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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.
Identification of persistent clusters and temporal trends of glanders in horses throughout Brazil.
Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology]    July 27, 2025   Volume 56, Issue 3 2193-2203 doi: 10.1007/s42770-025-01730-w
Silva VVD, Leite DPSBM, Gonçalves LMT, Oliveira PRF, Junior JWP, Mota RA.Glanders, caused by Burkholderia mallei, is a zoonotic disease with profound socioeconomic and public health implications, affecting equines and humans. This study investigated glanders cases in Brazil from 2006 to 2023 to identify persistent clusters and analyze temporal trends, providing a foundation for the formulation of effective control policies. Official data were obtained from the National Animal Health Information System (SIZ) and Brazilian Institute of Geography and Statistics (IBGE), encompassing case notifications and equine population statistics by state and year. The incidence ri...
Genetic relatedness and antimicrobial resistance profiles of β-lactamase-producing Escherichia coli from environmental and animal sources in West Texas: a One Health approach.
Journal of applied microbiology    July 25, 2025   Volume 136, Issue 8 lxaf190 doi: 10.1093/jambio/lxaf190
Tasnim Y, Rahman MK, Awosile B.We aimed to determine the genetic relatedness among β-lactamase-producing Escherichia coli isolated from soil, lake water, and feces of geese, pigs, dogs, cattle, coyotes, wild hogs, and horses at one health interface in West Texas. Results: Previously isolated 56 β-lactamase-producing E. coli isolates from the feces of geese, pigs, horses, coyotes, dogs, cattle, and wild hogs, and soil and lake water from different locations in West Texas were analyzed for genetic relatedness using whole-genome sequencing, core genome multilocus sequence typing, and phylogenetic single-nucleotide polymorphi...
Horse owners seeking online health information: a mixed-methods study.
Frontiers in veterinary science    July 23, 2025   Volume 12 1628421 doi: 10.3389/fvets.2025.1628421
Haase L, Winter J, Grummt S, Sedlmayr M, Sedlmayr B.Many people seek health-related information online, not only for themselves but also on behalf of others who cannot articulate their symptoms. This proxy information-seeking behavior is particularly relevant for animal owners, who must interpret their animals' symptoms without direct verbal feedback. While online health information-seeking in the context of one's own health is well-studied, the specific challenges of searching by proxy, especially for animal health information, remain largely unexplored. Unassigned: This study aimed to determine the specific information needs and search behavi...
Multi-host distribution of Rhodococcus equi (Prescottella equi) strains and their phylogenomic clustering.
BMC microbiology    July 21, 2025   Volume 25, Issue 1 447 doi: 10.1186/s12866-025-04152-8
Ghielmetti G, Stevens MJA, Schmitt S, Kittl S, Cernela N, Biggel M, Schulthess B, Keller PM, Schrenzel J, Stephan R.Rhodococcus equi is an intracellular bacterial pathogen that can cause infections in various hosts, including humans and animals. Host-associated virulence plasmids have been identified as key contributors to the pathogenicity of R. equi and potentially play a role in determining the host tropism of the bacteria. The investigation of additional clinical and environmental isolates is likely to provide novel insights into the population structure, infection pathways, and drug resistance of this important pathogen. We combined whole-genome sequencing and antimicrobial-susceptibility testing of 37...
How accurate are riders in assessing saddle position?
Journal of equine veterinary science    July 21, 2025   Volume 152 105655 doi: 10.1016/j.jevs.2025.105655
Douglas M, Williams J, Randle H.Recent research has highlighted the detrimental impact of an ill-fitting saddle on equine health, welfare and performance. A correctly fitting saddle may not fit if positioned incorrectly. Objective: This study assessed riders' ability to visually evaluate saddle position and examine factors that influenced accuracy of assessment. Methods: Survey participants were provided with photographs of a series of saddles on horses obtained from the lateral aspect of the left side of the horse. Saddles were either correctly positioned (n = 5), too far forward (n = 5) or too far back (n = 2). This was in...
West Nile virus transmission in the Metropolitan Area of Barcelona (Spain): A One-Health surveillance approach.
