����JFIFXX�����    $.' ",#(7),01444'9=82<.342  2!!22222222222222222222222222222222222222222222222222����"��4�� ���,�PG"Z_�4�˷����kjز�Z�,F+��_z�,�© �����zh6�٨�ic�fu���#ډb���_�N�?��wQ���5-�~�I���8����TK<5o�Iv-�����k�_U_�����~b�M��d����Ӝ�U�Hh��?]��E�w��Q���k�{��_}qFW7HTՑ��Y��F�?_�'ϔ��_�Ջt��=||I ��6�έ"�����D���/[�k�9���Y�8ds|\���Ҿp6�Ҵ���]��.����6�z<�v��@]�i%��$j��~�g��J>��no����pM[me�i$[����s�o�ᘨ�˸ nɜG-�ĨU�ycP�3.DB�li�;��hj���x7Z^�N�h������N3u{�:j�x�힞��#M&��jL P@_���� P��&��o8������9�����@Sz6�t7#O�ߋ �s}Yf�T���lmr����Z)'N��k�۞p����w\�Tȯ?�8`�O��i{wﭹW�[�r�� ��Q4F�׊���3m&L�=��h3����z~��#�\�l :�F,j@�� ʱ�wQT����8�"kJO���6�֚l����}���R�>ډK���]��y����&����p�}b��;N�1�m�r$�|��7�>e�@B�TM*-iH��g�D�)� E�m�|�ؘbҗ�a��Ҿ����t4���o���G��*oCN�rP���Q��@z,|?W[0�����:�n,jWiE��W��$~/�hp\��?��{(�0���+�Y8rΟ�+����>S-S����VN;�}�s?.����� w�9��˟<���Mq4�Wv'��{)0�1mB��V����W[�����8�/<� �%���wT^�5���b��)iM� pg�N�&ݝ��VO~�q���u���9� ����!��J27����$O-���! �:�%H��� ـ����y�ΠM=t{!S�� oK8������t<����è:a������[�����ա�H���~��w��Qz`�po�^ ����Q��n� �,uu�C�$ ^���,������8�#��:�6��e�|~���!�3�3.�\0��q��o�4`.|� ����y�Q�`~;�d�ׯ,��O�Zw�������`73�v�܋�<���Ȏ�� ـ4k��5�K�a�u�=9Yd��$>x�A�&�� j0� ���vF��� Y�|�y��� ~�6�@c��1vOp�Ig����4��l�OD���L����� R���c���j�_�uX6��3?nk��Wy�f;^*B� ��@�~a�`��Eu������+���6�L��.ü>��}y���}_�O�6�͐�:�YrG�X��kG�����l^w���~㒶sy��Iu�!� W ��X��N�7BV��O��!X�2����wvG�R�f�T#�����t�/?���%8�^�W�aT��G�cL�M���I��(J����1~�8�?aT ���]����AS�E��(��*E}� 2��#I/�׍qz��^t�̔���b�Yz4x���t�){ OH��+(E��A&�N�������XT��o��"�XC��'���)}�J�z�p� ��~5�}�^����+�6����w��c��Q�|Lp�d�H��}�(�.|����k��c4^�"�����Z?ȕ ��a<�L�!039C� �Eu�C�F�Ew�ç ;�n?�*o���B�8�bʝ���'#Rqf���M}7����]����s2tcS{�\icTx;�\��7K���P���ʇ Z O-��~��c>"��?�������P��E��O�8��@�8��G��Q�g�a�Վ���󁶠�䧘��_%#r�>�1�z�a��eb��qcPѵ��n���#L��� =��׀t� L�7�`��V���A{�C:�g���e@�w1 Xp3�c3�ġ����p��M"'-�@n4���fG��B3�DJ�8[Jo�ߐ���gK)ƛ��$���� ���8�3�����+���� �����6�ʻ���� ���S�kI�*KZlT _`���?��K����QK�d����B`�s}�>���`��*�>��,*@J�d�oF*����弝��O}�k��s��]��y�ߘ��c1G�V���<=�7��7����6�q�PT��tXԀ�!9*4�4Tހ3XΛex�46���Y��D ����� �BdemDa����\�_l,��G�/���֌7���Y�](�xTt^%�GE�����4�}bT���ڹ�����;Y)���B�Q��u��>J/J �⮶.�XԄ��j�ݳ�+E��d ��r�5�_D�1 ��o�� �B�x�΢�#���<��W�����8���R6�@g�M�.��� dr�D��>(otU��@x=��~v���2� ӣ�d�oBd��3�eO�6�㣷�����ݜ6��6Y��Qz`��S��{���\P�~z m5{J/L��1������<�e�ͅPu�b�]�ϔ���'������f�b� Zpw��c`"��i���BD@:)ִ�:�]��hv�E�w���T�l��P���"Ju�}��وV J��G6��. J/�Qgl߭�e�����@�z�Zev2u�)]կ�����7x���s�M�-<ɯ�c��r�v�����@��$�ޮ}lk���a���'����>x��O\�ZFu>�����ck#��&:��`�$�ai�>2Δ����l���oF[h��lE�ܺ�Πk:)���`�� $[6�����9�����kOw�\|���8}������ބ:��񶐕��I�A1/�=�2[�,�!��.}gN#�u����b��� ~��݊��}34q����d�E��Lc��$��"�[q�U�硬g^��%B �z���r�pJ�ru%v\h1Y�ne`ǥ:g���pQM~�^�Xi� ��`S�:V29.�P���V�?B�k�� AEvw%�_�9C�Q����wKekPؠ�\�;Io d�{ ߞo�c1eP����\� `����E=���@K<�Y���eڼ�J���w����{av�F�'�M�@/J��+9p���|]�����Iw &`��8���&M�hg��[�{��Xj��%��Ӓ�$��(����ʹN���<>�I���RY���K2�NPlL�ɀ)��&e����B+ь����( � �JTx���_?EZ� }@ 6�U���뙢ط�z��dWI�n` D����噥�[��uV��"�G&Ú����2g�}&m��?ċ�"����Om#��������� ��{�ON��"S�X��Ne��ysQ���@Fn��Vg���dX�~nj�]J�<�K]:��FW��b�������62�=��5f����JKw��bf�X�55��~J �%^����:�-�QIE��P��v�nZum� z � ~ə ���� ���ة����;�f��\v���g�8�1��f24;�V���ǔ�)����9���1\��c��v�/'Ƞ�w�������$�4�R-��t���� e�6�/�ġ �̕Ecy�J���u�B���<�W�ַ~�w[B1L۲�-JS΂�{���΃������A��20�c#��@ 0!1@AP"#2Q`$3V�%45a6�FRUq��� ����^7ׅ,$n�������+��F�`��2X'��0vM��p�L=������5��8������u�p~���.�`r�����\���O��,ư�0oS ��_�M�����l���4�kv\JSd���x���SW�<��Ae�IX����������$I���w�:S���y���›R��9�Q[���,�5�;�@]�%���u�@ *ro�lbI �� ��+���%m:�͇ZV�����u�̉����θau<�fc�.����{�4Ա� �Q����*�Sm��8\ujqs]{kN���)qO�y�_*dJ�b�7���yQqI&9�ԌK!�M}�R�;������S�T���1���i[U�ɵz�]��U)V�S6���3$K{�ߊ<�(� E]Զ[ǼENg�����'�\?#)Dkf��J���o��v���'�%ƞ�&K�u�!��b�35LX�Ϸ��63$K�a�;�9>,R��W��3�3� d�JeTYE.Mϧ��-�o�j3+y��y^�c�������VO�9NV\nd�1 ��!͕_)a�v;����թ�M�lWR1��)El��P;��yوÏ�u 3�k�5Pr6<�⒲l�!˞*��u־�n�!�l:����UNW ��%��Chx8vL'��X�@��*��)���̮��ˍ��� ���D-M�+J�U�kvK����+�x8��cY������?�Ԡ��~3mo��|�u@[XeY�C�\Kp�x8�oC�C�&����N�~3-H���� ��MX�s�u<`���~"WL��$8ξ��3���a�)|:@�m�\���^�`�@ҷ)�5p+��6���p�%i)P M���ngc�����#0Aruz���RL+xSS?���ʮ}()#�t��mˇ!��0}}y����<�e� �-ή�Ԩ��X������ MF���ԙ~l L.3���}�V뽺�v�����멬��Nl�)�2����^�Iq��a��M��qG��T�����c3#������3U�Ǎ���}��לS�|qa��ڃ�+���-��2�f����/��bz��ڐ�� �ݼ[2�ç����k�X�2�* �Z�d���J�G����M*9W���s{��w���T��x��y,�in�O�v��]���n����P�$�JB@=4�OTI�n��e�22a\����q�d���%�$��(���:���: /*�K[PR�fr\nڙdN���F�n�$�4�[�� U�zƶ����� �mʋ���,�ao�u 3�z� �x��Kn����\[��VFmbE;�_U��&V�Gg�]L�۪&#n%�$ɯ�dG���D�TI=�%+AB�Ru#��b4�1�»x�cs�YzڙJG��f��Il��d�eF'T� iA��T���uC�$����Y��H?����[!G`}���ͪ� �纤Hv\������j�Ex�K���!���OiƸ�Yj�+u-<���'q����uN�*�r\��+�]���<�wOZ.fp�ێ��,-*)V?j-kÊ#�`�r��dV����(�ݽBk�����G�ƛk�QmUڗe��Z���f}|����8�8��a���i��3'J�����~G_�^���d�8w������ R�`(�~�.��u���l�s+g�bv���W���lGc}��u���afE~1�Ue������Z�0�8�=e�� f@/�jqEKQQ�J��oN��J���W5~M>$6�Lt�;$ʳ{���^��6�{����v6���ķܰg�V�cnn �~z�x�«�,2�u�?cE+Ș�H؎�%�Za�)���X>uW�Tz�Nyo����s���FQƤ��$��*�&�LLXL)�1�" L��eO��ɟ�9=���:t��Z���c��Ž���Y?�ӭV�wv�~,Y��r�ۗ�|�y��GaF�����C�����.�+� ���v1���fήJ�����]�S��T��B��n5sW}y�$��~z�'�c ��8 ��� ,! �p��VN�S��N�N�q��y8z˱�A��4��*��'������2n<�s���^ǧ˭P�Jޮɏ�U�G�L�J�*#��<�V��t7�8����TĜ>��i}K%,���)[��z�21z ?�N�i�n1?T�I�R#��m-�����������������1����lA�`��fT5+��ܐ�c�q՝��ʐ��,���3�f2U�եmab��#ŠdQ�y>\��)�SLY����w#��.���ʑ�f��� ,"+�w�~�N�'�c�O�3F�������N<���)j��&��,-� �љ���֊�_�zS���TǦ����w�>��?�������n��U仆�V���e�����0���$�C�d���rP �m�׈e�Xm�Vu� �L��.�bֹ��� �[Դaզ���*��\y�8�Է:�Ez\�0�Kq�C b��̘��cө���Q��=0Y��s�N��S.���3.���O�o:���#���v7�[#߫ ��5�܎�L���Er4���9n��COWlG�^��0k�%<���ZB���aB_���������'=��{i�v�l�$�uC���mƎҝ{�c㱼�y]���W�i ��ߧc��m�H� m�"�"�����;Y�ߝ�Z�Ǔ�����:S#��|}�y�,/k�Ld� TA�(�AI$+I3��;Y*���Z��}|��ӧO��d�v��..#:n��f>�>���ȶI�TX��� 8��y����"d�R�|�)0���=���n4��6ⲑ�+��r<�O�܂~zh�z����7ܓ�HH�Ga롏���nCo�>������a ���~]���R���̲c?�6(�q�;5%� |�uj�~z8R=X��I�V=�|{v�Gj\gc��q����z�؋%M�ߍ����1y��#��@f^���^�>N�����#x#۹��6�Y~�?�dfPO��{��P�4��V��u1E1J �*|���%���JN��`eWu�zk M6���q t[�� ��g�G���v��WIG��u_ft����5�j�"�Y�:T��ɐ���*�;� e5���4����q$C��2d�}���� _S�L#m�Yp��O�.�C�;��c����Hi#֩%+) �Ӎ��ƲV���SYź��g |���tj��3�8���r|���V��1#;.SQ�A[���S������#���`n�+���$��$I �P\[�@�s��(�ED�z���P��])8�G#��0B��[ى��X�II�q<��9�~[Z멜�Z�⊔IWU&A>�P~�#��dp<�?����7���c��'~���5 ��+$���lx@�M�dm��n<=e�dyX��?{�|Aef ,|n3�<~z�ƃ�uۧ�����P��Y,�ӥQ�*g�#먙R�\���;T��i,��[9Qi歉����c>]9�� ��"�c��P�� �Md?٥��If�ت�u��k��/����F��9�c*9��Ǎ:�ØF���z�n*�@|I�ށ9����N3{'��[�'ͬ�Ҳ4��#}��!�V� Fu��,�,mTIk���v C�7v���B�6k�T9��1�*l� '~��ƞF��lU��'�M ����][ΩũJ_�{�i�I�n��$���L�� j��O�dx�����kza۪��#�E��Cl����x˘�o�����V���ɞ�ljr��)�/,�߬h�L��#��^��L�ф�,íMƁe�̩�NB�L�����iL����q�}��(��q��6IçJ$�W�E$��:������=#����(�K�B����zђ <��K(�N�۫K�w��^O{!����)�H���>x�������lx�?>Պ�+�>�W���,Ly!_�D���Ō�l���Q�!�[ �S����J��1��Ɛ�Y}��b,+�Lo�x�ɓ)����=�y�oh�@�꥟/��I��ѭ=��P�y9��� �ۍYӘ�e+�p�Jnϱ?V\SO%�(�t� ���=?MR�[Ș�����d�/ ��n�l��B�7j� ��!�;ӥ�/�[-���A�>�dN�sLj ��,ɪv��=1c�.SQ�O3�U���ƀ�ܽ�E����������̻��9G�ϷD�7(�}��Ävӌ\�y�_0[w ���<΍>����a_��[0+�L��F.�޺��f�>oN�T����q;���y\��bՃ��y�jH�<|q-eɏ�_?_9+P���Hp$�����[ux�K w�Mw��N�ی'$Y2�=��q���KB��P��~������Yul:�[<����F1�2�O���5=d����]Y�sw:���Ϯ���E��j,_Q��X��z`H1,#II ��d�wr��P˂@�ZJV����y$�\y�{}��^~���[:N����ߌ�U�������O��d�����ؾe��${p>G��3c���Ė�lʌ�� ת��[��`ϱ�-W����dg�I��ig2��� ��}s ��ؤ(%#sS@���~���3�X�nRG�~\jc3�v��ӍL��M[JB�T��s3}��j�Nʖ��W����;7��ç?=X�F=-�=����q�ߚ���#���='�c��7���ڑW�I(O+=:uxq�������������e2�zi+�kuG�R��������0�&e�n���iT^J����~\jy���p'dtG��s����O��3����9* �b#Ɋ�� p������[Bws�T�>d4�ۧs���nv�n���U���_�~,�v����ƜJ1��s�� �QIz��)�(lv8M���U=�;����56��G���s#�K���MP�=��LvyGd��}�VwWBF�'�à �?MH�U�g2�� ����!�p�7Q��j��ڴ����=��j�u��� Jn�A s���uM������e��Ɔ�Ҕ�!)'��8Ϣ�ٔ��ޝ(��Vp���צ֖d=�IC�J�Ǡ{q������kԭ�߸���i��@K����u�|�p=..�*+����x�����z[Aqġ#s2a�Ɗ���RR�)*HRsi�~�a &f��M��P����-K�L@��Z��Xy�'x�{}��Zm+���:�)�) IJ�-i�u���� ���ܒH��'�L(7�y�GӜq���� j��� 6ߌg1�g�o���,kر���tY�?W,���p���e���f�OQS��!K�۟cҒA�|ս�j�>��=⬒��˧L[�� �߿2JaB~R��u�:��Q�] �0H~���]�7��Ƽ�I���(}��cq '�ήET���q�?f�ab���ӥvr� �)o��-Q��_'����ᴎo��K������;��V���o��%���~OK ����*��b�f:���-ťIR��`B�5!RB@���ï�� �u �̯e\�_U�_������� g�ES��3�������QT��a����x����U<~�c?�*�#]�MW,[8O�a�x��]�1bC|踤�P��lw5V%�)�{t�<��d��5���0i�XSU��m:��Z�┵�i�"��1�^B�-��P�hJ��&)O��*�D��c�W��vM��)����}���P��ܗ-q����\mmζZ-l@�}��a��E�6��F�@��&Sg@���ݚ�M����� ȹ 4����#p�\H����dYDo�H���"��\��..R�B�H�z_�/5˘����6��KhJR��P�mƶi�m���3�,#c�co��q�a)*Pt����R�m�k�7x�D�E�\Y�閣_X�<���~�)���c[[�BP����6�Yq���S��0����%_����;��Àv�~�| VS؇ ��'O0��F0��\���U�-�d@�����7�SJ*z��3n��y��P����O���������m�~�P�3|Y��ʉr#�C�<�G~�.,! ���bqx���h~0=��!ǫ�jy����l�O,�[B��~��|9��ٱ����Xly�#�i�B��g%�S��������tˋ���e���ې��\[d�t)��.+u�|1 ������#�~Oj����hS�%��i.�~X���I�H�m��0n���c�1uE�q��cF�RF�o���7� �O�ꮧ� ���ۛ{��ʛi5�rw?׌#Qn�TW��~?y$��m\�\o����%W� ?=>S�N@�� �Ʈ���R����N�)�r"C�:��:����� �����#��qb��Y�. �6[��2K����2u�Ǧ�HYR��Q�MV��� �G�$��Q+.>�����nNH��q�^��� ����q��mM��V��D�+�-�#*�U�̒ ���p욳��u:�������IB���m���PV@O���r[b= �� ��1U�E��_Nm�yKbN�O���U�}�the�`�|6֮P>�\2�P�V���I�D�i�P�O;�9�r�mAHG�W�S]��J*�_�G��+kP�2����Ka�Z���H�'K�x�W�MZ%�O�YD�Rc+o��?�q��Ghm��d�S�oh�\�D�|:W������UA�Qc yT�q������~^�H��/��#p�CZ���T�I�1�ӏT����4��"�ČZ�����}��`w�#�*,ʹ�� ��0�i��課�Om�*�da��^gJ݅{���l�e9uF#T�ֲ��̲�ٞC"�q���ߍ ոޑ�o#�XZTp����@ o�8��(jd��xw�]�,f���`~�|,s��^����f�1���t��|��m�򸄭/ctr��5s��7�9Q�4�H1꠲BB@l9@���C�����+�wp�xu�£Yc�9��?`@#�o�mH�s2��)�=��2�.�l����jg�9$�Y�S�%*L������R�Y������7Z���,*=�䷘$�������arm�o�ϰ���UW.|�r�uf����IGw�t����Zwo��~5 ��YյhO+=8fF�)�W�7�L9lM�̘·Y���֘YLf�큹�pRF���99.A �"wz��=E\Z���'a� 2��Ǚ�#;�'}�G���*��l��^"q��+2FQ� hj��kŦ��${���ޮ-�T�٭cf�|�3#~�RJ����t��$b�(R��(����r���dx� >U b�&9,>���%E\� Ά�e�$��'�q't��*�א���ެ�b��-|d���SB�O�O��$�R+�H�)�܎�K��1m`;�J�2�Y~9��O�g8=vqD`K[�F)k�[���1m޼c��n���]s�k�z$@��)!I �x՝"v��9=�ZA=`Ɠi �:�E��)`7��vI��}d�YI�_ �o�:ob���o ���3Q��&D&�2=�� �Ά��;>�h����y.*ⅥS������Ӭ�+q&����j|UƧ����}���J0��WW< ۋS�)jQR�j���Ư��rN)�Gű�4Ѷ(�S)Ǣ�8��i��W52���No˓� ۍ%�5brOn�L�;�n��\G����=�^U�dI���8$�&���h��'���+�(������cȁ߫k�l��S^���cƗjԌE�ꭔ��gF���Ȓ��@���}O���*;e�v�WV���YJ\�]X'5��ղ�k�F��b 6R�o՜m��i N�i����>J����?��lPm�U��}>_Z&�KK��q�r��I�D�Չ~�q�3fL�:S�e>���E���-G���{L�6p�e,8��������QI��h��a�Xa��U�A'���ʂ���s�+טIjP�-��y�8ۈZ?J$��W�P� ��R�s�]��|�l(�ԓ��sƊi��o(��S0��Y� 8�T97.�����WiL��c�~�dxc�E|�2!�X�K�Ƙਫ਼�$((�6�~|d9u+�qd�^3�89��Y�6L�.I�����?���iI�q���9�)O/뚅����O���X��X�V��ZF[�یgQ�L��K1���RҖr@v�#��X�l��F���Нy�S�8�7�kF!A��sM���^rkp�jP�DyS$N���q��nxҍ!U�f�!eh�i�2�m���`�Y�I�9r�6� �TF���C}/�y�^���Η���5d�'��9A-��J��>{�_l+�`��A���[�'��յ�ϛ#w:݅�%��X�}�&�PSt�Q�"�-��\縵�/����$Ɨh�Xb�*�y��BS����;W�ջ_mc�����vt?2}1�;qS�d�d~u:2k5�2�R�~�z+|HE!)