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Topic:Clinical Study

Clinical studies in equine research involve the systematic investigation of health and disease in horses through structured scientific methods. These studies aim to evaluate the safety and efficacy of treatments, understand disease mechanisms, and improve veterinary care practices. Clinical studies can include randomized controlled trials, observational studies, and case-control studies. They may focus on various aspects such as pharmacokinetics, therapeutic interventions, and diagnostic techniques. This page compiles peer-reviewed research studies and scholarly articles that explore the design, implementation, and findings of clinical studies in equine medicine, providing insights into their impact on horse health and veterinary practices.
The effect of single pretreatment with salbutamol on recovery of bronchoalveolar lavage fluid in horses with suspected or confirmed severe equine asthma.
Journal of veterinary internal medicine    February 1, 2019   Volume 33, Issue 2 976-980 doi: 10.1111/jvim.15359
Varegg MS, Kløverød KM, Austnes MK, Siwinska N, Slowikowska M, Zak A, Niedzwiedz A.Bronchoalveolar lavage (BAL) is a method for the recovery of respiratory secretion from the lower airways. Objective: To investigate if the administration of a single dose of a bronchodilatator in horses with a suspected or confirmed severe equine asthma could improve recovery of bronchoalveolar lavage fluid (BALF). Methods: Twenty-eight horses with severe equine asthma. Methods: Horses were divided into 2 groups: group "treated" was given salbutamol before endoscopic examination and BALF collection, whereas group "not treated" was not given. BAL was performed with BAL-catheter by instilling 3...
Can the hoof be shod without limiting the heel movement? A comparative study between barefoot, shoeing with conventional shoes and a split-toe shoe.
Veterinary journal (London, England : 1997)    February 1, 2019   Volume 246 7-11 doi: 10.1016/j.tvjl.2019.01.012
Brunsting J, Dumoulin M, Oosterlinck M, Haspeslagh M, Lefère L, Pille F.Conventional shoeing restricts heel movement, which may have a negative effect on the orthopaedic health of the horse. A randomised crossover experimental study using noninvasive techniques was performed to compare the mediolateral heel movement in barefoot horses, horses shod with a conventional toe clipped shoe and with a new type of shoe with a split toe. In eight horses, 16 forelimbs were tested barefoot, shod with a conventional shoe and with the split-toe (ST) shoe, in random order. A displacement sensor was secured on the heels and measurements were collected continuously at a frequency...
Using Movement Sensors to Assess Lying Time in Horses With and Without Angular Limb Deformities.
Journal of equine veterinary science    January 31, 2019   Volume 75 55-59 doi: 10.1016/j.jevs.2019.01.011
Clothier J, Small A, Hinch G, Barwick J, Brown WY.Chronic musculoskeletal pathologies are common in horses, however, identifying related effects can be challenging. This study tested the hypothesis that movement sensors and analgesics could be used in combination to confirm the presence of restrictive pathologies by assessing lying time. Four horses presenting a range of angular limb deformities (ALDs) and four nonaffected controls were used. The study comprised two trials at separate paddock locations. Trial A consisted of a 3-day baseline phase and 2 × 3-day treatment phases, during which two analgesics were administered to two ALD horses...
Ophthalmologic findings associated with Rhodococcus equi bronchopneumonia in foals.
Veterinary ophthalmology    January 31, 2019   Volume 22, Issue 5 660-665 doi: 10.1111/vop.12637
Tarancón I, Leiva M, Jose-Cunilleras E, Ríos J, Peña T.To describe ocular findings associated with Rhodococcus equi bronchopneumonia in foals, and to determine whether severity of the ocular lesions is related with outcome. Methods: Foals diagnosed with R equi infection at the VTH-UAB from January 2002 to December 2017. Methods: Rhodococcus equi infection was diagnosed by means of clinical signs, radiographic/ultrasonographic findings, and/or positive culture. In all the foals, a complete ophthalmic examination by a boarded ophthalmologist was performed and ocular signs were recorded and graded (0-4). Results: Thirty-nine foals were included in t...
[Vigilance for veterinary medicinal products: Reports of adverse reactions in the year 2017].
