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Training Veterinary Personnel for Effective Identification and Diagnosis of Exotic Animal Diseases

	ABSTRACT

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
The requirements for exotic animal disease (EAD) training were considered at a workshop organized for those with responsibilities for EAD response management in the different states of Australia, with the objective of identifying the optimum strategy for training veterinarians to identify and act upon EADs. It was concluded that there should be specialized within-country training in EAD recognition for an elite group of diagnostic veterinarians who are required to recognize the major exotic diseases of animals, instigate the correct procedures to confirm the diagnosis of the disease, and undertake appropriate measures for effective initial management of the disease. The use of live, deliberately infected animals for demonstration purposes is not currently supported by any research indicating an improved learning outcome compared with that from alternatives, such as videos, necropsy specimens, and dedicated computer-aided learning packages. Therefore, ethical requirements to minimize the use of animals in teaching and research may prevent live-animal use. It is concluded that training should take place within each country via a course of instruction that includes an initial intensive course followed by continued professional development, with examination of knowledge at the end of each.

Key Words: exotic animal disease • foreign animal disease • veterinary training

	INTRODUCTION

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
Previously the term "exotic animal disease" (EAD) has referred to a disease exotic to the country of interest that has the potential for serious socioeconomic consequences if an outbreak occurs. In recent years the terms "transborder animal disease" (TAD) and "foreign animal disease" (FAD) have also been used. The term "emergency animal disease" is more generic and can refer to a TAD, an unusual outbreak of an endemic disease, or an outbreak of a new or emerging disease.

International responsibility for EADs rests principally with the World Organisation for Animal Health (OIE), which approved the formation of a single list of notifiable diseases in May 2005. This list came into effect in 2006 and is the reference point for exotic or emergency animal diseases. One of the OIE's aims is to disseminate information on disease preparedness among member countries; member countries have the opportunity to contribute to the Information on Disease Emergency Preparedness section of the OIE Web site. Countries that have published their full dossiers on the OIE site include Australia, New Zealand, Switzerland, and Estonia. Other countries have published disease specific dossiers, such as the United Kingdom's dossier on foot-and-mouth disease.

This article focuses on issues associated with the training of veterinary personnel involved in the initial diagnosis of an EAD. It is recognized that other strategies are also important in limiting the spread of EADs, such as restrictions on livestock movement and implementation of a national livestock identification scheme to aid traceability.

	OVERVIEW OF EXOTIC DISEASE PREPAREDNESS

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
The Food and Agriculture Organisation of the United Nations provides a manual¹ for disease preparedness that can be adapted by individual countries. Preparedness depends on, first, early warning of a threat and, second, early response to that threat. Early warning strategies that relate to training include

• developing good farmer and public awareness and strategies to strengthen the farmer–veterinarian bond
  
• training field veterinary staff and veterinary auxiliary staff to recognize serious epidemic diseases
  

In the section titled "Training of Veterinarians and Other Animal Health Staff in Early Recognition of Emergency Diseases," the FAO manual states,

Obviously, it will be neither practicable nor necessary to train personnel to a high level of expertise in these diseases. In most cases it is sufficient for trainees to be familiar with the basic clinical, pathological and epidemiological features of risk diseases and to know what to do if they suspect one of these diseases ... To ensure early recognition of emergency diseases, all veterinarians and animal health workers should be trained to recognize basic clinical features, and to report immediately on any suspicions that arise during their everyday work.¹

The manual further states that "More specialized training will be needed for personnel who are nominated as members of specialist diagnostic teams." These teams would normally consist of a pathologist, an epidemiologist, a veterinarian highly experienced in epidemic diseases, and other relevant specialists (e.g., entomologist). In Australia, mainly because of large distances and sparse population, there is some overlap of designations, with many field officers receiving specialist EAD diagnostic training.

