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‹#› ------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/master05.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/master02.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252"
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------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Palliative Care - Nathalie Steiner Collet
Palliative Care
Dr. N= athalie Steiner Collet, Geneva
Training in Reproductive Health Research
Geneva 2006
Geneva Foundation for Medical Education and Research
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Palliative care: WHO definition
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Palliative care
=
=
=
n «…is an approach that improves the qu= ality of life of patie= nts and their families facing the problems associated with life-threatening illness, through = the = prevention of suffering by means of e= arly identification and impeccable assessm= ent and = treatment of pain and other problems, physical, psycho= social and spiritual »
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Palliative care: core principles (1)
=
=
=
nProvides relief from pain and other symptoms
nAffirms life, and regards dying as a = normal process
nIntends neither to hasten nor to post= pone death
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Palliative care: core principles (2)
=
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nIntegrates psychosocial and spiritual= aspects of patient care<= br>
nOffers a support system to help patie= nts live as actively as possible until death
nOffers a support system to help the f= amily cope during the patient’s illness and their own bereavement
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Palliative care: core principles (3)
=
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nUses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated=
nWill enhance quality of life, and may also positively influence the course of illness<= /span>
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Palliative care: core principles (4)
=
=
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nIs applicable early in the course of illness, in = conjunction with a range of other the= rapies that are inten= ded to prolong life, such as chemotherapy, radiation therapy, and includes those investigatio= ns <= span lang=3DEN-US style=3D'font-size:75%'>needed to better understand and manage distressing complications
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Palliative care
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nPerson oriented (not disease oriented)
 = ;
nNot primarily concerned with life prolongation (or shortening)
nHolistic
 = ;
nMultidisciplinary
nDefinition does not mention the place of care
 = ;
n« There is always something that can be done to improve quality of life remaining to the patient »
Palliative care in= the developing world. IAHPC 2004
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Principles of palliative care
nAttitude to care:
carin= g, commitment, consideration of individuality, culture, consent, choice of site of care
nCommunication:
Amon= gst healthcare professionals, with patients and families
 = ;
nThe care:
Clinical context: appropriate, comprehensive and multidisciplinary, care excellence, consistent, coordinated, continuity, caregiver support, continued reassessment
Palliative care in the developin= g world. IAHPC 2004
<= /span>
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Communication with patients
nBasic rules
Inter= view in person, privacy, sit down,
enough time, with= family member or friend
 = ;
nProviding information
Medi= cal situation, what treatment can be offered, possible = benefits+ burden, avoid precise prognostication, as much/little information as wanted
nInformation conveyed
In a= caring and sympathetic way, understandable, clear, truthful, in a positive manner, use independent interpreters
Palliative care in the developin= g world. IAHPC 2004
<= /span>
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Palliative care:  when?
nPalliative care spans the period from= the diagnosis of advanced disease until the end of bereavement;  this may vary from years to weeks or (rarely) days.  It is not synonymous with terminal care, but encompasses it.
n<= span lang=3DEN-US style=3D'font-size:75%;display:none'>
n =
n
n
n =
n COUNCIL OF EUROPE Recommenda= tion Rec(2003)24 of the Committee of Ministers to member states on the organisation of palliative care and explanatory memorandum.   www.coe.int
Potentially from diagnosis until bereavement
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Traditional view of palliative care:

Sympt= omatic and supportive PC is withheld until all avenues of treatment for underlying disease are exhausted and the treatment of other medical problems considered inappropriate
<= /span>
Treatment of the underlying disease
Active treatment of medical problems
Diagnosis of symptomatic incurable illness Death
Palliative =
&#= 13;
Care=
Palliative care in the developing world. IAHPC 2004<= /span>
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Modern view of palliative care:
 Symptomatic and supportive PC is complementary to, and seamlessly
integrated with, active treatment of the underlying disease
Treatment of un= derlying disease
Cancer: anticancer treatment
AINDS: antiviral therapy <= /div>
Active medical treatment
Cancer: hypercalcemia, fractures, GI obstruction
AIDS: opportunistic infections, malignancies
Symptomatic and supportive palliative care
Pain and physical symptoms, and psychological,
social, cultural and spiritual/existential problems <= /span>
Diagnosis of symptomatic incu= rable illness Death
<= /span>
Palliative care in= the developing world. IAHPC 2004
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Increasing palliative care needs
nGlobal cancer rates:
May = increase by 50%; from 10 to 15 Mo new cases worldwide between 2000 and 2020:
 = ;n - 1/3 could be prevented,
 - 1/3 cured
 - 1/3 treated with quality inexpensive PC
 = ;nAI= DS projections, 53 most affected countries:
Exce= ss mortality due to HIV might increase from 53 to 178 Mo between the current decade and 2000 mid-century
Palliative care in the developin= g world. IAHPC 2004
<= /span>
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Increasing palliative care needs
nAgeing population:

