Audiogenic reflex seizures in cats

This study aims at characterizing feline audiogenic reflex seizures (FARS). An online questionnaire was developed to capture information from owners with cats suffering FARS. This was collated with the medical records from the primary veterinarian. Ninety-six cats were included. Myoclonic seizures were one of the cardinal signs of this syndrome (90/96), frequently occurring prior to generalized tonic-clonic seizures (GTCS) in this population. Other features include a late-onset (median 15 years) and absence seizures (6/96), with most seizures triggered by high frequency sounds amid occasional spontaneous seizures (up to 20%). Half the population (48/96) had hearing impairment or were deaf. One third of cats (35/96) had concurrent diseases, most likely reflecting the age distribution. Birmans were strongly represented (30/96). Levetiracetam gave good seizure control. The course of the epilepsy was non-progressive in the majority (68/96) with an improvement over time in some (23/96). Only 33/96 and 11/90 owners respectively felt the GTCS and myoclonic seizures affected their cat’s quality of life (QoL). Despite this, many owners (50/96) reported a slow decline in their cat’s health becoming less responsive (43/50), not jumping (41/50), uncoordinated or weak in the pelvic limbs (24/50), and exhibiting dramatic weight loss (39/50). These signs were exclusively reported in cats experiencing seizures for >2 years with 42/50 owners stating these signs affected their cat’s QoL. In gathering data on audiogenic seizures in cats, we have identified a new epilepsy syndrome named FARS with a geriatric-onset. Further studies are warranted to investigate potential genetic predispositions to this condition

Levetiracetam in the management of feline audiogenic reflex seizures: a randomised, controlled, open-label study

OBJECTIVES: Currently, there are no published randomised, controlled veterinary trials evaluating the efficacy of antiepileptic medication in the treatment of myoclonic seizures. Myoclonic seizures are a hallmark of feline audiogenic seizures (FARS). METHODS: This prospective, randomised, open-label trial compared the efficacy and tolerability of levetiracetam (20-25 mg/kg q8h) with phenobarbital (3-5 mg/kg q12h) in cats with suspected FARS that experienced myoclonic seizures. Cats were included that had ⩾12 myoclonic seizure days during a prospective 12 week baseline period. This was followed by a 4 week titration phase (until a therapeutic serum concentration of phenobarbital was achieved) and a 12 week treatment phase. RESULTS: Fifty-seven cats completed the study: 28 in the levetiracetam group and 29 in the phenobarbital group. A reduction of ⩾50% in the number of myoclonic seizure days was seen in 100% of patients in the levetiracetam group and in 3% of patients in the phenobarbital group (P <0.001) during the treatment period. Levetiracetam-treated cats had higher freedom from myoclonic seizures (50.0% vs 0%; P <0.001) during the treatment period. The most common adverse events were lethargy, inappetence and ataxia, with no difference in incidence between levetiracetam and phenobarbital. Adverse events were mild and transient with levetiracetam but persistent with phenobarbital. CONCLUSIONS AND RELEVANCE: These results suggest that levetiracetam is an effective and well-tolerated treatment for cats with myoclonic seizures and is more effective than phenobarbital. Whether it will prevent the occurrence of generalised tonic-clonic seizures and other forebrain signs if used early in the course of FARS is not yet clear

Association of dialysis facility-level hemoglobin measurement and erythropoiesis-stimulating agent dose adjustment frequencies with dialysis facility-level hemoglobin variation: a retrospective analysis