Schweizer Archiv fur Tierheilkunde    January 31, 2019   Volume 161, Issue 2 107-112 doi: 10.17236/sat00197
Müntener C, Kupper J, Naegeli H, Gassner B.A total of 306 reports of adverse reactions to veterinary medicinal products were received during the year 2017 representing an increase of 21% compared to the previous year. The majority of these reports described reactions concerning companion animals (180 dogs and 59 cats) as well as cattle (38 reports) and horses (14 reports). Most of the reported reactions were linked to the use of antiparasitics (158 reports), hormone products (30 reports) and anti-inflammatory products (25 reports). 40 reports were generated from consultations with Tox Info Suisse in Zürich and mainly involved the ex...
Atypical myopathy-associated hypoglycin A toxin remains in sycamore seedlings despite mowing, herbicidal spraying or storage in hay and silage.
Equine veterinary journal    January 30, 2019   Volume 51, Issue 5 701-704 doi: 10.1111/evj.13070
González-Medina S, Montesso F, Chang YM, Hyde C, Piercy RJ.Several pasture management strategies have been proposed to avoid hypoglycin A (HGA) intoxication in horses, but their efficacy has never been investigated. Objective: To evaluate the effect of mowing and herbicidal spraying on HGA content of sycamore seedlings and the presence of HGA in seeds and seedlings processed within haylage and silage. Methods: Experimental study. Methods: Groups of seedlings were mowed (n = 6), sprayed with a dimethylamine-based (n = 2) or a picolinic acid-based herbicide (n = 1). Seedlings were collected before intervention, and at 48 h, 1 and 2 weeks after. ...
Thyroid Hormone and Thyrotropin Concentrations and Responses to Thyrotropin-Stimulating Hormone in Horses with PPID Compared with Age-Matched Normal Horses.
Journal of equine veterinary science    January 30, 2019   Volume 75 35-40 doi: 10.1016/j.jevs.2019.01.008
Breuhaus BA.Glucocorticoids are known to exert inhibitory action on the hypothalamic-pituitary-thyroid axis. With recent evidence that free plasma cortisol and urinary excretion of cortisol metabolites may be increased in horses with pituitary pars intermedia dysfunction (PPID), it is important to further examine thyroid function in horses with PPID. To test the hypothesis that serum thyrotropin (TSH) concentrations are decreased in horses with PPID, baseline serum thyroid hormone and TSH concentrations, and responses to TSH-releasing hormone (TRH), were compared between 12 horses diagnosed as having PPID...
Leukocyte Esterase Reagent Strips for Stall-Side Diagnosis of Endometritis in Mares.
Journal of equine veterinary science    January 30, 2019   Volume 81 102672 doi: 10.1016/j.jevs.2019.01.009
Kelley DE, Schnobrich MR, Gayer S, Scoggin C, Bradcamp E, Canisso IF.The objective of this study was to compare a commercially available leukocyte esterase strip test with endometrial cytology in diagnosing endometritis and establish a cutoff point, sensitivity, and specificity for the leukocyte esterase test (LET). Forty-six light breed mares presented for breeding management were enrolled in this study. Transrectal palpation and ultrasonography examinations were performed to determine when the mares were in estrus. Kalayjian endometrial swabs were used for culture, cytology, and the LET by using the cap to retrieve an endometrial scraping. Thirty-six mares ha...
Heterologous Wharton’s Jelly Derived Mesenchymal Stem Cells Application on a Large Chronic Skin Wound in a 6-Month-Old Filly.
Frontiers in veterinary science    January 30, 2019   Volume 6 9 doi: 10.3389/fvets.2019.00009
Lanci A, Merlo B, Mariella J, Castagnetti C, Iacono E.A complex feedback of growth factors, secreted by a variety of cell types, is responsible for the mediation of skin healing. Despite the recent advances in wound healing management, this fails up to 50% and skin wounds can still be considered one of the main causes of morbidity, both in human and veterinary medicine. Regenerative medicine, involving mesenchymal stromal cells (MSCs), is nowadays a promising solution for skin wound healing. Indeed, MSCs are involved in the modulation of the inflammatory local response and cell replacing, by a paracrine mode of action. Local application of equine...
Are Respiratory Clinical Signs in Horses Associated With Strongyle Egg Shedding Rates on Farms With Varying Egg Shedding Levels?
