{"corpus": "blind2", "id": "h001", "kind": "dictation", "category": "discharge instructions", "ref": "So what we're sending home today is Apoquel, that's oclacitinib, one 16 mg tablet PO BID for the itching, give it with food for the first few days. Skin should look better within a week. Call if diarrhea returns or he seems more tired than usual.", "spoken": "So what we're sending home today is Apoquel, that's oclacitinib, one sixteen milligram tablet by mouth twice daily for the itching, give it with food for the first few days. Skin should look better within a week. Call if diarrhea returns or he seems more tired than usual.", "drugs": ["Apoquel", "oclacitinib"], "trap": ""}
{"corpus": "blind2", "id": "h002", "kind": "dictation", "category": "discharge instructions", "ref": "We're going to start Rex on Rimadyl, that's carprofen, 75 mg PO SID with food for his hip pain. No human ibuprofen or Tylenol on top of it, that combination can really hurt his stomach and kidneys. Keep him on leash walks only for two weeks. He's back in three weeks to recheck how he's moving.", "spoken": "We're going to start Rex on Rimadyl, that's carprofen, seventy five milligrams by mouth once daily with food for his hip pain. No human ibuprofen or Tylenol on top of it, that combination can really hurt his stomach and kidneys. Keep him on leash walks only for two weeks. He's back in three weeks to recheck how he's moving.", "drugs": ["Rimadyl", "carprofen"], "trap": ""}
{"corpus": "blind2", "id": "h003", "kind": "dictation", "category": "discharge instructions", "ref": "Make sure Bella finishes the whole course of Convenia, we already gave the injection here today so you don't need to give anything by mouth for that. What you will need to give at home are the gabapentin chews for anxiety before car rides, half a chew about two hours before you leave. I'll say it again, the gabapentin is only for travel days, not every day.", "spoken": "Make sure Bella finishes the whole course of Convenia, we already gave the injection here today so you don't need to give anything by mouth for that. What you will need to give at home are the gabapentin chews for anxiety before car rides, half a chew about two hours before you leave. I'll say it again, the gabapentin is only for travel days, not every day.", "drugs": ["Convenia", "gabapentin"], "trap": ""}
{"corpus": "blind2", "id": "h004", "kind": "dictation", "category": "discharge instructions", "ref": "Give the famotidine 10 mg PO SID and the metronidazole 250 mg PO BID together with breakfast and dinner until the diarrhea clears up, and use the chlorhexidine drops in his ear once a day for the next ten days. Recheck the ear in two weeks if it's still red or itchy at all.", "spoken": "Give the famotidine ten milligrams by mouth once daily and the metronidazole two hundred fifty milligrams by mouth twice daily together with breakfast and dinner until the diarrhea clears up, and use the chlorhexidine drops in his ear once a day for the next ten days. Recheck the ear in two weeks if it's still red or itchy at all.", "drugs": ["famotidine", "metronidazole", "chlorhexidine"], "trap": ""}
{"corpus": "blind2", "id": "h005", "kind": "dictation", "category": "discharge instructions", "ref": "Her owner decided against the Bravecto chew this visit, we'll revisit flea prevention next time, but we did send her home on doxycycline 5 mg/kg PO BID for two weeks for the tick-borne infection. Stop the doxycycline early if she starts vomiting and call us right away.", "spoken": "Her owner decided against the Bravecto chew this visit, we'll revisit flea prevention next time, but we did send her home on doxycycline five milligrams per kilogram by mouth twice daily for two weeks for the tick-borne infection. Stop the doxycycline early if she starts vomiting and call us right away.", "drugs": ["Bravecto", "doxycycline"], "trap": ""}
{"corpus": "blind2", "id": "h006", "kind": "dictation", "category": "referral letter", "ref": "Dear Dr. Alvarez, thank you for referring Max, a 9 year old male neutered Boxer, for evaluation of his heart murmur. Echocardiogram confirmed stage B2 degenerative mitral valve disease. I've started him on Vetmedin, that's pimobendan, 5 mg PO BID, along with enalapril 2.5 mg PO BID. Please continue to monitor his respiratory rate at home and recheck in three months.", "spoken": "Dear Doctor Alvarez, thank you for referring Max, a nine year old male neutered Boxer, for evaluation of his heart murmur. Echocardiogram confirmed stage B two degenerative mitral valve disease. I've started him on Vetmedin, that's pimobendan, five milligrams by mouth twice daily, along with enalapril two point five milligrams by mouth twice daily. Please continue to monitor his respiratory rate at home and recheck in three months.", "drugs": ["Vetmedin", "pimobendan", "enalapril"], "trap": ""}
{"corpus": "blind2", "id": "h007", "kind": "dictation", "category": "referral letter", "ref": "Dear Dr. Nguyen, I saw Daisy, your 6 year old spayed female Cavalier, for chronic vomiting. We started maropitant, brand name Cerenia, 2 mg/kg SQ once daily for three days, then sent her home on Cerenia tablets, and added omeprazole 1 mg/kg PO SID. Abdominal ultrasound was unremarkable. I'd suggest a food trial before we consider further workup.", "spoken": "Dear Doctor Nguyen, I saw Daisy, your six year old spayed female Cavalier, for chronic vomiting. We started maropitant, brand name Cerenia, two milligrams per kilogram under the skin once daily for three days, then sent her home on Cerenia tablets, and added omeprazole one milligram per kilogram by mouth once daily. Abdominal ultrasound was unremarkable. I'd suggest a food trial before we consider further workup.", "drugs": ["maropitant", "Cerenia", "omeprazole"], "trap": ""}
{"corpus": "blind2", "id": "h008", "kind": "dictation", "category": "referral letter", "ref": "Dear Dr. Osei, thank you for seeing Winston, a 10 year old male neutered Lab. As background, he was on prednisolone last year for a suspected immune-mediated anemia, tapered off successfully by August. He's now presenting with new onset seizures. We started levetiracetam 20 mg/kg PO TID pending your workup, and phenobarbital was discussed but held for now given his liver values.", "spoken": "Dear Doctor Osei, thank you for seeing Winston, a ten year old male neutered Lab. As background, he was on prednisolone last year for a suspected immune-mediated anemia, tapered off successfully by August. He's now presenting with new onset seizures. We started levetiracetam twenty milligrams per kilogram by mouth three times daily pending your workup, and phenobarbital was discussed but held for now given his liver values.", "drugs": ["prednisolone", "levetiracetam", "phenobarbital"], "trap": ""}
