Ascribing Sentience: Evidential and Ethical Considerations in Policymaking.

Deciding which animals are sentient is an important precursor for decisions about the application of animal welfare legislation, and the wider assessment of the impacts of policies on animal suffering. We ascribe sentience in order to inform decisions about how animals should be treated, and how their treatment should be regulated. This ascription is both an ethical and an evidential process, and what evidence to use and require are ethical questions. Policymakers, therefore, cannot simply rely on scientific evidence in an ethically neutral way, but must be conscious of the ethical assumptions and positions underlying the process of ascription and its application in policy and law. As such, ethical principles that apply to policymaking apply to the ascription of sentience. This paper considers the implications of the Nolan principles for public service on the ascription of animals.

A One Medicine Mission for an Effective Rabies Therapy.

Despite the disease's long history, little progress has been made toward a treatment for rabies. The prognosis for patient recovery remains dire. For any prospect of survival, patients require aggressive critical care, which physicians in rabies endemic areas may be reluctant or unable to provide given the cost, clinical expertise required, and uncertain outcome. Systematic clinical research into combination therapies is further hampered by sporadic occurrence of cases. In this Perspective, we examine the case for a One Medicine approach to accelerate development of an effective therapy for rabies through the veterinary care and investigational treatment of naturally infected dogs in appropriate circumstances. We review the pathogenesis of rabies virus in humans and dogs, including recent advances in our understanding of the molecular basis for the severe neurological dysfunction. We propose that four categories of disease process need to be managed in patients: viral propagation, neuronal degeneration, inflammation and systemic compromise. Compassionate critical care and investigational treatment of naturally infected dogs receiving supportive therapy that mimics the human clinical scenario could increase opportunities to study combination therapies that address these processes, and to identify biomarkers for prognosis and therapeutic response. We discuss the safety and ethics of this approach, and introduce the Canine Rabies Treatment Initiative, a non-profit organization with the mission to apply a One Medicine approach to the investigation of diagnostic, prognostic, and therapeutic options for rabies in naturally infected dogs, to accelerate transformation of rabies into a treatable disease for all patients.

AntiPORT: adaptation of a transfusion prediction score to an Australian cardiac surgery population.

Introduction: Risk scoring systems exist to predict perioperative blood transfusion risk in cardiac surgery, but none have been validated in the Australian or New Zealand population. The ACTA-PORT score was developed in the United Kingdom for this purpose. In this study, we validate and recalibrate the ACTA-PORT score in a large national database. Methods: We performed a retrospective validation study using data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database between 1 September 2016 and 31 December 2018. The ACTA-PORT score was calculated using an equivalent of EuroSCORE I. Discrimination and calibration was assessed using area under the receiver operating characteristic (AUROC) curves, Brier scores, and calibration plots. ACTA-PORT was then recalibrated in a development set using logistic regression and the outcome of transfusion to develop new predicted transfusion rates, termed "AntiPORT", using AusSCORE "all procedures" as the regional equivalent of EuroSCORE I. The accuracy of these new predictions was assessed as for ACTA-PORT. Results: 30 388 patients were included in the study at 37 Australian centres. The rate of red blood cell transfusion was 33%. Discrimination of ACTA-PORT was good but calibration was poor, with overprediction of transfusion (AUROC curve, 0.76; 95% CI, 0.75-0.76; Brier score, 0.19). The recalibrated AntiPORT showed significantly improved calibration in both development and validation sets without compromising discrimination (AUROC curve, 0.76; 95% CI, 0.75-0.76; Brier score, 0.18). Conclusions: The AntiPORT is the first red cell transfusion risk scoring system for cardiac surgery patients to be validated using Australian data. It is accurate and simple to calculate. The demonstrated accuracy of AntiPORT may help facilitate benchmarking and future research in patient blood management, as well as providing a useful tool to help clinicians target these resource-saving strategies.

Sentience, Harmony and the Value of Nature.

Concern for nature and for animal sentience are important public and political moral concerns. Using frameworks such as Harmony for Nature and One Health and the recent IPBES report on the Diverse Values of Nature, this paper considers how the two issues interrelate, in terms of our concepts of sentience and nature, and sentience-based values' importance in relation to nature-based values. Animals' sentience is part of nature, and part of its diversity, harmony, health and value. Sentient animals' feelings represent animals' evaluations of nature that go beyond valuing nature for solely for market-based and anthropocentric interests. Sentience is therefore relevant for measurement, leveraging and embedding sentience-based values in environmental concerns, including in environmental impact assessments, science-based UN policy-making, interdisciplinary and interagency collaboration, and to strengthen transformative and system-based action for nature.

Preoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study.

BACKGROUND: Preoperative anaemia affects one third of patients undergoing cardiac surgery and is associated with increased mortality and morbidity. Although it is recommended that perioperative teams should identify and treat patients with preoperative anaemia before surgery, introducing new treatment protocols can be challenging in surgical pathways. The aim of this study was to assess the feasibility and effectiveness of introducing a preoperative intravenous iron service as a national initiative in cardiac surgery. METHODS: We performed a multicentre, stepped, observational study using the UK Association of Cardiothoracic Anaesthesia and Critical Care Research Network. The primary feasibility outcome was the ability to set up an anaemia and intravenous iron clinic at each site. The primary efficacy outcome was change in haemoglobin (Hb) concentration between intervention and operation. Secondary outcomes included blood transfusion and hospital stay. Patients with anaemia were compared with non-anaemic patients and with those who received intravenous iron as part of their routine treatment protocol. RESULTS: Seven out of 11 NHS hospitals successfully set up iron clinics over 2 yr, and 228 patients were recruited into this study. Patients with anaemia who received intravenous iron were at higher surgical risk, were more likely to have a known previous history of iron deficiency or anaemia, had a higher rate of chronic kidney disease, and were slightly more anaemic than the non-treated group. Intravenous iron was administered a median (inter-quartile range, IQR [range]) of 33 (15-53 [4-303]) days before surgery. Preoperative intravenous iron increased [Hb] from baseline to pre-surgery; mean (95% confidence interval) change was +8.4 (5.0-11.8) g L-1 (P<0.001). Overall, anaemic compared with non-anaemic patients were more likely to be transfused (49% [59/136] vs 27% (22/92), P=0.001) and stayed longer in hospital (median days [IQR], 9 [7-15] vs 8 [6-11]; P=0.014). The number of days alive and at home was lower in the anaemic group (median days [IQR], 20 [14-22] vs 21 [17-23]; P=0.033). CONCLUSION: The development of an intravenous iron pathway is feasible but appears limited to selected high-risk cardiac patients in routine NHS practise. Although intravenous iron increased [Hb], there is a need for an appropriately powered clinical trial to assess the clinical effect of intravenous iron on patient-centred outcomes.

Naturalness and Animal Welfare.

Naturalness is considered important for animals, and is one criterion for assessing how we care for them. However, it is a vague and ambiguous term, which needs definition and assessments suitable for scientific and ethical questions. This paper makes a start on that aim. This paper differentiates the term from other related concepts, such as species-typical behaviour and wellbeing. It identifies contingent ways in which naturalness might be used, as: (i) prompts for further welfare assessment; (ii) a plausible hypothesis for what safeguards wellbeing; (iii) a threshold for what is acceptable; (iv) constraints on what improvements are unacceptable; and (v) demarcating what is not morally wrong, because of a lack of human agency. It then suggests an approach to evaluating animals' behaviour that is quantitative, is based on reality, and which assesses naturalness by degrees. It proposes classing unaffected wild populations as natural by definition. Where animals might have been affected by humans, they should be compared to the closest population(s) of unaffected animals. This approach could allow us both to assess naturalness scientifically, and to make practical decisions about the behaviour of domestic animals.

Using the Five Domains Model to Assess the Adverse Impacts of Husbandry, Veterinary, and Equitation Interventions on Horse Welfare.

