Spotlight on Rheumatology

Sheetal Desai, MD, MSEd
Credits: 0.75 AANP / AAPA / CME
A Light in the Darkness: Advances in Systemic Lupus Erythematosus
Sheetal Desai, MD, MSEd
Integrity Continuing Education, Inc.

A Light in the Darkness: Advances in Systemic Lupus Erythematosus

Start

Activity Details

Free CME/AAPA/AANP
0.75 AMA PRA Category 1 Credit
0.75 Contact Hour(s)
Released: March 31, 2022
Expires: March 31, 2023
45 minutes to complete

Provider Statement

This CME activity for ACCME and AAPA credit is provided by Integrity Continuing Education, Inc.

This CE activity for AANP credit is jointly provided by Global Education Group and Integrity Continuing Education, Inc.

Target Audience

This educational activity has been designed to meet the needs of rheumatologists, nurse practitioners, and physician assistants involved in the management of patients with Systemic Lupus Erythematosus (SLE).

Learning Objectives

  • DEMONSTRATE how to apply current evidence to the effective management of SLE
  • DESCRIBE current and emerging clinical evaluation tools and rating instruments used in clinical trials and/or clinical practice for patients with SLE
  • DISCUSS the utility of patient-centered shared decision-making and patient-reported outcomes in improving adherence and quality of life in patients with SLE
  • REVIEW mechanisms of action and outcomes data from recent clinical trials on new and emerging SLE targeted therapies

Activity Description

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disorder associated with significant morbidity and mortality, which impacts quality of life and life expectancy. Therapeutic strategies rely heavily on the use of corticosteroids to control inflammation; however, chronic use of these agents is responsible for much of the long-term damage accrual in SLE. Alongside corticosteroids, immunomodulators (hydroxychloroquine and vitamin D) should be maximized, and active disease should be controlled with immunosuppression or biologics when required. Due to the lack of standardized, objective clinical measures, rheumatology clinicians may delay escalation to an advanced therapy, causing many patients to linger unnecessarily on first-line therapies.

This activity will address evolving clinical evaluation tools and rating instruments that are necessary to fully understand clinical trial outcomes, integrate emerging treatments into clinical practice, and identify patients who would benefit most from these novel therapies.

Faculty

Sheetal Desai, MD, MSEd
Associate Professor
Department of Rheumatology
University of California, Irvine
Orange, California

Conflict of Interest Policy/Disclosure Statement

Integrity Continuing Education, Inc. and Global Education Group require 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 they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education, Inc. and Global Education Group, for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. All relevant financial relationships have been mitigated.

The following faculty/planners reported the financial relationships or relationships to products or devices they have with ineligible companies related to the content of these CE/CME activities:

Sheetal Desai, MD, MSEd
Consulting: AstraZeneca, Aurinia Pharmaceuticals Inc., GlaxoSmithKline, Janssen Pharmaceuticals

Dave Mittman, DMSc (h.d.), PA, DFAAPA (Peer Reviewer) has no real or apparent conflicts of interest to report.

The following project managers/planners: Olivia Benevento, Stefani Chiarolanza, Lindsay Borvansky, Ashley Cann, Kristin Delisi, NP, Donna Fausak, Andrea Funk, Liddy Knight, and Patima Tanapat, PhD, reported that they or their spouses/life partners have no financial relationships or relationships to products or devices with commercial interests related to the content of this CE/CME activity.

Accreditation

Physician Continuing Education

Accreditation Statement
Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Integrity Continuing Education, Inc. designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integrity Continuing Education, Inc. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 0.75 contact hour(s) (which includes 0.2 hour(s) of pharmacology).

Physician Assistant Continuing Education (AAPA)
This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. Approval is valid from 3/31/2022 to 3/31/2023. PAs should only claim credit commensurate with the extent of their participation. AAPA reference number: CME-204547.

Instructions for Receiving Credit

There are no fees for participating and receiving CE/CME credit for this activity. During the period of March, 31, 2022 through March, 31, 2023, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Successful completion of the posttest is required to earn AAPA Category 1 CME credit. Successful completion is defined as a cumulative score of at least 70 percent correct.

Statement of Commercial Support

This activity is supported by an education grant from AstraZeneca Pharmaceuticals.

Disclaimer Statement/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. Integrity Continuing Education, Inc. and Global Education Group, 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 any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Contact Information for Questions About the Activity

For information about ACCME or AAPA accreditation of this activity, please contact Integrity Continuing Education, Inc. at (855) 835-4004 or cme@integrityce.com.

