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Topic:Public Health

The topic of Public Health and horses encompasses the study of interactions between equine populations and human health systems. It involves examining the transmission of zoonotic diseases, which are diseases that can be transferred between animals and humans, as well as the role of horses in the epidemiology of such diseases. This field also considers the impact of equine-related activities on public health, including injuries and environmental effects. Research in this area often explores preventive measures, management strategies, and policies to mitigate health risks associated with horses. This page compiles peer-reviewed research studies and scholarly articles that investigate the intersection of equine and public health, focusing on disease transmission, risk assessment, and health management strategies.
Efficacy of a brain-penetrant antiviral in lethal Venezuelan and eastern equine encephalitis mouse models.
Science translational medicine    April 12, 2023   Volume 15, Issue 691 eabl9344 doi: 10.1126/scitranslmed.abl9344
Cao X, Yang D, Parvathareddy J, Chu YK, Kim EJ, Fitz-Henley JN, Li X, Lukka PB, Parmar KR, Temrikar ZH, Dhole P, Adcock RS, Gabbard J, Bansal S....Venezuelan and eastern equine encephalitis viruses (VEEV and EEEV, respectively) are mosquito-borne, neuroinvasive human pathogens for which no FDA-approved therapeutic exists. Besides the biothreat posed by these viruses when aerosolized, arthropod transmission presents serious health risks to humans, as demonstrated by the 2019 outbreak of EEE disease in the United States that resulted in 38 confirmed cases, 19 deaths, and neurological effects in survivors. Here, we describe the discovery of a 2-pyrrolidinoquinazolinone scaffold, efficiently synthesized in two to five steps, whose structural...
Comparison of Trap and Equine Attraction to Mosquitoes.
Insects    April 11, 2023   Volume 14, Issue 4 374 doi: 10.3390/insects14040374
Dilling SC, TenBroeck SH, Hogsette JA, Kline DL.Mosquitoes are pests of horses, but mosquito trap efficacy data, especially the ability of traps to protect horses, are lacking. Studies were conducted to investigate the comparative attraction between traps and horses, increase trap attraction by adding horse odors to the airstream of a trap, determine the spatial distribution of adult mosquitoes, estimate the numbers of mosquitoes feeding on horses, determine the relative attraction of horses to mosquitoes, and estimate the range of mosquitoes' attraction between two horses. When a horse and a mosquito trap were placed 3.5 m apart, there was...
Molecular Identification of Culicoides Species and Host Preference Blood Meal in the African Horse Sickness Outbreak-Affected Area in Hua Hin District, Prachuap Khiri Khan Province, Thailand.
Insects    April 8, 2023   Volume 14, Issue 4 doi: 10.3390/insects14040369
Kamyingkird K, Choocherd S, Chimnoi W, Klinkaew N, Kengradomkij C, Phoosangwalthong P, Thammasonthijarern N, Pattanatanang K, Inpankaew T, Phasuk J....African horse sickness (AHS) was reported as an outbreak in Thailand in 2020. Hematophagous insects from the genus Culicoides are the suspected vector responsible for AHS transmission. Horses in Hua Hin district, Prachuab Khiri Khan province, Thailand, were affected and died from AHS in 2020. However, the potential Culicoides species and its host preference blood meal in the affected areas are unknown. To investigate the potential vectors of AHS, Culicoides were collected using ultraviolet light traps placed near horse stables. Six horse farms, including five farms with AHS history and one far...
Equine assisted services impact on social skills in autism spectrum disorder: A meta-analysis.
Progress in neuro-psychopharmacology & biological psychiatry    April 7, 2023   Volume 125 110765 doi: 10.1016/j.pnpbp.2023.110765
Madigand J, Rio M, Vandevelde A.Many studies focus on the impact of equine assisted services (EAS) on social skills in autism spectrum disorder (ASD) but existing data are not consensual and the only available meta-analysis included only three studies and did not consider the social responsiveness scale (SRS). This meta-analysis aims to measure the impact of EAS on social skills in ASD. Using Pubmed, Embase, Web of Science and the Cochrane Library, the means and standard deviations of every available SRS post-intervention scores in each participant group were collected from the five selected randomised controlled trials with...
Where Are We Now? Feeds, Feeding Systems and Current Knowledge of UK Horse Owners When Feeding Haylage to Their Horses.
