DAMNIT-V COMBINED EVIDENCE SNAPSHOT v12
==================================================

PATIENT
-------
Name: Eddy
Owner: Bright
Species: Canine
Breed: Border Collie
Sex: Male
Desexed Status: 
Life Stage: 
Activity Level: 
Current Weight kg: 23.00
Ideal Weight kg: 
BCS: 7.00

CASE
----
Case Title: New Clinical Case - 08/06/2026 05:39
Primary Complaint: 
Status: Open
Date Opened: 08/06/2026

CLINICAL NARRATIVE
------------------
Head tilt, head skaing and walking ion circles 
crying when scratching legft ear

Inner Wolf Chicken 
2 x chicken wings 
1 Joint Guard 

INITIAL DIFFERENTIAL NOTES
--------------------------


LOCAL / REGIONAL CLINICAL CONTEXT
---------------------------------
No matching active local/regional clinical context entries found for the recorded species and presenting signs.

CLINICAL INTAKE DOCUMENTS
-------------------------

DOCUMENT: Clinical Intake - 08/06/2026 05:40
Type: Clinical History
Source: Clinical intake / AI consult
Uploaded: 08/06/2026 05:40

Head tilt, head skaing and walking ion circles 
crying when scratching legft ear

Inner Wolf Chicken 
2 x chicken wings 
1 Joint Guard 

NUTRITION ASSESSMENTS
---------------------
Total nutrition assessments for this case: 1

LATEST NUTRITION ASSESSMENT
---------------------------
Assessment ID: 82
Title: Nutrition Review
Date: 08/06/2026
Feeding Goal: Maintenance
Current Diet Type: Mixed / to be verified
Body Weight kg: 23.00
Ideal Weight kg: 
BCS: 7.00
Muscle Condition: Not recorded
Appetite: Not recorded
Owner Goals: 
Diet Concerns: 
Skin / Coat Notes: 
Digestive Notes: 
Stool Quality: 
Owner-Reactive Foods: 
Owner-Tolerated Foods: 

NUTRITION EVIDENCE SNAPSHOT
---------------------------
Latest Assessment ID: 82
Assessment Date: 08/06/2026
Energy Intake: 2221.7 kcal/day
Estimated Requirement: 997.74 kcal/day
Energy Percent: 222.7%
Energy Status: High / above estimated requirement
Protein: 193.6 g/day
Fat: 170.25 g/day
Carbohydrate: 12 g/day
Matched Diet Items: 2 / 2
Unmatched Diet Items: 0
Micronutrient Confidence: Partial / incomplete
Nutrition Confidence: Moderate / partial evidence

Owner-Reactive / Avoid Foods:
None recorded.

Owner-Tolerated Foods:
None recorded.

Ingredient-Derived Reactive Groups:
purine

RAC-Reactive Foods:
Not yet connected. Future build will compare RAC-reactive foods against current diet, owner-reactive foods and tolerated foods.

EVIDENCE INCLUDED
-----------------
Clinical intake documents: 1
Nutrition assessments: 1
Accepted food / commercial diet entries: 2
Accepted treat entries: 0
Accepted supplement entries: 1
Nutrition calculation: 2221.7 kcal/day, 222.7% of estimated requirement
Nutrition matched items: 2 / 2
Nutrition micronutrient confidence: Partial / incomplete
RAC / Audiomixer documents: 0
Pathology / laboratory reports: 0
Imaging reports: 0
HTMA reports: 0
Microbiome reports: 0
Supplement reviews: 0

EVIDENCE PENDING / NOT YET ADDED
--------------------------------
- Accepted nutrition entries are present and used for nutrition calculations.
- RAC / Audiomixer DOCX reports
- Pathology / laboratory reports
- Imaging reports
- HTMA report if requested
- Microbiome report if requested
- Supplement review

EVIDENCE STATUS
---------------

Evidence Used In This Snapshot:
- Clinical Intake: Used
- Nutrition: Used

Additional Evidence Available If Clinically Indicated:
- RAC / Audiomixer screening: may help prioritise which physical tests or evidence domains should be pursued next.
- Pathology / laboratory testing: available if clinical signs, risk assessment, or response to treatment justify testing.
- Imaging: available if obstruction, foreign body, mass, trauma or structural disease remains a concern.
- HTMA: available if mineral/toxic element patterning is clinically relevant.
- Microbiome: available if chronic gastrointestinal, immune, dermatological or inflammatory patterns require deeper investigation.

Clinical Context:
A veterinary assessment is commonly made using the evidence that is clinically justified and practically available. This section records what was used and what could be added later, without implying that every possible test is required for every patient.

