďĞƌƐ,ĞĞƌƐƉŝŶŬ1 ĸůŝĂƟŽŶƐ 1_{ĞƉĂƌƚŵĞŶƚŽĨůŝŶŝĐĂůWŚĂƌŵĂĐLJĂŶĚWŚĂƌŵĂĐŽůŽŐLJ͕hŶŝǀĞƌƐŝƚLJDĞĚŝĐĂů} ĞŶƚĞƌ'ƌŽŶŝŶŐĞŶ͕ƚŚĞEĞƚŚĞƌůĂŶĚƐ 2_{ĞƉĂƌƚŵĞŶƚŽĨWĞĚŝĂƚƌŝĐEĞƉŚƌŽůŽŐLJ͕hŶŝǀĞƌƐŝƚLJDĞĚŝĐĂůĞŶƚĞƌ} 'ƌŽŶŝŶŐĞŶ͕ƚŚĞEĞƚŚĞƌůĂŶĚƐ ůŝŶŝĐĂŚŝŵŝĐĂĐƚĂ͕ϮϬϭϲ͖ϰϱϴ͗ϭϮϬͲϭϮϯ

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518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

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Abstract

Background ŽƩŽŶǁŽŽůŽƌƉĂŶƚLJůŝŶĞƌƐƉůĂĐĞĚŝŶĂĚŝĂƉĞƌĐĂŶďĞƵƐĞĚĂƐƵƌŝŶĞĐŽůůĞĐƟŽŶĚĞǀŝĐĞƐĨŽƌ ĂůďƵŵŝŶƵƌŝĂŵĞĂƐƵƌĞŵĞŶƚƐŝŶLJŽƵŶŐ͕ŶŽƚĐŽŶƟŶĞŶƚĐŚŝůĚƌĞŶ͘tĞƚĞƐƚĞĚĂŶĞǁĐŽůůĞĐƟŽŶ ŵĞƚŚŽĚ;WĞĞ^ƉŽƚΠͿĨŽƌŝƚƐĂŶĂůLJƟĐĂůƉĞƌĨŽƌŵĂŶĐĞ͕ĂŶĚĐŽŵƉĂƌĞĚŝƚǁŝƚŚƚŚĞƉĂŶƚLJůŝŶĞƌ ƚĞĐŚŶŝƋƵĞ͘ Methods ŝŐŚƚLJͲŽŶĞ ƵƌŝŶĞ ƐĂŵƉůĞƐ ǁŝƚŚ Ă ǁŝĚĞ ƌĂŶŐĞ ŽĨ ĂůďƵŵŝŶƵƌŝĂ ǁĞƌĞ ƉŝƉĞƩĞĚ ŽŶ ƚŚĞ ƉĂŶƚLJůŝŶĞƌĂŶĚWĞĞ^ƉŽƚŝŶĚƵƉůŝĐĂƚĞ͘dŚĞƐĞǁĞƌĞŝŶĐƵďĂƚĞĚĨŽƌϯŚŽƵƌƐĂƚϯϳo_{;ƐŝŵƵůĂƟŶŐ} ƚŚĞƟŵĞĂƚŽĚĚůĞƌǁĞĂƌƐĂĚŝĂƉĞƌͿ͕ĂŶĚƐƵďƐĞƋƵĞŶƚůLJϳϮŚŽƵƌƐĂƚƌŽŽŵƚĞŵƉĞƌĂƚƵƌĞ ;ƐŝŵƵůĂƟŶŐƚƌĂŶƐƉŽƌƚƚŽĂĐĞŶƚƌĂůůĂďŽƌĂƚŽƌLJͿ͘hƌŝŶĞǁĂƐĞdžƚƌĂĐƚĞĚďLJĐĞŶƚƌŝĨƵŐĂƟŽŶ ĂŶĚĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶ;h_AcͿǁĂƐŵĞĂƐƵƌĞĚ͘h_ŵĞĂƐƵƌĞĚďLJƚŚĞƚǁŽŵĞƚŚŽĚƐǁĂƐ ĐŽŵƉĂƌĞĚǁŝƚŚh_ŝŶĂŶƵŶƉƌŽĐĞƐƐĞĚƌĞĨĞƌĞŶĐĞĂůŝƋƵŽƚƐƚŽƌĞĚĨŽƌϳϱŚŽƵƌƐĂƚϰΣ͘ŝĂƐ ;ŵĞĂŶƉĞƌĐĞŶƚĂŐĞh_ĚŝīĞƌĞŶĐĞďĞƚǁĞĞŶƚĞƐƚĂŶĚƌĞĨĞƌĞŶĐĞͿ͕ƉƌĞĐŝƐŝŽŶ;ŝŶƚĞƌƋƵĂƌƟůĞ ƌĂŶŐĞŽĨƚŚĞh_ĚŝīĞƌĞŶĐĞͿĂŶĚĂĐĐƵƌĂĐLJ;ƉƌŽƉŽƌƟŽŶŽĨƐĂŵƉůĞƐǁŝƚŚŝŶϯϬйŽĨƌĞĨĞƌĞŶĐĞ h_ͿǁĞƌĞĐĂůĐƵůĂƚĞĚ͘ Results DĞĚŝĂŶh_ŝŶƚŚĞƌĞĨĞƌĞŶĐĞĂůŝƋƵŽƚǁĂƐϲϲ͘ϬŵŐͬ>΀Ϯϱth_-75th_{ƉĞƌĐĞŶƟůĞϮϱ͘ϬʹϮϭϭ͘Ϭ΁͕} ƉĂŶƚLJůŝŶĞƌϯϮ͘ϬŵŐͬ>΀ϰ͘ϳͲϭϲϱ͘Ϭ͖WфϬ͘ϬϬϭǀƐƌĞĨĞƌĞŶĐĞ΁͕ĂŶĚWĞĞ^ƉŽƚϲϭ͘ϬŵŐͬ>΀Ϯϳ͘ϬͲ Ϯϭϲ͘Ϭ͖WсϬ͘ϴϰǀƐƌĞĨĞƌĞŶĐĞ΁͘ŝĂƐ͕ƉƌĞĐŝƐŝŽŶĂŶĚĂĐĐƵƌĂĐLJŝŶƉĂŶƚLJůŝŶĞƌǁĞƌĞͲϯϰ͘Ϯй͕ϯϭ͘ϯ ŵŐͬ>ĂŶĚϰϴ͘ϭй͖ŝŶWĞĞ^ƉŽƚϯ͘ϯй͕ϱ͘ϬŵŐͬ>ĂŶĚϵϲ͘ϯй͘WĂƐƐŝŶŐͲĂďůŽŬƌĞŐƌĞƐƐŝŽŶĂŶĚ ůĂŶĚͲůƚŵĂŶƉůŽƚƐŚŽǁĞĚĂŶƵŶĚĞƌĞƐƟŵĂƟŽŶĨŽƌƚŚĞƉĂŶƚLJůŝŶĞƌďƵƚŶŽƚĨŽƌƚŚĞWĞĞ^ƉŽƚ͘ Conclusion dŚĞWĞĞ^ƉŽƚŝƐĂŶĂĐĐƵƌĂƚĞĂŶĚƉƌĞĐŝƐĞƚŽŽůĨŽƌĐŽůůĞĐƟŶŐƵƌŝŶĞĨŽƌĂůďƵŵŝŶŵĞĂƐƵƌĞŵĞŶƚ ŝŶLJŽƵŶŐĐŚŝůĚƌĞŶĂŶĚƐŚŽƵůĚďĞƉƌĞĨĞƌƌĞĚŽǀĞƌƚŚĞĂůƚĞƌŶĂƟǀĞĐŽƩŽŶǁŽŽůĐŽůůĞĐƟŽŶ ƚĞĐŚŶŝƋƵĞ͘

