SureFlap has launched the SureSense Microchip Reader, a pocket-sized unit designed for use by veterinary and pet care professionals.

The new reader is compatible with all ISO 15-digit (FDX-B) identification microchips. It features an integrated LCD screen that displays microchip numbers in a large, easy-to-read format and it also reports the temperature of temperature-sensing microchips.

Sureflap says the reader is lightweight, ergonomically designed, fits easily into the hand and is easy to operate. The company also says that its small size makes it less intimidating for pets.

Dr Nick Hill, managing director of SureFlap said: "The SureSense Microchip Reader was developed following feedback from veterinary and shelter staff that they often had to share microchip readers.

"The reader is our first professional product, developed exclusively for veterinary professionals, shelters, breeders and pet care professionals. Its affordability and size will ensure that it is possible to have multiple readers in each veterinary practice and shelter."

For further information, contact your wholesaler or the SureFlap team on 0800 9127 114 or via email vet@sureflap.com.

Dechra Veterinary Products - maker of Zycortal - has teamed up with some of Europe’s leading endocrinologists to draw up 'Five Golden Rules', a set of guidelines designed to help veterinary professionals who are diagnosing and treating canine hypoadrenocorticism.

Addison’s disease is caused by a reduction in corticosteroid secretion from the adrenal glands. Symptoms can include lack of appetite, tremors or vomiting, diarrhoea, lethargy, low heart rate, muscle weakness, low body temperature and collapse. If left untreated, Addison’s disease can present as an acute, life-threatening emergency.

Zycortal is the only European licensed treatment for the disease. It is a prolonged-release suspension used as replacement therapy for mineralocorticoid. Dechra says it has proved highly effective in clinical trials with more than 80% of dogs responding positively to treatment¹.

The golden rules are available at: www.dechra.co.uk/goldenrules.

Dechra has also produced a series of six video presentations to help veterinary surgeons in their diagnosis and treatment and created a dedicated owner website - www.myaddisonsdog.co.uk - to help owners understand the condition and monitor their pet's progress.

Dechra Brand Manager Craig Sankey said: "Addison’s can be a hidden disease but Zycortal presents a very visible answer. With the wealth of expertise from the endocrinologists, the Five Golden Rules should be an important reference tool for vets.

"We hope that the series of resources we have produced, used in partnership with Zycortal, will make the diagnosis, treatment and management of dogs with Addison’s an easier journey for both vets and owner."

Reference

1. CVMP Assessment report for Zycortal (EMEA/V/C/003782/0000) 2015 pg. 19

A new study carried out by The University of Salford and sponsored by Merial has found that ticks present a risk all year round in the UK¹.

Researchers found that ticks continued to quest in woodlands throughout the year, even during the coldest months and ticks could also be detected on dogs throughout the year.

These observations concur with the results of a recent analysis of practice electronic health records which showed the presence of ticks on pets in all weeks between December and March².

The study confirms the importance of treating dogs all year round to help reduce the risk of transmission of tick-borne diseases.

Lynda Maris, Product Manager for NexGard Spectra at Merial said: "It’s been thought for some time that ticks are very inactive or even dormant in winter and don’t present a risk. These findings show that they continue to quest in an attempt to find a host and are often successful. If ticks are attaching and feeding during the winter months, the risk of Lyme disease and babesiosis remains a real possibility. If the appropriate product is selected, the same year-round treatment programme that controls fleas and other parasites, will also treat ticks and thus help reduce the risk of tick-borne diseases."

The study recruited nine veterinary practices and monitored tick activity across three woodland sites in Southern Cumbria. In some cases multiple ticks were found on the animals – with one animal hosting an incredible 21.

Post graduate student Jessica Hall has been running the study since 2013, which has also involved running PCR for detection of DNA from Borrelia burdorferi (Lyme disease) on the collected ticks, with this data due to be released early next year. She said: "From the data we have collected in this longitudinal study we have identified questing ticks all year round at some sites and have shown that this pattern of questing activity results in pets being bitten by ticks even during winter."

References

1. Sanchez-Vizcaino et al. Canine babesiosis and tick activity monitored using companion animal electronic health records in the UK. Vet Record (2016) 179 : 35
2. Report MERUK02. Data on file.

Photo: Questing tick; Mcvoorhis, Wikipedia, CC BY-SA 3.0

The RCVS Disciplinary Committee has dismissed a case against Nottinghamshire-based Emma Frances Faulkner MRCVS.

