Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

STUDY DESIGN: A multicenter, retrospective review of C5 palsy after cervical spine surgery. OBJECTIVE: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. METHODS: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ(2) tests or Fisher exact tests for categorical variables. RESULTS: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). CONCLUSION: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Growth and Bone Development in the Horse: When Is a Horse Skeletally Mature?

Within the lay literature, and social media in particular, there is often debate about the age at which a horse should be started and introduced to racing or sport. To optimize the welfare and longevity of horses in racing and sport, it is important to match exercise with musculoskeletal development and the ability of the musculoskeletal system to respond to loading. The justification for not exercising horses at a certain age is often in contrast to the scientific literature and framed, with incorrect generalizations, with human growth. This review provides a relative comparison of the growth and development of the horse to the descriptors used to define growth and development in humans. Measures of physeal closure and somatic growth demonstrate that the horse completes the equivalent of rapid infant growth by weaning (4–6 months old). At approximately 11 months old, the horse completes the equivalent of the childhood phase of growth and enters puberty. At 2 years old, the horse has achieved most measures of maturity used within the human literature, including the plateauing of vertical height, closure of growth plates, and adult ratios of back length:wither height and limb length:wither height. These data support the hypothesis that the horse evolved to be a precocious cursorial grazer and is capable of athletic activity, and use in sport, relatively early in life

Proactive Management of the Equine Athlete

Across many equestrian disciplines the median competition career of a horse is relatively short. One of the major reasons for short career length is musculoskeletal injury and a consistent variable is the trainer effect. There are significant opportunities within equestrian sport for a holistic approach to horse health to attenuate musculoskeletal injury. Proactive integration of care by health professionals could provide a mechanism to attenuate injury risk and the trainer effect. However, the limited data available on current exercise regimens for sport horses restricts interpretation of how management and exercise volume could be modified to reduce injury risk. Early exercise in the juvenile horse (i.e., pre weaning) has a positive effect on stimulating the musculoskeletal system and primes the horse for an athletic career. The early introduction to sport competition has also been identified to have a positive effect on career length. These data indicate that management systems reflecting the cursorial evolution of the horse may aid in attenuating loss from sport due to musculoskeletal injury

Proactive Management of the Equine Athlete

Across many equestrian disciplines the median competition career of a horse is relatively short. One of the major reasons for short career length is musculoskeletal injury and a consistent variable is the trainer effect. There are significant opportunities within equestrian sport for a holistic approach to horse health to attenuate musculoskeletal injury. Proactive integration of care by health professionals could provide a mechanism to attenuate injury risk and the trainer effect. However, the limited data available on current exercise regimens for sport horses restricts interpretation of how management and exercise volume could be modified to reduce injury risk. Early exercise in the juvenile horse (i.e., pre weaning) has a positive effect on stimulating the musculoskeletal system and primes the horse for an athletic career. The early introduction to sport competition has also been identified to have a positive effect on career length. These data indicate that management systems reflecting the cursorial evolution of the horse may aid in attenuating loss from sport due to musculoskeletal injury

Responding to Risk: Regulation or Prohibition? New Zealand Media Reporting of Thoroughbred Jumps Racing 2016–2018

Jumps racing involves a higher risk of accident and fatality than flat racing. The wide accessibility of media, combined with alternate views regarding the place of animals in society, raises the question of the acceptability of the continuation of jumps racing. Racing data and media articles from Newztext and Google news search were collected for the 2016/2017 and 2017/2018 jumps racing seasons, during which the fatality rate was 5.8 per 1000 starters. Jumps racing articles comprised 3.4% of all race reporting, and the volume of discussion about jumps racing was minimal (2.9% of jumps race articles related to the continuation of jumps racing), short-lived and related to horse fatalities. Articles were categorised and analysed using rhetorical analysis to determine the main arguments. The inherent risk posed by jumps racing to the horse formed a basis for two argumentative positions. Proponents of jumps racing argued that risks were reasonable, with risk minimisation measures best determined by expertise and care from within the racing industry, labelling opponents as naïve extremists. Opponents of jumps racing used anthropomorphism of the horse to argue that any risk was unacceptable and jumps racing should be banned. Horses were attributed with rights, and from this perspective, the racing industry exploited horses for entertainment. These two different arguments were used to shape claims for and against the continuation of jumps racing, allowing both to be built upon a shared acceptance of inherent risk