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

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Introduction

DŝĐƌŽĂůďƵŵŝŶƵƌŝĂŚĂƐďĞĞŶĞƐƚĂďůŝƐŚĞĚĂƐĂƌŝƐŬŵĂƌŬĞƌĨŽƌĐĂƌĚŝŽǀĂƐĐƵůĂƌĂŶĚƌĞŶĂů ĚŝƐĞĂƐĞ͘1-6_{/ŶƚŚĞŐĞŶĞƌĂůĂĚƵůƚƉŽƉƵůĂƟŽŶĂůďƵŵŝŶƵƌŝĂůĞǀĞůƐĚŝīĞƌƐƵďƐƚĂŶƟĂůůLJďĞƚǁĞĞŶ} ŝŶĚŝǀŝĚƵĂůƐĂŶĚŵŝĐƌŽĂůďƵŵŝŶƵƌŝĂŝƐƉƌĞǀĂůĞŶƚŝŶĂƉƉƌŽdžŝŵĂƚĞůLJϳйŽĨƚŚĞŝŶĚŝǀŝĚƵĂůƐ͘7 _We ƌĞĐĞŶƚůLJƐŚŽǁĞĚƚŚĂƚĂůďƵŵŝŶƵƌŝĂůĞǀĞůƐƐŚŽǁĂǁŝĚĞǀĂƌŝĂďŝůŝƚLJďĞƚǁĞĞŶƚŽĚĚůĞƌƐĂŶĚ ƚŚĂƚŵŝĐƌŽĂůďƵŵŝŶƵƌŝĂŝƐĂůƐŽƉƌĞƐĞŶƚŝŶĂƉƉƌŽdžŝŵĂƚĞůLJϳйŽĨƚŚĞƚŽĚĚůĞƌƉŽƉƵůĂƟŽŶ͘8 ƐŽƉƉŽƐĞĚƚŽĂĚƵůƚƐ͕ƚŚĞĐŽůůĞĐƟŽŶŽĨƵƌŝŶĞĨŽƌĂůďƵŵŝŶŵĞĂƐƵƌĞŵĞŶƚƐŝŶƚŽĚĚůĞƌƐ ŝƐĐƵŵďĞƌƐŽŵĞ͘DŽĚĞƌŶĚŝĂƉĞƌƐĂƌĞĞdžƚƌĞŵĞůLJĞĸĐŝĞŶƚŝŶƌĞƚĂŝŶŝŶŐƵƌŝŶĞ͕ƚŚƵƐŽůĚ ĨĂƐŚŝŽŶĞĚĐŽƩŽŶǁŽŽůŽƌŵŽĚĞƌŶƉĂŶƚLJůŝŶĞƌƐĂƌĞŽŌĞŶƵƐĞĚƚŽŚĞůƉƌĞĐŽǀĞƌŝŶŐƚŚĞƵƌŝŶĞ͘ dŚŝƐƚĞĐŚŶŝƋƵĞŝƐŶŽƚŽŶůLJ͚ŵĞƐƐLJ͛ďƵƚĚŽĞƐĂůƐŽŶŽƚƌĞƐƵůƚŝŶƌĞƉƌŽĚƵĐŝďůĞƌĞƐƵůƚƐ͘9,10 ŶĂůƚĞƌŶĂƟǀĞǁĂƐĨŽƵŶĚŝŶƚĂƉĞĚƉůĂƐƟĐďĂŐƐǁŚŝĐŚĂƌĞĨƌĞƋƵĞŶƚůLJƵƐĞĚŝŶĐůŝŶŝĐĂů ƉƌĂĐƟĐĞ͘,ŽǁĞǀĞƌƚŚĞƐĞŚĂǀĞƚŚĞĚŝƐĂĚǀĂŶƚĂŐĞƚŚĂƚƚŚĞLJĚĞƚĂĐŚĞĂƐŝůLJĂŶĚĂƉƉĞĂƌƚŽ ďĞƵŶĐŽŵĨŽƌƚĂďůĞ͘9_{ZĞĐĞŶƚůLJ͕ĂŶŽǀĞůĚĞǀŝĐĞĨŽƌĐŽůůĞĐƟŶŐƵƌŝŶĞŝŶĐŚŝůĚƌĞŶŚĂƐďĞĞŶ} ĚĞǀĞůŽƉĞĚ͕ƐŽͲĐĂůůĞĚWĞĞ^ƉŽƚ;&ŝŐƵƌĞϭͿ͕ǁŚŝĐŚƉŽƚĞŶƟĂůůLJĂůůŽǁƐĨŽƌŵŽƌĞƌĞůŝĂďůĞĂŶĚ ĞĂƐLJƚŽƵƐĞŵĞĂƐƵƌĞŵĞŶƚƐ͘/ŶƚŚŝƐƐƚƵĚLJǁĞĐŽŵƉĂƌĞĚƚŚĞĂŶĂůLJƟĐĂůƉĞƌĨŽƌŵĂŶĐĞŽĨƚŚĞ ƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚǁŝƚŚƚŚĞWĞĞ^ƉŽƚŵĞƚŚŽĚ͘ Figure 1. 7KH3HH6SRWV\VWHP8ULQHDEVRUSWLRQSDGLVSODFHGLQGLDSHUDQGUHPRYHGDIWHU YRLGLQJXVLQJWKHKDQGJULS+DQGJULSZLWKWKHXULQHDEVRUSWLRQSDGLVSODFHGLQWKH WUDQVSRUWWXEHFORVHGZLWKWKHVFUHZFDS

