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Name-Brand Medication vs. Generic: What's the Difference?
Most prescriptions meds are available in generic form. Find out the similarities and differences between the two and how to determine whether a generic is right for you. Approximately 80 percent of prescriptions sold today are generics. If you’re taking a prescription medication, chances are it’s a generic form of the brand-name drug. But are you getting the same quality in a generic medication? Do generics measure up? The answer in most cases is yes — generics, just like branded products, are regulated by the Food and Drug Administration. “To have a generic product approved by the FDA, the generic manufacturer must prove that its product is bioequivalent to the branded product,” explains Adam Porath, PharmD, BCPS AQ-Cardiology, BCACP and Vice President of Pharmacy Services. Basically, it has to function the same. “Generic products are extremely well tolerated and will provide the same results as using a branded product,” Porath says. Here’s how generics are the same as name-brand prescriptions: Generic products contain the same active ingredients. They produce the same desired clinical effect and accompanying side effects. Generics come in the same form as their branded counterparts: pill, liquid or inhaler, for example. Release into the bloodstream matches the name brand in timing and strength. Here’s how they differ: Generics generally cost less. Federal law requires generics have different names and look different: shape, size, markings and color. Generics contain different inactive ingredients, like binders, fillers and artificial colors. Different side effects with generics can usually be attributed to these additions. Why do generics cost less? When pharmaceutical companies develop a new drug, they are paying for research, development, clinical studies, marketing — in some cases it can cost more than $800 million and take 10 to 15 years to develop a new drug. “The manufacturers of branded medication products have to recoup their research and development costs,” Porath says. So companies are granted a limited patent to sell their drug without the competition of generic counterparts. “When patent exclusivity ends, the market is open for any generic manufacturer to make a competing product with FDA approval.” Without the same startup costs, companies can sell generics at 80 to 85 percent less. And because more than one company can produce the same generics, competition drives prices even lower.
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Family-Friendly Bike Trails in Our Region
Bicycling is a great way to get the whole family moving. We’ve reviewed some family-friendly bike trails that’ll get everyone outdoors for some good, old-fashioned fun on two wheels. During the ongoing COVID-19 (coronavirus) pandemic, it is important to practice physical distancing and wear a mask when it’s impossible to stay six feet away from others. 1. Damonte Ranch Wetland Loop in Reno Duration: 3.1 mile loop. Skill Level: Easy. This paved loop trail is easy to access and has ample wildlife viewing opportunities with plenty of birds and wildflowers in the wetland. Parking and Trail Access: Start at Damonte Ranch Park and follow the paved trail around the wetland loop. 2. Tahoe East Shore Trail Duration: 5.2 miles out and back. Skill Level: Easy. The Tahoe East Shore Trail closely hugs the shore of Lake Tahoe. The paved trail has mild inclines that make it the perfect adventure for all ages and skill levels. Parking and Trail Access: Park along State Route 28 in Incline Village near Ponderosa Ranch Road for direct access to the trail. 3. Caughlin Ranch Trails in Reno Duration: 3.5 miles out and back Skill Level: Easy. This paved trail wanders through the Caughlin Ranch neighborhood and features creeks, wildlife and shade. Parking and Trail Access: Park along Caughlin Ranch Parkway for easy trail access. 4. Sagehen Creek Trail in Truckee Duration: 6 miles out and back. Skill Level: Intermediate. This dirt loop trail is a short drive from Reno and ends at Stampede Reservoir. Parking and Trail Access: Park at the marked trailhead off of North Highway 89. 5. Truckee River Trail in West Tahoe Duration: 7.5 miles one way. Skill Level: Intermediate. Looking for a longer trail? This point-to-point trail meanders along the Truckee River through the scenic Olympic Valley. Parking and Trail Access: Park at the Squaw Valley Village or in Tahoe City. Coordinate with two cars to make the trip one way. What family-friendly bike routes does your family enjoy? We’d love to know!
