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.............................. The Manitoba Pharmaceutical Association NEWSLETTER 200 Tache Avenue, Winnipeg, Manitoba, Canada R2H 1A7 Telephone (204) 233-1411 • Fax (204) 237-3468 • Email: [email protected] Website: www.mpha.ca SEPTEMBER 2012 OFFICERS Kyle MacNair, President, Carman Kristine Petrasko, Vice President, Winnipeg Geoff Namaka, Exec. Treasurer, Winnipeg Shawn Budgen, Past President, Morden COUNCILLORS Dr. Neal Davies, Dean, Winnipeg Jennifer Ludwig, Brandon Glenda Marsh, Brandon Dinah Santos, Winnipeg Kurt Schroeder, Selkirk Randall Stephanchew, Winnipeg LAY MEMBERS Donna Forbes Kim Sharman LIAISON MEMBERS Jarrid McKitrick, C.S.H.P. (MB. Branch) Melissa Gobin, Student Liaison Brenna Shearer, M.S.P. Liaison Rob Shaffer, Government Liaison .............................. Licence Renewal this Fall! To be eligible for licence renewal, practicing pharmacists are required to participate in a minimum of 25 hours of professional development (PD) learning activities by October 31st. Of the 25 hours, a minimum of 15 hours must be from accredited learning activities with a balance of 10 hours of participation in either accredited or non-accredited learning activities. Members can record their professional development hours by accessing the new online PD Log after signing into their account on the MPhA website. All relevant links are under the 'My Professional Development' tab, including a guide to using the PD Log. Please note that members may submit electronic copies of their PD Logs to MPhA for this PD year, but next year the use of the online PD Logs will be the only method to record your PD activities in order to qualify for licensure. All practicing pharmacists are required to submit their PD Logs as well as their th licence renewal applications by November 30 . If not received by November 30th, the fee for licence renewal will increase by fifty percent. In October, Council will be announcing this year's licence renewal fees. Please watch for that information in an upcoming issue of Friday Five. ASSOCIATION STAFF Ronald Guse, Registrar Susan Lessard-Friesen, Deputy Registrar Ross Forsyth, Assistant Registrar Kim McIntosh, Assistant Registrar Rem Weiss, Field Officer Ronda Eros, Professional Practice Consultant Kathy Wright, Executive Assistant Bev Robinson, Administrative Assistant Pamela Gordon, Administrative Secretary Lita Hnatiuk, Communications & Quality Assurance Secretary VISION Creating the Framework for Excellence in Pharmacy Practice MISSION To protect the health and well being of the public by ensuring and promoting safe, patient centered and progressive pharmacy practice. VALUES The MPhA activities are based on the following values and are the foundation of what we do: ~ Integrity ~ Respect ~ Excellence ~ Accountability ~ Collaboration ~ Life Long Learning included in this mailing . . . • • • Canadian Adverse Reaction Newsletters Volume 22 - Issue 3 - July 2012 NAPRA National Drug Schedules Notice Board Structured Practical Experimental Program (SPEP) Update 2011-2012 This NEWSLETTER is published by The Manitoba Pharmaceutical Association and is forwarded to every licensed pharmacist in the Province of Manitoba. Decisions of the Manitoba Pharmaceutical Association regarding all matters such as regulations, drug related incidents, etc. are published in the Newsletter. The Manitoba Pharmaceutical Association therefore assumes that all pharmacists are aware of these matters. The Manitoba Pharmaceutical Association 200 Tache Avenue, Winnipeg, MB R2H 1A7 Phone: (204) 233-1411 • Fax: (204) 237-3468 E-mail: [email protected] ......................... SEPTEMBER 2012 MPhA Newsletter ONE 1 .............................................. Pharmacy Technicians UPDATE GABAPENTIN Potential for Abuse The MPhA welcomes pharmacy technicians to our newsletter. The regulatory oversight of pharmacy technicians is an ongoing, national project that will enable pharmacists to focus on the provision of patient-centered care. Pharmacy technicians will have an expanded scope of technical roles dealing with the preparation and assessment of prescriptions. According to the British Columbia Drug and Poison Information Centre and reports from Manitoba, pharmacists need to be aware of the possibility of abuse and misuse of gabapentin. Gabapentin is used as an adjunctive therapy for epilepsy, as well as management of neuropathic pain. Therapy is initially titrated to improve tolerability of side effects and to assess effectiveness of therapy. Discontinuation of therapy must also be tapered over a period of time as patients often experience withdrawal symptoms such as insomnia, anxiety, sweating and nausea similar to symptoms of benzodiazepine withdrawal. The MPhA recently made a revision to our website to include information related to pharmacy technicians. Found on the “Pharmacy Practice” page of the MPhA website, the “Pharmacy Technicians” section has been updated