Methods

hƌŝŶĞƐĂŵƉůĞƐǁĞƌĞĐŽůůĞĐƚĞĚĨƌŽŵĐŚŝůĚƌĞŶǁŚŽǀŝƐŝƚĞĚƚŚĞŽƵƚƉĂƟĞŶƚĐůŝŶŝĐŝŶƚŚĞ ĚĞƉĂƌƚŵĞŶƚŽĨƉĞĚŝĂƚƌŝĐŶĞƉŚƌŽůŽŐLJŽĨƚŚĞhŶŝǀĞƌƐŝƚLJDĞĚŝĐĂůĞŶƚĞƌ'ƌŽŶŝŶŐĞŶ͘^ĂŵƉůĞƐ ǁĞƌĞƉƌŽĐĞƐƐĞĚĂŶŽŶLJŵŽƵƐůLJĂŶĚƉĂƟĞŶƚƐĂŶĚƉĂƌĞŶƚƐŐĂǀĞƉĞƌŵŝƐƐŝŽŶĨŽƌƵƐĞŽĨƚŚĞ ƵƌŝŶĞŝŶƚŚŝƐƐƚƵĚLJ͘ƚŚŝĐĂůĂƉƉƌŽǀĂůǁĂƐŶŽƚŶĞĞĚĞĚĨŽƌƚŚŝƐƐƚƵĚLJ͕ĂƐĚĞƚĞƌŵŝŶĞĚďLJdŚĞ DĞĚŝĐĂůƚŚŝĐƐŽŵŵŝƩĞĞŽĨƚŚĞhŶŝǀĞƌƐŝƚLJDĞĚŝĐĂůĞŶƚĞƌ'ƌŽŶŝŶŐĞŶŝŶƚŚĞEĞƚŚĞƌůĂŶĚƐ͘ &Žƌ ƚŚĞ ŵĞƚŚŽĚ ĐŽŵƉĂƌŝƐŽŶ͕ ƚŚĞ ƉĂŶƚLJůŝŶĞƌ ŵĞƚŚŽĚ ĂŶĚ ƚŚĞ WĞĞ^ƉŽƚ ŵĞƚŚŽĚ ;,ĞƐƐĞůƐн'ƌŽď͕ >ŝĞƌĞŶ͕ ƚŚĞ EĞƚŚĞƌůĂŶĚƐͿ ĂƌĞ ĐŽŵƉĂƌĞĚ ƚŽ Ă ƌĞĨĞƌĞŶĐĞ ;ƌĞĨĞƌƌĞĚ ƚŽ ĂƐ͚ƐƚĂŶĚĂƌĚŵĞƚŚŽĚ͛Ϳ͘hƌŝŶĞƐĂŵƉůĞƐǁĞƌĞƉŝƉĞƩĞĚŽŶĂƉĂŶƚLJůŝŶĞƌĂŶĚWĞĞ^ƉŽƚŝŶ

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518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 42PDF page: 42PDF page: 42PDF page: 42

