{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/48\\\/16\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;15\\\/48\\\/16\u0022}],\u0022ac\u0022:{\u0022spmdc;15\\\/48\\\/16\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;15\\\/48\\\/16\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe ASPECT-cIAI trial demonstrates high clinical cure rates, similar to those of meropenem, with ceftolozane\/tazobactam plus metronidazole in patients with complicated intra-abdominal infections in a European population. In addition, a post hoc analysis shows similar outcomes between patients who are nonobese and obese.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eceftolozane\/tazobactam\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emetronidazole\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emeropenem\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecomplicated intra-abdominal infection\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EASPECT-cIAI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEuropean population\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eobesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einfectious diseases clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eemerging therapies\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EA major challenge in the treatment of complicated intra-abdominal infections (cIAIs), including secondary or tertiary peritonitis and cIAI associated with health care, is the potential that a resistant pathogen is responsible for the infection [Eckmann C, Shekarriz H. \u003Cem\u003EEur Infect Dis\u003C\/em\u003E. 2012]. In these settings, extended-spectrum \u03b2-lactamase (ESBL)\u2013producing organisms and multidrug-resistant \u003Cem\u003EPseudomonas\u003C\/em\u003E are particularly prevalent. Treatment may be additionally complex in patients who are obese, as a result of obesity-associated factors such as decreased immune function or dysregulation, the presence of comorbidities, and respiratory dysfunction. Furthermore, the pharmacokinetics\/pharmacodynamics of \u03b2-lactam antibiotics may be altered in patients who are obese [Pai MP, Bearden DT. \u003Cem\u003EPharmacotherapy\u003C\/em\u003E. 2007].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETwo presentations reporting on different subsets of patients focused on the safety profile and efficacy of ceftolozane\/tazobactam (TOL\/TAZ) plus metronidazole (MTZ) in the treatment of cIAIs based on data from the ASPECT-cIAI trial [Solomkin J et al. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EChristian Eckmann, MD, Academic Hospital of Medical University Hannover, Peine, Germany, presented data assessing TOL\/TAZ plus MTZ compared with meropenem (MER) in European patients. TOL\/TAZ, which is currently approved by the FDA for the treatment of complicated urinary tract infections and cIAIs, has demonstrated activity against \u003Cem\u003EPseudomonas aeruginosa\u003C\/em\u003E in vitro, including organisms with drug-resistant mechanisms [Farrell DJ et al. \u003Cem\u003EAntimicrob Agents Chemother\u003C\/em\u003E. 2013]. While TOL\/TAZ is active against some of the most common anaerobic pathogens encountered in cIAI, including \u003Cem\u003EBacteroides fragilis\u003C\/em\u003E, it is not active against all anaerobic pathogens; therefore, it must be used with MTZ in patients with cIAIs [Snydman DR et al. \u003Cem\u003EAntimicrob Agents Chemother\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the international double-blind phase 3 ASPECT-cIAI trial, 993 adults with clinical evidence of cIAI were randomly assigned to receive TOL\/TAZ 1.5 g plus MTZ 500 mg every 8 hours or MER 1 g every 8 hours intravenously for 4 to 14 days [Solomkin J et al. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E. 2015]. Patients were excluded if the cIAI was managed by staged abdominal repair without closed fascia, the source control during surgery was likely inadequate, systemic antimicrobials were used to treat cIAI for \u0026gt;\u200524 hours prior to initiation of study drug, the creatine clearance was \u0026lt;\u200530 mL\/min, and there was a presence of septic shock.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients (n\u2005=\u2005764) enrolled in European centers were analyzed. The mean age was 51.4 years, and about 56% of patients were men. At baseline, 51.5% of patients received prior antibiotic therapy, and the mean Acute Physiology and Chronic Health Evaluation II score was 6. Major anatomic locations of the cIAI included the appendix, biliary tract, small bowel, and colon.