By 20= 25: estimated 135 Mo >79 yrs old

Of th= ose, 80 Mo in the developing world
n
n Increase in chronic degenerative disorders, disabilities, dementia, malignancies needing pallia= tive care
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Insufficient access to palliative care
n50% of world’s new cancer cases and d= eaths occur in deve= loping nations, already 80% already incurable at the time of diagnosis
 nAdequ= ate palliative care is still unavailable to 80-90% patients in those countries
n =
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Access to palliative care
nInequitable and insufficient in spite= of existing knowledge
 nThe development of palliative care through effective and = low cost approaches represents a prio= rity in order to resp= ond to the urgent needs of the sick and improve their quality of life
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Symptom management
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Symptom prevalence in advanced cancer= = patients
n275 consecutive advanced cancer patients
= _________________________________________________
S= ymptom     Prevalence 95% confidence interval
= _________________________________________________Asthenia 90 81-100
Anorexia 85 78-92
n Pain 76 62-85
Nausea 68 61-75
Constipation 65 40-80
Sedation-confusi= on 60 40-75
Dys= pnea 12 8-16
Bruera. Oxford = Textbook of Pall Med 1998
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Definition of pain
n «Pain is an unpleasant sensory and emotional e= xperience associated with actual and potential= tissue damage or described in terms of such = damage ».
n Pain is always subjective<= /u>.
= 3;
n IASP (International Association for the Study of Pain)
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1. Production/construct <= /span>
2. Perception <= /span>
3. Expression <= /span>
Modulation
Cognitive status
Mood
Beliefs
Cultural issues

Biography <= /span>
Treatment
1. Production / construct <= /span>
2. Perception
3. Expression
Bruera Cancer T= reat Rev 1996;22(supp A):3-12
Schema of symptom construct
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Principles of pain management (1)
nAdequate and constant evaluation:<= br>
1. C= ause (cancer, cancer treatment, not related to cancer)

2. I= ntensity (visual analogue scale, numerical, verbal, etc)

3. Alcoholism/drugs (CAGE questionnaire, etc)

4. Psychosocial distress (somatization)

5. C= ognitive function (MMSE, etc)

6. M= echanism (neuropathic, nociceptive, etc)

7. N= ature (continuous, incidental)

8. Other related = symptoms (ESAS, etc)
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Assessment of pain intensity
nVisual analog scale:
No pain
Worst
possible pain
0   1    2    3    4    5    6    7    8    9    10
n Numerical scale:
No pain = ;
<= /span>
Worst possible pain
n Categorical scale= :
No Week Moderate Severe  Very severe Extreme
pain pai= n pain pain      p= ain pain
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= Ed= monton symptom assessment
No pain
Worst possible pain
No fatigue
Worst possible fatigue <= /div>
No nausea
Worst possible nausea=
No depression
 Worst possible depression <= /div>
No anxiety
 Worst possible anxiety
No drowsiness
Worst possible drowsiness <= /div>
Excellent appetite
Best sensation of well-being=
No shortness of breath <= /div>
No appetite
    Worst sensation of well-being
 Worst possible shortness = of breath <= /div>
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=
=