Animals : an open access journal from MDPI    April 7, 2023   Volume 13, Issue 8 1280 doi: 10.3390/ani13081280
Moore-Colyer M, Westacott A, Rousson L, Harris P, Daniels S.Despite our improved understanding of equid digestive health and accurate rations formulations, obesity in the UK horse population remains high. Study aims: (1) to determine how owners are feeding their horses and what influences their choices, (2) to understand owners' knowledge of haylage and (3) to identify key areas that require additional education. Data were collected in 2020 from 1338 UK horse owners via two online surveys. Survey 1 was on general feeding practices, and Survey 2 was specifically on the feeding of haylage. Data were processed using chi square analyses + Bonferroni tests,...
Corynebacteria of the diphtheriae Species Complex in Companion Animals: Clinical and Microbiological Characterization of 64 Cases from France.
Microbiology spectrum    April 6, 2023   Volume 11, Issue 3 e0000623 doi: 10.1128/spectrum.00006-23
Museux K, Arcari G, Rodrigo G, Hennart M, Badell E, Toubiana J, Brisse S.Corynebacteria of the diphtheriae species complex (CdSC) can cause diphtheria in humans and have been reported from companion animals. We aimed to describe animal infection cases caused by CdSC isolates. A total of 18,308 animals (dogs, cats, horses, and small mammals) with rhinitis, dermatitis, nonhealing wounds, and otitis were sampled in metropolitan France (August 2019 to August 2021). Data on symptoms, age, breed, and the administrative region of origin were collected. Cultured bacteria were analyzed for tox gene presence, production of the diphtheria toxin, and antimicrobial susceptibili...
Relevant Brachycera (Excluding Oestroidea) for Horses in Veterinary Medicine: A Systematic Review.
Pathogens (Basel, Switzerland)    April 6, 2023   Volume 12, Issue 4 568 doi: 10.3390/pathogens12040568
Frisch V, Fuehrer HP, Cavalleri JV.In equine stables and their surroundings, a large number of insects are present that can be a nuisance to their equine hosts. Previous studies about dipterans transmitting infectious agents to Equidae have largely focused on Nematocera. For the preparation of this systematic review, the existing literature (until February 2022) was systematically screened for various infectious agents transmitted to Equidae via insects of the suborder Brachycera, including Tabanidae, Muscidae, Glossinidae and Hippoboscidae, acting as pests or potential vectors. The PRISMA statement 2020 (Preferred Reporting It...
A comparative survey of veterinarians, equine owners, and equine keepers regarding the knowledge and implementation of legal requirements in Germany for the use and documentation of veterinary medicines in equines intended for slaughter.
PloS one    April 6, 2023   Volume 18, Issue 4 e0283371 doi: 10.1371/journal.pone.0283371
Schneider ST, Meemken D, Gehlen H, Merle R, Langkabel N.In Europe, equines destined for human consumption (hereafter called slaughter equines) are subject to the same restrictions of usage of veterinary drugs as other food-producing animals, with amendments regulated in the so-called 'positive list', Regulation (EC) No. 1950/2006. Due to the complex legal requirements for drug administration in slaughter equines, it might be that specific knowledge regarding the legislation of slaughter equines may be insufficient among veterinarians, equine owners, and equine keepers. To study this assumption, three target group-specific surveys were conducted in ...
First Detection of Anti-Besnoitia spp. Antibodies in Equids in Israel and the Palestinian Authority.
Microorganisms    April 3, 2023   Volume 11, Issue 4 929 doi: 10.3390/microorganisms11040929
Berman N, Tirosh-Levy S, Steinman A, Minderigiu A, Blinder E, Leszkowicz Mazuz M. is a tissue cyst forming coccidia, which affects multiple host species worldwide. Equine besnoitiosis is characterized mainly by generalized skin lesions and cysts in the scleral conjunctiva. Recent reports revealed exposure to in equines in Europe and the United States. However, the exposure to spp. in the Israeli equine population was never investigated. The aim of this study was to evaluate the seroprevalence and associated risk factors for besnoitiosis in equids in Israel. A cross-sectional serosurvey was performed using serum samples of apparently healthy horses ( = 347), donkeys ( = 9...