{"corpus": "blind2", "id": "h009", "kind": "dictation", "category": "referral letter", "ref": "Dear Dr. Kessler, I'm referring Duke, a 4 year old Rottweiler, for a torn cranial cruciate ligament. He's currently managed on Galliprant for comfort and we've had him on Adequan injections as well, both seem to be helping some, but he's still quite lame on the right hind. I think he's a good surgical candidate given his age and activity level.", "spoken": "Dear Doctor Kessler, I'm referring Duke, a four year old Rottweiler, for a torn cranial cruciate ligament. He's currently managed on Galliprant for comfort and we've had him on Adequan injections as well, both seem to be helping some, but he's still quite lame on the right hind. I think he's a good surgical candidate given his age and activity level.", "drugs": ["Galliprant", "Adequan"], "trap": ""}
{"corpus": "blind2", "id": "h010", "kind": "dictation", "category": "referral letter", "ref": "Dear Dr. Farrow, following up on Milo's cluster seizures, I increased his levetiracetam to 30 mg/kg PO TID last week; if the levetiracetam dose increase doesn't control things within two weeks I'd like your opinion on adding a second anticonvulsant. He tolerated the levetiracetam increase well with no sedation noted.", "spoken": "Dear Doctor Farrow, following up on Milo's cluster seizures, I increased his levetiracetam to thirty milligrams per kilogram by mouth three times daily last week; if the levetiracetam dose increase doesn't control things within two weeks I'd like your opinion on adding a second anticonvulsant. He tolerated the levetiracetam increase well with no sedation noted.", "drugs": ["levetiracetam"], "trap": ""}
{"corpus": "blind2", "id": "h011", "kind": "dictation", "category": "technician treatment sheet", "ref": "0800, gave Baytril, that's enrofloxacin, 68 mg PO SID with breakfast, patient ate the full meal without hesitation. 1200, walked patient around the back lot, urinated a normal amount, gait looked comfortable. 1600, rechecked the incision, clean and dry with no discharge noted. 2000, gave second dose of famotidine 10 mg PO before lights out.", "spoken": "Oh eight hundred, gave Baytril, that's enrofloxacin, sixty eight milligrams by mouth once daily with breakfast, patient ate the full meal without hesitation. Twelve hundred, walked patient around the back lot, urinated a normal amount, gait looked comfortable. Sixteen hundred, rechecked the incision, clean and dry with no discharge noted. Twenty hundred, gave second dose of famotidine ten milligrams by mouth before lights out.", "drugs": ["Baytril", "enrofloxacin", "famotidine"], "trap": ""}
{"corpus": "blind2", "id": "h012", "kind": "dictation", "category": "technician treatment sheet", "ref": "0700, premed patient with dexmedetomidine and butorphanol IM per protocol, tolerated the injection well with no vocalization. 0900, patient recovering well in the padded kennel, given buprenorphine injection for pain once fully extubated. 1100, ambulatory and steady on her feet, offered water, drank a small amount and seemed interested in more.", "spoken": "Oh seven hundred, premed patient with dexmedetomidine and butorphanol I M per protocol, tolerated the injection well with no vocalization. Oh nine hundred, patient recovering well in the padded kennel, given buprenorphine injection for pain once fully extubated. Eleven hundred, ambulatory and steady on her feet, offered water, drank a small amount and seemed interested in more.", "drugs": ["dexmedetomidine", "butorphanol", "buprenorphine"], "trap": ""}
{"corpus": "blind2", "id": "h013", "kind": "dictation", "category": "technician treatment sheet", "ref": "0800, bathed patient with chlorhexidine shampoo per derm protocol, towel dried and placed in clean run. 1200, gave cephalexin 500 mg PO with a small meatball of canned food, ate it right away. 1800, skin looks less red than this morning, rechecked with Dr. Patel.", "spoken": "Oh eight hundred, bathed patient with chlorhexidine shampoo per derm protocol, towel dried and placed in clean run. Twelve hundred, gave cephalexin five hundred milligrams by mouth with a small meatball of canned food, ate it right away. Eighteen hundred, skin looks less red than this morning, rechecked with Doctor Patel.", "drugs": ["chlorhexidine", "cephalexin"], "trap": ""}
{"corpus": "blind2", "id": "h014", "kind": "dictation", "category": "technician treatment sheet", "ref": "1400, applied Malaseb medicated shampoo to affected areas, left on for ten minutes then rinsed thoroughly per label, this is the second Malaseb bath this week and her coat already looks a bit better. 1700, ears cleaned, no odor present. Owner instructed at pickup to continue Malaseb twice weekly at home for another month.", "spoken": "Fourteen hundred, applied Malaseb medicated shampoo to affected areas, left on for ten minutes then rinsed thoroughly per label, this is the second Malaseb bath this week and her coat already looks a bit better. Seventeen hundred, ears cleaned, no odor present. Owner instructed at pickup to continue Malaseb twice weekly at home for another month.", "drugs": ["Malaseb"], "trap": ""}
{"corpus": "blind2", "id": "h015", "kind": "dictation", "category": "technician treatment sheet", "ref": "0700, blood glucose checked at 210, gave Vetsulin 8 units SQ per order in the scruff. 1100, blood glucose down to 165, patient resting comfortably. 1500, blood glucose 140, patient bright and alert, eating well from her bowl. 1900, blood glucose back up to 190, gave second Vetsulin dose of 8 units SQ before overnight.", "spoken": "Oh seven hundred, blood glucose checked at two hundred ten, gave Vetsulin eight units under the skin per order in the scruff. Eleven hundred, blood glucose down to one hundred sixty five, patient resting comfortably. Fifteen hundred, blood glucose one hundred forty, patient bright and alert, eating well from her bowl. Nineteen hundred, blood glucose back up to one hundred ninety, gave second Vetsulin dose of eight units under the skin before overnight.", "drugs": ["Vetsulin"], "trap": ""}
{"corpus": "blind2", "id": "h016", "kind": "dictation", "category": "phone triage", "ref": "Hi, this is Dr. Reyes returning your call about Coco. It's normal for stool to be a little soft the first day or two on Clavamox, that's amoxicillin-clavulanate, but if she starts vomiting or refuses food, bring her back in. Otherwise finish out the full ten days even if she looks better sooner.", "spoken": "Hi, this is Doctor Reyes returning your call about Coco. It's normal for stool to be a little soft the first day or two on Clavamox, that's amoxicillin-clavulanate, but if she starts vomiting or refuses food, bring her back in. Otherwise finish out the full ten days even if she looks better sooner.", "drugs": ["Clavamox", "amoxicillin-clavulanate"], "trap": ""}
{"corpus": "blind2", "id": "h017", "kind": "dictation", "category": "phone triage", "ref": "So it sounds like the trazodone isn't calming him down enough for the fireworks tonight, I don't want you doubling the dose on your own. Come by before five and we can send you home with something stronger, or we could try adding gabapentin alongside it next time instead.", "spoken": "So it sounds like the trazodone isn't calming him down enough for the fireworks tonight, I don't want you doubling the dose on your own. Come by before five and we can send you home with something stronger, or we could try adding gabapentin alongside it next time instead.", "drugs": ["trazodone", "gabapentin"], "trap": ""}