42 ĚƵƉůŝĐĂƚĞ͘dŚĞƉĂŶƚLJůŝŶĞƌĂŶĚWĞĞ^ƉŽƚǁĞƌĞƐƚŽƌĞĚĨŽƌϯŚŽƵƌƐŝŶĂƐƚŽǀĞĂƚϯϳΣƚŽ ƐŝŵƵůĂƚĞƚŚĞƟŵĞĂƚŽĚĚůĞƌǁĞĂƌƐĂĚŝĂƉĞƌ͘ŌĞƌϯŚŽƵƌƐƚŚĞƉĂŶƚLJůŝŶĞƌĂŶĚĂďƐŽƌƉƟŽŶ ĮůƚĞƌŽĨƚŚĞWĞĞ^ƉŽƚǁĞƌĞƌĞŵŽǀĞĚĨƌŽŵƚŚĞƐƚŽǀĞĂŶĚƐƚŽƌĞĚĨŽƌϳϮŚŽƵƌƐĂƚƌŽŽŵ ƚĞŵƉĞƌĂƚƵƌĞƚŽƐŝŵƵůĂƚĞƚŚĞƟŵĞĨŽƌƐĞŶĚŝŶŐƚŚĞƉĂŶƚLJůŝŶĞƌŽƌĂďƐŽƌƉƟŽŶĮůƚĞƌƚŽĂ ĐĞŶƚƌĂůůĂďŽƌĂƚŽƌLJ͘ŌĞƌϳϮŚŽƵƌƐ͕ƚŚĞƉĂŶƚLJůŝŶĞƌƐǁĞƌĞŽƉĞŶĞĚ͕ƚŚĞĐŽƩŽŶǁŽŽůǁĂƐ ƉůĂĐĞĚŝŶĂĐĞŶƚƌŝĨƵŐĞƚƵďĞ;YŝĂŶŐĞŶ͕Y/ƐŚƌĞĚĚĞƌŵŝŶŝƐƉŝŶĐŽůƵŵŶͿ͕ĂŶĚƚŚĞƚƵďĞƐ ǁĞƌĞĐĞŶƚƌŝĨƵŐĞĚĂƚϭϬϬϬϬƌƉŵĨŽƌϭϬŵŝŶƵƚĞƐ;ZŽƟŶĂϯϱZͿ͘dŚĞĂďƐŽƌƉƟŽŶĮůƚĞƌƐŽĨƚŚĞ WĞĞ^ƉŽƚǁĞƌĞƉůĂĐĞĚǁŝƚŚŝŶƚŚĞŚŽůĚĞƌŝŶƚŚĞƚƵďĞĂŶĚĐĞŶƚƌŝĨƵŐĞĚĂƚϯϱϬ'ĨŽƌϱŵŝŶƵƚĞƐ ;ZŽƟŶĂϯϱZͿ͘dŚĞŽďƚĂŝŶĞĚƵƌŝŶĞƐĂŵƉůĞƐǁĞƌĞƉŝƉĞƩĞĚŝŶĐƵƉƐĂŶĚƵƌŝŶĂƌLJĂůďƵŵŝŶ ĐŽŶĐĞŶƚƌĂƟŽŶ;h_ͿĂŶĚĐƌĞĂƟŶŝŶĞĐŽŶĐĞŶƚƌĂƟŽŶǁĞƌĞŵĞĂƐƵƌĞĚǁŝƚŚZŽĐŚĞDŽĚƵůĂƌ W ;DĂŶŶŚĞŝŵ͕ 'ĞƌŵĂŶLJͿ͕ ƵƐŝŶŐ ƌĞƐƉĞĐƟǀĞůLJ ƚŚĞ ŝŵŵƵŶŽƚƵƌďŝŵĞƚƌŝĐ ĂƐƐĂLJ ĂŶĚ ƚŚĞ ĞŶnjLJŵĂƟĐŵĞƚŚŽĚ͘ƐƌĞĨĞƌĞŶĐĞ͕ǁĞƐƚŽƌĞĚĂƚƵďĞŽĨƚŚĞƐĂŵĞƵƌŝŶĞŝŶƚŚĞƌĞĨƌŝŐĞƌĂƚŽƌ ĂƚϰΣĨŽƌϳϱŚŽƵƌƐ͕ĂŶĚŵĞĂƐƵƌĞĚĂůďƵŵŝŶĂŶĚĐƌĞĂƟŶŝŶĞĐŽŶĐĞŶƚƌĂƟŽŶĂŌĞƌǁĂƌĚƐ͘ &ŽƌƚŚĞǀĂůŝĚĂƟŽŶŽĨƚŚĞƵƌŝŶĞĐŽůůĞĐƟŽŶŵĞƚŚŽĚƐ͕ƚŚĞEĂƟŽŶĂůŽŵŵŝƩĞĞĨŽƌůŝŶŝĐĂů >ĂďŽƌĂƚŽƌLJ^ƚĂŶĚĂƌĚƐ;E>^ͿŐƵŝĚĞůŝŶĞƐĨŽƌŵĞƚŚŽĚĐŽŵƉĂƌŝƐŽŶǁĞƌĞƵƐĞĚ͘11_{ĐĐŽƌĚŝŶŐ} ƚŚĞE>^ŐƵŝĚĞůŝŶĞƐĂƚůĞĂƐƚϰϬƐĂŵƉůĞƐĂĐƌŽƐƐƚŚĞĞdžƉĞĐƚĞĚĐŽŶĐĞŶƚƌĂƟŽŶƌĂŶŐĞŚĂǀĞ ƚŽďĞĂŶĂůLJnjĞĚĨŽƌŵĞƚŚŽĚĐŽŵƉĂƌŝƐŽŶ͘/ŶƚŚŝƐƐƚƵĚLJϴϭƵƌŝŶĞƐĂŵƉůĞƐǁĞƌĞĂŶĂůLJnjĞĚŝŶ ĚƵƉůŝĐĂƚĞ͘dŚĞŵĞĂŶŽĨƚŚĞƚǁŽŵĞĂƐƵƌĞŵĞŶƚƐǁĂƐƵƐĞĚĨŽƌĂŶĂůLJƐŝƐ͘ŝīĞƌĞŶĐĞďĞƚǁĞĞŶ ŵĞĚŝĂŶĂůďƵŵŝŶƵƌŝĂĐŽŶĐĞŶƚƌĂƟŽŶƐǁĂƐĂƐƐĞƐƐĞĚǁŝƚŚƉĂŝƌĞĚƐĂŵƉůĞdͲƚĞƐƚŽŶƚŚĞ ůŽŐĂƌŝƚŚŵŽĨĂůďƵŵŝŶƵƌŝĂĐŽŶĐĞŶƚƌĂƟŽŶƐ͘WĞƌĨŽƌŵĂŶĐĞŽĨƚŚĞƉĂŶƚLJůŝŶĞƌĂŶĚWĞĞ^ƉŽƚ ǁĂƐĚĞƚĞƌŵŝŶĞĚďLJĐĂůĐƵůĂƟŶŐďŝĂƐ͕ƉƌĞĐŝƐŝŽŶĂŶĚĂĐĐƵƌĂĐLJĂƐĚĞƐĐƌŝďĞĚĞĂƌůŝĞƌ͘12,13_ŝĂƐ ǁĂƐĚĞĮŶĞĚĂƐƚŚĞŵĞĚŝĂŶĚŝīĞƌĞŶĐĞďĞƚǁĞĞŶƚŚĞƐƚĂŶĚĂƌĚŵĞƚŚŽĚĂŶĚƚŚĞƚĞƐƚŵĞƚŚŽĚ ;ƉĂŶƚLJůŝŶĞƌŽƌWĞĞ^ƉŽƚŵĞƚŚŽĚͿ͘WƌĞĐŝƐŝŽŶŽĨƚŚĞĚŝīĞƌĞŶĐĞďĞƚǁĞĞŶƚŚĞƚĞƐƚŵĞƚŚŽĚĂŶĚ ƐƚĂŶĚĂƌĚŵĞƚŚŽĚŝƐƌĞƉƌĞƐĞŶƚĞĚďLJƚŚĞŝŶƚĞƌƋƵĂƌƟůĞƌĂŶŐĞŽĨƚŚĞĚŝīĞƌĞŶĐĞďĞƚǁĞĞŶƚŚĞ ƐƚĂŶĚĂƌĚŵĞƚŚŽĚĂŶĚƚĞƐƚŵĞƚŚŽĚ͘ĐĐƵƌĂĐLJŝƐĐĂůĐƵůĂƚĞĚĂƐƚŚĞƉƌŽƉŽƌƟŽŶŽĨǀĂůƵĞƐ ŽĨƚŚĞƚĞƐƚŵĞƚŚŽĚǁŝƚŚŝŶцϯϬйŽĨƚŚĞƐƚĂŶĚĂƌĚŵĞƚŚŽĚ͘dŚĞƌĂŶŐĞŽĨϯϬйǁĂƐĐŚŽƐĞŶ ďĂƐĞĚŽŶƉƌŝŽƌŵĞƚŚŽĚĐŽŵƉĂƌŝƐŽŶƐƚƵĚŝĞƐŝŶŶĞƉŚƌŽůŽŐLJŝŶǁŚŝĐŚĂϯϬйƌĂŶŐĞĨŽƌ ĂĐĐƵƌĂĐLJǁĂƐƵƐĞĚ͘12-14_{dŚĞƌĞƉĞĂƚĂďŝůŝƚLJŽĨƚŚĞƐƚĂŶĚĂƌĚŵĞƚŚŽĚ͕ƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚ} ĂŶĚWĞĞ^ƉŽƚŵĞƚŚŽĚǁĞƌĞĚĞƚĞƌŵŝŶĞĚďLJĐĂůĐƵůĂƟŶŐƚŚĞŵĞĂŶŽĨƚŚĞĚŝīĞƌĞŶĐĞĂŵŽŶŐ ĚƵƉůŝĐĂƚĞŵĞĂƐƵƌĞŵĞŶƚƐŽĨĞĂĐŚŵĞƚŚŽĚ͘dŚĞƐĞŶƐŝƟǀŝƚLJĂŶĚƐƉĞĐŝĮĐŝƚLJĨŽƌŝŶĐƌĞĂƐĞĚ ĂůďƵŵŝŶƵƌŝĂ;h_шϮϬŵŐͬ>ͿŽĨƚŚĞƉĂŶƚLJůŝŶĞƌĂŶĚWĞĞ^ƉŽƚǁĞƌĞĂůƐŽĐĂůĐƵůĂƚĞĚ͘WĂƐƐŝŶŐͲ ĂďůŽŬƌĞŐƌĞƐƐŝŽŶǁĂƐƉĞƌĨŽƌŵĞĚƚŽĚĞƚĞƌŵŝŶĞĂŶĂůLJƟĐĂůĂĐĐƵƌĂĐLJ͘ůĂŶĚͲůƚŵĂŶƉůŽƚƐ ǁĞƌĞĐƌĞĂƚĞĚƚŽĂƐƐĞƐƐďŝĂƐ͘

