Veterinary anesthesia: an opportunity to reduce the environmental footprint of clinical care.

Volatile anesthetic agents are potent greenhouse gases with warming potential hundreds to thousands of times greater than CO2. As health systems, both human and veterinary, seek to reduce their environmental impacts, responsible anesthetic stewardship is a topic of great interest. Through an online survey, we explored the levels of awareness, beliefs, interest, needs, and current actions of veterinary anesthesia professionals around the climate impacts of anesthetic care. We found that even within a respondent group with specialized training and experience, there were significant knowledge gaps about anesthesia's environmental impacts. We also found there is much interest in learning more about climate-friendly anesthesia and broader sustainability initiatives for the veterinary profession. Fortunately, there already exist many ways for the profession to reduce our environmental impact while still providing excellent patient care. In this article, we explore 5 broad categories of action: (1) reducing the overall quantity of anesthetic agent used; (2) choosing lower-impact anesthetics; (3) considering the fate of the anesthetic end product; (4) expanding learning through formal education, experience, and research; and (5) reaching beyond anesthesia to implement a range of sustainability initiatives at veterinary workplaces. Together, we have an opportunity to create a healthier future for our world, our patients, and each other.

The Social Ecology of Health Beliefs and Misinformation Framework: Examining the impact of misinformation on vaccine uptake through individual and sociological factors.

BACKGROUND: Misinformation presents a critical concern for academic and public health discourse, particularly around vaccine response. Before the COVID-19 pandemic, vaccine hesitancy was responsible for decreased immunization uptake for vaccine-preventable diseases. Misinformation connected to the novel COVID-19 vaccine has further fueled vaccine hesitancy in Colorado and the United States. Our study brings together three different perspectives - physicians, public health professionals, and parents - to understand the impact of misinformation on vaccine uptake in Colorado. Our study proposes a framework for combining the Health Belief Model with the Socio-Ecological model to account for societal factors in healthcare decision making. METHODS: Semi-structured interviews and focus groups with public health professionals, physicians, and parents (n = 31) were conducted in late spring and summer 2022. Data were coded inductively using thematic analysis. Identified themes were deductively categorized according to the Socio-Ecological Model and Health Belief Model. RESULTS: Using a theoretical framework that combined the Health Belief Model and the Socio-Ecological Model, we identified seven factors that influenced vaccine hesitancy in Colorado. Intrapersonal factors included routine vaccine hesitancy connected to perceptions of severity and susceptibility, efficacy, and benefits and barriers to vaccine uptake; interpersonal factors included social networks; institutional factors included mass mediated platforms, portrayals of uncertainty, distrust in institutional sources of information, and political influences in vaccine decision making; and structural factors included economic barriers behind vaccine hesitancy. CONCLUSIONS: Our study provides a unique, triangulated, post-positivist perspective on the role of misinformation in vaccine hesitancy in Colorado. The findings provide evidence that misinformation is an important barrier to vaccination uptake and can permeate multiple socio-ecological determinants/characteristics to influence vaccination behaviors including intrapersonal, interpersonal, institutional, and structural levels. We introduce the Social Ecology of Health Beliefs and Misinformation Framework to account for how misinformation may interrupt vaccine uptake.

Environmental risk factors for UV-induced cutaneous neoplasia in horses: A GIS approach.

Objective: Ultraviolet light (UV) is a risk factor for the development of cutaneous neoplasia in many mammalian species. This study evaluated UV exposure as a risk factor of concern for the development of cutaneous neoplasia in equine species due to the significant UV exposure that may accrue over their lifetimes. Animals and samples: Neoplastic biopsy specimens from 3272 horses that were submitted over a 10-year period to the Colorado State University Diagnostic Medicine Center and to the University of Saskatchewan Western College of Veterinary Medicine and Prairie Diagnostic Services were evaluated. Procedure: This retrospective study assessed the spatial relationships between altitude, latitude, longitude, and UV maximum value and the probability of UV-induced cutaneous neoplasia. Results: Cases from areas at high altitude proved to have a higher prevalence of UV-induced cutaneous neoplasia than those from areas at lower elevations. A multivariable regression analysis demonstrated that altitude was the only factor significantly and positively associated with the diagnosis of UV-induced neoplasia. Conclusion and clinical relevance: Evidence of cutaneous neoplasia in horses and environmental factors that influence the degree of UV exposure in a geographic location may aid in diagnosis and suggest preventive measures from UV overexposure.