Pharmacokinetics of aminocaproic acid in thoroughbred horses.
Journal of veterinary pharmacology and therapeutics    March 30, 2023   Volume 46, Issue 4 250-256 doi: 10.1111/jvp.13124
Maxwell L, McCarrel TM, Hay S, Cole C.The antifibrinolytic agent aminocaproic acid (ACA) is occasionally used prior to episodes of intense training in racehorses suffering from exercise-induced pulmonary hemorrhage. Although a previous study indicated that the drug is cleared rapidly in horses, some racetrack practitioners claim that recent adverse analytical findings for ACA in postrace samples were from ACA administrations 5-7 days before the race. The purpose of this study was to re-examine the pharmacokinetics of ACA in horses to address this apparent conundrum. Eight exercise-conditioned thoroughbred horses were administere...
Spontaneous Sepsis in Adult Horses: From Veterinary to Human Medicine Perspectives.
Cells    March 30, 2023   Volume 12, Issue 7 1052 doi: 10.3390/cells12071052
Blangy-Letheule A, Vergnaud A, Dupas T, Rozec B, Lauzier B, Leroux AA.Sepsis is a life-threatening disease defined as an organ dysfunction caused by a dysregulated host response to an infection. Early diagnosis and prognosis of sepsis are necessary for specific and timely treatment. However, no predictive biomarkers or therapeutic targets are available yet, mainly due to the lack of a pertinent model. A better understanding of the pathophysiological mechanisms associated with sepsis will allow for earlier and more appropriate management. For this purpose, experimental models of sepsis have been set up to decipher the progression and pathophysiology of human seps...
Horse-riding hazards: an observational cohort study mapping equestrian related injuries at a Scandinavian trauma centre.
BMC sports science, medicine & rehabilitation    March 28, 2023   Volume 15, Issue 1 46 doi: 10.1186/s13102-023-00646-y
Franzén Lindgren E, Hammarqvist F, Ahl Hulme R.Horse-riding is practiced on a regular basis by 500,000 people in Sweden. It is reputed to be one of the most dangerous sports. On average, there were 1756 acute injuries and three fatalities each year between 1997 and 2014 in Sweden related to horses. The primary aim of this study was to outline the injury spectrum related to equestrian activities cared for at a large Swedish trauma centre. The secondary aim was to identify trends in clinical outcomes and to investigate the association between age and such outcomes. Methods: The electronic medical records system at Karolinska University Hosp...
Clinical Aspects of Bacterial Distribution and Antibiotic Resistance in the Reproductive System of Equids.
Antibiotics (Basel, Switzerland)    March 28, 2023   Volume 12, Issue 4 664 doi: 10.3390/antibiotics12040664
Tyrnenopoulou P, Fthenakis GC.Antibiotic administration is a standard therapeutic practice for the treatment of reproductive disorders of equids. This might lead to undesirable microbial imbalance and could favour the acquisition of antibiotic resistance. Therefore, it is imperative for clinicians to understand patterns of antibiotic resistance when considering and developing treatment regimes. Continued engagement of clinicians with novel alternative approaches to treat reproductive infections would be essential in order to address this rising threat within the One Health perspective. The objectives of the present review ...
A Horse of a Different Color: A Case Report of Streptococcus Equi Meningitis in a Kidney Transplant Recipient.
Transplantation proceedings    March 26, 2023   Volume 55, Issue 3 664-666 doi: 10.1016/j.transproceed.2023.02.061
Eichenberger EM, Dent A, Hayes T, Woc-Colburn L.Streptococcus equi is an opportunistic pathogen in horses that has rarely been transmitted to humans. Here we present a zoonotic S. equi meningitis case in a kidney transplant recipient with exposure to infected horses. We discuss the patient's risk factors, clinical presentation, and management in the context of the limited literature on S. equi meningitis.
Seroprevalence and Risk Factors for Toxoplasma gondii Infection in Horses.
