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There is a gap in knowledge about implementing diagnostic tools and therapy for heart failure with preserved ejection fraction (HFpEF) in clinical practice. This survey aimed to assess real-world practice in HFpEF diagnosis and treatment in the international medical community. An independent academic web-based 29-question survey was designed by a group of heart failure specialists and posted by email and through scientific societies and social networks to a broad community of physicians worldwide. 1.460 physicians from 95 countries answered the survey, with a mean age of 42.2±10.4 years, 39.4 % females, and 85.1 % were cardiologists. The left ventricular ejection fraction cut-off value selected for HFpEF diagnosis was 50 % for 89 % of participants. The scores for the probability of diagnosis of HFpEF were used only by 47.2 %, and H2FPEF was the most used score (31 %). Natriuretic peptides were used by 87.4 % of participants for the diagnostic workup, while the diastolic stress test was only used by 26.2 %. 54.4 % of participants chose SGLT2 inhibitors as their first drug treatment, followed by diuretics (18.6 %) and ACE inhibitors (8.4 %). In an international academic survey on HFpEF management, the criteria for screening and diagnosis of HFpEF patients remain aligned with classic international guidelines with a low use of diagnostic scores. SGLT2i is the leading therapeutic drug class used for this heterogeneous patient population. These results raise the need to improve education and awareness on diagnosing and managing HFpEF patients. [Display omitted] [ABSTRACT FROM AUTHOR]

• We used an urban tree inventory and high-resolution climate projections to identify species and locations at risk from climate change in Melbourne, Australia. • The climate safety margin, an indicator of species' climatic tolerance, was used as a metric of climate risk. • Presently, 218 species (46%) are exceeding their temperature safety margins; this number is predicted to increase to 322 species (68%) by 2050. • Similarly, 255 species (54%) are exceeding their precipitation safety margins; this number is predicted to increase to 257 species (54%) by 2050. • Our approach provides spatial information on climate risk at local scales appropriate for management decisions. Climate change represents a threat to the performance and persistence of urban forests and the multiple benefits they provide to city dwellers. Here, we use a novel approach to identify species and areas at high risk of climate change using the city of Melbourne, Australia, as a case study. We derive a safety margin, calculated based on climatic tolerance to two extreme climate variables (maximum temperature of the warmest month, MTWM; precipitation of the driest quarter, PDQ), for 474 tree species recorded in Melbourne for baseline (average for 2011–2020) and future (2041–2070) climatic conditions. For MTWM, 218 species (46%) are exceeding baseline climatic safety margins; this number is predicted to increase to 322 species (68%) by 2055 under the Shared Socioeconomic Pathway 5–8.5. For PDQ, 255 and 257 species (54%) are identified as at risk for baseline and future climates, respectively. Using georeferenced locations of trees and high-resolution climate data, we map spatial patterns in climate risk, showing high risk areas across the city. We demonstrate how using urban tree inventories and climate risk metrics can aid in the identification of vulnerable species and locations at high climate risk to prioritise areas for monitoring and assist urban planning. [ABSTRACT FROM AUTHOR]

