From: Subject: Comprehensive Management of Pediatric Asthma-Guidelines (Slides/Transcript) Date: Mon, 15 Sep 2008 13:06:15 +0800 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_006D_01C91733.D5F87290" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3350 This is a multi-part message in MIME format. ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.medscape.com/viewarticle/577795_2 Comprehensive = Management of Pediatric Asthma-Guidelines (Slides/Transcript)
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Selection = from: Comprehensive=20 Management of Pediatric Asthma: Using the Guidelines to = Develop=20 Effective, Long-Term Plans
=AB = Previous Page=20

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Slide 31.

Finally, in this section of asthma control, we have some = ideas of=20 predictors from first visits of future poor asthma control = or=20 patients who perhaps deserve more attention. Those = predictors are=20 listed on the left side, and we can see if these predictors = are=20 either increasing or decreasing risk by their odds ratio on = the=20 right side.

Significant predictors that increase risk include = multiple=20 courses of oral corticosteroids, unscheduled visits or=20 hospitalizations for asthma in the past year, as well as = smoking,=20 additional chronic obstructive lung disease on top of = asthma, and=20 some other demographic features.

Reducing risk includes regular specialist care management = for=20 asthma and more than 4 prescribed inhaled corticosteroids = canisters=20 in the prior year, as well as increasing numbers of = prescribed=20 long-acting beta agonist canisters in the prior year.

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Slide 32.

I would like to update you on some of the changes in our=20 understanding of these asthma therapies.

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Slide 33.

With long-acting bronchodilators, there is now a black = box=20 warning that identifies an increase in the risk of = asthma-related=20 exacerbations and deaths when used. Primarily the concern is = the use=20 of long-acting bronchodilators with no anti-inflammatory = therapy at=20 the same time. Thus, for the most part, long-acting = bronchodilators=20 are only used for asthmatics as add-on therapy to inhaled=20 corticosteroids and largely only exist as combination = controller=20 therapy at this point.

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Slide 34.

The cromones, which include cromolyn and nedocromil, now = have a=20 lesser place in asthma management, especially on a = controller or a=20 routine basis. They are not recommended in the international = Global=20 Initiative for Asthma guidelines, the GINA guidelines, but = are still=20 noted in the US national guidelines as an option.

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Slide 35.

Leukotriene modifiers have now been available for = prescribing for=20 a number of years. We have a lot of experience with their = use now in=20 this new version of the guidelines. They have historically = had an=20 excellent safety profile. Leukotriene antagonists may be = considered=20 as first-line therapies at step 2 as an alternative to = inhaled=20 corticosteroids, or as add-on to inhaled corticosteroids in = higher=20 step level care.

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Slide 36.

Omalizumab is a monoclonal antibody that is injected on a = once-every-2-to-4-week basis to block IgE. This is only = approved for=20 usage in children older than the age of 12 and adults, and = is=20 primarily indicated for difficult-to-control asthma or = severe=20 asthma. It has a rare risk of anaphylaxis, which is about 1 = in 1000,=20 and thus, post-injection patients need to be monitored for = some=20 period of time.

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Slide 37.

Inhaled corticosteroid therapy as an asthma controller = has now=20 been out for a long time. We have a good understanding of = its=20 efficacy, its safety, and its limitations. It is effective = in nearly=20 all aspects of asthma impairment and risk and reducing = symptoms,=20 improving lung function, reducing airway twitchiness, = improving=20 inflammation, and reducing the frequency and severity of=20 exacerbations.

There is the potential for some side effects with = long-term=20 treatment that can occur especially when inhaled = corticosteroids are=20 used at high dosages. In children, there is a small effect = on linear=20 growth, primarily in the first year of inhaled = corticosteroid use,=20 that is possibly transient or reverses after the inhaled=20 corticosteroids are discontinued.

Some limitations of inhaled corticosteroids is that they = do not=20 seem to affect airway remodeling features in the doses that = we=20 currently use or prescribe, and they do not seem to change = the=20 likelihood of outgrowing asthma. Thus, inhaled = corticosteroid=20 therapy can achieve control but cannot cure.

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Slide 38.

We have good information on whether or not inhaled=20 corticosteroids can help to modify or prevent asthma = persistence=20 from several studies, perhaps one of the strongest being = this=20 Prevention of Early Asthma in Kids study that was sponsored = by the=20 National Institutes of Health (NIH). In this study, young = children=20 under the age of 3 who met the Asthma Predictive Index = criteria for=20 persistent asthma were treated with either inhaled = corticosteroids=20 or placebo for a 2-year period.

Following that 2-year period, the inhaled corticosteroid = therapy=20 was discontinued and the child was observed for 1 year to = see if the=20 inhaled corticosteroid treatment in early life had reduced = the=20 prevalence of asthma.

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Slide 39.

Here we can see one of the main outcomes. In the inhaled=20 corticosteroid-treated group in blue, we can see that during = the=20 2-year treatment period, the proportion of episode-free days = is=20 maintained at a high level and better than the placebo = group. But=20 once inhaled corticosteroids are discontinued, within a = matter of=20 weeks, those on inhaled corticosteroids dropped to the level = of the=20 placebo group. In other words, inhaled corticosteroids can = achieve=20 and maintain good asthma control just as it can in older = children=20 and adults; however, similarly again, when inhaled = corticosteroids=20 are discontinued after 2 years of usage, asthma returns.

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Slide 40.

Now let's turn our attention to managing asthma=20 exacerbations.

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Slide 41.

Asthma exacerbations are defined as acute or subacute = progressive=20 episodes of asthma.

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Slide 42.

The management of these exacerbations, the treatments are = primarily short-acting bronchodilators such as albuterol, = oral=20 corticosteroids, and oxygen.

The best management strategy is to provide patients with=20 education that such exacerbations can occur and an action = plan of=20 stepwise intervention to try to keep these exacerbations = from=20 getting worse.

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Slide 43.

This table from our new national guidelines describes the = management approach to asthma exacerbations based on their = severity.=20 As you can see from the left side column, asthma = exacerbations can=20 be rated as mild, moderate, severe, or life-threatening.

For signs and symptoms, you can see that the main = parameter that=20 helps define the exacerbation severity is the level of = dyspnea or=20 shortness of breath.

It also helps to define the usual clinical course, that = being for=20 mild with mild dyspnea, these exacerbations can usually be = managed=20 at home; if they progress to moderate, these exacerbations = usually=20 require an urgent office visit or an ED visit; if it = progresses to=20 severe, these exacerbations usually require an ED visit and = a likely=20 hospitalization; and if life-threatening, hospitalization = and an=20 intensive care unit (ICU) visit are often the norm.

In the middle are peak flow criteria that can be used to = help=20 distinguish asthma exacerbation severity. I would provide = one=20 caution, and that is if an exacerbation is moderate to = severe or=20 worse, measuring a peak flow is not necessary and can = actually=20 provoke an asthma exacerbation.

3D"Slide
Slide 44.

Here we provide some additional notes of managing = exacerbations=20 in infants. Primarily, infants can get in trouble more = easily=20 because they have less respiratory reserve, they have less=20 development of accessory muscles, a more pliable ribcage. = All of=20 this makes it more difficult for them to breathe when they = are=20 having an asthma exacerbation.

When oxygenation drops, such as that measured by oxygen=20 saturation, to less than 90%, this is actually a late sign = in an=20 exacerbation for asthma, and this is actually what we are = trying to=20 avoid by the early intervention on asthma exacerbations. = With=20 infants, lack of therapeutic response is often an indication = for=20 hospitalization to assure that the exacerbation is not only=20 controlled but that control can be maintained.

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Slide 45.

Now let's shift our attention to common comorbidities = associated=20 with asthma.

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Slide 46.

Asthma can be viewed along with other common allergic = childhood=20 diseases as part of the allergic march of early childhood. = In the=20 allergic march, young children, especially infants, often = present=20 with food allergies and eczema, and then subsequently = present with=20 persistent asthma and allergic rhinitis or the airways = allergic=20 diseases.

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Slide 47.

The prevalence of rhinosinusitis in asthmatics is very = high,=20 about 60% to 80%, compared with 10% to 20% in the general=20 population.

The linkage between atopic dermatitis and asthma is also = strong,=20 especially with severe atopic dermatitis. For those who have = severe=20 atopic dermatitis, almost 100% will develop inhalant = allergen=20 sensitization and 75% develop allergic respiratory disease = in=20 subsequent years.

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Slide 48.

There is also a developing understanding of the link = between food=20 allergies and asthma. We know that food allergies are more = common in=20 people with asthma than in the general population. We know = that for=20 those who have food allergies, that a significant number of = people=20 will have asthma symptoms as part of their food reaction. = More=20 recently, we can see that food allergies are especially = common in=20 those who have severe asthma exacerbations.

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Slide 49.

Treatments for asthma and allergic rhinitis may overlap = in that=20 certain treatments can improve both conditions. Our approach = to=20 environmental control measures is key to both = conditions.

Intranasal corticosteroids that are used to treat = allergic=20 rhinitis also improve asthma symptoms. Especially in = patients with=20 mild asthma, treatments with antihistamines and especially=20 treatments with leukotriene antagonists can be useful in = addressing=20 not only symptoms of allergic rhinitis but also asthma. = Allergy=20 immunotherapy is also a helpful treatment for allergic = rhinitis and=20 asthma.

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Slide 50.

Here we see another common comorbid condition with = asthma:=20 gastroesophageal reflux disease or GERD.

