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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\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses data on the effects of neoadjuvant and adjuvant chemotherapy (CT) and chemoradiotherapy (CRT) in patients undergoing surgery for gastroesophageal cancer. Evidence on the ways to improve morbidity and mortality associated with esophagectomy is also reviewed.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHead \u0026amp; Neck Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn this session, the first 2 presenters discussed data on the effects of neoadjuvant and adjuvant chemotherapy (CT) and chemoradiotherapy (CRT) in patients undergoing surgery for gastro-esophageal cancer. The third presenter reviewed evidence on the ways to improve morbidity and mortality associated with esophagectomy.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENEOADJUVANT TREATMENT FOR GASTROESOPHAGEAL JUNCTION CANCER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAdvantages of neoadjuvant CT for gastroesophageal junction (GEJ) cancer include downstaging of disease, treatment of micrometastases, evaluation of chemosensitivity, and improved safety of CT before postoperative morbidity, according to Marc Ychou, MD, Centre R\u00e9gional de Lutte Contre le Cancer Val d\u0027Aurelle, Montpellier, France. Disadvantages include disease progression before surgery, increased postoperative morbidity, and difficult primary tumor response assessment.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe Medical Research Council Adjuvant Gastric Infusional Chemotherapy [MAGIC; Cunningham D et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2006] and F\u00e9d\u00e9ration Nationale des Centres de Lutte contre le Cancer (FNCLCC)\u2013F\u00e9d\u00e9ration Francophone de Canc\u00e9rologie Digestive (FFCD) [Ychou M et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2011] trials evaluated perioperative CT and surgery (CT + S) compared with surgery alone (S) in patients with GEJ.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ETumor downstaging was significantly greater in the MAGIC CT + S group versus S group (tumor, p = .009; nodes, p = .01), but there was no significant difference between the CT + S and S groups in the FNCLCC-FFCD study. The curative resection (R0) rate for the CT + S arm versus S arm was 69.3% versus 66.4% in the MAGIC study and 84% versus 74% (p = .04) in the FNCLCC-FFCD study. Five-year overall survival (OS) was better with CT + S versus S in the MAGIC trial (36% vs 23%; HR, 0.75; 95% CI, 0.60 to 0.93; p = .009) and FNCLCC-FFCD trial (38% vs 24%; HR, 0.69; 95% CI, 0.50 to 0.95; p = .02), respectively.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ETumor recurrence was reported in 39% versus 57% (MAGIC) and 55% versus 64% (FNCLCC-FFCD) of patients in the CT + S versus S groups, respectively.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EA meta-analysis found that preoperative CT + S versus S for GEJ cancer was associated with longer overall survival (HR, 0.81; 95% CI, 0.73 to 0.89; p \u0026lt; .0001), longer disease-free survival (DFS), and higher R0 and downstaging rates [Ronellenfitsch U et al. \u003Cem\u003EEur J Cancer\u003C\/em\u003E. 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EChris Willet, MD, Duke University Medical Center, Durham, North Carolina, USA, presented evidence for the use of neoadjuvant CRT in patients with GEJ cancer. He agreed that perioperative CT improves progression-free survival and OS. However, the impact of CT is modest, and the evidence on extent of resection is inconclusive. Furthermore, perioperative CT has no impact on locoregional failure (LRF) and distant metastasis (DM).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ENeoadjuvant and adjuvant CRT have been shown to improve locoregional control and enhance survival (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \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\/14859\/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\/14859\/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\/14859\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 \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EAdjuvant and Neoadjuvant CRT Studies\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EIn the Intergroup 0116 trial, patients treated with adjuvant CRT versus S had improved OS and DFS and decreased relapse, LRF, and DM rates [MacDonald JS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2001; Smalley SR et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2012]. The CROSS trial demonstrated that neoadjuvant CRT improves R0 rates and OS and decreases LRF, DM, and peritoneal carcinomatosis [van Hagen P et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2012; Oppedijk V et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2014]. In a comparison of neoadjuvant CT versus CRT in patients with esophageal cancer, preoperative CRT improved OS only in locally advanced esophagogastric adenocarcinoma [Stahl M et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E. 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EDr Willet concluded that neoadjuvant CRT improves LRF and enhances survival. Neoadjuvant or perioperative CT improves survival by increasing the extent of resection and decreasing DM. Dr Willett concluded that neoadjuvant CRT and perioperative CT are effective.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESTRATEGIES FOR IMPROVING MORBIDITY AND MORTALITY ASSOCIATED WITH ESOPHAGECTOMY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EChristophe Mariette, MD, PhD, University Hospital of Lille, France, explored ways to improve surgery outcomes in patients with esophageal cancer. Appropriate patient selection is important to reduce morbidity and mortality associated with surgery. Relative contraindications include severe or multiple comorbidities, weight loss \u0026gt; 15% not corrected by nutritional support, grade \u2265 3 arteriopathy, and cirrhosis with no portal hypertension. In the past, age \u0026gt; 70 years was considered a contraindication, but now surgery is being performed successfully in patients in their 80s. Absolute contraindications include persistent weight loss \u0026gt; 20% despite nutritional support, World Health Organization performance status 3 or 4, respiratory insufficiency, decompensated cirrhosis or portal hypertension, and cardiac or renal insufficiency.