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Topic:Veterinary Medicine

Veterinary medicine for horses encompasses the study and application of medical practices to diagnose, treat, and prevent diseases in equine species. This field involves a comprehensive understanding of equine anatomy, physiology, pathology, and pharmacology. Veterinary practitioners employ a range of diagnostic tools and therapeutic interventions to address health issues in horses, including lameness, gastrointestinal disorders, respiratory conditions, and infectious diseases. Preventative care, such as vaccination and deworming programs, is also a significant aspect of equine veterinary medicine. This page gathers peer-reviewed research studies and scholarly articles that explore various aspects of veterinary medicine as it pertains to horses, including advancements in diagnostic techniques, treatment protocols, and preventive health strategies.
Use of high resolution/accurate mass full scan/data-dependent acquisition for targeted/non-targeted screening in equine doping control.
Analytical methods : advancing methods and applications    March 12, 2021   Volume 13, Issue 13 1565-1575 doi: 10.1039/d0ay02297g
You Y, Proctor RM, Guo K, Li X, Xue E, Guan F, Robinson MA.High-resolution mass spectrometry (HRMS) is a very powerful technology for equine doping control analysis. The more recently developed hybrid type of Orbitrap-based HRMS instrument allows for both targeted and non-targeted screening analyses in a single liquid chromatography-high resolution tandem mass spectrometry (LC-HRMS/MS) run. In the present study, an LC-HRMS/MS method was developed and validated to detect prohibited substances in equine sports. The substances were recovered from equine plasma by liquid-liquid extraction (LLE) using methyl tert-butyl ether and were separated on a C18 rev...
Relationship between hepatic grayish-white solid nodules in horses imported from Canada and larval Echinococcus multilocularis infection.
The Canadian veterinary journal = La revue veterinaire canadienne    March 12, 2021   Volume 62, Issue 3 285-288 
Hifumi T, Tanaka T, Hernandez EP, Akioka K, Yamada K, Imamura Y, Hatai H, Miyoshi N.Histopathological and genetic examinations were conducted on grayish-white solid hepatic nodules in 150 horses imported from Canada, in order to investigate larval Echinococcus multilocularis infection. Ten of the 150 horses (6.7%) were diagnosed with alveolar hydatid disease. The sequences of the mitochondrial cytochrome b genes obtained from all 10 polymerase chain reaction positive samples had 99 to 100% identity with the European haplotype E1 of E. multilocularis. Therefore, we concluded that the infections likely originated in Canada. Relation entre les nodules hépatiques solides blanc-g...
Prevalence of heterophilic antibodies in serum samples from horses in an equine hospital, and elimination of interference using chicken IgY.
Acta veterinaria Scandinavica    March 12, 2021   Volume 63, Issue 1 10 doi: 10.1186/s13028-021-00575-1
Dong B, Bergman D, Holst BS.Heterophilic antibodies in serum and plasma can interfere with mammalian antibodies in immunoassays and result in false test results, usually false positive. Although studies screening for heterophilic antibodies as well as elimination studies have been conducted in dogs and cats, knowledge of the presence of heterophilic antibodies in other species in veterinary medicine is limited. In this study, a 2-site sandwich-type interference assay that detects anti-mouse antibodies was used to detect heterophilic antibodies in a population of horses treated in an animal hospital. Results: A total of 1...
Study design synopsis: How to conduct, prepare, analyse and report equine biomechanical studies.
Equine veterinary journal    March 12, 2021   Volume 53, Issue 4 645-648 doi: 10.1111/evj.13439
Egenvall A, Marr CM, Byström A.No abstract available
Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses.
Veterinary surgery : VS    March 12, 2021   Volume 50, Issue 4 775-783 doi: 10.1111/vsu.13612
Labens R, Jermyn K.To assess suspensory ligament extensor branch location and fracture gap reduction with simulation of standing and recumbent cortical bone screw repair of experimental incomplete parasagittal proximal phalanx (P1) fractures. Methods: Controlled laboratory study. Methods: Twenty equine cadaver forelimbs. Methods: Simulated fractures were repaired twice in random order. A proximal cortical bone screw was placed in lag fashion with the limb unloaded (simulated recumbent repair) and loaded to 38% of body weight (range, 375-568 kg; simulated standing repair). Changes in fracture gap width were ass...
