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.right {font-family: Arial, sans-serif; font-size: 11px; padding-left: 6px; padding-top: 10px; padding-bottom: 10px; color: #000000;}
h1.title {
	font-family: palatino, serif;
	font-size: 1.75em;
	font-weight: normal;
	color: #006DA9;
	margin: 0px 0px 10px 0px;
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.title {
	font-family: palatino, serif;
	font-size: 1.75em;
	font-weight: normal;
	color: #006DA9;
	margin: 0px 0px 10px 0px;
	padding: 0px 0px 0px 0px;
}
.subtitle {font-family: Arial, sans-serif; font-size: 13px; font-weight: bold; color: #000066;}
.buckethead {font-family: Arial, sans-serif; font-size: 12px; font-weight: bold; padding-left: 5px; height: 21px; color: #000000;}
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.credits {font-family: Arial, sans-serif; font-size: 13px; padding-left: 10px; color: #000000;}
.cmetag  {font-family: Arial, sans-serif; font-size: 11px; font-weight: bold; color: #990000;}
.results {font-family: Arial, sans-serif; font-size: 13px; padding-top: 4px; color: #000000;}
.rctoctext {font-family: Arial, sans-serif; font-size: 12px; padding-left: 5px; padding-top: 10px; padding-bottom: 10px; color: #000000;}
.rcheadtext {font-family: Arial, sans-serif; font-size: 12px; padding-left: 5px; padding-top: 5px; padding-bottom: 5px; color: #000000;}
.videoicon {width: 69px; height: 14px; font-size: 11px; padding: 2px 0px 1px 16px; background-image: url(http://images.medscape.com/pi/global/buttons/btn-video3.gif); background-position: top left; background-repeat: no-repeat;}
span.videoicon a:link {text-decoration: none; color: #000000;}
span.videoicon a:visited {text-decoration: none; color: #000000;}
span.videoicon a:hover {text-decoration: none; color: #000000;}
span.videoicon a:active {text-decoration: none; color: #000000;}
.byline {display: block; font-family: arial, sans-serif; font-size: 11px; color: #666666;}

/* TEMP NEWS FIX ON RCs */
#rcnewstemp ul {
	font-family: Arial, sans-serif;
	font-size: 13px;
	margin: 8px 0 0 8px;
	padding: 0;
	list-style: none;
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	position: relative;
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#rcnewstemp li a {
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	font-size: 13px;
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/* END TEMP NEWS FIX ON RC */

/* TEMP ATE Panel Styles */
#steeringcommittee {
	border: 1px solid #BFBFBF;
	width: 408px;
	margin: 10px 0 15px 0;
	padding: 10px 0px 0 10px;
	background-color: #EEEEEE;
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#steeringcommittee h3 {
	margin: 0;
	padding: 0;
	font-family: arial, sans-serif;
	font-size: 1.2em;
	color: #003366;
	font-weight: bold;
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.leftsccontainer {
	float: left;
	width: 194px;
	\width: 204px;
	w\idth: 194px;
	margin: 10px 0 0 0;
	padding: 0 10px 0 0;
	}
.rightsccontainer {
	float: right;
	width: 194px;
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	margin: 10px 0 0 0;
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.thumbnails {
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/* TEMP ATE Panel Styles */

#steeringcommittee ul {
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#steeringcommittee li {
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.newsText {
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.containerBorder { 
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.containerTitleBg { 
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.containerOtherBg { 
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.containerContentBg { 
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table.source { 
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table.related {
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.caption {
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.pullquote-left {
            float: left;
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            margin: 10px 10px 10px 0px;
            background-color: #dddeeb;
            background-image: url(http://images.medscape.com/pi/global/ornaments/pullquote-top.gif); 
            background-position: top left; 
            background-repeat: no-repeat;
            font-weight: bold;
            }
.pullquote-right {
            float: right;
            width: 220px;
            margin: 0px 0px 10px 10px;
            background-color: #dddeeb;
            background-image: url(http://images.medscape.com/pi/global/ornaments/pullquote-top.gif); 
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.closequote {
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.powerpoint {
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.inlineimageleft {
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/* MEDLINE Ad styles */

td #sponsorad {
	width: 300px;
	margin: 0px 0px 15px 10px;		
	}
#sponsoradtitle {
	position: relative;
	width: 124px;
	margin: 0px 0px -6px 4px;
	background-color: #FFFFFF;
	background-image: url(http://images.medscape.com/pi/global/ornaments/bg_textadtitle.gif);
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#sponsoradtitle h6 {
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	font-weight: normal;
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#sponsoradborder {
	background-color: #FFFFFF;
	padding: 6px 6px 6px 6px;
	border: 1px solid #B3B3B3;
	}
#sponsoradbg {
	background-color: #EEEEEE;
	padding: 4px 4px 8px 8px;	
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#sponsorlistings a {
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#sponsorlistings p {
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	margin: 0px 0px 0px 0px;
	padding: 0px 0px 0px 0px;
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#sponsorlistings ul li {
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.headertext {font-family: Arial, sans-serif; font-size: 23px; color: #000000;}

