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OBJECTIVE: To determine incidence and risk factors of post-sterilization hyphema in shelter cats. ANIMALS STUDIED: Retrospective medical record review of 1,204 cats and prospective screening of 195 cats. PROCEDURES: The study consisted of 3 parts: (1) Survey responses were collected from 20 veterinarians, who perform high-quality high-volume spay-neuter (HQHVSN) in both shelter and public clinic settings. (2) Medical records of 1,204 cats were analyzed retrospectively over a 14-month time period. (3) Ophthalmic examinations, including tonometry, were performed prospectively on 195 cats before and after sterilization surgery over 8 weeks. RESULTS: Nine of 20 surveyed veterinarians reported having witnessed hyphema in cats following sterilization surgery. Retrospective review of 1,204 medical record and prospective screening of 195 cats showed that 3 juvenile (1 year of age) cats, respectively. CONCLUSIONS: Survey responses and 3 observed cases confirm the existence of feline post-sterilization hyphema with an estimated incidence of 0.2%. The underlying mechanism for this occurrence remains unknown.

Background and Objectives: Family physicians play a crucial role in addressing the opioid epidemic. We studied a novel peer-review opioid prescribing educational intervention for family medicine residents that incorporates guided instruction from an interdisciplinary care team. Methods: We used a mixed-methods study design in the setting of a family medicine residency program in the Midwestern United States. Residents participated in small group, peer-to-peer discussions of patients chronically prescribed opioids with guidance and input from faculty, a pharmacist, and pharmacy students. Discussions followed a structured approach to evaluation based on guidelines, and written recommendations were given to the patients’ resident primary care physician (PCP). For each patient, we reviewed electronic medical records to assess whether PCPs implemented the written recommendations. We used one-way analyses of variance to determine the statistical significance of changes made. The principal investigator interviewed seven participating residents to survey their satisfaction with the curriculum and collated suggestions for improvement. Results: Over a 3-year period, we reviewed 59 patients as part of the intervention; of these, 53 had complete records reviewed for this study. Patients’ morphine milligram equivalent dosage (MME) declined modestly (P=.035). The number and proportion of recommendations implemented was correlated with the decline in MME (P=.004 and P=.013, respectively). Interviewed residents unanimously evaluated the curriculum positively, citing that the structured approach helped align their practices with guidelines. Conclusions: The guided peer-review intervention effectively decreased chronic opioid use among patients, and residents positively evaluated the curriculum.

Background As pharmacists assume a larger role in prenatal and preconception care, providing an evidence-based recommendation for a prenatal vitamin is essential. Objectives To identify the prenatal vitamins that community pharmacists are recommending to patients and compare the contents with national and international standards. The secondary objectives were to compare responses between the type of pharmacy (chain, grocery, or independent) and region of Michigan. Methods A female student pharmacist posing as a patient anonymously interviewed 60 community pharmacists distributed across 5 different regions of Michigan through telephone to determine prenatal vitamin recommendations for preconception use. The regions of Michigan were included to determine if sociodemographic factors were associated with varying responses or recommendations. Results Of the pharmacists interviewed, 97% recommended a prenatal vitamin, with 81% recommending an over-the-counter (OTC) prenatal vitamin. Only 33% of the pharmacists provided a specific brand name. Folic acid was the most common ingredient that the pharmacists identified to look for in a prenatal vitamin, followed by docosahexaenoic acid and iron. No difference was detected in the pharmacist responses across type of pharmacy (chain, grocery store chain, or independent). A difference was found between regions of Michigan and recommendations for a specific prenatal vitamin brand (P = 0.017). Conclusion Most of the community pharmacists recommended an OTC prenatal vitamin with an adequate amount of folic acid. Considering the broad range of prenatal vitamins on the market, a clear recommendation from a pharmacist about a specific prenatal vitamin that contains adequate nutrients is paramount. Expanding the knowledge and understanding of key prenatal vitamin ingredients and availability may strengthen future recommendations.

