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Mitral transcatheter edge-to-edge repair (MTEER) is an established therapeutic approach for mitral regurgitation (MR). Functional mitral regurgitation originating from atrial myopathy (A-FMR) has been described.We sought to assess the clinical, echocardiographic and hemodynamic considerations in A-FMR patients undergoing MTEER.From 2014 to 2020, patients undergoing MTEER for degenerative MR (DMR), functional MR (FMR), and mixed MR were assessed. A-FMR was defined by the presence of MR moderate in severity; left ventricular (LV) ejection fraction (LVEF) ≥ 50%; and severe left atrial (LA) enlargement in the absence of LV dysfunction, leaflet pathology, or LV tethering. The diagnosis of A-FMR (vs. ventricular-FMR [V-FMR]) was confirmed by three independent echocardiographers. Baseline characteristics, procedural outcomes as well as clinical and echocardiographic follow-up are reported. Device success was defined as final MR grade ≤ moderate; MR reduction ≥1 grade; and final transmitral gradient5 mmHg.306 patients underwent MTEER, including DMR (62%), FMR (19%), and mixed MR (19%). FMR cases included 37 (63.8%) V-FMR and 21 (36.2%) A-FMR. Tricuspid regurgitation (≥ moderate) was higher in A-FMR (80.1%) compared to V-FMR (54%) and DMR (42%). Device success did not significantly differ between A-FMR and V-FMR (57% vs. 73%, p = 0.34) or DMR (57% vs. 64%, p = 1.0). The A-FMR cohort was less likely to achieve ≥3 grades of MR reduction compared to V-FMR (19% vs. 54%, p = 0.01) and DMR (19% vs. 49.7%, p = 0.01). Patients with V-FMR and DMR demonstrated significant reductions in mean left atrial pressure (LAP) and peak LA V-wave, though A-FMR did not (LAP -0.24 ± 4.9, p = 0.83; peak V-wave -1.76 ± 9.1, p = 0.39). In follow-up, echocardiographic and clinical outcomes were similar.In patients undergoing MTEER, A-FMR represents one-third of FMR cases. A-FMR demonstrates similar procedural success but blunted acute hemodynamic responses compared with DMR and V-FMR following MTEER. Dedicated studies specifically considering A-FMR are needed to discern the optimal therapeutic approaches.

OBJECTIVE To quantify the extent that professional skills topics were presented to veterinary students at US colleges and schools of veterinary medicine (ie, veterinary schools) in 2019 and compare findings with similar data collected in 1999 and 2009. SAMPLE All 30 US veterinary schools in 2019. PROCEDURES An electronic questionnaire was sent to the associate deans for academic affairs of all 30 veterinary schools in the United States during fall of 2019. Results were compared with published results of a similar survey performed in 1999 and 2009. RESULTS A 100% (30/30) response rate was achieved for 2019. A total of 173 courses on professional skills topics were reported, of which 115 (66%) were required. The most common topic was communication (79/136 [58%] courses). Overall, courses were most frequently delivered in the first 3 years of the curriculum (129/158 [82%]), with required courses most common in years 1 and 2 (79/112 [71%]). Most courses (116/150 [77%]) were assigned 1 or 2 credit hours. These results represented continuation of a substantial increase in the teaching of professional skills, compared with findings for 1999 and 2009. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested a growing commitment to the teaching of professional skills on the part of US veterinary schools and the willingness to change on the basis of the current perceived needs of their graduates. The observed increases align nicely with the emerging framework for competency-based veterinary education and its substantial focus on assessing competency in professional skills as an important outcome of veterinary medical education.

Constrictive pericarditis (CP) results in pericardial non-compliance and diastolic dysfunction. Definitive treatment is pericardiectomy, but data on CP after orthotopic heart transplantation (OHT) are limited. Accordingly, a retrospective review of 8 cases of surgically proven CP after OHT undergoing pericardiectomy was conducted. In this series, all patients were male. The median time to symptomatic CP after OHT was 1.7 years (range: 0.8-18.1 years). The echocardiographic assessment was diagnostic for CP in 3 cases (38%). Cross-sectional imaging was performed in 6 cases, revealing ≥ mild pericardial thickening in all. A total of 6 patients (75%) underwent cardiac catheterization, which revealed CP in 5 (83%). Post-pericardiectomy 30-day mortality was 13% (1 patient). The median survival after pericardiectomy was 2.3 years (range: 18 days-14.6 years) and 5-year survival was 29%. Overall, CP after OHT represents a subset of patients with CP with high morbidity and mortality, and multimodality assessment is essential for its diagnosis. Despite a relatively low surgical mortality, long-term survival is poor.

Aortic valve stenosis (AS) results in significant cardiovascular morbidity and mortality. To guide patient stratification and treatment in AS, echocardiographically defined cardiac damage classes h...

In pacemaker-dependent patients with a newly implanted cardiac device, acute lead dislodgement constitutes one of the most common causes of loss of capture and ventricular asystole. In a biventricular system, it would be expected that such a potentially catastrophic event would be prevented with back-up right ventricular pacing unless both leads dislodge.

Objectives The aim of this study was to demonstrate the physiologic effects of percutaneous mitral paravalvular leak (PVL) closure through pre- and post-closure left and right heart catheterization. Background Mitral PVL represents a significant source of morbidity and mortality following mitral valve repair and replacement. Although percutaneous PVL closure is an effective treatment with improvements in symptoms and mortality, data regarding the acute hemodynamic effects of such closure are lacking. Methods Consecutive patients with clinically significant heart failure and/or hemolysis attributed to mitral PVL underwent percutaneous mitral PVL closure with pre- and post-procedural right and left heart catheterization. Hemodynamic measurements of cardiovascular function obtained in this manner were compared and stratified according to pre- and post-procedural echocardiographic severity of PVL. Results Twenty-four patients (age 68 ± 9.4 years, 75% male) underwent percutaneous mitral PVL closure. Significant improvements were found in left atrial pressure (LAP) (mean LAP lowered from 21 ± 4 to 19 ± 3 mm Hg, P = 0.005), pulmonary artery pressure (PAP) (mean PAP lowered from 36 ± 11 to 33 ± 9, P = 0.04), and cardiac index (increased from 2.8 ± 0.8 to 3.0 ± 0.7 L/min/m2, P = 0.01). Left atrial v-wave reduction of 20% was associated with ≤ mild residual PVL by transesophageal echocardiography (P = 0.09). Conclusions Percutaneous mitral PVL closure is associated with significant reductions in LAP and PAP and an increase in cardiac index. These hemodynamic effects underlie the clinical benefits of PVL closure and may be a useful tool for intraprocedural guidance. © 2017 Wiley Periodicals, Inc.

