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UNT H EALTH S CIENCE C ENTER

Winter 2014

F OR A H EALTHIER C OMMUNITY

INSIDE: Battlefield instincts take over Keeping a cowboy in the saddle On his feet again When no one else could help

USAF Maj. Michael Carletti (TCOM '06)


Kids get a shot in the arm to stay in school When the call came last year that 150 seventh-graders at Morningside Middle School couldn't start school until they received state-mandated vaccinations, Laura Standish, RN, sprang into action. Standish, Director of UNT Health Science Center’s mobile pediatrics program, obtained vaccines, recruited volunteers and set up shop in the Morningside library. Soon, the seventhgraders were cleared to begin classes. Morningside officials praised the pediatrics program, operated with funding from the Rainwater Charitable Foundation and one of the ways UNTHSC serves the community. "Our kids need every minute in the classroom,� Assistant Principal Danny Fracassi said.

The mobile pediatrics program becomes truly mobile early this year when a specially equipped mobile medical unit arrives for service. Although community funds have fully underwritten the cost of the unit, the Office of Institutional Advancement is seeking gifts to support continued outreach services. To learn how your gift can help, please contact Susan Smith at 817-735-2174.

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A HEALTHY SPORTING LIFE Daniel Clearfield, DO, Assistant Professor of Orthopaedic Surgery at UNT Health Science Center, served a two-week rotation last year at the U.S. Olympic Training Facility in Colorado Springs, Colo. What advice do you give people who are just starting a new sport to avoid injury? Start low and go slow. Many people who have been inactive for a long time tend to try to pick up where they left off, and end up injuring themselves in the process. My advice is to start with a reasonable amount of activity. Don't lift too much weight or go too much distance.

What advice do you give people who are looking to train for an event like the Cowtown Marathon on Feb. 23? Take it seriously, as these are events that one cannot simply decide to do last minute. Start a training regimen and stick to it. Discipline is key, and you don’t want to over- or under-train so you injure yourself before or during the race.

Why is it important for people to have a concussion baseline conducted before engaging in a sport such as football? Without baseline neurocognitive testing, all we can do is compare someone's mental and cognitive status, as well as physical and vestibular exams, with individual databases of similar aged individuals around the country. While this is helpful, it's still not as good as comparing someone after an injury to how they were before their injury.

Winter 2014

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HEALTHIER .COMMUNITIES

Starting the day off right Darrin D’Agostino, DO, MPH, Chair and Associate Professor of Internal Medicine, says a healthy, balanced breakfast provides some important heart-protective effects, including: • Balancing certain hormones, including insulin. • Reducing the temptation to overeat later in the day. Taking your time and chewing your food carefully also are beneficial. “Remember, balance is always the key,” he said. “If everything in your life is in moderation and balance, you’ll probably be very healthy.”

Better BP can prompt sweet dreams High blood pressure and sleep problems: The connection between the two keeps Ann Schreihofer, PhD, Associate Professor of Integrative Physiology, awake at night. "People with sleep apnea have a greater risk for developing high blood pressure," Dr. Schreihofer said. "Blood pressure increases if the subjects live under conditions that mimic sleep apnea." Dr. Schreihofer's lab focuses on how the brain regulates blood pressure and how high blood pressure disrupts breathing during sleep. She hopes that her research may assist physicians who treat patients with hypertension Ann Schreihofer, PhD to customize patient treatment and medications aligned with the person's individual medical issues, rather than on the most costeffective blood pressure medication available. 4

Mae Cora Peterson and Janice Knebl, DO

SAGE honored for work with older adults UNT Health Science Center’s innovative mentorship program linking teams of medical and other health profession students with older citizens has been honored for its work in improving patients’ general health. The Seniors Assisting in Geriatric Education (SAGE) program received the Mae Cora Peterson Healthy Aging Award from Senior Citizens Services, a nonprofit group dedicated to empowering older adults in Tarrant County to live with purpose, independence and dignity. The award is named after Mae Cora Peterson, a patient of Janice Knebl, DO, Chief of UNTHSC's Division of Geriatrics and leader of the SAGE program. SAGE students offer older patients advice and direction on such issues as home safety, the implications of medical history, the physiology of aging and medications.