{"corpus": "blind2", "id": "h018", "kind": "dictation", "category": "phone triage", "ref": "The ondansetron should kick in within the hour and help settle her stomach, if she's still retching by dinnertime give me a call back and we'll have you come in tonight. In the meantime just offer small sips of water, nothing else until tomorrow morning, and try to keep her calm and resting.", "spoken": "The ondansetron should kick in within the hour and help settle her stomach, if she's still retching by dinnertime give me a call back and we'll have you come in tonight. In the meantime just offer small sips of water, nothing else until tomorrow morning, and try to keep her calm and resting.", "drugs": ["ondansetron"], "trap": ""}
{"corpus": "blind2", "id": "h019", "kind": "dictation", "category": "phone triage", "ref": "Go ahead and give him the meloxicam 0.1 mg/kg once today only, then switch tomorrow to the gabapentin 10 mg/kg every eight hours for the pain, and skip the meloxicam entirely after today since we don't want to stack it with anything else, especially not on an empty stomach.", "spoken": "Go ahead and give him the meloxicam zero point one milligrams per kilogram once today only, then switch tomorrow to the gabapentin ten milligrams per kilogram every eight hours for the pain, and skip the meloxicam entirely after today since we don't want to stack it with anything else, especially not on an empty stomach.", "drugs": ["meloxicam", "gabapentin"], "trap": ""}
{"corpus": "blind2", "id": "h020", "kind": "dictation", "category": "phone triage", "ref": "You can absolutely switch him from the topical to Credelio, it's a monthly chew instead of the drops, a lot of clients like that better for bath schedules and it won't wash off if he goes swimming. Just don't give both products in the same month, pick one and stick with it consistently.", "spoken": "You can absolutely switch him from the topical to Credelio, it's a monthly chew instead of the drops, a lot of clients like that better for bath schedules and it won't wash off if he goes swimming. Just don't give both products in the same month, pick one and stick with it consistently.", "drugs": ["Credelio"], "trap": ""}
{"corpus": "blind2", "id": "h021", "kind": "dictation", "category": "euthanasia/hospice discussion", "ref": "I know this is such a hard decision to sit with. The Librela injections have kept her comfortable for the pain, but I'm not seeing improvement in her appetite or her willingness to get up anymore, and that tells me her quality of life is really declining. Whenever you're ready, we're here to help you and her through this gently.", "spoken": "I know this is such a hard decision to sit with. The Librela injections have kept her comfortable for the pain, but I'm not seeing improvement in her appetite or her willingness to get up anymore, and that tells me her quality of life is really declining. Whenever you're ready, we're here to help you and her through this gently.", "drugs": ["Librela"], "trap": ""}
{"corpus": "blind2", "id": "h022", "kind": "dictation", "category": "euthanasia/hospice discussion", "ref": "We're going to start with a sedative injection, dexmedetomidine and butorphanol together, so she drifts off peacefully first and won't feel anything else after that. It usually takes about five to ten minutes to take full effect, and you're welcome to stay right here with her the whole time.", "spoken": "We're going to start with a sedative injection, dexmedetomidine and butorphanol together, so she drifts off peacefully first and won't feel anything else after that. It usually takes about five to ten minutes to take full effect, and you're welcome to stay right here with her the whole time.", "drugs": ["dexmedetomidine", "butorphanol"], "trap": ""}
{"corpus": "blind2", "id": "h023", "kind": "dictation", "category": "euthanasia/hospice discussion", "ref": "She was on Rimadyl for about a year and it worked really well until this spring, but her kidney values started climbing so we had to stop it, and honestly since then nothing we've tried has given her the same relief. That's part of why we're having this conversation today.", "spoken": "She was on Rimadyl for about a year and it worked really well until this spring, but her kidney values started climbing so we had to stop it, and honestly since then nothing we've tried has given her the same relief. That's part of why we're having this conversation today.", "drugs": ["Rimadyl"], "trap": ""}
{"corpus": "blind2", "id": "h024", "kind": "dictation", "category": "euthanasia/hospice discussion", "ref": "I know the Cytopoint injections helped so much with his itching over the years, he really was comfortable in his skin because of that, but the cancer is a different problem entirely and it's progressing faster than we'd hoped. I want to talk with you honestly about what the next few weeks might look like for him.", "spoken": "I know the Cytopoint injections helped so much with his itching over the years, he really was comfortable in his skin because of that, but the cancer is a different problem entirely and it's progressing faster than we'd hoped. I want to talk with you honestly about what the next few weeks might look like for him.", "drugs": ["Cytopoint"], "trap": ""}
{"corpus": "blind2", "id": "h025", "kind": "dictation", "category": "euthanasia/hospice discussion", "ref": "We tried increasing the phenobarbital twice now and her seizures are still breaking through every few days, her liver panel this week was worse than last month's, so I don't think pushing the dose any higher is fair to her anymore. I think it's time we talk about comfort care instead of more medication changes.", "spoken": "We tried increasing the phenobarbital twice now and her seizures are still breaking through every few days, her liver panel this week was worse than last month's, so I don't think pushing the dose any higher is fair to her anymore. I think it's time we talk about comfort care instead of more medication changes.", "drugs": ["phenobarbital"], "trap": ""}
{"corpus": "blind2", "id": "h026", "kind": "dictation", "category": "anesthesia record", "ref": "Premed: dexmedetomidine 5 mcg/kg and butorphanol 0.2 mg/kg given IM at 0715 in the left epaxial muscle, patient settled within fifteen minutes with only minimal resistance to handling, respiratory rate and heart rate both trending down nicely before we moved her to the induction area for catheter placement.", "spoken": "Premed: dexmedetomidine five micrograms per kilogram and butorphanol zero point two milligrams per kilogram given I M at oh seven fifteen in the left epaxial muscle, patient settled within fifteen minutes with only minimal resistance to handling, respiratory rate and heart rate both trending down nicely before we moved her to the induction area for catheter placement.", "drugs": ["dexmedetomidine", "butorphanol"], "trap": ""}
