Predicting the risks of kidney failure and death in adults with moderate to severe chronic kidney disease: multinational, longitudinal, population based, cohort study.

OBJECTIVE: To train and test a super learner strategy for risk prediction of kidney failure and mortality in people with incident moderate to severe chronic kidney disease (stage G3b to G4). DESIGN: Multinational, longitudinal, population based, cohort study. SETTINGS: Linked population health data from Canada (training and temporal testing), and Denmark and Scotland (geographical testing). PARTICIPANTS: People with newly recorded chronic kidney disease at stage G3b-G4, estimated glomerular filtration rate (eGFR) 15-44 mL/min/1.73 m2. MODELLING: The super learner algorithm selected the best performing regression models or machine learning algorithms (learners) based on their ability to predict kidney failure and mortality with minimised cross-validated prediction error (Brier score, the lower the better). Prespecified learners included age, sex, eGFR, albuminuria, with or without diabetes, and cardiovascular disease. The index of prediction accuracy, a measure of calibration and discrimination calculated from the Brier score (the higher the better) was used to compare KDpredict with the benchmark, kidney failure risk equation, which does not account for the competing risk of death, and to evaluate the performance of KDpredict mortality models. RESULTS: 67 942 Canadians, 17 528 Danish, and 7740 Scottish residents with chronic kidney disease at stage G3b to G4 were included (median age 77-80 years; median eGFR 39 mL/min/1.73 m2). Median follow-up times were five to six years in all cohorts. Rates were 0.8-1.1 per 100 person years for kidney failure and 10-12 per 100 person years for death. KDpredict was more accurate than kidney failure risk equation in prediction of kidney failure risk: five year index of prediction accuracy 27.8% (95% confidence interval 25.2% to 30.6%) versus 18.1% (15.7% to 20.4%) in Denmark and 30.5% (27.8% to 33.5%) versus 14.2% (12.0% to 16.5%) in Scotland. Predictions from kidney failure risk equation and KDpredict differed substantially, potentially leading to diverging treatment decisions. An 80-year-old man with an eGFR of 30 mL/min/1.73 m2 and an albumin-to-creatinine ratio of 100 mg/g (11 mg/mmol) would receive a five year kidney failure risk prediction of 10% from kidney failure risk equation (above the current nephrology referral threshold of 5%). The same man would receive five year risk predictions of 2% for kidney failure and 57% for mortality from KDpredict. Individual risk predictions from KDpredict with four or six variables were accurate for both outcomes. The KDpredict models retrained using older data provided accurate predictions when tested in temporally distinct, more recent data. CONCLUSIONS: KDpredict could be incorporated into electronic medical records or accessed online to accurately predict the risks of kidney failure and death in people with moderate to severe CKD. The KDpredict learning strategy is designed to be adapted to local needs and regularly revised over time to account for changes in the underlying health system and care processes.

Case report: Acute dyspnea secondary to urinothorax following ureteroscopy.

A 63-year-old female presented with a tension urinothorax after pyeloscopy, lithotripsy, and percutaneous nephrolithotomy that manifested as dyspnea and abdominal pain. CT Thorax demonstrated a large right pleural effusion with middle and lower lobe collapse with leftward shift concerning for tension hydrothorax. Analysis of the effusion after pigtail catheter demonstrated an exudative effusion with resultant resolution of the effusion after a 5-day hospital course. This case illustrates a uniquely rare complication of percutaneous urologic intervention. We highlight this case to stress the importance of considering urinothorax as a cause for dyspnea and abdominal pain after renal and ureteric interventions.

Detection of Nitroaromatic and Peroxide-Based Explosives with Amine- and Phosphine-Functionalized Diketopyrrolopyrroles.

Effective strategies for the detection and identification of explosives are highly desirable. Herein, we illustrate the efficient optoelectronic detection of nitroaromatic and peroxide-based explosives using amine- and phosphine-substituted diketopyrrolopyrroles. Selective quenching and an unprecedented enhancement of thin-film emission in the presence of nitroaromatic vapors are demonstrated via the judicious choice of amine substituents. The modulation of fluorescence emission in each case is shown to be dominated by electronic and thermodynamic effects, the vapor pressure of explosives, and the thin-film morphology. For peroxide detection, we describe an approach exploiting redox-mediated functional group transformation. The rapid oxidation of triphenylphosphine to phosphine oxide with hydrogen peroxide affords a significant increase in fluorescence emission, facilitating the sensitive turn-on detection of an important class of explosives at ppb concentrations.