It was alleged that in September 2015, she had acted inappropriately by striking a Shih Tzu/Toy Poodle cross puppy called Arnie on his head.

The hearing commenced on Tuesday 3 January 2017 with evidence being given by the owner of the animal ("TC"). However, the corroborating witness, who was also the complainant in the case, failed to attend the hearing to give evidence.

Efforts were made by the College to contact the complainant and remind her that she had been summoned to appear before the Committee – however, she still chose not to attend the hearing to give evidence. In response to her non-appearance the Committee decided that her written evidence was inadmissible as there would be no opportunity to cross-examine her about the discrepancies between her account and that of TC.

Miss Faulkner’s counsel then made an application to the Committee that the College had failed to sufficiently prove its case to the requisite standard such that it would not be necessary for her to adduce any evidence in her defence. The Committee granted this on the grounds that there were clear inconsistencies in the evidence given by TC at different stages of the investigation and during the hearing itself.

Chitra Karve, chairing the Committee and speaking on its behalf, said: "The Committee was unable to conclude that TC was a reliable witness. Given TC’s centrality to the case the Committee is unable to be satisfied so that it is sure that her account of events as outlined in her oral evidence is accurate. Accordingly, the Committee is not satisfied that the College has proved to the requisite standard that the respondent did in fact strike Arnie to the head as alleged.

"Accordingly, the Committee accepts the submission made by the respondent that the College has not adduced sufficient evidence upon which it can find the facts alleged in the charge to be proved. Therefore, it is not necessary for the Committee to consider this matter any further. There is no case for the respondent to answer."

The National Office of Animal Health (NOAH) has issued a briefing document for veterinary surgeons to help clarify which antibiotic classes should be considered as critically important antibiotics – those classified as such by scientific assessment by the European Medicines Agency.

The responsible use of antibiotics termed critically important is an important strand in the UK policy to fight antibiotic resistance development.

However, NOAH says there is much confusion about which antibiotics should be considered within this group, with different organisations referring to different classes.

Donal Murphy, Head of Technical and Regulatory Affairs at NOAH said: "NOAH believes the classification and use of antibiotics in veterinary medicine should be driven and guided by the regulators, who are independent and make science based decisions and recommendations.

"Of course, all classes of antibiotics, whether critically important or not, should be used responsibly and guided by the principle outlined by the Responsible Use of Medicines in Agriculture Alliance (RUMA) who state they should be used  'as little as possible but as much as necessary'. The use of these important products in this manner can ensure that the availability and efficacy of antibiotics can be maintained to ensure animal health and welfare in the future."

You can download the briefing document here.

A comprehensive review published open access online in the Veterinary Record today has concluded that there is insufficient evidence to support the use of homeopathy in food producing animals as a way to prevent or treat infectious diseases.

Homeopathy is widely used in livestock, especially to replace or reduce the use of antibiotics in the treatment of infectious diseases, although its use is often seen as controversial. For organic agriculture, homeopathy is even promoted. 

In the review, Dr Caroline Doehring and Professor Albert Sundrum from the University of Kassel, Germany, assessed peer-reviewed studies on the efficacy of homeopathy in cattle, pigs and poultry published between 1981 and 2014.

They analysed a total of 52 clinical trials, 34 with cattle, 12 with pigs and six with poultry. They were published in 48 publications. 

Of these, 28 concluded that the homeopathic remedy administered was effective, 22 showed no efficacy and 2 were inconclusive. 

Only 10 trials provided information on cure rates for the treatments. These varied to a high degree, while the remedy used did not seem to make a big difference. 

Trials on pigs were frequently efficacious, while studies with cattle or poultry had a similar distribution of efficacious and non-efficacious treatment. 

Double-blind randomised controlled trials reported efficacy of the homeopathic treatment almost as often as they reported lack of it. 

Meanwhile, single-blind and non-blind randomised controlled trials, and observational trials were more likely to present evidence of efficacy, suggesting that positive outcomes may be due to bias. 

Other study limitations, such as potential conflict of interests, low sample size, risk for selective reporting and bias, were found in the majority of trials. 

While some clinical trials showed effectiveness, the authors of the review question the reliability of the evidence, because all studies had a range of limitations. For example, all clinical trials were conducted under very specific conditions and none were repeated under comparable conditions.

