Winter 2014

Page 1

memorial

Medical Milestones Fall 2014

Where To Go and When Page 10

Doctor Visit? Urgent Care?

Emergency Room? Relief for AAA Page 4

Stem Cells Promote Healing Page 8

Physician Spotlight Page 12


To our community SETTING THE BAR HIGH When you go out and search for your healthcare provider, along the way you probably ask yourself “who is the best at providing the care I need?” It is one thing to say you are the best and another to actually take the steps and put in the work to be the best. The various departments and doctors within the Memorial Health System go above and beyond to earn accreditations and board certifications that not only provide continuing education, but accountability in providing top medical care.

Lake Charles Memorial Health System Accreditations

Our specialists have gone the extra mile when it comes to their specialties. All of our physicians are either board certified, board eligible or fellowship trained in their area of expertise. This means they voluntarily participate in activities to stay up-to-date with the latest advances in medicine and patient care.

Hospital – The Joint Commission’s Gold Seal of Approval® for health care quality and safety in hospitals Cancer Center – Commission on Cancer

Each doctor earns initial board certification by passing a written and, in some cases, an oral examination created and administered by the member board in his or her specialty. To maintain board certification, a doctor must actively keep pace with the latest advances in his or her specialty and demonstrate best practices for patient safety, communications and ethics.

Memorial/LSUHSC Family Medicine Residency Program – Accreditation Council for Graduate Medical Education Breast Health – American College of Radiology and Food and Drug Administration Mammography Quality Standards Act.

When it comes to hospital-wide accreditations, Memorial voluntarily asks outside expert organizations to evaluate the different departments on the job we are doing and how to do them better. This effort has lead to many accreditations that prove to you, when you choose Memorial as your healthcare provider, you are getting the best.

Laboratory – College of American Pathologists and American Association of Blood Banks Diabetes Education – American Diabetes Association Certificate of Recognition Respiratory – College of American Pathologists Heart & Vascular Center – Intersocietal Commission for the Accreditation of Nuclear Laboratories

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)

2


memorial

Medical Milestones Page 4

Innovations 4 Abdominal Aortic Aneurism Repair

Fighting Prematurity

6

Eliminating Early Elective Deliveries

Quick Recovery 8 Stem Cells Promote Healing

Cover Story

10

Where to go and when

Physician Spotlight

12

Page 6

Brad Forsyth, MD: Dancing Doc

Memorial Cares 14 Giving Employees

Coming Events 16 Education Classes and Support Groups

New Location Opens

18

Family Practice in Moss Bluff

Page 10

On the Cover Seeking the Right Treatment Page 18 3

Page 12


Ovation Prime速 Kidney Metal Stent with Anchors Soft Material-Filled Rings

Main Body

Abdominal Aortic Aneurysm Iliac Limbs

Ovation Prime速 Stent

EVAR is non-surgical, can be done under local anesthesia and usually requires only an overnight stay in the hospital.

Innovations

4


Relief for the Silent Killer An abdominal aortic aneurysm (or AAA) is caused by a weakening of the aorta due to age, disease or other conditions. As the bulge grows, the wall of the aorta becomes weaker. This condition, if left untreated, could cause the aorta to rupture or burst. A rupture of the aorta leads to serious internal bleeding or death. “An aneurysm can occur in any artery in the body, but it usually occurs in the abdominal aorta, just below the kidneys,” says Dr. J. King White, a cardiologist at the Heart & Vascular Center, a part of the Memorial Medical Group.

“The blood flow is cut off to the aneurysm and overtime the aneurysm will decrease in size.” There are several stent graphs available, but the Ovation Prime is the least invasive stent graft on the market today. It offers a unique sealing technology that utilizes polymer-filled sealing rings to maximize seal and conformability in both straightforward and challenging anatomies.

AAAs are known as the silent killer since they tend to grow over time and are usually asymptomatic. The likelihood of having an AAA increases if you have a family history of aneurysms, a history of smoking and/or high blood pressure. AAAs are more commonly found in men over 50 years of age, although younger people and women may also have them.

“This allows a less invasive procedure and quicker recovery for our patients,” Dr. White says.

