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Topic:Disease

The study of diseases in horses encompasses a wide range of conditions affecting equine health, including infectious diseases, metabolic disorders, and genetic abnormalities. These diseases can impact various systems within the horse, such as respiratory, gastrointestinal, and musculoskeletal systems, and can lead to significant health challenges. Research in this area focuses on understanding the pathophysiology, diagnosis, prevention, and treatment of equine diseases. Common diseases studied include equine influenza, equine herpesvirus, and laminitis. This page provides access to peer-reviewed research studies and scholarly articles that explore the etiology, clinical presentation, and management strategies of diseases in horses, contributing to the advancement of equine veterinary medicine.
Detection of papillomavirus DNA in uterine flushing samples from healthy mares reveals diverse genotypes with differing host ranges.
Scientific reports    May 8, 2026   Volume 16, Issue 1 21179 doi: 10.1038/s41598-026-52384-z
A molecular study to assess the presence of some papillomaviruses was performed on 105 uterine flushing samples of healthy mares using real time quantitative polymerase chain reaction (qPCR) and digital PCR (dPCR). Bovine, equine, and ovine papillomavirus DNA was detected in 27 uterine flushing samples through dPCR (~ 25.71%); qPCR was able to detect 18 positive samples (~ 17.14%). Differences between the two molecular protocols were significant as shown by McNemar's test (p˂ 0.005). EcPV DNA was detected in 10 samples by dPCR (~ 9.52%) of uterine flushing samples. qPCR detected EcPV DN...
[Retrospective evaluation of equine blood cultures sampled between 2022 and 2024].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    May 7, 2026   doi: 10.1055/a-2848-1852
Geisler ML, Heusinger A, Müller E.In this study, the results of equine blood cultures sampled during the period from 2022 to 2024 were evaluated. Samples were submitted as routine samples by veterinary practices to a veterinary diagnostic laboratory in Germany. The study focused mainly on the differentiation of the bacterial isolates. In order to place the results in a clinical context, the study was complemented by a questionnaire sent to the practices enquiring for sepsis-associated clinical signs. Unassigned: The study was carried out retrospectively. A total of 199 blood culture samples submitted by practices located in Ge...
Heavy metals in horses: A review of the toxicity, clinical consequences and expected safe tissue concentrations.
Environmental toxicology and pharmacology    May 7, 2026   Volume 124 105038 doi: 10.1016/j.etap.2026.105038
Ribeiro GSN, de Souza AF, Campos ML, Fonteque JH.Trace elements arsenic, cadmium, lead, chromium, mercury, nickel, and zinc are high-density, naturally occurring metals notable for their toxicity and environmental persistence. Cadmium and mercury are particularly concerning due to their capacity for bioaccumulation and biomagnification within the food chain. Dispersed through both anthropogenic and natural sources, these elements pose significant threats to ecosystems and animal health. In equines, they induce oxidative stress by disrupting mitochondrial function, generating reactive oxygen species, and inhibiting antioxidant enzymes, leadin...
Evaluation of synthetic peptides derived from glycoproteins gp45 and gp90 as candidates for the immunodiagnosis of equine infectious anemia.
Veterinary research communications    May 7, 2026   Volume 50, Issue 4 307 doi: 10.1007/s11259-026-11222-3
Domínguez-Odio A, González LIC, Alfonso DM, Martínez ER, Ríos MÁB, Cala-Delgado DL.The international scientific community continues to promote the development of diagnostic techniques with improved performance and novel capture antigens. On this basis, two synthetic peptides derived from gp45 and gp90 were evaluated to identify the best candidate for the indirect immunodetection of infection. In both assays, 68 serum samples from naturally infected horses in Granma Province (59 seropositive and 9 seronegative), previously classified using the agar gel immunodiffusion (AGID) test, were analyzed. The diagnostic performance of each candidate peptide was assessed by calculating ...
Genetic diversity of Toxoplasma gondii isolates from members of the families camelidae and equidae worldwide: a systematic review.