	TRAINING OF VETERINARY PERSONNEL

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
The first line of defense against EADs should be provided by people working with animals on a routine basis, particularly if those animals are at high risk of acquiring novel infections through contact with introduced animals or their managers, as is the case near ports. Such people would include veterinarians, agricultural workers, companion-animal owners, and managers and field staff who visit different animal holdings, such as agricultural advisors. A program of awareness for these staff, addressing the need to report anything unusual in the animals they work with, is essential and should provide easy access to the second line of defense.

As an example, the Australian Department of Education, Science and Training has nationally recognized, formally defined units of competency that are encompassed in a national training framework. These units of competency are used to give primary producers, animal-health workers, and field veterinarians nationally recognized, defined certification in aspects of EAD recognition and initial response.

The second line of defense will be provided, in such locations, by specialist veterinarians, who require regular and dedicated teaching on current EAD risks to augment their basic veterinary training in EADs.

	VETERINARY GRADUATE TRAINING IN EADS

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
Graduating veterinarians are generally trained to a level that allows recognition of an unusual epidemic disease and provides an understanding of the major EADs. Although most undergraduate programs in veterinary medicine do not include a separate course on EADs, the knowledge is usually presented as part of undergraduate courses in microbiology, infectious diseases, epidemiology, and species-specific medicine. In addition, there may be specific modules on EADs within other courses, such as Professional Studies. For example, the BVSc program at Charles Sturt University in Australia includes a separate course, Emergency Disease Management and Public Health, to be taken in the fifth year of the program.

Private practitioners are encouraged by both state and federal government agencies to update their knowledge on EAD recognition regularly, by reading journal publications and mail-outs and by attending sponsored workshops. Thus, a private practitioner (whether recent graduate or not) should be competent in suspecting a disease and will be expected to contact the appropriate authorities and take appropriate initial action.

	DESIRABLE FEATURES OF SPECIALIST EAD DIAGNOSTIC TRAINING

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
It is clear that no single course can effectively deliver comprehensive training in all EADs. The authors organized a workshop for Australian EAD professionals, which was attended by state and federal animal health representatives as well as by representatives from veterinary schools and professional organizations. This section of the article summarizes the workshop's conclusions and recommendations for an ideal course.

Sending veterinarians to exotic disease outbreaks overseas or to countries where "exotic" diseases are endemic is regarded as invaluable training. There are cost constraints on this, however, as well as other limitations, namely the restricted number of diseases that can be experienced at one time and the different clinical signs exhibited under different environmental conditions, which may confuse the issue. The presence of concurrent disease is perceived as another complicating factor. Thus, it is believed to be necessary for EAD preparedness to include high-level training in EAD diagnosis within national boundaries.

Courses using infected live animals to demonstrate diseases are held in countries that have secure bio-containment facilities, including

• National Centre for FAD Laboratory, Winnipeg, Canada
  
• Animal and Plant Health Inspection Service, Plum Island, USA
  
• Animal Health, Pirbright, UK
  
• Australian Animal Health Laboratories, Geelong, Australia
  

In the case of US, Canadian, and Australian centers, past courses have usually run for around eight days and included both theory and practical sessions. There are ethical implications to using live infected animals, however, and it must be considered whether this is necessary. Codes of practice may require justifying the use of live animals in the form of an improved learning outcome.

Suggested Aim, Objectives, and Learning Outcomes of an EAD Course
Overall Aim of the Course- To enhance the ability of field veterinarians to rapidly and confidently recognize exotic animal diseases.

Educational Objectives- On completion of the course, attendees will be able to

• Recognize the major exotic diseases of animals when presented with an animal or groups of animals showing the clinical signs and/or gross pathology of one of those diseases
  
• Instigate the correct procedures to confirm the diagnosis of the disease
  
• Undertake appropriate measures for effective initial management of the disease
  

Learning Outcomes- After completing this course, attendees will be able to

• Describe the etiology, infectivity, epidemiology, clinical signs, clinical progression, and pathology of the major exotic and emerging animal diseases
  
• Discuss how this knowledge can be incorporated into the diagnostic process for endemic diseases
  
• Collect and dispatch appropriate pathological specimens from production species
  
• Describe the laboratory procedures used for the diagnosis of exotic animal diseases
  
• Discuss the accuracy of the clinical signs and laboratory tests used to diagnose EADs and the comparable endemic diseases
  
• Outline appropriate methods of containment and decontamination practices for effective initial management of EADs
  

Prerequisites
Prerequisites should be clearly defined. Consultation with EAD specialists indicates that prerequisites should include the following.