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 43PDF page: 43PDF page: 43PDF page: 43

43

Results

DĞĚŝĂŶƵƌŝŶĂƌLJĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶǁĂƐϲϲ͘ϬŵŐͬ>΀Ϯϱth_-75th_{ƉĞƌĐĞŶƟůĞϮϱ͘ϬʹϮϭϭ͘Ϭ} ŵŐͬ>΁͕ŵĞĚŝĂŶƵƌŝŶĂƌLJĂůďƵŵŝŶ͗ĐƌĞĂƟŶŝŶĞƌĂƟŽŶ;h_ZͿǁĂƐϮϯ͘ϯŵŐͬŵŵŽů΀ϲ͘ϲͲϲϮ͘ϳŵŐͬ ŵŵŽů΁ŝŶƚŚĞƌĞĨĞƌĞŶĐĞƐĂŵƉůĞƐ͘/ŶĐŽŵƉĂƌŝƐŽŶ͕ŵĞĚŝĂŶƵƌŝŶĂƌLJĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶ ĨƌŽŵƚŚĞƉĂŶƚLJůŝŶĞƌǁĂƐϯϮ͘ϬŵŐͬ>΀ϰ͘ϳʹϭϲϱ͘ϬŵŐͬ>͕WфϬ͕ϬϬϭǀƐƌĞĨĞƌĞŶĐĞƐĂŵƉůĞ΁ĂŶĚ ĨƌŽŵƚŚĞWĞĞ^ƉŽƚǁĂƐϲϭ͘ϬŵŐͬ>΀Ϯϳ͘ϬʹϮϭϲ͘ϬŵŐͬ>͕WсϬ͘ϴϰ΁͘DĞĚŝĂŶh_ZǁĂƐϴ͘ϴŵŐͬ ŵŵŽů΀ϭ͘ϳʹϯϴ͘ϵŵŐͬŵŵŽů͕WфϬ͘ϬϬϭ΁ŝŶƚŚĞƉĂŶƚLJůŝŶĞƌĂŶĚϮϯ͘ϵŵŐͬŵŵŽů΀ϳ͘ϭʹϲϴ͘ϯ ŵŐͬŵŵŽů͕WсϬ͘ϱϯ΁ŝŶƚŚĞWĞĞ^ƉŽƚ͘dĂďůĞϭƐŚŽǁƐƚŚĞŽǀĞƌĂůůĂŶĂůLJƟĐĂůƉĞƌĨŽƌŵĂŶĐĞ ŽĨƚŚĞƚǁŽƚĞƐƚŵĞƚŚŽĚƐĐŽŵƉĂƌĞĚƚŽƚŚĞƐƚĂŶĚĂƌĚŵĞƚŚŽĚ͘ŝĂƐĂŶĚƉƌĞĐŝƐŝŽŶǁĞƌĞ ŵĂƌŬĞĚůLJŚŝŐŚĞƌĂŶĚĂĐĐƵƌĂĐLJůŽǁĞƌǁŝƚŚƚŚĞƉĂŶƚLJůŝŶĞƌĐŽŵƉĂƌĞĚƚŽƚŚĞWĞĞ^ƉŽƚ͘dŚĞ ůĂŶĚůƚŵĂŶƉůŽƚƐŚŽǁĞĚĂŶƵŶĚĞƌĞƐƟŵĂƟŽŶŽĨƚŚĞƵƌŝŶĂƌLJĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶĨŽƌ ƚŚĞƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚďƵƚŶŽƚĨŽƌƚŚĞWĞĞ^ƉŽƚ;&ŝŐƵƌĞϮͿ͘ZĞƐƵůƚƐǁĞƌĞƐŝŵŝůĂƌǁŚĞŶh_Z ŝŶƐƚĞĂĚŽĨh_ǁĂƐƵƐĞĚ;^ƵƉƉůĞŵĞŶƚĂůĮŐƵƌĞϭͿ͘&ŽƌƚŚĞƉĂŶƚLJůŝŶĞƌ͕ƚŚĞŵĞĂŶĚŝīĞƌĞŶĐĞ ǁĂƐͲϯϮ͘ϮŵŐͬ>;ϵϱй>ŝŵŝƚŽĨŐƌĞĞŵĞŶƚ;>ŽͿͲϭϵϴ͘ϲƚŽϭϯϰ͘ϮŵŐͬ>Ϳ͘&ŽƌƚŚĞWĞĞ^ƉŽƚ͕ ƚŚĞŵĞĂŶĚŝīĞƌĞŶĐĞǁĂƐϰ͘ϴŵŐͬ>;ϵϱй>ŽͲϮϳ͘ϲƚŽϯϳ͘ϯŵŐͬ>Ϳ͘dŚĞƌĞƉĞĂƚĂďŝůŝƚLJŽĨ ƚŚĞƐƚĂŶĚĂƌĚŵĞƚŚŽĚǁĂƐϮ͘ϲŵŐͬ>͕ŽĨƚŚĞƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚϯϱ͘ϰŵŐͬ>͕ĂŶĚŽĨƚŚĞ WĞĞ^ƉŽƚŵĞƚŚŽĚϰ͘ϵŵŐͬ>͘dŚĞƐĞŶƐŝƟǀŝƚLJĂŶĚƐƉĞĐŝĮĐŝƚLJĨŽƌĚĞƚĞĐƟŽŶŽĨƵƌŝŶĂƌLJĂůďƵŵŝŶ ĐŽŶĐĞŶƚƌĂƟŽŶхϮϬŵŐͬ>ǁĞƌĞϲϰ͘ϮйĂŶĚϭϬϬйĨŽƌƚŚĞƉĂŶƚLJůŝŶĞƌĂŶĚϭϬϬйĂŶĚϵϯ͘ϯй ĨŽƌƚŚĞWĞĞ^ƉŽƚ͘

