Understanding Implicit Bias and Its Impact in Veterinary Medicine.

Implicit biases are those we are unwilling to admit, yet they influence our behavior in ways that impact our experience in the workplace. Literature demonstrates that implicit bias influences career choice and limits success within a chosen career. Discrimination in the veterinary workplace is pervasive and has a negative impact that is responsible for financial loss. It can also influence client communication, patient-care, and be inadvertently perpetuated by well-meaning community clinics. Strategies can be employed to acknowledge implicit bias and to foster behavioral change, which results in a healthier workplace and improved client and patient-care.

'First, do no harm': systematic program evaluation of an equine veterinary service-learning initiative with Indigenous communities in Canada.

BACKGROUND: Veterinary students have historically lacked meaningful experiential learning opportunities in equine medicine. At the same time, there are barriers to accessing veterinary care in Indigenous communities stemming from colonial injustices. In 2018-2019, a partnership was initiated where University of Calgary students began to provide equine veterinary services to Indigenous communities. As the first-documented equine veterinary service-learning initiative in Indigenous communities embedded in a veterinary curriculum, the purpose of the study is to systematically evaluate the program for its potential impact as part of a formative process for improvement. METHODS: Multiple parties in the program were engaged in a convergent, parallel, mixed-methods systematic program evaluation to explore the main program outcomes: (1) equine veterinary care; (2) clinical experiential student education; (3) cultural training of veterinary professionals and students; and (4) education of community members. The hypothesis was that ethical development using the "first, do no harm principle" would lead to benefits including a healthy horse population, a technically and culturally competent veterinary community, and an educated horse clientele. RESULTS: The program had a positive impact on accessibility to veterinary care and self-reported improvement in veterinary and cultural competency. In addition to the hypothesized program outcomes, additional program outcomes and effects were identified, including reciprocal learning and relationship building with the Indigenous community, leading to trust and equity-building. The students learned from both the in-community programming as well as the Indigenous community members they worked with. CONCLUSION: Program evaluation of an equine service-learning initiative in Indigenous communities reveals multiple and profound impacts including improved patient health status, wider scope of veterinary and cultural learning, strengthened relationships, and reciprocal learning with partnering Indigenous communities.

Pseudohyperkalemia in horses with rhabdomyolysis reported by an enzymatic chemistry analyzer.

OBJECTIVE: To investigate pseudohyperkalemia occurring in horses experiencing rhabdomyolysis when serum chemistry profiles are run on an VetScan VS2 analyzer (Abaxis). ANIMALS: 18 horses with rhabdomyolysis (creatine kinase [CK] > 1,000 U/L). METHODS: In 3 horses with serum CK activities > 5,800 U/L and persistent serum potassium concentrations of > 8.5 mmol/L (VetScan VS2), potassium concentrations were reevaluated with either i-STAT Alinity Base Station (Abbott), Catalyst (Idexx), or Cobas c501 (Roche) ion-specific analyzers. Paired serum samples from 15 additional horses (median serum CK activity, 7,601 U/L; range, 1,134 to 192,447 U/L) were analyzed on both VetScan VS2 and Cobas c501 machines. Serum potassium concentrations were compared between the VetScan VS2 and ion-specific analyzers by Bland-Altman and Wilcoxon ranked tests and correlated to log10 CK activity via Pearson correlation. RESULTS: Serum potassium concentrations were significantly higher on the VetScan VS2 (6.7 ± 1.6 mmol/L) versus the ion-specific analyzers (4.0 ± 1.1 mmol/L; P < .0001), with high bias shown in Bland-Altman analysis (43.1 ± 27.9). Potassium concentrations positively correlated with log10 CK activity with the VetScan VS2 (R2 = 0.51; P = .003) but not the Cobas (R2 = 0.09; P = .3) analyzer. CLINICAL RELEVANCE: An alternate analyzer to the VetScan VS2 should be used to evaluate serum potassium concentrations in horses with rhabdomyolysis because the VetScan VS2 methodology uses lactate dehydrogenase, which increases in serum with rhabdomyolysis and falsely elevates potassium concentrations.

Comparison of transrectal and transabdominal transducers for use in fast localized abdominal sonography of horses presenting with colic.