EVIDENCE WEIGHTING ENGINE v1
----------------------------
Domain weights used in this snapshot:
- Imaging: 5
- Pathology / Laboratory: 5
- Clinical Examination: 4
- Clinical History / Intake: 4
- Nutrition: 3
- HTMA: 2
- Microbiome: 2
- RAC / Audiomixer: 1
- Supplement Review: 1

Current snapshot contains Clinical Intake and Nutrition evidence only. Imaging, pathology, HTMA, microbiome and RAC are pending.

DIFFERENTIAL PRIORITIES v2 - WEIGHTED
-------------------------------------

1. Vestibular / neurological syndrome requiring localisation
Weighted Evidence Score: 7
Weighted Confidence: Low-Moderate
Evidence:
- [V - Clinical History +5] Head tilt, circling, balance or vestibular-type signs are present in the clinical history.
- [V - Clinical Examination +2] Neurological localisation and otic versus central vestibular distinction require examination.

2. Otitis externa / media / interna or ear-associated pain
Weighted Evidence Score: 6
Weighted Confidence: Low-Moderate
Evidence:
- [I - Clinical History +4] Ear-related clinical language supports otic inflammation / infection.
- [D - Clinical History +2] Head shaking, ear scratching pain or crying when touched may also require structural ear examination.

3. Concurrent metabolic / nutritional patient-state issue
Weighted Evidence Score: 5
Weighted Confidence: Low-Moderate
Evidence:
- [M - Nutrition / Patient-State +3] Accepted diet calculation shows energy intake 222.7% of estimated requirement.
- [M - Nutrition / Patient-State +2] Accepted diet calculation has partial / incomplete micronutrient confidence.

DAMNIT-V EVIDENCE-CONDITIONED POSSIBILITY MAP v2
------------------------------------------------
All DAMNIT-V domains remain visible, but each domain is interpreted according to the evidence actually collected in this snapshot. Low-evidence domains are retained for completeness without being over-prioritised.


UNIFIED DAMNIT-V DOMAIN SCORES v1
---------------------------------
These scores integrate clinical intake, accepted nutrition calculations and RAC ontology classification where available.

V - Vascular / Neurological
Clinical Score: 8
Nutrition / Patient-State Score: 0
RAC Score: 0
Total Unified Score: 8
Evidence:
- Clinical intake contains head tilt, circling, balance or vestibular-type signs.

M - Metabolic / Nutritional
Clinical Score: 0
Nutrition / Patient-State Score: 6
RAC Score: 0
Total Unified Score: 6
Evidence:
- Accepted nutrition calculation shows energy intake 222.7% of estimated requirement.
- Accepted nutrition calculation has partial / incomplete micronutrient confidence.

I - Infectious / Inflammatory / Immune
Clinical Score: 4
Nutrition / Patient-State Score: 0
RAC Score: 0
Total Unified Score: 4
Evidence:
- Clinical intake contains ear pain, head shaking or scratching-ear signs supporting otic inflammation/infection.

D - Degenerative / Structural
Clinical Score: 2
Nutrition / Patient-State Score: 0
RAC Score: 0
Total Unified Score: 2
Evidence:
- Ear-related signs may require structural examination of external canal, middle ear or local tissues.

A - Allergic / Reactive
Clinical Score: 0
Nutrition / Patient-State Score: 0
RAC Score: 0
Total Unified Score: 0
Evidence:
- No direct case-specific evidence currently recognised.

N - Neoplastic
Clinical Score: 0
Nutrition / Patient-State Score: 0
RAC Score: 0
Total Unified Score: 0
Evidence:
- No direct case-specific evidence currently recognised.

T - Toxic / Traumatic
Clinical Score: 0
Nutrition / Patient-State Score: 0
RAC Score: 0
Total Unified Score: 0
Evidence:
- No direct case-specific evidence currently recognised.

DOMAIN-SCORED CLINICAL PRIORITIES v1
------------------------------------
- V - Vascular / Neurological: unified score 8
- M - Metabolic / Nutritional: unified score 6
- I - Infectious / Inflammatory / Immune: unified score 4
- D - Degenerative / Structural: unified score 2

1. V - Vascular / Neurological
Evidence Score: 7
Evidence Strength: Moderate
Evidence found in this snapshot:
- Neurological, vestibular, seizure, collapse, paresis or vascular wording is present.
- Head tilt, circling, balance or vestibular-type signs are present in the clinical history.
Possibilities supported by current evidence:
- Neurological dysfunction, vestibular disease, seizure disorder, vascular event or autonomic dysregulation.
- Peripheral vestibular disease, central vestibular disease, otitis media/interna, cranial nerve involvement or other neurological localisation.
Possibilities not currently supported / missing evidence:
- No neurological examination, imaging, blood pressure, coagulation or RAC vascular/neurological screen is currently attached.
Suggested RAC screen if this domain remains clinically relevant:
- Vestibular / neurological axis
- Autonomic dysregulation
- Vascular compromise
- Coagulation / perfusion pattern
Suggested physical confirmation if justified:
- Neurological examination if signs are present
- Blood pressure and perfusion assessment if clinically indicated
- Advanced imaging or referral only if justified by signs

