ࡱ> 24/01y *rbjbj 8{{iA\ \ Dzn$G*:""""eGgGgGgGgGgGgG$JLG""G4G%%%eG%eG%%6A(C\z,"BQGG0GBxMU#xM8CCxMDh"%0"""GG[$$"""GxM"""""""""\ |:   Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London A partnership between Great Ormond Street Hospital for Children NHS Foundation Trust and A strategy for patient and public involvement and engagement (PPI/E) in research 2013 2017 I have always taken the view that public involvement in research should be the rule not the exception -Professor Dame Sally Davies, Chief Medical Officer for England Vision At the Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) and the University College London (UCL) Biomedical Research Centre (BRC), we want to involve patients and the public in our research at all stages. It is only by doing this that we can be sure that the research we carry out addresses what matters most to them. Patients and the public will be embedded in our research decision making and structures to guide and influence our strategy and support our delivery, ensuring our research results in patient benefit. Defining patient and public involvement/engamgement in research This strategy is about both patient and public involvement, as well as engagement, in research. For the purposes of this document, the INVOLVE definition of public involvement in research will be used, which is, research being carried outwith orbymembers of the public rather thanto,about orforthem. INVOLVE goes on to describe public as, patients, potential patients, carers and people who use health and social care services. Therefore, in the context of GOSH and the UCL BRC this refers mostly to children, parents, and families. Patient and public engagement can be defined as, where people are given information about research and can discuss it with researchers and research organisations. Background to this strategy The Trust encourages patient and public involvement/engagement (PPI/E) across a range of its activities, including research. To date, although there are a number of excellent examples of how patients and the public have been involved with research at GOSH, there has been no overarching strategy for PPI/E in research. The expectation is that this strategy will complement the Trusts policy, PPI (Patient and Public Involvement) and Patient Experience: What we plan to do, 2012 2015. This strategy has been driven forward by the GOSH UCL BRC, however the expectation is that this will apply to all research at GOSH and the UCL BRC and that good PPI/E practice developed could be used across UCL Partners. Development of the strategy To develop this strategy, several methods were used: Internet searching was used to identify key publications on PPI/E from relevant healthcare sources. Internet sources consulted included websites for INVOLVE, other BRCs, the Research Design Service London, HealthTalk Online, the Medicines for Children Research Network, People in Research, and the James Lind Alliance. (These websites, along with other websites of use, are listed in Appendix 3 of this document.) Interviews with academics and clinicians who were considered to be experts in the area, or who have used PPI/E in their own research. This includes theme leads from within the BRC, staff from GOSH, PPI leads from other BRCs, and individuals external to these organisations working strategically in PPI/E, e.g. INVOLVE and the NIHR Central Commissioning Facility. See Appendix 1 for a list of who was interviewed and Appendix 2 for a summary of information gathered from the interviews. Consultation with young people involved in the London Young Persons Advisory Group, from the Medicines for Children Research Network (MCRN). Interviews with parents of children participating in clinical trials at the