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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.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\u003EPatients with heart failure (HF) often remain symptomatic and have a poor prognosis despite treatment with existing therapies [Cleland JG et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011]. Several new therapeutic options are currently emerging for HF, including direct renin inhibitors, neprilysin inhibitors, selective If channel inhibitors, cardiac myosin activators, vasopressin receptor antagonists, and phosphodiesterase type 5 inhibitors. This article discusses clinical trial data for direct renin inhibitors and neprilysin inhibitors.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPatients with heart failure (HF) often remain symptomatic and have a poor prognosis despite treatment with existing therapies [Cleland JG et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011]. Several new therapeutic options are currently emerging for HF, including direct renin inhibitors, neprilysin inhibitors, selective \u003Cem\u003EIf\u003C\/em\u003E channel inhibitors, cardiac myosin activators, vasopressin receptor antagonists, and phosphodiesterase type 5 (PDE-5) inhibitors. Barry H. Greenberg, MD, University of California, San Diego, La Jolla, California, USA, discussed clinical trial data for direct renin inhibitors and neprilysin inhibitors.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESeveral trials are ongoing or have been completed for aliskiren, which binds to the active site of renin to block production of angiotensin I. In the ALOFT trial [McMurray JJ et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2008], aliskiren significantly reduced plasma brain natriuretic peptide (BNP) concentrations compared with placebo (p=0.0106) in patients with HF and a history of hypertension who had been treated with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker and \u03b2-blocker.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EResults were less promising in the ALTITUDE trial [Parving HH et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012] in which patients with type 2 diabetes who were at high risk for cardiovascular (CV) and renal events were randomized to receive aliskiren or placebo in addition to standard therapy. The trial was stopped prematurely due to a significantly higher occurrence of hyperkalemia (11.2% vs 7.2%) and hypotension (12.1% vs 8.3%) in the aliskiren group compared with the placebo group (p\u0026lt;0.001) and no apparent benefit.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOverall, aliskiren should be used with caution in this patient population due to the risk of hyperkalemia in patients on background renin-angiotensin-aldosterone system antagonists.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ELCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, significantly reduced N-terminal pro (BNP) compared with valsartan (p=0.005) in a Phase 2 trial in patients with HF [PARAMOUNT; Solomon SD et al. \u003Cem\u003ELancet\u003C\/em\u003E 2012]. The PARADIGM-HF study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01035255\u0026amp;atom=%2Fspmdc%2F13%2F2%2F34.atom\u0022\u003ENCT01035255\u003C\/a\u003E], a Phase 3 trial comparing LCZ696 with enalapril in patients with HF with reduced ejection fraction, is currently underway.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EMaya E. Guglin, MD, PhD, University of South Florida, Tampa, Florida, USA, presented data and guidelines for ivabradine, a selective \u003Cem\u003EIf\u003C\/em\u003E channel inhibitor. SHIFT [Swedberg K et al. \u003Cem\u003ELancet\u003C\/em\u003E 2010] enrolled 6558 patients with symptomatic HF, left ventricular ejection fraction (LVEF) of \u226435%, sinus rhythm with heart rate \u226570 bpm, on stable doses of background treatment, who had been admitted to the hospital for HF in the previous year.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe primary endpoint for SHIFT was the composite of CV death and hospital admission for worsening HF [Swedberg K et al. \u003Cem\u003ELancet\u003C\/em\u003E 2010]. In the ivabradine group, 24% of patients had a primary endpoint event compared with 29% of patients in the placebo group (p\u0026lt;0.0001). Based on these data, the European Society of Cardiology recommends the use of ivabradine in the situations outlined in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E [McMurray JJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012].\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\/13151\/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\/13151\/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\/13151\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-9\u0022 class=\u0022first-child\u0022\u003EEuropean Society of Cardiology Recommendations for the Use of Ivabradine\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EFady Malik, MD, PhD, Amgen, San Francisco, California, USA, provided an update on the status of omecamtiv mecarbil, a direct cardiac myosin activator. In the Phase 1, placebo-controlled, dose-escalation study, CY 1111 [Teerlink JR et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011], omecamtiv mecarbil infusion resulted in dose-dependent increases in systolic ejection time (p\u0026lt;0.0001). Stroke volume, fractional shortening, and ejection fraction were also significantly increased at a dose of 0.5 mg\/kg\/hour of omecamtiv mecarbil (p\u0026lt;0.0001).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIn the placebo-controlled, dose-ranging Phase 2 trial, CY 1121 [Cleland JG et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011], omecamtiv mecarbil was given intravenously for 2, 24, or 72 hours to patients with HF and LV systolic dysfunction receiving guideline-indicated treatment. Placebo-corrected changes from baseline indicated concentration-dependent increases in LV ejection time and stroke volume (p\u0026lt;0.0001). A small reduction in heart rate was also noted (p\u0026lt;0.0001).