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Sunday, September 27, 2020

A New Era of Disease Detection? Canines Uncovering COVID

     The remarkable ability of dogs to seemingly sniff out medical conditions has developed, expanded, and garnered criticism over the last several decades. In 1992, popular magazine Dog World brought attention to epilepsy detection in dogs. As of now, there is limited scientific evidence that seizure alert dogs are effective, but the field remains one of considerable interest. In 2019, researchers confirmed the presence of an olfactory profile associated with epileptic seizures. Anecdotal evidence abounds of dogs able to reliably detect flucuations in blood sugar associated with diabetes mellitus, but these claims have not stood up to the rigor of scientific investigation, with one study finding only about ~36% sensitivity. Cancer detection among dogs has faced the same fate, with limited evidence drawing some substantial criticism. Studies have found that there appears to be a detectable compound in the breath of lung and breast cancer patients, as well as in the breath and urine of bladder cancer patients. Nonetheless, there are many anecdotal reports of  behaviors changes in pets that prompted owners to seek medical care, subsequently finding cancer. Perhaps most recently explored is the space for canines in scent detection of infectious disease. Thus we find ourselves in 2020-- with dogs being trained to detect infection with the pathogen currently sweeping the globe, SARS-COV-2. 

    News reports as early as April discussed intention to train dogs for this purpose, particularly in light of resource shortage and few rapid-detection tests available. Penn Vet launched a pilot program. Multiple proof-of-concept studies followed. A pre-print published in June found success rate varying from 83-100% among 8 dogs and over 300 trials. A late-July publication reported 82% sensitivity (the ability to accurately identify true positives) and 96% specificity (the ability to accurately reject true negatives), with an overall detection rate of 94%. The latest pre-print, posted September 9th, further confirmed promise for this detection method, with 86% sensitivity and 93% specificity. As of late September, these results have culminated in real-world application. Helsinki's airport is now using COVID-detection dogs as part of a volutary screening program. The entire process takes less than a few minutes, and those that test positive per the dogs are then offered a free medical test. 

    Could this be the future of disease detection? It certainly isn't perfect. The dogs do still need to be trained for detection, as well as trained for use in a public setting. As of now, the dogs aren't alerting to passerby-- a sample must be collected on a wipe and then isolated for the dog to smell independently alongside negative samples. However, if rapid detection tests remain scarce as we move forward, dogs may become a key player in the fight to get this pandemic under control. What are your thoughts?

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Friday, September 18, 2020

Preparing for Interviews (Ask a Vet Student)

 Want to submit your own question? Ask here

Anonymous user asks: 

"How did you prepare yourself for the interview?"

   First of all, congratulations to everyone who submitted an application. For those that don't know, the collective veterinary school application, VMCAS, was due 9/15. The application is a huge step, and regardless of the outcomes, you should be proud of your accomplishment in submitting it. Depending on when you submitted and the processes of the schools you chose, interview invitations may go out as early as the next few weeks and as late as February and March. Take this time to relax and refocus, and maybe bookmark this to read later once you receive an interview.  At the end of this post, I've included examples of potential interview questions. Feel free to use it for a mock interview for yourself. 

    I did mock interviews. I began by informing my mentor (and pre-vet advisor and professor) at my undergraduate university that I was invited for interviews and asked for advice. He offered to do a mock interview with me and directed me to another resource on my campus that offered recorded mock interviews in the style of your selected graduate professional program. These mock interviews were invaluable and greatly improved my confidence. If your institution doesn't offer a resource like that, reach out to friends and family to see if they'll interview you. Practicing mock interviews can feel awkward with people you know, but the intention is two-fold. Not only do you get the opportunity to practice answering questions on the spot verbally, you can also recieve feedback on any habits you may have-- twirling your hair, kicking your feet, avoiding eye contact, etc. Beyond those primary benefits, a true mock interview also gives you an idea of the process: how you're going to enter the room, how you greet your interviewers and introduce yourself, and where you look as you take your seat. 

