From: <Saved by Windows Internet Explorer 7>
Subject: Ophthalmology Management
Date: Wed, 17 Dec 2008 10:30:06 +0200
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                <TD><FONT style=3D"FONT-SIZE: 8pt">Issue: </B><SPAN=20
                  id=3DlblArticleIssueRight><A=20
                  =
href=3D"http://www.ophmanagement.com/archive.aspx?searchOptions=3DrbIssue=
&amp;tm=3D12/1/2008"><FONT=20
                  color=3D#000000>December 2008</FONT></A></SPAN></FONT> =

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                  <META http-equiv=3DContent-Language content=3Den-us>
                  <H6>Instrument Insider</H6>
                  <H1>Doctors and Patients Collaborate to Manage Dry=20
                  AMD</H1><IMG height=3D81=20
                  =
src=3D"http://www.ophmanagement.com/archive/2008/December/images/OMD_Dece=
mber_A15_Fig01.jpg"=20
                  width=3D64>=20
                  <H3>By Paul Garfinkle, M.D.</H3>
                  <P><B><I>As a precursor to wet or exudative</I></B>=20
                  age-related macular degeneration (AMD), dry AMD =
represents a=20
                  crucial stage in the disease's progression. By working =

                  together in a collaborative effort, both patient and =
doctor=20
                  can create a management plan that incorporates =
preventive=20
                  measures to slow or halt vision loss. The following =
outlines=20
                  the measures I take with my patients to maximize =
compliance=20
                  and produce positive results when it comes to managing =
dry=20
                  AMD.</P>
                  <H4>Early Detection Followed by Regular =
Monitoring</H4>
                  <P>With many medical conditions, early detection has a =
major=20
                  influence on treatment efficacy. Continual monitoring =
is=20
                  imperative in helping to maximize treatment =
effectiveness.=20
                  Because patients in the early stages of AMD may =
experience few=20
                  visual changes or be asymptomatic, patients depend on =
us for=20
                  diagnosis and management. For healthy seniors, normal =
protocol=20
                  should involve a routine annual eye exam to monitor =
for any=20
                  sign of vision change. Once early stages of the =
disease are=20
                  diagnosed, it is best to administer one-on-one patient =

                  education and provide patients with educational =
material as a=20
                  follow-up. Patient education materials are helpful for =

                  answering questions about uncertainties and also allow =

                  patients to do more in-depth research on their own if =
they=20
                  desire.</P>
                  <P>Although standard treatments for dry AMD don't =
exist yet,=20
                  there are therapies you can explore with your =
patients.=20
                  Assessing risk factors is especially important. =
Smoking=20
                  cessation and improving lipid profiles with Omega 3=20
                  supplements should be discussed. While AREDS did not =
identify=20
                  any benefit from high-dose antioxidants for early AMD=20
                  (category 2), it can be useful to discuss =
multivitamins,=20
                  antioxidants and lutein at this point with patients. =
Also be=20
                  sure to schedule an annual exam to ensure regular =
monitoring=20
                  of the patient's condition.</P>
                  <P>When patients are found to be at the intermediate =
dry AMD=20
                  stage, during which risk of vision loss increases=20
                  significantly, it may be necessary to implement a more =

                  aggressive monitoring regimen. AREDS vitamins, which =
have been=20
                  shown to reduce the risk of vision loss at this stage, =
paired=20
                  with quarterly tests with Preferential Hyperacuity =
Perimetry=20
                  (Foresee PHP, Sightpath Medical), complement a =
biannual=20
                  dilated exam.</P>
                  <P>By pairing these PHP tests with dilated exams, you =
and your=20
                  patients are working together to maximize the chances =
of early=20
                  detection and timely treatment. The Bressler et al. =
study=20
                  indicates that PHP testing leads to a diagnosis of wet =
AMD=20
                  before standard exams and Amsler grid testing in four =
out of=20
                  five patients.<SUP>1</SUP> This 10-minute PHP test can =
easily=20
                  be administered by any office staffer, and the results =
are=20
                  beneficial to monitoring AMD progression.</P>
                  <P>The PHP device maps defects within a patient's =
visual field=20
                  by analyzing responses to "dot deviation signals" that =
are=20
                  flashed on a computer screen in an adaptation of the=20
                  preferential looking strategy that has been described =
in=20
                  preverbal vision testing. After comparing the results =
to a=20
                  normative database, the device generates a report =
disclosing=20
                  the relative location of macular defects. The PHP has =
been=20
                  shown to produce results with 82% sensitivity and 88%=20
                  specificity,<SUP>1</SUP> thus making it a reliable =
test that=20
                  can give you the satisfaction of knowing you are doing =

                  everything in your power to track changes in your =
patients'=20
                  visual field resulting from AMD progression.</P>
                  <P>If the PHP reports abnormalities, it is advisable =
to repeat=20
                  the test to confirm the abnormality. Then, follow up =
with an=20
                  OCT and a fluorescein angiogram, if indicated, to =
determine if=20
                  retinal referral is necessary.</P>
                  <H4>A Case of PED</H4>
                  <P>I have seen firsthand the benefits of using the =
Foresee PHP=20
                  and its ability to detect changes in the eye =
consistent with=20
                  the conversion from dry AMD to wet. One particular =
case has=20
                  cemented my belief in the benefits of this tool. In =
April=20
                  2006, an 80-year-old patient presented with a new =
choroidal=20
                  neovascular membrane and poor vision of 20/300 in her =
left=20
                  eye. Vision in her right eye was 20/40. The left eye =
had been=20
                  treated with five ranibizumab (Lucentis, Genentech)=20
                  injections, one intravitreal kenalog injection and two =

