Non-Clinical Benefits of Evidence - Based Veterinary Medicine

<div><strong>Clinical bottom line</strong></div><ul><li>There are few studies addressing business benefits of EBVM.</li><li>While the need for a wider adoption of EBVM has been highlighted and linked to commercial benefits, further empirical studies are needed to identify and quantify such linkages.</li></ul><p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /></p

The Evidence Base for Developing a Veterinary Business Management Curriculum

<p><strong>Objective: </strong>This paper sets out to highlight the ongoing need for integrated teaching of business skills in the veterinary curriculum.</p><p><strong>Background:</strong> In response to the changing environment of the veterinary profession, it is important to understand the future needs of veterinary practitioners. While changes to the veterinary curriculum have been made in recent years, they have been highly varied across schools and little evidence is available on how these have improved students’ non-technical skills, knowledge, aptitudes, and attitudes. </p><p><strong>Evidentiary value:</strong> This literature review of 23 papers provides a solid basis for the further development of knowledge on business management issues in veterinary curricula. The impact on practice from our findings is substantial. The role of clinicians in academia is recognised as a primary source of engaging students with business management through their day-to-day teaching. Furthermore, the role of first-opinion vets who take on placement students (known as extra mural studies or ‘EMS’ in the UK) cannot be underestimated as they play an essential role in ensuring that students perceive business skills with the same importance as clinical skills.</p><p><strong>Methods:</strong> This research draws on the findings of 23 papers that emerged as relevant from the structured literature search.  The search yielded 124 papers but many were excluded because they focused on issues beyond the search strategy, did not report empirical findings so were based largely on discussion and conjecture, were not about the undergraduate veterinary curriculum, were not written in English or were not related to business teaching.</p><p><strong>Results: </strong> Employers of recent graduates highly value business skills, and often base their hiring decision on non-technical skills, rather than clinical skills. While changes to the veterinary curriculum have been made to include more non-technical training by individual veterinary schools, it is unclear how effective these programmes have been.</p><p><strong>Conclusion: </strong> Veterinarians have identified a need for greater inclusion of business skills in the veterinary curriculum, however successfully integrating business skills into the curriculum will mean that students learn business principles in non-traditional, non-lecture-style environments with materials inter-twining with clinical teaching. This will mean a significant shift from traditional classroom based delivery of business lectures to an integrated approach. This can only be achieved if business and clinical teaching staff work together in delivering business education to the next generation of veterinarians. That said, the evidence regarding the importance of business within the veterinary medical curriculum, coupled with increasing competition in the market for first-opinion veterinary services, means that changes in the approach to teaching business may be easier to achieve than ever before.</p><p><strong>Application:</strong> The results of this research are applicable to practicing veterinarians in both academic and private practice. It is clear that business management needs to be integrated throughout the veterinary curriculum and thus ‘owned’ by academics with both clinical and non-clinical roles. Veterinarians in private practice also have a critical role to play as these people are the gatekeepers to the real-world experience that placement students encounter. </p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /

Discovery of VHE and HE emission from the blazar 1ES 0414+009 with H.E.S.S and Fermi-LAT

The high energy peaked BL Lac (HBL) object 1ES 0414+009 (z=0.287) is a distant very high-energy (VHE, E > 100 GeV) blazars with well-determined redshift. This source was detected with the High Energy Stereoscopic System (H.E.S.S.) between October 2005 and September 2009. It was also detected with the Fermi Large Area Telescope (LAT) in 21 months of data. The combined high energy (HE) and VHE spectra, once corrected for gamma-gamma absorption on the extragalactic background light (EBL), indicate a Compton peak located above few TeV, among the highest in the BL Lac class.Comment: proceeding from the 25th Texas Symposium on Relativistic Astrophysics (Heidelberg, Germany, 2010

Improving plantain (Musa spp. AAB) yields on smallholder farms in West and Central Africa

