Qualitative analysis of small animal veterinarian-perceived barriers to nutrition communication.

OBJECTIVE: Nutrition is important in preventing and managing disease. Veterinarians are an important source of nutrition information; however, nutrition communication between veterinarians and pet owners is relatively infrequent. The purpose of this study was to conduct a qualitative review of barriers to nutrition communication and possible solutions, reported by small animal veterinarians. SAMPLE: 18 veterinarians from Maryland, Michigan, Virginia, Washington DC, and West Virginia. METHODS: In a qualitative focus group study, 5 virtual focus groups using the Zoom platform were conducted from February 3, 2021, to April 2, 2021. Each focus group was audio recorded, and transcripts were created using Otter.ai software. Transcripts were analyzed in Atlas.ti qualitative data analysis software using a hybrid of inductive and deductive thematic analysis. RESULTS: The 4 barriers to nutrition communication identified by veterinarians were as follows: (1) time, (2) misinformation and information overload, (3) pet owners' apprehension toward new information, and (4) veterinarians' confidence in nutrition knowledge and communication skills. Potential solutions include (1) improving communication and nutrition education, (2) improving and increasing access to client-friendly resources, and (3) empowering credentialed veterinary technicians and support staff to discuss nutrition. CLINICAL RELEVANCE: This study provides guidance for how to focus efforts to break down barriers to nutrition communication in small animal veterinary practice.

Two-Dose Ceftiofur Treatment Increases Cephamycinase Gene Quantities and Fecal Microbiome Diversity in Dairy Cows Diagnosed with Metritis.

Antimicrobial resistance is a significant concern worldwide; meanwhile, the impact of 3rd generation cephalosporin (3GC) antibiotics on the microbial communities of cattle and resistance within these communities is largely unknown. The objectives of this study were to determine the effects of two-dose ceftiofur crystalline-free acid (2-CCFA) treatment on the fecal microbiota and on the quantities of second-and third-generation cephalosporin, fluoroquinolone, and macrolide resistance genes in Holstein-Friesian dairy cows in the southwestern United States. Across three dairy farms, 124 matched pairs of cows were enrolled in a longitudinal study. Following the product label regimen, CCFA was administered on days 0 and 3 to cows diagnosed with postpartum metritis. Healthy cows were pair-matched based on lactation number and calving date. Fecal samples were collected on days 0, 6, and 16 and pooled in groups of 4 (n = 192) by farm, day, and treatment group for community DNA extraction. The characterization of community DNA included real-time PCR (qPCR) to quantify the following antibiotic resistance genes: blaCMY-2, blaCTX-M, mphA, qnrB19, and the highly conserved 16S rRNA back-calculated to gene copies per gram of feces. Additionally, 16S rRNA amplicon sequencing and metagenomics analyses were used to determine differences in bacterial community composition by treatment, day, and farm. Overall, blaCMY-2 gene copies per gram of feces increased significantly (p ≤ 0.05) in the treated group compared to the untreated group on day 6 and remained elevated on day 16. However, blaCTX-M, mphA, and qnrB19 gene quantities did not differ significantly (p ≥ 0.05) between treatment groups, days, or farms, suggesting a cephamycinase-specific enhancement in cows on these farms. Perhaps unexpectedly, 16S rRNA amplicon metagenomic analyses showed that the fecal bacterial communities from treated animals on day 6 had significantly greater (p ≤ 0.05) alpha and beta diversity than the untreated group. Two-dose ceftiofur treatment in dairy cows with metritis elevates cephamycinase gene quantities among all fecal bacteria while paradoxically increasing microbial diversity.

A risk-based mutual insurance premium framework for establishing indices of vulnerability to the intentional introduction of transboundary animal diseases.