Acquired Hemophilia A Secondary to an Immune Checkpoint Inhibitor: A Case Report.

We report a case of a patient with extensive-stage SCLC who developed acquired hemophilia A during maintenance atezolizumab therapy. The patient initially presented with asymptomatic anemia, a prolonged acquired prothrombin time, and factor VIII (FVIII) deficiency. Acquired FVIII autoantibodies were detected, confirming the diagnosis of acquired hemophilia. Atezolizumab was ceased and high-dose prednisolone was initiated. He subsequently developed an extensive spontaneous upper limb subcutaneous hematoma and shoulder hemarthrosis despite improving FVIII inhibitor titers on prednisolone. His acute bleeding was successfully treated with recombinant factor VII, and rituximab was added to prednisolone. Given the quiescent malignancy, 16 months of preceding treatment with atezolizumab, and improvement with immunosuppression, a diagnosis of immune checkpoint inhibitor-induced hemophilia A was made. Severe hematologic immune-related adverse events such as this case of acquired hemophilia have rarely been reported in the literature.

The role of abnormal subaortic morphometry as a substrate for left ventricular outflow tract obstruction following atrioventricular septal defect repair.

OBJECTIVES: Although left ventricular outflow tract (LVOT) obstruction is a recognized risk after atrioventricular (AV) septal defect (AVSD) repair, quantitative assessments to define the substrate of the obstruction are lacking. METHODS: Morphometric analyses were based on measurements from early 2-dimensional echocardiographic scans (within 3 months postoperatively) for 117 patients (82 CAVVO = common AV valve; 35 SAVVO = separate AV valve orifices), which were compared to 50 age/weight matched controls (atrial septal defect/ventricular septal defect). Late echocardiographic analyses were performed in 57 patients with AVSD (follow-up range, 1.2-10.7 years). RESULTS: Adequate z scores (above -2.5) were observed in 109 (93%) patients with AVSD at the aortic annulus and in 89 (76%) with AVSD in the subaortic area. Compared to the control group, patients with AVSD had lower median z scores at the aortic annulus (-0.64 vs 0.60; P < 0.001) and the subaortic areas (-1.48 vs 0.59; P < 0.001), disproportionate subaortic/aortic annulus ratio <1.00 (67% vs 22%; P < 0.001), narrower annuloaortic-septal angle (94.0 vs 104.0; P < 0.001) and annuloaortic left AV valve angle (78.0 vs 90.0; P < 0.001). Compared to patients with CAVVO, those with SAVVO had narrower annuloaortic-septal angles (P = 0.022) that persisted at late analysis, with lower subaortic/aortic annular ratios (P = 0.039). In patients with CAVVO, lower early postoperative subaortic z scores were found following modified single-patch repairs (median -2.12 vs -1.02 in two-patch repairs; P = 0.004). A total of 6/117 (5%) patients (4 CAVVO, 5% and 2 SAVVO, 6%) required reoperations for LVOT obstruction (mean 6.9 years postoperatively), with no difference in morphology or types of operations. CONCLUSIONS: Despite having adequate z scores, patients with AVSD demonstrated abnormal LVOT morphometrics early postoperatively. Besides intrinsic morphology, repair techniques may have an impact on postoperative LVOT morphometrics and requires further evaluation.

Population Epidemiology of Hyperkalemia: Cardiac and Kidney Long-term Health Outcomes.

