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truth. Such expressions of confidence (ie, subjective probability or uncertainty) depend on the factors listed above rather than objective data. Indeed, providing objective probability estimates would be impossible because of the factors involved

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in Journal of the American Veterinary Medical Association

single value for each input variable, and the amount of uncertainty or variation around that value is not considered. 12,13 Alternately, stochastic risk analysis models use probability distributions estimated from historical data or deduced from expert

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in Journal of the American Veterinary Medical Association

, and the main reasons they chose to not report abuse were uncertainty about whether it was actually abuse and a desire to educate their clients instead of reporting them to the authorities. The survey respondents appeared to be fairly representative

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in Journal of the American Veterinary Medical Association

Summary

The complexity and uncertainty of diagnostic information makes the diagnostic process difficult to learn, teach, and practice. Fuzzy logic methods, used successfully with complex industrial control problems, may be appropriate to model the range of uncertainties found in medical diagnostic information. A fuzzy systems model for use with diagnostic and other medical decisions is described. Combining a state space view of an animal in which each dimension of the space represents a variable of the animal with a fuzzy sets representation of the variables and states of the animal leads to a fuzzy systems model, which can be used to successfully diagnose disease. Partitioning the multidimensional state space of the animal into healthy and specific disease regions provides a diagnostic space for evaluating the health of the animal. When an input vector representing the variables of a sick animal is entered into the system, the model can provide a diagnosis and, potentially, a prognosis for that animal. The model can be implemented on a desktop computer for convenient use, and it provides a helpful geometric interpretation of the concepts of "diagnosis" and "prognosis" for teaching diagnostic reasoning. The fuzzy systems approach has advantages that are unavailable in other methods. The capability of fuzzy systems to act as universal approximators allows them to accomodate complex, nonlinear, imprecise, and even conflicting relationships to provide accurate knowledge representation. With these advantages over standard rule-based methods of modeling the medical diagnostic process, fuzzy expert systems have broad potential for use in medicine and warrant further study to determine their application and possible limitations. (J Am Vet Med Assoc 1997;210:390-396)

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in Journal of the American Veterinary Medical Association
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Abstract

Antibiotic recommendations for treating skin infections have been published many times in the past 30 years. Prior to 2000, the recommendations focused on the use of β-lactam antibiotics, such as cephalosporins, amoxicillin-clavulanate, or β-lactamase stable penicillins. These agents are still recommended, and used, for wild-type methicillin-susceptible strains of Staphylococcus spp. However, since the mid-2000s there has been an increase in methicillin-resistant Staphylococcus spp (MRSP). The increase among S pseudintermedius in animals coincided with the increase in methicillin-resistant S aureus that was observed in people near the same time. This increase led veterinarians to reevaluate their approach to treating skin infections, particularly in dogs. Prior antibiotic exposure and hospitalization are identified as risk factors for MRSP. Topical treatments are more often used to treat these infections. Culture and susceptibility testing is performed more often, especially in refractory cases, to identify MRSP. If resistant strains are identified, veterinarians may have to rely on antibiotics that were previously used uncommonly for skin infections, such as chloramphenicol, aminoglycosides, tetracyclines, and human-label antibiotics such as rifampin and linezolid. These drugs carry risks and uncertainties that must be considered before they are routinely prescribed. This article will discuss these concerns and provide veterinarians guidance on the treatment of these skin infections.

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in Journal of the American Veterinary Medical Association

OBJECTIVE

To explore veterinarians' perceptions and veterinary experts' opinions regarding antimicrobial stewardship (AMS) on dairy farms in the western United States.

SAMPLE

20 dairy veterinarians and 9 AMS experts.

PROCEDURES

3 focus group discussions involving 20 dairy veterinarians from California, Idaho, and Washington and an expert opinion study involving 9 North American AMS experts were conducted. During focus group discussions, participants were asked open-ended questions regarding implementation of AMS programs on dairy farms. Discussions were recorded and transcribed for thematic analysis. An asynchronous nominal group process was used for the expert opinion study. Participants were asked to complete a series of 3 online surveys consisting of open-ended questions. Expert opinion data underwent thematic analysis and were compared with results obtained from focus group discussions.

RESULTS

Veterinarian-perceived barriers to implementation of AMS on dairy farms included variable relationships with clients and farm employees, ensuring AMS provided value to the farm, and uncertainty about regulations for monitoring on-farm antimicrobial use (AMU). Veterinarians were willing to accept additional responsibility for AMU provided that protocols were adopted to ensure them more complete control of on-farm AMU and they were compensated. The AMS experts indicated that effective implementation of AMS on dairy farms requires producer buy-in and tools to facilitate treatment protocol development and monitoring.

CONCLUSIONS AND CLINICAL RELEVANCE

Additional veterinary oversight of AMU on dairy farms will require engagement by both veterinarians and producers and practical value-added methods for AMS. Continuing education programs should address treatment protocol development, AMU monitoring strategies, and employee training.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine the frequency of nonspecific clinical signs in dogs with separation anxiety, thunderstorm phobia, noise phobia, or any combination of these conditions and determine whether these conditions are associated in dogs.

Design—Case series.

Animals—141 dogs.

Procedure—Diagnoses were established using specific criteria. Owners of dogs completed a questionnaire on how frequently their dogs exhibited destructive behavior, urination, defecation, vocalization, and salivation when the owners were absent and the types and frequency of reactions to thunderstorms, fireworks, and other noises.

Results—Associations of the 3 conditions and of various nonspecific clinical signs within and between diagnoses were nonrandom. The probability that a dog would have separation anxiety given that it had noise phobia was high (0.88) and approximately the same as the probability it would have separation anxiety given that it had thunderstorm phobia (0.86). However, the probability that a dog would have noise phobia given that it had separation anxiety (0.63) was higher than the probability that it would have thunderstorm phobia given that it had separation anxiety (0.52). The probability that a dog would have noise phobia given that it had thunderstorm phobia (0.90) was not equivalent to the converse (0.76).

Conclusions and Clinical Relevance—Results suggested that dogs with any of these conditions should be screened for the others. Interactions among these conditions are important in the assessment and treatment of dogs with > 1 of these conditions. Responses to noise were different from those to thunderstorms, possibly because of the unpredictability and uncertainty of thunderstorms. (J Am Vet Med Assoc 2001;219:467–473)

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in Journal of the American Veterinary Medical Association

philosophy of medicine. Decisions in medicine are based not, as commonly believed, on certainty but on degrees of uncertainty. 2 Our ability to define and handle this uncertainty surely is the core of our expertise. Step outside the clinical area into any of

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in Journal of the American Veterinary Medical Association

level of confidence associated with an interpretation of the submitted sample. These studies have demonstrated disconnect between the intended degree of certainty (or uncertainty) that the pathologists hope to convey with specific modifying terms and the

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in Journal of the American Veterinary Medical Association
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Dana Peterson, chief economist at The Conference Board. She will provide information on the current economic climate, actions to take for long-term success, and how to be strategic in the face of economic uncertainty, including our current inflationary

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in Journal of the American Veterinary Medical Association