Direct Measurement of Veterinary Student Learning Outcomes for the NAVMEC Professional Competencies in a Multi-User Virtual Learning Environment.

Education in veterinary medicine, as in other allied health care-health science professions and academia in general, has been subject to the public call for accountability for the quality of its student learning outcomes. A principal stakeholder in veterinary medicine is the American Veterinary Medical Association-Council on Education (AVMA-COE). AVMA-COE has adopted program accreditation standards requiring veterinary colleges to provide evidence that they are measuring and assessing the clinical competency of students before graduation and again shortly after graduation. Schools and colleges are required to develop relevant measures to validate scientific knowledge, skills, and values aligned with North American Veterinary Medical Education Consortium (NAVMEC) core competencies. Beginning in May 2012, the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University modified the professional veterinary medical curriculum by including a required clinical rotation centered on veterinary emergency preparedness and response. A distinguishing major component of the instructional design of the clinical rotation includes Second Life, a commercially obtained computer-generated multi-user virtual simulation learning environment. The virtual reality situations require high-volume, mass-casualty medical triage decision making. The interpersonal communications and interactivity among students, faculty, and third-party actors enable faculty and instructor observers and simulation facilitators to evaluate students actively engaged in critical thinking and complex problem solving while demonstrating skill in the NAVMEC professional competencies. The Second Life virtual simulation has been adopted as a primary tool for direct measurement of student learning objectives outcomes achieved in this clinical rotation and is being implemented in other clinical teaching platforms.

Evaluating geostatistical modeling of exceedance probability as the first step in disease cluster investigations: very low birth weights near toxic Texas sites.

BACKGROUND: The first step in evaluating potential geographic clusters of disease calls for an evaluation of the disease risk comparing the risk in a defined location to the risk in neighboring locations. Environmental exposures, however, represent continuous exposure levels across space not an exposure with a distinct boundary. The objectives of the current study were to adapt, apply and evaluate a geostatistical approach for identifying disease clusters. METHODS: The exceedance probability for very low birth weight (VLBW; < 1.5 kg) infants was mapped using an Intrinsic Conditional Autoregressive model. The data were applied to a 20 by 20 grid of 1 km2 pixels centered on each of the 13 National Priority List Superfund Sites in Harris County, Texas. RESULTS: Large clusters of VLBW were identified in close proximity to four of the 13 Superfund Sites. Three of the Superfund Sites, associated with disease clusters, were located close together in central Houston and these sites may have been surrounded by a single, confluent disease cluster. CONCLUSIONS: Geostatistical modeling of the exceedance probability for very low birth weights identified disease clusters of varying size, shape and statistical certainty near Superfund Sites in Harris County, Texas. The approach offers considerable potential as the first step for investigating potential disease clusters.

How a disaster preparedness rotation helps teach the seven NAVMEC professional competencies: the Texas A&M University Experience.

Changing societal expectations provide new challenges and opportunities for the veterinary medical profession. These changing expectations and approaches to the education of veterinary students in the future are reflected in the North American Veterinary Medical Education Consortium's report "Roadmap for Veterinary Medical Education in the 21st Century: Responsive, Collaborative, Flexible." They are also reflected in the expectations of the populace, who no longer find it acceptable that animals are not included in both planning for and responding to natural or manmade disasters. In response to the changing needs of society and the veterinary profession, Texas A&M University College of Veterinary Medicine has developed a required rotation in the fourth-year curriculum on emergency planning and response. The unique requirements of emergency preparedness and response and the design of the rotation provide an ideal platform for providing this valued public service while simultaneously addressing the seven professional competencies outlined in the NAVMEC roadmap. This article describes an overview of the rotation and its content and identifies opportunities for students to practice these important professional competencies using the tools introduced in this new rotation.

Risk factors associated with nasopharyngeal cicatrix syndrome in horses.

OBJECTIVE: To determine risk factors associated with the development of nasopharyngeal cicatrix syndrome (NCS) in horses. DESIGN: Retrospective case-control study. ANIMALS: 242 horses referred for endoscopic evaluation of the upper portion of the respiratory tract (121 horses with NCS and 121 control horses). PROCEDURES: Medical records of horses that had an endoscopic evaluation of the upper airway performed between January 2003 and December 2008 were reviewed. Signalment, housing management, and season of evaluation were recorded and reviewed for each horse. The associations between clinical signs and endoscopic findings were evaluated by the use of a prospective logistic model that included a Bayesian method for inference. Results-Breed and sex had no significant effect on the risk of having NCS. The risk that a horse had NCS increased significantly with age. Exclusive housing in a stall was protective against the development of NCS. In addition, the amount of pasture turnout had a dose-related effect, with exclusive pasture turnout positively correlated with increased risk of developing NCS, compared with a mixture of pasture turnout and stall confinement. Horses were significantly more likely to be evaluated because of clinical signs of the syndrome during the warm months of the year. CONCLUSIONS AND CLINICAL RELEVANCE: The risk factors for NCS identified in this study may support chronic environmental exposure to an irritant or infectious agent as the cause of NCS. Information gained from this study should be useful for investigating the cause of NCS.

Serologic and bacteriologic culture prevalence of Corynebacterium pseudotuberculosis infection in goats and sheep and use of Bayesian analysis to determine value of assay results for prediction of future infection.