Irish veterinary journal    May 7, 2026   doi: 10.1186/s13620-026-00344-4
Hataminejad M, Lashaki EK, Behboudi E, Esmaeili B, Ahmadi S, Galeh TM.Toxoplasma gondii is an apicomplexan parasite with a global distribution and significant public health and veterinary treatment implications. The present systematic review collates worldwide information on the genotypic diversity of T. gondii isolates infecting Camelidae (camels, alpacas, llamas, etc.) and Equidae (horses, donkeys, zebras, mules, etc.) and highlights their potential role as sentinels of environmental contamination and zoonotic spread. An exhaustive literature search of six electronic databases (PubMed, Web of Science, Scopus, ProQuest, Science Direct, and Google Scholar) from ...
The Equine Reproductive Microbiota: Composition, Dynamics, Dysbiosis, and Implications for Fertility in Mares and Stallions.
Animals : an open access journal from MDPI    May 5, 2026   Volume 16, Issue 9 1414 doi: 10.3390/ani16091414
Pelenė U, Šiukščius A, Nainienė R, Merkelytė I, Šveistienė R.The equine reproductive microbiota has emerged as an important factor influencing reproductive health and fertility in both mares and stallions. Traditionally, the equine uterus was considered sterile, and microbial presence was interpreted primarily in the context of infection. However, sequencing-based studies have demonstrated that the reproductive tract, including the uterus and semen, contains detectable microbial communities or microbial DNA signatures, challenging this traditional paradigm. In mares, the vaginal microbiota is consistently dominated by , , , and , whereas the uterine env...
Accuracy of large language model-based artificial intelligence tools for equine topics.
Journal of equine veterinary science    May 1, 2026   105924 doi: 10.1016/j.jevs.2026.105924
Aldworth-Yang S, Coleman SJ, O'Reilly K, Catalano DN.Artificial intelligence (AI) platforms are becoming increasingly popular as resources for equine information. However, these platforms generate responses from a wide range of sources and do not always distinguish between fact and opinion. Objective: The objective of this study was to assess the accuracy and quality of AI-generated answers to equine-related questions. Researchers hypothesized that AI platforms could answer basic equine questions effectively but would perform poorly on complex topics or questions. Methods: Forty questions were written covering general horse care, facilities mana...
Unusual, fatal neck cancer in a foal: immunohistological investigations and differential diagnosis.
Journal of equine veterinary science    May 1, 2026   105921 doi: 10.1016/j.jevs.2026.105921
Romanucci M, Baghini S, Canonici F, Canonici P, Di Luzio Paparatti F, Marruchella G.Neck masses may represent a diagnostic challenge for equine veterinarians, since they may involve different structures with a similar clinical appearance. Whereas neck masses in foals mostly result from non-neoplastic conditions, including various congenital abnormalities, neoplastic cervical masses have been rarely documented. This report describes the unusual case of a rapidly growing neck cancer in a four-month-old colt, resulting in a fatal outcome. Gross and immunohistological findings were most consistent with a poorly differentiated thymic carcinoma with sarcomatoid features and multifo...
Retrospective assessment of equine herpesvirus type 1 (EHV-1) genotype-associated clinical disease in Ontario.
The Canadian veterinary journal = La revue veterinaire canadienne    May 1, 2026   Volume 67, Issue 5 499-503 
Espinosa MA, Lack A, Kenney D, Arroyo LG.Equine herpesvirus type 1 (EHV-1) is an important viral pathogen in horses, associated with diverse clinical manifestations including fever, upper and lower respiratory disease, neurological signs, ocular disease, and abortion. Currently, EHV-1 variants (genotypes) are classified based on a single nucleotide polymorphism mutation of the open reading frame 30 (ORF30). Unassigned: The aim of this retrospective study was to evaluate the EHV-1 genotypes present in horses with various clinical presentations, including respiratory disease, abortion, and neurological disease, at a referral center in ...
In vitro cultivation of Trypanosoma equiperdum: Comparison of in vitro and in vivo antigens for an ethical and sustainable serological diagnosis of Dourine.
Veterinary parasitology    April 30, 2026   Volume 345 110790 doi: 10.1016/j.vetpar.2026.110790
Armillotta G, Capista S, Rodomonti D, Traini S, Testa L, Serroni A, Laguardia C, Palucci C, Di Pancrazio C, Di Febo T, Puglielli O, Ronchi GF....The protozoan Trypanosoma equiperdum is the causative agent of Dourine, a contagious sexually transmitted disease of equines that can manifest itself in chronic or acute form. Dourine has serious veterinary and economic implications, as there are no vaccines available for prevention and the management of the disease requires the culling of infected animals, together with rigorous sanitary control measures. This study compares the traditional production of T. equiperdum antigen grown in vivo, with an in vitro cultivation methodology developed to eliminate the use of animals. The in vitro and in...