Somers Clinical Research Facility (CRF), at GOSH. Finally, a PPI/E project steering group was formed, which included William VantHoff, Emma Pendleton, Julian Hughes, Jo Wray, Ruth Nightingale, and Erin Walker. The group met fortnightly where possible, to comment on, and make recommendations about, the progress of the strategy development. Objectives In order to achieve our vision and support the GOSH UCL BRC strategy, there are three key objectives underlying the development of PPI/E activities. They are: Involvement: we will actively consult, listen to and involve patients and members of the public about their views on the research carried out at the BRC and across GOSH. To achieve this objective we will develop involvement opportunities for patients and the public in different specialties and at every level: Form a BRC PPI/E group (adults and/or children and young people) that could feed into strategic decision-making by: Input into the BRC Strategic Board Input into each of the four BRC Themes1.2 Support the active involvement of patients and public in programmes of research, e.g. advise on patient priorities for new research; helping to make applications for research funding so potential funders know that patient priorities are being addressed1.3 Support the active involvement of patients and public in individual research projects e.g. helping to plan and run studies so patients want to participate; helping to explain studies to patients (i.e. information leaflets) so they are fully accessible.1.4 Working in partnership with other PPI groups to increase diversity of involvement e.g. GOSH Youth Forum, MCRN Young Persons Advisory Group, parent groups, charities.1.5 Enable BRC and GOSH researchers to work with patients and public in their research by: 1.5.1. Supporting researchers to involve patients and members of the public at all stages of research projects. 1.5.2. Collaborating with other BRCs (e.g. Guys & St Thomas, UCLH, Moorfields) to provide training for researchers around PPI/E. 1.5.3. Provision of PPI/E advice/drop ins to researchers planning PPI/E.1.6. Enable a diverse group of patients and members of the public to be meaningfully involved in PPI/E activities by: 1.6.1. Exploring a range of methods to provide learning and support e.g. training courses potentially delivered in partnership with other London BRCs; mentoring by another patient, member of the public or researcher. 1.6.2. Ensure adequate funding is available for PPI/E activities (see resources section) so patients and members of the public are properly remunerated for their contributions. Engagement: we will inform and educate patients and the public about the work of the BRC and GOSH researchers. To achieve this objective we will: 2.1 Hold an annual BRC open day showcasing facilities such as the CRF and GOSgene 2.2. Work collaboratively with other research networks (e.g. Centre for Nursing and Allied Health Research, Medicines for Children Research Network) to promote childrens research at relevant eventsSupport schools to learn about the work of the BRC through: 2.3.1. Holding regular hands-on workshops, including laboratory-based activities, to introduce school students to BRC research 2.3.2. Support BRC researchers to engage with post-16 students e.g. providing placements and mentoring in partnership with In2Science 2.3.3. Support BRC researchers to develop roles as STEM (Science, Technology, Engineering and Mathematics) Ambassadors 2.3.4. Get involved in events targeted at school-aged studentsDisseminate information about the work of the BRC and GOSH researchers in accessible formats e.g. website, newsletters (see BRC communication plan) Reporting and learning: we will develop processes to report