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Management","i":"{1F9D1EF9-79B9-49BB-8BBF-B4CD2D48DC8D}"},{"ss":"Pulmonology","i":"{B9003F24-5F79-4778-9C12-583D91CFF65A}"},{"ss":"Addiction","i":"{47D2B84B-2D19-4C88-B589-9750B222BF6F}"},{"ss":"Pharmacology","i":"{739C25BF-CDB8-4A91-A9C6-D7D640B9C156}"},{"ss":"Psychiatry","i":"{403AD9E5-9446-44A0-96F8-8F698E4DB7E1}"},{"ss":"Pain Management","i":"{3DC09C4F-C0B9-48AE-ACE1-B054B84219E3}"},{"ss":"Ophthalmology","i":"{A01EA372-ED7E-4543-B22A-882F45FC8C4D}"},{"ss":"Allergy/Asthma/Immunology","i":"{B06B2B3F-AF19-4374-BF2A-DD3132B277FA}"},{"ss":"Vaccination","i":"{740FE7F0-1F20-4F8A-89D7-0755CC0CBE22}"},{"ss":"Gynecology/Obstetrics","i":"{F78F1F27-D52F-4EB6-B601-DD4C6DC7ACDB}"},{"ss":"Adolescent Medicine","i":"{0D5D01D2-5042-4B3A-93C9-901CCC896652}"},{"ss":"Women\u0027s Health","i":"{120343A6-56C9-4D8A-A0EA-7785D4E61D05}"},{"ss":"Nutrition and Fitness","i":"{43C4CA9B-C69C-442F-BE33-4E808E0E515A}"},{"ss":"Obesity","i":"{1C402BB6-9980-46E7-B647-DA4CA813F5A9}"},{"ss":"Sleep Medicine","i":"{1AAE22CB-DF9D-42C9-AB8E-E93BAE1547D2}"},{"ss":"Geriatric Medicine","i":"{D6CE7AB2-D6C2-489F-A1C4-55776E561142}"},{"ss":"Complementary/Alternative Medicine","i":"{CE7B8D47-7E5E-4D91-9BB5-3FCB5B168AF5}"},{"ss":"Dermatology","i":"{CE9503A7-6BAC-49DA-9226-C6906A40878A}"},{"ss":"Cardiology","i":"{ADADD939-74DD-43EB-A575-451B5BA7203E}"},{"ss":"Infectious Diseases","i":"{13CC841B-0F58-4C57-A72A-34EDA475DFDE}"},{"ss":"Diabetes","i":"{40461654-C570-4ED9-AB87-9648579277D6}"},{"ss":"Rheumatology","i":"{F8470179-5DCF-4F16-A1E4-16ED97B96989}"},{"ss":"IBD-Associated Arthritis","i":"{D3DA82F0-9A16-4179-84B0-FE6057BAF598}"},{"ss":"Spondyloarthropathies","i":"{C6EC85BA-BCE0-41DE-A572-FCAFF4DAB541}"},{"ss":"Vasculitis and Giant Cell Arteritis","i":"{41248AD2-2851-4953-9F92-2FF9361A292C}"},{"ss":"Lupus","i":"{2C3AA5F0-AA5B-4993-BAAD-17FAEA0AD31A}"},{"ss":"Pain Management","i":"{456CF563-1F43-46F6-A19F-69BDFB4E2B0D}"},{"ss":"Polymyositis","i":"{1326803C-0039-425D-A967-4B068F1CC049}"},{"ss":"Infection","i":"{64D3060D-10BD-41FF-A2CA-04E68A0E744C}"},{"ss":"Juvenile Arthritis","i":"{349DB4A1-38E2-4A55-9077-5C079A63A9EC}"},{"ss":"Psoriatic Arthritis","i":"{7B3F3641-FCC4-4751-95D3-950A8880E443}"},{"ss":"Practice Management","i":"{F73CEAB7-6C4A-4A5D-B5E2-C18BD501A06C}"},{"ss":"Fibromyalgia","i":"{C8423EC6-E560-4329-A37F-B3CA5ED13F0D}"},{"ss":"Hemochromatosis","i":"{3A527268-F906-4712-8EA4-3D61A946BEF2}"},{"ss":"Scleroderma","i":"{2C332282-08FE-435C-90FE-7E0A290C6DFF}"},{"ss":"Raynaud’s Syndrome","i":"{B86D661E-189B-4CB0-8081-4EAFFCB42A42}"},{"ss":"Gout","i":"{0F5DC212-52AC-40B8-B730-C9F4BEB63DD1}"},{"ss":"Sjögren’s Syndrome","i":"{ED77D737-BD16-48FE-BF58-B6D490F07CD5}"},{"ss":"Osteoporosis and Bone Disorders","i":"{4E5B6559-DCD1-4305-B56B-4D0A006A3E3D}"},{"ss":"Rheumatoid Arthritis","i":"{7B88647F-240F-4B05-B0F2-08166AC4AF02}"},{"ss":"Imaging","i":"{073D6761-DE60-4A2F-B3F6-C6D8F705222D}"},{"ss":"Physicians’ Life","i":"{9405DF8F-BCA6-45B9-A22F-6167169822D9}"},{"ss":"Antiphospholipid Syndrome","i":"{B91870A7-25BE-4D8F-9633-198F67808838}"},{"ss":"Reactive Arthritis","i":"{EAB5C095-9D11-4F68-AF55-A1160548EE11}"}]'; var arrHealioSubSpecialtyLookup = JSON.parse(healioSubSpecialtyLookup); //set ITJ JSON var filterJson = '[{"i":"{EE7A8DA0-AD54-4DA0-B135-246997762FBE}","sl":[{"i":"{2A383104-3EDF-4BC9-9F61-AC66CCFF99A1}"},{"i":"{0D62C911-FDAE-4BC0-9ED3-F162FEC9A25C}"},{"i":"{A492F9FF-2E6B-49AC-B96E-AC1389FA7B45}"},{"i":"{835909DD-CBD4-40B3-9399-BF9F1F495B0E}"},{"i":"{567EBDD9-B5C4-425D-AAB6-544BDFB5BB88}"},{"i":"{528FE895-DD34-4563-A722-7AAA77221FA3}"},{"i":"{2345DF49-D3D4-44B9-85B6-38D271531B5D}"},{"i":"{834954F1-B891-4CA1-8FED-8737FEECB352}"},{"i":"{FA4E93A8-0469-407E-A754-C4A027FB16CF}"},{"i":"{65A06C56-B132-442B-BF20-8A58D3612F3D}"},{"i":"{F036D9E3-1789-4CEE-BA54-A6395302588C}"},{"i":"{96535EC1-F9E2-406E-B410-94717F79959D}"}],"jl":[{"j":"Advanced Materials","li":"{2A383104-3EDF-4BC9-9F61-AC66CCFF99A1}|{0D62C911-FDAE-4BC0-9ED3-F162FEC9A25C}|{A492F9FF-2E6B-49AC-B96E-AC1389FA7B45}|{567EBDD9-B5C4-425D-AAB6-544BDFB5BB88}|{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{65A06C56-B132-442B-BF20-8A58D3612F3D}|{528FE895-DD34-4563-A722-7AAA77221FA3}|{2345DF49-D3D4-44B9-85B6-38D271531B5D}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{FA4E93A8-0469-407E-A754-C4A027FB16CF}|{F036D9E3-1789-4CEE-BA54-A6395302588C}|{96535EC1-F9E2-406E-B410-94717F79959D}","i":"{6E557798-AF15-46E4-87B1-EC10E02B2715}"},{"j":"Alimentary Pharmacology and Therapeutics","li":"{2A383104-3EDF-4BC9-9F61-AC66CCFF99A1}|{0D62C911-FDAE-4BC0-9ED3-F162FEC9A25C}|{A492F9FF-2E6B-49AC-B96E-AC1389FA7B45}|{567EBDD9-B5C4-425D-AAB6-544BDFB5BB88}|{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{0E23C14A-0A45-48D3-B1D9-44CE08F762A2}|{65A06C56-B132-442B-BF20-8A58D3612F3D}|{528FE895-DD34-4563-A722-7AAA77221FA3}|{2345DF49-D3D4-44B9-85B6-38D271531B5D}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{FA4E93A8-0469-407E-A754-C4A027FB16CF}|{F036D9E3-1789-4CEE-BA54-A6395302588C}|{96535EC1-F9E2-406E-B410-94717F79959D}|{C839429C-71E2-4C1B-A267-D4FC9922E0BF}|{CEC6FF95-6F4B-4A4D-8148-C97F6FDA883B}|{EDF5C680-D35A-42A0-841D-29C356BEAD42}|{8CA70737-3808-489C-B7A0-479C77E94F5D}|{BE556303-5731-4BA1-A310-A4A7B1AA2442}|{601DD2D6-B720-4990-9ED4-4003D57AF43E}|{9F5E20B6-7240-4B7D-9AB0-C2C8A4B571A0}|{11CB9839-F2DC-419F-9779-1A6D59258F9D}|{6234A60A-8F9D-4B49-8474-0086076957EE}|{E8B6E684-176F-4A18-A1A7-E17