Mitral valvulopathy presents as regurgitation, stenosis, or mixed disease and can occur in both native and prosthetic valves. Such disease develops in conjunction with pathophysiologic changes in the left atrium (LA) and drives changes in LA compliance, pressure, and thus clinical syndromes. With advances in the understanding and treatment of structural heart disease and in the setting of higher-risk patient populations, less-invasive transcatheter approaches have become increasingly commonplace in the treatment of mitral valve disease. Over time, transcatheter mitral valve interventions have evolved to include paravalvular leak closure, mitral valve repair, and mitral valve replacement. Parallel to this evolution, advances in invasive intracardiac pressure monitoring, particularly at the level of the LA, have also occurred. These advances emphasize the unique interplay between mitral valve disease and LA function; account for limitations of noninvasive assessment; and guide beneficial outcomes in each area of transcatheter mitral valve intervention. As a result, continuous transseptal LA pressure monitoring has developed into an indispensable instrument in successful percutaneous mitral valve intervention, complementing traditional noninvasive assessment.

OBJECTIVE To understand the clinical and hemodynamic response of patients with stenotic versus regurgitant prosthetic mitral valve degeneration to transseptal transcatheter mitral valve-in-ring/-valve replacement (TMVR). BACKGROUND Patients with prosthetic mitral valve repair/replacement failure frequently present high-risk surgical challenges. TMVR has been employed as an alternative to surgery. METHODS Forty-four patients with stenotic/regurgitant degeneration of prior prosthetic mitral annuloplasty and replacement (38) underwent mitral TMVR. Clinical, echocardiographic, and invasive hemodynamic monitoring was conducted at baseline and follow-up. RESULTS Relative to patients with regurgitant degeneration (28), patients with stenotic degeneration had baseline higher mitral valve gradients (12 ± 4 vs. 7 ± 3 mmHg, p

Silicon oxycarbide glass has been investigated as a potential immobilisation medium for irradiated graphite waste from nuclear power generation. The glass was synthesised via sol-gel techniques using alkoxysilane precursors. Attempts to produce a wasteform via conventional sintering were unsuccessful, but dense wasteforms were achieved by spark plasma sintering (SPS). Microstructural investigations showed that the addition of graphite to the glass did not alter the structure of the matrix; no reaction between the graphite and the glass matrix was observed. Silicon oxycarbide glass is a viable candidate for encapsulation of graphite waste prior to disposal.

Veterinary medical school challenges students academically and personally, and some students report depression and anxiety at rates higher than the general population and other medical students. This study describes changes in veterinary medical student self-esteem (SE) over four years of professional education, attending to differences between high and low SE students and the characteristics specific to low SE veterinary medical students. The study population was students enrolled at the Michigan State University College of Veterinary Medicine from 2006 to 2012. We used data from the annual anonymous survey administered college-wide that is used to monitor the curriculum and learning environment. The survey asked respondents to rate their knowledge and skill development, learning environment, perceptions of stress, skill development, and SE. Participants also provided information on their academic performance and demographics. A contrasting groups design was used: high and low SE students were compared using logistic regression to identify factors associated with low SE. A total of 1,653 respondents met inclusion criteria: 789 low SE and 864 high SE students. The proportion of high and low SE students varied over time, with the greatest proportion of low SE students during the second-year of the program. Perceived stress was associated with low SE, whereas perceived supportive learning environment and skill development were associated with high SE. These data have provided impetus for curricular and learning environment changes to enhance student support. They also provide guidance for additional research to better understand various student academic trajectories and their implications for success.

The fiscal environment for academic veterinary medicine has changed substantially over the past 50 years. Understanding the flux of state and federal government support and the implications for student debt, academic programs, and scholarly work is critical for planning for the future. The recent precipitous decline in public funding highlights the urgent need to develop and maintain an economically sustainable model that can adapt to the changing landscape and serve societal needs.

OBJECTIVES To measure the intraprocedural change in left atrial pressure (LAP) with saline administration during transcatheter mitral valve repair (TMVR). BACKGROUND TMVR with MitraClip offers an alternative to surgery in select patients. During this procedure, large volumes of fluid are routinely administered with anesthesia and to facilitate transcatheter valve repair. LAP, a measure used to guide repair, may thereby change as a result of volume expansion, suggesting a need for continuous intracardiac pressure monitoring. METHODS Consecutive patients with severe mitral regurgitation underwent TMVR with MitraClip and continuous LAP monitoring through a dedicated sampling catheter. Specific LAP values were acquired immediately after transseptal access; before first clip deployment; and after deployment of the last clip. RESULTS 151 patients (age 80 ± 8 years, 64% male) underwent TMVR with MitraClip and continuous LAP monitoring. Mean LAP and v-wave pressure increased significantly from baseline to pre-MitraClip deployment (P

Cardiac ischemia-reperfusion (I-R) injury remains a significant problem as there are no therapies available to minimize the cell death that can lead to impaired function and heart failure. We have shown that high-molecular-weight polyethylene glycol (PEG) (15-20 kD) can protect cardiac myocytes in vitro from hypoxia-reoxygenation injury. In this study, we investigated the potential protective effects of PEG in vivo.Adult rats underwent left anterior descending artery occlusion for 60 minutes followed by 48 hours or 4 weeks of reperfusion. One milliliter of 10% PEG solution or phosphate-buffered saline (PBS) control (n = 10 per group) was administered intravenously (IV) immediately before reperfusion.Fluorescein-labeled PEG was robustly visualized in the myocardium 1 hour after IV delivery. The PEG group had significant recovery of left ventricular ejection fraction at 4 weeks versus a 25% decline in the PBS group (P.01). There was 50% less LV fibrosis in the PEG group versus PBS with smaller peri-infarct and remote territory fibrosis (P.01). Cell survival signaling was upregulated in the PEG group with increased Akt (3-fold, P.01) and ERK (4-fold, P.05) phosphorylation compared to PBS controls at 48 hours. PEG also inhibited apoptosis as measured by TUNEL-positive nuclei (56% decrease, P.02) and caspase 3 activity (55% decrease, P.05).High-molecular-weight PEG appears to have a significant protective effect from I-R injury in the heart when administered IV immediately before reperfusion. This may have important clinical translation in the setting of acute coronary revascularization and myocardial protection in cardiac surgery.

Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown.The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF.Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside.Forty-one subjects (25 with low flow [LF], stroke volume index [SVI] ≤35 ml/mNitroprusside reduces afterload and left ventricular filling pressures in patients with LGSAS and preserved EF, enabling reclassification to moderate stenosis in 25% of patients. An inverse relationship between baseline SVI and change in SVI with afterload reduction was observed, suggesting that heightened sensitivity to afterload is a significant contributor to LF-LGSAS pathophysiology. These data highlight the utility of afterload reduction in the diagnostic assessment of LGSAS.

Veterinary technology has generally established itself well in companion-animal and mixed-animal veterinary medical practice, but the career's growth trajectory is uncertain. Michigan State University (MSU) convened a national conference, “Creating the Future of Veterinary Technology—A National Dialogue,” in November 2011 to explore ways to elevate the veterinary technician/technologist's role in the veterinary medical profession and to identify new directions in which the career could expand. Veterinary technicians/technologists might advance their place in private practice by not only improving their clinical skills, but by also focusing on areas such as practice management, leadership training, business training, conflict resolution, information technology, and marketing/communications. Some new employment settings for veterinary technicians/technologists include more participation within laboratory animal medicine and research, the rural farm industry, regulatory medicine, and shelter medicine. Achieving these ends would call for new training options beyond the current 2-year and 4-year degree programs. Participants suggested specialty training programs, hybrid programs of various types, online programs, veterinary technician residency programs of 12–18 months, and more integration of veterinary technician/technology students and veterinary medicine students at colleges of veterinary medicine.

The aim of this study was to demonstrate the physiologic effects of percutaneous mitral paravalvular leak (PVL) closure through pre- and post-closure left and right heart catheterization.Mitral PVL represents a significant source of morbidity and mortality following mitral valve repair and replacement. Although percutaneous PVL closure is an effective treatment with improvements in symptoms and mortality, data regarding the acute hemodynamic effects of such closure are lacking.Consecutive patients with clinically significant heart failure and/or hemolysis attributed to mitral PVL underwent percutaneous mitral PVL closure with pre- and post-procedural right and left heart catheterization. Hemodynamic measurements of cardiovascular function obtained in this manner were compared and stratified according to pre- and post-procedural echocardiographic severity of PVL.Twenty-four patients (age 68 ± 9.4 years, 75% male) underwent percutaneous mitral PVL closure. Significant improvements were found in left atrial pressure (LAP) (mean LAP lowered from 21 ± 4 to 19 ± 3 mm Hg, P = 0.005), pulmonary artery pressure (PAP) (mean PAP lowered from 36 ± 11 to 33 ± 9, P = 0.04), and cardiac index (increased from 2.8 ± 0.8 to 3.0 ± 0.7 L/min/mPercutaneous mitral PVL closure is associated with significant reductions in LAP and PAP and an increase in cardiac index. These hemodynamic effects underlie the clinical benefits of PVL closure and may be a useful tool for intraprocedural guidance. © 2017 Wiley Periodicals, Inc.

The purposes of this Association of American Veterinary Medical Colleges (AAVMC) study was to develop a profile of deans to understand the knowledge, skills, and attitudes that current deans of schools and colleges of veterinary medicine consider important to job success and to inform the association's leadership development initiatives. Forty-two deans responded to an online leadership program needs survey, which found that knowledge, skills, and abilities related to communication, finance and budget management, negotiation, conflict management, public relations, and fundraising were recommended as the most important areas for fulfilling a deanship. Most respondents speculated that the greatest challenges for their institutions will be in the areas of faculty recruitment and retention and financing veterinary education. Reflecting on their experiences, respondents offered an abundance of advice to future deans, often citing the importance of preparation, communication, and leadership qualities as necessary for a successful and satisfying deanship. More than three-quarters of the respondents indicated moderate to high interest in an AAVMC multi-phase leadership training program to develop administrative leaders. A nearly equal number also indicated support for formal leadership training for current veterinary medical college and school deans. The study suggests leadership development topics that AAVMC could provide at existing meetings or through new programming. The study also suggests directions for individual institutions as they seek to implement leadership development activities at the local level.

Our purpose in this study was to determine professional development needs of faculty in the Association of American Veterinary Medical Colleges' (AAVMC's) member institutions, including those needs associated with current and emerging issues and leadership development. The survey asked respondents to report their level of job satisfaction and their perceptions of professional development as they related to support and resources, teaching, research, career planning, and administration. Five hundred and sixty-five individuals from 49 member institutions responded to an online professional development needs survey. We found that job satisfaction was associated with a variety of workplace variables correlated with academic rank, with those of higher academic rank expressing greater levels of satisfaction. Respondents with tenure also expressed generally higher levels of satisfaction. Most of the respondents expressed interest in learning more about topics related to teaching (e.g., effective questioning, giving feedback, principles of learning and motivation), research (e.g., research design, writing grants), career planning (e.g., mentoring, time management), and administration (e.g., fostering innovation, enhancing productivity, improving the work environment). Just more than half of the respondents indicated moderate to high interest in an AAVMC multi-phase leadership training program. The study suggests topics for which AAVMC should provide professional development opportunities either at existing meetings or through new programming. The study also suggests directions for individual institutions as they seek to implement professional development activities at the local level.

