Analyze Diet

Topic:Risk Factors

Risk factors in horses refer to variables or conditions that increase the likelihood of disease, injury, or other adverse health outcomes in equine populations. These factors can be intrinsic, such as age, breed, and genetic predisposition, or extrinsic, including environmental conditions, management practices, and exposure to infectious agents. Understanding risk factors is important for developing preventive strategies and improving health management in horses. This page aggregates peer-reviewed research studies and scholarly articles that explore the identification, assessment, and mitigation of risk factors in equine health, with the aim of enhancing disease prevention and promoting overall well-being in horses.
A Retrospective Study on Pre- and Intraoperative Predictors on the Recovery Quality of Horses After General Anesthesia.
Veterinary sciences    March 11, 2025   Volume 12, Issue 3 doi: 10.3390/vetsci12030262
Román Durá B, Dunham O, Grulke S, Salciccia A, Dupont J, Sandersen C.Equine anesthesia is related to high morbidity and mortality rates and recent studies suggested that the period of recovery remains the phase associated with the greatest risk of mortality in horses. Intraoperative hypotension, hypoxemia, and hypercapnia are recognized as potential determinants of recovery quality. This study, conducted at the Equine University Hospital of Liege, aimed to explore how these factors influence recovery outcomes and compare complications between non-emergency and emergency procedures. We analyzed data from 1057 horses, with a mean weight of 498 kg (ranging from 15...
Risk Factors and Long-Term Outcomes in Horses After the 2021 Outbreak of Equine Herpesvirus 1 Myeloencephalopathy, Valencia, Spain.
Journal of veterinary internal medicine    March 9, 2025   Volume 39, Issue 2 e70040 doi: 10.1111/jvim.70040
de la Cuesta-Torrado M, Velloso Alvarez A, Santiago-Llorente I, Armengou L, Nieto F, Ríos J, Cruz-López F, Jose-Cunilleras E.Equine herpesvirus myeloencephalopathy (EHM) is a persistent threat to horses, with unclear risk factors and disease severity. Objective: To evaluate risk factors, effective reproduction rate (Rt), and long-term athletic outcomes of an EHM outbreak. Methods: Retrospective study of the 2021 EHM outbreak in Valencia, Spain, examining associations between risk factors (sex, age, breed, country of origin, and vaccination status) and case fatality rate, EHM development, and odds of returning to competition using odds ratios [95% CI] and Rt via the Robert Kochs Institute method. Results: Among 191 h...
Seroprevalence and Risk Factors of Crimean-Congo Hemorrhagic Fever Exposure in Wild and Domestic Animals in Benin.
Viruses    March 8, 2025   Volume 17, Issue 3 387 doi: 10.3390/v17030387
Yessinou RE, Farougou S, Olopade JO, Oluwayelu DO, Happi A, Happi C, Groschup M.Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic viral disease prevalent in Africa. While infection is asymptomatic in animals, it can cause severe illness with hemorrhagic manifestations and high mortality rates in humans. This study aimed to determine the seroprevalence and potential risk factors of CCHF in wild (rodents, birds) and domestic (cattle, horses) animals in Benin. A cross-sectional study was carried out from 2022 to 2024 with the assistance of cattle breeders, hunters, farmers and bushmeat sellers in 15 districts found in three agroecological zones in the country. ...
‘We just make do’: the use, comfort and functionality of personal protective equipment in the UK mounted police.
Ergonomics    February 19, 2025   1-12 doi: 10.1080/00140139.2025.2466014
Hudson S, Blackburn J, Fish M, Ousey K.Police officers wear personal protective equipment (PPE) to reduce their risk of injury while on duty. Despite the unique policing activity of riding a horse, little is known about the PPE used by mounted officers. The aim of this research was to assess the use, comfort, and functionality of mounted police PPE. Twenty officers from three UK Mounted Sections were recruited. Semi-structured interviews and range of movement assessments were conducted. Interview data was analysed using reflexive thematic analysis. Three main themes were generated: and Much of the PPE worn by mounted officers is ...
Evaluation of a stent dressing and abdominal bandage on surgical site infection following emergency equine laparotomy: A randomised controlled trial.
