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Abstract Background Reusable surgical drapes have a lower lifetime environmental impact than disposable drapes in most cases. There is limited evidence regarding whether drape choice impacts patient outcomes including post-operative wound complications. The aim of this study is to compare wound complication rates following routine neutering surgeries in cats and dogs when reusable drapes are used as compared with disposable drapes. Methods The trial will be conducted as a pragmatic, multi-centre, parallel group randomised controlled trial in the UK. Dogs and cats undergoing routine neutering will be randomised to disposable or reusable drapes with all other aspects of care occurring as they usually would at the practice. The required sample size is 2,850, with 4750 animals to be recruited from up to ten practices to allow for a 40% loss to follow-up. Demographic data and details on peri-operative care will be collected at the time of surgery. Post-operative wound complications will be assessed and recorded as usual at each practice using clinical codes. The post-operative wound clinical codes and any antibiotic use within 30 days of surgery will be retrieved from the practice management software. The primary outcome that will be compared between the two groups is the rate of post-operative wound complications within 30 days of surgery which will be analysed by multivariable logistic regression with a binary outcome of wound complication (yes/no). Secondary outcomes are the prevalence of different types of complications and antibiotic use within 30 days of surgery which will be compared between the two groups by chi square analysis. Discussion Our hypothesis is that there will be no difference in post-operative wound complication rates between disposable and reusable drapes. If the likely rate of post-surgical wound complications with reusable drapes is similar to that with disposable drapes, then veterinary clinical teams can choose the more sustainable option, confident that their patients will not be impacted by this choice. Trial registration We have retrospectively registered the protocol on the Open Science Framework on 14 Nov 2023 (Trial registration entry: https://doi.org/10.17605/OSF.IO/72HMA ).

BackgroundCardiovascular disease remains the leading cause of mortality worldwide. Cardiac fibrosis impacts the underlying pathophysiology of many cardiovascular diseases by altering structural integrity and impairing electrical conduction. Identifying cardiac fibrosis is essential for the prognosis and management of cardiovascular disease; however, current diagnostic methods face challenges due to invasiveness, cost, and inaccessibility. Electrocardiograms (ECGs) are widely available and cost-effective for monitoring cardiac electrical activity. While ECG-based methods for inferring fibrosis exist, they are not commonly used due to accuracy limitations and the need for cardiac expertise. However, the ECG shows promise as a target for machine learning (ML) applications in fibrosis detection. ObjectiveThis study aims to synthesize and critically evaluate the current state of ECG-based ML approaches for cardiac fibrosis detection. MethodsWe conducted a scoping review of research in ECG-based ML applications to identify cardiac fibrosis. Comprehensive searches were performed in PubMed, IEEE Xplore, Scopus, Web of Science, and DBLP databases, including publications up to October 2024. Studies were included if they applied ML techniques to detect cardiac fibrosis using ECG or vectorcardiogram data and provided sufficient methodological details and outcome metrics. Two reviewers independently assessed eligibility and extracted data on the ML models used, their performance metrics, study designs, and limitations. ResultsWe identified 11 studies evaluating ML approaches for detecting cardiac fibrosis using ECG data. These studies used various ML techniques, including classical (8/11, 73%), ensemble (3/11, 27%), and deep learning models (4/11, 36%). Support vector machines were the most used classical model (6/11, 55%), with the best-performing models of each study achieving accuracies of 77% to 93%. Among deep learning approaches, convolutional neural networks showed promising results, with one study reporting an area under the receiver operating characteristic curve (AUC) of 0.89 when combined with clinical features. Notably, a large-scale convolutional neural network study (n=14,052) achieved an AUC of 0.84 for detecting cardiac fibrosis, outperforming cardiologists (AUC 0.63-0.66). However, many studies had limited sample sizes and lacked external validation, potentially impacting the generalizability of the findings. Variability in reporting methods may affect the reproducibility and applicability of these ML-based approaches. ConclusionsML-augmented ECG analysis shows promise for accessible and cost-effective detection of cardiac fibrosis. However, there are common limitations with respect to study design and insufficient external validation, raising concerns about the generalizability and clinical applicability of the findings. Inconsistencies in methodologies and incomplete reporting further impede cross-study comparisons. Future work may benefit from using prospective study designs, larger and more clinically and demographically diverse datasets, advanced ML models, and rigorous external validation. Addressing these challenges could pave the way for the clinical implementation of ML-based ECG detection of cardiac fibrosis to improve patient outcomes and health care resource allocation.

