@charset "UTF-8";meta.foundation-version{font-family:"/5.5.2/"}meta.foundation-mq-small{font-family:"/only screen/";width:0}meta.foundation-mq-small-only{font-family:"/only screen and (max-width: 40em)/";width:0}meta.foundation-mq-medium{font-family:"/only screen and (min-width:40.0625em)/";width:40.0625em}meta.foundation-mq-medium-only{font-family:"/only screen and (min-width:40.0625em) and (max-width:64em)/";width:40.0625em}meta.foundation-mq-large{font-family:"/only screen and (min-width:64.0625em)/";width:64.0625em}meta.foundation-mq-large-only{font-family:"/only screen and (min-width:64.0625em) and (max-width:90em)/";width:64.0625em}meta.foundation-mq-xlarge{font-family:"/only screen and (min-width:90.0625em)/";width:90.0625em}meta.foundation-mq-xlarge-only{font-family:"/only screen and (min-width:90.0625em) and (max-width:120em)/";width:90.0625em}meta.foundation-mq-xxlarge{font-family:"/only screen and (min-width:120.0625em)/";width:120.0625em}meta.foundation-data-attribute-namespace{font-family:false}.reveal-modal-bg{background:#000;background:rgba(0,0,0,.45);bottom:0;display:none;left:0;position:fixed;right:0;top:0;z-index:1004;left:0}.reveal-modal{border-radius:3px;display:none;position:absolute;top:0;visibility:hidden;width:100%;z-index:1005;left:0;background-color:#fff;padding:3.125rem 1.5625rem 1.5625rem 1.5625rem;border:solid 1px #666;box-shadow:0 0 10px rgba(0,0,0,.4)}@media only screen and (max-width:40em){.reveal-modal{min-height:100vh}}.reveal-modal .column,.reveal-modal .columns{min-width:0}.reveal-modal>:first-child{margin-top:0}.reveal-modal>:last-child{margin-bottom:0}@media only screen and (min-width:40.0625em){.reveal-modal{left:0;margin:0 auto;max-width:780px;right:0;width:80%}}@media only screen and (min-width:40.0625em){.reveal-modal{top:6.25rem}}.reveal-modal.radius{border-radius:3px}.reveal-modal.round{border-radius:1000px}.reveal-modal.collapse{padding:0}@media only screen and (min-width:40.0625em){.reveal-modal.tiny{left:0;margin:0 auto;max-width:780px;right:0;width:30%}}@media only screen and (min-width:40.0625em){.reveal-modal.small{left:0;margin:0 auto;max-width:780px;right:0;width:40%}}@media only screen and (min-width:40.0625em){.reveal-modal.medium{left:0;margin:0 auto;max-width:780px;right:0;width:60%}}@media only screen and (min-width:40.0625em){.reveal-modal.large{left:0;margin:0 auto;max-width:780px;right:0;width:70%}}@media only screen and (min-width:40.0625em){.reveal-modal.xlarge{left:0;margin:0 auto;max-width:780px;right:0;width:95%}}.reveal-modal.full{height:100vh;height:100%;left:0;margin-left:0!important;max-width:none!important;min-height:100vh;top:0}@media only screen and (min-width:40.0625em){.reveal-modal.full{left:0;margin:0 auto;max-width:780px;right:0;width:100%}}.reveal-modal.toback{z-index:1003}.reveal-modal .close-reveal-modal{color:#aaa;cursor:pointer;font-size:2.5rem;font-weight:700;line-height:1;position:absolute;top:.3125rem;right:1.375rem}form{margin:0 0 1.25rem}form .row .row{margin:0 -.625rem}form .row .row .column,form .row .row .columns{padding:0 .625rem}form .row .row.collapse{margin:0}form .row .row.collapse .column,form .row .row.collapse .columns{padding:0}form .row .row.collapse input{-webkit-border-bottom-right-radius:0;-webkit-border-top-right-radius:0;border-bottom-right-radius:0;border-top-right-radius:0}form .row input.column,form .row input.columns,form .row textarea.column,form .row textarea.columns{padding-left:.625rem}label{color:#4d4d4d;cursor:pointer;display:block;font-weight:600;line-height:1.5;margin-bottom:.5em}label.right{float:none!important;text-align:right}label.inline{margin:0 0 1.25rem 0;padding:.6875rem 0}label small{text-transform:capitalize;color:#676767}.postfix,.prefix{border-style:solid;border-width:1px;display:block;font-size:.875rem;height:inherit1.875rem-.0625rem;line-height:inherit1.875rem-.0625rem;overflow:visible;padding-bottom:0;padding-top:0;position:relative;text-align:center;width:100%;z-index:2}.postfix.button{border-color:true}.prefix.button{border:none;padding-left:0;padding-right:0;padding-bottom:0;padding-top:0;text-align:center}.prefix.button.radius{border-radius:0;-webkit-border-bottom-left-radius:3px;-webkit-border-top-left-radius:3px;border-bottom-left-radius:3px;border-top-left-radius:3px}.postfix.button.radius{border-radius:0;-webkit-border-bottom-right-radius:3px;-webkit-border-top-right-radius:3px;border-bottom-right-radius:3px;border-top-right-radius:3px}.prefix.button.round{border-radius:0;-webkit-border-bottom-left-radius:1000px;-webkit-border-top-left-radius:1000px;border-bottom-left-radius:1000px;border-top-left-radius:1000px}.postfix.button.round{border-radius:0;-webkit-border-bottom-right-radius:1000px;-webkit-border-top-right-radius:1000px;border-bottom-right-radius:1000px;border-top-right-radius:1000px}label.prefix,span.prefix{background:#f2f2f2;border-right:none;color:#333;border-color:#ccc}label.postfix,span.postfix{background:#f2f2f2;color:#333;border-color:#ccc}input[type=color],input[type=date],input[type=datetime-local],input[type=datetime],input[type=email],input[type=month],input[type=number],input[type=password],input[type=search],input[type=tel],input[type=text],input[type=time],input[type=url],input[type=week],textarea{-webkit-appearance:none;-moz-appearance:none;border-radius:0;background-color:#fff;border-style:solid;border-width:1px;border-color:#ccc;box-shadow:inherit;display:block;font-family:inherit;margin:0 0 1.25rem 0;padding:.625rem;box-sizing:border-box;transition:border-color .15s linear,background .15s linear}input[type=color]:focus,input[type=date]:focus,input[type=datetime-local]:focus,input[type=datetime]:focus,input[type=email]:focus,input[type=month]:focus,input[type=number]:focus,input[type=password]:focus,input[type=search]:focus,input[type=tel]:focus,input[type=text]:focus,input[type=time]:focus,input[type=url]:focus,input[type=week]:focus,textarea:focus{outline:0}input[type=color]:disabled,input[type=date]:disabled,input[type=datetime-local]:disabled,input[type=datetime]:disabled,input[type=email]:disabled,input[type=month]:disabled,input[type=number]:disabled,input[type=password]:disabled,input[type=search]:disabled,input[type=tel]:disabled,input[type=text]:disabled,input[type=time]:disabled,input[type=url]:disabled,input[type=week]:disabled,textarea:disabled{background-color:inherit;cursor:default}fieldset[disabled] input[type=color],fieldset[disabled] input[type=date],fieldset[disabled] input[type=datetime-local],fieldset[disabled] input[type=datetime],fieldset[disabled] input[type=email],fieldset[disabled] input[type=month],fieldset[disabled] input[type=number],fieldset[disabled] input[type=password],fieldset[disabled] input[type=search],fieldset[disabled] input[type=tel],fieldset[disabled] input[type=text],fieldset[disabled] input[type=time],fieldset[disabled] input[type=url],fieldset[disabled] input[type=week],fieldset[disabled] textarea,input[type=color][disabled],input[type=color][readonly],input[type=date][disabled],input[type=date][readonly],input[type=datetime-local][disabled],input[type=datetime-local][readonly],input[type=datetime][disabled],input[type=datetime][readonly],input[type=email][disabled],input[type=email][readonly],input[type=month][disabled],input[type=month][readonly],input[type=number][disabled],input[type=number][readonly],input[type=password][disabled],input[type=password][readonly],input[type=search][disabled],input[type=search][readonly],input[type=tel][disabled],input[type=tel][readonly],input[type=text][disabled],input[type=text][readonly],input[type=time][disabled],input[type=time][readonly],input[type=url][disabled],input[type=url][readonly],input[type=week][disabled],input[type=week][readonly],textarea[disabled],textarea[readonly]{background-color:inherit;cursor:default}input[type=color].radius,input[type=date].radius,input[type=datetime-local].radius,input[type=datetime].radius,input[type=email].radius,input[type=month].radius,input[type=number].radius,input[type=password].radius,input[type=search].radius,input[type=tel].radius,input[type=text].radius,input[type=time].radius,input[type=url].radius,input[type=week].radius,textarea.radius{border-radius:3px}form .row .prefix-radius.row.collapse button,form .row .prefix-radius.row.collapse input,form .row .prefix-radius.row.collapse select,form .row .prefix-radius.row.collapse textarea{border-radius:0;-webkit-border-bottom-right-radius:3px;-webkit-border-top-right-radius:3px;border-bottom-right-radius:3px;border-top-right-radius:3px}form .row .prefix-radius.row.collapse .prefix{border-radius:0;-webkit-border-bottom-left-radius:3px;-webkit-border-top-left-radius:3px;border-bottom-left-radius:3px;border-top-left-radius:3px}form .row .postfix-radius.row.collapse button,form .row .postfix-radius.row.collapse input,form .row .postfix-radius.row.collapse select,form .row .postfix-radius.row.collapse textarea{border-radius:0;-webkit-border-bottom-left-radius:3px;-webkit-border-top-left-radius:3px;border-bottom-left-radius:3px;border-top-left-radius:3px}form .row .postfix-radius.row.collapse .postfix{border-radius:0;-webkit-border-bottom-right-radius:3px;-webkit-border-top-right-radius:3px;border-bottom-right-radius:3px;border-top-right-radius:3px}form .row .prefix-round.row.collapse button,form .row .prefix-round.row.collapse input,form .row .prefix-round.row.collapse select,form .row .prefix-round.row.collapse textarea{border-radius:0;-webkit-border-bottom-right-radius:1000px;-webkit-border-top-right-radius:1000px;border-bottom-right-radius:1000px;border-top-right-radius:1000px}form .row .prefix-round.row.collapse .prefix{border-radius:0;-webkit-border-bottom-left-radius:1000px;-webkit-border-top-left-radius:1000px;border-bottom-left-radius:1000px;border-top-left-radius:1000px}form .row .postfix-round.row.collapse button,form .row .postfix-round.row.collapse input,form .row .postfix-round.row.collapse select,form .row .postfix-round.row.collapse textarea{border-radius:0;-webkit-border-bottom-left-radius:1000px;-webkit-border-top-left-radius:1000px;border-bottom-left-radius:1000px;border-top-left-radius:1000px}form .row .postfix-round.row.collapse .postfix{border-radius:0;-webkit-border-bottom-right-radius:1000px;-webkit-border-top-right-radius:1000px;border-bottom-right-radius:1000px;border-top-right-radius:1000px}input[type=submit]{-webkit-appearance:none;-moz-appearance:none;border-radius:0}textarea[rows]{height:auto}textarea{max-width:100%}::-webkit-input-placeholder{color:#ccc}:-moz-placeholder{color:#ccc}::-moz-placeholder{color:#ccc}:-ms-input-placeholder{color:#ccc}select{-webkit-appearance:none!important;-moz-appearance:none!important;background-color:#fafafa;border-radius:0;background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHZlcnNpb249IjEuMSIgeD0iMTJweCIgeT0iMHB4IiB3aWR0aD0iMjRweCIgaGVpZ2h0PSIzcHgiIHZpZXdCb3g9IjAgMCA2IDMiIGVuYWJsZS1iYWNrZ3JvdW5kPSJuZXcgMCAwIDYgMyIgeG1sOnNwYWNlPSJwcmVzZXJ2ZSI+PHBvbHlnb24gcG9pbnRzPSI1Ljk5MiwwIDIuOTkyLDMgLTAuMDA4LDAgIi8+PC9zdmc+);background-position:100% center;background-repeat:no-repeat;border-style:solid;border-width:1px;border-color:#ccc;color:rgba(0,0,0,.75);font-family:inherit;font-size:inherit;line-height:normal;padding:.625rem;border-radius:0;height:inherit1.875rem-.0625rem}select::-ms-expand{display:none}select.radius{border-radius:3px}select:hover{background-color:#f3f3f3;border-color:#999}select:disabled{background-color:inherit;cursor:default}select[multiple]{height:auto}input[type=checkbox],input[type=file],input[type=radio],select{margin:0 0 1.25rem 0}input[type=checkbox]+label,input[type=radio]+label{display:inline-block;margin-left:.625rem;margin-right:1.25rem;margin-bottom:0;vertical-align:baseline}input[type=file]{width:100%}fieldset{border:1px solid #ddd;margin:1.125rem 0;padding:1.25rem}fieldset legend{background:#fff;font-weight:700;margin-left:-.1875rem;margin:0;padding:0 .1875rem}[data-abide] .error small.error,[data-abide] .error span.error,[data-abide] small.error,[data-abide] span.error{display:block;font-size:.75rem;font-style:italic;font-weight:400;margin-bottom:1.25rem;margin-top:-1px;padding:.375rem .5625rem .5625rem;background:#f04124;color:#fff}[data-abide] small.error,[data-abide] span.error{display:none}small.error,span.error{display:block;font-size:.75rem;font-style:italic;font-weight:400;margin-bottom:1.25rem;margin-top:-1px;padding:.375rem .5625rem .5625rem;background:#f04124;color:#fff}.error input,.error select,.error textarea{margin-bottom:0}.error input[type=checkbox],.error input[type=radio]{margin-bottom:1.25rem}.error label,.error label.error{color:#f04124}.error small.error{display:block;font-size:.75rem;font-style:italic;font-weight:400;margin-bottom:1.25rem;margin-top:-1px;padding:.375rem .5625rem .5625rem;background:#f04124;color:#fff}.error>label>small{background:0 0;color:#676767;display:inline;font-size:60%;font-style:normal;margin:0;padding:0;text-transform:capitalize}.error span.error-message{display:block}input.error,select.error,textarea.error{margin-bottom:0}label.error{color:#f04124}html{box-sizing:border-box}*,::after,::before{box-sizing:inherit}.umb-col{color:#000!important}.ama-col{color:#426!important}.jama-col{color:#d71635!important}.jama-col-sec{color:#981b1e!important}.umb-col-sec{color:#d71534!important}.jama{color:#d71635}.jama-cardiology{color:#d71635}.jama-dermatology{color:#006f3b}.jama-facial-plastic-surgery{color:#ed1c24}.jama-internal-medicine{color:#006e96}.jama-neurology{color:#981b1e}.jama-oncology{color:#3b923f}.jama-ophthalmology{color:#66bc29}.jama-otolaryngology-head--neck-surgery{color:#34b6e4}.jama-pediatrics{color:#0084c0}.jama-psychiatry{color:#005276}.jama-surgery{color:#f47920}.archives-of-neurology--psychiatry{color:#005276}.jama-network-open{color:#ed0973}.bd-jama{border-color:#d71635!important}.bd-jama-cardiology{border-color:#d71635!important}.bd-jama-dermatology{border-color:#006f3b!important}.bd-jama-facial-plastic-surgery{border-color:#ed1c24!important}.bd-jama-internal-medicine{border-color:#006e96!important}.bd-jama-neurology{border-color:#981b1e!important}.bd-jama-oncology{border-color:#3b923f!important}.bd-jama-ophthalmology{border-color:#66bc29!important}.bd-jama-otolaryngology-head--neck-surgery{border-color:#34b6e4!important}.bd-jama-pediatrics{border-color:#0084c0!important}.bd-jama-psychiatry{border-color:#005276!important}.bd-jama-surgery{border-color:#f47920!important}.bd-archives-of-neurology--psychiatry{border-color:#005276!important}.bd-jama-network-open{border-color:#ed0973!important}.bd-jama-sec{border-color:#981b1e!important}.bd-jama-cardiology-sec{border-color:#981b1e!important}.bd-jama-dermatology-sec{border-color:#3b923f!important}.bd-jama-facial-plastic-surgery-sec{border-color:#981b1e!important}.bd-jama-internal-medicine-sec{border-color:#005276!important}.bd-jama-neurology-sec{border-color:#d71635!important}.bd-jama-oncology-sec{border-color:#006f3b!important}.bd-jama-ophthalmology-sec{border-color:#006f3b!important}.bd-jama-otolaryngology-head--neck-surgery-sec{border-color:#005276!important}.bd-jama-pediatrics-sec{border-color:#005276!important}.bd-jama-psychiatry-sec{border-color:#0084c0!important}.bd-jama-surgery-sec{border-color:#981b1e!important}.bd-archives-of-neurology--psychiatry-sec{border-color:#0084c0!important}.bd-jama-network-open-sec{border-color:#9e1f63!important}.pg_collection .bd-jama .article--formats *{color:#981b1e}.pg_collection .bd-jama-cardiology .article--formats *{color:#981b1e}.pg_collection .bd-jama-dermatology .article--formats *{color:#3b923f}.pg_collection .bd-jama-facial-plastic-surgery .article--formats *{color:#981b1e}.pg_collection .bd-jama-internal-medicine .article--formats *{color:#005276}.pg_collection .bd-jama-neurology .article--formats *{color:#d71635}.pg_collection .bd-jama-oncology .article--formats *{color:#006f3b}.pg_collection .bd-jama-ophthalmology .article--formats *{color:#006f3b}.pg_collection .bd-jama-otolaryngology-head--neck-surgery .article--formats *{color:#005276}.pg_collection .bd-jama-pediatrics .article--formats *{color:#005276}.pg_collection .bd-jama-psychiatry .article--formats *{color:#0084c0}.pg_collection .bd-jama-surgery .article--formats *{color:#981b1e}.pg_collection .bd-archives-of-neurology--psychiatry .article--formats *{color:#0084c0}.pg_collection .bd-jama-network-open .article--formats *{color:#9e1f63}.tdm-content__content-row .tdm-content__site-logo{background:#000}.tdm-content__content-row.umb .tdm-content__site-logo{background:#000}.tdm-content__content-row.learn .tdm-content__site-logo{background:#4978bc}.tdm-content__content-row.JAMA .tdm-content__site-logo,.tdm-content__content-row.jama .tdm-content__site-logo{background:#d71635}.tdm-content__content-row.CARDIOLOGY .tdm-content__site-logo,.tdm-content__content-row.cardi .tdm-content__site-logo{background:#be1e32}.tdm-content__content-row.DERM .tdm-content__site-logo,.tdm-content__content-row.derm .tdm-content__site-logo{background:#006f3b}.tdm-content__content-row.FACI .tdm-content__site-logo,.tdm-content__content-row.faci .tdm-content__site-logo{background:#ed1c24}.tdm-content__content-row.INTEMED .tdm-content__site-logo,.tdm-content__content-row.intem .tdm-content__site-logo{background:#006e96}.tdm-content__content-row.NEUR .tdm-content__site-logo,.tdm-content__content-row.neur .tdm-content__site-logo{background:#981b1e}.tdm-content__content-row.ONCOLOGY .tdm-content__site-logo,.tdm-content__content-row.oncol .tdm-content__site-logo{background:#3b923f}.tdm-content__content-row.OPHTH .tdm-content__site-logo,.tdm-content__content-row.ophth .tdm-content__site-logo{background:#66bc29}.tdm-content__content-row.OTOL .tdm-content__site-logo,.tdm-content__content-row.otol .tdm-content__site-logo{background:#34b6e4}.tdm-content__content-row.PEDS .tdm-content__site-logo,.tdm-content__content-row.peds .tdm-content__site-logo{background:#0084c0}.tdm-content__content-row.PSYCH .tdm-content__site-logo,.tdm-content__content-row.psych .tdm-content__site-logo{background:#005276}.tdm-content__content-row.SURG .tdm-content__site-logo,.tdm-content__content-row.surg .tdm-content__site-logo{background:#f47920}.tdm-content__content-row.NEURPSYCH .tdm-content__site-logo,.tdm-content__content-row.neurp .tdm-content__site-logo{background:#005276}.tdm-content__content-row.jaman .tdm-content__site-logo{background:#ed0973}[data-thm=umb] .image-box .featured,[data-thm=umb] .themed-border{border-top:10px solid #d71534}[data-thm=umb] .image-box .featured:before,[data-thm=umb] .themed-border:before{background:#000}[data-thm=umb] .branded-bar{background:#000}[data-thm=umb] .branded-bar:after{background:#d71534}[data-thm=umb] .modal{border-top:8px solid #000}[data-thm=umb] .h6,[data-thm=umb] .list-style-1 li:before,[data-thm=umb] .logged-in .auth--trigger:before,[data-thm=umb] .master-main .email-signup--text,[data-thm=umb] .table .column:before,[data-thm=umb] .thm-col,[data-thm=umb] h6{color:#000}[data-thm=umb] .h6:hover,[data-thm=umb] .list-style-1 li:before:hover,[data-thm=umb] .logged-in .auth--trigger:before:hover,[data-thm=umb] .master-main .email-signup--text:hover,[data-thm=umb] .table .column:before:hover,[data-thm=umb] .thm-col:hover,[data-thm=umb] h6:hover{color:#000}[data-thm=umb] .comment-form-item input::-webkit-input-placeholder,[data-thm=umb] .comment-form-item textarea::-webkit-input-placeholder{color:#000}[data-thm=umb] .comment-form-item input:-ms-input-placeholder,[data-thm=umb] .comment-form-item textarea:-ms-input-placeholder{color:#000}[data-thm=umb] .comment-form-item input::placeholder,[data-thm=umb] .comment-form-item textarea::placeholder{color:#000}[data-thm=umb] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#d71534}[data-thm=umb] .comment-form-item .radio-label:before{border:#d71534}[data-thm=umb] .thm-learning{color:#4978bc}[data-thm=umb] .thm-learning:hover{color:#4978bc}[data-thm=umb] .thm-col-lt{color:gray}[data-thm=umb] .thm-col-lt:hover{color:gray}[data-thm=umb] .thm-bg-col{background:#000}[data-thm=umb] .header-logo-wrapper,[data-thm=umb] .site-links-wrap{background:#000}[data-thm=umb] .thm-bg{background:#d71534}[data-thm=umb] .thm-bg-hover:hover{background:#d71534}[data-thm=umb] .thm-bg-learning{background:#4978bc}[data-thm=umb] .thm-col-sec{color:#d71534!important}[data-thm=umb] .just-published--more-text:before,[data-thm=umb] .just-published--more:hover .just-published--more-button{color:#d71534}[data-thm=umb] .tabs--link.target-tab-active{color:#d71534}[data-thm=umb] .tabs--link.target-tab-active:before{border-top:5px solid #d71534}[data-thm=umb] a{color:#d71534}[data-thm=umb] a:active,[data-thm=umb] a:hover{color:#d71534}[data-thm=umb] p.box-text{background:#d71534}[data-thm=umb] .pullquote,[data-thm=umb] .thm-bd-color{border-color:#000}[data-thm=umb] .thm-bd-top{border-top:1px solid #000}[data-thm=umb] .underlined-header{border-bottom:1px solid #000}[data-thm=umb] .underlined-header span{color:#000;border-bottom:5px solid #000}[data-thm=umb] .header-wrap{border-bottom:5px solid #000}[data-thm=umb] .nav-journal-level{border-left:8px solid #000}[data-thm=umb] .btn,[data-thm=umb] .btn-small{background:#d71534;border:2px solid #d71534}[data-thm=umb] .btn-small:hover,[data-thm=umb] .btn:hover{color:#d71534}[data-thm=umb] .btn-alt,[data-thm=umb] .btn-small-alt{color:#d71534}[data-thm=umb] .btn-alt:hover,[data-thm=umb] .btn-small-alt:hover{background:#d71534}[data-thm=umb] .tab-nav-trigger.target-tab-active{color:#d71534}[data-thm=umb] .tab-nav-trigger.target-tab-active:hover{color:#d71534}[data-thm=umb] .tab-nav-trigger.target-tab-active:before{color:#d71534}[data-thm=umb].pg_abstract .full-text-link{background:#d71534;border-right:3px solid #000}[data-thm=umb].pg_abstract .full-text-link:hover{background:#000}[data-thm=umb] .widget-MagazineView .decorated-hed:after,[data-thm=umb].pg_abstract .decorated-hed:after{border-bottom:1px solid #000}[data-thm=umb] .widget-MagazineView .decorated-hed .heading-text,[data-thm=umb].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #000}[data-thm=umb] .themed-hed{border-top:1px solid #000}[data-thm=umb] .themed-hed:before{background:#000}[data-thm=umb] .auth--purchase{border-top:.0625rem solid #000}[data-thm=learn] .image-box .featured,[data-thm=learn] .themed-border{border-top:10px solid #4978bc}[data-thm=learn] .image-box .featured:before,[data-thm=learn] .themed-border:before{background:#4978bc}[data-thm=learn] .branded-bar{background:#4978bc}[data-thm=learn] .branded-bar:after{background:#4978bc}[data-thm=learn] .modal{border-top:8px solid #4978bc}[data-thm=learn] .h6,[data-thm=learn] .list-style-1 li:before,[data-thm=learn] .logged-in .auth--trigger:before,[data-thm=learn] .master-main .email-signup--text,[data-thm=learn] .table .column:before,[data-thm=learn] .thm-col,[data-thm=learn] h6{color:#4978bc}[data-thm=learn] .h6:hover,[data-thm=learn] .list-style-1 li:before:hover,[data-thm=learn] .logged-in .auth--trigger:before:hover,[data-thm=learn] .master-main .email-signup--text:hover,[data-thm=learn] .table .column:before:hover,[data-thm=learn] .thm-col:hover,[data-thm=learn] h6:hover{color:#4978bc}[data-thm=learn] .comment-form-item input::-webkit-input-placeholder,[data-thm=learn] .comment-form-item textarea::-webkit-input-placeholder{color:#4978bc}[data-thm=learn] .comment-form-item input:-ms-input-placeholder,[data-thm=learn] .comment-form-item textarea:-ms-input-placeholder{color:#4978bc}[data-thm=learn] .comment-form-item input::placeholder,[data-thm=learn] .comment-form-item textarea::placeholder{color:#4978bc}[data-thm=learn] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#4978bc}[data-thm=learn] .comment-form-item .radio-label:before{border:#4978bc}[data-thm=learn] .thm-learning{color:#4978bc}[data-thm=learn] .thm-learning:hover{color:#4978bc}[data-thm=learn] .thm-col-lt{color:#a4bcde}[data-thm=learn] .thm-col-lt:hover{color:#a4bcde}[data-thm=learn] .thm-bg-col{background:#4978bc}[data-thm=learn] .header-logo-wrapper,[data-thm=learn] .site-links-wrap{background:#4978bc}[data-thm=learn] .thm-bg{background:#4978bc}[data-thm=learn] .thm-bg-hover:hover{background:#4978bc}[data-thm=learn] .thm-bg-learning{background:#4978bc}[data-thm=learn] .thm-col-sec{color:#4978bc!important}[data-thm=learn] .just-published--more-text:before,[data-thm=learn] .just-published--more:hover .just-published--more-button{color:#4978bc}[data-thm=learn] .tabs--link.target-tab-active{color:#4978bc}[data-thm=learn] .tabs--link.target-tab-active:before{border-top:5px solid #4978bc}[data-thm=learn] a{color:#4978bc}[data-thm=learn] a:active,[data-thm=learn] a:hover{color:#4978bc}[data-thm=learn] p.box-text{background:#4978bc}[data-thm=learn] .pullquote,[data-thm=learn] .thm-bd-color{border-color:#4978bc}[data-thm=learn] .thm-bd-top{border-top:1px solid #4978bc}[data-thm=learn] .underlined-header{border-bottom:1px solid #4978bc}[data-thm=learn] .underlined-header span{color:#4978bc;border-bottom:5px solid #4978bc}[data-thm=learn] .header-wrap{border-bottom:5px solid #4978bc}[data-thm=learn] .nav-journal-level{border-left:8px solid #4978bc}[data-thm=learn] .btn,[data-thm=learn] .btn-small{background:#4978bc;border:2px solid #4978bc}[data-thm=learn] .btn-small:hover,[data-thm=learn] .btn:hover{color:#4978bc}[data-thm=learn] .btn-alt,[data-thm=learn] .btn-small-alt{color:#4978bc}[data-thm=learn] .btn-alt:hover,[data-thm=learn] .btn-small-alt:hover{background:#4978bc}[data-thm=learn] .tab-nav-trigger.target-tab-active{color:#4978bc}[data-thm=learn] .tab-nav-trigger.target-tab-active:hover{color:#4978bc}[data-thm=learn] .tab-nav-trigger.target-tab-active:before{color:#4978bc}[data-thm=learn].pg_abstract .full-text-link{background:#4978bc;border-right:3px solid #4978bc}[data-thm=learn].pg_abstract .full-text-link:hover{background:#4978bc}[data-thm=learn] .widget-MagazineView .decorated-hed:after,[data-thm=learn].pg_abstract .decorated-hed:after{border-bottom:1px solid #4978bc}[data-thm=learn] .widget-MagazineView .decorated-hed .heading-text,[data-thm=learn].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #3d76c8}[data-thm=learn] .themed-hed{border-top:1px solid #4978bc}[data-thm=learn] .themed-hed:before{background:#3d76c8}[data-thm=learn] .auth--purchase{border-top:.0625rem solid #4978bc}[data-thm=jama] .image-box .featured,[data-thm=jama] .themed-border{border-top:10px solid #981b1e}[data-thm=jama] .image-box .featured:before,[data-thm=jama] .themed-border:before{background:#d71635}[data-thm=jama] .branded-bar{background:#d71635}[data-thm=jama] .branded-bar:after{background:#981b1e}[data-thm=jama] .modal{border-top:8px solid #d71635}[data-thm=jama] .h6,[data-thm=jama] .list-style-1 li:before,[data-thm=jama] .logged-in .auth--trigger:before,[data-thm=jama] .master-main .email-signup--text,[data-thm=jama] .table .column:before,[data-thm=jama] .thm-col,[data-thm=jama] h6{color:#d71635}[data-thm=jama] .h6:hover,[data-thm=jama] .list-style-1 li:before:hover,[data-thm=jama] .logged-in .auth--trigger:before:hover,[data-thm=jama] .master-main .email-signup--text:hover,[data-thm=jama] .table .column:before:hover,[data-thm=jama] .thm-col:hover,[data-thm=jama] h6:hover{color:#d71635}[data-thm=jama] .comment-form-item input::-webkit-input-placeholder,[data-thm=jama] .comment-form-item textarea::-webkit-input-placeholder{color:#d71635}[data-thm=jama] .comment-form-item input:-ms-input-placeholder,[data-thm=jama] .comment-form-item textarea:-ms-input-placeholder{color:#d71635}[data-thm=jama] .comment-form-item input::placeholder,[data-thm=jama] .comment-form-item textarea::placeholder{color:#d71635}[data-thm=jama] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#981b1e}[data-thm=jama] .comment-form-item .radio-label:before{border:#981b1e}[data-thm=jama] .thm-learning{color:#4978bc}[data-thm=jama] .thm-learning:hover{color:#4978bc}[data-thm=jama] .thm-col-lt{color:#eb8b9a}[data-thm=jama] .thm-col-lt:hover{color:#eb8b9a}[data-thm=jama] .thm-bg-col{background:#d71635}[data-thm=jama] .header-logo-wrapper,[data-thm=jama] .site-links-wrap{background:#d71635}[data-thm=jama] .thm-bg{background:#981b1e}[data-thm=jama] .thm-bg-hover:hover{background:#981b1e}[data-thm=jama] .thm-bg-learning{background:#4978bc}[data-thm=jama] .thm-col-sec{color:#981b1e!important}[data-thm=jama] .just-published--more-text:before,[data-thm=jama] .just-published--more:hover .just-published--more-button{color:#981b1e}[data-thm=jama] .tabs--link.target-tab-active{color:#981b1e}[data-thm=jama] .tabs--link.target-tab-active:before{border-top:5px solid #981b1e}[data-thm=jama] a{color:#981b1e}[data-thm=jama] a:active,[data-thm=jama] a:hover{color:#981b1e}[data-thm=jama] p.box-text{background:#981b1e}[data-thm=jama] .pullquote,[data-thm=jama] .thm-bd-color{border-color:#d71635}[data-thm=jama] .thm-bd-top{border-top:1px solid #d71635}[data-thm=jama] .underlined-header{border-bottom:1px solid #d71635}[data-thm=jama] .underlined-header span{color:#d71635;border-bottom:5px solid #d71635}[data-thm=jama] .header-wrap{border-bottom:5px solid #d71635}[data-thm=jama] .nav-journal-level{border-left:8px solid #d71635}[data-thm=jama] .btn,[data-thm=jama] .btn-small{background:#981b1e;border:2px solid #981b1e}[data-thm=jama] .btn-small:hover,[data-thm=jama] .btn:hover{color:#981b1e}[data-thm=jama] .btn-alt,[data-thm=jama] .btn-small-alt{color:#981b1e}[data-thm=jama] .btn-alt:hover,[data-thm=jama] .btn-small-alt:hover{background:#981b1e}[data-thm=jama] .tab-nav-trigger.target-tab-active{color:#981b1e}[data-thm=jama] .tab-nav-trigger.target-tab-active:hover{color:#981b1e}[data-thm=jama] .tab-nav-trigger.target-tab-active:before{color:#981b1e}[data-thm=jama].pg_abstract .full-text-link{background:#981b1e;border-right:3px solid #d71635}[data-thm=jama].pg_abstract .full-text-link:hover{background:#d71635}[data-thm=jama] .widget-MagazineView .decorated-hed:after,[data-thm=jama].pg_abstract .decorated-hed:after{border-bottom:1px solid #d71635}[data-thm=jama] .widget-MagazineView .decorated-hed .heading-text,[data-thm=jama].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #e30a2d}[data-thm=jama] .themed-hed{border-top:1px solid #d71635}[data-thm=jama] .themed-hed:before{background:#e30a2d}[data-thm=jama] .auth--purchase{border-top:.0625rem solid #d71635}[data-thm=cardi] .image-box .featured,[data-thm=cardi] .themed-border{border-top:10px solid #981b1e}[data-thm=cardi] .image-box .featured:before,[data-thm=cardi] .themed-border:before{background:#be1e32}[data-thm=cardi] .branded-bar{background:#be1e32}[data-thm=cardi] .branded-bar:after{background:#981b1e}[data-thm=cardi] .modal{border-top:8px solid #be1e32}[data-thm=cardi] .h6,[data-thm=cardi] .list-style-1 li:before,[data-thm=cardi] .logged-in .auth--trigger:before,[data-thm=cardi] .master-main .email-signup--text,[data-thm=cardi] .table .column:before,[data-thm=cardi] .thm-col,[data-thm=cardi] h6{color:#be1e32}[data-thm=cardi] .h6:hover,[data-thm=cardi] .list-style-1 li:before:hover,[data-thm=cardi] .logged-in .auth--trigger:before:hover,[data-thm=cardi] .master-main .email-signup--text:hover,[data-thm=cardi] .table .column:before:hover,[data-thm=cardi] .thm-col:hover,[data-thm=cardi] h6:hover{color:#be1e32}[data-thm=cardi] .comment-form-item input::-webkit-input-placeholder,[data-thm=cardi] .comment-form-item textarea::-webkit-input-placeholder{color:#be1e32}[data-thm=cardi] .comment-form-item input:-ms-input-placeholder,[data-thm=cardi] .comment-form-item textarea:-ms-input-placeholder{color:#be1e32}[data-thm=cardi] .comment-form-item input::placeholder,[data-thm=cardi] .comment-form-item textarea::placeholder{color:#be1e32}[data-thm=cardi] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#981b1e}[data-thm=cardi] .comment-form-item .radio-label:before{border:#981b1e}[data-thm=cardi] .thm-learning{color:#4978bc}[data-thm=cardi] .thm-learning:hover{color:#4978bc}[data-thm=cardi] .thm-col-lt{color:#df8f99}[data-thm=cardi] .thm-col-lt:hover{color:#df8f99}[data-thm=cardi] .thm-bg-col{background:#be1e32}[data-thm=cardi] .header-logo-wrapper,[data-thm=cardi] .site-links-wrap{background:#be1e32}[data-thm=cardi] .thm-bg{background:#981b1e}[data-thm=cardi] .thm-bg-hover:hover{background:#981b1e}[data-thm=cardi] .thm-bg-learning{background:#4978bc}[data-thm=cardi] .thm-col-sec{color:#981b1e!important}[data-thm=cardi] .just-published--more-text:before,[data-thm=cardi] .just-published--more:hover .just-published--more-button{color:#981b1e}[data-thm=cardi] .tabs--link.target-tab-active{color:#981b1e}[data-thm=cardi] .tabs--link.target-tab-active:before{border-top:5px solid #981b1e}[data-thm=cardi] a{color:#981b1e}[data-thm=cardi] a:active,[data-thm=cardi] a:hover{color:#981b1e}[data-thm=cardi] p.box-text{background:#981b1e}[data-thm=cardi] .pullquote,[data-thm=cardi] .thm-bd-color{border-color:#be1e32}[data-thm=cardi] .thm-bd-top{border-top:1px solid #be1e32}[data-thm=cardi] .underlined-header{border-bottom:1px solid #be1e32}[data-thm=cardi] .underlined-header span{color:#be1e32;border-bottom:5px solid #be1e32}[data-thm=cardi] .header-wrap{border-bottom:5px solid #be1e32}[data-thm=cardi] .nav-journal-level{border-left:8px solid #be1e32}[data-thm=cardi] .btn,[data-thm=cardi] .btn-small{background:#981b1e;border:2px solid #981b1e}[data-thm=cardi] .btn-small:hover,[data-thm=cardi] .btn:hover{color:#981b1e}[data-thm=cardi] .btn-alt,[data-thm=cardi] .btn-small-alt{color:#981b1e}[data-thm=cardi] .btn-alt:hover,[data-thm=cardi] .btn-small-alt:hover{background:#981b1e}[data-thm=cardi] .tab-nav-trigger.target-tab-active{color:#981b1e}[data-thm=cardi] .tab-nav-trigger.target-tab-active:hover{color:#981b1e}[data-thm=cardi] .tab-nav-trigger.target-tab-active:before{color:#981b1e}[data-thm=cardi].pg_abstract .full-text-link{background:#981b1e;border-right:3px solid #be1e32}[data-thm=cardi].pg_abstract .full-text-link:hover{background:#be1e32}[data-thm=cardi] .widget-MagazineView .decorated-hed:after,[data-thm=cardi].pg_abstract .decorated-hed:after{border-bottom:1px solid #be1e32}[data-thm=cardi] .widget-MagazineView .decorated-hed .heading-text,[data-thm=cardi].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #c9132a}[data-thm=cardi] .themed-hed{border-top:1px solid #be1e32}[data-thm=cardi] .themed-hed:before{background:#c9132a}[data-thm=cardi] .auth--purchase{border-top:.0625rem solid #be1e32}[data-thm=derm] .image-box .featured,[data-thm=derm] .themed-border{border-top:10px solid #3b923f}[data-thm=derm] .image-box .featured:before,[data-thm=derm] .themed-border:before{background:#006f3b}[data-thm=derm] .branded-bar{background:#006f3b}[data-thm=derm] .branded-bar:after{background:#3b923f}[data-thm=derm] .modal{border-top:8px solid #006f3b}[data-thm=derm] .h6,[data-thm=derm] .list-style-1 li:before,[data-thm=derm] .logged-in .auth--trigger:before,[data-thm=derm] .master-main .email-signup--text,[data-thm=derm] .table .column:before,[data-thm=derm] .thm-col,[data-thm=derm] h6{color:#006f3b}[data-thm=derm] .h6:hover,[data-thm=derm] .list-style-1 li:before:hover,[data-thm=derm] .logged-in .auth--trigger:before:hover,[data-thm=derm] .master-main .email-signup--text:hover,[data-thm=derm] .table .column:before:hover,[data-thm=derm] .thm-col:hover,[data-thm=derm] h6:hover{color:#006f3b}[data-thm=derm] .comment-form-item input::-webkit-input-placeholder,[data-thm=derm] .comment-form-item textarea::-webkit-input-placeholder{color:#006f3b}[data-thm=derm] .comment-form-item input:-ms-input-placeholder,[data-thm=derm] .comment-form-item textarea:-ms-input-placeholder{color:#006f3b}[data-thm=derm] .comment-form-item input::placeholder,[data-thm=derm] .comment-form-item textarea::placeholder{color:#006f3b}[data-thm=derm] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#3b923f}[data-thm=derm] .comment-form-item .radio-label:before{border:#3b923f}[data-thm=derm] .thm-learning{color:#4978bc}[data-thm=derm] .thm-learning:hover{color:#4978bc}[data-thm=derm] .thm-col-lt{color:#80b79d}[data-thm=derm] .thm-col-lt:hover{color:#80b79d}[data-thm=derm] .thm-bg-col{background:#006f3b}[data-thm=derm] .header-logo-wrapper,[data-thm=derm] .site-links-wrap{background:#006f3b}[data-thm=derm] .thm-bg{background:#3b923f}[data-thm=derm] .thm-bg-hover:hover{background:#3b923f}[data-thm=derm] .thm-bg-learning{background:#4978bc}[data-thm=derm] .thm-col-sec{color:#3b923f!important}[data-thm=derm] .just-published--more-text:before,[data-thm=derm] .just-published--more:hover .just-published--more-button{color:#3b923f}[data-thm=derm] .tabs--link.target-tab-active{color:#3b923f}[data-thm=derm] .tabs--link.target-tab-active:before{border-top:5px solid #3b923f}[data-thm=derm] a{color:#3b923f}[data-thm=derm] a:active,[data-thm=derm] a:hover{color:#3b923f}[data-thm=derm] p.box-text{background:#3b923f}[data-thm=derm] .pullquote,[data-thm=derm] .thm-bd-color{border-color:#006f3b}[data-thm=derm] .thm-bd-top{border-top:1px solid #006f3b}[data-thm=derm] .underlined-header{border-bottom:1px solid #006f3b}[data-thm=derm] .underlined-header span{color:#006f3b;border-bottom:5px solid #006f3b}[data-thm=derm] .header-wrap{border-bottom:5px solid #006f3b}[data-thm=derm] .nav-journal-level{border-left:8px solid #006f3b}[data-thm=derm] .btn,[data-thm=derm] .btn-small{background:#3b923f;border:2px solid #3b923f}[data-thm=derm] .btn-small:hover,[data-thm=derm] .btn:hover{color:#3b923f}[data-thm=derm] .btn-alt,[data-thm=derm] .btn-small-alt{color:#3b923f}[data-thm=derm] .btn-alt:hover,[data-thm=derm] .btn-small-alt:hover{background:#3b923f}[data-thm=derm] .tab-nav-trigger.target-tab-active{color:#3b923f}[data-thm=derm] .tab-nav-trigger.target-tab-active:hover{color:#3b923f}[data-thm=derm] .tab-nav-trigger.target-tab-active:before{color:#3b923f}[data-thm=derm].pg_abstract .full-text-link{background:#3b923f;border-right:3px solid #006f3b}[data-thm=derm].pg_abstract .full-text-link:hover{background:#006f3b}[data-thm=derm] .widget-MagazineView .decorated-hed:after,[data-thm=derm].pg_abstract .decorated-hed:after{border-bottom:1px solid #006f3b}[data-thm=derm] .widget-MagazineView .decorated-hed .heading-text,[data-thm=derm].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #006f3b}[data-thm=derm] .themed-hed{border-top:1px solid #006f3b}[data-thm=derm] .themed-hed:before{background:#006f3b}[data-thm=derm] .auth--purchase{border-top:.0625rem solid #006f3b}[data-thm=faci] .image-box .featured,[data-thm=faci] .themed-border{border-top:10px solid #981b1e}[data-thm=faci] .image-box .featured:before,[data-thm=faci] .themed-border:before{background:#ed1c24}[data-thm=faci] .branded-bar{background:#ed1c24}[data-thm=faci] .branded-bar:after{background:#981b1e}[data-thm=faci] .modal{border-top:8px solid #ed1c24}[data-thm=faci] .h6,[data-thm=faci] .list-style-1 li:before,[data-thm=faci] .logged-in .auth--trigger:before,[data-thm=faci] .master-main .email-signup--text,[data-thm=faci] .table .column:before,[data-thm=faci] .thm-col,[data-thm=faci] h6{color:#ed1c24}[data-thm=faci] .h6:hover,[data-thm=faci] .list-style-1 li:before:hover,[data-thm=faci] .logged-in .auth--trigger:before:hover,[data-thm=faci] .master-main .email-signup--text:hover,[data-thm=faci] .table .column:before:hover,[data-thm=faci] .thm-col:hover,[data-thm=faci] h6:hover{color:#ed1c24}[data-thm=faci] .comment-form-item input::-webkit-input-placeholder,[data-thm=faci] .comment-form-item textarea::-webkit-input-placeholder{color:#ed1c24}[data-thm=faci] .comment-form-item input:-ms-input-placeholder,[data-thm=faci] .comment-form-item textarea:-ms-input-placeholder{color:#ed1c24}[data-thm=faci] .comment-form-item input::placeholder,[data-thm=faci] .comment-form-item textarea::placeholder{color:#ed1c24}[data-thm=faci] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#981b1e}[data-thm=faci] .comment-form-item .radio-label:before{border:#981b1e}[data-thm=faci] .thm-learning{color:#4978bc}[data-thm=faci] .thm-learning:hover{color:#4978bc}[data-thm=faci] .thm-col-lt{color:#f68e92}[data-thm=faci] .thm-col-lt:hover{color:#f68e92}[data-thm=faci] .thm-bg-col{background:#ed1c24}[data-thm=faci] .header-logo-wrapper,[data-thm=faci] .site-links-wrap{background:#ed1c24}[data-thm=faci] .thm-bg{background:#981b1e}[data-thm=faci] .thm-bg-hover:hover{background:#981b1e}[data-thm=faci] .thm-bg-learning{background:#4978bc}[data-thm=faci] .thm-col-sec{color:#981b1e!important}[data-thm=faci] .just-published--more-text:before,[data-thm=faci] .just-published--more:hover .just-published--more-button{color:#981b1e}[data-thm=faci] .tabs--link.target-tab-active{color:#981b1e}[data-thm=faci] .tabs--link.target-tab-active:before{border-top:5px solid #981b1e}[data-thm=faci] a{color:#981b1e}[data-thm=faci] a:active,[data-thm=faci] a:hover{color:#981b1e}[data-thm=faci] p.box-text{background:#981b1e}[data-thm=faci] .pullquote,[data-thm=faci] .thm-bd-color{border-color:#ed1c24}[data-thm=faci] .thm-bd-top{border-top:1px solid #ed1c24}[data-thm=faci] .underlined-header{border-bottom:1px solid #ed1c24}[data-thm=faci] .underlined-header span{color:#ed1c24;border-bottom:5px solid #ed1c24}[data-thm=faci] .header-wrap{border-bottom:5px solid #ed1c24}[data-thm=faci] .nav-journal-level{border-left:8px solid #ed1c24}[data-thm=faci] .btn,[data-thm=faci] .btn-small{background:#981b1e;border:2px solid #981b1e}[data-thm=faci] .btn-small:hover,[data-thm=faci] .btn:hover{color:#981b1e}[data-thm=faci] .btn-alt,[data-thm=faci] .btn-small-alt{color:#981b1e}[data-thm=faci] .btn-alt:hover,[data-thm=faci] .btn-small-alt:hover{background:#981b1e}[data-thm=faci] .tab-nav-trigger.target-tab-active{color:#981b1e}[data-thm=faci] .tab-nav-trigger.target-tab-active:hover{color:#981b1e}[data-thm=faci] .tab-nav-trigger.target-tab-active:before{color:#981b1e}[data-thm=faci].pg_abstract .full-text-link{background:#981b1e;border-right:3px solid #ed1c24}[data-thm=faci].pg_abstract .full-text-link:hover{background:#ed1c24}[data-thm=faci] .widget-MagazineView .decorated-hed:after,[data-thm=faci].pg_abstract .decorated-hed:after{border-bottom:1px solid #ed1c24}[data-thm=faci] .widget-MagazineView .decorated-hed .heading-text,[data-thm=faci].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #f91019}[data-thm=faci] .themed-hed{border-top:1px solid #ed1c24}[data-thm=faci] .themed-hed:before{background:#f91019}[data-thm=faci] .auth--purchase{border-top:.0625rem solid #ed1c24}[data-thm=intem] .image-box .featured,[data-thm=intem] .themed-border{border-top:10px solid #005276}[data-thm=intem] .image-box .featured:before,[data-thm=intem] .themed-border:before{background:#006e96}[data-thm=intem] .branded-bar{background:#006e96}[data-thm=intem] .branded-bar:after{background:#005276}[data-thm=intem] .modal{border-top:8px solid #006e96}[data-thm=intem] .h6,[data-thm=intem] .list-style-1 li:before,[data-thm=intem] .logged-in .auth--trigger:before,[data-thm=intem] .master-main .email-signup--text,[data-thm=intem] .table .column:before,[data-thm=intem] .thm-col,[data-thm=intem] h6{color:#006e96}[data-thm=intem] .h6:hover,[data-thm=intem] .list-style-1 li:before:hover,[data-thm=intem] .logged-in .auth--trigger:before:hover,[data-thm=intem] .master-main .email-signup--text:hover,[data-thm=intem] .table .column:before:hover,[data-thm=intem] .thm-col:hover,[data-thm=intem] h6:hover{color:#006e96}[data-thm=intem] .comment-form-item input::-webkit-input-placeholder,[data-thm=intem] .comment-form-item textarea::-webkit-input-placeholder{color:#006e96}[data-thm=intem] .comment-form-item input:-ms-input-placeholder,[data-thm=intem] .comment-form-item textarea:-ms-input-placeholder{color:#006e96}[data-thm=intem] .comment-form-item input::placeholder,[data-thm=intem] .comment-form-item textarea::placeholder{color:#006e96}[data-thm=intem] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#005276}[data-thm=intem] .comment-form-item .radio-label:before{border:#005276}[data-thm=intem] .thm-learning{color:#4978bc}[data-thm=intem] .thm-learning:hover{color:#4978bc}[data-thm=intem] .thm-col-lt{color:#80b7cb}[data-thm=intem] .thm-col-lt:hover{color:#80b7cb}[data-thm=intem] .thm-bg-col{background:#006e96}[data-thm=intem] .header-logo-wrapper,[data-thm=intem] .site-links-wrap{background:#006e96}[data-thm=intem] .thm-bg{background:#005276}[data-thm=intem] .thm-bg-hover:hover{background:#005276}[data-thm=intem] .thm-bg-learning{background:#4978bc}[data-thm=intem] .thm-col-sec{color:#005276!important}[data-thm=intem] .just-published--more-text:before,[data-thm=intem] .just-published--more:hover .just-published--more-button{color:#005276}[data-thm=intem] .tabs--link.target-tab-active{color:#005276}[data-thm=intem] .tabs--link.target-tab-active:before{border-top:5px solid #005276}[data-thm=intem] a{color:#005276}[data-thm=intem] a:active,[data-thm=intem] a:hover{color:#005276}[data-thm=intem] p.box-text{background:#005276}[data-thm=intem] .pullquote,[data-thm=intem] .thm-bd-color{border-color:#006e96}[data-thm=intem] .thm-bd-top{border-top:1px solid #006e96}[data-thm=intem] .underlined-header{border-bottom:1px solid #006e96}[data-thm=intem] .underlined-header span{color:#006e96;border-bottom:5px solid #006e96}[data-thm=intem] .header-wrap{border-bottom:5px solid #006e96}[data-thm=intem] .nav-journal-level{border-left:8px solid #006e96}[data-thm=intem] .btn,[data-thm=intem] .btn-small{background:#005276;border:2px solid #005276}[data-thm=intem] .btn-small:hover,[data-thm=intem] .btn:hover{color:#005276}[data-thm=intem] .btn-alt,[data-thm=intem] .btn-small-alt{color:#005276}[data-thm=intem] .btn-alt:hover,[data-thm=intem] .btn-small-alt:hover{background:#005276}[data-thm=intem] .tab-nav-trigger.target-tab-active{color:#005276}[data-thm=intem] .tab-nav-trigger.target-tab-active:hover{color:#005276}[data-thm=intem] .tab-nav-trigger.target-tab-active:before{color:#005276}[data-thm=intem].pg_abstract .full-text-link{background:#005276;border-right:3px solid #006e96}[data-thm=intem].pg_abstract .full-text-link:hover{background:#006e96}[data-thm=intem] .widget-MagazineView .decorated-hed:after,[data-thm=intem].pg_abstract .decorated-hed:after{border-bottom:1px solid #006e96}[data-thm=intem] .widget-MagazineView .decorated-hed .heading-text,[data-thm=intem].