�Ǟl��7`��0�<�,�2*���Hl-��x�^����'_TV�gZA�'j� ^�2Ϊ��N7t�����?w�� �x1��f��Iz�C-Ȗ��K�^q�;���-W�DvT�7��8�Z�������� hK�(P:��Q- �8�n�Z���܃e貾�<�1�YT<�,�����"�6{/ �?�͟��|1�:�#g��W�>$����d��J��d�B��=��jf[��%rE^��il:��B���x���Sּ�1հ��,�=��*�7 fcG��#q� �eh?��2�7�����,�!7x��6�n�LC�4x��},Geǝ�tC.��vS �F�43��zz\��;QYC,6����~;RYS/6���|2���5���v��T��i����������mlv��������&� �nRh^ejR�LG�f���? �ۉҬܦƩ��|��Ȱ����>3����!v��i�ʯ�>�v��オ�X3e���_1z�Kȗ\<������!�8���V��]��?b�k41�Re��T�q��mz��TiOʦ�Z��Xq���L������q"+���2ۨ��8}�&N7XU7Ap�d�X��~�׿��&4e�o�F��� �H����O���č�c�� 懴�6���͉��+)��v;j��ݷ�� �UV�� i��� j���Y9GdÒJ1��詞�����V?h��l����l�cGs�ځ�������y�Ac�����\V3�? �� ܙg�>qH�S,�E�W�[�㺨�uch�⍸�O�}���a��>�q�6�n6����N6�q������N ! 1AQaq�0@����"2BRb�#Pr���3C`��Scst���$4D���%Td�� ?���N����a��3��m���C���w��������xA�m�q�m���m������$����4n淿t'��C"w��zU=D�\R+w�p+Y�T�&�պ@��ƃ��3ޯ?�Aﶂ��aŘ���@-�����Q�=���9D��ռ�ѻ@��M�V��P��܅�G5�f�Y<�u=,EC)�<�Fy'�"�&�չ�X~f��l�KԆV��?�� �W�N����=(� �;���{�r����ٌ�Y���h{�١������jW����P���Tc�����X�K�r��}���w�R��%��?���E��m�� �Y�q|����\lEE4���r���}�lsI�Y������f�$�=�d�yO����p�����yBj8jU�o�/�S��?�U��*������ˍ�0������u�q�m [�?f����a�� )Q�>����6#������� ?����0UQ����,IX���(6ڵ[�DI�MNލ�c&���υ�j\��X�R|,4��� j������T�hA�e��^���d���b<����n�� �즇�=!���3�^�`j�h�ȓr��jẕ�c�,ٞX����-����a�ﶔ���#�$��]w�O��Ӫ�1y%��L�Y<�wg#�ǝ�̗`�x�xa�t�w��»1���o7o5��>�m뭛C���Uƃߜ}�C���y1Xνm�F8�jI���]����H���ۺиE@I�i;r�8ӭ����V�F�Շ| ��&?�3|x�B�MuS�Ge�=Ӕ�#BE5G�����Y!z��_e��q�р/W>|-�Ci߇�t�1ޯќd�R3�u��g�=0 5��[?�#͏��q�cf���H��{ ?u�=?�?ǯ���}Z��z���hmΔ�BFTW�����<�q�(v� ��!��z���iW]*�J�V�z��gX֧A�q�&��/w���u�gYӘa���; �i=����g:��?2�dž6�ى�k�4�>�Pxs����}������G�9��3 ���)gG�R<>r h�$��'nc�h�P��Bj��J�ҧH� -��N1���N��?��~��}-q!=��_2hc�M��l�vY%UE�@|�v����M2�.Y[|y�"Eï��K�ZF,�ɯ?,q�?v�M 80jx�"�;�9vk�����+ ֧�� �ȺU��?�%�vcV��mA�6��Qg^M����A}�3�nl� QRN�l8�kkn�'�����(��M�7m9و�q���%ޟ���*h$Zk"��$�9��: �?U8�Sl��,,|ɒ��xH(ѷ����Gn�/Q�4�P��G�%��Ա8�N��!� �&�7�;���eKM7�4��9R/%����l�c>�x;������>��C�:�����t��h?aKX�bhe�ᜋ^�$�Iհ �hr7%F$�E��Fd���t��5���+�(M6�t����Ü�UU|zW�=a�Ts�Tg������dqP�Q����b'�m���1{|Y����X�N��b �P~��F^F:����k6�"�j!�� �I�r�`��1&�-$�Bevk:y���#yw��I0��x��=D�4��tU���P�ZH��ڠ底taP��6����b>�xa����Q�#� WeF��ŮNj�p�J* mQ�N����*I�-*�ȩ�F�g�3 �5��V�ʊ�ɮ�a��5F���O@{���NX��?����H�]3��1�Ri_u��������ѕ�� ����0��� F��~��:60�p�͈�S��qX#a�5>���`�o&+�<2�D����: �������ڝ�$�nP���*)�N�|y�Ej�F�5ټ�e���ihy�Z �>���k�bH�a�v��h�-#���!�Po=@k̆IEN��@��}Ll?j�O������߭�ʞ���Q|A07x���wt!xf���I2?Z��<ץ�T���cU�j��]��陎Ltl �}5�ϓ��$�,��O�mˊ�;�@O��jE��j(�ا,��LX���LO���Ц�90�O �.����a��nA���7������j4 ��W��_ٓ���zW�jcB������y՗+EM�)d���N�g6�y1_x��p�$Lv:��9�"z��p���ʙ$��^��JԼ*�ϭ����o���=x�Lj�6�J��u82�A�H�3$�ٕ@�=Vv�]�'�qEz�;I˼��)��=��ɯ���x �/�W(V���p�����$ �m�������u�����񶤑Oqˎ�T����r��㠚x�sr�GC��byp�G��1ߠ�w e�8�$⿄����/�M{*}��W�]˷.�CK\�ުx���/$�WPw���r� |i���&�}�{�X� �>��$-��l���?-z���g����lΆ���(F���h�vS*���b���߲ڡn,|)mrH[���a�3�ר�[1��3o_�U�3�TC�$��(�=�)0�kgP���� ��u�^=��4 �WYCҸ:��vQ�ר�X�à��tk�m,�t*��^�,�}D*� �"(�I��9R����>`�`��[~Q]�#af��i6l��8���6�:,s�s�N6�j"�A4���IuQ��6E,�GnH��zS�HO�uk�5$�I�4��ؤ�Q9�@��C����wp�BGv[]�u�Ov���0I4���\��y�����Q�Ѹ��~>Z��8�T��a��q�ޣ;z��a���/��S��I:�ܫ_�|������>=Z����8:�S��U�I�J��"IY���8%b8���H��:�QO�6�;7�I�S��J��ҌAά3��>c���E+&jf$eC+�z�;��V����� �r���ʺ������my�e���aQ�f&��6�ND��.:��NT�vm�<- u���ǝ\MvZY�N�NT��-A�>jr!S��n�O 1�3�Ns�%�3D@���`������ܟ 1�^c<���� �a�ɽ�̲�Xë#�w�|y�cW�=�9I*H8�p�^(4���՗�k��arOcW�tO�\�ƍR��8����'�K���I�Q�����?5�>[�}��yU�ײ -h��=��% q�ThG�2�)���"ו3]�!kB��*p�FDl�A���,�eEi�H�f�Ps�����5�H:�Փ~�H�0Dت�D�I����h�F3�������c��2���E��9�H��5�zԑ�ʚ�i�X�=:m�xg�hd(�v����׊�9iS��O��d@0ڽ���:�p�5�h-��t�&���X�q�ӕ,��ie�|���7A�2���O%P��E��htj��Y1��w�Ѓ!����  ���� ࢽ��My�7�\�a�@�ţ�J �4�Ȼ�F�@o�̒?4�wx��)��]�P��~�����u�����5�����7X ��9��^ܩ�U;Iꭆ 5 �������eK2�7(�{|��Y׎ �V��\"���Z�1� Z�����}��(�Ǝ"�1S���_�vE30>���p;� ΝD��%x�W�?W?v����o�^V�i�d��r[��/&>�~`�9Wh��y�;���R��� ;;ɮT��?����r$�g1�K����A��C��c��K��l:�'��3 c�ﳯ*"t8�~l��)���m��+U,z��`(�>yJ�?����h>��]��v��ЍG*�{`��;y]��I�T� ;c��NU�fo¾h���/$���|NS���1�S�"�H��V���T���4��uhǜ�]�v;���5�͠x��'C\�SBpl���h}�N����� A�Bx���%��ޭ�l��/����T��w�ʽ]D�=����K���ž�r㻠l4�S�O?=�k �M:� ��c�C�a�#ha���)�ѐxc�s���gP�iG��{+���x���Q���I= �� z��ԫ+ �8"�k�ñ�j=|����c ��y��CF��/��*9ж�h{ �?4�o� ��k�m�Q�N�x��;�Y��4膚�a�w?�6�>e]�����Q�r�:����g�,i"�����ԩA�*M�<�G��b�if��l^M��5� �Ҩ�{����6J��ZJ�����P�*�����Y���ݛu�_4�9�I8�7���������,^ToR���m4�H��?�N�S�ѕw��/S��甍�@�9H�S�T��t�ƻ���ʒU��*{Xs�@����f�����֒Li�K{H�w^���������Ϥm�tq���s� ���ք��f:��o~s��g�r��ט� �S�ѱC�e]�x���a��) ���(b-$(�j>�7q�B?ӕ�F��hV25r[7 Y� }L�R��}����*sg+��x�r�2�U=�*'WS��ZDW]�WǞ�<��叓���{�$�9Ou4��y�90-�1�'*D`�c�^o?(�9��u���ݐ��'PI&� f�Jݮ�������:wS����jfP1F:X �H�9dԯ���˝[�_54 �}*;@�ܨ�� ð�yn�T���?�ןd�#���4rG�ͨ��H�1�|-#���Mr�S3��G�3�����)�.᧏3v�z֑��r����$G"�`j �1t��x0<Ɔ�Wh6�y�6��,œ�Ga��gA����y��b��)��h�D��ß�_�m��ü �gG;��e�v��ݝ�nQ� ��C����-�*��o���y�a��M��I�>�<���]obD��"�:���G�A��-\%LT�8���c�)��+y76���o�Q�#*{�(F�⽕�y����=���rW�\p���۩�c���A���^e6��K������ʐ�cVf5$�'->���ՉN"���F�"�UQ@�f��Gb~��#�&�M=��8�ט�JNu9��D��[̤�s�o�~������ G��9T�tW^g5y$b��Y'��س�Ǵ�=��U-2 #�MC�t(�i� �lj�@Q 5�̣i�*�O����s�x�K�f��}\��M{E�V�{�υ��Ƈ�����);�H����I��fe�Lȣr�2��>��W�I�Ȃ6������i��k�� �5�YOxȺ����>��Y�f5'��|��H+��98pj�n�.O�y�������jY��~��i�w'������l�;�s�2��Y��:'lg�ꥴ)o#'Sa�a�K��Z� �m��}�`169�n���"���x��I ��*+� }F<��cГ���F�P�������ֹ*�PqX�x۩��,� ��N�� �4<-����%����:��7����W���u�`����� $�?�I��&����o��o��`v�>��P��"��l���4��5'�Z�gE���8���?��[�X�7(��.Q�-��*���ތL@̲����v��.5���[��=�t\+�CNܛ��,g�SQnH����}*F�G16���&:�t��4ُ"A��̣��$�b �|����#rs��a�����T�� ]�<�j��BS�('$�ɻ� �wP;�/�n��?�ݜ��x�F��yUn�~mL*-�������Xf�wd^�a�}��f�,=t�׵i�.2/wpN�Ep8�OР���•��R�FJ� 55TZ��T �ɭ�<��]��/�0�r�@�f��V��V����Nz�G��^���7hZi����k��3�,kN�e|�vg�1{9]_i��X5y7� 8e]�U����'�-2,���e"����]ot�I��Y_��n�(JҼ��1�O ]bXc���Nu�No��pS���Q_���_�?i�~�x h5d'�(qw52] ��'ޤ�q��o1�R!���`ywy�A4u���h<קy���\[~�4�\ X�Wt/� 6�����n�F�a8��f���z �3$�t(���q��q�x��^�XWeN'p<-v�!�{�(>ӽDP7��ո0�y)�e$ٕv�Ih'Q�EA�m*�H��RI��=:��� ���4牢) �%_iN�ݧ�l]� �Nt���G��H�L��� ɱ�g<���1V�,�J~�ٹ�"K��Q�� 9�HS�9�?@��k����r�;we݁�]I�!{ �@�G�[�"��`���J:�n]�{�cA�E����V��ʆ���#��U9�6����j�#Y�m\��q�e4h�B�7��C�������d<�?J����1g:ٳ���=Y���D�p�ц� ׈ǔ��1�]26؜oS�'��9�V�FVu�P�h�9�xc�oq�X��p�o�5��Ա5$�9W�V(�[Ak�aY錎qf;�'�[�|���b�6�Ck��)��#a#a˙��8���=äh�4��2��C��4tm^ �n'c���]GQ$[Wҿ��i���vN�{Fu ��1�gx��1┷���N�m��{j-,��x�� Ūm�ЧS�[�s���Gna���䑴�� x�p 8<������97�Q���ϴ�v�aϚG��Rt�Һ׈�f^\r��WH�JU�7Z���y)�vg=����n��4�_)y��D'y�6�]�c�5̪�\� �PF�k����&�c;��cq�$~T�7j ���nç]�<�g ":�to�t}�159�<�/�8������m�b�K#g'I'.W�����6��I/��>v��\�MN��g���m�A�yQL�4u�Lj�j9��#44�t��l^�}L����n��R��!��t��±]��r��h6ٍ>�yҏ�N��fU�� ���� Fm@�8}�/u��jb9������he:A�y�ծw��GpΧh�5����l}�3p468��)U��d��c����;Us/�֔�YX�1�O2��uq�s��`hwg�r~�{ R��mhN��؎*q 42�*th��>�#���E����#��Hv�O����q�}�����6�e��\�,Wk�#���X��b>��p}�դ��3���T5��†��6��[��@�P�y*n��|'f�֧>�lư΂�̺����SU�'*�q�p�_S�����M�� '��c�6�����m�� ySʨ;M��r���Ƌ�m�Kxo,���Gm�P��A�G�:��i��w�9�}M(�^�V��$ǒ�ѽ�9���|���� �a����J�SQ�a���r�B;����}���ٻ֢�2�%U���c�#�g���N�a�ݕ�'�v�[�OY'��3L�3�;,p�]@�S��{ls��X�'���c�jw�k'a�.��}�}&�� �dP�*�bK=ɍ!����;3n�gΊU�ߴmt�'*{,=SzfD� A��ko~�G�aoq�_mi}#�m�������P�Xhύ����mxǍ�΂���巿zf��Q���c���|kc�����?���W��Y�$���_Lv����l߶��c���`?����l�j�ݲˏ!V��6����U�Ђ(A���4y)H���p�Z_�x��>���e��R��$�/�`^'3qˏ�-&Q�=?��CFVR �D�fV�9��{�8g�������n�h�(P"��6�[�D���< E�����~0<@�`�G�6����Hг�cc�� �c�K.5��D��d�B���`?�XQ��2��ٿyqo&+�1^� DW�0�ꊩ���G�#��Q�nL3��c���������/��x ��1�1[y�x�პCW��C�c�UĨ80�m�e�4.{�m��u���I=��f�����0QRls9���f���������9���~f�����Ǩ��a�"@�8���ȁ�Q����#c�ic������G��$���G���r/$W�(��W���V�"��m�7�[m�A�m����bo��D� j����۳� l���^�k�h׽����� ��#� iXn�v��eT�k�a�^Y�4�BN��ĕ��0 !01@Q"2AaPq3BR������?���@4�Q�����T3,���㺠�W�[=JK�Ϟ���2�r^7��vc�:�9 �E�ߴ�w�S#d���Ix��u��:��Hp��9E!�� V 2;73|F��9Y���*ʬ�F��D����u&���y؟��^EA��A��(ɩ���^��GV:ݜDy�`��Jr29ܾ�㝉��[���E;Fzx��YG��U�e�Y�C���� ����v-tx����I�sם�Ę�q��Eb�+P\ :>�i�C'�;�����k|z�رn�y]�#ǿb��Q��������w�����(�r|ӹs��[�D��2v-%��@;�8<a���[\o[ϧw��I!��*0�krs)�[�J9^��ʜ��p1)� "��/_>��o��<1����A�E�y^�C��`�x1'ܣn�p��s`l���fQ��):�l����b>�Me�jH^?�kl3(�z:���1ŠK&?Q�~�{�ٺ�h�y���/�[��V�|6��}�KbX����mn[-��7�5q�94�������dm���c^���h� X��5��<�eޘ>G���-�}�دB�ޟ� ��|�rt�M��V+�]�c?�-#ڛ��^ǂ}���Lkr���O��u�>�-D�ry� D?:ޞ�U��ǜ�7�V��?瓮�"�#���r��չģVR;�n���/_� ؉v�ݶe5d�b9��/O��009�G���5n�W����JpA�*�r9�>�1��.[t���s�F���nQ� V 77R�]�ɫ8����_0<՜�IF�u(v��4��F�k�3��E)��N:��yڮe��P�`�1}�$WS��J�SQ�N�j�ٺ��޵�#l���ј(�5=��5�lǏmoW�v-�1����v,W�mn��߀$x�<����v�j(����c]��@#��1������Ǔ���o'��u+����;G�#�޸��v-lη��/(`i⣍Pm^���ԯ̾9Z��F��������n��1��� ��]�[��)�'������:�֪�W��FC����� �B9،!?���]��V��A�Վ�M��b�w��G F>_DȬ0¤�#�QR�[V��kz���m�w�"��9ZG�7'[��=�Q����j8R?�zf�\a�=��O�U����*oB�A�|G���2�54 �p��.w7� �� ��&������ξxGHp� B%��$g�����t�Џ򤵍z���HN�u�Я�-�'4��0��;_��3 !01"@AQa2Pq#3BR������?��ʩca��en��^��8���<�u#��m*08r��y�N"�<�Ѳ0��@\�p��� �����Kv�D��J8�Fҽ� �f�Y��-m�ybX�NP����}�!*8t(�OqѢ��Q�wW�K��ZD��Δ^e��!� ��B�K��p~�����e*l}z#9ң�k���q#�Ft�o��S�R����-�w�!�S���Ӥß|M�l޶V��!eˈ�8Y���c�ЮM2��tk���� ������J�fS����Ö*i/2�����n]�k�\���|4yX�8��U�P.���Ы[���l��@"�t�<������5�lF���vU�����W��W��;�b�cД^6[#7@vU�xgZv��F�6��Q,K�v��� �+Ъ��n��Ǣ��Ft���8��0��c�@�!�Zq s�v�t�;#](B��-�nῃ~���3g������5�J�%���O������n�kB�ĺ�.r��+���#�N$?�q�/�s�6��p��a����a��J/��M�8��6�ܰ"�*������ɗud"\w���aT(����[��F��U՛����RT�b���n�*��6���O��SJ�.�ij<�v�MT��R\c��5l�sZB>F��<7�;EA��{��E���Ö��1U/�#��d1�a�n.1ě����0�ʾR�h��|�R��Ao�3�m3 ��%�� ���28Q� ��y��φ���H�To�7�lW>����#i`�q���c����a��� �m,B�-j����݋�'mR1Ήt�>��V��p���s�0IbI�C.���1R�ea�����]H�6����������4B>��o��](��$B���m�����a�!=��?�B� K�Ǿ+�Ծ"�n���K��*��+��[T#�{E�J�S����Q�����s�5�:�U�\wĐ�f�3����܆&�)����I���Ԇw��E T�lrTf6Q|R�h:��[K�� �z��c֧�G�C��%\��_�a�84��HcO�bi��ؖV��7H �)*ģK~Xhչ0��4?�0��� �E<���}3���#���u�?�� ��|g�S�6ꊤ�|�I#Hڛ� �ա��w�X��9��7���Ŀ%�SL��y6č��|�F�a 8���b��$�sק�h���b9RAu7�˨p�Č�_\*w��묦��F ����4D~�f����|(�"m���NK��i�S�>�$d7SlA��/�²����SL��|6N�}���S�˯���g��]6��; �#�.��<���q'Q�1|KQ$�����񛩶"�$r�b:���N8�w@��8$�� �AjfG|~�9F ���Y��ʺ��Bwؒ������M:I岎�G��`s�YV5����6��A �b:�W���G�q%l�����F��H���7�������Fsv7��k�� 403WebShell
403Webshell
Server IP : 104.21.45.146  /  Your IP : 172.69.214.219
Web Server : Apache/2.4.52 (Ubuntu)
System : Linux ip-172-31-19-221 6.8.0-1029-aws #31~22.04.1-Ubuntu SMP Thu Apr 24 21:16:18 UTC 2025 x86_64
User : www-data ( 33)
PHP Version : 8.1.28
Disable Function : NONE
MySQL : OFF  |  cURL : ON  |  WGET : ON  |  Perl : ON  |  Python : OFF  |  Sudo : ON  |  Pkexec : ON
Directory :  /efsdata/scitechnol.com/httpdocs/submission/uploads/

Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 

Command :


[ Back ]     

Current File : /efsdata/scitechnol.com/httpdocs/submission/uploads/2532-0-Manuscript-2015-01-27.doc
��ࡱ�>��	�������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������	��Fcbjbj�:�:	(��P�P�T7�������P	P	%%%%8]D�T%gHh��"��\  0�G�G�G�G�G�G�G�I�qL�GuP P T �G|"�!H|"|"|"X <�@|"P �G|"|"��2��4��7
.�%�!�\3�4�7H0gHr3M|"M,�4|"�4D�4P P P ����������������������������P	��:
	Utility of Routine Transthoracic Echocardiography in Hospitalized Syncope Patients Risk Stratified by EGSYS Score

Ali Shafiq, MD, �* Hardik Bhansali, MD,� Meredith Mahan, MS,� Karthik Ananthasubramaniam, MD FACC FASE FASNC FRCP(Glas)�
*Department of Cardiology, Saint Luke�s Mid America Heart Institute, Kansas City, MO, USA
�Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
�Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
�Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA

Address correspondence to 
Karthik Ananthasubramaniam MD FACC FASE FASNC FRCP (Glas)
Heart and Vascular Institute 
Henry Ford Hospital 
2799 W Grand Blvd
Detroit, MI 48202
Ph: 313-916-4420
Fax: 313-916-8901
Email: kananth1@hfhs.org

Running head: Routine echocardiography in syncope 
Funding sources: No external funding sources
ABSTRACT
Background:  The yield of routine transthoracic echocardiography (TTE) in the diagnosis and risk stratification of syncope has been a subject of debate. 
Purpose and Methods: To compare the yield of TTE in different risk categories of syncope patients, we performed a retrospective study of patients who had a TTE with an admission diagnosis of syncope. The patients were then stratified into low and high risk categories based on their Evaluation of Guidelines in Syncope Study (EGSYS) score of < 3 and > 3, respectively. Three downstream health resources were evaluated: cardiology consultation, further testing and therapeutic interventions after TTE was done. 
Results: Of the study group, 65% (295/456) of patients were found to have utilized no downstream health resources. The remaining 35% (161/456) had at least used 1 resource; 29.2% (133/456) utilized 1, 5 %( 23/456) utilized 2 and 1.1% (5/456) utilized all 3 of these resources. Of the total study group, 51 %( 233/456) were low risk for cardiac syncope according to the EGSYS score. Only 23.2% (54/233) of these low risk patients utilized 1 or more of the downstream health resources, but no patients in this group needed any cardiac intervention. 
Conclusion: There was a significant difference of the yield and thus incremental value of TTE between high and low risk group categories based on the EGSYS score. A low EGSYS score seems to be a good initial tool in identifying patients who likely will not require additional interventions related to further downstream testing. 

Keywords:  Syncope, transthoracic echocardiography, yield, utilization
INTRODUCTION
Syncope is defined as a transient loss of consciousness due to global transient loss of cerebral perfusion and is usually rapid in onset, short in duration and associated with spontaneous and complete recovery.HYPERLINK \l "_ENREF_1" \o "Moya, 2009 #1" ADDIN EN.CITE  ADDIN EN.CITE.DATA 1 It is a common problem representing 1%-5% of emergency department visits and 1%-3% of hospital admissions. ADDIN EN.CITE  ADDIN EN.CITE.DATA HYPERLINK \l "_ENREF_2" \o "Brignole, 2001 #2"2,HYPERLINK \l "_ENREF_3" \o "Day, 1982 #3"3 Transthoracic echocardiography (TTE) is an excellent readily available modality used widely for evaluation of ventricular and valve function and intracardiac anatomy definition. It has been used for risk stratification of syncope. ADDIN EN.CITE  ADDIN EN.CITE.DATA HYPERLINK \l "_ENREF_4" \o "Linzer, 1997 #4"4,HYPERLINK \l "_ENREF_5" \o "Cheitlin, 1997 #5"5 However, routine use of TTE and its incremental value beyond traditional risk assessment has not been well established. ADDIN EN.CITE  ADDIN EN.CITE.DATA HYPERLINK \l "_ENREF_2" \o "Brignole, 2001 #2"2,HYPERLINK \l "_ENREF_4" \o "Linzer, 1997 #4"4,HYPERLINK \l "_ENREF_5" \o "Cheitlin, 1997 #5"5 Recently the Evaluation of Guidelines in Syncope Study (EGSYS) score has been proposed as a simple diagnostic and prognostic tool to identify patients who may have a cardiac etiology of syncope that need further evaluation. This score was derived from the patients participating in the �The Evaluation of Guidelines in Syncope Study 2 (EGSYS-2)� and is sensitive for identifying patients at high or low risk for cardiac syncope.HYPERLINK \l "_ENREF_6" \o "Brignole, 2006 #6" ADDIN EN.CITE  ADDIN EN.CITE.DATA 6

We aimed to determine if use of EGSYS score to classify hospitalized syncope patients into different risk groups score could guide appropriate utilization of TTE in these patients by comparing their yield (utilization of downstream health resources).

MATERIALS AND METHODS
This was a retrospective observational cohort study. The study was approved by the Institutional Review Board of Henry Ford Health System. Data were collected through a retrospective chart review of all patients admitted from December 1, 2011 to August 31, 2012. Patients who had a TTE with admission diagnosis of syncope were screened. Patients without true syncope (no loss of postural tone, etc) and not needing inpatient admission were excluded. EGSYS score was calculated by the summation of 6 risk factors that were collected from each patient�s chart (Table I). The patients were then stratified into low and high risk categories based on their EGSYS score of < 3 and > 3, respectively. The yield of TTE was defined as use of 3 downstream health resources: cardiology consultation, further diagnostic testing and therapeutic interventions after TTE.