F5A0302C4}|{6442856C-EA5D-4CE9-9EAA-E33CE6548D5E}|{3079A814-A9F2-42BA-B45E-1053450C0D0F}|{441C0385-D092-4267-9746-DB2EB24D24AB}|{47702B4B-FBAC-404B-904A-9368CDC613B5}|{1018C3DD-904F-4C44-A347-1F70E0E9366E}|{DE5A8284-5677-4F37-8C4C-95B2A6BCA594}|{C8062F9D-BBE6-444E-8CFA-AE02F129A05F}|{53AAA377-1F06-4A43-A451-75BB8304EC49}|{E209C64C-39F3-479C-B8CD-37EF577BFA3A}|{0814843B-0962-45B5-AC6D-08FED7DC8850}|{50EBBF76-9C28-402B-ACFC-B22413118375}|{E28D32AA-1286-46F5-960C-8143299D1579}|{66337F66-2636-47CD-BDFB-249347F8F96E}|{6D25F1D6-CE64-4D58-9BED-69C48A719D6B}|{98913DFB-96AE-4CD0-9D21-AB3372307BEA}|{9C4CC670-C0EF-46B6-8ED4-4C242C809D51}|{7B8CCFD4-72D1-4632-B4A2-C85C3EFBE4A5}|{C4871C84-3B26-4E5B-8355-58F097164967}|{E1E95A81-1F37-4426-989C-E58C0D33E148}|{2949056E-6FD2-4E5C-A0CD-8CB61768C6CF}|{0E7951F0-BDDC-46B9-BE11-6C7037A22081}|{7A3BDEAB-6168-4E9B-86BD-271F644E187A}|{FD201F01-F702-4482-8C74-4022C16009FE}|{DFD5186F-1B2C-4872-BEAA-E29C1D995DF9}|{D5E5D668-A451-40F2-B149-43733665D3F9}|{1D3F00EB-1985-43DD-B40E-F70C28F18813}|{3D9AC3E2-794B-46E1-8A93-2CAFDB338F56}|{3667B68D-5D83-4318-8D90-5D0449F5F71B}|{D16CFA1D-0C30-4DE7-B6C6-5D350066292F}|{97955770-39C9-468F-B031-D9E4FA596C60}|{FB689E6D-06AD-4EC4-9CDD-F895414784D1}","i":"{0B1A4115-DA0E-4113-9C71-5F9009F15128}"},{"j":"American Journal of Clinical Nutrition","li":"{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{65A06C56-B132-442B-BF20-8A58D3612F3D}","i":"{F8E9EED9-CCBA-4B26-9868-F25BB0351911}"},{"j":"American Journal of Managed Care","li":"{2A383104-3EDF-4BC9-9F61-AC66CCFF99A1}|{0D62C911-FDAE-4BC0-9ED3-F162FEC9A25C}|{A492F9FF-2E6B-49AC-B96E-AC1389FA7B45}|{567EBDD9-B5C4-425D-AAB6-544BDFB5BB88}|{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{0E23C14A-0A45-48D3-B1D9-44CE08F762A2}|{65A06C56-B132-442B-BF20-8A58D3612F3D}|{528FE895-DD34-4563-A722-7AAA77221FA3}|{2345DF49-D3D4-44B9-85B6-38D271531B5D}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{FA4E93A8-0469-407E-A754-C4A027FB16CF}|{F036D9E3-1789-4CEE-BA54-A6395302588C}|{96535EC1-F9E2-406E-B410-94717F79959D}","i":"{912F1277-E3A5-4CB9-A581-E72943826071}"},{"j":"American Journal of Medical 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of Nutrition Education and Behavior","li":"{A492F9FF-2E6B-49AC-B96E-AC1389FA7B45}|{567EBDD9-B5C4-425D-AAB6-544BDFB5BB88}|{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{FA4E93A8-0469-407E-A754-C4A027FB16CF}","i":"{5B42A9F6-B95F-4372-9D93-D535BB6AFAC3}"},{"j":"Journal of Obstetrics and Gynaecology Research","li":"{F036D9E3-1789-4CEE-BA54-A6395302588C}|{CEC6FF95-6F4B-4A4D-8148-C97F6FDA883B}|{9F5E20B6-7240-4B7D-9AB0-C2C8A4B571A0}","i":"{2107A4CC-E2AD-4512-9055-69BB7676931F}"},{"j":"Journal of School Health","li":"{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{65A06C56-B132-442B-BF20-8A58D3612F3D}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{FA4E93A8-0469-407E-A754-C4A027FB16CF}","i":"{A5B097DB-EB6D-49CB-8C10-BD4C98950E0C}"},{"j":"Journal of the Academy of Nutrition and 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of the American College of 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of the American Geriatrics 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of the American Geriatrics 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of Medical 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of the American College of 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of the American College of 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of the American Geriatrics 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Lancet HIV","li":"{98913DFB-96AE-4CD0-9D21-AB3372307BEA}|{9C4CC670-C0EF-46B6-8ED4-4C242C809D51}|{7B8CCFD4-72D1-4632-B4A2-C85C3EFBE4A5}|{C4871C84-3B26-4E5B-8355-58F097164967}|{E1E95A81-1F37-4426-989C-E58C0D33E148}|{2949056E-6FD2-4E5C-A0CD-8CB61768C6CF}|{0E7951F0-BDDC-46B9-BE11-6C7037A22081}|{7A3BDEAB-6168-4E9B-86BD-271F644E187A}|{FD201F01-F702-4482-8C74-4022C16009FE}|{96E28273-D9BC-4376-A88C-40CCFA6B0139}|{D5E5D668-A451-40F2-B149-43733665D3F9}|{1D3F00EB-1985-43DD-B40E-F70C28F18813}|{3D9AC3E2-794B-46E1-8A93-2CAFDB338F56}|{3667B68D-5D83-4318-8D90-5D0449F5F71B}|{D16CFA1D-0C30-4DE7-B6C6-5D350066292F}|{97955770-39C9-468F-B031-D9E4FA596C60}|{FB689E6D-06AD-4EC4-9CDD-F895414784D1}","i":"{EAB0BEE6-A9BE-4F35-BA4B-8AD59F0E68FA}"},{"j":"The Lancet Infectious 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Control","li":"{2A383104-3EDF-4BC9-9F61-AC66CCFF99A1}|{0D62C911-FDAE-4BC0-9ED3-F162FEC9A25C}|{A492F9FF-2E6B-49AC-B96E-AC1389FA7B45}|{567EBDD9-B5C4-425D-AAB6-544BDFB5BB88}|{835909DD-CBD4-40B3-9399-BF9F1F495B0E}|{0E23C14A-0A45-48D3-B1D9-44CE08F762A2}|{65A06C56-B132-442B-BF20-8A58D3612F3D}|{528FE895-DD34-4563-A722-7AAA77221FA3}|{2345DF49-D3D4-44B9-85B6-38D271531B5D}|{834954F1-B891-4CA1-8FED-8737FEECB352}|{FA4E93A8-0469-407E-A754-C4A027FB16CF}|{F036D9E3-1789-4CEE-BA54-A6395302588C}|{96535EC1-F9E2-406E-B410-94717F79959D}|{EDF5C680-D35A-42A0-841D-29C356BEAD42}|{11CB9839-F2DC-419F-9779-1A6D59258F9D}|{6442856C-EA5D-4CE9-9EAA-E33CE6548D5E}|{601DD2D6-B720-4990-9ED4-4003D57AF43E}|{9F5E20B6-7240-4B7D-9AB0-C2C8A4B571A0}|{BE556303-5731-4BA1-A310-A4A7B1AA2442}|{8CA70737-3808-489C-B7A0-479C77E94F5D}|{47702B4B-FBAC-404B-904A-9368CDC613B5}|{66337F66-2636-47CD-BDFB-249347F8F96E}|{C4871C84-3B26-4E5B-8355-58F097164967}|{1D3F00EB-1985-43DD-B40E-F70C28F18813}","i":"{00361E20-1CFE-42E0-B3FC-F6251DFA21F3}"},{"j":"Value 