RATIONALE & OBJECTIVE: The population burden and long-term implications of hyperkalemia have not been comprehensively studied. We studied how often and where hyperkalemia occurs as well as its independent association with survival and long-term cardiac and kidney health. STUDY DESIGN: Population-based cohort study of adult residents of Grampian, United Kingdom. SETTING & PARTICIPANTS: Among the 468,594 adult residents (2012-2014), 302,630 people with at least 1 blood test were followed until 2019. EXPOSURE: Hyperkalemia was defined as serum potassium ≥ 5.5 mmol/L. Adjustment for comorbidities, demographics, measures of acute and chronic kidney function, and medications prescribed before measurement of serum potassium. OUTCOME: All-cause mortality, cardiac events, and kidney failure. ANALYTICAL APPROACH: Description of the annual incidence of hyperkalemia and the characteristics associated with its occurrence, and adjusted Cox proportional hazards (PH) analysis to evaluate the independent long-term association of hyperkalemia with all-cause mortality among people who survived ≥90 days after blood testing. Cause-specific PH models were fit to evaluate the association of hyperkalemia with cardiac events/death, noncardiac death, and kidney failure. Effect modification by level of estimated glomerular filtration rate (eGFR) at the time of blood testing was explored. RESULTS: The annual population incidence of hyperkalemia was 0.96 per 100 person-years. This represented 2.3%, 2.1%, and 1.9% of people with at least one blood test in 2012, 2013, and 2014, respectively. Two-thirds of episodes of hyperkalemia occurred in the community. The hyperkalemia rate was 2-fold higher for each 10-year greater age. Those with hyperkalemia were 20 times more likely to have concurrent acute kidney injury (AKI), and 17 times more likely to have an eGFR of <30 mL/min/1.73 m2. Throughout 5 years of follow-up evaluation (2,483,452 person-years), hyperkalemia was associated with poorer health outcomes. This association held across all levels of kidney function and was irrespective of concurrent AKI, but was stronger among those with a baseline eGFR of ≥60 mL/min/1.73 m2 (P for interaction < 0.001). The adjusted HRs (hyperkalemia vs no hyperkalemia) for people with eGFR ≥60 mL/min/1.73 m2 and eGFR <30 mL/min/1.73 m2 were 2.3 (95% CI, 2.2-2.5) and 1.5 (95% CI, 1.3-1.6) for mortality; 1.8 (95% CI, 1.6-1.9) and 1.4 (95% CI, 1.2-1.6) for cardiac events; and 17.0 (95% CI, 9.3-31.1) and 2.0 (95% CI, 1.5-2.8) for kidney failure, respectively. LIMITATIONS: The observational nature of this study limits evaluation of causal relationships. CONCLUSIONS: There is a substantial burden of hyperkalemia in the general population. Hyperkalemia is associated with poorer long-term health outcomes, especially kidney outcomes, that are independent of other established risk factors.

Patient-reported outcomes in human papillomavirus-related oropharyngeal cancer.

This review explores how human papillomavirus-related oropharyngeal cancer affects health-related quality of life (HR-QoL) and the role patient-reported outcomes (PROs) can play in optimizing treatment. PRO measures (PROMs) are comprehensive, subjective assessments of patients' day-to-day HR-QoL. Developed through a scientifically robust, multistage process, PROMs offer insight into patients' symptoms, function, and satisfaction with care. The use of PROMs can increase symptom awareness, stimulate discussion, and enhance shared decision-making between patients and healthcare providers.

Intraosseous Regional Prophylactic Antibiotics Decrease the Risk of Prosthetic Joint Infection in Primary TKA: A Multicenter Study.

BACKGROUND: Recent studies have demonstrated that the administration of regional prophylactic antibiotics by intraosseous (IO) injection achieves tissue concentrations around the knee that are 10- to 15-fold higher than intravenous (IV) delivery of prophylactic antibiotics. It is currently unknown whether the use of regional prophylactic antibiotics for primary TKA would result in a lower risk of prosthetic joint infection (PJI). QUESTIONS/PURPOSES: (1) Is IO injection of prophylactic antibiotics associated with a decreased risk of early (< 12 months) deep PJI compared with traditional IV prophylactic antibiotics? (2) What other patient factors are associated with an increased risk of early PJI after TKA, and do regional prophylactic antibiotics influence these risk factors? (3) Can IO antibiotics be administered to all patients, and what complications occurred from the delivery of IO prophylactic antibiotics? METHODS: A retrospective comparative study of all primary TKAs (1909 TKAs) over a 5-year period (January 2013 to December 2017) was performed to determine the risk of early PJI. Three primary TKAs did not meet the study inclusion criteria and were excluded from the study, leaving a total of 1906 TKAs (725 IO, 1181 IV) for analysis at a minimum of 12 months after index procedure. Both cohorts exhibited similar ages, BMI, and American Society of Anesthesiologists (ASA) grades; however, a greater proportion of patients in the IO cohort were smokers (p = 0.01), while a greater proportion of patients were diabetic in the IV cohort (p = 0.006). The PJI risk between IO and IV delivery techniques was compared while adjusting for patient demographics and medical comorbidities. Complications related to IO delivery-inability to administer via IO technique, compartment syndrome, fat embolism, and red man syndrome with vancomycin use-were recorded. RESULTS: The delivery of regional prophylactic antibiotics by the IO technique resulted in a lower PJI risk than IV prophylactic antibiotics (0.1% [1 of 725] compared with 1.4% [16 of 1181]; relative risk 0.10 [95% CI 0.01 to 0.77]; p = 0.03). BMI (ß = -0.17; standard error = 0.08; p = 0.02), diabetes (ß = -1.80; standard error = 0.75; p = 0.02), and renal failure (ß = -2.37; standard error = 0.84; p = 0.01) were factors associated with of PJI, while smoking, sex, and ASA score were not contributing factors (p > 0.05). Although BMI, diabetes, and renal failure were identified as infection risk factors, the use of IO antibiotics in these patients did not result in a lower PJI risk compared with IV antibiotics (p > 0.05). IO antibiotics were able to be successfully administered to all patients in this cohort, and there were no complications related to the delivery of IO antibiotics. CONCLUSION: Surgeons should consider administering regional prophylactic antibiotics in primary TKA to reduce the risk of early PJI. Future randomized prospective clinical trials are needed to validate the efficacy of regional prophylactic antibiotics in reducing the PJI risk in primary TKA. LEVEL OF EVIDENCE: Level III, therapeutic study.

