Characterizing Decision-Making Surrounding Exercise in ARVC: Analysis of Decisional Conflict, Decisional Regret, and Shared Decision-Making.

BACKGROUND: Limiting high-intensity exercise is recommended for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) due to its association with penetrance, arrhythmias, and structural progression. Guidelines recommend shared decision-making (SDM) for exercise level, but there is little evidence regarding its impact. Therefore, we sought to evaluate the extent and implications of SDM for exercise, decisional conflict, and decisional regret in patients with ARVC and at-risk relatives. METHODS: Adults diagnosed with ARVC or with positive genetic testing enrolled in the Johns Hopkins ARVC Registry were invited to complete a questionnaire that included exercise history and current exercise, SDM (SDM-Q-9), decisional conflict, and decisional regret. RESULTS: The response rate was 64.8%. Two-thirds of participants (68.0%, n=121) reported clinically significant decisional conflict regarding exercise at diagnosis/genetic testing (DCS [decisional conflict scale]≥25), and half (55.1%, n=98) in the past year. Prevalence of decisional regret was also high with 55.3% (n=99) reporting moderate to severe decisional regret (DRS [decisional regret scale]≥25). The extent of SDM was highly variable ranging from no (0) to perfect (100) SDM (mean, 59.6±25.0). Those diagnosed in adolescence (≤age 21) reported significantly more SDM (P=0.013). Importantly, SDM was associated with less decisional conflict (ß=-0.66, R2=0.567, P<0.01) and decisional regret (ß=-0.37, R2=0.180, P<0.001) and no difference in vigorous intensity aerobic exercise in the 6 months after diagnosis/genetic testing or the past year (P=0.56; P=0.34, respectively). CONCLUSIONS: SDM is associated with lower decisional conflict and decisional regret; and no difference in postdiagnosis exercise. Our data thus support SDM as the preferred model for exercise discussions for ARVC.

Barriers to and facilitators of pet grooming among clients served by a subsidized grooming service program.

Grooming is an important aspect of basic hygiene care for most companion animals. The consequences of not receiving routine grooming care can pose significant risks to animals' health and wellbeing. The current study examined barriers and facilitators of maintaining pets' grooming needs among clients of a subsidized grooming service program in New York City (N = 167), as well as the impact of a tailored nail-trimming demonstration on clients' confidence trimming pets' nails. Ninety-two percent of the sample reported experiencing at least one barrier to maintaining their pet's grooming (e.g., income, transportation) and nearly half (46%) experienced three or more barriers to providing grooming. Ninety-one percent endorsed that at least one supply/support (e.g., brush/comb, behavioral support) would be beneficial in maintaining their pet's grooming needs at home and more than half reported that three or more supplies/services would be beneficial. Differences in the prevalence of specific barriers to grooming were found across income groups, service locations, and service settings. Clients who received nail-trimming demonstrations, on average, reported statistically significant increases in confidence trimming nails following their appointment. We discuss the implications of these findings for improving animal welfare and veterinary professionals' capacity for preventing grooming-related omissions of care and increasing communities' capacity to support pet owners' access to essential pet care supplies and supports. Future research is needed to determine (a) how and for whom grooming demonstrations and subsidized services are most effective, (b) whether an increase in pet owner confidence following nail trimming demonstrations is associated with maintaining nail trimming at home over time, and (c) whether providing clients with supplies and supports is an effective way of preventing and/or ameliorating future grooming-related omissions of care and hygiene-related health concerns observed by veterinarians, animal control professionals, shelter staff, and law enforcement.

Grooming-Related Concerns Among Companion Animals: Preliminary Data on an Overlooked Topic and Considerations for Animals' Access to Health-Related Services.

Grooming is an essential health maintenance activity that is fundamental to the welfare of many companion animals. Despite the potentially serious consequences of inadequate grooming for pets and their caregivers, few studies have examined the role of access to pet grooming services and supplies in promoting and maintaining companion animal health and welfare. The goal of this paper was 2-fold: (1) To provide preliminary findings demonstrating the scope of grooming and matting concerns among animals served by a large, non-profit animal welfare organization and (2) to provide a call for research to guide effective prevention of and responses to grooming-related omissions of care. We retrospectively extracted data from five American Society for the Prevention of Cruelty to Animals (ASPCA) programs serving the New York City area: ASPCA Animal Hospital (AAH), Community Medicine (CM), One ASPCA Fund, ASPCA-NYPD (New York City Police Department) Partnership, and the Community Engagement (CE) Program. The prevalence of grooming-related concerns was relatively consistent across all three veterinary service programs (AAH: 6%; CM: 4%; One ASPCA Fund: 6%). Thirteen percent of the ASPCA-NYPD Partnership's cruelty cases involved general hair matting concerns and/or strangulating hair mat wounds (93% were long-haired dog breed types). Five percent of CE cases received grooming-related supplies to support pet caregivers' in-home grooming capabilities. Our findings underscore the need to understand the scope of grooming-related concerns among animals served by veterinarians and other community programs to improve animals' access to health-related services.

The safety, efficacy and pharmaceutical quality of male enhancement nutraceuticals bought online: Truth versus claim.

OBJECTIVE: Nutraceutical products are widely used for their claimed therapeutic benefits. However, falsified or adulterated nutraceuticals present a major health threat to consumers. This study investigates the pharmaceutical quality, safety and anti-inflammatory effects of six male enhancement nutraceuticals that claim to be 100% natural. METHODS: Three batches of six male enhancement products were tested to detect the presence and levels of adulterants via high-performance liquid chromatography (HPLC). The pharmaceutical quality of the selected nutraceuticals was tested with near infrared spectroscopy (NIR) and SeDeM. The cytotoxic effects of these products on HepG2 cells were determined through cell proliferation (XTT) and lactate dehydrogenase (LDH) cytotoxicity assays. Lastly, the in vitro inflammatory effects of these products were investigated using murine J774 macrophages through cytokine release analysis. RESULTS: HPLC analysis detected the presence of sildenafil citrate, a vasodilator, and the active ingredient in Viagra and Revatio, in all batches of the products we analyzed. Amount of sildenafil citrate ranged from 0.45 mg to 51.85 mg among different batches. NIR assessment showed inter- and intra-batch heterogeneity in product composition. Results of the XTT and LDH assays showed significant cytotoxic effects of the analyzed products. XTT analysis revealed that the viability of HepG2 treated with tested products varied from 27.57% to 41.43%. Interestingly, the male enhancement products also showed anti-inflammatory effects. CONCLUSION: Despite their labeling as 100% natural, all products tested in this study contained levels of sildenafil citrate, which was not reported on the packaging. There was a lack of pharmaceutical uniformity among products of the same batch and across different batches. Additionally, the products we tested had cytotoxic effects. These study findings highlight the adulteration, poor quality and hazard of these nutraceuticals. Therefore, strict regulation of these products and standardization of the definition of nutraceuticals are urgently needed. Further, these falsely advertised products should be withdrawn from the market due to potential adverse effects on the health of their consumers.

Catalytic methyl transfer from dimethylcarbonate to carboxylic acids.

Although methylation reactions are commonplace, currently used reagents are hazardous, toxic, and/or unstable. Dimethylcarbonate has been put forth as an inexpensive, nontoxic, and "green" potential methylating reagent. Herein we report a general, base-catalyzed methyl transfer from dimethylcarbonate to carboxylic acids. High selectivity for esterification is observed even in the presence of unprotected phenols, and the mild reaction conditions enable conservation of stereochemistry at epimerizable stereocenters. Isotope-labeling studies suggest a mechanism proceeding by direct methyl transfer from dimethylcarbonate to the substrate.