{"corpus": "blind2", "id": "h027", "kind": "dictation", "category": "anesthesia record", "ref": "Induction: ketamine 5 mg/kg IV given slowly over about thirty seconds at 0730 once the catheter was secured, patient lost her palpebral reflex quickly and was intubated without difficulty on the first pass, then maintained on isoflurane at two percent for the remainder of the dental cleaning.", "spoken": "Induction: ketamine five milligrams per kilogram I V given slowly over about thirty seconds at oh seven thirty once the catheter was secured, patient lost her palpebral reflex quickly and was intubated without difficulty on the first pass, then maintained on isoflurane at two percent for the remainder of the dental cleaning.", "drugs": ["ketamine", "isoflurane"], "trap": ""}
{"corpus": "blind2", "id": "h028", "kind": "dictation", "category": "anesthesia record", "ref": "Maintenance: isoflurane adjusted between one and a half and two percent throughout the roughly sixty minute procedure depending on jaw tone and eye position, heart rate and oxygen saturation stayed stable the entire time, capnography never dropped below normal range, and no additional analgesia was needed intraoperatively beyond what was given at premed.", "spoken": "Maintenance: isoflurane adjusted between one and a half and two percent throughout the roughly sixty minute procedure depending on jaw tone and eye position, heart rate and oxygen saturation stayed stable the entire time, capnography never dropped below normal range, and no additional analgesia was needed intraoperatively beyond what was given at premed.", "drugs": ["isoflurane"], "trap": ""}
{"corpus": "blind2", "id": "h029", "kind": "dictation", "category": "anesthesia record", "ref": "Recovery: extubated at 0845 once her swallowing reflex returned and she was chewing lightly on the tube, given buprenorphine 0.02 mg/kg IV for post-op pain at 0850 before moving her to a padded recovery kennel, and by 0915 she was resting comfortably sternal with a normal temperature and steady breathing.", "spoken": "Recovery: extubated at oh eight forty five once her swallowing reflex returned and she was chewing lightly on the tube, given buprenorphine zero point zero two milligrams per kilogram I V for post-op pain at oh eight fifty before moving her to a padded recovery kennel, and by oh nine fifteen she was resting comfortably sternal with a normal temperature and steady breathing.", "drugs": ["buprenorphine"], "trap": ""}
{"corpus": "blind2", "id": "h030", "kind": "dictation", "category": "anesthesia record", "ref": "Post-op pain control for this one: we started her on Simbadol, that's buprenorphine, 0.24 mg/kg SQ given once at discharge from anesthesia, and this long-acting formulation should carry her comfortably through the next twenty-four hours without needing any additional injections from you overnight or first thing tomorrow morning.", "spoken": "Post-op pain control for this one: we started her on Simbadol, that's buprenorphine, zero point two four milligrams per kilogram under the skin given once at discharge from anesthesia, and this long-acting formulation should carry her comfortably through the next twenty four hours without needing any additional injections from you overnight or first thing tomorrow morning.", "drugs": ["Simbadol", "buprenorphine"], "trap": ""}
{"corpus": "blind2", "id": "h031", "kind": "dictation", "category": "feline case", "ref": "Whiskers' total T4 came back elevated again at his recheck, so we're bumping his methimazole from 2.5 mg PO BID up to 5 mg PO BID starting today. Keep an eye on his appetite and energy over the next month, and we'll recheck his thyroid level and kidney values again in four weeks before we talk about anything more permanent.", "spoken": "Whiskers' total T four came back elevated again at his recheck, so we're bumping his methimazole from two point five milligrams by mouth twice daily up to five milligrams by mouth twice daily starting today. Keep an eye on his appetite and energy over the next month, and we'll recheck his thyroid level and kidney values again in four weeks before we talk about anything more permanent.", "drugs": ["methimazole"], "trap": ""}
{"corpus": "blind2", "id": "h032", "kind": "dictation", "category": "feline case", "ref": "Her kidney values have crept up again on this recheck, so along with the prescription renal food I want to start her on Cerenia, that's maropitant, 1 mg/kg SQ once daily for the nausea, plus famotidine 5 mg PO SID for stomach comfort. We'll plan to see her back in six weeks unless she stops eating or seems nauseous sooner than that, in which case call us right away.", "spoken": "Her kidney values have crept up again on this recheck, so along with the prescription renal food I want to start her on Cerenia, that's maropitant, one milligram per kilogram under the skin once daily for the nausea, plus famotidine five milligrams by mouth once daily for stomach comfort. We'll plan to see her back in six weeks unless she stops eating or seems nauseous sooner than that, in which case call us right away.", "drugs": ["Cerenia", "maropitant", "famotidine"], "trap": ""}
{"corpus": "blind2", "id": "h033", "kind": "dictation", "category": "feline case", "ref": "We're going to switch him to Vetsulin injections, 2 units SQ BID with meals, starting tonight, and I want you tracking his water intake and weight weekly on the chart we gave you. If he ever seems wobbly or disoriented, offer him a small amount of corn syrup on his gums and call us immediately.", "spoken": "We're going to switch him to Vetsulin injections, two units under the skin twice daily with meals, starting tonight, and I want you tracking his water intake and weight weekly on the chart we gave you. If he ever seems wobbly or disoriented, offer him a small amount of corn syrup on his gums and call us immediately.", "drugs": ["Vetsulin"], "trap": ""}
{"corpus": "blind2", "id": "h034", "kind": "dictation", "category": "feline case", "ref": "Based on the chest X-rays and how hard she's been breathing, I think we're dealing with feline asthma, so we're going to start her on prednisolone 5 mg PO SID for the next week, then we'll taper it down slowly. If she has another open-mouth breathing episode at home, that's an emergency and you need to bring her in right away.", "spoken": "Based on the chest X-rays and how hard she's been breathing, I think we're dealing with feline asthma, so we're going to start her on prednisolone five milligrams by mouth once daily for the next week, then we'll taper it down slowly. If she has another open-mouth breathing episode at home, that's an emergency and you need to bring her in right away.", "drugs": ["prednisolone"], "trap": ""}
{"corpus": "blind2", "id": "h035", "kind": "dictation", "category": "feline case", "ref": "This is actually the second time this year he's blocked, and last time we managed him with buprenorphine for the pain and he did fine after the catheter came out, but with two episodes now I really think we need to talk seriously about a perineal urethrostomy before this happens a third time.", "spoken": "This is actually the second time this year he's blocked, and last time we managed him with buprenorphine for the pain and he did fine after the catheter came out, but with two episodes now I really think we need to talk seriously about a perineal urethrostomy before this happens a third time.", "drugs": ["buprenorphine"], "trap": ""}