For information about AANP accreditation of this activity, please contact Global Education Group at (303) 395-1782 or cme@globaleducationgroup.com.

Activity Details

Free CME/AAPA/AANP
0.75 AMA PRA Category 1 Credit
0.75 Contact Hour(s)
Released: March 31, 2022
Expires: March 31, 2023
45 minutes to complete

Provider Statement

This CME activity for ACCME and AAPA credit is provided by Integrity Continuing Education, Inc.

This CE activity for AANP credit is jointly provided by Global Education Group and Integrity Continuing Education, Inc.

Target Audience

This educational activity has been designed to meet the needs of rheumatologists, nurse practitioners, and physician assistants involved in the management of patients with Systemic Lupus Erythematosus (SLE).

Learning Objectives

  • DEMONSTRATE how to apply current evidence to the effective management of SLE
  • DESCRIBE current and emerging clinical evaluation tools and rating instruments used in clinical trials and/or clinical practice for patients with SLE
  • DISCUSS the utility of patient-centered shared decision-making and patient-reported outcomes in improving adherence and quality of life in patients with SLE
  • REVIEW mechanisms of action and outcomes data from recent clinical trials on new and emerging SLE targeted therapies

Activity Description

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disorder associated with significant morbidity and mortality, which impacts quality of life and life expectancy. Therapeutic strategies rely heavily on the use of corticosteroids to control inflammation; however, chronic use of these agents is responsible for much of the long-term damage accrual in SLE. Alongside corticosteroids, immunomodulators (hydroxychloroquine and vitamin D) should be maximized, and active disease should be controlled with immunosuppression or biologics when required. Due to the lack of standardized, objective clinical measures, rheumatology clinicians may delay escalation to an advanced therapy, causing many patients to linger unnecessarily on first-line therapies.

This activity will address evolving clinical evaluation tools and rating instruments that are necessary to fully understand clinical trial outcomes, integrate emerging treatments into clinical practice, and identify patients who would benefit most from these novel therapies.

Faculty

Sheetal Desai, MD, MSEd
Associate Professor
Department of Rheumatology
University of California, Irvine
Orange, California

Conflict of Interest Policy/Disclosure Statement

Integrity Continuing Education, Inc. and Global Education Group require 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 they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education, Inc. and Global Education Group, for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. All relevant financial relationships have been mitigated.

The following faculty/planners reported the financial relationships or relationships to products or devices they have with ineligible companies related to the content of these CE/CME activities:

Sheetal Desai, MD, MSEd
Consulting: AstraZeneca, Aurinia Pharmaceuticals Inc., GlaxoSmithKline, Janssen Pharmaceuticals

Dave Mittman, DMSc (h.d.), PA, DFAAPA (Peer Reviewer) has no real or apparent conflicts of interest to report.

The following project managers/planners: Olivia Benevento, Stefani Chiarolanza, Lindsay Borvansky, Ashley Cann, Kristin Delisi, NP, Donna Fausak, Andrea Funk, Liddy Knight, and Patima Tanapat, PhD, reported that they or their spouses/life partners have no financial relationships or relationships to products or devices with commercial interests related to the content of this CE/CME activity.

Accreditation

Physician Continuing Education

Accreditation Statement
Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Integrity Continuing Education, Inc. designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integrity Continuing Education, Inc. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 0.75 contact hour(s) (which includes 0.2 hour(s) of pharmacology).

Physician Assistant Continuing Education (AAPA)
This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. Approval is valid from 3/31/2022 to 3/31/2023. PAs should only claim credit commensurate with the extent of their participation. AAPA reference number: CME-204547.

Instructions for Receiving Credit

There are no fees for participating and receiving CE/CME credit for this activity. During the period of March, 31, 2022 through March, 31, 2023, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Successful completion of the posttest is required to earn AAPA Category 1 CME credit. Successful completion is defined as a cumulative score of at least 70 percent correct.

Statement of Commercial Support

This activity is supported by an education grant from AstraZeneca Pharmaceuticals.

Disclaimer Statement/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. Integrity Continuing Education, Inc. and Global Education Group, 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 any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Contact Information for Questions About the Activity

For information about ACCME or AAPA accreditation of this activity, please contact Integrity Continuing Education, Inc. at (855) 835-4004 or cme@integrityce.com.

For information about AANP accreditation of this activity, please contact Global Education Group at (303) 395-1782 or cme@globaleducationgroup.com.

