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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\u003EMany studies have shown that improved glucose control in patients with diabetes reduces microvascular complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors improve glucose control and were thought to reduce the risk of cardiovascular events and all-cause mortality in patients with type 2 diabetes [Monami M et al. \u003Cem\u003EDiabetes Obes Metab\u003C\/em\u003E 2013]. This article discusses the Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care trial [EXAMINE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00968708\u0026amp;atom=%2Fspmdc%2F13%2F17%2F27.atom\u0022\u003ENCT00968708\u003C\/a\u003E] and Saxagliptin Assessment of Vascular Outcomes Recorded in patients with diabetes mellitus [SAVOR]-TIMI 53 trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01107886\u0026amp;atom=%2Fspmdc%2F13%2F17%2F27.atom\u0022\u003ENCT01107886\u003C\/a\u003E] trials.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMany studies have shown that improved glucose control in patients with diabetes reduces microvascular complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors improve glucose control and were thought to reduce the risk of cardiovascular (CV) events and all-cause mortality in patients with type 2 diabetes (T2DM) [Monami M et al. \u003Cem\u003EDiabetes Obes Metab\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETwo presentations from the Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care trial [EXAMINE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00968708\u0026amp;atom=%2Fspmdc%2F13%2F17%2F27.atom\u0022\u003ENCT00968708\u003C\/a\u003E] reported on the benefits of alogliptin versus placebo as add-on therapy to standard care for patients with T2DM and acute myocardial infarction or unstable angina (UA).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EWilliam B. White, MD, University of Connecticut School of Medicine, Farmington, Connecticut, USA, noted that after a median duration of follow-up of 18 months there were no significant differences between alogliptin and placebo in the primary endpoint of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThis was a randomized double-blind, placebo-controlled, noninferiority study to demonstrate that major CV event rates were not higher with alogliptin compared with placebo in T2DM patients with recent acute coronary syndrome who are receiving standard of care for diabetes and secondary CV prevention. Secondary endpoints included an evaluation of the time from randomization to the first occurrence of the primary endpoint, urgent revascularization due to UA, and heart failure hospitalization.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EApproximately 5400 men and women receiving antihyperglycemic therapy (mono- or combination therapy) were followed for up to 3.5 years post randomization. At baseline, median duration of diabetes was 7.1 years, median body mass index (BMI) was 29.7 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, mean HbA1C level was 8.0%\u00b11.1% (range, 6.55%\u201311.0%). An MI was the qualifying event for study entry in most (77%) of patients.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe incidence of the primary endpoints between the two groups was not significantly different (placebo 11.8% vs 11.3% for alogliptin; HR, 0.96; one-sided repeated CI bound, 1.16).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere were no significant differences in secondary endpoints, the subgroup analysis, or rates of withdrawal or adverse events between the groups. Alogliptin did not increase major adverse CV event rates compared with placebo.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ESimon Heller, MD, University of Sheffield, Sheffield, United Kingdom, reported alogliptin in patients with T2DM and recent acute CV problems was well tolerated and improved glycemic control without increasing rates of serious or nonserious hypoglycemia.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EPatients were administered 25, 12.5, or 6.25 mg alogliptin (depending on kidney function) or placebo QD after randomization. HbA1C, fasting plasma glucose (FPG) levels, concomitant medications, body weight, adverse events, and lipids were measured at each study visit. Throughout the study, HbA1C was consistently lower and by the end of the study mean HbA1C was \u22120.36% lower compared with the placebo group (p\u0026lt;0.001; \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\/17\/27\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Comparison of HbA1C Levels Over 36 Months in EXAMINE\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-781942957\u0022 data-figure-caption=\u0022Comparison of HbA1C Levels Over 36 Months in EXAMINE\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\/17\/27\/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\/17\/27\/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\/17\/27\/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\/13805\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-11\u0022 class=\u0022first-child\u0022\u003EComparison of HbA1C Levels Over 36 Months in EXAMINE\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from S Heller, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EMean decreases from baseline FPG were significantly greater for alogliptin patients (\u22120.33 mmol\/L; p\u0026lt;0.001). Significantly (p\u0026lt;0.001) more alogliptin patients achieved HbA1C levels \u0026lt;7.0% and \u0026lt;8.0% at 6, 12, 24 months, and last visit compared with placebo. Body weight remained stable in both groups. Serious hypoglycemia and pancreatitis were uncommon with no differences noted between the groups. Adverse events and initiation of dialysis were similar. There were no cases of pancreatic cancer.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EReports from the Saxagliptin Assessment of Vascular Outcomes Recorded in patients with diabetes mellitus [SAVOR]-TIMI 53 trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01107886\u0026amp;atom=%2Fspmdc%2F13%2F17%2F27.atom\u0022\u003ENCT01107886\u003C\/a\u003E] were presented by Itamar Raz, MD, Hadassah University Hospital, Israel and Deepak L Bhatt, MD, MPH, Brigham and Women\u0027s Hospital, Boston, Massachusetts, USA.