with the following: • Requirements for becoming a pharmacy technician under the December 2006 Pharmaceutical Act; • a Frequently Asked Questions section related to pharmacy technicians; • a PDF document detailing duties currently permitted for pharmacy technicians, along with a list of duties that will be permitted upon proclamation of the “Pharmaceutical Act of December 2006;”and • Useful links to pharmacy technician related websites. Along with this information is the invitation for pharmacy technicians and assistants to receive the electronic MPhA newsletter and email. Under the new legislation pharmacy technicians will be allowed to perform the technical duties that were previously assigned to pharmacists, allowing pharmacists more time to focus on the clinical and cognitive needs of patients. With this extended responsibility, pharmacy technicians need to be kept up to date with the latest in pharmacy practices through publications such as this newsletter. To date, fifty-six technicians/assistants have signed up for this program. Have you informed your pharmacy technicians of this new provision? If not, please do so today! 2 SEPTEMBER 2012 MPhA Newsletter Initially, gabapentin was thought to have a low potential for abuse. However, due to its possible psychoactive effects, abuse does occur. It has been a drug of abuse in persons with a prior history of cocaine or alcohol dependency. Gabapentin is used to help deal with cravings or withdrawal symptoms or as a substitute for the addiction. Recreational abuse of gabapentin is widely reported on the internet as well. The federal government Non-Insured Health Benefits Program has included gabapentin in its Prescription Monitoring Program (NIHB-PMP) which addresses concerns over potential abuse or misuse of prescription medications such as benzodiazepines, opioids and stimulants. Under this program, a patient's utilization of these medications is reviewed and if it exceeds a safe established threshold, the client is contacted to choose a single prescriber for these medications. Additional information on this program can be found at h t t p : / / w w w. h c - s c . g c . c a / f n i a h spnia/alt_formats/pdf/pubs/nihb-ssna/drug-med/pmppsm/index-eng.pdf Pharmacists should be monitoring patient usage and frequency of refills for this medication and be on the alert for potential abuse. In Memoriam Jean Rose, Deceased: June 30/12 Patricia Taylor, Deceased: July 10/12 Charles Newbury, Deceased: July 11/12 ....................................... .............................................. September Administration of Injections Practical Skills Workshops One hundred and five Members of the Manitoba Pharmaceutical Association participated in the Administration of Injections Practical Skills Workshops and successfully completed the Administration of Injections Training Program for Manitoba Pharmacists this September. The program was put on by the MPhA in collaboration with the University of Manitoba Faculty of Pharmacy and Faculty of Nursing to teach the participants how to administer subcutaneous, intramuscular, and intradermal injections and immunizations. The first workshop was scheduled for Friday, September 7, 2012, and filled up almost immediately, so another workshop th was offered on Wednesday, September 5 , 2012. Prior to attending the workshop, participants were required to complete the online CCCEP-accredited program entitled, “Immunization Competencies Education Program” (ICEP), the Manitoba Specific Module which was made available on the Advancing Practice website on August 27, 2012, and possess valid certification in CPR Level C or Level HCP and Emergency or Standard First Aid from an accredited training program. The workshop days started off with a brief review of the learning modules that participants completed in advance of the workshop, and an introduction to the seven rights of medication administration, landmarking, and injection technique. After the didactic presentations by Casey Sayre and Theresa Bowser, participants spent the rest of the day on the practical portion of the workshop. Pharmacists were able to apply theory and receive handson training to practice their new skills. Participants demonstrated an intramuscular (IM) and subcutaneous (SQ) injection on one of their peers for Faculty of Nursing staff in order to successfully complete the practical skills workshop. the Manitoba Society of Pharmacists on the Administration of Injections Training Program for Manitoba Pharmacists. Many individuals were involved in the development of the program. The Manitoba Pharmaceutical Association would like to acknowledge all those who helped with the development of the program and would like to send special thanks to Theresa Bowser from the University of Manitoba, Faculty of Nursing, and Casey Sayre, Chris Louizos and Lavern Vercaigne from the University of Manitoba, Faculty of Pharmacy for their countless hours of hard work and dedication to