    I did not write potential answers to interview questions. While I was advised to prepare answers, one of my concerns was losing my own voice and sounding rehearsed in an interview setting. Instead, I spent a small amount of time the nights leading up to my interview reviewing common veterinary school interview questions online, and mentally considering how I might provide an answer to that question. I did take down notes on important experiences in my life that I may have wanted to draw on in order to relate them to potential questions. For example, I wrote "High school and college marching band. Team environment. Accountability. Work ethic." I found that this allowed my interviews to progress more like a conversation, rather than feeling stilted or panicking trying to remember exactly what I had wanted to say. Thinking back on my experiences allowed me to highlight and display the diversity of my experiences and background during the interview process. The questions I considered most intensely were those most likely to be asked that I knew I would struggle with: Greatest Strength and Greatest Weakness. These questions, to me, feel like a balancing act. When discussing your greatest strength, you want to take pride in what you excel in, but you don't want to come across as unaware of your own limitations. Greatest weakness is even harder-- you need to own your shortcomings, but you also need to show the interviewers that you can overcome the areas where you struggle. The typical recommended formula for the answer is "weakness + example + how you've grown as a result of coping with that weakness or how you've overcome that weakness."

     I informed myself on current events and common controversies in the field of veterinary medicine and developed stances on those issues. I think a common hiccup people run into with these questions is believing that they need to give the 'right' answer, or that there even is a 'right' answer. The interviewers are less interested in gleaning information from your answer and more interested in seeing your ability to articulate and defend a position. This doesn't mean that you can just say anything-- there are answers that are more informed than others, and regardless of which side of an issue you may fall on, you should be sure that you understand the issue comprehensively. I'll briefly provide a few issues below as examples. Essentially, my approach to these questions is to state my understanding of the issue, discuss the reasons there are differences in opinion on the issue and what the support and problems are for each stance, then provide my own personal stance and justification/reasoning. Sometimes, the interviewers may question you after answering. You might feel like they're challenging you because you said the wrong thing. In reality, they're most likely just assessing how you respond to being questioned. If they offer you information you weren't aware of, own that and say you're thankful they let you know and express your intent to look into it more later. If they ask you to further defend your position, explain in whatever capacity is appropriate. If their question prompts you to reconsider your position, tell them that, thank them, and say you have something to think on. 

Above all else in your interviews, be yourself! So many people applying to veterinary school look very similar on paper. Interviews are your chance to show yourself off as the unique and valuable individual that you are. The school is interviewing you, sure, but be empowered by the fact that you are interviewing them, too! Veterinary schools need intelligent, driven students to graduate from their programs as much as veterinary students need a place to recieve their education. Hold your head high. You'll do great. 

Sample Interview Questions

1. Why are you applying to our program?

2. What is your favorite thing about this institution? 

3. Tell me about yourself. 

4. Why are you applying to veterinary school?

    - What are your goals in veterinary medicine

    - What are your interests in veterinary medicine

5. What will you do if you aren't accepted this cycle? 

6. What class did you struggle in the most?

    - Open packet interview: Can you explain your <C/D/F/W> in <class>?

7. What is your greatest strength/weakness?

    - Alternative: If you could change something about yourself, what and why?

8. What do you friends and family value most about you? 

9. How do you handle stress? 

    - What do you do outside of veterinary medicine?

10. Think of a time when ... What did you do / How did you react?

11. (Scenario). What would you do?

    - For 10 & 11:

        - Team project and a member isn't pulling their weight / is harming the group effort.

        - You had to be / have to be a leader for something (more common for 10.)

        - You or someone you work with made a mistake that impacted a patient's outcome.

        - You had to reassess your prioritis (more common for 10.)

        - You are in a stressful situation. 

        - You're in a situation and nothing is going right. 