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #006e96}[data-thm=intem] .themed-hed{border-top:1px solid #006e96}[data-thm=intem] .themed-hed:before{background:#006e96}[data-thm=intem] .auth--purchase{border-top:.0625rem solid #006e96}[data-thm=neur] .image-box .featured,[data-thm=neur] .themed-border{border-top:10px solid #d71635}[data-thm=neur] .image-box .featured:before,[data-thm=neur] .themed-border:before{background:#981b1e}[data-thm=neur] .branded-bar{background:#981b1e}[data-thm=neur] .branded-bar:after{background:#d71635}[data-thm=neur] .modal{border-top:8px solid #981b1e}[data-thm=neur] .h6,[data-thm=neur] .list-style-1 li:before,[data-thm=neur] .logged-in .auth--trigger:before,[data-thm=neur] .master-main .email-signup--text,[data-thm=neur] .table .column:before,[data-thm=neur] .thm-col,[data-thm=neur] h6{color:#981b1e}[data-thm=neur] .h6:hover,[data-thm=neur] .list-style-1 li:before:hover,[data-thm=neur] .logged-in .auth--trigger:before:hover,[data-thm=neur] .master-main .email-signup--text:hover,[data-thm=neur] .table .column:before:hover,[data-thm=neur] .thm-col:hover,[data-thm=neur] h6:hover{color:#981b1e}[data-thm=neur] .comment-form-item input::-webkit-input-placeholder,[data-thm=neur] .comment-form-item textarea::-webkit-input-placeholder{color:#981b1e}[data-thm=neur] .comment-form-item input:-ms-input-placeholder,[data-thm=neur] .comment-form-item textarea:-ms-input-placeholder{color:#981b1e}[data-thm=neur] .comment-form-item input::placeholder,[data-thm=neur] .comment-form-item textarea::placeholder{color:#981b1e}[data-thm=neur] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#d71635}[data-thm=neur] .comment-form-item .radio-label:before{border:#d71635}[data-thm=neur] .thm-learning{color:#4978bc}[data-thm=neur] .thm-learning:hover{color:#4978bc}[data-thm=neur] .thm-col-lt{color:#cc8d8f}[data-thm=neur] .thm-col-lt:hover{color:#cc8d8f}[data-thm=neur] .thm-bg-col{background:#981b1e}[data-thm=neur] .header-logo-wrapper,[data-thm=neur] .site-links-wrap{background:#981b1e}[data-thm=neur] .thm-bg{background:#d71635}[data-thm=neur] .thm-bg-hover:hover{background:#d71635}[data-thm=neur] .thm-bg-learning{background:#4978bc}[data-thm=neur] .thm-col-sec{color:#d71635!important}[data-thm=neur] .just-published--more-text:before,[data-thm=neur] .just-published--more:hover .just-published--more-button{color:#d71635}[data-thm=neur] .tabs--link.target-tab-active{color:#d71635}[data-thm=neur] .tabs--link.target-tab-active:before{border-top:5px solid #d71635}[data-thm=neur] a{color:#d71635}[data-thm=neur] a:active,[data-thm=neur] a:hover{color:#d71635}[data-thm=neur] p.box-text{background:#d71635}[data-thm=neur] .pullquote,[data-thm=neur] .thm-bd-color{border-color:#981b1e}[data-thm=neur] .thm-bd-top{border-top:1px solid #981b1e}[data-thm=neur] .underlined-header{border-bottom:1px solid #981b1e}[data-thm=neur] .underlined-header span{color:#981b1e;border-bottom:5px solid #981b1e}[data-thm=neur] .header-wrap{border-bottom:5px solid #981b1e}[data-thm=neur] .nav-journal-level{border-left:8px solid #981b1e}[data-thm=neur] .btn,[data-thm=neur] .btn-small{background:#d71635;border:2px solid #d71635}[data-thm=neur] .btn-small:hover,[data-thm=neur] .btn:hover{color:#d71635}[data-thm=neur] .btn-alt,[data-thm=neur] .btn-small-alt{color:#d71635}[data-thm=neur] .btn-alt:hover,[data-thm=neur] .btn-small-alt:hover{background:#d71635}[data-thm=neur] .tab-nav-trigger.target-tab-active{color:#d71635}[data-thm=neur] .tab-nav-trigger.target-tab-active:hover{color:#d71635}[data-thm=neur] .tab-nav-trigger.target-tab-active:before{color:#d71635}[data-thm=neur].pg_abstract .full-text-link{background:#d71635;border-right:3px solid #981b1e}[data-thm=neur].pg_abstract .full-text-link:hover{background:#981b1e}[data-thm=neur] .widget-MagazineView .decorated-hed:after,[data-thm=neur].pg_abstract .decorated-hed:after{border-bottom:1px solid #981b1e}[data-thm=neur] .widget-MagazineView .decorated-hed .heading-text,[data-thm=neur].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #a11215}[data-thm=neur] .themed-hed{border-top:1px solid #981b1e}[data-thm=neur] .themed-hed:before{background:#a11215}[data-thm=neur] .auth--purchase{border-top:.0625rem solid #981b1e}[data-thm=oncol] .image-box .featured,[data-thm=oncol] .themed-border{border-top:10px solid #006f3b}[data-thm=oncol] .image-box .featured:before,[data-thm=oncol] .themed-border:before{background:#3b923f}[data-thm=oncol] .branded-bar{background:#3b923f}[data-thm=oncol] .branded-bar:after{background:#006f3b}[data-thm=oncol] .modal{border-top:8px solid #3b923f}[data-thm=oncol] .h6,[data-thm=oncol] .list-style-1 li:before,[data-thm=oncol] .logged-in .auth--trigger:before,[data-thm=oncol] .master-main .email-signup--text,[data-thm=oncol] .table .column:before,[data-thm=oncol] .thm-col,[data-thm=oncol] h6{color:#3b923f}[data-thm=oncol] .h6:hover,[data-thm=oncol] .list-style-1 li:before:hover,[data-thm=oncol] .logged-in .auth--trigger:before:hover,[data-thm=oncol] .master-main .email-signup--text:hover,[data-thm=oncol] .table .column:before:hover,[data-thm=oncol] .thm-col:hover,[data-thm=oncol] h6:hover{color:#3b923f}[data-thm=oncol] .comment-form-item input::-webkit-input-placeholder,[data-thm=oncol] .comment-form-item textarea::-webkit-input-placeholder{color:#3b923f}[data-thm=oncol] .comment-form-item input:-ms-input-placeholder,[data-thm=oncol] .comment-form-item textarea:-ms-input-placeholder{color:#3b923f}[data-thm=oncol] .comment-form-item input::placeholder,[data-thm=oncol] .comment-form-item textarea::placeholder{color:#3b923f}[data-thm=oncol] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#006f3b}[data-thm=oncol] .comment-form-item .radio-label:before{border:#006f3b}[data-thm=oncol] .thm-learning{color:#4978bc}[data-thm=oncol] .thm-learning:hover{color:#4978bc}[data-thm=oncol] .thm-col-lt{color:#9dc99f}[data-thm=oncol] .thm-col-lt:hover{color:#9dc99f}[data-thm=oncol] .thm-bg-col{background:#3b923f}[data-thm=oncol] .header-logo-wrapper,[data-thm=oncol] .site-links-wrap{background:#3b923f}[data-thm=oncol] .thm-bg{background:#006f3b}[data-thm=oncol] .thm-bg-hover:hover{background:#006f3b}[data-thm=oncol] .thm-bg-learning{background:#4978bc}[data-thm=oncol] .thm-col-sec{color:#006f3b!important}[data-thm=oncol] .just-published--more-text:before,[data-thm=oncol] .just-published--more:hover .just-published--more-button{color:#006f3b}[data-thm=oncol] .tabs--link.target-tab-active{color:#006f3b}[data-thm=oncol] .tabs--link.target-tab-active:before{border-top:5px solid #006f3b}[data-thm=oncol] a{color:#006f3b}[data-thm=oncol] a:active,[data-thm=oncol] a:hover{color:#006f3b}[data-thm=oncol] p.box-text{background:#006f3b}[data-thm=oncol] .pullquote,[data-thm=oncol] .thm-bd-color{border-color:#3b923f}[data-thm=oncol] .thm-bd-top{border-top:1px solid #3b923f}[data-thm=oncol] .underlined-header{border-bottom:1px solid #3b923f}[data-thm=oncol] .underlined-header span{color:#3b923f;border-bottom:5px solid #3b923f}[data-thm=oncol] .header-wrap{border-bottom:5px solid #3b923f}[data-thm=oncol] .nav-journal-level{border-left:8px solid #3b923f}[data-thm=oncol] .btn,[data-thm=oncol] .btn-small{background:#006f3b;border:2px solid #006f3b}[data-thm=oncol] .btn-small:hover,[data-thm=oncol] .btn:hover{color:#006f3b}[data-thm=oncol] .btn-alt,[data-thm=oncol] .btn-small-alt{color:#006f3b}[data-thm=oncol] .btn-alt:hover,[data-thm=oncol] .btn-small-alt:hover{background:#006f3b}[data-thm=oncol] .tab-nav-trigger.target-tab-active{color:#006f3b}[data-thm=oncol] .tab-nav-trigger.target-tab-active:hover{color:#006f3b}[data-thm=oncol] .tab-nav-trigger.target-tab-active:before{color:#006f3b}[data-thm=oncol].pg_abstract .full-text-link{background:#006f3b;border-right:3px solid #3b923f}[data-thm=oncol].pg_abstract .full-text-link:hover{background:#3b923f}[data-thm=oncol] .widget-MagazineView .decorated-hed:after,[data-thm=oncol].pg_abstract .decorated-hed:after{border-bottom:1px solid #3b923f}[data-thm=oncol] .widget-MagazineView .decorated-hed .heading-text,[data-thm=oncol].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #319c36}[data-thm=oncol] .themed-hed{border-top:1px solid #3b923f}[data-thm=oncol] .themed-hed:before{background:#319c36}[data-thm=oncol] .auth--purchase{border-top:.0625rem solid #3b923f}[data-thm=ophth] .image-box .featured,[data-thm=ophth] .themed-border{border-top:10px solid #006f3b}[data-thm=ophth] .image-box .featured:before,[data-thm=ophth] .themed-border:before{background:#66bc29}[data-thm=ophth] .branded-bar{background:#66bc29}[data-thm=ophth] .branded-bar:after{background:#006f3b}[data-thm=ophth] .modal{border-top:8px solid #66bc29}[data-thm=ophth] .h6,[data-thm=ophth] .list-style-1 li:before,[data-thm=ophth] .logged-in .auth--trigger:before,[data-thm=ophth] .master-main .email-signup--text,[data-thm=ophth] .table .column:before,[data-thm=ophth] .thm-col,[data-thm=ophth] h6{color:#66bc29}[data-thm=ophth] .h6:hover,[data-thm=ophth] .list-style-1 li:before:hover,[data-thm=ophth] .logged-in .auth--trigger:before:hover,[data-thm=ophth] .master-main .email-signup--text:hover,[data-thm=ophth] .table .column:before:hover,[data-thm=ophth] .thm-col:hover,[data-thm=ophth] h6:hover{color:#66bc29}[data-thm=ophth] .comment-form-item input::-webkit-input-placeholder,[data-thm=ophth] .comment-form-item textarea::-webkit-input-placeholder{color:#66bc29}[data-thm=ophth] .comment-form-item input:-ms-input-placeholder,[data-thm=ophth] .comment-form-item textarea:-ms-input-placeholder{color:#66bc29}[data-thm=ophth] .comment-form-item input::placeholder,[data-thm=ophth] .comment-form-item textarea::placeholder{color:#66bc29}[data-thm=ophth] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#006f3b}[data-thm=ophth] .comment-form-item .radio-label:before{border:#006f3b}[data-thm=ophth] .thm-learning{color:#4978bc}[data-thm=ophth] .thm-learning:hover{color:#4978bc}[data-thm=ophth] .thm-col-lt{color:#b3de94}[data-thm=ophth] .thm-col-lt:hover{color:#b3de94}[data-thm=ophth] .thm-bg-col{background:#66bc29}[data-thm=ophth] .header-logo-wrapper,[data-thm=ophth] .site-links-wrap{background:#66bc29}[data-thm=ophth] .thm-bg{background:#006f3b}[data-thm=ophth] .thm-bg-hover:hover{background:#006f3b}[data-thm=ophth] .thm-bg-learning{background:#4978bc}[data-thm=ophth] .thm-col-sec{color:#006f3b!important}[data-thm=ophth] .just-published--more-text:before,[data-thm=ophth] .just-published--more:hover .just-published--more-button{color:#006f3b}[data-thm=ophth] .tabs--link.target-tab-active{color:#006f3b}[data-thm=ophth] .tabs--link.target-tab-active:before{border-top:5px solid #006f3b}[data-thm=ophth] a{color:#006f3b}[data-thm=ophth] a:active,[data-thm=ophth] a:hover{color:#006f3b}[data-thm=ophth] p.box-text{background:#006f3b}[data-thm=ophth] .pullquote,[data-thm=ophth] .thm-bd-color{border-color:#66bc29}[data-thm=ophth] .thm-bd-top{border-top:1px solid #66bc29}[data-thm=ophth] .underlined-header{border-bottom:1px solid #66bc29}[data-thm=ophth] .underlined-header span{color:#66bc29;border-bottom:5px solid #66bc29}[data-thm=ophth] .header-wrap{border-bottom:5px solid #66bc29}[data-thm=ophth] .nav-journal-level{border-left:8px solid #66bc29}[data-thm=ophth] .btn,[data-thm=ophth] .btn-small{background:#006f3b;border:2px solid #006f3b}[data-thm=ophth] .btn-small:hover,[data-thm=ophth] .btn:hover{color:#006f3b}[data-thm=ophth] .btn-alt,[data-thm=ophth] .btn-small-alt{color:#006f3b}[data-thm=ophth] .btn-alt:hover,[data-thm=ophth] .btn-small-alt:hover{background:#006f3b}[data-thm=ophth] .tab-nav-trigger.target-tab-active{color:#006f3b}[data-thm=ophth] .tab-nav-trigger.target-tab-active:hover{color:#006f3b}[data-thm=ophth] .tab-nav-trigger.target-tab-active:before{color:#006f3b}[data-thm=ophth].pg_abstract .full-text-link{background:#006f3b;border-right:3px solid #66bc29}[data-thm=ophth].pg_abstract .full-text-link:hover{background:#66bc29}[data-thm=ophth] .widget-MagazineView .decorated-hed:after,[data-thm=ophth].pg_abstract .decorated-hed:after{border-bottom:1px solid #66bc29}[data-thm=ophth] .widget-MagazineView .decorated-hed .heading-text,[data-thm=ophth].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #64c71e}[data-thm=ophth] .themed-hed{border-top:1px solid #66bc29}[data-thm=ophth] .themed-hed:before{background:#64c71e}[data-thm=ophth] .auth--purchase{border-top:.0625rem solid #66bc29}[data-thm=otol] .image-box .featured,[data-thm=otol] .themed-border{border-top:10px solid #005276}[data-thm=otol] .image-box .featured:before,[data-thm=otol] .themed-border:before{background:#34b6e4}[data-thm=otol] .branded-bar{background:#34b6e4}[data-thm=otol] .branded-bar:after{background:#005276}[data-thm=otol] .modal{border-top:8px solid #34b6e4}[data-thm=otol] .h6,[data-thm=otol] .list-style-1 li:before,[data-thm=otol] .logged-in .auth--trigger:before,[data-thm=otol] .master-main .email-signup--text,[data-thm=otol] .table .column:before,[data-thm=otol] .thm-col,[data-thm=otol] h6{color:#34b6e4}[data-thm=otol] .h6:hover,[data-thm=otol] .list-style-1 li:before:hover,[data-thm=otol] .logged-in .auth--trigger:before:hover,[data-thm=otol] .master-main .email-signup--text:hover,[data-thm=otol] .table .column:before:hover,[data-thm=otol] .thm-col:hover,[data-thm=otol] h6:hover{color:#34b6e4}[data-thm=otol] .comment-form-item input::-webkit-input-placeholder,[data-thm=otol] .comment-form-item textarea::-webkit-input-placeholder{color:#34b6e4}[data-thm=otol] .comment-form-item input:-ms-input-placeholder,[data-thm=otol] .comment-form-item textarea:-ms-input-placeholder{color:#34b6e4}[data-thm=otol] .comment-form-item input::placeholder,[data-thm=otol] .comment-form-item textarea::placeholder{color:#34b6e4}[data-thm=otol] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#005276}[data-thm=otol] .comment-form-item .radio-label:before{border:#005276}[data-thm=otol] .thm-learning{color:#4978bc}[data-thm=otol] .thm-learning:hover{color:#4978bc}[data-thm=otol] .thm-col-lt{color:#9adbf2}[data-thm=otol] .thm-col-lt:hover{color:#9adbf2}[data-thm=otol] .thm-bg-col{background:#34b6e4}[data-thm=otol] .header-logo-wrapper,[data-thm=otol] .site-links-wrap{background:#34b6e4}[data-thm=otol] .thm-bg{background:#005276}[data-thm=otol] .thm-bg-hover:hover{background:#005276}[data-thm=otol] .thm-bg-learning{background:#4978bc}[data-thm=otol] .thm-col-sec{color:#005276!important}[data-thm=otol] .just-published--more-text:before,[data-thm=otol] .just-published--more:hover .just-published--more-button{color:#005276}[data-thm=otol] .tabs--link.target-tab-active{color:#005276}[data-thm=otol] .tabs--link.target-tab-active:before{border-top:5px solid #005276}[data-thm=otol] a{color:#005276}[data-thm=otol] a:active,[data-thm=otol] a:hover{color:#005276}[data-thm=otol] p.box-text{background:#005276}[data-thm=otol] .pullquote,[data-thm=otol] .thm-bd-color{border-color:#34b6e4}[data-thm=otol] .thm-bd-top{border-top:1px solid #34b6e4}[data-thm=otol] .underlined-header{border-bottom:1px solid #34b6e4}[data-thm=otol] .underlined-header span{color:#34b6e4;border-bottom:5px solid #34b6e4}[data-thm=otol] .header-wrap{border-bottom:5px solid #34b6e4}[data-thm=otol] .nav-journal-level{border-left:8px solid #34b6e4}[data-thm=otol] .btn,[data-thm=otol] .btn-small{background:#005276;border:2px solid #005276}[data-thm=otol] .btn-small:hover,[data-thm=otol] .btn:hover{color:#005276}[data-thm=otol] .btn-alt,[data-thm=otol] .btn-small-alt{color:#005276}[data-thm=otol] .btn-alt:hover,[data-thm=otol] .btn-small-alt:hover{background:#005276}[data-thm=otol] .tab-nav-trigger.target-tab-active{color:#005276}[data-thm=otol] .tab-nav-trigger.target-tab-active:hover{color:#005276}[data-thm=otol] .tab-nav-trigger.target-tab-active:before{color:#005276}[data-thm=otol].pg_abstract .full-text-link{background:#005276;border-right:3px solid #34b6e4}[data-thm=otol].pg_abstract .full-text-link:hover{background:#34b6e4}[data-thm=otol] .widget-MagazineView .decorated-hed:after,[data-thm=otol].pg_abstract .decorated-hed:after{border-bottom:1px solid #34b6e4}[data-thm=otol] .widget-MagazineView .decorated-hed .heading-text,[data-thm=otol].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #29bbf0}[data-thm=otol] .themed-hed{border-top:1px solid #34b6e4}[data-thm=otol] .themed-hed:before{background:#29bbf0}[data-thm=otol] .auth--purchase{border-top:.0625rem solid #34b6e4}[data-thm=peds] .image-box .featured,[data-thm=peds] .themed-border{border-top:10px solid #005276}[data-thm=peds] .image-box .featured:before,[data-thm=peds] .themed-border:before{background:#0084c0}[data-thm=peds] .branded-bar{background:#0084c0}[data-thm=peds] .branded-bar:after{background:#005276}[data-thm=peds] .modal{border-top:8px solid #0084c0}[data-thm=peds] .h6,[data-thm=peds] .list-style-1 li:before,[data-thm=peds] .logged-in .auth--trigger:before,[data-thm=peds] .master-main .email-signup--text,[data-thm=peds] .table .column:before,[data-thm=peds] .thm-col,[data-thm=peds] h6{color:#0084c0}[data-thm=peds] .h6:hover,[data-thm=peds] .list-style-1 li:before:hover,[data-thm=peds] .logged-in .auth--trigger:before:hover,[data-thm=peds] .master-main .email-signup--text:hover,[data-thm=peds] .table .column:before:hover,[data-thm=peds] .thm-col:hover,[data-thm=peds] h6:hover{color:#0084c0}[data-thm=peds] .comment-form-item input::-webkit-input-placeholder,[data-thm=peds] .comment-form-item textarea::-webkit-input-placeholder{color:#0084c0}[data-thm=peds] .comment-form-item input:-ms-input-placeholder,[data-thm=peds] .comment-form-item textarea:-ms-input-placeholder{color:#0084c0}[data-thm=peds] .comment-form-item input::placeholder,[data-thm=peds] .comment-form-item textarea::placeholder{color:#0084c0}[data-thm=peds] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#005276}[data-thm=peds] .comment-form-item .radio-label:before{border:#005276}[data-thm=peds] .thm-learning{color:#4978bc}[data-thm=peds] .thm-learning:hover{color:#4978bc}[data-thm=peds] .thm-col-lt{color:#80c2e0}[data-thm=peds] .thm-col-lt:hover{color:#80c2e0}[data-thm=peds] .thm-bg-col{background:#0084c0}[data-thm=peds] .header-logo-wrapper,[data-thm=peds] .site-links-wrap{background:#0084c0}[data-thm=peds] .thm-bg{background:#005276}[data-thm=peds] .thm-bg-hover:hover{background:#005276}[data-thm=peds] .thm-bg-learning{background:#4978bc}[data-thm=peds] .thm-col-sec{color:#005276!important}[data-thm=peds] .just-published--more-text:before,[data-thm=peds] .just-published--more:hover .just-published--more-button{color:#005276}[data-thm=peds] .tabs--link.target-tab-active{color:#005276}[data-thm=peds] .tabs--link.target-tab-active:before{border-top:5px solid #005276}[data-thm=peds] a{color:#005276}[data-thm=peds] a:active,[data-thm=peds] a:hover{color:#005276}[data-thm=peds] p.box-text{background:#005276}[data-thm=peds] .pullquote,[data-thm=peds] .thm-bd-color{border-color:#0084c0}[data-thm=peds] .thm-bd-top{border-top:1px solid #0084c0}[data-thm=peds] .underlined-header{border-bottom:1px solid #0084c0}[data-thm=peds] .underlined-header span{color:#0084c0;border-bottom:5px solid #0084c0}[data-thm=peds] .header-wrap{border-bottom:5px solid #0084c0}[data-thm=peds] .nav-journal-level{border-left:8px solid #0084c0}[data-thm=peds] .btn,[data-thm=peds] .btn-small{background:#005276;border:2px solid #005276}[data-thm=peds] .btn-small:hover,[data-thm=peds] .btn:hover{color:#005276}[data-thm=peds] .btn-alt,[data-thm=peds] .btn-small-alt{color:#005276}[data-thm=peds] .btn-alt:hover,[data-thm=peds] .btn-small-alt:hover{background:#005276}[data-thm=peds] .tab-nav-trigger.target-tab-active{color:#005276}[data-thm=peds] .tab-nav-trigger.target-tab-active:hover{color:#005276}[data-thm=peds] .tab-nav-trigger.target-tab-active:before{color:#005276}[data-thm=peds].pg_abstract .full-text-link{background:#005276;border-right:3px solid #0084c0}[data-thm=peds].pg_abstract .full-text-link:hover{background:#0084c0}[data-thm=peds] .widget-MagazineView .decorated-hed:after,[data-thm=peds].pg_abstract .decorated-hed:after{border-bottom:1px solid #0084c0}[data-thm=peds] .widget-MagazineView .decorated-hed .heading-text,[data-thm=peds].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #0084c0}[data-thm=peds] .themed-hed{border-top:1px solid #0084c0}[data-thm=peds] .themed-hed:before{background:#0084c0}[data-thm=peds] .auth--purchase{border-top:.0625rem solid #0084c0}[data-thm=psych] .image-box .featured,[data-thm=psych] .themed-border{border-top:10px solid #0084c0}[data-thm=psych] .image-box .featured:before,[data-thm=psych] .themed-border:before{background:#005276}[data-thm=psych] .branded-bar{background:#005276}[data-thm=psych] .branded-bar:after{background:#0084c0}[data-thm=psych] .modal{border-top:8px solid #005276}[data-thm=psych] .h6,[data-thm=psych] .list-style-1 li:before,[data-thm=psych] .logged-in .auth--trigger:before,[data-thm=psych] .master-main .email-signup--text,[data-thm=psych] .table .column:before,[data-thm=psych] .thm-col,[data-thm=psych] h6{color:#005276}[data-thm=psych] .h6:hover,[data-thm=psych] .list-style-1 li:before:hover,[data-thm=psych] .logged-in .auth--trigger:before:hover,[data-thm=psych] .master-main .email-signup--text:hover,[data-thm=psych] .table .column:before:hover,[data-thm=psych] .thm-col:hover,[data-thm=psych] h6:hover{color:#005276}[data-thm=psych] .comment-form-item input::-webkit-input-placeholder,[data-thm=psych] .comment-form-item textarea::-webkit-input-placeholder{color:#005276}[data-thm=psych] .comment-form-item input:-ms-input-placeholder,[data-thm=psych] .comment-form-item textarea:-ms-input-placeholder{color:#005276}[data-thm=psych] .comment-form-item input::placeholder,[data-thm=psych] .comment-form-item textarea::placeholder{color:#005276}[data-thm=psych] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#0084c0}[data-thm=psych] .comment-form-item .radio-label:before{border:#0084c0}[data-thm=psych] .thm-learning{color:#4978bc}[data-thm=psych] .thm-learning:hover{color:#4978bc}[data-thm=psych] .thm-col-lt{color:#80a9bb}[data-thm=psych] .thm-col-lt:hover{color:#80a9bb}[data-thm=psych] .thm-bg-col{background:#005276}[data-thm=psych] .header-logo-wrapper,[data-thm=psych] .site-links-wrap{background:#005276}[data-thm=psych] .thm-bg{background:#0084c0}[data-thm=psych] .thm-bg-hover:hover{background:#0084c0}[data-thm=psych] .thm-bg-learning{background:#4978bc}[data-thm=psych] .thm-col-sec{color:#0084c0!important}[data-thm=psych] .just-published--more-text:before,[data-thm=psych] .just-published--more:hover .just-published--more-button{color:#0084c0}[data-thm=psych] .tabs--link.target-tab-active{color:#0084c0}[data-thm=psych] .tabs--link.target-tab-active:before{border-top:5px solid #0084c0}[data-thm=psych] a{color:#0084c0}[data-thm=psych] a:active,[data-thm=psych] a:hover{color:#0084c0}[data-thm=psych] p.box-text{background:#0084c0}[data-thm=psych] .pullquote,[data-thm=psych] .thm-bd-color{border-color:#005276}[data-thm=psych] .thm-bd-top{border-top:1px solid #005276}[data-thm=psych] .underlined-header{border-bottom:1px solid #005276}[data-thm=psych] .underlined-header span{color:#005276;border-bottom:5px solid #005276}[data-thm=psych] .header-wrap{border-bottom:5px solid #005276}[data-thm=psych] .nav-journal-level{border-left:8px solid #005276}[data-thm=psych] .btn,[data-thm=psych] .btn-small{background:#0084c0;border:2px solid #0084c0}[data-thm=psych] .btn-small:hover,[data-thm=psych] .btn:hover{color:#0084c0}[data-thm=psych] .btn-alt,[data-thm=psych] .btn-small-alt{color:#0084c0}[data-thm=psych] .btn-alt:hover,[data-thm=psych] .btn-small-alt:hover{background:#0084c0}[data-thm=psych] .tab-nav-trigger.target-tab-active{color:#0084c0}[data-thm=psych] .tab-nav-trigger.target-tab-active:hover{color:#0084c0}[data-thm=psych] .tab-nav-trigger.target-tab-active:before{color:#0084c0}[data-thm=psych].pg_abstract .full-text-link{background:#0084c0;border-right:3px solid #005276}[data-thm=psych].pg_abstract .full-text-link:hover{background:#005276}[data-thm=psych] .widget-MagazineView .decorated-hed:after,[data-thm=psych].pg_abstract .decorated-hed:after{border-bottom:1px solid #005276}[data-thm=psych] .widget-MagazineView .decorated-hed .heading-text,[data-thm=psych].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #005276}[data-thm=psych] .themed-hed{border-top:1px solid #005276}[data-thm=psych] .themed-hed:before{background:#005276}[data-thm=psych] .auth--purchase{border-top:.0625rem solid #005276}[data-thm=surg] .image-box .featured,[data-thm=surg] .themed-border{border-top:10px solid #981b1e}[data-thm=surg] .image-box .featured:before,[data-thm=surg] .themed-border:before{background:#f47920}[data-thm=surg] .branded-bar{background:#f47920}[data-thm=surg] .branded-bar:after{background:#981b1e}[data-thm=surg] .modal{border-top:8px solid #f47920}[data-thm=surg] .h6,[data-thm=surg] .list-style-1 li:before,[data-thm=surg] .logged-in .auth--trigger:before,[data-thm=surg] .master-main .email-signup--text,[data-thm=surg] .table .column:before,[data-thm=surg] .thm-col,[data-thm=surg] h6{color:#f47920}[data-thm=surg] .h6:hover,[data-thm=surg] .list-style-1 li:before:hover,[data-thm=surg] .logged-in .auth--trigger:before:hover,[data-thm=surg] .master-main .email-signup--text:hover,[data-thm=surg] .table .column:before:hover,[data-thm=surg] .thm-col:hover,[data-thm=surg] h6:hover{color:#f47920}[data-thm=surg] .comment-form-item input::-webkit-input-placeholder,[data-thm=surg] .comment-form-item textarea::-webkit-input-placeholder{color:#f47920}[data-thm=surg] .comment-form-item input:-ms-input-placeholder,[data-thm=surg] .comment-form-item textarea:-ms-input-placeholder{color:#f47920}[data-thm=surg] .comment-form-item input::placeholder,[data-thm=surg] .comment-form-item textarea::placeholder{color:#f47920}[data-thm=surg] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#981b1e}[data-thm=surg] .comment-form-item .radio-label:before{border:#981b1e}[data-thm=surg] .thm-learning{color:#4978bc}[data-thm=surg] .thm-learning:hover{color:#4978bc}[data-thm=surg] .thm-col-lt{color:#fabc90}[data-thm=surg] .thm-col-lt:hover{color:#fabc90}[data-thm=surg] .thm-bg-col{background:#f47920}[data-thm=surg] .header-logo-wrapper,[data-thm=surg] .site-links-wrap{background:#f47920}[data-thm=surg] .thm-bg{background:#981b1e}[data-thm=surg] .thm-bg-hover:hover{background:#981b1e}[data-thm=surg] .thm-bg-learning{background:#4978bc}[data-thm=surg] .thm-col-sec{color:#981b1e!important}[data-thm=surg] .just-published--more-text:before,[data-thm=surg] .just-published--more:hover .just-published--more-button{color:#981b1e}[data-thm=surg] .tabs--link.target-tab-active{color:#981b1e}[data-thm=surg] .tabs--link.target-tab-active:before{border-top:5px solid #981b1e}[data-thm=surg] a{color:#981b1e}[data-thm=surg] a:active,[data-thm=surg] a:hover{color:#981b1e}[data-thm=surg] p.box-text{background:#981b1e}[data-thm=surg] .pullquote,[data-thm=surg] .thm-bd-color{border-color:#f47920}[data-thm=surg] .thm-bd-top{border-top:1px solid #f47920}[data-thm=surg] .underlined-header{border-bottom:1px solid #f47920}[data-thm=surg] .underlined-header span{color:#f47920;border-bottom:5px solid #f47920}[data-thm=surg] .header-wrap{border-bottom:5px solid #f47920}[data-thm=surg] .nav-journal-level{border-left:8px solid #f47920}[data-thm=surg] .btn,[data-thm=surg] .btn-small{background:#981b1e;border:2px solid #981b1e}[data-thm=surg] .btn-small:hover,[data-thm=surg] .btn:hover{color:#981b1e}[data-thm=surg] .btn-alt,[data-thm=surg] .btn-small-alt{color:#981b1e}[data-thm=surg] .btn-alt:hover,[data-thm=surg] .btn-small-alt:hover{background:#981b1e}[data-thm=surg] .tab-nav-trigger.target-tab-active{color:#981b1e}[data-thm=surg] .tab-nav-trigger.target-tab-active:hover{color:#981b1e}[data-thm=surg] .tab-nav-trigger.target-tab-active:before{color:#981b1e}[data-thm=surg].pg_abstract .full-text-link{background:#981b1e;border-right:3px solid #f47920}[data-thm=surg].pg_abstract .full-text-link:hover{background:#f47920}[data-thm=surg] .widget-MagazineView .decorated-hed:after,[data-thm=surg].pg_abstract .decorated-hed:after{border-bottom:1px solid #f47920}[data-thm=surg] .widget-MagazineView .decorated-hed .heading-text,[data-thm=surg].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #ff7715}[data-thm=surg] .themed-hed{border-top:1px solid #f47920}[data-thm=surg] .themed-hed:before{background:#ff7715}[data-thm=surg] .auth--purchase{border-top:.0625rem solid #f47920}[data-thm=neurp] .image-box .featured,[data-thm=neurp] .themed-border{border-top:10px solid #0084c0}[data-thm=neurp] .image-box .featured:before,[data-thm=neurp] .themed-border:before{background:#005276}[data-thm=neurp] .branded-bar{background:#005276}[data-thm=neurp] .branded-bar:after{background:#0084c0}[data-thm=neurp] .modal{border-top:8px solid #005276}[data-thm=neurp] .h6,[data-thm=neurp] .list-style-1 li:before,[data-thm=neurp] .logged-in .auth--trigger:before,[data-thm=neurp] .master-main .email-signup--text,[data-thm=neurp] .table .column:before,[data-thm=neurp] .thm-col,[data-thm=neurp] h6{color:#005276}[data-thm=neurp] .h6:hover,[data-thm=neurp] .list-style-1 li:before:hover,[data-thm=neurp] .logged-in .auth--trigger:before:hover,[data-thm=neurp] .master-main .email-signup--text:hover,[data-thm=neurp] .table .column:before:hover,[data-thm=neurp] .thm-col:hover,[data-thm=neurp] h6:hover{color:#005276}[data-thm=neurp] .comment-form-item input::-webkit-input-placeholder,[data-thm=neurp] .comment-form-item textarea::-webkit-input-placeholder{color:#005276}[data-thm=neurp] .comment-form-item input:-ms-input-placeholder,[data-thm=neurp] .comment-form-item textarea:-ms-input-placeholder{color:#005276}[data-thm=neurp] .comment-form-item input::placeholder,[data-thm=neurp] .comment-form-item textarea::placeholder{color:#005276}[data-thm=neurp] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#0084c0}[data-thm=neurp] .comment-form-item .radio-label:before{border:#0084c0}[data-thm=neurp] .thm-learning{color:#4978bc}[data-thm=neurp] .thm-learning:hover{color:#4978bc}[data-thm=neurp] .thm-col-lt{color:#80a9bb}[data-thm=neurp] .thm-col-lt:hover{color:#80a9bb}[data-thm=neurp] .thm-bg-col{background:#005276}[data-thm=neurp] .header-logo-wrapper,[data-thm=neurp] .site-links-wrap{background:#005276}[data-thm=neurp] .thm-bg{background:#0084c0}[data-thm=neurp] .thm-bg-hover:hover{background:#0084c0}[data-thm=neurp] .thm-bg-learning{background:#4978bc}[data-thm=neurp] .thm-col-sec{color:#0084c0!important}[data-thm=neurp] .just-published--more-text:before,[data-thm=neurp] .just-published--more:hover .just-published--more-button{color:#0084c0}[data-thm=neurp] .tabs--link.target-tab-active{color:#0084c0}[data-thm=neurp] .tabs--link.target-tab-active:before{border-top:5px solid #0084c0}[data-thm=neurp] a{color:#0084c0}[data-thm=neurp] a:active,[data-thm=neurp] a:hover{color:#0084c0}[data-thm=neurp] p.box-text{background:#0084c0}[data-thm=neurp] .pullquote,[data-thm=neurp] .thm-bd-color{border-color:#005276}[data-thm=neurp] .thm-bd-top{border-top:1px solid #005276}[data-thm=neurp] .underlined-header{border-bottom:1px solid #005276}[data-thm=neurp] .underlined-header span{color:#005276;border-bottom:5px solid #005276}[data-thm=neurp] .header-wrap{border-bottom:5px solid #005276}[data-thm=neurp] .nav-journal-level{border-left:8px solid #005276}[data-thm=neurp] .btn,[data-thm=neurp] .btn-small{background:#0084c0;border:2px solid #0084c0}[data-thm=neurp] .btn-small:hover,[data-thm=neurp] .btn:hover{color:#0084c0}[data-thm=neurp] .btn-alt,[data-thm=neurp] .btn-small-alt{color:#0084c0}[data-thm=neurp] .btn-alt:hover,[data-thm=neurp] .btn-small-alt:hover{background:#0084c0}[data-thm=neurp] .tab-nav-trigger.target-tab-active{color:#0084c0}[data-thm=neurp] .tab-nav-trigger.target-tab-active:hover{color:#0084c0}[data-thm=neurp] .tab-nav-trigger.target-tab-active:before{color:#0084c0}[data-thm=neurp].pg_abstract .full-text-link{background:#0084c0;border-right:3px solid #005276}[data-thm=neurp].pg_abstract .full-text-link:hover{background:#005276}[data-thm=neurp] .widget-MagazineView .decorated-hed:after,[data-thm=neurp].pg_abstract .decorated-hed:after{border-bottom:1px solid #005276}[data-thm=neurp] .widget-MagazineView .decorated-hed .heading-text,[data-thm=neurp].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #005276}[data-thm=neurp] .themed-hed{border-top:1px solid #005276}[data-thm=neurp] .themed-hed:before{background:#005276}[data-thm=neurp] .auth--purchase{border-top:.0625rem solid #005276}[data-thm=jaman] .image-box .featured,[data-thm=jaman] .themed-border{border-top:10px solid #9e1f63}[data-thm=jaman] .image-box .featured:before,[data-thm=jaman] .themed-border:before{background:#ed0973}[data-thm=jaman] .branded-bar{background:#ed0973}[data-thm=jaman] .branded-bar:after{background:#9e1f63}[data-thm=jaman] .modal{border-top:8px solid #ed0973}[data-thm=jaman] .h6,[data-thm=jaman] .list-style-1 li:before,[data-thm=jaman] .logged-in .auth--trigger:before,[data-thm=jaman] .master-main .email-signup--text,[data-thm=jaman] .table .column:before,[data-thm=jaman] .thm-col,[data-thm=jaman] h6{color:#ed0973}[data-thm=jaman] .h6:hover,[data-thm=jaman] .list-style-1 li:before:hover,[data-thm=jaman] .logged-in .auth--trigger:before:hover,[data-thm=jaman] .master-main .email-signup--text:hover,[data-thm=jaman] .table .column:before:hover,[data-thm=jaman] .thm-col:hover,[data-thm=jaman] h6:hover{color:#ed0973}[data-thm=jaman] .comment-form-item input::-webkit-input-placeholder,[data-thm=jaman] .comment-form-item textarea::-webkit-input-placeholder{color:#ed0973}[data-thm=jaman] .comment-form-item input:-ms-input-placeholder,[data-thm=jaman] .comment-form-item textarea:-ms-input-placeholder{color:#ed0973}[data-thm=jaman] .comment-form-item input::placeholder,[data-thm=jaman] .comment-form-item textarea::placeholder{color:#ed0973}[data-thm=jaman] .comment-form-item input[type=radio]:checked+.radio-label:before{background-color:#9e1f63}[data-thm=jaman] .comment-form-item .radio-label:before{border:#9e1f63}[data-thm=jaman] .thm-learning{color:#4978bc}[data-thm=jaman] .thm-learning:hover{color:#4978bc}[data-thm=jaman] .thm-col-lt{color:#f684b9}[data-thm=jaman] .thm-col-lt:hover{color:#f684b9}[data-thm=jaman] .thm-bg-col{background:#ed0973}[data-thm=jaman] .header-logo-wrapper,[data-thm=jaman] .site-links-wrap{background:#ed0973}[data-thm=jaman] .thm-bg{background:#9e1f63}[data-thm=jaman] .thm-bg-hover:hover{background:#9e1f63}[data-thm=jaman] .thm-bg-learning{background:#4978bc}[data-thm=jaman] .thm-col-sec{color:#9e1f63!important}[data-thm=jaman] .just-published--more-text:before,[data-thm=jaman] .just-published--more:hover .just-published--more-button{color:#9e1f63}[data-thm=jaman] .tabs--link.target-tab-active{color:#9e1f63}[data-thm=jaman] .tabs--link.target-tab-active:before{border-top:5px solid #9e1f63}[data-thm=jaman] a{color:#9e1f63}[data-thm=jaman] a:active,[data-thm=jaman] a:hover{color:#9e1f63}[data-thm=jaman] p.box-text{background:#9e1f63}[data-thm=jaman] .pullquote,[data-thm=jaman] .thm-bd-color{border-color:#ed0973}[data-thm=jaman] .thm-bd-top{border-top:1px solid #ed0973}[data-thm=jaman] .underlined-header{border-bottom:1px solid #ed0973}[data-thm=jaman] .underlined-header span{color:#ed0973;border-bottom:5px solid #ed0973}[data-thm=jaman] .header-wrap{border-bottom:5px solid #ed0973}[data-thm=jaman] .nav-journal-level{border-left:8px solid #ed0973}[data-thm=jaman] .btn,[data-thm=jaman] .btn-small{background:#9e1f63;border:2px solid #9e1f63}[data-thm=jaman] .btn-small:hover,[data-thm=jaman] .btn:hover{color:#9e1f63}[data-thm=jaman] .btn-alt,[data-thm=jaman] .btn-small-alt{color:#9e1f63}[data-thm=jaman] .btn-alt:hover,[data-thm=jaman] .btn-small-alt:hover{background:#9e1f63}[data-thm=jaman] .tab-nav-trigger.target-tab-active{color:#9e1f63}[data-thm=jaman] .tab-nav-trigger.target-tab-active:hover{color:#9e1f63}[data-thm=jaman] .tab-nav-trigger.target-tab-active:before{color:#9e1f63}[data-thm=jaman].pg_abstract .full-text-link{background:#9e1f63;border-right:3px solid #ed0973}[data-thm=jaman].pg_abstract .full-text-link:hover{background:#ed0973}[data-thm=jaman] .widget-MagazineView .decorated-hed:after,[data-thm=jaman].pg_abstract .decorated-hed:after{border-bottom:1px solid #ed0973}[data-thm=jaman] .widget-MagazineView .decorated-hed .heading-text,[data-thm=jaman].pg_abstract .decorated-hed .heading-text{border-bottom:5px solid #f60072}[data-thm=jaman] .themed-hed{border-top:1px solid #ed0973}[data-thm=jaman] .themed-hed:before{background:#f60072}[data-thm=jaman] .auth--purchase{border-top:.0625rem solid #ed0973}.pg_journal[data-thm=jaman] .header-ad-wrap{background:#9e004c}.pg_journal[data-thm=jama] .header-ad-wrap{background:#8b0018}.pg_journal[data-thm=cardi] .header-ad-wrap{background:#7a0416}.pg_journal[data-thm=derm] .header-ad-wrap{background:#00411b}.pg_journal[data-thm=faci] .header-ad-wrap{background:#9e0b0f}.pg_journal[data-thm=intem] .header-ad-wrap{background:#00465d}.pg_journal[data-thm=neur] .header-ad-wrap{background:#5a0000}.pg_journal[data-thm=oncol] .header-ad-wrap{background:#165d22}.pg_journal[data-thm=ophth] .header-ad-wrap{background:#487b2a}.pg_journal[data-thm=otol] .header-ad-wrap{background:#1b7798}.pg_journal[data-thm=peds] .header-ad-wrap{background:#005a7a}.pg_journal[data-thm=psych] .header-ad-wrap{background:#003360}.pg_journal[data-thm=surg] .header-ad-wrap{background:#c6401b}.pg_journal [data-thm=neur] .header-ad-wrap{background:#5a0000}.pg_journal [data-thm=jaman] .header-ad-wrap{background:#9e1f63}body{font-size:16px;font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif;color:#333;word-wrap:break-word;-webkit-hyphens:auto;-ms-hyphens:auto;hyphens:auto;word-break:break-word;-moz-hyphens:none}@media (max-width:767px){body{font-size:15px}}.screenreader-text,.sr-t{position:absolute;text-indent:-99999px}.h1,.h2,.h3,.h4,.h5,.h6,h1,h2,h3,h4,h5,h6{font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif;margin-top:.2em;margin-bottom:.5em}.h1,h1{font-size:2.125em;font-weight:600;line-height:1.3}@media (max-width:767px){.h1,h1{font-size:2em;line-height:1.25}}.h2,h2{font-size:2.125em;font-weight:400;line-height:1.353}@media (max-width:767px){.h2,h2{font-size:1.8em}}.h3,h3{font-size:1.75em;font-weight:500;line-height:1.3}@media (max-width:767px){.h3,h3{font-size:1.5em}}.h4,h4{font-size:1.25em;font-weight:700;line-height:1.3}.h5,h5{font-size:1.25em;font-size:18px;font-weight:500;line-height:1.3}@media (max-width:767px){.h5,h5{font-size:1.1em}}.h6,h6{font-size:1em;font-weight:700;margin-top:5px;line-height:1.3}.module-title{color:#000;margin-bottom:.3em;font-size:1.5em;font-weight:700}.module-title.jn-open{margin-bottom:1.75rem}[data-thm=jaman] .module-title{font-size:1.625rem;font-weight:600}.para,p{line-height:1.7;margin:0 0 1.25em 0;word-wrap:break-word;-webkit-font-feature-settings:"liga","dlig";font-feature-settings:"liga","dlig"}.para.large-text,p.large-text{font-size:1.5em;text-align:center;font-weight:500;line-height:1.35}@media (max-width:767px){.para.large-text,p.large-text{font-size:1.3em}}.para strong,p strong{color:#000}.text{line-height:1.7!important;color:#333!important;font-size:16px!important;font-weight:400!important}@media (max-width:767px){.text{font-size:15px!important}}a{text-decoration:none;transition:all .15s ease-in-out}a:active,a:focus{text-decoration:none}a:hover{cursor:pointer;text-decoration:underline}a:hover:after,a:hover:before{text-decoration:none}a.link-title{font-weight:700;clear:both;display:block}a sup{display:inline-block}ul{margin-left:18px;margin-bottom:1.25em;padding-left:0}ul li ol,ul li ul{margin-left:20px;margin-bottom:0}ul.circle li ul,ul.disc li ul,ul.square li ul{list-style:inherit}ul.square{list-style-type:square}ul.circle{list-style-type:circle}ul.disc{list-style-type:disc}ul.no-bullet,ul.simple{list-style:none}ul.inline-list::after{clear:both;content:"";display:table!important}ul.inline-list li{float:left;margin-left:15px}ul.roman-upper{list-style-type:upper-roman}ul.alpha-upper{list-style-type:upper-alpha}ul.alpha-lower{list-style-type:lower-alpha}ol{margin-left:20px}ol li ol,ol li ul{margin-left:20px;margin-bottom:0}ol li ol.alpha-upper{list-style-type:upper-alpha}.has-cb{padding-left:22px}.has-cb input[type=checkbox]{margin:0 4px 0 -21px}.has-cb.large{padding-left:39px}.has-cb.large input[type=radio]{margin:0 8px 0 -39px}hr{border:none;border-top:1px solid #ddd;margin:1.25em 0}.online-quiz ol.alpha-upper{list-style-type:upper-alpha}@font-face{font-family:ama_icons;src:url(/UI/app/fonts/ama_icons.eot?cJZuxJ);src:url(/UI/app/fonts/ama_icons.eot?cJZuxJ#iefix) format("embedded-opentype"),url(/UI/app/fonts/ama_icons.ttf?cJZuxJ) format("truetype"),url(/UI/app/fonts/ama_icons.woff?cJZuxJ) format("woff"),url(/UI/app/fonts/ama_icons.svg?cJZuxJ#ama_icons) format("svg");font-weight:400;font-style:normal}.ama-icon-minus{content:""}.ama-icon-jn_circle_logo{content:""}.ama-icon-filter{content:""}.ama-icon-image{content:""}.ama-icon-powerpoint{content:""}.ama-icon-youtube_full,.footer .you-tube:before{content:""}.ama-icon-author_interview{content:""}.ama-icon-url{content:""}.ama-icon-audio{content:""}.ama-icon-audio_cme{content:""}.ama-icon-cite_u_like_full{content:""}.ama-icon-facebook_full,.footer .facebook:before{content:""}.ama-icon-google_plus_full,.footer .google-plus:before{content:""}.ama-icon-interactive_cme{content:""}.ama-icon-linked_in_full,.footer .linked-in:before{content:""}.ama-icon-multimedia_cme{content:""}.ama-icon-pinterest_full,.footer .pinterest:before{content:""}.ama-icon-play{content:""}.ama-icon-play_cme{content:""}.ama-icon-quiz_cme{content:""}.ama-icon-rss_circle_full,.footer .rss:before{content:""}.ama-icon-twitter_full,.footer .twitter:before{content:""}.ama-icon-free,.image-box .featured-label.free:before,.widget-ArticleTopInfo .meta-access-type.free-access:before{content:""}.ama-icon-online_first,.widget-ArticleTopInfo .meta-group-type.online-first:before{content:""}.ama-icon-online_only,.widget-ArticleTopInfo .meta-group-type.online-only:before{content:""}.ama-icon-alert{content:""}.ama-icon-alerts{content:""}.ama-icon-attach{content:""}.ama-icon-calendar{content:""}.ama-icon-carrot_down,.footer-heading:before,.just-published--title:after,.self-serve .collapsible button:after,.self-serve .collapsible-list-header:after,.site-search-bar .cs-skin-border .cs-placeholder:after{content:""}.ama-icon-cart,.link-store:before,.nav-network-other .link-store:before{content:""}.ama-icon-check{content:""}.ama-icon-cite_this,.toolbar-citation:before{content:""}.ama-icon-cite_u_like{content:""}.ama-icon-close,.pg_collection #searchedTerm