A:active {color: #000066;}
A:link {color: #000066;}
A:visited {color: #000066;}

/* QA Tool Styles */

form {margin: 0px 0px 0px 0px; padding: 0px 0px 0px 0px;}
input {font-family: Arial, sans-serif;}
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option {font-family: Arial, sans-serif;}
textarea {font-family: Arial, sans-serif;}
.qacontainer {margin: 15px 0px 15px 0px; padding: 10px 10px 10px 10px; background-color: #DDDDDD; border: 1px solid #000000; width: 550px;}
.questionintro {margin: 0px 0px 7px 0px; font-family: Arial, sans-serif; font-size: 13px; color: #000000;} 
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.question {font-family: Georgia, serif; font-size: 13px; color: #00264D;}
.answer {font-family: Arial, sans-serif; font-size: 13px; padding: 0px 0px 10px 0px; color: #000000;}
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.responseanswer {padding: 0px 0px 14px 17px;}
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.pollbox {padding: 10px 10px 10px 10px; background-color: #FFFFFF; border: 1px solid #000000;}
.pollheader {margin: 0px 0px 3px 0px; font-family: Arial, sans-serif; font-size: 11px; font-weight: bold; color: #000000;}
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.polltable td {padding: 0px 0px 7px 0px;}
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.incorrectquestion {margin: 0px 0px 4px 0px; font-family: Georgia, serif; font-size: 13px; color: #F96300;}
.correctanswer {margin: 0px 0px 21px 0px; font-family: Arial, sans-serif; font-size: 13px; color: #000000;}
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			displaystr = 'hiddenlayer0' + n;
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			displaystr = 'hiddenlayer' + n;
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			stylestr.style.left = '150px';
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			stylestr.style.zIndex = 500;
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}

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{
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		if (document.getElementById('ratingtoolbox')) {
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				}
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}