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EPreoperative conditioning includes tobacco and alcohol cessation, buccodental hygiene, and respiratory physiotherapy and rehabilitation. Malnutrition is present in 60% to 85% of surgery candidates. Patients who have lost weight have higher operative mortality and morbidity rates than patients who maintain their weight. Prof Mariette et al [\u003Cem\u003EAnn Surg Oncol\u003C\/em\u003E. 2012] published guidelines for nutritional supplementation in surgery candidates (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Weight loss \u0026lt; 10% should be treated with oral supplements, while enteral feeding is necessary for \u0026gt; 10% loss. Immunoenhanced nutrition decreases morbidity after gastrointestinal surgery [Cerantola Y et al. \u003Cem\u003EBR J Surg.\u003C\/em\u003E 2012]. A Phase 3 trial is investigating immunoenhanced nutrition during the neoadjuvant phase [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01423799\u0026amp;atom=%2Fspmdc%2F14%2F22%2F21.atom\u0022\u003ENCT01423799\u003C\/a\u003E].\u003C\/p\u003E\n         \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\/14\/22\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Algorithm for Preoperative and Postoperative Nutritional Supplementation\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-268069928\u0022 data-figure-caption=\u0022Algorithm for Preoperative and Postoperative Nutritional Supplementation\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\/14\/22\/21\/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\/14\/22\/21\/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\/14\/22\/21\/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\/14857\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EAlgorithm for Preoperative and Postoperative Nutritional Supplementation\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EEN=enteral nutrition.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced from Mariette C et al. Surgery in esophageal and gastric cancer patients: what is the role for nutrition support in your daily practice? \u003Cem\u003EAnn Surg Oncol.\u003C\/em\u003E 2012;19:2128\u20132134. With kind permission from Springer Science and Business Media.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-16\u0022\u003ESurgical technique affects the outcomes of surgery. An extended transthoracic esophagectomy with R0 resection and extended 2-field lymphadenectomy with examination of \u2265 23 lymph nodes can reduce recurrences and improve survival [Mariette C et al. \u003Cem\u003ELancet Oncol.\u003C\/em\u003E 2011; Peyre CG et al. \u003Cem\u003EAnn Surg\u003C\/em\u003E. 2008]. Minimally invasive esophagectomy (MIE) has outcomes similar to open esophagectomy, with reduced blood loss, shorter hospital stay, and decreased morbidity and respiratory complications [Mariette C et al. \u003Cem\u003ERecent Results Cancer Res.\u003C\/em\u003E 2010; Nagpal K et al. \u003Cem\u003ESurg Endosc\u003C\/em\u003E. 2010]. A randomized trial of MIE (n = 56) versus open esophagectomy (n = 59) demonstrated reduced pulmonary infection in-hospital and within 2 weeks and no significant difference in nodes resected, R0 rates, and in-hospital and 30-day mortality [Biere SS et al. \u003Cem\u003ELancet\u003C\/em\u003E. 2012]. An ongoing multicenter randomized trial will assess morbidity, mortality, DFS, OS, and quality of life with laparoscopic MIE versus open esophagectomy [Briez N et al. \u003Cem\u003EBMC Cancer\u003C\/em\u003E. 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EEnhanced recovery after surgery, or fast-track surgery, uses accelerated postoperative convalescence with a multimodal rehabilitation program to attenuate stress response and enable rapid recovery after surgery. Munitiz V et al [\u003Cem\u003EBr J Surg\u003C\/em\u003E. 2010] found that patients with a clinical pathway for multidisciplinary postoperative management had significantly reduced pulmonary complications (14% vs 23%; p = .025), postoperative mortality (1% vs 5%; p = .010), and hospital stay (5 to 98 vs 8 to 106 days; p = .012) versus controls.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EA systematic review and meta-analysis found that postoperative mortality and long-term survival (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) are reduced at high-versus low-volume centers [Wouters MW et al. \u003Cem\u003ECancer\u003C\/em\u003E. 2012].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\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\/14\/22\/21\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Center Volume and Long-term Survival\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-268069928\u0022 data-figure-caption=\u0022Center Volume and Long-term Survival\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/22\/21\/F2.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\/14\/22\/21\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\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\/14\/22\/21\/F2.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\/14858\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-19\u0022 class=\u0022first-child\u0022\u003ECenter Volume and Long-term Survival\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Wouters MW et al. The volume-outcome relation in the surgical treatment of esophageal cancer. \u003Cem\u003ECancer.\u003C\/em\u003E 2012;118:1754\u20131763. With permission from John Wiley \u0026amp; Sons.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EThe evidence shows that surgical outcomes can be improved with appropriate patient selection and preconditioning. Outcomes are also improved with the enhanced recovery after surgery approach and in high-volume centers.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\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\/14\/22\/21.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?nzl66q\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?nzl66q\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?nzl66q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}