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAt the test-of-cure visit (24 to 32 days from start of therapy), the overall clinical cure rates were similar between treatment arms, with a weighted difference of 0.6 (99% CI, \u22123.99 to 5.13) in the clinically evaluable population. However, the clinical cure rates differed among the treatment arms according to pathogen (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). TOL\/TAZ plus MTZ treatment resulted in greater clinical cure rates in patients infected with \u003Cem\u003EKlebsiella pneumonia\u003C\/em\u003E, ESBL-producing \u003Cem\u003EKlebsiella pneumoniae\u003C\/em\u003E, and \u003Cem\u003EP aeruginosa\u003C\/em\u003E compared with MER. In contrast, MER treatment resulted in higher clinical cure rates in patients infected with \u003Cem\u003EEnterobacter cloacae\u003C\/em\u003E compared with TOL\/TAZ treatment.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16616\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16616\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16616\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EClinical Cure Rates According to Pathogen in European Patients in ASPECT-cIAI\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003ETreatment-emergent adverse events (TEAEs) occurred more frequently in the TOL\/TAZ plus MTZ arm compared with the MER arm (36.9% vs 34.5%). Common TEAEs included nausea, vomiting, diarrhea, pyrexia, hypokalemia, and insomnia. Serious TEAEs occurred in 7% of patients in the TOL\/TAZ arm and 4.7% of patients in the MER arm. In the TOL\/TAZ and MER arms, 9 and 5 deaths occurred, respectively; however, the investigators determined that the deaths were due to treatment failures for unrelated conditions or were indeterminate and not associated with the study drugs. In the study, 10 (2.7%) and 7 (1.8%) of patients who received TOL\/TAZ and MER, respectively, discontinued the study due to TEAEs.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIn conclusion, Prof Eckmann stated that the data from the ASPECT-cIAI trial suggest that treatment of cIAI with TOL\/TAZ plus MTZ resulted in high clinical cure rates, with greater success than MER for the pathogen \u003Cem\u003EP aeruginosa\u003C\/em\u003E and many Enterobacteriaceae, including ESBL-positive strains.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EBenjamin Miller, PharmD, Cubist Pharmaceuticals, Lexington, Massachusetts, USA, presented a post hoc analysis of the ASPECT-cIAI trial assessing clinical response in nonobese and obese patients. Of the total patients in the trial, 239 were considered obese, with a mean body mass index (BMI) of 32.9 kg\/m\u003Csup\u003E2\u003C\/sup\u003E.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThe clinical cure rates with TOL\/TAZ treatment were somewhat lower vs MER in patients who were nonobese (BMI\u2005\u0026lt;\u200530; 83.8% vs 87.5%), whereas they were higher in patients who were obese (BMI\u2005\u2265\u200530; 84.3% vs 82.3%). In addition, TOL\/TAZ treatment appeared to be least effective in patients with a mean BMI of \u2265\u200525 to \u0026lt;\u200530 kg\/m\u003Csup\u003E2\u003C\/sup\u003E (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). However, Dr Miller concluded that, overall, TOL\/TAZ efficacy and safety outcomes were similar between nonobese and obese patients.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Clinical Cure Rates in ASPECT-cIAI According to BMIBMI, body mass index; MER, meropenem; MTZ, metronidazole; TOL\/TAZ, ceftolozane\/tazobactam.Reproduced with permission from B Miller, PharmD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2065277106\u0022 data-figure-caption=\u0022Clinical Cure Rates in ASPECT-cIAI According to BMIBMI, body mass index; MER, meropenem; MTZ, metronidazole; TOL\/TAZ, ceftolozane\/tazobactam.Reproduced with permission from B Miller, PharmD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16615\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EClinical Cure Rates in ASPECT-cIAI According to BMI\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EBMI, body mass index; MER, meropenem; MTZ, metronidazole; TOL\/TAZ, ceftolozane\/tazobactam.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EReproduced with permission from B Miller, PharmD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003EThe most common TEAEs in obese and nonobese patients included diarrhea, nausea, vomiting, and pyrexia, with diarrhea and nausea occurring more commonly in obese patients in the TOL\/TAZ plus MTX arm vs the MER arm.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003ETo conclude, BMI had no impact on clinical outcomes in patients treated with TOL\/TAZ plus MTZ. With the exception of diarrhea and nausea in the obese subset, TEAEs were comparable between the 2 treatment arms.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/48\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzllxf\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}