Asthma and GERD often occur together; and are most = commonly seen=20 in asthma patients who are difficult to control in part = because=20 their GERD has not been addressed. It seems to be = particularly=20 common in children with asthma; may go asymptomatic from a = GERD=20 standpoint; and is often associated with nocturnal = wheezing.

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Slide 51.
This feature requires the newest version = of Flash.=20 You = can=20 download it here.

I would like to share with you this case of a teenage = cheerleader=20 with exercise-induced asthma problems.

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Slide 52.

Exercise-induced bronchospasm is essentially the norm for = asthmatics, occurring in 90% of patients with asthma. It = often=20 indicates poorly controlled asthma, and as such, long-term=20 controller therapy generally helps exercise-induced = bronchospasm=20 symptoms.

In addition to good long-term controller therapy, we can = also=20 pretreat prior to exercise to help prevent asthma symptoms.=20 Pretreatment can be with bronchodilators or leukotriene = antagonists,=20 as well, warming up prior to exercise and breathing in warm = air can=20 be helpful to reduce exercise-induced bronchospasm.

3D"Slide
Slide 53.

Finally, in this demonstration of comorbidities = associated with=20 asthma, I would like to show you these high-resolution CT = scan=20 images of asthmatics. The one on the left has some = highlighted=20 pixilation in yellow that is actually identifying air = trapping in=20 alveoli. This air trapping in alveoli is an interesting = measure of=20 airflow obstruction in asthma that is quite distal or down = at the=20 end of the airways.

3D"Slide
Slide 54.

This peripheral airways obstruction can occur in the = absence of=20 changes in the common lung function measure, forced = expiratory=20 volume in 1 second (FEV1). Because it is so distal, there is = some=20 concern that conventional inhaled corticosteroid therapies, = at least=20 some of them, may not reach these small peripheral airways, = and that=20 newer inhaled corticosteroids or inhaled medications that = have very=20 small particulate, as well as oral systemic therapies, may = be one=20 way to reach these peripheral affected airways in = asthma.

3D"Slide
Slide 55.

I would like to end with a few pointers for asthma = management in=20 clinical practice.

3D"Slide
Slide 56.

The first point is an example of these validated control=20 assessment questionnaires that can simplify your asthma = management=20 in clinical practice.

This asthma control test is a 5-question questionnaire = that is=20 supposed to be administered to the patient prior to your = seeing=20 them. They complete this on their own, and this is freely = available=20 to you through a number of venues. It asks 5 questions that = have=20 been validated, and together, they provide an additive score = that=20 can help you determine whether your asthmatics are well = controlled,=20 not well controlled, or very poorly controlled based on = established=20 validated cut points.

This can save you the time in practice of having to ask = these=20 questions yourself. It is not 100% foolproof but about 70% = to 75% of=20 the time, this asthma control test will give you the right=20 determination for the level of asthma control.

3D"Slide
Slide 57.

When patients return to us and their asthma is not being=20 controlled, our goals are not being achieved, what is = underlying=20 this problem? We have an understanding of some of the things = that=20 contribute to that in most cases.

Commonly, there are differences in perception or = expectations of=20 what constitutes good asthma control. Many patients may not=20 understand or believe that their asthma can essentially be=20 normalized as defined in the new asthma guidelines. It is = very=20 common in practice if we ask our patients, how is your = asthma, they=20 will say, my asthma is good; my asthma is fine. But when we = actually=20 ask about the individual parameters, their idea that their = asthma is=20 fine may be that they have 4 or 5 exacerbations a year, that = they=20 can't exercise, but they are not having multiple daily = symptoms or=20 are not having a frank exacerbation all the time. Thus, the = new=20 guidelines are helpful in defining the different parameters = that we=20 like to see completely controlled or well controlled across = the=20 board, not just 1 or 2 of them, and also to the extent that = we are=20 looking for normalization.

Poor adherence to treatment regimens is also a common = problem.=20 For example, a situation that I commonly see involves = patients that=20 are unable to take their inhaled medications correctly. This = is=20 something that needs to be revisited especially if you are = depending=20 on inhaled medications for good asthma control.

Still, in an ideal world, when there is a good = understanding of=20 asthma control and there is good adherence with the = management plan,=20 there are still some patients who do not respond to the = initially or=20 subsequently prescribed therapy because there is variability = in=20 response to treatments and some of that variability can be = due to=20 pharmacogenomic issues.

3D"Slide
Slide 58.

The last point for clinical practice that I would like to = review=20 with you is when to refer a patient to an asthma = specialist.

Generally speaking, when patients have life-threatening=20 exacerbations, are difficult-to-control, when additional = diagnostic=20 tests are needed, or additional asthma education is needed, = when=20 there are problems with adherence and the thinking that = additional=20 testing or education may be helpful, allergen immunotherapy, = or=20 repeated exacerbations, these are some indications for when = an=20 asthma specialist can be helpful in defining a good asthma = plan to=20 achieve and maintain control.

3D"Slide
Slide 59.

In conclusion of this program, we understand asthma as a = common=20 condition beginning in early childhood and that is = clinically=20 variable but biologically persistent.

New asthma guidelines are helpful in showing us how to = assess,=20 achieve, and maintain asthma control for the larger majority = of our=20 patients.

Finally, our management approach should be tailored = within the=20 guidelines to meet the individual needs of each patient, and = also=20 provide some guidance on when to refer to a specialist on = how to=20 achieve good control. Thank you for joining = us.