Development of a video analysis protocol and assessment of fall characteristics in equestrian cross-country eventing.

Cross-country eventing is one of the highest-risk sporting activities for serious injury outcomes. This study investigated relationships between fall characteristics and high-risk falls at jumps in cross-country eventing. A video analysis protocol was systematically developed to analyze 87 video recordings of high-risk rider falls; defined as when the rider's head impacted the ground and/or where there was potential horse impact with the rider. Falls were classified according to competition type, jump type, horse-related, and rider-related factors. At least one high-risk fall characteristic was observed in 45 of 87 examined falls. Multivariable best subsets regression identified five independent variables explaining 38.4% of the variance in the number of high-risk falls. Increased likelihood of high-risk falls was associated with continuation of horse direction or speed upon rider ground impact, higher jump approach speed, changes in rider body posture upon landing, rider air jacket usage, and reduced rider fall time. The Eventing Fall Assessment Instrument (EFAI) video analysis protocol (attached as supplementary material) facilitated systematic examination of multiple characteristics associated with high-risk falls and identified likely influential characteristics. Based on EFAI and subsequent data analyses, findings suggest optimized approach speed for correct striding and take-off; jump design to enable run-out; and rider training could help reduce the occurrence of high-risk falls. Air jacket usage and their design characteristics warrant further investigation.

Predictors of surgical complications in patients with sinonasal malignancy.

OBJECTIVES: Sinonasal and skull base tumors are rare, making it difficult to identify trends in surgical outcome. This study examines complications in a large cohort of patients undergoing surgery for sinonasal malignancy. METHODS: Following IRB approval, an institutional database was reviewed to identify patients who underwent surgery for sinonasal or skull base malignancies from 1973 to 2016 at our institution. Charlson comorbidity index score and Clavien-Dindo grade were calculated. The main study endpoint was subgroup analysis of Clavien-Dindo Grade 0, Grades 1-2, and Grades 3-5 complications. An ordinal logistic regression model was constructed to assess the association between comorbidities, demographics, tumor characteristics, and surgical complications. RESULTS: In total, 448 patients met inclusion criteria. Perioperative mortality rate at 30 days was 1.6% (n = 7). The rate of severe complications (Clavien-Dindo 3 or higher) was 13.6% (n = 61). Multivariate analysis using an ordinal logistic regression model showed no association between Charlson comorbidity index score and Clavien-Dindo grade of postoperative complication. Advanced T-stage was significantly associated with complications (p = 0.0014; odds ratio: 3.442 [95% confidence interval: 1.615, 7.338]). CONCLUSION: Surgery for sinonasal and skull base tumors is safe with a low mortality rate. Advanced T-stage is associated with postoperative complications. These findings have implications for preoperative risk stratification. Key Points Surgery for sinonasal malignancy is safe with a 30 mortality of 1.6% and rate of severe complications of 12.8%. There is no association between patient comorbidity and post operative complication. On multivariate analysis, only advanced T stage was associated with increased rate of surgical complication.

Factors associated with unplanned reinterventions and their relation to early mortality after pediatric cardiac surgery.