One health (Amsterdam, Netherlands)    July 21, 2025   Volume 21 101150 doi: 10.1016/j.onehlt.2025.101150
Busquets N, Gardela J, José-Cunilleras E, Solé A, Salvador MJ, Obón E, Molina-López R, Aranda C, Montalvo T, Corbella I, Bou-Monclús MA....West Nile virus (WNV), mainly transmitted by mosquitoes, poses significant health risks to humans and horses, particularly in endemic regions. The first detection of WNV lineage 2 in Spain was in 2017 in Catalonia (northeastern Spain). In 2023, WNV was confirmed in a young yellow-legged gull and a probable human case was notified within the urban settings. We aimed to define the zone of WNV circulation in the Barcelona Metropolitan Area where these infections occurred and the effectiveness of the One Health approach for early WNV detection. The Catalan WNV surveillance and control programs in...
Unwelcome neighbours: Tracking the transmission of Streptococcus equi in the United Kingdom horse population.
Equine veterinary journal    July 20, 2025   doi: 10.1111/evj.14558
McGlennon AA, Verheyen KL, Newton JR, van Tonder A, Wilson H, Parkhill J, de Brauwere N, Frosth S, Waller AS.Strangles (Streptococcus equi infection) remains endemic in the UK, with ~300 laboratory diagnoses annually. Sub-clinically infected long-term carriers are considered a key driver of endemicity. Analysing genomes of circulating strains could provide valuable transmission insights of this pathogen. Objective: To determine the population structure and diversity of UK S. equi isolates and to model transmission using epidemiological and whole genome sequencing data. Methods: Retrospective cross-sectional epidemiological and genomic surveillance. Methods: A dated phylogenetic tree derived from 511â...
West Nile Virus Antibody Prevalence in Horses During the 2023 Outbreak in Tunisia, North Africa.
Vector borne and zoonotic diseases (Larchmont, N.Y.)    July 11, 2025   doi: 10.1177/15303667251359822
Dachraoui K, Ben Osman R, Ben Slama S, Sayadi A, Maachach Y, Trifi M, Labidi I, Lachheb J, Badr C, Larbi I, Zhioua E.A total of 20 horses belonging to the Pasteur Institute of Tunis used for the production of therapeutic serum antiscorpion venom were tested for the presence of antibodies anti-West Nile virus (WNV) during the 2023 outbreak of West Nile disease that affected humans and horses in Tunisia. Of the 20 samples tested in November 2023 by enzyme-linked immuno-sorbent assay (ELISA), five were positive, leading to a seroprevalence of 25%. Since the number of horses is not substantial, all samples were tested also by virus microneutralization test (MNT) using the Tunisian strain of WNV lineage 1 isolate...
Genomic snapshot of Klebsiella spp. isolates from clinically ill animals reveal diverse lineages with limited relatedness to human isolates.
BMC veterinary research    July 11, 2025   Volume 21, Issue 1 458 doi: 10.1186/s12917-025-04686-z
Martin G, Tyson GH, Guag J, Strain E, Ceric O.Klebsiella spp. is an important human and animal pathogen, and it is commonly found with resistance to clinically important antimicrobials worldwide. The main goals of this study were to determine the prevalence of antimicrobial resistance genes in our study population and to assess the relatedness between Klebsiella spp. isolated from humans and animals. Isolates were collected in 2019 and 2020 from various animal hosts that presented to veterinary hospitals in the U.S. that participate in the FDA's Center for Veterinary Medicine Veterinary Laboratory Investigation and Response Network's anti...
Antimicrobial Resistance Patterns of Staphylococcus aureus Cultured from the Healthy Horses’ Nostrils Sampled in Distant Regions of Brazil.
Antibiotics (Basel, Switzerland)    July 9, 2025   Volume 14, Issue 7 693 doi: 10.3390/antibiotics14070693
Saraiva MMS, Rodrigues HLS, Benevides VP, de Leon CMCG, Santos SCL, Stipp DT, Givisiez PEN, Vieira RFC, Oliveira CJB. () is a major cause of opportunistic infections in humans and animals, leading to severe systemic diseases. The rise of MDR strains associated with animal carriage poses significant health challenges, underscoring the need to investigate animal-derived . Objective: This study examined the genotypic relatedness and phenotypic profiles of antimicrobial resistance in . , previously sampled from nostril swabs of healthy horses from two geographically distant Brazilian states (Northeast and South), separated by over 3700 km. The study also sought to confirm the presence of methicillin-resistant (M...
