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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\u003EThis article discusses current recommendations for lung cancer screening, as well as some of the similarities and differences between the clinical practice guidelines of the European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) for treatment of lung cancer. This article also compares these guidelines for early-stage and locally advanced non\u2014small cell lung cancer (NSCLC), demonstrating that despite their similarities, there are often subtle differences in their recommendations.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESmoking Cessation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECancer Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESmoking Cessation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EJames L. Mulshine, MD, Rush University Medical Center, Chicago, Illinois, USA, launched a series of presentations that discussed current recommendations for lung cancer screening, as well as some of the similarities and differences between the clinical practice guidelines of the European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) for treatment of lung cancer.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESCREENING GUIDELINES FOR NON-SMALL CELL LUNG CANCER (NSCLC)\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ELung cancer is the most common of all annual tobacco-related deaths (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Yet despite the declining rate of heavy smoking in the United States, more than 90 million current or former smokers remain at risk for lung cancer. Because the introduction of low-dose spiral computed tomography (CT) has enhanced the ability to detect lung cancer early, and therefore increased its curability, researchers conducting the National Lung Screening Trial (NLST) sought to determine whether screening with CT could reduce lung cancer mortality.\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\/3\/26\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Causes of Tobacco-Related Death\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-714166227\u0022 data-figure-caption=\u0022Causes of Tobacco-Related Death\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\/3\/26\/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\/3\/26\/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\/3\/26\/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\/15816\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-4\u0022 class=\u0022first-child\u0022\u003ECauses of Tobacco-Related Death\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ESource: CDC. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses\u2014United States, 1997\u20132001. \u003Cem\u003EMMWR\u003C\/em\u003E 2005;54(25):6 25\u2013628.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThis was a randomized, multicenter trial involving more than 53,000 participants (55 to 74 years of age) who were current or former smokers with a history of at least 30 pack-years, and were considered to be at high risk of lung cancer. Participants were randomly assigned to receive either CT or chest radiography (CXR) at 3 annual screenings (baseline, Year 1, and Year 2), with follow-up throughout 6 years. A positive screening was obtained in 24.2% and 6.9% of the CT and CXR groups, respectively, and the rate of false positives was 96.4% and 94.5%, respectively.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe incidence of lung cancer was higher in the CT group compared with the CXR group (645 cases per 100,000 person-years [1,060 cancers] vs 572 cases per 100,000 person-years [941 cases]; risk ratio, 1.13; 95% CI, 1.03 to 1.23). The incidence of death was lower in the CT group compared with the CXR group (247 vs 309 per 100,000 person-years), demonstrating that patients screened with low-dose CT had a 20% lower risk of dying from lung cancer than those screened by CXR (95% CI, 6.8 to 26.7; p=0.004). The rate of death from any cause was also reduced by 6.7% in the CT group (95% CI, 1.2 to 13.6; p=0.02) [National Lung Screening Trial Research Team. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe results from the NLST also formed much of the basis for the recently updated guidelines on lung cancer screening published by the United States Preventive Services Task Force (USPSTF). These guidelines recommend annual lung cancer screening with low-dose CT in asymptomatic, average- or high-risk patients (55 to 79 years) with a 30 pack-year history of smoking who currently smoke or stopped within the past 15 years [Moyer VA and US Preventive Services Task Force. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2014]. The NCCN guidelines provide a management schema for the evaluation of findings from screenings (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\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\/3\/26\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Management of Screening Results: Recommendations from the National Comprehensive Cancer Network\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-714166227\u0022 data-figure-caption=\u0022Management of Screening Results: Recommendations from the National Comprehensive Cancer Network\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\/3\/26\/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\/3\/26\/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\/3\/26\/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\/15818\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-8\u0022 class=\u0022first-child\u0022\u003EManagement of Screening Results: Recommendations from the National Comprehensive Cancer Network\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ELDCT=low-dose computed tomography; PET\/CT=positron emission tomography\/computed tomography.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003ESource: National Comprehensive Cancer Network.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDespite the benefits of lung cancer screening, however, the USPSTF emphasized that lung cancer is still a tobacco-related disease, and lung cancer screening cannot help with the many other tobacco-related causes of death beyond lung cancer.