Regarding verbal output, the only difference was in word counts: IWSs use fewer words than NCSs when they describe emotional situations.5 Facial expression The face is certainly the most, expressive and specific part, in the body where emotions arc expressed. Hkman6 and Izard7 have shown that, some emotions have cross-cultural expressions, and they have developed rating scales for facial emotional expressions. The results of their research were incorporated

into schizophrenia research. Facial expressions can be divided into two types: voluntary/posed and Inhibitors,research,lifescience,medical involuntary/spontaneous expressions, with the presumption that, these two types of expressions use two different neurological pathways. When compared with NCSs, 13 studies Inhibitors,research,lifescience,medical reported that medicated or unmedicated IWSs are less expressive, in frequency and intensity, for posed

and spontaneous emotional expressions and for all emotions, and that this deficit, is stable over time. Three studies reported contrasting results, and four studies did not find any significant, differences in expressiveness between IWSs and NCSs.8-11 Studies have also compared IWSs with depressed patients. Most studies (n=6) did not find any significant. differences between these two groups. Two studies12,13 selected schizophrenia patients with Inhibitors,research,lifescience,medical blunted affect, and reported decreased expressions in the schizophrenia group. Three studies reported a higher level Inhibitors,research,lifescience,medical of expressiveness in schizophrenia.5,8,14,15 Surprisingly, some studies11,16-20 could not find any correlations between emotional expressions and clinical ratings of blunted affect. Acoustic expression ‘The voice can convey affective signals.21 Among emotions, disgust is poorly recognized and happiness is not easily recognized, while anger, interest, and boredom are highly recognizable. The most, significant parameters involved in emotional

speech are pitch, voice intensity, and speech rate. Inhibitors,research,lifescience,medical However, it. is not clear to what, extent the Afatinib variations in these acoustic parameters fully explain the human encoding processes and decoding capacities. As for facial expressions, vocal expressions can be divided into spontaneous and voluntary expressions. In voluntary expressions, subjects are asked to read sentences with a specific emotional tone. For spontaneous first expressions, subjects are asked to report an emotional event. The first, question is whether IWSs express emotions as well as other groups. Five studies12,22-25 found that. IWSs were less accurate in spontaneous and voluntary emotion expressions, while, in one study,26 positive schizophrenia patients were more accurate than NCSs. IWSs were less accurate than depressed patients in two studies, while positive schizophrenia patients were more accurate than depressed patients in a third study.

Conclusion The two major theories of schizophrenia, the neurodevelopmental and the dopamine hypotheses, have hitherto been largely distinct and indeed independent of much of the epidemiological evidence concerning risk factors for the condition. However, these theories are now beginning to be integrated through the growing evidence that the

major developmental risk factors for schizophrenia appear to act by facilitating Inhibitors,research,lifescience,medical dopamine dysregulation; this latter appears to be the final common pathway underlying psychosis. The challenge is now to delineate the exact chain of pathogenic mechanisms which connect such risk factors to dopamine dysregulation.
To this day, the pharmacological management of schizophrenia Inhibitors,research,lifescience,medical is based upon the serendipitous discovery, over 50 years ago, of the antipsychotic effects of chlorpromazine.1 Subsequent drug discovery for schizophrenia treatments was

directed at identifying agents with comparable properties inferred by quite indirect criteria such as protection against apomorphine-induced Inhibitors,research,lifescience,medical canine vomiting or improvement in the conditioned avoidance FK228 research buy response, while at the same time seeking increased potency and attenuated neurologic side effects.2 Carlson3 proposed that antipsychotic drugs produced their therapeutic effects by blocking dopamine receptors. Advances in ligand-binding techniques

led Snyder and Seemen to demonstrate that there was a specific and highly robust correlation Inhibitors,research,lifescience,medical between the clinical potencies of antipsychotics and their ability to block the dopamine D2 receptor.5-5 With the target of therapeutic action clearly identified, pharmacologists could then “build” into new agents other neurotransmitter receptor interactions to minimize side effects. However, these modifications, while virtually eliminating extrapyramidal see more Inhibitors,research,lifescience,medical side effects, introduced other serious problems including weight gain, hyperlipidosis, and glucose intolerance.6 The introduction of antipsychotic medications was associated with the progressive decline in the number of patients held in state mental hospitals. The vast majority of these suffered from psychotic disorders, and the inference was that the antipsychotic medications had a profound impact on their care, permitting this deinstitutionalization. A less sanguine view would note that currently half of the homeless suffer from serious mental illness,7 and that the number of prison beds on a percapita basis has largely replaced the closed mental hospital beds, consistent with a shift in the locus of confinement.

