Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness.

Effects of Multi-Month Dispensing on Clinical Outcomes: Retrospective Cohort Analysis Conducted in Kenya.

Multi-month dispensing (MMD) has been widely adopted by national HIV programs as a key strategy for improving the quality of HIV care and treatment services while meeting the unique needs of diverse client populations. We assessed the clinical outcomes of clients receiving MMD in Kenya by conducting a retrospective cohort study using routine programmatic data in 32 government health facilities in Kenya. We included clients who were eligible for multi-month antiretroviral therapy (ART) dispensing for ≥ 3 months (≥ 3MMD) according to national guidelines. The primary exposure was enrollment into ≥ 3MMD. The outcomes were lost to follow-up (LTFU) and viral rebound. Multilevel modified-Poisson regression models with robust standard errors were used to compare clinical outcomes between clients enrolled in ≥ 3MMD and those receiving ART dispensing for less than 3 months (< 3MMD). A total of 3,501 clients eligible for ≥ 3MMD were included in the analysis, of whom 65% were enrolled in ≥ 3MMD at entry into the cohort. There was no difference in LTFU of ≥ 180 days between the two types of care (aRR 1.1, 95% CI 0.7-1.6), while ≥ 3MMD was protective for viral rebound (aRR 0.1 95% CI 0.0-0.2). As more diverse client-focused service delivery models are being implemented, robust evaluations are essential to guide the implementation, monitor progress, and assess acceptability and effectiveness to deliver optimal people-centered care.

Evaluating the immediate effects of hoof trimming on dairy goat hoof conformation and joint positions.

Hoof overgrowth in commercial housed dairy goats is a major health and welfare concern; thus, it is important to better understand hoof trimming, a priority practice which addresses hoof growth. We evaluated the immediate effects of trimming on external conformation, internal joint positions, and hoof wall overgrowth of front and hind hooves. Eighty female goats were enrolled. Pre and post hoof trimming data were collected at 13, 17, 21 and 25 months of age. Overall, before trimming, a high percentage of hooves were scored as overgrown (77.8%). Trimming decreased the percentage of overgrown hooves (17.6%: P < 0.001) and other moderate/severe conformational issues: dipped heels (49.3% vs. 26.7; P < 0.001), misshaped claws (37.0% vs. 17.6%; P < 0.001), splayed claws (73.7% vs. 56.7%; P < 0.001). More hind than front hooves had dipped heels pre-trimming and (91.3% vs. 7.3%; P < 0.001) and post-trimming (52.8% vs. 0.6%; P < 0.001); over half of the hind heels were not restored to an upright position. A greater proportion of toe length was removed from the hind hooves compared to the front (0.50 vs. 0.43, P < 0.001), with the greatest proportion of hoof wall overgrowth removed from the hind hoof medial claw at the 13-month assessment (P < 0.001). Following trimming, distal interphalangeal joint angle decreased more in hind compared to front hooves (11.0° vs. 6.9°; P < 0.001); distal interphalangeal joint height decreased (0.21 cm, P < 0.001), and proximal interphalangeal joint, and heel, angles increased (7.76° and 8.93°, respectively; P < 0.001). Trimming did not restore conformation of all hooves when trimmed every 4 months, suggesting a need to investigate reasons for underlying poor conformation, including trimming frequency.

Assessing Extensive Cow-Calf Welfare in Namibia: Feasibility of Adapting a New Zealand Beef Cow Welfare Assessment Protocol.

Namibia needs a robust welfare assessment protocol for beef cattle for benchmarking and trade. As there is presently no such protocol, one was developed for Namibian conditions based on one designed for extensive beef cattle in New Zealand which had been derived from the Welfare Quality and UC Davis Cow-Calf protocols, the modified protocol was evaluated in a semi-commercial farming village during the pregnancy testing of 141 cows from 5 herds of different households. Animal- and stockperson-based measures were assessed directly, cows were observed at grazing, and a questionnaire-guided interview was conducted. The protocol provided a good basis for welfare assessment, but additional measures and modifications were needed for the Namibian system. These were the effects of recurrent drought, predation, plant poisoning, external parasites, walking long distances to water and grazing, compulsory hot-iron branding, extraneous cattle marking, and variable standards of handling facilities. The protocol was modified to incorporate these changes, resulting in a total of 40 measures. It now needs full validation through widespread testing across the range of beef production systems used in Namibia.

