Observations on the Dissection of a Heifer With Ectopic Cordis

The heifer (seen alive in November, 1962) appeared in good flesh, and her activity did not seem hampered by her cervical heart. Casual observation revealed that the animal\u27s heart was located between the thoracic inlet and the midcervical region. The heart protruded laterally 3-5 cm on either side in the normally loose tissues of the ventral neck. As she stood quietly the heart moved in a cranio-caudal direction with each contraction; when she walked, the heart swung from side to side

Case-Control Study of Risk Factors Associated with Feline and Canine Chronic Kidney Disease

An age-matched case-control study was initiated to determine the major risk factors associated with CKD in cats and dogs and to determine what clinical signs cat and dog owners observed before their veterinarian diagnosed their pet with CKD. When compared to controls, the feline cases were more likely to have had polydipsia and polyuria in the year before the owners' cats were diagnosed with CKD. In the dogs, increased water intake, increased urination, small size and a recent history of weight loss and bad breath were noticed by the dog owners before veterinary CKD diagnosis. Dog owners recognized abnormal drinking and urination behavior over half a year before their pet's veterinary diagnosis with CKD, and they recognized weight loss almost 4 months before CKD diagnosis. Bad breath was noticed 1.2 years before recognition of CKD by a veterinarian. Given that earlier CKD diagnosis should have been possible in most cases, clinical trials should proceed to measure the efficacy of early interventions

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

I am dreaming of my Irish rose, blooming there beneath the Irish [first line of chorus]

Performance Medium: Piano, Voice and Chord

Hoover Dam and the Evolution of Uplift Theory

The earliest technical article by an American engineer on hydraulic uplift was the ASCE Presidential Address by James B. Francis in 1888. He suggested applying full hydrostatic pressure at the upstream heel of a dam, diminishing to zero pressure at the downstream toe. Thoughts on the potentially destabilizing role of uplift were mentioned by John R. Freeman in 1911 in his comments on the failure of Bayless Dam near Austin, PA. Between 1911-1918 Arnold C. Koenig, J. B. T. Coleman, and James B. Hays discussed how to account for uplift in masonry dams in the ASCE Proceedings and Transactions. Up until 1927-28 most engineers assumed that uplift pressure was tied to the permeability of the foundation and that of the dam structure. Most assumed that concrete was impervious and incapable of transmitting meaningful pore pressure. The textbooks cited by the engineers who drafted the plans for the St. Francis Dam cited examples that appeared in textbooks published between 1908-18. In 1918 Edward Wegmann asserted that it was impossible to accurately estimate the uplift that might develop beneath a dam and that engineers should rely on their own judgment. Others suggested that an uplift pressure diagram in the shape of a trapezoid be employed, assuming development of two-Thirds the theoretical uplift, varying lineally to zero at the toe, unless uplift relief wells were employed. All the various theories were called into question when Hoover Dam was filled to capacity in 1934-41 and excessive uplift pressures developed beneath the dam\u27s downstream face. This led to tripling the depth of the grout curtain, which took nine years complete. In 1936 Karl Terzaghi introduced his theory of effective stress, which established a distinction between total stress and those ascribable to hydrostatic (pore water) pressure. In 1939 ASCE formed a Subcommittee on Uplift in Masonry Dams. In 1945 Terzaghi summarized the results of experimental work that suggested water was able to transmit pore pressures in concrete. The ASCE committee released their final report in 1952, which included uplift measurements of a modest number of high-head dams and commented on what they felt constituted reasonable bounds on how much uplift could develop if relief wells were installed immediately downstream of grout curtains