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2px; BORDER-LEFT: #b3b3b3 1px solid; COLOR: #666666; PADDING-TOP: 0px } .polltable { BORDER-RIGHT: #b3b3b3 1px solid; BORDER-TOP: #b3b3b3 1px solid; = MARGIN-BOTTOM: 5px; BORDER-LEFT: #b3b3b3 1px solid; BORDER-BOTTOM: = #b3b3b3 1px solid } .polltable TD { FONT-SIZE: 11px } .useranswerheader { FONT-WEIGHT: bold } .useranswer { MARGIN-LEFT: 10px } P#preassessmentlink { FONT-WEIGHT: bold; MARGIN: 15px 0px } #learnobjectauthors { MARGIN: 0px 0px 10px; BACKGROUND-COLOR: #ffffff; TEXT-ALIGN: left } #learnobjectauthors H6 { FONT-SIZE: 12px; MARGIN: 0px; FONT-FAMILY: arial, sans-serif } #learnobjectauthors P { FONT-SIZE: 11px; MARGIN: 0px } #learnobjectauthors OL { PADDING-RIGHT: 0px; PADDING-LEFT: 23px; FONT-SIZE: 11px; = PADDING-BOTTOM: 6px; MARGIN: 0px; PADDING-TOP: 0px } #learnobjectauthors UL { PADDING-RIGHT: 0px; PADDING-LEFT: 23px; FONT-SIZE: 11px; = PADDING-BOTTOM: 6px; MARGIN: 0px; PADDING-TOP: 0px } #authorrightcolscroll { BORDER-RIGHT: #c3c3c3 1px solid; PADDING-RIGHT: 0px; BORDER-TOP: = #c3c3c3 1px solid; PADDING-LEFT: 3px; PADDING-BOTTOM: 2px; OVERFLOW: = auto; BORDER-LEFT: #c3c3c3 1px solid; PADDING-TOP: 2px; BORDER-BOTTOM: = #c3c3c3 1px solid; HEIGHT: 180px; TEXT-ALIGN: left } #learnobjectauthors2 { BORDER-RIGHT: #aec6d4 1px solid; PADDING-RIGHT: 5px; BORDER-TOP: = #aec6d4 1px solid; PADDING-LEFT: 5px; FLOAT: right; PADDING-BOTTOM: 5px; = MARGIN: 12px 0px 8px 8px; BORDER-LEFT: #aec6d4 1px solid; WIDTH: 150px; = PADDING-TOP: 8px; BORDER-BOTTOM: #aec6d4 1px solid; BACKGROUND-COLOR: = #f5f9ff; TEXT-ALIGN: left } #learnobjectauthors2 H6 { FONT-SIZE: 11px; MARGIN: 0px; FONT-FAMILY: arial, sans-serif } #learnobjectauthors2 P { FONT-SIZE: 11px; MARGIN: 0px } #learnobjectauthors2 OL { PADDING-RIGHT: 0px; PADDING-LEFT: 23px; FONT-SIZE: 11px; = PADDING-BOTTOM: 6px; MARGIN: 0px; PADDING-TOP: 0px } #learnobjectauthors2 UL { PADDING-RIGHT: 0px; PADDING-LEFT: 23px; FONT-SIZE: 11px; = PADDING-BOTTOM: 6px; MARGIN: 0px; PADDING-TOP: 0px } #learnobjectauthors2 #authorrightcolscroll { BORDER-RIGHT: #c3c3c3 1px solid; PADDING-RIGHT: 0px; BORDER-TOP: = #c3c3c3 1px solid; PADDING-LEFT: 3px; PADDING-BOTTOM: 2px; OVERFLOW: = auto; BORDER-LEFT: #c3c3c3 1px solid; PADDING-TOP: 2px; BORDER-BOTTOM: = #c3c3c3 1px solid; HEIGHT: 150px; TEXT-ALIGN: left } ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: text/css; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://images.medscape.com/medcss/footer/footer-global.css #medscapefooter { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 5px; = PADDING-TOP: 0px } #footersearch { PADDING-RIGHT: 0px; BACKGROUND-POSITION: left bottom; BORDER-TOP: #ddd = 8px solid; PADDING-LEFT: 0px; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-userinfo.gif); = PADDING-BOTTOM: 1px; PADDING-TOP: 6px; BACKGROUND-REPEAT: repeat-x; = BACKGROUND-COLOR: #fff; TEXT-ALIGN: center } #footercontents { BORDER-BOTTOM: #d4d4d4 1px solid; BACKGROUND-COLOR: #eee } #footerbar { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: 6px = 0px 10px 14px; PADDING-TOP: 0px } #footerbar UL { PADDING-RIGHT: 0px; LIST-STYLE: none none inside; PADDING-LEFT: 0px; = PADDING-BOTTOM: 0px; MARGIN: 0px; PADDING-TOP: 0px } #footertextinput { BORDER-RIGHT: #e4e4e4 2px solid; PADDING-RIGHT: 0px; BORDER-TOP: #999 = 2px solid; PADDING-LEFT: 3px; FONT-SIZE: 11px; PADDING-BOTTOM: 0px; = MARGIN: 0px; BORDER-LEFT: #999 2px solid; WIDTH: 465px; CURSOR: text; = PADDING-TOP: 2px; BORDER-BOTTOM: #e4e4e4 2px solid; HEIGHT: 16px; = BACKGROUND-COLOR: #fff } INPUT#footersubmit { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: 0px = 0px 4px; VERTICAL-ALIGN: middle; PADDING-TOP: 0px } #radioformfooter { FONT-SIZE: 0.95em } .inactiveradio { DISPLAY: none } .activeradio { DISPLAY: block } #adtagfooter { MARGIN: 3px 0px 0px 15px } #footerbar A { FONT-WEIGHT: bold } .footernavstart { BORDER-RIGHT: #666 1px solid; PADDING-RIGHT: 8px; DISPLAY: inline; = FONT-WEIGHT: normal; FONT-SIZE: 0.85em } .footernav { BORDER-RIGHT: #666 1px solid; PADDING-RIGHT: 8px; DISPLAY: inline; = PADDING-LEFT: 7px; FONT-WEIGHT: normal; FONT-SIZE: 0.85em; BORDER-LEFT: = #b6b5b4 1px solid } .footernavend { DISPLAY: inline; PADDING-LEFT: 8px; FONT-WEIGHT: normal; FONT-SIZE: = 0.85em; BORDER-LEFT: #b6b5b4 1px solid } .legaltext { FONT-SIZE: 0.85em; MARGIN: 12px 10px 0px; COLOR: #444 } ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: text/css; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://images.medscape.com/medcss/header/header-global.css #medscapeheadercontainer { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; FONT-SIZE: 1.05em; = PADDING-BOTTOM: 3px; MARGIN-LEFT: auto; WIDTH: 760px; MARGIN-RIGHT: = auto; PADDING-TOP: 0px; FONT-FAMILY: arial, sans-serif; = BACKGROUND-COLOR: #ddd; TEXT-ALIGN: left } #adtagheader { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: = 0px; PADDING-TOP: 0px; BACKGROUND-COLOR: #ddd; TEXT-ALIGN: center } #headertop { MARGIN: 0px 0px 0px 1px; WIDTH: 758px } #headertop A:link { COLOR: #006699; TEXT-DECORATION: none } #headertop A:visited { COLOR: #006699; TEXT-DECORATION: none } #headertop A:hover { COLOR: #24a2dd; TEXT-DECORATION: underline } #headertop A:active { COLOR: #006699; TEXT-DECORATION: none } #headerleft { FLOAT: left; WIDTH: 235px } #headerright { FLOAT: right; WIDTH: 516px } #headerright2 { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 5px; MARGIN: = 0px; WIDTH: 513px; PADDING-TOP: 0px; TEXT-ALIGN: right } #supernav { BORDER-RIGHT: #fff 2px solid; PADDING-RIGHT: 0px; BACKGROUND-POSITION: = left top; BORDER-TOP: #fff 2px solid; PADDING-LEFT: 0px; FONT-SIZE: = 10px; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-supernavbox.gif); = PADDING-BOTTOM: 0px; MARGIN: 1px 0px 0px; BORDER-LEFT: #fff 2px solid; = WIDTH: 230px; PADDING-TOP: 3px; BORDER-BOTTOM: #fff 2px solid; = BACKGROUND-REPEAT: repeat } #supernav UL { PADDING-RIGHT: 0px; PADDING-LEFT: 19px; PADDING-BOTTOM: 0px; MARGIN: = 0px; COLOR: #ff7e00; PADDING-TOP: 0px; LIST-STYLE-TYPE: square } #supernav LI { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 2px; MARGIN: = 0px; PADDING-TOP: 0px } #supernavselected A:link { TEXT-DECORATION: none } #supernavselected A:visited { TEXT-DECORATION: none } #supernavselected A:hover { TEXT-DECORATION: underline } #supernavselected A:active { TEXT-DECORATION: none } #supernavpulldown { DISPLAY: inline } #supernavpulldown A { COLOR: #919191 } #supernavleft { FONT-SIZE: 12px; FLOAT: left; WIDTH: 90px } #supernavright { FLOAT: right; WIDTH: 135px } #headersearch { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; FLOAT: left; PADDING-BOTTOM: = 0px; MARGIN: 0px; WIDTH: 305px; PADDING-TOP: 0px } #headersearchtop { BACKGROUND-POSITION: left bottom; FONT-SIZE: 1px; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-searchtop760.gif); = WIDTH: 305px; LINE-HEIGHT: 1px; BACKGROUND-REPEAT: no-repeat; HEIGHT: = 4px } #headersearchcontent { BACKGROUND-POSITION: left bottom; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-searchmid760.gif); = WIDTH: 305px; BACKGROUND-REPEAT: repeat-y; HEIGHT: 45px; = BACKGROUND-COLOR: #fdfefe; TEXT-ALIGN: center } #headersearchtypes { PADDING-RIGHT: 0px; PADDING-LEFT: 10px; FONT-SIZE: 11px; = PADDING-BOTTOM: 2px; PADDING-TOP: 2px; TEXT-ALIGN: left } #headersearchtypes A.searchtypeselected { FONT-WEIGHT: normal; COLOR: #000 } #headertextinput { BORDER-RIGHT: #e4e4e4 2px solid; PADDING-RIGHT: 0px; BORDER-TOP: #999 = 2px solid; PADDING-LEFT: 3px; FONT-SIZE: 11px; PADDING-BOTTOM: 0px; = MARGIN: 0px; BORDER-LEFT: #999 2px solid; WIDTH: 195px; CURSOR: text; = PADDING-TOP: 2px; BORDER-BOTTOM: #e4e4e4 2px solid; HEIGHT: 15px; = BACKGROUND-COLOR: #fff } INPUT#headersubmit { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: 0px = 0px 4px; VERTICAL-ALIGN: middle; PADDING-TOP: 0px } #headersearchbtm { BACKGROUND-POSITION: left top; FONT-SIZE: 1px; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-searchbtm760.gif); = WIDTH: 305px; LINE-HEIGHT: 1px; BACKGROUND-REPEAT: no-repeat; HEIGHT: = 4px } #userinfo { BORDER-RIGHT: #fff 2px solid; PADDING-RIGHT: 0px; BACKGROUND-POSITION: = left bottom; BORDER-TOP: #fff 2px solid; PADDING-LEFT: 0px; FLOAT: = right; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-userinfo.gif); = PADDING-BOTTOM: 2px; MARGIN: 1px 0px 0px; BORDER-LEFT: #fff 2px solid; = WIDTH: 200px; PADDING-TOP: 1px; BORDER-BOTTOM: #fff 2px solid; = BACKGROUND-REPEAT: no-repeat; HEIGHT: 41px; BACKGROUND-COLOR: #fff; = TEXT-ALIGN: center } .welcomename { FONT-WEIGHT: normal; FONT-SIZE: 11px; FONT-FAMILY: georgia, times, = serif } .usertools { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; FONT-SIZE: 10px; PADDING-BOTTOM: = 2px; COLOR: #cccbcb; PADDING-TOP: 2px } .headerinvites { FONT-SIZE: 11px } .headerinvitesnumber { FONT-WEIGHT: bold; COLOR: #ff7e00 } #splashuserinfo { BORDER-RIGHT: #fff 2px solid; PADDING-RIGHT: 0px; BACKGROUND-POSITION: = left bottom; BORDER-TOP: #fff 2px solid; PADDING-LEFT: 0px; FLOAT: = right; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-userinfo.gif); = PADDING-BOTTOM: 2px; MARGIN: 0px; BORDER-LEFT: #fff 2px solid; WIDTH: = 195px; PADDING-TOP: 1px; BORDER-BOTTOM: #fff 2px solid; = BACKGROUND-REPEAT: no-repeat; HEIGHT: 40px; BACKGROUND-COLOR: #fff; = TEXT-ALIGN: center } #splashuserinfo A.userinfoselected:link { COLOR: #767676; TEXT-DECORATION: none } #splashuserinfo A.userinfoselected:visited { COLOR: #767676; TEXT-DECORATION: none } #splashuserinfo A.userinfoselected:hover { COLOR: #767676; TEXT-DECORATION: underline } #splashuserinfo A.userinfoselected:active { COLOR: #767676; TEXT-DECORATION: none } .splashusertools { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; FONT-SIZE: 0.95em; = PADDING-BOTTOM: 0px; COLOR: #cccbcb; PADDING-TOP: 13px } #specialtieslayer { BORDER-RIGHT: #333 3px solid; MARGIN-TOP: 25px; Z-INDEX: 1000; LEFT: = 0px; MARGIN-LEFT: 5%; BORDER-BOTTOM: #333 3px solid; POSITION: absolute; = TOP: 0px; TEXT-ALIGN: left } #specpdlist { BORDER-RIGHT: #b3b3b3 1px solid; BORDER-TOP: #333 1px solid; = BORDER-LEFT: #333 1px solid; WIDTH: 460px; BORDER-BOTTOM: #b3b3b3 1px = solid; BACKGROUND-COLOR: #fff } #specpdlist TD { PADDING-RIGHT: 10px; PADDING-LEFT: 10px; PADDING-BOTTOM: 10px; = PADDING-TOP: 0px } #specpdlist UL { PADDING-RIGHT: 0px; LIST-STYLE: none none outside; PADDING-LEFT: 0px; = FONT-SIZE: 11px; PADDING-BOTTOM: 0px; MARGIN: 0px; PADDING-TOP: 0px } #specpdlist UL LI { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 3px; = PADDING-TOP: 0px } #specpdlist