So Much STI Data: Information to help you stay current and informed – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-25-030-H01-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

The material presented here does not necessarily reflect the views of The University of Connecticut School of Pharmacy or its co-sponsor affiliates. These materials may discuss uses and dosages for therapeutic products, processes, procedures and inferred diagnoses that have not been approved by the United States Food and Drug Administration. A qualified health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education participants should verify all information and data before treating patients or employing any therapies described in this continuing education activity.

1.) A 19-year-old female is at the clinic. She had recent unprotected sexual intercourse with her partner. She has not had any previous STI screenings. Which STIs are indicated for screening at this time?
a. HIV, gonorrhea, and chlamydia
b. Gonorrhea, chlamydia, and syphilis
c. Chlamydia, syphilis, and HPV

2.) Which of the following STIs have shown a continued increase in incidence based on 2023 data?
a. Congenital syphilis
b. Gonorrhea in the population
c. Chlamydia cases in men

3.) After completing gonorrhea treatment, when should a clinician re-screen the patient?
a. 1 month after completing treatment
b. 3 months after completing treatment
c. 1 year after completing treatment

4.) What is the guideline-based treatment recommendation for a 200 lb male patient with a confirmed gonorrhea and chlamydia co-infection?
a. Ceftriaxone 500 mg IM x 1 and azithromycin 1000 mg PO x 1
b. Ceftriaxone 250 mg IM x 1 and doxycycline 100 mg PO BID x 7 days
c. Ceftriaxone 500 mg IM x 1 and doxycycline 100 mg PO BID x 7 days

5.) Which population should receive seven days of treatment with metronidazole for trichomoniasis?
a. Young males 15 – 24 years old
b. Males 25 – 45 years old
c. Females of any age

6.) A pregnant patient is positive for primary syphilis. What is the guideline recommended treatment for her?
a. 2.4 million units benzathine penicillin G IM x 1
b. 2.4 million units benzathine penicillin G IM x 3 weekly doses
c. 100 mg PO doxycycline 2 time daily doses for 28 days
7.) Which of the following is a newly approved type of product that will increase patient access?
a. OTC bacterial Pre-Exposure Prophylaxis
b. OTC home screening tests for STIs
c. OTC HIV Post Exposure Prophylaxis

8.) What should pharmacists warn healthcare providers about regarding possible alternatives during a shortage of Bicillin LA for syphilis?
a. Impact of HIV cases
b. Adverse effects from the frequent use of the medication
c. Antimicrobial resistance

9.) You are working with emergency department physicians to manage a shortage of ceftriaxone. One concern is the treatment of gonorrhea. Which of the following would be a stewardship principle applied to this STI management choice?
a. Use the most recent antibiotic approved for the indication
b. Use alternative based on narrowest effect spectrum and incorporating local resistance data, if known
c. Choose an alternative that will also cover other STIs just in case

Patient Safety: Anticoagulation Stewardship: Identifying Key Data, Avoiding Errors, and Enhancing Safety – RECORDED WEBINAR

Learning Objectives

Differentiate high-priority, practice-changing information from less relevant or conflicting data after reviewing the anticoagulation guidelines, literature and clinical updates.

Recognize common anticoagulation-related errors in pharmacy practice and implement strategies to minimize patient safety risks

Identify red flag situations in anticoagulation management that pose patient safety risks.

Determine the appropriate guidelines or evidence-based resources to guide clinical decision-making and referrals

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-25-029-H05-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

1. Which of the following BEST represents a high-priority takeaway from current guideline recommendations for DOAC use in atrial fibrillation?
a) DOACs are preferred over warfarin in all patients with AF
b) Apixaban is the only DOAC that does not require renal dosing adjustments
c) DOACs should not be used in patients with mechanical heart valves

2. A 68-year-old male with nonvalvular atrial fibrillation (weight 60 kg, age 78) and SCr 1.4 mg/dL is started on apixaban. Which of the following would be considered a dosing error?
a) apixaban 5 mg BID
b) apixaban 2.5 mg BID
c) warfarin with a target INR of 2–3