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Evolution","li":"{98913DFB-96AE-4CD0-9D21-AB3372307BEA}|{9C4CC670-C0EF-46B6-8ED4-4C242C809D51}|{7B8CCFD4-72D1-4632-B4A2-C85C3EFBE4A5}|{C4871C84-3B26-4E5B-8355-58F097164967}|{E1E95A81-1F37-4426-989C-E58C0D33E148}|{2949056E-6FD2-4E5C-A0CD-8CB61768C6CF}|{0E7951F0-BDDC-46B9-BE11-6C7037A22081}|{7A3BDEAB-6168-4E9B-86BD-271F644E187A}|{FD201F01-F702-4482-8C74-4022C16009FE}|{96E28273-D9BC-4376-A88C-40CCFA6B0139}|{DFD5186F-1B2C-4872-BEAA-E29C1D995DF9}|{D5E5D668-A451-40F2-B149-43733665D3F9}|{1D3F00EB-1985-43DD-B40E-F70C28F18813}|{3D9AC3E2-794B-46E1-8A93-2CAFDB338F56}|{3667B68D-5D83-4318-8D90-5D0449F5F71B}|{D16CFA1D-0C30-4DE7-B6C6-5D350066292F}|{97955770-39C9-468F-B031-D9E4FA596C60}|{FB689E6D-06AD-4EC4-9CDD-F895414784D1}","i":"{7F0BF562-CC42-4B84-883D-38F097F1F542}"}]}]'; var arrFilterJson = JSON.parse(filterJson); //load the specialty dropdown $j.each(arrFilterJson, function (key, value) { var specName = ""; var sid = value.i; for (var i = 0; i < arrHealioSpecialtyLookup.length; i++) { if (arrHealioSpecialtyLookup[i].i === sid) { specName = arrHealioSpecialtyLookup[i].s; } } $j('<option />', { value: sid, text: specName }).appendTo(ddSpec); }); //set selected values for specialty dropdown if (!isStringEmpty(closestSpecId) && isStringEmpty(selectedSpecId)) { $j(ddSubspec).empty(); $j(ddSubspec).get(0).options[0] = new Option("All Topics", ""); $j(ddJournals).empty(); $j(ddJournals).get(0).options[0] = new Option("All Journals", ""); var exists = false; $j("[id=itjSpecialtyOptions] option").each(function () { if (this.value == closestSpecId) { exists = true; } }); if (exists) { $j(ddSpec).val(closestSpecId); } else { closestSpecId = ""; } } else if (!isStringEmpty(selectedSpecId) && selectedSpecId !== "{0CD6633E-9B46-479D-8CE4-87DEA2F83A3B}") { $j(ddSubspec).empty(); $j(ddSubspec).get(0).options[0] = new Option("All Topics", ""); $j(ddJournals).empty(); $j(ddJournals).get(0).options[0] = new Option("All Journals", ""); $j(ddSpec).val(selectedSpecId); } else { $j(ddSubspec).empty(); $j(ddSubspec).get(0).options[0] = new Option("All Topics", ""); $j(ddJournals).empty(); $j(ddJournals).get(0).options[0] = new Option("All Journals", ""); $j(ddSubspec).attr('disabled', 'disabled'); } //load the subspecialties if ((!isStringEmpty(selectedSubspecId) || !isStringEmpty(closestSpecId)) && selectedSpecId !== "{0CD6633E-9B46-479D-8CE4-87DEA2F83A3B}") { loadSubspecialties(); } //load the journals if ((!isStringEmpty(selectedSubspecId) || !isStringEmpty(closestSpecId)) && selectedSpecId !== "{0CD6633E-9B46-479D-8CE4-87DEA2F83A3B}") { loadJournals(); } //on ddSpec change, reset and load subspecialties and journals $j(ddSpec).change(function () { var selectedSpecialty = $j(ddSpec).val(); if (!isStringEmpty(selectedSpecialty)) { selectedSpecId = ""; selectedSubspecId = ""; selectedJournalId = ""; $j(ddSubspec).empty(); $j(ddSubspec).get(0).options[0] = new Option("All Topics", ""); loadSubspecialties(); $j(ddJournals).empty(); $j(ddJournals).get(0).options[0] = new Option("All Journals", ""); loadJournals(); } }); //on ddSubspec change, reset and load journals $j(ddSubspec).change(function () { console.log("Changed Subspecialty"); var selectedSubspecialty = $j(ddSubspec).val(); if (!isStringEmpty(selectedSubspecialty)) { selectedSubspecId = ""; selectedJournalId = ""; $j(ddJournals).empty(); $j(ddJournals).get(0).options[0] = new Option("All Journals", ""); loadJournals(); } }); //load supspecialties function loadSubspecialties(specid) { var selectedSpecialtyId = $j(ddSpec).val(); $j.each(arrFilterJson, function (key, value) { var specName = ""; for (var i = 0; i < arrHealioSpecialtyLookup.length; i++) { if (arrHealioSpecialtyLookup[i].i === selectedSpecialtyId) { specName = arrHealioSpecialtyLookup[i].s; } } if (value.i === selectedSpecialtyId) { //load subspecialty list object var ssObj = value.sl; console.log(ssObj); $j.each(ssObj, function (key, value) { var subspecName = ""; var sid = value.i; for (var i = 0; i < arrHealioSubSpecialtyLookup.length; i++) { if (arrHealioSubSpecialtyLookup[i].i === sid) { subspecName = arrHealioSubSpecialtyLookup[i].ss; } } if (isStringEmpty(subspecName)) return true; //used if subspecialty is unpublished if (!isStringEmpty(selectedSubspecId) && sid === selectedSubspecId) { $j('<option />', { value: sid, text: subspecName, selected: "selected" }).appendTo(ddSubspec); } else { $j('<option />', { value: sid, text: subspecName }).appendTo(ddSubspec); } }); } }); //enable the subspecialty dropdown $j(ddSubspec).prop("disabled", false); } //load journals function loadJournals() { //get ITJ Journals (specialtyID or SubspecialtyID) var selectedSpecialtyId = $j(ddSpec).val(); var selectedSubSpecialtyId = $j(ddSubspec).val(); console.log("Loading Journals: selectedSpecialty: " + selectedSpecialtyId); console.log("Loading Journals: selectedSubSpecialty: " + selectedSubSpecialtyId); $j.each(arrFilterJson, function (key, value) { var specName = ""; for (var i = 0; i < arrHealioSpecialtyLookup.length; i++) { if (arrHealioSpecialtyLookup[i].i === selectedSpecialtyId) { specName = arrHealioSpecialtyLookup[i].s; } } console.log("Loading Journals: Specialty Name: " + specName); if (value.i == selectedSpecialtyId) { var ssObj = value.jl; $j.each(ssObj, function (key, value) { var listJournalSpecs = value.li; console.log(listJournalSpecs); if (!isStringEmpty(selectedSubSpecialtyId) && listJournalSpecs.indexOf(selectedSubSpecialtyId) >= -1) { console.log("Loading