A new study, published in the Equine Veterinary Journal (EVJ)1 has concluded that whilst horse owners are increasingly looking to vets for worm control advice and use faecal worm egg counts more frequently, they remain largely unaware of the threat of resistance to dewormers and the importance of appropriate 'targeted' dosing.
The authors of the study say that although the findings are encouraging, they indicate that further effort is needed to help owners fully understand the issue of dewormer resistance, in order to help preserve the efficacy of dewormers currently available and protect the health and welfare of their horses.
According to the British Equine Veterinary Association (BEVA), resistance of equine gastrointestinal worms to the currently available dewormers is a serious problem. The association says small redworm are the greatest concern, given their very high prevalence, potential to cause life-threatening disease and high levels of resistance. Of the three classes of anthelmintic available for their control, there is now widespread resistance to benzimidazoles (e.g. fenbendazole) and tetrahydropyrimidines (e.g. pyrantel) and reduced effectiveness of macrocyclic lactones (ivermectin and moxidectin). With no new classes of dewormer on the horizon, it's essential that efficacy of existing effective products is preserved.
The study was conducted by a UK team, led by Claire Stratford, Horse Trust Clinical Scholar in Equine Medicine at the Royal (Dick) School of Veterinary Studies, and at Moredun Research Institute. The collaborators were also supported by funding from the Elise Pilkington Trust and Horserace Betting Levy Board.
The study examined equine helminth control practices in Scotland, and was based on responses from 193 questionnaires detailing the parasite control programmes of 993 horses and ponies. The results demonstrated a lack of awareness of the significance of dewormer resistance, with 86% of respondents stating that they were unaware of the presence of resistance on their yard. The majority were relatively unconcerned about dewormer resistance, assigning a score of only 6/10 (with 10 representing highest level of concern) when asked to grade how important they perceived it to be.
On a more positive note, many respondents stated that they involved their vet in planning control strategies. Faecal worm egg count (FWEC) analysis had been performed on 62% of yards and annual treatment frequency had been reduced accordingly. The macrocyclic lactones or related combination products were the most commonly administered products; however, owners did have misconceptions regarding the specific worms they should be targeting.
Although treatments licensed for use against encysted small redworm larvae were administered by 80% of respondents, only 57% perceived that they treated for this parasite stage. Similarly, only 78% of respondents believed they were treating for tapeworm when, in fact, 90% reported using a product licensed for tapeworm treatment.
While responses indicated increased implementation of strategic (44% respondents) or targeted control (40% respondents), variations in the apparent influence of the targeted approach on treatment practices suggested some confusion over this term. Claire Stratford said: "Targeted dosing involves using regular FWEC analysis to identify an individual's egg shedding level. This is currently considered best practice, when used in conjunction with annual dosing against encysted small redworm and tapeworm. The survey indicates a need for continued knowledge transfer, together with a consistent definition of 'targeted' treatment."
Professor Celia Marr, Editor of Equine Veterinary Journal said: "It's very encouraging to see that vet advice is being increasingly sought and it seems logical that the use of FWECs is rising accordingly. But, it is equally important that the information gained from the FWECs is used wisely. Resistance to dewormers is a major health concern that is with us right now and horse owners need to be made more aware of it."
Reference
The British Equine Veterinary Association (BEVA) has released the results of a survey carried out earlier this year which has found that there may be up to 5 times as many veterinary graduates wanting to work in equine practice as there are jobs available.
The survey was carried out amongst the 2,500 vets and vet students who are members of BEVA to help ascertain manpower requirements of equine practices in the UK.
Of the 819 new veterinary graduates in the UK in 2012, BEVA says it estimates conservatively that between 10-15% intend to work in equine practice. Meanwhile, the extrapolated results of the survey suggest that in 2012 there was less than 1% growth in full time equine vet positions and as few as 24 new permanent jobs available in the UK.
BEVA says that in line with the survey's suggestion of restricted opportunities, some of its members are also finding that internships, commonly the domain of new graduates to gain paid, supervised experience in practice, are now often taken by vets with some post-graduate experience. Furthermore, unpaid externships, which traditionally gave vet students valuable work experience, appear to be being filled by unemployed veterinary graduates wanting to gain experience in order to improve their chances of securing a job in equine practice.
Tim Mair, a partner at Bell Equine Veterinary Clinic in Kent said: "Earlier this year we had more than 80 applications for just one internship. Several years ago we would expect 50 or so applications for an advertised intern post but now, without advertising at all, we are constantly receiving applications, not just from new graduates but also from those who have been qualified for a year or more."
Charlie Schreiber, a partner at Donnington Grove Veterinary Surgery in Berkshire, said: "We take on an average of two externs a month and over the past four years have had more than 350 applicants but their calibre is noticeably changing. We used to hear primarily from students but now it tends to be recent graduates or those who have already done a job in mixed practice and are keen to move into equine but can't find an internship."
Andrew Harrison, a partner at Three Counties Equine Hospital in Gloucestershire, said: "In addition to the numerous applications we received for our recently advertised internship position, we are inundated with unsolicited enquiries about job opportunities from recent veterinary graduates from across the globe. Our most recent advertisement for an equine veterinary nurse has attracted interest from a handful of recently qualified vets desperate to find work. This employment problem is not confined to internships; some of our recent interns have found it very difficult, if not impossible to find a job in horse practice, once they've completed their internship."
Amanda Piggot, a recent graduate, has first hand experience of the challenge of finding a suitable placement. She said: "I have always wanted to work in equine practice and my approach has been very strategic. It took me five months to find my current position at Kessock Equine Vets in Inverness, which necessitated moving 500 miles further north than I ideally wanted. For my next position I applied to Liphook twice and had no luck but I have now been accepted by Rossdales for a two year internship."
According to the British Veterinary Association (BVA) the problem isn't confined to equine practice. The Association's President Peter Jones said: "The findings of the BEVA survey make sober reading and reflect the growing concerns in the wider veterinary profession about opportunities for new graduates in all types of veterinary practice.
"The issue has recently been brought into sharp focus by the announcement of a new veterinary school opening at the University of Surrey in 2014, with many BVA and BEVA members worried about an oversupply of veterinary graduates into an already competitive market. We are expecting the results of the RCVS survey of recent graduates shortly and, alongside the findings of the BEVA survey, they will provide an evidence-base to build on as we continue to assess the UK veterinary manpower implications of potential new veterinary schools in the future."