a.close:before{content:""}.ama-icon-cme,.image-box .featured-label.education:before,.toolbar-cme:before{content:""}.ama-icon-comments{content:""}.ama-icon-contents{content:""}.ama-icon-copyright,.toolbar-permissions:before{content:""}.ama-icon-document{content:""}.ama-icon-double_arrow,.meta-author-title:before{content:""}.ama-icon-download,.figure-table-links .download-ppt:before{content:""}.ama-icon-edit{content:""}.ama-icon-education{content:""}.ama-icon-email,.footer-email-updates .email-signup--input-wrap:before,.toolbar-email:before{content:""}.ama-icon-facebook,.facebook:before,.figure-table-links .figure-table-facebook:before,.toolbar-facebook:before{content:""}.ama-icon-figures{content:""}.ama-icon-follow{content:""}.ama-icon-full_screen,.figure-table-links .view-large:before{content:""}.ama-icon-full_text,.just-published--more-text:before,.pg_abstract .full-text-link:before,.toolbar-full-text:before,.widget-MagazineView .full-text-link:before{content:""}.ama-icon-google_plus,.google-plus:before,.toolbar-google:before{content:""}.ama-icon-grid_view{content:""}.ama-icon-info{content:""}.ama-icon-interactive{content:""}.ama-icon-jn,.footer-network .footer-network-heading:before,.image-box .cta .icon-header.jn:before,.image-box .featured-info .jn-icon:before{content:""}.ama-icon-jobs,.link-jobs:before,.nav-network-other .link-jobs:before{content:""}.ama-icon-journal_club{content:""}.ama-icon-learning,.link-jn-learning:before,.link-learning:before,.nav-network-other .link-jn-learning:before,.nav-network-other .link-learning:before{content:""}.ama-icon-left{content:""}.ama-icon-linked_in,.linked-in:before,.toolbar-linkedin:before{content:""}.ama-icon-list_view{content:""}.ama-icon-mobile,.link-mobile:before,.nav-network-other .link-apps:before,.nav-network-other .link-mobile:before{content:""}.ama-icon-multimedia{content:""}.ama-icon-open_access,.widget-ArticleTopInfo .meta-access-type.open-access:before{content:""}.ama-icon-pdf{content:""}.ama-icon-pdf_color .path1{content:"";color:#231f20}.ama-icon-pdf_color .path2{content:"";margin-left:-1em;color:#ec2227}.ama-icon-pdf_color .path3{content:"";margin-left:-1em;color:#ec2227}.ama-icon-pdf_color .path4{content:"";margin-left:-1em;color:#fff}.ama-icon-pdf_color .path5{content:"";margin-left:-1em;color:#fff}.ama-icon-pdf_color .path6{content:"";margin-left:-1em;color:#fff}.ama-icon-pinterest,.pinterest:before{content:""}.ama-icon-plus_follow{content:""}.ama-icon-podcast,.podcast:before{content:""}.ama-icon-podcast_social,.footer .podcast:before{content:""}.ama-icon-profile,.auth .auth--trigger:before,.widget-UserComment .comment-form--author .author-name:before{content:""}.ama-icon-quiz{content:""}.ama-icon-references{content:""}.ama-icon-related{content:""}.ama-icon-right{content:""}.ama-icon-rss,.issue--journal-rss:before{content:""}.ama-icon-rss_circle,.rss:before{content:""}.ama-icon-search,.header .toolbar-search-trigger:before,.pg_learningsearchresults .advanced-search-link:before,.pg_searchresults .advanced-search-link:before,.site-search .search-button:before{content:""}.ama-icon-share,.toolbar-trigger .toolbar-tool.toolbar-share:before{content:""}.ama-icon-top{content:""}.ama-icon-trash{content:""}.ama-icon-twitter,.figure-table-links .figure-table-twitter:before,.toolbar-twitter:before,.twitter:before{content:""}.ama-icon-user-comments,.toolbar-comments:before{content:""}.ama-icon-video,.auth .auth--trigger:after,.site-links-wrap .site-link.has-sub-nav span:after,.social-share .toolbar-share-more-link:after,.toolbar .toolbar-share-more-link:after,.toolbar-trigger .toolbar-share-more-link:after{content:""}.ama-icon-youtube,.you-tube:before{content:""}.ama-icon-institutions,.link-institutions-librarians:before,.nav-network-other .link-institutions-librarians:before{content:url(/UI/app/svg/institutions.svg)}.ama-icon-apps,.link-apps:before{content:url(/UI/app/svg/apps.svg)}.ama-icon-permissions,.link-reprints-permissions:before,.nav-network-other .link-reprints-permissions:before{content:url(/UI/app/svg/copyright-white.svg)}.ama-icon-save-search,.pg_learningsearchresults .save-search-link:before,.pg_searchresults .save-search-link:before{content:url(/UI/app/svg/save_search.svg)}.ama-icon-X-with-circle,.pg_learningsearchresults .clear-selected-save-search:before,.pg_searchresults .clear-selected-save-search:before{content:url(/UI/app/svg/X_with_circle.svg)}.ama-icon-save-search-learning,.pg_learningsearchresults .save-search-link-learning:before,.pg_searchresults .save-search-link-learning:before{content:url(/UI/app/svg/save_search_learning.svg)}.ama-icon-X-with-circle-learning,.pg_learningsearchresults .clear-selected-save-search-learning:before,.pg_searchresults .clear-selected-save-search-learning:before{content:url(/UI/app/svg/X_with_circle_learning.svg)}[class*=" icon-"],[class^=icon-]{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale}.icon-minus:before{content:""}.icon-learning:before{content:""}.icon-jn_circle_logo:before{content:""}.icon-filter:before{content:""}.icon-image:before{content:""}.icon-powerpoint:before{content:""}.icon-youtube_full:before{content:""}.icon-author_interview:before{content:""}.icon-url:before{content:""}.icon-audio:before{content:""}.icon-audio_cme:before{content:""}.icon-check:before{content:""}.icon-cite_u_like_full:before{content:""}.icon-facebook_full:before{content:""}.icon-google_plus_full:before{content:""}.icon-interactive_cme:before{content:""}.icon-linked_in_full:before{content:""}.icon-multimedia_cme:before{content:""}.icon-pinterest_full:before{content:""}.icon-play:before{content:""}.icon-play_cme:before{content:""}.icon-quiz_cme:before{content:""}.icon-rss_circle_full:before{content:""}.icon-twitter_full:before{content:""}.icon-free:before{content:""}.icon-online_first:before{content:""}.icon-online_only:before{content:""}.icon-alert:before{content:""}.icon-alerts:before{content:""}.icon-attach:before{content:""}.icon-calendar:before{content:""}.icon-carrot_down:before{content:""}.icon-cart:before{content:""}.icon-cite_this:before{content:""}.icon-cite_u_like:before{content:""}.icon-close:before{content:""}.icon-cme:before{content:""}.icon-comments:before{content:""}.icon-contents:before{content:""}.icon-copyright:before{content:""}.icon-document:before{content:""}.icon-double_arrow:before{content:""}.icon-download:before{content:""}.icon-edit:before{content:""}.icon-education:before{content:""}.icon-email:before{content:""}.icon-facebook:before{content:""}.icon-figures:before{content:""}.icon-follow:before{content:""}.icon-full_screen:before{content:""}.icon-full_text:before{content:""}.icon-google_plus:before{content:""}.icon-grid_view:before{content:""}.icon-grid_toggle{height:1.5rem;width:1.5rem}.icon-grid_toggle:before{content:url(/UI/app/svg/grid-toggle.svg)}.icon-info:before{content:""}.icon-interactive:before{content:""}.icon-jn:before{content:""}.icon-jobs:before{content:""}.icon-journal_club:before{content:""}.icon-left:before{content:""}.icon-linked_in:before{content:""}.icon-list_view:before{content:""}.icon-list_toggle{height:1.5rem;width:1.5rem}.icon-list_toggle:before{content:url(/UI/app/svg/list-toggle.svg)}.icon-mobile:before{content:""}.icon-multimedia:before{content:""}.icon-open_access:before{content:""}.icon-pdf:before{content:""}.icon-pdf_color .path1:before{content:"";color:#231f20}.icon-pdf_color .path2:before{content:"";margin-left:-1em;color:#ec2227}.icon-pdf_color .path3:before{content:"";margin-left:-1em;color:#ec2227}.icon-pdf_color .path4:before{content:"";margin-left:-1em;color:#fff}.icon-pdf_color .path5:before{content:"";margin-left:-1em;color:#fff}.icon-pdf_color .path6:before{content:"";margin-left:-1em;color:#fff}.icon-pinterest:before{content:""}.icon-plus_follow:before{content:""}.icon-podcast:before{content:""}.icon-podcast_social:before{content:""}.icon-profile:before{content:""}.icon-quiz:before{content:""}.icon-references:before{content:""}.icon-related:before{content:""}.icon-right:before{content:""}.icon-rss:before{content:""}.icon-rss_circle:before{content:""}.icon-search:before{content:""}.icon-share:before{content:""}.icon-top:before{content:""}.icon-trash:before{content:""}.icon-twitter:before{content:""}.icon-video:before{content:""}.icon-youtube:before{content:""}.icon-institutions:before{content:url(/UI/app/svg/institutions.svg)}.icon-apps:before{content:url(/UI/app/svg/apps.svg)}.icon-permissions:before{content:url(/UI/app/svg/copyright-white.svg)}.icon-save-search:before{content:url(/UI/app/svg/save_search.svg)}.icon-X-with-circle:before{content:url(/UI/app/svg/X_with_circle.svg)}.icon-save-search-learning:before{content:url(/UI/app/svg/save_search_learning.svg)}.icon-X-with-circle-learning:before{content:url(/UI/app/svg/X_with_circle_learning.svg)}.icon-user-comments:before{content:""}.icon-check:before{content:""}.content-comment-link:before{font-family:ama_icons;font-size:32px;content:"";vertical-align:middle;margin-right:6px;color:#000}.content-comment-link:hover{text-decoration:none}.content-comment-link:hover span{text-decoration:underline}.is-a:after,.is-b:before{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale}.pdf-icon{height:38px;width:38px;display:block;background:url(/UI/app/svg/pdf_color.svg);background-repeat:no-repeat;background-size:contain;-webkit-print-color-adjust:exact}.pdf-icon.large{height:50px;width:50px}#learning-pdf{float:left;padding-right:10px;margin-top:5px}.self-serve .mp--player-link [class^=icon-]:before{font-size:1em}body,html{padding:0;margin:0;overflow-x:hidden}@media (max-width:1023px){body.nav-active,html.nav-active{height:100%;overflow:hidden}}body .accessible,html .accessible{position:absolute;left:-10000px;top:auto;width:1px;height:1px;overflow:hidden}body .accessible:focus,html .accessible:focus{position:static;width:auto;height:auto}@media all and (max-width:500px){body .visuallyhidden,html .visuallyhidden{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}}html.page-article{overflow-x:visible}@-webkit-keyframes fadeIn{0%{opacity:0}50%{opacity:0}100%{opacity:1}}@keyframes fadeIn{0%{opacity:0}50%{opacity:0}100%{opacity:1}}.cssanimations body{-webkit-animation:fadeIn .6s ease-in-out;animation:fadeIn .6s ease-in-out}input{font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif;padding:0 15px;font-size:1em;border:none}input::-webkit-input-placeholder{color:#777}input::-moz-placeholder{color:#777}input:-moz-placeholder{color:#777}input:-ms-input-placeholder{color:#777}button:focus,input:focus,select:focus,textarea:focus{outline:0}.master-main{padding-bottom:100px;line-height:1.6}.master-main::after{clear:both;content:"";display:table!important}.pg_abstract .master-main,.pg_article .master-main,.pg_index .master-main,.pg_journal .master-main,.pg_multimediaplayer .master-main{padding-bottom:0}.content{padding-top:15px;padding-bottom:15px;max-width:1300px;margin-left:auto;margin-right:auto}.content::after{clear:both;content:"";display:table!important}@media (max-width:1350px){.content{padding:15px}}@media (max-width:767px){.content{padding:15px 12px}}@media (max-width:480px){.content{padding:15px 6px}}.sans{font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif}.serif{font-family:"Guardian Egyptian",Georgia,Cambria,"Times New Roman",Times,serif}.center-block{margin-left:auto;margin-right:auto}.cur-p:hover{cursor:pointer!important}.text-normal{font-size:1rem!important}.text-small{font-size:14px!important}.text-extra-small{font-size:12px!important}.text-xxs{font-size:10px!important}.fs-n{font-style:normal!important}.large-icon{font-size:2.25rem;margin-right:10px}.ov-h{overflow:hidden!important}.cf::after{clear:both;content:"";display:table!important}.cb{clear:both!important}.fw-n{font-weight:400!important}.fw-5{font-weight:500!important}.fw-b{font-weight:700!important}.stroke{padding-bottom:.5em;border-bottom:1px solid #ddd}.bd-stroke{border:1px solid #ddd}.bdt-none{border-top:none}.bd-none{border:none!important}.right{float:right!important}.left{float:left!important}@media (max-width:767px){.fl-n-m{float:none!important}}.fl-n{float:none!important}.no-mw{min-width:0!important}.va-m{vertical-align:middle!important}@media (max-width:767px){.va-m-m{vertical-align:middle}}.t-c,.ta-c{text-align:center!important}.ta-r{text-align:right!important}.ta-l{text-align:left!important}.d-ib{display:inline-block!important}@media (max-width:767px){.d-ib-m{display:inline-block}}.d-b{display:block!important}@media (max-width:767px){.d-b-m{display:block!important}}.d-i{display:inline!important}.tt-u{text-transform:uppercase!important}.mw-100{max-width:100%!important}.mw-row-small{max-width:1000px;margin-left:auto;margin-right:auto}.m-auto{margin-left:auto!important;margin-right:auto!important}@media (max-width:767px){.w-auto-m{width:auto!important}}.m0{margin:0!important}.mt0{margin-top:0!important}.mt05{margin-top:.5rem!important}.mt1{margin-top:1rem!important}.mt2{margin-top:1.5rem!important}.mt3{margin-top:3rem!important}.mt10{margin-top:10rem!important}.mt-75{margin-top:-.75rem!important}.mb0{margin-bottom:0!important}.mb05{margin-bottom:.5rem!important}.mb1{margin-bottom:1rem!important}.mb2{margin-bottom:2rem!important}.ml0{margin-left:0!important}.ml05{margin-left:.5rem!important}.ml1{margin-left:1rem!important}.ml2{margin-left:2em}.ml3{margin-left:3em}.ml4{margin-left:4em}.mr0{margin-right:0!important}.mr05{margin-right:.5rem!important}.mr1{margin-right:1rem!important}.mr3{margin-right:3em}.p0{padding:0!important}@media (max-width:767px){.p0-m{padding:0!important}}.p05{padding:.5rem!important}.p025{padding:.25rem!important}.p1{padding:1rem!important}.p2{padding:1.5rem!important}.pl1{padding-left:1rem}.pr1{padding-right:1rem}.pt0{padding-top:0!important}.pt1{padding-top:1rem!important}@media (max-width:1023px){.pt1-td{padding-top:1rem!important}}.pb0{padding-bottom:0!important}.pb1{padding-bottom:1rem!important}.no-wrap{white-space:nowrap}.pl0{padding-left:0!important}@media (max-width:767px){.pl0-m{padding-left:0!important}}@media (max-width:1023px){.pl10-t{padding-left:10px!important}}.static{position:static}.relative{position:relative}.absolute{position:absolute}.fixed{position:fixed}.sugar-cookie{background:#edede3!important}.lh1{line-height:1}.lh-text{line-height:1.6!important}.black{color:#000!important}.white{color:#fff!important}.green{color:green!important}.red{color:red!important}.bgc-white{background-color:#fff}.gray{color:#888}.bg-transparent{background:0 0!important}.bg-box{background:#f4f4f4}.bg-white{background:#fff}.radius{border-radius:5px!important}.nudge-up{top:-2px}.nudge-down{top:2px}.clip-last-child>:last-child{margin-bottom:0}.pipe-before{position:relative}.pipe-before:before{content:"|";display:inline-block;margin:0 6px}.reg-trade{display:inline-block;font-size:16px;position:relative;top:0}.list-spacing{line-height:1.35;margin-bottom:15px;display:block}.question-mark{display:inline-block;height:25px;width:25px;line-height:23px;text-align:center;vertical-align:middle;margin-right:5px;border-radius:50%;font-weight:400;border:1px solid #333}.td-n{text-decoration:none!important}.td-n:hover{text-decoration:none!important}.td-u{text-decoration:underline}body .btn,body .btn-alt{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700}body .btn-alt:hover,body .btn:hover{cursor:pointer;text-decoration:none;background:#fff}body .btn-alt.gap,body .btn.gap{margin-bottom:.75em}body .btn-alt.disabled,body .btn.disabled{background:#999!important;border-color:#999!important;color:#fff!important;cursor:default!important;pointer-events:none}body .btn-alt.full,body .btn.full{width:100%;max-width:420px}body .btn-interests{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700;background:#ccc;border-color:#ccc;color:#000;text-align:left;width:120%;height:57px;line-height:50px;margin-left:-25px;margin-bottom:-15px;padding-left:25px;vertical-align:middle}body .btn-interests:hover{cursor:pointer;text-decoration:none;background:#fff}body .btn-interests.gap{margin-bottom:.75em}body .btn-interests.disabled{background:#999!important;border-color:#999!important;color:#fff!important;cursor:default!important;pointer-events:none}body .btn-interests.selected,body .btn-interests:hover{background:#999;color:#000;border-color:#999}body .btn-interests.full{width:100%;max-width:420px}body .btn-small{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:2px 10px;font-weight:500}body .btn-small:hover{cursor:pointer;text-decoration:none;background:#fff}body .btn--wide{padding:4px 22px;font-size:15px}body .btn-alt{background:#fff}body .btn-alt:hover{color:#fff}body .btn--jama.btn--jama{background:#d71635;border-color:#d71635}body .btn--jama.btn--jama.selected,body .btn--jama.btn--jama:hover{background:#fff;color:#d71635;border-color:#d71635}body .btn--jama-sec.btn--jama-sec{background:#981b1e;border-color:#981b1e}body .btn--jama-sec.btn--jama-sec.selected,body .btn--jama-sec.btn--jama-sec:hover{background:#fff;color:#981b1e;border-color:#981b1e}.branded-bar{height:4px;position:relative;z-index:2}.branded-bar:after{position:absolute;height:100%;right:0;width:40%;z-index:1;content:""}.branded-bar.tall{height:8px}.themed-border{position:relative}.themed-border:before{content:"";position:absolute;top:-10px;left:0;width:60%;height:10px}.no-data-message{padding:1em 0}.themed-hed{padding:5px 0;position:relative;margin-top:10px}.themed-hed:before{content:"";width:100px;height:8px;position:absolute;bottom:100%}@media (min-width:768px){.two-column-list{-webkit-columns:2;columns:2;-webkit-column-width:50%;column-width:50%;-webkit-column-fill:balance;column-fill:balance;-webkit-column-gap:40px;column-gap:40px;-webkit-column-break-inside:avoid;break-inside:avoid-column}}.two-column-list li{-webkit-column-break-inside:avoid;break-inside:avoid-column;font-size:.95em;line-height:1.3;margin-bottom:6px}.hide{display:none}@media (max-width:767px){.hide-small{display:none}}@media (min-width:479px){.tiny-only{display:none}}@media (max-width:480px){.tiny-up{display:none}}@media (min-width:768px){.small-only{display:none!important}}@media (max-width:767px){.tablet-up{display:none!important}}@media (min-width:1024px){.tablet-down{display:none!important}}@media (max-width:1023px){.desktop-only{display:none!important}}.flex{display:-webkit-box;display:-webkit-flex;display:flex}.flex-auto{-webkit-box-flex:1;-webkit-flex:1 1 auto;flex:1 1 auto;min-width:0;min-height:0}.flex-none{-webkit-box-flex:0;-webkit-flex:none;flex:none}.flex-column{-webkit-box-orient:vertical;-webkit-box-direction:normal;-webkit-flex-direction:column;flex-direction:column}.flex-wrap{-webkit-flex-wrap:wrap;flex-wrap:wrap}.items-start{-webkit-box-align:start;-webkit-align-items:flex-start;align-items:flex-start}.items-end{-webkit-box-align:end;-webkit-align-items:flex-end;align-items:flex-end}.items-center{-webkit-box-align:center;-webkit-align-items:center;align-items:center}.items-baseline{-webkit-box-align:baseline;-webkit-align-items:baseline;align-items:baseline}.items-stretch{-webkit-box-align:stretch;-webkit-align-items:stretch;align-items:stretch}.self-start{-webkit-align-self:flex-start;align-self:flex-start}.self-end{-webkit-align-self:flex-end;align-self:flex-end}.self-center{-webkit-align-self:center;-ms-grid-row-align:center;align-self:center}.self-baseline{-webkit-align-self:baseline;align-self:baseline}.self-stretch{-webkit-align-self:stretch;-ms-grid-row-align:stretch;align-self:stretch}.justify-start{-webkit-box-pack:start;-webkit-justify-content:flex-start;justify-content:flex-start}.justify-end{-webkit-box-pack:end;-webkit-justify-content:flex-end;justify-content:flex-end}.justify-center{-webkit-box-pack:center;-webkit-justify-content:center;justify-content:center}.justify-between{-webkit-box-pack:justify;-webkit-justify-content:space-between;justify-content:space-between}.justify-around{-webkit-justify-content:space-around;justify-content:space-around}.content-start{-webkit-align-content:flex-start;align-content:flex-start}.content-end{-webkit-align-content:flex-end;align-content:flex-end}.content-center{-webkit-align-content:center;align-content:center}.content-between{-webkit-align-content:space-between;align-content:space-between}.content-around{-webkit-align-content:space-around;align-content:space-around}.content-stretch{-webkit-align-content:stretch;align-content:stretch}.order-0{-webkit-box-ordinal-group:1;-webkit-order:0;order:0}.order-1{-webkit-box-ordinal-group:2;-webkit-order:1;order:1}.order-2{-webkit-box-ordinal-group:3;-webkit-order:2;order:2}.order-3{-webkit-box-ordinal-group:4;-webkit-order:3;order:3}.order-4{-webkit-box-ordinal-group:5;-webkit-order:4;order:4}.order-5{-webkit-box-ordinal-group:6;-webkit-order:5;order:5}.order-last{-webkit-box-ordinal-group:100000;-webkit-order:99999;order:99999}.pg_journal .leader-ad .advertisement{margin-bottom:0}.leader-ad{margin-top:0;margin-bottom:1em}.advertisement{text-align:center;margin:0 auto 4em;display:block;position:relative;z-index:1}.resource-tab .advertisement{margin-top:4em}.sidebar .advertisement{margin-top:2em}.footer-ad .advertisement,.leader-ad .advertisement{margin-bottom:1.5em}.issue-view-tab--sidebar .advertisement{margin-bottom:2.75em}.suppress-ads .advertisement{display:none!important}.advertisement.ad-dual-box-mobile{margin:2em auto}@media (max-width:767px){.advertisement.ad-article-contents-sky{display:none}}@-webkit-keyframes rise-up{0%{bottom:-250px}25%{bottom:0}75%{bottom:0}100%{bottom:-250px}}@keyframes rise-up{0%{bottom:-250px}25%{bottom:0}75%{bottom:0}100%{bottom:-250px}}.ad-riser-wrap{display:none;opacity:0;transition:all .25s ease-out}.ad-riser-wrap.ad-loaded{opacity:1}.ad-riser-wrap.closed{opacity:0}.split-screen .ad-riser-wrap{display:block;-webkit-animation-name:rise-up;animation-name:rise-up;-webkit-animation-duration:8s;animation-duration:8s;-webkit-animation-iteration-count:1;animation-iteration-count:1;-webkit-animation-timing-function:ease-in-out;animation-timing-function:ease-in-out;-webkit-animation-delay:4s;animation-delay:4s;position:absolute;bottom:-250px;left:50%;z-index:1000;-webkit-transform:translateX(-50%);transform:translateX(-50%)}.split-screen .ad-riser-wrap .ad-riser--dismiss{width:24px;height:24px;line-height:24px;font-weight:700;background:#000;color:#fff;position:absolute;top:-10px;right:-10px;z-index:1000;border-radius:50%}.split-screen .ad-riser-wrap .ad-riser--dismiss:hover{cursor:pointer}.ad-text{line-height:1.2}.ad-text:before{content:"Advertisement";font-size:12px;text-align:center;color:#555;display:block}.ad-text.vert:before{position:absolute;left:-46px;top:38px;-webkit-transform:rotate(-90deg);transform:rotate(-90deg)}.ad-text.vert.ad-riser:before{background:#fff;left:-53px;top:37px;padding:1px 0;width:90px}.header-ad-wrap{width:100%;max-height:130px}.pg_index .leader-ad,.pg_journal .leader-ad{padding:19.5px 0 21px 0;margin:0 auto}.pg_journal .header-ad-wrap .ad-text:before,[data-thm=umb] .header-ad-wrap .ad-text:before{color:#fff}.footer-ad,.leader-ad{width:732px;text-align:center;margin:1.5em auto;min-height:90px}.suppress-ads .footer-ad,.suppress-ads .leader-ad{display:none!important}.footer-ad img,.leader-ad img{max-width:100%;height:auto}.pg_collection .leader-ad{display:none}.pg_learningsearchresults .leader-ad{display:none}.pg_learningsearchresults .footer-ad{display:none}.footer-ad .ad-anchorboard{z-index:7}.box-section{padding:1em;margin-bottom:1.25em}.box-content{padding:1em;background:#f4f4f4;margin-bottom:1.25em}[data-tab]{display:none}@media speech{[class*=" icon-"]:before,[class^=icon-]:before{display:none}}.icon-carrot_down.rotated{-webkit-transform:rotate(-90deg);transform:rotate(-90deg);transition:all .15s ease-in-out}.target-active .icon-carrot_down.rotated{-webkit-transform:rotate(0);transform:rotate(0)}.jumbotron-bg{background-image:url(/UI/app/img/Jumbo_BG.jpg);width:100%;height:300px}.widget-GdprCookieBanner{position:fixed;bottom:0;left:0;right:0;z-index:6}.widget-GdprCookieBanner .gdpr-cookie-wrapper{margin:0 auto;padding:12px 18px;line-height:1.5;box-shadow:0 3px 6px 0 rgba(0,0,0,.35);background-color:#f8f8f8;border:solid 1px #dadbdb;position:relative}@media all and (min-width:600px){.widget-GdprCookieBanner .gdpr-cookie-wrapper{max-width:85%}}@media all and (min-width:900px){.widget-GdprCookieBanner .gdpr-cookie-wrapper{max-width:647px;display:-webkit-box;display:-webkit-flex;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;justify-content:space-between}}.widget-GdprCookieBanner .gdpr-cookie-body,.widget-GdprCookieBanner .gdpr-cookie-links_wrap{font-size:14px;line-height:18px}.widget-GdprCookieBanner .gdpr-cookie-body a,.widget-GdprCookieBanner .gdpr-cookie-links_wrap a{text-decoration:underline;color:#4688f1}.widget-GdprCookieBanner .gdpr-cookie-body .js-gdpr-cookie-acceptLink,.widget-GdprCookieBanner .gdpr-cookie-links_wrap .js-gdpr-cookie-acceptLink{font-weight:700}.widget-GdprCookieBanner .gdpr-cookie-body .js-gdpr-cookie-close,.widget-GdprCookieBanner .gdpr-cookie-links_wrap .js-gdpr-cookie-close{position:absolute;right:1rem;top:1rem;color:#000}#ad-interstitial{display:none}.make-red{color:#981b1e!important}input{width:100%}select{width:100%}input[type=submit]{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700;width:auto}input[type=submit]:hover{cursor:pointer;text-decoration:none;background:#fff}input[type=button],input[type=checkbox],input[type=radio]{width:auto}@font-face{font-family:"Guardian TextSans Web";src:url(/UI/app/fonts/GuardianTextSans-Regular-Web.eot);src:url(/UI/app/fonts/GuardianTextSans-Regular-Web.eot?#iefix) format("embedded-opentype"),url(/UI/app/fonts/GuardianTextSans-Regular-Web.woff) format("woff"),url(/UI/app/fonts/GuardianTextSans-Regular-Web.ttf) format("truetype"),url("/UI/app/fonts/GuardianTextSans-Regular-Web.svg#Guardian TextSans Web") format("svg");font-weight:400;font-style:normal;font-stretch:normal}.GuardianTextSans-Regular-Web{font-family:"Guardian TextSans Web";font-weight:400;font-style:normal;font-stretch:normal}@font-face{font-family:"Guardian TextSans Web";src:url(/UI/app/fonts/GuardianTextSans-RegularIt-Web.eot);src:url(/UI/app/fonts/GuardianTextSans-RegularIt-Web.eot?#iefix) format("embedded-opentype"),url(/UI/app/fonts/GuardianTextSans-RegularIt-Web.woff) format("woff"),url(/UI/app/fonts/GuardianTextSans-RegularIt-Web.ttf) format("truetype"),url("/UI/app/fonts/GuardianTextSans-RegularIt-Web.svg#Guardian TextSans Web") format("svg");font-weight:400;font-style:italic;font-stretch:normal}.GuardianTextSans-RegularIt-Web{font-family:"Guardian TextSans Web";font-weight:400;font-style:italic;font-stretch:normal}@font-face{font-family:"Guardian TextSans Web";src:url(/UI/app/fonts/GuardianTextSans-Medium-Web.eot);src:url(/UI/app/fonts/GuardianTextSans-Medium-Web.eot?#iefix) format("embedded-opentype"),url(/UI/app/fonts/GuardianTextSans-Medium-Web.woff) format("woff"),url(/UI/app/fonts/GuardianTextSans-Medium-Web.ttf) format("truetype"),url("/UI/app/fonts/GuardianTextSans-Medium-Web.svg#Guardian TextSans Web") format("svg");font-weight:500;font-style:normal;font-stretch:normal}.GuardianTextSans-Medium-Web{font-family:"Guardian TextSans Web";font-weight:500;font-style:normal;font-stretch:normal}@font-face{font-family:"Guardian TextSans Web";src:url(/UI/app/fonts/GuardianTextSans-MediumIt-Web.eot);src:url(/UI/app/fonts/GuardianTextSans-MediumIt-Web.eot?#iefix) format("embedded-opentype"),url(/UI/app/fonts/GuardianTextSans-MediumIt-Web.woff) format("woff"),url(/UI/app/fonts/GuardianTextSans-MediumIt-Web.ttf) format("truetype"),url("/UI/app/fonts/GuardianTextSans-MediumIt-Web.svg#Guardian TextSans Web") format("svg");font-weight:500;font-style:italic;font-stretch:normal}.GuardianTextSans-MediumIt-Web{font-family:"Guardian TextSans Web";font-weight:500;font-style:italic;font-stretch:normal}@font-face{font-family:"Guardian TextSans Web";src:url(/UI/app/fonts/GuardianTextSans-Bold-Web.eot);src:url(/UI/app/fonts/GuardianTextSans-Bold-Web.eot?#iefix) format("embedded-opentype"),url(/UI/app/fonts/GuardianTextSans-Bold-Web.woff) format("woff"),url(/UI/app/fonts/GuardianTextSans-Bold-Web.ttf) format("truetype"),url("/UI/app/fonts/GuardianTextSans-Bold-Web.svg#Guardian TextSans Web") format("svg");font-weight:700;font-style:normal;font-stretch:normal}.GuardianTextSans-Bold-Web{font-family:"Guardian TextSans Web";font-weight:700;font-style:normal;font-stretch:normal}@font-face{font-family:"Guardian TextSans Web";src:url(/UI/app/fonts/GuardianTextSans-BoldIt-Web.eot);src:url(/UI/app/fonts/GuardianTextSans-BoldIt-Web.eot?#iefix) format("embedded-opentype"),url(/UI/app/fonts/GuardianTextSans-BoldIt-Web.woff) format("woff"),url(/UI/app/fonts/GuardianTextSans-BoldIt-Web.ttf) format("truetype"),url("/UI/app/fonts/GuardianTextSans-BoldIt-Web.svg#Guardian TextSans Web") format("svg");font-weight:700;font-style:italic;font-stretch:normal}.GuardianTextSans-BoldIt-Web{font-family:"Guardian TextSans Web";font-weight:700;font-style:italic;font-stretch:normal}.cs-select{display:inline-block;vertical-align:middle;position:relative;text-align:left;background:#fff;z-index:100;width:100%;max-width:500px;-webkit-touch-callout:none;-webkit-user-select:none;-moz-user-select:none;-ms-user-select:none;user-select:none}.cs-select.cs-active{z-index:200}.cs-select:focus{outline:0}.cs-select select{display:none}.cs-select span{display:block;position:relative;cursor:pointer;padding:1em;white-space:nowrap;overflow:hidden;text-overflow:ellipsis}.cs-select .cs-options{position:absolute;overflow:hidden;width:100%;background:#fff;visibility:hidden}.cs-select.cs-active .cs-options{visibility:visible}.cs-select ul{list-style:none;margin:0;padding:0;width:100%}.cs-select ul span{padding:1em}.cs-select ul li.cs-focus span{background-color:#ddd}.cs-select ul li.cs-optgroup ul{padding-left:1em}.cs-select ul li.cs-optgroup>span{cursor:default}.cs-select .cs-placeholder:after{content:'\25BE';right:1em}.cs-select .cs-selected span::after,.cs-select>span::after{speak:none;position:absolute;top:50%;-webkit-transform:translateY(-50%);transform:translateY(-50%);-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale}.header-wrap{background:#333;min-height:30px;position:fixed;width:100%;z-index:1000}.auth--dropdown-active .header-wrap{z-index:2010}.header{position:static;text-align:center}.header::after{clear:both;content:"";display:table!important}@media (min-width:768px){.header{height:92px}}.z2010{z-index:2010!important}.collection--header-bd{margin-top:2em;border-top:3px solid #e5e5e5}.network-bar{padding:10px 12px;background:#262626;height:36px;overflow:hidden}.network-bar::after{clear:both;content:"";display:table!important}@media (max-width:767px){.network-bar{padding:12px 8px;font-size:14px}}.network-bar .jama-network{float:left;height:14px}.network-bar .jama-network:hover{color:#fff}.network-bar .title-image{height:14px}.network-bar .auth--inst{float:right;color:gray;font-size:14px}@media (max-width:767px){.network-bar .auth--inst{font-size:13px}}@media (max-width:767px){.network-bar .auth--provided-by{display:none}}[data-thm=umb] .nav-toggler{width:182px}@media (max-width:767px){[data-thm=umb] .nav-toggler{width:150px}}[data-thm=learn] .nav-toggler{width:182px}@media (max-width:767px){[data-thm=learn] .nav-toggler{width:150px}}[data-thm=jama] .nav-toggler{width:126px}@media (max-width:767px){[data-thm=jama] .nav-toggler{width:97px}}[data-thm=cardi] .nav-toggler{width:198px}@media (max-width:767px){[data-thm=cardi] .nav-toggler{width:164px}}[data-thm=derm] .nav-toggler{width:214px}@media (max-width:767px){[data-thm=derm] .nav-toggler{width:180px}}[data-thm=faci] .nav-toggler{width:282px}@media (max-width:767px){[data-thm=faci] .nav-toggler{width:150px}}[data-thm=intem] .nav-toggler{width:245px}@media (max-width:767px){[data-thm=intem] .nav-toggler{width:208px}}[data-thm=neur] .nav-toggler{width:196px}@media (max-width:767px){[data-thm=neur] .nav-toggler{width:162px}}[data-thm=oncol] .nav-toggler{width:190px}@media (max-width:767px){[data-thm=oncol] .nav-toggler{width:156px}}[data-thm=ophth] .nav-toggler{width:232px}@media (max-width:767px){[data-thm=ophth] .nav-toggler{width:196px}}[data-thm=otol] .nav-toggler{width:252px}@media (max-width:767px){[data-thm=otol] .nav-toggler{width:210px}}@media (max-width:767px){[data-thm=otol] .nav-toggler-indicator{left:4px}}@media (max-width:767px){[data-thm=otol] .nav-toggler-site{left:35px;max-width:calc(100% - 35px)}}[data-thm=peds] .nav-toggler{width:192px}@media (max-width:767px){[data-thm=peds] .nav-toggler{width:158px}}[data-thm=psych] .nav-toggler{width:194px}@media (max-width:767px){[data-thm=psych] .nav-toggler{width:160px}}[data-thm=surg] .nav-toggler{width:176px}@media (max-width:767px){[data-thm=surg] .nav-toggler{width:142px}}[data-thm=neurp] .nav-toggler{width:234px}@media (max-width:767px){[data-thm=neurp] .nav-toggler{width:194px}}[data-thm=jaman] .nav-toggler{width:234px}@media (max-width:767px){[data-thm=jaman] .nav-toggler{width:194px}}.nav-toggler{float:left;padding:0 10px;background:#000;height:56px;width:300px;position:relative;text-align:left}@media (max-width:1023px){.nav-toggler{width:275px}}@media (max-width:767px){.nav-toggler{width:300px;height:50px;margin-right:0}}@media (max-width:480px){.nav-toggler{width:208px;padding:0 4px 0 8px}}.nav-toggler-indicator{width:35px;height:35px;position:absolute;left:12px;top:18px;-webkit-transform:rotate(0);transform:rotate(0);transition:.5s ease-in-out;cursor:pointer}@media (max-width:767px){.nav-toggler-indicator{top:15px;left:6px;height:26px;width:26px}}.nav-toggler-indicator .indicator-stroke{display:block;position:absolute;height:2px;width:100%;background:#fff;border-radius:9px;opacity:1;left:0;-webkit-transform:rotate(0);transform:rotate(0);transition:.25s ease-in-out}.nav-toggler-indicator .indicator-stroke:nth-child(1){top:0}.nav-toggler-indicator .indicator-stroke:nth-child(2),.nav-toggler-indicator .indicator-stroke:nth-child(3){top:10px}@media (max-width:767px){.nav-toggler-indicator .indicator-stroke:nth-child(2),.nav-toggler-indicator .indicator-stroke:nth-child(3){top:9px}}.nav-toggler-indicator .indicator-stroke:nth-child(4){top:20px}@media (max-width:767px){.nav-toggler-indicator .indicator-stroke:nth-child(4){top:18px}}.nav-toggler.target-active .indicator-stroke:nth-child(1){top:10px;width:0%;left:50%}@media (max-width:767px){.nav-toggler.target-active .indicator-stroke:nth-child(1){top:9px}}.nav-toggler.target-active .indicator-stroke:nth-child(2){-webkit-transform:rotate(45deg);transform:rotate(45deg)}.nav-toggler.target-active .indicator-stroke:nth-child(3){-webkit-transform:rotate(-45deg);transform:rotate(-45deg)}.nav-toggler.target-active .indicator-stroke:nth-child(4){top:10px;width:0%;left:50%}@media (max-width:767px){.nav-toggler.target-active .indicator-stroke:nth-child(4){top:9px}}.nav-toggler-site{display:block;color:#fff;position:absolute;max-width:calc(100% - 50px);padding:0 6px 0 10px;left:50px;width:100%;line-height:1.3;top:50%;z-index:1;-webkit-transform:translateY(-50%);transform:translateY(-50%)}@media (max-width:767px){.nav-toggler-site{padding:0;max-width:calc(100% - 39px);left:39px}}.nav-toggler .network{font-weight:700}[data-thm=jama] .nav-toggler .network{position:relative}[data-thm=jama] .nav-toggler .network:after{content:"\00AE";font-size:50%;vertical-align:top}.site-search{margin:10px 0;width:64.28571%;max-width:1000px;display:inline-block}.site-search::after{clear:both;content:"";display:table!important}@media (max-width:1425px){.site-search{max-width:880px}}@media (max-width:1375px){.site-search{max-width:830px}}@media (max-width:1325px){.site-search{max-width:780px}}@media (max-width:1275px){.site-search{max-width:730px}}@media (max-width:1225px){.site-search{max-width:680px}}@media (max-width:1175px){.site-search{max-width:630px}}@media (max-width:1125px){.site-search{max-width:580px}}@media (max-width:1075px){.site-search{max-width:530px}}@media (max-width:1018px){.site-search{max-width:580px}}@media (max-width:968px){.site-search{max-width:530px}}@media (max-width:918px){.site-search{max-width:480px}}@media (max-width:868px){.site-search{max-width:430px}}@media (max-width:818px){.site-search{max-width:380px}}@media (max-width:767px){.site-search{display:none;width:100%;clear:both;max-width:none;margin:0;padding:10px}}@media (max-width:480px){.site-search{padding:10px 0}}@media (min-width:1024px){.site-search.other-tools-shown{width:385px;float:right}}@media (min-width:1300px){.site-search.other-tools-shown{width:580px}}@media (min-width:1024px){.site-search.other-tools-shown .search-term{width:260px}}@media (min-width:1300px){.site-search.other-tools-shown .search-term{width:430px}}@media (min-width:1024px){.site-search.other-tools-shown .site-search-bar{width:385px;float:right}}@media (min-width:1300px){.site-search.other-tools-shown .site-search-bar{width:560px}}.site-search .search-button{border-radius:0 5px 5px 0;display:block;width:50px;height:35px;background:#000;float:left;text-align:center}@media (max-width:480px){.site-search .search-button{width:40px}}.site-search .search-button:before{color:#fff;font-size:1.5em;position:relative;top:5px}.site-search .search-input-container{background:#fff;position:relative}.site-search .search-input,.site-search .search-input-container,.site-search .search-term,.site-search .searchTerm{box-sizing:border-box;width:calc(100% - 270px - 50px);height:35px;margin:0;float:left;border:none}@media (min-width:768px) and (max-width:1023px){.site-search .search-input,.site-search .search-input-container,.site-search .search-term,.site-search .searchTerm{width:calc(100% - 120px - 50px)}}@media (max-width:480px){.site-search .search-input,.site-search .search-input-container,.site-search .search-term,.site-search .searchTerm{width:calc(100% - 120px - 40px)}}.site-search .search-term,.site-search .searchTerm{width:100%;background:0 0;height:35px;line-height:1;padding-bottom:0!important;padding-top:0!important}.site-search .searchTerm{z-index:1}.site-search .search-term{z-index:2}.site-search #umbrellaSiteSearchInputHint{color:silver;border-color:transparent;margin-top:-35px;z-index:1}.site-search .term-list{position:absolute;top:34px;width:100%!important;list-style:none inside;margin:0 0 2em 0;padding:0 0 0;text-align:left;color:#777;background:#fff;font-weight:400;border:1px solid #eee;border-top:none}.site-search .term-list li{border-top:none;float:none!important}.site-search .term-list li a{float:none!important;z-index:9999;display:block;color:#333}.site-search .term-list a{padding:.5em 10px;display:-webkit-inline-box}.site-search .term-list a.active,.site-search .term-list a:hover{background:#f2f2f2}.site-search .term-list strong{color:#444;font-weight:700}.site-search .term-list--hidden,.site-search .term-list--hidden a{display:none}.site-search-bar::after{clear:both;content:"";display:table!important}.search-input-container::after{clear:both;content:"";display:table!important}.search-input-container .search-term{position:absolute;background:0 0}.search-input-container .searchTerm{position:absolute;top:35px;left:0}.searchTerm ul{float:none!important;width:94%}.site-search-bar .cs-skin-border{background:0 0;font-weight:400;max-width:600px;width:270px;float:left;position:relative;height:35px}@media (max-width:767px){.site-search-bar .cs-skin-border{font-size:1em}}@media (min-width:768px) and (max-width:1023px){.site-search-bar .cs-skin-border{width:120px}}@media (max-width:480px){.site-search-bar .cs-skin-border{width:120px}}.site-search-bar .cs-skin-border .cs-placeholder{background:#edede3;padding:0 40px 0 12px;line-height:35px;border-radius:5px 0 0 5px;transition:all .1s linear;font-weight:500;color:#000}@media (min-width:768px) and (max-width:1023px){.site-search-bar .cs-skin-border .cs-placeholder{padding:0 25px 0 12px}}@media (max-width:480px){.site-search-bar .cs-skin-border .cs-placeholder{padding:0 20px 0 8px}}@media (min-width:768px) and (max-width:1023px){.site-search-bar .cs-skin-border .cs-placeholder:after{right:.5em}}@media (max-width:480px){.site-search-bar .cs-skin-border .cs-placeholder:after{right:.4em}}.site-search-bar .cs-skin-border>span{background:#edede3;transition:background .2s,border-color .2s;height:100%}.site-search-bar .cs-skin-border ul li:last-child span{border-radius:0 0 5px 5px}.site-search-bar .cs-skin-border ul span{padding:.5em .75em;-webkit-backface-visibility:hidden;backface-visibility:hidden;color:#000;font-size:1em;transition:all .1s linear}.site-search-bar .cs-skin-border ul span:after{content:'';opacity:0}.site-search-bar .cs-skin-border li.cs-focus span{background:#edede3}.site-search-bar .cs-skin-border .cs-options{opacity:0;transition:opacity .2s,visibility 0s .2s;min-width:262px;background:#edede3}@media (max-width:767px){.site-search-bar .cs-skin-border .cs-options{min-width:230px}}.site-search-bar .cs-skin-border .cs-options li span:hover{background:#ddddca}.site-search-bar .cs-skin-border.cs-active>span{background:#edede3;color:#000}.site-search-bar .cs-skin-border.cs-active .cs-options{opacity:1;transition:opacity .2s;border-radius:0 0 5px 5px}.site-search-bar .cs-skin-border.cs-active .cs-placeholder{border-radius:5px 0 0 0}.header .toolbar-search-trigger{display:none;margin:0;padding:15px 10px;float:right;border-left:1px solid #000;color:#fff}@media (max-width:767px){.header .toolbar-search-trigger{display:inline-block;padding:12px 10px}}.header .toolbar-search-trigger:hover{color:#fff}.header .toolbar-search-trigger:before{font-size:26px}.nav{z-index:-1;position:fixed;background:#000;width:300px;height:auto;top:92px;opacity:0;-webkit-overflow-scrolling:touch;-webkit-transform:translateX(-100%);transform:translateX(-100%);transition:all .25s ease-in-out}@media (max-width:767px){.nav{top:86px}}@media (max-width:480px){.nav{width:300px}}.nav.active-state{-webkit-transform:translateX(0);transform:translateX(0);opacity:.96;z-index:3000}@media (max-height:1125px){.nav.active-state{height:calc(100% - 92px);overflow-y:scroll}}@media (max-width:767px){.nav.active-state{height:calc(100% - 86px)}}.nav a{display:block;padding:7px 15px 7px 40px;color:#fff;font-weight:400;line-height:1.4}.nav a:hover{color:#fff}.nav.nav-open{left:0}.nav-journal-level{border-top:1px solid #242424}.nav-journal-level a{padding-left:30px}.nav-journals{margin-bottom:1em}.nav-journals a{position:relative}.nav-journals a:before{content:"";display:inline-block;position:absolute;margin-left:-18px;top:14px;height:7px;width:7px;border-radius:50%;background:red}.nav-journals a.theme-jama:before{background:#d71635}.nav-journals a.theme-jama:after{content:"\00AE";font-size:50%;vertical-align:top}.nav-journals a.theme-jama-network-open{border-bottom:1px solid #242424}.nav-journals a.theme-jama-cardiology:before{background:#be1e32}.nav-journals a.theme-jama-dermatology:before{background:#006f3b}.nav-journals a.theme-jama-facial-plastic-surgery:before{background:#ed1c24}.nav-journals a.theme-jama-internal-medicine:before{background:#006e96}.nav-journals a.theme-jama-neurology:before{background:#981b1e}.nav-journals a.theme-jama-oncology:before{background:#3b923f}.nav-journals a.theme-jama-ophthalmology:before{background:#66bc29}.nav-journals a.theme-jama-otolaryngology-head-neck-surgery:before{background:#34b6e4}.nav-journals a.theme-jama-pediatrics:before{background:#0084c0}.nav-journals a.theme-jama-psychiatry:before{background:#005276}.nav-journals a.theme-jama-surgery:before{background:#f47920}.nav-journals a.theme-archives-of-neurology-psychiatry:before{background:#005276}.nav-journals a.theme-jama-network-open:before{background:#ed0973}.nav-network-other a{border-top:1px solid #242424;border-bottom:1px solid #242424;padding:1.25em 1em 1.25em 65px;margin-top:-1px;position:relative}.nav-network-other a:before{font-size:2.1em;margin-right:10px;position:absolute;margin-left:-45px;top:50%;-webkit-transform:translateY(-50%);transform:translateY(-50%)}.nav-network-other .link-apps:before{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;width:34px}.nav-network-other .link-institutions-librarians:before{width:35px}.nav-network-other .link-reprints-permissions:before{width:33px}.nav-heading{color:#b9b9b9;text-transform:uppercase;font-size:1.5em;padding:.7em .75em;border-top:1px solid #242424;border-bottom:1px solid #242424;font-weight:400;margin:0 0 .5em 