Morbidity data were extracted as primary and secondary diagnoses and subdivided into main disease groups, in accordance with the World Health Organization (WHO) criteria for ICD-10. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the main diagnoses. For the main diagnostic groups #A-1210477 in vivo randurls[1|1|,|CHEM1|]# that showed significant differences, we performed subgroup analyses to determine the most common diagnoses in each category that were associated with a PD diagnosis. We used a threshold of 1%, values greater than Inhibitors,research,lifescience,medical which were taken to indicate

that diseases were selected. Odds ratios were then calculated for each of them. Statistical analyses were done using SAS 9.1.3 (SAS, Inc., Cary, NC). The study was approved by the Danish Data Protection Agency. Data were handled to ensure personal anonymity, so neither individual nor ethical approval was required. Results We identified 10,490 patients with PD and compared their data with those of 42,505 control subjects, aged more than 20 years. The age distribution Inhibitors,research,lifescience,medical of the patients and control subjects is shown in Table ​Table11. Table 1 Age and gender

distributions of patients at the time of diagnosis and matched controls Morbidity before PD Diagnosis The morbidities, subdivided into percentage incidence and OR with Inhibitors,research,lifescience,medical 95% CI, are shown in Table ​Table22 for diagnoses made in more than 1% of PD patients (Table ​(Table33). Table 2 Morbidities 3 years before diagnosis of Parkinson’s Inhibitors,research,lifescience,medical disease, by major disease groups Table 3 Parkinson’s disease: Morbidities 3 years before PD diagnosis. Only diseases occurring at a frequency of more than 1% are included Parkinson’s disease was positively associated with the presence of mental and behavioral disorders (OR = 1.74), diseases of the nervous system (OR = 1.72), digestive system (OR = 1.16), musculoskeletal system and connective tissue (OR = 1.12), and genitourinary system (OR = 1.31), symptoms, signs and abnormal clinical and laboratory Inhibitors,research,lifescience,medical findings not classified elsewhere (OR = 1.26), injuries, poisonings

and certain other consequences of external causes (OR = 1.36), and other factors influencing health status and contact with health services (OR = 1.22). PD was negatively associated with: neoplasm (OR = 0.85), diseases of the ear, nose, and throat (OR = 0.93), the circulatory system (OR = 0.82), Liothyronine Sodium and respiratory system (OR = 0.91). Discussion The current data show that symptoms other than classic Parkinsonian symptoms are present early PD and perhaps before the latter type are dominant enough to enable diagnosis. This study used a national database to identify all diagnoses before hospital-registered diagnosis of PD in a controlled design. We show that nonmotor diagnoses include a wide range of disease areas, including genitourinary, digestive, neurological, and psychiatric disorders, and, notably, are associated with a significantly higher risk of falls/injuries.

Pulsatile CFD was performed for three cardiac cycles (Schirmer and Malek 2007a) with a 500 timestep pulsatile velocity waveform that was derived from waveforms described in healthy human subjects by Ford et al. (Holdsworth et al. 1999). Validation of the computational approach used in this study has been previously reported (Schirmer and Malek 2007a, b, 2008). Postprocessing was performed using Ensight software (Ver. 8, CEI, Apex, NC). Statistical analysis of

mean values was Inhibitors,research,lifescience,medical performed using Student’s t-tests and statistical significance was assumed for P < 0.05 (SAS, Cary, NC). Results Changes of the flow pattern in CS Starting with laminar flow in the common carotid (CCA), a considerable distortion of the flow pattern was seen in all eight cases (Fig. 2A). The average Reynolds number in the stenosis was 114 ± 30, the maximum 162. Three modes of flow alteration Inhibitors,research,lifescience,medical were discerned as a function of the geometry of the stenosis: in axisymmetric stenosis of the ICA (cases 1 and 7) recirculation and secondary flow patterns was seen downstream from the stenosis in the poststenotic dilatation of the vessel. The jet of accelerated blood in the center of the vessel downstream of the stenosis evolves into increased twisting and curling of the flow, characterized by the pseudoscalar quantity helicity (Fig. 1B, cases 1 and 7). In cases where the stenosis was close to

