From: Subject: Arch Ophthalmol -- Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children, October 2008, Convergence Insufficiency Treatment Trial Study Group 126 (10): 1336 Date: Tue, 9 Dec 2008 09:04:54 -0500 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0042_01C959DD.33C039D0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 This is a multi-part message in MIME format. ------=_NextPart_000_0042_01C959DD.33C039D0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: mhtml:file://\\superior_eye\eyecare\Word\VT Studies\Arch Ophthalmol -- Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children, October 2008, Convergence Insufficiency Treatment Trial Study Group 126 (10) 1336.mht Arch Ophthalmol -- Randomized Clinical Trial of = Treatments for Symptomatic Convergence Insufficiency in Children, = October 2008, Convergence Insufficiency Treatment Trial Study Group 126 = (10): 1336

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3D" 3D" Vol. 126 No. 10, October = 2008 3D" 3D"
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Randomized Clinical Trial = of Treatments=20 for Symptomatic Convergence Insufficiency in=20 Children=20

Convergence=20 Insufficiency Treatment Trial Study Group* =

Arch = Ophthalmol. 2008;126(10):1336-1349.=20

ABSTRACT
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Objective  To compare home-based pencil = push-ups=20 (HBPP), home-based computer = vergence/accommodative=20 therapy and pencil push-ups (HBCVAT+), = office-based=20 vergence/accommodative therapy with home = reinforcement=20 (OBVAT), and office-based placebo therapy with = home=20 reinforcement (OBPT) as treatments for symptomatic=20 convergence insufficiency.

Methods  In a randomized clinical trial, 221 = children=20 aged 9 to 17 years with symptomatic convergence=20 insufficiency were assigned to 1 of 4 = treatments.=20

Main Outcome Measures  Convergence = Insufficiency=20 Symptom Survey score after 12 weeks of treatment. = Secondary outcomes were near point of convergence = and=20 positive fusional vergence at near.

Results  After 12 weeks of treatment, the = OBVAT=20 group's mean Convergence Insufficiency Symptom = Survey=20 score (15.1) was statistically significantly = lower than=20 those of 21.3, 24.7, and 21.9 in the HBCVAT+, = HBPP, and=20 OBPT groups, respectively = (P < .001).=20 The OBVAT group also demonstrated a significantly = improved near point of convergence and positive = fusional=20 vergence at near compared with the other groups = (P  .005 for all comparisons). A = successful or=20 improved outcome was found in 73%, 43%, 33%, and = 35% of=20 patients in the OBVAT, HBPP, HBCVAT+, and OBPT = groups,=20 respectively.

Conclusions  Twelve weeks of OBVAT results in = a=20 significantly greater improvement in symptoms and = clinical measures of near point of convergence = and=20 positive fusional vergence and a greater = percentage of=20 patients reaching the predetermined criteria of = success=20 compared with HBPP, HBCVAT+, and OBPT.

Application to Clinical Practice  = Office-based=20 vergence accommodative therapy is an effective = treatment=20 for children with symptomatic convergence=20 insufficiency.

Trial Registration  clinicaltrials.gov = Identifier: NCT00338611=20



INTRODUCTION
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 =95 Introduction
 =95 M= ethods
 =95 R= esults
 =95 C= omment
 =95 C= onclusions
 =95 A= uthor=20 information
 =95 R= eferences
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Convergence=20 insufficiency (CI) is a common binocular vision=20 disorder1-4=20 that is often associated with a variety of symptoms,=20 including eyestrain, headaches, blurred vision, = diplopia,=20 sleepiness, difficulty concentrating, movement of = print=20 while reading, and loss of comprehension after = short=20 periods of reading or performing close = activities.5-13=20 Various treatments10,=20 14-23=20 are commonly prescribed, including passive = treatment with=20 base-in prism reading glasses and active = treatment, such=20 as home-based therapy using pencil push-ups = (HBPP) alone,=20 home-based therapy using pencil push-ups plus = other=20 therapy techniques, office-based vision therapy, = and=20 orthoptics. Consensus regarding the most effective=20 treatment is lacking and there are considerable=20 differences among treatments in time and cost. = Recent=20 studies that surveyed the ophthalmic community = suggest=20 that HBPP is the most commonly prescribed = treatment by=20 both ophthalmologists and optometrists for young = patients=20 with symptomatic CI.24-26=20

Active therapies for the treatment of symptomatic CI=20 typically involve the purposeful, controlled = manipulation=20 of target blur, vergence demand, and/or target = proximity=20 with the aim of normalizing the accommodative and = vergence systems and their mutual interactions.27=20 The various active treatment approaches for CI differ = in=20 their (1) ability to control and manipulate = stimulus=20 parameters (eg, vergence and accommodative = demand), (2)=20 dosage, (3) mode of administration, and (4) use = of motor=20 learning theory and patient feedback. It is = unknown,=20 however, whether these differences affect the = outcome of=20 treatment.

Until recently, there has been a scarcity of rigorously=20 performed scientific studies that document the=20 effectiveness of treatments for CI. In = preparation for=20 our randomized clinical trial, the Convergence=20 Insufficiency Treatment Trial (CITT) Study Group=20 completed 2 pilot studies that were = placebo-controlled,=20 randomized trials investigating the effectiveness = of=20 passive and active treatments for symptomatic CI = in=20 children.28-29=20 In the trial that evaluated the effectiveness of = base-in=20 prism reading glasses prescribed according to = Sheard's=20 criterion (convergence amplitudes less than twice = the=20 near phoria),30=20 prism glasses were found to be no more effective = than=20 placebo reading glasses.28=20 The other randomized trial that compared the=20 effectiveness of HBPP, office-based vision=20 therapy/orthoptics, and office-based placebo = vision=20 therapy/orthoptics found office-based vision = therapy/orthoptics=20 to be more effective than pencil push-ups or placebo=20 therapy in improving both the signs and symptoms=20 associated with CI.29=20 A limitation of the latter study was a 19% (9 of 47) = loss=20 to follow-up before treatment completion. In = addition, it=20 was suggested that a more intensive home-based = vision=20 therapy/orthoptics regimen should have been = included as a=20 treatment arm.31=20

The purpose of this randomized clinical trial was to = further=20 evaluate the commonly used active treatments for CI. = We=20 compared the effectiveness of 12 weeks of = treatment using=20 HBPP, home-based computer vergence/accommodative = therapy=20 and pencil push-ups (HBCVAT+), office-based=20 vergence/accommodative therapy with home = reinforcement=20 (OBVAT), and office-based placebo therapy (OBPT) = in=20 improving symptoms and signs associated with = symptomatic=20 CI in children.


METHODS
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 =95 In= troduction
 =95 Methods
 =95 R= esults
 =95 C= omment
 =95 C= onclusions
 =95 A= uthor=20 information
 =95 R= eferences
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We followed=20 the tenets of the Declaration of Helsinki throughout = the=20 study. The institutional review boards of all = participating=20 centers approved the protocol and informed consent = forms.=20 The parent or guardian (subsequently referred to = as=20 parent) of each study patient gave written = informed consent and each patient assented to=20 participation. There was an initial consent process = for=20 performing an eligibility examination followed by a = second=20 consent for the enrollment and randomization of = eligible=20 patients into the trial. Health Insurance = Portability and=20 Accountability Act authorization was obtained = from=20 parents. Study oversight was provided by an = independent=20 data and safety monitoring committee.

PATIENT SELECTION=20

Major eligibility criteria for the trial was being aged 9 = to=20 17 years and having exodeviation at near of at least 4 = prism diopters (3D{Delta}=20) greater than at far, a receded near point of=20 convergence (NPC) break (3D≥=20 6 cm), insufficient positive fusional = vergence=20 at near (PFV) (convergence amplitudes) (ie, failing=20 Sheard's criterion [PFV less than twice the near=20 phoria]30=20 or minimum PFV of 3D≤=20153D{Delta}=20 base-out blur or break), and a CI Symptom Survey = (CISS) score of 16 or greater. Because patients = with=20 symptomatic CI often have an associated = accommodative=20 insufficiency,12=20 patients with symptomatic CI associated with=20 accommodative insufficiency were included in the = study.=20 However, children with monocular accommodative = amplitudes=20 of less than 5 diopters (D) were excluded because = the=20 severity of their accommodative insufficiency may=20 indicate an organic etiology. The eT= able=20 provides a complete listing of eligibility and = exclusion=20 criteria.

A refractive correction was prescribed for patients if = they=20 had a significant refractive error or a significant = change=20 in refractive correction. A significant = refractive error=20 or change was defined as 1.50 D or greater of = hyperopia,=20 0.50 D or greater of myopia, 0.75 D or greater of = astigmatism, 0.75 D or greater of anisometropia = in=20 spherical equivalent, or 1.50 D or greater of=20 anisometropia in any meridian (based on cycloplegic=20 refraction). For hyperopes, the investigator = could reduce=20 the prescription by up to 1.25 D. For myopia, = full=20 correction was required. After wearing the = glasses for at=20 least 2 weeks, eligibility testing was repeated = to=20 determine if the patient still met the eligibility=20 criteria. Thus, the CISS and eligibility testing were=20 always performed with appropriate refractive = correction=20 in place.

EXAMINATION PROCEDURES=20

Eligibility testing included administration of the CISS = to=20 identify whether the child was = symptomatic.12-13,32-33=20 Other eligibility tests included best-corrected = visual=20 acuity at distance and near, a sensorimotor = examination=20 (cover testing at distance and near, NPC, and = positive=20 and negative fusional vergence at near [fusional=20 convergence and divergence amplitudes]), near=20 stereoacuity, monocular accommodative amplitude, = monocular=20 accommodative facility (the ability to quickly = achieve=20 clear vision while alternately viewing 20/30 = print=20 through +2 D and =962 D lenses), a cycloplegic = refraction,=20 and an ocular health evaluation. Convergence=20 Insufficiency Treatment Trial=96trained and = =96certified=20 ophthalmologists or optometrists performed all = testing=20 using a previously described standardized protocol.34=20 Eligible patients who consented to participate were=20 enrolled in the study, and the measures taken at = their=20 eligibility examination were used as the study = baseline=20 measures.

RANDOMIZATION=20

Using a permuted block design, we randomly assigned = eligible=20 patients who consented to participate with equal=20 probability to HBPP, HBCVAT+, OBVAT, or OBPT.=20 Randomization was achieved using a secure Web = site=20 created and managed by the data coordinating = center. To=20 ensure approximately equal numbers of patients in = each=20 treatment arm by site, randomization was stratified by=20 clinical site.

TREATMENT PROTOCOLS=20

The therapy regimens each lasted 12 weeks. Patients were=20 taught their assigned therapy procedures by = CITT-trained=20 and -certified therapists. Therapists were either = optometrists, vision therapists, or orthoptists = with at=20 least 1 year of experience; most optometrists = were=20 residency-trained. Patients were required to = demonstrate=20 their understanding and ability to perform home = therapy=20 procedures in the office before the therapies = were=20 prescribed for home. Instructional handouts were = also=20 provided for the home treatment procedures. = Patients in=20 all groups maintained a home therapy log and = recorded=20 their performances for each home therapy session. = Monthly=20 office visits were scheduled for those assigned to the = 2=20 home-based therapy groups. At these visits, the = therapists=20 answered questions, reviewed home therapy procedures, = and=20 estimated adherence (compliance). In addition, = the=20 therapist contacted the patients by telephone on = a weekly=20 basis, during which time the home therapy = procedures and=20 home logs were reviewed and attempts were made to = motivate the patients to adhere to treatment. = Those=20 assigned to office-based therapy groups were scheduled=20 for weekly office therapy visits.

All treatments included time for instruction, feedback,=20 review of the home log, and discussion about = adherence.=20 For the office-based groups, this all occurred = during the=20 weekly office visits. For the home-based groups, = these=20 interactions occurred every 4 weeks in the office = and=20 weekly via a telephone call with the therapist. = The total=20 treatment time for each group included the time spent = in=20 therapy at home or in the office plus the contact with = the=20 therapist via the weekly phone calls (for the = home-based=20 therapy groups).

HOME-BASED PENCIL PUSH-UPS=20

The pencil push-ups procedure involved using a pencil = with=20 20/60 reduced Snellen letters and a white index = card=20 placed in the background to provide a suppression = check=20 by using physiological diplopia awareness. The = goal of=20 the procedure was to move the pencil to within 2 = to 3 cm=20 of the brow, just above the nose on each push-up = while=20 trying to keep the target single and clear. = Patients were=20 instructed to perform the pencil push-ups procedure = 15=20 minutes per day, 5 days per week. They maintained home = therapy=20 logs, recording the closest distance that they could=20 maintain fusion after each 5 minutes of = therapy.=20

HOME-BASED COMPUTER VERGENCE/ACCOMMODATIVE = THERAPY=20 AND PENCIL PUSH-UPS=20

Patients in this group were taught to perform the pencil=20 push-up procedure as well as procedures on the = Home=20 Therapy System/Computerized Vergence System = (HTS/CVS)=20 computer software system (Computer Orthoptics, = Gold=20 Canyon, Arizona). Using this program, they = performed=20 fusional vergence and accommodative therapy procedures, = including vergence base-in, vergence base-out, = autoslide=20 vergence, and jump ductions vergence programs = using=20 random-dot stereopsis targets. The accommodative = rock=20 program was used for accommodative therapy. Much = like a=20 clinician would do at each follow-up visit, this = computer=20 program automatically modified the therapy program = after=20 each session based on the patient's performance. = Patients=20 were instructed to do pencil push-ups 5 minutes per = day, 5=20 days per week, and the HTS software program for = 15=20 minutes per day, 5 days per week, and to save = their data=20 on a disk provided by the study and to bring the = disk to=20 each follow-up visit.

OFFICE-BASED VERGENCE/ACCOMMODATIVE THERAPY = WITH HOME=20 REINFORCEMENT=20

The OBVAT group received a weekly 60-minute in-office=20 therapy visit with additional prescribed = procedures to be=20 performed at home for 15 minutes a day, 5 days = per week.=20 The therapy procedures are described in detail=20 elsewhere29=20 and those performed during the weekly OBVAT = sessions are=20 shown in the eF= igure.=20 At each office-based therapy session, the patient = performed 4 to 5 procedures with constant = supervision and=20 guidance from the therapist. There were no = diagnostic=20 tests performed during these sessions. The = therapist=20 followed a detailed and specific protocol from the = CITT=20 manual of procedures (http://optometry= .osu.edu/research/CITT/4363.cfm);=20 this document describes each procedure, amount of time = procedure was performed, expected performance, = and=20 criteria for ending the procedure and advancing = to a more=20 difficult level.

OFFICE-BASED PLACEBO = THERAPY=20

Patients in the OBPT group received therapy during a = weekly=20 60-minute office visit and were prescribed procedures = to=20 be performed at home for 15 minutes per day, 5 = days per=20 week. The placebo therapy program consisted of 16 = in-office therapy procedures and 4 home therapy=20 procedures, which were designed to look like real = vergence/accommodative therapy procedures yet not to = stimulate=20 vergence, accommodation, or fine saccadic eye movement = skills beyond normal daily visual activities. The = therapist followed a detailed protocol from the = CITT=20 manual of procedures. Five procedures were = performed=20 during each office therapy visit and 2 procedures = were=20 assigned for home therapy each week. Placebo = procedures=20 included traditional vergence/accommodative therapy=20 procedures modified to be monocular rather than = binocular;=20 binocular procedures performed at 0 vergence = disparity;=20 and testing procedures that did not require = significant=20 demand on the vergence, accommodative, or fine = saccadic=20 eye movement systems. For example, in 1 placebo=20 procedure, the patient wore the appropriate filter = glasses=20 and performed vergence therapy at 0 vergence = demand on=20 the Computer Orthopter (Computer Orthoptics). = Some=20 procedures were designed to have increasing = levels of=20 difficulty. As in real therapy, patients = frequently wore=20 filter glasses and were told that the glasses = ensured=20 that both eyes were being used together. Objectives = and=20 goals were established for each placebo procedure to = simulate=20 real therapy. For motivational purposes, the therapist = told the patient the objective of each procedure = before=20 beginning the technique.

MASKING OF THERAPISTS AND = PATIENTS=20

Because experienced therapists provided the treatments, = it=20 was not feasible to mask them to patients' = assigned=20 treatment. However, each therapist followed a=20 well-defined protocol for all treatments and was=20 instructed to interact in an identical fashion with = all=20 patients. Although patients were obviously aware of = whether=20 they were assigned to office- or home-based therapy, = those=20 receiving office-based treatment were masked = regarding=20 whether they were assigned to = vergence/accommodative or=20 placebo therapy.

To determine the effectiveness of masking, patients = assigned=20 to either of the 2 office-based treatments were asked = at=20 the completion of their treatment whether they = thought=20 they were randomized into the active or placebo=20 treatment. To assess examiner masking, examiners = were=20 asked if they thought they could identify the = patient's=20 treatment assignment at the completion of each = masked=20 examination. In addition, at the completion of the = 12-week=20 outcome examination, examiners were asked to guess the = patient's group assignment and to report a level = of=20 confidence in the response.

FOLLOW-UP EXAMINATIONS=20

Protocol-specified follow-up visits were conducted after = 4=20 and 8 weeks of treatment. The primary outcome = assessment=20 was made at the visit following the 12th week of=20 treatment. At these follow-up visits, an examiner = who was=20 masked to the patient's treatment group = administered the=20 CISS and a sensorimotor examination that included = cover=20 testing at distance and near, NPC, PFV, = accommodative=20 amplitude, and accommodative facility testing. = After the=20 clinical testing was completed, the CISS was = readministered.=20

TREATMENT ADHERENCE DATA=20

To assess adherence with home-based therapy, at each = masked=20 examination the therapist was asked, "What percent = (0%,=20 1%-24%, 25%-49%, 50%-74%, 75%-99%, or 100%) of = the time=20 do you feel the patient adhered to the home = protocol?"=20 The therapists' estimate was based on a review of = the=20 home log, electronic data from the computer = therapy=20 program, and a discussion with the patient about = home=20 therapy. Thus, this estimate was primarily based = on=20 patient reports. The response options of 0%, 1% to 24%, = 25%=20 to 49%, and 50% to 74% were combined into 1 category=20 (0%-74%) for data analysis because only 16% of = patients=20 were categorized into the response options below=20 75%.