Equine veterinary journal    February 19, 2025   doi: 10.1111/evj.14482
Isgren CM, Pinchbeck GL, Salem SE, Hann MJ, Townsend NB, Cullen MD, Archer DC.Surgical site infection (SSI) is a frequent complication following emergency equine laparotomy, negatively impacting equine welfare, increasing treatment costs and presenting a hospital biosecurity risk. Objective: To determine if a sutured-on stent dressing for incisional protection during anaesthetic recovery reduced SSI following emergency laparotomy. Methods: Randomised controlled trial. Methods: Eligible horses were randomised to a sutured-on stent (intervention) or textile dressing (control) as the primary component of a 3-layer abdominal bandage placed for anaesthetic recovery. Horses w...
The change in third metacarpal mid-diaphyseal radiographic dimensions in Thoroughbred foals through growth.
Equine veterinary journal    February 19, 2025   doi: 10.1111/evj.14484
Son JK, De Paz P, Kim J, Sanaei R, Ryu S, Bailey S, Davies HMS.Changes in the third metacarpal (MC3) mid-diaphyseal dimensions were measured radiographically in young Thoroughbred racehorses through race training and found to be associated with a higher risk of shin soreness. However, it is still unclear whether such negative MC3 morphologies are set congenitally or through development. Objective: To quantify MC3 bone dimensional changes through growth. Methods: Longitudinal. Methods: Twenty privately owned Thoroughbred foals were radiographed bimonthly from birth to 14 months of age. Four linear MC3 parameters (proximodistal MC3 length, mid-diaphyseal do...
[Statement on the efficacy and immunological safety of EHV vaccines in horses].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    February 18, 2025   Volume 53, Issue 1 39-48 doi: 10.1055/a-2518-1976
In February 2021, a serious EHV-1 outbreak occurred at an international jumping competition in Valencia, with several subsequent outbreaks in various European countries. As a consequence, several equestrian associations introduced compulsory vaccination against EHV-1, and in the immediate aftermath of the outbreak, demand for EHV vaccinations increased sharply. The initial concern has now dissipated. One equestrian association has abolished the compulsory vaccination that had only been introduced a year before, and a general debate began questioning the efficacy and safety of EHV-vaccines. Thi...
Linkage of jockey falls and injuries with racehorse injuries and fatalities in Thoroughbred flat racing in Victoria, Australia.
Frontiers in veterinary science    February 13, 2025   Volume 11 1481016 doi: 10.3389/fvets.2024.1481016
Morrice-West AV, Thomas M, Wong ASM, Flash M, Whitton RC, Hitchens PL.Racehorse and jockey incidents on race-days frequently occur together, yet risk factors for their occurrence have historically been investigated separately. Consideration of both horses and humans in tandem is required for a One Health approach to risk reduction. Our objectives were to therefore identify modifiable risk factors for adverse outcomes that are common or conflicting to both horses and their jockeys in Thoroughbred racing. Unassigned: Australian Single National System records for the 2004/05 to 2018/19 flat racing season were merged with the corresponding Australian Racing Incident...
Serosurvey of Leishmania infantum in equids in different European countries.
Preventive veterinary medicine    February 11, 2025   Volume 238 106463 doi: 10.1016/j.prevetmed.2025.106463
Leishmaniosis is a vector-borne and zoonotic disease with major sanitary implications at global scale. In Europe, Leishmania infantum is the only endemic etiologic agent, which has been previously reported in a wide range of mammal. However, the information about the role of equids in the L. infantum epidemiology is limited. We aimed to assess the seroprevalence and identify potential risk factors associated with L. infantum seropositivity in equine populations across several European countries. A total of 1364 equids, including 1005 horses, 240 donkeys and 119 mules/hinnies from Spain, Italy,...
Post-mortem computed tomography features associated with fracture of the fetlock joint in racing Thoroughbreds.
Equine veterinary journal    February 10, 2025   doi: 10.1111/evj.14465
Beck C, Hitchens PL, Whitton RC.Post-mortem studies have shown that fractures involving the metacarpophalangeal/metatarsophalangeal or fetlock joint are associated with focal areas of microdamage. Identification of computed tomography (CT) features consistent with microdamage and their association with fracture may aid in identification of horses at risk of fracture. Objective: To identify CT features associated with fracture of the metacarpophalangeal/metatarsophalangeal joint. Methods: Retrospective cohort study. Methods: Post-mortem CT images of 367 limbs from 157 Thoroughbred racehorses were graded for CT features. Multi...