2. I - Infectious / Inflammatory / Immune
Evidence Score: 4
Evidence Strength: Low-Moderate
Evidence found in this snapshot:
- Ear pain, head shaking or scratching-ear history can support otic inflammatory or infectious processes.
Possibilities supported by current evidence:
- Otitis externa, otitis media/interna, inflammatory ear canal disease or secondary microbial involvement.
Possibilities not currently supported / missing evidence:
- No cytology, culture, CBC, biopsy, pathology or RAC infection/inflammation screen is yet attached.
Suggested RAC screen if this domain remains clinically relevant:
- Bacterial burden
- Yeast / Malassezia burden
- Immune dysregulation
- Inflammatory cytokine / tissue inflammation pattern
- Barrier breakdown pattern
Suggested physical confirmation if justified:
- Skin cytology
- Tape prep / impression smear where lesions are active
- CBC / biochemistry if systemic signs are present
- Culture or biopsy if recurrent, severe or non-responsive

3. M - Metabolic / Nutritional
Evidence Score: 3
Evidence Strength: Low-Moderate
Evidence found in this snapshot:
- Nutrition assessment evidence is present as supporting context.
- Accepted Review Centre diet entries are available for nutrition calculation.
- Accepted diet calculation: 2221.7 kcal/day, 222.7% of estimated requirement.
- Calculated energy intake is above estimated maintenance requirement.
- Micronutrient evidence is partial or incomplete.
Possibilities supported by current evidence:
- Nutritional excess / overfeeding risk based on accepted diet calculation.
- Incomplete micronutrient certainty; deficiencies or excesses cannot be fully excluded.
Possibilities not currently supported / missing evidence:
- No pathology, endocrine testing, HTMA or complete micronutrient confirmation is currently attached.
Suggested RAC screen if this domain remains clinically relevant:
- Zinc / copper / selenium / vitamin A / vitamin E pattern
- Essential fatty acid sufficiency
- Liver / endocrine metabolic stress
- Energy balance and protein utilisation
Suggested physical confirmation if justified:
- Review unmatched diet items and incomplete micronutrient fields
- Pathology if systemic or endocrine signs are present
- HTMA if mineral/toxic patterning is clinically relevant
- Diet correction and longitudinal response tracking

4. D - Degenerative / Structural
Evidence Score: 2
Evidence Strength: Low
Evidence found in this snapshot:
- Ear-related signs may require structural examination of the external canal, middle ear or local tissues.
Possibilities supported by current evidence:
- Ear canal foreign body, otic structural disease or local painful lesion depending on examination findings.
Possibilities not currently supported / missing evidence:
- No direct imaging or structural confirmation has been added to this snapshot.
Suggested RAC screen if this domain remains clinically relevant:
- Structural obstruction / restriction signal
- Regional tissue integrity
- Pain or mechanical stress localisation
Suggested physical confirmation if justified:
- Physical examination and palpation
- Imaging if structural disease is clinically suspected
- Serial monitoring if signs are mild or improving

5. A - Allergic / Reactive
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No allergy testing, skin cytology, biopsy, RAC reactivity screen or challenge result is yet attached.
Suggested RAC screen if this domain remains clinically relevant:
- Current foods against allergic / reactive burden
- Owner-reactive foods
- Histamine / mast-cell pattern
- Atopy / environmental allergen pattern
- Contact irritant pattern
Suggested physical confirmation if justified:
- Skin cytology if lesions are active
- Controlled elimination / challenge logic if clinically appropriate
- Environmental and contact exposure review
- Secondary infection assessment if pruritus or lesions persist

6. N - Neoplastic / Nutrition
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No mass, imaging, pathology, cytology or RAC neoplasia evidence has been collected in this snapshot.
Suggested RAC screen if this domain remains clinically relevant:
- Mass / nodule signal if any lesion is palpable
- Mast cell / inflammatory nodule distinction
- N-Neoplasia versus N-Nutrition clarification where relevant
Suggested physical confirmation if justified:
- Clinical examination of any lump or lesion
- FNA / cytology if a discrete mass is present
- Biopsy or imaging only if clinically justified

