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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\u003Cp id=\u0022p-1\u0022\u003ERecent publications were presented highlighting new molecular and genomic approaches for rapid diagnosis and susceptibility testing, and management of invasive fungal infections. Emphasis was on serum galactomannan assay and polymerase chain reaction\u2013based detection of invasive Aspergillosis and other fungal infections in children and adults.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Efungal infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediagnostic strategies\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einvasive Aspergillosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Egalactomannan assay\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evoriconazole\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003E\n               \u003Cem\u003ECandida glabrata\u003C\/em\u003E\n            \u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecaspofungin\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eantifungal\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einfectious diseases clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThis session was devoted to a review of the most important recent papers in diagnostic and susceptibility testing, and management of fungal infections. Rosemary Barnes, MD, Cardiff University Institute of Infection and Immunity, Cardiff, United Kingdom, opened with her assessment of the top 10 recent studies describing diagnostic strategies and susceptibility testing.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe first study reviewed showed that a combined strategy of serum galactomannan (GM) assay and polymerase chain reaction (PCR)\u2013based detection of serum \u003Cem\u003EAspergillus\u003C\/em\u003E DNA monitoring was associated with an earlier diagnosis and a lower incidence of invasive aspergillosis (IA) in high-risk hematologic malignancy and hematopoietic stem-cell transplant patients [Aguado JM et al. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the next study, which assessed definitions, the investigators found that using the European Organization for Research and Treatment of Cancer\/Mycoses Study Group 2008 definitions of IA vs the earlier definitions from the Global Comparative Aspergillus Study resulted in a better classification of the episodes and confirmed the higher efficacy of voriconazole (VRC) over amphotericin B deoxycholate as initial therapy in mycologically documented IA (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Herbrecht R et al. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E. 2015].\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\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Voriconazole Improves 12-Week Survival Compared With AmB DeoxycholateAmB, amphotericin B; IA, invasive aspergillosis; VOR, voriconazole.A, possible, probable, and proven IA; B, probable and proven IA; C, possible IA; D, possible, probable, and proven IA in allogenic hematopoietic stem cell transplant recipients.Reprinted from Herbrecht R et al, Application of the 2008 Definitions for Invasive Fungal Diseases to the Trial Comparing Voriconazole Versus Amphotericin B for Therapy of Invasive Aspergillosis: A Collaborative Study of the Mycoses Study Group (MSG 05) and the European Organization for Research and Treatment of Cancer Infectious Diseases Group. Clin Infect Dis, 2015; Vol 60; Issue 5: Pages 713-720, by permission of Oxford University Press on behalf of the Infectious Diseases Society of America.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1141921769\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Voriconazole Improves 12-Week Survival Compared With AmB DeoxycholateAmB, amphotericin B; IA, invasive aspergillosis; VOR, voriconazole.A, possible, probable, and proven IA; B, probable and proven IA; C, possible IA; D, possible, probable, and proven IA in allogenic hematopoietic stem cell transplant recipients.Reprinted from Herbrecht R et al, Application of the 2008 Definitions for Invasive Fungal Diseases to the Trial Comparing Voriconazole Versus Amphotericin B for Therapy of Invasive Aspergillosis: A Collaborative Study of the Mycoses Study Group (MSG 05) and the European Organization for Research and Treatment of Cancer Infectious Diseases Group. \u0026amp;lt;em\u0026amp;gt;Clin Infect Dis\u0026amp;lt;\/em\u0026amp;gt;, 2015; Vol 60; Issue 5: Pages 713-720, by permission of Oxford University Press on behalf of the Infectious Diseases Society of America.\u0026amp;lt;\/div\u0026amp;gt;\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\/22\/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\/22\/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\/22\/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\/16623\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-5\u0022 class=\u0022first-child\u0022\u003EVoriconazole Improves 12-Week Survival Compared With AmB Deoxycholate\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAmB, amphotericin B; IA, invasive aspergillosis; VOR, voriconazole.