Uremic bleeding syndrome is a recognized consequence of renal failure and can result in clinically significant sequelae. Although the pathophysiology of the condition has yet to be fully elucidated, it is believed to be multifactorial. This article is a review of both the normal hemostatic and homeostatic mechanisms that operate within the body to prevent unnecessary bleeding, as well as an in-depth discussion of the dysfunctional components that contribute to the complications associated with uremic bleeding syndrome. As a result of the multifactorial nature of this syndrome, prevention and treatment options can include one or a combination of the following: dialysis, erythropoietin, cryoprecipitate, desmopressin, and conjugated estrogens. Here, these treatment options are compared with regard to their mechanism of action, and onset and duration of efficacy. An extensive review of the clinical trials that have evaluated each treatment is also presented. Lastly, we have created an evidence-based treatment algorithm to help guide clinicians through most clinical scenarios, and answered common questions related to the management of uremic bleeding.
In this overview we describe literature on how speech production and speech perception change in healthy or normal aging across the adult lifespan. In the production section we review acoustic characteristics that have been investigated as potentially distinguishing younger and older adults. In the speech perception section studies concerning speaker age estimation and those investigating older listeners' perception are addressed. Our discussion focuses on major themes and other fruitful areas for future research. This article is categorized under: Linguistics > Language in Mind and Brain Linguistics > Linguistic Theory Psychology > Development and Aging
Sensory loss is most common, and perhaps most debilitating, in the optical and auditory systems, and may occur congenitally or as a result of illness or trauma. How well a dog adjusts to the loss will depend on the speed of onset, the severity of the loss and the individual temperament of the dog. Owners may also find their dog's disability emotionally distressing or challenging to manage. As diagnosis of sensory loss and treatment of associated conditions generally occurs in the veterinary surgery, the practice team is ideally placed to help both dogs and their owners adjust to this change. Adaptations may include maintaining a consistent environment and utilising the remaining senses to enable stress free navigation, modification of methods of communication to preserve the client–pet relationship, and training commands that enable owners to guide their dog. Alterations to exercise routines and provision of appropriate outlets for natural drives can ensure ongoing quality of life. Directing clients to web resources and support groups can also provide inspiration and maintain morale through shared experience.
There have been ground breaking advances in the field of dog training and behaviour modification in the last 20 years. Traditional theories advocating the use of ‘dominance’ to control dog behaviour have given way to ‘force free’ techniques that rely on understanding and changing the dog's motivation. An entirely hands off approach is not realistic in all cases in veterinary practice. However routine application of contemporary behavioural principles to the approach and handling of dogs in practice can improve welfare and reduce defensive aggression for the benefit of both patient and staff alike.
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