Foundations for Meaningful Consent in Canada's Digital Health Ecosystem: Retrospective Study.

BACKGROUND: Canadians are increasingly gaining web-based access to digital health services, and they expect to access their data from these services through a central patient access channel. Implementing data sharing between these services will require patient trust that is fostered through meaningful consent and consent management. Understanding user consent requirements and information needs is necessary for developing a trustworthy and transparent consent management system. OBJECTIVE: The objective of this study is to explore consent management preferences and information needs to support meaningful consent. METHODS: A secondary analysis of a national survey was conducted using a retrospective descriptive study design. The 2019 cross-sectional survey used a series of vignettes and consent scenarios to explore Canadians' privacy perspectives and preferences regarding consent management. Nonparametric tests and logistic regression analyses were conducted to identify the differences and associations between various factors. RESULTS: Of the 1017 total responses, 716 (70.4%) participants self-identified as potential users. Of the potential users, almost all (672/716, 93.8%) felt that the ability to control their data was important, whereas some (385/716, 53.8%) believed that an all or none control at the data source level was adequate. Most potential users preferred new data sources to be accessible by health care providers (546/716, 76.3%) and delegated parties (389/716, 54.3%) by default. Prior digital health use was associated with greater odds of granting default access when compared with no prior use, with the greatest odds of granting default access to digital health service providers (odds ratio 2.17, 95% CI 1.36-3.46). From a list of 9 information elements found in consent forms, potential users selected an average of 5.64 (SD 2.68) and 5.54 (SD 2.85) items to feel informed in consenting to data access by care partners and commercial digital health service providers, respectively. There was no significant difference in the number of items selected between the 2 scenarios (P>.05); however, there were significant differences (P<.05) in information types that were selected between the scenarios. CONCLUSIONS: A majority of survey participants reported that they would register and use a patient access channel and believed that the ability to control data access was important, especially as it pertains to access by those outside their care. These findings suggest that a broad all or none approach based on data source may be accepted; however, approximately one-fifth of potential users were unable to decide. Although vignettes were used to introduce the questions, this study showed that more context is required for potential users to make informed consent decisions. Understanding their information needs will be critical, as these needs vary with the use case, highlighting the importance of prioritizing and tailoring information to enable meaningful consent.

Meaningful Digital Consent in Canada: Recommendations from Pan-Canadian Consent Management Workshops.

The digital health landscape is rapidly evolving with regard to how society accesses and interacts with digital information and technologies. With a largely commercial marketplace, there are growing concerns that users are not fully informed about how their data are used. Canadian privacy legislation is currently undergoing modernization to improve the transparency of commercial information handling practices through the introduction of meaningful consent. This paper reports on workshops held across Canada, exploring the implications of meaningful consent in a digital health context. Recommendations focus on measures to promote transparency, improve digital literacy and foster public trust in digital health innovations.

Varying Opinions about Animal Welfare in the Australian Live Export Industry: A Survey.

There is significant public interest in the Australian live animal export industry and a need to develop a program that can measure and monitor animal welfare throughout the supply chain. An online survey of stakeholder opinions of this industry and animal welfare measures was carried out in 2015 with 921 respondents: 30% from the public who identified as animal welfare advocates (AWAs); 44% from the public who did not identify as AWAs (general public; GP); 26% live export industry (LEI) workers. AWA and GP respondents expressed greater concern than LEI respondents for animal welfare throughout the supply chain but had less concern for animals at Australian feedlots than in other parts of the supply chain. The majority of AWA and GP respondents believed data collected on animal welfare should be made public and should be collected by independent welfare officers and used to regulate the industry and impose penalties for poor welfare. LEI workers believed that data should be confidential, collected by LEI workers and used by the industry to self-regulate. AWA and GP respondents rated the importance and practicality of a number of welfare indicators greater than LEI workers, while respondents shared an analogous view of the importance and practicality of these indicators. Results can be used to develop welfare assessments that ensure a better understanding between industry members and those not in the industry, while facilitating welfare improvements and promoting greater transparency for the live export industry.

Preliminary Findings on a Novel Behavioural Approach for the Assessment of Pain and Analgesia in Lambs Subject to Routine Husbandry Procedures.

The identification and assessment of pain in sheep under field conditions are important, but, due to their stoic nature, are fraught with many challenges. In Australia, various husbandry procedures that are documented to cause pain are routinely performed at lamb marking, including ear tagging, castration, mulesing, and tail docking. This study evaluated the validity of a novel methodology to assess pain in lambs: qualitative behavioural assessment (QBA) was used to compare the behavioural expression of control lambs (CONTROL) with that of lambs subject to these procedures that received either a saline placebo 15 min before procedures (PLACEBO), or were administered meloxicam 15 min before procedures in addition to the standard analgesic Tri-Solfen at the time of procedures, as per the manufacturer's recommendations (ANALGESIC TREATMENT; AT). In terms of behavioural expression, it was expected that: CONTROL ≠ PLACEBO, AT = CONTROL, and PLACEBO ≠ AT. Video footage of the 6-8-week-old lambs (n = 10 for each treatment) was captured approximately 1.5 h postprocedure and was presented, in a random order, to 19 observers for assessment using the Free-Choice Profiling (FCP) approach to QBA. There was significant consensus (p < 0.001) among the observers in their assessment of the lambs, with two main dimensions of behavioural expression explaining 69.2% of the variation. As expected, observers perceived differences in the demeanour of lambs in the first dimension, scoring all lambs subject to the routine husbandry procedures as significantly more 'dull' and 'uneasy' compared to the control lambs (p < 0.05). Contrary to expectations, the results also suggested that analgesic treatment did not provide relief at the time of observation. Further investigations to validate the relationship between behavioural expression scores and pain are necessary, but these results suggest that painful husbandry procedures alter the behavioural expression of lambs and these differences can be captured using QBA methodology.