journals by Subspecialty ID"); var journalName = value.j; var sid = value.i; $j('<option />', { value: sid, text: journalName }).appendTo(ddJournals); } else if (isStringEmpty(selectedSubSpecialtyId)) { console.log("Loading journals by Specialty ID"); var journalName = value.j; var sid = value.i; $j('<option />', { value: sid, text: journalName }).appendTo(ddJournals); } }); } }); if (!isStringEmpty(selectedJournalId)) { $j(ddJournals).val(selectedJournalId); } } //load years for (i = new Date().getFullYear() ; i >= 2014; i--) { $j('#fromYear').append($j('<option />').val(i).html(i)); $j('#toYear').append($j('<option />').val(i).html(i)); } //handle dates if (!isStringEmpty(selectedFromYear)) { $j("#fromYear").val(selectedFromYear); } else { $j("#fromYear").val(defaultFromYear); } if (!isStringEmpty(selectedFromMonth)) { $j("#fromMonth").val(selectedFromMonth); } else { $j("#fromMonth").val(defaultFromMonth); } if (!isStringEmpty(selectedToMonth)) { $j("#toMonth").val(selectedToMonth); } else { $j("#toMonth").val(defaultToMonth); } if (!isStringEmpty(selectedToYear)) { $j("#toYear").val(selectedToYear); } else { $j("#toYear").val(defaultToYear); } //reset $j(".itj-reset-btn").on("click", function (e) { $j(ddSpec).val($j("#itjSpecialtyOptions option:first").val()); $j(ddSubspec).empty(); $j(ddSubspec).get(0).options[0] = new Option("All Topics", ""); $j(ddJournals).empty(); $j(ddJournals).get(0).options[0] = new Option("All Journals", ""); $j(ddSubspec).attr('disabled', 'disabled'); $j("#fromYear").val(defaultFromYear); $j("#fromMonth").val(defaultFromMonth); $j("#toMonth").val(defaultToMonth); $j("#toYear").val(defaultToYear); }); //pagination to use POST $j(".itj-list .pagination a").on("click", function (e) { var currentTabUrl = $j(this).attr('href'); e.preventDefault(); // cancel the link itself e.stopImmediatePropagation(); //create the formpost var formString = ""; if (!isStringEmpty(selectedSpecId)) { formString = "<input name='itjSpecialtyOptions' value='" + selectedSpecId + "'/>"; } if (!isStringEmpty(selectedSubspecId)) { formString = formString + "<input name='itjSubSpecialtyOptions' value='" + selectedSubspecId + "'/>"; } if (!isStringEmpty(selectedJournalId)) { formString = formString + "<input name='itjJournalOptions' value='" + selectedJournalId + "'/>"; } if (!isStringEmpty(selectedFromMonth)) { formString = formString + "<input name='fromMonth' value='" + selectedFromMonth + "'/>"; } if (!isStringEmpty(selectedFromYear)) { formString = formString + "<input name='fromYear' value='" + selectedFromYear + "'/>"; } if (!isStringEmpty(selectedToMonth)) { formString = formString + "<input name='toMonth' value='" + selectedToMonth + "'/>"; } if (!isStringEmpty(selectedToYear)) { formString = formString + "<input name='toYear' value='" + selectedToYear + "'/>"; } $j('<form/>').append(formString).attr('action', currentTabUrl).attr('method', 'POST').appendTo('body').submit(); }); $j("#accordionFilter a").click(function () { toggleMenuIcons($j(this).find("i"), "fa fa-chevron-down", "fa fa-chevron-up"); }); }); //function to check if the element contains content. function isStringEmpty(el) { return !$j.trim(el); } </script> <script type="text/javascript"> var value1 = $j('input:hidden[name=gsafilter]').val(); var value2 = "partialfields=content_type:in+the+journals"; var u = ""; //desktop search $j("#btnSearchGoItj").click(function () { value1 = value1 + "&" + value2; u = "/search?q=" + $j("input#srch-term-itj").val() + ((typeof (value1) === 'undefined' || value1 == "") ? "" : "&" + value1); //module tracking.. Special case: Event will not fire correctly when button is clicked if (window.TrackModule) { var module = FullModuleName(this); TrackModule(this, module, 'Button Clicked', $j("input#srch-term-itj").val(), 0); } //end module tracking window.location.replace(u); }); $j('#srch-term-itj').bind('keypress keydown keyup', function (e) { if (e.keyCode == 13 && $j(this).val()) { e.preventDefault(); value1 = value1 + "&" + value2; u = "/search?q=" + $j("input#srch-term-itj").val() + ((typeof (value1) === 'undefined' || value1 == "") ? "" : "&" + value1); //module tracking.. Special case: Event will not fire correctly when button is clicked if (window.TrackModule) { var module = FullModuleName(this); TrackModule(this, module, 'Button Clicked', $j("input#srch-term-itj").val(), 0); } //end module tracking window.location.replace(u); } }); </script>   <div class="col-xs-16 itj-title-meta"> <h1 class="itj-title">Acromegaly associated with late-onset diabetes</h1> <p class="itj-subtitle"> <p class="itj-meta"><a href="https://web.archive.org/web/20160822130119/http://www.eje-online.org/content/early/2016/08/15/EJE-16-0562.abstract" id="rId7" target="_new">Sardella C, et al. <i>Euro J </i><i>Endocrinol</i><i>. </i>2016;doi:10.1530/EJE-16-0562</a></p> <p class="itj-date">August 19, 2016</p> </div>  <div class="col-xs-16 itj-tab-group hidden-xs"> <div>  <ul class="nav nav-tabs" role="tablist" id="itjTabs"> <li role="presentation" id="tabAbstract"><a href="#abstract" aria-controls="abstract" role="tab" data-toggle="tab" name="abstract"><i class="fa fa-list-ul"></i> Abstract Excerpt</a></li> <li role="presentation" id="tabExecutiveSummary" class="active" style="display: none;"><a href="#execsummary" aria-controls="executive summary" role="tab" data-toggle="tab" name="executive summary"><i class="fa fa-file-text"></i> Executive