Evaluating the long-term conformation and hoof growth effects of starting hoof trimming at 5 months of age in New Zealand dairy goats.

Hoof overgrowth is associated with poor conformation, an altered weight-bearing surface, and a reduction in the hoof's anatomic and functional integrity. As a result of housing systems that promote hoof overgrowth, hoof trimming is considered a priority in dairy goats. However, there are few data on the effects of the timing of first trimming on hoof conformation and growth rate. The aims of this study were (1) to evaluate the long-term effects of 2 different hoof trimming start times and (2) to investigate the pattern of hoof growth across the first 2 yr of life. Eighty 5-mo-old female Saanen-cross commercially housed dairy goats were allocated randomly to 1 of 2 treatments: (1) early trimmed (trimming beginning at 5 mo old; hooves were trimmed every 4 mo thereafter) and (2) late trimmed (trimming beginning at 13 mo old; hooves were trimmed every 4 mo thereafter). Using a combination of photographs and radiographs, hoof conformation, joint positions, and hoof wall length were assessed before the 13- and 25-mo trimming events. Hoof growth was assessed every 12 wk using caliper measurements. Overall, starting hoof trimming earlier had minor and inconsistent effects. However, detrimental changes in conformation and joint positions occurred between trimming events, particularly in the hind hooves, regardless of trimming treatment. At both assessments, there was a high percentage of overgrown toes and dipped heels, with the hind hooves being more affected compared with the front (overgrown toes at 13 mo, 97.1 vs. 79.1 ± 5.2%; overgrown toes at 25 mo, 91.7 vs. 56.3 ± 6.7%; dipped heels at 13 mo, 98.5 vs. 19.3 ± 5.0%; dipped heels at 25 mo, 88.3 vs. 4.9 ± 4.8%). In addition, at both assessments, the distal interphalangeal joint angle was greater in the hind hooves compared with the front (13 mo, 79.5 vs. 65.2 ± 1.7°; 25 mo, 79.0 vs. 66.7 ± 0.9°), whereas heel angles were less in the hind hooves compared with the front (13 mo, 41.8 vs. 57.1 ± 1.5°; 25 mo, 44.9 vs. 55.9 ± 1.1°). On average, the front hooves grew 4.39 mm/mo and the hind hooves grew 4.20 mm/mo. Early trimming did not have consistent effects on hoof growth rate. Importantly, our results suggest that trimming every 4 mo is not sufficient to prevent hoof overgrowth, the development of poor conformation, and detrimental changes in joint positions, particularly in the hind hooves. Furthermore, the detrimental changes may have masked any long-term treatment effects. Therefore, trimming frequency and age of first trimming should be considered when devising hoof care protocols for dairy goats housed in environments that do not offer opportunities for natural hoof wear.

A search for predictive biomarkers of ovine pre-partum vaginal prolapse.

Ovine pre-partum vaginal prolapse (known as bearings in sheep) occurs within a few weeks prior to lambing and unless treated both ewes and unborn lambs will die. It is a worldwide problem with no clear aetiology. Rates of prolapse in New Zealand typically vary from 0.1 to 2% per annum, varying between seasons and farms. In order to determine preclinical changes leading to prolapse, blood samples were collected prior to prolapse occurring and analysed for changes in both protein and specific hormone and vitamin levels. 650 ewes were ear tagged and blood samples were taken one month prior to the beginning of lambing; 28 of these ewes subsequently prolapsed. Using an improved proteomic method plasma samples were subjected to 2D DIGE (two dimensional differential in gel electrophoresis) to determine if there were differences between the pre-prolapse and non-prolapsing ewes. Acidic isoforms of haptoglobin, a major acute phase protein in ruminants, increased approximately 3-fold in ewes prior to prolapse occurring. Total haptoglobin quantitation was confirmed with an independent assay. Although another plasma protein, α-1B-glycoprotein, was down regulated close to prolapse, the biological significance of this is unknown. While vitamin D levels were not associated with subsequent prolapse there was, however, a negative correlation between cortisol and days to prolapse from sampling (r2 = 0.36); i.e. ewes sampled closest to prolapse had higher plasma cortisol concentrations than controls. This raises the possibility that the ewes which prolapsed may have been suffering from chronic stress. Further research is needed.