on, monitor, review, learn from and share PPI/E activities in the work of the BRC and GOSH researchers. To achieve this objective we will: 3.1 Develop a checklist to collect information about any PPI/ E activity which takes place in the BRC or GOSH3.2 Complete an annual audit of PPI/E activities 3.3 Develop methods to collect and share case studies that demonstrate the value and impact of PPI/E in funded research studies3.4 Ensure a visible BRC presence at local, national and international PPI/E events and conferences Resources To properly embed PPI/E in research across the BRC and GOSH, staff labour and financing will be necessary, both for individual research projects, and across the BRC and GOSH. Costs for PPI/E should be factored in to each research project and grant application. INVOLVE has recently developed an Involvement Cost Calculator, for researchers to budget PPI/E in a research project ( HYPERLINK "http://www.invo.org.uk/resource-centre/involvement-cost-calculator/" http://www.invo.org.uk/resource-centre/involvement-cost-calculator/ ). The Research Design Service London also offers funds for PPI/E activities, through their Enabling Involvement Fund( HYPERLINK "http://www.rdslondon.co.uk/Patient---Public-Involvement/Enabling-Involvement-Fund.aspx" http://www.rdslondon.co.uk/Patient---Public-Involvement/Enabling-Involvement-Fund.aspx). In addition, researcher time should be taken in to account to run PPI/E activities and events. This information will be provided to researchers as part of the grant application process. However, in order to develop a culture of PPI/E for research, commitment to core resources is required. To fulfill the objectives within the strategy, a 1.0 WTE role will be developed for a PPI/E Worker as part of the Division of Research and Innovation. This post holder will provide PPI/E support for research projects in the BRC, and across GOSH. Equally, the BRC and GOSH will support this individual with promoting PPI/E. This individual will be the point of contact for researchers to liaise with families and charities, and vice versa. The individual will also plan engagement events in the community, and in-house training for research staff. In addition, funds should be set aside in the annual budget for PPI/E activities. These funds could be put towards items such as refreshments and remuneration for participants (e.g. vouchers, or money paid at the INVOLVE rate), and directly incurred costs for running PPI/E activities. Operational plan To build on existing PPI/E activities and develop further opportunities for patient and public involvement in research activities, an operational plan for the following 12 months has been drawn up. This includes the following; the detailed operational plan is also included. Within the next 6 months: Appoint a PPI/E Worker in R&I. Submit copy to GOSH/BRC publications to raise awareness of the PPI/E service in R&I Start up PPI/E drop-in sessions, offered by R&I for any staff wanting to conduct research, to be delivered by the PPI/E Worker. Develop a checklist and database of PPI/E activity in research across the Trust and the UCL BRC Participate in the Bloomsbury Festival in October 2013 Collaborate with Guys and St Thomas BRC to develop and deliver a training day for researchers around PPI/E Support the review of the research website pages on the GOSH and UCL BRC sites. Start the process of identifying and contacting interested parents and/or children and young people with view to forming a Research PPI/E group Within the next 12 months: Prepare a PPI/E stand/activity for International Clinical Trials day in May, 2014. Participate in the Big Bang, London, in July 2014. To facilitate at least one meeting of the Research PPI/E group Depending