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IMPORTANCE Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. OBJECTIVE To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient's lifetime.DESIGN, SETTING, AND PARTICIPANTS Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months.INTERVENTIONS Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. MAIN OUTCOMES AND MEASURESThe primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient's lifetime for the primary outcome and the secondary outcome of death from any cause.RESULTS A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. CONCLUSIONS AND RELEVANCEThese findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03036124

The decision-making for urban rail transit emergency events takes an important role in both reducing the losses caused by disasters and ensuring the safety of passengers. For the rainstorm emergency decision-making without certain scenario prediction information, considering the characteristic that the predisaster prevention measures will influence the effect of in-process countermeasures, this paper aimed to analyze the whole process scenarios for the occurrence, evolution, and development of rainstorm disaster in urban rail transit by considering the regret aversion of the decision makers. An emergency decision-making method for the beforehand-ongoing two stages rainstorm emergencies was developed to assess the emergency decision-making of urban rail transportation in different rainfall flood scenarios. Besides, the utilities and application costs of the emergency plans are also considered when defining the optimal emergency decision-making. This paper purposes the emergency decision-making model based on regret theory to define the optimal predisaster prevention method and ongoing responding measure for different disaster scenarios. Taking the Tianjin rail transportation as an example, this paper defines the optimal emergency decision-making to respond typhoon “Lekima.” The results show that if this method can be implemented in the rail transportation rainstorm disaster emergency responding and relevant disaster prevention management, then the reliability and risk responding capability of public transportation service can both be improved.

Objective: To determine whether the benefits of dapagliflozin in patients with heart failure and reduced ejection fraction (HFrEF) and type 2 diabetes in DAPA-HF varied by background glucose-lowering therapy (GLT). Research design and methods: We examined the effect of study treatment by the use or not of GLT, and by GLT classes and combinations. The primary outcome was a composite of worsening HF (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. Results: In the 2139 type 2 diabetes patients, the effect of dapagliflozin on the primary outcome was consistent by GLT use/no use (hazard ratio 0.72 [95%CI 0.58-0.88] versus 0.86 [0.60-1.23]; P-interaction=0.39) and across GLT classes. Conclusions: In DAPA-HF, dapagliflozin improved outcomes irrespective of use/no use of GLT or by GLT type used in patients with type 2 diabetes and HFrEF.

BackgroundPrevious studies regarding rhythm control in patients with atrial fibrillation (AF) could not sufficiently demonstrate the efficacy of available anti-arrhythmic drugs. ‘Upstream therapy’ has emerged as a potential strategy for the prevention and treatment of AF. The use of angiotensin II receptor blockers and statins has been suggested to decrease new-onset AF, but which remains inadequately explored. This study was designed to examine whether valsartan or fluvastatin can reduce the risk of non-permanent AF in patients with hypertension.Methods/designThe VF-HT-AF study is a multicenter, randomized, open-label, four-arm parallel group study with comparative evaluation of valsartan and fluvastatin as upstream therapies for the treatment of non-permanent AF complicated by hypertension. The primary outcome measure is change in the development of paroxysmal AF into persistent or permanent AF, the development of persistent AF to permanent AF, and change in incidence of overall and persistent AF recurrence, as evaluated by 7-days ambulatory electrocardiograph monitoring (Holter) and patients’ diaries during 2 years’ follow-up. Secondary outcome measures of this study include the occurrence of: (1) fatal and nonfatal myocardial infarction; (2) heart failure (New York Heart Association stage III or IV); (3) cardiogenic shock; (4) serious bleeding necessitating hospitalization; (5) malignant ventricular arrhythmia; (6) revascularization therapy; (7) radiofrequency catheter ablation of AF; (8) changes of left atrial dimension, as measured by ultrasound echocardiography; (9) stroke; (10) cardiovascular mortality; and (11) all-cause mortality. A total of 1879 patients will be investigated from 15 medical centers throughout China to obtain the relevant information.DiscussionThis is the first study in hypertensive patients complicated non-permanent AF in the Chinese population. Results of this study will inform the use of upstream therapies of AF.Trial registrationchictr.org, ChiCTR-TRC-12002642Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0836-5) contains supplementary material, which is available to authorized users.