function confirmsent()
{
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		{
		document.getElementById('emailconfirmation').style.display = "block";
		document.getElementById('emailform').style.display = "none";
		return false;
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}_5http://www.medscape.com/files/scripts/articletools.js_application/x-javascript╘OIbplist00╘
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АААААА\Content-Type]Last-Modified]Accept-RangesVServerZConnectionTDate^Content-LengthTEtag_Fri, 06 Jul 2001 16:53:28 GMTUbytesVApacheZkeep-alive_Thu, 15 Feb 2007 02:05:52 GMTR43_"8fd885-2b-3886fbc0f5200"╥12bcгcd6_NSMutableDictionary\NSDictionary╥12fgвg6_NSHTTPURLResponseInternal╥12ijгjk6_NSHTTPURLResponse]NSURLResponse    $ ) 2 D I L b d В И л о ▓ ╡ ╣ ╝ ┐ ├ ╞ ╔ ═ ╨ ╙ ┌ ▌ с ф ц ш ъ ь ю ў ∙ √ ,.02ns|ЗЛСШбл▓┤╢╕┐╩╥█▌▀сухчщыЇЎ°·№■ !/6AFUZzАЗТ▓╡╤╓┌Ё¤!&*>             l              LO+GIF89a  А        !∙    ,       D ;_9http://images.medscape.com/pi/global/ornaments/spacer.gif╘OUbplist00╘
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АААААА\Content-Type]Last-Modified]Accept-RangesVServerZConnectionTDate^Content-LengthTEtag_Mon, 08 May 2006 20:52:57 GMTUbytesVApacheZkeep-alive_Thu, 15 Feb 2007 02:07:07 GMTT1733_"5bf94-6c5-4134d0e1c7c40"╥12bcгcd6_NSMutableDictionary\NSDictionary╥12fgвg6_NSHTTPURLResponseInternal╥12ijгjk6_NSHTTPURLResponse]NSURLResponse    $ ) 2 D I L b d В И л о ▓ ╡ ╣ ╝ ┐ ├ ╞ ╔ ═ ╨ ╙ ┌ ▌ с ф ц ш ъ ь ю ў · №!-/13}ВЛЦЪаз░║┴├┼╟╬┘съьюЁЄЇЎ°·	"0>EPUdiЙПЦб┴╞тчы27;O             l              ]O┼GIF89aЕ  ц  @@@┐┐┐┬█щяяяoзЕ╖╙   000▀▀▀╧╧╧╩╒рwУояЄїМд╗╧╪тfЕдСз╜рцэЩ│`Ббфщя╝╩╫їў∙ыяєИа╕Ъп├sРм┴═┌шьё▄уъ▓┬╤cГвй║╠о╛╬¤¤■╖╞╘pНк╙▄хЯ▓╞д╢╔┼╤▌^Я√√№°∙√Цл└ГЬ╡ЄїўlКиiЗж{Ц░╪ршpиpppППП```ЯЯЯPPPппп*В│╤фяIФ╛г╔▐ЁЎ∙:Л╕XЭ├д╔▐ЁЎ·gж╔Ф└┘xнXЬ├oисэЇwп╬yнHУ╜vо╬╤фюрэЇvп╬▓╥ф9К╕Ф└╪gе╚│╥фHУ╛▓╥у*Б▓HФ╛*Б│9Л╕pи                                                                                                      !∙     ,    Е    А>A]K_ИЙC]МЙПРЙ5ДСЧШЩЪЫП#+-04&)$"!('./3%12 *_Е][СBХОЬП5]╨╒╓╨Юавджикмо░▓┤╢╕║╝╛└┬─╞I<М=П@]BI╧╓М╫¤■ЭЯBН*u*╒кVпb═кu+╫о^┐В+v╠PЧ$¤р▒пK╛j Й╝ЦM ╖В▀К[X╬!║Иы("ыA)╚#!N·m_НС@9Х▄F╨█┴p
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ААААААVServer]Last-Modified]Accept-RangesZConnectionTDate^Content-LengthTEtag\Content-TypeVApache_Thu, 17 Jan 2002 15:52:42 GMTUbytesZkeep-alive_Wed, 21 Feb 2007 02:06:01 GMTS234_"4cb99a-ea-397c19dcbe680"╥12bcгcd6_NSMutableDictionary\NSDictionary╥12fgвg6_NSHTTPURLResponseInternal╥12ijгjk6_NSHTTPURLResponse]NSURLResponse    $ ) 2 D I L b d В И л о ▓ ╡ ╣ ╝ ┐ ├ ╞ ╔ ═ ╨ ╙ ┌ ▌ с ф ц ш ъ ь ю ў ∙ √ ,.02v{ДПУЩай│║╝╛└╟╥┌ухчщыэяёє№■ 
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i`Ф эГ╦┐ ╫Xe)мр,!╨мЁ┬└в]%	╧╤ Wlё┼gмё╞wЬ1wOьё┼B0F╚▄`1mX┤0└╦0╟,є╠4╫lє═8╙▄В╝ ╕Ь│╠ |pК┐1Л╡Ё╤}4<c$4р/╥PПВ@}└╤└ПQG┴A─|Р╞╓Y#З/OўсAEАp└м-D	д╤╢Ь0№k5╓ТPA─ XP█n2w	T ВЗУ┬╪|r└hQўрCpаЎтDLРБюАD|Р@qб9ъ╤°	`AыпуЭ Б оУАёAяBАА║╫·T▒K*,└ВфT╨: &А╣ЬрА	й0БА`Aсp▀mAd┴э╪═xс░'pB▐Н0■Ў║Oр╢	Ш{Р╖Ў$ В╫║(I┘╬p d`qш  жA 
дч2 ╛ьeаrGh▄ыМ 7∙AаqзВ■Tч╝t z ш@┬@╨Бч}х`ХX 
ш вnБо√▐Ё7Д╛нВ=╘]ч:pB╤▒ПГqЛ;09&с БДЧ└╠e`|D`Б)QЦ═┴Зh^ыжw╜# x▒B°$hД
рNГG,B°8╨А╣oi;┴	 ?)┴ДЬSТ╖╝Тn{ХЫ,╨╗ойё а#-ghyM@[Lр║8aН═+Ь *	 ╕P~Д)}╖5,┴i╚ЫДа┼А}м@3ч╖=тq└бр"А─uаqxг[0?G╬А╗бЎ╘G╔
рТC@┴ ├╞═n┴#Ёж8╟∙/СНьЬшLз:╫╔Nx1
>√Щ<чI╧z┌єЮP┴░ ;_]http://www.medscape.com/publishers/medscape/medwire/description/logo-medscape-mednews-3-d.gif╘╘*+,OVbplist00╘
Y$archiverX$versionT$topX$objects_NSKeyedArchiver Жа╤	_WebResourceResponseАп)/078<RSTUVWXYZ[\]^_`7aehU$null▀ !"#$%&'(R$6S$10R$2S$13R$7R$3S$11R$8R$4S$14R$9R$0V$classR$5S$12R$1ААА #Aз╜┤█ц?x #Aз╜л░╒AА#Aзc╗ы;UhА╙*+!-.WNS.base[NS.relativeА АА_Hhttp://images.medscape.com/pi/global/logos/mscp/logo-medscape.142x34.gif╥1234X$classesZ$classnameг456UNSURLV%NSURLXNSObjectYimage/gif╙9:;АА╚╙=>?HQZNS.objectsWNS.keysи@ABCDEFGААААААААиIJKLMNOPАА	А