Objective—To compare present values of expected income streams for 5 distinct veterinary medical career tracks. Design—Present value model. Sample Population—AVMA survey data. Procedures—Present values of expected income streams (net of debt repayment) were created and ranked. Sensitivity to each independent variable was assessed. Results—Career present value at 34 years after graduation (CPV34) was highest for board-certified specialist (SP; $2,272,877), followed by practice owner (PO; $2,119,596), practice owner buying into practice after 10 years (PO-10; $1,736,333), SP working three-fouths time (SP3/4; $1,702,744), and general practitioner (GP; $1,221,131). Compared with CPV34 for SP, other career tracks yielded values of 93.3% (PO), 76.4% (PO-10), 74.9% (SP3/4), and 53.7% (GP). The model was robust to debt, interest rate, loan term, and discount rate but was sensitive to mean starting incomes and mean incomes. Conclusions and Clinical Relevance—Greatest return on time and money invested by a veterinary student is through practicing full-time as an SP or through being a PO. Being an SP or SP3/4 was substantially more lucrative than being a GP and was comparable to being a PO. Practice ownership and working as an SP3/4 may be options for balancing financial gain with free time. Specialty training and practice ownership may be career tracks with the best potential repayment options for veterinarians with a large educational debt. Regardless of the amount of debt, the type of practice, mean incomes in a particular field, personal lifestyle, and professional interests are important factors when deciding among career tracks.

Objective—To evaluate US consumer expenditures for veterinary services, pets-pet supplies, and pet-related services. Design—Retrospective economic analysis. Sample Population—US consumers from 1980 through 2005. Procedures—Descriptive statistics and probit regressions were calculated. Results—From 1980 to 2005, total inflation-adjusted expenditures on pet-related and veterinary services increased, as did the percentage of households with a pet-related expenditure. The percentage of households with veterinary service expenditures was fairly constant. Among households with a pet-related expenditure, the percentage purchasing veterinary services decreased. The probability for pet-related and veterinary service expenditures increased with income, education, and family size and was higher for household heads who were white, were married, owned their residence, and lived in a rural area. Conclusions and Clinical Relevance—Overall spending on veterinary services increased substantially, providing no indication that successful practices should change strategy. Households that spent money on veterinary services increased their spending sufficiently to exceed the loss of income for veterinarians associated with the increasing proportion of pet-owning households that did not spend anything on veterinary services. Because the probability of veterinary service expenditures was strongly related to household income, caution is suggested in planning provision of veterinary services when incomes are constrained. Among households with pet-related expenditures, the decreasing percentage of households with veterinary service expenditures suggests a growing proportion of pet owners who are not having their veterinary service needs met. Because non-white households were less likely to purchase veterinary services, the veterinary profession cannot afford to delay efforts to enhance diversity and cultural competence.

The current environment in higher education calls for increasingly progressive leadership and management. This report describes the efforts of the College of Veterinary Medicine (CVM) at Michigan State University (MSU) to strengthen its leadership using a whole-system approach. Developing a leadership culture is the responsibility of leaders, and the pursuit of such a culture requires considerable and justifiable investment of time, energy, and resources. The volatile and changing environment in which colleges of veterinary medicine exist makes creating such a culture imperative if society's needs are to be successfully met. Noteworthy cultural change has occurred within the MSU CVM because of the efforts described here.

Veterinary teaching hospitals (VTHs) are facing more and greater challenges than at any time in the past. Changes in demand, expanding information, improving technology, an evolving workforce, declining state support, and an increasingly diverse consumer base have combined to render many traditional VTH modes of operation obsolete. In pursuit of continued success in achieving their academic mission, VTHs are exploring new business models, including innovative collaborations with the private sector. This report provides details on existing models for public–private collaboration at several colleges and schools of veterinary medicine, including those at Kansas State University, Purdue University, the University of Florida, and Tufts University. Although each of these institutions’ models is unique, several commonalities exist, related to expansion of the case load available for teaching, the potential positive impact on recruitment and retention of clinical faculty, and the potential for easing financial pressures on the associated VTH. These new models represent innovative approaches that work to meet many of the key emerging challenges facing VTHs today.

JAVMA, Vol 230, No. 11, June 1, 2007 T National Commission on Veterinary Economic Issues (NCVEI) was formed in 2000 by the AVMA, the American Animal Hospital Association (AAHA), and the Association of American Veterinary Medical Colleges (AAVMC) in response to the findings of the 1999 KPMG study of which the executive summary (The current and future market for veterinarians and veterinary medical services in the United States) was published in 1999. As one approach to improving the economic health of the veterinary profession, the NCVEI formed a working group to enhance the nontechnical skills, knowledge, aptitudes, and attitudes (SKAs) of veterinarians. This action was taken as a result of increasing evidence that many veterinarians, although clinically competent, may lack some of the crucial SKAs that typically are correlated with, and could be essential for, their professional success. One key source of this evidence was the KPMG study itself, which suggested directly that a weakness in SKAs was a problem facing the veterinary medical profession. In addition, the KPMG study identified other key issues of economic importance to veterinary medicine, some of which have been attributed indirectly to a lack of critical SKAs. A separate study, contemporary with the KPMG study, identified similar issues related to the nontechnical skills and attributes of veterinarians. It has been several years since the KPMG study was published. A considerable amount of discussion and work has been completed in the interim, and much has been accomplished. As one of the three agencies that sponsored the KPMG study and initiated the NCVEI, the AAVMC has been actively engaged in a number of efforts to enhance the SKAs. The objectives of this commentary are to provide an overview of the SKAs-related work coordinated through the NCVEI and to suggest future directions for such work. Enhancing nontechnical skills, knowledge, aptitudes, and attitudes in the veterinary profession through the work of the National Commission on Veterinary Economic Issues

