Impact of a Spectrum of Care Elective Course on Third-Year Veterinary Students' Self-Reported Knowledge, Attitudes, and Competencies.

Veterinary services' rising cost is an increasing barrier to pet care. Spectrum of care (SpOC) refers to evidence-based veterinary medicine options along the socioeconomic spectrum. To meet growing pet owner financial constraints and pet care needs, training to equip veterinarians with competencies to provide SpOC as Day One graduates is argued to be added as part of the veterinary curriculum. Objectives of our prospective pre- and post-survey study were to (a) determine baseline self-reported knowledge, attitudes, and competencies (KACs) surrounding SpOC in third-year DVM students; (b) develop and assess impact of a SpOC course on student self-reported SpOC KACs; and (c) obtain student feedback on the course and future SpOC training. Enrolled students (n = 35) completed the pre-survey (n = 35) and post-survey (n = 33). Results indicated that students were aware of the need for SpOC training within the veterinary curriculum, and positive changes occurred in self-reported KAC from pre- to post-survey. Students tended (p = .08) to predict better outcomes in SpOC cost-barrier scenarios from pre- (34%) to post-survey (76%), such as reduced perceived likelihood of euthanasia (63%-39%) and unsuccessful outcomes (40%-27%). Most students (31/33, 94%) predicted the course would benefit them in clinical practice and had preferred future training preferences (online modules [70%], seminars [60%], webinars [58%]). Data indicate benefits in student self-reported KACs following the SpOC course, warranting formal course inclusion, with tracking of students into clinical practice to document objective KAC impacts and perhaps similar course rollout to other institutions.

Predictors of 1-year mortality after adult lung transplantation: Systematic review and meta-analyses.

BACKGROUND: Prognostic factors in lung transplantation are those variables that are associated with transplant outcomes. Knowledge of donor and recipient prognostic variables can aid in the optimal allocation of donor lungs to transplant recipients and can also inform post-operative discussions with patients about prognosis. Current research findings related to prognostic factors in lung transplantation are inconsistent and the relative importance of various factors is unclear. This review aims to provide the best possible estimates of the association between putative prognostic variables and 1-year all-cause mortality in adult lung transplant recipients. METHODS: We searched 5 bibliographic databases for studies assessing the associations between putative predictors (related to lung donors, recipients, or the transplant procedure) and 1-year recipient mortality. We pooled data across studies when justified and utilized GRADE methodology to assess the certainty in the evidence. RESULTS: From 72 eligible studies (2002-2020), there were 34 recipient variables, 4 donor variables, 10 procedural variables, and 7 post-transplant complication variables that were amenable to a meta-analysis. With a high degree of certainty in the evidence only post-transplant need for extra-corporeal membrane oxygenation (ECMO) (HR 1.91, 95% CI 1.79-2.04) predicted 1-year mortality. No donor variables appeared to predict transplant outcome with high or even moderate certainty. CONCLUSION: Across the range of contemporary donors and recipients that clinicians accept for lung transplantation, this review, with high certainty, found 1 prognostic factor that predicted 1-year mortality, and 37 additional factors with a moderate degree of certainty. The lack of prognostic significance for some widely accepted factors (e.g., donor smoking, age) likely relates to existing limits in the range of these variables at the time of donor and recipient selection.

Knowledge, attitudes and influencers of cat owners in North America around antimicrobials and antimicrobial stewardship.

OBJECTIVES: The primary aims of this study were to determine preferences of North American cat owners when they are prescribed an antimicrobial for their cat with regard to cost, method of administration and the importance of antibiotics for treating infections in people, and to establish baseline knowledge, attitudes and influencers of cat owners on antimicrobial resistance and stewardship. METHODS: An online questionnaire was used for data collection from two cat-owner groups: US cat owners and Canadian cat owners. Participants were queried on antimicrobial resistance and stewardship, and their preferences for their own cat when prescribed an antimicrobial, with respect to cost, method of drug administration and the importance of a drug for treating infections in people. Responses were evaluated through conjoint analysis and Likert-type questions. Data were analyzed using descriptive and analytic statistics. RESULTS: A total of 630 complete responses were included in the final analysis. Cost (37%) and method of administration (38%) were of similar participant preference when assessed using conjoint analysis. The importance of a drug for treating infections in people was lower priority (21%). The majority of cat owners preferred an antimicrobial that was 'very important' in treating human infections. A low proportion (21%) of participants responded that antimicrobial use in pets posed a risk to humans. Participants with a university education were more likely to respond that antimicrobial use in pets was a concern for people (31%; P <0.001). CONCLUSIONS AND RELEVANCE: Cat owners prioritize antimicrobial cost and method of administration equally. Few cat owners recognized the human antimicrobial resistance risks associated with antimicrobial use in pets.

Prognostic value of blood pressure in ambulatory heart failure: a meta-analysis and systematic review. Ambulatory blood pressure predicts heart failure prognosis.