0}.editors-choice-header{max-width:1300px;margin-left:auto;margin-right:auto;padding-top:90px}.editors-choice-header::after{clear:both;content:"";display:table!important}@media (min-width:768px) and (max-width:1023px){.editors-choice-header{padding-top:75px}}@media (max-width:767px){.editors-choice-header{padding-top:68px}}@media (min-width:1024px){.editors-choice-header img{float:left;display:block;margin-right:1.20482%;width:85.54217%;margin-left:7.22892%}.editors-choice-header img:last-child{margin-right:0}}@media (max-width:767px){.editors-choice-header img{width:900px}}.hamburger-menu-legal{word-break:normal;word-wrap:normal}.master-main img{max-width:100%;height:auto}.footer-wrap{background:#191919}.footer{max-width:1300px;margin-left:auto;margin-right:auto;background:#191919;position:relative;direction:ltr}.footer::after{clear:both;content:"";display:table!important}.footer::after{clear:both;content:"";display:table!important}.footer a{color:#fff;font-size:.94118em;display:inline-block;min-width:51%;line-height:1.3;margin-bottom:.5em}.footer a :hover{color:#fff}.footer .email-signup{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap}.footer .email-signup .email-signup--text{-webkit-box-ordinal-group:1;-webkit-order:0;order:0}.footer .email-signup .email-signup--input-wrap{-webkit-box-ordinal-group:2;-webkit-order:1;order:1}.footer .email-signup .email-signup--link{-webkit-box-ordinal-group:3;-webkit-order:2;order:2;margin-left:59px}.footer .email-signup .email-signup--submit{-webkit-box-ordinal-group:4;-webkit-order:3;order:3}.footer-heading-wrap{min-height:61px;position:relative;border-bottom:1px solid #555;margin-bottom:.5em}@media (max-width:767px){.footer-heading-wrap{margin:0}}.footer-heading{color:#fff;margin:0;font-size:1.17647em;padding:18px 10px 18px 25px;font-weight:400}@media (max-width:767px){.footer-heading:hover{cursor:pointer}}.footer-heading:before{display:none}@media (max-width:767px){.footer-heading{padding-left:20px;height:auto;margin:0}.footer-heading:before{display:inline}}@media (min-width:768px){.footer-heading:before{display:none}}@media (max-width:767px){.footer-heading:before{font-size:1.25em;margin-right:12px;vertical-align:middle}}[data-thm=jama] #footer-microsite .footer-heading:after{content:"\00AE";font-size:50%;vertical-align:top}.footer-subheading{color:grey;text-transform:uppercase;font-size:1.17647em;font-weight:400}.footer-microsite{float:left;display:block;margin-right:1.20482%;width:20.48193%;margin-right:0}.footer-microsite:last-child{margin-right:0}@media (min-width:768px) and (max-width:1023px){.footer-microsite{width:28.57143%}}@media (max-width:767px){.footer-microsite{width:100%;float:none}}@media (max-width:767px){.footer-microsite-links-wrap{padding-top:.5em;display:none}}.footer-microsite-contents{float:left;padding-left:25px;margin-bottom:1.75em}@media (max-width:767px){.footer-microsite-contents{float:left;display:block;margin-right:1.20482%;width:49.39759%;padding-left:20px}.footer-microsite-contents:last-child{margin-right:0}}@media (max-width:480px){.footer-microsite-contents{width:100%;float:none}}.footer-microsite-services{padding-left:25px;padding-bottom:10px;margin-bottom:10px;border-bottom:1px solid #555}@media (max-width:767px){.footer-microsite-services{float:left;display:block;margin-right:1.20482%;width:49.39759%;margin-right:0;padding-left:20px;border:none}.footer-microsite-services:last-child{margin-right:0}}@media (max-width:480px){.footer-microsite-services{width:100%;float:none}}.footer-network-other{padding-left:25px;clear:both}@media (max-width:767px){.footer-network-other{padding-top:.75em;border-top:1px solid #555;padding-left:20px}}.link-network-other{position:relative;margin-left:42px;padding:4px 0}.link-network-other:before{font-size:1.5em;margin-right:10px;position:absolute;margin-left:-42px;top:50%;-webkit-transform:translateY(-50%);transform:translateY(-50%)}.link-apps:before{width:34px}.link-institutions-librarians:before{width:35px}.link-reprints-permissions:before{width:25px}.footer-microsite-subscribe{padding-left:25px;margin:1.75em 0 0 0}.footer-microsite-subscribe::after{clear:both;content:"";display:table!important}@media (max-width:767px){.footer-microsite-subscribe{padding-left:20px;margin-bottom:1em}}.footer-microsite-subscribe .subscribe-image{color:#fff;float:left;margin-right:.75em;width:75px}@media (min-width:768px) and (max-width:1023px){.footer-microsite-subscribe .subscribe-image{width:70px}}.footer-microsite-subscribe .subscribe-meta{overflow:hidden;padding-right:8px}.footer-microsite-subscribe .subscribe-heading{text-transform:none;color:#fff;margin:0 0 10px 0;line-height:1}.footer-microsite-subscribe .subscribe-submit{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700}.footer-microsite-subscribe .subscribe-submit:hover{cursor:pointer;text-decoration:none;background:#fff}[data-thm=umb] .subscribe-image{display:none}[data-thm=learn] .subscribe-image{display:none}.footer-network{float:left;display:block;margin-right:1.20482%;width:56.62651%;background:#000;margin-right:0}.footer-network:last-child{margin-right:0}.footer-network::after{clear:both;content:"";display:table!important}@media (min-width:768px) and (max-width:1023px){.footer-network{width:71.42857%}}@media (max-width:767px){.footer-network{width:100%;float:none}}.footer-network .footer-network-heading{vertical-align:middle}.footer-network .footer-network-heading:before{font-size:1.5em;vertical-align:middle;margin-right:8px}@media (max-width:767px){.footer-network .footer-network-heading:before{font-size:1.25em;margin-right:12px}}.footer-network .footer-network-heading:after{content:"\00AE";font-size:50%;vertical-align:top}@media (max-width:767px){.footer-network .footer-network-heading{padding-left:20px}.footer-network .footer-network-heading:before{content:""}}.copyright:after{content:"\00AE";font-size:50%;vertical-align:top}@media (max-width:767px){.footer-network-links-wrap{padding-top:.5em;display:none}}.footer-network-sites{float:left;display:block;margin-right:1.20482%;width:63.85542%;padding:0 35px 40px 25px}.footer-network-sites:last-child{margin-right:0}@media (max-width:767px){.footer-network-sites{padding-left:20px;float:left;display:block;margin-right:1.20482%;width:56.62651%}.footer-network-sites:last-child{margin-right:0}}@media (max-width:480px){.footer-network-sites{width:100%;float:none}}.footer-network-sites .internal{margin-bottom:1.75em}.footer-network-sites .internal a:first-of-type{position:relative}.footer-network-sites .internal a:first-of-type:after{content:"\00AE";font-size:50%;vertical-align:top}.footer-network-info{float:left;display:block;margin-right:1.20482%;width:34.93976%;padding-right:20px}.footer-network-info:last-child{margin-right:0}@media (max-width:767px){.footer-network-info{padding-bottom:1em;float:left;display:block;margin-right:1.20482%;width:42.16867%}.footer-network-info:last-child{margin-right:0}}@media (max-width:480px){.footer-network-info{width:100%;float:none;padding-left:25px}}@media (max-width:480px) and (max-width:767px){.footer-network-info{padding-left:20px}}.footer-network-info .learning-links{margin-bottom:1.75em}.footer-network-info .information-for-links{margin-bottom:1.75em}.footer-network-info .for-media-links{margin-bottom:1.75em}.footer-network-info .services-links{margin-bottom:1.75em}.footer-resources-wrap{float:left;display:block;margin-right:1.20482%;width:20.48193%}.footer-resources-wrap:last-child{margin-right:0}.footer-resources-wrap h3{padding:18px 10px 18px 20px}@media (min-width:768px) and (max-width:1023px){.footer-resources-wrap{width:100%;border-top:1px solid #555;display:-webkit-box;display:-webkit-flex;display:flex}}@media (max-width:767px){.footer-resources-wrap{width:100%;float:none}}.footer-resources-wrap .footer-subheading{color:#fff;text-transform:none}@media (min-width:768px) and (max-width:1023px){.footer-resources-wrap .footer-heading-wrap{display:none}}.footer-resources{border-bottom:1px solid #555;padding:10px 20px}@media (min-width:768px) and (max-width:1023px){.footer-resources{border-bottom:none;border-right:1px solid #555;border-left:1px solid #555;margin-left:-1px;width:33.3%}}@media (max-width:767px){.footer-resources{width:100%;float:none}}@media (max-width:767px){.footer-resources .footer-subheading{display:none}}@media (max-width:767px){.footer-resources{display:none}}.footer-resources h4{display:none}@media (min-width:768px) and (max-width:1023px){.footer-resources h4{display:block;padding-bottom:.1em}}.footer-bar{padding:15px 40px;clear:both;border-top:1px solid #555;text-align:center}.footer-bar::after{clear:both;content:"";display:table!important}@media (max-width:900px){.footer-bar{padding:15px}}.footer-bar a{display:inline}.footer-bar .footer-bar-sis{display:inline-block;float:right;width:33.33%;text-align:right}@media (max-width:900px){.footer-bar .footer-bar-sis{float:none;text-align:center;margin:1em auto;width:250px;display:block}}.footer-bar-sis-img{width:235px}@media (max-width:900px){.footer-bar-sis-img{width:220px}}.footer-bar-jn-logo{float:left;width:33.33%;text-align:left}@media (max-width:900px){.footer-bar-jn-logo{float:none;width:100%;text-align:center}}.footer-bar-jn-logo img{width:290px}@media (max-width:900px){.footer-bar-jn-logo img{width:240px}}.copyright{color:#fff;padding:13px 20px;width:33.33%;float:left}@media (max-width:900px){.copyright{width:100%;float:none}}.split-screen .footer{overflow-x:hidden;position:inherit}.split-screen .footer:before{display:none}@media (min-width:1024px){.split-screen .footer-heading-wrap{margin:0}}@media (min-width:1024px){.split-screen .footer-heading{padding-left:20px;height:auto;margin:0}}@media (min-width:1024px){.split-screen .copyright,.split-screen .footer-bar-heading,.split-screen .footer-bar-sis,.split-screen .footer-microsite,.split-screen .footer-network,.split-screen .footer-resources,.split-screen .footer-resources-wrap{width:100%;float:none}}@media (min-width:1024px){.split-screen .footer-email-updates,.split-screen .footer-resources,.split-screen .footer-social{padding-left:20px}}@media (min-width:1024px){.split-screen .footer-bar-sis{width:100%;float:none;text-align:center}}.split-screen .footer-bar-heading{text-align:center}@media (min-width:1024px){.split-screen .footer-microsite-links-wrap{padding-top:.5em}}@media (min-width:1024px){.split-screen .footer-network-heading{padding-left:20px}}@media (min-width:1024px){.split-screen .footer-network-other{padding-top:.75em;border-top:1px solid #555;padding-left:20px}}@media (min-width:1024px){.split-screen .footer-microsite-contents{float:left;display:block;margin-right:1.20482%;width:49.39759%;padding-left:20px}.split-screen .footer-microsite-contents:last-child{margin-right:0}}@media (min-width:1024px){.split-screen .footer-microsite-services{float:left;display:block;margin-right:1.20482%;width:49.39759%;margin-right:0;padding-left:20px;border:none}.split-screen .footer-microsite-services:last-child{margin-right:0}}@media (min-width:1024px){.split-screen .footer-microsite-subscribe{padding-left:20px;margin-bottom:1em}}@media (min-width:1024px){.split-screen .footer-network-links-wrap{padding-top:.5em}}@media (min-width:1024px){.split-screen .footer-network-sites{padding-left:20px;float:left;display:block;margin-right:1.20482%;width:56.62651%}.split-screen .footer-network-sites:last-child{margin-right:0}}@media (min-width:1024px){.split-screen .footer-network-info{padding-bottom:1em;float:left;display:block;margin-right:1.20482%;width:42.16867%}.split-screen .footer-network-info:last-child{margin-right:0}}.widget-ArticleNavLinks{display:inline-block;margin:.5em .25em 1.5em 0}.widget-ArticleNavLinks .toc-link{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700}.widget-ArticleNavLinks .toc-link:hover{cursor:pointer;text-decoration:none;background:#fff}@media (max-width:767px){.widget-ArticleNavLinks{float:none;margin-bottom:0}}.widget-PersonalizedContent{transition:max-height 1s ease-in-out;overflow:hidden}@media all and (max-width:1100px){.widget-PersonalizedContent{margin-bottom:4em}}@media (max-width:767px){[data-thm=jaman] .widget-PersonalizedContent{margin-bottom:0}}.ymal--leader .widget-PersonalizedContent{max-height:0;background:#edede3;margin-bottom:1em}.ymal--leader .widget-PersonalizedContent .ymal{padding:15px 80px}@media (max-width:1350px){.ymal--leader .widget-PersonalizedContent .ymal{padding:15px 95px}}@media (max-width:1023px){.ymal--leader .widget-PersonalizedContent .ymal{padding:15px 6px}}.ymal--leader .widget-PersonalizedContent .ymal--hed{text-align:center;font-weight:500}.ymal--leader .widget-PersonalizedContent.loaded{max-height:500px}@media (max-width:1350px){.ymal--footer .widget-PersonalizedContent .ymal{padding:0 15px}}@media (max-width:1023px){.ymal--footer .widget-PersonalizedContent .ymal{margin-bottom:2em}}.ymal--footer .widget-PersonalizedContent .ymal--hed{text-align:center;font-weight:500}.split-screen .widget-PersonalizedContent .ymal{padding:0}.journal-contents .widget-PersonalizedContent{margin-bottom:2em}.journal-contents .widget-PersonalizedContent .ymal--hed{color:#000;padding-bottom:.4em;border-bottom:1px solid #ddd;margin-bottom:1em}.sidebar .widget-PersonalizedContent{padding:15px;text-align:left}.sidebar .widget-PersonalizedContent.loaded{border:1px solid #ddd;background:#f4f4f4}.pg_collection .sidebar .widget-PersonalizedContent{margin-bottom:15px}.pg_collection .sidebar .widget-PersonalizedContent h4,.pg_collection .sidebar .widget-PersonalizedContent span{color:#000!important}@media all and (max-width:1100px){.split-screen .widget-PersonalizedContent{margin-bottom:0}}@media (max-width:767px){.pg_currentissue .ymal--footer{margin-top:0!important}}.sm-linked-content{margin:-.5rem 0 2rem}.resources-panel .sm-linked-content{padding:0 0 1.5em;border-bottom:1px solid #ddd;margin:0 0 1.5em}.sm-linked-content--item{margin-right:1.5rem;display:inline-block}@media (max-width:480px){.sm-linked-content--item{display:block;margin-bottom:12px}}@media (max-width:480px){.sm-linked-content--item:last-child{margin-bottom:0}}.sm-linked-content--link{font-size:13px}.sm-linked-content .icon-url{border-radius:50%;font-size:1.8rem;margin-right:7px}.first-page-preview{border:1px solid #ddd}.first-page-preview--header{line-height:1;padding:8px 10px;background:#f4f4f4}.first-page-preview--modal.first-page-preview--modal{max-width:1050px}@media all and (max-width:767px){.errata-notifications{margin-top:1em}.pb0 .errata-notifications{margin-top:0}}.errata-notification{background:#333;text-align:center;margin-bottom:1em;padding:8px;font-weight:500;color:#fff}.errata-links{background:#333;margin-bottom:1.5em;text-align:center;font-weight:500;padding:8px;color:#fff}.errata-links.alert-bg{background:#981b1e;padding:15px 15px 20px}.errata-links .errata-links--title{color:#fff;margin:0 0 1em}.errata-link{margin-bottom:1em}.errata-link:last-of-type{margin-bottom:0}.errata-link .errata-link--btn{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;background:#fff;padding:6px 12px;font-weight:700;color:#981b1e}.errata-link .errata-link--btn:hover{cursor:pointer;text-decoration:none;background:#fff}.errata-link .errata-link--btn:hover{color:#981b1e}.is-retracted-article.content-panel{background:url(/UI/app/img/retracted.png) left top repeat}.is-retracted-article.article-content{background:url(/UI/app/img/retracted.png) 85px top repeat;background-clip:content-box}@media (max-width:768px){.is-retracted-article.article-content{background:url(/UI/app/img/retracted.png) -10px top repeat}}.widget-ArticleTopInfo{margin-bottom:2em}.widget-ArticleTopInfo .meta-access-type{display:inline-block;float:right}@media (max-width:480px){.widget-ArticleTopInfo .meta-access-type{float:none}}.widget-ArticleTopInfo .meta-access-type:before{font-size:1.3em;margin-left:10px}@media (max-width:480px){.widget-ArticleTopInfo .meta-access-type:before{margin-left:0;margin-bottom:10px}}.widget-ArticleTopInfo .meta-group-type{float:right}@media (max-width:480px){.widget-ArticleTopInfo .meta-group-type{float:none}}.widget-ArticleTopInfo .meta-group-type:before{font-size:1.3em;margin-left:10px}@media (max-width:480px){.widget-ArticleTopInfo .meta-group-type:before{margin-left:0;margin-bottom:10px}}.meta-article-type-wrap{margin-bottom:.5em}.meta-article-type{font-size:1.25em;font-weight:600;margin-bottom:.3em;display:inline;line-height:1.2}.meta-super-class{display:inline;font-size:1.25em;font-weight:500}.meta-super-class:before{content:" | ";display:inline}.meta-date{font-size:1.2em;margin-bottom:.2em}.meta-article-title-wrap{position:relative}.meta-article-title{font-size:2.125em;font-weight:600;line-height:1.3;margin-bottom:.35em}@media (max-width:767px){.meta-article-title{font-size:2em;line-height:1.25}}.meta-article-title.has-jc-ppt{padding-right:100px}@media (max-width:480px){.meta-article-title.has-jc-ppt{padding-right:0}}.meta-article-title .subtitle,.meta-article-title .subtitle-no-colon{display:block;font-weight:400}.meta-journal-club{position:absolute;right:0;top:4px;width:60px}@media (max-width:480px){.meta-journal-club{position:static;width:40px}}.byline{display:block;font-size:.9em;font-weight:400}.meta-authors{margin-bottom:.75em;font-size:.875em;line-height:1.6}@media (max-width:560px){.meta-authors{line-height:1.8}}.meta-authors a{color:#444}.meta-authors--remaining{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0;opacity:0;transition:all .3s ease-in-out}.meta-authors--remaining.accessible-show{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;opacity:1}.meta-author{margin-bottom:.5em;font-size:.875em;color:#444}.meta-author-title{display:inline-block}.meta-author-title:before{position:relative;top:-1px;margin-right:2px;display:inline-block;transition:all .2s ease-in-out}.meta-author-title.target-active:before{-webkit-transform:rotate(90deg);transform:rotate(90deg)}.meta-author-content{display:none}.meta-author-affiliations{list-style-type:none;margin-left:0;padding-left:1em}.meta-author-affiliation{line-height:1.3;margin-bottom:.6em}.meta-author .meta-author-name{display:inline}.meta-author .meta-author-aff{display:inline}.meta-author .meta-articleinfo-jumplink{position:relative;display:none}.meta-author .meta-articleinfo-jumplink:before{content:"|";display:inline-block;margin:0 10px 0 8px}.meta-author .meta-articleinfo-jumplink.no-affiliations:before{display:none}.meta-author .meta-articleinfo-jumplink.target-exists{display:inline-block}.meta-citation-wrap{font-size:.875em}.meta-citation-wrap .meta-citation-journal-name{font-style:italic}#articleInfo{margin-bottom:.4em}.product-book{font-size:.875em}.product-book .fn-source{font-weight:700}.product-journal .fn-source{font-style:italic}.colon-for-citation-subtitle{display:none}.get-citation-citation .colon-for-citation-subtitle{display:inline}.get-citation-format{display:block;line-height:1.3;margin-bottom:6px}.topic-suggestions{margin-bottom:2rem}.resources-panel .topic-suggestions{border-bottom:1px solid #ddd;padding-bottom:1.5em}.topic-suggestions-heading{text-transform:none;text-align:center;margin-bottom:1.5em}.topic-suggestions .topic-suggestion{display:inline-block;font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif;margin:0 4px 15px 0;padding:2px 10px;line-height:1.3;border-radius:15px;border:2px solid #000;color:#000}.topic-suggestions .topic-suggestion:hover{text-decoration:none;background:#000;color:#fff}.topic-suggestions.personalized-topics{border-bottom:none;padding-bottom:0}.pg_abstract .topic-suggestions,.widget-MagazineView .topic-suggestions{border-bottom:none}.pg_index .topic-suggestions,.pg_journal .topic-suggestions{margin-bottom:0}.resources-panel .related-content{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap;list-style-type:none;margin:0 0 1em 0;padding:0;margin-bottom:1.5em}.resources-panel .related-content .related-article{border-bottom:1px solid #ddd;width:50%;padding:1em;line-height:1.5;-webkit-box-flex:1;-webkit-flex-grow:1;flex-grow:1}.resources-panel .related-content .related-article:nth-child(odd){border-right:1px solid #ddd;padding-left:0}@media (max-width:560px){.resources-panel .related-content .related-article:nth-child(odd){border-right:none;padding-left:0}}.resources-panel .related-content .related-article.odd:last-of-type{border-right:none}@media (max-width:560px){.resources-panel .related-content .related-article{width:100%;padding-left:0}}.resources-panel .related-content .related-article-authors{display:none}.resources-panel .related-content .related-article-title{font-weight:700;display:block;text-decoration:none;color:#000;margin-bottom:.4em}.resources-panel .related-content .related-article-title:hover{text-decoration:none;cursor:pointer;color:#000}.resources-panel .related-content .related-article-title .subtitle:before{content:": "}.resources-panel .related-content .related-article-type{font-style:italic;display:inline;font-weight:700;color:#888;position:relative}.resources-panel .related-content .related-article-type:after{content:" | ";font-style:normal}.resources-panel .related-content .related-article-date{font-style:italic;display:inline;font-weight:700;color:#888;margin-bottom:.5em}.resources-panel .related-content .related-article-abstract-type{font-weight:700;font-size:.85em;display:block;text-decoration:none;color:#000}.resources-panel .related-content .related-article-abstract-type:hover{text-decoration:none;cursor:pointer;color:#000}.resources-panel .related-content .related-article-excerpt{font-size:.875em}.no-flexbox .related-content{display:block}.no-flexbox .related-content .related-article{width:100%;padding:1em 1em 1em 0}.no-flexbox .related-content .related-article:nth-child(odd){border-right:none}.related-abstract-content{overflow:hidden;list-style-type:none;padding:32px 0 0 32px;margin:0 0 1.5em 0}@media (max-width:480px){.related-abstract-content{padding:20px 0 0 20px}}.related-abstract-content .related-article-abstract-link{text-decoration:none;color:#000}.related-abstract-content .related-article-abstract-link:hover{text-decoration:none;cursor:pointer;color:#000}.related-abstract-content .related-abstract-article{padding-left:10px;position:relative;margin-bottom:1.25em;line-height:1.4}@media (max-width:480px){.related-abstract-content .related-abstract-article{padding-left:8px}}.related-abstract-content .related-article-abstract-title{display:block;margin-bottom:.5em}.related-abstract-content .related-article-abstract-type{font-weight:700;font-size:.9em;display:block;position:relative}.related-abstract-content .related-article-abstract-type:before{content:"";display:block;position:absolute;height:200px;width:32px;border-left:1px solid #888;border-bottom:1px solid #888;bottom:12px;bottom:calc(100% - 8px);right:101%;right:calc(100% + 10px - 1px)}@media (max-width:480px){.related-abstract-content .related-article-abstract-type:before{width:20px;right:101%;right:calc(100% + 8px - 1px)}}.section-jump-links li{line-height:1.3;margin-bottom:15px}.section-jump-link.contents-tab-jump-link{color:#000}.section-jump-link.top-of-article{font-weight:700;display:block}.section-jump-link.figure-link,.section-jump-link.multimedia-link,.section-jump-link.supplement-link,.section-jump-link.table-link{background:#edede3}.ref-link{line-height:1}p sup{line-height:1}.math-section img{display:block;margin:0 auto 1.25em}.article-full-text span.math-section{display:block;margin:20px 0}.figure-table-wrapper{padding:.6em 0 1rem 0;margin-bottom:4em}.figure-table-wrapper.figure-table-wrapper{border-top-width:2px}.magazine-content .figure-table-wrapper{margin:1.8rem 0;border-bottom:1px solid #000}.article-content .figure-table-wrapper.figure-no-label,.article-content .figure-table-wrapper.inline{border-top:none!important;padding-top:0;margin:1.8rem 0}.figure-table::after{clear:both;content:"";display:table!important}.figure-table-image{display:block;margin:0 .25em .75em .25em;text-align:center}.widget-MagazineView .figure-no-label .figure-table-image{text-align:left}.figure-table-image .content-img{min-height:250px}.figure-table-image .content-img.loaded{min-height:0}.figure-table-wrapper.inline .content-img{display:block;margin-bottom:5px}.inline-graphic{padding-bottom:6px;border-bottom:1px solid #000;margin-bottom:4px}.widget-MagazineView .inline-graphic{border-bottom:none}.figure-credit{font-size:13px;color:#000}.figure-table-links{text-align:right;margin-bottom:1em}.figure-no-label .figure-table-links,.inline .figure-table-links{display:none}.figure-table-links .figure-table-link{display:inline-block;text-decoration:none;color:#000;font-weight:500;margin-right:15px}.figure-table-links .figure-table-link:hover{text-decoration:none;cursor:pointer;color:#000}@media (max-width:480px){.figure-table-links .figure-table-link{margin-right:12px}}.figure-table-links .figure-table-link:before{font-size:1.5em;margin-right:5px}@media (max-width:560px){.figure-table-links .figure-table-link:before{margin-right:0}}@media (max-width:480px){.figure-table-links .view-large{margin-right:15px}}@media (max-width:560px){.figure-table-links .view-large-text{display:none}}.figure-table-links .download-ppt:before{font-size:1.8em;margin-top:1px}@media (max-width:560px){.figure-table-links .download-ppt-text{display:none}}.figure-table-links .figure-table-social{text-decoration:none}.figure-table-links .figure-table-social:before{font-size:2em;margin-right:0}.figure-table-links .figure-table-twitter{margin-right:5px}@media (max-width:560px){.figure-table-links .figure-table-twitter{margin-right:10px}}.figure-table-links .figure-table-facebook{margin-right:0}.figure-label{font-weight:700;float:left;margin-bottom:.5em}.graphical-abstract-label{font-weight:700;float:left;margin-bottom:.5em}.figure-title{font-weight:700}.figure-attribution,.figure-caption{font-size:.875rem}.figure-attribution p,.figure-caption p{font-size:.875rem}.table-title{font-weight:700}.table-label{font-weight:700;float:left;margin-bottom:.5em}.table-caption{font-size:.875rem}.table-caption p{font-size:.875rem}span.heading-text{display:inline-block}.languageTranslateLink{text-transform:capitalize}.languageTranslateLink::before{content:"|";display:inline-block;margin:0 .5rem}.article-full-text{margin-bottom:2em}.blockquote{border-left:5px solid #fff;padding-left:12px}.blockquote .para{margin-bottom:0}.blockquote .para:first-of-type{margin-left:1em}.has-back-to-top .back-to-top{display:inline-block;float:right;min-width:85px;margin-top:10px;font-size:16px;font-weight:400}@media (max-width:767px){.has-back-to-top .back-to-top{margin:6px 0 5px 0}}@media (max-width:480px){.has-back-to-top .back-to-top{display:block;float:none}}.article-pdf-only{position:relative}@media (max-width:767px){.article-pdf-only{padding-left:52px}}.article-pdf-only:before{content:"";display:block;width:60px;height:60px;background:url(/UI/app/svg/pdf_color.svg);background-repeat:no-repeat;background-size:contain;float:left;margin-right:10px;position:relative;top:0;left:0}@media (max-width:767px){.article-pdf-only:before{width:45px;height:45px}}@media (max-width:767px){.article-pdf-only:before{top:3px}}span.speaker{font-weight:700;margin-right:5px}.supplement{margin-bottom:2em}.supplement .supplement-title{overflow:hidden}.supplement .supplement-type{display:block;float:left;width:60px;height:60px;vertical-align:middle;background-size:contain;background-repeat:no-repeat;background-position:top left;margin-right:20px}@media (max-width:767px){.supplement .supplement-type{width:35px;height:35px}}.supplement .supplement-type.pdf{background-image:url(/UI/app/svg/pdf_color.svg)}.supplement .supplement-type.powerpoint{background-image:url(/UI/app/img/ppt.png)}.supplement .supplement-type.powerpoint:before{font-size:60px}@media (max-width:767px){.supplement .supplement-type.powerpoint:before{font-size:35px}}.supplement .supplement-type.word{background:url(/UI/app/svg/microsoft_word.svg)}.supplement .supplement-type.excel{background:url(/UI/app/svg/microsoft_excel.svg)}.supplement .supplement-link{color:#333;overflow:hidden;padding-left:1em;display:block}@media (max-width:767px){.supplement .supplement-link{padding-left:.75em}}.supplement .supplement-link:hover{text-decoration:none;color:#333}.supplement .title-label{font-size:1.75em;font-weight:500;line-height:1.3;display:block;margin:0 0 .5em 0;line-height:1.1}@media (max-width:767px){.supplement .title-label{font-size:1.5em}}.references{margin-bottom:2em}.references .reference{margin-bottom:1em;clear:both}.references .reference .reference-number{float:left;width:44px;font-weight:700;color:#000;display:block;padding-right:10px;text-align:right}.references .reference .reference-number:hover{text-decoration:none;color:#000;cursor:default}.references .reference .reference-content{overflow:hidden}.references .reference .reference-content a:first-of-type:before{display:inline-block}.references .reference .reference-content a.crossref-doi:before,.references .reference .reference-content a.google-scholar-ref-link:before,.references .reference .reference-content a.jn-article-link:before,.references .reference .reference-content a.pubmed-link:before{content:" ";display:block;position:relative}.references .reference .reference-content a.crossref-doi+a:before,.references .reference .reference-content a.google-scholar-ref-link+a:before,.references .reference .reference-content a.jn-article-link+a:before,.references .reference .reference-content a.pubmed-link+a:before{display:inline-block;content:"|";color:#000}.references a.google-scholar-ref-link+.crossref-doi,.references a.jn-article-link+.crossref-doi,.references a.jn-article-link+.google-scholar-ref-link,.references a.jn-article-link+.pubmed-link,.references a.pubmed-link+.crossref-doi,.references a.pubmed-link+.google-scholar-ref-link{display:inline-block}.references a.google-scholar-ref-link+.crossref-doi:before,.references a.jn-article-link+.crossref-doi:before,.references a.jn-article-link+.google-scholar-ref-link:before,.references a.jn-article-link+.pubmed-link:before,.references a.pubmed-link+.crossref-doi:before,.references a.pubmed-link+.google-scholar-ref-link:before{margin:0 10px}.references a.google-scholar-ref-link+.crossref-doi+a:before,.references a.jn-article-link+.crossref-doi+a:before,.references a.jn-article-link+.google-scholar-ref-link+a:before,.references a.jn-article-link+.pubmed-link+a:before,.references a.pubmed-link+.crossref-doi+a:before,.references a.pubmed-link+.google-scholar-ref-link+a:before{margin:0 10px}.references a.google-scholar-ref-link+.crossref-doi+a img,.references a.jn-article-link+.crossref-doi+a img,.references a.jn-article-link+.google-scholar-ref-link+a img,.references a.jn-article-link+.pubmed-link+a img,.references a.pubmed-link+.crossref-doi+a img,.references a.pubmed-link+.google-scholar-ref-link+a img{position:relative;top:4px}.drop-cap{font-size:3.5em;float:left;line-height:.95;display:block;margin-right:5px;position:relative}.box-section{padding:1em;margin-bottom:1.25em;color:#333;background:#f4f4f4!important}.box-section--title{font-size:1.25em;font-weight:700;line-height:1.3;margin-top:0;border-bottom:1px solid #ddd;padding-bottom:6px}.box-section li .para,.box-section li p{margin-bottom:.75em}.box-section .label{font-size:1.25em;font-weight:700;line-height:1.3;float:left;margin-right:2px;margin-right:.5ch}.box-section strong{color:#333}.box-section a:hover{color:#981b1e}.box-section sup{font-size:.75em}.box-section.online-quiz{background:#edede3;color:#333}.box-section.online-quiz .box-section--title{margin-bottom:0;font-size:1.75em;font-weight:500;line-height:1.3;border-bottom:1px solid #ddd;padding-bottom:.3em}@media (max-width:767px){.box-section.online-quiz .box-section--title{font-size:1.5em}}.box-section.online-quiz p{padding:.85em;margin:0;border-bottom:1px solid #ddd}.box-section.online-quiz p:last-of-type{border-bottom:none}.box-section.online-quiz a,.box-section.online-quiz strong{color:#333}.box-section.online-quiz ol,.box-section.online-quiz ul{margin:0;padding:0;list-style-position:inside}.box-section.online-quiz ol:last-of-type,.box-section.online-quiz ul:last-of-type{margin-bottom:0}.box-section.online-quiz ol li,.box-section.online-quiz ul li{border-bottom:1px solid #ddd}.box-section.online-quiz ol li:last-of-type,.box-section.online-quiz ul li:last-of-type{border-bottom:none}.box-section.online-quiz ol li .para,.box-section.online-quiz ul li .para{display:inline-block;width:calc(100% - 40px)}ol,ul{list-style-type:none}ol.simple,ul.simple{list-style-type:none}ol.bullet,ol.list-bullet,ul.bullet,ul.list-bullet{list-style-type:initial}ol.bullet li ul,ol.list-bullet li ul,ul.bullet li ul,ul.list-bullet li ul{list-style-type:circle}ol.bullet li ul li ul,ol.list-bullet li ul li ul,ul.bullet li ul li ul,ul.list-bullet li ul li ul{list-style-type:square}ol.bullet li ul li ul li ul,ol.list-bullet li ul li ul li ul,ul.bullet li ul li ul li ul,ul.list-bullet li ul li ul li ul{list-style-type:disc}ol.bullet li ul li ul li ul li ul,ol.list-bullet li ul li ul li ul li ul,ul.bullet li ul li ul li ul li ul,ul.list-bullet li ul li ul li ul li ul{list-style-type:circle}ol.bullet li ul li ul li ul li ul li ul,ol.list-bullet li ul li ul li ul li ul li ul,ul.bullet li ul li ul li ul li ul li ul,ul.list-bullet li ul li ul li ul li ul li ul{list-style-type:square}ol.list-decimal,ol.number,ol.order,ol.outline-arabicnum,ol.outline-arabicnumparen,ul.list-decimal,ul.number,ul.order,ul.outline-arabicnum,ul.outline-arabicnumparen{list-style-type:decimal}ol.alpha-lower,ol.list-lower-alpha,ol.outline-loweralpha,ol.outline-loweralphaparen,ul.alpha-lower,ul.list-lower-alpha,ul.outline-loweralpha,ul.outline-loweralphaparen{list-style-type:lower-alpha}ol.greek-lower,ol.list-lower-greek,ul.greek-lower,ul.list-lower-greek{list-style-type:lower-greek}ol.latin-lower,ol.list-lower-latin,ul.latin-lower,ul.list-lower-latin{list-style-type:lower-latin}ol.list-lower-roman,ol.outline-lowerroman,ol.outline-lowerromanparen,ol.roman-lower,ul.list-lower-roman,ul.outline-lowerroman,ul.outline-lowerromanparen,ul.roman-lower{list-style-type:lower-roman}ol.alpha-upper,ol.list-upper-alpha,ol.outline-upperalpha,ul.alpha-upper,ul.list-upper-alpha,ul.outline-upperalpha{list-style-type:upper-alpha}ol.latin-upper,ol.list-upper-latin,ul.latin-upper,ul.list-upper-latin{list-style-type:upper-latin}ol.list-upper-roman,ol.outline-upperroman,ol.roman-upper,ul.list-upper-roman,ul.outline-upperroman,ul.roman-upper{list-style-type:upper-roman}ol ol,ol ul,ul ol,ul ul{padding-left:convert-unit(rem-px,1)}.multimedia-tab .multimedia-item{padding:1em;margin-bottom:1em}.multimedia-tab .multimedia-item.extrinsic-video{padding:1em;background:#edede3;border-top:none;margin-bottom:2em}.multimedia-tab .multimedia-item.extrinsic-video .brightcove-video-wrap{margin-top:.6em}.multimedia-tab .multimedia-item .brightcove-video{height:0;position:relative}.multimedia-tab .multimedia-item .brightcove-video[data-aspect-ratio="0.5625"]{padding-bottom:56.25%}.multimedia-tab .multimedia-item .brightcove-video[data-aspect-ratio="0.75"]{padding-bottom:75%}.multimedia-tab .multimedia-item .BrightcoveExperience{position:absolute;top:0;left:0;width:100%;height:100%}.multimedia-tab .multimedia-link{display:block}.multimedia-tab .multimedia-link:hover{text-decoration:none}.multimedia-tab .multimedia-link .multimedia-title{display:inline-block;vertical-align:middle;width:calc(100% - 105px);margin-bottom:0}.multimedia-tab .multimedia-link .multimedia-title .multimedia-group{float:left}.multimedia-tab .multimedia-link .multimedia-title .multimedia-group::after{content:" ";white-space:pre}.multimedia-tab .multimedia-link .multimedia-title .multimedia-title{display:block;width:calc(100% - 60px)}.multimedia-tab .multimedia-link--icon{border-right:1px solid #000;margin-right:.5em;padding-right:.5em}.multimedia-tab .multimedia-link--icon:before{font-size:40px;display:inline-block;color:#000}@media (max-width:480px){.multimedia-tab .multimedia-link--icon:before{font-size:28px;display:block}}@media (max-width:480px){.multimedia-tab .multimedia-link--icon{margin-bottom:.25em}}.multimedia-tab .multimedia-link .icon-audio_cme:before{font-size:32px}@media (max-width:480px){.multimedia-tab .multimedia-link .icon-audio_cme:before{font-size:22px}}.multimedia-tab .multimedia-link .icon-audio_cme+.multimedia-title{width:calc(100% - 160px)}@media (max-width:480px){.multimedia-tab .multimedia-link .icon-audio_cme+.multimedia-title{width:calc(100% - 80px)}}.multimedia-tab .multimedia-link .icon-audio_cme+.multimedia-title .multimedia-title{width:100%}.multimedia-tab .multimedia-content-wrap{position:relative;padding-right:60px;margin-bottom:1em}@media (max-width:480px){.multimedia-tab .multimedia-content-wrap{padding-right:0}}.multimedia-tab .multimedia-content-wrap .icon-multimedia_cme:before{font-size:23px}.multimedia-tab .multimedia-content{display:inline-block;vertical-align:middle;width:calc(100% - 75px);margin-bottom:0}@media (max-width:480px){.multimedia-tab .multimedia-content{width:calc(100% - 60px)}}.multimedia-tab .video-anchor{height:1px}.multimedia-tab .widget-MultimediaInfo{margin-bottom:2em}.multimedia-wrap{padding:.5rem 0 1.5rem 0;margin-bottom:1.8rem;border-bottom:1px solid #000}.widget-MagazineView .multimedia-wrap{border-top-width:2px;padding-bottom:0;border-bottom:none;margin-top:2rem}.multimedia-title,.video-label-title{font-weight:700;margin-bottom:.35em;color:#000;line-height:1.5}.video-caption{font-size:.875em;margin-bottom:1.25em}@media (max-width:480px){.video-caption{margin-right:0}}.video-caption .para:last-of-type{margin-bottom:0}.is-backfile .sidebar .advertisement{display:none}.user-comments{margin-top:2rem;padding:1rem 0 .25rem 0}.user-comments .comment-header{padding:0 0 1rem 0}.user-comments .comment-header .comment-count{width:15rem}.user-comments .comment-header .comment-expand-all{text-decoration:none}.user-comments .comment-item{margin:0 0 2rem 0;padding:1rem 0 2rem 0;background-color:#fff}.user-comments .comment-item--author,.user-comments .comment-item--text,.user-comments .comment-item--title{padding:.25rem 0}.user-comments .comment-item--text-limited.ellipsis:after{content:" ..."