Charts were reviewed electronically through the hospital�s electronic medical record system by 4 abstractors using a standardized abstraction form. The medical record was used to extract age, sex, race and the final echocardiogram reports. The history was thoroughly reviewed to determine the EGSYS variables. 

Statistical analysis 
The aim of this analysis was to determine the downstream resource utilization based on stratification of patient groups into low and high EGSYS scores (< 3 or e" 3). As a secondary outcome, all patient data were compared between these 2 score groups and the effect of our primary outcomes on score was examined. Continuous data are described using means, standard deviations, medians, minimums and maximums. Groups were compared using two-group independent t-tests or Wilcoxon rank-sum tests as appropriate based on the distribution of each variable. Categorical data are described using counts and percentages and group comparisons were done using Fisher's exact or chi-square tests based on expected cell count. Unadjusted odds ratios were obtained using univariate logistic regression. Statistical significance was set at p < 0.05 and all analyses were done using SAS 9.2 (SAS Institute Inc, Cary, NC, USA). 

RESULTS
Baseline characteristics of the study population are shown in Table II. Out of a total of 526 patients screened, 456 patients qualified for inclusion in the study group. Overall, 48% (220/456) of the study group were males and 66% were African American. In the study group, a majority (65% [295/ 456]) of the patients were found to have utilized no downstream health resources after TTE. The remaining 35% (161/456) had at least used 1 resource: 29.2% (133/456) utilized 1, 5% (23/456) utilized 2 and 1.1% (5/456) utilized all 3 of these resources after index TTE. Specifically, 35 patients utilized further diagnostic testing, 150 patients had a cardiology consult during their admission and only 9 patients (all in the high risk group) had any cardiac intervention performed (automatic implantable defibrillator in 4, pacemaker in 2, loop recorder in 1 and percutaneous coronary intervention in 1 patient). 

Of the total study group, 49% (223/456) were high risk (EGSYS score e" 3) for cardiac syncope. Among the high risk patients, 48% (107/223) had utilized 1 or more of the downstream health resources: 29 had further testing, 99 had a cardiology consult and 9 patients had a cardiac intervention. Of the total study group, 51% (233/456) were low risk by EGSYS score. Among the low risk patients, 23.2% (54/233) utilized 1 or more of the downstream health resources: 6 had further testing and 51 had a cardiology consult, but there were no patients who needed a cardiac intervention (Figure 1). 

There was a statistical difference in detection of new aortic stenosis between the low and high EGSYS groups (p < 0.05). However, there was no significant difference in the detection of new mitral stenosis and hypertrophic cardiomyopathy between the 2 EGSYS groups (p 0.306 and 0.478, respectively). The univariate comparisons between the high and low risk EGSYS scores are shown in Table III. On univariate logistic regression analysis, the presence of an EGSYS score e" 3 had an unadjusted odds ratio of 5.66 (CI 2.3 to 13.91, p d" 0.001) for predicting further downstream testing. 

DISCUSSION
TTE is a key technique to diagnose the presence of structural cardiac disease and is widely used in hospitalized syncope patients as the first imaging modality. It is most useful when used in syncope patients when there is a previous known heart disease or suspicion of an underlying cardiovascular etiology (7). However the benefit of doing a TTE in patients who are at low risk for cardiac syncope may be limited. Our study indicates that employing the EGSYS score for syncope risk stratification may help reduce need for routine TTE given reduced  need for downstream utilization of health resources  as no interventions were performed using echo information in any patient with low EGSYS score.

The ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Echocardiography Appropriate Use Criteria (AUC)HYPERLINK \l "_ENREF_7" \o "Douglas, 2011 #7" ADDIN EN.CITE  ADDIN EN.CITE.DATA 7 indicate that TTE can be used for clinical symptoms or signs consistent with a cardiac diagnosis known to cause lightheadedness/presyncope/syncope, including but not limited to aortic stenosis, hypertrophic cardiomyopathy, or heart failure (AUC 9). Also, the criteria state that using TTE for lightheadedness/presyncope when there are no other symptoms or signs of cardiovascular disease is inappropriate. The criteria, however, do mention that using TTE for patients with syncope when there are no other symptoms or signs of cardiovascular disease is still appropriate (AUC 7),HYPERLINK \l "_ENREF_7" \o "Douglas, 2011 #7" ADDIN EN.CITE  ADDIN EN.CITE.DATA 7 which is rather liberal as it sets the stage for widespread use of TTE. However, as shown in our study, TTE had no major downstream impact in patients that were stratified as low risk by EGSYS score. Even though 23.2% of EGSYS low risk syncope patients qualified in our study as having used downstream utilization, these were primarily driven by cardiology consultation and further diagnostic testing, and none of these patients had the need for any cardiac intervention as a result of TTE being performed. Thus it could be argued that in low risk EGSYS patients, routine TTE may lead to more downstream costs with testing, yet not lead to any definitive treatment strategies for syncope.

We also determined that only a small subset of the study population (about one-third) actually got any kind of downstream evaluation overall and that the yield, i.e. further testing, consults and interventions, were significantly higher in the high compared to low risk EGSYS category. Actually every patient who had a definitive intervention to treat a suspected cardiac etiology of syncope was stratified as a high risk EGSYS patient. Thus, EGSYS score did not miss any high risk cardiac syncope patients based on our study. Although the current guidelines suggest that performing TTE for patients with syncope in the absence of cardiovascular disease is appropriate, review of the literature suggests that TTE may not be useful for all of these patients. For instance, one recently conducted retrospective study showed that structural abnormalities are unlikely in syncope patients with a normal electrocardiogram making TTE use limited.HYPERLINK \l "_ENREF_8" \o "Anderson, 2012 #9" ADDIN EN.CITE  ADDIN EN.CITE.DATA 8 Also, a prospective study showed that TTE was only useful for risk stratification in patients with unexplained syncope and with a positive cardiac history or an abnormal electrocardiogram.HYPERLINK \l "_ENREF_9" \o "Sarasin, 2002 #10" ADDIN EN.CITE <EndNote><Cite><Author>Sarasin</Author><Year>2002</Year><RecNum>10</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sarasin, F. P.</author><author>Junod, A. F.</author><author>Carballo, D.</author><author>Slama, S.</author><author>Unger, P. F.</author><author>Louis-Simonet, M.</author></authors></contributors><auth-address>Department of Internal Medicine, Hopital Cantonal, University of Geneva Medical School, Geneva, Switzerland. francois.sarasin@hcuge.ch</auth-address><titles><title>Role of echocardiography in the evaluation of syncope: a prospective study</title><secondary-title>Heart</secondary-title><alt-title>Heart (British Cardiac Society)</alt-title></titles><periodical><full-title>Heart</full-title><abbr-1>Heart</abbr-1><abbr-2>Heart</abbr-2></periodical><pages>363-7</pages><volume>88</volume><number>4</number><edition>2002/09/17</edition><keywords><keyword>Aged</keyword><keyword>Echocardiography</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Heart Diseases/complications/ ultrasonography</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Syncope/etiology/ ultrasonography</keyword></keywords><dates><year>2002</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1468-201X (Electronic)&#xD;1355-6037 (Linking)</isbn><accession-num>12231593</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767372/pdf/hrt08800363.pdf</url></related-urls></urls><custom2>PMC1767372</custom2><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>9 Therefore, careful consideration should be given to assess the need for a TTE, and cost savings can be achieved by performing the test in the right patient population rather than using it as a mass screening of all syncope patients. Our study shows that all of the cardiac interventions happened in the high risk EGSYS group and the EGSYS score predicted further downstream evaluation. 

LIMITATIONS
Our study should be reviewed in the context of its limitations as an observational retrospective analysis. The unmeasured confounding variables could not be excluded as well as cause and effect could not be proved. Our study population had baseline characteristics which may not be applicable to other institutions due to unique patient demographics (66% African American patients). Furthermore, this was a single center study and the number of patients included in the study was modest, limiting the ability to generalize the results. These findings should be confirmed in a larger patient population across other institutions.

CONCLUSION
There was a significant difference of the yield and thus incremental value of TTE between high and low risk group categories based on the EGSYS score. Initial comprehensive risk assessment with available scoring systems may help identify subgroups of syncope patients who may benefit from TTE. Directed TTE could translate into cost savings and efficient utilization of downstream resources in this common clinical condition.

CONFLICTS OF INTEREST
The authors declare that they have no conflict of interest. 

ACKNOWLEDGEMENTS
The authors thank Stephanie Stebens, MLIS, AHIP, of Sladen Library Henry Ford Hospital for her expert assistance in manuscript preparation

Author Contributions: 
Ali Shafiq MD: Contributed to formulating the main idea, study design, data collection and writing the manuscript.
Hardik Bhansali, MD: Contributed to data collection and study design.
Meredith Mahan, MS: Helped with all the statistical methods and study design.
Karthik Ananthasubramaniam MD: Contributed towards mentorship of the idea, study design and writing of the manuscript.

REFERENCES
 ADDIN EN.REFLIST 1.	Moya A, Sutton R, Ammirati F, et al.: Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009:30:2631-2671.
2.	Brignole M, Alboni P, Benditt D, et al.: Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001:22:1256-1306.
3.	Day SC, Cook EF, Funkenstein H, et al.: Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 1982:73:15-23.
4.	Linzer M, Yang EH, Estes NA, 3rd, et al.: Diagnosing syncope. Part 2: unexplained syncope. Ann Intern Med 1997:127:76-86.
5.	Cheitlin MD, Alpert JS, Armstrong WF, et al.: ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997:95:1686-1744.
6.	Brignole M, Ungar A, Bartoletti A, et al.: Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals. Europace 2006:8:644-650.
7.	Douglas PS, Garcia MJ, Haines DE, et al.: ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr 2011:24:229-267.
8.	Anderson KL, Limkakeng A, Damuth E, et al.: Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting. Ann Emerg Med 2012:60:478-484.
9.	Sarasin FP, Junod AF, Carballo D, et al.: Role of echocardiography in the evaluation of syncope: a prospective study. Heart 2002:88:363-367.


Table I: EGSYS Score
The point score is found as the sum of the following risk factors:Risk FactorsScorePalpitations preceding syncope4Abnormal EKG/Heart disease or both3Effort syncope 3Syncope in supine 2Precipitating and predisposing factors-1Autonomic prodromes -1A score greater e" 3 implies an increased risk of cardiac syncope. EKG, electrocardiography


Table II: Baseline characteristics
Total Syncope Patients (n=456)Age (years)66.6 � 17.3Male sex48%Race�     White/Caucasian26%     Black/African American66%     Other8%Past medical historyDiabetes mellitus30%Hyperlipidemia47%Hypertension77%Hypertrophic cardiomyopathy1%Coronary artery disease21%Congestive heart failure14%Aortic stenosis3%Mitral stenosis0%Smoking22%Clinical characteristics at admissionOrthostatics +ve21%EKG abnormal34%Troponin > 0.237%Palpitations preceding syncope7%Abnormal EKG and/or heart disease51%Effort syncope3%Supine syncope1%Precipitating and predisposing factors11%Autonomic prodromes10%Findings after EchocardiogramEjection fraction > 5091%New aortic stenosis5%New mitral stenosis0%New hypertrophic cardiomyopathy2%Yield (downstream utilization of resources)Further testing8%Cardiology consult33%Any intervention, n (%)9 (2%)Intervention type, n (%)�     Automatic implantable defibrillator4 (1%)     Pacemaker2 (0%)     Loop recorder1 (0%)     Ablation1 (0%)     Percutaneous coronary intervention1 (0%)EKG, electrocardiography





Table III: Univariate analysis based on EGSYS score 
Score < 3Score > 3p-Value(n=233)(n=223)Age; Mean (SD)64.6 � 16.8368.65 � 17.610.012Male sex41%56%0.001Race��0.969Caucasian26%26%�African American66%66%�Other8%8%�Past medical historyDiabetes mellitus27%32%0.307Hyperlipidemia40%53%0.006Hypertension70%83%0.002Hypertrophic cardiomyopathy0%1%0.076Coronary artery disease7%36%<0.001Congestive heart failure3%25%<0.001Aortic stenosis0%5%<0.001Mitral stenosis0%0%0.306Smoking23%21%0.589Clinical characteristics at admissionOrthostatics +ve24%18%0.114EKG abnormal12%57%<.001Troponin > 0.25%9%0.102Palpitations preceding syncope0%15%<0.001Abnormal EKG and/or heart disease16%88%<0.001Effort syncope1%6%0.003Supine syncope0%1%0.076Precipitating and predisposing factors19%4%<0.001Autonomic prodromes16%4%<0.001Findings after EchocardiogramEjection fraction > 50 %97%85%<0.001New aortic stenosis3%7%0.042New mitral stenosis0%0%0.306New hypertrophic cardiomyopathy2%3%0.478Further testing3%13%<0.001Cardiology consult22%44%<0.001Any intervention, n (%)0%9(4%)0.002Intervention type, n (%)���    Automatic implantable defibrillator0%4(1%)�    Pacemaker0%2 (0%)�    Loop recorder0%1 (0%)�    Ablation0%1 (0%)�    Percutaneous coronary intervention0%1 (0%)�SD, standard deviation; EKG, electrocardiography
FIGURE LEGENDS
Figure 1. Flow diagram outlining study population, risk stratification and downstream resource utilization 









PAGE  


Ananthasubramaniam  PAGE 1



cdsvw����������������F	G	�	�	�	�	n
o
	ijtl
m
n
�������������������������������������������������»�������瞩���j�	h{
�U�jh{
�Ujh{
�Uh�Meh{
�h�yjh>b�h{
�h�Meh{
�>*	h{
�H*h�Meh{
�H*h�Eh{
�H*hZN�h{
�H*h{
�h�Meh{
�	h{
�5�h�Meh{
�5�5rs�F	�	�	 
!
<
v
�
�
�
�
�
�
	