3. A 55-year-old female patient with atrial fibrillation (weight 75 kg, SCr 1.6 mg/dL) and recent MI has been taking apixaban 5 mg BID, clopidogrel 75 mg daily, aspirin 81 mg daily, and pantoprazole 40 mg for the past 7 months. Which of the following should be considered a red flag that would prompt pharmacist stewardship at this point?
a) Use of aspirin in combination with DAPT
b) Use of clopidogrel in a patient with CAD
c) Use of apixaban for stroke prevention at the incorrect dose

4. You are managing a patient with cirrhosis (Child-Pugh Class B) who requires anticoagulation for VTE. Which of the following is the most appropriate course of action?
a) Prescribe rivaroxaban using its complete prescribing information recommendation
b) Refer to hepatology/hematology to discuss bleeding risk and treatment alternatives
c) Use warfarin because it’s always the safest anticoagulant in liver disease

5. A patient newly started on warfarin reports they “just stopped eating leafy greens” to be safe. What is the best pharmacist action?
a) Encourage the patient to continue avoiding all vitamin K-containing foods
b) Educate that consistent vitamin K intake is more important than avoiding it
c) Schedule weekly INR checks and adjust the warfarin dose aggressively

Information overload in Chronic Coronary Disease – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-25-028-H01-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

1. A female patient is interested in lifestyle modification. Which of the following would you recommend?
a. Switch from EVOO to coconut oil
b. Switch from smoking weed to “doing” crystal methamphetamine
c. Limit alcohol to a maximum of 1 drink a day

2. A patient with CCD is determined to have “high risk” of experiencing an ASCVD event. The patient cannot receive high- or even moderate-intensity statins due to a history of significant rises in liver enzymes 8-10 weeks after initiation on two occasions. Which is true of the patient’s recommended lipid regimen?
a. The patient needs high-intensity statin regardless of the liver issues and ezetimibe should be added if the LDL on the statin is over 70mg/dL
b. The patient could receive a low intensity statin + a PCSK9 inhibitor and if the LDL remains over 70mg/dL, ezetimibe can be added
c. The patient could receive a PCSK9 inhibitor and if the LDL remains over 70mg/dL, ezetimibe can be added

3. Why can’t metoprolol tartrate be used to terminate a new onset angina pectoris event?
a. Because the onset of action is 30 minutes, and the maximum effect is felt 2 hours after ingestion
b. Because I am a pharmacist and I said so, that’s why
c. Because metoprolol does not work on the coronary arteries and only coronary dilators can be used for acute angina pectoris events

4. A student is explaining the PPCP process to you. Which of the following statements would you question and ask the student to research?
a. The PPCP process helps structure an assessment to be sure that important drug related problems are all included
b. Major pharmacy organizations agreed upon this process to show regulators, clinicians, patients, payers and insurers our unique patient services
c. “PPCP” is an old term; major professional organizations have replaced it with the subjective-objective-assessment-plan process

5. When would it be useful to recommend nitroglycerin spray instead of sublingual nitroglycerin?
a. In a patient taking an anticholinergic
b. In a patient taking an SSRI
c. In a patient taking benzodiazepines

6. JP is a patient who has rheumatoid arthritis and chronic coronary disease. He has an hsCRP test taken and the level is 7.2 mg/dL. Would this patient be a candidate for colchicine therapy according to the AHA/ACC Guideline and why or why not?
a. Yes, colchicine should be used in all people with elevated hsCRP
b. Yes, colchicine should be used in all patients regardless of hsCRP
c. No, specific disease modifying antirheumatic drug are used in patients with RA

7. AT is a patient with heart failure with reduced ejection fraction, who also has chronic coronary disease. Would an SGLT2 inhibitor or a GLP-1 agonist be preferred for the treatment of this patient?
a. Neither drug should be used at all
b. The SGLT-2 inhibitor would be preferred
c. The GLP-1 agonist would be preferred

