University of Groningen Evidence-b(i)ased psychiatry de Vries, Ymkje Anna

Evidence-b(i)ased psychiatry

de Vries, Ymkje Anna

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Publication date: 2018

Link to publication in University of Groningen/UMCG research database

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de Vries, Y. A. (2018). Evidence-b(i)ased psychiatry. University of Groningen.

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RRk 0 10 20 30 40 1994 − 2003 2004 − 2009 2010 − 2014 Percentage Amitriptyline Citalopram Clomipramine Fluoxetine Fluvoxamine Imipramine Mirtazapine Others Paroxetine Sertraline Venlafaxine

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6B`bi MiB/2T`2bbMi

P7 HH vQmM; T2QTH2 BMBiBiBM; i`2iK2Mi rBi? M MiB/2T`2bbMi- i?2 T`QTQ`iBQM T`2b+`B#2/ ~mQt2iBM2 BM+`2b2/ /m`BM; i?2 bim/v T2`BQ/ 7`QK RyXRW BM RNN9 @ kyyj iQ RNXdW BM kyRy Ĝ kyR9 U6B;m`2 3XRV- #mi ~mQt2iBM2 rb M2p2` i?2 KQbi +QKKQMHv T`2b+`B#2/ MiB/2T`2bbMiX AMbi2/- MiB/2T`2bbMi i`2iK2Mi rb KQbi +QKKQMHv BMBiBi2/ rBi? T`Qt2iBM2 BM RNN9 @ kyyj M/ rBi? +BiHQT`K 7`QK kyy9 QMr`/X  7mHH HBbiBM; Q7 HH MiB/2T`2bbMib Bb

T`QpB/2/ BM h#H2 3Xj BM i?2 TT2M/BtX

ai`iB}+iBQM #v T`2b+`B#2` U6B;m`2 3XkV b?Qr2/ i?i bT2+BHBbib r2`2 bHB;?iHv KQ`2 HBF2Hv iQ T`2b+`B#2 ~mQt2iBM2 i?M :Sb i 2+? iBK2 TQBMiX AM kyRy Ĝ kyR9- :Sb BMBiBi2/ i`2iK2Mi rBi? ~mQt2iBM2 BM R8X3W Q7 +b2b- r?BH2 bT2+BHBbib /B/ bQ BM kRX8W Q7 HH +b2bX aT2+BHBbib KQbi +QKKQMHv BMBiBi2/ i`2iK2Mi rBi? +BiHQT`K- r?BH2 :Sb KQbi +QKKQMHv BMBiBi2/ i`2iK2Mi rBi? KBi`BTivHBM2X "Qi? :Sb M/ bT2+BHBbib b?Qr2/  bi22T /2+`2b2 BM i?2

8

KHV #27Q`2 +H+mHiBM; i?2 ...f/vX q2 2t+Hm/2/ TiB2Mib rBi? KBbbBM; /BHv /Qb2b U9 UyXRWV TiB2MibV Q` rBi? mM`2HBbiB+HHv HQr Uy ...f/v- k8e U3XdWV TiB2MibV Q` ?B;? U=j ...f/v- e UyXkWV TiB2MibV /Qb2b- b i?2b2 `2 HBF2Hv iQ `2~2+i /i 2Mi`v 2``Q`b UBM T`iB+mH`- 2Mi2`BM; y b i?2 MmK#2` Q7 mMBib T2` /vVX

h?2 KBMi2MM+2 /Qb2 Q7 MiB/2T`2bbMib rb /2i2`KBM2/ BM  bBKBH` 7b?BQMX JBMi2@ MM+2 rb /2}M2/ b  T2`BQ/ BM r?B+? i H2bi k T`2b+`BTiBQMb rBi? i?2 bK2 /Qb2 r2`2 }HH2/- +QMiBMBM;  KBMBKmK Q7 ey /vbǶ bmTTHvX S`2b+`BTiBQMb r2`2 `2[mB`2/ iQ #2 Qp2`@ HTTBM;- BX2X- i?2 MmK#2` Q7 /vb BM i?2 }`bi T`2b+`BTiBQM Kmbi #2 bm{+B2Mi iQ +Qp2` i?2 }HH /i2 Q7 i?2 bm#b2[m2Mi T`2b+`BTiBQM- 7i2` //BM; k8W iQ i?2 MmK#2` Q7 /vb iQ ++QmMi 7Q` TQbbB#H2 MQM@+QKTHBM+2X

6Q` TiB2Mib r?Q ?/ KmHiBTH2 KBMi2MM+2 T2`BQ/b- r2 b2H2+i2/ i?2 T2`BQ/ rBi? i?2 HQM;2bi /m`iBQM M/ i?2 ?B;?2bi /Qb2 UB7 KmHiBTH2 T2`BQ/b ?/ i?2 bK2 /m`iBQMVX JBbbBM; /Qb2b r2`2 b2i iQ yX q2 2t+Hm/2/ TiB2Mib rBi? mM`2HBbiB+HHv HQr Uy ...f/v- 3 UyXRWV TiB2MibV Q` ?B;? KBMi2MM+2 /Qb2b U=9 ...f/v- y TiB2MibVX 6B7iv@i?`22 T2`+2Mi Q7 HH TiB2Mib ?/ i H2bi QM2 KBMi2MM+2 T2`BQ/ rBi?  `2HBbiB+ /Qb2X

