1
|
Hernandez Torres SI, Holland L, Edwards TH, Venn EC, Snider EJ. Deep learning models for interpretation of point of care ultrasound in military working dogs. Front Vet Sci 2024; 11:1374890. [PMID: 38903685 PMCID: PMC11187302 DOI: 10.3389/fvets.2024.1374890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Military working dogs (MWDs) are essential for military operations in a wide range of missions. With this pivotal role, MWDs can become casualties requiring specialized veterinary care that may not always be available far forward on the battlefield. Some injuries such as pneumothorax, hemothorax, or abdominal hemorrhage can be diagnosed using point of care ultrasound (POCUS) such as the Global FAST® exam. This presents a unique opportunity for artificial intelligence (AI) to aid in the interpretation of ultrasound images. In this article, deep learning classification neural networks were developed for POCUS assessment in MWDs. Methods Images were collected in five MWDs under general anesthesia or deep sedation for all scan points in the Global FAST® exam. For representative injuries, a cadaver model was used from which positive and negative injury images were captured. A total of 327 ultrasound clips were captured and split across scan points for training three different AI network architectures: MobileNetV2, DarkNet-19, and ShrapML. Gradient class activation mapping (GradCAM) overlays were generated for representative images to better explain AI predictions. Results Performance of AI models reached over 82% accuracy for all scan points. The model with the highest performance was trained with the MobileNetV2 network for the cystocolic scan point achieving 99.8% accuracy. Across all trained networks the diaphragmatic hepatorenal scan point had the best overall performance. However, GradCAM overlays showed that the models with highest accuracy, like MobileNetV2, were not always identifying relevant features. Conversely, the GradCAM heatmaps for ShrapML show general agreement with regions most indicative of fluid accumulation. Discussion Overall, the AI models developed can automate POCUS predictions in MWDs. Preliminarily, ShrapML had the strongest performance and prediction rate paired with accurately tracking fluid accumulation sites, making it the most suitable option for eventual real-time deployment with ultrasound systems. Further integration of this technology with imaging technologies will expand use of POCUS-based triage of MWDs.
Collapse
Affiliation(s)
- Sofia I. Hernandez Torres
- Organ Support and Automation Technologies Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| | - Lawrence Holland
- Organ Support and Automation Technologies Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| | - Thomas H. Edwards
- Hemorrhage Control and Vascular Dysfunction Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
- Texas A&M University, School of Veterinary Medicine, College Station, TX, United States
| | - Emilee C. Venn
- Veterinary Support Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| | - Eric J. Snider
- Organ Support and Automation Technologies Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| |
Collapse
|
2
|
Carter AJ, Hall EJ, Bradbury J, Beard S, Gilbert S, Barfield D, O'Neill DG. Post-exercise management of exertional hyperthermia in dogs participating in dog sport (canicross) events in the UK. J Therm Biol 2024; 121:103827. [PMID: 38518416 DOI: 10.1016/j.jtherbio.2024.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024]
Abstract
Exercise is a common trigger of heat-related illness (HRI) events in dogs, accounting for 74% of canine HRI cases treated under primary veterinary care in the United Kingdom. However, few empirical studies have evaluated the effectiveness of differing cooling methods for dogs with exertional hyperthermia or HRI. This study aimed to prospectively evaluate effects of ambient conditions and post-exercise management practices (cooling methods and vehicular confinement) on the post-exercise temperature change of dogs participating in UK canicross events. Canine temperature was recorded at three intervals post-exercise: as close as possible to 0- (immediately post-exercise), 5-, and 15-min post-exercise. Ambient conditions and post-exercise management were recorded for 115 cooling profiles from 52 dogs. In 28/115 (24.4%) profiles, the dog's temperature increased during the first 5-min post-exercise. Overall, 68/115 (59.1%) profiles included passive cooling (stood or walked outside), 35 (30.4%) active cooling (cold-water immersion or application of a cooling coat), and 12 (10.4%) involved no cooling and were immediately housed in vehicles. No dogs developed hypothermia during the study and no adverse effects were observed from any cooling method. In hyperthermic dogs, overall post-exercise body temperature change was significantly negatively associated (i.e. the dogs cooled more) with 0-min post-exercise body temperature (β = -0.93, p < 0.001), and not being housed in a vehicle (β = -0.43, p = 0.013). This study provides evidence cold-water immersion (in water at 0.1-15.0 °C) can be used to effectively and safely cool dogs with exertional hyperthermia. Progressive temperature increases in many dogs - even after exercise has terminated - supports the message to "cool first, transport second" when managing dogs with HRI. When transporting dogs post-exercise or with HRI even after active cooling, care should be taken to cool the vehicle before entry and promote air movement around the dog during transport to facilitate ongoing cooling and prevent worsening of hyperthermia during travel.