Review of Livestock Welfare Indicators Relevant for the Australian Live Export Industry.

Animal welfare is an important issue for the live export industry (LEI), in terms of economic returns, community attitudes and international socio-political relations. Mortality has traditionally been the main welfare measure recorded within the LEI; however, high mortality incidents are usually acted upon after adverse events occur, reducing the scope for proactive welfare enhancement. We reviewed 71 potential animal welfare measures, identifying those measures that would be appropriate for use throughout the LEI for feeder and slaughter livestock species, and categorised these as animal-, environment- and resource-based. We divided the live export supply chain into three sectors: (1) Australian facilities, (2) vessel and (3) destination country facilities. After reviewing the relevant regulations for each sector of the industry, we identified 38 (sector 1), 35 (sector 2) and 26 (sector 3) measures already being collected under current practice. These could be used to form a 'welfare information dashboard': a LEI-specific online interface for collecting data that could contribute towards standardised industry reporting. We identified another 20, 25 and 28 measures that are relevant to each LEI sector (sectors 1, 2, 3, respectively), and that could be developed and integrated into a benchmarking system in the future.

Remote Identification of Sheep with Flystrike Using Behavioural Observations.

Flystrike is a major problem affecting sheep in Australia. Identification of 'flystruck' individuals is crucial for treatment; but requires labour-intensive physical examination. As the industry moves toward more low-input systems; there is a need for remote methods to identify flystruck individuals. The aim of this study was to investigate the behaviour of sheep with breech flystrike within a paddock setting. Video footage of sixteen Merino sheep; eight later confirmed with flystrike and eight without; was collected as they moved freely within the paddock with conspecifics. Quantitative behavioural measurements and a qualitative behavioural assessment (QBA) were conducted and compared to their breech conditions (i.e., faecal/urine staining; flystrike severity). Both qualitative and quantitative assessments indicated behavioural differences between flystruck and non-flystruck animals. Flystruck sheep had a behavioural profile characterised by restless behaviour; abnormal postures and reduced grazing time (p < 0.05). Furthermore; flystruck sheep were scored to have a more 'exhausted/irritated' demeanour using QBA (p < 0.05). The behavioural responses also corresponded to the flystrike severity scores and condition of the breech area. We conclude that remotely assessed behaviour of flystruck sheep diverges markedly from non-flystruck sheep; and thus could be a low-input method for identifying and treating affected animals.

Kinetic Gait Analysis of Agility Dogs Entering the A-Frame.

OBJECTIVE: The main purpose of this study was to investigate the effect of a decrease in the A-frame angle of incline on the vertical and cranio-caudal ground reaction forces observed in a homogeneous cohort of agility dogs during entrance and contact with the A-frame. MATERIALS AND METHODS: A crossover study design was applied to eight large breed dogs to compare the vertical and cranio-caudal ground reaction forces entering the A-frame at three angles of incline: 40° (standard), 35° and 30°. The peak vertical force, passive impact peak, peak propulsive force, peak braking force, the time point (percentile) in the stance phase at which these events occurred and the proportion of time for limb contact spent in braking (% braking) and propulsion (% propulsion) were examined.The variables measured from three trials at each incline were evaluated for a significant effect of A-frame angle with height and velocity included as covariates. RESULTS: The peak propulsive force and the % propulsion were significantly higher at the 40° angle of incline compared with 30° (p = 0.013, p = 0.0165 respectively) and the % braking was significantly lower at the 40° angle of incline compared with 30° (p = 0.0165). There was no significant effect of A-frame angle on the vertical ground reaction forces measured. CLINICAL SIGNIFICANCE: Compared with 30° incline, ascent up the A-frame at a 40° incline requires a higher propulsive force and extended time in propulsion to maintain forward movement and convert potential energy into forward kinetic energy.

Qualitative Behavioural Assessment as a Method to Identify Potential Stressors during Commercial Sheep Transport.