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EA, possible, probable, and proven IA; B, probable and proven IA; C, possible IA; D, possible, probable, and proven IA in allogenic hematopoietic stem cell transplant recipients.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EReprinted from Herbrecht R et al, Application of the 2008 Definitions for Invasive Fungal Diseases to the Trial Comparing Voriconazole Versus Amphotericin B for Therapy of Invasive Aspergillosis: A Collaborative Study of the Mycoses Study Group (MSG 05) and the European Organization for Research and Treatment of Cancer Infectious Diseases Group. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E, 2015; Vol 60; Issue 5: Pages 713-720, by permission of Oxford University Press on behalf of the Infectious Diseases Society of America.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EThe third study looked at patients with hematologic malignancies or hematopoietic cell transplantation having IA diagnosis established by radiographic findings and GM positivity and found these patients had better survival outcomes when treated with a combination of VRC and anidulafungin vs VRC monotherapy [Marr KA et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe next group of studies focused on diagnostic approaches. In study 4, a rapid, noninvasive, pathogen-specific breath test for \u003Cem\u003EAspergillus\u003C\/em\u003E secondary metabolite signature successfully identified IA in patients with suspected fungal pneumonia [Koo S et al. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E. 2014]. In study 5, PLEX-ID, a technique that uses PCR-electrospray ionization\/mass spectrometry for rapid identification of infectious agents, was found to be not useful as a standalone tool for microbiological diagnosis in suspected respiratory infections and had limited impact on management of therapy [Huttner A et al. \u003Cem\u003EClin Microbiol Infect\u003C\/em\u003E. 2014]. Investigators in the next 2 studies determined that a microarray system using the internal transcribed spacer region of the rRNA gene amplified isothermally is an efficient and robust method for identifying a variety of fungal species [Sakai K et al. \u003Cem\u003EMycopathologia\u003C\/em\u003E. 2014] and that testing for urine GM as opposed to serum GM shows potential for IA screening [Duettmann W et al. \u003Cem\u003EMed Mycol\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EStudy 8 validated a new multiplex real-time PCR assay that allows for sensitive and fast detection of \u003Cem\u003EAspergillus\u003C\/em\u003E species directly from bronchoalveolar lavage (BAL) fluid samples [Chong GL et al. \u003Cem\u003EJ Clin Microbiol\u003C\/em\u003E. 2015]. This assay has the potential to detect and differentiate wild-type from azole resistant strains, even if BAL fluid cultures remain negative.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe last 2 studies focused on \u003Cem\u003ECandida\u003C\/em\u003E. Study 9 reported the European Committee on Antimicrobial Susceptibility Testing method compared favorably with the Clinical and Laboratory Standards Institute method for generating minimum inhibitory concentration (MIC) values for most isolates of \u003Cem\u003ECandida\u003C\/em\u003E [Pfaller MA et al. \u003Cem\u003EDiagn Microbiol Infect Dis\u003C\/em\u003E. 2014]; meanwhile, in the final study to be reviewed, the investigators reported that of the current species-specific epidemiologic cutoff values (ECVs) for \u003Cem\u003ECandida glabrata\u003C\/em\u003E, the current caspofungin ECV may not reproducibly differentiate resistant and susceptible \u003Cem\u003EC glabrata\u003C\/em\u003E strains in hospitals with varying MIC distributions [Ben-Ami R et al. \u003Cem\u003EDiagn Microbiol Infect Dis\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003ENext, Souha S. Kanj, MD, American University of Beirut Medical Center, Beirut, Lebanon, discussed the top papers in the management of invasive fungal infections.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThe first paper Prof Kanj reviewed was from a randomized controlled trial that included 454 patients with hematologic malignancies or hematopoietic stem cell transplantation and compared the safety and efficacy of VRC plus anidulafungin with VRC monotherapy [Marr KA et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E. 2015]. Mortality rates at 6 and 12 weeks were lower in the group that received combination therapy, but the results were not statistically significant. In a subgroup with positive GM, however, all-cause mortality was lower and statistically significant with combination therapy (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.037). In contrast, the subsequent study in 181 patients with hematologic malignancies