Physician Assistants: A higher health care profile Physician assistants have played an important role in the health care system since the 1960s. But as millions of Americans newly insured under the Affordable Care Act seek care, the PAs’ role will become even more crucial. Good thing, then, that UNT Health Science Center’s Physician Assistant Studies (PAS) program is one of the best in the nation. In the last five years, 98 percent of its graduates passed their national certification exam on their first try. That’s 4 percent higher than the national average. Said PAS student Ryan English: “We are able to help the patient, and we are able to help the health care system. More people are able to get care at a lower cost because of PAs.”

PAS students Ana Maria Chaidez, Marianne Siebert, Stephen Saenz and Sarah Shuler with Instructor Tom Diver, PA-C (center)

Learning from their mistakes College freshmen who drink too much learn more from some mistakes than others, says Scott Walters, PhD, Professor of Behavioral and Community Health. In a large national sample of incoming college freshmen, heavy drinkers who hurt themselves, damaged Scott Walters, PhD property or experienced other external harms were the most likely to take precautions the next time they drank, Dr. Walters said. "Students who were older, non-white, or female were the most likely to learn from their mistakes, regardless of what kind of problems they experienced," he said. Physical consequences, such as a hangover, did not significantly influence students' drinking patterns, according to the study published online in Substance Use & Misuse. The insight into student behavior could lead to intervention programs tailored to specific populations.

The best – and only – defense against measles Prevention is not only the best defense but just about the only one for measles, a contagious disease that saw a recent unexpected resurgence in Tarrant County, says David Lar, MD, Assistant Professor of Pediatrics. Children should receive vaccinations at their one-year checkup and then a second dose between ages 4 and 6, Lar said. "You've got to get immunized. Prevention is always the best medicine," he said. "There's isn't a good treatment once you have contracted measles."

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Nicotine: Enhancing brain performance? Nicotine usually is associated with cigarette smoking and cancer. But Victor Uteshev, PhD, Associate Professor of Pharmacology and Neuroscience, also sees some good in nicotine. Dr. Uteshev's research concentrates on the positive effects chemicals such as nicotine may have on the brain – as in enhancing cognitive performance and resistance to brain injury, particularly in aging patients and people who have high

risk for stroke and traumatic brain injury. The detrimental effects of smoking are well known. But the chemical changes in the brain created when nicotine enters the bloodstream can be beneficial, in optimal doses. "Some smokers can think more clearly for a few minutes or so after a cigarette," Dr. Uteshev said. "We are focusing on compounds that are similar to nicotine but can bring mostly positive effects.”

Victor Uteshev, PhD

Shaping state health policy Andrew Crim, Executive Director of Professional and Continuing Education, will help advise state policy makers on how to meet Texans’ health care needs. Crim is a newly Andrew Crim appointed member of the Statewide Health Coordinating Council, one of only two university representatives on the 17-member council. "The SHCC gives our university and our community a strong voice in how the governor and Legislature allocate health resources," Crim said. The council's broad purpose is to ensure health care services and facilities are available to all Texans through health planning activities. 6

The holidays are over. You’ve over-indulged and under-exercised. Now what? UNT Health Science Center health and nutrition specialists Kyle Pawlak and Chelsea Barron offer tips on how to get back on track. • Have a plan: Schedule your workouts and put them on your calendar. Treat them as a priority. • Do something active every day: Get moving for at least 30 minutes each day. Go for walks, play with the kids in the yard or turn on your favorite music and dance. Make chores more challenging by picking up the pace. • Reward yourself: On days you’re active, reward yourself with a non-food item or activity that makes you feel good. Or create an activity reward savings jar – each time you work out, throw in a few dollars. • Get some sleep: Lack of sleep increases hunger hormones, causes sugar cravings and aids in the accumulation of belly fat. Turn off the electronics and go to bed early.