the program. Please remember that pharmacists will not be permitted to administer injections until the December 2006 Pharmaceutical Act is proclaimed, even if they have successfully completed all the requirements. Only once all of the supporting legislation is in place, final regulations are approved by the members and proclaimed by government, can this area of practice be implemented. Once the legislation is in place, only members who have successfully completed the training program, and hold a practicing licence, will be able to administer injections in Manitoba. The MPhA is pleased to announce that additional workshops are being planned for 2013. Members will be updated on future dates as further information becomes available. The MPhA was pleased to collaborate with the Canadian Society of Hospital Pharmacists Manitoba Branch; Faculty of Nursing, University of Manitoba; Faculty of Pharmacy, University of Manitoba; Manitoba Health; and Administration of Injections Practical Skills Workshop, Sept 7, 2012. ....................................... SEPTEMBER 2012 MPhA Newsletter ONE 3 .............................................. focus on patient safety Building an awareness for the systems that can lead to adverse events and changing the culture from “blaming” to reporting and learning from medication adverse events are some of the key steps in addressing patient safety in pharmacy practice. It is hoped that this column may facilitate taking those key steps. Preventing Methotrexate Dosing Errors • Pharmacists are the final check and safeguard for the patient receiving the right drug, dose and treatment plan. Patients do not get medication unless the prescription is approved by the pharmacist. Many times, through the day, pharmacists prevent many medication mishaps and provide that important final check for patient safety. If methotrexate is ordered with a dosing frequency more often than weekly, and the indication is unclear, contact the prescriber to verify the appropriateness of the dosing schedule. • Ensure that a pharmacist reviews every methotrexate order for dosing accuracy before dispensing. • Include explicit dosing instructions such as the day of the week on pharmacy-generated labels. • Ensure written information provided to the patient about the use of methotrexate has appropriate dosing listed. • Pharmacists counsel on all methotrexate prescriptions to remind patients of once weekly dosing. • Encourage patients to keep track of the day of the week they take each dose of methotrexate such as marking off the date on a calendar. • When possible, dispense only 1 month's supply of methotrexate at a time to prompt a review and followup if the patient makes a refill request sooner than anticipated. • Build alerts in electronic prescribing systems and pharmacy information systems prompting practitioners to review the indication and dosing frequency on prescriptions for methotrexate. Methotrexate, originally introduced as a valuable chemotherapy agent used to treat a variety of cancers is also commonly prescribed to treat autoimmune disorders, such as rheumatoid arthritis and has a wide variance in daily and weekly dosing regimens depending upon the condition being treated. It is critical to confirm the prescribed dosage is consistent with the condition being treated, is safe and the dispensed dose accurately reflects the prescribed dose as the drug has a small therapeutic window and a high risk for fatality in cases of overdose. All oral methotrexate prescriptions must receive additional checks for appropriate dosing and counseling to ensure the patient's understanding of how to take the prescribed dose. All pharmacists must be on high alert anytime they are dispensing methotrexate whether as a refill or new prescription. Pharmacists must thoroughly review all prescription orders prior to dispensing, immediately intervene with prescribers if dosing is incorrect or unclear and thoroughly counsel patients on all prescriptions for methotrexate, whether a refill or new prescription, with no exception. The Institute for Safe Medication Practices Canada made recommendations to prevent medication incidents associated with weekly oral methotrexate dosing in the ISMP bulletin dated April 4, 2008. The measures suggested include: For the complete ISMP Canada Safety Bulletin on Incidents of Inadvertent Daily Administration of Methotrexate (Volume 8, Issue 2, April 4, 2008) visit the ISMP Canada website at : http://ismpcanada.org/download/safetyBulletins/ISMPCSB200802Methotrexate.pdf continued on next page . . . 