The objective of this study was to empirically determine the economic value of genetic information in the selection of dairy replacements, and assess whether this value was sufficient to prompt producers to select replacements on this basis. The data set consisted of 1982 Michigan Holstein replacements in 115 herds. Each herd had a minimum of 10 replacements that were born in the last 6 months of 1992 and calved within the last 6 months of 1994. The data for each replacement included the estimated breeding value (EBV) for milk at the beginning and end of the rearing period, and the estimated lifetime profit corrected for the opportunity cost of postponed replacement (ELPCOC). The replacement selection decision for a profit-maximizing dairy producer selecting 70 or 80% of the replacements was modeled. We modeled three methods of selection: genetic, random and ex poste. Genetic selection was evaluated using the EBV milk available at the beginning or end of the rearing period. For each herd, the profit associated with each of the three methods of selection was simulated. The value of the genetic information and perfect information were the differences in herd profits of genetic selection and ex poste selection relative to random selection, respectively. The difference in value of the genetic information between the end of the rearing period and the beginning of the rearing period was the increase in value of the genetic information due to updating. The value of information was calculated as the average herd profit per replacement. The value of the genetic information ranged from 22 dollars/replacement to 30 dollars/replacement and was statistically greater than zero at a 95% confidence level. It is unclear whether this value is sufficient to prompt producers to select replacements on the basis of EBV milk as has been recommended. The negative value of EBV milk (from the end of the rearing period when selecting 80% of the replacements) for 32 herds was consistent with the noisiness of the genetic estimates as messages of ELPCOC. The increased value of the genetic information due to updating was approximately 5 dollars/replacement. This increased value is likely insufficient to warrant delaying replacement selection decisions solely to obtain the updated information. The value of EBV milk was approximately 4 dollars/replacement higher when selecting 70% of the replacements versus 80%. The genetic information captured between 15% (selecting 70% at the beginning of the rearing period) and 20% (selecting 80% at the end of the rearing period) of the value of perfect information.

Three projects recently funded by the American Veterinary Medical Association (AVMA) through the National Commission on Veterinary Economic Issues (NCVEI) focused on the veterinary school applicant pool, leadership skills in the veterinary profession, and a veterinary teaching hospital business model, respectively. The Skills, Knowledge, Aptitude, and Attitude (SKAs) Colloquium was designed to present the results of these three projects, to discuss their importance for the future of the veterinary profession, and to develop action plans accordingly. In all, 24 veterinary colleges were represented at the workshop and a total of 72 attendees participated, achieving a broad representation of the veterinary profession (both academic and non-academic). Through an orchestrated combination of general sessions and facilitated small group discussions, recommendations for implementation and initial action plans for next steps were developed. From these, a list of potential AAVMC follow-up activities was developed, including advocating and facilitating programs across schools to engage and educate faculty regarding the results of these projects; developing realistic information on careers in veterinary medicine; organizing an AAVMC leadership consortium; working toward further development and implementation of the veterinary teaching hospital (VTH) business model; coordinating and sponsoring a national forum on the future of the VTH; reviewing admissions processes; integrating leadership into veterinary curricula; and organizing opportunities for faculty development in leadership.

Published in 2002, the “Template for a Recommended Curriculum in ‘Veterinary Professional Development and Career Success’” compiled a comprehensive list of recommended topics to develop an effective complement of nontechnical skills, knowledge, aptitudes, and attitudes (SKAs) in veterinary students.1 Authors of the curriculum recognized that developing an effective delivery system for the suggested material would likely present a challenge and formulated a set of recommendations to help achieve that end. These included collaborating with the National Commission on Veterinary Economic Issues (NCVEI) to achieve visibility and broad-based support across the veterinary profession; seeking support from private practitioners and academic administrators in Association of American Veterinary Medical Colleges (AAVMC) member institutions; developing liaison with the Association of Veterinary Practice Management Consultants and Advisors (AVPMCA) to garner both their input and support; and coordinating meetings to help fine-tune the recommended curriculum and to work together on overcoming implementation constraints. To that end, a workshop was conducted on July 19, 2003, for veterinary college administrators, educators, and practice management consultants. The workshop had two objectives: (1) demonstrating educational methods that have been successfully used for teaching in the arena of career development and practice management and (2) developing a professional network to facilitate communication and collaboration toward effective teaching and learning. Sponsored by the NCVEI Working Group on SKAs (with additional financial support from Hill’s Pet Nutrition, Inc.), the program included presentations from several individuals on methods being used to successfully teach career development and practice management by their respective institutions. Each presentation was allocated 15 to 20 minutes, followed by five to 10 minutes of discussion. Summaries of several of these presentations follow.

A workshop was designed to (1) present results of the Core Competencies for Veterinary Medicine project conducted by Personnel Decisions International (PDI); (2) discuss and analyze the implications of the PDI study results for academia, private practice, and industry; (3) identify actionable items—discuss opportunities and barriers; and (4) develop appropriate recommendations—devise specific actions for implementation as next steps. In total, 25 veterinary colleges were represented at the workshop and a total of 110 attendees participated, achieving a broad cross-section of the veterinary profession (both academic and non-academic). Through an orchestrated combination of general sessions and facilitated, small group discussions, prioritized recommendations for implementation and initial action plans for next steps were developed. Recommendations included publicizing results of the PDI study, reconsidering current admissions policies and processes, evaluating the applicant pool and current recruitment programs, developing structured mentoring programs, enhancing DVM/VMD training programs, coordinating the development of continuing education programs, and overcoming existing barriers to change. Next steps should involve collaborative efforts across all sectors of the veterinary profession to develop plans for implementing the workshop’s recommendations. Leadership for follow-up might reasonably come from the Association of American Veterinary Medical Colleges (AAVMC), the American Veterinary Medical Association (AVMA), and the American Animal Hospital Association (AAHA), either individually or collectively through the National Commission on Veterinary Economic Issues (NCVEI). Partnerships with industry are also possible and should be strongly considered.

Recent studies of the veterinary profession have established a need for training in various areas beyond those directed toward building competence and proficiency as a clinician. To address this need, a workshop was designed whose objective was to develop a detailed outline of a model curriculum that would encompass the skills, knowledge, aptitudes, and attitudes deemed essential for economic success in the veterinary profession. The model curriculum was created from comprehensive input provided by consultants and educators. Constraints for implementation of this curriculum are identified, and future directions are discussed.