}.user-comments .comment-item--separator-collapse,.user-comments .comment-item--text-remaining{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0;opacity:0;transition:all .3s ease-in-out}.user-comments .comment-item--separator-collapse.accessible-show,.user-comments .comment-item--text-remaining.accessible-show{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;opacity:1;margin:28px 0 0 0}.user-comments .comment-item--disclosure-collapse{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0;opacity:0;transition:all .3s ease-in-out}.user-comments .comment-item--disclosure-collapse.accessible-show{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;opacity:1;margin:22px 0 0 0}.user-comments .comment-item--separator{margin:1rem 0 1rem 0;border-top:5px solid;width:3%}@media (max-width:767px){.user-comments .comment-item--separator{width:5%}}.user-comments .comment-item--separator-collapse.accessible-show{border-top:5px solid;width:3%;margin:11px 0 0 0}@media (max-width:767px){.user-comments .comment-item--separator-collapse.accessible-show{width:5%}}.user-comments .comment-item--read-more-link{margin:1rem 0;text-decoration:none}.user-comments-secondary-text,a.user-comments-secondary-text{color:#6f6f6f;font-size:13px;font-family:'Guardian TextSans Web'}.char-limit-text{font-weight:400}.comment-count,.comment-item--read-more-link{font-weight:600}.split-screen .resource-tabs{height:100%}.split-screen .related-tab .manage-interest{text-align:center;margin:1rem 0 3rem 0}@media (max-width:767px){.split-screen .related-tab .manage-interest{margin-top:0}}.split-screen .comments-tab{background-color:#f2f2f2}.split-screen .comments-tab.tab-active{height:100%;padding:0 3rem}.split-screen .user-comments .comment-header{margin:0 0 1rem 0}.split-screen .user-comments .comment-item{padding:1rem 1rem 3.5rem 1rem}.content-comment-bubble{margin-bottom:1.5em;margin-top:-1.5em}.content-comment-bubble .content-comment-text{text-align:left;color:#000;font-weight:700}.article--title .subtitle,.article--title .subtitle-no-colon{display:block}#get-citation .article--title .subtitle,#get-citation .article--title .subtitle-no-colon,.article--title #get-citation .subtitle,.article--title #get-citation .subtitle-no-colon,.article--title .issue-view-tab .subtitle,.article--title .issue-view-tab .subtitle-no-colon,.issue-view-tab .article--title .subtitle,.issue-view-tab .article--title .subtitle-no-colon{display:inline}.article--title .subtitle:before{content:": "}.article--title .subtitle-no-colon:before{content:" "!important}.master-main .learning .result--title,.master-main .learning--title{font-size:1.75em;font-weight:500;line-height:1.3;margin:15px 5px;font-size:1em;display:block;font-weight:700;color:#000}@media (max-width:767px){.master-main .learning .result--title,.master-main .learning--title{font-size:1.5em}}.learning .result--title a,.learning--title a{color:#000}.learning .result--title .content--journal-info,.learning--title .content--journal-info{font-weight:400}.learning .badges{display:inline-block}.learning .badge:before{vertical-align:middle;font-size:1.25em;margin-right:10px;display:inline-block}.learning .badge.icon-cme:before{font-size:1.4em}.learning .badge.icon-multimedia{font-size:1.3em}.learning .badge.icon-audio{font-size:1.35em}.learning .result--content{float:left;width:calc(100% - 265px)}@media (max-width:1150px){.learning .result--content{width:calc(100% - 210px)}}@media (max-width:950px){.learning .result--content{float:none;width:auto}}.learning .result--image{max-width:230px;margin-left:35px;margin-top:5px}@media (max-width:1150px){.learning .result--image{max-width:190px;margin-left:20px}}@media (max-width:950px){.learning .result--image{float:none;width:auto;margin:12px 0 0 0;max-width:230px}}.learning .result--image .video-overlay{background:#d71635;bottom:0;left:0;display:inline-block;font-size:30px;padding:5px 10px}@media (min-width:1024px){.ss-content{padding-top:.25em}}.space-above{margin-top:4rem}.ss-ui-only{display:none}.self-serve{max-width:1300px}.self-serve .demo-label{margin:50px 0;color:#333;border-bottom:1px solid #ccc;background:#f2f2f2;padding:5px}.self-serve h1,.self-serve h2,.self-serve h3,.self-serve h4,.self-serve h5,.self-serve h6{line-height:1.3}.self-serve h1.special,.self-serve h2.special,.self-serve h3.special,.self-serve h4.special,.self-serve h5.special,.self-serve h6.special{border-bottom:1px solid #ddd;padding-bottom:8px;margin-bottom:25px}.self-serve h3{font-size:2.3em;font-weight:400}.self-serve h4{font-size:1.25em}.self-serve .underlined-header{display:block;margin-bottom:10px;font-size:1.25em}.self-serve .underlined-header span{display:inline-block;font-weight:500}.self-serve-special-announcements{text-align:center;max-height:150px;overflow:hidden;margin:0 0 1.5em 0}.self-serve-special-announcements .announcement{display:inline-block;padding-left:15px;margin:0 0 15px 15px}.self-serve-special-announcements .announcement:first-of-type{padding-left:0;margin-left:0}@media (max-width:767px){.self-serve-special-announcements .announcement{display:block;padding-left:0;margin:0 0 8px 0}.self-serve-special-announcements .announcement:not(:first-of-type){display:none}}.self-serve-special-announcements .large-text{margin-bottom:0}.self-serve-image-and-text{margin-bottom:20px}.self-serve-image-and-text img{float:left;padding-right:20px}.self-serve .link-title{color:#000;line-height:1.35;margin-bottom:.3em;font-size:1.2em;font-weight:700}.self-serve p{max-width:820px}.self-serve .collapsible .collapsible-header{display:block}.self-serve .collapsible .collapsible-header button{font:inherit}.self-serve .collapsible .collapsible-content{padding-bottom:15px}.self-serve .collapsible button{padding-left:0;text-align:inherit;border:none;background:0 0;font-size:inherit;font-weight:inherit}.self-serve .collapsible button:hover{cursor:pointer}.self-serve .collapsible button:after{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;font-size:25px;padding:5px;-webkit-transform:rotate(-90deg);transform:rotate(-90deg)}.self-serve .collapsible [aria-expanded=true]:after{-webkit-transform:rotate(0);transform:rotate(0)}.self-serve .collapsible [aria-hidden=false]{display:block}.self-serve .collapsible [aria-hidden=true]{display:none}.self-serve .self-serve-table-wrapper{width:100%;overflow:auto;margin-bottom:20px}.self-serve table{min-width:600px;border-collapse:collapse}.self-serve table tr{border:1px solid gray}.self-serve table tr:nth-child(odd){background:#f2f2f2}.self-serve table td{background:0 0}.self-serve table th{color:#fff;background:#1a1a1a}.self-serve .table{display:table;border-bottom:2px solid #666;color:#222;margin:10px 0 2em 0;max-width:1200px;width:100%}.self-serve .table .table-head{display:table-header-group;word-break:keep-all}.self-serve .table .table-head .column{background:#222!important;color:#fff;font-weight:700;border-right:0 solid #5d5d5d;border-bottom:none}.self-serve .table .row{background-color:#eee;display:table-row;word-break:keep-all}.self-serve .table .row .column:nth-child(1){border-left:0 solid #666}.self-serve .table .row:last-child .column{border-bottom:none}.self-serve .table .column{display:table-cell;padding:10px 20px!important;border-bottom:1px solid #666;border-right:0 solid #666}@media (max-width:767px){.self-serve .table .column,.self-serve .table .column:before,.self-serve .table .row,.self-serve .table .table{display:block}.self-serve .table .table{width:100%}.self-serve .table .row .column:last-child,.self-serve .table .table{border-bottom:none}.self-serve .table .table-head{position:absolute;top:-1000em;left:-1000em}.self-serve .table .row{border:1px solid #666;border-top:2px solid #666;border-bottom:2px solid #666;margin:20px 0!important}.self-serve .table .row .column:nth-child(1){border-left:none}.self-serve .table .row .column:last-child{border-right:none}.self-serve .table .column,.self-serve .table .row:last-child .column{border-bottom:1px solid #666}.self-serve .table .column:before{font-weight:700;padding-right:20px;content:" " attr(data-label) " "}}.self-serve ol{padding-left:0}.self-serve .icon-list{line-height:2}.self-serve .icon-list li{padding:10px}.self-serve [class^=icon-]:before{font-size:44px}.self-serve .collapsible-list{list-style-type:none}.self-serve .collapsible-list-header:after{-webkit-transform:rotate(-90deg);transform:rotate(-90deg);font-size:15px;position:relative;top:-1px;padding:3px;font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale}.self-serve .collapsible-list-header[aria-selected=true]:after{-webkit-transform:rotate(0);transform:rotate(0)}.self-serve .collapsible-list ul{list-style-type:none}.self-serve .collapsible-list a{font-size:1em;display:block;margin-bottom:10px}.self-serve .collapsible-list .collapsible-list-target{display:none;margin-left:35px;margin-bottom:10px}.self-serve .collapsible-list .collapsible-list-target.is-active{display:block}.self-serve .collapsible-list .collapsible-list-target-is-active{display:block}.self-serve .collapsible-list [class^=icon-]:before{font-size:25px;padding-right:5px}.self-serve .pullquote{float:left;font-size:24px;width:350px;margin:10px 30px;display:block;position:relative;border-top:10px solid;font-weight:700;line-height:1.5;padding-top:10px}.self-serve p.box-text{padding:20px;color:#fff;font-size:1em;font-weight:500}.self-serve p.box-text strong{color:#fff}.self-serve p.box-text.inverted{background:#f2f2f2;color:#000}.self-serve .inline-figure img{border:1px solid #ccc}.self-serve .inline-figure-caption{border-top:1px solid #000;font-size:14px;font-weight:700;padding-top:5px;margin-top:5px}[data-thm=jaman] .widget-instance-AMA_JournalHome_HomePromo2{margin-bottom:4.938rem}blockquote{border-left:5px solid;padding-left:12px}.color-box{padding:10px;display:block;margin:10px auto;margin-bottom:50px;width:100%;border-top:1px solid;background:#f2f2f2}.color-box .link-title{font-size:1.125em;line-height:1.35}.color-box p{font-weight:500;color:#737373;font-size:.85em}.rail-promo{border:1px solid #ddd;padding:1em;margin-bottom:2em}.rail-promo::after{clear:both;content:"";display:table!important}.rail-promo--title{font-weight:700;color:#d71635;font-size:1.3em}.rail-promo--img{width:130px;float:right;margin-left:10px}.rail-promo--text{overflow:hidden;line-height:1.5;font-weight:700}.ss-box{padding:.75em 1.25em 1em;margin-bottom:2em;background:#f2f2f2;position:relative}@media (max-width:767px){.ss-box{padding:.6em .75em .75em}}.ss-box:before{content:"";position:absolute;top:-10px;left:0;width:60%;height:10px}.ss-box.sugar-cookie{background:#edede3}.ss-box>:last-child{margin-bottom:0}.image-box{max-height:300px;overflow:hidden;margin-bottom:3em}.ss-content .image-box{margin-bottom:2em}@media (max-width:1023px){.image-box{margin-bottom:2em}}@media (max-width:767px){.image-box{max-height:none}}.image-box img{width:100%;height:auto;margin-bottom:-7px}.image-box.sugar-cookie .featured{background:#edede3;border-top:none}.image-box.sugar-cookie .featured:before{display:none}.image-box .featured{background:#f2f2f2;position:relative}.image-box .featured::after{clear:both;content:"";display:table!important}.image-box .featured:before{content:"";position:absolute;top:-10px;left:0;width:60%;height:10px}.image-box .featured-image{width:320px;float:left}@media (min-width:1024px) and (max-width:1200px){.image-box .featured-image{width:295px}}@media (max-width:767px){.image-box .featured-image{width:auto;float:none}}.image-box .featured-info{padding:.6em 1.25em;overflow:hidden}@media (max-width:767px){.image-box .featured-info{padding:.6em .75em}}@media (min-width:1024px){.image-box .featured-info{padding:1em 1.25em}}.image-box .featured-info .svg{height:32px;width:auto;margin-bottom:12px;display:inline-block;vertical-align:middle}.image-box .featured-info .jn-icon:before{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;font-size:2.5em;color:#be1e32;margin-bottom:12px;margin-right:5px}.image-box .featured-article-details{color:#444;font-size:.85em;font-style:italic;font-weight:500;margin-bottom:.25em}.image-box .featured-label{margin-right:10px;display:inline-block;font-size:20px;margin-bottom:.25em}.image-box .featured-label.free:before{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale}.image-box .featured-label.education:before{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;font-size:30px}.image-box .cta .tagline{font-size:1.3125em;line-height:1.4;font-weight:500;margin-bottom:.85em;max-height:100px;overflow:hidden}@media (max-width:767px){.image-box .cta .tagline{max-height:none}}.image-box .cta .icon-header{margin-bottom:.2em}.image-box .cta .icon-header.jn{font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif;font-weight:700}.image-box .cta .icon-header.jn:before{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;padding-right:10px;font-size:1.25em;position:relative;top:-2px}.image-box .btn.gap{margin-top:.75em}[data-thm=umb] .btn{background:#000;border-color:#000}[data-thm=umb] .btn:hover{border-color:#000;color:#000;background:#fff}[data-thm=umb] .btn-alt{border-color:#000;color:#000;border:2px solid #000}[data-thm=umb] .btn-alt:hover{background:#000}.list-style-1{list-style-type:none;margin:0 0 1.25em 0;padding-left:13px;text-indent:-13px}.list-style-1 li{font-weight:700;font-size:1em;position:relative;line-height:1.3;margin-bottom:7px}.list-style-1 li:before{content:"\00BB";margin-right:4px}.siderail-image-box{margin-bottom:2em}@media (max-width:1023px){.siderail-image-box{margin-left:auto;margin-right:auto;max-width:500px}}.siderail-image-box img{display:block}@media (min-width:768px) and (max-width:1023px){.siderail-image-box img{max-width:100%}}.siderail-image-box h6{color:#000;font-weight:500;font-size:.9em;margin-bottom:.25em;text-transform:uppercase}.siderail-image-box h6:hover{color:#000}.siderail-image-box .link-title{font-size:1em}.content-grid{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap;-webkit-box-pack:justify;-webkit-justify-content:space-between;justify-content:space-between;margin-bottom:3em;transition:all .15s ease-in-out}.content-grid .grid-item{background:#f8f8f8;width:32%;margin-bottom:1em}@media (max-width:767px){.content-grid .grid-item{width:48.75%}}@media (max-width:480px){.content-grid .grid-item{width:100%}}.content-grid .grid-item--title{font-weight:700;color:#000;margin:0 15px;transition:all .15s ease-in-out}.content-grid .grid-item--description{color:#333;margin:5px 15px 15px;line-height:1.5;transition:all .15s ease-in-out}.no-flexbox .content-grid::after{clear:both;content:"";display:table!important}.no-flexbox .content-grid .grid-item{display:block;float:left;width:32.5%;margin-right:1%}@media (min-width:768px){.no-flexbox .content-grid .grid-item:nth-of-type(3n){margin-right:0}}@media (min-width:768px){.no-flexbox .content-grid .grid-item:nth-of-type(3n+1){clear:left}}@media (max-width:767px){.no-flexbox .content-grid .grid-item{width:49%;margin-left:.5%;margin-right:.5%}}@media (max-width:767px){.no-flexbox .content-grid .grid-item:nth-of-type(2n+1){clear:left}}@media (max-width:480px){.no-flexbox .content-grid .grid-item{float:none!important;width:auto}}.no-flexbox .content-grid .grid-item--description{padding-bottom:10px}.abstract-toolbar .toolbar-tool,.magazine-toolbar .toolbar-tool,.social-share .toolbar-tool,.toolbar .toolbar-tool,.toolbar-trigger .toolbar-tool{color:#000}.abstract-toolbar .toolbar-tool:hover,.magazine-toolbar .toolbar-tool:hover,.social-share .toolbar-tool:hover,.toolbar .toolbar-tool:hover,.toolbar-trigger .toolbar-tool:hover{text-decoration:none;color:#000}.toolbar-tool{display:block;text-align:center;padding:10px 5px;font-weight:500;position:relative}.toolbar-tool:before{margin-right:6px}@media (max-width:375px){.toolbar-tool:before{margin-right:3px}}@media (min-width:1024px) and (max-width:1140px){.toolbar-tool:before{margin-right:2px}}.toolbar-pdf:before{display:inline-block;content:" ";width:22px;height:22px;vertical-align:middle;background:url(/UI/app/svg/pdf_color.svg);background-repeat:no-repeat;background-size:contain}@media (min-width:1024px){.toolbar-pdf:before{height:24px}}.toolbar-permissions{margin-right:0}.toolbar,.toolbar-trigger{list-style-type:none;display:table;width:100%;text-align:center;margin:0 0 1.5em 0;padding:0;border-collapse:collapse}@media (max-width:767px){.toolbar,.toolbar-trigger{margin:1em 0 1.5em 0}}.toolbar .toolbar-tool:before,.toolbar-trigger .toolbar-tool:before{font-size:1.5em}.toolbar .toolbar-tool-wrap,.toolbar-trigger .toolbar-tool-wrap{border-collapse:collapse;display:table-cell;border:1px solid #ddd}.toolbar .jama-active-cme-button,.toolbar-trigger .jama-active-cme-button{background-color:#981b1e;color:#fff}.toolbar .jama-active-cme-button:hover,.toolbar-trigger .jama-active-cme-button:hover{color:#fff}.toolbar .toolbar-share-wrap,.toolbar-trigger .toolbar-share-wrap{min-width:130px}@media (min-width:768px) and (max-width:1023px){.toolbar .toolbar-share-wrap,.toolbar-trigger .toolbar-share-wrap{min-width:170px}}@media (max-width:480px){.toolbar .toolbar-share-wrap,.toolbar-trigger .toolbar-share-wrap{min-width:118px}}@media (min-width:1024px) and (max-width:1140px){.toolbar .toolbar-share-wrap,.toolbar-trigger .toolbar-share-wrap{min-width:120px}}.toolbar .toolbar-share,.toolbar-trigger .toolbar-share{color:#000}.toolbar .toolbar-share:hover,.toolbar-trigger .toolbar-share:hover{text-decoration:none;color:#000}.toolbar .toolbar-share:before,.toolbar-trigger .toolbar-share:before{margin-right:2px;color:#666;font-size:1.5em}@media (min-width:1024px) and (max-width:1140px){.toolbar .toolbar-share:before,.toolbar-trigger .toolbar-share:before{margin-right:-3px}}.toolbar .share-text,.toolbar-trigger .share-text{display:none;color:#000}.toolbar .toolbar-pdf:before,.toolbar-trigger .toolbar-pdf:before{display:inline-block;content:" ";width:22px;height:22px;vertical-align:middle;background:url(/UI/app/svg/pdf_color.svg);background-repeat:no-repeat;background-size:contain}@media (min-width:1024px){.toolbar .toolbar-pdf:before,.toolbar-trigger .toolbar-pdf:before{height:24px}}@media (max-width:400px){.toolbar .toolbar-citation-wrap,.toolbar-trigger .toolbar-citation-wrap{display:none}}@media (max-width:560px){.toolbar .toolbar-citation-wrap .toolbar-link-text,.toolbar-trigger .toolbar-citation-wrap .toolbar-link-text{display:none}}@media (min-width:1024px) and (max-width:1140px){.toolbar .toolbar-citation-wrap .toolbar-link-text,.toolbar-trigger .toolbar-citation-wrap .toolbar-link-text{display:none}}@media (max-width:560px){.toolbar .toolbar-citation-wrap .toolbar-tool:before,.toolbar-trigger .toolbar-citation-wrap .toolbar-tool:before{margin:0}}@media (max-width:400px){.toolbar .toolbar-permissions-wrap,.toolbar-trigger .toolbar-permissions-wrap{display:none}}@media (max-width:560px){.toolbar .toolbar-permissions-wrap .toolbar-link-text,.toolbar-trigger .toolbar-permissions-wrap .toolbar-link-text{display:none}}@media (min-width:1024px) and (max-width:1140px){.toolbar .toolbar-permissions-wrap .toolbar-link-text,.toolbar-trigger .toolbar-permissions-wrap .toolbar-link-text{display:none}}@media (max-width:560px){.toolbar .toolbar-permissions-wrap .toolbar-tool:before,.toolbar-trigger .toolbar-permissions-wrap .toolbar-tool:before{margin:0}}.toolbar .toolbar-share-more-link,.toolbar-trigger .toolbar-share-more-link{color:#000;position:relative}.toolbar .toolbar-share-more-link:hover,.toolbar-trigger .toolbar-share-more-link:hover{text-decoration:none;color:#000}.toolbar .toolbar-share-more-link:after,.toolbar-trigger .toolbar-share-more-link:after{-webkit-transform:rotate(90deg);transform:rotate(90deg);display:inline-block;font-size:.75em;color:#000;margin-left:2px;position:relative}.toolbar .toolbar-share-more,.toolbar-trigger .toolbar-share-more{display:none;position:absolute;top:calc(100% - 1px);left:-1px;right:-1px;padding:0 .5em;text-align:left;border:1px solid #ddd;border-top:none;background:#fff;z-index:10}.toolbar .toolbar-share-more.active-state,.toolbar-trigger .toolbar-share-more.active-state{display:block}.toolbar .toolbar-share-more .toolbar-share,.toolbar-trigger .toolbar-share-more .toolbar-share{display:block;padding:3px 0}.toolbar .toolbar-share-more .toolbar-share:before,.toolbar-trigger .toolbar-share-more .toolbar-share:before{margin-right:5px}.toolbar .toolbar-share-more .share-text,.toolbar-trigger .toolbar-share-more .share-text{display:inline}@media (max-width:1400px){.toolbar .toolbar-link-text-extra,.toolbar-trigger .toolbar-link-text-extra{display:none}}@media (min-width:768px) and (max-width:1023px){.toolbar .toolbar-link-text-extra,.toolbar-trigger .toolbar-link-text-extra{display:inline}}.abstract-toolbar::after,.magazine-toolbar::after{clear:both;content:"";display:table!important}@media (max-width:1023px){.abstract-toolbar,.magazine-toolbar{display:none}}.abstract-toolbar .toolbar-tool,.magazine-toolbar .toolbar-tool{height:62px;margin:-1px 0 0 0;width:50%;border:1px solid #ddd;float:left;padding:14px 5px}.abstract-toolbar .toolbar-tool:before,.magazine-toolbar .toolbar-tool:before{font-size:2em;margin-right:6px}@media (max-width:375px){.abstract-toolbar .toolbar-tool:before,.magazine-toolbar .toolbar-tool:before{margin-right:3px}}@media (min-width:1024px) and (max-width:1140px){.abstract-toolbar .toolbar-tool:before,.magazine-toolbar .toolbar-tool:before{margin-right:2px}}.abstract-toolbar .toolbar-pdf,.magazine-toolbar .toolbar-pdf{padding:11px 5px}.abstract-toolbar .toolbar-pdf:before,.magazine-toolbar .toolbar-pdf:before{width:32px;height:32px}@media (min-width:1024px){.abstract-toolbar .toolbar-pdf:before,.magazine-toolbar .toolbar-pdf:before{height:32px}}.abstract-toolbar .toolbar-pdf-text,.magazine-toolbar .toolbar-pdf-text{display:inline-block;vertical-align:middle;line-height:1.2;text-align:left}.abstract-toolbar .toolbar-pdf .toolbar-link-text-extra,.magazine-toolbar .toolbar-pdf .toolbar-link-text-extra{display:block}.abstract-toolbar .jama-active-cme-button,.magazine-toolbar .jama-active-cme-button{background-color:#981b1e;color:#fff}.abstract-toolbar .jama-active-cme-button:hover,.magazine-toolbar .jama-active-cme-button:hover{color:#fff}.social-share{float:left;margin:0 0 0 -75px;width:60px}@media (max-width:767px){.social-share{display:none}}.social-share .toolbar-share{display:block;margin-bottom:.4em}.social-share .toolbar-share:before{font-size:2.25em;color:#6d6e70}.social-share .toolbar-share:hover{text-decoration:none}.social-share .toolbar-share .share-text{display:none;color:#000}.social-share .toolbar-share-more-link{color:#000;margin-bottom:.5em;display:block}.social-share .toolbar-share-more-link:hover{text-decoration:none;color:#000}.social-share .toolbar-share-more-link:after{transition:all .2s ease-in-out .3s;-webkit-transform:rotate(90deg);transform:rotate(90deg);display:inline-block;font-size:.8em;color:#000;margin-left:2px}.social-share .toolbar-share-more-link.target-active:after{-webkit-transform:rotate(-90deg);transform:rotate(-90deg)}.social-share .toolbar-share-more{display:none}.social-share .toolbar-share-more.active-state{display:block}.magazine-toolbar .toolbar-pdf{width:100%}.magazine-toolbar .toolbar-pdf .toolbar-link-text-extra{display:inline}.toolbar-trigger{display:none}@media (max-width:1023px){.toolbar-trigger{display:table}}.toolbar-trigger .toolbar-share-wrap{min-width:105px}@media (max-width:400px){.toolbar-trigger .toolbar-share-wrap{min-width:80px}}@media (min-width:768px){.toolbar-trigger .toolbar-share-wrap{display:none}}@media (max-width:400px){.toolbar-trigger .toolbar-share-wrap .toolbar-share:before{display:none}}.toolbar-trigger .toolbar-share-more-link:after{display:none}@media (max-width:900px){.toolbar-trigger .toolbar-link-text-extra{display:none}}@media (max-width:475px){.toolbar-trigger .toolbar-pdf-text{display:none}}@media (max-width:460px){.toolbar-trigger .toolbar-citation-wrap,.toolbar-trigger .toolbar-permissions-wrap{display:none}}@media (max-width:650px){.toolbar-trigger .toolbar-citation-wrap .toolbar-link-text,.toolbar-trigger .toolbar-permissions-wrap .toolbar-link-text{display:none}}.toolbar-trigger.magazine .toolbar-citation-wrap{display:table-cell}.toolbar-trigger.magazine .toolbar-permissions-wrap{display:table-cell}.toolbar-trigger.magazine .toolbar-pdf-text{display:inline}.tab-nav{height:92px;background:#5c5c5c;font-weight:500;direction:ltr;position:relative;z-index:2000}@media (max-width:1100px){.tab-nav{height:65px}}.tab-nav.is_stuck{margin-top:-3px}.tab-nav .tab-nav-trigger{display:block;float:left;text-align:center;padding:4px 20px;height:100%;text-transform:uppercase;vertical-align:middle;position:relative;font-weight:500;color:#fff;border-right:1px solid #fff}.tab-nav .tab-nav-trigger:hover{color:#fff;text-decoration:none}@media (min-width:1100px){.tab-nav .tab-nav-trigger{vertical-align:top;padding:0 23px}}@media (min-width:1300px){.tab-nav .tab-nav-trigger{padding:0 8px}}@media (max-width:767px){.tab-nav .tab-nav-trigger{padding:4px 15px}}@media (max-width:560px){.tab-nav .tab-nav-trigger{padding:4px 10px}}@media (max-width:480px){.tab-nav .tab-nav-trigger{padding:4px 7px}}.tab-nav .tab-nav-trigger:after{background:0 0;transition:.15s all ease-in-out;content:"";position:absolute;width:calc(100% + 2px);height:5px;bottom:100%;left:-1px}.tab-nav .tab-nav-trigger.target-tab-active{background:#fff}.tab-nav .tab-nav-trigger.target-tab-active:after{background:#fff}.tab-nav .tab-nav-trigger i:before{display:block;font-size:1.8rem;line-height:1;margin:12px 0}@media (min-width:1024px){.tab-nav .tab-nav-trigger i:before{font-size:2rem;margin-top:14px;margin-bottom:.125rem}}.tab-nav .tab-nav-trigger.tab-nav-full-text i:before{display:inline-block}@media (max-width:1023px){.tab-nav .tab-nav-trigger.tab-nav-full-text .tab-nav-tab-name{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;display:inline-block;font-size:1.1em;margin-left:8px;border:none;vertical-align:middle}}@media (max-width:480px){.tab-nav .tab-nav-trigger.tab-nav-full-text .tab-nav-tab-name{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}}@media (min-width:1024px){.tab-nav .tab-nav-trigger.tab-nav-supplemental{padding:0 .5em}}@media (min-width:1300px){.tab-nav .tab-nav-trigger.tab-nav-supplemental{padding:0 .75em}}.tab-nav-tab-name{margin-bottom:.5em;line-height:1.3;font-size:.8em}@media (max-width:1300px){.tab-nav-tab-name{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}}.modal,.reveal-modal{line-height:1.7;min-width:350px;z-index:10000;font-size:15px}.modal .close-reveal-modal,.reveal-modal .close-reveal-modal{text-decoration:none;color:#ccc}.modal .close-reveal-modal:hover,.reveal-modal .close-reveal-modal:hover{text-decoration:none;cursor:pointer;color:#ccc}.modal .close-reveal-modal:before,.reveal-modal .close-reveal-modal:before{font-size:.6em}.modal li,.reveal-modal li{line-height:1.4;margin-bottom:.25em}.modal .modal--title,.reveal-modal .modal--title{font-size:1.5em}.modal .modal--options,.reveal-modal .modal--options{margin-bottom:1em}@media (min-width:1180px){.modal .modal--options,.reveal-modal .modal--options{width:50%;float:left;padding-right:20px}}.modal .modal--options a,.reveal-modal .modal--options a{font-weight:700}.modal .modal--option,.reveal-modal .modal--option{padding:.85em 0;border-top:1px solid #ddd}.modal .modal--box,.reveal-modal .modal--box{padding:1em;background:#f6f6f6;overflow:hidden}.comment-submission{padding-bottom:0}.comment-submission .modal--box.comment-submission{background:#fff;text-align:center;padding-bottom:0}.comment-submission .modal--box.comment-submission .modal--custom-message{border-top:1px solid #111;color:#000;font-size:.875rem;line-height:1.3;margin-top:.75rem;padding:1.5rem 0 2rem 0}.comment-submission .modal--box.comment-submission .network-logo{margin-bottom:4.25rem}.comment-submission .custom-message-text{padding:1rem 2.5rem 0 2.5rem;font-size:12px}.comment-submission.reveal-modal.tiny{width:25%}@media (max-width:767px){.comment-submission.reveal-modal.tiny{width:100%}}.no-access .modal--options{margin-top:11px}.no-access .purchase-access a{font-weight:700}.no-access .purchase-access h4{margin-top:0}@media (min-width:1024px){#no-access-reveal.small{max-width:420px}}@media (min-width:1024px){#login-paid-pdf-reveal.small{max-width:420px}}.register-free-pdf{color:#000}.register-free-pdf .no-access--alerts-input{float:left;margin-top:5px;display:inline-block;width:auto}.register-free-pdf .signin-hed{display:none}.register-free-pdf .no-access--alerts-content{overflow:hidden;padding-left:10px}.register-free-pdf label{font-weight:400;color:#000}#no-access-follow-collection #no-access-follow-collection--alerts-input{float:left;margin-top:5px;display:inline-block;width:auto}#no-access-follow-collection .no-access-follow-collection--alerts-content{overflow:hidden;padding-left:10px}#no-access-follow-collection label{font-weight:400;color:#000}#no-access-follow-collection .modal--box{margin:3rem 0 0 0}#no-access-user-comments--alerts-input{float:left;margin-top:5px;display:inline-block;width:auto}#no-access-user-comments .no-access-user-comments--alerts-content{overflow:hidden;padding-left:10px}#no-access-user-comments label{font-weight:400;color:#000}.manage-interests-modal{border-top:none!important;padding-left:0;padding-right:0;padding-top:1.25rem;background-color:#d7d8d6;max-width:577px}.manage-interests-modal .manage-interests--header{padding:0 2.25rem 0 4rem}.manage-interests-modal .icon-close,.manage-interests-modal .icon-close:hover{color:#000;font-weight:400}.widget-instance-AMA_Magazine_UserComment{margin:82px 0 2rem 0}.widget-instance-AMA_Abstract_UserComment,.widget-instance-AMA_SplitScreen_UserComment{margin:2rem 0}.split-screen .widget-UserComment .comment-form-input{border-width:0}.split-screen .widget-UserComment .comment-form-text-area{border-width:0}.widget-UserComment .comment-form-item{margin:1rem 0}.widget-UserComment .comment-form-input{height:48px}.widget-UserComment .comment-form-text-area{font-size:1rem}.widget-UserComment .submit-errors{clear:both;margin:5rem 0}.widget-UserComment .submit-errors label,.widget-UserComment .submit-errors ul>li{color:red;cursor:default}.widget-UserComment .comment-form-modal{margin:3rem 0 6rem 0}.widget-UserComment .comment-form--author .author-name:before{font-size:26px;display:inline-block;margin-right:2px}.widget-UserComment .comment-form--disclosure p{margin:1rem 0}.widget-UserComment .comment-form--disclosure p:first-of-type{margin-top:.25rem}.widget-UserComment .comment-form--disclosure .disclosure-radio{position:relative;margin:.25rem 0}.widget-UserComment .comment-form--disclosure .disclosure-input{margin-left:2rem}.widget-UserComment .comment-form--disclosure #Disclosure{margin-bottom:0}.widget-UserComment .comment-form--disclosure input[type=radio]{display:none}.widget-UserComment .comment-form--disclosure .radio-label{margin:0;padding-left:35px;display:inline-block;position:relative}.widget-UserComment .comment-form--disclosure .radio-label:before{width:20px;height:20px;content:'';position:absolute;left:0;top:50%;margin-top:-10px;border:1px solid}.widget-UserComment .comment-form-item input::-webkit-input-placeholder,.widget-UserComment .comment-form-item textarea::-webkit-input-placeholder{opacity:.5}.widget-UserComment .comment-form-item input:-ms-input-placeholder,.widget-UserComment .comment-form-item textarea:-ms-input-placeholder{opacity:.5}.widget-UserComment .comment-form-item input::placeholder,.widget-UserComment .comment-form-item textarea::placeholder{opacity:.5}body.metrics-modal-open{overflow:hidden}.clearfix:after,.color-box:after,.self-serve-image-and-text:after,.split-screen .contents-tab:after,.widget-MostViewedCited .most--links:after{content:"";display:table;clear:both}.article-metrics-wrapper{display:inline-block;margin-top:4px}@media (max-width:767px){.article-metrics-wrapper{margin-top:0}}.artmet-table{display:none}.lt-ie9 .artmet-table{display:block}.artmet-condensed-wrap,.artmet-full-wrap{line-height:1.3}.artmet-number{font-weight:700}.artmet-widget-title-1{font-size:34px;font-weight:700;line-height:1.2;padding-bottom:5px}.artmet-widget-title-2{font-size:27px;font-weight:700;line-height:1.2;margin-bottom:15px}.artmet-condensed-wrap{padding:0}@media (max-width:767px){.artmet-condensed-wrap{margin-top:1em}}.artmet-condensed-wrap .artmet-item{text-align:center;margin-right:4px;display:inline-block;vertical-align:middle;position:relative}.artmet-condensed-wrap .artmet-item:after{content:"|";margin-left:2px;display:inline-block;color:#ccc}.artmet-condensed-wrap .artmet-item:last-of-type:after{display:none}@media (max-width:480px){.artmet-condensed-wrap .artmet-item{font-size:.9em}}.artmet-condensed-wrap .artmet-item .artmet-citations-link,.artmet-condensed-wrap .artmet-item .artmet-comments-link{text-decoration:none;color:#000}.artmet-condensed-wrap .artmet-item .artmet-citations-link:hover,.artmet-condensed-wrap .artmet-item .artmet-comments-link:hover{text-decoration:none;cursor:pointer;color:#000}.artmet-condensed-wrap .artmet-text{display:inline-block;padding-bottom:2px;border-bottom:1px solid #000}.artmet-condensed-wrap .artmet-condensed-stats{clear:both}.artmet-condensed-wrap .artmet-modal-trigger-wrap{display:none}.artmet-condensed-wrap .artmet-comments:hover,.artmet-condensed-wrap .artmet-views:hover{cursor:pointer}.artmet-condensed-wrap .artmet-altmetric .widget-AltmetricLink{display:inline-block}.artmet-condensed-wrap .artmet-altmetric a{text-decoration:none;color:#fff}.artmet-condensed-wrap .artmet-altmetric a:hover{text-decoration:none;cursor:pointer;color:#fff}.artmet-condensed-wrap .artmet-altmetric a ._altmetric_score{font-weight:700;color:#000}.artmet-condensed-wrap .artmet-altmetric a ._altmetric_score:before{content:"Altmetric ";display:inline-block;padding-bottom:2px;font-weight:400;border-bottom:1px solid #000;margin-right:5px}.artmet-full-wrap .artmet-views-wrap{margin:20px 0 30px 0;max-width:450px}.artmet-full-wrap .artmet-views{border:1px solid #ccc;border-top:4px solid #d71635;margin-bottom:5px}.artmet-full-wrap .artmet-total-views{width:26%;float:left;padding:10px;text-align:right;border-right:1px solid #ccc}.artmet-full-wrap .artmet-total-views .artmet-number{display:block}.artmet-full-wrap .artmet-page-views,.artmet-full-wrap .artmet-pdf-views{width:74%;float:left;padding:5px 12px}.artmet-full-wrap .artmet-page-views{border-bottom:1px solid #ccc}.artmet-full-wrap .artmet-views-since{text-align:right;font-size:12px}.artmet-full-wrap .ct-chart{margin-bottom:40px}.artmet-full-wrap .artmet-altmetric,.artmet-full-wrap .artmet-citations{width:50%;float:left}.artmet-full-wrap .artmet-citations .artmet-number{display:inline-block;padding:12px;margin:30px 15px;border:1px solid #ccc;font-size:20px}.artmet-modal{display:none;position:fixed;top:0;right:0;bottom:0;left:0;background:rgba(0,0,0,.45);z-index:99999;opacity:0;transition:opacity .4s ease-in}.artmet-modal-contents{width:70%;max-width:790px;position:relative;margin:2% auto;padding:25px;background:#fff;max-height:94%;overflow-y:auto}.artmet-modal-contents .artmet-close-modal{position:absolute;top:10px;right:10px;cursor:pointer;font-size:30px}@media only all and (max-width:1120px){.artmet-full-wrap .artmet-altmetric,.artmet-full-wrap .artmet-citations{width:100%;float:none}.artmet-full-wrap .artmet-citations .artmet-number{margin:0 10px 25px 15px}}@media only all and (max-width:640px){.artmet-modal-contents{width:100%}}body{-webkit-text-size-adjust:100%}.row{max-width:1300px;margin-left:auto;margin-right:auto}.row::after{clear:both;content:"";display:table!important}.row::after{clear:both;content:"";display:table!important}@media (max-width:767px){.row{float:none;margin:0}.row:after{display:none}}.highlight .row{margin-left:-80px}.row .col.collapse,.row .collapse.col-1,.row .collapse.col-10,.row .collapse.col-11,.row .collapse.col-12,.row .collapse.col-2,.row .collapse.col-3,.row .collapse.col-4,.row .collapse.col-5,.row .collapse.col-6,.row .collapse.col-7,.row .collapse.col-8,.row .collapse.col-9{padding-left:10px}.col,.col-1,.col-10,.col-11,.col-12,.col-2,.col-3,.col-4,.col-5,.col-6,.col-7,.col-8,.col-9{float:left;padding-left:40px}@media (max-width:767px){.col,.col-1,.col-10,.col-11,.col-12,.col-2,.col-3,.col-4,.col-5,.col-6,.col-7,.col-8,.col-9{float:none;padding:0}}.highlight .col,.highlight .col-1,.highlight .col-10,.highlight .col-11,.highlight .col-12,.highlight .col-2,.highlight .col-3,.highlight .col-4,.highlight .col-5,.highlight .col-6,.highlight .col-7,.highlight .col-8,.highlight .col-9{padding-left:80px}.col.collapse,.collapse.col-1,.collapse.col-10,.collapse.col-11,.collapse.col-12,.collapse.col-2,.collapse.col-3,.collapse.col-4,.collapse.col-5,.collapse.col-6,.collapse.col-7,.collapse.col-8,.collapse.col-9{padding-left:0}.col-1{width:8.33333%}@media (max-width:1023px){.col-1{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-1{width:100%;padding:0 10px}}.col-2{width:16.66667%}@media (max-width:1023px){.col-2{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-2{width:100%;padding:0 10px}}.col-3{width:25%}@media (max-width:1023px){.col-3{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-3{width:100%;padding:0 10px}}.col-4{width:33.33333%}@media (max-width:1023px){.col-4{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-4{width:100%;padding:0 10px}}.col-5{width:41.66667%}@media (max-width:1023px){.col-5{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-5{width:100%;padding:0 10px}}.col-6{width:50%}@media (max-width:1023px){.col-6{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-6{width:100%;padding:0 10px}}.col-7{width:58.33333%}@media (max-width:1023px){.col-7{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-7{width:100%;padding:0 10px}}.col-8{width:66.66667%}@media (max-width:1023px){.col-8{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-8{width:100%;padding:0 10px}}.col-9{width:75%}@media (max-width:1023px){.col-9{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-9{width:100%;padding:0 10px}}.col-10{width:83.33333%}@media (max-width:1023px){.col-10{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-10{width:100%;padding:0 10px}}.col-11{width:91.66667%}@media (max-width:1023px){.col-11{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-11{width:100%;padding:0 10px}}.col-12{width:100%}@media (max-width:1023px){.col-12{width:100%;padding:0 20px;max-width:100%}}@media (max-width:767px){.col-12{width:100%;padding:0 10px}}@media (max-width:1023px){.col-2{width:50%}}@media (max-width:767px){.col-2{width:100%}}@media (max-width:1023px){.col-3{width:50%}}@media (max-width:767px){.col-3{width:100%}}@media (max-width:1023px){.col-4{width:50%}}@media (max-width:767px){.col-4{width:100%}}@media (max-width:1023px){.col-5{width:50%}}@media (max-width:767px){.col-5{width:100%}}@media (max-width:1023px){.col-6{width:50%}}@media (max-width:767px){.col-6{width:100%}}@media (min-width:768px) and (max-width:1023px){.full-width-tablet{width:100%}}@media (min-width:1300px){.full-width-desktop-large{margin-left:calc(-100vw / 2 + 1300px / 2);margin-right:calc(-100vw / 2 + 1300px / 2)}}@media (max-width:1299px){.full-width-desktop-large{margin:2em -16px 0;width:calc(100% + 32px);max-width:calc(100% + 32px)}}@media (max-width:480px){.full-bleed-mobile{margin:0 -16px;width:calc(100% + 32px);max-width:calc(100% + 32px)}}.main-content{width:calc(100% - 340px - 40px);float:left}@media (max-width:1023px){.main-content{width:auto;float:none}}.sidebar{width:340px;float:right;margin-left:1.5em;margin-bottom:1.5em}@media (max-width:1023px){.sidebar{float:none;margin:2em auto;width:auto}}.sidebar>:first-child{margin-top:0}.pg_collection .movable-ad-target.collex{margin:40px 0}.pg_collection .sf-group-header-journal .title{color:transparent;display:inline-block;margin-bottom:2px!important}.pg_collection .sf-group-header-journal .title:after{content:"Filter By Journal";color:#000;float:left;text-indent:0}.pg_collection .sf-group-header-article-type .title{color:transparent;margin-bottom:2px!important}.pg_collection .sf-group-header-article-type .title:after{content:"Filter By Article Type";color:#000;float:left;text-indent:0}.pg_collection .sf-group-header-article-type+.sf-facet-list{display:block}@media (min-width:641px){.pg_collection .movable-ad-target{width:300px!important}}.pg_collection .journal-facet-all{display:inline-block;vertical-align:middle}@media (max-width:767px){.pg_collection .journal-facet-all{display:block;margin-bottom:12px}}.pg_collection .sf-facet{display:inline-block;width:50%}@media (max-width:767px){.pg_collection .sf-facet{line-height:1.3;width:100%}.pg_collection .sf-facet input[type=checkbox]{margin:0 4px 0 0}}.pg_collection .sf-facet label{display:inline-block;text-transform:capitalize}@media (max-width:767px){.pg_collection .sf-facet label{vertical-align:top;line-height:1.3}}@media (min-width:768px){.pg_collection .sf-facet-journal{width:calc(50% - 25px);margin-right:20px}}.pg_collection .article-browse{transition:all .2s ease-in-out}.pg_collection .article-browse--term-search-label{top:17px;left:16px;padding-right:8px;border-right:2px solid #ddd}@media (max-width:767px){.pg_collection .article-browse--term-search-label{position:static;border-right:none;margin-bottom:5px}}.pg_collection #searchedTerm .btn{padding:4px 4px 6px 6px;line-height:1.5;font-weight:400;border-radius:2px}.pg_collection #searchedTerm .btn:hover{background:#000;color:#fff;text-decoration:none;cursor:default}@media (max-width:767px){.pg_collection #searchedTerm .btn{line-height:1;padding:5px 4px 5px 6px}}.pg_collection #searchedTerm a.close{color:#fff;display:inline-block;padding:0 4px 0 8px;font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;font-size:0}.pg_collection #searchedTerm a.close:before{font-size:18px}.pg_collection #searchedTerm a.close:hover{text-decoration:none}.pg_collection .learning-search-results-contents{transition:all .2s ease-in-out}.pg_collection .learning-search-results-contents--term-search-label{top:17px;left:16px;padding-right:8px;border-right:2px solid #ddd}@media (max-width:767px){.pg_collection .learning-search-results-contents--term-search-label{position:static;border-right:none;margin-bottom:5px}}.pg_collection.collection-facets--wrap-active .article-browse{-webkit-transform:translateX(250px);transform:translateX(250px)}.pg_collection.collection-facets--wrap-active .learning-search-results-contents{-webkit-transform:translateX(250px);transform:translateX(250px)}.pg_collection .collection-facets--wrap{transition:all .2s ease-in-out;position:relative;z-index:10}@media (max-width:767px){.pg_collection .collection-facets--wrap.active-state{-webkit-transform:translateX(0);transform:translateX(0)}}.pg_collection .drop-selected-article-type,.pg_collection .drop-selected-journal{padding:.625rem;font-size:16px;border:none;cursor:pointer;border:1px solid #ddd;border-radius:5px;margin:0 0 1.25rem 0}.pg_collection .drop-selected-article-type:hover,.pg_collection .drop-selected-journal:hover{border:1px solid #c6c6c6}.pg_collection .drop-selected-article-type:after,.pg_collection .drop-selected-journal:after{content:"";line-height:1.5;float:right}.pg_collection #dropdown-journal{width:calc(50% - 25px)}@media (max-width:767px){.pg_collection #dropdown-journal{width:100%}}.pg_collection #dropdown-article-type{width:calc(50%)}@media (max-width:767px){.pg_collection #dropdown-article-type{width:100%}}.pg_collection .dropdown-content{display:none;position:absolute;background-color:#fff;min-width:160px;overflow:auto;z-index:1;margin-top:-23px;border:1px solid #ddd;border-bottom-left-radius:5px;border-bottom-right-radius:5px;padding:0 .625rem}.pg_collection .dropdown-content .dropdown-item{line-height:1em;padding-bottom:1.25em}.pg_collection .dropdown-content .dropdown-options{padding-top:1em;margin-bottom:1em;width:100%;border-bottom:1px solid #ddd}.pg_collection .dropdown-content .dropdown-option-checkall,.pg_collection .dropdown-content .dropdown-option-uncheckall{white-space:nowrap;margin-right:20px;display:inline-block;margin-bottom:1.25em}.pg_collection .dropdown-content .apply-facets .btn{margin-bottom:1.25em}.pg_collection .dropdown-content input{margin-bottom:0}.pg_collection .dropdown-content label{font-weight:400;line-height:1em;margin-left:2px;display:inline-table;margin-right:0;width:calc(100% - 40px)}@media (max-width:767px){.pg_collection .dropdown-content .dropdown-item{padding:.5em 0}}@media (max-width:767px){.pg_collection .dropdown-content{padding-bottom:1em}}.pg_collection .show{display:block}.search-results{overflow:hidden;padding-left:45px;transition:all .2s ease-in-out}@media (max-width:1150px){.search-results{padding-left:25px}}@media (min-width:768px) and (max-width:1023px){.search-results{padding-left:15px}}@media (max-width:767px){.search-results{padding-left:0}}.search-facets{width:290px;float:left;font-weight:700;transition:all .2s ease-in-out;background:#fff}@media (max-width:1023px){.search-facets{width:230px}}@media (max-width:767px){.search-facets{float:none;position:absolute;-webkit-transform:translateX(-240px);transform:translateX(-240px)}}@media (max-width:767px){.search-facets.active-state{-webkit-transform:translateX(0);transform:translateX(0)}}.search-facets ul{list-style-type:none;margin-left:0;padding-left:0;margin-bottom:0}.search-facets li.sf-facet{line-height:1.4;margin-bottom:1em;font-size:.9em}.search-facets .type-multi-select li.sf-facet,.search-facets .type-single-prefix li.sf-facet{padding-left:18px}.search-facets .type-multi-select li.sf-facet .chkSelect,.search-facets .type-single-prefix li.sf-facet .chkSelect{margin-left:-17px}.search-facets input{margin-bottom:0;vertical-align:middle;width:auto}.search-facets a{color:#000}.search-facets h4.facet-title{font-size:1.25em}.search-facets .date-facet label{margin-bottom:.25em}.search-facets .date-facet input{margin-bottom:.75em;width:100%}.search-facets .clear{color:#fff;text-transform:uppercase;font-size:12px;margin:5px 0 0 5px;font-weight:700;padding:3px 4px;float:right}.search-facets .clear:hover{text-decoration:none}.search-facets .clear:before{content:"x ";font-weight:400;text-transform:lowercase;vertical-align:1px}.search-facets .facet-more-less{color:#d71534}.search-facets .facet-more-less:hover{text-decoration:none}.search-facets .facet-more-less .symbol{letter-spacing:.075em}.pg_learningsearchresults.search-facets-active .search-results,.pg_searchresults.search-facets-active .search-results{-webkit-transform:translateX(250px);transform:translateX(250px)}.pg_learningsearchresults h2.sr-description,.pg_searchresults h2.sr-description{font-size:1em}.pg_learningsearchresults h2.sr-description .sr-terms,.pg_searchresults h2.sr-description .sr-terms{display:block;font-size:2em;font-weight:700}.pg_learningsearchresults .advanced-search-link,.pg_searchresults .advanced-search-link{font-size:1.25em;margin-bottom:1em;font-weight:700;color:#981b1e;display:inline-block;vertical-align:middle}.pg_learningsearchresults .advanced-search-link:hover,.pg_searchresults .advanced-search-link:hover{color:#981b1e}@media (max-width:767px){.pg_learningsearchresults .advanced-search-link,.pg_searchresults .advanced-search-link{margin-bottom:.65em}}.pg_learningsearchresults .advanced-search-link:before,.pg_searchresults .advanced-search-link:before{margin-right:8px;position:relative;top:-1px}.pg_learningsearchresults .search-facet,.pg_searchresults .search-facet{padding:15px;border:1px solid #ddd;margin-bottom:1.25em}.pg_learningsearchresults .sr-active-facets,.pg_searchresults .sr-active-facets{color:#fff;padding:2px 10px;margin-bottom:.5em}.pg_learningsearchresults .sr-active-facets a.close,.pg_searchresults .sr-active-facets a.close{margin-right:5px;display:inline-block;background:#fff;line-height:1;padding:2px 4px}.pg_learningsearchresults .sr-active-facets a.close:hover,.pg_searchresults .sr-active-facets a.close:hover{text-decoration:none}.pg_learningsearchresults .view-edit-btn,.pg_learningsearchresults .view-edit-learning-btn,.pg_searchresults .view-edit-btn,.pg_searchresults .view-edit-learning-btn{margin:.5em 0 1em 0;color:#fff}.pg_learningsearchresults .view-edit-btn,.pg_searchresults .view-edit-btn{background:#d71534;border-color:#d71534}.pg_learningsearchresults .saved-search-name-textbox,.pg_searchresults .saved-search-name-textbox{background-color:#f2f2f2}.pg_learningsearchresults .selected-save-search-txt,.pg_searchresults .selected-save-search-txt{padding-left:2px}.pg_learningsearchresults .selected-save-search-learning .selected-save-search-txt,.pg_searchresults .selected-save-search-learning .selected-save-search-txt{color:#4978bc}.pg_learningsearchresults .clear-selected-save-search-learning:before,.pg_learningsearchresults .clear-selected-save-search:before,.pg_searchresults .clear-selected-save-search-learning:before,.pg_searchresults .clear-selected-save-search:before{width:20px;margin-right:5px;padding-bottom:2px}.pg_learningsearchresults .clear-selected-save-search-learning,.pg_searchresults .clear-selected-save-search-learning{color:#4978bc}.pg_learningsearchresults .save-search-link-learning:before,.pg_learningsearchresults .save-search-link:before,.pg_searchresults .save-search-link-learning:before,.pg_searchresults .save-search-link:before{width:25px;margin-right:5px;padding-bottom:5px}.pg_learningsearchresults .save-search-link,.pg_searchresults .save-search-link{color:#d71534}.pg_learningsearchresults .learning-saved-searches{border-bottom:1px solid #ddd;padding-bottom:.25em;margin-bottom:.625em}.pg_learningsearchresults .save-search a{color:#4978bc}.pg_learningsearchresults .sr-content{border-bottom:none}.pg_learningsearchresults .sr-header{border-top:1px solid #ddd;margin-top:1.25rem;padding-top:2rem}.pg_learningsearchresults .save-search a,.pg_searchresults .save-search a{font-weight:400!important}.pg_searchresults #no-access-reveal-saved-searches,.pg_searchresults #save-a-search-modal,.pg_searchresults #view-edit-search-modal{border-top:8px solid #d71635}.sr-sort{font-size:.9em;margin-bottom:1em}.sr-sort .separator{margin-left:3px;margin-right:3px}.sr-sort .separator:last-of-type{display:none}.sr-content{text-align:left;margin-right:15px;border-bottom:1px solid #ddd;margin:1em}.sort-item{position:relative;border-bottom:1px solid #000}.sort-item:hover{text-decoration:none}.sort-item.active{border:none}.search-results-list{margin:0 0 2em 0;list-style-type:none}.pg_collection .narrow-filter,.pg_searchresults .narrow-filter{display:block;margin-bottom:1em;padding:4px 0;position:relative;color:#981b1e;font-weight:700;font-size:1.25em;transition:none}.pg_collection .narrow-filter:hover,.pg_searchresults .narrow-filter:hover{text-decoration:none;color:#981b1e}.pg_collection .narrow-filter.target-active,.pg_searchresults .narrow-filter.target-active{background:#981b1e;color:#fff}.pg_collection .narrow-filter.target-active:after,.pg_searchresults .narrow-filter.target-active:after{background:#981b1e}.pg_collection .narrow-filter:after,.pg_searchresults .narrow-filter:after{content:"";width:120%;top:0;bottom:0;left:-30px;z-index:-1;transition:all .15em ease-in-out;border-top:1px solid #000;border-bottom:1px solid #000;position:absolute}.pg_learningsearchresults .narrow-filter{display:block;margin-bottom:1em;padding:4px 0;position:relative;color:#4978bc;font-weight:700;font-size:1.25em;transition:none}.pg_learningsearchresults .narrow-filter:hover{text-decoration:none;color:#4978bc}.pg_learningsearchresults .narrow-filter.target-active{background:#4978bc;color:#fff}.pg_learningsearchresults .narrow-filter.target-active:after{background:#4978bc}.pg_learningsearchresults .narrow-filter:after{content:"";width:120%;top:0;bottom:0;left:-30px;z-index:-1;transition:all .15em ease-in-out;border-top:1px solid #000;border-bottom:1px solid #000;position:absolute}.learning-facets--wrap-active .article-browse{-webkit-transform:translateX(250px);transform:translateX(250px)}.learning-facets--wrap{transition:all .2s ease-in-out;position:relative;z-index:10}@media (max-width:767px){.learning-facets--wrap{width:240px;padding:0 10px}}@media (max-width:767px){.learning-facets--wrap{float:none;position:absolute;-webkit-transform:translateX(-250px);transform:translateX(-250px)}}@media (max-width:767px){.learning-facets--wrap.active-state{-webkit-transform:translateX(0);transform:translateX(0)}}.pg_journalarticlecme .search-list-header,.pg_journalarticlecme .search-list-item,.pg_learning .search-list-header,.pg_learning .search-list-item,.pg_learningsearchresults .search-list-header,.pg_learningsearchresults .search-list-item,.pg_multimediaplayer .search-list-header,.pg_multimediaplayer .search-list-item,.pg_myaccount .search-list-header,.pg_myaccount .search-list-item,.pg_quiz .search-list-header,.pg_quiz .search-list-item,.pg_searchresults .search-list-header,.pg_searchresults .search-list-item{border-bottom:.1px solid #ddd}.pg_journalarticlecme .search-list,.pg_learning .search-list,.pg_learningsearchresults .search-list,.pg_multimediaplayer .search-list,.pg_myaccount .search-list,.pg_quiz .search-list,.pg_searchresults .search-list{padding:0;margin:0;list-style-position:inside}.pg_journalarticlecme .search-list-item-view,.pg_learning .search-list-item-view,.pg_learningsearchresults .search-list-item-view,.pg_multimediaplayer .search-list-item-view,.pg_myaccount .search-list-item-view,.pg_quiz .search-list-item-view,.pg_searchresults .search-list-item-view{padding:1em 0}.pg_journalarticlecme .search-list-item-view .search-list-item-delete-link,.pg_journalarticlecme .search-list-item-view .search-list-item-rename-link,.pg_learning .search-list-item-view .search-list-item-delete-link,.pg_learning .search-list-item-view .search-list-item-rename-link,.pg_learningsearchresults .search-list-item-view .search-list-item-delete-link,.pg_learningsearchresults .search-list-item-view .search-list-item-rename-link,.pg_multimediaplayer .search-list-item-view .search-list-item-delete-link,.pg_multimediaplayer .search-list-item-view .search-list-item-rename-link,.pg_myaccount .search-list-item-view .search-list-item-delete-link,.pg_myaccount .search-list-item-view .search-list-item-rename-link,.pg_quiz .search-list-item-view .search-list-item-delete-link,.pg_quiz .search-list-item-view .search-list-item-rename-link,.pg_searchresults .search-list-item-view .search-list-item-delete-link,.pg_searchresults .search-list-item-view .search-list-item-rename-link{padding-left:1em;color:#000;text-decoration:underline}.pg_journalarticlecme .search-list-item-view:last-child,.pg_learning .search-list-item-view:last-child,.pg_learningsearchresults .search-list-item-view:last-child,.pg_multimediaplayer .search-list-item-view:last-child,.pg_myaccount .search-list-item-view:last-child,.pg_quiz .search-list-item-view:last-child,.pg_searchresults .search-list-item-view:last-child{border-bottom:none}.pg_journalarticlecme .search-list-item-edit,.pg_learning .search-list-item-edit,.pg_learningsearchresults .search-list-item-edit,.pg_multimediaplayer .search-list-item-edit,.pg_myaccount .search-list-item-edit,.pg_quiz .search-list-item-edit,.pg_searchresults .search-list-item-edit{padding:1em 0;display:inline-block;width:98%}.pg_journalarticlecme .search-list-item-edit span,.pg_learning .search-list-item-edit span,.pg_learningsearchresults .search-list-item-edit span,.pg_multimediaplayer .search-list-item-edit span,.pg_myaccount .search-list-item-edit span,.pg_quiz .search-list-item-edit span,.pg_searchresults .search-list-item-edit span{float:left;margin-right:5px;padding-top:10px}.pg_journalarticlecme .search-list-item-edit .search-list-item-edit-field,.pg_learning .search-list-item-edit .search-list-item-edit-field,.pg_learningsearchresults .search-list-item-edit .search-list-item-edit-field,.pg_multimediaplayer .search-list-item-edit .search-list-item-edit-field,.pg_myaccount .search-list-item-edit .search-list-item-edit-field,.pg_quiz .search-list-item-edit .search-list-item-edit-field,.pg_searchresults .search-list-item-edit .search-list-item-edit-field{overflow:hidden}.pg_journalarticlecme .