Paternally expressed retrotransposon Gag-like 1 gene, RTL1, is one of the crucial elements for placental angiogenesis in horses†.
Biology of reproduction    March 12, 2021   Volume 104, Issue 6 1386-1399 doi: 10.1093/biolre/ioab039
Dini P, Carossino M, Balasuriya UBR, El-Sheikh Ali H, Loux SC, Esteller-Vico A, Scoggin KE, Loynachan AT, Kalbfleisch T, De Spiegelaere W, Daels P....RTL1 (retrotransposon Gag-like 1) is an essential gene in the development of the human and murine placenta. Several fetal and placental abnormalities such as intrauterine growth restriction (IUGR) and hydrops conditions have been associated with altered expression of this gene. However, the function of RTL1 has not been identified. RTL1 is located on a highly conserved region in eutherian mammals. Therefore, the genetic and molecular analysis in horses could hold important implications for other species, including humans. Here, we demonstrated that RTL1 is paternally expressed and is localized...
A national trauma data bank analysis of large animal-related injuries.
Injury    March 12, 2021   Volume 52, Issue 9 2677-2681 doi: 10.1016/j.injury.2021.03.020
Buchanan FR, Cardenas TC, Leede E, Riley CJ, Brown LH, Teixeira PG, Aydelotte JD, Coopwood TB, Trust MD, Ali S, Brown CVR.Large animal-related injuries (LARI) are relatively uncommon, but, nevertheless, a public hazard. The objective of this study was to better understand LARI injury patterns and outcomes. Methods: We performed a retrospective review of the 2016 National Trauma Data Bank and used ICD-10 codes to identify patients injured by a large animal. The primary outcome was severe injury pattern, while secondary outcomes included mortality, hospital length of stay, ICU admission, and mechanical ventilation usage. Results: There were 6,662 LARI included in our analysis. Most LARI (66%) occurred while riding ...
Evaluation of equine corneal disease using ultrasound biomicroscopy.
Veterinary ophthalmology    March 11, 2021   Volume 25 Suppl 1 179-184 doi: 10.1111/vop.12881
Keenan AV, Townsend WM.To describe the clinical use of ultrasound biomicroscopy (UBM) to evaluate equine corneal disease. Methods: Images were obtained using a 50-MHz probe ultrasound biomicroscopy system (Quantel Aviso) and Clear Scan® probe cover. Six horses with corneal disease were evaluated via UBM for lesion size, lesion depth, and continuity of Descemet's membrane. Horses were sedated and received auriculopalpebral nerve blocks and application of topical anesthetic prior to UBM. Results: Ultrasound biomicroscopy was easily performed in all cases. UBM evaluation of three cases of corneo-limbal squamous cell c...
Plasma amino acid concentrations during experimental hyperinsulinemia in 2 laminitis models.
Journal of veterinary internal medicine    March 11, 2021   Volume 35, Issue 3 1589-1596 doi: 10.1111/jvim.16095
Stokes SM, Stefanovski D, Bertin FR, Medina-Torres CE, Belknap JK, van Eps AW.Endocrinopathic laminitis develops in association with insulin dysregulation, but the role of insulin in the pathogenesis remains unclear. Hyperinsulinemia can cause hypoaminoacidemia, which is associated with integumentary lesions in other species and therefore warrants investigation as a potential mechanism in laminitis. Objective: Evaluate plasma amino acid concentrations in the euglycemic-hyperinsulinemic clamp (EHC) and prolonged glucose infusion (PGI) laminitis models. Methods: Sixteen Standardbred horses. Methods: Prospective experimental study. Plasma amino acid concentrations were mea...
Minimally invasive tenotomy of the tibial insertion of the semitendinosus muscle: An ex vivo study in horses.
Veterinary surgery : VS    March 11, 2021   Volume 50, Issue 4 843-847 doi: 10.1111/vsu.13609
Zetterström SM, Boone LH, Weatherall KM, Caldwell FJ.To describe a minimally invasive technique for semitendinosus tenotomy with ultrasonographic guidance and to evaluate procedural complications. Methods: Experimental study. Methods: Cadaveric equine hind limbs (n = 16). Methods: A stab incision was performed distocaudal to the tibial insertion of the semitendinosus muscle with ultrasonographic assistance. After transection of the tendon with an arthroscopic retrograde knife, the tendon edges palpably retracted, and complete transection was confirmed by ultrasound. Limbs were dissected to confirm the degree of tendon transection and to identify...