Objectives The objectives of this study were to determine the prevalence of canine infectious respiratory disease pathogens among asymptomatic client-owned dogs, and to compare the risks of asymptomatic pathogen carriage between client-owned dogs and dogs in an animal shelter. Materials and methods Pooled tonsillar, conjunctival and nasal cavity swabs from asymptomatic client-owned dogs (n=133) were tested using a real-time polymerase chain reaction canine respiratory panel. Identical samples from asymptomatic dogs in an animal shelter (n=295) were similarly tested for selected pathogens. Risk differences were calculated between client-owned dogs and shelter dogs for each of the respiratory pathogens included in the analyses. Results A total of 15 of 133 (11.3%) asymptomatic client-owned dogs were positive for at least one pathogen in the complex. Seven dogs (6.1%) were positive for M. cynos, six (5.2%) were positive for B. bronchiseptica, two (1.7%) were positive for canine herpesvirus type 1 and two (1.7%) were positive for canine respiratory coronavirus. For all eight pathogens tested in both groups, the proportion of positive cases was higher among shelter dogs than among client-owned dogs. Shelter dogs had a higher risk for M. cynos (0.18, 95% confidence interval: 0.12 to 0.25), canine respiratory coronavirus (0.15, 95% confidence interval: 0.10 to 0.19), canine distemper virus (0.06, 95% confidence interval: 0.03 to 0.09), and canine pneumovirus (0.05, 95% confidence interval: 0.03 to 0.08) than client-owned dogs. Odds ratios for M. cynos (0.31, 95% confidence interval: 0.08 to 0.92) and canine respiratory coronavirus (0.05, 95% confidence interval: 0.01 to 0.18) were significantly different between client-owned and shelter dogs. In all cases except for canine herpesvirus type 1, dogs within the shelter population were observed to be at higher risk of exhibiting asymptomatic carriage of a respiratory pathogen as compared to client-owned dogs. The strength of this association was strongest for M. cynos and canine respiratory coronavirus. Clinical significance The risk of canine infectious respiratory disease pathogen exposure posed by asymptomatic client-owned dogs is poorly defined. This study also corroborates previous reports of high canine infectious respiratory disease prevalence among clinically healthy shelter dogs, and further determined that the overall prevalence of canine infectious respiratory disease pathogen carriage among clinically healthy client-owned dogs is low but is highest for the traditional pathogen B. bronchiseptica and the emerging pathogen M. cynos.

The Michigan Society of Health-System Pharmacists (MSHP) held a Pharmacy Practice Model Initiative Michigan conference (PPMI[2][1]) in October 2011 after the ASHP Pharmacy Practice Model Summit.[1][2],[2][1] After the PPMI[2][1] conference, the 2013 MSHP board of directors (BOD) identified a need to

This November, New Yorkers will have the authority to call a constitutional convention. A constitutional convention is a special body that convenes to propose changes to how our government works, as well as rights and protections granted to the people. New York is one of a handful of states that possess this constitutional clause and something that comes out of a Jeffersonian view that state constitutions should be revisited every “nineteen or twenty years” or for “periodic repairs.” The last time a convention was approved by voters was in 1967. It is imperative to provide as much information to the public so they may make an informed decision. That is why the Rockefeller Institute of Government, with other stakeholders, is working to educate New Yorkers on what it means to hold a constitutional convention, as well as the other specific changes to the constitution. As an educational organization, we have no position on the constitutional convention or other individual constitutional amendments on the ballot. In the following pages, we offer an overview of the process, benefits, and challenges to convening a constitutional convention, and, finally, various perspectives on the issue — those who support, those who are against, alternative pathways to reform, and potential agendas and issues to be considered at a convention.

Sixty percent of all contaminants responsible for dirt defects on painted surfaces are brought into the paint booth by personnel. Lint causes more than half of those defects. Lint fibers are shed from street clothes, hats, gloves, and coveralls. Fibrous lint is a unique dirt source since it is continuously generated and has good air transport due to its low settling rates. Even lint-resistant coveralls become contaminated with loose fibers when donned over street clothes. Air showers, when properly designed and used, will remove loose dust, lint, and dirt from personnel at the entry points to contamination-controlled areas. This source control device adds value to the painted product by significantly reducing surface defects; in addition, it saves money for the manufacturer by eliminating costly rework.

Purpose The efficacy and safety of glucagon-like peptide (GLP)-1 receptor agonists for weight loss in adult patients without diabetes is reviewed. Summary GLP-1 receptor agonists have been associated with significant weight loss in patients with diabetes, raising the question of whether these agents could be used for weight loss in patients without diabetes. The mechanism by which GLP-1 receptor agonists induce weight loss is believed to be related to multiple actions involving the brain and gastrointestinal tract, with the primary action related to an increase in satiety. Trials examining the effects of GLP-1 receptor agonists for weight loss have compared exenatide, liraglutide, and orlistat. Of the studies completed to date, the majority of patients have been enrolled in trials involving liraglutide. Based on the reviewed literature, both exenatide 10 μg twice daily and liraglutide in dosages of up to 3 mg daily resulted in significant weight loss in patients without diabetes. A decrease in the proportion of patients with prediabetes was also found in studies of liraglutide. Nausea and vomiting were the most frequently reported adverse events in patients from these studies. Symptomatic hypoglycemia was reported in only one study with liraglutide in patients without diabetes and was not objectively confirmed by laboratory data. A higher frequency of psychiatric disorders, specifically insomnia, was reported by patients taking high doses of liraglutide. Conclusion GLP-1 receptor agonists offer a reasonable alternative for nondiabetic patients not able to achieve weight-loss goals with lifestyle modifications alone.