Rheumatology Presentations

Sheetal Desai, MD, MSEd
0.75 AANP / AAPA / CME
Integrity Continuing Education, Inc.
A Light in the Darkness: Advances in Systemic Lupus Erythematosus

A Light in the Darkness: Advances in Systemic Lupus Erythematosus

Start

Activity Details

Free CME/AAPA/AANP
0.75 AMA PRA Category 1 Credit
0.75 Contact Hour(s)
Released: March 31, 2022
Expires: March 31, 2023
45 minutes to complete

Provider Statement

This CME activity for ACCME and AAPA credit is provided by Integrity Continuing Education, Inc.

This CE activity for AANP credit is jointly provided by Global Education Group and Integrity Continuing Education, Inc.

Target Audience

This educational activity has been designed to meet the needs of rheumatologists, nurse practitioners, and physician assistants involved in the management of patients with Systemic Lupus Erythematosus (SLE).

Learning Objectives

  • DEMONSTRATE how to apply current evidence to the effective management of SLE
  • DESCRIBE current and emerging clinical evaluation tools and rating instruments used in clinical trials and/or clinical practice for patients with SLE
  • DISCUSS the utility of patient-centered shared decision-making and patient-reported outcomes in improving adherence and quality of life in patients with SLE
  • REVIEW mechanisms of action and outcomes data from recent clinical trials on new and emerging SLE targeted therapies

Activity Description

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disorder associated with significant morbidity and mortality, which impacts quality of life and life expectancy. Therapeutic strategies rely heavily on the use of corticosteroids to control inflammation; however, chronic use of these agents is responsible for much of the long-term damage accrual in SLE. Alongside corticosteroids, immunomodulators (hydroxychloroquine and vitamin D) should be maximized, and active disease should be controlled with immunosuppression or biologics when required. Due to the lack of standardized, objective clinical measures, rheumatology clinicians may delay escalation to an advanced therapy, causing many patients to linger unnecessarily on first-line therapies.

This activity will address evolving clinical evaluation tools and rating instruments that are necessary to fully understand clinical trial outcomes, integrate emerging treatments into clinical practice, and identify patients who would benefit most from these novel therapies.

Faculty

Sheetal Desai, MD, MSEd
Associate Professor
Department of Rheumatology
University of California, Irvine
Orange, California

Conflict of Interest Policy/Disclosure Statement

Integrity Continuing Education, Inc. and Global Education Group require 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 they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education, Inc. and Global Education Group, for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. All relevant financial relationships have been mitigated.

The following faculty/planners reported the financial relationships or relationships to products or devices they have with ineligible companies related to the content of these CE/CME activities:

Sheetal Desai, MD, MSEd
Consulting: AstraZeneca, Aurinia Pharmaceuticals Inc., GlaxoSmithKline, Janssen Pharmaceuticals

Dave Mittman, DMSc (h.d.), PA, DFAAPA (Peer Reviewer) has no real or apparent conflicts of interest to report.

The following project managers/planners: Olivia Benevento, Stefani Chiarolanza, Lindsay Borvansky, Ashley Cann, Kristin Delisi, NP, Donna Fausak, Andrea Funk, Liddy Knight, and Patima Tanapat, PhD, reported that they or their spouses/life partners have no financial relationships or relationships to products or devices with commercial interests related to the content of this CE/CME activity.

Accreditation

Physician Continuing Education

Accreditation Statement
Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Integrity Continuing Education, Inc. designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integrity Continuing Education, Inc. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 0.75 contact hour(s) (which includes 0.2 hour(s) of pharmacology).

Physician Assistant Continuing Education (AAPA)
This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. Approval is valid from 3/31/2022 to 3/31/2023. PAs should only claim credit commensurate with the extent of their participation. AAPA reference number: CME-204547.

Instructions for Receiving Credit

There are no fees for participating and receiving CE/CME credit for this activity. During the period of March, 31, 2022 through March, 31, 2023, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Successful completion of the posttest is required to earn AAPA Category 1 CME credit. Successful completion is defined as a cumulative score of at least 70 percent correct.

Statement of Commercial Support

This activity is supported by an education grant from AstraZeneca Pharmaceuticals.

Disclaimer Statement/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. Integrity Continuing Education, Inc. and Global Education Group, 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 any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Contact Information for Questions About the Activity

For information about ACCME or AAPA accreditation of this activity, please contact Integrity Continuing Education, Inc. at (855) 835-4004 or cme@integrityce.com.