How decision-making about euthanasia for animals is taught to Australasian veterinary students.

This study set out to explore how euthanasia decision-making for animals was taught to students in eight Australasian veterinary schools. A questionnaire-style interview guide was used by a representative at each university to interview educators. Educators were interviewed about their teaching of euthanasia decision-making for four categories of animals: livestock, equine, companion and avian/wildlife. Using thematic analysis, the terms provided by participants to describe how (mode of teaching) and what (specific content) they taught to students were categorised. Information about content was categorised into human-centred factors that influence decision-making, and animal-based indicators used to directly inform decision-making. All eight representatives reported some teaching relevant to euthanasia decision-making at their university for livestock, companion animal and avian/wildlife. One representative reported no such teaching for equid animals at their university. Observation of a euthanasia case was rarely reported as a teaching method. Five universities reported multiple modes of teaching relevant information, while two universities made use of modalities that could be described as opportunistic teaching (e.g., 'Discussion of clinical cases'). Factors taught at most universities included financial considerations, and that it is the owner's decision to make, while animal-based indicators taught included QoL/animal welfare, prognosis and behaviour change. Overall, most universities used a variety of methods to cover relevant material, usually including lectures and several other approaches for all animal types. However, because two universities relied on presentation of clinical cases, not all students at these veterinary schools will be exposed to make, or assist in making, euthanasia decisions.

A retrospective descriptive analysis of race-day injuries of greyhounds in New Zealand.

OBJECTIVES: To describe the distribution, and determine the incidence, of veterinary reported injuries experienced by greyhounds during racing in New Zealand. MATERIALS AND METHODS: This retrospective cohort study utilised data obtained on all greyhound race starts and all racing injuries sustained in New Zealand between 10 September 2014 and 19 June 2019. Greyhound injuries were described by the number and percentage of the type, location, and presumed cause of injuries. The overall incidence of injuries per 1000 racing starts was calculated and stratified incidence rates were calculated for race year, racetrack, race number, sex of the greyhound, country of origin of the greyhound, starting box number, race type, race class and race distance. Poisson regression was used to calculate incidence rate ratios for the outcome of injury and race exposure variables. RESULTS: There were 213,630 race starts and 4100 injuries. The incidence of injury was 19.2 per 1000 starts, while the number of fatalities at the track was 1.3 per 1000 race starts. Most injuries experienced by greyhounds on race-day were minor (soft-tissue). Most injuries affected the limbs of the greyhounds (82.8%, n = 3393/4100). The rate of injuries was higher in Australian dogs compared with New Zealand dogs, the incidence rate of injury increased with advancing age group and the incidence rate varied among racetracks. CONCLUSION: The injury rates were similar to those previously reported for racing greyhounds in New Zealand. This study highlighted the need for greater uniformity and conciseness around the classification of injuries to permit comparisons across jurisdictions.

A simple model for the total number of SARS-CoV-2 infections on a national level.

This study aimed to identify an appropriate simple mathematical model to fit the number of coronavirus disease 2019 (COVID-19) cases at the national level for the early portion of the pandemic, before significant public health interventions could be enacted. The total number of cases for the COVID-19 epidemic over time in 28 countries was analysed and fit to several simple rate models. The resulting model parameters were used to extrapolate projections for more recent data. While the Gompertz growth model (mean R2 = 0.998) best fit the current data, uncertainties in the eventual case limit introduced significant model errors. However, the quadratic rate model (mean R2 = 0.992) fit the current data best for 25 (89%) countries as determined by R2 values of the remaining models. Projection to the future using the simple quadratic model accurately forecast the number of future total number of cases 50% of the time up to 10 days in advance. Extrapolation to the future with the simple exponential model significantly overpredicted the total number of future cases. These results demonstrate that accurate future predictions of the case load in a given country can be made using this very simple model.