4 SEPTEMBER 2012 MPhA Newsletter ....................................... .............................................. New MIPS Resources on Patient Safety - Coming in the Fall The Manitoba Institute for Patient Safety (MIPS) will be launching new resources in October. These resources are part of the It's Safe to Ask health literacy initiative. They complement the Self-Advocacy For Everyone (SAFE) toolkit. One resource is a Declaration of Patient and Family Engagement in Patient Safety. The purposes of this resource are to: • Help patients and families be more involved in their care decisions • Confirm that patient values and input are key parts of a culture of patient safety • Support efforts that include patient values in healthcare policies and actions The second resource is a S.A.F.E. Patients Blog. The purposes of the blog are to: • Educate the public on self-advocacy related to patient safety topics and patient involvement in their health care decisions • Connect people with patient safety resources • Support people who want to learn how to be engaged in their health care • Share lessons learned on advocacy in health care The health care system is complex and not easily understood. People can be nervous about being involved and asking questions. This blog is a place for the public to share their lessons learned and to learn from others about how to be more comfortable and involved in their care decisions and talks with their health care team. The blog site will link with Facebook, Twitter, YouTube and RSS feed. We encourage you and your clients to visit the www.safetoask.ca website and follow the topics and related discussions when the blog is launched in the fall. Medication incidents (including near misses or good catches) can be reported to ISMP Canada: (i) through the website: http://www.ismp-canada.org/err_report.htm or (ii) by phone: 416-733-3131 or toll free: 1-866-544-7672 ISMP Canada guarantees confidentiality and security of information received, and respects the wishes of the reporter as to the level of detail to be included in publications. Institute for Safe Medication Practices Canada (ISMP Canada) 4711 Yonge Street, Suite 501, Toronto, ON M2N 6K8 416-733-3131 or 1-866-544-7672 (1-866-54-ISMPC) Email: [email protected] Website: www.ismp-canada.org ISMP Canada Newsletter Subscriptions ISMP Canada Safety Bulletins are designed to disseminate timely, targeted information to reduce the risk of medication incidents. The purpose of the bulletins is to confidentially share the information received about medication incidents which have occurred and to suggest medication system improvement strategies for enhancing patient safety. The bulletins will also share alerts and warnings specific to the Canadian market place. The following ISMP Canada Safety Bulletins have been issued since the last issue of the MPhA Newsletter. 2012 - ISMP Canada • • • • Canadian Medication Incident Reporting and Prevention System (CMIRPS) CMIRPS is a national voluntary medication incident and 'near miss' reporting program founded for the purpose of sharing the learning experiences from medication errors. Implementation of preventative strategies and system safeguards to decrease the risk for error-induced injury and thereby promote medication safety in healthcare is our collaborative goal. Vol. 12 Issue 9 - Concerned Reporting: Mix-ups between Bisoprolol and Bisacodyl Vol. 12 Issue 8 - Pharmaceutical Bar Coding: National Recommendations Vol. 12 Issue 7 - Identifying Knowledge Deficits Related to HYDROmorphone Vol. 12 Issue 6 - ALERT: Medication Mix-up with Faxed Prescription All issues of the ISMP Canada Safety Bulletins, including those issued in previous years, are freely downloadable from the ISMP Canada website at www.ismp-canada.org . ISMP Canada is pleased to distribute The Medication Safety Alert! (US) newsletters along with ISMP Canada Safety Bulletins to Canadian practitioners and corporations. To subscribe and for more information on all ISMP Canada's publications, events and services visit the ISMP Canada website at www.ismp-canada.org . If you have made changes in your pharmacy, which focus on patient safety that you would like to share with your colleagues, please contact Susan Lessard-Friesen at 204-233-1411. ....................................... SEPTEMBER 2012 MPhA Newsletter 5 .............................................. Practice Advisories for Patient Safety • • • Part of the MPhA Council's commitment to enhance the quality of care and patient safety in Manitoba pharmacies was to instruct the Chair of the Complaints Committee to issue a report following meetings of the Committee. The intention of the information is to inform pharmacists of medication incidents thereby providing an opportunity to relate and reflect upon their practice. PROTECTION OF PERSONAL HEALTH INFORMATION Over the past several months the Complaints Committee has received an increasing number of complaints from the public regarding failure to ensure privacy and confidentiality of personal health information (PHI) within the pharmacy. These complaints describe situations in which prescription information has been left in view of the public in the dispensary or when prescription information or medication/medical histories are overheard by others during discussions by pharmacy staff with and/or about patients. The Personal