No pain

No fatigue
<= /span>
No nausea
No depression
No anxiety
No drowsiness

Excellent appetite
No shortness
of breath
Best sensation
of well-being
nWorst possible
pain
n
nWorst possible
nfatigue
n
nWorst possible nausea
n
nWorst possible depression<= br>
nWorst possible anxiety
n
Worst possible drowsiness
n
nNo appetite
n
nWorst possible shortness = of breath&#= 13;
n
nWorst possible sensation = of well-bei= ng
Edmonton Symptom Assessment System <= /div>
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=    Types of pain<= /div>
=
Noci= ceptive pain
Activation of nociceptors in the different tissues/organs =
by tissue damage
 
Somatic pain
Well localised
 Visceral pain&#= 13;
 Poorly localised, = deep, dull, cram= ping, referred
Modified from Mazzocato, Sylvana 02
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------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/slide0045.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Palliative Care - Nathalie Steiner Collet
=
nNeuropathic pain <= /div>
nPeripheral or central alteration of = nerve conduction <= /span>
n
nDysesthesias: burning sensation, num= bness, tin= gling, as well as sharp and shooting, paroxystic exacerbations =
n
nAssociated with a sensory deficit, <= /span>hyperesthesia, allodyni= a; in the region innervated by the affected nerve structure (dermatoma, radicular distribution, etc.)
=    Types of pain<= /div>
Modified from Mazzocato, Sylvana 02
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Principles of pain management (2)
nGeneral measures:
<= br> - Communication, environment
nTreat the cause (when possible and reasonable)
nTreat the symptoms:

- pharmacologically systemic analgesics (WHO guidelines)

- lo= cal measures: eg; cold, heat, position, local application of
  anaesthetics or opioids in painful ulcerations

- inv= asive treatments: injection of trigger zones, blocks (eg coeliac
  plexus in painful pancreatic cancer if specialist
  available and simple analgesics fail)<= br>
nHolistic care, considering patient as family as the unit of care
------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/slide0019.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Palliative Care - Nathalie Steiner Collet
Symptomatic pain medication
By the clock= 3;
By the mouth= 3;
n =
By = the ladder
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Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/slide0020.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Palliative Care - Nathalie Steiner Collet
WHO analgesic ladder
Reference: oral morphine= 3;
Hydromorphone methadone, fentanyl,
+/- non-opioïds
+/- adjuvants
Codeine, tramadol
+/- non-opioïds
+/- adjuvants
Non-opioïd:
Paracetamol, AINS
+/- adjuvants
WHO, in collaboration with IA= SP 1999= 3;
Step 3= 3;
Step 2= 3;
Step 1= 3;
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Step 2: Codein
nBiotransformation into morphine by Cy= t. P450.
n Iso-enzyme absent in 7-10% Caucasians. In those cases, codein will probably be poorly effective
n Dose: 30-60 mg/4h
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Step 2: Tramadol
<= span style=3D'font-size:63%'>nW= eak Opioïd + noradrenergic effect (noradrenalin and serotonin)
<= span style=3D'position:absolute;top:0%;left:4.14%;width:95.85%;height:57.57%'><= span style=3D'font-size:63%'>nK= idney elimination
= nD= oses:
init= ially: 50 mg/6-8h and 15-20 mg breakthrough
(ana= lgesic effect: 3-7h with chronic administration)
maxi= mal studied dose: 400 mg/d.  In the el= derly > 75 yrs: 300 mg
 = ;
<= span style=3D'font-size:63%'>nF= requent side effects:
nau= sea/vomiting, dizziness, sweating, dry mouth, constipation
risk of convulsi= ons
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Step 2: Tramadol
nPotentially dangerous drug interactio= ns, particularly with antidepressants: SSRIs, tricyclics, IMAO:

serot= oninergic syndrome


 Sc= haad, Med et Hyg 2001;2346
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Serotoninergic syndrome
Sweats
Hyperthermia
Hyperreflexia
Other
Confusion
Dyso= rientation
Psychiatric
Tachycardia
Hypo/hypertension
Card= iovascular collapsus
Cardiovascular
Headaches
Dysarthria
Incoordination
Myoclonia
Neurological
Cramps
Diarrhea
Gastro-intestinal
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Step 3: initiation of treatment
nMorphine is the narcotic of first = choice, since
= it is the most cost-effective

