Management of incidentally detected heart murmurs in dogs and cats

A dog or a cat has an incidentally detected heart murmur if the murmur is an unexpected discovery during a veterinary consultation that was not initially focused on the cardiovascular system. This document presents approaches for managing dogs and cats that have incidentally-detected heart murmurs, with an emphasis on murmur characteristics, signalment profiling, and multifactorial decision-making to choose an optimal course for a given patient

Can the Hunger Vital Sign™ act as a prescreen for other social needs?

Background: Addressing health-related social needs is essential for improving health and reducing longstanding disparities. However, barriers to screening – including clinician and patient time burden of screening for multiple social needs – limit identification. To address this concern and promote the uptake of screening by clinicians, it is important that screening tools effectively and efficiently identify social needs’ presence and absence among patients. Objective: This study evaluated whether a validated and widely implemented 2-question food insecurity screening tool, the Hunger Vital Sign™ (HVS™), has adequate negative predictive value to serve as a pre-screen for other social needs. Methods: In 2007-2015, Children\u27s HealthWatch interviewed 28,611 publicly insured caregivers from households with low incomes with children age 0-48 months at 5 pediatric clinic/emergency departments (AR, MA, MD, MN, PA). Caregivers self-reported information about their households. Descriptive data were used to describe the sample and negative predictive value was calculated between the Hunger Vital Sign™ and other household hardships. Results: A negative Hunger Vital Sign™ identified 18,259 households (63.8%) as food secure. The negative predictive value in these households was 77.4% (95% CI 76.7, 78.2) for housing instability, 82.4% (95% CI 81.9, 83.0) for energy insecurity, 87.2% (95% CI 86.7, 87.7) for foregone health care at the household level, and 97.5% (95% CI 97.3, 97.7) at the child level. Results demonstrate, at varying levels, high NPV of the HVS™ to correctly identify other hardships’ absence, indicating that families who do not endorse the HVS™ may not be the highest priority for screening for other hardships. However, clinicians should be aware that roughly 20% of families who do not endorse the HVS™ do, in fact, experience other hardships and would not be identified as warranting further hardship-specific screening by this method. Conclusions: This is the first paper to our knowledge that examines the NPV of a screening tool for other social needs. While acknowledging the limited amount of time during a clinical visit, we recommend clinicians choose a multi-domain screener to obtain a nuanced understanding of their patients’ unique challenges. To best inform screening tool selection, providers seeking to screen for and address health-related social needs should first and foremost achieve clarity of purpose - by identifying the social needs of concern, the institution\u27s ability to suitably identify those needs, and what targeted actions will be taken. Further research to replicate and expand these findings in diverse samples of children of varying ages and more economically diverse circumstances as well as in other geographic regions is needed to develop a maximally efficient approach for clinical screening for social determinants of health. Beyond adopting a SDOH framework, providers and the health care sector can advocate for strong evidence-based policies that enable them to better address health inequities and improve health outcomes

Bodily relations and reciprocity in the art of Sonia Khurana

This article explores the significance of the ‘somatic’ and ‘ontological turn’ in locating the radical politics articulated in the contemporary performance, installation, video and digital art practices of New Delhi-based artist, Sonia Khurana (b. 1968). Since the late 1990s Khurana has fashioned a range of artworks that require new sorts of reciprocal and embodied relations with their viewers. While this line of art practice suggests the need for a primarily philosophical mode of inquiry into an art of the body, such affective relations need to be historicised also in relation to a discursive field of ‘difference’ and public expectations about the artist’s ethnic, gendered and national identity. Thus, this intimate, visceral and emotional field of inter- and intra-action is a novel contribution to recent transdisciplinary perspectives on the gendered, social and sentient body, that in turn prompts a wider debate on the ethics of cultural commentary and art historiography