                  treatments with photodynamic therapy (PDT). =
Unfortunately, her=20
                  vision remained poor in the count fingers range. Upon =
her=20
                  latest injection in December 2006, a PHP test revealed =
an=20
                  abnormal area in her right eye (<B>Figure =
1</B>).</P><IMG=20
                  height=3D666=20
                  =
src=3D"http://www.ophmanagement.com/archive/2008/December/images/OMD_Dece=
mber_A15_Fig02.jpg"=20
                  width=3D532>=20
                  <P><B>Figure 1. PHP: abnormal test indicates a high=20
                  probability of neovascular AMD.</B></P>
                  <P>I found the test to be reliable based on indices of =
false=20
                  negative and false positive results. After a follow-up =
OCT=20
                  confirmed the presence of a pigment epithelial =
detachment=20
                  (PED) (<B>Figure 2</B>), I discussed with the patient=20
                  treatment versus observation. Since PEDs are =
unpredictable and=20
                  may be stable for a long time, we elected to watch for =
now.=20
                  Upon her return visit after 1 month, her vision had =
dropped=20
                  from 20/40 to 20/80 and repeat OCT revealed a larger =
PED=20
                  (<B>Figure 3</B>). At that time we instituted Lucentis =
for the=20
                  right eye as well. Thus far, she has had a total of =
seven=20
                  Lucentis injections, two pegaptanib (Macugen, OSI=20
                  Pharmaceuticals) injections, one PDT, and two Avastin=20
                  (Genentech) injections. As of July 2008, the date of =
her last=20
                  injection, her vision was stable at 20/60. I believe =
the=20
                  information generated by the Foresee PHP saved her =
sight by=20
                  picking up her lesion much earlier, allowing me to =
treat=20
                  promptly.</P><IMG height=3D165=20
                  =
src=3D"http://www.ophmanagement.com/archive/2008/December/images/OMD_Dece=
mber_A15_Fig03.jpg"=20
                  width=3D254>=20
                  <P><B>Figure 2. Mild pigment epithelial detachment=20
                  (PED).</B></P><IMG height=3D165=20
                  =
src=3D"http://www.ophmanagement.com/archive/2008/December/images/OMD_Dece=
mber_A15_Fig04.jpg"=20
                  width=3D254>=20
                  <P><B>Figure 3. Much larger PED after 1 month.</B></P>
                  <H4>Silver Lining</H4>
                  <P>While dry AMD can progress to wet AMD, and =
eventually=20
                  blindness if left undetected and untreated, you and =
your=20
                  patients can work together to ensure the best possible =
visual=20
                  outcomes by using sophisticated diagnostic technology. =
PHP can=20
                  improve monitoring of AMD progression and provide =
valuable=20
                  information when making treatment decisions. Many =
macular=20
                  degeneration patients know someone who has experienced =
partial=20
                  or complete vision loss, thus they are motivated to =
care for=20
                  their own vision. As a practitioner, the more you can=20
                  encourage your patients to take a hands-on approach, =
the more=20
                  likely they are to have a positive outcome. =
<B>OM</B></P>
                  <H4>Reference</H4>
                  <P>1. Alster Y, Bressler NM, Bressler SB, et al; =
Preferential=20
                  Hyperacuity Perimetry Research Group. Preferential =
Hyperacuity=20
                  Perimeter (PreView PHP) for detecting choroidal=20
                  neovascularization study. <I>Ophthalmology.</I>=20
                  2005;112:1758-1765.</P>
                  <TABLE border=3D1>
                    <TBODY>
                    <TR>
                      <TD><B>Paul Garfinkle, M.D.,</B> is a retina and=20
                        comprehensive ophthalmologist at Ohio =
EyeAlliance. He=20
                        has experience in the diagnosis and treatment of =
medical=20
                        retinal disease, including ARMD and diabetic=20
                        retinopathy, as well as performing small =
incision=20
                        cataract surgery. He states that he has no =
financial=20
                        interest in the company or product mentioned. =
Dr.=20
                        Garfinkle may be reached at eyedoc7@neo.rr.com =
or by=20
                        phone at (330) =
823-1680.</TD></TR></TBODY></TABLE><!--archive\2008\December\--></SPAN></=
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var ERA_RC =3D window.ERA_RC||{};
ERA_RC.resource =3D function()
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used for related links JavaScript output.
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			current_document.write("<link href=3D'" + DEFAULT_CSS_URL + "' =
type=3D'text/css' rel=3D'stylesheet' />");
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if (matchResult !=3D null)
{
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current_window.era_rc["ContentId"] !=3D null)
		{
			return (current_window.era_rc["ContentId"]);
		}
		else if (IsTestMode(current_window) && current_window.era_rc["Test"] =
=3D=3D 'true')
		{
			return '0';
		}
		else
		{
			return GetCustomContentID();
		}
	}

	//Gets the stylesheet to use
	function GetStylesheet(current_window)
	{
		if (current_window.era_rc !=3D null && =
current_window.era_rc["OverrideCss"] !=3D null)
		{
			return (current_window.era_rc["OverrideCss"]);
		}
		return '';
	}
=09
	//Gets the style id to use
	function GetStyleId(current_window)
	{=09
		if (current_window.era_rc !=3D null && =
current_window.era_rc["StyleId"] !=3D null)
		{
			return (current_window.era_rc["StyleId"]);
		}
		return '0';
	}

	//Checks to see if the request is to be in test mode. (Randomly =
generated links)
	function IsTestMode(current_window)
	{
		if (current_window.era_rc !=3D null && current_window.era_rc["Test"] =
!=3D null)
		{
			return current_window.era_rc["Test"];
		}
		return false;
	}