Facteurs de risque environnementaux des néoplasies cutanées induites par les UV chez le cheval : une approche SIG. Objectif: La lumière ultraviolette (UV) est un facteur de risque pour le développement de néoplasies cutanées chez de nombreuses espèces de mammifères. Cette étude a évalué l'exposition aux UV en tant que facteur de risque préoccupant pour le développement de néoplasies cutanées chez les équidés en raison de l'exposition importante aux UV qui peut s'accumuler au cours de leur vie. Animaux et échantillons: Des échantillons de biopsie néoplasique de 3272 chevaux qui ont été soumis sur une période de 10 ans au Colorado State University Diagnostic Medicine Center et au University of Saskatchewan Western College of Veterinary Medicine and Prairie Diagnostic Services ont été évalués. Procédure: Cette étude rétrospective a évalué les relations spatiales entre l'altitude, la latitude, la longitude et la valeur maximale des UV et la probabilité de néoplasie cutanée induite par les UV. Résultats: Les cas des régions de haute altitude se sont avérés avoir une prévalence plus élevée de néoplasie cutanée induite par les UV que ceux des régions de basse altitude. Une analyse de régression multivariée a démontré que l'altitude était le seul facteur significativement et positivement associé au diagnostic de néoplasie induite par les UV. Conclusion et pertinence clinique: Les preuves de néoplasie cutanée chez les chevaux et les facteurs environnementaux qui influencent le degré d'exposition aux UV dans un lieu géographique peuvent aider au diagnostic et suggérer des mesures préventives contre la surexposition aux UV.(Traduit par Dr Serge Messier).

Long-term assessment of relationships between changing environmental conditions and the physiology of southern Beaufort Sea polar bears (Ursus maritimus).

Climate change is influencing polar bear (Ursus maritimus) habitat, diet, and behavior but the effects of these changes on their physiology is not well understood. Blood-based biomarkers are used to assess the physiologic health of individuals but their usefulness for evaluating population health, especially as it relates to changing environmental conditions, has rarely been explored. We describe links between environmental conditions and physiologic functions of southern Beaufort Sea polar bears using data from blood samples collected from 1984 to 2018, a period marked by extensive environmental change. We evaluated associations between 13 physiologic biomarkers and circumpolar (Arctic oscillation index) and regional (wind patterns and ice-free days) environmental metrics and seasonal and demographic co-variates (age, sex, season, and year) known to affect polar bear ecology. We observed signs of dysregulation of water balance in polar bears following years with a lower annual Arctic oscillation index. In addition, liver enzyme values increased over time, which is suggestive of potential hepatocyte damage as the Arctic has warmed. Biomarkers of immune function increased with regional-scale wind patterns and the number of ice-free days over the Beaufort Sea continental shelf and were lower in years with a lower winter Arctic oscillation index, suggesting an increased allocation of energetic resources for immune processes under these conditions. We propose that the variation in polar bear immune and metabolic function is likely indicative of physiologic plasticity, a response that allows polar bears to remain in homeostasis even as they experience changes in nutrition and habitat in response to changing environments.

COVID-19 and obstetric outcomes: a single-center retrospective experience in a predominantly Black population.

