ProMedica Health System: INSIDE

Staying Fit with Our CEO

Randy Oostra enjoys running and working out to stay in shape. ProMedica Health System’s president and chief executive officer also tells Inside that exercise is essential to his routine and he finds it to be a great stress-reliever. Randy enjoys activities that get him outside with family, friends and colleagues. As a “sporadic” golfer, he hit a hole-in-one in 2009—“proof that there’s hope for every golfer,” according to Randy.

So, what does this mean for ProMedica employees? “My personal commitment to staying fit motivates me to promote ProMedica’s mission to improve the health of the patients and communities we serve,” states Randy. “Exercising and taking other steps to lead a healthy life, like eating right, have done so much for me. In turn, I’m proud to be part of an organization that helps others achieve their own personal wellness goals.”

Randy cites Fields of Green, ProMedica’s signature initiative to combat obesity, as an example of what ProMedica is doing to encourage wellness on a broad scale throughout our system. Fields of Green is an umbrella for a variety of education, health and nutrition programs developed by ProMedica. These programs include the Fields of Green high school scholarship competition, with finalist teams from each of ProMedica’s five regions, and the 1, 2, 3, and ½ Keys to Good Health Conversation Map^® education program for children in grades four – six and their parents, with facilitators trained to present the program to faith-based groups, schools, 4-H groups, and community organizations in every region.

“Our partnerships with local organizations, such as the Mud Hens and Walleye sports teams, and local venues, like Westfield Franklin Park shopping mall and regional farmers markets, also give us opportunities to present health and wellness information to the public in a fun, interactive way,” notes Randy. “This supports our mission to promote healthy living.

“ProMedica is also proud to be the northwest Ohio sponsor of the American Heart Association’s Start! Movement throughout 2010,” Randy continues. “This program encourages participants to walk more, eat well and ultimately live longer.”

With the Start! sponsorship comes an added opportunity for ProMedica employees to participate in an individual walking challenge. The ProMedica Employee Wellness Program will help promote this challenge during the second quarter of 2010. For more information about the Start! Movement, visit http://www.startwalkingnow.org.

“We believe in making plenty of opportunities available for employees to maintain or improve their health, which is why ProMedica supports the efforts of the Employee Wellness Program,” says Randy. “We hope everyone takes advantage of the wellness activities and events that this growing program offers.”

Information and resources from the Employee Wellness Program are available in the “Employee Wellness” section of myProMedica (http://my.promedica.org).

Randy encourages you to contact him directly with your questions at randy.oostra@promedica.org. Answers will be included in upcoming Inside issues.

Editor’s Note: If you have suggestions for relevant topics you would like to see Randy address in future issues of Inside, please send them to inside@promedica.org. We value your input.

ProMedica in Discussions with St. Luke’s Hospital

ProMedica Health System (PHS) and St. Luke’s Hospital are officially in discussions to determine the best ways the two organizations may work together to better meet the health care needs of area residents and the communities we similarly serve.

States Randy Oostra, President and Chief Executive Officer, PHS, “Amid the landscape of health care reform, ProMedica appreciates the opportunity to hold ongoing dialog with St. Luke’s on how to further improve the quality of health care while continuing to provide consumers with easy access.”

He further notes, “St. Luke’s mission of collaboration and teamwork, integrity, continual improvement in performance, and service to the community are very closely aligned with ProMedica’s Mission and Values.”

Read future issues of Inside and announcements on myProMedica for updates about ProMedica – St. Luke’s in the coming weeks.

ProMedica’s Quality of Care Compared to National Averages

How does the quality of care provided at ProMedica Health System’s hospitals measure up to national averages? To see for yourself, log on to www.promedica.org today and click the “Quality Reports” button.

ProMedica has made extensive quality of care statistics available nationally for more than six years. Recently, though, ProMedica made its quality information even more transparent by creating a public Quality Reports section of www.promedica.org to empower consumers to make informed decisions about their health care.

With easy-to-read graphs and explanations, the quality section of www.promedica.org reports how safe, effective, patient-centered, timely, and efficient the care provided in our facilities is. It also compares our quality results to national averages.

“Our web content features the most current quality information and reflects recent improvements every six months,” offers Linda Yielding, RN, BAS, MBA, corporate director, quality, ProMedica. She explains that quality statistics on national web sites can be more than a year old due to the extensive process of collecting and cross-verifying information.