Give explanation= s to the patient, patient and family education
n =
<= span style=3D'font-size:63%'>nS= tart with a short acting substance; oral morphine

= A. Opioid naive patient:
5 mg/4h
Bre= akthrough, if pain in between regular dosis:  4-hourly dose, to be repeated if needed up to every hour. Monitor treat= ment response (an= algesic as well as possible adverse effects)

= B. Patient previously treated with another opioid (ex.: step2):
Sta= rt at least by the equianalgesic dose!
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Step 3: dose titration
nA/ Increases by approx. 30%
n Regular doses + breakthroughs taken in 24h
nB/ ____________________________________=3D new 4 hourly dose
n 6

n Adjust breakthrough doses (4 hourly dose)
n
n Reassess if need for more than 3 breakthroughs/day
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Step 3:
when = stable and well controlled pain
nSwitch to a slow-release form if nece= ssary: eg MSContin
24h dose slow-rele= ase form=3D 24h dose short acting form
Slow = release morphine tablets: q 12h
 =
nPrescribe breakthrough doses (in shor= t acting form):
Equiv= alent to the 4 hourly dose, q 1h
 =
nReassess at regular intervals
Adapt doses by app= rox. 30%
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Another interesting opioid: methadone!
nVery cheep
 nProba= bly more effective in neuropathic pain
 nTo be= used by experienced professionals only:
parti= cular pharmacological characteristics (long half-life:   
1 to = > 60 hrs, important interindividual variability, pharmacological interactions)<= /span>
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Some other opioids
nFentanyl: Ex Transdermal Duragesic= :
<= br> Pure= µ agonist, 100x mor= e potent than morphine
Only= for stable pain, previous titration with short acting  opioid
Main= ly liver metabolism
Very expensive!
nBuprenorphine:
<= br> Part= ial agonist, ceiling effect
Do n= ot associate it with other opioids
Liver metabolism, no accumulation in renal failure
nMeperidine/pethidine:
<= br> Cont= raindicated for chronic use
Neur= otoxic: risk of myoclonus and seizures
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Opioids: feared effects
<= span style=3D'font-size:69%'>n<= b>Addiction:
=
Alm= ost never in a well managed pain treatment
n<= b>Physical dependence:

Means withdrawal when medication abruptly stopped of in the case of administration of an antagoni= st
= n<= b>Tolerance:
=
Nee= d to increase doses in order to maintain the same effect
Very rarely a= problem in clinical practice
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Opioid side effects
Hydrate. If possible change opioid. Rule out aggravating factors. Treat symptoms (ex haloperidol)
Particularly if renal failure.
Myoc= lonus, delirium,
hype= ralgesia/allodynia,
hall= ucinations
Neurotoxicity
Assess. If major, decrease dose. Rule out aggravating factors
Often mild during 1st days of treatment
Drowsiness
Metoclopramide or haloperidol
Approx. 30% patients 1st week
Nausea-vomiting
Systematic prevention and treatment
Stim= ulant and osmotic laxatives
No tolerance
Constipation
Treatment
Characteristics
Type of effect
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Adjuvant analgesics
Flue-like symptoms, beware renal failure. Expensive
Metastatic bone pain and decreased « bone events »
Bisphosphonates
Ex: Pamidronate, Zoledronate, Clodronate
Beware side effects and interactions
Neuropathic pain
Antidepressants
Ex: amitryptiline=
Beware side effects
Neuropathic pain
Anticonvulsants
Ex: Gabapentin
Intestinal or urinary muscle spams
Spasmolytics
(Bus= copan)
Beware side effects, especially long term.
Decr= ease to minimal effective dose
Intracranial hypertension, epidural spinal cord compression, distension of liver capsule
Corticosteroids:
Ex: dexamethasone
Beware side effects, eg renal failure and opioid toxicity
Bone pain, inflammatory process
NSAIDS
Precautions
Indications
Type of drugs
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Efficacy of cancer pain management
nWHO step ladder is said to be able to successfully manage pain in approximately 80-90% of patients
 nDespi= te available knowledge and drugs, studies show that 38-74% cancer patients suffer fr= om unrelieved pain