Objective—To determine the likelihood of false-positive results when testing milk samples from individual cows by use of 3 commercially available assays (Penzyme Milk Test and the SNAP β-lactamand Delvo- SP assays) labeled for use with commingled milk. Sample Population—Milk samples from 111 cows with mild clinical mastitis. Procedure—Cows were randomly assigned to the control (no antimicrobials) or intramammary treatment group. Posttreatment milk samples were collected at the first milking after the labeled withholding period or an equivalent time for controls, randomly ordered, and tested twice by use of each assay and once by use of high-performance liquid chromatography. Sensitivity, specificity, and positive and negative predictive values were determined for each assay. Concordance of results for the same sample was assessed for each assay by calculating κ. Results—Sensitivities of the Delvo-SP and SNAP β-lactam assays were > 90%, whereas the sensitivity of the Penzyme Milk Test was 60%. Positive predictive values (range, 39.29 to 73.68%) were poor for all 3 assays. Concordance of test results was excellent for the SNAP β-lactam and Delvo-SP assays (κ = 0.846 and 0.813, respectively) but was less for the Penzyme Milk Test (κ = 0.545). Conclusions and Clinical Relevance—Because of the low positive predictive values, these 3 assays may not be useful for detecting violative antimicrobial residues in individual milk samples from cows treated for mild clinical mastitis. However, repeatability of each assay was considered good to excellent. (Am J Vet Res 2001;62:1716–1720)

Objective—To compare endoscopic findings of the upper portion of the respiratory tract in Thoroughbred yearlings with their subsequent race records to determine whether subjective assessment of airway function may be used as a predictor of future racing performance. Design—Retrospective study. Animals—427 Thoroughbred yearlings. Procedures—Endoscopic examination findings were obtained from the medical records and the videoendoscopic repository of the Keeneland 1996 September yearling sales. Racing records were requested for the yearlings through the end of their 4-year-old racing season (1997–2000). Twenty-nine measures of racing performance were correlated with endoscopic findings. Subjective arytenoid cartilage movement grades were determined, using a 4-point grading scale (grade 1 = symmetrical synchronous abduction of the arytenoid cartilages; grade 4 = no substantial movement of the left arytenoid cartilage). Results—Of the 427 Thoroughbred yearlings included in this study, 364 established race records, and 63 did not. Opinions regarding suitability for purchase, meeting conditions of the sale, and the presence of epiglottic abnormalities had no significant association with racing performance. Arytenoid cartilage movement grades were significantly associated with many of the dependent variables. However, palatine abnormalities were not predictive of inferior racing performance. Conclusions and Clinical Relevance—Thoroughbred yearlings with grade-1 and -2 arytenoid cartilage movements had significantly better racing performance as adults, compared with yearlings with grade- 3 arytenoid cartilage movements. In contrast, epiglottic and palatine abnormalities were not predictive of inferior racing performance. Therefore, evaluation of laryngeal function, but not epiglottic or palatine abnormalities, using the 4-point grading system, should be the major factor in developing recommendations for prospective buyers. (J Am Vet Med Assoc 2001;219: xxx–xxx)

Most veterinary students enrolled at AAVMC member institutions take at least 1 VPM course prior to graduation. These courses are characterized by widespread involvement of outside lecturers with business expertise, which likely adds to their strength. However, it remains that wide variation in VPM education exists across the AAVMC with regard to the topics addressed, the specific business expertise of faculty and administrative course specifics. As such, the situation provides several key opportunities. Foremost among these is the immediate need for profession-wide discourse on VPM education to define reasonable expectations with regard to the business skills of veterinary graduates. In addition, outcomes assessment would provide information on which of the widely varying approaches to VPM education is most likely to produce successful graduates. The opportunity also exists for development of academic research programs to support VPM education directly by strengthening the related disciplinary knowledge base. Effective leadership for these efforts will be crucial to their success.

A study was conducted to assess veterinary practice management (VPM) educational and research needs from the perspective of consultants and teachers. An online focus group discussion was designed, involving two separate groups (consultants and teachers). One week was allocated to each group, with five to eight questions posed per day. Pseudonyms were used to provide confidentiality. Teachers were selected by inviting the primary VPM course coordinator at each AAVMC school. Consultants required at least two recommendations and were selected in a stratified, non-random manner to achieve both geographic and disciplinary diversity. Participation was stronger within the consultant group: 98 pages of data were generated by the consultants and 35 pages by teachers. Participants agreed that the sub optimal economic conditions that characterize the veterinary profession are reflective of relatively low level management skills. This situation establishes the need to strengthen VPM educational and research programs. Many specific suggestions were provided. It was recommended that a cooperative effort between academia and the private sector be employed. However, participants recognized that successful DVM education programs in VPM will be difficult to achieve and sustain without strong support from college administrators and faculties.

A prospective cohort study design was used to evaluate the impact of subclinical Mycobacterium paratuberculosis infection on days open in a sample of Michigan dairy herds with a history of cows positive for M. paratuberculosis diagnosed by fecal culture. Participating herds were tested and productivity and reproduction records were monitored for 18 months. All cows > or = 24 months old were tested for M. paratuberculosis infection using the ELISA and radiometric fecal-culture (RFC) techniques. Test-negative cows were re-tested at the conclusion of the monitoring period. Multivariable regression models were used. Using both tests in parallel, the overall sample apparent prevalence for M. paratuberculosis infection was 41.8% (223/533 animals tested). Adjusting for diagnostic sensitivity and specificity, this resulted in a calculated sample true prevalence of 59.9%. ELISA-positive cows (on average) had a 28-day increase in days open when compared to ELISA-negative cows (p=0.02). The diagnostic method used to define a case altered the apparent association between paratuberculosis test status and days open. Fecal culture was a less-effective diagnostic tool for use in herds with a high prevalence of infected animals. The increase in days open in the ELISA-positive cows was an indication that perhaps reduced estrus expression or an increased post-partum anestrous period occurred in the subclinically infected ELISA-positive animals. This might have been due to a negative energy balance associated with M. paratuberculosis infection.