TD#specpdlistheading { PADDING-RIGHT: 0px; PADDING-LEFT: 10px; FONT-WEIGHT: bold; = PADDING-BOTTOM: 5px; TEXT-TRANSFORM: uppercase; PADDING-TOP: 8px } #closespecpd { PADDING-RIGHT: 10px; FONT-SIZE: 11px; FLOAT: right } .inactive { DISPLAY: none } .active { DISPLAY: block } #medscapeheader { CLEAR: both; BORDER-RIGHT: #cccbcb 1px solid; BACKGROUND-POSITION: left = top; BORDER-TOP: #cccbcb 1px solid; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/ornaments/bg-header.gif); = MARGIN: 6px 0px 7px; BORDER-LEFT: #cccbcb 1px solid; BORDER-BOTTOM: = #cccbcb 1px solid; BACKGROUND-REPEAT: no-repeat; HEIGHT: 58px } #medscapeheaderleft { FLOAT: left; WIDTH: 440px } #medscapeheaderright { FLOAT: right; WIDTH: 318px } H1#headerh1 { PADDING-RIGHT: 0px; PADDING-LEFT: 0px; FONT-WEIGHT: bold; FONT-SIZE: = 1.25em; PADDING-BOTTOM: 0px; MARGIN: 0px; WIDTH: 440px; COLOR: #003366; = PADDING-TOP: 0px; FONT-FAMILY: palatino, georgia, times, serif; HEIGHT: = 58px } H1#headerh1 A { FLOAT: left; WIDTH: 440px; HEIGHT: 58px; TEXT-DECORATION: none } H1#headerh1 A:link { FLOAT: left; WIDTH: 440px; HEIGHT: 58px; TEXT-DECORATION: none } H1#headerh1 A:visited { FLOAT: left; WIDTH: 440px; HEIGHT: 58px; TEXT-DECORATION: none } H1#headerh1 A:hover { FLOAT: left; WIDTH: 440px; HEIGHT: 58px; TEXT-DECORATION: none } H1#headerh1 A:active { FLOAT: left; WIDTH: 440px; HEIGHT: 58px; TEXT-DECORATION: none } #spnamehide { DISPLAY: none } #sitelinks { PADDING-RIGHT: 10px; PADDING-LEFT: 0px; FLOAT: right; PADDING-BOTTOM: = 0px; MARGIN: 0px; PADDING-TOP: 14px } #medscapenavbar { TEXT-TRANSFORM: uppercase; COLOR: #4b4b4b; FONT-FAMILY: frutiger, = arial, sans-serif } #medscapenavbar UL { PADDING-RIGHT: 0px; LIST-STYLE: none none inside; PADDING-LEFT: 0px; = PADDING-BOTTOM: 6px; MARGIN: 0px; PADDING-TOP: 0px; TEXT-ALIGN: right } .navlist1 { DISPLAY: block } .navlist2 { DISPLAY: block } .navlinkstart { BORDER-RIGHT: #bbc9d0 1px solid; PADDING-RIGHT: 11px; DISPLAY: inline; = FONT-WEIGHT: normal; FONT-SIZE: 11px } .navlinkstart A:link { COLOR: #006699; TEXT-DECORATION: none } .navlinkstart A:visited { COLOR: #006699; TEXT-DECORATION: none } .navlinkstart A:hover { COLOR: #24a2dd; TEXT-DECORATION: underline } .navlinkstart A:active { COLOR: #006699; TEXT-DECORATION: none } .navlink { BORDER-RIGHT: #bbc9d0 1px solid; PADDING-RIGHT: 11px; DISPLAY: inline; = PADDING-LEFT: 10px; FONT-WEIGHT: normal; FONT-SIZE: 11px } .navlink A:link { COLOR: #006699; TEXT-DECORATION: none } .navlink A:visited { COLOR: #006699; TEXT-DECORATION: none } .navlink A:hover { COLOR: #24a2dd; TEXT-DECORATION: underline } .navlink A:active { COLOR: #006699; TEXT-DECORATION: none } .navlinkend { DISPLAY: inline; PADDING-LEFT: 11px; FONT-WEIGHT: normal; FONT-SIZE: = 11px } .navlinkend A:link { COLOR: #006699; TEXT-DECORATION: none } .navlinkend A:visited { COLOR: #006699; TEXT-DECORATION: none } .navlinkend A:hover { COLOR: #24a2dd; TEXT-DECORATION: underline } .navlinkend A:active { COLOR: #006699; TEXT-DECORATION: none } .navlinkstarton { BORDER-RIGHT: #bbc9d0 1px solid; PADDING-RIGHT: 11px; DISPLAY: inline; = FONT-WEIGHT: normal; FONT-SIZE: 11px } .navlinkstarton A:link { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkstarton A:visited { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkstarton A:hover { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkstarton A:active { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkon { BORDER-RIGHT: #bbc9d0 1px solid; PADDING-RIGHT: 11px; DISPLAY: inline; = PADDING-LEFT: 11px; FONT-WEIGHT: normal; FONT-SIZE: 11px } .navlinkon A:link { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkon A:visited { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkon A:hover { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkon A:active { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkendon { DISPLAY: inline; PADDING-LEFT: 11px; FONT-WEIGHT: normal; FONT-SIZE: = 11px } .navlinkendon A:link { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkendon A:visited { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkendon A:hover { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } .navlinkendon A:active { FONT-WEIGHT: bold; COLOR: #4b4b4b; TEXT-DECORATION: none } #sp_splash { BACKGROUND-POSITION: left top; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/header/sp/bg-sp-medscape.gif); = BACKGROUND-REPEAT: no-repeat } #sp_38 { BACKGROUND-POSITION: left top; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/header/sp/bg-sp-allergy.gif); = BACKGROUND-REPEAT: no-repeat } #sp_21 { BACKGROUND-POSITION: left top; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/header/sp/bg-sp-business.gif); = BACKGROUND-REPEAT: no-repeat } #sp_2 { BACKGROUND-POSITION: left top; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/header/sp/bg-sp-cardiology.gif);= BACKGROUND-REPEAT: no-repeat } #sp_32 { BACKGROUND-POSITION: left top; BACKGROUND-IMAGE: = url(http://images.medscape.com/pi/global/header/sp/bg-sp-criticalcare.gif= ); BACKGROUND-REPEAT: no-repeat } #sp_33 { BACKGROUND-POSITION: left top; 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searchlinkstate3 =3D document.getElementById("emedsearchlink2");=0A= var searchlinkstate4 =3D = document.getElementById("drugrefsearchlink2");=0A= var searchlinkstate5 =3D = document.getElementById("medlinesearchlink2");=0A= setElementClass(searchlinkstate1, 'searchtypeselected');=0A= setElementClass(searchlinkstate2, '');=0A= setElementClass(searchlinkstate3, '');=0A= setElementClass(searchlinkstate4, '');=0A= setElementClass(searchlinkstate5, '');=0A= }=0A= else if (thislink =3D=3D "medscape") {=0A= var searchlinkstate1 =3D document.getElementById("allsearchlink2");=0A= var searchlinkstate2 =3D = document.getElementById("medscapesearchlink2");=0A= var searchlinkstate3 =3D document.getElementById("emedsearchlink2");=0A= var searchlinkstate4 =3D = document.getElementById("drugrefsearchlink2");=0A= var searchlinkstate5 =3D = document.getElementById("medlinesearchlink2");=0A= setElementClass(searchlinkstate1, '');=0A= setElementClass(searchlinkstate2, 'searchtypeselected');=0A= setElementClass(searchlinkstate3, '');=0A= setElementClass(searchlinkstate4, '');=0A= setElementClass(searchlinkstate5, '');=0A= }=0A= else if (thislink =3D=3D "emedicine") {=0A= var searchlinkstate1 =3D document.getElementById("allsearchlink2");=0A= var searchlinkstate2 =3D = document.getElementById("medscapesearchlink2");=0A= var searchlinkstate3 =3D document.getElementById("emedsearchlink2");=0A= var searchlinkstate4 =3D = document.getElementById("drugrefsearchlink2");=0A= var searchlinkstate5 =3D = document.getElementById("medlinesearchlink2");=0A= setElementClass(searchlinkstate1, '');=0A= setElementClass(searchlinkstate2, '');=0A= setElementClass(searchlinkstate3, 'searchtypeselected');=0A= setElementClass(searchlinkstate4, '');=0A= setElementClass(searchlinkstate5, '');=0A= }=0A= else if (thislink =3D=3D "drug") {=0A= var searchlinkstate1 =3D document.getElementById("allsearchlink2");=0A= var searchlinkstate2 =3D = document.getElementById("medscapesearchlink2");=0A= var searchlinkstate3 =3D document.getElementById("emedsearchlink2");=0A= var searchlinkstate4 =3D = document.getElementById("drugrefsearchlink2");=0A= var searchlinkstate5 =3D = document.getElementById("medlinesearchlink2");=0A= setElementClass(searchlinkstate1, '');=0A= setElementClass(searchlinkstate2, '');=0A= setElementClass(searchlinkstate3, '');=0A= setElementClass(searchlinkstate4, 'searchtypeselected');=0A= setElementClass(searchlinkstate5, '');=0A= }=0A= else if (thislink =3D=3D "medline") {=0A= var searchlinkstate1 =3D document.getElementById("allsearchlink2");=0A= var searchlinkstate2 =3D = document.getElementById("medscapesearchlink2");=0A= var searchlinkstate3 =3D document.getElementById("emedsearchlink2");=0A= var searchlinkstate4 =3D = document.getElementById("drugrefsearchlink2");=0A= var searchlinkstate5 =3D = document.getElementById("medlinesearchlink2");=0A= setElementClass(searchlinkstate1, '');=0A= setElementClass(searchlinkstate2, '');=0A= setElementClass(searchlinkstate3, '');=0A= setElementClass(searchlinkstate4, '');=0A= setElementClass(searchlinkstate5, 'searchtypeselected');=0A= }=0A= }=0A= else {=0A= var radiobtnlist =3D radiobtn.length;=0A= if (radiobtnlist =3D=3D undefined) {=0A= radiobtn.checked =3D (radiobtn.value =3D=3D thislink.toString());=0A= return;=0A= }=0A= for (var i =3D 0; i < radiobtnlist; i++) {=0A= radiobtn[i].checked =3D false;=0A= if (radiobtn[i].value =3D=3D thislink.toString()) {=0A= radiobtn[i].checked =3D true;=0A= }=0A= }=0A= document.SmartSearch2.submit();=0A= }=0A= }=0A= =0A= /* Poll feature for showing Allow Other Answers" */=0A= function showotherfield(state, layerid, state2, layerid2) {=0A= if (document.getElementById) {=0A= var contentlayer =3D document.getElementById(layerid);=0A= var contentlayer2 =3D document.getElementById(layerid2);=0A= setElementClass(contentlayer, state);=0A= setElementClass(contentlayer2, state2);=0A= }=0A= }=0A= /* Character counter. */=0A= function getObject(obj) {=0A= var theObj;=0A= if(document.all) {=0A= if(typeof obj=3D=3D"string") {=0A= return document.all(obj);=0A= } else {=0A= return obj.style;=0A= }=0A= }=0A= if(document.getElementById) {=0A= if(typeof obj=3D=3D"string") {=0A= return document.getElementById(obj);=0A= } else {=0A= return obj.style;=0A= }=0A= }=0A= return null;=0A= }=0A= =0A= =0A= function counter(entrance,exit,text,characters) {=0A= var entranceObj=3DgetObject(entrance);=0A= var exitObj=3DgetObject(exit);=0A= var length=3Dcharacters - entranceObj.value.length;=0A= if(length <=3D 0) {=0A= length=3D0;=0A= text=3D' '+text+' ';=0A= entranceObj.value=3DentranceObj.value.substr(0,characters);=0A= }=0A= exitObj.innerHTML =3D text.replace("{CHAR}",length);=0A= }=0A= =0A= /* Remove OSUN Notice */=0A= function removeosun(state) {=0A= if (document.getElementById) {=0A= if (document.getElementById("whiteoutlayer")) {=0A= var element2 =3D document.getElementById("whiteoutlayer");=0A= while (element2.firstChild) {=0A= element2.removeChild(element2.firstChild);=0A= }=0A= document.getElementById("whiteoutlayer").id =3D ""; =0A= }=0A= var osunid =3D document.getElementById("osun");=0A= setElementClass(osunid, state);=0A= }=0A= }=0A= =0A= /* CME Search Layer Functions */=0A= function addalertlayer(continueURL) {=0A= var newDiv =3D parent.document.createElement("div");=0A= newDiv.setAttribute("id", "cmesearchalert2");=0A= continueURL=3DcontinueURL.replace(/\"/g,""");=0A= newDiv.innerHTML =3D "