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox,.pg_learning .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox,.pg_learningsearchresults .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox,.pg_multimediaplayer .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox,.pg_myaccount .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox,.pg_quiz .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox,.pg_searchresults .search-list-item-edit .search-list-item-edit-field .search-list-item-edit-textbox{background-color:#f2f2f2;display:block}.pg_journalarticlecme .search-list-item-edit-btn,.pg_learning .search-list-item-edit-btn,.pg_learningsearchresults .search-list-item-edit-btn,.pg_multimediaplayer .search-list-item-edit-btn,.pg_myaccount .search-list-item-edit-btn,.pg_quiz .search-list-item-edit-btn,.pg_searchresults .search-list-item-edit-btn{margin-right:5px}.pg_journalarticlecme .saved-searches-no-result,.pg_learning .saved-searches-no-result,.pg_learningsearchresults .saved-searches-no-result,.pg_multimediaplayer .saved-searches-no-result,.pg_myaccount .saved-searches-no-result,.pg_quiz .saved-searches-no-result,.pg_searchresults .saved-searches-no-result{padding:1em 0}.pg_journalarticlecme .search-alert,.pg_learning .search-alert,.pg_learningsearchresults .search-alert,.pg_multimediaplayer .search-alert,.pg_myaccount .search-alert,.pg_quiz .search-alert,.pg_searchresults .search-alert{padding-left:1rem}.pg_journalarticlecme .search-alert .icon-email,.pg_learning .search-alert .icon-email,.pg_learningsearchresults .search-alert .icon-email,.pg_multimediaplayer .search-alert .icon-email,.pg_myaccount .search-alert .icon-email,.pg_quiz .search-alert .icon-email,.pg_searchresults .search-alert .icon-email{font-size:1.4rem;padding:0 10px 3px 0}.advanced-search-content{color:#000}.advanced-search-content h1{margin-bottom:1em}.advanced-search-content input{border-radius:5px;padding:10px 10px;width:auto;font-size:.95em}.advanced-search-content select{font-size:.95em}.advanced-search-content label{font-size:.95em;color:#000}.advanced-search-content .sub-label{font-weight:400;margin-bottom:0}.advanced-search-content select{border-radius:5px}.advanced-search-content .search-field-options{clear:both;margin:-10px 0 20px 0}.advanced-search-content .search-field-options label{font-weight:400}@media (max-width:480px){.advanced-search-content .search-field-options label{margin-bottom:.3em}}.advanced-search-content .search-field-options .section-label{font-weight:700}@media (max-width:480px){.advanced-search-content .search-field-options .section-label{line-height:1.1}}.advanced-search-content .search-field-options input{margin-bottom:0}@media (max-width:480px){.advanced-search-content .search-field-options li:not(:first-of-type){width:calc(100% - 110px);float:right}}.advanced-search-content .input-full{width:calc(100% - 110px)}@media (max-width:767px){.advanced-search-content .input-full{width:100%}}.advanced-search-content .input-large{width:83%;float:left;margin-bottom:0}@media (max-width:480px){.advanced-search-content .input-large{width:77%}}.advanced-search-content .input-medium{width:calc(83% - 110px);float:left;margin-bottom:0}@media (max-width:767px){.advanced-search-content .input-medium{width:83%}}@media (max-width:480px){.advanced-search-content .input-medium{width:77%}}@media (min-width:768px){.advanced-search-content .inline-input-label{width:110px;float:left;height:40px;line-height:40px;text-align:right;padding-right:20px}}.advanced-search-content .search-input-wrap{margin-bottom:20px}.advanced-search-content .submit{width:15%;float:right;height:40px;line-height:36px;padding:0}@media (max-width:480px){.advanced-search-content .submit{width:21%}}.advanced-search-content .icon-search{font-size:1.3em}.advanced-search-content .inline-input-wrap{width:16%;float:left;margin-right:1.5%}@media (min-width:768px) and (max-width:1023px){.advanced-search-content .inline-input-wrap{width:15%}}@media (max-width:767px){.advanced-search-content .inline-input-wrap{width:100%;margin:0 0 .5em 0}}.advanced-search-content .citation-input{width:100%;margin-bottom:5px}.advanced-search-content .articletype-filter-wrap,.advanced-search-content .publication-filter{margin-bottom:1.5em}.advanced-search-content .articletype-filter-wrap .journal-filter-wrap .submit,.advanced-search-content .publication-filter .journal-filter-wrap .submit{float:left;width:200px}@media (max-width:767px){.advanced-search-content .articletype-filter-wrap .journal-filter-wrap .submit,.advanced-search-content .publication-filter .journal-filter-wrap .submit{width:120px}}.advanced-search-content .articletype-filter-wrap .articletype-filter,.advanced-search-content .articletype-filter-wrap .journal-filter,.advanced-search-content .publication-filter .articletype-filter,.advanced-search-content .publication-filter .journal-filter{margin:0 0 2em 0}@media (min-width:768px){.advanced-search-content .articletype-filter-wrap .articletype-filter,.advanced-search-content .articletype-filter-wrap .journal-filter,.advanced-search-content .publication-filter .articletype-filter,.advanced-search-content .publication-filter .journal-filter{-webkit-columns:2;columns:2;-webkit-column-width:50%;column-width:50%;-webkit-column-fill:balance;column-fill:balance;-webkit-column-gap:40px;column-gap:40px;-webkit-column-break-inside:avoid;break-inside:avoid-column}}.advanced-search-content .articletype-filter-wrap .articletype-filter li,.advanced-search-content .articletype-filter-wrap .journal-filter li,.advanced-search-content .publication-filter .articletype-filter li,.advanced-search-content .publication-filter .journal-filter li{-webkit-column-break-inside:avoid;break-inside:avoid-column;font-size:.95em;line-height:1.3;margin-bottom:6px}.advanced-search-content .articletype-filter-wrap .inline-input-label,.advanced-search-content .publication-filter .inline-input-label{height:auto;line-height:1.3}.advanced-search-content .articletype-filter-wrap{margin-bottom:0}.advanced-search-content input[type=checkbox]{margin-bottom:0;position:relative;top:1px}.advanced-search-content .date{width:40%;width:calc(50% - 55px);float:left;margin-bottom:20px}.advanced-search-content .date:first-of-type{padding-right:20px}@media (max-width:560px){.advanced-search-content .date:first-of-type{margin-right:0}}@media (max-width:767px){.advanced-search-content .date{width:50%}}.advanced-search-content .date input{width:100%;margin-bottom:5px}.advanced-search-content .more-facets{padding:15px 20px;background:#fafafa;border:1px solid #ddd}@media (max-width:767px){.advanced-search-content .more-facets{padding:10px}}.advanced-search-content .toggle-facets{font-size:1.25em}@media (max-width:767px){.advanced-search-content .toggle-facets{font-size:1em}}.advanced-search-content .toggle-facets i{top:6px}@media (max-width:767px){.advanced-search-content .toggle-facets i{top:4px}}.limit-results-search{margin-top:25px;display:none}.expanded .limit-results-search{display:block}.limit-results-search .author{margin-bottom:.25em}#advSearchContainer.section-container{border-top:none}#advSearchContainer .search-section{margin-bottom:2.5em}#advSearchContainer .section-title{margin:0 0 1em 0;padding-bottom:4px;border-bottom:1px solid #ddd}#advSearchContainer .section-title a{color:#000}@media (min-width:1024px){#advSearchContainer .section-title a{pointer-events:none}}#advSearchContainer .search-module{padding:0 50px}@media (min-width:768px) and (max-width:1023px){#advSearchContainer .search-module{padding:0 30px}}@media (max-width:767px){#advSearchContainer .search-module{padding:0 15px}}@media (max-width:480px){#advSearchContainer .search-module{padding:0}}#advSearchContainer>section{margin-bottom:15px;padding-bottom:15px}#advSearchContainer>section>.title{cursor:default}#advSearchContainer .panel{border:none;margin-bottom:0;padding:0;background:0 0}#advSearchContainer .inbetween{line-height:32px;vertical-align:middle;text-align:center}#advSearchContainer ul{list-style-type:none}.heading-text a{color:#333}.heading-text a:hover{color:#333}@media (min-width:1024px){body.split-screen{height:100%;position:absolute;top:0;left:0;right:0;bottom:0;overflow:hidden}}.split-screen .editors-choice-header,.split-screen .footer-ad,.split-screen .leader-ad{display:none}.split-screen .master-main{padding-top:calc(92px + 5px)}@media (min-width:1024px){.split-screen .master-main{height:calc(100vh)}}@media (max-width:767px){.split-screen .master-main{padding-top:calc(86px + 5px)}}.content-panel{width:50%;height:calc(100% - 92px - 5px);overflow-y:auto;overflow-x:hidden;position:absolute;left:0;direction:rtl}@media (max-width:1023px){.content-panel{width:auto;height:auto;overflow:auto;position:relative}}@media (max-width:767px){.content-panel{height:calc(100% - 86px - 5px)}}@media (max-width:1023px){.nav-active .content-panel{overflow:hidden}}.content-panel .full-text-tab{direction:ltr;padding:1.5em}@media (min-width:1024px){.content-panel .full-text-tab{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;position:relative}}@media (max-width:767px){.content-panel .full-text-tab{padding:1em}}.content-panel .scroll-to{color:#981b1e}.resources-panel{width:50%;height:calc(100% - 92px - 5px);overflow-y:auto;overflow-x:hidden;position:absolute;overflow-y:scroll;right:0;border-left:1px solid #ddd}@media (max-width:1023px){.resources-panel{width:auto;height:auto;overflow:auto;position:relative}}@media (max-width:767px){.resources-panel{height:calc(100% - 86px - 5px)}}@media (max-width:1023px){.resources-panel{overflow-y:hidden}}@media (max-width:1023px){.nav-active .resources-panel{overflow:hidden}}.resource-tab{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0;padding:1.5em}@media (max-width:480px){.resource-tab{padding:1em}}.resource-tab.tab-active{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;position:relative}.contents-tab .toolbar-pdf{text-align:left;color:#000;font-weight:700;padding-left:0;margin-bottom:1.5em}.contents-tab .toolbar-pdf:before{height:40px;width:40px}.linked-content-toolbar .graphical-abstract-tab .figure-table-wrapper{margin-bottom:0;padding-bottom:0}.linked-content-toolbar .graphical-abstract-tab .figure-table-image{margin-bottom:0}.split-screen .contents-tab-contents{float:left}@media all and (max-width:480px){.split-screen .contents-tab-contents{float:none}}.split-screen .contents-tab-ad{float:right}@media all and (max-width:480px){.split-screen .contents-tab-ad{float:none}}.split-screen .advertisement{margin-top:0}.split-screen .graphical-abstract .figure-label{display:none}.quizSection.highlighted{background-color:#feffb1}.quizSection.highlighted a{background:0 0}@media (max-width:1023px){.pg_index .main-content .advertisement,.pg_journal .main-content .advertisement{display:block}}.site-links-wrap{border-bottom:1px solid #ddd;margin-bottom:1.4em;margin-top:0!important}@media (max-width:1023px){.site-links-wrap{margin-top:0!important}}@media (max-width:560px){.site-links-wrap{display:none}}.site-links-wrap .site-links{display:table;max-width:1300px;margin-left:auto;margin-right:auto;width:100%}.site-links-wrap .site-links::after{clear:both;content:"";display:table!important}.site-links-wrap .site-link{display:table-cell;text-align:center;padding-top:5px;padding-bottom:5px;color:#fff;font-weight:500;position:relative;border-right:.0625rem solid #fff;border-top:1px solid transparent;width:20%}.site-links-wrap .site-link:hover{color:#fff;text-decoration:underline!important}.site-links-wrap .site-link:first-child{border-left:.0625rem solid #fff}@media (max-width:1300px){.site-links-wrap .site-link:first-child{border-left:none}}@media (max-width:1300px){.site-links-wrap .site-link:last-child{border:none}}.site-links-wrap .site-link:hover{text-decoration:none}.site-links-wrap .site-link.has-sub-nav{min-width:200px}.site-links-wrap .site-link.has-sub-nav:hover{color:#333}.site-links-wrap .site-link.has-sub-nav span{position:relative}.site-links-wrap .site-link.has-sub-nav span:after{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;position:absolute;margin-left:8px;top:5px;color:transparent;left:100%;display:inline-block;font-size:.8em;vertical-align:inherit;-webkit-transform:rotate(90deg);transform:rotate(90deg)}.site-links-wrap .site-link.target-active{border-top:1px solid #ddd;background:#f8f6f7}.site-links-wrap .site-link.target-active span:after{color:#000}.site-links-wrap .site-link.target-active:after{content:"";display:block;height:1px;background:#ddd;position:absolute;left:0;width:100%;width:calc(100% - 24px);top:100%;left:12px;z-index:1000}.site-links-wrap .site-link.target-active .site-link--sub-nav{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none;position:absolute;top:100%;left:-1px;width:calc(100% + 2px);text-align:left;z-index:15;background:#f8f6f7;border:1px solid #ddd;border-top:none}.site-links-wrap .site-link--sub-nav{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}.site-links-wrap .site-link a{display:block;line-height:1.3;padding:7px 12px;border-bottom:1px solid #ddd;color:#333}.site-links-wrap .site-link a:hover{text-decoration:none;background:#e8e5e1;color:#d71534}.pg_journal .content{padding-top:0}@media (max-width:560px){.pg_journal .content{margin-top:0!important}}.pg_journal .site-link{width:25%}.pg_journal .header-wrap{border-bottom:none}.pg_journal .ad-interstitial{height:0}.pg_journal .header-logo-wrapper{padding:29.5px 0 26px 0}@media all and (max-width:1023px){.pg_journal .header-logo-wrapper{padding-top:48px}}@media all and (max-width:560px){.pg_journal .header-logo-wrapper{margin-bottom:1.4rem}}.pg_journal[data-thm=jaman] .header-logo-wrapper{padding-top:32px;padding-bottom:30px}@media all and (max-width:1023px){.pg_journal[data-thm=jaman] .header-logo-wrapper{padding-top:48px}}@media (max-width:767px){.pg_journal[data-thm=jaman] .journal-sidebar{margin-bottom:0}}.pg_journal[data-thm=jama] .header-logo-wrapper{padding-top:32px;padding-bottom:31px}@media all and (max-width:1023px){.pg_journal[data-thm=jama] .header-logo-wrapper{padding-top:50px}}@media all and (max-width:560px){.pg_journal[data-thm=jama] .header-logo-wrapper{padding-bottom:31px}}.pg_journal[data-thm=intem] .header-logo-wrapper,.pg_journal[data-thm=peds] .header-logo-wrapper{padding-top:32px;padding-bottom:36px}@media all and (max-width:1023px){.pg_journal[data-thm=intem] .header-logo-wrapper,.pg_journal[data-thm=peds] .header-logo-wrapper{padding-top:50px}}@media all and (max-width:560px){.pg_journal[data-thm=intem] .header-logo-wrapper,.pg_journal[data-thm=peds] .header-logo-wrapper{padding-bottom:32px}}.pg_journal[data-thm=otol] .header-logo-wrapper{padding-top:28px;padding-bottom:25px}@media all and (max-width:1023px){.pg_journal[data-thm=otol] .header-logo-wrapper{padding-top:48px}}@media all and (max-width:560px){.pg_journal[data-thm=otol] .header-logo-wrapper{padding-top:44px}}.pg_journal .header-logo-height{margin:0;height:56px}@media all and (max-width:767px){.pg_journal .header-logo-height{height:40px}}@media all and (max-width:400px){.pg_journal .header-logo-height{height:22px}}.pg_journal[data-thm=faci] .header-logo-height{height:55px}@media all and (max-width:767px){.pg_journal[data-thm=faci] .header-logo-height{height:40px}}@media all and (max-width:400px){.pg_journal[data-thm=faci] .header-logo-height{height:22px}}.pg_journal[data-thm=peds] .header-logo-height{margin:0;height:45px}@media all and (max-width:767px){.pg_journal[data-thm=peds] .header-logo-height{height:30px}}@media all and (max-width:400px){.pg_journal[data-thm=peds] .header-logo-height{height:20px}}.pg_journal[data-thm=intem] .header-logo-height{margin:0;height:44px}@media all and (max-width:767px){.pg_journal[data-thm=intem] .header-logo-height{height:30px}}@media all and (max-width:400px){.pg_journal[data-thm=intem] .header-logo-height{height:20px}}.pg_journal[data-thm=otol] .header-logo-height{height:118px}@media all and (max-width:767px){.pg_journal[data-thm=otol] .header-logo-height{height:80px}}@media all and (max-width:400px){.pg_journal[data-thm=otol] .header-logo-height{height:50px}}.pg_journal[data-thm=jaman] .header-logo-height{height:55px}@media all and (max-width:767px){.pg_journal[data-thm=jaman] .header-logo-height{height:42px}}@media all and (max-width:400px){.pg_journal[data-thm=jaman] .header-logo-height{height:32px}}.pg_journal[data-thm=jama] .header-logo-height{height:52px}@media all and (max-width:767px){.pg_journal[data-thm=jama] .header-logo-height{height:32px}}@media all and (max-width:400px){.pg_journal[data-thm=jama] .header-logo-height{height:22px}}@media all and (max-width:480px){.pg_journal[data-thm=faci] .journal-name-header,.pg_journal[data-thm=intem] .journal-name-header,.pg_journal[data-thm=ophth] .journal-name-header,.pg_journal[data-thm=otol] .journal-name-header{width:90%;height:auto;margin:0 auto;display:block}}.pg_journal .journal-name-header{max-height:100%;display:block;margin:0 auto}@media (max-width:1023px){.pg_journal[data-thm=jaman] .master-main>div.h1{width:300%;margin-left:-100%}}@media (max-width:767px){.pg_journal[data-thm=jaman] .master-main>div.h1{width:300%;margin-left:-100%}}.pg_index .header-wrap{border-bottom:none}.pg_index .header-ad-wrap{background:#8b0018}.pg_index .header-logo-wrapper{background:#d71635;padding-top:30px;padding-bottom:37px}@media all and (max-width:1023px){.pg_index .header-logo-wrapper{padding-top:46px}}@media all and (max-width:560px){.pg_index .header-logo-wrapper{margin-bottom:1.4rem;padding-bottom:30px}}.pg_index .header-logo-height{margin:0;height:52px;text-align:center}.pg_index .header-logo-height img{height:100%;max-height:100%}@media all and (max-width:767px){.pg_index .header-logo-height{height:28px}}@media all and (max-width:400px){.pg_index .header-logo-height{height:22px}}.pg_index .journal-name-header{max-height:100%;display:block;margin:0 auto}.pg_index .ad-interstitial{height:0}.pg_index .site-links-wrap{background:#d71635}.pg_index .content{margin-top:0!important}[data-thm=jaman] .just-published--header{border-bottom:none;margin-bottom:1em}[data-thm=jaman] .issue-group.group--clinical-practice-guideline .article:first-child,[data-thm=jaman] .issue-group.group--consensus-statement .article:first-child,[data-thm=jaman] .issue-group.group--invited-commentary .article:first-child,[data-thm=jaman] .issue-group.group--jama-network-open-masthead .article:first-child,[data-thm=jaman] .issue-group.group--letter .article:first-child,[data-thm=jaman] .issue-group.group--original-investigation:nth-of-type(2) .article:first-child{border-top:1px solid #ed0973}[data-thm=jaman] .article--linked-articles{margin-top:1em}[data-thm=jaman] .article .linked-article--type-small{margin-bottom:.4em}[data-thm=jaman] .article .article-date,[data-thm=jaman] .article .article-superclass,[data-thm=jaman] .article .article-type{font-size:.9em}[data-thm=jaman] .article .article-superclass::after,[data-thm=jaman] .article .article-type::after{content:" | "}@media (max-width:610px){[data-thm=jaman] .widget-IssuesTabbedView .issue-view-trigger span{display:inline!important}}.just-published--header{border-bottom:1px solid #ddd;margin-bottom:1.5em}.just-published--title:after{-webkit-transform:rotate(-90deg);transform:rotate(-90deg);font-size:.7em;margin-left:6px}.just-published--date{color:#000;float:right;font-weight:500;margin-top:6px}@media (max-width:1023px){.just-published--date{margin-top:4px}}@media (max-width:480px){.just-published--date{float:none}}.just-published--group{width:32%;margin-right:2%;float:left;margin-bottom:1em}.just-published--group:last-of-type{margin-right:0}@media (max-width:640px){.just-published--group{width:auto;float:none;margin:0 0 2em 0}}.just-published--type{font-weight:700;margin-bottom:.5em;line-height:1.3}.just-published--more{clear:both;display:block;background:#f3f3f3;padding:.6em 1em;margin-bottom:2em}.just-published--more::after{clear:both;content:"";display:table!important}.just-published--more:hover{text-decoration:none}.just-published--more:hover .just-published--more-button{background:#fff}[data-thm=jaman] .just-published--more{padding:.3rem 1rem}.just-published--more-text{color:#000;font-weight:500;color:#000;font-size:1.5em}.just-published--more-text:before{font-size:1.75em;margin-right:12px}@media (max-width:480px){.just-published--more-text:before{font-size:1.25em}}.just-published--more-button{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700;float:right;font-weight:500;min-width:120px;margin-top:.3em}.just-published--more-button:hover{cursor:pointer;text-decoration:none;background:#fff}@media (max-width:480px){.just-published--more-button{margin-top:0;min-width:auto}}.page-multimediaplayer .quiz-no-access,.page-quiz .quiz-no-access{padding:2em 0 0 0}.page-multimediaplayer .quiz-no-access a,.page-quiz .quiz-no-access a{margin-bottom:1em}.page-multimediaplayer .quiz-no-access p,.page-quiz .quiz-no-access p{margin-bottom:0}.page-multimediaplayer .has-cb label,.page-quiz .has-cb label{display:inline}.page-multimediaplayer .has-cb input,.page-quiz .has-cb input{padding:8px}.page-multimediaplayer .has-cb input[type=checkbox]+label,.page-quiz .has-cb input[type=checkbox]+label{margin-left:0}.page-multimediaplayer .ed-objective-survey-scores input[type=radio]+label,.page-quiz .ed-objective-survey-scores input[type=radio]+label{margin-right:1rem}@media (max-width:767px){.pg_learningsearchresults .cme-info .cme-credits{display:none}}@media (max-width:767px){.pg_learningsearchresults .cme-info .cme-complete{font-size:20px;padding-top:20px;padding-bottom:10px}}@media (max-width:767px){.pg_learningsearchresults .cme-info .cme-activities{font-size:20px;padding-top:20px;padding-bottom:10px}}.cme-info{text-align:center;color:#000;padding-bottom:10px}.cme-info .icon-profile{font-size:22px;margin-right:6px}.cme-info .cme-credits{display:inline-block;margin:0 15px}.cme-info .cme-credits a{font-weight:500}.cme-info .cme-complete{margin:0 15px;display:inline-block}.cme-info .saved-search-status{margin:0 15px;display:inline-block}.cme-info .cme-activities{margin:0 15px;display:inline-block}.cme-info.access{line-height:2}.cme-info.access a{color:#000;vertical-align:middle}.cme-info.no-access{font-weight:500}.cme-subscription{text-align:center}.cme-subscription{font-size:14px}@media all and (max-width:360px){.cme-subscription{font-size:12px}}.page-learning .cme-subscription{text-align:left;margin-bottom:0;border-bottom:none;padding-bottom:0}.page-learning .cme-subscription-expiration{font-size:13px}@media all and (max-width:360px){.page-learning .cme-subscription-expiration{font-size:12px}}.page-learning .cme-complete{padding-bottom:1em}.page-learning .cme-activities{padding-bottom:1em}.page-journalarticlecme .widget-CreditStatusBar{min-width:325px}.page-journalarticlecme .cme-complete{padding-bottom:1em}.page-journalarticlecme .cme-activities{padding-bottom:1em}.page-journalarticlecme .cme-subscription{border:none;margin-bottom:0;padding-bottom:0;text-align:left}.page-journalarticlecme .cme-subscription-expiration{font-size:13px}@media all and (max-width:1200px){.page-journalarticlecme .cme-subscription-expiration{font-size:12px}}@media all and (max-width:1000px){.page-journalarticlecme .cme-subscription-expiration{font-size:13px}}@media all and (max-width:360px){.page-journalarticlecme .cme-subscription-expiration{font-size:12px}}.cme-number,.saved-search-number{background:#000;color:#f4f4f4;font-weight:700;font-size:12px;display:inline-block;border-radius:50%;line-height:16px;height:22px;min-width:22px;margin-right:6px;padding:3px;text-align:center;-webkit-print-color-adjust:exact}.cme-number--text,.saved-search-number--text{display:inline-block;font-weight:700;vertical-align:middle}.cme-avail-number{color:#4978bc;font-weight:700;font-size:12px;display:inline-block;border-radius:50%;border-style:solid;border-width:1px;border-color:#4978bc;line-height:16px;height:22px;min-width:22px;margin-right:6px;padding:3px;text-align:center;-webkit-print-color-adjust:exact}.cme-avail-number--text{display:inline-block;font-weight:700;vertical-align:middle}.activity-quiz-view-tabs{border:1px solid #ddd;padding:1em}@media (max-width:767px){.activity-quiz-view-tabs{padding:0}}.activity-quiz-view-tabs .btn{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700;background:#4978bc;border-color:#4978bc!important;color:#fff!important}.activity-quiz-view-tabs .btn:hover{cursor:pointer;text-decoration:none;background:#fff}.activity-quiz-view-tabs .btn:hover{color:#4978bc!important}.activity-quiz-view-tabs .take-quiz-tab a{color:#4978bc}.ed-objective{font-size:14px}.ed-objective b{font-size:1.25em;font-weight:700;line-height:1.3;line-height:2}.quiz-no-access{padding:1em}@media (max-width:767px){.quiz-no-access{padding:0}}.quiz-no-access .btn.btn--sign-in{margin-right:1em}@media (max-width:480px){.quiz-no-access .btn.btn--sign-in{margin:0 0 1em 0}}@media (max-width:480px){.quiz-no-access .btn{display:block}}.quiz--question-wrap{padding:.25em 4em}@media (max-width:767px){.quiz--question-wrap{padding:0}}.quiz--footer{padding:0 1em 1em 1.5em}@media (max-width:767px){.quiz--footer{padding:0}}.quiz--result--answer{margin-bottom:.75em}.content-cme-info{font-weight:500;margin-bottom:10px}.content-cme-info .cme-label{vertical-align:middle}.content-cme-info .cme-label:after{content:" | ";margin-left:2px;font-weight:500;margin:0 4px}.content-cme-info .cme-label:last-of-type:after{display:none}.content-cme-info .cme-label.credit-text{font-weight:700}.content-cme-info .cme-zero{background:#d3d3d3;color:#000}.superClassification{color:#000;font-size:1em;font-weight:700;line-height:1.3;margin-bottom:.5em}.no-csscolumns .pg_pastissues .issue-browse--decade-nav,.no-csscolumns .pg_pastissues .issue-browse--year-nav,.no-flexbox .pg_pastissues .issue-browse--decade-nav,.no-flexbox .pg_pastissues .issue-browse--year-nav{width:86px;float:left;overflow:hidden}.no-csscolumns .pg_pastissues .issue-browse--issue-nav,.no-flexbox .pg_pastissues .issue-browse--issue-nav{overflow:hidden;padding:0}.no-csscolumns .pg_pastissues .issue-entry,.no-flexbox .pg_pastissues .issue-entry{width:33%;float:left}@media (min-width:1024px){.no-csscolumns .pg_pastissues .issue-entry:nth-child(3n+1),.no-flexbox .pg_pastissues .issue-entry:nth-child(3n+1){clear:left}}@media (max-width:1023px){.no-csscolumns .pg_pastissues .issue-entry,.no-flexbox .pg_pastissues .issue-entry{width:50%}}@media (max-width:1023px){.no-csscolumns .pg_pastissues .issue-entry:nth-child(2n+1),.no-flexbox .pg_pastissues .issue-entry:nth-child(2n+1){clear:left}}.issue-view-links{margin-bottom:2em;text-align:center;position:relative}.issue-view-links:after{content:"";height:1px;display:block;border-bottom:1px solid #ddd;z-index:5;margin-top:1px}.issue-view-tab--contents{width:calc(100% - 340px - 40px);float:left}@media (max-width:1023px){.issue-view-tab--contents{width:auto;float:none}}.issue-view-tab--sidebar{width:340px;float:right;margin-left:1.5em;margin-bottom:1.5em}@media (max-width:1023px){.issue-view-tab--sidebar{float:none;margin:2em auto;width:auto}}@media (max-width:767px){.pg_currentissue .issue-view-tab--sidebar{margin-bottom:0}}.widget-IssuesTabbedView .issue-view-trigger{font-size:1.6rem;font-weight:700;margin:0 .6em;background:#f2f2f2;border:1px solid #ddd;border-bottom:none;display:inline-block;color:#000;position:relative;line-height:1.1;padding:.5em .75em;box-sizing:border-box;vertical-align:middle}.widget-IssuesTabbedView .issue-view-trigger:hover{text-decoration:none;color:#000}.widget-IssuesTabbedView .issue-view-trigger.target-tab-active{background:#fff;z-index:5;top:2px}.widget-IssuesTabbedView .issue-view-trigger.target-tab-active:before{position:absolute;content:"";display:block;height:1px;top:-5px;width:100%;width:calc(100% + 2px);left:-1px;box-sizing:border-box}.widget-IssuesTabbedView .issue-view-trigger.target-tab-active{cursor:default}@media (max-width:767px){.widget-IssuesTabbedView .issue-view-trigger{font-size:1.3rem}}@media (max-width:610px){.widget-IssuesTabbedView .issue-view-trigger{margin:0 .4em;padding:.3em .75em}}@media (max-width:480px){.widget-IssuesTabbedView .issue-view-trigger{font-size:1.25rem;margin:0 .2em;padding:.3em .4em}}@media (max-width:610px){.widget-IssuesTabbedView .issue-view-trigger span{display:block}}.issue--text{font-size:1.5em;color:#000}.issue--info{clear:both;margin-bottom:2.5em;position:relative;padding-right:75px}.issue--journal-rss{position:absolute;top:0;right:10px}.issue--journal-rss:before{font-size:1.75em;color:#000}.widget-IssuesNextAndPrevious .next,.widget-IssuesNextAndPrevious .previous{font-size:30px;color:#000}.widget-IssuesNextAndPrevious .next.disabled,.widget-IssuesNextAndPrevious .previous.disabled{color:#999}.widget-IssuesNextAndPrevious .previous{margin-right:.5em}.pg_currentissue .master-main,.pg_newonline .master-main,.pg_pastissues .master-main{padding:1em;max-width:1200px;margin:2em auto}.pg_currentissue .master-main::after,.pg_newonline .master-main::after,.pg_pastissues .master-main::after{clear:both;content:"";display:table!important}@media (max-width:480px){.pg_currentissue .master-main,.pg_newonline .master-main,.pg_pastissues .master-main{padding:1em 8px}}.pg_currentissue .always-hide,.pg_newonline .always-hide,.pg_pastissues .always-hide{display:none}.pg_currentissue .issue-content-section .issue-meta,.pg_newonline .issue-content-section .issue-meta,.pg_pastissues .issue-content-section .issue-meta{display:none}.pg_currentissue .issue-content-section .innerList li.selected,.pg_newonline .issue-content-section .innerList li.selected,.pg_pastissues .issue-content-section .innerList li.selected{background:#5bb5bb}.pg_currentissue select,.pg_newonline select,.pg_pastissues select{width:100%}.pg_currentissue .select-hed,.pg_newonline .select-hed,.pg_pastissues .select-hed{font-weight:500}.pg_currentissue .ad-single-box-mobile,.pg_newonline .ad-single-box-mobile,.pg_pastissues .ad-single-box-mobile{margin-top:.75em;margin-bottom:3em}.pg_currentissue .ad-interstitial{height:0}.pg_newonline .owl-carousel{display:block}.pg_newonline .new-online--controls{margin-bottom:2em}@media (max-width:767px){.pg_newonline .new-online--controls{display:none}}.pg_newonline .new-online--years{text-align:center}.pg_newonline .new-online--day,.pg_newonline .new-online--year{font-weight:400;font-size:1.25em;display:inline-block;padding:.5em;color:#333}.pg_newonline .new-online--day:hover,.pg_newonline .new-online--year:hover{text-decoration:none}.pg_newonline .new-online--day.selected,.pg_newonline .new-online--year.selected{font-weight:700}.pg_newonline .new-online--day.selected:hover,.pg_newonline .new-online--year.selected:hover{cursor:default}@media (max-width:480px){.pg_newonline .new-online--day,.pg_newonline .new-online--year{padding:.5em .25em}}.pg_newonline .new-online--days-wrap{position:relative;border-top:1px solid #ddd;border-bottom:1px solid #ddd}.pg_newonline .new-online--days{background:#edede3;padding:0 2em;text-align:center}.new-online-controls--mobile{margin-bottom:1em}.new-online-controls--mobile::after{clear:both;content:"";display:table!important}@media (min-width:768px){.new-online-controls--mobile{display:none}}.new-online-controls--mobile .year-wrap{width:52%;float:left;padding-right:20px}.new-online-controls--mobile .day-wrap{width:48%;float:left}.issue-browse--mobile{margin-bottom:1em}@media (min-width:768px){.issue-browse--mobile{display:none}}.issue-browse--mobile .decade-wrap{width:52%;float:left;padding-right:20px}.issue-browse--mobile .year-wrap{width:48%;float:left}.issue-browse--mobile .issue-select{padding-right:25px}.past-issues--range{font-size:1.5em;color:#000;margin-bottom:25px;font-weight:700}@media (max-width:767px){.past-issues--range{margin-bottom:20px}}.pg_pastissues .issue-browse{margin-bottom:3em;display:-webkit-box;display:-webkit-flex;display:flex}.pg_pastissues .issue-browse::after{clear:both;content:"";display:table!important}@media (max-width:767px){.pg_pastissues .issue-browse{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}}.pg_pastissues .issue-browse--decade-nav,.pg_pastissues .issue-browse--year-nav{-webkit-box-flex:0;-webkit-flex:0 0 86px;flex:0 0 86px;display:block;text-align:center}.pg_pastissues .issue-browse--year-nav{background:#edede3;border:1px solid #ddd}.pg_pastissues .issue-browse--issue-nav{padding:0;-webkit-box-flex:3;-webkit-flex-grow:3;flex-grow:3}.pg_pastissues .issue-browse--issues{margin:0;padding:0;list-style-type:none;-webkit-columns:3;columns:3;-webkit-column-width:180px;column-width:180px;-webkit-column-rule:1px solid #ddd;column-rule:1px solid #ddd;-webkit-column-fill:balance;column-fill:balance;-webkit-column-gap:0;column-gap:0;-webkit-column-break-inside:avoid;break-inside:avoid-column;overflow:hidden}.pg_pastissues .issue-browse--decades,.pg_pastissues .issue-browse--years{margin:0;padding:0}.pg_pastissues .issue-entry{font-weight:700;font-size:.875em;padding:5px 15px;line-height:1.4;color:#000;display:block;-webkit-column-break-inside:avoid;break-inside:avoid-column}.pg_pastissues .issue-entry:hover{text-decoration:none}.pg_pastissues .issue-entry.selected{background-color:#edede3;border:1px solid #ddd}.pg_pastissues .issue-theme,.pg_pastissues .issue-volume-page{font-weight:400;color:#333}.pg_pastissues .decade-entry,.pg_pastissues .year-entry{font-size:1.25em;font-weight:500;line-height:1.3;padding:11px 0;display:block;color:#000;display:block}.pg_pastissues .decade-entry:hover,.pg_pastissues .year-entry:hover{text-decoration:none}.pg_pastissues .decade-entry.selected{background-color:#edede3;position:relative;left:1px;border:1px solid #ddd;border-right:none}@-webkit-keyframes fadeInSlow{0%{opacity:0}80%{opacity:0}100%{opacity:1}}@keyframes fadeInSlow{0%{opacity:0}80%{opacity:0}100%{opacity:1}}.page-abstract .ad-interstitial{height:0}@media all and (max-width:1023px){.pg_abstract .ymal--leader,.pg_article .ymal--leader{margin-top:40px}}@media all and (max-width:767px){.pg_abstract .content{padding:40px 12px}.pg_article .article-content{padding-top:40px}}.pg_abstract .article-content,.widget-MagazineView .article-content{float:left;width:calc(100% - 340px - 50px);padding-left:100px}.pg_abstract .article-content::after,.widget-MagazineView .article-content::after{clear:both;content:"";display:table!important}@media (max-width:1180px){.pg_abstract .article-content,.widget-MagazineView .article-content{width:calc(100% - 300px - 30px)}}@media (max-width:1023px){.pg_abstract .article-content,.widget-MagazineView .article-content{width:auto;max-width:100%}}@media (max-width:767px){.pg_abstract .article-content,.widget-MagazineView .article-content{padding-left:0;padding-right:0}}.pg_abstract .sidebar,.widget-MagazineView .sidebar{-webkit-animation:fadeInSlow 1.5s ease-in-out;animation:fadeInSlow 1.5s ease-in-out;width:340px;float:right}@media (max-width:1180px){.pg_abstract .sidebar,.widget-MagazineView .sidebar{width:300px}}@media (max-width:1023px){.pg_abstract .sidebar,.widget-MagazineView .sidebar{clear:both;width:auto;margin:2em auto;float:none;text-align:center}}.pg_abstract .full-text-link,.widget-MagazineView .full-text-link{color:#fff;display:block;width:80px;margin:0 0 0 -100px;float:left;border-radius:5px 0 0 5px;padding:6px;line-height:1.2}@media (max-width:767px){.pg_abstract .full-text-link,.widget-MagazineView .full-text-link{display:none}}.pg_abstract .full-text-link--text,.widget-MagazineView .full-text-link--text{font-size:.8em;display:inline-block;vertical-align:middle}.pg_abstract .full-text-link--text-top,.widget-MagazineView .full-text-link--text-top{display:block}.pg_abstract .full-text-link:before,.widget-MagazineView .full-text-link:before{font-size:32px;margin-right:2px}.pg_abstract .full-text-link:hover,.widget-MagazineView .full-text-link:hover{color:#fff;text-decoration:none}.pg_abstract .abstract-content,.pg_abstract .magazine-content,.widget-MagazineView .abstract-content,.widget-MagazineView .magazine-content{margin-bottom:3em}.pg_abstract .widget-ArticleNavLinks,.widget-MagazineView .widget-ArticleNavLinks{margin:.5em .25em 1em 0}@media (max-width:767px){.pg_abstract .widget-ArticleNavLinks,.widget-MagazineView .widget-ArticleNavLinks{margin-bottom:0}}.pg_abstract .h3,.pg_abstract .section-title,.widget-MagazineView .h3,.widget-MagazineView .section-title{position:relative;text-transform:none;font-size:1.5em;margin-bottom:.75em}.pg_abstract .h3:after,.pg_abstract .section-title:after,.widget-MagazineView .h3:after,.widget-MagazineView .section-title:after{display:block;height:0;content:""}.pg_abstract .h3 .heading-text,.pg_abstract .section-title .heading-text,.widget-MagazineView .h3 .heading-text,.widget-MagazineView .section-title .heading-text{display:inline-block}.pg_abstract .related-topics-heading,.widget-MagazineView .related-topics-heading{text-align:left;margin-bottom:1em}@media (max-width:1023px){.pg_abstract .branded-bar,.widget-MagazineView .branded-bar{display:none}}.pg_abstract .cme-promo img,.widget-MagazineView .cme-promo img{display:block}@media (max-width:1023px){.pg_abstract .cme-promo img,.widget-MagazineView .cme-promo img{width:auto;margin-left:auto;margin-right:auto}}.pg_abstract .article-full-text .section-jump-link{color:#333}.pg_abstract .article-full-text .section-jump-link:hover{text-decoration:none;cursor:default}.abstract-content .full-text-link{width:200px}.abstract-content .full-text-link--text{font-size:1.2em;font-weight:700;margin-left:2px}.abstract-content .full-text-link--text-top{display:inline}.pg_signinshibboleth .shib-signin-right{padding-top:1em}@media (max-width:1023px){.pg_signinshibboleth .shib-signin-right{margin-top:2em}}.pg_signinshibboleth .athens-link{display:inline-block;margin-bottom:2em}.acct-section{font-size:15px;border-top:1px solid #ddd;border-bottom:1px solid #ddd;margin-top:-1px}.acct-section--hed{margin:0;padding:20px 0;transition:all .15s ease-in-out}.acct-section--hed:hover{cursor:pointer;color:#d71534}.acct-section--hed.target-active{color:#d71534}.acct-section--hed.target-active i{transition:all .15s ease-in-out}.acct-section--hed-count{color:#888}.acct-section--body{padding:0 48px 50px 48px}@media (max-width:767px){.acct-section--body{padding:0 40px 50px 40px}}@media (max-width:560px){.acct-section--body{padding:0 5px 50px 5px}}.acct-section .icon-edit{margin-right:4px}.acct-section .icon-email{position:relative;top:-1px}.edit-link{font-weight:700;font-size:13px;vertical-align:middle}.ama-profile,.jama-profile{font-weight:700;vertical-align:middle;margin-right:5px}.ama-account-profile{border-bottom:2px