OBJECTIVE: To determine the serologic and bacteriologic culture prevalence of Corynebacterium pseudotuberculosis infection in sheep and goats and the value of such assays for prediction of future development of caseous lymphadenitis (CL). DESIGN: Observational study. ANIMALS: 919 goats and sheep in 3 herds in southwest Texas. PROCEDURES: During an initial evaluation, serologic and bacteriologic culture status for CL was determined for all animals. Subsequently, animals were evaluated every 6 months for a 13-month period to detect external CL lesions. Affected animals in 2 herds were treated with tulathromycin or a control treatment; affected animals in 1 herd were culled. The value of assays for prediction of future development of CL lesions was determined. RESULTS: The serologic prevalence of CL in herds at the start of the study ranged from 7.52% to 69.54%. The bacteriologic culture prevalence of CL ranged from 0% to 6.12% at the start of the study and 0% to 9.56% at the end of the study. Synergistic hemolysin inhibition results were poor predictors of future development of CL lesions in animals during the study period; however, animals with positive bacteriologic culture results for CL were more likely to develop lesions in the future than were animals with negative bacteriologic culture results. CONCLUSIONS AND CLINICAL RELEVANCE: Caseous lymphadenitis was detected in animals in this study despite prior management of affected animals in herds via culling. Use of a synergistic hemolysin inhibition test for management of CL may cause unnecessary culling of animals; treatment might allow retention of genetically valuable CL-affected animals in a herd without substantially increasing the prevalence of CL.

Risks of childhood cancer among Texas watersheds, based on mothers' living locations at the time of birth.

Cancer is the most common fatal disease among US children. The fetus has reduced resistance to toxic injury and is especially prone to mutagenic injury because of the high rate of cell division. A fetus can be exposed to environmental toxins through maternal consumption of contaminated water. The objective of this study was to estimate the incidence risk for childhood cancers within each watershed in Texas. The approach modeled risk for 19 cancer histotypes incorporating correlations among the cancer types and spatial correlation. Several watersheds in a very large area known as the Central Great Plains of North Texas were associated with increased risk for astrocytoma. Two watersheds near Houston, Buffalo-San Jacinto and West Galveston Bay, had increased risk for renal cancer and acute lymphoid leukemia, respectively. A watershed in South Texas, the South Laguna Madre, had increased risk for atypical leukemias. The possibility that waterborne toxins cause these childhood cancers should be investigated further.

Comparison of three treatment regimens for sheep and goats with caseous lymphadenitis.

OBJECTIVE: To compare the effectiveness of 3 treatment regimens for small ruminants with caseous lymphadenitis. DESIGN: Randomized clinical trial. ANIMALS: 44 client-owned sheep and goats. PROCEDURES: Aspirates were obtained from 48 lesions of 44 enrolled animals and submitted for bacterial culture. Animals were randomly assigned to 1 of 3 treatment groups. Treatment for group A (n = 15 lesions) consisted of opening, draining, and flushing the lesions and SC administration of procaine penicillin G. Treatment for group B (n = 15 lesions) consisted of closed-system lavage and intralesional administration of tulathromycin. Treatment for group C (n = 18 lesions) consisted of closed-system lavage and SC administration of tulathromycin. All animals were reexamined approximately 1 month after treatment, unless treatment failure was detected prior to that time. RESULTS: 43 animals with lesions had positive results (Corynebacterium pseudotuberculosis) for bacterial culture. Proportions of lesions that had resolution of infection by 1 month after treatment did not differ significantly among the treatment groups (group A, 13/14 [92.9%]; 95% confidence interval [CI], 69.5% to 99.6%; group B, 10/12 [83.3%]; 95% CI, 54.9% to 97.1%; and group C, 14/17 [82.4%]; 95% CI, 59.1% to 95.3%). CONCLUSIONS AND CLINICAL RELEVANCE: Acceptable alternatives to opening, draining, and flushing of lesions may exist for treatment of sheep and goats with caseous lymphadenitis. Use of tulathromycin and penicillin in this study constituted extralabel drug use, which would require extended withholding times before milk or meat of treated sheep and goats can be sold for human consumption.

Use of Walpole's solution for treatment of goats with urolithiasis: 25 cases (2001-2006).

OBJECTIVE: To determine results of ultrasound-guided cystocentesis and percutaneous infusion of Walpole's solution for treatment of male goats with urolithiasis. DESIGN: Retrospective case series. ANIMALS: 25 male goats with urolithiasis treated with Walpole's solution. PROCEDURES: Information obtained from the medical records included signalment, degree of urethral obstruction (partial vs complete), pertinent examination findings, concurrent illnesses, diet, other treatments administered, duration of hospitalization, whether the obstruction resolved, and outcome (ie, discharged vs euthanized). RESULTS: 14 (58%) animals had complete urethral obstruction, and 10 (42%) had partial obstruction (degree of urethral patency was not recorded in 1 animal). Walpole's solution was infused once in 18 (72%) animals, twice in 6 (24%) animals, and 3 times in 1 (4%) animal. The amount of Walpole's solution required to achieve the target urine pH of 4 to 5 ranged from 50 to 250 mL. In 20 (80%) goats, the urethral obstruction resolved, and the goat was discharged. The remaining 5 (20%) goats were euthanized because of unresolved urethral obstruction. Six of the 20 (30%) goats that were discharged were reexamined because of recurrence of urethral obstruction. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ultrasound-guided cystocentesis in combination with percutaneous infusion of Walpole's solution may be a useful treatment in male goats with obstructive urolithiasis.

Imaging diagnosis--bacterial diskospondylitis in a goat.

A 3-year-old intact male Boer goat was evaluated for paraplegia. Computed tomography (CT) indicated the presence of diskospondylitis, which had previously not been reported in this species, and significant compressive myelopathy. Chronic bacterial pneumonia, epididymitis, nephritis, and soft-tissue abscesses were believed to result in hematogenous spread of bacteria to the affected disk spaces. Staphylococcus spp. and Archanobacterium pyogenes were both identified from postmortem cultures of the vertebral column.