CINXE.COM

<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIzMiIgaGVpZ2h0PSIzMiIgZmlsbD0ibm9uZSI+PHBhdGggZmlsbD0iI0IyMEYwMyIgZD0iTTE2IDNhMTMgMTMgMCAxIDAgMTMgMTNBMTMuMDE1IDEzLjAxNSAwIDAgMCAxNiAzbTAgMjRhMTEgMTEgMCAxIDEgMTEtMTEgMTEuMDEgMTEuMDEgMCAwIDEtMTEgMTEiLz48cGF0aCBmaWxsPSIjQjIwRjAzIiBkPSJNMTcuMDM4IDE4LjYxNUgxNC44N0wxNC41NjMgOS41aDIuNzgzem0tMS4wODQgMS40MjdxLjY2IDAgMS4wNTcuMzg4LjQwNy4zODkuNDA3Ljk5NCAwIC41OTYtLjQwNy45ODQtLjM5Ny4zOS0xLjA1Ny4zODktLjY1IDAtMS4wNTYtLjM4OS0uMzk4LS4zODktLjM5OC0uOTg0IDAtLjU5Ny4zOTgtLjk4NS40MDYtLjM5NyAxLjA1Ni0uMzk3Ii8+PC9zdmc+);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "jamanetwork.com",cType: 'managed',cRay: '929adb83fb18cdd5',cH: 'KB0D_OkN088zTBs..cWBwBIgPWMISeh8anuE3GEjMBk-1743539564-1.2.1.1-XReFgb929oXtegWxDzg0aB9p6Rt6fB9r9Mhs2HAew3.kOu2CjLH1Xw8kL6IXuDWB',cUPMDTk: "\/channels\/war?__cf_chl_tk=xgKSnfqOLYCj_HjcvIy5sHCzuzCVT1V93kGUnCHUMCE-1743539564-1.0.1.1-sFspthKWWMn7fn7kcdjupzQ5UTEeGG7hSnV2bAs0UjA",cFPWv: 'b',cITimeS: '1743539564',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/channels\/war?__cf_chl_f_tk=xgKSnfqOLYCj_HjcvIy5sHCzuzCVT1V93kGUnCHUMCE-1743539564-1.0.1.1-sFspthKWWMn7fn7kcdjupzQ5UTEeGG7hSnV2bAs0UjA",md: "QNm8A.rbLvTiRIORtdvVqlnXmUnWmSN73lNaane5EI0-1743539564-1.2.1.1-TGrFZ4vqpR6N3OdMk4OsW.xV3JX6H_jYmHfOyr0rlF_.5A1tRya7pdnuLScFiPzupr8tHlSOWHUqzg6eMok9FdwJPTarDr5IW3UFAM1vXNst.Oc3BsxsTvKv713U2ZQ6R_dakxIKObfp6gIDWElmfD2wknqX42HERKENgR2uldWap0xRPiYDHnuDhZMkbsHUZSTA3v.5OkTD7zTyGfpmeanV4A_xkjQ9xF9935xosZS8UTDaHZOjM13RbX9587I3xfahA65n8xVo0eSefSAOE27Q.MkjZ_Me5mw9pSfVd83rKx.2hvRh3kYPNBjC7gggQV2SLQINnL8K9MWoLVOpWZQPoXOUzhLFMI4soRgL9NuYOTx8xodrfaxGSqW3CMZqBIJYihnhF44EoofV.8cO31vLYVo84CA2_TMi_1aU5pxxaABaoehxF8gtLLqfv4Z9eJWA2z_yebwgJq8fhysQNND784.qUNB6AI7kyLB._4_SNqi7vkAqsx2X8gDbU2esHddUmgHLpwWmOMX1Zj8fb0WRHJn16G_TQqqnd8mVx7SJ2nmk8iXy1q2cujwErZQFTfrB9cZD8h30NxSm.eOr5maNjg10eWYizbKea8ZIUJk24AWa_qMLYOPvEy.kgwZL4LxkWl59I7Z8Gi8ewrCHYgVL1RNOV4_jMnZSErM3OAZRhYLdZ.KuuGr5MKXQeplUMYVPSf6a1mQpb8QdSyLw0oCVSvicS4ZR6iGY56oKkPC9zeOSTmLz_DjBGDDEFunYEPeH2DQl50B3frDGglB7fg57oQDRHOS0A2Is.pDpsT79vtqnNR1DhY8Cn94L2sw_pu_CCKjDpmTUZd4VUD.EcwLSa47c6zHZ_tQgsuYSOA_CauNCcw002Usjr_7R.Bz.JC2gnoCK.9cbTkSB6BUWUTg.TBgPL4iKqhVLZkw74_jGrAuC3yCsZE8Pu16cma4f6v2eYEwW5PoXKFaL6eyX9DFCvQq0EU6LNsSnWyQJXuYYEHtN2KA3z2UqhjMO.0aAJEmmnWYYno8Vs0KGxPUK6R0LJKDhxjYbtuE9Mgf50.gDcmIHPdKUkKthFQo61n2XzsuTFlCdjlHmnMahtKAgOvicMUZ0UTOCk7WoZC3TsheECZEC058huQrmjywzUP5kDKa54cEi1Zi3qzfrt586uf_OxmgTwuweQSU_WwdYeVmF4bgDivJmy0ONoXeBS.xUoGZ2o7oX_2P88vDQ515MjrzLnLNtuZfLTN9j4S62jYo",mdrd: "RKFuW5ZI8xmWtef8PrSkzVP4PCojFRuGFe1Oj6pD.EQ-1743539564-1.2.1.1-mLgUU6IB0xdRqimazHtA09verRJRa64Vses7gJryYJyWXCL5.q_4U.so4QopC6.VSuolY7XSXyBDIomJf5DNfOBKLR2pPMzob4J8b6D7BF3dHQhpE9hIabRDUvCkGCL59klU41QbMdJX6HuHjbAaNUstRSc0AP3V7KSevHMUoJ_ZTsItxCYs_l.IGWxqqNliFim0TCVMANv7PqbKuKLMnTI4pnNHvc2pXKd2RUrknY2faBMyfg1_hfneBDOsyeSlKryNZNNAw7kJj2S2d2RB4Nrjpalt06giNFIgNWIGSyTRBHkFgH2wVkbb5PxHhqJL7kc53S_c6Qv3agThmPkrkRozJ2cwmHsU7dCyWCZpoIXEMszjmPYFIrF731wD2YbqWGlExsyMZd00V8j.JCamY3ya_mhgrLABERqUHPLFHuOZjgsDx86aCE.kxfpqnOuxXfpdBtXZ3xpLLax5dYtq9iwPMkprSwfjK0qqtjd42DnscUyVJCe4TouSiR5My8izj_zR_hEhPil1vX3fCWiEVVBZTjRfSq8KUaaWqbtjI.ZKhk45ue_67sMkIdq5T7VwD4NOxThhwhD0fIMxpHkhGethXo0n8cU4x.zuiQl09weiRV0867wNMU.ENDUP__CwggYJ8moqIzO8eTNmOZ_fTHFwgI1kbvI8wV7K1sv.VcpB1V1eBEdIo2qJTXhEpU86jH25ky2wskI.zJ8gDsI9_WCJCOklhjxCd0BaZIFJ0iXVR6Atli4H9kBmhZkNifKUkcXqluCkx8IORIVOPNnom9Lt7NNCIkJ5jhSa1h5e7Cf.skylE7aizjb5bAb17J6565_8NyA0M4ultKylP1cdKDS_fVT8HYEGMta9qA.Jdnds9Euov..s1XV10svZKH8TdQhLcR0OfWysTq91pEb6aV9VXJpw7ht_rNmP0IQIpl5Q0ce8qxZPQrLRtvq7ORWn6JMZktv5BzlW0ojImNgleK8xj3YD3FpQD1VB5zZtWXvdyoBs90FL62kzaWHIbQkcWeHZnAd1KCTjICTiCYDhuNMxs.eF069KV0.6pqWVZ4SupFmtmcjIDRGpoYkACH4_eAIW04rKA2nkMCunIat4vNQ2zsUTfs8cmIlZqF4Td27N.z8Wgeb87IYWeijVCK6R5meRHCZU3m6ryAuQPsg.VDuGj_NukYZR.UE8ZhQ5PR80LFwBuVLMGehipE7dIPm7UBOoOTDaD5lPR_TuSvkEaXvVipkP73B4AEcngIOeySzcwfOvHDAreGTbW6h6fagA4t0JKMiKbcSYGW9WDQE84SFG_xmz_t_Ai7BCZi_z_V1WXlg8K.gzrg7gH6OkgCpvjP2Pw2RrdQEy9kXmT6TZ_dDNNfkw9mQfYCcRLCRF8u_2OqTtTEO_wTmzYqQBvWwkBrVSy4rUWzvdtLvZOr8V3pVWSqQs5jo.No.yN9A97IEmMDgu5EHbt9nxO.zje78QIqDwAq8KWhaoUi5Ng1IFIRDSG6ZYo4T9eqXpVQ48ifrFISLGEMrB5STBr3VI3EanVa6u0YQhJMqab6pqXWWsbRai1kmgEwHODvVfz7hQlvotBvsr9KudSow4x4yBvJ99UO0lh4tYVUNWswTQ7YqrebxMWAzuknAT.0W39hwfhLRB0reU9Xx18rm2U6oqwsim6BAK_dQ05pSijDMPYRHR3FJ.yinZ9YZpP0f0WQNGu2Y_aHpUFb1bSjSaZonruGci5MdiP2jg0VMZo_Y3PK0pkqqRlCIA7qLbZQjNHGa7S9AaeXLLtZ5gDkzTlTOQJ3IPIZbk.FsZDxY0.lTXR51CirjhZPBRghxLALtQG99viCTlxu6BvrZGUEM88RSh4Fk9cVrmHqi5AsCra57sAfKjh2qDvvjG3T3tP13b68s0FIayYq1YKmm_ML5cfyYPtQLv5ePj_RxemlV6zpNIBdanEXpEkHut9dUmr_RRuqAWmTt8nRECiwrx8h.yhgfr89Yhj9QUZRs31jwiSL6KqnjhQylQgz2rMbGzJoJeXyFAWRc6A8JqV2JAPAwEhJONHOlx"};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/b/orchestrate/chl_page/v1?ray=929adb83fb18cdd5';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/channels\/war?__cf_chl_rt_tk=xgKSnfqOLYCj_HjcvIy5sHCzuzCVT1V93kGUnCHUMCE-1743539564-1.0.1.1-sFspthKWWMn7fn7kcdjupzQ5UTEeGG7hSnV2bAs0UjA" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>