dotted #ddd;padding-bottom:1.5em;margin-bottom:1.5em}.need-help{margin:25px 20px 0 40px;padding:1em;background:#edede3}@media (max-width:767px){.need-help{margin:2em 0}}.need-help p:last-of-type{margin-bottom:0}h5.decorated{color:#000;font-weight:700;padding-bottom:10px;margin:25px 0 15px 0;border-bottom:1px solid #ddd}.jama-email-value{display:inline;font-weight:700}.data-row{line-height:1.4;margin-bottom:8px}.data-row:last-child{margin-bottom:0}.data-value{font-weight:700}.ast{color:#d71635}.data-label .ast{margin-left:-6px}.cme--create-pdf,.search-new-activity{display:inline}@media (max-width:480px){.cme--create-pdf,.search-new-activity{display:block;margin:1em 0 0 0}}.cme--summary{margin-bottom:.5em}@media (max-width:480px){.cme--summary{margin-bottom:1em}}.cme-number--text{margin-right:1em}.pg_myaccount .saved-search-status{display:inline-block}.pg_myaccount .saved-search-status .saved-search-number{background:#fff;border:2px solid #d71635;color:#d71635;height:24px;min-width:24px}.saved-search-status a:hover,.saved-search-status a:link{text-decoration:none}.cme--year{text-align:right}@media (max-width:480px){.cme--year{text-align:left}}@media (min-width:1024px){.cme--year{display:block;width:50%;float:right}}.cme--year [name=SelectedYear]{width:120px;margin:0 1em 0 0;padding:5px 10px}.cme--year label{margin-bottom:0}.responsive-table-wrap{overflow:auto;margin-bottom:1em}.accreditation-info p{font-size:13px;max-width:none}table.my-acct--table{border-collapse:collapse;font-size:14px;min-width:650px;width:100%}table.my-acct--table.my-subscriptions{min-width:480px}table.my-acct--table td,table.my-acct--table th{max-width:300px;min-width:94px}@media (max-width:900px){table.my-acct--table td,table.my-acct--table th{padding:10px 5px}}table.my-acct--table td .productDescription,table.my-acct--table th .productDescription{margin-left:30px}table.my-acct--table th{border-bottom:2px solid #ddd;font-weight:500;text-align:left;font-size:15px}table.my-acct--table th.completed-by{width:60%}table.my-acct--table td{border-bottom:2px dotted #ddd;vertical-align:top;padding:18px 9px}table.my-acct--table .checkbox-cell{padding-left:4px;padding-right:4px}table.my-acct--table .cme--title{font-weight:700}table.my-acct--table .cme--citation{color:#888}table.my-acct--table .cme--info{line-height:1.4}table.my-acct--table .cme--info>div{margin-bottom:6px}.affinity-alert-signup-box{background-color:#999;display:block;height:59px;margin:0;position:relative}.affinity-alert-signup-box a{color:#fff;font-family:"Guardian TextSans Web","Helvetica Neue",Helvetica,Arial,sans-serif;font-size:1rem;font-weight:700;line-height:19px;letter-spacing:.8px;position:relative;text-decoration:none;top:17%;display:block}.affinity-alert-signup-box+.widget-ManageCollectionInterests{margin-bottom:2rem}[data-thm=jaman] .affinity-alert-signup-box{margin:0 auto 2.5rem}.affinity-alert-signup-box__angle{width:0;height:0;border-style:solid;border-width:59px 0 0 59px;border-color:transparent transparent transparent #9e1f63;float:left;margin-right:10px}.manage-interests--categories{overflow-y:scroll;height:auto;max-height:470px;padding:0 4rem;background-color:#fff}.manage-interests--categories ul.category-list{margin-left:0}.manage-interests--categories ul.category-list li{font-size:1.5rem;color:#ccc;margin:0 0 .2rem 23px;list-style-type:circle}.manage-interests--categories ul.category-list li .category-list-item{display:inline-block;font-size:15px;cursor:pointer;position:relative;top:-2px;padding:.25rem 20px .25rem 29px;margin-left:-37px;vertical-align:middle;color:#000;border:2px solid #fff;border-radius:1rem}.manage-interests--categories ul.category-list .followed{font-weight:700;border:.15rem solid #000!important;background-color:rgba(0,0,0,.082)}.manage-interests--alert-signup{padding-top:1rem}.manage-interests--alert-signup .self-serve{text-align:center;margin:1rem 0 .25rem 0}.manage-interests--alert-signup .alert-input{font-size:.9rem!important;margin-top:8px!important;text-align:center}.manage-interests--alert-signup .alert-input div{display:inline-block;margin:0 1rem}.manage-interests--alert-signup .alert-input input[type=checkbox]{-ms-transform:scale(1.5);-moz-transform:scale(1.5);-webkit-transform:scale(1.5);-o-transform:scale(1.5);margin-bottom:0}.manage-interests--save-preferences{width:35%;text-align:center;background-color:#ccc;margin:0 auto;padding-top:0;position:relative;top:-5px}.manage-interests--save-preferences .save-preferences-btn{border-radius:.32rem;color:#fff;padding:.25rem;margin:2rem 0 .5rem 0}.manage-interests--save-preferences .save-preferences-btn-text{font-size:.9rem!important}.manage-interests--privacy-terms{color:#333;text-align:center;font-size:.75em}.manage-interests--privacy-terms-color{color:#333!important}.pg_myaccount .widget-ManageCollectionInterests .manage-interests--privacy-terms{padding-left:95px;text-align:left}.enabled{cursor:pointer}#my-interests .save-preferences-confirm{display:none;margin-bottom:1rem}#my-interests .save-preferences-confirm .save-preferences-feedback{color:#4a4a4a;font-size:14px;margin-left:4rem}#my-interests .manage-interests--categories{padding:0 1rem;border-top:1px solid #979797;padding-top:.25rem}#my-interests .manage-interests--alert-signup{border-top:1px solid #979797;margin-top:1rem}#my-interests .manage-interests--alert-signup .inner-div{width:50%}#my-interests .manage-interests--alert-signup .self-serve{margin-top:1rem;text-align:left}#my-interests .manage-interests--alert-signup .alert-input{text-align:left;margin:1rem 0 0 3rem}@media (max-width:767px){#my-interests .manage-interests--alert-signup .inner-div{width:100%}#my-interests .manage-interests--alert-signup .self-serve{text-align:center}}#my-interests .manage-interests--save-preferences{text-align:left;margin-left:4rem;background-color:#fff}#my-interests .manage-interests--save-preferences .save-preferences-btn{min-width:150px;width:50%;text-align:center}@media (max-width:767px){#my-interests .manage-interests--save-preferences{width:50%;margin:0 auto}#my-interests .manage-interests--save-preferences .save-preferences-btn{width:100%;text-align:center}}.ma-resource{padding:.75em 1.5em .75em 4em;border-top:1px solid #ddd;border-bottom:1px solid #ddd;margin-top:-1px}.ma-resource-title .icon-jn{margin-left:-37px;font-size:28px;margin-right:4px}@media (max-width:767px){.renew-selected--note{display:block;margin:-10px 0 15px}}.my-email-alerts{font-weight:500}.ma-resource{padding:.75em 1.5em .75em 4em;border-top:1px solid #ddd;border-bottom:1px solid #ddd}.ma-resource-title .icon-jn{margin-left:-37px;font-size:28px;margin-right:4px}.error--title{margin-bottom:.2em}.error--message{margin-bottom:2em}.error--return{margin-bottom:1.5em}[data-thm=learn] .cme--microsites a:hover,[data-thm=learn] .cme--microsites li.activeTab a{color:#4978bc}[data-thm=learn] .btn--jama-sec.btn--jama-sec,[data-thm=learn] .btn--jama.btn--jama{background:#4978bc;border-color:#4978bc}[data-thm=learn] .btn--jama-sec.btn--jama-sec.selected,[data-thm=learn] .btn--jama-sec.btn--jama-sec:hover,[data-thm=learn] .btn--jama.btn--jama.selected,[data-thm=learn] .btn--jama.btn--jama:hover{background:#fff;color:#4978bc;border-color:#4978bc}[data-thm=learn] .btn--jama-sec.btn--jama-sec.selected:hover,[data-thm=learn] .btn--jama.btn--jama.selected:hover{background-color:#4978bc;border-color:#4978bc;color:#fff}[data-thm=learn] .learning-email-signup .email-signup--text,[data-thm=learn] .learning-email-signup-mobile .email-signup--text{color:#000}[data-thm=learn] .cme-info .cme-zero{background:#4978bc;color:#fff}[data-thm=learn] .content-cme-info .cme-zero{background:#000;color:#fff}[data-thm=learn] .cme-info-box .btn--jama-sec.btn--jama-sec,[data-thm=learn] .cme-info-box .btn--jama.btn--jama{background:#4978bc;border-color:#4978bc}[data-thm=learn] .cme-info-box .btn--jama-sec.btn--jama-sec.selected,[data-thm=learn] .cme-info-box .btn--jama-sec.btn--jama-sec:hover,[data-thm=learn] .cme-info-box .btn--jama.btn--jama.selected,[data-thm=learn] .cme-info-box .btn--jama.btn--jama:hover{background:#fff;color:#4978bc;border-color:#4978bc}[data-thm=learn] .cme-info-box .btn--free-cme{background:#000;border-color:#000}[data-thm=learn] .cme-info-box .btn--free-cme.selected,[data-thm=learn] .cme-info-box .btn--free-cme:hover{background:#fff;color:#000;border-color:#000}[data-thm=learn] .cme-info-box .btn-alt{color:#000;border:2px solid #000}[data-thm=learn] .cme-info-box .btn-alt:hover{background:#000;color:#fff}[data-thm=learn] .cmeCoursesContainer .branded-bar{background:#000}[data-thm=learn] .jama-col-sec{color:#4978bc!important}[data-thm=learn] .cme>.self-serve .collapsible button:after{color:#4978bc}[data-thm=learn] .credit-status{border-bottom:1px solid #ddd;padding-bottom:10px;margin-bottom:2em}@media all and (max-width:1024px){[data-thm=learn] .credit-status{padding-top:1em}}[data-thm=learn] .cme-info .icon-profile:before,[data-thm=learn] .cme-info-box .icon-profile:before{color:#4978bc}[data-thm=learn] .cme-info .cme-number,[data-thm=learn] .cme-info .saved-search-number,[data-thm=learn] .cme-info-box .cme-number,[data-thm=learn] .cme-info-box .saved-search-number{background:#4978bc}[data-thm=learn] .cme-info .cme-avail-number,[data-thm=learn] .cme-info-box .cme-avail-number{background:0 0;color:#4978bc;border-color:#4978bc;border-radius:50%}[data-thm=learn] .accreditation-disclosure h6{color:#000}[data-thm=learn] .learning-tab-contents .badges,[data-thm=learn] .learning-tab-contents .learn-by--pub-name,[data-thm=learn] .learning-tab-contents .learning--title{margin:.5em 1em}[data-thm=learn] .learn-by--item .badges,[data-thm=learn] .learn-by--item .learn-by--pub-name,[data-thm=learn] .learn-by--item .learning--title{margin:.5em 1em}[data-thm=learn] .ss-box.themed-border:before{background:#000}[data-thm=learn] .underlined-header{border-bottom:1px solid #000}[data-thm=learn] .underlined-header span{color:#000;border-bottom:5px solid #000}[data-thm=learn] .list-style-1 li:before{color:#000}[data-thm=learn] .underlined-header span{color:#000}.learning .learn-by--item .article{display:none}.learning-content{max-width:1300px;margin-left:auto;margin-right:auto}.free-cme-offer{margin-bottom:2em}@media (max-width:1023px){.free-cme-offer{margin-bottom:.5em}}@media (min-width:1024px){.accreditation-disclosure{height:169px}}.accreditation-disclosure p{font-size:.9em}.accreditation-disclosure div.self-serve{max-height:116px;overflow:auto}@media (max-width:1023px){.accreditation-disclosure div.self-serve{max-height:150px}}@media (max-width:1023px){.pg_learning .accreditation-disclosure div.self-serve{max-height:none}}.learning-image img{width:100%}.learn-by--item .learn-by--pub-name,.learn-by--item .learning-pub-info{margin:.5em 0}.learn-by--item .badges{margin-bottom:10px}.most--tab .learn-by--item .badges{display:none}.learning-view-button{float:right}.learn-by--footer .more--btn{clear:both;display:block;background:#f3f3f3;padding:.6em 1em;margin-bottom:2em;font-weight:700;line-height:1.45;font-size:1.5em;margin-right:10px;color:#000}.learn-by--footer .more--btn .btn{font-size:16px;float:right}.learn-by--footer .more--btn:hover .btn{text-decoration:none;background:#fff;color:#4978bc;border-color:#4978bc}.learn-by--footer .more--btn:hover{text-decoration:none;color:#000}.learn-by--footer .more--btn .icon-audio:before,.learn-by--footer .more--btn .icon-multimedia:before,.learn-by--footer .more--btn .icon-quiz:before{color:#4978bc}.learn-by--footer .more--btn .icon-quiz{font-size:30px}.learn-by--footer .more--btn .icon-audio{font-size:30px}.learn-by--footer .more--btn .icon-multimedia{font-size:35px}.learn-by--hed{border-bottom:1px solid #ddd;padding-bottom:8px;margin-bottom:25px}.learning-email-signup-mobile,.learning-sign-in-mobile{margin-top:2em;display:none}.learning-email-signup-mobile .box-content,.learning-sign-in-mobile .box-content{background:0 0}.learning-email-signup,.learning-sign-in{display:block}.learning-sign-in .btn,.learning-sign-in .btn--jama.btn--jama,.learning-sign-in-mobile .btn,.learning-sign-in-mobile .btn--jama.btn--jama{background:#000;border-color:#000}.learning-sign-in .btn--jama.btn--jama:hover,.learning-sign-in .btn:hover,.learning-sign-in-mobile .btn--jama.btn--jama:hover,.learning-sign-in-mobile .btn:hover{border-color:#000;color:#000;background:#fff}.learning-sign-in .jama-col-sec,.learning-sign-in-mobile .jama-col-sec{color:#4978bc!important}.learning-sign-in .btn-alt,.learning-sign-in-mobile .btn-alt{border-color:#000;color:#000;border:2px solid #000}.learning-sign-in .btn-alt:hover,.learning-sign-in-mobile .btn-alt:hover{background:#000}.learning-view-tab-sidebar{margin-right:.5em}@media (max-width:1030px){.learning-content{margin:2em}.learning-email-signup-mobile,.learning-sign-in-mobile{display:block}.learning-email-signup,.learning-sign-in{display:none}.learning-selfserve-footer{width:auto;float:none}}@media (min-width:1030px){.learning-selfserve-footer,.learning-tab-contents{width:calc(100% - 340px - 68px);margin-left:20px}}.learning-jumbotron-selfserve{width:100%;max-width:none;text-align:center}.learning-jumbotron-selfserve .self-serve{max-height:450px;overflow:hidden;max-width:none}.learning-jumbotron-selfserve img{height:auto;width:100%}.learning-jumbotron-selfserve h1{padding-top:50px}.learning-jumbotron-selfserve .btn{background:0 0;border-color:#fff}.learning-jumbotron-selfserve .btn:hover{background:#fff;border-color:#fff;color:#000}.about-cme-links a,.about-cme-links a:hover{color:#000}.learning-search .sr-filters a{color:#4978bc}.learning-search .facet-more-less{color:#4978bc}.learning-search .facet-more-less:hover{text-decoration:none}.learning-search .facet-more-less .symbol{letter-spacing:.075em}.learning--pagination .pagination{float:left;width:50%;text-align:right;border-top:0;margin:0}.learning--pagination .pagination .btn{width:45%;min-width:110px;background-color:#fff;border-color:#4978bc;color:#4978bc}.learning--pagination .pagination .btn:hover{background-color:#4978bc;border-color:#fff;color:#fff}@media (max-width:767px){.learning--pagination .pagination .btn{padding:2px 12px;font-size:1em}}@media (max-width:767px){.learning--pagination .pagination{height:100px;float:none;text-align:center;margin:0 auto}}.learning--pagination .learning--start-learning{width:50%;float:left;padding:2em 1em}.learning--pagination .learning--start-learning .btn{min-width:95px}@media (max-width:767px){.learning--pagination .learning--start-learning .btn{padding:2px 12px;font-size:1em}}@media (max-width:767px){.learning--pagination .learning--start-learning{height:100px}}.learning--pagination .learning-results-buttons{border-top:1px solid #ddd;margin:1em}.learning-search-results-footer-ss{display:inline-block;width:100%}.learning-search-results-contents .article{width:calc(25% - 10px);margin-right:10px;margin-bottom:21px;-webkit-box-flex:0;-webkit-flex-grow:0;flex-grow:0;-webkit-flex-shrink:0;flex-shrink:0}@media (min-width:1024px){.learning-search-results-contents .article:nth-of-type(4n){margin-right:0}}@media (min-width:640px) and (max-width:1030px){.learning-search-results-contents .article{width:calc(50% - 10px);margin-right:20px;margin-bottom:20px}.learning-search-results-contents .article .learning--title{font-size:1em}}@media (max-width:1030px){.learning-search-results-contents .article:nth-of-type(even){margin-right:0}}@media (max-width:640px){.learning-search-results-contents .article{width:100%;margin:0 0 1em 0}.learning-search-results-contents .article .learning--title{font-size:1em}}.widget-LearningNextActivity,.widget-instance-AMA_PersonalizedContent_LearningNextActivity{overflow:visible;position:relative}.widget-LearningNextActivity .home-breadcrumb,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .home-breadcrumb{margin:1.5em 0}.widget-LearningNextActivity .home-breadcrumb a,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .home-breadcrumb a{font-weight:700}.widget-LearningNextActivity .learning-search-results-contents .next,.widget-LearningNextActivity .learning-search-results-contents .previous,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .previous{position:absolute;top:268px;font-size:40px}.widget-LearningNextActivity .learning-search-results-contents .next.disabled,.widget-LearningNextActivity .learning-search-results-contents .previous.disabled,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next.disabled,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .previous.disabled{color:#ddd!important;cursor:default!important;pointer-events:none}.widget-LearningNextActivity .learning-search-results-contents .next .activity-label,.widget-LearningNextActivity .learning-search-results-contents .previous .activity-label,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next .activity-label,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .previous .activity-label{display:none}.widget-LearningNextActivity .learning-search-results-contents .previous,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .previous{-webkit-transform:translateX(-135%) translateY(-100%);transform:translateX(-135%) translateY(-100%)}.widget-LearningNextActivity .learning-search-results-contents .next,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next{left:auto;right:0;-webkit-transform:translateX(135%) translateY(-100%);transform:translateX(135%) translateY(-100%)}@media (max-width:1100px){.widget-LearningNextActivity .learning-search-results-contents .next,.widget-LearningNextActivity .learning-search-results-contents .previous,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .previous{bottom:0;top:auto;-webkit-transform:translateX(0) translateY(100%);transform:translateX(0) translateY(100%);left:0}.widget-LearningNextActivity .learning-search-results-contents .next .activity-label,.widget-LearningNextActivity .learning-search-results-contents .previous .activity-label,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next .activity-label,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .previous .activity-label{display:block;display:inline;padding:0 10px;vertical-align:middle;font-size:22px}.widget-LearningNextActivity .learning-search-results-contents .next,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .next{left:auto;right:0}}.widget-LearningNextActivity .learning-search-results-contents .article,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .article{width:calc(20% - 10px);margin-right:10px;margin-bottom:21px;-webkit-box-flex:0;-webkit-flex-grow:0;flex-grow:0;-webkit-flex-shrink:0;flex-shrink:0}@media (min-width:1024px){.widget-LearningNextActivity .learning-search-results-contents .article.rowItem-5,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .article.rowItem-5{margin-right:0;margin-left:10px}}@media (max-width:1100px){.widget-LearningNextActivity .learning-search-results-contents .article,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .article{width:calc(50% - 10px);margin-right:10px;margin-bottom:20px}.widget-LearningNextActivity .learning-search-results-contents .article .learning--title,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .article .learning--title{font-size:1em}}@media (max-width:1030px){.widget-LearningNextActivity .learning-search-results-contents .article .rowItem-4,.widget-LearningNextActivity .learning-search-results-contents .article.rowItem-2,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .article .rowItem-4,.widget-instance-AMA_PersonalizedContent_LearningNextActivity .learning-search-results-contents .article.rowItem-2{margin-right:0}}.learn-by--item .outer-crop{white-space:nowrap;width:100%;padding-bottom:100%;position:relative;height:0;display:block;overflow:hidden;text-align:center;margin-bottom:1px}.learn-by--item .inner-crop{width:100%;height:100%;position:absolute}.learn-by--item .helper{display:inline-block;height:100%;vertical-align:middle}.learn-by--item img{display:block;min-width:100%;min-height:100%;max-width:120%;width:auto;height:auto;margin:auto;position:absolute;top:-100%;right:-100%;bottom:-100%;left:-100%}.related-topics .topic-suggestions-heading{text-transform:capitalize;text-align:left;margin-bottom:.75em}.widget-MostViewedCited{clear:both;margin-bottom:2em}.widget-MostViewedCited .most--links{text-align:center;padding:0 8px}.widget-MostViewedCited .most--tab-link{background:#f2f2f2;border:1px solid #ddd;border-bottom:none;display:inline-block;color:#000;position:relative;line-height:1.1;padding:.5em .75em;box-sizing:border-box;vertical-align:middle;text-transform:uppercase;font-weight:500;padding:.9em .5em;margin:0;display:block;float:left;width:50%;box-sizing:border-box}.widget-MostViewedCited .most--tab-link:hover{text-decoration:none;color:#000}.widget-MostViewedCited .most--tab-link.target-tab-active{background:#fff;z-index:5;top:2px}.widget-MostViewedCited .most--tab-link.target-tab-active:before{position:absolute;content:"";display:block;height:1px;top:-5px;width:100%;width:calc(100% + 2px);left:-1px;box-sizing:border-box}.widget-MostViewedCited .most--tab-link:hover{cursor:pointer}.widget-MostViewedCited .most--tab-link.target-tab-active{top:1px}.widget-MostViewedCited .icon-rss{font-size:1.2em;margin:-2px 0 0 8px}@media (max-width:375px){.widget-MostViewedCited .icon-rss{margin-left:2px}}.widget-MostViewedCited .most--text{font-size:.9em;width:67%;display:inline-block;vertical-align:inherit}.widget-MostViewedCited .most--tabs{padding:0 8px;border:1px solid #ddd}.widget-MostViewedCited .most--tab{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}.widget-MostViewedCited .most--tab.tab-active{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none}[data-thm=jaman] .widget-MostViewedCited{margin-bottom:2.5rem}.journal-sidebar .widget-MostViewedCited .most--tab-link{padding:.6em .5em}.journal-sidebar .widget-MostViewedCited .most--text{font-size:.9em}@media (max-width:350px){.journal-sidebar .widget-MostViewedCited .most--text{font-size:1em}}.social-links{padding:0 0 2em 0}@media (max-width:1023px){.pg_collection .social-links{text-align:center}}.social-links .social-link{display:inline-block;width:auto;min-width:0;margin-bottom:.3em;color:#404040}.social-links .social-link:before{font-size:2.5em}.social-links .social-link:hover{text-decoration:none}.social-links .social-link:last-of-type{margin-bottom:.1em}.social-links .twitter:hover{color:#527fb6}.social-links .facebook:hover{color:#3d5b97}.social-links .linked-in:hover{color:#1677bb}.social-links .google-plus:hover{color:#d64937}.social-links .pinterest:hover{color:#cc2127}.social-links .podcast:hover{color:#970c11}.social-links .you-tube:hover{color:#ec2828}.social-links .rss:hover{color:#fc981c}.footer .social-links{padding:10px 20px;border-bottom:1px solid #555}@media (min-width:768px) and (max-width:1023px){.footer .social-links{width:33.3%;border-bottom:none;border-right:1px solid #555}}.footer .social-link{color:#fff}@media (min-width:768px) and (max-width:1023px){.journal-sidebar .social-links,.network-sidebar .social-links{width:50%;float:left;margin-top:.5em}}@media (max-width:1023px){.journal-sidebar .social-links,.network-sidebar .social-links{text-align:center}}@media (max-width:480px){.journal-sidebar .social-links,.network-sidebar .social-links{margin-left:-5px;margin-right:-5px}}.journal-sidebar .social-link,.network-sidebar .social-link{margin-left:-1px;margin-right:-1px}@media (max-width:480px){.journal-sidebar .social-link,.network-sidebar .social-link{margin-left:-2px;margin-right:-2px}}#learning_social_share{font-size:xx-large}#learning_social_share .social-share{display:inline-block;float:none;width:auto;margin:0}#learning_social_share .toolbar-share{display:inline-block}#learning_social_share a{color:#333}.linked-content-toolbar{margin-bottom:2em;display:none}.linked-content-toolbar::after{clear:both;content:"";display:table!important}.linked-content-toolbar.activated{display:block}.linked-content-toolbar .linked-content-controls{display:table;width:100%}.linked-content-toolbar .linked-content-trigger{font-weight:500;display:table-cell;text-align:center;border-left:1px solid #ddd;padding:10px 2px;color:#000}.linked-content-toolbar .linked-content-trigger:last-child{border-right:1px solid #ddd}.linked-content-toolbar .linked-content-trigger:hover{color:#000}.linked-content-toolbar .linked-content-trigger i:before{font-size:1.5em;margin-right:5px}.linked-content-toolbar .linked-content-trigger.target-tab-active{background:#edede3}.linked-content-toolbar .linked-content-trigger .trigger-text{line-height:1.2;font-size:.8em}@media (max-width:560px){.linked-content-toolbar .linked-content-trigger .trigger-text{display:none}}.linked-content-tab{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0;clear:both;padding:1em;background:#edede3;font-size:.85em;font-weight:500;line-height:1.5}.linked-content-tab.tab-active{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none}.linked-content-tab .article-links{margin:0;padding:0;list-style-type:none}.linked-content-tab .article-links .article-link{margin-bottom:1em}.linked-content-tab .article-links .article-link:last-of-type{margin-bottom:0}.linked-content-tab .article-abstract-links .article-link:last-of-type{margin-bottom:0}.linked-content-tab a{color:#000}.linked-content-tab a:hover{text-decoration:none}.linked-content-tab .related-article-title{display:block}.linked-content-tab .related-article-title .subtitle:before{content:": "}.linked-content-tab .related-article-type{display:inline-block;position:relative;font-style:italic;color:#888;font-weight:700}.linked-content-tab .related-article-authors{font-weight:400;color:#888}.linked-content-tab .related-article-date{font-style:italic;display:inline-block;font-weight:400;color:#888}.linked-content-tab .multimedia-item{margin-bottom:1em}.linked-content-tab .multimedia-item:last-of-type{margin-bottom:0}.linked-content-tab .multimedia-duration,.linked-content-tab .multimedia-group-type{font-style:italic;color:#888;font-weight:700}.linked-content-tab .related-abstract-content{padding:0;margin:0}.linked-content-tab .figure-caption,.linked-content-tab .figure-label,.linked-content-tab .figure-table-links,.linked-content-tab .graphical-abstract-label{display:none}.article-type-group{font-weight:700;font-size:1.6em;padding-bottom:.5em;display:block;line-height:1.2}.article-type-group:hover{text-decoration:none}.article{border-top:1px solid #ddd;padding-top:1.25em;padding-bottom:1.5em}.article::after{clear:both;content:"";display:table!important}[data-thm=jaman] .article{padding-top:1.875rem}.article:last-child{border-bottom:none}.article .pdfaccess{float:right;margin:0 0 1em 3em;display:block;width:60px;height:60px;background:url(/UI/app/svg/pdf_color.svg);background-repeat:no-repeat;background-size:contain}@media (max-width:767px){.article .pdfaccess{width:45px;height:45px}}@media (max-width:767px){.article .pdfaccess{margin:5px 0 .5em .25em}}.article .nopdf{float:right;margin:0 0 1em 3em;padding:0 5em 4em 0}@media (max-width:767px){.article .nopdf{margin:5px 0 .5em .25em}}.article.learning{border-top:0}.master-main .article .result--title,.master-main .article--title{font-size:1.75em;font-weight:500;line-height:1.3;margin:0 0 .3em 0;font-size:1.5em;display:block;font-weight:700;color:#000}@media (max-width:767px){.master-main .article .result--title,.master-main .article--title{font-size:1.5em}}.article .result--title a,.article--title a{color:#000}.master-main .article .learning-result-title{margin:0 0 .3em 0;font-size:1em;display:block;font-weight:700;color:#000}.article .learning-result-title a{color:#000}.article .learning-result-title .content--label{font-weight:400}.article--authors{margin-bottom:8px;font-size:.9em}[data-thm=jaman] .article--authors{font-size:.875rem}.article--links{font-weight:700;margin:.5em 0 8px 0;font-size:.9em}[data-thm=jaman] .article--links{font-size:1rem}.article--links .icon-pdf{font-size:20px}.article--author-interview p{display:inline}.article--author-interview .icon-podcast{font-size:2.6em;margin-right:5px}@media (max-width:1023px){.article--author-interview .icon-podcast{float:left}}@media (min-width:1024px){.article--author-interview-text{display:inline-block;width:calc(100% - 52px);vertical-align:middle}}.article--cme,.article--full-text,.article--pdf{position:relative}.article--cme:before,.article--full-text:before,.article--pdf:before{content:"|";display:inline-block;margin:0 8px}.article .badges{display:inline-block;margin:0 0 .3em 0}@media (max-width:767px){.article .badges{margin-bottom:8px}}.article .badge:before{vertical-align:middle;font-size:1.25em;margin-right:10px;display:inline-block}.article .badge.icon-cme:before{font-size:1.4em}.article .badge.icon-multimedia{font-size:1.3em}.article .badge.icon-audio{font-size:1.35em}.article--citation{font-size:.9em;display:inline;vertical-align:middle;line-height:1.4;margin-bottom:.5em}@media (max-width:767px){.article--citation{display:inline-block}}.article .result--journal,.article--journal{font-weight:700;margin-bottom:4px;font-size:.9em}.article .result--content{float:left;width:calc(100% - 265px)}@media (max-width:1150px){.article .result--content{width:calc(100% - 210px)}}@media (max-width:950px){.article .result--content{float:none;width:auto}}.article .learning-result-content{margin:1em}.article .learning-result-content .pub-date{display:inline-block}.article .result--image{float:right;max-width:230px;margin-left:35px;margin-top:5px}@media (max-width:1150px){.article .result--image{max-width:190px;margin-left:20px}}@media (max-width:950px){.article .result--image{float:none;width:auto;margin:12px 0 0 0;max-width:230px}}.article .result--image .video-overlay{background:#d71635;bottom:0;left:0;display:inline-block;font-size:30px;padding:5px 10px}.article .result--excerpt,.article--excerpt{color:#000;font-weight:500}.article .result--excerpt p,.article--excerpt p{margin-bottom:0}.article .result--excerpt p:last-of-type,.article--excerpt p:last-of-type{margin-bottom:0}.article--excerpt{margin:1.25rem 0 8px 0}.article--excerpt p{font-size:1rem}.article .result--excerpt{margin-top:8px;font-size:.9em}.article--count-text{display:block}.article--linked-articles{overflow:hidden;list-style-type:none;padding:0 0 0 32px;margin:.75em 0 1.25em 0}.article--linked-articles.left-align{padding:0 0 0 10px}@media (max-width:480px){.article--linked-articles{padding:0 0 0 10px;margin:.75em 0 .25em 0}}[data-thm=jaman] .article--linked-articles .article--links{font-size:.875rem}.article .linked-article--article{padding-left:10px;position:relative;padding-bottom:14px;line-height:1.4}@media (max-width:480px){.article .linked-article--article{padding-left:0}}.article .linked-article--article:last-child{padding-bottom:0}.article .linked-article{font-weight:700;display:block;margin:25px 0 .5em 0}.article .linked-article--type{font-size:1.35em}.article .linked-article--type-small{font-size:1em;margin-bottom:1em}.article .linked-article--title{display:block;margin-bottom:.3em;font-weight:700;color:#000;font-size:1.1em;position:relative}.article .linked-article--title .subtitle:before{content:": "}[data-thm=jaman] .article .linked-article--title{margin-bottom:.375rem}.article .vertical-line:before{content:"";display:block;position:absolute;height:calc(100% - 6%);border-left:1px solid #9e1f63;right:101%;margin-top:.25rem}@media (max-width:480px){.article .vertical-line:before{width:20px;right:97%}}.article .angled-line:before{content:"";display:block;position:absolute;height:200px;width:32px;border-left:1px solid #888;border-bottom:1px solid #888;bottom:12px;bottom:calc(100% - 11px);right:101%;right:calc(100% + 10px - 1px)}@media (max-width:480px){.article .angled-line:before{width:10px;right:101%;right:calc(100% + 8px - 1px)}}.article .linked-article--authors{margin-bottom:8px;font-size:.9em}[data-thm=jaman] .article .linked-article--authors{margin-bottom:.375rem}.featured-list--contents{margin:0;padding:0;list-style-type:none;font-weight:500;line-height:1.45}.sidebar .widget-ArticleListWithTocHeadings .featured-list--contents{margin-bottom:1em}.featured-list--contents .article{padding:1em 0}.featured-list--contents .article--title{display:inline;font-weight:500;font-size:1em;margin:0;vertical-align:middle;line-height:1.4}.featured-list--contents .article--title .subtitle{display:none}.featured-list--contents .article--comments,.featured-list--contents .article--date,.featured-list--contents .article--type{font-size:.85em;font-style:italic;color:#535353;margin-bottom:.6em}.widget-ArticleBrowseSearchResults .featured-list--contents .article--comments,.widget-ArticleBrowseSearchResults .featured-list--contents .article--date,.widget-ArticleBrowseSearchResults .featured-list--contents .article--type{font-style:normal}.widget-ArticleBrowseSearchResults .featured-list--contents .article--pub-name{font-style:italic;color:#535353}.featured-list--contents .article--access-type:before{margin-bottom:0}.sidebar .widget-ArticleListWithTocHeadings .featured-list--contents .article{border-top:none;border-bottom:1px solid #ddd}.sidebar .widget-ArticleListWithTocHeadings .featured-list--contents .article--title{margin-bottom:8px;display:block}.most--tabs .featured-list--contents .article{padding:1em .5em 1em 0;margin:0;border-top:1px solid #ddd}.most--tabs .featured-list--contents .article:first-of-type{border-top:none}@media (max-width:480px){.most--tabs .featured-list--contents .article{padding:1em 0}}.most--tabs .featured-list--contents .article--count{float:left;width:80px;padding-right:5px;text-align:center;margin-top:2px}@media (max-width:480px){.most--tabs .featured-list--contents .article--count{width:72px}}.most--tabs .featured-list--contents .article--meta{overflow:hidden}.most--tabs .featured-list--contents .article--access-type,.most--tabs .featured-list--contents .article--img-wrapper,.most--tabs .featured-list--contents .article--related-articles,.most--tabs .featured-list--contents .article--type{display:none}.widget-JustPublished .featured-list--contents .article{margin-bottom:0;border-bottom:none}.widget-JustPublished .featured-list--contents .article--author-list{display:none}.widget-JustPublished .featured-list--contents .article--access-type{display:inline-block;margin-bottom:.6em}.widget-JustPublished .featured-list--contents .article--related-articles{line-height:1.3;margin-bottom:.35em}.widget-JustPublished .featured-list--contents .article--related{font-size:.85em;color:#000;position:relative;font-weight:600}.widget-JustPublished .featured-list--contents .article--related:first-of-type:before{display:none}.widget-JustPublished .featured-list--contents .article--related:before{content:"|";display:inline-block;margin:0 5px;color:#000}.article-browse .featured-list--contents .article,.journal-contents .ymal .featured-list--contents .article,.widget-JustPublished .featured-list--contents .article,.ymal--footer .featured-list--contents .article{background:#f3f3f3;padding:.6em .75em}.article-browse .featured-list--contents .article--title,.journal-contents .ymal .featured-list--contents .article--title,.widget-JustPublished .featured-list--contents .article--title,.ymal--footer .featured-list--contents .article--title{font-weight:700;margin-bottom:.5em;display:block;line-height:1.45}.article-browse .featured-list--contents .article .advertisement,.journal-contents .ymal .featured-list--contents .article .advertisement,.widget-JustPublished .featured-list--contents .article .advertisement,.ymal--footer .featured-list--contents .article .advertisement{margin-bottom:0;margin-top:-5px}.learning-search-results-contents .featured-list--contents .article{background:#f3f3f3;padding:0}.learning-search-results-contents .featured-list--contents .article--title{font-weight:700;margin-bottom:.5em;display:block;line-height:1.45}.learning-search-results-contents .featured-list--contents .article .advertisement{margin-bottom:0;margin-top:-5px}.article-browse .featured-list--contents .article,.journal-contents .ymal .featured-list--contents .article,.ymal--footer .featured-list--contents .article{width:calc(33.333% - 14px);margin-right:21px;margin-bottom:21px;-webkit-box-flex:0;-webkit-flex-grow:0;flex-grow:0;-webkit-flex-shrink:0;flex-shrink:0}@media (min-width:1024px){.article-browse .featured-list--contents .article:nth-of-type(3n),.journal-contents .ymal .featured-list--contents .article:nth-of-type(3n),.ymal--footer .featured-list--contents .article:nth-of-type(3n){margin-right:0}}@media (max-width:640px){.article-browse .featured-list--contents .article,.journal-contents .ymal .featured-list--contents .article,.ymal--footer .featured-list--contents .article{width:100%;margin:0 0 1em 0}}[data-thm=jaman] .article-browse .featured-list--contents .article,[data-thm=jaman] .journal-contents .ymal .featured-list--contents .article,[data-thm=jaman] .ymal--footer .featured-list--contents .article{margin-bottom:.75rem}@media (min-width:640px) and (max-width:1023px){.article-browse .featured-list--contents .article{width:calc(50% - 10px);margin-right:20px;margin-bottom:20px}}@media (min-width:640px) and (max-width:1023px){.article-browse .featured-list--contents .article:nth-of-type(even){margin-right:0}}.article-browse .featured-list--contents .article.pre-ad-item{-webkit-box-flex:2;-webkit-flex-grow:2;flex-grow:2;-webkit-flex-shrink:2;flex-shrink:2;width:25%}@media (min-width:640px) and (max-width:1023px){.article-browse .featured-list--contents .article.movable-ad-target+.article{-webkit-box-flex:2;-webkit-flex-grow:2;flex-grow:2;-webkit-flex-shrink:2;flex-shrink:2;width:45%}}.ymal--leader .featured-list--contents .article{width:50%;float:left;padding:0 1.25em;border-top:none}.ymal--leader .featured-list--contents .article:nth-of-type(even){border-left:1px solid #ddd;margin-left:-1px}.ymal--leader .featured-list--contents .article:nth-of-type(odd){border-right:1px solid #ddd}.featured-list--contents .badge{margin-bottom:10px}.most--tab .featured-list--contents .badge{display:none}.featured-list--contents .meta-item{display:inline-block;position:relative;font-size:.9em}.featured-list--contents .meta-item:after{content:"|";margin-left:6px;margin-right:1px}.featured-list--contents .meta-item:last-of-type:after{display:none}.pg_collection .pipe{padding:0 .5rem}.pg_collection .header--image img{width:100%}.pg_collection .header--description p{font-size:1em;line-height:1.75}.pg_collection .header--alert{margin-top:.75em}.pg_collection .header--alert p{font-size:.9em}.pg_collection .header--alert p .icon-follow,.pg_collection .header--alert p .icon-minus{font-size:2em;padding-right:5px}.pg_collection .header--alert p .not-red{color:#333}.pg_collection .collection-follow-links .follow-link,.pg_collection .collection-follow-links .unfollow-link{color:#333}.pg_collection .collection-follow-links .icon-follow,.pg_collection .collection-follow-links .icon-minus{font-size:1.5em;padding-right:5px;vertical-align:top}.pg_collection .article-browse .featured-list--contents .article{position:relative;width:100%;padding-bottom:1.5em}.pg_collection .article-browse .featured-list--contents .article .personalized-topics{margin-top:.5em}.pg_collection .article-browse .featured-list--contents .article--formats{height:100%;vertical-align:middle}.pg_collection .article-browse .featured-list--contents .article--bottom{background:#ddd;position:absolute;bottom:0;margin-left:-.75em;padding:0 .75em;width:100%}.pg_collection .article-browse .featured-list--contents .article--bottom a{line-height:45px;display:inline-block;margin:0 3px;font-size:.9em}@media (max-width:480px){.pg_collection .article-browse .featured-list--contents .article--bottom a{font-size:.8em;margin:0}}.pg_collection .article-browse .featured-list--contents .article .badge{float:right;font-size:1.1em;color:#000;margin:10px 0 0 0}@media (max-width:480px){.pg_collection .article-browse .featured-list--contents .article .badge{font-size:.9em;margin-top:15px}}.pg_collection .article-browse .featured-list--contents .article .badges{margin:0}.pg_collection .article-browse .featured-list--contents .article .icon-pdf{font-size:1.7em;margin-top:-4px}@media (max-width:480px){.pg_collection .article-browse .featured-list--contents .article .icon-pdf{display:none}}.pg_collection .article-browse .featured-list--contents .article .topic-suggestion{font-size:.775em;margin-bottom:8px}body[data-sitename=jamanetworkopen] .journal-name{margin-bottom:34px}body[data-sitename=jamanetworkopen] .announcement{margin-bottom:0}body[data-sitename=jamanetworkopen] .badge{vertical-align:baseline}body[data-sitename=jamanetworkopen] .badge:before{font-size:1.25rem}body[data-sitename=jamanetworkopen] .badges{margin-left:-4px}body[data-sitename=jamanetworkopen] .ymal--hed.thm-col-sec{border-bottom:none;padding-bottom:0;font-size:1.5em!important;font-weight:700;margin-bottom:1.688rem}body[data-sitename=jamanetworkopen].pg_journal .suggested-for-you .ymal--hed.thm-col-sec{color:#000!important}body[data-sitename=jamanetworkopen] .ymal--content .article--date.meta-item.no-wrap:after{display:none}body[data-sitename=jamanetworkopen] .ad-interstitial{height:0}body[data-sitename=jamanetworkopen] .bd-jama-network-open-sec{border-color:#ed0973!important}body[data-sitename=jamanetworkopen] a.article--title{margin-bottom:0!important}body[data-sitename=jamanetworkopen] .article--date{font-weight:400}body[data-sitename=jamanetworkopen] .article--authors{color:#535353;margin-top:4px;margin-bottom:8px}body[data-sitename=jamanetworkopen] .personalized-topics,body[data-sitename=jamanetworkopen] .topic-suggestions{margin-bottom:0}body[data-sitename=jamanetworkopen] .personalized-topics a,body[data-sitename=jamanetworkopen] .topic-suggestions a{font-weight:400;border-width:1px}body[data-sitename=jamanetworkopen] .featured-list--contents .personalized-topics a,body[data-sitename=jamanetworkopen] .featured-list--contents .topic-suggestions a{font-size:.75rem}body[data-sitename=jamanetworkopen] .widget-instance-AMA_JournalHome_Specialties{margin-bottom:2em}body[data-sitename=jamanetworkopen] .issue-group .article .article-date,body[data-sitename=jamanetworkopen] .issue-group .article .article-type{font-size:.75rem}body[data-sitename=jamanetworkopen] .issue-group-articles .article .article-superclass{font-size:.75rem}body[data-sitename=jamanetworkopen] .article--excerpt p{margin-bottom:.3em}body[data-sitename=jamanetworkopen] .article--linked-articles{margin-top:2em}body[data-sitename=jamanetworkopen] .article--citation,body[data-sitename=jamanetworkopen] .linked-article--authors{color:#535353}body[data-sitename=jamanetworkopen] .badges .badge:before{margin-top:-5px}body[data-sitename=jamanetworkopen] .article-type-group .badge{margin-top:1px}body[data-sitename=jamanetworkopen] .article-type-group .badge:before{font-size:1.25rem}body[data-sitename=jamanetworkopen] .article--linked-articles,body[data-sitename=jamanetworkopen] .article--links{margin-bottom:0}body[data-sitename=jamanetworkopen] .article .article--citation,body[data-sitename=jamanetworkopen] .article .article--title,body[data-sitename=jamanetworkopen] .article .para{margin-bottom:0}body[data-sitename=jamanetworkopen] .article .article--citation{display:inline-block;margin-bottom:.4375rem}body[data-sitename=jamanetworkopen] .article .badges .badge:before{margin-top:-12px}body[data-sitename=jamanetworkopen] .article .article--links{margin-top:0}body[data-sitename=jamanetworkopen].pg_pastissues .article .article--citation{margin-bottom:.625rem}body[data-sitename=jamanetworkopen] .featured-list--contents li.article{position:relative;height:100%}body[data-sitename=jamanetworkopen] .featured-list--contents .linked-articles{bottom:0;text-align:center;margin-left:-.85em;width:110%;font-size:.85em}body[data-sitename=jamanetworkopen] .featured-list--contents .linked-articles a{font-weight:700;display:block;background:#ddd;height:100%;padding:.6em;color:#000}body[data-sitename=jamanetworkopen] .email-signup{margin-bottom:1rem}body[data-sitename=jamanetworkopen] .email-signup input{margin-bottom:0}@media (max-width:1023px){body[data-sitename=jamanetworkopen] .social-links{text-align:center}}@media (max-width:480px){body[data-sitename=jamanetworkopen] .social-links{margin-left:-5px;margin-right:-5px}}body[data-sitename=jamanetworkopen] .footer .email-signup--link{padding-top:10px}body[data-sitename=jamanetworkopen] .article-type-group+.issue-group-articles .article:first-child{border-top:1px solid #ed0973}body[data-sitename=jamanetworkopen] .article-type-group{margin-top:2rem;padding-bottom:.25em;line-height:1}body[data-sitename=jamanetworkopen] .superClassification{font-size:.75rem!important;font-weight:400}body[data-sitename=jamanetworkopen] .featured-specialties{margin-bottom:2.5rem}body[data-sitename=jamanetworkopen].split-screen .ymal--hed .badge:before{font-size:1.25rem}body[data-sitename=jamanetworkopen] #BodyContent_PageContent_yamlSfyMid .featured-list--contents{display:block}body[data-sitename=jamanetworkopen] #BodyContent_PageContent_yamlSfyMid .article{width:100%;padding:.6em .75em 0 .75em}body[data-sitename=jamanetworkopen] #BodyContent_PageContent_yamlSfyMid .article--date{color:#535353;font-style:normal;margin-top:4px;margin-bottom:2em;font-size:.85em}body[data-sitename=jamanetworkopen] #BodyContent_PageContent_yamlSfyMid .linked-articles{text-align:left}body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap}@media (max-width:640px){body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents{display:block}}body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col{display:inline-block;position:relative;width:calc(50% - 11px);margin-right:21px;margin-bottom:21px;-webkit-box-flex:0;-webkit-flex-grow:0;flex-grow:0;-webkit-flex-shrink:0;flex-shrink:0;padding-bottom:33px}body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col:nth-last-of-type(-n+2){margin-bottom:.75rem}body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col .article--superclassification{text-transform:uppercase;font-size:.75rem;line-height:2em;font-weight:400}body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col .article--related-articles{position:absolute;bottom:0;text-align:center;margin:1em -.75em 0 -.75em;height:33px;width:100%}body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col .article--related-articles a.article--related{display:block;background:#ddd;width:100%;height:100%;padding:.6em}@media (min-width:640px){body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col:nth-of-type(2n){margin-right:0}}@media (max-width:640px){body[data-sitename=jamanetworkopen] .widget-JustPublished .featured-list--contents .article.two-col{width:100%;margin:0 0 1em 0}}@media (min-width:768px){[data-thm=jaman].pg_currentissue .ymal--hed.thm-col-sec{margin-top:2.75rem}}h3.themed-hed{font-size:1.25em;font-weight:700;margin-bottom:0;padding-bottom:0}.journal-contents .ymal--content,.ymal--footer .ymal--content{display:-webkit-box;display:-webkit-flex;display:flex}@media (max-width:640px){.journal-contents .ymal--content,.ymal--footer .ymal--content{display:block}.journal-contents .ymal--content .ymal--item,.ymal--footer .ymal--content .ymal--item{width:auto;float:none;margin:0 0 1em 0}}@media (min-width:1024px) and (max-width:1300px){.split-screen .ymal--content{display:block}.split-screen .ymal--content .ymal--item{width:auto;float:none;margin:0 0 1em 0}}.sidebar .ymal--content .article--type{margin:2px 5px 4px 0}.sidebar .ymal--content .badge:before{margin-right:5px;font-size:1.1em;margin-bottom:4px}.sidebar .ymal--content .ymal--item{border:none;padding:0;margin-bottom:1.25em}.sidebar .ymal--content .ymal--item:last-child{margin-bottom:.5em}.pg_featuredtopic .filter-wrap{background:#f2f2f2;padding:.75rem}.pg_featuredtopic .filter-wrap::after{clear:both;content:"";display:table!important}.pg_featuredtopic .filter-wrap input{border-radius:5px;margin:0}@media all and (min-width:560px){.pg_featuredtopic .filter-wrap input{float:left;width:calc(100% - 65px)}}@media all and (max-width:559px){.pg_featuredtopic .filter-wrap .view-toggle_wrap{display:none}}@media all and (min-width:560px){.pg_featuredtopic .filter-wrap .view-toggle_wrap{float:right;line-height:2.5rem}.pg_featuredtopic .filter-wrap .view-toggle_wrap a{margin-left:.5rem}.pg_featuredtopic .filter-wrap .view-toggle_wrap a:first-of-type{margin-left:0}.pg_featuredtopic .filter-wrap .view-toggle_wrap i{font-size:1.5rem}}.pg_featuredtopic .featured-topics-content_wrap{list-style-type:none}.pg_featuredtopic .featured-topics-content_wrap.grid-view{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap;margin:2rem -1rem 0 0}.pg_featuredtopic .featured-topics-content_wrap.grid-view .featured-topics-image_wrap img{width:100%}.pg_featuredtopic .featured-topics-content_wrap.grid-view .featured-topics-content_item{margin:0 1rem 1rem 0}@media all and (min-width:560px){.pg_featuredtopic .featured-topics-content_wrap.grid-view .featured-topics-content_item{width:calc(50% - 1rem)}}@media all and (min-width:768px){.pg_featuredtopic .featured-topics-content_wrap.grid-view .featured-topics-content_item{width:calc(33.333% - 1rem)}}@media all and (min-width:1024px){.pg_featuredtopic .featured-topics-content_wrap.grid-view .featured-topics-content_item{width:calc(25% - 1rem)}}.pg_featuredtopic .featured-topics-content_wrap.list-view{margin:2rem 0 0 0}@media all and (max-width:559px){.pg_featuredtopic .featured-topics-content_wrap.list-view{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap;margin:2rem 0 0 0}.