the carotid bulb or just downstream to the bifurcation (cases 3–5 and 8), recirculation Inhibitors,research,lifescience,medical developed both upstream and downstream to the stenosis. Significant Inhibitors,research,lifescience,medical twisting of the flow with increased helicity, however, could only be demonstrated on orthogonal cutplanes through the stenosis itself (panel b) and in the poststenotic segment of the flow (see insert panel a in Fig. 1C, cases 1–2 and 6–7). Inhibitors,research,lifescience,medical The increase in helicity is characterized by the development of a division of the pathlines into a right-handed and left-handed twisting component of the

flow. One case with an elongated and flattened stenosis twisted around itself (case 6) had only small areas of recirculation, but increased helicity along the length of the stenotic vessel segment (Fig. 1C, case 6). The two corkscrew components of the flow merge further downstream upon restoration of a laminar flow condition tuclazepam (Fig. 1B, case 2, distal ICA). Figure 1 (A) Pathlines color coded for the time-averaged velocity magnitude. (B) Examples of pathlines, color coded for the helicity density. (C) Helicity Barasertib clinical trial density on orthogonal cutplanes that correspond to a prestenotic cutplane a (see schematic), a cutplane at … Figure 2 (A–C) Three example (case 3, 5, and 6) detailing the temporal evolution of the instantaneous wall shear stress (WSS) vectors at the stenosis and poststenotic region (PSR) during the cardiac cycle (reds points on pulse wave). Regions of antegrade … WSS in carotid stenosis The WSS magnitude, averaged over the course of the cardiac cycle, was computed and exhibited a visible increase in the area of the stenosis (Fig.

A wide QRS complex is very uncommon in DHF patients, therefore, the QRS duration is not a major determinant for the presence of systolic and diastolic dyssynchrony. Unlike patients with SHF, mechanical dyssynchrony in DHF may occur as a result of myocardial disease rather than electromechanical coupling delay. Coexistence but not cause-effect relationship of cardiac dysfunction

and mechanical dyssynchrony was described in previous Inhibitors,research,lifescience,medical studies, while the correlation between the two facets of LV performance differed among studies.11-13),71) Therefore, apart from the severity of myocardial dysfunction, dyssynchronous LV relaxation and impairment of ventricular restoring forces may also interfere the LV filling and lead to a diastolic dyssynchrony,72) or vice versa. Interestingly, medical therapy for DHF, including diuretics, beta-blockers, Inhibitors,research,lifescience,medical calcium-channel blockers, angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, was EGFR cancer associated with shortening of diastolic intraventricular delay, which in turn correlated with improvement of Inhibitors,research,lifescience,medical LV stiffness and reduction of filling pressure.12) However, it remains to define what extent LV dyssynchrony is involved in the pathophysiologic mechanism of DHF. Dyssynchrony and Mortality in Heart Failure The prognostic implication of mechanical

dyssynchrony was initially reported by Bader et al.73) where 104 CHF patients with ejection fraction ≤ 45%, over half of them had wide QRS complexes, were examined by the use of pulsed TDI and followed up for one year. Although no mortality occurred at the end of follow up, 86 patients (83%) were admitted for decompensated CHF. As a result, intraventricular dyssynchrony was found Inhibitors,research,lifescience,medical to be most important independent predictor of heart Inhibitors,research,lifescience,medical failure hospitalization, and the other two independent predictors included LV ejection fraction and QRS width. In another early study of 106 CHF patients with LV ejection fraction < 35% and QRS duration ≤ 120 ms who were followed up for a mean of 17 ± 11 months, intraventricular dyssynchrony was measured by TDI as the Ts-SD from both basal and middle LV segments in apical

4- and 2-chamber views. A Ts-SD cutoff value of > 37 ms was associated with a significant increase in clinical event of including heart Thiamine-diphosphate kinase failure hospitalization or cardiac transplantation.74) The same group recently published their study on 167 CHF patients with a mean follow up of 33 months. Electrical dyssynchrony defined as the QRS duration ≥ 120 ms and mechanical delay as the septal-to-lateral wall delay ≥ 65 ms were investigated for their association with adverse events.75) In multivariate Cox regression analysis, the septal-to-lateral wall delay [hazard ratio (HR), 2.37; p = 0.002] showed a better predictive value than QRS duration (HR, 1.88; p = 0.028) for cardiac events. Moreover, patients with both electrical and mechanical dyssynchrony had a HR of 3.98 (p < 0.