=jt
1{|��������������������������d�gd{
���d�^��gd{
�
$d�a$gd{
�|�������JKa�#�#�#�'�'++,+�.�.�.:2;2M8N8F����������������������������L�d�]�L�gd{
�d�gd{
����efgvw������������������������-./012`abd�����456789efgh���������������������������߾�����������������ߨ�������������j�lh{
�U�jpSh{
�U�j�Ch{
�U�jl4h{
�U�j�#h{
�U�jXh{
�Uh{
�h�Meh{
�jh{
�UhGBRh{
�H*mHnHu>hij��������HIJxyz���������������
'Gy��\]��Ka�#�#=$?$�%������������������ȷѦ����ߟ�ߗߐ����߁����ߗߗ���h�Meh{
�>*hOiyh{
�h�]h{
�h�Meh{
�5�h�_\h{
� �j�h{
�UmHnHu �j��h{
�UmHnHuh{
�mHnHujh{
�UmHnHuh�Meh{
�h{
�jh{
�UhGBRh{
�H*mHnHu2�%�%�&�&�'("+&+G,H,W,X,Y,�,�,�.�.1�1�1�1�192�2�2�2�2�2�2�2�2�2�2�2�2�2?5@5A5n5p55�5�5�5�5�5�5�5�5�7�7�8�8l9u9G:H:�;�;�;�;�;)<�������������������������۷������ۡ۷��������������j��h{
�U�jt�h{
�UhGBRh{
�H*mHnHu�j@�h{
�U�j�h{
�Ujh{
�Uh�Meh{
�5�h�Meh{
�h;v h�Meh{
�h{
�?)<+<:<;<O<P<Q<R<S<T<V<===B=D=�D�D�D�DF*F�G�G�G�GH	H�H�HVJkJ�J�J�J�J�J�J�J�J�J�J�J�JFK�K�K�K�KL)LeLL�L�L�L�L�L�L�L�U��������������������ȶȮ����������������������h{
�mHnHuh�Meh{
�B*ph# h\#!h{
�5�h�Meh{
�hCt�h�Meh{
�5�h�Meh{
�hGBRh{
�H*mHnHu�j�h{
�U�j��h{
�Uh{
�jh{
�U<FF*F�H�H�HUJVJlJ�J�J�JFKGK^K�KLeL�L�L�L�MN�N.O�PlQT���������������������������d�gd{
��L�d�]�L�gd{
�T�T�U�U�U�U�U�U�U�U������}�n$d�$Ifa$gd{
�mkdL�$$If�l�����P^
t��0�������^6���������4�4�
la�^p�
��d�$Ifgd{
�d�gd{
�	�U�U�U�U�WXXX+X,XKXLXdXeXrXsXxXzX{X�X�X�X�X�X�X�X�X�X�X�XYYYY8Y9YUYVYsYtY�Y�Y�Y�Y�Y�Y�Y�Y�Y�Y�Y�Y�YZ
Z/Z0ZVZWZiZjZ|Z}Z�Z�Z�Z�Z�Z�������������������������������������h�Meh{
�6�B*phh�Meh{
�B*phh�Meh{
�B*\�phh�Meh{
�5�B*\�phh�Meh{
�B*ph# h{
�h�Meh{
�jh{
�UC�U�U$V(Vym^$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��M�0��P�~	
t��0�������^6�������������4�4�
la�^p�����(V*VpVtVym^$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l����0��P�~	
t��0�������^6�������������4�4�
la�^p�����tVvV�V�Vym^$d�$Ifa$gd{
�d�$Ifgd{
��kdE�$$If�l��p�0��P�~	
t��0�������^6�������������4�4�
la�^p������V�V�V�Vym^$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l����0��P�~	
t��0�������^6�������������4�4�
la�^p������V�VWWym^$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l����0��P�~	
t��0�������^6�������������4�4�
la�^p�����WWHWNWym^$d�$Ifa$gd{
�d�$Ifgd{
��kd^�$$If�l��Y�0��P�~	
t��0�������^6�������������4�4�
la�^p�����NWPW�Wymd�$Ifgd{
��kd�$$If�l���0��P�~	
t��0�������^6�������������4�4�
la�^p������W�WXXX+X,XKX�����}n$d�$Ifa$gd{
�d�$Ifgd{
�d�gd{
�mkd��$$If�l��V��P^
t��0�������^6���������4�4�
la�^p�
��KXLXXXdX�yj$d�$Ifa$gd{
�d�$Ifgd{
�zkdW�$$If�l����0���0\
@
t��0��������6�������������4�4�
la�dXeXnXrXj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������rXsXxXzXj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������zX{X�X�Xj^O$d�$Ifa$gd{
�d�$Ifgd{
��kdz�$$If�l��y�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������X�X�X�Xj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd@�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������X�X�X�Xj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������X�X�X�Xj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l����0���0\
@	���
t���������0��������6�������������4�4�
la�p��������X�X�X�Xj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��U�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������X�XYYj^O$d�$Ifa$gd{
�d�$Ifgd{
��kdX�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������YYYYj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������YY5Y8Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������8Y9YQYUYj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������UYVYoYsYj^O$d�$Ifa$gd{
�d�$Ifgd{
��kdp�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������sYtY�Y�Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd6�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Y�Y�Y�Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l���0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Y�Y�Y�Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Y�Y�Y�Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l����0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Y�Y�Y�Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kdN�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Y�Y�Y�Yj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Y�YZZj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������Z
Z,Z/Zj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������/Z0ZRZVZj^O$d�$Ifa$gd{
�d�$Ifgd{
��kdf�$$If�l��q�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������VZWZfZiZj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd,�$$If�l���0���0\
@	���
t���������0��������6�������������4�4�
la�p�������iZjZyZ|Zj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������|Z}Z�Z�Zj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Z�Z�Z�Zj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd~�$$If�l��h�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Z�Z�Z�Zj^O$d�$Ifa$gd{
�d�$Ifgd{
��kdD�$$If�l����0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Z�Z�Z�Z�Z�Z�Z[[-[.[Q[R[~[[�[�[�[�[�[�[�[�[�[\\/\0\J\K\`\a\�\�\�\�\�\�\�\]]]_]d]�]�]�^_``p`}`�a�a�a�a�a�a�a�abb"b)bVb]bvb�����������������������������������̺��׺ק������׺�������������h�Meh{
�6�h�Meh{
�5�>*\�h�Meh{
�5�\�h{
�B*ph# h�Meh{
�B*ph# h�Meh{
�h�Meh{
�B*phh�Meh{
�6�B*phh{
�6�B*phA�Z�Z�Z�Zj^O$d�$Ifa$gd{
�d�$Ifgd{
��kd
�$$If�l����0���0\
@	���
t���������0��������6�������������4�4�
la�p��������Z�Z[[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������[[*[-[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������-[.[N[Q[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd\�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������Q[R[~[[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd"�$$If�l��C�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������[�[�[�[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��$�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������[�[�[�[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������[�[�[�[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kdt�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������[�[�[�[j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd:�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������[�[\\j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������\\(\/\j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������/\0\C\J\j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd��$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������J\K\Y\`\j^O$d�$Ifa$gd{
�d�$Ifgd{
��kdR�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������`\a\�\�\j^O$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l��J�0���0\
@	���
t���������0��������6�������������4�4�
la�p��������\�\�\�\�\�\�\�\�\�\jbbbbbbbVd�$Ifgd{
�d�gd{
��kd�$$If�l��;�0���0\
@	���
t���������0��������6�������������4�4�
la�p�������	�\�\�\]���$d�$Ifa$gd{
�]]]+d�$Ifgd{
��kd��$$If�l4����\�
�PJ`�
FT`�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������]]]]���d�$Ifgd{
�$d�$Ifa$gd{
�]]%]2]8,$d�$Ifa$gd{
�d�$Ifgd{
��kd�$$If�l4����\�
�PJ��
FT��	���
t�����������0�������X6���������������������4�4�
la�^p�����������������2]@]F]G]���kd$$If�l4��,�\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������$d�$Ifa$gd{
�G]P]T]X]^]����$d�$Ifa$gd{
�d�$Ifgd{
�^]_]d]."d�$Ifgd{
��kd,$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(������������d]f]h]n]���$d�$Ifa$gd{
�n]o]y]+d�$Ifgd{
��kdO$$If�l4����\�
�PJ�
'F'T�	���
t��(�����������0�������X6���������������������4�4�
la�^f4p�(����������y]}]�]�]���$d�$Ifa$gd{
��]�]�]."d�$Ifgd{
��kd�$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(�������������]�]�]�]���$d�$Ifa$gd{
��]�]�]."d�$Ifgd{
��kd�$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(�������������]�]�]�]���$d�$Ifa$gd{
��]�]�]."d�$Ifgd{
��kd�$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(�������������]�]�]�]���$d�$Ifa$gd{
��]�]�]."d�$Ifgd{
��kd�$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(�������������]�]�]�]���$d�$Ifa$gd{
��]�]�]+d�$Ifgd{
��kd$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������]�]^^���$d�$Ifa$gd{
�^^^+d�$Ifgd{
��kd9	$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������^^^"^���$d�$Ifa$gd{
�"^#^?^+d�$Ifgd{
��kdb
$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������?^B^E^K^���$d�$Ifa$gd{
�K^L^d^+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������d^g^k^r^���$d�$Ifa$gd{
�r^s^�^+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������^�^�^�^���$d�$Ifa$gd{
��^�^�^+d�$Ifgd{
��kd�
$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������^�^�^�^���$d�$Ifa$gd{
��^�^�^+d�$Ifgd{
��kd$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������^�^�^�^���$d�$Ifa$gd{
��^�^�^+d�$Ifgd{
��kd/$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������^�^�^�^���$d�$Ifa$gd{
��^�^_+d�$Ifgd{
��kdX$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������____���$d�$Ifa$gd{
�__(_+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������(_,_0_6_���$d�$Ifa$gd{
�6_7_D_+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������D_H_L_R_���$d�$Ifa$gd{
�R_S_b_+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������b_e_h_n_���$d�$Ifa$gd{
�n_o_�_+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������_�_�_�_���$d�$Ifa$gd{
��_�_�_+d�$Ifgd{
��kd%$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������_�_�_�_���$d�$Ifa$gd{
��_�_�_+d�$Ifgd{
��kdN$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������_�_�_�_���$d�$Ifa$gd{
��_�_�_+d�$Ifgd{
��kdw$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������_�_``���$d�$Ifa$gd{
�``.`+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������.`2`5`<`���$d�$Ifa$gd{
�<`=`Q`+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������Q`U`X`_`���$d�$Ifa$gd{
�_```~`+d�$Ifgd{
��kd�$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������~``�`�`���$d�$Ifa$gd{
��`�`�`+d�$Ifgd{
��kd$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������`�`�`�`���$d�$Ifa$gd{
��`�`�`+d�$Ifgd{
��kdD$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������`�`�`�`���$d�$Ifa$gd{
��`�`�`+d�$Ifgd{
��kdm $$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������`�`�`�`���$d�$Ifa$gd{
��`�`
a+d�$Ifgd{
��kd�!$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������
aaaa���$d�$Ifa$gd{
�aa*a+d�$Ifgd{
��kd�"$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������*a-a1a8a���$d�$Ifa$gd{
�8a9aLa+d�$Ifgd{
��kd�#$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������LaPaTa[a���$d�$Ifa$gd{
�[a\ata+d�$Ifgd{
��kd%$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(������������tawa}a�a���$d�$Ifa$gd{
��a�a�a+d�$Ifgd{
��kd:&$$If�l4����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^f4p�(�������������a�a�a�a���$d�$Ifa$gd{
��a�a�a+d�$Ifgd{
��kdc'$$If�l4����\�
�PJ�
'F'T�	���
t��(�����������0�������X6���������������������4�4�
la�^f4p�(�����������a�a�a�a���$d�$Ifa$gd{
��a�a�a."d�$Ifgd{
��kd�($$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(�������������a�a�a�a���$d�$Ifa$gd{
��a�ab."d�$Ifgd{
��kd�)$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(������������bbbb���$d�$Ifa$gd{
�bbb."d�$Ifgd{
��kd�*$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(������������b"b)b+b���$d�$Ifa$gd{
�+b,bSb."d�$Ifgd{
��kd,$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(������������SbVb]b_b���$d�$Ifa$gd{
�_b`b�b�b
c.&&&d�gd{
��kd$-$$If�l����\�
�PJ�
FT�	�����
t��(�������������0�������X6���������������������4�4�
la�^p�(������������vbwbxb�b�b�b�b�b�bcc
ccccccccccc!c"c#c%c8c9c?c@cAcBcCcFc��������������������������������h��h{
�h{
�0JmHnHujh��h{
�0JUh��h{
�0J
h{
�0Jjh{
�0JUjh{
�Uh`)^h{
�B*ph# h{
�5�B*ph# h�Meh{
�5�B*ph# h�Meh{
�B*ph# h�Meh{
�h{
�!
cccccccccc#c$c%cCcDcEcFc����������������$�h]�ha$gd{
��h]�hgd{
�����&`#$gd{
�d�gd{
�&1�h:p{
���/ ��=!��"��#��$��%��	D<EndNote><Cite><Author>Moya</Author><Year>2009</Year><RecNum>1</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moya, A.</author><author>Sutton, R.</author><author>Ammirati, F.</author><author>Blanc, J. J.</author><author>Brignole, M.</author><author>Dahm, J. B.</author><author>Deharo, J. C.</author><author>Gajek, J.</author><author>Gjesdal, K.</author><author>Krahn, A.</author><author>Massin, M.</author><author>Pepi, M.</author><author>Pezawas, T.</author><author>Ruiz Granell, R.</author><author>Sarasin, F.</author><author>Ungar, A.</author><author>van Dijk, J. G.</author><author>Walma, E. P.</author><author>Wieling, W.</author></authors></contributors><titles><title>Guidelines for the diagnosis and management of syncope (version 2009)</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></periodical><alt-periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></alt-periodical><pages>2631-71</pages><volume>30</volume><number>21</number><edition>2009/08/29</edition><keywords><keyword>Age Distribution</keyword><keyword>Ambulatory Care/methods</keyword><keyword>Continuity of Patient Care</keyword><keyword>Cost of Illness</keyword><keyword>Diagnostic Techniques, Neurological</keyword><keyword>Exercise Test</keyword><keyword>Humans</keyword><keyword>Prevalence</keyword><keyword>Quality of Life</keyword><keyword>Recurrence</keyword><keyword>Referral and Consultation</keyword><keyword>Risk Assessment</keyword><keyword>Risk Factors</keyword><keyword>Syncope/ diagnosis/etiology/ therapy</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1522-9645 (Electronic)&#xD;0195-668X (Linking)</isbn><accession-num>19713422</accession-num><urls></urls><custom2>PMC3295536</custom2><electronic-resource-num>10.1093/eurheartj/ehp298</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>�	D<EndNote><Cite><Author>Moya</Author><Year>2009</Year><RecNum>1</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moya, A.</author><author>Sutton, R.</author><author>Ammirati, F.</author><author>Blanc, J. J.</author><author>Brignole, M.</author><author>Dahm, J. B.</author><author>Deharo, J. C.</author><author>Gajek, J.</author><author>Gjesdal, K.</author><author>Krahn, A.</author><author>Massin, M.</author><author>Pepi, M.</author><author>Pezawas, T.</author><author>Ruiz Granell, R.</author><author>Sarasin, F.</author><author>Ungar, A.</author><author>van Dijk, J. G.</author><author>Walma, E. P.</author><author>Wieling, W.</author></authors></contributors><titles><title>Guidelines for the diagnosis and management of syncope (version 2009)</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></periodical><alt-periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></alt-periodical><pages>2631-71</pages><volume>30</volume><number>21</number><edition>2009/08/29</edition><keywords><keyword>Age Distribution</keyword><keyword>Ambulatory Care/methods</keyword><keyword>Continuity of Patient Care</keyword><keyword>Cost of Illness</keyword><keyword>Diagnostic Techniques, Neurological</keyword><keyword>Exercise Test</keyword><keyword>Humans</keyword><keyword>Prevalence</keyword><keyword>Quality of Life</keyword><keyword>Recurrence</keyword><keyword>Referral and Consultation</keyword><keyword>Risk Assessment</keyword><keyword>Risk Factors</keyword><keyword>Syncope/ diagnosis/etiology/ therapy</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1522-9645 (Electronic)&#xD;0195-668X (Linking)</isbn><accession-num>19713422</accession-num><urls></urls><custom2>PMC3295536</custom2><electronic-resource-num>10.1093/eurheartj/ehp298</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>�D<EndNote><Cite><Author>Brignole</Author><Year>2001</Year><RecNum>2</RecNum><DisplayText><style face="superscript">2,3</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brignole, M.</author><author>Alboni, P.</author><author>Benditt, D.</author><author>Bergfeldt, L.</author><author>Blanc, J. J.</author><author>Bloch Thomsen, P. E.</author><author>van Dijk, J. G.</author><author>Fitzpatrick, A.</author><author>Hohnloser, S.</author><author>Janousek, J.