Medscape physician members have an = opportunity to earn CME credits for Internet Point of Care (PoC) through = self directed learning on topics relevant to clinical care. Physicians = participate in a 3 step learning cycle to receive a half (0.5) AMA = PRA Category 1 credit.

The 3 steps include:
  1. Search = Medscape: Identify a clinical question by entering a search term
  2. Learn: Review information sources = (search results)
  3. Complete Action Plan: Briefly document how you = will implement learning in clinical practice

These = activities will be recorded in your CME Tracker with the 3 step = documentation available in print format on your certificate and CME = Tracker.

";=0A= var my_div =3D parent.document.getElementById("bodypadding");=0A= parent.document.body.insertBefore(newDiv, my_div);=0A= document.getElementById("cmesearchalert2").style.top =3D '75px';=0A= document.getElementById("cmesearchalert2").style.left =3D '150px';=0A= document.getElementById("cmesearchalert2").style.position =3D = "absolute";=0A= document.getElementById("cmesearchalert2").style.zIndex =3D 500;=0A= movelayers('cmesearchalert2');=0A= }=0A= =0A= =0A= function removealertlayer() {=0A= var element =3D document.getElementById("cmesearchalert2");=0A= while (element.firstChild) {=0A= element.removeChild(element.firstChild);=0A= }=0A= document.getElementById("cmesearchalert2").id =3D "";=0A= }=0A= =0A= function changeDivcmesearch(id, str) {=0A= if(!document.getElementById) return; // Not Supported=0A= =0A= if(document.getElementById) {=0A= document.getElementById(id).innerHTML =3D str;=0A= document.getElementById("cmesearchalert").style.visibility =3D = "visible";=0A= movelayers(id);=0A= }=0A= }=0A= =0A= function popsearchalert(idname) {=0A= document.getElementById("cmesearchalert").style.top =3D '75px';=0A= document.getElementById("cmesearchalert").style.left =3D '150px';=0A= document.getElementById("cmesearchalert").style.position =3D "absolute";=0A= document.getElementById("cmesearchalert").style.zIndex =3D 500;=0A= searchalert =3D "

Medscape physician members have an = opportunity to earn CME credits for Internet Point of Care (PoC) through = self directed learning on topics relevant to clinical care. Physicians = participate in a 3 step learning cycle to receive a half (0.5) AMA = PRA Category 1 credit.

The 3 steps include:
  1. Search = Medscape: Identify a clinical question by entering a search term
  2. Learn: Review information sources = (search results)
  3. Complete Action Plan: Briefly document how you = will implement learning in clinical practice

These = activities will be recorded in your CME Tracker with the 3 step = documentation available in print format on your certificate and CME = Tracker.

CLOSE";=0A= incompletealert =3D "

Please note that in order to earn = AMA/PRA category 1 credit, you must first read at least one article from = your list of search results.

Medscape physician members have an = opportunity to earn CME credits for Internet Point of Care (PoC) through = self directed learning on topics relevant to clinical care. Physicians = participate in a 3 step learning cycle to receive a half (0.5) AMA = PRA Category 1 credit.

The 3 steps include:
  1. Search = Medscape: Identify a clinical question by entering a search term
  2. Learn: Review information sources = (search results)
  3. Complete Action Plan: Briefly document how you = will implement learning in clinical practice

These = activities will be recorded in your CME Tracker with the 3 step = documentation available in print format on your certificate and CME = Tracker.