Table 1 $QDO\WLFDO SHUIRUPDQFH PHDVXUHV RI SDQW\OLQHU DQG 3HH6SRW PHWKRG YHUVXV standard method

Performance measure Pantyliner PeeSpot

hƌŝŶĂƌLJůďƵŵŝŶŽŶĐĞŶƚƌĂƟŽŶ ŝĂƐ;ŵŐͬ>Ϳ Ͳϭϰ͘Ϭ Ϯ͘ϱ ŝĂƐ;йͿ Ͳϯϰ͘Ϯ ϯ͘ϯ WƌĞĐŝƐŝŽŶ;ŵŐͬ>Ϳ ϯϭ͘ϯ ϱ͘Ϭ WƌĞĐŝƐŝŽŶ;йͿ ϳϭ͘Ϯ ϰ͘ϯ ĐĐƵƌĂĐLJ;йͿ ϰϴ͘ϭ ϵϲ͘ϯ ůďƵŵŝŶ͗ƌĞĂƟŶŝŶĞƌĂƟŽ ŝĂƐ;ŵŐͬŵŵŽůͿ ͲϮ͘ϲ Ϭ͘ϳ ŝĂƐ;йͿ Ͳϯϯ͘ϯ ϯ͘ϰ WƌĞĐŝƐŝŽŶ;ŵŐͬŵŵŽůͿ ϭϰ͘Ϯ ϭ͘ϵ WƌĞĐŝƐŝŽŶ;йͿ ϳϰ͘ϴ ϲ͘ϯ ĐĐƵƌĂĐLJ;йͿ ϰϲ͘ϵ ϵϮ͘ϲ

3

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 44PDF page: 44PDF page: 44PDF page: 44

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 45PDF page: 45PDF page: 45PDF page: 45