How management of grief associated with ending the life of an animal is taught to Australasian veterinary students.

OBJECTIVE: Veterinarians have an important role in supporting and understanding their clients' grief. Veterinary schools have a duty to teach students how best to manage grief - both that of the students/future veterinarians and the clients. This study explores how grief management, associated with ending the life of an animal, was taught to students in eight Australasian veterinary schools. METHODS: A questionnaire-style interview guide was used by a representative at each university to conduct structured interviews with educators in a snowball sampling approach. Educators were interviewed about the teaching of grief management for four categories of animals: livestock, equine, companion and avian/wildlife. The terms used by participants to describe what they taught were grouped into common themes. Teaching was defined by individual participants and included structured and unstructured approaches. The stage in the degree (preclinical or clinical years) that grief management was taught in the veterinary curriculum and by whom (e.g. clinicians or psychologists) is also described. RESULTS: Grief management was taught more in preclinical than clinical years. However, due to how grief was characterised, much of this teaching was general 'nonspecific' teaching that included all categories of animals. Client grief was taught more generically, whereas, grief of veterinarians was taught using specific examples given by clinicians. CONCLUSION: A more robust end-of-life (EoL) management curriculum that includes all aspects of grief management is likely to increase job satisfaction, client happiness and professional satisfaction.

Behaviour of twin- and triplet-born lambs and their dam 3 to 18 hours after birth is not a useful predictor of lamb survival to weaning.

OBJECTIVE: An experiment was designed to determine if behaviour traits expressed by twinand triplet-bearing lambs and their dams at 3 to 18 hours of age (after the immediate ewelamb bonding had occurred) were associated with lamb survival to weaning. METHODS: The behaviour of twin and triplet lambs and their dams was assessed in the paddock at 3 to 18 hours after birth. Observations were made of the number of high- and low-pitched bleats, time to stand, make contact with dam, suck from dam and follow dam were recorded for each lamb. The maternal behaviour score of each dam was assessed. A random sub-sample of lambs were assessed during a maternal-recognition test at 12 or 24 hours of age. Traits included time spent standing, sitting, walking, time taken to reach the ewes and time spent with the ewes as well as the number of high- and low-pitched bleats emitted by the lamb. RESULTS: In the paddock, for each additional second required for twin-born lambs to follow their dam, lambs were 1.004 (95% confidence interval [CI] 1.000 to 1.008) times more likely to survive to weaning (p<0.05). The opposite relationship, however, was seen in triplet lambs. For each additional second required for triplet-born lambs to follow their dam, lambs were 0.996 (95% CI 0.993 to 0.999) times as likely to survive to weaning (p<0.05). During the maternal recognition test, twin-born lambs were 0.989 (95% CI 0.979 to 1.000) times as likely to survive to weaning for every additional second they took to reach the contact zone (p<0.05). Similarly, triplet-born lambs were 0.994 (95% CI 0.989 to 0.999) as likely to survive for every additional second they took to reach their dam (p<0.05). CONCLUSION: All ewe behaviours and the majority of lamb paddock and test behaviours were not associated with the survival of twin- or triplet-born lambs and, therefore, are of little use as indicators of lamb survival to weaning.

Prevalence and characterisation of wounds in sheep attributed to attacks by kea (Nestor notabilis) on high country farms in New Zealand.