CLOSE";=0A= emptydiv =3D "
";=0A= if (idname =3D=3D "whatissearchcme") {=0A= changeDivcmesearch('cmesearchalert', searchalert);=0A= }else if (idname =3D=3D "incompletealert") {=0A= changeDivcmesearch('cmesearchalert', incompletealert); =0A= } else if (idname =3D=3D "clearsearchcmealert") {=0A= changeDivcmesearch('cmesearchalert', emptydiv);=0A= }=0A= }=0A= =0A= /* Invites Functions */=0A= function showinvite(state, layerid) {=0A= if (document.getElementById) {=0A= var contentlayer =3D document.getElementById(layerid);=0A= setElementClass(contentlayer, state);=0A= movelayers(layerid);=0A= }=0A= }=0A= function showwhatthis(state) {=0A= if (document.getElementById) {=0A= var contentlayer =3D document.getElementById("whatthisp");=0A= setElementClass(contentlayer, state);=0A= }=0A= }=0A= =0A= /* POM Ad functions */=0A= function playPOMswf() {=0A= var flashid =3D document.getElementById("flashcontent300x600s");=0A= setElementClass(flashid, 'inactive');=0A= var flashid2 =3D document.getElementById("flashcontent300x600");=0A= setElementClass(flashid2, 'active');=0A= PlayFlashMovie("POMFlashAd"); =0A= }=0A= function addjscript(onepx) {=0A= if (document.getElementById("hidden1x1")) {=0A= var onepx2 =3D document.getElementById("hidden1x1").value;=0A= var newDiv =3D document.createElement("div");=0A= newDiv.setAttribute("id", "1x1enlargepx");=0A= newDiv.innerHTML =3D "3D\"\"";=0A= if (document.getElementById("1x1enlargepx")) {=0A= addjscript2();=0A= }=0A= else {=0A= var my_div =3D document.getElementById("endofpomad");=0A= my_div.parentNode.insertBefore(newDiv, my_div);=0A= addjscript2();=0A= }=0A= }=0A= else {=0A= var newDiv =3D document.createElement("div");=0A= newDiv.setAttribute("id", "1x1enlargepx");=0A= newDiv.innerHTML =3D "3D\"\"";=0A= if (document.getElementById("1x1enlargepx")) {=0A= addjscript2();=0A= }=0A= else {=0A= var my_div =3D document.getElementById("endofpomad");=0A= my_div.parentNode.insertBefore(newDiv, my_div);=0A= addjscript2();=0A= }=0A= }=0A= }=0A= function addjscript2() {=0A= var flashid =3D document.getElementById("pomad");=0A= setElementClass(flashid, 'showmovie');=0A= movelayers("pomad");=0A= setTimeout("PlayFlashMovie('POMFlashLayer');",1);=0A= }=0A= function removePOMadlayer() {=0A= StopFlashMovie("POMFlashLayer");=0A= RewindFlashMovie("POMFlashAd");=0A= var flashid =3D document.getElementById("pomad");=0A= setElementClass(flashid, 'hidemovie');=0A= PlayFlashMovie("POMFlashAd");=0A= RewindFlashMovie("POMFlashLayer");=0A= }=0A= function removePOMadlayerstatic() {=0A= StopFlashMovie("POMFlashLayer");=0A= var flashid =3D document.getElementById("pomad");=0A= setElementClass(flashid, 'hidemovie');=0A= RewindFlashMovie("POMFlashLayer");=0A= }=0A= =0A= function StopFlashMovie(passmovieid)=0A= {=0A= var flashMovie=3DgetFlashMovieObject(passmovieid);=0A= flashMovie.StopPlay();=0A= }=0A= =0A= function PlayFlashMovie(passmovieid)=0A= {=0A= var flashMovie=3DgetFlashMovieObject(passmovieid);=0A= flashMovie.Play();=0A= //embed.nativeProperty.anotherNativeMethod();=0A= }=0A= =0A= function RewindFlashMovie(passmovieid)=0A= {=0A= var flashMovie=3DgetFlashMovieObject(passmovieid);=0A= flashMovie.Rewind();=0A= }=0A= =0A= function getFlashMovieObject(movieName)=0A= {=0A= if (window.document[movieName]) =0A= {=0A= return window.document[movieName];=0A= }=0A= if (navigator.appName.indexOf("Microsoft Internet")=3D=3D-1)=0A= {=0A= if (document.embeds && document.embeds[movieName])=0A= return document.embeds[movieName]; =0A= }=0A= else // if (navigator.appName.indexOf("Microsoft Internet")!=3D-1)=0A= {=0A= return document.getElementById(movieName);=0A= }=0A= }=0A= /* Functions for Scrolling Feature Widget */=0A= function autoscrollwidget(passfeatnum) {=0A= var listel =3D new Array();=0A= listel =3D = document.getElementById('featurewidgetcontent').getElementsByTagName('li'= );=0A= document.getElementById('featnuminput').value =3D passfeatnum;=0A= var featnum =3D document.getElementById('featnuminput').value;=0A= if (document.getElementById('loopinput').value < "2") {=0A= if (featnum =3D=3D "0") {=0A= setElementClass(listel[0], 'active');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= timeset =3D setTimeout("autoscrollwidget(1)",3000);=0A= }=0A= else if (featnum =3D=3D "1") {=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'active');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= timeset =3D setTimeout("autoscrollwidget(2)",3000);=0A= }=0A= else if (featnum =3D=3D "2") {=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'active');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= var looptime =3D (document.getElementById('loopinput').value * 1) + 1;=0A= document.getElementById('loopinput').value =3D looptime;=0A= timeset =3D setTimeout("autoscrollwidget(0)",3000);=0A= }=0A= }=0A= else {=0A= scrollwidgetto0();=0A= }=0A= }=0A= function scrollwidgetfrw() {=0A= clearTimeout(timeset);=0A= var listel =3D new Array();=0A= listel =3D = document.getElementById('featurewidgetcontent').getElementsByTagName('li'= );=0A= var featnum =3D document.getElementById('featnuminput').value;=0A= if (featnum =3D=3D "0") {=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'active');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= document.getElementById('featnuminput').value =3D "1";=0A= }=0A= else if (featnum =3D=3D "1") {=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'active');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= document.getElementById('featnuminput').value =3D "2";=0A= }=0A= else if (featnum =3D=3D "2") {=0A= setElementClass(listel[0], 'active');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= document.getElementById('featnuminput').value =3D "0";=0A= }=0A= }=0A= function scrollwidgetbck() {=0A= clearTimeout(timeset);=0A= var listel =3D new Array();=0A= listel =3D = document.getElementById('featurewidgetcontent').getElementsByTagName('li'= );=0A= var featnum =3D document.getElementById('featnuminput').value;=0A= if (featnum =3D=3D "0") {=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'active');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= document.getElementById('featnuminput').value =3D "2";=0A= }=0A= else if (featnum =3D=3D "1") {=0A= setElementClass(listel[0], 'active');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= document.getElementById('featnuminput').value =3D "0";=0A= }=0A= else if (featnum =3D=3D "2") {=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'active');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= document.getElementById('featnuminput').value =3D "1";=0A= }=0A= }=0A= =0A= function scrollwidgetto0() {=0A= clearTimeout(timeset);=0A= var listel =3D new Array();=0A= listel =3D = document.getElementById('featurewidgetcontent').getElementsByTagName('li'= );=0A= setElementClass(listel[0], 'active');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= document.getElementById('featnuminput').value =3D "0";=0A= }=0A= function scrollwidgetto1() {=0A= clearTimeout(timeset);=0A= var listel =3D new Array();=0A= listel =3D = document.getElementById('featurewidgetcontent').getElementsByTagName('li'= );=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'active');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= setElementClass(listel[2], 'inactive');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= document.getElementById('featnuminput').value =3D "1";=0A= }=0A= function scrollwidgetto2() {=0A= clearTimeout(timeset);=0A= var listel =3D new Array();=0A= listel =3D = document.getElementById('featurewidgetcontent').getElementsByTagName('li'= );=0A= setElementClass(listel[0], 'inactive');=0A= document.getElementById('featwidgetled1').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[1], 'inactive');=0A= document.getElementById('featwidgetled2').