Early detection of AAAs is crucial to prevent rupture and death. AAAs are usually detected by ultrasound or computerized tomography. They are occasionally found on routine physical examinations by a primary care physician.

You can contact the Heart & Vascular Center by calling 337.494.3278.

If the aneurysm has reached a certain size, the abdominal aneurysm can be treated by either open surgical repair or more commonly by a minimally invasive technique called endovascular aneurysm repair (EVAR). Open surgical repair involves making an abdominal incision from below the breastbone to the top of the pubic bone, and then sewing a graft into the artery above and below the aneurysm. EVAR is non-surgical, can be done under local anesthesia and usually requires only an overnight stay in the hospital. “To perform an EVAR we make two small puncture sites in the groin. We put half of the graft through one side and the other half of the graft through the other side and connect them once they are inside the aneurysm,” Dr. White says.

Dr. J. King White

5

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)


Fighting

Prematurity

Louisiana is a leader in premature births and Lake Charles Memorial Hospital for Women is working to change that. In Louisiana, an average of 9,563 babies are born premature each year, and more than 450 infants die before their first birthday. Recent research by the March of Dimes, the National Institutes of Health, and the U.S. Food and Drug Administration found that although the overall threat is small, the risk of death more than doubles for infants born at 37 weeks of pregnancy when compared to babies born at 40 weeks, for all races and ethnicities.

Babies who survive an early birth often face the risk of lifelong health challenges; such as breathing problems, cerebral palsy, learning disabilities and others. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants.


“The last weeks of pregnancy are very important. Important “This recognition is great for our hospital,” McSwain says. “It is development of the brain, lungs and other vital organs occurs a testament to the commitment of our doctors, nurses and in the last few weeks of pregnancy,” said Marilyn McSwain, a everyone involved with our Family Birth Center to make sure the registered nurse and administrator of Memorial for Women. babies born here have the best start to life.” “That’s why we have made it a policy at Memorial to keep the March of Dimes created the hospital recognition banner program babies in the womb as long as possible.” to recognize hospitals that have achieved optimal success in the The hospital was recognized through a partnership between the elimination of non-medically indicated elective deliveries before Louisiana Department of Health and Hospitals Birth Outcomes 39 weeks gestational age. Initiative, the Louisiana Hospital Association Research and Education Foundation Hospital Engagement Network (LHAREF More than 960 early elective deliveries have been prevented, HEN), and the March of Dimes for the work it has done in which translates to an 83 percent reduction since the beginning of the initiative in 2012, according to data released from the eliminating unnecessary early deliveries. LHAREF HEN. These efforts equated to $700,000 in direct cost The hospital has eliminated all early elective deliveries before savings, not including savings resulting from reductions in NICU the 39th week of pregnancy for the past three years. A baby will utilization. Dr. Peter Angelopoulos only be born early if there is a medical reason. Certain health insurance plans are also joining in the fight as Memorial for Women is one of only 18 hospitals in the state and Blue Cross and Blue Shield of Louisiana and Medicare recently the only one in Southwest Louisiana to meet the criteria for announced they will no longer pay for early elective deliveries recognition. The hospital received a recognition banner for its before 39 weeks. work.

Receiving the March of Dimes recognition banner were doctors, nurses and administrators of Memorial for Women.

7

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)


stem cells promote faster healing

Dr. Brett Cascio

8 8

Dr. Thomas Axelrad


Unlike an organ donation where there is a potential for rejection, these stem cells are immunological.

The

body

does not recognize them as being foreign and does not reject them.

It was a typical January day for Chad Theriot. The athletic 30-something was playing a game of pick-up basketball when he made a basic cut with the ball and felt something snap in his left foot.

Since the injury was not healing, Dr. Cascio recommended an injection of non-embryonic stem cells in his foot. “The stem cells we use are harvested from donated placenta that would otherwise be discarded after a baby is born,” Dr. Cascio says. “The cells are then tested, prepared and frozen until they are needed.”

The snap was the tearing of his plantar fascia ligament. It is the longest ligament in the foot and forms the arch on the sole from the heel to the toes.

Dr. Cascio uses an x-ray guided needle to inject the cells at the injury site.

“I heard a very loud snap and felt the pop in the arch of my foot,” Theriot recalls. “An hour later I couldn’t even walk.”