{"corpus": "blind2", "id": "h036", "kind": "dictation", "category": "second opinion", "ref": "So before you saw her, the other clinic apparently had her on Rimadyl for about two months, but her owner tells me it never really touched the limping and they eventually stopped it on their own without telling anyone. Looking at her now, I actually think we're dealing with a partial cruciate tear rather than pure arthritis, which would explain why the carprofen alone wasn't cutting it.", "spoken": "So before you saw her, the other clinic apparently had her on Rimadyl for about two months, but her owner tells me it never really touched the limping and they eventually stopped it on their own without telling anyone. Looking at her now, I actually think we're dealing with a partial cruciate tear rather than pure arthritis, which would explain why the carprofen alone wasn't cutting it.", "drugs": ["Rimadyl", "carprofen"], "trap": ""}
{"corpus": "blind2", "id": "h037", "kind": "dictation", "category": "second opinion", "ref": "I hear you, and I'm sorry the Apoquel didn't seem to help much before you came to us. Looking at her skin today, I actually think Cytopoint might work better for her long term since it's a monthly injection instead of a daily pill, and some cats and dogs respond to one better than the other for reasons we don't fully understand.", "spoken": "I hear you, and I'm sorry the Apoquel didn't seem to help much before you came to us. Looking at her skin today, I actually think Cytopoint might work better for her long term since it's a monthly injection instead of a daily pill, and some cats and dogs respond to one better than the other for reasons we don't fully understand.", "drugs": ["Apoquel", "Cytopoint"], "trap": ""}
{"corpus": "blind2", "id": "h038", "kind": "dictation", "category": "second opinion", "ref": "Reading through the records you brought in, it looks like she was started on phenobarbital 3 mg/kg PO BID back in March, but then it was discontinued in May after her bloodwork showed liver enzymes climbing pretty fast. Given that history, I'd actually lean toward levetiracetam this time since it's generally much easier on the liver long term.", "spoken": "Reading through the records you brought in, it looks like she was started on phenobarbital three milligrams per kilogram by mouth twice daily back in March, but then it was discontinued in May after her bloodwork showed liver enzymes climbing pretty fast. Given that history, I'd actually lean toward levetiracetam this time since it's generally much easier on the liver long term.", "drugs": ["phenobarbital", "levetiracetam"], "trap": ""}
{"corpus": "blind2", "id": "h039", "kind": "dictation", "category": "second opinion", "ref": "Honestly, I don't blame you for wanting a second set of eyes on this. The metronidazole and the probiotic paste your last vet sent home clearly weren't enough here, her stool's still soft and she's lost weight since then, so I want to run a full GI panel before we just guess at another medication.", "spoken": "Honestly, I don't blame you for wanting a second set of eyes on this. The metronidazole and the probiotic paste your last vet sent home clearly weren't enough here, her stool's still soft and she's lost weight since then, so I want to run a full G I panel before we just guess at another medication.", "drugs": ["metronidazole"], "trap": ""}
{"corpus": "blind2", "id": "h040", "kind": "dictation", "category": "second opinion", "ref": "It looks like your last vet had her on enalapril 1.25 mg PO BID and furosemide 12.5 mg PO BID for the heart failure diagnosis last winter, and honestly that's a very reasonable starting protocol, I just want to get updated chest X-rays and bloodwork today before deciding whether we need to adjust either dose going forward.", "spoken": "It looks like your last vet had her on enalapril one point two five milligrams by mouth twice daily and furosemide twelve point five milligrams by mouth twice daily for the heart failure diagnosis last winter, and honestly that's a very reasonable starting protocol, I just want to get updated chest X-rays and bloodwork today before deciding whether we need to adjust either dose going forward.", "drugs": ["enalapril", "furosemide"], "trap": ""}
{"corpus": "blind2", "id": "h041", "kind": "dictation", "category": "wellness/parasite conversation", "ref": "Since he's still a puppy and was born outside, we like to send everybody home with Panacur, that's fenbendazole, it's just a liquid you mix with his food for three days in a row, super easy, no big deal. Puppies almost always pick up some worms from mom, so this is really routine and nothing to stress about.", "spoken": "Since he's still a puppy and was born outside, we like to send everybody home with Panacur, that's fenbendazole, it's just a liquid you mix with his food for three days in a row, super easy, no big deal. Puppies almost always pick up some worms from mom, so this is really routine and nothing to stress about.", "drugs": ["Panacur", "fenbendazole"], "trap": ""}
{"corpus": "blind2", "id": "h042", "kind": "dictation", "category": "wellness/parasite conversation", "ref": "For heartworm prevention you've basically got two good options, you can do the Heartgard chew every month, which is easy if you remember to give it, or we can just do the ProHeart shot once a year and then you don't have to think about it at all. A lot of my clients like the shot honestly, one less thing to remember.", "spoken": "For heartworm prevention you've basically got two good options, you can do the Heartgard chew every month, which is easy if you remember to give it, or we can just do the ProHeart shot once a year and then you don't have to think about it at all. A lot of my clients like the shot honestly, one less thing to remember.", "drugs": ["Heartgard", "ProHeart"], "trap": ""}
{"corpus": "blind2", "id": "h043", "kind": "dictation", "category": "wellness/parasite conversation", "ref": "Simparica Trio covers you for fleas, ticks, and heartworm all in one monthly chew, so instead of juggling three different products you're just giving one thing on the same day every month, which honestly most people find way easier to remember. It's got a mild beef flavor so most dogs think it's a treat.", "spoken": "Simparica Trio covers you for fleas, ticks, and heartworm all in one monthly chew, so instead of juggling three different products you're just giving one thing on the same day every month, which honestly most people find way easier to remember. It's got a mild beef flavor so most dogs think it's a treat.", "drugs": ["Simparica Trio"], "trap": ""}