The aim of this study was to conduct a series of paper-based exercises in order to assess the negative (adverse) welfare impacts, if any, of common interventions on domestic horses across a broad range of different contexts of equine care and training. An international panel (with professional expertise in psychology, equitation science, veterinary science, education, welfare, equestrian coaching, advocacy, and community engagement; n = 16) met over a four-day period to define and assess these interventions, using an adaptation of the domain-based assessment model. The interventions were considered within 14 contexts: C1 Weaning; C2 Diet; C3 Housing; C4 Foundation training; C5 Ill-health and veterinary interventions (chiefly medical); C6 Ill-health and veterinary interventions (chiefly surgical); C7 Elective procedures; C8 Care procedures; C9 Restraint for management procedures; C10 Road transport; C11 Activity-competition; C12 Activity-work; C13 Activity-breeding females; and C14 Activity-breeding males. Scores on a 1-10 scale for Domain 5 (the mental domain) gathered during the workshop were compared with overall impact scores on a 1-10 scale assigned by the same panellists individually before the workshop. The most severe (median and interquartile range, IQR) impacts within each context were identified during the workshop as: C1 abrupt, individual weaning (10 IQR 1); C2 feeding 100% low-energy concentrate (8 IQR 2.5); C3 indoor tie stalls with no social contact (9 IQR 1.5); C4 both (i) dropping horse with ropes (9 IQR 0.5) and forced flexion (9 IQR 0.5); C5 long-term curative medical treatments (8 IQR 3); C6 major deep intracavity surgery (8.5 IQR 1); C7 castration without veterinary supervision (10 IQR 1); C8 both (i) tongue ties (8 IQR 2.5) and (ii) restrictive nosebands (8 IQR 2.5); C9 ear twitch (8 IQR 1); C10 both (i) individual transport (7.00 IQR 1.5) and group transport with unfamiliar companions (7 IQR 1.5); C11 both (i) jumps racing (8 IQR 2.5) and Western performance (8 IQR 1.5); C12 carriage and haulage work (6 IQR 1.5); C13 wet nurse during transition between foals (7.5 IQR 3.75); and C14 teaser horse (7 IQR 8). Associations between pre-workshop and workshop scores were high, but some rankings changed after workshop participation, particularly relating to breeding practices. Domain 1 had the weakest association with Domain 5. The current article discusses the use of the domain-based model in equine welfare assessment, and offers a series of assumptions within each context that future users of the same approach may make when assessing animal welfare under the categories reported here. It also discusses some limitations in the framework that was used to apply the model.

Introducing forensic entomology in cases of suspected animal neglect.

Cases of arthropod-infested, abandoned or abused animals are sometimes brought to the attention of veterinarians by animal welfare authorities, with the requirement for a full postmortem examination towards criminal or civil proceedings. In these situations, entomology is an important support tool for the pathologists' investigation since the presence of arthropod life cycle stages serve as reliable forensic markers, especially for blowflies which form the first waves of activity following death. In the present study, 70 cadavers from a total of 544 referred to the Institute of Veterinary Science, University of Liverpool, between 2009 and 2014 displayed evidence of infestation. Here, the authors introduce principles of applied entomology and simplified approaches for estimating the minimum time since death, relevant in the context of routine submissions and the broad remit of individual cases. Despite often limited availability of scene of the crime and local thermal data, the interpretation of the minimum postmortem interval has nonetheless proved valuable as an adjunct to the expert pathology report. However, future developments and enhanced accuracy in this area of animal welfare require resource and training in expertise, and agreed standardisation of both laboratory and field procedures.

A Critical Analysis of the British Horseracing Authority's Review of the Use of the Whip in Horseracing.

There is increasing controversy about the use of the whip as a performance aid in Thoroughbred horseracing and its impact on horse welfare. This paper offers a critical analysis of the British Horseracing Authority's (BHA) 2011 Report Responsible Regulation: A Review of the Use of the Whip in Horseracing. It examines the BHA's process of consultation and use of science and public opinion research through the application of current scientific literature and legal analysis. This analysis suggests that the BHA's findings on the welfare impact and justification for whip use are insufficiently defended by the report. These findings indicate that the report is an inadequate basis from which to draw any definitive conclusions on the impact of whips on racehorse welfare. Further review is needed, undertaken by an independent scientific body, to advance this debate.

ISFM guidelines on population management and welfare of unowned domestic cats (Felis catus).

UNLABELLED: GUIDELINES RATIONALE: Cats are among the most commonly kept domestic pets, and coexist with humans in a variety of different circumstances. Cats are sentient beings and, as such, humans have a responsibility for cat welfare where humans and cats coexist. Because cats reproduce efficiently, measures to control populations are frequently needed, but these should be based on ethical and humane approaches. FRAMEWORK: These consensus guidelines from the International Society of Feline Medicine's Welfare Advisory Panel provide a framework for the approach to welfare and population control measures, primarily among unowned cats and those going through a homing programme.

Maximising canine welfare in veterinary practice and research: a review.

This article looks at the existing evidence-base by which veterinary surgeons can make welfare-focused treatment choices. Narrative and structured reviews were conducted. Papers were categorised under headings based on (1) themes in the UK Animal Welfare Act (AWA 2006) - behaviour, environment, nutrition, company and health; (2) iatrogenic harm induced by treatment; (3) decision-making methods, and (4) the subjects' context (e.g. home versus laboratory). There is more information available about 'overt' problems (e.g. acute disease), than 'covert' issues (e.g. chronic pain, lack of company and obesity). Forty of 109 papers covered pain, suffering, injury and disease, compared to 69 across four other themes in the AWA. Twelve papers were identified as focusing on welfare assessment and clinical decision-making. Veterinary surgeons should consider each of the five welfare themes described in the AWA in both veterinary practice and in determining veterinary research priorities.