OBJECTIVE: Unplanned reintervention (uRE) is used as an indicator of patient morbidity and quality of care in pediatric cardiac surgery. We investigated associated factors and early mortality after uREs. METHODS: Morbidity data were prospectively collected in 5 UK centers between 2015 and 2017; uRE included surgical cardiac, interventional transcatheter cardiac, permanent pacemaker, and diaphragm plication procedures. Mortality (30-day and 6-month) in uRE/no-uRE patients was reported before and after matching. Predicted 30-day mortality was calculated using the Partial Risk Adjustment in Surgery score. RESULTS: A total of 3090 procedures (2861 patients) were included (median age, 228 days). There were 146 uREs, resulting in an uRE rate of 4.7%. Partial Risk Adjustment in Surgery score, 30-day mortality and 6-month mortality in uRE and no-uRE groups were 2.4% versus 1.3%, 8.9% versus 1%, and 17.1% versus 2.4%, respectively. After matching, mortality at 6 months remained higher in uRE compared with no-uRE (12.2% vs 1.4%; P = .02; 74 pairs). In the uRE group, 21 out of 25 deaths at 6 months occurred when at least 1 additional postoperative complication was present. In multivariable analysis, neonatal age (P = .002), low weight (P = .009), univentricular heart (P < .001), and arterial shunt (P < .001) were associated with increased risk of uRE, but Partial Risk Adjustment in Surgery score was not (only in univariable analysis). CONCLUSIONS: uREs are a relatively frequent complication after pediatric cardiac surgery and are associated with some patient characteristics, but not the Partial Risk Adjustment in Surgery risk score. Early mortality was higher after uRE, independent of preoperative factors, but linked to other postoperative complications.

Readability of foot and ankle consent forms in Queensland.

BACKGROUND: The aim of this study was to conduct a readability analysis on both patient take-home information and consent forms for common foot and ankle procedures. Our hypothesis was that the objective reading skills required to read and comprehend the documentation currently in use would exceed the recommendations in place by both national and international bodies. METHODS: The current Queensland Health consent forms are divided into specific subsections. The readability of consent form subsections C and G (sections containing detailed information on risks of the procedure and pertaining to informed patient consent specifically) and patient take-home information (provided as take-home leaflet from the consent form which is procedure specific) was assessed by an online readability software program using five validated methods calculated by application of the algorithms for (i) Flesch-Kincaid grade level, (ii) the SMOG (Simple Measure of Gobbledygook), (iii) Coleman-Liau index, (iv) automated readability index and the (v) Linsear Wriste formula. RESULTS: The mean ± standard deviation reading grade level of risk (section C), grade level of patient consent (section G) and grade level for procedure-specific take-home patient information were 8.7 ± 0.9, 11.6 ± 1.2 and 7.5 ± 0.2, respectively. CONCLUSION: The readability of sections C and G of the Queensland Health consent form exceeds the recommendations by national and international bodies, but the patient take-home information appears suitable. Consideration should be given to lower the reading grade level of patient consent forms to better reflect the reading grade of the Australian population.

The Development of a Novel Questionnaire Approach to the Investigation of Horse Training, Management, and Behaviour.

The Equine Behaviour Assessment and Research Questionnaire (E-BARQ) is a questionnaire instrument developed to obtain quantitative data on the domestic equine triad of training, management, and behaviour of horses. The E-BARQ was developed to identify how changes in training and management impact behaviour over time, to define normal behaviour in horses, and to discover how to improve rider safety and horse welfare, leading to ethical equitation. During the development of the E-BARQ, we also investigated how best to motivate stakeholders to engage with this citizen science project. The pilot version of the E-BARQ collected qualitative data on respondents' experience of the questionnaire. The pilot questionnaire was developed with the assistance of an international panel (with professional expertise in horse training, equitation science, veterinary science, equestrian coaching, welfare, animal behaviour, and elite-level riding), and was used to collect data on 1320 horses from approximately 1194 owner/caregiver respondents, with an option for respondents to provide free-text feedback. A Rotated Principal Component Analysis of the 218 behavioural, management, and training questionnaire items extracted a total of 65 rotated components. Thirty-six of the 65 rotated components demonstrated high internal reliability. Of the 218 questionnaire items, 43 items failed to reach the Rotated Principal Component Analysis criteria and were not included in the final version of the E-BARQ. Survey items that failed the Rotated Principal Component Analysis inclusion criteria were discarded if found to have a less than 85% response rate, or a variance of less than 1.3. Of those that survived the Rotated Principal Component Analysis, items were further assigned to horse temperament (17 rotated components), equitation (11 rotated components), and management and equipment (8 rotated components) groups. The feedback from respondents indicated the need for further items to be added to the questionnaire, resulting in a total of 214 items for the final E-BARQ survey. Many of these items were further grouped into question matrices, and the demographic items for horse and handler included, giving a final total of 97 questions on the E-BARQ questionnaire. These results provided content validity, showing that the questionnaire items were an acceptable representation of the entire horse training, management, and behavioural domain for the development of the final E-BARQ questionnaire.