MAINTENANCE THERAPY=20

Patients who demonstrated sufficient improvement on the = CISS=20 at the 12-week outcome visit were considered = asymptomatic=20 (CISS score <16) and were prescribed = maintenance=20 therapy of 15 minutes per week using home therapy = procedures specific to the patient's assigned = treatment=20 group. Patients not demonstrating sufficient = improvement=20 on the CISS, and thus considered symptomatic = (CISS score=20 3D≥=2016), were referred to a non-CITT eye care = provider=20 to receive alternative treatment for their CI. =

OUTCOME MEASURES=20

Patients with CI who seek treatment usually do so because = they are symptomatic (or perceived to be by their = parents), and successful treatment should result = in a=20 lessening or abatement of symptoms. Thus, we used = symptom=20 level (as measured by the CISS) as the primary = outcome=20 measure (Figure=20 1). The questionnaire consisted of 15 items = that were=20 read aloud to the child by the examiner. The = examiner=20 read the questions while the child looked at a = card with=20 5 answer options and was instructed to choose 1 of = those=20 possible answers (never, infrequently, sometimes, = fairly=20 often, or always). Each response was scored on a scale = of=20 0 to 4, with 4 representing the highest frequency = of=20 symptom occurrence (ie, always). The 15 items = were summed=20 to obtain the total CISS score. The lowest = possible score=20 (least symptomatic) was 0 and the highest was 60 = (most=20 symptomatic). Based on our previous work,13,=20 32=20 a CISS score of less than 16 is considered asymptomatic = and a decrease of at least 10 or more points is = considered=20 improved.



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Figure 1. Convergence = Insufficiency=20 Symptom Survey.=20 =


The goal of treatment for CI is not only to eliminate=20 patient symptoms, but also to improve the = patient's=20 convergence ability. Thus, we used NPC and PFV as = secondary outcome measures. A normal NPC was = defined as=20 less than 6 cm and an improved NPC was defined as = an=20 improvement (decrease) in NPC of 4 cm or more from = baseline=20 to the 12-week outcome examination. To be classified = as=20 having normal PFV, a patient had to pass Sheard's = criterion (ie, PFV blur or if no blur, then break = value=20 at least twice the near phoria magnitude) and = have a PFV=20 blur/break of more than 153D{Delta}=20. Improvement in PFV was defined as an = increase=20 of 103D{Delta}=20 or more from baseline to the 12-week = outcome=20 examination.

To evaluate each treatment's ability to improve both = signs=20 and symptoms, we also developed a composite = outcome=20 classification that considered the change in all = 3=20 outcome measures from baseline to the 12-week=20 examination. A successful outcome was a score of = less=20 than 16 on the CISS, a normal NPC (<6 cm), and a=20 normal PFV (>153D{Delta}=20 and passing the Sheard's criterion). = Improved=20 was defined as a score of less than 16 or a 10-point=20 decrease in the CISS score, and at least 1 of the = following: normal NPC, an improvement in NPC of = more than=20 4 cm, normal PFV, or an increase in PFV of more = than=20 103D{Delta}=20. Patients who did not meet the criteria = for=20 successful treatment or improved outcome were = considered=20 nonresponders.

STATISTICAL ANALYSIS=20

All sample size calculations were performed using PASS = 2000=20 software35=20 and assuming a 2-sided test with 90% power. For a = given=20 outcome measure, the common standard deviation (SD) = obtained=20 from the CITT pilot study29=20 was used as an estimate of variability. To = control for=20 multiple comparisons (4 groups, with 2 compared = at a time=20 [6 pair-wise comparisons]), the 3D{alpha}=20 level used for determining sample = size was set=20 at 0.0083 (0.05/6).

The CITT was powered to reject the null hypothesis of no=20 difference between groups, assuming that the true = population differences between groups are 10 = points on=20 the CISS, 4 cm in NPC, and 103D{Delta}=20 in PFV. These differences were based = on=20 clinician expert opinion and the repeatability of = each=20 measure.13,=20 36=20 The sample size of 52 children per group was = based on the=20 required sample size for the 3 outcome variables = and=20 adjusted for a 10% loss to follow-up.

All data analyses were performed using SAS, version 9.1 = (SAS=20 Institute, Cary, North Carolina). All analyses = followed=20 the intention-to-treat principle. The mean of the = 2=20 measures of the CISS score and the 3 measures of = both the=20 NPC and PFV obtained at each study visit were = used for=20 analyses. Positive fusional vergence at near was = obtained=20 from the base-out to blur measure if present; = otherwise,=20 base-out to break was used.

As planned a priori, a 4-group by 3-period = repeated-measures=20 analysis of covariance (ANCOVA) was used to compare = the=20 treatment groups at week 12. Using data from both = the=20 4-and 8-week visits maximizes the degrees of = freedom,=20 thus ensuring the most appropriate estimate of = the mean=20 square error used in group mean comparisons. The = baseline=20 value of the outcome measure was used as a covariate=20 because our initial pilot data showed a strong = correlation=20 between baseline and all subsequent values. In = addition,=20 all clinical and demographic variables collected = at=20 baseline were examined as potential confounders = of the=20 true relationship between a particular outcome = measure=20 and treatment group. For these analyses, the 3D{alpha}=20 level for inclusion in the final ANCOVA model = was set=20 at 0.10. If the final ANCOVA model indicated a=20 significant group effect or group x time interaction, Tukey's = method of=20 adjustment for multiple pairwise group = comparisons was=20 used to hold the overall error rate at 3D{alpha}=20 =3D 0.05. The mean square error = from=20 the ANCOVA model was also used to construct 95% = confidence=20 intervals for the mean difference between groups. =

A 3D{chi}=202 test was used to compare the = percentage of=20 patients in each group who were classified as = having=20 successful or improved outcomes or as a = nonresponder.=20 Post hoc pairwise group comparisons of the = percentage in=20 each classification were achieved using logistic=20 regression models. The baseline value of each outcome=20 measure was included in the regression model. An=20 unweighted 3D{kappa}=20 statistic and the 95% confidence = interval were=20 used to assess the agreement between the = examiner's guess=20 and the patient's actual group assignment. =


RESULTS
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 =95 In= troduction
 =95 M= ethods
 =95 Results
 =95 C= omment
 =95 C= onclusions
 =95 A= uthor=20 information
 =95 R= eferences
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ENROLLMENT=20

Between July 2005 and October 2006, 221 patients were=20 enrolled in the study. The number of patients = enrolled at=20 the 9 sites ranged from 14 to 35 (median, 25). = The mean=20 age of the patients was 11.8 years (SD, 2.3 = years); 59%=20 were female, 55% were white, 30% were African = American,=20 and 34% were Hispanic. At baseline, the mean (SD) = clinical findings were 23D{Delta}=20 (2.83D{Delta}=20) exodeviation at distance; 9.33D{Delta}=20 (4.43D{Delta}=20) exodeviation at near; NPC break/recovery = of=20 14.2 (7.5) cm/17.9 (8.2) cm; and PFV break/recovery at = near=20 of 12.7 (4.6)3D{Delta}=20/8.8 (4.5)3D{Delta}=20. Tabl 1 provides the study = population=20 demographics and pertinent clinical measures at = baseline=20 by treatment group. While children with constant=20 strabismus were excluded, patients with = intermittent=20 exotropia were eligible for the study and a small = number=20 (4-7 patients) were randomized to each treatment = group.=20 Although there was an imbalance at baseline in = medication=20 used among the 4 groups (highest in the OBPT = group), only=20 psychotropic medications had potential effects on = accommodation, and the groups were balanced for these=20 medications. Based on initial bivariate analyses, = no=20 confounders were identified for inclusion in the = ANCOVA=20 model for any of the 3 outcome measures.


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Table 1. CITT Population = Demographics and=20 Clinical Measures at Baseline=20 =


PATIENT FOLLOW-UP=20

Of the 221 patients who entered the trial, 218 (99%)=20 completed the 12-week outcome examination (Figure=20 2). Less than 2% of all study visits through = week 12=20 were missed. The highest percentage of missed = visits=20 occurred in the OBPT group (18 of 648 visits = [2.8%]). Of=20 the 720 study visits scheduled in the OBVAT group, = only=20 17 were missed (2.4%). In both of the home-based = treatment=20 groups, the percentage of visits missed was less than = 1.5%=20 (1.3% of 639 visits in the HBPP group and 1.4% of = 636=20 visits in the HBCVAT+ group).



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Figure 2. Flowchart of the = randomized, clinical Convergence = Insufficiency=20 Treatment Trial. HBCVAT+ indicates = home-based=20 computer vergence/accommodative therapy = and pencil=20 push-ups; HBPP, home-based pencil push-up = therapy;=20 OBPT, office-based placebo therapy with = home=20 reinforcement; and OBVAT, office-based=20 vergence/accommodative therapy with home=20 reinforcement. *One missed visit.=20 =


TREATMENT ADHERENCE DATA=20

At 12 weeks, the percentage of CITT patients rated by=20 therapists as compliant with the home therapy = protocol at=20 least 75% of the time was 67.3% in the HBCVAT+ = group,=20 84.9% in the HBPP group, 87% in the OBPT group, = and 91.4%=20 in the OBVAT group (Table=20 2). Accounting for the observed differences = in=20 estimated adherence did not affect the results of = the=20 treatment group comparisons for symptom score, = NPC, or=20 PFV (data not shown).


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Table 2. Patients Rated by = Therapist as=20 Compliant With Home Therapy Protocol at = Least 75%=20 of the Time=20 =


MASKING=20

Eighty-five percent of the patients assigned to placebo=20 therapy and 93% of those assigned to=20 vergence/accommodative therapy believed that they = had=20 been assigned to the active therapy group. None = of the=20 examiners felt that they could identify the patients'=20 group assignment at the 4- or 8-week masked = examinations,=20 and only 1 examiner felt that he could identify = the group=20 assignment at outcome. One-third of the examiners = responded that their patient was assigned to the = OBVAT=20 group, 24% responded that he/she was assigned to = HBCVAT+,=20 21% said their patient was assigned to HBPP, and = 21% said=20 their patient was assigned to the OBPT group. = Examiners,=20 when asked to guess, were correct in identifying = the=20 patient's group assignment only 34% of the time, which = is=20 less than is expected by chance (ie, 50% correct vs=20 incorrect, P < .001). There = was low=20 agreement between the actual group assignment and = the=20 examiner's guess of assigned treatment group = (=3D 0.11, 95% confidence interval, = 0.04-0.20).=20

PRIMARY OUTCOME MEASURE=20

Figure=20 3 displays the cumulative distribution plots of the = mean=20 symptom level for the 4 treatment groups at baseline = and=20 after 12 weeks of treatment. At the 12-week = outcome=20 examination, patients assigned to the OBVAT group = reported a significantly lower mean symptom level = compared with patients in the 3 other treatment = groups=20 (Table=20 3). The mean CISS score at 12 weeks in patients = in=20 the OBVAT group was 6.8 points lower than that in = patients=20 assigned to OBPT (95% confidence interval, 3.4-10.3;=20 P < .001). A mean difference = of 7.9=20 points was found between the OBVAT and HBPP = groups (95%=20 confidence interval, 4.4-11.4; = P < .001).=20 The largest difference in mean symptom level was 8.4=20 points (95% confidence interval, 4.9-11.9;=20 P < .001), observed between = the OBVAT=20 and HBCVAT+ groups. No significant differences = were=20 observed among the HBPP, HBCVAT+, and OBPT groups = (pairwise P 3D≥=20 .38 for all).



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Figure 3. Cumulative = distribution of=20 Convergence Insufficiency Symptom Survey = scores=20 collected during the eligibility = examination and=20 at the masked examination at week 12. = HBCVAT+=20 indicates home-based computer=20 vergence/accommodative therapy and pencil=20 push-ups; HBPP, home-based pencil push-up = therapy;=20 OBPT, office-based placebo therapy with = home=20 reinforcement; and OBVAT, office-based=20 vergence/accommodative therapy with home=20 reinforcement.=20 =



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Table 3. Means and 95% Confidence = Intervals=20 for Each Outcome by Treatment Group and = Time=20 =


As seen in Table=20 4, the percentage of patients in each group = who were=20 considered asymptomatic (ie, CISS score <16) or=20 improved (ie, change in score of 3D≥=2010 points at the outcome examination) = was=20 significantly higher in the OBVAT group compared with = the=20 other treatment groups (HBPP, = P =3D .013;=20 HBCVAT+, P < .001; OBPT,=20 P =3D .004). There was no significant = difference=20 in the percentage of patients considered asymptomatic = or=20 improved between the OBPT group and the 2 = home-based=20 groups (pairwise P > .60 for=20 all).


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Table 4. Improvement in Signs and = Symptoms=20 of Convergence Insufficiency by Therapy = Group=20 =


We also used an alternate definition of success in which=20 patients who achieved a symptom score of less = than 16=20 were only considered to have had successful = treatment if=20 improvement was 10 or more points (Table=20 4). This eliminated the chance that patients with=20 CISS scores that just met the eligibility criterion = (16) would be classified as achieving = successful=20 treatment when the change in the CISS score was = within=20 the normal variability of the survey. Sixty-six = percent=20 of patients in the OBVAT group met this criterion, = which=20 was significantly greater than that observed in any of=20 the other treatment groups (38% in HBPP,=20 P =3D .003; 33% in HBCVAT+,=20 P < .001; 35% in OBPT,=20 P =3D .001); there were no = statistical=20 differences among the latter 3 treatment groups = (pairwise=20 P > .50 for all).

SECONDARY OUTCOME MEASURES=20

NPC Break=20

Figure=20 4 displays the cumulative distribution plots of the = mean=20 NPC break for the 4 treatment groups at baseline and = after=20 12 weeks of treatment. At the outcome visit, the = mean NPC=20 was significantly improved in the OBVAT group = compared=20 with the other 3 groups (pairwise = P  .005 for all) (Table=20 3). While the mean NPC of both home-based = groups=20 measured significantly closer than that of the = OBPT group=20 (pairwise P 3D≤=20 .01 for all), there were no = statistically=20 significant differences between the 2 home-based = therapy=20 groups (P =3D .33).



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Figure 4. Cumulative = distribution of=20 near point of convergence data collected = during=20 the eligibility examination and at the = masked=20 examination at week 12. HBCVAT+ indicates=20 home-based computer vergence/accommodative = therapy=20 and pencil push-ups; HBPP, home-based = pencil=20 push-up therapy; OBPT, office-based = placebo=20 therapy with home reinforcement; and = OBVAT,=20 office-based vergence/accommodative = therapy with=20 home reinforcement.=20 =


The percentage of patients who had normal (break <6 = cm)=20 or improved (decrease of 3D≥=204 cm) NPC at the 12-week outcome examination = was=20 significantly greater in the OBVAT group compared with = the=20 other treatment groups (HBPP, = P =3D .008;=20 HBCVAT+, P =3D .006; OBPT,=20 P < .001) (Table=20 4). There were slightly more patients with a = normal=20 or improved NPC in both the HBPP and HBCVAT+ = groups=20 compared with the OBPT group; however, the = difference was=20 not statistically significant = (P =3D .06=20 and .07, respectively). There was no significant=20 difference between the 2 home-based groups=20 (P =3D .93).

We also used an alternate definition of successful = treatment=20 in which patients who achieved a normal NPC were only=20 considered to have had a successful treatment if=20 improvement was greater than 4 cm (Table=20 4). Eighty-seven percent of patients in the = OBVAT=20 group achieved this criterion, a significantly higher=20 percentage than that found in any of the other = treatment=20 groups (71% in HBCVAT+, = P =3D .023; 64% in=20 HBPP, P =3D .002; and 54% in = OBPT group,=20 P < .001). There was also a=20 significant difference between the HBCVAT+ and the OBPT = groups=20 (P =3D .032); no differences were = found between=20 the HBPP group and either the HBCVAT+=20 (P =3D .37) or OBPT=20 (P =3D .20) groups. This conservative = estimate=20 would not include some patients who would be = considered=20 to have had clinically successful treatment (eg, = a 7 cm=20 NPC at baseline, which improves to 3.5 cm). =

PFV at Near=20

Figure=20 5 displays the cumulative distribution plots of the = mean=20 PFV at near for the 4 treatment groups at baseline and = after 12 weeks of treatment. At the outcome = examination,=20 the mean PFV for patients in the OBVAT group was=20 significantly greater than all other groups = (pairwise=20 P < .001 for all). The mean = PFV in=20 the HBCVAT+ group was significantly better (higher) = than=20 in the HBPP (P =3D .037) and OBPT=20 (P =3D .008) groups. There was = no=20 significant difference in response in the HBPP = and OBPT=20 groups (P =3D .57).



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Figure 5. Cumulative = distribution of=20 positive fusional vergence data collected = during=20 the eligibility examination and at the = masked=20 examination at week 12. HBCVAT+ indicates=20 home-based computer vergence/accommodative = therapy=20 and pencil push-ups; HBPP, home-based = pencil=20 push-up therapy; OBPT, office-based = placebo=20 therapy with home reinforcement; OBVAT,=20 office-based vergence/accommodative = therapy with=20 home reinforcement; and 3D{Delta}, prism diopter.=20 =


As seen in Table=20 4, the percentage of patients with normal or = improved=20 PFV at the outcome examination was significantly higher = in the OBVAT group compared with all other treatment=20 groups (HBPP, P =3D .002; = HBCVAT+,=20 P =3D .007; OBPT,=20 P < .001). There were no = significant=20 differences in the percentage of patients with = normal or=20 improved PFV in the latter 3 treatment groups = (pairwise=20 P > .10 for all).