BEVA is keen to help both potential employees and employers tackle the situation as constructively as possible. BEVA President Keith Chandler said: "BEVA is proud that equine practice is attractive to so many younger members of the profession and it can provide a rewarding and fulfilling career. However we urge all stakeholders to ensure that current and prospective veterinary students are fully aware of the very limited opportunities in equine practice. Most of all we urge the students themselves to consider carefully their career path and prospects before making their final decisions."
Next month the RCVS will be releasing details of a survey of vets who have graduated within the past five years and how easy they have found it to find a job that meets their needs.
A new study published this month in the Equine Veterinary Journal (EVJ)1 has concluded that toxins from the seeds of the sycamore tree (Acer pseudoplatanus) are the likely cause of Atypical Myopathy (AM) in Europe.
However, to avoid confusion, the authors of the study point out that the American Sycamore (also just called 'the sycamore' in the USA), is a completely different species: Platanus occidentalis. Furthermore, the sycamore found in the UK is also known as the sycamore maple in other countries.
The new research follows on the heels of a study in the USA earlier this year that linked toxins from the box elder tree (Acer negundo) with Seasonal Pasture Myopathy (SPM), the US equivalent of AM2. The discovery marks an important step for the future prevention of this fatal disease.
Atypical Myopathy is a highly fatal muscle disease in the UK and Northern Europe. In ten years, approximately twenty European countries have reported the disease. Incidences tend to occur repeatedly in the autumn and in the spring following large autumnal outbreaks. Horses that develop AM are usually kept in sparse pastures with an accumulation of dead leaves, dead wood and trees in or around the pasture and are often not fed any supplementary hay or feed. SPM is a very similar disorder, prevalent in Midwestern USA and Eastern Canada that is now known to be caused by the ingestion of hypoglycin A, contained in seeds from the box elder tree.
The new European research1 was conducted by an international team led by Dominic Votion, University of Liege and involved 17 horses from Belgium, Germany and The Netherlands, suffering from Atypical Myopathy. High concentrations of a toxic metabolite of hypoglycin A, were identified in the serum of all of the horses. The pastures of 12 of the horses were visited by experienced botanists and the Acer pseudoplatanus, the sycamore maple, was found to be present in every case. This was the only tree common to all visited pastures.
Researchers believe hypoglycin A is the likely cause of both AM in Europe and SPM in North America. The sycamore and the box elder are known to produce seeds containing hypoglycin A and the pastures of the afflicted horses in Europe and the USA were surrounded by these trees.
Hypoglycin-A is found in various levels in the seeds of plants in the genus Acer as well as in various other genera in the family Sapindaceae such as ackee (Blighia sapida). In ackee, hypoglycin-A levels do vary with ripeness of the fruit and, if the fruit is eaten before it is mature, it causes hypoglycaemia to different degrees including a condition called "Jamaican vomiting sickness" (because of ackee's use in Jamaican cooking) and occasionally death in humans.
Researchers at the Universities of Minnesota2 and Liege are continuing their work to try to uncover exactly how the equine disease occurs. Dr Adrian Hegeman of University of Minnesota said: "It is likely that the most important contributing factors to horses becoming poisoned by hypoglycin-A are the availability of seed in the field combined with lack of other feeding options. The seeds from two species of maples (box elder and sycamore maples) that we have tested include significant quantities of hypoglycin-A.
"We know that seeds contain highly variable quantities from seed to seed, even within a single tree. We do not know yet how hypoglycin-A levels vary seasonally, nor do we know how its abundance varies with different levels of stress to the plant, though this may well explain seasonal variability in the occurrence of the malady. It is possible that conditions that stress the plants may contribute to significant seasonal changes in hypoglycin-A levels. At this point we just don't know. It is common held knowledge that trees under stress usually produce more seed."
Dr Jeff Gillman of University of Minnesota said: "Without question, further analysis of the seeds and other tissues from Acer species needs to be performed along with sampling of plant materials over multiple seasons and at various stress levels. Additionally, one cannot rule out more complex explanations for the seasonality of disease occurrence such as: animals may begin feeding on seed materials in response to depletion of more palatable choices under drought conditions; or simple explanations such as high wind events driving seeds into fields. These sorts of explanations for the occurrence of the disease do not depend on botanical variations in toxicity across seasons, sites or stress levels, yet also require consideration.
"Although limited examples are available, the experience of animals at a pasture site might also confer some degree of behavioral resistance to poisoning due to exposure at sub-lethal levels with prior exposure to seeds in the pasture."
Professor Celia Marr, Editor of Equine Veterinary Journal said: "This is an important advancement in our understanding of what causes AM and how it can be prevented. In immediate practical terms owners can take prompt measures to avoid exposing their horses to sycamore seeds this autumn. Where horses are grazing in the vicinity of sycamore trees, it is imperative that they are provided with sufficient supplementary feed as this will minimise the risk that horses might be tempted to ingest seeds containing this toxin. This must be done carefully and leaving wet hay on the ground should be avoided so providing extra carbohydrate feeds may be more practical."
References
Equine vets at the Animal Health Trust are appealing to horse riders to help with a research project, to assess the interaction between horse, saddle and rider.
Dr Sue Dyson, Head of Clinical Orthopaedics at the Centre for Equine Studies at the Animal Health Trust and Line Greve, PhD student, are conducting the study to find out how the horse, rider and saddle can influence each other. They are trying to understand better why a saddle may persistently slip to one side in some horses.
Line said: "Saddle slip is a problem seen in all sorts of horses and ponies and can contribute to back pain and thus impaired performance. Research suggests that 25% of British dressage horses have a history of back-related problems and subsequent reduced performance. Our preliminary studies involve just over 700 riders but for a more accurate picture we would like to bump this figure up to 1000 plus. We are urging all riders, whatever their level or ability, to help by completing the questionnaire."
The online questionnaire should take no more than 15 minutes to complete and all answers remain anonymous. The questions cover saddle types, fitting, use and maintenance; rider experience, training and 'handedness'; as well as horse type, use and any previous lameness or back-related problems.
To take part in the study, complete the questionnaire here: http://www.aht.org.uk/cms-display/premise_questionnaire.html. The AHT says that by doing so, you'll be helping to protect and improve the future health, welfare and longevity of the ridden horse.
The results will be presented at the Saddle Research Trust Conference in 2014.
