We assessed the effect of atrasentan therapy on a pre-specified panel of 13 urinary metabolites known to reflect mitochondrial function in patients with diabetic kidney disease. This post-hoc analysis was performed using urine samples collected during the RADAR study which was a randomized, double-blind, placebo-controlled trial that tested the effects of atrasentan on albuminuria reduction in patients with type 2 diabetes and nephropathy. At baseline, 4 of the 13 metabolites, quantified by gas-chromatography mass spectrometry, were below detectable levels, and 6 were reduced in patients with eGFR < 60 mL/min/1.73 m . After 12 weeks of atrasentan treatment in patients with eGFR < 60 mL/min/1.73 m , a single-value index of the metabolites changed by -0.31 (95%CI -0.60 to -0.02; P  = .035), -0.08 (-12 to 0.29; P  = .43) and 0.01 (-0.21 to 0.19; P  = .913) in placebo, atrasentan 0.75 and 1.25 mg/d, respectively. The metabolite index difference compared to placebo was 0.13 (-0.17 to 0.43; P  = .40) and 0.35 (0.05-0.65; P  = .02) for atrasentan 0.75 and 1.25 mg/d, respectively. These data corroborate previous findings of mitochondrial dysfunction in patients with type 2 diabetes, nephropathy and eGFR < 60 mL/min/1.73 m , suggesting that atrasentan may prevent the progression of mitochondrial dysfunction common to this specific patient population. Future studies of longer treatment duration with atrasentan are indicated.

Atmospheric rivers (ARs) are extratropical storms that produce extreme precipitation on the west coasts of the world's major landmasses and have been shown to be an important source of variations in precipitation and streamflow in the western U.S. and globally. ARs have been identified as the primary source of hydrologic flooding in the western U.S., yet their costs remain largely unquantified. A systematic analysis of 40 years of data from the U.S. National Flood Insurance Program (NFIP) establishes that ARs are the primary drivers of flood damages in the western United States. The NFIP claims and payments are combined with a catalog of ARs classified according to a recently developed AR scale, which varies from category 1 to 5. The data reveal that flood damages increase exponentially with AR intensity and duration. AR1 and AR2 storms are mostly beneficial, replenishing the water supply while causing median flood damages of less than a million dollars; AR4 and AR5 storms cause median damages in the tens and hundreds of millions of dollars, respectively. A research effort to improve forecast skill of AR landfall and duration has produced an informative set of AR forecast tools. Discussion of these tools along with examples of their use by water resources and emergency management officials is presented.