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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/20\\\/24\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/20\\\/24\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/20\\\/24\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/20\\\/24\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink 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\u003ECancer care has evolved to a focus on quality of life after treatment, in addition to survival, making fertility preservation (FP) a survivorship issue. This article reviews the success of integrating a formalized oncofertility program into acute cancer care and in improving the rates of FP.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einfertility\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ECancer care has evolved to a focus on quality of life after treatment, in addition to survival, making fertility preservation (FP) a survivorship issue. A large proportion of patients who survive cancer want to become biological parents, but evidence from surveys and a retrospective review revealed low rates of discussion about FP within usual cancer care. Robert E. Brannigan, MD, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA, reviewed the success of integrating a formalized oncofertility program into acute cancer care at his institution and in improving the rates of FP. An important issue is improving the rates of FP in adolescent and young men.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ESome 50% of men will receive cancer diagnoses in their lifetimes, said Dr. Brannigan. The incidence of cancer for males increases with age across the range from 0 to 45 years. Both the underlying cancer and cancer treatment can contribute to infertility. In young men with certain types of cancer, low fertility is seen at presentation, before treatment is started.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ESperm cryopreservation (SPC) has been underused, because physicians do not think there is sufficient time for it while addressing other acute health issues and because of the historically poor outcomes for cryopreserved sperm and low pregnancy rates after intrauterine insemination. However, markedly smaller numbers of sperm must be banked by a patient to achieve reproductive success with \u003Cem\u003Ein vitro\u003C\/em\u003E fertilization and intracytoplasmic sperm injection (ICSI).\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe American Society of Clinical Oncology (ASCO) Recommendations on Fertility Preservation in Cancer Patients called for physicians to discuss the risk for fertility impairment as early as possible and for prompt referral to a qualified specialist if the patient is interested [ASCO. \u003Cem\u003EJ Oncol Pract\u003C\/em\u003E 2006]. The ASCO recommendations were in part a response to the discordance between physician and patient perspectives on the discussion of fertility issues. All physicians reported that they discussed fertility issues with their cancer patients, and 26% reported being familiar with ICSI in a 1999 ASCO member survey in Minnesota [Zapzalka DM et al. \u003Cem\u003ECancer\u003C\/em\u003E 1999]. However, in a survey of 904 men (of whom 201 responded) aged 14 to 40 years with cancer, only 60% reported that they had been informed about fertility issues and 51% about sperm banking [Schover LR et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2002]. Furthermore, overall 51% reported that they wanted children after they were cured, and this number was 77% for those without children at the time of the survey. Sperm was banked by 24% overall and by 37% of those without children.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EA lower rate (44%) of awareness of the ASCO recommendations was reported in the Survey for Preservation of Adolescent Reproduction study [SPARE] by 209 physicians treating the pediatric cancer population [Kohler TS et al. \u003Cem\u003EJ Assist Reprod Genet\u003C\/em\u003E 2011]. In this study, 93% of the respondents were pediatric oncologists, 79% had university-based practices, and the most commonly treated cancers were leukemia, lymphoma, and brain tumors. Familiarity with ICSI was reported by 56% and with current FP research by 67%. Although \u0026gt; 80% agreed or strongly agreed that fertility risk was a major concern to clinicians and the parents of male patients, and that patients and their parents had asked about the risk to fertility, \u0026gt; 60% of the physicians reported that they never used the 2006 ASCO recommendations on FP or used them in \u0026lt; 25% of cases. The discordance between physician attitudes and practice regarding FP in SPARE is illustrated in \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\/14\/20\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Discrepancy Between Attitudes and Practice Pattern for Fertility Preservation\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1147698567\u0022 data-figure-caption=\u0022Discrepancy Between Attitudes and Practice Pattern for Fertility Preservation\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\/20\/24\/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\/20\/24\/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\/20\/24\/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\/16439\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-7\u0022 class=\u0022first-child\u0022\u003EDiscrepancy Between Attitudes and Practice Pattern for Fertility Preservation\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EFP=fertility preservation; tx=treatment.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Kohler TS et al. Results from the Survey for Preservation of Adolescent Reproduction (SPARE) study: gender disparity in delivery of fertility preservation message to adolescents with cancer. \u003Cem\u003EJ Assist Reprod Genet.