Chanelle has announced the launch of Ketamidor 100 mg/ml Solution for Injection (ketamine), licensed for use in cats, dogs, horses, cattle and swine in the UK and Ireland.
The company says the new product provides a versatile addition to anaesthetic regimes. It can be used in combination with other widely-used anaesthetics and sedatives. Chanelle says it also has analgesic properties that make it particularly beneficial to include in anaesthetic protocols when carrying out painful surgical procedures.
Ketamidor 100mg/ml Solution for Injection has a zero day withdrawal period for milk and meat when used in cattle and pigs, allowing high welfare standards to be maintained without compromising economic returns.
According to Chanelle, ketamine is now experiencing a resurgence of interest as its analgesic properties and minimal impact on spontaneous respiration become increasingly appreciated.1
Angela Wilkin, Chanelle UK's Sales and Marketing Manager said: "Ketamidor makes a great addition to our portfolio of pain management products. Our territory managers are looking forward to speaking to those vets who are already accustomed to using ketamine and those that may be considering adding it to their current protocols."
Zoetis, maker of Zylexis, is highlighting a new review published in Veterinary Immunology and Immunopathology, which has concluded that immune-modulators may provide a valuable contribution to the reduction of some equine respiratory diseases
The study reviewed the immune-modulators Parapoxvirus ovis and Propionbacterium acnes for the prevention of respiratory disease and other infections in the horse.
Parapoxvirus ovis (iPPVO) and Propionibacterium acnes (P.acnes) are currently used in equine medicine as immune-modulators for prophylactic treatment or adjunct to conventional therapy in order to improve immune defences, to prevent or treat infectious diseases. Their mode of action relies on a non-antigen-specific interaction with the innate and/or adaptive immune responses. iPPVO stimulates and regulates cytokine secretion by a number of leucocytes, while P. acnes acts primarily through activation of macrophages.
The review, conducted by Romain Paillot of the Animal Health Trust, Centre for Preventive Medicine, Newmarket, examined current scientific literature and reports on the use of immune-modulators in horses, particularly for the prevention or treatment of equine respiratory disease.
Stress factors such as weaning, transport and co-mingling predispose horses to infection and increase susceptibility to respiratory pathogens such as Streptococcus zoopidemicus and EHV-1/4. In the past 15 years iPPVO has been tested against several equine infectious respiratory diseases.
The review examined the results of studies on the beneficial use of iPPVO to limit the severity of respiratory infectious diseases in young horses, one of which evaluated the use of iPPVO for protection in yearlings exposed by contact challenge to EHV-1 or EHV-42,3,4. Yearlings treated with iPPVO were co-mingled with horses experimentally infected with EHV-1 and the trial was repeated with horses infected with EHV-4. Horses treated with iPPVO showed a 40% reduction in disease severity in the EHV-1 study and a 61% reduction in the EHV-4 study.
Further studies showed significantly increased frequency of recovery in horses with clinical signs of respiratory disease that had been treated with P. acnes. The decrease in disease severity was also significantly improved in the treated groups5,6.
Romain Palliot concluded: "Non-specific immune-modulators such as iPPVO or P. acnes may not provide protection against direct infection or transmission of respiratory pathogens but they seem to contribute to the reduction of the disease severity, subsequently reducing the frequency of complications and improving the rate of recovery."
A new study published in Equine Veterinary Journal's (EVJ) in partnership with the American Association of Equine Practitioners, has shown that a wireless, inertial sensor-based system can effectively measure a horse's response to a flexion test.
The authors say that opinions on the value of flexion tests in assessing equine lameness have been divided for many years, but their research should turn what has always been regarded as a subjective process into a wholly objective one.
Flexion tests are used routinely in horses with subtle or imperceptible lameness, to exacerbate the problem and make it apparent to the observer. The test involves applying a short period of pressure to the joints of the limb before re-examination, and evaluating any change in gait. However, flexion tests rely on the ability of the observer to identify and interpret changes in the horse's gait and in that respect these tests are subjective and not necessarily consistent between observers.
The research study was conducted by orthopaedic surgeons based at the University of Glasgow's School of Veterinary Medicine1. A total of 17 healthy adult horses, all in work, were fitted with sensors before being trotted in a straight line. The sensors measured vertical pelvic movement asymmetry for both right and left hind limb strides and the average difference in maximum and minimum pelvic height between right and left hind limb strides. A hind limb was randomly selected for 60 seconds of proximal flexion, after which the horse was trotted for a minimum of 10 strides. Response to the flexion was blindly assessed as negative or positive by an experienced observer.
John Marshall, lecturer in equine surgery at the University of Glasgow, who led the study, said: "A positive response to flexion resulted in significant changes to objective measurements of pelvic symmetry, supporting the use of inertial sensor systems to objectively assess response to flexion tests."
Professor Jim Moore, North American Editor of the EVJ, said: "The introduction of an objective approach to documenting lameness examination will not only help vets and trainers to investigate equine lameness more accurately. It will also serve as an unbiased method of communicating lameness examination findings among vets, trainers, farriers and other professionals."
The next phase of research will be to establish cut-off values for objective assessment of other equine lameness diagnostic procedures, such as nerve blocks.
The British Equine Veterinary Association (BEVA) has announced that it is reducing the cost of its CPD by 50% this year and making its webinars free to members.
David Mountford, Chief Executive of BEVA said: "Last year we were able to capitalise on some efficiencies in other areas of BEVA operations. We are delighted to be able to hand the resulting benefits directly back to our members across all our CPD programme during 2013."
The Association says its CPD covers a broad range of topics is aimed at busy vets who need to build CPD points, whether new graduates, equine or mixed practitioners. It takes the form of clinical workshops, regional meetings, nursing meetings, webinars and one, two and three day practical courses, held in the UK.
This year's courses include:
For more information, visit http://www.beva.org.uk/news-and-events/beva-courses or ring +44(0)1638 723555 or email info@beva.org.uk.
Richard Hepburn MRCVS has launched what is thought to be the world's first equine gastric ulcer study, designed to improve understanding and knowledge of ulceration in performance horses.
Mr Hepburn is conducting the InnerVision study of performance horses, which is being championed by the University of Liverpool, as part of his PhD.