{"corpus": "blind2", "id": "h044", "kind": "dictation", "category": "wellness/parasite conversation", "ref": "She's been on ivermectin for heartworm prevention for years and we'll keep that going, but I noticed she's not wearing any tick prevention right now, so let's talk about adding a Seresto collar since it lasts eight months and you won't have to remember monthly doses at all.", "spoken": "She's been on ivermectin for heartworm prevention for years and we'll keep that going, but I noticed she's not wearing any tick prevention right now, so let's talk about adding a Seresto collar since it lasts eight months and you won't have to remember monthly doses at all.", "drugs": ["ivermectin", "Seresto"], "trap": ""}
{"corpus": "blind2", "id": "h045", "kind": "dictation", "category": "wellness/parasite conversation", "ref": "Since he's an outdoor cat who hunts, I really do recommend deworming him with something that covers tapeworms too, praziquantel handles that part, and we usually pair it with pyrantel for the roundworms, so praziquantel plus pyrantel together covers just about everything a hunting cat picks up.", "spoken": "Since he's an outdoor cat who hunts, I really do recommend deworming him with something that covers tapeworms too, praziquantel handles that part, and we usually pair it with pyrantel for the roundworms, so praziquantel plus pyrantel together covers just about everything a hunting cat picks up.", "drugs": ["praziquantel", "pyrantel"], "trap": ""}
{"corpus": "blind2", "id": "h046", "kind": "trap", "category": "wellness chat", "ref": "Our clinic nurses have really been on the front line this flu season, we've been slammed. Anyway, for Buddy today, his heart rate was completely normal on exam, and honestly his weight and energy level looked adequate for his age, nothing concerning to report at this visit.", "spoken": "Our clinic nurses have really been on the front line this flu season, we've been slammed. Anyway, for Buddy today, his heart rate was completely normal on exam, and honestly his weight and energy level looked adequate for his age, nothing concerning to report at this visit.", "drugs": [], "trap": "front line, heart rate, and adequate are ordinary English words here, not the products Frontline, Heartgard/ProHeart, or Adequan"}
{"corpus": "blind2", "id": "h047", "kind": "trap", "category": "front desk chat", "ref": "An afternoon appointment is way more convenient for us with the kids' school schedule. He seemed pretty serene in the waiting room today actually, didn't pace at all. We tried to entice him with a treat for the nail trim and he took it right from my hand, no fuss.", "spoken": "An afternoon appointment is way more convenient for us with the kids' school schedule. He seemed pretty serene in the waiting room today actually, didn't pace at all. We tried to entice him with a treat for the nail trim and he took it right from my hand, no fuss.", "drugs": [], "trap": "convenient, serene, and entice are ordinary words here, not the products Convenia, Cerenia, or Entyce"}
{"corpus": "blind2", "id": "h048", "kind": "trap", "category": "small talk", "ref": "There's honestly been a whole revolution in how vaccine protocols get written over the last ten years, way more individualized now. Her husband works as some kind of interceptor technician for a defense contractor, kept telling me about radar systems the whole time I examined the cat.", "spoken": "There's honestly been a whole revolution in how vaccine protocols get written over the last ten years, way more individualized now. Her husband works as some kind of interceptor technician for a defense contractor, kept telling me about radar systems the whole time I examined the cat.", "drugs": [], "trap": "revolution and interceptor are used as ordinary lowercase words here, not the products Revolution or Interceptor"}
{"corpus": "blind2", "id": "h049", "kind": "trap", "category": "exam note", "ref": "On auscultation the apical pulse was strong and synchronous with the femoral pulse, no deficit noted. We'll plan a gradual increase in his exercise over the next month rather than jumping straight back into agility. Blood draw today was from the cephalic vein and he barely flinched, what a good boy.", "spoken": "On auscultation the apical pulse was strong and synchronous with the femoral pulse, no deficit noted. We'll plan a gradual increase in his exercise over the next month rather than jumping straight back into agility. Blood draw today was from the cephalic vein and he barely flinched, what a good boy.", "drugs": [], "trap": "apical, gradual, and cephalic are ordinary exam and anatomy terms here, not drug names"}
{"corpus": "blind2", "id": "h050", "kind": "trap", "category": "exam note", "ref": "X-rays confirmed there's no clavicle fracture, just soft tissue bruising from the fall. Given his history of pancreatitis two years ago we're keeping this diet strictly low fat going forward. Her skin looks pretty atopic to me on exam today, lots of redness between the toes and around the ears.", "spoken": "X-rays confirmed there's no clavicle fracture, just soft tissue bruising from the fall. Given his history of pancreatitis two years ago we're keeping this diet strictly low fat going forward. Her skin looks pretty atopic to me on exam today, lots of redness between the toes and around the ears.", "drugs": [], "trap": "clavicle, pancreatitis, and atopic are ordinary medical terms here, not the product Clavamox or Atopica"}
{"corpus": "blind2", "id": "h051", "kind": "trap", "category": "surgical note", "ref": "We used a fairly liberal amount of antiseptic scrub before the surgery given how dirty the wound was. Her symptoms today are actually pretty similar to what we saw back in March, same lethargy and same reduced appetite, so we'll run the same bloodwork panel again.", "spoken": "We used a fairly liberal amount of antiseptic scrub before the surgery given how dirty the wound was. Her symptoms today are actually pretty similar to what we saw back in March, same lethargy and same reduced appetite, so we'll run the same bloodwork panel again.", "drugs": [], "trap": "liberal and similar are ordinary words here, not the product Librela"}
{"corpus": "blind2", "id": "h052", "kind": "trap", "category": "front desk chat", "ref": "The owner mentioned during checkout that she actually needs a night guard herself for teeth grinding, funny coincidence given why she was here. Also, can someone swap the sim card in the front desk loaner phone, it keeps dropping calls and a client complained about it yesterday.", "spoken": "The owner mentioned during checkout that she actually needs a night guard herself for teeth grinding, funny coincidence given why she was here. Also, can someone swap the sim card in the front desk loaner phone, it keeps dropping calls and a client complained about it yesterday.", "drugs": [], "trap": "night guard and sim card are ordinary phrases here, not the products NexGard or Simparica"}
{"corpus": "blind2", "id": "h053", "kind": "trap", "category": "front desk chat", "ref": "Our new receptionist is such a pro, heart and soul in this job already after just two weeks, everyone loves her. Make sure the rabies certificate goes in a pocket of the discharge folder so it doesn't get lost between here and the front desk.", "spoken": "Our new receptionist is such a pro, heart and soul in this job already after just two weeks, everyone loves her. Make sure the rabies certificate goes in a pocket of the discharge folder so it doesn't get lost between here and the front desk.", "drugs": [], "trap": "pro heart and a pocket are ordinary phrases here, not the products ProHeart or Apoquel"}