h?2 /Bbi`B#miBQM Q7 bi`iBM; /Qb2b M/ KBMi2MM+2 /Qb2b rb /2i2`KBM2/ 7Q` 2+? M@ iB/2T`2bbMiX 6Q` i?2 aa_Ab ~mQt2iBM2- +BiHQT`K- b2`i`HBM2- M/ ~mpQtKBM2- i?2 /Bb@ i`B#miBQM rb +QKT`2/ iQ i?2 .mi+? /QbBM; ;mB/2HBM2b 7Q` +?BH/`2M (jjd- jj3)X h?2b2 ;mB/2HBM2b `2+QKK2M/  bi`iBM; /Qb2 Q7 8 K; UyXk8 ...V 7Q` ~mQt2iBM2 M/ +BiHQT`K-M/ k8 K; UyXk8 ...V 7Q` ~mpQtKBM2X 6Q` b2`i`HBM2- i?2 ;mB/2HBM2b #Qi? `2+QKK2M/ k8 K; UyX8 ...V 7Q` vQmM; +?BH/`2M- #mi QM2 ;mB/2HBM2 `2+QKK2M/b  ?B;?2` /Qb2 Q7 8y K; UR ...V 7Q` /QH2b+2Mib ;2/ Rj M/ QH/2` (jjd)X q2 +?Qb2 iQ +QKT`2 i?2 /Bbi`B#miBQM iQ i?2 Hii2`- KQ`2 H2MB2Mi ;mB/2HBM2X

am#b2[m2MiHv i?2 /i rb bi`iB}2/ #v T`2b+`B#2` M/ #v ;2 ;`QmT iQ 2tKBM2 i?2 TQb@ bB#H2 KQ/2`iBM; BM~m2M+2 Q7 i?2b2 p`B#H2bX q2 HbQ 2tKBM2/ ?Qr KMv TiB2Mib r2`2 T`2b+`B#2/  bi`iBM; /Qb2 Q7 ~mQt2iBM2 Q7 Ry K; Q` H2bb- b `2+QKK2M/2/ BM BMi2`MiBQMH ;mB/2HBM2b U2;- lMBi2/ EBM;/QK (jje)VX

_2bmHib

.2KQ;`T?B+b

 iQiH Q7 kN9k TiB2Mib r2`2 T`2b+`B#2/  }`bi MiB/2T`2bbMi /m`BM; i?2 bim/v T2`BQ/ M/ K2i BM+HmbBQM +`Bi2`B, RRN9 BM RNN9 Ĝ kyyj- 3R8 BM kyy9 Ĝ kyyN- M/ Njj BM kyRy @ kyR9X P7 i?2b2 TiB2Mib- RdjN U8NWV r2`2 72KH2- RR33 U9yWV r2`2 KH2- M/ 7Q` R8 URWV BM7Q`KiBQM #Qmi b2t rb KBbbBM;X

h?2 p2`;2 ;2 Q7 i?2 bKTH2 i BMBiBiBQM rb R9Xk v2`bX h?`22@?mM/`2/ M/ 2H2p2M URRWV TiB2Mib r2`2 +?BH/`2M- 8dj URNWV r2`2 T`2i22Mb- M/ ky83 UdyWV r2`2 i22MbX h?2

RRk 0 10 20 30 40 1994 − 2003 2004 − 2009 2010 − 2014 Percentage Amitriptyline Citalopram Clomipramine Fluoxetine Fluvoxamine Imipramine Mirtazapine Others Paroxetine Sertraline Venlafaxine

6B;m`2 3XR, S2`+2Mi;2 Q7 T`2b+`BTiBQMb 7Q` 2+? Q7 i?2 i2M KQbi +QKKQMHv T`2b+`B#2/

MiB/2T`2bbMib T2` iBK2 T2`BQ/X S`2b+`BTiBQMb 7Q` HH Qi?2` MiB/2T`2bbMib r2`2 +QK#BM2/ BMiQ i?2 +i2;Q`v ǶPi?2`bǶX

KDQ`Biv Q7 TiB2Mib UekWV `2+2Bp2/ i?2B` }`bi T`2b+`BTiBQM 7Q` M MiB/2T`2bbMi 7`QK i?2B` :S BM RNN9 Ĝ kyyj- #mi #v kyRy Ĝ kyR9 eNW Q7 TiB2Mib `2+2Bp2/ i?2B` }`bi T`2b+`BTiBQM 7`QK  bT2+BHBbiX

6B`bi MiB/2T`2bbMi

P7 HH vQmM; T2QTH2 BMBiBiBM; i`2iK2Mi rBi? M MiB/2T`2bbMi- i?2 T`QTQ`iBQM T`2b+`B#2/ ~mQt2iBM2 BM+`2b2/ /m`BM; i?2 bim/v T2`BQ/ 7`QK RyXRW BM RNN9 @ kyyj iQ RNXdW BM kyRy Ĝ kyR9 U6B;m`2 3XRV- #mi ~mQt2iBM2 rb M2p2` i?2 KQbi +QKKQMHv T`2b+`B#2/ MiB/2T`2bbMiX AMbi2/- MiB/2T`2bbMi i`2iK2Mi rb KQbi +QKKQMHv BMBiBi2/ rBi? T`Qt2iBM2 BM RNN9 @ kyyj M/ rBi? +BiHQT`K 7`QK kyy9 QMr`/X  7mHH HBbiBM; Q7 HH MiB/2T`2bbMib Bb

T`QpB/2/ BM h#H2 3Xj BM i?2 TT2M/BtX

ai`iB}+iBQM #v T`2b+`B#2` U6B;m`2 3XkV b?Qr2/ i?i bT2+BHBbib r2`2 bHB;?iHv KQ`2 HBF2Hv iQ T`2b+`B#2 ~mQt2iBM2 i?M :Sb i 2+? iBK2 TQBMiX AM kyRy Ĝ kyR9- :Sb BMBiBi2/ i`2iK2Mi rBi? ~mQt2iBM2 BM R8X3W Q7 +b2b- r?BH2 bT2+BHBbib /B/ bQ BM kRX8W Q7 HH +b2bX aT2+BHBbib KQbi +QKKQMHv BMBiBi2/ i`2iK2Mi rBi? +BiHQT`K- r?BH2 :Sb KQbi +QKKQMHv BMBiBi2/ i`2iK2Mi rBi? KBi`BTivHBM2X "Qi? :Sb M/ bT2+BHBbib b?Qr2/  bi22T /2+`2b2 BM i?2