1. Necropsy of relevant animal species and appropriate specimen collection- Animal-health veterinarians do not usually have the opportunity to perform necropsies on all relevant species in their routine work. A required prerequisite to EAD training may involve reviewing necropsy technique and completing a set number of necropsies in each species. This could be achieved in part through computer simulations/videos and augmented practical training. Specific necropsy training is already provided to field officers in some Australian states.

2. Species-specific training- It is likely that attending veterinarians do not regularly encounter all species. A good understanding of endemic diseases in all relevant domestic species should be a prerequisite, unless it is envisaged that EAD specialists will specialize in particular species. This will depend on the size of a country's EAD workforce. Poultry diseases are particularly noted, as several diseases endemic to many countries mimic EAD, and veterinarians should be familiar with the clinical signs and gross pathology of these diseases.

3. Epidemiology- Attending veterinarians should have an understanding of the principles of epidemiology.

Ideally, these prerequisite requirements should be tested using an easily accessible, attractive format. This could include tailored DVD presentations and interactive computer quizzes, which are used extensively in both undergraduate and post-graduate courses. Web-based tests are a component of overall assessment in many veterinary undergraduate courses, such as pathology and microbiology, and could be adapted for the use suggested here.

Conduct of the Course
Delivery of the course material should be done in such a way as to ensure that the learning outcomes are realized by participants. Outcomes should be examined at the end of the course and at regular intervals thereafter.

	ETHICAL IMPLICATIONS OF USING LIVE, DELIBERATELY INFECTED ANIMALS FOR EAD TRAINING AND ALTERNATIVES TO THE USE OF LIVE ANIMALS

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
Increasing constraints on the use of animals to support teaching and research activities in many countries has inevitably caused the use of live animals in EAD courses to be questioned. Notwithstanding this, one of the important reasons for EAD training is to reduce the potential for widespread animal and human suffering during an EAD event. Thus, recommendations to reduce the use of live animals in training need to be balanced against the potential suffering that may result from a less-than-optimal response to an EAD outbreak. Nevertheless, we obviously have a moral obligation to maximize the use of any animal that is used for training purposes. If the use of alternatives has a place in providing training, it could be either to replace the use of live animals entirely or as an adjunct to or partial replacement for live-animal use.

A list of audiovisual materials available worldwide, including US Department of Agriculture veterinary medical training films and videos² and relevant material produced by the Commonwealth Scientific and Industry Research Organisation,³ is presented in Table 1. Many of the available videos contain excellent material showing clear clinical signs and post-mortem findings. In some cases, the material may be out of date with respect to worldwide distribution of disease and current knowledge. There is a case to be made for revising or re-creating existing materials to increase their appeal and topicality, using modern multimedia facilities, and preparing versions translated into the major world languages.

1. The Association of Veterinarians for Animal Rights^a
This is a keyword-searchable database with many entries covering animal use in research and teaching. Search results are comprehensive; however, searches cannot be limited to specific types of resource (i.e., it is not possible to search for published articles only; results will include articles, books, videos, and models).

2. European Resource Centre for Alternatives in Higher Education^b
This group's Web site offers a large amount of information on alternatives and includes a section titled "Animals in Education," which provides links to numerous articles and presentations, including a survey of the educational efficacy of alternatives.⁷ This survey collates abstracts of peer-reviewed published articles that evaluate alternatives. Currently it includes 11 studies demonstrating superior educational efficacy of humane alternatives; 17 studies demonstrating equivalent educational efficacy of humane alternatives; two studies demonstrating inferior educational efficacy of humane alternatives; and 13 other relevant studies (e.g., comparisons not involving harmful animal use).