	//Prints the related links IFrame to the document.
	function DisplayEraFrame(eraLink, current_document, current_window)
	{
		current_document.write("<iframe name=3D'era_relatedLinks' width=3D'" + =
GetEraBlockWidth(current_window)+ "' height=3D'" + =
GetEraBlockHeight(current_window) + "' frameborder=3D'0' src=3D'" + =
eraLink + "' marginwidth=3D'0' marginheight=3D'0' scrolling=3D'no'>");
		current_document.write("</iframe>");
	}

	//Prints the related links JavaScript to the document.
	function DisplayEraJavaScript(eraLink, current_document, =
current_window)
	{
		current_document.write("<script type=3D\"text/javascript\" src=3D\"" + =
eraLink + "\"></script>");
	}

	//Adds double quotes to the provided string.
	function GetStringWithQuotes(checkString)
	{
		return checkString!=3Dnull ?'"'+ checkString + '"':'""'
	}
=09
	function GetReferrer(current_window, current_document)
	{
		if ('url'.toLowerCase() =3D=3D 'referrer')
		{
			return current_document.referrer;		=09
		}
		return current_window.location.href;
	}
=09
	function IsValidUrl(current_window, current_document)
	{
		return true
	}
=09
	//Generates the related links request link using the link parameters.
	function CreateEraLink(current_window, current_document)
	{
		if (IsValidUrl(current_window, current_document))
		{
			var eraLink =3D GetEraDomain(current_window) + "?";
		=09
			eraLink +=3D "ContentId=3D" + (GetContentId(current_window)) + =
"&numrequests=3D1&";
			eraLink +=3D "req1=3D" + GetContentType(current_window) + "||";
			eraLink +=3D GetEraMaxItems(current_window) + "|";
			eraLink +=3D "SortBy:" + GetEraSortType(current_window);
			eraLink +=3D "&Referrer=3D" + =
encodeURIComponent(GetReferrer(current_window, current_document));
		=09
			if (IsTestMode(current_window))
			{
				eraLink +=3D "&Test=3D" + IsTestMode(current_window);
			}

			if (GetStyleId(current_window) !=3D '')
			{
				eraLink +=3D "&StyleId=3D" + GetStyleId(current_window);
			}

			if (GetStylesheet(current_window) !=3D '')
			{
				eraLink +=3D "&OverrideCss=3D" + GetStylesheet(current_window);
			}

			// if UseIFrame property is set to no, write javascript, else use =
iframe
			if (GetUseIFrame(current_window))
			{
				eraLink +=3D "&";
				eraLink +=3D "OutputType=3Dhtml";
				DisplayEraFrame(eraLink, current_document, current_window);
			}
			else
			{
				eraLink +=3D "&";
				eraLink +=3D "OutputType=3Djavascript";
				DisplayEraJavaScript(eraLink, current_document, current_window);			=09
			}
		}
		current_window.era_rc =3D null;
	}

	//Calls functions to print the related links frame.
	function EraMain()
	{
		var current_window =3D window;
		var current_document =3D document;
		CreateEraLink(current_window, current_document);
	}
	EraMain();
})()

------=_NextPart_000_0000_01C96032.6DEFE780
Content-Type: application/octet-stream
Content-Transfer-Encoding: quoted-printable
Content-Location: http://www.google-analytics.com/urchin.js