• We performed cardiac CT in hyperacute stroke setting. • Hyperacute cardiac CT identified an intracardiac thrombus in 4.5% with etiology-confirmed stroke and 2.7% with cryptogenic stroke. • All of patients with intracardiac thrombus had NIHSS ≥4. • Patients with NIHSS ≥4 were more likely to have a diagnosis of cardioembolic stroke or cryptogenic stroke. Incorporating cardiac CT with hyperacute stroke imaging may increase the yield for cardioembolic sources. It is not clarified whether stroke severity influences on rates of intracardiac thrombus. We aimed to investigate a National Institutes of Health Stroke Scale (NIHSS) threshold below which acute cardiac CT was unnecessary. Consecutive patients with suspected stroke who underwent multimodal brain imaging and concurrent non-gated cardiac CT with delayed timing were prospectively recruited from 1st December 2020 to 30th November 2021. We performed receiver operating characteristics analysis of the NIHSS and intracardiac thrombus on hyperacute cardiac CT. A total of 314 patients were assessed (median age 69 years, 61% male). Final diagnoses were ischemic stroke (n=205; 132 etiology-confirmed stroke, independent of cardiac CT and 73 cryptogenic), transient ischemic attack (TIA) (n=21) and stroke-mimic syndromes (n=88). The total yield of cardiac CT was 8 intracardiac thrombus and 1 dissection. Cardiac CT identified an intracardiac thrombus in 6 (4.5%) with etiology-confirmed stroke, 2 (2.7%) with cryptogenic stroke, and none in patients with TIA or stroke-mimic. All of those with intracardiac thrombus had NIHSS ≥4 and this was the threshold below which hyperacute cardiac CT was not justified (sensitivity 100%, specificity 38%, positive predictive value 4.0%, negative predictive value 100%). A cutoff NIHSS ≥4 may be useful to stratify patients for cardiac CT in the hyperacute stroke setting to optimize its diagnostic yield and reduce additional radiation exposure. [ABSTRACT FROM AUTHOR]

Background: Patients with acute ischemic stroke and large vessel occlusion (LVO) may benefit from prehospital identification and transfer to a center offering endovascular therapy.Aims: We aimed to assess the accuracy of an existing 8-item stroke scale (National Institutes of Health Stroke Scale-8 [NIHSS-8]) for identification of patients with acute stroke with LVO.Methods: We retrospectively calculated NIHSS-8 scores in a population of consecutive patients with presumed acute stroke assessed by emergency medical services (EMS). LVO was identified on admission computed tomography angiography. Accuracy to identify LVO was calculated using receiver operating characteristics analysis. We used weighted Cohen's kappa statistics to assess inter-rater reliability for the NIHSS-8 score between the EMS and the hospital stroke team on a prospectively evaluated subgroup.Results: Of the 551 included patients, 381 had a confirmed ischemic stroke and 136 patients had an LVO. NIHSS scores were significantly higher in patients with LVO (median 18; interquartile range 14-22). The NIHSS-8 score reliably predicted the presence of LVO (area under the receiver operating characteristic curve .82). The optimum NIHSS-8 cutoff of 8 or more had a sensitivity of .81, specificity of .75, and Youden index of .56 for prediction of LVO. The EMS and the stroke team reached substantial agreement (κ = .69).Conclusions: Accuracy of the NIHSS-8 to identify LVO in a population of patients with suspected acute stroke is comparable to existing prehospital stroke scales. The scale can be performed by EMS with reasonable reliability. Further validation in the field is needed to assess accuracy of the scale to identify patients with LVO eligible for endovascular treatment in a prehospital setting. [ABSTRACT FROM AUTHOR]

Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21 months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes. Fifty-eight patients were assessed using telestroke, of which 41 were regarded to be acute ischemic strokes and 17 to be stroke mimics on clinical grounds. Of the 41 acute stroke patients, 22 patients were deemed eligible for thrombolysis. Using multimodal CT imaging, 8 more patients were excluded from treatment because of lack of treatment target. Multimodal imaging failed to be obtained in one patient. For the 14 treated patients, median door-imaging time was 38 min. Median door-treatment time was 91 min. A 90-day mRS ⩽2 was achieved in 40% of treated patients. We conclude that a telestroke service using advanced CT imaging for therapy decision assistance can be successfully implemented in regional Australia and can be used to guide acute stroke treatment decision-making and improve access to thrombolytic therapy. Efficiency and safety is comparable to established telestroke services. [ABSTRACT FROM AUTHOR]

