Serveur d'exploration sur Pittsburgh

Attention, ce site est en cours de développement !
Attention, site généré par des moyens informatiques à partir de corpus bruts.
Les informations ne sont donc pas validées.

Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.

Identifieur interne : 003962 ( Ncbi/Merge ); précédent : 003961; suivant : 003963

Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.

Auteurs : Sarah Deutsch [Oman] ; Pamela Koerner [États-Unis] ; Richard T. Miller [États-Unis] ; Zoie Craft [États-Unis] ; Karen Fancher [États-Unis]

Source :

RBID : pubmed:25301744

Descripteurs français

English descriptors

Abstract

The cycle management program (CMP) was implemented in 2008 at a national specialty pharmacy with a focus on providing specialized counseling and monitoring for patients on select oral oncology medications. The program now includes nine medications: bexarotene, dasatinib, erlotinib, everolimus, nilotinib, pazopanib, sorafenib, sunitinib, and vorinostat. Patients receive frequent assessments to encourage adherence, identify adverse events, and track discontinuations through a pharmacist outreach at the initiation of therapy, day 10 and 20 of the first month, then monthly thereafter. The use of oral agents is increasing in cancer patients, shifting away from regimens exclusively involving intravenous chemotherapy. This offers advantages for patients in terms of convenience, but introduces risk as patients become more responsible for the administration and monitoring of the medications.

DOI: 10.1177/1078155214547664
PubMed: 25301744

Links toward previous steps (curation, corpus...)