//-- Google Analytics Urchin Module=0A=
//-- Copyright 2007 Google, All Rights Reserved.=0A=
=0A=
//-- Urchin On Demand Settings ONLY=0A=
var _uacct=3D"";			// set up the Urchin Account=0A=
var _userv=3D1;			// service mode (0=3Dlocal,1=3Dremote,2=3Dboth)=0A=
=0A=
//-- UTM User Settings=0A=
var _ufsc=3D1;			// set client info flag (1=3Don|0=3Doff)=0A=
var _udn=3D"auto";		// (auto|none|domain) set the domain name for cookies=0A=
var _uhash=3D"on";		// (on|off) unique domain hash for cookies=0A=
var _utimeout=3D"1800";   	// set the inactive session timeout in seconds=0A=
var _ugifpath=3D"/__utm.gif";	// set the web path to the __utm.gif file=0A=
var _utsp=3D"|";			// transaction field separator=0A=
var _uflash=3D1;			// set flash version detect option (1=3Don|0=3Doff)=0A=
var _utitle=3D1;			// set the document title detect option =
(1=3Don|0=3Doff)=0A=
var _ulink=3D0;			// enable linker functionality (1=3Don|0=3Doff)=0A=
var _uanchor=3D0;			// enable use of anchors for campaign =
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var _utcp=3D"/";			// the cookie path for tracking=0A=
var _usample=3D100;		// The sampling % of visitors to track (1-100).=0A=
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//-- UTM Campaign Tracking Settings=0A=
var _uctm=3D1;			// set campaign tracking module (1=3Don|0=3Doff)=0A=
var _ucto=3D"15768000";		// set timeout in seconds (6 month default)=0A=
var _uccn=3D"utm_campaign";	// name=0A=
var _ucmd=3D"utm_medium";		// medium (cpc|cpm|link|email|organic)=0A=
var _ucsr=3D"utm_source";		// source=0A=
var _uctr=3D"utm_term";		// term/keyword=0A=
var _ucct=3D"utm_content";	// content=0A=
var _ucid=3D"utm_id";		// id number=0A=
var _ucno=3D"utm_nooverride";	// don't override=0A=
=0A=
//-- Auto/Organic Sources and Keywords=0A=
var _uOsr=3Dnew Array();=0A=
var _uOkw=3Dnew Array();=0A=
_uOsr[0]=3D"google";	_uOkw[0]=3D"q";=0A=
_uOsr[1]=3D"yahoo";	_uOkw[1]=3D"p";=0A=
_uOsr[2]=3D"msn";		_uOkw[2]=3D"q";=0A=
_uOsr[3]=3D"aol";		_uOkw[3]=3D"query";=0A=
_uOsr[4]=3D"aol";		_uOkw[4]=3D"encquery";=0A=
_uOsr[5]=3D"lycos";	_uOkw[5]=3D"query";=0A=
_uOsr[6]=3D"ask";		_uOkw[6]=3D"q";=0A=
_uOsr[7]=3D"altavista";	_uOkw[7]=3D"q";=0A=
_uOsr[8]=3D"netscape";	_uOkw[8]=3D"query";=0A=
_uOsr[9]=3D"cnn";	_uOkw[9]=3D"query";=0A=
_uOsr[10]=3D"looksmart";	_uOkw[10]=3D"qt";=0A=
_uOsr[11]=3D"about";	_uOkw[11]=3D"terms";=0A=
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_uOsr[13]=3D"alltheweb";	_uOkw[13]=3D"q";=0A=
_uOsr[14]=3D"gigablast";	_uOkw[14]=3D"q";=0A=
_uOsr[15]=3D"voila";	_uOkw[15]=3D"rdata";=0A=
_uOsr[16]=3D"virgilio";	_uOkw[16]=3D"qs";=0A=
_uOsr[17]=3D"live";	_uOkw[17]=3D"q";=0A=
_uOsr[18]=3D"baidu";	_uOkw[18]=3D"wd";=0A=
_uOsr[19]=3D"alice";	_uOkw[19]=3D"qs";=0A=
_uOsr[20]=3D"yandex";	_uOkw[20]=3D"text";=0A=
_uOsr[21]=3D"najdi";	_uOkw[21]=3D"q";=0A=
_uOsr[22]=3D"aol";	_uOkw[22]=3D"q";=0A=
_uOsr[23]=3D"club-internet"; _uOkw[23]=3D"query";=0A=
_uOsr[24]=3D"mama";	_uOkw[24]=3D"query";=0A=
_uOsr[25]=3D"seznam";	_uOkw[25]=3D"q";=0A=
_uOsr[26]=3D"search";	_uOkw[26]=3D"q";=0A=
_uOsr[27]=3D"wp";	_uOkw[27]=3D"szukaj";=0A=
_uOsr[28]=3D"onet";	_uOkw[28]=3D"qt";=0A=
_uOsr[29]=3D"netsprint";	_uOkw[29]=3D"q";=0A=
_uOsr[30]=3D"google.interia";	_uOkw[30]=3D"q";=0A=
_uOsr[31]=3D"szukacz";	_uOkw[31]=3D"q";=0A=
_uOsr[32]=3D"yam";	_uOkw[32]=3D"k";=0A=
_uOsr[33]=3D"pchome";	_uOkw[33]=3D"q";=0A=
_uOsr[34]=3D"kvasir";	_uOkw[34]=3D"searchExpr";=0A=
_uOsr[35]=3D"sesam";	_uOkw[35]=3D"q";=0A=
_uOsr[36]=3D"ozu"; _uOkw[36]=3D"q";=0A=
_uOsr[37]=3D"terra"; _uOkw[37]=3D"query";=0A=