{"corpus": "blind2", "id": "h054", "kind": "trap", "category": "phone message log", "ref": "The message on the machine just had the client saying 'sir' then something that sounded like 'esto' before it cut out, I couldn't make out the rest of it. We did send off a cytology sample from his ear swab to the outside lab. Clinda, our new tech, is the one who drove down for the drop-off this afternoon.", "spoken": "The message on the machine just had the client saying 'sir' then something that sounded like 'esto' before it cut out, I couldn't make out the rest of it. We did send off a cytology sample from his ear swab to the outside lab. Clinda, our new tech, is the one who drove down for the drop-off this afternoon.", "drugs": [], "trap": "sir esto is a garbled voicemail fragment near Seresto, cyto is embedded in cytology not Cytopoint, and Clinda is a technician's name not clindamycin"}
{"corpus": "blind2", "id": "h055", "kind": "trap", "category": "case history recount", "ref": "We started him on Anipryl a few months back for his cognitive decline and honestly his owner says he seems more engaged with the family again. He's also on Proin for the urinary leaking, twice daily, and we added Dasuquin for his joints since he's getting up there in age.", "spoken": "We started him on Anipryl a few months back for his cognitive decline and honestly his owner says he seems more engaged with the family again. He's also on Proin for the urinary leaking, twice daily, and we added Dasuquin for his joints since he's getting up there in age.", "drugs": [], "trap": "Anipryl, Proin, and Dasuquin are real veterinary products but none are on the formulary list"}
{"corpus": "blind2", "id": "h056", "kind": "trap", "category": "case history recount", "ref": "She's been on Cosequin as a joint supplement for a couple years now, seems to help with her stiffness in the mornings. During the procedure we reversed the sedation with Antisedan once we were done. Her liver values looked better on this recheck since starting Denamarin daily with her food.", "spoken": "She's been on Cosequin as a joint supplement for a couple years now, seems to help with her stiffness in the mornings. During the procedure we reversed the sedation with Antisedan once we were done. Her liver values looked better on this recheck since starting Denamarin daily with her food.", "drugs": [], "trap": "Cosequin, Antisedan, and Denamarin are real veterinary products but none are on the formulary list"}
{"corpus": "blind2", "id": "h057", "kind": "trap", "category": "case history recount", "ref": "Some clinics reach for Previcox or Onsior first for post-surgical pain in cats, but we tend to prefer other options here depending on the case. Her ear infection last year was actually treated with Zeniquin, worked well for her at the time from what the old records show.", "spoken": "Some clinics reach for Previcox or Onsior first for post-surgical pain in cats, but we tend to prefer other options here depending on the case. Her ear infection last year was actually treated with Zeniquin, worked well for her at the time from what the old records show.", "drugs": [], "trap": "Previcox, Onsior, and Zeniquin are real veterinary drugs but none are on the formulary list"}
{"corpus": "blind2", "id": "h058", "kind": "trap", "category": "second-opinion note", "ref": "The referring vet had tried marbofloxacin and Temaril-P for his skin issue without much luck before we saw him. We're actually switching him over to Cytopoint 1 mL SQ today since it targets the itch pathway more directly, and I think he'll do a lot better on it. Solensia is also an option down the road if arthritis pain becomes more of a factor as he ages.", "spoken": "The referring vet had tried marbofloxacin and Temaril-P for his skin issue without much luck before we saw him. We're actually switching him over to Cytopoint one milliliter under the skin today since it targets the itch pathway more directly, and I think he'll do a lot better on it. Solensia is also an option down the road if arthritis pain becomes more of a factor as he ages.", "drugs": ["Cytopoint"], "trap": "marbofloxacin, Temaril-P, and Solensia are off-list real drugs sitting right next to the on-list Cytopoint, which has a real dose and belongs in drugs"}
{"corpus": "blind2", "id": "h059", "kind": "trap", "category": "case history recount", "ref": "Some feline diabetics do really well on Prozinc instead, though we tend to reach for other insulins first depending on the case and the owner's comfort with injections. We also have her on fluoxetine for the anxiety around the other cats in the house, and sucralfate as needed if her stomach seems upset from all the stress.", "spoken": "Some feline diabetics do really well on Prozinc instead, though we tend to reach for other insulins first depending on the case and the owner's comfort with injections. We also have her on fluoxetine for the anxiety around the other cats in the house, and sucralfate as needed if her stomach seems upset from all the stress.", "drugs": [], "trap": "Prozinc, fluoxetine, and sucralfate are real drugs but none are on the formulary list"}
{"corpus": "blind2", "id": "h060", "kind": "trap", "category": "case discussion", "ref": "Cyclosporine drops are an option for his dry eye if the tear production numbers don't improve on the next Schirmer test. Selegiline came up in our conversation about his cognitive changes too, something to consider alongside behavioral enrichment at home. Cartrophen injections are popular for joint disease in some countries though we don't stock it here.", "spoken": "Cyclosporine drops are an option for his dry eye if the tear production numbers don't improve on the next Schirmer test. Selegiline came up in our conversation about his cognitive changes too, something to consider alongside behavioral enrichment at home. Cartrophen injections are popular for joint disease in some countries though we don't stock it here.", "drugs": [], "trap": "cyclosporine, selegiline, and Cartrophen are real drugs but none are on the formulary list"}
{"corpus": "blind2", "id": "h061", "kind": "trap", "category": "case history recount", "ref": "Her old vet had her on Metacam for years, and honestly it's very similar to what we'd reach for here just a different brand. Amitriptyline came up as an option for her interstitial cystitis flare-ups too. For the diabetic cat down the hall we're discussing Bexacat as an oral option instead of injections, and his hyperthyroid cat brother is doing well on Felimazole. We also recommended Zylkene for the car ride anxiety since it's just a calming supplement.", "spoken": "Her old vet had her on Metacam for years, and honestly it's very similar to what we'd reach for here just a different brand. Amitriptyline came up as an option for her interstitial cystitis flare-ups too. For the diabetic cat down the hall we're discussing Bexacat as an oral option instead of injections, and his hyperthyroid cat brother is doing well on Felimazole. We also recommended Zylkene for the car ride anxiety since it's just a calming supplement.", "drugs": [], "trap": "Metacam, amitriptyline, Bexacat, Felimazole, and Zylkene are real products but none are on the formulary list"}