Summary</a></li> <li role="presentation" id="tabPerspective" style="display: none;"><a href="#perspective" aria-controls="perspective" role="tab" data-toggle="tab" name="perspective"><i class="fa fa-quote-left"></i> Perspective</a></li> <li role="presentation" id="tabInfographic" style="display: none;"><a href="#infographic" aria-controls="infographic" role="tab" data-toggle="tab" name="infographic"><i class="fa fa-pie-chart"></i> Infographic</a></li> <li role="presentation" id="tabRelated" style="display: none;"><a href="#relcontent" aria-controls="related content" role="tab" data-toggle="tab" name="related content"><i class="fa fa-newspaper-o"></i> Related Content</a></li> </ul>  <div class="tab-content"> <div role="tabpanel" class="tab-pane" id="abstract"><p><strong>AUTHORS: </strong></p> <p>Sardella C, Cappellani D, Urbani C, Manetti L, Marconcini G, Tomisti L, Lupi I, Rossi G, Scattina I, Lombardi M, Di Bello V, Marcocci C, Martino E, Bogazzi F. </p> <p><strong>OBJECTIVE: </strong></p> <p>The primary objective was to identify the predictors of comorbidities and major adverse cardiovascular events (MACE) that can develop after diagnosis of acromegaly. The role of therapy for acromegaly in the event of such complications was also evaluated. <a href="https://web.archive.org/web/20160822130119/http://www.eje-online.org/content/early/2016/08/15/EJE-16-0562.abstract" target="_new">...</a></p></div> <div role="tabpanel" class="tab-pane" id="execsummary"><p>Uncontrolled, persistent acromegaly is a strong predictor of incident type 2 diabetes, whereas disease diagnosis at an older age, and not disease activity, was associated with hypertension and major adverse cardiac events, according to a recent analysis.</p> <p>“These findings suggest that the lack of a tight control of acromegaly activity plays a central role in the development of metabolic complications, whereas older age at diagnosis of disease influences the development of cardiovascular complications and events,” <strong><strong>Fausto Bogazzi, MD, PhD,</strong> </strong>associate professor of endocrinology at University of Pisa, Italy, and colleagues wrote. “In addition, being overweight or obese and [a] smoking habit increased the [CV] risk in acromegalic patients as in the general population.”</p> <div class="mug right"><img width="80" height="106" alt="Fausto Bogazzi" src="https://web.archive.org/web/20160822130119im_/http://m4.wyanokecdn.com/f7e8f540a4dc9521360e22d45afcc94a.jpg"><p class="name"><strong>Fausto Bogazzi</strong></p></div> <p>In a retrospective study, Sardella and colleagues analyzed medical records from 200 <a href="https://web.archive.org/web/20160822130119/http://www.healio.com/endocrinology/neuroendocrinology/news/in-the-journals/%7B0c4ce102-30f7-4762-8f2b-ed5763adc967%7D/targeted-acromegaly-screening-needed-to-improve-outcomes-reduce-complications" id="rId8" target="_new">patients with acromegaly</a> referred to the endocrinology section of the department of clinical and experimental medicine at University of Pisa between 1974 and 2014 (58.5% women). Using Cox regression analysis, researchers evaluated incidents of diabetes, hypertension and major adverse cardiac events. Each patient was included in the analysis of a specific outcome, unless they were affected when acromegaly was diagnosed. Patients were further classified as being in remission after pituitary adenomectomy, controlled by somatostatin analogue therapy or not controlled by somatostatin analogue therapy.</p> <p>At diagnosis, 64 patients (32%) had diabetes 93 patients (46.5%) had hypertension and 17 patients (8.5%) already experienced a CV event.</p> <p>After a diagnosis of acromegaly, diabetes occurred in 40.8% of patients. Researchers found that patients not controlled by somatostatin analogue therapy had a higher risk for diabetes vs. those who underwent adenomectomy (HR = 3.32; <em>P = </em>.006), whereas those well controlled with somatostatin analogue therapy had a 1.4-fold higher risk (<em>P</em> = .38) for diabetes vs. the adenomectomy group.</p> <p>“It has been reported that [somatostatin analogue therapy] can worsen glucose metabolism by inhibiting insulin secretion and may be less effective than pituitary surgery in reducing the risk for death in patients affected by diabetes,” the researchers wrote. “However, it is possible that the relatively small number of patients included in the study affected the power of the analysis.”</p> <p>Researchers found that age (HR = 1.06, <em>P</em> = .01) and BMI (HR = 1.05; <em>P</em> = .01) were <a href="https://web.archive.org/web/20160822130119/http://www.healio.com/endocrinology/diabetes/news/in-the-journals/%7Bfe74bb74-ad83-4de8-b276-207edb58e042%7D/combined-gestational-diabetes-hypertension-increase-risk-for-type-2-diabetes-prediabetes" id="rId9" target="_new">predictors of hypertension</a>, which occurred in 35.5% of patients after acromegaly diagnosis. Age (HR = 1.09; 95% CI, 1.02-1.17) and smoking (HR = 5.95; 95% CI, 1.52-25.26) were predictors of major adverse CV events, which occurred in 11.8% of patients after diagnosis. Therapy for acromegaly did not influence hypertension or major adverse CV events, according to researchers.