Musical components important for the Mozart K448 effect in epilepsy

There is growing evidence for the efficacy of music, specifically Mozart’s Sonata for Two Pianos in D Major (K448), at reducing ictal and interictal epileptiform activity. Nonetheless, little is known about the mechanism underlying this beneficial “Mozart K448 effect” for persons with epilepsy. Here, we measured the influence that K448 had on intracranial interictal epileptiform discharges (IEDs) in sixteen subjects undergoing intracranial monitoring for refractory focal epilepsy. We found reduced IEDs during the original version of K448 after at least 30-s of exposure. Nonsignificant IED rate reductions were witnessed in all brain regions apart from the bilateral frontal cortices, where we observed increased frontal theta power during transitions from prolonged musical segments. All other presented musical stimuli were associated with nonsignificant IED alterations. These results suggest that the “Mozart K448 effect” is dependent on the duration of exposure and may preferentially modulate activity in frontal emotional networks, providing insight into the mechanism underlying this response. Our findings encourage the continued evaluation of Mozart’s K448 as a noninvasive, non-pharmacological intervention for refractory epilepsy

How Do Climate Change Experiments Alter Plot-Scale Climate?

To understand and forecast biological responses to climate change, scientists frequently use field experiments that alter temperature and precipitation. Climate manipulations can manifest in complex ways, however, challenging interpretations of biological responses. We reviewed publications to compile a database of daily plot-scale climate data from 15 active-warming experiments. We find that the common practices of analysing treatments as mean or categorical changes (e.g. warmed vs.unwarmed) masks important variation in treatment effects over space and time. Our synthesis showed that measured mean warming, in plots with the same target warming within a study, differed by up to 1.6 Celsius degrees (63% of target), on average, across six studies with blocked designs. Variation was high across sites and designs: for example, plots differed by 1.1Celsius degrees (47% of target) on average, for infrared studies with feedback control (n = 3) vs. by 2.2 Celsius degrees (80% of target) on average for infrared with constant wattage designs (n = 2). Warming treatments produce non-temperature effects as well, such as soil drying. The combination of these direct and indirect effects is complex and can have important biological consequences. With a case study of plant phenology across five experiments in our database, we show how accounting for drier soils with warming tripled the estimated sensitivity of budburst to temperature. We provide recommendations for future analyses, experimental design,and data sharing to improve our mechanistic understanding from climate change experiments, and thus their utility to accurately forecast species' responses

Psychiatric and medical admissions observed among elderly patients with new-onset epilepsy

<p>Abstract</p> <p>Background</p> <p>Inpatient utilization associated with incidence of geriatric new-onset epilepsy has not been characterized in any large study, despite recognized high levels of risk factors (comorbidity).</p> <p>Methods</p> <p>Retrospective study using administrative data (Oct '01-Sep '05) from the Veterans Health Administration from a nationwide sample of 824,483 patients over age 66 in the retrospective observational Treatment In Geriatric Epilepsy Research (TIGER) study. Psychiatric and medical hospital admissions were analyzed as a function of patient demographics, comorbid psychiatric, neurological, and other medical conditions, and new-onset epilepsy.</p> <p>Results</p> <p>Elderly patients experienced a 15% hospitalization rate in FY00 overall, but the subset of new-onset epilepsy patients (n = 1,610) had a 52% hospitalization rate. New-onset epilepsy was associated with three-fold increased relative odds of psychiatric admission and nearly five-fold increased relative odds of medical admission. Among new-onset epilepsy patients, alcohol dependence was most strongly associated with psychiatric admission during the first year after epilepsy onset (odds ratio = 5.2; 95% confidence interval 2.6-10.0), while for medical admissions the strongest factor was myocardial infarction (odds ratio = 4.7; 95% confidence interval 2.7-8.3).</p> <p>Conclusion</p> <p>From the patient point of view, new-onset epilepsy was associated with an increased risk of medical admission as well as of psychiatric admission. From an analytic perspective, omitting epilepsy and other neurological conditions may lead to overestimation of the risk of admission attributable solely to psychiatric conditions. Finally, from a health systems perspective, the emerging picture of the epilepsy patient with considerable comorbidity and demand for healthcare resources may merit development of practice guidelines to improve coordinated delivery of care.</p

Children and older adults exhibit distinct sub-optimal cost-benefit functions when preparing to move their eyes and hands