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-image_wrap img{width:100%}}.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_item{line-height:1;margin-bottom:1rem}.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_item::after{clear:both;content:"";display:table!important}@media all and (max-width:559px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-image_wrap{width:100%}}@media all and (min-width:560px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-image_wrap{width:50%;float:right;padding-top:0;text-align:right}}@media all and (min-width:768px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-image_wrap{width:33%}}@media all and (min-width:1024px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-image_wrap{max-height:150px;width:25%}}.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_text-wrap{float:left}@media all and (max-width:559px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_text-wrap{padding-top:1rem}}@media all and (min-width:560px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_text-wrap{width:50%}}@media all and (min-width:768px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_text-wrap{width:67%}}@media all and (min-width:1024px){.pg_featuredtopic .featured-topics-content_wrap.list-view .featured-topics-content_text-wrap{width:75%}}.pg_featuredtopic .featured-topics-content_item{background:#f2f2f2;padding:0}.pg_featuredtopic .featured-topics-content_text-wrap{padding:.75rem .75rem 1rem .75rem}.pg_featuredtopic .featured-topics-content_header{font-weight:700}.pg_featuredtopic .featured-topics-content_text{font-size:.875rem;line-height:1.4;margin-top:.75rem}.footer-email-updates,.widget-instance-AMAv2_EmailListSignUp_Collection,.widget-instance-AMAv2_EmailListSignUp_Index,.widget-instance-AMAv2_EmailListSignUp_Issue,.widget-instance-AMAv2_EmailListSignUp_Journal,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal{color:#fff}@media (min-width:768px) and (max-width:1023px){.footer-email-updates,.widget-instance-AMAv2_EmailListSignUp_Collection,.widget-instance-AMAv2_EmailListSignUp_Index,.widget-instance-AMAv2_EmailListSignUp_Issue,.widget-instance-AMAv2_EmailListSignUp_Journal,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal{width:33.3%}}.footer-email-updates .email-signup--text,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--text,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--text,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--text,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--text,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--text,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--text{margin-bottom:.7em}.footer-email-updates .email-signup--link,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--link,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--link,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--link,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--link,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--link,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--link{margin-bottom:16px;font-size:.75em;float:right;display:block}.footer-email-updates .email-signup--privacy,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--privacy,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--privacy,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--privacy,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--privacy,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--privacy,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--privacy{padding-right:1em;min-width:0}.footer-email-updates .email-signup--terms,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--terms,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--terms,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--terms,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--terms,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--terms,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--terms{padding-left:1em;min-width:0}.footer-email-updates .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--input,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--input,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--input{padding:.2em .5em;max-width:100%}@media (max-width:767px){.footer-email-updates .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--input,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--input,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--input,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--input{max-width:200px}}.footer-email-updates .email-signup--submit,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--submit,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--submit,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--submit,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--submit,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--submit,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--submit{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700}.footer-email-updates .email-signup--submit:hover,.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--submit:hover,.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--submit:hover,.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--submit:hover,.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--submit:hover,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--submit:hover,.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--submit:hover{cursor:pointer;text-decoration:none;background:#fff}.widget-instance-AMAv2_EmailListSignUp_Index{color:#000}.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--link{float:inherit}.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--privacy{color:#333}.widget-instance-AMAv2_EmailListSignUp_Index .email-signup--terms{color:#333}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue{color:#000}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--link{float:inherit;padding-top:20px}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--privacy{color:#333}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Issue .email-signup--terms{color:#333}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal{color:#000}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--link{float:inherit;padding-top:20px}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--privacy{color:#333}.widget-instance-AMAv2_JNOpen_EmailListSignUp_Journal .email-signup--terms{color:#333}.widget-instance-AMAv2_EmailListSignUp_Journal{color:#000}.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--link{float:inherit}.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--privacy{color:#333}.widget-instance-AMAv2_EmailListSignUp_Journal .email-signup--terms{color:#333}.widget-instance-AMAv2_EmailListSignUp_Issue{color:#000}.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--link{float:inherit}.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--privacy{color:#333}.widget-instance-AMAv2_EmailListSignUp_Issue .email-signup--terms{color:#333}.widget-instance-AMAv2_EmailListSignUp_Collection{color:#000}.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--link{float:inherit}.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--privacy{color:#333}.widget-instance-AMAv2_EmailListSignUp_Collection .email-signup--terms{color:#333}.widget-instance-AMAv2_EmailListSignUp_Footer{padding:10px 20px}.widget-instance-AMAv2_EmailListSignUp_Footer .email-signup--link{float:right}.widget-instance-AMAv2_EmailListSignUp_Footer .email-signup--privacy{color:#fff}.widget-instance-AMAv2_EmailListSignUp_Footer .email-signup--terms{color:#fff}.footer-email-updates .email-signup--input-wrap{padding-left:60px;position:relative}.footer-email-updates .email-signup--input-wrap:before{font-size:2.75em;position:absolute;left:0;color:#555;top:-.22em}.footer-email-updates .email-signup--submit{margin-left:60px}.issue-view-tabs .email-signup--input-wrap,.sidebar .email-signup--input-wrap{display:inline-block}.issue-view-tabs .email-signup--text,.sidebar .email-signup--text{font-size:1.25em;font-weight:700;margin-bottom:.5em;line-height:1.3}.issue-view-tabs .email-signup--input,.sidebar .email-signup--input{display:inline-block;border-radius:5px;padding:.2em .5em;margin-right:6px;width:200px}.issue-view-tabs .email-signup--submit,.sidebar .email-signup--submit{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:2px 10px;font-weight:500}.issue-view-tabs .email-signup--submit:hover,.sidebar .email-signup--submit:hover{cursor:pointer;text-decoration:none;background:#fff}@media (max-width:1023px){.issue-view-tabs .email-signup,.sidebar .email-signup{text-align:center;margin-bottom:2em}}.issue-view-tabs .email-signup{margin-bottom:1em}.pg_index .email-signup--submit{background:#000}.pg_index .email-signup--submit:hover{border-color:#000}@media (min-width:768px) and (max-width:1023px){.journal-sidebar .email-signup,.network-sidebar .email-signup{width:50%;float:left}}@media (max-width:767px){.journal-sidebar .email-signup,.network-sidebar .email-signup{margin-bottom:0}}.sign-in--athens{padding-right:6px;border-right:1px solid #666;margin-right:6px}[data-thm=umb] .logged-in .auth--trigger:before{color:#d71534}[data-thm=learn] .logged-in .auth--trigger:before{color:#4978bc}[data-thm=neurp] .logged-in .auth--trigger:before{color:#ae1f22}[data-thm=derm] .logged-in .auth--trigger:before{color:#008949}[data-thm=learn] .logged-in .auth--trigger:before{color:#5c86c3}[data-thm=psych] .logged-in .auth--trigger:before{color:#0075a9}.auth{width:185px;float:right;margin-right:0;height:56px;position:relative}@media (max-width:1023px){.auth{width:76px}}@media (max-width:767px){.auth{height:50px}}@media (max-width:480px){.auth{width:auto}}.auth .auth--trigger{padding:15px 15px 15px 10px;color:#fff;text-align:right;display:block;transition:none}@media (max-width:767px){.auth .auth--trigger{border-left:1px solid #000;padding:12px 10px}}.auth .auth--trigger:hover{color:#fff;text-decoration:none}.auth .auth--trigger .user-full-name{max-width:105px;overflow:hidden;text-overflow:ellipsis;display:inline-block;white-space:nowrap;vertical-align:middle}@media (max-width:1023px){.auth .auth--trigger .user-full-name{display:none}}.auth .auth--trigger:before{font-size:26px;display:inline-block;margin-right:2px}@media (max-width:480px){.auth .auth--trigger:before{margin-right:0}}.auth .auth--trigger:after{margin-left:2px;display:inline-block;-webkit-transform:rotate(90deg);transform:rotate(90deg)}@media (max-width:480px){.auth .auth--trigger:after{display:none}}.auth .auth--trigger.target-active{background-color:#000;height:61px}.auth--subscribe{line-height:1.3}.auth--dropdown{position:absolute;right:0;width:300px;min-width:300px;z-index:110;background:#000;text-align:left;font-size:15px;color:#fff;top:-2000px}.auth--dropdown.active-state{top:100%;top:calc(100% + 5px);line-height:1}.auth--dropdown a{padding-right:6px;border-right:1px solid #fff;margin-right:6px;color:#fff;margin-bottom:.75em;display:inline-block}.auth--dropdown a:hover{color:#fff}.auth--dropdown a:last-of-type{margin-bottom:0;padding-right:0;margin-right:0;border-right:none}.auth--option{padding:15px;border-top:1px solid #242424}.auth--option:first-of-type{border-top:none}.auth--title{color:#b9b9b9;margin-bottom:.75em}.auth .auth--athens{margin-bottom:0}.auth .auth--ind-sign-in{margin-bottom:0}.auth--ama-acct a{display:block;padding-right:0;margin-right:0;border-right:none}.auth--sign-out{border-top:none}.auth .widget-ToolboxPermissions{display:inline-block}.auth #GlobalSignIn_btnRentArticle{padding-right:6px;border-right:1px solid #fff;margin-right:6px}[data-thm=umb] .auth--purchase{border-top:.0625rem solid #d71534}.jobs-ad{position:relative;min-height:110px;border-top:5px solid #000;max-width:420px;margin-left:auto;margin-right:auto;margin-bottom:4rem}[data-thm=jaman] .jobs-ad{margin-bottom:2.5rem}.jobs-ad--icon{background:#4a494a;padding:1em .2em 1em 0;top:0;bottom:0;width:95px;position:absolute}.jobs-ad .icon-jobs{position:absolute;top:50%;-webkit-transform:translateY(-50%);transform:translateY(-50%);font-size:90px;left:0}.jobs-ad--title{font-size:1.2em;line-height:1.2}.jobs-ad--text{padding:1em 1em 1em 110px}.jobs-ad h6{letter-spacing:.05em;margin-bottom:.75em;font-size:.9em}.al-pagination,.pagination{text-align:center;border-top:1px solid #ddd;padding:2em 1em;margin:1em 0}.al-pagination::after,.pagination::after{clear:both;content:"";display:table!important}.al-pagination .active a,.al-pagination .al-currentPage,.pagination .active a,.pagination .al-currentPage{color:#fff}body.pg_collection .al-pagination .active a,body.pg_collection .al-pagination .al-currentPage,body.pg_collection .pagination .active a,body.pg_collection .pagination .al-currentPage{background-color:#000}.al-pagination .al-pageNumbers,.al-pagination li,.pagination .al-pageNumbers,.pagination li{display:inline-block;font-weight:700}.al-pagination .al-pageNumbers .separator,.al-pagination li .separator,.pagination .al-pageNumbers .separator,.pagination li .separator{margin-left:10px;margin-right:10px}.al-pagination .al-currentPage,.al-pagination .al-pageNumber,.al-pagination li,.pagination .al-currentPage,.pagination .al-pageNumber,.pagination li{margin:0;padding:.5em .85em}.al-pagination .al-currentPage:hover,.al-pagination .al-pageNumber:hover,.al-pagination li:hover,.pagination .al-currentPage:hover,.pagination .al-pageNumber:hover,.pagination li:hover{color:#fff;text-decoration:none}@media (max-width:480px){.pg_collection .al-pagination .al-pageNumbers,.pg_collection .pagination .al-pageNumbers{max-width:calc(100% - 50px)}}body.pg_collection .al-pagination .al-pageNumber,body.pg_collection .pagination .al-pageNumber{color:#000}body.pg_collection .al-pagination .al-pageNumber:hover,body.pg_collection .pagination .al-pageNumber:hover{background-color:#000;color:#fff}.al-pagination li a,.pagination li a{display:block}.al-pagination .al-next-text,.al-pagination .al-prev-text,.pagination .al-next-text,.pagination .al-prev-text{display:none}@media (max-width:480px){.al-pagination .al-nav-next,.al-pagination .al-nav-previous,.pagination .al-nav-next,.pagination .al-nav-previous{margin-top:-14px}}.al-pagination .al-nav-next:after,.al-pagination .al-nav-previous:after,.pagination .al-nav-next:after,.pagination .al-nav-previous:after{display:inline;line-height:1.5;font-size:1em}.al-pagination .al-nav-next:hover,.al-pagination .al-nav-previous:hover,.pagination .al-nav-next:hover,.pagination .al-nav-previous:hover{text-decoration:none}body.pg_collection .al-pagination .al-nav-next,body.pg_collection .al-pagination .al-nav-previous,body.pg_collection .pagination .al-nav-next,body.pg_collection .pagination .al-nav-previous{color:#000;font-weight:700}.al-pagination .al-nav-next,.pagination .al-nav-next{float:right}.al-pagination .al-nav-next:after,.pagination .al-nav-next:after{content:"Next \203A"}@media (max-width:480px){.al-pagination .al-nav-next:after,.pagination .al-nav-next:after{content:"\203A";font-size:2em}}.al-pagination .al-nav-previous,.pagination .al-nav-previous{float:left}.al-pagination .al-nav-previous:after,.pagination .al-nav-previous:after{content:"\2039 \00A0 Previous"}@media (max-width:480px){.al-pagination .al-nav-previous:after,.pagination .al-nav-previous:after{content:"\2039";font-size:2em}}.brightcove-video .vjs-big-play-button.vjs-big-play-button{top:50%;left:50%;-webkit-transform:translate(-50%,-53%);transform:translate(-50%,-53%)}.multimedia-player{padding-bottom:1.5em}@media (max-width:767px){.multimedia-player{padding-bottom:1em}}.mp--thumbnail{width:130px;float:left}@media (max-width:480px){.mp--thumbnail{width:auto;float:none}}.mp--thumbnail img{display:inline-block}@media (max-width:480px){.mp--thumbnail img{max-width:150px;margin:1em 0 0 1em}}.mp--player-section{padding:1.5em 1.5em 0 1.5em}@media (max-width:480px){.mp--player-section{padding:1em 1em 0 1em}}.mp--audio-player{width:100%}.mp--audio-player::-webkit-media-controls-enclosure{max-width:100%}.audio-type .mp--player-action{float:left;margin:0 1.5em .5em 0}@media (max-width:767px){.audio-type .mp--player-action{float:none;margin-right:0}}.mp--player-link{font-weight:700}.mp--player-link i{font-size:1.5em;margin-right:2px}@media (max-width:767px){.mp--player-link i.icon-download{margin-right:5px}}.mp--player-link i.icon-podcast{font-size:1.75em}.mp--player-link i.icon-carrot_down{font-size:1em}.audio-type .mp--view-articles{margin:0 1.5em .5em 0}@media (max-width:767px){.audio-type .mp--view-articles{margin:-2px 0 0 29px}}.mp--linked-articles{padding-top:15px}@media (max-width:767px){.mp--linked-articles{padding-top:8px}}.audio-type .mp--linked-articles{padding:15px 0 0 26px}@media (max-width:767px){.audio-type .mp--linked-articles{padding:8px 0 0 29px}}.mp--linked-articles-wrap{padding:1em 1.5em 0 1.5em}@media (max-width:767px){.mp--linked-articles-wrap{padding:1em 1em 0 1em}}.mp--linked-article{font-weight:500}.mp--linked-article .subtitle{display:none}.mp--description{padding:1.5em 1.5em 0 1.5em}@media (max-width:767px){.mp--description{padding:1em 1em 0 1em}}.mp--interactive-player{background:#fff;overflow:auto;padding-bottom:20px}.mp--interactive-player iframe{width:100%}.tabs--link-container{text-align:center}.tabs--link-container .tabs--link{font-size:1.6em;font-weight:700;margin:0;background:#f2f2f2;border:1px solid #ddd;border-bottom:none;display:inline-block;color:#000;position:relative;line-height:1.1;padding:.5em .75em;box-sizing:border-box;vertical-align:middle}.tabs--link-container .tabs--link:hover{text-decoration:none;color:#000}.tabs--link-container .tabs--link.target-tab-active{background:#fff;z-index:5;top:2px}.tabs--link-container .tabs--link.target-tab-active:before{position:absolute;content:"";display:block;height:1px;top:-5px;width:100%;width:calc(100% + 2px);left:-1px;box-sizing:border-box}.tabs--link-container .tabs--link.target-tab-active{pointer-events:none;cursor:default;top:1px}@media (max-width:767px){.tabs--link-container .tabs--link{font-size:1.4em}}@media (max-width:610px){.tabs--link-container .tabs--link{margin:0 .4em;padding:.3em .75em}}@media (max-width:480px){.tabs--link-container .tabs--link{font-size:1.35em;margin:0 .2em;padding:.3em .4em}}@media (max-width:610px){.tabs--link-container .tabs--link span{display:block}}@media (max-width:480px){.tabs--link-container.activity-quiz-view-controls .tabs--link{font-size:1.2em;padding:.5em .35em;margin:0 .15em}}.tabs--link-container.activity-quiz-view-controls i{margin:-2px 10px 0 0}@media (max-width:767px){.tabs--link-container.activity-quiz-view-controls i{margin-right:4px}}.tabs--tab{position:absolute;overflow:hidden;clip:rect(0 0 0 0);height:1px;width:1px;margin:-1px;padding:0;border:0}.tabs--tab.tab-active{position:static;overflow:auto;clip:auto;height:auto;width:auto;margin:0;border:none}.activity-quiz-view-tabs .tabs--tab{padding:1em}@media (max-width:560px){.activity-quiz-view-tabs .tabs--tab{padding:1em .8em}}.tabs--tab.take-quiz-tab{background:#f4f4f4}.sk-folding-cube{margin:20px auto;width:30px;height:30px;position:relative;-webkit-transform:rotateZ(45deg);transform:rotateZ(45deg)}.sk-folding-cube .sk-cube{float:left;width:50%;height:50%;position:relative;-webkit-transform:scale(1.1);transform:scale(1.1)}.sk-folding-cube .sk-cube:before{content:'';position:absolute;top:0;left:0;width:100%;height:100%;background-color:#333;-webkit-animation:sk-foldCubeAngle 2.4s infinite linear both;animation:sk-foldCubeAngle 2.4s infinite linear both;-webkit-transform-origin:100% 100%;transform-origin:100% 100%}.sk-folding-cube .sk-cube2{-webkit-transform:scale(1.1) rotateZ(90deg);transform:scale(1.1) rotateZ(90deg)}.sk-folding-cube .sk-cube3{-webkit-transform:scale(1.1) rotateZ(180deg);transform:scale(1.1) rotateZ(180deg)}.sk-folding-cube .sk-cube4{-webkit-transform:scale(1.1) rotateZ(270deg);transform:scale(1.1) rotateZ(270deg)}.sk-folding-cube .sk-cube2:before{-webkit-animation-delay:.3s;animation-delay:.3s}.sk-folding-cube .sk-cube3:before{-webkit-animation-delay:.6s;animation-delay:.6s}.sk-folding-cube .sk-cube4:before{-webkit-animation-delay:.9s;animation-delay:.9s}@-webkit-keyframes sk-foldCubeAngle{0%,10%{-webkit-transform:perspective(140px) rotateX(-180deg);transform:perspective(140px) rotateX(-180deg);opacity:0}25%,75%{-webkit-transform:perspective(140px) rotateX(0);transform:perspective(140px) rotateX(0);opacity:1}100%,90%{-webkit-transform:perspective(140px) rotateY(180deg);transform:perspective(140px) rotateY(180deg);opacity:0}}@keyframes sk-foldCubeAngle{0%,10%{-webkit-transform:perspective(140px) rotateX(-180deg);transform:perspective(140px) rotateX(-180deg);opacity:0}25%,75%{-webkit-transform:perspective(140px) rotateX(0);transform:perspective(140px) rotateX(0);opacity:1}100%,90%{-webkit-transform:perspective(140px) rotateY(180deg);transform:perspective(140px) rotateY(180deg);opacity:0}}.id-offset:before{display:block;content:" ";margin-top:-120px;height:120px;visibility:hidden}.pg_textdatamining .tdm-logo_wrap,.tdm-ss-page-wrap .tdm-logo_wrap{text-align:center}.pg_textdatamining .tdm-logo,.tdm-ss-page-wrap .tdm-logo{height:125px}.tdm-ss-page-wrap{max-width:1000px;margin:0 auto}@media (min-width:1024px){.tdm-ss-page-wrap>.row{margin-left:-40px}}.tdm-ss-page-wrap .tdm-ss-index{list-style-type:none}.pg_textdatamining h1{margin-top:1rem}.pg_textdatamining .gradient-border{height:.5rem;background-color:#d71635;background-image:linear-gradient(to right,#d71635,#d71635 55%,#000 55%)}.pg_textdatamining .tdm-ss-wrap_top{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap}.pg_textdatamining .tdm-img-wrap{background:#636467;padding:1.5rem;text-align:center;width:100%;position:relative}.pg_textdatamining .tdm-img-wrap img{max-height:225px}@media (min-width:768px){.pg_textdatamining .tdm-img-wrap{width:35%}.pg_textdatamining .tdm-img-wrap img{position:absolute;top:0;right:0;bottom:0;left:0;margin:auto}}.pg_textdatamining .js-filter-toggle{font-size:18px;font-weight:700;color:#333}.pg_textdatamining .js-filter-toggle:before{font-family:ama_icons;font-weight:400;content:"";margin-right:.375rem}.pg_textdatamining .js-filter-toggle:hover{text-decoration:none}.pg_textdatamining .tdm-text-wrap{padding:1.5rem;background:#eee}@media (min-width:480px){.pg_textdatamining .tdm-text-wrap{padding:1.5rem 2.5rem}}@media (min-width:768px){.pg_textdatamining .tdm-text-wrap{width:65%}}.pg_textdatamining .tdm__wrap{margin-top:1.5rem}@media (max-width:480px){.pg_textdatamining .tdm__wrap{padding:0 1rem}}.pg_textdatamining .tdm__wrap .tdm-filter__wrap{position:relative;margin-bottom:1.25rem}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .fast-search-input__wrap::after{clear:both;content:"";display:table!important}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .fast-search-input{height:2rem;float:left;width:calc(100% - 2rem);border:1px solid #ccc;outline:0;padding:0 .375rem}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .filter_input-trigger{width:2rem;height:2rem;border:1px solid #ccc;border-left:0;display:block;float:left;text-align:center;line-height:2rem}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .filter_input-trigger:before{color:#333;content:"";font-family:ama_icons;font-weight:700}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .filter_input-trigger:hover{text-decoration:none}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .fast-search{display:none;position:absolute;background:#fff;border:1px solid #ccc;padding:.5rem}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .fast-search ul{list-style-type:none;margin:0}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .fast-search li a{display:block;padding:.25rem;color:#333}.pg_textdatamining .tdm__wrap .tdm-filter__wrap .fast-search.open{display:block;z-index:1000}.pg_textdatamining .tdm__wrap .tdm-content__header{background:#eee}.pg_textdatamining .tdm__wrap .tdm-content__content-row,.pg_textdatamining .tdm__wrap .tdm-content__header{display:block;width:100%;padding:.5rem}.pg_textdatamining .tdm__wrap .tdm-content__content-row>div,.pg_textdatamining .tdm__wrap .tdm-content__header>div{display:inline-block;padding:0 .5rem;min-height:1px}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__site-logo,.pg_textdatamining .tdm__wrap .tdm-content__header .tdm-content__site-logo{width:1rem}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__title,.pg_textdatamining .tdm__wrap .tdm-content__header .tdm-content__title{width:calc(100% - 430px);color:#000}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__date,.pg_textdatamining .tdm__wrap .tdm-content__header .tdm-content__date{width:200px}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__action,.pg_textdatamining .tdm__wrap .tdm-content__header .tdm-content__action{width:200px;text-align:center}.pg_textdatamining .tdm__wrap .tdm-content__content-row>div{vertical-align:top}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__site-logo{border-radius:1rem;height:1rem;margin-top:.25rem;padding:0}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__title{font-weight:500}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__date{color:#565656;font-style:italic}@media (max-width:767px){.pg_textdatamining .tdm__wrap .tdm-content__content-row{display:-webkit-box;display:-webkit-flex;display:flex;-webkit-flex-wrap:wrap;flex-wrap:wrap;padding-right:0}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__site-logo{-webkit-box-ordinal-group:2;-webkit-order:1;order:1}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__title{-webkit-box-ordinal-group:3;-webkit-order:2;order:2;width:calc(100% - 230px)}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__date{-webkit-box-ordinal-group:5;-webkit-order:4;order:4;width:100%;padding:.5rem .5rem 0 1.5rem}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__action{-webkit-box-ordinal-group:4;-webkit-order:3;order:3;padding-right:0}}@media (max-width:480px){.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__site-logo{-webkit-box-ordinal-group:2;-webkit-order:1;order:1}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__title{-webkit-box-ordinal-group:3;-webkit-order:2;order:2;width:calc(100% - 16px)}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__date{-webkit-box-ordinal-group:4;-webkit-order:3;order:3;width:100%;padding:.5rem .5rem 0 1.5rem}.pg_textdatamining .tdm__wrap .tdm-content__content-row .tdm-content__action{-webkit-box-ordinal-group:5;-webkit-order:4;order:4;width:100%;padding:1rem .5rem 0 1.5rem;text-align:left}}.pg_textdatamining .tdm__wrap .tdm-content__header>div{color:#000;font-weight:700;font-size:.875rem}@media (max-width:767px){.pg_textdatamining .tdm__wrap .tdm-content__header{display:none}}.pg_textdatamining .tdm__wrap .tdm-content__content-row{padding:1rem .5rem;border-top:1px solid #ccc}@media (min-width:768px){.pg_textdatamining .tdm__wrap .tdm-content__content-row:first-of-type{border-top:0}}.pg_textdatamining .tdm__wrap .tdm-content__action-button{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700;border:2px solid #000;background:#000;color:#fff}.pg_textdatamining .tdm__wrap .tdm-content__action-button:hover{cursor:pointer;text-decoration:none;background:#fff}.pg_textdatamining .tdm__wrap .tdm-content__action-button:hover{background:#fff;color:#000}.pg_textdatamining .tdm__wrap .tdm-content__noaccess-button{display:inline-block;min-width:auto;border-radius:6px;line-height:1.3;text-align:center;transition:all 125ms linear;color:#fff;padding:5px 12px;font-weight:700;border:2px solid #000;background:#fff;color:#000}.pg_textdatamining .tdm__wrap .tdm-content__noaccess-button:hover{cursor:pointer;text-decoration:none;background:#fff}.pg_textdatamining .tdm__wrap .tdm-content__noaccess-button:hover{background:#000;color:#fff}.pg_textdatamining #termsAndConditionsModal .terms-text__scrollable{height:300px;overflow-y:scroll;margin-bottom:1.5rem}.pg_textdatamining #termsAndConditionsModal .term-accept__row{display:-webkit-box;display:-webkit-flex;display:flex;margin-bottom:1rem}.pg_textdatamining #termsAndConditionsModal .accept-input{height:1rem;width:1rem;display:block;float:left;border-radius:2px;border:2px solid #999;margin:0 4px 0 0;-webkit-align-self:center;-ms-grid-row-align:center;align-self:center}.pg_textdatamining #termsAndConditionsModal .accept-input .checkmark{display:none}.pg_textdatamining #termsAndConditionsModal .accept-input.checked{pointer-events:none}.pg_textdatamining #termsAndConditionsModal .accept-input.checked .checkmark{font-size:10px;display:block;height:12px;line-height:12px;color:green;text-align:center}.pg_textdatamining #termsAndConditionsModal .accept-input.disabled{pointer-events:none;border-color:#ddd}.pg_textdatamining #termsAndConditionsModal .download-link-wrap.hidden{visibility:hidden;display:none}.pg_textdatamining #termsAndConditionsModal .download-link{border:1px solid #ccc;padding:.5rem;margin-bottom:1rem}.pg_textdatamining .screen-reader-only{position:absolute;left:-10000px;top:auto;width:1px;height:1px;overflow:hidden}.owl-carousel .owl-wrapper:after{content:".";display:block;clear:both;visibility:hidden;line-height:0;height:0}.owl-carousel{display:none;position:relative;width:100%;-ms-touch-action:pan-y}.owl-carousel .owl-wrapper{display:none;position:relative;-webkit-transform:translate3d(0,0,0)}.owl-carousel .owl-wrapper-outer{overflow:hidden;position:relative;width:100%}.owl-carousel .owl-wrapper-outer.autoHeight{transition:height .5s ease-in-out}.owl-carousel .owl-item{float:left}.owl-controls .owl-buttons div,.owl-controls .owl-page{cursor:pointer}.owl-controls{-webkit-user-select:none;-moz-user-select:none;-ms-user-select:none;user-select:none;-webkit-tap-highlight-color:transparent}.grabbing{cursor:url(grabbing.png) 8 8,move}.owl-carousel .owl-item,.owl-carousel .owl-wrapper{-webkit-backface-visibility:hidden;-moz-backface-visibility:hidden;-ms-backface-visibility:hidden;-webkit-transform:translate3d(0,0,0);-moz-transform:translate3d(0,0,0);-ms-transform:translate3d(0,0,0)}.owl-theme .owl-controls{text-align:center}.owl-theme .owl-controls .owl-next,.owl-theme .owl-controls .owl-prev{position:absolute;top:50%;-webkit-transform:translateY(-50%);transform:translateY(-50%)}.owl-theme .owl-controls .owl-next.disabled,.owl-theme .owl-controls .owl-prev.disabled{display:none}.owl-theme .owl-controls .owl-next{right:15px;color:green}.owl-theme .owl-controls .owl-prev{left:15px}.owl-theme.new-online--days .owl-next{width:0;height:0;border-top:8px solid transparent;border-bottom:8px solid transparent;border-left:13.856px solid #c6c5c0}.owl-theme.new-online--days .owl-prev{width:0;height:0;border-top:8px solid transparent;border-right:13.856px solid #c6c5c0;border-bottom:8px solid transparent}.owl-theme.quiz .owl-next:before,.owl-theme.quiz .owl-prev:before{font-size:2.3em}@media (max-width:767px){.owl-theme.quiz .owl-next,.owl-theme.quiz .owl-prev{position:relative;top:0;-webkit-transform:translate(0);transform:translate(0)}}.owl-theme.quiz .owl-next{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;right:5px}.owl-theme.quiz .owl-next:before{content:""}@media (max-width:767px){.owl-theme.quiz .owl-next{float:right}}.owl-theme.quiz .owl-prev{font-family:ama_icons;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;vertical-align:middle;display:inline-block;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;left:5px}.owl-theme.quiz .owl-prev:before{content:""}@media (max-width:767px){.owl-theme.quiz .owl-prev{float:left;left:0}}.owl-theme.quiz .owl-buttons::after{clear:both;content:"";display:table!important}@media (max-width:767px){.owl-theme.quiz .owl-buttons{margin-top:.5em}}.owl-theme .owl-controls .owl-page.active span,.owl-theme .owl-controls.clickable .owl-page:hover span{filter:Alpha(Opacity=100);opacity:1}.owl-theme .owl-controls .owl-page span.owl-numbers{height:auto;width:auto;color:#fff;padding:2px 10px;font-size:12px;border-radius:30px}.owl-item.loading{min-height:150px;background:url(AjaxLoader.gif) no-repeat center center}[class*=" icon-"],[class^=icon-]{font-family:ama_icons!important;speak:none;font-style:normal;font-weight:400;font-variant:normal;text-transform:none;line-height:1;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale}.icon-visual-abstract{margin-right:5px}.icon-visual-abstract:before{content:""}.icon-check:before{content:""}.icon-user-comments:before{content:""}.icon-minus:before{content:""}.icon-jn_circle_logo:before{content:""}.icon-filter:before{content:""}.icon-image:before{content:""}.icon-powerpoint:before{content:""}.icon-youtube_full:before{content:""}.icon-author_interview:before{content:""}.icon-url:before{content:""}.icon-audio:before{content:""}.icon-audio_cme:before{content:""}.icon-cite_u_like_full:before{content:""}.icon-facebook_full:before{content:""}.icon-google_plus_full:before{content:""}.icon-interactive_cme:before{content:""}.icon-linked_in_full:before{content:""}.icon-multimedia_cme:before{content:""}.icon-pinterest_full:before{content:""}.icon-play:before{content:""}.icon-play_cme:before{content:""}.icon-quiz_cme:before{content:""}.icon-rss_circle_full:before{content:""}.icon-twitter_full:before{content:""}.icon-free:before{content:""}.icon-online_first:before{content:""}.icon-online_only:before{content:""}.icon-alert:before{content:""}.icon-alerts:before{content:""}.icon-attach:before{content:""}.icon-calendar:before{content:""}.icon-carrot_down:before{content:""}.icon-cart:before{content:""}.icon-cite_this:before{content:""}.icon-cite_u_like:before{content:""}.icon-close:before{content:""}.icon-cme:before{content:""}.icon-comments:before{content:""}.icon-contents:before{content:""}.icon-copyright:before{content:""}.icon-document:before{content:""}.icon-double_arrow:before{content:""}.icon-download:before{content:""}.icon-edit:before{content:""}.icon-education:before{content:""}.icon-email:before{content:""}.icon-facebook:before{content:""}.icon-figures:before{content:""}.icon-follow:before{content:""}.icon-full_screen:before{content:""}.icon-full_text:before{content:""}.icon-google_plus:before{content:""}.icon-grid_view:before{content:""}.icon-info:before{content:""}.icon-interactive:before{content:""}.icon-jn:before{content:""}.icon-jobs:before{content:""}.icon-journal_club:before{content:""}.icon-left:before{content:""}.icon-linked_in:before{content:""}.icon-list_view:before{content:""}.icon-mobile:before{content:""}.icon-multimedia:before{content:""}.icon-open_access:before{content:""}.icon-pdf:before{content:""}.icon-pdf_color .path1:before{content:"";color:#231f20}.icon-pdf_color .path2:before{content:"";margin-left:-1em;color:#ec2227}.icon-pdf_color .path3:before{content:"";margin-left:-1em;color:#ec2227}.icon-pdf_color .path4:before{content:"";margin-left:-1em;color:#fff}.icon-pdf_color .path5:before{content:"";margin-left:-1em;color:#fff}.icon-pdf_color .path6:before{content:"";margin-left:-1em;color:#fff}.icon-pinterest:before{content:""}.icon-plus_follow:before{content:""}.icon-podcast:before{content:""}.icon-podcast_social:before{content:""}.icon-profile:before{content:""}.icon-quiz:before{content:""}.icon-references:before{content:""}.icon-related:before{content:""}.icon-right:before{content:""}.icon-rss:before{content:""}.icon-rss_circle:before{content:""}.icon-search:before{content:""}.icon-share:before{content:""}.icon-top:before{content:""}.icon-trash:before{content:""}.icon-twitter:before{content:""}.icon-video:before{content:""}.icon-youtube:before{content:""}.datepicker{display:none;position:absolute;padding:4px;margin-top:1px;direction:ltr}.datepicker.dropdown-menu{position:absolute;top:100%;left:0;z-index:1000;float:left;display:none;min-width:160px;list-style:none;background-color:#fff;border:1px solid #ccc;border:1px solid rgba(0,0,0,.2);border-radius:5px;box-shadow:0 5px 10px rgba(0,0,0,.2);background-clip:padding-box;color:#333;font-size:13px;line-height:18px}.datepicker.dropdown-menu td,.datepicker.dropdown-menu th{padding:4px 5px}.datepicker td,.datepicker th{text-align:center;width:20px;height:20px;border:0;font-size:12px;padding:4px 8px;background:#fff;cursor:pointer}.datepicker td.active.day,.datepicker th.active.day{background:#2ba6cb}.datepicker td.active.year,.datepicker th.active.year{background:#2ba6cb}.datepicker td span.active,.datepicker th span.active{background:#2ba6cb}.datepicker>div{display:none}.datepicker.days div.datepicker-days{display:block}.datepicker.months div.datepicker-months{display:block}.datepicker.years div.datepicker-years{display:block}.datepicker table{border:0;margin:0}.datepicker-inline{width:220px}.datepicker-rtl{direction:rtl}.datepicker-rtl table tr td span{float:right}.datepicker-dropdown{top:0;left:0}.datepicker-dropdown:before{content:'';display:inline-block;border-left:7px solid transparent;border-right:7px solid transparent;border-bottom:7px solid #ccc;border-bottom-color:rgba(0,0,0,.2);position:absolute;top:-7px;left:6px}.datepicker-dropdown:after{content:'';display:inline-block;border-left:6px solid transparent;border-right:6px solid transparent;border-bottom:6px solid #fff;position:absolute;top:-6px;left:7px}.table-striped .datepicker table tr td,.table-striped .datepicker table tr th{background-color:transparent}.datepicker table tr td span{display:block;width:23%;height:54px;line-height:54px;float:left;margin:1%;cursor:pointer}.datepicker th.date-switch{width:145px}.datepicker tfoot tr:first-child th,.datepicker thead tr:first-child th{cursor:pointer}.datepicker .cw{font-size:10px;width:12px;padding:0 2px 0 5px;vertical-align:middle}.datepicker thead tr:first-child th.cw{cursor:default;background-color:transparent}.datepicker td.new,.datepicker td.old{color:#999}.datepicker td.day.disabled{color:#eee}.datepicker-dropdown:after,.datepicker-dropdown:before{display:none}.datepicker-close{position:absolute;top:-30px;right:0;width:15px;height:30px;padding:0;display:none}table th{font-weight:700}table td,table th{padding:9px 10px}table.responsive{margin-bottom:0}.scrollable table{border:none!important;width:100%}.pinned{position:absolute;left:0;top:0;background:#fff;overflow:hidden;border-right:1px solid #ccc;border-left:1px solid #ccc}.pinned table{margin-bottom:0!important;border-right:none;border-left:none;width:100%}.pinned table td,.pinned table th,.pinned table tr{white-space:nowrap;height:36px}.pinned td:last-child{border-bottom:0}div.table-wrapper{position:relative;margin-bottom:20px;overflow:hidden;border-right:1px solid #ccc}div.table-wrapper div.scrollable{overflow:scroll;overflow-y:hidden}table.responsive td,table.responsive th{position:relative;white-space:nowrap;overflow:hidden}.tabs-content{width:100%}@media only print{.master-footer,.master-header,.profiler-results{display:none!important}.print--hide-all *{visibility:hidden}.print--section{visibility:visible!important;position:absolute!important;left:0!important;top:0!important}.print--section *{visibility:visible!important}.print--section .print--hidden-section{display:none!important}}
/*# sourceMappingURL=app.min.css.map */