Retrospective analysis of oblique and straight distal sesamoidean ligament desmitis in 52 horses.
Equine veterinary journal    March 11, 2021   Volume 54, Issue 2 312-322 doi: 10.1111/evj.13438
Hawkins A, O'Leary L, Bolt D, Fiske-Jackson A, Berner D, Smith R.Injuries to the oblique (ODSL) or straight (SDSL) distal sesamoidean ligaments are a recognised cause of distal limb lameness in the horse. However, there are only limited publications addressing common diagnostic features and prognosis. Objective: (a) Report findings on ultrasonography and standing low-field magnetic resonance imaging (sMRI) in horses with ODSL or SDSL injury; (b) Identify clinical variables associated with lesion type and (c) Identify factors associated with return to soundness in horses with ODSL or SDSL injury. Methods: Retrospective case series. Methods: Horses with a pri...
Antioxidants in assisted reproductive technologies: An overview on dog, cat, and horse.
Journal of advanced veterinary and animal research    March 11, 2021   Volume 8, Issue 1 173-184 doi: 10.5455/javar.2021.h500
Ciani F, Maruccio L, Cocchia N, d'Angelo D, Carotenuto D, Avallone L, Namagerdi AA, Tafuri S.Assisted reproductive technologies (ARTs) are widely used as a tool to improve reproductive performance in both humans and animals. In particular, in the veterinary field, ARTs are used to improve animal genetics, recover endangered animals, and produce offspring in the event of subfertility or infertility in males or females. However, the use of ARTs did not improve the fertilization rate in some animals due to various factors such as the difficulty in reproducing an anatomical and humoral substrate typical of the natural condition or due to the increase in catabolites and their difficult eli...
Ultrasonographic guidance for perineural injections of the cervical spinal nerves in horses.
Veterinary surgery : VS    March 10, 2021   Volume 50, Issue 4 816-822 doi: 10.1111/vsu.13610
Wood AD, Sinovich M, Prutton JSW, Parker RA.To evaluate the accuracy of ultrasonographic guidance for injection near the ventral rami of the cervical spinal nerves (VRCSN). Methods: Ex vivo study. Methods: Ten cadavers (n = 40 injections). Methods: Left and right VRCSN at C4/5 and C5/6 were infiltrated at the intervertebral foramen (IVF) under ultrasonographic guidance. A vertically orientated 3.5-MHz curvilinear probe was used to identify the craniocaudal midpoint of the articular process joint (APJ). The probe was moved ventrally until the IVF was identified. An 18-gauge 15-cm-long spinal needle was aimed immediately below the ventral...
Parasites of Horses, Donkeys and Mules in Turkey.
Turkiye parazitolojii dergisi    March 10, 2021   Volume 45, Issue 1 56-75 doi: 10.4274/tpd.galenos.2020.7193
Yılgör Çırak V, Girişgin AO.Significant numbers of parasites such as protozoa, helminths and arthropods infest equids. Various investigations have been conducted in Turkey to detect these parasites. In this review, all parasites reported in horses, donkeys and mules have been listed. A total of 62, 52 and 21 helminths were recorded in horses, donkeys and mules, respectively. As protozoan parasites, 13 species were detected both in horses and donkeys, and 3 in mules. With regard to arthropods, 40, 23 and 6 species were detected in horses, donkeys and mules, respectively. In the recent years, various molecular diagnostic m...
The pharmacokinetics of a fentanyl matrix patch applied at three different anatomical locations in horses.
Equine veterinary journal    March 10, 2021   Volume 54, Issue 1 153-158 doi: 10.1111/evj.13424
Skrzypczak H, Reed R, Brainard B, Sakai D, Barletta M, Quandt J, Smyth C, Ruch M, Knych H.Matrix fentanyl patches have not been investigated in horses and may represent an effective means of providing analgesia over an extended time period without venous catheterisation. Objective: To describe the pharmacokinetics of a matrix transdermal fentanyl patch in horses. Methods: Randomised experiment, Latin-square design. Methods: Six adult horses were given each of three treatments with a 96-hour washout. For each treatment, two 100 µg/h matrix fentanyl patches were applied to the inguinal region (TXA), metacarpus (TXM) or ventral tail base (TXT) for 72 hours. Blood samples for fentan...