In addition to reporting quality indicators measured across ProMedica, the Quality Reports section of www.promedica.org offers links to other sources of quality information, such as the Ohio Hospital Compare web site.

In January 2010, when Ohio Hospital Compare went live, 13ABC interviewed Linda and Rebecca Zechman, RN, MSN, administrative director, patient care administration, The Toledo Hospital, about the site, which makes it easy for consumers to compare hospitals. Click here to watch the interview.

“ProMedica is supportive of statewide quality web sites and other efforts to make quality information more transparent,” states Robert Reiter, MD, associate chief medical officer, quality, ProMedica. “Making evidence-based information available to consumers will lead to better outcomes and hospital improvements.”

In addition to the public quality section of www.promedica.org that went live in October 2009, ProMedica created an internal quality section of the employee intranet that contains ProMedica’s complete quality report, including measures not featured publicly. All ProMedica employees are encouraged to review this site by logging on to myProMedica (http://my.promedica.org) and clicking “CORM (Corporate Quality)” under the “Departments” tab.

Phase II planning for ProMedica’s Quality Reports section of www.promedica.org is under way with implementation scheduled for fourth quarter 2010. This phase will include quality measures for ProMedica Continuing Care Services Corporation. Other areas are also under consideration.

For more information on quality, visit www.promedica.org.

Thanks for Your Inside Feedback

Last month, many of you shared your feedback with us about how you receive Inside. We are learning a lot from your responses and will use your input to plan future improvements where needed.

Some readers expressed having difficulty accessing the newsletter. Here are a few quick tips that might help you out with this:

• Click the “HOME” link at the top of this page to view all of the articles in this issue continuously. This eliminates the need to click back and forth between the articles you’re reading and the index.

• If you receive Inside via e-mail, remember that you don’t have to return to the e-mail message you received the next time you want to look at the newsletter. Inside is always available on
myProMedica (http://my.promedica.org) by clicking on the home page graphic (pictured left) or logging in, clicking the “Documents” tab at the top of the page, and selecting Inside from the dropdown menu.

• If you don’t receive Inside via e-mail and you would like to, you can subscribe to have monthly issues sent to your home or personal e-mail address at http://promedica.olhblogspace.com/join-our-newsletter/.

• To view articles from past issues of the newsletter, click the “HOME” link at the top of this page, scroll down to the “Archives” section underneath the “In This Issue” index, and click the link for the month you want to view.

This was only the first of an ongoing series of questionnaires about topics related to the Inside employee newsletter. Throughout the year, we’ll continue to ask you questions about what you’ve seen in the newsletter and what you might like to see.

We hope you’ll plan to respond to future questionnaires. In the meantime, we also welcome your feedback about Inside any time at inside@promedica.org.

—Corporate Communications

Regional Hospitals a Necessity in Emergencies

Two expecting Lenawee County women unexpectedly found themselves in desperate need of medical care this winter. One developed a life-threatening case of the H1N1 virus and the other delivered her baby at a local police station. Both situations ended happily, thanks to swift medical attention from physicians and staff at Bixby and Herrick Medical Centers.

                 Heidi Aldridge (Photo Credit: Daily Telegram)

Heidi Aldridge’s pregnancy was five months from full-term when she came down with a cough and fever in November.

After seeking initial treatment at Bixby Medical Center, Heidi went home and began to feel better. However, five days later her condition worsened, and she returned to the Emergency Center.

Bixby Medical Center’s physicians determined that she had a case of H1N1. She was quickly transferred to The Toledo Hospital where she received an experimental treatment.

Heidi told her story to the Daily Telegram. “My fever had quit for maybe a day or two, and (on Nov 6.) it went back up to 102, so I called my OB doctor,” she said. “And, by the time I got to the hospital, it was almost 104.”

Heidi credits Victor Cherfan, DO—her ProMedica Physician Group (PPG) obstetrician/gynecologist—with insisting on transferring her within ProMedica Health System to The Toledo Hospital for treatment—a decision she believes was crucial.

That’s where doctors saved Heidi’s life, using an alternative breathing machine, called an extracorporeal membrane oxygenation (ECMO) machine. It was the first time doctors at The Toledo Hospital used it.