Aims: To characterise and classify wounds in sheep suspected to have been caused by attacks by kea (Nestor notabilis) (kea strike), and to report the prevalence of these wounds on five high country farms in the South Island of New Zealand.Methods: Data were collected from farms between 28 August 2012 and 20 September 2013. Sheep were examined opportunistically immediately after shearing for signs of wounds caused by kea. The age and sex of sheep were also recorded. Wounds were measured and characterised as recent, healing, or healed, and the estimated true prevalence was calculated for each farm.Results: Injuries consistent with kea strike wounds were identified in 70/13,978 (0.5%) sheep examined. The estimated true prevalence varied between farms, from 0 (95% CI = 0-0.16) to 1.25 (95% CI = 0.97-1.61)%. Of the 76 wounds identified, 61 (80%) were located in the lumbar region, and 74 (97%) consisted of full-thickness ulceration of the skin, one showed evidence of injury to muscle and one to bone. The median length of the 63 wounds measured was 6 (min 1, max 23.5) cm, and 10/63 (13%) were categorised as recently healed, 47/63 (62%) as healing, and 17/63 (22%) as recent wounds.Conclusions: The results of this study show that kea strike on sheep was occurring at a low prevalence on the high country farms surveyed. The wounds identified were survivable, but the welfare impact of kea strike on sheep should be considered in balance with the conservation status of kea. There was clear variation in the prevalence of wounds attributed to kea strike between the farms but we were not able to identify the risk factors contributing to these differences. Future studies of kea strike should examine variables such as altitude, local kea density and distribution, and differences in kea strike management and husbandry practices, and should include high country farms without a history of kea strike.

Extreme diversity in the songs of Spitsbergen's bowhead whales.

Almost all mammals communicate using sound, but few species produce complex songs. Two baleen whales sing complex songs that change annually, though only the humpback whale (Megaptera novaeangliae) has received much research attention. This study focuses on the other baleen whale singer, the bowhead whale (Balaena mysticetus). Members of the Spitsbergen bowhead whale population produced 184 different song types over a 3-year period, based on duty-cycled recordings from a site in Fram Strait in the northeast Atlantic. Distinct song types were recorded over short periods, lasting at most some months. This song diversity could be the result of population expansion, or immigration of animals from other populations that are no longer isolated from each other by heavy sea ice. However, this explanation does not account for the within season and annual shifting of song types. Other possible explanations for the extraordinary diversity in songs could be that it results either from weak selection pressure for interspecific identification or for maintenance of song characteristics or, alternatively, from strong pressure for novelty in a small population.

Technical note: The development of a reliable 5-point gait scoring system for use in dairy goats.

Numerical rating scales are frequently used in gait scoring systems as indicators of lameness in dairy animals. The gait scoring systems commonly used in dairy goats are based on 4-point scales that focus on detecting and judging the severity of a definite limp. An uneven gait, such as a shortened stride or not "tracking up," is arguably the precursor to the development of a limp; thus, identifying such changes in gait could provide opportunity for early treatment. The objectives of this study were (1) to develop a 5-point gait scoring system that included an "uneven gait" category and compare the distribution of gait scores generated using this system to scores generated using a 4-point system, and (2) to determine whether this system could be reliably used. Forty-eight Saanen cross 2- and 3-yr-old lactating does were enrolled from a commercial dairy goat farm. Two observers carried out weekly live gait scoring sessions for 7 wk using the developed 5-point scoring system. The first 2 wk were used as training sessions (training sessions 1-2), with the subsequent 5 wk completed as gait assessments (assessments 1-5). In addition to training session 1 being lived scored, the goats were also video-recorded. This allowed observer 1 to re-score the session 4 times: twice using the developed 5-point system and twice using the previously used 4-point system. Comparisons of score distributions could then be made. Using the 4-point system, 81% of the goats were assigned score 1 (normal gait). Using the 5-point system, only 36% of the goats were assigned score 1 (normal gait), with 50% assigned score 2 (uneven gait). High levels of intra-observer reliability were achieved by observer 1 using both gait scoring systems [weighted kappa (κw) = 1.00: 4-point, κw = 0.96: 5-point]. At training session 1 (wk 1), inter-observer reliability was only moderate (κw = 0.54), but this was improved during the subsequent training session 2 (κw = 0.89). Inter-observer reliability was high among assessments 1 to 5 (κw = 0.90-1.00). During the training sessions, sensitivity for gait scores 1 and 2 was 77 and 65% (training session 1) and 89 and 94% (training session 2), respectively. Sensitivity was high among assessments 1 to 5 (score 1: 83-100%, score 2: 97-100%). This highlights the likely reason why existing gait scoring systems for dairy goats do not include an "uneven gait" category, as distinguishing it from a normal gait was challenging without training. In conclusion, with training, a 5-point gait scoring system could be reliably used. The 5-point system was found to be more sensitive than the 4-point system, allowing for a potential precursor to lameness to be identified. Further work is needed to determine whether the score can be reliably used in an on-farm setting.