VITAL STATS

With far more DEMAND than SUPPLY, competition for admission to UNT Health Science Center’s five schools and colleges is intense. Those who make the cut have the relentless drive – and the superior scores – to succeed. High-quality students, when matched with high-quality programs, become high-quality graduates who bring their best to their chosen fields. That’s at the heart of what we mean when we say we’re Creating Solutions for Healthier Communities.

2012 – 2013

ADMISSIONS

APPLICANTS

TEXAS COLLEGE OF OSTEOPATHIC MEDICINE

GRADUATE SCHOOL OF BIOMEDICAL SCIENCES

SCHOOL OF PUBLIC HEALTH

8%

57%

79%

SCHOOL OF HEALTH PROFESSIONS/ DOCTOR OF PHYSICAL THERAPY

SCHOOL OF HEALTH PROFESSIONS/ MASTER OF PHYSICIAN ASSISTANT STUDIES

UNT SYSTEM COLLEGE OF PHARMACY

7%

6%

24% Winter 2014

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Keeping a legendary cowboy in the saddle For more than seven decades, J.W. Stoker, 86, was a cowboy’s cowboy, a rodeo legend who began trick roping and riding at 12 and is a member of the National Cowboy and Western Heritage Hall of Fame and the Pro Rodeo Hall of Fame. But when his advancing years threatened to rob him of the work he loved most, Janice Knebl, DO, a geriatrics expert at UNT Health Science Center, used a multi-disciplinary approach to help the colorful Stoker stay in – or at least near – the saddle. Two of Stoker’s main health concerns included cardiovascular issues and a pinched nerve

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Janice Knebl, DO, and J.W. Stoker


in his back. Dr. Knebl, working closely with other specialists, is helping Stoker stay active by ensuring blood pressure medications are administered correctly and by improving his diet for overall heart health. “She takes care of business,” said Stoker of Dr. Knebl, holder of the Dallas Southwest Osteopathic Physicians Endowed Chair in Clinical Geriatrics. “She pays close attention and is genuinely interested in all her patients. She is full of life.” For the past few years, he’s trained The All American Cowgirl Chicks, a group of women who travel around the world entertaining crowds with their fast-paced drills and daring trick riding. He accompanies them to the Rose Bowl every year, rides a horse during the half-time show and credits Dr. Knebl for his energy and overall good health. Said Dr. Knebl, “In December 2012, my husband and I attended the Rose Bowl, and we saw J.W. during the halftime show. It made me excited seeing him out there riding on his horse looking so happy. My goal with every patient is to help them lead a healthier life so they can continue doing the activities they love.”

To contact Dr. Knebl or any of our geriatric providers, please call 817-735-DOCS (3627).

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Michael David Carletti (TCOM ’06) Major, United States Air Force, Medical Corps Flight Surgeon for Air Demonstration Squadron “Thunderbirds” Age: 35 Birthplace: Anchorage, Alaska TCU graduate: Bachelor’s degrees in mathematics, chemistry

WHEN BATTLEFIELD INSTINCTS TAKE OVER TCOM GRAD’S CARING COMPOSURE AT DAYTONA DISASTER You’ve seen them – sleek and insanely powerful F-16 Fighting Falcons dancing an aerial ballet as they arc through a sunlit sky at neck-snapping speeds. They’re the Thunderbirds, the U.S. Air Force’s Air Demonstration Squadron. Also known as “America’s Ambassadors in Blue,” this 120-plus-member team of precision-obsessed professionals regularly thrills millions with its aerobatic skills. But for one member in particular, the opportunity to serve was all too tragically earthbound. As team flight surgeon, USAF Maj. Michael Carletti (TCOM ’06) accompanies the Thunderbirds to all

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events. Saturday, Feb. 23, 2013, found him at Florida’s Daytona International Speedway for a race-day flyover at NASCAR’s biggest event, the world-famous Daytona 500. With its mission complete, the team settled in to watch the festivities. But with just one lap to go, a massive crash sent a vehicle flying into the barrier separating cars from fans. Large pieces of debris, including a tire, sprayed into the stands. Maj. Carletti’s medical and military training for mass casualty events kicked in. Plunging into the chaos almost without thinking, he helped organize triage efforts and coordinate first responders. Global sports network ESPN


Q&A WITH MAJ. CARLETTI How did you wind up with the Thunderbirds?