</author><author>Kapoor, W.</author><author>Kenny, R. A.</author><author>Kulakowski, P.</author><author>Moya, A.</author><author>Raviele, A.</author><author>Sutton, R.</author><author>Theodorakis, G.</author><author>Wieling, W.</author></authors></contributors><auth-address>Department of Cardiology and Arrhythmologic Centre, Ospedali Riuniti, Lavagna, Italy</auth-address><titles><title>Guidelines on management (diagnosis and treatment) of syncope</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></periodical><alt-periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></alt-periodical><pages>1256-306</pages><volume>22</volume><number>15</number><edition>2001/07/24</edition><keywords><keyword>Arrhythmias, Cardiac/complications/diagnosis/therapy</keyword><keyword>Carotid Sinus</keyword><keyword>Coronary Angiography</keyword><keyword>Diagnosis, Differential</keyword><keyword>Electrocardiography</keyword><keyword>Electrophysiologic Techniques, Cardiac</keyword><keyword>Exercise Test</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/diagnosis/therapy</keyword><keyword>Subclavian Steal Syndrome/complications/diagnosis/surgery</keyword><keyword>Syncope/diagnosis/ etiology/ therapy</keyword><keyword>Syncope, Vasovagal/diagnosis/etiology/therapy</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>2001</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0195-668X (Print)&#xD;0195-668X (Linking)</isbn><accession-num>11465961</accession-num><urls></urls><electronic-resource-num>10.1053/euhj.2001.2739</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Day</Author><Year>1982</Year><RecNum>3</RecNum><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Day, S. C.</author><author>Cook, E. F.</author><author>Funkenstein, H.</author><author>Goldman, L.</author></authors></contributors><titles><title>Evaluation and outcome of emergency room patients with transient loss of consciousness</title><secondary-title>Am J Med</secondary-title><alt-title>The American journal of medicine</alt-title></titles><periodical><full-title>American Journal of Medicine</full-title><abbr-1>Am. J. Med.</abbr-1><abbr-2>Am J Med</abbr-2></periodical><pages>15-23</pages><volume>73</volume><number>1</number><edition>1982/07/01</edition><keywords><keyword>Adult</keyword><keyword>Boston</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Medical History Taking</keyword><keyword>Middle Aged</keyword><keyword>Physical Examination</keyword><keyword>Prognosis</keyword><keyword>Risk</keyword><keyword>Seizures/complications</keyword><keyword>Stress, Psychological</keyword><keyword>Unconsciousness/ diagnosis</keyword></keywords><dates><year>1982</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0002-9343 (Print)&#xD;0002-9343 (Linking)</isbn><accession-num>7091170</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>�D<EndNote><Cite><Author>Brignole</Author><Year>2001</Year><RecNum>2</RecNum><DisplayText><style face="superscript">2,3</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brignole, M.</author><author>Alboni, P.</author><author>Benditt, D.</author><author>Bergfeldt, L.</author><author>Blanc, J. J.</author><author>Bloch Thomsen, P. E.</author><author>van Dijk, J. G.</author><author>Fitzpatrick, A.</author><author>Hohnloser, S.</author><author>Janousek, J.</author><author>Kapoor, W.</author><author>Kenny, R. A.</author><author>Kulakowski, P.</author><author>Moya, A.</author><author>Raviele, A.</author><author>Sutton, R.</author><author>Theodorakis, G.</author><author>Wieling, W.</author></authors></contributors><auth-address>Department of Cardiology and Arrhythmologic Centre, Ospedali Riuniti, Lavagna, Italy</auth-address><titles><title>Guidelines on management (diagnosis and treatment) of syncope</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></periodical><alt-periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></alt-periodical><pages>1256-306</pages><volume>22</volume><number>15</number><edition>2001/07/24</edition><keywords><keyword>Arrhythmias, Cardiac/complications/diagnosis/therapy</keyword><keyword>Carotid Sinus</keyword><keyword>Coronary Angiography</keyword><keyword>Diagnosis, Differential</keyword><keyword>Electrocardiography</keyword><keyword>Electrophysiologic Techniques, Cardiac</keyword><keyword>Exercise Test</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/diagnosis/therapy</keyword><keyword>Subclavian Steal Syndrome/complications/diagnosis/surgery</keyword><keyword>Syncope/diagnosis/ etiology/ therapy</keyword><keyword>Syncope, Vasovagal/diagnosis/etiology/therapy</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>2001</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0195-668X (Print)&#xD;0195-668X (Linking)</isbn><accession-num>11465961</accession-num><urls></urls><electronic-resource-num>10.1053/euhj.2001.2739</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Day</Author><Year>1982</Year><RecNum>3</RecNum><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Day, S. C.</author><author>Cook, E. F.</author><author>Funkenstein, H.</author><author>Goldman, L.</author></authors></contributors><titles><title>Evaluation and outcome of emergency room patients with transient loss of consciousness</title><secondary-title>Am J Med</secondary-title><alt-title>The American journal of medicine</alt-title></titles><periodical><full-title>American Journal of Medicine</full-title><abbr-1>Am. J. Med.</abbr-1><abbr-2>Am J Med</abbr-2></periodical><pages>15-23</pages><volume>73</volume><number>1</number><edition>1982/07/01</edition><keywords><keyword>Adult</keyword><keyword>Boston</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Medical History Taking</keyword><keyword>Middle Aged</keyword><keyword>Physical Examination</keyword><keyword>Prognosis</keyword><keyword>Risk</keyword><keyword>Seizures/complications</keyword><keyword>Stress, Psychological</keyword><keyword>Unconsciousness/ diagnosis</keyword></keywords><dates><year>1982</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0002-9343 (Print)&#xD;0002-9343 (Linking)</isbn><accession-num>7091170</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>�D<EndNote><Cite><Author>Linzer</Author><Year>1997</Year><RecNum>4</RecNum><DisplayText><style face="superscript">4,5</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linzer, M.</author><author>Yang, E. H.</author><author>Estes, N. A., 3rd</author><author>Wang, P.</author><author>Vorperian, V. R.</author><author>Kapoor, W. N.</author></authors></contributors><auth-address>University of Wisconsin School of Medicine, Department of Medicine, Madison 53792-2454, USA.</auth-address><titles><title>Diagnosing syncope. Part 2: unexplained syncope</title><secondary-title>Ann Intern Med</secondary-title><alt-title>Annals of internal medicine</alt-title></titles><periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></periodical><alt-periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></alt-periodical><pages>76-86</pages><volume>127</volume><number>1</number><edition>1997/07/01</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Algorithms</keyword><keyword>Echocardiography</keyword><keyword>Electrocardiography, Ambulatory/methods</keyword><keyword>Electrophysiology</keyword><keyword>Exercise Test</keyword><keyword>Heart Diseases/complications/diagnosis</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Risk Factors</keyword><keyword>Syncope/ etiology/psychology</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>1997</year><pub-dates><date>Jul 1</date></pub-dates></dates><isbn>0003-4819 (Print)&#xD;0003-4819 (Linking)</isbn><accession-num>9214258</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Cheitlin</Author><Year>1997</Year><RecNum>5</RecNum><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cheitlin, M. D.</author><author>Alpert, J. S.</author><author>Armstrong, W. F.</author><author>Aurigemma, G. P.</author><author>Beller, G. A.</author><author>Bierman, F. Z.</author><author>Davidson, T. W.</author><author>Davis, J. L.</author><author>Douglas, P. S.</author><author>Gillam, L. D.</author><author>Lewis, R. P.</author><author>Pearlman, A. S.</author><author>Philbrick, J. T.</author><author>Shah, P. M.</author><author>Williams, R. G.</author></authors></contributors><titles><title>ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography</title><secondary-title>Circulation</secondary-title><alt-title>Circulation</alt-title></titles><periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></periodical><alt-periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></alt-periodical><pages>1686-744</pages><volume>95</volume><number>6</number><edition>1997/03/18</edition><keywords><keyword>Echocardiography</keyword><keyword>Heart Diseases/ ultrasonography</keyword><keyword>Humans</keyword></keywords><dates><year>1997</year><pub-dates><date>Mar 18</date></pub-dates></dates><isbn>0009-7322 (Print)&#xD;0009-7322 (Linking)</isbn><accession-num>9118558</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>�D<EndNote><Cite><Author>Linzer</Author><Year>1997</Year><RecNum>4</RecNum><DisplayText><style face="superscript">4,5</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linzer, M.</author><author>Yang, E. H.</author><author>Estes, N. A., 3rd</author><author>Wang, P.</author><author>Vorperian, V. R.</author><author>Kapoor, W. N.</author></authors></contributors><auth-address>University of Wisconsin School of Medicine, Department of Medicine, Madison 53792-2454, USA.</auth-address><titles><title>Diagnosing syncope. Part 2: unexplained syncope</title><secondary-title>Ann Intern Med</secondary-title><alt-title>Annals of internal medicine</alt-title></titles><periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></periodical><alt-periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></alt-periodical><pages>76-86</pages><volume>127</volume><number>1</number><edition>1997/07/01</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Algorithms</keyword><keyword>Echocardiography</keyword><keyword>Electrocardiography, Ambulatory/methods</keyword><keyword>Electrophysiology</keyword><keyword>Exercise Test</keyword><keyword>Heart Diseases/complications/diagnosis</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Risk Factors</keyword><keyword>Syncope/ etiology/psychology</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>1997</year><pub-dates><date>Jul 1</date></pub-dates></dates><isbn>0003-4819 (Print)&#xD;0003-4819 (Linking)</isbn><accession-num>9214258</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Cheitlin</Author><Year>1997</Year><RecNum>5</RecNum><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cheitlin, M. D.</author><author>Alpert, J. S.</author><author>Armstrong, W. F.</author><author>Aurigemma, G. P.</author><author>Beller, G. A.</author><author>Bierman, F. Z.</author><author>Davidson, T. W.</author><author>Davis, J. L.</author><author>Douglas, P. S.</author><author>Gillam, L. D.</author><author>Lewis, R. P.</author><author>Pearlman, A. S.</author><author>Philbrick, J. T.</author><author>Shah, P. M.</author><author>Williams, R. G.</author></authors></contributors><titles><title>ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography</title><secondary-title>Circulation</secondary-title><alt-title>Circulation</alt-title></titles><periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></periodical><alt-periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></alt-periodical><pages>1686-744</pages><volume>95</volume><number>6</number><edition>1997/03/18</edition><keywords><keyword>Echocardiography</keyword><keyword>Heart Diseases/ ultrasonography</keyword><keyword>Humans</keyword></keywords><dates><year>1997</year><pub-dates><date>Mar 18</date></pub-dates></dates><isbn>0009-7322 (Print)&#xD;0009-7322 (Linking)</isbn><accession-num>9118558</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(D<EndNote><Cite><Author>Brignole</Author><Year>2001</Year><RecNum>2</RecNum><DisplayText><style face="superscript">2,4,5</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brignole, M.</author><author>Alboni, P.</author><author>Benditt, D.</author><author>Bergfeldt, L.</author><author>Blanc, J. J.</author><author>Bloch Thomsen, P. E.</author><author>van Dijk, J. G.</author><author>Fitzpatrick, A.</author><author>Hohnloser, S.</author><author>Janousek, J.</author><author>Kapoor, W.</author><author>Kenny, R. A.</author><author>Kulakowski, P.</author><author>Moya, A.</author><author>Raviele, A.</author><author>Sutton, R.</author><author>Theodorakis, G.</author><author>Wieling, W.</author></authors></contributors><auth-address>Department of Cardiology and Arrhythmologic Centre, Ospedali Riuniti, Lavagna, Italy</auth-address><titles><title>Guidelines on management (diagnosis and treatment) of syncope</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></periodical><alt-periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></alt-periodical><pages>1256-306</pages><volume>22</volume><number>15</number><edition>2001/07/24</edition><keywords><keyword>Arrhythmias, Cardiac/complications/diagnosis/therapy</keyword><keyword>Carotid Sinus</keyword><keyword>Coronary Angiography</keyword><keyword>Diagnosis, Differential</keyword><keyword>Electrocardiography</keyword><keyword>Electrophysiologic Techniques, Cardiac</keyword><keyword>Exercise Test</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/diagnosis/therapy</keyword><keyword>Subclavian Steal Syndrome/complications/diagnosis/surgery</keyword><keyword>Syncope/diagnosis/ etiology/ therapy</keyword><keyword>Syncope, Vasovagal/diagnosis/etiology/therapy</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>2001</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0195-668X (Print)&#xD;0195-668X (Linking)</isbn><accession-num>11465961</accession-num><urls></urls><electronic-resource-num>10.1053/euhj.2001.2739</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Cheitlin</Author><Year>1997</Year><RecNum>5</RecNum><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cheitlin, M. D.</author><author>Alpert, J. S.</author><author>Armstrong, W. F.</author><author>Aurigemma, G. P.</author><author>Beller, G. A.</author><author>Bierman, F. Z.</author><author>Davidson, T. W.</author><author>Davis, J. L.</author><author>Douglas, P. S.</author><author>Gillam, L. D.</author><author>Lewis, R. P.</author><author>Pearlman, A. S.</author><author>Philbrick, J. T.</author><author>Shah, P. M.</author><author>Williams, R. G.</author></authors></contributors><titles><title>ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography</title><secondary-title>Circulation</secondary-title><alt-title>Circulation</alt-title></titles><periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></periodical><alt-periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></alt-periodical><pages>1686-744</pages><volume>95</volume><number>6</number><edition>1997/03/18</edition><keywords><keyword>Echocardiography</keyword><keyword>Heart Diseases/ ultrasonography</keyword><keyword>Humans</keyword></keywords><dates><year>1997</year><pub-dates><date>Mar 18</date></pub-dates></dates><isbn>0009-7322 (Print)&#xD;0009-7322 (Linking)</isbn><accession-num>9118558</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Linzer</Author><Year>1997</Year><RecNum>4</RecNum><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linzer, M.</author><author>Yang, E. H.</author><author>Estes, N. A., 3rd</author><author>Wang, P.</author><author>Vorperian, V. R.</author><author>Kapoor, W. N.</author></authors></contributors><auth-address>University of Wisconsin School of Medicine, Department of Medicine, Madison 53792-2454, USA.