Students' opinions on welfare and ethics issues for companion animals in Australian and New Zealand veterinary schools.

OBJECTIVE: To determine what veterinary students in Australia and New Zealand consider important competences in companion animal welfare and ethics (AWE) required on their first day of practice, and to explore how their priorities relate to gender and stage of study. METHODS: Undergraduate students at all veterinary schools in Australia and New Zealand were sent an online survey. A subset of questions required participants to rank the importance of preselected AWE topics pertaining to companion animals. Data were analysed to determine differences in the way students of different gender or academic stage prioritised each of these AWE topics. RESULTS: Of 3220 currently enrolled students, 851 participated in the survey: 79% were female, 17% male, 4% unspecified. Ranking of the AWE topics, from highest to lowest importance, was: neutering, companion animal husbandry, euthanasia, behaviour and training, animal breeding, over-servicing in relation to animal needs and cosmetic surgery. Female students consistently ranked competency in AWE issues surrounding neutering more highly than male students (P = 0.006). Students in senior years of study ranked the importance of competency in animal abuse/hoarding (P = 0.048), shelter medicine (P = 0.012) and animal breeding (P = 0.002) less highly than those in junior years. CONCLUSIONS: Australasian veterinary students placed more importance on competency in AWE issues associated with clinical practice (such as neutering and euthanasia) than on professional behaviours (such as over-servicing and animal breeding). However, we consider that emphasis should still be placed on developing graduate competency in the latter categories to reflect growing societal concerns about companion animal over-supply and inappropriate professional conduct.

One amino acid in mouse activated factor VII defines its endothelial protein C receptor (EPCR) binding and modulates its EPCR-dependent hemostatic activity in vivo.

Essentials The lack of factor (F) VIIa-endothelial protein C receptor (EPCR) binding in mice is unresolved. A single substitution of Leu4 to Phe in mouse FVIIa (mFVIIa) enables its interaction with EPCR. mFVIIa with a Phe4 shows EPCR binding-dependent enhanced hemostatic function in vivo vs. mFVIIa. Defining the FVIIa-EPCR interaction in mice allows for further investigating its biology in vivo. SUMMARY: Background Human activated factor VII (hFVIIa), which is used in hemophilia treatment, binds to the endothelial protein C (PC) receptor (EPCR) with unclear hemostatic consequences. Interestingly, mice lack the activated FVII (FVIIa)-EPCR interaction. Therefore, to investigate the hemostatic consequences of this interaction in hemophilia, we previously engineered a mouse FVIIa (mFVIIa) molecule that bound mouse EPCR (mEPCR) by using three substitutions from mouse PC (mPC), i.e. Leu4→Phe, Leu8→Met, and Trp9→Arg. The resulting molecule, mFVIIa-FMR, modeled the EPCR-binding properties of hFVIIa and showed enhanced hemostatic capacity in hemophilic mice versus mFVIIa. These data implied a role of EPCR in the action of hFVIIa in hemophilia treatment. However, the substitutions in mFVIIa-FMR only broadly defined the sequence determinants for its mEPCR interaction and enhanced function in vivo. Objectives To determine the individual contributions of mPC Phe4, Met8 and Arg9 to the in vitro/in vivo properties of mFVIIa-FMR. Methods The mEPCR-binding properties of single amino acid variants of mFVIIa or mPC at position 4, 8 or 9 were investigated. Results and conclusions Phe4 in mFVIIa or mPC was solely critical for interaction with mEPCR. In hemophilic mice, administration of mFVIIa harboring a Phe4 resulted in a 1.9-2.5-fold increased hemostatic capacity versus mFVIIa that was EPCR binding-dependent. This recapitulated previous observations made with triple-mutant mFVIIa-FMR. As Leu8 is crucial for hFVIIa-EPCR binding, we describe the sequence divergence of this interaction in mice, now allowing its further characterization in vivo. We also illustrate that modulation of the EPCR-FVIIa interaction may lead to improved FVIIa therapeutics.