As with CISS score and NPC break, an alternate definition = of=20 success was used in which patients who achieved a = normal=20 PFV were only considered to have had a successful = treatment outcome if improvement was greater than = 10 (Table=20 4). Seventy-three percent of patients in the = OBVAT=20 group achieved this criterion, a significantly = higher=20 percentage than that in any of the other = treatment groups=20 (52% in the HBCVAT+ group, P =3D .02; = 40%=20 in the HBPP group, P< .001; and 26% in the = OBPT=20 group, P < .001). There was also a = significant difference between the HBCVAT+ and = OBPT=20 groups (P =3D .007); however, no = other=20 significant differences were detected=20 (P > .10 for all). Again, = this=20 conservative estimate would not include some = patients who=20 would be considered clinically successful (eg, = 10 exophoria at near with a PFV at near of 163D{Delta}=20 at baseline, which improves to 253D{Delta}=20).

Successful, Improved, and Nonresponder=20 Criteria=20

Using the composite outcome classification, which = combines=20 symptoms, NPC, and PFV, the proportion of = patients found=20 to have had successful treatment or improved = outcome in=20 the OBVAT group was significantly greater than = that in=20 any of the other groups (P < .002 = for=20 all). While nearly three-quarters of patients in the = OBVAT=20 group (73%) had either successful or improved = outcomes,=20 less than half the patients in the HBPP group = (43%),=20 one-third of the patients in the HBCVAT+ group = (33%), and=20 just more than one-third in the placebo group = (35%) were=20 similarly classified.

Secondary Measures Combined =

Previous studies have assessed treatment effectiveness by = evaluating whether improvements occurred in both = NPC and=20 PFV. Seventy-three percent, 40%, 37%, and 22% of = patients=20 in the OBVAT, HBPP, HBCVAT+, and OBPT groups,=20 respectively, achieved both a normal NPC and PFV. = The=20 percentage of patients who achieved both a normal NPC = and=20 a normal PFV was significantly higher in the OBVAT = group=20 compared with the other treatment groups=20 (P < .001 for each pairwise=20 comparison). No other group differences were = significant=20 (P > .11 for each pairwise = comparison).=20

Attention-Deficit/Hyperactivity=20 Disorder=20

Children with parent-reported=20 attention-deficit/hyperactivity disorder (ADHD) = scored=20 higher on the CISS at baseline than children = without=20 parent-reported ADHD, and there were slight differences = in the distribution of these children among treatment=20 groups at baseline. However, ADHD was not a = confounder=20 and did not affect the mean treatment differences = among=20 the groups. There was also no interaction between = ADHD=20 and treatment (P =3D .93). We = examined the=20 3-way interaction between ADHD, treatment, and = time and=20 found no significant effect = (P =3D .26).

ADVERSE EVENTS=20

Six adverse events that included eyes or vision were=20 reported. All were unexpected and further = evaluations=20 determined that none of the events were serious = or=20 related to the study treatment.


COMMENT
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 =95 In= troduction
 =95 M= ethods
 =95 R= esults
 =95 Comment
 =95 C= onclusions
 =95 A= uthor=20 information
 =95 R= eferences
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We compared=20 the effectiveness of 3 active vision therapy approaches = in 221 children with symptomatic CI. Office-based=20 vergence/accommodative therapy with home = reinforcement=20 was significantly more effective than HBPP, = HBCVAT+, and=20 OBPT in improving both the symptoms and clinical = signs=20 associated with symptomatic CI. Although symptoms = did=20 improve in the 2 home-based therapies, these treatments = were no more effective in improving symptoms than=20 office-based placebo therapy.

We established 4 criteria, a priori, to determine the=20 clinical relevance of the data from this study: = (1) the=20 score differences on the CISS between treatment = groups at=20 outcome, (2) the proportion of children who = achieved a=20 normal or improved symptom score on the CISS at = outcome,=20 (3) the change in secondary outcome measures, = NPC, and=20 PFV (convergence amplitudes) at outcome, and (4) = the=20 proportion of patients classified as having had=20 successful or improved outcomes when using the = composite=20 outcome classification (combining the treatment = effects=20 of all 3 outcome measures).

The first criterion, the treatment group difference in = the=20 CISS score at outcome, was difficult to establish = a=20 priori. Our survey instrument had not been = incorporated=20 into clinical practice, and, consequently, the = magnitude=20 of the difference between 2 treatment regimens = that=20 indicated clinical relevance had not been = established.=20 Based on the group mean differences found for the = CISS in=20 our previous pilot study,29=20 the CITT was designed to have 90% power to reject = the=20 null hypothesis of no group mean differences if = the true=20 population difference between groups in the CISS = score=20 was 10 points. This difference of 10 points, = along with=20 data on the variability in CISS scores obtained from = 3=20 separate randomized trials conducted by the CITT Study = Group,=20 translates into an effect size of greater than 1 = SD.=20

In the present study, we did not find a difference in = group=20 means of 10 or more points on the CISS. Instead, we = found=20 statistically significant group differences that = ranged=20 from 7 to 8.5 points between the OBVAT group and = each of=20 the other 3 treatment groups. This translates to = an=20 effect size that ranges from 0.77 to 0.94 SD. = Using=20 Cohen=92s37=20 guidelines for interpretation of effect size (0.2 = is=20 small, 0.5 is medium, 0.8 is large), the group=20 differences we found are considered large. Sloan et = al38=20 contend that an effect size of 0.5 is a = conservative=20 estimate of a clinically meaningful difference = that is=20 scientifically supportable and unlikely to be one = that=20 can be disregarded. Thus, group differences = observed in=20 this study are considered clinically meaningful, = though=20 they are less than the a priori estimate of a 10 or = more=20 points change between groups. Looking retrospectively = and=20 reviewing the literature on effect size, the = 10-point=20 difference was a significant overestimate of the=20 potential treatment effect. Further study and = refinement=20 of the CISS will help clarify the issue. =

The second criterion used to assess clinical relevance = was=20 whether there were differences among treatment = groups in=20 patients' ability to achieve a normal or improved = symptom=20 level on the CISS. After treatment, 73% of = patients=20 assigned to OBVAT met this criterion, in contrast = to 47%=20 assigned to HBPP, 39% assigned to HBCVAT+, and = 43%=20 assigned to OBPT. Changing the criterion to require = that=20 patients achieved both a score of less than 16 and a = change=20 of 10 or more points on the CISS resulted in lower = success=20 rates for all groups, but the differences among = treatment=20 groups remained the same.

The third criterion used was an evaluation of the = secondary=20 outcome measures, NPC and PFV (convergence = amplitudes), as=20 they are often used clinically to determine = treatment=20 success for CI. The proportion of patients who = achieved a=20 clinically normal level for both measures was 73% = in the=20 OBVAT group compared with no more than 40% in = each of the=20 other 3 treatment groups.

The fourth a priori criterion for determining clinical=20 significance was the proportion of patients = classified as=20 having successful or improved outcomes when using = the=20 composite outcome classification (combining the = treatment=20 effects of all 3 outcomes). A significantly = higher=20 proportion of children assigned to OBVAT (73%) compared = with the 3 other treatment groups was classified as = having=20 successful treatment or improved outcome. No = significant=20 differences were observed between the 2 = home-based groups=20 and the placebo therapy group. Thus, based on the = analysis of all 4 a priori criteria, we conclude = that=20 there are both statistically significant and = clinically=20 meaningful differences between the groups.

The results of this large, randomized clinical trial are=20 similar to those from the only previous = randomized trial=20 of vision therapy/orthoptics for CI in = children29=20 in which 3 treatment groups were studied: HBPP,=20 office-based vision therapy/orthoptics, and OBPT. In = that=20 pilot study, only the OBVAT group experienced a=20 significant improvement in symptoms, NPC, and = PFV.=20

The current study was not designed to show the maximal=20 possible improvement with treatment. Longer = treatment may=20 have resulted in additional changes in signs and=20 symptoms. Office-based vergence/accommodative = therapy=20 programs for CI often include 12 to 24 office visits.19-21=20 Our 12-week treatment program was based on the = assumption=20 that this represented the maximum length of time = that a=20 symptomatic patient who was not improving would = stay on=20 the assigned treatment. Because our 12-week = treatment=20 program is at the low end of the range of time=20 recommended for office-based CI therapy, it is = possible=20 that OBVAT might have been effective in more patients = had=20 the treatment program been longer. Likewise, a longer = treatment=20 program may have resulted in additional improvements = by=20 those assigned to the home-based treatment = groups. It is=20 also possible that using more home-based therapy=20 procedures or prescribing longer periods of daily = home-based therapy may have produced different = results.=20 Answers to these questions will have to await = further=20 study.

While a placebo effect could be associated with any of = the 4=20 treatments owing to the patient's expectation that the = treatment would be effective, office-based = therapy might=20 be more susceptible to this effect owing to the=20 enthusiasm, caring, and compassion of a therapist = who=20 spends 60 minutes per week with the patient.39=20 However, this is the second randomized trial of OBVAT = that=20 was designed to control for the effect of the = therapist=20 as a placebo40;=20 placebo therapy was designed to simulate bona fide = therapy=20 procedures and therapists were trained to behave=20 identically for patients in both of the = office-based=20 therapy groups. The data reported herein confirm = that we=20 were successful in achieving this objective, as = 85% of=20 the patients assigned to OBPT believed they had been=20 assigned to the actual OBVAT group. This compares well = with our previous pilot study in which 90% of the = patients assigned to placebo therapy believed = they had=20 been assigned to actual therapy.29=20 A no treatment group was not included; therefore, = it is=20 not known whether any improvements were due to = regression=20 to the mean or natural history of the disease. = However,=20 this should have affected all treatment groups = similarly=20 because there were no statistically significant = or=20 clinically relevant differences in any primary or = secondary outcome measure among the treatment = groups at=20 baseline. Therefore, the observed differences in=20 effectiveness between the OBVAT and placebo therapy = groups=20 are most likely attributable to treatment effect. =

The OBVAT used in this study represents a typical = approach=20 used in clinical practice.21=20 We conclude that this specific therapy protocol = was=20 successful in this study and should be applicable = to=20 children with similar clinical findings. A better = understanding=20 of which procedures were most effective will require=20 additional research.

While this study was not designed to determine which = factors=20 within a particular group contributed to the outcome, = the=20 procedures that comprise the OBVAT provide = therapists=20 with the greatest ability to control and = manipulate=20 stimulus parameters (eg, vergence amplitude and=20 accommodative demand) and to incorporate motor = learning=20 theory (eg, modeling and demonstration, transfer of=20 training, patient feedback). The weekly visits with = the=20 therapist during OBVAT also permit the inclusion = of a=20 variety of procedures that stress convergence and = accommodative abilities not typically addressed = in home=20 therapy programs. There were also differences = among the=20 treatment groups in time spent performing therapy = and=20 interacting with the therapist. The 2 office-based = groups=20 had a mean prescribed therapy time of 135 minutes per=20 week; the HBCVAT+ group averaged 115 minutes; and = the=20 HBPP group averaged 90 minutes, which included = weekly=20 telephone calls with the therapist. However, this = study=20 was not designed to equalize time spent = performing=20 therapy and/or interacting with a therapist; rather, = it=20 was designed as an effectiveness study to evaluate 3 = clinical=20 treatments typically provided in clinical practice. It = is=20 possible that the difference in treatment effect = found in=20 this study could be related to the OBVAT group = having=20 been prescribed more minutes of therapy per day = than the=20 home-based groups. However, having a patient = perform a=20 greater amount of daily home-based therapy, = particularly=20 pencil push-ups, is likely impractical.

There are limited data in the literature that suggest = there=20 is a relationship between CI and ADHD.41-42=20 Although we asked parents whether their child had = ADHD=20 (ie, parental report), this study was not = designed to=20 assess this relationship and was not powered for = such=20 subgroup analyses, nor was the diagnosis of ADHD=20 definitive. However, investigation of this possible=20 association is of interest and merits additional=20 research.

We could not identify any other sources of bias or=20 confounding factors to explain our findings. = Accounting=20 for slight differences in the distribution of = baseline=20 factors between groups in the analyses did not = alter the=20 interpretation of the results. The follow-up = visit rate=20 was excellent and almost identical in all 4 = groups. The=20 investigators performing the 4-, 8-, and 12-week=20 examinations were masked to the treatment group, and = the=20 patients in the 2 office-based treatment groups = were=20 effectively masked as well. We did have slight=20 differences in adherence among the groups, = however, and=20 accounting for these differences in estimated = adherence=20 did not affect the results of the treatment group=20 comparisons for the CISS score, NPC, or PFV. The = placebo=20 effect was accounted for by incorporating the = OBPT=20 group.

When translating these study results into clinical = practice,=20 it is important to recognize that they can only be = applied=20 to children with symptomatic CI who are aged 9 to = 17=20 years. Adults with symptomatic CI may respond=20 differently, as suggested by our pilot = study.43=20 Our findings indicate that the specific form of = vision=20 therapy/orthoptics we used, OBVAT with home = reinforcement,=20 is the most effective of the treatments we studied in = this=20 trial, with about 75% of patients achieving = normalization=20 of or improvement in symptoms and signs within 12 = weeks.

With regards to home-based therapy, it is important to = note=20 that the data reported in this study for the HBPP = group=20 were derived from a therapy program designed with = considerably closer follow-up than is typical in = clinical=20 practice. Patients were called on a weekly basis = by a=20 therapist, completed a home log, and returned for = office=20 visits every fourth week. It is possible that = this=20 treatment would be less effective if prescribed = according=20 to usual clinical practice, which does not include = weekly=20 telephone calls from a therapist and often has = less=20 frequent follow-up. The results of the CITT pilot = study,=20 in which the HBPP group did not receive weekly = phone=20 calls, provide some support for this hypothesis, = as none=20 of the 11 patients were classified as having = successful=20 or improved outcomes.29=20

It is easy to understand the clinical popularity of=20 home-based treatment because of its simplicity = and=20 cost-effectiveness. Both HBPP and HBCVAT+ can be = taught=20 to patients in a short time and require fewer = follow-up=20 visits than office-based therapy (4 visits for = home-based=20 treatments compared with 12 visits for = office-based=20 treatment). While our study was not designed to = conduct a=20 cost-utility analysis, this is worthwhile to explore = in=20 future research.

There are a number of interesting clinical questions that = cannot be answered at this time. It is possible = that=20 there may be psychological effects from the = interaction=20 between the therapist and the patient that could = affect=20 the office-based and home-based treatment groups' = results=20 differentially (if these effects were present, = and if=20 they were dependent on patient-therapist contact time). = In this study, we did not have a placebo home-based=20 therapy group and thus, do not know whether the = changes=20 found in the 2 home-based groups are due to a = real or=20 placebo treatment effect. It is possible that = different=20 protocols that more closely monitor and encourage = adherence would affect the outcomes. For the OBVAT=20 regimen, we do not know which procedures were most=20 effective or whether the treatment protocol can = be=20 modified to make it more effective. This includes = understanding the nature of the synergistic role = of the=20 active home treatment component as well as the = therapist=20 interaction. It is also not known whether the = treatment=20 effect will be sustained over time. Therefore, a = conclusion=20 about the long-term benefit of treatment must await = the=20 results of the 12-month follow-up study we are=20 conducting.


CONCLUSIONS
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 =95 In= troduction
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 =95 Conclusions
 =95 A= uthor=20 information
 =95 R= eferences
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This=20 large-scale multi-center, randomized clinical trial of=20 treatments for children with symptomatic CI = demonstrates=20 that a 12-week regimen of OBVAT with home = reinforcement=20 is more effective than a 12-week program of HBPP = or=20 HBCVAT+ in improving symptoms and signs = associated with=20 CI.


AUTHOR INFORMATION
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 =95 C= onclusions
 =95 Author=20 information
 =95 R= eferences
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Correspondence: Mitchell Scheiman, OD,=20 Pennsylvania College of Optometry, 1200 W Godfrey = Ave,=20 Philadelphia, PA 19141 (mscheiman{at}pco.edu ).

Submitted for Publication: December 11, 2007; = final=20 revision received June 4, 2008; accepted June 5,=20 2008.

Financial Disclosure: Dr Cooper has a financial = interest=20 in Computer Orthoptics, the company that sells = the=20 program used for the HBCVAT+ group.

