Real-world experience of direct oral anticoagulant use in a single pediatric center.

BACKGROUND: Pediatric venous thromboembolism has increased by 130%-200%, specifically in hospitalized children, and direct oral anticoagulants (DOACs) offer several therapeutic advantages. METHODS: This study aims to evaluate the real-world epidemiological and outcome data from a retrospective review of pediatric patients treated with DOACs from January 1, 2013 to December 31, 2022. In this single-center, IRB-approved study, 65 patients were identified and analyzed using SPSS statistical software, and a descriptive statistical analysis was conducted. RESULTS: Of the 65 patients, 37% were on apixaban, 61.5% were on rivaroxaban, and 1.5% were on dabigatran. Per the 2023 ISTH outcome definitions, one (2%) patient had a major bleeding episode, six (9%) had clinically relevant non-major bleeding, three (5%) patients had patient-important heavy menstrual bleeding (HMB), and one (1.5%) patient had minor bleeding. Seven (19%) of 37 postmenarchal patients had evidence of HMB. Six (9.2%) patients had recurrent venous thromboembolism while on a DOAC (one was on apixaban, and five were on rivaroxaban) and were transitioned to other forms of anticoagulation. CONCLUSION: Thus, bleeding rates after DOAC therapy are comparable to previous DOAC trials, as well as other anticoagulants in pediatrics. HMB is an important outcome measure and should continue to be investigated. This study reports a higher rate of recurrent thrombosis (9.2%) compared to other trials. However, this observation may be attributed to patients who had ongoing risk factors, as well as a longer duration of study follow-up. Additional multicentered outcome studies evaluating DOAC use in children are needed to determine long-term recurrence and HMB risks.

In vivo measurement of strontium absorption from the rumen of dairy cows as an index of calcium absorption capacity.

Absorption of dietary calcium from the rumen is a quantitatively important process in calcium homeostasis of ruminants. In 3 separate experiments in dairy cows, we applied a technique developed in sheep to measure the rate of strontium (Sr) absorption from the rumen as an indicator of calcium absorption capacity. Absorption from the rumen after an oral dose of SrCl2 resulted in a maximum plasma concentration of Sr after 1 h, whereas absorption from the small intestine after injection of SrCl2 into the abomasum through a cannula occurred more slowly. The second experiment demonstrated that the calcium absorption capacity index of the rumen was significantly greater in 21 lactating Friesian cows (230 ± 66, mean ± SEM) than in 6 mature, nonlactating, nonpregnant heifers (101 ± 21, mean ± SEM). In a third experiment, we compared clinically normal cows at the onset of lactation with those that developed parturient paresis. In cows that developed severe hypocalcemia, plasma concentrations of 1,25(OH)2D were significantly elevated (144 ± 60 pg/mL vs. 90 ± 54 pg/mL; means ± SEM) and their rumen calcium absorption index was significantly decreased compared with that of clinically normal cows. Evidence suggested that mobilization of calcium from bone as lactation commenced was significantly depressed in paretic cows compared with those that did not show clinical signs of hypocalcemia. Moreover, ruminal stasis suppressed the absorption of calcium from the rumen. We conclude that measurement of Sr concentration in blood plasma after an oral dose of SrCl2 into the rumen can be used as an index of rumen calcium absorption capacity under different states of calcium homeostasis.

In vivo measurement of the absorption of strontium in the rumen and small intestine of sheep as an index of calcium absorption capacity.

In the present study, a method was developed for determining the alimentary tract Ca absorption capacity of ruminant animals by measuring the absorption rate of Sr after the administration of an oral dose of strontium chloride acting as a tracer analogue of Ca. A close correlation between the absorption rates of the two tracers was observed upon simultaneous administration of an oral dose of stable Sr and radioactive calcium (r 0·98). The Ca absorption capacity of the rumen and small intestine was determined separately by either directing the solution into the rumen or by diverting it into the post-ruminal tract by vasopressin-induced closure of the ruminoreticular groove. The animals were treated with 1α-hydroxyvitamin D3 administered via subcutaneously implanted mini-osmotic pumps. The effect of elevated plasma 1,25-dihydroxycholecalciferol concentrations on the Ca absorption capacity of the alimentary tract was then determined. An increased rate of Sr absorption was observed in both the rumen and small intestine of sheep after treatment, although it is unclear whether the rumen possesses the same vitamin D-dependent Ca absorption pathway as the small intestine.