Journal of equine veterinary science    January 30, 2019   Volume 75 104-111 doi: 10.1016/j.jevs.2019.01.006
Sperl C, Gerber V, Drießlein D, Klima A, Becher AM.Respiratory signs or more specifically severe equine asthma (SEA) is in some studies reported to be associated with decreased strongyle egg shedding. This association can be reproduced in a larger population of unrelated horses. The owners of 209 horses, on seven farms in Bavaria, were interviewed using, an in prior studies validated questionnaire. Horses were categorized into classes of the horse owner assessed respiratory signs index (HOARSI 1-4, unaffected to severely affected). In total, 1,035 fecal samples were analyzed between March 2011 and September 2014 using a modified McMaster proce...
Evaluation of a Proprietary Slow-Release Oxytocin Formulation on Corpus Luteum Function in Mares.
Journal of equine veterinary science    January 29, 2019   Volume 77 28-30 doi: 10.1016/j.jevs.2019.01.004
Sarnecky BA, Vanderwall DK, Mason HM, Kirschner SM, Ambrose B, Parker TL.Prolonging function of the corpus luteum (CL) is a method of suppressing estrus that relies on continued secretion of endogenous progesterone to keep mares out of heat naturally. The use of oxytocin treatment to prolong CL function is gaining increasing use, and the most common treatment protocol involves administration of 60 units of oxytocin intramuscularly (IM) once daily on days 7-14 after ovulation (eight daily treatments). Although that protocol induces prolonged CL function in ≥70% of treated mares, the need for daily administration is a drawback to its use. Therefore, the objective o...
Effect of Topical 1% Cyclopentolate Hydrochloride on Tear Production, Intraocular Pressure, and Pupil Size in Healthy Turkman Horses.
Journal of equine veterinary science    January 29, 2019   Volume 75 25-29 doi: 10.1016/j.jevs.2019.01.002
Ansari Mood M, Rajaei SM, Faghihi H, Ghiadi A.This study was performed to evaluate the effect of topical 1% cyclopentolate hydrochloride on tear production (STT), intraocular pressure (IOP), and vertical pupil diameter (VPD) in healthy Turkman horses. Forty eyes of 20 clinically normal horses were used for this study, which were randomly assigned to two groups. Before instillation of 1% cyclopentolate, the baseline STT, IOP, and VPD of each group were recorded. Then, one drop of cyclopentolate was instilled randomly into one eye of each animal, and the contralateral eye served as control. Measurements were repeated at 20 minutes, 60 min...
Phenotypic, hormonal, and clinical characteristics of equine endocrinopathic laminitis.
Journal of veterinary internal medicine    January 29, 2019   Volume 33, Issue 3 1456-1463 doi: 10.1111/jvim.15419
de Laat MA, Sillence MN, Reiche DB.Equine endocrinopathic laminitis is common and can be associated with an underlying endocrinopathy, such as equine metabolic syndrome (EMS), pituitary pars intermedia dysfunction (PPID), pasture consumption, or any combination of these factors. Objective: The aim of the study was to improve the risk assessment capabilities of clinicians, and to inform management strategies, for acute endocrinopathic laminitis by prospectively examining the phenotypic, hormonal, and clinical characteristics of the disease in a large cohort. Methods: Privately owned horses and ponies (n = 301) of any age, se...
Low field magnetic resonance imaging of the equine distal interphalangeal joint: Comparison between weight-bearing and non-weight-bearing conditions.
PloS one    January 28, 2019   Volume 14, Issue 1 e0211101 doi: 10.1371/journal.pone.0211101
Evrard L, Audigié F, Bertoni L, Jacquet S, Denoix JM, Busoni V.This descriptive study aimed to compare the magnetic resonance appearance of the distal interphalangeal joint articular cartilage between standing weight-bearing and non-weight-bearing conditions. Ten forefeet of live horses were scanned in a standing low-field magnetic resonance system (0.27 T). After euthanasia for reasons unrelated to the study, the non-weight-bearing isolated feet were scanned in a vertical positioning reproducing limb orientation in live horses. The same acquisition settings as during the weight-bearing examination were used. Thickness and cross-sectional area of the dist...
Two-dimensional echocardiographic measurements of the right coronary artery in healthy horses – a pilot study.