Therefore, the authors say the findings cannot be be used to recommend homeopathy: "The current evidence of studies providing evidence in favour of homeopathy lacks reproducibility and therefore cannot claim to have sufficient prognostic validity."

"Due to a lack of prognostic validity, replacing or reducing antibiotics with homeopathy currently cannot be recommended unless evidence of efficacy is reproduced by RCTs and proven in various farm practice conditions."

The RCVS Disciplinary Committee has postponed judgement on Hertfordshire-based veterinary surgeon Amir Kashiv, who was charged with the inadequate care of a dog, for a period of two years.

At the outset of the hearing, Mr Kashiv, from Vets & Pets, Broxbourne, denied all aspects of the charges against him. During the course of the inquiry, some heads of charge were not pursued and some he admitted, leaving the remaining heads of charge to be determined. 

The charges concerned the treatment of a Scottish Terrier, called Tanzy, whose owner, Mrs Greenhill, brought her in to see Mr Kashiv on 5 March 2015. Mrs Greenhill was concerned about blood in Tanzy’s urine and swellings in her mammary glands. After carrying out a cytopathology test, Mr Kashiv advised Mrs Greenhill that Tanzy would require surgery to remove the mammary glands. There were no further tests conducted, and no alternatives to surgery suggested.

On 13 March another veterinary surgeon at Vets & Pets therefore undertook a right-side mammary strip on Tanzy, discharging her the following day. On 17 March Mrs Greenhill brought Tanzy back in for a post-operative check and was seen by a locum veterinary surgeon, who found her to be in good condition.

On 20 March Mrs Greenhill then became concerned about Tanzy’s deteriorating condition and returned her to see Mr Kashiv. He admitted Tanzy for observation over the weekend but did not conduct any further tests at that stage, apart from radiography on 22 March. The hospitalisation records were of poor quality and substantially incomplete.

On 23 March Mr Kashiv then informed Mrs Greenhill that Tanzy could be discharged, although he recommended an MRI scan to assist in the diagnosis; this was declined on cost grounds. He did not however explain clearly to Mrs Greenhill that Tanzy’s prognosis was bleak, and did not give adequate home care instructions.

Tanzy continued to deteriorate, and on 24 March Mrs Greenhill took Tanzy to the RSPCA Harmsworth Hospital where a veterinary surgeon conducted tests which showed that Tanzy was in renal failure. The veterinary surgeon then called Mrs Greenhill and recommended that Tanzy was put to sleep, which was then performed in Mrs Greenhill’s presence.

The Committee found that Mr Kashiv had failed to conduct the necessary investigations when Tanzy was admitted from 20 to 23 March 2015, being satisfied that, by the time Tanzy had been hospitalised for a period of three days, it was mandatory for a blood test to have been performed, given her marked deterioration.

The Committee also found while Mr Kashiv did express his opinion that Tanzy’s prognosis was poor, he did not give the full explanation required in the circumstances of this case to enable Mrs Greenhill to understand fully the prognosis. The Committee also considered that Tanzy was not in a fit state to be discharged on 23 March 2015, and that he had failed to keep sufficiently clear and/or detailed and/or accurate records.

After full consideration, the Committee found that Mr Kashiv’s actions amounted to serious professional misconduct, and was satisfied that his actions fell far short of the conduct to be expected of a reasonably competent veterinary surgeon in respect of heads of charge 1, 2 and 3 but not 4.

Although it was concerned "about the culture of care in the practice, in particular not having in place proper protocols and procedures and without necessary support from properly trained staff", in deciding on appropriate sanction, the Committee was satisfied that there were "a number of serious misjudgements by Mr Kashiv in this case".

The Committee decided to postpone judgement for a period of two years, whilst recommending that Mr Kashiv agree to undertake a structured programme to benefit his clinical practice including a Personal Development Plan, mentoring, practice visits, additional CPD and regular reports to the Disciplinary Committee.

Non-compliance with these undertakings may result in the hearing being resumed at a date earlier than the two-year period.

Stuart Drummond, Chairing the Disciplinary Committee and speaking on its behalf, said: "The Committee considers that Mr Kashiv is a dedicated veterinary surgeon, as evidenced by the large number of testimonials, and that he provides a valuable service to the community, particularly with rescue animals.