The Impact of the Sex of Handlers and Riders on the Reported Social Confidence, Compliance and Touch Sensitivity of Horses in Their Care.

Current evidence of how human sex-related differences in riders and handlers may influence horse behaviour is limited. The Equine Behaviour Assessment and Research Questionnaire (E-BARQ) was used to collect demographic data on riders and handlers (n = 1420) and behavioural data on their horses. It includes demographic items about the sex of the respondent and how frequently the horse has been ridden or handled by male and female humans. The questionnaire then gathers observations on the horse's behaviour on the ground and under saddle or when driven. Using E-BARQ's battery of 97 questions, the current study showed differences in ridden and non-ridden horse behaviour that were related to the sex of the rider or handler. Data were evaluated using multivariate analysis and revealed that horses handled by male humans were significantly more difficult to catch (t-value = -3.11; p = 0.002) and significantly more defensive when approached (t-value = -2.104; p = 0.035), but significantly less likely to pull on the reins/brace the neck or toss their head (t-value 1.980; p = 0.048) than horses handled more frequently by female humans. The differences found between male and female horse handlers suggest that sex is an important factor to consider when understanding equine behaviour. Our study explored reported differences in confidence, handling and working compliance and touch sensitivity among horses ridden and handled by male and female humans and suggested further research into how these differences are gendered.

Identifying Sources of Potential Bias When Using Online Survey Data to Explore Horse Training, Management, and Behaviour: A Systematic Literature Review.

Owner-reported behavioural observations form an essential part of the veterinarians' diagnosis and treatment plan. The way we train and manage horses affects their behaviour and, in turn, their health and welfare. Current horse training and management practices are largely driven by traditional techniques and longstanding methodologies. These approaches generally lack an evidence base for evaluation purposes. The absence of evidence and evaluation contributes to the persistent use of risky practices and this, in turn, increases risk of potential harms for both horse and rider, and fuels questioning of the equine industry's current social license to operate. Objective evidence is required to make training and management decisions based on demonstrable best practice. Large-scale experimental or intervention studies using horses are generally not practical because of the associated costs and logistics of gaining ethical approval. Small studies generally lack statistical power and are subject to the effects of many forms of bias that demand caution in the interpretation of any observed effects. An alternative to collecting large amounts of empirical data is the use of owner-reported observations via online survey. Horse owners are ideally placed to report on the domestic equine triad of training, management, and behaviour. The current article highlights three sources of potential bias in a systematic review of literature on large-scale online studies of horse owners' observational reports that met the following selection criteria: English-language, published, peer-reviewed articles reporting on studies with over 1000 respondents and open access to the survey instrument. The online surveys were evaluated for three common forms of bias: recall, confirmation, and sampling bias. This review reveals that online surveys are useful for gathering data on the triad of horse training, management, and behaviour. However, current use of online surveys to collect data on equitation science (including horse training, management, and behaviour) could be improved by using a standardised and validated tool. Such a tool would facilitate comparisons among equine and equitation science studies, thus advancing our understanding of the impacts of training and management on horse behaviour. The authors of the current review suggest the use of a standardised behavioural and management assessment tool for horses. Such a tool would help define what constitutes normal behaviour within geographically disparate populations of horses, leading to improvements in rider safety and horse welfare.

Equine Responses to Acceleration and Deceleration Cues May Reflect Their Exposure to Multiple Riders.

It is logical to assume that horses with multiple riders encounter variation in application of training cues. When training cues are inconsistent, we expect to see a decrease in trained responses or an increase in conflict behaviours. This study investigated the relationship between the number of people that regularly ride or handle a horse and the horse's response to operant cues. Data on 1819 equids were obtained from the Equine Behavior Assessment and Research Questionnaire (E-BARQ), an online global survey of horse owners and caregivers. Three mutually independent indices (acceleration, deceleration, and responsiveness) were derived from a parallel analysis of E-BARQ items related to acceleration and deceleration cues. These indices were then subjected to multivariable modelling against a range of dependent variables including horse and human demographics, horse management, and the number of riders or handlers. The number of riders or handlers was a significant predictor for two out of three indices. As the number of riders or handlers increased, horses were more difficult to accelerate (regression coefficient = 0.0148 ± 0.0071; p = 0.0366) and less difficult to decelerate (regression coefficient = -0.017 ± 0.008; p = 0.030) than those with fewer riders or handlers. These findings suggest that horses' responses to rein tension cues are more persistent than their responses to leg pressure or whip cues. Alternatively, horses with these responses may be actively selected for multiple rider roles. Longitudinal studies of this sort should reveal how the number of riders or handlers affects horse behaviour and could lead to safer and more humane equestrian practices.