3. Norwegian School of Veterinary Sciences^c
This is a comprehensive database on alternatives. Searching is by keyword, and results can be searched by type of material (e.g., book, CD-ROM, reference article, etc.). The database concentrates on books and conference proceedings rather than on reference articles.

4. The Humane Society of the United States^d
This undated Web site features a list of studies from several scientific journals that compare dissection and other uses of animals with alternative teaching methods, including students from seventh grade through undergraduate university programs. The list includes 18 studies that demonstrate equivalent performance on the part of students using alternative methods and those using traditional dissection methods; 15 studies in which students using alternative methods outperformed those performing dissections; and a single study that found students who conducted dissections performing better than those who used alternative methods.

	OTHER ALTERNATIVE TRAINING METHODS

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
There are plans to amend the FAD course offered by the USDA's Animal and Plant Health Inspection Service to provide a videoconferencing facility with real-time transmission of images from animal and necropsy rooms at Plum Island to four locations in the United States.⁷ It may be possible for other organizations to use a similar approach or to incorporate some of the Plum Island material into future EAD courses in countries outside the United States.

Another approach is to develop a bank of preserved necropsy specimens for repeated use. Animals must first be heavily anesthetized; preservative is then infused intravenously just before euthanasia. There is some potential to use animals from research projects in this way to produce preserved specimens to demonstrate gross pathology. There are limitations to this potential, however: many of the EADs demonstrated in current courses show little gross pathology, because of the need to preserve the animal's welfare by euthanizing before major adverse impact of the disease.

A significant body of evidence supports the use of alternatives to the use of live animals in undergraduate veterinary teaching of major diseases. Unfortunately, there has not been any similar research comparing outcomes from live animals with alternatives in the demonstration of EADs. In undergraduate teaching of surgery and anatomy, there has been substantial research on alternatives, much of which demonstrates equivalent outcomes (e.g., for training students to perform intestinal anastomoses⁸ or in the use of a hemostasis model to teach basic surgical skills).⁶ Students’ attitudes to the usefulness of alternatives may become much more positive after they have experienced them⁹ or, in other cases, may not change at all.⁸ However, such comparisons depend on the quality of the instruction that uses live animals and alternatives. It is possible that there is publication bias favoring alternatives because of the funding available to investigate their efficacy, whereas there is little or no funding to investigate the benefits of using live animals. However, existing experiments^8,9 appear to have been designed and conducted to a high scientific standard, making the latter possibility unlikely.

The different teaching methods present different opportunities and problems. Live-animal demonstration provides the opportunity for maximum sensory impact, and particularly visual impact. It is likely that students’ experience may be more memorable because of the greater empathy they would be expected to feel for a live exhibit of a suffering animal, as compared with the same animal displayed on a video screen. It is also possible, however, that students may more easily become desensitized to animal suffering when viewing the live animal rather than just an image. Tactile contact would not usually be possible with animals infected with zoonotic diseases but may be important in the case of other diseases. However, apart from repeated presentation during the course, however, live-animal demonstrations offer no opportunity for trainees to be reminded of symptoms at a later date, unless alternative methods are used; furthermore, only a narrow range of symptoms would normally be provided, specific to the conditions under which the animals are infected and to the animals themselves. This would not normally include advanced stages of the disease, because of the animal-welfare implications of allowing animals to experience these final stages. On the other hand, while alternatives have more limited sensory impact at the time of presentation, there may be a better opportunity for trainees to revisit their audiovisual presentations at a later date, either during a refresher course or, when appropriate, through the use of multimedia facilities that they will almost certainly have available at work or at home. Such opportunities could also be presented to students who were originally trained with live animals, but these students will be less familiar with this method of presentation and may not have the materials readily available. A possible method of delivery could include both live-animal demonstrations and a follow-up using alternative methods. If alternatives are well designed and produced, there is the opportunity to present a range of different manifestations of the disease in different types of animal or under different environmental conditions.