_uOsr[38]=3D"nostrum"; _uOkw[38]=3D"query";=0A=
_uOsr[39]=3D"mynet"; _uOkw[39]=3D"q";=0A=
_uOsr[40]=3D"ekolay"; _uOkw[40]=3D"q";=0A=
_uOsr[41]=3D"search.ilse"; _uOkw[41]=3D"search_for";=0A=
=0A=
//-- Auto/Organic Keywords to Ignore=0A=
var _uOno=3Dnew Array();=0A=
//_uOno[0]=3D"urchin";=0A=
//_uOno[1]=3D"urchin.com";=0A=
//_uOno[2]=3D"www.urchin.com";=0A=
=0A=
//-- Referral domains to Ignore=0A=
var _uRno=3Dnew Array();=0A=
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=0A=
//-- **** Don't modify below this point ***=0A=
var =
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var _ugifpath2=3D"http://www.google-analytics.com/__utm.gif";=0A=
if (_udl.hash) _udlh=3D_udl.href.substring(_udl.href.indexOf('#'));=0A=
if (_udl.protocol=3D=3D"https:") =
_ugifpath2=3D"https://ssl.google-analytics.com/__utm.gif";=0A=
if (!_utcp || _utcp=3D=3D"") _utcp=3D"/";=0A=
function urchinTracker(page) {=0A=
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 if (_utimeout && _utimeout!=3D"") {=0A=
  x=3Dnew Date(_udt.getTime()+(_utimeout*1000));=0A=
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 if (_ulink) {=0A=
  if (_uanchor && _udlh && _udlh!=3D"") s=3D_udlh+"&";=0A=
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  if (t!=3D"-" && t!=3D"") c+=3D"utmcid=3D"+_uEC(t);=0A=
  if (t2!=3D"-" && t2!=3D"") { if (c !=3D "") c+=3D"|"; =
c+=3D"utmcsr=3D"+_uEC(t2); }=0A=
  if (t3!=3D"-" && t3!=3D"") { if (c !=3D "") c+=3D"|"; =
c+=3D"utmgclid=3D"+_uEC(t3); }=0A=
  t=3D_uGC(s,_uccn+"=3D","&");=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"|utmccn=3D"+_uEC(t);=0A=
  else c+=3D"|utmccn=3D(not+set)";=0A=
  t=3D_uGC(s,_ucmd+"=3D","&");=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"|utmcmd=3D"+_uEC(t);=0A=
  else  c+=3D"|utmcmd=3D(not+set)";=0A=
  t=3D_uGC(s,_uctr+"=3D","&");=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"|utmctr=3D"+_uEC(t);=0A=
  else { t=3D_uOrg(1); if (t!=3D"-" && t!=3D"") =
c+=3D"|utmctr=3D"+_uEC(t); }=0A=
  t=3D_uGC(s,_ucct+"=3D","&");=0A=
  if (t!=3D"-" && t!=3D"") c+=3D"|utmcct=3D"+_uEC(t);=0A=
  t=3D_uGC(s,_ucno+"=3D","&");=0A=
  if (t=3D=3D"1") o=3D1;=0A=
  if (z!=3D"-" && o=3D=3D1) return "";=0A=
 }=0A=
 if (c=3D=3D"-" || c=3D=3D"") { c=3D_uOrg(); if (z!=3D"-" && =
_ufno=3D=3D1)  return ""; }=0A=
 if (c=3D=3D"-" || c=3D=3D"") { if (_ufns=3D=3D1)  c=3D_uRef(); if =
(z!=3D"-" && _ufno=3D=3D1)  return ""; }=0A=
 if (c=3D=3D"-" || c=3D=3D"") {=0A=
  if (z=3D=3D"-" && _ufns=3D=3D1) { =
c=3D"utmccn=3D(direct)|utmcsr=3D(direct)|utmcmd=3D(none)"; }=0A=
  if (c=3D=3D"-" || c=3D=3D"") return "";=0A=
 }=0A=
 if (z!=3D"-") {=0A=
  i=3Dz.indexOf(".");=0A=
  if (i>-1) i=3Dz.indexOf(".",i+1);=0A=
  if (i>-1) i=3Dz.indexOf(".",i+1);=0A=
  if (i>-1) i=3Dz.indexOf(".",i+1);=0A=
  t=3Dz.substring(i+1,z.length);=0A=
  if (t.toLowerCase()=3D=3Dc.toLowerCase()) cs=3D1;=0A=
  t=3Dz.substring(0,i);=0A=
  if ((i=3Dt.lastIndexOf(".")) > -1) {=0A=
   t=3Dt.substring(i+1,t.length);=0A=
   cn=3D(t*1);=0A=
  }=0A=
 }=0A=
 if (cs=3D=3D0 || _ufns=3D=3D1) {=0A=
  t=3D_uGC(dc,"__utma=3D"+_udh+".",";");=0A=
  if ((i=3Dt.lastIndexOf(".")) > 9) {=0A=
   _uns=3Dt.substring(i+1,t.length);=0A=
   _uns=3D(_uns*1);=0A=
  }=0A=
  cn++;=0A=
  if (_uns=3D=3D0) _uns=3D1;=0A=
  _ubd.cookie=3D"__utmz=3D"+_udh+"."+_ust+"."+_uns+"."+cn+"."+c+"; =
path=3D"+_utcp+"; "+x+_udo;=0A=
 }=0A=
 if (cs=3D=3D0 || _ufns=3D=3D1) return "&utmcn=3D1";=0A=
 else return "&utmcr=3D1";=0A=
}=0A=
function _uRef() {=0A=
 if (_ur=3D=3D"0" || _ur=3D=3D"" || _ur=3D=3D"-") return "";=0A=