Prevalence of anti-N. caninum and anti-N. hughesi antibodies in horses and associated risk factors in two selected equine zones of Punjab, Pakistan.
Veterinary parasitology, regional studies and reports    February 2, 2025   Volume 58 101211 doi: 10.1016/j.vprsr.2025.101211
Talib MT, Nasir A, Kashif M, Rahman A, Rehman AU, Akbar H, Nadeem A, Howe DK, Azam MN.The aim of this study was to determine the prevalence of anti-Neospora (N.) caninum and anti-N. hughesi antibodies in horses and to appraise the associated risk factors in the two central districts (Jhang and Toba Tek Singh) of Punjab Province, Pakistan. A total of 300 horse sera were analyzed for the presence of antibodies to Neospora spp. using a competitive ELISA. The overall prevalence of antibodies against Neospora species in horses was 25 % (75/300; 95 % CI 20.1-29.9). The prevalence of antibodies to N. caninum and N. hughesi species was 12.3 % (37/300; 95 % CI 8.6-16) and 19.3 % (5...
Healthy as a Horse? Characterising the UK and Ireland’s Horse Owners, Their Horses, and Owner-Reported Health and Behavioural Issues.
Animals : an open access journal from MDPI    January 31, 2025   Volume 15, Issue 3 397 doi: 10.3390/ani15030397
Watson WL, MacKay JRD, Dwyer CM.This study focuses on recreational horse owners in the UK and Ireland to explore the relationship between horse characteristics and welfare issues. An online questionnaire was distributed to 1501 horse owners to collect data on the owners, horses, and health/behavioural issues. Most respondents were female (98%), lived in England (56%), and did not insure their horses for veterinary costs (51%). Horses were typically over 5 years of age (96%), taller than 154 cm (55%), and mostly geldings (65%). Common welfare issues reported included lameness (26%), handling problems (11%), antisocial behavio...
Association between fungal detection, airways inflammation and diagnosis of moderate to severe asthma in horses.
Equine veterinary journal    January 29, 2025   doi: 10.1111/evj.14470
Barbazanges P, Couroucé A, Le Digarcher G, Cardwell JM, Schmitt E, Toquet MP, Lemonnier LC, Richard EA.Fungi are ubiquitous in horses' environment. Their contribution to the pathophysiology of severe asthma (SA) is acknowledged, while controversies remain for mild-moderate asthma (MA). Objective: We hypothesised that fungi are a risk factor for asthma. Our objective was to compare different combinations of analytical methods (cytology, culture) and sampling sites (tracheal wash (TW), bronchoalveolar lavage fluid (BALF)) in relation to clinical status (control, MA, SA). Methods: Prospective cross-sectional study. Methods: The study population included asymptomatic racing horses in the field and ...
Molecular and Serological Investigation of Equine Herpesvirus Type 1 (EHV-1) and Type 4 (EHV-4) in Horses In Ibagué, Tolima.
Veterinary medicine international    January 29, 2025   Volume 2025 1661949 doi: 10.1155/vmi/1661949
Petano-Duque JM, Urueña-Martinez E, Cabezas-Callejas LL, Perilla-Amaya J, Rueda-García V, Rondón-Barragán IS, Lopera-Vásquez R.EHV-1 is one of the most prevalent viral pathogens in horses; however, its prevalence is not well defined by cross-reactions of serological tests. Thus, this study aims to determine EHV-1/-4 prevalence in Colombian creole horses from Ibagué, Tolima, using molecular techniques, as well as to determine possible risk factors associated with viral infection. A cross-sectional study was carried out in 110 equines blood, serum, and semen samples from Ibagué, Tolima. Antibodies against EHV-1/-4 were determined through indirect ELISA. EHV-1 was detected by amplifying the glycoprotein H gene through ...
Essential and risk elements in horses affect haematology, serum biochemistry and oxidative status parameters.