Links to Exploration step

pubmed:25301744

Le document en format XML

<record>
<TEI>
<teiHeader>
<fileDesc>
<titleStmt>
<title xml:lang="en">Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.</title>
<author>
<name sortKey="Deutsch, Sarah" sort="Deutsch, Sarah" uniqKey="Deutsch S" first="Sarah" last="Deutsch">Sarah Deutsch</name>
<affiliation wicri:level="1">
<nlm:affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA sarah.deutsch@walgreens.com.</nlm:affiliation>
<country wicri:rule="url">Oman</country>
<wicri:regionArea>Walgreens Specialty Pharmacy, Carnegie, PA</wicri:regionArea>
<wicri:noRegion>PA</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Koerner, Pamela" sort="Koerner, Pamela" uniqKey="Koerner P" first="Pamela" last="Koerner">Pamela Koerner</name>
<affiliation wicri:level="2">
<nlm:affiliation>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Miller, Richard T" sort="Miller, Richard T" uniqKey="Miller R" first="Richard T" last="Miller">Richard T. Miller</name>
<affiliation wicri:level="2">
<nlm:affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Walgreens Specialty Pharmacy, Carnegie, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Craft, Zoie" sort="Craft, Zoie" uniqKey="Craft Z" first="Zoie" last="Craft">Zoie Craft</name>
<affiliation wicri:level="2">
<nlm:affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Walgreens Specialty Pharmacy, Carnegie, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Fancher, Karen" sort="Fancher, Karen" uniqKey="Fancher K" first="Karen" last="Fancher">Karen Fancher</name>
<affiliation wicri:level="2">
<nlm:affiliation>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
</titleStmt>
<publicationStmt>
<idno type="wicri:source">PubMed</idno>
<date when="2016">2016</date>
<idno type="RBID">pubmed:25301744</idno>
<idno type="pmid">25301744</idno>
<idno type="doi">10.1177/1078155214547664</idno>
<idno type="wicri:Area/PubMed/Corpus">000040</idno>
<idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000040</idno>
<idno type="wicri:Area/PubMed/Curation">000040</idno>
<idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000040</idno>
<idno type="wicri:Area/PubMed/Checkpoint">000040</idno>
<idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000040</idno>
<idno type="wicri:Area/Ncbi/Merge">003962</idno>
</publicationStmt>
<sourceDesc>
<biblStruct>
<analytic>
<title xml:lang="en">Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.</title>
<author>
<name sortKey="Deutsch, Sarah" sort="Deutsch, Sarah" uniqKey="Deutsch S" first="Sarah" last="Deutsch">Sarah Deutsch</name>
<affiliation wicri:level="1">
<nlm:affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA sarah.deutsch@walgreens.com.</nlm:affiliation>
<country wicri:rule="url">Oman</country>
<wicri:regionArea>Walgreens Specialty Pharmacy, Carnegie, PA</wicri:regionArea>
<wicri:noRegion>PA</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Koerner, Pamela" sort="Koerner, Pamela" uniqKey="Koerner P" first="Pamela" last="Koerner">Pamela Koerner</name>
<affiliation wicri:level="2">
<nlm:affiliation>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Miller, Richard T" sort="Miller, Richard T" uniqKey="Miller R" first="Richard T" last="Miller">Richard T. Miller</name>
<affiliation wicri:level="2">
<nlm:affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Walgreens Specialty Pharmacy, Carnegie, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Craft, Zoie" sort="Craft, Zoie" uniqKey="Craft Z" first="Zoie" last="Craft">Zoie Craft</name>
<affiliation wicri:level="2">
<nlm:affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Walgreens Specialty Pharmacy, Carnegie, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Fancher, Karen" sort="Fancher, Karen" uniqKey="Fancher K" first="Karen" last="Fancher">Karen Fancher</name>
<affiliation wicri:level="2">
<nlm:affiliation>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA</wicri:regionArea>
<placeName>
<region type="state">Pennsylvanie</region>
</placeName>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners</title>
<idno type="eISSN">1477-092X</idno>
<imprint>
<date when="2016" type="published">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Antineoplastic Agents (therapeutic use)</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Neoplasms (drug therapy)</term>
<term>Pharmaceutical Services</term>
<term>Pharmacists</term>
<term>Pharmacy (methods)</term>
<term>Retrospective Studies</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Antinéoplasiques (usage thérapeutique)</term>
<term>Femelle</term>
<term>Humains</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Pharmacie ()</term>
<term>Pharmaciens</term>
<term>Services pharmaceutiques</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Tumeurs (traitement médicamenteux)</term>
<term>Études rétrospectives</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en">
<term>Antineoplastic Agents</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en">
<term>Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en">
<term>Pharmacy</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr">
<term>Tumeurs</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr">
<term>Antinéoplasiques</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pharmaceutical Services</term>
<term>Pharmacists</term>
<term>Retrospective Studies</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Femelle</term>
<term>Humains</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Pharmacie</term>
<term>Pharmaciens</term>
<term>Services pharmaceutiques</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Études rétrospectives</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">The cycle management program (CMP) was implemented in 2008 at a national specialty pharmacy with a focus on providing specialized counseling and monitoring for patients on select oral oncology medications. The program now includes nine medications: bexarotene, dasatinib, erlotinib, everolimus, nilotinib, pazopanib, sorafenib, sunitinib, and vorinostat. Patients receive frequent assessments to encourage adherence, identify adverse events, and track discontinuations through a pharmacist outreach at the initiation of therapy, day 10 and 20 of the first month, then monthly thereafter. The use of oral agents is increasing in cancer patients, shifting away from regimens exclusively involving intravenous chemotherapy. This offers advantages for patients in terms of convenience, but introduces risk as patients become more responsible for the administration and monitoring of the medications.</div>
</front>
</TEI>
<pubmed>
<MedlineCitation Status="MEDLINE" Owner="NLM">
<PMID Version="1">25301744</PMID>
<DateCreated>
<Year>2015</Year>
<Month>12</Month>
<Day>16</Day>
</DateCreated>
<DateCompleted>
<Year>2016</Year>
<Month>09</Month>
<Day>20</Day>
</DateCompleted>
<DateRevised>
<Year>2015</Year>
<Month>12</Month>
<Day>16</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">1477-092X</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>22</Volume>
<Issue>1</Issue>
<PubDate>
<Year>2016</Year>
<Month>Feb</Month>
</PubDate>
</JournalIssue>
<Title>Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners</Title>
<ISOAbbreviation>J Oncol Pharm Pract</ISOAbbreviation>
</Journal>