“If not for the machine,” William Rachwal, MD, FACS—a cardiothoracic surgeon with PPG—told the Daily Telegram, “she would have died that day.”

Denise Baker, director of obstetrics for Bixby and Herrick Medical Centers, also credits physicians at Bixby, where Heidi initially received treatment. Denise says Heidi’s examination at her hometown hospital and transfer within ProMedica Health System saved precious time.

“If Heidi had to drive 50 miles to be seen, she may have waited. Given the rapid course of her disease, that wait could have proven disastrous,” says Denise. “We as a community need to appreciate and utilize our local hospital when we need it.”

Heidi is scheduled to give birth via a C-section on March 23. Dr. Cherfan believes the baby was unaffected by Heidi’s H1N1 illness.

Katie Muysenberg only had a few precious minutes when her daughter, Ireland Clinton Earl Jones, decided to come into the world fast and furiously.

Katie and Ireland’s father, Jeff Jones, began driving to University of Michigan Health System when Katie started feeling contractions. But they never made it to Ann Arbor. The contractions were coming too quickly.

The couple told their story to the Tecumseh Herald. “I only had a couple of contractions and started feeling a little like it was time to go,” said Katie. “It all went very, very fast.”

Jeff turned the car around and they ended up at the Clinton Police Department, where only minutes later, in the hallway of the police station, Katie gave birth. From the time the couple left their home to the birth, only 25 minutes had passed.

Katie and the newborn were immediately transferred to Herrick Medical Center, where doctors finished treatment. Katie stayed at Herrick for two days after the birth of her daughter.

Check Out TMA My Guides

ProMedica Health System has partnered with The Toledo Museum of Art to sponsor My Guides—a program designed to allow visitors to take self-guided tours through the museum based on specific themes.

ProMedica employees may be interested in the “Stay Healthy” tour and “Against the Odds” tour, which focus on health and wellness.

“My Guides is a very popular program with our visitors, with hundreds of the brochures being used every week. It gives people direction to engage with the collections in a non-intimidating and fun way,” says Carol Bintz, development officer for corporate and planned giving, The Toledo Museum of Art.

Several pieces from the “Stay Healthy” tour feature artwork from ancient Egypt and ancient Greece. This tour directs visitors to works of art that promote healthy living as it was interpreted during the period of time in which the art was created.

The second tour, “Against the Odds” exhibits a collection of artwork from artists who overcame physical and/or mental health conditions in the midst of creating their works of art.

Adding to these health and wellness tours, The Toledo Museum of Art will soon add a tour designed to reduce stress on the job. This too will be a free tour for the community to enjoy.

Admission hours for The Toledo Museum of Art are: Tuesdays – Thursdays,
10 a.m. – 4 p.m.; Fridays, 10 a.m. – 10 p.m.; Saturdays, 10 a.m. – 6 p.m.;
and Sundays, noon – 6 p.m. Admission to the museum is free.

To experience a My Guides tour, visit the museum’s Libbey Court or www.toledomuseum.org/collection.

TTH Earns Organ Donation Award

Each day, thousands of Ohioans are waiting for an organ transplant. Thanks to The Toledo Hospital (TTH) and other area hospitals, the wait is getting shorter in northwest Ohio. The Department of Health and Human Services (HHS) recently presented TTH with a gold medal of honor for its success in increasing the number of organs available for transplantation.

TTH is one of 30 hospitals nationwide and one of two hospitals in Ohio to reach and/or exceed all three HHS Community of Practice goals. The goals consist of improving donation rates, expanding clinical processes for recovering organs, and increasing the number of organs donated per individual donor to 3.75 or higher.

“Thanks to our staff and their commitment to honor patient and family wishes with regard to organ donation, The Toledo Hospital is phenomenally increasing the number of organs we have for donation,” says Kevin Webb, PhD, FACHE, president, TTH. “In 2005, we were near the bottom of the Department of Health and Human Services’ organ donation list, but with hard work, we have managed to soar to the top. We will continue to work intensely to meet the Community of Practice goals.

“Because we are the largest acute-care facility in the region, it is imperative that we aim to be leaders in areas such as organ donation,” relays Kevin. “We have strong values here at The Toledo Hospital and as a national organ donation leader we’re exemplifying our compassion for the life of our patients.”