Scientific reports    January 28, 2025   Volume 15, Issue 1 3489 doi: 10.1038/s41598-025-87908-6
Halo M, Kirchner R, Tirpák F, Slanina T, Tokárová K, Kováčik A, Miškeje M, Greń A, Formicki G, Halo M, Madeddu R, Massányi P.The abundance of chemical elements in the blood of horses can indicate the physiological balance, health of animal as well as can be taken as an indicator of environmental pollution. The aim of this work was to analyse haematological, biochemical parameters, TOS, FRAP, SOD, Gpx, TAS and their correlations with concentrations of essential and risk elements in blood of horses stabled in two different locations: The National Stud Farm Topoľčianky (n = 11; 11 stallions, consisting of the breeds 6 Lipizzan, 3 Slovak warmblood, 2 Holsteiner) and Experimental Centre at Institute of Animal Husba...
Complications associated with equine transvaginal ultrasound-guided follicle aspiration: Practitioner survey and field results.
Journal of equine veterinary science    January 27, 2025   Volume 146 105363 doi: 10.1016/j.jevs.2025.105363
Hinrichs K, Schnobrich M, Fernandes CB, Fleury P, Barillari V, Bruggeworth S.Transvaginal ultrasound-guided follicle aspiration (TVA) is being performed commonly in clinical equine practice. There is limited information in the literature about the type and incidence of complications related to TVA. We conducted a survey (Study 1), completed by 23 practicing veterinarians, soliciting information about the types and incidence of minor and major complications and of fatalities they had experienced associated with performance of TVA. In Study 2, data from a large clinical practice in which six veterinarians performed over 14,000 TVAs over a period of 7 years was reviewed t...
Motorcycle and Equestrian Trauma: An ACS TQIP Comparative Study.
Journal of trauma nursing : the official journal of the Society of Trauma Nurses    January 27, 2025   Volume 32, Issue 1 15-22 doi: 10.1097/JTN.0000000000000828
Ross DE, Ghodasara SK, Roskam JS, Gaccione AG, DiFazio LT, Bilaniuk JW, Nemeth ZH.Motorcycle and equestrian accidents can share similar trauma mechanisms and can result in serious injuries. Objective: This study aims to analyze variations in injuries and safety standards through types, severity, and outcomes of traumatic injuries in both motorcycle and equestrian riders. Methods: Using the 2020 ACS TQIP database, we split patients into two groups based on their primary injury. We chose codes V28 and V80.0 to identify non-collision fall or throw injuries for motorcycle and equestrian accidents respectively. A total of 17,730 motorcycle and 5,461 equestrian patients were iden...
Assessment of tree-associated atypical myopathy risk factors in Acer pseudoplatanus (sycamore) seeds and leaves.
Equine veterinary journal    January 25, 2025   doi: 10.1111/evj.14475
González-Medina S, Hyde C, Chang YM, Piercy RJ.Sycamore tree-derived hypoglycin A (HGA) toxin causes atypical myopathy (AM), an acute, equine pasture-associated rhabdomyolysis but incidence fluctuates. Objective: Investigate whether tree or environmental factors influence HGA concentration in sycamore material and are associated with AM relative risk. Methods: Retrospective and experimental prospective study. Methods: UK sycamore population, seed production and AM incidence data were obtained. HGA concentration was measured in seeds from trees from 10 different central UK locations. The effect of tar spot infection, seed maturity, tree tru...
Equine temporomandibular joint diseases: A systematic review.
Equine veterinary journal    January 24, 2025   doi: 10.1111/evj.14462
Jasiński T, Turek B, Kaczorowski M, Brehm W, Skierbiszewska K, Domino M.The temporomandibular joint (TMJ) is a unique joint that enables mandibular movement. Temporomandibular diseases (TMDs) impair joint function, leading to more or less specific clinical signs. Objective: To compile and disseminate clinical data and research findings from existing publications on equine TMD. Methods: Systematic review. Methods: Following PRISMA 2020 guidelines, literature searches were conducted in PUBMED, Scopus, and Web of Knowledge. The inclusion criteria covered case reports and research articles on equine TMDs. The selected records were grouped considering septic TMJ arthri...
Demographic patterns in horseback riding head and neck injuries within the United States: A NEISS database study.
Injury    January 24, 2025   Volume 56, Issue 3 112167 doi: 10.1016/j.injury.2025.112167
Sharma S, Reardon LM, Guda R, Carr MM, Man LX, Alicea D.Our primary objective was to identify and describe demographic trends in head and neck injuries incurred while participating in horseback riding. Methods: Cross-sectional analysis. Methods: National Database. Methods: Head and neck injuries related to horseback riding over a ten-year period (2014-2023) were analyzed using data from the National Electronic Injury Surveillance System (NEISS). A total of 3,177 cases were identified. Inclusion criteria encompassed injuries to the head, neck, face, mouth, or ear. Variables included age, gender, injury type, anatomical location, and patient disposit...