Despite significant reductions over the past 45 years in the percentage of individuals smoking cigarettes, tobacco-related illnesses remain the leading cause of preventable death in the United States. Although the health risks of tobacco use have been clearly outlined, addiction to nicotine traditionally has been one of the more challenging habits to break. Seven first-line therapies to treat tobacco use and dependence are available; however, annual quit rates remain surprisingly low, suggesting that continued research and development in the area of smoking cessation are warranted. In an attempt to improve long-term quit rates and blunt the reinforcing effects of nicotine in the brain, the nicotine conjugate vaccine was developed as a novel approach for the treatment of nicotine dependence. Vaccine administration produces nicotine-specific antibodies that bind to nicotine from exogenous sources, creating a large unit that is not able to cross the blood-brain barrier, which limits the rate and extent of nicotine absorption into the brain. Results of clinical trials indicate that individuals achieving high nicotine-specific antibody levels with the nicotine conjugate vaccine have greater success with smoking cessation at 12 months compared with those with lower levels. Adverse effects associated with the nicotine conjugate vaccine have been primarily mild and localized in nature, with minimal systemic effects. The most commonly reported adverse effects include tenderness and ache at the injection site, general discomfort, headache, and muscle ache. Awaiting results of phase III trials, the true clinical utility of the nicotine conjugate vaccine is yet to be realized, although this investigational vaccine represents a distinctive administration model that may improve patient adherence and increase the ability to achieve abstinence from cigarette smoking.

P162 Background: rt-PA is the only currently available FDA approved therapy for acute ischemic stroke. We sought to determine the type and frequency of challenges/barriers to offering this therapy 4 years after FDA approval. Methods: We performed a systematic survey in April, 2000 of all 34 hospitals in the Detoit Metropolitan area (population 3.9 million people) that have an acute care emergency facility. A standardized, structured questionnaire/interview was conducted with the directors of the emergency facilities. Questions included: volume of stroke, priority of care given, relationship with Emergency Medical Services (EMS), use of protocols, pathways, and NIH Stroke Scale,time to processes and personnel involved. Surveys were returned, data was tabulated and analyzed descriptively. Results: All 34(100%) of the hospitals responded and wished to participate. While EMS called the Emergency Department(ED) prior to their transport of a suspected stroke patient in 28 centers (82%)only 19 centers (68%) utilized this information to expedite the care of the stroke patient. Stroke patients are given top priority for CT scanning in only 22 centers (64%). The range of times from ED arrival to CT scan performance ranged from 5 minutes to one hour. CT technicians are available 24hrs/day in-house in 56%. In the 44% with on-call, out-of-the hospital CT technicians, time to their arrival ranges from 30–60 minutes. Only a radiologist reads the CT in 18 Hospital, ED physicians review the CT in 15 and only a neurologist in 1. Only 10 (30%) collected data on stroke patients in the ED. Once the patient is considered for treatment with rt-PA, the number of physicians involved in the process varied from 1 to 3. Most commonly involved were a neurologist (22 centers) and ED physicians(at nearly all the centers). Stroke teams were involved at only two hospitals. If more than one physician is involved the average response time is 27 minutes. An NIHSS is performed in 53% of the hospitals. Conclusions: While considerable progress has been made in many Detroit-area hospitals to deliver rt-PA therapy for acute stroke, several key process improvement areas have been identified that could increase the percentage of acute stroke patients treated with rt-PA.

The author, a family therapist whose practice is based on the theoretical orientation of Dr. Murray Bowen, has conducted two research studies, one in 1977, and one in 1982, to explore the pet's position in the family system. Pet ownership is widespread in the United States; approximately 60" of American families share their homes with one or more companion animals. Pets serve other positive purposes in the family such as a means for pleasure, fun, and exercise, as a source of physical security and protection, as a means of teaching children responsibility and a respect for life, and as a catalyst for establishing human contact and interaction. Dr. Murray Bowen considers the triangle to be the basic building block of any emotional system. A triangle is formed when the tension within a two person emotional system exceeds a certain level.