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Generic Drugs – What You Need to Know About Them
Without a doubt, taking medications can not only be expensive, but also confusing. In the United States, generic prescriptions are widely used, with 9 out of 10 people choosing them over a name brand. Pharmacists are a great resource to help us understand the benefits and side effects of any medication. We asked Adam Porath, PharmD, Vice President of Pharmacy at Renown Health, to answer some common questions about generic drugs. What is a generic drug? A generic drug has the same active ingredients of brand-name drugs. Brand-name drugs have a patent (special license) protecting them from competition to help the drug company recover research and development costs. When the patent expires other manufacturers are able to seek approval for a generic drug. However, the color, shape and inactive elements may be different. Per the U.S. Food & Drug Administration (FDA), a generic medicine works in the same way and provides the same clinical benefit as its brand-name version. Why do they cost less? Generic drug makers do not have the expense of costly development, research, animal and human clinical trials, marketing and advertising. This savings is passed on to the public. Also after a patent expires, several companies will compete on a generic version of a drug, further driving down prices.
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Pharmacists Answer Questions about the COVID-19 Vaccines
Vaccines that provide protection against the COVID-19 virus are bringing us closer to the end of this deadly pandemic. Two different COVID-19 vaccines are currently available in the U.S. today: one from Pfizer and the other from Moderna. Kate Ward, PharmD, BCPS, Director of Clinical Pharmacy at Renown Health and Adam Porath, PharmD, Vice President of Pharmacy at Renown, share what you need to know about these vaccines. When two COVID-19 vaccines were approved by the U.S. Food & Drug Administration (FDA) in December 2020, it was cause for celebration. Why? Because according to the CDC, the vaccines are 94 percent or more effective in providing protection against the COVID-19 virus! Many people are seeking information about the new Moderna and Pfizer vaccines. Below, our pharmacy leaders provide answers to some commonly asked questions. How do the COVID-19 Vaccines Work? The Pfizer and Moderna vaccines are both mRNA vaccines that help your immune system develop antibodies against the COVID-19 virus. The vaccines use messenger RNA, or mRNA, to show our bodies’ protein-making cells how to make the spike proteins of the COVID-19 virus. Our immune system reacts to these spike proteins by creating antibodies that can recognize and destroy them. So when a person is exposed to the virus in the future, they will be less likely to get sick. What are the Differences between the Pfizer and Moderna Vaccines? The Pfizer and Moderna COVID-19 vaccines are very similar, with just a few small differences worth noting. The main difference between the two vaccines is when you should receive your follow-up dose. Patients who receive a first dose of Pfizer should receive their second dose about three weeks later. Those who receive a first dose of Moderna should receive their follow-up vaccination roughly four weeks after their first dose. People 18 years and older can receive the Moderna vaccine while people 16 years and older can receive the Pfizer vaccine. Dosage for the Moderna vaccine is 0.5 ml (100 mcg). Dosage for the Pfizer vaccine is 0.3 ml (30 mcg).
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Five Reasons to Switch to Renown’s Modern-Day Pharmacy
Renown Health has two retail pharmacy locations – one at Renown Regional on Pringle Way and another on Locust Street. And while many people think of a pharmacy as where we get prescriptions and pick up refills, it’s so much more. Adam Porath, vice president of pharmacy services at Renown, discusses five benefits of switching to a Renown Pharmacy. 1. Hospital Integration With the Meds-to-Beds Program, the Renown Health Pharmacy delivers prescriptions to patients on the floor when they leave the hospital. Another thing that is interesting about the pharmacy is its integration with providers. So, if there is a problem with your prescription, the Renown Pharmacy can get hold of your provider right away. We also can see your lab results and make sure that the dose you are prescribed is the right one. 2. On-Site Vaccinations The Renown Health Pharmacy has a private consultation area to administer vaccines on-site. Their team routinely stocks more than a dozen vaccines, and you can call either location (Regional: 775-982-7737 and Locust Street: 775-982-5280) to see if what you're looking for is in stock. Appointments are available in MyChart. 3. Compounding Services Only a fraction of pharmacies in the United States provides compounding services. In the Reno/Sparks area, there are just a few and Renown Pharmacy is one of them. Traditional retail pharmacies take drugs received from a drug manufacturer and put them into a smaller container in the individual amount that the doctor prescribed for a patient. A compounding pharmacy provides medications that are not available commercially. For example, a doctor has prescribed a dose that is smaller than what is commercially available. Compounding the medication will provide the dosage as prescribed. Another example could be a child who can’t take a tablet. The pharmacy may be able to use compounding to convert medications into something that is the child can take.
