Ranking disease control strategies with stochastic outcomes

GenPup-M: A novel validated owner-reported clinical metrology instrument for detecting early mobility changes in dogs

OBJECTIVE

To use a previously validated veterinary clinical examination sheet, Liverpool Osteoarthritis in Dogs (LOAD) questionnaire, combined with kinetic and kinematic gait analysis in dogs with/without mobility problems to demonstrate the capacity of a novel clinical metrology instrument ("GenPup-M") to detect canine mobility impairments.

DESIGN

Quantitative study.

ANIMALS

62 dogs (31 with mobility impairments and 31 without mobility impairments).

PROCEDURE

The dogs' clinical history was obtained from owners and all dogs underwent a validated orthopaedic clinical examination. Mobility impairments were diagnosed in the mobility impaired group based on clinical history and orthopaedic examination. Owners were asked to complete GenPup-M along with a previously validated mobility questionnaire (Liverpool Osteoarthritis in Dogs (LOAD)) to identify construct validity. As a test of criterion validity, the correlation between instrument scores and the overall clinical examination scores, along with force-platform obtained peak vertical forces (PVF) were calculated. GenPup-M underwent internal consistency and factor analysis. Spatiotemporal parameters were calculated for dogs with/without mobility impairments to define the gait differences between these two groups.

RESULTS

Principal Component Analysis identified GenPup-M had two components with Eigenvalues >1 ("stiffness/ease of movement" and "willingness to be active/exercise"). Cronbach's α was used to test internal consistency of GenPup-M and was found to be "good" (0.87). There was a strong, positive correlation between GenPup-M and LOAD responses (r2 = 0.69, p<0.001) highlighting construct validity. Criterion validity was also shown when comparing GenPup-M to clinical examination scores (r2 = 0.74, p<0.001) and PVF (r2 = 0.43, p<0.001). Quantitative canine gait analysis showed that there were statistically significant differences between peak vertical forces (PVF) of mobility impaired and non-mobility impaired dogs (p<0.05). Analyses of PVF showed that non-mobility impaired dogs more evenly distributed their weight across all thoracic and pelvic limbs when compared to mobility impaired dogs. There were also consistent findings that mobility impaired dogs moved slower than non-mobility impaired dogs.

CONCLUSION AND CLINICAL RELEVANCE

GenPup-M is a clinical metrology instrument (CMI) that can be completed by dog owners to detect all mobility impairments, including those that are early in onset, indicating the versatility of GenPup-M to assess dogs with and without mobility impairments. Results of the study found that GenPup-M positively correlated with all three objective measures of canine mobility and consequently showed criterion and construct validity. Owner-reported CMIs such as GenPup-M allow non-invasive scoring systems which veterinary surgeons and owners can use to allow communication and longitudinal assessment of a dog's mobility. It is anticipated that GenPup-M will be used by owners at yearly vaccinations/health checks, allowing identification of any subtle mobility changes, and enabling early intervention.

Health risk assessment with multiple reference indices

BACKGROUND

Conducting a risk assessment can be challenging, especially when dealing with several reference indices, which could lead to conflicting conclusions between studies. The common approach is to use a reference index from a single source based on the risk assessor's preference.

OBJECTIVES

To propose an approach for constructing a multi-reference index-based aggregated risk estimate using mathematical objectivity to reflect all of the available information.

METHODS

The aggregated risk estimate based on multiple reference indices (AREMRI) results from the weighted linear combination of risk distributions that were obtained with each reference index available. The weights were calculated using the degree of agreement among the reference index-based risk distributions. The approach is illustrated through three practical cases of benzene inhalation cancer risk assessment using inhalation unit risks (IURs) from six different regulatory agencies.

RESULTS

The degrees of agreement between the reference index-based risk distribution, obtained with the six IURs, ranged from 0.7 to 92%. The highest weights were attributed to reference index-based risk distributions that had the highest degree of agreement with the maximum number of other reference index-based risk distributions. Regardless of the practical case considered, the AREMRI risk distribution resulted in the third highest risk compared to the six single risk distributions.

CONCLUSION

Our approach can be useful in the presence of several reference indices by providing useful insights, consistency and direct comparisons between studies to support better-informed risk assessment and management decisions. This approach can shed some light on some of the uncertainties associated with the toxicological reference values in a risk assessment associated with the toxicological reference values. If the uncertainty is large, more detailed evaluation of the toxicological reference values would be needed.