8. WC is a patient who just had a PCI procedure but also has atrial fibrillation and is treated with rivaroxaban. What is the proper regimen to prevent stent occlusion?
a. Clopidogrel + aspirin + rivaroxaban for one month, then clopidogrel + rivaroxaban for 5 months, then just rivaroxaban alone thereafter
b. Clopidogrel + aspirin + rivaroxaban for six months, then clopidogrel + rivaroxaban for 6 months, then just rivaroxaban alone thereafter
c. Clopidogrel + aspirin + rivaroxaban for 12 months, then rivaroxaban + clopidogrel then rivaroxaban for 6 months, then rivaroxaban alone

Information overload to action: Decoding academic concepts for pharmacy preceptors- RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-25-026-H04-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

1. Joey is an IPPE student under your supervision this month. He observes as you meet with a patient who has a question about various options to treat psoriasis. You tell the patient you will get back to him about medications covered by his plan, out of pocket costs, the time burden associated with treatment, and potential adverse effects. Joey wants to help. What can Joey do?
A. Collect information, asking for help if or when he needs it
B. Observe how you collect information but assess independently
C. Collect information only under direct and proactive supervision

2. Phoebe is an APPE student in her first clinical rotation. She aspires to obtain an industry fellowship and hopes to receive the best grade possible on this rotation with the least work. She says, "I don't plan to work in a clinical position, so this is not a priority for me. What is the BEST answer?
A. The PPCP is not just applicable to clinical situations. It structures processes for all kinds of projects, not just clinical challenges.
B. Most students who aspire to work in industry do not get fellowships, and you need to know the PPCP if you land in an actual pharmacy.
C. Say nothing. Allow Phoebe to do minimal work.

3. Rachel is on her last APPE rotation before graduation. YAY! She works up a patient who has a cardiac issue. She collects a lot of appropriate information, and her assessment is almost perfect. She makes one statement that seems "off" to you. She recommends using a medication that is no longer first-line treatment. What is the MOST LIKELY cause for her omission?
A. She relied on only one guideline for evidence
B. She collects too much information and is confused
C. She is hyper-focused on cost, not effectiveness

4. Joey is now an APPE student on a general medicine rotation. You assign him a patient to review for your discussion this afternoon. When Joey joins you, he provides background information on the patient, reports on the physical notes, pertinent laboratory values and his conversation with the patient. What step of the Pharmacist Patient Care Process is Joey demonstrating?
A. Collect
B. Assess
C. Plan

5. Ross, an APPE student on your ambulatory care rotation, is writing up a SMART goal for his patient with diabetes. The goal reads “Reduce the patient’s blood glucose within six months. Patient will start metformin XL 500mg PO daily and follow up with the pharmacy team for titration every seven days. Reduction in the patient’s A1c will lead to better health outcomes and reduce the severity of complications from his diabetes.” What part of the SMART goal is Ross missing?
A. Specific
B. Measurable
C. Realistic

6. What is the performance goal for a “practice ready” APPE student in terms of level of entrustability on each of the entrustable professional activities (EPAs)?
A. Direct supervision
B. Reactive supervision
C. General Direction

Law: Understanding Disabled Pharmacy Patients’ Right to Nondiscrimination-RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-25-027-H03-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

1. What was Congress’ purpose when it wrote the definition of “individual with a disability”:
A. To make it easier for people with disabilities to be covered by federal law
B. To restrict coverage to people with certain medical diagnoses
C. To only cover people with physical impairments

2. When may a pharmacist refuse to administer the flu shot to a person with HIV?
A. If the patient is in a rehabilitation program for using illegal drugs.
B. If the patient hasn’t made an appointment ahead of time and all patients must make appointments ahead of time.
C. If special gloves are not available for administering shots to people with communicable diseases.