Carletti, in dark blue jumpsuit, helps carry a victim from the stands.

caught footage of him amid the devastation and produced a 4-minute feature praising his quick thinking and calm, assured response. In all, 33 people were injured. Fortunately, everyone survived. When asked about his experience, the usually voluble Maj. Carletti turns quiet. But his dark eyes still betray a deep pain. He has yet to see the ESPN video and doubts he ever will. “I just don’t want to relive that day,” he says in a near whisper.

It’s all about timing. I was fortunate enough to have a very well-rounded military/medical first assignment at Tinker Air Force base in Oklahoma with diverse training exercises and deployments. All that allowed me to be competitive for the Thunderbird Flight Surgeon application process and here I am! There are lots of great surgeons in the Air Force serving airmen worldwide. I was fortunate to be selected to represent them on the team. Regarding the Daytona race accident, what were you thinking when you went into the stands? Actually, I wasn’t really thinking. I just went into auto-pilot mode. I focused on stabilizing and prioritizing the patients and resources we had. It’s the way Air Force physicians are trained: Help however you can. What I did is no different than our medics serving in deployment settings or helping others in humanitarian crises overseas. Clearly, the accident affected you.

To see the video, go to YouTube and search “Thunderbird 9 NASCAR Feature for ESPN.”

“On that terrible day, Major Carletti demonstrated the sacred commitment that embodies the best of who we are at UNTHSC. His actions speak to all of us about a higher calling and sense of purpose as well as supreme bravery, service and dedication.” ~Dr. Michael R. Williams (TCOM ’81), UNTHSC President

It was difficult afterward, wondering if we did enough or could we have done things better or should we have done things differently. But the folks at Daytona had a great team of first responders, and I was happy to hear that many of the people affected by the accident are doing well. You're third-generation Air Force. Your father and grandfather are 20-year men. Do you anticipate serving that long, too? Well, I have seven years of active duty service in addition to five years of time in the Reserves, but I would eventually like to come back to Fort Worth to sub-specialize and then stay to practice.

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Lance Thornhill works on a home project.

O N HIS FEET AG AIN Lance Thornhill, 61, a general contractor and carpenter, is the definition of an active man. He spent years as a safety inspector for the city of North Richland Hills and relished remodeling his home and hardscaping his backyard with a gazebo and waterfalls. But out of the blue, when he woke up the day after Halloween 2012, he couldn’t move his right leg.

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When he tried to sleep at night, the pain was so bad, “my wife, Trudee, held me while I bawled,” he said. She took him, limping all the way, to his primary care provider and a neurologist, among others, who offered various incorrect diagnoses, “all fatal,” she said, including spinal tumors and Lou Gehrig’s disease. The best they could get: a diagnosis of “foot drop,” which makes it all but impossible to lift the front part of the foot. Then he met Ryan Seals, DO, Assistant Professor of Osteopathic Medicine, who practices at UNT Health’s Patient Care Center on the

UNTHSC campus. After just two treatments, Thornhill was moving almost normally. Today, he’s walking vigorously for exercise and receives treatments from Dr. Seals every three weeks. “I’m pleased that he’s making progress,” Dr. Seals said. “The dropped foot has resolved, and now we’re working on back pain and sensory issues.” “The first doctor in this whole sorry mess to really care was Dr. Seals,” Thornhill said. “He got me functional and back in the race as a human being.”


Thornhill credits Dr. Seals with making him mobile again.

Foot drop What it is: The inability to raise the front part of the foot because of weakness or paralysis of the muscles that lift the foot. What causes it: • • • • • • • • • • •

Multiple sclerosis Stroke Cerebral palsy Polio Lou Gehrig’s disease Nerve root injury Charcot-Marie-Tooth disease Peripheral neuropathy Peroneal nerve damage Muscular dystrophy Myositis

Source: National Institute of Neurological Disorders and Stroke

“Everyone at UNT Health cares about the patient – nurses and receptionist included. And the doctor actually listens to you.” ~Lance Thornhill

To make an appointment with a UNT Health physician, please call 817-735-DOCS (3627).