Studying the Shape Variations of the Back, the Neck, and the Mandibular Angle of Horses Depending on Specific Feeding Postures Using Geometric Morphometrics.
Animals : an open access journal from MDPI    March 10, 2021   Volume 11, Issue 3 doi: 10.3390/ani11030763
Raspa F, Roggero A, Palestrini C, Marten Canavesio M, Bergero D, Valle E.The effects of specific feeding positions upon the horse's shape variations of the back and neck postures as well as the variations of the mandibular angle have never been objectively studied. For this reason, geometric morphometrics was applied. Six horses, aged 14 ± 8 years (mean ± standard deviation, SD), were video-recorded while using three different feeding positions: on the ground-control position (CP); neck held 15 ± 3° below withers height with low hay net position (LP); neck held 15 ± 3° above withers height with high hay net position (HP). Data were analyzed using principal co...
Colloidal Iron Oxide Formulation for Equine Hoof Disinfection.
Animals : an open access journal from MDPI    March 10, 2021   Volume 11, Issue 3 766 doi: 10.3390/ani11030766
Isola M, Piccinotti C, Magro M, Fasolato L, Vianello F, Menandro ML, Memarian P, Rossi M, Falomo ME.The presence of bacteria of various origins on horse hoofs enables the onset of infections following trauma or even post-surgical wounds. Thus, the analysis of new antibacterial substances is of fundamental importance. In this study, the antibacterial efficacy of Iron Animals (IA), a stable colloidal suspension of iron oxide, organic acids, and detergents, was tested in vitro and in vivo. In vitro assays were performed to test the unspecific inhibitory effect of IA on both gram-positive and gram-negative bacteria monitoring the microorganism growth by spectrophotometry (optical density OD600) ...
Use of quantitative real-time PCR to determine the local inflammatory response in the intestinal mucosa and muscularis of horses undergoing small intestinal resection.
Equine veterinary journal    March 10, 2021   Volume 54, Issue 1 52-62 doi: 10.1111/evj.13429
Lisowski ZM, Lefevre L, Mair TS, Clark EL, Hudson NPH, Hume DA, Pirie RS.Studies in rodents and humans have demonstrated that intestinal manipulation or surgical trauma initiates an inflammatory response in the intestine which results in leucocyte recruitment to the muscularis externa causing smooth muscle dysfunction. Objective: To examine the intestinal inflammatory response in horses undergoing colic surgery by measuring relative differential gene expression in intestinal tissues harvested from surgical colic cases and control horses. Methods: Prospective case-control study. Methods: Mucosa and muscularis externa were harvested from healthy margins of resected s...
Morphological variability of the atrioventricular valve cusps in the equine heart.
Equine veterinary journal    March 10, 2021   Volume 54, Issue 1 167-175 doi: 10.1111/evj.13434
De Silva M, Tagliavia C, Galiazzo G, Gifuni G, Caiazza M, Chiocchetti R, Grandis A.The morphometric studies of the atrioventricular valves are still limited in the horse. Objective: To investigate the anatomy of the atrioventricular valves in the horse, focusing on the morphometric features of the valvular leaflets and the tendinous cords. We hypothesised that accessory leaflets occur commonly and exist as independent structures in the atrioventricular valves of the horse. Methods: Descriptive anatomical study. Methods: Twenty normal hearts from slaughtered half-bred horses were used. The cardiac weight and circumference were recorded. The atrioventricular valves were expose...
Single-Chamber Cardiac Pacemaker Implantation in a Donkey with Complete AV Block: A Long-Term Follow-Up.
Animals : an open access journal from MDPI    March 9, 2021   Volume 11, Issue 3 746 doi: 10.3390/ani11030746
Sedlinská M, Kabeš R, Novák M, Kološ F, Melková P.A five-month-old African jenny was presented with a history of exercise intolerance and syncopal episodes. Severe bradycardic arrhythmia due to a high-grade second-degree atrioventricular (AV) block with progression to complete AV block was diagnosed. The jenny underwent a transvenous single-chamber pacemaker implantation. The implantation procedure was performed in a lateral recumbency and the ventricular lead was inserted through the jugular vein. Positioning of the lead was guided by echocardiography. The pacemaker was programmed to VVI mode with a minimal ventricular rate of 40 pulses per ...