Objective: This retrospective, single-center case series was designed to characterize the effects of perinatal COVID-19 diagnosis on obstetric and neonatal outcomes in a predominantly high-risk, urban Black population.Study Design: Data were collected via retrospective chart review on all COVID-19-positive obstetric patients and their neonates who presented to the University of Chicago Medical Center between March 2020 and November 2020, before the availability of the COVID-19 vaccine. Patient demographics, delivery outcomes, COVID-19 symptoms, treatment, and outcomes were analyzed.Results: A total of 56 COVID-19-positive obstetric patients were included in the study, of which four were lost to follow-up before delivery. The median age of patients was 27 years (IQR 23, 32), with 73.2% publicly insured and 66.1% Black. Patients had a median body mass index (BMI) of 31.6 kg/m2 (IQR 25.9, 35.5). 3.6% of patients had chronic hypertension, 12.5% had diabetes, and 16.1% had asthma. Perinatal complications were common. Twenty-six patients (50.0%) had a diagnosis of a hypertensive disorder of pregnancy (HDP). 28.8% had gestational hypertension, and 21.2% had preeclampsia (with and without severe features). The rate of maternal ICU admission was 3.6%. Furthermore, 23.5% of patients delivered preterm (<37 weeks gestation), and 50.9% of infants were admitted to the Neonatal Intensive Care Unit (NICU).Conclusion: In our study of a predominantly Black, publicly-insured, unvaccinated group of COVID-19-positive pregnant patients, we found high rates of hypertensive disorders of pregnancy, preterm delivery, and NICU admission compared to rates reported in existing literature before widespread vaccine availability. Our findings suggest that SARS-CoV-2 infection during pregnancy, irrespective of maternal disease severity, may exacerbate existing obstetric health disparities by disproportionately impacting Black, publicly insured patients. Larger comparative studies are needed to better characterize possible racial and socioeconomic disparities in obstetric outcomes in the setting of SARS-CoV-2 infection during pregnancy. These studies should examine the pathophysiology of SARS-CoV-2 infection during pregnancy, as well as potential associations between adverse perinatal outcomes and disparities in access to care, COVID-19 vaccination, and other social determinants of health amongst more vulnerable populations infected with SARS-CoV-2 during pregnancy.

What to Teach in Small Animal Veterinary Orthopedics: A Survey of Practicing Veterinarians to Inform Curriculum Development.

Competency-based veterinary education focuses on the knowledge and clinical skills required to generate a productive and confident practitioner. Accurate identification of clinically relevant core competencies enables academic institutions to prioritize which new and foundational information to cover in the limited time available. The goal of this study was to aggregate the opinions of veterinary practitioners about small animal core competencies in veterinary orthopedics. An online 20-question survey was distributed with questions regarding respondent demographics, education, practice type, caseload, involvement in orthopedic procedures, access to referral hospitals, frequency of orthopedic condition presentation and procedure performance, and proposed percent allocation of various orthopedic curriculum topics. Responses were included from 721 respondents, largely first-opinion veterinarians (81%, n = 580/721). The majority (58%; n = 418/721) of respondents performed less than 10% of the orthopedic surgeries themselves and, 37% (n = 266/721) reported never performing orthopedic surgery; of those performing surgeries, 78% (n = 354/455) performed less than six orthopedic procedures monthly. The five most common orthopedic conditions seen included: generalized osteoarthritis, patellar luxation, cranial cruciate ligament disease, hip dysplasia/arthritis, and muscle/tendon injuries. Median respondent scores for the percentage which a topic should comprise in an ideal orthopedic curriculum were 20% each for 'orthopedic exam' and for 'non-surgical orthopedic knowledge', 15% each for 'non-surgical orthopedic skills,' 'orthopedic imaging (radiographs),' and 'surgical orthopedic knowledge,' 10% for 'surgical orthopedic skills,' and 2% for 'advanced orthopedic imaging.' Based on these results, a curriculum focusing on the most clinically relevant orthopedic conditions with an emphasis on diagnosis establishment and non-surgical treatments is proposed.

Waste not want not: piloting a clinical waste audit at a United States university veterinary teaching hospital.