For information about AANP accreditation of this activity, please contact Global Education Group at (303) 395-1782 or cme@globaleducationgroup.com.

Activity Details

Free CME/AAPA/AANP
0.75 AMA PRA Category 1 Credit
0.75 Contact Hour(s)
Released: March 31, 2022
Expires: March 31, 2023
45 minutes to complete

Provider Statement

This CME activity for ACCME and AAPA credit is provided by Integrity Continuing Education, Inc.

This CE activity for AANP credit is jointly provided by Global Education Group and Integrity Continuing Education, Inc.

Target Audience

This educational activity has been designed to meet the needs of rheumatologists, nurse practitioners, and physician assistants involved in the management of patients with Systemic Lupus Erythematosus (SLE).

Learning Objectives

  • DEMONSTRATE how to apply current evidence to the effective management of SLE
  • DESCRIBE current and emerging clinical evaluation tools and rating instruments used in clinical trials and/or clinical practice for patients with SLE
  • DISCUSS the utility of patient-centered shared decision-making and patient-reported outcomes in improving adherence and quality of life in patients with SLE
  • REVIEW mechanisms of action and outcomes data from recent clinical trials on new and emerging SLE targeted therapies

Activity Description

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disorder associated with significant morbidity and mortality, which impacts quality of life and life expectancy. Therapeutic strategies rely heavily on the use of corticosteroids to control inflammation; however, chronic use of these agents is responsible for much of the long-term damage accrual in SLE. Alongside corticosteroids, immunomodulators (hydroxychloroquine and vitamin D) should be maximized, and active disease should be controlled with immunosuppression or biologics when required. Due to the lack of standardized, objective clinical measures, rheumatology clinicians may delay escalation to an advanced therapy, causing many patients to linger unnecessarily on first-line therapies.

This activity will address evolving clinical evaluation tools and rating instruments that are necessary to fully understand clinical trial outcomes, integrate emerging treatments into clinical practice, and identify patients who would benefit most from these novel therapies.

Faculty

Sheetal Desai, MD, MSEd
Associate Professor
Department of Rheumatology
University of California, Irvine
Orange, California

Conflict of Interest Policy/Disclosure Statement

Integrity Continuing Education, Inc. and Global Education Group require 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 they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Integrity Continuing Education, Inc. and Global Education Group, for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. All relevant financial relationships have been mitigated.

The following faculty/planners reported the financial relationships or relationships to products or devices they have with ineligible companies related to the content of these CE/CME activities:

Sheetal Desai, MD, MSEd
Consulting: AstraZeneca, Aurinia Pharmaceuticals Inc., GlaxoSmithKline, Janssen Pharmaceuticals

Dave Mittman, DMSc (h.d.), PA, DFAAPA (Peer Reviewer) has no real or apparent conflicts of interest to report.

The following project managers/planners: Olivia Benevento, Stefani Chiarolanza, Lindsay Borvansky, Ashley Cann, Kristin Delisi, NP, Donna Fausak, Andrea Funk, Liddy Knight, and Patima Tanapat, PhD, reported that they or their spouses/life partners have no financial relationships or relationships to products or devices with commercial interests related to the content of this CE/CME activity.

Accreditation

Physician Continuing Education

Accreditation Statement
Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
Integrity Continuing Education, Inc. designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integrity Continuing Education, Inc. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 0.75 contact hour(s) (which includes 0.2 hour(s) of pharmacology).

Physician Assistant Continuing Education (AAPA)
This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. Approval is valid from 3/31/2022 to 3/31/2023. PAs should only claim credit commensurate with the extent of their participation. AAPA reference number: CME-204547.

Instructions for Receiving Credit

There are no fees for participating and receiving CE/CME credit for this activity. During the period of March, 31, 2022 through March, 31, 2023, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pretest
  • Study the educational activity
  • Complete the posttest and the evaluation form

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.

Successful completion of the posttest is required to earn AAPA Category 1 CME credit. Successful completion is defined as a cumulative score of at least 70 percent correct.

Statement of Commercial Support

This activity is supported by an education grant from AstraZeneca Pharmaceuticals.

Disclaimer Statement/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. Integrity Continuing Education, Inc. and Global Education Group, 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 any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Contact Information for Questions About the Activity

For information about ACCME or AAPA accreditation of this activity, please contact Integrity Continuing Education, Inc. at (855) 835-4004 or cme@integrityce.com.

For information about AANP accreditation of this activity, please contact Global Education Group at (303) 395-1782 or cme@globaleducationgroup.com.