Objective—To test the hypothesis that dairy farms certified in the Milk and Dairy Beef Quality Assurance Program (QAP) were more likely to use prudent drug management practices than farms that were not certified. Design—Cross-sectional study. Sample Population—141 Michigan dairy farms of which 74 were not certified in the QAP, 30 were involuntarily certified, and 37 were voluntarily certified. Procedure—Dairy producers completed a self-administered questionnaire that focused on herd health management, drug use, record keeping, personnel management, and descriptive characteristics of their farm during 1993. Separate multivariable logistic regression models were developed to determine the association of QAP certification with each of the management practices. Results—Results suggested that farms adopted specific management practices irrespective of certification. Many farms used visible identification and nonemergency veterinary services and discussed residue prevention with employees. Involuntary certification was associated with maintenance of good written treatment records and performance of on-farm drug residue testing. Voluntary certification was weakly associated with use of refrigerated drug storage. Conclusions and Clinical Relevance—QAP certification appeared to have been associated with the adoption of only a few prudent drug use practices, although QAP materials and framework were developed to assist veterinarians in the promotion of disease prevention, client communication, and residue prevention practices on farms. Veterinary care would benefit from the development and encouragement of better record keeping on farms. (J Am Vet Med Assoc 2000;216:1960–1964)

A study was designed to model the fluctuations of nine specific element concentrations in mammary secretions from periparturient mares over time. During the 1992 foaling season, serial samples of mammary secretions were collected from all 18 pregnant Arabian mares at the Michigan State University equine teaching and research center. Non-linear regression techniques were used to model the relationship between element concentration in mammary secretions and days from foaling (which connected two separate sigmoid curves with a spline function); indicator variables were included for mare and mare parity. Element concentrations in mammary secretions varied significantly during the periparturient period in mares. Both time trends and individual variability explained a significant portion of the variation in these element concentrations. Multiparous mares had lower concentrations of K and Zn, but higher concentrations of Na. Substantial serial and spatial correlation were detected in spite of modeling efforts to avoid the problem. As a result, p-values obtained for parameter estimates were likely biased toward zero. Nonetheless, results of this analysis indicate that monitoring changes in mammary-secretion element concentrations might reasonably be used as a predictor of impending parturition in the mare. In addition, these results suggest that element concentrations warrant attention in the development of neonatal milk-replacement therapies. This study demonstrates that non-linear regression can be used successfully to model time-series data in animal-health management. This approach should be considered by investigators facing similar analytical challenges.

The objective of this study was to test the association between parents’ predicted transmitting abilities (PTAs) for milk, fat and protein and subsequent culling of heifers during rearing or first lactation. The data from 1992 to 1996 consisted of the culling outcome of 5619 Michigan Holstein heifers during rearing or first lactation, and the heifers’ parents’ PTAs from the period in which the heifers were born. Fixed-effect probit models (both dichotomous and ordered) estimated the relationships between culling and parents’ PTAs. Herd effect was modeled as a fixed-effect. There was no association between PTAs of milk, fat, and protein for each heifer’s parents and subsequent culling of the heifer during rearing or first lactation. Weak evidence for the necessity of modeling the herd effect as fixed was present. The lack of association between parents’ PTAs and reason-specific culling (voluntary versus involuntary) — coupled with the counter-intuitive effects of parents’ PTAs on the probability of being culled for each of the reasons — raised questions about the utility of classifying culling reasons according to the voluntary nature of the culling decision. We concluded that Michigan producers are not using parents’ genetics in heifer-culling decisions.

A retrospective cohort study was designed to determine differences in profitability, asset efficiency, operating efficiency, and labor efficiency between Michigan dairy farms implementing management-intensive grazing (MIG) and conventionally managed dairy farms. Financial information and labor use data for the calendar year 1994 were collected with surveys and personal interviews from 35 MIGdairies and 18 conventionally managed dairies. Because the geographic distribution of MIG and conventionally managed farms in this study did not include Michigan's "dairy belt," extrapolation of these results to an average Michigan or Midwest dairy should be made with care. Within the areas represented, however, multivariate linear regression indicated that MIG dairies had more economic profit than conventionally managed dairies. They captured this profit by being more efficient in asset use, operating practices, and labor use. These results suggest that MIG could provide a sustainable alternate management tool for portions of Michigan's dairy industry.

A clinical trial was performed to determine the effect of bST on reproductive performance in dairy cows on 4 Michigan dairy farms when bST was used according to labeled directions. Holstein cows (n = 555) at 4 Michigan dairy farms were randomly assigned to receive bovine somatotropin (bST) or to serve as untreated controls. Bovine somatotropin (500 mg, SC) was administered every 14 d beginning at 63 to 69 d of lactation and continuing until approximately 21 d prior to the end of lactation or until the producer removed the animal from the herd. A total of 229 (42.57%) animals consisting of 112 (48.91 %) controls and 117 (51.09%) bST-treated cows were not diagnosed pregnant and were considered as having reproductive failure by 150 d of lactation and 92 (17.10%) of the animals consisting of 45 (48.91%) controls and 47 (51.09%) bST-treated cows had reproductive failure at the end of their lactation. No significant difference in the incidence of reproductive failure existed between the study treatment groups during either time frame. Cows with cystic ovarian disease had more instances of reproductive failure at 150 d of lactation than cows without this disease. Cows with dystocia, twin births, metritis, displaced abomasum and cystic ovarian disease had more instances of reproductive failure by the end of lactation than cows without these diseases. The bST-treated cows developed more nonspecific off feed conditions during the study lactation and had more twin births at the calving following bST administration compared to control cows. No differences were found between the study treatment groups in calculations of reproductive parameters. Logistic regression analysis found no significant effect of bST on reproductive failure; the odds ratios for the bST treatment effect on reproductive failure at 150 d of lactation and reproductive failure at the end of lactation were 0.95 (95% CI 0.67 to 1.36) and 0.95 (95% CI 0.59 to 1.54), respectively. Overall, bST was not found to have a significant impact on reproductive performance in the herds studied.