Collapse
Affiliation(s)
- Anne J Carter
- Veterinary and Animal Sciences, Barony Campus, Scotland's Rural College, Parkgate, Dumfries, DG1 3NE, UK.
| | - Emily J Hall
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Jude Bradbury
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Sian Beard
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Sophie Gilbert
- Vets Now, Penguin House, Castle Riggs, Dunfermline, KY11 8SG, UK
| | - Dominic Barfield
- Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Dan G O'Neill
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| |
Collapse
|
3
|
Corridan CL, Dawson SE, Mullan S. Potential Benefits of a 'Trauma-Informed Care' Approach to Improve the Assessment and Management of Dogs Presented with Anxiety Disorders. Animals (Basel) 2024; 14:459. [PMID: 38338102 PMCID: PMC10854685 DOI: 10.3390/ani14030459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024] Open
Abstract
Dog caregiver reporting on the spectrum of fearful-aggressive behaviours often describes 'unpredictable' or 'exaggerated' responses to a situation/animal/person. A possible explanation for these behavioural responses considers that the dog is reacting to triggered memories for which the dog has a negative association. For many dogs undergoing veterinary behavioural treatment or rehabilitation through a canine rescue organisation, the assessing clinician relies on "proxy" reporting of the history/background by a caregiver (dog owner, foster carer, or shelter personnel). Detailed information on the event or circumstances resulting in this negative association may be limited or absent altogether. Consideration of a trauma-informed care (TIC) approach, currently applied in a wide range of human psychology and social care fields, may be helpful in guiding the clinical approach taken. The literature relating to adverse early experience (AEE) and trauma-informed care (TIC) in puppies/dogs compared to children/adults was evaluated to identify common themes and conclusions identified across both species. In the absence of known/identifiable trauma, behavioural assessment and management should consider that a 'problem' dog may behave as it does, as the result of previous trauma. The dog can then be viewed through a lens of empathy and understanding, often lacking for dogs presenting with impulsive, reactive, or aggressive behaviours. Assessment must avoid re-traumatising the animal through exposure to triggering stimuli and, treatment options should include counselling of caregivers on the impact of adverse early experiences, consideration of the window of tolerance, and TIC behavioural modification techniques.
Collapse
Affiliation(s)
| | - Susan E. Dawson
- Research Fellow in Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Siobhan Mullan
- Animal Welfare & Ethics, UCD School of Veterinary Science, Belfield, D04 V1W8 Dublin, Ireland;
| |
Collapse
|
4
|
Spinella G, Valentini S, Lopedote M. Internet-Based Survey on Physical Activity and Incidence of Injury in Active Working Dogs. Animals (Basel) 2023; 13:ani13101647. [PMID: 37238077 DOI: 10.3390/ani13101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
A survey with 100 multiple choice and open-ended questions was proposed by free access to working dogs' handlers. One hundred and nine respondents were recorded and their dates processed. The most represented breeds were: Belgian Malinois, Labrador, Border Collie and German Shepherds. Of these, 71.6% were intact dogs and 28.4% were spayed or neutered, with a median age range of 3-4 years. Furthermore, 55.5% had undergone early radiographic examinations for hip or elbow dysplasia diagnosis. The dogs performed the following activities: search and rescue on surface (59%), search and rescue on rubble (37%), Internationale Gebrauchshund Pruefung (IGP) (9%), man trailing (5%), sled dog (5%), search on avalanche (4%), dog towing (3%), canine shows (3%), hunting (2%), water rescue (1%), pet therapy (1%), wildlife conservation dog (1%), Mondioring (1%). Only 36.4% of respondents submitted their dogs to a specific sports medical examination and 55.5% to an orthopaedic examination. An injury incidence of 45.5% was recorded, generally related to mild musculoskeletal trauma. A limited number of handlers routinely performed warm-up and/or cool-down activities. A positive assessment emerged of the need for many respondents to attend and request education courses and updates on the proper health management of their dogs.