ААААААVServer]Last-Modified]Accept-RangesZConnectionTDate^Content-LengthTEtag\Content-TypeVApache_Mon, 08 May 2006 20:52:58 GMTUbytesZkeep-alive_Wed, 21 Feb 2007 01:58:40 GMTT1144_"3d945-478-4134d0e2bbe80"╥12bcгcd6_NSMutableDictionary\NSDictionary╥12fgвg6_NSHTTPURLResponseInternal╥12ijгjk6_NSHTTPURLResponse]NSURLResponse    $ ) 2 D I L b d В И л о ▓ ╡ ╣ ╝ ┐ ├ ╞ ╔ ═ ╨ ╙ ┌ ▌ с ф ц ш ъ ь ю ў · №!-/13~ГМЧЫби▒╗┬─╞╚╧┌тыэяёєїў∙√
+9DIX]jqСЧв┬╟ушь38<P             l              ^OxGIF89aО " ─  @@@АААВ╖╒┐┐┐яяяЯЯЯ╧╧╧```яЎ·0И╣п╤ф`д╔╧фя ┤ mй                                                   !∙     ,    О "    $ОdiЮhкоlы╛Ёщ╠ЇмиJэ─(У№ЙoH,ЮH▌B╡╨GБ (|Zп/ЭБBh▒"L.УM┌эФKW▒т╖ynu┤хйЩГу;tВFvnБ&	5dАГПCv}6&9Л~pЩРЬ,v5z$MШrVОЭк*ЯnИ	жЗWйлЬ ИУ$Ц▓М'
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:црЛ╫GqG┬\─╤Р└Ю╓ar~P%вI 0#[|CфK╔тb%ЄЁI@J▄XМОм№╪┘]J╔╒С+P└mM>&аI╣=ЙpЭ)eхжАVВr%|╪╠ ╒Фе
Г!Ъ ЪЩрJнЩ┤f	╧9А\|c╠ўP9врИE'
ж0АD&¤ўзnБ·иЪОyjХi"LI%}s^щцvФл╣ wЧб)ваUYjЪPжиЯrХ+Л1Ю╞ж/j┤ъGkФ╨D0╔ЪРиzрС@Xїб╒╓Ж═Jжб7*к╝Гн=╪Ъъ▒ъ╫жєїEk5jЭvSХШц╓╩+Ww┘ЖщF`О`У`ДЪр╫ЬI0─└SMИЄ|!▒fШЙQ╘(Ф`╓Ё^┼иUС∙TТаb
[M-YюБcйe┐#ИR.0√иГp94;Л=G┼Жu╬░cКЁ ·╝─Сн ПЇ╤Шj9aЁ╪╥V]f+Keсфйї╨c
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и-╬	(nК█K▄мA▄+0РЎKr▀тwv -°р$N°с~О°тЬ(╬°уt8∙фV┤$╡5┼Z ;_Hhttp://images.medscape.com/pi/global/logos/mscp/logo-medscape.142x34.gif╘╘╘012O<bplist00╘
Y$archiverX$versionT$topX$objects_NSKeyedArchiver Жа╤	_WebResourceResponseАп)/078<RSTUVWXY7Z[\]^_`aehU$null▀ !"#$%&'(R$6S$10R$2S$13R$7R$3S$11R$8R$4S$14R$9R$0V$classR$5S$12R$1ААА #AзяёDЙ+ #Aзя╡ЩgА#AзiHр─T▐А╙*+!-.WNS.base[NS.relativeА АА_1http://bi.medscape.com/pi/global/medscape-1x1.gif╥1234X$classesZ$classnameг456UNSURLV%NSURLXNSObjectYimage/gif╙9:;АА╚╙=>?HQZNS.objectsWNS.keysи@ABCDEFGААААААААиIJKLMNOPАА	А
АААААА\Content-Type]Last-Modified]Accept-RangesVServerZConnectionTDate^Content-LengthTEtag_Fri, 10 Feb 2006 20:59:07 GMTUbytesVApacheZkeep-alive_Thu, 15 Feb 2007 02:05:52 GMTR43_"3a8896-2b-40c76fff89cc0"╥12bcгcd6_NSMutableDictionary\NSDictionary╥12fgвg6_NSHTTPURLResponseInternal╥12ijгjk6_NSHTTPURLResponse]NSURLResponse    $ ) 2 D I L b d В И л о ▓ ╡ ╣ ╝ ┐ ├ ╞ ╔ ═ ╨ ╙ ┌ ▌ с ф ц ш ъ ь ю ў ∙ √ ,.02fktГЙРЩгкмо░╖┬╩╙╒╫┘█▌▀суьюЁЄЇЎ°·№■'.9>MRrxКкн╔╬╥шї·¤"6             l              DO+GIF89a  А        !∙    ,       D ;_1http://bi.medscape.com/pi/global/medscape-1x1.gif╘456Obplist00╘
Y$archiverX$versionT$topX$objects_NSKeyedArchiver Жа╤	_WebResourceResponseАп#)/078<Z[\]^_`abcdefghijklmnop7quxU$null▀ !"#$%&'(R$6S$10R$2S$13R$7R$3S$11R$8R$4S$14R$9R$0V$classR$5S$12R$1ААА #Aз╜л°АR[ь #Aз╜л▒ЭкА"#Aз·ё╣XА╙*+!-.WNS.base[NS.relativeА АА_:http://img.webmd.com/bi_common/bi_medscape.js?d=02/20/2007╥1234X$classesZ$classnameг456UNSURLV%NSURLXNSObject_application/x-javascript╙9:;АА!╚╙=>?LYZNS.objectsWNS.keysм@ABCDEFGHIJKААААААААААААмMNOPQRSTUVWXАА	А
АААААААААА VServerTVary]Last-Modified]Accept-Ranges_Content-Encoding]Cache-Control^Content-LengthWExpiresTDateZConnectionTEtag\Content-TypeVApache_Accept-Encoding_Fri, 12 May 2006 19:42:11 GMTUbytesTgzip\max-age=7853T8783_Wed, 21 Feb 2007 04:09:29 GMT_Wed, 21 Feb 2007 01:58:36 GMTZkeep-alive_"80d1c8-5bec-4139c88652ac0"╥12rsгst6_NSMutableDictionary\NSDictionary╥12vwвw6_NSHTTPURLResponseInternal╥12yzгz{6_NSHTTPURLResponse]NSURLResponse    $ ) 2 D I L b d К Р │ ╢ ║ ╜ ┴ ─ ╟ ╦ ╬ ╤ ╒ ╪ █ т х щ ь ю Ё Є Ї Ў  !)579;x}ЖСХЫвл╞═╧╤╙┌хэ·№■ 
!#%')+-/13579@ESatВСЩЮйо╗┬╘Ї· 1Q\zГЩжло╩╧╙ч             |              їO[ь// TO CODE:  s_error_url