        - You have a strong ethical conflict with someone you're working with

12. (Ethical dilemma). What would you do?

    - Veterinarian on staff electing to peform a convenience euthanasia you disagree with

    - Alt: Client asking you to perform a convenience euthanasia

    - You witness a classmate cheating / driving drunk / doing drugs on campus

    - Your supervisor is abusing position of senority, but you really need the job/internship

    - Someone comes in with their pet, needs care, doesn't have money

    - Practice manager asks you to do something you don't agree with, assures you it will be fine

13. (Controversial issue or current event). What are your thoughts?

    - Zoos, aquariums, and captivity

    - Trap neuter release vs impact of cats on wildlife

    - Animal research

    - (Large animal or equine interest) Wild horses in the USA

    - Suicide, burnout, and compassion fatigue in the veterinary profession

14. Where do you see yourself (5/10/15/etc) years after leaving our program?

15. If you weren't going to be a veterinarian, what would your career be?

Resources for Current Events in Veterinary Medicine

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Saturday, September 5, 2020

One Health and Veterinarians: Career Options and How to Get Involved (Ask a Vet Student)

    Want to ask your own question? Ask here

 For the first installment of 'Ask a Vet Student,' Anonymous user writes:

"What kind of options are there that deal with One Health?"
     For those that aren't familiar, One Health is a movement towards recognizing and embracing the inextricable links between human health, animal health, and the environment. Pressing modern issues like antibiotic resistance, zoonotic disease outbreaks, climate change, and the global food supply chain are all quintessential 'One Health' areas of interest. Veterinarians all have a role to play in One Health initiaves, by virtue of their very profession. The Veterinarian's Oath reads: 

Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.

I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.

I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.

    All veterinarians, regardless of their ultimate career, are stewards of public health, and by proxy, key players in the One Health movement. However, there are many veterinarians that pursue careers geared explicitly towards One Health initiatives. 

Careers in One Health

Research: Veterinarians are medical professionals and can easily become involved with private or public research endeavors. Studies on emerging diseases and disease treatments can always utilize a veterinarian on the team. There are many diseases that effect both humans and companion animals (like diabetes mellitus, chronic renal failure, cancers of all types, and psychological disorders like depression and anxiety) and teams of collaborative health professionals allows innovation through the combination of different perspectives. Veterinarians can also provide a unique perspective to the environmental sciences, issues of conservation and the effects of pollution, providing a medical lens to various impacts on ecosystems. If not participating in research endeavors as investigators... veterinarians can work on the healthcare team overseeing the use of animals in studies.

NIH and Lab Animal Veterinarians: Veterinarians at the NIH support the health and welfare of animals utilized for research. More broadly, the American College of Lab Animal Medicine provides board certification for veterinarians that work with research animals. Lab Animal Veterinarians work with research facilities to ensure the humane and responsible use of animals in studies. These veterinarians may provide medical care to populations of lab animals, train research personel on appropriate surgical techniques, and review and adjust research protocol proposals. They exist in a career balance between medical practice and administrative oversight. 

CDC: The CDC offeres fellowships for medical professionals that are interested in involvement with public health in a broader context. The Epidemic Intelligence Service, for example, is a two year program offered to physicians, veterinarians, PhD, and allied health professionals, that allows officers to respond to disease outbreaks in the field, developing and initiating control strategies, and instituting guidelines for preventing future outbreaks. The FLIGHT Program, Future Leaders In Infections and Global Health Threats, is three years and it is open to physicians and veterinarians that have graduated from the EIS program. They also provide a residency program for prospective laboratory animal veterinarians. The CDC also employs veterinarians to detect and respond to disease outbreaks, conduct research on disease prevention, and develop and advocate for public health policies. Veterinarians have been particularly valuable in providing medical context to agricultural issues, granting a unique insight to environmental concerns, and addressing prominent zoonotic diseases of companion animals. 