Mixed infection of Leishmania (Leishmania) infantum and Leishmania (Viannia) braziliensis in a mare (Equus ferus caballus) from Minas Gerais State, Southeastern Brazil.
Journal of equine veterinary science    July 9, 2025   Volume 152 105649 doi: 10.1016/j.jevs.2025.105649
Martins ALM, Estevam LGTM, Freire MA, Lima ACVMDR, de Oliveira FCB, Dutra-Rêgo F, Carvalho GML, Ribeiro VM, Paz GF.Equine leishmaniasis is a widespread disease in Brazil, mainly caused by Leishmania (Viannia) braziliensis, with occasional cases involving Leishmania (Leishmania) infantum. This study reports a mixed infection in a 6-year-old mare from rural Itabirito, Minas Gerais, Brazil. The mare exhibited nodular cutaneous lesions on all limbs but had no other health issues. Skin and bone marrow samples were collected and analyzed using parasitological and molecular methods targeting the hsp70 gene and ITS1 region. Both L. (V.) braziliensis and L. (L.) infantum were identified, confirming a mixed infectio...
High seroprevalence of Francisella tularensis with low titers in Oklahoma equids from 2021-2023 suggests widespread exposure in the state’s equine population.
American journal of veterinary research    July 8, 2025   1-8 doi: 10.2460/ajvr.25.03.0085
Crisman EC, Furr M, Ramachandran A.To determine the seroprevalence of Francisella tularensis in horses in Oklahoma and to describe factors associated with seropositivity. Unassigned: In this observational study, 238 frozen equine serum samples were tested for F tularensis by microagglutination assay (MAT). Samples were collected from 36 of 77 Oklahoma counties from 2021 through 2023. Exclusion criteria included insufficient sample quantity, cross-reactivity to Brucella abortus, and county outside of Oklahoma. The Fisher exact test was used to compare the proportion of positive tests by year, river basin, and topographic region....
Zoonotic pathogens in equids in Central Europe: a systematic review.
BMC veterinary research    July 8, 2025   Volume 21, Issue 1 451 doi: 10.1186/s12917-025-04915-5
Arshad A, Reif AH, Cavalleri JV, Desvars-Larrive A.Equids serve diverse roles in contemporary society. Their use as companion animals, in sports, transportation, and food production brings them into close contact with humans, creating potential zoonotic risks. This review had two objectives: (i) to catalogue zoonotic pathogens detected in equids across Central Europe, and (ii) to analyse research trends and collaborations in equid zoonosis studies within the region. We conducted a systematic literature search following PRISMA guidelines to identify publications on naturally occurring zoonotic pathogens in equids from nine countries: Austria, t...
Striking a Balance: Stakeholder Perceptions of Risk in Horse Racing.
Equine veterinary journal    July 7, 2025   doi: 10.1111/evj.14561
McCarthy J, Cameron-Whytock HA, Bennet ED.Thoroughbred racing is a major industry, and in recent years, public concerns about equine safety have become more prominent, particularly in relation to on-track injuries and fatalities. This has challenged the industry's social licence to operate (SLO). Objective: To investigate and elucidate how UK and Irish racing stakeholders perceive risks to racehorses on race day and how those risks should be managed. Methods: Qualitative analysis of stakeholder perspectives using a constructionist approach. Methods: Twelve stakeholders from veterinary, communication and regulatory sectors within racin...
Orthoflavivirus nilense surveillance in the State of Piauí, northeastern Brazil.
Memorias do Instituto Oswaldo Cruz    July 7, 2025   Volume 120 e240218 doi: 10.1590/0074-027602402180
Lobato OL, Nogueira TDS, Lima TET, Andrade FJDC, de Macedo MGG, Pereira RS, Xavier J, Amorim MR, Barbosa PP, da Rocha AS, Silva SDC, Alcantara LCJ....The cycle of the Orthoflavivirus nilense (West Nile virus - WNV) involves birds and mosquitoes, while humans and equids serve as terminal hosts. In 2014, the first human case in Brazil was confirmed in Piauí State. Objective: To investigate the presence of WNV in birds, mosquitoes, and equids in municipalities of Piauí. Methods: Collections were carried out following recommendations from the Ministry of Health of Brazil, in 11 municipalities (all with human cases or bird mortality), where biological samples were collected from birds, mosquitoes, and equids. The Viral RNA extraction was perfo...