on the workload of the PPI/E Worker, consider developing a post for a second PPI/E Worker, to be employed at 0.5 WTE or 1.0 WTE. Develop a mandatory online PPI/E training module to be delivered through GOLD. Staff interested in conducting research would have to complete this training as part of the R&I governance application process. The training would have to be repeated every two years. ObjectiveActionsLead ByTimescaleAction to DateForm a BRC PPI/E group (adults and/or children and young people) that could feed into strategic decision-making by: Input into the BRC Strategic Board Input into each of the four BRC ThemesAgree with the BRC Scientific Board role and remit of the Board / Agree with BRC Board the levels at which PPI input will be sought overall, theme, project level? Advertise for members Set-up the first meetingPPI Research Lead with input from the BRC Scientific BoardJanuary 14 February 14 June 14 1.2 Support the active involvement of patients and public in programmes of research, e.g. advise on patient priorities for new research; helping to make applications for research funding so potential funders know that patient priorities are being addressedWork with the Senior Research Project Manager and Clinical Research Facilitator within R&I to support the grant application process Start drop-in sessions for research staff PPI Research LeadFrom January 14 and then ongoing From February 14 and then ongoing 1.3 Support the active involvement of patients and public in individual research projects e.g. helping to plan and run studies so patients want to participate; helping to explain studies to patients (i.e. information leaflets) so they are fully accessible.Provide advice to researchers as and when required Collate good practice examples of PPI to share PPI Research Lead From January 14 and then ongoing April 14 and then ongoing 1.4 Working in partnership with other PPI groups to increase diversity of involvement e.g. GOSH Youth Forum, MCRN Young Persons Advisory Group, parent groups, charities. Establish links with other PPI groups and those who lead the groupsPPI Research LeadMay 14 and then ongoing1.5 Enable BRC and GOSH researchers to work with patients and public in their research by: 1.5.1. Supporting researchers to involve patients and members of the public at all stages of research projects. 1.5.2. Collaborating with other BRCs (e.g. Guys & St Thomas, UCLH, Moorfields) to provide training for researchers around PPI/E. 1.5.3. Provision of PPI/E advice/drop ins to researchers planning PPI/E.Establish links with PPI leads across the BRC infrastructure Develop and deliver a joint training day with Guys & St Thomas Start drop-in sessions for research staff Work with the Senior Research Project Manager and Clinical Research Facilitator within R&I to support the grant application process Scope option of providing on-line PPI training PPI Research LeadMarch 14 and then ongoing March 2014 From February 14 and then ongoing From January 14 and then ongoing Nov 141.6. Enable a diverse group of patients and members of the public to be meaningfully involved in PPI/E activities by: 1.6.1. Exploring a range of methods to provide learning and support e.g. training courses potentially delivered in partnership with other London BRCs; mentoring by another patient, member of the public or researcher. 