Health Information Act (PHIA) sets out to protect the rights of patients to access their health information as well as to protect the privacy and security of their information. Under PHIA, pharmacists shall protect personal health information by adopting reasonable administrative, technical and physical safeguards that ensure confidentiality, security, accuracy and integrity of the information. The MPhA Code of Ethics requires pharmacists to respect the confidential and personal nature of patient health information and the records of this information kept by the pharmacy. Standards of Practice state that pharmacists shall provide patient medication counseling in an atmosphere of patient confidentiality and privacy. Pharmacy site requirements include a confidential and private area within the pharmacy to counsel patients. In addition, safeguards such as the Joint Statement on the Facsimile Transmission of Prescriptions are in place to ensure the security, privacy and confidentiality of PHI when it is sent to and received by the pharmacy. Pharmacists must be vigilant to protect patient health information during every step of the patient care process receipt, entry and storage of prescription records, patient counseling and destruction of patient information. 6 SEPTEMBER 2012 MPhA Newsletter • • Is the public able to view prescriptions sitting on the counter waiting to be entered? Is the information on the computer screen visible to the public? Are you counseling patients in an area that provides privacy and confidentiality? Are you aware of other patients or customers nearby during patient discussions? Does your pharmacy properly destroy and dispose of patient information? Take a fresh look around your pharmacy to find ways to improve how you protect patient privacy and confidentiality. Discuss the importance of PHIA with your staff to ensure all are aware of their responsibility in protecting patient health information. Canadian Patient Safety Week October 29 - November 2, 2012 Ask. Listen. Talk. Put the spotlight on patient safety issues, share information about best practices, and grow your patient safety and quality initiatives during Canadian Patient Safety Week. Canadian Patient Safety Week is a national annual campaign started in 2005 to inspire extraordinary improvement in patient safety and quality. Working together, thousands of healthcare professionals, patients, and families help spread the message that good healthcare starts with good communication. This year Canadian Patient Safety Week takes place from October 29 to November 2, 2012. During this week, you can participate in activities and events designed to help our healthcare system ensure that every patient experience is safe. Further information will be sent to all members via our Friday Five e-newsletter. ....................................... .............................................. Discipline Decision 4. Kaur Singh Sidhu Pursuant to Notices of Hearing dated the 22nd day of March, 2011 (Notice #1), and the 3rd day of November, 2011 (Notice #2), it was alleged that Kaur Singh Sidhu, being a pharmacist under the provisions of the Act, and a registrant of the Association, was guilty of unskilled practice or professional misconduct, as described in Section 35 of the Act. 5. Mr. Sidhu entered a plea of guilty to the following, in that in 2010, he did: NOTICE #1: 3. in his role of pharmacist and /or pharmacy manager at Zellers Pharmacy, add refills to prescriptions for patient “HG” without requesting or obtaining the authorization of the prescribing physician; and 4. in his role of pharmacist and/or pharmacy manager, upon receiving a request to transfer prescriptions to a particular pharmacy, transfer the prescriptions for patient “HG” from the Zellers Pharmacy to a pharmacy he selected and not the pharmacy authorized by the patient's agent; 6. 7. NOTICE #2: 1. in or about September and October 2010, in his role as pharmacist and/or pharmacy manager at the Zellers Pharmacy he contacted patients in order to have them transfer their prescriptions to other pharmacies in which he had or intended to have a direct or indirect financial interest; 2. in or about September or October 2010, in his role as pharmacist and/or pharmacy manager at the Zellers Pharmacy, he transferred prescriptions for patients to another pharmacy or pharmacies in which he had or intended to have a direct or indirect financial interest, and intentionally misidentified the pharmacy or pharmacies in the Zellers Pharmacy records in order to conceal the true destination of the transferred prescriptions; 3. in or about September or October 2010, in his role as pharmacist and/or pharmacy manager at the Zellers Pharmacy, he transferred prescriptions for patients to another pharmacy or pharmacies in which he had or intended to have a direct or indirect financial interest and failed to record the name of the pharmacy filling the prescriptions, thereby breaching sub-section 