Collapse
Affiliation(s)
- Giuseppe Spinella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, 40064 Bologna, Italy
| | - Simona Valentini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, 40064 Bologna, Italy
| | - Mirella Lopedote
- Ambulatorio Veterinario Fisio & Sport, Grumo di San Michele all'Adige, 38010 Trento, Italy
| |
Collapse
|
5
|
Hardjo S, Haworth M, Croton C, Purcell S, Goodwin W. Pre-hospital emergency cricothyrotomy in dogs part 2: Airway sealing and ventilation using cricothyrotomy tubes. Front Vet Sci 2023; 10:1129462. [PMID: 36876002 PMCID: PMC9981793 DOI: 10.3389/fvets.2023.1129462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Cricothyrotomy (CTT) has been recommended for use in the pre-hospital setting for military working dogs and Operational K9s during airway emergencies. Although the CTT can establish a patent airway for spontaneous ventilation, the ability to seal the airway and provide positive pressure ventilation (PPV) using tubes designed for humans has not been determined. Using various CTT tubes placed in cadaver dog airways, this study aimed to determine: (1) Whether the tube cuff could create a functional airway seal with safe intra-cuff pressures; (2) The magnitude of delivered tidal volume (TV) loss during a standard breath to assess the possibility of delivering an adequate tidal volume with a bag-valve device (BVM); (3) The best performing tubes for either test; (4) The reasons behind the findings using observations from upper airway endoscopy, dissection, and measurements. Cadaver dogs of similar weights to MWD and Operational K9 breeds had various CTT tubes placed including three from commercial kits, a standard endotracheal tube, and a tracheostomy tube. The minimum occlusive volume technique was used to inflate the tube cuff and a pressure ≤ 48 cm H2O with an adequate seal was considered successful. Individual TVs were calculated for each dog and added to the volume lost during delivery of a standard breath from an ICU ventilator. Endoscopy and airway dissection were performed to assess the relationship between tubes cuffs and the airway. The tubes from the CTT kits performed poorly with regards to producing an airway seal with the H&H tube failing to seal the airway all tests. Tracheal dimensions were significantly associated with successful airway sealing (P = 0.0004). Tidal volume loss could be compensated using a BVM in 34/35 tests with the H&H tube in cadaver 8 the only to fail. Tracheal airway sealing is influenced by airway anatomy when tube cuffs are inflated to a target pressure and larger tubes do not always provide a better seal. The CTT tubes tested have the potential to facilitate ventilation with a BVM under the conditions set in this study. The 8.0 mm endotracheal tube performed the best and the H&H the worst in both tests.
Collapse
Affiliation(s)
- Sureiyan Hardjo
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Mark Haworth
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Catriona Croton
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Sarah Purcell
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Wendy Goodwin
- Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| |
Collapse
|
6
|
Brown DJ, Frasier L, Robinson FE, Cheney M, Davis WT, Salvator A, Andresen M, Proctor M, Earnest R, Pritts T, Strilka R. Relevance of Deployment Experience and Clinical Practice Characteristics on Military Critical Care Air Transport Team Readiness: A Study of Simulation Construct Validity. Mil Med 2022; 188:usac142. [PMID: 35639920 DOI: 10.1093/milmed/usac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Critical Care Air Transport Team (CCATT) Advanced course utilizes fully immersive high-fidelity simulations to train CCATT personnel and assess their readiness for deployment. This study aims to (1) determine whether these simulations correctly discriminate between students with previous deployment experience ("experienced") and no deployment experience ("novices") and (2) examine the effects of students' clinical practice environment on their performance during training simulations. MATERIALS AND METHODS Critical Care Air Transport Team Advanced student survey data and course status (pass/no pass) between March 2006 and April 2020 were analyzed. The data included students' specialty, previous exposure to the CCATT Advanced course, previous CCATT deployment experience, years in clinical practice (<5, 5-15, and >15 years), and daily practice of critical care (yes/no), as well as a description of the students' hospital to include the total number of hospital (<100, 100-200, 201-400, and >400) and intensive care unit (0, 1-10, 11-20, and >20) beds. Following descriptive analysis and comparative tests, multivariable regression was used to identify the predictors of passing the CCATT Advanced course. RESULTS A total of 2,723 surveys were analyzed: 841 (31%) were physicians (MDs), 1,035 (38%) were registered nurses, and 847 (31%) were respiratory therapists (RTs); 641 (24%) of the students were repeating the course for sustainment training and 664 (24%) had previous deployment experience. Grouped by student specialty, the MDs', registered nurses', and RTs' pass rates were 92.7%, 90.6%, and 85.6%, respectively. Multivariable regression results demonstrated that deployment experience was a robust predictor of passing. In addition, the >15 years in practice group had a 47% decrease in the odds of passing as compared to the 5 to 15 years in practice group. Finally, using MDs as the reference, the RTs had a 61% decrease in their odds of passing. The daily practice of critical care provided a borderline but nonsignificant passing advantage, whereas previous CCATT course exposure had no effect. CONCLUSION Our primary result was that the CCATT Advanced simulations that are used to evaluate whether the students are mission ready successfully differentiated "novice" from "experienced" students; this is consistent with valid simulation constructs. Finally, novice CCATT students do not sustain their readiness skills during the period between mandated refresher training.