21 appointed practices across the UK are participating in the study, and with each practice scoping between 10 and 20 animals, it will include well over 200 performance horses. Mr Hepburn said: "Gastric ulceration in sports horses is poorly understood, especially compared with racehorses. But what we do know is that it's a very important factor in the performance and well-being of many horses in training and competition."
2012 Paralympic Gold medallist Deb Criddle MBE also attended the launch event. She explained the difference that regular gastroscopy and ulcer management of Paralympic team horses had made to her success. Speaking about her Beijing ride, Pavaroti, she said: "If it weren't for the diagnosis and treatment of Pavaroti's ulcers I don't know what we'd have done. I would probably have had to withdraw him from training, so it made the difference between our partnership continuing or not".
Mr Hepburn expects a prevalence of approximately 60% and, keen to increase understanding of glandular ulceration, participants are being tasked to scope all areas of the stomach, pylorus and duodenum to ensure that every incidence of ulceration is diagnosed and recorded.
He says he is particularly eager to find out more about glandular disease, which hitherto has had little research: "Glandular disease appears to have a very different aetiology to squamous ulceration, and often presents with different signs. We also believe that prevalence of glandular ulceration is most common in sports horses."
"We hope that publication of this study will help all equine vets in their work with performance horses and the quest to prevent and manage equine ulcers," he added.
Merial is supporting the study with management assistance.
Virbac has launched Inflacam, a meloxicam-based NSAID for the alleviation of pain in both acute and chronic musculo-skeletal disorders in dogs and horses.
Inflacam is presented both as an oral suspension and as a chewable tablet for dogs. The suspension is available in 200ml, 100ml, 42ml and 15ml sizes with a measuring syringe provided. The tablets come in two sizes - 1 mg and 2.5 mg - and are available in packs of 100. It is available for horses as an oral suspension.
Virbac Product Manager Chris Geddes MRCVS, said: "Virbac is well known for launching innovative products in areas such as dermatology and reproduction but we also aim to support practices by offering tried and trusted practice 'standards' for everyday use. Inflacam fits this brief well - meloxicam is the most commonly-used NSAID in dogs and we are delighted to add it to our range."
For more information contact your territory manager or call Virbac on 01359 243 243.
Six individuals have been announced as the winners of the second annual Ceva Animal Welfare Awards, honoured for their contributions to the prevention and reduction of animal welfare problems in the UK and abroad.
All winners were originally nominated by friends, colleagues or family. The judging panel consisted of panel chairman and veterinary surgeon Chris Laurence MBE, Ross Tiffin of the International Cat Care (formerly the Feline Advisory Bureau), Dennis Baker, OBE, Chief Executive at Wood Green, the Animal Charity and media vet, Joe Inglis. Marc Abraham also assisted in the Volunteer categories.
Dr. Pascal Raoul, Ceva's Head of Global Pharmaceuticals, said: "Ceva is delighted to host these Animal Welfare Awards as they help to highlight the incredible affection and care that people have for animals. With 6 billion people living in megacities in the future, companion animals will often be their major link to nature. The benefits that animals have on improving human health are well documented; in turn we all have a duty to protect them and this evening we have seen some of the best examples, from professionals, members of the public, young and old as to how that should be done."
Timothy Phillips, a Plymouth-based vet from the Elm Veterinary Group (above right), was awarded the Chris Laurence Vet of the Year Award for his 15 years of charitable work in the Greek Islands with Friends of the Strays of Greece. Tim performs surgeries and other treatments, helping to establish a re-homing system, with dogs fully vaccinated and declared healthy by the vets before being flown out of Greece.
Veterinary Nurse Scott Parry of Bridge Veterinary Surgery was awarded Welfare Nurse of the Year for his work with the RSPCA's Brent Knoll Animal Centre. Scott has spent hours of his own time raising funds and helping with the rehabilitation of a number of traumatised dogs. He also recently assisted in an RSPCA visit to a travellers' camp to vaccinate more than 50 dogs following an outbreak of Parvo Virus on the site.
Other award winners included Logan McKerron, aged 6, who was awarded Young Person of the Year for his fundraising for Hearing Dogs for Deaf People; Kim Taylor, co-founder of the charity Animal Care Egypt, was awarded the Charity Professional of the Year accolade for her work setting up a large animal hospital helping more than 26,000 animals every year; Faye Stacey of People4Ponies in Devon was awarded the UK Volunteer of the Year Award for the large part she has played in stopping ear cutting, notching and tagging of equines in the UK; Jen White has been named International Volunteer of the Year for her work with the Gambia Horse and Donkey Trust.
Zoetis, formerly Pfizer Animal Health has launched Ovatec Plus, which it claims will make equine faecal collection and in-practice worm count testing quicker and easier.
Ovatec Plus is designed to facilitate the in-house detection of worm burdens by enabling the coproscopic examination of parasite eggs, larvae and cysts. Zoetis says the built-in sample collection scoop allows for hands-off, quick, clean sample collection and controlled sample size, while the built-in cap, which can be written on for easy identification, snaps shut to seals the contents safely for contamination-free transport.
The system is based on zinc sulphate flotation technology, with a flotation time of ten minutes to provide rapid analysis. The Ova-Spin feature will break up difficult samples. The positive-locking filter chamber prevents any spill of test samples and reduces operator exposure to potential hazards. The overflow reservoir prevents overfills leaking onto the lab bench.
Zoetis says the high sensitivity and excellent specificity of Ovatec Plus enable informed treatment decisions to be made. A study has shown that samples proving negative with Ovatec Plus provide 95% certainty that the sample is <150epg and 100% certainty that the sample is <250epg, which means treatment may not be necessary1. Samples that prove positive, with one or more eggs seen, can be verified using a quantitative technique if needed, alternatively treatment may be indicated.
Ben Lacey, equine business unit manager at Zoetis, said: "Ovatec Plus is an excellent addition to our equine worm control portfolio. It's ideal for use in many test situations, giving a quick, easy and convenient solution."
To find out more, speak to your Zoetis Account Manager, call 0845 300 8034 or email CustomerSupportUK@zoetis.com.
Kruuse has launched a range of seven specialized sterile surgical disposable drapes and gowns developed for the surgery team working in equine clinics or hospitals.
The company says its new surgical sets have been designed so they include a comprehensive set of sterile drapes, towels, instrument covers and adhesive tapes needed to perform particular procedures:
Andrew Groom, Managing Director, Kruuse UK Ltd. said: "This exciting new range of products increase the Kruuse's equine product portfolio and develop further our commitment to provide specialist species available products to support the veterinary practitioner."