21(i) of Pharmaceutical Regulation P60 R.M. 56/92; 8. in or about September or October 2010, in his role as pharmacist and/or pharmacy manager at the Zellers Pharmacy, he transferred prescriptions for patients “AT”, “ET” and “KP” from the Zellers Pharmacy to another pharmacy or pharmacies in which he had or intended to have a direct or indirect financial interest, without obtaining the patients' authorizations for the transfers of their prescriptions; in or about September or October 2010, in his role as pharmacist and/or pharmacy manager at the Zellers Pharmacy, he transferred prescriptions for patient “MH” from the Zellers Pharmacy to another pharmacy in which he had or intended to have a direct or indirect financial interest, without obtaining the patient's authorization for the transfer of the prescriptions to that pharmacy; in or about October through December 2010, in his role as pharmacist at Danial Pharmacy located at #2 505 Sargent Avenue, Winnipeg, Manitoba, he contacted patients who were customers/clients of Zellers Pharmacy in order to have them transfer their prescriptions to another pharmacy or pharmacies in which he had or intended to have a direct or indirect financial interest; in or about January through February 2011, in his role as pharmacist and/or pharmacy manager at River East Pharmacy located at 1417A Henderson Highway, Winnipeg, Manitoba, he contacted patients who were formerly customers/clients of Zellers Pharmacy in order to have them transfer their prescriptions to River East Pharmacy in which he had a direct or indirect financial interest, and by using patients' personal health information to contact the customers/clients and former customers/clients of the Zellers Pharmacy to solicit their business, he breached Section 21 of the Personal Health Information Act of Manitoba. The Discipline Committee accepted that the sanctions contained in the joint recommended disposition served to satisfy that the public's interest was protected and public's confidence was retained and found, pursuant to section 36(2) of the Act, that Mr. Sidhu was guilty of unskilled practice and professional misconduct, and pursuant to section 38(1)(a) and (b) ordered that Mr. Sidhu pay: a. a fine to the amount of $4,000.00; and b. a contribution towards the costs of the investigations and proceedings in the amount of $16,000.00, within 30 days hereof. Mr. Sidhu has complied with this decision. ....................................... SEPTEMBER 2012 MPhA Newsletter 7 .............................................. Awards Nominations are Coming Soon! Dinah Santos . . . Barbara Bromilow . . . Chuck McClure . . . Cenzina Caligiuri . . . what do these pharmacists have in common? All were the recipients of MPhA's prestigious awards which were presented at The 2012 Pharmacy Conference. Manitoba Pharmaceutical Association 2012 - 2014 Council and Liaison FRONT ROW (L-R): Jarrid McKitrick (CSHP Liaison), Kristine Petrasko (Vice President), Dinah Santos, Melissa Gobin (Pharmacy Student Liaison), Jennifer Ludwig, Glenda Marsh, Jill Ell (MSP Liaison) CENTRE ROW (L-R): Neal Davies, Donna Forbes, Kim Sharman BACK ROW (L-R): Geoff Namaka (Executive Treasurer), Kyle MacNair (President), Randy Stephanchew, Shawn Bugden (Past President), Kurt Schroeder Do you know a pharmacist who has made a significant contribution to the profession during their career? Do you know a pharmacist who demonstrates outstanding excellence in optimizing patient care? Do you know a pharmacist who is so dedicated to serving their community, regardless of the personal sacrifice required? Do you know a pharmacist who has made a significant and lasting improvement to patient safety and healthcare quality through a specific initiative or project? If you answered “YES!” to any of these questions, you could be nominating our next award winners. In coming months, the MPhA will be accepting nominations for the following awards: • • • • • The Pharmacist of the Year Bonnie Schultz Award for Pharmacy Practice Excellence Bowl of Hygeia Patient Safety Award As well as Honorary Life Members, Honorary Members, and Centennial Award Winners Who will you nominate this year? Please visit the MPhA website for more information on all of the awards. Meet the Newest MPhA Staff! Please welcome Ronda Eros, as she joins the staff at MPhA in a term position as Professional Practice Consultant. Ronda brings her experience as a practicing pharmacist to assist the MPhA with pharmacy practice inquiries. Lita Hnatiuk joined the MPhA administrative staff on August 7, 2012. Lita brings her communications experience to the MPhA as the new Communications and Quality Assurance Secretary. Thank you Melissa Gobin Thanks to our summer student, Melissa Gobin, for her terrific contributions to the MPhA and the protection of the public. The MPhA wishes her good luck in her studies at the University of Manitoba this fall. 8 SEPTEMBER 2012 MPhA Newsletter .......................................