BackgroundPhotographs from medical case reports published in academic journals have previously been found in online image search results. This means that patient photographs circulate beyond the original journal website and can be freely accessed online. While this raises ethical and legal concerns, no systematic study has documented how often this occurs. ObjectiveThe aim of this cross-sectional study was to provide systematic evidence that patient photographs from case reports published in medical journals appear in Google Images search results. Research questions included the following: (1) what percentage of patient medical photographs published in case reports were found in Google Images search results? (2) what was the relationship between open access publication status and image availability? and (3) did the odds of finding patient photographs on third-party websites differ between searches conducted in 2020 and 2022? MethodsThe main outcome measure assessed whether at least 1 photograph from each case report was found on Google Images when using a structured search. Secondary outcome variables included the image source and the availability of images on third-party websites over time. The characteristics of medical images were described using summary statistics. The association between the source of full-text availability and image availability on Google Images was tested using logistic regressions. Finally, we examined the trend of finding patient photographs using generalized estimating equations. ResultsFrom a random sample of 585 case reports indexed in PubMed, 186 contained patient photographs, for a total of 598 distinct images. For 142 (76.3%) out of 186 case reports, at least 1 photograph was found in Google Images search results. A total of 18.3% (110/598) of photographs included eye, face, or full body, including 10.9% (65/598) that could potentially identify the patient. The odds of finding an image from the case report online were higher if the full-text paper was available on ResearchGate (odds ratio [OR] 9.16, 95% CI 2.71-31.02), PubMed Central (OR 7.90, 95% CI 2.33-26.77), or Google Scholar (OR 6.07, 95% CI 2.77-13.29) than if the full-text was available solely through an open access journal (OR 5.33, 95% CI 2.31-12.28). However, all factors contributed to an increased risk of locating patient images online. Compared with the search in 2020, patient photographs were less likely to be found on third-party websites based on the 2022 search results (OR 0.61, 95% Cl 0.43-0.87). ConclusionsA high proportion of medical photographs from case reports was found on Google Images, raising ethical concerns with policy and practice implications. Journal publishers and corporations such as Google are best positioned to develop an effective remedy. Until then, it is crucial that patients are adequately informed about the potential risks and benefits of providing consent for clinicians to publish their images in medical journals.

Abstract Background The relationship between healthcare interventions and context is widely conceived as involving complex and dynamic interactions over time. However, evaluations of complex health interventions frequently fail to mobilise such complexity, reporting context and interventions as reified and demarcated categories. This raises questions about practices shaping knowledge about context, with implications for who and what we make visible in our research. Viewed through the lens of case study research, we draw on data collected for the Triple C study (focused on Case study, Context and Complex interventions), to critique these practices, and call for system-wide changes in how notions of context are operationalised in evaluations of complex health interventions. Methods The Triple C study was funded by the Medical Research Council to develop case study guidance and reporting principles taking account of context and complexity. As part of this study, a one-day workshop with 58 participants and nine interviews were conducted with those involved in researching, evaluating, publishing, funding and developing policy and practice from case study research. Discussions focused on how to conceptualise and operationalise context within case study evaluations of complex health interventions. Analysis focused on different constructions and connections of context in relation to complex interventions and the wider social forces structuring participant’s accounts. Results We found knowledge-making practices about context shaped by epistemic and political forces, manifesting as: tensions between articulating complexity and clarity of description; ontological (in)coherence between conceptualisations of context and methods used; and reified versions of context being privileged when communicating with funders, journals, policymakers and publics. Conclusion We argue that evaluations of complex health interventions urgently requires wide-scale critical reflection on how context is mobilised - by funders, health services researchers, journal editors and policymakers. Connecting with how scholars approach complexity and context across disciplines provides opportunities for creatively expanding the field in which health evaluations are conducted, enabling a critical standpoint to long-established traditions and opening up possibilities for innovating the design of evaluations of complex health interventions.

Abstract Background Although dogs are a commonly owned companion animal in the UK, the species experiences many health problems that are predictable from demographic information. This study aimed to use anonymised veterinary clinical data from the VetCompass™ Programme to report the frequency of common disorders of dogs under primary veterinary care in the UK during 2016 and to explore effects associated with age, sex and neuter status. Results From an available population of 905,543 dogs under veterinary care at 886 veterinary clinics during 2016, the current study included a random sample of 22,333 (2.47 %) dogs from 784 clinics. Prevalence for each disorder was calculated at the most refined level of diagnostic certainty (precise-level precision) and after grouping to a more general level of diagnostic precision (grouped-level precision). The most prevalent precise-level precision disorders recorded were periodontal disease (prevalence 12.52 %, 95 % CI: 12.09–12.97), otitis externa (7.30 %, 95 % CI: 6.97–7.65) and obesity (7.07 %, 95 % CI: 6.74–7.42). The most prevalent grouped-level disorders were dental disorder (14.10 %, 95 % CI: 13.64–14.56), skin disorder (12.58 %, 95 % CI: 12.15–13.02) and enteropathy (10.43 %, 95 % CI: 10.04–10.84). Associations were identified for many common disorders with age, sex and neuter. Conclusions The overall findings can assist veterinarians and owners to prioritise preventive care and to understand demographic risk factors in order to facilitate earlier diagnosis of common disorders in dogs. The information on associations with age, sex and neuter status provides additional contextual background to the complexity of disorder occurrence and supports targeted health controls for demographic subsets of dogs.