In 2010, about 930,000 deaths were estimated to be attributable to tobacco in India.18 The high prevalence of tobacco usage has led to increases in disease burden and high health care costs in BGJ398 developing countries. There is a high incidence of smoking reported amongst youth from Bangladesh, India, and Indonesia.19 While the incidence of head and neck cancers is decreasing in Europe and North America, it remains unabated in the developing world.20 In India, nearly two-thirds of patients present with advanced stages.13,21 Inhibitors,research,lifescience,medical The mean age of patients at presentation of head and neck cancers is the fifth and early sixth decades in Asian populations compared with the seventh and eighth decades in the North

American population.22–26 HUMAN PAPILLOMAVIRUS (HPV) PREVALENCE The overall prevalence of HPV in HNSCC is around 50%,27 with the highest prevalence in cancers of the tonsil and base of tongue.28 The rise in HPV-related cancers has been mainly attributed to the change in sexual practices in the Western Inhibitors,research,lifescience,medical world. These patients are younger, have bulky nodes, predominantly oropharynx involvement, equal gender distribution, and have better survival.29–31 HPV-16 is the most common type, being present in 30.9% of oropharyngeal carcinomas,

16% of oral cancers, and 16.6% of laryngeal cancers. Prevalence of HPV Inhibitors,research,lifescience,medical in oral cancers is similar in Europe (16%) and North America (16.1%), but greater in Asia (33%).32 The HPV prevalence in India ranges from 33.6% in the Eastern Inhibitors,research,lifescience,medical region to 67% in South India and 15% in Western India.33,34 The prevalences of HPV-6, HPV-11, HPV-16, and HPV-18 were 13%, 20%, 42%, and 47%, respectively.33 HPV-16 was most common, followed by HPV-18 and then cross-infection (16 and 18); 41% of patients had multiple Inhibitors,research,lifescience,medical HPV infections.33 Lesions of the tongue had the highest rate (9 of 11) of HPV infection. Another study showed a rate of HPV infections of 56.3% in cancers

of the mandible, 37.5% in cheek, and 38.6% in maxilla. The study also reported that the advanced stages (III, IV) had higher infection rates as compared to earlier stage.35 The vaccination of HPV has not been incorporated in the national immunization program of India. There is no evidence to show that HPV vaccination may prevent enough HNSCC. MOLECULAR BIOLOGY OF HEAD AND NECK CANCERS Between developed and developing countries, there are not only differences in the age, subsite, and habit but also in the molecular biology. The prevalence of the p53 mutation is common in Europe and USA but rare in India. The recent data show the prevalence to be 81% in the Western world. Multiple genetic abnormalities are common in head and cancers in India and Southeast Asia. These include a preponderance of Ha-ras mutations (35%), loss of heterozygosity of Ha-ras (30%), N-ras amplification (28%), and N-myc amplification (29%). These mutations in ras oncogenes are uncommon in the Western world.

In their approach, Hädicke and Klamt [15] address the limitation that MCSs have of disabling desired functionalities along with the targeted functionalities, by generalizing MCSs to cMCSs that allow for a set of desired modes, with a minimum number

preserved, to be defined. This generalization can be applied to existing methods which can be reformulated Inhibitors,research,lifescience,medical as special cMCS problems, providing the capacity for systematic enumeration of all equivalent gene deletion combinations and determining robust knockout strategies for coupled product and biomass synthesis, altogether offering great flexibility in defining and solving knock out problems. Other examples of MCSs in metabolic engineering can be seen in [14,29], discussed earlier in Section 3.2. 5. Similar concepts 5.1. Bottlenecks Bottlenecks characterize a point of congestion in a Inhibitors,research,lifescience,medical system that happens when workloads arrive at

a given point more quickly than can be handled at that point. In a metabolic network consisting of enzymes (nodes) and substrate-product metabolite fluxes (directional edges), three topological centralities that are used to measure the importance of nodes Inhibitors,research,lifescience,medical in controlling information transfer are: in degree which refers to the number of links forwarded to the node under consideration, out degree which refers to the number of links going out of the node, and betweenness which Inhibitors,research,lifescience,medical measures the number of “shortest paths” [53] going selleck products through the node. Bottlenecks are those nodes that have many “shortest paths” going through them, much like major bridges