Abdominal ultrasonography is valuable in the diagnosis of equine colic. Fast localized abdominal sonography of horses (FLASH) enables practitioners with limited experience to perform ultrasonography in emergency settings. However, many practitioners only possess rectal format linear array transducers (RFLT). The hypotheses are: (a) A low frequency curvilinear transducer (LFCT) and RFLT will detect free abdominal fluid and abnormal small intestinal loops with similar frequency during FLASH, and (b) there will be a difference between the transducers for detection of gastric abnormalities and nephrosplenic entrapment. The objective is to compare transcutaneous abdominal ultrasonographic detection of abnormalities in horses presenting with colic using a LFCT and RFLT. Twenty-four horses requiring FLASH for investigation of colic were enrolled. Horses that were too painful to undergo transcutaneous abdominal ultrasonographic examination were excluded. A single investigator performed FLASH on all horses using a RFLT, while one of three other clinicians simultaneously performed FLASH using a LFCT. Comparison of abnormal findings between the two transducers was performed using Chi square, Fisher's exact or Wilcoxon tests. The incidence of identification of abnormal findings was similar between the two transducers for all comparisons except the visibility of the left kidney and stomach (kidney LFCT 81.25% vs. RFLT 22.92%, stomach LFCT 87.5% vs. RFLT 62.5%). While there are limitations to using a RFLT to identify nephrosplenic entrapment of the colon and detection of the stomach, it reliably detects other common abnormalities, including peritoneal effusion, lesions of the small intestine, and changes to the wall of the large colon and cecum.

Incidence of superficial abdominal organ identification is similar using high-frequency linear (transrectal) and low-frequency curvilinear (abdominal) transducers in clinically healthy horses: A pilot study.

Abdominal organ displacement is a potentially life-threatening condition in horses. Primary care veterinarians commonly make referral decisions based on a combination of clinical and ultrasonographic findings. However, published studies describing the effects of transducer on identifying abdominal organ locations in horses are currently lacking. The objective of this prospective, methods comparison, pilot study was to compare organ identification using a high-frequency linear (transrectal) transducer and a low-frequency curvilinear (abdominal) transducer for transcutaneous abdominal ultrasonography of healthy horses. Twelve clinically normal adult horses owned by the University of Calgary were enrolled in the study. Abdominal ultrasonography was performed by four practitioners, each randomly assigned to an alternating rotation of transrectal or abdominal transducer and left or right side of a horse. Using a Chi square test or Fisher's exact test, the frequency of identification for each organ was compared between both transducers. There was no significant difference in organ identification on the right side of the abdomen. On the left side, the stomach, liver, and kidney were less likely to be detected with the transrectal transducer. Compared with a low-frequency abdominal transducer, a high-frequency linear transrectal transducer delivers images that allow for organ identification in transcutaneous ultrasonography of the equine abdomen except for the left kidney, left liver, and stomach.

Paediatric Gliomas: BRAF and Histone H3 as Biomarkers, Therapy and Perspective of Liquid Biopsies.

Paediatric gliomas categorised as low- or high-grade vary markedly from their adult counterparts, and denoted as the second most prevalent childhood cancers after leukaemia. As compared to adult gliomas, the studies of diagnostic and prognostic biomarkers, as well as the development of therapy in paediatric gliomas, are still in their infancy. A body of evidence demonstrates that B-Raf Proto-Oncogene or V-Raf Murine Sarcoma Viral Oncogene Homolog B (BRAF) and histone H3 mutations are valuable biomarkers for paediatric low-grade gliomas (pLGGs) and high-grade gliomas (pHGGs). Various diagnostic methods involving fluorescence in situ hybridisation, whole-genomic sequencing, PCR, next-generation sequencing and NanoString are currently used for detecting BRAF and histone H3 mutations. Additionally, liquid biopsies are gaining popularity as an alternative to tumour materials in detecting these biomarkers, but still, they cannot fully replace solid biopsies due to several limitations. Although histone H3 mutations are reliable prognosis biomarkers in pHGGs, children with these mutations have a dismal prognosis. Conversely, the role of BRAF alterations as prognostic biomarkers in pLGGs is still in doubt due to contradictory findings. The BRAF V600E mutation is seen in the majority of pLGGs (as seen in pleomorphic xanthoastrocytoma and gangliomas). By contrast, the H3K27M mutation is found in the majority of paediatric diffuse intrinsic pontine glioma and other midline gliomas in pHGGs. pLGG patients with a BRAF V600E mutation often have a lower progression-free survival rate in comparison to wild-type pLGGs when treated with conventional therapies. BRAF inhibitors (Dabrafenib and Vemurafenib), however, show higher overall survival and tumour response in BRAF V600E mutated pLGGs than conventional therapies in some studies. To date, targeted therapy and precision medicine are promising avenues for paediatric gliomas with BRAF V600E and diffuse intrinsic pontine glioma with the H3K27M mutations. Given these shortcomings in the current treatments of paediatric gliomas, there is a dire need for novel therapies that yield a better therapeutic response. The present review discusses the diagnostic tools and the perspective of liquid biopsies in the detection of BRAF V600E and H3K27M mutations. An in-depth understanding of these biomarkers and the therapeutics associated with the respective challenges will bridge the gap between paediatric glioma patients and the development of effective therapies.