Winter 2014

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WHEN NO ONE ELSE COULD HELP Albert Yurvati, DO, gives new lease on life to suffering teen

Breana Marin, 17, was afraid she’d never find anyone who could tell her why she hurt. For four years, she experienced pain in her chest that radiated to her back, neck and shoulders. Her mother, Lorena, took her to several physicians, but none were able to diagnose the pain. A few months later, Lorena started working at the UNT Health Science Center. While reading an issue of Solutions magazine, she came across an article about a teenager named Kylie Ducat who was helped by Albert Yurvati, DO (TCOM '86), Chairman and Professor of Surgery at UNT Health, the physicians group at UNTHSC. Lorena immediately realized that her daughter and Kylie shared the same symptoms, and she made an immediate appointment with Dr. Yurvati. His diagnosis? Breana had suffered an injury to the xiphoid process, the lower portion of the sternum. "It was the first thing I thought of," Dr. Yurvati said. "It was pressing on the sac enclosing her heart. That's why she couldn't breathe and why it was so painful. “UNT Health currently has the most experience in the treatment for this problem,” he added. “Our approach has yielded consistent success with excellent post-operative function for these patients.” Within two weeks of her surgery, Briana felt well enough to go on a church mission trip to the Dominican Republic. “Dr. Yurvati changed my life,” she said. “I’m now able to play volleyball and run for long distances again. I’m so grateful to have my life back.” Lorena Marin said of Dr. Yurvati, “He really listens and cares for his patients. I feel so fortunate to work on a campus with doctors like him.”

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To schedule an appointment with Dr. Yurvati, or any UNT Health surgeon, contact 817-735-DOCS (3627).


Clayton Royder, DO (TCOM ’84); James Royder, DO; and Katarina Royder

Giving is all in the family James Royder, DO, has always made every minute count. From serving in the U.S. Naval Reserve to running a successful medical practice, even walking away from a small plane crash while on a medical mission to Mexico, he’s a believer in forward momentum. That sense of impetus apparently runs in his family. Recently, he handed over day-today management of the James O. Royder Scholarship to his son, Clayton Royder, DO (TCOM ’84), and granddaughter Katarina. The three of them are cheerfully dedicated to – in the scholarship’s parlance – “honoring and supporting the advancement of the osteopathic philosophy and practice of health care” for second-year TCOM students.

“I believe in the osteopathic tradition,” asserted Dr. Royder senior, who also served as a TCOM professor from 1976 to 1981. “I’m proud of the school and proud that my son and granddaughter will perpetuate that tradition through this scholarship.” “Our relationship with TCOM really is a family affair,” Clayton said. “There’s dad’s relationship, of course, and my wife, Mona, received her Master's at the University of North Texas. Our daughter, Katarina, who’s in her senior year at TCU, is strongly considering applying to TCOM for 2015. “I guess the place just gets in your blood!” he laughed.

Spencer Septien (TCOM ’16) is the latest recipient of the Royder family’s generosity. In a thank-you letter, he said, “I’ll continue to work hard to ensure that the next generation of osteopathic physicians, my generation, will grow and expand the awareness and understanding of the osteopathic profession.” Winter 2014

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WHEN SCIENCE STEPS IN to help Alzheimer’s patients and their caregivers

James Hall, PhD

Right now, there’s just one definitive way … … to diagnose Alzheimer’s disease: a brain autopsy. But what if a quick, simple, routine blood test could render a much more timely diagnosis? Such a test might help caregivers determine better methods of treatment and potentially even transform geriatric medicine. Sid O’Bryant, PhD, Interim Director of the Institute for Aging and Alzheimer’s Disease Research at UNT Health Science Center, is the lead investigator in developing such a test,

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which measures the presence of key proteins that indicate whether a patient has Alzheimer’s. “Our research is focused on developing low-cost, useful tools that primary care physicians can use in clinical settings,” he says. Next steps: create standards that can be used globally in collecting blood for Alzheimer’s analysis.