BMC veterinary research    January 28, 2019   Volume 15, Issue 1 43 doi: 10.1186/s12917-019-1792-1
Siwinska N, Michalek M, Zak A, Slowikowska M, Noszczyk-Nowak A, Niedzwiedz A, Paslawska U.Precise understanding of the dimensions of the vascular lumina is essential for accurate interpretation of cardiac vessels imaging. To the authors' best knowledge, this is the first study focusing on the ultrasound measurement of the right coronary artery (RCA) in the horse. The aim of this study was to determine both the ultrasonographic range of the normal diameter and lumen area of the RCA in horses and the influence of gender, age and level of training on the RCA dimensions. An additional aim of the study was to assess intra- and inter-observer repeatability of the collected measurements. ...
Effects of dofetilide and ranolazine on atrial fibrillatory rate in a horse model of acutely induced atrial fibrillation.
Journal of cardiovascular electrophysiology    January 28, 2019   Volume 30, Issue 4 596-606 doi: 10.1111/jce.13849
Carstensen H, Hesselkilde EZ, Haugaard MM, Flethøj M, Carlson J, Pehrson S, Jespersen T, Platonov PG, Buhl R.The atrial fibrillatory rate is a potential biomarker in the study of antiarrhythmic drug effects on atrial fibrillation (AF). The purpose of this study was to evaluate whether dose-dependent changes in the atrial fibrillatory rate can be monitored on surface electrocardiography (ECG) following treatment with dofetilide, ranolazine, and a combination of the two in an acute model of AF in horses. Eight horses were subjected to pacing-induced AF on 4 separate days. Saline (control), dofetilide, ranolazine, or a combination of dofetilide and ranolazine was administered in four incremental doses. ...
No evidence of bovine papillomavirus type 1 or 2 infection in healthy equids.
Equine veterinary journal    January 28, 2019   Volume 51, Issue 5 612-616 doi: 10.1111/evj.13061
Pratscher B, Hainisch EK, Sykora S, Brandt S, Jindra C.There is a large body of evidence supporting bovine papillomavirus types 1 and 2 (BPV1; BPV2) as aetiological agents of equine sarcoids. However, there is conflicting data regarding BPV1/2 infection in sarcoid-free equids. Objective: Data obtained between 2007 and 2017 by BPV1/2 screening of sarcoids and nonsarcoid tumours vs. samples from healthy equids are presented to help clarify this issue. Methods: Cross-sectional study. Methods: Tumour material obtained from horses, donkeys and mules with confirmed sarcoids (n = 130), suspected sarcoids (n = 120), or nonsarcoid lesions (n = 70), s...
Ultrasound-guided injection of the cranial tibial artery for stem cell administration in horses.
Equine veterinary journal    January 28, 2019   Volume 51, Issue 5 681-687 doi: 10.1111/evj.13065
Torrent A, Spriet M, Espinosa-Mur P, Clark KC, Whitcomb MB, Borjesson DL, Galuppo LD.A technique for intra-arterial injection of mesenchymal stem cells (MSC) has been established for front limbs with the use of the median artery. This approach has been proposed for treatment of soft tissue injuries of the equine distal limb. A technique has not been validated yet for hindlimb injection. Objective: To assess the feasibility of injection of the cranial tibial artery in horses, and to evaluate the distribution and persistence of MSC after injection. Methods: In vivo experiment. Methods: In a first phase, the cranial tibial arteries of both hindlimbs of three research horses were ...
Assessing pain in horses.
The Veterinary record    January 27, 2019   Volume 184, Issue 4 124 doi: 10.1136/vr.l385
Gleerup KB.No abstract available
Association of catastrophic condylar fracture with bony changes of the third metacarpal bone identified by use of standing magnetic resonance imaging in forelimbs from cadavers of Thoroughbred racehorses in the United States.
American journal of veterinary research    January 27, 2019   Volume 80, Issue 2 178-188 doi: 10.2460/ajvr.80.2.178
Peloso JG, Cohen ND, Vogler JB, Marquis PA, Hilt L.OBJECTIVE To compare bony changes of the third metacarpal bone (MC3) of Thoroughbred racehorse cadavers with (cases) or without (controls) catastrophic condylar fracture by use of standing MRI. SAMPLE 140 forelimbs from 26 case horses (both forelimbs) and 88 control horses (single forelimb). PROCEDURES Bone marrow lesions (BMLs), identified as a decrease in T1-weighted (T1W) signal and increases in T2*-weighted (T2*W) and short tau inversion recovery (STIR) signals, and dense bone volume percentage (DBVP), identified as decreases in T1W, T2*W, and STIR signals, in the distopalmar aspect of MC3...