Urban warming affects many millions of city dwellers worldwide. The current study evaluated the extent to which trees reduce air and surface temperatures in urban settings across Greater Sydney, Australia. Summertime air and surface temperatures were measured directly in the shade of 470 individual trees planted in three contrasting contexts (parks, nature strips, asphalt) and compared with temperatures in paired adjacent areas receiving full sunlight. Differences between shade and sunlit temperatures were evaluated against measured morphological traits (leaf area index [LAI], clear stem height, crown depth, height and diameter at breast height) for all trees. On average, tree shade reduced mean and maximum air temperatures by 1.1 °C and 3.7 °C, respectively. Temperatures of standardised reference surfaces (black and white tiles and artificial grass) in tree shade were up to 45 °C lower compared to full-sun exposure, and were also lower in parks and nature strips compared to asphalt settings. The surface temperature of shaded natural grass was cooler compared to sunlit natural grass, although this difference did not vary between nature strip and park settings. The magnitude of air and surface temperature reductions due to tree shade was significantly, positively related to tree-level LAI and these relationships were stronger in asphalt and park contexts compared to nature strips. These findings can inform decisions made by urban managers and planners around the selection of tree characteristics to enhance cooling benefits in different contexts, as an important step towards more liveable and resilient cities. [ABSTRACT FROM AUTHOR]

• Urban tree inventories were used to assess growth and failure rates. • The highest growth rates were estimated in trees planted in gardens and for the exotics Celtis australis and Ulmus parvifolia. • During early establishment, vandalism and health decline were the main causes of tree failure. • Long-term monitoring recording tree size, health and management actions are necessary to assess growth and failure rates. The delivery of services and benefits provided by urban forests is threatened by tree limited growth, decline and mortality. Determining drivers of tree decline and mortality is challenging but essential in urban forestry planning to reduce environmental and socio-economic losses associated with tree failures. Urban tree inventories (UTI) are essential for managing and monitoring urban forests, which can help to identify successes (i.e., good tree growth/health) and failures (i.e., removals/dead trees). However, UTI are rarely implemented to assess urban tree growth and failure rates. Here, we used UTI from two Australian cities to demonstrate how these inventories can aid in (1) assessing species' relative growth rates and (2) identifying species failures and their determinant. We found UTI are useful to assess tree growth and failures. However, they require recording trees at the time of planting, long-term monitoring (e.g., recording tree size, health), and incorporating management actions (e.g., irrigation, pruning, removals) to inform species performance and improve urban planning and management. [ABSTRACT FROM AUTHOR]

Urban tree inventories are useful tools to assess the environmental and socio-economic services provided by urban forests. These inventories enable the evaluation of the climate change risk to urban forests, and governments rely on such inventories for urban planning and management. Here, we assessed the future climate risk of Australia and the state of urban tree inventories across 116 local government areas (LGAs), representing 21 % of the country's LGAs and encompassing 55 % of the national human population. We evaluated projected changes in temperature and precipitation by 2050 for each LGA and conducted a survey to obtain information on the extent and types of data available in existing urban tree inventories. Additionally, we compiled demographic, socio-economic, and geographical data for all LGAs to explore correlates with tree inventory status. Temperature increases in 2050 were predicted in all LGAs, with higher latitude and smaller LGAs identified to undergo greater increases in temperature compared to larger and lower latitude LGAs. Decreases in seasonal precipitation were predicted for 97 LGAs. Seventy-six (66 %) of surveyed LGAs had urban tree inventories, which most commonly included trees along streets and in parks. Sixty-one LGAs record information on tree mortality, while 31 LGAs dynamically update their inventories. The presence of an inventory and the area it covered were positively associated with human population density. More than 30 years ago, in 1988, John Gray wrote that "insufficient statistics were available in Australia to provide an accurate picture of the urban forest estate". Our research shows there has not been a significant advance in the adoption and use of urban forest inventories over the past three decades. Long-term, dynamically updated inventories are crucial for urban forest management to inform planting choices to support sustainable and resilient cities. • Urban tree inventories are useful tools to assess the environmental and socio-economic services provided by urban forests. • We used a survey to assess the state of urban tree inventories in Australian cities. • Of 116 local government areas (LGAs) in Australia, 76 (66 %) had urban tree inventories. • Species name, location and plating date are the most common attributes collected after tree establishment. • By 2050, temperature increases were predicted in all 116 LGAs and decreases in precipitation were predicted in 97 LGAs. [ABSTRACT FROM AUTHOR]