Validation of the Equine Behaviour Assessment and Research Questionnaire (E-BARQ): A New Survey Instrument for Exploring and Monitoring the Domestic Equine Triad.

The Equine Behaviour Assessment and Research Questionnaire (E-BARQ) was developed to obtain quantitative data on the domestic equine triad: training, management and behaviour. It can be taken repeatedly, thus collecting longitudinal data to enable evaluation of how changes in a horse's training and management are reflected in that horse's behaviour over time and how these changes can impact horse welfare in the longer term. Questionnaire validation and reliability were tested by determining (a) whether an owner's subjective ratings of their horse's problematic behaviours or undesirable temperament traits were reflected in the questionnaire scores obtained for that horse (construct validity), (b) whether two respondents, equally familiar with a particular horse, reported comparable scores for that horse through the questionnaire (inter-rater reliability), and (c) whether the same respondent, scoring the same horse after a known interval of time, recorded similar responses (intra-rater reliability). Construct validity testing of 1923 responses showed significant alignment between owners' reported experience of focal horses' behaviour and those horses' E-BARQ scores, with scores varying from 1.13 to 1.34 for ridden horse behaviour (all p < 0.001) and from 1.06 to 1.43 for non-ridden horse behaviour (all p < 0.001). Inter-rater reliability testing of ten horse-rider pairs revealed that 203 of the 215 question items were significantly aligned (p < 0.001) when tested by two independent raters. Of the remaining 19 items, four had fair alignment (ĸ = 0.174-0.316; p = 0.281) and ten items, largely related to whether the horse shows behavioural signs related to anxiety when taken away from home, did not align (ĸ = 0; p = 1). Intra-rater reliability tests showed that the responses significantly aligned on all 215 question items tested (p < 0.001). The results of these tests confirmed the construct validity and reliability of E-BARQ as a standardised behavioural assessment tool for horses.

Sensory Abilities of Horses and Their Importance for Equitation Science.

Vision, hearing, olfaction, taste, and touch comprise the sensory modalities of most vertebrates. With these senses, the animal receives information about its environment. How this information is organized, interpreted, and experienced is known as perception. The study of the sensory abilities of animals and their implications for behavior is central not only to ethology but also to animal welfare. Sensory ability, perception, and behavior are closely linked. Horses and humans share the five most common sensory modalities, however, their ranges and capacities differ, so that horses are unlikely to perceive their surroundings in a similar manner to humans. Understanding equine perceptual abilities and their differences is important when horses and human interact, as these abilities are pivotal for the response of the horse to any changes in its surroundings. This review aims to provide an overview of the current knowledge on the sensory abilities of horses. The information is discussed within an evolutionary context and also includes a practical perspective, outlining potential ways to mitigate risks of injuries and enhance positive horse-human interactions. The equine sensory apparatus includes panoramic visual capacities with acuities similar to those of red-green color-blind humans as well as aural abilities that, in some respects exceed human hearing and a highly developed sense of smell, all of which influence how horses react in various situations. Equine sensitivity to touch has been studied surprisingly sparingly despite tactile stimulation being the major interface of horse training. We discuss the potential use of sensory enrichment/positive sensory stimulation to improve the welfare of horses in various situations e.g. using odors, touch or sound to enrich the environment or to appease horses. In addition, equine perception is affected by factors such as breed, individuality, age, and in some cases even color, emphasizing that different horses may need different types of management. Understanding the sensory abilities of horses is central to the emerging discipline of equitation science, which comprises the gamut of horse-human interactions. Therefore, sensory abilities continue to warrant scientific focus, with more research to enable us to understand different horses and their various needs.

The 2020 Five Domains Model: Including Human-Animal Interactions in Assessments of Animal Welfare.