var s_live=false;
try { if (s_account == "webmddev") { s_live=false;} 
	else {s_account="webmdp1global"; s_live=true;}
} catch(e) {var s_account="webmdp1global"; s_live=true; }

var s_md=s_gi(s_account)

s_md.cookieDomainPeriods="3"
s_md.jsCookieDomainPeriods="2"
s_md.charSet="ISO-8859-1"
s_md.currencyCode="USD"
s_md.trackDownloadLinks=true
s_md.trackExternalLinks=true
s_md.trackInlineStats=true
s_md.linkDownloadFileTypes="exe,zip,wav,mp3,mov,mpg,avi,wmv,doc,pdf,xls"
s_md.linkInternalFilters="javascript:,.medscape.com"
s_md.linkLeaveQueryString=false
s_md.linkTrackVars="prop50"
s_md.linkTrackEvents="None"
s_md.visitorNamespace="webmd"
s_md.usePlugins=true
function s_md_doPlugins(s) {
	if (!s_md.pageName) {
		s_md.pageName=location.protocol + "//" + location.host + location.pathname;
	}
}
s_md.doPlugins=s_md_doPlugins
s_md.c_gd=new Function(""
+"var s=this,d=s.wd.location.hostname,n=s.jsCookieDomainPeriods,n2=s."
+"cookieDomainPeriods,p;if(d&&!s.c_d){n=n?n:n2;n=n?parseInt(n):2;n=n>"
+"2?n:2;p=d.lastIndexOf('.');while(p>=0&&n>1){p=d.lastIndexOf('.',p-1"
+");n--}s.c_d=p>0&&s.pt(d,'.','c_gdf',0)?d.substring(p):'';}return s."
+"c_d");
s_md.trackGAS=new Function(""
+"var s_md=this,gifa=document.getElementsByTagName('iframe'),gif;for(v"
+"ar i=0;i<gifa.length;i++){if(gifa[i].src.indexOf('googlesyndication."
+"com')>-1){gif=gifa[i];if(gif.attachEvent){gif.attachEvent('onfocus',"
+"s_md.gasf);}}}");
s_md.gasf=new Function(""
+"var s_md=s_gi(s_account);s_md.prop36=s_md.pageName;s.tl(true,'o','Go"
+"ogle Exit Link');");
/* Google AdSense Tracking */
s_md.trackGAS();
/* WEBMD code for Medscape start here */
var s_bu="pro";
var s_siteclass="oop";
var s_site="medscape";