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Dorm Safety and Bacterial Meningitis
Bacterial meningitis is probably the last thing on your mind as you help your child prepare for college. Buying books and stocking up on necessities may top your list, but it’s a good idea to ensure your student is up-to-date on their meningitis vaccine. How Bacterial Meningitis Spreads According to the Centers for Disease Control and Prevention, people living in close quarters are more likely to spread this illness to one another. For example, you may have heard about the higher risk of meningococcal (or bacterial) meningitis for new college students. The risk is so serious that many colleges and universities require proof of a vaccine for new students moving into campus housing. This includes the University of Nevada, Reno. To clarify, all incoming freshmen under 23 years of age must show proof of their up-to-date meningitis shot. “Bacterial meningitis is considered a medical emergency, and anyone with the signs and symptoms should be evaluated in the emergency room immediately,” says Vanessa Slots, MD, Renown pediatrician. Symptoms of Bacterial Meningitis Fever Nausea Vomiting Irritability Headache Confusion Back pain Stiff or painful neck Leg pain Light sensitivity Rash on the torso or lower extremities It’s important to know many of these symptoms for both bacterial and viral meningitis are the same. However, the viral type is more common, often clearing up in seven to 10 days without complications. Nonetheless, you should go to the emergency room to be looked at, as the signs are similar for both illnesses. Why is Bacterial Meningitis Dangerous? This illness moves quickly, and in some cases, it can seem like the flu or severe strep throat and take a few days to develop. Or, it can hit in just hours. “Bacterial meningitis has an overall death rate of 10 to 15 percent despite treatment with antibiotics,” Dr. Slots warns. Another critical point is problems after recovery can also be severe. Frequently these include brain damage, amputations, infections around the heart, seizures and shock.
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Pharmacy Mail Order Thank You
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Renown Pharmacy Vaccinations
Pharmacy Vaccinations by Appointment The Renown Pharmacy team can order additional vaccines with advanced notice. Please call 775-982-7737 before scheduling to check on availability. Renown Pharmacy provides vaccinations by appointment for the following: Bivalent Vaccine (Updated COVID-19 vaccine booster) COVID-19 (Pfizer-BioNTech for 12+ and Moderna) Tetanus, provided though the tetanus, diphtheria and pertussis (Tdap) booster (Adacel) Measles, Mumps, Rubella (MMR) Shingles vaccine (Shingrix) Pneumonia vaccine (Pneumovax23 and Prevnar 20) Influenza/Flu vaccine (High dose for 65+ and standard dose for those six months to 64 years) Meningococcal (meningitis) vaccine (Menactra) Meningococcal B vaccine (Trumenba) Hepatitis B vaccine (HEPLISAV-B) Human Papillomavirus (HPV) vaccine (Gardasil 9) Monkeypox vaccine (JYNNEOS) You may request appointments for any of these vaccines within MyChart
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Renown Children's Hospital Announces 2021 Children's Miracle Network Champion Child Ambassador
Despite numerous medical challenges, Emmalee Sutton is a determined, bright and outgoing 14-year-old with a joy for life and passion for helping others. Renown Children’s Hospital and Children’s Miracle Network Hospitals (CMNH) are excited to announce Emmalee Sutton as the 2021 Champion Child Ambassador. A fighter from a very young age, 14-year-old Emmalee has been a source of hope and inspiration to everyone she meets, never letting her medical challenges slow her down. A video introducing Emmalee and her journey can be found here. Emmalee was diagnosed with autoimmune hepatitis at age 2, and she has endured a long road of illnesses and hospitalizations since. She also has Addison’s disease, which means her body under-produces critical hormones. She had her gallbladder removed at age 8, port surgery at 13, and has received several liver biopsies over the years. Over time, heavy steroid use has stunted her growth — at 14 years old, she is 49 inches tall. It has also caused extreme weight gains and losses. She also faces daily issues with her calcium, potassium and sodium levels. Due to her lack of immunities, she is unable to attend school in-person