<p>Abstract</p> <p>Background</p> <p>A key goal of anemia management in dialysis patients is to maintain patients' hemoglobin (Hb) levels consistently within a target range. Our aim in this study was to assess the association of facility-level practice patterns representing Hb measurement and erythropoiesis-stimulating agent (ESA) dose adjustment frequencies with facility-level Hb variation.</p> <p>Methods</p> <p>This was a retrospective observational database analysis of patients in dialysis facilities affiliated with large dialysis organizations as of July 01, 2006, covering a follow-up period from July 01, 2006 to June 30, 2009. A total of 2,763 facilities representing 436,442 unique patients were included. The predictors evaluated were facility-level Hb measurement and ESA dose adjustment frequencies, and the outcome measured was facility-level Hb variation.</p> <p>Results</p> <p>First to 99th percentile ranges for facility-level Hb measurement and ESA dose adjustment frequencies were approximately once per month to once per week and approximately once per 3 months to once per 3 weeks, respectively. Facility-level Hb measurement and ESA dose adjustment frequencies were inversely associated with Hb variation. Modeling results suggested that a more frequent Hb measurement (once per week rather than once per month) was associated with approximately 7% to 9% and 6% to 8% gains in the proportion of patients with Hb levels within a ±1 and ±2 g/dL range around the mean, respectively. Similarly, more frequent ESA dose adjustment (once per 2 weeks rather than once per 3 months) was associated with approximately 6% to 9% and 5% to 7% gains in the proportion of patients in these respective Hb ranges.</p> <p>Conclusions</p> <p>Frequent Hb measurements and timely ESA dose adjustments in dialysis patients are associated with lower facility-level Hb variation and an increase in proportion of patients within ±1 and ±2 g/dL ranges around the facility-level Hb mean.</p

What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care.</p> <p>Methods</p> <p>We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria.</p> <p>Results</p> <p>From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51%) but the remainder showed no correlation (16/51 31%) or a paradoxical correlation (9/51 18%).</p> <p>Conclusion</p> <p>The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.</p

Does 3,4-dimethylpyrazole phosphate or N-(n-butyl) thiophosphoric triamide reduce nitrous oxide emissions from a rain-fed cropping system?

© 2018 CSIRO. Nitrification and urease inhibitors have been used to reduce nitrous oxide (N2 O) emissions and increase nitrogen use efficiency in many agricultural systems. However, their agronomic benefits, such as the improvement of grain yield, is uncertain. A two-year field experiment was conducted to (1) investigate whether the use of 3,4-dimethylpyrazole phosphate (DMPP) or N-(n-butyl) thiophosphoric triamide (NBPT) can reduce N2 O emissions and increase grain yield and (2) explore the financial benefit of using DMPP or NBPT in a rain-fed cropping system in south-eastern Australia. The experiment was conducted at Wagga Wagga, New South Wales, Australia with wheat (Triticum aestivum L.) iN2012 and canola (Brassica napus L.) iN2013. Results showed that urea coated with DMPP reduced the cumulative N2 O emission by 34% for a wheat crop iN2012 (P < 0.05) and by 62% for a canola crop iN2013 (P < 0.05) compared with normal urea, but urea coated NBPT had no effect on N2 O emission for the wheat crop iN2012. Neither nitrification nor urease inhibitors increased crop yields because the low rainfall experienced led to little potential for gross N loss through denitrification, leaching or volatilisation pathways. In such dry years, only government or other financial incentives for N2 O mitigation would make the use of DMPP with applied N economically viable

A framework for mathematics graphical tasks: the influence of the graphic element on student sense making

Graphical tasks have become a prominent aspect of mathematics assessment. From a conceptual stance, the purpose of this study was to better understand the composition of graphical tasks commonly used to assess students’ mathematics understandings. Through an iterative design, the investigation described the sense making of 11–12-year-olds as they decoded mathematics tasks which contained a graphic. An ongoing analysis of two phases of data collection was undertaken as we analysed the extent to which various elements of text, graphics, and symbols influenced student sense making. Specifically, the study outlined the changed behaviour (and performance) of the participants as they solved graphical tasks that had been modified with respect to these elements. We propose a theoretical framework for understanding the composition of a graphical task and identify three specific elements which are dependently and independently related to each other, namely: the graphic; the text; and the symbols. Results indicated that although changes to the graphical tasks were minimal, a change in student success and understanding was most evident when the graphic element was modified. Implications include the need for test designers to carefully consider the graphics embedded within mathematics tasks since the elements within graphical tasks greatly influence student understanding