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Historically, pre-clinical professional veterinary instruction has relied heavily on didactic methods. With the shift toward competency-based education in health professions teaching, instructors at The Ohio State University College of Veterinary Medicine are exploring alternative engagement strategies to focus on learner outcomes. In this article, we report on the integration of competency-based active learning techniques in a large-lecture setting, along with preliminary outcomes from the student perspective. A total of 110 students from Zoonotic Diseases, a two-credit core course offered in the second year of the 4-year professional curriculum, participated in the learning techniques and retrospective pre-/post-questionnaire. Results of the questionnaire indicated improvement in learners’ perceived competency. For practical skills (e.g., donning and doffing of personal protective equipment), students also reported improved self-efficacy. Students enjoyed the interactive and self-directed learning techniques and described an improvement in their ability to evaluate their own understanding of relevant course concepts. The active learning techniques described herein may be used to supplement, and even transform, primarily lecture-based courses to better achieve professional competency and develop practice-ready veterinarians.

Background: Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g., Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals, and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases, food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing. Methods: In 2018 the “Application of the One Health Approach to Global Health Centers” conference held at the Albert Einstein College of Medicine convened experts involved in One Health policy and practice. The conference examined issues relevant to One Health approaches, sharing examples of challenges and successes to guide application to medical school curricula and clinical practice for human health. This paper presents a synthesis of conference proceedings, framed around objectives identified from presentations and audience feedback. Findings and Recommendations: The following objectives provide opportunities for One Health involvement and benefits for medical schools and global health centers by: 1) Improving One Health resource sharing in global health and medical education; 2) Creating pathways for information flow in clinical medicine and global health practice; 3) Developing innovative partnerships for improved health sector outcomes; and 4) Informing and empowering health through public outreach. These objectives can leverage existing resources to deliver value to additional settings and stakeholders through resource efficiency, more holistic and effective service delivery, and greater ability to manage determinants of poor health status. We encourage medical and global health educators, practitioners, and students to explore entry points where One Health can add value to their work from local to global scale.

Most of the world’s sea otters reside in Alaska, but there has never been an assessment of long-term mortality patterns for this keystone predator. We examined data collected from 780 northern sea otter (Enhydra lutris kenyoni)carcasses recovered in Alaska from 2002 to 2012 to evaluate the causes of mortality and risk factors associated with death. A smaller group (n= 144, 18%) of fresh non-frozen carcasses were included in a more detailed mortality analysis. Forty-four% of the fresh dead otters were determined to have died from infectious endocarditis, meningoencephalitis, and/or septicemia due to systemic streptococcosis (“Strepsyndrome”).Streptococcus lutetiensis, a member of theStreptococcus bovis/equinus(SB/E) group was most commonly isolated, although other members of the SB/E group were identified. There were fewer cases whereS. phocaeand other streptococci were isolated. A regression analysis revealed age and location risk factors forStrepsyndrome. Subadults were the highest risk age group, and otters recovered from the Kachemak Bay region were 3.6 times (95% CI: 2.2–5.9) more likely to die fromStrepsyndrome than otters recovered elsewhere. Diagnosis of thisStrepsyndrome had not been reported in other marine mammals in Alaska. Sporadic cases of septicemia and infectious endocarditis due toS. lutetiensishave been seen in the southern sea otter population in California. Other causes of death for the fresh otters included neurologic diseases (10%), trauma (8%), nutritional diseases (7%), cardiovascular diseases (7%), gastrointestinal diseases /parasites (6%), undetermined (5%), septicemia (3%), and neoplasia (3%). All other causes of death (oiling, hepatobiliary, fungal, marine biotoxins, pulmonary) were at or below 1%. Twenty percent of fresh animals were positive for phocine distemper virus (PDV) by polymerase chain reaction (PCR, 11/55), 18% seropositive for PDV (7/38), and paramyxovirus-like particles were demonstrated by electron microscopy within inclusion bodies from one animal. Low concentrations of the harmful algal bloom toxins domoic acid and saxitoxin were also detected in 26% and 22% of fresh animals, respectively. Protozoal disease was rare. These patterns of disease differ from sea otters in other regions and possible reasons are discussed.

The University of Gondar College of Veterinary Medicine and Animal Sciences (UoG-CVMASc) and the Ohio State University College of Veterinary Medicine (OSU-CVM) developed an objective methodology to assess the curriculum of veterinary institutions and implement changes to create a curriculum that is harmonized with OIE standards while also covering the needs and realities of Gondar and Ethiopia. The process, developed under the sponsorship of the World Organisation for Animal Health (OIE) Veterinary Education Twinning Programme, is outlined in this article with the hope that it can be applied by other countries wishing to improve national veterinary services (VS) through the improvement of their academic programs. The plan created by the UoG-OSU Twinning team consisted of an in-depth curriculum assessment and development process, which entailed three consecutive stages. Stage 1 (Curriculum Assessment) included the design and development of an Evaluation Tool for OIE Day 1 Graduating Veterinarian Competencies in recent graduates, and the mapping and evaluation of the current UoG-CVMASc curriculum based on the OIE Veterinary Education Core Curriculum. Stage 2 (Curriculum Development) consisted of the identification and prioritization of possible solutions to address identified curriculum gaps as well as the development of an action plan to revise and update the curriculum. Finally, Stage 3 (Curriculum Implementation) focused on the process to launch the new curriculum. In September 2017, 53 first-year students started the professional program at the UoG-CVMASc as the first cohort to be accepted into the newly developed OIE Harmonized Curriculum, the first of its kind in Africa.