GP Specialist 1994 − 2003 2004 − 2009 2010 − 2014 1994 − 2003 2004 − 2009 2010 − 2014 0 10 20 30 40 50 Percentage Amitriptyline Citalopram Clomipramine Fluoxetine Fluvoxamine Imipramine Mirtazapine Others Paroxetine Sertraline Venlafaxine

6B;m`2 3Xk, S2`+2Mi;2 Q7 T`2b+`BTiBQMb 7Q` 2+? Q7 i?2 i2M KQbi +QKKQMHv T`2b+`B#2/

MiB/2T`2bbMib T2` iBK2 T2`BQ/- bi`iB}2/ #v T`2b+`B#2`X S`2b+`BTiBQMb 7Q` HH Qi?2` M@ iB/2T`2bbMib r2`2 +QK#BM2/ BMiQ i?2 +i2;Q`v ǶPi?2`bǶX

mb2 Q7 T`Qt2iBM2- Hi?Qm;? i?Bb /2+`2b2 Q++m``2/ 2`HB2` 7Q` bT2+BHBbib i?M 7Q` :SbX ai`iB}+iBQM #v ;2 ;`QmT b?Qr2/ HQr `i2b Q7 MiB/2T`2bbMi BMBiBiBQM rBi? ~mQt2iBM2 BM 2+? ;2 ;`QmT U6B;m`2 3XjVX *?BH/`2M r2`2 T`2b+`B#2/ ~mQt2iBM2 H2bi 7`2[m2MiHv UIeX8W i?`Qm;?Qmi i?2 bim/v T2`BQ/VX S`2i22Mb r2`2 T`2b+`B#2/ ~mQt2iBM2 BM 3XeW Q7 +b2b BM RNN9 Ĝ kyyj- BM+`2bBM; iQ R8XkW BM kyRy Ĝ kyR9X h22Mb r2`2 T`2b+`B#2/ ~mQt2iBM2 `2HiBp2Hv 7`2[m2MiHv- i RRX9W BM RNN9 Ĝ kyyj M/ kkXNW BM kyRy Ĝ kyR9X *BiHQT`K rb i?2 KQbi +QKKQMHv T`2b+`B#2/ MiB/2T`2bbMi BM HH ;2 ;`QmTb #v kyRy Ĝ kyR9X AM T`iB+mH`-+?BH/`2M M/ T`2i22Mb `2+2Bp2/ +BiHQT`K BM dyXNW M/ 8eXyW Q7 +b2b `2bT2+iBp2Hv BM kyRy Ĝ kyR9X

ai`iBM; /Qb2b

h?2 K2/BM bi`iBM; /Qb2 7Q` i`B+v+HB+ MiB/2T`2bbMib rb [mBi2 HQr- i `QmM/ yXR Ĝ yXj ...f/vX 6Q` aa_Ab- i?2 K2/BM bi`iBM; /Qb2 rb R ...f/v 7Q` ~mQt2iBM2- T`Qt2iBM2-2b+BiHQT`K- M/ b2`i`HBM2- r?BH2 Bi rb yX8 ...f/v 7Q` +BiHQT`K M/ ~mpQtKBM2X JB`ixTBM2 M/ p2MH7tBM2 ?/ K2/BM bi`iBM; /Qb2b Q7 yX8 M/ yXd8 ...f/v `2bT2+@ iBp2HvX  7mHH HBbiBM; Q7 bi`iBM; /Qb2b Bb ;Bp2M BM h#H2 3X9 BM i?2 TT2M/BtX

RR9

Child Preteen Teen

1994 − 2003 2004 − 2009 2010 − 2014 1994 − 2003 2004 − 2009 2010 − 2014 1994 − 2003 2004 − 2009 2010 − 2014 0 20 40 60 Percentage Amitriptyline Citalopram Clomipramine Fluoxetine Fluvoxamine Imipramine Mirtazapine Others Paroxetine Sertraline Venlafaxine

6B;m`2 3Xj, S2`+2Mi;2 Q7 T`2b+`BTiBQMb 7Q` 2+? Q7 i?2 i2M KQbi +QKKQMHv T`2b+`B#2/

MiB/2T`2bbMib T2` iBK2 T2`BQ/- bi`iB}2/ #v ;2 ;`QmTX S`2b+`BTiBQMb 7Q` HH Qi?2` M@ iB/2T`2bbMib r2`2 +QK#BM2/ BMiQ i?2 +i2;Q`v ǶPi?2`bǶX

J2/BM bi`iBM; /Qb2b r2`2 bBKBH` i?`Qm;?Qmi i?2 bim/v T2`BQ/ 7Q` KQbi MiB/2T`2bbMib-#mi /2+`2b2/ 7Q` T`Qt2iBM2- KB`ixTBM2- M/ p2MH7tBM2X 6Q` +BiHQT`K-i?2 K2/BM bi`iBM; /Qb2 /2+`2b2/ 7`QK R ...f/v BM RNN9 Ĝ kyyj iQ yX9 ...f/v BM kyRy Ĝ kyR9c 7Q` T`Qt2iBM2 M/ KB`ixTBM2- i?2 K2/BM bi`iBM; /Qb2 /2+`2b2/ 7`QK R ...f/v BM RNN9 Ĝ kyyj iQ yX8 ...f/v BM kyRy Ĝ kyR9c M/ 7Q` p2MH7tBM2- i?2 K2/BM bi`iBM; /Qb2 /2+`2b2/ 7`QK yXd8 ...f/v BM RNN9 Ĝ kyyj iQ yXjd8 ...f/v BM kyRy Ĝ kyR9X :mB/2HBM2 /?2`2M+2 HbQ BKT`Qp2/ bQK2r?i rBi?BM i?2 bim/v T2`BQ/ 7Q` +BiHQT`K M/ ~mpQtKBM2- rBi? /?2`2M+2 `i2b #2BM; 99XjW 7Q` +BiHQT`K M/ k3XeW 7Q` ~mpQtKBM2 BM kyRy Ĝ kyR9X