The spatially heterogeneous nature and geographical scale of surface urban heat island (SUHI) driving mechanisms remain largely unknown, as most previous studies have focused solely on their global performance and impact strength. This paper analyzes diurnal and nocturnal SUHIs in China based on the multiscale geographically weighted regression (MGWR) model for 2005, 2010, 2015, and 2018. Compared to results obtained using the ordinary least square (OLS) model, the MGWR model has a lower corrected Akaike information criterion value and significantly improves the model’s coefficient of determination (OLS: 0.087–0.666, MGWR: 0.616–0.894). The normalized difference vegetation index (NDVI) and nighttime light (NTL) are the most critical drivers of daytime and nighttime SUHIs, respectively. In terms of model bandwidth, population and Δfine particulate matter are typically global variables, while ΔNDVI, intercept (i.e., spatial context), and NTL are local variables. The nighttime coefficient of ΔNDVI is significantly negative in the more economically developed southern coastal region, while it is significantly positive in northwestern China. Our study not only improves the understanding of the complex drivers of SUHIs from a multiscale perspective but also provides a basis for urban heat island mitigation by more precisely identifying the heterogeneity of drivers.

Summary Aim To investigate the upstream therapeutic effects of fluvastatin and valsartan on hypertensive patients with non‐permanent atrial fibrillation (AF). Methods A total of 189 patients who were admitted to outpatient and inpatient department from eight medical centers in China, diagnosed as hypertension with non‐permanent AF, were divided into four groups randomly: the CCBs group (group A, n = 45); CCB + fluvastatin group (group B, n = 48); valsartan group (group C, n = 46); valsartan + fluvastatin group (group D, n = 50). The four groups were followed up for 24 months. The blood routine, biochemical examination, echocardiography, high sensitive C‐reactive protein (hs‐CRP), N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), the maintenance rate of sinus rhythm, and the recurrence of paroxysmal AF or persistent AF incidence were observed in these groups before and after 24 months' treatment. Results After 24 months of follow‐up, there were 178 cases of patients who have completed the study. (a) There was no significant difference in blood routine, liver, and renal function in each group (P > 0.05). (b) The blood lipids level in groups B and D was significantly reduced after treatment (P < 0.01). There was no significant difference of hs‐CRP level in group A (P > 0.05). The left ventricular remodeling was significantly alleviated in group C and group D (P < 0.05). The NT‐ProBNP level was significantly decreased in group D (P < 0.05). (c) The sinus rhythm maintenance rate of group B, group C, and group D was higher than group A (77.78%, 70.45%, 79.17% vs 43.90%), the occurrence of persistent AF was significantly lower than group A (11.11%, 14.29%, 8.33% vs 31.71%; P < 0.05). Conclusions CCB plus fluvastatin and valsartan can reduce the recurrence rate of non‐permanent AF and to delay the progression from non‐permanent AF to permanent AF in patients with hypertension. The combined application of valsartan and fluvastatin is more effective than valsartan or CCB alone in the upstream therapies of AF.

PPP model is an important model which provides public products or services based on the coordination between the public sector and private sector. The implementation of PPP model is helpful for relieving the stress of insufficient funding for public sector and improving the efficiency of resource allocation. Comparing with traditional infrastructure project, PPP project involves many stakeholders, and the cooperation efficiency during the different stakeholders impacts the results of the project directly. Thus, it is important to explore the cooperation efficiency of PPP project. Based on grey clustering model, this paper evaluates the cooperation efficiency of PPP project. An evaluation index system including 36 indexes is established based on the aims and objectives of three stakeholders (public sector, private sector, and passengers). A case study of Beijing Metro Line 4 PPP project is implemented to verify the validity and applicability of the evaluation model. And the results showed that the cooperation efficiency of Beijing Metro Line 4 PPP project is relatively high. The model also provided insights into the shortage of the cooperation efficiency of Beijing Metro Line 4 PPP project. As such, the results can assist all stakeholders in adjusting the cooperation efficiency.