"Nevertheless, the Committee considers that there were a number of fundamental failings in Mr Kashiv’s clinical competence which are required to be addressed during the period of postponement. For the reasons set out above the Committee considers that Mr Kashiv’s clinical practice will benefit from a structured programme over the period of postponement, whilst protecting the welfare of animals, maintaining public confidence in the profession and declaring and upholding proper standards of conduct."

For the full charges, findings and decisions, see: http://www.rcvs.org.uk/concerns/disciplinary-hearings/ 

The RCVS Veterinary Nurse Disciplinary Committee has suspended Gwent-based veterinary nurse Samantha Giles from the Register for two months after she failed to respond to repeated requests to provide her CPD records.

At the outset of the hearing, Ms Giles admitted that between 1 August 2012 and 21 June 2016 she had failed to respond to reasonable requests from the RCVS to share her CPD records – these requests amounted to 11 letters, two emails and three telephone calls. Of these attempts to contact Ms Giles, she responded to just one email. This was in May 2016 in which she issued an apology (and an explanation that she had moved address) and offered to provide certificates proving that she had undertaken CPD – despite the fact that no such evidence could in fact be produced.

During the proceedings the RCVS asserted that Ms Giles had failed to comply with several crucial aspects of the Code of Professional Conduct for Veterinary Nurses – namely that all members of the profession are expected to undertake at least 45 hours of CPD over a rolling three-year period in order to keep their professional skills and competences up-to-date, that these CPD records should be provided upon request and that members of the profession must comply with reasonable requests from the RCVS.

In her evidence Ms Giles said that she knew she should have responded to these requests but admitted that she did not originally regard the requests as important and thought that the matter would 'go away' if she did not respond. When it became clear that this was not the case she said she found it difficult to face up to her obligations. She also admitted that her failures to respond were unprofessional and that she now has an appreciation of the importance of undertaking CPD in terms of keeping up with changing practices and advances in veterinary and nursing practice.

Having found the charges against her proved and finding her guilty of disgraceful conduct, the Committee then considered its sanction against Ms Giles. The Committee took into account the seriousness of Ms Giles' failings in that she made repeated decisions not to comply with requests from the RCVS over a protracted period of four years. 

Professor Alistair Barr, chairing the Committee and speaking on its behalf, said: "Your failures show, inevitably, a disregard for the regulatory responsibilities of the RCVS to police veterinary nurses' obligations to fulfil their CPD requirements."

He added: "The RCVS can only seek to ensure compliance with those obligations at one step removed, namely by requesting information from its registrants that they have complied with their CPD obligations. They are in this respect, therefore, heavily dependent on the cooperation of registrants to provide full, honest and prompt responses to their reasonable requests for confirmation of their compliance. It is that which has been sorely absent in this case."

The Committee heard mitigating evidence on behalf of Ms Giles including witness statements and letters from current and former colleagues which complimented her communication skills with work colleagues and animal owners and in which it was accepted that she is a "valued member of the veterinary nursing profession."

The Committee also recognised that she had shown insight into her failings, that she had not attempted to excuse the failures to respond to the RCVS and had been making efforts to keep records of her CPD.

However, the Committee decided that a suspension from the Register would be the most appropriate sanction. Professor Barr said: "The mitigation that has been advanced on your behalf has been considered by the Committee and that has served to reduce the period of suspension that a bare account of the facts pertaining to the charge laid against you might suggest is appropriate.

"In the result that mitigation has persuaded us that we would be acting consistently with our public duty by imposing a period of suspension of two months. In imposing that sanction we have noted the evidence as to your professional competence and your other professional qualities. The Committee trusts, therefore, that once you have served your period of suspension you will return to the practice which you say you love."

Dechra Veterinary Products and Rockster Superfood for Dogs have picked up Best Stand Awards from VetSurgeon.org at the London Vet Show.

John Alborough presented the awards at the event. Liz Rawlings from Dechra said: "It was certainly a whirlwind at this year’s LVS and we are delighted to have scooped such a prestigious award." Zoe Appleyard-Ley, Co-Founder and Managing Director at Rockster Superfood for Dogs said: "We were so excited by the response Rockster had at the London Vet Show, and thrilled to have been given the award by VetSurgeon.org."

Ceva Animal Health, maker of Amodip, has found that only 20% of the owners of older cats have had a blood pressure check suggested by their vet¹, despite the International Society of Feline Medicine recommendation that one be performed annually in cats over seven years old².