1.6.2. Ensure adequate funding is available for PPI/E activities (see resources section) so patients and members of the public are properly remunerated for their contributions.Collate examples of what learning and support other BRCs/ organisations provide to patients and public who get involved Agree funding required with the BRC Scientific Board for PPI activities 9including training, support for PPI groups etc.) Prepare additional applications for funding as requiredPPI Research Lead PPI Research Lead with support from Deputy Director of R&I PPI Research Lead with support from Deputy Director of R&I April 14 and then ongoing March 14 As required2.1 Hold an annual BRC open day showcasing facilities such as the CRF and GOSgeneFirst open day to be held in 2014PPI Research Lead with support from BRC Co-coordinator and administrative support from the R&D office Sept / Oct 142.2. Work collaboratively with other research networks (e.g. Centre for Nursing and Allied Health Research, Medicines for Children Research Network) to promote childrens research at relevant eventsSource opportunities to advertise GOSH/ BRC research and contribute to these events in 2014: Big Bang Science Festival, International Clinical Trials Day PPI Research Lead with support from BRC Scientific Board FacultyInternational Clinical Trials Day May 14 Big Bang July 14 Support schools to learn about the work of the BRC through: 2.3.1. Holding regular hands-on workshops, including laboratory-based activities, to introduce school students to BRC research 2.3.2. Support BRC researchers to engage with post-16 students e.g. providing placements and mentoring in partnership with In2Science 2.3.3. Support BRC researchers to develop roles as STEM (Science, Technology, Engineering and Mathematics) Ambassadors Get involved in events targeted at school-aged studentsOrganise internal BRC school and college events, building on events already organised within the themes Run a workshop at the 2014 Big Bang Science Festival Advertise the role of STEM ambassadors to BRC supported staff and provide training as appropriate PPI Research Lead with support from BRC Co-coordinator and administrative support from the R&D officeJan 15 July 14 April14 and ongoingDisseminate information about the work of the BRC and GOSH researchers in accessible formats e.g. website, newsletters (see BRC communication plan)Contribute to the R&I website project Provide content for the BRC and GOSH newsletterPPI Research LeadFrom January 14 Quarterly news stories for the BRC newsletter3.1 Develop a checklist to collect information about any PPI/ E activity which takes place in the BRC or GOSH Produce a checklistPPI Research LeadJanuary 143.2 Complete an annual audit of PPI/E activitiesSet up a database of PPI and PPE activity at GOSH/ICH PPI Research LeadApril 14 and then ongoing3.3 Develop methods to collect and share case studies that demonstrate the value and impact of PPI/E in funded research studiesPrepare case studies for publishing on the BRC website, BRC newsletter and GOSH newsletterPPI Research LeadQuarterly updates to be provided the website and quarterly news stories for the BRC newsletter 3.4 Ensure a visible BRC presence at local, national and international PPI/E events and conferencesAttend meetings as appropriate and present PPI activity (each year attend at least one national conference to advertise the work of the BRC) Provide annual report of PPI/E activity to GOSH PPIE CommitteePPI Research LeadDecember 14 Appendix 1: Interviews/consultation during May-October 2013 which informed the development of the PPI/E strategy NameRoleOrganisation Miss Rehana AhmedPatient and Public Involvement (PPI) and Patient Experience OfficerGreat Ormond Street Hospital for Children NHS Foundation Trust (GOSH)Ms Laura Brannon Biomedical Research Centre (BRC) PPI Project ManagerBRC, Guys & St Thomas NHS Foundation Trust Ms Jenny JacksonPPI representativeUniversity College London (UCL) PartnersMs Laura KassoumeriResearch FacilitatorArthritis Research UK Centre for Adolescent Rheumatology at UCL, University College London Hospital (UCLH) and GOSHMr Nigel MillsClinical