Thus the authors conclude that a limited number of studies comparing alternatives and live animals in veterinary education appear to have shown that students who use alternatives are not disadvantaged. The references cited, however, do not pose the specific questions considered in this course—in particular, Are alternatives adequate for training veterinarians in EAD diagnosis?

The closest available parallel to EAD teaching is the teaching of endemic animal diseases to undergraduate veterinary students. In this case, the students are not exposed to animal exhibits of the disease but are taught through the principles of differential diagnosis, sometimes with the aid of multimedia description of the signs of the disease, supported by laboratory-based evidence. This theoretical knowledge is reinforced when students see the diseases during practical work on farms and veterinary clinics. In Australia, the induction of disease in live animals for the purpose of teaching veterinary undergraduate students was phased out gradually during the 1970s and 1980s. However, it can be argued that the potential impact of incorrect diagnosis is greater for EADs than for endemic disease, and opportunities for observing diseases in the field, to reinforce didactic teaching, exist only for endemic diseases.

In the absence of specific information on the benefits of using live animals in teaching EADs, and because it is unlikely that students will encounter EADs, the authors see a need to conduct comparative studies to determine whether or not effective teaching of EAD preparedness requires the use of live animals. Such a study would require careful planning but would include a comparison of the learning outcomes experienced by a group of students who participated in both lectures and live-animal experiments with those of students who participated in both lectures and alternatives to the use of animals (audiovisual materials, case-based learning, etc.). Ideally, a switchback design would be used, with two groups of students passing through either first live-animal instruction, then alternatives, or vice versa. Assessment after each instruction period would minimize any bias. It would be prudent to combine a comparison study with the augmentation of existing available audiovisual aids (e.g., hiring a professional audiovisual team to permanently record the live animals with a view to providing alternative audiovisual materials). Classes should be delivered by the same person(s), and assessment of the achievement of learning objectives should be independent. The biggest challenge for this approach would be the testing method: if alternative rather than live-animal testing methods are employed, then alternative training methods may appear to yield more favorable results than would actually be the case in the event of a disease event.

The study could usefully include a third group that is exposed to both live animals and alternatives, in order to investigate whether live animals add sufficient value to be recommended for inclusion in EAD educational programs. In this case, an incomplete Latin square design would probably be most appropriate, with cohorts proceeding through two of the three "treatments."

	FOLLOW-UP TRAINING

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 
Veterinarians should be further trained in EAD principles and practice through ongoing in-house training, but it is believed to be very important to the effectiveness of their elite diagnostic capabilities that they invest in specific follow-up training. Such training should be considered just as important as the initial course, which will introduce principles that will be of value to these diagnosticians throughout their careers. It is recommended that a formal annual or biennial Web-based update and test be a requirement of maintaining the "elite diagnostician" status.

A Web-based update on the major exotic and emerging animal diseases, current relative risks posed, and likely pathways of introduction, followed by an online examination, could be a cost-effective way of providing ongoing training, as long as there is effective control of the integrity of the examination process. Ensuring that elite diagnosticians undertake an examination is essential to maintaining confidence and capabilities at a high level. The examination could be presented in multiple-choice format and could provide an automatic result certificate showing the examination score and providing an acknowledgement of the number of continuing professional development units that the refresher course is worth to the diagnostician.

A comprehensive Foreign Animal Disease online course¹⁰ is offered in the United States by the Foreign Animal and Zoonotic Disease Centre, acting under the direction of the non-profit Humanitarian Resource Institute. The course has an online test component that encompasses 200 true/false questions. Upon completion and online submission of the test, individuals who attain a passing grade of 90% or above (this requirement was implemented on August 30, 2004) receive a certificate of completion from the Humanitarian Resource Institute.

	ACKNOWLEDGMENTS

 
The authors acknowledge the financial support of the Department of Agriculture, Fisheries and Food, Australia, for conducting this study, and the contribution of representatives from the states and territories of Australia who gave freely of their time for this project.

	Footnotes

 
AUTHOR INFORMATION

Carmel Kerwick, BVSc, MACVS (Animal Welfare), is a consultant in animal welfare with experience as an animal welfare officer for research and teaching institutions. Address: 6 Cyril Street, Camp Hill, QLD 4152 Australia. E-mail: carmelk{at}acacia.net.au.