Boehringer Ingelheim has announced that its 'Talk About Laminitis' campaign will run from Mid March until the end of June.
Last year, the initiative saw over 9000 horses and ponies tested for PPID through its free ACTH test scheme. This year, to build on this success and support the testing of even more animals, the company has announced a high impact, co-ordinated campaign to drive awareness that up to 90% of laminitis cases may have an underlying endocrine cause1,2.
Once again, Boehringer is urging veterinary surgeons to carry out free ACTH blood tests on laminitic or foot-sore horses as part of the campaign, which is backed by Redwings, The British Horse Society and World Horse Welfare.
Professor Andy Durham from the Liphook Equine Hospital, where the ACTH tests are performed, said: "We are learning so much from these tests. For example, we are now recognising PPID routinely in laminitic horses and ponies as young as 10 years old, and in the spring when we might expect to see more EMS cases, where veterinary surgeons have also tested for PPID we are seeing both abnormally elevated ACTH and insulin. Unless the PPID is addressed, horses will continue to be at risk of painful recurrent laminitic episodes which is a significant welfare issue to the horse and extremely frustrating for owners."
To participate in the scheme, veterinary surgeons and horse owners can download ACTH blood test vouchers from www.talkaboutlaminitis.co.uk. Attach the voucher to the ACTH sample submission form and the ACTH laboratory fees will not be charged.
Lee Hackett from The British Horse Society said: "Without the 'Talk About Laminitis' initiative and the support of Boehringer Ingelheim, literally thousands of horses may not be receiving the appropriate treatment and management for their laminitis to help prevent recurrence. We hope as many veterinary surgeons as possible get involved this year to continue this welfare success."
To ensure that horse owners are fully aware of the initiative, a PR and advertising campaign in the equine consumer media will start in March. The ad campaign includes an infomercial on Horse & Country TV (SKY Channel 280), with viewer numbers in excess of 450,000 per month.
There will also be a live online broadcast for horse owners on endocrinopathic laminitis presented by David Rendle BVSc MVM CertEM(IntMed) DipECEIM MRCVS, from the Liphook Equine Hospital in Hampshire. The one-hour webinar, which takes place at 8.00pm on Wednesday 10 April, will educate horse owners on how the veterinary profession's understanding of this debilitating and devastating disease has been completely revolutionised over the past five years. It will be followed by an interactive Q&A session when viewers will be able to pose questions for David to answer.
David said: "As our knowledge of the two hormonal diseases responsible for the majority of cases of laminitis improves, veterinary surgeons can offer their clients more comprehensive advice on treatment options to prevent laminitis. For many owners who have struggled with this condition, this is an absolute revelation and has enormous welfare benefits".
Horse owners can register to view the online programme by visiting www.talkaboutlaminitis.co.uk.
To ensure that veterinary surgeons are versed in the most up to date research available, Boehringer Ingelheim will also be hosting a webinar for veterinary professionals at 8.00pm on Wednesday 13th March, presented by Professor Andy Durham BSc BVSc CertEP DEIM DipECEIM MRCVS. The online seminar, 'The laminitis revolution.... An update on our understanding of endocrinopathic causes of laminitis', will entitle the viewer to a downloadable certificate for one hour of CPD. To register, visit www.bi-academy.co.uk. Places are limited, so register early to avoid disappointment. The webinar will also be available to view after the event on demand.
For further information on how you can promote 'Talk About Laminitis' in your practice contact your Boehringer Ingelheim Territory Manager or call 01344 746959
1. Karikoski et al. (2011). The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital. Domestic Animal Endocrinology 41 111-117
2. Donaldson et al. (2004). Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis. J Am Vet Med Assoc;224:1123-1127.
A new study1 published in the Equine Veterinary Journal's (EVJ) special American Association of Equine Practitioners supplement has concluded that maggots can play an integral role in modern veterinary care for a variety of wounds in horses.
The study assessed the efficacy of maggot debridement therapy in a diversity of equine lesions and found that the method was beneficial in 93% of cases.
Maggots have been used for the treatment of wounds for hundreds of years. Freshly emerged, germ-free larvae of the common green bottle fly are usually used for the purpose. Their wound-healing action is attributed to a debridement effect, an antiseptic effect, a direct effect on cytokine and cell proliferation involved in wound healing and breakdown of biofilm formation. Maggots also destroy and digest bacteria and may also be beneficial in the fight against multi-drug-resistant bacteria such as MRSA.
The study involved the retrospective analysis of 41 horses with various lesions including foot injury, limb laceration, soft tissue abscesses and musculoskeletal infection. Depending on the type, size and location of the wound the maggots were applied either in direct or indirect contact. In some cases a second maggot application was necessary to reach the desired level of healing. Debridement, disinfection and healing occurred in all but three cases, in less than a week. Of the three that did not respond two were complicated by the presence of tumours and one by pre-existing damage to the underlying bone.
Olivier Lepage of the University of Lyon, who led the study, said: "These results show that maggot debridement therapy potentially has an integral place in modern veterinary wound care. It can be used to treat many types of lesions, although not those involving tumours or bone sequestration. Associated high costs present a limiting factor but maggot debridement therapy should certainly be considered for lesions that fail to respond to conventional methods."
Professor Celia Marr, Editor of the EVJ, said: "Horses often suffer from non-healing wounds, particularly in the limbs where the skin is under continuous movement and there is very little subcutaneous tissue. Although at first glance this study might seem counter-intuitive and we might think of maggots as being the last thing one would want on a clean wound, it shows that maggots can be an effective way to clear damaged tissue and this is an important adjunctive approach in equine wound management."
1The use of maggot debridement therapy in 41 equids OM Lepage, A Doumbia, MF Perron-Lepage and M Gangl. EVJ ISSN 0425-1644 DOI: 10.1111/j.2042-3306.2012.00609.x
The study is published by Wiley-Blackwell and can be accessed at http://onlinelibrary.wiley.com/doi/10.1111/j.2042-3306.2012.00609.x/abstract
The Animal Health Trust's (AHT) Dr Sue Dyson has been awarded a place in the International Equine Veterinarians Hall of Fame, in recognition of her contribution to hoof care in horses.