\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EIn both CY 1111 and CY 1121, there was no consistent pattern of adverse events in patients tolerant of all study-drug infusions. Myocardial ischemia occurred at high plasma concentrations of omecamtiv mecarbil and was the dose-limiting toxic effect.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EMarvin A. Konstam, MD, Tufts Medical Center, Boston, Massachusetts, USA, discussed the treatment of hyponatremia with vasopressin antagonists in patients with HF. EVEREST [Gheorghiade M et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007; Konstam MA et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007] was 2 identical short-term Phase 3 trials and one long-term outcome trial investigating the effects of tolvaptan, a vasopressin 2 receptor antagonist, in patients hospitalized for HF (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\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\/13\/2\/34\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022EVEREST Objectives\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1139495830\u0022 data-figure-caption=\u0022EVEREST Objectives\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\/13\/2\/34\/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\/13\/2\/34\/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\/13\/2\/34\/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\/13149\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\u003EEVEREST Objectives\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission frm MA Konstam, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EThe primary endpoints for EVEREST were all-cause mortality and CV death or hospitalization. No significant difference was observed in all-cause mortality (p=0.68), or the number of CV deaths or hospitalizations for HF (p=0.55) between the tolvaptan and placebo groups [Konstam MA et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EHowever, in the EVEREST post hoc subgroup analysis of HF patients with hyponatremia (Na \u0026lt;130 mEq\/L), the point estimate favored tolvaptan for all-cause mortality, and for the number of CV deaths or hospitalizations (p\u0026lt;0.05). According to Dr. Konstam, the data suggest that further studies are warranted with vaptans in HF patients who have hyponatremia.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EMarc J. Semigran, MD, Harvard Medical School, Boston, Massachusetts, USA, provided an overview of PDE-5 inhibitor treatment in patients with HF. Several clinical trials have investigated the clinical viability of PDE5Is as adjunct treatment for HF.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EThe Chronic Sildenafil Treatment in Heart Failure trial [Guazzi M et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2011] examined the effect of sildenafil in patients with stable systolic HF. Sildenafil significantly increased exercise capacity as measured by peak oxygen consumption (VO\u003Csub\u003E2\u003C\/sub\u003E) at 6 and 12 months of treatment compared with placebo (p\u0026lt;0.01). The ventilation relative to carbon dioxide production (VE\/VCO\u003Csub\u003E2\u003C\/sub\u003E) slope was significantly decreased in the sildenafil group compared with the placebo group at 6 and 12 months (p\u0026lt;0.01).\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EIn the same study, sildenafil also improved LV systolic dysfunction by reversing LV remodeling. LV end-diastolic volume and LV mass index were significantly decreased in the sildenafil group compared with the placebo group (p\u0026lt;0.01). In addition, LVEF was significantly improved by sildenafil compared with placebo (p\u0026lt;0.01) [Guazzi M et al. \u003Cem\u003ECirc Heart Fail\u003C\/em\u003E 2011]. The PDE5 Inhibition and Pulmonary Hypertension in Diastolic Heart Failure trial [Guazzi M et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2011] evaluated sildenafil treatment in patients with HF with preserved EF. By 6 months after the start of treatment, sildenafil had mediated significant improvements in right ventricular function (p\u0026lt;0.01) and pulmonary function (p\u0026lt;0.01). Pulmonary arteriolar resistance was decreased with sildenafil by 69%\u00b118.0% (p\u0026lt;0.01).\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EAlthough further studies are still necessary to determine the role of most of these emerging agents in the treatment of HF, many may offer potential options for improving the future management of this challenging disease.\u003C\/p\u003E\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\/13\/2\/34\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Chronic PDE5 Inhibition Improves Left Ventricular Systolic Dysfunction\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1139495830\u0022 data-figure-caption=\u0022Chronic PDE5 Inhibition Improves Left Ventricular Systolic Dysfunction\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\/13\/2\/34\/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\/13\/2\/34\/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\/13\/2\/34\/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\/13150\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-22\u0022 class=\u0022first-child\u0022\u003EChronic PDE5 Inhibition Improves Left Ventricular Systolic Dysfunction\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ELVEDV=left ventricular end diastolic volume; LVMI=left ventricular myocardial infarction; LVEF-left ventricular ejection fraction; PDE-5=phosphodiesterase type 5.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003E*p\u0026lt;0.01 vs placebo; #p\u0026lt;0.01 vs baseline.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Guazzi M et al. PDE5 Inhibition With Sildenafil Improves Left Ventricular Diastolic Function, Cardiac Geometry, and Clinical Status in Patients With Stable Systolic Heart Failure: Results of a 1-Year, Prospective, Randomized, Placebo-Controlled Study. Circulation Heart Failure 2011;4(1)8\u201317.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 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\/13\/2\/34.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?nzo24e\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?nzo24e\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?nzo24e\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}