Association Between Duration of Human Immunodeficiency Virus (HIV)-1 Viral Suppression Prior to Renal Transplantation and Acute Cellular Rejection.

Renal transplant has become an important option for human immunodeficiency virus (HIV)-infected patients with end-stage renal disease; however, these patients experience a high rate of acute cellular rejection (ACR). Guidelines do not currently exist for the optimal duration of viral suppression prior to transplantation. In a retrospective cohort analysis of 47 HIV-infected renal transplant recipients, we compared the rate of ACR between patients based on the length of time of viral suppression prior to transplantation. Of the patients who achieved viral suppression for >6 months but less than 2 years prior to transplantation (n = 15), 60% experienced ACR compared to 41% of patients suppressed at least 2 years or more (n = 32) prior to transplant (p = 0.21). Patients suppressed <2 years experienced ACR at 2.48 times the rate of those suppressed 2 years or longer. Induction immunosuppression, HLA mismatch and panel-reactive antibodies (PRAs) did not significantly differ between the two groups.

Coding and quantification of a facial expression for pain in lambs.

Facial expressions are routinely used to assess pain in humans, particularly those who are non-verbal. Recently, there has been an interest in developing coding systems for facial grimacing in non-human animals, such as rodents, rabbits, horses and sheep. The aims of this preliminary study were to: 1. Qualitatively identify facial feature changes in lambs experiencing pain as a result of tail-docking and compile these changes to create a Lamb Grimace Scale (LGS); 2. Determine whether human observers can use the LGS to differentiate tail-docked lambs from control lambs and differentiate lambs before and after docking; 3. Determine whether changes in facial action units of the LGS can be objectively quantified in lambs before and after docking; 4. Evaluate effects of restraint of lambs on observers' perceptions of pain using the LGS and on quantitative measures of facial action units. By comparing images of lambs before (no pain) and after (pain) tail-docking, the LGS was devised in consultation with scientists experienced in assessing facial expression in other species. The LGS consists of five facial action units: Orbital Tightening, Mouth Features, Nose Features, Cheek Flattening and Ear Posture. The aims of the study were addressed in two experiments. In Experiment I, still images of the faces of restrained lambs were taken from video footage before and after tail-docking (n=4) or sham tail-docking (n=3). These images were scored by a group of five naïve human observers using the LGS. Because lambs were restrained for the duration of the experiment, Ear Posture was not scored. The scores for the images were averaged to provide one value per feature per period and then scores for the four LGS action units were averaged to give one LGS score per lamb per period. In Experiment II, still images of the faces nine lambs were taken before and after tail-docking. Stills were taken when lambs were restrained and unrestrained in each period. A different group of five human observers scored the images from Experiment II. Changes in facial action units were also quantified objectively by a researcher using image measurement software. In both experiments LGS scores were analyzed using a linear MIXED model to evaluate the effects of tail docking on observers' perception of facial expression changes. Kendall's Index of Concordance was used to measure reliability among observers. In Experiment I, human observers were able to use the LGS to differentiate docked lambs from control lambs. LGS scores significantly increased from before to after treatment in docked lambs but not control lambs. In Experiment II there was a significant increase in LGS scores after docking. This was coupled with changes in other validated indicators of pain after docking in the form of pain-related behaviour. Only two components, Mouth Features and Orbital Tightening, showed significant quantitative changes after docking. The direction of these changes agree with the description of these facial action units in the LGS. Restraint affected people's perceptions of pain as well as quantitative measures of LGS components. Freely moving lambs were scored lower using the LGS over both periods and had a significantly smaller eye aperture and smaller nose and ear angles than when they were held. Agreement among observers for LGS scores were fair overall (Experiment I: W=0.60; Experiment II: W=0.66). This preliminary study demonstrates changes in lamb facial expression associated with pain. The results of these experiments should be interpreted with caution due to low lamb numbers.

