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.

The impact of comprehensive air purification on patient duration of stay, discharge outcomes, and health care economics: A retrospective cohort study.

BACKGROUND: Infectious airborne and surface pathogens constitute a substantial and poorly explored source of patient subclinical illness and infections. With that in mind, a system of advanced air purification technology was designed to destroy the DNA and RNA of all bacteria, fungi, and viruses. This study compares the effects of advanced air purification technology versus high efficiency particulate air filtration with respect to certain metrics of health care economics and resource utilization at a large, community-based, urban hospital. Our hypothesis was that the use of the advanced air purification technology would decrease health care durations of stay, lead to fewer nonhome discharges, and decrease hospital charges. METHODS: After the installation of advanced air purification technology, 3 resultant air purification "zones" were established: zone C, a control floor with high efficiency particulate air filtration; zone B, a mixed high efficiency particulate air and advanced air purification technology floor; and zone A, a comprehensive advanced air purification technology remediation. This study included nonbariatric surgical patients admitted to any zone between December 2017 and December 2018, with reported case mix index on discharge. We analyzed hospital duration of stays, discharge destination, and hospital charges with adjustment for severity of illness using the case mix index. The likelihood of mortality, health care-associated infection, and readmission for each study zone was examined using logistic regression adjusting for case mix index, age, sex, and source of admission. RESULTS: The study included 1,002 patients across the 3 zones, with mean age of 55.8 years (53.7% female), average case mix index of 1.98, and mortality of 1.7%. Compared with zone C, patients in zones A and B demonstrated decreased hospital stays, a greater percentage of home discharges (86.5-87.8% vs 64.7%), and less hospital charges. In addition, logistic regression modeling performed on 999 study patients showed that the likelihood of mortality, hospital-acquired infections, and readmissions did not differ among the 3 zones. A trend toward a lesser incidence of hospital-acquired infections was noted in zones A and B (0.40% and 0.48%, respectively) when compared with zone C (0.63%). CONCLUSION: Patients in the advanced air purification technology zones demonstrated statistically significant improvements in durations of stay, discharge to home, and costs after adjusting for case mix index. In addition, a trend toward fewer hospital-acquired infections in advanced air purification technology zones was noted. These findings suggest that environmental factors may affect key clinical and economic outcomes, supporting further research in this important and largely unexplored area.

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.

The equine practitioner-farrier relationship: building a partnership.

The importance of hoof care in maintaining the health and soundness of a horse cannot be overstated. The aphorism, "No foot, no horse" still holds true. For equine ambulatory practitioners, the time devoted to a thorough understanding of the equine digit and it's care is well worth the investment. The effort devoted to developing good relationships with individuals who will likely be responsible for implementing the changes suggested as a result of that understanding will be rewarded many times over in the course of the equine ambulatory practitioner's career.

An evaluation of the health status of the Lavaca Bay, Texas ecosystem using Crassostrea virginica as the sentinel species.

Locational risks for compromised ecosystem health for the eastern oysters (Crassostrea virginica) harvested from Lavaca Bay, Texas were estimated. Flow cytometric evaluation of variations in DNA content and the lysosomal destabilization assay were used for evaluation of genotoxicity and stress, respectively. Bayesian geo-statistical methods were utilized to estimate and evaluate spatial effects. For models with spatial risks, continuous surface maps of predicted parameter values were created to evaluate risk location. Lysosomal destabilization assay results were spatially oriented whereas flow cytometry results were fit best with the random effects model. While not spatially oriented, the highest levels of variations in DNA content were also present near industrial facilities. Locational risks of increased biomarkers of genotoxicity and stress in the eastern oyster (Crassostrea virginica) were increased with proximity to industrial facilities.

Geostatistical analysis of biomarkers of genotoxicity in cattle, Bos taurus and Bos taurus x Bos indicus, sentinels near industrial facilities.

This study, performed at the behest of ranchers living and working down-prevailing wind from industrial facilities located in Calhoun County, Texas investigated locational risks to ecosystem health associated with proximity to specific industrial complexes. Concerns expressed were for potential genotoxicity in cattle resulting from the release of complex chemical mixtures. The Comet Assay and flow cytometric evaluation of variations in DNA content were utilized to evaluate DNA damage. Bayesian geo-statistical analysis revealed the presence of important spatial processes. The Comet assay's optical density provided a strong indication of increased damage down-prevailing wind from the industrial complexes. Results indicated that proximity to and location down-prevailing winds from industrial facilities increased the locational risk of genotoxicity in this sentinel species.

Bayesian spatial modeling of Lavaca Bay pollutants.