Nurse Specialist, Adolescent MedicineGOSHProfessor Francesco MuntoniTheme lead for 'Novel therapies in childhood disease'GOSH UCL BRCMs Sophie NewboundPopulation Sciences Cluster ManagerBRC, Guys & St Thomas NHS Foundation TrustDr Sophie Petit-ZemanActing Director of patient involvement in researchOxford BRCProfessor Jugnoo Rahi Professor of Ophthalmic EpidemiologyOpthalmic Epidemiology, Medical Research Council (MRC) Centre of Epidemiology for Child Health, Institute for Child Health (ICH)Dr Daniel RobothamSenior theme research and coordinator for 'Patient and Carer Participation'South London and Maudsley NHS Foundation Trust BRCMr Andreas RoposchConsultant orthopaedic surgeonGOSHMs Elisabeth ReusPaediatric Research MatronClinical Research Facility, Guys & St Thomas NHS Foundation TrustProfessor Neil SebireTheme lead for 'Diagnostics and imaging in childhood diseases'GOSH UCL BRCMs Ann-Marie SmithOffice Manager and PPI leadLondon (South) Comprehensive Local Research NetworkNameRoleOrganisationDr. Sophie StaniszewskaSenior Research FellowPatient and Public Involvement and Patient Experiences, University of WarwickMiss Jo StudhamClinical Director - Nursing UCL/UCLH CRFUCLH CRF Dr Val TadicResearch AssociateOpthalmic Epidemiology, MRC Centre of Epidemiology for Child Health, ICHMs Maryrose TarpeySenior Public Involvement AdviserINVOLVEDr Rachel TaylorReader in Children and Young People's Healthcare, Senior Research Manager Department of Children's Nursing London South Bank University, AND Cancer Clinical Trials Unit University College London Hospitals NHS Foundation TrustMs Anita SolankiCohort ManagerUniversity College London Hospitals NHS Foundation TrustDr Lorna FernResearch and development co-ordinator for the Teenage and Young Adult Clinical Studies Group'National Cancer Research Institute University College London Hospitals NHS Foundation TrustDr Nicola WilliamsDeputy Director of ResearchNorth Bristol NHS TrustMs Philippa YeelesHead of PPI National Institute of Health Research (NIHR) Central Commissioning Facility Ms Rosamund YuPPI Manager UCL/ UCLH Joint Research OfficeInterviews with mothers and fathers of children who are currently participating in research studies in the Somers CRFConsultation with 10 young people, aged 10-18 who are members of the MCRN Young Peoples Advisory Group Appendix 2: Summary of information gathered from interviews and consultation The following information was disclosed to the strategy authors (EW and RN) in interviews with individuals listed in Appendix 1. This information from interviews and consultation about PPI/E activities has been collated into similar categories as those used in the strategys objectives. Involvement examples: Set up topic specific groups e.g. cancer, stroke, womens health, dermatology, cardiovascular, mental health. Groups have face to face meetings where researchers visit to consult on studies, but also consultation by email between meetings Lay members of topic specific groups join steering groups for individual research projects. May become co-applicants on grant applications Patient and Public Involvement Advisory Group: strategic group looking at all areas of research activity taking place in a BRC and shapes future research activity Condition specific groups (e.g. parents, young people) review a specific study. Involvement can be one-off or ongoing. Link in with patient/parent support groups, charities and existing PPI groups (e.g. focused on care/service issues) to consult around studies and recruit to advisory groups PPI leads offer advice, training and support to researchers to carry out PPI and signpost to available resources Lay members part of PPI stakeholder implementation group to advise on research networks PPI