</p> <p>“Our study pointed out that the control of acromegaly activity is necessary but is not the only target in the whole management of patients with this rare syndrome,” Bogazzi told <em>Endocrine Today. </em>“The cure (and prevention) of systemic complications of acromegaly is the mainstay of the therapeutic strategy and should include prevention of hypertension, diabetes, cessation of smoking and a weight loss program. All those objectives did not differ from those advocated for non-acromegalic patients.” – <em>by Regina Schaffer</em> </p> <p> <strong>Disclosure: </strong>Pfizer S.p.A Italy supported this study through an unrestricted grant. The researchers report no relevant financial disclosures.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p></div> <div role="tabpanel" class="tab-pane" id="perspective"></div> <div role="tabpanel" class="tab-pane" id="infographic"></div> <div role="tabpanel" class="tab-pane" id="relcontent"> </div> </div> </div> </div>   <div class="col-xs-16 itj-accordion visible-xs"> <div>  <div class="panel-group" id="accordionAbstract" role="tablist" aria-multiselectable="true"> <div class="panel panel-default"> <div class="panel-heading" role="tab" id="headingOne"> <h4 class="panel-title"> <a role="button" data-toggle="collapse" data-parent="#accordionAbstract" href="#collapseOne" aria-expanded="True" aria-controls="collapseOne" name="abstract"><i class="fa fa-list-ul"></i> Abstract Excerpt <i class="fa fa-chevron-down"></i></a> </h4> </div> <div id="collapseOne" class="panel-collapse collapse" role="tabpanel" aria-labelledby="headingOne"> <div class="panel-body"><p><strong>AUTHORS: </strong></p> <p>Sardella C, Cappellani D, Urbani C, Manetti L, Marconcini G, Tomisti L, Lupi I, Rossi G, Scattina I, Lombardi M, Di Bello V, Marcocci C, Martino E, Bogazzi F. </p> <p><strong>OBJECTIVE: </strong></p> <p>The primary objective was to identify the predictors of comorbidities and major adverse cardiovascular events (MACE) that can develop after diagnosis of acromegaly. The role of therapy for acromegaly in the event of such complications was also evaluated. <a href="https://web.archive.org/web/20160822130119/http://www.eje-online.org/content/early/2016/08/15/EJE-16-0562.abstract" target="_new">...</a></p></div> </div> </div> </div> <div class="panel-group" id="accordionExec" role="tablist" aria-multiselectable="true" style="display: none;"> <div class="panel panel-default"> <div class="panel-heading" role="tab" id="headingTwo"> <h4 class="panel-title"> <a role="button" data-toggle="collapse" data-parent="#accordionExec" href="#collapseTwo" aria-expanded="true" aria-controls="collapseTwo" name="executive summary"><i class="fa fa-file-text"></i> Executive Summary <i class="fa fa-chevron-down"></i></a> </h4> </div> <div id="collapseTwo" class="panel-collapse collapse in" role="tabpanel" aria-labelledby="headingTwo"> <div class="panel-body"><p>Uncontrolled, persistent acromegaly is a strong predictor of incident type 2 diabetes, whereas disease diagnosis at an older age, and not disease activity, was associated with hypertension and major adverse cardiac events, according to a recent analysis.</p> <p>“These findings suggest that the lack of a tight control of acromegaly activity plays a central role in the development of metabolic complications, whereas older age at diagnosis of disease influences the development of cardiovascular complications and events,” <strong><strong>Fausto Bogazzi, MD, PhD,</strong> </strong>associate professor of endocrinology at University of Pisa, Italy, and colleagues wrote. “In addition, being overweight or obese and [a] smoking habit increased the [CV] risk in acromegalic patients as in the general population.”</p> <div class="mug right"><img width="80" height="106" alt="Fausto Bogazzi" src="https://web.archive.org/web/20160822130119im_/http://m4.wyanokecdn.com/f7e8f540a4dc9521360e22d45afcc94a.jpg"><p class="name"><strong>Fausto Bogazzi</strong></p></div> <p>In a retrospective study, Sardella and colleagues analyzed medical records from 200 <a href="https://web.archive.org/web/20160822130119/http://www.healio.com/endocrinology/neuroendocrinology/news/in-the-journals/%7B0c4ce102-30f7-4762-8f2b-ed5763adc967%7D/targeted-acromegaly-screening-needed-to-improve-outcomes-reduce-complications" id="rId8" target="_new">patients with acromegaly</a> referred to the endocrinology section of the department of clinical and experimental medicine at University of Pisa between 1974 and 2014 (58.5% women). Using Cox regression analysis, researchers evaluated incidents of diabetes, hypertension and major adverse cardiac events. Each patient was included in the analysis of a specific outcome, unless they were affected when acromegaly was diagnosed. Patients were further classified as being in remission after pituitary adenomectomy, controlled by somatostatin analogue therapy or not controlled by somatostatin analogue therapy.</p> <p>At diagnosis, 64 patients (32%) had diabetes 93 patients (46.5%) had hypertension and 17 patients (8.5%) already experienced a CV event.</p> <p>After a diagnosis of acromegaly, diabetes occurred in 40.8% of patients. Researchers found that patients not controlled by somatostatin analogue therapy had a higher risk for diabetes vs. those who underwent adenomectomy (HR = 3.32; <em>P = </em>.006), whereas those well controlled with somatostatin analogue therapy had a 1.4-fold higher risk (<em>P</em> = .38) for diabetes vs. the adenomectomy group.