A Comparison of the Colonic Microbiome and Volatile Organic Compound Metabolome of Anoplocephala perfoliata Infected and Non-Infected Horses: A Pilot Study.
Animals : an open access journal from MDPI    March 9, 2021   Volume 11, Issue 3 doi: 10.3390/ani11030755
Slater R, Frau A, Hodgkinson J, Archer D, Probert C.Anoplocephala perfoliata is a common equine tapeworm associated with an increased risk of colic (abdominal pain) in horses. Identification of parasite and intestinal microbiota interactions have consequences for understanding the mechanisms behind parasite-associated colic and potential new methods for parasite control. A. perfoliata was diagnosed by counting of worms in the caecum post-mortem. Bacterial DNA was extracted from colonic contents and sequenced targeting of the 16S rRNA gene (V4 region). The volatile organic compound (VOC) metabolome of colonic contents was characterised using gas...
Three-dimensional printed guides for screw placement in equine navicular bones.
Veterinary surgery : VS    March 9, 2021   Volume 50, Issue 4 758-766 doi: 10.1111/vsu.13616
Perez-Jimenez EE, Biedrzycki AH, Morton AJ, McCarrel TM.To determine the influence of a custom 3D-printed guide for placement of cortical bone screws in the equine navicular bone. Methods: Ex vivo study. Methods: Eight pairs of normal adult equine forelimbs. Methods: A 3.5 × 55 mm cortical screw was placed in the longitudinal axis of each intact navicular bone. Screws were placed with a 3D-printed guide (3D) in one bone and with a traditional aiming device (AD) in the contralateral bone within each pair. Duration of surgery and the number of fluoroscopy images were compared between techniques. Screw placement was subjectively evaluated by gros...
Subconjunctival enucleation with orbital implant placement in standing horses: 20 cases (2014-2017).
Journal of the American Veterinary Medical Association    March 9, 2021   Volume 258, Issue 6 661-667 doi: 10.2460/javma.258.6.661
Betbeze CM, Dray SM, Fontenot RL.To develop a protocol for subconjunctival enucleation and orbital implant placement in standing horses and to document short- and long-term complications, cosmesis, and client satisfaction. Methods: 20 horses with nonneoplastic ocular disease requiring enucleation. Methods: A standardized protocol of surgical suite cleaning, patient preparation, sedation, local nerve blocks, surgical procedure, and postoperative care was performed. Owners were required to provide follow-up information at 1 year after surgery during a phone questionnaire. Additionally, some owners provided follow-up information...
Influence of full-time housing in vector-protected facilities on equine cortisol levels, heart rate, and behavior during the African horse sickness outbreak in Thailand.
Journal of applied animal welfare science : JAAWS    March 9, 2021   Volume 26, Issue 1 52-67 doi: 10.1080/10888705.2021.1894147
Joongpan W, Tongsangiam P, Poochipakorn C, Charoenchanikran P, Chanda M.Horses were provided full-time housing in unfamiliar vector-protected facilities during the African horse sickness (AHS) outbreak in Thailand. This study aimed to investigate the impact of this housing arrangement on the equine stress response. Nine healthy horses were housed in both a traditional barn and a vector-protected barn. Equine behavior and stress response data were collected in association with the housing environment and time of day. The mean behavioral score of horses housed in the vector-protected barn was lower at night than during the day. In addition, the horses' mean heart ra...
Radiological, vascular osteochondrosis occurs in the distal tarsus, and may cause osteoarthritis.
Equine veterinary journal    March 9, 2021   Volume 54, Issue 1 82-96 doi: 10.1111/evj.13432
Sigurdsson SF, Olstad K, Ley CJ, Björnsdóttir S, Griffiths DJ, Fjordbakk CT.Osteochondrosis occurs due to failure of the blood supply to growth cartilage. Osteochondrosis lesions have been identified in small tarsal bones and suggested to cause distal tarsal osteoarthritis; however, it has not been determined whether distal tarsal osteochondrosis lesions were the result of vascular failure. Objective: To perform post-mortem arterial perfusion and micro-computed tomography (CT) of the central (CTB) and third tarsal bones (TIII) of fetuses and foals up to 5 months old, to describe tarsal development and any lesions detected. Methods: Descriptive, nonconsecutive case se...