State Health Departments & Public Health Veterinarians: State Public Health Veterinarians focus on the epidemiology of zoonotic diseases and have done important work on antibiotic resistance, particularly in the context of agriculture and food animals. These veterinarians may work with animal control agencies, do work with disease vectors such as parasites, and assist in the development of legislative guidelines for zoonotic diseases like rabies. 

USDA: Veterinarians with the USDA help ensure and maintain the safety of our food system. Many work in plants where meat and poultry are processed, overseeing and enforcing inspection procedures and standard protocols. This includes ensuring humane slaughter, and extends even to the transport and distribution of final products. These veterinarians also collaborate with the CDC to investigate and prevent foodborne illness outbreaks. 

FDA: Veterinarians with the FDA are responsible for assisting in the approval of new drugs for animal use. This includes oversight of drugs approved for use in food animals, which has more stringent requirements than drugs used in companion animals. Veterinarians with the Office of Safety and Compliance ensure that drugs approved are safe and effective on the broader population. The FDA also does work on the issue of antibiotic resistance. 

Disaster Response: When disaster strikes, veterinarians are value for a number of tasks. When people are evacuated and displaced, shelters must be provided that can accomodate the animals that live with displaced people. These pets often require medical care, and may need to be housed in temporary pop-up shelters. Additionally, anywhere people need rescued, animals may too, whether that is from flooding, building collapse, wild fire, or a sink hole. Veterinarians can receive training for technical rescue, and can provide invaluable assistance to rescue teams, having access to sedative drugs and having the knowledge to triage and provide emergency care to injured animals. 

Shelter Medicine: The Shelter Medicine speciality is an emerging and developing field of veterinary medicine, with the Association of Shelter Veterinarians founded in 2001. Shelter veterinarians oversee the health and welfare of pets in shelter environments. In addition to that, there is a growing movement to supply a public service in the form of accessible veterinary care to disadvantaged members of communities. American Pets Alive! and Human Animal Support Services are two great resources for learning more about these initiatives. Veterinarians that work in the shelter environment are often cross-trained for another aspect of veterinary medicine with a strong One Health application... foresenic veterinary medicine. 

Forensic Veterinary Medicine:  Animal cruelty comes in two forms: neglect, which causes harm without intent to harm, and abuse, in which harm is knowingly and intentionally inflected. Neglect is often seen by veterinarians. Veterinarians in any practice setting can provide education to help prevent neglect and treat the illnesses that arise from it. However, veterinarians are also increasingly being educated on how to recognize and document signs of animal abuse. There is still a long way to come on that front. However, it is important from a One Health perspective, as the link between domestic violence, other forms of crime, and animal abuse has been well established. Forsenic veterinarians document lesions and injuries that may be consistent with abuse for the sake of legal documents that can be utilized in court. Additionally, these veterinarians may provide expert witness in the court of law, describing how lesions may (or may not be) consistent with evidence of abuse. 

How to Get Involved

Many veterinary schools have public health or One Health clubs. If not, start one! Reach out to other campuses at your University (School of Pharmacy, School of Medicine, School of Epidemiology, School of Public Health, Department for Emerging Diseases, School of Agriculture, etc and see if they are interested in collaborative speaker events. Reach out to faculty and administration at your college that have a background or research interest in public health). Additionally, a growing number of veterinary schools offer dual-degree programs for obtaining a DVM-MPH. 

Every two years, the CDC hosts a veterinary student day in Atlanta, Georgia. This is a good opportunity to network with other veterinary students, hear from public health veterinarians on their career path and day to day, and meet representatives from different organizations. 

To stay up to date on One Health developments and specific opportunities for involvement, I recommend the following:

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Additional Resources:

Recommended Reading:
Zoobiquity: The Astonishing Connection Between Human and Animal Health by  Barbara Natterson-Horowitz, Kathryn Bowers

Spillover: Animal Infections and the Next Human Pandemic by David Quammen