Biological agents as weapons of agro-crime or agro-terrorism pose threats to peace and economic stability. Such agents pre-exist worldwide as hazards, adversely affecting animal health, as well as imposing substantial burdens on many nations. Few studies have quantified the global risks and vulnerabilities of countries and regions to potential terrorist or criminal operations targeting animal health. We present here a risk-based mutual insurance premium framework for animal health outcomes built upon the World Organisation for Animal Health (WOAH) quantitative risk assessment paradigm. Our objective was to generate dimensionless and relative domain indices related to release and exposure for several biological factors, as well as to assess the preparedness and response ability of each country. We also considered disease-specific measures relating to pathogens, targeted animal populations, the ongoing disease situation, within- and among-country peace or conflict, disease-specific control measures, and the availability of technical tools and personnel for successful disease management. National economic, political, and research and development competencies were used to assess each WOAH Member's potential for resilience. We formulated indices of vulnerability for 25 WOAH Members selected from five worldwide regions; initially, against four transboundary infectious animal diseases that target diverse animal species. We developed these indices using variables obtained from public databases arising from multiple intergovernmental organizations. Subsequently, we compared the relative vulnerability indices among countries for each given disease using three different index building methods: arithmetic mean, distance matrix, and principal component analysis (PCA). The PCA-based approach provided the greatest ability to discriminate among the components and among countries and regions. Due to its transparency and reliance on publicly available datasets, the risk premium framework proposed herein may readily be adjusted by policymakers and agencies and utilized to improve risk management strategies against agro-crime or agro-terror events, as well as for unintentional disease introductions.

Prevalence and Profiles of Antibiotic Resistance Genes mph(A) and qnrB in Extended-Spectrum Beta-Lactamase (ESBL)-Producing Escherichia coli Isolated from Dairy Calf Feces.

The use of antibiotics to treat dairy calves may result in multidrug-resistant extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. This study investigated fluoroquinolone and macrolide resistance genes among ESBL-producing E. coli isolated from dairy calves. Fresh fecal samples from 147 dairy calves across three age groups were enriched to select for ESBL-producing E. coli. Plasmid-mediated fluoroquinolone (qnrB), macrolide (mph(A)), and beta-lactam (blaCTX-M groups 1 and 9) resistance genes were identified by PCR and gel electrophoresis in ESBL-producing E. coli. Beta-lactamase variants and antibiotic resistance genes were characterized for eight isolates by whole-genome sequencing. Seventy-one (48.3%) samples were positive for ESBL-producing E. coli, with 159 (70.4%) isolates identified as blaCTX-M variant group 1 and 67 (29.6%) isolates as blaCTX-M variant group 9. Resistance gene mph(A) was more commonly associated with blaCTX-M variant group 1, while resistance gene qnrB was more commonly associated with variant group 9. E. coli growth was quantified on antibiotic media for 30 samples: 10 from each age group. Significantly higher quantities of ceftriaxone-resistant E. coli were present in the youngest calves. Results indicate the dominant blaCTX-M groups present in ESBL-producing E. coli may be associated with additional qnrB or mph(A) resistance genes and ESBL-producing E. coli is found in higher abundance in younger calves.

Teaching Medical Students How to Teach: A Scoping Review.

PHENOMENON: Teaching medical students how to teach is a growing and essential focus of medical education, which has given rise to student teaching programs. Educating medical students on how to teach can improve their own learning and lay the foundation for a professional identity rooted in teaching. Still, medical student-as-teacher (MSAT) programs face numerous obstacles including time constraints, prioritizing curriculum, and determining effective evaluation techniques. The purpose of this scoping review is to map the current landscape of the literature on medical school initiatives designed to train students to teach to describe why medical student teaching programs are started; the benefits and barriers; who teaches them; what content is taught; and how content is delivered. With this new map, the authors aimed to facilitate the growth of new programs and provide a shared knowledge of practices derived from existing programs. APPROACH: The authors conducted a scoping review, guided by Arksey and O'Malley's framework, to map the literature of MSAT training programs. Six databases were searched using combinations of keywords and controlled vocabulary terms. Data were charted in duplicate using a collaboratively designed data charting tool. This review builds on the Marton et al. review and includes articles published from 2014 to 2020. FINDINGS: Of the 1,644 manuscripts identified, the full-text of 57 were reviewed, and ultimately 27 were included. Articles included empirical research, synthetic reviews, opinion pieces, and a descriptive study. Analysis focused on modalities for teaching medical students how to teach; content to teach medical students about teaching; benefits and barriers to starting teaching programs; and the value of teaching programs for medical students. INSIGHTS: The rapid growth of MSAT programs suggests that this curricular offering is of great interest to the field. Literature shows an increase in evaluative efforts among programs, benefits for students beyond learning to teach, and evidence of effective engagement in medical students' designing and implementing programs.

Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom from 2001 to 2011: A Bayesian Network Analysis.

PURPOSE: To update the epidemiology of ocular injuries in soldiers admitted to Walter Reed Army Medical Center (WRAMC) from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). METHODS: Data were collected in the Walter Reed Ocular Trauma Database. A Bayesian Network Analysis was completed to better understand the relationships between different ocular demographic variables, injuries, surgeries, ocular trauma scores (OTS) and visual outcomes. RESULTS: There were 890 consecutive globe or adnexal combat injuries, or both, sustained by 652 United States soldiers treated at WRAMC between 2001 and 2011.The primary mechanism of injury was improvised explosive device (62.47%). Many patients (62.0%) had final visual acuity (VA) grades of 1-2 (20/15 - 20/200), while 29.9% of patients had final VA grades of 3-5 (less than 20/200), and 8.1% had unknown final VA grades. Bayesian Network Analysis revealed that the injury variables of Retina (47.9%), Lens (44.6%), Posterior Segment (43.7%) and Anterior Segment (40.3%), and the surgical variables of Enucleation (97.6%) and cataract extraction and posterior capsule intraocular lens placement (CEPCIOL; 43.3%) all had probabilities greater than 40% for a poor final VA, while all other variables were less than 40%. CONCLUSION: Modern-day combat trauma results in complicated ocular injuries causing 30% of patients to be left legally blind in their injured eye. It is critical to maintain a wide variety of deployable, specialty trained ophthalmologists to ensure the best visual outcomes for wounded warriors and to maintain mission readiness.

Cornea thinning in two cases of ICE syndrome.

We present two patients with a new finding of symmetrical corneal thinning early in the clinical course of iridocorneal endothelial syndrome. Patient 1 was evaluated for uncontrolled angle closure glaucoma of the left eye (OS) status post laser peripheral iridotomy (LPI). After placement of an Ahmed glaucomatous valve and trabeculectomy with mitomycin C were performed, the patient was diagnosed with Chandler syndrome. The patient's pachymetry at the time of diagnosis revealed stable central corneal thickness (CCT) of 481 µm of the right eye (OD) (baseline 494 µm) and central cornea thinning with CCT of 407 µm OS (baseline 486 µm). Patient 2 was evaluated for ocular hypertension and Chandler syndrome OS was diagnosed. The patient had a good short-term response to LPI and ocular hypotensive medications. This patient was also found to have thinning of his affected cornea with CCT 523 µm OD and 476 µm OS.

Economic effects of policy options restricting antimicrobial use for high risk cattle placed in U.S. feedlots.

The rising public health threat of antimicrobial resistance, the influence of food service companies, as well as the overall lack of positive image of using medical products in intensive farming are major drivers curbing antimicrobial use. In the future, government policies may affect practices of antimicrobial use in beef production in feedlots, a prominent current user of antimicrobials in animal agriculture, but also the agricultural industry generating the highest cash receipt in the U.S. Our objective was to estimate the cost effect from the following policies in feedlots: 1) using antimicrobials for disease prevention, control, and treatment; 2) using antimicrobials only for treatment of disease; and 3) not using antimicrobials for any reason. We modelled a typical U.S. feedlot, where high risk cattle may be afflicted by diseases requiring antimicrobial therapy, namely respiratory diseases, liver abscesses and lameness. We calculated the net revenue loss under each policy of antimicrobial use restriction. With moderate disease incidence, the median net revenue loss was $66 and $96 per animal entering the feedlot, for not using antimicrobials for disease prevention and control, or not using any antimicrobials, respectively, compared to using antimicrobials for disease prevention, control, and treatment. Losses arose mainly from an increase of fatality and morbidity rates, almost doubling for respiratory diseases in the case of antimicrobial use restrictions. In the case of antimicrobial use prohibition, decreasing the feeder cattle price by 9%, or alternatively, increasing the slaughter cattle price by 6.3%, would offset the net revenue losses for the feedlot operator. If no alternatives to antimicrobial therapy for prevention, control and treatment of current infectious diseases are implemented, policies that economically incentivize adoption of non-antimicrobial prevention and control strategies for infectious diseases would be necessary to maintain animal welfare and the profitability of beef production while simultaneously curbing antimicrobial use.

