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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\u003EThe session \u201cSleep for the Practicing Neurologist\u201d includes a presentation on the challenges of diagnosis and treatment for hypersomnolence disorders, including idiopathic hypersomnia and narcolepsy with and without cataplexy. The second presentation focuses on the association between obstructive sleep apnea and increased incidence of cardiovascular events, particularly stroke.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiovascular events\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecataplexy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edeath\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehypersomnia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehypersomnolence\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInternational Classification of Sleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eobstructive sleep apnea\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enarcolepsy type 1\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etype 2\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneurology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eepisodic \u0026amp; paroxysmal disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EIn a session designed to investigate various sleep orders, 2 speakers presented new theories and updates on topics related to hypersomnolence and obstructive sleep apnea (OSA).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ELynn Marie Trotti, MD, Emory University, Atlanta, Georgia, USA, discussed the diagnostic challenges and emerging treatments of disorders of daytime sleepiness that occur despite sufficient quality, quantity, and timing of nocturnal sleep, collectively referred to as \u003Cem\u003Ehypersomnolence\u003C\/em\u003E. Patients with hypersomnolence experience an excessive duration of sleep, deteriorated quality of wakefulness, and sleep inertia.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe International Classification of Sleep Disorders (ICSD) recently updated naming conventions for hypersomnolence disorders [American Academy of Sleep Medicine. \u003Cem\u003EICSD\u003C\/em\u003E, 3rd ed. 2014]. Narcolepsy with cataplexy and narcolepsy without cataplexy have been reclassified as narcolepsy types 1 (NT1) and 2 (NT2), respectively. Instead of basing the definition on the absence or presence of cataplexy, it is now based on the absence (NT1) or presence (NT2) of hypocretin measured in cerebrospinal fluid. The new classification of idiopathic hypersomnia (IH) now encompasses the formerly split classifications of IH with \u2265\u200510 hours sleep and IH with \u0026lt;\u200510 hours sleep.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAn ideal diagnostic test for hypersomnolence disorders would be sensitive for problematic sleepiness, specific for pathologic sleepiness, and reproducible, and it would appropriately categorize patients based on phenotype. The Multiple Sleep Latency Test (MSLT) is heavily relied on to differentiate among hypersomnolence disorders. However, a study found that 71% of patients with IH and long sleep have a normal MSLT [Vernet C, Arnulf I. \u003Cem\u003ESleep\u003C\/em\u003E. 2009]. Another study reported that among 100 patients with excessive daytime sleepiness, 24-hour polysomnography results were indistinguishable between patients with IH and those with subjective excessive daytime sleepiness [Pizza F et al. \u003Cem\u003EJ Sleep Res\u003C\/em\u003E. 2013]. Two studies found that the MSLT had poor test-retest reliability [Goldbart A et al. \u003Cem\u003ESleep\u003C\/em\u003E. 2014; Trotti LM et al. \u003Cem\u003EJ Clin Sleep Med\u003C\/em\u003E. 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe third edition of \u003Cem\u003EICSD\u003C\/em\u003E recommends that, in addition to a sleep log, patients should be assessed with actigraphy for 1 to 2 weeks before the MSLT [American Academy of Sleep Medicine. \u003Cem\u003EICSD\u003C\/em\u003E, 3rd ed. 2014]. In a study of drug-na\u00efve patients with NT1 (n\u2005=\u200539) and IH (n\u2005=\u200524) and 30 healthy controls, actigraphy provided a reliable objective parameter to differentiate among hypersomnolence disorders, particularly NT1 cases [Filardi M et al. \u003Cem\u003ESleep Med\u003C\/em\u003E. 2015]. A study of the Psychomotor Vigilance Task found no correlation with the MSLT, a moderate correlation with maintenance of wakefulness tests latency (\u003Cem\u003Er\u003C\/em\u003E\u2005=\u20050.349), and strong correlation with the driving simulation test (\u003Cem\u003Er\u003C\/em\u003E\u2005=\u2005\u22120.521) [Thomann J et al. \u003Cem\u003EJ Clin Sleep Med\u003C\/em\u003E. 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EModafinil is a first-line treatment for patients with narcolepsy and IH. A crossover trial of modafinil vs placebo in patients with narcolepsy (n\u2005=\u200513) and IH (n\u2005=\u200514) evaluated maintenance of wakefulness tests and real driving performance after 5 days of treatment [Philip P et al. \u003Cem\u003ESleep\u003C\/em\u003E. 2014]. When treated with modafinil vs placebo, patients made fewer inappropriate line crossings (1.1\u2005\u00b1\u20050.3 vs 2.1\u2005\u00b1\u20050.7; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.05) and had lower standard deviation of lateral position (23.6\u2005\u00b1\u20050.6 vs 24.9\u2005\u00b1\u20050.9 cm; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.06).\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EOther treatments studied for hypersomnolence include pitolisant, flumazenil, and clarithromycin (\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\/16572\/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\/16572\/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\/16572\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\u003EStudies of Treatments for Hypersomnolence Disorders\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\u003EDr Trotti concluded that more studies are needed on pharmacologic treatments for hypersomnolence but some exciting advances are emerging.