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L. Hernando, M.B. B.A.O., M.B.B.Ch., Ph.D.
Program Director, Duquesne University College of Osteopathic Medicine
B, shows aggressive odontoplasty with complete removal of the cingula (red arrows) and transverse ridge (green arrow). Effect of dental floating on weight gain, body condition score, feed digestibility and fecal particle size in pregnant mares. Effect of rostrocaudal mobility of the mandible on feed digestibility and fecal particle size in horses. Evaluation of sedation and analgesia in standing horses after administration of xylazine, butorphanol, and subanesthetic doses of ketamine. A new understanding of oral and dental disorders of the equine incisor and canine teeth. Evidence-based veterinary dentistry: A systematic review of homecare for prevention of periodontal disease in dogs and cats. Biomechanical evaluation of the equine masticatory action: Calculation of the masticatory forces occurring on the cheek tooth battery. An expansion screw device to facilitate eruption of a mandibular premolar in a horse. The maxillary cheek teeth have prominent vertical ridges (cingula or styles) along the buccal aspect. With the layering of the cementum, enamel, and dentin, these cingula give strength and support to the cheek teeth so that they are able to withstand the forces of mastication. Transverse ridges are linear cusps that run along the occlusal surface in a buccal to palatal/ lingual direction. The transverse ridges allow for an increased occlusal surface area for mastication. The combination of the enamel point, cingula, and transverse ridge allows for an enhanced tearing and shearing function with roughage/forage and an improved mastication process. Aggressive enamel point, cingula, and transverse ridge odontoplasty will weaken the dentition and reduce functional mastication. Duration of pressure is even more important than the magnitude of pressure when dealing with equilibrating orthodontic forces and tooth movement. With the increased pressures and almost constant mastication of the equine patient, orthodontic forces are continually in effect compared with other species. As a result, minor changes with odontoplasty will still have a tremendous orthodontic effect, whereas excessive odontoplasty could be devastating. An orthodontic examination should entail an accurate evaluation of how masticatory forces are effecting a Class I malocclusion. Occlusal forces can be reduced or eliminated with minimal focal odontoplasty of the involved teeth. A diagnosis should be made on a "tooth-by-tooth" basis so that a treatment plan of precise focal odontoplasty can be developed and implemented. Significant association between tooth extrusion and tooth resorption in domestic cats. A comparison of the occurrence of common dental abnormalities in stabled and free-grazing horses. Effect of premolar and molar occlusal angle on feed digestibility, water balance, and fecal particle size in horses. A retrospective evaluation of 204 diagonal incisor malocclusion corrections in the horse. How to manage maleruptions of upper fourth premolars in the miniature horse, in Proceedings. Two- and three-dimensional computed tomographic anatomy of the enamel, infundibulae and pulp of 126 equine cheek teeth. The most common factors responsible for poor quality dental radiographs are below: Patient movement Improper positioning of "standard" views Poor radiographic technique (combination of kVp and mAs) Outdated or malfunctioning radiographic equipment or imaging software 2.
Unemployment rates for visually impaired people who do not use braille is 77% compared to 44% for those who can read braille. Those who can read braille are also 3 times as likely to achieve an advanced degree. Technology has made it easy to actively convert printed or electronic information into a refreshable tactile braille output that can be read more quickly than what is possible through visual- or audio-assistive devices. Therefore, learning to read braille is important to promote as a way to improve future employment and academic success. While learning to read with a braille code takes at least as much time with skilled instruction as it takes for anyone else to learn and read visually, it would not be correct to call braille a language of its own. This is because the same braille system is used to encode many different written languages. Audio reading machines translate text into spoken words, which is the skill of listening rather than reading (reading = literacy). For those with sufficient visual ability, reading magnified print is a helpful option, but again, people can read much more text in a unit of time by reading braille. He has a history of a heart murmur as an infant and was thought to need surgery, but was not able to have that done. He is not able to participate in gym class in his new school because he gets too short of breath. On physical examination, you note that he is cyanotic, but not in any acute distress. His weight is 19 kg (sixth percentile) and his height is 122 cm (50th percentile). His heart rate is 100 beats/min, his respiratory rate is 30 breaths/min, his blood pressure is 85/45 mm Hg, and his oxygen saturation is 78% on room air. Screening laboratory test results are significant for a hemoglobin of 17 g/dL (170 g/L) and a hematocrit of 51%. The lack of the usual holosystolic murmur is consistent with equal pressures in the left and right ventricles. Both aortic stenosis and pulmonic stenosis with gradients of 60 mm Hg would cause loud systolic murmurs in the outflow tract locations at the upper sternal borders. This child in the vignette has pulmonary hypertension and the murmur in this case is a result of tricuspid regurgitation. The airplane flight made this child worse because airplanes are pressurized only to what would be encountered at 8,000 ft elevation. Since it is small, the speed of the blood across the defect will be rapid and the murmur will be loud. Most will cause a murmur by 3 to 4 weeks of age as the pulmonary vascular resistance drops. Blood may be flowing from the left to right ventricle, but it is not across a pressure gradient, so the speed of the flow is not rapid or audible. Results of surgery have become so reliable at younger ages that there is not