and tunnels on a highway map. For example, the bottleneck Inhibitors,research,lifescience,medical nodes a and b in Figure 8 below, control most of the information flow because they form an essential highway to get information from the blue to the yellow nodes so, if either of nodes a or b is knocked out, the network would collapse. In effect, bottlenecks indicate essentiality new of the nodes. Figure 8 Example of a bottleneck in metabolic networks. The essentiality of the bottleneck nodes is illustrated in the above graph which shows that they are “AND” nodes, traversed in series and you cannot get from the input nodes to the output except through node a “AND” node b. The in degree of node a is 4 and the out degree is 1; these centralities only consider the partners connected directly to a particular node, whereas the betweenness considers a node’s position in the network and, as shown for a, is much higher e.g. 28. Thus, bottlenecks in metabolic networks could be defined as nodes with a high betweenness centrality.

Long-term safety questions, including effect on serum prostate-specific antigen levels and risk of prostate cancer, have yet to be answered. Intraprostatic BoNT-A

may ultimately become a useful treatment in patients with BPH/LUTS refractory to oral medications, especially those who are not candidates for surgery. Trials evaluating the gonadotropin-releasing hormone (GnRH) antagonist cetrorelix have reported conflicting findings. Additional randomized, Inhibitors,research,lifescience,medical placebo-controlled trials that are appropriately powered need to be conducted to verify clinical benefit and safety. NX-1207 is a new drug under investigation for the treatment of symptomatic BPH. Four clinical trials yet to be published in the peer-reviewed literature have been interpreted to show improvement in LUTS exceeding that of all other medical therapies currently marketed for the treatment of BPH. These clinical benefits were maintained after

angle injection for a year. Phase III Inhibitors,research,lifescience,medical studies are underway to define the true efficacy, safety, and mechanism of action of this Inhibitors,research,lifescience,medical novel approach to treating BPH. Men with clinical BPH are best treated initially with α-blocker monotherapy to relieve LUTS. Although combination therapy does decrease disease progression relative to monotherapy, the clinical relevance and cost-effectiveness of this outcome in an unselected group of men with clinical BPH are highly questionable. In the subset of men with large prostates, both α-blockers Inhibitors,research,lifescience,medical and 5-ARIs significantly decrease LUTS and this clinical benefit appears to be additive. In men with large prostates, 5-ARIs are superior to α-blockers at preventing AUR and BPH surgery; however, one has to treat a large cohort of men for 4 years with the addition of a 5-ARI to prevent a single episode of AUR or BPH surgery. Even in this highly selected cohort, the clinical

significance of a 5-ARI for preventing disease progression is marginal. A study evaluating tolterodine/tamsulosin Inhibitors,research,lifescience,medical combination therapy falls short of demonstrating, or even suggesting, the safety and efficacy of the Resveratrol combination of an α-blocker and anticholinergic for the treatment of BPH.
Prostate cancer is the most common solid organ malignancy among men, as well as the second most common type of cancer and the third leading cause of cancer deaths among male patients, according to the National Cancer Institute (NCI).1–3 In 2009, NCI estimates for new cases of diagnosed prostate cancer were at 192,280, with 27,360 deaths see more attributed to this malignancy.4 As of the late 1980s, a large number of men were diagnosed with clinically localized prostate cancer with the introduction of prostate-specific antigen (PSA) screening.

A similar trend of increased PON1 protein association with HDL was observed in males following POMxl consumption, as after 4 weeks of POMxl consumption HDL-bound PON1 protein increased by 17% compared to baseline values. The above results were confirmed also in in vitro study where serum from diabetic patients was incubated with PJ or with punicalagin, or with no addition (control), for 2 hours at 37°C. Then, HDL was isolated from the serum by ultracentrifugation,

and Western blot analysis was Inhibitors,research,lifescience,medical performed. After serum incubation with PJ (18μg gallic acid equivalents (GAE)/mL) or with punicalagin, the protein content of HDL-bound PON1 significantly increased by 36% and by 14%, respectively, as compared to Luminespib control serum. Upon increasing the concentration of PJ or punicalagin up to 36μg GAE/mL, HDL-bound PON1 protein further increased, and it was 62% or 83% higher than that observed in control Inhibitors,research,lifescience,medical patients’ serum (no PJ), respectively. Figure 3. The effect of PJ consumption by diabetic males on their HDL-associated Inhibitors,research,lifescience,medical PON1 activities. We thus conclude that PJ as well