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EOSA is a risk factor for stroke, the fifth-leading cause of death in the United States [CDC. \u003Ca href=\u0022http:\/\/www.cdc.gov\/stroke\/facts.htm\u0022\u003Ehttp:\/\/www.cdc.gov\/stroke\/facts.htm\u003C\/a\u003E. Accessed May 1, 2015]. Approximately 15 million adults in the United States have OSA [Somers VK et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2008]. The link between OSA and stroke and the impact of treating OSA were discussed by Pablo R. Castillo, MD, Mayo Clinic, Jacksonville, Florida, USA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003ENonrapid eye movement sleep is a state of cardiovascular quiescence, with reduced sympathetic activity, heart rate, blood pressure, and arrhythmogenicity. OSA causes chronic intermittent hypoxia, nocturnal sympathetic activation, sleep loss, inflammation, and metabolic dysregulation. OSA also has been identified as a secondary cause of diurnal hypertension. The American Heart Association\/American Stroke Association\u2019s guideline on preventing ischemic stroke recommends questioning patients (and their bed partners) with abdominal obesity and hypertension about symptoms of OSA and referral to a sleep specialist [Goldstein LB et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2006]. The gold standard for diagnosis of OSA is attended overnight level 1 polysomnography. Other assessments include the subjective parameters of sleepiness, witnessed apneas, and snoring; morphometric data, including body mass index, neck size, and cephalometric measures; associated hypertension; and oximetry data.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAbout 25% of strokes occur during sleep, while wake-up stroke occurs close to awakening [Rimmele DL, Thomalla G. \u003Cem\u003EFront Neurol\u003C\/em\u003E. 2014]. OSA has been shown to increase the risk of stroke independent of traditional risk factors, such as hypertension and diabetes [Mohsenin V. \u003Cem\u003EAm J Med\u003C\/em\u003E. 2015]. In a 2005 study of 1022 consecutive patients with no previous stroke, 68% had OSA. The probability of event-free survival was significantly lower for patients with OSA compared with controls (log-rank \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.003). Trend analysis showed a stepwise increase in the risk of stroke or death with increasing OSA severity (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.005; \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). A significant association was found between OSA and stroke or death from any cause in unadjusted (HR, 2.24; 95% CI, 1.30 to 3.86; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004) and adjusted analyses (HR, 1.97; 95% CI, 1.12 to 3.48; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.01).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\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\/16573\/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\/16573\/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\/16573\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 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003ETrend Analysis for Relationship Between Increased OSA Severity and Composite of Stroke or Death From any Cause\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-19\u0022\u003ETreatment of OSA was associated with better cardiovascular outcomes before treatment with continuous positive airway pressure (CPAP) became available. In a 2005 study, the potential protective effect of CPAP was studied in a male population of 264 healthy men, 377 simple snorers, 403 with untreated mild to moderate OSA, 235 with untreated severe OSA, and 372 with CPAP-treated OSA. Patients with untreated severe OSA had a significantly higher incidence of fatal (1.06\/100 person-years) and nonfatal (2.13\/100 person-years) cardiovascular events compared with the other groups (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\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\/15\/9\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Incidence of Fatal and Nonfatal CV EventsCV, cardiovascular; CPAP, continuous positive airway pressure; OSAH, obstructive sleep apnea-hypopnea syndrome.Source: Marin JM et al. Lancet. 2005.Reproduced with permission from PR Castillo, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-689608196\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Incidence of Fatal and Nonfatal CV EventsCV, cardiovascular; CPAP, continuous positive airway pressure; OSAH, obstructive sleep apnea-hypopnea syndrome.Source: Marin JM et al. \u0026amp;lt;em\u0026amp;gt;Lancet\u0026amp;lt;\/em\u0026amp;gt;. 2005.Reproduced with permission from PR Castillo, MD.\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\/9\/23\/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\/9\/23\/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\/9\/23\/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\/16571\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 \n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EIncidence of Fatal and Nonfatal CV Events\u003C\/p\u003E\n               \u003Cp id=\u0022p-21\u0022\u003ECV, cardiovascular; CPAP, continuous positive airway pressure; OSAH, obstructive sleep apnea-hypopnea syndrome.\u003C\/p\u003E\n               \u003Cp id=\u0022p-22\u0022\u003ESource: Marin JM et al. \u003Cem\u003ELancet\u003C\/em\u003E. 2005.\u003C\/p\u003E\n               \u003Cp id=\u0022p-23\u0022\u003EReproduced with permission from PR Castillo, MD.\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-24\u0022\u003EOSA is a valid syndrome that increases cardiovascular risk. The long-term ongoing randomized SAVE trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00738179\u0026amp;atom=%2Fspmdc%2F15%2F9%2F23.atom\u0022\u003ENCT00738179\u003C\/a\u003E] is examining whether CPAP treatment of OSA reduces the risk of cardiovascular events. The trial has a global recruitment target of 5000 patients, and results are expected in early 2016.\u003C\/p\u003E\n      \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\/9\/23.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?nzlom2\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?nzlom2\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?nzlom2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}