Age Dependence of Antimicrobial Resistance Among Fecal Bacteria in Animals: A Scoping Review.

Introduction: A phenomenon of decreasing antimicrobial resistance (AMR) among fecal bacteria as food animals age has been noted in multiple field studies. We conducted a scoping review to summarize the extent, range, and nature of research activity and the data for the following question: "does AMR among enteric/fecal bacteria predictably shift as animals get older?". Methods: This review followed a scoping review methodology framework. Pertinent literature published up until November 2018 for all animals (except humans) was retrieved using keyword searches in two online databases, namely, PubMed® and the Web of Science™ Core Collection, without filtering publication date, geographic location, or language. Data were extracted from the included studies, summarized, and plotted. Study quality was also assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines for all included papers. Results: The publications with detailed relevant data (n = 62) in food animals, poultry, and dogs were identified. These included longitudinal studies (n = 32), cross-sectional studies of different age groups within one food animal production system or small-animal catchment area (n = 16), and experimental or diet trials (n = 14). A decline in host-level prevalence and/or within-host abundance of AMR among fecal bacteria in production beef, dairy cattle, and swine was reported in nearly two-thirds (65%) of the identified studies in different geographic locations from the 1970's to 2018. Mixed results, with AMR abundance among fecal bacteria either increasing or decreasing with age, have been reported in poultry (broiler chicken, layer, and grow-out turkey) and dogs. Conclusions: Quantitative synthesis of the data suggests that the age-dependent AMR phenomenon in cattle and swine is observed irrespective of geographic location and specific production practices. It is unclear whether the phenomenon predates or is related to antimicrobial drug use. However, almost 50% of the identified studies predate recent changes in antimicrobial drug use policy and regulations in food animals in the United States and elsewhere.

Preparing Future Medical Educators: Development and Pilot Evaluation of a Student-Led Medical Education Elective.

INTRODUCTION: Although all medical school graduates are expected to be educators as residents, and subsequently as faculty, most students receive no formal education on how to teach. At the Uniformed Services University (USU), no formal educational training previously existed for senior medial students as they prepared for residency. A novel Medical Education Elective for MS4s was developed and run by MS4s with faculty mentoring at USU with implementation between January and June 2018. MATERIALS AND METHODS: The overall goal of the 4-week course was to provide a forum for MS4s to gain exposure to educational theories and teaching methods with an opportunity to practice learned skills in the underclass curriculum. The course's three core components were: didactics, observed teaching, and independent teaching. The course was evaluated via multiple methods including verbal and survey feedback from both first and fourth year medical students. RESULTS: The preliminary outcomes revealed the course had a positive impact on both first-year medical students (MS1s) and MS4s. As of May 2018, 100% (n = 59) of MS1s surveyed reported that having an MS4 teacher contributed positively to their learning experience. All MS4s surveyed (n = 12) agreed that the course enhanced their confidence in teaching. CONCLUSIONS: Medical education courses not only offer an opportunity for senior students to cultivate educational theoretical knowledge and teaching skills in preparation for residency but also contribute positively to the learning experiences of underclass students. Now that the elective has been piloted with initial data suggesting feasibility and benefit to both MS4 and MS1 students, the next steps are to focus on ensuring longevity of the course offering at USU and to consider working with senior students at other institutions that lack formal training in education to start similar student run medical education initiatives.

Use of ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma.