Veterinary sciences    March 22, 2023   Volume 10, Issue 3 237 doi: 10.3390/vetsci10030237
Marzok M, Al-Jabr OA, Salem M, Alkashif K, Sayed-Ahmed M, Wakid MH, Kandeel M, Selim A. is classified as intracellular protozoa and is one of the major zoonotic parasites. Most warm-blooded intermediate hosts, including humans, are commonly infected by this parasite. The epidemiology of infection in Egyptian horses is currently poorly understood. Methods: 420 blood samples were randomly collected from horses raised in four governorates in Northern Egypt (110 each from Giza and Kafr El Sheikh, and 100 each from Qalyubia and Gharbia) to investigate the existence of antibodies against using a commercial ELISA kit, and to ascertain the risk factors for the infection. Results: the ...
Animals Exposed to Leptospira Serogroups Not Included in Bacterins in the United States and Puerto Rico.
Tropical medicine and infectious disease    March 22, 2023   Volume 8, Issue 3 doi: 10.3390/tropicalmed8030183
Anderson T, Hamond C, Haluch A, Toot K, Nally JE, LeCount K, Schlater LK.Leptospirosis is a worldwide zoonotic disease. Pathogenic leptospires colonize the renal tubules and genital tract of animals and are excreted via urine. Transmission occurs via direct contact or through contaminated water or soil. The microscopic agglutination test (MAT) is the gold standard for the serodiagnosis of leptospirosis. The present study aims to evaluate animal exposure to Leptospira in the U.S. and Puerto Rico during the period 2018-2020. The presence of antibodies against pathogenic Leptospira spp. was assessed with the MAT according to the standards of the World Organisation for...
Equine disease surveillance: quarterly update.
The Veterinary record    March 18, 2023   Volume 192, Issue 6 doi: 10.1002/vetr.2861
No abstract available
Seroexposure to Zoonotic Anaplasma and Borrelia in Dogs and Horses That Are in Contact with Vulnerable People in Italy.
Pathogens (Basel, Switzerland)    March 16, 2023   Volume 12, Issue 3 470 doi: 10.3390/pathogens12030470
Traversa D, Milillo P, Maggi R, Simonato G, Di Cesare A, Pezzuto C, Grillini M, Morelli S, Colombo M, Passarelli A, Grassano A, Serio P, Losurdo M....Equine and canine anaplasmosis and borreliosis are major tick-borne zoonotic diseases caused by and various species of (the most important being s.l.), respectively. This study evaluated the seroexposure to and in dogs and horses used in Animal-Assisted Interventions or living in contact with children, elderly people or immunocompromised persons. A total of 150 horses and 150 dogs living in Italy were equally divided into clinically healthy animals and animals with at least one clinical sign compatible with borreliosis and/or anaplasmosis (present at clinical examination or reported in th...
Helicobacter kumamotonensis sp. nov., isolated from human clinical specimens.
International journal of systematic and evolutionary microbiology    March 16, 2023   Volume 73, Issue 3 doi: 10.1099/ijsem.0.005732
Kawamura Y, Fujimoto Y, Kutsuna R, Tomida J, Yamamoto KI, Miyoshi-Akiyama T, Okuno M, Ogura Y, Matsuoka M, Kawaguchi T, Tsutsuki H, Sawa T.A Gram-stain-negative, spiral bacterium (PAGU 1991T) was isolated from the blood of a patient with diffuse large B-cell lymphoma. Phylogenetic analysis based on 16S rRNA gene sequences showed that the isolate was very closely related to Helicobacter equorum LMG 23362T (99.1 % similarity), originally isolated from a faecal sample from a healthy horse. PAGU 1991T was also very closely related to PAGU 1750 in our strain library (=CCUG 41437) with 99.7 % similarity. Additional phylogenetic analyses based on the 23S rRNA gene sequence and GyrA amino acid sequence further supported the close rel...
Risk factors for, and prediction of, exertional heat illness in Thoroughbred racehorses at British racecourses.
Scientific reports    March 14, 2023   Volume 13, Issue 1 3063 doi: 10.1038/s41598-023-27892-x
Trigg LE, Lyons S, Mullan S.The development of exertional heat illness (EHI) is a health, welfare and performance concern for racehorses. However, there has been limited multivariable assessment of the possible risk factors for EHI in racehorses, despite such information being vital for regulators to effectively manage the condition. Consequently, this study aimed to identify the risk factors associated with the occurrence of EHI in Thoroughbred racehorses and assess the ability of the risk factor model to predict the occurrence of EHI in racehorses to assist in early identification. Runners at British racecourses record...