3. A patient enters the pharmacy with a dog, and you are not sure if it’s a service animal or not. Which of the following questions may you ask the patient?
A. What is the nature and extent of your disability?
B. Do you need the dog to be present because of a physical, sensory, psychiatric, intellectual or other mental disability?
C. Is the dog required because of a disability?

4. A patient enters the pharmacy with a dog. When you ask what tasks the dog has been trained to perform, the patient says that it is a comfort animal and has undergone no training. Can you ask the patient to leave and come back without the comfort animal?
A. No, because comfort animals are considered service animals under federal law.
B. Yes, because comfort animals are not protected by federal law.
C. No, because that would be discrimination.

5. A patient enters the pharmacy with a bulldog. When you ask if the patient needs the bulldog because of a disability, the patient says yes. Can you exclude the bulldog?
A. No, because a service animal cannot be excluded based solely on its breed.
B. Yes, because bulldogs are known to be aggressive.
C. Yes, because the patient has not disclosed their specific disability in response to your question.

6. If a patient enters the pharmacy using a mobility device, a pharmacist is permitted to inquire about which of the following?

A. The nature and extent of the patient’s disability.
B. What paperwork the patient has with them to prove that the mobility device has been serviced recently.
C. Whether the mobility device is needed because of the patient’s disability.

Law: People are not Cows and Off-label Prescribing is Utterly Different – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-24-018-H03-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

1. Off label drug uses generally do not become on-label uses. What is a primary reason for this?
A. There is a financial disincentive to manufacturers.
B. The FDA has no easy mechanism to accomplish this.
C. Manufacturers want to emphasize their drug’s primary.

2. You have a sick cow. Which of the following is correct about the type of drug that can be used for treatment?
A. Any drug approved by the FDA for human use.
B. A drug approved for use in chickens if there is no comparable drug approved for cows.
C. A drug that can be compounded by a pharmacist and added to the cow's feed.

3. What category of drugs has the highest rate of off-label use? (Prior to the pandemic.)
A. Anti-seizure drugs
B. Anti-depressants
C. Antibiotics
4. Why does the FDA take a hands-off approach to off-label use?
A. The FDA is not permitted to prevent manufacturers from touting an unapproved use once a drug has been approved.
B. The FDA does not regulate the practice of medicine.
C. The FDA can only act after it receives information of unintended consequences from off-label use.

5. When may a pharmacist recommend an OTC human drug for an animal?
A. Under any circumstances so long as it is not a food animal.
B. When there is no comparable veterinary product available.
C. A pharmacist may not recommend a human OTC drug for use in an animal.

6. Which of the following is a notable risk associated with illicit use of xylazine?
A. Naloxone-resistant overdose
B. Whole body rash and desquamation
C. Respiratory depression

7. The FDA was sued for publishing a warning about the off-label use of ivermectin for COVID. What was the basis of the lawsuit?
A. The FDA cannot prevent physicians from prescribing a drug off-label and need not issue warnings.
B. The FDA's warning on ivermectin was erroneous and used misplaced humor to try to sway opinions.
C. In publishing warning overstepped the FDA’s authority and interfered with the doctor-patient relationship.

Compounding: Go Hog Wild: Creative (and Informed) Veterinary Compounding – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-24-019-H07-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

1. Farmer Brown's large Maine Coon cat needs fluoxetine. Considering size, anatomy, and skin absorption, which animal would require a similar dose of fluoxetine transdermal gel?
A . A small terrier dog
B. A medium sized sphinx (hairless) cat
C. A large barn owl

2. Meow-Meow is a domestic American cat. She weighs 6.3 pounds, although she needs to gain at least 3 pounds. She needs medication for her heart condition, and the veterinarian wants to prescribe lisinopril 0.25 mg/kg once daily. YIKES! You calculate that Meow-Meow weighs 2.9 kg and needs a dose of 0.725 mg of lisinopril. Can you compound this dose?
A. No, the veterinarian needs to find a different medication
B. Yes, but it would be easier to give 1.5 mg every other day
C. Yes, because a commercial product is unavailable in this strength