Locational risk of increased mercury and PAH concentrations in Lavaca Bay, Texas sediments and eastern oysters (Crassostrea virginica) harvested from Lavaca Bay, Texas were analysed. Chemical analysis results were evaluated utilizing Bayesian geo-statistical methods for comparison of the model fit of a random effects model versus a convoluted model which included both random and spatial effects. For those results fit best with the convoluted model, continuous surface maps of predicted parameter values were created. Sediment and oyster concentrations of mercury and the majority of measured PAHs were fit best with the convoluted model. The locational risks of encountering elevated concentrations of these pollutants in Lavaca Bay sediments and oysters were highest in close proximity to industrial facilities.

Musculoskeletal problems associated with lameness and poor performance among horses used for barrel racing: 118 cases (2000-2003).

OBJECTIVE: To identify types of musculoskeletal problems associated with lameness or poor performance in horses used for barrel racing. DESIGN: Retrospective case series. ANIMALS: 118 horses. PROCEDURE: Medical records were reviewed for information on signalment, history, physical and lameness examination findings, diagnostic tests performed, diagnosis, and treatment. RESULTS: Most horses were examined because of lameness (n = 72 [61%]) rather than poor performance (46 [39%]), but owner complaint was not significantly associated with age or body weight of the horse. The most common performance change was refusal or failure to turn properly around the first barrel (19/46 [41%]). The right forelimb (n = 57 [48%]) was most commonly affected, followed by the left forelimb (51 [43%]), the left hind limb (31 [26%]), and the right hind limb (25 [21%]). In 31 horses (26%), both forelimbs were affected, and in 6 (5%), both hind limbs were affected. The most common musculoskeletal problems were forelimb foot pain only (n = 39 [33%]), osteoarthritis of the distal tarsal joints (17 [14%]), suspensory ligament desmitis (15 [13%]), forelimb foot pain with distal tarsal joint osteoarthritis (11 [9%]), and bruised feet (10 [8.5%]). In 81 (69%) horses, the affected joint was treated with intra-articular medications. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in horses used for barrel racing that are examined because of lameness or poor performance, the forelimbs are more likely to be affected than the hind limbs, with forelimb foot pain and osteoarthritis of the distal tarsal joints being the most common underlying abnormalities.

Lameness and poor performance in horses used for team roping: 118 cases (2000-2003).

OBJECTIVE: To determine the types of musculoskeletal problems that result in lameness or poor performance in horses used for team roping and determine whether these problems are different in horses used for heading versus heeling. DESIGN: Retrospective study. ANIMALS: 118 horses. PROCEDURE: Medical records of team roping horses that were evaluated because of lameness or poor performance were reviewed to obtain information regarding signalment, primary use (ie, head horse or heel horse), history, results of physical and lameness examinations, diagnostic tests performed, final diagnosis, and treatment. RESULTS: Among horses evaluated by lameness clinicians, the proportion with lameness or poor performance was significantly greater in horses used for heading (74/118) and lower in horses used for heeling (44/118) than would be expected under the null hypothesis. Most horses examined for poor performance were lame. A significantly greater proportion of horses used for heading had right forelimb lameness (26/74 [35%]), compared with horses used for heeling (7/44 [16%]). Horses used for heading had more bilateral forelimb lameness (18/74 [24%]), compared with horses used for heeling (4/44 [9%]). Horses used for heeling had more bilateral hind limb lameness (3/44 [7%]), compared with horses used for heading (0%). The most common musculoskeletal problems in horses used for heading were signs of pain limited to the distal sesamoid (navicular) area, signs of pain in the navicular area plus osteoarthritis of the distal tarsal joints, and soft tissue injury in the forelimb proximal phalangeal (pastern) region. Heeling horses most commonly had signs of pain in the navicular area, osteoarthritis of the metatarsophalangeal joints, and osteoarthritis of the distal tarsal joints. CONCLUSIONS AND CLINICAL RELEVANCE: Horses used for heading were most commonly affected by lameness in the right forelimb. Horses used for heeling had more bilateral hind limb lameness than horses used for heading.

Hoof wall defects: chronic hoof wall separations and hoof wall cracks.

Hoof wall defects in horses are common occurrences, and, fortunately, many of those detected present little or no danger to the individual horse. Those defects that are either presently a problem or have a great likelihood of being a problem do often require specialized consideration. Horse shoeing and farriery are ancient practices; over the years, a multitude of methods, theories, and management schemes have been proposed. It is unfortunate to note that few studies are available to provide an accurate incidence rate, a better understanding of the various causes, and, lastly, a comparative appreciation of the possible modes of treatment and management. This discussion reflects the thinking and experience of the author and, as such, should be read and viewed with an open and critical mind set.