Pleistocene Brawley and Ocotillo Formations: Evidence for Initial Strike-Slip Deformation Along the San Felipe and San Jacinto Fault Zones, Southern California

We examine the Pleistocene tectonic reorganization of the Pacific–North American plate boundary in the Salton Trough of southern California with an integrated approach that includes basin analysis, magnetostratigraphy, and geologic mapping of upper Pliocene to Pleistocene sedimentary rocks in the San Felipe Hills. These deposits preserve the earliest sedimentary record of movement on the San Felipe and San Jacinto fault zones that replaced and deactivated the late Cenozoic West Salton detachment fault. Sandstone and mudstone of the Brawley Formation accumulated between ∼1.1 and ∼0.6–0.5 Ma in a delta on the margin of an arid Pleistocene lake, which received sediment from alluvial fans of the Ocotillo Formation to the west-southwest. Our analysis indicates that the Ocotillo and Brawley formations prograded abruptly to the east-northeast across a former mud-dominated perennial lake (Borrego Formation) at ∼1.1 Ma in response to initiation of the dextral-oblique San Felipe fault zone. The ∼25-km-long San Felipe anticline initiated at about the same time and produced an intrabasinal basement-cored high within the San Felipe–Borrego basin that is recorded by progressive unconformities on its north and south limbs. A disconformity at the base of the Brawley Formation in the eastern San Felipe Hills probably records initiation and early blind slip at the southeast tip of the Clark strand of the San Jacinto fault zone. Our data are consistent with abrupt and nearly synchronous inception of the San Jacinto and San Felipe fault zones southwest of the southern San Andreas fault in the early Pleistocene during a pronounced southwestward broadening of the San Andreas fault zone. The current contractional geometry of the San Jacinto fault zone developed after ∼0.5–0.6 Ma during a second, less significant change in structural style

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo