Spotlight on Internal Medicine

Credits: 0.75 CME
Clinical Reflections®: Reflecting on Errors and Missed Opportunities in Chronic Urticaria
Michael E. Manning, MD, FAAAAI, FACAAI
Postgraduate Institute for Medicine

Clinical Reflections®: Reflecting on Errors and Missed Opportunities in Chronic Urticaria

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Activity Details

Free CME
0.75 AMA PRA Category 1 Credits
Released: February 1, 2019
Expires: January 31, 2020
45 minutes to complete

Jointly Provided By

Postgraduate Institute for Medicine (PIM) in joint providership with RMEI Medical Education (RMEI).

Target Audience

US-based allergy/immunology and dermatology clinicians

Learning Objectives

After engaging in this educational activity, participants will be able to:

  1. Recognize physical exam findings and symptomatology suggestive of chronic urticaria (CU) and appropriately apply evidence-based practices regarding diagnostic testing and laboratory workup
  2. Utilize a guideline-driven approach to treatment intensification for safe and effective management of CU patients in need of second- and third-line treatment options, while taking into account quality of life issues

Activity Description

This unique educational initiative harnesses the power of reflection and recognition of suboptimal approaches to patient care to allow you to rethink clinical decisions based on the scenarios presented, and to modify treatment plans accordingly. You can compare your responses to interactive questions with those of your peers and learn from our expert faculty.

Statement of Educational Need

Urticaria is an inflammatory skin condition characterized by intensely pruritic, erythematous wheals, commonly referred to as “hives,” ranging from several millimeters to several centimeters in diameter.1 Individual wheals characteristically resolve within 24 hours of development without leaving residual skin markings. However, resolving lesions are often concomitantly replaced by new wheals.

Acute urticaria tends to be self-limiting, often resolving within hours to days.2 By contrast, a diagnosis of chronic urticaria (CU), also referred to as chronic idiopathic urticaria (CIU) or chronic spontaneous urticaria (CSU), is made when symptoms last >6 weeks.3 In some cases of CU, symptoms persist continually, while others are episodic with symptoms occurring at varying intervals (hours to weeks).4 Approximately 40% of patients with CU also develop angioedema,5 characterized by rapid swelling of the lower layers of the dermis and the subcutaneous or submucosal tissue of the skin and mucous membranes, most commonly affecting the lips and eyelids, or more rarely, the respiratory or gastrointestinal tracts.6 The point prevalence of CU is estimated at 0.5% to 1%.4

References:
  1. World Allergy Organization. Urticaria and angioedema: synopsis. 2004. www.worldallergy.org/professional/allergic_diseases_center/urticaria/urticariasynopsis.php. Accessed December 21, 2018.
  2. Axelrod S, Davis-Lorton M. Urticaria and angioedema. Mt Sinai J Med. 2011;78(5):784-802.
  3. Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000;105(4):664-672.
  4. Powell RJ, Du Toit GL, Siddique N, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37(5):631-650.
  5. Amar SM, Dreskin SC. Urticaria. Prim Care. 2008;35(1):141-157.
  6. Maurer M, Weller K, Bindsley-Jensen C, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA²LEN task force report. Allergy. 2011;66(3):317-330.

Faculty

Michael E. Manning, MD, FAAAAI, FACAAI
Michael E. Manning, MD, FAAAAI, FACAAI
President/Medical Director
Medical Research of Arizona
Allergy, Asthma and Immunology Associates, Ltd.
Scottsdale, AZ

Michael E. Manning, MD, FAAAAI, FACAAI, is president of Allergy, Asthma and Immunology Associates, Ltd., and medical director of the clinical research division, Medical Research of Arizona.

Dr Manning is a graduate of Baylor University in Waco, TX and he received his medical degree from the University of Texas Medical School at Houston. He completed an internship and subsequently residency in internal medicine at St. Joseph’s Hospital and Medical Center in Phoenix, AZ, and an allergy and immunology fellowship at Scripps Clinic and Research Foundation in La Jolla, CA.

Dr Manning has served as president of the Greater Phoenix Allergy Society, the Arizona State Allergy and Asthma Society, and the Western Society of Allergy, Asthma and Immunology. He is a fellow of the American College of Allergy, Asthma and Immunology and American Academy of Allergy, Asthma and Immunology. Dr Manning is currently on the Board of Regents of the American College of Allergy, Asthma and Immunology.

Michael E. Manning, MD, FAAAAI, FACAAI, has affiliations with CSL Behring, DBV Technologies, Pharming, Shire (Consulting Fees); AstraZeneca, CSL Behring, Genentech, Pharming, Shire (Speakers Bureaus); Aimmune, BioCryst, CSL Behring, Genentech/Novartis, GSK, Hoffmann-La Roach, Merck, Sanofi, Shire/Dyax (Contracted Research).



Anne Marie Ditto, MD 
Associate Professor of Medicine
Division of Allergy-Immunology 
Northwestern University
Feinberg School of Medicine 
Chicago, IL 

Anne Marie Ditto, MD, is an associate professor of medicine in the division of Allergy-Immunology at Northwestern University Feinberg School of Medicine in Chicago, IL. She earned her medical degree at the University of Illinois at Chicago. Her internship, residency, and fellowship were all completed at Northwestern University. Dr Ditto is board certified in allergy-immunology.

Dr Ditto is a practicing allergist with a special interest in urticaria, eosinophilic esophagitis, asthma, and idiopathic anaphylaxis. She volunteers monthly at the Community Health Clinic where she founded an asthma/allergy clinic. She is also actively involved in the allergy-immunology training program at Northwestern, where she has trained over 75 allergists and teaches students and residents in outpatient clinics.

Dr Ditto was invited to fellowship in the American College of Physicians (ACP) and Royal Society of Medicine (RSM) and her distinguished teaching and volunteer work has been recognized through numerous awards, including the Northwestern Medical Faculty Foundation “Center of Excellence Award” for Community Service and Community Health’s “Volunteer Specialist of the Year.

Dr Ditto is a former president of the Illinois Society of Allergy, Asthma and Immunology and currently serves as Governor of the Midwest Region of the American Academy of Allergy, Asthma and Immunology’s Federation of Regional State and Local Allergy, Asthma and Immunology Societies (RSLAAIS) and also serves as vice-chair of the AAAAI anaphylaxis committee. She has published numerous articles and book chapters in the field of allergy- immunology and recently edited the “Anaphylaxis” issue of Immunology and Allergy Clinics of North America.

Anne Marie Ditto, MD, has no affiliations with commercial interests to disclose.



Luz Fonacier, MD, FAAAAI, FACAAI
Professor of Medicine
State University of New York at Stony Brook
Stony Brook, NY
Head of Allergy
Program Director, Allergy and Immunology
Fellowship Program
NYU Winthrop Hospital
Mineola, NY 

Luz Fonacier, MD, FAAAAI, FACAAI, is the head of allergy in NYU Winthrop Hospital, a clinical campus of Stony Brook University School of Medicine and serves as the program director for the Allergy and Immunology Fellowship Program. Dr Fonacier is also a professor of medicine in USNY at Stony Brook. She completed residencies in dermatology and internal medicine, a fellowship in allergy and immunology in New York Hospital-Cornell Medical Center, and a fellowship in dermal immunology at New York University Medical Center.

Dr Fonacier serves as the Treasurer of the American College of Allergy, Asthma and Immunology (ACAAI). She chaired the Committee on Dermatologic Allery of the ACAAI and the Food Allergy, Dermatologic, Drug and Anaphylaxis Interest Section of the American Academy of Allergy, Asthma and Immunology (AAAAI). She is the recipient of the ARTrust™  and Anjuli Seth Nayak AAAAI Lectureship, the ACAAI John P. McGovern Lectureship, the ACAAI Jean A. Chapman Memorial Lectureship, the ACAAI “Women in Allergy Award”, and the Presidential Award of Asian Pacific Association of Allergy and Clinical Immunology. Dr Fonacier also served as president of the Long Island Allergy Society.

Dr Fonacier has numerous publications in textbooks and journals and continues to be a speaker and faculty in the annual national conventions of ACAAI, AAAAI, and other national and international societies. Because of her training in dermatology, allergy, and immunology, Dr Fonacier’s special interest is the dermatologic manifestations of allergic diseases.

Luz Fonacier, MD, FAAAAI, FACAAI, has affiliations with Regeneron (Consulting Fees); Regeneron (Speakers Bureaus); Pfizer, Regeneron, Shire (Contracted Research).



Conflict of Interest Policy/Disclosure Statement

The Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and RMEI Medical Education, LLC. The Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Receiving Credit

By reviewing the course content and successfully completing the post-test and evaluation, physicians, nurse practitioners, and PAs are entitled to receive up to 0.75 AMA PRA Category 1 Credit(s)™. A statement of credit will be available to print from your user history page. Users must:

  • Read the learning objectives and faculty disclosures.
  • Participate in the activity.
  • Complete the activity evaluation.

Physicians, nurse practitioners, and PAs who successfully complete the post-test and evaluation will receive CME credit. You must score 75% or higher on the post-test to receive credit for this activity. All other participants who successfully complete the post-test and evaluation will receive a certificate of participation. If you would like to contact Postgraduate Institute for Medicine, please email information@pimed.com.

Complete the evaluation form and participants will be entered into a drawing to win a $100 Amazon Gift Card!

*The expense for this gift card is solely funded by RMEI Medical Education. No supporter funding was used for the expense of this gift card.

Rules and Regulations
This sweepstakes is managed by RMEI Medical Education, LLC (RMEI), a full-service medical education company. The winner will be selected via automated random drawing on a monthly basis from among all eligible entries and notified through the contact information provided. In accordance with our privacy policy, we do not share your information with any third parties. By entering the sweepstakes, you grant RMEI permission to use your email address to reach you for notification and prize fulfillment. Only individuals who complete the evaluation forms and provide contact information will be eligible to win. Open to those who have a US postal address and who are 18 years or older. Only one prize per person and per household will be awarded. The prize will be a $100 Amazon gift card.

Statement of Commercial Support

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Hardware/Software Requirements

Pro-CME recommends using the latest versions of these supported browsers: Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, Safari. Depending on your browser of choice, additional software, such as Adobe Reader® and Adobe® Flash® Player may be required.

Internal Medicine Presentations

1.00 CME / CNE
American Heart Association
CASE STUDIES: Reducing Cardiovascular Risk in Patients with HIV

CASE STUDIES: Reducing Cardiovascular Risk in Patients with HIV

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Accredited By

American Heart Association

Activity Details

Free CME/CE
1.0 AMA PRA Category 1 Credit
1.0 Contact Hour
Released: June 28, 2017
Expires: June 28, 2020
60 minutes to complete

Target Audience

Physicians (Cardiology, Family Practice, Infectious Disease, HIV Specialist and Internal Medicine); Physician Assistants (Cardiology, Family Practice, Infectious Disease, HIV Specialist, and Internal Medicine); Nurses/Nurse Practitioners; Other (Clinicians involved in the treatment and management of patients with HIV/AIDS)

Learning Objectives

1) State the CDC/USPSTF recommendation for universal opt-out HIV testing 2) Discuss preventive approaches to reduce risk of ASCVD in patients infected with HIV 3) Recognize the challenge of predicting cardiovascular risk in patients who are HIV-positive 4) Examine the treatment of ASCVD in patients who are HIV-positive

Activity Description

The program addresses the need for cardiovascular practitioners, family medicine physicians, infectious disease specialists, and other members of the target audience to illustrate the intersection between cardiovascular disease (CVD) and human immunodeficiency virus (HIV) infection.

Additionally, the program reviews epidemiologic patterns in HIV and the relevance of these for understanding the scope of CVD among HIV-infected individuals. Important concepts related to HIV screening and prevention, as well as CVD screening and prevention will be discussed; including new developments and existing barriers regarding CVD treatment for HIV-infected individuals will be reviewed. The activity uses a case-based format interspersed with didactic training to bridge the gap between theory and practice for practitioners caring for HIV-infected individuals.

Statement of Educational Need

The program addresses the need for cardiovascular practitioners, family medicine physicians, infectious disease specialists, and other members of the target audience to illustrate the intersection between cardiovascular disease (CVD) and human immunodeficiency virus (HIV) infection.

Agenda

45 minutes - Presentation of Case Studies: Reducing Cardiovascular Risk in Patients with HIV

15 minutes – Q & A

Presenters

Matthew J. Feinstein, MD
Assistant Professor of Medicine (Cardiology) and Preventive Medicine
Northwestern Medicine
Feinberg School of Medicine
Chicago, IL


David G. Weismiller, MD, ScM, FAAFP
Professor of Family Medicine
University of Nevada, Las Vegas
School of Medicine,
Las Vegas, NV


Planning Committee (Content Developers)

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA
Matthew J. Feinstein, MD
Matthew S. Freiberg, MD, MSc
Mark J. Haykowsky, PhD
Priscilla Hsue, MD
Wendy S. Post, MD, MS
David G. Weismiller, MD ScM, FAAFP

Disclosures

All persons who develop and/or control educational content in CME/CE activities provided by the American Heart Association will disclose to the audience all financial relationships with any commercial supporters of this activity as well as with other commercial interests whose lines of business are related to the CME/CE-certified content of this activity. In addition, presenters will disclose unlabeled/unapproved uses of drugs or devices discussed in their presentations. Such disclosures will be made in writing in course presentation materials.

The disclosures listed below represents the relationships of this educational activity’s faculty members that may be perceived as actual or reasonable perceived conflicts of interest as reported on the Disclosure Questionnaire which all AHA volunteers are required to complete and submit. The focus is on relevant financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content.

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA – No Disclosures
Matthew J. Feinstein, MD – No Disclosures
Matthew S. Freiberg, MD, MSc – No Disclosures
Mark J. Haykowsky, PhD – No Disclosures
Priscilla Hsue, MD – Honoraria – Gilead; Research Grant – Pfizer; Other Research Support – Novartis
Wendy S. Post, MD, MS – No Disclosures
David G. Weismiller, MD ScM, FAAFP – No Disclosures

Accreditation Statements

ORIGINAL RELEASE DATE: 06/28/2017

TERMINATION DATE: 06/28/2020

LAST REVIEW DATE: June 2017

JOINT ACCREDITATION TERM: 06/28/2017 – 06/28/2020

The American Heart Association is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

AMA Credit Designation Statement - Physicians
The American Heart Association designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA Credit Acceptance Statement – Physician Assistants
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hours of Category 1 credit for completing this program.

AANP Credit Acceptance Statement – Nurse Practitioners
American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. **AMA Credit must be claimed within 6 months of attendance. Credit will no longer be available to claim after the 6 months claiming period.

ANCC Credit Designation Statement - Nurses
The maximum number of hours awarded for this CE activity is 1.0 contact hours. **ANCC Credit must be claimed within 6 months of attendance. CME/CE will no longer be available to claim after the 6 months claiming period.

AAFP Credit Statement - Physicians
This Enduring Material activity, CASE STUDIES: Reducing Cardiovascular Risk in Patients with HIV, has been reviewed and is acceptable for up to 1.0 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 06/28/2017. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participation and Successful Completion

Successful completion of this CE activity includes the following: 

  1. Register and view the course online.
  2. View the content in its entirety.
  3. Complete a post-test with a minimum score of 80%.
  4. Complete a survey of your learning experience.
  5. Claim your CME/CE Certificate.

Statement of Commercial Support

This activity is supported by an independent medical educational grant from Gilead Sciences.

Disclaimer Statement/ Disclosure of Unlabeled Use

When an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during an educational activity, the faculty must disclose that the product is not labeled for the use under discussion or that the product is still investigational.

Contact Information for Questions about the Activity

Luci Ochoa, MBA
Manager, Lifelong Learning, AHA National Center
luci.ochoa@heart.org

Hardware/Software Requirements

Pro-CME recommends using the latest versions of these supported browsers: Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, Safari. Depending on your browser of choice, additional software, such as Adobe Reader® and Adobe® Flash® Player may be required.

1.00 CME / CNE
American Heart Association
Cardiac Issues in HIV: Patient Cases

Cardiac Issues in HIV: Patient Cases

Start

Accredited By

American Heart Association

Activity Details

Free CME/CE
1.0 AMA PRA Category 1 Credit
1.0 Contact Hour
Released: November 8, 2017
Expires: November 8, 2020
60 minutes to complete

Target Audience

Physicians (Cardiology, Family Practice, Infectious Disease, HIV Specialist and Internal Medicine); Physician Assistants (Cardiology, Family Practice, Infectious Disease, HIV Specialist, and Internal Medicine); Nurses/Nurse Practitioners; Other (Clinicians involved in the treatment and management of patients with HIV/AIDS)

Learning Objectives

1) Assess the clinical aspects of HIV-associated cardiovascular issues
2) Review the HIV-specific issues that are essential for management of CVD in the HIV-infected individual
3) Evaluate the management of CVD in the setting of HIV

Activity Description

This program will assess the clinical aspects of HIV-associated cardiovascular issues, review HIV-specific issues that are essential for the management of CVD in the HIV-infected individual as well as evaluate the management of CVD in the setting of HIV.

Statement of Educational Need

The program addresses the need for cardiovascular practitioners, family medicine physicians, infectious disease specialists, and other members of the target audience to illustrate the intersection between cardiovascular disease (CVD) and human immunodeficiency virus (HIV) infection.

Agenda

45 minutes - Cardiac Issues in HIV: Patient Cases

15 minutes – Q & A

Presenters

Priscilla Hsue, MD, FACC
William Watt Kerr Professor of Medicine
UCSF School of Medicine
San Francisco, CA


Wendy S. Post, MD, MS
Professor of Medicine and Epidemiology
Division of Cardiology, Department of Medicine
John Hopkins University School of Medicine and
Bloomberg School of Public Health


Planning Committee (Content Developers)

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA
Matthew J. Feinstein, MD
Matthew S. Freiberg, MD, MSc
Mark J. Haykowsky, PhD
Priscilla Hsue, MD
Wendy S. Post, MD, MS
David G. Weismiller, MD ScM, FAAFP

Disclosures

All persons who develop and/or control educational content in CME/CE activities provided by the American Heart Association will disclose to the audience all financial relationships with any commercial supporters of this activity as well as with other commercial interests whose lines of business are related to the CME/CE-certified content of this activity. In addition, presenters will disclose unlabeled/unapproved uses of drugs or devices discussed in their presentations. Such disclosures will be made in writing in course presentation materials.

The disclosures listed below represents the relationships of this educational activity’s faculty members that may be perceived as actual or reasonable perceived conflicts of interest as reported on the Disclosure Questionnaire which all AHA volunteers are required to complete and submit. The focus is on relevant financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content.

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA – No Disclosures
Matthew J. Feinstein, MD – No Disclosures
Matthew S. Freiberg, MD, MSc – No Disclosures
Mark J. Haykowsky, PhD – No Disclosures
Priscilla Hsue, MD – Honoraria – Gilead; Research Grant – Pfizer; Other Research Support – Novartis
Wendy S. Post, MD, MS – No Disclosures
David G. Weismiller, MD ScM, FAAFP – No Disclosures

Accreditation Statements

ORIGINAL RELEASE DATE: 11/08/2017

TERMINATION DATE: 11/08/2020

LAST REVIEW DATE: September 2017

JOINT ACCREDITATION TERM: 11/08/2017 – 11/08/2020

The American Heart Association is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

AMA Credit Designation Statement - Physicians
The American Heart Association designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA Credit Acceptance Statement – Physician Assistants
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hours of Category 1 credit for completing this program.

AANP Credit Acceptance Statement – Nurse Practitioners
American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. **AMA Credit must be claimed within 6 months of attendance. Credit will no longer be available to claim after the 6 months claiming period.

ANCC Credit Designation Statement - Nurses
The maximum number of hours awarded for this CE activity is 1.0 contact hours. **ANCC Credit must be claimed within 6 months of attendance. CME/CE will no longer be available to claim after the 6 months claiming period.

AAFP Credit Statement - Physicians
This Enduring Material activity, Cardiac Issues in HIV: Patient Cases, has been reviewed and is acceptable for up to 1.0 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 11/08/2017. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participation and Successful Completion

Successful completion of this CE activity includes the following: 

  1. Register and view the course online.
  2. View the content in its entirety.
  3. Complete a post-test with a minimum score of 80%.
  4. Complete a survey of your learning experience.
  5. Claim your CME/CE Certificate.

Statement of Commercial Support

This activity is supported by an independent medical educational grant from Gilead Sciences.

Disclaimer Statement/ Disclosure of Unlabeled Use

When an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during an educational activity, the faculty must disclose that the product is not labeled for the use under discussion or that the product is still investigational.

Contact Information for Questions about the Activity

Luci Ochoa, MBA
Manager, Lifelong Learning, AHA National Center
luci.ochoa@heart.org

Hardware/Software Requirements

Pro-CME recommends using the latest versions of these supported browsers: Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, Safari. Depending on your browser of choice, additional software, such as Adobe Reader® and Adobe® Flash® Player may be required.

1.00 CME / CNE
American Heart Association
HIV and CVD: Beyond Coronary Heart Disease

HIV and CVD: Beyond Coronary Heart Disease

Start

Accredited By

American Heart Association

Activity Details

Free CME/CE
1.0 AMA PRA Category 1 Credit
1.0 Contact Hour
Released: September 21, 2017
Expires: September 21, 2020
60 minutes to complete

Target Audience

Physicians (Cardiology, Family Practice, Infectious Disease, HIV Specialist and Internal Medicine); Physician Assistants (Cardiology, Family Practice, Infectious Disease, HIV Specialist, and Internal Medicine); Nurses/Nurse Practitioners; Other (Clinicians involved in the treatment and management of patients with HIV/AIDS)

Learning Objectives

1) Describe the general epidemiology of cardiovascular disease (CVD) related complications of human immunodeficiency virus (HIV) 2) Describe risk factors and mechanisms of atherosclerotic CVD in HIV 3) Describe approaches to predict, prevent, and treat atherosclerotic CVD in HIV 4) Review the scope of non-atherosclerotic CVD in HIV, as well as related mechanisms and treatment approaches

Activity Description

The program reviews epidemiologic patterns in HIV and the relevance of these for understanding the scope of CVD among HIV-infected individuals. Important concepts related to atherosclerotic and non-atherosclerotic cardiovascular diseases in people living with HIV, focusing on heart failure, arrhythmias and sudden cardiac death will be discussed; including new developments and existing barriers regarding CVD treatment for HIV-infected individuals.

Statement of Educational Need

The program addresses the need for cardiovascular practitioners, family medicine physicians, infectious disease specialists, and other members of the target audience to illustrate the intersection between cardiovascular disease (CVD) and human immunodeficiency virus (HIV) infection.

Agenda

45 minutes - HIV and CVD: Beyond Coronary Heart Disease Presentation

15 minutes – Q & A

Presenters

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA
Assistant Professor of Medicine & Global Health
Director, Cardiovascular Global Health
Duke University Medical Center
Duke Clinical Research Institute
Durham, NC 27705


Matthew S. Freiberg, MD, MSc
Director, Vanderbilt Center for Clinical Cardiovascular outcomes
Research And Trials Evaluation (V-C3REATE)
West End Home Foundation Scholar
Associate Professor of Medicine
Vanderbilt University Medical Center
Nashville, TN


Planning Committee (Content Developers)

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA
Matthew J. Feinstein, MD
Matthew S. Freiberg, MD, MSc
Mark J. Haykowsky, PhD
Priscilla Hsue, MD
Wendy S. Post, MD, MS
David G. Weismiller, MD ScM, FAAFP

Disclosures

All persons who develop and/or control educational content in CME/CE activities provided by the American Heart Association will disclose to the audience all financial relationships with any commercial supporters of this activity as well as with other commercial interests whose lines of business are related to the CME/CE-certified content of this activity. In addition, presenters will disclose unlabeled/unapproved uses of drugs or devices discussed in their presentations. Such disclosures will be made in writing in course presentation materials.

The disclosures listed below represents the relationships of this educational activity’s faculty members that may be perceived as actual or reasonable perceived conflicts of interest as reported on the Disclosure Questionnaire which all AHA volunteers are required to complete and submit. The focus is on relevant financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content.

Gerald S. Bloomfield, MD, MPH, FACC, FASE, FAHA – No Disclosures
Matthew J. Feinstein, MD – No Disclosures
Matthew S. Freiberg, MD, MSc – No Disclosures
Mark J. Haykowsky, PhD – No Disclosures
Priscilla Hsue, MD – Honoraria – Gilead; Research Grant – Pfizer; Other Research Support – Novartis
Wendy S. Post, MD, MS – No Disclosures
David G. Weismiller, MD ScM, FAAFP – No Disclosures

Accreditation Statements

ORIGINAL RELEASE DATE: 09/21/2017

TERMINATION DATE: 09/21/2020

LAST REVIEW DATE: June 2017

JOINT ACCREDITATION TERM: 09/21/2017 – 09/21/2020

The American Heart Association is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

AMA Credit Designation Statement - Physicians
The American Heart Association designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA Credit Acceptance Statement – Physician Assistants
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hours of Category 1 credit for completing this program.

AANP Credit Acceptance Statement – Nurse Practitioners
American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. **AMA Credit must be claimed within 6 months of attendance. Credit will no longer be available to claim after the 6 months claiming period.

ANCC Credit Designation Statement - Nurses
The maximum number of hours awarded for this CE activity is 1.0 contact hours. **ANCC Credit must be claimed within 6 months of attendance. CME/CE will no longer be available to claim after the 6 months claiming period.

AAFP Credit Statement - Physicians
This Enduring Material activity, HIV and CVD: Beyond Coronary Heart Disease, has been reviewed and is acceptable for up to 1.0 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 09/21/2017. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Participation and Successful Completion

Successful completion of this CE activity includes the following: 

  1. Register and view the course online.
  2. View the content in its entirety.
  3. Complete a post-test with a minimum score of 80%.
  4. Complete a survey of your learning experience.
  5. Claim your CME/CE Certificate.

Statement of Commercial Support

This activity is supported by an independent medical educational grant from Gilead Sciences.

Disclaimer Statement/ Disclosure of Unlabeled Use

When an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during an educational activity, the faculty must disclose that the product is not labeled for the use under discussion or that the product is still investigational.

Contact Information for Questions about the Activity

Luci Ochoa, MBA
Manager, Lifelong Learning, AHA National Center
luci.ochoa@heart.org

Hardware/Software Requirements

Pro-CME recommends using the latest versions of these supported browsers: Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, Safari. Depending on your browser of choice, additional software, such as Adobe Reader® and Adobe® Flash® Player may be required.

0.50 CME / CE
Postgraduate Institute for Medicine
Research-based Clinical Strategies to Prevent and Address Adolescent Substance Use and Prescription Medication Misuse—Being Part of the Solution Part 2

Research-based Clinical Strategies to Prevent and Address Adolescent Substance Use and Prescription Medication Misuse—Being Part of the Solution Part 2

Start

Activity Details

Free
AAFP, ACCME, ANCC, ADA

0.5 Credit

Released: June 29, 2017

Expires: June 27, 2019

30 minutes

No registration required

Target Audience

This activity had been designed to meet the educational needs of clinicians including, physicians, physician assistants, nurse practitioners, nurses, and dentists/oral maxillofacial surgeons, involved in the care of adolescent patients.

Learning Objectives

  • Discuss strategies to address substance use and prescription drug misuse in adolescent patients based on their level of use
  • Summarize when and how to follow up with adolescent patients who use substances or misuse prescription drugs

Activity Description

Videos from your peers enhance this course, which aims to help you navigate confidentiality and confidence in having effective discussions with your teen patients about their substance use. Features tips and talking points for patients at all risk levels, and considerations prescription drug misuse. This course was developed by a Coalition Healthcare Organizations and Providers to help clinicians identify, prevent, and address substance use and prescription medication misuse in their adolescent patients.

Instruction for Claiming Credit

A brief post-test and course evaluation will follow the completion of the course. Please complete these questionnaires to claim credit for this course.

Education Coalition

This activity was developed by an education Coalition of experts and medical professional organization representatives. The Coalition comprises the following organizations and experts:

Type of Reviewer:
Organization/Expert Consultant
Reviewer Name
California Academy of Family Physicians (CAFP) Cynthia Kear, Senior Vice President
American Society of Addiction Medicine (ASAM) Jennifer Butchart, Education Coordinator
Penny Mills, Executive Vice President / CEO
Arlene Deverman, VP Professional Development
American Osteopathic Association (AOA)

Stephanie Townsell, Director, Public Health
Marla Kushner, DO

American Association of Nurse Practitioners (AANP) Anne Norman, DNP, APRN, FNP-C, FAANP Vice President of Education and Accreditation
American Academy of Pediatrics (AAP) Renee Jarrett, Manager, Mental Health and Foster Care Initiatives
Div of Developmental Pediatrics and Preventive Services
American Academy of Physician Assistants (AAPA) Daniel Pace, Vice President, Education
Marie-Michele Leger, MPH, PA-C, Director, Clinical Education
Sara Evans, PMP, Project Manager, Quality Improvement Initiatives
American Association of Oral and Maxillofacial Surgeons (AAOMS) Vincent DiFabio, DDS
Consultant Samantha Mattiucci, PharmD, Director of Medical Education
Consultant Jan Schultz, BSN, MSN, RN, CCMEP, Director of Education Outcomes and Accreditation Services
Consultant Dan Alford, MD, Associate Professor of Medicine, Assistant Dean and Program Director of the Addiction Medicine Residency program at Boston University School of Medicine
Consultant Sharon Levy, MD, MPH, FAAP, Director, Adolescent Substance Abuse Program (ASAP) Assistant Professor in Pediatrics, Boston Children's Hospital
Consultant Jeff Baxter, MD, Assistant Professor
Department of Family Medicine and Community Health, University of Massachusetts Medical School
Consultant Marc Fishman, MD
Consultant Carol Havens, MD

Conflict of Interest Policy/ Disclosure Statement

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The Education Coalition members reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Marc Fishman, MD discloses the following: Consulting Fees: US World Meds; Contracted Research: Media Rez, US World Meds; Ownership Interest: Maryland Treatment Centers

The following Education Coalition members have nothing to disclose: Cynthia Kear, Jennifer Butchart, Penny Mills, Arlene Deverman, Stephanie Townsell, Marla Kushner, Anne Norman, Renee Jarrett, Daniel Pace, Marie-Michele Leger, Sara Evans, Vincent DiFabio, Jan Schultz, Dan Alford, Sharon Levy, Jeff Baxter, Marc Fishman, and Carol Havens

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

The following PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, RN, BSN and Jan Schultz, RN, MSN, CHCP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following National Institute on Drug Abuse planners and managers, Elisabeth Davis; Carol Krause; Josie Anderson; Jack Stein, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

 The following JBS International, Inc. planners and managers, Candace Baker; Susan Hayashi; Laura Nolan; Bethel Arya; and Veronica Junghahn, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Physician Continuing Medical Education

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and the National Institute for Drug Abuse. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity has been reviewed and is acceptable for up to 1.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 06/30/2017. Term of approval is for one year from this date.

This continuing medical education activity has been reviewed by the American Academy of Pediatrics and is acceptable for a maximum of 1.00 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

Nursing Continuing Education

Credit Designation
This educational activity for 0.5 contact hour is provided by Postgraduate Institute for Medicine.

Accreditation Statement
Accreditation Council for Pharmacy EducationPostgraduate Institute for Medicine is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.


American Dental Association CERP Recognition

This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint sponsorship efforts between Postgraduate Institute for Medicine and the National Institute for Drug Abuse.

Postgraduate Institute for Medicine is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of the credit hours by boards of dentistry.

Postgraduate Institute for Medicine designates this activity for 0.5 continuing education credit.

Statement of Commercial Support

There is no commercial funding for this activity.

Media

Internet activity

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Hardware / Software Requirements

Pro-CME recommends using the latest versions of these supported browsers: Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, Safari. Depending on your browser of choice, additional software, such as Adobe Reader® and Adobe® Flash® Player may be required.

0.50 CME / CE
Postgraduate Institute for Medicine
Research-based Clinical Strategies to Prevent and Address Adolescent Substance Use and Prescription Medication Misuse—Being Part of the Solution Part 1

Research-based Clinical Strategies to Prevent and Address Adolescent Substance Use and Prescription Medication Misuse—Being Part of the Solution Part 1

Start

Activity Details

Free
AAFP, ACCME, ANCC, ADA

0.5 Credit

Released: June 29, 2017

Expires: June 27, 2019

30 minutes

No registration required

Target Audience

This activity had been designed to meet the educational needs of clinicians including, physicians, physician assistants, nurse practitioners, nurses, and dentists/oral maxillofacial surgeons, involved in the care of adolescent patients.

Learning Objectives

  • Describe the prevalence of substance use and prescription medication misuse among adolescents
  • Explain why adolescents are at high risk of developing a substance use disorder, and how clinicians can help to prevent it
  • Demonstrate strategies to build trust with adolescent patients, and ensure confidentiality when addressing substance use and prescription medication misuse

Activity Description

Videos from your peers enhance this course, which aims to help you navigate confidentiality and confidence in having effective discussions with your teen patients about their substance use. Features tips and talking points for patients at all risk levels, and considerations of prescription drug misuse. This course was developed by the Coalition of Healthcare Organizations and Providers to help clinicians identify, prevent, and address substance use and prescription medication misuse in their adolescent patients.

Instruction for Claiming Credit

A brief post-test and course evaluation will follow the completion of the course. Please complete these questionnaires to claim credit for this course.

Education Coalition

This activity was developed by an education Coalition of experts and medical professional organization representatives. The Coalition comprises the following organizations and experts:

Type of Reviewer:
Organization/Expert Consultant
Reviewer Name
California Academy of Family Physicians (CAFP) Cynthia Kear, Senior Vice President
American Society of Addiction Medicine (ASAM) Jennifer Butchart, Education Coordinator
Penny Mills, Executive Vice President / CEO
Arlene Deverman, VP Professional Development
American Osteopathic Association (AOA)

Stephanie Townsell, Director, Public Health
Marla Kushner, DO

American Association of Nurse Practitioners (AANP) Anne Norman, DNP, APRN, FNP-C, FAANP Vice President of Education and Accreditation
American Academy of Pediatrics (AAP) Renee Jarrett, Manager, Mental Health and Foster Care Initiatives
Div of Developmental Pediatrics and Preventive Services
American Academy of Physician Assistants (AAPA) Daniel Pace, Vice President, Education
Marie-Michele Leger, MPH, PA-C, Director, Clinical Education
Sara Evans, PMP, Project Manager, Quality Improvement Initiatives
American Association of Oral and Maxillofacial Surgeons (AAOMS) Vincent DiFabio, DDS
Consultant Samantha Mattiucci, PharmD, Director of Medical Education
Consultant Jan Schultz, BSN, MSN, RN, CCMEP, Director of Education Outcomes and Accreditation Services
Consultant Dan Alford, MD, Associate Professor of Medicine, Assistant Dean and Program Director of the Addiction Medicine Residency program at Boston University School of Medicine
Consultant Sharon Levy, MD, MPH, FAAP, Director, Adolescent Substance Abuse Program (ASAP) Assistant Professor in Pediatrics, Boston Children's Hospital
Consultant Jeff Baxter, MD, Assistant Professor
Department of Family Medicine and Community Health, University of Massachusetts Medical School
Consultant Marc Fishman, MD
Consultant Carol Havens, MD

Conflict of Interest Policy/ Disclosure Statement

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The Education Coalition members reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Marc Fishman, MD discloses the following: Consulting Fees: US World Meds; Contracted Research: Media Rez, US World Meds; Ownership Interest: Maryland Treatment Centers

The following Education Coalition members have nothing to disclose: Cynthia Kear, Jennifer Butchart, Penny Mills, Arlene Deverman, Stephanie Townsell, Marla Kushner, Anne Norman, Renee Jarrett, Daniel Pace, Marie-Michele Leger, Sara Evans, Vincent DiFabio, Jan Schultz, Dan Alford, Sharon Levy, Jeff Baxter, Marc Fishman, and Carol Havens

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

The following PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, RN, BSN and Jan Schultz, RN, MSN, CHCP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following National Institute on Drug Abuse planners and managers, Elisabeth Davis; Carol Krause; Josie Anderson; Jack Stein, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

 The following JBS International, Inc. planners and managers, Candace Baker; Susan Hayashi; Laura Nolan; Bethel Arya; and Veronica Junghahn, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Physician Continuing Medical Education

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and the National Institute for Drug Abuse. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity has been reviewed and is acceptable for up to 1.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 06/30/2017. Term of approval is for one year from this date.

This continuing medical education activity has been reviewed by the American Academy of Pediatrics and is acceptable for a maximum of 1.00 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

Nursing Continuing Education

Credit Designation
This educational activity for 0.5 contact hour is provided by Postgraduate Institute for Medicine.

Accreditation Statement
Accreditation Council for Pharmacy EducationPostgraduate Institute for Medicine is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.


American Dental Association CERP Recognition

This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint sponsorship efforts between Postgraduate Institute for Medicine and the National Institute for Drug Abuse.

Postgraduate Institute for Medicine is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of the credit hours by boards of dentistry.

Postgraduate Institute for Medicine designates this activity for 0.5 continuing education credit.

Statement of Commercial Support

There is no commercial funding for this activity.

Media

Internet activity

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Hardware / Software Requirements

Pro-CME recommends using the latest versions of these supported browsers: Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, Safari. Depending on your browser of choice, additional software, such as Adobe Reader® and Adobe® Flash® Player may be required.

Pages