but is on the home/hospital program through the Washoe County School District. Despite Emmalee’s medical challenges, her sheer joy and spark for life remains untouched. “I am so honored to be chosen as the 2021 Champion Child Ambassador and represent all the kids at Renown Children’s Hospital. I hope my story can inspire other young patients to believe in themselves,” said Emmalee. “It can be hard dealing with health challenges, but I always think about those who have it worse than me. Instead of complaining about the things I can’t do, I celebrate all the things I can do.” “We can all learn from Emmalee’s enthusiasm, determination and positive outlook,” said Tony Slonim, MD, DrPH, President & CEO of Renown. “She has never met an obstacle too great or faced a challenge too difficult, and she effortlessly inspires others to view life through that same lens. Emmalee has already touched so many hearts here at Renown, and as our 2021 Champion Child Ambassador, her impact is sure to be incredible.” Emmalee loves to talk to and help other children, especially when she visits Renown Children’s Hospital for treatments. One of her favorite things to do in the hospital is visit with other patients and try to make them feel better. “Emmalee is very patient with all the doctors she sees, the medications she takes and the frequent lab testing and blood draws she receives,” said her mom, Ann Sutton. “She always remains positive and comforts those who think they are hurting her. This makes her quite the beloved patient at Renown Children’s Hospital!” Emmalee enjoys spending time with her four dogs and rabbit, and she also has an affinity for frogs, lizards and fish. She loves to sew and crochet, and for the past six years, she has held the title of top cookie-seller in her Girl Scout troop. When Emmalee grows up, she wants to be a pediatric nurse so she can help other kids who are going through what she has experienced. Her ultimate goal in life is to make the world a better place in many ways. “From the moment I met Emmalee, I knew she was a champion,” said Kiemmy Thai, MBA, Foundation Manager of Children's Hospital at Renown. “Her courage and perseverance inspire so many pediatric patients with hope when they need it most. Her smile is contagious, and her words of wisdom at such a young age will have a great impact on our community. We are excited to work with Emmalee and help bring out the champion in others.” Emmalee will serve as Renown Children’s Hospital’s CMNH Champion Child for the next two years, acting as the face of the hospital in the community and sharing her heartwarming and inspiring story. Supporting Champions Like Emmalee Funds from the Children's Miracle Network Hospitals’ have helped purchase equipment for several of the subspecialists Emmalee needs to see. Additionally, Emmalee has benefited from equipment that CMNH has funded during her in-patient stays, such as distraction machines, iPads and CinemaVision goggles. You can support local champion children like Emmalee by visiting renown.childrensmiraclenetworkhospitals.org. About Renown Children’s Hospital Renown Children’s Hospital is the only dedicated children’s hospital in northern Nevada, and offers a variety of programs and services designed specifically to care for the community's families. It has the region’s only Children’s ER and Pediatric ICU. Renown Children’s Hospital is the only hospital affiliated with Children’s Miracle Network Hospitals (CMNH) in the region and local CMN Hospitals' programs and events directly benefit children in the Truckee Meadows. It is also the only hospital in the region affiliated with CHA (Children’s Hospital Association). For more information, visit here. About Children’s Miracle Network Hospitals Children’s Miracle Network Hospitals® raises funds and awareness for 170 member hospitals that provide 32 million treatments each year to kids across the U.S. and Canada. Donations stay local to fund critical treatments and healthcare services, pediatric medical equipment and charitable care. Since 1983, Children’s Miracle Network Hospitals has raised more than $7 billion, most of it $1 at a time through the charity's Miracle Balloon icon. Its various fundraising partners and programs support the nonprofit's mission to save and improve the lives of as many children as possible. Find out why children's hospitals need community support, and learn about your member hospital, at CMNHospitals.org and facebook.com/CMNHospital.