</auth-address><titles><title>Diagnosing syncope. Part 2: unexplained syncope</title><secondary-title>Ann Intern Med</secondary-title><alt-title>Annals of internal medicine</alt-title></titles><periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></periodical><alt-periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></alt-periodical><pages>76-86</pages><volume>127</volume><number>1</number><edition>1997/07/01</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Algorithms</keyword><keyword>Echocardiography</keyword><keyword>Electrocardiography, Ambulatory/methods</keyword><keyword>Electrophysiology</keyword><keyword>Exercise Test</keyword><keyword>Heart Diseases/complications/diagnosis</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Risk Factors</keyword><keyword>Syncope/ etiology/psychology</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>1997</year><pub-dates><date>Jul 1</date></pub-dates></dates><isbn>0003-4819 (Print)&#xD;0003-4819 (Linking)</isbn><accession-num>9214258</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(D<EndNote><Cite><Author>Brignole</Author><Year>2001</Year><RecNum>2</RecNum><DisplayText><style face="superscript">2,4,5</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brignole, M.</author><author>Alboni, P.</author><author>Benditt, D.</author><author>Bergfeldt, L.</author><author>Blanc, J. J.</author><author>Bloch Thomsen, P. E.</author><author>van Dijk, J. G.</author><author>Fitzpatrick, A.</author><author>Hohnloser, S.</author><author>Janousek, J.</author><author>Kapoor, W.</author><author>Kenny, R. A.</author><author>Kulakowski, P.</author><author>Moya, A.</author><author>Raviele, A.</author><author>Sutton, R.</author><author>Theodorakis, G.</author><author>Wieling, W.</author></authors></contributors><auth-address>Department of Cardiology and Arrhythmologic Centre, Ospedali Riuniti, Lavagna, Italy</auth-address><titles><title>Guidelines on management (diagnosis and treatment) of syncope</title><secondary-title>Eur Heart J</secondary-title><alt-title>European heart journal</alt-title></titles><periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></periodical><alt-periodical><full-title>European Heart Journal</full-title><abbr-1>Eur. Heart J.</abbr-1><abbr-2>Eur Heart J</abbr-2></alt-periodical><pages>1256-306</pages><volume>22</volume><number>15</number><edition>2001/07/24</edition><keywords><keyword>Arrhythmias, Cardiac/complications/diagnosis/therapy</keyword><keyword>Carotid Sinus</keyword><keyword>Coronary Angiography</keyword><keyword>Diagnosis, Differential</keyword><keyword>Electrocardiography</keyword><keyword>Electrophysiologic Techniques, Cardiac</keyword><keyword>Exercise Test</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/diagnosis/therapy</keyword><keyword>Subclavian Steal Syndrome/complications/diagnosis/surgery</keyword><keyword>Syncope/diagnosis/ etiology/ therapy</keyword><keyword>Syncope, Vasovagal/diagnosis/etiology/therapy</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>2001</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0195-668X (Print)&#xD;0195-668X (Linking)</isbn><accession-num>11465961</accession-num><urls></urls><electronic-resource-num>10.1053/euhj.2001.2739</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Cheitlin</Author><Year>1997</Year><RecNum>5</RecNum><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cheitlin, M. D.</author><author>Alpert, J. S.</author><author>Armstrong, W. F.</author><author>Aurigemma, G. P.</author><author>Beller, G. A.</author><author>Bierman, F. Z.</author><author>Davidson, T. W.</author><author>Davis, J. L.</author><author>Douglas, P. S.</author><author>Gillam, L. D.</author><author>Lewis, R. P.</author><author>Pearlman, A. S.</author><author>Philbrick, J. T.</author><author>Shah, P. M.</author><author>Williams, R. G.</author></authors></contributors><titles><title>ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography</title><secondary-title>Circulation</secondary-title><alt-title>Circulation</alt-title></titles><periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></periodical><alt-periodical><full-title>Circulation</full-title><abbr-1>Circulation</abbr-1><abbr-2>Circulation</abbr-2></alt-periodical><pages>1686-744</pages><volume>95</volume><number>6</number><edition>1997/03/18</edition><keywords><keyword>Echocardiography</keyword><keyword>Heart Diseases/ ultrasonography</keyword><keyword>Humans</keyword></keywords><dates><year>1997</year><pub-dates><date>Mar 18</date></pub-dates></dates><isbn>0009-7322 (Print)&#xD;0009-7322 (Linking)</isbn><accession-num>9118558</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite><Cite><Author>Linzer</Author><Year>1997</Year><RecNum>4</RecNum><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linzer, M.</author><author>Yang, E. H.</author><author>Estes, N. A., 3rd</author><author>Wang, P.</author><author>Vorperian, V. R.</author><author>Kapoor, W. N.</author></authors></contributors><auth-address>University of Wisconsin School of Medicine, Department of Medicine, Madison 53792-2454, USA.</auth-address><titles><title>Diagnosing syncope. Part 2: unexplained syncope</title><secondary-title>Ann Intern Med</secondary-title><alt-title>Annals of internal medicine</alt-title></titles><periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></periodical><alt-periodical><full-title>Annals of Internal Medicine</full-title><abbr-1>Ann. Intern. Med.</abbr-1><abbr-2>Ann Intern Med</abbr-2></alt-periodical><pages>76-86</pages><volume>127</volume><number>1</number><edition>1997/07/01</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Algorithms</keyword><keyword>Echocardiography</keyword><keyword>Electrocardiography, Ambulatory/methods</keyword><keyword>Electrophysiology</keyword><keyword>Exercise Test</keyword><keyword>Heart Diseases/complications/diagnosis</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Risk Factors</keyword><keyword>Syncope/ etiology/psychology</keyword><keyword>Tilt-Table Test</keyword></keywords><dates><year>1997</year><pub-dates><date>Jul 1</date></pub-dates></dates><isbn>0003-4819 (Print)&#xD;0003-4819 (Linking)</isbn><accession-num>9214258</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>&D<EndNote><Cite><Author>Brignole</Author><Year>2006</Year><RecNum>6</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brignole, M.</author><author>Ungar, A.</author><author>Bartoletti, A.</author><author>Ponassi, I.</author><author>Lagi, A.</author><author>Mussi, C.</author><author>Ribani, M. A.</author><author>Tava, G.</author><author>Disertori, M.</author><author>Quartieri, F.</author><author>Alboni, P.</author><author>Raviele, A.</author><author>Ammirati, F.</author><author>Scivales, A.</author><author>De Santo, T.</author><author>Evaluation of Guidelines in Syncope Study 2 ( EGSYS-2) Group,</author></authors></contributors><auth-address>Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy. mbrignole@asl4.liguria.it</auth-address><titles><title>Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals</title><secondary-title>Europace</secondary-title><alt-title>Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology</alt-title></titles><periodical><full-title>Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology</full-title><abbr-1>Europace</abbr-1><abbr-2>Europace</abbr-2><abbr-3>Europace: European Pacing, Arrhythmias, &amp; Cardiac Electrophysiology</abbr-3></periodical><pages>644-50</pages><volume>8</volume><number>8</number><edition>2006/07/26</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Decision Making, Organizational</keyword><keyword>Emergency Service, Hospital/economics/ standards</keyword><keyword>Female</keyword><keyword>Guideline Adherence/economics/standards</keyword><keyword>Hospital Costs</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Physician&apos;s Practice Patterns/economics/statistics &amp; numerical data</keyword><keyword>Practice Guidelines as Topic/ standards</keyword><keyword>Prospective Studies</keyword><keyword>Syncope/diagnosis/economics/ therapy</keyword></keywords><dates><year>2006</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1099-5129 (Print)&#xD;1099-5129 (Linking)</isbn><accession-num>16864618</accession-num><urls></urls><electronic-resource-num>10.1093/europace/eul071</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>&D<EndNote><Cite><Author>Brignole</Author><Year>2006</Year><RecNum>6</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brignole, M.</author><author>Ungar, A.</author><author>Bartoletti, A.</author><author>Ponassi, I.</author><author>Lagi, A.</author><author>Mussi, C.</author><author>Ribani, M. A.</author><author>Tava, G.</author><author>Disertori, M.</author><author>Quartieri, F.</author><author>Alboni, P.</author><author>Raviele, A.</author><author>Ammirati, F.</author><author>Scivales, A.</author><author>De Santo, T.</author><author>Evaluation of Guidelines in Syncope Study 2 ( EGSYS-2) Group,</author></authors></contributors><auth-address>Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy. mbrignole@asl4.liguria.it</auth-address><titles><title>Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals</title><secondary-title>Europace</secondary-title><alt-title>Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology</alt-title></titles><periodical><full-title>Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology</full-title><abbr-1>Europace</abbr-1><abbr-2>Europace</abbr-2><abbr-3>Europace: European Pacing, Arrhythmias, &amp; Cardiac Electrophysiology</abbr-3></periodical><pages>644-50</pages><volume>8</volume><number>8</number><edition>2006/07/26</edition><keywords><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Decision Making, Organizational</keyword><keyword>Emergency Service, Hospital/economics/ standards</keyword><keyword>Female</keyword><keyword>Guideline Adherence/economics/standards</keyword><keyword>Hospital Costs</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Physician&apos;s Practice Patterns/economics/statistics &amp; numerical data</keyword><keyword>Practice Guidelines as Topic/ standards</keyword><keyword>Prospective Studies</keyword><keyword>Syncope/diagnosis/economics/ therapy</keyword></keywords><dates><year>2006</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1099-5129 (Print)&#xD;1099-5129 (Linking)</isbn><accession-num>16864618</accession-num><urls></urls><electronic-resource-num>10.1093/europace/eul071</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>4
D<EndNote><Cite><Author>Douglas</Author><Year>2011</Year><RecNum>7</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Douglas, P. S.</author><author>Garcia, M. J.</author><author>Haines, D. E.</author><author>Lai, W. W.</author><author>Manning, W. J.</author><author>Patel, A. R.</author><author>Picard, M. H.</author><author>Polk, D. M.</author><author>Ragosta, M.</author><author>Parker Ward, R.</author><author>Weiner, R. B.</author></authors></contributors><titles><title>ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians</title><secondary-title>J Am Soc Echocardiogr</secondary-title><alt-title>Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography</alt-title></titles><periodical><full-title>Journal of the American Society of Echocardiography</full-title><abbr-1>J. Am. Soc. Echocardiogr.</abbr-1><abbr-2>J Am Soc Echocardiogr</abbr-2></periodical><pages>229-67</pages><volume>24</volume><number>3</number><edition>2011/02/23</edition><keywords><keyword>Cardiology/ standards</keyword><keyword>Echocardiography/ standards</keyword><keyword>Heart Diseases/ diagnosis</keyword><keyword>Humans</keyword><keyword>United States</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1097-6795 (Electronic)&#xD;0894-7317 (Linking)</isbn><accession-num>21338862</accession-num><urls><related-urls><url>http://ac.els-cdn.com/S0894731710010461/1-s2.0-S0894731710010461-main.pdf?_tid=0c57efe6-5300-11e4-9853-00000aab0f01&amp;acdnat=1413222220_d58322063520200bef8bd357da480c3e</url></related-urls></urls><electronic-resource-num>10.1016/j.echo.2010.12.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>4
D<EndNote><Cite><Author>Douglas</Author><Year>2011</Year><RecNum>7</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Douglas, P. S.</author><author>Garcia, M. J.</author><author>Haines, D. E.</author><author>Lai, W. W.</author><author>Manning, W. J.</author><author>Patel, A. R.</author><author>Picard, M. H.</author><author>Polk, D. M.</author><author>Ragosta, M.</author><author>Parker Ward, R.</author><author>Weiner, R. B.</author></authors></contributors><titles><title>ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians</title><secondary-title>J Am Soc Echocardiogr</secondary-title><alt-title>Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography</alt-title></titles><periodical><full-title>Journal of the American Society of Echocardiography</full-title><abbr-1>J. Am. Soc. Echocardiogr.</abbr-1><abbr-2>J Am Soc Echocardiogr</abbr-2></periodical><pages>229-67</pages><volume>24</volume><number>3</number><edition>2011/02/23</edition><keywords><keyword>Cardiology/ standards</keyword><keyword>Echocardiography/ standards</keyword><keyword>Heart Diseases/ diagnosis</keyword><keyword>Humans</keyword><keyword>United States</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1097-6795 (Electronic)&#xD;0894-7317 (Linking)</isbn><accession-num>21338862</accession-num><urls><related-urls><url>http://ac.els-cdn.com/S0894731710010461/1-s2.0-S0894731710010461-main.pdf?_tid=0c57efe6-5300-11e4-9853-00000aab0f01&amp;acdnat=1413222220_d58322063520200bef8bd357da480c3e</url></related-urls></urls><electronic-resource-num>10.1016/j.echo.2010.12.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>4
D<EndNote><Cite><Author>Douglas</Author><Year>2011</Year><RecNum>7</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Douglas, P. S.</author><author>Garcia, M. J.</author><author>Haines, D. E.</author><author>Lai, W. W.</author><author>Manning, W. J.</author><author>Patel, A. R.</author><author>Picard, M. H.</author><author>Polk, D. M.</author><author>Ragosta, M.</author><author>Parker Ward, R.</author><author>Weiner, R. B.</author></authors></contributors><titles><title>ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians</title><secondary-title>J Am Soc Echocardiogr</secondary-title><alt-title>Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography</alt-title></titles><periodical><full-title>Journal of the American Society of Echocardiography</full-title><abbr-1>J. Am. Soc. Echocardiogr.</abbr-1><abbr-2>J Am Soc Echocardiogr</abbr-2></periodical><pages>229-67</pages><volume>24</volume><number>3</number><edition>2011/02/23</edition><keywords><keyword>Cardiology/ standards</keyword><keyword>Echocardiography/ standards</keyword><keyword>Heart Diseases/ diagnosis</keyword><keyword>Humans</keyword><keyword>United States</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1097-6795 (Electronic)&#xD;0894-7317 (Linking)</isbn><accession-num>21338862</accession-num><urls><related-urls><url>http://ac.els-cdn.com/S0894731710010461/1-s2.0-S0894731710010461-main.pdf?_tid=0c57efe6-5300-11e4-9853-00000aab0f01&amp;acdnat=1413222220_d58322063520200bef8bd357da480c3e</url></related-urls></urls><electronic-resource-num>10.1016/j.echo.2010.12.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>4