ai`iB}+iBQM #v T`2b+`B#2` b?Qr2/ 72r /Bz2`2M+2b #2ir22M T`2b+`B#2`b- Hi?Qm;? bT2+BH@ Bbib T`2b+`B#2/ bQK2 aa_Ab BM bHB;?iHv HQr2` /Qb2b i?M :SbX ai`iB}+iBQM #v ;2 b?Qr2/ i?i +?BH/`2M i2M/2/ iQ #2 T`2b+`B#2/ HQr2` /Qb2b U aa_AbX S`2i22Mb `2+2Bp2/ bHB;?iHv ?B;?2` /Qb2b, yX8 ...f/v 7Q` HH aa_Ab 2t+2Ti b2`i`@ HBM2 UR ...f/vVX h22Mb `2+2Bp2/ i?2 ?B;?2bi /Qb2b- i R ...f/v 7Q` HH aa_Ab 2t+2Ti

8

GP Specialist 1994 − 2003 2004 − 2009 2010 − 2014 1994 − 2003 2004 − 2009 2010 − 2014 0 10 20 30 40 50 Percentage Amitriptyline Citalopram Clomipramine Fluoxetine Fluvoxamine Imipramine Mirtazapine Others Paroxetine Sertraline Venlafaxine

6B;m`2 3Xk, S2`+2Mi;2 Q7 T`2b+`BTiBQMb 7Q` 2+? Q7 i?2 i2M KQbi +QKKQMHv T`2b+`B#2/

MiB/2T`2bbMib T2` iBK2 T2`BQ/- bi`iB}2/ #v T`2b+`B#2`X S`2b+`BTiBQMb 7Q` HH Qi?2` M@ iB/2T`2bbMib r2`2 +QK#BM2/ BMiQ i?2 +i2;Q`v ǶPi?2`bǶX

mb2 Q7 T`Qt2iBM2- Hi?Qm;? i?Bb /2+`2b2 Q++m``2/ 2`HB2` 7Q` bT2+BHBbib i?M 7Q` :SbX ai`iB}+iBQM #v ;2 ;`QmT b?Qr2/ HQr `i2b Q7 MiB/2T`2bbMi BMBiBiBQM rBi? ~mQt2iBM2 BM 2+? ;2 ;`QmT U6B;m`2 3XjVX *?BH/`2M r2`2 T`2b+`B#2/ ~mQt2iBM2 H2bi 7`2[m2MiHv UIeX8W i?`Qm;?Qmi i?2 bim/v T2`BQ/VX S`2i22Mb r2`2 T`2b+`B#2/ ~mQt2iBM2 BM 3XeW Q7 +b2b BM RNN9 Ĝ kyyj- BM+`2bBM; iQ R8XkW BM kyRy Ĝ kyR9X h22Mb r2`2 T`2b+`B#2/ ~mQt2iBM2 `2HiBp2Hv 7`2[m2MiHv- i RRX9W BM RNN9 Ĝ kyyj M/ kkXNW BM kyRy Ĝ kyR9X *BiHQT`K rb i?2 KQbi +QKKQMHv T`2b+`B#2/ MiB/2T`2bbMi BM HH ;2 ;`QmTb #v kyRy Ĝ kyR9X AM T`iB+mH`-+?BH/`2M M/ T`2i22Mb `2+2Bp2/ +BiHQT`K BM dyXNW M/ 8eXyW Q7 +b2b `2bT2+iBp2Hv BM kyRy Ĝ kyR9X

ai`iBM; /Qb2b

h?2 K2/BM bi`iBM; /Qb2 7Q` i`B+v+HB+ MiB/2T`2bbMib rb [mBi2 HQr- i `QmM/ yXR Ĝ yXj ...f/vX 6Q` aa_Ab- i?2 K2/BM bi`iBM; /Qb2 rb R ...f/v 7Q` ~mQt2iBM2- T`Qt2iBM2-2b+BiHQT`K- M/ b2`i`HBM2- r?BH2 Bi rb yX8 ...f/v 7Q` +BiHQT`K M/ ~mpQtKBM2X JB`ixTBM2 M/ p2MH7tBM2 ?/ K2/BM bi`iBM; /Qb2b Q7 yX8 M/ yXd8 ...f/v `2bT2+@ iBp2HvX  7mHH HBbiBM; Q7 bi`iBM; /Qb2b Bb ;Bp2M BM h#H2 3X9 BM i?2 TT2M/BtX

RR9

Child Preteen Teen

1994 − 2003 2004 − 2009 2010 − 2014 1994 − 2003 2004 − 2009 2010 − 2014 1994 − 2003 2004 − 2009 2010 − 2014 0 20 40 60 Percentage Amitriptyline Citalopram Clomipramine Fluoxetine Fluvoxamine Imipramine Mirtazapine Others Paroxetine Sertraline Venlafaxine

6B;m`2 3Xj, S2`+2Mi;2 Q7 T`2b+`BTiBQMb 7Q` 2+? Q7 i?2 i2M KQbi +QKKQMHv T`2b+`B#2/

MiB/2T`2bbMib T2` iBK2 T2`BQ/- bi`iB}2/ #v ;2 ;`QmTX S`2b+`BTiBQMb 7Q` HH Qi?2` M@ iB/2T`2bbMib r2`2 +QK#BM2/ BMiQ i?2 +i2;Q`v ǶPi?2`bǶX