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EAlthough continued smoking results in a markedly elevated risk of lung cancer throughout time, more than half of new lung cancers arise in individuals who stopped smoking. Even when a patient has stopped smoking for decades, lung cancer risk does not return to the never-smoker level (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Vineis P et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2004].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F3\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\/3\/26\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The Lifelong Risk of Lung Cancer After Stopping Smoking\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-714166227\u0022 data-figure-caption=\u0022The Lifelong Risk of Lung Cancer After Stopping Smoking\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/3\/26\/F3.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\/3\/26\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\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\/3\/26\/F3.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\/15820\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 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EThe Lifelong Risk of Lung Cancer After Stopping Smoking\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Vineis P et al. Tobacco and Cancer: Recent Epidemiological Evidence. \u003Cem\u003EJCNI\u003C\/em\u003E 2004;96:99\u2013106. With permission from Oxford University Press.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EScreening is therefore not an alternative to smoking cessation, and Dr. Mulshine stressed that every effort should still be made to continue to help people to stop smoking. Using data from a cost-utility analysis of lung cancer screening based on data from the NLST, he showed that repeat annual screening in the high-risk population is predicted to be highly cost-effective and could save more than 985,000 quality-adjusted life years throughout the next 15 years. Adding a smoking cessation intervention to that screening process could further improve its cost-effectiveness [Villanti AC et al. \u003Cem\u003EPLoS One\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe demographics of cancer are also evolving in general. The United States\u0027 population is aging, and during the next 20 years, the incidence of cancer will increase in older adults compared with younger adults. In 2030, the incidence of all cancers is predicted to increase by about 60% in older adults and by about 11% in younger adults [Smith B et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2009]. Consequently, the need for lung cancer screening is high.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETREATMENT GUIDELINES FOR NSCLC\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EHealth care professionals have access to numerous published guidelines that serve as important resources to assist the clinical decision-making process. ESMO [Vansteenkiste I et al. \u003Cem\u003EAnn Oncol\u003C\/em\u003E 2013; Fruh M et al. \u003Cem\u003EAnn Oncol\u003C\/em\u003E 2013], ASCO [Pisters KMW et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2007], and NCCN [Ettinger DS et al. \u003Cem\u003EJ Natl Compr Canc Netw\u003C\/em\u003E 2013] all publish clinical practice guidelines for the management of lung cancer. Wilfried Eberhardt, MD, University Hospital Essen, Essen, Germany, compared these guidelines for early-stage and locally advanced NSCLC, demonstrating that despite their similarities, there are often subtle differences in their recommendations.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EFor example, in all 3 guidelines, the goal of surgery in stage I and II disease is complete resection. There are, however, some differences with respect to mediastinal evaluation. In the ESMO guidelines, mediastinal lymph node (LN) dissection is based on the International Association for the Study of Lung Cancer (IASCL) criteria. And although systematic LN dissection and sampling are discussed in the NCCN guidelines, no data are given in the ASCO guidelines for the surgical approaches to these cases.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EFor diagnosis of locally advanced stage III disease, both the ESMO and NCCN guidelines recommend the use of CT and positron emission tomography bronchoscopy. Similarly, they both advise endobronchial ultrasound and endoscopic ultrasound of suspicious LNs, followed by mediastinography if those investigations are negative. No data are available in the ASCO guidelines, however, to guide the diagnostic approach.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EEnriqueta Felip, MD, PhD, Vall d\u0027Hebron University Hospital, Barcelona, Spain, compared the guidelines for treatment of stage IV disease. For patients with epidermal growth factor receptor (EGFR)-mutated NSCLC, for example, the ESMO guidelines recommend the EGFR tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib as the preferred first-line treatment, whereas the NCCN recommends erlotinib or afatinib. Prof. Felip also shared the recently published recommendations from the 2nd ESMO Consensus Conference on Lung Cancer, another source of recommendations for lung cancer management. These guidelines address questions on various areas, including treatment of advanced NSCLC, and they also recommend the use of an EGFR-TKI as the preferred first-line treatment for EGFR-mutated NSCLC [Besse B et al. \u003Cem\u003EAnn Oncol\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EIn conclusion, Prof. Eberhardt emphasized that no single clinical practice guideline is optimal, but all are complementary. Because the guidelines range from purely evidence-based recommendations, as in the ASCO and ESMO publications, to very practical guidelines with algorithms that discuss clinical scenarios, as in the NCCN publication, he stressed that the choice of guideline must be governed by the physician\u0027s needs and expectations.\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\/3\/26.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?nzpb9d\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?nzpb9d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}