45

Discussion

/ŶƚŚŝƐƐƚƵĚLJǁĞĐŽŵƉĂƌĞĚƚǁŽŵĞƚŚŽĚƐĨŽƌŵĞĂƐƵƌŝŶŐĂůďƵŵŝŶƵƌŝĂŝŶLJŽƵŶŐĐŚŝůĚƌĞŶ͘ tĞƐŚŽǁĞĚƚŚĂƚƚŚĞƌĞĐĞŶƚůLJĚĞǀĞůŽƉĞĚWĞĞ^ƉŽƚĚĞǀŝĐĞƉƌŽǀŝĚĞƐŚŝŐŚůLJĂĐĐƵƌĂƚĞĂŶĚ ƉƌĞĐŝƐĞŵĞĂƐƵƌĞŵĞŶƚƌĞƐƵůƚƐĂŶĚƉĞƌĨŽƌŵƐŵĂƌŬĞĚůLJďĞƩĞƌŝŶŵĞĂƐƵƌŝŶŐƵƌŝŶĂƌLJĂůďƵŵŝŶ ĐŽŵƉĂƌĞĚƚŽƚŚĞƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚ͘ tŚLJǁĂƐƚŚĞƉĞƌĨŽƌŵĂŶĐĞŽĨƚŚĞƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚůĞƐƐƚŚĂŶƚŚĞWĞĞ^ƉŽƚ͍tŚĞŶ ǁĞĞǀĂůƵĂƚĞĚĂůůŝŶĚŝǀŝĚƵĂůŵĞĂƐƵƌĞŵĞŶƚƌĞƐƵůƚƐǁĞŶŽƚĞĚƚŚĂƚŝŶϯϭ;ϭϵ͘ϭйͿƐĂŵƉůĞƐ ƚŚĞĐŽŶĐĞŶƚƌĂƟŽŶŵĞĂƐƵƌĞĚďLJƚŚĞƉĂŶƚLJůŝŶĞƌǁĂƐďĞůŽǁƚŚĞĚĞƚĞĐƟŽŶůŝŵŝƚǁŚĞƌĞĂƐ ƚŚĞĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶŝŶƚŚĞƌĞĨĞƌĞŶĐĞƐĂŵƉůĞƐǁĂƐĨĂƌĂďŽǀĞƚŚĞĚĞƚĞĐƟŽŶůŝŵŝƚ͕ ǁŝƚŚĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶƐǀĂƌLJŝŶŐĨƌŽŵϳ͘ϵƚŽϱϮϱŵŐͬ>͘/ŶƚŚĞƌĞŵĂŝŶŝŶŐƐĂŵƉůĞƐ ƚŚĞĂůďƵŵŝŶĐŽŶĐĞŶƚƌĂƟŽŶĐŽƌƌĞƐƉŽŶĚĞĚǁĞůůǁŝƚŚƚŚĞƌĞĨĞƌĞŶĐĞƐĂŵƉůĞƐ͘KďǀŝŽƵƐůLJ͕ ƚŚŝƐĞīĞĐƚŚĂĚĂďŝŐŝŵƉĂĐƚŽŶƚŚĞƉĞƌĨŽƌŵĂŶĐĞŽĨƚŚĞƉĂŶƚLJůŝŶĞƌŵĞƚŚŽĚ͘ƐŝŵŝůĂƌ ƉŚĞŶŽŵĞŶŽŶŚĂƐďĞĞŶŽďƐĞƌǀĞĚŝŶĂƐƚƵĚLJƚŚĂƚŝŶǀĞƐƟŐĂƚĞĚƚŚĞƌĞĐŽǀĞƌLJŽĨĂůďƵŵŝŶ ǁŚĞŶƵƐŝŶŐĐŽƩŽŶďĂůůƐĂƐĂƵƌŝŶĞĐŽůůĞĐƟŽŶƚĞĐŚŶŝƋƵĞ͘15_{tĞŚĂǀĞŶŽĐůĞĂƌĞdžƉůĂŶĂƟŽŶ} ĨŽƌƚŚŝƐĞīĞĐƚďƵƚŝƚŵĂLJďĞƉŽƐƐŝďůĞƚŚĂƚĂůďƵŵŝŶďŝŶĚƐƚŽƚŚĞĐŽƩŽŶǁŽŽůŝŶƚŚĞ ĐĞŶƚƌŝĨƵŐĞƚƵďĞĂŶĚƚŚĞƌĞĨŽƌĞŝƐŶŽƚƉƌĞƐĞŶƚŝŶƚŚĞĮŶĂůƵƌŝŶĞĂŌĞƌĐĞŶƚƌŝĨƵŐŝŶŐ͘tĞ ƚĞƐƚĞĚǁŚĞƚŚĞƌƚŚŝƐĞīĞĐƚĐŽƵůĚďĞǀŝƐƵĂůŝnjĞĚĂŶĚƋƵĂŶƟĮĞĚďLJƵƐŝŶŐŇƵŽƌĞƐĐĞŶƚĂƐƐĂLJƐ ŽƌƐƉĞĐŝĮĐƉƌŽƚĞŝŶĂƐƐĂLJƐĨŽƌŚƵŵĂŶĂůďƵŵŝŶďƵƚƚŚĞĂƵƚŽͲŇƵŽƌĞƐĐĞŶƚĐŽƩŽŶǁŽŽůŽĨƚŚĞ ƉĂŶƚLJůŝŶĞƌƉƌĞǀĞŶƚĞĚǀŝƐƵĂůŝnjĂƟŽŶĂŶĚǀĞƌŝĮĐĂƟŽŶŽĨƚŚŝƐƉŽƐƐŝďŝůŝƚLJ͘ dŚĞ ƉŽŽƌ ƌĞĐŽǀĞƌLJ ŽĨ ĂůďƵŵŝŶ ŝŶ ƐŽŵĞ ĐŚŝůĚƌĞŶ ƵƐŝŶŐ ƚŚĞ ƉĂŶƚLJůŝŶĞƌ ƚĞĐŚŶŝƋƵĞ ŵĂLJŚĂǀĞŝŶŇƵĞŶĐĞĚƌĞƐƵůƚƐŽĨƉƌĞǀŝŽƵƐƐƚƵĚŝĞƐ͘/ŶĂƉƌŝŽƌƐƚƵĚLJǁĞƌĞƉŽƌƚĞĚůĂƌŐĞ ĚŝīĞƌĞŶĐĞƐŝŶĂůďƵŵŝŶƵƌŝĂďĞƚǁĞĞŶLJŽƵŶŐĐŚŝůĚƌĞŶ͕ĂŶĚĨŽƵŶĚƚŚĂƚƚŚĞƉƌĞǀĂůĞŶĐĞŽĨ ŵŝĐƌŽĂůďƵŵŝŶƵƌŝĂŝŶƚŽĚĚůĞƌƐĞƋƵĂůƐƚŚĞƉƌĞǀĂůĞŶĐĞŽĨŵŝĐƌŽĂůďƵŵŝŶƵƌŝĂŝŶƚŚĞŐĞŶĞƌĂů ĂĚƵůƚƉŽƉƵůĂƟŽŶ͘dŚĞƐĞƌĞƐƵůƚƐŵĂLJŚĂǀĞďĞĞŶďŝĂƐĞĚďLJƚŚĞĐŽůůĞĐƟŽŶƚĞĐŚŶŝƋƵĞ͘ ,ŽǁĞǀĞƌ͕ƚŚŝƐďŝĂƐŝƐŶŽƚůŝŬĞůLJƚŽŚĂǀĞŚĂĚĂďŝŐŝŶŇƵĞŶĐĞŽŶƚŚĞĐŽŶĐůƵƐŝŽŶƐŽĨƚŚĂƚ ƐƚƵĚLJ͕ƐŝŶĐĞ͕ŝŶĂŶLJĐĂƐĞ͕ƚŚĞďŝŶĚŝŶŐŽĨĂůďƵŵŝŶƚŽƚŚĞĐŽƩŽŶǁŽŽůǁŽƵůĚŚĂǀĞƌĞƐƵůƚĞĚ ŝŶĂŶƵŶĚĞƌĞƐƟŵĂƟŽŶŽĨƚŚĞƉƌĞǀĂůĞŶĐĞŽĨŵŝĐƌŽĂůďƵŵŝŶƵƌŝĂŝŶĐŚŝůĚƌĞŶ͘ ƉĂƌƚĨƌŽŵďĞŝŶŐŵŽƌĞĂĐĐƵƌĂƚĞĂŶĚƉƌĞĐŝƐĞ͕ƚŚĞƌĞĂƌĞƐĞǀĞƌĂůŽƚŚĞƌĂĚǀĂŶƚĂŐĞƐ ŽĨƚŚĞWĞĞ^ƉŽƚĨŽƌƵƐĞŝŶĐůŝŶŝĐĂůƉƌĂĐƟĐĞ͘&ŝƌƐƚ͕ƚŚĞWĞĞ^ƉŽƚŵĞƚŚŽĚŝƐĞĂƐŝĞƌŝŶŝƚƐƵƐĞ ďĞĐĂƵƐĞĨĞůƚƐĐĂŶďĞĐĞŶƚƌŝĨƵŐĞĚŝŶƐƚĂŶƚĂŶĞŽƵƐůLJ͘/ŶĐŽŶƚƌĂƐƚ͕ƚŚĞƉĂŶƚLJůŝŶĞƌƌĞƋƵŝƌĞƐ ŵŽƌĞŚĂŶĚůŝŶŐƉƌŽĐĞĚƵƌĞƐƐŝŶĐĞƚŚĞĐŽƩŽŶǁŽŽůŚĂƐƚŽďĞĞdžƚƌĂĐƚĞĚĨƌŽŵƚŚĞƉĂŶƚLJůŝŶĞƌ ĮƌƐƚ͘DŽƌĞŽǀĞƌ͕ƚŚĞWĞĞ^ƉŽƚŵĞƚŚŽĚŝƐŵŽƌĞŚLJŐŝĞŶŝĐĂƐƚŚĞŵĞƚŚŽĚĂůůŽǁƐƉƌŽĐĞƐƐŝŶŐ