Effectiveness of Simulated Horseback Riding for Patients With Chronic Low Back Pain: A Randomized Controlled Trial.
Journal of sport rehabilitation    January 25, 2019   Volume 29, Issue 2 179-185 doi: 10.1123/jsr.2018-0252
Kim T, Lee J, Oh S, Kim S, Yoon B.A simulated horseback riding (SHR) exercise is effective for improvement of pain and functional disability, but its comparative effectiveness with the other is unknown. Objective: The authors aimed to demonstrate the effect of a SHR exercise in people with chronic low back pain. Methods: A randomized controlled trial. Methods: Community and university campus. Methods: A total of 48 participants with chronic low back pain were divided into 2 groups, and SHR exercises (n = 24) or stabilization (STB) exercises (n = 24) were performed. Methods: The exercises were performed for 30 minutes, 2 days p...
The Effect of Core Abdominal Muscle Rehabilitation Exercises on Return to Training and Performance in Horses After Colic Surgery.
Journal of equine veterinary science    January 25, 2019   Volume 75 14-18 doi: 10.1016/j.jevs.2019.01.001
Holcombe SJ, Shearer TR, Valberg SJ.We conducted a retrospective cohort study to test the hypothesis that performing 4 weeks of core abdominal rehabilitation exercises (CARE) postoperatively would be safe and associated with faster return to training and improved performance after colic surgery. Performance horses that recovered from colic surgery performed by the same surgeon and survived ≥ 1 year from 2008 to 2017 were included. Data were obtained from a review of medical records. Information about the horses' rehabilitation and performance was obtained from owners/trainers. Data from horses that completed a 4-week CARE pr...
Effects of body weight gain on insulin and lipid metabolism in equines.
Domestic animal endocrinology    January 24, 2019   Volume 68 111-118 doi: 10.1016/j.domaniend.2019.01.003
Blaue D, Schedlbauer C, Starzonek J, Gittel C, Brehm W, Einspanier A, Vervuert I.The objective of this study was to illuminate the changes in serum NEFA concentrations during a combined glucose-insulin test (CGIT) and basal serum triacylglycerides (TGs) with increasing BW in Shetland ponies and warmblood horses. Therefore, basal blood samples were taken during fasting and a CGIT was performed in 19 healthy equines (10 Shetland ponies, 9 warmblood horses) (t0). After one (t1) and two (t2) year(s) of receiving 200% of their maintenance metabolizable energy requirement, procedures were repeated in the same equines. Sixteen of 19 equines had no signs of insulin dysregulation c...
Use of standard diagnostic techniques to determine eradication of infection in experimental equine septic arthritis. Koziy RV, Yoshimura S, Dickinson R, Rybicka JM, Moshynskyy I, Ngeleka M, Bracamonte JL, Simko E.Septic arthritis is an important disease in horses, necessitating aggressive and prolonged therapy. In order to guide therapy, reliable methods of detecting the eradication of infection are needed. Therefore, the objective of this study was to investigate detection of eradication of infection in an experimental model of equine septic arthritis using standard diagnostic techniques. For this purpose, 17 adult horses were assigned to 3 experimental groups. The middle carpal joint of each horse was injected with (Septic group, = 8), lipopolysaccharide (LPS) (LPS group, = 6), or sterile saline (...
Modelling of oscillatory cortisol response in horses using a Bayesian population approach for evaluation of dexamethasone suppression test protocols.
Journal of pharmacokinetics and pharmacodynamics    January 23, 2019   Volume 46, Issue 1 75-87 doi: 10.1007/s10928-018-09617-0
Held F, Ekstrand C, Cvijovic M, Gabrielsson J, Jirstrand M.Cortisol is a steroid hormone relevant to immune function in horses and other species and shows a circadian rhythm. The glucocorticoid dexamethasone suppresses cortisol in horses. Pituitary pars intermedia dysfunction (PPID) is a disease in which the cortisol suppression mechanism through dexamethasone is challenged. Overnight dexamethasone suppression test (DST) protocols are used to test the functioning of this mechanism and to establish a diagnosis for PPID. However, existing DST protocols have been recognized to perform poorly in previous experimental studies, often indicating presence of ...
Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking.
Journal of veterinary internal medicine    January 22, 2019   Volume 33, Issue 2 923-932 doi: 10.1111/jvim.15410
Sheldon SA, Aleman M, Costa LRR, Santoyo AC, Howey Q, Madigan JE.Trigeminal-mediated headshaking results from low-threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal-mediated headshaking. Objective: To investigate head-shaking behavior in affected horses after IV magnesium sulfate infusion. Methods: Six geldings with trigeminal-mediated headshaking. Methods: Prospective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextros...
Total intravenous anesthesia with alfaxalone, dexmedetomidine and remifentanil in healthy foals undergoing abdominal surgery.
Veterinary anaesthesia and analgesia    January 22, 2019   Volume 46, Issue 3 315-324 doi: 10.1016/j.vaa.2019.01.003
Jones T, Bracamonte JL, Ambros B, Duke-Novakovski T.To evaluate effects of anesthesia induced with alfaxalone and maintained with alfaxalone, dexmedetomidine and remifentanil infusions in foals. Methods: Prospective, experimental study. Methods: A group of six healthy foals [median (range) 11 (8-33) days] undergoing abdominal surgery. Methods: Intravenous (IV) dexmedetomidine (3-7μgkg) provided sedation for insertion of a pulmonary artery catheter. IV anesthesia was induced with alfaxalone (2mgkg) and maintained with alfaxalone (6mgkghour), dexmedetomidine (1μgkghour) and remifentanil (3μgkghour). Foals were endotracheally intubated and lung...
Surgical treatment of epiploic foramen entrapment in 142 horses (2008-2016).
Veterinary surgery : VS    January 21, 2019   Volume 48, Issue 3 291-298 doi: 10.1111/vsu.13161
van Bergen T, Haspeslagh M, Wiemer P, Swagemakers M, van Loon G, Martens A.To report the clinical features, outcomes, and prognostic factors associated with the surgical treatment of epiploic foramen entrapment (EFE). Methods: Retrospective study at a single referral hospital. Methods: Horses (n = 142) undergoing surgery (n = 145) for EFE. Methods: Preoperative, perioperative, and postoperative data of surgeries on horses that underwent exploratory laparotomy for EFE were obtained. The postoperative outcome was assessed by follow-up telephone calls with the owners/caregivers. Factors associated with postoperative reflux (POR), relaparotomy, hospital discharge...
Comparison of three acute colic pain scales: Reliability, validity and usability.
Veterinary journal (London, England : 1997)    January 21, 2019   Volume 246 71-77 doi: 10.1016/j.tvjl.2019.01.004
Sutton GA, Atamna R, Steinman A, Mair TS.A valid, reliable and usable scale is needed for assessing severity of acute abdominal pain in horses. The study aim was to compare three different scales: (1) the equine acute abdominal pain scale (EAAPS); (2) a scale described by Mair and Smith (2005; M and S); and (3) a numerical rating scale (NRS). Forty brief films of horses (35 of colic cases and five of control horses) were randomly presented to 46 equine veterinarians from different countries. Participants, randomly divided into three groups, each used one scale. Five randomly selected films were shown twice for determining intra-obser...
Left paralumbar fossa approach combined with mesocolon fenestration for bilateral equine ovariectomy.
Veterinary surgery : VS    January 20, 2019   Volume 48, Issue 5 735-741 doi: 10.1111/vsu.13166
Devick IF, Hendrickson DA.To describe a standing left paralumbar fossa approach combined with mesocolon fenestration for bilateral equine ovariectomy. Methods: Prospective experimental clinical study. Methods: Four healthy client-owned mares and 1 client-owned Molly mule. Methods: Mares were restrained in standing stocks and sedated with an α -agonist continuous infusion to effect. The abdominal cavity was approached via a left paralumbar fossa approach, and the contralateral right ovary was accessed through an incision in the mesocolon. The location of the window was adjusted to allow triangulation, adequate visualiz...