7. T - Toxic / Traumatic
Evidence Score: 0
Evidence Strength: Currently unsupported / retained for completeness
Evidence found in this snapshot:
- No direct supporting evidence currently collected.
Possibilities supported by current evidence:
- None currently supported beyond DAMNIT-V completeness.
Possibilities not currently supported / missing evidence:
- No toxicology, exposure confirmation, trauma imaging or RAC toxic/trauma screen is currently attached.
Suggested RAC screen if this domain remains clinically relevant:
- Chemical / toxin burden
- Drug reaction burden
- Environmental irritant
- Trauma localisation
- Tick / envenomation pattern if regionally relevant
Suggested physical confirmation if justified:
- Exposure history
- Physical examination of affected region
- Pathology or toxicology only where clinically indicated
- Imaging if penetrating injury, foreign body or deeper trauma is suspected

SNAPSHOT INTERPRETATION NOTE
----------------------------
This section does not remove any DAMNIT-V domain. It prevents all domains being displayed as equally likely by separating evidence-supported possibilities from framework-completeness possibilities.

RAC-GUIDED NEXT EVIDENCE v1
---------------------------
RAC is treated here as a screening and prioritisation layer. A positive RAC signal does not replace physical diagnosis, but it can increase the justification for targeted physical testing when cost, risk, or uncertainty make broad testing difficult.

Suggested workflow:
1. Generate broad differential possibility map.
2. Run RAC screening against the most plausible branches.
3. Compare RAC positives with clinical history, nutrition, examination and owner observations.
4. Increase priority for physical confirmation where RAC and clinical evidence converge.
5. Record later confirmation and outcome so RAC predictions can be validated longitudinally.

INTERPRETIVE CAUTION
--------------------
This evidence snapshot is not a final diagnosis. It represents the evidence currently available at the time of generation. Later laboratory, imaging, HTMA, microbiome, RAC, nutrition, or supplement evidence may change the interpretation.

CASE EVIDENCE BUNDLE v1
=======================

PATIENT
-------
Name: Eddy
Owner: Bright
Species: Canine
Breed: Border Collie
Sex: Male
Desexed Status: 
Life Stage: 
Activity Level: 
Current Weight kg: 23.00
Ideal Weight kg: 
BCS: 7.00

CASE
----
Case ID: 20
Title: New Clinical Case - 08/06/2026 05:39
Primary Complaint: 
Status: Open
Date Opened: 08/06/2026

CLINICAL NARRATIVE
------------------
Head tilt, head skaing and walking ion circles 
crying when scratching legft ear

Inner Wolf Chicken 
2 x chicken wings 
1 Joint Guard 

INITIAL DIFFERENTIAL NOTES
--------------------------


CLINICAL INTAKE DOCUMENTS
-------------------------
Count: 1

Document: Clinical Intake - 08/06/2026 05:40
Type: Clinical History
Source: Clinical intake / AI consult
Uploaded: 08/06/2026 05:40
Head tilt, head skaing and walking ion circles 
crying when scratching legft ear

Inner Wolf Chicken 
2 x chicken wings 
1 Joint Guard 

NUTRITION EVIDENCE
------------------
Nutrition source rule: calculations must use accepted Review Centre food, treat and supplement entries, not raw clinical intake text.
Nutrition assessments: 1
Latest Assessment ID: 82
Date: 08/06/2026
Feeding Goal: Maintenance
Current Diet Type: Mixed / to be verified
Body Weight kg: 23.00
Ideal Weight kg: 
BCS: 7.00
Appetite: Not recorded
Digestive Notes: 
Stool Quality: 
Skin / Coat Notes: 
Owner Reactive Foods: 
Owner Tolerated Foods: 

Nutrition Calculation Summary:
Energy: 2221.7 kcal/day
Protein: 193.6 g/day
Fat: 170.25 g/day
Carbohydrate: 12 g/day

Accepted Review Centre Calculation Lines:
- Chicken Raw Bites | 1200 g/day | 1864.2 kcal | Match: Matched | DAMNIT-V reactive groups: purine
- Chicken, ground, raw | 250 g/day | 357.5 kcal | Match: Matched | DAMNIT-V reactive groups: 

RAC / AUDIOMIXER EVIDENCE
-------------------------
RAC reports: 0
Positive classified RAC markers: 0

RAC MARKERS BY DAMNIT-V DOMAIN
------------------------------
No positive classified RAC marker results currently attached to this case.

PATHOLOGY / LABORATORY EVIDENCE
--------------------------------
Pathology reports: 0

IMAGING EVIDENCE
----------------
Imaging reports: 0

EVIDENCE BUNDLE NOTE
--------------------
This bundle is the shared evidence source for Snapshot and Multi-Model review. Case-specific DAMNIT-V reasoning should be generated from this bundle, not from isolated keyword rules.