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EIn the SAVOR trial, the DPP-4 inhibitor saxagliptin neither reduced nor increased the risk of the primary composite endpoint of CV death, nonfatal MI, or ischemic stroke compared with placebo. Patients (n=16,492) with T2DM and established CV disease (CVD) or multiple CV risk factors were randomized 1:1 to 5 mg saxagliptin or placebo once daily, then followed for a median duration of 2.1 years. Major secondary endpoints included the components of the composite endpoint, hospitalization for heart failure, UA, or coronary revascularization.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EEnrolled patients were aged \u226540 years, had documented HbA1C \u22656.5% in the previous 6 months, and were at high risk for CV events. Baseline characteristics were similar between the two groups. Median duration of diabetes was 10 years and mean HbA1C was 8.0%. The majority of patients were also being treated with aspirin, statins, or ACE inhibitors for CV risk, and metformin for diabetes.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EMean HbA1C was significantly lower in patients treated with saxagliptin compared with placebo at 1 and 2 years, and significantly more saxagliptin-treated patients achieved HbA1C \u0026lt;7.0% at 1 and 2 years. These changes in glycemic control were in the context of a 23% decrease in the intensification of antihyperglycemic medications with saxagliptin compared with control (p\u0026lt;0.001), and a 30% decrease in the initiation of insulin therapy for \u0026gt;3 months with saxagliptin compared with control (p\u0026lt;0.001; \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\/13\/17\/27\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Glycemic Control at 1 and 2 Years in SAVOR\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-781942957\u0022 data-figure-caption=\u0022Glycemic Control at 1 and 2 Years in SAVOR\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\/17\/27\/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\/17\/27\/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\/17\/27\/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\/13806\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-17\u0022 class=\u0022first-child\u0022\u003EGlycemic Control at 1 and 2 Years in SAVOR\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ERand=randomization.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced with permission from DL Bhatt, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003EA primary endpoint event occurred in 613 patients in the saxagliptin group and in 609 patients in the placebo group (7.3% and 7.2%, respectively; HR, with saxagliptin, 1.00; 95% CI, 0.89 to 1.12; p=0.99 for superiority; p\u0026lt;0.001 for noninferiority.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003ESimilar results were reported for the secondary endpoints. There were no significant differences for any of the individual endpoints except hospitalization for heart failure (2.8% with placebo vs 3.5% with saxagliptin; p=0.007). Subgroup analysis showed no differences. Rates of adjudicated cases of acute and chronic pancreatitis were similar in the two groups [Scirica BM et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EThe investigators concluded that when added to standard of care for patients with T2DM and high CV risk saxagliptin improves glycemic control and after a median 2.1 years is noninferior to placebo for CV outcomes. They cautioned that no conclusions regarding longer treatment periods could be made. This study also was not designed to assess the impact of therapy on microvascular events.\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EIn the second SAVOR presentation, the general safety of incretin-based therapy was proven, particularly the use of saxagliptin in patients with long disease duration, broad HbA1C levels, various antidiabetic medications, concomitant CVD, and other comorbidities. Saxagliptin improved glycemic control, prevented the progression of microalbuminuria, and decreased the need for the initiation of insulin therapy without an increased risk of hypoglycemia and major hypoglycemia, except in patients treated with sulfonylurea and with baseline HbA1C \u0026lt;7.0%. There were no increases in the rate of primary or secondary CV endpoints for patients treated with sulfonylurea or for hospitalization for hypoglycemia.\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003ESignificantly more patients treated with saxagliptin achieved HbA1C \u0026lt;7% without hypoglycemic events (excluding patients with HbA1C \u0026lt;7% at baseline) at 1 and 2 years and by end of trial regardless of ongoing treatment (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E).\u003C\/p\u003E\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\/13\/17\/27\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Proportion of Patients Achieving HbA1C \u0026amp;lt;7% by Treatment\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-781942957\u0022 data-figure-caption=\u0022Proportion of Patients Achieving HbA1C \u0026amp;amp;lt;7% by Treatment\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\/13\/17\/27\/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\/13\/17\/27\/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\/13\/17\/27\/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\/13807\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-23\u0022 class=\u0022first-child\u0022\u003EProportion of Patients Achieving HbA1C \u0026lt;7% by Treatment\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EIns=insulin; Met=metformin; Saxa=saxagliptin; SU=sulfonylurea.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EReproduced with permission from DL Bhatt, MD.\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\/17\/27.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?nznlgd\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?nznlgd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}