Funding/Support: This study was supported by the = National=20 Eye Institute of the National Institutes of = Health,=20 Department of Health and Human Services. =


The CITT Study Group=20

Clinical Sites=20

Sites are listed in order of the = number of=20 patients enrolled in the study, with the = number=20 of patients in parentheses after the site = name and=20 location. Personnel are listed as PI = for=20 principal investigator, SC for site=20 coordinator, E for examiner, and VT for vision=20 therapist.=20

Bascom Palmer Eye Institute, = Miami,=20 Florida (35): Dr Tamkins (PI); = Hilda=20 Capo, MD (E); Mark Dunbar, OD (E); Craig = McKeown, MD=20 (co-PI); Arlanna Moshfeghi, MD (E); = Kathryn=20 Nelson, OD (E); Vicky Fischer, OD = (VT); Adam=20 Perlman, OD (VT); Ronda Singh, OD (VT); Eva=20 Olivares (SC); Ana Rosa (SC); Nidia = Rosado=20 (SC); and Elias Silverman (SC).=20

State University of New York College of = Optometry,=20 New York, New York (28): Dr = Cooper (PI);=20 Audra Steiner, OD (E, Co-PI); Marta = Brunelli=20 (VT); Stacy Friedman, OD (VT); Steven = Ritter,=20 OD (E); Lily Zhu, OD (E); Lyndon Wong, OD = (E); Ida=20 Chung, OD (E); and Kaity Colon (SC).=20

University of Alabama at Birmingham=20 School of Optometry, Birmingham (28): = Dr=20 Hopkins (PI); Marcela Frazier, OD, = MPH (E);=20 Janene Sims, OD (E); Marsha Swanson, OD = (E);=20 Katherine Weise, OD, MBA (E); Adrienne = Broadfoot, MS,=20 OTR/L (VT, SC); Michelle Anderson, OD = (VT);=20 and Catherine Baldwin (SC).=20

Nova Southeastern University, Ft = Lauderdale,=20 Florida (27): Dr Coulter (PI); = Deborah=20 Amster, OD (E); Gregory Fecho, OD = (E); Tanya=20 Mahaphon, OD (E); Jacqueline Rodena, OD (E); = Mary=20 Bartuccio, OD (VT); Yin Tea, OD (VT); and = Annette=20 Bade, OD (SC).=20

Pennsylvania College of = Optometry,=20 Philadelphia (25): Dr Gallaway (PI); = Brandy=20 Scombordi, OD (E); Mark Boas, OD (VT); = Tomohiko=20 Yamada, OD (VT); Ryan Langan (SC), = Ruth=20 Shoge, OD (E); and Lily Zhu, OD (E).=20

The Ohio State University = College of=20 Optometry, Columbus (24): Dr Kulp = (PI);=20 Michelle Buckland, OD (E); Michael Earley, OD, = PhD=20 (E); Gina Gabriel, OD, MS (E); Aaron = Zimmerman, OD=20 (E); Kathleen Reuter, OD (VT); Andrew = Toole,=20 OD, MS (VT); Molly Biddle, MEd (SC); = and=20 Nancy Stevens, MS, RD, LD (SC).=20

Southern California College of=20 Optometry, Fullerton (23): Dr Cotter (PI); = Eric=20 Borsting, OD, MS (E); Dr Rouse (E); = Carmen=20 Barnhardt, OD, MS (VT); Raymond Chu, = OD, MS=20 (VT); Susan Parker (SC); Rebecca Bridgeford = (SC);=20 Jamie Morris (SC); and Javier Villalobos = (SC).=20

University of California=96San = Diego=20 Ratner Children's Eye Center, San = Diego=20 (17): Dr Granet (PI); Lara Hustana, OD (E); = Shira=20 Robbins, MD (E); Erica Castro (VT); = and=20 Cintia Gomi, MD (SC).=20

Mayo Clinic, Rochester, = Minnesota=20 (14): Dr Mohney (PI); Jonathan Holmes, = MD=20 (E); Melissa Rice, OD (VT); Virginia Karlsson, = BS, CO=20 (VT); Becky Nielsen (SC); Jan Sease, = COMT, BS=20 (SC); and Tracee Shevlin (SC).=20

CITT Study Chair=20

Dr Scheiman (study chair); Karen Pollack = (study coordinator); Dr Cotter (vice = chair); Dr=20 Hertle (vice chair); and Dr Rouse=20 (consultant).=20

CITT Data Coordinating Center=20

Ms Mitchell (PI); Tracy Kitts = (project=20 coordinator); Melanie Bacher = (programmer);=20 Linda Barrett (data entry); Loraine Sinnott, = PhD=20 (biostatistician); Kelly Watson (student = worker);=20 and Pam Wessel (office associate).=20

National Eye Institute, Bethesda, MD=20

Dr Redford; and Paivi Miskala, = PhD.=20

CITT Executive Committee=20

Dr Scheiman; Ms Mitchell; Dr = Cotter; Dr=20 Hertle; Dr Kulp; Dr Redford; and Dr = Rouse.=20

Data and Safety Monitoring Committee=20

Marie Diener-West, PhD (chair); = Rev Andrew=20 Costello, CSsR; William V. Good, MD; = Ron D.=20 Hays, PhD; Argye Hillis, PhD (through March = 2006);=20 and Ruth Manny, OD, PhD.=20 =



*Authors/Writing Committee: The = following members=20 of the Convergence Insufficiency Treatment Trial Study Group = take=20 authorship responsibility for the results: Lead authors: = Mitchell=20 Scheiman, OD; Susan Cotter, OD, MS; G. Lynn Mitchell, MAS; = Marjean=20 Kulp, OD, MS; Michael Rouse, OD, MEd; Richard Hertle, MD; = and=20 Maryann Redford, DDS, MPH. Additional writing committee = members=20 (alphabetical): Jeffrey Cooper, MS, OD; Rachel Coulter, OD; = Michael=20 Gallaway, OD; David Granet, MD; Kristine Hopkins, OD, MSPH; = Brian G.=20 Mohney, MD; and Susanna Tamkins, OD.


REFERENCES
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 Jump to=20 Section
 =95 To= p
 =95 In= troduction
 =95 M= ethods
 =95 R= esults
 =95 C= omment
 =95 C= onclusions
 =95 A= uthor=20 information
 =95 References
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1.=20 L=E9tourneau JE, Lapierre N, Lamont A. The relationship = between=20 convergence insufficiency and school achievement. Am J = Optom=20 Physiol Opt. 1979;56(1):18-22. ISI |=20 PUBMED
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2.=20 L=E9tourneau JE, Ducic S. Prevalence of convergence = insufficiency=20 among elementary school children. Can J Optom.=20 1988;50:194-197.
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3.=20 Porcar E, Martinez-Palomera A. Prevalence of general = binocular=20 dysfunctions in a population of university students. = Optom Vis=20 Sci. 1997;74(2):111-113. FULL = TEXT | ISI |=20 PUBMED
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4.=20 Rouse MW, Borsting E, Hyman L; et al. Frequency of = convergence=20 insufficiency among fifth and sixth graders. Optom Vis = Sci.=20 1999;76(9):643-649. FULL = TEXT | ISI |=20 PUBMED
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5.=20 Daum KM. Convergence insufficiency. Am J Optom Physiol = Opt.=20 1984;61(1):16-22. ISI |=20 PUBMED
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6.=20 Cooper J, Duckman R. Convergence insufficiency: incidence,=20 diagnosis, and treatment. J Am Optom Assoc.=20 1978;49(6):673-680. ISI |=20 PUBMED
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7.=20 Kent PR, Steeve JH. Convergence insufficiency: incidence = among=20 military personnel and relief by orthoptic methods. Mil = Surg.=20 1953;112(3):202-205. = PUBMED
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8.=20 Poynter HL, Schor C, Haynes HM, Hirsch J. Oculomotor = functions in=20 reading disability. Am J Optom Physiol Opt.=20 1982;59(2):116-127. ISI |=20 PUBMED
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9.=20 Mazow ML. The convergence insufficiency syndrome. J = Pediatr=20 Ophthalmol. 1971;8:243-244.
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10.=20 Duke-Elder S, Wybar K. Ocular motility and strabismus. In:=20 Duke-Elder S, ed. System of Ophthalmology. St Louis, = MO:=20 Mosby; 1973.=20
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11.=20 Pickwell LD, Hampshire R. The significance of inadequate=20 convergence. Ophthalmic Physiol Opt. = 1981;1(1):13-18. ISI |=20 PUBMED
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12.=20 Borsting E, Rouse MW, Deland PN; et al. Association of = symptoms and=20 convergence and accommodative insufficiency in school-age = children.=20 Optometry. 2003;74(1):25-34. PUBMED
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13.=20 Borsting EJ, Rouse MW, Mitchell GL; et al. Validity and = reliability=20 of the revised convergence insufficiency symptom survey in = children=20 aged 9-18 years. Optom Vis Sci. = 2003;80(12):832-838. FULL = TEXT | ISI |=20 PUBMED
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14.=20 von Noorden GK. Binocular Vision and Ocular Motility: = Theory and=20 Management of Strabismus. St Louis, MO: Mosby; 1996.=20
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15.=20 Abrams D. Duke-Elder's Practice of Refraction. = Edinburgh,=20 Scotland: Churchill-Livingstone; 1993.=20
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16.=20 Cibis G, Tongue A, Stass-Isern M. Decision Making in = Pediatric=20 Ophthalmology. Philadelphia, PA: Mosby-Year Book; = 1993.=20
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17.=20 Pratt-Johnson JA, Tillson G. Management of Strabismus and = Amblyopia. New York, NY: Thieme Medical Publishers; = 2001.=20
3D"
18.=20 von Noorden G, Helveston E. Strabismus: A Decision Making = Approach. St Louis, MO: Mosby-Year Book; 1994.=20
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19.=20 Griffin JR, Grisham JD. Binocular Anomalies: Diagnosis = and Vision=20 Therapy. Boston, MA: Butterworth-Heinemann; 2002.=20
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20.=20 Press LJ. Applied Concepts in Vision Therapy. St = Louis, MO:=20 Mosby-Year Book; 1997.=20
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21.=20 Scheiman M, Wick B. Clinical Management of Binocular = Vision:=20 Heterophoric, Accommodative and Eye Movement Disorders.=20 Philadelphia, PA: Lippincott, Williams and Wilkins; = 2002.=20
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22.=20 Hugonnier R, Clayette-Hugonnier C. Strabismus, = Heterophoria and=20 Ocular Motor Paralysis. St Louis, MO: CV Mosby; = 1969.=20
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23.=20 Gallaway M, Scheiman M, Malhotra K. The effectiveness of = pencil=20 pushups treatment for convergence insufficiency: a pilot = study.=20 Optom Vis Sci. 2002;79(4):265-267. FULL = TEXT | ISI |=20 PUBMED
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24.=20 Chin FH, Faibish B, Hisaka C, Thal L, Tsuda K. A survey of = the=20 treatment of convergence insufficiency. J Beh Optom.=20 1995;6:91-92, 109. =
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25.=20 Scheiman M, Cooper J, Mitchell GL; et al. A survey of = treatment=20 modalities for convergence insufficiency. Optom Vis = Sci.=20 2002;79(3):151-157. = FULL = TEXT | ISI |=20 PUBMED
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26.=20 Scheiman M, Mitchell GL, Cotter S; et al. Convergence = insufficiency:=20 randomized clinical trial [reply]. Arch Ophthalmol.=20 2005;123(12):1760-1761. FREE FULL=20 TEXT
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27.=20 Ciuffreda KJ. The scientific basis for and efficacy of = optometric=20 vision therapy in nonstrabismic accommodative and binocular = vision=20 disorders. Optometry. 2002;73(12):735-762. PUBMED
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28.=20 Scheiman M, Cotter S, Rouse M; et al. Randomised clinical = trial of=20 the effectiveness of base-in prism reading glasses versus = placebo=20 reading glasses for symptomatic convergence insufficiency in = children. Br J Ophthalmol. 2005;89(10):1318-1323. FREE FULL TEXT
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29.=20 Scheiman M, Mitchell GL, Cotter S; et al. A randomized trial = of the=20 effectiveness of treatments for convergence insufficiency in = children. Arch Ophthalmol. 2005;123(1):14-24. FREE FULL TEXT
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30.=20 Sheard C. Zones of ocular comfort. Am J Optom. = 1930;7:9-25.
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31.=20 Kushner BJ. The treatment of convergence insufficiency = [editorial].=20 Arch Ophthalmol. 2005;123(1):100-101. FREE FULL=20 TEXT
3D"
32.=20 Borsting E, Rouse MW, De Land PN. Prospective comparison of=20 convergence insufficiency and normal binocular children on = CIRS=20 symptom surveys. Convergence Insufficiency and Reading Study = (CIRS)=20 group. Optom Vis Sci. 1999;76(4):221-228. FULL = TEXT | ISI |=20 PUBMED
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33.=20 Mitchell G, Scheiman M, Borsting E; et al. Evaluation of a = symptom=20 survey for convergence insufficiency patients. Optom Vis = Sci.=20 2001;78(12S):37. FULL = TEXT | ISI |=20 PUBMED
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34.=20 The Convergence Insufficiency Treatment Trial (CITT) Study = Group.=20 The Convergence Insufficiency Treatment Trial: design, = methods, and=20 baseline data. Ophthalmic Epidemiol. = 2008;15(1):24-36. FULL = TEXT | ISI |=20 PUBMED
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35.=20 Hintze J. NCSS and PASS. Kaysville, UT: Number = Cruncher=20 Statistical Systems; 2000.=20
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36.=20 Rouse MW, Hyman L, Hussein M. Reliability of binocular = vision=20 measurements used in the classification of convergence=20 insufficiency. Optom Vis Sci. 2002;79(4):254-264. FULL = TEXT | ISI |=20 PUBMED
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37.=20 Cohen J. Statistical Power Analyses for the Behavioral=20 Sciences. Hillsdale, NH: Earlbaum Associates; 1988.=20
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38.=20 Sloan JA, Cella D, Hays RD. Clinical significance of=20 patient-reported questionnaire data: another step toward = consensus.=20 J Clin Epidemiol. 2005;58(12):1217-1219. FULL = TEXT | ISI |=20 PUBMED
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39.=20 Brody H. The doctor as a therapeutic agent: a placebo effect = research agenda. In: Harrington A, ed. The Placebo = Effect: An=20 Interdisciplinary Exploration. Cambridge, MA: Harvard = University=20 Press; 1997.=20
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40.=20 Margo CE. The placebo effect. Surv Ophthalmol.=20 1999;44(1):31-44. FULL = TEXT | ISI |=20 PUBMED
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41.=20 Borsting E, Rouse M, Chu R. Measuring ADHD behaviors in = children=20 with symptomatic accommodative dysfunction or convergence=20 insufficiency: a preliminary study. Optometry.=20 2005;76(10):588-592. = PUBMED
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42.=20 Granet DB, Gomi CF, Ventura R, Miller-Scholte A. The = relationship=20 between convergence insufficiency and ADHD. = Strabismus.=20 2005;13(4):163-168. = FULL = TEXT | PUBMED
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43.=20 Scheiman M, Mitchell GL, Cotter S; et al. A randomized = clinical=20 trial of vision therapy/orthoptics versus pencil pushups for = the=20 treatment of convergence insufficiency in young adults. = Optom Vis=20 Sci. 2005;82(7):583-595. FULL = TEXT | ISI |=20 PUBMED
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SECTION=20 EDITOR: ROY W. BECK, MD, PhD=20


RELATED=20 ARTICLE=20
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Treatment Options for Symptomatic Convergence=20 Insufficiency
David K. Wallace
Arch=20 Ophthalmol. 2008;126(10):1455-1456.
EXT= RACT=20 | FULL=20 TEXT  =20