Lessons learnt from horse-related human fatalities: Accident analysis using HFACS-Equestrianism.
Heliyon    January 24, 2025   Volume 11, Issue 3 e42276 doi: 10.1016/j.heliyon.2025.e42276
Chapman M, Fenner K, Thomas MJW.Equestrianism has an opportunity to learn lessons relating to safer human-horse interactions from those who no longer have a voice, by drawing data from the investigation of horse-related human fatalities and participating in accident analysis. Many human-horse related injuries and fatalities are not examined in equestrianism for the purpose of developing safer future risk mitigation practice, often due to the philosophy that horse sport is simply dangerous. This study analysed data from the Australian National Coronial Information System (NCIS) relating to fatalities involving human-horse int...
Factors associated with time to return to horse racing following a clavicle fracture in jockeys competing in Great Britain: A review and analysis of medical records.
PloS one    January 23, 2025   Volume 20, Issue 1 e0317724 doi: 10.1371/journal.pone.0317724
Newton LJ, Dobbin N, Goodwin P, Crampton JS.Competitive horse racing is the second largest sport in Great Britain by spectator attendance, employability, and revenue. It is a lucrative yet hazardous sport, with high injury rates, particularly from falls. Clavicular fractures are one of the most common injuries reported, yet their management, especially regarding return to racing, is under-researched. The purpose of this study was to explore the factors associated with the time to return to competition following a clavicular fracture in jockeys competing in Great Britain. Methods: This review of medical records utilised data from the Bri...
Yearling laryngeal function grades II.2 and below are not associated with reduced performance.
Equine veterinary journal    January 21, 2025   Volume 57, Issue 4 953-966 doi: 10.1111/evj.14452
Hardwick JL, Ahern BJ, Crawford KL, Allen KJ, Anderson BH, Rose KJ, Franklin SH.The relationship between Thoroughbred yearling laryngeal function (YLF) grade and race performance is unclear. Objective: To determine the effect of YLF on future race performance. Methods: Retrospective cohort study. Methods: Post-sale endoscopic recordings were reviewed from Australian yearling sales in 2018-2019. Race performance was evaluated for career and as 2-, 3- and ≥4-year-olds. Multivariable generalised linear modelling examined the association between YLF and performance, with risk estimates presented as coefficients (95% CI). Results: The YLF in 5175 examinations was graded I in...
Australian guidelines for equine internal parasite management.
Australian veterinary journal    January 21, 2025   Volume 103, Issue 4 151-158 doi: 10.1111/avj.13424
Beasley A, Abbas G, Hughes K, El-Hage C, Jacobson C, Bauquier J, Wilkes E, Carrigan P, Cudmore L, Hurley J, Beveridge I, Nielsen M, Jabbar A.Over the past few decades, the emergence of resistance amongst intestinal parasites of horses to all available anthelmintic classes has emphasised the need for a paradigm shift in parasite control approaches within the Australian equine industry. Findings of a recent Australia-wide research project have provided new insights into intestinal parasites (i.e. strongyles and ascarids) and parasite control from the perspectives of Australian horse breeders and equine veterinarians. The published data have revealed recent trends in parasite prevalence and distribution, breeders' and veterinarians' a...
A retrospective case-control study of pregnancy failure in Thoroughbred horses in Australia.
Preventive veterinary medicine    January 17, 2025   Volume 237 106424 doi: 10.1016/j.prevetmed.2025.106424
Wilson CS, Carrick J, Shearer P, Heller J, Brookes VJ.Pregnancy failure is a serious economic and welfare concern in the Thoroughbred horse industry, yet its incidence and risk factors in Australia remain unclear. This retrospective, nested, case-control study investigated pregnancy failure in resident mares on studs in the Hunter Valley, Australia, in 2021-2022, in early (46-150 days), mid (151-270 days), and late (>270 days) gestation. We found an annual incidence risk of 5.4 pregnancy failure cases/100 45-day pregnancies (0.05 cases/mare; 95 % CI 0.04-0.07), with full-term (perinatal) losses (≥320 days) accounting for 24 % of cases (9...