"© 2015 Gonzalez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited"Numerous activities require an individual to respond quickly to the correct stimulus. The provision of advance information allows response priming but heightened responses can cause errors (responding too early or reacting to the wrong stimulus). Thus, a balance is required between the online cognitive mechanisms (inhibitory and anticipatory) used to prepare and execute a motor response at the appropriate time. We investigated the use of advance information in 71 participants across four different age groups: (i) children, (ii) young adults, (iii) middle-aged adults, and (iv) older adults. We implemented 'cued' and 'non-cued' conditions to assess age-related changes in saccadic and touch responses to targets in three movement conditions: (a) Eyes only; (b) Hands only; (c) Eyes and Hand. Children made less saccade errors compared to young adults, but they also exhibited longer response times in cued versus non-cued conditions. In contrast, older adults showed faster responses in cued conditions but exhibited more errors. The results indicate that young adults (18 -25 years) achieve an optimal balance between anticipation and execution. In contrast, children show benefits (few errors) and costs (slow responses) of good inhibition when preparing a motor response based on advance information; whilst older adults show the benefits and costs associated with a prospective response strategy (i.e., good anticipation)

The antisaccade task as an index of sustained goal activation in working memory: modulation by nicotine

The antisaccade task provides a laboratory analogue of situations in which execution of the correct behavioural response requires the suppression of a more prepotent or habitual response. Errors (failures to inhibit a reflexive prosaccade towards a sudden onset target) are significantly increased in patients with damage to the dorsolateral prefrontal cortex and patients with schizophrenia. Recent models of antisaccade performance suggest that errors are more likely to occur when the intention to initiate an antisaccade is insufficiently activated within working memory. Nicotine has been shown to enhance specific working memory processes in healthy adults. MATERIALS AND METHODS: We explored the effect of nicotine on antisaccade performance in a large sample (N = 44) of young adult smokers. Minimally abstinent participants attended two test sessions and were asked to smoke one of their own cigarettes between baseline and retest during one session only. RESULTS AND CONCLUSION: Nicotine reduced antisaccade errors and correct antisaccade latencies if delivered before optimum performance levels are achieved, suggesting that nicotine supports the activation of intentions in working memory during task performance. The implications of this research for current theoretical accounts of antisaccade performance, and for interpreting the increased rate of antisaccade errors found in some psychiatric patient groups are discussed

The use of complementary and alternative medicine by women experiencing menopausal symptoms in Bologna

<p>Abstract</p> <p>Background</p> <p>The present study describes Complementary and Alternative Medicine (CAM) use amongst Italian women transitioning through menopause. Popularity and perceived effectiveness of CAM treatments, use of pharmaceutical medications, characteristics of CAM users, the extent of communication between medical practitioners and women about their use of CAM, and variables associated with CAM use were also investigated.</p> <p>Methods</p> <p>Women, aged 45-65 years attending Family Planning and Women's Health clinics or Menopause Centres in Bologna were invited to complete a voluntary, anonymous, self administered questionnaire, which was used in a previous study in Sydney. The questionnaire was translated and adapted for use amongst Italian women. Data on general demographic and health characteristics, menopause related symptoms and the use of CAM and pharmaceutical treatments during the previous 12 months were collected.</p> <p>Results</p> <p>In total, 1,203 women completed the survey, of which 1,106 were included in the final sample. Of women who had symptoms linked with menopause and/or used remedies to alleviate symptoms, 33.5% reported to have used CAM. Among these, 23.5% had consulted one or more practitioners and 24% had used at least one CAM product.</p> <p>Approximately nine out of ten respondents reported medical practitioners did not seek information about their use of CAM; while one third of CAM users did not disclose the use of CAM to their physician. Nevertheless, medical practitioners were the most popular source of information. From the multivariate analysis, variables associated with CAM use were: professional employment, time since the last natural menses, use of CAM for conditions other than menopause, and presence of some severe symptoms.</p> <p>Conclusions</p> <p>The relatively high prevalence of CAM use by women transitioning through menopause should encourage research initiatives into determining which CAM treatments are the safest and effective. The increasing and likely concomitant use of CAM with HRT and other pharmaceuticals underlines the need for the implementation of a surveillance system to report and monitor possible drug-herb adverse events. The discrepancy between women preferring to seek information about CAM from their medical doctor and the difficulties noted in communication between doctor and patient should encourage educational initiatives on CAM by health-care agencies and institutions.</p