Davi= s MP, Walsh D. Am J Hospice and Palliative Care 2004
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n
n
n
n
n
n
n
n
n
n
n                                 Cicely Saunders - WHO - 1990
Total pain
Physical
pain
Moral
pain
Spiritual
pain
Social
pain
Care of the whole person
Ne= ed for competence and empathy
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Barriers to pain management
nInadequate assessment of pain
nInadequate knowledge about pain an its treatment
nConcerns about possible side effects = of pain medications
nPatients’ and physicians’ attitudes, = fears and misconceptions about pain and opioids
nMisinformation about opioid tolerance= and dependence issues
nPoorly accessible or unavailable pain management services
nImproper and misguided regulation by governing agencies
Palliative care in the developing world. IAHPC 2004<= /span>
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Guiding principles for service pl= anning
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Care for incurable patients:
levels of care needed
n1.= Palli= ative approach
n2. Specialist palliative       inter= ventions
n3. Specialist palliative   care teams
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Levels of care needed
=
=
n1. <= span lang=3DEN-US style=3D'mso-hansi-font-family:Arial;font-size:75%'>Pallia= tive approach
n Possible by all healthcare professionals, provided = appropria= te training, drug availability and recognition

*  Central role of = GP and nurse providing home visits

*  Importance of ca= re provided by family and friends, who need to be empower= ed as effective caregivers
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Levels of care needed
n2. Specialist palliative interventions
nProvided by different specialists:

* Oncologists. Ex: chemo-hormone therapy for sensitive
   tumors

* Radio-oncologists. Ex: irradiation of bone mets, epidural
   spinal cord compression

* Surgeons. Ex stabilisation of an impending fracture

* Anesthesiologists. Ex: nerve blocks, coeliac plexus block=
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Levels of care needed
n3. Specialist palliative care teams
 nSpecially trained teams in:

* Inpatient hospices

* Consult hospice or palliative care home care teams

* Hospital palliative care consult teams

Complex patient and family situations, support for the healthca= re professionals, teaching and research
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Levels of care needed
n = Each of = those levels
must learn to work
in close
communication
and
coordination
n with eachother
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Homecare
Elderly
homes&= #13;
 Ambulatory 
Palliative
care
hospice
Hospital
Other
health
structures
CONTINUOUS
CARE<= b>
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Foundation measures:
little cost, big effect (Stjernswärd J. JPSM 2002;24(2)259)
Education
-Public, professionals
- Undergraduate education
 for doctors= and nurses
- Postgraduate training
- Advocacy (policy makers,
administrators, drug
regulators)
= Drug availability
- Changes in legislation to improve
availability especially of cost effective
opioids
such as morphine sulfate tablets
- Prescribing made easier
and distribution, dispensing
and administration improved
 
= Governmental policy
- National policy emphasizing the need to alleviate unneces= sary pain and
suffering of the chronically and terminally ill
- Governmental policy integrating PC into the healthcare system
- Separate systems of care are neither necessary nor desira= ble
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HEALTH POLICY
Potential access-
structural indicators= 3;
Potential access-
process indicators:
Characteristics of population
at risk
= 3;
Realized access-subjective
indicators:
= Consumer satisfaction
Realized access-objective
indicators= 3;
BOTTOM DOWN
PC developed, implemented and
provided as a result of Policy <= /span>
BOTTOM UP
Policy is created by influence
and demand at the grass root level
Mechanisms of entry
Mechanisms of entry
=
Palliative care in= the developing world. IAHPC 2004
Access to palliat= ive care model
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<= /span>
Palliative care: importance of re= search and audit
------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/slide0168.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252" Palliative Care - Nathalie Steiner Collet
Importance of networks and partnerships
nShare knowledge, ideas and practices
 = ;nThrou= gh creative and systematic efforts, collect informations and evaluate the most promising approaches
 = ;nAdd visibility to palliative care
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Palliative care:
useful international organisations
nInternational Association for Hospice= and Palliative Care
www.hospicecare.com
nWHO Programme on Cancer Control
nEAPC (European Association for Pallia= tive Care)
www.eapcnet.org and www.eapca= re.org
nHospice Information Service St Christ= opher’s Hospice Londo= n
www.hospiceinformation.co.uk=
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Palliative care: some references
nOxford Textbook of Palliative Medicine 2005
nPalliative Care in the developing wor= ld: principles and practice. IAHPC Press 2004
nWHO guidelines on Cancer pain, opioid availability, symptom control and palliative care
nRipamonti et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer 2001;9:223-233
nEdmonton Regional Pallative Care Prog= ram: www.palliative.org
n    (useful contents about: clinical wor= k, educational opportunities, informations for general public, links, research a= nd literature)
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L= a notion de douleur totale a été développée par C. Saunders
  
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return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId() { return sId=3Dlocation.href.substring(location.href.la= stIndexOf('/')+1) } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } }function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { =09 if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D58, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(= "slide0106.htm",1,-1,1),new hrefList("slide0107.htm",1,-1,1),new hrefList("= slide0108.htm",1,-1,1),new hrefList("slide0109.htm",1,-1,1),new hrefList("s= lide0110.htm",1,-1,1),new hrefList("slide0111.htm",1,-1,1),new hrefList("sl= ide0093.htm",1,-1,1),new hrefList("slide0198.htm",1,-1,1),new hrefList("sli= de0197.htm",1,-1,1),new hrefList("slide0177.htm",1,-1,1),new hrefList("slid= e0178.htm",1,-1,1),new hrefList("slide0179.htm",1,-1,1),new hrefList("slide= 0180.htm",1,-1,1),new hrefList("slide0089.htm",1,-1,1),new hrefList("slide0= 181.htm",1,-1,1),new hrefList("slide0184.htm",1,-1,1),new hrefList("slide01= 47.htm",1,-1,1),new hrefList("slide0092.htm",1,-1,1),new hrefList("slide011= 4.htm",1,-1,1),new hrefList("slide0159.htm",1,-1,1),new hrefList("slide0113= .htm",1,-1,1),new hrefList("slide0189.htm",1,-1,1),new hrefList("slide0190.= htm",1,-1,1),new hrefList("slide0191.htm",1,-1,1),new hrefList("slide0044.h= tm",1,-1,1),new hrefList("slide0045.htm",1,-1,1),new hrefList("slide0192.ht= m",1,-1,1),new hrefList("slide0019.htm",1,-1,1),new hrefList("slide0020.htm= ",1,-1,1),new hrefList("slide0116.htm",1,-1,1),new hrefList("slide0117.htm"= ,1,-1,1),new hrefList("slide0119.htm",1,-1,1),new hrefList("slide0120.htm",= 1,-1,1),new hrefList("slide0121.htm",1,-1,1),new hrefList("slide0122.htm",1= ,-1,1),new hrefList("slide0025.htm",1,-1,1),new hrefList("slide0167.htm",1,= -1,1),new hrefList("slide0165.htm",1,-1,1),new hrefList("slide0123.htm",1,-= 1,1),new hrefList("slide0166.htm",1,-1,1),new hrefList("slide0164.htm",1,-1= ,1),new hrefList("slide0134.htm",1,-1,1),new hrefList("slide0195.htm",1,-1,= 1),new hrefList("slide0161.htm",1,-1,1),new hrefList("slide0133.htm",1,-1,1= ),new hrefList("slide0135.htm",1,-1,1),new hrefList("slide0136.htm",1,-1,1)= ,new hrefList("slide0137.htm",1,-1,1),new hrefList("slide0138.htm",1,-1,1),= new hrefList("slide0140.htm",1,-1,1),new hrefList("slide0196.htm",1,-1,1),n= ew hrefList("slide0162.htm",1,-1,1),new hrefList("slide0193.htm",1,-1,1),ne= w hrefList("slide0141.htm",1,-1,1),new hrefList("slide0168.htm",1,-1,1),new= hrefList("slide0050.htm",1,-1,1),new hrefList("slide0051.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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charset="windows-1252" Palliative Care - Nathalie Steiner Collet ------=_NextPart_01C64A90.F8665580 Content-Location: file:///C:/2A09C636/Palliative_Care_Steiner_2006_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="windows-1252"
 No= tes
Slide Show
Outline
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