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!!document.evaluate=0A= },=0A= =0A= ScriptFragment: '(?:)((\n|\r|.)*?)(?:<\/script>)',=0A= emptyFunction: function() {},=0A= K: function(x) { return x }=0A= }=0A= =0A= var Class =3D {=0A= create: function() {=0A= return function() {=0A= this.initialize.apply(this, arguments);=0A= }=0A= }=0A= }=0A= =0A= var Abstract =3D new Object();=0A= =0A= Object.extend =3D function(destination, source) {=0A= for (var property in source) {=0A= destination[property] =3D source[property];=0A= }=0A= return destination;=0A= }=0A= =0A= Object.extend(Object, {=0A= inspect: function(object) {=0A= try {=0A= if (object =3D=3D undefined) return 'undefined';=0A= if (object =3D=3D null) return 'null';=0A= return object.inspect ? object.inspect() : object.toString();=0A= } catch (e) {=0A= if (e instanceof RangeError) return '...';=0A= throw e;=0A= }=0A= },=0A= =0A= keys: function(object) {=0A= var keys =3D [];=0A= for (var property in object)=0A= keys.push(property);=0A= return keys;=0A= },=0A= =0A= values: function(object) {=0A= var values =3D [];=0A= for (var property in object)=0A= values.push(object[property]);=0A= return values;=0A= },=0A= =0A= clone: function(object) {=0A= return Object.extend({}, object);=0A= }=0A= });=0A= =0A= Function.prototype.bind =3D function() {=0A= var __method =3D this, args =3D $A(arguments), object =3D args.shift();=0A= return function() {=0A= return __method.apply(object, args.concat($A(arguments)));=0A= }=0A= }=0A= =0A= Function.prototype.bindAsEventListener =3D function(object) {=0A= var __method =3D this, args =3D $A(arguments), object =3D args.shift();=0A= return function(event) {=0A= return __method.apply(object, [( event || = window.event)].concat(args).concat($A(arguments)));=0A= }=0A= }=0A= =0A= Object.extend(Number.prototype, {=0A= toColorPart: function() {=0A= var digits =3D this.toString(16);=0A= if (this < 16) return '0' + digits;=0A= return digits;=0A= },=0A= =0A= succ: function() {=0A= return this + 1;=0A= },=0A= =0A= times: function(iterator) {=0A= $R(0, this, true).each(iterator);=0A= return this;=0A= }=0A= });=0A= =0A= var Try =3D {=0A= these: function() {=0A= var returnValue;=0A= =0A= for (var i =3D 0; i < arguments.length; i++) {=0A= var lambda =3D arguments[i];=0A= try {=0A= returnValue =3D lambda();=0A= break;=0A= } catch (e) {}=0A= }=0A= =0A= return returnValue;=0A= }=0A= }=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= var PeriodicalExecuter =3D Class.create();=0A= PeriodicalExecuter.prototype =3D {=0A= initialize: function(callback, frequency) {=0A= this.callback =3D callback;=0A= this.frequency =3D frequency;=0A= this.currentlyExecuting =3D false;=0A= =0A= this.registerCallback();=0A= },=0A= =0A= registerCallback: function() {=0A= this.timer =3D setInterval(this.onTimerEvent.bind(this), = this.frequency * 1000);=0A= },=0A= =0A= stop: function() {=0A= if (!this.timer) return;=0A= clearInterval(this.timer);=0A= this.timer =3D null;=0A= },=0A= =0A= onTimerEvent: function() {=0A= if (!this.currentlyExecuting) {=0A= try {=0A= this.currentlyExecuting =3D true;=0A= this.callback(this);=0A= } finally {=0A= this.currentlyExecuting =3D false;=0A= }=0A= }=0A= }=0A= }=0A= Object.extend(String.prototype, {=0A= gsub: function(pattern, replacement) {=0A= var result =3D '', source =3D this, match;=0A= replacement =3D arguments.callee.prepareReplacement(replacement);=0A= =0A= while (source.length > 0) {=0A= if (match =3D source.match(pattern)) {=0A= result +=3D source.slice(0, match.index);=0A= result +=3D (replacement(match) || '').toString();=0A= source =3D source.slice(match.index + match[0].length);=0A= } else {=0A= result +=3D source, source =3D '';=0A= }=0A= }=0A= return result;=0A= },=0A= =0A= sub: function(pattern, replacement, count) {=0A= replacement =3D this.gsub.prepareReplacement(replacement);=0A= count =3D count =3D=3D=3D undefined ? 1 : count;=0A= =0A= return this.gsub(pattern, function(match) {=0A= if (--count < 0) return match[0];=0A= return replacement(match);=0A= });=0A= },=0A= =0A= scan: function(pattern, iterator) {=0A= this.gsub(pattern, iterator);=0A= return this;=0A= },=0A= =0A= truncate: function(length, truncation) {=0A= length =3D length || 30;=0A= truncation =3D truncation =3D=3D=3D undefined ? '...' : truncation;=0A= return this.length > length ?=0A= this.slice(0, length - truncation.length) + truncation : this;=0A= },=0A= =0A= strip: function() {=0A= return this.replace(/^\s+/, '').replace(/\s+$/, '');=0A= },=0A= =0A= stripTags: function() {=0A= return this.replace(/<\/?[^>]+>/gi, '');=0A= },=0A= =0A= stripScripts: function() {=0A= return this.replace(new RegExp(Prototype.ScriptFragment, 'img'), '');=0A= },=0A= =0A= extractScripts: function() {=0A= var matchAll =3D new RegExp(Prototype.ScriptFragment, 'img');=0A= var matchOne =3D new RegExp(Prototype.ScriptFragment, 'im');=0A= return (this.match(matchAll) || []).map(function(scriptTag) {=0A= return (scriptTag.match(matchOne) || ['', ''])[1];=0A= });=0A= },=0A= =0A= evalScripts: function() {=0A= return this.extractScripts().map(function(script) { return = eval(script) });=0A= },=0A= =0A= escapeHTML: function() {=0A= var div =3D document.createElement('div');=0A= var text =3D document.createTextNode(this);=0A= div.appendChild(text);=0A= return div.innerHTML;=0A= },=0A= =0A= unescapeHTML: function() {=0A= var div =3D document.createElement('div');=0A= div.innerHTML =3D this.stripTags();=0A= return div.childNodes[0] ? div.childNodes[0].nodeValue : '';=0A= },=0A= =0A= toQueryParams: function() {=0A= var pairs =3D this.match(/^\??(.*)$/)[1].split('&');=0A= return pairs.inject({}, function(params, pairString) {=0A= var pair =3D pairString.split('=3D');=0A= var value =3D pair[1] ? decodeURIComponent(pair[1]) : undefined;=0A= params[decodeURIComponent(pair[0])] =3D value;=0A= return params;=0A= });=0A= },=0A= =0A= toArray: function() {=0A= return this.split('');=0A= },=0A= =0A= camelize: function() {=0A= var oStringList =3D this.split('-');=0A= if (oStringList.length =3D=3D 1) return oStringList[0];=0A= =0A= var camelizedString =3D this.indexOf('-') =3D=3D 0=0A= ? oStringList[0].charAt(0).toUpperCase() + = oStringList[0].substring(1)=0A= : oStringList[0];=0A= =0A= for (var i =3D 1, len =3D oStringList.length; i < len; i++) {=0A= var s =3D oStringList[i];=0A= camelizedString +=3D s.charAt(0).toUpperCase() + s.substring(1);=0A= }=0A= =0A= return camelizedString;=0A= },=0A= =0A= inspect: function(useDoubleQuotes) {=0A= var escapedString =3D this.replace(/\\/g, '\\\\');=0A= if (useDoubleQuotes)=0A= return '"' + escapedString.replace(/"/g, '\\"') + '"';=0A= else=0A= return "'" + escapedString.replace(/'/g, '\\\'') + "'";=0A= }=0A= });=0A= =0A= String.prototype.gsub.prepareReplacement =3D function(replacement) {=0A= if (typeof replacement =3D=3D 'function') return replacement;=0A= var template =3D new Template(replacement);=0A= return function(match) { return template.evaluate(match) };=0A= }=0A= =0A= String.prototype.parseQuery =3D String.prototype.toQueryParams;=0A= =0A= var Template =3D Class.create();=0A= Template.Pattern =3D /(^|.|\r|\n)(#\{(.*?)\})/;=0A= Template.prototype =3D {=0A= initialize: function(template, pattern) {=0A= this.template =3D template.toString();=0A= this.pattern =3D pattern || Template.Pattern;=0A= },=0A= =0A= evaluate: function(object) {=0A= return this.template.gsub(this.pattern, function(match) {=0A= var before =3D match[1];=0A= if (before =3D=3D '\\') return match[2];=0A= return before + (object[match[3]] || '').toString();=0A= });=0A= }=0A= }=0A= =0A= var $break =3D new Object();=0A= var $continue =3D new Object();=0A= =0A= var Enumerable =3D {=0A= each: function(iterator) {=0A= var index =3D 0;=0A= try {=0A= this._each(function(value) {=0A= try {=0A= iterator(value, index++);=0A= } catch (e) {=0A= if (e !=3D $continue) throw e;=0A= }=0A= });=0A= } catch (e) {=0A= if (e !=3D $break) throw e;=0A= }=0A= return this;=0A= },=0A= =0A= eachSlice: function(number, iterator) {=0A= var index =3D -number, slices =3D [], array =3D this.toArray();=0A= while ((index +=3D number) < array.length)=0A= slices.push(array.slice(index, index+number));=0A= return slices.collect(iterator || Prototype.K);=0A= },=0A= =0A= all: function(iterator) {=0A= var result =3D true;=0A= this.each(function(value, index) {=0A= result =3D result && !!(iterator || Prototype.K)(value, index);=0A= if (!result) throw $break;=0A= });=0A= return result;=0A= },=0A= =0A= any: function(iterator) {=0A= var result =3D false;=0A= this.each(function(value, index) {=0A= if (result =3D !!(iterator || Prototype.K)(value, index))=0A= throw $break;=0A= });=0A= return result;=0A= },=0A= =0A= collect: function(iterator) {=0A= var results =3D [];=0A= this.each(function(value, index) {=0A= results.push(iterator(value, index));=0A= });=0A= return results;=0A= },=0A= =0A= detect: function (iterator) {=0A= var result;=0A= this.each(function(value, index) {=0A= if (iterator(value, index)) {=0A= result =3D value;=0A= throw $break;=0A= }=0A= });=0A= return result;=0A= },=0A= =0A= findAll: function(iterator) {=0A= var results =3D [];=0A= this.each(function(value, index) {=0A= if (iterator(value, index))=0A= results.push(value);=0A= });=0A= return results;=0A= },=0A= =0A= grep: function(pattern, iterator) {=0A= var results =3D [];=0A= this.each(function(value, index) {=0A= var stringValue =3D value.toString();=0A= if (stringValue.match(pattern))=0A= results.push((iterator || Prototype.K)(value, index));=0A= })=0A= return results;=0A= },=0A= =0A= include: function(object) {=0A= var found =3D false;=0A= this.each(function(value) {=0A= if (value =3D=3D object) {=0A= found =3D true;=0A= throw $break;=0A= }=0A= });=0A= return found;=0A= },=0A= =0A= inGroupsOf: function(number, fillWith) {=0A= fillWith =3D fillWith || null;=0A= var results =3D this.eachSlice(number);=0A= if (results.length > 0) (number - = results.last().length).times(function() {=0A= results.last().push(fillWith)=0A= });=0A= return results;=0A= },=0A= =0A= inject: function(memo, iterator) {=0A= this.each(function(value, index) {=0A= memo =3D iterator(memo, value, index);=0A= });=0A= return memo;=0A= },=0A= =0A= invoke: function(method) {=0A= var args =3D $A(arguments).slice(1);=0A= return this.collect(function(value) {=0A= return value[method].apply(value, args);=0A= });=0A= },=0A= =0A= max: function(iterator) {=0A= var result;=0A= this.each(function(value, index) {=0A= value =3D (iterator || Prototype.K)(value, index);=0A= if (result =3D=3D undefined || value >=3D result)=0A= result =3D value;=0A= });=0A= return result;=0A= },=0A= =0A= min: function(iterator) {=0A= var result;=0A= this.each(function(value, index) {=0A= value =3D (iterator || Prototype.K)(value, index);=0A= if (result =3D=3D undefined || value < result)=0A= result =3D value;=0A= });=0A= return result;=0A= },=0A= =0A= partition: function(iterator) {=0A= var trues =3D [], falses =3D [];=0A= this.each(function(value, index) {=0A= ((iterator || Prototype.K)(value, index) ?=0A= trues : falses).push(value);=0A= });=0A= return [trues, falses];=0A= },=0A= =0A= pluck: function(property) {=0A= var results =3D [];=0A= this.each(function(value, index) {=0A= results.push(value[property]);=0A= });=0A= return results;=0A= },=0A= =0A= reject: function(iterator) {=0A= var results =3D [];=0A= this.each(function(value, index) {=0A= if (!iterator(value, index))=0A= results.push(value);=0A= });=0A= return results;=0A= },=0A= =0A= sortBy: function(iterator) {=0A= return this.collect(function(value, index) {=0A= return {value: value, criteria: iterator(value, index)};=0A= }).sort(function(left, right) {=0A= var a =3D left.criteria, b =3D right.criteria;=0A= return a < b ? -1 : a > b ? 1 : 0;=0A= }).pluck('value');=0A= },=0A= =0A= toArray: function() {=0A= return this.collect(Prototype.K);=0A= },=0A= =0A= zip: function() {=0A= var iterator =3D Prototype.K, args =3D $A(arguments);=0A= if (typeof args.last() =3D=3D 'function')=0A= iterator =3D args.pop();=0A= =0A= var collections =3D [this].concat(args).map($A);=0A= return this.map(function(value, index) {=0A= return iterator(collections.pluck(index));=0A= });=0A= },=0A= =0A= inspect: function() {=0A= return '#';=0A= }=0A= }=0A= =0A= Object.extend(Enumerable, {=0A= map: Enumerable.collect,=0A= find: Enumerable.detect,=0A= select: Enumerable.findAll,=0A= member: Enumerable.include,=0A= entries: Enumerable.toArray=0A= });=0A= var $A =3D Array.from =3D function(iterable) {=0A= if (!iterable) return [];=0A= if (iterable.toArray) {=0A= return iterable.toArray();=0A= } else {=0A= var results =3D [];=0A= for (var i =3D 0; i < iterable.length; i++)=0A= results.push(iterable[i]);=0A= return results;=0A= }=0A= }=0A= =0A= Object.extend(Array.prototype, Enumerable);=0A= =0A= if (!Array.prototype._reverse)=0A= Array.prototype._reverse =3D Array.prototype.reverse;=0A= =0A= Object.extend(Array.prototype, {=0A= _each: function(iterator) {=0A= for (var i =3D 0; i < this.length; i++)=0A= iterator(this[i]);=0A= },=0A= =0A= clear: function() {=0A= this.length =3D 0;=0A= return this;=0A= },=0A= =0A= first: function() {=0A= return this[0];=0A= },=0A= =0A= last: function() {=0A= return this[this.length - 1];=0A= },=0A= =0A= compact: function() {=0A= return this.select(function(value) {=0A= return value !=3D undefined || value !=3D null;=0A= });=0A= },=0A= =0A= flatten: function() {=0A= return this.inject([], function(array, value) {=0A= return array.concat(value && value.constructor =3D=3D Array ?=0A= value.flatten() : [value]);=0A= });=0A= },=0A= =0A= without: function() {=0A= var values =3D $A(arguments);=0A= return this.select(function(value) {=0A= return !values.include(value);=0A= });=0A= },=0A= =0A= indexOf: function(object) {=0A= for (var i =3D 0; i < this.length; i++)=0A= if (this[i] =3D=3D object) return i;=0A= return -1;=0A= },=0A= =0A= reverse: function(inline) {=0A= return (inline !=3D=3D false ? this : this.toArray())._reverse();=0A= },=0A= =0A= reduce: function() {=0A= return this.length > 1 ? this : this[0];=0A= },=0A= =0A= uniq: function() {=0A= return this.inject([], function(array, value) {=0A= return array.include(value) ? array : array.concat([value]);=0A= });=0A= },=0A= =0A= inspect: function() {=0A= return '[' + this.map(Object.inspect).join(', ') + ']';=0A= }=0A= });=0A= var Hash =3D {=0A= _each: function(iterator) {=0A= for (var key in this) {=0A= var value =3D this[key];=0A= if (typeof value =3D=3D 'function') continue;=0A= =0A= var pair =3D [key, value];=0A= pair.key =3D key;=0A= pair.value =3D value;=0A= iterator(pair);=0A= }=0A= },=0A= =0A= keys: function() {=0A= return this.pluck('key');=0A= },=0A= =0A= values: function() {=0A= return this.pluck('value');=0A= },=0A= =0A= merge: function(hash) {=0A= return $H(hash).inject($H(this), function(mergedHash, pair) {=0A= mergedHash[pair.key] =3D pair.value;=0A= return mergedHash;=0A= });=0A= },=0A= =0A= toQueryString: function() {=0A= return this.map(function(pair) {=0A= return pair.map(encodeURIComponent).join('=3D');=0A= }).join('&');=0A= },=0A= =0A= inspect: function() {=0A= return '#';=0A= }=0A= }=0A= =0A= function $H(object) {=0A= var hash =3D Object.extend({}, object || {});=0A= Object.extend(hash, Enumerable);=0A= Object.extend(hash, Hash);=0A= return hash;=0A= }=0A= ObjectRange =3D Class.create();=0A= Object.extend(ObjectRange.prototype, Enumerable);=0A= Object.extend(ObjectRange.prototype, {=0A= initialize: function(start, end, exclusive) {=0A= this.start =3D start;=0A= this.end =3D end;=0A= this.exclusive =3D exclusive;=0A= },=0A= =0A= _each: function(iterator) {=0A= var value =3D this.start;=0A= while (this.include(value)) {=0A= iterator(value);=0A= value =3D value.succ();=0A= }=0A= },=0A= =0A= include: function(value) {=0A= if (value < this.start)=0A= return false;=0A= if (this.exclusive)=0A= return value < this.end;=0A= return value <=3D this.end;=0A= }=0A= });=0A= =0A= var $R =3D function(start, end, exclusive) {=0A= return new ObjectRange(start, end, exclusive);=0A= }=0A= =0A= var Ajax =3D {=0A= getTransport: function() {=0A= return Try.these(=0A= function() {return new XMLHttpRequest()},=0A= function() {return new ActiveXObject('Msxml2.XMLHTTP')},=0A= function() {return new ActiveXObject('Microsoft.XMLHTTP')}=0A= ) || false;=0A= },=0A= =0A= activeRequestCount: 0=0A= }=0A= =0A= Ajax.Responders =3D {=0A= responders: [],=0A= =0A= _each: function(iterator) {=0A= this.responders._each(iterator);=0A= },=0A= =0A= register: function(responderToAdd) {=0A= if (!this.include(responderToAdd))=0A= this.responders.push(responderToAdd);=0A= },=0A= =0A= unregister: function(responderToRemove) {=0A= this.responders =3D this.responders.without(responderToRemove);=0A= },=0A= =0A= dispatch: function(callback, request, transport, json) {=0A= this.each(function(responder) {=0A= if (responder[callback] && typeof responder[callback] =3D=3D = 'function') {=0A= try {=0A= responder[callback].apply(responder, [request, transport, = json]);=0A= } catch (e) {}=0A= }=0A= });=0A= }=0A= };=0A= =0A= Object.extend(Ajax.Responders, Enumerable);=0A= =0A= Ajax.Responders.register({=0A= onCreate: function() {=0A= Ajax.activeRequestCount++;=0A= },=0A= =0A= onComplete: function() {=0A= Ajax.activeRequestCount--;=0A= }=0A= });=0A= =0A= Ajax.Base =3D function() {};=0A= Ajax.Base.prototype =3D {=0A= setOptions: function(options) {=0A= this.options =3D {=0A= method: 'post',=0A= asynchronous: true,=0A= contentType: 'application/x-www-form-urlencoded',=0A= parameters: ''=0A= }=0A= Object.extend(this.options, options || {});=0A= },=0A= =0A= responseIsSuccess: function() {=0A= return this.transport.status =3D=3D undefined=0A= || this.transport.status =3D=3D 0=0A= || (this.transport.status >=3D 200 && this.transport.status < = 300);=0A= },=0A= =0A= responseIsFailure: function() {=0A= return !this.responseIsSuccess();=0A= }=0A= }=0A= =0A= Ajax.Request =3D Class.create();=0A= Ajax.Request.Events =3D=0A= ['Uninitialized', 'Loading', 'Loaded', 'Interactive', 'Complete'];=0A= =0A= Ajax.Request.prototype =3D Object.extend(new Ajax.Base(), {=0A= initialize: function(url, options) {=0A= this.transport =3D Ajax.getTransport();=0A= this.setOptions(options);=0A= this.request(url);=0A= },=0A= =0A= request: function(url) {=0A= var parameters =3D this.options.parameters || '';=0A= if (parameters.length > 0) parameters +=3D '&_=3D';=0A= =0A= /* Simulate other verbs over post */=0A= if (this.options.method !