Sue, who is Head of Clinical Orthopaedics at the AHT, has lectured internationally and is known for both her clinical work with horses and an extensive research record, having published more than 200 refereed papers on lameness and diagnostic imaging in scientific journals. She has also co-authored several veterinary textbooks as well as training and competing as a high-level rider in international events.
Established in 1997, the International Equine Veterinarians Hall of Fame honours veterinary surgeons who have contributed to the knowledge and recognition of proper hoof care for horses. Vets are nominated either as practicing equine vets who work closely with farriers in the field, or as college and industry vets involved in teaching, research or other important aspects of equine veterinary and hoof care.
Anyone can nominate an equine vet for the award, which is sponsored by the American Farriers Journal, but selection is completed by previous inductees into the International Equine Veterinarians Hall of Fame. Awards are presented each year during the International Hoof-Care Summit in Cincinnati, Ohio.
Sue said: "I was completely surprised, but absolutely thrilled, to learn that I had been selected to join the distinguished list of people who have previously been appointed to the International Equine Veterinarians Hall of Fame.
"I think it is very humbling to recognise that, despite the knowledge that my team and I have amassed in the last 30 years, there is so much more to learn. From every new finding come many more questions. I hope that the enthusiastic dedication of my team will continue to result in learning and discovering more, and inspire others to do likewise, to the ultimate benefit of the welfare of our great friend, the horse."
Sue has has worked at the AHT for 30 years and is currently researching the association between hindlimb lameness and saddle slip. She has observed some association between the two for several years, however saddle slip has traditionally been attributed to an ill-fitting saddle, asymmetry of the horse's back shape or a crooked rider.
In 2011 Sue carried out a prospective research project with Intern Line Greve: 'Saddle slip may be an indicator of the presence of hindlimb lameness'. It was presented at the 51st Annual Congress of the British Equine Veterinary Association, Birmingham 2012, and identified that in some cases, saddle slip was directly linked to the presence of hindlimb lameness.
Research results showed that of 128 horses assessed for lameness grade and degree of saddle slip when ridden by two riders, the saddle consistently slipped to one side in 54% of the horses with hindlimb lameness, in comparison to just 4% of the horses with forelimb lameness. Diagnostic analgesia to abolish the hindlimb lameness eliminated the saddle slip in 97% of the horses observed in the study.
Sue and Line are currently undertaking further research to measure movement of the back, and forces under the saddle, with the aim of explaining biomechanically what is happening during the occurrence of saddle slip.
Defra Minister David Heath has announced the latest bute (phenylbutazone) test results. The presence of bute has been confirmed in 8 samples out of 206 tests.
Chief Medical Officer Professor Dame Sally Davies has stated that horsemeat containing phenylbutazone presents a very low risk to human health.
Responding to these latest developments the British Veterinary Association (BVA) and British Equine Veterinary Association (BEVA) have issued the following statement:
"The presence of phenylbutazone (or bute) in horses intended for the food chain will be of concern to consumers who rightly expect the UK food chain to be robust. We are grateful to the Chief Medical Officer for clarifying the very low level of risk that this presents to human health and we will work with the FSA and Defra in any way we can to assist their investigations into these incidents.
"The ability to treat horses with bute is very important for equine welfare. Bute provides affordable, long-term pain relief for horses and is unique in this respect.
"The UK Horse Passport Regulations are designed to facilitate the ongoing medical treatment of horses not intended for the human food chain, whilst ensuring that these animals do not enter the food chain.
"We fully support the concept of the Horse Passport Regulations but have argued for some time that there are problems with the system in terms of the number of Passport Issuing Authorities and the vulnerability of the system to fraud. We are very keen to continue our dialogue with Defra and others to find ways to make the system more robust.
"Our members are aware of the strict rules regarding the regulation of medicines (including bute) and the use of horse passports, and in recent years we have provided clear guidance on the regulations to help both vets and their clients. These incidents will hopefully reinforce these messages amongst horse owners and all of us involved in equine healthcare."
Guidance notes are available via the BEVA website Medicines Page (http://www.beva.org.uk/useful-info/Vets/Guidance/Medicines)
The British Equine Veterinary Association (BEVA) has launched two guides to help veterinary professionals and their clients negotiate the complexities of equine insurance.
BEVA highlights that with up to 40% of horses becoming ill or injured in any one year and 25% of insured horses having a claim in any one year, vet fees insurance is a sensible way for horse owners to budget for unexpected healthcare costs.
The Veterinary Surgeon's guide to riding and sport horse insurance provides general guidelines to help vets understand the requirements and issues relating to equine insurance. It explains the three main types of insurance cover available: veterinary fees, death and permanent loss of use, as well as insurance recommendations for pre-purchase and pre-insurance vetting. The final section contains a jargon-busting guide to commonly used insurance terminology.
Complementing the vet guide is The BEVA leisure and sports horse Insurance Guide for horse owners, a handout for clients about to embark on taking out insurance. It covers the frequently asked questions relating to vets fees and death, including when and how to insure, the importance of pre-purchase vetting, exclusions and permanent loss of use.
Andrew Harrison, Junior Vice President of BEVA, said: "Whether a vet or a horse owner, understanding equine insurance can be intimidating for the best of us. The new guides should make it easier for you and your clients to understand the finer points of policies, premiums and claim protocols."
The guides can be downloaded from the BEVA website via the following links:
For additional information visit www.beva.org.uk
The Department for Environment, Food and Rural Affairs (Defra) and the Food Standards Agency (FSA) are reminding veterinary surgeons of their legal responsibilities under the Horse Passport Regulations 2009.
The move follows a small number of horses testing positively for the presence of phenylbutazone, which, if consumed, can be harmful to human health.
Defra and the FSA have asked for the assistance of the profession in ensuring that treatment with phenylbutazone is properly recorded in Horse Passports and have said that they are working together to understand the cause of the positive tests, and what longer term measures can be put in place to stop this happening.
In the interim, all horses slaughtered for human consumption will be sampled for the presence of phenylbutazone, with immediate effect.
The letter from Defra and the FSA can be downloaded from the RCVS website.
The full advice can be read in a Veterinary Medicines Directorate/Defra leaflet, which can be found online at http://www.vmd.defra.gov.uk/pdf/leaflet_horses.pdf.
Mark Bowen, Chair of the British Equine Veterinary Association's Health and Medicines Committee, said: "The number of horses entering the human food chain from the UK has doubled since 2009 and is no longer an insignificant minority of horses. All vets should be checking horse passports and only dispensing sensible quantities of this drug, and its prodrug suxibuzone."