Previous primary studies have explored the association between blood pressure (BP) and mortality in ambulatory heart failure (HF) patients reporting varying and contrasting associations. The aim is to determine the pooled BP prognostic value and explore potential reasons for between-study inconsistency. We searched Medline, Cochrane, EMBASE and CINAHL from January 2005 to October 2018 for studies with ≥ 50 events (mortality and/or hospitalization) and included BP in a multivariable model in ambulatory HF patients. We pooled hazard ratios (random effects model) for systolic BP (SBP) or diastolic BP (DBP) effect on mortality and/or hospitalization risk. We used a priori defined sub-group analyses to explore heterogeneity and GRADE approach to assess the certainty of the evidence. Seventy-one eligible articles (239,467 screened) at low to moderate risk of bias included 235,752 participants. Higher SBP was associated with reduced all-cause mortality (HR 0.93, 95%CI 0.91-0.95, I2 = 87.13%, moderate certainty), all-cause hospitalization events (HR 0.91, 95%CI 0.88-0.93, I2 = 44.4%, high certainty) and their composite endpoint (HR 0.93 per 10 mmHg, 95%CI 0.91-0.94, I2 = 86.3%, high certainty). DBP did not demonstrate a statistically significant effect for all outcomes. The association strength was significantly weaker in studies following patients with either LVEF > 40%, higher average SBP (> 130 mmHg), increasing age and diabetes. All other a priori subgroup hypotheses did not explain between study differences. Higher ambulatory SBP is associated with reduced risk of all-cause mortality and hospitalization. Patients with lower BP and reduced LVEF are in a high-risk group of developing adverse events with moderate certainty of evidence.

Validation of the International Society for Heart and Lung Transplantation primary graft dysfunction instrument in heart transplantation.

BACKGROUND: In 2014, the International Society for Heart and Lung Transplantation (ISHLT) developed a classification instrument for left ventricular (LV) and isolated right ventricular (RV) primary graft dysfunction post‒heart transplant. The instrument classifies LV-PGD as mild, moderate, or severe. In this study, we evaluated the predictive validity of this instrument. METHODS: We conducted a cohort study of 412 consecutive patients transplanted between 2004 and 2015 at the Toronto General Hospital and Ottawa Heart Institute (Canada). We classified LV-PGD as mild, moderate, or severe, using the ISHLT instrument. To assess predictive validity, we evaluated the association between LV-PGD severity and 1-year post-transplant mortality using a Cox regression model adjusted for recipient age. RESULTS: The cohort was predominantly male (71%), mean age 50 ± 13 years, mean donor age 38 ± 14 years, with 25% female donors. Mean ischemic time was 3.7 ± 1.1 hours. LV-PGD was mild in 3.6% of patients, moderate in 9.5%, and severe in 3.9%. All levels of LV-PGD were associated with increased 1-year mortality, with a gradient in the association between mild, moderate, and severe. We only observed a statistically significant association for moderate and severe forms of LV-PGD (mild: hazard ratio [HR] 2.4, 95% confidence interval [CI] 0.6 to 10.2; moderate: HR 7.0, 95% CI 3.4 to 14.6; severe: HR 15.9, 95% CI 7.2 to 35.0). CONCLUSIONS: The ISHLT LV-PGD classification convincingly identifies a substantial increase in the risk of death at 1 year, and an increased gradient of risk, in those with moderate or severe LV-PGD.

Image Based Mango Fruit Detection, Localisation and Yield Estimation Using Multiple View Geometry.

This paper presents a novel multi-sensor framework to efficiently identify, track, localise and map every piece of fruit in a commercial mango orchard. A multiple viewpoint approach is used to solve the problem of occlusion, thus avoiding the need for labour-intensive field calibration to estimate actual yield. Fruit are detected in images using a state-of-the-art faster R-CNN detector, and pair-wise correspondences are established between images using trajectory data provided by a navigation system. A novel LiDAR component automatically generates image masks for each canopy, allowing each fruit to be associated with the corresponding tree. The tracked fruit are triangulated to locate them in 3D, enabling a number of spatial statistics per tree, row or orchard block. A total of 522 trees and 71,609 mangoes were scanned on a Calypso mango orchard near Bundaberg, Queensland, Australia, with 16 trees counted by hand for validation, both on the tree and after harvest. The results show that single, dual and multi-view methods can all provide precise yield estimates, but only the proposed multi-view approach can do so without calibration, with an error rate of only 1.36% for individual trees.

Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies.

OBJECTIVE:  To determine the frequency of survival, stroke, atrial fibrillation, structural valve deterioration, and length of hospital stay after surgical replacement of an aortic valve (SAVR) with a bioprosthetic valve in patients with severe symptomatic aortic stenosis. DESIGN:  Systematic review and meta-analysis of observational studies. DATA SOURCES:  Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. STUDY SELECTION:  Eligible observational studies followed patients after SAVR with a bioprosthetic valve for at least two years. METHODS:  Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural valve deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay. RESULTS:  In patients undergoing SAVR with a bioprosthetic valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural valve deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15). CONCLUSION:  Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural valve deterioration. The rate of deterioration increases rapidly after 10 years, and particularly after 15 years.