Post-disaster recovery linked with pre-disaster land development and damage density of Typhoon Yolanda: Toward better land-use planning in Tacloban City, the Philippines

Coastal cities in Asia face increasing risks of extreme climate events and urgently need to develop risk-reduction plans to mitigate the harmful socioeconomic consequences of such events. In this study, we undertook geographical analyses and conducted interviews with stakeholders in the Tacloban City area, the Philippines, to investigate the relationships among building types, storm-surge inundation and post-disaster recovery after 2013 Typhoon Yolanda. Squatter settlements in low-lying urban and coastal areas were destroyed by the typhoon, but were rapidly rebuilt by squatters using debris from the typhoon. Government programs relocated some of the affected squatter populations to new socialized housing developments on safe higher ground that were some distance from the squatters\u27 former urban and coastal livelihoods, thus causing reluctance to relocation. Our GIS analysis of available geo-spatial data, coupled with extensive stakeholder interviews, showed that there were enough vacant lots within pre-existing housing subdivisions to house more than 7000 squatters and provide them with plots for urban vegetable farming that would provide their livelihood. Interviews with stakeholders suggested that this approach would not encounter excessive resistance. Thus, our study demonstrated that comprehensive GIS analyses and stakeholder involvement can contribute to effective land-use planning for community resilience

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