Meanwhile, a form is available from the British Equine Veterinary Association website for veterinary surgeons to use if the horse passport is not available, but emergency treatment is required: http://www.beva.org.uk/_uploads/documents/emergency-treatment-form-no-passport-2011.pdf
Eclipse Veterinary Software has released a new mobile addition to its equine veterinary practice management system.
Eclipse Mobile allows veterinary surgeons to access up-to-date clinical information wherever it is needed, be that on the yard, at the practice, or while making field visits.
When Eclipse Mobile is offline, all the information the vet needs is stored on the device. When next connected via 3G or Wi-Fi, any new details are sent to and from the practice - syncing notes made by the vet, adding follow-on appointments and To Do messages, services delivered and products administered to keep everyone up-to-date throughout the day.
Whilst online, client payments can be taken via debit/ credit cards within the app and detailed drug batch information recorded using the iPad/iPhone's camera as a barcode scanner, if required.
Jeanne Razzell, CEO of Eclipse said: "Many of the vets we work with have been keen to carry animal histories with them on visits, including the latest lab test results, together with recent clinical notes, and diagnostic imaging, e.g. x-rays, ultrasounds and MRI, CT or bone scans. Now, with Eclipse Mobile, every vet can have all of this information at their fingertips automatically - at every appointment; both in the consult room and on the road."
Eclipse Mobile is available for iPad, iPad mini, iPhone, Android smart phones/tablets and Microsoft Windows Surface
For more information, contact Jeanne Razzell, CEO, Eclipse Veterinary Software Limited, on +44 (0)1799 532988 or +44 (0)7515 906466. Website: www.eclipsesoftware.info
New research from the USA, published in the Equine Veterinary Journal (EVJ), has shown that a toxin from the box elder tree is the likely cause of Seasonal Pasture Myopathy (SPM), the US equivalent of the European disease known as Atypical Myopathy (AM).
According to the British Equine Veterinary Association, preliminary comparisons of these results with cases of AM in Europe suggest that the European condition may be linked to similar trees which could have an important bearing on the future prevention of the disease in Europe.
Seasonal Pasture Myopathy is a highly fatal muscle disease in Midwestern USA and Eastern Canada. A similar disorder called Atypical Myopathy is becoming increasingly frequent in the UK and Northern Europe. Outbreaks of both diseases tend to be seasonal, with most cases occurring in the autumn. Horses that develop SPM and AM are usually kept in sparse pastures with an accumulation of dead leaves dead wood and trees in or around the pasture and are often not fed any supplementary hay or feed.
The research1 identified that seeds from box elder trees were consistently present in the autumn pastures of all 12 horses enrolled in the study. These horses were from 11 different farms and had all presented with the clinical signs of SPM, which include muscular weakness and stiffness, dark urine, periods of recumbency, colic-like signs and muscle trembling. The toxic amino acid hypoglycin A, which is known to cause acquired multiple acyl CoA dehydrogenase deficiency (MADD) was shown to be present in the box elder seeds and hypoglycin metabolites were identified in the serum or urine of all the horses. All but one of the cases proved fatal.
Professor Valberg DVM PhD of the Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, who instigated the study, said: "The fact that another acquired form of MADD in rats and humans is caused by hypoglycin A ingestion strengthens our conclusion that hypoglycin A is the likely toxic cause of SPM in horses. We are intending to conduct further studies to determine the factors that affect the highly variable hypoglycin A concentrations in box elder seeds."
Professor Valberg has established collaborative links with groups in Europe in order to investigate if a similar toxin is involved in European Atypical Myopathy. Working with Professor Vince Gerber and Dr Lucia Unger at the University of Bern, Professor Valberg has obtained seeds from a tree related to the Box Elder found on many pastures where Atypical Myopathy has occurred.
Professor Celia Marr, Editor of Equine Veterinary Journal said: "This is a really important step forwards. We don't yet know for sure that the cause of European disease, Atypical Myopathy, is the same as Seasonal Pasture Myopathy in the US. But the clinical signs and MADD aberrations are identical and both conditions have a high fatality rate. It remains to be seen whether this research will help European horses, but there is no doubt that it will allow American horse owners to prevent this devastating condition affecting their horses with immediate effect."
1 Seasonal Pasture Myopathy/Atypical Myopathy in North America associated with Ingestion of Hypoglycin A within Seeds of the Box Elder Tree Stephanie J Valberg DVM PhD1, Beatrice T Sponseller Dr. med. vet2, Adrian D Hegeman PhD3, Jennifer Earing PhD, Jeffery B. Bender DVM MS1, Krishona L Martinson PhD4, Steven E Patterson PhD5, Lawrence Sweetman PhD1
The British Equine Veterinary Association (BEVA) and the British Association of Equine Dental Technicians (BAEDT) have joined forces to set recognised standards for equine dental treatment.
The two organisations are working in association with the RCVS, BVA, BVDA, WWAED and LANTRA to develop National Occupational Standards that will pave the way to allowing equine dental technicians the freedom to work within the Law under an Exemption Order. This should make it safer and easier for owners to source the most suitable dental treatment for their horses.
Currently all equine dental care falls within the Veterinary Surgeons Act 1966 (VSA) and should only be carried out by veterinary surgeons. Equine vets from BEVA and equine dental technicians from the BAEDT have been trying to address this anomaly with government for many years. In 2004 the organisations drew up a list (revised in 2009) of procedures that could be safely carried out by suitably qualified equine dental technicians and a list of those which should only be carried out by qualified veterinary surgeons because they involve sensitive tissues.
The envisaged Exemption Order will also provide better protection for horses and their owners by reinforcing the fact that only suitably qualified individuals are allowed to carry out equine dental care and treatments. While unqualified individuals should become easier to identify under the proposed new scheme, those qualified will also be held to account if their performance is not up to scratch.
The first step towards the Exemption Order is the drawing up of National Occupational Standards for Equine Dental Technicians. It is hoped that these will be formalised by LANTRA in early 2013.
Keith Chandler, BEVA President said: "After many years of working closely with the BAEDT on the continuing education and qualification of its members, we are thrilled that progress is finally being made towards an Exemption Order."
BAEDT Chair, Gemma Lilly, said: "BAEDT and its membership is very happy to be a key part of the team that hopes to put the Exemption Order in place - it will be good news for equine dental technicians, horse owners, and their animals."