function _clean(a) {
	//a=a.split("/").join("-");a=a.split("&").join("-");a=a.split("?").join("-");
	a=a.toLowerCase();
	return a;
}
function _urlClean(a) {a=a.toLowerCase();a=a.split("https://www.").join("");a=a.split("http://www.").join("");
a=a.split("https://").join("");a=a.split("http://").join("");
//a=a.split("|").join("-");a=a.split("'").join("");
//a=a.split("#").join("-");a=a.split("$").join("-");a=a.split("%").join("");a=a.split("^").join("");
//a=a.split("*").join("");a=a.split(":").join("");a=a.split("!").join("");a=a.split("<").join("");
//a=a.split(">").join("");a=a.split("~").join("");a=a.split(";").join("");a=a.split(" ").join("+");
a=a.split(".html").join("");a=a.split(".htm").join("");a=a.split(".aspx").join("");a=a.split(".asp").join("");a=a.split(".jsp").join("");
return a;
}
function _readC(name)
{
	var qName = name + "=";
	var ca = document.cookie.split(';');
	for(var i=0;i < ca.length;i++)
	{
		var c = ca[i];
		while (c.charAt(0)==' ') c = c.substring(1,c.length);
		if (c.indexOf(qName) == 0) return c.substring(qName.length,c.length);
	}
	return "";
}
function _writeC(sName, sValue)
{
   date = new Date(3000, 1, 1, 0, 0, 0);
   document.cookie = sName + "=" + escape(sValue) + "; expires=" + date.toGMTString();
}
function _readQ(name)
{
	var qName = name.toLowerCase() + "=";
	if (document.URL.indexOf("?")==-1)
	{
		return "";
	}
	var _url = document.URL.split('?');
	var ca = String(_url[1]).toLowerCase().split('&');
	for(var i=0;i < ca.length;i++)
	{
		var c = ca[i];
		while (c.charAt(0)==' ') c = c.substring(1,c.length);
		if (c.indexOf(qName) == 0) return c.substring(qName.length,c.length);
	}
	return "";
}

var _URL = "";
try{ _URL=s_pagename; } catch (e){}
try{ _URL=s_pageName; } catch (e){}
if (_URL=="") {
  _URL1=String(document.location).split("?"); 
  _URL2=_URL1[0].split(";");
  _URL=_URL2[0]; 
}
_URL=_urlClean(_URL);

var _asset = _URL.substr(_URL.indexOf("/")+1);
_asset = String(_clean(_asset));


var s_query="";
var s_filter="";
var s_pagenum="";

if (!s_query){ 
	s_query = _readQ("querytext");
	if (s_query) {
		s_filter="drug";
	}
	s_pagenum="1";
}

try{if(_readQ("pagenumber")>1){s_pagenum=_readQ("pagenumber");}}catch(e){}

var _prop47fromPage="";
s_md.prop47="undefined";

if(!s_user_origin){var s_user_origin="";}
if(_readC("medauth")!=""){
	//logged in user
	if(s_user_origin.toLowerCase()=="us"){
    try{ if(s_user_group.toLowerCase()=="physician") {  _prop47fromPage="us-physician"; } else{_prop47fromPage="us-other";}}catch(e){}
	}else{
		 try{ if(s_user_group.toLowerCase()=="physician") {  _prop47fromPage="non-us-physician"; } else{_prop47fromPage="non-us-other";}}catch(e){}
	}
	s_md.eVar4=_prop47fromPage;
	try{s_md.prop47=_readC("medpermauth").toLowerCase();}catch(e){}
}else if(_readC("medpermauth")!=""){
	//not logged in user
	s_user_group="undefined";
	s_user_origin="undefined";
	try{s_md.prop47=_readC("medpermauth").toLowerCase();}catch(e){}

}
else{
  //cookies are not accepted user
  s_user_group="undefined";
  s_user_origin="undefined";
 }

//_writeC("prop47", "us-physician");
s_md.prop50="webmdp1medscapevista";
s_md.hier1="webmd,pro,oop,medscape,-";

try{if (s_not_pageview) {if (s_not_pageview!="n") {s_not_pageview="y";}} else {var s_not_pageview="n";}} 
catch (e){var s_not_pageview="n";}

if(!s_print){
	if(_readQ("prt")=='true'){var s_print=1;}
	if(_URL.indexOf('_print')>0){var s_print=1;}
}

