Breaking barriers in trauma research: A narrative review of opportunities to leverage veterinary trauma for accelerated translation to clinical solutions for pets and people.

Trauma is a common cause of morbidity and mortality in humans and companion animals. Recent efforts in procedural development, training, quality systems, data collection, and research have positively impacted patient outcomes; however, significant unmet need still exists. Coordinated efforts by collaborative, translational, multidisciplinary teams to advance trauma care and improve outcomes have the potential to benefit both human and veterinary patient populations. Strategic use of veterinary clinical trials informed by expertise along the research spectrum (i.e., benchtop discovery, applied science and engineering, large laboratory animal models, clinical veterinary studies, and human randomized trials) can lead to increased therapeutic options for animals while accelerating and enhancing translation by providing early data to reduce the cost and the risk of failed human clinical trials. Active topics of collaboration across the translational continuum include advancements in resuscitation (including austere environments), acute traumatic coagulopathy, trauma-induced coagulopathy, traumatic brain injury, systems biology, and trauma immunology. Mechanisms to improve funding and support innovative team science approaches to current problems in trauma care can accelerate needed, sustainable, and impactful progress in the field. This review article summarizes our current understanding of veterinary and human trauma, thereby identifying knowledge gaps and opportunities for collaborative, translational research to improve multispecies outcomes. This translational trauma group of MDs, PhDs, and DVMs posit that a common understanding of injury patterns and resulting cellular dysregulation in humans and companion animals has the potential to accelerate translation of research findings into clinical solutions.

Sidestream dark field imaging and biomarker evaluation reveal minimal significant changes to the microcirculation and glycocalyx in a canine hemorrhagic shock model.

OBJECTIVE: To investigate the effects of hemorrhagic shock and fresh whole blood resuscitation on the microcirculation and endothelial glycocalyx using sidestream dark field (SDF) imaging and plasma biomarkers. ANIMALS: 8 purpose-bred dogs. METHODS: Pressure-targeted hemorrhagic shock was induced in anesthetized dogs. SDF measurement of perfused boundary region and microcirculatory variables (RBC flow, total vessel density, and relative and absolute capillary blood volume), biomarker measurement (heparan sulfate, hyaluronan, VE-cadherin, and syndecan-1), mean arterial blood pressure, and cardiac output measurement were performed before anesthesia (TP0), after induction (TP1), after hemorrhagic shock (TP2), and after 50% retransfusion (TP3) and 100% retransfusion (TP4). RESULTS: At TP1, TP2, TP3, and TP4, mean arterial blood pressure was 74.25 ± 7.17 mm Hg, 49.50 ± 13.74 mm Hg, 63.50 ± 13.29 mm Hg, and 71.38 ± 8.77 mm Hg, and cardiac output was 2.57 ± 1.01 L/min, 0.8 ± 0.36 L/min, 1.81 ± 0.57 L/min, and 2.93 ± 1.22 L/min, respectively. Heparan sulfate, hyaluronan, syndecan-1, and VE-cadherin ranges were 24.80 to 77.72 ng/mL, 5.77 to 105.06 ng/mL, below detection to 1,545.69 pg/mL, and 0 to 2.52 ng/mL, respectively. Perfused boundary region, RBC flow, total vessel density, and relative and absolute capillary blood volume ranges were 1.75 to 2.68 µm, 89.6 to 584.5 µm/s, 51.7 to 1,914.3 mm/m2, 0.94 to 1.53 103 µm3, and 1.50 to 94.30 103 µm3, respectively. Heparan sulfate decreased significantly over time (P = .016). No significant differences were found for microcirculatory variables, perfused boundary regions, or other biomarkers. CLINICAL RELEVANCE: This was the first study to assess microvascular dysfunction and endothelial shedding in a canine hemorrhagic shock model using SDF microscopy (Glycocheck) and plasma biomarkers. Further studies are needed to determine clinical relevance.

Comparison of placement characteristics using two intraosseous devices in canine and feline cadavers by novice users.