Molecular and serological survey on Theileria equi and Babesia caballi infecting Arabian horses in the northern provinces of Syria.
Open veterinary journal    April 30, 2026   Volume 16, Issue 4 2203-2211 doi: 10.5455/OVJ.2026.v16.i4.22
Abdaljwad M, Al-Sabi MNS, Shawaf T, Mokahwi AA, Alfares W, Abdalkader A.Equine babesiosis is one of the prevalent diseases in horses worldwide, but its presence in Syria generally and in the northern region specifically is not known. In Syria, the civil war has severely disrupted veterinary services, hence disease control measures, creating a fertile ground for the spread of tick-borne diseases. Unassigned: This study aimed to conduct a comprehensive molecular and serological survey of and . in Arabian horses from the northern provinces of Syria, regions heavily impacted by the war. Unassigned: A total of 110 Arabian horses, aged between 2 and 10 years, were inc...
Rostral hard palate swelling (lampas) in horses: true or fiction?
Journal of equine veterinary science    April 29, 2026   105917 doi: 10.1016/j.jevs.2026.105917
Pereira LMA, Schade J, Pereira LMA, Tocheto R, Cristo TG, Casagrande RA, Souza AF, Fonteque JH.This study aimed to determine the occurrence of swellings (lampas) in the rostral portion of the hard palate in young, adult, and elderly horses and to characterize them histologically. One hundred and twenty horses of different ages were evaluated by oral inspection. Horses were classified with lampas when the mucosa of the hard palate extended beyond the occlusal surface of the upper incisors and samples of palatal mucosa were collected. Ten other horses without rostral hard palate alterations, euthanized for unrelated causes, were included as the control group. Histological analysis include...
Circulating microRNA profiles as diagnostic and prognostic biomarkers for acute and carrier Theileria equi infection.
Experimental parasitology    April 29, 2026   Volume 285 109144 doi: 10.1016/j.exppara.2026.109144
Attia MM, Mohamed HI.Equine piroplasmosis caused by Theileria equi exhibits a wide clinical spectrum ranging from acute disease to lifelong asymptomatic carriage, posing significant diagnostic and epidemiological challenges. In this cross-sectional case-control study, equines were classified as acutely infected, asymptomatic carriers, or uninfected controls based on clinical examination and quantitative PCR. Hematological and biochemical alterations were assessed, and plasma miRNA profiles were characterized using small RNA sequencing, followed by qRT-PCR validation of selected miRNAs. Cytokine gene expression in ...
Additional Evidence Fails to Associate Variation in KCNE4 With Equine Anhidrosis.
Animal genetics    April 27, 2026   Volume 57, Issue 3 e70109 doi: 10.1002/age.70109
Petersen JL, Finno CJ.A prior genome-wide association (GWA; N = 200) including Thoroughbreds and stock horses implicated chromosome 6 (NC_009149.3) in owner-reported equine anhidrosis. A missense variant in KCNE4 (NC_009149.3:g.11813731A>G) was proposed as a risk allele, although its association with anhidrosis was not reported. Variant annotation and protein modelling in the original study suggested the G allele conferred risk. We reported no association of the G allele with anhidrosis in 50 horses phenotyped by an intradermal terbutaline sweat test (ITST); all horses produced sweat regardless of genotype. ...
Equine sentinels and one health: a comprehensive serological survey of Crimean-Congo hemorrhagic fever virus in southeastern and Central Europe.
Frontiers in veterinary science    April 24, 2026   Volume 13 1810641 doi: 10.3389/fvets.2026.1810641
Italiya J, Nekudova P, Vaclavek P, Rusenova NV, Rusenov AG, Mihalca AD, Bărbuceanu F, Vuta VB, Hristescu DV, Modry D, Hensley LE, Rimoin AW, Zurek L.Crimean-Congo hemorrhagic fever (CCHF) is the widespread tick-borne viral disease affecting humans with endemic circulation across Africa, Asia, Eastern and Southern Europe. Climate change, global travel, and animal trade have accelerated the expansion of spp., the primary tick vectors of CCHF, into previously non-endemic areas, including the Czech Republic. To assess the current distribution of CCHF in equids across Southeastern and Central Europe, we screened serum samples from horses and donkeys from Bulgaria ( = 579), Romania ( = 1,534), and the Czech Republic ( = 576) by the ...