3. Your 30-pound hound, Bosco, is begging to eat the food you left on your plate after dinner. In keeping with your house rule never to feed the dog from the table, you take your plate to the sink and get Bosco’s bowl. Which of the following things should you throw in the trash rather than feed to Bosco?
A. The piece of grilled, boned ribeye steak
B. The grapes and raisins on the salad
C. The plain baked potato with yogurt

4. Your client, Venice Marriot, needs to have a medication compounded for her teacup chihuahua Tokyo. She indicates that she and Tokyo prefer medications that are pink. After discussing the pros and cons of compounding with color, which food coloring should you use to make a pink oral solution?
A. Natural beet extract
B. FD&C Red No. 3
C. Neither

5. Which of these basic oral paste formulas would be best to use for Farmer Brown’s cat?
Ingredient Formula 1 Formula 2 Formula 3
Polyethylene glycol 300 65 grams 25 grams
Polyethylene glycol 3350 35 grams 25 grams 25 grams
Propylene glycol 50 grams 25 grams
Molasses (for horses) 50 grams

A. Formula 1
B. Formula 2
C. Formula 3

6. Which flavoring would be best suited for a picky Emperor penguin at Mystic Aquarium?
A. Orange or mango flavoring
B. Sardine or tuna flavors
C. Beef or liver flavoring

7. What Is the BEST way to improve pharmacy personnel’s knowledge of veterinary medications?
A. Pharmacies can be sure to have a veterinary drug handbook at the pharmacy and that the computer system flags veterinary precautions.
B. Pharmacists can complete a continuing education activity on veterinary pharmacy and require all other staff members to take it also.
C. Pharmacy owners and systems can take out extra liability insurance and pray that nothing happens to any animal that receives a prescription from their pharmacies.

Patient Safety: Teaching Old Dogs New Tricks: Dispensing for Companion Animals in Community Pharmacy – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-24-020-H05-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

The Human-Animal Bond: How Close Is Too Close? – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-24-021-H01-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

The Human-Animal Bond: How Close is Too Close?

Recognize and describe different zoonotic diseases: Rabies, Lyme Disease, Ringworm (Dermatophytosis), Leptospirosis, Giardia, and Toxoplasmosis
Describe method of transmission of each disease
List the treatment of each disease (if possible)
Indicate the species of animal that can harbor the disease
Describe how to prevent the disease

1. At what age is the earliest a dog or cat can receive the rabies vaccination?
A. 8 weeks
B. 6 months
C. 12 weeks

2. What is the symptom of Lyme Disease in dogs that owners tend to notice first?
A. Shifting lameness
B. Vomiting
C. Increased thirst and urination (PUPD)

3. What is the best way to prevent most zoonotic infections?
A. Avoid wildlife
B. Use essential oils
C. Wash your hands

4. What antibiotic do veterinarians use most often to treat Spirochete bacterial infections?
A. Doxycycline
B. Clindamycin
C. Amoxicillin-clavulanic Acid

5. How are most zoonotic intestinal parasites are spread?
A. Aerosolized
B. Infection through break in the skin
C. Fecal-oral

6. What zoonotic disease causes an itchy, circular red lesion on the skin?
A. Lyme disease
B. Ringworm
C. Leptospirosis

7. What species most commonly carries toxoplasma?
A . Cats
B. Dogs
C. Ferrets

Animal Models of Disease: Barking up the Right Tree – RECORDED WEBINAR

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and Pharmacy Technicians are eligible to participate in this application-based activity and will receive 1.0 CE Hour for completing the activity (ACPE UAN 0009-0000-24-022-H01-P), passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor online system and your participation will be recorded with CPE Monitor within 72 hours of submission.

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts

Post Test Pharmacist

Learning Objectives

Accreditation Statement

Grant Funding

Faculty

Faculty Disclosure

Disclaimer

Content

Handouts