=3D 'get' && this.options.method !=3D = 'post') {=0A= parameters +=3D (parameters.length > 0 ? '&' : '') + '_method=3D' = + this.options.method;=0A= this.options.method =3D 'post';=0A= }=0A= =0A= try {=0A= this.url =3D url;=0A= if (this.options.method =3D=3D 'get' && parameters.length > 0)=0A= this.url +=3D (this.url.match(/\?/) ? '&' : '?') + parameters;=0A= =0A= Ajax.Responders.dispatch('onCreate', this, this.transport);=0A= =0A= this.transport.open(this.options.method, this.url,=0A= this.options.asynchronous);=0A= =0A= if (this.options.asynchronous)=0A= setTimeout(function() { this.respondToReadyState(1) = }.bind(this), 10);=0A= =0A= this.transport.onreadystatechange =3D = this.onStateChange.bind(this);=0A= this.setRequestHeaders();=0A= =0A= var body =3D this.options.postBody ? this.options.postBody : = parameters;=0A= this.transport.send(this.options.method =3D=3D 'post' ? body : = null);=0A= =0A= /* Force Firefox to handle ready state 4 for synchronous requests = */=0A= if (!this.options.asynchronous && this.transport.overrideMimeType)=0A= this.onStateChange();=0A= =0A= } catch (e) {=0A= this.dispatchException(e);=0A= }=0A= },=0A= =0A= setRequestHeaders: function() {=0A= var requestHeaders =3D=0A= ['X-Requested-With', 'XMLHttpRequest',=0A= 'X-Prototype-Version', Prototype.Version,=0A= 'Accept', 'text/javascript, text/html, application/xml, text/xml, = */*'];=0A= =0A= if (this.options.method =3D=3D 'post') {=0A= requestHeaders.push('Content-type', this.options.contentType);=0A= =0A= /* Force "Connection: close" for Mozilla browsers to work around=0A= * a bug where XMLHttpReqeuest sends an incorrect Content-length=0A= * header. See Mozilla Bugzilla #246651.=0A= */=0A= if (this.transport.overrideMimeType)=0A= requestHeaders.push('Connection', 'close');=0A= }=0A= =0A= if (this.options.requestHeaders)=0A= requestHeaders.push.apply(requestHeaders, = this.options.requestHeaders);=0A= =0A= for (var i =3D 0; i < requestHeaders.length; i +=3D 2)=0A= this.transport.setRequestHeader(requestHeaders[i], = requestHeaders[i+1]);=0A= },=0A= =0A= onStateChange: function() {=0A= var readyState =3D this.transport.readyState;=0A= if (readyState !=3D 1)=0A= this.respondToReadyState(this.transport.readyState);=0A= },=0A= =0A= header: function(name) {=0A= try {=0A= return this.transport.getResponseHeader(name);=0A= } catch (e) {}=0A= },=0A= =0A= evalJSON: function() {=0A= try {=0A= return eval('(' + this.header('X-JSON') + ')');=0A= } catch (e) {}=0A= },=0A= =0A= evalResponse: function() {=0A= try {=0A= return eval(this.transport.responseText);=0A= } catch (e) {=0A= this.dispatchException(e);=0A= }=0A= },=0A= =0A= respondToReadyState: function(readyState) {=0A= var event =3D Ajax.Request.Events[readyState];=0A= var transport =3D this.transport, json =3D this.evalJSON();=0A= =0A= if (event =3D=3D 'Complete') {=0A= try {=0A= (this.options['on' + this.transport.status]=0A= || this.options['on' + (this.responseIsSuccess() ? 'Success' : = 'Failure')]=0A= || Prototype.emptyFunction)(transport, json);=0A= } catch (e) {=0A= this.dispatchException(e);=0A= }=0A= =0A= if ((this.header('Content-type') || = '').match(/^text\/javascript/i))=0A= this.evalResponse();=0A= }=0A= =0A= try {=0A= (this.options['on' + event] || Prototype.emptyFunction)(transport, = json);=0A= Ajax.Responders.dispatch('on' + event, this, transport, json);=0A= } catch (e) {=0A= this.dispatchException(e);=0A= }=0A= =0A= /* Avoid memory leak in MSIE: clean up the oncomplete event handler = */=0A= if (event =3D=3D 'Complete')=0A= this.transport.onreadystatechange =3D Prototype.emptyFunction;=0A= },=0A= =0A= dispatchException: function(exception) {=0A= (this.options.onException || Prototype.emptyFunction)(this, = exception);=0A= Ajax.Responders.dispatch('onException', this, exception);=0A= }=0A= });=0A= =0A= Ajax.Updater =3D Class.create();=0A= =0A= Object.extend(Object.extend(Ajax.Updater.prototype, = Ajax.Request.prototype), {=0A= initialize: function(container, url, options) {=0A= this.containers =3D {=0A= success: container.success ? $(container.success) : $(container),=0A= failure: container.failure ? $(container.failure) :=0A= (container.success ? null : $(container))=0A= }=0A= =0A= this.transport =3D Ajax.getTransport();=0A= this.setOptions(options);=0A= =0A= var onComplete =3D this.options.onComplete || = Prototype.emptyFunction;=0A= this.options.onComplete =3D (function(transport, object) {=0A= this.updateContent();=0A= onComplete(transport, object);=0A= }).bind(this);=0A= =0A= this.request(url);=0A= },=0A= =0A= updateContent: function() {=0A= var receiver =3D this.responseIsSuccess() ?=0A= this.containers.success : this.containers.failure;=0A= var response =3D this.transport.responseText;=0A= =0A= if (!this.options.evalScripts)=0A= response =3D response.stripScripts();=0A= =0A= if (receiver) {=0A= if (this.options.insertion) {=0A= new this.options.insertion(receiver, response);=0A= } else {=0A= Element.update(receiver, response);=0A= }=0A= }=0A= =0A= if (this.responseIsSuccess()) {=0A= if (this.onComplete)=0A= setTimeout(this.onComplete.bind(this), 10);=0A= }=0A= }=0A= });=0A= =0A= Ajax.PeriodicalUpdater =3D Class.create();=0A= Ajax.PeriodicalUpdater.prototype =3D Object.extend(new Ajax.Base(), {=0A= initialize: function(container, url, options) {=0A= this.setOptions(options);=0A= this.onComplete =3D this.options.onComplete;=0A= =0A= this.frequency =3D (this.options.frequency || 2);=0A= this.decay =3D (this.options.decay || 1);=0A= =0A= this.updater =3D {};=0A= this.container =3D container;=0A= this.url =3D url;=0A= =0A= this.start();=0A= },=0A= =0A= start: function() {=0A= this.options.onComplete =3D this.updateComplete.bind(this);=0A= this.onTimerEvent();=0A= },=0A= =0A= stop: function() {=0A= this.updater.options.onComplete =3D undefined;=0A= clearTimeout(this.timer);=0A= (this.onComplete || Prototype.emptyFunction).apply(this, arguments);=0A= },=0A= =0A= updateComplete: function(request) {=0A= if (this.options.decay) {=0A= this.decay =3D (request.responseText =3D=3D this.lastText ?=0A= this.decay * this.options.decay : 1);=0A= =0A= this.lastText =3D request.responseText;=0A= }=0A= this.timer =3D setTimeout(this.onTimerEvent.bind(this),=0A= this.decay * this.frequency * 1000);=0A= },=0A= =0A= onTimerEvent: function() {=0A= this.updater =3D new Ajax.Updater(this.container, this.url, = this.options);=0A= }=0A= });=0A= function $() {=0A= var results =3D [], element;=0A= for (var i =3D 0; i < arguments.length; i++) {=0A= element =3D arguments[i];=0A= if (typeof element =3D=3D 'string')=0A= element =3D document.getElementById(element);=0A= results.push(Element.extend(element));=0A= }=0A= return results.reduce();=0A= }=0A= =0A= if (Prototype.BrowserFeatures.XPath) {=0A= document._getElementsByXPath =3D function(expression, parentElement) {=0A= var results =3D [];=0A= var query =3D document.evaluate(expression, $(parentElement) || = document,=0A= null, XPathResult.ORDERED_NODE_SNAPSHOT_TYPE, null);=0A= for (var i =3D 0, len =3D query.snapshotLength; i < len; i++)=0A= results.push(query.snapshotItem(i));=0A= return results;=0A= }=0A= }=0A= =0A= document.getElementsByClassName =3D function(className, parentElement) {=0A= if (Prototype.BrowserFeatures.XPath) {=0A= var q =3D ".//*[contains(concat(' ', @class, ' '), ' " + className + = " ')]";=0A= return document._getElementsByXPath(q, parentElement);=0A= } else {=0A= var children =3D ($(parentElement) || = document.body).getElementsByTagName('*');=0A= var elements =3D [], child;=0A= for (var i =3D 0, len =3D children.length; i < len; i++) {=0A= child =3D children[i];=0A= if (child.className.length =3D=3D 0) continue;=0A= if (child.className =3D=3D className ||=0A= child.className.match(new RegExp("(^|\\s)" + className + = "(\\s|$)")))=0A= elements.push(Element.extend(child));=0A= }=0A= return elements;=0A= }=0A= }=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= if (!window.Element)=0A= var Element =3D new Object();=0A= =0A= Element.extend =3D function(element) {=0A= if (!element) return;=0A= if (_nativeExtensions || element.nodeType =3D=3D 3) return element;=0A= =0A= if (!element._extended && element.tagName && element !=3D window) {=0A= var methods =3D Object.clone(Element.Methods), cache =3D = Element.extend.cache;=0A= =0A= if (element.tagName =3D=3D 'FORM')=0A= Object.extend(methods, Form.Methods);=0A= if (['INPUT', 'TEXTAREA', 'SELECT'].include(element.tagName))=0A= Object.extend(methods, Form.Element.Methods);=0A= =0A= for (var property in methods) {=0A= var value =3D methods[property];=0A= if (typeof value =3D=3D 'function')=0A= element[property] =3D cache.findOrStore(value);=0A= }=0A= }=0A= =0A= element._extended =3D true;=0A= return element;=0A= }=0A= =0A= Element.extend.cache =3D {=0A= findOrStore: function(value) {=0A= return this[value] =3D this[value] || function() {=0A= return value.apply(null, [this].concat($A(arguments)));=0A= }=0A= }=0A= }=0A= =0A= Element.Methods =3D {=0A= visible: function(element) {=0A= return $(element).style.display !=3D 'none';=0A= },=0A= =0A= toggle: function(element) {=0A= element =3D $(element);=0A= Element[Element.visible(element) ? 'hide' : 'show'](element);=0A= return element;=0A= },=0A= =0A= hide: function(element) {=0A= $(element).style.display =3D 'none';=0A= return element;=0A= },=0A= =0A= show: function(element) {=0A= $(element).style.display =3D '';=0A= return element;=0A= },=0A= =0A= remove: function(element) {=0A= element =3D $(element);=0A= element.parentNode.removeChild(element);=0A= return element;=0A= },=0A= =0A= update: function(element, html) {=0A= $(element).innerHTML =3D html.stripScripts();=0A= setTimeout(function() {html.evalScripts()}, 10);=0A= return element;=0A= },=0A= =0A= replace: function(element, html) {=0A= element =3D $(element);=0A= if (element.outerHTML) {=0A= element.outerHTML =3D html.stripScripts();=0A= } else {=0A= var range =3D element.ownerDocument.createRange();=0A= range.selectNodeContents(element);=0A= element.parentNode.replaceChild(=0A= range.createContextualFragment(html.stripScripts()), element);=0A= }=0A= setTimeout(function() {html.evalScripts()}, 10);=0A= return element;=0A= },=0A= =0A= inspect: function(element) {=0A= element =3D $(element);=0A= var result =3D '<' + element.tagName.toLowerCase();=0A= $H({'id': 'id', 'className': 'class'}).each(function(pair) {=0A= var property =3D pair.first(), attribute =3D pair.last();=0A= var value =3D (element[property] || '').toString();=0A= if (value) result +=3D ' ' + attribute + '=3D' + = value.inspect(true);=0A= });=0A= return result + '>';=0A= },=0A= =0A= recursivelyCollect: function(element, property) {=0A= element =3D $(element);=0A= var elements =3D [];=0A= while (element =3D element[property])=0A= if (element.nodeType =3D=3D 1)=0A= elements.push(Element.extend(element));=0A= return elements;=0A= },=0A= =0A= ancestors: function(element) {=0A= return $(element).recursivelyCollect('parentNode');=0A= },=0A= =0A= descendants: function(element) {=0A= element =3D $(element);=0A= return $A(element.getElementsByTagName('*'));=0A= },=0A= =0A= previousSiblings: function(element) {=0A= return $(element).recursivelyCollect('previousSibling');=0A= },=0A= =0A= nextSiblings: function(element) {=0A= return $(element).recursivelyCollect('nextSibling');=0A= },=0A= =0A= siblings: function(element) {=0A= element =3D $(element);=0A= return = element.previousSiblings().reverse().concat(element.nextSiblings());=0A= },=0A= =0A= match: function(element, selector) {=0A= element =3D $(element);=0A= if (typeof selector =3D=3D 'string')=0A= selector =3D new Selector(selector);=0A= return selector.match(element);=0A= },=0A= =0A= up: function(element, expression, index) {=0A= return Selector.findElement($(element).ancestors(), expression, = index);=0A= },=0A= =0A= down: function(element, expression, index) {=0A= return Selector.findElement($(element).descendants(), expression, = index);=0A= },=0A= =0A= previous: function(element, expression, index) {=0A= return Selector.findElement($(element).previousSiblings(), = expression, index);=0A= },=0A= =0A= next: function(element, expression, index) {=0A= return Selector.findElement($(element).nextSiblings(), expression, = index);=0A= },=0A= =0A= getElementsBySelector: function() {=0A= var args =3D $A(arguments), element =3D $(args.shift());=0A= return Selector.findChildElements(element, args);=0A= },=0A= =0A= getElementsByClassName: function(element, className) {=0A= element =3D $(element);=0A= return document.getElementsByClassName(className, element);=0A= },=0A= =0A= getHeight: function(element) {=0A= element =3D $(element);=0A= return element.offsetHeight;=0A= },=0A= =0A= classNames: function(element) {=0A= return new Element.ClassNames(element);=0A= },=0A= =0A= hasClassName: function(element, className) {=0A= if (!(element =3D $(element))) return;=0A= return Element.classNames(element).include(className);=0A= },=0A= =0A= addClassName: function(element, className) {=0A= if (!(element =3D $(element))) return;=0A= Element.classNames(element).add(className);=0A= return element;=0A= },=0A= =0A= removeClassName: function(element, className) {=0A= if (!(element =3D $(element))) return;=0A= Element.classNames(element).remove(className);=0A= return element;=0A= },=0A= =0A= observe: function() {=0A= Event.observe.apply(Event, arguments);=0A= return $A(arguments).first();=0A= },=0A= =0A= stopObserving: function() {=0A= Event.stopObserving.apply(Event, arguments);=0A= return $A(arguments).first();=0A= },=0A= =0A= // removes whitespace-only text node children=0A= cleanWhitespace: function(element) {=0A= element =3D $(element);=0A= var node =3D element.firstChild;=0A= while (node) {=0A= var nextNode =3D node.nextSibling;=0A= if (node.nodeType =3D=3D 3 && !/\S/.test(node.nodeValue))=0A= element.removeChild(node);=0A= node =3D nextNode;=0A= }=0A= return element;=0A= },=0A= =0A= empty: function(element) {=0A= return $(element).innerHTML.match(/^\s*$/);=0A= },=0A= =0A= childOf: function(element, ancestor) {=0A= element =3D $(element), ancestor =3D $(ancestor);=0A= while (element =3D element.parentNode)=0A= if (element 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style) {=0A= element =3D $(element);=0A= for (var name in style)=0A= element.style[name.camelize()] =3D style[name];=0A= return element;=0A= },=0A= =0A= getDimensions: function(element) {=0A= element =3D $(element);=0A= if (Element.getStyle(element, 'display') !