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgetoff.gif";=0A= setElementClass(listel[2], 'active');=0A= document.getElementById('featwidgetled3').src =3D = "http://images.medscape.com/pi/features/scrollbox/icon-widgeton.gif";=0A= document.getElementById('featnuminput').value =3D "2";=0A= }=0A= /* Utility Function For Showing Hidden Layer */=0A= function showcontent(state, layerid) {=0A= if (document.getElementById) {=0A= var contentlayer =3D document.getElementById(layerid);=0A= setElementClass(contentlayer, state);=0A= movelayers(layerid);=0A= }=0A= }=0A= /* Utility Function For Showing Hidden Layer */=0A= function invitereminder(state, layerid) {=0A= if (document.getElementById) {=0A= var contentlayer =3D document.getElementById(layerid);=0A= setElementClass(contentlayer, state);=0A= movelayers(layerid);=0A= }=0A= }=0A= =0A= /* Utility Function Move Layers */=0A= function movelayers(num)=0A= {=0A= if (window.innerHeight)=0A= {=0A= pos =3D window.pageYOffset=0A= }=0A= else if (document.documentElement && document.documentElement.scrollTop)=0A= {=0A= pos =3D document.documentElement.scrollTop=0A= }=0A= else if (document.body)=0A= {=0A= pos =3D document.body.scrollTop=0A= }=0A= =0A= if (pos < theTop)=0A= {=0A= pos =3D theTop;=0A= }=0A= else=0A= {=0A= pos +=3D 75;=0A= }=0A= =0A= if (pos =3D=3D old)=0A= {=0A= document.getElementById(num).style.top =3D (pos + 'px');=0A= document.getElementById(num).style.left =3D '150px';=0A= }=0A= else=0A= {=0A= old =3D pos;=0A= movelayers(num);=0A= }=0A= }=0A= =0A= /* Function For Header Specialty List Menu */=0A= function headershowspeclist(state, layerid) {=0A= if (document.getElementById) {=0A= var contentlayer =3D document.getElementById(layerid);=0A= setElementClass(contentlayer, state);=0A= }=0A= }=0A= =0A= /* Utility Functions */=0A= function getElementClass(element) {=0A= if (element.getAttribute("class")) {=0A= return element.getAttribute("class");=0A= } else if (element.getAttribute("className")) {=0A= return element.getAttribute("className");=0A= }=0A= }=0A= =0A= function setElementClass(element, classValue) {=0A= if (element.setAttribute("class", classValue)) {=0A= element.setAttribute("class", classValue);=0A= } else if (element.setAttribute("className", classValue)) {=0A= element.setAttribute("className", classValue);=0A= }=0A= } ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://www.medscape.com/files/scripts/hp-pulldown.js function goToUrl(myUrl)=0A= {=0A= if (myUrl!=3D"")=0A= {=0A= parent.location.href=3DmyUrl;=0A= }=0A= }=0A= ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://www.medscape.com/files/scripts/popup.js function resizeWin(newLoc, newHeight, newWidth) {=0A= newWin =3D = open("",newLoc,"scrollbars=3Dyes,resizable=3Dyes,height=3D" + newHeight = + ",width=3D" + newWidth);=0A= }=0A= ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://www.medscape.com/files/scripts/swfobject.js /**=0A= * SWFObject v1.4.4: Flash Player detection and embed - = http://blog.deconcept.com/swfobject/=0A= *=0A= * SWFObject is (c) 2006 Geoff Stearns and is released under the MIT = License:=0A= * http://www.opensource.org/licenses/mit-license.php=0A= *=0A= * **SWFObject is the SWF embed script formerly known as FlashObject. = The name was changed for=0A= * legal reasons.=0A= */=0A= if(typeof deconcept =3D=3D "undefined") var deconcept =3D new Object();=0A= if(typeof deconcept.util =3D=3D "undefined") deconcept.util =3D new = Object();=0A= if(typeof deconcept.SWFObjectUtil =3D=3D "undefined") = deconcept.SWFObjectUtil =3D new Object();=0A= deconcept.SWFObject =3D function(swf, id, w, h, ver, c, = useExpressInstall, quality, xiRedirectUrl, redirectUrl, detectKey){=0A= if (!document.getElementById) { return; }=0A= this.DETECT_KEY =3D detectKey ? detectKey : 'detectflash';=0A= this.skipDetect =3D deconcept.util.getRequestParameter(this.DETECT_KEY);=0A= this.params =3D new Object();=0A= this.variables =3D new Object();=0A= this.attributes =3D new Array();=0A= if(swf) { this.setAttribute('swf', swf); }=0A= if(id) { this.setAttribute('id', id); }=0A= if(w) { this.setAttribute('width', w); }=0A= if(h) { this.setAttribute('height', h); }=0A= if(ver) { this.setAttribute('version', new = deconcept.PlayerVersion(ver.toString().split("."))); }=0A= this.installedVer =3D deconcept.SWFObjectUtil.getPlayerVersion();=0A= if(c) { this.addParam('bgcolor', c); }=0A= var q =3D quality ? quality : 'high';=0A= this.addParam('quality', q);=0A= this.setAttribute('useExpressInstall', useExpressInstall);=0A= this.setAttribute('doExpressInstall', false);=0A= var xir =3D (xiRedirectUrl) ? xiRedirectUrl : window.location;=0A= this.setAttribute('xiRedirectUrl', xir);=0A= this.setAttribute('redirectUrl', '');=0A= if(redirectUrl) { this.setAttribute('redirectUrl', redirectUrl); }=0A= }=0A= deconcept.SWFObject.prototype =3D {=0A= setAttribute: function(name, value){=0A= this.attributes[name] =3D value;=0A= },=0A= getAttribute: function(name){=0A= return this.attributes[name];=0A= },=0A= addParam: function(name, value){=0A= this.params[name] =3D value;=0A= },=0A= getParams: function(){=0A= return this.params;=0A= },=0A= addVariable: function(name, value){=0A= this.variables[name] =3D value;=0A= },=0A= getVariable: function(name){=0A= return this.variables[name];=0A= },=0A= getVariables: function(){=0A= return this.variables;=0A= },=0A= getVariablePairs: function(){=0A= var variablePairs =3D new Array();=0A= var key;=0A= var variables =3D this.getVariables();=0A= for(key in variables){=0A= variablePairs.push(key +"=3D"+ variables[key]);=0A= }=0A= return variablePairs;=0A= },=0A= getSWFHTML: function() {=0A= var swfNode =3D "";=0A= if (navigator.plugins && navigator.mimeTypes && = navigator.mimeTypes.length) { // netscape plugin architecture=0A= if (this.getAttribute("doExpressInstall")) { = this.addVariable("MMplayerType", "PlugIn"); }=0A= swfNode =3D '';=0A= } else { // PC IE=0A= if (this.getAttribute("doExpressInstall")) { = this.addVariable("MMplayerType", "ActiveX"); }=0A= swfNode =3D '';=0A= swfNode +=3D '';=0A= var params =3D this.getParams();=0A= for(var key in params) {=0A= swfNode +=3D '';=0A= }=0A= var pairs =3D this.getVariablePairs().join("&");=0A= if(pairs.length > 0) {swfNode +=3D '';}=0A= swfNode +=3D "";=0A= }=0A= return swfNode;=0A= },=0A= write: function(elementId){=0A= if(this.getAttribute('useExpressInstall')) {=0A= // check to see if we need to do an express install=0A= var expressInstallReqVer =3D new deconcept.PlayerVersion([6,0,65]);=0A= if (this.installedVer.versionIsValid(expressInstallReqVer) && = !this.installedVer.versionIsValid(this.getAttribute('version'))) {=0A= this.setAttribute('doExpressInstall', true);=0A= this.addVariable("MMredirectURL", = escape(this.getAttribute('xiRedirectUrl')));=0A= document.title =3D document.title.slice(0, 47) + " - Flash Player = Installation";=0A= this.addVariable("MMdoctitle", document.title);=0A= }=0A= }=0A= if(this.skipDetect || this.getAttribute('doExpressInstall') || = this.installedVer.versionIsValid(this.getAttribute('version'))){=0A= var n =3D (typeof elementId =3D=3D 'string') ? = document.getElementById(elementId) : elementId;=0A= n.innerHTML =3D this.getSWFHTML();=0A= return true;=0A= }else{=0A= if(this.getAttribute('redirectUrl') !=3D "") {=0A= document.location.replace(this.getAttribute('redirectUrl'));=0A= }=0A= }=0A= return false;=0A= }=0A= }=0A= =0A= /* ---- detection functions ---- */=0A= deconcept.SWFObjectUtil.getPlayerVersion =3D function(){=0A= var PlayerVersion =3D new deconcept.PlayerVersion([0,0,0]);=0A= if(navigator.plugins && navigator.mimeTypes.length){=0A= var x =3D navigator.plugins["Shockwave Flash"];=0A= if(x && x.description) {=0A= PlayerVersion =3D new = deconcept.PlayerVersion(x.description.replace(/([a-zA-Z]|\s)+/, = "").replace(/(\s+r|\s+b[0-9]+)/, ".").split("."));=0A= }=0A= }else{=0A= // do minor version lookup in IE, but avoid fp6 crashing issues=0A= // see = http://blog.deconcept.com/2006/01/11/getvariable-setvariable-crash-intern= et-explorer-flash-6/=0A= try{=0A= var axo =3D new ActiveXObject("ShockwaveFlash.ShockwaveFlash.7");=0A= }catch(e){=0A= try {=0A= var axo =3D new ActiveXObject("ShockwaveFlash.ShockwaveFlash.6");=0A= PlayerVersion =3D new deconcept.PlayerVersion([6,0,21]);=0A= axo.AllowScriptAccess =3D "always"; // throws if player version < = 6.0.47 (thanks to Michael Williams @ Adobe for this code)=0A= } catch(e) {=0A= if (PlayerVersion.major =3D=3D 6) {=0A= return PlayerVersion;=0A= }=0A= }=0A= try {=0A= axo =3D new ActiveXObject("ShockwaveFlash.ShockwaveFlash");=0A= } catch(e) {}=0A= }=0A= if (axo !=3D null) {=0A= PlayerVersion =3D new = deconcept.PlayerVersion(axo.GetVariable("$version").split(" = ")[1].split(","));=0A= }=0A= }=0A= return PlayerVersion;=0A= }=0A= deconcept.PlayerVersion =3D function(arrVersion){=0A= this.major =3D arrVersion[0] !=3D null ? parseInt(arrVersion[0]) : 0;=0A= this.minor =3D arrVersion[1] !=3D null ? parseInt(arrVersion[1]) : 0;=0A= this.rev =3D arrVersion[2] !