The research also found that awareness of feline hypertension amongst cat owners is very low, with 80% of those questioned unaware that cats could have high blood pressure and nearly 20% believing that it was only an issue in humans.

Amongst those cat owners who are aware of feline hypertension, only 25% said they would consider asking their vet for a blood pressure check for their pet. 

However, once made aware of the risks of high blood pressure, including blindness, seizures and kidney disease, 83% of owners said they would ask their vet for a blood pressure test for their cat.

Dr Natalie Borrill MRCVS, veterinary technical manager for cardionephrology at Ceva Animal Health, said: "Feline hypertension is a common condition in older cats; it is estimated that one in five cats from nine years of age are at risk of suffering from the condition³, but there is a low level of awareness amongst cat owners about this condition.

"By increasing awareness of the disease amongst owners, they will be more inclined to visit the vet with their older cat for regular blood pressure checks. It can also be very helpful for an owner to be present when blood pressure is measured because this can help reduce stress and anxiety in their cat. For more information cat owners can visit amadeus.vet."

The research results were released as part of Feline Hypertension Month, which is running until the end of May to raise awareness of hypertension and improve the detection and management of high blood pressure in cats. As part of the campaign, veterinary practices are being urged to measure their feline patients' blood pressure in cats over the age of seven.

Ceva says it will continue its Mercury Challenge throughout 2019 to increase veterinary professionals' confidence in measuring blood pressure and identifying feline hypertension. Participating practices are given the opportunity to win diagnostic tools to help them identify feline hypertension. 

For information, contact cevauk@ceva.com or visit mercurychallenge.ceva.com.

References

1. Atomik Research, 2,001 UK cat owners.  March 2019.
2. Taylor et al., ISFM consensus guidelines on the diagnosis and management of hypertension, JFMS 2017 19(3): 288-303.
3. Conroy et al., Survival after diagnosis of hypertension in cats attending primary care practice in the UK, JVIM, 2018 32(6): 1846-1855.

The RCVS has announced that over the next few years, it is planning to roll out a new outcomes-based model of continuing professional development (CPD), whereby practitioners will be obliged to reflect upon what they learned and to record their reflections.

A shift towards a more outcomes-based model of CPD for veterinary surgeons and veterinary nurses has been under discussion for a number of years and one of its main proponents has been the current RCVS Senior Vice-President Professor Stephen May (pictured right), who chaired the CPD Policy Working Party. 

Stephen said: "There has been increasing recognition over a range of different professions that CPD records based on ‘inputs’ alone, for example, measuring the number of hours attending a lecture, do not necessarily prove that any significant learning has taken place or that this learning will be used to improve professional practice. 

"By contrast, research has demonstrated that CPD activities focused on outcomes encourage professionals to reflect on what they have learned, how they will apply their learning and how it will improve their practice, which has a positive impact on professionalism and patient health outcomes. Numerous other professions, including human medicine and dentistry, have moved to this model and the veterinary world has been somewhat ‘behind the curve’ as a result.

"However, as with any significant shift in policy, there has been a recognition that we needed to take the profession with us and not force through change. This is why, in March 2017, we launched a pilot scheme for the outcomes-based model with veterinary and veterinary nurse volunteers, including people who, during the initial consultation stage, had voiced some skepticism towards the concept.

"The overall feedback from volunteers was very positive and supportive towards the changes and I look forward, over the coming years, to talking to the professions at large about the benefits of the approach and how to best engage with the model."

In all, around 120 volunteers took part in the pilot, of whom 70% were veterinary surgeons and 30% veterinary nurses. When the pilot finished in October 2018, volunteers provided feedback as part of the evaluation process. Of the 57% of volunteers (n=70) who responded to the survey: 

• 77% said they would be willing to use an outcomes-based CPD model in the future; 

• 41% found it ‘easy’ or ‘very easy’ to implement outcomes-based CPD while only 11% thought it was either ‘difficult’ or ‘very difficult’;

• 61% thought that the outcomes-based model made CPD more meaningful for them and 25% said it encouraged them to undertake a wider range of CPD activities than previously;

• Other feedback included the need for a better CPD recording system and more information and guidance ahead of any future changes. 