• Climate analogues and vulnerability metrics can be used to inform species selection. • Across 10 Canadian cities, 233 species (∼67 %) will be at high risk of increased temperatures by 2050. • Resilient species represent potential alternatives to replace species at high risk of climate change in Canadian cities. • Our approach is a potential tool to aid urban tree selection and integrate climate change into urban forest management. Urban forests provide ecosystem services to more than 4.2 billion people living in cities; however, the provision of these services is threatened by climate change. Cities will experience novel, warmer climates that will impact tree species survival. Here, we present an empirical approach combining the use of climate analogues and vulnerability metrics to guide urban tree species selection. Climate analogues can be used to identify where the current climate in a given location is similar to the projected future climate of another location. Using vulnerability metrics, tree species in both locations can then be compared and species at risk of future climate change can be identified and substituted with species known to be resilient to climatic changes in the other location. Using Canadian cities as a case study, we show how our approach can become a useful tool to inform species selection and facilitate urban forest decision-making in response to climate change. [ABSTRACT FROM AUTHOR]

Modern cities are dominated by impervious surfaces that absorb, store and release heat in summer, create large volumes of runoff and provide limited biodiversity habitat and poor air quality can also be a health issue. Future climate change, including more frequent and extreme weather events will likely exacerbate these issues. Green infrastructure such as parks, gardens, street trees and engineered technologies such as green roofs and walls, facades and raingardens can help mitigate these problems. This relies on selecting plants that can persist in urban environments and improve stormwater retention, cooling, biodiversity and air pollution. However, plant selection for green infrastructure is challenging where there is limited information on species tolerance to heat and water variability or how these species can deliver multiple benefits. Therefore, we draw on research to illustrate how plant performance for green infrastructure can be inferred from plant attributes (i.e., traits) or from analysis of their natural distribution. We present a new framework for plant selection for green infrastructure and use a case study to demonstrate how this approach has been used to select trees and shrubs for Australian cities. We have shown through the case study and examples, how plant traits and species' natural distribution can be used to overcome the lack of information on tolerance to both individual and multiple stressors; and how species contribute to the provision of benefits such as stormwater retention, cooling, biodiversity and air pollution mitigation. We also discuss how planting design and species diversity can contribute to achieving multiple benefits to make the most of contested space in dense cities, and to also reduce the risk of failure in urban greening. • Urban greening and green infrastructure can help mitigate problems caused by urbanization. • This relies on selecting plant species that can persist and provide desired ecosystem services. • Species selection is often difficult due to limited information on plant tolerance or function. • We discuss how to infer tolerance and function from traits and natural distribution. • Planting species mixtures can help achieve multiple objectives, diversity and reduce failure. [ABSTRACT FROM AUTHOR]

Introduction: Continuous surveillance of stroke admissions has been conducted in the Hunter region, Australia, over the past two decades. We aimed to describe the trends in incidence rates of hospitalised stroke and case-fatality rates in this region, 2001-2019.Methods: From a hospital-based stroke registry, data for admitted adult stroke patients residing in the Hunter region were collected using ICD-10 codes for ischemic and haemorrhagic stroke. Negative binomial regression and logistic regression analysis were used to analyse trends for age-standardised and age-specific incidence rates of hospitalised stroke and 28-day case-fatality rates.Results: A total of 14,662 hospitalisations for stroke in 13,242 individuals were registered. The age-standardised incidence rate declined from 123 per 100,000 population in the 2001-2005 epoch to 96 in the 2016-2019 epoch (mean annual change -2.0%, incidence rate ratio (IRR) = 0.980 [95%CI: 0.976-0.984]). Age-specific analyses identified significant reduction in the group aged 75-84 (1039 per 100,000 population in 2001-2005 to 633 in 2016-2019, annual change -3.5%, IRR= 0.965 [95%CI: 0.960-0.970]). The 28-day case-fatality rates fluctuated over time (18.5% in 2001-2005, 20.8% in 2010-2015, and 17.8% in 2016-2019).  Projected population aging suggests annual volume of patients with new stroke will increase by 77% by 2041 if incidence rates remain unchanged at the 2016-2019 level.Conclusion: Although age-standardised hospitalised stroke incidence rates have declined in the Hunter region, the health system will face an increase in stroke hospitalisations related to the aging population. [ABSTRACT FROM AUTHOR]