Biomedical waste is a well-recognized environmental problem, yet less is known about the waste generated in the delivery of veterinary care compared to human medicine. The objective of this project was to develop and pilot a waste audit protocol for veterinary medicine that could inform waste management at a US university veterinary teaching hospital and the broader veterinary community. We conducted a multi-day review of the Colorado State University Veterinary Teaching Hospital's small animal surgery and anesthesia units to measure the types and amounts of waste generated during routine surgeries. Metrics included total weight, number of bags, and individual counts for specific items of concern and items with sustainable alternatives. We calculated frequencies and percentages of waste by waste audit material category and noted any erroneous materials sorted. Despite waste being a prioritized sustainability issue in veterinary medicine, this work highlighted opportunities for better education on managing and optimizing existing resources through behavior modification. This article explores ways the 5Rs (Rethink, Reduce, Reuse, Recycle, Research) could be better operationalized in veterinary hospitals.

Opportunities for Expanding Access to Veterinary Care: Lessons From COVID-19.

The COVID-19 pandemic impacted people and professions around the world, including veterinary medicine. The epidemiology of SARS-CoV-2 broadened the definition of vulnerability in human populations, and the virus' economic impacts exacerbated well-established financial barriers to providing equal access to medical care. The objective of this study was to explore how the pandemic was impacting access to companion animal care in the months March-September of 2020, with a focus on traditionally vulnerable as well as newly vulnerable populations. Additionally, this study sought to identify areas on which the veterinary profession can focus in order to help increase access to veterinary care, including the veterinary school curriculum, continuing education, and telemedicine. We conducted surveys and interviews with animal owners (n = 1009), veterinarians and clinic staff (n = 516), and access to veterinary care organizations (n = 17). Collectively, these responses highlighted how the COVID-19 pandemic created new, and amplified existing, issues with accessing and providing veterinary care. Three critical themes arose; (1) opportunities for further learning for the veterinary profession; including curricula around telemedicine, financially resilient business models and understanding health disparities and vulnerable populations; (2) a need for a network of collaboration and communication across veterinary clinics and access to care organizations and (3) future preparedness for health, economic or other crises response. Overall, the pandemic emphasized the complexity of access to care, as well as the role of veterinarians in public health. This information can be used to develop strategies to aid in increased access to veterinary care now and in the face of future disasters.

Women's perspectives and attitudes towards the utility of angiogenic biomarkers in preeclampsia.

OBJECTIVE: This study aimed to evaluate womens' perspectives about current and novel preeclampsia testing methods at an urban tertiary medical center. METHODS: This was an observational survey study conducted between October 1, 2020 and December 31, 2020. Subjects were eligible if they were ≥ 18 years of age and had a diagnosis of gestational hypertension, preeclampsia, or superimposed preeclampsia at the time of delivery. Informed consent was obtained, and the 26-question survey was administered after delivery. A detailed medical record review was completed for respondents (patients) and their neonates. RESULTS: A total of 100 women were included in the study. The majority of participants were Black (78%) and/or on Medicaid (51%). Most respondents agreed that they fully trust their doctor and medical team (96%) and that the newest medical tests, treatments, and technologies should always be used (91%). Most women (80%) at least somewhat agreed they have enough knowledge about preeclampsia and its complications. Over 90% of women agreed a test to predict complications of preeclampsia would be useful to them. Most women reported a rule out test would be useful to them because it would help them worry less (68%), reduce hospitalizations (32%) and reduce interventions (17%). CONCLUSION: There was majority support for novel methods such as biomarker testing among this cohort. Most patients reported the test would decrease worry associated with preeclampsia development and complications.

Empowering Veterinarians to Be Planetary Health Stewards Through Policy and Practice.

Veterinarians are established public health professionals, committing to promote public health when they take their veterinary oath. The issue of climate change and its impact on planetary health is vital to public health, and therefore, it is critical that climate change is regarded as within the veterinary scope of practice. However, climate change is a multi-faceted issue which requires interdisciplinary collaboration and integrated stakeholder involvement in order to establish effective solutions and impactful policies. As a result, in this perspective, we discuss how policy is critical to support veterinarians in the climate change space and argue that more explicit support is needed for veterinarians to take an active role in climate change adaption, resilience, and mitigation. We address the discrepancies between the human health and veterinary professions with respect to providing policy support and capacity for practitioners to be stewards to promote planetary health and shed light on the lack of veterinary capacity in this area. We stress that veterinary professional societies are well equipped to bolster their policies, expand education for veterinary professionals and students in policy and advocacy, and establish calls to action to address climate change and planetary health issues. Ultimately, as public health professionals, veterinarians are uniquely poised to be contributors to climate change solutions and they should be actively involved in policy decision-making and empowered to take active roles in interdisciplinary conversations surrounding this important issue.