Last April, ProMedica Health System joined a statewide initiative to increase the number of registered donors in Ohio. By joining the statewide initiative, ProMedica is helping to heighten awareness among employees and the community about registering to become a tissue and organ donor. To become a donor, visit www.donatelifeohio.org.

In addition, ProMedica participates with organizations in Michigan to help raise awareness among employees and volunteers there about registering to become organ and tissue donors. For more information or to register to become a donor in Michigan, please visit www.giftoflifemichigan.org.

News Briefs

Second Earthquake Strikes Haiti, Donations Appreciated

In response to the devastating earthquakes in Haiti and an overwhelming need for supplies and monetary donations, ProMedica Health System made a significant contribution in support of American Red Cross relief efforts. There are now hundreds Red Cross workers from around the world in Haiti, as well as thousands of local volunteers. In addition, planes and trucks carrying Red Cross humanitarian assistance are arriving in the region every day, delivering much needed materials. ProMedica thanks all employees who made donations in support of this relief effort.

Health Care Reform Topic of Upcoming Lectures

ProMedica Health System employees and volunteers are invited to attend a free public presentation, “A High-performing Health System: Lessons from Abroad,” on Thurs., Feb. 18, at 7:30 p.m. in the Millennium Theatre on the campus of Maumee Valley Country Day School (MVCDS), 1715 S. Reynolds Rd., Toledo.

Economist Karen Davis, PhD, president of The Commonwealth Fund and recently named one of Modern Healthcare’s Top 25 Women in Healthcare, 2009, will be the featured speaker. A dessert reception will follow the lecture. In addition to Davis, Randy Oostra, president and CEO, ProMedica, will participate in a special panel discussion on health care reform for MVCDS students on Fri., Feb. 19.

FH Participates in Glass Baby Bottle Initiative

Brittany Wortham and her newborn daughter, Kyli Pendleton

Flower Hospital (FH) is participating in an initiative with O-I, the world’s largest manufacturer of glass packaging, to distribute glass baby bottles as part of their “New Mom” kits. O-I donated the glass bottles to two area hospitals, including FH. Made from all-natural, raw materials, glass baby bottles present no risk of chemicals or additives seeping into the contents. The contents can be frozen and heated without risking transfer of harmful chemicals, and the bottles also wash cleanly and can be sterilized.

“Given the unknown risks associated with some packaging materials, we’re pleased to be able to offer our new moms this clear alternative,” says Elaine Ozarzak, LDRP, director, OB-GYN services, FH. “Glass baby bottles are the perfect complement to all-natural breast milk.”

ProMedica Hospice Now Accepting Volunteers

Whether visiting patients, helping in the office or sharing a special talent, volunteers are the backbone of the ProMedica Hospice team and are indispensable to patients, families and staff. Training for volunteers will be held Sat., March 6, and Sat., March 13, from 8 a.m. – 4:30 p.m. at Flower Hospital, 8th Floor, Conference Rooms C and F. Attendance is required at both sessions. To register for these training sessions or to learn more about the hospice volunteer program, please contact Nancy Pfau, manager, volunteer coordinator, ProMedica Hospice, at 419-824-7413.

You Can Always Count on Change

Reflections from Lynn Sinclair, director of customer satisfaction services, ProMedica Health System

While the health care reform movement continues to evolve, one thing we already know we can count on is change. Change necessitates that we keep fluid, flexible and agile, making adjustments that require us to shift gears on a dime. If we as professionals feel pressured under these circumstances, imagine how the health care consumer feels.

Consumers are making decisions each and every day amid uncertainty about the future of their own health care coverage and well-being. It is quite understandable that patients may react with a healthy dose of skepticism to services rendered under these conditions.

In the face of such change, it is always wise to acknowledge patients’ feelings of uncertainty with a good dose of practicality. The reality is that we will always treat our patients with respect—even in the face of change, with knowledge when we have facts to share, and with humility and human kindness when things are not perfect.

Go Green with eStatements

ProMedica Federal Credit Union (PFCU) is offering members $5 cash and entry into a monthly drawing for $100 when they sign up for eStatements. Faster and safer than the mail, eStatements are also a great way to lessen papers in your filing cabinet. You can view one year of statements, save them or print what you need. Simplify your life and “go green” at the same time.

Past $100 winners include Pam Tanner, Clay Ersig, Robin Matteson, and Ellen Stoner. For information about how to sign up for eStatements, contact any PFCU office or visit www.promedicafcu.com.