J2/BM bi`iBM; /Qb2b r2`2 bBKBH` i?`Qm;?Qmi i?2 bim/v T2`BQ/ 7Q` KQbi MiB/2T`2bbMib-#mi /2+`2b2/ 7Q` T`Qt2iBM2- KB`ixTBM2- M/ p2MH7tBM2X 6Q` +BiHQT`K-i?2 K2/BM bi`iBM; /Qb2 /2+`2b2/ 7`QK R ...f/v BM RNN9 Ĝ kyyj iQ yX9 ...f/v BM kyRy Ĝ kyR9c 7Q` T`Qt2iBM2 M/ KB`ixTBM2- i?2 K2/BM bi`iBM; /Qb2 /2+`2b2/ 7`QK R ...f/v BM RNN9 Ĝ kyyj iQ yX8 ...f/v BM kyRy Ĝ kyR9c M/ 7Q` p2MH7tBM2- i?2 K2/BM bi`iBM; /Qb2 /2+`2b2/ 7`QK yXd8 ...f/v BM RNN9 Ĝ kyyj iQ yXjd8 ...f/v BM kyRy Ĝ kyR9X :mB/2HBM2 /?2`2M+2 HbQ BKT`Qp2/ bQK2r?i rBi?BM i?2 bim/v T2`BQ/ 7Q` +BiHQT`K M/ ~mpQtKBM2- rBi? /?2`2M+2 `i2b #2BM; 99XjW 7Q` +BiHQT`K M/ k3XeW 7Q` ~mpQtKBM2 BM kyRy Ĝ kyR9X

ai`iB}+iBQM #v T`2b+`B#2` b?Qr2/ 72r /Bz2`2M+2b #2ir22M T`2b+`B#2`b- Hi?Qm;? bT2+BH@ Bbib T`2b+`B#2/ bQK2 aa_Ab BM bHB;?iHv HQr2` /Qb2b i?M :SbX ai`iB}+iBQM #v ;2 b?Qr2/ i?i +?BH/`2M i2M/2/ iQ #2 T`2b+`B#2/ HQr2` /Qb2b U aa_AbX S`2i22Mb `2+2Bp2/ bHB;?iHv ?B;?2` /Qb2b, yX8 ...f/v 7Q` HH aa_Ab 2t+2Ti b2`i`@ HBM2 UR ...f/vVX h22Mb `2+2Bp2/ i?2 ?B;?2bi /Qb2b- i R ...f/v 7Q` HH aa_Ab 2t+2Ti

h#H2 3Xk, :mB/2HBM2 +QKTHBM+2 Q7 bi`iBM; /Qb2b

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6BMHHv- KBMi2MM+2 /Qb2b r2`2 M2`Hv Hrvb BM ;`22K2Mi rBi? i?2 ;mB/2HBM2bc r?2`2 i?2v r2`2 MQi- i?Bb rb mbmHHv #2+mb2 i?2 /Qb2 rb HQr2` i?M `2+QKK2M/2/X AM ;2M2`H- KBMi2MM+2 /Qb2b r2`2 p2`v bBKBH` iQ bi`iBM; /Qb2bX lT@iBi`iBQM 7`QK  HQr bi`iBM; /Qb2 Bb `2+QKK2M/2/ BM i?2 ;mB/2HBM2b- #mi iBi`iBQM Q++m``2/ BM  KBMQ`Biv Q7 +b2b- T`Q##Hv #2+mb2 i?2 bi`iBM; /Qb2 rb H`2/v rBi?BM i?2 KBMi2MM+2 `M;2X lT@iBi`iBQM rb KQ`2 HBF2Hv 7Q` b2+QM/@;2M2`iBQM MiB/2T`2bbMib HBF2 +BiHQT`K M/ p2MH7tBM2- 7Q` r?B+?  `2HiBp2Hv HQr bi`iBM; /Qb2 rb HbQ KQ`2 HBF2HvX

h?2 MmK#2` Q7 vQmM; T2QTH2 BMBiBiBM; MiB/2T`2bbMi i`2iK2Mi /2+`2b2/ BM i?2 2`Hv kyyyb- 7QHHQr2/ #v  `2im`M iQ i?2 H2p2H Q7 kyyRX am+?  i`2M/ rb HbQ 7QmM/ BM +QmMi`B2b HBF2 i?2 lE (j9e)- #mi QMHv iQ  bHB;?i 2ti2Mi Q` MQi i HH BM Qi?2` +QmMi`B2b- bm+? b *M/ (j8N) Q` .2MK`F (jey)X h?2 /2+`2b2 BM MiB/2T`2bbMi BMBiBiBQM BM vQmM; T2QTH2 rb HBF2Hv `2Hi2/ iQ K2/B +Qp2`;2 Q7 i?2 TQi2MiBH 7Q` i`2iK2Mi@2K2`;2Mi bmB+B/HBiv rBi? MiB/2T`2bbMi i`2iK2Mi (j93)- #mi i?Bb 2z2+i TT2`b iQ ?p2 #22M i`MbB2MiX

AKT`QpBM; ;mB/2HBM2 /?2`2M+2

/?2`2M+2 iQ ;mB/2HBM2b Bb Q7i2M TQQ` (jeR)- M/ T?vbB+BMbǶ T`2b+`BTiBQM +?QB+2b `2 BM~m@ 2M+2/ #v  KmHiBim/2 Q7 Qi?2` 7+iQ`b #2bB/2b ;mB/2HBM2b M/ +QMiBMmBM; K2/B+H 2/m+iBQMX h?2b2 BM~m2M+2b Kv BM+Hm/2 i?2 Kbb K2/B Ur?B+? Kv ?p2 #22M 2bT2+BHHv BKTQ`iMi rBi? `2;`/ iQ i?2 `2/m+iBQM BM T`2b+`BTiBQMb 7Q` T`Qt2iBM2V (j93) M/ T`QKQiBQM #v T?`K+2miB+H +QKTMB2b (jek)X  H`;2 #Q/v Q7 `2b2`+? ?b 2tKBM2/ #``B2`b M/ 7+BHBiiQ`b iQ i?2 BKTH2K2MiiBQM Q7 ;mB/2HBM2b BM +HBMB+H T`+iB+2 (jej- je9- je8)X /?2`@ 2M+2 Bb KQ`2 HBF2Hv r?2M `2+QKK2M/iBQMb `2 bT2+B}+ M/ +QM+`2i2 `i?2` i?M p;m2-r?2M 72r //BiBQMH `2bQm`+2b `2 `2[mB`2/ 7Q` BKTH2K2MiiBQM- M/ p;m2-r?2M i?2 2pB/2M+2 Bb bi`QM; M/ bi`B;?i7Q`r`/ (je8- jee)X