Throughout its 25-year history, the Five Domains Model for animal welfare assessment has been regularly updated to include at each stage the latest authenticated developments in animal welfare science thinking. The domains of the most up-to-date Model described here are: 1 Nutrition, 2 Physical Environment, 3 Health, 4 Behavioural Interactions and 5 Mental State. The first four domains focus attention on factors that give rise to specific negative or positive subjective experiences (affects), which contribute to the animal's mental state, as evaluated in Domain 5. More specifically, the first three domains focus mainly on factors that disturb or disrupt particular features of the body's internal stability. Each disturbed or disrupted feature generates sensory inputs which are processed by the brain to form specific negative affects, and these affects are associated with behaviours that act to restore the body's internal stability. As each such behaviour is essential for the survival of the animal, the affects associated with them are collectively referred to as "survival-critical affects". In contrast, Domain 4, now named Behavioural Interactions, focusses on evidence of animals consciously seeking specific goals when interacting behaviourally with (1) the environment, (2) other non-human animals and (3) as a new feature of the Model outlined here, humans. The associated affects, evaluated via Domain 5, are mainly generated by brain processing of sensory inputs elicited by external stimuli. The success of the animals' behavioural attempts to achieve their chosen goals is reflected in whether the associated affects are negative or positive. Collectively referred to as "situation-related affects", these outcomes are understood to contribute to animals' perceptions of their external circumstances. These observations reveal a key distinction between the way survival-critical and situation-related affects influence animals' aligned behaviours. The former mainly reflect compelling motivations to engage in genetically embedded behavioural responses, whereas the latter mainly involve conscious behavioural choices which are the hallmarks of agency. Finally, numerous examples of human-animal interactions and their attendant affects are described, and the qualitative grading of interactions that generate negative or positive affect is also illustrated.

Building Bridges between Theory and Practice: How Citizen Science Can Bring Equine Researchers and Practitioners Together.

Over the last decade, equitation scientists have increasingly relied on online survey tools to gather information on horse training, management, behaviour and other equine-related subjects. With a detailed knowledge of their animals, horse owners and riders are ideally placed to contribute to research but are sometimes reluctant to engage with and devote time to surveys. The current article reveals, through consultation with stakeholder groups, the potential of a range of motivational items to boost horse-owner participation. A short, three-question inquiry was developed to rank respondents' (n = 747) preferred survey tools and other items designed to engage the equestrian community with the donation of data. Respondents were asked to assign themselves to one of four categories: academics/researchers, professionals, practitioners and enthusiasts. The inquiry offered respondents the choice of three hypothetical tools: a standardised tool to measure behaviour over time; a logbook tool to record training and behaviour on a regular basis; and a chart to compare an individual horse's behaviour with that of the general horse population. While analysis revealed that stakeholders considered at least one of the tools to be useful, it also exposed significant differences among the perceived usefulness of the various tools themselves. Using free-text responses, participants described the challenges faced when gathering information on horse training, management and behaviour. Qualitative analysis of these data revealed the need to improve the current dissemination of scientific findings to bridge various knowledge gaps. The Equine Behavior Assessment and Research Questionnaire (E-BARQ) is a longitudinal instrument that investigates horse training and management practices and permits an analysis of their relationship with behaviour. The current stakeholder consultation contributed to the final version of the E-BARQ questionnaire, identified incentivising items that can be offered to putative E-BARQ respondents, guided the eventual selection of a Share-&-Compare feedback chart, and reinforced the need for open-access dissemination of findings.

Slippery liquid infused fluoropolymer coating for central lines to reduce catheter associated clotting and infections.

Thrombosis and infections are two grave, interrelated problems associated with the use of central venous catheters (CVL). Currently used antibiotic coated CVL has limited clinical success in resisting blood stream infection and may increase the risk of emerging antibiotic resistant strains. We report an antibiotic-free, fluoropolymer-immobilized, liquid perfluorocarbon-coated peripherally inserted central catheter (PICC) line and its effectiveness in reducing catheter associated thrombosis and pathogen colonization, as an alternative to antibiotic coated CVL. Commercially available polyurethane PICC catheter was modified by a three-step lamination process, with thin fluoropolymer layers to yield fluoropolymer-polyurethane-fluoropolymer composite structure before applying the liquid perfluorocarbon (LP). This high throughput process of modifying commercial PICC catheters with fluoropolymer is quicker, safer and shows higher thromboresistance than fluorinated, omniphobic catheter surfaces, produced by previously reported self-assembled monolayer deposition techniques. The LP immobilized on the fluoropolymer is highly durable in physiological flow conditions for over 60 days and continue to resist Staphylococcus colonization.