Unlike with an organ donation where there is a potential for rejection, these stem cells are immunological. The body does not recognize them as being foreign and does not reject them.

Theriot went to see a foot and ankle specialist and an MRI showed a severe rupture in the ligament. He was put in a cast but as days turned into weeks and weeks into months, his foot did not get better.

“The cells take on the same characteristics as the ligament cells and help to speed up healing,” says Dr. Thomas Axelrad, an orthopaedic surgeon with Orthopaedic Specialists, a part of the Memorial Medical Group, who uses the stem cells with his patients.

Theriot became more and more frustrated as the time ticked by. He works offshore and he and his wife are owners of a local fitness club. The injury kept him off his feet and unable to perform either job.

The procedure has helped Theriot and he is on his way to being back at work and back in the game.

“I could barely do things for myself, much less go to work or help around the gym,” Theriot says. “Plus, we have a newborn that I couldn’t help my wife with.”

“I feel fantastic and no longer need assistance to move around,” Theriot says. “I can help out around the gym and look forward to putting on some steal toe boots and heading back out offshore.”

Theriot had enough and was ready for a second opinion. He saw Dr. Brett Cascio, an orthopaedic surgeon with Orthopaedic Specialists, a part of the Memorial Medical Group.

For more information, contact Orthopaedic Specialists 337.494.4900.

9

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)


Cover Story

Where To Go and When Injury or illness, when you need a doctor, waiting is the last thing you want to do. But how do you know what level of care to seek. Do you need a trip to the emergency room, urgent care or will a trip to the doctor’s office be enough to help you? Whatever the situation, Lake Charles Memorial Health System has you covered. Here is a guide to help you know what level of care to seek and when.

Doctor Visit at YOUR DOCTOR’S OFFICE If you need to see a doctor and it does not require immediate care or it is not life-threatening, call your primary care physician and let them know you are ill. They can tell you whether or not to make an appointment or go to urgent care. If you need routine shots, updated prescriptions or a referral to one of our specialists, make an appointment with primary care. Your doctor knows you and your health history and has access to your medical records. If you don’t have a doctor, you can call 1-800-494-LCMH (5264) or go to www.lcmh.com/mmg for a list of primary care doctors. PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)

10


Urgent Care at MOSS MEMORIAL WALTERS ST. For non life-threatening, urgent medical problems. No appointment needed. • Colds, flu, fever • Abrasions, cuts, bruises • Sprains and strains

• Minor burns • Minor eye injury • Ear, eyes and skin infections

• Respiratory infections • Urinary tract infections

Emergency Room at MEMORIAL OAK PARK BLVD. The American College of Emergency Physicians recommends that patients go to the Emergency Department if the following warning signs are exhibited: • Chest pain or pressure • Severe, persistent abdominal pain or pressure • Inability to breathe • Uncontrollable bleeding • Head injury or broken bones • Severe headaches

• Poisoning or suspected overdose • Seizure or loss of consciousness • Numbness or paralysis of face, arm or leg • Major burns 11

• Sudden slurred speech, visual changes or weakness • Intense pain • Severe reaction to bites, medication or food • Suspected child abuse


Physician Spotlight Brad Forsyth, MD OB/GYN and Dancing Doc

K

Roddy Johnson Photography © 2014

Brad Forsyth, MD calls his day job one of the most rewarding there is; being a part of the beginning and growth of a family. Although referring to his work as a “day job” may be a little of a stretch as Dr. Forsyth spends his professional life as an obstetrician and gynecologist at Lake Charles Memorial Hospital for Women.

12


Dr. Brad Forsyth “I have very little control over when a baby decides to come,” he says. “You just know that is the way it is. You plan a lot of things tentatively and you go a lot of places in two cars. Your family understands that there are things that you are going to miss along the way.” Most of those “missed things” tend to be small family events such as a movie night. For the bigger events of life, he is able to plan ahead. Dr. Forsyth is a Sulphur native, whose medical training took him to Louisiana Tech, LSU in New Orleans and Carolina’s Medical Center in Charlotte, North Carolina. He moved back to the Lake Area in 2008 and now spends his days in a mix of practicing medicine in exam rooms, in an operating room or a labor and delivery suite. The lifestyle does not leave a whole lot of time for hobbies, though if you were to ask him, he would tell you that his hobbies are his children. He spends time teaching Sunday school at Trinity Baptist Church, along with coaching league soccer and basketball.