Frequent location and severity of sports-related fractures in children in a tertiary care-center. A retrospective observational cohort study.
Orthopaedics & traumatology, surgery & research : OTSR    July 4, 2025   104327 doi: 10.1016/j.otsr.2025.104327
Cordonnier T, Germon V, Lemé C, Jouve JL, Launay F, Pesenti S.Despite benefits in children, sport practice has been reported with higher risk of fractures. Our objective was to report the characteristics of sport-related fractures in children and to compare them to fractures sustained in a domestic context. Our hypothesis was that sports-related fractures more frequently required surgical treatment, and could therefore be considered more severe METHODS: We conducted a retrospective cohort study including patients under 16 years old, diagnosed with a fracture at the emergency department, excluding skull and face fractures. Demographic data, context of inj...
Targeting the Risk of Diptera-Borne Zoonoses by a Sentinel Equestrian Centers Program.
Pathogens (Basel, Switzerland)    July 4, 2025   Volume 14, Issue 7 661 doi: 10.3390/pathogens14070661
Diptera-borne diseases pose a major threat to global health, and their distribution is constantly changing due to climate change, globalization, and environmental changes. To improve the knowledge of dipteran species and their distribution in equine facilities, CDC-UV and oviposition traps were placed, and the dipping technique was performed in 16 equestrian centers of Northwest (NW) Spain (Galicia and Castilla y León Autonomous Communities) between July and November 2023. A questionnaire was distributed among the horse owners to obtain additional information. Four genera of culicids, (51.8%...
Emergence of ciprofloxacin- and tigecycline-resistant extended-spectrum β-lactamase (ESBL)-producing Salmonella enterica serovar Kentucky ST198 from horse, China.
Journal of global antimicrobial resistance    July 3, 2025   Volume 44 207-210 doi: 10.1016/j.jgar.2025.06.020
Zhang XX, Huang X, Li XQ, Wang ZY, Jiang Y, Jiao X, Li Q, Wang J, Zhong FG.Salmonella enterica serovar Kentucky ST198 has been increasingly reported in diverse sources worldwide, emerging as a globally epidemic clone. In this study, we aim to characterise the first isolated S. Kentucky ST198 strain from a horse in China. Methods: Twelve faecal samples were collected from horses at a farm in Shihezi, Xinjiang Province, China, and investigated for the presence of Salmonella. The minimum inhibitory concentrations of 15 antimicrobial agents were determined using the broth microdilution method. The whole genome of Sal140 was sequenced using the Illumina Hiseq platform and...
The reemergence of the New World screwworm and its potential distribution in North America.
Scientific reports    July 3, 2025   Volume 15, Issue 1 23819 doi: 10.1038/s41598-025-04804-9
Valdez-Espinoza UM, Fadda LA, Marques R, Osorio-Olvera L, Jiménez-García D, Lira-Noriega A.The reemergence of the New World screwworm (Cochliomyia hominivorax) poses a significant threat to animal and public health with minimal regulatory oversight. This study analyzes the potential distribution and reemergence of this pest, which is endemic to South America but was previously eradicated in North America. We first developed bioclimatic suitability models, and then incorporated these findings along with reemergence records and inspection point data to simulate possible dispersal routes into Mexico and the United States. Our results document the historical distribution of C. hominivor...
Horse handlers’ knowledge, attitudes, and perceptions of African horse sickness in South-West, Nigeria.
Scientific reports    July 1, 2025   Volume 15, Issue 1 21880 doi: 10.1038/s41598-025-07991-7
Akinniyi OO, Lawal TR, Rufai N, Jolayemi KO, Amaje J.African horse sickness (AHS) is endemic in Nigeria. Despite this, little is known about the perspective of horse handlers in Nigeria regarding AHS. The study aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of horse handlers in Southwest Nigeria regarding AHS. A cross-sectional survey study was conducted, which involved convenient sampling of 131 horse handlers in Lagos and Oyo States by February - April 2024. The pre-validated questionnaires were administered via face-to-face interviews, covering demographics, knowledge of AHS transmission, clinical signs, prevention and cont...