RR3

q?BH2 i?2 `2+QKK2M/iBQM iQ BMBiBi2 MiB/2T`2bbMi i`2iK2Mi BM +?BH/`2M rBi? ~mQt2iBM2 Bb ?B;?Hv bT2+B}+ M/ /Q2b MQi `2[mB`2 Mv //BiBQMH `2bQm`+2b- i?2 2pB/2M+2 #b2 7Q` i?2 mb2 Q7 ~mQt2iBM2 BM vQmM; T2QTH2 Bb `2HiBp2Hv HBKBi2/- Hi?Qm;? bi`QM;2` i?M i?i 7Q` Qi?2` MiB/2T`2bbMib (jjN)- r?B+? Kv z2+i T?vbB+BMbǶ +QM}/2M+2 BM i?2 `2+QKK2M/iBQMX .2/B+i2/ 2zQ`i- 7Q` 2tKTH2 BKTH2K2MiiBQM BMi2`p2MiBQMb (jed)- Kv #2 M22/2/ iQ BK@ T`Qp2 /?2`2M+2 iQ ;mB/2HBM2bX  p`B2iv Q7 BMi2`p2MiBQMb ?p2 #22M 7QmM/ iQ BM+`2b2 ;mB/2HBM2 /?2`2M+2- BM+Hm/BM; T`QpBbBQM Q7 2/m+iBQMH Ki2`BHb- m/Bi M/ 722/#+F-M/ `2KBM/2`b- #mi 2z2+ib `2 KQ/2bi (je3)X 1/m+iBQMH K22iBM;b- r?B+? `2  +QKKQM 7Q`K Q7 +QMiBMmBM; K2/B+H 2/m+iBQM- HbQ ?p2 bKHH 2z2+ib QM BKT`QpBM; ;mB/2HBM2 /@ ?2`2M+2 (jeN)X  #2ii2` mM/2`biM/BM; Q7 i?2 `2bQMb #2?BM/ T?vbB+BMbǶ T`272`2M+2 7Q` +BiHQT`K Kv ?2HT +H`B7v ?Qr ;mB/2HBM2 /?2`2M+2 +QmH/ #2 BKT`Qp2/X

ai`2M;i?b M/ HBKBiiBQMb

h?Bb bim/v ?b b2p2`H bi`2M;i?bX 6B`bi- mb2 Q7  ;2M2`H TQTmHiBQM T`2b+`BTiBQM /i#b2 2t+Hm/2b i?2 TQbbB#BHBiv Q7 `2+HH #Bb M/ b2H2+iBQM #BbX MQi?2` BKTQ`iMi bi`2M;i? Bb i?i r2 bT2+B}+HHv 2tKBM2/ }`bi T`2b+`BTiBQMb- BM +QMi`bi iQ KMv T`2pBQmb bim/B2bX 6m`i?2`KQ`2- r2 BM+Hm/2/  HQM; iBK2 T2`BQ/ Q7 kR v2`b- r?B+? HHQr2/ mb iQ 2tKBM2 iBK2 i`2M/b M/ i?2 TQbbB#H2 BM~m2M+2 Q7 KDQ` 2p2Mib- bm+? b i?2 `2+Q;MBiBQM Q7  HBMF #2ir22M MiB/2T`2bbMib M/ bmB+B/HBiv BM vQmM; T2QTH2 BM kyyj Ĝ kyy9X h?Bb HQM; iBK2 T2`BQ/ HbQ BM+Hm/2/ p2`v `2+2Mi /i UmT iQ M/ BM+Hm/BM; kyR9VX

aQK2 HBKBiiBQMb Kmbi HbQ #2 +FMQrH2/;2/X M BKTQ`iMi HBKBiiBQM Bb i?i r2 /B/ MQi ?p2 BM7Q`KiBQM #Qmi i?2 BM/B+iBQM 7Q`  T`2b+`BTiBQMX b i?2 ;mB/2HBM2 `2+QKK2M/BM; ~mQt2iBM2 Bb  ;mB/2HBM2 7Q` i?2 i`2iK2Mi Q7 /2T`2bbBQM BM vQmM; T2QTH2- Bi Kv MQi TTHv iQ HH T`2b+`BTiBQMb BM+Hm/2/ ?2`2BMX

AM T`iB+mH`- KBi`BTivHBM2 rb 7`2[m2MiHv T`2b+`B#2/ BM +?BH/`2M M/ /QH2b+2Mib UT@ T`QtBKi2Hv R8W Q7 HH T`2b+`BTiBQMbV- 2p2M i?Qm;? i`B+v+HB+ MiB/2T`2bbMib `2 MQi `2+@ QKK2M/2/ 7Q` i?2 i`2iK2Mi Q7 /2T`2bbBQMX Hi?Qm;? r2 ii2KTi2/ iQ `2KQp2 T`2b+`BT@ iBQMb 7Q` #2/@r2iiBM; M/ TBM- i?2 `2KBMBM; TiB2Mib Kv biBHH ?p2 #22M i`2i2/ rBi? KBi`BTivHBM2 7Q` +QKTHBMib Qi?2` i?M /2T`2bbBQMX

 bim/v KQM; .mi+? :Sb bm;;2bi2/ i?i aa_Ab r2`2 mbmHHv T`2b+`B#2/ 7Q` /2T`2bbBQM Q` MtB2iv- #mi i`B+v+HB+b r2`2 Q7i2M T`2b+`B#2/ 7Q` #2/@r2iiBM;- ?vT2`+iBpBiv- i2MbBQM ?2/+?2 Q` MQM@bT2+B}+ /Bb2b2- M/ QMHv ``2Hv 7Q` /2T`2bbBQM (jdy)X *QMb2[m2MiHv-rBi?Qmi BM7Q`KiBQM QM i?2 BM/B+iBQM 7Q` KBi`BTivHBM2 T`2b+`BTiBQMb- Bi Bb /B{+mHi iQ /2i2`KBM2 r?2i?2` i?2b2 T`2b+`BTiBQMb r2`2 TT`QT`Bi2 UHi?Qm;? #2/@r2iiBM; Bb i?2 QMHv TT`Qp2/ BM/B+iBQM 7Q` +?BH/`2M M/ /QH2b+2Mib BM i?2 L2i?2`HM/bVX