Introduction: Intraosseous (IO) catheterization enables rapid access to systemic circulation in critical patients. A battery-powered IO device (BPIO) utilized in veterinary practice is reliable in facilitating IO catheter placement. A new spring-powered IO device (SPIO) has been developed for people but has not been tested in veterinary patients. The goal of our study was to compare placement characteristics and flow rates achieved with the BPIO compared to the SPIO in animals when operated by novice users. Methods: Six veterinary students performed 72 catheterizations in the humeri and tibias of 12 dog and 6 cat cadavers. The user, cadaver, device, and site of placement were randomized. Flow rates were determined by three-minute infusions. Results: In dogs, overall success rates (50% BPIO, 46% SPIO; p = 0.775) and flow rates based on location were similar between devices. Successful placement was faster on average with the BPIO (34.4 s for BPIO and 55.0 s for SPIO, p = 0.0392). However, time to successful placement between devices was not statistically significant based on location (humerus: 34.7 s for BPIO and 43.1 s for SPIO, p = 0.3329; tibia: 33.3 s for BPIO and 132.6 s for SPIO, p = 0.1153). In cats, success rates were similar between devices (16.7% for BPIO and 16.7% for SPIO, p = 1.000), but limited successful placements prevented further analysis. Discussion: This is the first study to examine the use of the SPIO in animals, providing preliminary data for future IO studies and potential applications for training in the clinical setting.

Parallel Pandemics Illustrate the Need for One Health Solutions.

African Swine Fever (ASF) was reported in domestic pigs in China in 2018. This highly contagious viral infection with no effective vaccine reached pandemic proportions by 2019, substantially impacting protein availability in the same region where the COVID-19 pandemic subsequently emerged. We discuss the genesis, spread, and wide-reaching impacts of this epidemic in a vital livestock species, noting parallels and potential contributions to ignition of COVID-19. We speculate about impacts of these pandemics on global public health infrastructure and suggest intervention strategies using a cost: benefit approach for low-risk, massive-impact events. We note that substantive changes in how the world reacts to potential threats will be required to overcome catastrophes driven by climate change, food insecurity, lack of surveillance infrastructure, and other gaps. A One Health approach creating collaborative processes connecting expertise in human, animal, and environmental health is essential for combating future global health crises.

Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog-A Multicentric Retrospective Study of 69 Cases (2007-2013).

Objective: To describe resuscitation patterns of critically bleeding dogs, including those receiving massive transfusion (MT). Design: Retrospective study from three universities (2007-2013). Animals: Critically bleeding dogs, defined as dogs who received ≥ 25 ml/kg of blood products for treatment of hemorrhagic shock caused by blood loss. Measurements and Main Results: Sixty-nine dogs were included. Sources of critical bleeding were trauma (26.1%), intra/perioperative surgical period (26.1%), miscellaneous (24.6%), and spontaneous hemoabdomen (23.1%). Median (range) age was 7 years (0.5-18). Median body weight was 20 kg (2.6-57). Median pre-transfusion hematocrit, total protein, systolic blood pressure, and lactate were 25% (10-63), 4.1 g/dl (2-7.1), 80 mm Hg (20-181), and 6.4 mmol/L (1.1-18.2), respectively. Median blood product volume administered was 44 ml/kg (25-137.4). Median plasma to red blood cell ratio was 0.8 (0-4), and median non-blood product resuscitation fluid to blood product ratio was 0.5 (0-3.6). MT was given to 47.8% of dogs. Survival rate was 40.6%. The estimated odds of survival were higher by a factor of 1.8 (95% CI: 1.174, 3.094) for a dog with 1 g/dl higher total protein above reference interval and were lower by a factor of 0.6 (95% CI: 0.340, 0.915) per 100% prolongation of partial thromboplastin time above the reference interval. No predictors of MT were identified. Conclusions: Critical bleeding in dogs was associated with a wide range of resuscitation patterns and carries a guarded to poor prognosis.

e-Portfolios and Self-Assessment in Dental Hygiene Education: A Pilot Study.

