Posted on February 17, by Scott Alexander I got many good responses to my Considerations On Cost Disease post, both in the comments and elsewhere. A lot of people thought the explanation was obvious; unfortunately, they all disagreed on what the obvious explanation was. Below are some of the responses I found most interesting.
Why are cardiology researchers inventing bogus definitions of species-wide heart enlargement to test risky drugs?
Diuretics, of course, would not be appropriate prior to congestive heart failure, because their purpose is to remove retained fluids from the lungs, a situation which does not exist until CHF occurs. In the past year, veterinary research publications have been focusing their medication advice upon MVD-affected dogs with enlarged hearts rather than those in CHF.
Research into the efficacy of pimobendan and other drugs in treating MVD-affected dogs with enlarged hearts but prior to CHF — in other words, in Stage B2 — has prompted this change of focus.
The point at which a dog reaches CHF has been relatively clear-cut, based upon constant rapid breathing, x-rays showing pulmonary congestion, and other physically observable signs. Most primary care veterinarians have been trained to recognize the symptoms of CHF.
However, detecting heart enlargement — which customarily occurs before CHF — calls for a totally different approach. The most accurate has been the vertebral heart score VHS method proposed by Dr. James Buchanan of PennVet in Enlargement means getting larger — not just being large Of course, one set of x-rays will provide only one set of measurements.
Enlargement means that the size of the heart has gotten bigger over time. The x-rays above, left show the increase in heart size of one cavalier over 5 years. They look for a more rounded appearance, bulging, and other deviations from the typical normally shaped heart, and whether the heart is impacting the trachea, in addition to the size of the heart.
To the practiced eye of a cardiologist, the heart in the x-ray above will clearly show enlargement. But oddly, the measurements now are species-wide — not even limited to breed-specific, much less the individual canine patient. These researchers contend, in their published articles, that these species-wide parameters are the precise measurements of the thresholds of enlarged hearts.
In other words, anything less than their minimums define a normal heart and anything above their minimums is necessarily an enlarged heart in any dog of any breed.
They use these ad hoc definitions of enlargement both as inclusion criteria in their testing and as recommendations to clinicians in their conclusions.
The researchers also have bastardized the definition of Stage B2 in that they use the term but ignore its meaning. One thing the researchers neglect to do is include any citations to prior research or other peer-reviewed justification for their minimum parameters.
Oh, they might throw in a footnote or two with a cited article when they list their inclusion criteria, but those cited articles are either irrelevant to the subject matter or even expressly contradict those parameters.
The obvious reason they do not — and cannot — cite any peer-reviewed research justifying their species-wide minimum heart enlargement measurements is, because none exists.
The first of these studies discussed below, the EPIC Studydefines heart enlargement for all dogs by three minimum measurements — a VHS value and two echo measurements.
Its VHS minimum value is Other studies discussed below define species-wide heart enlargement by arbitrary VHS values alone, varying from minimum values of But regarding minimum VHS values, keep in mind that there is at least one peer-reviewed publication which expressly contradicts the notion that all cavaliers with a VHS value of Cavalier King Charles spaniel: Other breeds reportedly have normal sizes as high as above Individual variations in actual heart size and vertebral length between dogs need to be considered as well as narrowed disc spaces.
Even breed-specific VHS measurements are unreliable. Now to review the six recent articles: The earliest of these recent reports using species-wide minimum parameters for determining heart enlargement is the EPIC Study reportpublished in the November issue of the Journal of Veterinary Internal Medicine by three lead investigators A.
Gordon and 33 other cardiologists. But keep in mind that the study was funded in full, including research, travel, speaking fees, consultancy fees, and preparation of educational materials, even down to matching windbreaker jackets for each of the 36 participating cardiologists, by Boehringer Ingelheim Vetmedica, Inc.
Now this was to be a very delicate study, because much of the prior published evidence about administering pimobendan to dogs before they reached heart failure was that it could drastically accelerate the progression of MVD, and there have been reports of pre-CHF dogs suddenly dropping dead shortly after starting on pimobendan.
Adrian Boswood, stated in a November audio interview at time Boswood is in this quote, this is not the only mocking comment he made about its parameters in just this one interview.
More to come later. One can only imagine what he may have to say about the study off-mic. Sonya Gordon, wrote in a June article: Nearly half of the dogs were cavaliers. We have not heard from Dr. Could it be the sponsor?
This is a flagrant act of citation bluffing, a ruse in which the EPIC Study authors engage more than just once.Oct 15, · Explain the two main causes of market failure and give an example of each?
A recent example of this is the market for "Auction-rate Preferreds" where seven-day paper was touted widely for almost 20 years as an alternative to money-market funds until February when the auctions failed and those backing these markets just Status: Resolved.
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This also works for any work that has been dubbed into a different language from the original. French characters in an originally French film are assumed to be speaking French to one another, even if everything has been translated for the convenience of an English-speaking audience.
In the standard or "hemodynamic" model of heart failure, there are many causes of CHF but once the heart is damaged for any reason, the same series of events almost always takes rutadeltambor.com the heart is damaged, it pumps out less blood, which fires up the nervous rutadeltambor.com blood flow through the kidneys causes release of chemicals called renin and angiotensin II.
Explain The Two Main Causes Of Market Failure And Give An Example Of Each. INTRODUCTION TO MICRO ECONOMICS ”MARKETS FAILURE” Preface The existence of the market have a very important function.
For consumers, the market will make it easier to obtain goods and services daily needs. One of the main causes of market failures are also externalities.
Externalities are costs that aren't directly incurred by the buyer or seller. For example, smoking probably indirectly causes healthcare costs and decreased labour, but these costs are not paid by the seller or buyer at least at the time of purchase.