The prevalence of intestinal nematodes in cats and dogs from Lancashire, north-west England.

OBJECTIVES: To estimate prevalence of clinically-relevant intestinal nematodes in UK cats and dogs using the sensitive faecal analysis technique FLOTAC. METHODS: Faecal samples were collected from 171 domestic dogs and 131 domestic cats living in urban areas of Lancashire and examined for the ova of intestinal parasites using the FLOTAC technique. All tested individuals were at least 6 months old, had not been treated with anthelmintics since 6 months of age nor in the 3 weeks prior to testing. RESULTS: In total, 5·3% of dogs (9/171) were positive for Toxocara canis; of these, 5/9 had <100 T. canis epg. Two dogs were positive for Uncinaria stenocephala, and 3 were positive for Strongyloides species. Single animals had Ancylostoma species and Spirocerca lupi infection. All egg counts were <100 epg. 26% of cats (34/131) were infected with Toxocara cati; of these, 6/34 had <100 T. cati epg. Two cats were positive for Strongyloides species, four for Ancylostoma species and single case for U. stenocephala, Toxascaris leonina and S. lupi. CLINICAL SIGNIFICANCE: The high prevalence and zoonotic potential of Toxocara species in cats and dogs suggests the need for greater awareness of the need for repeated treatment. The discovery of S. lupi warrants further investigation and awareness of the clinical signs that this parasite may cause in cats and dogs.

Ad libitum Pasture Feeding in Late Pregnancy Does Not Improve the Performance of Twin-bearing Ewes and Their Lambs.

The present study evaluated the effect of controlled ryegrass-white clover herbage availability from day 128 until day 142 of pregnancy in comparison to unrestricted availability, on the performance of twin-bearing ewes of varying body condition score (BCS; 2.0, 2.5, or 3.0) and their lambs. It was hypothesised that under conditions of controlled herbage availability, the performance of lambs born to ewes with a greater BCS would be greater than those born to ewes with a lower BCS. During the period that the nutritional regimens were imposed, the pre- and post-grazing herbage masses of the Control regimen (1,070±69 and 801±30 kg dry matter [DM]/ha) were lower than the ad libitum regimen (1,784±69 and 1,333±33 kg DM/ha; p<0.05). The average herbage masses during lactation were 1,410±31 kg DM/ha. Nutritional regimen had no effect on ewe live weight, BCS and back fat depth or on lamb live weight, indices of colostrum uptake, maximal heat production, total litter weight weaned or survival to weaning (p>0.05). The difference in ewe BCSs and back fats observed among body condition groups was maintained throughout pregnancy (p<0.05). At weaning, ewes from the BCS2.0 group had lower BCS and live weight (2.4±0.2, 74.3±2.6 kg) than both the BCS2.5 (2.6±0.2, 78.6±2.4 kg) and BCS3.0 ewes (2.7±0.2, 79.0±2.6 kg; p<0.05), which did not differ (p>0.05). Ewe BCS group had no effect on lamb live weight at birth or weaning or on maximal heat production (p>0.05). Serum gamma glutamyl transferase concentrations of lambs born to BCS3.0 ewes were higher within 36 hours of birth than lambs born to BCS2.0 ewes and BCS2.5 ewes (51.8±1.9 vs 46.5±1.9 and 45.6±1.9 IU/mL, respectively [p<0.05]). There was, however, no effect of ewe body condition on lamb plasma glucose concentration (p>0.05). Lamb survival was the only lamb parameter that showed an interaction between ewe nutritional regimen and ewe BCS whereby survival of lambs born to BCS2.5 and BCS3.0 ewes differed but only within the Control nutritional regimen ewes (p<0.05). These results indicate farmers can provide twin-bearing ewes with pre- and post-grazing ryegrass-white clover herbage covers of approximately 1,100 and 800 kg DM/ha in late pregnancy, provided that herbage covers are 1400 in lactation, without affecting lamb performance to weaning. The present results also indicate that under these grazing conditions, there is little difference in ewe performance within the BCS range of 2.0 to 3.0 and therefore they do not need to be managed separately.