=3D null ? parseInt(arrVersion[2]) : 0;=0A= }=0A= deconcept.PlayerVersion.prototype.versionIsValid =3D function(fv){=0A= if(this.major < fv.major) return false;=0A= if(this.major > fv.major) return true;=0A= if(this.minor < fv.minor) return false;=0A= if(this.minor > fv.minor) return true;=0A= if(this.rev < fv.rev) return false;=0A= return true;=0A= }=0A= /* ---- get value of query string param ---- */=0A= deconcept.util =3D {=0A= getRequestParameter: function(param) {=0A= var q =3D document.location.search || document.location.hash;=0A= if(q) {=0A= var pairs =3D q.substring(1).split("&");=0A= for (var i=3D0; i < pairs.length; i++) {=0A= if (pairs[i].substring(0, pairs[i].indexOf("=3D")) =3D=3D param) {=0A= return pairs[i].substring((pairs[i].indexOf("=3D")+1));=0A= }=0A= }=0A= }=0A= return "";=0A= }=0A= }=0A= /* fix for video streaming bug */=0A= deconcept.SWFObjectUtil.cleanupSWFs =3D function() {=0A= if (window.opera || !document.all) return;=0A= var objects =3D document.getElementsByTagName("OBJECT");=0A= for (var i=3D0; i < objects.length; i++) {=0A= objects[i].style.display =3D 'none';=0A= for (var x in objects[i]) {=0A= if (typeof objects[i][x] =3D=3D 'function') {=0A= objects[i][x] =3D function(){};=0A= }=0A= }=0A= }=0A= }=0A= // fixes bug in fp9 see = http://blog.deconcept.com/2006/07/28/swfobject-143-released/=0A= deconcept.SWFObjectUtil.prepUnload =3D function() {=0A= __flash_unloadHandler =3D function(){};=0A= __flash_savedUnloadHandler =3D function(){};=0A= if (typeof window.onunload =3D=3D 'function') {=0A= var oldUnload =3D window.onunload;=0A= window.onunload =3D function() {=0A= deconcept.SWFObjectUtil.cleanupSWFs();=0A= oldUnload();=0A= }=0A= } else {=0A= window.onunload =3D deconcept.SWFObjectUtil.cleanupSWFs;=0A= }=0A= }=0A= if (typeof window.onbeforeunload =3D=3D 'function') {=0A= var oldBeforeUnload =3D window.onbeforeunload;=0A= window.onbeforeunload =3D function() {=0A= deconcept.SWFObjectUtil.prepUnload();=0A= oldBeforeUnload();=0A= }=0A= } else {=0A= window.onbeforeunload =3D deconcept.SWFObjectUtil.prepUnload;=0A= }=0A= /* add Array.push if needed (ie5) */=0A= if (Array.prototype.push =3D=3D null) { Array.prototype.push =3D = function(item) { this[this.length] =3D item; return this.length; }}=0A= =0A= /* add some aliases for ease of use/backwards compatibility */=0A= var getQueryParamValue =3D deconcept.util.getRequestParameter;=0A= var FlashObject =3D deconcept.SWFObject; // for legacy support=0A= var SWFObject =3D deconcept.SWFObject;=0A= ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://as.medscape.com/js.ng/transactionid%3D1221455002547&site%3D1&pos%3D901&affiliate%3D1&pf%3D10&usp%3D60&ct%3Dmy&artid%3D577795&spon%3Dcme&ssp%3D9 document.write('');=0A= if ("html" =3D=3D "html"){ =0A= document.bgColor =3D 'transparent';=0A= }=0A= document.write('
\n'); ------=_NextPart_000_006D_01C91733.D5F87290 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://www.medscape.com/files/scripts/articletools.js var theTop =3D 75;=0Dvar old =3D theTop;=0D=0Dwindow.onload =3D = function() {=0D hidearticletools();=0D hidecontent();=0D = hiddenlayers();=0D}=0D=0Dfunction hidearticletools()=0D{=0D if = (document.getElementById('emailtoolbox')) {=0D = document.getElementById('emailtoolbox').style.display =3D "none";=0D = }=0D if (document.getElementById('ratingtoolbox')) {=0D = document.getElementById('ratingtoolbox').style.display =3D "none";=0D = }=0D if (document.getElementById('emailconfirmation')) {=0D = document.getElementById('emailconfirmation').style.display =3D = "none";=0D }=0D if (document.getElementById('ratingthanks')) {=0D = document.getElementById('ratingthanks').style.display =3D "none";=0D = }=0D if (document.getElementById('ratingthanks2')) {=0D = document.getElementById('ratingthanks2').style.display =3D "none";=0D = }=0D if (document.getElementById('synonymskeywords')) {=0D = document.getElementById('synonymskeywords').style.display =3D "none";=0D = }=0D}=0D=0Dfunction hidecontent()=0D{=0D if = (document.getElementById('references')) {=0D = document.getElementById('references').style.display =3D "none";=0D = document.getElementById('references').style.top =3D '75px';=0D = document.getElementById('references').style.left =3D '150px';=0D = document.getElementById('references').style.position =3D "absolute";=0D = document.getElementById('references').style.zIndex =3D 500;=0D }=0D = if (document.getElementById('suggestedreading')) {=0D = document.getElementById('suggestedreading').style.display =3D "none";=0D = document.getElementById('suggestedreading').style.top =3D '75px';=0D = document.getElementById('suggestedreading').style.left =3D '150px';=0D = document.getElementById('suggestedreading').style.position =3D = "absolute";=0D = document.getElementById('suggestedreading').style.zIndex =3D 500; =0D = }=0D if (document.getElementById('relatedlinkswin')) {=0D = document.getElementById('relatedlinkswin').style.display =3D "none";=0D = document.getElementById('relatedlinkswin').style.top =3D '75px';=0D = document.getElementById('relatedlinkswin').style.left =3D '150px';=0D = document.getElementById('relatedlinkswin').style.position =3D = "absolute";=0D document.getElementById('relatedlinkswin').style.zIndex = =3D 500; =0D }=0D if (document.getElementById('cmeinformation')) = {=0D document.getElementById('cmeinformation').style.display =3D = "none";=0D document.getElementById('cmeinformation').style.top =3D = '75px';=0D document.getElementById('cmeinformation').style.left =3D = '150px';=0D document.getElementById('cmeinformation').style.position = =3D "absolute";=0D = document.getElementById('cmeinformation').style.zIndex =3D 500; =0D = }=0D if (document.getElementById('authordisclosures')) {=0D = document.getElementById('authordisclosures').style.display =3D = "none";=0D document.getElementById('authordisclosures').style.top =3D = '75px';=0D document.getElementById('authordisclosures').style.left =3D = '150px';=0D = document.getElementById('authordisclosures').style.position =3D = "absolute";=0D = document.getElementById('authordisclosures').style.zIndex =3D 500; = =0D }=0D}=0D=0Dfunction showcontent(tent) {=0D if = (document.getElementById(tent).style.display =3D=3D "none") {=0D = hidecontent();=0D document.getElementById(tent).style.display =3D = "block";=0D document.getElementById(tent).style.height =3D "auto";=0D = movelayers(tent);=0D } else {=0D = document.getElementById(tent).style.display =3D "none";=0D = }=0D}=0D=0Dfunction movecontent(tent)=0D{=0D if (window.innerHeight)=0D = {=0D pos =3D window.pageYOffset=0D }=0D else if = (document.documentElement && document.documentElement.scrollTop)=0D {=0D = pos =3D document.documentElement.scrollTop=0D }=0D else if = (document.body)=0D {=0D pos =3D document.body.scrollTop=0D }=0D =0D if = (pos < theTop)=0D {=0D pos =3D theTop;=0D }=0D else=0D {=0D pos = +=3D 75;=0D }=0D =0D if (pos =3D=3D old)=0D {=0D = document.getElementById(tent).style.top =3D (pos + 'px');=0D = document.getElementById(tent).style.left =3D '150px';=0D }=0D else=0D = {=0D old =3D pos;=0D movelayers(tent);=0D }=0D}=0D=0D=0Dfunction = hiddenlayers() {=0D var displaystr =3D null;=0D var stylestr =3D = null;=0D=0D for(n =3D1; n < 100; n++){=0D if(n <10)=0D displaystr =3D = 'hiddenlayer0' + n;=0D else=0D displaystr =3D 'hiddenlayer' + n;=0D = stylestr =3D document.getElementById(displaystr);=0D if(stylestr !=3D = null) {=0D stylestr.style.display =3D "none";=0D stylestr.style.top = =3D '75px';=0D stylestr.style.left =3D '150px';=0D = stylestr.style.position =3D "absolute";=0D stylestr.style.zIndex =3D = 500;=0D } =0D else=0D break;=0D }=0D}=0D=0Dfunction = showlayers(num) {=0D if (document.getElementById(num).style.display = =3D=3D "none") {=0D hiddenlayers();=0D = document.getElementById(num).style.display =3D "block";=0D = document.getElementById(num).style.height =3D "auto";=0D = movelayers(num);=0D } else {=0D = document.getElementById(num).style.display =3D "none";=0D = }=0D}=0D=0Dfunction movelayers(num)=0D{=0D if (window.innerHeight)=0D = {=0D pos =3D window.pageYOffset=0D }=0D else if = (document.documentElement && document.documentElement.scrollTop)=0D {=0D = pos =3D document.documentElement.scrollTop=0D }=0D else if = (document.body)=0D {=0D pos =3D document.body.scrollTop=0D }=0D =0D if = (pos < theTop)=0D {=0D pos =3D theTop;=0D }=0D else=0D {=0D pos = +=3D 75;=0D }=0D =0D if (pos =3D=3D old)=0D {=0D = document.getElementById(num).style.top =3D (pos + 'px');=0D = document.getElementById(num).style.left =3D '150px';=0D }=0D else=0D = {=0D old =3D pos;=0D movelayers(num);=0D }=0D}=0D=0Dfunction = showemailtoolbox()=0D{=0D if = (document.getElementById('emailtoolbox').style.display =3D=3D "none")=0D = {=0D document.getElementById('emailtoolbox').style.display =3D = "block";=0D if (document.getElementById('ratingtoolbox')) {=0D = document.getElementById('ratingtoolbox').style.display =3D "none";=0D = }=0D }=0D else=0D {=0D = document.getElementById('emailtoolbox').style.display =3D "none";=0D = }=0D =0D}=0D=0Dfunction confirmsent()=0D{=0D if = (document.getElementById('emailconfirmation').style.display =3D=3D = "none")=0D {=0D = document.getElementById('emailconfirmation').style.display =3D = "block";=0D document.getElementById('emailform').style.display =3D = "none";=0D return false;=0D }=0D}=0D=0Dfunction = showratingtoolbox()=0D{=0D if = (document.getElementById('ratingtoolbox').style.display =3D=3D = "none")=0D {=0D document.getElementById('ratingtoolbox').style.display = =3D "block";=0D if (document.getElementById('emailtoolbox')) {=0D = document.getElementById('emailtoolbox').style.display =3D "none";=0D = }=0D }=0D else=0D {=0D = 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