Background The Mnisi community is a livestock-dependent community neighbouring the Great Limpopo Transfrontier Conservation Area in South Africa. Here, zoonotic pathogens contribute to as many as 77% of cases of acute febrile illness, including those associated with tick, domestic animal, rodent, and wildlife exposure. Previous gender-disaggregated analysis has shown that men and women have different risks of zoonotic illness, suggesting that exposure routes for zoonotic infections should be further explored to inform gender-sensitive risk mitigation strategies. Using a One Health approach, we focused on interactions between community residents, domestic animals, and the built and natural environment to investigate potential exposure pathways for zoonotic infections from a gendered perspective. Methods We used an ethnographic approach, combining data from direct household observations and focus group discussions, to examine behaviours that may be linked to zoonotic pathogen exposure. Participating households were randomly selected from three villages under the leadership of the Mnisi Traditional Authority in Mpumalanga, South Africa. We conducted four household observations in each village followed by one male and one female focus group per village. Observations and discussions focused on previously identified gendered tasks such as domestic animal care, water collection, and food preparation, and how and by whom these tasks were performed. Data were triangulated across methods, and analysis included translation, transcription, and thematic coding using fundamental grounded theory. Findings Observations and focus groups took place during July, 2019. The focus groups included 44 participants: 23 men and 21 women, mean age was 36 years. Mean household size was nine people. Observations were conducted in 12 households (four per village) for a total of 50 h. We noted gender differences for household tasks, animal care duties, and environmental exposure. Male gender-typed roles included cattle husbandry such as taking cattle to the bush daily for grazing (13 mentions) and slaughter of cattle (7 mentions). Female gender-typed tasks included household duties such as food preparation (13 mentions), household cleaning including sweeping the yard, taking out trash (10 mentions), water collection from boreholes or neighbourhood taps (7 mentions), and feeding and care of smaller livestock such as goats and chickens (4 mentions). Other emergent themes included decreased water and grazing land availability in the community, affecting both men and women, as water collection and cattle grazing now required more time spent in the bush and increased potential vector-borne disease exposure. From observations, it was noted that men wore covered protective work clothes (such as long trousers and closed-toe shoes) more commonly than women did, but women did not often wear these for household duties including water collection in the bush. Conflict with wild animals and domestic animals, such as wild animals killing domestic animals in the bush and domestic animals entering other households was also noted as a concern by men and women (13 mentions). Interpretation We recommend that these gender-typed roles serve as specific critical control points for zoonotic pathogen exposure. For example, tick-bite exposure prevention should be directed at both men and women based on their daily activities, such that prevention in men should target exposure from cattle and prevention in women should focus on personal protective measures during water collection. Exposure prevention strategies at the household level for water-borne zoonotic diseases like leptospirosis should be targeted towards women. These findings contribute to a more detailed understanding of risk behaviour and critical control points for zoonotic disease—a significant contributor to acute febrile illness in this rural, resource-limited setting. Funding Ohio State University College of Veterinary Medicine Veterinary Scholars Summer Research Program Global Health Fellowship; Ohio State University College of Veterinary Medicine Global Engagement Grant; Investigator Funds; The Ohio State University Global One Health Initiative.

The One Health approach has gained support across a range of disciplines; however, training opportunities for professionals seeking to operationalize the interdisciplinary approach are limited. Academic institutions, through the development of high-quality, experiential training programs that focus on the application of professional competencies, can increase accessibility to One Health education. The Rx One Health Summer Institute, jointly led by US and East African partners, provides a model for such a program. In 2017, 21 participants representing five countries completed the Rx One Health program in East Africa. Participants worked collaboratively with communities neighboring wildlife areas to better understand issues impacting human and animal health and welfare, livelihoods, and conservation. One Health topics were explored through community engagement and role-playing exercises, field-based health surveillance activities, laboratories, and discussions with local experts. Educational assessments reflected improvements in participants’ ability to apply the One Health approach to health and disease problem solving, as well as anticipate cross-sectoral challenges to its implementation. The experiential learning method, specifically the opportunity to engage with local communities, proved to be impactful on participants’ cultural awareness. The Rx One Health Summer Institute training model may provide an effective and implementable strategy by which to contribute to the development of a global One Health workforce.