Plantain is an important staple in West and Central Africa, where it is predominantly grown by smallholder farmers. On-farm data are rare but yields are considered to be low. We collated actual yields in the region, reviewed regional plantain research published from 1976 to 2013, then estimated what yields would be attainable on smallholder farms if the proven, best-fit innovations were adopted. Mean actual yields reported ranged from 2.9 to 8.9 Mg ha?1 with a mean of 5.7 Mg ha?1 for False horn plantain and 4.5 to 10.2 Mg ha?1 with a mean of 7.8 Mg ha?1 for French plantain. Experiments found dealt with: cultural practices, particularly intercropping; abiotic factors such as fertiliser, mulch application and irrigation; biotic factors, predominantly sucker sanitation methods, but including three controlled yield loss studies on nematodes and black sigatoka; landrace comparisons and the introduction of improved cultivars, predominantly those exhibiting black sigatoka-tolerance. We conclude that intercropping should be retained according to farmer preference as there was no evidence of yield reductions for plantain. Boiling water treatment of suckers should be universally recommended. Inputs, whether mulch or K fertiliser up to 300 kg ha?1, should be applied as both reduced plant losses and increased bunch mass. With the highest yielding local landrace type, on-farm yields could be increased from 7.8 Mg ha?1 to 35.5 Mg ha?1 with purchased inputs or to 23.7 Mg ha?1 without purchased inputs

An exploratory study investigating the non-clinical benefits of evidence-based vetinary medicine

<p><strong>Objective: </strong>As little prior research exists about the non-clinical benefits of evidence-based veterinary medicine (EBVM), this exploratory study was conducted to identify non-clinical benefits of EBVM to veterinary practices, as well as highlighting the barriers to further implementation, and ways to overcome them.</p><p><strong>Background:</strong> A PICO-based literature review (Hauser and Jackson, 2016) was conducted to establish current knowledge about the non-clinical benefits of EBVM. It found that while there are some papers suggesting a link between the practice of EBVM and better non-clinical benefits such as client satisfaction and client retention, a single study, focusing on the non-clinical benefits of EBVM, had yet to be conducted.</p><p><strong>Evidentiary value:</strong> This exploratory study provides a solid basis for the further development of a confirmatory study of the themes identified in the interviews. The impact on practice from our findings is significant as it details the key areas where the use of EBVM can yield commercial benefits from the perspective of a group of EBVM experts via interview. It is entirely possible that international veterinary environments which mirror that of the UK will find this research beneficial.</p><p><strong>Methods: </strong>Due to the paucity of data about the non-clinical benefits of EBVM, an exploratory, qualitative approach was taken to this research in order to build a platform for further confirmatory, quantitative investigation (Zikmund, 2003). In February and March 2016 interviews with 16 RCVS Knowledge Group chairs<a name="_ftnref1" href="#_ftn1"></a>[1] were conducted. The interview guide contained broad, open-ended questions to explore existing tacit knowledge about the non-commercial benefits of EBVM. The interviews were audio recorded and transcribed <em>verbatim</em> and subsequently analysed using NVivo 11 software.</p><p><strong>Results:</strong> This qualitative enquiry showed that the key areas where the use of EBVM can yield non-clinical benefits are through increased client satisfaction and retention, improved reputation and confidence of the veterinarian,  as well as employee engagement. In order to yield these benefits the two main barriers, time and resources, need to be overcome.</p><p><strong>Conclusion: </strong>The themes highlighted in this paper provide a solid, real world base for further, quantitative study of the non-clinical benefits of practising EBVM.  </p><p><strong>Application:</strong> The results of this research are applicable to practicing veterinarians, nurses and other practice staff. It is clear that practising EBVM not only leads to better clinical outcomes, but can also result in commercial benefits, such as better client retention and employee engagement</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /

Stress effect on magnetoimpedance (MI) in amorphous wires at GHz frequencies and application to stress-tunable microwave composite materials

The effect of tensile stress on magnetoimpedance (MI) in CoMnSiB amorphous wires at microwave frequencies (0.5-3 GHz) is investigated both experimentally and theoretically. In the presence of the dc bias magnetic field of the order of the anisotropy field, the impedance shows very large and sensitive change when the wire is subjected to a tensile stress: 100% and 60% per 180 MPa for frequencies 500 MHz and 2.5 GHz, respectively. It is demonstrated that this behavior owes mainly to the directional change in the equilibrium magnetization caused by the applied stress and field, which agrees well with the theoretical results for the surface impedance. This stress effect on MI is proposed to use for creating microwave stress-tunable composite materials containing short magnetic wires. The analysis of the dielectric response from such materials shows that depending on the stress level in the material, the dispersion of the effective permittivity can be of a resonant or relaxation type with a considerable change in its values (up to 100% at 600 MPa). This media can be used for structural stress monitoring by microwave contrast imaging

Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions.