=3D 'none')=0A= return {width: element.offsetWidth, height: element.offsetHeight};=0A= =0A= // All *Width and *Height properties give 0 on elements with display = none,=0A= // so enable the element temporarily=0A= var els =3D element.style;=0A= var originalVisibility =3D els.visibility;=0A= var originalPosition =3D els.position;=0A= els.visibility =3D 'hidden';=0A= els.position =3D 'absolute';=0A= els.display =3D '';=0A= var originalWidth =3D element.clientWidth;=0A= var originalHeight =3D element.clientHeight;=0A= els.display =3D 'none';=0A= els.position =3D originalPosition;=0A= els.visibility =3D originalVisibility;=0A= return {width: originalWidth, height: originalHeight};=0A= },=0A= =0A= makePositioned: function(element) {=0A= element =3D $(element);=0A= var pos =3D Element.getStyle(element, 'position');=0A= if (pos =3D=3D 'static' || !pos) {=0A= element._madePositioned =3D true;=0A= element.style.position =3D 'relative';=0A= // Opera returns the offset relative to the positioning context, = when an=0A= // element is position relative but top and left have not been = defined=0A= if (window.opera) {=0A= element.style.top =3D 0;=0A= element.style.left =3D 0;=0A= }=0A= }=0A= return element;=0A= },=0A= =0A= undoPositioned: function(element) {=0A= element =3D $(element);=0A= if (element._madePositioned) {=0A= element._madePositioned =3D undefined;=0A= element.style.position =3D=0A= element.style.top =3D=0A= element.style.left =3D=0A= element.style.bottom =3D=0A= element.style.right =3D '';=0A= }=0A= return element;=0A= },=0A= =0A= makeClipping: function(element) {=0A= element =3D $(element);=0A= if (element._overflow) return element;=0A= element._overflow =3D element.style.overflow || 'auto';=0A= if ((Element.getStyle(element, 'overflow') || 'visible') !=3D = 'hidden')=0A= element.style.overflow =3D 'hidden';=0A= return element;=0A= },=0A= =0A= undoClipping: function(element) {=0A= element =3D $(element);=0A= if (!element._overflow) return element;=0A= element.style.overflow =3D element._overflow =3D=3D 'auto' ? '' : = element._overflow;=0A= element._overflow =3D null;=0A= return element;=0A= }=0A= }=0A= =0A= // IE is missing .innerHTML support for TABLE-related elements=0A= if(document.all){=0A= Element.Methods.update =3D function(element, html) {=0A= element =3D $(element);=0A= var tagName =3D element.tagName.toUpperCase();=0A= if (['THEAD','TBODY','TR','TD'].indexOf(tagName) > -1) {=0A= var div =3D document.createElement('div');=0A= switch (tagName) {=0A= case 'THEAD':=0A= case 'TBODY':=0A= div.innerHTML =3D '' + html.stripScripts() + = '
';=0A= depth =3D 2;=0A= break;=0A= case 'TR':=0A= div.innerHTML =3D '' + html.stripScripts() = + '
';=0A= depth =3D 3;=0A= break;=0A= case 'TD':=0A= div.innerHTML =3D '
' + = html.stripScripts() + '
';=0A= depth =3D 4;=0A= }=0A= $A(element.childNodes).each(function(node){=0A= element.removeChild(node)=0A= });=0A= depth.times(function(){ div =3D div.firstChild });=0A= =0A= $A(div.childNodes).each(=0A= function(node){ element.appendChild(node) });=0A= } else {=0A= element.innerHTML =3D html.stripScripts();=0A= }=0A= setTimeout(function() {html.evalScripts()}, 10);=0A= return element;=0A= }=0A= }=0A= =0A= Object.extend(Element, Element.Methods);=0A= =0A= var _nativeExtensions =3D false;=0A= =0A= if (!window.HTMLElement && = /Konqueror|Safari|KHTML/.test(navigator.userAgent)) {=0A= /* Emulate HTMLElement, HTMLFormElement, HTMLInputElement, = HTMLTextAreaElement,=0A= and HTMLSelectElement in Safari */=0A= ['', 'Form', 'Input', 'TextArea', 'Select'].each(function(tag) {=0A= var klass =3D window['HTML' + tag + 'Element'] =3D {};=0A= klass.prototype =3D document.createElement(tag ? tag.toLowerCase() : = 'div').__proto__;=0A= });=0A= }=0A= =0A= Element.addMethods =3D function(methods) {=0A= Object.extend(Element.Methods, methods || {});=0A= =0A= function copy(methods, destination) {=0A= var cache =3D Element.extend.cache;=0A= for (var property in methods) {=0A= var value =3D methods[property];=0A= destination[property] =3D cache.findOrStore(value);=0A= }=0A= }=0A= =0A= if (typeof HTMLElement !=3D 'undefined') {=0A= copy(Element.Methods, HTMLElement.prototype);=0A= copy(Form.Methods, HTMLFormElement.prototype);=0A= [HTMLInputElement, HTMLTextAreaElement, = HTMLSelectElement].each(function(klass) {=0A= copy(Form.Element.Methods, klass.prototype);=0A= });=0A= _nativeExtensions =3D true;=0A= }=0A= }=0A= =0A= var Toggle =3D new Object();=0A= Toggle.display =3D Element.toggle;=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= Abstract.Insertion =3D function(adjacency) {=0A= this.adjacency =3D adjacency;=0A= }=0A= =0A= Abstract.Insertion.prototype =3D {=0A= initialize: function(element, content) {=0A= this.element =3D $(element);=0A= this.content =3D content.stripScripts();=0A= =0A= if (this.adjacency && this.element.insertAdjacentHTML) {=0A= try {=0A= this.element.insertAdjacentHTML(this.adjacency, this.content);=0A= } catch (e) {=0A= var tagName =3D this.element.tagName.toLowerCase();=0A= if (tagName =3D=3D 'tbody' || tagName =3D=3D 'tr') {=0A= this.insertContent(this.contentFromAnonymousTable());=0A= } else {=0A= throw e;=0A= }=0A= }=0A= } else {=0A= this.range =3D this.element.ownerDocument.createRange();=0A= if (this.initializeRange) this.initializeRange();=0A= = this.insertContent([this.range.createContextualFragment(this.content)]);=0A= }=0A= =0A= setTimeout(function() {content.evalScripts()}, 10);=0A= },=0A= =0A= contentFromAnonymousTable: function() {=0A= var div =3D document.createElement('div');=0A= div.innerHTML =3D '' + this.content + = '
';=0A= return $A(div.childNodes[0].childNodes[0].childNodes);=0A= }=0A= }=0A= =0A= var Insertion =3D new Object();=0A= =0A= Insertion.Before =3D Class.create();=0A= Insertion.Before.prototype =3D Object.extend(new = Abstract.Insertion('beforeBegin'), {=0A= initializeRange: function() {=0A= this.range.setStartBefore(this.element);=0A= },=0A= =0A= insertContent: function(fragments) {=0A= fragments.each((function(fragment) {=0A= this.element.parentNode.insertBefore(fragment, this.element);=0A= }).bind(this));=0A= }=0A= });=0A= =0A= Insertion.Top =3D Class.create();=0A= Insertion.Top.prototype =3D Object.extend(new = Abstract.Insertion('afterBegin'), {=0A= initializeRange: function() {=0A= this.range.selectNodeContents(this.element);=0A= this.range.collapse(true);=0A= },=0A= =0A= insertContent: function(fragments) {=0A= fragments.reverse(false).each((function(fragment) {=0A= this.element.insertBefore(fragment, this.element.firstChild);=0A= }).bind(this));=0A= }=0A= });=0A= =0A= Insertion.Bottom =3D Class.create();=0A= Insertion.Bottom.prototype =3D Object.extend(new = Abstract.Insertion('beforeEnd'), {=0A= initializeRange: function() {=0A= this.range.selectNodeContents(this.element);=0A= this.range.collapse(this.element);=0A= },=0A= =0A= insertContent: function(fragments) {=0A= fragments.each((function(fragment) {=0A= this.element.appendChild(fragment);=0A= }).bind(this));=0A= }=0A= });=0A= =0A= Insertion.After =3D Class.create();=0A= Insertion.After.prototype =3D Object.extend(new = Abstract.Insertion('afterEnd'), {=0A= initializeRange: function() {=0A= this.range.setStartAfter(this.element);=0A= },=0A= =0A= insertContent: function(fragments) {=0A= fragments.each((function(fragment) {=0A= this.element.parentNode.insertBefore(fragment,=0A= this.element.nextSibling);=0A= }).bind(this));=0A= }=0A= });=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= Element.ClassNames =3D Class.create();=0A= Element.ClassNames.prototype =3D {=0A= initialize: function(element) {=0A= this.element =3D $(element);=0A= },=0A= =0A= _each: function(iterator) {=0A= this.element.className.split(/\s+/).select(function(name) {=0A= return name.length > 0;=0A= })._each(iterator);=0A= },=0A= =0A= set: function(className) {=0A= this.element.className =3D className;=0A= },=0A= =0A= add: function(classNameToAdd) {=0A= if (this.include(classNameToAdd)) return;=0A= this.set(this.toArray().concat(classNameToAdd).join(' '));=0A= },=0A= =0A= remove: function(classNameToRemove) {=0A= if (!this.include(classNameToRemove)) return;=0A= this.set(this.select(function(className) {=0A= return className !=3D classNameToRemove;=0A= }).join(' '));=0A= },=0A= =0A= toString: function() {=0A= return this.toArray().join(' ');=0A= }=0A= }=0A= =0A= Object.extend(Element.ClassNames.prototype, Enumerable);=0A= var Selector =3D Class.create();=0A= Selector.prototype =3D {=0A= initialize: function(expression) {=0A= this.params =3D {classNames: []};=0A= this.expression =3D expression.toString().strip();=0A= this.parseExpression();=0A= this.compileMatcher();=0A= },=0A= =0A= parseExpression: function() {=0A= function abort(message) { throw 'Parse error in selector: ' + = message; }=0A= =0A= if (this.expression =3D=3D '') abort('empty expression');=0A= =0A= var params =3D this.params, expr =3D this.expression, match, = modifier, clause, rest;=0A= while (match =3D = expr.match(/^(.*)\[([a-z0-9_:-]+?)(?:([~\|!]?=3D)(?:"([^"]*)"|([^\]\s]*))= )?\]$/i)) {=0A= params.attributes =3D params.attributes || [];=0A= params.attributes.push({name: match[2], operator: match[3], value: = match[4] || match[5] || ''});=0A= expr =3D match[1];=0A= }=0A= =0A= if (expr =3D=3D '*') return this.params.wildcard =3D true;=0A= =0A= while (match =3D expr.match(/^([^a-z0-9_-])?([a-z0-9_-]+)(.*)/i)) {=0A= modifier =3D match[1], clause =3D match[2], rest =3D match[3];=0A= switch (modifier) {=0A= case '#': params.id =3D clause; break;=0A= case '.': params.classNames.push(clause); break;=0A= case '':=0A= case undefined: params.tagName =3D clause.toUpperCase(); break;=0A= default: abort(expr.inspect());=0A= }=0A= expr =3D rest;=0A= }=0A= =0A= if (expr.length > 0) abort(expr.inspect());=0A= },=0A= =0A= buildMatchExpression: function() {=0A= var params =3D this.params, conditions =3D [], clause;=0A= =0A= if (params.wildcard)=0A= conditions.push('true');=0A= if (clause =3D params.id)=0A= conditions.push('element.id =3D=3D ' + clause.inspect());=0A= if (clause =3D params.tagName)=0A= conditions.push('element.tagName.toUpperCase() =3D=3D ' + = clause.inspect());=0A= if ((clause =3D params.classNames).length > 0)=0A= for (var i =3D 0; i < clause.length; i++)=0A= conditions.push('Element.hasClassName(element, ' + = clause[i].inspect() + ')');=0A= if (clause =3D params.attributes) {=0A= clause.each(function(attribute) {=0A= var value =3D 'element.getAttribute(' + attribute.name.inspect() = + ')';=0A= var splitValueBy =3D function(delimiter) {=0A= return value + ' && ' + value + '.split(' + = delimiter.inspect() + ')';=0A= }=0A= =0A= switch (attribute.operator) {=0A= case '=3D': conditions.push(value + ' =3D=3D ' + = attribute.value.inspect()); break;=0A= case '~=3D': conditions.push(splitValueBy(' ') + = '.include(' + attribute.value.inspect() + ')'); break;=0A= case '|=3D': conditions.push(=0A= splitValueBy('-') + '.first().toUpperCase() = =3D=3D ' + attribute.value.toUpperCase().inspect()=0A= ); break;=0A= case '!=3D': conditions.push(value + ' !=3D ' + = attribute.value.inspect()); break;=0A= case '':=0A= case undefined: conditions.push(value + ' !=3D null'); break;=0A= default: throw 'Unknown operator ' + attribute.operator = + ' in selector';=0A= }=0A= });=0A= }=0A= =0A= return conditions.join(' && ');=0A= },=0A= =0A= compileMatcher: function() {=0A= this.match =3D new Function('element', 'if (!element.tagName) return = false; \=0A= return ' + this.buildMatchExpression());=0A= },=0A= =0A= findElements: function(scope) {=0A= var element;=0A= =0A= if (element =3D $(this.params.id))=0A= if (this.match(element))=0A= if (!scope || Element.childOf(element, scope))=0A= return [element];=0A= =0A= scope =3D (scope || = document).getElementsByTagName(this.params.tagName || '*');=0A= =0A= var results =3D [];=0A= for (var i =3D 0; i < scope.length; i++)=0A= if (this.match(element =3D scope[i]))=0A= results.push(Element.extend(element));=0A= =0A= return results;=0A= },=0A= =0A= toString: function() {=0A= return this.expression;=0A= }=0A= }=0A= =0A= Object.extend(Selector, {=0A= matchElements: function(elements, expression) {=0A= var selector =3D new Selector(expression);=0A= return = elements.select(selector.match.bind(selector)).collect(Element.extend);=0A= },=0A= =0A= findElement: function(elements, expression, index) {=0A= if (typeof expression =3D=3D 'number') index =3D expression, = expression =3D false;=0A= return Selector.matchElements(elements, expression || '*')[index || = 0];=0A= },=0A= =0A= findChildElements: function(element, expressions) {=0A= return expressions.map(function(expression) {=0A= return expression.strip().split(/\s+/).inject([null], = function(results, expr) {=0A= var selector =3D new Selector(expr);=0A= return results.inject([], function(elements, result) {=0A= return elements.concat(selector.findElements(result || = element));=0A= });=0A= });=0A= }).flatten();=0A= }=0A= });=0A= =0A= function $$() {=0A= return Selector.findChildElements(document, $A(arguments));=0A= }=0A= var Form =3D {=0A= reset: function(form) {=0A= $(form).reset();=0A= return form;=0A= }=0A= };=0A= =0A= Form.Methods =3D {=0A= serialize: function(form) {=0A= return this.serializeElements(Form.getElements($(form)));=0A= },=0A= =0A= serializeElements: function(elements) {=0A= var queryComponents =3D new Array();=0A= =0A= for (var i =3D 0; i < elements.length; i++) {=0A= var queryComponent =3D Form.Element.serialize(elements[i]);=0A= if (queryComponent)=0A= queryComponents.push(queryComponent);=0A= }=0A= =0A= return queryComponents.join('&');=0A= },=0A= =0A= getElements: function(form) {=0A= return $A($(form).getElementsByTagName('*')).inject([], = function(elements, child) {=0A= if (Form.Element.Serializers[child.tagName.toLowerCase()])=0A= elements.push(Element.extend(child));=0A= return elements;=0A= });=0A= },=0A= =0A= getInputs: function(form, typeName, name) {=0A= form =3D $(form);=0A= var inputs =3D form.getElementsByTagName('input');=0A= =0A= if (!typeName && !name)=0A= return inputs;=0A= =0A= var matchingInputs =3D new Array();=0A= for (var i =3D 0; i < inputs.length; i++) {=0A= var input =3D inputs[i];=0A= if ((typeName && input.type !=3D typeName) ||=0A= (name && input.name !=3D name))=0A= continue;=0A= matchingInputs.push(input);=0A= }=0A= =0A= return matchingInputs;=0A= },=0A= =0A= disable: function(form) {=0A= form =3D $(form);=0A= var elements =3D Form.getElements(form);=0A= for (var i =3D 0; i < elements.length; i++) {=0A= var element =3D elements[i];=0A= element.blur();=0A= element.disabled =3D 'true';=0A= }=0A= return form;=0A= },=0A= =0A= enable: function(form) {=0A= form =3D $(form);=0A= var elements =3D Form.getElements(form);=0A= for (var i =3D 0; i < elements.length; i++) {=0A= var element =3D elements[i];=0A= element.disabled =3D '';=0A= }=0A= return form;=0A= },=0A= =0A= findFirstElement: function(form) {=0A= return Form.getElements(form).find(function(element) {=0A= return element.type !=3D 'hidden' && !element.disabled &&=0A= ['input', 'select', = 'textarea'].include(element.tagName.toLowerCase());=0A= });=0A= },=0A= =0A= focusFirstElement: function(form) {=0A= form =3D $(form);=0A= Field.activate(Form.findFirstElement(form));=0A= return form;=0A= }=0A= }=0A= =0A= Object.extend(Form, Form.Methods);=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= Form.Element =3D {=0A= focus: function(element) {=0A= $(element).focus();=0A= return element;=0A= },=0A= =0A= select: function(element) {=0A= $(element).select();=0A= return element;=0A= }=0A= }=0A= =0A= Form.Element.Methods =3D {=0A= serialize: function(element) {=0A= element =3D $(element);=0A= var method =3D element.tagName.toLowerCase();=0A= var parameter =3D Form.Element.Serializers[method](element);=0A= =0A= if (parameter) {=0A= var key =3D encodeURIComponent(parameter[0]);=0A= if (key.length =3D=3D 0) return;=0A= =0A= if (parameter[1].constructor !=3D Array)=0A= parameter[1] =3D [parameter[1]];=0A= =0A= return parameter[1].map(function(value) {=0A= return key + '=3D' + encodeURIComponent(value);=0A= }).join('&');=0A= }=0A= },=0A= =0A= getValue: function(element) {=0A= element =3D $(element);=0A= var method =3D element.tagName.toLowerCase();=0A= var parameter =3D Form.Element.Serializers[method](element);=0A= =0A= if (parameter)=0A= return parameter[1];=0A= },=0A= =0A= clear: function(element) {=0A= $(element).value =3D '';=0A= return element;=0A= },=0A= =0A= present: function(element) {=0A= return $(element).value !