PURPOSE: Self-assessment and critical thinking skills are required for students to reflect on the knowledge and skills they acquire in a dental hygiene program. The Commission on Dental Accreditation states that all graduates must be competent in the knowledge, skills, and values needed to practice as a new practitioner. In order to foster self-assessment, an e-portfolio incorporating a graduate competency template was implemented into a newly designed seminar course. The purpose of this study was to gain student perceptions of a newly implemented e-portfolio as a method to self-assess their knowledge and skills. METHODS: Three cohorts, including 98 dental hygiene students, completed a paper post-course survey that included yes/no questions, a Likert-scale statement, and open-ended questions regarding the e-portfolios. RESULTS: Approximately 94% of students believed they were able to self-assess their abilities by developing an e-portfolio with the graduate competency template. In regards to the graduate competency template, 98% of students stated that the template was helpful during their self-assessment process. Students reported that they received meaningful feedback from the instructor about their ability to self-assess their knowledge, values, and skills. CONCLUSION: E-portfolios can be utilized as a self-assessment tool and a method for students to demonstrate competence.

Impact of Implementing a Competency-Based Clinical Curriculum: Transitioning a Dental Hygiene Program.

PURPOSE: Competency-based education is employed to ensure students are prepared to perform tasks required by entry-level practitioners. The American Dental Education Association's curriculum for dental hygiene programs states that students should learn skills consistently performed by dental hygienists to the level of competence. The purpose of this study was to assess the implementation of a competency- based dental hygiene clinical program at University of Arkansas for Medical Sciences. The program included components such as the development of competencies, assessment techniques, portfolios (self-assessment/reflection), mock boards, faculty feedback, remediation, and competency notebooks. METHODS: To evaluate the competency-based clinical program, surveys were conducted on 30 students and 5 faculty members who experienced the transition from a traditional grade-based clinical program to a non-graded competency-based program. Survey questions included Likert-type questions, ranking aspects of the competency- based program in order of importance, and open-ended questions. Frequency/descriptive statistics were stated in aggregate form to evaluate the students' and faculty's perceptions of the competency-based program. RESULTS: Survey results showed that the majority of students and faculty members felt confident in the students' skills to practice as entry-level hygienists. Students and faculty thought the most valuable aspect of the competency- based program was quad scale experiences. The least beneficial aspect was reflection/ self-assessment. CONCLUSION: There were many challenges involved in implementing a newly established non-graded competency- based clinical program. Although there was resistance from students and faculty, their overall perceptions of the program were positive.

Hibernating Little Pocket Mice Show Few Seasonal Changes in Bone Properties.

Periods of disuse or physical inactivity increases bone porosity and decreases bone mineral density, resulting in a loss of bone mechanical competence in many animals. Although large hibernators like bears and marmots prevent bone loss during hibernation, despite long periods of physical inactivity, some small hibernators do lose bone during hibernation. Little pocket mice (Perognathus longimembris) remain underground during winter hibernation and undergo bouts of torpor and interbout arousals, but the torpor bout duration is shorter than other rodent hibernators. Additionally, little pocket mice may enter torpor during summer estivation. In this study, cortical and trabecular bone architectural, mineral, and mechanical properties were analyzed for femurs from little pocket mice captured during 8 different months (March to October) to determine seasonal effects on bone. There were no differences in any bone properties between the pre-hibernation month of October and the post-hibernation month of March, suggesting winter hibernation did not adversely affect bone properties. However, cortical area was higher in March than April, May, and June. Bone mechanical and osteocyte lacunar properties were not different between any months. Trabecular bone in the distal femoral epiphysis showed no changes between months. The distal femoral metaphyseal region showed higher trabecular spacing and lower trabecular number in May than August, otherwise, there were no differences in trabecular parameters. The few monthly differences in bone properties may be due to physical inactivity from periodic summer estivation or from the timing of birth and growth in spring and summer months. Anat Rec, 300:2175-2183, 2017. © 2017 Wiley Periodicals, Inc.