Race-Level Reporting of Incidents Using an Online System during Three Seasons (2019/2020–2021/2022) of Thoroughbred Flat Racing in New Zealand

In the 2019/20 Thoroughbred racing season, the paper-based reporting process of stipendiary steward reports was upgraded to an online system (‘Infohorse database’) to allow for the rapid entry of precise event and injury data. The objectives of this study were to describe the incident and non-incident examinations during the 2019/20, 2020/21, and 2021/22 Thoroughbred flat racing seasons in New Zealand and describe the primary injury and reporting outcomes. The introduction of the online system was associated with fewer miscoding events with horse identification (0.1%). An improvement in the definition and prompts in reporting within the online system compared with the previous paper-based system resulted in a greater frequency of non-incident examinations being undertaken. The increased frequency of reporting the clinical outcome, ‘no observable abnormalities detected’ (NOAD), demonstrates the role of stipendiary stewards to carry out routine screening. The frequency of most clinical findings, such as musculoskeletal fractures (0.5 per 1000 starts, 95% CI = 0.3–0.6), remained similar compared to previously reported data using the paper-based system. The online system provided a more structured dataset compared with the paper-based system, making it a useful tool for the monitoring of incidents, injuries, and potential risk factors within Thoroughbred racing in New Zealand. Therefore, evidence-based changes to the management and structure of racing can be undertaken to ensure the industry meets its duty of care for racehorse and jockey welfare

The Reporting of Racehorse Fatalities in New Zealand Thoroughbred Flat Racing in the 2011/12–2021/22 Seasons

Race day fatalities as a consequence of catastrophic musculoskeletal injury and cardiac failure are both a welfare concern and provide a challenge for the social perceptions of equine welfare within the racing industry. To reduce race day fatalities, the risk factors under New Zealand racing conditions need to be identified. The aim of this study was to examine race and horse-level risk factors for fatalities in New Zealand Thoroughbred flat racing using retrospective race day data from the 2011/12–2021/22 racing seasons. Horse and race-level factors associated with a suspected cardiac failure and fatal fracture were identified by merging fatality data with the master race dataset for the corresponding seasons. Most fatalities were associated with fatal fracture (0.4 per 1000 starts, 95% CI 0.4–0.5). Horses which raced over distances > 1600 m were 1.7 times (95% CI 1.2–2.5) more likely to sustain a fatal fracture than horses racing ≤ 1600 m. Male horses and firmer track conditions were also associated with an increase in the risk of fatal fracture. Horses aged 5 years and older were 2.1 (95% CI 1.1–4.6) times more likely to suffer a suspected cardiac failure than younger horses. Changes in the industry reporting system improved the level of detail provided for fatalities, enabling the identification of specific risk factors

Preliminary Examination of the Biological and Industry Constraints on the Structure and Pattern of Thoroughbred Racing in New Zealand over Thirteen Seasons: 2005/06–2017/18

This study aimed to examine thirteen seasons of flat racing starts (n = 388,964) in the context of an ecological system and identify metrics that describe the inherent characteristics and constraints of the New Zealand Thoroughbred racing industry. During the thirteen years examined, there was a 2–3% per year reduction in the number of races, starts and number of horses. There was a significant shift in the racing population with a greater number of fillies (aged 2–4 years) having a race start, and subsequent longer racing careers due to the inclusion of one more racing preparation post 2008 (p < 0.05). Additionally, there was an increasingly ageing population of racehorses. These changes resulted in more race starts in a career, but possibly because of biological constraints, there was no change in the number of race starts per season, starts per preparation, or days spelling between preparations (p < 0.05). There was no change in the proportion of horses having just one race start (14% of new entrants), indicating that the screening for suitability for a racing career remained consistent. These data identify key industry parameters which provide a basis for future modelling of intervention strategies to improve economic performance and reduce horse injury. Consideration of the racing industry as a bio-economic or ecological model provides framework to test how the industry may respond to intervention strategies and signal where changes in system dynamics may alter existing risk factors for injury