s_md.pageName=_URL;
try{s_md.prop1=s_bu.toLowerCase();}catch(e){}
try{s_md.prop2=s_siteclass.toLowerCase();}catch(e){}
try{s_md.prop3=s_site.toLowerCase();}catch(e){}
try{s_md.prop4=s_channel;s_md.channel=s_channel;}catch(e){}
try{s_md.prop5=s_asset_type.toLowerCase();}catch(e){}
try{s_md.prop6=s_asset_class.toLowerCase();}catch(e){}
try{s_md.prop7=_asset.toLowerCase();}catch(e){}
try{s_md.prop8=s_pub.toLowerCase();}catch(e){s_md.prop8="-";}
try{s_md.prop9=s_pagenum;}catch(e){}
try{s_md.eVar1=s_query.toLowerCase(); s_md.prop10=s_query;}catch (e) {}
try{s_md.eVar2=s_filter.toLowerCase(); s_md.prop11=s_filter;}catch (e) {}
//try{s_md.eVar4=_prop47fromPage;}catch (e) {}
try{s_md.prop12=s_results;}catch(e){}
try{s_md.prop13=s_spell;}catch(e){}
try{s_md.prop14=s_g_ads;}catch(e){}
try{if (s_campaign){s_md.prop15=s_campaign;
	s_md.campaign="z:"+s_campaign;}}catch(e){}
try{if (s_rss){
	s_md.prop16=s_rss;
	s_md.campaign="rss:"+s_rss;}}catch(e){}
try{s_md.prop17=s_sponsor.toLowerCase();}catch(e){}
try{s_md.prop18=s_product.toLowerCase();}catch(e){}
try{s_md.prop19=s_user_group.toLowerCase();}catch(e){}
try{s_md.prop22=s_print;}catch(e){}
try{s_md.prop23=s_board;}catch(e){}
try{s_md.prop24=s_refpath.toLowerCase();}catch(e){}
try{s_md.prop25=s_override.toLowerCase();}catch(e){}
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  <TITLE>Midday Napping Slows Heart Disease</TITLE>

  
<META name="authors" content="Carole  Bullock; Charles P Vega, MD; "><META name="cmeFlag" content="CME"><META name="continuingEd" content=", 6, 1"><META name="date" content="02/14/2007"><META name="description" content="Midday napping, or a "siesta," was linked with one-third lower risk for coronary heart disease mortality, according to a Greek study that included almost 24,000 healthy people."><META name="ContentType" content="News CME"><META name="ContentGroup" content="News"><META name="displayTitle" content="Midday Napping Slows Heart Disease"><META name="keywords" content=""><META name="linkURL" content="/viewarticle/552173"><META name="Site" content="mscp"><META name="TopicCenter" content="2, 17, 24, 42, 25, 34, 18, 
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	  <DIV class="title">
		 Midday Napping Slows Heart Disease
		
	<SPAN class="cmetag">CME</SPAN>

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	 <P>
	 
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	  <B>News Author: Carole Bullock<BR>
CME Author: Charles Vega, MD, FAAFP</B> 
<BR>
	  <P>Complete author <A href="#authors">affiliations and disclosures, and other CME information</A>, are available at the end of this activity.</P>
	  
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<B>Release Date: 
February 14, 2007</B>;┬а<B style="color: #990000;">Valid for credit through 

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</B>


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	<BR><P><FONT class="text10">from <A href="http://www.theheart.org" target="_blank"><B>Heart<I>wire</I></B></A> тАФ a professional news service of WebMD</FONT></P><P>February 14, 2007 тАФ What could be some of the most welcome heart-healthy advice in a long time comes from Greek researchers who say daytime napping тАФ taking a siesta тАФ may add years to your life.</P><P>Appearing in the February 12 issue of the <I>Archives of Internal Medicine</I>, the study included 23,681 participants from the cohort of the Greek European Prospective Investigation (EPIC) into Cancer and Nutrition.</P><P>Men who occasionally napped had a 12% (95% confidence interval [CI], 0.48 - 1.60) lower coronary heart disease (CHD) mortality; those who napped almost daily did even better, with a 37% (95% CI, 0.42 - 0.93) mortality decrease. A separate analysis was conducted to compare working and nonworking men.</P><P>"We found the association among non-working men weaker," he noted.</P><P>Researchers did not find a similar pattern in women, which could be due to the lower mortality rates in the cohort.</P><P>"If this is confirmed, we may have new weapon against CHD," Antonia Trickopoulou, MD, of the Harvard School of Public Health in Boston, Massachusetts, said in an interview with <B>heart<I>wire</I></B>.</P><P>"Many speculate that the lower CAD [coronary artery disease] mortality in some (Latin and Mediterranean) countries may be related to diet, which may be true, but we wanted to see if there were other habits that could play a role," Dr. Trickopoulou, said.</P><P>EPIC spanned from 1994 to 1999 and was conducted in 10 European countries. At baseline, all individuals (ages 20 - 86 years) were asked to report whether they were taking midday naps and the duration (5-minute increments).</P><P>The participants were categorized as never taking naps, those taking midday naps regularly (at least 3 times a week, average duration, 30 minutes), those with systematic napping (at least 30 minutes, average duration 30 minutes), those taking midday naps irregularly (once or twice a week), or those taking occasional naps (duration of &lt; 30 minutes, irrespective of weekly frequency).</P><P>The study endpoints were death rate and cause of death; the mean duration of follow-up was 6.3 years. There were 85 CHD deaths in men and 48 CHD deaths in women. Researchers controlled for physical activity, body mass index, smoking status, and diet.</P><P>"Afternoon siesta in a healthy individual may act as a stress-reducing habit, and there is considerable evidence that stress has both short- and-long-term adverse effects on the incidence and mortality from CHD," said Dr. Trickopoulou.</P><P>According to Gerald Fletcher, MD, of the Mayo Clinic in Jacksonville, Florida, and an American Heart Association spokesperson, "The siesta may be a stress-reducing habit that allows people to slow-down."</P><P>Dr. Fletcher takes a nap occasionally. "It's a way to relax and mesmerize, and re-charge," he said in an interview with <B>heart<I>wire</I></B>.</P><P>Benjamin Franklin had a sleep-pattern characterized by periodic napping, noted Dr. Fletcher, "and he was very productive."</P><P><I>Arch Intern Med</I>. 2007;167:296-301.</P>