The impact on physical performance, pain and psychological wellbeing of chronic low back pain patients during 12-weeks of equine- facilitated therapy intervention.
Frontiers in veterinary science    March 14, 2023   Volume 10 1085768 doi: 10.3389/fvets.2023.1085768
Mattila-Rautiainen S, Venojärvi M, Rautiainen H, Keski-Valkama A.Equine - Facilitated Therapy (EFT), an equine environment, and horses themselves can meet many physical and mental health needs beyond diagnostic categories. The horse's ability to produce a walk-like movement and the participant's ability to connect to non-judgemental living creatures, both of which can benefit participation and construct a positive self-image for chronic pain patients. The objective of this study is to evaluate the impact of EFT on perceived physical performance, level of pain, pain acceptance, depression and anxiety, and quality of life within a 12-week intervention for chr...
Molecular identification and genetic diversity of equine ocular setariasis in Thailand based on the COI, 12S rDNA, and ITS1 regions.
Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases    March 11, 2023   Volume 110 105425 doi: 10.1016/j.meegid.2023.105425
Junsiri W, Kamkong P, Chinkangsadarn T, Ouisuwan S, Taweethavonsawat P.Equine ocular setariasis is mainly caused by Setaria digitata, and the identification of this filarial nematode is based on morphology. However, morphological characterization alone is insufficient for the detection and differentiation of S. digitata from its congeners. In Thailand, the molecular detection of S. digitata is lacking and its genetic diversity is still unknown. This study aimed to phylogenetically characterize equine S. digitata from Thailand based on sequences derived from the mitochondrial cytochrome c oxidase subunit 1 (COI), the mitochondrial small subunit ribosomal DNA (12S ...
Safety and efficacy of a feed additive consisting of an essential oil from the leaves of Laurus nobilis L. (laurel leaf oil) for all animal species (FEFANA asbl).
EFSA journal. European Food Safety Authority    March 9, 2023   Volume 21, Issue 3 e07875 doi: 10.2903/j.efsa.2023.7875
Bampidis V, Azimonti G, Bastos ML, Christensen H, Durjava M, Kouba M, López-Alonso M, López Puente S, Marcon F, Mayo B, Pechová A, Petkova M....Following a request from the European Commission, the EFSA Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) was asked to deliver a scientific opinion on the safety and efficacy of an essential oil from the leaves of L. (laurel leaf oil), when used as a sensory additive for all animal species. The additive contains up to 4% methyleugenol. The use of the additive at 2 mg/kg complete feed in dogs and cats was considered of low concern. For other long-living and reproductive animals, the use of the additive at 10 mg/kg was considered of concern. For short-living animal...
Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia.
PloS one    March 9, 2023   Volume 18, Issue 3 e0278964 doi: 10.1371/journal.pone.0278964
Robertson E, Abera C, Wood K, Deressa K, Mesfin S, Scantlebury C.Antifungal medications are vital in combatting fungal diseases that affect over a billion people annually. Antifungal medications for people and equids are scarce in Ethiopia, where lack of resources to treat fungal infection, in particular histoplasmosis, is a major health challenge. Histoplasmosis is endemic within the equine population in Ethiopia, where it is estimated that one in five horses are infected. This disease has far reaching impacts on equine welfare and the socio-economic wellbeing of families. The burden of histoplasmosis in people in Ethiopia is currently unknown, representin...
Mapping Eastern (EEE) and Venezuelan Equine Encephalitides (VEE) among Equines Using Geographical Information Systems, Colombia, 2008-2019.
Viruses    March 8, 2023   Volume 15, Issue 3 707 doi: 10.3390/v15030707
Bonilla-Aldana DK, Bonilla Carvajal CD, Moreno-Ramos E, Barboza JJ, Rodriguez-Morales AJ.Eastern equine encephalitis virus (EEEV) and Venezuelan equine encephalitis virus (VEEV) viruses are zoonotic pathogens affecting humans, particularly equines. These neuroarboviruses compromise the central nervous system and can be fatal in different hosts. Both have significantly influenced Colombia; however, few studies analyse its behaviour, and none develop maps using geographic information systems to characterise it. To describe the temporal-spatial distribution of those viruses in Colombia between 2008 and 2019. Retrospective cross-sectional descriptive study, based on weekly reports by ...