Epidemiology of open and closed diastemata in equine cheek teeth and associations with periodontal pathology.
Veterinary research communications    April 23, 2026   Volume 50, Issue 4 280 doi: 10.1007/s11259-026-11216-1
Mata F, Johnson C.Cheek-tooth diastemata are a common dental abnormality in horses and are considered a major predisposing factor for periodontal disease. However, the influence of diastema type and anatomical location on disease severity remains incompletely understood. To determine the prevalence and distribution of open and closed cheek-tooth diastemata and evaluate their association with periodontal disease severity in horses, while assessing the influence of age, sex, jaw location and laterality, fifty equine cadaver heads obtained from an abattoir were examined. Diastemata were identified through visual a...
Integrating clinical and rna-seq findings in a mare with recurrent endocrinopathic laminitis linked to equine metabolic syndrome.
Journal of equine veterinary science    April 22, 2026   Volume 163 105906 doi: 10.1016/j.jevs.2026.105906
Isgrigg J, Marchio S, Brown H, Norton P, Boakari YL, Macon E.Equine metabolic syndrome (EMS) is characterized by insulin dysregulation and obesity, which increase the risk of the development of hyperinsulinemia-induced laminitis (HAL). The present report describes a case of severe endocrinopathic laminitis associated with EMS, refractory to treatment. A 5-year-old mare with recurrent HAL presented transient relief upon a low nonstructural carbohydrate diet and conventional therapy. An SGLT2 inhibitor was introduced to reduce resting insulin levels, and improvement was observed until October 2024, when the most severe episode started. Despite adding perg...
Diffuse idiopathic skeletal hyperostosis in a Roman-period horse from Gerulata (Bratislava-Rusovce, Slovakia): Diagnostic Considerations.
International journal of paleopathology    April 21, 2026   Volume 53 82-91 doi: 10.1016/j.ijpp.2026.03.005
Smíšek M, Dvořáková R, Kolon T, Hrnčiarik E, Bíšková J, Hanáček F, Klontza-Jaklová V.To evaluate pathological changes identified in a skeleton of a horse from Roman-period Gerulata, Slovakia. Methods: The remains consist of a partially preserved, articulated skeleton of an adult horse from today's southern urban district of Bratislava-Rusovce in southwestern Slovakia. Methods: The specimen underwent macroscopic analysis to assess taxonomic identification, biological profile, and pathological changes. Thoracolumbar lesions were further evaluated using computed tomography (CT). Radiocarbon dating determined the absolute age of the remains. Results: Species determination indicate...
Glanders: Past, Present and Future of a Neglected Zoonosis as a Threat in Veterinary and Human Health.
Veterinary medicine and science    April 21, 2026   Volume 12, Issue 3 e70950 doi: 10.1002/vms3.70950
Kanani Y, Oryan A, Derakhshandeh A.Burkholderia mallei is the causative agent of glanders, a serious zoonotic disease of major concern for both animal and human health. This highly contagious and potentially fatal bacterium is always classified as a biothreat agent. In this review, we covered a comprehensive overview of glanders, including the biology of the pathogen, epidemiology, pathogenesis, diagnosis, control strategies and ongoing eradication programs in Eurasia. We also summarized human case reports, differential diagnosis, treatment and organism's antimicrobial properties. The section on vaccine development is among the...
Autochthonous Leishmaniosis in Dogs, Cats, Horses, and Wildlife in the United States of America.
Microorganisms    April 20, 2026   Volume 14, Issue 4 930 doi: 10.3390/microorganisms14040930
Yao C, Yang Y, Du A.Leishmaniasis is endemic in 99 countries worldwide, including the United States of America (USA). Its causative pathogens, spp. have been detected in both humans and animals within the USA. Lately, we have comprehensively reviewed autochthonous leishmaniasis in humans in this region. Animals play a pivotal role in maintaining its endemicity in some endemic areas and regions, for example, dogs in Brazil and the Mediterranean. In this review, we thoroughly examine autochthonous leishmaniosis in dogs, cats, horses, and wildlife in the USA, and we synthesize integration across species, transmissi...