</p> <p>“It has been reported that [somatostatin analogue therapy] can worsen glucose metabolism by inhibiting insulin secretion and may be less effective than pituitary surgery in reducing the risk for death in patients affected by diabetes,” the researchers wrote. “However, it is possible that the relatively small number of patients included in the study affected the power of the analysis.”</p> <p>Researchers found that age (HR = 1.06, <em>P</em> = .01) and BMI (HR = 1.05; <em>P</em> = .01) were <a href="https://web.archive.org/web/20160822130119/http://www.healio.com/endocrinology/diabetes/news/in-the-journals/%7Bfe74bb74-ad83-4de8-b276-207edb58e042%7D/combined-gestational-diabetes-hypertension-increase-risk-for-type-2-diabetes-prediabetes" id="rId9" target="_new">predictors of hypertension</a>, which occurred in 35.5% of patients after acromegaly diagnosis. Age (HR = 1.09; 95% CI, 1.02-1.17) and smoking (HR = 5.95; 95% CI, 1.52-25.26) were predictors of major adverse CV events, which occurred in 11.8% of patients after diagnosis. Therapy for acromegaly did not influence hypertension or major adverse CV events, according to researchers.</p> <p>“Our study pointed out that the control of acromegaly activity is necessary but is not the only target in the whole management of patients with this rare syndrome,” Bogazzi told <em>Endocrine Today. </em>“The cure (and prevention) of systemic complications of acromegaly is the mainstay of the therapeutic strategy and should include prevention of hypertension, diabetes, cessation of smoking and a weight loss program. All those objectives did not differ from those advocated for non-acromegalic patients.” – <em>by Regina Schaffer</em> </p> <p> <strong>Disclosure: </strong>Pfizer S.p.A Italy supported this study through an unrestricted grant. 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control-label">Email</label> <div class="col-md-9"> <input type="text" class="form-control" name="emailaddress" id="emailaddress"> </div> </div> <div class="form-group"> <div class="col-md-5 col-md-offset-3"> <button type="submit" class="btn btn-warning" id="sendpassword">Send</button> <img class="loading" style="display: none;" src="https://web.archive.org/web/20160822130119im_/http://i3.wyanokecdn.com/ajax-loader.gif" alt="Loading..."> </div> </div> <div class="form-group" style="font-weight: bold;"> In order to view this content, you must register below or <a href="#" onclick="showLoginForm();">log in</a>. </div> </div> </div> <div class="modal-footer togclose"> <a class="btn" data-dismiss="modal"><i class="fa fa-times"></i> Close</a> </div> </div>  </div>  </div>  <style>.form-group { overflow: hidden; }</style> <script>$j(document).ready(function() { $j('form').submit(function(ev) { if ($j('#dripmodal').is(':visible')) { ev.preventDefault(); if ($j('#loginform').is(':visible')) { doLogin(); return; } if ($j('#identifyform').is(':visible')) { checkDripReg(); return; } if ($j('#forgotpassword').is(':visible')) { forgotPassword(); return; } } }); $j('#dripmodal').on('hide.bs.modal', function() { $j("#identifyform").show(); $j("#loginform").hide(); $j("#forgotpassword").hide(); $j("#outputmessage").html(""); $j("#outputmessage").hide(); $j("#instructions").show(); $j("#instructions").html("In order to view this content, you must register below or <a href='#' onclick='showLoginForm();'>log in</a>."); $j('#dripmodal .modal-title').html("Please Register"); }); //rules $j('#identifyform') .bootstrapValidator({ feedbackIcons: { valid: null, invalid: null, validating: null }, fields: { firstname: { validators: { notEmpty: { message: 'Your first name is required' } } }, lastname: { validators: { notEmpty: { message: 'Your last name is required' } } }, email: { validators: { notEmpty: { message: 'Your email address is required' }, emailAddress: { message: 'Your email address is in an invalid format' } } } } }).on('success.field.bv', function(e, data) { var $parent = data.element.parents('.form-group'); $parent.removeClass('has-success'); $parent.find('.form-control-feedback[data-bv-icon-for="' + data.field + '"]').hide(); });; $j("#dripcheck").click(function(e) { e.preventDefault(); checkDripReg(); }); $j("#dologin").click(function(e) { e.preventDefault(); doLogin(); }); $j("#sendpassword").click(function(e) { e.preventDefault(); forgotPassword(); }); function checkDripReg() { var email = $j('#email').val(); var firstname = $j('#firstname').val(); var lastname = $j('#lastname').val(); if (!email || !firstname || !lastname) { $j("#outputmessage").show(); $j("#outputmessage").html("Please fill out all fields before continuing.<br/>"); return; } var jData = { "email": email, "fname": firstname, "lname": lastname, "source" : "Drip Registration" }; $j(".loading").show(); $j.ajax({ type: "POST", url: "/registrationapp/json/checkemailwithshortregacc", data: JSON.stringify(jData), contentType: "application/json; charset=utf-8", success: function(msg) { var response = JSON.stringify(msg); var obj = $j.parseJSON(response); //$j("#outputmessage").text(response); if (obj.CheckEmailWithShortRegAccResult.AccountPreviouslyExist == true && obj.CheckEmailWithShortRegAccResult.EmailExist == false) { if (window.ga) { ga('send', 'event', 'Drip Registration', 'X Click Registration', 'Prompt Login', 0, { 'nonInteraction': true }); } $j("#identifyform").hide(); $j('#dripmodal .modal-title').html("Please Login"); $j("#username").val(email); $j("#instructions").html('You already have an account with Healio.com. Please log in.'); $j("#instructions").show(); $j("#outputmessage").hide(); $j("#outputmessage").html(''); $j('#loginform').show(); $j('.loading').hide(); return; } else { //invalid email domain if (obj.CheckEmailWithShortRegAccResult.InvalidEmail == true) { $j("#outputmessage").show(); $j("#outputmessage").html('' + obj.CheckEmailWithShortRegAccResult.Message + ''); $j('#email').focus(); $j('.loading').hide(); return; } if (clickedLink != null && clickedLink != '') { // setting the cookie for those who came through the drip registration so they will able to step through all but post test step of activity (gamification) setCookie("edlabcmedripreg", obj.CheckEmailWithShortRegAccResult.UserId, 1); //$j('#dripmodal').modal('hide'); $j("#outputmessage").hide(); $j("#outputmessage").html(''); window.location.assign(clickedLink); return; } if (window.ga) { ga('send', 'event', 'Drip Registration', 'X Click Registration', 'Completed Short Registration', 1, { 'nonInteraction': true }); } var location = "/footer/account-information/create-new-user" + obj.CheckEmailWithShortRegAccResult.Message + "&returnurl=" + window.location.pathname; window.location.assign(location); return; } }, error: function(jqXHR, textStatus, errorThrown) { //alert(textStatus + ": please make sure you fill in all fields."); $j('.loading').hide(); }, complete: function() { //$j("#outputmessage").html(""); //$j('.loading').hide(); } }); } function doLogin() { var username = $j("#username").val(); var password = $j("#password").val(); if (!username || !password) { $j("#outputmessage").show(); $j("#outputmessage").html("Please fill out all fields before continuing.<br/>"); return; } $j(".loading").show(); var jData = {}; jData.email = username; jData.password = password; $j.ajax({ type: "POST", url: "/registrationapp/json/login", data: JSON.stringify(jData), contentType: "application/json; charset=utf-8", dataType: "json", success: function(msg) { var response = JSON.stringify(msg); var obj = $j.parseJSON(response); if (obj.LoginResult.Message == "Login Successful") { if (window.ga) { ga('send', 'event', 'Drip Registration', 'X Click Registration', 'Successful Login', 1, { 'nonInteraction': true }); } //$j("#outputmessage").html("<p>Welcome back. You may continue</p>"); // "Gourmand" cookies need to be set setCookie("edlabcmedriplogin", obj.LoginResult.UserId, ""); if (clickedLink != '') { window.location.assign(clickedLink); return; } else { location.reload(true); return; } //$j('#dripmodal').modal('hide'); } else { $j("#outputmessage").show(); $j("#outputmessage").html(obj.LoginResult.Message); $j('.loading').hide(); } }, error: function(jqXHR, textStatus, errorThrown) { alert(textStatus + ": please make sure you fill in all fields."); $j('.loading').hide(); }, complete: function() { //$j('.loading').hide(); } }); }; function forgotPassword() { var emailaddress = $j("#emailaddress").val(); if (!emailaddress) { $j("#outputmessage").show(); $j("#outputmessage").html("Please fill out all fields before continuing.<br/>"); return; } $j(".loading").show(); var jData = {}; jData.email = emailaddress; jData.website = "Healio"; jData.itemId = "{9FFB2568-23D5-47DA-85C9-C55E1EC8F4FF}"; jData.returnurl = window.location.pathname; $j.ajax({ type: "POST", url: "/registrationapp/json/forgetpassword", data: JSON.stringify(jData), contentType: "application/json; charset=utf-8", dataType: "json", success: function(msg) { var response = JSON.stringify(msg); var obj = $j.parseJSON(response); if (obj.ForgetPasswordResult.EmailSent) { $j("#outputmessage").show(); $j("#instructions").hide(); $j("#outputmessage").html("An email has been sent to the email address provided. Please follow the instructions on how to reset your password."); $j("#forgotpassword").hide(); $j("#loginform").show(); $j("#password").val(""); $j('#dripmodal .modal-title').html("Please Login"); $j("#username").val(emailaddress); } else { $j("#outputmessage").show(); $j("#outputmessage").html(obj.ForgetPasswordResult.Message); } }, error: function(jqXHR, textStatus, errorThrown) { //alert(textStatus + ": please make sure you fill in all fields."); }, complete: function() { $j('.loading').hide(); } }); } }); function showLoginForm() { $j("#identifyform").hide(); $j('#dripmodal .modal-title').html("Please Login"); $j("#outputmessage").html(""); $j('#forgotpassword').hide(); //$j("#instructions").hide(); $j("#instructions").html("You already have an account with Healio.com. Please log in."); $j("#outputmessage").hide(); $j("#username").val($j("#email").val()); $j('#loginform').show(); } function showForgotPasswordForm() { $j('#loginform').hide(); $j('#forgotpassword').show(); $j("#instructions").show(); $j("#instructions").html("Enter your email address and we will send you a link to reset your password."); $j("#outputmessage").hide(); $j("#emailaddress").val($j("#username").val()); $j('#dripmodal .modal-title').html("Forgot Password"); } function showDripRegModal(href) { clickedLink = href; $j('#dripmodal').modal('show'); } function lockScreen() { //hide close buttons $j(".togclose").hide(); //disable background click dismiss $j('#dripmodal').modal({ backdrop: 'static', keyboard: false }); //disable scroll $j('html, body').css({ 'overflow': 'hidden', 'height': '100%' }); } $j("input[type='text'], input[type='password']").keypress(function (e) { if (e.keyCode == 13) { var thisid = this.id; if (thisid == 'username' || thisid == 'password') { $j('#dologin').trigger('click'); 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