INTRODUCTION: Primary congenital glaucoma is a rare ocular disorder that is responsible for 0.01%-0.04% of total blindness worldwide.1 The goal of congenital glaucoma management is to allow for proper development of the immature visual system by controlling intraocular pressure. Medical therapy usually provides a supportive role to temporarily reduce intraocular pressure, but patients typically require iridocorneal angle surgery to facilitate aqueous humor outflow. In this report, we describe the use of minimally invasive ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma. CASE DESCRIPTION: A 13-month-old male with bilateral primary congenital glaucoma due to a loss of function TEK mutation. He had bilateral findings of elevated intraocular pressures, buphthalmos, Haab's striae, photophobia, and myopia. Over the course of 6 weeks, three ab interno trabeculectomies with a Kahook Dual Blade were performed in the patient's left eye and one in the patient's right eye. After 3 months, intraocular pressures while receiving pressure reducing ophthalmic drops bilaterally reduced from 43 to 21 mmHg in the right eye after a single surgery and from 44 to 34 mmHg in the left eye after three surgeries, eventually requiring glaucoma drainage implant placement. There were no complications. CONCLUSION: Ab interno Kahook Dual Blade Trabeculectomy is a minimally invasive and potentially successful procedure for the treatment of congenital glaucoma. The safety profile of minimally invasive glaucoma surgery warrants consideration for congenital glaucoma patients, as they usually require iridocorneal angle surgery because pharmacologic therapy is typically inadequate.

The Occurrence and Characterization of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli Isolated from Clinical Diagnostic Specimens of Equine Origin.

Escherichia coli isolates were recovered from clinical specimens of equine patients admitted to the Texas A&M Veterinary Medical Teaching Hospital over a five-year period. Ceftiofur resistance was used as a marker for potential extended-spectrum beta-lactamase (ESBL)-activity, and of the 48 ceftiofur-resistant E. coli isolates, 27.08% (n = 13) were phenotypically ESBL-positive. Conventional PCR analysis followed by the large-scalebla Finder multiplex PCR detected the ESBL genes, CTX-M-1 and SHV, in seven out of the 13 isolates. Moreover, beta-lactamase genes of TEM-1-type, BER-type (AmpC), and OXA-type were also identified. Sequencing of these genes resulted in identification of a novel TEM-1-type gene, called blaTEM-233, and a study is currently underway to determine if this gene confers the ESBL phenotype. Furthermore, this report is the first to have found E. coli ST1308 in horses. This subtype, which has been reported in other herbivores, harbored the SHV-type ESBL gene. Finally, one out of 13 E. coli isolates was PCR-positive for the carbapenemase gene, blaIMP-1 despite the lack of phenotypically proven resistance to imipenem. With the identification of novel ESBL gene variant and the demonstrated expansion of E. coli sequence types in equine patients, this study underscores the need for more investigation of equines as reservoirs for ESBL-producing pathogens.

Antimicrobial Policies in United States Beef Production: Choosing the Right Instruments to Reduce Antimicrobial Use and Resistance Under Structural and Market Constraints.

Antimicrobial use (AMU) in animal agriculture contributes to the selection of resistant bacteria, potentially constituting a public health threat. To address antimicrobial resistance, public policies set by governments, as well as intra-sectoral approaches, can be implemented. In this paper, we explore how common policy instruments such as regulations, economic incentives, and voluntary agreements could help reduce AMU in beef production. We first describe the structure of the beef supply chain which directly influences the choice of policy instruments. We describe how externalities and imperfect information affect this system. We then discuss how five policy instruments would each perform to achieve a reduction in AMU. Bovine respiratory disease complex (BRD) represents the major driver of AMU in beef production; consequently, reducing its incidence would decrease significantly the amounts of antimicrobials administered. We consider control options for BRD at different stages of the beef supply chain.

Effects of supplemental zinc sulfate on growth performance, carcass characteristics, and antimicrobial resistance in feedlot heifers.

