Because of the ruling, Maryland is the only state in the country with a policy singling out a particular type of dog, when 16 other states have explicitly banned breed specific laws and ordinances. Nationally recognized sources like the Centers for Disease Control and the American Veterinary Medical Association have repeatedly found that no breed of dog is more dangerous than another. The December 2013 issue of The Journal of the American Veterinary Medical Association (JAVMA) included the most comprehensive study of dog bite related fatalities since this subject was first studied in the 1970s. Researchers identified multiple preventable factors that contribute to serious dog bites, including whether the dog was kept as a "family" dog inside the home or a "resident" dog, the victim's relationship with the dog, and whether the dog was spayed or neutered, among others. They confirmed that a multifaceted approach to dog bite prevention is most effective. Researchers also found that the breed of dog could not be reliably identified in more than 80 percent of the cases.