Sid O'Bryant, PhD, Leigh Johnson, PhD, and James Hall, PhD.

Depression and Alzheimer’s disease …

Cholesterol plays a role …

… often go hand in hand. Lending a helping hand are UNTHSC researchers, who have identified a specific subset of depressed patients that is at greater risk of developing mild cognitive impairment (MCI) or Alzheimer’s disease. Leigh Johnson, PhD, was first author, in collaboration with James Hall, PhD, and Dr. O’Bryant, on a study that appeared in PLOS One, a peerreviewed journal published by the Public Library of Science. The UNTHSC researchers found that positive answers to five specific questions correlated to an increased risk of cognitive problems such as MCI and Alzheimer’s. The questions addressed memory problems, “feeling blue,” feeling worthless, frequently crying and trouble concentrating. “We know there is a relationship between depression and Alzheimer’s disease,” said Dr. Johnson, Assistant Professor of Internal Medicine. “But we tried to determine what type of symptoms put someone at greatest risk for cognitive problems.”

… as a major predictor of neuropsychiatric symptoms among men with Alzheimer’s disease. In a study written by UNTHSC researchers, with Dr. Hall, as first author, cholesterol is identified as the major predictor of neuropsychiatric symptoms among men with Alzheimer’s. These symptoms – apathy, depression, psychosis, agitation and disturbances of sleep – are major factors in nursing home placements for patients and the top cause of stress and burnout for caregivers. Men with dementia who have lower cholesterol are less likely to experience those symptoms, according to the study, which appeared in the Journal of Alzheimer’s Disease. “Cholesterol is the single best predictor we see in men for developing these symptoms,” said Dr. Hall, Professor of Psychiatry and Behavioral Health.

Winter 2014

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A LEGENDARY EVENING AT THE BASS On a cool evening last November, country-music legend Clint Black entranced a crowd at Bass Performance Hall with an intimate acoustic concert. Black, a consummate performer, delighted the audience with his songs and on-stage banter. The event raised thousands of dollars to fund the important work of world-class medical researchers at UNT Health Science Center and to create scholarships for the next generation of health care providers.

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An Evening with a Legend “An Evening with a Legend” celebrated more than 40 years of partnership between UNT Health Science Center and the Fort Worth community.

THANK YOU TO OUR SPON SORS TITLE SPONSOR

PRESENTING SPONSOR

RECEPTION SPONSOR

TECHNOLOGY SPONSOR

VALET SPONSOR

AIRLINE SPONSOR

Walsh Foundation PLATINUM Ann & Michael Williams

GOLD Drs. Janice Knebl and Thomas Fairchild u Elena and Tom Yorio u University of North Texas

FRIENDS Tim Doke u Michele and Fred Reynolds u The Ryan Foundation

SILVER Cantey Hanger LLP u Cash America International, Inc. u Dewberry u Paul Dorman and Arnie Gachman u JACOBS u Elaine and Myron Jacobson u Kelly Hart & Hallman LLP u Legend Healthcare u Jude and Don Peska u Pinnacle Bank u Texas Christian University u Texas Health Resources u Dr. and Mrs. Albert Yurvati

ADDITIONAL SPONSORS Mr. and Mrs. Edward P. Bass u The Center for Cancer and Blood Disorders u Four Star Café u Firestone & Robertson Distilling Co. u UNT System Board of Regents

MEDIA 360 West u Fort Worth Business Press u Star-Telegram u 94.9 KLTY u WBAP AM/FM Winter 2014

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F OR A H EALTHIER C OMMUNITY

UNT Health Science Center | 3500 Camp Bowie Blvd. | Fort Worth, TX 76107 | news@unthsc.edu | 817.735.5190 facebook.com/unthsc | www.unthsc.edu | twitter.com/unthsc Copyright Š 2014, All rights reserved.


Solutions Magazine - Winter 2014