Racial Differences in Readmissions in Hypertensive Disorders of Pregnancy.

Hypertensive disorders of pregnancy (HDP) are associated with maternal and neonatal morbidity as well as postpartum hospital readmission. This study seeks to characterize differences among patients with postpartum readmissions related to HDP. This is a retrospective study of patients with HDP admitted at an urban tertiary care center from January 2019 to November 2019 following the implementation of a standardized readmission workflow for patients with HDP at a single institution. Medical information up to 6 weeks postpartum was collected by chart review. The primary outcome was readmission. Secondary outcomes included reason for readmission, location of initial evaluation, and blood pressure values at time of readmission. A total of 729 patients with HDP delivered over the study period, 79.7% (N = 581) of whom were Black and 11.0% (N = 80) of all patients were readmitted within 6 weeks of delivery. Patients who were older, privately insured, and with chronic hypertension/cardiac disease were more likely to be readmitted. There was no difference in readmission rate by race. However, Black patients were more likely to be readmitted for preeclampsia with severe features (43.3% vs 10.0% non-Black, p = 0.01). Black patients who were readmitted were more likely to be initially evaluated in the emergency room compared to non-Black patients (43.3% vs 15.0%, p = 0.03). Our results suggest although readmission rates did not differ by race, there are significant differences at the patient and system level between Black and non-Black patients readmitted to the hospital after a pregnancy affected by HDP.

HISTOLOGIC LESIONS IN PLACENTAS OF NORTHERN FUR SEALS (CALLORHINUS URSINUS) FROM A POPULATION WITH HIGH PLACENTAL PREVALENCE OF COXIELLA BURNETII.

Coxiella burnetii is an intracellular bacterial pathogen that can be associated with significant reproductive disease or acute mortality in livestock and wildlife. A novel marine mammal-associated strain of C. burnetii has been identified in pinnipeds of the northwestern Pacific Ocean. Little is known about C. burnetii infection in regard to reproductive success or population status. Our objective was to characterize the severity and extent of histologic lesions in 117 opportunistically collected placentas from presumed-normal northern fur seals (Callorhinus ursinus) in July 2011 on St. Paul Island, Alaska, US, where a high placental prevalence of C. burnetii had been reported. Sections were examined by histology and immunohistochemistry and impression smears with modified acid-fast stain. The nature and frequency of histologic changes were compared with target COM1 PCR-confirmed C. burnetii positive and negative placentas. Overall, histologic changes were similar to placental lesions described in aborting ruminants; however, changes were variable within and between placentas. Vasculitis and occasional intracellular bacteria were seen only in C. burnetii PCR-positive placentas. Dystrophic mineralization, edema, and inflammation were seen in PCR-positive and negative placentas, although they were statistically more common in PCR-positive placentas. Results suggest that C. burnetti and associated pathologic changes are multifocal and variable in placentas from these presumably live-born pups. Therefore, multiple sections of tissue from different placental areas should be examined microscopically, and screened by PCR, to ensure accurate diagnosis as the genomes per gram of placenta may not necessarily represent the severity of placental disease. These limitations should inform field biologists, diagnosticians, and pathologists how best to screen and sample for pathogens and histopathology in marine mammal placental samples.

Elimination of racial disparities in postpartum hypertension follow-up after incorporation of telehealth into a quality bundle.