strategy and plan. Aim to increase recruitment by creating databases of patients and public who are interested in participating in research Developing systems where patients can access their health records online and record information about their health on their records; these records could then be used by researchers and to develop patient/carer reported outcome measures. Consultation with patients about how samples collected for biobanks/ resources are used in research Patients with research contracts are part of a group who carry out patient-led research Set up condition specific group with remit to look at range of issues including research (e.g. fundraising, developing website, research) Link in with People in Research local groups  HYPERLINK "http://www.peopleinresearch.org/" http://www.peopleinresearch.org/ Lay reviewers of studies submitted for research programme grant Lay members on commissioning panel to review PPI aspect of research grant applications Offer guidance, training and support to lay members involved in research activities Work with James Lind Alliance to form partnerships which include lay members to identify research priorities Plan for BRC to have James Lind Alliance coordinator posts to utilise approach used by James Lind Alliance to identify research priorities for BRC Involve lay members in advising on making website more accessible for the public Engagement examples: Developed a booklet Why do Research? about what kinds of research participants could take part in. Available on website Run Research Roadshow events in local area to tell people about their research Hold school events, running various science demonstrations for local schools to attend Information on website includes examples of research being conducted, participants accounts of participating in research and links to how public can participate in studies Shares information about research via newsletters, key stories, photography exhibitions, CRF open days (e.g. invite local schools) Work collaboratively with Trust Patient Engagement Officer to provide information on research being carried out Reporting and learning examples: Reporting on PPI/E activities is part of annual report e.g. case studies (Who was involved? What were they involved in? Why were they involved? What was the impact of the involvement?) Audit research studies to assess which have included PPI Audit of Ethics/IRAS forms e.g. Question A14-1. In which aspects of the research process have you actively involved, or will you involve, patients, service users, and/or their carers, or members of the public? PPI Officer records all requests for support around PPI Send monitoring forms/surveys to PIs / network leads etc. to gather information on PPI (low response rate) Carried out survey with dermatology patients to measure their awareness of research. Survey completed when dermatology topic PPI group was initially set up and plan to repeat survey at a later stage to assess impact of the group on awareness of research amongst patients Quarterly update on website of PPI/E activities e.g. information about PPI activities which have taken place, the scope and scale of activities (i.e. description of activity, what worked/ didnt work) BRC plans to fund a Research Fellow post to evaluate the impact of local PPI activities Developed GRIPP checklist to provide guidance to researchers on how to report PPI Recommendations to provide narrative/qualitative account of PPI to consider the impact of PPI on the involved lay member, the researchers and the research. Appendix 3: Helpful websites Involve http://www.invo.org.uk/ James Lind Alliance http://www.lindalliance.org/ Manchester BRC http://www.manchesterbrc.org/index.phplk RDS London