Following the feedback, particularly around the need for a new approach to CPD recording, it was also recommended to Council that a new online CPD recording system should be introduced. This system will integrate the current disparate systems, such as the Student Experience Log (for vet students), Nursing Progress Log (for student VNs) and the Professional Development Phase (for recent vet graduates), making it a ‘one-stop shop’ professional development recording platform.

Richard Burley, RCVS Chief Technology Officer, said: "We will be building a new platform, consolidating all professional development-related capability for all members, into a single, integrated solution, seamlessly accessible via our ‘My Account’ online portal, and forthcoming mobile app. We have assembled a new, dedicated, software development team to drive this work and more details about this system will be published in coming months."

Linda Prescott-Clements, RCVS Director of Education, added:"Following the approval of the CPD proposals by RCVS Council, a phased roll-out of the new model and the accompanying IT system will take place. This includes recruiting a group of volunteers from the profession later this year to get some initial feedback around the guidance resources and online CPD platform, with members of the profession being voluntarily able to sign up to the new model and IT system from January 2020 onwards. 

"Implementation of the new CPD requirement for all members is expected to start in January 2022 but, prior to that, we will be working hard to talk to the profession about why an outcomes-based model is a more effective and meaningful way of undertaking CPD and this will include workshops, webinars and roadshows. Look out for more news on our plans over the coming months."

For more information about the College’s current CPD policy requirement and policy, visit: www.rcvs.org.uk/cpd

A new study published in the Journal of Feline Medicine and Surgery has found 'compelling circumstantial' evidence of a link between a commercial raw diet and an outbreak of tuberculosis in cats caused by Mycobacterium bovis¹.

The link emerged after six cats were taken to separate practices in England suffering with clinical signs of TB. Further tests confirmed that they were all infected with Myobacterium bovis. Seven more cats from the same household were also infected, but asymptomatic.

Researchers at the University of Edinburgh’s Royal (Dick) School of Veterinary Studies carried out an investigation to identify the source of infection.

The one common factor identified, as detailed in their paper, was that all the animals, which were kept exclusively indoors, had been fed Natural Instinct's Wild Venison cat food.

The authors concluded that whilst not conclusive (they were not able to test the food), their research provided 'compelling, if circumstantial, evidence of an association between the commercial raw diet of these cats and their M. bovis infections.

Natural Instinct withdrew the Wild Venison product last December, as some of the ingredients were not inspected in line with EU requirements.

A spokesperson from Natural Instinct said: "Everything we do at Natural Instinct is done so with the best interests of our customers and their pets in mind. We can assure our customers that Natural Instinct followed, and continues to follow, every food standard, hygiene regulation and best practice required to produce raw pet food in the commercial marketplace.

"As a responsible manufacturer, we are regularly inspected by the Animal and Plant Health Authority (APHA). We have complied with all of the necessary requirements, and consequently APHA have confirmed they are satisfied all standards have been met by us.

"Even though we no longer manufacture and sell the Venison cat product, we are continuing to work with Food Standards Agency as part of the investigation into the Venison cat food product."

The big question is what broader implications this incident has for feeding animals with raw diets.

Professor Danièlle Gunn-Moore from the Royal (Dick) School of Veterinary Studies, a co-author of the paper, said: "With this outbreak, the problem has been feeding wild venison – the law states the stalker must have their Deer stalker level 1 qualification, but this is only a 3-day course with just one day of disease recognition etc (apparently).

"Natural Instinct apparently sourced their deer from stalkers in the Edge area re TB risk. The stalker is supposed to inspect the gralloch (innards) wild ‘on the hill’ then leave it there for wildlife to eat. They only bring the carcass in skin back with them – which means significant pathology can easily be missed.

"Do we need to strength the law? Either that, or only feed raw venison from Scotland or other areas with no M. bovis (I am ignoring all the other potential infections here).

On the broader issue of feeding cats commercial raw food, Danièlle added: "In concept I think raw food can be far more environmentally stimulating – especially for housecats.

"But that is only safe if we can master 2 things: 1) be nutritionally sound – this is now possible with good companies doing this, and 2) be free of infectious agents – and this is a real problem, especially where the meat has been minced – which they need to be to get the minerals and vitamins correctly mixed in. So I don’t see how to square the circle at present." 

Reference

• Conor O’Halloran et al. Tuberculosis due to Mycobacterium bovis in pet cats associated with feeding a commercial raw food diet. Journal of Feline Medicine and Surgery, 2019. DOI: 10.1177/1098612X19848455