BACKGROUND: Black people have a disproportionately higher risk of hypertensive disorders of pregnancy and postpartum complications than White people but historically lower rates of postpartum follow-up. Few studies have investigated telehealth in the postpartum population. OBJECTIVE: This study aimed to investigate whether rapid switch to telehealth with audio-based visits during the COVID-19 pandemic decreased racial disparities in postpartum hypertension follow-up adherence. STUDY DESIGN: This retrospective cohort study included all the patients with hypertensive disorders of pregnancy who delivered between December 2019 and June 2020 at an urban tertiary care center. A preexisting postpartum hypertension quality improvement initiative was in place at this institution. Follow-up adherence within 6 weeks postpartum and at the 6-week visit were compared before February 15, 2020 (pretelehealth period) and following March 14, 2020 (post-telehealth period), with a 1-month implementation or washout period. The blood pressures at these visits were compared between time periods as a secondary outcome. RESULTS: A total of 473 patients were included in this analysis, of whom 76.3% were non-Hispanic Black. There were 215 and 258 patients in the pre- and post-telehealth cohorts, respectively. Among those who attended follow-up, the proportion of visits done over telehealth went from 0% pretelehealth to 98.0% post-telehealth. The proportion of postpartum hypertension follow-up attendance changed from 48.5% to 76.3% among non-Hispanic Black people (P<.0001) and from 73.1% to 76.7% among non-Hispanic White people (P=.76), leaving only a 0.4% racial gap (P=.97). This resulted in an elimination of the racial disparities in the post-telehealth period. CONCLUSION: Transition to telehealth with audio-based visits at the onset of the COVID-19 pandemic improved attendance at postpartum hypertension visits among non-Hispanic Black people. This, therefore, led to significant decreases in the racial disparities in follow-up rates at our institution in the setting of an existing quality improvement initiative. Further research should focus on the intentional use of telehealth in improving maternal outcomes, especially among the non-Hispanic Black people.

Exploration of Immersive Virtual Reality in Teaching Veterinary Orthopedics.

The COVID-19 pandemic has catalyzed the use of novel teaching modalities to enhance the provision of remote veterinary education. In this study, we describe the use of immersive virtual reality (iVR) as a teaching aid for veterinary medicine students during their orthopedics clinical rotation. Student sentiments were assessed using voluntary electronic surveys taken by veterinary students before and after the rotation. The most noteworthy benefits students reported were improved engagement with the course content, information retention, radiographic interpretation, and clinical reasoning skills. Obstacles encountered during the initial stages of the program included financial and temporal investment in equipment and content development, technical troubleshooting, and motion sickness. Though it is unlikely that iVR will ever fully replace hands-on learning experiences, it presents an educational opportunity to supplement traditional learning methods, motivate students, and fill information gaps. As iVR technology continues to evolve and improve, potential applications in the veterinary curriculum grow, making the modality's use progressively more advantageous. Although this study describes its application in an orthopedic setting, the versatility of the iVR modality lends the potential for it to be implemented in a number of clinical and didactic settings.

Environmental Sustainability in Veterinary Medicine: An Opportunity for Teaching Hospitals.

Climate change is one of the greatest public health threats of the twenty-first century. Recent surveys of veterinary students and practicing veterinarians have highlighted their concerns about the impacts of climate change on animal health and a strong desire to be knowledgeable about the practice and promotion of environmental sustainability within clinical practice. Most American Veterinary Medical Association (AVMA)-accredited veterinary schools have a veterinary teaching hospital (VTH) where veterinary students receive their core clinical education. Given this, VTHs may provide opportunities for students to learn how veterinary clinics can decrease their environmental footprint and actions they could incorporate into their future clinical work. To assess the feasibility of and support for introducing environmentally sustainable practices into VTHs, we distributed an anonymous online survey to all AVMA-accredited veterinary schools with an associated VTH. Responses were received from 843 individuals representing 23 VTHs in 7 countries. While the overwhelming majority of responding personnel believe this is an important topic, there is little evidence that sustainable behaviors are being practiced or showcased within VTHs. Respondents were most interested in working to increase recycling and reduce general waste and energy consumption within their hospitals. In addition to a lack of educational resources, funding was a commonly identified barrier to incorporating more environmentally sustainable practices. These results add to the growing evidence that enhanced incorporation of sustainability into veterinary medical education at all stages is needed and that VTHs provide a unique opportunity to lead by example.