Mare colostrum quality and relationship with foal serum immunoglobulin G concentrations and average daily weight gains.
Equine veterinary journal    January 15, 2025   Volume 57, Issue 4 904-914 doi: 10.1111/evj.14471
Gallacher K, Champion K, Denholm KS.Foals suffer from total failure to transfer passive immunity (TFTPI) when serum immunoglobulin (IgG) is <4 g/L, and partial failure to transfer passive immunity (PFTPI) when serum IgG is 4-8 g/L. Objective: To explore risk factors for poor serum IgG concentration. Methods: Retrospective observational study. Methods: Data from 535 Thoroughbred foals born to 177 mares were analysed and included foal sex, birthweight, month and year of birth and colostrum Brix %. Associations between dam age and colostrum Brix (%); and between foal serum IgG and liveweight gains were also measured. Pre-suckle...
A genome-wide association study for recurrent laryngeal neuropathy in the Thoroughbred horse identifies a candidate gene that regulates myelin structure.
Equine veterinary journal    January 10, 2025   doi: 10.1111/evj.14461
McGivney CL, McGivney BA, Farries G, Gough KF, Han H, Holtby AR, MacHugh DE, Katz LM, Hill EW.Equine recurrent laryngeal neuropathy (RLN) is an economically important upper respiratory tract (URT) disease with a genetic contribution to risk, but genetic variants independent of height have not been identified for Thoroughbreds. The method of clinical assessment for RLN is critical to accurately phenotype groups for genetic studies. Objective: To identify genetic risk loci for RLN in Thoroughbreds in a genome-wide association study (GWAS) following high-resolution phenotyping. Methods: Case-control. Methods: Thoroughbred horses were characterised as RLN cases and controls using resting a...
Does dietary supplementation of pregnant mares with a commercial stud feed balancer improve the transfer of passive immunity in their foals? A controlled field trial.
Journal of equine veterinary science    January 6, 2025   Volume 145 105346 doi: 10.1016/j.jevs.2025.105346
Stoneham SJ, Tyler N, Holmes MA, Archer DC.This prospective, controlled field trial aimed to determine the effect of dietary supplementation of mares in late pregnancy with a commercial stud feed balancer on the transfer of passive immunity to their foals. Eighty-two pregnant mares on a single stud farm that were eligible for inclusion were assigned into two groups (Intervention and Control) based primarily on existing social groupings. Between 64-224 days prepartum, all mares received the same forage-based diet but mares in the Intervention group received an in-feed commercial stud feed balancer and mares in the Control group received...
Assessing the benzimidazole resistance in equine strongyles by in vitro methods.
Veterinary parasitology    January 3, 2025   Volume 334 110387 doi: 10.1016/j.vetpar.2024.110387
Königová A, Babják M, Kuzmina TA, Burcáková Ľ, Syrota Y, Várady M.The study aimed to conduct a survey on the occurrence of benzimidazole (BZ) resistance in strongyles by in vitro egg hatch test (EHT) and larval development test (LDT) and to identify the effective indicators of early resistance detection on horse farms with associated risk factors analysis appraisal. In total, 203 horses from 8 farms underwent the fecal sampling of which 77 horses were selected for in vitro testing. Simultaneously, 18 horses were chosen to analyse the results of in vitro tests compared to the in vivo fecal egg count reduction test (FECRT). The EHT indicated the presence of re...
Equestrian Sports Safety: An Update on Safety Equipment and Event Medical Coverage.
Current sports medicine reports    January 1, 2025   Volume 24, Issue 1 11-17 doi: 10.1249/JSR.0000000000001222
Gould S, Roy IR, Gabriel FD, Lowe R, Lin CY.Equestrian sports are associated with high rates of major injury compared to collision and powered two-wheel sports. Advancements in rider and horse safety equipment and the implementation of comprehensive emergency action planning standards may help mitigate injuries, particularly in regard to the Olympic disciplines of dressage, show jumping, and three-day eventing covered in this review. Personal safety equipment to consider includes helmets, safety and air vests, and horse tack including safety stirrups, acoustic dampeners, and breakaway reins. Equestrian event medical coverage requires em...
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