Review of the Online One Welfare Portal: Shared Curriculum Resources for Veterinary Undergraduate Learning and Teaching in Animal Welfare and Ethics.

This article introduces the online One Welfare learning and teaching portal (OWP) and describes its development, use, importance and relevance to animal welfare and ethics (AWE) stakeholders. As animal welfare issues increase in importance, veterinarians must be trained to lead the science that underpins AWE discourses. The OWP is a collection of resources designed to engage and challenge veterinary science students as they become advocates for animals. It was developed collaboratively by all eight veterinary schools in Australia and New Zealand, and funded by the Australian Government Office for Learning and Teaching. Surveys to investigate the attitudes of students and educators to AWE issues in six context-specific themes based on the Australian Animal Welfare Strategy (AAWS) (companion animals; animals used in research and teaching; livestock/production animals; animals used for sport, recreation or display; animals in the wild and aquatic animals) were administered through all participating schools. Students assigned more importance to Day One competence in knowledge of welfare concepts than did educators for the following groups: production animals, companion animals, animals in the wild, aquatic animals, animals used in research and teaching, and animals used for sport, recreation or display (all p < 0.01). Agreement between educators and students was closer regarding the importance of Day One competence for euthanasia for all six context-specific themes (p < 0.01 - 0.03). Students assigned more importance than educators to social, economic and cultural drivers of welfare outcomes in production animals (p < 0.01); slaughter and preslaughter inspections in production animals (p < 0.01); animal abuse and hoarding in companion animals (p < 0.01); shelter medicine in companion animals (p < 0.01); disaster preparedness in wildlife animals (p < 0.01); pain and distress caused by fishing in aquatic animals (p < 0.01); conscientious objection related to animals held for research and teaching (p < 0.01); behaviour, selection and training of animals used for sport, recreation and display (p = 0.046) and educating the public around sporting animal welfare (p < 0.01). Agreement between educators and students was closer for strategies to address painful husbandry procedures in production animals (p = 0.03); behaviour and training of companion animals (p = 0.03); veterinarians' duties to wild animals in wildlife (p = 0.02); the 3Rs in animals held for research and teaching (p = 0.03) and ownership responsibility in sporting animals (p = 0.01). This report discusses the reasons for differences among students and educators as they approach these issues. The portal is expected to gather more content as veterinary schools in other countries use its resources and users submit scenarios and discussion topics that reflect local needs.

It's all about the sex, or is it? Humans, horses and temperament.

We propose that the anthropomorphic application of gender stereotypes to animals influences human-animal interactions and human expectations, often with negative consequences for female animals. An online survey was conducted to explore riders' perceptions of horse temperament and suitability for ridden work, based on horse sex. The questionnaire asked respondents to allocate three hypothetical horses (a mare, gelding and stallion) to four riders compromising a woman, man, girl and boy. Riders were described as equally capable of riding each horse and each horse was described as suitable for all riders. Participants were also asked which horses (mares, geldings or stallions) were most suitable for the three equestrian disciplines of show-jumping, dressage and trail-riding. Logistic regression analyses were conducted to investigate people's perceptions about suitability of horse types for particular riders, to evaluate if age, strength or gender were important in rider choice and to investigate riders' allocation of various descriptors to a gelding, stallion or mare. There were 1,233 survey respondents, 94% of whom were female and 75% of whom were riders with at least eight years of experience. Binomial logistic regression revealed the girl had 2.5 times the odds of being allocated the gelding compared to the boy (p < 0.001). Respondents were significantly more likely to allocate the stallion to the man and nearly 50% of respondents did not allocate a horse to the boy, even though they ranked rider gender as least important to their choice (p < 0.001). In a forced choice selection of a positive or negative descriptor from a series of nine paired terms to describe horse temperament, a greater proportion of respondents assigned geldings positive ratings on terms such as calm, trainable, reliable and predictable. In terms of suitability for the three equestrian disciplines of show-jumping, dressage and trail-riding, participants overwhelmingly chose geldings for trail-riding, with mares being least preferred for both dressage and show-jumping disciplines. The results suggest that female riders are entering the horse-human dyad with gendered ideas about horse temperament and view horse-riding as an activity primarily for women and girls. This could have far-reaching implications for equine training and welfare.