 var i=3D0,h,k,n;=0A=
 if ((i=3D_ur.indexOf("://"))<0 || _uGCse()) return "";=0A=
 h=3D_ur.substring(i+3,_ur.length);=0A=
 if (h.indexOf("/") > -1) {=0A=
  k=3Dh.substring(h.indexOf("/"),h.length);=0A=
  if (k.indexOf("?") > -1) k=3Dk.substring(0,k.indexOf("?"));=0A=
  h=3Dh.substring(0,h.indexOf("/"));=0A=
 }=0A=
 h=3Dh.toLowerCase();=0A=
 n=3Dh;=0A=
 if ((i=3Dn.indexOf(":")) > -1) n=3Dn.substring(0,i);=0A=
 for (var ii=3D0;ii<_uRno.length;ii++) {=0A=
  if ((i=3Dn.indexOf(_uRno[ii].toLowerCase())) > -1 && =
n.length=3D=3D(i+_uRno[ii].length)) { _ufno=3D1; break; }=0A=
 }=0A=
 if (h.indexOf("www.")=3D=3D0) h=3Dh.substring(4,h.length);=0A=
 return =
"utmccn=3D(referral)|utmcsr=3D"+_uEC(h)+"|"+"utmcct=3D"+_uEC(k)+"|utmcmd=3D=
referral";=0A=
}=0A=
function _uOrg(t) {=0A=
 if (_ur=3D=3D"0" || _ur=3D=3D"" || _ur=3D=3D"-") return "";=0A=
 var i=3D0,h,k;=0A=
 if ((i=3D_ur.indexOf("://"))<0 || _uGCse()) return "";=0A=
 h=3D_ur.substring(i+3,_ur.length);=0A=
 if (h.indexOf("/") > -1) {=0A=
  h=3Dh.substring(0,h.indexOf("/"));=0A=
 }=0A=
 for (var ii=3D0;ii<_uOsr.length;ii++) {=0A=
  if (h.toLowerCase().indexOf(_uOsr[ii].toLowerCase()) > -1) {=0A=
   if ((i=3D_ur.indexOf("?"+_uOkw[ii]+"=3D")) > -1 || =
(i=3D_ur.indexOf("&"+_uOkw[ii]+"=3D")) > -1) {=0A=
    k=3D_ur.substring(i+_uOkw[ii].length+2,_ur.length);=0A=
    if ((i=3Dk.indexOf("&")) > -1) k=3Dk.substring(0,i);=0A=
    for (var yy=3D0;yy<_uOno.length;yy++) {=0A=
     if (_uOno[yy].toLowerCase()=3D=3Dk.toLowerCase()) { _ufno=3D1; =
break; }=0A=
    }=0A=
    if (t) return _uEC(k);=0A=
    else return =
"utmccn=3D(organic)|utmcsr=3D"+_uEC(_uOsr[ii])+"|"+"utmctr=3D"+_uEC(k)+"|=
utmcmd=3Dorganic";=0A=
   }=0A=
  }=0A=
 }=0A=
 return "";=0A=
}=0A=
function _uGCse() {=0A=
 var h,p;=0A=
 h=3Dp=3D_ur.split("://")[1];=0A=
 if(h.indexOf("/")>-1) {=0A=
  h=3Dh.split("/")[0];=0A=
  p=3Dp.substring(p.indexOf("/")+1,p.length);=0A=
 }=0A=
 if(p.indexOf("?")>-1) {=0A=
  p=3Dp.split("?")[0];=0A=
 }=0A=
 if(h.toLowerCase().indexOf("google")>-1) {=0A=
  if(_ur.indexOf("?q=3D")>-1 || _ur.indexOf("&q=3D")>-1) {=0A=
   if (p.toLowerCase().indexOf("cse")>-1) {=0A=
    return true;=0A=
   }=0A=
  }=0A=
 }=0A=
}=0A=
function _uBInfo() {=0A=
 var sr=3D"-",sc=3D"-",ul=3D"-",fl=3D"-",cs=3D"-",je=3D1;=0A=
 var n=3Dnavigator;=0A=
 if (self.screen) {=0A=
  sr=3Dscreen.width+"x"+screen.height;=0A=
  sc=3Dscreen.colorDepth+"-bit";=0A=
 } else if (self.java) {=0A=
  var j=3Djava.awt.Toolkit.getDefaultToolkit();=0A=
  var s=3Dj.getScreenSize();=0A=
  sr=3Ds.width+"x"+s.height;=0A=
 }=0A=
 if (n.language) { ul=3Dn.language.toLowerCase(); }=0A=
 else if (n.browserLanguage) { ul=3Dn.browserLanguage.toLowerCase(); }=0A=
 je=3Dn.javaEnabled()?1:0;=0A=
 if (_uflash) fl=3D_uFlash();=0A=
 if (_ubd.characterSet) cs=3D_uES(_ubd.characterSet);=0A=
 else if (_ubd.charset) cs=3D_uES(_ubd.charset);=0A=
 return =
"&utmcs=3D"+cs+"&utmsr=3D"+sr+"&utmsc=3D"+sc+"&utmul=3D"+ul+"&utmje=3D"+j=
e+"&utmfl=3D"+fl;=0A=
}=0A=
function __utmSetTrans() {=0A=
 var e;=0A=
 if (_ubd.getElementById) e=3D_ubd.getElementById("utmtrans");=0A=
 else if (_ubd.utmform && _ubd.utmform.utmtrans) =
e=3D_ubd.utmform.utmtrans;=0A=
 if (!e) return;=0A=
 var l=3De.value.split("UTM:");=0A=
 var i,i2,c;=0A=
 if (_userv=3D=3D0 || _userv=3D=3D2) i=3Dnew Array();=0A=
 if (_userv=3D=3D1 || _userv=3D=3D2) { i2=3Dnew Array(); c=3D_uGCS(); }=0A=
=0A=
 for (var ii=3D0;ii<l.length;ii++) {=0A=
  l[ii]=3D_uTrim(l[ii]);=0A=
  if (l[ii].charAt(0)!=3D'T' && l[ii].charAt(0)!=3D'I') continue;=0A=