Land transport is an unavoidable experience for most livestock, yet there is limited research comparing animal welfare under different conditions. We video recorded sheep responses during short (2 h) commercial road transport journeys. Using Qualitative Behavioural Assessment, observers (blinded to the treatments) scored the behavioural expression of sheep and reached significant consensus in their scoring patterns (p < 0.001). There were also significant effects of vehicle crate design (sheep transported in a 'standard' crate were more calm/relaxed than those transported in a 'convertible' crate), deck position (sheep on upper decks were more curious/alert than those on lower decks), and sheep breed (fat-tail sheep were more agitated/distressed than merino sheep) on observer scores. We only found marginal differences for sheep originating from feedlot or saleyard. Significant effects of vehicle driver (included as a random factor in all but one of our analyses) suggest driving patterns contributed to demeanour of the sheep. Finally, the fourteen drivers who participated in the study were asked their opinions on livestock transport; none of the factors we tested were identified by drivers as important for sheep welfare during transport. This study supports the use of qualitative measures in transport and revealed differences that could inform truck design.

Reduction of the A-Frame Angle of Incline does not Change the Maximum Carpal Joint Extension Angle in Agility Dogs Entering the A-Frame.

OBJECTIVE: This article aims to investigate the effect of a decrease in the A-frame angle of incline on the highest carpal extension angle in agility dogs. METHODS: Kinematic gait analysis (two-dimensional) measuring carpal extension was performed on 40 dogs entering the A-frame at 3 angles of incline: 40° (standard), 35° and 30°. The highest carpal extension angle from three trials at each incline was examined for a significant effect of A-frame angle with height, body weight and velocity included as covariates. RESULTS: There was no significant effect of A-frame angle on the highest carpal joint extension angle for the first or second limb. The adjusted mean carpal extension angle for the first limb at 40° was 64° [95% confidence interval (CI), 60-68), at 35° was 61° (95% CI, 57-65) and at 30° was 62° (95% CI, 59-65). The raw mean carpal extension angle for all dogs across all A-frame angles for the first limb was 62° (95% CI, 60-64) and the second limb was 61° (95% CI, 59-63). CLINICAL SIGNIFICANCE: Decreasing the A-frame angle of incline from 40° to 30° did not result in reduced carpal extension angles. The failure to find a difference and the narrow CI of the carpal angles may indicate that the physiologic limits of carpal extension were reached at all A-frame angles.

Characterization of inappetent sheep in a feedlot using radio-tracking technology.

The feeding and drinking behaviours of sheep were monitored using RFID technology at a commercial pre-embarkation feedlot in Western Australia with the aim of characterizing feeding and drinking patterns of inappetent sheep that might allow them to be treated. Feeding and drinking behaviours of sheep were compared with their survival and change in body condition. Patterns of number of visits and the time spent at feed and water troughs were analyzed for a total of 8,206 sheep, representing four consignments that were monitored for a range of 6-31 d. Data for feeding and drinking behaviours were compared for the first 6 d. For animals that were alive at exit, 18.9% of sheep attended the feed trough for less than 0.25 h d-1 (15 min per day) on day 1; this decreased to only 2.4% of sheep by day 6. Of the sheep monitored, 0.93% died (n = 76); Salmonella spp. infection was the leading cause of death (n = 40; 52.6% of all deaths) across all months and was accompanied with inanition. There was marked variability in the average time spent at the feed trough for sheep that died eventually from salmonella/inanition (contributing to the lack of statistical difference in time spent at feed trough between sheep dying from different causes; P = 0.056). Over half (55%) of the animals diagnosed with salmonella/inanition spent an average of less than 0.50 h d-1 (30 min per day) and 45% less than 0.25 h d-1 at the feed trough. There was a negative correlation (r) in time spent at the feed trough overtime for individual sheep that died from salmonella/inanition, indicating that these individuals went off their feed. This pattern was not evident for animals that died from other causes (significant difference in r values between five categories of cause of death; P = 0.040). Characterization of feeding behaviour of sheep that died from salmonella/inanition therefore appears to require more than simply monitoring daily intake. There was no difference in time spent at water troughs between sheep that died or were alive at exit (average 0.30 ± 0.23 h d-1). This study reveals that the patterns of feeding and drinking behaviours during pre-embarkation feedlotting do not readily allow identification of animals that warrant singling out for veterinary care or alternative feed arrangements. This result highlights the need for experienced stockmanship in handling these animals.

Validating the use of qualitative behavioral assessment as a measure of the welfare of sheep during transport.

We tested the application of qualitative behavioral assessment (QBA) as a welfare assessment tool. Sheep were exposed to road transport treatments, and behavioral expressions were compared between experimental treatments and validated by correlation with physiological measures. We compared journeys differing in ventilation (closed vs. open-sided trailer), flooring (grip vs. nongrip flooring), and driving styles (stop-start vs. continuous driving). Blood samples were collected immediately before loading and after unloading; heart rate and core body temperatures were recorded continuously. Continuous video footage was edited to show individual sheep to observers for QBA using free-choice profiling (observers used their own descriptive terms). There was significant consensus in observers' scores for the sheep in each experiment (p < .001). Observers distinguished between sheep exposed to flooring (p = .014) or driving-style (p = .005) treatments, but not between ventilation treatments. QBA scores were compared (p < .05) with plasma leptin, glucose, and insulin-like growth factor-1 concentrations; white blood cell profiles; red blood cell counts; hematocrit; body temperatures; and heart rate variability. Observer assessments reflected treatment differences, and correlations between behavioral expression and physiological responses were found.