Rabies in livestock in the United States (2012-2021).
American journal of veterinary research    June 30, 2025   1-8 doi: 10.2460/ajvr.25.01.0019
Payette-Stroman A, Ross Y, Ma X, Boutelle C, Holschbach C, Blanton JD, Wallace R.Rabies in livestock in the United States (US) poses a significant public health concern due to the potential for human exposure and economic losses to producers. Understanding the epidemiology of rabies in livestock supports broader One Health goals by enhancing early detection of viral incursions and protecting both animal and human health. This study assessed the epidemiology of rabies in livestock in the US from 2012 to 2021 using surveillance data reported to the National Rabies Surveillance System. A sensitivity analysis was conducted to estimate economic losses, including livestock value...
Risk Factors Associated with the Prevalence of Antibodies Against Brucellosis in Equids from Western Pará, Brazil.
Microorganisms    June 30, 2025   Volume 13, Issue 7 1525 doi: 10.3390/microorganisms13071525
Picanço EMB, Assis FFV, Peleja PL, Sousa ABB, Barrêto Júnior RA, Lima RF, Neves KAL, Minervino AHH.This study aimed to determine the prevalence of antibodies against equine brucellosis in three distinct equid groups (farm animal, urban carthorse, and sport horse) in Western Pará, Brazil, and to identify associated risk factors. A cross-sectional study, involving 75 farms across 14 municipalities, sampled 1069 equids composed of urban carthorses and sport horses. Serum samples were tested for antibodies against spp. using the buffered acidified plate antigen (BAPA) test for screening, followed by the serum agglutination in tubes with 2-mercaptoethanol (2-ME) for confirmation. Univariate an...
Comparative genomic and virulence analyses of a novel sequence type 420 Streptococcus equi subspecies zooepidemicus isolated from donkey.
Virulence    June 29, 2025   Volume 16, Issue 1 2525964 doi: 10.1080/21505594.2025.2525964
Tian Y, Su Y, Jiang X, Su L, Zhang B, Lv F.The zoonotic pathogen subspecies (SEZ) frequently colonizes equines harmlessly but can occasionally cause disease or cross species barriers. Currently, growing evidence suggests SEZ can lead to severe clinical manifestations in horses and other animals, posing a threat to human and companion animal health. In this study, we sequenced the complete genome of the SEZ strain HT321, a novel sequence type 420 isolated from a donkey with a respiratory infection in China. Subsequently, we conducted comparative genomics, core genome single nucleotide polymorphisms (cgSNP), phylogenetic analysis multi...
Spinal Injuries from Equestrian Activity: A US Nationwide Study.
Journal of clinical medicine    June 26, 2025   Volume 14, Issue 13 4521 doi: 10.3390/jcm14134521
Loder RT, Walker AL, Blakemore LC. Equestrian activities can result in spine injuries. Most studies are from single centers, and none use a national database. It was the purpose of this study to describe the demographics, injury mechanisms, and types of equestrian-associated spinal injuries using a US national ED database. The National Electronic Injury Surveillance System database was queried for equestrian-related spine injuries from 2000-2023. ED disposition was categorized as discharged or not discharged. Statistical analyses accounted for the weighted, stratified nature of the data to obtain national estimates. There we...
Antimicrobial resistance in bacteria isolated from diseased horses in Poland, 2010-2022.
Polish journal of veterinary sciences    June 25, 2025   Volume 28, Issue 2 291-302 doi: 10.24425/pjvs.2025.154948
Żychska M, Rzewuska M, Kizerwetter-Świda M, Chrobak-Chmiel D, Stefańska I, Kwiecień E, Witkowski L.The rise of antibiotic resistance is a global health crisis affecting human and veterinary medicine, highlighted within the One Health framework. Horses, classified as both meat and companion animals, play a crucial role in facilitating resistant bacteria spread to humans. Despite increased awareness and reduced antibiotic use in livestock, data on equine antibiotic use and resistance remain limited. This retrospective study examines antimicrobial resistance in 978 bacterial isolates from horses in Poland over 12 years (2010-2022), utilizing data from the Microbiological Diagnostic Laboratory ...