BACKGROUND:Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). OBJECTIVE:To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. METHODS:We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. RESULTS:Compared with RMS patients, PPMS patients had higher numbers of SELs (p = 0.002) and higher T2 volumes of SELs (p &lt; 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. CONCLUSION:We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS

Electromagnetic interferences from plasmas generated in meteoroids impacts

It is shown that the plasma, generated during an impact of a meteoroid with an artificial satellite, can produce electromagnetic radiation below the microwave frequency range. This interference is shown to exceed local noise sources and might disturb regular satellite operations.Comment: 6 pages, no figures. This version macthes the published versio

Anti-CD20 therapy depletes activated myelin-specific CD8+ T cells in multiple sclerosis.

CD8+ T cells are believed to play an important role in multiple sclerosis (MS), yet their role in MS pathogenesis remains poorly defined. Although myelin proteins are considered potential autoantigenic targets, prior studies of myelin-reactive CD8+ T cells in MS have relied on in vitro stimulation, thereby limiting accurate measurement of their ex vivo precursor frequencies and phenotypes. Peptide:MHC I tetramers were used to identify and validate 5 myelin CD8+ T cell epitopes, including 2 newly described determinants in humans. The validated tetramers were used to measure the ex vivo precursor frequencies and phenotypes of myelin-specific CD8+ T cells in the peripheral blood of untreated MS patients and HLA allele-matched healthy controls. In parallel, CD8+ T cell responses against immunodominant influenza epitopes were also measured. There were no differences in ex vivo frequencies of tetramer-positive myelin-specific CD8+ T cells between MS patients and control subjects. An increased proportion of myelin-specific CD8+ T cells in MS patients exhibited a memory phenotype and expressed CD20 compared to control subjects, while there were no phenotypic differences observed among influenza-specific CD8+ T cells. Longitudinal assessments were also measured in a subset of MS patients subsequently treated with anti-CD20 monoclonal antibody therapy. The proportion of memory and CD20+ CD8+ T cells specific for certain myelin but not influenza epitopes was significantly reduced following anti-CD20 treatment. This study, representing a characterization of unmanipulated myelin-reactive CD8+ T cells in MS, indicates these cells may be attractive targets in MS therapy

Chronic white matter lesion activity predicts clinical progression in primary progressive multiple sclerosis.

Chronic active and slowly expanding lesions with smouldering inflammation are neuropathological correlates of progressive multiple sclerosis pathology. T1 hypointense volume and signal intensity on T1-weighted MRI reflect brain tissue damage that may develop within newly formed acute focal inflammatory lesions or in chronic pre-existing lesions without signs of acute inflammation. Using a recently developed method to identify slowly expanding/evolving lesions in vivo from longitudinal conventional T2- and T1-weighted brain MRI scans, we measured the relative amount of chronic lesion activity as measured by change in T1 volume and intensity within slowly expanding/evolving lesions and non-slowly expanding/evolving lesion areas of baseline pre-existing T2 lesions, and assessed the effect of ocrelizumab on this outcome in patients with primary progressive multiple sclerosis participating in the phase III, randomized, placebo-controlled, double-blind ORATORIO study (n = 732, NCT01194570). We also assessed the predictive value of T1-weighted measures of chronic lesion activity for clinical multiple sclerosis progression as reflected by a composite disability measure including the Expanded Disability Status Scale, Timed 25-Foot Walk and 9-Hole Peg Test. We observed in this clinical trial population that most of total brain non-enhancing T1 hypointense lesion volume accumulation was derived from chronic lesion activity within pre-existing T2 lesions rather than new T2 lesion formation. There was a larger decrease in mean normalized T1 signal intensity and greater relative accumulation of T1 hypointense volume in slowly expanding/evolving lesions compared with non-slowly expanding/evolving lesions. Chronic white matter lesion activity measured by longitudinal T1 hypointense lesion volume accumulation in slowly expanding/evolving lesions and in non-slowly expanding/evolving lesion areas of pre-existing lesions predicted subsequent composite disability progression with consistent trends on all components of the composite. In contrast, whole brain volume loss and acute lesion activity measured by longitudinal T1 hypointense lesion volume accumulation in new focal T2 lesions did not predict subsequent composite disability progression in this trial at the population level. Ocrelizumab reduced longitudinal measures of chronic lesion activity such as T1 hypointense lesion volume accumulation and mean normalized T1 signal intensity decrease both within regions of pre-existing T2 lesions identified as slowly expanding/evolving and in non-slowly expanding/evolving lesions. Using conventional brain MRI, T1-weighted intensity-based measures of chronic white matter lesion activity predict clinical progression in primary progressive multiple sclerosis and may qualify as a longitudinal in vivo neuroimaging correlate of smouldering demyelination and axonal loss in chronic active lesions due to CNS-resident inflammation and/or secondary neurodegeneration across the multiple sclerosis disease continuum