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Renown's Dr. Kate Ward Honored with Nevada Society of Health System Pharmacists (NVSHP) President's Award
The award is given annually to a member of the Nevada pharmacy community making significant and sustained contributions to the field Kate Ward, Pharm.D., BCPS Director of Clinical Pharmacy at Renown Health is the 2022 recipient of the Nevada Society of Health System Pharmacists (NVSHP) President’s Award. Dr. Ward has been with Renown for over a decade, starting as a Clinical Pharmacist in 2009. As the Director of Clinical Pharmacy, she is responsible for the oversight of all clinical pharmacy activities at Renown Regional, South Meadows and Rehab. Additionally, Dr. Ward is the Residency Director of the Post-Graduate Year 1 (PGY1) Pharmacy Practice Residency at Renown Regional Medical Center. “We are so proud that Kate has been recognized by the Nevada Society of Health System Pharmacists with the President’s Award and for her many accomplishments as a member of our Renown Pharmacy team. With 66% of adults taking five or more drugs per day and 27% taking 10 or more per day, a pharmacist’s review is critical in supporting patient safety and well-being,” says Tom Graf, MD, interim CEO, Renown Health. “Beyond that, pharmacists have the ability to suggest methods for accurately and effectively taking prescribed medications, discuss medication safety, identify and manage side effects and assist patients and families in managing chronic health conditions.” As a licensed pharmacist, Dr. Ward holds The Doctor of Pharmacy degree (abbreviated Pharm.D. or PharmD) from the University of Colorado. The Pharm.D. is a professional degree similar to a Doctor of Medicine (MD) or Doctor of Dental Surgery (DDS). As a doctorate, it represents the increasing responsibility pharmacists have in healthcare systems and the high trust Americans have in pharmacists. The Doctor of Pharmacy degree takes three to four years of undergraduate pre-professional (prerequisite) coursework, followed by four academic years in a professional program. Most students need four years to complete their prerequisite courses. Thus, it usually takes eight years of college study to earn a Pharm.D. and become a pharmacist. Pharmacists working in hospitals and health systems often complete additional post-graduate training after a Pharm.D. degree. Dr. Ward completed a PGY1 Residency at Stanford prior to joining the Pharmacy Department at Renown. “Dr. Ward is such an asset to Renown and our community. Her incredible perseverance to reach for and achieve higher aspirations has resulted in this important recognition by our peers across the state. She consistently contributes her pharmacy expertise to patients, physicians, clinicians and healthcare students and volunteers her time to advance the profession at both the state and national level through pharmacy professional organization participation. It is wonderful to have her efforts recognized by NVSHP,” says Adam Porath, Pharm.D., BCACP, BCPS, FASHP, Vice President, Pharmacy. On Sept. 24, NVSHP and the Nevada Pharmacy Alliance held their annual joint meeting at Renown Regional Medical Center. During this meeting, Dr. Ward was awarded the NVSHP President’s Award. The President’s Award is awarded annually at NVSHP President's discretion to a member making significant and sustained contributions to NVSHP. Dr. Ward was specifically recognized for representing the State of Nevada at the American Society Health System Pharmacists House of Delegates for several consecutive years, as well as her continuous contributions to the annual NVSHP Student Symposium. Established in October 2006, NVSHP has diligently worked on continuing the strong foundation developed to better meet the needs of health-system pharmacists in Nevada. The organization was established on a strong mission statement that enables Nevada's pharmacists to be heard, from all regions of the state and in one collective voice to advocate for patient care. Are you interested in working with this award-winning team? The Renown Health Pharmacy is hiring for multiple roles, including pharmacy technician and clinical pharmacist. For more information, visit careers.renown.org. About Renown Health Renown Health is the region’s largest, locally governed, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. With a diverse workforce of more than 6,500 employees, Renown has fostered a longstanding culture of excellence, determination and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the region’s largest, locally owned not-for-profit insurance company, Hometown Health. Renown is currently enrolling participants in a community-based genetic population health study, the Healthy Nevada Project®.