Collapse
Affiliation(s)
- Daniel J Brown
- Department of Emergency Medicine, Wright State University, Dayton, OH 45324, USA
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Lane Frasier
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - F Eric Robinson
- Department of Acceleration and Sensory Sciences, Naval Medical Research Unit Dayton, Wright-Patterson AFB, OH 45433, USA
| | - Mark Cheney
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - William T Davis
- The En Route Care Research Center, United States Air Force En Route Care Research Center/59th MDW/Science and Technology, Fort Sam Houston, TX 78234, USA
| | - Ann Salvator
- Air Force Research Laboratory Airman Biosciences Division, Dayton, OH 45433, USA
| | - Mark Andresen
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Melissa Proctor
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Ryan Earnest
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Timothy Pritts
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Richard Strilka
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| |
Collapse
|
7
|
Hardjo S, Palmer L, Haworth MD. Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits. Front Vet Sci 2021; 8:705695. [PMID: 34604369 PMCID: PMC8483268 DOI: 10.3389/fvets.2021.705695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
The surgical cricothyrotomy (CTT) has been recommended for emergency front of neck airway access (eFONA) during a cannot intubate, cannot oxygenate scenario for military working dogs (MWD) and civilian law enforcement working dogs (operational K9s). In prehospital and austere environments, combat medics and emergency medical service providers are expected to administer emergency medical care to working dogs and may only have emergency airway kits designed for humans at their disposal. The objective of this article is to provide a detailed description of the application of such devices in cadaver dogs and highlight potential alterations to manufacturer guidelines required for successful tube placement. The kits evaluated included the Portex® PCK, Melker universal cricothyrotomy kit and H&H® emergency cricothyrotomy kit. A novel technique for awake cricothyrotomy in the dog is also described, which can also be considered for in-hospital use, together with the open surgical method described for the H&H® kit. To the authors' knowledge, this is the first publication documenting and providing instruction on the application of commercial cricothyrotomy kits in dogs.
Collapse
Affiliation(s)
- Sureiyan Hardjo
- UQ VETS, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - Lee Palmer
- Veterinary Medical Director, National Association of Veterinary Emergency Medical Services, Auburn, AL, United States
| | - Mark David Haworth
- UQ VETS, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| |
Collapse
|
8
|
Resuscitation Strategies for the Small Animal Trauma Patient. Vet Clin North Am Small Anim Pract 2020; 50:1385-1396. [PMID: 32912607 DOI: 10.1016/j.cvsm.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Traumatic injuries in small animals are a common cause for presentation to emergency departments. Severe traumatic injury results in a multitude of systemic responses, which can exacerbate initial tissue damage. Trauma resuscitation should focus on the global goals of controlling hemorrhage, improving tissue hypoperfusion, and minimizing ongoing inflammation and morbidity through the concept of "damage-control resuscitation." This approach focuses on the balanced use of blood products, hemorrhage control, and minimizing aggressive crystalloid use. Although these tenets may not be directly applicable to every veterinary patient with trauma, they provide guidance when managing the most severely injured subpopulation of these patients.
Collapse
|