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3

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 46PDF page: 46PDF page: 46PDF page: 46

46 ŽĨƚŚĞƵƌŝŶĞǁŝƚŚŽƵƚƚŽƵĐŚŝŶŐŝƚďLJŚĂŶĚĂŶĚŝƐŵŽƌĞĐŽŶǀĞŶŝĞŶƚƚŽƵƐĞŝŶĂůƌĞĂĚLJƉŽƩLJͲ ƚƌĂŝŶĞĚƚŽĚĚůĞƌƐƚŚĂŶƉĂŶƚLJůŝŶĞƌƐ͘ dŚĞƌĞĂƌĞĂĨĞǁůŝŵŝƚĂƟŽŶƐƚŽŽƵƌƐƚƵĚLJ͘tĞƚƌŝĞĚƚŽƐŝŵƵůĂƚĞĂƐĐůŽƐĞĂƐƉŽƐƐŝďůĞ ƚŚĞĐŽŶĚŝƟŽŶƐŽĨƵƌŝŶĞŝŶĂĚŝĂƉĞƌŝŶƌĞĂůůŝĨĞ͘EĞǀĞƌƚŚĞůĞƐƐ͕ǁĞŵĂLJŚĂǀĞŵŝƐƐĞĚĐĞƌƚĂŝŶ ƐƉĞĐŝĮĐĐŝƌĐƵŵƐƚĂŶĐĞƐǁŚŝĐŚĐŽƵůĚŚĂǀĞďŝĂƐĞĚŽƵƌƌĞƐƵůƚƐ͘tĞǁĞƌĞĂůƐŽƵŶĂďůĞƚŽĮŶĚ ƚŚĞĐĂƵƐĞŽĨƚŚĞƉŽŽƌĂůďƵŵŝŶƌĞĐŽǀĞƌLJŝŶƐŽŵĞŽĨƚŚĞƉĂŶƚLJůŝŶĞƌƐĂŵƉůĞƐ͘ /ŶĐŽŶĐůƵƐŝŽŶ͕ŽĨĂůůƚŚĞĂǀĂŝůĂďůĞŵĞƚŚŽĚƐƚŽĐŽůůĞĐƚƵƌŝŶĞŝŶLJŽƵŶŐŶŽŶĐŽŶƟŶĞŶƚ ĐŚŝůĚƌĞŶ͕ǁĞƉƌĞĨĞƌƚŚĞWĞĞ^ƉŽƚĂƐƚŚĞŵĞƚŚŽĚŝƐŵŽƌĞĂĐĐƵƌĂƚĞ͕ƉƌĞĐŝƐĞ͕ĂŶĚƉƌĂĐƟĐĂů ŝŶƵƐĞ͘

Disclosures

ĚĞĞĞƵǁŚĂƐĐŽŶƐƵůƚĂŶĐLJĂŐƌĞĞŵĞŶƚƐǁŝƚŚƚŚĞĨŽůůŽǁŝŶŐĐŽŵƉĂŶŝĞƐ͗ďďǀŝĞ͕ƐƚĞůůĂƐ͕ ŚĞŵŽĐĞŶƚƌLJdž͕ůŝͲ>ŝůůLJ͕&ƌĞƐĞŶŝƵƐ͕:ŽŚŶƐŽŶΘ:ŽŚŶƐŽŶ͕DĞƌĐŬĂƌŵƐƚĂĚƚ͘ůůŚŽŶŽƌĂƌŝĂ ĂƌĞƉĂŝĚƚŽŚŝƐŝŶƐƟƚƵƟŽŶ͘,:>,ĞĞƌƐƉŝŶŬŚĂƐĐŽŶƐƵůƚĂŶĐLJĂŐƌĞĞŵĞŶƚƐǁŝƚŚƚŚĞĨŽůůŽǁŝŶŐ ĐŽŵƉĂŶŝĞƐ͗ďďǀŝĞ͕ƐƚĞůůĂƐ͕ƐƚƌĂĞŶĞĐĂ͕ŽĞŚƌŝŶŐĞƌ/ŶŐĞůŚĞŝŵ͕:ŽŚŶƐŽŶΘ:ŽŚŶƐŽŶ͕ ZĞĂƚĂWŚĂƌŵĂĐĞƵƟĐĂůƐĂŶĚEͲWŚĂƌŵĂ͘ůůŚŽŶŽƌĂƌŝĂĂƌĞƉĂŝĚƚŽŚŝƐŝŶƐƟƚƵƟŽŶ͘

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 47PDF page: 47PDF page: 47PDF page: 47

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References

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3

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Processed on: 17-4-2018 PDF page: 48PDF page: 48PDF page: 48PDF page: 48

518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018

Processed on: 17-4-2018 PDF page: 49PDF page: 49PDF page: 49PDF page: 49

49

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518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt 518800-L-sub01-bw-vdBelt Processed on: 17-4-2018 Processed on: 17-4-2018 Processed on: 17-4-2018