Cows as canaries: The effects of ambient air pollution exposure on milk production and somatic cell count in dairy cows.

Exposure to air pollution, including criteria pollutants such as fine particulate matter (PM2.5) and ozone (O3), has been associated with morbidity and mortality in mammals. As a genetically homogenous population that is closely monitored for health, dairy cattle present a unique opportunity to assess the association between changes in air pollution and mammalian health. Milk yield decreases in the summer if temperature and humidity, measured by the Temperature Humidity Index (THI). As O3 levels increase with warmer temperatures, and summer PM2.5 may increase with wildfire smoke, dairy cows may serve as a useful sentinel species to evaluate subacute markers of inflammation and metabolic output and ambient pollution. Over two years, we assessed summertime O3 and PM2.5 concentrations from local US EPA air quality monitors into an auto-regressive mixed model of the association between THI and daily milk production data and bulk tank somatic cell count (SCC). In unadjusted models, a 10 unit increase THI was associated with 28,700 cells/mL (95% CI: 17,700, 39,690) increase in SCC. After controlling for ambient air pollutants, THI was associated with a 14,500 SCC increase (95% CI: 3,400, 25,680), a 48% decrease in effect compared to the crude model. Further, in fully adjusted models, PM2.5 was associated with a 105,500 cells/mL (95% CI: 90,030, 121,050) increase in SCC. Similar results were found for milk production. Results were amplified when high PM2.5 days (95th percentile of observed values) associated with wildfire smoke were removed from the analyses. Our results support the hypothesis that PM2.5 confounds the relationships between THI and milk yield and somatic cell count. The results of this study can be used to inform strategies for intervention to mitigate these impacts at the dairy level and potentially contribute to a model where production animals can act as air quality sentinels.

Postpartum Outcomes With Systematic Treatment and Management of Postpartum Hypertension.

OBJECTIVE: To test the ability of a hospital-wide, bundled quality-improvement initiative to improve postpartum maternal blood pressure control and adherence to postpartum follow-up among patients with hypertensive disorders of pregnancy. METHODS: This quality-improvement initiative consisted of a bundle of clinical interventions including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting. We implemented this initiative in patients with hypertensive disorders of pregnancy starting in January 2019 at the University of Chicago. The study period was divided into four periods, which correspond to preintervention, distinct bundle roll outs, and postintervention. Our primary outcome was postpartum hypertension visit adherence. Secondary outcomes included blood pressure values and antihypertensive medication use in the immediate postpartum and outpatient postpartum time periods. We then stratified our outcomes by race to assess whether the effect size differed. RESULTS: A total of 926 patients who delivered between September 2018 and November 2019 were included. Postpartum hypertension visit adherence improved from preintervention period compared with the full implementation period (33.5% vs 59.4%, P<.001). Blood pressure in the first 24 hours postpartum decreased from preintervention compared with full implementation (preintervention median [interquartile range] systolic blood pressure 149 mm Hg [138, 159] vs 137 [131, 146] in postimplementation; P<.001). After implementation, fewer patients experienced a blood pressure of 140/90 mm Hg or higher at the first postpartum blood pressure check, when compared with preintervention (39.1% vs 18.5%, P=.004). The effect size did not differ by race. CONCLUSION: A bundled quality-improvement initiative for patients with hypertensive disorders of pregnancy was associated with improved postpartum visit adherence and blood pressure control in the postpartum period.

Establishing a reference interval for acute phase proteins, cytokines, antioxidants and commonly measured biochemical and hematologic parameters in the northern fur seal (Callorhinus ursinus).