Applause, Applause

PPG Physician Serves As U.S. Team Physician

Roger J. Kruse, MD, was the U.S. team physician for the Grand Prix Final of Figure Skating, Dec. 3 – 6, 2009, in Tokyo, Japan. The U.S. team captured six medals, including two gold medals, at this event. Many of these skaters will be part of the U.S. Olympic Team in Vancouver in February 2010.

FCH Employee Gets Healthy, Loses Weight

On June 4, 2009, Kimmie Daniel, radiological technologist, Fostoria Community Hospital, threw a graduation party for her daughter. Later, when she saw the photos of herself from that day, Kimmie realized it was time to get healthy. At the time, Kimmie weighed 230 pounds and was a size 16.

She wanted to improve her health and did research before starting her wellness plan. Kimmie decided to limit her diet to natural, fiber-rich foods and foods that balanced her diet. She also began to exercise by walking every day.

Now she eats mostly fruits and vegetables with lean meat and other food groups, like a serving of cheese or yogurt, to ensure that she gets proper daily nutrition. It took three months for Kimmie’s hard work to pay off—she lost 85 lbs.

“My plan was nothing fancy or special. I wanted to lose weight and look good—not be skinny, just healthy,” Kimmie says. “For me, it was an easy choice—cut out the fake foods and exercise. Now I don’t even crave the sugars and fats, and it’s amazing how great I feel!”

Kimmie’s exercise regimen started small, and the more she walked, the further she could go. By September, she was walking five miles a day. By December, she was keeping up with her daughter, running five miles a day, five days a week.

Kimmie credits ProMedica Employee Wellness Program activities with keeping her motivated. “ProMedica Employee Wellness continuously sends out information. It’s a constant reminder to be healthy,” Kimmie says. “It’s been the greatest thing for me.

“The Healthy Eating Challenge gave me new ideas,” continues Kimmie. “The programs have tips and recipes, and it’s right there for everyone.”

Kimmie’s Tips To Get Healthy

Do Your Research: Take time to learn which foods are healthy, high in fiber and complete a balanced diet. Check out the “Employee Wellness” section of myProMedica (http://my.promedica.org) for nutrition information and upcoming programs.

Eat a Natural, Balanced Diet: Skip items with preservatives, high sodium and unnatural sugars. If you have a craving for sweets, grab some fruit instead. Cut out excess fats, sugars and empty calories. Try new fruits, vegetables, lean meat, and healthy snack combinations to vary your food intake and prevent monotony in your diet. Give up soda pop; stick to water instead.

Eat Often and Increase Your Fiber: Eat small meals throughout the day, and eat primarily fruits and vegetables. Also, eat more fiber. It fills you up, decreases feelings of hunger, and satisfies cravings for fats and sugar.

When Eating Out, Order Carefully: If you choose to eat out, stick to grilled or broiled lean meats; salads with no cheese, no croutons and light dressing; or split your meal with a friend or family member.

Exercise Regularly: This is one of the most important parts of any wellness regimen, and it can cost you nothing but your excess fat. Start small and inexpensively by walking outside.

Reward Yourself: Buy yourself a gift or allow yourself a non-food indulgence as a reward for sticking to your healthy eating plan, exercising and keeping the weight off.

Jon Michel, Cara Imm, Gary Cates, Doug Mangas

In 2009, Gary Cates, president of Defiance Regional Medical Center (DRMC) and DRMC Employee Wellness Council member, issued a 12-week weight loss challenge to ProMedica North Region (NR). The four-person team and region that lost the greatest percentage of body weight would be declared the winners of the Weight Loss Showdown.

More than 150 employees from DRMC and 130 employees from NR participated in this challenge. The two regions lost a combined total of 1,590 pounds, but DRMC triumphed over NR by a margin of nearly 500 pounds.

The winning teams from each region were:

DRMC—Gary Cates, Cara Imm, Doug Mangas, and Jon Michel

NR—Amanda Dominique, Jody McCasky, Kristina Urbina, and Nicole Wilson

Members of the winning DRMC team have some advice to share with current participants in the ProMedica Employee Wellness Program’s Lose Healthy Challenge.