and IA who were treated with primary or salvage therapy with caspofungin, VRC, or the combination of both showed that for primary or salvage therapy, no difference in outcome was noted between combination treatment and VRC monotherapy [Raad II et al. \u003Cem\u003EInt J Antimicrob Agents\u003C\/em\u003E. 2015]. However, in the salvage therapy group, VRC monotherapy led to lower \u003Cem\u003EAspergillus\u003C\/em\u003E-associated death compared with caspofungin monotherapy (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\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\/15\/48\/22\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Probability of IA Deaths by Treatment in Salvage Therapy Group                   P\u0026#x2005;=\u0026#x2005;.11; n\u0026#x2005;=\u0026#x2005;75.IA, invasive aspergillosis.Reprinted from Int J Antimicrob Agents, Vol 45, Raad II et al, Clinical experience of the use of voriconazole, caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies, Pages 283-288, Copyright 2014, with permission from Elsevier.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1141921769\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Probability of IA Deaths by Treatment in Salvage Therapy Group                   \u0026amp;lt;em\u0026amp;gt;P\u0026amp;lt;\/em\u0026amp;gt;\u0026#x2005;=\u0026#x2005;.11; n\u0026#x2005;=\u0026#x2005;75.IA, invasive aspergillosis.Reprinted from \u0026amp;lt;em\u0026amp;gt;Int J Antimicrob Agents\u0026amp;lt;\/em\u0026amp;gt;, Vol 45, Raad II et al, Clinical experience of the use of voriconazole, caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies, Pages 283-288, Copyright 2014, with permission from Elsevier.\u0026amp;lt;\/div\u0026amp;gt;\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\/15\/48\/22\/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\/15\/48\/22\/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\/15\/48\/22\/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\/16624\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\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EProbability of IA Deaths by Treatment in Salvage Therapy Group\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003E\n                  \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.11; n\u2005=\u200575.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EIA, invasive aspergillosis.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EReprinted from \u003Cem\u003EInt J Antimicrob Agents\u003C\/em\u003E, Vol 45, Raad II et al, Clinical experience of the use of voriconazole, caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies, Pages 283-288, Copyright 2014, with permission from Elsevier.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-19\u0022\u003EThe next study assessed the characteristics of IA caused by \u003Cem\u003EAspergillus terreus\u003C\/em\u003E in patients with hematologic malignancy [Hachem R et al. \u003Cem\u003EJ Antimicrob Chemother\u003C\/em\u003E. 2014]. The investigators noted that this form of \u003Cem\u003EA terreus\u003C\/em\u003E has intrinsic or acquired resistance to amphotericin B, is associated with more breakthrough infections, and has a lower rate of final response to antifungal therapy and a higher rate of IA-associated mortality. It appears in younger patients more likely to have leukemia, but less likely to have lymphoma. Factors independently associated with IA death included treatment with azoles and having the \u003Cem\u003EA terreus\u003C\/em\u003E vs non-terreus \u003Cem\u003EAspergillus\u003C\/em\u003E species.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EThe next 2 studies focused on candidiasis. In the first, investigators reported that preemptive (but not prophylactic) caspofungin treatment was safe and significantly reduced the incidence of proven or probable invasive candidiasis (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.04; safety population only) when used in the intensive care unit [Ostrosky-Zeichner L et al. \u003Cem\u003EClin Infect Dis\u003C\/em\u003E. 2014]. The next study reported that 42 days of prophylactic fluconazole treatment compared with placebo did not reduce the incidence of composite death or invasive candidiasis in infants with a birth weight \u0026lt;\u2005750 g [Benjamin DK Jr et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EIn the last study Prof Kanj reviewed, the investigators reported that micafungin, prophylactically administered twice weekly at a dosage of 3 to 4 mg\/kg of body weight in children at high risk for invasive fungal disease, may be a convenient, safe, and efficient alternative for antifungal prophylaxis [Bochennek K et al. \u003Cem\u003EJ Antimicrob Chemother\u003C\/em\u003E. 2015].\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\/22.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?nzlme2\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?nzlme2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}