Genetic Variation in the Glycoprotein B Sequence of Equid Herpesvirus 5 among Horses of Various Breeds at Polish National Studs.
Pathogens (Basel, Switzerland)    March 9, 2021   Volume 10, Issue 3 322 doi: 10.3390/pathogens10030322
Stasiak K, Dunowska M, Trewick S, Rola J.Equid herpesvirus 5 (EHV-5) is one of two γ-herpesviruses that commonly infect horses worldwide. The objective of the study was to estimate the genetic variability within EHV-5 viruses circulating among horses in Poland. Partial glycoprotein B (gB) sequences from 92 Polish horses from 13 studs throughout Poland were compared to each other and to three EHV-5 sequences from other countries. Despite the overall high level of conservation, considerable variability was observed around the putative furin cleavage site. Based on phylogenetic analysis, the viruses clustered within two major lineages ...
Association between antimicrobial treatment of subclinical pneumonia in foals and selection of macrolide- and rifampicin-resistant Rhodococcus equi strains at horse-breeding farms in central Kentucky.
Journal of the American Veterinary Medical Association    March 9, 2021   Volume 258, Issue 6 648-653 doi: 10.2460/javma.258.6.648
Huber L, Giguère S, Hart KA, Slovis NM, Greiter ME, Dailey CA, Cohen ND.To compare soil concentrations of macrolide- and rifampicin-resistant strains (MRRE) on horse-breeding farms that used thoracic ultrasonographic screening (TUS) to identify foals with subclinical pneumonia combined with subsequent administration of macrolides and rifampin to affected foals (TUS farms) versus soil concentrations on farms that did not (non-TUS farms), determine whether the combined use of TUS and antimicrobial treatment of subclinically affected foals was associated with soil concentration of MRRE, and assess whether there were temporal effects on soil concentrations of MRRE du...
Clinical features, treatment, and outcome of aural hematomas in horses: 7 cases (2008-2019).
Journal of the American Veterinary Medical Association    March 9, 2021   Volume 258, Issue 6 654-660 doi: 10.2460/javma.258.6.654
Boorman S, Boone LH, White A.To characterize the clinical features, treatment, and outcome of aural hematomas in horses. Methods: 7 horses with 1 or 2 aural hematomas (8 ears in total) treated at a veterinary teaching hospital in 2008 through 2019. Methods: Data retrieved from medical records included signalment, pertinent historical information, clinical signs, diagnostic procedures (including dermatologic assessment), and treatments. Case outcome was determined from documentation in the medical record or via telephone communication with owners or referring veterinarians. Results: 3 horses were presented after recurrence...
The inhibition of spermatic cystine/glutamate antiporter xCT (SLC7A11) influences the ability of cryopreserved stallion sperm to bind to heterologous zonae pellucidae.
Theriogenology    March 9, 2021   Volume 167 24-31 doi: 10.1016/j.theriogenology.2021.03.002
Ortiz-Rodriguez JM, Nerozzi C, Bucci D, Mislei B, Mari G, Tamanini C, Peña FJ, Spinaci M, Galeati G.Sperm are redox-regulated cells, and deregulation of their redox status is considered to affect male fertility and to reduce their fertilizing ability following biotechnological procedures, such as cryopreservation. Cystine (CysS), after incorporation in sperm via SLC7A11 antiporter, has been demonstrated to increase intracellular GSH content, the most important non enzymatic antioxidant. This study was aimed at investigating the role of SLC7A11 antiporter on frozen-thawed stallion sperm ability to respond to in vitro capacitating environment after post-thaw incubation with CysS and/or Sulfas...
A Commentary on the Contemporary Issues Confronting Animal Assisted and Equine Assisted Interactions.
Journal of equine veterinary science    March 8, 2021   Volume 100 103436 doi: 10.1016/j.jevs.2021.103436
Fine AH, Andersen SJ.The field of human-animal interactions and, more specifically, animal-assisted interventions and equine assisted interactions (equine assisted interactions have significantly evolved over the past half century. The primary purpose of this paper is to provide a brief commentary of both fields and the challenges they are presently experiencing as they move forward in their future. More specifically within this commentary, attention will be given to highlighting some of the directions taken in both fields, including clarifying their terminology as it applies to scope of practices, trends in resea...