Joanne Meers, BVSc, DipVetPath, Phd, is Associate Professor of Veterinary Virology in the School of Veterinary Science, University of Queensland, St Lucia, QLD 4067 Australia. Her research has focused on several viruses of veterinary importance, including viruses of both domestic and native animal species. Her research interests include viruses of the brushtail possum, koala retrovirus, feline immunodeficiency virus, and Newcastle disease virus.

Clive Phillips, BSc, MA, PhD, is Professor, Chair of Animal Welfare and Director of the Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, St Lucia, QLD 4067 Australia. E-mail: c.phillips{at}uq.edu.au. His research interests focus on the welfare of farm, companion, and captive wild animals. Animal-welfare topics that are investigated include malnutrition, health, housing, transport, and reproduction, with an emphasis on farm livestock and captive wild animals.

NOTES

^a Association of Veterinarians for Animal Rights <http://avar.org/alted/>. Accessed 12/20/07.

^b European Resource Centre for Alternatives in Higher Education <http://www.eurca.org/animal_education.asp>. Accessed 12/20/07.

^c Norwegian School of Veterinary Sciences <http://oslovet.veths.no/fag.aspx?fag=57>. Accessed 12/20/07.

^d The Humane Society of the United States <http://www.hsus.org/animals_in_research/animals_in_education/comparative_studies_of_dissection_and_other_animal_uses.html>. Accessed 12/20/07.

	REFERENCES

TOP ABSTRACT INTRODUCTION OVERVIEW OF EXOTIC DISEASE... TRAINING OF VETERINARY PERSONNEL VETERINARY GRADUATE TRAINING IN... DESIRABLE FEATURES OF SPECIALIST... ETHICAL IMPLICATIONS OF USING... OTHER ALTERNATIVE TRAINING... FOLLOW-UP TRAINING REFERENCES

 

1. Food and Agriculture Organisation of the United Nations [FAO]. Manual on the Preparation of National Animal Disease Emergency Preparedness Plans. Rome: FAO, 1999. <http://www.fao.org/DOCREP/004/X2096E/X2096E00.htm>. Accessed 07/20/06.
2. United States Animal Health Association [USAHA]. Foreign Animal Diseases: The Gray Book, 6th ed ed. St. Joseph, MO: USAHA, 1998. <http://www.vet.uga.edu/vpp/gray_book02/index.php>. Accessed 03/10/08.
3. Commonwealth Scientific and Industry Research Organisation [CSIRO]. CSIRO price list and order form for overseas customers. Canberra: CSIRO, 2007. <http://www.csiro.au/forms/ExoticDiseaseOrderForm_OS.pdf#search=%22CSIRO%20%2B%20%22Two%20of%20a%20kind%22%22>. Accessed 03/10/08.
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6. Patronek GJ, Rauch A. Systematic review of comparative studies examining alternatives to the harmful use of animals in biomedical education. J Am Vet Med Assoc 230: 37–43, 2007.[CrossRef][Medline]
7. Chair Brown C. Report of the Committee on Foreign and Emerging Diseases. US Department of Agriculture, 2004. <http://www.usaha.org/committees/reports/2004/report-fe-2004.pdf#search=%22a%20video%20conferencing%20facility%20with%20real-time%20transmission%20of%20images%20from%20animal%20and%20necropsy%20rooms%20at%20Plum%20Island%20%22>. Accessed 03/10/08.
8. Carpenter LG, Peirmattei DL, Salman MD, Orton EC, Wendell NA, Smeak DD, Jennings PB, Taylor RA. A comparison of surgical training with live anesthetised dogs and cadavers. Vet Surg 20: 373–378, 1991.[Medline]
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10. Foreign Animal Disease Online Course (FADOC), Humanitarian Resource Institute, 2002. <http://www.humanitarian.net/biodefense/fazdc/fadc1/>. Accessed 12/28/07.

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