Extreme climate conditions, including more frequent and prolonged heatwaves, are increasing in many regions throughout the world. Urban trees can aid in mitigating the adverse impacts of climate extremes; however, their capacity to do so is limited by species differences in ability to maintain function and retain leaves to provide shade under extreme temperatures. To assess tree vulnerability to heatwaves, we used a common garden experiment in Western Sydney, Australia, which included four widely-planted tree species; two native evergreen and two exotic deciduous species. Data were collected during 2019 and 2020, the two hottest summers on local record with maximum air temperatures reaching 45 °C. We monitored plant physiological status as stomatal conductance (g S) and midday leaf water potential (Ψ mid). We determined heat tolerance by measuring the leaf critical temperature (T crit) for photosynthesis and leaf turgor loss point (π tlp) as thresholds for loss of function and calculated the thermal safety margin. Plant performance was assessed by measuring tree growth and leaf damage after heatwaves. Species responded dynamically with g S decreasing as air temperature and vapor pressure deficit increased during heatwaves. Exotic species had higher g S , T crit and π tlp than native species. Leaf damage under heatwave conditions was overall lower in native species. Our results highlight the impact of heatwaves on urban trees and the value of physiological metrics to inform tree species selection to create more resilient urban environments. [ABSTRACT FROM AUTHOR]

Background: In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes.Aims: This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data.Methods: A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs.Results: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 - 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit.Conclusions: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors. [ABSTRACT FROM AUTHOR]

• Urban trees presented functional adaptations in response to local climate. • Urban trees had different levels of trait plasticity along a climatic gradient. • Turgor loss point was the best surrogate for changes in precipitation and maximum temperature. • Leaf-level traits showed a greater plasticity across species and sites. In urban environments, long-term tree survival and performance requires physiological tolerance or phenotypic plasticity in plant functional traits. Knowledge of these traits can inform the likely persistence of urban forests under future, more severe climates. We assessed the plasticity of morphological and physiological traits of tree species planted along an urban climatic gradient in the Greater Sydney region during a severe, multi-year drought in eastern Australia. We selected four sites along a ∼55 km east-west transect, ranging from the cool/wet coast to the warm/dry inland. We assessed five tree species (four natives, one exotic) with different predicted climatic vulnerability based on climate-origins, estimating functional traits indicative of drought tolerance: carbon isotope composition (δ 13C), Huber value (HV), specific leaf area (SLA), wood density (WD), and leaf turgor loss point (π tlp). Broadly, trees planted in warm/dry sites had more negative π tlp , higher WD, δ 13C and HV, and lower SLA than cool/wet sites, indicating phenotypic plasticity to drought. The leaf-level traits π tlp , δ 13C and SLA were more strongly correlated with temperature and precipitation, compared to HV and WD. Species differed in the extent of their trait shifts along the transect, with greater plasticity evident in the exotic Celtis australis and the more temperate cool-climate Tristaniopsis laurina , compared to the more tropical, warm-climate Cupaniopsis anacardioides , which showed limited plasticity and lower drought tolerance. Our findings reveal adaptive capacity of urban trees to climate via plasticity in drought tolerance traits, which can direct species selection to improve urban forests resistance to climate change. [ABSTRACT FROM AUTHOR]