D<EndNote><Cite><Author>Douglas</Author><Year>2011</Year><RecNum>7</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Douglas, P. S.</author><author>Garcia, M. J.</author><author>Haines, D. E.</author><author>Lai, W. W.</author><author>Manning, W. J.</author><author>Patel, A. R.</author><author>Picard, M. H.</author><author>Polk, D. M.</author><author>Ragosta, M.</author><author>Parker Ward, R.</author><author>Weiner, R. B.</author></authors></contributors><titles><title>ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians</title><secondary-title>J Am Soc Echocardiogr</secondary-title><alt-title>Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography</alt-title></titles><periodical><full-title>Journal of the American Society of Echocardiography</full-title><abbr-1>J. Am. Soc. Echocardiogr.</abbr-1><abbr-2>J Am Soc Echocardiogr</abbr-2></periodical><pages>229-67</pages><volume>24</volume><number>3</number><edition>2011/02/23</edition><keywords><keyword>Cardiology/ standards</keyword><keyword>Echocardiography/ standards</keyword><keyword>Heart Diseases/ diagnosis</keyword><keyword>Humans</keyword><keyword>United States</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1097-6795 (Electronic)&#xD;0894-7317 (Linking)</isbn><accession-num>21338862</accession-num><urls><related-urls><url>http://ac.els-cdn.com/S0894731710010461/1-s2.0-S0894731710010461-main.pdf?_tid=0c57efe6-5300-11e4-9853-00000aab0f01&amp;acdnat=1413222220_d58322063520200bef8bd357da480c3e</url></related-urls></urls><electronic-resource-num>10.1016/j.echo.2010.12.008</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>8	D<EndNote><Cite><Author>Anderson</Author><Year>2012</Year><RecNum>9</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Anderson, K. L.</author><author>Limkakeng, A.</author><author>Damuth, E.</author><author>Chandra, A.</author></authors></contributors><auth-address>Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA. kentonlanderson@gmail.com</auth-address><titles><title>Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting</title><secondary-title>Ann Emerg Med</secondary-title><alt-title>Annals of emergency medicine</alt-title></titles><periodical><full-title>Annals of Emergency Medicine</full-title><abbr-1>Ann. Emerg. Med.</abbr-1><abbr-2>Ann Emerg Med</abbr-2></periodical><alt-periodical><full-title>Annals of Emergency Medicine</full-title><abbr-1>Ann. Emerg. Med.</abbr-1><abbr-2>Ann Emerg Med</abbr-2></alt-periodical><pages>478-484</pages><volume>60</volume><number>4</number><edition>2012/05/29</edition><keywords><keyword>Acute Coronary Syndrome/complications/diagnosis</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Arrhythmias, Cardiac/complications/diagnosis</keyword><keyword>Echocardiography</keyword><keyword>Electrocardiography</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Heart Defects, Congenital/complications/ diagnosis</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Retrospective Studies</keyword><keyword>Stroke Volume</keyword><keyword>Syncope/ diagnosis/etiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1097-6760 (Electronic)&#xD;0196-0644 (Linking)</isbn><accession-num>22632775</accession-num><urls></urls><electronic-resource-num>10.1016/j.annemergmed.2012.04.023</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>8	D<EndNote><Cite><Author>Anderson</Author><Year>2012</Year><RecNum>9</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Anderson, K. L.</author><author>Limkakeng, A.</author><author>Damuth, E.</author><author>Chandra, A.</author></authors></contributors><auth-address>Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA. kentonlanderson@gmail.com</auth-address><titles><title>Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting</title><secondary-title>Ann Emerg Med</secondary-title><alt-title>Annals of emergency medicine</alt-title></titles><periodical><full-title>Annals of Emergency Medicine</full-title><abbr-1>Ann. Emerg. Med.</abbr-1><abbr-2>Ann Emerg Med</abbr-2></periodical><alt-periodical><full-title>Annals of Emergency Medicine</full-title><abbr-1>Ann. Emerg. Med.</abbr-1><abbr-2>Ann Emerg Med</abbr-2></alt-periodical><pages>478-484</pages><volume>60</volume><number>4</number><edition>2012/05/29</edition><keywords><keyword>Acute Coronary Syndrome/complications/diagnosis</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Arrhythmias, Cardiac/complications/diagnosis</keyword><keyword>Echocardiography</keyword><keyword>Electrocardiography</keyword><keyword>Emergency Service, Hospital</keyword><keyword>Female</keyword><keyword>Heart Defects, Congenital/complications/ diagnosis</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Retrospective Studies</keyword><keyword>Stroke Volume</keyword><keyword>Syncope/ diagnosis/etiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1097-6760 (Electronic)&#xD;0196-0644 (Linking)</isbn><accession-num>22632775</accession-num><urls></urls><electronic-resource-num>10.1016/j.annemergmed.2012.04.023</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>�$$If�^!vh5�^#v^:V�l��
t��0�������^6,�5�^a�^p�
���$$If�^!vh5��5�~	#v�#v~	:V�l�M
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5��5�~	#v�#v~	:V�l��
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5��5�~	#v�#v~	:V�l�p
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5��5�~	#v�#v~	:V�l��
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5��5�~	#v�#v~	:V�l��
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5��5�~	#v�#v~	:V�l�Y
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5��5�~	#v�#v~	:V�l�
t��0�������^6,�5��5�~	a�^p������$$If�^!vh5�^#v^:V�l�V
t��0�������^6,�5�^a�^p�
���$$If�!vh5�\
5�@#v\
#v@:V�l��
t��0��������6,�5�\
5�@�$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�y	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l��	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�U	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l��	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�q	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�h	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l��	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l��	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�C	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�$	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�J	���
t���������0��������65�\
5�@p��������$$If�!vh5�\
5�@#v\
#v@:V�l�;	���
t���������0��������65�\
5�@p�������7$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X6+�+�,�5��
5�F5�T5��a�^f4p�(������������$$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	���
t�����������0�������X6+�+�,�,�5��
5�F5�T5��a�^p�����������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4�,	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������3$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	���
t��(�����������0�������X6,�5��
5�F5�T5��9�a�^f4p�(����������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������'$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	�����
t��(�������������0�������X65��
5�F5�T5��a�^f4p�(������������3$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l4��	���
t��(�����������0�������X6,�5��
5�F5�T5��9�a�^f4p�(����������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(������������!$$If�^!vh5��
5�F5�T5��#v�
#vF#vT#v�:V�l��	�����
t��(�������������0�������X65��
5�F5�T5��a�^p�(�������������0@P`p������2(�� 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p��8X�V~��8X�V~_HmH	nH	sH	tH	@`�@D|NormalCJ_HaJmH	sH	tH	DA`�D
Default Paragraph FontRi@�R�Table Normal�4�
l4�a�(k �(
No ListH��HD|Balloon TextCJOJQJ^JaJR�RD|Colorful List - Accent 11^��@`@D|Header
���!mHsHtH:�/�!:D|Header CharCJ_HaJ.)@�1.D|Page NumberB' �ABD|Comment ReferenceCJaJ< R<D|Comment TextCJaJJ�/�aJD|Comment Text Char_HmH	sH	tH	Lj QRLD|Comment Subject5�\�mHsHtHJ�/�JD|Comment Subject Char
5�\�_H@  �@D|Footer
�H�$mHsHtH:�/�:D|Footer CharCJ_HaJ6U �6D|	Hyperlink>*B*ph�D� ��D�WpRevisionCJ_HaJmH	sH	tH	PK!���[Content_Types].xml���j�0���u$Nwc$�a�n�s�@8Jb���VK��S��(��.Y��$��8���<Uz�Z!Y�8�*��y��J��	+}�����M�9LJ�)U�gO�$��)�I2��#���3�th��XO��O�.W��v`����Dڵz>�MV��g��LYS��]��"��(U�����֎�_��o[g��v;
f>K���H����|;\XV�!]�օ	O�ȥs�h�]Hg3߶���PK!�֧�6_rels/.rels���j�0���}Q��%v/��C/�}�(h"���O�
����=������ ����C?�h�v=��Ʌ��%[xp��{۵_�Pѣ<�1�H�0���O�R�Bd���JE�4b$��q_����6L�R�7`������0̞O��,�En7�Li�b��/�S���e��е�����PK!ky���theme/theme/themeManager.xml�M
� @�}�w��7c�(Eb�ˮ��C�AǠҟ����7��՛K
Y,�
�e�.���|,���H�,l����xɴ��I�sQ}#Ր���� ֵ+�!�,�^�$j=�GW��)�E�+&
8���PK!�\���theme/theme/theme1.xml�YOoE�#�F{o'N�Du�ر	�i��-�q�;�N3���'�
�G$$DA�č*���iEP�~���w�q�4��;�{o��?�g�^;N:$BR�6�����4�M���v�si-@R�4Œ�����m���U��b���� V*�XX�!cy�g$�w.��Q"��@o��WL��8����*��By��c����j�đ0�蠦r,[L�C���9VbX*x��_��yuo�BL͐��u�_.�DKfN1엓�:��+ۥ~`j�n�[�Z��p��֖��zg��,tV@������b��W�/Oټ�l6W�s[�R�?�S����֒�7 �_��כ[�֪�7 �_��w����]�Ō�Sh�N'�^B��x�k_[��dC�]z�Oլ\K�=.:�@�M�gd�C��f�/��o\yc�B95��B24S��CEL�|���gO���'�<y���V�#���aU��7����#�_<�܏�U�/���O���P>s��ק����o�>��W�=��n�#��p̰�ZN��|�Ӫ�V:�8�z������1f؃k��;ڇ���cp7#�����z�8�]�Y�/�\�{�t�\���}�}s�p�ķ=ʠoR��VL3�N��(���B<|ݥ��u���K>P�.EML���h�ɦ��M .c��o���;�ə��mr�"�*0��#̡�=<R8���U	��U�3�;aז
"=$��vD�����o%�סu�þ�Ɖ���t��W����$�a�4�����(F{\��ܭ�q���pߡ�	����6:&MD�	Kh�NNh��v�@7�ݹ�v
�W�<���6�- �W	;���,����"�o~��ƣt�@�O/<o[�ۖ��[�z���Nz+�]����b�ENf����3rC�M��u"��3�CR���~�}�
62Hp�!Uq7�l�k�V2���D�p�3�^��te��+��`���j�GvxY�R�Ym���YL���;��\)��:�մQs�V3��V��V�1�v
K6a�`�,��\O
�H�y�ko��'D��֑GĆ���Y3�+R�\@JyBw>6Kր���0i1;�$�P0!Y�ݩjbi��X������J�B�5�I�g�AФ޲a6�{�P	��g֢)҉����-Ì�q�8Rmc��Wy�X�g��/��u�]�6Q_Ê�5H��
�Z2�PU�]���Ǽ�"�GG��FbC��S�OD%�,���p
��6��ޚw����q̲��R_�g��J�S�<��k�q�芿(W�i�?sE/p�_�tB���zm\��C�bv���w@��U*���.�/ȡ��֜�a��kj������X�m�d��j��cU�\�ɨ��2�f��!a=�WuP�n�I��t���y��z�R�7���K���z�b��:���[�_��Y���/�Ȫ#��d�T/��Y����^ӄy��Zk;֔�K+�q�i�a���dp]��?��Q2�aA/�=���w������d�n��W�=v�&�Ve��w>��b���j9�)��e���d��(w:�/��a�k;6�j�����Aq1�1_���x�z��G�~F�<�:��ɮ>��O&�k�N�a4���d�ht\�?J&l	�O�٠��N�Rp�whps���e)�t�p)af��]
�2����7n}��m��k]\S,�+��a��2��g^��A�z
���)˙�>E
G��鿰��L7)��'��PK!
ѐ��'theme/theme/_rels/themeManager.xml.rels��M
�0���wooӺ�&݈Э���5
6?$Q��
�,.�a��i����c2�1h�:�q��m��@RN��;d�`��o7�g�K(M&$R(.1�r'J��ЊT���8��V�"��AȻ�H�u}��|�$�b{��P����8�g/]�QAsم(����#��L�[������PK-!���[Content_Types].xmlPK-!�֧�6/_rels/.relsPK-!ky���theme/theme/themeManager.xmlPK-!�\����theme/theme/theme1.xmlPK-!
ѐ��'
theme/theme/_rels/themeManager.xml.relsPK]<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<a:clrMap xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main" bg1="lt1" tx1="dk1" bg2="lt2" tx2="dk2" accent1="accent1" accent2="accent2" accent3="accent3" accent4="accent4" accent5="accent5" accent6="accent6" hlink="hlink" folHlink="folHlink"/>�T�����	666669�h�%)<�U�ZvbFc69:;<?c�|FT�U(VtV�V�VWNW�WKXdXrXzX�X�X�X�X�XYY8YUYsY�Y�Y�Y�Y�Y�YZ/ZVZiZ|Z�Z�Z�Z�Z[-[Q[[�[�[�[�[\/\J\`\�\�\]]]2]G]^]d]n]y]�]�]�]�]�]�]�]�]�]�]^^"^?^K^d^r^�^�^�^�^�^�^�^�^__(_6_D_R_b_n_�_�_�_�_�_�_�_`.`<`Q`_`~`�`�`�`�`�`�`�`
aa*a8aLa[ata�a�a�a�a�a�a�abbb+bSb_b
cFc78=>@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abdefghijklmnopqrstuvwxyz{|}~������������������������������������������������������������������������
�
�
�
�
�
�
�
fv�������������
-
/
1
`
b
c
�
�
468egi���Ixy�����M%{%|%�%�%�%�%�%�'((*(@(B(D(E(�.�.�.�.�.�.�./�/�/�/@7B7C7�?�?.H�TX�QQ�@������QQ�@��X��X��̕�QQ�@��X���X��̕�QQ�@��X��X��X�̕�X�QQ�@������X�QQ�@������X�QQ�@������X�QQ�@������X�Q������Q����*139!�!�����H�(@�����������0�(	��&1)
��B
�S����	?���IDX_ENREF_1_ENREF_2_ENREF_3_ENREF_4_ENREF_5_ENREF_6_ENREF_7_ENREF_8_ENREF_9_GoBack"�?7@�@\A�A]CD�F�G�R�T	
"6@�@[A�A\CD�F�G,H�R�T�T�T w}����������Q�
�
f��d
�
�y�|%�%(E(�./�/C7�?/H�T�T�T�T�T�T�T�T�T�T�T�T�T�T�T�T�T������d
�
�y�|%�%(E(�./�/C7�?/H�T�T�T�T�T�T�T�T�T�T�T�T�T�T�T�T�T::����BF���������X&2�r����������Q�%0������������V�'<iP������������M�N�\���������~-rR�Lt}����������#�RZ^����������i�k��5������������^�`�OJQJo(�8�����^�8`���OJQJo(��������^�`���OJQJ^Jo(o��	����p^��	`���OJQJo(��������@^��`���OJQJo(���x����^�x`���OJQJo(���H�����^�H`���OJQJ^Jo(o������^�`���OJQJo(���������^��`���OJQJo(���8���^�8`���o(-������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���o(-������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�������^��`���)��������^��`���.��p�L��p^�p`�L�.��@����@^�@`���.������^�`���.����L���^��`�L�.��������^��`���.��������^��`���.��P�L��P^�P`�L�.�����^��`���o(-������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�����^��`���o()������^��`���.��p�L�^�p`�L�.��@���^�@`���.�����^�`���.����L�^��`�L�.������^��`���.������^��`���.��P�L�^�P`�L�.�������^��`���B*o(ph�)��������^��`���.��p�L��p^�p`�L�.��@����@^�@`���.������^�`���.����L���^��`�L�.��������^��`���.��������^��`���.��P�L��P^�P`�L�.�8���^�8`���o(-�����^�`���.���	�L�^��	`�L�.������^��`���.��x���^�x`���.��H�L�^�H`�L�.�����^�`���.������^��`���.����L�^��`�L�.�#�R�V�'~-rR�Q�%��M�i�kX&���������������������������������������p�,�								���																	r��																										p�,�								bz��(�.bz������e�n�(�.�{
�0HFH�H�H�H�H�H�H�H�H�H�H�H�H�H�HIII6I9I:IOIRISI�I�I�I�I�I�I�IJJJJJJ#J%J&J;J?J@J\J`JaJlJoJpJ�J�J�J�J�J�J�J�J�J�J�J�J�J�J�J�JKKKKK/K2K3KCKFKGKOKSKTKzK{K|K�K�K�K�K�K�K�K�K�K�K�K�K�KLLLLL$L'L(LOLSLTLhLlLmL�L�L�L�L�L�L�L�L�L�L�L�L�L�L�L)M*M+M;M>M?MRMVMWMoMvMwM�M�M�M�M�M�M�M�M�M�M�M�MNNN4N;N<NZN�N�N�N�N�N�N�N�N�N�N�N�N�N�N�N�N�N�NO	O
OOOOOO$O(O,O.O/O@ODOHOJOKOQOTOWOYOZOoOpOqOrOsO�O�O�O�O�O�O�O�O�O�O�O�O�O�O�O�O�O�O�O�OPPPPP7P:P>PEPFPVPYP\PcPdPtPwPzP�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P�P
QQQQQ9Q<Q@QGQHQjQnQrQyQzQ�Q�Q�Q�Q�Q�Q�Q�Q�Q�Q�Q�Q�Q�Q�Q�QRR
RR)R*R+R,R-RFRJRNRURVRjRmRpRvRwR�R�R�R�R�R�R�R�R�R�R�R�R�R�R�R�R�R�RSSS"S(S.S/SHSJSLSNSOSwSzS�S�S�S�S�S�S�S�S�S�S�S�S�S�S�S�S�S�S�STT
TT�T�T�T�T�T�T�T�D�D�D��EN.InstantFormat(Fu&	EN.LayoutL)EN.LibrariesR)�<ENInstantFormat><Enabled>1</Enabled><ScanUnformatted>1</ScanUnformatted><ScanChanges>1</ScanChanges><Suspended>0</Suspended></ENInstantFormat>�<ENLayout><Style>Echocardiography</Style><LeftDelim>{</LeftDelim><RightDelim>}</RightDelim><FontName>Times New Roman</FontName><FontSize>12</FontSize><ReflistTitle></ReflistTitle><StartingRefnum>1</StartingRefnum><FirstLineIndent>0</FirstLineIndent><HangingIndent>720</HangingIndent><LineSpacing>2</LineSpacing><SpaceAfter>0</SpaceAfter><HyperlinksEnabled>1</HyperlinksEnabled><HyperlinksVisible>0</HyperlinksVisible></ENLayout><Libraries><item db-id="afwrs9asfs2fr4ever35a5a8et9sdfz2ta5v">Ananthasubramaniam Transthoracic Echocardiography<record-ids><item>1</item><item>2</item><item>3</item><item>4</item><item>5</item><item>6</item><item>7</item><item>9</item><item>10</item></record-ids></item></Libraries>�@p���!�"�H�I�T`@` `D@`(`T@`.``@`V`�@��Unknown������������G�Times New Roman5��Symbol3�Arial5��X��)��Tahoma?�	Courier New;��Wingdings 1���h�Z1K]1A�E#�����x���4d�U|B#q���HP	�7'���������������������D|0"���[Utilization of Routine Transthoracic Echocardiography in Hospitalized Patients with SyncopeStephanie StebensP31191,��
��Oh��+'��0����(<	LX
|�
�����'\Utilization of Routine Transthoracic Echocardiography in Hospitalized Patients with SyncopeStephanie StebensNormal.dotmP311913Microsoft Macintosh Word@@�㌯-�@�1
.�A�E��
��՜.��+,��D��՜.��+,���\hp��������
�<'Henry Ford Health System�#�U\Utilization of Routine Transthoracic Echocardiography in Hospitalized Patients with SyncopeTitle� 8@_PID_HLINKS'A�NHL�	_ENREF_9ID�	_ENREF_8F<�	_ENREF_7F4�	_ENREF_7G,�	_ENREF_6D(�	_ENREF_5E%�	_ENREF_4C"�	_ENREF_2D�	_ENREF_5E�	_ENREF_4B�	_ENREF_3C�	_ENREF_2@�	_ENREF_1	

 !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~�����������������������������������������������������������������������������������������������������������������������������������	

 !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`����bcdefghijklmnopqrstuvwxyz{|}~���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������Root Entry��������	�F/�=
.���Data
�������������G.1Table��������a�MWordDocument����(�SummaryInformation(�������������DocumentSummaryInformation8���������CompObj����`ObjectPool��������������=
.���=
.�����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������	�F Microsoft Word 97-2004 Document����NB6WWord.Document.8

Youez - 2016 - github.com/yon3zu
LinuXploit