  var r=3DMath.round(Math.random()*2147483647);=0A=
  if (!_utsp || _utsp=3D=3D"") _utsp=3D"|";=0A=
  var f=3Dl[ii].split(_utsp),s=3D"";=0A=
  if (f[0].charAt(0)=3D=3D'T') {=0A=
   s=3D"&utmt=3Dtran"+"&utmn=3D"+r;=0A=
   f[1]=3D_uTrim(f[1]); if(f[1]&&f[1]!=3D"") =
s+=3D"&utmtid=3D"+_uES(f[1]);=0A=
   f[2]=3D_uTrim(f[2]); if(f[2]&&f[2]!=3D"") =
s+=3D"&utmtst=3D"+_uES(f[2]);=0A=
   f[3]=3D_uTrim(f[3]); if(f[3]&&f[3]!=3D"") =
s+=3D"&utmtto=3D"+_uES(f[3]);=0A=
   f[4]=3D_uTrim(f[4]); if(f[4]&&f[4]!=3D"") =
s+=3D"&utmttx=3D"+_uES(f[4]);=0A=
   f[5]=3D_uTrim(f[5]); if(f[5]&&f[5]!=3D"") =
s+=3D"&utmtsp=3D"+_uES(f[5]);=0A=
   f[6]=3D_uTrim(f[6]); if(f[6]&&f[6]!=3D"") =
s+=3D"&utmtci=3D"+_uES(f[6]);=0A=
   f[7]=3D_uTrim(f[7]); if(f[7]&&f[7]!=3D"") =
s+=3D"&utmtrg=3D"+_uES(f[7]);=0A=
   f[8]=3D_uTrim(f[8]); if(f[8]&&f[8]!=3D"") =
s+=3D"&utmtco=3D"+_uES(f[8]);=0A=
  } else {=0A=
   s=3D"&utmt=3Ditem"+"&utmn=3D"+r;=0A=
   f[1]=3D_uTrim(f[1]); if(f[1]&&f[1]!=3D"") =
s+=3D"&utmtid=3D"+_uES(f[1]);=0A=
   f[2]=3D_uTrim(f[2]); if(f[2]&&f[2]!=3D"") =
s+=3D"&utmipc=3D"+_uES(f[2]);=0A=
   f[3]=3D_uTrim(f[3]); if(f[3]&&f[3]!=3D"") =
s+=3D"&utmipn=3D"+_uES(f[3]);=0A=
   f[4]=3D_uTrim(f[4]); if(f[4]&&f[4]!=3D"") =
s+=3D"&utmiva=3D"+_uES(f[4]);=0A=
   f[5]=3D_uTrim(f[5]); if(f[5]&&f[5]!=3D"") =
s+=3D"&utmipr=3D"+_uES(f[5]);=0A=
   f[6]=3D_uTrim(f[6]); if(f[6]&&f[6]!=3D"") =
s+=3D"&utmiqt=3D"+_uES(f[6]);=0A=
  }=0A=
  if (_udl.hostname && _udl.hostname!=3D"") =
s+=3D"&utmhn=3D"+_uES(_udl.hostname);=0A=
  if (_usample && _usample !=3D 100) s+=3D"&utmsp=3D"+_uES(_usample);=0A=
=0A=
  if ((_userv=3D=3D0 || _userv=3D=3D2) && _uSP()) {=0A=
   i[ii]=3Dnew Image(1,1);=0A=
   i[ii].src=3D_ugifpath+"?"+"utmwv=3D"+_uwv+s;=0A=
   i[ii].onload=3Dfunction() { _uVoid(); }=0A=
  }=0A=
  if ((_userv=3D=3D1 || _userv=3D=3D2) && _uSP()) {=0A=
   i2[ii]=3Dnew Image(1,1);=0A=
   =
i2[ii].src=3D_ugifpath2+"?"+"utmwv=3D"+_uwv+s+"&utmac=3D"+_uacct+"&utmcc=3D=
"+c;=0A=
   i2[ii].onload=3Dfunction() { _uVoid(); }=0A=
  }=0A=
 }=0A=
 return;=0A=
}=0A=
function _uFlash() {=0A=
 var f=3D"-",n=3Dnavigator;=0A=
 if (n.plugins && n.plugins.length) {=0A=
  for (var ii=3D0;ii<n.plugins.length;ii++) {=0A=
   if (n.plugins[ii].name.indexOf('Shockwave Flash')!=3D-1) {=0A=
    f=3Dn.plugins[ii].description.split('Shockwave Flash ')[1];=0A=
    break;=0A=
   }=0A=
  }=0A=
 } else {=0A=
  var fl;=0A=
  try {=0A=
   fl =3D new ActiveXObject("ShockwaveFlash.ShockwaveFlash.7");=0A=
   f =3D fl.GetVariable("$version");=0A=
  } catch(e) {}=0A=
  if (f =3D=3D "-") {=0A=
   try {=0A=
    fl =3D new ActiveXObject("ShockwaveFlash.ShockwaveFlash.6");=0A=
    f =3D "WIN 6,0,21,0";=0A=
    fl.AllowScriptAccess =3D "always";=0A=
    f =3D fl.GetVariable("$version");=0A=
   } catch(e) {}=0A=
  }=0A=
  if (f =3D=3D "-") {=0A=
   try {=0A=
    fl =3D new ActiveXObject("ShockwaveFlash.ShockwaveFlash");=0A=
    f =3D fl.GetVariable("$version");=0A=
   } catch(e) {}=0A=
  }=0A=
  if (f !=3D "-") {=0A=
   f =3D f.split(" ")[1].split(",");=0A=
   f =3D f[0] + "." + f[1] + " r" + f[2];=0A=
  }=0A=
 }=0A=
 return f;=0A=
}=0A=
function __utmLinkerUrl(l,h) {=0A=
 var p,k,a=3D"-",b=3D"-",c=3D"-",x=3D"-",z=3D"-",v=3D"-";=0A=
 var dc=3D_ubd.cookie;=0A=
 var iq =3D l.indexOf("?");=0A=
 var ih =3D l.indexOf("#");=0A=
 var url=3Dl;=0A=
 if (dc) {=0A=
  a=3D_uES(_uGC(dc,"__utma=3D"+_udh+".",";"));=0A=
  b=3D_uES(_uGC(dc,"__utmb=3D"+_udh,";"));=0A=
  c=3D_uES(_uGC(dc,"__utmc=3D"+_udh,";"));=0A=
  x=3D_uES(_uGC(dc,"__utmx=3D"+_udh,";"));=0A=