Multivalent Disabled Infectious Single Animal (DISA)-DIVA vaccine for all nine serotypes of African horse sickness virus (AHSV) is broadly protective in IFNAR (-/-) mice.
Veterinary research    April 16, 2026   doi: 10.1186/s13567-026-01753-7
Utrilla-Trigo S, Jiménez-Cabello L, van Gennip RGP, van Rijn PA, Ortego J, Calvo-Pinilla E.African horse sickness (AHS) is a highly severe, midge-borne disease of equids showing a mortality rate of > 90% in naive domestic horses. Outbreaks are caused by AHS virus (AHSV) and result in devastating economic losses in developing countries as equids play a crucial role in the agricultural industry and many households. The AHSV species encompasses nine serotypes showing no or limited cross protection, which is challenging regarding AHS vaccine development. Recently, and like bluetongue virus (BTV), the AHS Disabled Infectious Single Animal (DISA)-DIVA vaccine platform was developed...
Evidence of occipitoatlantoaxial malformations independent of the HOXD3 mutation in an Arabian horse.
Journal of equine veterinary science    April 12, 2026   105894 doi: 10.1016/j.jevs.2026.105894
Vanderbiest L, Rousseau L, Renaville B, Aleman M, Finno C, Milan A, Vinardell T.Occipitoatlantoaxial malformations (OAAM) are developmental disorders occurring at the occiput, atlas and axis. OAAM type 1 is a familial disorder affecting Arabian horses. Currently, a single genetic mutation in the HOXD3 gene region can be tested to confirm the diagnosis. This case describes a 3-year-old Arabian gelding affected with OAAM. Clinical examination revealed a proximal cervical deformation on the right side and severe stiffness of the neck in the sagittal plane without associated pain. Neurological examination demonstrated a generalized proprioceptive ataxia. Radiographs revealed ...
HERDA-associated variant in bull-catching (vaquejada) Brazilian Northeastern bull-catching Quarter Horses.
Journal of equine veterinary science    April 11, 2026   105892 doi: 10.1016/j.jevs.2026.105892
Caceres AM, Sperandio LMS, Alvarenga NACA, Borges AS, Oliveira-Filho JP.Bull-catching (vaquejada) accounting for approximately 13% of sport horses in Brazil. Genetic screening has enabled strategies to reduce the spread of inherited disorders, including Hereditary Equine Regional Dermal Asthenia (HERDA), a major skin disease included in the Six Panel required for registration by the Brazilian Quarter Horse Breeders Association. Although the HERDA-associated variant has been extensively studied in other disciplines, it had not been evaluated in Bull-catching Quarter Horses (QH). Objective: The present study aimed to determine the allele frequency of the pathogenic ...
Evaluation and Management of the Horse with Head and Neck Disorders.
The Veterinary clinics of North America. Equine practice    April 9, 2026   S0749-0739(26)00013-1 doi: 10.1016/j.cveq.2026.02.001
Story MR, Nout-Lomas YS.Recognizing possible causes of equine head and neck problems requires a careful and systematic evaluation. While for some disorders reaching a diagnosis and treatment plan is relatively straightforward, for others this can be a complicated road requiring extensive diagnostic techniques, treatment trials, and management strategies. The ability to determine whether the patient is in a painful state, experiencing functional deficits, or in a combination of pain and dysfunction is critical to developing an effective treatment plan. Frequently, behavioral concerns often associated with pain must be...
Successful Use of Vincristine in a Quarter Horse Gelding with Immune-Mediated Thrombocytopenia.
Journal of equine veterinary science    April 8, 2026   105889 doi: 10.1016/j.jevs.2026.105889
Salewski KE, Talavera MA, Gonzalez GA, Waldridge BM, White JM, Williams MJ, Williams ML.This case reports the successful use of vincristine in a Quarter Horse with presumed immune-mediated thrombocytopenia. A 15-year-old Quarter Horse gelding presented for a pinch skin graft procedure on the left forelimb over the cannon bone. On day 10 of hospitalization, the horse developed a fever (102.6°F, RI: 99-101°F), and severe petechiae of the mucous membranes. A complete blood count (CBC) (Advia 2120i) revealed a severe thrombocytopenia (16,000 platelets/μL, RI:100,000-400,000/μL). Diagnostic testing was negative for Anaplasma phagocytophilum by PCR, Theileria equi and Babesia cabal...