>Qr2p2`- b i?2 KDQ`Biv Q7 aa_A T`2b+`BTiBQMb iQ +?BH/`2M M/ /QH2b+2Mib `2 7Q` i?2 Tm`TQb2 Q7 i`2iBM; /2T`2bbBQM (jdy)- i?Bb HBKBiiBQM /Q2b MQi BMpHB/i2 Qm` }M/BM; i?i +BiHQT`K Bb T`272``2/ Qp2` ~mQt2iBM2- BM +QMi`bi iQ i?2 ;mB/2HBM2X 6m`i?2`KQ`2- HQr

8

6Q` +BiHQT`K- i?2 ?B;?2` /?2`2M+2 iQ ;mB/2HBM2b Kv #2 /m2 iQ i?2 pBH#BHBiv Q7  HB[mB/ bQHmiBQM 7Q` +BiHQT`K- r?B+? 7+BHBii2b HQr bi`iBM; /Qb2bX AM +QMi`bi- 7Q` ~mQt2@ iBM2- i?2 i#H2i rBi? i?2 HQr2bi /Qb2 +m``2MiHv pBH#H2 BM i?2 L2i?2`HM/b +QMiBMb ky K; UR ...V- r?B+? KF2b Bi /B{+mHi iQ T`QpB/2 i?2 `2+QKK2M/2/ /Qb2 Q7 8 K;X Hi?Qm;? HB[mB/ ~mQt2iBM2 rb T`2pBQmbHv pBH#H2- Bi Bb MQi +m``2MiHv QM i?2 .mi+? K`F2iX h?2 /B{+mHiv Q7 T`QpB/BM; HQr /Qb2b Q7 ~mQt2iBM2 Kv #2 QM2 `2bQM 7Q` T?vbB+BMbǶ T`272`2M+2 7Q` +BiHQT`KX

a2p2`H TQbBiBp2 }M/BM;b r2`2 HbQ TT`2MiX q?BH2 :Sb T`2b+`B#2/ i?2 KDQ`Biv Q7 MiB/2@ T`2bbMib BM RNN9 Ĝ kyyj- T`2b+`BTiBQMb b?B7i2/ iQ bT2+BHBbib Qp2` iBK2- b `2+QKK2M/2/ #v ;mB/2HBM2bX q2 HbQ 7QmM/ i?i i?2 bi`iBM; /Qb2b Q7 bQK2 MiB/2T`2bbMib- T`iB+m@ H`Hv +BiHQT`K- /2+`2b2/ Qp2` i?2 bim/v T2`BQ/- bm;;2biBM; BM+`2bBM; r`2M2bb KQM; T?vbB+BMb Q7 i?2 BKTQ`iM+2 Q7 HQr bi`iBM; /Qb2b BM vQmM; T2QTH2X h?Bb }M/BM; ;`22b rBi?  T`2pBQmb bim/v BM i?2 la b?QrBM; BM+`2b2/ T`2b+`BTiBQM Q7 HQr /Qb2b 7i2` i?2 6. r`MBM; BM kyy9 (j8R)X

6BMHHv- KBMi2MM+2 /Qb2b r2`2 M2`Hv Hrvb BM ;`22K2Mi rBi? i?2 ;mB/2HBM2bc r?2`2 i?2v r2`2 MQi- i?Bb rb mbmHHv #2+mb2 i?2 /Qb2 rb HQr2` i?M `2+QKK2M/2/X AM ;2M2`H- KBMi2MM+2 /Qb2b r2`2 p2`v bBKBH` iQ bi`iBM; /Qb2bX lT@iBi`iBQM 7`QK  HQr bi`iBM; /Qb2 Bb `2+QKK2M/2/ BM i?2 ;mB/2HBM2b- #mi iBi`iBQM Q++m``2/ BM  KBMQ`Biv Q7 +b2b- T`Q##Hv #2+mb2 i?2 bi`iBM; /Qb2 rb H`2/v rBi?BM i?2 KBMi2MM+2 `M;2X lT@iBi`iBQM rb KQ`2 HBF2Hv 7Q` b2+QM/@;2M2`iBQM MiB/2T`2bbMib HBF2 +BiHQT`K M/ p2MH7tBM2- 7Q` r?B+?  `2HiBp2Hv HQr bi`iBM; /Qb2 rb HbQ KQ`2 HBF2HvX

h?2 MmK#2` Q7 vQmM; T2QTH2 BMBiBiBM; MiB/2T`2bbMi i`2iK2Mi /2+`2b2/ BM i?2 2`Hv kyyyb- 7QHHQr2/ #v  `2im`M iQ i?2 H2p2H Q7 kyyRX am+?  i`2M/ rb HbQ 7QmM/ BM +QmMi`B2b HBF2 i?2 lE (j9e)- #mi QMHv iQ  bHB;?i 2ti2Mi Q` MQi i HH BM Qi?2` +QmMi`B2b- bm+? b *M/ (j8N) Q` .2MK`F (jey)X h?2 /2+`2b2 BM MiB/2T`2bbMi BMBiBiBQM BM vQmM; T2QTH2 rb HBF2Hv `2Hi2/ iQ K2/B +Qp2`;2 Q7 i?2 TQi2MiBH 7Q` i`2iK2Mi@2K2`;2Mi bmB+B/HBiv rBi? MiB/2T`2bbMi i`2iK2Mi (j93)- #mi i?Bb 2z2+i TT2`b iQ ?p2 #22M i`MbB2MiX