One thing that helped Cara Imm stay successful during the showdown was keeping a journal. “It is a great way to keep track of not only what you eat, but also how much you eat and when you eat,” she says. “You may notice that you tend to have a snack at 3 p.m. every day. Start bringing fruit, vegetables or some pretzels as a healthy alternative to scouring the vending machines.

“One important thing to remember with journaling is to always be 100% honest with yourself. If you make a mistake, make sure to write it down,” Cara continues. “It may make you rethink dessert later in the day.”

Jon Michel attributed his weight loss to some very simple lifestyle changes. “In truth, I just modified my serving sizes and exercised more,” he says. “The secret to my success was not cutting out the foods I loved, just eating less of them and adding healthier alternatives.”

The DRMC team was on the same page when they talked about accountability—not only for themselves, but for the team. They relied on each other and made sure that they were all working toward their individual goals.

“It’s hard to eat unhealthy food when you have several people not only watching, but judging everything you eat,” says Jon. “Your team is your support system—use them.”

Show Your Team Spirit!

Send us your team name and attach a group photo. We’ll feature you in the next issue of Inside.

Matters of the Heart: TTH’s First Open Heart-Pump Surgery Patient More Than 50 Years Later

Sandra’s remarkable surgery was featured on the front page of TTH’s employee newsletter in November 1959.
Click here to read the story.

In November 1959 at the age of 12, Sandra Schermbeck underwent the first open heart-pump surgery performed at The Toledo Hospital (TTH). At the time, TTH was the only health care provider in Toledo that owned a surgical heart-lung machine.

Sandra was born with a narrow pulmonary valve in her heart, which controls the blood flow from the right side of the heart into the lungs. The normal size of a pulmonary valve is about three-quarters of an inch in diameter. In Shermbeck’s case, the opening of her valve was smaller than the head of a match.

“Prior to my surgery, there were so many everyday activities that I could not participate in because of the lack of blood flow to my heart,” says Sandra. “If it was not for the surgery, I would have never known what it really felt like to be a kid.”

As a result of her narrow pulmonary valve, Sandra’s heart was strained severely and her heart was failing. Such a heart condition was highly uncommon and the majority of people who suffered from this same condition died before reaching adulthood.

To date, Sandra is living a healthy, normal life—more than 50 years after her surgery. She is married with three children and four grandchildren.

“I don’t remember much about the surgery, besides it saved my life,” relays Sandra.

Sandra’s surgery was performed by a team of 14 staff members, following three years of preparation and research. While doctors operated, the grant-funded heart-lung machine pumped blood and oxygen through Sandra’s body to keep her alive.

Fifty years later, heart and vascular medicine has come a long way. Today, we still use heart-lung machines to keep people alive during open heart surgery, but the technology is very advanced. Physicians now perform cardiovascular procedures using minimally invasive techniques and robotics surgery.

This month, ProMedica launches ProMedica Heart and Vascular Institutes, a collaboration of physicians and medical experts across the system. The institutes feature an impressive network of the region’s leading cardiac surgeons, vascular surgeons and cardiologists, all working with the most advanced technologies available, offering the community access to more services, specialists and research than any single hospital in our region.

To learn more about ProMedica Heart and Vascular Institutes, call 1-877-303-5558 or visit online at www.promedica.org/PHVI.

Get Fit! Resistance Training with Exercise Bands

Resistance Training with Exercise Bands
Bruce Sibbersen, PT, clinical coordinator, Total Rehab, and Kristin Crawford, BS, exercise physiologist, Total Wellness, show you resistance training moves to help you get fit! Use the exercise band and handout you received in your Lose Healthy Challenge starter kit to perform these exercises. Exercise bands can also be purchased from Total Rehab, as well as many sporting goods and other retail locations.

Learn more

Need a Reason To Quit?

Ready To Kick the Habit?

Free Tobacco Cessation Resources Are at Your Fingertips
It frequently takes several serious attempts before a smoker is successful at kicking the habit. There are free resources out there to help you. So, keep trying! Start the eight-week, online Staywell® Quit Smoking Action Plan offered by Paramount Health Care. Also, learn more about additional free resources available from Paramount, Ohio Quit Line and American Heart Association.

More health & wellness resources

Have Something To Buy or Sell?

HR Offers Free Employee Classifieds

Log in now to submit your ad and while your there feel free to browse.

2010 Olympic Winter Games – What Will You Watch?

 Loading ...