He approached the competition just like he did the marathon, knowing full well he was going to spend a lot of time training and preparing for it. He and his dance partner would spend time practicing over the next six months to get ready for a twominute Broadway routine to the music of Cabaret.

Two years ago, he took golf lessons with his oldest son. Last year it was a trip to The Windy City to run in the Chicago Marathon. This past summer, Dr. Forsyth was coaxed into stepping out of his comfort zone and onto the dance floor as part of The Whistle Stop’s Mad Hot Ballroom Celebrity Dancing Gala.

The night ended up being the most successful yet for the gala and Dr. Forsyth says he was honored to be a part of such a worthy cause.

“I was approached to participate and the first thing I thought was no way, I’m not a dancer,” he recalls. “It was for charity and it’s something I thought would open me to new things and a new group of people. At the end of the day, I thought it would be a neat opportunity to participate in something I would not normally do, but it will be fun, so I went for it.”

“You are always trying to get your kids to try something new,” he says. “I can always look back and tell them, ‘Remember when I did that dancing thing?’ I can hold that over their head that I was willing to try new things so they need to be willing as well.” The questions remains, what will the next new thing be?

The event raises money for Dancing Classrooms, an arts in education program teaching ballroom dance to students of participating schools.

Dr. Forsyth can be reached at 337.480.5540.

13

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)


Memorial Cares

2013 I Gave A Day Memorial Employees At the beginning of this year, Lake Charles Memorial broke ground on $55 million in improvements, upgrades and expansions across the health system. The reason is simple, to build a better patient experience. The growth of the hospital and the expansion of services have made those upgrades possible. On the other end, there are several projects that have happened over the years and will soon take place that are possible due to the generosity of Memorial Health System employees and volunteers. Back in 2010, The Foundation at Lake Charles Memorial Hospital launched the I Gave a Day program. How it works is employees donate the equivalent to a day’s pay utilizing their PTO hours. The money is then used to fund a project in the hospital. “There is a lot of pride associated with the I Gave a Day program. It’s a superior show of commitment from employees and physicians on all levels of the Memorial Health System,” says Leif Pedersen, Senior Vice President of Philanthropy. “They believe in what we are doing here and the drive we all have to make this health system the best it can be.” The first I Gave a Day campaign in 2010 raised $95,000 to renovate the hospital’s cafeteria, Café Bon Vie. The 2011/2012 campaign raised $75,000 designated towards the future renovation and redesign of the hospital’s admissions area. In 2013, $80,000 was donated to build the David B. Usher Reading Room. Just recently, the 2014 campaign brought in more than $80,000 to build the Independence Walk.

14


Patients going through physical rehabilitation will have practical applications like walking on surfaces they encounter every day of their lives, such as gravel, paved bricks, turf and aggregate. Many daily activities must be re-learned by patients undergoing rehab, for instance getting in and out of an automobile, reaching for groceries on a high supermarket shelf or simply getting in and out of bed. The Independence Walk will bring these dynamics to the patient in a hospital setting. The multi-textured walking track will be the focal point of the setting, but of equal importance will be the workout stations duplicating conditioned experiences in typical physical rehab settings. These stations will include equipment such as stair steps, treadmills and parallel bars. And the best part – no longer will inclement weather prohibit regular sessions from taking place.

In total, all four campaigns have raised $330,000. The volunteer auxiliary has donated around $100,000 to the foundation consistently over past few years. Volunteers operate The Wishing Well gift shop at the entrance to the hospitals and the volunteers donate the money they make there back to the foundation. This is used to buy needed equipment around the hospital. Since 1968, the Volunteer Auxiliary has donated close to $2 million to the hospital. The Auxiliary also donates to the Aileen and Hazel Dyer Scholarship Fund. The fund is a medical scholarship fund. Three $1,500 scholarships are awarded to McNeese State University students each semester. The scholarship money is made possible through various fundraisers the Volunteer Auxiliary holds each year. “I can’t say enough about the selfless sacrifice our employees and volunteers have made to make Memorial better for us and our patients,” Pedersen says. “They have put in their time and money that will allow us to continue our state-of-the-art renovations here at Memorial.”