First Detection of West Nile Virus (WNV) Lineage 2 in Mosquitoes in the Republic of Kosovo.
Transboundary and emerging diseases    June 24, 2025   Volume 2025 3208806 doi: 10.1155/tbed/3208806
Hoxha I, Xhekaj B, Muja-Bajraktari N, Sekulin K, Unterköfler MS, Schlamadinger L, Situmorang T, Fuehrer HP, Obwaller AG, Camp JV, Walochnik J....West Nile virus (WNV, family Flaviviridae) is the most geographically widespread arbovirus affecting humans. It circulates between wild birds and mosquitoes, while humans and horses are dead-end hosts. In recent years, several outbreaks have been reported from European countries, including the Balkan Peninsula. In the Republic of Kosovo, a southern Balkan country, data on WNV are scarce, and neither mosquito monitoring nor WNV surveillance is established. To address this gap, we aimed to assess a first monitoring approach that should set the basis and support future large-scale activities in t...
Using Tennessee youth hippology contest results as a needs assessment for 4-H horse project members and development of a train-the-trainer program for Tennessee extension agents.
Translational animal science    June 23, 2025   Volume 9 txaf068 doi: 10.1093/tas/txaf068
Main SC, Ivey JLZ, Strickland LG, Rhinehart JD, Sun X.Land-Grant Institutions and Cooperative Extension Services seek to disseminate information to the public; however, Extension agents differ in areas of expertise, leaving some counties with minimal ability to provide 4-H horse project members with sufficient content knowledge while agents in other counties are more well versed in equine-specific areas. Results from the 2021 and 2023 Tennessee regional and 2022 Eastern National 4-H Hippology contests were used to determine areas of knowledge deficiency. Nutrition, tack, selection, health, and breeds were categories identified as areas in which 4...
Equine zoonotic disease risks in remote Aboriginal and Torres Strait Islander communities: a critical review.
Australian veterinary journal    June 22, 2025   Volume 103, Issue 10 693-714 doi: 10.1111/avj.13462
Christofi E, Hoopes J, El-Hage C, Coffin J, Riley T, Cumming B.Since their arrival in the 1700s, horses have played a significant role in shaping the identity of rural and remote communities. However, Indigenous perspectives on the historical role of horses in communities have been largely underrepresented. In remote regions, where access to veterinary and medical services is limited, interactions between people and free-roaming horses present a potential risk for zoonotic disease transmission. This review identifies potential pathways for the transmission of equine zoonoses in rural and remote Aboriginal and Torres Strait Islander communities, aiming to ...
Effectiveness of steam cleaning technology on reducing the occurrence of ESKAPE organisms and Escherichia coli in the stables of an equine referral hospital.
Journal of equine veterinary science    June 21, 2025   Volume 151 105636 doi: 10.1016/j.jevs.2025.105636
Sosa-Portugal S, Dale L, Devaney J, Sharp A, Malalana F, Timofte D.The "ESKAPE" bacteria include a group of organisms known for their multidrug resistance and potential association with nosocomial infections in human and veterinary hospitals. Objective: This study aimed to evaluate the effectiveness of steam cleaning in reducing the number of ESKAPE organisms on environmental surfaces from the stables of an equine veterinary referral hospital. Methods: Environmental sampling was performed at two timepoints (pre- and post-steam cleaning) on smooth metallic doors and rough rubber stable walls. Microbiological culture targeted ESKAPE organisms and Escherichia co...
Attitudes and experiences of UK vets towards control and prevention of strangles.
The Veterinary record    June 20, 2025   Volume 196, Issue 12 e5697 doi: 10.1002/vetr.5697
Whitlock F, McGlennon A, Newton R, Riley K.As part of her undergraduate research project, Cambridge vet student Katie Riley surveyed the attitudes of UK veterinarians with regard to preventing and controlling strangles, including the use of vaccination. Here, she and Fleur Whitlock, Abigail McGlennon and Richard Newton of Equine Infectious Disease Surveillance discuss her findings.