usually any need to wait until after a year of age if closure is indicated. Pulmonary arterial hypertension in adults born with a heart septal defect: the Euro Heart Survey on adult congenital heart disease. This treatment regimen can lead to decreased bone mineral density, and is 1 of the major risk factors for osteoporosis in young patients. Osteoporosis is defined as a decrease in bone mineral mass per volume of bone tissue without evidence of mineralization defects (ie osteomalacia or rickets). This can occur in idiopathic juvenile osteoporosis and genetic connective tissue diseases such as Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta. Secondary osteoporosis may occur with neuromuscular disorders, inborn errors of metabolism, endocrine diseases, various chronic diseases, gastroenterologic and nutritional disorders, and certain medications or treatments (Item C73). The best initial step in the management of osteoporosis is control of the underlying condition, and reduction of other risk factors for bone loss. Risk factors include low body mass, undernutrition, low levels of physical activity and/or weight bearing, hypogonadism, minimal sun exposure, and other lifestyle choices such as smoking or significant soft drink intake. Patients at risk for osteoporosis should be counseled regarding nutritional and lifestyle factors, including the importance of appropriate calcium, phosphorous, and vitamin D intake. Malnutrition and undernutrition are common in many chronic conditions and should be directly addressed.
Introduction One of the most often discussed topics in the area of practice management is how does one finance the acquisition of a veterinary practice. Internal financing involves the seller of an interest in a practice providing financing. External financing involves a buyer working with a source other than the seller to provide the financing necessary to purchase an interest in a practice. These external sources can include financial institutions such as banks or other external sources such as family members. Ultimately, any financing source, whether external or internal, is going to use the cash flow from the practice as a source for the repayment of the financing they provide. This means that before any financing can be provided a buyer must be able to clearly identify how much money the practice is providing for its owners. Some practices struggle with clearly identifying how much money is being paid to the current owners that could be used to repay debt if a transfer or ownership were to occur. Internal Financing the internal financing of the acquisition of a veterinary practice typically involves the existing owner or owners selling a portion or all of their interest to existing associate veterinarians. The buyer signs a note to the seller as part, if not all, the consideration for the acquisition of the interest in the practice. This process involves several aspects including the valuation of the practice interest being acquired, the actual terms of the note the buyer is executing for the benefit of the seller, the readiness of the associate to become an owner, and the seller being "ready" to sell an interest in the practice. Valuation is always a difficult subject but in an internally financed practice acquisition it can become even more difficult. It is more difficult due to the fact that there is no outside entity involved to help determine the value of the interest being transferred. This situation potentially exaggerates the differences that a seller and buyer may have regarding the value of the interest being sold. The typical seller in this situation may have founded the practice or at a minimum has owned it for a very long time and in all likelihood has become emotionally attached to the ownership of the practice and therefore may believe the practice is worth more than can be justified using generally accepted valuation methodology. Also, a seller may have not done any advance preparation and planning for a succession and therefore they may need to get more for the practice than it is worth in order to feel secure as they move into a phase of life where they will not be making a regular income. Generally speaking, financial institutions are willing to loan money for practice acquisitions when the potential transaction meets their criteria. These criteria vary by institution but generally include some type of valuation criteria, terms of the note, security for the note, and credit worthiness of the buyer. Most financial institutions want the after-tax cash flow of the business to be able to fund all of the future payments of the note within the given term of the note. It is always prudent when working with a financial institution to explore your financial options with more than one institution. Typically, the big "national banks" will have an established criterion for financing practice ownership transactions. In fact, many of the big national banks and the big regional banks will have loan officers and departments within the bank that specialize in veterinary lending. Typically, the terms offered by the national and big regional banks seem to be better for the buyer/borrower than terms presented to the buyer/ borrower from local financial institutions. Many times, however, if presented with the big bank term sheet, the local bank will meet or exceed the terms offered by the big bank. For this reason, it is always a good idea to explore financing with multiple financial institutions and have at least one big bank and one local bank involved in the process. Financing and Cash Flow Are Connected cause of existing student debt or other financial hardship. Sometimes potential buyers simply lack sufficient training and experience to take on the duties that come with ownership. Although most of these challenges have little or nothing to do with the actual value of the practice, it does have a very real effect on the perception of the value of the practice. Without assistance from an outside advisor, whether it be a bank, accountant, or consultant, all of these potential challenges to internal financing can become amplified and potentially derail what should be a great succession opportunity. In an internally financed practice transfer, one must determine the actual terms of the note.