as POMxl consumption by diabetic patients contributes to PON1 stabilization by increasing its association with HDL and therefore enhancing PON1 catalytic activities. The ratio between HDL-associated PON1 and free PON1 gradually decreased as the extent of HDL oxidation increased. The antioxidants vitamin E or PJ inhibited the oxidation-mediated Inhibitors,research,lifescience,medical redistribution of PON1 in serum. Indeed, PJ and its purified major polyphenols punicalagin, gallic acid, and ellagic acid all increased PON1 binding also to HDL.33 Furthermore, PON1 associated more efficiently with HDLs isolated from diabetic patients after PJ consumption

versus the patients’ HDL isolated Inhibitors,research,lifescience,medical prior to PJ consumption.33 THE INHIBITORY EFFECT OF POMEGRANATE CONSUMPTION ON BLOOD PRESSURE As some antioxidants were recently shown to reduce blood pressure (BP), we studied the effect of PJ consumption (50mL, 1.5mmol of total polyphenols per day, for 2 weeks) by hypertensive patients on their BP and on serum angiotensin-converting enzyme (ACE) activity.34 A 36% decrement in serum ACE activity and a 5% reduction in systolic also BP were noted. A similar dose-dependent inhibitory effect (31%) of PJ on serum ACE activity was observed also in vitro. As reduction in serum ACE activity, even with no decrement in blood pressure BP, was previously shown to attenuate atherosclerosis, PJ can offer a wide protection against cardiovascular diseases which could be related to its inhibitory effect on oxidative stress and on serum ACE activity. In CAS patients the systolic BP was significantly (P<0.05) reduced by 7%, 11%,10%, 10%, and 12% after 1, 3, 6, 9, and 12 months of PJ consumption, respectively, compared to values obtained before treatment.

2 These include medical knowledge, patient care, communication, practice-based learning, system-based practice, and interpersonal relationships. Medical schools now use these competencies for training students, and the Joint Commission on Accreditation of Hospitals is also using the framework of these competencies to accredit hospitals and other health care institutions. However, the definitions

of these domains and the glossary of terms used to define them are unclear to cardiologists and other health team members Inhibitors,research,lifescience,medical who are not intimately involved in medical education. Thus, below is a simplistic perspective of what a cardiologist needs to know to achieve competence as currently defined. We also outline the role of professional societies and academic medical centers in facilitating the attainment and documentation of competence. Table 1 American Board of Medical Specialties six core competencies for improved quality of care. http://www.selleckchem.com/products/2-Methoxyestradiol(2ME2).html specific Areas of Physician Competencies Know What You Should Know All cardiologists should have a basic Inhibitors,research,lifescience,medical fund of knowledge in the field of cardiovascular diseases, consisting of a core Inhibitors,research,lifescience,medical of information germane to the care of a wide spectrum of patients. This core knowledge should be updated regularly and augmented by validated advances in diagnostics and

therapeutics as established by new discoveries. It is the responsibility of professional societies to organize, prioritize and provide the physician with this core knowledge. The American College of Cardiology (ACC) Inhibitors,research,lifescience,medical has brought together educational and clinical practice experts to create core competencies related to each major cardiovascular disease, including acute coronary syndromes, heart failure, and many others. These core competencies are updated on a regular basis by experts in the respective fields. A competent cardiologist will need to understand the core competencies, determine where their “gaps” exist, and then

fill these gaps with dedicated study. Educational programs and products will in the future be based on a curriculum derived from the core competencies, and certifying bodies should base testing on this Adenosine Inhibitors,research,lifescience,medical predefined core knowledge across all six domains. Know What You Don’t Know (and Ask) In a busy clinical practice, the average physician has 8 to 20 knowledge “gaps” during a day of patient care. However, in many instances these questions do not get answered, as the crush of practice prevents practitioners from seeking answers to their specific questions at the point of care. A competent cardiologist should seek out answers to their questions before making clinical decisions. One of the major barriers that physicians face is the inability to find expert-vetted information at the point of care. National guidelines such as the ACC/AHA (American Heart Association) Practice Guidelines have a rigorous systematic approach to synthesize evidence-based information vetted by experts in the field.