\u003C\/em\u003E 2011;28:269\u2013277. With permission from Springer.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EA retrospective review at Northwestern University showed that 30 of 32 male pediatric patients (mean age, 16.6 years) were able to provide samples for sperm banking and that 28 (88%) successfully banked sperm [Sharma V et al. American Urological Association 2012 (abstract 1372)]. Compared with the World Health Organization reference standard, the semen parameters in these patients were at or near the cutoffs, and even in the younger patients, they were at levels sufficient for assisted reproduction.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EONCOFERTILITY PROGRAM\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ENorthwestern University established a formalized oncofertility program in 2005 to improve FP in male patients with cancer [Sheth KR et al. \u003Cem\u003EJ Urol\u003C\/em\u003E 2012]. The program comprised a multidisciplinary team, a patient navigator, and a complete FP consultation. The team included urologists, endocrinologists, hematologists, oncologists, and laboratory staff members, as well as pediatric oncologists, nurses (urology, oncology), psychologists, and administrative staff members. The referring physician is a key member of the team, noted Dr. Brannigan. A patient navigator guided patients through the FP process during their cancer treatment (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Redig AJ et al. \u003Cem\u003ECancer\u003C\/em\u003E 2011]. A complete FP consultation was conducted, including a history, a physical examination, a discussion about their reproductive goals, and counseling.\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\/20\/24\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The Patient Navigator Model for Fertility Preservation in Patients With Cancer\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1147698567\u0022 data-figure-caption=\u0022The Patient Navigator Model for Fertility Preservation in Patients With Cancer\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\/20\/24\/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\/20\/24\/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\/20\/24\/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\/16440\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-10\u0022 class=\u0022first-child\u0022\u003EThe Patient Navigator Model for Fertility Preservation in Patients With Cancer\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EIVF=\u003Cem\u003Ein vitro\u003C\/em\u003E fertilization.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Redig AJ et al. Incorporating fertility preservation into the care of young oncology patients. \u003Cem\u003ECancer\u003C\/em\u003E. 2011;117(1):4\u201310. With permission from John Wiley \u0026amp; Sons Inc.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe program improved FP in male patients with cancer [Sheth KR et al. \u003Cem\u003EJ Urol\u003C\/em\u003E 2012]. Among men with cancer aged 18 to 40 years, from 2002 to 2010, the proportion who were offered FP consultation increased from 23.4% to 43.3%, and those who underwent SPC increased from 15.2% to 27.9% (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E). The increase in SPC was consistent across all types of cancer. The number of men who were diagnosed with cancer during this time period remained constant.\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\/20\/24\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Number and Percentage of Patients With Cancer Aged 18 to 40 Years Banking Sperm\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1147698567\u0022 data-figure-caption=\u0022Number and Percentage of Patients With Cancer Aged 18 to 40 Years Banking Sperm\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\/20\/24\/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\/20\/24\/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\/20\/24\/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\/16441\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-12\u0022 class=\u0022first-child\u0022\u003ENumber and Percentage of Patients With Cancer Aged 18 to 40 Years Banking Sperm\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EReproduced from Sheth KR et al. Improved fertility preservation care for male patients with cancer after establishment of formalized oncofertility program. \u003Cem\u003EJ Urol\u003C\/em\u003E 2012;187:987\u2013994. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-13\u0022\u003ESPC by men with cancer has been shown to successfully result in pregnancy. In a study of 118 couples who underwent 169 IVF cycles, there was a 56.8% rate of pregnancy per retrieval [Hourvitz A et al. \u003Cem\u003EFertil Steril\u003C\/em\u003E 2008]. Ninety-six pregnancies led to the births of 126 children.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EDr. Brannigan noted that increased efforts are needed to address the issue of fertility risk in patients from minority groups and in adolescents, particularly prepubertal patients. Education materials are needed that are appropriate for the age and maturity of prepubertal patients, and providers who are comfortable delivering this information. Sperm production from testicular or other tissue, aided by technology, is a future goal to address the fertility risk in these young patients.\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\/20\/24.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?nzoyj2\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?nzoyj2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}