=3D '';=0A= },=0A= =0A= activate: function(element) {=0A= element =3D $(element);=0A= element.focus();=0A= if (element.select)=0A= element.select();=0A= return element;=0A= },=0A= =0A= disable: function(element) {=0A= element =3D $(element);=0A= element.disabled =3D true;=0A= return element;=0A= },=0A= =0A= enable: function(element) {=0A= element =3D $(element);=0A= element.blur();=0A= element.disabled =3D false;=0A= return element;=0A= }=0A= }=0A= =0A= Object.extend(Form.Element, Form.Element.Methods);=0A= var Field =3D Form.Element;=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= Form.Element.Serializers =3D {=0A= input: function(element) {=0A= switch (element.type.toLowerCase()) {=0A= case 'checkbox':=0A= case 'radio':=0A= return Form.Element.Serializers.inputSelector(element);=0A= default:=0A= return Form.Element.Serializers.textarea(element);=0A= }=0A= return false;=0A= },=0A= =0A= inputSelector: function(element) {=0A= if (element.checked)=0A= return [element.name, element.value];=0A= },=0A= =0A= textarea: function(element) {=0A= return [element.name, element.value];=0A= },=0A= =0A= select: function(element) {=0A= return Form.Element.Serializers[element.type =3D=3D 'select-one' ?=0A= 'selectOne' : 'selectMany'](element);=0A= },=0A= =0A= selectOne: function(element) {=0A= var value =3D '', opt, index =3D element.selectedIndex;=0A= if (index >=3D 0) {=0A= opt =3D element.options[index];=0A= value =3D opt.value || opt.text;=0A= }=0A= return [element.name, value];=0A= },=0A= =0A= selectMany: function(element) {=0A= var value =3D [];=0A= for (var i =3D 0; i < element.length; i++) {=0A= var opt =3D element.options[i];=0A= if (opt.selected)=0A= value.push(opt.value || opt.text);=0A= }=0A= return [element.name, value];=0A= }=0A= }=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= var $F =3D Form.Element.getValue;=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= Abstract.TimedObserver =3D function() {}=0A= Abstract.TimedObserver.prototype =3D {=0A= initialize: function(element, frequency, callback) {=0A= this.frequency =3D frequency;=0A= this.element =3D $(element);=0A= this.callback =3D callback;=0A= =0A= this.lastValue =3D this.getValue();=0A= this.registerCallback();=0A= },=0A= =0A= registerCallback: function() {=0A= setInterval(this.onTimerEvent.bind(this), this.frequency * 1000);=0A= },=0A= =0A= onTimerEvent: function() {=0A= var value =3D this.getValue();=0A= if (this.lastValue !=3D value) {=0A= this.callback(this.element, value);=0A= this.lastValue =3D value;=0A= }=0A= }=0A= }=0A= =0A= Form.Element.Observer =3D Class.create();=0A= Form.Element.Observer.prototype =3D Object.extend(new = Abstract.TimedObserver(), {=0A= getValue: function() {=0A= return Form.Element.getValue(this.element);=0A= }=0A= });=0A= =0A= Form.Observer =3D Class.create();=0A= Form.Observer.prototype =3D Object.extend(new Abstract.TimedObserver(), {=0A= getValue: function() {=0A= return Form.serialize(this.element);=0A= }=0A= });=0A= =0A= /*-----------------------------------------------------------------------= ---*/=0A= =0A= Abstract.EventObserver =3D function() {}=0A= Abstract.EventObserver.prototype =3D {=0A= initialize: function(element, callback) {=0A= this.element =3D $(element);=0A= this.callback =3D callback;=0A= =0A= this.lastValue =3D this.getValue();=0A= if (this.element.tagName.toLowerCase() =3D=3D 'form')=0A= this.registerFormCallbacks();=0A= else=0A= this.registerCallback(this.element);=0A= },=0A= =0A= onElementEvent: function() {=0A= var value =3D this.getValue();=0A= if (this.lastValue !=3D value) {=0A= this.callback(this.element, value);=0A= this.lastValue =3D value;=0A= }=0A= },=0A= =0A= registerFormCallbacks: function() {=0A= var elements =3D Form.getElements(this.element);=0A= for (var i =3D 0; i < elements.length; i++)=0A= this.registerCallback(elements[i]);=0A= },=0A= =0A= registerCallback: function(element) {=0A= if (element.type) {=0A= switch (element.type.toLowerCase()) {=0A= case 'checkbox':=0A= case 'radio':=0A= Event.observe(element, 'click', = this.onElementEvent.bind(this));=0A= break;=0A= default:=0A= Event.observe(element, 'change', = this.onElementEvent.bind(this));=0A= break;=0A= }=0A= }=0A= }=0A= }=0A= =0A= Form.Element.EventObserver =3D Class.create();=0A= Form.Element.EventObserver.prototype =3D Object.extend(new = Abstract.EventObserver(), {=0A= getValue: function() {=0A= return Form.Element.getValue(this.element);=0A= }=0A= });=0A= =0A= Form.EventObserver =3D Class.create();=0A= Form.EventObserver.prototype =3D Object.extend(new = Abstract.EventObserver(), {=0A= getValue: function() {=0A= return Form.serialize(this.element);=0A= }=0A= });=0A= if (!window.Event) {=0A= var Event =3D new Object();=0A= }=0A= =0A= Object.extend(Event, {=0A= KEY_BACKSPACE: 8,=0A= KEY_TAB: 9,=0A= KEY_RETURN: 13,=0A= KEY_ESC: 27,=0A= KEY_LEFT: 37,=0A= KEY_UP: 38,=0A= KEY_RIGHT: 39,=0A= KEY_DOWN: 40,=0A= KEY_DELETE: 46,=0A= KEY_HOME: 36,=0A= KEY_END: 35,=0A= KEY_PAGEUP: 33,=0A= KEY_PAGEDOWN: 34,=0A= =0A= element: function(event) {=0A= return event.target || event.srcElement;=0A= },=0A= =0A= isLeftClick: function(event) {=0A= return (((event.which) && (event.which =3D=3D 1)) ||=0A= ((event.button) && (event.button =3D=3D 1)));=0A= },=0A= =0A= pointerX: function(event) {=0A= return event.pageX || (event.clientX +=0A= (document.documentElement.scrollLeft || document.body.scrollLeft));=0A= },=0A= =0A= pointerY: function(event) {=0A= return event.pageY || (event.clientY +=0A= (document.documentElement.scrollTop || document.body.scrollTop));=0A= },=0A= =0A= stop: function(event) {=0A= if (event.preventDefault) {=0A= event.preventDefault();=0A= event.stopPropagation();=0A= } else {=0A= event.returnValue =3D false;=0A= event.cancelBubble =3D true;=0A= }=0A= },=0A= =0A= // find the first node with the given tagName, starting from the=0A= // node the event was triggered on; traverses the DOM upwards=0A= findElement: function(event, tagName) {=0A= var element =3D Event.element(event);=0A= while (element.parentNode && (!element.tagName ||=0A= (element.tagName.toUpperCase() !=3D tagName.toUpperCase())))=0A= element =3D element.parentNode;=0A= return element;=0A= },=0A= =0A= observers: false,=0A= =0A= _observeAndCache: function(element, name, observer, useCapture) {=0A= if (!this.observers) this.observers =3D [];=0A= if (element.addEventListener) {=0A= this.observers.push([element, name, observer, useCapture]);=0A= element.addEventListener(name, observer, useCapture);=0A= } else if (element.attachEvent) {=0A= this.observers.push([element, name, observer, useCapture]);=0A= element.attachEvent('on' + name, observer);=0A= }=0A= },=0A= =0A= unloadCache: function() {=0A= if (!Event.observers) return;=0A= for (var i =3D 0; i < Event.observers.length; i++) {=0A= Event.stopObserving.apply(this, Event.observers[i]);=0A= Event.observers[i][0] =3D null;=0A= }=0A= Event.observers =3D false;=0A= },=0A= =0A= observe: function(element, name, observer, useCapture) {=0A= element =3D $(element);=0A= useCapture =3D useCapture || false;=0A= =0A= if (name =3D=3D 'keypress' &&=0A= (navigator.appVersion.match(/Konqueror|Safari|KHTML/)=0A= || element.attachEvent))=0A= name =3D 'keydown';=0A= =0A= Event._observeAndCache(element, name, observer, useCapture);=0A= },=0A= =0A= stopObserving: function(element, name, observer, useCapture) {=0A= element =3D $(element);=0A= useCapture =3D useCapture || false;=0A= =0A= if (name =3D=3D 'keypress' &&=0A= (navigator.appVersion.match(/Konqueror|Safari|KHTML/)=0A= || element.detachEvent))=0A= name =3D 'keydown';=0A= =0A= if (element.removeEventListener) {=0A= element.removeEventListener(name, observer, useCapture);=0A= } else if (element.detachEvent) {=0A= try {=0A= element.detachEvent('on' + name, observer);=0A= } catch (e) {}=0A= }=0A= }=0A= });=0A= =0A= /* prevent memory leaks in IE */=0A= if (navigator.appVersion.match(/\bMSIE\b/))=0A= Event.observe(window, 'unload', Event.unloadCache, false);=0A= var Position =3D {=0A= // set to true if needed, warning: firefox performance problems=0A= // NOT neeeded for page scrolling, only if draggable contained in=0A= // scrollable elements=0A= includeScrollOffsets: false,=0A= =0A= // must be called before calling withinIncludingScrolloffset, every = time the=0A= // page is scrolled=0A= prepare: function() {=0A= this.deltaX =3D window.pageXOffset=0A= || document.documentElement.scrollLeft=0A= || document.body.scrollLeft=0A= || 0;=0A= this.deltaY =3D window.pageYOffset=0A= || document.documentElement.scrollTop=0A= || document.body.scrollTop=0A= || 0;=0A= },=0A= =0A= realOffset: function(element) {=0A= var valueT =3D 0, valueL =3D 0;=0A= do {=0A= valueT +=3D element.scrollTop || 0;=0A= valueL +=3D element.scrollLeft || 0;=0A= element =3D element.parentNode;=0A= } while (element);=0A= return [valueL, valueT];=0A= },=0A= =0A= cumulativeOffset: function(element) {=0A= var valueT =3D 0, valueL =3D 0;=0A= do {=0A= valueT +=3D element.offsetTop || 0;=0A= valueL +=3D element.offsetLeft || 0;=0A= element =3D element.offsetParent;=0A= } while (element);=0A= return [valueL, valueT];=0A= },=0A= =0A= positionedOffset: function(element) {=0A= var valueT =3D 0, valueL =3D 0;=0A= do {=0A= valueT +=3D element.offsetTop || 0;=0A= valueL +=3D element.offsetLeft || 0;=0A= element =3D element.offsetParent;=0A= if (element) {=0A= if(element.tagName=3D=3D'BODY') break;=0A= var p =3D Element.getStyle(element, 'position');=0A= if (p =3D=3D 'relative' || p =3D=3D 'absolute') break;=0A= }=0A= } while (element);=0A= return [valueL, valueT];=0A= },=0A= =0A= offsetParent: function(element) {=0A= if (element.offsetParent) return element.offsetParent;=0A= if (element =3D=3D document.body) return element;=0A= =0A= while ((element =3D element.parentNode) && element !=3D = document.body)=0A= if (Element.getStyle(element, 'position') !=3D 'static')=0A= return element;=0A= =0A= return document.body;=0A= },=0A= =0A= // caches x/y coordinate pair to use with overlap=0A= within: function(element, x, y) {=0A= if (this.includeScrollOffsets)=0A= return this.withinIncludingScrolloffsets(element, x, y);=0A= this.xcomp =3D x;=0A= this.ycomp =3D y;=0A= this.offset =3D this.cumulativeOffset(element);=0A= =0A= return (y >=3D this.offset[1] &&=0A= y < this.offset[1] + element.offsetHeight &&=0A= x >=3D this.offset[0] &&=0A= x < this.offset[0] + element.offsetWidth);=0A= },=0A= =0A= withinIncludingScrolloffsets: function(element, x, y) {=0A= var offsetcache =3D this.realOffset(element);=0A= =0A= this.xcomp =3D x + offsetcache[0] - this.deltaX;=0A= this.ycomp =3D y + offsetcache[1] - this.deltaY;=0A= this.offset =3D this.cumulativeOffset(element);=0A= =0A= return (this.ycomp >=3D this.offset[1] &&=0A= this.ycomp < this.offset[1] + element.offsetHeight &&=0A= this.xcomp >=3D this.offset[0] &&=0A= this.xcomp < this.offset[0] + element.offsetWidth);=0A= },=0A= =0A= // within must be called directly before=0A= overlap: function(mode, element) {=0A= if (!mode) return 0;=0A= if (mode =3D=3D 'vertical')=0A= return ((this.offset[1] + element.offsetHeight) - this.ycomp) /=0A= element.offsetHeight;=0A= if (mode =3D=3D 'horizontal')=0A= return ((this.offset[0] + element.offsetWidth) - this.xcomp) /=0A= element.offsetWidth;=0A= },=0A= =0A= page: function(forElement) {=0A= var valueT =3D 0, valueL =3D 0;=0A= =0A= var element =3D forElement;=0A= do {=0A= valueT +=3D element.offsetTop || 0;=0A= valueL +=3D element.offsetLeft || 0;=0A= =0A= // Safari fix=0A= if (element.offsetParent=3D=3Ddocument.body)=0A= if (Element.getStyle(element,'position')=3D=3D'absolute') break;=0A= =0A= } while (element =3D element.offsetParent);=0A= =0A= element =3D forElement;=0A= do {=0A= if (!window.opera || element.tagName=3D=3D'BODY') {=0A= valueT -=3D element.scrollTop || 0;=0A= valueL -=3D element.scrollLeft || 0;=0A= }=0A= } while (element =3D element.parentNode);=0A= =0A= return [valueL, valueT];=0A= },=0A= =0A= clone: function(source, target) {=0A= var options =3D Object.extend({=0A= setLeft: true,=0A= setTop: true,=0A= setWidth: true,=0A= setHeight: true,=0A= offsetTop: 0,=0A= offsetLeft: 0=0A= }, arguments[2] || {})=0A= =0A= // find page position of source=0A= source =3D $(source);=0A= var p =3D Position.page(source);=0A= =0A= // find coordinate system to use=0A= target =3D $(target);=0A= var delta =3D [0, 0];=0A= var parent =3D null;=0A= // delta [0,0] will do fine with position: fixed elements,=0A= // position:absolute needs offsetParent deltas=0A= if (Element.getStyle(target,'position') =3D=3D 'absolute') {=0A= parent =3D Position.offsetParent(target);=0A= delta =3D Position.page(parent);=0A= }=0A= =0A= // correct by body offsets (fixes Safari)=0A= if (parent =3D=3D document.body) {=0A= delta[0] -=3D document.body.offsetLeft;=0A= delta[1] -=3D document.body.offsetTop;=0A= }=0A= =0A= // set position=0A= if(options.setLeft) target.style.left =3D (p[0] - delta[0] + = options.offsetLeft) + 'px';=0A= if(options.setTop) target.style.top =3D (p[1] - delta[1] + = options.offsetTop) + 'px';=0A= if(options.setWidth) target.style.width =3D source.offsetWidth + = 'px';=0A= if(options.setHeight) target.style.height =3D source.offsetHeight + = 'px';=0A= },=0A= =0A= absolutize: function(element) {=0A= element =3D $(element);=0A= if (element.style.position =3D=3D 'absolute') return;=0A= Position.prepare();=0A= =0A= var offsets =3D Position.positionedOffset(element);=0A= var top =3D offsets[1];=0A= var left =3D offsets[0];=0A= var width =3D element.clientWidth;=0A= var height =3D element.clientHeight;=0A= =0A= element._originalLeft =3D left - parseFloat(element.style.left || = 0);=0A= element._originalTop =3D top - parseFloat(element.style.top || = 0);=0A= element._originalWidth =3D element.style.width;=0A= element._originalHeight =3D element.style.height;=0A= =0A= element.style.position =3D 'absolute';=0A= element.style.top =3D top + 'px';;=0A= element.style.left =3D left + 'px';;=0A= element.style.width =3D width + 'px';;=0A= element.style.height =3D height + 'px';;=0A= },=0A= =0A= relativize: function(element) {=0A= element =3D $(element);=0A= if (element.style.position =3D=3D 'relative') return;=0A= Position.prepare();=0A= =0A= element.style.position =3D 'relative';=0A= var top =3D parseFloat(element.style.top || 0) - = (element._originalTop || 0);=0A= var left =3D parseFloat(element.style.left || 0) - = (element._originalLeft || 0);=0A= =0A= element.style.top =3D top + 'px';=0A= element.style.left =3D left + 'px';=0A= element.style.height =3D element._originalHeight;=0A= element.style.width =3D element._originalWidth;=0A= }=0A= }=0A= =0A= // Safari returns margins on body which is incorrect if the child is = absolutely=0A= // positioned. For performance reasons, redefine = Position.cumulativeOffset for=0A= // KHTML/WebKit only.=0A= if (/Konqueror|Safari|KHTML/.test(navigator.userAgent)) {=0A= Position.cumulativeOffset =3D function(element) {=0A= var valueT =3D 0, valueL =3D 0;=0A= do {=0A= valueT +=3D element.offsetTop || 0;=0A= valueL +=3D element.offsetLeft || 0;=0A= if (element.offsetParent =3D=3D document.body)=0A= if (Element.getStyle(element, 'position') =3D=3D 'absolute') = break;=0A= =0A= element =3D element.offsetParent;=0A= } while (element);=0A= =0A= return [valueL, valueT];=0A= }=0A= }=0A= =0A= Element.addMethods(); ------=_NextPart_000_0042_01C959DD.33C039D0 Content-Type: application/octet-stream Content-Transfer-Encoding: quoted-printable Content-Location: http://archopht.ama-assn.org/js/archopht.js // NOTE: this prototype extension is courtesy of = http://www.agileweb.org/articles/2006/07/28/onload-final-update=0A= =0A= Object.extend(Event, {=0A= observe: function(element, name, observer, useCapture) {=0A= var element =3D $(element);=0A= useCapture =3D useCapture || false;=0A= if (name =3D=3D 'keypress' && = (navigator.appVersion.match(/Konqueror|Safari|KHTML/) || = element.attachEvent)) name =3D 'keydown';=0A= if (name =3D=3D 'load' && element.screen) this._observeLoad(element, = name, observer, useCapture);=0A= else this._observeAndCache(element, name, observer, useCapture);=0A= },=0A= _observeLoad : function(element, name, observer, useCapture) {=0A= if (!this._readyCallbacks) {=0A= var loader =3D this._onloadWindow.bind(this);=0A= if (document.addEventListener) = document.addEventListener("DOMContentLoaded", loader, false);=0A= /*@cc_on @*/=0A= /*@if (@_win32)=0A= if (! $("__ie_onload")) {=0A= document.write("