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Renown Children's Hospital Announces 2023 Children's Miracle Network Champion Child
Renown Children’s Hospital and Children’s Miracle Network Hospitals (CMNH) are excited to announce Shaylie Edwards as the 2023 Champion Child. A fighter from a young age, seven-year-old Shaylie has overcome many challenges in her short life. In 2019 when she was three, Shaylie was hit by a car while using a crosswalk with her father. She was admitted to the Wilbur D. May Pediatric Intensive Care Unit (PICU) at Renown Children’s Hospital and stayed there for three months. A video introducing Shaylie and her journey can be found here. Shaylie’s mom, Erica Edwards reports that as a result of the accident, Shaylie has been treated by Renown Children’s Hospital physicians, nurses and team for a broken neck in two places, a broken jaw in two places, a fractured sacrum, a broken femur and three small brain bleeds. She has been in outpatient therapy for the last three years and continues making strides daily. “Shaylie’s perseverance, dedication and joy inspires all of us at Renown Children’s Hospital,” said Kristina Deeter, MD, MBA, FAAP Physician-in-Chief, Renown Children’s Hospital and Chair of Pediatrics, University of Nevada, Reno School of Medicine,” (pictured right with Shaylie). “It has been an incredible joy to witness her progress and to care for Shaylie and her family. We are thrilled she has been chosen to share her story with the world.” The New England Journal of Medicine cites preventable injuries as the number one leading cause of death among children. This includes motor vehicle accidents, firearm injuries, drowning, poisoning, burns and suffocation. According to Safe Kids Worldwide, an average of 155 children under the age of 10 die every year as a result of pedestrian injury, with 64% of those involving motor vehicles. Across the U.S., due to distracted driving, a pedestrian is killed every two hours and injured every seven minutes. Most drivers feel they can safely take their eyes off the road for 0-2 seconds, but a car can travel the length of a football field in 5 seconds at 55 MPH. Shaylie’s family and the team at Renown Children’s Hospital urge drivers to be fully aware and eliminate distractions while driving. “We were in the Wilbur D. May PICU for three months and the first five days were very iffy. We did not know if she would come out of her coma, but Shaylie is a fighter. The care team at Renown Children’s Hospital made me feel at home and like we were all going through this together,” said Shaylie’s mother, Erica Edwards. “Shaylie’s recovery was a collaboration between doctors, nurses, and our family. Together we were there to support Shaylie, who has proven to us repeatedly that she has a greater purpose in life.” “It was heartwarming to meet Shaylie and her family,” said Dr. Brian Erling, MBA, CEO of Renown Health. “Shaylie is truly a champion! She and her family have faced life's unanticipated events with strength and resilience. Despite the struggles, they have carried on with hope and determination. They find joy in life every day and inspire us all. We have much to learn from their example.” Through Renown Children’s Hospital, Shaylie and 100,000 area children now have access to more than 60 pediatricians, including those specializing in adolescent medicine; anesthesia; cardiology; craniofacial surgery; dentistry; ear, nose and throat conditions; emergency medicine; endocrinology; gastroenterology; general pediatrics; hospitalist medicine; intensive care; neonatology; neurology; oncology; ophthalmology; orthopedics; psychiatry; psychology; pulmonology; surgery; urology and other subspecialties previously lacking in the community, as well as a pediatric emergency room, pediatric ICU and contemporary healthcare services at Renown Children’s Hospital. Prior to 2016, about 30% of all pediatric patients had to leave northern Nevada to receive the specialty care they needed. Now, thanks to donor support, Renown estimates that 97% of all pediatric patients and their families can receive both general and specialty pediatric care locally. The next nearest children’s hospital in the state is 7 hours or 438 miles away in Las Vegas. Renown Children’s Hospital is proud to be the only CMNH hospital in northern Nevada, one of only 170 premier children’s hospitals in North America. Shaylie will serve as Renown Children’s Hospital’s CMNH Champion Child for the next year, shining as the face of the hospital in the community and sharing her inspiring story. Renown Health Foundation oversees the local CMNH programs and its fundraising. One hundred percent of all funds raised by CMNH partners stay local to support children and families in our community. Your generous support affords much-needed items to help our littlest patients cope with the potential stressors associated with hospitalization and illness. To donate, visit www.renown.org/donate. About Renown Health Renown Health is Nevada’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the locally owned not-for-profit insurance company, Hometown Health. Renown is hiring people like you. Visit us at www.renown.org/careers. About Children’s Miracle Network Hospitals Children’s Miracle Network Hospitals® raises funds and awareness for 170 member hospitals that provide 32 million treatments each year to kids across the U.S. and Canada. Donations stay local to fund critical treatments and healthcare services, pediatric medical equipment, and charitable care. Since 1983, Children’s Miracle Network Hospitals has raised more than $7 billion, most of it $1 at a time through the charity's Miracle Balloon icon. Its various fundraising partners and programs support the nonprofit's mission to save and improve the lives of as many children as possible. Find out why children's hospitals need community support, and learn about your member hospital, at www.renown.org/CMNH.
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