http://www.rdslondon.co.uk/ Health Talk Online http://healthtalkonline.org/ Medicines for Children Research Network http://www.mcrn.org.uk/ People in Research http://peopleinresearch.org/ NIHR CCF http://www.ccf.nihr.ac.uk/PPI/Pages/default.aspx     PAGE  PAGE 15 PPI/E strategy October 2013  VXYZ\]2 ⠈pU>2>. h!LB*OJQJ^Jphh!Lh!Lh!L5CJaJ,h!Lh!L5B*CJOJQJ^JaJph4h,h!L5B*CJOJQJ^JaJmH phsH .h!L5B*CJOJQJ^JaJmH phsH .h!L5B*CJOJQJ^JaJmH phsH Hjh!Lh}d5B*CJOJQJU^JaJmHnHphsH tH u9h}d5B*CJOJQJ^JaJmHnHphsH tH u9h!L5B*CJOJQJ^JaJmHnHphsH tH u Z]y3 < = > E _ ` a   gdFgda gdb$a$gd+cgd!L -DM gd!L$-DM a$gd!L$a$gd!Lgd}d2 3 C a p x ; < = վydWM@/%hDOJQJ^J!h9hDB* OJQJ^Jphh9hDOJQJ^Jh2zJOJQJ^Jh9hbOJQJ^J)h!Lh^MB* CJ OJQJ^JaJ ph,h!Lh!5B* CJ OJQJ^JaJ ph,h!LhD5B* CJ OJQJ^JaJ ph,h!Lhz5B* CJ OJQJ^JaJ ph,h!Lhb5B* CJ OJQJ^JaJ ph,h!Lh<^U5B* CJ OJQJ^JaJ ph&hD5B* CJOJQJ^JaJph = > E H L M _ ` a k  ӿӵӵӫrbrUh9hAOJQJ^Jh~5B* OJQJ^Jph$h9hA5B* OJQJ^Jph$h9h<^U5B* OJQJ^Jph$h9hhDq5B* OJQJ^JphhAOJQJ^JhUOJQJ^JhXOJQJ^JhIOJQJ^Jh9ha OJQJ^J$h9hfVx5B* OJQJ^Jphh9h2zJOJQJ^J $ A S _ l x z | 溟gCGh9hp0JB*OJQJ^Jeh@fHph333q r@9h9hp0J5B*OJQJ^JfHph333q 5h9hp5B*OJQJ^JfHph333q 5h9hF5B*OJQJ^JfHph333q h9hF5OJQJ^Jh9h&OJQJ^J!hohFB* OJQJ^Jphh9hFOJQJ^Jh9h0OJQJ^J ڿ~bGb~~-~2h9hpB*OJQJ^JfHph333q 5h9hF5B*OJQJ^JfHph333q 6h9hp0JB*OJQJ^JfHph333q Gh9hp0JB*OJQJ^Jeh@fHph333q r@9h9hp0J5B*OJQJ^JfHph333q 5h9hp5B*OJQJ^JfHph333q Jh9hp0J5B*OJQJ^Jeh@fHph333q r@ hʰxnxaWF9h9h?OJQJ^J!hoh?B* OJQJ^Jphh MOJQJ^Jh9hdIOJQJ^JhXOJQJ^Jh9hXOJQJ^JhDOJQJ^JhIOJQJ^J,hIB*OJQJ^JfHph333q 2h9huB*OJQJ^JfHph333q 2h9hpB*OJQJ^JfHph333q 5h9hF5B*OJQJ^JfHph333q  xy\]^zMN56DEjklmngd9gdnshgda`gd<^U & Fgd<^Ugd.gd?gdbgdFguvxy*.ʺuuuguuVuHuh'OJQJ^JmH sH  h9huOJQJ^JmH sH hFOJQJ^JmH sH  h9h.OJQJ^JmH sH hXOJQJ^JmH sH $h9hVJ5B* OJQJ^Jph$h9hD5B* OJQJ^Jphh2zJ5B* OJQJ^Jphh?OJQJ^Jh?OJQJ^JmH sH  hoh?OJQJ^JmH sH hoh?OJQJ^J\|}  &\]^yz޴´ަޘ޴´޴ހs`M$h9hF5B* OJQJ^Jph$h9hhDq5B* OJQJ^Jphh9h2zJOJQJ^Jh(TOJQJ^JhDOJQJ^JmH sH hIOJQJ^JmH sH h MOJQJ^JmH sH hUOJQJ^JmH sH h'OJQJ^JmH sH hXOJQJ^JmH sH  h9h.OJQJ^JmH sH  h9h@nOJQJ^JmH sH z^t{LNXY^w.04@_|~xxnaWaahUOJQJ^Jh9hte7OJQJ^JhDOJQJ^Jh9hgVOJQJ^Jh9hnsh6OJQJ^JhyJOJQJ^JhXOJQJ^Jh9h];OJQJ^Jh9hE ;OJQJ^Jh9h)OJQJ^JhFOJQJ^Jh9hD6OJQJ^Jh9h<^UOJQJ^Jh9hDOJQJ^J"~456Tdkϸϸ|rh[M[h9hnsh6OJQJ^Jh9hnshOJQJ^Jh9OJQJ^JhDOJQJ^Jh'OJQJ^Jh9ha`6OJQJ^Jh9ha`OJQJ^Jh R3hDOJQJ^Jh R3OJQJ^Jh R3hUg%OJQJ^JhyJOJQJ^Jh R3h R3OJQJ^JhUg%OJQJ^Jh9hDOJQJ^Jh9hte7OJQJ^J39=BCDPSUl~ijkq}}l^Th+~OJQJ^Jhl OJQJ^JmH sH  h9hDOJQJ^JmH sH $h9h95B* OJQJ^Jphh2zJ5B* OJQJ^Jphh2zJOJQJ^JhFOJQJ^Jh9h9OJQJ^Jh9OJQJ^JhnshOJQJ^Jh'OJQJ^JhDOJQJ^Jh9hnshOJQJ^JhIOJQJ^Jnopq}VW  & F$Ifgd, $If^gd=lq  & F$Ifgd, & Fgd9gd9 +VWegTbcjVr03`-/[ܳܥܓ{p{{fff\f\hFOJQJ^JhIOJQJ^Jh96OJQJ^Jh9h96OJQJ^Jh9OJQJ^J#h9h96OJQJ^JmH sH h=lqOJQJ^JmH sH hFOJQJ^JmH sH h9h9OJQJ^JhIOJQJ^JmH sH  h9h9OJQJ^JmH sH #h9h95OJQJ^JmH sH $&hkdݐ$$Iflp## t0644 layt, $Ifgd,hkdh$$Iflp## t0644 layt,"&hkdǑ$$Iflp## t0644 layt, $Ifgd,hkdR$$Iflp## t0644 layt,"_` `!hkd<$$Iflp## t0644 layt, $Ifgd,[]^ ^!_!a!b!g!h!s!!!""""L""""""""""߄wjw``V``h9OJQJ^JhDOJQJ^Jh=lqh=lqOJQJ^Jh=lqh+~OJQJ^Jh=lqh9OJQJ^J h9h9OJQJ^JmH sH #h9h95OJQJ^JmH sH h9hs|OJQJ^Jhs|OJQJ^Jh9OJQJ^Jha OJQJ^Jh9h9OJQJ^JhIOJQJ^JhFOJQJ^J!`!a!b!c!d!e!f!g!h!!!N"x $Ifgd+~h^hgd9 & Fgd9gd9hkd$$Iflp## t0644 layt, N"O"##$jkd$$Ifl#$ t0644 layt, $Ifgd,hkd&$$Ifl#$ t0644 layt,"""""""""""#J#Q#S#p#$$$$%\%%%o&p&&&''v'x''''''((ζΓl$h9h95B* OJQJ^JphhpRgOJQJ^JhQLOJQJ^J h9hDOJQJ^JmH sH #h9h95OJQJ^JmH sH hUOJQJ^Jh+~OJQJ^JmH sH  h9h9OJQJ^JmH sH hyJOJQJ^JhDOJQJ^Jh9h9OJQJ^J&#S##X$$%%\%%x $Ifgd=lqhkd$$Ifl#$ t0644 layt, $Ifgd,  & F$Ifgd,%%%o&p&&x $Ifgd,h^hgd9 & Fgd9gd9hkd$$Ifl#$ t0644 layt,&&'''&hkds$$Ifl#$ t0644 layt, $Ifgd,hkd$$Ifl#$ t0644 layt,''''&hkd]$$Ifl#$ t0644 layt, $Ifgd,hkd$$Ifl#$ t0644 layt,''(((,,..///001 1t11T222H3333gd: & Fgd46? 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