Over the past several decades there has been a precipitous decline of northern fur seals (Callorhinus ursinus; NFS) at their breeding grounds on the Pribilof Islands in the Bering Sea. The cause of this decline is likely multifactorial and could include changes in environmental parameters, prey abundance and distribution as well as exposure to pathogens and pollutants. Evaluation of inflammatory markers and antioxidant levels of the current population of fur seals in addition to hematologic and biochemical profiles could provide important information regarding health and subclinical or clinical disease in this population. Serum and plasma samples were obtained from clinically healthy adult female NFS and references intervals were determined for multiple parameters that can be altered in response to the presence of disease and environmental stressors. We established a reference interval for cytokines involved in acute inflammation and infection (TNFa, IL1, IL6, IL8, KC, IL10, C-reactive Protein) by utilizing commercially available canine cross-reactive antibodies. Reference intervals were also established for reactive oxygen species (hydrogen peroxide and malondialdehyde), as well as antioxidant levels (vitamin E and selenium) and acute phase proteins evaluated by serum electrophoresis. To improve the ability to compare and interpret indicators of health and disease in this species, we developed reference intervals for commonly utilized hematologic and biochemical tests in addition to the aforementioned markers of oxidative stress and inflammatory biomarkers. There were several animals identified as outliers indicating that they may have had subclinical illness or inflammation. Further investigation utilizing these tests in clinically ill animals and comparison to animals that exhibit normal behavior and no overt signs of illness could increase our understanding of the utility of measuring these parameters in this species.

A Systematic Review of Environmental Sustainability in Veterinary Practice.

A transition toward environmentally conscious business practices is underway in many sectors. For healthcare, the topic is both concerning and tragically ironic as hospitals have substantial environmental footprints, which are now known to contribute to significant health problems that the system itself was designed to treat. The human medical field has been proactive in taking steps to reduce waste and carbon emissions by identifying best practices to minimize such impacts. Characterization of needs and gaps has been addressed through reviews of the literature regarding environmental sustainability in the context of human hospitals. Our objective was to replicate methods used in a recent review of environmental sustainability in human hospitals to summarize information available to clinical veterinarians. Two search algorithms were used across 8 databases, however only 3 peer-reviewed opinion articles specific to veterinary medicine were identified. These papers included 1 on anesthesia and 2 on production animals. Interestingly, all articles were written by United Kingdom-based authors and none were specific to companion animal practice, the largest sector in the veterinary industry in the United States. Results of this review highlight need for research and communication that supports veterinary clinics in adopting more environmentally sustainable practices. Proposed starting points informed from research in other sectors, including 5 physical themes of energy efficiency, water, waste, sustainable procurement, and transportation, and human behavior changes on the individual, group, and organizational levels, are discussed. Additional work is needed to support veterinarians and other animal health professionals to practice medicine in a way that upholds the veterinary profession's oath to promote the health of animals, the public, and the environment we all share.

Veterinary-Prescribed Physical Activity: Feasibility and Acceptability among Veterinary Staff and Dog Owners.

Physical inactivity remains a global epidemic leading to an estimated 5 million preventable deaths per year. Although there exist numerous public-health campaigns aimed at increasing physical activity (PA), a potentially fruitful but underexplored avenue to promote both human and animal health is veterinary-prescribed PA programs. The aim of this study was to determine the feasibility and acceptability of incorporating veterinary-prescribed PA programming into a diverse array of clinic settings. Participants (n = 722 veterinary-clinic staff (VS); n = 1028 dog owners (DOs)) completed an online survey assessing: (a) the perceived importance of PA for promoting health and preventing disease, (b) willingness to participate in a veterinary-prescribed PA program, and (c) potential benefits and barriers of such a program. Both groups of participants indicated that PA is important for both human and animal health (97% and 98% of VS and 92% and 93% of DOs said PA is very or extremely important for animal and human health, respectively). Additionally, most participants in both groups expressed an interest in participating in a veterinary-prescribed PA program in the future, with only 11% of DOs and 10% of VS saying they were not interested. Benefits and barriers of this type of intervention for both practitioners and patients were also identified. Incorporating veterinary-prescribed PA programming into veterinary clinics seems to be acceptable to both DOs and VS. Additionally, many VS believe such programming would be feasible at their clinics; thus, pursuing such programs appears to be a promising avenue for promoting human and animal health.