This study investigated the relationship between body condition and milk yield of dairy cows. Holstein cows (n = 779) on a commercial dairy farm were scored for body condition weekly beginning at dry-off and continuing until 120 d of lactation. Multiple linear regression and principal component analysis were used to characterize relationships. Mean body condition scores were 2.77 and 2.66 at dry-off and parturition, respectively. Principal component analysis was used to reduce the collinearity among independent variables, to calculate new parameter estimates, and to rank the relationship of each variable with milk yield. Results indicated that change in body condition during the dry period was ranked first, followed by lactation number, and then body condition score at dry-off for multiparous cows. A one-point increase in body condition score between dry-off and parturition was associated with 545.5 kg more milk in the first 120 d of lactation. Each additional point of body condition at dry-off was associated with 300 kg less milk at 120 d of lactation. Results suggested that cows that gained condition during the dry period yielded more milk in the first 120 d of lactation and had an accelerated rate of increase in milk yield. The results of this study indicate that body condition score is an important tool for monitoring dairy herds.

Much discussion has transpired in recent years related to the rising cost of veterinary medical education and the increasing debt loads of graduating veterinarians. Underlying these trends are fundamental changes in the funding structure of higher education in general and of academic veterinary medicine specifically. As a result of the ongoing disinvestment by state governments in higher education, both tuition rates and academic programs have experienced a substantial impact across US colleges and schools of veterinary medicine. Programmatically, the effects have spanned the entire range of teaching, research, and service activities. For graduates, both across higher education and in veterinary medicine specifically, the impact has been steadily increasing levels of student debt. Although the situation is clearly worrisome, viable repayment options exist for these escalating debt loads. In combination with recent income and employment trends for veterinarians, these options provide a basis for cautious optimism for the future.

The associations between nitrate contained in drinking water and farrowing swine health and productivity were examined. The study was conducted from November 1989 through February 1991 on 571 randomly selected swine farms (27 207 farrowing swine) in the United States. At the beginning and end of each farm's 3-month monitoring period, the drinking water provided to the farrowing swine was tested for nitrate. Data on farrowing swine health and productivity were observed and recorded daily by the animal caretaker. Data were analyzed on a farm basis. Nitrate was detected in 53.2% (304/571) of well-water samples, with a median concentration of 2.1 ppm. No association was seen between the nitrate concentration of drinking water and the farm litter size (P = 0.94), proportion of the pigs stillborn (P = 0.48), or the risk of having an above median percentage of the litter born mummified (OR= 1.0; 95% CI 0.99,1.00). No association was seen between nitrate and the health of farrowing swine as measured by the risk of having an above median percentage of farrowing swine ill (OR = 1.0; 95% CI 0.99, 1.00) or dead (OR = 0.99; 95% CI 0.98,1.01) due to farrowing problems, other reproductive problems (ill OR = 1.0, 95% CI 1.00, 1.01; dead OR = 1.0, 95% CI 0.98, 1.01 ), other known health problems (ill OR = 1.0, 95% CI 0.99, 1.00; dead OR= 1.0, 95% CI 0.99, 1.01), or unknown health problems (ill OR = 1.0, 95% CI 0.99, 1.01; dead OR= 1.0, 95% CI 0.99, 1.01). The results of this study indicate that nitrate contained in drinking water, at the concentrations seen during the National Swine Study, is not associated with the farrowing swine health or productivity parameters studied.

Objective—To gain a better understanding of the role of interpersonal trust in veterinarian-client interactions during routine health-care visits, develop a measure of trust uniquely suited to the context of veterinary medicine, and interpret the actions, beliefs, and perceptions that capture client trust toward veterinarians. Design—Correlational study. Sample—103 veterinary students and 19 standardized clients with pets from a college of veterinary medicine at a large public Midwestern university. Procedures—A measure of trust specific to veterinarian-client interactions was constructed on the basis of preexisting conceptualizations of the construct and administered to veterinary students and standardized clients following interactions in 2 medical scenarios in a high-fidelity simulated animal health clinic. Exploratory and confirmatory factor analytic techniques were used to validate the measure of trust, and hierarchic linear modeling was used to explore indicators of standardized client trust perceptions in one of the scenarios. Results—Factor analysis revealed that the measure captured 2 perceptions indicative of trust in veterinary contexts: professionalism and technical candor. Students who had behaviors reflecting these factors as well as those who were perceived as more technically competent were seen as more trustworthy by standardized clients. Conclusions and Clinical Relevance—The development of trustworthy relationships between clients and veterinarians is important to the continued growth and success of the profession. By identifying characteristics of veterinarian trustworthiness and developing related measurement tools, proactive approaches to monitoring veterinarian-client relations can be implemented and incorporated into veterinary training and practice programs to identify areas for improvement.

A stochastic, distributed delay simulation model was developed to conduct economic analysis of respiratory disease in Michigan dairy cattle. This economic analysis employed non-traditional methods for estimation of the cost of disease. These include (1) a stochastic distributed delay simulation model, (2) inclusion of the reduction in feed costs due to disease, (3) measurement of the effect of risk factors on disease costs, and (4) incorporation of disease data from a randomly sampled, prospectively-monitored population of herds. This approach resulted in an increase in the estimated cost of respiratory disease to $4604 yr−1 from $ 1490 yr−1 (as previously reported in the same herds) by considering the effects of disease on growth, milk production, lost genetic potential, and replacement costs. It is hoped that this model or some of these modelling approaches may be useful to others attempting to estimate the cost of disease and the effect of intervention strategies.

Decision tree analysis was used to evaluate control strategies for bovine virus diarrhoea virus through calculation of the loss and expenses due to cattle being persistently infected. The study was performed in eight Danish dairy herds with outbreaks of mucosal disease. The calculations were made for three alternative control strategies referriing to different test and slaughter policies after the initial case of mucosal disease: (1) no blood testing, (2) blood testing of all animals in a risk group defined as animals that are within 3 months of age of the first mucosal disease case and (3) blood testing of all animals in the herds. Sensitivity analyses were made on test price for virological examination, loss from an animal dying, loss due to an animal being slaughtered and the probability of persistently infected cattle dying if they were not blood tested. Under the assumptions used, the blood testing of animals in the defined risk group resulted in the lowest immediate loss and expenses when calculations were made on all eight herds together. However, on an individual-farm basis the recommended control strategy showed some mild sensitivity to the incorporated variables, though testing the defined risk group was always most beneficial to the greatest number of farms.