Social License to Operate-Why Public Perception Matters for Horse Sport-Some Personal Reflections.
Journal of equine veterinary science    March 8, 2023   Volume 124 104266 doi: 10.1016/j.jevs.2023.104266
Heleski CR.What is a social license to operate (SLO)? Why would this concept matter for horse sport? In perhaps its simplest form, "social license to operate" is the public's perception of an industry or activity. It is a challenging concept to fully grasp because it does not arrive as a document given by a government agency. Yet it is every bit as important-perhaps more so. Does the industry in question operate with transparency? Does the public believe in the integrity of the stakeholders who are most likely to benefit from the activity? Do people believe there is legitimacy in the scrutinized industry...
Usage of Antimicrobials in Equine Veterinary Practice in Denmark – A Case-Based Survey.
Journal of equine veterinary science    March 8, 2023   Volume 126 104267 doi: 10.1016/j.jevs.2023.104267
Jacobsen ABJE, Damborg P, Hopster-Iversen C.Horses may be carriers of important resistant bacteria like methicillin-resistant staphylococci. Such bacteria can potentially threaten both equine and public health, but little is known about predisposing factors like antimicrobial usage patterns in equines. Objectives of this study were to investigate the antimicrobial usage practices by Danish equine practitioners as well as factors impacting usage. A total of 103 equine practitioners filled in an online questionnaire. When asked to explain their typical treatment of six clinical case scenarios, only 1% and 7% of respondents prescribed syst...
The first report of macrocyclic lactone resistant cyathostomins in the UK.
International journal for parasitology. Drugs and drug resistance    March 7, 2023   Volume 21 125-130 doi: 10.1016/j.ijpddr.2023.03.001
Bull KE, Allen KJ, Hodgkinson JE, Peachey LE.In recent years, resistance to the benzimidazole (BZ) and tetrahydropyrimidine (PYR) anthelmintics in global cyathostomin populations, has led to reliance on the macrocyclic lactone drugs (ML-of which ivermectin and moxidectin are licensed in horses) to control these parasites. Recently, the first confirmed case of resistance to both ivermectin (IVM) and moxidectin (MOX) was reported in the USA in yearlings imported from Ireland. This suggests that ML resistance in cyathostomins has emerged, and raises the possibility that regular movement of horses may result in rapid spread of ML resistant c...
Impacts of Domestication and Veterinary Treatment on Mobile Genetic Elements and Resistance Genes in Equine Fecal Bacteria.
Applied and environmental microbiology    March 7, 2023   Volume 89, Issue 3 e0159022 doi: 10.1128/aem.01590-22
Mitchell SW, Moran RA, Elbourne LDH, Chapman B, Bull M, Muscatello G, Coleman NV.Antimicrobial resistance in bacteria is a threat to both human and animal health. We aimed to understand the impact of domestication and antimicrobial treatment on the types and numbers of resistant bacteria, antibiotic resistance genes (ARGs), and class 1 integrons (C1I) in the equine gut microbiome. Antibiotic-resistant fecal bacteria were isolated from wild horses, healthy farm horses, and horses undergoing veterinary treatment, and isolates (9,083 colonies) were screened by PCR for C1I; these were found at frequencies of 9.8% (vet horses), 0.31% (farm horses), and 0.05% (wild horses). A co...
Dynamics of Eastern equine encephalitis virus during the 2019 outbreak in the Northeast United States.
medRxiv : the preprint server for health sciences    March 6, 2023   2023.03.06.23286851 doi: 10.1101/2023.03.06.23286851
Hill V, Koch RT, Bialosuknia SM, Ngo K, Zink SD, Koetzner CA, Maffei JG, Dupuis AP, Backenson PB, Oliver J, Bransfield AB, Misencik MJ, Petruff TA....Eastern equine encephalitis virus (EEEV) causes a rare but severe disease in horses and humans, and is maintained in an enzootic transmission cycle between songbirds and mosquitoes. In 2019, the largest EEEV outbreak in the United States for more than 50 years occurred, centered in the Northeast. To explore the dynamics of the outbreak, we sequenced 80 isolates of EEEV and combined them with existing genomic data. We found that, like previous years, cases were driven by frequent short-lived virus introductions into the Northeast from Florida. Once in the Northeast, we found that Massachusetts...
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