<H3>Learning Objectives for This Educational Activity</H3>Upon completion of this activity, participants will be able to:

<UL>

<LI>Describe previous research on the effect of napping (siestas) on the risk for myocardial infarction.</LI>

<LI>Identify the effect of napping (siestas) on the risk for coronary mortality.</LI>

</UL>


<H3>Clinical Context</H3><P>Short daytime naps, also known as siestas, may help reduce stress and, consequently, the risk for CHD. However, siestas may also serve as a marker of reduced physical activity, a known cardiovascular risk factor. A study by Campos and Siles, which was published in the June 2000 issue of the <I>International Journal of Epidemiology</I>, suggests that the latter effect may predominate. The authors performed a case-control analysis on 1027 adults who had or had not experienced a myocardial infarction. They found that increasing frequency and duration of siestas were both associated with an increased rate of myocardial infarction. The study results remained unchanged after adjustment for the presence of other cardiovascular risk factors.</P>

<P>The current research also examines the effects of siestas on cardiovascular disease, but it uses a prospective design. This methodologic improvement can potentially reduce confounders and include patients with a history of death secondary to myocardial infarction.</P>

<H3>Study Highlights</H3><UL>

<LI>Patients eligible for study participation were between the ages of 20 and 86 years and lived in Greece. Patients with a history of CHD, stroke, or cancer were excluded from the research protocol.</LI>

<LI>Participants were evaluated at baseline for the frequency and duration of daytime napping. They also completed questionnaires regarding diet and physical activity.</LI>

<LI>Subjects were followed up for a mean of 6.32 years. The main study outcome was the relationship between siestas and the risk for coronary mortality, which was assessed from death certificates. This result was adjusted for age, smoking status, years of education, body mass index, levels of physical activity, adherence to the Mediterranean diet, and hip circumference.</LI>

<LI>Examining all patients with and without a previous history of cardiovascular disease, siestas did not have a significant effect on overall mortality.</LI>

<LI>23,681 individuals comprised the main study cohort. 792 deaths occurred during follow-up, 133 of which were due to CHD. Deaths were significantly more common among men compared with women.</LI>

<LI>Traditional cardiovascular risk factors increased the rate of coronary mortality, particularly among women. Body mass index was minimally associated with the propensity to nap.</LI>

<LI>Compared with subjects who did not take siestas, men and women who reported napping had odds ratios of 0.51 and 0.96 for coronary mortality, respectively. Combining data from both sexes, subjects who reported napping systematically had a 37% reduction in coronary mortality compared with participants who did not nap. The relative reduction in coronary mortality among subjects who took occasional siestas vs no siestas was only 12%.</LI>

<LI>Overall, the odds ratio of coronary mortality for any napping was 0.66 compared with no napping, and this result was statistically significant.</LI>

<LI>Siestas were most protective against coronary mortality among men who worked vs those who were unemployed. The benefits of siesta were apparent regardless of patient age.</LI>

</UL>

<H3>Pearls for Practice</H3><UL>

<LI>A previous case-control study found that the risk for myocardial infarction increased with increasing duration and frequency of siestas.</LI>

<LI>The current prospective study demonstrates that siestas can reduce the rate of coronary mortality. This effect was most profound among working men.</LI>

</UL>


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<H4>News Author</H4><BLOCKQUOTE><P><B>Carole  Bullock</B><BR>is a freelance journalist for Medscape. She has been writing and reporting on health and science news since 1980. She was the Senior Communications Manager for the American Heart Association for 9 years. Carole has a B.A. in Biology from the University of Texas and a M.A. in Journalism from New York University. She can be contacted at <A href="mailto:carole.bullock@yahoo.com">carole.bullock@yahoo.com</A></P><P></P><P>Disclosure: Carole Bullock has disclosed no relevant financial relationships.</P></BLOCKQUOTE><H4>CME Author</H4><BLOCKQUOTE><P><B>Charles P Vega, MD</B><BR>Associate Professor, Residency Director, Department of Family Medicine, University of California, Irvine</P><P></P><P>Disclosure: Charles Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.</P></BLOCKQUOTE>


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