Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Proximity and Perceived Safety as Determinants of Urban Trail Use: Findings from a Three-City Study

In this study we focus on individual and environmental determinants of urban trail use in three diverse urban settings: Chicago, Dallas, and Los Angeles. Explanatory factors include individual psychosocial and health characteristics, distance between home and trail, and land-use and social characteristics of trailside neighborhoods. Model results suggest that intrinsic motivation, general health status, perceived trail safety, perceived miles between home and trail, and neighborhood connectivity were significantly related to probability of trail use and extent of trail use, while working-class status, commuting distance, and physical barriers to the trail were negatively related. Efforts to increase perceived trail safety, accessibility, and awareness about trails thus may result in a higher rate of trail use and more time spent on urban trails

Narrating Resilience: Transforming Urban Systems Through Collaborative Storytelling

How can communities enhance social-ecological resilience within complex urban systems? Drawing on a new urbanist proposal in Orange County, California, it is suggested that planning that ignores diverse ways of knowing undermines the experience and shared meaning of those living in a city. The paper then describes how narratives lay at the core of efforts to reintegrate the Los Angeles River into the life of the city and the US Fire Learning Network’s efforts to address the nation’s wildfire crisis. In both cases, participants develop partially shared stories about alternative futures that foster critical learning and facilitate co-ordination without imposing one set of interests on everyone. It is suggested that narratives are a way to express the subjective and symbolic meaning of resilience, enhancing our ability to engage multiple voices and enable self-organising processes to decide what should be made resilient and for whose benefit