Progressive structural and functional change in horses: a conceptual framework for systemic equine (patho-)physiology.
Frontiers in veterinary science    April 7, 2026   Volume 13 1767386 doi: 10.3389/fvets.2026.1767386
Diehl M, Bader K.A wide range of locomotor, postural, and behavioral pathophysiology in horses-often grouped under terms such as Topline Syndrome, Myofascial Dysfunction, or Poor Posture Syndrome-lack a coherent systemic explanation. These presentations share reduced performance, stability, and resilience, yet are commonly managed through isolated symptom-focused interventions. To address this gap, we propose progressive structural and functional change (PSF) as a systemic framework describing progressive reorganization processes within the equine body that link fragmented pathological domains into a coherent ...
Mucosal T cell activation pathways are upregulated by equine herpesvirus type 1 infection.
Veterinary research    April 6, 2026   doi: 10.1186/s13567-026-01741-x
Holmes CM, Babasyan S, Wagner B.Equine herpesvirus type 1 (EHV-1) is a high morbidity and mortality virus that impacts horse populations worldwide. As a respiratory virus, it enters through the upper respiratory tract (URT), where mucosal immunity plays a crucial role in preventing severe disease. In this study, flow cytometry was used to characterize the nasal leukocyte population during EHV-1 infection, and RNA sequencing of nasal secretions was employed to assess transcriptional markers of the mucosal immune response. Horses with distinct immune statuses were compared at four stages: pre-infection, early (day 1 and 3 post...
Crimean-Congo Haemorrhagic Fever Virus Exposure in Horses and Donkeys in Border Livestock Markets of Nigeria.
Zoonoses and public health    April 5, 2026   doi: 10.1111/zph.70056
Ehizibolo DO, Oyekan O, Mkpuma N, Haliru H, Garba I, Turaki IZ, Kennedy S, Shallangwa JM, Kilyobas CS, Mohammed A, Muhammad MA, Abubakar M....Crimean-Congo haemorrhagic fever virus (CCHFV) is a tick-borne zoonotic pathogen of major public health importance in Africa. Although CCHFV exposure has been reported in several livestock species in Nigeria, data on equids remain limited despite their extensive involvement in livestock movement and trade. This study assessed CCHFV seroprevalence in horses and donkeys in major international livestock markets in northern Nigeria and examined factors associated with exposure. Methods: From June 2023 to July 2024, a longitudinal sero-surveillance study was conducted in three high-volume livestock...
Evaluation of episcleral silicone matrix cyclosporine implants for presumed equine immune-mediated keratitis: a retrospective study.
Journal of equine veterinary science    April 3, 2026   105880 doi: 10.1016/j.jevs.2026.105880
Bruneel E, Hermange T, Casamatta JM, Pereira A, Pimenta J, Caseiro AR.Immune-mediated keratitis (IMMK) is a chronic inflammatory corneal disease in horses. Long-term topical therapy with cyclosporine is often impractical, highlighting the need for sustained-release alternatives. Objective: To assess clinical response, tolerability, and duration of effect of episcleral silicone matrix cyclosporine implants (ESMC) in horses with presumed IMMK. Methods: Medical records of 12 horses (14 eyes) treated between 2019 and 2023 were retrospectively reviewed. IMMK subtypes were classified as epithelial (n = 3 eyes), anterior stromal (n = 9), or mid-stromal (n =...
Modified mucosal digestion procedure improves precision of encysted larval cyathostomin counts in horses.
Veterinary parasitology    April 2, 2026   Volume 344 110761 doi: 10.1016/j.vetpar.2026.110761
Smith MA, Ripley N, Gravatte H, Nielsen MK.With rising anthelmintic resistance in adult cyathostomins, the most pervasive equine parasites, the need to assess larvicidal efficacy has increased, yet available methods remain limited. Encysted larvae are quantified using mucosal digestion, wherein a 5% subsample of intestinal mucosa is processed, and a 2% aliquot is counted for early third stage (EL3) and late third stage/mucosal fourth stage (LL3/L4) larvae. This method is imprecise and post-treatment larval differences are often not observed. The following study aimed to assess standard and modified protocol precision and sensitivity. I...