Video Recording in Veterinary Medicine OSCEs: Feasibility and Inter-rater Agreement between Live Performance Examiners and Video Recording Reviewing Examiners.

The Objective Structured Clinical Examination (OSCE) is a valid, reliable assessment of veterinary students' clinical skills that requires significant examiner training and scoring time. This article seeks to investigate the utility of implementing video recording by scoring OSCEs in real-time using live examiners, and afterwards using video examiners from within and outside the learners' home institution. Using checklists, learners (n=33) were assessed by one live examiner and five video examiners on three OSCE stations: suturing, arthrocentesis, and thoracocentesis. When stations were considered collectively, there was no difference between pass/fail outcome between live and video examiners (χ2 = 0.37, p = .55). However, when considered individually, stations (χ2 = 16.64, p < .001) and interaction between station and type of examiner (χ2 = 7.13, p = .03) demonstrated a significant effect on pass/fail outcome. Specifically, learners being assessed on suturing with a video examiner had increased odds of passing the station as compared with their arthrocentesis or thoracocentesis stations. Internal consistency was fair to moderate (0.34-0.45). Inter-rater reliability measures varied but were mostly moderate to strong (0.56-0.82). Video examiners spent longer assessing learners than live raters (mean of 21 min/learner vs. 13 min/learner). Station-specific differences among video examiners may be due to intermittent visibility issues during video capture. Overall, video recording learner performances appears reliable and feasible, although there were time, cost, and technical issues that may limit its routine use.

Suspected systemic calcinosis and calciphylaxis in 5 horses.

Five horses were presented with signs of myopathy along with systemic malaise, hyperfibrinogenemia, hyperphosphatemia, and an elevated calcium phosphorus product (Ca*P). Postmortem findings were consistent with systemic calcinosis, a syndrome of calcium deposition in the tissue of organs including lungs, kidneys, muscle, and heart that has not been previously described in horses.

Time-dependent alterations in gene expression of interleukin-8 in the bronchial epithelium of horses with recurrent airway obstruction.

OBJECTIVE: To evaluate time-dependent alterations in gene expression of chemokines in bronchial epithelium of recurrent airway obstruction (RAO)-affected horses and whether alterations resulted from increases in gene expression of interleukin (IL)-17 in cells isolated from bronchoalveolar lavage fluid (BALF). ANIMALS: 8 RAO-susceptible horses and 9 control horses. PROCEDURE: In 2 experiments, both groups of horses were evaluated after being maintained on pasture and after being stabled and fed dusty hay for 1, 14, 35, and 49 days (experiment 1) or 14 and 28 days (experiment 2). In experiment 1, gene expression of IL-8, chemokine (C-X-C motif) ligand 1 (CXCL1), granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), and Toll-like receptor 4 (TLR4) in epithelium and IL-8, IL-17, and TLR4 in BALF cells was measured. In experiment 2, bronchial biopsy specimens were evaluated for IL-8 immunoreactivity. RESULTS: In RAO-susceptible horses after 14 days of challenge exposure, there was a 3- and 10-fold increase in gene expression of IL-8 for epithelial and BALF cells and an increase in IL-8 immunoreactivity in epithelial cells. Challenge exposure failed to alter gene expression of CXCL1, GM-CSF, G-CSF, and TLR4 in epithelial cells of any horses at any time point. During challenge exposure, gene expression of BALF cell IL-17 was downregulated in control horses (day 1) and upregulated in RAO-affected horses (day 35). CONCLUSIONS AND CLINICAL RELEVANCE: Epithelial-derived IL-8 may promote airway neutrophilia, but the inciting stimulus is unlikely to be IL-17 because upregulation of this gene is subsequent to that of IL-8 in epithelial cells.