15

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)


Support Groups COPING WITH CANCER

LOOK GOOD, FEEL BETTER

For those cancer patients who are newly diagnosed, undergoing treatment, or who have

Looking good can often be an important step toward feeling good - especially for women who

completed treatment. For more information call

are fighting the cancer battle. With that in mind,

Lenore Hayes, Memorial’s Patient Navigator, (337)

Memorial and the American Cancer Society

494-4890. First Wednesday of each month

are offering women struggling with cancer - the diagnosis, treatment and concerns about their

Café Bon Vie – Memorial Hospital Cafeteria

appearance - a chance to Look Good...Feel Better.

5:30pm – 6:30pm

For more information, call (337) 433-5817. Fourth Monday of every other month

DESIGNER GENES

Shearman Conference Room

A support group by and for the parents of

Noon - 2:00pm

children with genetic disorders. Located at Memorial Hospital for Women, 1900 W. Gauthier Road. For more information, call the group’s

SARCOIDOSIS SUPPORT GROUP A group for people in our area dealing with this

founders, Ashleigh Hornsby (337) 853-7657 or Jessi James (337) 563-1178.

incurable disease, to come together to share their stories, health tips and support. For more

Second Saturday of each month Memorial for Women • Noon

information, call Sabrina Sonnier at (337) 8425939.

DIABETES SUPPORT GROUP

Third Tuesday of each month Shearman Conference Room

Don’t underestimate the importance of education and peer support when living with diabetes. Located at Memorial’s Diabetes Education Office,

6pm - 7pm

2804 2nd Avenue. For more information, call Memorial’s Diabetes Education at (337) 494-6425.

A breastfeeding group, La Leche League offers a series of meetings consisting of four classes that

First Tuesday of each month Diabetes Education Office • 10am – 11am

are helpful for pregnant moms and moms who are already nursing. Meetings are free and open to mothers and babies. First Thursday of each month Memorial for Women Education Room 2 10am – 11:30am

LA LECHE LEAGUE

SISTERS SURVIVING A breast cancer support group for AfricanAmerican women, but open to any woman regardless of race. For more information, call (337) 433-5817. Third Tuesday of each month MOB II Conference Room • 6pm

16


Prenatal and Family Education Classes Registration is required for all classes. For more information or to register, call 480-7243. All classes are held in the education rooms at Memorial for Women, 1900 W. Gauthier Road. Tours are available after all prenatal classes and at 1:30pm on the first Thursday of each month. PREPARED CHILDBIRTH CLASS 4-WEEK SERIES

SIBLING CLASS

This class is highly recommended for its hands-on, and often fun, approach to dealing with labor, delivery and recovery. Birth

This class is recommended during the last three months of pregnancy. Preparing siblings for the arrival of a new baby can be

preparation is discussed regarding natural delivery, birth with an

as confusing as it is joyous. This class focuses on the unity of the

epidural and cesarean birth. Bring your pillows, your questions

family. Older siblings ages 2-10 are asked to attend with one or

and don’t forget to breathe. Recommended during the last three months of pregnancy. January 6, 13, 20, 27, 2015 July 1, 8, 15, 22, 2015

both parents. The children will have hands-on practice with dolls to learn how to interact with a new baby. Parents will receive

March 2, 9, 16, 23, 2015 May 5, 12, 19, 26, 2015

informative guidelines and everyone will tour the mother/baby

September 2, 9, 16, 23, 2015

unit.

6pm – 8pm • $40/Couple ONE DAY PREPARED CHILDBIRTH CLASS Learn comfort, relaxation, positioning, breathing, and massage techniques for increasing the comfort level and enhancing the

December 2, 2014 February 10, 2015

August 6, 2015 September 21, 2015

April 6, 2015 June 4, 2015

November 2, 2015 December 2, 2015

6pm – 7pm • $10/Family

birth experience during this condensed version of the Prepared Childbirth Series. Recommended for the last 3 months of

BABY CARE CLASS

pregnancy. February 7, 2015 April 11, 2015

baby care, early parenting issues and community resources. Recommended during the last 3 months of pregnancy.