Abstract Background Dogs are the most popular mammal kept as a companion animal globally. Positive human-dog relationships can benefit both the human owners as well as the dogs. However, popularity as a companion animal species does not universally benefit dogs in reverse. Breed-related health problems in dogs have received increasing attention over the last decade, sparking increased concerns for dog welfare across many stakeholders. Progress towards improved welfare requires meaningful collaboration between all those working in dog health, science and welfare. The International Partnership for Dogs (IPFD), together with an alternating host organisation, holds biennial meetings called the International Dog Health Workshops (IDHW). The IPFD 4th IDHW was hosted by the UK Kennel Club in Windsor, UK in May 2019. With the aim of encouraging international and multi-stakeholder collaborations that are effective and ongoing, the 4th IDHW 2019 provided a forum to identify specific needs and actions that could improve health, well-being and welfare in dogs, building on outcomes and evaluating actions of previous IDHWs. Results The workshop included 126 decision-leaders from 16 countries and was structured around five key themes identified as needing international, multi-stakeholder attention. These included the concept of “breed”, supply and demand, breed-specific strategies for health and breeding, genetic testing and extreme conformations. The review of progress made since the 3rd IDHW 2017 and the comprehensive lists of actions agreed upon during the current meeting suggest that movement from information and collaboration to action has been achieved. Working groups with specific tasks were identified and many plan to continue to communicate through forum communities on DogWellNet.com . Conclusions The IDHW provides a forum for formal and informal discussion between relevant groups so that key dog health and welfare issues can be identified and defined, and plans can be agreed for effective actions to address them. The 3rd IDHW 2017 resulted in a number of significant outcomes. New and continuing actions were laid down at the 4th IDHW 2019, which will be re-evaluated at the 5th IDHW facilitating continual progress.

Neanderthals had complex land use patterns, adapting to diversified landscapes and climates. Over the past decade, considerable progress has been made in reconstructing the chronology, land use and subsistence patterns, and occupation types of sites in the Rhône Valley, southeast France. In this study, Neanderthal mobility at the site of Payre is investigated by combining information from lithic procurement analysis ("chaîne evolutive" and "chaîne opératoire" concepts) and strontium isotope analysis of teeth (childhood foraging area), from two units (F and G). Both units date to the transition from Marine Isotope Stage (MIS) 8 to MIS 7, and show similar environmental conditions, but represent contrasting occupation durations. Level Gb (unit G) represents a long-term year-round use, in contrast to short-term seasonal use of the cave in level Fb (unit F). For both levels, lithic material and food were generally collected from a local to semi-local region. However, in level Gb, lithic materials were mainly collected from colluviums and food collected in the valley, whereas in level Fb, lithic procurement focused primarily on alluvial deposits and food was collected from higher elevation plateaus. These procurement or exchange patterns might be related to flint availability, knapping advantages of alluvial flint or occupation duration. The site of Payre is located in a flint rich circulation corridor and the movement of groups or exchanges between groups were organized along a north-south axis on the plateaus or towards the east following the river. The ridges were widely used as they are rich in flint, whereas the Rhône Valley is not an important source of lithic raw materials. Compared to other western European Middle Palaeolithic sites, these results indicate that procurement strategies have a moderate link with occupation types and duration, and with lithic technology. The Sr isotope ratios broadly match the proposed foraging areas, with the Rhône Valley being predominantly used in unit G and the ridges and limestone plateaus in unit F. While lithic reconstructions and childhood foraging are not directly related this suggests that the three analysed Neanderthals spend their childhood in the same general area and supports the idea of mobile Neanderthals in the Rhône Valley and neighbouring higher elevation plateaus. The combination of reconstructing lithic raw material sources, provisioning strategies, and strontium isotope analyses provides new details on how Neanderthals at Payre practised land use and mobility in the Early Middle Palaeolithic.