Effects of supplemental Zn as Zn sulfate on feedlot performance, carcass traits, and antimicrobial resistance were evaluated using 480 crossbred heifers (BW = 385 kg ± 13.08) in a randomized complete block design. Heifers were blocked by BW and randomly assigned within block to diets with 0, 30, 60, or 90 mg supplemental Zn/kg DM. Heifers were housed in dirt-surfaced pens (20 animals per pen; 6 pens per treatment) equipped with fence-line feed bunks and automatic water fountains. Heifers were fed once daily to ensure ad libitum intake. Plasma was collected on day 0 from five randomly selected heifers per pen and repeated on days 63 and 115 to determine plasma Zn concentrations. Random samples of freshly voided feces were collected from the surface of each pen the day of harvest to determine antibiotic resistance. Heifers were transported on day 144 to a commercial abattoir where hot carcass weight (HCW) and incidence of liver abscesses were recorded at harvest and HCW, dressed yield, ribeye area, 12th rib fat, quality and yield grades were recorded after 36 h of refrigeration. Plasma Zn concentration increased (P = 0.02) linearly in response to increasing concentrations of dietary Zn. Final BW and ADG were unaffected by supplementation (P ≥ 0.29). Quantified levels of resistance to ceftriaxone and tetracycline among fecal Escherichia coli were not impacted (P > 0.05) by dietary zinc concentrations. Increasing Zn concentrations tended to decrease (linear effect, P = 0.07) DMI, resulting in a linear (P = 0.03) and tendency for quadratic (P = 0.12) improvement in feed efficiency with increasing Zn concentration. No differences were detected for HCW, dressed yield, ribeye area, 12th rib fat, percentages of carcasses grading Select or Choice, or yield grade (P > 0.53), but added Zn tended to affect percentage of carcasses that graded Prime, peaking at 60 mg/kg added Zn (quadratic effect, P = 0.07). In vitro fermentations were performed using ruminal fluid cultures containing 0, 30, 60, 90, 120, or 150 mg Zn/kg substrate DM to determine impact of Zn on gas production, VFA concentrations, and in vitro DM disappearance (IVDMD). There were no effects of Zn on in vitro gas production, IVDMD, or most VFA (P > 0.15), but isovalerate decreased linearly in response to added Zn (P = 0.05). Supplementing finishing heifers up to 60 mg Zn/kg diet DM improved feed efficiency compared to other treatments.

Distribution of the pco Gene Cluster and Associated Genetic Determinants among Swine Escherichia coli from a Controlled Feeding Trial.

Copper is used as an alternative to antibiotics for growth promotion and disease prevention. However, bacteria developed tolerance mechanisms for elevated copper concentrations, including those encoded by the pco operon in Gram-negative bacteria. Using cohorts of weaned piglets, this study showed that the supplementation of feed with copper concentrations as used in the field did not result in a significant short-term increase in the proportion of pco-positive fecal Escherichia coli. The pco and sil (silver resistance) operons were found concurrently in all screened isolates, and whole-genome sequencing showed that they were distributed among a diversity of unrelated E. coli strains. The presence of pco/sil in E. coli was not associated with elevated copper minimal inhibitory concentrations (MICs) under a variety of conditions. As found in previous studies, the pco/sil operons were part of a Tn7-like structure found both on the chromosome or on plasmids in the E. coli strains investigated. Transfer of a pco/sil IncHI2 plasmid from E. coli to Salmonella enterica resulted in elevated copper MICs in the latter. Escherichia coli may represent a reservoir of pco/sil genes transferable to other organisms such as S. enterica, for which it may represent an advantage in the presence of copper. This, in turn, has the potential for co-selection of resistance to antibiotics.

Clinical Practice Guidelines: Whose Practice Are We Guiding?

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has just released an update to the clinical practice guideline (CPG) on otitis media with effusion. This common condition is frequently managed by primary care providers; however, their awareness and utilization of the AAO-HNSF CPGs are unknown. We performed a cross-sectional survey to assess familiarity with otologic diagnoses, evaluation skills, and guidelines. Only 38.5% of respondents use pneumatic otoscopy, and roughly 50% utilize a CPG for management of otitis media or for referral for tympanostomy tube insertion. Providers predominantly use the acute otitis media guideline from the American Academy of Pediatrics. In this single-institution study, providers are largely unaware of the AAO-HNSF CPGs and could benefit from additional training, including workshops taught by otolaryngologists within individual health care systems or development of a national otolaryngology medical student curriculum. A more immediate option includes referencing our CPGs on specialty societies' websites or newsletters.