June 27, 2015

The Baby Care Class reviews newborn characteristics, general

August 22, 2015 October 17, 2015

January 5, 2015 February 9, 2015

November 14, 2015

9am – 4pm • $40/Couple

August 3, 2015 September 14, 2015

April 13, 2015 October 26, 2015 June 1, 2015 November 30, 2015 6pm – 8pm • $10/Couple

BREASTFEEDING CLASS Learn positioning, latch-on, early feedings and the importance of assessing baby’s intake during the Breastfeeding Class. Recommended during the last 3 months of pregnancy.

INFANT AND CHILD CPR CLASS FOR FAMILY AND FRIENDS Learn and practice rescue for choking and CPR for infants. This

December 4, 2014 July 9, 2015 January 15, 2015 August 20, 2015 February 19, 2015 September 10, 2015 March 19, 2015 October 15, 2015 April 16, 2015 November 12, 2015 May 14, 2015 December 10, 2015 June 11, 2015 6pm – 8:30pm • $10/Couple

is NOT a certifying or credentialing course, but is recommended for expectant parents, new parents and support persons. December 3, 2014 August 4, 2015 February 5, 2015 October 19, 2015 April 14, 2015 November 16, 2015 June 2, 2015 6pm – 8:15pm • $10/Person

17

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)


Memorial Medical Group Family Medicine Clinic - Moss Bluff

Family medicine physicians Dr. Stewart Greathouse, Dr. Ashley Greenman and Dr. Micah LeLeux.

PHYSICIAN REFERRAL • 1-800-494-LCMH (5264)

Parish Rd

Theriot Rd

Sid Lane

Sam Houston Jones Pkwy Bruce Circle

Conveniently located at 217 Sam Houston Jones Pkwy, Suite 104, in Moss Bluff. • For more information or to schedule an appointment, call 337-480-8989 or visit www.lcmh.com/mmg.

Armistead Lane

Providing comprehensive care for the whole family. Accepting new patients.

C

18

i

as

c al

Moss Bluff

r

ve

Hwy. 171

eu

Ri


Letters Susan Clark

On February 21, 2014 I was treated in the emergency room at Memorial Hospital. When I entered the waiting room it was overflowing with sick people. However, all of us were treated with great care and comfort for the amount of time we were waiting. I was so impressed with the care and concern that Ann Miller gave to each and everyone in the ER waiting area. She came around to each person and offered to give them a warm blanket, some coffee and watched over a young child so her mother could use the restroom. Just watching her compassion for all of us was overwhelming. It made me realize all that could be done for those waiting was being done. When I was in a room in the ER, I was greeted by the most wonderful people, from the x-ray technician to all the nurses who were attending to me. This included getting me something to eat as I had been without anything since breakfast and was in the ER until around 3 pm. I was especially impressed with the Nurse Practitioner, Karie Savoy, who was so kind and helpful in explaining what was going on and what I needed to do. My husband and I have always used Memorial Hospital and we have never had a bad experience there. Yes, the wait is long sometimes, but knowing that there is a very caring staff waiting for you is much appreciated and worth the wait. I’m sure you don’t always get the compliments your hospital deserves, but I do feel that I needed to write this letter to let you know there is a very satisfied customer here wanting to let you know what a great staff you have in the ER!! Thank you ever so much. Susan Clark Lake Charles


1701 Oak Park Blvd. Lake Charles, LA 70601

Memorial Medical Milestones Kathy DeRouen Senior Vice President of Marketing Matt Felder Communications Manager This is a publication from Lake Charles Memorial Hospital. The information in this newsletter is intended to inform patients and potential patients about subjects pertinent to their care not as medical education. © 2014 Printed in U.S.A.

Be a Quitter. Memorial invites you to

Quit with Us at our Smoking Cessation Health Fair

Thursday, November 20, 2014 • 3pm – 7pm • Prien Lake Mall This educational event is free and open to the public. Join us for information on how and why you and your loved ones should quit, as well as some free giveaways! There will be representatives and medical personnel from various departments at Memorial, as well as special guests from the local cancer prevention community.


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.