<ArticleTitle>Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.</ArticleTitle>
<Pagination>
<MedlinePgn>68-75</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1177/1078155214547664</ELocationID>
<Abstract>
<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The cycle management program (CMP) was implemented in 2008 at a national specialty pharmacy with a focus on providing specialized counseling and monitoring for patients on select oral oncology medications. The program now includes nine medications: bexarotene, dasatinib, erlotinib, everolimus, nilotinib, pazopanib, sorafenib, sunitinib, and vorinostat. Patients receive frequent assessments to encourage adherence, identify adverse events, and track discontinuations through a pharmacist outreach at the initiation of therapy, day 10 and 20 of the first month, then monthly thereafter. The use of oral agents is increasing in cancer patients, shifting away from regimens exclusively involving intravenous chemotherapy. This offers advantages for patients in terms of convenience, but introduces risk as patients become more responsible for the administration and monitoring of the medications.</AbstractText>
<AbstractText Label="PURPOSE" NlmCategory="OBJECTIVE">To evaluate utilization patterns of the oral oncology medications in the CMP including adverse event occurrence, medication discontinuations, and adherence markers.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">This study is a retrospective review of patient-reported data from the CMP assessments completed in 2013. Data collected include adverse events and grades, adherence markers, and discontinuation rates. A total of 1163 assessments were reviewed from 557 patients. The assessments included in the analysis were the initial assessment, 10-day assessment, 20-day assessment, and the first monthly follow-up assessment, which encompasses the first two months of therapy.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">A total of 1453 adverse events were reported. Adverse events were cited as the reason for 39% of discontinuations and 28% of missed/held doses. A total of 101 discontinuations were reported across the nine CMP medications based on the first two months of data. Missed or held doses were reported in 130 assessments.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Patient engagement and pharmacist interventions, through programs such as the CMP, are important to help patients manage these complex, high-risk medications.</AbstractText>
<CopyrightInformation>© The Author(s) 2014.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y">
<Author ValidYN="Y">
<LastName>Deutsch</LastName>
<ForeName>Sarah</ForeName>
<Initials>S</Initials>
<AffiliationInfo>
<Affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA sarah.deutsch@walgreens.com.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Koerner</LastName>
<ForeName>Pamela</ForeName>
<Initials>P</Initials>
<AffiliationInfo>
<Affiliation>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Miller</LastName>
<ForeName>Richard T</ForeName>
<Initials>RT</Initials>
<AffiliationInfo>
<Affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Craft</LastName>
<ForeName>Zoie</ForeName>
<Initials>Z</Initials>
<AffiliationInfo>
<Affiliation>Walgreens Specialty Pharmacy, Carnegie, PA, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Fancher</LastName>
<ForeName>Karen</ForeName>
<Initials>K</Initials>
<AffiliationInfo>
<Affiliation>Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList>
<PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic">
<Year>2014</Year>
<Month>10</Month>
<Day>08</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo>
<Country>England</Country>
<MedlineTA>J Oncol Pharm Pract</MedlineTA>
<NlmUniqueID>9511372</NlmUniqueID>
<ISSNLinking>1078-1552</ISSNLinking>
</MedlineJournalInfo>
<ChemicalList>
<Chemical>
<RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D000970">Antineoplastic Agents</NameOfSubstance>
</Chemical>
</ChemicalList>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList>
<MeshHeading>
<DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D000970" MajorTopicYN="N">Antineoplastic Agents</DescriptorName>
<QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D009369" MajorTopicYN="N">Neoplasms</DescriptorName>
<QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D010593" MajorTopicYN="N">Pharmaceutical Services</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D010595" MajorTopicYN="N">Pharmacists</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D010604" MajorTopicYN="N">Pharmacy</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName>
</MeshHeading>
</MeshHeadingList>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="N">Oral oncology</Keyword>
<Keyword MajorTopicYN="N">adherence</Keyword>
<Keyword MajorTopicYN="N">adverse events</Keyword>
<Keyword MajorTopicYN="N">cycle management</Keyword>
<Keyword MajorTopicYN="N">oral chemotherapy</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData>
<History>
<PubMedPubDate PubStatus="entrez">
<Year>2014</Year>
<Month>10</Month>
<Day>11</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed">
<Year>2014</Year>
<Month>10</Month>
<Day>11</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline">
<Year>2016</Year>
<Month>9</Month>
<Day>22</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList>
<ArticleId IdType="pubmed">25301744</ArticleId>
<ArticleId IdType="pii">1078155214547664</ArticleId>
<ArticleId IdType="doi">10.1177/1078155214547664</ArticleId>
</ArticleIdList>
</PubmedData>
</pubmed>
<affiliations>
<list>
<country>
<li>Oman</li>
<li>États-Unis</li>
</country>
<region>
<li>Pennsylvanie</li>
</region>
</list>
<tree>
<country name="Oman">
<noRegion>
<name sortKey="Deutsch, Sarah" sort="Deutsch, Sarah" uniqKey="Deutsch S" first="Sarah" last="Deutsch">Sarah Deutsch</name>
</noRegion>
</country>
<country name="États-Unis">
<region name="Pennsylvanie">
<name sortKey="Koerner, Pamela" sort="Koerner, Pamela" uniqKey="Koerner P" first="Pamela" last="Koerner">Pamela Koerner</name>
</region>
<name sortKey="Craft, Zoie" sort="Craft, Zoie" uniqKey="Craft Z" first="Zoie" last="Craft">Zoie Craft</name>
<name sortKey="Fancher, Karen" sort="Fancher, Karen" uniqKey="Fancher K" first="Karen" last="Fancher">Karen Fancher</name>
<name sortKey="Miller, Richard T" sort="Miller, Richard T" uniqKey="Miller R" first="Richard T" last="Miller">Richard T. Miller</name>
</country>
</tree>
</affiliations>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Wicri/Amérique/explor/PittsburghV1/Data/Ncbi/Merge
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 003962 | SxmlIndent | more

Ou

HfdSelect -h $EXPLOR_AREA/Data/Ncbi/Merge/biblio.hfd -nk 003962 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Wicri/Amérique
   |area=    PittsburghV1
   |flux=    Ncbi
   |étape=   Merge
   |type=    RBID
   |clé=     pubmed:25301744
   |texte=   Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program.
}}

Pour générer des pages wiki

HfdIndexSelect -h $EXPLOR_AREA/Data/Ncbi/Merge/RBID.i   -Sk "pubmed:25301744" \
       | HfdSelect -Kh $EXPLOR_AREA/Data/Ncbi/Merge/biblio.hfd   \
       | NlmPubMed2Wicri -a PittsburghV1 

Wicri

This area was generated with Dilib version V0.6.38.
Data generation: Fri Jun 18 17:37:45 2021. Site generation: Fri Jun 18 18:15:47 2021