We used a community engagement approach to develop a One Health profile of an agro-pastoralist population at the interface of wildlife areas in eastern South Africa. Representatives from 262 randomly-selected households participated in an in-person, cross-sectional survey. Questions were designed to ascertain the participants' knowledge, attitudes, and practices with regard to human health, domestic animal health, and natural resources including wildlife and water. Surveys were conducted within four selected villages by a team of trained surveyors and translators over four weeks in July-August 2013. Questions were a combination of multiple choice (single answer), multiple selection, open-ended, and Likert scale. The study found that nearly three-quarters of all households surveyed reported owning at least one animal (55% owned chickens, 31% dogs, 25% cattle, 16% goats, 9% cats, and 5% pigs). Among the animal-owning respondents, health concerns identified included dissatisfaction with government-run cattle dip facilities (97%) and frequent morbidity and mortality of chickens that had clinical signs consistent with Newcastle disease (49%). Sixty-one percent of participants believed that diseases of animals could be transmitted to humans. Ninety-six percent of respondents desired greater knowledge about animal diseases. With regard to human health issues, the primary barrier to health care access was related to transportation to/from the community health clinics. Environmental health issues revealed by the survey included disparities by village in drinking water reliability and frequent domiciliary rodent sightings positively associated with increased household size and chicken ownership. Attitudes towards conservation were generally favorable; however, the community demonstrated a strong preference for a dichotomous approach to wildlife management, one that separated wildlife from humans. Due to the location of the community, which neighbors the Great Limpopo Transfrontier Conservation Area, and the livestock-dependent lifestyle of the resource-poor inhabitants, a One Health approach that takes into consideration the interconnectedness of human, animal, and environmental health is necessary. The community profile described in this study provides a foundation for health research and planning initiatives that are driven by community engagement and consider the multitude of factors affecting health at the human-domestic animal-wildlife interface. Furthermore, it allows for the determination and quantification of the linkages between human, animal, and environmental health.

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii, the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities ("dip tanks") were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9-30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002-1.06). Twenty-one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58-45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49-43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001-0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non-significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.

The interface between humans, domestic animals, and wildlife has been implicated in the emergence of infectious diseases and the persistence of endemic human and animal diseases. For individuals who reside at this interface, particularly those in low-resource settings, the development of disease risk assessment and mitigation skills must be prioritized. Using a community engagement-One Health approach, we implemented a training program aimed at advancing these skills among agro-pastoralists living adjacent to conservation areas in South Africa. The program included professional development of local facilitators who then conducted workshops with community members. Workshops used a series of experiential, inquiry-based activities to teach participants the concepts of pathogen transmission and disease risk assessment and mitigation. The program was implemented over four weeks with 10 facilitators and 78 workshop participants. We conducted a within-subjects experimental study using a mixed methods design to evaluate the program in terms of facilitator and participant One Health knowledge and practices. Quantitative data included pre/post written assessments; qualitative data included focus group discussions, semi-structured interviews, and pre/post photographs. Mean post-test scores of facilitators increased by 17% (p=0.0078). For workshop participants, improvements in knowledge were more likely for females than males (OR=7.315, 95% CI=2.258–23.705, p=0.0009) and participants with a higher versus lower education level, albeit borderline non-significant (OR=4.781, 95% CI=0.942–24.264, p=0.0590). Qualitative analysis revealed the implementation of risk mitigation strategies by 98% (60/61) of workshop participants during the three-month follow-up and included improved personal and domestic hygiene practices and enhanced animal housing. Although further evaluation is recommended, this program may be appropriate for consideration as a scalable approach by which to mitigate human and animal infectious disease risk in high-risk/low-resource communities. Keywords: Community engagement, Health promotion, Experiential learning, Risk assessment, Infectious disease, Program evaluation

A retrospective cohort study was conducted to determine the risk of bovine tuberculosis (TB) among animals sold out from herds that were free to trade animals during the year 2005 according to their bovine TB testing history during the year 2005. The present study sample comprised of 338,960 animals, of which 124,360 animals were sold out from herds that were restricted from trading at some stage during 2005 (bovine TB 'exposed') and 214,600 animals that were sold from herds which did not have their trading status withdrawn in 2005 (bovine TB 'non-exposed'). The overall risk of a diagnosis of bovine TB during the two-year period after the animals were sold out was 0.69 per cent. The odds of bovine TB were 1.91 higher for animals sold out from bovine TB 'exposed' herds compared with animals sold out from bovine TB 'non-exposed' herds (OR 95 per cent CI: 1.76 to 2.07, P0.0001). Ten per cent of animals identified during field surveillance with bovine TB did so less than two months after being sold out in 2005, and similarly, 10 per cent of the animals classified as bovine TB positive by finding a bovine TB lesion at slaughter did so within 25 days (or less) of being sold out in 2005.