{"corpus": "blind2", "id": "h062", "kind": "trap", "category": "phone triage", "ref": "Just give her 0.5 mL/kg PO BID for now, nothing complicated, and if that's confusing on the phone I can text you a picture of the syringe markings so you can see exactly where to fill it to.", "spoken": "Just give her point five milliliters per kilogram by mouth twice daily for now, nothing complicated, and if that's confusing on the phone I can text you a picture of the syringe markings so you can see exactly where to fill it to.", "drugs": [], "trap": "the rapid dosing string spoken quickly could be misheard by an ASR system as a drug name; no formulary drug is actually named here"}
{"corpus": "blind2", "id": "h063", "kind": "trap", "category": "schedule note", "ref": "Simba, the Nguyens' orange tabby, is due for his annual exam next month, I already see him on the schedule for the fourteenth. Also, Rex Guard, that giant mastiff mix from the shelter, is coming in this afternoon for his intake exam, apparently he was found wandering near the highway.", "spoken": "Simba, the Nguyens' orange tabby, is due for his annual exam next month, I already see him on the schedule for the fourteenth. Also, Rex Guard, that giant mastiff mix from the shelter, is coming in this afternoon for his intake exam, apparently he was found wandering near the highway.", "drugs": [], "trap": "Simba and Rex Guard are pet names that sound drug-adjacent, not medications"}
{"corpus": "blind2", "id": "h064", "kind": "trap", "category": "front desk log", "ref": "Mrs. Sereno called earlier asking to move her appointment to Friday instead, said Thursday doesn't work with her work schedule anymore. Separately, Bravo Kennels dropped off three puppies for their wellness exams and first vaccines, all from the same litter, all looking bright and active today.", "spoken": "Mrs. Sereno called earlier asking to move her appointment to Friday instead, said Thursday doesn't work with her work schedule anymore. Separately, Bravo Kennels dropped off three puppies for their wellness exams and first vaccines, all from the same litter, all looking bright and active today.", "drugs": [], "trap": "Mrs. Sereno and Bravo Kennels are a client's name and a boarding facility name that sound drug-adjacent, not medications"}
{"corpus": "blind2", "id": "h065", "kind": "trap", "category": "office admin note", "ref": "We just switched our exam room floor cleaner to a new brand called Revolve Fresh, smells a lot better than the old one honestly. It's just a janitorial supply the office manager found online for a better price, nothing medical about it at all.", "spoken": "We just switched our exam room floor cleaner to a new brand called Revolve Fresh, smells a lot better than the old one honestly. It's just a janitorial supply the office manager found online for a better price, nothing medical about it at all.", "drugs": [], "trap": "Revolve Fresh is a cleaning product brand name that sounds a bit like the product Revolution, but is spelled differently and is unrelated"}
{"corpus": "blind2", "id": "h066", "kind": "trap", "category": "inventory note", "ref": "Front desk needs to reorder Bravecto and Convenia this week, we're down to just a few boxes of each in the pharmacy closet, can someone call the distributor before Friday so we don't run out before the holiday weekend rush.", "spoken": "Front desk needs to reorder Bravecto and Convenia this week, we're down to just a few boxes of each in the pharmacy closet, can someone call the distributor before Friday so we don't run out before the holiday weekend rush.", "drugs": ["Bravecto", "Convenia"], "trap": "Bravecto and Convenia are genuine on-list drug names appearing correctly here, so drugs is not empty even though this is an inventory note rather than a prescription"}
{"corpus": "blind2", "id": "h067", "kind": "trap", "category": "staff chat", "ref": "I heard the new vet at the emergency clinic down the street likes to reach for Cerenia first for any vomiting case that comes through the door, pretty standard choice honestly, nothing unusual about that at all.", "spoken": "I heard the new vet at the emergency clinic down the street likes to reach for Cerenia first for any vomiting case that comes through the door, pretty standard choice honestly, nothing unusual about that at all.", "drugs": ["Cerenia"], "trap": "Cerenia is genuinely named here in casual shop talk, correctly spelled, so it belongs in drugs despite the casual context"}
{"corpus": "blind2", "id": "h068", "kind": "trap", "category": "small talk", "ref": "How's the new house coming along, did you guys finally get the kitchen finished? We should be able to get Daisy in and out pretty quickly today, it's really just a nail trim and a quick look at that ear she's been scratching.", "spoken": "How's the new house coming along, did you guys finally get the kitchen finished? We should be able to get Daisy in and out pretty quickly today, it's really just a nail trim and a quick look at that ear she's been scratching.", "drugs": [], "trap": "ordinary small talk and appointment context, no drug names of any kind present"}
{"corpus": "blind2", "id": "h069", "kind": "trap", "category": "scheduling note", "ref": "Can you block off Thursday afternoon for the mobile spay clinic, we're expecting about fifteen cats from the rescue group and I want the whole surgical suite free starting at noon so we're not rushing anybody through recovery before we close.", "spoken": "Can you block off Thursday afternoon for the mobile spay clinic, we're expecting about fifteen cats from the rescue group and I want the whole surgical suite free starting at noon so we're not rushing anybody through recovery before we close.", "drugs": [], "trap": "purely scheduling and admin content, no drug names present at all"}
{"corpus": "blind2", "id": "h070", "kind": "trap", "category": "lab results discussion", "ref": "Bloodwork came back completely unremarkable across the board, kidney and liver values are both right in the middle of normal range, and the urinalysis showed nothing concerning either, so honestly at this point I think we're just looking at normal age-related slowing down rather than anything specific we need to treat.", "spoken": "Bloodwork came back completely unremarkable across the board, kidney and liver values are both right in the middle of normal range, and the urinalysis showed nothing concerning either, so honestly at this point I think we're just looking at normal age-related slowing down rather than anything specific we need to treat.", "drugs": [], "trap": "lab results discussion with no drug names mentioned; tests whether an empty drugs list is correctly returned even in a clinical-sounding context"}