Equine Dental Technician and member of the Worldwide Association of Equine Dentists, Martin Brookes, also supports the initiative. He said: "This will be a really important step forward for responsible Equine Dental Technicians. It will further improve the working relationships between EDTs and vets and help to protect the welfare of the horse."
HRH The Princess Royal has opened the Animal Health Trust's new cancer treatment and research facility in Suffolk.
The facility has been purpose-built to treat horses, dogs and cats with cancer. It will also assist in furthering understanding of the disease in animals.
Peter Webbon, Chief Executive of the AHT, said: "2012 marks 70 years of the AHT fighting disease and injury in animals, and the addition of the Cancer Centre is a landmark achievement in our history. We believe this is the first facility of its kind in Europe, purpose-built to treat horses, dogs and cats with cancer. We now have a short commissioning process to undertake but anticipate welcoming the first patients through the doors in early 2013."
The Kennel Club Cancer Centre at the AHT houses a linear accelerator (pictured right) and brachytherapy machine used in radiotherapy treatment, along with a 16-slice CT scanner to aid radiotherapy planning.
The new facility complements the AHT's existing cancer treatment options of surgery and chemotherapy meaning the Suffolk-based charity will be able to offer each and every patient the very best options for their specific case, whatever the diagnosis. With one in four dogs and one in six cats developing cancer at some time in their life the new centre will help many more animals fight cancer.
Peter Webbon, added: "It was thanks to a generous donation from the late Tom Scott, a long-term supporter of the AHT, that we were able to start this development. His donation, along with that from many other AHT supporters, and an interest-free loan of £1.5 million from the Kennel Club has meant this ambitious project has come to fruition so quickly."
It has taken just over a year to build the Cancer Centre which contains more than 2,600 tonnes of concrete and has eight-feet wide solid concrete walls.
On opening the facility, HRH The Princess Royal, President of the AHT, said: "This Cancer Centre is an exciting development at the AHT and will make a real difference for animals with cancer, here and now. It will improve the chances, for many animals, of beating this pernicious disease.
"Countless other horses, dogs and cats across the world with cancer, who will never be seen by an AHT clinician, will also benefit from knowledge gained from research in The Kennel Club Cancer Centre at the AHT."
The AHT has a strong history in cancer research and the Kennel Club Cancer Centre will enhance the charity's well established cancer research programme. Knowledge gained through the treatment of animals in the facility will contribute to the study of cancers, their causes, early diagnosis and treatment, and ultimately hopefully the prevention of some forms of the disease.
Steve Dean, Kennel Club Chairman, said: "I am very proud to be here today to celebrate the opening of the Kennel Club Cancer Centre. Thanks to the expertise available here at the Animal Health Trust, the Cancer Centre will provide advanced techniques for the diagnosis and treatment of cancer, to the benefit of many animals. It is exciting to consider how synergy between the Kennel Club Cancer Centre and the Kennel Club Genetics Centre can help to further the understanding of the inheritance factors that influence the development of cancer."
BCF Technology has announced the launch of the Logiq S7 Expert ultrasound system.
BCF says the new system offers the latest in ultrasound technology and represents a significant leap forward in imaging capability.
The Logiq S7 ultrasound system includes features such as B-Flow, Elastography, Flow Quantification, Contrast Imaging, B-Steer+, 3D/4D ultrasound, Volume Imaging and Multi-Modality Imaging Display.
Nigel Perry from BCF said: "The new Logiq S7 Expert provides the highest image quality currently available in the market. With a wide range of probes available for every veterinary application. If you are looking for the ultimate in ultrasound capability then the Logiq S7 is the system for you."
For more information, visit http://www.bcftechnology.co.uk/ or call +44(0)1506 460 023.
The Animal Health Trust has presented the results of a study which has identified a significant link between hind limb lameness and saddle slip, showing consistent saddle slip in some horses with hind limb lameness, even when the lameness is fairly subtle and difficult to detect.
According to the AHT, saddle slip in sports horses is a well-recognised problem that can occur for a variety of reasons, including asymmetry in the shape of the horse's back, riders sitting crookedly and ill-fitting saddles. Sue Dyson, Head of Clinical Orthopaedics at the Centre for Equine Studies at the Animal Health Trust, had also observed that saddle slip may occur because of hind limb lameness. The intention of the study, therefore, was to find out more about the interrelationships between the horse, saddle and rider and to document the frequency of occurrence of saddle slip in horses with hind limb lameness compared with other horses.
The research was undertaken by Sue Dyson and Intern Line Greve and was presented at the British Equine Veterinary Association (BEVA) Congress last month. It is thought to be the first study of its kind, and was supported by the Saddle Research Trust (SRT). The SRT is a charitable organisation, aiming to facilitate research and provide support as well as advice on the influence of the saddle on the welfare and performance of horses and riders.
The study assessed 128 horses of varying size, age and type. The degree of lameness of each horse was graded; back shape and symmetry were measured and saddles assessed for symmetry and fit. Each horse was ridden by at least two riders and rider straightness plus weight were recorded. The grade of saddle slip, whether it occurred with more than one rider, and whether saddle slip was influenced by the direction of movement or the diagonal on which the rider was sitting were also noted.
The saddle consistently slipped to one side in 54% of horses with hind limb lameness, compared with 4% of horses with fore limb lameness, 0% with back pain and/or sacroiliac joint region pain and 0% of non-lame horses. Diagnostic analgesia was subsequently used to abolish the hind limb lameness and this eliminated the saddle slip in 97% of cases.
Sue said: "Our findings emphasise the need to educate owners, veterinarians, physiotherapists, trainers, riders and saddle fitters that saddle slip is frequently an indicator of lameness, not necessarily a manifestation of an ill-fitting saddle or asymmetric shape of the horse's back. Detection of saddle slip provides an opportunity for the owner, riders and trainers to detect low-grade and subclinical lameness, with important welfare consequences."
Further scientific studies are planned, with the support of the Saddle Research Trust, in order to build on these findings. To this end the SRT is currently seeking an honorary fundraiser to help secure ongoing financial support. For further information contact Anne Bondi on 07775 912202 or email annebondi@me.com.
1An investigation of the relationship between hindlimb lameness and saddle slip, L. Greve and S.J. Dyson, Centre for Equine Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, UK.