  z=3D_uES(_uGC(dc,"__utmz=3D"+_udh+".",";"));=0A=
  v=3D_uES(_uGC(dc,"__utmv=3D"+_udh+".",";"));=0A=
  k=3D(_uHash(a+b+c+x+z+v)*1)+(_udh*1);=0A=
  =
p=3D"__utma=3D"+a+"&__utmb=3D"+b+"&__utmc=3D"+c+"&__utmx=3D"+x+"&__utmz=3D=
"+z+"&__utmv=3D"+v+"&__utmk=3D"+k;=0A=
 }=0A=
 if (p) {=0A=
  if (h && ih>-1) return;=0A=
  if (h) { url=3Dl+"#"+p; }=0A=
  else {=0A=
   if (iq=3D=3D-1 && ih=3D=3D-1) url=3Dl+"?"+p;=0A=
   else if (ih=3D=3D-1) url=3Dl+"&"+p;=0A=
   else if (iq=3D=3D-1) url=3Dl.substring(0,ih-1)+"?"+p+l.substring(ih);=0A=
   else url=3Dl.substring(0,ih-1)+"&"+p+l.substring(ih);=0A=
  }=0A=
 }=0A=
 return url;=0A=
}=0A=
function __utmLinker(l,h) {=0A=
 if (!_ulink || !l || l=3D=3D"") return;=0A=
 _udl.href=3D__utmLinkerUrl(l,h);=0A=
}=0A=
function __utmLinkPost(f,h) {=0A=
 if (!_ulink || !f || !f.action) return;=0A=
 f.action=3D__utmLinkerUrl(f.action, h);=0A=
 return;=0A=
}=0A=
function __utmSetVar(v) {=0A=
 if (!v || v=3D=3D"") return;=0A=
 if (!_udo || _udo =3D=3D "") {=0A=
  _udh=3D_uDomain();=0A=
  if (_udn && _udn!=3D"") { _udo=3D" domain=3D"+_udn+";"; }=0A=
 }=0A=
 if (!_uVG()) return;=0A=
 var r=3DMath.round(Math.random() * 2147483647);=0A=
 _ubd.cookie=3D"__utmv=3D"+_udh+"."+_uES(v)+"; path=3D"+_utcp+"; =
expires=3D"+_uNx()+";"+_udo;=0A=
 var s=3D"&utmt=3Dvar&utmn=3D"+r;=0A=
 if (_usample && _usample !=3D 100) s+=3D"&utmsp=3D"+_uES(_usample);=0A=
 if ((_userv=3D=3D0 || _userv=3D=3D2) && _uSP()) {=0A=
  var i=3Dnew Image(1,1);=0A=
  i.src=3D_ugifpath+"?"+"utmwv=3D"+_uwv+s;=0A=
  i.onload=3Dfunction() { _uVoid(); }=0A=
 }=0A=
 if ((_userv=3D=3D1 || _userv=3D=3D2) && _uSP()) {=0A=
  var i2=3Dnew Image(1,1);=0A=
  =
i2.src=3D_ugifpath2+"?"+"utmwv=3D"+_uwv+s+"&utmac=3D"+_uacct+"&utmcc=3D"+=
_uGCS();=0A=
  i2.onload=3Dfunction() { _uVoid(); }=0A=
 }=0A=
}=0A=
function _uGCS() {=0A=
 var t,c=3D"",dc=3D_ubd.cookie;=0A=
 if ((t=3D_uGC(dc,"__utma=3D"+_udh+".",";"))!=3D"-") =
c+=3D_uES("__utma=3D"+t+";+");=0A=
 if ((t=3D_uGC(dc,"__utmx=3D"+_udh,";"))!=3D"-") =
c+=3D_uES("__utmx=3D"+t+";+");=0A=
 if ((t=3D_uGC(dc,"__utmz=3D"+_udh+".",";"))!=3D"-") =
c+=3D_uES("__utmz=3D"+t+";+");=0A=
 if ((t=3D_uGC(dc,"__utmv=3D"+_udh+".",";"))!=3D"-") =
c+=3D_uES("__utmv=3D"+t+";");=0A=
 if (c.charAt(c.length-1)=3D=3D"+") c=3Dc.substring(0,c.length-1);=0A=
 return c;=0A=
}=0A=
function _uGC(l,n,s) {=0A=
 if (!l || l=3D=3D"" || !n || n=3D=3D"" || !s || s=3D=3D"") return "-";=0A=
 var i,i2,i3,c=3D"-";=0A=
 i=3Dl.indexOf(n);=0A=
 i3=3Dn.indexOf("=3D")+1;=0A=
 if (i > -1) {=0A=
  i2=3Dl.indexOf(s,i); if (i2 < 0) { i2=3Dl.length; }=0A=
  c=3Dl.substring((i+i3),i2);=0A=
 }=0A=
 return c;=0A=
}=0A=
function _uDomain() {=0A=
 if (!_udn || _udn=3D=3D"" || _udn=3D=3D"none") { _udn=3D""; return 1; }=0A=
 if (_udn=3D=3D"auto") {=0A=
  var d=3D_ubd.domain;=0A=
  if (d.substring(0,4)=3D=3D"www.") {=0A=
   d=3Dd.substring(4,d.length);=0A=
  }=0A=
  _udn=3Dd;=0A=
 }=0A=
 _udn =3D _udn.toLowerCase(); =0A=
 if (_uhash=3D=3D"off") return 1;=0A=
 return _uHash(_udn);=0A=
}=0A=
function _uHash(d) {=0A=
 if (!d || d=3D=3D"") return 1;=0A=
 var h=3D0,g=3D0;=0A=
 for (var i=3Dd.length-1;i>=3D0;i--) {=0A=
  var c=3DparseInt(d.charCodeAt(i));=0A=
  h=3D((h << 6) & 0xfffffff) + c + (c << 14);=0A=
  if ((g=3Dh & 0xfe00000)!=3D0) h=3D(h ^ (g >> 21));=0A=
 }=0A=
 return h;=0A=
}=0A=
function _uFixA(c,s,t) {=0A=
 if (!c || c=3D=3D"" || !s || s=3D=3D"" || !t || t=3D=3D"") return "-";=0A=
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}=0A=
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