AKT`QpBM; ;mB/2HBM2 /?2`2M+2

/?2`2M+2 iQ ;mB/2HBM2b Bb Q7i2M TQQ` (jeR)- M/ T?vbB+BMbǶ T`2b+`BTiBQM +?QB+2b `2 BM~m@ 2M+2/ #v  KmHiBim/2 Q7 Qi?2` 7+iQ`b #2bB/2b ;mB/2HBM2b M/ +QMiBMmBM; K2/B+H 2/m+iBQMX h?2b2 BM~m2M+2b Kv BM+Hm/2 i?2 Kbb K2/B Ur?B+? Kv ?p2 #22M 2bT2+BHHv BKTQ`iMi rBi? `2;`/ iQ i?2 `2/m+iBQM BM T`2b+`BTiBQMb 7Q` T`Qt2iBM2V (j93) M/ T`QKQiBQM #v T?`K+2miB+H +QKTMB2b (jek)X  H`;2 #Q/v Q7 `2b2`+? ?b 2tKBM2/ #``B2`b M/ 7+BHBiiQ`b iQ i?2 BKTH2K2MiiBQM Q7 ;mB/2HBM2b BM +HBMB+H T`+iB+2 (jej- je9- je8)X /?2`@ 2M+2 Bb KQ`2 HBF2Hv r?2M `2+QKK2M/iBQMb `2 bT2+B}+ M/ +QM+`2i2 `i?2` i?M p;m2-r?2M 72r //BiBQMH `2bQm`+2b `2 `2[mB`2/ 7Q` BKTH2K2MiiBQM- M/ p;m2-r?2M i?2 2pB/2M+2 Bb bi`QM; M/ bi`B;?i7Q`r`/ (je8- jee)X

RR3

q?BH2 i?2 `2+QKK2M/iBQM iQ BMBiBi2 MiB/2T`2bbMi i`2iK2Mi BM +?BH/`2M rBi? ~mQt2iBM2 Bb ?B;?Hv bT2+B}+ M/ /Q2b MQi `2[mB`2 Mv //BiBQMH `2bQm`+2b- i?2 2pB/2M+2 #b2 7Q` i?2 mb2 Q7 ~mQt2iBM2 BM vQmM; T2QTH2 Bb `2HiBp2Hv HBKBi2/- Hi?Qm;? bi`QM;2` i?M i?i 7Q` Qi?2` MiB/2T`2bbMib (jjN)- r?B+? Kv z2+i T?vbB+BMbǶ +QM}/2M+2 BM i?2 `2+QKK2M/iBQMX .2/B+i2/ 2zQ`i- 7Q` 2tKTH2 BKTH2K2MiiBQM BMi2`p2MiBQMb (jed)- Kv #2 M22/2/ iQ BK@ T`Qp2 /?2`2M+2 iQ ;mB/2HBM2bX  p`B2iv Q7 BMi2`p2MiBQMb ?p2 #22M 7QmM/ iQ BM+`2b2 ;mB/2HBM2 /?2`2M+2- BM+Hm/BM; T`QpBbBQM Q7 2/m+iBQMH Ki2`BHb- m/Bi M/ 722/#+F-M/ `2KBM/2`b- #mi 2z2+ib `2 KQ/2bi (je3)X 1/m+iBQMH K22iBM;b- r?B+? `2  +QKKQM 7Q`K Q7 +QMiBMmBM; K2/B+H 2/m+iBQM- HbQ ?p2 bKHH 2z2+ib QM BKT`QpBM; ;mB/2HBM2 /@ ?2`2M+2 (jeN)X  #2ii2` mM/2`biM/BM; Q7 i?2 `2bQMb #2?BM/ T?vbB+BMbǶ T`272`2M+2 7Q` +BiHQT`K Kv ?2HT +H`B7v ?Qr ;mB/2HBM2 /?2`2M+2 +QmH/ #2 BKT`Qp2/X

ai`2M;i?b M/ HBKBiiBQMb

h?Bb bim/v ?b b2p2`H bi`2M;i?bX 6B`bi- mb2 Q7  ;2M2`H TQTmHiBQM T`2b+`BTiBQM /i#b2 2t+Hm/2b i?2 TQbbB#BHBiv Q7 `2+HH #Bb M/ b2H2+iBQM #BbX MQi?2` BKTQ`iMi bi`2M;i? Bb i?i r2 bT2+B}+HHv 2tKBM2/ }`bi T`2b+`BTiBQMb- BM +QMi`bi iQ KMv T`2pBQmb bim/B2bX 6m`i?2`KQ`2- r2 BM+Hm/2/  HQM; iBK2 T2`BQ/ Q7 kR v2`b- r?B+? HHQr2/ mb iQ 2tKBM2 iBK2 i`2M/b M/ i?2 TQbbB#H2 BM~m2M+2 Q7 KDQ` 2p2Mib- bm+? b i?2 `2+Q;MBiBQM Q7  HBMF #2ir22M MiB/2T`2bbMib M/ bmB+B/HBiv BM vQmM; T2QTH2 BM kyyj Ĝ kyy9X h?Bb HQM; iBK2 T2`BQ/ HbQ BM+Hm/2/ p2`v `2+2Mi /i UmT iQ M/ BM+Hm/BM; kyR9VX

aQK2 HBKBiiBQMb Kmbi HbQ #2 +FMQrH2/;2/X M BKTQ`iMi HBKBiiBQM Bb i?i r2 /B/ MQi ?p2 BM7Q`KiBQM #Qmi i?2 BM/B+iBQM 7Q`  T`2b+`BTiBQMX b i?2 ;mB/2HBM2 `2+QKK2M/BM; ~mQt2iBM2 Bb  ;mB/2HBM2 7Q` i?2 i`2iK2Mi Q7 /2T`2bbBQM BM vQmM; T2QTH2- Bi Kv MQi TTHv iQ HH T`2b+`BTiBQMb BM+Hm/2/ ?2`2BMX

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